This is why socialist health care doesn't scare me at all

[cschin4]

You mentioned Lipitor. The statin drugs are a good example. Prior to Mevacor, the first statin, there wasn't much of anything to do for high cholesterol. Just wait for the patient to have a heart attack and hope they survived. The statins have reduced the death rate from coronary artery disease significantly. Of course, it is true that if people weren't so darned fat, there wouldn't be so much heart disease in the first place, but that doesn't lessen the value of drugs like Lipitor.

The American Academy of Pediatrics came out recently to recommend that children be put on this drug with no regard for long term effects on the liver for taking this for 50+ yrs and then retracted. We seem to have an inordinate amount of pills to treat relatively minor problems like heartburn and cholesterol. Why so many pills? Because they are obvious money makers and you can put ALOT of people on these for their imaginary diseases while people die and suffer from serious illnesses. Surely you cannot deny this.

[disneysteve]

We seem to have an inordinate amount of pills to treat relatively minor problems like heartburn and cholesterol.

I agree with your point but I'm not sure you are picking the best examples to support it. High cholesterol is not a "relatively minor" problem considering that heart disease is the number one cause of death in this country. Being on a statin sharply lowers the risk of a cardiac event in a patient at elevated risk. Lots of data suggest that a statin lowers the risk of a heart attack (or stroke) even in patients not considered to be high risk (which I would think is where the pediatric recommendation came from).

As for cost, now that we have several generic statins, for about $40/year, we could put lots more folks on statins and greatly reduce the number of heart attacks and strokes in this country.

[swanson719]

isn't it 5%, not 57%, to support this program?

The total marginal tax rate levied on those with an annual income of $1 Million or more will be 58.68% for those living in the New York City area. That includes a 5.4% surcharge taxed out of the adjusted gross income, not normal gross.

DEMOCRATS HEALTH CARE PLAN FUNDING MAY TAX NEW YORK WEALTHY 57% - New York Post

[cschin4]

Although statins can be life-saving for those who have high cholesterol and have already had heart attacks, recent studies show no reduction in deaths for people over the age of 65 – regardless of how much the drug lowered their cholesterol – and no benefit at all for women of any age!

Even though Americans are bombarded with ads touting the benefits of statins, close study of drug company ads tell a different tale. In small print, an ad for Lipitor stated that ‘in a large clinical study, 3% of patients taking a sugar pill or placebo had a heart attack compared to 2% of patients taking Lipitor.” The trial lasted over three years, meaning that for every one hundred people taking Lipitor for at least three years, only one person avoided having a heart attack. The other 99 got no benefit. Other studies have indicated that as many as 250 patients would need to be treated in order to benefit one person.

[cschin4]

Lipitor and other statins are drugs that they are spending inordinate amounts to find some minor improvement, overblow it, and sell it to the public as a cure all. Are they helpful? Probably. But, does the cost of putting millions of Americans on these like water justify the expense versus benefit? That remains to be seen.

[disneysteve]

Valid points, for sure, cschin4. I guess the bottom line in my mind is that our lifespan continues to gradually increase. Lord knows it isn't due to better diet and exercise. Better medical treatment must have something to do with it. We are able to effectively treat diseases and conditions that we couldn't treat well (if at all) not all that long ago, even within my relatively short medical career. I definitely believe that better drugs and better surgical procedures have helped extend lives, or at the very least, make treatment easier to undergo and make patients more comfortable with fewer side effects.

Does that mean that all new drugs and procedures are great? Of course not. I could list a dozen drugs that have been recalled due to possible unforeseen risks when they were first approved. There have also been recalls of medical devices and abandonment of surgical procedures.

I don't think any of that changes the fact that medicines today are far better than they were 10 or 20 years ago. Yes, they are more costly. Yes, we need to find a way to rein in those costs (stopping the glut of TV commercials would be a good first step IMO) but don't throw out the benefits we've gained in order to save money.

