Project Awakening Vol. 1, issue 2. June 6, 2008.
Change cannot happen if people don’t want to change, and nobody wants to change if they are not aware of the need for it. The purpose of the Project Awakening electronic newsletter is to make people more aware of the lesser known, health-related news, and to expose the corruption and injustice that are still such a large part of everyday life. With greater awareness of lesser known, but still important, issues, I hope this will spark the desire to change that will lead to greater efforts to correct that which needs correcting. Please, read, click on the links, and forward to all those you think will benefit. Although, if you do forward this, I ask that you forward the entire document. All opinions expressed in this document are mine, and mine alone. Keep an open mind, but remember to think for yourself. Critical thinking is an essential element of a free, open, and truly democratic society. Read, and be enlightened.
Has Merck Learned Anything from Vioxx and Vytorin?
First, an example of how the drive by pharmaceutical companies to maintain or increase market share may sometimes be detrimental to patient safety, courtesy of Alternet. The JAMA articles mentioned in this piece are well worth reading (see references below). Psaty and Kronmal (2008) write about how Merck marketed Vioxx (rofecoxib) using selective reporting of positive results from its own drug trials, while suppressing negative information that may have either lead the FDA to withhold approval or depressed sales, in order to continue making millions of dollars and meet short term financial goals in the stock market. (By the way, the study Psaty and Kronmal cite is the same study where the data about increased cardiac risk factors came from that prompted Merck to withdraw the drug from the market in the first place. Isn’t it odd that Merck was studying effects on cognitive impairment rather than on pain?)
The other JAMA article (Ross, Hill, Egilman, and Krumholz, 2008), which I find a good deal more disturbing, discusses the industry-wide practice of utilizing ghost-writers at certain medical education companies to write articles about new drugs coming onto the market, and providing legitimacy to those articles by having certain clinicians sign their names to them. Granted, this is a case study regarding one company’s efforts to promote a drug, but there is evidence that this is an industry-wide practice. For more information, see Melody Petersen’s book, Our Daily Meds, and check out the websites of some of those medical education companies involved: IntraMed (click on "publication planning"), Axis Healthcare Communications (click on the "expertise" tab), and Excerpta Medica (note that they are a division of Elsevier).
This article is also noteworthy for illustrating the paucity of innovation behind much of their new product. Merck really has run out of ideas if what they consider "new" drugs include combinations of older medications (Vytorin or ezetimibe and simvastatin, used to synergistically lower blood cholesterol) and yet another triglyceride-lowering agent (Cordaptive or niacinamide mixed with laropiprant, which was to be marketed as a flush-free version of niacinamide for triglyceride reduction) (Lai et al, 2007). It is shameful to see an industry that should be more involved in the development of truly innovative, curative, and life-saving medications grubbing for money the way that it is. It’s a shame that the healthcare industry places so much emphasis on the industrial, profit-centered motive, and not enough on the caring aspect.
The moral of this story: always approach medical literature, no matter how respected the journal it appears in, with skepticism. If it is about a brand new drug or a drug that has not come onto the market yet then you need to be especially careful. Look carefully at the fine print accompanying each article in order to find out if the author(s) have a potential conflict of interest. Perhaps, they are being paid by a pharmaceutical or medical device company and may have written, or not as the case may be, the article as part of a marketing campaign intended to increase sales and profit. By extension, because all continuing education utilizes scholarly articles in some capacity as the knowledge base for each course, one should also be wary whenever completing such courses. You might need to independently verify the information that was presented just in case! In any case, you might be better off recommending the use of or prescribing pharmaceuticals or medical devices that have been around on the market longer, and about which there is more information.
References:
Lai, E, Lepeleire, ID, Crumley, TM, Liu, F, Wenning, LA, Michiels, N, Vets, E, O'Neill, G, Wagner, JA and Gottesdiener, K (2007) Suppression of niacin-induced vasodilation with an antagonist to prostaglandin D2 receptor subtype 1. Clinical Pharmacology & Therapeutics, 81, 849–857. Published online 28 March 2007.
Psaty, BM & Kronmal, RA (2008) Reporting mortality findings in trials of Rofecoxib for alzheimer disease or cognitive impairment. JAMA, 299(15):1813-1817.
