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Culture & Society, Current Events, Doctors, Featured, Health Policy, Medicine, What's New

America Out Loud PULSE: Do We Really Need to Take So Many Pharmaceuticals?

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From my America Out Loud Pulse podcast with Richard Amerling, MD – https://www.americaoutloud.news/do-we-really-need-to-take-so-many-pharmaceuticals-richard-amerling-md/#

The second opinion is—or should be—a staple of medicine. Second opinions can help you make better decisions about your health. In one large national survey, one-fifth of patients who saw a doctor in the past year sought a second opinion. According to one study, a second opinion affected treatment plans for 37 percent of patients and changed diagnoses for almost 15 percent.

And why should you get as second opinion? Sometimes your insurer requires one, especially for surgery or expensive treatments. I doubt they are looking out for you. They are likely making sure they can save a few bucks. If you have an unclear diagnosis or want an expert on your condition, you should definitely talk to another physician. It may turn out that the recommendations are the same. If you are still uncomfortable, get a third opinion.

One very important reason for getting a second opinion is that your current treatment is not working, is risky, and/or you have major side effects. You may wonder if such drastic treatment is actually necessary. On the flip side, always get a second opinion if your doctor tells you that you have no options. And remember to ask if waiting is an option.

I have a few personal rules about treatment. The doctor is not always right. In a trusting relationship, your doctor will welcome your questions and offer that you get another opinion. He or she will not be insulted if you ask whether the treatment is really necessary. Never feel rushed unless a real emergency. It’s your body; the final choice is up to you.

One of the things I can thank Covid for is that it exposed the flaws in the “follow the science” mantra. It got many doctors asking, whose science? Does anybody really have the last word in how to treat patients? Remember statins, low fat diets and countless other differing and changing opinions in medicine?

Unfortunately, during Covid, many doctors were whipped into submission by fear and intimidation. But standing your ground works. Physicians filed lawsuits against California’s AB 2098 (Sec. 2270 of Business and Professions Code). This was the “misinformation” law that threatened physicians with the loss of their licenses if they disagreed with the official “scientific consensus” on Covid-19. Then magically, this Covid misinformation law was quietly repealed by a late amendment provision (sec. 19) to Senate Bill 815.

In today’s episode, my guest and I will talk about medical opinions, medical consensus, and your overall health.

Bio

Dr. Richard Amerling is a board-certified internist/nephrologist with over 35 years of clinical experience, mostly in New York City.  In 2016, he took a position at St. George’s University and taught there until July 2021, when he refused the Covid vaccine. Dr. Amerling is Past-President of the Association of American Physicians and Surgeons. 

Featured, Health Policy, Politics, What's New

America Out Loud PULSE: A Pharmacist Tells All

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From my America Out Loud Pulse podcast with Kenneth H. Schell, Pharm.D – https://www.americaoutloud.news/kenneth-h-schell-pharm-d-a-pharmacist-tells-all/

Medications have changed the face of medicine. Untreatable conditions became treatable. Many surgeries were made unnecessary.

Prescription medications can be lifesavers or a substitute for a comprehensive look into a patient’s health status, including family and work life. Let’s look at prescription drugs by the numbers.

We love our pharmaceuticals but we hate the prices. Sometimes paying cash is cheaper than using your insurance. The Inflation Reduction Act of 2022 has a set of provisions (Sections 11001(c) and 11002(c)) aimed at lowering prices for Medicare program starting in 2026. Medicare plans to negotiate prices for up to 60 drugs over the next four years, and then up to 20 more drugs every subsequent year.

The program starts with 10 drugs that account for the highest Medicare spending—$3.4 billion in 2022. The list includes Eliquis® and Xarelto®, for preventing strokes and blood clots. They now cost about $450 for a 3 month supply. Also included is Entresto® for heart failure that costs $650 per month. Others are Jardiance® for diabetes and heart failure, Januvia® for diabetes, Farxiga® for chronic kidney disease, Enbrel®, for arthritis and other autoimmune conditions, Imbruvica®, for blood cancers, Stelara®, for Crohn’s disease, Fiasp® and NovoLog® insulin products, for diabetes.

The Congressional Budget Office (CBO) projects that the negotiation program would save the government $98.5 billion over 10 years.

Not so fast. Even the CBO admits that the program would result in decreased research and development of new drugs. One economist estimates that 135 fewer drugs will be brought to market, resulting in loss of 331.5 million life years in the U.S.

Additionally, the new drug program is coercive. The Centers for Medicare and Medicaid Services (CMS) set the deadline at October 1, 2023 for drug companies that manufacture the selected drugs to sign agreements to participate in the program. A manufacturer that does agree to the negotiation process will be assessed an escalating noncompliance fee levied as an excise tax, potentially increasing to 95 percent of product sales. CMS plans to send an initial price offer to companies by Feb. 1,2024 and the drugmakers have 30 days to either accept the offer, make a counter-offer or decide to withdraw their drugs from coverage under Medicare and Medicaid. CMS will only have 3 negotiating meetings. Worse, there are many aspects of the program that are exempt from administrative or judicial review.

Consequently, several companies and industry groups have sued to block the program, arguing that the negotiations will stifle drug development and that the program is unconstitutional, saying it violates the First Amendment (compelled speech), Fifth Amendment (due process and unlawful taking), and the Eighth Amendment (excessive fines) as well as other constitutional harms.

We want lower prices but not at the expense of the Constitution and advancements in research and ultimately of our health.

