Pharma

The Book of the Week is “Pharma– Greed, Lies, and the Poisoning of America” by Gerald Posner, published in 2020.

In 2016, the “superbug” Enterobacteriaceae turned out to be resistant to 26 different antibiotics. About half of patients who contract it, die. There are a bunch of other similar bacteria in the world. The author warned that in the future, a bacterial pandemic was on the way, for which there would be no antibiotic cure. Apparently, there can be a viral pandemic, too– one that cannot be treated with antibiotics at all.

For, antibiotics kill only bacteria, if that. Yet, in the United States, for decades, antibiotics have been prescribed to treat (mild!) viral illnesses. That is one major reason that superbugs have become a trend. And there has been an epidemic of diabetes type II. And many other adverse consequences.

Anyway, the author recounted the history of big-name drug companies, which began selling morphine to soldiers during the American Civil War. In the second half of the 1800’s, Pfizer, Squibb, Wyeth, Parke-Davis, Eli Lilly, and Burroughs-Wellcome began mostly as family proprietorships that sold highly addictive, unregulated drugs. Bayer produced heroin in 1898. The twentieth century saw Merck put cocaine in its products; other companies jumped on the cocaine bandwagon.

In 1904, the head of the United States government’s Bureau of Chemistry, Harvey Wiley, was concerned about contaminants in the nation’s food supply. Consumers were being sickened by chemicals that were supposed to retard spoilage or enhance the appeal of foods. They included, but were far from limited to: borax, salicylic acid, formaldehyde, benzoate, copper sulfate and sulfites. Trendy patent medicines were also doing harm to consumers. The word “patent” gave the impression of approval or regulation of some kind, but actually meant nothing.

Through the first third of the twentieth century, the government continued categorizing, monitoring and taxing drugs, but the pharmaceutical companies continued using trade groups and legal strategists to protect their profits. The 1930’s saw the big drug companies start research laboratories. Finally in 1938, the government established the Food and Drug Administration, and began to require extensive product-testing and labeling, and factory inspections. That same year, the Wheeler-Lea Act prohibited false advertising of drugs, except for previously manufactured barbiturates and amphetamines.

After Pearl Harbor was attacked in December 1941, America sought to manufacture penicillin in volume. For, the newly introduced antibiotic would be very helpful to the war wounded. But the drug’s fermentation process required a rare ingredient. In spring 1942, one patient who had friends in high places was cured. That largely used up the penicillin supply in the entire country. Other kinds of antibiotics were produced in the next decade, but their profitability was hampered by the bureaucratic processes of patent applications and FDA approval applications.

In the late 1940’s, Arthur Sackler and his brothers founded a family drug-company dynasty. The author revealed excessive trivia from FBI files on them and other greedy characters whose tentacles pervaded all businesses that could help sell (translation: maximize profits of) the family’s healthcare goods and services. This meant consulting, advertising, publishing, charities, public relations, database services, etc. The parties failed to disclose countless conflicts of interest.

In the early 1950’s, drug companies successfully lobbied the U.S. Patent and Trademark Office to allow drugs with strikingly similar molecular structures to be deemed different so that they could be granted separate patents. A higher number of drugs could then be rushed to market sooner, and make the most money.

In 1952, farmers fed Pfizer’s antibiotics to their animals so that they grew bigger (both Pfizer and the animals). In the mid-1950’s, Pfizer, Lederle, Squibb, Bristol and Upjohn engaged in an illegal tetracycline price-fixing scheme. They reaped hundreds of millions of dollars in earnings. The FDA chief was in Sackler’s back pocket. So when violations came to light, the FTC and FDA gave the offenders a slap on the wrist. However, senator Estes Kefauver was a thorn in their side.

Kefauver led an investigation as to why America’s drug prices were so excessively high when compared with those in other nations. In fighting back, the drug industry smeared Kefauver as a liberal pinko, claiming he had designs on forcing socialized medicine on the United States. The nineteen drugmakers under the gun gave bogus excuses. The real reason is that America’s drug prices and patents are subjected to minimal or no regulation, unlike everywhere else.

