Monday Musing for Monday March 3, 2014
Volume IV, No, 9/165
Thinking Things Through
By Assad Meymandi, MD, PhD, DLFAPA*
Inventing Disease To Sell Pills
I have spoken against the unholy alliance of medical-pharmaceutical complex. The alliance seems to medicalize all social ills and treat them with pills. Fortunately, our medical profession is doing away with free lunches, free trips and free favors provided by drug companies. Yes, in medicine, we do have waste, duplication and in some instances, fraud. The US medical system is broken and expensive. It is eating 17 % of the gross domestic product (GDP) annually. However, the line must be drawn. I am referring to the recent decision by US Preventive Health Service (USPH) and Food and Drug Administration (FDA) to disallow prostate specific antigen (PSA) test for cancer of prostate. In the US, there are roughly 250,000 patients with cancer of prostate annually of whom about 10%, or 28,000 die. Cancer of prostate is one of the most painful types of cancer especially if it metastasizes (spreads) to the adjacent pelvic bones. PSA is a reliable test to measure the rate of progress in prostate cancer. If the values shown by the test are rapidly elevated from year to year, more aggressive treatment is indicated.
The rational for disallowing the test is that all men will get cancer of prostate if they live beyond 80. USPA and FDA suggest that since there is only a small percentage of the afflicted who die, it is much too expensive to run tests and do procedures on a relatively non-lethal disease. The denial of testing is a cost saving measure.
No, I am not a urologist. No, I am not writing to suggest how wrong it is to disallow this vital test because I am on the north side of 70, and am slowly approaching the decade of octogenary. I write because I believe it is fundamentally wrong to politicize the medical profession. Disallowing PSA test is the start of a slide on the slippery slopes to ultimate formation of “Death Panels” designed to determine who gets dialysis, transplants and ventilators. Let’s not pursue that ominous path. American government is not a socialized monolith, nor should it be allowed to become one.
Alcohol and College Age Students
While prohibition is often counterproductive, I believe the answer to binging, abuse and unreasonable use of alcohol is education. The answer also lies in curtailing greed and hunger for money. The university leaders ought to cut out advertising of beer from all TV sports. It is sheer greed to have alcohol products sponsoring sports events, and it is sheer hypocrisy for university leaders to tolerate this practice because it produces revenue for their institutions. Ban alcohol ads from all television sports.
A Brief History of Duke
Next time you are in Scotland, be sure you will take the time and visit Edinburgh Botanic Garden, (they call it Botanic and not Botanical Garden), all 300 acres of plush land every inch planned and designed to perfection. They have trees as acrobatics twisting around boulders and walls. The trees and shrubs look like dancers doing the ballet of life.The air in that piece of heaven is pure-bearing the promise of eternity and the ether of many tomorrows. It is in many ways a replica of Angkor Wat of Cambodia.
A bit of history:
327 years ago, the plot of land—the Botanic Garden of Edinburgh–was used to plant the pharmacopeia for Edinburgh Medical School. They had foxglove (Digitalis), opium, sunflower seed oil, tarragon and other herbs. Four of the Edinburgh Doctors came to US to start the Johns Hopkins University, and in 1931, four of the JH’s University physicians came to NC to start Duke Medical School. An aside, one of the four was pathologist, Dr. Wiley Forbus whose daughter George Ellen married Raleighite Duke medical student, who became a psychiatrist, the late Wilmer Betts—we used to tease Wilmer that he married the professor’s daughter so he would get a passing grade in pathology. So, Duke and North Carolina have a direct intellectual and professional connection with Scotland and Edinburgh University
Canary And The Mine
It seems that the arts and humanities are the canaries and the mine, the first victims of any tight budget. The recent elimination of music programs in Peace University and Meredith College, without any public hearing and discourse, was appalling. I learned about them through the pages of our Raleigh News and Observer, only after the ugly and unwelcome deed was done. I do hope that the new administration of both these fine and historic institutions of higher learning will revive their programs of the arts and humanities.
Tobacco Should Be Regulated By FDA
I strongly disagree with Senators Richard Burr and Kay Hagan in their united front against stricter regulation on tobacco as reported by the press. Congressman Henry Waxman, whose voting record waxes and wanes, got this one right. Food and Drug Administration should be in charge of regulating tobacco products and the tobacco industry. Tobacco is a killer. It is a dangerous drug. Growing tobacco is not any different from growing coca leaves to produce cocaine. Why we have such an ominous and morally bankrupt double standard for nicotine is beyond any reasonable thinking. And why the two NC Senators have taken a leave of their common sense and oppose the much-needed regulation proposed by other solons, is confounding. We need to treat tobacco the same way we treat cocaine.
*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He serves as a Visiting Scholar and lecturer on Medicine, the Arts and Humanities at his alma mater the George Washington University School of Medicine and Health.