Are We Living In ‘The Age Of Depression?’
52 CommentsBy Ed Silverman // March 26th, 2008 // 11:32 am
Close to 10 percent of men and women in America are reportedly taking drugs to combat depression. How did a once rare condition become so common? That’s the question asked in a lengthy piece in a recent issue of Scientific American. And the author suggests there are two overarching reasons…
1 - Many docs conflate conventional sadness - as from the loss of a loved one or a life-changing event such as a divorce - with the more serious and life-quashing condition of clinical depression.
2 - A second contributing factor is a change in the standard diagnostic guide, which caused many milder mental ailments to fall under the seemingly neutral label of “disorder.”
“Depression, once considered a rare disease usually associated with elderly women, is overwhelmingly the mental health diagnosis of choice of our time,” the mag writes, which then labels this era as “The Age of Depression.”
“…To anyone reasonably experienced in the mental health field, there is depression and then there is Depression. The first type is a terribly broad and bland term, indicating ‘the blues,’ ‘feeling down,’ ‘bummed out,’ ‘in the dumps,’ ‘low,’ ‘a little tired,’ ‘not quite myself,’ each a standard part of the daily human predicament,” the essay states. “Major depressive disorder, however, is a harrowing and indisputably profound and serious medical condition. To confuse the two, depression with Depression, is to compare a gentle spring rain to a vengeful typhoon.”
To read the entire piece, please click here…
Nathan
It’s nice to see that Scientific American doesn’t blame the pharmaceutical industry. I’m sure that within 10 minutes commentors on this site will start placing blame on the pharma industry — even though the article seemingly does not.
Justice in Michigan
Well, ten minutes have elapsed…
I actually don’t intend to “blame” anyone. I do think there has been a “perfect storm” of circumstances that have led to an over-dx’ing of depression which includes some of the media hype that the early SSRIs got (remember when Prozac caused weight loss) and a bunch of social/political/econ factors that leave many feeling helpless, sleepless, restless, powerless, angry, etc. etc.
Has pharma found opportunities in all of that? Of course. Beyond that, much could be said but not one-dimensionally.
Dan
A couple of facts about depression:
1. About 50 years ago, about 1 in 10000 people were diagnosted with depression. Today, it’s closer to 2000 out of every 10000 people. Disease mongering.
2. Yet the disease is real. In fact, there are several medications that can cause brutal depression upon discontinuation of such meds. This is not suprising to me.
3. SSRIs are worthless in regards to efficacy, although it’s been confirmed that they have helped many, which may be somewhat of a placebo effect. A good exercise session will provide the same medicinal benefits of an anti-depressant. Yet it’s my belief that a neurological imbalance does exist that is a catalyst for this disease for some. In my opinion, this imbalance becomes overt as the lifespan progresses.
Lisa Van S
Dan,
‘been confirmed to help many” Anecdotal my dear,.. anecdotal
HorusCat
The fact that SSRIs have helped millions is not anecdotal. Trials, limited though they may be because of the way they have to be structured, offer evidence that many depressed people do well with SSRIs. The testimony of millions goes beyond anecdote.
Good comment, Nathan. I think most psychs do a good job of distinguishing between situational depression (someone dies, or you lose your job, etc.) and true MDD. Someone with situational depression just needs lifestyle adaptations, exercise, counseling, time. Someone with MDD needs all that and medication, too.
Is it really disease mongering on the part of pharma? Perhaps a little. The good thing is that most people only fill a scrip a few times, so the situationally depressed quit taking the meds on their own. Those of us who have truly experienced MDD know that the meds make a hugh difference in our quality of life–and maybe in having life, period.
Is it placebo? Probably not. Placebo effect wears off over time–which short-term studies don’t show. The long-term trials that are out there show that the relapse rate is higher in placebo than in active drug.
Laurie
“The good thing is that most people only fill a scrip a few times, so the situationally depressed quit taking the meds on their own. ”
And thousands do this and end up in withdrawal….which gets classified as “depression” and the drugs continue.
HorusCat
Laurie,
I disagree with you about withdrawal getting labeled as depression. Most docs, psychs at least, are aware of the withdrawal syndrome associated with the SSRIs with shorter half-lives. It can be really hard to get patients off of those.
Justice, I think you alluded to a much bigger issue: the environment in which we find ourselves living, perhaps with a physiology that has not adapted to the social and industrial change that has taken place. Bear with me while I tell you a story:
A while back there was a short documentary, on Discovery, I think, about starvation in Sub-Saharan Africa. A western doctor working there developed a food substance called Plumpy-Nut. It’s basically peanut butter, powdered milk and vitamin/mineral additives. The beauty of it is that mothers can take their child to the clinic, get him/her treated, and take home a month’s supply of Plumpy-Nut, because it doesn’t have to be refrigerated. The doctor said that it is like a miracle cure for childhood malnutrition. What was instructive was this: the interviewer asked about peanut allergies. If the doctor could have had a thought bubble over her head, it would have said, “What are you effin’ talking about?” Instead, what she said, very diplomatically, was that there are no peanut allergies in Sub-Saharan Africa. So does that mean there are no peanut allergies in America? Of course not. And I bet there is not a lot of SSRI use in Sub-Saharan Africa, either. But that does not mean there isn’t depression here.
