Tag Archives: pharmaceuticals

Reading Notes #2 (For-profit medicine): Cancer drugs. Expensive doctors. Health care monopolies. Dental care.

fear-of-dentist

Here are more articles of interest I’ve come across recently while reading NEJM, JAMA, and New Scientist. These items all relate to for-profit medicine.

Bulleted titles in the following list link to the individual items below. Under References I indicate the accessibility of articles: OA means open access, $ indicates a pay wall. Note that emphasis in quotations has been added by me.

FOR-PROFIT MEDICINE

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When health was something we could simply “forget about”

get-well-soon

I came across the following sentence in The Positive Thinkers, a book originally published in 1965. It strikes me as a good example of how the meaning of health has changed. (emphasis added)

Health is ordinarily regarded — when it is “regarded” at all, for ordinarily the point of being healthy is to be able to forget about it — as a means to other things; healthy men are those able to pursue their ends.

Health is hardly something we’re able to forget about today. We live in a culture where it’s commercially profitable to constantly remind us of widespread, proliferating risks. The conscious, highly intentional pursuit of health is a mark of social status for which we expect to be admired and envied. We “regard” it all the time. Read more

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Medical screening, overdiagnosis, and the motives of for-profit hospitals

Image by @spleenal (Nigel Auchterlounie), who blogs at Spleenal
Image by @spleenal (Nigel Auchterlounie), who blogs at Spleenal

[I don’t seem to be able to display that image anymore, but here’s a link to what I’m talking about.]

This superb graphic was created to dramatize what’s happening these days in the UK, where the National Health Service is being ruthlessly privatized. Here in the US, for-profit medicine is so taken-for-granted that we barely notice it. It’s true, we hear a good deal about conflicts of interest involving pharmaceuticals. Doctors get paid — in one way or another — to increase the profits of Big Pharma, a practice that is detrimental to the financial and/or medical interests of their patients. We hear less about scaring healthy patients into using doctors and services that increase hospital profits (also known as fear mongering). So it was nice to see a recent opinion piece in JAMA that discussed precisely this. Read more

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Journal of the History of Medicine and Allied Sciences – July 2014

adelle-davis-books

In the July issue of Journal of the History of Medicine and Allied Sciences:

  • A comparison of 19th century public health measures and the contemporary approach to the AIDS pandemic
  • The conflict between the medical profession and religion in their attempts to portray habitual drunkenness
  • The understanding of dementia paralytica in the Netherlands at a time when psychiatry was attempting to establish itself as a medical profession
  • Adelle Davis’ role in creating the ideology of nutritionism.

There’s also a commentary on the Adelle Davis article, an ‘In Memoriam’ for Sherwin B. Nuland, and reviews of ten books (of which I’ve featured here only two).

Thanks to h-madness (a great blog) for bringing my attention to this new issue. Somatosphere (a most excellent blog — highly recommended) often covers this journal, but I haven’t yet seen the July issue there, so I’ll go ahead and post these abstracts. Note that all articles (other than their abstracts/extracts) are behind a paywall. (emphasis added in what follows) Read more

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The Journal of Medicine & Philosophy – June 2014

cognitive-enhancement

The theme of the June issue of Medicine & Philosophy is disagreements among bioethicists. This is an interesting topic in its own right (see the extract from the Introduction to the issue below), plus there are a few articles that especially appealed to me. The discussion of cognitive enhancement appears to argue for a more tolerant attitude toward enhancement drugs based on an attitude of humility, plus toleration and transparency. There’s also an article that points out how we assume the art of clinical medicine is an innate skill and that, as a result, we fail to teach it.

Note that nothing is this journal is open access (and also that I have added the emphasis).

