Ask Your Doctor

NOTE: In one of those uncany coincidences that occasionally occur, on the same day The Gazette published this column, below, its lead story -- page one, above the fold -- was the FDA's approval of the sale of Biogen's version of the Alzheimer drug aducanumab they call Aduhelm, "despite a scathing assessment in November by the FDA’s outside panel of neurological experts." The price of this questionable drug? $56,000 a year. Matthew Perrone, "FDA approves much-debated Alzheimer’s drug panned by experts," Associated Press, June 7, 2021, https://apnews.com/article/science-government-and-politics-business-health-2147d824af9cfde629041d83d9ca7a8d

Ask Your Doctor About Big Pharma Ads;
Another Example of Americans Paying Corporations to Join Their Sales Force

Nicholas Johnson
The Gazette, June 8, 2021, p. 6A
“Ask your doctor if your purchase of this over-priced, patent-protected, copy of a generic drug, with its possible hazardous side effects might be right for our shareholders.”

In 2001 global pharmaceutical sales were $390 billion. In 2020 they were $1.27 trillion.

In 2018 the pharma industry spent $6.46 billion on direct-to-consumer (DTC) “ask your doctor” TV commercials – enlisting you and me to help boost their sales. (It also spent nearly $30 billion wooing doctors with speaking fees, travel, meals, free samples and “education.”)

When I was young, companies paid people to walk around downtown Iowa City wearing small advertising billboards. Today people pay companies to display company names and logos on their hats, shirts, pants and shoes.

Persuading doctors to write prescriptions for drugs we don’t need, may cause harm, or with no more significant benefits than generics, may be another example of our paying corporations to join their sales force.

But it’s much more serious. The West Health Policy Center reports “If current drug pricing trends continue [some patients’ inability to pay those prices] will result in the premature deaths of 112,000 beneficiaries a year, making it a leading cause of death in the U.S., ahead of diabetes, influenza, pneumonia, and kidney disease.”

Once again, “We’re Number One!” We’re number one in defense spending, and percentage of persons in prisons – and now “ask your doctor” commercials.

But this time we’re not just number one, we are almost the only one. Only two countries permit advertising drugs directly to consumers. (New Zealand permits it, but robust opposition continues.)

We go to doctors because few patients are equipped to self-diagnose or choose remedies. The American Medical Association made a strong case for banning the ads. It was unsuccessful. [Photo credit: patients asking their doctor; Rhoda Baer, commons.wikimedia.org]

How can this be? Every year between 1999 and 2018 the pharmaceutical industry spent an average of $1.5 billion on political contributions and lobbying.

Isn’t it kind of weird to advertise a product to those legally forbidden to buy it? We can’t go into a drug store and buy this stuff. We must nag our doctor for the permission slip called a “prescription.”

Want an analogy? Think about TV ads for toys on children’s programs. Aside from a handful of young, energetic entrepreneurs – and kids with advanced degrees in parental manipulation – children cannot buy what the capitalists are advertising.

That’s like big pharma’s “ask your doctor” TV spots – except we’re now the children and the doctors are our parents.

Listening to the FDA-required itemization of side effects makes you question whether it is “right for you” – or anyone else. But you don’t listen, because the commercial keeps telling you, “Oh, look at the squirrel.” See the happy grandparents with their happy grandchildren; the couple fishing or swimming in the lake or lovingly watching the sunset from the deck of their $400,000 summer cabin.

There are things capitalism can do better than public programs. Providing the pharmaceutical portion of our nation’s healthcare is not one of them.
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Nicholas Johnson, former co-director, Institute for Health, Behavior and Environmental Policy, is the author of What Do You Mean and How Do You Know? mailbox@nicholasjohnson.org

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Sources Embedded in Text
“Ask your doctor if your purchase of this over-priced, patent-protected, copy of a generic drug, with its possible hazardous side effects might be right for our shareholders.”

In 2001 global pharmaceutical sales were $390 billion. In 2020 they were $1.27 trillion.

“Revenue of the worldwide pharmaceutical market from 2001 to 2020,” Statista, May 4, 2021, https://www.statista.com/statistics/263102/pharmaceutical-market-worldwide-revenue-since-2001/

In 2018 the pharma industry spent $6.46 billion on direct-to-consumer (DTC) “ask your doctor” TV commercials – enlisting you and me to help boost their sales. (It also spent nearly $30 billion wooing doctors with speaking fees, travel, meals, free samples and “education.”)

