93crawler

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Although this has been discussed before in previous threads, what is everyone's take on this issue. I think it's just as important that we solve this nation's health care crisis, as getting out of Iraq. Below is an article about the lies and misconceptions of one former Mayor of New York.



Prostates and Prejudices
By PAUL KRUGMAN

"My chance of surviving prostate cancer — and thank God I was cured of it — in the United States? Eighty-two percent," says Rudy Giuliani in a new radio ad attacking Democratic plans for universal health care. "My chances of surviving prostate cancer in England? Only 44 percent, under socialized medicine."

It would be a stunning comparison if it were true. But it isn't. And thereby hangs a tale — one of scare tactics, of the character of a man who would be president and, I'm sorry to say, about what's wrong with political news coverage.

Let's start with the facts: Mr. Giuliani's claim is wrong on multiple levels — bogus numbers wrapped in an invalid comparison embedded in a smear.

Mr. Giuliani got his numbers from a recent article in City Journal, a publication of the conservative Manhattan Institute. The author gave no source for his numbers on five-year survival rates — the probability that someone diagnosed with prostate cancer would still be alive five years after the diagnosis. And they're just wrong.

You see, the actual survival rate in Britain is 74.4 percent. That still looks a bit lower than the U.S. rate, but the difference turns out to be mainly a statistical illusion. The details are technical, but the bottom line is that a man's chance of dying from prostate cancer is about the same in Britain as it is in America.

So Mr. Giuliani's supposed killer statistic about the defects of "socialized medicine" is entirely false. In fact, there's very little evidence that Americans get better health care than the British, which is amazing given the fact that Britain spends only 41 percent as much on health care per person as we do.

Anyway, comparisons with Britain have absolutely nothing to do with what the Democrats are proposing. In Britain, doctors are government employees; despite what Mr. Giuliani is suggesting, none of the Democratic candidates have proposed to make American doctors work for the government.

As a fact-check in The Washington Post put it: "The Clinton health care plan" — which is very similar to the Edwards and Obama plans — "has more in common with the Massachusetts plan signed into law by Gov. Mitt Romney than the British National Health system." Of course, this hasn't stopped Mr. Romney from making similar smears.

At one level, what Mr. Giuliani and Mr. Romney are doing here is engaging in time-honored scare tactics. For generations, conservatives have denounced every attempt to ensure that Americans receive needed health care, from Medicare to S-chip, as "socialized medicine."

Part of the strategy has always involved claiming that health reform is suspect because it's un-American, and exaggerating health care problems in other countries — usually on the basis of unsubstantiated anecdotes or fraudulent statistics. Opponents of reform also make a practice of lumping all forms of government intervention together, pretending that having the government pay some health care bills is just the same as having the government take over the whole health care system.

But here's what I don't understand: Why isn't Mr. Giuliani's behavior here considered not just a case of bad policy analysis but a character issue?

For better or (mostly) for worse, political reporting is dominated by the search for the supposedly revealing incident, in which the candidate says or does something that reveals his true character. And this incident surely seems to fit the bill.

Leave aside the fact that Mr. Giuliani is simply lying about what the Democrats are proposing; after all, Mitt Romney is doing the same thing.

But health care is the pre-eminent domestic issue for the 2008 election. Surely the American people deserve candidates who do their homework on the subject.

Yet what we actually have is the front-runner for the Republican nomination apparently basing his health-care views on something he read somewhere, which he believed without double-checking because it confirmed his prejudices.

By rights, then, Mr. Giuliani's false claims about prostate cancer — which he has, by the way, continued to repeat, along with some fresh false claims about breast cancer — should be a major political scandal. As far as I can tell, however, they aren't being treated that way.

To be fair, there has been some news coverage of the prostate affair. But it's only a tiny fraction of the coverage received by Hillary's laugh and John Edwards's haircut.

And much of the coverage seems weirdly diffident. Memo to editors: If a candidate says something completely false, it's not "in dispute." It's not the case that "Democrats say" they're not advocating British-style socialized medicine; they aren't.

