Dr. Stephen R. Keister : Poverty and Public Health in America

The picture of poverty in America. Image from Bay View.
Poverty and public health:
The social causes of death in America

By Dr. Stephen R. Keister / The Rag Blog / June 29, 2011

"[The] incredible absolute size and commanding market positions [of a few immense corporations] make them the most exceptional manmade creatures of the twentieth century... In terms of the size of their constituency, volume of receipts and expenditures, effective power, and prestige, they are more akin to nation-states than business enterprises of the classic variety." -- Richard Barber, from the book Friendly Fascism by Bertrand Gross.

These days we are always on the lookout for a bit of encouraging news. But the final analysis of the Vermont health care plan comes as a bitter disappointment. The online organization Single Payer Action on June 21 provided us with the sad news: the much-touted Vermont plan is not single payer, not even close.

It seems that the phrase "single payer" was stripped out during the final negotiations, and the implementation of the legislation is dependent on federal approval. It also appears that agencies in Washington will not grant needed waivers. The bill permits the private insurers to operate in Vermont indefinitely.

ScienceDaily reports on a study done at the Columbia University School of Public Health that brings home once again the great failings of the healthcare system in the United States. The study “found that poverty, low levels of education, poor social support and other social factors contribute about as many deaths in the U.S. as such familiar causes as heart attacks, strokes, and lung cancer.”

The investigators found that approximately 245,000 deaths in the year 2000 could be attributed to low levels of education, 176,000 to racial segregation, 162,000 to low social support, 133,000 to individual poverty, 119,000 to income inequality, and 39,000 to area-level poverty.

Overall, 4.5% of U.S. deaths were found to be attributable to poverty -- midway between previous estimates of 6% and 2.3%. However, the risks associated with both poverty and low education were higher for individuals ages 25-64 than for those of 65 or older. The authors’ findings for a broader public health conceptualization of the causes of mortality and an expansive policy approach that considers how social factors can be addressed to improve the health of populations.

Meanwhile, our elected representatives continue their budget negotiations in Washington with an eye on further cutting an already inadequate Medicaid program and "revising" Medicare benefits, continuing the downward spiral of health care for the poor, the disabled, our returning servicemen/women, and the emotionally ill.

Happily, there is some galvanizing opposition, as witnessed by a massive protest by National Nurses United in Lafayette Square demanding a tax revenue increase from corporations in order to prevent such cuts in Medicaid and Medicare.

I am encouraged by the rare occasions that a group of dedicated Americans will gather in public to speak up against injustice. But I also wonder about the lack of public militancy against injustice here that we see demonstrated by the citizens in our fellow democracies in Europe, especially in Greece, Spain, France, and the United Kingdom.

It would seem that there is an answer, a disturbing answer, contained in an article by Harriet Fraad, published in Tikkun and distributed by AlterNet. The title: "Why Are Americans Passive as Millions Lose Their Homes, Jobs, Families, and the American Dream?" While Dr. Fraad offers some suggestions, one hopes that they do not come too late.

Noam Chomsky peripherally addressed this matter in a 1995 essay when he wrote:

A final point, something I've written about elsewhere (e.g., in a discussion in Z papers and in the last chapter of Year 501). There has been a striking change in the behavior of the intellectual class in recent years. The left intellectuals who... years ago would have been teaching in working-class schools, writing books like Mathematics for the Million, participating in and speaking for popular organizations, etc., are now largely disengaged from such activities, and although quick to tell us that they are far more radical than thou, they are not to be found, it seems, when there is an obvious and growing need and even explicit request for the work they could do out there in the world of people with live problems and concerns. That's not a small problem. This country right now is in a very strange and ominous state.

People are frightened, angry, disillusioned, skeptical, confused. That's an organizer’s dream... It’s also fertile ground for demagogues and fanatics who can (and, in fact, already do) rally substantial popular support with messages that are not unfamiliar from their predecessors in somewhat similar circumstances. We know where it has led in the past; it could again. There's a huge gap that once was at least partially filled by left intellectuals willing to engage with the general public and their problems. It has ominous implications, in my opinion.

A few bright lights in the darkness: Senator Bernie Sanders is facing down the pharmaceutical industry. He has introduced a bill in the Senate authorizing government expenditures of some $80 billion per year to buy up the patents that were awarded to the drug companies for "carrying out research."

These patents, in essence, provide government-granted patent monopolies, thus providing the pharmaceutical companies the right to price drugs at hundreds of dollars per prescription and sometimes several thousand dollars per prescription in the United States.

The money would come from a tax on public and private insurers. The savings from lower-cost drugs would immediately repay more than 100 per cent of the tax.

The country is projected to spend almost $300 billion on prescription drugs this year. Prices would fall to roughly one-tenth the amount in the absence of patent monopolies, leading to a savings of more than $250,000 billion. The savings on lower drug prices should easily exceed the size of the tax, leaving a substantial net reduction in costs to the government and private insurers. For more details about the legislation, see "The Drug Market Scam" by Dean Baker on AlterNet.

The other side of the coin involves a decision by the Supreme Court on June 23, 2011, freeing the generic drug makers from providing consumers with the specific dangers of using a drug. The court, at the same time, gave the pharmaceutical industry access to prescriptions written by physicians for their patients. So much for “patient-physician confidentiality”!

The other bit of good news came in a June 16 New York Times op-ed by President Jimmy Carter, when he joined the chorus of those asking the government to call off the Global War on Drugs. Thus he added his voice to those of Richard Branson, George Shultz, and Paul Volker. President Carter pointed out that this legislation has increased our prison population from 500,000 people in 1980 to 2.3 million in 2009. The increase mostly is for crimes that are non-violent and related to drug possession. There are 743 people in prison for every 100,000 Americans, a higher proportion than in any other country and seven times as great as in Europe. Some 7.2 million people are either in prison, on probation, or on parole -- more than 3% of all American adults.

The cost? California in 1980 spent 10% of the state's budget on higher education and 3% on prisons. In 2010, almost 11% went to prisons and only 7.5% to higher education.

Of course, the fight for enlightened drug policy, as seen in most European nations, will be fought tooth and nail by those who are financially rewarded by the so-called war on drugs — the crime cartels and those receiving baksheesh from the criminal enterprises (corrupt law enforcement officers, politicians, judges, and the operators of our uniquely American private prisons).

One final personal thought: The Republicans keep repeating the mantra that if we increase the taxes on the wealthy, they will not have the funds to create jobs. Of course, this is pure and simple poppycock. Their wealth is not used to produce employment. In the autumn of 2008 at the time of the financial crash, I was talking to a Swiss banker who works for a typical big Swiss bank. In the autumn of 2008, he said, the bank’s below-street-level gold vault, encased in concrete, cracked open under the weight of the gold bullion being shipped in from the U.S.A.

Create jobs!?! Maybe for Swiss concrete workers...

[Dr. Stephen R. Keister lives in Erie, Pennsylvania. He is a retired physician who is active in health care reform and is a regular contributor to The Rag Blog. Read more articles by Dr. Stephen R. Keister on The Rag Blog]

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David P. Hamilton : My Remission and the Business of American Medicine

Graphic from The Patient's Doctor.
Rheumatoid arthritis, my remission,
and the business of American medicine

Their deficiencies, spawned by the system’s economic organization, might be more tolerable if doctors didn’t so often act like they had been anointed by God with special powers to save your life provided you have a deferential attitude and the right insurance.

By David P. Hamilton / The Rag Blog / December 15, 2010

Over two years ago I was diagnosed with rheumatoid arthritis (RA). According to all rheumatologists, it is an incurable and progressively degenerative disease. These alleged specialists earn an average of $224,000 a year “treating” it. They confidently assert that once you have RA, it’s permanent and dealing with it becomes the dominating feature of your remaining life.

With RA, your immune system inexplicably short-circuits and attacks your own body, particularly in the joints of the arms and legs. The onset of the disease requires a genetic predisposition and a triggering incident. Three months previous to the RA diagnosis, I had hip replacement surgery. In conformity with the apparent professional secret code to cover for colleagues, no doctor I’ve asked has been willing to speculate on the possibility of that being the trigger.

The RA diagnosis was based on several assumptions. Since I had it, it was assumed I had some triggering incident and the required gene, although I’m aware of no genetic test being done or speculation on what may have been the trigger. The hip replacement surgeon, whose specialty averages over $600,000 a year, performed his task with great technical skill, but failed to mention RA as a possible side effect.

The diagnosis of RA is not made in a casual manner. It is quite scientific and quantifiable on the basis of a blood test to determine your “rheumatoid factor”. For men, above the score of 30 is positive. At one point, I was 176. Once you’re positive, it is “standard medical practice” to never test for that factor again, based on the assumption that the disease is always chronic, so further tests would be superfluous.

When I asked for a new test after months without symptoms or medications, my rheumatologist at first resisted, but acceded to my request since she had a blood lab on site at the VA. The new “rheumatoid factor” reading was down to 27. She declined to speculate on the cause of the score dropping. A few months later, it was back to 94, but I still had no symptoms.

RA won’t kill you in a few months or even years. However, it hastens one’s general physical deterioration leading to earlier death from something else. Along the way it cripples you and makes you wish you were dead because you can’t walk or use your hands. It is also quite painful and disfiguring. Not the Last Act one would choose.

