So I've stated that the problem is that medicines in this country cost too much. But why? There are many reasons. The first, and probably the most or second-most important one, has to do with lawyers.
The next time you have to actually pay for a prescription (yeah, I know, there are oh so many of you out there who never see anything but a co-pay, and that's also part of the problem), when you take out your wallet or your credit card and hear it scream as the money is ripped viciously out of it, blame a class-action lawsuit. Or two. Or three. Or fourteen. Or any big number you want to pick; at the rate we're going in the USA, we'll reach it right quick. The class-action lawsuit is sucking money out of our economy at a tremendous rate, and that rate is accelerating. And only a certain group of individuals benefits from this vacuum effect -- the lawyers.
Don't get me wrong here. I am not anti-lawsuit. If someone is truly harmed by a product or a person or a corporation, they certainly have a right to seek legal redress in a court of law. Unfortunately, the way class-action lawsuits work today, you don't have to be actually harmed by a product, etc., in order to sue. Just using a product puts you at potential harm. Never mind that you never experienced any adverse reaction from the product. You might have experienced one. And that's enough to put you and everybody else that walked by the drug bottle into a group (a class) that's so big that the judgment (when it comes) has to be big as well.
What's wrong with this? In legal terminology, a harm is called a tort. In order for a tort to have occurred, you must have come to harm. A potential harm is not a tort. It didn't happen. No harm, no foul, no reason to be compensated. Or that's the way it should be. That's the way it used to be. Until the lawyers realized that the bigger the group, the bigger the judgment, so they came up with a way to to maximize the size of the group by including even the potentially harmed, who technically have not received a tort. Supposedly the basis is that of psychological or emotional distress (oh, my, it could have been me!) but that's a bunch of hogwash.
Let's look at an example. A few years back, a diabetes drug called Rezulin came onto the market. It was the first in a new class of diabetes drugs that worked by improving the resistance to the action of insulin that is the hallmark of non-insulin-dependent diabetes mellitus. But there was a problem. A tiny fraction of the human population contain a gene that causes them to react badly to Rezulin thus causing liver damage and/or failure. The percentage of people who have this gene is so small that the reaction could not have been statistically detected by even the largest reasonable pre-release drug trial. Within the first 18 months that Rezulin was on the market, over 1.5 million people took the drug. Tragically, 64 people (that's 0.0043% or less -- less than 1/200th of a percent) were harmed by the drug and either died or required liver transplants. Those 64 people or their families had a right to sue the manufacturer (Warner-Lambert, now owned by Pfizer). But what happened? Ultimately a series of class-action lawsuits were filed, on behalf of not just the 64 injured parties, but on behalf of almost everyone who ever took the drug. Pfizer settled most of these suits, after losing the first few, to the total amount of several hundred million dollars. But how was the money divided? The persons actually harmed were compensated adequately; the exact amounts were not revealed. The vast majority of the other "litigants" got a $25 coupon to use on their next prescription fill. But the majority of the money, tens or even hundreds of millions of dollars, was divided by the handful of lawyers that tried the cases.
This lawsuit abuse is not just in the realm of medicine however. I recently saw a "Notice of Proposed Class-Action Settlement" in the TV Guide. It was a suit brought against 3M Corp alleging that their rebate program for 3M tape products caused people to pay more for their tape than they should have. (This fails to consider that a retailer can charge whatever he wants for a product; it's called capitalism.) The class here is defined as anyone who bought 3M tape products between certain dates that extend over many months to a year or more. (Potentially including almost every American.) The proposed settlement was for 3M to pay the 15 "representative" members of the class a sum to compensate them for their time, which sounded like it was going to be around $15,000 each. 3M would also donate $41 million of tape products to various charities. There would also be a fund established to pay the lawyers which would not exceed (and I'll bet would not be less than) $7 million. Who is getting the greatest benefit here? It would seem to be only the lawyers!! As an aside, I bought 3M tape during the specified period. No one put a gun to my head; if I had thought the price was too high, I would have bought another brand. I'm writing a letter to the court asking to be excluded from the class as I refuse to take part in the legal extortion of an American corporation.
