The Push To Prescribe To Women
25 CommentsBy Ed Silverman // December 24th, 2009 // 8:47 am
The controversies over aggressive - if not inappropriate - marketing continues to dog the pharmaceutical industry, especially amid accusations that diseases, not just drugs, are being promoted.
Anne Rochon Ford says that when this happens - and things go wrong - the people whose health is most likely to be compromised are women. She is the co-editor of ‘The Push To Prescribe: Women and Canadian Drug Policy,’ as well as the coordinator of Women and Health Protection, a national committee that is funded at arms length by Health Canada, to provide advice on the drug safety.
In an interview with Anne Maria Tremonti of the Canadian Broadcasting Corporation, Ford discusses a host of medicines and related issues, from hormone replacement therapies, statins and Viagra, to direct-to-consumer advertising to silicone gel implants. You can listen here (just click on ‘Listen to Part Two’)
Justice in MI
Good item, Ed. I wonder if anyone out there has any general stats about the number of rx’s written for women relative to men? If disaggregated and longitudinal, even better.
Happy Holidays!
Justice in MI
Got part of answer to own question. Abstract here:
http://www.theannals.com/cgi/content/abstract/36/1/30
atlex
One can agree or disagree with the premise of this report, but if you track back to the organizations involved, one can easily find an anti-pharma connection. Thus, one could have predicted the results in advance.
Among the goals by one of the key organizations (within Canada) are:
“Reduce over-prescribing and make drugs affordable. Drug companies are adding millions to health care costs by driving up prices. We need to repeal the drug patent protection legislation which prevents competition and enact law reform that promotes lower drug prices. Controlling over-prescribing and drug costs would free up millions for health care services.”
and
“Eliminate profit-making from illness. Public administration of medicare has saved Canadians billions of dollars. The practice of “deinsuring” health services by eliminating them from Medicare coverage, the move to user fees, the creation of profit-making clinics - all these changes create a two-tier health care system where private insurance companies profit. There is no room for profit and inequity in health care.”
Of course, it should come as no surprise that this is also tied to the US organization Public Citizen, which is proud of its anti-pharma positions.
Anonymous
One way or another the stories eventually become personal for all of us. My 87 year old frightened mother convinced by oncologist and other “expert” that she must take this drug to “prevent cancer” s/p lumpectomy. Now incapacitated with leg and joint pains and congestive heart failure, the doc insists no connection to the drug and she should continue with it. See patient AERS from women who look like reliable history givers to me.
http://www.askapatient.com/viewrating.asp?drug=20726&name=FEMARA
Anonymous_
Atlex,
The Anti-pharma positions of citizens groups didn’t come about overnight and are only a direct result of the aggressive and over-reaching marketing of medications that can kill. Pharma has no one to blame for citizen groups with wanting to check and balance marketing overzealousness but themselves. They pay off politicians and scare the FDA from doing it.. It, like the trust factor polls we see see monthly, is nothing but a reflection of a behavior that pushes pills versus being a responsible partner in the health care paradigm. Until the marketing is taken out of being the control part of pharmaceutical companies guiding force, the good work many people do will constantly be tainted. Pfizer’s CEO may talk the talk seeing the writing on the wall but until he walks the walk- pharma will constantly be at odds with the better part of the public.
Atlex
To Anonymous #1, rather than blame the oncologist and some other “expert” why not take control of the situation and go to another doctor for a second opinion. Also, even if they all agree that Femara is the best “clinical” option, your mother and you still have the choice of staying on the drug or pursuing other alternatives that may not have as positive a clinical outcome, but a much more positive humanistic outcome. Remember, oncologists treat the cancer, not necessarily the whole patient. Sometimes what’s best for the whole patient is different than what is best to treat the cancer.
Atlex
To Anonymous #2, I didn’t comment as to why certain citizen groups like or dislike pharma, I was only pointing out that there was a built-in bias to the report. Again, it doesn’t make it right (or wrong), but it should be noted in the spirit of transparency. Additionally, I felt that it was valuable to point out that this group opposes any profiting from health care. Of course, this not only means single-payer care, it really does mean fully socialized medicine (much beyond what Canada and most European countries have) where doctors are all salaried, hospitals are either non-profit or government owned,R&D (in pharma discovery and development) is funded and directed by the government, etc. Personally, while universal coverage is critical and, perhaps, single payer (I prefer the term “funder”) a possible option (afterall, Medicare Part D is an excellent example of government funding care that is delivered at a profit through private entities), the concept of no profit in health care would significantly dampen innovation and hurt consumers in the long run. To me, someone who carries that viewpoint will likely come to conclusions biased against any profit-making entity.
Anonymous
To Atlex:
Wrote: convinced by oncologist and other “expert”…which last time I checked makes 2 opinions.