Conventional American medical wisdom is that the pace of the inevitable degeneration caused by RA can be slowed only by the use of drugs so toxic as to require frequent tests of one’s liver function, if any. Rheumatologists offer no cure and no allopathic physician ever gave me the slightest reason to hope that I would ever be well again, let alone be playing tennis and strolling the boulevards of Paris without pain.

Yet, today I have had no symptoms in well over a year, remain athletic, haven’t taken pharmaceuticals for RA for over a year and recently returned from two months in France, celebrating my remission, which included many such strolls. My last rheumatologist has dismissed me from her care “until further notice,” her way of warning me that it may return. My general practitioner calls my recovery “truly remarkable,” but has no explanation. Getting well, even if it is only temporary, while consistently rejecting medical advice was never considered a reasonable option.

Both the rheumatologists I saw recommended I take methotrexate. This drug was first developed in the late 1940’s to treat cancer. It was FDA-approved for the treatment of RA in 1988 and remains “the gold standard” of RA treatment. It was once a breakthrough in cancer treatment, but that was over a half century ago and cancer chemotherapy has come a very long way since then. According to Wikipedia, methotrexate “inhibits the synthesis of DNA, RNA, thymidylates, and proteins.” Not exactly the stuff one takes to return the body to a natural state of balance.

The first rheumatologist I saw was the local big wheel of the specialty with the big office on the central lobby of the first floor of the big private medical center of which he very likely owns a big part. First, he sent me to various of his colleagues in the facility for multiple expensive tests, sometimes of questionable necessity, thus helping enrich his co-owners who operate large and expensive pieces of medical diagnostic machinery and their collective corporate enterprise.

After this process, he prescribed the same stuff he prescribes to almost everyone, methotrexate. That’s what he does most days, over and over, for those big bucks. He looked justifiably bored. He had absolutely no advice for me besides taking that caustic pharmaceutical, only grudgingly conceding that fish oil might have some limited benefit.

When asked if walking would be a good form of exercise for me, he responded, “It won’t do much harm as long as you can tolerate the pain.” When I suggested employing a less invasive, more holistic regimen for starters, he dismissed such approaches as having “no scientific basis,” the sooner I started on the methotrexate the better, and I’d probably be on it for the rest of my life. Of course, I fired him, walking out after telling him I’d seek other opinions.

My second rheumatologist was at the local VA clinic. Since I’m a veteran and she’s a VA doctor on salary, she had to put up with me regardless of my routinely and overtly not following her advice either. Being able to talk back to your doctor without being thrown out into the street is a seldom recognized benefit of socialized medicine.

She wanted me to take methotrexate too. I again refused and requested her guidance in a more holistic approach. She willingly acknowledged having no special training in the use of “alternative therapies.” Apparently, in the official parlance, “alternative” is anything other than stuffing yourself with chemical combinations that are by definition toxic.

She did, however, loan me a book from her own library put out by the Arthritis Foundation that evaluated such alternatives. [Alternative Therapies for Arthritis by Dorothy Foltz-Gray, Arthritis Foundation.] She also gave me a stack of pamphlets describing each pharmaceutical commonly used to treat RA and asked me to decide which, if any, I would agree to take. Her attitude seemed a great leap forward, a willingness to enter into the aberrant state of patient directed medical care. Maybe she had no choice, but she was an empathetic woman, and that was progress.

I expected the book to be a smear on holistic therapies. Surprisingly, the author tried to strike a pose of tolerance, likely in deference to the widespread resort to alternative remedies by RA patients dissatisfied with conventional pharmaceutical approaches. Much of the evidence cited was inconclusive, but you could get the drift of what they thought was fraudulent and what they thought might help.

There are lots of natural anti-inflammatories, but nothing that anyone would claim cures RA. The book inspired me to buy a round of exotic supplements like borage oil and stinging nettle extract. The combination of several such concoctions did nothing noticeable about my RA but may be implicated in a subsequent attack of diarrhea. My cynicism in regards to American allopathic medicine began to spread to its alternatives.

More important, the book let slip a closely guarded secret that rheumatologists are loath to acknowledge -- that some RA patients go into complete spontaneous remission, at least for long periods of time, and the medical specialists don’t know why. This is not so surprising when you realize they don’t know what starts it either.

There are various definitions of “RA remission,” one of which has the patient asymptomatic, but on the heavy drugs. These variations cloud the issue somewhat, but there are indeed a small percentage of people diagnosed with RA, perhaps as much as 10%, that experience “spontaneous remission," meaning that they did it outside the guidelines of established medical practice. Medical journal articles on RA remission sometimes throw these cases out of their studies since they distract from their focus on what expensive new pharmaceutical might be effective.

It bothered me that until recently the most common drugs used to treat RA were originally developed to treat something else. Also troubling in my case was that RA strikes many more women than men and usually hits people before they are 50. I was a 64 year-old guy, way outside the standard pattern. My doctors offered no explanation for this anomaly. It all gave me the impression that rheumatology was less than a precise science and that its practitioners didn’t have a very solid grip on causes or effective treatments, regardless of their standard pose of all-knowingness.

The question to me was how to be among that small group that somehow got well without resort to the standard pharmaceutical regimen. There were many ideas floating about the internet, but no clear path. For example, there were numerous dietary suggestions. Many claimed their particular diet had beneficial effects on RA, but none claimed it cured it. Although some foods were suggested repeatedly (e.g., fish oil, avocados), the diets varied widely and in some cases were contradictory. There was no shortage of suggestions, often endorsed with great certitude by alternative true believers.

Over the course of a year, my body somehow healed itself despite continued positive blood tests for RA. I don’t know how. It was probably some genetic luck. I simply took good care of myself. My approach was eclectic; some of this, some of that, but not methotrexate or anything similar.

I improved what was already a very rich organic, whole grain, localavore diet, became more disciplined about my exercise routine, added some of the suggested supplements to my preexisting supplement regimen, tried to keep my stress level down and adopted a fighting spirit. Nothing revolutionary. Just enhancements to what I had already been doing, including the maintenance of our 400 square foot kitchen garden.

For almost a year I took what seemed to me to be the most benign of the recommended RA prescription drugs; an antibiotic (minocycline) and an old anti-malaria drug (hydroxychloriquine). They didn’t seem to do much except make me more susceptible to sun. I quit taking them more than a year ago, of course “against doctor’s advice.”

I also spent several hours being interviewed by a homeopathic physician (also an MD) who concocted a couple of crystals for me to ingest. His primary distinction was being the only medical professional that said he could cure me. Whether he did or not, who knows? I tossed the crystals down, added to the mix.

I have long felt that if there were such a thing as a fountain of youth, it was endorphins. I continue to firmly believe that you cannot be very healthy without a serious exercise routine, something that should take about an hour of your day, every day, and cause sweat.

With the RA diagnosis, I became a very disciplined walker, eventually evolving into a speed walker through hills, progressively adding weight to my daypack to make it harder. But like other features of my therapeutic approach, this was an augmentation of a preexisting practice, not some new feature of my lifestyle. I had been a runner and tennis player for decades.

My approach was anything but scientific. It has worked so far, but it’s impossible to know what factor was crucial or even important or that it was even anything I did at all. Perhaps I was predestined to get better regardless. But now that I have returned to an enviable state of wellness, even fitness, for someone 67, the question naturally arises: what happened? What, if anything, did I do to help cause remission? There is no way to answer that question with precision.

One factor, however, is very clear to me, and all my most trusted medical consultants agree. For me to have ever recovered not only my health, but also the ability to walk, even run, and the normal use my hands, it was essential that I rejected standard medical opinion and resisted the pharmaceutical path. That path leads to long term prescription drug dependency and a rotting liver, not back to true health.

I have come to see my wellness as exemplary of a conceptual failure of America’s allopathic medical practice. My body healing itself was simply not on their radar, because they don’t make money from healthy people who are independent of pharmaceuticals.

Doctors have no special training in the benign and natural means to promote the body’s capacity to heal itself. The intellectual monopoly of the pharmaceutical model blocks out such approaches. Conventional American medicine pays minimal attention to either prevention or enhancing natural recuperation. They’re not profitable. The focus of our medical system is instead on devising salable products that replace natural recuperative mechanisms with artificial ones, producing and distributing such products so that health care becomes a commodity and doctors are transformed into entrepreneurs.

It is an inherent and inescapable feature of the capitalist health care model that it profits from illness. The average U.S. doctor makes nearly a quarter million a year, most specialists a half a million and surgeons more. Scant few don’t become millionaires. On average, they’re the best-paid national professional group in the world. Yet, the U.S. wallows at 37th (behind Oman, Portugal, Morocco, Columbia, and Costa Rica) in the World Health Organization’s ranking of the quality of national health care systems, 74th according to the UN, and 49th in life expectancy.

Compared to the other G8 nations, the U.S. has the highest infant mortality, the most mothers who die during childbirth, the most lives lost that could have been saved, and the worst in treatment of cancer. In the American system, there are no poor doctors, but lots of sick people, bankrupt patients and 59 million miscreants without “coverage."

