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Monthly Archives: April 2012

Earlier this month, I had World News with Diane Sawyer in the background as I was cleaning my apartment when a particular news report captured my attention. According to the report, Americans here in the United States are being screened too often for medical tests that they really do not need. In fact, a number of those additional medical tests are doing more harm than good. How so? Because there are a number of health risks that patients are being exposed to when these medical tests are being conducted, according to Dr. Christine Cassel, the president and chief executive officer of the American Board of Internal Medicine Foundation. Therefore, in an effort to reduce this less than beneficial trend that appears to be transpiring in the healthcare world, the ABIM Foundation and Consumer Reports have teamed up to develop the “Choosing Wisely” project. In this project, nine physician groups have compiled a list of five medical tests–in a variety of fields–that are performed on patients more often than necessary. Those five tests are as follows: the cardiac stress test, chest x-rays, imaging tests that include MRIs and CT scans, colonoscopies, bone density scans, and bone mineral density tests, which are commonly known as dual-energy x-ray absorptiometry, or a DEXA scan.

This news report honestly left me not only speechless, but a little outraged. As I speak, there is an elderly woman in a remote village in Africa whose osteoporosis has left her within the confinements of her home. She has neither the strength nor the money to afford the appropriate testing and treatment for her painful bone condition. Or, there is a gentleman in his early 60’s in southeast Asia suffering from symptoms that are evocative of colon cancer. However, he has never been properly diagnosed. He is reaching the end of his fight, for the cancer has spread. But if he had had access to a colonoscopy in his early 50’s, doctors could have not only detected his precancerous growths, but removed them as well. As a result, his death rate would have been reduced by 53%. I understand that there are a number of factors (lack of infrastructure, government funds, etc.) that influence whether or not citizens of third world countries can have access to the very same tests that Americans are being inundated with here in the U.S. But like we discussed in class a few weeks back, NGOs most not limit their focus to only  life-threatening illnesses; they must also promote the idea of “quality of life” by addressing non-communicable diseases (or NCDs) as well. To the surprise of many, there has been a shift of NCDs to developing countries, where 63% of deaths in third world countries are non-communicable in nature, and 1/3 of those deaths occur before the age of 60. If NGOs do not take the time to address and treat the occurrences of NCDs, they are in violation of the human right to a healthy life.

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On April 11th 2012, the FDA finally took a step in the direction of protecting humans from the build-up of drug resistant bacteria.

Many don’t like to admit that bacteria are often smarter than even our best scientists. But the truth is that for every antibiotic we create, a stronger and more drug resistant strain of bacteria is generated.

NYTimes journalist Gardiner Harris writes, “Using small amounts of antibiotics over long periods of time leads to the growth of bacteria that are resistant to the drugs’ effects, endangering humans who become infected” (The New York Times). The New York Times also gives the estimate that 99,000 people die each year from infections they contracted at a hospital, and that the majority of these are due to resistant strains of bacteria.

Despite all of the research and data that has been collected, the US has done very little to cut back on the unnecessary use of antibiotics, specifically in the meat industry. Are we naively allowing industries interest to threaten the health of our entire population and especially of future generations?

The meat industry has been routinely including antibiotics in healthy livestock’s feed and water since the realization that it induced phenomenal growth.

One of the reasons antibiotics are not sold over the counter for human use is to reduce unnecessary use of such drugs that can create resistant strains of harmful bacteria. Until this April, however, there was hardly any regulation of antibiotic use for livestock.

The FDA announced on April 11th that in order for livestock to be given antibiotics, the antibiotics would need to be prescribed by a veterinarian. This was a victory in helping to preserve humans right to health. However, many more steps towards eliminating unnecessary antibiotic use are needed. Some are also concerned that both the meat and antibiotic industries will hold off making any changes in hope that the administration after the upcoming election will change the policy.

I am curious to see if people think this is a human rights issue where the government is failing to protect our right to health, or if people feel this is simply a policy issue.

Read more at http://www.nytimes.com/2012/04/12/us/antibiotics-for-livestock-will-require-prescription-fda-says.html

Over the counter vs. prescription: What are the effects on pricing?

