Dealing With America's Broken Healthcare System,
One State at a Time
May 15, 2008.
I was sitting in my daughter's orientation for a year overseas with the AFS Program
listening to this over-protective mother keep babbling on about how her daughter
hadn't been assigned to a program yet, didn't have a visa, blah blah blah.
When she started to fret about what would happen if she got in an accident
overseas and needed healthcare I just had to but in.
Me: "She'll probably get a lot better healthcare overseas than she would get in the US.
And I'm a physician."
[and also a blogger who wrote about his experiences getting stitched up
for free by a foxy Danish doctor
("Our Healthcare System Sucks")]
Unknown Woman: "But what if they don't take her health insurance in that country?"
Me: "You don't need health insurance in countries that have a national health care system."
Outside I ran into a guy who had heard my comments.
Guy: "So is this just a bunch of propaganda about how you have to wait longer for healthcare in Canada?"
Me: "It's not true that you have to wait for treatment life-threatening conditions.
But you might have to wait for an MRI while you could just walk in to any place
in the US and get one right away if you could pay for it or you had the
right insurance. The US has over built imaging centers and same day surgery
or procedure centers (like cardiac catheterization labs) in order to pump up
their profits. A lot of this imaging and procedures is not useful."
Guy: "My doctor ordered an X-ray for my back because I had low back
pain. When I went to the imaging center they wanted to do a CT scan.
I had to argue with them about it to do an X-ray as the doctor had
requested instead of a CT scan."
Me: "It just goes to show you that when they have the expensive machines they
feel that they need to use them to pay for them."
The fact is that the US healthcare system is enormously wasteful and inefficient, and is gobbling
up more and more of the gross national product. Almost
16% of our Gross Domestic Product is spent on healthcare, versus 11% for France
and 8% for Britain. As the costs of healthcare keep going up they threaten to
drown small business owners and swamp our economy as a whole. And believe me, many of these costs are for
Mickey Mouse things like CT scans you don't need or "screening" lab tests
that have no real value. Insurance companies, drug companies,
hospitals and doctors organizations, together with their politician pals
and sleazy lobbyists, is force feeding the American public on a hi-fat hi-cholesterol
diet of lies about our healthcare system being the best in the world, or how
people are dying while waiting for their MRI in Canada. The fact is that when
the insurance company shills shell out that stuff about how foreigners are
unhappy with their healthcare, they are lying. If you don't believe me
you can read the actual research done on that topic
here. 37% of Americans skip medications or recommended care because of cost--
rates well above those in any other country. This is in spite of the fact that
the US as a whole spends twice as much on healthcare as any other country in the
world. And the price keeps going up and up.
Take a look at the case of the self-employed. There are many hard-working people
who are self-employed and who forgo health insurance because it is prohibitively
expensive without the special deals that people working for large companies can get.
Their health is at risk because of their lack of access to care. Take the case of
Paul Hannum, a self-employed film maker without health insurance, who was not
admitted to the hospital with abdominal pain, and who later died.
34% of Americans said that the healthcare system needs to be rebuilt completely--
also way higher than any other country in the world. Americans also reported the
highest rate of medical errors, with one third of patients with chronic medical
conditions reporting a medical, medication or lab test error in the past year.
As pointed out in a recent
editorial, healthcare doesn't really respond to the supply and demand
aspects of the typical marketplace. Like more competition makes better 'products'.
When you try to apply that logic tohealthcare things get incredibly
expensive real fast. And wasteful. It's just because you've been listening
to a bunch of fruit-loops like Rush Limbaugh and Neil Boortz that you think
the marketplace should apply to healthcare. Turn off your radio.
The fact is that our healthcare system is broken and needs to be rebuilt from the ground up.
(An opinion shared by 34% of Americans).
This morning I was lying in bed listening to the radio when I got the answer.
You see the Governor of the State of Georgia, Sonny Perdue, signed a bill
into law that allows you to go into restaurants or parks packing a hidden gun.
He also signed a bill that allowed the auto insurance industry to raise insurance
premiums whenever they want. That is when it hit me... Why don't they just extend
the rules to places where you can carry a concealed gun to the legislature building,
so that disgruntled patients can brandish their weapons whenever corrupt policians
or their lobbyist friends want to pass legislation that will pass us further
into the sinkhole of the collapsing American healthcare system?
What a lovely thought.
Rebuilding America's healthcare system. From the ground up. One state at a time.
And what better state to start in than Georgia.
May 13, 2008.
Prescription Medications, Ha Ha Ha!
I was a little worried that The Huffington Post wouldn't know what to do with my last blog
called Pine Straw Update
... but they featured it! And then it got reposted by a bunch of
Southern papers/sites like the Savannah Post! Maybe Arianna liked it because she won't be accused
of being an exclusive blue state elitist if she has posts like mine. After all, only
60 years ago almost a quarter of the people in Georgia were mentally dulled either because
they had chronic hookworm infections (caused by the common practice of going barefoot
because they couldn't afford shoes) or because of pellagra (vitamin deficiency caused
by the diet of fatback, cornbread and molasses). Maybe Arianna wants to get something
in the Living section of her site that is not related to sluts, whores and cheaters. I mean that makes for
compelling reading, but you can't live on a diet of chocolate ice cream forever.