…for an elderly woman of a generation that entrusts her medical decisions to her
doctors with loyalty and trust that they know what is best for her. There was a time when this would have been a fair approach. Time to stop blaming the patients for not knowing how to navigate the infested waters.
riv
Anti-pharmaceutical INDUSTRY criminal behavior comes about as a result of being incapacitated and disabled or watching a loved one die from side effects of a pharmaceutical drug, particularly when it has never been tested on anyone like you, has no clinical evidence for you, and negative but relevant drug information contradicting the advertising and CME has been hidden, suppressed, withheld.
I do not know any anti-pharmaceutical advocates. You and your handlers having pissed on the word doesn’t make it your territory. Certainly, I know no anti-pharmaceutical industry criminal behavior advocate who, unlike you, has been paid to do what we do.
I do know hundreds upon hundreds of people who have taken oaths to protect and act in the best interests of the patient. And that’s what they’ll continue to do. Including the authors of the para you quoted.
I also know many people who want drugs to be better tested with all harmful information made available openly to the consumer.
Anyway, your screed is so pathetic to anyone with a modicum of intelligence, apparently not a requirement for detailers today, that no-one but someone grounded by stratus crapus with intermittent spruce trees and OD’d on Xmas cake would respond to you.
riv
Sacre bleu. The following is so dangerous. So, so…undemocratic. How can they even THINK this?!
Ten Goals for Good Health
Developed by the members of the Canadian Health Coalition for improving the health of Canadians
1. Create Good Health. We must create conditions for good health. That means we need public policies that make for healthy people: safe food, a clean environment, full employment at decent wages, housing, a strong social safety net, education, peace, and a safe workplace. Public policies that allow the gap between rich and poor to widen will lead to higher health costs.
2. Preserve and strengthen the Canada Health Act, the foundation of Medicare. The five principles of medicare must be maintained: universal coverage, accessibility, portability between provinces and territories, comprehensive coverage, and public non-profit administration. The federal government should maintain sufficient cash transfers to the provinces to guarantee equal access to health services as a right for all Canadians. The federal government should withhold cash transfers to provinces that violate the Canada Health Act.
3. Make the health care system democratic, accountable and representative. Let all Canadians participate in health decision-making, not just private corporations and un-elected boards. Bring everyone - including patients, members of the public and health care workers - into the reform and evaluation of the health care system. There should be elections for hospital and health care boards. Health care workers should be fully involved in workplace decision-making, not just harnessed in “quality management” schemes to cut costs at the expense of appropriate care.
4. Provide a continuum of care from large institutions to the home. This means providing good quality care with appropriate treatment and supports while providing choice of location to the patient. Governments have used the rhetoric of moving to community care to downsize institutional care without actually expanding non-profit, accountable services in the community. Health care reforms should improve and increase services to seniors and the community.
5. Protect our investment in the skills and abilities of our health care workers. Cutting front line workers means cutting quality of care. We have built up a tremendous resource in the skills and abilities of health care workers. Negotiating employment security agreements enables displaced workers to access comparable jobs in the health care system. Allow health care workers to retain their existing rights by encouraging unionization in emerging health care organizations. With secure employment workers can participate more freely in the restructuring of the health care system.
6. Ensure fair wages for all health care providers. The burden of providing health care is being shifted onto poorly paid workers in the community and unpaid family care-givers in the home, most of whom are women. Health care reform should not rob communities of “good jobs” and contribute to the development of a low-wage economy. Wage parity with existing institutional jobs recognizes that fair wages and decent working conditions contributes to quality of care.
7. Eliminate profit-making from illness. Public administration of medicare has saved Canadians billions of dollars. The practice of “deinsuring” health services by eliminating them from Medicare coverage, the move to user fees, the creation of profit-making clinics - all these changes create a two-tier health care system where private insurance companies profit. There is no room for profit and inequity in health care.
8. Reduce over-prescribing and make drugs affordable. Drug companies are adding millions to health care costs by driving up prices. We need to repeal the drug patent protection legislation which prevents competition and enact law reform that promotes lower drug prices. Controlling over-prescribing and drug costs would free up millions for health care services.
9. Stop fee-for-service payments. We should pay health workers on the salaried basis, not the fee-for-service system used by physicians, some health care providers, and private labs. Fee-for-service (payment for the number and type of services provided) encourages over-booking, over-prescribing, over-treating and the concentration of physicians in urban areas at the expense of rural areas.
10. Expand methods of health care and the role of non-physician health providers. We must develop holistic approaches to health care that expand the role of non-physician health care providers. Nurses, midwives and others can handle many procedures within the full scope of their profession including areas neglected by the medical profession, such as services for women or cultural communities. More information should be made available to the public so they can make informed decisions and are aware of choices in treatment.
Atlex
Anonymous,
I’m not blaming the patient. I’m only suggesting that you can help take control of the situation instead of sitting back and complaining about the oncologist. Many of us with elderly parents are faced with similar issues, whether the treatment is surgical, drug, or something else.
