Pharmaceuticals: cost, choice, medical collusion, adverse reactions in patients

I was most interested in this article published in The Age to-day under Dan Harrison's by-line.

I have written to Dan and the letter is set out below.  I would love to hear from others with similar experiences.

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Dear Dan,

Would have liked to submit this as a comment on your article in The Age but could not find somewhere to do it.  That's why I am writing to you as author of the article.

I am an Aged Pensioner with a Health Card.  When I go to the chemist to get a prescription filled, I am asked whether I am happy to have a generic brand.  I always agree to generics.

Q:  Is this me doing something for the Federal Budget or does it not make one iota of difference?

My understanding is that in being offered a generic, I am being asked to accept a product which is in the same pharmaceutical class as that prescribed by my medical practitioner.

Q:  Is this correct?

I have grave distrust for pharmaceutical companies.  From my research on the internet, I understand that major pharmaceutical corporations are not allocating funds to research as well they might considering the large profits accruing from some of their best-selling drugs.  Instead, the PCs  look for other uses for their drugs.  

As well, because of collusion between medical practitioners and pharmaceutical corporations, virtually no attention is made to adverse reactions to pharmaceuticals in patients.  As an instance of this, I give you Lipitor manufactured by Pfizer.  I was taking Lipitor and other medications including nutrition supplements (some of these prescribed by my GP).  I was 66 years of age at the time.  I am 69 this year. I was most unwell and going downhill fast.  I thought to myself: I am on all these medications which, supposedly, are to make me well.  I was so unwell that I was on a walking stick.  Too reach out to turn a light switch on and off hurt.  I could not put my bra on in the time-honoured way.  It was too painful.  My shoulders hurt so much.  I had to fasten my bra at the front and then twist and turn to get it on correctly.  

I made a decision - without telling my GP.  I went off all medications - even vitamin pills.  

I sent the list of my medications to a pharmacist I knew.  He emailed back and said: I think it's the statin.  The statin was Lipitor.  After a few days without my medications, I began to feel better.  After a week, I was becoming markedly better and continue to be so.  I gradually re-introduced everything except the Lipitor.  Things remained OK - so, clearly, no culprits there. Definitely, the statin!  

After a month, I went to my GP and told her.  Oh, yes, she said, you can get a few tweaks and twinges on Lipitor.  I have refused Lipitor ever since.  This drives whoever is my GP at the time nuts!  Could tell you a few more stories about medicos and statins but you get the drift.  

There is a reason I have taken time to explain this experience.  That is the unscientific attitudes of the medical profession and their collusion with pharmaceutical companies.  You see, there is nowhere that I have been able to find - and I have searched and asked - somewhere to report adverse reactions to pharmaceuticals.  One GP who I complained to about this said: That's because we already know the contraindications.  My response was: Yes, you may know the contraindications but you don't have any data on how many contraindications to pharmaceuticals there are in Australia; whether the numbers are going up and down; their dispersion by geography, gender, age etc.  

Q:  Can you do a story on the this topic? 

Lipitor is not the only pharmaceutical to which I have adverse reaction.  The other is an antibiotic called Macrodantin.  Because of this medication, I ended up hospitalised with asymptomatic pneumonia (otherwise known as Walking Pneumonia because it doesn't have the same painful symptoms as ordinary Pneumonia). When I got out of hospital and recovered after this most debilitating illness, I looked up on the product site the contraindications for Macrodantin.  Turns out that one of the obscure reactions is Walking Pneumonia - one of the SARS group.  On admission to the hospital, I mentioned that I felt it may be an adverse reaction to Macrodantin.  No one discussed this with me.  No one came back and said we researched this and we found out that what you are suffering could be an adverse reaction to the drug.  In short, no one wants to know. Why?  In the absence of any other reason that I can think of, I consider it is because of collusion between medicos and pharmaceutical companies.  I would not be surprised to find similar collusion between governments and the aforesaid pharmaceutical companies.

I mentioned that I am an Aged Pensioner.  I have formed the view, based on my adverse experiences, that - as far as pharmaceutical companies are concerned - the aged and the chronically ill are repeat business; the same sort of repeat business that gambling, alcohol, and tobacco produce with the exception that the doorway to this repeat business is a university educated medical practitioner.  

I have described to you adverse reactions to two drugs.  You could also investigate the repeat business of anti-depressant drugs such as Effexor.  I am pleased that these drugs are there to help.  I have a family member who has been on Effexor for years.  She had tried to get off the drug and ended up hospitalised.  Last year she eventually did it - with the support of a helpful partner and a helpful website who gave a strict regimen for how to do it.  As the family member said, getting on Effexor is easy.  Try getting off!  Repeat business you see.  

Most ordinary citizens don't seek out prescription drugs to abuse.  People are actually abused by professional collusion.  One of the factors, I believe, is that such professionals forget that they are in professions based on science.  In science - even sociology which is part of my uni degree - one learns about the bell curve.  It seems that our medicos have forgotten this little fact: a bell curve has a lot of numbers at the top (where most people are at) but there are smaller numbers either side (the exceptions to the majority rule).  Medicos that I have struck seem to forget there are exceptions.  That people like me exist.

Back to the Grattan Institute. I have a suggestion.  If govt is to do precisely what GI want and save billions, then I want a Consumers Medical/Pharmaceutical Research Institute established and managed by government - not the medical or pharmaceutical institutes or corporations - which is based on the experience of consumers in the medico-pharma industry.  Now that might prove to be a good return on investment!

Lastly, I would refer you to this program from ABC's Catalyst: http://www.abc.net.au/catalyst/stories/2981241.htm

I particularly love this quote from the Catalyst program:

Prof David Le Couteur 
One of the joys of geriatric medicine is stopping medications and seeing people get better. We have phoenixes that rise from the ashes in geriatric medicine unlike any other specialty. People who come in that are very unwell and by the simple intervention of stopping medications we see people get better.

Would love to hear from you, @DHarrisonAgeSMH, that you can do a Walkley Award winning story about all this.

Aussie healthcare - becoming unaffordable and inaccessible? #healthaccess #prescriptions #affordability #accessibility #abs #statistics

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Scary news to-day about how and if we can access health services in Australia and how many of us don't get prescriptions filled because we can't afford it.  

This scares me - and I am sure it will many Australians - because I am so ready to condemn the USA because of the experiences of poorer Americans.  

I am in receipt of that well-known arts subsidy, the Aged Pension.  What I read to-day makes me feel as if I am living in the lap of luxury.  I am bulk-billed at the doctors and my medication, by and large, is subsidised through the PBS and my GP, where she can, takes care to prescribe nutritional supplements so that they can be cheaply obtained.  In the USA, there are aged people who cross the body to Canada to smuggle (coz it's against the law) their pharmaceuticals back into the USA because of cost.  

I am sure Australians will be shocked - because this is why we have Medicare Australia, so we think. I am sure that Australians living in poorly surviced areas in rural and regional Australians will be exasperated - but perhaps thankful that there are statistics to push in the face of governments across the continent.

For further details, please download the Australian Bureau of Statistics document below:

Doctor's order: how do you get your medication in the bush?

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We will from time to time, Networkers, hear of shortages of doctors in regional, rural and remote Australia.  How often do you hear of the availability of pharmacists in these same areas?  

So much is taken for granted in the urban populations which dominate our political processes.  But out there, at the back of beyond, there are people - people who are citizens just like the urban populace but who have a difficult time accessing the most basic of services to which they should have an entitlement.  Unsung in this battle for services is access to having prescribed medication in the community in which you live.

You can get insights into this issue if you read the experience of Robbo over at Biting the Dust.  Robbo is in such a remote area it is not even one of the dots on the map above.  .

PUBLIC HEALTH CARE IN AUSTRALIA: A PERSONAL EXPERIENCE FOR CITIZENS OF THE U.S.A. WHO THINK PUBLIC HEALTH CARE IS EVIL OR SOCIALIST

Here is the website of Medicare Australia

My forty-five year old daughter arrived back in Australia on Thursday night from a beautiful ten-day holiday in Malaysia. She had become ill on the day of departure with what she believed was food poisoning. She didn't emerge from her bedroom yesterday. Then, about 4pm yesterday, Friday, I am sitting in my office next to her bedroom. I could hear her shivering and groaning. The short version is that I got her to the Emergency Department of one of Melbourne's major public hospitals just fifteen minutes from our home.

I won't bore you with a blow by blow description but her illness was treated seriously. In fact she did not make it into a hospital bed until 8.30am this morning because her condition was difficult to stabilise and at one stage it was thought that she would have to be prepared for surgery. Finally, she made it to the ward and, because of her condition, was placed in a private room with ensuite. The majority of the beds are in four-bed rooms. At this stage, I don't see my daughter coming home before Monday at least. She is still very, very ill and is receiving drip after drip with anti-biotics and the nurses continue to take heaps of blood from her for testing.

My daughter and I believe that she is receiving the best of treatment appropriate to her condition. Over her bed is a list of four streams of medics who work in this ward. The streams comprise teams of four doctors, two of whom are Associate Professors. Clearly, there are experienced people on hand for consultation.

And all of this will not result in a bill - not for the hospital bed; not for the medical and nursing care; not for the pharmaceuticals. My daughter carries no health insurance. She, like all tax-paying Australians, pays what is known as the Medicare Levy. This is paid annually when individuals submit their income tax return and is calculated as a percentage of income. Australians receive a green plastic card with an identifying number. All that had to happen at the hospital is that my daughter presented her Medicare Card.

