June 1, 2015
Pernicious Low Tech Issues In Healthcare
By Michael D. Shaw
A wildly disproportionate amount of what is proposed for healthcare reform involves technical matters. Ten years ago, the pundits assured us that the forced adoption of electronic health records would save billions and revolutionize health care. Unfortunately, EHRs have cost billions, are almost universally despised by providers, and are responsible for thousands of errors—some of which have proved to be fatal. The situation is bad enough that even the clueless Feds have decided to back off on some of their more onerous EHR requirements, at least temporarily.
Other voices have suggested that the answer lies in drug discovery, massively expanded; high tech systems to measure outcomes; or fancier approaches to public health education.
Perhaps it’s time to consider a few low tech matters, which date back to the dawn of civilization itself. Big Pharma deserves kudos for a host of miracle drugs, and the industry has surely been well rewarded. But how much is enough? Greed would lead to huge damage awards, paid out for such disasters as Vioxx—the risks of which were no secret to manufacturer Merck years before the drug was taken off the market.
Another celebrated case features greed, of course, but throws fraud, corruption, and additional players into the mix, as well. Decades ago, the diabetes industry became frustrated with the relatively small number of true type 1 diabetics—meaning those individuals who need exogenous insulin to survive, due to autoimmune pancreatic ß-cell destruction. The classic symptom of diabetes mellitus is hyperglycemia. By happy coincidence, blood glucose levels—especially these days—are exceedingly easy to measure.
For a variety of reasons, mostly linked to obesity and aging, there are also tens of millions of people who are hyperglycemic, and this number grows with each dubious lowering of the official criterion. This condition—actually, this lab result—is called “type 2 diabetes.” Cynical and purposeful conflation of type 1 diabetes complications into the type 2 cohort fuels the fires of drug-induced glycemic control. Bear in mind that such glycemic control has always had its pitfalls, with hypoglycemia from insulin injections, to lactic acidosis from metformin analogs buformin and phenformin (both taken off the market).
With metformin going generic, and drug discovery considered a panacea, a new class of diabetes drugs called thiazolidinediones (TZDs) was introduced in the late 1990s . Of the three TZDs, Rezulin was removed from the market in 2000, while Avandia and Actos carry a black box warning for congestive heart failure. There is more than enough culpability to go around, given the FDA, Pfizer, GlaxoSmithKline, Takeda, the American Diabetes Association, and all the other glycemic control profiteers.
Ironically, there is some evidence that the cardiac complications derive from obese patients remaining at basic risk for heart disease, in that they don’t bother losing weight since they assume the drugs will prevent the complications of diabetes! How Karmic and meta can you get?
As to psychotropic meds, we have greed, corruption, fraud, and that old favorite—bearing false witness. Last month, we covered a Maudsley Debate, addressing the topic “Does long term use of psychiatric drugs cause more harm than good?” The “Yes” side, led by Professor Peter C. Gøtzsche, director of the Nordic Cochrane Centre—Copenhagen, won handily.
Unable to counter Gøtzsche’s arguments in any rational or scientific manner, organized psychiatry, and, alas, members of the Cochrane Collaboration itself, have disgraced themselves with suspiciously speedy and mendacious denigrations of his work. What must it be like to labor for years to obtain a medical degree and academic position, only to become little more than shills for Big Pharma? Might I inquire: What about the patients?
Gøtzsche is by no means alone in his contention that patients disagree strongly with the psychiatrists about psychiatric drugs. In fact, according to clinical trials and surveys, the patients do not like the meds, and maintain that they are not terribly effective. As he puts it, “We need a revolution in psychiatry and widespread withdrawal clinics because many patients have become dependent on psychiatric drugs, including antidepressants, and need help to stop taking them slowly and safely.”
More people speaking truth to power are sorely needed in healthcare, even though this activity is aggressively discouraged (cf. The Department of Veterans Affairs). Expect the climate for whistle-blowers to improve, though, as the vultures in power finally exhaust their unlimited budgets.