The fact is that the prostate affair is part of a pattern: Mr. Giuliani has a habit of saying things, on issues that range from health care to national security, that are demonstrably untrue. And the American people have a right to know that.

fmb

Currently, I work in the healthcare industry; not as a provider, but in a supporting role. I am the emergency manager and safety guy. However, I have been involved in the medical side of this for a number of years, as an emergency medical technician.

I really believe one of the major problems associated with medical care in the United States is lawsuits; you have no idea how many test, evaluations, and procedures are performed to "rule out" oversights because the doctor (and facility) don't want to be involved in a lawsuit. All things done and/or performed to, and on, you cost money. Either your insurance company, you, or the taxpayer. Medicine costs; how much this costs is determined by many factors. Something must be done, but I don't have the answer.

93crawler

Yeah actually I do have quite a bit of an idea of what's involved with the medical profession, and insurance industry. I just recently did a 50 plus page paper on the health care system, and I'm a pre-med major. So yeah I now a little about this, probably more than you. Are you for or against universal health care in any form, I assume you're against it since you're a Republican. I only say you're a Republican because of the content in your previous posts. Thanks for responding.

kulotsalot

Leave this sort of thing out of the EOTH, please. This forum is for discussions, not pissing contests.

And please, for the love of god, can you leave the Republican/Democrat debate out of this? NOT everyone on this forum is in the US, not everyone has to deal with the Rep/Dem issue. I know I don't. Bringing that into the mix will just discourage non-American WRers from posting and sharing their thoughts. Yes, you are in the US and it's one of the things you guys are concerned with; however, let's allow others to chime in without having to take a side politically. DO NOT force them to choose or label them (as you have done with fmb). That is not cool in this forum.

msub

The use of misleading statistics is pretty common anywhere you go, whoever you talk to. It's a well known oratory fallacy that's been studied by philosophers since Aristotle. I guess it still gets healthy usage because most people (in the US anyway) are most likely to get their info (around which they'll base their opinion) from entertainment news networks (CNN, MSNBC, FOX) instead of reading a news paper, and will probably never look up the statutes themselves which are publicly available.

I did a quick google search for news articles related to SCHIP, the national health care system for children from low income families which has recently been an arguing point for democrats and republicans. Here's two articles that have drastically different tones and data. You really have to wonder some times, who's telling more of the truth?





Notice the choice of issues here? The focus of the first article is states running out of money, while the other mainly laments that people who aren't "poor" will receive coverage. Both leave out each other's points.

I have to say though, having been on both private health care and state provided children's health care when my mom lost her job and went back to college full time, you're definitely treated differently and have a smaller selection of physicians when you're on the state care plan.

fmb

93Crawler:

I'm glad you're in a pre-med program; hopefully, you will continue your studies in medicine and put your skills to use helping people. Also, I believe your recent school paper required considerable research, analysis, and thought in delivering a useful product. During your research, I believe you found articles and other papers for, against, and in the middle ground on the topic.

Am I for or against a government funded universal health care program? Yes, no, maybe? I'm not really sure what my answer is. I worked for (and with) politicians in previous jobs; one thing I am sure of is government is not the whole answer. (No) Everyone deserves to be able to see a doctor when they're sick, and should have access to the required/needed medicines. (Yes) In the end, I believe there will be hybrid medical coverage; this will be a mixture of government and private health care insurance plans. (The maybe)

I do have a vested interest in the discussion, possible outcome, and probable implementation of whatever health programs are developed. I was diagnosed with type I diabetes in 1996; currently, I have an insulin pump, and am a variety of preventive medications, and (fortunately) have absolutely no indications this disease has negatively affected me (eyesight, kidneys, etc.).

For my part, to stay in great health requires alot of physical activity and daily surveillance to remain in compliance with the goals my doc and I establish. Having an insulin pump and the required parts to use it, as well as the other meds I take for preventive purposes takes a great deal of money. Fortunately, I have pretty good health insurance; however, this still takes a great deal of money from my pocket. I can't imagine what state my health would be in if I were like many and did not have decent health insurance.

kulotsalot

# bug

fmb

Thanks Kulots!!