In 1956, Americans were told they were stressed, but a wonder drug called “Miltown” would help calm them down. The mild tranquilizer became a best-seller, until it was counterfeited and appeared on the black market, and its adverse side effects gave it bad publicity. Oh, well.

Then in the 1960’s came the culture-changing birth control Pill, and Valium– also called “mother’s little helper” that was marketed as a weight-loss aid. The next game-changer was thalidomide. Kefauver used the worldwide backlash against this drug to push through some drug safety and effectiveness regulation in the United States in 1963. For a change. Even so, in 1972, when the U.S. Supreme Court confirmed certain regulatory powers conferred on the FDA, drugmakers merely sought additional markets for their products on other continents.

In 1976, there was a swine flu epidemic in America. Healthcare companies were reluctant to develop a vaccine for it, fearing an orgy of litigation from victims if any harm was done. So the government unwisely agreed to foot any legal bills. Sure enough, some vaccine recipients developed cases of Guillain Barre syndrome, and neurological complications. The (taxpayer-funded) Justice Department took the hit. Other parties piled on. “The CDC had exploited ‘Washington’s panic’ to ‘increase the size of its empire and multiply its budget.’ “

Moving on, the author told the whole sordid story of the “opioid crisis” in America. In a nutshell: in May 2002, Purdue Pharma, maker and unethical marketer of OxyContin, hired Rudy Giuliani’s firm to defend it against the firestorm from its host of illegal activities. The firm collected a $3 million fee per month. Purdue collected $30 million per week from OxyContin sales. To be fair, Purdue and the Sackler family were the poster-scapegoats of the crisis. Numerous other parties aided and abetted them: other pharmaceutical companies, doctors, FDA bureaucrats, and pain management “experts” and pharmacists. The far-reaching consequences have caused a lot of trouble for society as a whole in the areas of: increased healthcare costs, criminal justice, social services, drug rehabilitation services, lost productivity and earnings, etc.

Read the book to learn an additional wealth of details and the details of wealth of the healthcare industry’s evolution into a hegemonic legal behemoth / excessive profit center, in the form of a series of cautionary tales in various topic areas– drug advertising, blood donations, biotech, epidemics, pharmacy benefit managers– that wrought major good and bad (mostly bad) cultural and regulatory changes (including the Hatch-Waxman Act and the Orphan Drug Act); plus the family battles following the sudden death of Arthur Sackler.

Morphine, Ice Cream, and Tears. (sic) / Chasing My Cure – BONUS POST

The First Bonus Book of the Week is “Morphine, Ice Cream and Tears. (sic) Tales of a City Hospital” by Joseph Sacco, M.D., published in 1989.

The cynical author did his medical internship and residency in New York City in the early 1980’s. He discussed emotional, financial and ethical issues that doctors-in-training encountered in his generation, illustrating his points with real-life cases.

Healthcare workers, not just medical doctors, must of course not only physically, but emotionally contend with the unpleasant sights and smells of a patient’s body fluids. Such fluids frequently end up on their person, unless they choose a specialty that is not so messy. The author remarked that, therefore, a huge number of medical-school students in their third year realize that they would feel most comfortable specializing in radiology. That partly accounts for why nuclear medicine has become so wildly popular in recent decades.

One medical-industry financial issue that has remained largely the same for the last forty years, has been the profit motive. Thus, emergency rooms are still overstaffed with specialists who overtreat patients to maximize profits for themselves and/or their employers, while drug-addicted patients are also selfish: “This patient was too stupid for conscious manipulation but had succeeded to (sic) engage the attention of doctors, nurses, the EMS, the police, his family, and probably a number of others, as well as to spend a good six figures of public money in his care.”

Healthcare is fraught with ethical issues. One is the completion of the death certificate. The author, as an intern, was tasked with such lowly paperwork. He got scolded for improperly filling in the correct words or phrases (there was a list of them) that constituted “acceptable” causes of death. Overworked and sleep-deprived, most interns sought peace more than accuracy, so the primary or secondary cause of death became “cardiopulmonary arrest” repeatedly. This systemic quirk probably put a wrench in death statistics in the United States. Perhaps it has even been manipulated for political purposes. Enough said about that.

During his residency, the author treated female teenage patients for minor ailments. Because he saw so many who were pregnant, of his own volition, he took the opportunity to counsel them about birth control. He felt that the pill was their best option. He “… sent her off with two free packets and a prescription for several months more. Most incredibly, some patients even decided to use them .”

Read the book to learn of the author’s trials and tribulations, and of other ways times have changed for aspiring medical doctors in America.

The second Bonus Book of the Week is “Chasing My Cure, A Doctor’s Race to Turn Hope into Action, A Memoir” by David Fajgenbaum, published in 2019.

The author’s ordeal began in 2010, when he was halfway through medical school. He suffered from a mysterious illness for weeks, with multiple-organ failure, and misguided, incorrect diagnoses of lymphoma, or an infectious or rheumatologic disease. It turned out he had a rare disease whose origins were auto-immune or cancerous.

Later on, through his own actions, he determined the correct categorization. He connected the dots on many fronts, mentioning two traits peculiar to him: when he was a student, his consumption of energy drinks was excessive, and he had inherited a tendency to have an excessive number of blood vessels in various body parts, compared to other people. The former environmental factor, and the latter genetic factor, when they came together, could have played a role in his responding poorly to treatment, and his having to be bombarded with an extremely powerful chemotherapy cocktail approximately every one to two years.

The above are the kinds of factors scientists take into account when attempting to explain why certain patients do better than others with different treatment options. When patients who have a fatal disease are out of options, they aren’t usually as lucky, insightful and resource-rich as Fajgenbaum was. But even he had to overcome numerous obstacles and nearly died on several occasions.

When he initially tried to do research on his fatal ailment, the author was frustrated by scant, old, inaccurate knowledge on it and scattered sources. He likened the medical community’s situation to that of law enforcement prior to 9/11: “..no one talked to one another, no prime database existed, there was no expectation of coordination or data sharing.” Competition for federal funding meant that resources dedicated to all different kinds of medical research varied widely– a matter of money and politics. Even so, this wasn’t due to malicious intent, but merely honest ineptitude– one would hope. Nevertheless, there was a lot of wasted talent, and a lot of misallocated resources (not to mention, unnecessary deaths!).

The above provided an argument for why the author decided to earn an MBA (he had already completed a medical master’s degree) right after graduating medical school, instead of beginning his residency. Acquiring money-oriented, management and leadership knowledge and experience would be more important than practicing medicine. It would allow him to create a medical-research group that he hoped would find a cure for his disease before he died.

Read the book to learn: how the author broke tradition in thinking about the cause of his illness; how that led to his helping to pioneer a medical-treatment trend that will endure in the future; how his actions have led to sooner diagnoses and saved lives (hint– he marshaled resources to consolidate knowledge, and his team found that “… it’s much more efficient to go directly to patients for [blood] samples, just like we do for patient data in the registry study.”); and to learn about other aspects of healthcare in the United States.

ENDNOTE: The above state of affairs provides yet another argument in favor of a national healthcare system for the United States. Free-market economics is fine for business, but healthcare is super-complicated because it also involves matters of life and death. For more information, see the posts: “full circle” (sic)–eleventh paragraph from the top, and “Here at the New Yorker“– fourth paragraph from the bottom, onward. The best healthcare delivery requires the right balance between cooperation and competition among specific parties. This is why training for both war and healthcare delivery utilizes divestiture socialization. Healthcare delivery works best when there is cooperation within a team and among teams, and disease is the enemy. A capitalistic approach to healthcare necessitates an unhealthy level of competition, as Fajgenbaum learned.

Where Have All Our Leaders Gone?

WHERE HAVE ALL OUR LEADERS GONE?