OK, enough nostalgia! Maybe I can use my new huffpost entry to convince my son's 4th grade
teacher, Peter, at Paideia School in Atlanta, that pine straw and chiggers are at least
as interesting as the medieval origin of prescription drugs! (Not that medieval drugs aren't
interesting, but you know what I mean... I mean, let's have some local pride! Pine straw
makes us really unique!) And the funniest thing about my new huffpost blog entry is that it is peppered with ads
for Atlanta landscaping companies! And for search engine sites that can give you information
about chiggers!
Which gets me to the topic of this blog. Prescription medications are... well... funny!
When did I first learn that this was the case? In my first TV interview a couple months ago about my
book on prescription medications, vitamins, and supplements, I was interviewed by Susan
Hoffman of Georgia Public TV. I was a little nervous, because who knows what kind of zingers
an author of a book with the subtitle 'Why the drug industry may be bad for your health' might get?
So I was a little nervous sitting in the 'on deck' room watching her interview the guest
that came before me. He was a State of Georgia bureaucrat talking about legislation
related to the Georgia drought. Her 'lead in' said that in the next half hour they
would be talking about prescription meds, and "did you know that 120 men die every
year from Viagra?" As he came off the set he said "how am I supposed to compete with
Viagra?"
That was when I realized that prescription meds were... well... funny!
A couple of weeks later I was invited to give a talk with Neil Shulman MD
(author of Doc Hollywood and real life inspiration for the film starring Michael J Fox)
and Belinda Stinson on positive psychology, proper living, and health. Belinda talked about the
importance of diet and nutrition, but did it in her clothes she wore when she
weighed 300 pounds, but now she had lost 100 pounds. They were a little... droopy!
Neil did a stand-up comedy routine dressed as a doctor clown.
Which just illustrates the fact that... doctors need to lighten up a little!
I could give the same advice to some of the people who have posted comments
on the recent articles I have written online, which I can categorize as doctors
pissed off that I say you don't need annual checkups, and vitamin lovers
pissed off that I say that vitamins can have harmful side effects (surprised?).
When I spoke at the conference I announced that... I had discovered the cure for smoking, diabetes,
heart disease and depression. For the smoking cure noone yet had relapsed using my method!
It was, Write a book called Before You Take
That Pill: Why the Drug Industry May be Bad for Your Health, in which you say
that changing your lifestyle, including diet, exercise, and smoking is always better
than prescription medications, and you will stop smoking, otherwise you will
be a total hypocrite. You see, I smoked while writing this book, but I quit
when it was published. This method has worked wonders, and no relapses so far! (N=1)
As for diabetes, heart disease and depression, exercise and diet changes are
as good as or better than prescription medications.
OK, the other parts of our presentation included a Chinese Herbal Medicine practitioner,
a laughter therapist, a poet, a representative of a local stop smoking organization,
and others.
After I got home I tried to implement some of the things the laughter therapist taught us.
I assembled my family in the kitchen.
[turning to my 10 year old son with hand outstretched]
"Ha ha ha!" I said.
"Ha ha ha!" he replied while shaking my hand. "I like that!"
Addressing the entire family, I said "Now take two imaginary glasses in your hands,
pour one glass into the other, then pour the second glass into the first, then look
at the ceiling and give a belly laugh "Ha ha ha!"
We all tried to do it together. My son Dylan said "that was great!"
But my wife Viola and my daughter Sabina couldn't get the belly laugh going.
Oh well. My next plan for my medical comedy routine is to juggle brightly colored
prescription medications while standing on one foot and wearing a funny
hat. Or maybe juggling three different insurance plans that are all unaffordable and that
all have incomprehensible 'benefit packages'. Or how about three different hospital bills.
Or three different books of three different 'preferred providers. Or maybe all at once.
Maybe that will get me another feature post on the Huffington Post.
May 12, 2008.
Vitamins That Kill
I was watching public TV a couple of years ago when a researcher was being interviewed
about the
Beta Carotene and Retinol Efficacy Trial (CARET), in which 18,314 smokers took either
beta carotene and Vitamin A or a placebo. He embarrassedly stated that the beta carotene
(found in carrots and orange vegetables) and Vitamin, even though they are 'anti-oxidant'
and theoretically should prevent heart disease and cancer, actually increased it in their trial.
In fact people on supplements equal to four carrots a day had 17% more
heart disease and were 17% more likely to die than people on a placebo.
I found that pretty surprising, especially since you hear those natural health guru
types yapping on the radio all the time about the benefits of anti-oxidant vitamins.
I later visited my sister-in-law Rossana (pronounced ROE - SSSS - ana, as my kids always point out)
in the US Virgin Islands. Rumaging in her refrigerator while she was at work (hey I didn't have anything
else to do) I found several large bottles of vitamins and supplements. I looked
at the ingredients and found that she was taking Vitamin A at several times the recommended daily
levels. When she got home from work I confronted her about it.
Doug: "Rossana, why are you taking so many vitamins and supplements?"
Rossana: "I don't have time to cook meals and eat enough vegetables, so this gives me what I need."
Doug: "But did you realize that the amount of Vitamin A you are taking may cause osteoporosis?"
I don't want to be dodgy and name the company that made the vitamins and supplements
she was taking, but I looked them up on the internet, and if you followed their recommendations,
you would be spending $7,128 dollars per year on their products!
