Category Archives: drug industry

The Myth of the Greedy Geezer

The following appeared today as an opinion piece on Al Jazeera English.

Old people are becoming everyone’s favourite scapegoat for America’s economic woes. Among the growing ranks of self-styled deficit hawks, Social Security and
Medicare are depicted as an intolerable burden to the nation’s already crippled
economy, which can only be saved through massive cuts to these so-called old-age entitlement programs. To advance this agenda, proponents of entitlement cuts have attacked not only the programs themselves, but the people who benefit from them – the selfish old folks like myself, who insist upon bankrupting the
country for the sake of their own costly health care and retirement income.

We in the over-65 set have become the present-day equivalent of Reagan’s notorious “welfare queens,” supposedly living high on the hog at the expense of the taxpayer. According to what I call the Myth of the Greedy Geezer, we lucky
oldsters spend our time lolling about in lush retirement villas, racing our golf
carts to under-priced early-bird dinner specials and toasting our good fortune
with cans of Ensure – all at the expense of struggling young people, who will
never enjoy such pleasures since the entitlement “Ponzi scheme” will collapse
long before they are old.

The fervour for entitlement-cutting remains strongest among conservatives, but these days, even President Obama is taking part, promoting the recommendations of his National Commission on Fiscal Responsibility and Reform, commonly known as the Deficit Commission (and to its opponents as the Cat food Commission, since that’s what old people will be eating when the Commission finishes its work).

The appointed chair of the Deficit Commission, Alan Simpson, is one of the primary promulgators of the Myth of the Greedy Geezer. A former Republican senator from Wyoming who is known for his colourful turns of phrase, Simpson insists that “This country is gonna go to the bow-wows unless we deal with entitlements, Social Security and Medicare.” The majority of the people opposed to such cuts, he claims, are “These old cats 70 and 80 years old who are not
affected in one whiff. People who live in gated communities and drive their
Lexus to the Perkins restaurant to get the AARP discount. This is madness.”…

Read the rest at Al Jazeera.

Soylent Greenbacks: David Brooks Wants Some People to Die for Debt Reduction

To help solve the debt crisis, the best thing I can do is die. Maybe not right now, but certainly before I put too much strain on the public purse—and since I’m 74, that means pretty soon. If I should be lucky enough to contract a fatal disease, I can do the right thing by eschewing expensive medical care that might extend my life. If that doesn’t happen, and I enter a slow and costly decline, then in the interests of the greater good I should take the Hemingway solution.

That’s pretty much the message of David Brooks’s column in today’s New York Times. “This fiscal crisis is about many things,” he writes, “but one of them is our
inability to face death — our willingness to spend our nation into bankruptcy
to extend life for a few more sickly months.”

Here’s how Brooks comes by his position: To begin with, he says: “The fiscal crisis is driven largely by health care costs.” Never mind two futile wars and ten years of tax relief for millionaires—it’s primarily health care that’s driving us into national penury.

Furthermore, Brooks argues, the reason for these soaring health care costs is that very old and very sick people insist on clinging on to their miserable lives, when they ought to be civic-minded enough to kick off. It’s not the insurance companies, which reap huge profits by serving as useless, greed-driven middlemen. It’s not the drug companies, which are making out like bandits with virtually no government regulation. It’s not the whole corrupt, overpriced system of medicine-for-profit, which delivers the 37th best health care in the world, according to the WHO, at more than twice the cost of the best system (France). No. It’s all about us greedy geezers. We’re the ones who are placing an untenable burden on the younger, heartier citizenry, with our selfish desire to live a little longer.

Brooks cites the usual figures: “A large share of our health care spending is devoted to ill patients in the last phases of life,” he writes, and Alzheimer’s patients will soon cost us hundreds of billions. He continues: “Obviously, we are never going to cut off Alzheimer’s patients and leave them out on a hillside.” (Thanks, Dave.) “We are never coercively going to give up on the old and ailing.” Nonetheless, Brooks hopes than many “old and ailing” people will make the choice made by Dudley Clendinen, a man suffering from A.L.S., who wrote a moving essay in the Times about his decision to end his life before the disease takes its full course and renders him “a conscious but motionless, mute, withered, incontinent mummy of my former self.”

I have great respect for Clendinen’s decision. As I’ve written before in Mother Jones, I am a big supporter of what these days is called “choice in dying” or “death with dignity”—each person’s right to decide when and where and in what
circumstances they will die. But I don’t want anyone else making those decisions for me, or telling me when the time is right—not an insurance company or a Medicare bureaucrat, not Barack Obama or John Boehner, and certainly not
David Brooks. I have every intention of being my own one-man death panel. But I won’t be persuaded to die a moment sooner than I want to just because it might
save some money–money that could easily be saved by far more equitable and less draconian means.

Brooks writes that “it is hard to see us reducing health care inflation seriously unless people and their families are willing to do what Clendinen is doing —confront death and their obligations to the living.” But why is it “hard to see us reducing health care inflation” any other way? Because conservatives like Brooks don’t believe in challenging the profit-driven health care system, and the people who pass these days for liberals lack the moxie to stand up to them.

Based on models from countries like France and Canada, we could bring about whopping savings in health care expenditures through a single payer system without rationing or compromising the quality of care. Short of this, we could opt for much more regulation and still save more money than we could by pulling the plug on every geezer in the land.

If I have any “obligation to the living,” it’s to leave them with a better health care system than we have now—a health care system that values all human life above profits. But I know that’s not likely to happen before my death—which, if I listen to Brooks, could be right around the corner.

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As Numbers of Uninsured Soar, Health Insurance Companies Plan Rate Hikes

The latest report from the Census Bureau, which shows a significant rise in the number of Americans living in poverty in 2009, is making news today. Less widely reported are the figures for those living without health insurance, which indicate that in 2009 there were 50.7 million uninsured or 16 .7% of population, up from 46.3 million and 15.4% in 2008. Kaiser Health News has a roundup of stories on the sharp rise in the uninsured. The details from the Census Bureau report are as follows.

  • The number of people with health insurance decreased from 255.1 million in 2008 to 253.6 million in 2009. Since 1987, the first year that comparable health insurance data were collected, this is the first year that the number of people with health insurance has decreased.
  • Between 2008 and 2009, the number of people covered by private health insurance decreased from 201.0 million to 194.5 million, while the number covered by government health insurance climbed from 87.4 million to 93.2 million. The number covered by employment-based health insurance declined from 176.3 million to 169.7 million. The number with Medicaid coverage increased from 42.6 million to 47.8 million.
  • Comparable health insurance data were first collected in 1987. The percentage of people covered by private insurance (63.9 percent) is the lowest since that year, as is the percentage of people covered by employment-based insurance (55.8 percent). In contrast, the percentage of people covered by government health insurance programs (30.6 percent) is the highest since 1987, as is the percentage covered by Medicaid (15.7 percent).
  • In 2009, 10.0 percent (7.5 million) of children under 18 were without health insurance. Neither estimate is significantly different from the corresponding 2008 estimate.
  • The uninsured rate for children in poverty (15.1 percent) was greater than the rate for all children.
  • In 2009, the uninsured rates decreased as household income increased: from 26.6 percent for those in households with annual incomes less than $25,000 to 9.1 percent in households with incomes of $75,000 or more.
  • These figures are sure to reignite the health care squabbling in Congress, and add to the Tea Party shrieks that Obamacare won’t cure the health care mess, which is now more of a disaster than ever. While their analysis is flawed, the Tea Partisans’ conclusion is, sadly, pretty much on the mark. 

    In the wake of health care reform, insurance companies are raising their rates–apparently, in preparation for the tepid new rules that won’t go into effect for years, and thus give the industry plenty of time to jack up their prices and protect their profits.  The Wall Street Journal reports that premiums for individuals and small businesses will go up in 2011, in some cases by as much as 20 percent. 

    Once the reform measures do go into full effect, the government is supposed to turn the 50 million uninsured into new customers for the price-gouging private insurance companies, which will enjoy no competition from a public option. As I have been arguing since this so-called debate over the future of health care began, it all looks like a sham exercise by Congress that will only end up extending the grip of the insurance and pharmaceutical industries in the health care market. 

    Any serious economic recovery will be stopped in its tracks by these numbers. And with more price hikes in store, God only knows what the 2011 figures will look like.

    The Puppy Protection Act Offers (Slim) Hope to (Some) Abused Pups

    Congress.org reports today on bills recently introduced in both houses of Congress. The Puppy Uniform Protection and Safety (PUPS) Act (S 3424 and HR 5434) would “amend the Animal Welfare Act to provide further protection for puppies.”

    The bills, from Sen. Dick Durbin (D-Ill.) and Rep. Sam Farr (D-Calif.), were introduced at the end of May and tail a Department of Agriculture inspector general report regarding federal investigations of breeders.

