More Reason to Ban Drug Ads

The last time I wrote a “Don’t Ask Your Doctor” piece was almost three years ago. It was a follow up to the original in November 2012. 

It seems clear that the many drug ads on TV and in magazines with the punch line “Ask your doctor if [fill-in-the-blank drug] is right for you” are merely an attempt by pharmaceutical companies to bypass doctors to increase sales by appealing directly to Americans with a demonstrated weakness in the area of discipline. The companies try to use the patients to put additional pressure on their doctors to prescribe expensive medications. It often interferes with the doctors’ ability to make a proper decision for fear of getting into an unnecessary battle with or ultimately losing a patient.

A common example of this patient pressure that I have run across in the past is the number of people who have gotten antibiotics from their doctors to fight a cold. Antibiotics are not effective for a cold, because it is a viral infection, not bacterial. Doctors know this. It is a waste of money for the patient and a danger to the rest of us as it promotes the evolution of stronger, more drug-resistant viruses.

I am not alone in my objection to these ads. The Washington Times points out that “only doctors have the training about, and knowledge of, such drugs, as well as insight into their patients’ medical backgrounds that may or may not be appropriate for such medications” and that the ads “contribute more confusion than useful information.” The US and New Zealand are the only countries in the world to allow this practice.

The American Medical Association has been calling for a ban on those ads for many years. Their position “reflects concerns among physicians about the negative impact of commercially-driven promotions, and the role that marketing costs play in fueling escalating drug prices.”

And those marketing costs are high! From 1997, when it was first allowed, to 2016 “spending on medical marketing of drugs, disease awareness, health services, and laboratory testing nearly doubled, going from $17.7 billion to $29.9 billion.” The direct-to-consumer portion increased the most, both in amount and proportion of spending from $2.1 billion (11.9% of total spending) in 1997 to $9.6 billion (32.0%),” while the amount spent in journals directed at the doctors decreased.  That spending adds to the cost.

This is doubly important today when we have such strong evidence of how easily patients, and in this case parents, are influenced by misinformation and make such foolish decisions, pressuring their doctors about vaccinations. 

Here is a subject where the science is clear, while warnings and side effects are not buried in the fine print. It’s simple; measles can kill. Vaccinations work.

In 2015, California passed a law eliminating personal belief exemptions for vaccinations that kids must receive before they can attend public school. They can only get a medical exemption from a doctor. Fearful parents are pressuring doctors, causing this medical exemption category to increase by 250% over the first two years of implementation. Some doctors are even cashing in on this unwarranted fear by charging $300 to $500 to write recurring exemptions. The understanding about measles prevention is clear, but there has been an outbreak on the West Coast (and in Europe). These falsified exemptions and parental beliefs endanger not only the kids with fearful parents, but those who cannot be vaccinated due to valid medical exemptions.

This single example casts doubt on the FDA’s original argument for TV ads, that giving consumers more information would lead to better outcomes. It has more likely led to more unnecessary prescriptions and higher drug costs.

Easy Resolutions

It’s the end of another year; time to consider a few resolutions.  The trouble with resolutions is they take will power.  The dimension of discipline comes into play.  Why can’t there be some easy resolutions that are more about not doing something than about working hard.  That should make things considerably easier, and more rewarding in terms of that feeling of success.

A Christmas visitor directed me to this website.  The title of the article is “7 bad science and health ideas that should die with 2016.”  The authors write about how some wrong ideas just seem to stick around.  Friends tell friends.  Ideas become ingrained, and despite all the good science to the contrary, they just won’t go away.  According to the article, this particularly applies to seven myths “that were decisively debunked this year” or possibly debunked again in one more attempt to make them go away. 

This is one of my personal favorite subjects; the things people continue to believe and refuse to change their opinion despite overwhelming contrary evidence.  Instead they look to social media friends or their favorite echo-chamber news source for reassurance.  Throughout the last five and a half years I have brought up many of these subjects.  (For a few of my examples, just look to the history over the last six months where the title begins, “One More Time.”)

In this case though, since these are bad ideas, shown to be decisively incorrect, a good and easy New Year’s resolution would be simply to stop believing them.

The first myth – Exercise will help you lose weight.  Many studies show that “the extra calories you burn only account for a small part of your total energy expenditure, and that cutting your food intake is a much more efficient way to lose weight.”  

The actual myth should read "increasing exercise alone would lead to significant and lasting weight loss."  Exercise is really good.  It gets the blood pumping, which is good for the heart, and good for the bones and good for the brain.  It even helps reduce the chance of getting certain diseases.  But no one can increase exercise while maintaining the same diet and lose much weight.  Unfortunately, it doesn’t work that way.  Programs led by the NFL and the First Lady are not going to impact the childhood obesity epidemic unless diets change also.  We could all start running marathons and it wouldn’t help.

The second myth – There’s been no global warming since 1998.  They present several charts and graphs to point out that the temperature has increased over that period.  There have been ups and downs – not unusual for a small data set, in this case less than 20 annual observations.  These ups and downs have led some to doubt whether the warming has persisted.  But the temperature has been increasing for the last 400 years, so the fact that we have not had a dramatic flattening or change of direction should surprise no one.

