Category Archives: Health

The Weight

** Below is a brief excerpt from a book of health care stories I’m working on.  Having spent around 24 years wrapped up in that first career of mine, I have some pretty gruesome stories to tell.  But this one is mild in some respects, from the early days, but it starts to set the mood.

***

The old stand-up scales squealed and rattled as I rolled it down the hall on the two wheels soldered on the bottom, below the weighing platform.  I wondered what the patients thought hearing this beast as we approached the rooms for daily weights.  The patient weights were all supposed to be taken roughly at the same time of day to duplicate the patients’ conditions.  So, we performed this routine in pairs, moving down the hallway from one room to the next.  Filling in the appropriate box on the flow sheet hanging at the foot of each bed.  More numbers to the list that defined who was in the bed.  Numbers not names.

I remember the way she looked when we entered the room.  I was helping one of the RNs weigh this thirty-three-year-old woman dying of cervical cancer.  Her eyes sunken.  Her hollow face, which became taunt with pain as we stood her up to the scales.  The nurse I was with impatiently yanked her to get her out of bed and inflicted a little more pain than was necessary.  RNs are in a hurry.  Other patients and duties were waiting.

Moving a patient is a chance to assess them.  If you’re observant.  Strength, flexibility, balance, body temperature, skin color for oxygenation, skin turgor for hydration, abrasions, bruising, breathing – relaxed or labored, diaphoresis, the color of the sclera of the eyes, and their facial expressions and what they reveal.  It’s all there, if you look.

I can see her arms and legs, only 3 centimeters (1.2 inches) in diameter.  I can feel her weakness, the muscle mass wasting away, the fragility of her bones.  If I squeezed too hard her arms would break.  She had poor balance and could barely stand.  She sweated profusely with the effort.  Her skin, cold and clammy, tinge of blue beneath the fingernails.  Poor oxygenation.  Breathing as though a boulder was on her chest.  Heart pounding.  I can feel my own gut tighten as I help her to use the emesis basin, barely having enough strength to bring her stomach contents up the length of her esophagus.  The acrid smell of her vomitus blending with the smell of antiseptics.

I still see, hear, smell, and feel this scene.  It’s burned into my brain.

I look around the four-bed room on the surgical floor.  Three other women, each with a different cancer, look away from us, and from each other.  They all lay on their sides, facing the bleached-out, green tile walls.  Their backs in alignment with each other.  Maybe, if they look away, their cancers will not get ideas about devouring them.  Denial is powerful medicine.

I stand confused, for I am only a nursing assistant.  I have no formal training, yet.  No one has taught me how to build barriers to human suffering and emotions, yet.  I don’t think that I will ever become a RN, but eventually I will.  I stand outside the door and cry.  No one notices.

The next evening, when it’s time for her weight, I insert myself between her and the RN.  I gently cradle her in my arms, placing her arms around my neck.  I lift her out of bed and her face remains relaxed — still hollow.  Her breathing is effortless.  Her skin dry.  Her stomach calm.  I stand on the scales and the RN weighs us together.  I gently lay her down in her bed and say, “I’m sorry.”  She barely whispers back, “Thank you.”  I weigh myself and subtract the two weights – 38.6 kilograms or 85 pounds.  Down again.  The cancer and the chemotherapy continue to consume her.

I promise myself that I will always feel the pain and never lose my compassion.

***

Hospital Scales

In the old days, before electronic scales, they looked like this.  They weighed a ton and their color even matched the walls and the floors – all uniformly designed.

Photos:  I found these pictures on the Internet in the public domain.  I could find no further attribution for them.

Seeding, Misleading, Switching, and Stealing: The Vocabulary of Competition in Today’s Pharmaceutical Industry

* Disclaimers:  The image for this post was found on the internet in the public domain and it is in no way identified or affiliated with any entity or particular drug manufacturer.  While the article references specific companies in relation to a Wall Street Journal publication, it is in no way implying those companies, or any other specific companies, have engaged in the practices identified by Dr. Kessler, former Commissioner of the FDA, which are described in this article.

** This article was published in the editorial sections of the Columbia Missourian on July 12, 1995 and in the Columbia Daily Tribune on July 18, 1995.  Please see my Daily Musings post called “Detours” for an introduction to this flash from the past.

Recently, the Wall Street Journal reported that several pharmaceutical companies increased their donations to the GOP to influence legislation that ultimately saved them $1 billion dollars.  It seems Abbott Laboratories, Bristol-Meyers Squibb and American Home Products donated more “soft-money” to the Republicans this past year than the previous six years combined in an effort to eliminate rebates to the government from the sale of infant formula to the Women, Infants and Children program.  Paying off legislators, however, is just one method of dominating the pharmaceutical market, and these corporations go to great lengths to promote products that are much more lethal than infant formula.

