Legal Drugs: US and Nicaragua

Quite a few people have talked about medicines, medical care, ... contrasting US doctors, US-made//first world-made medications and such with what is the norm in Nicaragua. For that reason, I felt this article in Natural News fits here.

I see two different issues:

  • US doctors are better than Nicaragua doctors (maybe)
  • US made drugs are higher quality (maybe)

The Natural News article at least gives us something to think about on both of these issues. The article is all about bribery. It doesn't mean that US doctors aren't better, it just means they may not be making decisions in your best interest. As for drug costs, maybe the US ones just cost more to pay for the concert tickets.

(NaturalNews) British registered company, GlaxoSmithKline, faces $3 billion in penalties after pleading guilty to the biggest health care fraud case in history. GSK admitted that physicians had been bribed to push potentially dangerous drugs in exchange for Madonna tickets, Hawaiian holidays, cash and lucrative speaking tours. They also admitted distributing misleading information regarding the antidepressant Paxil. The report claimed that it was suitable for children, but failed to acknowledge data from studies proving its ineffectiveness in children and adolescents.

GSK faced charges that they had used the gifts to sell three drugs that were either unsafe, or used for purposes that were not approved.

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...biggest health care fraud case in history....

Sad part is -and this might have little to do with what percentage of doctors participated in making such decisions for the real or implied reasons- is that Glaxo made nearly 3x that on each of the 3 drugs sold during the Court enforced time frame. So, in reality, the Justice Dept decision differs little from 30% tax - which means it is cost-effective for an outfit like Glaxo to keep doing the same thing. Worse yet, no individual was charged in the Glaxo case - which ended in a "settlement". A lot seems directly tied to the bizarre U.S. practice of allowing massive public advertising of tightly controlled drug products that consumers cannot directly purchase anyway (the FDA ban on such ended in the late 1990's - but for no good reason).

Various commenters and at least one prosecutor agreed

Spitzer said that the problem won't stop until chief executives go to prison.

Direct advertising to consumers is only legal in two countries -- the US and New Zealand.

The Wikipedia article is very interesting: http://en.wikipedia.org/wiki/Direct-to-consumer_advertising Seems like the medical community pushed against it.

First major approval was in 1983 (Reagan presidency, Democrats in control of the House, Republicans in control of the Senate), with a requirement that the ads included information on side effects and contraindications. In 1997, the rules changed to allow the drug companies to have a freer hand (Democratic president, Republican control of the House and Senate).

"This great amount of advertising has been successful in raising the prescription rate of DTC drugs by 34.2%, compared to only a 5.1% increase in other prescriptions..." from the Wikipedia article.

Apparently direct to the consumer is far far more effective than smoozing doctors. This is also why I'm wary of the whole alternative medicine game -- it too makes its appeals directly to the consumers and with practitioners who are less likely to say anything to suggest that the things they're selling are problematic.

Found this bit of nonsense on one of the more woowoo sites last night:

"Almost all of the alternative community mutually agrees that cancer can be cured through drastic changes in diet, avoidance of tainted water (e.g. tap water), internal hydrogen peroxide, omega-3 with sulfur proteins (The Budwig Diet), key vitamins (in particular F.D.A. banned B17), mega-doses of vitamin C, detox, and herbal supplements to help speed the process; since the root causes of cancers are internal fermentation combined with acidosis (low pH) and nutritional deficiencies."