    The IG report, released May 25, says large breeders who sell animals covered under the Animal Welfare Act (AWA, PL 89-544) online are exempt from inspection and licensing requirements “due to a loophole in AWA.” The IG says there are “an increasing number” of these unlicensed, unmonitored breeders.

    The bills would require licensing and inspection of dog breeders that sell more than 50 dogs per year to the public (including online) and would also outline additional exercise requirements for dogs at facilities – such as having sufficient, clean space and proper flooring.

    According to a press release, Durbin said he would work administratively with the USDA to fix problems at its Animal and Plant Health Inspection Services, and then introduce addition legislation if needed.

    Supporting humane treatment of puppies would seem like a political no-brainer, right? As Liliana Segura pointed out on Twitter earlier today, what could be better in the upcoming midterm elections than “to be able to say ‘our opponents HATE puppies'”? Mainstream groups like the Humane Society have been pushing for legislation action on puppy mills for years, to little avail. (Click here to see video of a Humane Society raid on a massive puppy mill in Tennessee, and here to read some gruesome details from the USDA’s report on puppy mills.) Yet the bills are not exactly barreling their way through Congress; both are waiting for attention from agricultural subcommittees, and after two months, the Senate bill has only seven co-sponsors.

    In addition, when it comes to animals routinely used in cosmetic testing, and animals (including puppies and dogs) treated cruelly in drug testing and medical research, the federal government has pretty much sat on its hands–or worse. To take one particularly galling example, the Physicians Committee for Responsible Medicine last year exposed an effort on the part of the National Institutes of Health to sell young constituents on the idea of animal experimentation. As Stephanie Ernst wrote on Change.org:

    [T]he NIH promotes, on its Web site, a children’s coloring book that gives a skewed view of animal experiments. The coloring book implies that researchers are trying to cure animals that are already sick—rather than purposely infecting them with diseases—and ignores the fact that animals suffer and die in the process. The coloring book, entitled The Lucky Puppy, was produced by an industry trade group, the North Carolina Association for Biomedical Research, whose members have a financial interest in the continuation of animal research…

    The book erroneously portrays the lives of animals in laboratories as pleasant and carefree. Published scientific research and numerous undercover investigations clearly demonstrate that animals in laboratories suffer pain and distress from experimental procedures and routine laboratory practices. The coloring book also makes misleading claims about the benefits of animal experiments, implying that research findings from experiments on animals are directly applicable to both the animals used in research and to humans.

    The federal government is also actively engaged in protecting animal testing and experimentation against animal rights activists. Anyone who chooses to take action against an animal testing facility is not, as one would expect, subject to charges of breaking-and-entering or vandalism. Instead, they are branded terrorists under the notorious Animal Enterprise Terrorism Act; for actions in which no human being were harmed, they can end up serving long sentences in a federal supermax Communications Management Unit.  (See the blog Green Is the New Red for the best information on AETA.)

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    Meet the Real Death Panels: The Truth About Age-Based Health Care Rationing

    The latest issue of Mother Jones includes an article by me about the controversy over age-based health care rationing, which got transformed by the right into government “death panels.” Unfortunately, liberals have fallen into a different trap, because they refuse to take on the real enemies of affordable health care for all: the insurance companies, drug manufacturers, and other profiteers of our private health care system.

    As a result, old people are being asked if we would be willing to give up some expensive, life-sustaining treatment so that our grandchildren can have health care. This is a bogus question, and a bogus “choice.” The real question, as I say in the article, is whether we should give up the treatment “so some WellPoint executive can take another expensive vacation, so Pfizer can book $3 billion in annual profits instead of $2 billion, or so private hospitals can make another campaign contribution to some gutless politician.”

    It’s a long article, and I’m including just the opening here, with a link at the end to continue reading at the Mother Jones web site. Or you can read the whole thing at MotherJones.com by clicking here. And if you’re one of those geezers who still likes reading print and turning pages, the July/August issue is on newsstands now.

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    From Mother Jones, July/August 2010

    There’s a certain age at which you cease to regard your own death as a distant hypothetical and start to view it as a coming event. For me, it was 67—the age at which my father died. For many Americans, I suspect it’s 70—the age that puts you within striking distance of our average national life expectancy of 78.1 years. Even if you still feel pretty spry, you suddenly find that your roster of doctor’s appointments has expanded, along with your collection of daily medications. You grow accustomed to hearing that yet another person you once knew has dropped off the twig. And you feel more and more like a walking ghost yourself, invisible to the younger people who push past you on the subway escalator. Like it or not, death becomes something you think about, often on a daily basis.

