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Are We Suffering From Medication Madness?

Post Published: 02 March 2010
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Category: Dear Thyroid guest bloggers, Health Care and Health Care Reform Column
This post currently has 44 responses. Leave a comment

Written by, Doug Bremner, MD

It seems like the healthcare system in America has gone completely bananas. It looks like the effort to “fix” the system through healthcare reform is making things worse.

I’m going to be honest with you. I am a physician and I believe in a single payer health insurance plan for the US. I think when doctors and hospitals are incentivized to put making money over the needs of their patients, that is a problem. So if you are a teabagger I won’t be offended if you hit the exit. But I am not going to talk about politics now. Just the facts.

Half of all Americans take prescription medications. Eighty one percent take some type of pill. 100,000 die every year from a prescription med that they either didn’t need or that was not properly prescribed or from another healthcare intervention related mistake.

A recent study showed that, in spite of all the noise made about the inferiority of the Canadian healthcare system, their long waits in line, etc, that Canadians on average live three years longer than Americans, and how sick they are predicts whether or not they go to specialists. What predicts who goes to specialists in the US? You guessed it. How much money they have.

What is going on here?

We shouldn’t be surprised that a profit-driven healthcare system should drive things toward the situation where pharmaceutical companies, hospitals, insurance companies, and doctors behave in a way that maximizes profits. Drug company marketing leads to efforts to promote the positive aspects of drugs and deemphasize the risks. The spin gets so loud that after a while it gets hard to separate reality from fiction. The relentless marketing drive means that prescription meds are promoted for more and more people. Do all these people really need to be taking prescription medications?

If you followed the US guidelines, half of all men (based on their LDL cholesterol levels) would be on a statin drug like Lipitor. Half of women over age 72 would be on a bisphosphonate drug like Fosamax or Boniva, for prevention of osteoporotic fracture. And half of women over age 50 would be diagnosed with “osteopenia” and advised to “talk to their doctor” (presumably about taking a pill to prevent osteoporosis). And if you followed the USDA guidelines for minimal intake of vitamins and minerals, all of us would be on a multivitamin. More recommendations… Everyone take an aspirin and fish oil supplement to prevent heart disease, all women should take calcium, etc etc.

Have we gone nuts?

In 1997 the FDA lifted the ban on direct to consumer advertising along with the law that required ads to list every possible side effect. Soon after, Americans were bombarded daily with commercials for prescription drugs. The US is the only country in the world where you can turn on the TV and have an announcer tell you to go ‘ask your doctor’ for a drug.

Doctors often will give medications to patients even if they don’t think they need it. For example, one study showed that 54% of the time doctors will prescribe a specific brand and type of medication if patients ask for it. Drug companies also buy information about the medications that doctors prescribe from major chain drug stores like CVS, and then use this information to reward doctors who prescribe their drugs frequently. Research studies show that this can influence behavior, like how often a doctor will try to have a drug from that particular company put on his hospital’s formulary.

Expert guidelines promoting the use of prescription medication can also drive prescription behavior, because doctors feel like they need to be following the guidelines to adhere to accepted standards of care.

In 2005 in the aftermath of the Vioxx debacle and withdrawal from the market, Janet Woodcock, Deputy Commissioner of Operations at the FDA, said that the nation’s drug safety system had, “pretty much broken down.” She charged that neither doctors nor patients had enough information about the side effects of drugs to make informed decisions about taking them. Dr. Woodcock went on to say that, “the bottom line is that a lot of drug safety problems are actually preventable, [because] most adverse events are from known side effects.”

All of this suggests that America has a prescription drug problem. The US spends two times more on drugs, and takes twice as many drugs, as other countries, and has worse health. In fact, we have some of the worst healthcare outcomes in the industrialized world, including total life expectancy, and survival of children to their 5th birthday. In a survey of 13 industrialized nations, the US was found to be last in many health-related measures, and overall was 2nd to the last. Even England, which has higher rates of smoking and drinking and a fattier diet, has better health than the US.

Another problem is the government. Agencies like the US Department of Agriculture (USDA) publish guidelines like the Recommended Daily Allowance (RDA) of vitamins and minerals. This is great for manufacturers of vitamin and supplement products, since there is no way to get enough of the recommended vitamins and minerals in normal food without overeating.

Ironically most recent health gains have come through increased knowledge of health risks and better health practices (or prevention). We smoke less, have better access to nutritious fruits and vegetables year round, pay more attention to cleanliness and hygiene, and have improved safety in general. For instance, in the 19th century it was not known that dirty water and shared cups could spread disease. Hand washing is still the single most powerful way to prevent the spread of communicable disease, but this was not discovered until 1847, when Ignaz Semmelweis, a young Viennese doctor in an obstetrics ward, observed that midwives who washed their hands had lower mortality rates among their patients than doctors, who often went from autopsy room to delivery ward without so much as a hand wipe.

Future advances in health will likely come more from changes in lifestyle, diet and exercise, than from medications. Almost all of the chronic conditions for which pills are prescribed are preventable through such changes. Other conditions like cancer are partially preventable.