Let's look at one more example in the field of medicine, and here I'll demonstrate how this is driving up the cost of your medicines. Take for example poor Wyeth. They made most of the products now more readily recognized by the pseudonym Fen/Phen. Wyeth has so far agreed to pay in settlement of Fen/Phen lawsuits (and more are still pending) 27 Billion dollars. That's billion with a 'B'. Now, do you think Wyeth has $27 billion sitting in a vault or a back room somewhere? Of course not. Where will they get that money? Why, from selling drugs -- that's what they do. If they decide to recoup this loss with the sale of the next 500 million prescriptions that they sell, which may take them 7 or 8 years or more, that increases the price of each of those prescriptions by $56! Your $30 drug is now a $86 drug. Your $60 drug is now a $116 drug. And on and on. Such is the effect of only one set of lawsuits against one drug company regarding only one drug. And there are many more where this one came from.
The Vioxx lawsuits against Merck will ultimately lead to payouts well in excess of $27 billion. And poor Wyeth faces an even bigger payout when the Premarin suits start coming in (despite the fact that they are unwarranted). And these suits are just the tip of the iceberg. Only this iceberg isn't just going to sink the Titanic, or Wyeth, or Merck. It could sink the entire economy. You can't destroy giant pharmaceutical companies (and yes, these suits could bankrupt these companies) without there being a ripple effect through the entire economy. Not to mention the detrimental effect on the advancement of pharmaceutical research.
Oh, by the way, all that money going to the lawyers? Think it comes from the drug companies? You'd be wrong. Ultimately it comes from you and me. Let's see......that's $90 from every man, woman, and child in the United States just from the Fen/Phen suits. It was a little less from the Rezulin suits, and it'll be a lot more for the Vioxx, Premarin, et al. suits to come. Just make your check out to your local pharmacy.
Thursday, April 27, 2006
Saturday, April 08, 2006
Your Doctor Does Not Believe in the Hippocratic Oath
It never seems to fail that whenever a doctor is perceived to have mistreated a patient, somewhere along the line someone will accuse him of violating his Hippocratic Oath. It will come as quite a surprise to most people to learn that most doctors cannot violate the Hippocratic Oath -- because they have never taken it! I have never taken the Hippocratic Oath either, and furthermore, I would refuse to take it if asked. And I'll bet your doctor has not taken it either.
In order to understand this seemingly incomprehensible fact, we must first understand what it is that we're talking about. Everyone has heard about the Hippocratic Oath and the name is bandied about like it is some irrefutable axiom of medicine. But I suspect that most people (and likely most doctors today) have never actually read it. So let's do so right now.
THE HIPPOCRATIC OATH
I swear by Apollo the physician, by Æsculapius, Hygeia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and myjudgmentt, the following Oath.
To consider dear to me as my parents him who taught me this art; to live in common with him and if necessary to share my goods with him; To look upon his children as my own brothers, to teach them this art if they so desire without fee or written promise; to impart to my sons and the sons of the master who taught me and the disciples who have enrolled themselves and have agreed to the rules of the profession, but to these alone the precepts and the instruction.
I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.
To please no one will I prescribe a deadly drug nor give advice which may cause his death.
Nor will I give a woman a pessary to procure abortion.
But I will preserve the purity of my life and my art.
I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.
In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.
All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.
If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.
Okay, so why have most doctors not taken this Oath? Let me rephrase that -- why have most physicians not taken it? Why do I make that distinction? Because the Oath does. The words "physician" and "doctor" are not synonyms, at least in medical parlance. A "doctor" is anyone who has graduated from medical school and been granted an advanced degree in the study of medicine. A "physician" is a person trained (today exclusively in medical schools) in the diagnosis and treatment of illness. "Physician" is distinguished from "surgeon" by the Oath in the phrase "I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art"; those "practitioners" were surgeons, who in the days of Hippocrates were glorified barbers. Thank goodness surgeons today are highly trained, skilled specialists with advanced degrees in the study of medicine. Also note that the world famous medical dictum "First do no harm" (Primum non nocere) is not actually in the Oath. This translation does say "and never do harm to anyone" but other translations do not use these words. Primum non nocere comes from another source.
Going through the Oath from top to bottom:
"I swear by Apollo the physician, by Æsculapius, Hygeia, and Panacea, and I take to witness all the gods, all the goddesses" -- Few if any physicians today would swear by these pagan gods, whether they are Christian, Jewish, Muslim, Hindu, or other. This is the part that would keep me from taking the classic Oath.
"To consider dear to me as my parents...but to these alone the precepts and the instruction" -- Medicine is no longer taught by the apprenticeship method as it was in antiquity and up until the latter part of the 19th Century. Also, I doubt in this modern world that any physician could afford to teach disciples free of charge.