Even though in the laboratory there has been shown some connection between
oxidative stress and heart disease, and in spite of the known role of vitamins C and E as anti-oxidants,
you can't get around the fact that there is now a large body of research including studies with tens of thousands
of patients that have shown that vitamins do not prevent heart disease or lengthen your life.
In fact, they may actually have the opposite effect.
One study of Vitamin E combined with Vitamin C showed that vitamins actually
accelerated the progression of thickening of the coronary arteries, and doubled
the risk of dying of heart disease. Another study of a combination of
anti-oxidants, including Vitamins E, C, beta carotene, and selenium, showed that vitamins actually
blocked the effects of anti-cholesterol treatment (simvastatin plus niacin) on reducing
atherosclerosis and preventing heart attacks and strokes. The vitamins in this study
interfered with the ability of the other medications to raise HDL (good) cholesterol.
Looking at
all studies combined in which Vitamin E was given with beta carotene, there was
a 10% overall increase in mortality.
I think the vitamins may be giving a boost to little tumors that wouldn't have been a problem otherwise.
Based on these studies, I believe there is no role for vitamins in the treatment or prevention of heart disease.
May 6, 2008.
Does America Have a Prescription Drug Problem?
While it's true that many drugs help people live longer and better lives, it is also
true that they can have unintended side effects. Pharmaceutical and supplement manufacturers
have to increase sales and profits, as all businesses must, and they do so in part by
developing drugs to treat disease and also by convincing people they need meds to prevent
disease or lessen the perceived risk of future illness. Marketing leads to efforts to
promote the positive aspects of drugs, sometimes at the expense of acknowledging the negatives.
Study results are extracted to different groups, e.g. lipid lowering drugs like Lipitor
are promoted for women based on studies in men. This relentless drive means that prescription
meds are promoted for more and more people. Do all these people really need to be taking prescription medications?
If you followed the US guidelines, half of all men (based on their LDL cholesterol levels)
would be on a statin drug like Lipitor. Half of women over age 72 would be on a bisphosphonate
drug like Fosamax or Boniva, for prevention of osteoporotic fracture. And half of women over
age 50 would be diagnosed with "osteopenia" and advised to "talk to their doctor"
(presumably about taking a pill to prevent osteoporosis). And if you followed the USDA
guidelines for minimal intake of vitamins and minerals, all of us would be on a multivitamin.
More recommendations... Everyone take an aspirin and fish oil supplement to prevent heart
disease, all women should take calcium, etc etc.
Have we gone nuts?
A factor that has expanded use of prescription medications happened in 1997, when the FDA
lifted the ban on direct to consumer advertising along with the law that required ads to
list every possible side effect. Soon after, Americans were bombarded daily with commercials
for prescription drugs. The US is the only country in the world where you can turn on the TV
and have an announcer tell you to go 'ask your doctor' for a drug.
Doctors often will give medications to patients even if they don't think they need it. For example,
one study showed that 54% of the time doctors will prescribe a specific brand and type of medication
if patients ask for it. Drug companies also buy information about the medications that doctors
prescribe from major chain drug stores like CVS, and then use this information to reward doctors
who prescribe their drugs frequently. Research studies show that this can influence behavior,
like how often a doctor will try to have a drug from that particular company put on his hospital's formulary.
In 2005 in the aftermath of the Vioxx debacle and withdrawal from the market,
Janet Woodcock, Deputy Commissioner of Operations at the FDA, said that the nation's
drug safety system had,
"
pretty much broken down." She charged that neither doctors nor patients
had enough information about the side effects of drugs to make informed decisions
about taking them. Dr. Woodcock went on to say that, "the bottom line is that
a lot of drug safety problems are actually preventable, [because] most adverse events are from known side effects."
I'm not saying that some drugs don't ever successfully prevent disease, or that newly described
diseases and syndromes are necessarily invalid. But the fact is that no matter how you look at it,
the US (and to a lesser extent other countries) has a prescription drug problem. The US spends
two times more on drugs, and takes twice as many drugs, as other countries, and has worse health.
In fact, we have some of the worst healthcare outcomes in the industrialized world, including
total life expectancy, and survival of children to their 5th birthday. In a survey of 13 industrialized
nations, the US was found to be last in many health-related measures, and overall was 2nd to the last.
Even England, which has higher rates of smoking and drinking and a fattier diet, has better health than the US.
Did you know that you
shouldn't go to the doctor for annual physical examinations if you are not sick and have no risk factors for disease?
Who says that? The American Medical Association! Why? Because there isn't any evidence that annual physicals really improves health outcomes.
Many Americans have become disgusted with prescription drugs,
so they turn to alternative medicine, who frequently promote vitamins, herbs and supplements.
However vitamins and supplements can and do indeed cause harm. And unfortunately the government has
contributed to misinformation about vitamins and supplements. The US Department of Agriculture (USDA),
whose job it is to promote the interests of agriculture (i.e., makers of meat and milk) and not health,
regulate foods and beverages. Vitamins and supplements are classified as foods, not drugs. Lobbyists
for the vitamin and supplements industry have blocked efforts by the Department of Health and Human
Services (DHHS), the federal agency responsible for health, to get involved.