My guest is going to talk about the world of pharmaceuticals and what we can do to improve access and affordability.

Bio

Kenneth H Schell, Pharm.D earned his Doctorate in Pharmacy from the University of California, San Francisco. He has almost 40 years’ experience in clinical pharmacology and pharmaceutical science, including overseeing pharmacy operations in managed care, pediatric and adult hospitals, medical groups, home infusion, hospice and mail order organizations. Dr. Schell served as president of the California State Board of Pharmacy and on the Board of Directors and as Presidential Officer of the California Society of Health System Pharmacists. He is also lectures at the Skaggs UCSD School of Pharmacy and Pharmaceutical Sciences where he teaches Pharmacy Law and Ethics. He currently serves on the Sharp Healthcare Institutional Review Board for research projects.  He also served in compliance and privacy as Chief Compliance and Privacy Officer at a major Pharmacy Benefit Manager (PBM).

Dr. Schell also serves on several other Boards including Disability Rights Now, which champions disabled individuals seeking to become attorneys and ACTG Biopharma, an organization seeking to support novel therapies for individuals with brain injuries.

Culture & Society, Featured, Health Policy, Medicine, What's New

America Out Loud PULSE: Foundations of Good Health – And it is Not Pharmaceuticals

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From my America Out Loud Pulse podcast with Dr Molly Rutherford –

At its last count, the Centers for Disease Control and Prevention (CDC) estimated that 40 percent of U.S. adults age 20 and over, 21 percent of teens, and 14 percent of preschoolers are obese. A December 2019 study that analyzed 26 years of body mass index (BMI [the relation of weight to height]) data concluded that half of U.S. adults will be obese (BMI>25) by 2030. Some 25 percent will be severely obese (BMI>35).

And a recent mathematical model using 15 years if data published in the journal Diabetes Care, predicted a 700 percent increase of type 2 diabetes diagnoses in Americans under the age of 20 through 2060. Type 1 diabetes could also increase 65 percent among young Americans in the next 40 years. To save our children, we have to stop the current unhealthy trend.

Additionally, even when people living in “food deserts” were presented with healthy options, only 10 percentchanged their evil eating ways. Moreover, less than 5 percent of adults get the recommended 30 minutes a day of physical activity.

According to the CDC’s last comprehensive analysis, the annual medical cost of obesity in the United States to Medicare, Medicaid, and private insurers was $147 billion in 2008. And the medical costs for obese people were $1,429 higher than those of healthier weights.

A few weeks back, the television show 60 Minutes had a segment entitled “Obesity.” It turned out it was a 20 minute advertisement for pharmaceuticals. The takeaway was that overeating is not your fault and drugs can solve your obesity problem. This reliance on drugs is yet another way to strip us of our personal responsibility and turn us into slugs, dependent on others for our existence.

Now children are being groomed to be dependent on pharmaceuticals. The American Academy of Pediatrics (AAP) is now recommending that pediatricians provide “immediate, intensive obesity treatment to each patient” as soon as they receive a diagnosis. (Such patients are children and adolescents with overweight (defined as a body mass index [BMI] at or above the 85th percentile and below the 95th percentile) or obesity (defined as a BMI at or above the 95th percentile.)

The guidelines authors note that “watchful waiting” just allows children to get fatter. The guidelines suggest drugs and surgery in addition to behavioral and lifestyle treatment. The guidelines’ author in an interview with MedPage Today also chastised healthcare providers for their weight bias and their “misconception that obesity is a personal failing or matter of willpower, or ultimately a fault of the child and parent.” It is curious that the guidelines do not address prevention. The AAP says they will work on that in another guideline document. Wouldn’t you think that “an ounce of prevention is worth as pound of cure” applies with obesity.

Direct to consumer advertising has been around since 1985, but lately it seems that every ad on television is for a drug of some sort. Drug companies spent $7 billion on advertising last year, with most of that going to television ads. Even if you DVR your favorite shows you can’t escape flashes of one drug or another. Only your doctor can prescribe these drugs, so the purpose of the ads must be to train us to believe drugs are the solution to all of our health issues.

How do we square the notion that obesity is not your fault with all the warnings that our Western diet full of sugar, saturated fats, and carbohydrates as well as lack of exercise contribute to obesity.

Tonight, we will talk about an approach to living in good health with a friend of the show, Dr. Molly Rutherford.

Featured, Medicine, Politics, What's New

America Out Loud PULSE: China’s Stranglehold on Pharmaceuticals

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From my America Out Loud Pulse podcast with  Rosemary Gibson – https://www.americaoutloud.com/chinas-stranglehold-on-pharmaceuticals/

“Without firing a missile or hacking the electric grid, China can take America down by disrupting access to essential drugs.”

Rosemary Gibson has done a great job alerting us to the genesis of China’s grip on our supply of medications. China is now the largest global supplier of the active ingredients and chemical building blocks need to make many vitamins, and prescription and over-the-counter drugs. These include antibiotics, steroids, and cancer drugs.

Until the mid-1990s U.S., Europe, and Japan manufactured 90 percent of the global supply of key ingredients for the world’s medications. Our weakness for bargains created a monster. China undercut the price of drugs and components; the artificially low price forces other companies out of the market; then the company is free to manipulate the price and supply at will. Now more than half of the 4,000 active ingredients needed to make medications depend on China.

In this episode we discuss how and why the United States became so dependent on China for medications, the risks of such dependence, and most importantly, the solutions. The Chinese think ahead with their well-known “five-year plans.” America must start planning for our future as well.

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