"Sickening - How Big Pharma Broke American Health Care"

[tony]

I'm in healthcare and can say that a large majority of people I see choose not to get and/or stay healthy. They use the medical system to keep them "healthy" thinking that there is a pill to fix everything.

Man, so much truth here.
I’ve been a paramedic for 30 years, nurse for about 15. Worked in the emergency dept and a prison.
Majority of ED users are overweight welfare recipient that smoke, drink, and use drugs. This demographic use the ED as their primary care provider. Non compliant with medications and overall self care.
The prison I work in is an all female population. Over half are in for drug crimes, a good 75% are positive for hep C acquired from drug use. 90% have received little to no dental care. The meth users all have zombie mouths. We have one that’s over 600 pounds. Her crime? Child neglect, she literally ate all the food she would buy and starved her kid. Yeah somebody bred with her.
Point being, personal responsibility is lacking in most people. It’s really not that hard to just eat right, clean up your diet and walk a little. Brush and floss your teeth.

 

[Marbles]

The fact that he uses insulin as an example of needles changes makes me question his honesty. Most of the changes are to improve compliance and safety. Not everyone is willing to check a glucose 4 or more times a day. Not everyone is willing to give themselves multiple injections a day. Etc. Sounds like an ivory tower academic with a lack of real would experience. That, or a man with an axe to grind.

Similarly, his stating that adalimumab is just as good as methotrexate ignores the significant side effects of methotrexate or the fact that many people would prefer not to go to an infusion clinic to get there medication administered.

Don't get me wrong, pharmaceutical companys (like big farma and the retarded recommendation for dairy consumption) have a good deal to answer for. And it sounds like he may have some good points. However, from reading positive reviews and the positive comments on this thread, I have to question the author's agenda.

Open data, open trials, and publication of negative results are all needed improvements.

Pricing is ridiculous, but it is inabled by the insurance model, which means the customer rarely sees the price. Fixing one, much less both, dides of that runs into thorny problems with strong ideology. Governments fixing prices is rarely as effective as a free market (though health care is hardly a true free market), likewise, outlawing insurance or going to a single payer system are both unlikely and fraught with problems.

I don't have any good answers on how to fix the system. I think the problems are as much rooted in the Culture of America as in the health system.

 

[Buzby]

But Americans are not living longer, at least compared to other wealthy nations

American are living longer than Americans used to. Fact. Other countries may very well be passing us, I don’t doubt that. I’d argue the average American lifestyle/diet would play into that a great deal.

 

[grfox92]

There's ways out of almost every ailment without the use of medications. Changes in lifestyle and diet can get you out of type 2 diabetes, high blood pressure, high cholesterol, arthritis, back pain, joint pain.

So many people are walking around eating foods that are causing inflammation in their body, And they are so out of touch with their own bodies that they don't even recognize that there are certain foods causing these problems.


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[Buzby]

Good thing we produce roughly 4x the amount of published data that GBR does. Especially when you consider we have approx 5x the population.

That’s a garbage graph.

We rank terribly in the US at most healthcare metrics except profitability. It seems unlikely to change at this point.


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So China, and India should be producing 4x the published data than the US does? Population and published data are not directly correlated.

 

[pk_]

This information has not been reviewed by the food and drug administration.

 

[fwafwow]

American are living longer than Americans used to. Fact. Other countries may very well be passing us, I don’t doubt that. I’d argue the average American lifestyle/diet would play into that a great deal.

We are living longer than we used to, and I expect some of that is due to advances in medical treatment, and specifically including pharmaceutical developments. I don't doubt that the American lifestyle contributes to overall health (or lack thereof). I don't think we are completely unique in our lifestyle though, but the author points out that the US has the highest obesity rate of any country in the OECD. I don't believe, fwiw, that obesity and lifestyle explains everything, and since I consider myself fairly healthy, I still found things that could be improved in our system that apply to me and my family.

 

[fwafwow]

The fact that he uses insulin as an example of needles changes makes me question his honesty. Most of the changes are to improve compliance and safety. Not everyone is willing to check a glucose 4 or more times a day. Not everyone is willing to give themselves multiple injections a day. Etc. Sounds like an ivory tower academic with a lack of real would experience. That, or a man with an axe to grind.

FWIW, I think his take is more complicated. He walks through the history of insulin - from insulin derived from pig and cow pancreases, to recombinant human insulin (Humulin R and N), to insulin analogs. I don't think he argues that the changes are needless, but that the stated benefits of insulin analogs are exaggerated - including a 2003 Cochrane Collaboration study that compared recombinant human insulin to the predecessor, and three more Cochrane Reviews between '06 and '08 comparing analogs to recombinant human insulins - but 90% of insulin prescriptions were for analogs by 2010.

