This blog is a way of sharing the information and resources that have helped me to recover my son Roo from an Autism Spectrum Disorder. What I have learned is to view our symptoms as the results of underlying biological cause, which can be identified and healed. I say "our symptoms" because I also have a neuro-immune disorder called Myalgic Encephalomyelitis.

And, of course, I am not a doctor (although I have been known to impersonate one while doing imaginative play with my son)- this is just our story and information that has been helpful or interesting to us. I hope it is helpful and interesting to you!


Sunday, July 2, 2023

The Corrupting Influence of Money in Medicine

The influence of money has wormed its way into all aspects of the American medical system- research, practice, access, the guidelines and advice patients are given about their health, and even how diagnostic criteria are determined.  This money represents the domination of a few pharmaceutical companies that have twisted and tweaked the entire system to serve their profit motive.  The effects of what is called regulatory and institutional capture by economists has had a devastating effect on the health of Americans.  It has also led to an unprecedented amount of wealth consolidation at record speed.

In Minnesota, the Mayo Clinic Sometimes Called the Shots With Gov. Tim Walz
Tim Walz has a very close relationship with The Mayo Clinic, to the point that he has allowed them to re-write legislation that was passed by the Minnesota legislature.  The Mayo Clinic has costs that are 88% higher than average in Minnesota adjusted for medical complexity of patients.  Mayo has consistently fought and eliminated efforts to reduce the cost of health care, often emphasizing internal strategies instead such as AI programs to handle staffing.  They were instrumental in killing any "public option" or single payer healthcare including regarding the ACA under Obama. 

Industry's Influence in Medicine: Duped, Doped and Dying in America
Gwen Olsen, a former pharmaceutical drug rep, tells about her experiences seeing pharma companies from the inside.  She says that the system is predatory and was intentionally set up to control us by doping us up and dumbing us down for profit.  

It finally happened: Goldman Sachs asks 'Is curing patients a sustainable business model?

Mother’s death sparks concern about hospital investment
Private equity firms have bought hospitals and extract all the wealth they can from them, leaving them unable to properly care for patients, which can be deadly.

The average yearly cost of health insurance in the US is $7 K.  The US spends more on healthcare than any other country, but the quality of care is the lowest among all wealthy nations.  Patients are over0charged by billions of dollars every year.  "A handful of companies have turned healthcare into a trillion dollar scam".  Profits are valued over human lives.  In Canada, one vial of insulin costs $30 but here in America the same vial costs $300, and the price for one specific AIDS drug in the US is $2 K while it costs only $8 in Australia.  From the New York Times-"Among those who reported problems paying their bills despite having insurance, 63% said they used up all or most of their savings; 42% took on an extra job or more work hours; 14% moved or took in roommates; and 11% turned to charity."  A study found that 66.5% of all bankruptcies were tied to medical issues, which is about 500 K families going into bankruptcy each year. The US is the only developed country that doesn't have universal health care.  Many poorer countries, including Pakistan, Iran, and Rwanda, provide free medical care to their people.  
 
Insurance companies have tried to say that they offer a valuable service because they negotiate prices down so much, but it turns out that they start with a very inflated price, so they aren't really saving you money.  Hospitals and other providers won't negotiate their prices down so much with individuals because they say they don't have representation.  Another way of saying this is that hospitals penalize people without insurance by adding a charge of several hundred percent on your medical bill.  You could say that hospitals and insurance companies collude in a mafia-like scheme, where hospitals enforce penalties if you don't pay insurance companies for protection.  The rate of c-sections in America is more than double the world average and this is largely due to c-sections being much more lucrative.  There are even hospitals that charge you if you want to hold your baby after birth as "skin to skin contact".  

Blackstone is one of the largest investing firms on earth, and owns the biggest medical staffing company in America, called TeamHealth.  It came out in a deposition that TeamHealth's prices were "higher than those of 95% of other providers and 8 or 9 times more than what medicare would pay", and that "the actual costs of medical services are not a factor in setting TeamHealth's prices".  So if you've ever wondered where all the money you pay for medical care goes, it goes to investors.  Almost every publicly traded hospital, medical, and pharma company is at least partially owned by either BlackRock or Vanguard.  These two companies have almost total control over the American health care system and use their influence to bring in huge returns while more and more Americans can't afford healthcare at all.

Pharmaceutical companies pay the most to lobby congress by far, which is twice as much as the next highest spender.  Life expectancy is dropping faster in America than anywhere else, and the maternal mortality rate is increasing.  Medical errors are the third leading cause of death in the country, 10% of all deaths each year.