It is time for Americans to rethink the role of medications and other pills in their lives in relation to other actions that can be taken to maximize health, such as making changes in diet; incorporating exercise into one’s daily routine; learning and using stress reduction techniques; and changing other behaviors like quitting smoking. The most common disorders, like diabetes and heart disease, are always better treated and prevented through changes in lifestyle than they are with medication.

Doug Bremner MD, is a physician, researcher, and writer, and Professor of Psychiatry and Radiology at Emory University School of Medicine and the Atlanta VAMC in,  Atlanta,  GA. He is author of Before You Take That Pill: Why the Drug Industry May Be Bad for Your Health, and Does Stress Damage the Brain: Understanding Trauma-Related Disorders from a Mind-Body Perspective He is also a blogger on a wide range of health related topics. Follow him on twitter @dougbremner.

Doug Bremner’s Website, Blog, Books “Before You Take That Pill” and “Does Stress“.

What are your thoughts on this topic? What do you agree with? What do you disagree with? What resonates the most for you about Dr. Bremner’s article?

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44 Responses to “Are We Suffering From Medication Madness?”

  1. Lolly says:

    Hi Doug,

    I live in the UK so can’t really answer most of what you have said about health reform in the USA. I do believe however many people suffer for lack of insurance or second rate care because there income is low and this is where things need to change, that everyone gets an equal opportunity to the same care be you rich or be you poor. We have the NHS yes it is made up of good things and bad things but in general it works.

    It seems that health care to me in the USA is about money, where has caring for the patient and that time isn’t money.

    I agree on your points about we take far too many medications and that life style changes such as exercising quitting smoking healthy diets should be incorporated in preventing many diseases either medication induced or life style triggers such as stress obesity and don’t please include hypothyroidism in that equation.
    I feel that eduction is the key here to getting a healthier citizen and preventing alot of diseases and ailments.

    I won;t go into the pharmaceutical companies because we do things differently here in the UK and yes we may advertise OTC medications. but in general it’s down to the GP specialists to prescribe not false advertising. Big pharms are the ones who profit from all of this and the poor consumer is taken in not knowing what side effects these drugs may carry or what might have an adverse effect when taken with another drug.

    So Yes I totally agree that it is becoming medication madness. I don’t take alot of medication just the ones to keep me alive as for supplemention I try to get as much as I can in good food wholesome and cooked from fresh. I may supplement a little but not on a multi vit level just the ones I feel I may lack because of my diseases and metabolism.

    thank you for your Article it makes sense, but I don’t agree on all your points after all you are a Doctor and we are so called patients.

    Lolly

  2. Doug Bremner says:

    @Lolly

    Thanks for your comment. Yes, I do agree the problem is worse in the states due to the profit driven nature of the system, which is why people in the US take twice as many prescription medications as people in other countries but our health outcomes are not better, in fact worse.

  3. […] I justed posted a guest blog on the Dear Thyroid website, which is a advocacy group for patients with thyroid disease here. […]

  4. dearthyroid says:

    Lolly;

    I love your points.

    1) American health care has become about money for the most part, which is a HUGE ISSUE. Health care shouldn’t be a privilege and everyone, as you said, rich or poor, should have access to health care.

    2) The NHS system in the UK is not 100% perfect and definitely needs work, to be sure.

    3) Question, what do you think UK health care reform needs?

    4) I do think some, not all doctors have a propensity to over-medicate versus work with their patients to find other solutions, especially solutions that patients are eager to try nutritionally and supplement wise.

    5) Like you, I agree with some of Dr. Bremnar’s points and disagree with others. I am very glad that he wrote this article because it made me think and I appreciate that he’s departing from ‘old school’ practices to speak up about what’s really going on with American Health Care. Do you know what I mean?

    Thanks for your kick ass comment, Lolly!

    xo

  5. dearthyroid says:

    Another point I wanted to make, if I may, is that I do not believe that we create or invite disease into our lives. The question is, how do we manage it when it does enter our lives?

  6. Robyn says:

    Dr. Bremner,
    Thanks so much for taking the time to contribute to Dear Thyroid.

    I pretty much agree with the gist of your column–better health through healthy lifestyle, rather than better health through chemistry.

    I also agree that the government, big pharma, and doctors are inextricably tangled in bed together. And while that makes it difficult to maintain the proper checks and balances between the three, it is also true that money makes the world go ’round. There is only so much money the NIH has to give (and, of course, they are a governmental agency). The alternatives are NGO sources, and big pharma sources of funding–I’ve noticed on your CV that you have done funded studies supported by GSK, Eli Lilly, etc. with anti-depressant meds–and while researchers claim to not be beholden to their funding agencies, studies have shown there is bias there, just as there is bias with doctor’s prescribing meds that give them perks as simple as coffee mugs and pens even if these doctors consciously try to avoid such bias.