Perhaps the human organism is poorly suited for an environment where it is not physically challenged (we don’t have to go chase down our food or plow, hoe and harvest), it is extremely emotionally challenged (worrying about nuclear bombs, environmental collapse, money, etc., etc.), and it has a lot of leisure time. Add to that the lack of extended family and a loss of community, and maybe you have the perfect setting for depression. It is an opportunistic disease that has found the perfect storm in the 20th/21st century.
And where doctors used to really know their patients, now they see them for what, 7 minutes? They don’t have time to talk about family, faith, exercise, hope, etc. Much easier to prescribe 50 mg of Zoloft.
I don’t think that this is all the fault of pharma. Drug companies aren’t incentivized to teach people about family connections, meditation, stress management, and all that. And I believe that medication is often a necessary adjunct to other measures, such as prayer, counseling, family/friends/community support, exercise, proper nutrition.
I am sure there are people getting PhDs looking at all of the sociological issues of western civilization that lead to the proliferation of mental illness. What we can be sure of is that the structure of society isn’t going to change much–we’re not going to go back to extended families living on farms.
What I think is dangerous is the mind-set that refuses to believe that medication is a needed tool in combatting mental illness, and the resulting desire to deny that tool to those who need it. I find that mentality rife on this site–fortunately, the voices of those who have suffered from mental illness and benefitted from medication are far stronger. Brooke Shields shut down Tom Cruise.
Lisa Van S
HorusCat,
Where have you been!!…. Brooke and Tom kissed, and made up. more than a year ago.
Lisa Van S
HorusCat
Withdrawal!!! Hmmm. I believe this document speaks for itself
http://www.paxilharmschildren.com/doc/paxil_moneybag.pdf
Lisa Van S
HorusCat
Long term studies,.. no such thing.
Laurie
Horus, I talk to thousands of ssri users every single day from all over the world. While I would love to be able to substantiate your belief that doctors are well aware of withdrawal, that is absolutely NOT the case. The majority continue to deny that withdrawal exists, and if they do admit it’s existence they are ignorant about a safe weaning schedule.
HorusCat
Lisa,
I don’t know what that picture is supposed to tell me. Maybe I missed a page or something.
Just because a doctor uses a drug to treat something doesn’t mean a drug rep told him to. Believe it or not, doctors are pretty smart people and they do think independently. They take pharmacology in medical school and they are very creative at coming up with ways to use drugs based on their mechanism of action. I have doctors tell me they have tried crazy things with my drugs, really crazy things. I don’t argue with them, but I don’t encourage them, either.
I sold Zoloft for 5 years, and I never once mentioned depression to chid psychs. Not only because it isn’t indicated, but because I believe childhood depression is a very tricky issue that requires a lot of in-depth knowledge of the family situation, other adult interaction, possible abuse, etc. I can’t speak about the Paxil people; the ones I ran into on a regular basis weren’t pushing it for kids–I never saw them in my child psych offices, though.
Children by nature don’t get MDD the way adults do, so if a child is truly depressed, there is something going on that needs more than drugs to address it. Having said that, there are different schools of thought among child psychiatrists. Some are very quick to use meds, others aren’t. It doesn’t have much to do with pharma, it has a lot more to do with how the doctors view the process of depression, how much work they want to do to delve into the child’s psychosocial situation, etc. I don’t know about primary care and depression in kids; I never called on pediatricians. I do know there is a shortage of child psychs, and so pediatricians are doing more diagnosis and treatment of childhood mental illness. This is also true with adult psychiatric issues, by the way.
Child psychiatrists often fly by the seat of their pants, because so few drugs are indicated for kids and there isn’t a lot of clinical literature out there even for off-label stuff. A few adventurous docs try something out, and then word spreads about what works. I know this is what happens with the antipsychotics, I am less well versed with SSRIs, because again, we didn’t sell Zoloft for childhood depression.
And there are long-term studies with Zoloft and depression, OCD and PTSD. Trials up to 24 months. You can’t really argue with that–the data are out there. It’s like trying to argue the earth isn’t round; you can do it, but you just sound ignorant.
HorusCat
Laurie,
What in the heck are you doing that you talk to thousands of people every day? Must wear you out.
I can’t speak about primary care docs, because I don’t call on them. Psychiatrists are certainly aware of withdrawal issues, and at least in my limited experience (after all, I only talk to about 120 of them), they do consider that when they prescribe. Perhaps this is one area where drug reps provide a service, because when there was competition for SSRI prescriptions, Paxil’s and Effexor’s competitors were talking about withdrawal! Those issues may not make them stop using a drug, though. Effexor XR is very popular, and I think it has withdrawal issues. The docs use it because it seems to work pretty well, it’s on all the formularies…I don’t know what they tell them about weaning. Your experience is probably more telling than mine, because I’m not talking about depression with my docs. I talk to psych residents all the time; I will have to ask them what they are told about weaning pts off SSRIs and SNRIs.
I do think you can’t just pin it all on the docs, though. A lot of people start feeling better, and they just stop their medication. They don’t even go back to the doctor, let alone tell him they are discontinuing their meds. And doctors, who tell us all the time they can learn everything they need to know about drugs on the internet, don’t seem to be doing their research. I mean, c’mon, it’s an issue that has been in the news–why aren’t doctors aware of it and learning about it?
