Tuesday, March 27, 2012
Monday, March 26, 2012
In terms of how to fix the issue of the over-saturation of me-too drugs in the market, it is first important that patients learn about the truth and myths shrouding the generic brand drugs that they buy. While it is not to say that one generic is better than another, at least if the public knew about the attention that is focused on rehashing old drugs rather than coming up with new solutions, it would be able to put pressure on congress to create reforms in legislation. The FDA needs to be strengthened so that it can create checks on the the pharmaceutical industry, and it also needs to create a more stringent regulations on the approval of similar drugs before entering the market. The drug companies need pressure to create and fund more innovative solutions to new problems, instead of coasting and producing similar products for their own monetary benefit.
In The Truth About Drug Companies, Marcia Angell describes how she believes “Big Pharma” is both corrupt and corrupting. The current system of the pharmaceutical industry in America is a failing alliance of medicine, politics, and capitalism. Pharmaceutical companies blame high drug prices on research and development expenses, yet they spend more on marketing old drugs to physicians and consumers than developing new ones. As a result of the amount of money drug companies spend on lobbying Congress, pressuring the FDA, manipulating patents through the legal system to extend marketing rights, and influencing doctors, the consumers are left with disproportionately high drug prices.
The system in place now has also negatively affected the current state of scientific knowledge and development. There is an absence of innovation in the pharmacology field to due to the financial risks involved in the development of a new drug. While national academic and research institutions are often the sites of major intellectual breakthroughs, they often lack the resources to fund the development of a drug or bring it to the market. As a result, outside investments are necessary. There has also been a change in the pathology of disease today. Infections are mostly easy to treat, but it is more difficult to treat diseases that are chronic or accompany old age. Scientific transition must occur between the earlier breakthroughs such as that as antibiotics to new things like anti-cancer agents and gene therapies, a process that “Big Pharma” is hindering.
While there must be changes to the corporate culture that is dominating the pharmaceutical industry that would most likely occur in the legal arena regarding things such as patent rights and bribes, I believe that the creation of an alternative system to the current mode of producing and selling drugs could be a viable solution. I believe that profit and the marketplace should not drive pharmacological discovery and distribution. A parallel system that includes different entities in charge of drug discovery, production of drugs in large quantities, clinical trials to test for safety, and marketing drugs to doctors and the public could possibly decrease the influence of drug companies, thus reducing marketing expenditures and lowering the prices of drugs. However, there are many legal and licensing changes that must be made to sustain such a system. For a long-term solution, I believe that it may be a better idea to create a new, alternative system rather than attempt to make changes to the current system.
Among other things, I thought Peter Conrad’s book was a delightful introduction to how healthcare and medicine are becoming but another American consumer commodity. The factoids concerning the medicalization and practices of pharmaceutical companies appear disturbing and unethical. There is no question that duping the public through the marketing and distribution of drugs is a disturbing occurrence, particularly since health and trusted physicians is involved. But to me these issues merely reflect the American heritage of politics and business. Capitalism and meritocracy both have conflicting interests with the ethical treatment of patients. Universal healthcare contradicts on some level the basic notion relating hard work the allocation of resources among Americans. Most Americans would agree that everyone should have complete and equal access to medical care, but it does not translate so smoothly to our markets. The consumption and sale of pharmaceutical drugs however, fits seamlessly into profit making and capitalist venturing, as apparent by the success of “andropause” medication. Most physicians and studies agree that prescribing testosterone for this unrecognized disorder is questionable, and that progressive androgen deficiency is perfectly natural as one ages. But if there is a market for such products, it is perfectly patriotic for these pharmaceutical companies to advertise and sell them.
It is also disturbing to hear about the gifts and vacations allocated to physicians for prescribing expensive medication, however this is also a problem deeply rooted in our culture and politics. Apart from some silent veil expecting physicians to act devoid of monetary incentives, the current healthcare system has some very distinct routes for medical students to pursue a profit driven career. And after rigorous years in school and graduating with considerable debt, who is to blame physicians for opting for a career in dermatology, a free vacation or Montblanc pens?
In the end, these costs do come out of the pockets of the patients. And this is difficult to face, as on some level they are being manipulated and entering a market they do not fully comprehend. But this is the tragedy of the American consumer across the board. We are constantly being alienated from the true origins and implications of our purchases. When we are buying food for our family, toys for the kids, or pumping fuel into our vehicles. We are kept distanced from intelligent consumerism. This is a particularly complex issue in health, as the theory and intricacies involved in choosing which medicine to consume usually require years of training to fully understand. If we as a nation soldier up and opt for ethical and equal care for patients (which may resolve many healthcare cost issues) we need to decide where the buck stops. I personally believe the political and commercial sectors (i.e. government and drug companies) cannot be expected to make such decisions due to aforementioned American ideals. Medical institutions and education need to instill a sense of greater obligations in physicians, and have a pure emphasis on healing and quality of care. There needs to be a penalty for a system that pays doctors and hospitals set fees for providing services regardless of quality or efficiency, and a discouragement for prescribing profit-driven drugs (such as the propublica information).
