Disease Is A Profitable Business

Sometimes useful insights come from unexpected places. Fortune Magazine publishes an annual report on Americas top 500 companies. Included in this is an overview of business sectors and how they have fared the previous year. Not surprisingly, 2009 was not a great year for many businesses.

There are of course exceptions. To quote Fortune, “For the drug industry it is as if the recession never happened”. Earnings in the pharmaceutical industry were up by one-third last year. Even sales of Botox came in at $1.3 billion; slightly down on 2008. A numbers of reasons were given for this. The most significant one in my opinion was that the industry is credited with the ability to raise prices even in tough times.

Given that this all occurred against the backdrop of major debate over health reform, lack of insurance cover for many, and the costs of healthcare in general, makes it all the more remarkable. So why is the pharmaceutical industry able to raise prices and make money when times are tough?

There are a few reasons for this. It is held that people are more likely to get sick in hard times, although this has been strongly disputed. Medications are seen as essential so people may cut back on other items before pills. However given that much of the cost is borne by insurers this is not the whole answer either.

In my view the reason is simple economics 101-supply and demand. There is an increasing demand for medications and this allows the suppliers a greater degree of price control than in areas where demand for product is less. Doctors, many of whom unfortunately see pills as the answer to most problems, drive much of this demand.

This was illustrated perfectly by a letter I got from a cardiologist in which he extols primary care physicians on the importance of treating diabetics with high doses of statin medication together with at least two blood pressure medications. As usual this advice is based on “evidence” which comes from trials. Whether or not pharmaceutical manufacturers funded these trials is not clear.

The letter did not mention weight loss, exercise or stress management. It also did not mention the study earlier this year, which showed once again that weight loss leads to lower blood pressure. The lead author of this study concluded, that it was important for people to know that they can try diet instead of pills and get the same results.

Other studies have shown reduced rates of heart disease and stroke in people who ate more foods containing vitamin B6 and folate. Those who ate more processed foods and foods with added sugar had higher rates of heart disease. Olive oil reduces inflammatory activity, again reducing heart disease as we see in those following a Mediterranean diet.

People see the world through their own eyes. Unfortunately doctors, in many instances have become conditioned to see pharmaceuticals as the answer to lifestyle related conditions. For some people there will be a role for pharmaceuticals. However the best solution to lifestyle related conditions are lifestyle changes.

These will not boost the profits of the drug industry though.

Pills Are Not The Answer to Better Health

In what could almost be a man bites dog story, Australian researchers have criticized Australian doctors for not prescribing enough pills. The study released this week surveyed 322 General Practitioners (family physicians) looking at their management of patients over 55 with risk factors for cardiovascular (heart) disease. Each doctor filled out a survey on 15-20 consecutive patients. The total number of patients was 5293, of which 29% had established heart disease and 22% had risk factors.

The authors concluded there was “substantial under treatment of patients…” and that “ We recommend that GPs … ensure that high-risk patients receive evidence based pharmacotherapy”. It may not come as a surprise to find of the eight authors, five have been paid, in various ways by pharmaceutical companies and two are employed by a pharmaceutical company. Only one of the eight has no financial ties.

Now I have no issue with people earning a living and no issue with the pharmaceutical industry promoting their wares. However, I do have an issue when the only recommendation to reduce the chances of people getting heart disease is to use more pills.

Treatment of risk factors is a favorite in the pharmaceutical industry as it is lifelong therapy and a “no lose” situation as it is not the disease being treated, In other words treating risk factors means you get credit if the event does not occur and can claim to have done your best even if it does

Nowhere in this piece is a recommendation that there might be other ways to reduce the risk of disease. There is no recommendation that GP's advise patients about the importance of eating more fruits and vegetables. There is no recommendation that the doctors talk to their patients about weight reduction.

There is no recommendation that people be advised on the importance of Omega 3’s. There is no recommendation that exercise be considered. There is no recommendation that stress be looked at or managed. The fact that just following a Mediterranean diet results in a 10% drop in mortality from cardiovascular disease and cancer did not get a mention either.

In other words the whole solution is to put more people on more pills in the hope that if enough people take enough pills that all would be well with the world.Call me one of the “bad” doctors if you like, and I am sure our researcher friends would, but I do not buy this. Conditions like heart disease, strokes, diabetes, obesity and many others are not due to a shortage of circulating pharmaceuticals in the blood stream, they are a consequence of the choices we have made over an extended period of time. The solution then is to make the changes in our diets and daily life not just to pop more pills. After doing all this, there will still be a role for some pharmaceuticals in some people, but far less than is currently suggested be prescribed.

Meanwhile, just to show that not all research is a way to sell drugs, a study in the European Heart Journal has shown being happy can reduce heart disease by around 40%. The connections between the heart and happiness are legendary and like many things, which are part of human existence; there is a basis which science has not caught up with yet.

To get the benefit, people did not have to be happy all the time and it did not matter if they had down periods. What mattered is that they enjoyed life overall and had some fun. This could be as simple as listening to music for 15 minutes or walking in the park, anything which you enjoyed doing. This is Pillar 8 of DIY Health 101.

Advising people with their lifestyle choices and the importance of some fun in their lives is a much better role for doctors than dishing out pills even if that makes me a bad doctor in the eyes of certain researchers and their bosses.

Just in time for April 1 -The Pollypill

Two days before April fools comes news of a polypill which reduces the chances of “cardiovascular events” (read heart disease ) in healthy people with one “risk factor” for heart disease. The pill contained five different drugs There was aspirin, a cholesterol lowering drug and three drugs used for high blood pressure

The study was done on around 2000 people in India over an 18 month period. The conclusion was that this pill could be “conveniently used to reduce multiple risk factors and cardiovascular risk”

Are you kidding me ? Two days later it could have be put down to an April fools joke. It is hard to know exactly whether this should be taken seriously or not. Firstly there are all the issues to do with statistics and the presentation of medical findings. A drop in rates from 1% to 0.5 % can be presented as a 50%drop in disease rather than a 0.5% drop hence making it sound more impressive

Then there is the small number studied and the short space of time the study ran for. In promoting life long treatment an 18 month trial is meaningless. Most importantly is the confusion of risk factors with actual disease. Reducing” risk factors”, is not the same as reducing disease .This has been well documented The two are in my opinion though, often confused .

Treating risk factors is very popular It is seen as being proactive. It is also potentially life long “treatment “ .However it is essentially reclassifying people with no need for medication into a group of people who” need “medication for the rest of their lives. This is also called the medicalisation of the human condition

Heart disease high blood pressure, stokes and other cardiovascular diseases are largely lifestyle related They are mainly function of our diets weight and physical activity(or lack thereof) This means the solution is not five drugs It means the solution is putting the right fuels into our bodies and regularly moving our bodies. It means carrying the weight the body is designed to rather than an excess

Being on a Mediterranean diet which is high in fruits and vegetables poly unsaturated fats (like olive oil) nuts and unrefined grains and a bit of red wine has a much higher impact on rates of heart disease than any drugs and no side effects .There has even been talk of a polymeal of garlic fish olive oil vegetables blueberries and red wine as a way to reduce heart disease as it has all the right nutrients .This has got to be better than a pollypill

DIY health is all about the things you can do to influence your health now and in the future .Despite our best efforts there may be times when drugs are still needed There is no need for people to take 5 drugs lifelong when change in diet and activity levels would have the same or greater effect

http://www.watoday.com.au/lifestyle/superpill-may-cut-heart-disease-study-20090331-9hg8.html

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60611-5/abstract