“Direct-to-consumer spending of the pharmaceutical industry in the United States from 2012 to September 2019,” Statista, Sept. 24, 2020, https://www.statista.com/statistics/686906/pharma-ad-spend-usa/

Roopal Luhana, “Pharmaceutical Companies Paid Billions to Doctors in 2018: Influencing Prescriptions?” New York Injury Law News, Legal Examiner, Aug. 2, 2019, https://newyork.legalexaminer.com/health/pharmaceutical-companies-paid-billions-to-doctors-in-2018-influencing-prescriptions/

When I was young, companies paid people to walk around downtown Iowa City wearing small advertising billboards. Today people pay companies to display company names and logos on their hats, shirts, pants and shoes.

Persuading doctors to write prescriptions for drugs we don’t need, may cause harm, or with no more significant benefits than generics may be another example of our paying corporations to join their sales force.

But it’s much more serious. The West Health Policy Center reports “If current drug pricing trends continue [some patients’ inability to pay those prices] will result in the premature deaths of 112,000 beneficiaries a year, making it a leading cause of death in the U.S., ahead of diabetes, influenza, pneumonia, and kidney disease.”

“More than 1.1 million deaths among Medicare recipients due to high cost of drugs,” West Health Institute, American Association for the Advancement of Science (AAAS), EurekAlert!, Nov. 19, 2020, https://www.eurekalert.org/pub_releases/2020-11/whi-mt1111820.php

Once again, “We’re Number One!” We’re number one in defense spending, and percentage of persons in prisons – and now “ask your doctor” commercials.

Aran Ali, “Mapped: The World’s Top Countries for Military Spending,” Visual Capitalist, May 15, 2021, https://www.visualcapitalist.com/worlds-top-countries-for-military-spending/

“Countries with the largest number of prisoners per 100,000 of the national population, as of May 2021,” Statista, June 2, 2021, https://www.statista.com/statistics/262962/countries-with-the-most-prisoners-per-100-000-inhabitants/

But this time we’re not just number one, we are almost the only one. Only two countries permit advertising drugs directly to consumers. (New Zealand permits it, but robust opposition continues.)

Susan Kelly, “U.S. doctor group calls for ban on drug advertising to consumers,” Reuters, Nov. 17, 2015, https://www.reuters.com/article/us-pharmaceuticals-advertising/u-s-doctor-group-calls-for-ban-on-drug-advertising-to-consumers-idUSKCN0T62WT20151117 (“The United States and New Zealand are the only two countries that allow direct-to-consumer advertising of prescription drugs.”)

Beth Snyder Bulik, “Doctors in New Zealand—the only non-U.S. country that allows DTC advertising—call for bans,” Fierce Pharma, March 20, 2017, https://www.fiercepharma.com/marketing/doctors-new-zealand-only-other-country-allows-dtc-advertising-hate-it-too

“Statement from New Zealand Public Health Experts on Direct-to-Consumer Advertising of Prescription Drugs (relating to Consumer NZ Poll),” Media Release from University of Otago, New Zealand Doctor, August 7, 2019, https://www.nzdoctor.co.nz/article/undoctored/statement-new-zealand-public-health-experts-direct-consumer-advertising

Joel Lexchin, David B. Menkes, “Can Direct-to-Consumer Advertising of Prescription Drugs be Effectively Regulated?” New Zealand Medical Journal, no date, dates on footnoted material go to 2019, https://www.nzma.org.nz/journal-articles/can-direct-to-consumer-advertising-of-prescription-drugs-be-effectively-regulated (Conclusion: “Taken together with international evidence that regulation has consistently failed to prevent the inappropriate promotion of prescription drugs, these findings suggest that DTCA is more likely to cause harm than benefit and should be banned.”)

Raktim Kumar Ghosh, Samhati Mondai Ghosh, “Drug advertisements: what a physician should know,” The New Zealand Medical Journal, vol. 123, no. 1314, May 14 2010, https://assets-global.website-files.com/5e332a62c703f653182faf47/5e332a62c703f6f72e2fd7ea_kumar.pdf

We go to doctors because few patients are equipped to self-diagnose or choose remedies. The American Medical Association made a strong case for banning the ads. It was unsuccessful.