Sunday, March 25, 2012
Marcia Angell doesn’t seem too fond of lobbyists, mentioning the pharmaceutical industry’s presence in the lobbying world of D.C. and the conflict of interest that exists when lobbyists are related to members of Congress. Jonathan Rauch coined the term “demosclerosis” in his 1995 book Demosclerosis: The Silent Killer of the American Government to describe the gridlock that lobbyists cause in D.C., likening them to a hardening of the Nation’s political arteries as bills can’t get through with so many interest groups vying for attention from members of the House and Senate. Granted, by the Nownes count there are 85,000 registered lobbyists in D.C. alone, and an estimated 1.2 million nationally, but this really doesn’t tell the whole story.
Here’s the thing about lobbyists: we tend to see them as the source of evil in American politics, but they serve an important role in advocacy and policy-making. In fact, the majority of lobbyists are in the nonprofit sector and don’t see as large of a financial return for themselves or the organizations they represent, as Angell would have us believe. A lot of the representation for and communication with the American public can be attributed to lobbyists—sure, in the case of drug companies there may be some misrepresentation of information happening, but for every big pharma lobbyist, there’s one pushing back from the other side. Because of the connection they provide between the public and government, they are a source of great mobilization, which leads to public opinion and increasing public involvement and action. This ultimately has a hand in effecting policy, which often times works in the public’s benefit. For example, lobbyists were a big motivator in the passing of the Affordable Care Act when Blue Cross Blue Shield jacked premiums up by 39% after the bill seemed dead, helping to channel American’s distress to politicians.
I think Angell presented lobbyists rather poorly, making it seem like the pharmaceutical industry dominates lobbying and has a direct pipeline to politicians, a grand oversimplification of who lobbyists represent. Everyone is represented by a lobbyist—NYU even has a few! So, yes, big drug companies have lobbyists that they send to D.C. to push their products, but just about every other industry does, too. Without lobbyists, we’d lose a connection between the public and the government.
Tuesday, March 20, 2012
Monday, March 19, 2012
These changing definitions have both their positive and negative attributes, as society becomes either more lenient or firmer on what is considered acceptable. As seen in the ADD/ADHD example, consumerism in the health care industry steers the definition of the “disease” from neurological to a wider range of symptoms, thus including more people under the treatment umbrella than previously before.
The consumerism of health care then begs the question of ethics. Is it ethical to have someone take medication for a disease when it is possible that he/she can live a normal life without medical treatment, such as ADD/ADHD? Consumerism in the health care industry, I think, goes against the basic principles of medicine, which should aim at treating individuals, rather than targeting them with advertisements that destigmatize certain diseases, thus making it socially acceptable to receive unnecessary treatments that are covered by medical insurance.
It seems that the medical and pharmaceutical industries have taken on heavily capitalistic undertones, almost mimicking the economic system and values of the United States by providing "consumers" (formerly known as patients) with goods (medications.) Furthermore, many of these drugs, especially the most lucrative on the market, are provided to abate socially constructed "diseases" which undermine culturally defined norms of behavior and gender stereotypes. This concept definitely aligns itself with the social constructivist phenomenon in conceding that most societal values are not innately human but constructed and reflections of a specific culture. This idea is further justified in how familiar/common discussion has become surrounding these "diseases" which once went "untreated" because of their taboo like qualities (i.e- erectile dysfunction, PMS.) Nowadays, discussing menstruation, selling erection pills or advertising for the new and improved bionic penis surgery is common, strewn throughout newspapers, even. It seems as if modern medicalization conveys how society has evolved from one embracing privacy to a more liberal forum. After all, just a few decades ago seeking out and discussing the need for psychological/psychiatric help was unheard of and now it seems everyone has a shrink.
Throughout Conrad's book I found myself continuously asking the same questions. Does modern, evolving medicalization create a better quality of life for our society by utilizing capitalistic rituals within the healthcare system? Or does modern medicalization stigmatize natural occurrences which once went undiscussed for a reason? Is our medical system creating more insecurities for an already vulnerable society?
