A recent Op/Ed piece in The New York Times by John La Puma, an internist and author (http://www.nytimes.com/2014/02/04/opinion/dont-ask-your-doctor-about-low-t.html?ref=todayspaper) is entitled: Don’t ask your doctor about Low T. For those of you who don’t know, Low T is shorthand branding for testosterone levels ≤350 nanograms/deciliter of blood serum. Low testosterone is a consequence of some diseases (e.g. diabetes), as well as a normal part of the aging process. There are FDA-approved therapies (i.e. clinically tested and legal) in various forms indicated to raise testosterone levels. While Dr. La Puma wisely points out the dangers associated with testosterone supplements, he unfairly maligns the pharmaceutical companies who manufacture, promote and sell such therapies. This is not uncommon. In fact, there is a rampant hysteria about pharmaceutical companies and their brainwashing of customers into thinking that they have diseases and conditions that don’t exist. Nothing could be further from the truth.
Whenever I am interviewed about this topic (I will be appearing in a BBC TV series entitled The Men Who Make Us Buy this coming spring), my first reaction to accusations about the lack of integrity on the part of Big Pharma is a challenge: name one imaginary or invented condition that any healthcare manufacturer has ever promoted in the last 40 years. Of course, they can’t name a single one because no such charlatanism exists. Critics just irresponsibly proclaim nefarious intentions, and then manufacture false historical practices on the part of pharma to justify what is, essentially, an erroneous and slanderous assumption on their part. Talk about an inconvenient truth.
Restless Leg Syndrome, Seasonal Affective Disorder and Erectile Dysfunction (to name a few) are all legitimate conditions, as much so as Depression, Alzheimer’s disease and Multiple Sclerosis. I cite these three latter conditions because not so long ago they were referred to as The Blues, Senility and Hysteria respectively. (Clarifying and legitimizing trivialized or poorly understood health conditions is progress, people.) Further, like the more recent conditions I have mentioned above, they too have no official test or clinical way to provide a conclusive diagnosis. Yet just because there is no test for something such as depression doesn’t mean that it is a fantasy condition.
By telling people that they should not go to their doctor and ask about a particular condition and its remedies, Dr. La Puma—and other manic critics of the pharmaceutical industry—throw the baby out with the bathwater. Every condition sits on a continuum:
No need to treat Treat mildly Treat in a normal range Treat aggressively
It is not that the medical conditions are fabricated, which any patient who suffers from such conditions will tell you. It’s that many people who either don’t have the condition—or have the condition but don’t require treatment—sometimes receive the therapy incorrectly. That is called mis-prescribing or over-prescribing, and it happens in many different conditions, from hypercholesterolemia to anxiety and depression. It is a bad practice, and needs to be addressed. (Under-prescribing also occurs, but people suffering without proper medication do not seem to bother the critics as much. Hard to believe that patient welfare is really the cause for which critics claim they are crusading.) So, yes, there are probably people who are getting prescriptions for things they may not absolutely need, but let’s not question the entire dynamic because of the few exceptions to the rule; let’s uphold the dynamic for the great majority of people who are clarifying their health issues with their physicians, and try to make the situation better. Dialogue is good. “Ask your doctor” is good. What would the alternative be? Going back to the days when we were ashamed or ignorant or fearful of our own health conditions and just kept them to ourselves out of embarrassment?
What goes completely unexamined in the equation of the promotion and purchasing of controlled and restricted products such as pharmaceuticals is the very customers who are demanding cures to every health problem and annoyance under the sun. I have yet to meet a crusading critic of pharma companies who has actually talked to any patients at all. In the course of my career, I’ve spoken to, or researched, tens of thousands of patients across dozens of medical categories. In many cases, they are insatiable for “remedies” that will help them resolve their bad life choices or the ravages of age. If their knees hurt, they will badger physicians about pain relievers, whatever the consequences. If they cannot sleep, they will try each and every sleep aid they can get a doctor to prescribe. They want quick fixes. They want pharma companies to produce miracles. People cannot be trusted to look out for their own well being in many cases. And that’s why the laws are set up so that doctors act as professional intermediaries, trying to manage the information and choices so that real benefits can be achieved through medical intervention. The entire equation is mandated to insure proper treatment and good outcomes. Yet conspiracy theories abound.