Like their plan for innumerable others, my doctors wanted me to take caustic chemicals for the rest of my life while pouring my meager savings into their bank accounts for my perpetual “treatment," a steady income source for them throughout my remaining years of worsening disability.

In the capitalist oriented American health care system, private doctors have a clear vested economic interest in patients not getting well. My chronic is their meal ticket. My wellness hurts their bottom line. How could I be so naïve as to expect them to cure me when my sickness is so much more lucrative?

The standard Western doctor operates almost exclusively on a very narrow procedural model. They order expensive diagnostic tests done by other specialists in order to determine which prescribed drug to give you. In most cases, that’s all. To a great degree, they are agents of the pharmaceutical industry in charge of customer service. Patients wait patiently to see doctors. Big Pharma reps walk right in.

It is nearly axiomatic that whenever you go to the doctor’s office, you leave with a prescription. Otherwise, most patients feel cheated. If you’re a favored patient, you’ll get some of the doctor’s stash of free samples the pharmaceutical reps have graciously left. Whatever your germ, doctors have exclusive access to the appropriate specialized germ killers. These medications, however, have high toxic potential or they wouldn’t have to be “prescribed."

The cornerstone of American doctor’s wealth is their monopoly on the right to prescribe drugs to which the government has restricted access. If your condition further deteriorates, they “operate," i.e., cut you open and remove or install things, a service that costs many thousands, requires the expenditure of many thousands more in ancillary products and is dangerous because the fourth leading cause of death in the U.S. is going to the hospital.

If you asked most U.S. doctors what s/he could do to improve your health besides pills, shots, and surgery, they’d be out of their element. Especially don’t ask about nutrition or exercise routines and expect an expert opinion.

Their deficiencies, spawned by the system’s economic organization, might be more tolerable if doctors didn’t so often act like they had been anointed by God with special powers to save your life provided you have a deferential attitude and the right insurance. Many an idealistic youth who set out to serve mankind by being a doctor, became seduced by the Big-Pharma orthodoxy of the training institutions. And after pre-med, med school, internships, residencies, and the related costs, developed a sense of material entitlement not matched by equally educated PhD’s.

There are, of course, legions of doctors operating in the capitalist medical system who have maintained at least some of the most humanist motives for practicing medicine. There are, without doubt, saints among them. I’m especially partial to general practitioners, pediatricians, trauma specialists, and women doctors. Many surgeons have great technical skill. Morally unimpeachable motives and competency, however, are largely irrelevant to the operating economic principals of the system.

The American medical model is systematically corrupted by its capitalist character, resulting in serious conceptual limitations. These corruptions derive from health care being a commodity instead of a right and from illness being a source of profit. A principal conceptual limitation is their failure to focus on methods to enhance the body’s natural recuperative potential, favoring instead doctor controlled pharmaceutical dependency.

The most effective and economical approaches to health care for most people involve prevention, health maintenance and recuperation. For this, important societal inputs would be nutrition education, subsides for genuinely healthy foods and lifestyles, community fitness programs, low job stress, social security, sufficient time off to pursue personally rewarding activities, and universal public health care so that people don’t neglect seeing a doctor for fear of the costs associated with getting medical care.

The problem is that in the unfettered market system, none of these components of optimal health care offer the pharmaceutical, hospital and health insurance industries opportunities for profit even close to equaling those offered by the existing model.

[David P. Hamilton has been a political activist in Austin since the late 1960s when he worked with SDS and wrote for The Rag, Austin's underground newspaper.]

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Big Pharma : The Orgasm Scam

'Restless Vagina Syndrome':
Big Pharma's newest fake disease

By Terry J. Allen / November 9, 2009

It’s not your fault, ladies (and certainly not your partner’s), that you don’t orgasm every time you have intercourse, or that you lack the libido of a 17-year-old boy. You have a disease: female sexual dysfunction (FSD), and the pharmaceutical industry wants to help.

You are among the "43 percent of American women [who] experience some degree of impaired sexual function," according to a Journal of the American Medical Association article. The FDA’s evolving definition of FSD includes decreased desire or arousal, sexual pain and orgasm difficulties -- but only if the woman feels "personal distress" about it.

So, convincing women to feel distress is a key component of the drug company strategy to market a multi-billion-dollar pill that will cure billions of women of what may not ail them.

By promoting the belief that "normal" women have explosive sex all the time, BigPharma helped launch the disease. However, the FDA has yet to approve a treatment for women who fall short. Until then, they could try the Orgasmatron: a dial-a-delight spinal implant that rarely works -- and risks infection and paralysis. Or, for $60/month, pop LexaFem pills -- containing (how-could-it-not-work) "horny goat weed extract" in order to "feel like a real woman today." Its website promises, "You won’t ever feel unhappy again with LexaFem in your arsenal."

But the big swinging dicks of global FSD marketing (and off-label marketing) are Pfizer -- whose stop-gap strategy is selling women Viagra based on the fact that it works for men, and Procter & Gamble (P&G), which, using the same logic, has put its money on testosterone.

Viagra’s failure in trial after trial to work on women has not stopped doctors from writing 1.4 million off-label prescriptions. FSD is "a classic example of starting with some preconceived, and non-evidence based diagnostic categorization for women’s sexual dysfunctions, based on the male model," said John Bancroft, director of the Kinsey Institute, in an interview with BMJ (British Medical Journal).

No drug follows the male model more literally than testosterone. Despite FDA refusal to approve P&G’s testosterone patch Intrinsa, U.S. doctors wrote 2 million off-label testosterone prescriptions in 2007. Like Pfizer’s little blue pill, the Intrinsa patch doesn’t really work for women. No wonder: Researchers don’t even know what constitutes a "normal" female testosterone level, and women with low levels of the hormone are as likely as those with high levels to be happy with their sex lives. And as filmmaker Liz Canner shows in her excellent new documentary Orgasm, Inc., testosterone is usually teamed with estrogen, which increases risks for stroke, cancers and dementia.

The companies and clinics that narrow the range of sexual normality to porn industry standards suffer their own disease. Symptoms include: a compulsion to concoct illnesses and then develop drugs to treat them, and vice versa. Either way, the syndrome is typically accompanied by a rash of conflicts of interest.

A Pfizer survey in Malaysia found that Malay women are even more diseased than their American counterparts, with "69.6 percent experiencing some form of FSD," according to the Journal of Sexual Medicine, which also published an industry-supported supplement on FSD. Journal editor and urologist Irwin Goldstein denies a conflict of interest. "Science is science," he says. "It comes down to the bottom line. What the data shows, the data shows." Actually, no. Drug company-funded studies are more likely than independent studies to find the new drug superior to the old. Perhaps the bottom line Dr. Goldstein refers to is his income as a paid consultant for drug companies, including P&G and Pfizer.

Goldstein established an FSD clinic with Dr. Jennifer Berman, who now heads a Beverly Hills clinic and appears on Oprah. As one of the health professionals on a 1998 panel that received financial sponsorship from eight pharmaceutical companies, she helped define female sexual dysfunction. Some 22 drug companies, including Pfizer, had financial ties to 18 of the 19 authors of that panel’s report, the BMJ revealed.

"Maybe the best approach is not ineffective, over-hyped drugs with nasty side effects, but an end to disease mongering and a strong dose of comprehensive sex education," says filmmaker Canner. Her film hits female erogenous zones that pharmaceutical fixes can’t find: your brain and your funny bone. 

© 2009 In These Times. All rights reserved.

Terry J. Allen is a senior editor of In These Times. Her work has appeared in Harper's, The Nation, New Scientist and other publications.]

Source / In These Times / AlterNet

Thanks to Mariann Wizard / The Rag Blog

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Did Obama Make a Deal with Big Pharma?

Internal Memo Confirms Big Giveaways In White House Deal With Big Pharma
By Ryan Grim / August 16, 2009

A memo obtained by the Huffington Post confirms that the White House and the pharmaceutical lobby secretly agreed to precisely the sort of wide-ranging deal that both parties have been denying over the past week.

The memo, which according to a knowledgeable health care lobbyist was prepared by a person directly involved in the negotiations, lists exactly what the White House gave up, and what it got in return.

It says the White House agreed to oppose any congressional efforts to use the government's leverage to bargain for lower drug prices or import drugs from Canada -- and also agreed not to pursue Medicare rebates or shift some drugs from Medicare Part B to Medicare Part D, which would cost Big Pharma billions in reduced reimbursements.

In exchange, the Pharmaceutical Researchers and Manufacturers Association (PhRMA) agreed to cut $80 billion in projected costs to taxpayers and senior citizens over ten years. Or, as the memo says: "Commitment of up to $80 billion, but not more than $80 billion."

Representatives from both the White House and PhRMA, shown the outline, adamantly denied that it reflected reality. PhRMA senior vice president Ken Johnson said that the outline "is simply not accurate." "This memo isn't accurate and does not reflect the agreement with the drug companies," said White House spokesman Reid Cherlin.

Stories in the Los Angeles Times and the New York Times last week indicated that the administration was confirming that such a deal had been made.

