It's known as the "con within a con" strategy. Classically, it's the one where the "mark" is convinced they have seen the con, and can avoid its consequences. While all the time it's the con underneath which gets them. The one they didn't see.
Medicare D is about the surface con in getting medicine: the sheer difficulty of paying for it. There's much attention and righteous outrage over the struggles of people managing their drug costs. And that is a worthy goal. The Republican version of this plan is deliberately rigged against our citizens. The pharmaceutical companies are overcharging. People should be able to afford their medicine, period.
But in paying attention to this con, we are missing the con lurking within it. Is there a way drug companies can lose the battle over their price gouging, but still win? It's the biggest con of all: What if some of those drugs aren't worth buying in the first place?
An inconvenient drug truth, on the flip:
As often happens, I found a comment getting long and a little off topic, (Sacred Ground: At the pharmacy with a Donut-Holed senior:
http://www.dailykos.com/...) which led to a diary. This is something I've been researching for a while, and it's time to get it out there. My family has paid for this in blood. It should do someone, somewhere, some good.
Heart disease is THE leading cause of death in America. And statins (such as Lipitor and Crestor) are THE most prescribed drug for heart disease, actual or potential. You don't have to have a heart problem to get it given to you. The drug companies tell us it's good for anyone with "high" cholesterol who isn't nursing or pregnant. And what constitutes "high" cholesterol got redefined in 2003, to set the bar that much lower.
Statins are the hottest drug to treat heart disease, only it doesn't. It lowers your cholesterol count, but that's still unproven as an effective heart disease strategy. After all, did you know half of all heart attacks occur in people with normal cholesterol levels? The cholesterol scare is going down in history as the worst medical misconception since "bleeding" killed George Washington.
http://theomnivore.com
It should be common knowledge that, from the beginning, cholesterol research got "tweaked." In fact, the whole "fat is bad for you" thing turns out to be simply wrong.
http://www.frontpagemag.com/...
This is a nice summary of a study from 2003:
http://www.ti.ubc.ca/...
And here's some conclusions in this meta study (combining many studies for overall trends.) Therefore, statins have not been shown to provide an overall health benefit in primary prevention trials. And even the studies that showed a prevention effect DID NOT show this effect for women. Thus the coronary benefit in primary prevention trials appears to be limited to men.
My grandmother had a heart valve problem, and she was prescibed statins. Even though cholesterol has no effect on a mechanical problem like a leaky heart valve. Because "heart disease" equals statins. Oh, but if statins prevent heart attacks, she should take it, right? Apparently not, since THERE IS NO STUDY THAT SHOWS THESE DRUGS WORK IN WOMEN.
And then she lost her vision due to macular degeneration. Coincidence? After all, the US has a number of studies that show statins are supposed to help eye disease. Are they right?
This February 2006 study thinks not:
http://www.moacir-cunha.com.br/...
Hey, maybe my grandmother would have lost her vision anyway. And when she recently passed away at 88, it wasn't a heart attack, it was that leaky valve. I should expect that trouble she had walking was her arthritis, right? Which was making her so tired? I wonder, because:
Even my aunt, who was dying from ovarian cancer, was still prescribed statins, at $800 a month. Her cholesterol was high when she was well, and the drugs just kept coming. We all pressed for a new test, since she hadn't been really been eating for six months, and sure enough, her cholesterol was down and we were able to eliminate it. But they wouldn't have if we hadn't pushed, and the doctors apparently didn't think that anyone going through chemotherapy might not need the added burden on the liver... and the fact that statins have been shown to be carcinogenic in laboratory animals.
I suppose it was just a coincidence that when we took her off the statins, my aunt was able to walk again. Those side effects from statins, the ones the commercials don't even mention, includes nerve damage and muscular degeneration. Statin drugs deplete the body of an important anti-oxidant (CQ10) with muscle wasting and heart failure as a result.
Gee, the irony, of prescribing a drug that can cause heart failure. (Which, after all, caused my grandmother to die.) But if you have a heart attack while you are on statins, you and your family feel "it could be much worse if I hadn't taken the drug." And if the drug makes you among the half of people with a heart attack who had "normal" cholesterol, well, they should have been taking statins too.
And did you know statins have been implicated in serious memory loss? Oh, I guess that slipped your mind. A NASA physician wrote this book on his experience: Lipitor, Thief of Memory.
http://www.amazon.com/...
...hundreds of people wrote in to say they, too, had experienced severe memory loss while on Lipitor. "Patients are reluctant to report amnesia, or they attribute the symptoms to old age or early Alzheimer's," explained Dr. Graveline. "And doctors are reluctant to see that the drug they prescribed was the cause." Still, the official word on Lipitor is that memory loss is not a statin side effect. "Thousands of cases of memory dysfunction have been reported to the FDA's Medwatch program," he said, "but after two years, the agency still hasn't acted. And most practicing physicians are unaware of the problem."
http://www.newmediaexplorer.org/...