Introduction

Bioethics and Disagreement: Organ Markets, Abortion, Cognitive Enhancement, Double Effect, and Other Key Issues in Bioethics

Victor Saenz

I. BIOETHICS AND DISAGREEMENT

Bioethics was born in the 20th century out of an attempt to cope with rapidly and radically developing medical technologies, especially as they arose around the time of the Second World War. Albert R. Jonsen, one of the founders of bioethics, writes in reminiscence:

New techniques, from antibiotics to transplanted and artificial organs, genetic discoveries, and reproductive manipulations, together with the research that engendered them, presented the public, scientists, doctors, and politicians with questions which had never before been asked. (Jonsen, 2000, 115; cf. Jonsen, 1998)

But more importantly, bioethics arose as well due to major cultural changes that marginalized previous approaches to moral issues in health care and that brought into question medical ethics as an enterprise grounded in the medical profession. Read more

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Drug shortages: “We are talking about people’s lives; this is not a cell phone contract”

iv-fluidThe shortage of pharmaceutical drugs is a serious problem in the US. The number of drugs in short supply has tripled since 2007. In an article in The New York Times, Sabrina Tavernise reports that the number of drugs in short supply in 2012 was 456.

The types of drugs affected cover a very wide range and include such things as cancer drugs and nitroglycerine used in heart surgeries. The situation is quite disruptive for hospitals, doctors (especially oncologists), and patients.

IV fluid shortage threatens patient care

This year, in addition to drug shortages, there is a nationwide shortage of IV fluid. Intravenous therapy is essential for treating dehydration and electrolyte imbalances, for blood transfusions, and for delivering medications such as those used in chemotherapy. IV fluid is a hospital staple.

A recent JAMA article quotes Erin R. Fox, director of the Drug Information Service at the University of Utah in Salt Lake City: (emphasis added in the following quotations)

“It’s maddeningly frustrating that we don’t have these basics.” … Fox said that although shortages of drugs, particularly sterile injectables, have become common in recent years, it is unheard-of to have a shortage of such a basic supply. …

Why is the supply chain so fragile that it creates a national crisis? asked Fox. …

“Physicians, nurses, and pharmacists are working together to minimize the harm to patients, but it is really a challenge,” she said.

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Pharma finds creative new ways to be reprehensible

brand-vs-generic-drugsThe pharmaceutical industry is in the business of making profits. It’s not in the business of improving the health of individuals or populations, nor does it care about the cost of health care, even as those costs spiral out of control in the US.

This is hardly news, I know. The behavior of pharma, along with its reputation, has perhaps sunk lower than that of the tobacco industry. Public disapproval and huge monetary fines for illegal activities have no impact. In its quest for profits, pharma finds creative new ways to sink to ever greater depths.

An article in a recent issue of The New England Journal of Medicine illustrates this. Read more

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Profit-driven medicine: Satisfying patients at the expense of their health

Why would patients who report greater satisfaction with their health care be worse off medically? This JAMA article, Patient Satisfaction & Patient-Centered Care: Necessary but Not Equal, offers an explanation that makes sense. It points to the commercialization of health care – treating the patient as a consumer – as the villain. (All quotations in what follows are from this article.)

The patient (consumer) satisfaction survey

In the US, many doctors are evaluated and rewarded based on patient satisfaction surveys. Motivated to produce high patient satisfaction scores, doctors are inclined to order more diagnostic tests. Why? It’s more than a simple desire to please the patient.

When physicians’ performance evaluations and incomes are tied to patient satisfaction, the situation becomes ripe for overuse and misuse of diagnostic and therapeutic procedures because it allows the physician to rationalize decision making in terms of patient satisfaction.

Pleasing a patient is a conscious, individualized choice. Rationalized decision making can easily become an automatic habit that requires no additional thought. Read more

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (4) The abnormal part

Abnormal psychologyContinued from parts one, two, and three.

A year ago, when I decided to call my declining rate of blogging a ‘sabbatical,’ I wrote down some questions to explore while I took time off to read.

