The press release made sense to me, but it seriously will meet lots of antagonism because of the prevalent trend of obese children in the USA these days. I bet these kids have ridiculously high cholesterol levels – and certainly not from eating too much “nutrient dense” foods. So while I as a scientist and also as mother of a toddler who needs lots of “good fats” can sympathize, I don’t think the argument here can stand up to even one voice saying “… then what about all this concern with childhood obesity?”

I sent my query off to the publicist, who got in touch with the Sally Fallon Morell, president of the Weston A. Price Foundation to respond to my challenge above. Sally’s response is here.

I followed the links given as references, including the one from the Foundation itself:
Dietary Recommendations for Children –A Recipe for Future Heart Disease?

“Just Say No!”
When it comes to feeding their children, parents should “just say no!” to the government’s dietary guidelines. Children need a diet rich in traditional fats in order to achieve optimum growth and development, as well as protection from heart disease later in life.

I wished it had addressed additionally the issue of fast foods – because this is the reality of “kids’ diets” these days… if saturated fat plays a role in children’s growth, at what point do parents draw the line in where that source of saturated fat comes from? (this question was answered by another link that Sally’s response included, but I wished the above information would address it immediately rather than me having to look at another (non-related to the foundation) link.

I also found the Swedish study findings interesting, mostly because I’ve been drinking more whole milk (full fat) since that’s what I give to my child, who is almost 2 at this writing. Our pediatrician had told us that at this point, we should cut back milk for him because it doesn’t really do much for him other than the calcium and vitamin D that he can be easily getting from other sources.

I don’t know how much this would convince you as a consumer about the benefits of cholesterol in children. On an objectivity scale, I would have preferred that the links I received were original source citations (i.e. links to the original scientific studies published – such as from PubMed) rather than what appears to be commercial pages or user-contributed pages.

This does make for an attractive commercial market to give consumers “concentrated” forms of antioxidants – except most of companies providing these types of nutrition products are not regulated by the FDA – that branch of the government regulating food and drugs to make sure that you as a consumer aren’t being ripped off or worse – physically harmed by ingesting unsafe products. Unfortunately, history has shown that the FDA only steps in when enough people get sick or if a few people begin to die from the so-called “nutraceutical” – just look at the ephedrine cases in the multi-billion dollar weight-loss industry.

Currently there is no agreed projection of antioxidant intake because this can fluctuate based on individual energy intake, caloric consumption, and especially environmental or confounding health related factors like exposure to cigarette smoke or disease (increasing body’s oxidation burden). There are researchers who are trying to determine what these individual needs may be, but for the most part, consumers have been inundated by commercial entities eager to profit on a perceived benefit of “high antioxidant intake”. For example, via Quackwatch:
http://www.quackwatch.com/01QuackeryRelatedTopics/PhonyAds/acai.html

The verdict? If you like to drink exotic berries for the taste, there’s no problem with indulging yourself but if you’re looking for some of these commercial products for bona fide healthcare benefits, require the claims to be backed up by randomized, double-blind placebo controlled clinical trials, with full disclosure of side effect profiles experienced by the human subjects.

(…and if there is really some miracle plant bearing amazing therapeutic properties, the pharma companies would outrun anyone to isolate the agents, synthesize/mass produce, and submit it through the proper legal govt channels for commercialization! that was how we got cancer drugs from the pacific yew tree.)

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

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”?

“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.

Jane Chin’s Profile

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.

Yvette at 9:03am April 30
Seems to me advertising is fulfilling the monetary power urge of those it serves – that seldom being the public. I find there to be little by way of serious ethical factoring at play in either advertising or the broad range of medical/pharmaceutical relating. My sister at one time in her career was a pharmaceutical rep! The practices troubled me … Could anyone seriously argue that it is other than mostly about the almighty $$$?

Jane Chin at 9:07am April 30
I have no problem with ppl making a ton of $$ when done in a responsible (i.e. true needs-based) manner esp. when health and human lives are involved. Also, it is because I STILL respect the ethical intent, or claims to “want to do best for patients”, of pharma execs that I know they can DO BETTER in this area.

Dmitriy Kruglyak at 9:10am April 30
Nobody is forcing anyone to buy what ads are selling. As far as the types of ads that do create demand for
*products* they are still merely fulfilling demand for solutions to problems, whether real or perceived. I think anti-marketing campaign has gone too far.

Jane Chin at 9:15am April 30
That is the same argument I’ve heard from a pharma executive who wanted to engage in what I saw as illegal off-label promotion. “No one is forcing these doctors to do these ’studies’. No one is forcing these doctors to write drugs for these off-label uses.”

Of course no one is forcing anyone to do anything. That’s why it’s great to be in the US, where we have free will, and where some of us know how to manipulate free will for their own gain.

I can see how anti-marketing campaigns can go too far. I can also see how the “non-force” argument is over-used in pharma marketing.

