Overdosed America (42 page)

ulcer, 43

U.S. health measures and, 52–53

duration, research study, 70, 29–31, 104–5, 243–44

DynaCirc, 109

education

life expectancy and, 49

marketing as, 63, 154–55 (
see also
marketing)

medical (
see
medical education)

strokes and, 20

efficiency.
See
performance, health care system

Eli Lilly, 161–63, 217

emotional lability, 117, 243

end-of-life care, 183

endometrial cancer, 62, 70

Endovascular Technologies, 243–44

environmental factors, 11, 48–50.
See also
lifestyle health factors

estrogen therapy.
See
hormone replacement therapy (HRT)

Europe, ban on DTC ads in, 157

evidence, scientific.
See
commercial research bias

excellence, myth of, 39–53

breast cancer and faith in, 39–42

costs of faith in, 50–53

health comparisons of U.S. and other countries, 44–47

marketing and, 167

medical breakthroughs and, 42–44

roots of, 48–50

exercise.
See also
lifestyle health factors

basic health and, 237–39

cancer and, 234

coronary heart disease and, 100, 134, 222–25

depression and, 11, 233–34

diabetes and, 230

obesity and, 236–37

osteoporosis and, 217–18, 247

strokes and, 17, 20

expenses.
See
costs, medical

experts.
See
conflicts of interest

faith.
See
trust

fall-prevention programs, 218

family medicine.
See
primary care

FDA.
See
Food and Drug Administration (FDA)

federal government.
See
government, U.S.

fiber, 135

financial issues.
See
conflicts of interest; costs, medical; funding; profits

fish consumption, 17, 238

fitness.
See
exercise

Flexner Report, 196–97

Fludara, 89

folk medicine, biomedicine as, 201–4

Food and Drug Administration (FDA)

antidepressants approval, 115–17, 243

Celebrex review, 23–24, 30, 32–33

Claritin review, 152–53

declining oversight by, 157–58, 161

DTC advertising approval, 150–52

financial ties of, with drug companies, xxii, 85–87, 89–90, 125, 249–50

hormone replacement therapy approval, 59

medical journals and, 37–38

Warning Letters (
see
Warning Letters, FDA)

web site and data, 28, 37

Forteo, 217

Fosamax, 213–15, 218, 246

4S study, 142, 143

Framingham Heart Study, 63, 130–35, 141

free drug samples, 124–26

funding.
See also
conflicts of interest

FDA drug reviews, 85–90, 249

medical research, 94–95, 196–97, 252–53

universal health insurance, xxii, 253–54

gastroesophageal reflux disease (GERD), 101–2

gastrointestinal complications, 24–25, 28–36, 43

gemfibrozil, 133

Genentech, 226–27

germ theory of disease, 195

ghostwriters, 106–7

Gleevac, 43–44

goals, commercial vs. health, 21–22, 50–51

government, U.S.

health care quality and, 257–59

Medicaid, 20, 75, 162

Medicare prescription drug bill and purchasing power of, 245 (
see also
Medicare)

regulatory role of, xxii, 157–58, 161, 249–53 (
see also
Food and Drug Administration; National Institutes of Health)

Republican Party and medical industry, 90–91, 247

research funding by, 94–95

universal health insurance, xvii, xxii, 20, 46, 253–54 (
see also
health insurance)

Guidant, 99, 243–44

guidelines.
See
clinical practice guidelines

Harlem, stroke research in, 18–22

HDL cholesterol, 18–20, 67.
See also
cholesterol

health

advances in, 48–50

basic guidelines, 237–39 (
see also
lifestyle health factors)

comparing U.S., and other countries, 44–47

goals vs. commercial goals for research, 21–22, 50–51

supply-side medical care and, 184–85

health care system, U.S.

author’s experience in, xviii–xxii

biomedical model (
see
biomedical model)

commercialization of, xix–xxi, 21–22, 50–51, 241–44 (
see also
commercial research bias; doctors, deception of; marketiing; drug companies; medical-device companies; supply-side medical care)

comparisons of, with other countries, 44–47, 172–73, 174

doctor-patient relationship vs.medical consumerism, 3–11 (
see also
doctor-patient relationship; medical consumerism)

individual responsibility for, 256–60

Medicare prescription drug bill issue, 244–49

myth of excellence of (
see
excellence, myth of)

promoting quality care, 254–56

restoring medical research integrity, 249–53

universal health insurance coverage, 253–54 (
see also
health insurance)

health guidelines (basic), 237–39.
See also
lifestyle health factors

health insurance

advertising and, 151

lack of universal, xiv, xxi, 20, 46, 253–54

managed care plans, HMOs, and indemnity, 77 (
see also
health maintenance organizations)

Medicaid, 20, 75, 162

Medicare (
see
Medicare)

prescription drug coverage, 21–22, 79–80

supply-side medical care and, 178–79

health maintenance organizations (HMOs), xviii–xix, 75–91.
See also
health insurance

FDA and NIH conflicts of interest and, 85–90

drug company lobby and, 90–91

patients as consumers and, 78–80

public backlash against, 80–82 rise of, 75–78

health technology assessment programs, 176–77, 219

healthy life expectancy, 45–47, 49

heart attacks.
See also
coronary heart disease (CHD)

aspirin and, 49

causes of, 132

cholesterol and, 141–43

defibrillators and, 99–101

exercise after, 223

hormone replacement therapy and, 140

pravastatin study and, 14, 136–37

supply-side care for, 169–73, 174–76

Vioxx and, 26, 34

heartburn, 30, 246

heart disease.
See
coronary heart disease (CHD)

Heart Protection Study, 146, 229, 231

heart surgery, 43, 169–73, 175–76

hemorrhagic strokes, 226.
See also
strokes

HERS study, 67–68, 140

high blood pressure.
See
blood pressure

hip fractures, 70, 211–20

HIV, 43, 80

Holmer.Alan, 122, 154

Holter heart monitor tests, 114

hormone replacement therapy (HRT), 55–71

cholesterol and, 140

doctor-patient relationship and, 55–58

end of routine, 68–71

marketing of, for osteoporosis, 62–64

medicalizing menopause, 58–62

research methods and, 64–68

hospitals, 175–76, 179–80, 183

hydrochlorothiazide, 245

ibuprofen, 25, 29–30

immunizations, 49

implantable defibrillators, 98–101

imported drugs, 159–61

indemnity insurance, 77.
See also
health insurance

independent research review board, 249–54

individual responsibility, 256–60

infant mortality, 45, 174

information, 167, 219.
See also
knowledge

informed censoring, 30

Institute of Medicine, 248–49, 250, 253

insurance, health.
See
health insurance

insurance, malpractice, 84

Internet.
See
web sites

Interpublic, 109

ischemic strokes, 18–21, 225–26.
See also
strokes

isoniazid, 49

Johns Hopkins University, 195–97

Journal of the American Medical Association (JAMA)
, 37–38, 96

journals.
See
medical journals

key opinion leaders (KOLs), 119

kickbacks, 177

knee replacement surgery, 102–3

knowledge, 149–50, 167, 219.
See
commercial research bias; health guidelines; marketing; medical journals; web sites

Koch, Robert, 195

laminectomy, 177

Lancet, The
, 96

LDL cholesterol, 18–20, 67, 129–31, 142–43, 224.
See also
cholesterol

legal reviews, delayed FDA, 158

Letters, FDA Warning.
See
Warning Letters, FDA

leukemia, 43–44, 89–90

life expectancy, 45–49, 172–73.
See also
mortality rates

lifestyle health factors.
See also
diet; exercise; health guidelines; smoking

biomedical model vs., 11, 201–6, 251

defibrillators vs., 100–101

individual responsibility and, 256–60

medical news stories and, 166

osteoarthritis, 190–94

preventive care and, 49, 166

strokes, 17, 20–22

tendonitis, 6–7

life support, 183

LIPID study, 142–43

Lipitor, 119, 133, 246

literature, medical.
See
medical journals

litigation, malpractice, 84, 127

liver toxicity, Rezulin, 87–88

liver transplants, 44

lobbyists, xiv, 90–91

longevity.
See
life expectancy; mortality rates

Lopid, 133

lovastatin, 133, 137–39, 246

lung cancer, 234

Lyon Diet Heart Study, 201–2, 224, 234–35

magnetic resonance imaging (MRI), 44, 53, 181–83

malaria, 110, 195

malpractice litigation, 84, 127

managed care plans, 77.
See also
health insurance; health maintenance organizations (HMOs)

