In 1996 I was diagnosed with rheumatoid arthritis (RA), partly by symptoms and partly by a blood test for Rheumatoid Factor (RF). A normal RF level is less than 60 units per cc of blood (some labs use 50 or even 40). My level was 100 u/cc. At the advice of a doctor named Oliver, I also had a test for antibodies to the Mycoplasma organism, and that test was positive. After some discussion and disputation with my doctor, I was treated with tetracycline, on a regimen Dr. Oliver recommended to my doctor, and after three years I was free of symptoms. In 2009, after a lapse of ten years, I was re-tested for RF and other, newer clinical indicators. I was then told I have no clinical signs of RA. I had it, and now I don't; I was cured. Yet most doctors, if you ask about treating RA with antibiotics, will tell you it is a quack remedy.
My father had found Doctor Oliver years earlier, looking for an effective treatment for his own arthritis. Dr. Oliver was a colleague of Dr. Thomas M. Brown, who developed the understanding that arthritis is a bacterial allergy, treatable by antibiotics to eliminate the bacteria. You can learn more from the resources provided at The Road Back Foundation, named based on Dr. Brown's first book, The Road Back. More recent editions by his co-author Henry Scammell are titled Arthritis Breakthrough.
Most RA specialists treat the symptoms (not the disease) with a series of quite expensive treatments, including gold injections and various semi-steroid and steroid pain management medicines. There is a sort of standard round of treatments that lasts about twenty years before they declare they are out of effective treatments, and leave you to the tender mercies of NSAIDs such as Advil, just at the age when a large dose of Advil is most likely to cause a perforation of your stomach lining. During that twenty years, you and your insurance company together will spend about $100,000 on treatments.
A one-year supply of tetracycline costs less than $30. It takes three to five years to cure arthritis when it is caught early enough. In my father's case, his infection has proven too advanced to cure completely, so he is still taking tetracycline, at a cost of $30 yearly. For him, tetracycline is like a vitamin. Without it, he soon loses the ability to walk without pain.
I have written a number of times that the main problem with American medicine is that it has become a big business. Little did I know. I just finished reading White Coat, Black Hat: Adventures on the Dark Side of Medicine by Carl Elliott (M.D., PhD, if I read his CV right). I am horrified. I am also fortified, when I run up against my doctor saying he relies on "evidence based medicine." As shown in the second chapter of the book, the "evidence" is largely fudged! But I'm getting ahead of myself. I'll go chapter by chapter.
- Chapter 1, "The Guinea Pigs" – Phase I trials of a new drug test whether it has acceptable levels of side effects and how safe it is. Such trials often involve unpleasant procedures such as colonoscopies or frequent blood testing, and often require residential sequestering of some or all subjects. So trial subjects are paid, and most such trials are dominated by "professional guinea pigs" who make a living at it. Many will lie about their state of health, how recently they may have done a previous trial, and other things that invalidate the results of the trial. Bottom line: Phase I trials of new drugs are often worthless, which is why every couple of years there is a problem with a Phase II or Phase III trial, such as patients dying of a supposedly "safe" dose.
- Chapter 2, "The Ghosts" – Every pharmaceutical company employs teams of writers who write a great variety of materials, some disguised as journalism, some being direct press releases, but many being articles intended for publication in medical journals. These articles report the results of drug trials as favorably as possible. They are published under the name of a medical researcher, who has usually been paid for the use of his or her name. Sometimes the "author" never sees the article. A bit of statistical lingo here: A "significant" result is one that is "different from a null hypothesis at the 0.95 level". That means if you do something twenty times, you'll probably get a "significant" result at least once, just by chance. Then there are "outliers". A statistical analyst is allowed to throw out an extra-high or extra-low result, claiming it was "experimental error". This will often change a finding of "nothing of significance" to "significant." Then there's the "drawer veto". A trial that yields negative results is often left to molder in a drawer while the trial is repeated (if the company has enough money). The repeated trial will show a better result about half the time, and by throwing out an outlier or two, a "significant" result can he claimed, so they go to publication, pay an unwitting "author", and get "scientific" backing, or "evidence" that the new drug works. Bottom line: Several studies of medical literature have been done, tracing the source of articles about specific drugs. In every case, more than half (up to 75%) of the articles were ghostwritten by writers in the employ of a drug company. "Evidence based medicine" is illusory, at least as regards drug trials.
- Chapter 3, "The Detail Men" – This is the older term for "Reps" or drug company representatives, the very personable, very attractive, very well dressed salespersons who show up at a doctor's office, often with pizza for everyone on the staff, with baskets full of pens, note pads, wall calendars, perhaps anatomical posters, all helpfully branded with the company's logo, and of course, samples of the current "hot drugs". I have yet to see a physician's office that was free of drug company trinkets. Dr. Elliott shows with overwhelming evidence that doctors are strongly influenced by even small gifts. Public databases show that after a Rep visit, prescriptions for the "hot drugs" skyrocket. Bottom Line: Your doctor's suggestion for a prescription is quite likely to be influenced by whose Rep visited the office last, more than by the exact medical needs of your case.
- Chapter 4, "The Thought Leaders" – These are public figures, manufactured out of mild-mannered researchers by generous stipends, star/celebrity treatment, lots of force-fed PowerPoint presentations helpfully written by drug company staff. They speak at conventions, often organized by the companies; they get on TV talk shows; they give press briefings; and generally promote the drug company's interests, but nearly never mention the source of their paycheck. Bottom Line: The people you doctor is listening to are most likely KOLs, Key Opinion Leaders, in the employ of large pharmaceutical companies.
- Chapter 5, "The Flacks" – At this point, I confess I was becoming overwhelmed by the pervasive manipulation of perception the book's author was describing. It got worse. These are the Public Relations specialists. They take a page from the fellow who first learned to sell pianos by selling the public on the idea that every home ought to have a Music Room, even if it was just a corner of the parlor. What else ya gonna put in your music room? They take it much further, preparing the public's perception of a drug for years before it passes through its trials (if it does). The rather recent FDA ruling that allowed drugs to be marketed directly to the public (one third of all TV ads, by my count), has just upped the ante. Doctors who decline to prescribe the latest "hot drug" to their anxious patients soon lose those patients to more complaisant doctors. Bottom Line: The people you are listening to are a different kind of KOL, the ad company writer.
- Chapter 6, "The Ethicists" – Imagine a warehouse full of gold, surrounded by a pack of attack dogs. But! The dogs are all munching on steaks supplied by your friendly local gold thief while he waltzes in and out with a wheelbarrow. Do you really need details? A great many, perhaps most, ethical review professionals are in the employ of the drug companies. They are allowed certain freedoms, and even encouraged to criticize certain abuses. But those few who allow themselves to become too independent, who expose the more sensitive misdeeds of their benefactor, find themselves without funding, and may find it hard to secure employment. Bottom Line: Where you stand depends on where you sit. American Big Pharma is doing their darndest to make sure everyone who matters is sitting right where they want them.
One rule I follow as strictly as I can, is to request generic drugs whenever possible. This is not primarily to keep my money out of drug company coffers (though that is a nice side benefit), but it restricts the pool of drugs to those that have been used for ten or twenty years, because they are out of patent, and have at least not been taken off the market for excessive danger. Their effectiveness has also become pretty well known. Few "younger" drugs are likely to be significantly better. Make your doctor prove that a "hot drug" is really so much better it is worth the extra cost and extra risk. Don't be a passive patient. You might know more than your doctor does!
No comments:
Post a Comment