Dan Mangan, “Americans Oppose Fast Approvals, Want Drug Ads Off TV: Survey,” NBC News, May 11, 2016, https://www.nbcnews.com/health/health-care/americans-oppose-fast-approvals-want-drug-ads-tv-survey-n572301 (“the American Medical Association, the nation's largest physicians' group, called for a ban on direct-to-consumer advertising of prescription drugs and medical devices.”)

How can this be? Every year between 1999 and 2018 the pharmaceutical industry spent an average of $1.5 billion on political contributions and lobbying.

Olivier J. Wouters, “Lobbying Expenditures and Campaign Contributions by the Pharmaceutical and Health Product Industry in the United States, 1999-2018,” JAMA Internal Medicine, March 3, 2020, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7054854/

Isn’t it kind of weird to advertise a product to those legally forbidden to buy it? We can’t go into a drug store and buy this stuff. We must nag our doctor for the permission slip called a “prescription.”

Want an analogy? Think about TV ads for toys on children’s programs. Aside from a handful of young, energetic entrepreneurs – and kids with advanced degrees in parental manipulation – children cannot buy what the capitalists are advertising.

That’s like big pharma’s “ask your doctor” TV spots – except we’re now the children and the doctors are our parents.

Listening to the FDA-required itemization of side effects makes you question whether it is “right for you” – or anyone else. But you don’t listen, because the commercial keeps telling you, “Oh, look at the squirrel.” See the happy grandparents with their happy grandchildren; the couple fishing or swimming in the lake or lovingly watching the sunset from the deck of their $400,000 summer cabin.

There are things capitalism can do better than public programs. Providing the pharmaceutical portion of our nation’s healthcare is not one of them. # # #

Eradicating COVID-19

Eradicating COVID-19 Should Be Goal

Nicholas Johnson
The Gazette, November 10, 2020, p. A6

A post-election return to a pre-COVID “normal” requires our understanding the difference between mitigation and eradication. The most important step in reaching one’s goal is to clearly define what it is.

Hospital beds and health workers, masks and social distancing are examples of essential, ongoing mitigation efforts when numbers of sick and dying coronavirus victims are surging. [Photo credit: President Trump rally; wikimedia; Hayden Schiff, Cincinnati, Oct. 13, 2020]

But the goal is – or should be – global eradication of the virus. Mitigation efforts may slow the surge of COVID, but they won’t eradicate it. It continues to spread.

What about a vaccine, or herd immunity?

Yes, a vaccine ultimately eliminated global smallpox. But consider the history.

Edward Jenner’s first experiments and papers were in the 1790s. The disease was not eliminated in the U.S. and Europe until the 1950s.

In 1959 the World Health Organization began its global eradication effort. The last death occurred in 1978, and WHO declared mission accomplished in 1980.

Although herd immunity (“survival of the fittest”) or “vaccination” might mitigate, neither is the answer. Each is rejected by many, takes too long, and produces many thousands of avoidable additional deaths.

Yes, the “test, trace, quarantine, and isolate” procedure would have been multiples cheaper and easier when experts first urged it. (See my April 4 column, “How to Eliminate COVID-19,” https://tinyurl.com/yxymwpol). But it is still the fastest and most effective path to the goal of eradication.

Impossible? Too expensive? Too slow? A Chinese city of nine million tested everyone in five days. We’ve spent trillions trying to boost a COVID-crippled economy. Even massive testing could be done for low billions.

It works. The World Health Organization reported countries’ COVID cases and deaths per 1 million population during an October week (not our worst). The U.S. was 23,000 cases and 576 deaths per one million. Australia 1068 and 35. New Zealand 314 and 5.

It also works politically.

The New Zealand prime minister’s electoral victory is credited to her management of COVID-19. And President Trump’s lack of response was a major issue in our recent election.

There are many alternative ways to do it today. Here are samples.

Start with a dozen or fewer cities or states. Choose the most successful, with metrics such as infected persons per 100,000 population, or lowest percentage infected of those tested.

Test-trace everyone in the selected areas every two weeks including newcomers to the area. Isolate or quarantine those infected and contacts.