marketing, 149–67

Celebrex and Vioxx, 5–7, 23–24, 28

commercial research bias as, 96, 242 (
see also
commercial research bias)

deception of doctors (
see
doctors, deception of)

direct-to-consumer (DTC) advertising and, 150–59

FDA warnings about (
see
Warning Letters, FDA)

ghostwriters and, 107

hormone replacement therapy, 62–64

medical consumerism and (
see
medical consumerism)

medical journals and, 112–13

medical news stories, 163–67

public knowledge and, 149–50

public relations campaigns, 149, 159–63

web sites, 79, 218–19, 230–31

meat consumption, 45, 238

media, news, 80, 163–67

medical consumerism

doctor-patient relationship vs., xx, 5–7, 9–11, 38

health insurance and, 78–80

marketing and, 150, 155–57 (
see also
marketing)

responsible, 257

medical-device companies, 42–44, 176–77, 243–44.
See also
drug companies

medical education

biomedical model and, 195–200

continuing medical education (CME), 117–24, 250

drug companies and, 111–12, 125–26

medical education and communication companies (MECCs), 121

medical industry.
See
drug companies; medical-device companies

medical journals

commercial research bias in, 96–97, 105–6, 242 (
see also
commercial research bias)

doctor trust of articles in, 17, 93–94, 106, 112–13

FDA relationship with, 37–38

peer review process, 25–27, 33, 37, 106, 252

medical news stories, xx, 163–67

medical research

commercialization of, 96–97, 241–44 (
see also
commercial research bias)

funding of, 94–95, 196–97, 252–53

marketing pressures vs., 174–78

methods, 29, 64–68

myth of excellence and, 42–44, 48–50

restoring integrity to, xx–xxii, 249–53

statistics, 14–16, 26, 165–66, 229

Medicare.
See also
health insurance

dialysis coverage, 43

oversupply of medical services and, 184

prescription drug bill, 160–61, 244–49

Xigris coverage, 162

medicine, American.
See
health care system, U.S.

Mediterranean diet, 201–2, 224, 234–35

Medtronic, 177–78

men

coronary heart disease and, 136–43

exercise and, 238

health life expectancy of, 47

strokes and, 16

menopause, 58–62.
See also
hormone replacement therapy (HRT); osteoporosis

Merck, 36, 153, 218

metaphysical perspectives, 208

methods, research, 29, 64–66.
See also
medical research

Mevacor, 133, 137–39, 221, 246

Miacalcin, 217

Million Women Study, 69–70

mortality rates

anti-arrhythmic drugs, 114

antidepressant drugs, 116–17

cholesterol drugs, 133, 134, 137–39, 142–46

coronary heart disease, 220–21

defibrillator, 99–101

diabetes, 228–31

hormone replacement therapy, 64, 66

life expectancy measures, 44–50

lifestyle factors and, 204–5

neonatal care, 45, 174

obesity, 236–37

post-heart attack care, 171–73

stroke, 225

Vioxx, 26, 36

Xigris, 162

MRI (magnetic resonance imaging) scans, 44, 53, 181–83

myth of excellence.
See
excellence, myth of

naproxen (Aleve), 25–27, 33–36, 203, 246

National Cholesterol Education Program, 129–31, 220, 224

National Institutes of Health (NIH), xxii, 71, 86–90, 172–73, 249

neonatal care, 173–74, 176, 184–85

New England Journal of Medicine
(NEJM), 25–27, 37–38, 96

news stories, 80, 163–67

Nexium, 101–2

nonprofit organizations