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This entry was posted on Thursday, April 2nd, 2009 at 10:29 AM and filed under Economics, Foreign Affairs, Health, Human Interest, Legal, Media, Politics. Follow comments here with the RSS 2.0 feed. Skip to the end and leave a response. Trackbacks are closed.

4 Responses to “NYT Op-Eds (4)”

1. JuliaSchopick said:

   Mr. Butler:

   I just found your wonderful blog – actually, all three of them – and I want to respond to Philip K. Howard’s NY Times editorial, “Just Medicine.” While I am an admirer of Mr. Howard’s criticisms of the legal system, I think this Op Ed misses the boat with reference to the medical system: He is, in essence, following the AMA’s self-serving party line, which states that malpractice litigation is the main reason that healthcare costs are spiraling out of control. While I agree that doctors’ fear of litigation may play a part, I strongly believe that it is a much smaller part than Mr. Howard believes it to be.

   I believe that a much larger part of the blame for skyrocketing healthcare costs must be placed squarely on Big Pharma’s shoulders. The pharmaceutical industry not only prices its drugs out of control (read former “New England Journal of Medicine” editor Marcia Angell, MD, for her astute observations on this topic), but also controls the world of clinical trials, by paying for the trials, hiring the “researchers,” and even dictating the results. And, to make matters even worse, the industry also controls the actual reporting of the results of these trials. (It is common knowledge that, if a drug company funds the research, that research will be more likely to yield positive results.)

   But the public is only now beginning to (finally!) realize that the “scientific” articles extolling the efficacy of these medications are often actually written by writers hired by the pharmaceutical companies that fund the trial(s). And the physician/researchers who sign their names to these journal articles are often paid by the pharmaceutical companies who funded the studies. Can a “cycle” possibly be more “vicious” than this one is?

   But the part Big Pharma plays in escalating our healthcare costs goes even further:
   Because the pharmaceutical industry influences doctors, not only with their “studies,” but by funding their “educational” seminars and giving them gifts, doctors are not open to other, less expensive –- money-saving — treatments. Doctors insist on calling these treatments “anecdotal,” even though their only “crime” is that they have not been subjected to the billion-dollar-plus randomized, double-blind “studies” -– the scientific “gold standard.” And why don’t they have this kind of backup? Because Big Pharma is not interested in “studying” treatments that will not make them Big Money.

   If more doctors would be open to learning about these less expensive, so-called “anecdotal” treatments, and if Big Pharma did not keep denigrating these promising treatments, our healthcare system could certainly save a huge amount of money.

   Please read eight articles contained in HonestMedicine’s “Anecdotal” Medical Treatment Series at http://tinyurl.com/btcn8h. These articles form the beginning chapters of a book I plan to publish, which will back up my assertion that Big Pharma is a huge part of the problem of skyrocketing healthcare costs.

   In this “Anecdotal Treatment” series, I describe several innovative, inexpensive, NON-pharmaceutical-company based treatments that have stood the test of time: they have been used successfully for over 30 years; they have helped thousands of patients worldwide to overcome very serious illnesses; and, very importantly, they have extremely devoted physician/champions who ardently believe in their efficacy.

   The one thing they lack — sadly — is Pharma backing/funding. By keeping the world from finding out about these less expensive, more effective treatments and others like them –- simply because they will not bring in Big Money — I believe that, in the end, Big Pharma (rather than malpractice lawyers) will prove to be an almost insurmountable obstacle to our ever obtaining cost-effective healthcare.

   To end, in his book, “Tipping Point,” Malcolm Gladwell posits an excellent analysis of the medical malpractice problem. He points out what lots of us who have dealt with the medical profession have known for years: People don’t sue doctors who make mistakes; they sue doctors who treat them badly.

   Thanks for letting me share my views with your visitors.

   Julia Schopick
   Health Writer/Medical Advocate
   http://www.HonestMedicine.com

   Posted on 03-Apr-09 at 9:49 pm | Permalink
2. Ian Alterman said:

   Ms. Schopick:

   Thank you for your well-informed and comprehensive response!

   First, welcome to Civic. As one of its editors, I hope you will continue to visit and find things of interest to you.

   Second, I absolutely hear you on Big Pharma. No question that it bears a huge responsibility for health care costs. One thing you do not mention that contributes to the cost of health care vis-a-vis drugs is that Big Pharma prices new drugs based on their CLAIMED R&D expenses (including, as you note, among other things, the cost of clinical trials and “double blind” studies). But R&D costs are almost unarguably the most “padded” of all costs associated with the release of new drugs.

   However, while Big Pharma bears a huge responsibility for health care costs in a number of ways, overall health care costs are the result of a number of factors. In this regard, Mr. Howard’s seeming apologia for the AMA’s “party line” is correct in its basics, even if he overstates his case. I have spoken with many doctors who echo many of Mr. Howard’s sentiments re their own fears associated with malpractice – and the costs (both financial and caregiving) associated with those fears. Indeed, what Mr. Howard fails to mention (which can either bolster or undermine his case, depending on how one looks at it) is the degree to which malpractice insurance is “required” in order to practice at all. This is a “hidden cost” that we pay when we see a doctor, and at least part (if not a large part) of why doctor’s fees can be so high (and get higher the more specialized the doctor).

   As well, Mr. Howard is correct about the advantage of separate courts with “specialized” knowledge. He only mentions bankruptcy court, but there are also family courts, housing courts, traffic courts and, in some states and/or municipalities, domestic violence courts and even quality of life courts. In all cases, these courts have been shown to be effective because the judges are either chosen for their knowledge of the subject, or receive special training. Thus, a health care court would seem to be a good idea, regardless of whether and to what degree Mr. Howard overstates his case.

   Finally, as a related aside, I am currently involved in the creation of a nonprofit group that plans to tackle the issue of the misdiagnosis of children vis-a-vis ADD and ADHD, and the rampant (and dangerous) prescription of neuroleptic drugs for children – an area in which Big Pharma is complicit up to its eyeballs. (e.g., see the case of Dr. Joseph Biederman, Harvard, and the Big Pharma connection.) So I have no great love for Big Pharma.

   Again, thank you so much for your deeply informed comment. Any further comments would be welcome!

   Peace.

   Ian Alterman
   Editor
   MB-Civic

   Posted on 04-Apr-09 at 7:28 am | Permalink
3. JuliaSchopick said:

   Dear Mr. Alterman:

   I enjoyed reading your response to my comment. (Thanks so much for calling it “deeply informed” — it is very important to me to be able to be a participant in the effort of making real changes to our healthcare system!)

   I do plan to write a longer answer to you over the next few days; you made so many excellent points. Right now, I want to offer extreme kudos to you re your formation of a nonprofit organization to “tackle the issue of the misdiagnosis of children vis-à-vis ADD and ADHD, and the rampant (and dangerous) prescription of neuroleptic drugs for children. . . .” Your mention of Dr. Beiderman immediately brings to mind his chilling remark made during his testimony in a deposition, as reported very recently in the “NY Times” (see http://tinyurl.com/dep7pz ), that the only rank higher than his — i.e., full professor at Harvard — is “GOD”!

   Good luck to you with your nonprofit organization. I am very interested in learning more it. Please keep me informed so that I can write about it (maybe interview you?) for HonestMedicine.com.

   Again, many thanks.
   Julia Schopick
   http://www.HonestMedicine.com

   Posted on 04-Apr-09 at 12:37 pm | Permalink
4. Ian Alterman said:

   Ms. Schopick:

   My pleasure. And thank you for taking my comments in the spirit in which they were offered: it is all too easy to misinterpret people’s intentions here in cyberspace. LOL.

   Re the organization I am helping create, it came about as the result of a gestalt that started with my outrage over this issue for over two decades. Add to this that I became a minister in 2003, and do pastoral and general counseling, including for children and parents – and the things I see in that regard (e.g., parents medicating their kids into submission) often make me cry. Then last year I started reading about Dr. Biederman and his ilk, and what was occurring in that regard. Finally, I read an extraordinary article last Fall in Skeptical Inquirer (yes, even ministers can appreciate a magazine devoted to science and skepticism…LOL) by a clinical psychologist who basically gave voice to exactly what I have been screaming about for over two decades.

   In addition to writing a lengthy letter in support of the article (which was published in its entirety in a later issue of SI), I contacted the psychologist, and suggested the idea of some sort of group to tackle the issue, suggesting that it might have added “cache” if it was a combination of scientific-medical types (including psychologists and psychiatrists) and clergy and others who are trained to provide “alternative” counseling (i.e., not based on an academic degree in psychology), but who work regularly with children and parents.

   He was very supportive of this idea, and agreed to brainstorm it with me, and we have been doing so since early this year. I am currently working on the “mission statement”; he has provided a rough first draft of the “clinician” piece; and I am working on a rough first draft of the “clergy” piece. We are also both outreaching to people who might be interested in what we are doing. (Although we have admittedly not finalized exactly what our mission and goals will be, they will primarily be the ADD/ADHD diagnosis; the rampant – and largely unnecessary – overmedication of children; and, probably, the tangential (but related) issue of pharmaceutical advertising on TV.)

   We would welcome your participation – though, again, we are only in the first planning stages of the group. Though, if you have ideas in this regard, they might be helpful as well. I will contact you through your blog with my contact info.

   I look forward to both your longer response on this site, and your personal response re the planned nonprofit.

   Peace.

   Ian Alterman
   Editor
   MB-Civic

   Posted on 06-Apr-09 at 11:46 am | Permalink