Readers’ Views on Healthcare

“If I were dictator,” I wrote on Monday, I’d emphasize proper nutrition, I’d tax junk food, I’d slash the budget of the FDA, I’d make the AMA reform, and I’d expect to see the drug industry, the medical device industry and above all the insurance industry shrink and lose power as my focus on proper nutrition took hold.

That column resulted in my heaviest email volume ever and I thank everyone who responded.

In total, 69% of respondents were supportive, 6% were critical, and the remainder addressed other items in the column, mainly American International Group (AIG), which I used as an object lesson of stocks to avoid.

But as several readers pointed out, I forgot one big thing, the need for tort reform!  That alone is worth a whole column, and maybe I’ll do it someday.  But today the words come from you.  Here’s a sampling of the best.

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“Your article was good as far as it went but there was a glaring omission in both President Obama’s and your thoughts. Tort reform will also be necessary as it adds as much as 25% to the cost of medical care because of malpractice insurance.”

R.F.

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“As a medical doctor, I do not understand why allowing practitioners of alternative medicine would benefit the patients. Those who believe in alternative medicine are already seeing these practitioners, who usually have not had much training in science, pharmacology, physiology, immunology, or biology. I believe that inclusion of these groups would actually increase the overall cost since they may actually delay the proper diagnoses with potentially deadly and/or more costly results. The way to reduce cost is to encourage an intellectual instead of a procedural approach.

I agree that health maintenance is far more important and curtailing the obesity epidemic in America should be the first step. Perhaps insurance premiums should be based on one’s waistline. Reinstating mandatory physical education for all students (including college students) will likely encourage more to participate in physical exercise.”

J.T.C., Maryland

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“You are not a dictator and I do not believe that the political will exists to do what you suggest.  As long as we are engaging in wishful thinking, why not try incentives?  Why not require smokers, obese folks and others with abusive lifestyle issues to pay a higher rate for health insurance than those who are not so afflicted or give a discount for those who exercise regularly?  Then the people who are acting responsibly will not get penalized for those who do not. There is some of this done in the case of individual coverage, but certainly not for large groups.  The start of the new system could be deferred long enough to permit people to get their habits and lifestyle corrected.  Incentives might work.”

T.A.H., Highland, Illinois

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“Seems to me health care was much, much better years ago when doctors made house calls and an office visit was less than $5.

“Solution:  I’ll pay for my health care; you pay for yours.

“Remember, if someone else pays for it, people will use more of it.”

R.G., Rolling Meadows, Illinois

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“I have practiced medicine in the USA for over 30 years, but have a home in Canada where I go every summer.  According to the local Canada paper, there is a six-to-nine month wait to have a fractured hip or arm fixed and this one-million people area, a suburb of Vancouver, does not have an orthopedic surgeon who accepts the government payment. First visit for all is $500. My friend paid $5,000 for a cataract operation, after professional discount. The stories could go on for days. ”

“Remember, most of the Russians were “happy” with Communism. Our school system has prepared our young people well for this Obama treat. We should clean our present system here before throwing it away. I priced 30 Augmentin, an antibiotic, at our local drug store, last week, and it was $115. Then I phoned Costco and the exact same prescription was $45. If you want a workable, affordable system a Christian Medical Society member, who works for the government, has one. But, Obama makes no secret that he hates Christians.”

R.E., Saratoga, California

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“Send a copy to Barack. He needs to hear from the rest of us and he wants to do a good job of it.  He is a bright man and has made himself accessible as well as having a transparent government.  I for one believe in him.  And thanks for all your good advice.”

D.R.

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“This is the FIRST VOICE OF REASON I’ve heard on how to fix our health-care system, beginning with what you’ve said about nutrition and preventative health care and through to the last about the health care insurance companies. Now please get Obama’s ear with these ideas.”

Dale

(Note, I did send the column to President Obama, but to do it electronically, I had to trim my 6,700 characters down to 5,000 to get it in his online submission box.  No response yet.)

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“In my opinion, you missed the third leg in this vicious puzzle–lawsuits.  The insurance industry, which never loses long haul; the doctor, who needs to accept pay cuts like the rest of us; and the attorneys, who drive up costs significantly. All need to be regulated to pull the system together … and I hate regulation.  Until this three-legged stool can be controlled, this is another American system that cannot render itself competitive.”

T.D.

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Finally, to remind us all that it is not so simple, comes this well-written letter from an FDA insider.

“While I think many of the proposals under your proposed regime are positive – and achievable through democratic results I might add–your contention about the FDA is both ill-informed and dangerous.

