This is one of the shorter longreads you'll ever find on here, but it touches on a handful of topics that I find to be very relevant to our discussions of health care.
1. Priorities in drug development. This point has been made by many others before, but it is sometimes shocking to think of how much time, money, and effort has been put into developing pills for things like weight loss, erectile dysfunction, and acne when there are many diseases for which there are no drug treatments or inadequate drug production (malaria, for example). Again, this goes to the profit motive for a pharmaceutical company. The return on investment for a drug like Viagra that is marketed to mostly wealthy people in developed countries is much higher than the ROI for drugs that are marketed to mostly poor people in developing countries. This raises difficult questions about how the pharmaceutical industry should be regulated or supported. As a company, the responsibility is with the shareholders. So how do you align the interests of the shareholders with the greater needs of society (not just in the US but worldwide)?
2. Drug approval. Most of us place a lot of trust in the FDA. However, over the years, the FDA has made a number of errors that have had serious consequences for consumers. It is hard to say whether those errors were honest mistakes or were a result of incompetence, negligence, or politics. I think the biggest concern -- and one that is not at all unfounded -- is that the political power of large pharmaceutical companies influences the drug approval process. As this article demonstrates, this is a scary proposition.
3. The failures of the health consumer. I went to a talk last year about reforming the health care system, and a huge portion of the talk focused on how consumers needed more information so that they could take control of their own care. In many ways, my own job fits squarely into this narrative that if we just give consumers all the information, they will make better decisions. Unfortunately, as many of the studies on neuroscience and decision-making have shown, simply having "the facts" often doesn't compel people to make the most rational decision. This is complicated even further when other variables are introduced such as the need to balance short-term and long-term benefits and risks or the need to understand what can be very complex and technical medical information. As this article points out, what we understand as "the facts" can be strongly influenced by marketing efforts (of the health care industry or doctors or even the anecdotal story of a friend/neighbor, etc.).
4. The search for the "magic bullet," especially with weight loss. I won't delve into this too much, but sometimes I wonder how much more benefit might be gained by focusing all the R&D funds for a weight-loss pill instead on trying to reach parents and kids early in life to encourage healthier habits. Losing weight is hard, and the appeal of a silver bullet is hard to resist. The upshot is that people take dangerous medications that often have limited or only fleeting benefits. How can we transition from a focus on "treating" obesity to preventing it in the first place?
Lots of big questions with very few real "right" answers. Welcome to the world of health care and health care policy.
"An Endless Quest for Weight-Loss Pills" by Danielle Ofri
Published in the New York Times (Well Blog), May 10, 2012
http://well.blogs.nytimes.com/2012/05/10/an-endless-quest-for-weight-loss-pills/
Eric
This is a fascinating article. I just read an article that compares a hunter-gatherer culture to sedentary cultures and finds that exercise doesn't contribute much to weight loss.
ReplyDeletehttp://www.nytimes.com/2012/08/26/opinion/sunday/debunking-the-hunter-gatherer-workout.html?_r=1&smid=fb-share
This is even more an argument for focusing on a holistic solution that focuses on diet. The article also blames sugar as a huge reason behind weight gain and diabetes.
That was an interesting study, although in some reviews about it, others were critical that it was a very small sample size and followed for only a very short period of time.
ReplyDeleteNevertheless, the takeaway message -- that weight loss stems primarily from diet and not exercise -- is something that I think has been known for quite some time. This also depends on one's theory of why weight gain happens. If you take the traditional view (calories in, calories out), exercise can help create a calorie deficit. If you take the low-carb view, there are some studies that show that certain types of exercise may improve insulin sensitivity.
It's still important to note though that the studies about the risks of a sedentary lifestyle for other health issues (not just weight) are pretty damning. And exercise is known to have a host of other important health benefits. But how we conceptualize the benefits of exercise may need to change in order to actually get people to do more of it -- see this article from the NYT Well blog published earlier this week -- http://well.blogs.nytimes.com/2012/08/27/changing-our-tune-on-exercise/.
Eric
The final sentence in that article is a great way to sum it up: "It’s how these activities make me feel: more energized, less stressed, more productive, more engaged and, yes, happier — better able to smell the roses and cope with the inevitable frustrations of daily life."
ReplyDelete