Former pharma Marketing Exec
Guess what? I am not going to blame Pharma - at least not entirely.
But first to JIM - thanks for using my “perfect storm” analogy, it works well with much of what we are learning these days.
We are a “quick fix” pop a pill and lets get better generation. In fact when the recent study broke showing that anti depressants in fact are no better than placebo’s in most mild cases of depression, I was not surprised. Commentary that I read on that study by highly regarded thought opinion leaders (I am too tired to google, so look it up yourself please..) stated very clearly that mild depression has a cycle of about 12 weeks. Interestingly, that is about how long it takes to switch patients around and get them adjusted to the anti-depressant. Then what happens is they think they have found “the one” that works, but no, the case of mild depression has really run its course. But, the patient and doctor continue down the happy of road of thinking it is the result of the magical pill.
All this to say, that with the information we have now, there is more of an incentive to develop 12 week programs for adolescents and adults alike to help them through the cycle - no drugs, just interpersonal counseling - amazing…
I do not question that there are individuals who do suffer from the debilitating forms of depression. My heart goes out to those who do suffer.
Pills can never be a good substitute for diet, exercise and mindful living habits along with unconditional parental support (for teens) and unconditional support for loved ones and family members.
Wouldn’t it be wonderful if we could spend a little more money on these preventative measures instead of trying to medicate ourselves into oblivion.
There are many good drugs, but like everything, abuse and you loose…
In the UK doctors are paid bonuses for how healthy their patients are. That means they get bonuses for helping their patients to quite smoking (and remain smoke free) and manage their weight and improve physical activity.
In our capitalistic society here something like this would surely work… Just think of the potential…
Nathan
HorusCat says:
“And doctors, who tell us all the time they can learn everything they need to know about drugs on the internet, don’t seem to be doing their research. I mean, c’mon, it’s an issue that has been in the news–why aren’t doctors aware of it and learning about it?”
What’s funny about this is that so many people on this site want to stop pharmaceutical funding for CME. What do you people think is going to happen? You think we have ignorant doctors now… Just wait.
Laurie
“What in the heck are you doing that you talk to thousands of people every day? Must wear you out.”
Yes, it is exhausting, but those who have been through withdrawal are supporting those who are going through it by the thousands. I can tell you that from those that are in withdrawal, they have absolutely no support from their prescribing doctor, psych or medical. As a nurse, I can tell you that the majority of doctors have NO clue about withdrawal. So while it’s great that you acknowledge it’s existence, that is not the case with most doctors. This is why patients go to the internet for advise and support. They are told that they withdrawal is “short lived and the drug is out of the system in 2 weeks”…..which is absurd considering the physiology of how ssri’s work.
“Child psychiatrists often fly by the seat of their pants, because so few drugs are indicated for kids and there isn’t a lot of clinical literature out there even for off-label stuff. A few adventurous docs try something out, and then word spreads about what works”
As as long as the parent knows this, then they know the risk. But sadly few are told that they are giving their child a drug with no FDA approval or clinical trial to prove it’s efficacy. And drugs should never, ever be the first in treatment for any child, on that we can agree.
Former pharma Marketing Exec
Nathan,
No CME would be better than Pharma sponsored CME. I know this, I have been there.
Better yet is the article on this site about “PharmOut” the med students who are kicking pharma out of the med schools and teaching students how to do it for themselves.
Hmm, give a fish - feed for a day, teach to fish, feed for a lifetime…
We would all be much better off.
Nathan
FPME,
I hope you are right. It’s a gamble with people’s lives that we’re talking about. There could be serious consequences if you are wrong.
There are a lot of drugs out there — keeping up with the latest studies about appropriate use of emerging drugs must be a daunting task to a physician that is scheduled to see dozens of patients every day. It seems to me that a biased education is better than no education…
HorusCat
FPME,
The “former” in your nickname may speak volumes. CME developed by professional vendors covers little more than what is in the package inserts, as well as disease state knowledge. I have sat through internet CME courses and CD CME courses and find them to be pretty bland and fair-balance and boring. The bias in them is primarily due to the fact that they center around drug-therapy, rather than other aspects of care that might be useful. They don’t provide any cutting edge information. Sometimes they address useful things like the metabolic issues surrounding anti-psychotics.
A lot of CME courses are developed by the university professors themselves–they might get the funding from pharma, but they pull together the agenda themselves. We gave funding for a recent CME day on multiple sclerosis–current drug therapy was not covered at all, since the docs are quite up on that. Instead, the day looked at coming therapies (no companies mentioned since most of the compounds are in Phase I and II), dealing with the medical issues associated with MS, ethical issues around clinical trials, patient advocacy and education and other ancillary issues. I think it was quite valuable for the docs that attended.
As for the student medical association, if you did a little digging into the background and motives of that group, you might be surprised. May I suggest you visit Pandabearmd.com and read a little about that group.
