Medical Detox Programs in a stress-free environment

There was a time when physicians, and the medical schools, were fiercely independent — scientifically, intellectually and financially. That is no longer the case, and the repercussions have damaged public perceptions and the quality of patient care.

Getting our stuff fixed properly, expertly and honestly — a car, an appliance, a leaky roof, almost anything — can sometimes present problems.

Will the mechanic or contractor diagnose the problem and fix it correctly the first time? Or will he botch it two or three times before getting it right, costing us unnecessary money and grief?

Will he do an honest job and charge us fairly for the service? Or will we be duped into paying for work that was not needed, gouged by the kind of greedy crook we hear about on the 11 o’clock news?

It’s been common for generations to ask friends to recommend a contractor or mechanic with proven honesty and capability. Yet even with a recommendation, we still proceed with watchful caution. But I can remember when we didn’t ask friends or relatives for the name of a clinic, hospital or doctor that could be trusted to do the job right, do it honestly with care and compassion, and not overcharge us, or god forbid, hurt us some way.

Back in the day, when it came time to repair our bodies, we expected nothing less than near-perfection from our healthcare professionals, regardless of whether or not such god-like standards existed — and indeed, any doctor will tell you they did not.

But we naively assumed medical science offered a standard of knowledge and ethical care that transcended the fraud and greed we might expect from shifty-eyed grease-monkeys at the local garage.

Oh my! How our perceptions have changed.

When it comes to repairing our bodies and our health these days, we’re no longer so innocent and trusting, according to reports. Horror stories from all parts of the country have become commonplace, usually about injuries or deaths due to hospital, physician and pharmaceutical errors, if not outright malfeasance.

In spite of the dedication and commitment of the vast majority of them, doctors in general have lost their halos, and hospitals have become institutions more often feared than trusted. Healthcare professionals and institutions are no longer perceived as able to deliver that absolute standard of care, even as they strive to do so. Public expectations are approaching rock-bottom.

There’s several reasons for this, and although they’re too complex to deal with in any detail here, for the most part they center around a shattering loss of independence in recent decades by doctors and hospitals — hospitals being basically a collection of complex services provided by doctors.

There was a time when physicians, and the universities that trained them, were independent — financially, scientifically and intellectually. As in any profession, there were always a few brilliant leaders and innovators, the rest being what you might call journeymen practitioners. But, excluding a very few bad apples here and there, they were all by and large ruled by their devotion to their science, their art, and their patients health and safety. The Hippocratic Oath, in part scientifically out of date and not obligatory for graduation or practice, still plays a role in medical practice — most doctors adhere to some standards of ethical care. But is it enough today?

To achieve the sky-high standard that raises medicine above the usual questions we might ask when looking for someone to fix our air-conditioning, physicians must be free from certain irrelevant and destructive influences that have corrupted their ability to deliver the safe and effective care they want to deliver, care that we, the public, expect and need.
 
To deserve the respect and trust they were once unquestioningly accorded (and which most patients yearn to accord again) physicians must regain their independence of thought and action from, at the very least:

1. Big Pharma’s “there’s a pill for everything” mentality, espoused endlessly in professional and consumer advertising. Get back to treating whole patients, not writing brush-off prescriptions for every tiny complaint.

2. Big Pharma’s $millions and their minions; get them out of all med schools and research institutes, completely and for good. Retake control of teaching and medical research from Big Pharma and Wall Street.

3. FDA’s drug approvals system that has seen far too many new drugs damaging too many people. Get more proactive, probably collectively through professional medical organizations, and demand that lawmakers provide the funding needed to make the FDA independent from Big Pharma.

4. Hospital systems and insurance plans designed to benefit the bottom line more than patient health and safety. Get more proactive here too, in overcoming the control big business has over what should be your patient care.

I know a lot of physicians. They mean well, they try hard, and many work exhausting schedules on behalf of their patients. But in my humble opinion, acceptance of the status quo — control of medical practice by forces not dedicated to patients but to profit — is an abdication of at least some of the responsibility that came with the diploma. And all the rest of us — including the lawmakers who are also patients — need to vociferously support the medical profession in its efforts to regain independence and control of its destiny.