The USDA's Recommended Daily Allowance (RDA) of vitamins and minerals has been great for the vitamin
and supplement industry, as well as cereal makers who supercharge sales by adding vitamins, and
minerals to breakfast foods, and then convince customers they need to eat these fortified products
to get their minimal daily requirements of vitamins and minerals. This is despite the fact that
there is no way to get enough of the recommended vitamins and minerals in normal food without
overeating. Government recommendations are actually four times higher than what you really need.
The fact is that you don't need extra vitamins, and that if you stick with fresh vegetables and
fruit and other whole foods, you will stay healthy. Those making big money on vitamins and supplements
are often doing so at the expense of your pocket book, and sometimes your life.
Ironically most recent health gains have come through increased knowledge of health risks and better
health practices (or prevention). We smoke less, have better access to nutritious fruits and
vegetables year round, pay more attention to cleanliness and hygiene, and have improved safety
in general. For instance, in the 19th century it was not known that dirty water and shared cups
could spread disease. Hand washing is still the single most powerful way to prevent the spread
of communicable disease, but this was not discovered until 1847, when Ignaz Semmelweis, a young
Viennese doctor in an obstetrics ward, observed that midwives who washed their hands had lower
mortality rates among their patients than doctors, who often went from autopsy room to delivery
ward without so much as a hand wipe.
Future advances in health will likely come more from changes in lifestyle, diet and exercise, than
from medications. Almost all of the chronic conditions for which pills are prescribed are preventable
through such changes. Other conditions like cancer are partially preventable.
It is time for Americans to rethink the role of medications and other pills in their lives in relation
to other actions that can be taken to maximize health, such as making changes in diet; incorporating
exercise into one's daily routine; learning and using stress reduction techniques; and changing other
behaviors like quitting smoking. The most common disorders, like diabetes and heart disease, are always
better treated and prevented through changes in diet, exercise, and lifestyle that they are with medication.
May 2, 2008.
Is Your Birth Control Pill Driving You Bananas?
A collective howl is going up amongst women over at medications.com over the birth control pill, Yasmin. These women are complaining of depression, anxiety, loss of sex drive, headaches, and dizziness, and most of them didn't feel like they were adequately informed about these potential side effects. In fact, Yasmin is the most bitched about drug on medications.com, with over 4,000 women logging in to report problems with it. It looks like Yasmin needs to join the blogroll of medications that if they don't kill you they will drive you crazy.
How can this be? Birth control pills (or oral contraceptive pills, or OCPs) are combinations of sex hormones related to estrogen and progesterone. Normally these sex hormones cycle throughout the month. In addition to controlling reproduction they also have effects on the brain, which is why they can cause anxiety and depression. Taking the pill effectively blunts the normal variation in hormones; it also eliminates ovulation, which also affects sexuality. In fact, one study showed that strippers who were ovulating made $15 more per hour than strippers who were not ovulating, and that strippers on the pill made significantly less than other strippers.
OK, you say, I can live with a little moodiness. But is my pill going to kill me? OCPs can increase blood clotting, which can lead to heart attacks or strokes. But for non-smoking women age 15-30, there is no increase in death rate for a comparable form of contraception, the IUD. Because of the health risks of pregnancy, the death rate amongst women from age 15-34 who are on the pill is actually lower than for women who do not use any form of birth control.
For smokers there is an increased risk with OCPs that gets worse with age. For instance, the risk of death is 1 in 200,000 per year in non-smoking women under the age of 35. However risk increases with age and smoking to 1 in 700 per year for smokers over age 35.
The risk of cancer with OCPs overall isn't great. Some cancers, like cervical cancer, increase after ten years of use, the overall risk from breast cancer is not increased. OCPs reduce the risks of ovarian and uterine (endometrial) cancers. OCPs reduce the risk of anemia, pelvic inflammatory disease, and osteoporosis.
Women who take the pill have identical fertility rates after going off the pill compared to women who never took the pill.
Use an OCP with low doses of estradiol (<50 µg). Taking an OCP is safe for women who don't smoke. For women who are smokers over age 35, or have other reasons not to take the regular pill (e.g. history of blood clots), consider the Minipill or another all progesterone pill, or one of the alternatives to the pill, like an IUD.
April 30, 2008.
Pine Straw Update
I blogged earlier in the week about pine straw and the division in the state of Georgia between what
I call the red counties (that gather up pine straw in the forests of South Georgia) and the blue
counties (that dutifully spread the pine straw in their gardens, although they have no idea why they are doing this),
a blog which I loosely tied in to musings about the goofy names of prescription medications ("Where Do They Come Up With All Those Goofy Names for Prescription Meds Anyway?"),
which is supposed to be the main topic of this blog. Anyway I got some interesting feedback from our
South Georgia/North Florida contingent about the topic of pine straw.
Steve (Dusty) wrote:
"I love the description of the pine straw business. Growing up in NW Fla., raking pine straw was one of my least favorite chores.
Imagine my amusement years later when I learned people would go through neighborhoods asking homeowners if they could “harvest” their pine straw!
If only there were a big market for grass clippings and dog poo!"