    So what *is* the answer? And why is the US so far behind other countries in health? Well, although there is lots of open funding out there right now on the NIH website for lifestyle, diet management, etc. of various conditions, I fear that money will be all for naught because of the “American Way”. We are an INSTANT GRATIFICATION NATION. We don’t want to be inconvenienced, dammit, even when we know it isn’t healthy. I can almost guarantee you that the majority of US citizens, if given a choice between a medication to “fix” a problem (even if it might have side effects), or a diet/lifestyle/exercise management program to prevent or fix that problem, will choose the pill every time. We have evolved into an entitled culture that does not value work and delayed responses–we are OWED good health, so give it to me NOW.

    So, I would add that just like every other “broke” facet of the US, the good ol’ red-blooded consumer is the frequently forgotten 4th dimension of the tangled over-medication phenomenon.

    But then again, I haven’t read your book, so maybe you discuss it. Unfortunately, I spent all my monthly allowance on supplements, so I can’t afford it! 😉

    In all seriousness, I’m wired to always be the devil’s advocate (I’m pretty sure I’m his spawn), so please don’t be offended by anything I have to say–I like to argue even when I agree! I look forward to hearing more of your thoughts in the future.

  7. Hi Doug – extremely important topic. Thanks for taking it on.

    I’m a Canadian. And while there are definite improvements our health care system could use, I am so glad that we have it. I’m old enough to remember the days before it was in place. I actually have a few scars on my body that are there because my parents couldn’t afford to take us to the doctor or hospital to get stitches when we got hurt. No one should have to live like that.

    And despite all that you hear about waiting lists, less than responsive care, etc. up here in Canada, there are tons of stories about caring, dedicated practitioners. I was quite nervous about some surgery I needed a few years back, my surgeon actually stood in the hallway holding my hand while he assured me I’d be fine. And my family doctor assisted in the surgery so she’d know first-hand if any complications arose.

    Anyhow, like you I don’t want to turn this into a political discussion. But I absolutely agree that we have become pill mad! As a life transition coach, it isn’t just in the medical arena of our lives that we desperately search for a ‘quick fix’. I get clients all the time who want me to perform some magic smoke & hoogie-woogie dance that makes all their issues disappear overnight! The personal growth equivalent of taking a course of antibiotics, I think.

    The degree of ‘structural integration’ (aka collusion) amongst pharmaceutical companies, regulators, media and the medical infrastructure is downright scary.

    So I encourage you to keep up the good work around interrupting the flow of medical lemmings streaming over the cliff into an ocean of pills. I’m glad to have learned about your books. I’ll be recommending them to clients, many of whom are so drugged up they hardly know anymore what ‘real life’ feels like.

    Gwen McCauley

  8. Dear Thyroid says:

    Robyn – I love that you added the 4th dimension, patients.

    In your opinion, have we become an instant gratification nation because of marketing and billions of dollars spent on advertising the one pill fits all philosophy or because of something else? I tend to learn in the direction of marketing.

    Another point you make that I hope Doug addresses, is in regards to (I’m paraphrasing) doctors need to earn a living as much as non-doctors do, so what is the happy medium? Where do we find balance?

    Great comment, kid.

  9. Dear Thyroid says:

    Dear Gwen;

    Thank you so much for sharing your thoughts. I’m really glad you did.

    You raise some excellent points. Having been on both sides of the health care fence, you see health care through a much different lens. From reading your comment, it seems to me that the health care system in Canada from your experience is working.

    I think in America, we need the public option, option being the operative word. Health care, as Lolly stated and I echoed, shouldn’t be a privilege.

    I agree with you a 1000% that as a whole, we’re more inclined to take a pill instead of do the work required to improve our quality of life.

    Brilliant comment! Really nice to meet you. I look forward to reading you and learning more about you.

    Thanks for making me think.

  10. Dear Thyroid says:

    An FYI — All of these comments that everyone has shared so far, has really made me think a bit differently. THANK YOU!

  11. Doug Bremner says:

    Hi

    I agree with all points. The problem is worse in the US, and not all doctors are pill pushers, it is just that the for profit system tends to drive up medication use, and our healthcare outcomes are not any better than Canada or Europe, they are in fact worse.

  12. dearthyroid says:

    Doug – Thank you so much for sharing your thoughts and responding to comments. You’ve raised so many wonderful questions and points.

    I agree, not all doctors are pill pushers. We have become a ‘for profit’ health system. What is the answer? How do we fix it? How do we make it better?

  13. Lolly says:

    Hi Katie,

    I’m very glad Dr.Dougoug wrote this article too and I promise to be Gentle. He’s been frank and honest and is speaking out takes Gutso.

    3) Question, what do you think UK health care reform needs?

    It needs for government to back out and let the medical profession do what they were trained to do not about meeting targets or how much money each surgery/Hospital spends.

    More money needs to be put into the services to improve awareness of diseases, prevention and possible cure money spent on research.
    Even something as basic as thyroid testing done on a annul check up and I don’t mean just a TSH but a full panel. Look how much money would be saved then if it is caught and treated sooner, never mind giving happy pills or saying someone need to diet they eat too much.

    They have some campaigns going at presents like stop smoking clinics advertising on TV about the dangers of smoking drinking drugs and that is good thing.

