Prescription drugs: a major health risk

Prescription drugs, even when properly prescribed, rank fourth along with stroke as a leading cause of death. About 128,000 people die every year from drugs prescribed for them. The drugs cause about 1.9 million hospitalizations a year, and about 81 million adverse reactions. The FDA itself states that “adverse drug reactions are one of the leading causes of morbidity and mortality in health care.”

Just because a drug has been approved by the FDA doesn’t mean it’s safe. The risk of serious adverse reactions that occur after approval is one in three. The most infamous example was Vioxx, an FDA-approved drug which experts say caused about 120,000 traumatic cardiovascular events and 40,000 deaths. The drug is no longer on the market.

May favorite drugs to hate are statins. While deaths from these drugs are uncommon, in the US statins have been linked to 3039 cases of rhabdomyolysis over twelve years. (With rhabdomyolysis, muscle fibers break down and release their contents into the bloodstream, some of which are harmful to the kidneys and may lead to kidney failure.) Two hundred and forty of these cases resulted in death. I guess that’s a small number considering the millions of people who take the drugs, but 250 deaths is not nothing. What’s more, because a common side effect of statins is muscle pain and weakness, the drugs are a frequent cause of falls in elderly people, which often lead to the slippery slope of death following hip fractures.

The reasons for the high mortality rate are the high prescription rates. In 2016, over four billion prescriptions were filled in the US. That’s about 12 prescriptions for every person in the country. Sixty-four percent of all patient visits to physicians result in prescriptions (this was in 2000; it’s probably much more now). Adverse drug reactions increase exponentially after a patient is on four or more medications.

I am so mistrustful of drugs that I take none. Seems safer that way.

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Non-profit hospitals: yeah; right

Because most hospitals are non-profit, they pay almost no property taxes and no federal, state, and local payroll taxes. Had they made such payments in 2011, for example, it would have amounted to $24.6 billion. In truth, not-for profit hospitals are just as profitable as capitalist corporations, but the excess money they acquire isn’t called “profit.” It’s called “operating surplus.”

To maintain their non-profit status, they are required to provide “charity care and community benefit,” so the trick is to keep the tax benefit while spending the least amount possible on charity care and community benefit. One provision of  the Affordable Care Act (Obamacare) is the requirement that hospitals provide quantitative accounting of their charitable activities.  (Prior to the Act, they could just provide a brochure or something similar.)  Even with the new provision, many, if not most, are not providing near the amount of charity care that would justify their tax exemption. For example, 196 hospitals in California received $3.3 billion in state and federal tax exemptions but spent only $1.4 billion on charity care. They use various strategies to prove “community benefit, such as  “spurring the economy” with construction jobs, or creating a “healing garden.” What’s more, hospitals who care for charity cases are compensated by a federal program that allows them to buy all their pharmaceuticals at a discount, and Medicare gives them bonuses for treating higher numbers of poor people.

Some cities fight back. For example San Francisco passed a Charity Care Ordinance to ensure that hospitals do what’s right. For one thing, approval for new hospital construction depends on a review of the hospitals’ charity performance. In one instance, Sutter Health, had to agree to a variety of conditions, including spending at least $86 million per year on charity care, Medicaid, and services for the poor. All in all, the final package came to $1.1 billion. Apparently the price was worth it to hang on to its tax-exempt status.

Incidentally, the New York Times Magazine recently ran full-page ads for three hospitals, at the cost of $107,000 each. Mt. Sinai pays at least this amount weekly for a back cover ad. To me, that's immoral.

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A pox on health insurance companies!

Before insurance companies became profit-making enterprises, they generally spent 95 cents out of every premium dollar on medical care. That percentage is called their “medical loss ratio.” After becoming huge money-making businesses in the ‘90s, their medical loss ratios went as low as 64.4 (Texas Blues). In other words, Texas Blues spent 64.4 percent on medical care and 45.6 percent on marketing, lobbying, administration, paying dividends, and astronomical salaries for their CEOs. (WellPoint’s Angela Braly “earned” $20 million in 2012, for example.) Insurance companies’ priorities are their investors, not patients.

Consider this: Medicare uses 98 percent of its funding for healthcare and only 2 percent on administration. To try to bring insurance companies closer in line with Medicare, framers of the Affordable Care Act (Obamacare) included a provision requiring them to spend 80 to 85 percent of every premium dollar on patient care. The insurers fought bitterly against this provision. Nevertheless, it was included in the ACA and hailed as a victory for consumers. But it wasn’t, really. To make up for the loss, companies simply increase premiums, co-payments, and deductibles. In 2015, Anthem Blue Cross raised premiums on some of its California ACA policies by 25 percent.

 Making big payouts to medical providers is no problem for the companies. The bigger the payout, the bigger their slice of the pie. Even with the 80 percent they are required to spend on the cost of the medical care, they can make big bucks on big payouts. If their payout is $100, they can keep $20 of the premium dollars. But if their payout is $100,000 they keep $20,000. As one owner of an employee benefits company says of insurance companies, “They don’t care whether the claims go up or down 20 percent as long as they get their piece. They’re too big to care about you.”

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The government's dietary guidelines: ignore them

Every five years, the government puts forth the “US Dietary Guidelines,” which have a big influence on nutrition education and food labeling. The problem, as explained by Nina Teicholz in the British Medical Journal (BMJ), is that the guidelines are misleading and not based on sound scientific evidence.

The guidelines are put together by a committee of 11-15 experts who seem reluctant to consider any evidence that contradicts the last 35 years of nutritional advice. What’s more, many committee members have financial interests in various food and drug companies, such as Unilever. The chairman is the president of a company that offers health advice. Rather than using rigorous methods for reviewing scientific data, the committee relies on professional associations, especially the American Heart association and the American College of Cardiology (this outfit received 38% of its funding from industry in 2012).

Unsurprisingly, the most glaring topics for which the committee ignored scientific evidence had to do with saturated fats and low carbohydrate diets. It strikes me that the committee members just can’t bring themselves to say that it’s OK to eat saturated fats and that eating all those grains may not be that great after all. It would be admitting that they’ve been wrong all these years—and they have been. Huge studies have proven that there is no link between eating saturated fat and heart disease. For example, the largest nutritional trial in history, the Women’s Health Initiative that studied 49,000 women showed that a diet low in fat and saturated fat is ineffective for fighting heart disease, obesity, diabetes or cancer. This study has been confirmed by many more. As to the efficacy of a low carbohydrate diet, a meta-analysis of 113 studies have concluded that low carbohydrate diets are better than other nutritional approaches for controlling type 2 diabetes.

I have long believed, based on my own research, that eating saturated fat won’t give you a heart attack and a diet low in carbohydrates can help prevent diabetes. Those are my own biases. I know I am right.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.