More than $58 billion a year is reaped by the U.S. pharmaceutical companies, but each individual company commands only a small share of this monetary battlefield.  Merck and Co., for example, controls the largest market share, dominating only 6.2 percent of the industry.  The fact that each drug manufacturer controls such a small portion or total pharmaceutical revenues fuels fierce competition to influence your physician to prescribe, or misprescribe, medications.  David Kessler of the Food and Drug Administration’s Center for Drug Evaluation and Research cites increasing evidence of illicit drug marketing practices that mislead or literally buy physicians’ prescribing practices.

One such technique is called a “seeding trial.”  The company identifies physicians, not based on qualifications, but by their habits of prescribing competitors’ products.  These doctors are then enticed to prescribe a given medication by signing them on for a drug trial of no scientific value.  Already FDA-licensed, these drugs require no additional studies.  The only criteria for participation is the physician’s willingness to write prescriptions.  Little to no data is collected, and no control groups are used to compare effects of medications.  The physician is paid a flat fee for each patient enrolled, which usually varies from $85 to $500 a head.  Essentially, these false studies are designed to change a doctor’s prescribing habits to a medication with no appreciable benefits to the patients involved.  In a marketing memo intercepted by the FDA, one company highlighted the importance of one such trial in this manner: “If at least 20,000 of the 25,000 patients enrolled remain in the study, it could mean up to a $10,000,000 boost in sales.”

This type of payment for questionable research has resulted in other problems.  In his article “Institutional Conflicts of Interest,” Ezekiel Emanuel documented that institutions and physicians receiving royalties and payments associated with drug research were more likely to fail to provide informed consent; to ignore adverse reactions and complications endangering their subjects; and to introduce bias into the collection and interpretation of data.  If drug companies are eliciting false drug trials and physicians are altering results based on payment for these studies, how can any patient trust that [they are] being prescribed the correct product for [their] ailment?

If physicians cannot be coerced into false studies to change their prescribing habits, then drug companies simply misrepresent the benefits of their products.  Unsubstantiated claims of superiority, minimizing or failing to mention risk and adverse reactions or presenting pharmacokinetic distinctions with dubious relevance are all part of a well-orchestrated false advertising campaign.  A study conducted at the University of San Diego School of Medicine demonstrated that, at best, pharmaceutical representatives were only 89 percent accurate in their advertising statements.  This 11 percent falsification of data could be all it takes for your physician to prescribe a lethal combination of medications.

If “seeding and misleading” can’t get your physician into the manufacturer’s camp, then how about the “switch campaign?”  Insurance companies encourage the use of cheaper generic drugs to hold down health-care costs.  To avoid this loss of revenue, however, pharmaceutical corporations offer direct payments to physicians to “switch” to another dosage form of the same product or to another product in the same therapeutic class.  No real benefit surfaces for the patient, but now there is no generic substitute for the switched classification and no loss of profits for the manufacturer.

If all of this doesn’t make you reach for your antacid, then consider the newest trend in the pharmaceutical industry: stealing.  Drug companies are trying to create alliances with insurers that will allow them to guide the patients’ care, provide their medications and bypass the physician altogether.  A nurse would monitor the patient by phone while hospital and physician visits are discouraged.  The drug company would provide only its products, eliminating the physician’s option to decide form a wide range of medications.  I guess “stealing” prescriptive authority is certainly one way to eliminate the competition, but then again just who is practicing medicine here, and whose interest do you think these companies are representing?

In the Nov. 15 issue of Hospital Practice, Robert Schrier documented a drug-dosing crisis in America that accounts for 60,000 to 140,000 unnecessary death each year.  Adverse reactions resulted in 10.8 percent of all hospitalizations and 14 percent of all in-patient hospital days, and once hospitalized there was an additional 18 to 30 percent chance of experiencing and adverse drug event.  Medication producing dizziness and sedation in the elderly population caused 32,000 hip fractures last year, and potentially life-threatening mixtures of medications were found in 88 percent of all elderly patients prescribed three or more medications.  Prescription medications, taken the way they are ordered, account for more deaths each year than guns (35,000), than high risk sexual behavior (30,000) or even motor vehicle accidents (25,000).  In fact, each year prescription medications kill more people than the entire 16 years of the Vietnam War, during which we lost 57,147 Americans.  With these types of statistics, it is not very comforting to know that our drug manufacturers are illicitly influence the way our doctors treat our ailments.

***

Kessler, D. A., et. al. (1994).  Therapeutic Class Wars – Drug Promotion in a Competitive                        Marketplace.  The New England Journal of Medicine, 331(20), 1350- 1353.

 

Photo:  This photo was found on the Internet in the public domain.  No other attribution could be found.

Update June 3, 2018: It looks like nothing has changed since 1994, except there are probably more zeros after the profit margins of Big Pharma.  Check it out: “Why Prescription Drugs Cost So Much.”  All links are subject to link rot.