Sung to the tune of “Where Have All the Flowers Gone?” with apologies to the estate of Pete Seeger, and Joe Hickerson.

Where have all our leaders gone?

Secretly scheming.

Where have all our leaders gone?

Plotting revenge.

Where have all our leaders gone?

Planting stories, every one.

Can we trust anything?

Can we trust anything?

Where has all the money gone?

Profits and patronage.

Where has all the money gone?

Honor among thieves.

Where has all the money gone?

Stimulus was two seconds of fun.

Aren’t we the guinea pigs?

Aren’t we the guinea pigs?

Where have all the candidates gone?

They’ve stopped campaigning.

Where have all the candidates gone?

They’re attorney-huddling.

Where have all the candidates gone?

No more substance from anyone.

Do we know anything?

Do we know anything?

Where have all our freedoms gone?

Fallen by the wayside.

Where have all our freedoms gone?

We don’t know.

Where have all our freedoms gone?

MORE SURPRISES IN STORE, SO HOLD ON.

ISN’T HISTORY CYCLICAL?

ISN’T HISTORY CYCLICAL?

Pertinent Post

“P” post.

Present pandemic’s politics produced:

  • propaganda
  • president-promotion
  • provisions-portioning predicaments
  • panic
  • profiteering
  • paranoia
  • patronage pigs
  • pissed, persecuted people
  • poseurs
  • puerile politicians (petty power plays)
  • pained physicians
  • problematic prescriptions
  • pressured paramedics
  • pestered practices
  • poor populations
  • plus, predictably:

POPPYCOCK.

Something About A Soldier

The Book of the Week is “Something About a Soldier, A young man’s life and loves in the peacetime army– in the Philippines and California– on the eve of World War II (sic – lack of capitalization)” by Charles Willeford, published in 1986. Some of the author’s experiences in the military were clearly of a bygone era.

The author, an aimless American high school dropout who had been in the National Guard, was looking for adventure in 1935. By chance, he got a tip about how to join the Air Corps. He did so by lying about his age and status, and got away with it. After a year in California, he had his request granted to go to the Philippines. He never did learn to fly.

Nevertheless, he drove a fire truck for a few hours each day. Military planes used to be fabric-covered and so might catch fire. But they never did catch fire. Since the work was light for most of the men in his outfit, they spent a lot of their leisure time in town at bars or with prostitutes.

Twice a year, the men heard the Articles of War read by an officer. A court-martial would result if a man directed expletives at a Senator or Congressman but it was permissible for him to fight a duel with another soldier.

The author foolishly volunteered to assemble a singing group to perform on the boat returning from the Philippines, when his two-year enlistment stint was up. The performers got a free carton of Red Cross cigarettes. However, his group simply embarrassed themselves because they had no talent, and sang “A Tisket, A Tasket.”

On the island of Guam, the hunting of grizzly bears with an Army rifle, and sale of the skins were permitted. Army soldiers stationed at Fort Drum (on an island near Corregidor), enjoyed a “Beer Call”– meaning, they could drink beer. In the morning.

Read the book to learn of many other interesting cultural and social practices of Air Corps men in the mid- to late 1930’s.

How We Do Harm

The Book of the Week is “How We Do Harm” by Otis Webb Brawley, M.D. with Paul Goldberg, published in 2011. This is yet another lamentation on the sorry state of affairs of the oncology industry in the United States. As is well known, the fear-mongering, lying and profit-seeking never stop in many parts of “the system.”

Brawley prudently wrote, “It’s always about the balance of what I know, what I don’t know, and what I believe.” However, so many medical professionals ignore the second, and offer up as facts, the third. This is where guidelines go awry. Hundreds of organizations globally distribute thousands of guidelines every year; many of them from profit-seekers.

American medical culture changed for the worse in the 1990’s. For, “…commercial interests usurped the language of clinical epidemiology, making it impossible even for an educated person to distinguish a real recommendation based on science from a thinly disguised advertisement for medical services.”