True: sometimes, as with testosterone replacement therapy, physicians need to be better educated and aware of proper patient selection and the full range of potential side effects. And sometimes, patients overrule their doctor’s refusal and demand a script anyway or else threaten to give the doctor negative ratings that threaten their practices. Pharma companies market and sell products more responsibly than any other goods manufacturer because they are legally bound to do so, and also they have their own internal regulatory practices that are usually stricter than those of the FDA. They cannot exploit patients because patients cannot obtain their goods unless a doctor says so.
So what are these rabid critics really angry about if it’s not patient welfare? Money? Someone is profiting? Do pharmaceutical companies make money off of people taking these therapies? Sure, just as Coca-Cola and McDonalds make money off of people consuming their products. However, while pharmaceutical remedies are developed and tested and sold under strict regulations to help people feel and function better, sugary drinks and high-fat/low nutrition fast food are freely sold and consumed despite having been linked to obesity, diabetes, high cholesterol and other morbid consequences. Making a profit off of people eating poorly and developing chronic illness is the American way, but developing therapies and promoting medical conditions to encourage patient/physician dialogue and help resolve health problems is despicable? What’s wrong with this picture?
Or maybe it’s about eliminating the competition for your healthcare dollar. Dr. La Puma is not only an internist, but also an author who is peddling a book that advocates diet and exercise as a better remedy for low energy instead of medical intervention. So ‘Don’t Ask Your Doctor About Low-T,’ ask your bookstore where to purchase Dr. La Puma’s treatise. It seems that if pharma companies avail themselves of their legal right to develop, promote and sell products and make money off of it, then it is somehow unethical or exploitative. (Try thinking this way the next time you have a splitting headache and reach for relief in the medicine cabinet.)
Scour the news for the last time a pharma company received any celebrated credit for creating the very therapies and procedures that have significantly reduced the morbidity and mortality of diseases and conditions that otherwise would kill or diminish us every day. In a June 19, 2013 article in The New York Times praising the dramatic drop of the HPV virus in American teens, the makers and promoters of the vaccines responsible for the reduction do not get a mention until three-quarters of the way through the article, and here is the “credit”: “There are two HPV vaccines, one made by Merck for boys and girls, and one by GlaxoSmithKline, for girls.” Wow. No congratulations? No atta boy? Somehow the journal that reported the news (The Journal of Infectious Diseases) and the governmental agency that tracks the infection rate (the Centers for Disease Control) get more press coverage about it. That seems fair, right?
Hepatitis. Heart disease. Cancer. Depression. Pain. Psoriasis. Overactive Bladder. And yes, Restless Leg Syndrome. The fact that these conditions have less power over us is taken for granted by us as a society, and even resented because somebody makes a profit over it. Healthcare is not an inalienable right in America, but people often act like it is. Indeed, political wars are fought over the idea that mandated governmental healthcare in the USA is a violation of our given freedoms under the constitution. Either make it mandatory, which will significantly shrink the costs associated with care, or shut up about the profitability of it in a culture that proudly defines itself as capitalistic. It may be difficult to reconcile the thought of companies (and hospitals and doctors writing books and nurses and pharmacists etc.) making money off of illness. However, it is also hard to reconcile casting so much defamation and resentment on the vital products and services they provide, which are overwhelmingly beneficial.
So please, feel free to talk to your doctor. And if you seriously doubt the existence of a medical condition, go ask a handful of people who have been diagnosed with it and see what they say about their suffering being a fabrication. And the next time you hear someone raging against Big Pharma for creating and promoting conditions that don’t exist, ask them to name one. Just one. Pharma is not the problem. Drugs are not the problem. Ignorance is the problem. And a slanderous, uninformed crusade against the very companies that commercialize highly-regulated, life-enhancing and life-saving therapies is the problem.