12 August 2012

American Medicine is Sick

First, here’s this:
Cancer-busting chemotherapy can cause damage to healthy cells which triggers them to secrete a protein that sustains tumour growth and resistance to further treatment, a study said Sunday.

Researchers in the United States made the "completely unexpected" finding while seeking to explain why cancer cells are so resilient inside the human body when they are easy to kill in the lab.

They tested the effects of a type of chemotherapy on tissue collected from men with prostate cancer, and found "evidence of DNA damage" in healthy cells after treatment, the scientists wrote in Nature Medicine.
Of course, it should be fairly obvious in the first place that chemotherapy is going to have rather toxic effects on the body since it is rather toxic.  Thus, it should surprise no one that its effects are toxic.  This then begs the question of why Chemotherapy is so widely used in combatting cancer.  The answer, unsurprisingly, is that chemotherapy is incredibly profitable to doctors (specifically, oncologists).  As to why, this is the case, consider:
This unique payment system started years ago because Medicare and insurers wanted to save money by moving cancer treatments out of the hospital. But it has come under increasing scrutiny as prices for some cancer drugs skyrocketed to tens of thousands of dollars a year.
Consider also this story:
A tuberculosis vaccine in use for 90 years may help reverse Type 1 diabetes and eliminate the life- long need for insulin injections, say Harvard University researchers raising money to conduct large, human studies.

The vaccine, a weakened form of the tuberculosis bacteria, stimulates production of TNF, a cell-signaling protein that plays a role in cell death. With more TNF, the body can attack those harmful immune cells while leaving the rest of the body’s defenses intact. The vaccine is approved by the U.S. Food and Drug Administration for tuberculosis though it isn’t generally recommended for use in the U.S. The vaccine also is approved to fight bladder cancer. [Emphasis added.]

Faustman and her colleagues at Massachusetts General in Boston are working to get the vaccine to market. After their early findings in studies with mice, she said they tried to interest every major drugmaker in developing the vaccine as a possible cure for diabetes. All told her there wasn’t enough money to be made in a cure that used an inexpensive, generically available vaccine, Faustman said.

So now, she is trying to raise money to pay for the expensive larger human trials. Her lab so far has received $11 million of the $25 million needed to pay for the next stage of testing. All of the money is coming from private donors, the largest of which is the Iacocca Family Foundation.
Notice how, in both cases, government intervention creates perverse incentives that are harmful to those who are suffering from illnesses.  In the case of chemotherapy, Medicare wanted to control cancer treatment costs, and so urged doctors to administer medicine directly, which encouraged doctors to mark up drug costs and, in order to increase profitability, overprescribe, with apparently little concern for their patients.  In the latter case, the FDA has not yet approved a drug for use in combatting diabetes, even though that same drug is approved for other uses.

Furthermore, this doesn’t even begin to consider how farming subsidies impact what food is brought to market, nor does it consider how corporate law encourages the production of highly processed frankenfood, nor does it consider the myriad regulations governing (and in some cases outlawing) unprocessed food.  And there are even more interventions beyond this that encourage people to eat unhealthy food, which makes them sick and unhealthy, which is then treated with expensive poison drugs that tend to mask symptoms rather than address the underlying pathologies.

Anyway, it’s no wonder Americans are so sick and unhealthy. Their government is trying to poison them.


  1. I can't speak for U.S. doctors, but here, where the cancer patient does not pay for the medicines and the doctors don't profit from their use, cancer therapy is horribly expensive.

    Regulatory compliance costs, forced onto the drug companies by the public, are astronomical. I think it costs about 1.5 billion to put a new drug onto the market. Because of the current patent laws, company only has seven to eight years to recoup the costs. But that's not all. The drug that eventually gets through the regulatory process, not only has to generate enough income to pay for its research costs and generate a reasonable return, but the drug itself has to pay for the research and compliances costs of all the other drugs that nearly made it through the system. Pfizer's return on equity is about 12%, which isn't much considering the risks it takes.

    Cancer therapies have their own problems. Most of the drugs are new and experimental and therefore very expensive.

    Drug companies live and die by profit. If there is not profit then the business and all the associate research dries up. The reason why they don't want to fund research into the generically available vaccine is because it would be grossly unprofitable for them. What other business would chose to knowingly spend money unprofitably? The board of directors would be accused of being negligent.

    This is a real problem at the moment. The public's desire for safe drugs pushes up compliance costs. The limited "patent time" available to the drug company means that it has to recoup it's costs and generate a profit quickly (therefore expensive) and as such, drug research and activity is limited to medicines which will generate a financial return. No company wants to take on the compliance costs only to see its competitors generate steal its profits.

