"When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov
''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.'' -Robert Ehrlich, drug advertising executive.
"Opinions are like sphincters, everyone has one." - Chris Rangel
I'll be away at a conference the rest of the week. Blogging will resume next Sunday.
posted by Sydney on
4/28/2002 07:06:00 AM
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European Doctors and Antisemitism: Sadly, the rampant anti-semitism in Europe extends beyond the liberal elite to the medical profession. The Jerusalem Post reports that the Israel Medical Association is threatened with expulsion from the World Medical Association:
“The Israel Medical Association (IMA) is in danger of being ousted from the World Medical Association (WMA), whose members include 130 national medical associations, because of the ongoing political campaign against Israel. The WMA due to meet in Geneva next week, will discuss charges made against Israel.”
We’re not talking about charges made against Israeli doctors here, we’re talking about charges made against the nation of Israel. Yet the Europeans want to exclude Israeli doctors on the basis of their nationality:
“The antagonism towards Israel was clear at last week's meeting in Vienna of the European Forum of the European Medical Associations, part of the World Health Organization, which Blachar attended. Critical resolutions were introduced by the Swedish and British delegations, but they did not pass because they required unanimity, said Blachar. "Weeks ago we received calls from IMA members and affiliated specialists' societies such as the Israel Pediatrics Society and the Israel Cardiology Society, who had fielded criticism from counterparts abroad," said Blachar.”
The Israel Medical Association is trying it’s best to make their position as physicians clear. They set up a committee made of both Arab and Jewish Israeli physicians to address the concerns of the International Red Cross and the World Health Organization:
“The position paper denounces terrorism and the indiscriminate killing of innocent civilians, and attacked the misuse of ambulances, such as when explosives were hidden in a Palestinian Red Crescent Society ambulance near Ramallah.
The IMA committee drafted a declaration affirming their allegiance to the Hippocratic Oath that posits life as a supreme value. It declared "that our obligation as doctors and as human beings to the people of both nations [Israelis and Palestinians] takes precedence over any dispute or confrontation. The declaration condemned "any restriction, constraint, or attempt to hinder the work of medical teams in the performance of their professional duties which is not necessitated by the realities of the situation." Blachar asked Dr. Ron Pundak, an architect of the Oslo Agreement who now works at the Peres Peace Center, to find a Palestinian counterpart to sign the declaration. But Pundak, said Blachar, did not get back with a name.”
No doubt Palestinian doctors are too afraid to sign such a declaration. They run the risk of being executed in the streets by their fellow Palestinians for “collaborating.” The anti-semitism of Europeans must indeed run deep for them to even consider removing the Israelis from the World Medical Association just because their country is at war. To do so would be to implicitly support the Palestinians. Yet it is the Palestinians who routinely massacre civilians, who hide explosives in ambulances, who execute their own in the streets without a fair trial, and who send their teenagers on murderous suicide missions. It baffles the imagination to think of a body of physicians acting in such a way. Then again, I used to be baffled by the Holocaust, but the more I hear of stories like this one, the less baffled I am.
posted by Sydney on
4/28/2002 06:23:00 AM
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More World Health Madness: The WHO is in a tizzy over the fried and baked food findings that were rushed into the public spotlight:
“The World Health Organization will gather experts for an "urgent" conference in June to assess the possible public health risks from acrylamide, the cancer-causing chemical that Swedish scientists reported this week was found at high levels in many fried and baked high-starch foods.
The WHO said the meeting, details of which were undetermined, was being called to analyze both the Swedish report and other information to determine the nature of the possible risk to people, to assess levels of acrylamide in food in nations other than Sweden, and to develop "appropriate guidance to reduce exposure to acrylamide."
Let’s hope they don’t get carried away and make recommendations to the EU about regulating cooking. Meanwhile, in the US, the study is also drawing concerns:
“Officials at the FDA and the Grocery Manufacturers of America said yesterday that they hoped to get copies of the Swedish data soon so they can analyze the testing process and determine whether the results can be repeated. They said that the Swedish results should be considered preliminary.
"This is the first time the compound has been found in large amounts," said GMA spokesman Gene Grabowski. "The industry has been quite concerned and is trying hard to find out what's going on. Scientists haven't been able to assess the nature of what's really involved because the data is unobtainable." (italics are mine)
That last bit sums up the whole problem with this study. When researchers publicize their sensational conclusions without providing the data to back them up, it usually means they don’t have good data.
