Better Health: Smart Health Commentary Better Health (TM): smart health commentary

Latest Posts

MTV Reality Show Runs More Like A Contraceptive Ad And Covers Little To No Side Effects

In this week’s episode of Teen Mom 2, Kailyn heads to her gynecologist for birth control and leaves with a Mirena IUD in her uterus.

The entire encounter, obviously edited, ran more like a commercial for Mirena than a contraceptive counseling session. Other contraceptives were mentioned generically only  -”a patch”, “a ring”, “the pill” – but when it came to the IUD, all we hear is the word Mirena – six times, to be exact, during the entire 2 and a half minute encounter with the doc.

DOC: If you don’t like the birth control pill, you do have other options. You know that there’s a birth control patch.
KAILYN: (suspiciously) Yeah
DOC: There’s a once a month vaginal ring. The ring itself is not uncomfortable. (Hands her the ring) They’re one size fits all – Right Isaac? (Baby plays with Nuvaring) They’re cool, right?
KAILYN: I just feel like me putting something in myself is all that much more room for error.
DOC: There’s also the Mirena.
KAILYN: Whaaaat is Mirena? Read more »

*This blog post was originally published at The Blog That Ate Manhattan*

Free Medical Apps Are Usually Paid For By Big Pharma

The medical app industry is a big business, but the apps are no longer the product – the physicians, nurses, and other healthcare providers who use them are. In the first part of this series, we examined some of the financial forces driving the medical app industry. Our focus then was Epocrates, the veritable founder of the industry. As is clearly stated in their recent SEC statement, Epocrates primary revenue stream has become the pharmaceutical industry and as such a key goal has become to further grow their user base by enhancing their free offerings.

Now, one might be tempted to say that this is just one company or even that it is just limited to free apps. An expected counter-example would be Skyscape, which probably has the largest cache of apps of any developer and nearly all for fee. As a private company, there isn’t much financial data available nor is the website particularly forthcoming, but it does appear that the company has been enjoying some success. A deeper look however suggests they in fact have more in common with Epocrates than you may think. Read more »

*This blog post was originally published at iMedicalApps*

Supreme Court: Data Mining OK, Even When Physician Privacy Is Compromised

The Supreme Court has sided with Big Pharma in their challenge to the Vermont Law limiting the pharmaceutical Industry’s access to physician prescribing information.

The nation’s high court handed down a verdict Thursday in the Sorrell v. IMS Health case, striking down by a 6-3 vote a 2007 Vermont law that that bans the practice of data mining — the sale and use of prescriber-identifiable information for marketing or promoting a drug, including drug detailing — unless a physician specifically gives his or her permission to use the information.

Apparently, Big Pharma’s right to “free speech” trumps my right to privacy. How getting access to my prescribing information has anything to do with free speech is beyond me.  In the twisted logic of the pro-business, anti-citizen Supreme Court -

Speech in aid of pharmaceutical marketing… is a form of expression protected by the Free Speech Clause of the First Amendment. Read more »

*This blog post was originally published at The Blog That Ate Manhattan*

Big Herba’s Research Deficit: Why It Isn’t About The Money

This is a guest post from Erik Davis of Skeptic North.


Bankers, Buyouts & Billionaires: Why Big Herba’s Research Deficit Isn’t About The Money

It’s a scene from the blogosphere that’s become all too familiar. A skeptic challenges a natural health product for the lack of an evidentiary base. A proponent of that product responds that the skeptic has made a logical error — an absence of evidence is not evidence of absence, and in such a scenario it’s not unreasonable to rely on patient reporting and traditional uses as a guide. The skeptic chimes back with a dissertation on the limits of anecdotal evidence and arguments from antiquity — especially when the corresponding pharma products have a data trail supporting their safety and efficacy. The proponent responds that it’s unfair to hold natural health products to the same evidentiary standard, because only pharma has the money to fund proper research, and they only do so for products they can patent. You can’t patent nature, so no research into natural health products gets done.

Okay, so maybe this isn’t a scene from an actual blog. The participants are way too civil, the arguments too coherent, and no one has been compared to Hitler. But it’s not a straw man either (look herehere, and here for recent examples), merely a distillation of an argument I’ve seen made repeatedly — that the deck has been stacked by Big Pharma, which has set a research bar that the much poorer natural health industry can’t possibly meet given the costs and lack of financial upside.

In my observation, skeptics don’t often have a good response to this argument beyond their basic scientific disposition toward only making assertions based on positive evidence. Typically, that’s not a disposition shared by the proponent, and thus they simply agree to disagree (read: trade barbs until the thread peters out from fatigue). Yet this need not be a purely philosophical debate. After all, there’s a testable premise embedded in this disagreement — that the natural health industry isn’t rich enough to sustain proper research. Is that true? Read more »

When Dietary Supplements Are Used As Medicines

I was surprised to get this e-mail from a reader:

Surely, Dr. Hall, the public mania for nutritional supplements is baseless. All the alleged nutrients in supplements are contained in the food we eat. And what governmental agency has oversight responsibility regarding the production of these so-call nutritional supplements? Even if one believes that such pills have value, how can the consumer be assured that the product actually contains what the label signifies? I have yet to find a comment on this subject on your otherwise informative website.

My co-bloggers and I have addressed these issues repeatedly.Peter Lipson covered DSHEA (The Diet Supplement Health and Education Act) nicely. It’s all been said before, but perhaps it needs to be said again — and maybe by writing this post I can make it easier for new readers to find the information.

Food, Medicine, or Something In Between?

The FDA regulates foods and has been instrumental in improving the safety of our food supply. It regulates prescription and over-the-counter medications, requiring evidence of effectiveness and safety before marketing. Surveys have shown that most people falsely assume these protections extend to everything on the shelves including diet supplements, but they don’t.

Under the 1994 Diet Supplement Health and Education Act (DSHEA), a variety of products such as vitamins, minerals, herbs and botanicals, amino acids, enzymes, organ tissues, and hormones can evade the usual controls if they are sold as diet supplements. Under the DSHEA, the manufacturer doesn’t have to prove to the FDA that a product is safe and effective; it is up to the FDA to prove that it isn’t safe, and until recently there was no systematic method of reporting adverse effects (required reporting is still limited to serious effects like death).

So far the FDA has only managed to ban one substance, ephedra, and it took the death of a prominent sports figure and considerable skirmishing with the courts to accomplish that. Independent lab tests of diet supplements have found a high rate of contamination (with things like heavy metals and prescription drugs) and dosages wildly varying from the label. A striking example was Gary Null’s recent poisoning with vitamin D from one of his own products which contained 1,000 times the intended amount.

The FDA has issued rules on good manufacturing practices, but standardization is not required and it remains to be seen whether the new rules will effectively improve product quality. Read more »

*This blog post was originally published at Science-Based Medicine*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

Read more »

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

Read more »

See all interviews »

Latest Cartoon

See all cartoons »

Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

Read more »

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

Read more »

Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

Read more »

See all book reviews »