“There are few people who are not ashamed of their love affairs when the infatuation is over.”
– François, Duc De La Rochefoucauld
The end of an infatuation is always rather sad – we have many expressions for it, “the bloom is off the rose” comes to mind. Falling out of love is often a moment of maturity, a moment of coming out of an illusion – never wholly welcome.
We have had many decades of uncritical, wholesale adolescent-style adoration, heartbreak and hate towards our politicians. We have been capable of sustaining illusions and uncritical thought with support from a similarly dazzled media. This has been done for years on both sides of the aisle. This kind of idealism says that we have finally found the man (party) who will (choose one) solve our problems, understand us, have complete integrity, be able to function in a trustworthy and honest fashion. This idealism comforted us by putting some in black hats and some in white. The comforts of certainty, zeal and clarity, even if untrue, are hard to resist. How long we can sustain this with any one politician or party depends on the filter we have, and how much attention we are paying. This is how crushes are sustained, in romance and in politics.
There are signs on the ground that we are beginning to grow up. We are beginning to understand that the corruption, self-interest, special interests and spin exist symbiotically on both sides of the aisle. With the deeply personal debate on health care and its associated reform costs, our need for honesty and successful policy to save our country is suddenly more important to us than the comfort of bedtime stories. This is political maturity.
What are the signs of this? Take for example, the publics’ realization that our representatives have not read a bill in its entirety. This conversation did not even occur as little as ten years ago – we assumed a level of expertise by our elected officials, or we didn’t care, but somehow, and this is the point, the illusion was maintained. In retrospect, I would imagine few bills were ever read page by page – and that the fact that they are not now is nothing new. What is new is that we now care about this. What is new is that we now see that legislation has a direct impact upon us. What is new is that we realize this congressional neglect shelters corruption in the form of deals, earmarks and policy that the public would not support if there was transparency. And we now see that there is transparency not provided by a beneficent body of elected officials or trusted news sources, but rather there is transparency because of the internet. It is unprecedented that we can summon chapter and verse of any bill onto our own computer – almost in real time.
This is a game-changer.
We are now (as voters) in a position to demand that legislation (including I daresay health-care reform) occur in incremental, transparent, understandable terms that voting citizens can vet themselves. Not thousands of pages of nearly incomprehensible gobbledygook. Anything short of that has become unacceptable, in part because we are also now able to contact our representatives at a moments notice. In years to come, we will now look back and see the final lipstick-on-the-collar moment in our relationship with Congress as the ramming through of the unread, un-vetted Stimulus Package.
The bloom is off the rose. It’s time for a new kind of politics: a mature, unprecedented realism.
Politicians should dismiss the public as “not ready for this” at their own risk.
“When patterns are broken, new worlds can emerge.”
-Tuli Kupferberg
*This blog post was originally published at Dr. Wes*
Demonizing the pharmaceutical industry has become a parlor game for many who enjoy the challenge of shooting at an oversized target. Scapegoating Big Pharma? Now, that takes guts.
Never mind the gazillions they spend on research and development to create tomorrow’s treatments for cancer, arthritis, depression, infectious diseases, heart attacks and strokes. I know that drug industry executives are not all eagle scouts whose mission is solely to save humanity. But, they are not an evil enemy that we need to contain like the “swine flu” pandemic. Sure, they make a profit, and they deserve to. Drugs cost multiple millions of dollars to develop, and most of them never make it to market. Those that do, after years of testing and F.D.A. review, can be summarily shut down when unexpected serious adverse reactions are suspected. In these cases, there may be no actual proof that the medicines were responsible for the ‘side effect’.
I’m not suggesting that we demand airtight proof before issuing drug warnings, only that we beware of what happens if drug company profits can be decimated with the stroke of a pen. Playing rough with the drug companies may appeal to our populist sensibilities, but it can go too far and stifle innovation.
Drug companies need the promise of large profits if they are to take the risks inherent in developing new and novel medicines for all of us. What other business would invest in a new product or technology without the potential for substantial financial gain? Before we advocate price controls for medicines or shortening intervals of patent protection, consider the side effects of this clumsy approach. If we hit Big Pharma too hard, then they will play it safe and churn out lots of drugs that we don’t really need.