The author served as a medical oncologist, professor, and officer of the American Cancer Society, among other roles in his career. He provided a series of anecdotes on the system’s victims and critical analyses of the fear-mongerers and liars.

One major irony is that people whose top-dollar medical care is supposedly dispensed by “experts” become victims of fear-mongering and lying and get overtreated and die unnecessarily. Whereas, poor people who forgo medical care except to save their lives and end up receiving publicly-funded care– because they can’t afford better– are more likely to survive because the caregivers have their patients’ best interests in mind rather than a desire to make more money.

The American mentality is that more is better– more early detection and treatment must be better than less. Not necessarily true. Often, the screening tests and the treatment are themselves carcinogenic, so more of each actually increases the likelihood of more medical problems.

The author described an FDA-approved (but insufficiently tested) drug launched in the single-digit 2000’s whose makers claimed it strengthened patients and reduced fatigue; it actually caused strokes and heart attacks and even tumors. But it was lucrative! That became apparent at an FDA advisory committee session, where “Billions of dollars in [stock] trades hinge[d] on the words of the [medical] doctors and the scientists…”

American oncology is reminiscent of the Jack Benny joke: A robber approaches a man on the street, points a gun at him and menacingly says, “Your money or your life.” The man becomes pensive for a few seconds. The robber says, “Well??” The man replies, “I’m thinking, I’m thinking.” The joke is that the man can’t spend his money after he’s dead, but he values both money and life equally.

But thinking is the right answer– instead of succumbing to panic instilled by the oncology industry that leads to the loss of both money and life. All of the victims in the author’s anecdotes had panic in common.

Read the book to learn the answer to the question “Does treatment of localized prostate cancer save lives?” (hint– statistically, tens of men might become incontinent and impotent unnecessarily for one life to be “saved”) plus other thought-provoking, awareness-raising issues in American medicine, and how not to get fooled by liars and fear-mongerers.

Deadly Spin

The Book of the Week is “Deadly Spin” by Wendell Potter, published in 2010. This is a book that explains how health insurance companies engage in unethical behavior in the name of profit, that results in needless deaths in the United States.

It follows then, that serving as a top executive at a health insurance company requires sociopathic tendencies, favoring money over people. One reason the insurance companies are so obsessed with their bottom lines (aside from the greed of their top executives) is that they have to answer to Wall Street.

Potter worked for Humana and then CIGNA a combined approximately twenty years as head of their public relations departments. By the late 1980’s, Humana realized it had a conflict in running a for-profit hospital and a managed-care plan simultaneously. The hospital was more than happy to maximize the stays of its most lucrative patients, while the plan’s goal was to minimize costs through preventive health care– promoting wellness.

The author learned to play the game of maximizing his employer’s profits through fighting legislative changes to his industry; and protecting, defending and enhancing his employer’s reputation. For, there was a direct relationship between his employer’s profits and his raises and bonuses. He therefore emotionally detached himself from health insurance plan members, and focused specifically on actuarial tables and legalese to help him project an image of his employer as a reasonable,  if not caring participant in patient care.

Whenever a threat to his former employers’ profits arose, such as the movie “Sicko” or proposed legislation that financially favored patients, his former employers hired a big-name, monster-sized public relations firm, and secretly co-funded and co-founded a political front group, such as “Health Care America” that publicly pretended to favor health care consumers, but truly sought to maximize insurance industry profits. The group was a propaganda machine, and an object lesson in how to lie with statistics.

Other tricks of the trade include:  “…rescinding individual policies, denying claims, cheating doctors, pushing new mothers and breast cancer patients out of the hospital prematurely and shifting costs to consumers.”

Read the book to learn additional details of the hegemony of the health insurance companies. One interesting endnote: “Obama opposed any requirement that everyone buy insurance, one of the few points on which he disagreed with Hillary.”

A Memoir According to Kathy Griffin – BONUS POST

The Bonus Book of the Week is “A Memoir According to Kathy Griffin” by Kathy Griffin, published in 2009.