Stephanie wrote:
"That's really funny. But, it's mostly the undocumented workers who gather the pine straw in south Georgia--it's the legislators who own the companies they work for. So, technically, I am not sure that pine straw could be considered a red-community product. It's more a foreign national product. You actually spread pine straw to smother out weeds and to help the soil retain moisture, but what is kind of ironic is that when it gets too dry and heats up in the southern summer sun, pine straw can spontaneously combust. People in south Georgia almost never, ever use the stuff--mostly because it's prime real estate for chiggers and if you've ever been bitten or infested by chiggers, then you can understand why south Georgians steer clear of pine straw."
[editorial note: the illegal immigrants would actually prefer to spread the pine straw in metro atlanta as well.
some times the professionals get confused about the actual balance on their credit cards and tell the illegal
immigrants that they don't have enough money to pay them to spread the pine straw and so they spread it themselves].
I like that--the fault line of Georgia below which red staters gather pine needles for blue state-types north of the fault line to scatter in their gardens in a symbiotic relationship. Brings to mind a query from half a generation ago: "Why can't we all just get along?"
After reading the posts about pine straw I naturally asked the question... what is a chigger?
Here are some definitions from the web
(chig·ger) the six-legged red larva of a mite of the family Trombiculidae; they infest many vertebrates, especially mammals ...
small tropical flea; the fertile female burrows under the skin of the host including humans
harvest mite: larval mite that sucks the blood of vertebrates including human beings causing intense irritation
Here is a picture of a chigger.
here is another description from bugguide.net
"Visiting my parents in Mississippi, I tromped happily with other family members over hill and dale. Then I left, resuming my travels.
"Some hours later, many welts began to rise. Eventually I counted more than fifty. They seemed to be flea bites, which I quite familiar with, as a cat owner. I pulled over to a dumpster and tossed in my sleeping bag, thinking it was infested with fleas!
"Later, when I called my father, he revealed that everyone in the family had bad cases of chigger bites. Meanwhile, I began to get kind of feverish and the itching was intense with 50+ bites to contend with. I stayed up all night in my motel room watching old reruns of Leave It to Beaver. Awful!
"Since then we have learned various tricks to avoid the bites. One is to tuck pants legs into socks, so the chiggers end up crawling up your pants rather than your leg. Another is to spray your shoes, socks, and the bottom of your pants leg with insect repellant before a walk. Another is to always shower, with plenty of soap, after every walk in the woods.
"In closing, I'll mention one sure sign that you have chigger bites: the bites are most common at your belt line. The chiggers walk up your legs and body until they meet an obstruction (like the tightness around your belt) and that is where they tend to stop and dig in)".
Hmm. Sounds almost as bad as some of the side effects you can get from prescription pharmaceuticals.
April 28, 2008.
That Sucking Noise May Be Coming From the Pharmaceutical Pipeline Running Dry
I have a secret (?) interest in drug news and the pharmaceutical industry but it seems
like the only place I can get a fix for my jones outside of pharmalot.com or the
pharma marketing blog is the Wall Street Journal (WSJ) or the New York Times Business Section.
But if you spend too much time reading the WSJ about drugs you will end up joining a cult
where everyone is involved in a plot to give Lipitor to the entire population of the US with the
sole purpose of propping up the profits of that (sorry ass) drug's manufacturer, regardless of the
side effects or consequences (or benefits?) to the drug's takers. And the New York Times Business Section
seems to look at the inevitable bad news about drug side effects not as an opportunity
to warn consumers about the potential negative side effects of prescription drugs,
but as a warning to hedge funds about future turns of that drug's manufacturers
stock price. Why else do they write about it in the business section and nowhere else?
And then those yappers start speed talking out of both sides of their
mouths about capitalism and the profit motive and the positive effect it will
have on Americans. Well like you I am thoroughly disgusted with the whole American
capitalism bullshit talk that they are trying to dish out to us as good for us
while in fact that is really good for corporations. I mean who do they think we are, culturally impaired beings
or something? When was the last time that the value of your 401k actually went... up?
OK here is the real dish from an MD who is not brain damaged and
who follows the pharma news. And whoopee doo it's free. (I would consult for
pay to a hedge fund but someone from pharma would probably hang me out to
dry for it anyway). Big Pharma has done a miracle job at convincing everyone that
they have an endless stream of miracle drugs that are barrelling out of their 'pipelines'
that are going to cure everything from shingles to diabetes. Well HELLO most
of those conditions are not CURABLE DISEASES but conditions that cannot be cured,
but whose symptoms can only be modified. And most of their drugs are 'me-too' drugs
that don't offer anything really new but rather another variant of a drug already on the market
that isn't any better than what is already out there. And the 'new classes' of drugs
can dazzle you with the fact that they have a 'new mechanism' that supposedly
is going to be better than the 'old' drugs which likely cost one tenth as much--
but that claim is likely to be not true.
Bottom line is that penicillin was a great drug, but since then... hasn't been
much but marketing. But hats off to those marketing folks... they did a great job!
But can they keep it rolling? If I were a betting man, I would say...
I don't think so.
Hmmm... Can hear that sucking noise now...
April 26, 2008.
Where Do They Come Up With All Those Goofy Names for Prescription Meds Anyway?