In about two months, when no one tests positive, all businesses can open while testing continues. Gradually expand the number of participating areas. Disinterested cities and states need not participate.

Or the focus could start with the most vulnerable (the 5 percent age 80 and over; those in long term living facilities). Or groups working in proximity (meat packing and factory workers; college students). There are many alternatives.

Mitigation, yes. But until we make eradication our goal, as Dr. Anthony Fauci has put it, “We’re in for a whole lot of hurt.”
__________
Nicholas Johnson of Iowa City is a former co-director of the Iowa Institute for Health, Behavior and Environmental Policy. Contact: mailbox@nicholasjohnson.org

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SOURCES
Smallpox – History of Smallpox, CDC, https://www.cdc.gov/smallpox/history/history.html (“Almost two centuries after Jenner published his hope that vaccination could annihilate smallpox, on May 8, 1980, the 33rd World Health Assembly officially declared the world free of this disease. Eradication of smallpox is considered the biggest achievement in international public health.”)

China – “Covid-19: China’s Qingdao to test nine million in five days,” BBC News, October 12, 2020, https://www.bbc.com/news/world-asia-54504785 (“The Chinese city of Qingdao is testing its entire population of nine million people for Covid-19 over a period of five days. The mass testing comes after the discovery of a dozen cases linked to a hospital treating coronavirus patients arriving from abroad. . . . The country has largely brought the virus under control.”)

WHO – "Coronavirus disease (COVID-19)," World Health Organization, Oct. 12, 2020, https://www.who.int/docs/default-source/coronaviruse/situation-reports/20201012-weekly-epi-update-9.pdf

New Zealand – Damien Cave, “Jacinda Ardern, Hero to Liberals Abroad, Is Validated at Home; New Zealand’s prime minister and her party are coasting to victory in national elections, though it is unclear how far she will push her progressive promises,” New York Times, Oct. 17, 2020, https://www.nytimes.com/2020/10/17/world/asia/jacinda-ardern-election-new-zealand.html (“Riding a wave of support for her ‘go hard, go early’ response to the coronavirus, which has effectively been stamped out in the country, [Prime Minister Jacinda] Ardern has now cemented her position as New Zealand’s most popular prime minister in generations, if not ever.”)

5% over 80 – “Population 65 Years and Over by Age, 1990, 2000, and 2010,” Infoplease (Source: U.S. Census Bureau, 2010 Census Brief), https://www.infoplease.com/us/population/population-65-years-and-over-age-1990-2000-and-2010

Fauci - Josh Dawsey and Yasmeen Abutaleb, “‘A whole lot of hurt’: Fauci warns of covid-19 surge, offers blunt assessment of Trump’s response,” Washington Post, Oct. 31, 2020, https://www.washingtonpost.com/politics/fauci-covid-winter-forecast/2020/10/31/e3970eb0-1b8b-11eb-bb35-2dcfdab0a345_story.html

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How to Eliminate Police Shootings

How to Eliminate Police Shootings

Nicholas Johnson
Iowa City Press-Citizen (online), July 4, 2020, p. A6
In 2010, I suggested a way to eliminate the cost of college. In 2013, it was "How to Totally Eliminate Flood Damage." Earlier this year, it was "How to Eliminate COVID-19."

Today, it's "How to Eliminate Police Shootings."

Iceland is the world’s 15th most armed country per capita. Yet a police shooting in 2013 was that nation’s first.

There were 461 "justifiable homicides" by U.S. police in 2013, but not one in the United Kingdom.

Data from Ireland, New Zealand and 12 Pacific island nations is similar.

How can this be? What are they doing?

Their formula isn't complicated. It turns out that it is virtually impossible for a police officer without a gun to shoot people. (In rare situations, an officer may check out a gun for a given assignment, after which it’s returned.)

Just as a gun in the home is many times more likely to kill a family member than an intruder, arming police apparently creates more gun violence than it prevents.

Doesn't this impose greater risk on those officers? Apparently not. A 2004 survey revealed 82% of British police did not want to be armed, even though one-third had sometimes feared for their lives. Less than one-fourth of Irish police are even qualified to use a gun.

Maybe begin with a community policing trial. Maybe we’d first need to remove the causes of crime, poverty and systemic racism from the U.S. But, shucks, we ought to be doing that anyway.

— Nicholas Johnson, Iowa City

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