Doctors Call for Single Payer Health Care, Cite Need to Move Beyond ACA

The American Journal of Public Health publishes physicians’ call for sweeping single-payer reform with detailed proposal signed by over 2,200 doctors nationwide

Unveiling of proposal coincides with heightened debate on ‘Medicare for All’ in presidential primaries

In a dramatic show of physician support for deeper health reform – and for making a decisive break with the private insurance model of financing medical care – 2,231 physicians called today [Thursday, May 5] for the creation of a publicly financed, single-payer national health program that would cover all Americans for all medically necessary care.

Single-payer health reform, often called “Medicare for All,” has been a hotly debated topic in the presidential primaries, thanks in part to it being a prominent plank in the platform of Sen. Bernie Sanders. The new physicians’ proposal is strictly nonpartisan, however.

The proposal, which was drafted by a blue-ribbon panel of 39 leading physicians, is announced today in an editorial titled “Moving Forward from the Affordable Care Act to a Single-Payer System” published in the American Journal of Public Health. The editorial links to the full proposal titled “Beyond the Affordable Care Act: A Physicians’ Proposal for Single-Payer Health Care Reform” and the names of all the signers, and it appeals for additional physicians to add their names as endorsers. The proposal currently has signers from 48 states and the District of Columbia.

“Our nation is at a crossroads,” said Dr. Adam Gaffney, a Boston-based pulmonary disease and critical care specialist, lead author of the editorial and co-chair of the Working Group that produced the proposal.

“Despite the passage of the Affordable Care Act six years ago, 30 million Americans remain uninsured, an even greater number are underinsured, financial barriers to care like co-pays and deductibles are rising, bureaucracy is growing, provider networks are narrowing, and medical costs are continuing to climb.

“Caring relationships are increasingly taking a back seat to the financial prerogatives of insurance firms, corporate providers, and Big Pharma,” Gaffney said. “Our patients are suffering and our profession is being degraded and disfigured by these mercenary interests.”

Dr. Steffie Woolhandler, a co-author of the editorial and proposal who is a professor of public health at the City University of New York’s Hunter College and lecturer at Harvard Medical School, commented: “We can continue down this harmful path – or even worse, take an alternative, ‘free-market’ route that would compound our problems – or we can embrace the long-overdue remedy that we know will work: the creation of a publicly financed, nonprofit, single-payer system that covers everybody. Today we’re saying we must quickly make that shift. Lives are literally at stake.”

Dr. Marcia Angell, a co-author of the editorial and proposal, co-chair of the working group, member of the faculty of global health and social medicine at Harvard Medical School and former editor-in-chief of the New England Journal of Medicine, said: “We can no longer afford to waste the vast resources we do on the administrative costs, executive salaries, and profiteering of the private insurance system. We get too little for our money. It’s time to put those resources into real health care for everyone.”

Under the national health program (NHP) outlined by the physicians:

* Patients could choose to go to any doctor and hospital. Most hospitals and clinics would remain privately owned and operated, receiving a budget from the NHP to cover all operating costs. Physicians could continue to practice on a fee-for-service basis, or receive salaries from group practices, hospitals or clinics.

* The program would be paid for by combining current sources of government health spending into a single fund with modest new taxes that would be fully offset by reductions in premiums and out-of-pocket spending. Co-pays and deductibles would be eliminated.

* The single-payer program would save about $500 billion annually by eliminating the high overhead and profits of insurance firms, and the massive paperwork they inflict on hospitals and doctors.

* The administrative savings of the streamlined system would fully offset the costs of covering the uninsured and upgraded coverage for everyone else, e.g. full coverage of prescription drugs, dental care and long-term care. Savings would also be redirected to currently underfunded health priorities, particularly public health.

* The “single payer” would be in a strong position to negotiate lower prices for medications and other medical supplies, yielding additional savings and reining in costs.

Surveys show strong, rising support for single-payer national health insurance among physicians. A 2008 survey of physicians found that 59 percent supported “legislation to establish national health insurance,” up from 49 percent five years earlier.

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“Moving Forward From the Affordable Care Act to a Single-Payer System,” by Adam Gaffney, M.D.; Steffie Woolhandler, M.D., M.P.H.; David U. Himmelstein, M.D.; Marcia Angell, M.D. American Journal of Public Health, June 2016, Vol. 106, No. 6, online first May 5, 2016, 1 p.m. Eastern. Includes link to full Physicians’ Proposal. Article available at this link.