[Joan.of.the.Arch]

It bothers me to see a discussion like this turn to focus on pharmaceuticals. I think there is a lot to Medicine (capital M, Medicine) that does not involve pills. I don't think any honest doctor's goal is to get every American on to a regimen of pills. Doctors do a lot more than just write prescriptions. I do wish they had more time to do more patient education. That rush in & out leaves people with so many misunderstandings, especially people who are afraid to ask questions or who do not see what it is they even need to ask about. Many times someone is needed to explain things to the patient, then to see if the patient really understands adequately. I have known people who truly misunderstood what their doctor told them and it negatively affected their own decisions about their health.

[cschin4]

I think we could easily improve the health of our country by having less Doctors. I don't mean this in anyway in a negative sense. But, I envision a medical office/clinic that would spend proportionately MORE time assessing your lifestyle, beliefs, perceptions, dietary needs, exercise, and on and on. And, interventions via exercise, smoking cessation, better nutrition, mental health, etc. And, then bring in the physician to address treatable medical ailments in conjunction with the other stuff. That would work more toward maximum health for everyone and also free up doctors to do the work they are truly needed for as well. What do you think steve?

[disneysteve]

I don't think any honest doctor's goal is to get every American on to a regimen of pills. Doctors do a lot more than just write prescriptions. I do wish they had more time to do more patient education. That rush in & out leaves people with so many misunderstandings, especially people who are afraid to ask questions or who do not see what it is they even need to ask about... I have known people who truly misunderstood what their doctor told them and it negatively affected their own decisions about their health.

I agree 100%. I've said before (perhaps in this thread but definitely on this site) that we need to focus far more on prevention. 75% of all healthcare spending in this country goes to treat PREVENTABLE diseases. Find a way to improve prevention and you solve the health care crisis. The money that would be freed up would be more than enough to provide insurance coverage for all those who don't currently have it.

I think we could easily improve the health of our country by having less Doctors. I don't mean this in anyway in a negative sense. But, I envision a medical office/clinic that would spend proportionately MORE time assessing your lifestyle, beliefs, perceptions, dietary needs, exercise, and on and on. And, interventions via exercise, smoking cessation, better nutrition, mental health, etc. And, then bring in the physician to address treatable medical ailments in conjunction with the other stuff. That would work more toward maximum health for everyone and also free up doctors to do the work they are truly needed for as well. What do you think steve?

Again, I agree that we need to shift our focus. Not just the focus of the doctors but, more importantly, the focus of the public.

I posted earlier that I am currently part of an experimental collaboration targeting diabetes treatment and education in my area. We are the "guinea pig" practice for what ultimately hopes to be a city-wide program. The original plan was to do a series of classes, 2 classes per group in July, August and September. They are being taught by a registered dietitian and certified diabetes educator. She (and the patients attending) realized by the end of the first session that 2 sessions wouldn't be nearly enough, so they expanded it to 4 sessions per group. The patient response has been tremendous. They are loving the concentrated teaching time. Patients who have been diabetic for 20 years are learning things about managing their disease that they never knew. And through the instructor, I've been learning information about long-time patients that I never knew that will help me better care for them. There is also an Endocrinologist working as part of this team and we've met with him a couple of times to help instruct us on better ways to manage our patients and their medical treatment. It is far too soon to know what lasting effect this will have on outcomes, but it can only be positive. If we can improve patient compliance, get people to take a more active role in their own well-being and understand the importance of diet, exercise and properly taking their meds and following up regularly with their doctor, we can reduce the long-term effects and complications that come from diabetes.

Sorry to ramble on but I'm just trying to illustrate that their are efforts being made to address problems in healthcare that don't involve the government. In fact, this program is being funded by a grant from one of the major pharmaceutical companies. So all the conspiracy theorists who believe that the drug companies don't want people to get better so that they can sell more drugs can go stick it.

[cschin4]

So all the conspiracy theorists who believe that the drug companies don't want people to get better so that they can sell more drugs can go stick it.
__________________

Yes, I really don't get the "drug companies are evil" mantra. Yes, they are making a profit. But, if they don't they aren't going to bother to test and develop new drugs. I do think though, that our society and world has lost it's way. Drug companies used to be about making drugs to make the world a better place and making a profit. I do think they have abandoned looking for cures for rare illnesses as there is no money in that and that is a shame. Obviously from their point of view, heartburn, high cholesterol, PMS, and the like are potential volume markets. So, I really don't know what the answer is. I am not saying those drugs are not effective, but at what cost? At what cost do we treat people with minor symptoms and problems and throw the kitchen sink at it but rarer, more serious and deadly diseases are set aside.

