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.

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.

Pink Boots and A Machete

The Book of the Week is “Pink Boots and A Machete, My Journey From NFL Cheerleader to National Geographic Explorer” by Mireya Mayor, published in 2011.

Mayor was born in February 1973 in Miami. While in her early twenties, she discovered her calling– primatologist / zoologist. An inspirational college professor helped her apply for a government grant to study a monkey in Guyana.

Thereafter, she braved infinite life-threatening dangers and primitive and uncomfortable conditions (like poor sanitation, and an extremely limited and at times– disgusting diet, and unbearable heat, to name three) on dozens of expeditions for weeks or months in obscure places to observe various animals in their natural habitats.

In the Congo, there were killer bees. In the jungle in Guyana, there were itinerant miners who were robbers and rapists; piranhas, malarial mosquitoes, tarantulas, vampire bats, ticks, leeches, etc. The author had to sleep in a hammock to avoid poisonous snakes on the ground.

In June 1997 in Madagascar, “Every visit to a village required a rum-soaked meeting with tribal elders that lasted through the night, occasionally for days.” While seeking a specific species of lemur in an animal reserve (that was not exactly a tourist attraction), she was bitten by a small scorpion and swarmed by wasps. Hundreds of cockroaches nestled in her pants legs overnight, shocking her when she went to put them on.

On another occasion in Guyana, she and her crew collected flora and fauna specimens from a mountain on which they camped (on the edge of a cliff, basically) in a “… flimsy sheet of nylon attached to the rock face by a single, six-inch steel pin.”

In Namibia, she was one of eight people who lifted the six-foot, six hundred pound neck of a tranquilized giraffe. The whole animal weighed approximately eighteen hundred pounds. The goal was to herd giraffes into a trailer to help them mate and reproduce.

On another occasion in Madagascar, when a mudslide from a monsoon prevented their hired truck from going any farther, she, another scientist and expensive porters (strong men) had to hike hours and hours with heavy gear, dozens of bags, crates and a generator to a campsite.

Mayor related that on another occasion in the Congo, “I woke up in an unusually good mood, considering it was 5am and I still had the worm [in the foot], the filarial bites, and the infected tick bite… Repeated hot soaks and antibiotic treatments finally banished it [the tick bite].”

Read the book to learn of the new species Mayor co-discovered, how she fared on a reality show, the kinds of issues she dealt with for being female in a male-dominated field, and much more.

Half-Life

The Book of the Week is “Half-Life, The Divided Life of Bruno Pontecorvo, Physicist or Spy” by Frank Close, published in 2015. The author himself was a physicist, so he interspersed physics concepts with the evolution of the development of nuclear technology and its major players. This book was written for readers who would like to learn some nuclear physics, and/or those readers curious about the people involved in Cold War / nuclear physics mysteries.

However, Close made an error, spelling “Lise Meitner” as “Lisa Meitner.” Additionally, since the author was neither a historian nor American (he was British) he was mistaken in declaring, “For supporters of communism in the West, this [the autumn 1956 Hungarian uprising which was bloodily crushed by the Soviets] was probably the most serious crisis of conscience since the Soviet pact with the Nazis in 1939.” Actually, in early 1956, Khrushchev revealed Stalin’s horrific crimes to the world. Americans, especially those who considered themselves Social Democrats, were thrown for a loop ideologically, and became bitterly conflicted in their own minds, and with each other.

Anyway, born in Italy in August 1913, Pontecorvo was the fourth of eight children. In 1931, he transferred from the University of Pisa to that of Rome for his third year of physics studies, mentored by Enrico Fermi. Knowledge of particle physics was in its infancy. Pontecorvo and other scientists jointly filed a patent in autumn 1935 in connection with experiments with neutrons and hydrogen.

The year 1936 saw Pontecorvo flee to Paris after Mussolini cracked down on Jews’ liberty. He studied with Frederic and Irene Joliot-Curie. He was turned on to Communist ideology by his cousin. They attended meetings and rallies.

By the late 1930’s, physicists (and governments) of different nations such as Germany, France, Italy, the USSR, etc. started to realize how important nuclear processes were for creating future weapons of mass destruction– instrumental for their respective homelands’ national security. Beginning in the summer of 1940, nuclear research became secret in the United States. Scientific journals would no longer publish articles on that topic.