    Our Doctors are not much better with not always listening and wanted to give you a pill for something you don’t even need. It’s also for the patient to refuse and say they are not happy to be taking this and what side effects does it have, and is there any other alternative. I don’t believe in popping pills for this a that and the other, I know I need to, but if I didn’t, I wouldn’t be taking anything. I didn’t bring on my disease just like you didn’t bring on yours. Could I have prevented it who knows this were research needs to be in preventing auto immune disease and there are many of them.

    Kick ass reply yourself.

    Good points too Robyn you put it so well. Me I am straight to the point and no messing plain English.

  14. Doug Bremner says:

    I think the answer for the US would be public option health insurance for starters. I was very disappointed when that was dropped as it helps keep the insurance companies honest. Also we need to get ads for drugs off TV, and get the academic doctors hands out of the pharma cookie jar. Whatever benefit that relationship may have had for the patient was far outweighed by the harm. Over and over the risks of drugs is coming out years after they should have. There needs to be more public advocacy for the patients; pharma and the insurance lobbies have hundreds of lobbyists and there is no counter balance. The current information stream is way tipped toward the pharma marketing viewpoint.

  15. Rebecca Elia says:

    Dr. Bremner,

    Thank you for your excellent article.

    As a fellow physician, I, too, am frustrated with the state of health and “healthcare” (disease-care) in our country.

    I, too, believe that we need to have a single-payer system so that ALL will be covered. It is unbelievable that we do not. When will we all recognize that it is much more costly not to have this system in place? Prevention is and always will be the best practice.

    You also hit on one of my biggest pet peeves–pharmaceutical TV commercials. It’s not only ridiculous to advertize prescription drugs to the general public, but, in many cases, misleading. I have been angered by everything from presciption medications for yeast to birth control pill ads. I have spent a lot of time with patients in the office trying to undo the consequences of this misleading information.

    I would add, as an Ob/Gyn, my frustration that women and children, once again, are being placed last, this time with regards to healthcare reform. It is unconscionable.

  16. Stephanie says:

    Thank you Doug for your comments. Wish more doctors like you were speaking out.

    I am currently in the 2nd month of waiting for my insurance company to approve some therapy for my son. I started to keep a log of all the notes, because literally, I was told something different every time I called. Either they do a pretty poor job of training their staff, or they have an objective to look for as many ways to deny care as they can. My cynical (and perhaps correct) mind thinks they want to deny care. And what’s funny is, I supposedly have good insurance.

    The lack of transparency of costs, and the waste and fraud that is endemic in the health care industry, plus the profit incentive has created a health care behemoth where some people are getting really rich, and many others aren’t getting well (or even taken care of).

    Don’t get me started on Big Pharma. I’ve had friends who work for drug companies defend them, saying – well, they do a lot of good research. Perhaps so, but research ain’t how they are making their money.

    As for me, I have turned to alternative health methods for most things. No drug company is making money off of me.

    I hope our current government can make something of the health care reform movement, as flawed as this whole process is. Seems like Big Pharma and insurance companies are winning, once again.

  17. dearthyroid says:

    Lolly – You’re right about the reform required in the UK. I didn’t realize that the lack of prevention and education issues were as prevalent in the UK as they are here. The only prevention issues I can honestly say I see in the US are about “Diabetes, AIDS and Breast Cancer”, all of which are fantastic, to be sure. I would also like to see more prevention/education about other issues, namely thyroid diseases and cancers.

    Love, love, love this point you made, Lolly I wouldn’t be taking anything. I didn’t bring on my disease just like you didn’t bring on yours. Could I have prevented it who knows this were research needs to be in preventing auto immune disease and there are many of them

    I hear you,
    K

  18. dearthyroid says:

    Doug – I agree with you so hard, I could burst through my screen and SCREAM. Thank you for sharing that bit.

  19. dearthyroid says:

    Rebecca – Thank you so much for sharing your thoughts.

    Disease Care — So true. I hadn’t looked at the overall health issue as disease care. Thank you for saying as much.

    I’m so nervous about taking drugs because as you and Doug said, we find out after the fact how horrible the drug was for us, to begin with; or, or, or that it’s been recalled.

    We need broad sweeping change in this country, period. No more pharma marketing. Done and done.

    Thank you so much for your fabulous comment. You got me thinking, too.

    K

  20. dearthyroid says:

    Bravo, Stephanie. Kick ass comment, too!

    the profit incentive has created a health care behemoth where some people are getting really rich, and many others aren’t getting well (or even taken care of). Sadly, that is painfully true.

    Like you, I’ve had it with pharma companies making money off of us. The other question that plagues me is research. What are the benefits of their research, really? Only to learn that 1-3 years later the medication that was prescribed can be severely detrimental to us in other ways?!

    With your homeopathic program, is it supervised by an integrative internist? What benefits have you seen? Would love to know more about this, if you don’t mind sharing.