The full, six-page Physicians’ Proposal with reference citations and 2,231 signatures (titled “Beyond the Affordable Care Act: A Physicians’ Proposal for Single-Payer Health Care Reform,” written by a 39-member Working Group on Single-Payer Program Design) is also accessible at the following link

PNHP’s summary of the Physicians’ Proposal is available here: summary

PNHP’s fact sheet on U.S. health care is here

Physicians for a National Health Program is a nonpartisan, nonprofit research and education organization founded in 1987. It includes physicians in every state and medical specialty. For local physician contacts or other information, contact PNHP’s headquarters in Chicago at (312) 782-6006. PNHP had no role in funding the articles described above.

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The Me-Too Drug Ripoff

In addition to the billions of health care dollars drug companies waste on disease mongering (see earlier posts), billions more are wasted on developing and marketing hundreds of “me-too” drugs. By definition, a “me-too” or “copycat” drug is a very slight variation of a drug already on the market.

The main downside of me-too drugs that they drive up health care costs  – the exorbitant cost of medical care is the main reason millions of Americans can’t afford a doctor when they’re ill. Other drawbacks of Big Pharma’s fixation with copycat drugs include the neglect of hundreds of potentially treatable illnesses and hundreds of cases of premature death and/or permanent disability related to inadequate safety profiling. Nearly all the major drug recalls in the last few years have involved copycat drugs that were assumed safe because they were chemically similar to medications already on the market.

An Issue First Raised by Ralph Nader

To the best of my recollection, Ralph Nader was the first to raise the issue of “me-too” drugs in his 2000 presidential campaign. Dr Marcia Angell, Harvard Senior Lecturer in Social Medicine, also covers the subject extensively in The Truth About the Drug Companies: How They Deceive Us and What To Do About It (2004) and in “Excess in the pharmaceutical industry” in the Canadian Medical Association Journal

According to Angell, it’s quite common for a drug company to manufacture their own copycat drugs when their patent is about to expire. The idea is to persuade doctors not to opt for cheaper generics when brand named drugs lose their patent protection. She gives the example of AstraZeneca reformulating the ulcer drug Priloxec to bring out Nexium, a nearly identical replacement. The company also shrewdly increased the price of Prilosec to get people to switch.

Three virtually identical cholesterol lowering drugs, Provochol, Zocor and Lipitor were introduced soon after Lipitor (introduced in 2002) became the best selling pharmaceutical in history . The latter was the first statin, a class of drugs that inhibits cholesterol formation in the liver. There are now eight virtually identical statin medications, excluding combination medications that contain it.

Billions Spent on Marketing Identical Drugs

OF all the drugs the FDA approved between 1993 and 2003, 78% were similar to already marketed drugs. Even more shocking, 68% weren’t even new compounds but a reformulation (change from capsule to tablet, short to long acting, etc) or a recombination of existing drugs.

Angell also laments the billions of dollars drug companies spend persuading doctors (and now patients through direct-to-consumer advertising) that their new me-too drug is more effective or safer than the older versions on the market. In most cases, they do this without a shred of scientific evidence. The FDA only requires pre-approval trials to compare me-too drugs to placebo and not to existing medications.

Big Pharma’s View on Me-Too drugs

Pharmaceutical companies want us to believe that me-too drugs enhance health care delivery. They allege that copycat drugs lower prescription costs by increasing competition. They also assert that doctors need a range of back-up drugs when the first-line medication doesn’t work or isn’t tolerated.

The claim about lowering prescription costs is utter rubbish. Copycat drugs are always priced the same or higher than the older drugs they supposedly compete with. And drug companies never, ever market their me-too drugs to doctors or patients on the basis of cost savings. As the price for brand name prescription drugs soars through the roof, only the easy availability of quality generics keeps prescription costs affordable for patients.

To justify the value of providing doctors a range of similar drugs to choose from, drug industry analysts give the example of the numerous copycat SSRIs available for treating depression. In doing so, they claim that some patients who fail to respond to Prozac, may respond to Paxil, Zoloft, Celexa, Priligy, Lexapro, Zelmid, Viibyrd or Upstene.

This is yet another marketing claim unsubstantiated by scientific research. After prescribing SSRIs for 25 years, I, like most of my colleagues, have never found a differential response to different brands. In fact my clinical experience coincides very closely to a recent literature review of SSRI effectiveness. This meta analysis revealed that only 35-38% of patients (only slightly higher than the rate of placebo response) get a positive response to any SSRI. The other 60+% fail to improve or experience horrible side effects.

What the Congressional Budget Office Found

In 2004, Angell could only estimate what drugs companies were spending on marketing, as this is considered proprietary corporate information. However in 2008, the Congressional Budget Office investigated and came up with the following findings:

• Drug companies spent approximately $20.5 billion on promotional activities (10.8% of total revenue) in 2008.
• Drug marketing costs, which grew rapidly between 1988 and 2006 had slowed and had been steady for three years at 10-11%. The CBO felt this was directly related to decreased rate of new drugs coming to market.
• In 2008 drug companies spent only slightly more on promoting new drugs than they did marketing copycat drugs.