This myth misses the key questions about climate change.  Warming is not the issue.  The major questions are: first, whether actions prescribed will have any measurable effect on the warming, and second, whether the change in climate will be catastrophic.  The assumed answer to both these questions is yes.  But the large consensus about warming does not extend to these assumptions.  The danger is that if the answer to either is no, we have wasted a lot of resources, resources that will be needed to adapt to a catastrophic change if it comes or resources that will be completely wasted.  In the latter case we will have sacrificed some our standard of living and deprived third-world countries of the ability to improve theirs significantly for nothing.  Of course none of that matters because debate is closed.

The third myth - Antibiotics cure colds.  This is simple.  Antibiotics kill bacteria.  Viruses cause colds.  Bacteria and viruses are not the same.  But people take antibiotics and the cold goes away.  People also take vitamin C, Echinacea, zinc and other products and the cold goes away.  Then they all swear by the effectiveness of whatever they tried.  Of course, some people take nothing and the cold goes away.

The particular danger with antibiotics is that “the more we take antibiotics – particularly when they're not necessary – the more we increase the chances of helping develop antibiotic-resistant bacteria.”  A second concern is that they can wipe out good bacteria in our guts.  A third problem is that it’s a waste of money.

Some good, easy resolutions would be to drop the idea that exercise alone will be an effective weight loss program, to admit the earth is warming but not to panic over every dismal prediction, knowing that dismal predictions drive so much funding, and to lay off the antibiotics unless prescribed for a bacterial infection.

Come back Monday for a few more easy resolutions.

Believing in Onions!

Here’s one that’s been going around the Internet for a number of years and has recently been resurrected on Facebook, the one place you can rely on for completely accurate scientific and medical advice.  (Not!)

The medical guidance is that putting an onion in the room of a sick person will absorb the illness leading to a complete cure in an unbelievably short time.  The truth in this statement is totally contained in the one word “unbelievably.”  Onions are said to so easily absorb bacteria that it’s not safe to store a partially cut up onion in your refrigerator for fear it will later infect you and your family with the gobs of germs it has collected from the air.

If you or someone in the family has the flu, place an onion sliced in half in a bowl in their room and not only will it cure the patient, it will also prevent the flu from spreading to others in the family.  Supposedly cutting it in half exposes more onion to the air.  But if that’s the case, why not dice it to expose so much more surface area?  Apparently no one asked that question, so the explanation stops at halves of an onion.

But it gets even better.  Sleeping with onions in your socks, or from another source, rubbing them on your feet and then wrapping plastic around them and your feet, and tying the whole package in place with white socks, helps alleviate the flu.  (I wonder why the socks have to be white – apparently another question no one has asked.)  There is probably some scientific reason for the color of the socks.  (I imagine a comedy routine about two people trying get intimate in bed feeling inhibited by the bags of onions each has tied to the feet.)

But people who get their medical advice from a site called healthybliss.net probably don’t get too worked up about real science.  They are satisfied with the fact that this cure has been used for thousands of years and that the ancient practice of Ayurveda has some good things to say about onions.

Speaking for real science, this article from McGill University Office of Science & Society, and subtitled Separating Sense from Nonsense, makes it clear that onions are not especially prone to bacterial contamination.  “Onions feature a variety of sulphur compounds that have antibacterial activity.  (Of course that doesn’t mean they can in any way protect against the flu which is a viral disease.)”  They don’t attract or absorb bacteria from the air, although they may absorb bacteria from a contaminated cutting board in the kitchen that was improperly cleaned.

There is some good news and some bad news here.  First, your leftover half onions should be perfectly safe in the refrigerator and better kept there than in the bedroom.

Second, there is hope for the problem of over-prescription of antibiotics that leads to antibiotic-resistant bacteria that leads to the emergence of super bugs and 23,000 deaths per year, which I referred to in the Epidemics posting of May 27, 2016.  Patients who insist on antibiotics to fight viral diseases like flu and the common cold can be prescribed an onion instead.  Their misunderstanding of medicine is obvious from the fact that they don’t distinguish between a bacterial and a viral infection and think antibiotics are the cure.  This sets them up perfectly to accept an onion as a valid cure for their cold and flu symptoms.  Problem solved!

The bad news, of course, is that these same people who apparently slept through science class and are so weak in critical thinking that they readily accept this kind of advice at face value from dubious Internet sources without doing any research on their own, also vote.  And their vote counts exactly the same as yours.

Epidemics

Two news stories came out in the past week to reinforce an earlier idea I presented under the title of “Don’t Ask Your Doctor.”  At that time I explained how drug companies want patients to put pressure on doctors to increase sales (not necessarily to apply the proper cure to whatever ails you).  The two recent issues are the overuse of antibiotics and the so-called opioid epidemic.

