Naked Medicine

Let's Face It: Medicine is Business

Category: Humanity in Medicine

Which Side Are You Really On, Jane Chin?!

I received what is probably the most passionate email from a reader of this blog that I’ve ever gotten since creating NakedMedicine.com in 2006. The email concludes with this:

I can’t figure out what your agenda is Ms Chin. Are siding with the poor hard working physicians who are fighting a losing battle with their idiot patient’s lifestyles? Are you siding with the tirelessly industrious pharmaceutical scientists who are selflessly dedicating their efforts to cure our ills? Are you siding with the poor neglected suffering individuals who are bravely pushing onward in their lives, struggling with disease, possible disease, possible pandemics, or just plain plainness requiring cosmetic medicine? Doctors, business, persons, for whom are you advocating?

I was shocked by the email, because this reader “hit the nail on the head”! He can’t figure out what my agenda is, because my agenda is in NONE of those sides he described. In other words, if I were guilty of picking “a side”, it wasn’t part of the “usual suspects”.

Here’s my very long response to my reader, to whom I’m grateful, because he took the time and effort to share with me this question that obviously is frustrating him.

******

You wrote what you felt, and I don’t fault you for that. I can sense a real feeling of frustration from you, and I don’t blame you for feeling frustrated about the healthcare system that seems to be broken in many ways.

I want to address specific points you brought up – first one being ‘cures’. I genuinely don’t think that the drug industry is prevented from, or are resistant to, discovering cures for diseases. It’s not about ‘cure’ versus ‘not the cure’ that is the problem. It is often the economy of scale that is the problem, and a very understandable one when you consider that the drug industry is – and has to run like a business – in order to remain in business. I have no doubt that the drug industry would love to find a cure – because they can charge for the price of a ‘cure’ and be justified in charging such a price.

The problem on the one hand is that many times we simply cannot find ONE underlying factor of a disease, especially the chronic diseases like diabetes and heart disease (in fact, many diabetics die of a heart attack and don’t live long enough to die of diabetes complications, especially those consuming a western diet). It is not like a bacterial infection where we can pinpoint ONE origin of the disease and target that specifically, the way we can target an infecting bacteria with an antibiotic and ‘cure’ the patient.

The other problem is about the number of people with a certain disease. For example, there may be fewer companies willing to research rare diseases that may be ‘repaired’ let alone ‘cured’, simply because the companies need to get the money somehow to do all the experiments and clinical trials necessary to jump through regulatory hurdles to even get the drug approved. When i was a graduate student, doing what are pretty simple experiments (and not even in people – i worked off the petri dishes), i was often using reagents that cost my employer thousands of dollars to purchase from reagent companies. Each of my experiments has to cost at least a thousand bucks, and many of my experiments failed and produced no result.

These prices are nothing compared to the amount of money it costs to run a clinical trial at the scale required by the FDA. Now the drug companies have to pay for the drugs, the cost of mountains of paperwork needed to get the clinical trials started, the doctors who do the clinical trials (and some doctors get really snobby and brag to each other about how much $ they can muscle out of drug companies “per patient” to enroll in the drug companies’ trials), not to mention the “overhead” that the academic institutions charge the drug companies because their doctors work there (and these overhead costs can mean more than 50% of the total study budget).

And then most of the drugs end up not passing the FDA’s requirements and fail to get approved. So if you’re running a company, you will tend to want to go into areas where you will likely have more customers – heart disease for example – just so you stand a better chance of keeping your company operating should it succeed in getting a drug treating that disease approved. This is also why the government has to create incentives for companies that are willing to go into rare or “orphan” diseases – for example, Gaucher’s disease is a rare lysosomal storage disease affecting maybe 1 in 40,000 people. A drug company that competes in this market will be happy selling 1 prescription every 3 months.

I honestly do not view drug companies as entities that profit from the suffering of others, because of the logic of this assumption: If drug companies are creating diseases in people in order to make drugs for the very diseases they created, then that to me qualifies for the statement. However, drug companies happen to offer the tools to treat the disease, not unlike device companies making scalpels and surgical tools to allow doctors to cut us open should our illnesses demand it. It seems illogical to me to accuse device companies for profiting from people having tumors that require scalpels to operate and excise the tumors – unless we’re also implying that the scalpel companies are putting tumors in people that only their brand of scalpel can remove.

Additionally, I have observed that for the most part, people in our society today tend to prefer that we “have a pill to treat XYZ”, so that they do not have to do the hard work required to get their own health back on track. And then you add to the fire media agencies that charge pharma companies millions of dollars to come up with brainless gimmicky advertisements, and it is no wonder why many people feel like the drug companies are “profiteers of suffering.” Some years ago, there was a government funded study that shows that rigorous diet and exercise will help reduce diabetes risk at a very real level – in fact – the study patients who had diet and exercise regimen did as well in reducing their diabetes symptoms as study patients who took an anti-diabetic drug.

