Naked Medicine

Let's Face It: Medicine is Business

Category: Society

Why I Chose NOT to be a Doctor

I was once a premed.

I chose not to become a doctor because I wasn’t truly interested in the profession, it was something I felt I “had” to do or “should” do because I happened to major in biology. And being a first generation Asian-American there was also pressure from being a “Tiger Cub”: we have limited career options: doctor, lawyer, engineer. I suck in math and was good in biology. Guess which option I had?

In my undergrad classes I was among other premeds; many of them went in for the Money, the Prestige, for their Parents. But they will all talk about how much they love helping people/patients on their applications.

I did consider taking the MCAT and even paid for one of those “prep courses”, in case I changed my mind. But I knew my grades weren’t good enough, I didn’t have “connections”, and I wasn’t going to throw good money after a bad risk, especially when that money was already borrowed money via student loans. I went to grad school instead.

Then I started working in the healthcare industry, first working for the pharma industry. Maybe the nature of my work in pharma predisposed me to witness the doctor-industry relationship in a way that brought out some of the unsavory traits of the medical profession.

I saw some of these doctors up close – their lives (and lack thereof), their values (and lack thereof), their character (and lack thereof), bedside manners (and lack thereof).

We are constantly reading about how “evil” the Pharmaceutical Industry is and how they corrupt doctors and so forth – that gets a lot of coverage in the presses. Well, I’ve seen it from the other side: there are doctors who have become savvier businessmen than they are savvy clinicians and they are perfectly capable of manipulating drug companies to fulfill their personal interests. I’ve had doctors asking me for favors that I knew had nothing to do with improving patient care. I’m not embarrassed to admit that my first year of working in industry had almost completely destroyed the trust I used to have in doctors.

I saw the state of Managed Care and the “healthcare business” that has made doctors more busy with administrative work than taking care of patients. A HMO doctor once explained to me that he goes through each day making sure he breaks even by seeing 50 patients. He knows how much $ he gets paid per patient from the HMO. So he has to see a certain # of patients to stay in business. Depending on the patient’s condition, say the patient has a cold, he’d spend a few seconds with the person, and knowing that the patient would expect “something” for the visit, the doctor would write a prescription for an antibiotic just to get that patient out of the office, so he could see the next patient.

The medical profession was not something I’d ever wanted for myself if I did not have a deep-rooted passion and conviction about going into the profession. In fact, the medical profession is one that I would not encourage my child to go into, unless again, he expresses a serious conviction about becoming a physician. I actually have to be careful about my own prejudices – that I do not vehemently discourage my child from considering this profession. That would be as bad as the Tiger Mothers who force their children into the medical profession.

I know this puts me in the “outlier” group of Asian mothers. But then again I’ve always been an outlier.

You Can Fall Victim to Healthcare Fraud!

Think “Healthcare Fraud” happens only with big drug companies with shady sales and marketing practices? Think again!

The next big wave of healthcare fraud is being perpetuated to average people – it’s called Medical Identity Theft.

That’s right… healthcare and insurance benefits are as valuable as cash – in some cases even more valuable than the face value of cash. That’s why ID thieves are targeting people’s healthcare benefits.

These thieves are the scum of the scum because they are literally stripping off people’s ability to save their own lives by messing with their healthcare insurance: imagine you or someone you love suddenly discover you have a catastrophic illness requiring tens of thousands of dollars’ worth of medical treatment. You have coverage except – it was all drained by a medical identity thief. I put these low-lives on par with scum who rip off senior citizens’ life savings.

Take a moment and visit the Federal Trade Commissions’ website to learn more about Medical Identity Theft and how to protect yourself and your family.

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

Pharma Offering Lifestyle Drugs – Power will Shift to Patient Customers

You’ve probably seen it coming – smelled hints of it on TV – pharmaceutical companies are getting into what we call “lifestyle drugs”; products that focus on “enhancing” your life rather than “extending” it.

Yes, there is a big difference, and you may think that “extending” life pays big, “enhancing” life may pay even BIGGER. (just ask the Botox people.)

It’s only a matter of time before pharmaceutical companies shift their focus from “therapeutic intervention” to “lifestyle / recreation” because they now deal with a ready-and-willing customer base who are willing to pay.

This also creates a more dramatic shift: one of bargaining power from the physicians to the patients. Eventually, pharma’s customers will become the patients more directly than before, with doctors becoming more of a “broker” – the people who writes the drugs but apart from that having no real power. Doctors are already complaining about patients leaving them if they don’t do what they’re told by the patients – “if you don’t write me this drug, I’ll go to someone else who will!”

There’s a bit of theatrical irony if this happens, because doctors will get a taste of what pharma sales reps have dealt with for years: being punted to the position of a measly “order taker” or “human sample dropper”. How about doctors eventually becoming “order takers” and “human Rx writers”?

Pharma Industry’s Job is NOT Disease Prevention. THAT’S YOUR JOB.

I’ve heard the argument, so have you.

“Those evil pharma companies aren’t interested in prevention! They want people to get sick and stay sick because that’s how they make their money! On the drugs!”