HorusCat
FPME and Nathan,
I guess what I am getting at is that if you were on the ground, so to speak, every day, like I am, you would see that 99% of what goes on with pharmaceutical marketing is pretty non-newsworthy. 99% of pre-packaged CME is dull and does nothing more than rehash package inserts. The university types that I interact with are very independent and not amenable at all to pharma telling them what to do with the funding that they receive for CME. Time was, yes, that we could “suggest” a speaker for Grand Rounds (which are usually CME)–thus influencing the material that was presented. That is very strictly verboten now, and we often provide the honorarium for a speaker on a disease state that has nothing to do with the meds we sell.
You can argue that the fact that we are involved at all predisposes the physicians to think kindly of us and therefore give preference to our products. Of course, all the companies are doing this, so it would be hard for one company to stand out. It probably does predispose the docs to use branded over generics, but I say, so what? The hard fact is that the profits generated from branded drugs are what is going to bring us new drugs in the future. Generics are not going to produce the funding for R&D. As I think I’ve said before, the issue is getting the R&D to focus on new stuff, not me-too, easy-money, been-there-done-that stuff–and for that we also need a sea change in Wall Street and the way they value businesses.
HorusCat
Furthermore (I am obviously thinking serially, here), we need to remember that drug costs are only about 12% of total medical costs in this country. A lot of energy gets spent talking about evil pharma and the money spent on drugs, while we ignore the elephants in the room (end-of-life care, anyone? Overuse of medical resources by people who “have no skin in the game” as John McCain might say?). Again, go to pandabearmd.com and read what he has to say about those issues. And that 12% doesn’t reveal what money might be saved in other costs by the use of drugs. For example, a shot of Consta for a chronic schizophrenic is $500 or so, but if it keeps him out of the inpatient unit (a 5-day stay is thousands of dollars), the money was worth it.
I think to some extent we do focus on pharma because corporations are such easy targets (go to the site stuffwhitepeoplelike and notice that one thing is “hating corporations”). It is much harder and tremendously uncomfortable to talk about rationing end-of-life care (sorry, no feeding tube for your demented, septic grandmother), kidney dialysis, transplants, reproductive therapies, etc. etc. No one wants to talk about denying liver transplants to alcoholics and things like that, because that might make us look “mean.” Far easier to yell about the cost of Lipitor.
Nathan
HorusCat your posts are like a breath of fresh air. Thanks for your insights.
HorusCat
Thanks, Nathan, I needed that. I am tremendously frightened about what is going to happen to medical care, not just pharmaceuticals, in this push for universal coverage. Not that I disagree with providing basic medical care for everyone. (Although I would argue, as a conservative, that medical care is not a right.) In our refusal to discuss the really hard issues, the really tough ethical stuff, we are going to come up with an expensive, bulky, inefficient system that stifles innovation and R&D. Because of the prevalent mindset that medical care should be “free,” we are going to come up with a system where most people “pay nothing” for their care. (Of course, they pay, but it will be hidden from them, and they won’t figure that out.) When people think something is free, they overuse it. Much of the cost in our system comes from this type of overuse–from end-of-life care to using the ER as a convenient clinic. Because of the growing push to have equality of outcomes versus equality of opportunity, we are going to have a one-size-fits-all system that fails everyone.
It is really scary, and I feel powerless, which frustrates me. Thanks again for your post. Now I’d better go influence some prescribing habits (lol).
Anne
BPMD
HorusCat,
Perhaps you and your company actually do what is right, but for every one that does there are 10 that don’t. Perhaps you are an MSL, MSS or the like. In which case, you conduct yourself with integrity. Many of the things you discuss, particularly CME, is manipulated big time by Big Pharma companies. I’ve been in the business for over 12 years and I’ve seen it first hand. The marketers sitting right at the table with the CME vendors and telling them what they want presented and who they want to present it. The slide reviews that take place with the marketers right before the session where last minute revisions are made. If the vendor doesn’t completely please the customer, then they won’t be hired again. These are standard practices, as is publication control. Not much has changed from 10-15 yeasr ago. It’s just better hidden!
Unfortunately, Big Pharma has made its’ bed and now must lie in it. They have lost the trust of the American people and it will take a long time to get it back. They’re at the bottom of the corporate list, with tobacco and oil. It didn’t have to be this way, but greed trumped honesty and integrity. When the MBAs took charge and left the scientists and physicians on the sidelines, things really changed for the worse.
HorusCat
BPMD,
If you knew who I worked for, you would laugh. No, I agree with you, big pharma has made a bed of nails and now has to lie in it. I had a discussion today with a colleague who is going to begin selling one of my drugs (and I am losing it). He told me about a discussion with a doctor about a group of patients who might benefit from this drug, and said the doctor knew nothing about my drug. He was basically calling me on the carpet for this doctor’s ignorance. I simply said I don’t talk to that specialty about my drug because it isn’t indicated in that group of patients. Period. He really pushed me on this and I can tell that he is going to push the envelope on it. I had mixed feelings about this:
1. The group of patients really do benefit from this class of drugs, even though all the use is off-label. Doctors want to know things about these drugs, just basic stuff like dosing, side effects, formulary access, etc. It is frustrating not to be able to share this with them.
2. We are absolutely prohibited from sharing this information–even I think, from telling a doctor in this specialty about the approved uses of the drug, because the “implication” is there that he will use it off-label, since he doesn’t see the indicated group of patients. Yet, our quotas reflect, I think, the expectation that we will market our drugs wherever possible, and the company sends a double signal about what we are to do.
Because of this dilemma, I have made the personal decision not to discuss my drugs off-label, no matter how common sense-ical (made up word) the use seems to be. The result may well be that I don’t make my numbers, and I may lose my job. That would really suck. You pays your money and you takes your chances, as my greek professor used to say.
Fortunately for me, I am being moved to an area where the drugs I have really don’t have any off-label uses. So maybe my dilemma will be solved for me.
Former pharma Marketing Exec
Horus Cat,
The Former in my moniker doesn’t speak volumes that would mean anything to you.
Think about this, Doctors made it through Med School, they were somehow able to access the education they needed to stay competitive in today’s world. Horus, I have a wealth of experience in CME, long before you were ever working in Pharma. I still am involved in it. Most of the time, it is biased. Medical writers who write the content are scripted by the marketing department. It is checked legally just to make sure we have covered ourselves. The CME that I work with now is independent non industry sponsored and absolutely refreshingly rewarding….
Most doctors I work with (”former” doesn’t mean not active)use the Pharma paid stuff as a fun diversion. The real learning comes from the independent academic stuff.
So, lets cut the costs out of the pretend games of pharma sponsored CME and put that money back where it belongs, R&D.
As for healthcare it needs to brought back to the people. Patients/People before profits.
42 million americans do not have access to health care and we call ourselves one of the greatest countries on earth? Who are we kidding.
I am definitely part of the solution…
Nathan
FPME,
Here’s a few things you say:
“I have a wealth of experience in CME, long before you were ever working in Pharma.”
“I still am involved in it.”
“I am definitely part of the solution…”
Wow — this is tantalizing. HorusCat and myself have shared our credentials. You have yet to say anything about your former or current work experience. For all I know you could be a high school biology teacher. If so, I agree. You are definitely part of the solution. Now once and for all: Give us some details. How are we supposed to take your comments seriously when you are unwilling to share what your actual experience is? Your “opinions” mean nothing unless they have relevant experience to back them up.
HorusCat
FPME,
I don’t know that I necessarily agree with you fully about industry sponsored CME. Just because it is influenced by the industry doesn’t make it bad. I would have to see examples: say a CME program not funded by industry about the antipsychotics and schizophrenia. And I think I spoke about some academic CME I have had experience with where pharma sponsors it, but the content is totally controlled by the academic center.
As for that 45 million uninsured….that is a topic for another time. Be careful, I think you have drunk the kool-aid. Flip over to pandabearmd.com and then we’ll talk about the uninsured and universal health coverage.
Former pharma Marketing Exec
Nathan,
I do not have to give you my credentials. My comments need no defense.
I have shared ample information here that clearly indicates that I know wat I am speaking of.
I am not like you and Horus - Sales reps…
I do not have to defend my position in order to keep my job, which allows me more objectivity. Not at all what we are seeing from you or Horus.
My current work experience is well, very current and also very much ethical.
I sleep very well at night.
Chris
For what it’s worth I’ll repeat what I said days ago. HorusCat speaks more common sense and shows more objectivity than most on here, myself included.
Nathan
FPME says:
“I have shared ample information here that clearly indicates that I know wat I am speaking of.”
MMMmmm. I’m not so sure.
“My current work experience is well, very current and also very much ethical.”
As is mine — the difference is that I’ve been very open about my work experience.
“I sleep very well at night”
As do I. I’m an integral part of an industry that has extended the lifetime and enhanced the wellbeing of hundreds of millions of people around the world.
Melody
HorusCat, you state:
Because of the prevalent mindset that medical care should be “free,” we are going to come up with a system where most people “pay nothing” for their care. (Of course, they pay, but it will be hidden from them, and they won’t figure that out.) When people think something is free, they overuse it.
I would respectfully disagree with your coclusions. First, I think most people are smart enough to realize that “paying nothing” does not equal “free.” Second, I would imagine that if any kind of universal system is implemented, there will, in the beginning, be a burdensome, overwhelming stampede to access “free” healthcare. Individuals with long-ignored or inadequately or untreated conditions will take advantage of “free” healthcare.
Finally, you imply that “free” encourages overuse. Admittedly, there are hypochondriacs among us; but most of us, IMO, have better things to do than overuse FREE healthcare. Discretionary time–like discretionary spending–is a limited resource for most people. On my ‘day off’ I would prefer to avail myself of ‘free’ fresh air and sunshine than ‘free’ healthcare. That being said, especially for those with little or no discretionary monies, the ability to address needed healthcare issues without having to forego basic necessities would be an unquantifiable blessing, akin to other entitlements like public education, veterans’ benefits and social security.
Justice in Michigan
HC - Respectfully, I think most of the polarizing was initiated by you when you first arrived here. I have noted, and appreciated, a change of tone in your posts, whether or not I agree with you. So thanks for that.
Former pharma Marketing Exec
Nathan,
You have no idea who you are talking to, but for what it is worth I find you to be quite amusing at times.