Which would you rather they invest in? Another drug for heartburn that is no better than all the others on the shelf, or a vaccine to prevent cancer?
If they succeed in the latter endeavor, I hope they earn hundreds of millions of dollars. This will still be less than the number of lives they will save.
Michael Kirsch is a gastroenterologist who blogs at MD Whistleblower.
I’ve been bemused by the debate on healthcare reform taking place in the U.S. right now. I used to thing that the single topic that people talk the most nonsense about is sport. You know, my sport is better than your sport, my team is better than your team etc. All good fun, but usually nonsense. And then I’ve watched pundits on TV and heard ordinary Americans talk about healthcare reform and wow….its got the sports conversations beaten for absolute gibberish.
So despite a reluctance to get involved because I recognize it’s an extremely complicated issue, I now feel compelled to say a few words. Part of it is because unlike most of the people expressing an opinion, I’ve worked and been a patient in the healthcare system in a country with “socialized medicine” (UK) and I also currently work and am sometimes a patient in the United States healthcare system.
So lets start off with a few basics. The United States has some of the most highly trained healthcare staff and by far and away the best healthcare technology in the world. Just to give an example, there are more scanners (MRI, PET, SPECT etc) within a 15 mile radius of my office in central New Jersey than in the whole of Scotland (population about 5 million). And the United States spends far more on healthcare than any other country in the world. But despite that vast wealth of resources that befits the worlds greatest economic power, the United States falls way down the league table on basic objective measures of health outcomes, and similarly down the league on patient satisfaction with healthcare. There are really very few people, (who have looked further than the end of their own nose into this issue) who don’t acknowledge there’s a very serious problem.
For many in the United States, the problem is not so apparent. So if, like me, you and your immediate family are fortunate enough to be relatively healthy, and to be covered by a relatively good employment-based health insurance package, then it may seem OK. It’s when you get very sick, or are unfortunate enough to lose your job, that some of the basic problems with the U.S. system become more apparent. It’s when you get sick that you may find that your policy doesn’t cover the kind of treatment you need, or has a high deductible (amount you have to pay before the insurance takes over). And its when you lose your job and have to start paying out of pocket for health insurance that you realize it is extremely expensive. And of course if you have a gap in coverage and get sick then the new insurer may refuse to cover your “pre-existing condition”.
To me, the single time in your life when you don’t want added financial stress is when you are sick. But many aspects of the U.S. system direct coverage and services to those who need it least (healthy, young ,well insured employees) and become a nightmare for those who need good healthcare most (aging, sick unemployed people). Now when you talk to people in countries like Britain about this, they are generally appalled and quickly see the problem. But one of the things that has surprised me most about the debate in the United States is that a significant proportion of people here seem to really believe that the old “survival of the fittest” philosophy is appropriate here. The attitude seems to be something like: “If someone gets sick and didn’t have the fore-thought to get adequate health insurance to cover the treatment, then that was their own fault. Why should I work my ass off to look after my family and their healthcare needs for some lazy unemployed person to get healthcare for free?”
So somewhere deep in the psyche of many Americans there is a basic belief that healthcare (insurance) is just like auto insurance….something we are all individually responsible for, and if we cant afford it, that’s tough. Many do not believe that healthcare access for all is a basic requirement of a civilized society (like roads and schools).
So President Obama and others who are currently trying to change the U.S. healthcare system have a tough task ahead. It is currently being made much tougher by some bizarre reporting on this topic by the right wing media (Fox etc). We hear weird stories about “death panels” of government bureaucrats who will decide which sick people should have the plug pulled on their healthcare under government healthcare. We hear weird stories that in countries with socialized medicine it’s the government, not the doctor who decides on what treatment is provided. Well I can tell you that I never saw “Big Brother” interfering in doctors’ clinical practice until I came to the United States. In this country it is bureaucrats working for health insurance companies, generally with no medical qualifications, who deny coverage for appropriate medical treatment hundreds of thousands of times a day.