Ross, JS, Hill, KP, Egilman, DS, and Krumholz, HM. (2008) Guest authorship and ghostwriting in publications related to rofecoxib. JAMA, 299(15), 1800-1812.
Flu Wiki Forum
Here’s a good website to check out for up-to-date news about influenza. It is a wiki, and like Wikipedia, anyone can contribute information. Of course, a certain amount of skepticism is required to read any individual posting, due to that fact, but much of the information presented here is invaluable for those tracking the various strains of flu worldwide for emergence of the next pandemic. Also see the WHO site and the U.S. Health and Human Services website for more details about preparing for the coming pandemic. So far, it seems calm, but appearances can be deceiving. Best be prepared.
How Clean is Clean Coal?
Clean coal technology, according to the US Department of Energy website, is "a new generation of energy processes that sharply reduce air emissions and other pollutants from coal-burning power plants". Essentially, it involves the use of certain techniques, such as carbon capture and storage (CCS), gasification, and pollution removal technologies, in order to burn coal more efficiently (see BBC News for more details). The idea is to reduce air pollution, which would be good for those suffering from conditions, such as asthma or lung disease, brought about by this air pollution. Now, one must as, "What about the solid waste, the coal ash?" This American News Project report details the increased prevalence of polycythemia vera in residents of towns close to where this coal ash is dumped. How clean is clean coal? The answer, not at all. One problem (air pollution) is minimized while another set of problems arises. Just another environmental factor to consider when assessing people with polycythemia vera.
Labor’s Growing Pains
Next, an article by Esther Kaplan that originally appeared in the Nation magazine. Wonderful article about the differences of opinion between the California Nurses Association (CNA) and the Service Employees International Union (SEIU) about the best way to unionize workers. The SEIU favors growing union membership at all costs, including making concessions to management. One such concession involved a labor-management partnership agreement (pdf file) that allowed for unskilled "service partners" and "care partners" to replace RNs at the bedside in hospitals that are part of the Kaiser Permanente chain, leading to some 1,800 nurse layoffs, according to the CNA. The CNA, understandably, was very upset and has been at loggerheads with the SEIU over this, and other incidents, ever since. The SEIU has been fighting back; if anybody got those "Shame on CNA" flyers in the mail a few months back and was wondering what that was about, now you know.
Still, the issue of unionization and collective bargaining is important. Many of the advances in improving pay, work conditions, and work safety have been the direct result of workers’ unions. The California nurse-to-patient ratio law is itself a direct result of lobbying by the CNA. (More about how effective this has been in a future issue.) It is much easier to effect change when working as a group than as individuals, and that applies whether one is trying to lobby for better pay, better staffing, universal, single-payer healthcare, or better rules and regulations against the use of ghostwriters to write drug articles with too much positive spin.
Fighting Child Prostitution (video clip, approximately 30 minutes)
Finally, PBS Now’s report on efforts by Atlanta’s mayor to fight the child and teenager prostitution trade. The really shocking bit: it’s the prostitutes who end up being prosecuted for vice crimes much more often than the pimps. Not to say that this kind of thing only happens in Atlanta. Check out the links on the bottom of the webpage for more information about how to help. I recommend the prostitution research and education website; Joe Parker’s essay alone is a powerful read, and the rest of the site is informative as well.
While you’re at it, check out Now’s report on Child Brides around the world: Child Brides: Stolen Lives, winner of the Edward R. Murrow award for Best TV Documentary from the Overseas Press Club. Note that it is an hour long, which is longer than the typical Now episode.
That’s it for now. Do you have any comments, suggestions for improvement, or news tips for the next issue? Would you like to subscribe to this newsletter? Please send all relevant requests via email to projectawakening@gmail.com. Thank you for reading, and I look forward to corresponding with you, either through email or in the next issue.
Jerome W. Wong BSPharm, RPh, BSN, RN
Copyright 2008 Project Awakening, a non-profit.
"If we can find the money to kill people, we can find the money to help people." --Tony Benn, former MP in the British Parliament, interviewed in Michael Moore's Sicko.
It's an old story: the greater the secrecy, the deeper the corruption. --Bill Moyers [Happy birthday, Bill!]
Get busy living, or get busy dying. --Stephen King, "Rita Hayworth and the Shawshank Redemption.