In the case of antibiotics, it’s fairly simple.  Antibiotics kill bacteria.  If bacteria cause an ailment, antibiotics may help.  Otherwise it’s worse than a waste; it’s a danger.  Over time bacteria can mutate into forms that are resistant to the latest antibiotics.  Then anyone who is sick due to the new, modified bacteria will not be helped.  Hence, the outbreak of the super-bugs like MERSA becomes a major and growing concern in the US. 

This is an aspect of what I call “virgin in the volcano” thinking.  According to lore, primitive island people would hold an annual ceremony to toss a virgin into the volcano to appease the gods.  If there was no eruption, they assumed it worked.  If there was an eruption they formulated some excuse to justify the discrepancy and the practice continued.  Viruses, not bacteria, cause the common cold.  It goes away in a couple of weeks.  Many people believe they need antibiotics and hound the doctor for them.  Either the doctor gives in, or they find another source.  They take the pills and the cold clears up, just as it would have had they not taken the pills.

This seems harmless enough except for that nasty ability of bacteria to adapt.  When doctors prescribe too many antibiotics, which they do 30% of the time, some bacteria become resistant.  The CBS News story takes it from there.  “According to the Centers for Disease Control and Prevention (CDC), antibiotic-resistant infections affect 2 million people and lead to about 23,000 deaths annually.”

Those 23,000 are not necessarily the same ones who caused the over-use.  They just happened to catch a very strong disease, one strengthened by its newly gained antibiotic resistance.

The second, related story also from CBS News tells us about another pill problem.  In the opinion of the former head of the FDA, opioid addiction in the US amounts to an epidemic.  Over 28,000 people die each year from an overdose of painkillers.  This is a major problem, but unlike the antibiotic problem, someone else overdosing will not put you in danger.

Similar to the antibiotic problem though, the focal point is the interaction between the patient and doctor and the understanding, sometimes on the part of both parties of what constitutes proper use.  Up to now, both have assumed that the pain is the problem and the answer was to keep popping pills until the pain went completely away.  This leads to the unrealistic expectation of a totally pain-free life and on from there to addiction.  The CDC now recommends that doctors first offer over-the-counter medications before turning to the addictive opioid drugs in more limited quantities.  This, again, becomes more difficult when patients are nagging for a particular drug they saw on TV, putting the advice of pharmaceutical ads over the advice of the doctor.

Both problems call for better education and more responsibility.  We can put the blame on government agencies for being lax and the proliferation of drug advertising with the “Ask Your Doctor” tag line, but then we become victims, giving up our very real ability to fix these problems. The doctors need to be more aware.  Their patients need to ask more questions instead of initiating the conversation with a request for medicine.

Asking the Right Questions

It seems that when faced with information they tend to agree with, news reporters become very sloppy or lazy.  They just lead the interviewee along allowing him or her to make the points, without asking questions to clarify the situation.

This was evident during one interview, as the CBS This Morning team were faced with a study from Consumer Reports about how using antibiotics in animals was harming the food supply.

The point being made was a good one.  Overuse of antibiotics has allowed bacteria to evolve leading to “superbugs” including MRSA and other resistant strains.  “At least 2 million Americans fall victim to antibiotic-resistant infections every year; 23,000 die.”  When antibiotics are needlessly used in healthy animals to promote growth, it merely “teases” the bacteria to mutate into more resistant varieties and these bacteria are passed along to consumers when they eat the infected meat and poultry.  This makes it more difficult to treat people who get sick.  Good farming practices mean using the drugs only for sick animals and good hygiene for the rest.

They showed a table with the results of the food they tested, comparing the amount found with superbugs.  Here is a basic reproduction.

	Conventionally Grown	w/o Antibiotics
Shrimp	17%	3%
Ground Beef	18%	9%
Chicken	69%	59%
Turkey	83%	80%

One host asked, “How do you label against this?”  That was followed by another graphic with an explanation.  They concluded with a comment that you don’t have to give up meat, but just be careful where you buy it.  The representative from Consumer Reports added, “And make sure you cook it thoroughly."

Yes, we want better and safer farming practices.  We want animals (as well as humans) being given antibiotics only when necessary.  But we are left with the impression that the “non-sustainable” farming in conjunction with the restaurants and grocery stores that are less careful about their sources are the big culprits in this superbug problem.

Look again at the table above.  No one asked why the difference in chicken and turkey seemed much less significant, and what would explain any superbugs at all in the “without antibiotics” category. 

Furthermore, no one asked how many of the 23,000 deaths are attributed to this problem.  In the Consumer Reports article it says, “calculations using data from the CDC show that about 20 percent of people sickened by an antibiotic-resistant bug don’t pick it up in the hospital or from another person—they get it from their food.”  So we are talking about only 20% of the problem!  That information was never clear in the interview.  In fact it was implied that the 23,000 deaths can be attributed to those poorly managed farms who didn’t observe “sustainable” practices.

Finally, the comment about thoroughly cooking the meat ended the segment.  Would anyone venture to say how important this is in the overall problem of foodborne illnesses in general, and to this superbug issues specifically?  That might be important information, except once they heard what they wanted to hear it was time to move on to more important news (like interviewing some celebrity).

Can we trust the news media to deliver the whole story?  At the very least we need to keep a very close eye on them.