    Actually, you don’t think about death, per se, as much as you do about dying—about when and where and especially how you’re going to die. Will you have to deal with a long illness? With pain, immobility, or dementia? Will you be able to get the care you need, and will you have enough money to pay for it? Most of all, will you lose control over what life you have left, as well as over the circumstances of your death?

    These are precisely the preoccupations that the right so cynically exploited in the debate over health care reform, with that ominous talk of Washington bean counters deciding who lives and dies. It was all nonsense, of course—the worst kind of political scare tactic. But at the same time, supporters of health care reform seemed to me too quick to dismiss old people’s fears as just so much paranoid foolishness. There are reasons why the death-panel myth found fertile ground—and those reasons go beyond the gullibility of half-senile old farts.

    While politicians of all stripes shun the idea of health care rationing as the political third rail that it is, most of them accept a premise that leads, one way or another, to that end. Here’s what I mean: Nearly every other industrialized country recognizes health care as a human right, whose costs and benefits are shared among all citizens. But in the United States, the leaders of both political parties along with most of the “experts” persist in treating health care as a commodity that is purchased, in one way or another, by those who can afford it. Conservatives embrace this notion as the perfect expression of the all-powerful market; though they make a great show of recoiling from the term, in practice they are endorsing rationing on the basis of wealth. Liberals, including supporters of President Obama’s health care reform, advocate subsidies, regulation, and other modest measures to give the less fortunate a little more buying power. But as long as health care is viewed as a product to be bought and sold, even the most well-intentioned reformers will someday soon have to come to grips with health care rationing, if not by wealth then by some other criteria.

    In a country that already spends more than 16 percent of each GDP dollar on health care (PDF), it’s easy to see why so many people believe there’s simply not enough of it to go around. But keep in mind that the rest of the industrialized world manages to spend between 20 and 90 percent less per capita and still rank higher than the US in overall health care performance. In 2004, a team of researchers including Princeton’s Uwe Reinhardt, one of the nation’s best known experts on health economics, found that while the US spends 134 percent more than the median of the world’s most developed nations, we get less for our money—fewer physician visits and hospital days per capita, for example—than our counterparts in countries like Germany, Canada, and Australia. (We do, however, have more MRI machines and more cesarean sections.)

    Where does the money go instead? By some estimates, administration and insurance profits alone eat up at least 30 percent of our total health care bill (and most of that is in the private sector—Medicare’s overhead is around 2 percent). In other words, we don’t have too little to go around—we overpay for what we get, and we don’t allocate our spending where it does us the most good. “In most [medical] resources we have a surplus,” says Dr. David Himmelstein, cofounder of Physicians for a National Health Program. “People get large amounts of care that don’t do them any good and might cause them harm [while] others don’t get the necessary amount.”

    Looking at the numbers, it’s pretty safe to say that with an efficient health care system, we could spend a little less than we do now and provide all Americans with the most spectacular care the world has ever known. But in the absence of any serious challenge to the health-care-as-commodity system, we are doomed to a battlefield scenario where Americans must fight to secure their share of a “scarce” resource in a life-and-death struggle that pits the rich against the poor, the insured against the uninsured—and increasingly, the old against the young.

    For years, any push to improve the nation’s finances—balance the budget, pay for the bailout, or help stimulate the economy—has been accompanied by rumblings about the greedy geezers who resist entitlement “reforms” (read: cuts) with their unconscionable demands for basic health care and a hedge against destitution. So, too, today: Already, President Obama’s newly convened deficit commission looks to be blaming the nation’s fiscal woes not on tax cuts, wars, or bank bailouts, but on the burden of Social Security and Medicare. (The commission’s co-chair, former Republican senator Alan Simpson, has declared, “This country is gonna go to the bow-wows unless we deal with entitlements.”)

    Old people’s anxiety in the face of such hostile attitudes has provided fertile ground for Republican disinformation and fearmongering. But so has the vacuum left by Democratic reformers. Too often, in their zeal to prove themselves tough on “waste,” they’ve allowed connections to be drawn between two things that, to my mind, should never be spoken of in the same breath: death and cost.

    Click here to the rest at MotherJones.com.

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    Newest Medical Combine: Delis and Hungry Docs

    Over the last year or so, there has been a campaign to break the hold of the pharmaceutical companies on doctors. The aim is to get more transparency so as to show the true relations between the drug industry and doctors, which involves taking gift , getting exotic all-expense- paid vacations, signing their names to articles they didn’t write, and on and on. The ultimate goal is to expose and eventually stop these practices.