Australians can also take out medical insurance which will cover them over and above Medicare for treatment by a private practitioner in a private hospital. My daughter choses not to carry private medical insurance. And the majority of Australians have to be cajoled, encouraged, and all but co-erced into taking out private insurance - because Medicare meets adequately the needs of the majority of Australians. In fact, it is often stated that should individuals need emergency care such as being involved in a road accident, they will be taken - irrespective of private insurance - in the first instance to the emergency department of a public hospital and their care from then on will be all that could expected - and all on Medicare.

In addition to Medicare, Australia also has the Pharmaceutical Benefits Scheme. The elderly in this country do not have to make criminals of themselves by smuggling in cheap pharmaceuticals because otherwise they would be deprived of adequate medication. The Pharmaceutical Benefits Scheme provides prescribed medication (not all, but most medication needs by most people) at reasonable prices to Australians.

As a person in receipt of the Aged Pension, I pay a small co-payment only. For instance, I can purchase Ventolin for my asthma over the counter. But my medical practitioner writes me a script for this pharmaceutical and its costs me only the co-payment. This makes a lot of difference for me.

It is important for procedures to have a Medicare number. A major development in the last few years under the Howard Government (the Conservative side of politics in Australia known as the Liberal-National Party Coalition) was the introduction of a process of Health Care Plans in Australia. Health Care Plans were open to individuals who suffered from two or more chronic conditions and was worked out with the patient and their medical practitioner.

It means that the services of allied health care professionals can now be accessed under Medicare when previously the cost of these services would be met entirely by the individual. I can now access, should I wish or need them, podiatry; psychology; dietary and nutrition; and dental services. Dental services were the most important to me. Dentists have dodged any Medicare involvement. This has been of increasing controversy as it has become clear what impact poor dental health has upon overall health of individuals.

The Howard Government adopted a health care plan which I could access through my local Community Health Service. These Services are widespread in my home state of Victoria. The new program entitled me, on referral from my medical practitioner under my Health Care Plan, to $4,250 in dental care. This came at a time when I need a lot of dental work which I could not afford. I was able to get all that I needed done. Although my wonderful young dentist (my own choice from a list available) did say that he did exceed the $4,250 cost. By how much, I don't know. Needless, to say I was impressed by the new program. Not only for myself. I felt a young dentist starting out in his own practice was able to get a boost in business as well.

I have written all this for citizens of the USA to read. Australians know all this stuff and have lived with it for a long, long time. A lot of the medical profession whinge about it. Many on the conservative side of politics would like to alter it if not eradicate it. However, they know that Australians are in favour of Medicare and they dare not tinker with it. In fact, years ago - when the conservative politicians used to try to tinker with it - their attitudes failed in practice and cost them votes. So Medicare is here to stay in Australia. As for the Pharmaceutical Benefits Scheme, Big Pharma works to get its stuff on the PBS lists so it can make a killing. However, in an attempt to balance this, consumers have the opportunity to specify a cheaper generic brand when one is available.

At this time, those of us outside the USA are hearing the most stupid, lying things being said against Public Health Care in the US debate. All this fulfil's one's worst prejudices about Americans. The USA is the only developed country in the world that does not have public health care. Not only that, through work related medical insurance, it adds an impost to the cost of doing business. Strange that, in such a capitalist country.

I once heard that, averaged out on production units, at General Motors the cost of medical insurance per vehicle came to more than the cost of steel in each vehicle. How silly is that! Then was there no competent actuary to draw attention to the fact that, with retirees continuing as members of industry based medical insurance companies, there would come a time when there were more non-productive than productive members of the insurance plans? How strange is that!

So citizens of the USA, do you really think the citizens of Europe, Japan, Canada, Australia, New Zealand are prize idiots? Do you think we don't know a good deal when we see one? Do you think that we lack compassion for those on lower or no incomes?

And do you really think this is a socialist or communist idea? Well, only if you are an ignorant bigot. In Australia, we wanted a system that was fair for all; where health care would not be just for those who had sufficient resources to afford it. We wanted young families stricken with winter illness to front up for medical care without a thought about how or if they could afford it. We wanted young families to be able to go to the pharmacy and get the medication they need. That's socialist? That's communist? No. It's compassion. The compassion of Christ. The compassion of Buddha. The compassion of a shared and common humanity.

So, citizens of the USA, you - as with all of us - are accountable for your actions. You will be accountable in relation to the compassion you demonstrate; the lack of knowledge and stewardship you exhibit in relation to your ability to have both; the lies you accept and promulgate. Please consider and re-consider.

In this wonderful Land of Oz, we have a phrase - the fair go. We want to see everyone have a fair go. We don't like people who get in the way of people having a fair go. In fact, we do our block. (Loose our cool, get angry.) So Americans, give your fellow citizens a fair go with medical and dental care and pharmaceuticals. Take the load away from business and put it squarely across the taxpaying public (at the same time considering whether you have a fair taxation system). You won't regret it. You will free up a lot of human resources who are now hamstrung by debt and poor health. So get over the bigotry; forego the lies and give yourselves a healthy future.