So far in class we have dedicated a lot of time to why drugs are inaccessible due to disturbing high pricing by pharmaceutical companies.  According to this article, soon some very common drugs for chronic, non-infectious illnesses such as high blood pressure and asthma might be available over the counter.  I think that this could benefit our access to medicine in two ways: 1) you will no longer have to pay for the visit to the provider/rack up insurance costs for the visit that essentially is 90 seconds long anyway just to get a prescription 2) It has the potential to be another route for pressure on pharmaceutical companies to lower the cost of their drugs.  Because you would hypothetically no longer need a script for your medication, the point is made that technically the immediate out-of-pocket costs of the consumer could go up since a majority of insurances don’t cover over the counter purchases.  But especially with an election coming up, I think it’d be an awesome time for politicians to pressure the big pharmaceutical companies to lower their prices so that people could potentially afford their medication.  I also think this is a great step towards people being more involved with their own treatment.  Especially with chronic, non-infectious diseases it’s a chance for people to be more independent, monitor their health, and also possibly be more committed to their treatment plan.  Many times, people will “self prescribe” by cutting their dosage to make their medication last longer, or will just not take it to avoid having to deal with another doctor’s appointment.  As someone with asthma, I know that I’ve gone for gaps of time without my medication not because of lack of medication or insurance but because I could simply not get an appointment with my doctor that coordinated with my schedule.  On the other hand, it could also be argued that the solution for lowering health insurance costs is not to cut out the provider.  Especially because the disease is chronic, this proposal could further distance the already strained relationship between patients and their providers.  Along with trying to form a relationship with their patients, doctors use the three month checkup to not only prescribe more drugs, but to also monitor the dosage, make sure there are no side effects, and also check for other conditions that could arise (i.e. if you have hypertension you are at a higher risk for a heart attack or stroke, so maybe you should be checked out by your doctor for physical warnings of these conditions that a questionnaire on a computer can’t catch. Thoughts on this proposal?  Is cutting out the provider just a band aid the government is putting on the bigger problem of health insurance costs skyrocketing? 

Once again, stringent drug law and anti-drug campaign action has resulted in a restriction of access to treatment.  A government anti-drugs agency in Russia has ordered that the Andrey Rylkov Foundation, a public health organization which deals with discussion of the drug methadone as a treatment for addiction, be shut down.  The motion was put into action because the organization was said to “[place] materials that propagandize (advertise) the use of drugs, information about distribution, purchasing of drugs and inciting the use of drugs.” 

 

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As we have discussed, methadone can be very successful in treating addiction, and, due to its tablet form, can prevent the spread of HIV through needle use.  Currently, there are nearly 1 million people in Russia living with HIV, many of which contracted the disease through unsanitary needle use.  Methadone, however, is illegal, and with the increasing control of the government on the information provided to the citizens, soon addicts will be unable to gain information on treatments alternative to “narcology” – an abstinence-based system, which has been shown to be largely ineffective, and even harmful. 

            While censorship has been an ongoing problem in Russia, it becomes even more concerning when it impedes upon the rights of citizens to access medicine and information on healthcare.  The right to information seems to be key here, as without knowing their options, heroin addicts are left stigmatized and forced to quit their habit “cold-turkey” (most, obviously, will not). 

            This example, along with the problem of access to morphine, demonstrates how tightly the war on drugs is wound with human rights and the global access to medicine.   We are, once again left asking the questions: do drug addicts have the same rights to healthcare and information as others?  Does the government have a right to withhold information, in fears that the information may lead to a rise in drug use, as opposed to a decrease? 

Thus far in our discussions of health and human rights I have noticed two things. The first, is that we often, unintentionally, fail to mention the human rights concern right here at home. The second, is that we have been discussing physical health concerns, while the rhetoric of the documents released by the various councils have mentioned that mental health concerns are just as important.

This week there was an article in the Washington Post regarding a hearing that took place due to the lack of assistance given to American veterans in dealing with mental health issues.