93crawler

This is part of the reason why universal health care would be a better idea I think. Lipitor, a "bad cholesterol" reducing pill made by the "good people" at Pfizer, costs around $2-3 per dose, while simvastatin, a generic equivalent, costs at most $.75 per dose and as little as $.10 per dose in discount pharmacies. Why does the health care system need to be reformed, this is but one example.


By STEPHANIE SAUL and ALEX BERENSON
Published: November 3, 2007

It is shaping up to be the biggest shift yet to a generic drug, potentially saving the nation $2 billion a year or more in prescription costs.
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A print ad from the Pfizer campaign featuring Dr. Robert Jarvik, the inventor of the artificial heart, endorsing Lipitor.

And scientists and doctors say that for most of the 16 million people in America who take drugs to reduce cholesterol, the low-priced alternative will work as well as the name-brand medicine — Lipitor, which is made by Pfizer and is the nation’s most widely prescribed drug.

While Lipitor itself is not available as a generic, a very similar drug made by Merck, Zocor, lost its patent protection last year. The generic version of Zocor, simvastatin, is now much cheaper than Lipitor, leading insurers to press doctors and patients to switch.

But Pfizer is not letting its flagship drug go down without a fight.

The company has mounted a campaign that includes advertisements, lobbying efforts and a paid speaking tour by a former secretary of the federal Department of Health and Human Services. Pfizer is also promoting a study — whose findings many experts are questioning — that concluded that British patients who switched to simvastatin had more heart attacks and deaths than those who remained on Lipitor.

The Lipitor battle has become a test of the pharmaceutical industry’s ability to defend name brands, even as insurers, patients and doctors seek to whittle the nation’s $270 billion annual prescription drug bill by using generic alternatives whenever possible.

Lipitor and other cholesterol-lowering drugs, sometimes called statins, are the largest drug class, with spending of $22 billion last year in the United States alone. And they have been researched more thoroughly than any other group of drugs, making head-to-head comparisons easier.

Many doctors have come to see simvastatin as a viable substitute for Lipitor. Studies show that at commonly prescribed doses Lipitor and simvastatin are equally effective at reducing LDL cholesterol, the so-called bad cholesterol.

A big difference is that Lipitor costs $2.50 to $3 a day, while simvastatin sells for 75 cents to $1 a day at most retail pharmacies, and as little as 10 cents a day at discount pharmacies like Costco’s.

Each month, doctors with patients on Lipitor are switching tens of thousands of them to simvastatin. And simvastatin is also taking a growing share of the market for new patients who need a cholesterol drug. “Simvastatin is much less expensive to society over all and to patients,” said Dr. Thomas H. Lee Jr., a prominent cardiologist. “If you put patients on generics,” he said, “the chances that they’re taking their medications six months later are higher than on a brand name drug. I think that a few hundred dollars a year does matter.”

But Pfizer argues that Lipitor is the most effective statin and that patients who are having good results with it are not well-served by moving to another drug.

“The only reason one would want to switch from one drug to another is for the benefit of the patient’s health,” said Dr. Michael Berelowitz, senior vice president for worldwide medical affairs for Pfizer.

In September Pfizer began sounding safety alarms by citing an analysis of the medical histories of 2,500 people in Britain who switched to simvastatin from Lipitor, compared with 9,000 who did not make the change. The study concluded that patients who switched were more likely to have a heart attack or stroke than those who remained on Lipitor.

The results were presented on a poster at a European cardiology conference. And Dr. Berelowitz said the study had been accepted by the British Journal of Cardiology and would soon be published.

But independent researchers say that limitations in the study, which was conducted by Pfizer’s own researchers, gives it little predictive power about what will happen to patients who take simvastatin instead of Lipitor. And they say the study is far less important than large clinical trials that have shown simvastatin’s effectiveness at reducing cholesterol.

“It will run counter to everything that’s been published to date if it’s true,” Dr. Lee said of the Pfizer study. He is president of the network of about 5,000 doctors in Partners HealthCare, the health system formed by Massachusetts General Hospital and Brigham and Women’s Hospital in Boston.