    Great comment,
    K

  21. Liz says:

    Thanks Dr. Bremner for contributing your thoughts! Unfortunately, you’re right about the marketing push towards drugs and medication-only care in this country. It should also be noted that those who work at easing or eliminating an illness via natural methods (that don’t require pharmaceuticals) as you stated, often get the blame for making the “cure” sound too easy. Because this country is so entrenched in the “a disease cannot be cured; you will most certainly need a medication the rest of your life; medication is your saving grace even if your symptoms never abate or you get terrible side-effects”, we become cynical to the idea that we can work against disease and toward better health ourselves (without the help of a pill).

    Robyn referred to instant gratification, and indeed, it seems that those taking another route (away from the medication-only approach) are criticized intensely. If we’re to move away from medication-only approaches to health and disease, we must understand that natural health is not the instant miracle cure-all that “unbelievers” make it out to be; it requires alot of personal effort. And that, is no miracle, but a shitload of hard work. Which, in contrast to subsisting on a pill the rest of one’s life with terrible and unrelenting symptoms, seems rather worthwhile… no matter what degree of wellness is achieved.

  22. dearthyroid says:

    Liz; Beautifully said. Many folks vehemently disagree with taking a lifestyle change approach to healing and wellness, which is a shame. We’ve become such an instant gratification nation combined with intense and constant media shoving pills down our throat. We do have choices and we can say “no” and while it takes enormous work, it’s worth it.

    Excellent comment. Thanks for sharing. Great learning day today…

  23. Robyn says:

    “…and get the academic doctors hands out of the pharma cookie jar…”

    Dr. Bremner, are you then saying that you have never received any funding from the pharma cookie jar? Did I misread your CV?

    While I do agree with a lot of what you have written here, I think full disclosure that you *have* been PI on several studies about efficacy of a drug that was funded by the manufacturing pharmaceutical company would be appropriate.

    Please correct me if I am wrong.

  24. Stephanie says:

    Hi K –

    Well, one of the benefits of going to see an integrative doctor, is the fact that I’m on natural dessicated thyroid. For years I was on Synthroid. It didn’t do anything for me at all (note that Synthroid is a very very popular drug, and for many doctors, esp. endocrinologists, it is the first drug of choice, of course you probably know all this). It wasn’t until I got on natural thyroid that my levels started to stabilize.

    A big issue I have with the state of health care in the US, is that many doctors know nothing about natural thyroid, and will often disparage it as a viable option. Indeed, many less invasive treatments are not even considered, yet it is easy enough for a doctor to write a prescription. Indeed, I had a resident prescribe me some obscure antibiotic for a case of hives that went away on its own. Thank goodness I never filled the prescription.

    We need more emphasis and education on diet, exercise, and healthy habits. I think someone mentioned earlier, we are an instant gratification society. For years as a kid, I believed that if you got sick, you could go just get a drug and it will make you better. Forget about doing anything else, getting a prescription will cure you.

    Also, the medicalization of childbirth is another topic that is a little discussed contributor to rising health costs. The C-section rate keeps going up – its major surgery people – and those surgeries aren’t cheap. I wanted to have a homebirth or birth at a birthing center, but my insurance wouldn’t cover it, even though it would be thousands of dollars cheaper for my insurance company. That’s because no one would be making money off of my childbirth.

    I could go on and on …

  25. Liz says:

    Oh Stephanie, I am right there with you on childbirth. Have you ever seen “The Business of Being Born”? Because, indeed, it *is* a business… gotta get those women in and out, no time for natural labor (time is money!!)… gotta induce and C-section.

  26. Robyn says:

    Katie (and others),
    I think there are several factors involved in our evolution into a “instant gratification” nation. And I’m not talking about just medical and pharma stuff.

    Marketing is a HUGE part. It starts young–commercials targeted to children, Disney movies being basically just a huge advertisement for the ensuing McD Happy Meal, plastic toy conglomerate, and newest theme park ride. By the time we are adults we are pretty used to the TV and the internet letting us know what we “need” to be “happy”. And I’m guilty too. I drool every time I fire up my computer and see the Apple homepage ad for the iPad. Why the fuck to I need an iPad? I have a MacBook AND an iPhone–but I feel the lure. It’s addictive!

    We are the “land of plenty” and we can buy whatever we want, dammit. As an economy, we totally depend on people buying shit. As a nation we don’t make anything, we buy it. What we do make is actually usually contracted overseas as well. When our economy tanked, so did everyone else’s–not because they screwed their financials up, but because the US stopped buying all their stuff.

    So, sure, if I pee every time I sneeze and some cute ad with people made out of pipes tells me they can fix this with a once a day pill (and the listed side effects are spewed so fast I won’t catch them) and I’m used to just opening up my wallet every time I want something, OF COURSE that’s the way I’m gonna go–I’ve been programmed that way my whole life (and the younger gens have it even worse).

    The bottom line is that “consumer is King”–so much is tied into this: medicine, litigation, consumer disposable crap, the car industry, housing, blah blah blah.

    I have no idea how to dig out of it. It pervades every aspect of our life and our government, and by extension, our bodies. It doesn’t matter if I want to stop buying stuff, either. The idea of a “durable good” is laughable. My parents washing machine, the one I learned to do laundry in, is still going strong at 30+ years old. I have now owned THREE since graduate school (less than 15 years).