How did we find our way into the dissatisfactions of the present – the commercialization of medicine, the corporatization of health care, the commodification of health? Does understanding the path we followed offer any insight into finding a better direction? Was the increasingly impersonal nature of the doctor-patient relationship inevitable once medicine became a science? Or was it only inevitable once health care emphasized profits over patients and the common good?

At the time I thought I would read primarily in the history of medicine, and that was how I started. Appreciating the historical context of medicine is important for understanding both how medicine ended up where it is today and what medicine could become. “The texture and context of the medical past provide perspective, allowing us to formulate questions about what we can realistically and ideally expect from medicine in our own time,” I wrote.

Now that I’ve become more familiar with the social determinants of health, I’m less optimistic about the future. The problem is not simply that the corporatization of health care has increased dissatisfaction among both doctors and patients. The problem is that our focus is so narrowly limited to health care systems that we fail to see the larger issue. As one metaphor puts it, doctors are so busy pulling diseased patients out of the river, there’s no time to look upstream and ask who’s throwing the bodies into the water. Read more

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (3) Connections

Continued from parts one and two, where I defined the terms used in the following diagram of my blogging interests. Click on the graphic for a larger image.

Blog topics and their connections

If I had written the previous two posts a year ago, I would have realized how much my interests were intertwined. I guess I wasn’t ready to do that. Anyway, in this post I catalog some of the connections.

Healthism

~ Healthism and psychological and physical conformity: Healthy lifestyle campaigns promote an ideal way of life that encourages individuals to alter their behavior and appearance. Although it’s true that we would all be better off if we didn’t smoke, that doesn’t make anti-smoking laws any less authoritarian, i.e., requiring conformity (see the section on anti-authority healthism in this post). The fitness aspect of healthy lifestyles promotes the desirability for both men and women of acquiring (i.e., conforming to) specific body images.

“Self-help is the psychiatric equivalent of healthism.” That’s a slogan I made up. I’m not sure yet if it will stand up to scrutiny. Certainly the self-help industry encourages self-criticism, which leads to a preoccupation with those aspects of personality currently considered undesirable. Read more

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (2) Economics & the socio-political

Continued from part one, where I discussed the first three of my six interests: healthism, medicalization, and psychological and physical conformity. Click on the graphic below to see a larger image.

Blog topics and their connections

The social determinants of health

Social determinants of health (often abbreviated SDOH) refers to unequally distributed social and economic conditions that correlate with unequal and inequitable distributions of health and disease. Presumably there is a causal relationship between the two, not merely a correlation. Definitively identifying the causal mechanisms, however, is difficult. A great many things influence our health (including things we’re not even aware of yet), and it can be difficult to isolate and scientifically study some of the ones we strongly suspect, like poverty, isolation, or a sense of being socially inferior.

The medical model is the preferred framework in modern westernized societies for explaining the distribution of health and disease. It emphasizes risk behavior (smoking, diet), clinical risk factors (blood pressure, blood sugar, cholesterol levels), genetics, health care access and quality, behavioral change, and patient education. One common characteristic of the medical model’s explanation of health and disease is that causes are located in the individual (behavior, genes), not in the individual’s economic and social environment. Read more

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On healthism, the social determinants of health, conformity, & embracing the abnormal: (1) Bodies, minds & medicine

It’s always hard to be sure about these things, but I think the reason I decided to take a ‘sabbatical’ from blogging last July was that I was interested in too many seemingly unrelated topics. Writing about all of them left me feeling like I never got to the ‘meat’ of any one of them. And I couldn’t convince myself to focus on just one or two things, since that would mean abandoning the others, which I was unwilling to do.

Now that I’ve taken the past year to read and reflect, I find – duh! – that my interests are not as unrelated as I’d assumed. In hindsight, I should have realized this long ago, but, alas, I did not. I’m writing this post to clarify to myself what I now see as the common threads that connect my interests.

Here is a diagram that groups my interests into six categories. (Click on the graphic to see a larger image.)