Critics on Capitol Hill and online responded with outrage at the reports that Obama had gone behind their backs and sold the reform movement short. Furthermore, the deal seemed to be a betrayal of several promises made by then-Sen. Obama during the presidential campaign, among them that he would use the power of government to drive down the costs of drugs to Medicare and that negotiations would be conducted in the open.

And over the past several days, both the White House and PhRMA have offered a series of sometimes conflicting accounts of what happened in an attempt to walk back the story.

The White House meeting took place on July 7th, as first reported that evening in the Wall Street Journal. Also on the same day, a health care lobbyist following the talks was provided the outline of the deal by a person inside the negotiations. That outline had been floating around K Street before being obtained by the Huffington Post. In order to learn more about its origin, HuffPost agreed not to reveal the name of the lobbyist who originally received it.

"That is the PhRMA deal," said the lobbyist of the outline. He then clarified, "It was the PhRMA deal."

The deal, as outlined in the memo:

Commitment of up to $80 billion, but not more than $80 billion.

1. Agree to increase of Medicaid rebate from 15.1 - 23.1% ($34 billion)

2. Agree to get FOBs done (but no agreement on details -- express disagreement on data exclusivity which both sides say does not affect the score of the legislation.) ($9 billion)

3. Sell drugs to patients in the donut hole at 50% discount ($25 billion)
This totals $68 billion

4. Companies will be assessed a tax or fee that will score at $12 billion. There was no agreement as to how or on what this tax/fee will be based.

Total: $80 billion

In exchange for these items, the White House agreed to:

1. Oppose importation

2. Oppose rebates in Medicare Part D

3. Oppose repeal of non-interference

4. Oppose opening Medicare Part B

"Non-interference" is the industry term for the status quo, in which government-driven price negotiations are barred. In other words, the government is "interfering" in the market if it negotiates lower prices. The ban on negotiating was led through Congress in 2003 by then-Rep. Billy Tauzin (R-La.), who is now the head of PhRMA.

The rebates reference is to Medicare overpayments Big Pharma managed to wrangle from the Republican Congress that Democrats are trying to recoup. The House bill would require Big Pharma to return some of that money. The rebate proposal would save $63 billion over ten years, according to the Congressional Budget Office. The White House, given the chance, declined to tell the Wall Street Journal for a July 17th article that it supported the effort to pursue the rebates.

The Medicare Part B item refers to "infusion drugs," which can be administered at home. If they fall under Part B, Big Pharma gets paid more than under Part D. The agreement would leave infusion drugs in Part B.

In the section on Big Pharma's concessions, "FOBs" refers to follow-on biological drugs. Democrats have pushed to make it easier to allow generic drug makers to produce cheaper versions of such drugs, an effort Big Pharma has resisted. The Senate health committee bill gives drug makers 12 years of market exclusivity, five more than the White House proposed.

PhRMA's Johnson cast doubts on the provenance of the outline. "The memo, as described, is simply not accurate," he said in a statement. "Anyone could have written it. Unless it comes from our board of directors, it's not worth the paper it's written on. Clearly, someone is trying to short circuit our efforts to try and make health care reform a reality this year. That's not going to happen. Too much is at stake for both patients and the U.S. economy. Our new ads supporting health care reform are starting this week, and we are redoubling our efforts to drive awareness of why this issue is so important to America's future."

Johnson added that "no outside lobbyists -- not a single one -- were ever involved in our discussions with the Senate Finance Committee or the White House so someone is blowing smoke."

But the lobbyist who was given the outline defended its authenticity. And although the White House now says that drug price negotiations and reimportation were not actually discussed in the talks with PhRMA, the lobbyist said: "Well, that's bull -- that's baloney. That was part of the deal, for them not to push that."

The new uncertainty surrounding the deal comes after House Speaker Nancy Pelosi (D-Calif.) has repeatedly said that her chamber is not bound by any agreement it is not a party to. On July 8th, the day after the Journal reported some elements of the deal, Energy and Commerce Committee Chairman Henry Waxman (D-Calif.) said in a public speech that his committee would not be tied down by the agreement.

Before recess, he followed through. His committee passed a bill that allowed for re-importation and drug-price negotiations.

In the Senate, Democrats Sherrod Brown (Ohio) and Byron Dorgan (N.D.) pressed White House officials at a closed-door meeting last week, asking whether the White House had tied the Senate's hands.

The health care lobbyist said that what deal still exists is uncertain, as a result of House pressure. "Now the White House is backing away from it, as you know, because of pressure from the House, because the House was not a party to the deal," he said. "The Speaker put enormous pressure on the White House, [saying], 'We weren't a party to it and we reserve the right to do whatever we want.' And which they did in the House Energy and Commerce Committee bill, which led the White House to say, 'Well, maybe it's not cast in concrete.'"

Obama is walking a tightrope here. He wants to keep PhRMA from opposing the bill, and benefits by having its support, which now includes a $150 million advertising campaign. That's a fortune in politics -- more than Republican presidential candidate John McCain spent on advertising during his entire campaign -- but it's loose change in the pharmaceutical business.

Opponents of the deal with PhRMA hope that Obama is playing a multilayered game, making a deal in order to keep the drug makers in his camp for now, but planning to double-cross them in the end if he needs to in order to pass his signature initiative.

Big Pharma, however, is still comfortable. "As far as the pharmaceutical industry, PhRMA and its member companies, yes, they say a deal is a deal. We'll see what happens," said the health care lobbyist.

Source / Global Research

Thanks to Phil Sigmund / The Rag Blog

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Obama Must Fight for Public Option, Real Health Care Reform

President Obama addresses the American Medical Association, June 15, 2009. Photo by Charles Rex Arbogast / AP.

In some way the message must get through to the Senate Democratic leadership that they were elected to represent THE PEOPLE and were not brought to Washington to be prostituted to various amoral monied interests.

By Dr. Stephen R. Keister / The Rag Blog / June 22, 2009

Webster's Universal College Dictionary defines "prostitute" in various ways; however, the most telling is: "A person who willingly uses his or her talent or ability in a base and unworthy way, usu.for money."

Enter the United States Senate. The latest reports from The Center for Responsive Politics as reported by The Lee Newspapers State Bureau showed that the campaign of Sen. Max Baucus and his Glacier PAC, which raises money and distributes it to other candidates, received 23% of their $14.8 million from health care and insurance interests. The $3.4 million from these sectors includes $853,000 from pharmaceutical and health products; 851,000 from health professionals; $467,000 from hospitals and nursing homes; $466,000 from health-service and HMO interests; and $784,000 from insurance. This is the Senator leads the way in the Senate concerning health care reform This is the Senator who had proponents of single payer, universal care arrested in handcuffs when they attempted to speak at his hearings.

Senator Baucus is not alone in his complicity with the insurance industry. He is joined by six or seven other turncoat Democratic Senators who are beholden to the monied interests in the insurance, pharmaceutical and health care industries. These were the same insurance companies whose executives testified before Congress, as reported in The L.A. Times, and when asked if they'll stop dropping customers except where they can show “intentional fraud.” All said "No.”

Executives of three of the nation's largest health insurers told lawmakers in Washington this past Tuesday that they would continue canceling medical coverage for some sick policyholders, despite withering criticism from Republican and Democratic members of Congress who decided the practices as unfair and abusive.

An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant, Inc. cancelled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period.

It also found that policyholders with breast cancer, lymphoma and more than 1,000 other conditions were targeted for recission and that employees were praised in performance reviews for terminating the policies of customers with expensive illnesses.

Thus we can easily understand the public’s responses in a Harris Health Care poll in January, 2009, which showed the following results. When asked, "How much do you trust each of the following to do the right thing for the health care of those whom they have a responsibility for?” Answers were broken down into several categories: A Lot; Some; Not Much; Not At All; Not Sure.

Those responding "A Lot": Nurses 65%; Doctors 61%; Dentists 56%; Pharmacies 49%; Hospitals 44%; Pharmaceutical Companies 14%; Employers 12%; Managed care companies 9%; Health Insurance Companies 8%.

Another category of questions : "And how much do you trust each of the following to do the right thing FOR YOU and your health care?" Those responding "a Lot". Your doctor or doctors 63%; Nurses who treat you 60%; Your dentist 58%; The pharmacy or pharmacies you use 50%; The last hospital you visited 47%; The prescription drugs you take 44% ; Your employer 16%; Your health insurance company 15%; Your managed care company 9%..

In some way the message must get through to the Senate Democratic leadership that they were elected to represent THE PEOPLE and were not brought to Washington to be prostituted to various amoral monied interests.

Happily, The House of Representatives has provided us with a discussion draft of a program that provides affordable health care for all Americans and controls health care cost growth. This was made available on June 19, 2009. Thus, we have here a small step in the correct direction.

There is little or no hope for "bipartisanship.” It’s either a pipe dream or a cop-out. The Republicans continue to reduce the discussion to absurdity, still claiming that single-payer or public option will lead to "government rationing" of health coverage. As Dan Lipsher points out in the Summit Daily, "Guess what: Private insurance companies already ration health care, but instead of the law determining what to cover and how much to pay, it's an insurance company making these decisions. Rather than being motivated by what's best for the patient, these insurance company employees are compensated on the basis of how much money they can save their employers/stockholders.” Ever wonder why "usual and customary" coverage is never enough to pay your full medical or dental bill? That’s because treatment cannot realistically be found at the price the insurance company arbitrarily sets.