Melody, I concur with what you are saying. Just look to Canada. The fact that the healthcare there is well provided for leaves time for Canadians to concern themselves with other issues. Studying the Canadian healthcare system as well as the European system is quite an interest of mine. It isn’t perfect, yes, there are delays. But I have spent a great deal of time there and in Europe and it isn’t nearly as bad as what we here in America portray it to be.
More on this later…
HorusCat
Melody,
I encourage you to go to http://www.pandabearmd.com and read what he has to say about overuse and abuse. I think you will be surprised; I was. When people don’t take money out of their wallet to pay for something, they discount the value of it. We need to incorporate some sort of payment into any universal system, even for the poor–read pandabear and tell me what you think. YOU don’t have time to waste, but that is not true of everyone. My docs have told me for years that the elderly overuse the system out of sheer loneliness. Going to the doctor can be the highlight of their day.
Lisa Van S
Nathan,
Do you have a name to go with those credentials? I love transparency, dont you.
HorusCat
Lisa,
Don’t get catty. Of course we aren’t going to tell you our names. I wouldn’t mind you knowing my name, but my company would probably fire me. Hell, you’d be welcome to come spend a day with me. You’d be entertained; my doctors are very funny people.
HorusCat
Lisa,
You were being so nice. Don’t be catty. Of course we can’t tell you our names.
Melody
HorusCat, you state:
When people don’t take money out of their wallet to pay for something, they discount the value of it.
In many circumstances, this statement may be true. But for basic rights and needs, I don’t think it holds water. As a youth, I strove for excellence even though I attended PUBLIC school . . . and essentially, it was free. People who need basic healthcare do NOT discount it because it is free–they are appreciative IF they can actually obtain it. There are always those who game the system; nothing can change that. And though I would imagine you maintain that it is the poor and uneducated who are most guilty of this entitlement mentality, again, I would disagree.
I’m a small business owner, and am sometimes amazed that some of my ‘professional’ clients (doctors, lawyers, etc)–those who can most easily afford the service I provide– somehow don’t mind asking ME for a discount . . . but would be highly offended if I reciprocated. On the other hand, some who find my fees a bit ‘pricey’–but appreciative of the quality I provide–will find another discretionary-corner to cut in order to pay my fees . . . and would not dream of asking for a discount.
I read the pandabearmd link (sorry, I’m not impressed. He’s entitled to HIS opinion . . . but facts are still facts. He espouses evidence-based medicine, trashes anything that is outside the currently accepted dogma, but fails to point out that much of what is now practiced by mainstream medicine is based on faulty, skewed, conflicted ‘evidence.’)
Nathan
Lisa,
I didn’t ask for FPME’s name. I asked for his credentials. I’ve given him mine. HorusCat is right: anyone in the pharma industry has to watch their back on a site like this. Giving your real name and company association on a site like this can be a recipe for a quick termination if you say the wrong thing.
HorusCat
Melody,
I wouldn’t say that taking advantage of something “free” is endemic only to lower socioeconomic classes. I think it is human nature. I can use my own situation as an example. Probably because I work for a pharmaceutical company, we have great drug benefits. All prescriptions are “free” (although our salary increases are less than they would be without such great benefits, so we really are paying for the benefits)…I often have to stop myself from falling into the trap of asking for say a branded antibiotic for my kids instead of amoxicillin.
The facts are pretty clear–PandaBear talks about the poor because that is who he sees in the ER, but when I had primary care docs, they talked about the overuse of the system by the elderly on Pacificare. The elderly paid nothing for office visits, and the doctors only received something like $15 per patient per month. The “patients” were in the office every week–they were lonely and wanted the human contact. In addition, when everything seems “free” patients are quick to demand the gamut of expensive tests…so doctors spend a lot of time and money ruling out zebras, instead of diagnosing horses. As an employer, you experience the health benefits debate from both sides. The average American does not.
When we have patients calling for an ambulance to take them to the ER because they don’t want to cough up busfare to the clinic (which happens on a regular basis), then we have overuse and abuse of the system.
I don’t think expecting almost all people to contribute something out of pocket to their medical care is unreasonable or inhumane. Healthcare is NOT a right. It is a service provided by a civilized society. We are right to DESIRE it for all citizens, but not to DEMAND it for all citizens.
I had a speaker give a perfect example of the skewed perceptions Americans have of their “right” to having others pay for what they should pay for themselves:
He had a patient who was complaining about the cost of drugs. He asked the patient if he had any children. The patient acknowledged that yes, he had five children. But! He was quick to add, those kids had a lot on their plates and couldn’t possibly be asked to contribute to their father’s healthcare. Yet, said the doctor, you expect your neighbors, who also have a lot on their plates, to pay for your healthcare. What is wrong with this picture?
The entitlement mentality in this country will be our downfall, because there is only so much money to go around. If we continue to steal from those who create wealth, then we will soon have no more wealth to distribute.
Nathan,
Right on, buddy. My immediate managers would wet their britches if they knew I was on here…
Lisa Van S
Nathan,
Im very good at keeping secrets… I can assure you that many in Industry consider me a huge thorn in their side, especially those companies who sell Psychotropic Drugs. GSK spin Dr.s even followed me to Senator Schumer’s Press Conference on Paxil and kids.
