Healthcare (2)

The first week of June doesn't appear too propitious for HEALTHCARE (actually health INSURANCE) in spite of Obama's having leading Senators at the White House on Monday. In an interview with Andrea Mitchell, Sen Ch. Grassley who seems a nice enough Midwestern, expressed his strong opposition to a public option, for, a.o. arguments, "rural doctors would not be fully reimbursed" and thus rural people will not have access to care. He also said there is already a public option, namely Medicare. It reminds me of the argument made a decade ago by Pennsylvania doctors who wanted the State to limit the cost of Malpractice insurance, for otherwise doctors would be leaving the State. The failed, but none that I use (and were active in these attempts) have left. Rural areas would perhaps get more Asian etc. physicians, as was the case in Phoenixville and Norristown in the 1980s (I haven't seen any for at least a decade).

But already today, rural areas in the Midwest etc., have problems of access, even if one has private insurance. It's a question of distance. We had a very nice birding trip in East-Central Montana last year and found that several small towns had no doctor and none had a hospital or a clinic. And one had to drive for an hour or more on lonely roads between those small towns, roads that had turn outs designated for putting on or removing snow chains. When we were in Alaska, the owner of the cottages had to take his wife to nearest hospital (Anchorage) a 2 1/2 hr drive one-way under normal conditions. It helps explain why the R.V. camps in Texas, Arizona and Florida have a preponderance of winter guests from northern rural areas.

The other piece of bad news was the announcement by the FDA that they may be less secretive and even open some of their files. The Pharm. industry maintains that the secrecy is necessary to protect their formulae. This could be a valid argument but one that would not apply to medical devices, for, once on the market, devices can be easily imitated (of course drugs can be analysed by competitors as well).

A NYT editorial of June 3, refers to an article on the subject (June 2) that revealed a "widely prescribed" heartburn drug was toxic to babies, that a diabetes an painkiller increased the risks of heart attacks and that antidepressants increased suicidal thoughts (a fact admitted by drug companies in their inserts distributed with the drugs and referred to in my earlier blog). The Editorial suggests that the agency has been more cautious in hiding information than required by law or its own previous practices.

This brings me to a full page ad in the same June 3 NYT, for Toprol-XL. Replete with medial and pharmacological terminology (all of it unknown to me and some of which I could not find in my dictionaries), it begins with "For full Prescribing information see package insert." It's indicated for the treatment of hypertension and may be used alone or in combination with other hypertension drugs. Then there follows a list of "contraindications," "warnings," "precautions" in general and for specific conditions or side effects. The latter are based on animal studies and are followed by the statement (relating to pregnancies): "There are no adequate and well-controlled studies of pregnant women. Because animal reproduction studies are not always predictive of human response this drug should be used during pregnancy only if clearly needed." What troubles me is that this statement is included in the paragraph on Pregnancy Category C, but would apply equally to all pregnancies.

Apart from Contraindications and Precautions there are warnings listed under the rubric Dosage and Administration which is followed by an extensive description of Adverse reaction, which refers back to Contraindications, Warnings and Precautions while giving a bit more precise information. Here we get to the misleading use of percentages. Three side effects of the drug occurred in 1.8, 1.5 and 1.4% of patients each 2x or 3x than in those given a placebo (was this control group told what side-effects to expect or do they occur in patients with hypertension at the same diminished rate already?) At the end there's one more rubric "Dosage and Administration." All this is followed on the next page by another ad suggesting you talk to your doctor to see if you can take Toprol-XL, a once-daily drug rather than its twice-daily generic equivalent with the advice to see "adjacent page for a brief summary of the full Prescribing Information. . ." (A brief summary of the full . . .information?). Then there's Spiriva that may help you breathe easier, but one of its possible side-effects is a narrowing of the airways making breathing MORE difficult. A similar drug, Advair, has similar side-effects plus it can increase the risk of getting pneumonia, weaken the immune system, increase blood pressure, etc. and then there is, as always, the statement that there may be other side-effects about which you should ask your healthcare provider or pharmacist.

Addendum: June 7. Today's NYT has further news on the Admin's wishes and a Mag. article on the Congressional insiders who are going to decide to what extent they will go along. There's also an editorial on the various problems, yet is still opting for a sort of Medicare extension to cover the currently uninsured; McCain favored taxing employer contributions during the campaign, an idea that's generally nixed.

Addendum: 11-15. The NYT has a long editorial on the cost of the Reforms if the House Bill were combined with the Senate Fin. Comm. (Baucus) Bill; also suggesting ways to address these costs. Very thoughtful it appears to me. And there's a long article by the Representative who proposed the "death panels" (so called) and the falshoods spread for the sake of partisan advantage.