Yvette at 9:38am April 30
Perhaps Dmitriy. As a consumer, however, my take is rather anti-marketing overall. I remember when all the pharma commercials began to come on the scene – there was often no mention for what particular ailment the drugs served – curious – so what? – a peculiar sense of some looming need for a drug to fix??? Just an open advert for a pharmaceutical product. Now at least all the ads I see direct you to their target dysfunction.

I am encouraged by your faith in the “ethical intent” of pharma exexs Jane – yet I am still of the opinion that we are subject to advertising overload – to what avail? Our better interests? I think not. Creating demand – I find myself more in agreement with.

Dmitriy Kruglyak at 10:57am April 30
Jane: My argument has nothing to do with off-label promotion, let’s not confuse these issues. Yes, I believe freedoms we (still) have in America are precious and deserve to be celebrated. The info is out there and people can decide.

Yvette: If you do not like marketing, you can ignore it. Why do you want to force your opinion on willing buyers and sellers? If pharmas are such evil profiteers, maybe we should just shut them all down and then die in the next pandemic?

Yvette at 12:31pm April 30
May be that moderation and awareness in all things serves best. Forcing I do not believe I am, offering an opinion, to be sure – as an individual who has made observations and who feels a right to speak of things such as the concerns of profit over welfare. Ignoring serves at times. Yet sometimes, alternate options
serve more useful ends.

Dmitriy Kruglyak at 1:14pm April 30
Moderation and awareness is all I am suggesting! I would not argue that there is some abuse in health
marketing, but as long as there is no deception and illegal / offlabel uses, I do not see reasons to spring up restrictions. Pharmas making profit? I am glad they are not asking for bailouts! I grew up in USSR and with their socialism and “no profit motive” (e.g. no incentive to be productive), they had constant shortages of even most basic medications.

Jane Chin at 1:19pm April 30
We absolutely should be making profits (i.e. any commercial/biz entity hanging a sign as a business entity has the obligation to do so). I’m also not suggesting restrictions, that would be antithetical to what I value more (freedom of speech). However, commercial speech is regulated speech where product claims and representation is concerned.

I think what we’ve done here in this “short” dialog is what I want to see more of. Therefore, I’m a big supporter of both pharma detailing and counter-detailing.

Dmitriy Kruglyak at 1:30pm April 30
Yup and thanks to you Jane for kicking it off!

I find it unfortunate that a lot of public discourse about pharma marketing is highly adversarial. There is too much presumption of guilt and assumptions of the worst motives. With this new “regulate everything” attitude in DC in my opinion this is outright dangerous, which is why I believe in … Read Morespeaking up about this and testing both pro and con arguments.

A good example is recent FDA’s action on search marketing, which in my view was harmful. In case you care, here is the blog I wrote about it: http://bit.ly/8y4SZ

Yvette at 1:32pm April 30
“Commercial speech is regulated speech …” precisely. Ethical profit and responsible business practices, a
useful end. Everyone benefits.

Jane Chin at 1:37pm April 30
You’re welcome Dmitriy.

Yvette, I have ulterior motives for wanting the selection pressure to come from “ethical profit-making”. Because this will force innovation. i.e. you can’t count on manipulating to make more $ than the true needs of the disease state, which means you’d better start innovating on the science or on business processes/practices and improve profit margins there.

Dmitriy Kruglyak at 2:07pm April 30
IMHO, science and marketing should not be adversarial either. Even the most innovative breakthrough has to be marketed to succeed. Ironically, many of the marketing restrictions that are being proposed can harm such innovations.

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.

Let’s take the trend of “personalized medicine” to start. Yes, gene-based and protein-based medicines sound alluring. We talk about targeted therapies like they’re silver bullets against deadly diseases, when we still don’t know of the long term effects of many small molecule and biologics as medicines.

All that talk about personalized medicine and how wonderful it would be if we were to have drugs tailored for us? We’ve been doing that for years!

Yet pharma has been providing a level of “personalized” medicine for years, which has created its reputation as a greedy industry with “mediocre” innovation as perceived by its critics.

Critics ask why we need yet another statin? Do we really need to have that many antidepressants in the SSRI class? How many more erectile dysfunction product ads can we endure? Should we blackbox all the glitazone drugs?

We can apply the “personalized” medicine argument to these so called “me-too” drugs reviled by academics and consumer watch dogs. We do need that many statins, because a patient may tolerate atorvastatin better than rosuvastatin. Someone’s life may be saved by paroxetine even when their depression symptoms didn’t respond well to sertraline.

But all this comes at a cost, because of the fundamental reality that personalized medicine requires segmentation of patient types to the point where what used to be ‘blockbuster marketing” is becoming “specific patient population/niche marketing”.

Truthfully, pharma marketers don’t like that. The return on investment isn’t as impressive. Investors on wall street are more impressed by blockbuster numbers than special patient populations. Executives don’t get as big of a bonus at the end of the year. Ad agencies don’t get as many multi-million dollar contracts for celebrity ads or computer graphic-generated creatures talking about allergies.

So the first shift requires pharma companies to begin training their marketers and sales teams to view patients as patient groups with specific tolerances and response profiles rather than a faceless generic group from which blockbusters are created.

This shift in marketing thinking, however, is going to take a while.