Why don't doctors speak out? They are conned by the never-ending stream of misleading studies, by the drug company. And why don't researchers speak out?
"Anyone who questions cholesterol usually finds his funding cut off," said Paul Rosch, MD.
Did somebody say "health care costs?"
Statin drugs are very expensive--a course of statins for a year costs between $900 and $1400. They constitute the mostly widely sold pharmaceutical drug, accounting for 6.5 percent of market share and 12.5 billion dollars in revenue for the industry. Your insurance company may pay most of that cost, but consumers always ultimately pay with higher insurance premiums. Payment for statin drugs poses a huge burden for Medicare, so much so that funds may not be available for truly lifesaving medical measures.
http://www.westonaprice.org/...
It is truly astonishing. And I feel guilty that I discovered these things too late to help my grandmother, whose last years were so circumscribed by her poor vision and her trouble walking. That I did help my aunt, for a little while, at least, to get up out of her recliner and get into the outdoors that mean to much to her.
I do think my family was hurt by statin drugs. But it stops here.
And I hope this diary helps others, too.
UPDATE:
This started in response to a comment below, but grew. Worthy of adding to this diary, I think.
Let me reiterate:
*Statins are designed to lower cholesterol numbers.
*The "cholesterol hypothesis" is unproven. Yes, I know they tell you otherwise. Perhaps this bunch of scientists who told me that are only making a good effort:
http://www.thincs.org
Actually, statins DO have an effect on heart attack survival rates, but it's not in the way one might think. It has nothing to do with cholesterol lowering. (see footnotes for the studies which came to these conclusions.)
So while statins have an effect, it's NOT through cholesterol lowering. Surprise! Maybe, just maybe, scientists should look into that, because the straight-forward cholesterol lowering approach has some serious drawbacks. (I think statins have some effect through "metabolic syndrome" which is very promising science, IMHO. The dominant underlying risk factors for this syndrome appear to be abdominal obesity and insulin resistance. Insulin resistance is a generalized metabolic disorder, in which the body can't use insulin efficiently. This is why the metabolic syndrome is also called the insulin resistance syndrome. It leads to CVD. AND diabetes, which leads to CVD. AND high blood pressure. Which leads to CVD. In this model, cholesterol counts are a symptom, not a cause.)
*Statins action in lowering cholesterol numbers is not without serious consequences, including heart failure, the very thing statins are supposed to prevent.
One thing that has been supported by cholesterol research is that cholesterol is part of the lipid chain that keeps our bodies functioning. Supressing this natural function has a cascade of consequences: nerve damage (the body is unable to repair the myelin sheaths around the nerves, and they deteriorate, leading to neuropathy,) poor anti-oxidant function (it blocks the body from delivering free radical repair components, which is part of the lipid chain,) muscle wasting (without proper feedback through the nerves, the muscles lose their signals for proper repair, and get into the tearing-down phase WITHOUT the re-build phase,) and all of this impacts the HEART, which statins are supposed to help.
So we have a drug whose only function is to lower a SYMPTOM (high cholesterol numbers) that has been shown to have a UNPROVEN relationship to heart attacks. Remember, HALF the people suffering a heart attack have what used to be called a "normal" cholesterol profile. Classic bad science: instead of taking this as an indicator that their hypothesis is incorrect, cholesterol science decided that the "proper" number should be cranked downward, even though cholesterol that is too low has been shown to have serious health consequences.
http://heartdisease.about.com/...
Since 1900 CVD has been the No. 1 killer in the United States every year but 1918 (the year the influenza epidemic swept through the US.) Why do all CVD statistics start in 1900, you might ask? Prior to 1900, clogged arteries were a medical rarity. That's right, it was an obscure disease. William Einthoven invented the electrocardiograph in 1903. In the 1920s, physicians who were trying to study CVD were hampered by a LACK of patients, and when Paul Dudley White introduced this machine at Harvard, his colleauges advised him to seek a more profitable branch of medicine.
So our incidence of CVD is not natural to our species. Therefore, something changed in the 20th century that shot it up to the top of the statistics, where is still is today. And has anything we have done so far changed the incidence?
No. And that should tell you something.
Statins were developed in the 1970's. That's over THIRTY YEARS. People with cardio-vascular disease have been taking them for over thirty years, without making a dent in the disease incidence.
Would you accept those statistics for any other drug? How about a polio vaccine that doesn't impact the numbers of people who come down with polio? How about a class of antibiotics that doesn't budge the infection numbers? How about a type of insulin that doesn't lower blood sugar counts?