Atlex
JaT
Atlex,
First of all, doctors don’t like being doubted. If you are non-compliant a note goes into your record for other doctors to see. They have to record it because if something goes wrong there has to be a record that they suggested a treatment. They stick together more often than not. To avoid issues with their own medical malpractice insurance rates?
(some think tort reform would resolve some of this)
On the flip side, if a drug messes you up, the very first thing a drug maker does is to make the assumption that the patient was non-compliant, non-diligent, even if that is not the case. They are no way going to take responsibility if their product harms you.
(thus the desire for FDA preemtion, which is yesterdays tort reform, in my opinion)
So be non-compliant, or compliant to your demise, or what?
JaT
preemption*
Bad day, pardon my mistakes.
Atlex
JaT,
I feel sorry for you being so paranoid. I’ve sought second opinions many times and never been blackballed by the original physician. If a doctor keeps “notes” on naughty patients, that’s a doctor I don’t want involved in my parent’s care.
In my opinion, if the patient’s son or daughter is concerned that the physician is not providing proper care, he or she needs to become more involved in the care. That is all I’m suggesting. I’ve been in a similar situation and persuaded one of my parents to seek the opinion of a different doctor.
In this instance. the symptoms being experienced by the patient are certainly possible side effects (and part of the labeled warnings). They might also be something else. A good physician will be willing to work with the patient to make the right diagnosis and the treatment decision that is truly in the best interest of the patient.
Atlex
JaT
Drug companies do say- drug didn’t work? The patient could not have taken it as directed. Compliance is high on the pharma vocabulary list. There is nothing paranoid about it. You can probably find several instances of it right here on this site.
Some doctors do have a God complex. And yes, some do add notes, but not exactly as you paint them. It is less about blackballing than undermining the patients ability to contribute to their own care if that patient chooses not to swallow whatever is presented to them. Funny because the patient obviously isn’t always wrong.
It takes a lot of searching for a good doctor sometimes.
Some doctors tend to get defensive or insulted or hurt if you ask for a referral (they are human) and it can change your relationship.
Paranoia? Nice try.
On that note…
elmore
There is a reason women are targeted. They may be more susceptible to certain kinds of advertising–toenail fungus, anyone? There are conditions such as IBS that are much more prevalent in women and treatments for those same condisionts that appear to work only in women. Women are more likely to watch TV talk shows and infomercials that cover health topics–whether legit or spurious (see Acai berry). And produces of those shows focus on health conditions women are interested in.
JPB
The other reason women are targeted is that women tend to be more conscientious about following their doctor’s orders…
Justice in MI
The study I referenced in the second message up thread will prove informative re: patterns of rx’s by age and gender.
Beyond that, it is clear that gender has been central in some of the better known “episodes” of pharma history–the various forms of “mother’s little helpers” from valium to thalidomide to HRT, etc. What seems to be expanding is increasing promotion to younger women (HPV vaccines, Yaz, etc.)–which, of course, means promotion to pediatricians, gyns, parents, university health services, etc..
riv
The reason women are targeted is the pervasive meme in our culture (and others) that women are fundamentally flawed: from birth to death, puberty to menopause, women’s natural life conditions are viewed as disease, so they are medicated, cut, and burned for reasons owing only to their sex.
JaT
Couple this with the recent report that suggests women are not treated with nitro and aspirin as quickly as men, that their is less urgency in their care, causing them to die of heart attacks unnecessarily. The debate being whether they are taken less seriously or that their symptoms differ.
The study that would be interesting would be one showing how many men, compared to women, are thought to be hypochondriacs, and why.
JaT
Couple this with the recent report that suggests women are not treated with nitro and aspirin as quickly as men, that there* is less urgency in their care, causing them to die of heart attacks unnecessarily. The debate being whether they are taken less seriously or that their symptoms differ.
The study that would be interesting would be one showing how many men, compared to women, are thought to be hypochondriacs, and why.
pharmavet
Just one correction/update: Percocet has taken over from Valium as “mother’s little helper”. However, it is a misnomer. In my observation there are as many men hooked on Percocet as women, as well as sons and daughters who hijack these meds from their parents’ medicine chests and sell them to their classsmates to bring them down from their Ritalin high.
Lisa Van Syckel
I truly enjoyed reading these posts, I have nothing to add, shocking isnt it…
pharmavet
I liked two points of JaT:
1) doctors don’t like to be doubted. I’m from a family of doctors, where we say “sometimes wrong, but never in doubt”
2) Doctors having a god complex. That’s almost right. In the movie “Malice” Alec Baldwin plays a brilliant young Harvard-trained surgeon being sued for malpractice. At the deposition the opposing attorney asks him “Doctor, do you think you have a god complex? to which Baldwin replies “I don’t think that I have a god complex; I AM God.”
FYI
The Mothers Act
http://uniteforlife.wordpress.com/the-mothers-act/