    It's also killing commercial research into niche drugs. Disease which only affect a small number of people are never going to have commercial money spent on them because the return is just not there. It's financial suicide for a company to undertake the research.

    The really frightening thing is that money is now being directed towards "lifestyle drugs" instead of "lifesaving drugs" since the profits in that area are expected to be enormous.

    The pharmaceutical industry is classic example of free market failure to provide for the common good. It's worth extensive study.

  2. @SP- There are, I think, a couple of serious flaws in your argument.

    First of all, the mere presence of the FDA, patent law, and licensing programs should suggest that we are not dealing with the free market. If the market were free, the aforementioned diabetes drug would likely be on the market since there would be no way to make marketing said drug so prohibitively expensive. Furthermore, patent laws encourage drug companies to seek out expensive medicines for cures instead of cheaper, more holistic approaches. Additionally, the licensing boards seek to decrease the supply of doctors while pushing for more prescription mandates, which requires people to go to the doctor instead of self-diagnosing and purchasing drugs directly.

    Additionally, the FDA, as well as food subsidy programs, encourage people to eat unhealthily. This problem is compounded by public-funded health care (historically, Medicaid and Medicare and, more recently, Obamacare) because people can rely on the government to bail them out. Also contributing to this mess is mandated care for the sick (i.e. patients can't be turned away from ERs, irrespective of their ability to pay), as well as government regulation of the health insurance industry (mandated coverage, e.g., as well as tax breaks for employer provision, etc.). This is hardly the free market in action, and cannot be classified as market failure.

    Additionally. this incentive structure tends to put more focus on curing diseases rather than preventing them. Why inventing new drugs is preferable to preventing rare diseases is beyond me. Personally, I would prefer an incentive structure that strongly encourages people to avoid junk food and processed food, and encourage people to eat healthily and exercise regularly. I bet this could be attained more readily by the free market than by government intervention.

  3. Disagree Simon.

    If the market were free, the aforementioned diabetes drug would likely be on the market since there would be no way to make marketing said drug so prohibitively expensive

    Perhaps. But there is another angle you haven't considered. If your mother died as a result of using the drug would you sue the company? Part of the other reason why drug companies spend so much money on research isn't just FDA regulation, but on ensuring that a drug is safe before it is released onto the market. The exposure to legal liability is another factor that also ensures that the cost of medicines remain high.

    which requires people to go to the doctor instead of self-diagnosing and purchasing drugs directly.

    As a doctor, one of the first things that is drummed into your head is that you never treat yourself or your family. In Australia it can get you deregistered. I've missed my own kid's asthma but nearly always diagnosed it in another. A colleague of mine missed his daughter's osteomyelitis. The problem with medicine is that diagnosis is hard. Your not paying the doctor for a script to treat the common cold, you're paying him to make sure you don't have meningitis.

    The reason why is not in order to generate work, but in the recognition of the that the individual, even highly trained, frequently lacks self-objectivity. I spend a hell of a lot of my time telling people not to take medications, but it is THEY who want to pop pills. They feel like they have been short changed if they haven't been given a script. A good doctor doesn't give you want (that's the free market), a good doctor gives you what you need.

    Additionally, the FDA, as well as food subsidy programs, encourage people to eat unhealthily.

    Did you see the Jamie Oliver Series in the U.K. and the U.S? Here the proles were provided subsidised good food and they refused to eat it. Their justifications were typically libertarian ones.

    I agree that the FDA requirements are excessive, but the FDA has some legitimacy. The solution to the FDA problem is for the community to accept a higher degree of risk of injury with regard to their medications. But of course the public wants perfect drugs at zero cost. Something that just isn't going to happen in the real world.

  4. @SP- I don't have an issue with liability. I think it's a wonderful market mechanism. I simply don't see why we need greater limits than simple liability. To me, the FDA seems redundant in this regard, and occasionally counter-productive in that it creates a false sense of security.

    The absence of self-objectivity is not an issue to me either. There are plenty of things that humans are self-objective on, like their driving abilities. And yet, they can get along just fine without regulations. The same is undoubtedly true of health care, although there will obviously be times when problems arise. but this is true of any endeavor, and the desire to eliminate risk and its attendant negative consequences from life is an unrealistic form of paternalism. Quite simply, people should be free to do whatever they want with their bodies, even if it causes self-harm.

    Regarding the FDA and food subsidy programs (which, for me, includes the fundamental market subsidy known as corporate status), I was referring more to the primacy of the distortions. While the removal of the current distortions would not immediately and completely undo their effects, I think a case can be made that the prolish desire to eat unhealthily is predicated on how the government interfered in the market some time ago (in essence, the hens have come home to roost).