I was spreading pine straw around the bushes in my yard in Atlanta, Georgia,
when I started thinking about... you guessed it! The goofy names that drug companies come up with for their
prescription drugs. Folks in the blue states are often interested in the customs of us
red state folks since they don't get to read about them in the op-ed pages of papers
like the New York Times (unless it is a scornful piece like the one about how the locals were
rooting for abortion clinic bomber Eric Ruby to get away... Run Ruby Run!). Like
when I wrote about the Georgia drought ("Drought and the Power of Prayer",
Part 1 and
Part 2),
people thanked me for the update on what is going on down here. Well here is another
interesting fascinoma (as we called it in med school). You see most people think that
the US is divided into red states and blue states. But you see within individual states
there is also a division between red counties and blue counties. In Georgia the
blue counties include Fulton and the other affluent areas in metropolitan Atlanta.
The red counties are those below the so called 'fault line' or 'gnat line' in the
southern half of the state. That is where the land is flat and the rivers run
smoothly, or there are more gnats, take your pick. And another interesting thing is that the
red and blue parts are mutually inter-dependent. You see it is the job of the red
parts to wander through the vast pine forests of South Georgia, gathering up
pine needles and bundling them up so that they can ship them to Metro Atlanta
(blue parts) where executives and professionals can take Saturdays off to buy the bundles of
pine straw at the local garden center and dutifully spread it in their gardens.
Nobody really knows why this ritual is necessary, but if the blue part people
didn't buy the pine straw then the red part people might starve to death since
there is no other industry in their area. And the red part people might rise up
in revolution and caste out the blue part people farther north.
Anyway the mandatory spreading of the pine straw that I share with my fellow Atlantans of the
executive and professional classes is such a boring ritual that my mind naturally wandered.
Who comes up with the names of prescription drugs anyway? Take for example the drug
abilify. An antipsychotic drug, the name is apparently meant to represent a new verb
that will stimulate non-functioning mental patients to jump out of their chairs and
start climbing the corporate ladder. Or how about that other anti-psychotic, trilafon?
The makers of this drug were obviously trying to suggest "try laughing". Obviously
the manufacturers of this pill had never personally experienced the scary delusions
or hallucinations that their pill was meant to treat, otherwise they would have
never made such a zany suggestion. Here's another one from the antipsychotic category:
Mellaril. I suggest that the marketing people for that drug come up with a
catchy tune with the words "Mellow out with mellaril". Maybe something from the
Country and Western category?
Lest we think that goofy drug names are restricted to the anti-psychotic class
(whose patrons might be thought to not be able to complain since they were, well... psychotic),
let's look at asthma drugs. Singulair is obviously meant to imply that you will only
need to take one (single!) drug to get some... air. Well singulair may be making
you want to go out to go out and catch some air since it may be making you, well... nuts.
(
("If they Can't Kill Us They Might Drive Us Crazy"). Oh, one more from the asthma category:
Serevent. This one is supposed to make us think of "breathing easy" (i.e. "SEREne VENTilation").
Kind of strange though for a drug that was described as causing patients to "die while
clutching their inhalers".
Hmmm. Not a very serene thought.
April 21, 2008.
Captain Pill Comes Back to His Home Port
I wrote before about the image of myself as
Captain Pill on the High Seas of
Pharmaceuticals
but tonight I came back to the home port
and checked in with the crew about the
status of our
overseas adventures,
namely first mate and skipper Dylan Bremner (age 10)
and Sabina Vaccarino Bremner (age 16).
Dylan reported that he had taken the flyer for my book to his school
(Paideia, in Atlanta) and had tried to convince his classmates that they should buy my book.
When his classmates asked why they should buy a book about pharmaceuticals when they didn't
take them, he replied that they should buy them for their parents.
"Do you talk about the side effects of drugs?" he asked me.
"Yes I do," I responded.
"Wow, this is a really useful book!" he exclaimed.
We did make one book sale, eventually, to the mother of his best friend Evan (Cindy Messina). Thanks guys!
Back at the home base over dinner, we had a discussion about Dylan's foray into the marketing world.
Here is a transcript of the dialogue (also useful for Mom, who is out of town now).
Dylan: One of my classmates said that his father owned a drug company. He asked
if you were against his drug company.
Dad: I am not against his drug company. I don't even know what his drug company is.
I am just trying to provide a complete picture of the risks and benefits of prescription drugs.
Sabina: But you are against the drug companies.
Dad: No I'm not. The job of drug companies is to sell drugs. And they do a
very good job of that. I am just trying to provide a more comprehensive picture of things.
Sabina: But you are against the drug companies.
Dad: If you say you are against something people will stop listening to you. What if someone
told you they were against doctors? Since your dad is a doctor and his income is based on
that you would stop listening to them. I would rather have a dialogue with people.
At that point my crew lost interest (sigh). Oh well.
April 16, 2008.
Why Don't They Just Pay Us To Swallow Their Pills?
Today in JAMA an
article
came out about how drug companies pay "ghost writers" to write favorable
articles about their drugs and then pay doctors and researchers
with established reputations in their field to be listed as the
author of the paper. That made it look like a professor from
a university had performed the research and written the paper, when
in fact it had been done by the drug company. In one case a basically
finished paper that listed as the first author "External Author?"
was later published with a doctor from an outside university listed as the first author.
Merck spewed out favorable papers about Vioxx while tens of thousands
of people were dropping dead from heart attacks that they could have
avoided by taking a Non-steroidal anti-inflammatory drug (NSAID)
which costs a tenth as much and works just as well. In a somewhat hilarious
response to a question about the Assessment of Differences Between Vioxx and
Naproxen to Ascertain Gastrointestinal Tolerability and Effectiveness
(ADVANTAGE) study, the first author
said “Merck designed the trial, paid for the
trial, ran the trial . . . Merck came to me after the study was completed and said,
‘We want your help to work on the paper.’ The initial paper was written at
Merck, and then was sent to me for editing.”