A government plan, on the other hand, can be required by law to pay 100% of the cost of necessary treatment. No more aftercare bills for hundreds or thousands of dollars because the cost of a CAT scan or chemo session exceeded the "usual and customary" allowance authorized by a nameless, faceless middle manager at Aetna or Blue Cross/Blue Shield. A government plan can also set maximum charges for treatments, reducing or eliminating overcharges by hospitals and other providers looking to maximize profits and making patients pay for months or years to satisfy their hospital bills -- and reducing personal bankruptcies by a significant percentage as well.

Republicans claim that private insurance companies will not be able to compete with a government-sponsored health plan. Yet private insurance profits are so excessive that they have agreed to voluntarily cut costs by $2 trillion over 10 years -- that's $200 billion a year. In other words, private insurers have been gouging businesses and consumers to the tune of $667 per person per year. We hear a lot about “letting the market dictate price,” but clearly the fix is in when it comes to insurance premiums, deductibles, and pay-outs.

Where is the White House in all of this discussion? President Obama seems to have held his own in his speech to the AMA; however, the President, like much of the public, appeared to have only a vague idea of the nature of the AMA. The AMA is not and never has been an organization representative of American physicians. The AMA membership probably represents 30% of the physicians in the United States, and possibly one half of those are retired. The AMA is basically a marketing organization, largely sponsored by the insurance and pharmaceutical industries. It has no disciplinary function. The educational function is limited -- most doctors keep abreast of their ongoing education through their speciality societies and journals.

The AMA traditionally has represented right wing politicians and opposed social change, i.e. Social Security and Medicare. It has imbued in the practicing physician the thought that high malpractice premiums are solely the fault of the "trial lawyers," disregarding the fact that the doctor’s own negligence, lack of caring, and failure to communicate with the patient or other attending physicians are indeed part of the problem. Further, when the malpractice insurance companies are losing in their investment portfolios they increase premiums, to maintain profits, and blame the increase on the trial lawyers.

Time becomes of the essence; hence, the President must speak out to the Senate, as he did to the Congress on the recent War Appropriations bill. He must schedule an address to the American people where he unequivocally fulfills his campaign promises to provide decent health care, as is available in the majority of the free world. I would think that President Obama is as ashamed as I am of seeing the United States ranked #32 worldwide in health care delivery, a notch above Slovenia. Obama must make his own decision and not accept the council of the duplicitous Rahm Emanuel.

One admires the President’s insight and knowledge in taking a reasonable, sensible, and enlightened stand as regards the present civil conflict in Iran; one trusts that he will show like courage in facing down the Senate regarding health care and, if necessary, request the Senate to enact the "nuclear option" to bypass the Republican obstructionism and the Democratic acceptance of health insurance industry bribery

I had hoped to further address the legalization of cannabis; however, space is limited. I would suggest that anyone interested in the subject, as well as in the "war on drugs" obtain the July-August issue of Mother Jones, as much of the magazine is devoted to those topics, including an excellent historical review.

[Dr. Stephen R. Keister, a retired physician who is active in health care reform, lives in Erie, PA. His previous articles on The Rag Blog can be found here.]

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Medical Ethics : The Campus Invasion of Big Pharma

Graphic by Mike Licht / NotionsCapital
Big Pharma and Medical Ethics

Drug companies are 'funneling money through universities for advertising and trying to disguise it as education.'

Dr. Gerry Lower / The Rag Blog / March 9, 2009

The New York Times reports that "In a first-year pharmacology class at Harvard Medical School, Matt Zerden grew wary as the professor promoted the benefits of cholesterol drugs and seemed to belittle a student who was concerned about side effects."

Zerden did a bit of Google searching online and he began sharing his findings with classmates. The professor was not only a full-time member of the Harvard Medical faculty, but a paid consultant to 10 drug companies, including five makers of cholesterol treatments.

David Tian, 24, a first-year Harvard Medical student, said: “Before coming here, I had no idea how much influence companies had on medical education. And it’s something that’s purposely meant to be under the table, providing information under the guise of education when that information is also presented for marketing purposes.”

This is the unjustifiable degree to which corporate influence has invaded even our medical schools in the U.S. Zerden’s minor stir four years ago has since grown into a full-blown movement with more than 200 Harvard Medical School students and sympathetic faculty, "intent on exposing and curtailing the industry influence in their classrooms and laboratories.”

Big Pharma does not have a very good reputation in testing new drugs for safety and it has no interest in and does not do a very good job of assessing relative efficacy, i.e., CER, comparative effectiveness research), mostly out of fear of losing market share.

As argued in Newsweek, "doctors have long resisted having science guide their practice. That's obvious from the disparity in clinical practices from one region of the U.S. to another."

One solution?

"An unbiased source of data, not drug companies, could really help us in primary care. There have to be allowances for individual differences, but you need standards."

No kidding.

In dealing with this extraordinary lapse in medical ethics, one approach is to deal with the symptoms of the problem, e.g., pass laws forbidding contributions from Big Pharma to medical school faculty members so as to curtail the conflicts of interest that would not exist without Big Pharma.

Consider that drug companies are "funneling money through universities for advertising and trying to disguise it as education. For example, from 2002 until 2008, Wyeth funded an online course promoting hormone therapy at the University of Wisconsin. Thousands of physicians took the course, backed by a $12 million grant.

The course "touted the benefits of hormone therapy and downplayed its risk" in a program described as "pure, undisguised marketing." The increased risks we are talking about here are an increased risk of breast cancer, heart disease, stroke and blood clots.

Even the director of the course, on the take to Wyeth, admitted that the hormone material was "presented in a more positive light" than she would have preferred. But, what the hell is one supposed to do?

Dealing with symptoms, of course, has never cured anything, providing only relief at best, because we need to be dealing with the cause of the symptoms. In getting to the core of this problem in medical ethics, it must be pointed out that this scenario did not "just happen." It was overtly promoted under the dominion of greed-driven capitalism.

It is not individuals who are unethical by nature, it is the entire capitalist socioeconomic system that is unethical by design, as well as being immoral on the international front (e.g., the Bush administration's preemptive attack on Iraq). It is best all left behind.

The fact that right wing Roman politics have been "voted to the edge of political irrelevance,” must be taken into consideration here as well. If the Republican Party fails utterly, as it seems destined to do under the "leadership" of Rush Limbaugh, the world will have to fill the void with human rights and democracy. That would be our only chance to get medicine back into the hands of physicians and government back into the hands of the People.

"Physician, Heal Thyself."

Please see the following references for this story:

• Harvard Medical School in Ethics Quandary by Duff Wilson / The New York Times / March 3, 2009
• Harvard Med Students Expose Big Pharma's Influence on Campus by AlterNet Staff / AlterNet, March 6, 2009
• Why Doctors Hate Science by Sharon Begley / Newweek / March 9, 2009
• Wyeth Funded Med School Course Promoting Risky Drugs by Alexandra Andrews / AlterNet / Feb. 23, 2009
• GOP at the Abyss by Michael Gerson / Washington Post / March 6, 2009

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Health Care in the USA : Go Team! We're 26th!

US Rep. John Conyers (D-MI), sponsor of HR 676, with filmmaker Michael Moore and US Rep. Dennis Kucinich (D-OH)on Capitol Hill in June, 2007. All are supporters of single-payer universal health care. Photo by AFP / Getty Images.

As a retired physician I am ashamed of health care in the United States, and having had first hand or collateral experience with health care in France, the U.K., and Italy I can well understand why we rank #26 in the industrialized world.

By Dr. Stephen R. Keister / The Rag Blog / January 18, 2009

As a retired, 87 year old physician, with 40 years of practice behind me, and in addition post-retirement working part time at the V.A. and subsequently at a neighborhood free clinic, I found Luke Mitchell's article in the February issue of Harpers very comprehensive and illuminating. Yet, one critical element was missing and that was any allusion to Physicians For A National Health Program, a 20 plus year old organization, with 15,000 members, from which evolved Rep. Conyer's HR 676. PNHP provided the basic studies incorporated in HR 676, and subsequently received the endorsement of the 125,000 member American College of physicians, The California Nurses Association, and numerous civic and labor groups.

As a retired physician I am ashamed of health care in the United States, and having had first hand or collateral experience with health care in France, the U.K., and Italy I can well understand why we rank #26 in the industrialized world. In no other country with universal care is it established for profit of the insurance industry. It is a travesty that any person with any foresight would envision a system in the United States that includes, even in part, the insurance and pharmaceutical industries, rather than being established for the citizenry as a whole.

Unfortunately if one does a bit of research at OpenSecrets.org one will discover how intensely prostituted many of our elected representatives are to the insurance/pharmaceutical complex. Our current health care system is merely a continuation of the economic theories that have currently brought our nation near to a disaster similar to that of 1929.

I have a series of articles on The Rag Blog that explores the problems involved in providing our country with health care. I am sure any one interested can further their knowledge of this area by checking into this web-site.

