What interests me most throughout the course is how actors such as big pharma, insurance companies, medical providers, policy makers and consumer groups influence the medical landscapes today on a macro level. Unlike most of the premed students in the classroom who resonate with the medical professionals more often, as a business major student I think more about the regulatory environment and sustainable growth for the companies (outside the limitation that defining ourselves by our majors, I surely learned a lot from my classmates and adjusted my opinions along the course). Not surprisingly, the mainstream sentiment in the teaching materials is the anger towards almost all the for-profit entities. But since further commercialization is inevitable in our social development, we need to shift from being angry to collaborating with the businesses with new corporate social responsibilities to create a better healthcare system. Furthermore, policymakers have huge power to allocate the interests among different groups thus shifting the whole landscape. For example, the coverage change in Medicare can transform the model of nursing homes, create a new industry such as Hospice, or significantly impact the life of certain population such as people diagnosed with cancer. Those topics are probably outside the scope of this course, but they could be very good extensions and leave questions for further research. Besides, I have only been in this country for about four months, so all the assumed knowledge towards US healthcare system is very new to me! Therefore, this course has been very eye-opening and rewarding.
In the article, “Being Lonely Can Warp Our Genes, And Our Immune Systems”, by Angus Chen, Chen discusses the different ways in which being lonely has been found to affect the human body. Chen even states that loneliness has been linked to diseases such as heart disease, Alzheimer’s disease, cancer. Chen explains that researchers have found that immune systems of lonely people work differently then immune systems of people who are not lonely. Chen states that, “Lonely people’s white blood cells seem to be more active in a way that increases inflammation, a natural immune response to wounding and bacterial infection. On top of that, they seem to have lower levels of antiviral compounds known as interferons.” Chen also states that loneliness causes a higher level of inflammation which could lead to many of these diseases. Steve Cole, a genomics researcher at the University of California backs Chen’s argument, “That explains very clearly why lonely people fall at increased risk for cancer, neurodegenerative disease and viral infections as well.”
Chen goes on to explain how and why loneliness can change our bodies. Cole explains how he tracked 141 people over five years, by measuring how they felt and by drawing their blood. He found that, “In a life-threatening situation, norepinephrine cascades through the body and starts shutting down immune functions like viral defense, while ramping up the production of white blood cells called monocytes.” Cole agreed with this, “”It’s this surge in these pro-inflammatory white blood cells that are highly adapted to defend against wounds, but at the expense of our defenses against viral diseases that come from close social contact with other people.” Chen also explained that during this process lonely people shut down genes that make their body sensitive to cortisol, which lowers inflammation.
With everything I read in the article it seems as if you are a lonely person then your health will suffer dramatically. The evidence that is provided in the article makes sense, however I feel as if it is exaggerated. I feel like this is just another attempt to medicalize a condition to raise profit for a particular group. If everyone who feels lonely read this article they would automatically become panicked and would try to find a solution. Solutions could include medication to stop inflammation, or therapies to become less lonely. This would raise profit for pharmaceutical companies and for psychiatrists, and therapists. I feel that eventually every human emotion and natural response will be medicalized in some way to increase the profit of various parts of health care. Articles like this one are the start to that medicalization process.
Cancer. It is a word the strikes fear in the hearts of many as many still equate being told one has cancer with one being given a death sentence. From that point on, one becomes somewhat of a living time bomb. However, for you, the cancer has been caught early on enough that you can still get treatment to combat the deadly illness. Immediately, one’s thoughts then go to how much will this treatment cost? For someone without insurance, the costs could be crippling. Imatinib is from a class of drugs commonly used to combat cancer. In the United States, a single year’s worth of treatment can cost upwards of $106,000. Luckily, you live in India.
In India, a year’s worth of treatment using Imatinib costs around $159. The difference between the costs for this type of drug between India and the United States is a price hike of over 66,566%. That’s right, five digits. A recent review of drug production costs and pricing presented this past September at the 2015 European Cancer Congress mapped out the money an individual would spend for a year’s treatment of three classes of drugs commonly used to combat cancer: Imatinibs, Erlotinibs, and Lapatinibs. In addition, these prices are already allowing for a 50% profit margin for pharmaceutical companies. The main reason why these life-saving drugs are cheaper in both India and in Europe (the price hike between Europe and the United States for Imatinib hovering at around 231%) is because generic versions of the drugs using Imatinibs are so much more readily available in India. The article takes the specific example of Gleevec, a drug used by people with leukemia and gastric cancer. Its patent, first approved by the FDA in 2001, should have expired this year. However, Novartis, the pharmaceutical company who has the patent, has managed to keep other companies trying to make generic version at bay by making the large amounts the drug needed to synthesize a generic version hard to attain by these other companies. This is a problem faced by many pharmaceutical companies as they try to produce cheaper generic versions of much more expensive drugs. The reason why expensive drugs are able to stay expensive is because there are no other competitors. As a result, people with these illnesses (usually more rare and not as researched) are forced to buy these expensive drugs as they have to alternative drug to turn to.