From http://healthwyze.org/index.php/dr-andrew-weil-and-integrative-medicine.... which attacks Dr. Andrew Weil for not being completely insane, though I suspect some of their points about Weil's finances are probably valid. What they're admitting is that many natural healers don't have even four year degrees. My exposure to herbal healers is that they've had some seminars and no actual science background, very much like the Big Pharma sales people. Dislike both sets, but at least the trained MD is a possible firewall against the Big Pharma sales force. Natural healing has no firewall at all. If you've got a cancer with a 5% survival rate according to results-based medicine, and someone tells you that cancer is fermentation inside your too acidic body and internal hydrogen peroxide, super-filtered water, and B 17 (http://en.wikipedia.org/wiki/Amygdalin, aka laetril) will cure you, I can't blame a person for believing, but none of this has passed clinical trials. If you're paranoid enough, you will believe that the whole medical profession wants you to die of cancer rather than use simple natural cures. It's like the counter-factual stuff about how the medical profession approaches diabetes II and pre-diabetic conditions in adults -- and I'd been through that in DC and knew that the people claiming the medical profession goes straight to drugs were lying or had been lied to. Alternative medicine is the goofier and more deluded alternative. I'll be polite if people don't try to push their misrepresentations on other people in a Lyndon Larouche supporter fashion.

If direct advertising to consumers who aren't trained increases drug sales by 34%, what are the data on the doctors who told their patients that the particular drug they were asking for wouldn't be quite right. At least some doctors (I'd suspect a majority) don't take the pharmaceutical sales woman's pompom dance for the drug of the week that seriously because they do read the literature, do due diligence, and perhaps are old enough to have lived through a couple of pharmaceutical fads.

The problems of therapeutic fads don't go away in alternative medicine. The problems of people being direct sellers of their medicines makes the possibility for out and out fraud even greater (and the convenient out for the alternative medical people as well as some specialties in conventional medicine is "the patient didn't really commit to getting well.").

Nicaragua is one of the countries that does not allow direct ads to consumers, apparently. Many people will either go through the pharmacist or a doctor or clinic for recommendations. Some people will go with what their friends recommend, and some people will go up to the healer who has hours in the cemetery on Tuesdays and Fridays. And the health department will vaccinate the babies and do well baby assessments of the newborns.

The issue that's troubling is the attack on things that have been proven to work -- importing to Nicaragua the kinds of woo woo that basically well-fed adults can afford to believe in. A marginally nourished child in a third world country will have a worse time of measles than I did, and I do remember how nasty it was. A crippled child in the US can have a better outcome than a crippled child in an agriculture community.

Do some things from traditional medicine work? Yes, things do look good for turmeric. Acupuncture -- nope, and the examples of it being used as major anesthesia turned out to be rigged with morphine as a supplement. One person I knew who was seriously into the alternative woo bemoaned the loss of one of the traditional Chinese cons -- and admitted that clinical validation of this was very sketchy, but it was something she wanted to believe in.

New health laws will mandate disclosure of any gifts over $10 to doctors from pharmaceutical companies.

Rebecca Brown

Yup, cost of doing business

Ultimately the consumer just pays for it. The price of drugs increase, the price of malpractice insurance increases, so the cost of doctor visits increases, ...

Historically we saw this when Ford Motor Company decided it would cost less to pay legal costs associated with exploding Pintos than it would cost to fix the defect. In that case it was just a Capitalist car manufacturer optimizing shareholder income. Here we expected better from the health care racket.

Should we? No, not really, because we have the same model: for profit companies optimizing shareholder income. To me, the consumer, it is worse because I can elect to buy a Toyota instead of a Ford but in the health care racket, as you say, consumers cannot directly purchase the products.

Pinto myth

"The myth of the exploding pinto" is now 20-some years old; it is well-documented in the Rutger's Law Review, in the article of the same name. The Ford "facts" are simply not as represented in the 40-some year old Mother Jones article the fueled the myth - so to speak, though the medical problems remain regardless.

One of the problems is that the alternative medical stuff

...is even more avaricious. Also the spiritual woowoo can be very toxic. My mother's neurosurgeon said we should disconnect life support but the hospital wouldn't do this without consent of the family. One now ex-brother-in-law got my baby sister to refuse for a while as he wanted us to give "God" a chance to do a miracle. The miracle was that my mother was dying without pain and awareness which was what she wanted. My brother got her to change her mind after the neurosurgeon talked to him. My dad said he'd have made Bess a widow if he'd known that shit was going on.

