Naked Medicine

Let's Face It: Medicine is Business

Category: Scientists

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

Zap Bad Memories with a Pill?

When Telegraph UK published the article, “Scientists find drug to banish bad memories” the piece was dugg over 1200 times. The article title effectively hypes up the idea that is currently backed up only by the most preliminary experiments. The truth in application remains years away – if indeed application of this idea is possible. That’s because many early scientific experiments of interesting chemicals working in mice and rats are hyped up by the press or by scientists themselves who can benefit from the publicity (translation: potential for future research funding).

What is not emphasized enough for the public is that what may look interesting in petri dishes or lab mice / lab rats remain just that – interesting. Does this interesting result translates to something actually happening in humans? Not always. Still it makes for good sci-fi movies or even a sequel to Eternal Sunshine of the Spotless Mind.

So what exactly is U0126? According to the Promega (a chemical supply company) website: U0126 is a synthetic chemical MEK Inhibitor that blocks the activity of the MAP (mitogen activated protein) kinase kinase (not a duplicate typo), MEK. U0126 is more potent and less toxic than PD098059, another MEK inhibitor that has been under investigation for potential therapeutic use for decades, but hasn’t resulted in a human application.

Making Businessmen of Doctors and Scientists

Some special interest groups are very critical of financial conflicts of interests between businesses (namely, pharmaceutical industry) and doctors and scientists. I’ve seen and worked on both sides. I think it’s very important to educate doctors and scientists on all aspects of medicine – the scientific, business, and sociopolitical aspects.

Don’t like the purported influence that drug companies have on doctors’ prescribing habits? Then teach doctors how drug companies market their products. Give doctors the tools and knowledge to ask meaningful questions to drug companies so that drug companies can do a better job at marketing in a fair balanced manner. (more…)

Media Hyping and Premature Promises Do Not Help

Recently, journalists picked up on a poster session on the effect of ginger on ovarian cancer cells at the 97th American Association for Cancer Research Annual Meeting (AACR) in Washington, DC (April 1-5, 2006). Forbes called it, “Ginger an Ovarian Cancer Killer.” The poster authors’ school, University of Michigan also sent out a press release subtitled, “Cell studies show promise for ginger as potential ovarian cancer treatment.”

This illustrates my concern of how a piece of scientific “evidence” is so preliminary, yet generates a level of sensation that is far from warranted.

I also object to U. of Michigan’s use of the word “promise” in the press release. I’d have preferred the entire subtitle replaced with the disclaimer, “Study done in petri dish – not even animals or human – please do not gorge on ginger.”

A definition of “promise” speaks to expectation of something that is likely to happen. This study is too early to speak of any promises. (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