But why hasn’t the government or the doctors (not the drug companies – their responsibility is in making drugs) done anything about this amazing result? Because the of costs involved to the clinics in order to make “diet and exercise” possible in patients at a therapeutic level. Clinics would need to hire case workers and nurses whose job is to counsel and support and follow each and every single patient who opts for this “natural and effective” treatment. OK then, how about asking patients themselves to do this? Seriously, if you are a patient at risk for diabetes (i.e. risk factors are there, but patient is still “pre-diabetic” and not yet requiring drugs to control their blood sugars), you have everything you need at your disposal to go for the natural and effective (and less expensive than prescription drugs) cure! why aren’t patients doing this? because willpower and discipline are key – and you’re going to need both for a lifetime to prolong the onset of disease.

I can share this true experience – my husband had prediabetic blood work results some years ago when I urged him to see an endocrinologist, because his side of the family also suffers from diabetes. the endocrinologist told him that because he was so young (not yet 40 at the time), she preferred that he try the old fashioned diet and exercise, and see if he could get the risk factors down, before she put him on a drug. He happens to have a level of willpower and discipline that even I don’t have – and he altered his lifestyle dramatically – and it was enormously difficult. 6 weeks later he went back and the endocrinologist was so impressed with his results that she told him that most of his blood work results were approaching normal numbers. But she also told us that not every patient she sees can make this happen – and often she is forced to give the patient drugs to make sure that the patient doesn’t end up with uncontrolled diabetes symptoms (resulting in all sorts of nasty things including death).

I see drugs as exactly what you said you wished to see – repairs and cures. However, the reality is, few are truly cures because of the complexities of most diseases, and repairs don’t always “fix” things without creating new problems (called side effects) EXACTLY because of the complexities of most diseases.

The doctors’ hands are tied not by pharma companies, but by insurance companies as well as their own malpractice lawsuit concerns. Your average primary care doctor has to track how many patients he sees everyday because he needs to make sure he breaks even. That’s not the drug companies doing, but the insurance companies that capitate how much doctors are paid for doing what. So you also have a system that don’t reward doctors for spending more time with patients – in fact – you’re making it very bad business for the doctor to spend too much time because then he’ll lose money that day – and this does not do well to cultivate trust with patients who then need to heed the doctors’ advice about doing the hard things they need to do to steer their health status back on track.

I hope my email begins to help you understand where I am coming from – perhaps I can’t take any sides because I don’t think there are any sides that I can reasonably take without acknowledging that there are other entities that also need to be held accountable. the healthcare ‘system” is truly a “system” and a staggering, complex one at that. the best I can do is to help the consumers – people like you and me – to think for ourselves about what is being “sold” to us whether it’s from the drug companies, insurance companies, the government, the doctors, even patient groups. If I am guilty of siding with anything, it will be on the side of “critical thinking” about the system of healthcare with all of its players.

Best wishes,
Jane Chin

Not Poor Enough or Not Sick Enough

Shirley Loewe had one of the most aggressive form of breast cancer (inflammatory breast cancer). Her tumor was already 4 inches wide when she was diagnosed in 2003.

Adding insult to cancer, Shirley was repeatedly denied care because she was either “not poor enough” to qualify on Medicaid in Texas because she made $15,000 a year, or “not sick enough” to receive treatment otherwise.

Texas had an obscure law that allowed women diagnosed in federally-funded cancer detection clinics to cover women with cancer by Medicaid even if they did not otherwise meet eligibility – only Shirley did not go to a federally-funded cancer detection clinic because she had no clue about this obscure law.

Since then, Texas amended the law to lift this restriction, but it was too late for Shirley – she died in June 2007.

Source: A Breast Cancer Death, Tangled in Bureaucracy.

Religious Doctors May Not Be Called to Serve the Poor

gif_occu_c_043_ss.gif For many doctors (religious or not), the practice of medicine is more a “job” than a “calling”, even though there may be an undercurrent of “desire to serve”. Ask any job applicant, and you’ll get the typical answer: “I am applying for this job because I want to help people.” Doctors enter medicine for many reasons, one of which may be “to help people”, but this is different from being called specifically to serve a certain group of people. It does bring a reality check for those patients who believe that a doctor’s religious affiliation may have a greater influence on the altruistic motives of that doctor than a doctor who does not claim a religious affiliation. (more…)

A Daughter’s Sacrifice

I recently signed up for MyBlogLog.com, which has a cool widget that I’ve installed on this page to showcase recent visitors to this website. I’m also seeing an unexpected benefits from MyBlogLog.com – discovering interesting blogs that I otherwise may never find. For example, today I came upon a blog by a vascular surgeon. If you can’t read Chinese, you may not be able to immediately appreciate the title of this post, but I’ll explain. (more…)

Why We Like the Doctors We Like

I’ve visited with many doctors in the past – primary care docs and specialists, both as a patient and years ago as a professional. I’ve come to really appreciate the importance of bedside manners and compassion in medicine.

Because of some of the behaviors I have seen from doctors when I worked in the pharmaceutical industry, it’s made me highly distrustful of physicians. So in writing this, I already have had bad experiences that had made me biased against how some doctors “practice medicine.”

