October 2011 - Page 2 of 2 - Hormones Matter

Are We Marks? The Greed and Chicanery of 21st Century Corporate Culture

Published on October 12, 2011

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Corporate Culture has Run Afoul

By now everyone is aware of Bank of America’s latest in a long stream of fee gouging practices- the $5 debit card fee. This is on top of an endless array transaction fees charged to customers that generate billions in profits annually, and of course, the billions from the bailouts and the foreclosure crisis. Although blatantly evident on Wall Street, the shift in corporate ideology that rewards chicanery pervades every aspect of American life, especially healthcare and most especially women’s and children’s healthcare.

We’re at a place in time where corporations would rather spend billions lobbying favorable regulations and billions more fighting and paying out consumer or patient lawsuits for faulty products than build a quality product or provide a quality service in the first place. How else does one explain the medical marketing of dangerous drugs to otherwise healthy women– think HRT, Yaz and Yasmin, Prozac, Wellbutrin and other anti-depressants to pregnant women (and to rest of the un-depressed population for that matter)? How else does one explain why incredibly dangerous products like Yaz/Yasmin are still on the market despite having more serious adverse events than drugs already off the market because of safety issues (VIOXX) (see comparison of Yaz side effects below, from www.adverseevents.com or click on the graphic below). How else do we explain why it took so many years to remove DES from the market place despite evidence of both teratogenic and carcinogenic effects from the onset or why HRT, was allowed to be marketed as the magic pill that cured all, without any evidence whatsoever? How else do we explain why we not only bought these drugs but demanded them (besides the fact that many are addictive)? How else does one explain that in the 21st century only 30% of practice guidelines for obstetricians and gynecologists are evidence based? Thirty-percent!!!

I guess one really doesn’t need evidence if the treatment choices are limited to bad and worse. Indeed, it’s probably a good thing that more people, patients and doctors alike, don’t question the prescribing practices, the medical efficacy or the very real risk some of these meds pose. Maybe we are marks.

Where did this racket of corporate miscreance come from? I would argue it came from us, or rather because of us. For some reason, we the consumer, the citizen, the patient, the physician, the politician, checked our common sense and personal responsibility at the door of mega-marketing. Somehow we convinced ourselves that we deserved everything, but had to pay for nothing. We abdicated our personal responsibility for our own health, happiness and financial stability to others. And now we are facing the consequences: ill-health, physical and economical, personal and global.

The economic crash exposed the fealty of our financial system and is exposing the very real flaws in our corporate, insurance-based, medical system. The system has taken medical decision-making away from the physician and the patient and placed it squarely in the hands of pharma marketing engines and insurance companies. We’re at a juncture in time, where the sheer economic reality of buying pills to solve all medical problems, is contrasted by the fact that many simply cannot afford their meds anymore and must look to alternative solutions for health.

With all crises comes innovation and change, maybe with this one, we can get back to the “first do no harm” principle of medicine. Maybe we can get back to personal responsibility for health. I think Bill Maher said it best “We’ll stop being sick,when we stop making ourselves sick.”

For a laugh-out loud assessment of modern healthcare by Bill Maher click here.

To look up or report adverse reactions to common medications go to: www.adverseevents.com

Warning: This site does not offer medical advice. If you have questions about your medications or your health, please consult your physician. Do not attempt to discontinue any medication without physician approval and supervision.

Are We Not Worth It? OB/Gyn Decisions Driven by Consensus not Evidence

by Chandler Marrs, PhD

Published on October 7, 2011

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A recent study by researchers at Columbia University uncovered what many women have suspected for years, that the clinical practice of obstetrics and gynecology (Ob/Gyn) is steeped in tradition and opinion but lacks data and evidence. The study, Scientific Evidence Underlying the American College of Obstetricians’ and Gynecologists’ Practice Guidelines authored by Dr. Jason D. Wright and colleagues found that only 30% of Ob/Gyn clinical practice guidelines were based on hard data or scientific evidence. Rather, the vast majority of practice guidelines (70%) were based on observational studies, consensus or expert opinion. Perhaps this is why it takes 5-10 years to diagnose common Gyn conditions, why oral contraceptives are the first line of treatment for every women’s health conditions or why most pregnancy complications are still, in the 21st century, considered idiopathic. Without data, it sure is difficult to sway expert opinion. What do you think?
Link to the press release: Ob/gyn Guidelines Often Based Opinion Weak Data

Reference
Wright JD, et al. Scientific Evidence Underlying the American College of Obstetricians’ and Gynecologists’ Practice Guidelines. Online in press version, September 2011, Obstetrics and Gynecology 118 (3).

Pondering Cancer: the Hubris of Innovation

by Chandler Marrs, PhD

Published on October 5, 2011

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This week begins breast cancer awareness month, a movement started 25 years ago largely by women and family members affected by cancer. The efforts of these men and women have been extraordinarily successful. Who doesn’t associate the pink ribbons with breast cancer? To boot, the public awareness catalyzed the need for research. The War on Cancer was born and a staggering amount of federal and private dollars research dollars have poured into cancer research. Federal breast cancer research dollars totaled $763 million in 2010.

And yet, except for the years between 1999-2005, which saw a 2% decline in new diagnoses (NCHS, SEER), largely attributed to the post-WHI decline in HRT use, breast cancer rates have increased steadily over the last two decades. The incidence of breast cancer is now 1 in 8 women (SEER). It seems the war on breast cancer has not been won.

I am not a cancer researcher and so my thoughts on cancer are offered with some trepidation. Sure, I did the requisite pharmacology papers and presentations in graduate school and even taught the basics in some of my undergraduate courses, but I don’t really know cancer, not like I know other disease processes. And so, as I pondered the state of cancer and reviewed the statistics, looking for an angle into this post, somewhere I could add to the conversation and not just regurgitate existing pablum, what became clear was a nagging sense of intellectual unease. Despite the billions spent on cancer research and the bevy of new treatments, more women are getting cancer than ever before. Perhaps better diagnostics explain the ever increasing incidence of breast cancer. Perhaps not.

Like so many modern diseases, cancer sits at the nexus between high and low science, between medicine and marketing. It is one of those diseases that at once benefits from 20th-21st century science and technology, and suffers immensely from the hubris of those same innovations.

A case and point: a report by the Personalized Medicine Coalition published three years ago and discussed last year in Bloomberg BusinessWeek indicates that of the $292 billion dollars spent on prescription medications in 2008 almost 50% went to medications that didn’t work. That means in one year, we spent $145 billion on medications that didn’t work. The report goes on to suggest that billions more were spent treating the side effects and adverse reactions.

Aside from the ridiculous amount of money spent on medications that don’t work and the billions more spent mitigating the potentially serious side-effects of these medications, both of which threaten our national economy in a very tangible manner; aside from the economics, the point that may be lost in this conversation, is that we are ingesting these medications and trusting them to work or at least not make us worse.

What happens when medications originally intended for one use are marketed for another? What happens when the need for blockbuster drug sales overshadows the actual benefits of a medication or worse yet, hides the dangers (DES, HRT, Vioxx, Yaz/Yasmin)? What happens when we disregard basic genetics, basic science and common sense when prescribing a medication? What happens when we use the one-size-fits-all or the one pill-cures-all approach?

Are we creating the very cancers we are trying to treat?