Blog topics and their connections

Four of the six categories relate to all five of the others. The two outliers (neoliberalism and medicalization) are not as directly related as I feel the others are. Read more

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Why is it so hard to reduce US health care costs?

Why is it so hard to reduce US health care costsProfessor Victor Fuchs and Dr. Arnold Milstein, both of Stanford University, have an article in a recent issue of The New England Journal of Medicine that asks: Why is it so difficult to reduce health care costs in the US? The article is available in its entirety online, but for those short of time, here’s a concise (and depressing) summary.

The graphic accompanying the article is dramatic in its simplicity. Health care spending in the US is 17% of GDP. In other developed countries (Western Europe, Canada, Australia), the number fluctuates around 10%. And yet life expectancy in the US is the lowest of these countries – almost four years below that of the number one country.

We know that some physicians and health care providers manage to operate at less than 20% of the average cost of care, without sacrificing quality. If everyone followed their example, the US could save $640 billion a year (US health care costs for 2008 were $2.3 trillion). Why doesn’t that happen, or as Fuchs and Milstein put it: “Why don’t cost-effective models diffuse rapidly in health care, as they do in other industries?” The answer comes down to perceptions and behaviors. Read more

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Can pharmaceutical drugs benefit society?

Goethe quotation: Whatever you can do ...Here in the US, we’re apt to hear about the British health authority NICE (National Institute for Health and Clinical Excellence) when a stage-four cancer patient makes a desperate appeal for access to an expensive drug not in the approved formulary. The British system has been characterized as rationing, and conservative US politicians like to use such incidents to argue against “socialized” medicine, which will surely do away with Granny before her time is up.

There are big changes currently underway in the British health care system, and NICE will actually be replaced by a different decision-making process in 2014. Although health care reform in the US (the Affordable Care Act) rejects the British model, a recent article in the New England Journal of Medicine suggests there’s much we can learn from the British experience.

Why not design drugs to have wider societal benefits?

Of particular interest is the concept of the social value of drugs. The idea is that if a drug demonstrates “wider societal benefits,” the British government would be willing to pay more for the drug. Presumably this financial incentive would lead the pharmaceutical industry to invest more heavily in products with a high value to society.

What might these values be? In discussions of how the new system would work, the only example provided is drugs that benefit the care-takers of patients. The article’s authors, however, suggest a few more: “narrowing health inequalities, advancing children’s life prospects, reducing burdens on social services, increasing tax revenues, and decreasing workforce absenteeism.” Read more

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From healthism to overdiagnosis

H Gilbert Welch OverdiagnosedIn his new book, Overdiagnosed: Making People Sick in the Pursuit of Health, Dr. H. Gilbert Welch enumerates how the cutoff points that determine whether a patient should be treated for a disease – diseases such as high blood pressure, diabetes, osteoporosis — have been creeping inexorably lower over the years.

Take diabetes. The cutoff point used to be a fasting blood sugar level of greater than 140. In 1997, the number was lowered to 126. This immediately created 1.7 million new diabetes patients.

In a highly publicized study that began in 2003, one group of patients with type 2 diabetes received “intensive therapy” to make their blood sugar “normal.” The control group – the other half of over 10,000 patients – received treatment to lower their blood sugar, but not to the new normal level. The trial was stopped in 2008 when it became clear that there was about a 25% increased risk of dying for the intensive therapy group.

Dr. Welch’s comment on this: “If it’s not good to make diabetics have near normal blood sugars, then it’s not good to label those with near normal blood sugar diabetics. Why? Because doctors will treat them. People with mild blood sugar elevations are the least likely to gain from treatment – and arguably the most likely to be harmed.”

High blood pressure (hypertension) was also redefined in 1997. Instead of the cutoff points being 160 systolic over 100 diastolic, the numbers dropped to 140 over 90. This created 13.5 million new patients.