The standard medical doctors told Kathy Acker that her cancer had spread and her best chance was chemotherapy. She went the alternative route and the cancer spread even further (might have anyway, of course, but the conventional doctor wasn't making outrageous promises). The London hospital that saw her later after the cancer had spread said that all they could offer was hospice care. The Mexican alternative cancer treatment center she went to after that was the place that was trying/selling her all sorts of both false hope and false cures. Laetrile has been proven not to work but people are still pushing it, and some are suing if people criticize this. When Kathy was dying, almost her last day, people were still trying to raise money for the quack clinic.

Rebecca Brown

My sister with a degree in marketing is a drug saleswoman

Very successful, and had almost no biology in college.

That story about Glaxo is showing up everywhere.

The further question, though, is whether herbal medicine is any different. A friend who's a nurse said that her hospital in Wales took in a patient who had herbally-induced anemia, caused by some herbs that the women in the valley recommended. I suspect that some herbal medicines work through a placebo effect due to mild poisoning (concealed by the rubbish of "the toxins coming out."). I've had an herbalist dose me for some condition I didn't have actually without my permission.

Big Pharm is a a problem, but the con artists are even more problematic.

What I've noticed with a lot of things is that people get trained in medicine, and tend to not keep up with changes in their fields, to believe that they can't possibly be fooled by a drug sales person, and to be gullible in believing both in their personal efficacy and in the efficacy of the drugs they prescribe. But alternative medicine even more tends to blame patients for failure to thrive. That attitude crept into mainstream medicine or never left it -- see Susan Sontag's ILLNESS AS METAPHOR.

It's not surprising that two of the three drugs were psychotrophic drugs, where modern medicine has its least capable practitioners (lowest scores in some standardized tests like the Millers Analogies Test, which now is considered an acceptable IQ test for Mensa membership). It's a field where even mainstream treatments are full of things that only produce full recovery in a third of the cases of psychosis (nurse near me in Philly had been a psych nurse). NC did a study of outcomes for patients in state-funded group therapy and found zero effect one year after treatment in terms of stable employment and a few other measures of well-being.

Diabetes seems to be one of those things that isn't just one disease process. For Type I, insulin is the way to go and really saves lives (discovered in Canada, by the way). For blood glucose levels that aren't quite Type II, diet works. It's possible that getting enough sleep works, and treating things like thyroid conditions definitely help.

What doctors believe is that people don't change their lifestyles and don't comply with restrictions on diet, so instead of working with those things, they go straight to the medical intervention (what I was told by someone who had recently finished an MD when I bitched about not being allowed to work on diet changes for a blood pressure issue). This may even be true.

The problems with conventional medicine are even worse with alternative medicine with even less oversight, and all the profit is in selling the mark something, instead of just part of the profit (I believe that HMOs pay some extra for prescribing -- as that proves the doctor did something, and I think that is an evil policy).

Here, I can buy the medicine from a pharmacy or from the doctor's own in-house pharmacy. The pharmacist I go to for most medical advice steered me away from one doctor "because you need to go to someone honest." Having the pharmacist being the primary advisor has some advantages and some disadvantages -- the pharmacist knows all the local doctors and has some sense of who does a better job, but isn't a fellow doctor who might not want to talk trash about people who might refer people to him (the doctor I was referred to sold his own medicines, so no cut for the pharmacist who recommended him and I'm sure she knew that.

People have where they studied on their shingles --- and word on the street is that Cuban trained doctors are very good.

Where I used to live in Virginia, except for the eye doctor, the local doctors were quite poor since they'd moved to the country to do any number of things rather than practice medicine -- like have a horse farm. I've had worse dentists than the ones here, and I don't remember more than one or two being better. Best eye treatment was in Philadelphia with someone who taught at UPenn. Worst podiatry was someone who taught at UPenn. US-ness doesn't mean good doctors -- the absolutely worst doctor was a college clinic doctor who looked at a growth on my arm from the door and told the nurse to pop it because it was a blood blister. It was a particular non-maligant growth that was highly vascularized and that didn't work, so I went to a real dermatologist who cut it out and had it biopsied just in case.