"To please no one will I prescribe a deadly drug nor give advice which may cause his death" -- Even over 2400 years ago, Hippocrates recognized the slippery slope of allowing physicians to participate in assisted suicide. He recognized that in order for people to trust and respect physicians, they had to know that the physician would not try to kill them. Additionally, one must remember that poisoning was a common form of assassination, so the physician had no way of knowing who the lethal draught would be used on. Unfortunately today some physicians have forgotten this and are ready and willing to slide down that slippery slope.
"Nor will I give a woman a pessary to procure abortion" -- It's amazing how much we have forgotten in 2400 years about the sanctity of life. Besides, 2400 years ago abortion agents (they didn't have D&C's) were as likely to kill the mother as they were to kill the fetus.
"I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art" -- Cutting for stone means surgical removal of kidney and/or bladder stones, a procedure that was almost universally fatal at that time. Best to let the barbers, uh surgeons, do that. Of course, unless you passed the stone, you would die anyway, but at least that way you had a little bit of a chance. Today it's irrelevant, as we have figured out how to do this safely. Would you want youphysicianan or surgeon to swear to not do this and let you die of a kidney stone?
"In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves" -- Can you believe there are people today that object to this clause being in the Oath? Naturally, I understand the bit about slaves, but there are those that object to the prohibition against having sexual relations with patients. Those people don't sit on state licensing boards however; do this and you'll likely lose your license to practice medicine.
The Hippocratic Oath came under assault beginning in the 1960's and 1970's, with various special interest groups wanting certain pieces dropped out of the Oath, for reasons similar to those listed above. 'How dare we prohibit performing abortions!' 'We don't dare mention or even imply the idea of homosexual relations!' 'It makes no sense to prohibit kidney stone surgery!' 'People have a right to choose when to die, and doctors should be allowed to help them do this in comfort!' So modern versions of the Oath were created, and even entirely new oaths were written. Most of these are so bland they'd put you easily to sleep. Interestingly, most of them are also longer than the classic Oath. A 1993 survey of medical schools showed that only 14% of modern oaths prohibit assisted suicide, 8% prohibit abortions, 11% mention any deity at the beginning, and only 3% forbid sexual contact with patients. I'd lay odds that in 2006, these numbers are even lower, especially for euthanasia and abortion. A recent survey of American medical schools revealed that only 2 schools still use the classic Hippocratic Oath.
So it is likely that your doctor did not take the Hippocratic Oath, and it is just as likely that there is something in the Oath that he just doesn't believe in. Yes, he took an oath when he graduated medical school, and it may have been called "the Hippocratic Oath", but it likely wasn't. But don't hold it against him. After all, it's been a long time since anyone built any temples to Apollo.
For further reading see these websites:
http://www.pbs.org/wgbh/nova/doctors/oath.html
http://en.wikipedia.org/wiki/Hippocratic_Oath
And, Medicare Part D must be destroyed!
In order to understand this seemingly incomprehensible fact, we must first understand what it is that we're talking about. Everyone has heard about the Hippocratic Oath and the name is bandied about like it is some irrefutable axiom of medicine. But I suspect that most people (and likely most doctors today) have never actually read it. So let's do so right now.
THE HIPPOCRATIC OATH
I swear by Apollo the physician, by Æsculapius, Hygeia, and Panacea, and I take to witness all the gods, all the goddesses, to keep according to my ability and myjudgmentt, the following Oath.
To consider dear to me as my parents him who taught me this art; to live in common with him and if necessary to share my goods with him; To look upon his children as my own brothers, to teach them this art if they so desire without fee or written promise; to impart to my sons and the sons of the master who taught me and the disciples who have enrolled themselves and have agreed to the rules of the profession, but to these alone the precepts and the instruction.
I will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.
To please no one will I prescribe a deadly drug nor give advice which may cause his death.
Nor will I give a woman a pessary to procure abortion.
But I will preserve the purity of my life and my art.
I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art.
In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves.
All that may come to my knowledge in the exercise of my profession or in daily commerce with men, which ought not to be spread abroad, I will keep secret and will never reveal.
If I keep this oath faithfully, may I enjoy my life and practice my art, respected by all men and in all times; but if I swerve from it or violate it, may the reverse be my lot.