The definition of high cholesterol (hyperlipidemia) changed following a 1998 clinical trial. The definition of “abnormal” total cholesterol fell from 240 to 200. This created 42.6 million new patients, an increase of 86% over the previous number of patients.

It’s the same with the definition of osteoporosis. A bone mineral density X-ray produces a T score. It’s a way to compare an individual’s bone density to what’s considered “normal.” For women, normal is defined as the bone density of an average white woman aged 20 to 29 (a T score of zero.) If your T score is less than zero, it’s assumed you have an increased risk of fracture.

In 2003 the definition of osteoporosis changed from having a T score less than -2.5 to less than -2.0 (i.e., closer to normal). This created 6.8 million new patients, an 85% increase in those now eligible for treatment with drugs that turned out to have significant side effects – as virtually all drugs do. Read more

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Are the most heavily marketed drugs the least beneficial?

Prescription drugs symbolIn a perfect world, doctors would not prescribe – and patients would not take – drugs that do more harm than good. But it’s complicated. The benefits and harms of drugs are determined in randomized, controlled clinical trials. For many reasons, the outcomes of such trials may not provide doctors with the information they need to decide who should take what.

For example, harmful effects (like death) may not show up during the limited time span of a trial. Data from trials may be selected – and other data ignored — to produce positive results. This is apt to happen when clinical trials are conducted by the pharmaceutical industry, rather than by economically disinterested parties, such as the NIH or independent academic institutions. Also, the participants in the trial may differ significantly (in age, gender, and health, e.g.) from patients who end up taking the drugs. As a recent article in JAMA put it, “most clinical trials fail to provide the evidence needed to inform medical decision making.”

The Inverse Benefit Law

If you follow pharma news, you will have noticed that many high profile, aggressively marketed drugs turn out to be either ineffective or positively dangerous (think Vioxx, widely prescribed for arthritis, which turned out to cause heart attacks and stroke). Howard Brody, MD, and Donald Light, PhD, have proposed an explanation for this phenomenon. They call it the Inverse Benefit Law: “The ratio of benefits to harms among patients taking new drugs tends to vary inversely with how extensively the drugs are marketed.” Or (for those who feel fuzzy about inversion): The more aggressively a drug is marketed, the more likely the drug will cause harm, be ineffective, or deliver little by way of benefit. Read more

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Complaints about pharma go way back … to ancient Rome

History of pharmacyOne hundred years ago, editors of The Journal of the American Medical Association voiced their complaints about “pharmaceutic” problems. In particular, they objected to proprietary remedies (compounds with secret formulas), the inappropriate substitution of one drug for another, counterfeit drugs, and flowery but meaningless names that served only to increase the popularity of a drug.

According to the anonymous editors, these practices were in fact nothing new, but could found in descriptions of the ancient Romans.

Pliny the elder (first century AD) complained that physicians of his time used remedies that had already been prepared, thus saving the time it would take to prepare them. A historian (Ludwig Friedlaender) writes of the Romans: “[O]ften the physicians did not know the exact ingredients of the compounds that they used and should they desire to make up written prescriptions, would be cheated by the salesmen.”

Pharma reps less than totally forthcoming? Hmmm.

In the second century AD, Galen also complained of physicians who used “ready-made” medicines. Both Galen and Pliny believed prescriptions should be carefully prepared by physician’s themselves, or at least under their close supervision. But no. Some doctors simply followed the line of least resistance and abdicated this most important function. Surely this brought harm to both patients and the physicians themselves. Read more

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Overdiagnosed and overprotected children

Helicopter parentsThere’s been much discussion for years now on whether children are overmedicated for behavioral problems. A very thoughtful report was just published by The Hastings Center: “Troubled Children: Diagnosing, Treating, and Attending to Context.” It asks the underlying question: Are increased rates of diagnosis and treatment with drugs appropriate or are healthily children simply being labeled as sick and given drugs to alter their moods and behavior? (The report is available online as a PDF file.)