The prices hospitals don't want you to see (NYT)   

How Profiteering and Corruption Harm Patients
A Place to Die’: For-Profit Health Care Crisis EXPOSED

Latest huge Big Pharma fraud settlement + shocking history of injury and death cover-ups

Drug Shortages Forcing Hard Decisions on Rationing Treatments
"In recent years, shortages of all sorts of drugs — anesthetics, painkillers,antibiotics, cancer treatments — have become the new normal in American medicine. The American Society of Health-System Pharmacists currently lists inadequate supplies of more than 150 drugs and therapeutics, for reasons ranging from manufacturing problems to federal safety crackdowns to drug makers abandoning low-profit products. But while such shortages have periodically drawn attention, the 
rationing that results from them has been largely hidden from patients and the public."

Medical Bills Leading Cause of Bankruptcy, Harvard Study Finds
"Illness and medical bills caused half of the 1,458,000 personal bankruptcies in 2001, according to a study published by the journal Health Affairs.  The study estimates that medical bankruptcies affect about 2 million Americans annually -- counting debtors and their dependents, including about 700,000 children.  Surprisingly, most of those bankrupted by illness had health insurance. More than three-quarters were insured at the start of the bankrupting illness. However, 38 percent had lost coverage at least temporarily by the time they filed for bankruptcy."

The High Cost of Drugs and Treatment and Paying Doctors to Prescribe Drugs
Transparency in medicine Dr Wen 

Leana Wen: What your doctor won’t disclose
TED talk by a doctor about issues of trust in the doctor-patient relationship, doctors resisting transparency about themselves and how they practice (including disclosing payments and perks from pharmaceutical companies). 

Docs on Pharma Payroll Have Blemished Records, Limited Credentials
"The implications are great for patients, who in the past have been exposed to such heavily marketed drugs as the painkiller Bextra and the diabetes drug Avandia — billion-dollar blockbusters until dangerous side effects emerged."
"A review of physician licensing records in the 15 most-populous states and three others found sanctions against more than 250 speakers, including some of the highest paid. Their misconduct included inappropriately prescribing drugs, providing poor care or having sex with patients. Some of the doctors had even lost their licenses.  More than 40 have received FDA warnings for research misconduct, lost hospital privileges or been convicted of crimes. And at least 20 more have had two or more malpractice judgments or settlements. This accounting is by no means complete; many state regulators don’t post these actions on their web sites.  Forty five who earned in excess of $100,000 did not have board certification in any specialty, suggesting they had not completed advanced training and passed a comprehensive exam. Some of those doctors and others also lacked published research, academic appointments or leadership roles in professional societies."

Lawsuits Say Pharma Illegally Paid Doctors to Push Their Drugs
"Pharma companies are being accused in lawsuits of paying doctors to push off-label uses of their drugs or financially rewarding doctors for prescribing their brand-name medications.  In the past three years alone, pharmaceutical companies have anteed up nearly $7 billion for settlements in cases such as one filed by Angela Maher, a former drug sales rep for Ortho-McNeil Pharmaceutical."

Despite improved transparency, conflicts of interest remain issue in medicine
“These conflicts undermine the reliability and credibility of the guidelines,” Nissen told Cardiology Today. “I don’t think that disclosure is the antidote here. The antidote is for physicians who are involved in public policy discussions not to accept money for promoting drugs.”

60 Minutes Episode Pharma execs used strip clubs, broke FDA laws to boost opioid sales

Forty-three percent of pediatricians receive industry payments "A significant proportion of pediatricians received payments from industry sources, such as pharmaceutical and device manufacturers, with the greatest amount of payments associated with attention-deficit/hyperactivity disorder treatments and vaccines, according to recent research in Pediatrics." 

Insulin should be cheap. Here’s why it's not

High Insulin Prices Drive Diabetics to Take Extreme Measures

Diabetics Are Hacking Their Own Insulin Pumps

Lawmakers grill Mylan CEO over EpiPen price hikes
"Jason Chaffetz (R-Utah), chairman of the House Committee on Oversight and Government Reform, held up an EpiPen to punctuate his point that epinephrine — “the juice” inside Mylan’s device — costs about $1 a dose. The list price of a two-pack of the pens is $608, up about 500 percent in a decade."

"You virtually have a monopoly, and you've used it to your advantage - but unfortunately, it's at the expense of people who need it," said Rep. Gerald E. Connolly (D-Va.). "I'm wondering what your sense of social responsibility is to those people."

FDA approves first generic version of EpiPen  The article discusses how the new generic version will help ease the chronic shortage of EpiPens that worsens near the end of the summer as kids need new prescriptions for school and other activities.  It also talks about how Mylan, the brand name version, actively fought the approval of the new generic
version out of self interest. 