Former pharma Marketing Exec
Nathan,
Good, now you know why I can’t say much more than I have. You are in the business, so you can figure out that if I have been in the business for 18 years, my pedigree and credentials are not something you can question.
HorusCat, About the taking the money out of the wallet - no value issue, you do realize that you cannot use that analogy with health care any more than you can with food and clothing. If you need further evidence to convince yourself of this, just watch how the refugees in Africa react when the free milk, rice and tents are offered.
About the elderly abusing a health care system out of shear loneliness. When the appropriate systems are set in place and the elderly are taken care of and have equitable access to services and even subsidized senior housing in some cases, there is less of a need to access the health care system. Universal health care programs can offer these programs. Their psychosocial needs are being met. They are better nourished and enjoy better health.
A lot of these arguments used against universally accessible health care are straw man arguments, that, as implied, are superficial. What is most frustrating about them is the harm they invariably do by the deceit they engender.
What I find interesting about studying the health care systems of progressive countries like Canada and the EU is the fact that the state has such a vested interest in the health care of its citizens. They are ahead of us in terms of prevention and they are becoming the thought leaders in these areas, whether we like it or not.
Bob Freeman
FPME, I agree that universal health systems in the EU are superior to the fragmented system in the US in that a financial safety net is in place that prevents people from dire financial straights associated with major illnesses. I would also argue they (the public) has a different perception of disease and innovation that we do. As long as Americans consider death optional we will have inappropriate utilization in this country.
It should come as no surprise that PPIs are not used that extensively in Europe since they don’t consider heart burn as a “serious medical condition” and HRT isn’t utilized since menapausal symptoms are considered normal and not a disease to be treated. A couple of apocryphal examples, I admit.
If you’ll admit one anecdote, if not, tangent: French women at one time had the highest per capita consumption of benzodiazapines in the world. When asked “why”, a prominent French psychiatrist said that perhaps it was due to the societal pressure to be beautiful, thin, etc. Then she added, “perhaps it is due to the fact we have to live with French men.”
(Disclaimer: I am an unapologetic Francophile. You have to love a country that has a Ministry for the Defense of the French Language, or some similar wording.)
HorusCat
FPME,
You need a different nickname, I always have to stop and think about the order I am typing those capital letters in. Maybe I will call you F for short.
You are obviously a big government fan. I am not. I do not think that I should have to work to provide subsidized housing for the elderly, for instance. Just as I do not believe I should have to provide health care for the babies that medicaid mothers churn out by the dozens.
The Canadian system has well-documented shortfalls in terms of access to care for emergent problems. The EU has a variety of systems, not all of them single payer. They are better at rationing care, which is not something Americans will receive very well. Just look at the end-of-life care we demand. That is where 1/3 of our health care dollars are spent, but just try to initiate a conversation around not putting a NG tube in grandma. Heck, the young girl that John Edwards exploited when he was running is a great example. Woe betide us that Cigna denied her her transplant–which would have, maybe, extended her life a couple of months. That is not the kind of care we can expect to provide universally. In the UK, MS sufferers have a hard time getting interferon therapy. Why? Because it is very expensive and does not prolong life, only improve the quality of life. I do not think that these are the example of thought leading that we want to emulate.
What is so awful about expecting everyone to contribute to their own welfare? If the average medicaid recipient can afford a cell phone and a big screen TV, he can pay $5 when he wants to see the doctor. If Joe Six-Pack can afford a six pack, he can pay $15 when he fills a prescription. If Mabel can afford to get her hair done at the beauty salon, she can pay $10 for her mammogram.
There is a big difference between the poor in America and the starving in Africa. For one thing, Africans aren’t given the opportunities to succeed that ever American is given. Being poor in America would be considered rich in Africa.
We aren’t going to agree about this. 40% of my paycheck goes to the government, while 50% of Americans pay no income tax (only social security and medicare). I find that reprehensible. You, of course, are free to send as much more of your paycheck to Washington as you like!
HorusCat
Bob,
Vous etes absolument correct! In Europe, dying is not viewed as something to be avoided at all costs. The kind of end of life care we provide is just not offered.
My husband is a perfect example (well, not him, his mom). His mom is extremely demented: MMSE of probably 7-8. She doesn’t recognize anyone, is incontinent, mute, completely out of reach. Yet she still get her Lipitor, Norvasc, diuretic and other medicine. Why? Why are we trying to keep this woman from dying from a heart attack? So she can live as a vegetable for another 2-3 years at a cost of $40,000 a year to her husband, plus whatever she uses in Medicaid? But when I suggested to my husband that they might want to DC all those meds, he about came unglued. That is how a lot of Americans are. If they had to pay for that end-of-life care, they might be less interested in keeping grandma alive at all costs.
And systems like New Zealand are very protective of their national health system. If someone immigrates to NZ, they have to prove they don’t have chronic medical problems, or that they have the resources to pay for their own care. I had a psychiatrist whose wife hated W so much she insisted they move to New Zealand. (Don’t ask me why New Zealand; maybe she liked sheep.) They got there, and discovered that a. the cost of living was very high and the tax rate exorbitant b. psychiatrists are paid very little in NZ and c. she would not be eligible to receive care for her chronic ulcerative colitis. They moved back to the US.