I believe his primary point, however, is the cost comparison. Humalog is said to have cost $21 per vial in 1996 and was $330 per vial by 2017 (compared to $38 in Canada).

As for any changes for compliance and safety, if the source of any basis for the same is a drug company study, that ends up (almost invariably) touting the newer and more expensive treatment, then that's an axe to grind.

Similarly, his stating that adalimumab is just as good as methotrexate ignores the significant side effects of methotrexate or the fact that many people would prefer not to go to an infusion clinic to get there medication administered.

I looked quickly at that chapter and I don't think that's what he is saying. The discussion focuses on how studies usually compare the new drug to doing nothing, as opposed to other existing therapies - like Humira/adalimumab as compared to methotrexate - for efficacy (and the studies show they are comparable - he does not mention side effects). Then he argues that the studies should have compared Humira to the most effective conventional therapy - methotrexate, HCL* and sulfasalazine. To try to be more succinct - I think in the adalimumab discussion, he's arguing for more info for doctors, not that one particular drug is better in all ways, for all patients.

Don't get me wrong, pharmaceutical companys (like big farma and the retarded recommendation for dairy consumption) have a good deal to answer for. And it sounds like he may have some good points. However, from reading positive reviews and the positive comments on this thread, I have to question the author's agenda.

I haven't read any positive reviews - I don't personally trust anyone else to review something, even a movie, for me. As for the positive comments on this thread, I am not sure how many have read the book.

Open data, open trials, and publication of negative results are all needed improvements.

All are argued for in the book.

Pricing is ridiculous, but it is inabled by the insurance model, which means the customer rarely sees the price. Fixing one, much less both, dides of that runs into thorny problems with strong ideology. Governments fixing prices is rarely as effective as a free market (though health care is hardly a true free market), likewise, outlawing insurance or going to a single payer system are both unlikely and fraught with problems.

Agree on all points.

I don't have any good answers on how to fix the system. I think the problems are as much rooted in the Culture of America as in the health system.

Agreed.

I was hoping you would chime in on this post. PM me your address and I will send you a copy of the book. I'm not suggesting that your reading it will mean you agree with him, or my points above - I actually want someone with medical knowledge to read it and tell me where he is missing the mark.

* - I hesitated to include this here due to a tangential issue that may arise...

 

[doc holiday13]

There is a huge disconnect between health and healthcare.. There is also a huge disconnect between health and food.

Obesity has skyrocketed since the concept that "low fat/no fat or low calorie/no calorie" options started hitting market. Our immediate and future health hinges on the choices we make regarding food. Our food pyramid is so fawked its crazy.. We should not be eating as much processed oils, simple carbohydrates, and sugar as we do.

IF you truly care about your future health, you'll look for people on the fringe to talk to. YES some of the fringe people have some crazy ideas but they certainly thrive in health and some of the happiest people out there. Start with Weston A Price foundation basic literature and read Carnivore Code

 

[5MilesBack]

I know genetics plays a big part in our health, but to what extent? If folks saw my adult life diet, they'd expect to see a 500lb bedridden 40 year old with diabetes and on the verge of multiple heart attacks, not a 57 year old 6'6" 225lb elk hunter.

I hadn't had a physical in probably 10-11 years, so since the king's mask edicts were finally over I decided to make an appt with my PCM, that I had never met. He ordered up a whole slew of blood and urine tests. He called last week to tell me that all the tests came back normal and in good ranges. Is that all just because of genetics? I don't do much for "pharma", except a nasal steroid and some Ibuprofen every now and then.

What I do know, is that with insurance companies and government mandates and regulations, we will never have a "free market" system to keep the costs in check.

 

[fwafwow]

Sounds like an ivory tower academic with a lack of real would experience. That, or a man with an axe to grind.

Sorry - I forgot to mention his mom-academic experience. Two years in the NIH Corps as a PCP in rural West Virginia followed by 20 years as a family medicine doctor outside of Boston.

 

[fwafwow]

There have been efforts to revise the food pyramid and dietary guidelines - check out https://www.nutritioncoalition.us/.