The Rag Blog

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Fatty Foods : All the Skinny

'Obesity, though some would prefer to call it eating disorders, is a big growth area, not just for the unwitting sufferers, but also for some food companies which contribute so greatly to the problem.'
By Asinus Asinum Fricat / November 18, 2008

A couple of days ago I wrote this diary and copped quite a few unkind comments, mostly from misinformed posters and a handful of hardcore denialists. Yet the problems persist, and shooting the messenger rarely helps. But I'm a tough cookie, comfortable in the knowledge of what I know and write about and in this diary I'm basically tackling the same issues albeit from a different angle: "Big Pharma" and the multinational junk & processed foods companies ("Big Food") which, worldwide, make gigantic profits on the back of unsuspecting consumers, specifically marketing non-nutritious food appealing to children and adults alike via disingenuous advertising.

Obesity, though some would prefer to call it eating disorders, is a big growth area, not just for the unwitting sufferers, but also for some food companies which contribute so greatly to the problem. "Big Pharma" which works in tandem with "Big Food" would love to "terminate" its main source of competition: the natural products industry and the organic movement.

First let me remind you that Barack Obama's election means that it is Big Pharma that stands to take a hit, according to The Boston Consulting Group. Its analysis concludes that Obama's plan to let the federal government negotiate Medicare drug prices could cut industry revenues by a whopping $10 billion to $30 billion. That's good news for those suffering from a plethora of illnesses. I'm not sure how his administration will handle Big Food but one thing is certain: like the banks it badly needs to get regulated particularly in the area of food additives, supersaturated produce with empty calories in the form of white flour, sugar, high-fructose corn syrup, transgenic (synthetic) fats, labeling and unscrupulously aggressive marketing.

There are over 320,000 food items on the market, and many food companies produce both "good" and "bad" food. If you thought that the following "modern" foods were harmless, think again: juices, yogurts, cheese sticks, corn flakes, pastries, chocolate & energy bars are all loaded with sweeteners and additives.

Soft drinks: (get rid of them) research indicates that if you drink as little as 2 sodas or colas a day, it promotes diabetes and weight gain. Informed nutritionists have known this for years, which is that taking in empty calories from sugar and high fructose corn syrup is not only wasteful, but can be harmful to the digestive system. HFCS is also found in condiments like ketchup, fruit juices and chocolate bars.

The dangers of hydrogenated oils and partially hydrogenated oils are also developed from otherwise harmless, natural elements. To make them hydrogenated, oils are heated in the presence of hydrogen and metal catalysts. This process helps prolong shelf life but simultaneously creates transfats, which only have to be disclosed on the label if the food contains more than 0.5 grams per serving. To avoid listing transfats, or to claim "transfat free" on their label, sneaky food manufacturers simply adjust the serving size until the transfat content falls under 0.5 grams per serving. Voila! The Harvard School of Public Health has estimated that at least 30,000 people, and more probably 100,000 people die every year in the US from cardiovascular disease caused by consuming hydrogenated oils, as opposed to natural vegetable oil.

Remember when some physicians told you about this new wonder drugs that can take off weight without even thinking? One such drug is Sanofi-Aventis' (SNY) rimonabant, which is marketed as Acomplia in the EU. No such "luck" in the US though, it was rightly rejected for its suicidal tendencies. The medicine supposedly suppresses the receptors in the brain that cause people to crave fatty foods. The other drug is GlaxoSmithkline's (GSK) Alli, which is now available over the counter.

Alli is essentially the over-the-counter version of Xenical, (generic name is orlistat) a prescription medicine already available. Xenical works by blocking the amount of fat absorbed through the digestive system.

At the time of the Alli's launch last year, GSK estimated it would eventually sell between five million and six million kits annually, translating to at least $1.5 billion in annual retail. A 60-capsule kit costs about $50 while a 90-capsule pack costs about $60. Does it work? Not enough to spark a run on Brazilian bikini but if you agree to a commitment to living your life in a new way as you must learn to change your eating and activity habits, then it's for you. But why spend that kind of money when you have to completely change your lifestyle and do all the proverbial heavy lifting? Those taking Alli, btw, have to put up with some diarrhea and flatulence.

And now on the legal front: on 17 April 2008, GSK, along with the American Dietetic Association and the Obesity Society (both regarded by many as fronts for the Big Pharma) petitioned the FDA to try to prevent any dietary supplement product making weight loss claims. The company wants weight loss claims to be re-classified as disease claims, therefore making them the sole domain of treatments with licensed pharmaceuticals. And since GSK's Alli product is the only weight loss drug that is on the over-the-counter market it doesn't take a rocket scientist to see their reasoning.

A lawsuit aimed at getting soft drinks firms out of US schools on obesity grounds is now ready to go, says one of the leading lawyers involved to BeverageDaily.com, as new research suggests obesity litigation will become the next "tobacco".

When it comes to using litigation as a strategy to combat obesity, food manufacturers should be most wary of lawsuits based on consumer protection acts, according to a new report that examines the application of tobacco litigation methods to obesity lawsuits.

The report uses the history of tobacco litigation as a model to evaluate potential legislation against the food industry, which the authors claim is another industry that poses a threat to public health.

Published in this month's issue of the American Journal of Preventive Medicine, the study says

that although national legislation against the food industry would be a "preferable" strategy to protect public health, lessons from the tobacco wars suggest that effective national legislation is currently unlikely.

One of the reasons for this is that the industry has a strong influence on the process, say authors Jess Alderman and Richard Daynard. Like tobacco, the food industry routinely- and often invisibly- seeks to influence both legislators and health professionals to support its agenda while ignoring its potential impact on public health".

And when it comes to individual personal injury lawsuits against food companies, these also could carry a slim chance of success, although the companies involved are likely to fight litigation at every step.

"Losing such a lawsuit could open the floodgates of litigation by encouraging millions of obese Americans to file similar cases, so it would be advantageous for the food industry to delay or defend every such lawsuit to the fullest extent."

However, as was demonstrated in the EU recently, lawsuits based on consumer protection acts are likely to be much more effective, as these avoid complicated causation issues and focus instead on deceptive marketing tactics and could fall under consumer protection statutes, together with false advertising, misleading claims and unfairly taking advantage of vulnerable consumers.

Indeed, back in 2005 an American consumer launched a lawsuit aimed at food companies including Kraft Foods, General Mills and Kellogg, alleging that "low sugar" labels on cereals were deceptive as the companies replace the sugar with other carbohydrates, thus offering no significant nutritional advantage. The suit claims that these cereals are misleading because they aren't any healthier than cereals with regular levels of sugar, according to the Wall Street Journal.

The food industry in general is coming under increasing pressure from food lobby groups and some parents, to "clean up its act" and offer healthier alternatives to help combat the obesity epidemic facing the world. Sugary cereals are frequently cited by these groups as guilty culprits, encouraging children to eat empty calories instead of nutritional whole foods. Will Obama appoint a food "czar", someone who can and will take on Big Food?

High fruit and vegetable prices may be linked to childhood obesity, says the US Department of Agriculture (USDA), although it suggests that further research is needed in order to confirm the "casual relationship" identified by its recent study.

The USDA's Economic Research Service (ERS) findings are based on an examination of the diets and weight of around 7,000 children between kindergarten and third grade.

"Children who lived in metropolitan areas where fruits and vegetables were relatively expensive gained significantly more weight than children who lived where fruit and vegetables were cheaper," said the USDA, adding that the children who participated in the study had a similar way and standard of living

Data from the Bureau of Labor cites that both American children and parents are spending increased time commuting from work, school and activities. Eating takes place en route from one venue or another, making sitting down to a home-cooked, carefully balanced meal even less of a reality for families. The absence of regulated family eating schedules was cited as one of the main causes of poor dietary habits. But other major concerns cited by respondents should serve as a warning to food makers that they are not about to be let off the hook just yet.

"Children's eating habits are suffering due to the lack of structured meal time, and this is as big a challenge as the lack of balanced meals," said Amanda Archibald, analyst and registered dietitian for Mintel. "Compressed schedules and cramped time availability for both children and parents may play a more important role than previously thought in making healthy food choices."

According to Mintel's Menu Insights, a menu-tracking system, more than 47 percent of children's menu items were fried. Chicken fingers led the way on the top 5 children's menu dishes list, followed by grilled cheese sandwiches, burgers, macaroni and cheese, and hot dogs.

Mintel's report also cites that overall restaurant portions have also steadily increased over time.

And recently, a number of academic studies presented at the AACR International Conference on Frontiers in Cancer Prevention Research reveal growing evidence that overall cancer incidence and mortality resulting from overweight and obesity is also increasing, something which places more pressure on the food industry, and presents regulators with another headache.

If you'd like to read about Big Pharma cloak & dagger scare tactics, look no further than here.

Source / La Vida Locavore

Thanks to Diane Stirling-Stevens / The Rag Blog

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Big Pharma and Your Pocketbook : Big Hurt

'In no other civilized nation, would you, as a sufferer from an illness, have the opportunity to subsidize one of the three most profitable industries in the world.'
By Dr. S.R. Keister / The Rag Blog / October 17, 2008

A special salute to those of you who have the privilege of going to the drug store to have your prescription(s) filled before the election. You are the select, the chosen, who as American citizens have been granted the right to pay the highest prices in the world for your prescription medicines. In no other civilized nation, would you, as a sufferer from an illness, have the opportunity to subsidize one of the three most profitable industries in the world, contribute to the excessive CEO salaries, pay in part the salaries of the hundreds of lobbyists in Washington as they pay baksheesh to many, many congressmen, by-in-large Republican, who work so hard for the pharmaceutical industry.