Heather Bresch, the CEO of Mylan, testifies in front of congress about price gauging the epi pen 

Damning NEW Email Puts Joe Manchin’s Daughter At Center Of EpiPen Price-Fixing Scheme

Drug executives to testify before Congress about their role in U.S. opioid crisis "Current and former executives with the pharmaceutical distributors that are accused of flooding communities with powerful prescription painkillers have been summoned to testify before Congress about their role in the U.S. opioid epidemic."

"Since 2000, the epidemic has killed 200,000 people — more than three times the number of U.S. military deaths in the Vietnam War."

A Giant Pain in the Wallet
How an effort by the FDA to evaluate drugs that have been on the market since before testing was required has allowed pharmaceutical companies to price-gauge patients.

Pharmaceutical advertisements in leading medical journals: experts' assessments.
"In the opinion of the reviewers, many advertisements contained deficiencies in areas in which the FDA has established explicit standards of quality. New strategies are needed to ensure that advertisements comply with standards intended to promote proper use of the products and to protect the consumer."

Accuracy of pharmaceutical advertisements in medical journals.
"Doctors should be cautious in assessment of advertisements that claim a drug has greater efficacy, safety, or convenience, even though these claims are accompanied by bibliographical references to randomized clinical trials published in reputable medical journals and seem to be evidence-based."

What if all US health care costs were transparent? | Jeanne Pinder
How drug companies make you buy more medicine than you need
This video talks about how pharmaceutical drugs are packaged and sold in ways that deliberately lead to waste, which creates costs that are then borne by the consumer.  For some drugs such as chemotherapy drugs these costs can be very high.  This issue is not something that the FDA regulates. This article by ProPublica goes into more detail about this topic.

Frequency and Magnitude of Co-payments Exceeding Prescription Drug Costs
"A co-payment suggests sharing the total cost between patients and payers. However, drug co-payments sometimes exceed costs, with the insurer or pharmacy benefit manager (PBM) keeping the difference. Furthermore, some pharmacists are contractually prevented from alerting patients when their co-payment exceeds the drug’s cash price. Although some have argued that the practice is uncommon, a 2016 survey of independent pharmacists indicates otherwise."

The case of the $629 Band-Aid — and what it reveals about American health care
We have all experienced the bizarrely high prices charged for many medical services and devices, and I think we can all relate to the parent who wrote this article about the absurdity of medical pricing. 

Pharma Influence over Practice and Patient Care
Leana Wen: What your doctor won’t disclose
TED talk by a doctor about issues of trust in the doctor-patient relationship, doctors resisting transparency about themselves and how they practice (including disclosing payments and perks from pharmaceutical companies).

Conflicts of interest pervade US treatment guidelines, reports say
"Financial conflicts of interest are widespread among the authors of US clinical practice guidelines, according to two research letters and an editor’s note that were published in JAMA Internal Medicine.  Such conflicts are “an intractable problem in the United States,” write Robert Steinbrook, editor at large of JAMA Internal Medicine, and Colette DeJong of the University of San Francisco."

US Physician Societies are completely Corrupted

Dollars for Docs- How Industry Dollars Reached Your Doctors

We Found Over 700 Doctors Who Were Paid More Than a Million Dollars by Drug and Medical Device Companies
"Each year from 2014 to 2018, drug and medical device companies spent between $2.1 billion and $2.2 billion paying doctors for speaking and consulting, as well as on meals, travel and gifts for them."

Docs on Pharma Payroll Have Blemished Records, Limited Credentials

Now There’s Proof: Docs Who Get Company Cash Tend to Prescribe More Brand-Name Meds
"A ProPublica analysis has found for the first time that doctors who receive payments from the medical industry do indeed tend to prescribe drugs differently than their colleagues who don’t. And the more money they receive, on average, the more brand-name medications they prescribe."
"doctors who received industry payments were two to three times as likely to prescribe brand-name drugs at exceptionally high rates as others in their specialty."
"nearly nine in 10 cardiologists who wrote at least 1,000 prescriptions for Medicare patients received payments from a drug or device company in 2014, while seven in 10 internists and family practitioners did."