With that on my mind, I was struck by a comment from Tanya Byron, an English psychologist, writer, and child therapist,

[W]e have to really listen and think about why a child is telling us something. The behaviour of children and young people is fundamental to a well-functioning society, because they can tell us what is going on more honestly than we tell ourselves.

If there really is an increase in mental disorders among children, what does this tell us? If there isn’t, what does giving psychopharmaceuticals to four-year-olds tell us about ourselves? And could we be honest about what it says?

Stigma: We are afraid to lose the competition of life

Byron also made a good point about the stigma of mental health: (emphasis added in the following quotations)

[I]t would be helpful if we could accept that mental illness and physical illness all lie on a continuum, and sometimes bits of our physical body don’t work very well, and sometimes bits of our mental body don’t work very well – and that that’s OK, and it’s actually not an indication of failure. If you break your leg, you are not going to suddenly be seen as less successful than you were before you had broken your leg. So why do we have this stigma around mental health?

… We are scared of people seeing us as somehow not the person they thought we were, as if life is a competition and the only way that you win it is by being completely invincible and robust and never being fragile or vulnerable. That is just ludicrous. That is why I like kids: because they remind us that life really isn’t like that.

On not letting children be children

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Robots dispense drugs and remove prostates

UCSF robot pharmacyEric Schmidt, chairman of Google, speaks of the “age of augmented humanity.” If we let computers do the things they do well, this will free up humans to be better at the things they do well. “The computer and the human each does something better because the other is helping.”

A win-win use of automation appears to be dispensing drugs in hospitals. The University of California, San Francisco (UCSF) has a team of robots that fills prescriptions for its medical center. Orders are submitted electronically. The drugs are retrieved from a secure, sterile environment. The dosage is as exact as a computer is logical. Medications are packaged for each patient – even assembled into 12-hour packets for the day. This eliminates possible errors by both pharmacists and nurses.

According to UCSF:

By using robots instead of people for previous manual tasks, pharmacists and nurses will have more time to work with physicians to determine the best drug therapy for a patient, and to monitor patients for clinical response and adverse drug reactions.

The dean of UCSF’s School of Pharmacy concurs:

The beauty of this robotic pharmacy system is that the pharmacist is taken out of that mechanical aspect of pharmacy practice, and they can use their intellect to be sure that the patients at the bedside are getting absolutely the right medicine.

It’s sort of like using scanners to buy groceries or to check out books at the library. It may put some people out of work, but hey. That’s the price we pay for the age of augmented humanity.

This video of the robots in action is actually quite good. Read more

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The unavoidable and burdensome responsibility to be happy

Victoria Huggins American IdolI came across this photo of Victoria Huggins, of American Idol fame, while searching for an image of an annoyingly cheerful person. It was on a relatively new blog called Media Studies, written by Andover media student (I presume) Kristina.

Kristina describes Victoria as “Possibly the most annoyingly loud, optimistic, cheerful person you will ever encounter. With an incredibly high-pitched, overly exaggerated Southern accent and a specialty in church music, she is the poster child for America.”

Fortunately, I missed the episode of American Idol when Victoria appeared and was promptly eliminated.

Another post on Kristina’s blog caught my attention, as the subject is close to my heart: How media/advertising images of the ideal body have … how shall I put this … messed us up. She comments on how her college-age contemporaries found the cast of MTV’s Skins so ugly they couldn’t watch it, when these young people are in fact – Kristina says — uniquely attractive. I agree. (Click here for image.) Kristina’s comment:

What is beauty anymore, anyway? What have you done to our standards? You have raised them to an impossible high that will never be met without a computer unless eating disorders and cancer-causing beauty products become common practice.

Precisely.