    Ah, fuck, I could go on forever. I’d better quit while I am ahead.

    But, before I go, my best friend’s husband works (hell, he’s a VP) for a big Pharma company. He doesn’t do research, he’s a business holdings kind of guy, but I get his side of it too. Research costs money. The approval process (while clearly flawed) is lengthy and expensive too. Many therapies (not drugs) never make it to market because there is no CONSUMER DEMAND. Big pharma would jump right on board with lifestyle change programs if it made them money–but it doesn’t because 1)not insurance $$ driven, 2)not quick and easy enough for us dumb Americans and 3)many doctors won’t get behind it.

    It’s a cyclical (circular) argument and problem, so while I’m all about REAL health, I’m also not willing to totally pin all the evils of today’s medical debacle on big Pharma.

    OK, I’m out! Sorry for the rant.

  27. Robyn says:

    Stephanie and Liz,
    I know, I said I was done. I was induced (wasn’t the original plan), and I had NO visions of a home birth and the associated pain. No thank you, and it does not make me any less of a woman to admit that, to each her own. After you’ve carried a child for 41 weeks and 3 days, you get pretty desperate.
    The cost, however, of a birth, is ridiculous, and GREATLY related to the malpractice cost. My OB friend pays $50,000/year just in insurance to deliver babies–that cost comes down to every patient. I’m against “elective” C-sections in the majority of cases, but am agog at the $10K to $15K billable for that surgery. A routine spay costs about $300 with all the bells and whistles at my clinic (and that includes ovaries OR ovaries and uterus, thankyouverymuch). C-sections in dogs and cats are usually emergencies with partially decompensated patients, and yet I don’t think I’ve ever seen one that cost more than $1500.00 Hmm….same surgery dog $1500, human $15,000…

  28. Stephanie says:

    Liz – I have seen Business of Being Born and it is right on. The more interventions that take place during labor, the risk of a C-Section increases (and add $$ to that too). I was lucky enough to do both my births naturally with midwives. However, both of those were in the hospitals, with the added costs.

    Robyn – I’m right there with you against elective C-Sections but those seem to be increasing. And I’m not discounting C-sections for those who really need it – but really, are doctors doing everything they should to avoid C-sections? And the cost of them I agree is astronomical!! In fact, I just had outpatient knee surgery. The total bill – over $14,000!!! and I didn’t even stay overnight!! I am lucky that I won’t have to pay all of that, but how do these numbers get calculated??

    And that is only the hospital bill. I haven’t even gotten the bills for the surgeon or the anesthesiologist and who knows who else is going to bill me.

    When I had my second child, I asked for the itemized hospital bill. There were charges on there for pain medication (which I did not have) and vaccines for my son (which I did not get). Why are these things on there when I never used them in the first place?

  29. Doug Bremner says:

    Hi all,

    Yes I have had research grants from the pharmaceutical industry, for Paxil, Prozac and Duloxetine. I can’t say that anyone is breaking down my doors these days, but… And I have also served on speaker’s bureaus giving what they would call today “promotional talks”. You can read about it in my post from last year “Confessions of a Psychnetter”. I think my view from the “inside” makes my viewpoint all the more useful. You can see my opinion on the current state of the relationship between academic medicine and the pharmaceutical industry here.

  30. Doug Bremner says:

    Maybe here is a better link for the story about my past speaking on behalf of pharma.

  31. dearthyroid says:

    Stephanie;

    Thanks so much for responding to my comment.

    I have an integrative internist and an endocrinologist. Quite honestly, my integrative internist is a thousand times better than my endo. She’s caught things that my endo overlooked. Moreover, she advocates for me and trying new supplements and nutritional changes, which I am tremendously grateful for. She’s so smart. She’s the second doctor I’ve worked with in my life, and since pre/post diagnosis, I’ve had too many to count, that I believe has my best interests at heart.

    I am a HUGE proponent of natural thyroid and believe that it’s vital to preserve the use of natural thyroid. What’s been going on with NT is appalling, disgusting and wrong on too many levels. Every medication for thyroid patients available should remain so.

    Unfortunately, I take synthroid because I’m severely allergic to meat and seafood, so I never had an opportunity to try natural thyroid. However, I do a lot of research and read Liz’s column, among other things to see what else I can do to treat my disease/manage my symptoms and improve overall wellness organically and nutritionally.

    I didn’t know those facts about childbirth and C-sections; I also had no idea that insurance companies don’t cover home births, though I’m sadly not surprised.