Matching Industry Payments to Medicare Prescribing Patterns: An Analysis
(this is mentioned in the above article)

Private equity ownership is killing people at nursing homes
"The researchers studied patients who stayed at a skilled nursing facility after an acute episode at a hospital, looking at deaths that fell within the 90-day period after they left the nursing home. They found that going to a private equity-owned nursing home increased mortality for patients by 10 percent against the overall average.  Or to put it another way: “This estimate implies about 20,150 Medicare lives lost due to [private equity] ownership of nursing homes during our sample period” of 12 years, the authors — Atul Gupta, Sabrina Howell, Constantine Yannelis, and Abhinav Gupta — wrote. That’s more than 1,000 deaths every year, on average."
This is the working paper behind this article:
DOES PRIVATE EQUITY INVESTMENT IN HEALTHCARE BENEFIT PATIENTS?  EVIDENCE FROM NURSING HOMES

Payments, Conflict of Interest, and Trustworthy Otolaryngology Clinical Practice Guidelines
"Clinical practice guidelines (CPGs) are the cornerstone of the evidence-based practice of otolaryngology–head and neck surgery. The American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) CPGs are widely distributed, as judged by frequency of downloads, webpage views, and CPG-related sessions at national meetings. Clinical practice guidelines are developed to reduce variation in care and to improve quality. They create debate and even controversy, with concerns expressed about restraints on clinician decision making as well as the medicolegal implications of recommendations. Clinical practice guidelines must be trustworthy, and the Institute of Medicine (IOM) and the Guideline International Network have provided standards for CPGs.1 A major threat to the creation of trustworthy guidelines is conflict of interest (COI) among the organizations and the committee members who create CPGs.

Influence Over Regulation and Policy
Why HEALTHCARE works the way it does: Look at these SHOCKING lobbying numbers

Third member of prestigious FDA panel resigns over approval of Biogen’s Alzheimer’s drug
"A third member of a key Food and Drug Administration advisory panel has resigned over the agency’s controversial decision to approve Biogen’s new Alzheimer’s drug, Aduhelm, CNBC has learned."

 "Dr. Aaron Kesselheim, a professor of medicine at Harvard Medical School, said the agency’s decision on Biogen “was probably the worst drug approval decision in recent U.S. history,” according to his resignation letter obtained by CNBC."

Secret Clinical Trial Data to Go Public: Drug companies have begun to share their clinical trial data. The long-overdue shift heralds a new era in medicine (from Scientific American)
"How well does a prescription drug work? It can be hard for even doctors to know. Pharmaceutical companies frequently withhold the results of negative or inconclusive trials. Without a full accounting, a physician who wants to counsel a patient about whether a drug works better than a sugar pill is frequently at a loss. Drug companies share only airbrushed versions of data on safety and usefulness.

As a consequence, regulators can approve drugs that have hidden health hazards. Clinical trials of GlaxoSmithKline's diabetes drug Avandia (rosiglitazone) and Merck's anti-inflammatory Vioxx (rofecoxib) revealed an elevated cardiac risk from the drugs, but relevant findings were held back from regulators or never published.* Far more drugs have gone to market with critical safety data kept secret. These scandals have tarnished the reputation of the pharmaceutical industry."

Bill Gates Almost Single-Handedly Derailed the Plan That Could Have Led to a 'People's Vaccine'
"But the inspiring plan devised by the scientists—which promised to create a vaccine essentially belonging to the world's people, not to corporate shareholders—was crushed fairly decisively when Bill Gates ventured into the fray."

 "Among other things, the vaccine tragedy highlights the danger posed by the extreme concentration of wealth and power that Bill Gates represents. It turns out that his mega-philanthropy comes with a hitch: it enables Gates to develop extraordinary influence over crucial matters, such as whether or not the world's poor will have a chance to survive the pandemic." 
 


Money in Medical Research
The Corruption of Evidence Based Medicine — Killing for Profit
"This has huge implications. Evidence based medicine is completely worthless if the evidence base is false or corrupted. It’s like building a wooden house knowing the wood is termite infested. What caused this sorry state of affairs? Well, Dr. Relman another former editor in chief of the NEJM said this in 2002  “The medical profession is being bought by the pharmaceutical industry, not only in terms of the practice of medicine, but also in terms of teaching and research. The academic institutions of this country are allowing themselves to be the paid agents of the pharmaceutical industry. I think it’s disgraceful”

The people in charge of the system — the editors of the most important medical journals in the world, gradually learn over a few decades that their life’s work is being slowly and steadily corrupted. Physicians and universities have allowed themselves to be bribed."

"The medical profession is being bought by the pharmaceutical industry, not only in terms of the practice of medicine, but also in terms of teaching and research," said the late Arnold Relman, a former editor-in-chief of the New England Journal of Medicine (NEJM) in 2002. He passed away in 2014.

"The academic institutions of this country are allowing themselves to be the paid agents of the pharmaceutical industry. I think it's disgraceful."