Here's a cheery statistic: The overall mortality trend for CVD has declined dramatically since the 1950s. (Note, two decades prior to any statin use.) That means we are better at keeping people alive with CVD. But the INCIDENCE of CVD has remained pretty constant. With or without statins.
No matter how you tweak the numbers, statins have not had an impact on how many people develop CVD. And they are supposed to. They are sold as a PREVENTATIVE therapy. Isn't lowering one's cholesterol supposed to prevent cardio vascular disease? And they do lower cholesterol. If lowered cholesterol translates to preventing CVD, they would have an impact, wouldn't they?
This would be inconsequential if statins were the equivalent of putting garlic on the windows to keep vampires away. (And it works! Do you see any vampires?) But statins have serious side-effects. And your comment illustrates the literally deadly irony of how the very people who take statins don't realise it.
Had a heart attack even though he/she was on statins? Well, people with cholesterol problems get heart attacks.
Aches and pains, trouble walking? Whaddaya want, yer old!
As far as anectodal report of memory loss. Dosn't mean a thing. Old people take statins. Old people have memory loss.
I don't have an MD or a PhD after my name. But I did get an education that included HOW to read and evaluate those dense papers doctors and scientists write to each other. And if there's something in them I don't understand, I can tool around on the Internet and get it explained to me. And breaking this down with the invaluable Reality Principles (TM) I discover:
Reality Principle #1: Reality Always Wins
It doesn't matter how elegant the theory is. Nor how neatly it would explain so much. Nor how happy it might make you on an intuitive level. An unproven thesis is no more than an unproven thesis. Ancel Keys, the father of cholesterol theory, gathered data from 22 countries. He deducted that cholesterol was related to higher mortality rate and incidence of CVD by selecting only the 7 countries that supported his hypothesis. Bad, bad, naughty science!
Reality Principle #2: Truth is a Constant.
Our number one tool in telling reality from fantasy is the Truth. It's true that Keys jiggered his numbers. It's true that this theory was controversial from the beginning because other scientists could not get the same results. It's true that the cholesterol-causes-heart-attacks dogma came into being without supporting scientific evidence because Keys appeared before a senate subcommittee and convinced them he was right, and the senate members didn't have the training to know he was full of it and on a crusade, the opposite of what science is supposed to be about.
People who take statins are operating on dogma. Not facts.
Reality Principle #3: If it works, it works.
Now we arrive at my personal favorite. If statins WORKED, they would make a dent in the CVD incidence statistics.
Statins are the top-selling class of prescription drugs in the United States, with $15.5 billion in sales in 2004. They have been prescribed more and more over the last thirty years. DESPITE the fact that in small, controlled studies statins do have a positive impact on HEART ATTACK mortality and incidence, statins still have not made a dent in overall CVD incidence.
In fact, their clear impact might be seen in another area entirely: the RISING rates of Congestive Heart Failure. The CHF death rate has increased by 35 percent in the past quarter century. Of course, correlation is not causation, the fact that statins came along at just this point could be meaningless coincidence, you know, the kind where an increased incidence of one kind of heart disease is foolishly correlated with an increase in the use of a certain class of drugs for those very patients, coupled with the fact that statin side-effects culminate in nerve damage and muscle weakness, which is what happens to the heart in Congestive Heart Failure... naw, it might be foolish to pursue THAT line of inquiry.
The disease is now the main cause or a contributor in nearly 53,000 U.S. deaths each year, according to the American Heart Association. And what is the only cure for congestive heart failure? A heart transplant.
You pays your money and you takes your chances. But only foolish gamblers bet against the House.
The House, in this case, is the big pharmaceutical companies. Garsh, they wouldn't be pushing dangerous drugs, hyping up the benefits while downplaying the side-effects, would they?
What are the odds?
Catch the sequel:
Health Care Con II: Sugar Shack
----------footnotes!-----
3. Shepherd J, et al. Prevention of Coronary Heart Disease with Pravastatin in Men with Hypercholesterolemia. New England Journal of Medicine, Nov 16, 1995; 333 (20): 1301-1308.
4. Sacks FM, et al. The Effect of Pravastatin on Coronary Events after Myocardial Infarction in Patients with Average Cholesterol Levels. New England Journal of Medicine, Oct 3, 1996; 335 (14): 1001-1009.
5. Sacks FM, et al. Relationship Between Plasma LDL Concentrations During Treatment With Pravastatin and Recurrent Coronary Events in the Cholesterol and Recurrent Events Trial. Circulation, 1998; 97: 1446-1452.
6. The Long-Term Intervention with Pravastatin In ischaemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. New England Journal of Medicine, 1998. Vol. 339: 1349-1357.
7. Downs JR, et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels. Journal of the American Medical Association, 1998; 279: 1615-1622.
8. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high risk individuals: a randomised placebo-controlled trial. Lancet, 2002; 360: 7-22M.