    Among the most fervent of these efforts has been carried out by groups of medical students and doctors who try to stop drug companies from handing out free lunches to busy medical professionals, who are often in hospitals on their short breaks.

    Now, the pharma-free lunch movement faces the wrath of the restauarant lobby, which in Massachusetts is said to face a serious loss of business due to the reduction in the numbers of lunches bought by Big Pharma for the docs. Restaurants in Massachusetts want the gift ban ended, according to BNET:

    Statehouse Democrats say the ban, which prevents drug sales reps from delivering free sandwiches to doctors, has “severely impacted the profitability” of local businesses. Rep. Brian Dempsey told the Boston Business Journal:… “We’ve been hearing from device and biotech companies, the convention center and the restaurant industry, that this is causing additional problems during the worst recession in memory.

    As BNET reports, a pumped up Jeff Norris from Twins Restaurant & Catering in Erie, Pennsylvania, tells EZ Restaurant Marketing, an outfit that counsels restauranteurs how to break into feeding docs:  

    “I used to do 2 maybe 3 luncheons per week, and soon I was doing 2 or 3 luncheons PER DAY…Thru June 30th , 2004 I have done 4 TIMES the amount of business with drug reps than I did in ALL of 2003. My marketing is on cruise control. I have some offices REQUIRING drug reps to call me for their luncheons!”

    In Los Angeles, for example, Dr. Lunch, an outfit that caters to docs,provides this testimonial from a Dr. Martin Levine: “My staff and I request their lunches repeatedly. We have always enjoyed the food and service provided by DR.LUNCH. The food is not only delicious, but always fresh. I highly recommend them for any event, whether it be your office or home. 

     BNET further reports:

    Some doctors get so used to free lunches that they issue instruction sheets to sales reps, such as this delightfully specific one from a Baltimore doctor obtained by [the blog]Pharmalot: “(Please do not order wraps, several members of the office have not tolerated them well).”

    And we’re not just talking sandwiches and chips. Free lunches can be elaborate. Angelo’s of Flemington, NJ, offers Tiger Shrimp sautéed in a pink cream vodka sauce with penne pasta.

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    Supreme Court on Pfizer’s Pharmaceutical Colonialism

    Victims and families protest outside the courthouse in Kano, Nigeria, in 2008. Photo: AFP.

    While the media was chewing over the Supreme Court’s gun decision earlier in the week, another significant action passed with little comment. That was the court’s refusal to throw out a case brought under the Alien Tort Statute on behalf of Nigerians whose children died or suffered terrible damage in a Pfizer drug experiment.

    The case is of considerable importance, because so many drug companies have conducted tests of new medicine’s abroad in poor countries, using the residents as lab rats in what some have dubbed “pharmaceutical colonialism.” The BBC reports:

    The US Supreme Court on Tuesday declined to take up a case examining whether drug giant Pfizer could be sued in an American court for allegedly conducting nonconsensual drug tests on 200 Nigerian children in 1996. The action allows the case to move toward a trial. Eleven of the children died, and many others were left blind, deaf, paralyzed, or brain-damaged, according to court documents.

    At issue in the Supreme Court appeal was whether the surviving children and relatives of the children were entitled to file a lawsuit in New York seeking to hold Pfizer responsible. Usually, such a suit would be filed in Nigeria. Lawyers for the children complained that Nigerian judges are corrupt and that the US court system holds the only promise of justice.

    The suit was filed under the Alien Tort Statute (ATS), which empowers federal judges to hear civil lawsuits filed by non-US citizens for violations of the “law of nations.” Lawyers for Pfizer denied that the Nigeria experiments were conducted without the consent and knowledge of the children and their guardians. In addition, the lawyers argued that the children’s case should be thrown out of court because the alleged drug experiments are not the precise type of international law violation covered under the ATS. What made the high court appeal potentially significant is that the Supreme Court has declared that foreign plaintiffs may rely on the ATS to file lawsuits, but only in a few limited circumstances. The high court has not yet identified precisely which few cases may be brought and which may not.

    For those interested in reading more on this grim subject, this long piece that appeared in Der Spiegel back in 2007 provides details on the Pfizer case. Sonia Shah’s 2006 book The Body Hunters uncovers other unethical drug trials throughout the developing world. And if you’re looking for some timely summer reading, John Le Carre’s 2001 book The Constant Gardener reimagines the story as a thriller, with Big Pharma cast as one of the leading villains of the post-Cold War world–which, of course, they are.