[disneysteve]

I do think they have abandoned looking for cures for rare illnesses as there is no money in that and that is a shame.

At what cost do we treat people with minor symptoms and problems and throw the kitchen sink at it but rarer, more serious and deadly diseases are set aside.

That's a definite problem. The reality is that it costs about a billion dollars to bring a drug to market. That cost is the same whether it is a drug that will treat a condition that millions of people suffer from or one that only hundreds suffer from. That's why there are drugs for rare conditions that literally cost tens of thousands of dollars per month of therapy. They need to recoup their costs somehow.

I do think we tend to overtreat diseases that have clear symptoms, like heartburn or depression, and undertreat more serious but generally asymptomatic diseases like high blood pressure, diabetes and high cholesterol. I have very little trouble getting patients to agree to take a pill to stop their heartburn. I have a great deal of trouble getting them to take their diabetes medicine.

[cschin4]

I have a great deal of trouble getting them to take their diabetes medicine.
__________________

Perhaps a few more pics of amputated legs and blindness would do the trick. It is a SERIOUS illness and I hear you when you say that is something that really needs to be addressed and managed well. Whatever happened to the idea of inhaled insulin? Or putting in more pumps? Or, better technology to check blood sugar like a pulse oximeter. Obviously, sticking yourself with needles is a great deterrent for most people in managing their illness. But, instead, we have 99 versions of the same cholesterol med. Not to harp on that but we all know that the drug companies change one molecule on the drug that essentially works the same and pronounce it a new and improved version.

[disneysteve]

Whatever happened to the idea of inhaled insulin?

It was a failure. Exubera was on the market for maybe a year and then Pfizer pulled it. It wasn't recalled or found to be harmful in any way. It just wasn't selling. It was a good idea that was poorly implemented. The inhalation device was very big and very awkward to use. Complicating that was the fact that the dosage regimen was also very cumbersome. Add in the fact that smokers and anyone with COPD or other lung disease couldn't use the drug and it left a very small market. Hopefully, they'll come up with a better delivery system and easier dosing regimen.

we all know that the drug companies change one molecule on the drug that essentially works the same and pronounce it a new and improved version.

This is a double-edged sword. Yes, there are a lot of "me-too" drugs on the market. However, sometimes changing that one molecule makes the difference between experiencing a side effect from the drug and not or even the drug working or not. I have patients who can not tolerate Lipitor, for example, but they do just fine on Crestor. I have patients whose acid reflux is not relieved by Nexium but they feel great with Prevacid. I have diabetics who swell up terribly on Actos but not at all on Avandia.

So having multiple drugs in the same class is kind of annoying, but at the same time, it also allows us to treat patients who can't use one of the drugs but can use another related drug.

[cschin4]

I agree with you disneysteve and I also know that you are in practice prescribing the very best for your patients. We could all hope for as much and I truly believe the vast, vast majority of physicians and healthcare providers do their absolute best but there are often many approaches to a problem.
I would like to see a panel of not just doctors making decisions. We need nurses, pharmacists and other medical professionals involved in the decision making process. I would like to see a return to the "old timey" GP who really was there to treat most things but then guide you for more of what you might need. And, I think high quality NP's and PA's are essential as well and should be accepted by the general public as working with the physicians. I think that people need to realize that there is no magic bullet and also that many things in medicine are simply the function of a tincture of time. Most people don't want to be told to go home and suffer with their viral infection for 3 days but that really is what is necessary, etc.

[disneysteve]

I would like to see a return to the "old timey" GP who really was there to treat most things but then guide you for more of what you might need.

This will never happen for the same reason that very few people do their own car repairs today. Cars are far more complex, filled with computer chips and electronics requiring costly specialized equipment to service. Medicine is also far more complex. We have hundreds of newer meds and one doc can't possibly keep track of them all. We have all kinds of diagnostic tests and procedures to identify and treat a wide variety of conditions. You need specialists and sub-specialists to keep track of it all.

Plus, the lawyers would have a field day with it.