The USSR did not lack for brains, but for uranium in the early 1940’s. Beginning in summer 1942 in Moscow, the Soviets worked on an atomic bomb. But scientists in the United Kingdom had a head start, having begun their work the previous year. In December 1942, the United States started the Manhattan Project.

By the end of the 1940’s, having done nuclear research in Tulsa in Oklahoma, the Northwest Territories in Canada and in Harwell in England, Pontecorvo was planning to move himself, his wife and three sons to Liverpool to become a physics professor. The British intelligence service MI5 secretly pushed him in that direction. As is well known, the United States was gripped by anti-Communist hysteria, with the arrests of spies Klaus Fuchs, David Greenglass and the Rosenbergs.

The summer of 1950 saw the Pontecorvo family take a summer vacation in France, Switzerland, and the Italian countryside. There is circumstantial evidence that he met with his Communist cousin and suddenly, all bets were off.

Read the book to learn the fate of the family, the contributions made to science by the scientist, learn why he neither won the Nobel Prize nor collected royalties on the aforementioned patent, and much more.

Gorsuch – BONUS POST

The Bonus Book of the Week is “Gorsuch, The Judge Who Speaks For Himself” by John Greenya, published in 2018.

This volume mostly discussed Neil Gorsuch’s nomination for the position of Supreme Court justice, gleaned from opinion pieces in online publications including blogs, and comments from interviews, in a disorganized fashion. With some of Obama’s political career thrown in. Plus the controversy surrounding Gorsuch’s mother. It got tedious after a while, and should not be classified as a biography.

As is well known, Gorsuch was nominated in an era with an especially emotionally charged political atmosphere. Of course, during his confirmation hearings, Gorsuch was grilled on one particularly extremely controversial issue: abortion.

Some Republicans propagandized that Gorsuch was a gentleman, and a good writer. Some Democrats propagandized that Gorsuch would seek to overturn Roe v. Wade. Prior to his SCOTUS nomination, he had served as an appellate judge for a decade, during which he saw no cases directly related to that case’s decision.

Gorsuch himself, in a book he wrote, conceded that whether abortion is the taking of a human life, hinges on the definition of “human life.” At his confirmation hearing, when pressed on whether he accepted that the Fourteenth Amendment of the U.S. Constitution does not consider a fetus a person, Gorsuch agreed it is federal law that says a fetus is not a person.

Abortion is one of the most, if not the most, volatile political issue in the United States, because it is a matter of religion and politics, life and death, and its legalization or not, has serious ripple effects on society. There are three major aspects, among a host of peripheral issues, upon which most people seize: biology, women’s rights, and economics.

The first major aspect relates to a few pieces of information that allow people to form opinions on the definition of “human life” to which there is no right or wrong:

A fetus’ heartbeat is detectable approximately two months into a pregnancy. Some people believe that when a heartbeat is detectable in a fetus, that that fetus is a human life.

Besides, a fetus can live outside the womb at approximately two months into a pregnancy, but it still requires a large amount of technological help with sustenance at that stage; around five months is when it can live outside the womb without the extensive assistance of medical technology.

Some people believe that if a fetus can live outside the womb (but the amount of life-support equipment any given fetus requires varies widely), that that fetus is a human life. Thus, some people believe abortion should be illegal from those respective points onward. Others believe life begins at conception. Therefore, according to them, abortion should never be legalized at any point.

The question of abortion obviously disproportionately affects females. Women’s rights involve a female’s control over her own body.

There are two major economics aspects to abortion:

Norman Mailer argued that from a purely economic (non-emotional) standpoint, abortion should have been legalized merely because, according to research, a lot of unwanted babies grow up to become career criminals. Legalization of abortion would eliminate the long-term costs to society of unwanted people.

Moreover, prior to the time abortions became legal, poor women who couldn’t afford illegal abortions done by an experienced medical professional, attempted abortion methods themselves, which were dangerous to their own health. So there arose long-term costs to society in the form of their medical expenses, if they didn’t die from complications.

Even though abortion is now legal conditionally, some poor women still cannot afford it. That raises the can of worms of whether abortions should be publicly funded. Which leads to a vicious cycle for poor women. And society.

Biological aspects of abortion that make abortion laws conditional, include: specifics on the trimester in which the procedure is performed, whether the mother’s or baby’s life is in danger and whether the baby is developmentally normal. An additional wrench in the works is whether a female should be able to have an abortion in a case of rape or incest.

The religious aspects of abortion are a whole other explosive ball of wax. Especially when sex education is thrown into the mix. Yet another cause of heated discussions is that it is impossible to prove how often abortion is used as a birth-control method.

The yelling and screaming, litigation and legislative debate is guaranteed to never stop, because there will always be questions such as: If the mother is extremely young– does she need a parent’s consent to have an abortion?

And can a pregnant woman of any age cross state lines in order to gain access to an abortion that is legal, given her situation? Which leads to the controversy of States’ Rights.

In the last several decades, the Democrats have faced a dilemma when they nominated a Catholic presidential candidate. The Democrats favor laws that allow abortion. Some Catholic and Christian voters say they would never vote for any candidate who is a Democrat for that reason alone. They say they wouldn’t waver on that. The question for the ages is: Is the number of these voters sufficient to affect the outcome of a presidential election?

Anyway, read the book to learn of other issues on which Gorsuch’s positions had yet to be seen as of the book’s writing, and tabloid writers’ and politicians’ take on his fitness for the U.S. Supreme Court.

The Last Man Who Knew Everything

The Book of the Week is “The Last Man Who Knew Everything, The Life and Times of Enrico Fermi, Father of the Atomic Age” by David N. Schwartz, published in 2017.

Born to a wealthy family in September 1901 in Italy, Fermi was mentored in science by a colleague of his father, who worked for the railroad. This, after suffering the trauma of having his older brother die unexpectedly having throat surgery in 1914.

Fermi had a photographic memory, which helped to make him a brilliant student in mathematics and physics from studying textbooks. He was required to learn German too, to keep abreast of developments in the scholarly journals.

Fermi eventually became a physics professor at the University of Rome. His teaching gig, which he was also really good at, lasted from 1926 to 1938. He married in July 1927 and several years later, he wrote, and his wife edited and translated, a high school physics textbook that became part of the standard high school curriculum in Italy.

Quantum statistical mechanics was his specialty. Athleticism was another. Fiercely competitive, he always outdid his colleagues in hiking and climbing the hills around Rome. He became well traveled, thanks to attendance at international physics conferences. Some were hosted in the United States, which had better research funding than his native country.

By the late 1920’s, Fermi had cofounded a world-class nuclear physics research institute in Rome. The first entering class consisted of three graduate students. The younger generation was reflecting on new quantum theories to which the old-school Italian physicists were resistant. Fermi was in the former group.

In spring 1929, Mussolini selected members, of which Fermi was one, for an elite scientific society. He offered them big money so that they would do Italy proud (like academic and athletic scholarships bestowed upon fiercely competitive students, dispensed by elitist schools in the United States nowadays).

In the early 1930’s, Fermi supervised scientists who traveled internationally to different labs to learn from their fellow Europeans; yet they also competed with physicists at prestigious institutions in Berlin, Paris, Berkeley in California, and Cambridge in England.

In October 1934, Fermi’s team discovered that “…slowing down neutrons enhanced the radioactivity induced by neutron bombardment.” In connection therewith, he applied for a patent in Italy and the United States. He got a new lab.

By 1936, Mussolini was finding that invading Ethiopia was an expensive proposition. He began to depend on financial aid from Nazi Germany. By summer 1938, Hitler had control over ruining careers of Jews in licensed professions, civil servants, and white collar jobs in Italy.

In late 1938, after much red tape and worrisome scheming, Fermi and his wife (who had been deemed Jewish) escaped Italy first for the Nobel Prize ceremony in Stockholm, at which he took his trophy and money, and then for the United States. He ended up working at Columbia University.

At a Washington, D.C. conference in January 1939, physicists announced they had figured out how to produce fission, the process required to detonate an atomic bomb. Some were concerned that if Hitler’s scientists got hold of such knowledge, he would order mass destruction of his enemies before they could stop him. Fermi felt there was a low probability that Germany could build such a device. But Fermi was persuaded to share the thereafter-secret formula with the United States Navy. This would show his loyalty to America at a time when Italy was not exactly America’s ally.

Read the book to learn the parties involved with, locations of, trials and tribulations regarding, and Fermi’s role in the Manhattan Project; what Fermi did thereafter; and the Edward Teller/J. Robert Oppenheimer dispute, plus other physics-related occurrences up until Fermi’s death.

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.