Okay, so why have most doctors not taken this Oath? Let me rephrase that -- why have most physicians not taken it? Why do I make that distinction? Because the Oath does. The words "physician" and "doctor" are not synonyms, at least in medical parlance. A "doctor" is anyone who has graduated from medical school and been granted an advanced degree in the study of medicine. A "physician" is a person trained (today exclusively in medical schools) in the diagnosis and treatment of illness. "Physician" is distinguished from "surgeon" by the Oath in the phrase "I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art"; those "practitioners" were surgeons, who in the days of Hippocrates were glorified barbers. Thank goodness surgeons today are highly trained, skilled specialists with advanced degrees in the study of medicine. Also note that the world famous medical dictum "First do no harm" (Primum non nocere) is not actually in the Oath. This translation does say "and never do harm to anyone" but other translations do not use these words. Primum non nocere comes from another source.
Going through the Oath from top to bottom:
"I swear by Apollo the physician, by Æsculapius, Hygeia, and Panacea, and I take to witness all the gods, all the goddesses" -- Few if any physicians today would swear by these pagan gods, whether they are Christian, Jewish, Muslim, Hindu, or other. This is the part that would keep me from taking the classic Oath.
"To consider dear to me as my parents...but to these alone the precepts and the instruction" -- Medicine is no longer taught by the apprenticeship method as it was in antiquity and up until the latter part of the 19th Century. Also, I doubt in this modern world that any physician could afford to teach disciples free of charge.
"To please no one will I prescribe a deadly drug nor give advice which may cause his death" -- Even over 2400 years ago, Hippocrates recognized the slippery slope of allowing physicians to participate in assisted suicide. He recognized that in order for people to trust and respect physicians, they had to know that the physician would not try to kill them. Additionally, one must remember that poisoning was a common form of assassination, so the physician had no way of knowing who the lethal draught would be used on. Unfortunately today some physicians have forgotten this and are ready and willing to slide down that slippery slope.
"Nor will I give a woman a pessary to procure abortion" -- It's amazing how much we have forgotten in 2400 years about the sanctity of life. Besides, 2400 years ago abortion agents (they didn't have D&C's) were as likely to kill the mother as they were to kill the fetus.
"I will not cut for stone, even for patients in whom the disease is manifest; I will leave this operation to be performed by practitioners, specialists in this art" -- Cutting for stone means surgical removal of kidney and/or bladder stones, a procedure that was almost universally fatal at that time. Best to let the barbers, uh surgeons, do that. Of course, unless you passed the stone, you would die anyway, but at least that way you had a little bit of a chance. Today it's irrelevant, as we have figured out how to do this safely. Would you want youphysicianan or surgeon to swear to not do this and let you die of a kidney stone?
"In every house where I come I will enter only for the good of my patients, keeping myself far from all intentional ill-doing and all seduction and especially from the pleasures of love with women or with men, be they free or slaves" -- Can you believe there are people today that object to this clause being in the Oath? Naturally, I understand the bit about slaves, but there are those that object to the prohibition against having sexual relations with patients. Those people don't sit on state licensing boards however; do this and you'll likely lose your license to practice medicine.
The Hippocratic Oath came under assault beginning in the 1960's and 1970's, with various special interest groups wanting certain pieces dropped out of the Oath, for reasons similar to those listed above. 'How dare we prohibit performing abortions!' 'We don't dare mention or even imply the idea of homosexual relations!' 'It makes no sense to prohibit kidney stone surgery!' 'People have a right to choose when to die, and doctors should be allowed to help them do this in comfort!' So modern versions of the Oath were created, and even entirely new oaths were written. Most of these are so bland they'd put you easily to sleep. Interestingly, most of them are also longer than the classic Oath. A 1993 survey of medical schools showed that only 14% of modern oaths prohibit assisted suicide, 8% prohibit abortions, 11% mention any deity at the beginning, and only 3% forbid sexual contact with patients. I'd lay odds that in 2006, these numbers are even lower, especially for euthanasia and abortion. A recent survey of American medical schools revealed that only 2 schools still use the classic Hippocratic Oath.
So it is likely that your doctor did not take the Hippocratic Oath, and it is just as likely that there is something in the Oath that he just doesn't believe in. Yes, he took an oath when he graduated medical school, and it may have been called "the Hippocratic Oath", but it likely wasn't. But don't hold it against him. After all, it's been a long time since anyone built any temples to Apollo.
For further reading see these websites:
http://www.pbs.org/wgbh/nova/doctors/oath.html
http://en.wikipedia.org/wiki/Hippocratic_Oath
And, Medicare Part D must be destroyed!
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