Undisclosed payments in research

"Industry payments to journal editors are common and often large, particularly for certain sub-specialties. Journals should consider the potential impact of such payments on public trust in published research."

Oncology trial authors don’t fully disclose financial conflicts of interests, analysis finds "A substantial proportion of US oncologists involved in clinical trials used to gain marketing authorization for cancer drugs do not fully disclose financial conflicts of interest when the trial is published, research in JAMA Oncology shows.  The analysis, published as a research letter,1 found that a of third of oncologist authors failed to completely disclose payments from the drug company sponsor of the trial when the trial was published."

Leading US cancer researcher failed to disclose industry ties in dozens of articles
"One of America’s most prominent breast cancer doctors failed to disclose pharmaceutical industry ties worth millions of dollars in authoring dozens of articles in major journals, according to a report by the New York Times and ProPublica.  José Baselga, physician-in-chief at Memorial Sloan Kettering Cancer Center in New York City, neglected to mention multiple directorships and consultancy fees when completing conflict of interest disclosure forms for leading publications including the New England Journal of Medicine and the Lancet, the report found.  Baselga also left out his industry payments when writing for Cancer Discovery, the journal of the American Association for Cancer Research (AACR), even though he was the joint editor-in-chief and president of the association."

Corruption and Profiteering in Medical Insurance and Medicare
Medicare Privatization Scheme Faced Legal Questions About Profiteering
"Diane Archer, founder of Just Care and a health policy expert, described a similar scenario in an email to The Intercept. “The way they make money is by spending as little as possible on patient care, while ensuring as best they can that they have all diagnoses possible for their enrollees in order to maximize government payments. The more diagnoses, the higher the government payments. Government payments are set upfront and unrelated to the cost or number of services people receive.
“And, yes, the incentive is to deny as much care as possible,” she continued, “it’s also to delay as much care as possible and to create administrative and financial barriers that make it hard for enrollees to get care"
 
Why I Left the Network
Extremely well done article about how insurance companies are avoiding coverage of mental health services, despite the ACA's requirement that they cover mental health services the same as they cover physical health services.  They create what are called "ghost networks", meaning that they will list providers who they know are deceased, retired, or not in their network in order to give the appearance that they have adequate coverage for services when in fact they don't.  They also keep reducing the amount that they reimburse providers, make it harder and harder for providers to get reimbursed, and challenge the legitimacy of provider's qualifications and treatments, all in an attempt to get providers to drop out of their network.  When they do drop out, their names are kept in the listings, and the companies find ways to make consumers work hard and take a long time to establish that care isn't available.

Health Insurance Whistleblower: Medicare Advantage Is "Heist" by Private Firms to Defraud the Public

The Reason Health Care Is So Expensive: Insurance Companies
"But the thing that few people talk about, and that no serious policy proposal attempts to fix—the arrangement that accounts for much of the difference between health spending in the U.S. and other places—is the enormous administrative overhead costs that come from lodging health-care reimbursement in the hands of insurance companies that have no incentive to perform their role efficiently as payment intermediaries."

"Because insurers are paid a fixed percentage of the claims they administer, they have no incentive to hold down costs. Worse than that, they have no incentives to do their jobs with even a modicum of competence."

CNN Exclusive: California launches investigation following stunning admission by Aetna medical director "California's insurance commissioner has launched an investigation into Aetna after learning a former medical director for the insurer admitted under oath he never looked at patients' records when deciding whether to approve or deny care."

Inside America’s ‘GoFundMe’ Health Crisis

Koch-backed study finds ‘Medicare for All’ would save U.S. trillions

"Using a comprehensive database of closed claims maintained by the Texas Department of Insurance since 1988, this study provides evidence on a range of issues involving medical malpractice litigation, including claim frequency, payout frequency, payment amounts, defense costs, and jury verdicts. The data present a picture of stability in most respects and moderate change in others. We do not find evidence in claim outcomes of the medical malpractice insurance crisis that produced headlines over the last several years and led to legal reform in Texas and other states. Controlling for population growth, the number of large paid claims (over $25,000 in real 1988 dollars) was roughly constant from 1990–2002. The number of smaller paid claims declined. Controlling for inflation, payout per large paid claim increased over 1988–2002 by an estimated 0.1 percent (insignificant) to 0.5 percent (marginally significant) per year, depending on the data set we use. Jury awards increased by an estimated 2.5 percent (insignificant) to 3.6 percent (marginally significant) per year, depending on the data set, but actual payouts in tried cases showed little or no time trend. Real defense costs per large paid claim rose by 4.2–4.5 percent per year. Real total cost per large paid claim, including defense costs, rose by 0.8–1.2 percent per year."