Where is it all headed? Medicine on another threshold. Allow me to present several previously unconnected news articles that illuminate the serious problem we face in today’s increasingly scientifically rootless world.
Who are scientific medicine’s friends; on whom can we rely for support of reason and common sense, unbiased approaches to funding, unbiased efficacy evaluation, fair law enforcement, and a return to the logical world of decades ago? The private insurance industry is taking it in the gut, while Pharma receives the repeated jabs. Corrupt administrations run off with hundreds of millions, inadequately punished for the degree of misbehavior. Academicians, no longer squeaky clean, unwilling to keep house on big-money grant recipients while tolerating massive private consulting fees. Schools infiltrated by mindless relativism satisfy the lowest academic levels despite the revolutionary changes in biology and massive knowledge base new MDs have to apply.
Just in 2 weeks a number of seemingly unrelated developments in the news got one to thinkin’, …there aren’t any to trust anymore. The government agencies are just as bad. Start with the FDA. Steve Barrett’s Consumer Health Digest Quackwatch.com has been trying to reassess the status of one or more quackery proponents and practitioners. One of his routes is the examination of FDA records of enforcement and warning letters to violators. From CHD of 3/11/08:
FDA “hides” old warning letters. The FDA Web site has made several changes that greatly decrease the visibility of warning letters about products and safety violations. Letters issued before January 2007 have been moved into a new directory so that all incoming links to them from other sites have been broken. This directory is also coded so that search engines cannot index its contents. Searching for warning letters on the FDA site is difficult because (a) the newer and older letters have to be searched separately, (b) the search page for pre-2007 pages in not easy to find. (c) letters are moved to the archive folder at irregular intervals, and (d) many of the older letters are in PDF format, which means that they will be found only if the searcher uses specific keywords. The agency as become extremely slow in responding to Freedom of Information Act requests. In August 2005, Dr. Barrett asked for a document related to a warning letter. If one exists, finding it would take only a few minutes. Barrett’s Congressman has asked twice for the document, and FDA staff members have phoned Barrett four times during the past year to find out whether he still wants it. But it still has not come. Bloomberg News has reported that in May 2007, the agency had 20,365 unfilled requests, including 1,924 that were more than three years old and that the the number of workers filling requests has been cut even though the backlog had been steadily rising. [Blum J. Drug, food risks stay secret as inquiries to U.S. FDA pile up. Bloomberg News, June 19, 2007]
It took Steve Barrett a year to get his requested information. Is this under-funding, incompetence, or intentional indifference to public exposure of misdeeds? FDA people have complained of under-funding and staffing since the DSHEA Act of 1994. Sen. Hatch maintains FDA has enough. The system seems poorly organized – to say the least. Last week I received this article from the AHIP Solutions SmartBrief , a health insurance industry newsletter, titled Senate seeks $375 million more for FDA:
The Senate passed a budget resolution Friday that includes an additional $375 million for the FDA ‘to close the glaring gaps in food and drug safety,’ said Sen. Edward Kennedy, D-Mass., who pressed for the new funding. The proposed 20% increase might face opposition from critics, including Rep. Rosa DeLauro, D-Conn., who says the FDA “doesn’t have the infrastructure to carry out its mission.
The summary was of this New York Times article. It was more complete and brought in party politics, with a threat of a veto of any bill increasing FDA appropriation. How come? GW may not have any direct interest in the matter, but Senators Hatch and Harkin, who control NIH and FDA funding, certainly do. One can only speculate on the pressures – they do and do not cross party lines. The article also reviewed the proposed stationing of FDA reps in various Chinese cities to monitor the impure and adulterated pharmaceutical precursors originating there (30-50 percent of US products.) How do they plan to monitor or analyze the massive trade in products with 10-20 offices in China?
Then I received this note from Carl Bartecchi, MD of the U. of Colorado about this deal, the request for Federal funding of acupuncture and homeopathy studies on war injuries. It’s getting really bad, said Dr. Bartecchi, who had also seen an article in the Hawaiian paper in August 25, 2002: The article headed: “Pentagon should consider alternative battlefield medicine” by Pat Linton and Dr. Wayne B. Jonas. Dr. Bartecchi reported the article to the former Air Force Surgeon General, who said that he didn’t know anything about it but would look into it. But the matter was apparently dropped.
Jonas, former Director of the National Center for Complementary/ Alternative Medicine and his sponsor, Samueli Institute have already received two separate grants from the Army and Air Force, each for $1 – 2 million. Samueli is the ultra-wealthy “CAM” support foundation funding the UC Irvine “CAM” group and its research. Samuelis are the people who developed the broadband.
The NCCAM and other NIH people have exceeded the $1 billion mark for research, now fund school training programs also, as their former employees are feeding and sucking from every government supported agency they can, sometimes via “earmarks.”
Then Consumer Health Digest reported on the policy of the American College of Physicians supporting the “Single Payer” proposal for funding all US medical care (other than Medicare and Medicaid.) That would be a Federal administered fund, supposedly privately administered locally. Every month or so I receive requests from ACP national office to write congress people not to REDUCE Medicare allowances for physicians. I have not seen an ACP attempt to reconcile these two opposing policies. Government plans have been compared to lobster traps – easy in, but hard to get out of. Ever see a tax supported plan that was not controlled by some governmental force?
As bad as the present private insurance system is, with lax laws and worse enforcement, does anyone around have experience dealing with the two Federal Medical systems now in place? Is any physician truly satisfied? Private docs out here do not see Medicaid patients and have left the Medicare system by hundreds to thousands. Reimbursement is below expense for Medicaid and barely equal to expense for Medi-Care. Raise hands those who can see a Federally funded single payer plan working better than the British, Canadian, or US Fed systems. Could it work if the system were as under-funded as much as FDA with equivalent lax enforcement of rip-off artists?
And finally, pseudoscience medicine will at last meet rational medicine on the field of economics as all players will be treated as professional equals, and “alternative” methods will be reimbursed while “cost-ineffective” scientific methods will not be because there is a voting bloc for the former.
Rational scientific physicians, as hard as it will be to find them, will no longer be in charge. It’s happened already in EBM, as physiology and rationality have given way to RCTs, and their reviews as Kim Atwood has pointed out. And it is happening in med school faculties and teaching, as we all have noted. Anyone got a solution (greater than 60X?)