So my question is, given that the drug companies are spending so much
money to do questionable studies clearly aimed at promoting drug sales,
paying ghost writers and doctors to promote their dubious claims,
why don't they just use that money to pay the patients themselves
to swallow their drugs? I mean most people don't see the bills for their
drugs since the insurance companies are paying for their drugs,
and nobody likes insurance companies anyway. That way if the patients
dropped dead from the drug at least they wouldn't feel like they
didn't get anything out of the arrangement.
April 11, 2008.
Why Don't We Let the Drug Companies Decide
Whether That Bad Outcome Was From Their Drug?
Well the obvious answer is because it isn't in their financial interest to do so. And
in spite of the words of Billy Tauzin, the ex-congressman from the state of Louisiana
who slipped (sliding... sliming?) over from his job as congressman (after passing key legislation for
the pharmaceutical industry) to president of the Pharmaceutical and Research Manufacturers
Association (PhARMA), or chief bully megaphone for the drug industry, who said
"we don't make handbags or ice cream, we make drugs that save lives," drugs
can save lives but they also can take lives, and when they do the drug manufacturers
are not always interested in admitting that. And the politicians who take their donations
for their political campaigns aren't either. Ditto for doctors, even when they didn't
get much from the drug companies, which I think is weird. I attribute it to some kind
of delayed mommy effect or getting bullied in the schoolyard or something. Anyway
I forgot what I was talking about, which happens to me a lot... oh yeah. Drug companies
will stonewall and deny that a side effect is caused by a drug for as long as they
can. And why shouldn't they? I mean if look at the examples of Vioxx or Accutane,
the drug companies were making a billion dollars a year while the debate about
side effects continues. Fiddling while Rome burned. Even at the end of the day Merck
will have made much more money from Vioxx than they will lose from litigation, even
for a drug that costs more than five times as much as Motrin, requires a doctor
prescription, doubles the risk of heart attack and is no better for pain relief.
Huh?
Well this post has to come to a conclusion or point or something which is...
ummm... duh... I don't know... well I guess if you expect a drug company or government official
or someone in authority to announce to you a new side effect so you can keep your loved
ones safe then you may be dissapointed. As always let the buyer of prescription
drugs beware.
April 8, 2008.
Stop That Patient! (Or The Corpocracy Rules, Part 1)
I had a stomach ache coming home on the plane this weekend from vacation
in Costa Rica and I couldn't tell if it was coming back online (literally
as well as figuratively) to America's prescription drug woes, the unwashed
fruit I had for breakfast in Costa Rica, or the magazine I was reading on the plane.
You see the March 16, 2008, issue of Forbes magazine had a cover title called
"Stop That Patient!" about how large general hospitals have infection and
mortality rates that are 400%-1000% higher than specialty hospitals that
focus on specific problems, like angioplasty or hip replacement.
I mean we all get so excited about pills that 'slash' the
risk of heart attack by 25%-- how about if I told you I had a pill for
you that would reduce your risk of dying by 1000%? You'd be
pretty excited about that one, right? And what's the difference
if you die under the knife or keel over with chest pain while
riding in your golf cart? You're dead just the same. But What was most
upsetting about this article was the hijinks that
the large hospitals are trying to go through to
squash the smaller guys, using arguments like "conflict of
interest" because the smaller hospitals are owned by
physicians. In answer to the question, shouldn't healthcare
consumers be able to comparison shop hospitals? a representative of the large hospitals said
that consumers shouldnt get that information because
they wouldn't know how to use it properly. Indeed! Most of the time we are shoveled a lot of
malarkey about how we are in a Democracy (your vote
counts) based on Capitalism (true competition is good
for business). However, we aren't. It is actually a
Corpocracy (meaning the corporations have more power than
you do and they chum up to one another to make sure all of their collective interests
are being pursued while pretending to compete,
and they don't care a rat's ass about whether
someone in Mexico is getting your job).
Whew! Glad I got that one off of my chest.
April 7, 2008.
Update on Singulair (Montelukast)
Over a week ago I posted on this site and sent an email newsletter ("If They Don't Kill Us They Will Drive Us Crazy")
on Singulair and psychiatric side effects; this was on the day that the FDA announced that they were
investigating an association between Singulair and increased risk of suicidality. The newsletter was
forwarded to journalists from the NJ Star Ledger and pharmawire.com who called me right
away. In the latter publication I was quoted as saying that it was unclear if there were
leukotriene receptors in the brain (which isn't true, there are). Right after talking to them
I updated my March 27 post to add that there are receptors in the brain which is an important
point in establishing a causal effect (i.e. it has to act on the brain in order to cause psychiatric side effects) .
The leukotriene receptors are involved in regulation of the inflammatory response and a link between
neural systems involved in the inflammatory response and mood is well established.
Other points related to whether a drug is shown to cause a particular side effects include
whether there are case reports of an association, whether the symptom comes on after
starting the drug, and whether the side effect goes away after stopping the drug. You can see at
medications.com a number of patients reporting all three of these. Finally, do other drugs
in the same class have the same effect, and as I posted last time the FDA is investigating psychiatric
side effects in all drugs in this class.