As a patient, I’ve met doctors who have been dismissive or judgmental, and who came across as barely caring about my wellbeing as a patient because I was just another body shuffling through the office in a highly managed care environment.

For example, a primary care doctor my husband and I went to had given us both annual physical exams and never bothered to call us about the blood test results. His office staff said that we would only get a call if something was “wrong.” I found this ridiculous especially when the doctor had made my husband take a 2 hour glucose tolerance test for his blood sugar levels. The doctor also made recommendations that ran counter to a world-class endocrinologist even when we told the doctor about family risk factors, etc.

This was a young doctor, and maybe that’s where his arrogance came from. (more…)

Suicide and SSRI When Medical Legal Risk is High

By Robert Lamberts, M.D.

I had a tough situation in the office yesterday.

One of my patients is a 17-year old who went to the ER on Sunday for shortness of breath. They said she had a panic attack and should follow-up with me as soon as possible.

When I saw her, she was clearly distressed, but not to the point of needing to be hospitalized. I asked her what was up and she told me that she had been kicked out of school recently because she stabbed someone with a knife – apparently only after that person grabbed her forcibly. She lives with her mother and her father is a homeless alcoholic. Her mother tells her not to talk to him, but he calls regularly and tells her that she is all he has. He also says that he might kill himself. She knows that he shouldn’t say this kind of thing to her, but it puts her in a hard situation. On one hand, she knows that it tears her apart to talk with him. On the other hand, she fears that if she does not talk to him, he will kill himself.

I asked her if she ever thought of killing herself, and she said she had – especially after talking to her father – but was not at this time suicidal. She had a real good friend with her who was very supportive.

So I am stuck in a dilemma. On one hand, she is clearly depressed and needs both medication and psychological counseling. On the other hand, since there is a black-box warning for using SSRI’s in teens, putting her on one would put me at huge risk for a lawsuit should she follow-through and kill herself. I think she is at very high risk of doing that in the long-run, and don’t really have a longstanding relationship with her as her doctor. I did what I could to tell her to talk with either her friend or me if she should feel she is close to killing herself, but I don’t really know her that well. I am trying to reach one of the local child psychiatrists, but most of them are several months out for new patient visits. (more…)

Personal Perspective of Manic Depression

By Tom Pauken II

“A Personal Perspective of Manic Depression: This reporter gives a first-hand account about the bipolar disorder” reprinted with permission from Mr. Tom Pauken II.

Bipolar disorder, commonly known as manic depression, affects 0.3 percent to 3.7 percent of the world’s population. Fifty percent of them seriously considered or attempted suicide. Forty-five percent of Americans with bipolar disorder believe this sickness made a high negative impact on their lives. Seventy percent of those same respondents assume the public doesn’t understand their condition.

These statistics were compiled by a Global Survey for World Mental Health Day 2005 (Oct. 10) also posted on the upliftprogram.com Web site. Are these statistics important? Do you know somebody afflicted with manic depression? Well, I consider these statistics important because I suffer from this ailment.

I make this revelation not to grab attention for myself. I’m more passionate writing about geo-political issues of the East Asia-Pacific region. I shun diaries and anticipate never using first person voice in future articles.

Nevertheless, I feel an obligation to my readers. I want those suffering from mental illness to feel inspired during their moments of darkness because I might be manic depressive but I’ve taken great strides to overcome my difficulties. (more…)

Here To Fight or Here To Die?

When I was a graduate student, a senior student teacher (scientist or professor in training?) got up to address the the group of college students and graduate student teachers. The senior student glossed over the usual orientation-related information. At the end, he became very solemn and said, “Please show some decorum around here. Remember that people come here to die. It’s necessary to show decorum.” It wasn’t until months later that I realized what bothered me about the comment. What disturbed me was that no one seemed to be offended at the senior student’s comment – for them it made sense.

Cancer patients do not come to die. They come to fight for their lives.

How many students did the teaching assistant influence with that perspective – those students who didn’t bother to question what he said, or didn’t see there was anything to question?

There is a widespread disconnect in perspectives of those who study cancer and those who live it. I had no clue what living with cancer is about even though I’ve scurried along the same hallways as emaciated, hairless patients who were wheeled around the hospital. I’ve seen children fighting cancer and felt as removed if I was watching a television. How many basic science (preclinical) students go through school wondering whether their project would make a difference at all?

Perspective on cancer matters not only to people living with cancer and to clinicians treating patients, but also to everyone else – graduate students researching on various aspects of cancer, individuals who influence social perspective (teachers, community leaders.) Perspective affects our decisions to to detach and become indifferent, or to increase awareness of and appreciation for individual courage in the fight against cancer.

From a breast cancer patient: “…having cancer has changed me for the better, I wish I could have changed a different way, but I’ll take this way if necessary. Cancer is a disease of LIFE, not just a disease of the body. And though others want you back to normal, normal is different now. It’s not about being strong; it’s about being grateful for every second.”

Naked Medicine © 2016 Frontier Theme