By John Ballard
Via Goozenews
Why Is Tom Friedman Championing Higher Health Care Costs?
Endostim, started by Cuban and Indian immigrants, is developing an implantable medical device to treat acid reflux disease. Nowhere in Tom Friedman's column Sunday extolling this touchstone of modern innovation did I read one word about the realities of acid reflux disease (sometimes known as heartburn), the costs it is levying on our overburdened health care system, or the nature of the miraculous cure that this yet-to-be-invented implantable device will provide for the suffering masses...
No doubt there are some people who suffer from chronic heartburn that doesn't respond to the lengthening pharmacopeia devoted to its control. In the 1970s, over-the-counter products like Pepto Bismol gave way to prescription H-2 antagonists like Zantac, ... It cured about 88 percent of patients in the clinical trials submitted to the Food and Drug Administration.
When that patent ran out, AstraZeneca introduced ...Prilosec, which ... raised the bar to about 92 percent of patients achieving temporary symptom relief.
When Prilosec's patent ran out ...Nexium...does exactly the same thing. ...racked up $6 billion in sales last year despite the availability of equally efficacious products being sold over-the-counter for less than a third the price.
Now, back to the people who have chronic heartburn and for whom none of these products work. Is an electro-mechanical implanted device that dams up the esophagus a solution? How much will the device cost? How much will the operation to implant it cost? Is there any reason to think it will work any better than the drugs that are already on the market?
The answers to those questions won't come cheap. Unless the company is able to use a loophole at the FDA that allows companies to avoid clinical testing by claiming the device is similar to something already on the market (i.e., not innovative), the company will need to find surgeons willing to enroll hundreds if not thousands of patients who failed drug therapy.
And if it passes that test, there's nothing in the law that limits its use only to patients with chronic disease who don't respond to other, less costly treatments. "Hey doc, can you give me one of those implantable devices? I hate taking these pills twice a day. By the way, pass the pizza."
Nexium's patent is going to run out someday (2014, according to the FDA Orange book, although its earliest patent expiry is surrounded by nearly two dozen other patents, some of which don't expire until 2020). By the time it does, I suspect the folks at Endostim, or whichever major device or pharmaceutical manufacturer buys them out, will be ready to pounce.
I can see the marketing campaign now. Patient advocacy groups, rolling in donations from the manufacturer or the marketer, will champion its superiority, complete with testimonials from people who look just like you or me claiming their lives were transformed by the operation.
Gastroenterologists, many of whom will be on the manufacturer's payroll, will swear by the results. Ditto for the invasive gastroenterologists who implant the devices. Articles will appear in the press poignantly describing the plight of obese patients who simply can't get control of their acid reflux with available drugs.
So instead of finally being out from beneath the wasted billions now being spent on brand name acid indigestion pills like Nexium, the health care system will be lined up to move onto the next chapter in the lengthening medical text for treating what for most people is a relatively minor and passing phenomenon.
Friedman is right. Endostim's success will create "the best jobs - top management, marketing, design" at company headquarters. But let's not forget that to create those jobs, the entire society through its collective health care system will have to pay an unnecessary tax, which burdens every other industry and shifts scarce societal resources away from potentially more useful activities.
In short, the medical equivalent of a tanning bed.
And we wonder why the cost of health care keeps going up, up, up...
This is what happens when the medical system is all about unbridled capitalism and not making people healthier. Much heart burn is the result of poor posture and the rest of it the result if eating stuff that isn't good for you. We spend billions a year on chemotherapy but the survival rate for 80% of the cancers is no better than it was 50 years ago. Friedman is such an ass.
ReplyDeleteOne of our children had my wife and me to dinner Friday night. The menu was homemade burritos and a delicious soup puree called "enchilada soup" with pulled chicken, fresh cilantro, avacado, onions and cheese to be sprinkled across the top. And beer. Do I need to tell you...?
ReplyDeleteI got up first at half past midnight and my wife slept another half hour before we got woke up with you-know-what, which neither of us usually has any more. We learned what and how much to eat (and avoid) years ago.
So what was the remedy?
About half a teaspoonful of baking soda washed down with about two or three ounces of plain water, watch TV for a little while to let it work, and a burp or two later we were both back to sleep, undisturbed until morning.
I'm sympathetic with those for whom indigestion is a chronic problem. Years in the food business have made me aware of reflux and hiatal hernias, especially in older people. But I have also noticed a great many people who reach for the salt shaker from habit every time they sit down to eat before the first bite.