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Healthy Skepticism International News

November 2007

More money, less health

A recently published table of life expectancies for infants born in various countries has caused me to ponder the US health care system.  Although the United States spends the most per capita of any country, we rank roughly 40th in life expectancy.  We spend the most on new drugs and other medical advances.  Yet a child born in Japan or Switzerland can be expected to live three to five years longer than one born in the US.  How can this discrepancy be explained?  Clearly there is no simple single answer. Is it a matter of genes? or diet? or guns? Is it our lack of a universal health care system?

My own experiences have led me to place a significant part of the blame on the commercialization of health care.  I would suggest that we have a medical system that optimizes profit at the expense of medical effectiveness.  We are like the passengers on the Titanic thinking we have the best, since we spend the most, while we are unknowingly heading for disaster.

I am not the first to suggest this.  In his book Overdosed America Dr. John Abramson points to the dominant influence of Big Pharma on our entire medical system as a major cause of the crisis in American health care.  What follows is my understanding of this situation based on the work of Dr. Gordon Guyatt of McMaster University in Canada, Dr. Beatrice Golomb of UCSD Medical School, Dr. Russell Blaylock’s Wellness Report and Dr. Abramson.

Who am I to be writing on this subject?  I am an 85-year old retired research scientist who had a 45-year career in support of the U.S. submarine navy.  Upon retirement I applied my research capabilities to such diverse fields as domestic violence, as a volunteer in the San Diego Police Department, and to genealogical studies of early American families.

My interest in the medical system stems from my personal experience with a statin.  After I suffered a heart attack in 2002, I was prescribed a minimal dose of the popular statin Lipitor to lower my cholesterol levels. During this same period, I developed muscle pain in both hips which I attributed to spinal stenosis.  I dealt with the hip pain with acupuncture and muscle therapy often going more than once a week for pain relief.  In spite of these treatments, the pain restricted my ability to walk.

Almost two years later another doctor increased the Lipitor because he thought my LDL cholesterol levels were still too high.  Now I could practically not walk at all, and I realized that my problem was the Lipitor.  I told my cardiologist nurse practitioner.  She took me off Lipitor and substituted the non-statins Welcol and Zetia.  Almost immediately the hip pains disappeared and I could walk again.  Three doctors had seen me in pain and none had suggested that the statin might be responsible.

What differs most about American health care when compared to other countries, and even as compared to 25 years ago in this country, is the emphasis on prescription drugs.  These days, prescription drugs are the dominant approach taken by doctors to the majority of ailments.

To be truly effective, this approach to medicine requires that our physicians have available to them reliable, accurate information about each drug they prescribe, including potential adverse reactions and possible dangerous interactions with other drugs. Up until a few years ago, I assumed this was the case.  However, through my own experience as a victim of a statin drug, and after hearing a talk by Dr. Abramson and having also learned about Dr. Golomb’s UCSD Statin Effects Study, I was inspired to delve deeper.

What I found is discouraging.  I truly believe that American doctors are dedicated to helping their patients.  However, the information on which they base their decisions is often corrupted. There are so many new drugs that they often must depend on information provided by persons in the employ of the drug companies. I have learned from studies conducted by the four doctors referred to above that even if medical practitioners find the time to read their professional journals, they may be reading summaries of clinical trials that are misleading and even in some cases contrary to the actual trial results.

Not only do drug companies support doctors in training, thus building confidence in a particular company, they also dominate the process by which new drugs are tested and approved for sale.  The reviewers of journal articles are frequently connected financially to the companies about whose drugs they are writing.  Even the FDA’s approval program is contaminated by drug company monies. 

One source of prescriptions for a particular drug is often patients’ requests, based on advertisements they have either read or seen on TV.  It is often hard for a physician to resist such a request.  I was shocked to learn that the U.S. is one of only two countries to permit such advertising. And since our publications are distributed worldwide, their influence is disproportionate. 

Probably the most disappointing aspect of the current system is the failure of doctors to consider seriously adverse effects of a drug as reported by their patients.  Whether this is because of lack of knowledge on their part or because verifying side effects and reporting them is both tedious and time consuming, the result is a vast underreporting of adverse effects once a drug has been approved.

It seems clear to me that we have indeed designed a medical system that optimizes profit at the expense of medical effectiveness.  It is unlikely that this situation will change in the near future.  The best a patient can do is to read carefully the information provided by his pharmacist, and to check his personal responses to every new medicine.  Even if the problem experienced is not a listed side effect, it may still be a real one.

 

 

HS Int News index

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Cases of wilful misrepresentation are a rarity in medical advertising. For every advertisement in which nonexistent doctors are called on to testify or deliberately irrelevant references are bunched up in [fine print], you will find a hundred or more whose greatest offenses are unquestioning enthusiasm and the skill to communicate it.

The best defence the physician can muster against this kind of advertising is a healthy skepticism and a willingness, not always apparent in the past, to do his homework. He must cultivate a flair for spotting the logical loophole, the invalid clinical trial, the unreliable or meaningless testimonial, the unneeded improvement and the unlikely claim. Above all, he must develop greater resistance to the lure of the fashionable and the new.
- Pierre R. Garai (advertising executive) 1963