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Menopause: Made in the USA

Part 2

Thanks to massive marketing by Premarin manufacturer Wyeth, the concept of menopause is pretty much limited to English speaking countries.

Historically 80% of Premarin sales have occurred in the US. Even in the US, the cessation of menstruation is a non-event in 75% of women, who experience no symptoms whatsoever. Most languages and cultures have no word for menopause. It’s actually quite common for women to experience improvement in their health and well-being when they stop having periods.

Cross Cultural “Menopause” Studies

There are interesting cross cultural studies of the “menopause” phenomenon. Non-western cultures typically view the cessation of monthly cycles asa milestone signaling transition to the role of community elder. The Filipino women Berger and Wenzel studied in Women, Body and Society: Cross-cultural Differences in Menopause were extremely pleased with their freedom from the inconvenience of menstruation. They saw it as an initiation into the joys of old age: better sex (estrogens suppress a woman’s sex drive, which is regulated by testosterone and oxytocin) and improved energy and mood.  Most of all they appreciated the new love and respect they enjoyed as elders.

As Berger and Wenzel’s and other cross cultural studies note, attitudes in the US and other English speaking countries are heavily influenced by a multibillion dollar PR industry that bombards women with messages glorifying youth, thinness and sexual attractiveness – and engendering frank terror of gray hair, facial wrinkles, weight gain and cellulite. Aggressive marketing preys on these insecurities to sell billions of dollars of plastic surgery, botox, wrinkle removing creams and lotions, age concealing make-up, hair coloring and diet products and programs.

Six Decades of False and Misleading Marketing

As revealed in internal documents uncovered in a few of the 5000+ lawsuits filed against Wyeth, the company’s culpability goes far beyond neglecting to inform menopausal women of cancer risks. They paint a very ugly picture of an aggressive public relations campaign to convince women and their doctors that estrogen replacement was the secret to eternal youth.

It was a win-win campaign. By 1992, Premarin was the most commonly prescribed drug in the US. Thanks to decades of marketing about the horrors of aging, post menopausal women were terrified of losing their sexual attractiveness without estrogen replacement. And because health “experts” were recommending it in medical journals, doctors were more than happy to overlook growing evidence that it causes cancer.

The NIH Shuts Down the WHI

Seventy percent of American women taking estrogen replacement discontinued it when the National Institute of Health shut down the Women’s Health Initiative (WHI) study in 2002 (see Wyeth and the Multibillion Dollar Menopause Industry). A year later this had resulted in a 7% decrease in new breast cancer cases – a total of  14,000 women spared the agony of a potentially fatal breast cancer diagnosis.

The study findings have also resulted in 5000+ cancer lawsuits against Wyeth for misrepresenting earlier cancer research to doctors – and their failure to inform women of the significant cancer risks associated with HRT.

Wyeth Fights Back

Wyeth’s response was to initiate a massive PR campaign discrediting the WHI study. They started with a letter to 500,000 doctors attacking the study, complaining that the women in the Premarin arm had other reasons for developing cancer – they were too old, too menopausal or weren’t checked for pre-existing heart disease.* This was followed by articles attacking the study in numerous medical journals. All were ghost written by the company and published under the names of doctors specializing in women’s health

Many of these doctors were affiliated with the notorious Council on Hormone Education at University of Wisconsin that Wyeth founded in response to the 2002 WHI study. In 2006 the Council was still offering a continuing medical education course promoting estrogen replacement called “Quality of Life, Menopausal Changes and Hormonal Therapy.”

Filing Suit: the Only Consumer Protection Against Big Pharma

Wyeth’s massive campaign to discredit the 2002 WHI study, at the expense of tens of thousands of women who would start or continue estrogen replacement, has clearly harmed their defense in the dozens or so of the 5000+ lawsuits that have made it through the courts.

The pharmaceutical company has yet to win a single lawsuit brought by women (or families of deceased women) who developed reproductive cancers as a result of taking Premarin or Prempro. Moreover there are still active information websites for affected women and/or families who have yet to file suit. If you or a loved one has developed breast, uterine or ovarian cancer as a result of taking Premarin or Prempro click here.

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Wyeth and the Multibillion Menopause Industry

(Part I of a two part series on the dangerous and cancer causing campaign by Wyeth Pharmaceuticals to “medicalize” menopause for profit),

I have written previously (see The Multibillion Dollar Depression Industry and Drug Companies: Killing Kids for profit)  about the ingenious – and deadly – strategy by pharmaceutical companies of inventing fictitious illnesses to market highly profitable drugs that allegedly “treat” them. The technical terms for this are “medicalizing” or “disease mongering.” In her 2004 The Truth About the Drug Companies: How They Deceive Us and What To Do About It, Dr Marcia Angell talks about “generalized anxiety disorder,” “erectile dysfunction,” “premenstrual dysphoric disorder,” and “gastro-esophogeal reflux disorder (heartburn).” These are other common complaints that drug companies have reinvented as chronic illnesses requiring lifelong treatment.

