July 19, 2005

Why I Am A Socialist

Ha, ha. Just kidding; not yet. But if it ever comes time to write the manifesto, I plan to kick it off with the following little set of statistics:
  • In the 1990s the U.S. National Health Institute's cholesterol guidelines noted that thirteen million Americans could benefit from treatment with statins (i.e., drugs to lower your cholesterol.)

  • In 2001, the guidelines were rewritten, and that number jumped to 36 million.

  • In 2003, the guidelines jumped again, and this time as it happened about 40 million Americans could really use these statins.
  • Why the rapid increase? Are cholesterol levels in the United States actually getting worse and worse? Are more and more people at risk of a heart attack? Hard to say. But whatever you do, don't look at this page noting all the financial ties between writers of the NIH guidelines and drug companies. Really, it's totally irrelevant that eight out of nine experts rewriting the guidelines in 2003 were paid consultants or paid speakers or paid researchers for Pfizer or Merck or GlaxoSmithKline or Bayer or other companies that would stand to benefit in a major, major way from new "official" recommendations that would expand the statin market to millions and millions of otherwise healthy Americans. Totally irrelevant. And we wonder why health care costs are so high. Maybe because they keep inventing diseases and conditions for us to go get treated for.

    That's not to bash statins. I have no idea if 40 million people need them or 40 thousand or what. They probably do many heart attack victims a world of good—although it's funny, independent researchers mostly seem to think their benefits for the rest of us are wildly overstated. Huh. Also, since my brain's still untarnished by the latest glossy Newsweek article pushing the latest disease dreamed up in GlaxoSmithKline headquarters, I would guess that some of those billions spent on, say, Lipitor might be better spent on public health programs instead. Then again, any scientific study I could dig up on public health is very likely to be funded by the diet and fitness industries—they've already got Paul Krugman in their thrall, why not me? And so it goes, with new diseases concocted and commodified every which way we turn. Some say Michel Foucault is dead. I just think he got hired by Merck.

    Anyway, I'm finishing up a book review on this topic right now, but I really, really, really have no idea what can be done about this problem. (And the cholesterol incident is just the tail of the whale here.) Independent, government-funded review boards would be nice to have—something akin to the National Institute for Clinical Excellence in the U.K.—anything that could tell us whether the latest "diagnosis" now hitting the newsstands is really all it's cracked up to be. I've heard that the Public Library of Science here in San Francisco is working on something like that. But they're just one lonely voice pushing back against the onslaught. Perhaps the health wonks among us can mull this problem over, while I ponder what it means when two of our nation's largest industries (health and defense) can essentially manufacture demand out of thin air. Free market, they call it. Baffling, I say.
    -- Brad Plumer 11:46 AM || ||