“The FDA has seen its budget cut dramatically in the last eight years while the amount of data they are required to review has mushroomed.  In the late 1980s, the submission for the approval of Fluoxitine, known commercially as Prozac, consisted of 100 bound books of over 1000 pages each.  They were shipped to the FDA in a truck.  Each page of those volumes had to be reviewed and checked for accuracy before it could be voted on for approval.  Today, the data submitted consists of a small package of 50 to 100 DVDs–and the volume of data can be more than TEN TIMES that of a submission made 20 years ago.

“As it stands, the FDA has nowhere near the resources to conclusively check the arguments offered by every company, and this result has not proved positive for Americans.  Pharmaceutical companies have long ago ceased to be run by scientists dedicated to serving doctors and patients.  Though these noble individuals work by the thousands in pharma corporations, their leaders now come from business schools, not medical programs.  Marketing and time-to-market against the competition are enormous forces that now overwhelmingly dictate research and development of medicines.

“The FDA stands as a necessary bulwark between the patient and the market-driven force of billions of dollars in profit that will ABSOLUTELY discount human life when factoring the risk of bringing a drug forward.  This exact phenomenon was documented during the investigation into Merck’s deliberate suppression of safety data during their submission to the FDA for approval of the drug Vioxx.

“Merck’s own studies showed a FOURFOLD INCREASE in the risk of heart attacks while taking their compound but successfully buried the data in the blizzard of information submitted to the FDA.  They also completely withheld this information when they submitted their main study (authored by Merck) to prove the safety and effectiveness of the drug to the New England Journal of Medicine. The journal article, of course, supported what seemed to be positive results.  Unable to comprehensively review the material submitted to them, it’s very likely that the board of the FDA relied on the tradition of rigorous peer review and used the NEJM article as a measuring stick when they moved forward to approve the drug for use.

“Merck made 2.5 billion dollars in one year off of Vioxx.  As many as 10,000 people are said to have died from cardiac events related to use of the drug.

“Now, it does not mean that Vioxx was poison.  It was, in fact, a good and potent medicine for certain patients for whom the risk was appropriate given the extremity of their disease.  But Merck’s sales and marketing unit sought to increase market share into populations for whom this drug was not the only answer–and by no means the safest choice–by misleading doctors into thinking the compound was much safer than it actually was.

“This happened because the people who determine what data gets pushed forth to the public are not the bench scientists or doctors within the company but the sales and marketing executives–a direct result of market forces driving human behavior in a large organization.

“Thanks to responsible doctors gathering their own data in the field, diligent investigation, and no doubt the help of some whistle-blowers, Merck was exposed and admitted publicly that its sales team had been “over-zealous” when informing the public about the drug.

“Use the term “over-zealous” to 10,000 families and see if they think that’s an appropriate term.

“I know about these things because I work extensively with marketing teams at pharmaceutical companies creating materials they use to speak to the community.  Most executives I work with are bright, ethical people.  But NONE of them are doctors and many of them don’t have the scientific education necessary to understand much of what they sell.  And the pressure they face to boost market share is remarkable.  I have watched people I liked personally stand up in front of rooms of doctors and say things like, “we’re going to crush the competition” when talking about drugs for arthritis.  One executive told me his brand plan was to have his drug, a very potent agent for dilating blood vessels, “replace aspirin at every turn, even beyond cardiac cases” five minutes after doctors on his own team said that would never be in a patient’s interest.

“One of the saving graces of my job is that every single word and image has to be formally reviewed by an internal team at the pharma company consisting of at least one doctor, an expert in FDA regulations, and a pharmacist.  What I told the guy who wanted to replace aspirin was, “I’m not sure we can get that one through review, but we’ll bring it forward and see what they say.”  And then when I do go to review, I make sure the committee looks at everything.  In the end, we arrive at a message that strives to communicate the true benefits of the miraculous compounds these companies make, ethically and accurately.

“The reason I have pride in my own work is because I am an ethical person, and I have the review committee to rely on and collaborate with.   But Tim, not everyone thinks like me, and from that, we need protection.  Period.

“The FDA is a slow and cumbersome organization.  It is a bureaucracy in the truest sense.  But it is also the last moment where science is given a chance to have its proper place in the process of approving drugs with accurate labels that will inform doctors and the public about what’s good for them.  To speed its processes we should not weaken it further, but the opposite.

All the best and good luck in your future in theoretical society building.”

S.C., Jersey City, New Jersey