Population medicine


Obamacare treats not for the patient in particular, but for the patient on average, globally, or in the abstract

This isn’t a problem specific to the ACA; it’s endemic in national health systems all over the world, all of which are more or less in the thrall of pharmaceutical companies who control and produce most of the research that determines population medicine.

The problem with the pharmaceutical companies sponsoring research however is twofold:  1, they control who gets into the study and define the outliers; and 2, most of these studies are not appropriate for population generalizations because they are small in size or short in length.  Oh, and I guess this makes it threefold:  any results that are not favorable to their drug will never see the light of day.

Now controlling who gets into the study is related to the outliers in that, if in the pretrial part of the study, people who have adverse reactions right away will be eliminated from the study.  So people who might give a truer picture of the drug’s ill effects will have been eliminated right off the bat.  And outliers are defined as people who have reactions that are supposedly really rare and do not give a true picture of the overall study results.  For instance, take Celebrex.  It’s a nonsteroidal anti-inflammatory drug, in the same class as aspirin, ibuprofen, naproxen, etc.  Pfizer, the manufacturer, said its drug was better than those others because it didn’t hurt the stomach.  Well, as it turns out, that was not the case at all.  The reason they were able to claim that is because, if you read the link above, you will find that they only released the first six months of a year’s worth of data.  Most of the stomach problems developed in the second half of the study; because of this they were able to deceive regulators, medical providers, and the public at large into believing this drug was safer.  They altered the study’s parameters to hide crucial data related to side effects, and they explained “poor results as the result of ‘statistical glitches.'”  ***statistical glitches is researcher speak for outlier***

Perhaps the worst offender in this is Merck.  Their drug, Vioxx was taken off the market because of the substantially increased risk of a heart attack while taking it.  This was defined as an outlier in their results – which means they knew there was an increased risk before this drug ever went on the market.  Yet they chose to define a statistically increased risk as an outlier, dump all the data related to the people who had had a heart attack during the course of the study, and publish results that were very positive toward their drug.  Of course, they also paid for a study to be published that was favorable to their product without disclosing their financial relationship and were subsequently sued.  Multiple times, in multiple countries.

Regarding study length:  In the case of Celebrex, they released results related to only six months of what ended up being a six year long study.  How can one make a decision about a medication’s safety or efficacy when the study hasn’t even been completed?  Where are the critical thinking skills for those who are in charge of approving a drug?  Where are the critical thinking skills for those prescribing the drug?  The public doesn’t have the general ability to decide if a study is good or not, they rely on the government to determine a drug’s safety and effectiveness, and they rely on their providers to prescribe drugs that have benefits that outweigh the risks.  They are being seriously failed on both accounts.

Unfavorable results are related to both of the above drugs.  Data that showed there was substantial risk for certain groups of people in both cases was simply hidden.  In many cases, studies are never published at all – their data is simply buried and never sees the light of day.

So why is any of this relevant?  Well, guidelines are created based on the cumulative results of published studies.  And guidelines are what are forced on providers in order to make sure they are adhering to the standard of care.  Standards of care are based on population medicine, not on individual people.  They don’t allow for individual preferences, variability in response to a drug, differences in financial circumstances or lifestyles, religious prohibitions, or any other individual determinants of a person’s ability (or desire) to adhere to a given regimen.

If we can’t rely on the results of studies, we can’t rely on guidelines that are created from them.  And this is a big problem when reimbursement, and even licensing is predicated on adhering to guidelines.  In a local to me case, an Arizona cardiologist is under investigation because he advocates non-guideline based recommendations for his patients.  This is a huge problem.  If a physician can’t read research and make decisions for his practice, but is expected to blindly follow guidelines or face having his license revoked, how can one trust one’s medical provider that they are doing the right thing for you, the patient?

In an even more insidious fashion, the powers that be (government in collusion with the pharmaceutical and insurance companies) are requiring (here in the States anyway) that a provider have an NPI.  That’s a national provider number.  And it has to be printed on all prescriptions or the pharmacist will not be required to fill them.  So what?  Well, if you don’t follow the guidelines, and you don’t accept the insurances the government wants you to — because you prefer to offer your patients advice that you feel is healthier and safer for them as an individual — you can have your provider number yanked even if your license is not revoked.  Either way you can’t fully care for patients and are out of business.  I wish I had links for you for this one, but I don’t.  I don’t even remember where I read this, but trust me when I say this is indeed going on.

