Kaiser Permanente Sunnyside Medical Center in Clackamas County, Oregon, USA. (Photo credit: Wikipedia)
While we have too many technological advancements in Modern Medicine, the cure takes longer, you are sure of the side effects and of course it is costly.
I am yet to see a Doctor of Modern Times( I mean from late eighties) who checks up your pulse, talks to you on your symptoms and family History.
They start writing prescriptions and order tests, not necessarily in that order,
Specialization in Medicine is fine but most of the Doctors seem to be unaware of the other parts of the body.
Nor they seem to be bothered about the side effects of the medicine they prescribe.
Hospitals having become Corporations, the Doctors do not even ask you your case, they have it recorded by some body else and you carry the paper inside.
To check the veracity of my statement please go to a Multi-speciality Hospital.
Now read the Research on the Clinical decisions of Modern medicine.
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The problem is that physicians don’t know what they’re doing. That is how David Eddy, MD, PhD, a healthcare economist and senior advisor for health policy and management for Kaiser Permanente, put the problem in a Business Week cover story about how much of healthcare delivery is not based on science. Plenty of proof backs up Eddy’s glib-sounding remark.
The plain fact is that many clinical decisions made by physicians appear to be arbitrary, uncertain and variable. Reams of research point to the same finding: physicians looking at the same thing will disagree with each other, or even with themselves, from 10 percent to 50 percent of the time during virtually every aspect of the medical-care process—from taking a medical history to doing a physical examination, reading a laboratory test, performing a pathological diagnosis and recommending a treatment. Physician judgment is highly variable.
Here is what Eddy has found in his research. Give a group of cardiologists high-quality coronary angiograms (a type of radiograph or x-ray) of typical patients and they will disagree about the diagnosis for about half of the patients. They will disagree with themselves on two successive readings of the same angiograms up to one-third of the time. Ask a group of experts to estimate the effect of colon-cancer screening on colon-cancer mortality and answers will range from five percent to 95 percent.
Ask fifty cardiovascular surgeons to estimate the probabilities of various risks associated with xenografts (animal-tissue transplant) versus mechanical heart valves and you’ll get answers to the same question ranging from zero percent to about 50 percent. (Ask about the 10-year probability of valve failure with xenografts and you’ll get a range of three percent to 95 percent.)
Give surgeons a written description of a surgical problem, and half of the group will recommend surgery, while the other half will not. Survey them again two years later and as many as 40 percent of the same surgeons will disagree with their previous opinions and change their recommendations. Research studies back up all of these findings, according to Eddy.”
“I agree SMJ brought out all Healthcare related ills in the open though it was never a secret. Though as an activist Doctor, I liked that episode, I felt it was slightly tilted to one side esp. Maj Rai’s case & wish the truth comes out in the court as that complaint is is sub-judice.
I also wish Aamir Khan, in subsequent episodes, has the gall to bring out role of Black money in movies, Casting Couch in Film world & role of underworld & politicians in film financing.Then I would consider him as a guy with guts.
Till then, lets copiously shed tears every Sunday morn 11-12 noon !”
The above is a response to my Blog from “Dr M Chandrashekhar‘
Thank You,Sir.
It needed some courage of conviction to say what you said.
Wish we had more Conscience keepers like you.
I agree regarding casting couch.
Yes, we will continue to shed tears as the Society warrants it.
( As a mater of fact,I strongly criticised Aamir Khan for his episode of Child Abuse, which I found to be nearing porn!
But the issue regarding Doctors was warranted ans was managed well though as The Doctor said slightly tilted.
That is understandable because of the pent-up anger against Doctors whom one trusts next only to God.
Satymev Jayate-Aamir Khan, Doctors and Unethical Practices.
Though all of us are aware of the malpractices of the Doctors, the credit for bringing out in the media must go to go Aamir Khan who exposed one of the most reprehensible corrupt practices of the Doctors, that of overcharging for a Life saving drug at a critical moment.
I have a friend whose son in Law is a distributor for Life Saving drugs.
English: Indian actor Aamir Khan (Photo credit: Wikipedia)
Incidentally my friend retired as an Executive in a Pharma Company.
A life saving drug for a serious heart condition costs Rs.1600(MRP)
Dealer price 1219.
The Doctors advice the Medical Retailers to charge the patients Rs 8000-10,000 and they share the extra amount in the ration of 50:50 with the Retailer!
Ever gone to a Multi Speciality hospital
For a common cold you are asked to go through a plethora of tests and you end up paying not less than Rs 5000 and the medicine offered would cost you Rs 15!
Couple of years back my daughter had constipation,
I told her to take Epsom Salt and told her a specialist will charge her heavily for the prescription and we had a wager of Rs 100.