The big wins for modern medicine were antibiotics and anesthesia, which made surgery safe and which kept people from dying of infections after injuries, and various vaccines and innoculations which eliminated smallpox, polio, and some of the other rather horrible childhood diseases from being the terrors they were in the 19th and early 20th Centuries.

I suspect it's cheaper to have a independent board evaluate new drugs and put them on on the approved drugs list or not than it is to send out people who get $100,000 a year and up to sell drugs to doctors (not counting the costs of the trinkets).

Natural News looks like it's got some flake sides, too. Kathy Acker may or may not have died if she'd gone the chemotherapy route, but all the fake natural organic crapola didn't save her. Someone who had conventional treatment and then used tumeric and all that -- dunno, and Kathy went for a while believing that she was cancer-free. Chemotherapy is generally used to catch tiny growths that spread from the original tumor but which would be undetectable. If the woman didn't have those, I'd say traditional treatment was what saved her. Tumeric does have verifiable anti-inflammatory properties: http://www.mayoclinic.com/health/curcumin/AN01741 (and tastes good in honey), and is cheap enough in powder form that taking it can't hurt.

http://www.naturalnews.com/035715_vaccines_history_fraud.html is the usual anti-vaccine distortion of what the study showed. Can't sell those immune-system building herbal supplements if people don't have to worry about their children getting smallpox, whooping cough, and polio. Smallpox has been eliminated as a disease problem for the world's population. Polio is almost eliminated world-wide. Rabies was eliminated in the UK and Hawaii (natural reservoirs in bats and skunks in the Americas make it a continuous problem here).

This is the real study on the whooping cough vaccine issue: http://news.yahoo.com/study-whooping-cough-vaccination-fades-3-years-150...

Is evidence-based medicine flawed, yeah, but the alternative is amazingly more flawed and dishonest.

Rebecca Brown

metaphor extended ...

Sontag's metaphor ("Illness" focuses on 'cancer') envelopes how modern society deal with death. (I'll start a new forum on the topic.)

In 1967 Sontag wrote (published): "The white race is the cancer of human history."

She later backed away from this statement, saying "it slandered cancer patients". (She & her mother were both ones.)

(Sorry about following the 'illegal' detour.)

Not really

Big Pharm is a a problem, but the con artists are even more problematic.

We, as consumers, should have the option to evaluate our choices and realize that if we do it wrong we get conned. The problem is that Big Pharma is cheating. They are bribing those who we think are independent to promote their products and, further, get Obama to make us pay for the fraud.

In Nicaragua I can walk into a pharmacy and get almost anything. In the US we are required to go through someone that Big Pharma has bought off in order to get a medication.

I have no problem if someone would rather trust their bought off doctor. That should be their choice. I would just like the FDA, doctors, ... to be on the patient side rather than on the side of Big Pharma or let me choose how to treat myself. I get to do that in Nicaragua.

You're assuming all the doctors are bought off

What I've noticed here is that people use their pharmacist as a primary care doctor, or they take in notes from their doctors to buy things. If the doctor is running his or her own pharmacy, then all the same cautions apply that would apply in the US.

Some things here, I'm rather surprised that I have to order -- blood glucose testing equipment is the biggy. And one pharmacy here doesn't always have thyroid pills in my dosage in stock (I've found another one that does).

Most people here are consulting either the pharmacist or a doctor for drug recommendations. I like it that this isn't mandatory, but I suspect that just as there are crooked eye doctors who try to sell people a new prescription set of glasses for whatever the problems might be, there are pharmacists who've got a deal on one antibiotic and will urge that one over another one, and there's advertising directly to the consumer (really more in the US than here perhaps).

Even here, OTC narcotics aren't available. One of the problems I had when I had a ruptured disc is the US doctors don't like to prescribe that, yet the clinical literature on ruptured cervical and lumbar discs says that not prescribing narcotics for the first week or so is inhumane (I agree).