This memoir described the comedian whose shtick consisted of telling humorous, embarrassing stories about members of the entertainment industry. Or, as she characterized herself: “… someone who gets fired, stirs up trouble, and gets debated about on CNN for saying bad things on award shows.” Kudos to her for being an honest, amusing attention whore. She must have brought in sufficient profits for the entertainment industry to tolerate her behavior.

Born in November 1960 in Forest Park, Illinois, the youngest of five children, Griffin grew up in Oak Park, Illinois. At eighteen years old, she moved to Santa Monica, California to be an actress. She apparently had the talent, drive and creativity to get famous.

In the early 2000’s, Griffin performed sufficiently well at the Laugh Factory in Los Angeles to double the length of her show to two hours. This allowed the cocktail waitresses to make sufficient money to pay their rent, “Plus they loved serving the gays, because they were well-dressed, respectful and tipped well.”

Griffin didn’t talk about Anna Nicole Smith right after she died out of respect. As Greg Giraldo would have said, “Too soon, too soon.” Griffin revealed deeply personal information– both of her parents were functional alcoholics, and her oldest brother was a pedophile and substance abuser.

Griffin tried to raise the alarm about her brother, but, as she joked– her parents thought “denial” was a river in Egypt. She admitted to two major errors in her life– poor judgment in both her marriage and in having liposuction. Read the book to learn the details of this and other episodes.

SERIOUS ENDNOTE: Griffin had no qualms about making political statements unrelated to the awards shows she attended. It is therefore not inappropriate to make a political statement unrelated to Griffin’s book, below.

This nation seems to be in denial about the amount of debt load currently carried by not only individuals and businesses, but by the federal government and local governments. It appears that bankruptcies of government entities is the next financial crisis in the offing; the reason why, will be explained shortly.

Within the last thirty or so years alone, the United States has seen greed fests and then busts with regard to junk bonds, savings and loan associations, derivatives, tech stocks, and subprime mortgages, just to name a few. Mortgage-backed securities used to be one of the lowest-risk investments around. Tax-free municipal bonds are presumably still one of the lowest-risk investments around.

BUT one small bond brokerage (and possibly others, too) whose website says it “specialize[s] in tax-free municipal bonds. That’s all we do.” recently changed the language on its customers’ monthly statements. It is forcing them to accept the words, “trading & speculation” (!) for their “Investment objective/Risk tolerance” or else they won’t be able to purchase bonds. It makes itself sound like a penny-stock broker-dealer of the 1980’s that churns accounts. Or a currency broker.

The brokerage is so phobic about covering itself legally that there must be bond issuers who are going to go belly up AFTER THE CURRENT PRESIDENT HAS BEEN REELECTED or has left office, whenever that is. (It might be recalled that Detroit took the plunge in July 2013, after Obama was reelected.) Or its brokers are getting greedy and unscrupulous. Or both. Good luck with that, all.

Mistaken Identity – BONUS POST

The Bonus Book of the Week is “Mistaken Identity” by Don & Susie Van Ryn and Newell, Colleen & Whitney Cerak, with Mark Tabb, published in 2008. This is a long, true story of a cluster-screw-up of honest ineptitude whose negative consequences were mitigated by the virtuous nature of the people involved.

The families of the victims described in this book weren’t vengeful and didn’t look for someone to blame or sue, pursuant to the tragedy. They were forgiving, and saw the positive consequences of it– they widened their social circle and became a good example for others of civil and mature behavior.

In late April 2006, two female Taylor College students from Michigan who shared an employer happened to be riding home in the same van in Fort Wayne, Indiana. They didn’t know each other. However, their appearance, build and facial features happened to be largely similar. The van was involved in a tragic accident. Along with other passengers, one of them died, and the other lived but had serious injuries.

In the aftermath, the one who lived remarked, “A lot of what was written in different magazines was wrong, and I think it gave me a different perspective on people and the media that I never had before.”

Read this book (not media stories) to get an accurate picture of what happened to the two families of the accident victims.