Dr. Mark Fendrick, a professor of internal medicine at the University of Michigan and a specialist in health care economics, notes that for patients with extremely high cholesterol, Lipitor may be a better choice. An 80-milligram daily dose of Lipitor, the top dose, can reduce cholesterol by up to 60 percent, compared with about 50 percent for an 80-milligram dose of simvastatin, also the top dose.

But most patients with moderately high cholesterol take 10 or 20 milligrams of Lipitor a day, and can get comparable benefit from 40 or 80 milligrams of simvastatin, Dr. Fendrick said.

Dr. Robert O. Bonow, the chief of cardiology at Northwestern Memorial Hospital in Chicago and a past president of the American Heart Association, said patients’ cholesterol levels should be monitored after the change, to make sure the simvastatin is having the desired effect.

“Switching itself is not a problem,” Dr. Bonow said. “It’s not that one drug has more risk or less risk.”

Lipitor’s share of the cholesterol-lowering drug market in this country has ebbed to 30 percent, down from 40 percent 18 months ago, when simvastatin was available only as name-brand Zocor — at prices that were higher than Lipitor’s.

No generic version of Lipitor is in the offing because the Lipitor patent remains valid until at least March 2010. But the advent of generic Zocor has dented sales enough to hurt Pfizer’s stock, which is trading near its lowest level in a decade.

In a recent conference call with Wall Street analysts, Pfizer vowed to step up its efforts to protect Lipitor. So far this year, the company has been spending more than 50 percent more on advertising the drug than it did in 2006, when its Lipitor ad spending for the year totaled $142.7 million.

Lately, Pfizer has been running a print and broadcast advertising campaign that features Dr. Robert Jarvik, the inventor of the artificial heart, endorsing Lipitor.

“There’s a common misconception that all cholesterol-lowering medications are the same,” Dr. Jarvik says in a radio ad. “They’re not. There is no generic version of Lipitor.”

Despite Pfizer’s efforts, analysts and physicians say they see little chance of the company’s stemming the generic tide. After two decades of prescribing cholesterol-lowering drugs, doctors are comfortable with both Lipitor and simvastatin, said Dr. Jon LeCroy, who is an industry analyst at Natixis Bleichroeder and a physician.

Insurers and pharmacy benefits companies are spurring patients to switch mainly by raising their out-of-pocket co-payments if they choose Lipitor, while lowering them for generic drugs. On Oct. 1, for example, Blue Cross and Blue Shield of Illinois raised the average co-payment for Lipitor by $10 to $20 a month, said Bridget Houlihan, a Blue Cross spokeswoman.

This year, Blue Care Network, a health maintenance organization affiliated with Blue Cross and Blue Shield of Michigan, offered to pay $100 to physicians for each patient who filled a prescription for a generic statin.

Pfizer is sponsoring a speaking tour by Dr. Louis W. Sullivan, a former secretary of Health and Human Services, who without citing Lipitor specifically is arguing against insurers’ efforts to influence medical decisions.

The company has also been fighting the generics trend in the political arena. In a Sept. 10 letter to state lawmakers in Ohio, a Pfizer lobbyist cited the potential risks of switching to cheaper medicines.

That letter, from Linda Martens, Pfizer’s assistant director of government relations in Ohio, noted the company’s British study, saying it showed a 30 percent increase in cardiac risks “in patients who were switched from the leading cholesterol-lowering medicine, Lipitor, to another statin drug, simvastatin.”

Independent researchers, however, say that the British study is of little value in comparing the two drugs, because it was not based on a clinical trial in which the two drugs were given to two randomly assigned groups of patients.

Instead, the Pfizer researchers simply compared the case histories of patients who had been switched with those who had not, regardless of the reasons they were taken off Lipitor. The results of the study are contradicted by a 9,000-patient clinical trial published in 2005, which found no statistically significant difference between Lipitor and Zocor.

Even a Pfizer doctor involved in the British study, Dr. Berkeley Phillips, said in an interview with the online publication WebMD that it did not prove that Lipitor worked better than simvastatin. “We can’t say from this study that switching is bad or that one statin is better than another,” Dr. Phillips said. “You would need a randomized clinical trial to say that.”