A great treat, for me, to meet Dr David Healy yesterday at a workshop at Uof T and to hear him talk .
The Eclipse of Medical Care
-a lecture to University of Toronto Faculty of Pharmacy by Dr David Healy.
“I want to challenge the certainty with which we hold some of our ideas”
He went on to say how some of what we were about to hear him say may lead us to think he is against pharmaceuticals –
“I am not against pharmaceuticals I prescribe pharmaceuticals to help treat people”
…and of how some of what we were about to hear him say may lead us to believe that he was against drug companies …
“I am not against drug companies – we need drug companies to be successful so they can find and make available new drugs that are useful to us as doctors and patients.”
The problem is not with doctors, or drugs or drug companies – it is with the system within which we require them to operate and that we have created.
good people doing dumb things in a dumb system
Dr Healy went on to paint a picture of how we have created a system that has moved significantly away from the conception of the practice of medicine that was widely held only fifty years ago and in which we cared for the person and held that all medicines have some toxicity – and that the art in practising medicine is in balancing the risks of the toxicity of the illness with the risks of the toxicity of the treatment.
We now have a system in which we treat symptoms; a system in which individual doctors are allowed very little room to develop then exercise good judgement; and in which both patients and doctors are kept in the dark about the true toxicity of patented, on-prescription “blockbuster” medications. Meanwhile drug companies are in the middle of a game of such high stakes that they are vulnerable to a single failure so must operate in ways that mean they cannot allow themselves to fail.
“We are in a world where pregnant women do not drink alchohol, do not eat unpasteurized cheese, do not take alchohol, take coffee or even take hot showers.
Yet pregnant women are prescribed more and more antidepressants without any knowledge of how that impacts the brain development of their unborn children.”
All the risk is taken to be in ‘the illness’ yet we intervene with agents that come with high toxicity – and the art is in finding the balance of risks
this is an illness where we cannot cure the patient if we do not care for the person…”
Approaches to risk – Doctors and Pilots
Dr Healy went on to compare approaches to safety and risk in medicine and air travel – when a pilot takes decisions about risks in flight the pilot is subject to the same outcome as their passengers. A Doctor is not vulnerable in the same way: risks to the patient are far greater and far more real than they are to the Doctor.
In Air travel when adverse incidents occur pilot reports are treated as serious evidence that attention need be paid to what happened. In medicine the system is so convoluted and bureaucratic that Doctors often do not file the adverse events and when they do they are treated as mere “anecdote” and dismissed as not real “evidence”.
Yet as patients we are not the consumers of on-prescription pharmaceutical medications Doctors are. This is reflected in the huge advertising efforts now focussed on doctors by pharmaceutical companies. Doctors are now the subject of the most intense and intensely focussed and intensely funded advertising effort in our history. And the purpose of that effort is to have doctors prescribe more medications to us.
evidence vs evident
In French and Latin languages, the word “evidence” means “it is evident that”. In english we have taken a different meaning: that a selected subset of data demonstrates that something is proven. This meaning is very well demonstrated in the system of clinical trials that was initially designed to make sure that unsafe medicines do not come to market yet is -very possibly – operating to the exact opposite effect.
Those operating this system get to make the rules; define what constitutes “evidence”; to select and withold evidence that draws doubt about new product; to present the “bad” as “good”; and to discount any evidence arising from other sources as simply not valid.
Again, this system enables and thus so incentivises companies to conceal, by not publishing, data from clinical trials that is not favourable to the new products they seek to bring to market and have already invested in heavily. Data from trials that cast doubt over efficacy and safety of new medicines is routinely witheld and often published later : selectively included with other data so that it can be presented in a way that seems favourable.
There are no laws that require pharmaceutical companies to publish, disclose or even register all data from all trials – or even to register all their trials. It takes years of hard work to uncover data that companies withold under the guise of “commercial in confidence”.
Dr Healey suggests one of the ways to bring more balance into the system is to introduce tools that help Doctor and Patient work together as a team.
The Rxisk.org is one such tool, a free-use tool for patients and healthcare professionals round the globe.
If you take medications or have had a medication suggested to you [and for any medications not just psyhiatric medications] you can:
- look up in a database of all reported risks associated with that medication
- report any adverse reactions you have experienced
- print out or email a report with this information – and take it to your health care professional and use it to inform a real conversation about balancing risks between whatever ails you and taking the medication recommended by your healthcare profesionals.
If you are a professional…
- you can report any adverse reactions in patients using medications
- look up risks associated with medications
- use the information to engage with your patient in a more informed conversation about risks and options and choice.
Rxisk.org is available now for you to use – currenty in beta test form so you can help develop it and iron out bugs and help with collating the data needed to make it work.
….and you can do it right now www.rxisk.orgNote: recoverynetwork:toronto coordinated by Kevin Healey- no relation to, but a big fan of, Dr David Healy.
Pharmageddon: how America got hooked on killer prescription drugs http://www.guardian.co.uk/world/2011/jun/09/us-drugs-oxycodone-painkillers-florida
RxISK a new data based site to research,report medicine side effects: Healy & Whitaker on the medical research team (bipolarsoupkitchen-stephany.blogspot.com)
- Pill that left a generation blighted by cancer: Women took it to prevent the agony of miscarriage, now their children are paying a terrible price (dailymail.co.uk)
- Doctors “fire” patients who refuse vaccines for their children: Ethical?(cbsnews.com)