    Thank you!
    Katie

  32. Robyn says:

    I am the first to admit that I have no idea how the medical insurance business works. I have tried to research it several times, and get a monumental headache. I’m not sure why it has to rival the tax code…

    I have major medical and surgical insurance for my horse (and mortality, which is required to buy the policy). The cost is 3% of the horse’s purchase price or value (or some value less than that if you prefer to hold your cost down, minimum of $5k I think) + $250/year for the major medical and surgical coverage. For me, it’s running $550/year total for up to $10K of coverage/year . Up front, there are a couple super common, chronic and pricey conditions it will not cover (both orthopaedic). If they pay on a claim for a health issue, that issue is often then excluded for the next 6-12 months (ie, if they remove a portion of your horse’s intestine during surgery, they will not cover that same surgery for a new claim for 6-12 months–but of course will cover anything related to that initial claim). There is a flat $250 deductible, and then a percentage reimbursement (anywhere from 60-100% depending on the issue, compared to what, 80% for most human plans) for diagnostics and procedures up to your insured amount.
    When my previous horse needed a surgery for a developmental bone “thing”, I scrubbed in to watch, ’cause I’m a nerd that way and the surgeon was one of my mentors in school. I spared NO expense–do the surgery the “right” way as though money were no object were my words. For a very complicated arthroscopic surgery with a leader in the field, with sophisticated human grade equipment and anesthesia, the total bill was around $3500. I paid my $250 deductible and probably an additional $300 or so for my uncovered portion. If you add my policy cost I paid about $1100 for a $3500 surgery. And seriously, even if I had to pay the whole thing, that’s a *reasonable* amount, vs. the $20K your surgery will likely cost all told for the same body part!

  33. dearthyroid says:

    Robyn;

    Please, please, please don’t apologize for that rant, it’s absolutely brilliant! I agree with you; we’re hammered with commercials about products we don’t need from the time we’re children in all mediums.

    I also agree with your last point regarding blaming big pharma co’s for everything. I do think broad sweeping change is the name of the game and accountability. We, as patients, need to educate ourselves, regardless of disease or circumstance. We need to consider both options and choose a hybrid or program that works best for us. For example, I bat for both teams: Eastern and Western. I believe there is a place and a need for both.

    Tighter regulations and education about all options needs to be more readily available.

    Great food for thought. Thanks!
    Katie

  34. dearthyroid says:

    Holy shit, Robyn; the numbers are insane.

    As for me, if I were to get pregnant and carry to term, I wouldn’t choose a home birth. I am not a fan of enduring pain for myself. I digress… I like both options.

    I have endometreosis. I take pain medication for it during my menses (for 2-3 days). While I absolutely HATE the way pain meds make me feel (nauseas, achey, etc.), that is more palatable than the pain. I also take other supplements like Evening Primrose and see an acupuncturist, so far neither has helped. That doesn’t mean I’m not open to continuing my search for a better option, make sense?

    Katie

  35. dearthyroid says:

    Doug – Thank you so much for sharing additional links and information about your background. I love your moxie, kid.

    Thank you so much for guest posting on Dear Thyroid today.

    Your brilliant post and everyone’s equally brilliant responses raised many excellent points and additional questions.

    Katie-

  36. dearthyroid says:

    Everyone who participated in today’s conversation, thank you! I am in awe of how knowledgeable and informed everyone is and I learned so much today. THANK YOU A MILLION TIMES OVER.

    Katie

  37. Robyn says:

    Dr. Bremner, thanks for the links. I do think it’s important that you give us the full background–you get more street cred to say you’ve been to the dark side and found it lacking than not to say anything.

    I also stand behind the opinion though, that it’s not all big Pharma’s fault. There are so many stinkin’ layers it looks and smells like an onion.

  38. Lolly says:

    Hi Dough,

    Sorry I never responded last night time difference and the fact I had to take my pills so I could go rattle off to bed. Only kidding.

    Thank you for taking the time to do this article if more Dr’s spoke up like you did, there are a few that do, this world would be a better place.
    I don’t know how you change the system but just speaking out is the first step.
    I know that not every Dr. is quick to write a prescription for drugs you don’t really need and then there are those who don’t prescribe ones you do like in my case just trying to get T3 cytomel because I am not converting T4 very well at all, it’s an ongoing struggle I am still working on that.

    Another thing I wanted to bring to your attention is drugs that are safe but not markerted by the drug companies one for instance is LDN Low Dose Naltrexone which is doing wonders in the MS community.Because there is no money in it and it cost little to produce they are not interested yet this drug could help so many who suffer with cancer, Auto immune disease etc. I have been on it and I can tell you 100% it helped my thyroid eye disease I’m not going to let a doctor tell me I can’t take something I will benefit from just because they are not sure, or won;t take some time to research it.

    I did all my research on the drug before even embarking on it, it carries little or no side effects the only one reported is possible sleep disturbances. I think the pharms want to keep us unhealthy so they can carry on making money from us is the thought I get.

    I think everyone has made some great points and this has been a great read.
    Thank you for being honest and upfront.
    I do hope that you can get your health care reforms sorted out adequately, so it is geared for everyone and that the dr’s pockets aren’t getting deeper so they got zips in there balls and the big pharms aren’t getting richer from keeping patients unhealthy spewing there advertising that is where things need to change at least it’s a start.

    thanks for listening

    Lollyliciousnotbeingmaliciousbeinghonest.

  39. Lolly says:

    And thank you Katie for making this possible.

    I learned so much today and could go on and on and on. but think the buck stops with big Pharm insurance etc.
    education education is the key to a healthy society life style changes, just as Liz promotes daily and most of all, we have to look after our planet, reduce pollutants a CFC gasses,exercise more quit smoking and passing on passive smoke,eat Healthier educate the young they are the new generation.

