| You don't want to know what I think about healthcare. Honest to god, you don't.
If I told you what I thought, you would crawl under the bed with a binky and a blankie and you would refuse to come out. The system is well and truly fucked and the only thing it has going for it is the people who do the jobs. That is why I think that whatever reform we get this time, people are going to like. And they are going to want more. The general population is going to eventually demand the single-payer, single-chart option that I have.
There is one thing that my healthcare is lacking that I don't miss and you would be better off without: the influence of marketing. There are no drug reps in the hallways of the clinics at Truman Medical Center foisting off drug samples and swag. There is a wall between the medical education going on there and the marketing wizards on Madison Avenue. I have more medical equipment, coffee cups, post-it notes, pens, rulers, coolers, lab coats, nail clippers, mouse pads...you name it...with drug names emblazoned on them in my <1100 sf walkup than you can find in the entire internal medicine department on the fourth floor of the clinic tower. When patients bring up the drugs they have seen advertised, they are gently disabused of the notion that big pharma really has their best interest at heart.
Just one example: Does anyone else think that it is a feature and not a bug in the eyes of big pharma that the side effects of many of the drugs to treat type II diabetes cause weight gain, and reducing ones body mass index is just about the most effective method of dealing with type II?
In no area has advertising been more influential than in the area of hormone replacement therapy for menopausal women, marketed as a panacea for aging women in spite of the risks they pose.
PREMPRO is a combination of Premarin, an estrogen drug derived from the urine of pregnant mares and first approved by the Food and Drug Administration in 1942, with an additional hormone, progestin.
Part of the Premarin saga shows how a drug maker successfully and cannily expanded a franchise whose central ingredient is horse estrogens into a billion-dollar panacea for aging women. Yet several hundred pages of court documents also raise questions about another aspect of Premarin's trajectory: how Wyeth worked over decades to maintain the image and credibility of its hormone drugs even as the products were repeatedly under siege.
Pfizer representatives say court documents paint an unfair picture of Wyeth's practices and that plaintiffs' lawyers have cherry-picked documents for out-of-context comments to sway juries.
Still, the documents offer a snapshot of Wyeth's efforts. Taken together, they depict a company that over several decades spent tens of millions of dollars on influential physicians, professional medical societies, scientific publications, courses and celebrity ads, inundating doctors and patients with a sea of positive preventive health messages that plaintiffs' lawyers say deflected users' attention from cancer concerns.
Even as evidence mounted of an association of the drugs with cancer - first in the 1970s with Premarin and endometrial cancer, then in the 1990s with Prempro and breast cancer - Wyeth tried to contain the concerns, the court documents show. (A note handwritten in 1996 by a Wyeth employee responding to a new report of breast cancer risks associated with hormone therapy said: "Dismiss/distract.")
In 2002, researchers halted the largest clinical trial ever conducted of women's health because participants who took certain combined hormones had an increased risk of breast cancer - as well as a higher risk of heart attack, stroke and blood clots in the lungs - compared with those taking a placebo.
Other parts of the same federal study, called the Women's Health Initiative, later found that hormone drugs increased the risk of dementia in a subset of participants, those age 65 and older.
Now, no one get excited. I am not saying that no one should be on hormone replacement therapy (HRT). Far from it. HRT is a wonderful breakthrough that has restored quality of life for millions and millions of women in the nearly seventy years since Premarin was first approved. HRT is not the enemy. For some women it is the best option. Problem is, it was marketed to all women, and I am saying that the marketing of pharmaceuticals directly to patients is the enemy, and that it should not be a part of healthcare decisions.
Unless you receive your healthcare through one of the existing public options, the chances are really, really good that your relationship with your physician is already influenced by the marketing of pharmaceuticals. It permeates your awareness and chances are at least fifty-fifty that your doctor gets some really, really nice things from big pharma - trips to golf resorts to learn about the latest miracle drug - hell, doctors get unsolicited checks for thousands of dollars from drug companies that come with an unstated but implied quid pro quo that that companies name-brand drugs will be the first that come to mind when the prescription pad comes out.
I am tangentially aware of private practice offices where well over half of all patients are being prescribed a name-brand anti-depressant for an off-label use. "What's the harm?" is the reasoning. The worst that can happen is the patient will feel "better than well" for the course of the drug...unless, of course, they are in that tiny percentage who suffer an organ failure or suicidal ideations because they took a drug they didn't need.
There ought to be a law. But there won't be. And do you know why? Because pharmaceutical corporations write millions of dollars of checks to congress critters, and dead or injured patients don't. And we all know who the fuckers really work for.
That we are not in the streets with pitchforks and torches over that fact says a lot about us, and none of it good. |
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