Often coverage is not denied on clinical grounds, but rather for a whole series of “technical” reasons (wrong diagnostic code, doctor not part of that health insurance plan, pre-existing condition, patient already used annual entitlement for that type of care, patient had that treatment already for longer than policy will pay, treatment carried out at a non-approved facility [go to one 30 miles away], patient hasn’t completed the 6-monthly confirmation of details form, health insurance company doesn’t cover that type of illness/service etc etc). But the underlying strategy is to make it so difficult to get a treatment covered and paid for, that fewer people will go for treatment, and fewer doctors will provide certain procedures because it is so much hassle for them to get paid for it. So the insurance companies hire more people to try to find ways to deny coverage and payments, and doctors have to employ billing specialists to figure out how they can get paid for providing treatment. And the result is an extremely inefficient beaurocratic mess.
Surely a country like the United States can do much better than this?
Now you might be wondering what any of this has to do with smoking? Well one link is that many health insurance policies in the United States do not cover a range of interventions they call “preventive” or “wellness enhancing” interventions. Frequently that means that patients cannot get tobacco dependence treatment (medicines or counseling) covered and so they don’t get the treatment. This is despite the fact that such treatment is one of the most cost-effective clinical interventions available. So an important part of the new proposals for healthcare reform is an increased emphasis on preventive healthcare. This is certainly a step in the right direction.
Senator Ted Kennedy’s death from brain cancer underscores the urgent need for more funding of basic cancer research. Despite the best efforts of a team of top doctors, Kennedy died 15 months after the diagnosis of a malignant brain tumor called glioblastoma. Over the past ten years, some progress has been made against this deadly illness and the silhouettes of some promising new approaches are becoming visible. But our treatment options remain woefully inadequate.
With over 560,000 cancer deaths each year, that comes to less than $10,000 in research spent for every cancer death. That simply is not enough money spent on a problem that strikes almost 1.5 million Americans each year and causes nearly one of four deaths.
Research for certain cancers is especially under funded. Earlier this year, I helplessly watched a dear friend and patient die from esophageal cancer, both of us knowing that only 22 million dollars each year – about $1,500 per death – was being spent by the NCI on the disease annually. One reason is that patients with esophageal cancer don’t have a strong advocacy group to push for their fair share of the funding pie. Lung cancer, which tops the list of cancer killers in America, only gets about $1,500 per death. At the top of the list based on research spending per death are cervical cancer (about $19,000), breast cancer (about $14,000) and brain cancer (about $12,000).
Click here for a chart that I compiled with the help of statisticians at the NCI that breaks down government spending on the top cancers.
Of course, there shouldn’t have to be a competition among cancer advocacy groups. There should be adequate funding of basic medical research to help discover the underlying cellular mechanisms that many cancers share and that hold the key to prevention, early diagnosis and effective treatment. But there’s not enough money for our young researchers. In 1980, almost 25 percent of first independent government grants went to scientists under age 35; that figure has plummeted to only 4 percent as the first-grant age rose from 34 to 42.
Faced with increasing competition for shrinking dollars, many of our best and brightest are considering other careers.
My cancer patients desperately need a bailout. The best way to increase our spending on cancer research responsibly is through health care reform. The Institute of Medicine has estimated that about 20 percent of the annual $2.5 trillion in health care costs is unnecessary. That’s $500 billion annually or 100 times the current budget of the National Cancer Institute. There could be no better tribute to Senator Kennedy or wiser investment in our own futures than to fix a broken system that threatens to bankrupt us while inadequately addressing one of our most devastating health problems.
For this week’s CBS Doc Dot Com, I take you behind the scenes to an edit bay at the CBS Broadcast Center in New York. I talk to Dr. Henry Friedman, an expert on brain cancer. He is co-deputy director of the Preston Robert Tisch Brain Tumor Center at Duke University Medical Center. In addition to hearing about the latest treatments for the disease, you’ll see the secret behind how we do long-distance interviews for the CBS Evening News with Katie Couric.
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