We visited Apollo Hospital in Chennai to meet up with a Gastroenterologist.
First question he asked was as to where she was working and what her salary was and whether she will be paying by Credit Card!
It is good that Aamir Khan is invited to Parliament.
At least Public would become aware this issue.
It is a different issue that many MPs have stakes in Pharma Companies and are also distributors for Pharma Products!
What is nauseating is that IMA has threatened to sue Aamir Khan and doctors have threatened him.
Guilty conscience!
Story:
New Delhi, Jun 19: Bollywood superstar Aamir Khanhas been invited to Parliament and he is expected to give a speech in Rajya Sabha on Thursday, Jun 21.
The star, who has recently raised issues related to alleged malpractice in medical sector through his TV reality show Satyameva Jayate, faced controversy. However, his research and the programme caught attention of many including Bharatiya Janata Party (BJP) MP Shanta Kumar.
Shanta Kumar, who is an MP in Rajya Sabha and also heads the Parliamentary standing committee on commerce, invited Aamir to enlighten them more about the shocking incident.
Aamir, during the episode of Satyameva Jayate on May 27, showed how doctors in several medical organisations allegedly robbed patients through over-pricing life-saving medicines.
During his show, Aamir spoke with many people who were victimised when they approached reputed hospitals for treatment. Many doctors have been accused of forcing patients to undergo surgeries, though it was clear that those people could have been cured with simple medicines.
Earlier Aamir refused to apologise to the Indian Medical Association which has accused him of defaming the medical profession through Satyameva Jayate.
“I am very comfortable if they (IMA) plan to take legal action if they feel that I have done something wrong. Of course, the courts are available for them. My answer is no, I will not be apologising,” Aamir told NDTV.
The actor denied IMA’s charge of defaming and insulting the medical profession. “I deny that I have done that. I have the highest respect and regard for the medical profession,” he said.
Now, after hearing hastily the symptoms, and in certain cases ask the patient what medicine he/she had taken the last time,starts writing a string of medicines and recommend a plethora of tests.
Examining patients and taking a medical history are more useful to hospital doctors in diagnosing patients than high-tech scans, according to a study from Israel.
Tests such as CT scans and ultrasounds add to hospital bills, but doctors said that such tests given right after patients showed up in emergency rooms only helped with diagnosis in roughly one of three cases, the study — published in the Archives of Internal Medicine — said.
There is also research showing that the radiation from multiple CT scans might increase the risk of cancer over the long term.
To see whether such scans were really helpful, researchers led by Ami Schattner of Kaplan Medical Center in Rehovot, Israel, followed all the patients who showed up at the emergency room of a teaching hospital and were subsequently admitted.
“Basic clinical skills remain a powerful tool, sufficient for achieving an accurate diagnosis in most cases,” Schattner and his colleagues wrote.
“Physicians may count more on their clinical faculties when making decisions about patients.”
In order for scientific studies to happen, someone has to pay for them.
The top funder for any drug trial is the pharmaceutical company that makes it, since the manufacturer is most invested in “proving” how spectacular its drug is. Dr. Golomb uses the case of statins as an example, stating that all of the major statin studies have been funded exclusively by the drug industry.
The second-highest funder of drug studies is the National Institute of Health (NIH), which is not the group of neutral government experts you may have assumed them to be. In fact, NIH accepts a great deal of money from Big Pharma and is deeply enmeshed with the industry.
But drug companies publish only a fraction of the studies they fund — the ones that promotetheir drugs.
In contrast, studies that have favorable findings almost always make the cut.
There are simply thousands of scientific studies out there that have never been seen by you or your physician because they have been screened out by editors and reviewers who are being paid to uphold an industry agenda.
Published studies overwhelmingly favor the funding company’s drug. Whichever drug is manufactured by the study sponsor is the drug that comes out on top, 90 percent of the time!
Given this, how can medical journals be considered unbiased?
Bias #2: Bad Results are Submitted as Good
When a scientific study has findings that cast doubt on the efficacy of a drug, oftentimes the negative findings are morphed into positive ones.
For example, in 2008, FDA officials analyzed a registry of 74 antidepressant trials, which included trials that were published and those that were not. The FDA’s findings were then written up in an article in the New England Journal of Medicine1.
This is what they found:
38 of the trials reported positive results, and 37 of the 38 were published.
36 trials had negative or questionable findings. Of the 36, 22 were not published at all, and 11 were published in a way that conveyed the results as though they were positive.
So, if you just went to the published literature, it would look like 94 percent of the studies were positive, when in reality only about 50 percent were positive … equivalent to a coin toss.
For statins, the odds that the funding company’s drug will come out on top are staggering1:
The odds that the funding company’s statin drug will come out looking better than anyone else’s statin in the “results” section of the article are 20:1.
