Dear Medical System: I Have 5 Questions for You

Sometimes it’s difficult to make sense out of how medical care works. To understand I’ll read further, ask questions, and try to learn. For the following 5 questions, I just don’t get it.

1. Do drugs have to be expensive?

Pharmaceutical companies claim the high price of drugs pay for the cost of research and development of new drugs. AARP disagrees, debunking the pharmaceutical industry’s claim of $1.3 billion to get a new drug to market. Using cancer drugs as an example, 2 industry insiders slash the cost to a more realistic $125 million per new drug, including the cost of research for drugs that didn’t work. By the way, the 10 largest drug companies have profit margins of 30%. How about cutting those margins a bit and lowering the cost of drugs at the counter?

2. Why does the CDC page on consumer education for ADHD have a checklist to see if you or your child has ADHD?

Is there a checklist to self-diagnose diabetes? Bipolar disorder? I don’t think so! The college entrance tests, SATs, require an extensive psychoeducational exam for even small test accommodations, such as extra time. Shouldn’t we require the same before giving kids drugs?

3. Did the American Heart Association really have to award Subway fast food chain the first “Heart Check” for heart-healthy meals?

Doesn’t that give consumers the wrong impression? Only 42% of Subway’s menu is “heart healthy,” 58% is not (that’s not counting the seasonal menu, which is highly promoted and rarely meets “Heart Check” requirements). By heart healthy, the AHA has set up requirements that some of the offerings have limited cholesterol, fat, saturated fat and sodium. The impression is that the food at Subway is healthy. Awarding Subway the AHA’s first award for “Heart Check” is ludicrous. The “administration fee” that Subway pays the AHA is said to be $700,000. The AHA notes on its website that “No donations are used to support the Heart Check program. Participating restaurants in the Restaurant Meal Certification Program pay an administrative fee to the American Heart Association which is used to cover program operating expenses.” I’m just saying, that’s a lot of program expenses.

4. Why can any doctor prescribe any drug as he or she sees fit?

The FDA approves most drugs for very specific uses, but any doc can prescribe a drug to anyone arbitrarily. I’m not suggesting that doctors are writing scrips willy-nilly with no regard for outcome. However, an extreme example is what has occurred with Subsys, a fentanyl (opioid) sublingual spray (sprayed under the tongue for near-instant delivery to the system). Subsys is a highly addictive painkiller that the FDA approved only for oncologists to use for cancer patients in extreme pain, most likely those who are terminally ill. I suggest that most often it’s inappropriate for the average general practitioner to prescribe it. Many articles point the finger at Subsys’ manufacturer, Insys, and its questionable sales techniques to docs. I point the finger at the docs who have no business prescribing a drug with which they are not completely familiar. Only about 50% of the prescriptions written for Subsys are by oncologists. Only 1% are written by pain specialists. And the balance? By a variety of general practitioners and other non-pain specialists. Subsys was approved to be used by a very small group of terribly sick people — it should not be a $100 million seller for Insys.

5. Is anyone else freaked out by the idea of not having a Pap smear every couple of years?

Cervical cancer was the number 1 killer of women in the early 20th century. With the advent of Pap tests, millions of lives were saved. An FDA Advisory Committee has recommended an HPV test that tests for a wider range of issues including cervical cancer. The time may come when a Pap test is history.

What makes you confused and angry about how the medical system works?


Suzanne B. Robotti

Suzanne Robotti founded MedShadow Foundation in 2012. Learn more about Su and her mission.

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