Bob Freeman
Very thoughtful post, Horuscat. You have commented eloquently on the amount of public dollars we spend on end of life care. I am also an unapologetic liberal, a throw-back actually to Humphry-McGovern-Mondale, and I see a legitimate role for a strong central government when it comes to the production and regulation of public goods. I no longer argue points–I peaked in the 60s–and am content associating with other aging lefties. I made a career out of being the token liberal in industry, although I think I finally wore out my welcome.
Frankly, I don’t like the discontinuance of employer-sponsored retirement benefits and the cost-shifitng to consumers. If you ask employers, they would prefer shifting these costs off their books onto the public sector. how this will eventually play out, I don’t know.
Anyway, I enjoy your comments, although we’re about as far apart on the political spectrum as one can get.
Former pharma Marketing Exec
HorusCat,
I am finding it difficult to follow you, I like the F for short - you wouldn’t be missing cafepharma would you?
Anyway, you might want to look up the definition for straw man. Let me help you with it. This sentence you wrote here: I do not think that I should have to work to provide subsidized housing for the elderly, for instance. Just as I do not believe I should have to provide health care for the babies that medicaid mothers churn out by the dozens.
How judgmental of you. In your version of universal health care you have now imagined that we will all work as slaves to help medicaid mothers turn out babies by the dozen you say? This doesn’t happen in Canad and other parts of the world. Why is that, because there is no US/WE attitude. Because they have access, FREE access to education and health care and birth control pills and family planning (if they want the access). None of which is mandatory.
Your MS interferon example - show me the data! I am pretty close to the situation over there and what you say is just not happening.
You are thinking about universal health care in the context of our capitalistic health care system and that is a fundamental mistake. You cannot mix the two.
Bob, I disagree that the EU has a skewed idea about diseases in general. But, I would say that since they subsidize the cost of drugs, they are much more inclined to scrutinize them. The drug better work and you better be able to support it and prove it. Which is something we don’t quite do well enough here. Yes they do look at pharmacoeconomics much more than we do, and I do not see anything wrong with that.
Most of us scrutinize our budgets, and invest more time in shopping for a car than we do on trying to make sure we have the right doctor. In fact, most Americans cannot actually choose the doctor they want unless they belong to the “right” plan.
And Bob, I know what you mean about the French - the women don’t gain as much weight either. Is it the wine or the cheese?
HorusCat
F,
I really had not thought of the implications of using only the F for your nickname. If you prefer, we can go with P.
We have a different culture here in the US with our generations and generations of people on welfare than they do in Canada, so you cannot compare the two societies. I know a girl from the ‘hood (her own words)…she has achieved escape velocity, but she is sharply critical of her friends, all of whom have several children now, at the ripe old age of 22. She says they know all about birth control and how to get access to it. They have the babies for various emotional reasons…wanting a connection to a man is a big one. It is not a matter of education and access. It is a matter of responsibility and expectations. And it’s not a racial thing…the same mindset happens out in the sticks.
And yes, I would call having the federal government taking more and more of my salary to pay for the entitlement benefits of others to be a kind of slavery. Socialism doesn’t work. It isn’t really working in the UK and Europe, despite what you think. They are in a hole financially; unemployment is through the roof; they are not producing enough children to pay for the welfare state…and they aren’t coming up with the technical and medical innovation that pushes an economy forward. They are stagnant cultures producing nothing. Well, except for really, really good food.
My big MS doc is the one who said patients have trouble getting interferons in England. Perhaps he is wrong, or perhaps they can get them but only through private health care.
You are obviously on the same side of the political fence as Bob. That’s cool. I happen to believe that the sorry record of the past 50 years and LBJ’s Great Society speak for themselves…
HorusCat
Oops. Bad grammar there, with disagreement between my pronoun in the predicate and my noun in the subject…the sorry record speaks for itself…
Former pharma Marketing Exec
Horus,
I am American so I am aware of our culture. Another fallacy is that thinking that universal health care is a form of socialism. That is yet again a straw man argument.
You want to talk about being n the hole financially? What do you call the foreclosures on people’s homes? Don’t kid yourself we are in a recession. So, capitalism isn’t working for us is it?
Perhaps when you have spent some more time studying international affairs, you would be able to engage in this type of conversation.
HorusCat
Former,
Just because someone disagrees with your opinions does not mean they are not well-versed or educated.
Taking money from one person to pay for another person’s health care is stealing. Some proportion of such theft is necessary to run a civil society. Having extensive governmental control of an industry with financing provided by the wealth-producers of a society is socialism.
Capitalism works better than anything else you can point to. Recessions come and go. And perhaps those whose homes are in foreclosure should not have purchased a home they could not afford. When I read about a gardener and a hotel maid in California buying a $750,000 home, I have little sympathy when they lose it. Nor do I think we should be quick to bail out the sub-prime lenders.
Your version of the European welfare state is fantasy. They are unable financially to support their entitlement programs. States that are flourishing economically are cutting taxes.
I would suggest you pick up a copy of Jonah Goldberg’s book, Liberal Fascism. YOU might learn something. In the meantime, after reading your posts to me elsewhere on this site, I am discontinuing any conversation with you. You are condescending and self-righteous–like I said once before, you sound like an ex-smoker turned non-smoking activist.