We as Americans are indeed the select who, by our purchase of pharmaceuticals, pay for the never ending stream of TV commercials, magazine ads, and newspaper ads for medications about which your physician should be familiar without the vulgar publicity. In spite of the propaganda from the pharmaceutical industry regarding "research costs" the industry spends much more on advertising and lobbying than on "research" I would call your attention to the book: The Truth About The Drug Companies by Marcia Angel, M.D.; Random House, Published 2004.

It should be noted that the United States and New Zealand are the only nations in the world that permit TV advertising for prescription medications. In no other nation does one have to sit with an eight-year old grandchild watching a sporting event and parry his questions during Viagra or Cialis ads about what an erection is, or what is better sex? Where are the hypocrites that cry out about sex education in school when there are ongoing ads on TV that tell one to see their doctor if "the erection" lasts more than four hours? I have heard nothing from these God fearing folks about sex education on TV! Remember what Dante wrote about the fate of the hypocrite?

In no other Western nation, nor in the V.A. facilities in the United States, are the ill taken advantage of as we see in the USA. In the European nations, in Canada, Australia, Japan, there is, under their national health plans, regulation of pharmaceutical prices, prohibiting excessive profits to the manufacturers. In the United States we have no price controls. Indeed the Republican Party, President Bush, and Senator McCain have bitterly opposed any price controls, and in fact have encouraged just the opposite in passing "Medicare Part D" several years ago, thus, scamming the elderly even more to the benefit of the pharmaceutical and insurance industries. The monstrous "plan," passed by the House of Representatives in the middle of the night, awarded billions of Medicare dollars to the pharmaceutical and insurance industries for their "participation,” and further provided for the insurance companies as carriers of the individual policies, resulting in a charge to the participating patient of somewhere around $30 per month for the privilege of “belonging.” This could have been managed by the present Medicare agency, with upgrading, and modification, without involving the insurance industry; however, the Bush/McCain/Republican beholding to the pharmaceutical and insurance industry trumped the interest of the citizen.

It should be noted that many of the Republican leaders in congress responsible for the Medicare Part D bill subsequently ended up working for various pharmaceutical companies or lobbying firms. And, these same folks who pushed the Medicare D Legislation forbid price negotiations by Medicare for price control, and also forbid getting medications from abroad at a more reasonable price. The "reason" for the latter was the administration’s concern that drugs from abroad might be dangerous or inferior. Of course this was pure poppy-cock; of the six or eight major pharmaceutical firms, several are multinationals with offices not only on the United States, but in Switzerland, France, Germany or Sweden. The products they sell in the United States could be made anywhere in the world. Recall several years ago the British subsidiary of one drug company found its flu vaccine supply contaminated and the U.S. government obtained the vaccine from a French subsidiary in the United States. At the same time there was a great concern about bird flu and the government stockpiled TamiFlu made in Switzerland. Happily, in many instances we are able to obtain medications from abroad. For instance, my medication for prostatic cancer costs $400 for 30 tablets in the United States. I can obtain it from Canada at 100 Tablets for $400.

A word about generic drugs. Under U.S. patent laws a drug company looses exclusive patent rights to a specific drug after 17 years, and then theoretically a generic manufacturer can produce the same medication under its chemical name, rather than the original vendor’s trade name. Generics are just as good, and just as safe, as the drug under the original brand name when given Food and Drug Administration approval. Yet the big drug companies can delay that change for some years by various spurious legal actions, thus maintaining the higher prices the consumer must pay. Another ploy is to permit the original drug to become generic, but change the chemical formula a bit and market a "new and better" version of the old drug. As a result of the companies’ huge advertising budgets, the lay public will buy into this nonsense. If you are wise stay with the original in generic form if it is doing the job.

I note that Sen. Obama favors changes in the present consumer punitive system, while his sloganeering opponent, with ruffles and flourishes, suggests he’d bring more of the same. Please note that currently under Medicare Part D, the insurance carriers in many instances are increasing monthly membership rates, increasing co-payments, and decreasing the choice of medications available, while the pharmaceutical manufacturers are increasing prices. A word of caution: your local pharmacist is not responsible for the high price of drugs. He is trapped in the same situation as your local gas station owner. Do not blame the messenger.

This becomes a more and more vital issue in today’s economic meltdown. I sincerely fear that relief may be some time away regardless of who wins the election since problems beyond belief will face the next president. I sincerely believe that Sen. Obama will diligently try to correct a situation that he had no hand in creating, a situation that goes back to the Reagan administration and the concept of "trickle down" economics for which Sen. McCain has been a great supporter, regardless of his politically motivated attempts to publically disengage from what he has helped to create. I note that the U.S. Treasury Department managed to provide the figures for the increase in next year’s social security payments before the November election. A good increase, a necessary increase, but an increase that seems a bit disingenuous in view of the impending decreased taxes available to the U.S. Treasury with the increasing unemployment.

For those with further interest in the machinations of the pharmaceutical industry I suggest the following reading; Critical Condition, Bartlett & Steele, Doubleday, Published 2004 and Health Care Meltdown, Bob Lebow M.D., J.R.I. Press, Boise ID 83703, Published 2002, or indeed my own personal ranting here. Click on position papers.

[Dr Keister is a retired physician who contributes regularly to The Rag Blog.]

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Emergency Room : Diagnosing the Candidates' Health Care Programs

'The McCain "health care" plan is a pure cop-out to the insurance industry.'
By Dr. S. R. Keister / The Rag Blog / October 3, 2008

It would appear to be a very simple exercise to write down in two columns what the candidates have to offer the public for future health care. Yet, upon delving into this I encounter a much more formidable task. This is much bigger and more complex than comparing two lists. I consider health care as a profession as I knew it when I started practice in 1950 and the evolution of health care into a business which it has become. We are looking at a cultural renaissance, not just taking care of the ill and injured, we are talking about a complex social revolution.

Let me start with two examples. I had a colleague who organized a "future physicians club" at a local high school in about 1970. This was a source of inspiration and enjoyment to he and the students. Somewhere in the 1980s he stopped the entire program as the students were no longer interested in the art and science of medicine, but as a business to make money. Second, I recall in 2004 watching CNN and the reporter was interviewing a family in the Middle West. The father was an out of work diabetic, two children were ill, they had no health insurance, were facing foreclosure. The correspondent asked the woman who they were going to vote for for president, and the answer was George Bush because he is against gay marriage.

Currently 60-70% of the public "want something done about health care." According to the New England Journal of Medicine some 60% of physicians are in favor of single payer, universal health care as outlined by Physicians For A National Health Program. Yet the public is being inundated by a series of TV commercials sponsored by the AARP and AMA both of which do not support single payer, universal health care, but in a subtle manner espouse more of the same with minor revisions of health care dominated and run by the insurance industry with subtle suggestions that "we do not want socialized medicine, do we?"

In 1950 when I started practice in Internal Medicine/Rheumatology the local hospitals demanded that to obtain admission privileges we give two months a year taking care of charity patients in the hospital, and as well spend one morning a week working with charity patients in outpatient clinics. When the insurance industry swept up passive physicians into the HMO movement the hospitals ceased the programs that had been their earmark dating back to medieval times. Now both physicians and hospitals are, by and large, the vassals of the insurance industry. In short, if either candidate attempts to promote universal health care as is indigenous in most European nations, with excellent universal coverage, with generous government subsidy, that candidate will be berated, libeled, and defamed by those who are the financial beneficiaries of the present system. With the American public slave to ads on TV the candidate has not the chance of a snowball in hell if he speaks of universal care.

The physician is not immune to our culture of greed, of the machinations of the neo-liberals (that term always seems to be an anachronism). Further, he is a victim of corporate capitalism and works in fear of his survival and the well-being of his family. He, as the balance of our society, has been overwhelmed by the forces discussed by Naomi Klein in her book "Shock Doctrine." Believe me, most honest, dedicated physicians are very unhappy with the status quo but they are afraid. Happily, 15,000 dedicated souls involved in Physicians For A National Health Program have risen above the morass and are attempting to move forward.

The greed runs rampant with "non-profit" homes for the elderly, nursing homes, free standing dental and medical centers. We see pharmaceuticals advertised on TV hour after hour, thus making prescription drugs more expensive in the United States than elsewhere in the world. We see the Bush administration following the neo-liberal format of 1) Privatization, 2)Deregulation and 3)Doing away with government subsidized social programs, in instituting "Medicare Advantage Plans," a backhanded way of turning Medicare over to the Insurance Industry. We see the crony relationship of the Pharmaceutical Industry and the congress in enacting the absurd Medicare part D, which enriches the pharmaceutical and insurance industries.