A devastating investigation by the Washington Post reveals how agency officials tried to by-pass contract bidding regulations to award a contract directly to a DC public relations agency with ties to the FDA official arranging the deal.

FDA execs are madly back-pedaling and calling for an internal investigation of a shady $300,000 deal to hire a PR agency without going through the government’s required bidding process to find the lowest bidder.

According to internal FDA memos and emails, says the Washington Post, agency officials had decided a PR company was needed to polish up the agency’s tarnished public image. But instead of calling for bids, numerous agency officials appear to be complicit in a scheme to award the contract to Alaska Newspapers Inc. (ANI), a firm owned by an Alaska Native corporation that does not have to compete for federal work because it qualifies for special Native American set-asides, which would then hand the work over to Qorvis Communications, a Washington PR firm specializing in corporate communications.

Adding to the stench wafting off this deal, Mildred Cooper, the FDA executive in charge of the project, had personal ties to Qorvis. Says the Post, she called a friend at Qorvis and was referred to Qorvis exec Don Goldberg, who with another Qorvis exec came up with the idea of putting the contract through ANI to avoid the bidding process. And subsequent correspondence from ANI confirms that the murky deal was indeed underway.

So here we have the FDA, Qorvis and ANI all complicit in an illegal, exceedingly  smelly deal, all starting with the FDA worried about its image. Well, that image is at an all-time new low after this.

Of course, senior agency officials are protesting any knowledge of wrong-doing, have suspended the PR contract, and are calling for an internal investigation. But lawmakers charged with FDA oversight appear less than appeased.

Rep. John Dingell (D-Mich.), chairman of the Committee on Energy and Commerce, which oversees the FDA, said: “The agency chose to use its limited resources to save face, instead of saving the public health.” And he has launched his own investigation.

Amen.

Few prescription drug samples actually go to needy children, and often don’t include black box warnings.

A new study has found that free prescription drug samples distributed to pediatric patients may be unsafe because they don’t carry new black box warnings or significant revisions to existing warnings. And they aren’t finding their way to poor and needy kids, their almost all going to insured or better-off kids whose parents can afford a private physician — and new drugs.

The study, published in the October 2008 issue of Pediatrics, examined data on 10,295 children and adolescents from the 2004 Medical Expenditure Panel Survey.

“New medications are frequently released before their safety profile is fully understood,” said lead author Sarah Cutrona, a physician at Cambridge Health Alliance and an instructor of medicine at Harvard Medical School, “and samples tend to be newer medications. Free samples encourage the casual use of medications in our children before enough is known about potential harm.”

Four of the 15 most frequently distributed samples in 2004 were identified by the FDA as having significant new safety concerns, including new black box warnings or significant revisions to existing warnings. The top 15 samples include Strattera (atomoxetine) and Adderall (amphetamine/dextroamphetamine), drugs used to treat attention deficit hyperactivity disorder (ADHD). Both of those medications are Schedule II controlled substances, meaning they are controlled and monitored by the DEA due to high potential for abuse.

Another author, Dr. Neal LeLeiko, director of the pediatric gastroenterology and nutrition at Hasbro Children’s Hospital, and a professor of pediatrics at the Warren Alpert Medical School of Brown University, said previous findings in adults strongly suggest that free drug samples are just a marketing tool. “Our study shows that samples can pose a serious and unappreciated risk to our children,” Dr. LeLeiko said.

Some physicians welcome the use of free sample medications as a way to get medications to needy patients. But this study’s findings showed that few free samples actually go to the children who most need them.

Only 16 percent of the children who received free samples were uninsured for all or part of 2004, and less than one-third had low family incomes, defined as less than $38,000 for a family of four. Children who were uninsured for part or all of the year were no more likely to receive free samples than were those who were insured all year (4.5% vs 5.1%). And 84.3% of all sample recipients were insured.