Recently I had railed against the pharma companies that are capitalizing on increasing trends of people using certain prescription drugs as “lifestyle drugs” – not to mention appearing on the Wall Street Journal this past Friday to rail against pharma companies that abuse the role of medical science liaisons, so I have my own pet peeves and criticisms with pharma. What irks me is when a criticism about any industry is not based on a fundamental flaw in that industry, but is simply born of politicking sensationalizing this-is-how-I-get-more-readers/viewers tactic.

Most of these people have taken a basic science class at some point in their lives and learned about a phenomenon called “entropy”. How things in a system tend to go toward disorder, and to halt this “natural” occurrence from occurring, you have to add in a great deal of energy, and even that won’t ultimately stop the inevitable.

Kind of like the idea of life and death, which is relevant to the assessment of this dimension of our hostility towards the pharmaceutical industry.

Obviously, pharma companies want you to stay alive, preferably as long as possible. This is not so they can capitalize on you dying (a dead person is no longer a customer)! The pharmaceutical industry is a business that capitalizes on your DESIRE to PROLONG YOUR LIFE AND MINIMIZE PHYSICAL PAIN AND SUFFERING. If you aren’t interested in prolonging life and minimizing physical pain and suffering, the pharma industry ain’t gonna benefit from YOU since you’re not a customer to begin with!

Let’s say you are sick from complications of heart disease.

Pharma companies that are in the heart disease business is not responsible for PREVENTING YOU from getting heart disease. YOU ARE RESPONSIBLE for making sure you do what you’re supposed to do to reduce your risk of getting heart disease, unless somehow you have signed the claim to your physical existence over to another person who is legally responsible for your physical survival and health.

Your family doctor may have a responsibility to educate you on mitigating the risks of getting heart disease, so those who want to rant about prevention may want to point their antennae to the medical profession, but ultimately YOU are STILL RESPONSIBLE for the behaviors and actions YOU TAKE that lead to the result of heart disease or no-heart disease. Your doctors can be the best doctors they can be and even give you a diet and exercise regimen that will lower your cholesterol, reduce your blood pressure, and take down your diabetes risk factors a few notches – but if you DON’T DO WHAT YOU’RE SUPPOSED TO, then you will end up with the health consequences. Actually, this is EXACTLY what happens in many obesity and heart disease cases today. Doctors themselves will admit that many of their patients won’t heed their advice, and most will lack the discipline required to stick with a rigorous healthy lifestyle to make a lifesaving change.

Are we saying that it’s the pharma industry’s job to PREVENT us from assuming behaviors that will put our health at risk? If there’s a pill for stopping us from risky behaviors, and pharma makes it commercially available, then we’ll simply turn around and say “now pharma wants to control our thoughts and actions!” (I think we already have those kind of pills, and there are activists and lawyers jumping on that bandwagon.)

Seriously, if you take care of your body, do everything healthy like you’re inundated by all media outlets to do (don’t drink, don’t smoke, don’t go out in the sun without wearing sunscreen, eat more fruits and vegetables, exercise at least 30 minutes a day, etc…), then you’re probably not going to need all those pharmaceuticals until the inevitable process of aging occurs, where your cells can’t care less what you’ve done because they’re all getting old and breaking down as a natural part of the decline of “life” in your physical human existence.

Female Sexual Dysfunction: Pharma’s Next Lifestyle Market

I’m posting this from one of Steve Woodruff’s blog posts that I shared via my Facebook profile, which turned into a full blown debate between me, Dmitriy Kruglyak, and Yvette – one of my FB friends.

Jane Chin
I’m pro-pharma, but I’m NOT happy w/ female sexual dysfunction disease mongering I expect to see from pharmacos! http://ow.ly/4xQH

Dmitriy Kruglyak at 8:18am April 30
Where do you draw the line between “disease mongering” and “disease awareness”?

Jane Chin at 8:21am April 30
When the ‘awareness” generated makes patients who otherwise are not candidates for the drug pressure docs to write the Rx.

Dmitriy Kruglyak at 8:23am April 30
Ah, but who gets to decide “who are the candidates” and what qualifies as “pressure”? Especially if we are talking DTC, rather than Rx. Are there hard and fast rules?

Jane Chin at 8:25am April 30
that’s why I don’t think DTC is responsible for niche diseases. Pressure=if you don’t write it, I’ll go to another doctor who will.

Dmitriy Kruglyak at 8:27am April 30
Hmmm, seems to me “if you don’t write it, I’ll go to another doctor who will” can come from any kind of patient empowerment, not just driven by Rx advertising.

Jane Chin at 8:28am April 30
Yes it can, but true patient empowerment IS NOT “take this pill, fix your problem” when the problem is not always solved by “a” pill.

Dmitriy Kruglyak at 8:47am April 30
Patients just want to do what they want to do. People have, are and will always look for quick fixes. That’s human nature.

Jane Chin at 8:51am April 30
I know this is human nature, and one capitalized by advertising. But where health and human life are concerned, the ethical standards should be higher.

Dmitriy Kruglyak at 8:53am April 30
Seems to me advertising is simply fulfilling demand

Jane Chin at 9:02am April 30
No, advertising is meant to CREATE demand. Even better when advertising increases the market from perception-based v. needs-based demand. (more…)

How to See Through Pharma Ad BS?