Why then, are these cancer drugs so much cheaper in India? With not as many restrictions within drug production and with drugs being so readily available, companies are able to attain enough samples to create many different generic versions of a single drug. As a result, the buying medication in India is more of a true free market as consumers can see how expensive each drug that would do the same thing is. Companies are then either forced to lower prices to beat out their competition or risk going out of business. As it would not really be beneficial for anyone (but Pharmaceutical companies) to lower drug production restrictions, the more feasible solution for the United States would be to put a cap on prices for each specific type of drug. Adopting something similar to Canada’s pharmaceutical policy where certain drugs cannot be sold within the county unless the price can be negotiated to a suitable arrangement would get affordable life-saving medication to those who need it the most without making them have to move halfway across the world to receive it.
Earlier this month, the New York Times published an article describing a new method to treat A.D.H. D. in children. Basically, Akili Interactive Labs is a company that develops “electronic medicine” using high-quality, interactive video games. Recently, they came out with Project: EVO, a computer program “created to improve attention and reduce impulsivity in children with attention deficit hyperactivity disorder.” However, while the creation of a treatment that doesn’t force children as young as three and four to be medicated seems to be a wonderful new development, Project: EVO already sparks some concerns.
On one hand, it’s remarkable that there is a group of cognitive neuroscientists, biomedical scientists and experts in medical devices that is committed to treating children with A.D.H.D. without using drugs in a culture that is constantly using medication solve problems. The theory behind the whole brain training industry that targets children with A.D.H.D. along with adults who are trying to prevent dementia and other age-related cognitive ailments, is that people will be able to improve cognitive functions by using interactive, repetitive, and increasingly difficult exercises to strengthen the brain the same way lifting weights at the gym strengths other muscles in the body. “Electronic medicine,” as opposed to drugs could be a great alternative for parents who worry about side effects of drugs like amphetamine and methylphenidate that are typically used to treat A.D.H.D.
However, the problem with that last point is that doctors are not being encouraged to prescribe electronic treatment over standard drugs; rather, they are to prescribe both to children. Especially considering the video games are recommended for half an hour a day, five times a week for four weeks, they could be more stigmatizing for children and they wouldn’t actually replace the potentially harmful side effects from drugs. Kids who use Project: EVO could also later have an increased dependence on screen time, which is proven to, at times, end up being harmful to the development and health of children.
Also, I can’t help but worry about one more thing in the context of our discussions about the ways in which pharmaceutical companies medicalize illnesses. According to the article, “Shire, which manufactures Adderall, was an early investor in Akili and helped design the recent pilot study.” Shire has a vested interest in seeing increased treatment of A.D.H.D. in order to sell more Adderall. This is clear conflict of interest that could skew reports on the true effectiveness of Project: EVO. Unfortunately, what could be happening here is that a franchise is being made out of the treatment of A.D.H.D. And when business gets in the way of medicine, it is the patients who suffer.
As part of Chapter 9 in his book “How Doctors Think”, Groopman describes how deeply pharmaceutical companies can affect the decisions that doctors make for their patients through aggressive marketing strategies. By offering things ranging from free samples of drugs available to patients at the doctor’s office in order to get a patient hooked on more expensive drugs to “gifts” (monetary or otherwise) given to doctors who push for the use of specific drugs or treatments, pharmaceutical companies can easily influence the medical field’s determination of what conditions should be medicalized.
The way pharmaceutical companies in a way “buy off” doctors really reminded me of how big corporations “buy off” politicians (essentially paying for the re-election campaigns of these politicians) to lobby (for example) bills to create tax or regulation loopholes. As there is a big push right now to get money out of politics, I was wondering, why there is not a big push to also get money out of the medical field? Has medicine really become so corporatized that the priority is no longer the well-being of the patient and is now more focused on how much profit everyone in each tier of the medical system can make? A more important question would probably be, would it even be possible to get money out of the medical field, with possible solutions including but not being limited to the standardization of drug prices (like in Canada)?