The same things that make doctors susceptible to drug sales people is the quality that makes less well trained people susceptible to quacks, someone who makes things simple, who assures you this will really work, who treats you as though you were important. And no side effects (Glaxo's game with the psychoactive drugs, apparently, earlier games with some very short term effective anti-arthritus drugs).

For a while, people were recommending glucostamine and condroitin for arthritis -- and the initial studies seemed to be very positive. I took it and my wrist stopped hurting after a while. But that is how arthritis works -- on and off -- and my wrist isn't hurting now even though I haven't taken any supplements for it for years. Subsequent studies proved it wasn't really working as theorized and was actually more a placebo effect (current studies suggest that acupuncture is also a placebo).

Assuming all doctors are bought off and uncritical consumers of adverting promos is a trifle simplistic. Anyone has a whole range of options for dealing with doctors, from blind trust to "well, that's probably useless but it won't hurt" to "this makes me feel worse so I think I'm going to find another doctor if she won't try something else." Implying that all doctors are bought off and working for Big Pharma is an move in the direction of playing either/or games with issues that don't come down to either/or that often. Humans are complex.

Are you as critical of the people trying to sell you the various alternatives? I've seen a quack at work -- and he ran his own pharmacy and sold all sorts of slaughterhouse by-products and various and sundry stuff to the gullible. In his case, I think he knew he was lying.

"Alternative medicine that works is called medicine." Things are either proven to work or proven not to work. A doctor may or may not look at the original studies. With some things, it's hard to separate out the quackery from the non-quackery (Google "statins" for an interesting afternoon). Some things work for some people. Blood poisoning doesn't respond to placebos. A third of the people who have psychotic breaks recover completely. Psychotherapy makes schizophrenics worse; anti-psychotic medicines seem to be the only useful control of the condition, but some doubts have been cast on that recently. Evidence-based medicine corrects itself.

Trust but verify. I don't have the time to research all the possible ailments I could possibly come down with in the next 20 years or so before I die of something that I hope isn't too painful, but I can check myself to see if the things I'm being told make sense.

The more something has remissions and recurrences, the more niches for the quacks -- the copper bracelets and the various supplements for arthritis being one of the on-going ones. My doctor told me that I just had to live with it and it would come and go, and when I had pain, take aspirin or some other OTC painkiller. That's not as much fun as believing that if I just take this magic pill, that I'll be all well. I gave up heavy cameras, which helped. If I write by hand, I use a fountain pen, not a ball point, for anything more than a couple of lines, which helps (the cheap and as helpful alternative are gel-point pens.

People's impatience with hearing "there isn't anything that works" is what opens the doors to quackery, just as the odds for certain cancers do.

My impression here is that not everyone in Nicaragua believes in germs. If they haven't quite accepted that invisible things can make them sick, getting them to do the basic things like not irrigate lettuce with shit-flled water would be more useful than trying to persuade them that they can stay perfectly healthy if they just eat more green vegetables.

I suspect that what's on the shelves of the farmacias here is as much sold to them as anything is sold to doctors in the US. At least in Jinotega, they simply don't carry everything. And I wouldn't be surprised if doctors here also got promotional literature, as you get promotional literature from the alternative medical people.

I was alive when one FDA doctor stopped Thalidomide from being sold in the US. Getting the FDA to be that sort of organization again would be excellent, but the reason we know about Glaxo is that they were busted. http://www.nytimes.com/2012/07/03/business/glaxosmithkline-agrees-to-pay... -- the US Federal Government did this after being told about the promotions by whistleblowers.

And this mentions that under the new US health care program, doctors will be forced to disclose their associations with pharmaceutical companies:

http://www.guardian.co.uk/commentisfree/2012/jul/04/glaxosmithkline-big-...

More on that here: https://www.federalregister.gov/articles/2011/12/19/2011-32244/medicare-...

Sounds like a step in the right direction to me.

Rebecca Brown