Medicine For People!

March 2003

  • Malpractice Insurance
  • Generic Drug Price Inflation
  • Smallpox Vaccination
  • Judging Supplement Quality
  • Letter- Corporations, Advertising, and Pharmaceutical companies

Medical Choices, Medical Chances

This month I am addressing issues of risk and certainty in medicine and health care. As a doctor, I face these issues with my patients every day. They ask: should I (or my child) get vaccinated? How can I trust a supplement? Which brand of medicine is best? None of these questions have easy answers. Often our medical choices are affected by outside forces - government and corporations - whose power and influence dwarf us. However we do have one thing on our side - the ability to get information and make reasoned judgments about our healthcare. I hope the information in this month's newsletter will give you the tools to make the best health care choices for you and your family.

Malpractice Insurance

About a year ago we had an exciting December. Our malpractice insurance carrier stopped writing policies for solo practitioners. Moreover, our broker seemed unable to find a company willing to insure us. Near the end of the month the crisis was solved; we found insurance at a cost of $26,000 for the year of 2002. We queried other insurance companies in hopes of a lower premium- to no avail. As December 2002 neared, we started pestering our broker to find out what our premium would be this year. "They are still crunching the numbers," he said. "We'll let you know when they tell us." On December 30th we learned that they had increased it to $48,000 for 2003.

That's the correct number of zeros. $48,000. We are looking for a less-expensive insurer so that we can hold down the cost of caring for you.

Generic Drug Price Inflation

The prices of brand-name drugs have been going up for years- that is not news. The solution has been to prescribe the older, non-patented, generic drugs which were much less expensive. Today the price of ordinary penicillin and many other generic drugs is rising rapidly. For example, generic amantadine, effective against type A influenza, has risen in wholesale cost from $16 to $58 per 100 tablets. Why, I do not know, but here are some likely causes. Maybe insurance for these companies is more expensive. Maybe the generic drug companies are simply charging what the market will bear. Or perhaps the bureaucrats at the Food and Drug Administration have increased the cost of regulatory compliance.

Smallpox Vaccine

In this time of international power politics and confrontation, those who wish to harm the United States have only to infect volunteers with smallpox and put them on a plane to this country. By the time these volunteers become too ill to travel further, they could have exposed hundreds or thousands of fellow travelers to smallpox. An epidemic could begin. In past smallpox epidemics, about a third of infected people died.

The smallpox vaccine also carries a risk. About one or two in a million of those who take the vaccine will die, and a handful of others will suffer disfiguring or life-threatening consequences.

The vaccine causes flu-like symptoms in up to 30% of recipients, so those who are vaccinated need to be ready to miss a few days of work. The CDC reports that in an initial group of 4000 health care workers, seven experienced reactions (two had fever, two had rash, two had itching, two had high blood pressure, two had sore throat.) See http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5207a4.htm for details. This is part of the plan to vaccinate core public health workers so that they will be able to immunize the public should an epidemic begin. This seems only prudent.

You can learn more at The Centers for Disease Control and Prevention (CDC) smallpox vaccination website.

You will not be offered the vaccine until public health authorities believe it wise to do so.

My recommendation:

If the vaccine is offered, and unless you have some reason NOT to be vaccinated, such as pregnancy, an infant at home, certain skin disorders or immune system impairment, I'd take the vaccine. There are many threats to us that we can do little about, as individuals. This is one we can do something about.

Improving resistance to vaccination side-effects

You can lessen your chances of suffering side effects from smallpox vaccination by strengthening your immune response to the virus used in the vaccine. Of the many types of white blood cells, T-helper 1 lymphocytes protect us from viral infection. You can learn more about how to strengthen your immune system from our website.

Also, if you are breastfeeding, keep it up. Studies show that your child will be more successful at developing immunity from the standard childhood immunizations. My bet is that your child would also be better protected in the event of exposure to smallpox.

Supplement Quality

People ask me how to find a quality supplement. Perhaps the best single source of information on the web is Consumerlab.com. This site independently analyzes supplements and lists the results on their website.

Dr Theo tells you only about brands of glucosamine, but does that very well, and so wins my recommendation. He buys 'em, he tests 'em, he posts results on his website and he names names. This is the way it should be for all supplements. (And if you want to learn more about joint pain, he'll tell you a great deal about osteoarthriitis. Check him out.)

If you want extra insurance that your supplement choice is a good one, one way is to look for a seal of approval from NSF International or the U.S. Pharmacopoeia. Both of these non-profit institutions test for known contaminants and for purity of ingredients. They will allow a manufacturer to place their seal on a product if it contains what it says it does and if the company uses good manufacturing practices.

For general pointers on evaluating supplements, check out the U.S. Food & Drug Administration's Center for Food Safety & Applied Nutrition. They'll give you a two-minute check-list to help you sort the hype from the reality. You'll also find links to give you in-depth knowledge on evaluation of websites, research claims, supplements and children, and lots more!

We get mail

Corporations, advertising, and pharmaceuticals

Dear Doc,

I found your article on advertising agencies behind the pharmaceutical companies very timely... I just watched with great interest the "Now" program with Bill Moyers on PBS last evening. The main story was exactly about this scam that is going on. Nasty corporate practices on every level are surfacing which risk the health of the public. What are your thoughts about what we citizens can do about this in taking charge of our health?

Thank you - Triza

Dear Triza,
Get up early, eat a good breakfast, work hard, get lots of exercise... What?? That's not what you were asking?

OK, more seriously, no one can force you to buy a drug you don't want. Here is what you can do to maintain control of your own health.

  • Realize that the benefits of healthful diet and exercise truly outweigh most medical interventions. Imagine two worlds. In one, there is an abundant and free healthcare system. But the only place you can eat is in a restaurant, and exercise is illegal. In the second world, there is no medical science and no health care system at all. But the food is fresh and healthful, and people live a physically active life. Most physicians I know would choose the latter world in a heartbeat. We know that we are more likely to enjoy a long healthful life in those conditions.
  • Discuss any medication your doctor prescribes to learn the reasons she thinks it will benefit you. Always request that she instruct the pharmacist to choose the least expensive generic, when such is available and of equivalent quality.
  • You may wonder why your doctor recommends brand name drugs. Are they actually better? The answer is that they may or may not be. You need to know that all medical schools are dependent, in part, upon research grants from the drug companies. Buildings or department chairmen are frequently sponsored by these companies. Your doctor has been trained in an environment where, for good reason, pharmaceutical companies are respected and appreciated. Further, once she enters practice, her ongoing education is usually sponsored by these companies. And lest you or I become too cynical about this, we need to remember that the directors of these companies are responsible for the interests of millions of stockholders, including your (or your parents') pension plan.
  • That's why I think a physician can better serve the patient's needs and keep the patient's best interest in mind if she stays clear of relationships with pharmaceutical companies. Yes, you may have to pay your doctor a bit more money if she doesn't take the subsidies I mention above, but where do you expect the better programming, NPR or a commercial network?

CJK 8/21/06

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Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington.