Denialism Blog

Denialism Blog

  • Drug Shortages Reveal the Free Market is Failing Our Sickest Patients

    **Update, the NYT has an editorial in their Sunday edition recommending the passage of two bills in congress requiring advanced notice from drug manufacturers in event of likely shortage.

    i-1ae05c713060a45402a652d348e56148-pngHealth affairs discusses the increasingly frequent shortages of critical, life-saving, generic drugs. This is a serious problem that seems mostly limited to the U.S. healthcare system, and may adversely affect you or someone you know.

    Many of the same drugs are not in such short and unpredictable supply in Europe, where in some cases they carry higher prices. This provides one major clue to the root cause: It’s the money.

    Three of every four drugs on the US government’s shortage list were sterile injectable drugs, according to a report by HHS. For the most part, these are relatively low-cost generics. Simply put, most of those drugs are not very profitable to produce and sell, or supplies of them would not have dried up.

    At an online presentation for journalists in November, Valerie Jensen, associate director of the FDA’s Drug Shortage Program, provided a casebook example. She mentioned the price of the tried-and-true sedative propofol, a lethal dose of which was found to have caused the death of singer Michael Jackson: The cost is forty-eight cents for a twenty-milliliter vial. “The older, sterile injectables are not economically attractive” for manufacturers to produce and market, Jensen said. Other generic drugs can have higher profit margins.

    Propofol, one of the most frequently used drugs by anesthesiologists, is in increasingly short supply. I get emails from my hospital about which drugs are in short supply as physicians then try to ration these drugs for the most critical cases. In my own experience in the last year I’ve seen shortages of everything from injectable calcium gluconate (for electrolyte deficits), to levophed (a life-saving pressor used in critical care), metoclopramide (anti-nausea), and fentanyl (a powerful and useful short-acting narcotic). The FDA has a full list of recent shortages and it’s scary. Parents are having trouble finding drugs for their kids’ ADHD, vital chemotherapeutics like daunorubicin and doxorubicin are in short supply, dexamethasone (a powerful steroid), valium, digoxin (a staple of congestive heart failure and anti-arrhythmic treatment), diltiazem (hypertension and anti-arrhythmic), phenytoin (anti-epileptic also often used in acute brain injury), furosemide (an ubiquitous diuretic), haloperidol (anti-psychotic and sedative), isoniazid (a antibiotic used in TB), ketorolac (an excellent anti-inflammatory and analgesic), levofloxacin (a quinalone broad spectrum antibiotic), methotrexate (immune modulator), midazolam (a great short acting sedative), naltrexone (for reversing opioid overdose), vasopressin (another pressor) all are in short supply.

    The drugs affected span all classes, what they have in common is they are all generic. Since there is too much competition in generics and too little profit margin, drug companies do not have a financial incentive to maintain adequate stocks to keep the drugs cheap and available. Shortages, if anything, increase profits because then the prices become artificially inflated.

    Manufacturers, not surprisingly, blame the FDA, however the FDA hasn’t changed its standards despite increasing problems with shortages due to contamination or impurity. And that’s just for manufacturers in this country, fully 80% of the medications are produced, or active ingredients are produced, abroad. The main problem seems to be a concentration of production to a handful of companies that have adequate production capacity to compete in the generic market:

    There is also a high level of concentration in US manufacturing for such drugs. That leaves little redundancy in the market as there would be for, say, generic statins. Three companies in particular–Hospira, Teva, and the Bedford Laboratories division of Boehringer Ingelheim–have been involved in selling 71 percent of the sterile injectable market by volume, the government says.7 All three have had manufacturing problems in the past two years.

    With such consolidation as well as tight inventory management practices, the specialized manufacturers of injectable drugs lack the flexibility to adapt to manufacturing disruptions. If one plant shuts down, it may overburden the limited remaining competitors or choke off the supply entirely.

    It’s hard to estimate the effects of these shortages, I don’t have good data on the damage done nationwide, only my personal experience. In particular, I remember during an ICU rotation running out of levophed, an incredibly important pressor that helps patients who are in shock from becoming fatally hypotensive.

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  • The Heartland Documents, Doubt is their Product

    Everyone is writing about desmogblog’s leak of internal documents from the Heartland Institute. But to me I think leaked documents are nothing compared to their fully public, out-in-the-open history of being openly contemptuous of science, funding cranks with advanced degrees (though not in climate) to disparage the field, and their hosting of denialpalooza.

    James rightly points out that much hay is being made of a single sentence that, could “easily be the result of sloppy editing, or at perhaps a Freudian slip.” This is of course is a sentence describing a curriculum developed by the HI that “shows the topic of climate chance is controversial and uncertain – two key points that are effective in dissuading teachers from teaching science.”

    But other aspects of the document instead suggest to me that these people are true believers. Even in context this quote sounds horrible, but I don’t think it reflects a conscious desire to deceive. After all, they think their beliefs are true. They are so blinded by ideology they are literally incapable of acknowledging facts that run counter to these core beliefs. I think, if anything, this sentence is interesting because it shows that they are picking up tactics from previous denialist campaigns by those that were intentionally deceptive, such as the DI anti-evolution campaign and tobacco company denial of health effects of smokng. They are not interested in actual science but rather are interested in methods of sowing doubt. Similar to the cigarette company strategy of denying the harm of tobacco smoke, “doubt is their product”. We already knew these guys were merchants of doubt, some of them are the very same people that deny tobacco smoke is harmful.

    I don’t think these documents are going to be a game changer. They’ve largely told us what we already know. HI is funded by oil interests. They pay cranks with degrees good money (11k a month to Idso – sweet!) to lend legitimacy to denialist pseudoscience. Their overriding goal is to undermine any science that conflicts with free market fundamentalism. They are trying to undermine climate science through sowing doubt and confusion in the public rather than pursuing actual scientific inquiry. To those that think HI is great, they think methods like this are just fine. To those of us who have seen how denialists operate, from the tobacco companies to the Discovery Institute, this is just another confirmation of their overarching strategy – to create doubt where there should be none.

  • Planned Parenthood: Trying to Addict Your Kids to Sex

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    How’s this for a tinfoil hat conspiracy, brought to you by the American Life League–

    Planned Parenthood’s strategy in this great world is to:

    Phase one: Get kids addicted to sex.
    Phase two: profit! Through selling birth control, STD testing, and abortion.

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  • Should doctors fire patients who won't vaccinate?

    WSJ has an article about the increasing number of pediatricians who fire their patients who refuse to vaccinate:

    Pediatricians fed up with parents who refuse to vaccinate their children out of concern it can cause autism or other problems increasingly are “firing” such families from their practices, raising questions about a doctor’s responsibility to these patients.

    Medical associations don’t recommend such patient bans, but the practice appears to be growing, according to vaccine researchers.

    In a study of Connecticut pediatricians published last year, some 30% of 133 doctors said they had asked a family to leave their practice for vaccine refusal, and a recent survey of 909 Midwestern pediatricians found that 21% reported discharging families for the same reason.

    By comparison, in 2001 and 2006 about 6% of physicians said they “routinely” stopped working with families due to parents’ continued vaccine refusal and 16% “sometimes” dismissed them, according to surveys conducted then by the American Academy of Pediatrics.

    “There’s more noise among pediatricians, more people willing to argue that it’s OK to do this versus 10 years ago,” said Douglas Diekema, a professor of pediatrics at the University of Washington in Seattle. Dr. Diekema wrote the AAP’s policy on working with vaccine refusers, which recommends providers address the issue at repeated visits, but respect parents’ wishes unless it puts a child at risk of significant harm.

    This is an interesting ethical question as there are several issues at play. Since the pediatrician is the child’s doctor, is it wrong to fire the family from the practice just because the parent is misinformed? Or is it a worse practice to tolerate parental medical foolishness and expose other patients in the practice to vaccine-preventable disease? Since vaccination is one of the most important roles of the pediatrician during well-child visits, is there any point at all in having regular pediatrician visits if you refuse vaccination?
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  • More Evidence that Universal Health Care Would be Less Expensive

    We’ve written quite a bit about single payer health care systems as well as other models that are a mixture of public and private spending.

    We’ve also analyzed some of the sources of excess cost of US healthcare to other countries. What is uniformly true about universal health care systems is that they all spend less on medical care per capita than the US. The next nearest country in spending to us, France, spends 50% of what we do per capita while providing top notch care, possibly the best in the world. And while the cause of our excess costs are multifactorial, one of the greatest sources of excess cost is likely due to increased use of emergency rooms over primary care providers. We already have universal healthcare, if someone shows up injured or ill, hospitals are obligated to treat them. But forcing people to come to the ER when their problems have become critical increases the costs of treatment dramatically. Now a new paper in Health Affairs demonstrates the cost of ER use over PCPs and their findings confirm that as much the costs of the uninsured to the health care system dropped by 50% once low-income uninsured patients received health coverage. This is good news as it suggests as health care reform is enacted we should see huge savings just from having a universal system.

    See more below…
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  • Damn you Pubmed.org!

    Somebody please tell me why the national library of medicine gave up their pubmed.com and pubmed.org domains? It used to be you could just type “pubmed.org” and get pubmed. Now, some cyber squatter has put some worthless spam search on the site. Before I realized it wasn’t a site redesign my search got me redirected to a celebrity gossip site, then experimenting with the same search I got a site selling anti-aging cream.

    Really? How much does it cost to keep a domain a year? And for that matter, what cyber squatter thinks redirecting scientists at celebrity gossip sites is a great business strategy.

    Is the budget really that tight at the NIH? They can’t fork over a couple hundred bucks a year to maintain some convenient domain names? I guess all that money being spent on security and a 10 foot iron gate around a science campus has them searching the couch cushions for pocket change. It’s certainly not going into grants given we’re seeing the lowest rate of funding for R01 applications in decades.

  • Stop Lurking Paul Krugman

    Sometimes I’m reading essays in major newspapers and have to wonder if they’ve been reading denialism blog. Today, Krugman on Santorum:

    Nor is this only about sex and religion: he has also declared that climate change is a hoax, part of a “beautifully concocted scheme” on the part of “the left” to provide “an excuse for more government control of your life.” You may say that such conspiracy-theorizing is hardly unique to Mr. Santorum, but that’s the point: tinfoil hats have become a common, if not mandatory, G.O.P. fashion accessory.

    I just gave Santorum the tinfoil hat a few days ago!
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    Is Krugman lurking around here? C’mon Paul. Come out and say hi. Please?

  • What Illegal Abortion Looks Like

    Many are linking to this story around the blogosphere and I encourage everyone to read it. In it, a Ob/Gyn describes her emergency care of a woman who arrived in her ED in hemorrhagic shock from a botched illegal abortion. Though clearly it was touch and go and there was some panicky action, our heroine thought fast and saved a life. My mother once worked in a labor and delivery ward to put herself through medschool in the days before Roe v Wade and this type of situation was common.

    This is a great story because it illustrates two points. One, the war on abortion by the right wing is futile. We know abortion is more common where it is illegal and cases like these are more common. Banning abortion does not save lives. It results in more abortions, and more lives lost. Worse, in countries with strict bans even treatment of ectopic pregnancy is forbidden where there is still a beating heart detected by ultrasound. Doctors in these countries can literally go to jail for saving a woman’s life, all for the sake of a non-viable embryo that will kill the mother. The hypocrisy of calling this position pro-life is demonstrated by cold hard data. More women die. More fetuses are aborted.

    Second, it shows how a well-trained doctor can save a life with some quick thinking. Hemorrhagic shock is something I’m pretty familiar with after my second year rotation in Shock Trauma, and in a few spectacular cases of bleeding on the wards. There are many times when as a doctor you think you’ve probably saved a life. Every case of appendicitis, dropped lung, or kid with a gastroschisis technically is a save but situations like those don’t have quite the same visceral terror and immediacy of someone who is bleeding to death right in front of you. It’s hard to keep a cool head when you’re elbow deep in a pool of blood. One case in particular that sticks out in my mind was during a nice calm Saturday in the fall. I had just finished assisting in an open appendectomy and was doing my usual neurotic repetitive rounds through the ICU I always did when I was on call. At this particular hospital, when on call I was responsible for all ED surgical consults, all the surgical floor patients, as well as the surgical ICU (I had to carry 4 pagers). So since I’d been in this case for the last hour or so I decided to check in with the ICU folks. It wasn’t the sickest ICU I’ve ever worked, nothing like the U Maryland Surgical ICU or Cardiac Surgery ICU, but, like the ocean, it’s never a good idea to turn your back on the ICU patients. So, I was passing by one patient’s room and I seen on the monitor a blood pressure of 60/40…
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  • More Examples of Right Wing Stupidity/Racism

    Lot’s of blogging hay was made over the conservatives = stupid and racist article two weeks ago, but it seems like since that was published they’re going out of their way to provide supporting evidence. Between reincarnating a 40 year old dead argument about whether or not women should be able to have birth control, and pretty unbelievably racist stunts at CPAC, even the wingers at little green footballs are shaking their heads and asking, what the hell is going on. For instance, some white republicans thought it would be a good idea to put on a rap show and throw around the N-word. No, I’m not kidding. Conservatives still think a bad rap parody is somehow edgy.

    Even if they’re saying “knickers”, which is BS, it’s still a wink and a nudge saying, “you know what we really think of black people.”

    And who missed Andrew Breitbart acting so crazy he made the Occupy protesters look good:

    Now that’s what Occupy needs, just invite Breitbart to your protests and people will think you’re positively angelic next to that wackjob.

    Then we’ve got the bizarre response to the Fox News article on Whitney Houston’s death. The thread is totally overrun with racist comments, for the highlights see Little green footballs list of gems.

    Now, comments on blogs are usually nothing you can judge a blog by, I’ve had some doozies here. But the sheer number and the unbelievable bigotry of the the Fox News commentariat is mind-boggling. I will not reproduce them here, but think of the ugliest racist thing you can say about Whitney Houston, then make it 100% worse and repeat it 50 times, generalize it to all black people and then include Obama. That’s the comment thread.

    What is going on here? I feel like I’ve done a reverse Rip Van Winkle and woken up in Mississippi in the 1950s.

  • The Great Labor Department Conspiracy to fake new jobs

    One of the characteristics of defective thinking, particularly of cranks (see theHOWTO) that we’ve discussed on scienceblogs is their poor ability to process information that is contradictory. Last week there were some interesting reports on a study which suggested those who believe in conspiracy theories can hold two seemingly contradictory pieces of information in their heads and not see the conflict. For instance:

    “The more people were likely to endorse the idea Princess Diana was murdered, the more they were likely to believe that Princess Diana is alive,” explained Douglas. People who thought it was unlikely she was murdered were also unlikely to think she did not die.

    This study is great because it’s direct confirmation that people who buy into conspiracy theories have fundamentally defective thought processes that allow them to believe things that are logically inconsistent. Just like we’ve been saying for years.

    Now, examine instance the Fox News reaction to the improving jobs numbers from the last month.

    The right has struggled with the news. Mitt Romney went into denial; his supporters desperately tried to convince people not to give President Obama credit; GOP leaders on Capitol Hill found themselves at a loss for words; and Fox News spent much of Friday going to comical lengths to pretend the jobs report wasn’t newsworthy at all.

    And then, there are the conspiracy theorists.

    Rep. Allen West (R-Fla.) came first, arguing on Friday there’s “something suspicious about the job numbers.” He did not elaborate.

    On Fox News’ “Fox & Friends” this morning, the cast went down this road with more enthusiasm. Here’s what Eric Bolling told viewers:

    “So are they playing around with the numbers? Look, it’s the Bureau of Labor Statistics, it’s supposed to be non-partisan, but that’s the Department of Labor. Hilda Solis heads the Department of Labor, Hilda Solis works directly to Obama. I’m, you know.”

    Steve Doocy raised the question of whether the Obama administration is “cooking the books,” while Gretchen Carlson emphasized the fact that this is “an election year.”

    The reality of the numbers isn’t what they want to hear, it conflicts with their overriding ideology that Obama is doing a terrible job to matter what, so it must be false. How could it be false? It’s a conspiracy! The department of labor statistics is cooking the books for Obama (but they didn’t cook it any other time in his presidency when it made him look bad or for any other president). Next month, if the numbers sour, they will again attain legitimacy, as long as the evidence is supportive of the overriding principal of Obama being the devil, it’s true, if it conflicts, it’s a conspiracy.

    This is the classic cognitive dissonance of the crank. They’re fixated on an idea, and when the data supports their belief it’s true, when it’s not, it’s false. There’s a conspiracy to manipulate the data because there can never be data that proves the crank is wrong about their overvalued idea.