 

[Hikein]

Most of us trusted big pharma. Most doctors did. They prescribed based on what appeared to be best science. Opiates, statins, all of it. But here is the one problem marrying medicine and capitalism, it’s profits over people. Shareholders over smart science.
If you’ve been outside the US most countries don’t allow drug ads on TV. Why are they allowed in the US? Our system is the Wild West here in America. More government controls have to happen to reform our broken system. I’m sorry to say this but I’ve received superior care in so called “socialist” countries. Go to the ER in Guatemala, or Taiwan or even Croatia. Fantastic care! I needed medical care in rural northern Finland last year. In and out less that an hour all fixed up with medication in hand, one stop “shopping”. Brilliant! Reform might sound scary, but at least looking at state controlled medicine might be the best option

 

[ODB]

One of the problems - direct to consumer advertising for prescription meds. Only one other country (New Zealand) permits this, and there the ads must be accurate. Not here.

I never understood how this was allowed. The caveats are longer than the ad sometimes. With the advent of Dr. Google, I imagine the average neurotic is banging down the doctor’s doors to get at the meds. It’s very strange.

 

[Michael Rankin]

There's ways out of almost every ailment without the use of medications. Changes in lifestyle and diet can get you out of type 2 diabetes, high blood pressure, high cholesterol, arthritis, back pain, joint pain.

So many people are walking around eating foods that are causing inflammation in their body, And they are so out of touch with their own bodies that they don't even recognize that there are certain foods causing these problems.


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If you don’t mind, Could you share any books or articles you have read regarding diet helping with arthritis, back and joint pain?

The way you posted this statement it seems as though you may have a personal experience with this, and had positive results.

 

[260madman]

I’m going to start taking some pills that are $20 a pop for migraines. $300/month. What a freaking joke. There’s a cholesterol drug that works really well but it’s $1200/month to take but wait, the pharmaceutical company dropped the price to make it more affordable at $900/month because insurance won’t cover it.

 

[fwafwow]

Typed fast. There are many participants in the failure and success of medicine. Tried to detail a few.

The boggie man is not pharma. I’d look to those claiming they are is more responsible or in part. Masking their responsibility. You know Solinski

I’m afraid I don’t know Solinski.

I’m also trying to understand and respond to some of the prior post. “Not going to deny bad apples in pharmacy, and I’d argue most aren’t us based.” Are you saying most of the known pharma transgressions (bad apples) aren’t US based, or that most pharma companies in general aren’t US based? As for the latter, 1/2 of the top 10 pharma companies based on 2020 revenue are US based - including (in order) Merck (Vioxx), AbbVie, Jansen/J&J (Pinnacle hip implant), Bristol-Myer Squibb and Pfizer (Neurontin and Bextra). The parenthetical products with known problems (and likely many deaths in the case of Vioxx) are only those listed in the book - there is no mention of AbbVie or Bristol-Myer Squibb, but I’m looking into them.

I get the bad apples point - one incident doesn’t mean everyone is a problem. But the repeated problems, and the fact that many problems aren’t visible due to secrecy about data, means that at least I am going to remain suspicious.

 

[doc holiday13]

I’m going to start taking some pills that are $20 a pop for migraines. $300/month. What a freaking joke. There’s a cholesterol drug that works really well but it’s $1200/month to take but wait, the pharmaceutical company dropped the price to make it more affordable at $900/month because insurance won’t cover it.

Well people shouldn't be taking medication for cholesterol to begin with so there's that. Cholesterol numbers have nothing to do with heart health. You should be looking at arterial plaque instead

 

[Gutshot007]

Not sure if anyone caught the movie/series "DOPESICK". interesting on history of oxycontin in Appalachia /big pharma marketing . Treating pain as "vital sign " the whole works. I work in healthcare and this brought to memory a time where there was massive marketing directly to healthcare providers. Now most clinics/hospitals will not allow it. Don't kid yourself pharma is a business . It's a huge double edged sword. They spend millions in research and expect to recoup losses on meds that never make it to market. Meanwhile the price of someone's Epi-pen or insulin goes through the roof. No easy answer. On the other hand your kid gets some horrible type of cancer and and big pharma invents a med that save their life and you are grateful that there is a med we didn't have 5 years ago. Some diseases obviously could be "cured" by lifestyle choices, others unfortunately just happen. No easy answer .one could type a million pages on the current state of healthcare in the US and not even scratch the surface. Stay healthy. Good health is a blessing we probably take for granted.

 

[Pacific_Fork]

Hell 9 out of 10 doctors are still telling people to stop eating red meat. Just the other day a family member was telling me (doctors orders) they had to give up red meat to get healthier, lower blood pressure and cholesterol. All the while continuing to eat processed foods and vegetable oils. The entire system is so insane you have to laugh.