The McCain "health care" plan is a pure cop-out to the insurance industry. It will make insurance coverage less accessible and affordable for those with high health care needs. It will increase coverage among the currently insured through the non group market, but reduce the number already covered by employers, leaving about the same number uninsured (45 million). Provide a tax credit to purchase insurance, but the credit for the average working family would only pay a fraction of the cost of a policy for a family of four.

The Obama plan is a step in the right direction, greatly increasing health insurance coverage but still leaving about 6% of the non- elderly uninsured, as compared with 17% today. Increase access to affordable coverage for those with the highest health care needs, including the chronically ill. Increase the affordability of care for low-income families. For the currently uninsured offer a program akin to that provided for members of congress.

Obama appears to be moving in the right direction if his program can be facilitated after the current Wall Street bailout. Funding may indeed be a problem. The PNHP plan would be much less expensive and provide universal coverage, but would be a political disaster to overtly espouse.

We have a long way to go and it will require much more than simple legislation unless many of our elected representatives have their umbilical cords cut to the insurance and pharmaceutical lobbies and much of the physician population can be encouraged to stand up and throw off the yokes of the HMOs.

Go to Physicians For A National Health Program.

And see the comparitive analysis of the Obama and McCain health care plans at the Urban Institute's Health Policy Center.

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Retired Physician : Our Health Care System an Outrage

'The insurance industry, and the Republican Party, over the years have sold the public a bill of goods'
By S. R. Keister / The Rag Blog / September 30, 2008

I have been reading Vincent Bugliosi's "The Prosecution of George W. Bush for Murder". Mr. Bugliosi is very, very angry, a justifiable anger, perhaps akin to Zola's anger when he penned "'J'Accuse.” Perhaps in today's world there should be increased justifiable anger. Perhaps if the nation would become aroused we, the citizens of The United States, could accomplish something with well directed, intelligently utilized anger. Perhaps we could awaken the dumbed down citizen who spends his/her time before a TV set, believing every word, to stand up for their own interests instead of believing in the propaganda that they are inundated with.

I am very, very angry. I am angry that I am an old retired physician with a malignancy. But I am especially angry at the state of health care in this country, a system of which I was proud when I started practice in the 1950s, but which, by the perfidy of the insurance and pharmaceutical industries has become one of the least desirable in the free world. Our health care currently ranks 25th in the world according to The Commonwealth Fund. I cringe when I see notices on public bulletin boards announcing a fund raiser at a fire hall for a child who needs money for a kidney transplant. Only in the United States!

I am angry when I hear seemingly intelligent folks say, "I wouldn't want 'socialized medicine',” yet they accept Medicare or government retirement health care and are too stupid to realize that they are receiving “socialized medicine.” The insurance industry, and the Republican Party, over the years have sold the public a bill of goods. Most every Western European nation, Australia, and Canada have government subsidized health care, with 100% of the population covered. I have personally had contact with the system in the U.K. and have had friends treated, both in and out of hospital, in France, Italy, and Norway and they attest to excellent care. Interestingly, in most instances, as guests in the countries, the costs were minimal if any.

The capitalist profits of doom ask the uninformed citizen; "Do you want to wait long weeks for medical care?" and "Do you want 'the government' dictating your health care? Of course this is balderdash worthy of P.T.Barnum. In most other industrialized western nations, one waits no longer for medical care than one does in the United States. Here or there certain procedures or appointments require a wait. A total knee replacement may get done sooner here, but emergency care is more immediately accessible abroad.

Europe has more physicians per 100,000 population than does the USA. They have more hospital beds and more CT Scanners, and their medical education is free, or nearly free, to students that academically qualify. In no nation with universal health care does the “government” determine choice, save in exceptional instances. One is totally free to choose one’s physician, dentist, or pharmacy. The insurance industries’ propaganda sources can always dig up, or manufacture, exceptions which are foisted on the credulous public as the normal experience.

Another facet of the health care mess in this country is how the public has been purposefully confused as re: "non-profit" institutions. The average American in some way has confused "non-profit" with "charitable institutions". Of course, most charitable institutions are non profit. BUT 'non-profit' insurers, most hospitals, many retirement homes, are non-profit only in the sense that they are profit making institutions without stock holders. They have tax concessions, can pay their executives extreme salaries, and list their 'profits' as 'surplus'. Again, it makes me very angry to see the American public completely duped by the big business enterprises in the United States. I am angry at the way our elderly are scammed in 'retirement homes', 'assisted care facilities', utilizing their savings to make unseemly profits for the corporations managing same. Only in the USA ! Why then, if we take such good care of our elderly, does the United States have shorter life spans than much of the industrialized world? Perhaps the same reasons that we have one of the highest infant mortality rates, and child poverty rates, of any nation in the Western World. I feel that I have reason to be angry.

I am angry, as well, at the fact that a majority of American physicians sit lethargically by and do nothing to change the situation. Perhaps it is that fact, thanks to the HMOs demanding that they care for more patients than in many instances is humanly possible, and the need to spend hours filling out insurance forms, that time for social action is limited. Perhaps, sadly, a few feel that income will be threatened by a change in the system. In any event, I have throughout my career noted that most doctors vote against their own best interests. Sort of a lemming effect. For instance, when Medicare was first introduced, most physicians opposed the plan, but in the long run most found it to be a boon. Perhaps, and I say this, in part, with tongue in cheek, they are too busy answering questions from patients who have noted a new drug on TV.

The USA and New Zealand are the only nations that advertise prescription drugs on TV, no doubt grossly increasing the prescription costs at the drug stores. Our politicians accept this, no-doubt because the vast majority are prostitutes to the drug and insurance industries. This creates a special anger within me. The public must realize that the current government not only wants to privatize Social Security, but is attempting to turn over Medicare, by default, to the private insurance industry via "Medicare Advantage Plans". Another con game not understood by the elderly subscribers, who are sold the bill of goods that this is for their benefit, but in the long run is really for the insurance industry, its executives, and stock-holders. The Medicare "Prescription Plan D" was purely a gift of billions of dollars of taxpayer money to the insurance and pharmaceutical companies disguised as a program to benefit the elderly. A less corrupt congress could have written a plan with better coverage, at much less cost to the tax-payer and the patient.

As summer phases into autumn one will be exposed to further libelous garbage produced by the insurance companies. Remember three things:

1.) The insurance industry is there for the profits of its owners and stockholders, just like any other business.

2.) Polls show a preponderance of the public for single payer, universal health care, ergo any politician that does not support his/her constituents is either (a) Totally disinterested in the voters needs and desires, or (b) is taking baksheesh from the insurance industry

3.). In anyone’s group of acquaintances one will find a chronic complainer. Such folks are meat for the insurance industry, as with a little financial inducement they will be happy to make commercials demeaning good health care, lies and exaggerations are no problem. So if you hear how bad Canadian care is consider that you are doubtlessly being scammed by a chronic unhappy, fault finding, dissident who will do the job of destroying the truth better than professional actors, who may be utilized as well. Remember the actors on TV who libeled Hillary Clinton's program in 1993 and she was espousing something far removed from single payer care.

I have had a bit of personal contact with foreign health care. Some 18-20 years ago my late wife and I were in Edinboro, Scotland. She became ill. Nearby was The Royal Infirmary. We headed for the emergency department (in Europe most nations do not have ERs as we know them but have two departments, one for the unassigned person who becomes ill and one for ambulance cases and such). We were directed to the former where a nice lady behind a desk asked us our names, where we were staying, and took a quick look at our passports. She directed us to an office where a young doctor spent an hour with us, prescribed, wished us a nice visit. When we departed I stopped at the desk to pay and was told that as guests in the UK that we were covered by National Health and there was no charge. Similarly, I know a young adult lady who was visiting in the Rhone delta area of France, her hostess cut a nasty gash on her hand, the family doctor was called, he came to the house with a portable suture kit and sewed up the lacerated hand. The charges were covered by the National Health Plan. She did not have to sit for two hours in an ER, fill out endless papers, sign many insurance, and other, forms, and be hurried through the procedure.

I find that putting this on paper helps my anger. What the psychiatrists call “ventilation therapy". But, with your forbearance, what do we do?

1.) Join in a joint effort on the Federal level to have Congress pass HR 676. a bill for single payer, universal health care. There is information regarding this from Physicians for a National Health Program. This group of 15,000-plus idealistic, humane doctors has been at this for 20 years and has recently been joined by the 125,000 member American College of Physicians,

2.) Check with your Congressional and Senatorial candidates and vote for the one that will support HR 676. If they refuse they do not give a damn about you.

For Pennsylvania citizens there is another alternative, a universal health care plan for The Commonwealth. Health Care for All Pa. Again if you want decent health care check whether your state senate or Legislative candidate supports this.

Unfortunately neither presidential candidate overtly supports universal, single payer health care. I would hope that Sen. Obama, once in office, will listen, especially if he has a progressive House and Senate. I would expect no action from Sen. McCain as he has announced that he wants to privatize Social Security and has long been a friend of the big corporations and insurance industry. He also seems a bit vague as re: geography, the Middle East, and international affairs. In the meantime please when possible make yourselves known to Sen.Obama.

Thank you for your forbearance and please let us unite in an effort to prevail. I note that the insurance industry is about to start a propaganda program of gigantic proportions to persuade the public that the United States has the 'best health care in the world'.

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