Mental Health Parity: On the face of it, the bill for parity in mental health care sounds like a good thing, but when given a closer look, it quickly becomes a boondogle. It turns out that the bill wants to mandate that employers and insurers cover all mental health diagnoses:
“In the coming debate, the battleground will shift to a 941-page book -- the American Psychiatric Association's Diagnostic and Statistical Manual, or DSM, a compendium of the diseases, disorders and distress that affect the human psyche. The primary issue is whether equal health benefits should be extended to every condition listed in the DSM or limited to the most serious disorders, such as schizophrenia, bipolar disorder and major depression.”
Extending healthcare coverage to every diagnosis in the book would be fiscally disasterous. We have expanded the definition of illness so widely that just about anyone can be classified as psychologically impaired. Take, for example, the cause of autism, or “social phobia.” I took the self-test for social phobia at the Paxil® web-site and was told that I probably suffer from it, even though I indicated that my daily functioning was not impaired. (The questions, of course, are designed so that just about everyone would answer in the affirmative to some degree in the hopes that they’ll pressure their doctor in writing a prescription for Paxil.)
Advocates of comlete coverage insist that having the diagnosis won’t mean the government will pay for it:
“The American Psychiatric Association said critics were spreading misinformation about the validity of the group's manual. Jay Cutler, special counsel for the association, said that diagnosis and treatment were separate issues, and that clinicians would offer treatment only to those people whose disorders significantly interfered with their lives.
"There would have to be clinically significant impairment" in order to be eligible for treatment, he said. "If I have a cold it would be covered, but should it be treated? If you only sneeze once, you are not going to get coverage."”
The problem is that in practice it’s almost impossible to limit coverage based on severity of symptoms. Every doctor who has ever treated a cold knows that. We are constantly fighting off pressure for antibiotics from patients under just the same circumstances that Mr. Cutler describes. It’s even harder for mental health issues, because the severity of the symptoms is largely within the province of the patient’s perception. A patient who, for example, has taken the Paxil test can easily become convinced that he has a disorder even though he’s functioning just fine. It’s extremely difficult to disabuse people of this notion once they’ve seen their perfectly normal reactions classified as abnormal in the media, even if it's only in an advertisement. The result is that more and more people get referred and treated for what is nothing more than normal human behavior. Congress should consider this issue carefully before jumping on the full parity bandwagon. Such a move may have been feasible twenty years ago, but not today when almost everything is classified as a disease. posted by Sydney on
4/28/2002 06:04:00 AM
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Mixed-Up Media: Are certain types of diabetes drugs safe or dangerous? (requires New York Times registration) The media isn't sure. The Reuters story says that Avandia, a drug that makes the body more sensitive to insulin, has been found to be free of liver toxicity:
"A review of clinical trials originally conducted by SmithKline Beecham Pharmaceuticals--the maker of Avandia--was undertaken by Dr. Harold E. Lebovitz of State University of New York in Brooklyn. Lebovitz, who is a major stock shareholder in SmithKline Beecham, also sits on the company's advisory board.
For the review, Lebovitz and his team re-examined the data from 13 studies that originally aimed to examine the efficacy and safety of Avandia.
"No evidence of (liver toxic) effects was observed in studies that involved 5,006 patients taking rosiglitazone," Lebovitz and colleagues write.” (Admitttedly, he might be a little biased.)
Yet, the New York Times says Avandia and a related drug, Actos, are risky:
“GlaxoSmithKline and Eli Lilly & Company have added warnings about heart and liver risks to the labels of their diabetes drugs, which are similar to a medication that was withdrawn from the market in 2000 because of links to fatal liver damage.
The Food and Drug Administration posted information today about heart and liver risks in Glaxo's drug, Avandia, and in Actos from Lilly, although warnings were added to the labels earlier.”
Actually, the New York Times story is wrong. The FDA did issue a warning about both Actos and Avandia, but it wasn’t about liver damage, it was about the risk of congestive heart failure. Even then, the FDA is being very conservative in issuing the warning. They based the decision on studies that compared people who take insulin alone to people who take both insulin and one of the drugs. The studies involved small numbers of patients, making it difficult to generalize the results. Only four of 566 patients in the Actos study developed heart failure. No numbers are given for the Avandia study. It’s not clear that these are clinically significant differences, especially when you consider that people with diabetes are already at risk for heart failure. That risk is higher for those whose diabetes is poorly controlled. Since both Avandia and Actos work by increasing the body’s sensitivity to insulin, they are used in patients who are not responding well to insulin alone. It could just be that the patients on both insulin and the drugs were in poorer health to begin with and had a higher risk of heart problems than those on insulin alone.
posted by Sydney on
4/28/2002 05:37:00 AM
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