Estrogen Deficiency Syndrome

Based on 30 years of research linking it to reproductive cancers, the marketing of so-called “estrogen deficiency syndrome” has been far more lethal. The condition is known as “menopause” in English-speaking countries. Other cultures have no word for it. The number of premature deaths from the so-called treatment – “hormone replacement therapy (HRT)” – is the millions.

In this case the culprit is a single company, Wyeth, which manufactures Premarin (conjugated estrogens extracted from pregnant mare urine) and Prempro, a combination of estrogen and progesterone (a second female hormone).

Estrogen, a hormone regulating the development and function of the female reproductive system, was first discovered in 1925. In the 1930s, the drug company Wyeth developed a process to extract conjugated estrogens from the urine of pregnant mares. They patented their product as the drug Premarin (PREgnantMAresurINe), which first appeared on the market in 1942.

From the beginning Wyeth marketed Premarin, not for temporary relief of menopausal symptoms, but as a lifelong treatment to help all women maintain “healthy” estrogen levels in later life. Obviously this is nonsense. A “healthy” or natural estrogen level in a post-menopausal woman is virtually zero.

Although the medical community (and Wyeth) have been aware of links between estrogen replacement and breast, uterine and ovarian cancer since the 1970s, this research was effectively concealed from the public. Until the frightening results of the Women’s Health Initiative (WHI) study hit the front page in 2002. Between 1993 and 1995, the National Institutes of Health enrolled 161,809 women in the double blind WHI study. In 2002 the NHI shut down the study. Although it was originally scheduled to finish in 2005, it was painfully obvious that the women taking HRT were experiencing a 26% increase in breast cancer (with the risk doubling after five years), a 41% increase in strokes and a 29% increase in heart disease.

1975: the First Study Linking Premarin with Cancer

The first study linking Premarin with uterine cancer appeared in 1975. It was replicated by other researchers in 1977 and 1979. Wyeth responded to these worrisome studies by promoting a small 1980 study that taking progesterone, a second female hormone, reduced the risk of uterine cancer with estrogen replacement.

Sadly, most doctors fell for Wyeth’s slick PR campaign. Thanks to all the free pens, watches, clocks, lunches and trips to overseas conferences, they conveniently overlooked the failure of Wyeth’s 1980 study to at cancer rates in women who took no hormone replacement or to study the possible role of combined treatment in inducing other hormone sensitive cancers, such as breast and ovarian cancer. Wyeth’s success in selling doctors on combined treatment would lead them to launch Prempro, a combination of Premarin and progesterone, in 1995.

The earliest studies linking Premarin with breast cancer appeared in early 1980. According to Nik Ismail in “Hormone Replacement Therapy and Gynaecological Cancers,” between 1975 and 1995, there were at least fifty studies linking estrogen replacement (also known as HRT) with breast and uterine cancer. Some were cross cultural studies revealing American women had more than ten times the incidence of breast cancer than Asian women, who don’t take estrogen replacement.

The Multibillion Dollar Wyeth Cover-up

Wyeth responded to the breast cancer studies with a new PR blitz. In addition to flooding doctors’ offices with literature claiming studies linking Premarin to cancer were “contradictory,” they promoted numerous company-funded studies allegedly showing that estrogen replacement prevents osteoporosis and hip fractures, dementia and heart disease. The spin Wyeth gave doctors was that the effect of reducing cardiovascular disease (heart disease and strokes) — the most common cause of death in Americans – outweighed the somewhat lower risk of developing breast cancer.

Ultimately the claim that Premarin and Prempro reduce elderly women’s risk of cardiovascular disease proved to be false. This was one of the main reasons the WHI study was stopped: the women in the Premarin/Prempro arm of the study were developing significantly more heart attacks, strokes and dementia.

The WHI points to some role for estrogen replacement in reducing osteoporosis. However no studies have ever controlled for long term fluoride ingestion or epidemic Vitamin D deficiency in elderly Americans – which both have a documented role in high US rates of osteoporosis and hip fracture.

The marketing blitz aimed at doctors was accompanied by an even more powerful PR campaign in Harper’s Bazaar, the Ladies Home Journal and other women’s magazines. The goal was to appeal to American women’s (largely manufactured) terror of aging by emphasizing the value of estrogen replacement in preserving sexual attractiveness by preventing the skin changes and vaginal drying associated with aging.

To be continued.

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