Population medicine.  Peak medicine.  Grasping for financial straws.  And you, and I, the little people suffer.

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Obamacare just might be going away after all.


http://www.motherjones.com/politics/2014/11/supreme-court-just-took-case-could-gut-obamacare-heres-how-states-can-save-it

So there you have it folks – it’s from a liberal perspective, so they’re all about saving it, but facts are facts.

How do you feel, if you live in a ‘red’  state, about having/not having this?

I’m concerned from the perspective that people won’t just go back on what they had before, if they had Medicaid or in Arizona’s case, AHCCCS (pronounced access).  They won’t have anything at all.  And I can tell you, from dealing with Obamacare in residents who were on AHCCCS and are now on ACA, it’s a poorer insurance with fewer choices, higher costs, and less coverage.  This is fine for those who should really be having some skin in the game, but for the elderly who were on some form of state sponsored long term insurance under medicare/medicaid, it’s really pretty paltry, and denies them access to the medicines they need unless they want to spend far more than half their monthly income on insurance premiums and medications.

I agree in principle that ACA must go.  It’s an insurance company bailout, and a gift to the pharmaceutical and hospital industries, nothing more.  But we really need to be having discussions about what will take its place.  When I get my license, I can provide visits for a quite reasonable fee, or barter for things we both benefit from, but that doesn’t help when the person needs to be hospitalized, or if the medicine they really need costs $249 per month.  By the time they’re at a place where they need a medicine that expensive, there are not many herbs I can prescribe that will do nearly so good a job of controlling symptoms.

Once again, we really need to be having discussions about alternative ways of care delivery.  And about medication costs.  And about hospital costs.  And about the elderly’s idea that medicare should be free for them.  And about the younger people’s idea that Obamacare should be free for them.  We STILL don’t have insurance.  Why?  Because it was too expensive even with the subsidies.  For a $12,700 deductible, we’ll just take our chances.   The penalty is significantly cheaper than buying the insurance would have been.

The system is broken.  We need to look at alternatives.  When can we begin this conversation?  Without having to talk about concierge care type systems that only benefit the wealthy, or subscription systems that still don’t address medications or acute care, or the idea that some should just go without or die?

I hate living at the twilight of empire sometimes.  Hobson’s choice indeed.

The Unaffordable Care Act


Obamacare Website Received just 51000 completed applications

If the numbers quoted in the above story, courtesy of the Daily Mail (UK). are correct, then it is as I said in my last post.  It’s not affordable and people aren’t going to sign up for it.  It’s going to fail, fantastically, within the year.

Why are we still pursuing this if only 38% of people polled even think this is a good idea?? The Guardian (UK) If more than half of all Americans oppose this, why are we still pursuing this?

I found out that providers (doctors, nurse practitioners, physician’s assistants) have to sign up to participate in the plans.  Given the fact that they have NOT been signing up in droves, I would guess that even if you are able to buy a plan, you are not going to be able to see the doctor of your choice.  Nor are you going to be able to go to the hospital of your choice — these plans are concentrating the participants to just a few facilities, which may or may not be the closest one to you, or the one best able to treat your issue.

I understand that the IRS does eventually catch up with tax dodgers, even if it takes years to do so.  I think that is because, relative to the total number of taxpayers, the number who don’t file taxes or pay what’s owed are relatively small — under 10% at the most.  What is going to happen when people figure out that if they file exempt they can keep all their wages other than Social Security and Medicare taxes?  How is the IRS going to be able to go after literally millions of people?

What is to stop people from simply working for cash?  I know a lot of people who have done that, or are doing that now.  They aren’t exactly big internet shoppers, and don’t have bank accounts, so it’s not like there’s an easy way to track their spending vs. their income; if a significantly larger portion of the workers and employers just ‘opt out’ of the mainline economy, how is the IRS to track them, let alone pursue lost tax revenue?

It’s time our government returned to understanding they work for us, not the other way around.  I don’t work to pay taxes.  I work to provide for my family.  And if my taxes pay your wages, you work for me.  It would be great if they all started acting like it.