Like all marketing campaigns, the aim of any pharma advertisement is to get you to think that you need a certain product or a service. I understand that all pharma companies will say that they want to educate patients on the condition first and foremost, but I guarantee that when pharma companies are forking over multimillion dollar checks to ad agencies, they’re looking for more product sales as a return on investment (ROI).

This is not a “bad” thing – this is business. Let’s say you’re an inventor and you created a program that would improve the amount of sassing teenagers give to their parents. Would you pay an agency half of your annual paycheck so that parents can be educated about the prevalence of sassing by teenagers? NO! You want parents to buy your program so you can make back at least the money you spent on the ad, plus more so you can pay your mortgage and keep your family fed!

Well, pharma’s like that. I know for some it is incredible to believe, but pharma companies are not alive in themselves, as if there is a force called “the pharma company” making decisions. Pharma companies are made up of hundreds of thousands of people who have to feed themselves and their families and put a roof over their heads. (Many of them are parents and most of them probably wish that you did invent a program that improves teen sassing of parents.)

So the key is not to spend your energy hating companies and talking trash about how misleading some commercials are or how annoying you find that a computer graphic bee is selling you asthma medication or how a group of red-towel clad women looking like they think they’re better than you want to sell you a hormone replacement drug.

As consumers, the key is to see through BS!

And the best way to see through any “BS” – whether it is from pharma or any other industry – is to know the difference between:

– what you NEED

– what you WANT

– what you are led to THINK you NEED

This last item – what you are led to think you need – is the crux of how ads work. Ads lead you think you need something, and usually tap into our animal instincts, or tap into our more “evolved” desires like convenience.

Example:

– buy this car and you’ll attract sexy partners (taps into animal instinct)

– take this pill (taps into convenience in some cases where diet, exercise, life style change is much harder)

Therefore, a question consumers can ask themselves whenever they are confronted with an agent of influence is,

“Is this what I REALLY need? Or is this what I want? Or is this what I am tempted to think I need?”

You can apply these questions to 99% of the junk ads you see on television these days, aside from pharma ads.

Why Smokers Do and Don’t Quit Smoking

My father-in-law is in his 70s and still smokes every day. He’s tried to quit before, but in the recent years has decided that he was old enough to live his life however he wanted, and that included smoking. Nevermind the fact that he has had a quadruple bypass operation for his clogged arteries (and other coronary operations), is on polypharmacy, leads a sedentary lifestyle, and has been nagged by his doctors and us about quitting smoking for years.

I know that many doctors – especially internists and general practitioners/family doctors – often encourage their smoking patients to quit smoking, citing the harms of smoking and the benefits of not smoking relative to the patient’s capacity to heal. Even those of us who do not practice medicine but work in the healthcare field know that smoking wreaks havoc on a variety of bodily functions right down to the molecular level.

Earlier this year, three Greek researchers published a study on why smokers quit or don’t quit smoking in Harm Reduction Journal (source: Harm Reduction Journal, March 29, 2006, 3:13 doi:10.1186/1477-7517-3-13). What they found may give some insight not just to medical doctors with an interest to helping their patients quit smoking, but for those of us with a personal interest to help either our loved ones or ourselves to quit smoking.

A popular assumption many doctors have about smokers quitting smoking is to introduce cognitive dissonance – an emotional state of mind where two beliefs are in conflict with each other. A person experiencing cognitive dissonance will move to resolve that conflict of belief. If a smoker believes that smoking is harmful to one’s health yet continues to smoke, the smoker experiences this contradiction and would move to resolve that contradiction. One would assume that the smoker would then stop smoking – right?

I doubt that smokers would deny the harmful effects of smoking. We can see from what’s happening in society that this is not the case – people still smoke even when they’ve been exposed to anti-smoking campaigns, nagging from friends and loved ones (I admit, I am one of those annoying people who remind their friends that smoking is bad for them), and shock-and-awe pictures of lungs blackened by chronic smoking.

(more…)

How Work-Life Imbalance Makes You Sick

Dr. Sheldon Cohen‘s keynote presentation at the 8th International Congress of Behavioral Medicine was published in International Journal of Behavioral Medicine (2005 Vol 12 No 3, 123-131).

Cohen summarized 20 years of research on psychosocial influences on infection susceptibility.

Cohen also debunks these pervasive myths of stress and disease:

  • Myth: Infectious disease-causing agents is wholly responsible for causing infectious disease.
  • Myth: Stress suppresses the immune system, which makes us susceptible to infections and disease.
  • Myth: Stress overstimulates cortisol production, which leads to susceptibility to disease.

According to Cohen’s article, infectious disease-causing agents are not sufficient causative agents for disease. Our immune system’s modulating responses against viruses in our body determine whether we become infected.

We would also assume that health-related behaviors like smoking, alcohol consumption, sleep, exercise, and diet contributed to disease susceptibility. Cohen has observed that these behaviors were independent of susceptibility to the common cold across five different strains of viruses (including 3 rhinovirus types).

(more…)

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