Anyway, all this by way of introducing the following video. It’s been around for a year, but I just discovered it (thanks to Psychiatric Times). It comes from The Onion and has had a million and a half viewers on YouTube. Production level is high, as is the humor level. Read more

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Sex, lies, and pharmaceuticals

Sex lies and pharmaceuticals Ray MoynihanJust a quick word in reply to a review of Ray Moynihan’s Sex, Lies, and Pharmaceuticals: How Drug Companies Plan to Profit from Female Sexual Dysfunction (co-authored by Barbara Mintzes).

First, the reviewer, British sociologist Linsey McGoey, criticizes the book for continuing its attack on the medicalization of life.

A few pages in, it’s hard not to feel déjà vu. Moynihan came out a few years ago with Selling Sickness, a book tackling the problem of medicalization, the tendency for typical life phases or human behaviour such as shyness to be medicalized – treated as disorders and diseases requiring medical treatment.

IMHO, there can never be enough books educating the public about medicalization.

Next she defends the pharmaceutical industry:

They [the authors] want to condemn [the pharmaceutical] industry for preying on human insecurity and profiting from the oldest adage in the book: Sex sells. The problem is, just as Viagra has been embraced by millions, its pink equivalent would be a sure seller – and not because consumers are dupes, or because industry is inherently malevolent, or because doctors are in the pockets of companies. Sure, some are, but such a thesis always oversimplifies the links between human disease and human desire. Most of them [sic] time, people want to be told that a problem is medical in orientation. It helps to exonerate a sense of personal blame.

Eliminating a sense of blame or shame is exactly the tactic pharmaceutical marketing employs. (See How the pharmas make us sick.) Viagra has been embraced by millions because ED has been medicalized! I was just reading about a “renegade” Canadian doctor who’s quoted on the subject: Read more

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Chocolate has antioxidants but is that a good thing?

Chocolate antioxidants Valentine's dayChocolate is a perennial favorite as a health topic. Readers are eager to learn of medical research that justifies something they want to do anyway.

WebMD recently ran an article called “Is Chocolate the Next Super Food?” The excuse for this particular article was a study that found the antioxidant activity of dark chocolate was higher than that of various “super” fruits (blueberry, acai, cranberry, pomegranate).

The article’s very last paragraph did mention — very casually — that the number of calories and fat grams in a serving of dark chocolate exceeds those of fruit juice. There was nothing but praise, however, for the ability of the antioxidants in chocolate to fight free radicals. The wisdom of the widespread consumption of antioxidants has recently been questioned. Getting the word out on that subject may prove awkward for WebMD, a site littered with ads for antioxidant supplements.

Free radicals fight toxins and cancer

Health and science journalist Sharon Begley had an excellent article on antioxidants and free radicals – “Antioxidants Fall From Grace” – in a recnt Newsweek. (emphasis added) Read more

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The ethics of a neuroenhanced future

NeuroscienceImplementing the discoveries of modern brain science raises ethical issues. For example: (emphasis added)

Issues of personhood and authenticity, for example, have become hotly debated among neuroethicists as pharmaceuticals developed for improving mental health disorders, sleeping disorders, or attention disorders in children are now being consumed at high rates as off-label “cognitive enhancers” to boost mood, memory, and alertness. If these drugs, or substances like oxytocin, become the Viagra of daily functioning and create new benchmarks for productivity, wakefulness, and emotional love, what will happen to the fabric of society and the character of our interactions with one another? Are these altered states a genuine reflection of a new and improved “me” or “we”, or some transient drug-induced condition that thoroughly confounds what we inherently value? Will we be coerced into conforming to a wave of drug intervention in the ever expanding, do-it-yourself, self-help world? The race for cognitive enhancers poses questions of social justice as well. Will the opportunity gaps between those who can afford them and those who cannot be widened or narrowed?

[H]ow shall scientists, physicians, legal scholars, policy makers, and society at large manage new tests that may soon be able to forecast with acceptable reliability unacceptable levels of risk for aggression, sociopathy, psychopathy, and suicide?