The odds that the funding company’s statin will come out on top in the “conclusions” part of the article are 35:1.
So, even if they can’t make the results look good, they can often find a way to twist the conclusions so that their drug appears favorable.
Selectively omitting negative trial results can be devastating to your health, as Merck & Co. proved when they concealed the fact that three patients suffered heart attacks from Vioxx during clinical trials. They conveniently omitted this data (along with other relevant findings) from the copy of the study they submitted to the New England Journal of Medicine for publication.
The omissions were uncovered years later during the 7,000 Vioxx lawsuit litigations.
Bias #3: A Favorable Study is Submitted Multiple Times
When a study yields positive results, it is often submitted multiple times in a way that the reader doesn’t realize it’s the same study, obscured by different author lists and different details. Analyzers have had to look very carefully to determine which studies are actually duplicates because they are so cleverly disguised.
Not surprisingly, trials reporting greater treatment efficacy were significantly more likely to be duplicated, according to Dr. Golomb’s reporting.
In one analysis of the published reports about ondansetron (an anti-nausea drug), the same study was published 5 times. This duplication of data led to a 23 percent overestimation of ondansetron’s effectiveness when a meta-analysis was performed.2
Talk about good mileage!
Bias #4: Follow-Up Reviews Done by Biased Experts
The editorials that follow from a study, submitted by so-called unbiased experts and then published in reputable journals, are often done by non-neutral parties who have a financial tie to the drug maker.
Dr. Golomb uses the case of calcium channel blockers (a type of heart medication) as an example. The connection between authors declaring their support for calcium channel blockers and those not in support of them was highly statistically tied to their affiliation with the drug manufacturer — in fact, the odds that their opinion was NOT due to their affiliation was more than 1,000:1.
Bias #5: Ghostwriting
Many of the articles that appear in medical journals purportedly written by well-known academics are actually written by unacknowledged ghostwriters on Big Pharma payroll.
Consider the example of Parke-Davis and their drug Neurontin.
Parke-Davis contracted with a “medical education communication company,” or MECC, which is a company paid almost exclusively by pharmaceutical companies to write articles, reviews, and letters to editors of medical journals to cast their products in a favorable light.
In this case, MECC was paid $13,000 to $18,000 per article. In turn, MECC paid $1,000 each to friendly physicians and pharmacists to sign off as authors of the articles, making the materialappear independent.
This was also done by Pfizer as a strategy for marketing Zoloft. A document was written that included 81 different articles promoting Zoloft’s usefulness for everything from panic disorder to pedophilia.
The only problem was, for some articles, the name of the author was listed as “to be determined,” even though the article was listed as already completed. They weren’t helping out an existing team of scientists who happened to be talentless at writing — Pfizer wrote the article, and then shopped around for scientists willing to claim authorship, to give it a veneer of credibility.
Medical journals are generally considered by medical practitioners to be a source of reliable information. But medical journals are also businesses.
Three editors, who agreed to discuss finances only if they remained anonymous, said a few journals that previously measured annual profits in the tens of thousands of dollars now make millions annually.
The truth is that Big Pharma has become quite adept at manipulating and brainwashing practitioners of conventional medicine. They influence the very heart and center of the most respected medical journals, creating dogma and beliefs that support the drug paradigm because it is blessed by the pinnacle of scientific integrity: the prestigious peer-reviewed medical journal.
Peer-reviewed medical journals contain advertisements that are almost exclusively for drugs, amidst articles that are biased toward promoting those drugs. If you have looked through a medical journal lately, you’ll see full-page Pharma glossies, cover to cover.
In 2003, drug companies spent $448 million dollars on advertising in medical journals2. It has been calculated that the return on investment on medical journal ads is between $2.22 and $6.86 for every dollar spent, with larger and older brands at the higher end.
Long-term returns may be even higher when you consider that one ad viewed by a physician could result in hundreds or even thousands of drug purchases, based on the prescriptions he or she writes.
The term “peer-review” has come to imply scientific credibility. But the fact is that many of the peer-reviewers are on the drug company’s payroll, and those who are not are unlikely to detect flawed research or outright fraud.
Medical journals are the number one source of medical information for physicians. In fact, nearly 80 percent of physicians use medical journals for their education, which exceeds information from any other source3.
Do you really want to blindly take the advise of a physician whose only source of medical information is a medical journal engaged in such profound conflicts of interest?
Advertisements for drugs focus the “latest and greatest” drugs to hit the market, drugs which may not be superior to existing, less expensive alternatives. So physicians are seduced into prescribing the newest, most expensive drugs, which drives up your healthcare costs.