I found the reading very interesting as it provided a solid background and answered some previous questions of mine. For example, I’ve always been interested in the fact that many drugs are able to be advertised to patients, or consumers, I’m torn between which is the proper term. So, it was useful to read about the increase in the ability for pharmaceutical companies to advertise directly to consumers as opposed to just physicians not only in magazines but also in television commercials. I was surprised to read that $4.5 billion was spent advertising medications in 2005 (Conrad, 17). I was even more surprised to read about how effective that advertising is on consumers with every $1 spent on advertising translating into $4.20 spent on pharmaceutical drugs (http://prescriptiondrugs.procon.org/sourcefiles/Impact-of-Direct-to-Consumer-Advertising-on-Prescription-Drug-Spending-Summary-of-Findings.pdf )** That’s a pretty amazing return and explains why pharmaceutical companies do spend so much on advertising their drugs. But it raises the question of whether it’s ethical. Should they be able to leverage so much influence on patients? Do you think that patients should be able to ask their doctors to try particular medications or should doctors recommend the medications? I’m personally slightly ambivalent in regards to this question. I think patients should have the ability to do research and make a decision about which prescription is right for them without being entirely influenced by the doctor, but I’m also wary about the influence that advertising or social groups might have on the individual’s decision. I I question how much of a role they should have in advertising, if any. There are certainly some perverse incentives for them to market certain illnesses as if to convince consumers they are suffering from the symptoms described in the commercial or magazine ad and that they should do something to get treated. I’m certainly looking forward to our next reading assignment on drug companies.
**note: I’m pretty sure this same statistic was mentioned in the reading too, but I couldn’t find it.
I always seem to find myself on the fence about many of these conditions, such as ADD and ADHD. As Professor Jennings mentioned today, many feel that we are simply medicating people instead of working to provide an environment conducive to growth. I agree with that anti-medicalization stance, but I also recognize that many of these "new" conditions which have come about do in fact have symptoms which can be helped through medicine. As a result, I think the classic drop in expectations of the "diseased" must be changed along with the amorphous category. Many of these conditions in contention, such as ADD/ADHD should not only be treated with only drugs or only without drugs (most people seem to be on one side or the other), but should be treated with both lifestyle changes, as well as drug intervention if needed.
I find it extremely difficult to take sides on any of these diseases or conditions, because I see the point of view that a pathology causes most of the conditions, as well as idea that medical intervention is not needed for most of them. I feel that this is where the thin line between "necessary treatment" and "quality treatment" lies. Of course one does not need Ritalin to survive, but treatment for ADHD could improve a person's life considerably. Essentially Conrad's book once again reinforced the idea that the relationship between society and healthcare is extremely complicated, and changes as society does.
I feel as if any of the symptoms can be personal insecurities that one can go through which is normal. It is no wonder that many adults self-diagnose themselves so easily because the symptoms are weaknesses people do not want to reveal to others. Living in a society where titles, degrees earned, and credentials are everything, we do not like to reveal signs of weaknesses. Also, as adults we have the capability to hide these symptoms and suppress them unlike children where we can clearly see their symptoms. Therefore, self-diagnosing yourself with ADHD can be a cover-up of one's unhealthy habits. Instead of trying to resolve the root of each problem, I feel that being diagnosed with ADHD is definitely an easy way out. I consider it to be an easy way out because through medication one can obtain faster results and people can continue on living with their bad habits. Overall, this is just my first reaction to this disorder. I hope to be able to understand this disorder better because I'm very unsure where the boundaries are when it comes to being diagnosed with ADHD.
In The Medicalization of Society, James Conrad explores a societal shift which I have noticed in my lifetime, but never really knew how to define. According to Conrad, the concept of medicalization is defined as "a process by which nonmedical problems become defined and treated as medical problems, usually in terms of illness and disorders". For example, disorders such as depression or ADHD were not traditionally considered diseases, but are now being treated medically. I will say that I have always been critical of this movement. However, after reading Conrad's dissection of the topic in his book, I am a bit conflicted about my opinion.
Perhaps it's because I was raised with the "deal with it" school of thought, but I've always considered the shift towards medicalization a bit spoiled. As a child, I was taught to think of medicine as a last resort or "easy way out" for dealing with colds, mild fevers, etc. Instead food, rest, and other remedies targetted towards overall health were preferred. (One of my friends almost never gets sick and attributes his resilience to the fact that he was never allowed to take cold medicine as a child.)
It's not that I'm against the idea of medicine, I just feel like idea of labeling an ailment as a "disease" instantly frees the person from responsibility. For example, I have been tempted to say that I was "depressed" before, but in reality all I needed to do was go outside and blow off some steam or find a new hobby. I am sensitive to the fact that chronic depression is a very real and serious concern for some, but that's not what I'm talking about. What scares me is how easy it is to dismiss discomfort as "disease".
In the first chapter of Conrad's book, he discusses the evolving roles of physicians and medical authority. He cites the the widespread influence of physicians as a driving force behind medicalization. He states thats that his relationship is evident in the medicalization of "hyperactivity, menopause, child abuse, and childbirth, among others." This point made me redefine my idea of medical intervention. Maybe medical treatment does not always relieve the patient from responsibilty, but sometimes actually helps them realize that they are ultimately responsible for their own health. (I think this is true in the case of obesity and drug related disorders.) Perhaps the modern physician's role in society is not to treat problems traditionally thought of as disease, but rather to provide support for a wide range of discomforts.