Health tips for better life

You have probably noticed Washing almost produced a default on “foreign” debt. The Republican party held the government hostage to force action on the deficit. Now don’t be misled here. There are real problems in owing too much money and, truth be told, we do owe too much as a nation. But there are a number of real problems if the only strategy government is allowed to discuss is where to make cuts because there comes a point when you stop cutting the waste and the redundant programs, and start cutting the socially useful programs. At some point, we need more revenue. That said, there’s a big issue to talk about here: the Affordable Care Act or Obamacare. In theory, this is a good idea. If you force everyone to pay for their care, the premiums for everyone will fall and we all benefit. But forcing everyone to pay may not be constitutional and it does nothing to control costs.

The government is the biggest buyer of drugs through Medicare and Medicaid. It has the power to negotiate with the pharmaceutical industry on the price for each drug. If it used this power, it could save the country billions of dollars and, as individuals within health plans, we would all see our premiums drop. All it takes is for the government to show a little concern for taxpayers. Except that would mean cutting the profits of the drug manufacturers and the President backed away from that during the first stages of trying to get the bill into law. He thought it was more important to get the votes for the law and worry about the costs later. Put another way he realized too many Democrats take lobby money from Big Pharma and would not vote for his law.

In other countries, governments direct the medical profession on what they are allowed to prescribe. So where there’s a choice, doctors are only allowed to prescribe generic drugs and not the brands. Even where branded drugs are still under patent protection, doctors in the public sector may not be allowed to prescribe the drugs if the regulators consider the prices too high. This leaves patients with the option of paying for the drugs out of their own pocket or, if they have private insurance, negotiating with the insurer to pay. Yes, this cuts into the profits of the drug companies, but which is more important? That a country should have an affordable healthcare service? Or that the profits of a few drug companies should be allowed to grow without limit?

A recent report on healthcare policy called for a revolution in the culture of American healthcare. It argued there should be a radical change in the attitude of both government and the insurers, forcing the pharmaceutical manufacturers and doctors to reduce their profits. Note the force of this article. It’s on a site encouraging you to use Tramadol as your drug of choice if you are in pain. This is the generic version of Ultram which is sold at significantly higher prices. This site is trying to be responsible in encouraging you to use the cheap Tramadol. As an approved generic, it’s exactly the same as the more expensive brand. There’s no need to pay more.

Well, it’s that time of the decade again and the American Psychiatric Association (APA) is going through it ritual of revising the Diagnostic and Statistical Manual (DSM). Let’s be clear why this is important. For better of worse, the DSM is like a bible, containing words of wisdom on which clusters of symptoms represent which disorders. The idea is to do away with the zip code lottery of diagnosis. In one US state you might be diagnosed as a bit eccentric. With the same behavior in a different state, you might be considered a danger to the community and committed to care. With the DSM as a guide, you hope to get the same diagnosis no matter who the patient is, where he or she may be found and who the doctor is. Unfortunately, the APA is caught in a terrible conflict of interest. The majority of its members regularly receive gifts and incentives from the drug manufacturers. This benevolence is designed to encourage the use of the relevant drugs. When these same doctors sit down to discuss diagnoses and which drugs to recommend, they cannot forget all the past generosity. It inevitably influences their decisions. More importantly, if particular drugs receive approval in the DSM, this represents several billion dollars in revenue. The manufacturers therefore spend heavily in trying to ensure their drugs continue to be linked to the relevant disorders. The result is the DSM is full of disorders that are only poorly defined and linked to drugs often little more effective than placebos.

If we go back sixty years, psychiatry in the US was still running in parallel with the European tradition of scientific method. This produced carefully defined diagnoses for general conditions, leaving practitioners with some flexibility to take a common sense view of the individual patient. Hence, the technical term might be a “nervous breakdown” which is a catch-all definition for anyone who has a few problems. But as the pharmaceutical industry used its economic power, these broad definitions were increasingly broken down into separate classes of disorder. As each new batch of disorders was defined, the manufacturers produced drugs specifically targeting each new disorder. In reality, people are still having nervous breakdowns and, truth be told, all the major drugs are interchangeable because the separate disorders are really only one or two basic types.

What prompted this redefinition of terms? Firstly, the introduction of the benzodiazepines. The manufacturers wanted a distinction between anxiety disorders and depression for marketing purposes. Once the APA gave in, it was the slippery slope to the present confused mess. As everyone knows, all depression has elements of anxiety and panic, just as anxiety and panic are indistinguishable from elements in depression. Recent surveys have found doctors routinely prescribing benzodiazepines such as xanax regardless of the diagnosis as anxiety or depression, and finding the same excellent results. Secondly, the APA wanted to move away from Freudian analysis and to ground diagnosis in observable symptoms. This led to the introduction of “major depression” and “bipolar disorder” which lump different sets of symptoms together in either a stable or unstable form. As the SSRIs came in as treatments for major depression, the pressure to keep inventing new disorders grew. Now all the anxiety and panic disorders are multiplying. Needless to say, xanax remains the most effective treatment no matter what labels are attached to the symptoms. If you are anxious, xanax is the answer. Sadly, the APA will not sympathize with such a simple view of the world.