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Following our discussion in class about the rights of prisoners, I came across an article by Mary Carmichael that discusses many of the issues that were brought up  about treatment for drug addicts in jails.

The article discusses some of the key issues related to the rights of drug addicts, in which the question of treatment for addiction in jails goes beyond that of providing medical care, but on if drug users, considered criminals, should be subject to the same human rights as anyone else.

The article quotes Amy Nunn, a professor of medicine at Brown University, explaining that “In spite of all of the proven clinical and social and economic benefits of pharmacological treatment, people really have a moral opposition to it…They think if you’re providing people with treatment, you’re not addressing their addiction in an appropriate way. They think people who have addictions deserve what they get, and that the only way to treat addiction is abstinence, when nothing could be further from the truth.”

After researching extensively about this topic for my final paper, I have come to agree with Dr. Nunn that many people just cannot get away from the desire to blame the users for their addicted state, and this leads them to believe that they deserve to be punished for the weakness of their choices. When discussing their rights in jail, many people thus do not see the need to take significant steps in helping addicts recover, or let alone fund their treatment.

In contrast to Carmichael’s article about the necessity of treating addicts as patients in need, an article by Dr. Theodore Dalryample expresses the opposite view that we should not perceive addiction as an illness and that we should stop spending our money trying to treat it.

The author here claims that addiction is constructed as a disease but that it is in fact a moral problem, not a medical one. However, this article has a reoccurring fundamental flaw, in my opinion, which is often used to support the claim against viewing drug addicts as victims of their condition– It claims that the only reason addicts continuously engage in drug use is because of their fear of suffering the temporary physical withdrawal symptoms. This implies that addicts act cowardly and weak by not “toughing up” the consequences of drug-withdrawal in order to rid of their habit. This is an overly simplistic and naive way of looking at drug addiction, as anyone who has met a person with an addiction, ranging from heroin to even caffeine, knows that the psychological complexity of addiction goes way beyond the mere physical consequences of withdrawal. To me, this perspective undermines the importance of mental health as compared to  physical health, as it fails to recognize the necessity of treating physical, psychological, and mental conditions aspects of well-being equally. It also fails to acknowledge the complex environmental and social factors that play into addiction and the difficulty of recovering from it.

As long as people continue to blame addicts for their immoral actions of drug use, they will not consider them worthy of full human rights, and will not take steps to assure that their rights to health and dignity are provided. But referring again to rights of prisoners, even if drug-use was in fact immoral, criminal, and harmful to society–is it still right to deny people certain fundamental human rights?

 

During my years of public school, and specifically during middle school and high school, I played highly competitive sports; running as a track athlete in state and national meets, endurance training and running all across New York, as well as playing on a US Soccer team in the Netherlands and playing against college and professional Soccer teams in the US. Through all of that, I cannot recall ever even considering to use drugs as a go-to means of assisting my performance, or preventing something that might not even occur. I recall hopping into a bucket of ice for a few minutes, occasionally rubbing icy hot on some of my burning muscles prior to sleeping, and I remember guzzling liter after liter of water, but not once did it ever occur to me to subject myself to the use of a drug, a man-made  medical creation intended for prescription use, as a means to prevent a feeling of pain, (to some extent any feeling in a given muscle at all) or to avoid hindering my performance. New York Times’ writer’s Ken Belson and Mary Pilon discuss the evolving cases of current NFL teams with their partial prophylactic use of anti-inflammatories, specifically Toradol, in the recently published article “Concern Raised Over Painkiller’s Use in Sports.” Of course this is not the first time we are seeing concern of drug-use in Sports, though I find this article especially intriguing while highlighting this over-arching phenomenon that so many (foremost) westerners hastily look to medicine for an answer to their health-related problems, or in some cases potential problems, prior to the consideration of any other form of assistance. Belson and Pilon make a critical point in abstracting the concern yielded by medical professionals on the “how” anti-inflammatories are being used among professional athletes. Often do people neglect use of their own intuition, or intelligence, et cetera, and habitually, without even taking a slight glimpse at their own actions, ask for or accept (medical) assistance.