An excellent article in PLoS Medicine regarding drug advertising in medical journals concludes4:
“The scholarly nature of journals confers credibility on both articles and advertisements within their pages. By exclusively featuring advertisements for drugs and devices, medical journals implicitly endorse corporate promotion of the most profitable products. Advertisements and other financial arrangements with pharmaceutical companies compromise the objectivity of journals.
The primary obligation of industry is to make money for its stockholders. The primary obligation of journals should be to physicians and their patients, who depend on the accuracy of information within these publications. Medical journals should not accept advertisements from pharmaceutical companies, medical device companies, or other industries ‘relevant to medicine.’”
In 2004, Dr. Richard Horton, editor of the Lancet, wrote, “Journals have devolved into information-laundering operations for the pharmaceutical industry.”5
Bias #7: Drug Companies Masquerading as Educators
The education of medical students and residents also comes through the filter of the drug industry, which seeks to groom them before they even finish medical school.
According to Dr. Golomb’s data, Big Pharma now spends $18.5 billion per year promoting their drugs to physicians. That amounts to $30,000 per year for every physician in the U. S.!
And drug companies are allowed to develop their own education curriculum for medical students and residents, lavishing them with gifts, indirectly paying them to attend meetings and events where they promote the company’s products.
Why is the Accrediting Commission for Continuing Medical Education (ACCME) so permissive with industry involvement?
Almost half of the members are representatives of Big Pharma or are consultants for businesses that work directly with it to prepare these educational programs. Only a few represent academic CME institutions.
Any discussion of physician “seduction” would be incomplete without the mentioning of the 100,000 drug reps, who are groomed and trained to wine and dine and otherwise shower physicians in sweetness until they are handing out prescriptions like candy.
Reps are even taught tactics for manipulating doctors for industry benefit, as a standard part of their training.6
Hell Hath No Fury
What happens if a physician or other person speaks up about these conflicts of interest? What happens to the proverbial whistle-blower?
Intimidating phone calls and direct threats, for starters.
In one case, Dr. Buse, an endocrinologist who is the incoming president of the American Diabetes Association, presented data in 1999 about his concerns about the risks of Avandia. Dr. Buse was intimidated with multiple phone calls by drug company officials. They suggested he could be financially liable to the company for $4 billion in lost revenues due to his “unscrupulous remarks.”
Other truth-tellers have had their reputations trashed or job offers rescinded for speaking the truths that Big Pharma works so hard to keep under wraps.
“Too Big to Nail”
An individual truth-teller might be vulnerable to the wrath of an angry drug company, but drug companies are unlikely to suffer much of a consequence for their crimes.
Pfizer, the world’s largest pharmaceutical company, engaged in illegally promoting their drug Bextra for off-label use, despite their knowledge that it was associated with an increased risk of stroke and heart attack.
Bextra was pulled from the market in 2005, but not before many people were damaged by its use. When Federal prosecutors realized that convicting Pfizer would likely be a corporate death sentence (as any company convicted of major health care fraud is excluded from Medicare and Medicaid), they cut Pfizer a deal. Just as the big banks on Wall Street were deemed “too big to fail,” Pfizer was deemed “too big to nail.”
Why?
Prosecutors claimed to be concerned about the loss of jobs by Pfizer employees and financial losses to Pfizer shareholders as a result of being excluded from the Medicaid/Medicare programs.
So the prosecutors charged a Pfizer subsidiary, Pharmacia & Upjohn Co., instead. In fact, this particular subsidiary company was created specifically for this purpose, as a sacrificial lamb, having been incorporated the very same day its lawyers filed a “guilty” plea in another case involving kick-backs, leaving Pfizer with the penalty equivalent of being sent to bed without supper.
In the end, all Pfizer lost was about three month’s profit, but all contracts, including those with Medicaid and Medicare, were spared.
This is just one more example of your federal government failing to protect you, and opting to protect big business’ interests instead.
The bottom line is, the drug companies aren’t going to protect you.
And it is unlikely that your physician can protect you either — even a well-meaning one — when he or she is operating within a system that has become RIGGED for Big Pharma profit.
Only you can protect yourself.
So, until real systemic change takes place, your best health strategy is quite simply to employ and maintain a naturally healthy lifestyle that will optimize your body’s innate healing abilities and minimize your need for the drug companies’ latest concoctions.
Five out of six approved prescription drugs seldom benefit patients, says a critic of the pharmacy industry. The 6th one works just because big pharma says it does.
Chloresterol-lowering statins were a conspicuous example of the drugs industry over-hyping a product to avert heart attacks, even though they could do more harm than good, said Donald Light, sociologist and professor of comparative health policy at the University of Medicine and Dentistry in New Jersey, U.S.
Drug corporates hyped-up patented medicines, spent astronomical sums on getting doctors to prescribe them and underplayed serious side-effects, reports the Telegraph.
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