    There are steps being taken in the UK and I am happy about that, there is still need for change we are getting there slowly, but at the end of the day it is down to us all.

    Lolly

  40. Bee says:

    well. as usual I’m a little late to the party.Just want to throw in my comments- I knew there was a reason I liked you people…to actually read about docs believing in single-payer health ins.warms my heart.Somewhere in my crazy life I have managed to surround myself with loved ones and friends who are turning into teabaggers before my very eyes. I’m learning to keep loving them inspite of our differences. I’ve worked in Radiology for 37 yes. In fact,I remember when we actually called patients PATIENTS and not clients. I am also a patient.I,like many here, take meds to basically keep me alive. My undiagnosed cardiac birth defect wasn’t DX’d until my 40th yr,and I’m sure w/out surgery or my daily meds I wouldn’t be here today. Throw in thyroid disease and the accompaniment of its related health issues and I’d be dead as a doornob for sure. Do I like taking all these meds? Heck no! But I was lucky enough to find a Canadian doc who practices in the US when my health started to go in the crapper and he encouraged lifestyle change way before another pill.Do I think big pharms’ role has enabled MANY US dr. to push pills before treating the pt? Hell yes. I now work in the private sector of med. Urology to be exact.Little did I know how enticing it was to Pharm co’s to have testicles and a scrotum. I was quite surprised to see my 1st testicular implant on a urology CT i performed. Really, a fake “nut”? Naturally it was covered by insurance. As I’m female and have friends willingly lop of whole boobs to save their lives, I was quite surprised… the fake nut looked like a marble. I’m sure it cost a whole lot more than my old catseye marble from my old marble collection. Give me an 80 yr. old man with prostate disease, impaired vision and hearing and a burning desire to obtain an erection and the pharm reps are knocking each other down trying to push their meds-and they push them succesfully. Many old men leave our office happy. If the meds don’t work we hook ’em up with a rep who will provide the lovely penile implant-also covered by insurance. However, after my double cardiac valves were replaced and I tried to go for my cardiac rehab,my insurance told me they wouldn’t cover it because I “just had valves replaced”. I guess if my heart had a penis that got damaged during the procedure I would’ve had better luck. I don’t know about you guys, but sometimes I think these TV ads are doing more harm to themselves because of their their disclosure requirements- and yeah for that. When i see a new drug that says I could go blind, develop a 3rd eye &/or uncontrolled seizures or become a werewolf and ultimately suffer the worst of the possible symptoms-DEATH- i tend not to find myself rushing to my PCP saying “sign me up.” And as for the “bennies” of all these pills-some actually keep people alive way longer than their dignity lasts. But as long as the drug companies successfully push these meds and docs are too tired and overworked or lazy to find alternative solutions, G’ma can successfully sustain life while crapping in her diaper and drooling down her chin…the only problem is Grandma doesn’t realize shes still with us. I, for one, plan on taking up smoking by the time I notice the first ravages of senility-enough of this whooeey about living to a hundred if my mind has left the building. However, by then, the tobacco industry will have come up with a delicious cigarette that makes me smell good so their friends in pharmaceuticals can successfully to treat my lung CA and the insurance cos.can rape and pillage my family for any medical expense not covered by private sector insurance.

  41. Stephanie says:

    Lolly – thanks for mentioning LDN. I have just started it, and I have high hopes for it. This drug has the potential to help many people, but the only marketing that is happening is word of mouth, since you’re right – there’s no money to be made off of it.

    Bee – I really enjoyed reading your post. It managed to make me laugh and shake my head in agreement at the same time. Something is very wrong when unnecessary penile implants are being approved while necessary cardiac rehab is not.

    Katie – thanks for starting the dialogue. BTW – just my insurance company doesn’t cover homebirths – I know there are some that do. Now I curse myself – I should’ve just had the homebirth despite the fact that insurance probably wouldn’t have paid for it. I then wouldn’t have had to deal with the hospital headaches afterwards.

  42. Doug Bremner says:

    Just want to say that I have been reading along. Great dialogue!

  43. carolyn says:

    doug

    as always, an excellent post. one small quibble- i’m pretty sure that new zealand is the only other country in the world that allows DTC marketing of pharmaceutical drugs. so the US is almost the only country to have this stupid free for all, bit not the only country.
    in july, an acquaintance put on klonoprin for anxiety suddenly went to the roof of his apartment building and jumped to his death. in october a colleaque put on levaquin for the flu suffered a major stroke.
    one wonders if there is a plot a foot to exterminate our population while making us pay through the nose for the privilege

  44. judy says:

    I seriously think something is going to happen to me, I am taking 50mc of L thyroxine a day now for 8 months, I can honestly say I am worse now than 8 months ago. When I wake up in the morning, I sit up on the side of my bed and cry…….My Dr. raised my level 4 months ago from 25 to 50mc she told me in 3 weeks she swore I would feel better, NO I am not, in anyway shape or form…can anyone out there help me…? thank you very much

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