With advanced capabilities, will an integrated understanding of the genetics and brain biology of these conditions [Alzheimer’s, schizophrenia, addiction, anxiety, stress] … plunge those affected into fatalistic states of hopelessness out of which they feel they cannot ever emerge?

Entrepreneurs will surely lose no time in selling the technology directly to consumers who may be curious for what they interpret to be a neurogenetic signature or fearful about their neurogenetic status. What, and how much, would you want to know? At what personal and financial cost?

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Andrew Wakfield: The integrity and validity of science

Andrew WakefieldAndrew Wakefield has received a great deal of negative publicity over the past few weeks, ever since journalist Brian Deer, writing in the British Medical Journal, presented evidence that Wakefield faked the data in his study linking the MMR vaccine to autism. Deer also made the case that Wakefield’s motive was financial gain: Wakefield was employed by a lawyer who planned a highly lucrative lawsuit against vaccine manufacturers and investors were promised millions.

Wakefield has publically responded to the charges. In a story from Bloomberg he asserts that his study was “not a hoax.” He also says: “I have lost my job, my career and my country.”

Given the stressful nature of Wakefield’s situation – some accuse him of a moral crime, others feel he should be prosecuted – it’s both eerie and fascinating to watch him defend himself. He appeared on “Good Morning America,” where he was interviewed by George Stephanopolous. In that interview, Wakefield claims his accuser committing a fraud by selectively omitting data.

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Atypical antipsychotics: Overprescribed, not safer, not more effective

Atypical antipsychoticsAbilify, Seroquel, Zyprexa, Risperal – these are among the atypical antipsychotics for which Americans paid $10 billion in 2008. $6 billion of that was for off-label use.

The FDA only approves drugs when their safety and efficacy have been tested for specific conditions. For example, an antipsychotic might be approved for the treatment of schizophrenia. When it’s prescribed for anxiety or depression, that’s an off-label use.

After heavily marketing off-label use, the makers of Zyprexa, Seroquel, and Abilify were fined a total of $2.3 billion for their defiance of FDA regulations. For the pharmaceutical industry these days, that’s just part of the cost of doing business.

This new generation of atypical antipsychotics is much more expensive than earlier drugs, which are now available as generics. According to a new study, they are not only more expensive. They are neither safer nor more effective than their predecessors, as initially assumed. Here’s what WebMD had to say. (emphasis added)

“Atypical agents were once thought to be safer and possibly more effective,” says study researcher G. Caleb Alexander, MD, an assistant professor in the department of medicine at the University of Chicago Hospitals. “And what we’ve learned over time is that they are not safer, and in the settings where there’s the best scientific evidence, they are no more effective.” …

“Since there were all these new drugs, and it costs 700 to 800 million to bring a drug to market, drug companies needed to make that money back,” says Jeffrey Lieberman, MD, chairman of the department of psychiatry at Columbia University, who was not involved in the study. “These drugs were marketed aggressively.”

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Prescription drug abuse and the Osbournes

Legal drug abuse car crashI remember a scene from The Osbournes where son Jack, recently released from drug rehab, talks about finding a few stray particles of OxyContin dust in his pocket. He immediately consumed them as if his life depended on it. The craving was overwhelming. His description made the feeling of addiction palpable. Read more

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How Big Pharma plans to stay big

The days of exponential growth for the pharmaceutical industry are past. Sales growth has been leveling off since the 1990s. Companies simulate growth by buying smaller companies and firing employees. What will Big Pharma look like as it moves into the future? FierceBiotech provides a summary of a forecast offered by industry expert, Steven Burrill.… Read more

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Novartis gender discrimination verdict: Guilty as charged

The Novartis gender discrimination trial has concluded, and damages have been awarded to the plaintiffs. Novartis must pay $3.4 million in compensatory damages and $250 million in punitive damages. Highlights of the trial’s testimony included the behavior of one manager, Brian Aiello, who asked female sales reps to sit on his lap while he showed… Read more

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