March 27, 2008.
If They Don't Kill Us They Will Drive Us Crazy
Now it looks like Merck is going to join the rosters of pharmaceutical companies like
Hoffmann La Roche that make drugs that, if they don't kill you, at least will drive you crazy.
Roche has specialized for years in making drugs with psychiatric side effects like depression
and suicidality, including Accutane (acne), larium (malaria), and Tamiflu (bird flu).
Chantix (smoking cessation, Pfizer) has also led to some pretty trippy experiences amongst users. No wonder
when you take a drug that affects the frontal lobe of the brain. However, Larium gets the door prize for psychiatric
side effects, with over half of people who take it developing psychiatric symptoms.
Now the FDA is investigating whether the asthma medication,
Singulair (montelukast), is associated with an increased risk of suicide.
Montelukast (Singulair) and zafirlukast (Accolate) are part of a new generation of asthma medications
that are leukotriene antagonists. These medications work by inhibiting the cysteinyl leukotriene
CysLT-1 receptor, which is involved in the inflammatory response.
Side effects include headache, gastritis, runny nose, dizziness, nausea, stomach pain, joint pain, and fever.
In rare cases they may be associated with Churg-Strauss syndrome, which involves inflammation of the blood vessels.
Over the past year Merck has added psychiatric side effects as possible outcomes with Singulair,
including tremor (March 2007), depression (April 2007), suicidality (suicidal thinking and behavior)
(October 2007), and anxiousness (February 2008). The FDA is also investigating Accolate and Zyflo for similar problems.
There are leukotriene receptors in the brain, and since this drug
binds to this receptor and since depression is mediated through the brain, this suggests a mechanism
by which Singulair could cause depression. Could other drugs in this class have similar effects?
The FDA is investigating all of the leukotriene antagonists, probably with good reason.
March 20, 2008.
Captain Pill on the High Seas of Pharmaceuticals
I was interviewed last week by John Mack of the Pharma Marketing News
(Before You Take That Pill: A 'Fair and Balanced' Critique?) who quoted me from my book
'Before You Take That Pill: Why the Drug Industry May be Bad for Your Health' as saying that "if you don't have multiple risk factors for heart disease,
you don't have to get your cholesterol checked, and I don't care what anyone says." His comment was "isn't that treason?" Curious choice of words. So am I now the treasonous Captain
Pill on the High Seas of Pharmaceuticals? You see with half of all Americans on prescription meds and one fourth recommended to take a statin
not only are we swimming in a literal sea of pharmaceuticals, we are also actually swimming in pharmaceuticals (since Prozac and Lipitor are now
physically in our drinking water, see my last post on "Pharmaceuticals in the Drinking Water") Since then I have been reviewing the evidence in my
mind. Since the 'primary prevention' trials were all in patients with multiple risk factors for heart disease and showed only modest heart
attack reduction with no effect on mortality, and since no studies have been done in men with high cholesterol without risk factors, there
is no justification to be putting millions of these men on statins. So now back to the question of treason. That is something you would say about
someone in the army, navy, air force or marines. So which branch am I in? I guess the parallel to the military-industrial complex in this country is
the medical-industrial complex, which would include the four 'services' of the Hospitals, insurance companies, hospitals, and doctors. I'm not blaming John for using the word 'treason'. After all he is a journalist, not a doctor.
But he tapped in to the prevailing view, that we have a common story we need to stick to. It's called the 'standard of care' and it's
dictated by 'expert consensus' and 'practice guidelines'. That's why 'treason' is a better description of it that 'an alternative interpretation
of the evidence' (or even an actual review of the evidence). Well I guess I better shut up now and get ready to walk the plank.
March 8, 2008.
They Said They Wanted to Put Pharmaceuticals in the Drinking Water, But I Didn't Think They Would Really Do It
That's what some of my cardiology colleagues were
quoted as saying about statins for cholesterol lowering, but a recent investigatory report
showed that we not only have statins like Lipitor in our drinking water, but also antidepressants like Prozac, mood stabilizing drugs, antibiotics, and much much more.
In fact, they had trouble finding any US city that didn't have multiple prescription drugs in the drinking water. You see when you go to the bathroom
your prescription drugs go down the toilet and water purification doesn't necessarily remove them from the drinking supply.
The article went on to say "Recent laboratory research has found that small amounts of medication have affected human embryonic kidney cells, human blood cells and human breast cancer cells. The cancer cells proliferated too quickly; the kidney cells grew too slowly; and the blood cells showed biological activity associated with inflammation.
Also, pharmaceuticals in waterways are damaging wildlife... Notably, male fish are being feminized, creating egg yolk proteins, a process usually restricted to females. Pharmaceuticals also are affecting sentinel species at the foundation of the pyramid of life — such as earth worms in the wild and zooplankton in the laboratory.
'It brings a question to people's minds that if the fish were affected ... might there be a potential problem for humans?" EPA research biologist Vickie Wilson told the AP. "It could be that the fish are just exquisitely sensitive because of their physiology or something. We haven't gotten far enough along.'"
In my prior posts on statins I said "put that stuff in your own damn drinking water", but I guess I was too late. Oh, well.
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