In Chapter 9, Marketing, Money, and Medical Decisions, in Groopman’s book, “How Doctors Think”, he illustrates how big pharmaceutical companies influences what becomes medicalized conditions in order to profit off of consumers. These aggressive pharmaceutical marketing leads to unnecessary invasive expensive procedures and financial gain from both the doctor and patient. These pharmaceutical companies tactics include giving gifts and bullying physicians into buying their drugs.
Douglas Watson, an executive in the pharmaceutical industry for 35 years, pushed for “ethical marketing” in which the aim of marketing should be the accurate education of a physician in the side effects and potential benefits of a particular agent. But, most doctors learn about their new products (drugs) from the pharmaceutical industry. Thus, as opposed to just selling the drug, the industry should help in the physicians’ education. Continue reading “Pharmaceutical Marketing and Medical Decisions”
In the excerpt “How Doctor’s Think” from Marketing, Money, and Medical Decisions, Jerome Groopman demonstrates how big markets like the pharmaceutical industry largely influence what becomes a medicalized condition by aiming sales tactics at physicians and a patient-consumer audience. Groopman details the experiences of endocrinologist Dr. Karen Delgado and how Big Pharma has pushed their testosterone product by exploiting hormonal related aspects of aging as medicalizable conditions. Pharmaceutical representatives often lobby for the sales of their products by bribery and bullying physicians into changing the way they normally practice and treat patients. Pharmaceutical companies also push for the medicalization of certain profitable conditions by creating ads that are directed to their potential consumers. The advertisements often list vague symptoms that feel applicable to much of the audience and recommends that they ask their doctor about their product. By directing sales tactics at physicians and marketing to potential patients, drug companies wield power in shaping what becomes medicalized and how it can be treated.
Both in lecture and discussion group, we talked about the preference on choosing male experiment animals over female ones in drug tests. We were surprised that not until 4 months ago that female labradors were introduced in cardiovascular medicine research as experiment objects. I suppose, first of all, science is perceived as relatively objective and fair (though the male dominance of researchers exists in many fields). Such sex preference seems so “outdated”. Second of all, we suspect and actually assume that only using the male objects will lead to disadvantages for female patients. We suspected that because the drugs produced will apply to male bodies more efficiently than female. But I think this conclusion seems too arbitrary.
First of all, the preference on experiment animals of a certain sex is determined by the contents of the experiment. Most of time, for the convenience of conducting the experiment. Sometimes scientists prefer male animals because pregnancy will make the experiment more difficult. For another, female animals are more easily influenced by hormonal levels, which disrupts the experiment results. There are tons of examples where female animals are preferred or only used or where equal quantities of male and female objects are required. For instance, in an experiment on the treatment for osteoporosis, there two common methods of causing osteoporosis artificially. The medicine injection method is very difficult and expensive while the other is the removal of ovaries, which is much easier. As a result, only female rats were used in this medical research project.
Some people can argue that we should not sacrifice equality for the sake of convenience. Well, it is not the case. Here scientists are trying their best to control the variables so they can test the elements they focus on, especially during the early stage of research and development. It seems very outdated and naive to me that insisting on absolute “gender equality” on every stage of the experiment. I support the equal treatments on men and women during the stage of clinical trials as it is important to ensure gender equality for the patients. All in all, the judgment on “gender inequality” in medical research depends on the details of the experiments. We should not jump to the conclusions too quickly. I am very sorry that I didn’t find the original articles about the no use of female labradors until 4 months ago. All complement and comments are welcomed.
As we learned in class earlier this week, medicalization is the process of making non-medical conditions medical and through this there is some sort of social control. We learned that through this that the medical profession, pharmaceutical companies, and the public themselves all use this to raise awareness to certain symptoms and how pharmaceutical companies might use to promote certain new drugs. I thought we could relate this to why the medical industry has stayed as powerful as it has despite the changing economy: medicalization. With research for both the medical profession and the pharmaceutical companies, new diseases or illnesses are being discovered at a rapid pace with only the medical profession with the help of the pharmaceutical companies to solve them. With the pressure of wanting to be normal and the medical profession and pharmaceutical company both defining what is normal, the doctors and drug companies will always stay in power as they are constantly setting new guidelines of what is healthy. Through this process, as well as the influence of mass media on the public, the medical industry will never falter until something takes away that power from them. So could medicalization be not only a means of social control but a way to maintain dominance in our current economic system?
Thought some of you might be interested in this upcoming online presentation hosted by the Harvard School of Public Health: