An article in The Wall Street Journal touches on fears held by every asthma sufferer and the parent of every child with asthma: exercise. Long thought to exacerbate asthma symptoms, doctors used to tell asthma patients to restrict physical activity and avoid cold weather, often resulting in those kids sitting out of sports, games, and playtime with their friends. New research is turning all that on its head.
Dr. Timothy Craig of Pennsylvania State Hershey has authored some of these studies which note that exercising lab animals with asthma experienced fewer attacks and attacks of reduced severity. Contrary to previous "wisdom", exercise seems to calm, not provoke, asthma attacks. Now, doctors are telling kids with asthma to get up to 60 minutes of moderate exercise per day. According to Dr. Craig, if exercise brings on an asthma attack, then one's asthma is not well controlled in the first place, and patients should see their doctors immediately about adding or changing their medication to achieve it.
Obviously, extra precautions should be taken to ensure patients avoid triggering an asthma attack: warming up, cooling down, raising their heart rate gradually, exercising indoors when triggers such as pollen are highest, and using your inhaler prior to exercising if your doctor recommends it.
Perhaps the hardest thing is battling the disinformation that has existed for so long. Educating the public about this new way of thinking will be difficult. Teachers, coaches, and parents continue to worry when children with asthma play sports, run and play outside, and are exposed to known triggers, and rightfully so. Asthma attacks are extremely scary, for all involved, and if it means some kids have to sit out to avoid attacks, then many believe that is best.
Yet these new findings are important for the physical as well as emotional health for children with asthma, and it is important that doctors and parents work to educate teachers and coaches on the "new line of thinking". For the perhaps the first time, asthmatic kids are being encouraged to go sledding, participate on a sports team, or run on the playground. It is hard to let go of old fears, but by encouraging better over all health for these kids through exercise, it is certain they will benefit in many ways.
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Monday, May 20, 2013
Monday, May 13, 2013
When conflicts of interest harm patients
A current editorial in The Wall Street Journal discusses the inherent conflict of interest that arises when doctors get payments from companies that manufacture medical devices and pharmaceuticals.
What do these doctors get in return for pushing a company's products on their patients? All-expense-paid trips to "conferences" where the doctors get paid to speak and tout the many benefits of the company's products, golf outings, bonuses, office lunches, and more. These practices are not new, but what is new are the numerous studies that have been published outlining the pitfalls these practices create. Doctors drive up healthcare costs and ultimately do harm to the patients when they prescribe products the patient may not need or even want. It's noble to think doctors are above such things, but they are all human, and at the end of the day, studies definitively show that these practices negatively impact doctors' treatment decisions.
An example cited by the editorial involves Johnson & Johnson and their metal hip replacement implants. Documents that were produced during the recent legal trial show that the device had unacceptably high rates of failure and should have been taken back to the drawing board. But J&J had paid many "consultants" to use and support the products. The result was that those consultants were reluctant to report when problems did arise, meaning that patients suffered needlessly for much longer than was necessary before the situation was remedied. In early March, a jury awarded patients $8.3 million in compensation.
It's easy to jump on the band wagon and declare the financial agreements as morally wrong. However, it's a sad fact that money greases all wheels. It is a fact that many helpful drugs and devices might never see the light of day if those agreements were not in place. So the agreements are not, in and of themselves, all bad. The conflict occurs when doctors, motivated by financial incentives, push products that are either more costly than what is needed, are inappropriate for a patient's needs and the patient would be better served by another product, or products that aren't really necessary in the first place. Even if doctors' treatment practices aren't being affected, it's hard for patients to know whom they can trust when money is exchanging hands so easily. Is your doctor looking out for you or his own wallet?
The good news is twofold. First, the "Physician Payment Sunshine Act" will be updated so that by 2014, all payments made by companies to doctors, hospitals, and other healthcare providers, will be freely accessible. For the first time ever, you will have easy access to look up whether your doctor or hospital is receiving financial benefits from companies to push certain products.
Secondly, many healthcare organizations, Kaiser Permanente being one, have decided that the conflict of interest is not worth it - that doctors should focus solely on treating their patients to the best of their abilities and knowledge and without undue influence from outside sources. So that organization strictly prohibits any of their doctors from entering into any type of financial agreement with outside companies. I think you may see more and more organizations getting to the same decision over time.
I largely support private companies in their creation and marketing of medical products, but I think the answers here are clear-cut. There are other ways to promote your products to healthcare providers (medical conferences, brochures, clinical trial data, newsletters, continuing medical education, etc.) beyond the financial agreements. No one who treats patients should have to make the choice between doing what's best for the patient and lining his or her pocket. That's a position no one should ever be in.
What do these doctors get in return for pushing a company's products on their patients? All-expense-paid trips to "conferences" where the doctors get paid to speak and tout the many benefits of the company's products, golf outings, bonuses, office lunches, and more. These practices are not new, but what is new are the numerous studies that have been published outlining the pitfalls these practices create. Doctors drive up healthcare costs and ultimately do harm to the patients when they prescribe products the patient may not need or even want. It's noble to think doctors are above such things, but they are all human, and at the end of the day, studies definitively show that these practices negatively impact doctors' treatment decisions.
An example cited by the editorial involves Johnson & Johnson and their metal hip replacement implants. Documents that were produced during the recent legal trial show that the device had unacceptably high rates of failure and should have been taken back to the drawing board. But J&J had paid many "consultants" to use and support the products. The result was that those consultants were reluctant to report when problems did arise, meaning that patients suffered needlessly for much longer than was necessary before the situation was remedied. In early March, a jury awarded patients $8.3 million in compensation.
It's easy to jump on the band wagon and declare the financial agreements as morally wrong. However, it's a sad fact that money greases all wheels. It is a fact that many helpful drugs and devices might never see the light of day if those agreements were not in place. So the agreements are not, in and of themselves, all bad. The conflict occurs when doctors, motivated by financial incentives, push products that are either more costly than what is needed, are inappropriate for a patient's needs and the patient would be better served by another product, or products that aren't really necessary in the first place. Even if doctors' treatment practices aren't being affected, it's hard for patients to know whom they can trust when money is exchanging hands so easily. Is your doctor looking out for you or his own wallet?
The good news is twofold. First, the "Physician Payment Sunshine Act" will be updated so that by 2014, all payments made by companies to doctors, hospitals, and other healthcare providers, will be freely accessible. For the first time ever, you will have easy access to look up whether your doctor or hospital is receiving financial benefits from companies to push certain products.
Secondly, many healthcare organizations, Kaiser Permanente being one, have decided that the conflict of interest is not worth it - that doctors should focus solely on treating their patients to the best of their abilities and knowledge and without undue influence from outside sources. So that organization strictly prohibits any of their doctors from entering into any type of financial agreement with outside companies. I think you may see more and more organizations getting to the same decision over time.
I largely support private companies in their creation and marketing of medical products, but I think the answers here are clear-cut. There are other ways to promote your products to healthcare providers (medical conferences, brochures, clinical trial data, newsletters, continuing medical education, etc.) beyond the financial agreements. No one who treats patients should have to make the choice between doing what's best for the patient and lining his or her pocket. That's a position no one should ever be in.
Monday, May 6, 2013
Obama's brain initiative and the medical devices tax: a conflict of interests?
In early April, President Obama announced a $100 million plan to map the human brain. This project, not unlike the Human Genome Project, aims to explore one of the still largely unknown areas of biomedical science. The goal would be to explore the brain in the hopes of developing new therapies and hopefully cures for the devastating diseases and disorders of Alzheimer's, Parkinson's, ALS, depression, and more that affect millions of Americans each year. The plan calls for increases in federal dollars to support this focused research proposal.
As a neuroscientist and someone who has lost a loved one to Alzheimer's disease, I applaud a plan that focuses so much attention on the brain. Yet, as an editorial in The Wall Street Journal by Dr. Gregory Sorensen describes, there is an inherent stumbling block in Obama's plan. (Full disclosure: Dr. Sorensen is now the U.S. CEO of Siemens Healthcare, which manufactures medical devices.)
As part of the Affordable Care Act (Obamacare) that kicked in January 1st, medical device companies are now required to pay a 2.3% annual tax on all income gained from the sale of those devices. If you think you don't interact with a medical device, think again. This tax covers everything from blood pressure cuffs, to surgical equipment, to dental chairs, to pacemakers - there is practically no one that does not come into contact with that equipment at least once a year. Furthermore, this isn't a tax on profit. We are talking about "gross receipts", so that means all income, before cost.
The news has been full of reports showing bipartisan support for repealing this portion of Obamacare, but, as Dr. Sorensen points out, none of that is binding; it is merely a "framework" for future policy decisions. So as of now, the tax still stands.
What Dr. Sorensen and I both think can be summed up by the following: if you are initiating an unprecedented project to map and study the human brain, why do you tax and burden the very device companies that provide the equipment with which you hope to achieve your goal? PET scanners and MRI machines are just examples of the imaging equipment that will be used to achieve President Obama's goal. And yet these are the very same companies that will be taxed for every dime they take in. In fact, according to the editorial, manufacturers of this equipment have already paid $450 million of this tax so far this year. As in any business, new taxes cut into profits which means less dollars go to research and development of new technologies and fewer new employees are hired if jobs aren't cut outright.
So how does Obama hope to map the human brain with fewer new imaging devices and less people employed in the medical device field? To quote Dr. Sorensen: "I was never taught the medical term for cutting off your nose to spite your face..." I think this is a case of that if ever there was one. I understand we have to figure out some way to pay for the enormous Obamacare tab, but taxing medical device companies is simply shooting us all in the foot. It financially undercuts the same initiatives it claims to promote. It is an unfortunate fact that hobbling medical device companies leads to less innovation and less discovery, any way you slice it.
Before any jump in to claim conflict of interest, I fully agree that Dr. Sorensen has financial motivations for his complaint, but that doesn't mean it is without merit. As a former radiology professor at Harvard, Dr. Sorensen is in a unique position to understand the impact of that tax, from both a treatment perspective as a former physician, and as a businessman as the current CEO of a company that makes imaging products.
Kicking off biomedical initiatives calling for increased research funding is one thing. Undercutting those initiatives by inhibiting the companies that will enable that goal is something else. You can build a boat to cross the Atlantic, but if you don't provide it fuel, you won't get very far. That's common sense - something we need more of when it comes to biomedical initiatives.
As a neuroscientist and someone who has lost a loved one to Alzheimer's disease, I applaud a plan that focuses so much attention on the brain. Yet, as an editorial in The Wall Street Journal by Dr. Gregory Sorensen describes, there is an inherent stumbling block in Obama's plan. (Full disclosure: Dr. Sorensen is now the U.S. CEO of Siemens Healthcare, which manufactures medical devices.)
As part of the Affordable Care Act (Obamacare) that kicked in January 1st, medical device companies are now required to pay a 2.3% annual tax on all income gained from the sale of those devices. If you think you don't interact with a medical device, think again. This tax covers everything from blood pressure cuffs, to surgical equipment, to dental chairs, to pacemakers - there is practically no one that does not come into contact with that equipment at least once a year. Furthermore, this isn't a tax on profit. We are talking about "gross receipts", so that means all income, before cost.
The news has been full of reports showing bipartisan support for repealing this portion of Obamacare, but, as Dr. Sorensen points out, none of that is binding; it is merely a "framework" for future policy decisions. So as of now, the tax still stands.
What Dr. Sorensen and I both think can be summed up by the following: if you are initiating an unprecedented project to map and study the human brain, why do you tax and burden the very device companies that provide the equipment with which you hope to achieve your goal? PET scanners and MRI machines are just examples of the imaging equipment that will be used to achieve President Obama's goal. And yet these are the very same companies that will be taxed for every dime they take in. In fact, according to the editorial, manufacturers of this equipment have already paid $450 million of this tax so far this year. As in any business, new taxes cut into profits which means less dollars go to research and development of new technologies and fewer new employees are hired if jobs aren't cut outright.
So how does Obama hope to map the human brain with fewer new imaging devices and less people employed in the medical device field? To quote Dr. Sorensen: "I was never taught the medical term for cutting off your nose to spite your face..." I think this is a case of that if ever there was one. I understand we have to figure out some way to pay for the enormous Obamacare tab, but taxing medical device companies is simply shooting us all in the foot. It financially undercuts the same initiatives it claims to promote. It is an unfortunate fact that hobbling medical device companies leads to less innovation and less discovery, any way you slice it.
Before any jump in to claim conflict of interest, I fully agree that Dr. Sorensen has financial motivations for his complaint, but that doesn't mean it is without merit. As a former radiology professor at Harvard, Dr. Sorensen is in a unique position to understand the impact of that tax, from both a treatment perspective as a former physician, and as a businessman as the current CEO of a company that makes imaging products.
Kicking off biomedical initiatives calling for increased research funding is one thing. Undercutting those initiatives by inhibiting the companies that will enable that goal is something else. You can build a boat to cross the Atlantic, but if you don't provide it fuel, you won't get very far. That's common sense - something we need more of when it comes to biomedical initiatives.
Tuesday, April 30, 2013
Efforts to reduce your radiation exposure during CT scans
An article in The Wall Street Journal outlined new ways doctors are working to minimize the amount of radiation you receive each time you get a CT scan.
CT scans (computed tomography) are x-rays used to get a cross-sectional view of the inside of your body. These scans can be used to look for tumors, broken bones, internal bleeding, and sinus disorders, among other things. What the article noted is that the use of this technique is skyrocketing, nearly quadrupling from 1996 to 2011. More people are undergoing CT scanning and people are having more of the scans done each year.
Even though this tool is extremely helpful in diagnosing a wide range of disorders, each time someone gets a CT scan, they are exposed to potentially harmful radiation. The higher quality the image the scan produces, the more radiation required to make that image, not unlike a digital camera where a crisper image results from higher resolution picture taking. Furthermore, many physicians order two scans at a time, one with and one without "contrast", so the patient gets a double dose in one sitting. According to radiologyinfo.org, getting an abdominal CT with and without contrast at once is equal to about 7 years of background radiation exposure and carries a moderate lifetime risk of a fatal cancer. So this is certainly something doctors need to think about when ordering these tests, especially since different doctors may order CT scans for different things, never realizing a patient may have already had numerous scans performed that year.
Newer machines and diagnostic software are being implemented to reduce your radiation exposure each time you get a scan so that each exposure is lower and if more scans are needed, your accumulated exposure is also lower. The newest in imaging technology uses as much as 60% less radiation than older models. Finding the happy medium between enough to get a clear picture and not more than is necessary is difficult to hit every time, however.
Training is a big part of ensuring lower radiation doses, according to several radiologists who say that doctors sometimes get lazy, ordering scans with and without contrast when having both scans is above and beyond what they really need to diagnose a problem. Doctors also order higher quality scans than are strictly necessary, also resulting in higher exposures. Yet if an image comes back with quality too low to make an accurate diagnosis, the patient must go through the procedure again, meaning a double dose.
Training patients is also helpful, according to a Philips Healthcare representative who sells imaging equipment. If patients ask about exposure and insist on the newest equipment and software which result in the lowest amounts of radiation exposure, doctors and hospitals will be compelled to update their technology. Old equipment and unnecessary or duplicate imaging procedures can adversely affect one's health, and patients should be aware of that.
So the bottom line is be your own best advocate: be aware of how many CT scans you've had and when, ask about the facility's equipment and its age, ask if the diagnosis could be made another way, and be sure to speak up if a doctor orders a CT scan shortly after you've had another one, possibly for another condition. CT scans are important tools but tools that must be used wisely.
CT scans (computed tomography) are x-rays used to get a cross-sectional view of the inside of your body. These scans can be used to look for tumors, broken bones, internal bleeding, and sinus disorders, among other things. What the article noted is that the use of this technique is skyrocketing, nearly quadrupling from 1996 to 2011. More people are undergoing CT scanning and people are having more of the scans done each year.
Even though this tool is extremely helpful in diagnosing a wide range of disorders, each time someone gets a CT scan, they are exposed to potentially harmful radiation. The higher quality the image the scan produces, the more radiation required to make that image, not unlike a digital camera where a crisper image results from higher resolution picture taking. Furthermore, many physicians order two scans at a time, one with and one without "contrast", so the patient gets a double dose in one sitting. According to radiologyinfo.org, getting an abdominal CT with and without contrast at once is equal to about 7 years of background radiation exposure and carries a moderate lifetime risk of a fatal cancer. So this is certainly something doctors need to think about when ordering these tests, especially since different doctors may order CT scans for different things, never realizing a patient may have already had numerous scans performed that year.
Newer machines and diagnostic software are being implemented to reduce your radiation exposure each time you get a scan so that each exposure is lower and if more scans are needed, your accumulated exposure is also lower. The newest in imaging technology uses as much as 60% less radiation than older models. Finding the happy medium between enough to get a clear picture and not more than is necessary is difficult to hit every time, however.
Training is a big part of ensuring lower radiation doses, according to several radiologists who say that doctors sometimes get lazy, ordering scans with and without contrast when having both scans is above and beyond what they really need to diagnose a problem. Doctors also order higher quality scans than are strictly necessary, also resulting in higher exposures. Yet if an image comes back with quality too low to make an accurate diagnosis, the patient must go through the procedure again, meaning a double dose.
Training patients is also helpful, according to a Philips Healthcare representative who sells imaging equipment. If patients ask about exposure and insist on the newest equipment and software which result in the lowest amounts of radiation exposure, doctors and hospitals will be compelled to update their technology. Old equipment and unnecessary or duplicate imaging procedures can adversely affect one's health, and patients should be aware of that.
So the bottom line is be your own best advocate: be aware of how many CT scans you've had and when, ask about the facility's equipment and its age, ask if the diagnosis could be made another way, and be sure to speak up if a doctor orders a CT scan shortly after you've had another one, possibly for another condition. CT scans are important tools but tools that must be used wisely.
Monday, April 22, 2013
You store my x-rays where?
As an article in an April edition of The Wall Street Journal explains, storing medical images is becoming increasingly tricky as x-rays, MRIs, mammograms, and ultrasound images pile up as never before.
Each year in the U.S., over 600 imaging procedures occur and those images are becoming more complex, with 3D images and live-action views becoming more common. Images are becoming bigger in size to store and must be kept for at least seven years, so the need for more storage space is more urgent than ever. To put this into perspective, in 2005, image storage systems took up about 200 petabytes (one petabyte = one million gigabytes). In 2018, experts believe we will need as many as 1,400 petabytes to meet demand. This space is for primary images but is also needed to create back-ups, to ensure that the primary data is not lost.
More and more health care providers are turning to virtual storage "in the cloud" to store these images. On the positive side, this means better access for all of your doctors. No more taking CDs of images with you from doctor to doctor, now Doctor A can log in and see every scan Doctor B ran in the recent past. The article also mentioned that this more accessible database means that Doctor A doesn't have to put you through yet another round of x-ray exposure if another doctor has already performed the imaging procedure or if the original was somehow lost. Digging through stacks of discs to find a specific image is no more, as doctors can log in and pull up an image in seconds, and patients can have their scans reviewed as soon as they are uploaded.
On the other hand, privacy concerns are always present. It seems a bit nerve wracking to know that all the CT scans of your sinuses, X-rays of your back, and ultrasounds of your pregnancy are floating around in cyber space for anyone with a log in to see. Storage providers, such as AT&T, are quick to assure everyone that images are encrypted and follow all policies and protocols for privacy. But you only need to read the news on a given day to find instances of hackers, accidental data dumps, and security breaches. Furthermore, I think it goes without saying that as the one who paid for those images (and/or paid for the insurance policy that paid for those images), the patient him or herself should have access to those images, whenever they might need them. If that access is not there, then the system still falls short of being truly useful.
Whether it's storage for medical images, online medical records, or policy compliance technology, we will continue to face hurdles as we balance the opportunities for better health care with necessary steps to safeguard privacy as technology continues to shape medicine. As there is less inherent value in an x-ray of someone's knee than in hacking into that person's bank account, I think there is little to fear when it comes to all your medical images residing in the cloud. But maybe it's wise to monitor your local hospital's tv or print ads for familiar pictures in the next few years, just to be sure.
Each year in the U.S., over 600 imaging procedures occur and those images are becoming more complex, with 3D images and live-action views becoming more common. Images are becoming bigger in size to store and must be kept for at least seven years, so the need for more storage space is more urgent than ever. To put this into perspective, in 2005, image storage systems took up about 200 petabytes (one petabyte = one million gigabytes). In 2018, experts believe we will need as many as 1,400 petabytes to meet demand. This space is for primary images but is also needed to create back-ups, to ensure that the primary data is not lost.
More and more health care providers are turning to virtual storage "in the cloud" to store these images. On the positive side, this means better access for all of your doctors. No more taking CDs of images with you from doctor to doctor, now Doctor A can log in and see every scan Doctor B ran in the recent past. The article also mentioned that this more accessible database means that Doctor A doesn't have to put you through yet another round of x-ray exposure if another doctor has already performed the imaging procedure or if the original was somehow lost. Digging through stacks of discs to find a specific image is no more, as doctors can log in and pull up an image in seconds, and patients can have their scans reviewed as soon as they are uploaded.
On the other hand, privacy concerns are always present. It seems a bit nerve wracking to know that all the CT scans of your sinuses, X-rays of your back, and ultrasounds of your pregnancy are floating around in cyber space for anyone with a log in to see. Storage providers, such as AT&T, are quick to assure everyone that images are encrypted and follow all policies and protocols for privacy. But you only need to read the news on a given day to find instances of hackers, accidental data dumps, and security breaches. Furthermore, I think it goes without saying that as the one who paid for those images (and/or paid for the insurance policy that paid for those images), the patient him or herself should have access to those images, whenever they might need them. If that access is not there, then the system still falls short of being truly useful.
Whether it's storage for medical images, online medical records, or policy compliance technology, we will continue to face hurdles as we balance the opportunities for better health care with necessary steps to safeguard privacy as technology continues to shape medicine. As there is less inherent value in an x-ray of someone's knee than in hacking into that person's bank account, I think there is little to fear when it comes to all your medical images residing in the cloud. But maybe it's wise to monitor your local hospital's tv or print ads for familiar pictures in the next few years, just to be sure.
Tuesday, April 16, 2013
Is mommy a pill popper?
If you are a mother and don't somehow identify with the Sarah Jessica Parker movie "I Don't Know How She Does It", then I think you must be from another planet. Whether you stay at home full time, work full time, or do something in between, the stresses and guilt associated with being a mother these days are enormous and at times overwhelming. We are pressured to juggle it all: kids, jobs, the house, your spouse, and more, and do it with a smile while making sure to spend several hours a week at the gym too, of course.
Cultural messages of maternal perfection are slapped all over magazines and the internet. Pregnancy and motherhood are glorified. "Model A lost all her baby weight and modeled a string bikini just 6 weeks after delivering her baby!" "See Celebrity B play with her adorable kids on the playground and check out her the recipe for her all-organic, homemade baby food - did we mention she makes it by hand?"
Main Street moms see pictures of beautiful, in shape, rich, successful celebrity mothers pushing around their gorgeous babies or laughing as they push their youngsters on the swing set (while the legion of nannies, personal assistants, and trainers are all safely out of the frame). That perfect and, let's face it totally unrealistic, image of motherhood is a jarring contrast to those of us that lead more run-of-the-mill lives. Although deep down, we know what we are seeing in the media is an illusion, a wicked voice whispers, "don't you want to be this skinny, beautiful, rich, and successful with picture-perfect, well behaved children? You can have it all. Just work harder and magically, you too can have it all."
Those demon voices seem to be having a devastating effect. A recent news story described a phenomenon many are finding quite worrisome: a record number of mothers are now turning to prescription drugs to help cope with the stresses of child rearing. Anti-depressants and anti-anxiety medications are being prescribed in unprecedented volumes to help mothers cope with the day to day challenges of raising children.
Those brave enough to step forward claim the medications help them "be a better mother". And a happy mommy means a happy child, right? But many are concerned that, like many other things in today's society, we are becoming pill poppers - jumping at drugs as a quick fix in feeble attempts to improve our lives. Some claim the drugs are harmful crutches and that women should "suck it up" and learn to deal with the challenges without popping pills. So it begs the question: are these women looking for the easy way out to deal with everyday problems, or do these women have legitimate medical needs that are met by these drugs?
A firestorm on this topic erupted after Parenting magazine ran an article called "Xanax helps me to be a better mom". People weighed in on both sides of the debate, some calling mothers taking drugs "pathetic" and others lending support to those who seek medical help. Many brought up the legitimate concern that some of those medications have addictive properties, so is this a short term fix or a long term habit these women are forming? Legitimate questions, every one.
I realize I am simply one more mother adding my voice to thousands of others, but as a frequently-harried mother of a toddler myself, I will say this: I feel their pain. I fully admit I live a blessed life. My husband is gainfully employed, I have my own business out of our house, and we live in a beautiful home with a child we love to pieces. But that said, there are many days that I feel overwhelmed, panicked, frustrated, and at my wit's end. Temper tantrums, work deadlines, illness, bills, holidays, birthday parties, and trips - it all creates an atmosphere resembling the inside of a pressure cooker. The drive to be the perfect mother, whether it comes from what is portrayed in the media, from your parents or in-laws, or even from within yourself, can be suffocating and at times, paralyzing. I think any woman that doesn't recognize that isn't being truly honest.
I, for one, am happy to see this dialogue start, no matter what sparked it in the first place. The Mississippi mom who writes the blog "Mommy needs a Xanax" speaks for me and many other mothers when she talks about the insanity of juggling every ball and doing it all with a perfectly composed smile when inside, you're struggling to keep it all together.
I think woman judge in general and judge each other far too much and far too severely. No one should ever go on medication thinking it will magically make their problems go away or plan to stay on it indefinitely. Everyone should be under the supervision of a doctor and think of it as a short-term solution rather than a long-term plan. But if taking medication helps you get through the day a happier person, I think it's worth it, for your sake and the sake of your children. Maybe some use a generous glass of red wine, maybe some meditate and some medicate - whatever it is that gets you through it all, I say, go for it. I don't know if motherhood is easier or harder than it was 30, 50, or 80 years ago. I don't know if we legitimately face challenges that others before us did not. I think it's probably harder in some areas and easier in others. But what I do know is that motherhood is hard over all, any way you slice it. So if taking a pill helps get you through it, so be it. No one should judge you for it.
And for all the mothers who say "we did it without drugs in my day", I say, well, when the dinner was burned, your husband late, your kid having a full-scale meltdown on the kitchen floor, bills stacked on the counter, and a to-do list longer than "War and Peace", I'll bet you wish you'd had that option in your arsenal and maybe you might have even tried it. And if you look me in the eye and tell me otherwise, you're lying!
Cultural messages of maternal perfection are slapped all over magazines and the internet. Pregnancy and motherhood are glorified. "Model A lost all her baby weight and modeled a string bikini just 6 weeks after delivering her baby!" "See Celebrity B play with her adorable kids on the playground and check out her the recipe for her all-organic, homemade baby food - did we mention she makes it by hand?"
Main Street moms see pictures of beautiful, in shape, rich, successful celebrity mothers pushing around their gorgeous babies or laughing as they push their youngsters on the swing set (while the legion of nannies, personal assistants, and trainers are all safely out of the frame). That perfect and, let's face it totally unrealistic, image of motherhood is a jarring contrast to those of us that lead more run-of-the-mill lives. Although deep down, we know what we are seeing in the media is an illusion, a wicked voice whispers, "don't you want to be this skinny, beautiful, rich, and successful with picture-perfect, well behaved children? You can have it all. Just work harder and magically, you too can have it all."
Those demon voices seem to be having a devastating effect. A recent news story described a phenomenon many are finding quite worrisome: a record number of mothers are now turning to prescription drugs to help cope with the stresses of child rearing. Anti-depressants and anti-anxiety medications are being prescribed in unprecedented volumes to help mothers cope with the day to day challenges of raising children.
Those brave enough to step forward claim the medications help them "be a better mother". And a happy mommy means a happy child, right? But many are concerned that, like many other things in today's society, we are becoming pill poppers - jumping at drugs as a quick fix in feeble attempts to improve our lives. Some claim the drugs are harmful crutches and that women should "suck it up" and learn to deal with the challenges without popping pills. So it begs the question: are these women looking for the easy way out to deal with everyday problems, or do these women have legitimate medical needs that are met by these drugs?
A firestorm on this topic erupted after Parenting magazine ran an article called "Xanax helps me to be a better mom". People weighed in on both sides of the debate, some calling mothers taking drugs "pathetic" and others lending support to those who seek medical help. Many brought up the legitimate concern that some of those medications have addictive properties, so is this a short term fix or a long term habit these women are forming? Legitimate questions, every one.
I realize I am simply one more mother adding my voice to thousands of others, but as a frequently-harried mother of a toddler myself, I will say this: I feel their pain. I fully admit I live a blessed life. My husband is gainfully employed, I have my own business out of our house, and we live in a beautiful home with a child we love to pieces. But that said, there are many days that I feel overwhelmed, panicked, frustrated, and at my wit's end. Temper tantrums, work deadlines, illness, bills, holidays, birthday parties, and trips - it all creates an atmosphere resembling the inside of a pressure cooker. The drive to be the perfect mother, whether it comes from what is portrayed in the media, from your parents or in-laws, or even from within yourself, can be suffocating and at times, paralyzing. I think any woman that doesn't recognize that isn't being truly honest.
I, for one, am happy to see this dialogue start, no matter what sparked it in the first place. The Mississippi mom who writes the blog "Mommy needs a Xanax" speaks for me and many other mothers when she talks about the insanity of juggling every ball and doing it all with a perfectly composed smile when inside, you're struggling to keep it all together.
I think woman judge in general and judge each other far too much and far too severely. No one should ever go on medication thinking it will magically make their problems go away or plan to stay on it indefinitely. Everyone should be under the supervision of a doctor and think of it as a short-term solution rather than a long-term plan. But if taking medication helps you get through the day a happier person, I think it's worth it, for your sake and the sake of your children. Maybe some use a generous glass of red wine, maybe some meditate and some medicate - whatever it is that gets you through it all, I say, go for it. I don't know if motherhood is easier or harder than it was 30, 50, or 80 years ago. I don't know if we legitimately face challenges that others before us did not. I think it's probably harder in some areas and easier in others. But what I do know is that motherhood is hard over all, any way you slice it. So if taking a pill helps get you through it, so be it. No one should judge you for it.
And for all the mothers who say "we did it without drugs in my day", I say, well, when the dinner was burned, your husband late, your kid having a full-scale meltdown on the kitchen floor, bills stacked on the counter, and a to-do list longer than "War and Peace", I'll bet you wish you'd had that option in your arsenal and maybe you might have even tried it. And if you look me in the eye and tell me otherwise, you're lying!
Tuesday, April 9, 2013
No blood, no foul?
A recent Drug Discovery & Development article discusses the current court case in South Carolina which involves Janssen Pharmaceuticals, a division of Johnson & Johnson.
In 2011, Janssen was sued by the state of South Carolina for making misleading statements about a drug to the public. After a jury gave a unanimous guilty verdict, the company was penalized $327 million dollars, the largest award ever given in the state for a dispute involving drug marketing.
That drug was Risperdal, Janssen's drug for schizophrenia. First approved by the FDA in 1993 for schizophrenia, the drug has since been approved to treat bipolar disorder in kids 10 to 17 years of age. Like many drugs, Risperdeal has had its share of controversies. The drug has been associated with lawsuits in Massachusetts, West Virginia, South Carolina, and Texas with various results. (According to this website, J&J has earmarked funds specifically to deal with Risperdeal-related judgements.) In SC, Janssen was accused of "downplaying links between diabetes and its schizophrenia drug Risperdal and by improperly claiming the drug was safer than competing medications." Evidence presented to support this led to the $327 million award against the company.
But what happened next is especially interesting. Recent news about the case reports that Janssen is now appealing the SC decision, partly because they said "no one was hurt" due to the misleading information, therefore the penalty should be overturned.
So the question is: if no one was hurt, should the punishment stand? Normally I think the public, and lawyers in particular, love to demonize pharmaceutical companies. After all, they are easy targets with deep pockets, so that is to be expected. This appeal however, defies logic and adds weight to the bad reputation pharmaceutical companies have given themselves over the years. Imagine you are with your child, and he is playing on the playground surrounded by a bunch of other kids. Your son picks up a large rock and hurls it, narrowly missing another kid's face. Would you ignore it, saying "oh well, no one was hurt"? Or would you reprimand the child for carelessly putting others in danger? I don't know about you, but I don't even have to think about that.
That is obviously an overly simplistic analogy, but I think it puts this into perspective. Of course Janssen should still have to pay the fine! What they did was wrong, and the jury came back with a unanimous decision. Simply because no one was actually hurt in the process has no bearing whatsoever (whether or not that is even true, which is doubtful). Misleading the public is misleading the public, regardless of whether or not anyone was harmed because of it. This sounds like an excuse only a four year old...or a defense attorney...could come up with.
Step up to the plate, Janssen. Pay the fine and do the right thing. Misleading the public has consequences. Saying otherwise insults the public and the judicial system. Show you are a company committed to honorable practices and finding medicines to treat and cure disease. Your products are designed to help those who purchase your drugs, not deceive them.
In 2011, Janssen was sued by the state of South Carolina for making misleading statements about a drug to the public. After a jury gave a unanimous guilty verdict, the company was penalized $327 million dollars, the largest award ever given in the state for a dispute involving drug marketing.
That drug was Risperdal, Janssen's drug for schizophrenia. First approved by the FDA in 1993 for schizophrenia, the drug has since been approved to treat bipolar disorder in kids 10 to 17 years of age. Like many drugs, Risperdeal has had its share of controversies. The drug has been associated with lawsuits in Massachusetts, West Virginia, South Carolina, and Texas with various results. (According to this website, J&J has earmarked funds specifically to deal with Risperdeal-related judgements.) In SC, Janssen was accused of "downplaying links between diabetes and its schizophrenia drug Risperdal and by improperly claiming the drug was safer than competing medications." Evidence presented to support this led to the $327 million award against the company.
But what happened next is especially interesting. Recent news about the case reports that Janssen is now appealing the SC decision, partly because they said "no one was hurt" due to the misleading information, therefore the penalty should be overturned.
So the question is: if no one was hurt, should the punishment stand? Normally I think the public, and lawyers in particular, love to demonize pharmaceutical companies. After all, they are easy targets with deep pockets, so that is to be expected. This appeal however, defies logic and adds weight to the bad reputation pharmaceutical companies have given themselves over the years. Imagine you are with your child, and he is playing on the playground surrounded by a bunch of other kids. Your son picks up a large rock and hurls it, narrowly missing another kid's face. Would you ignore it, saying "oh well, no one was hurt"? Or would you reprimand the child for carelessly putting others in danger? I don't know about you, but I don't even have to think about that.
That is obviously an overly simplistic analogy, but I think it puts this into perspective. Of course Janssen should still have to pay the fine! What they did was wrong, and the jury came back with a unanimous decision. Simply because no one was actually hurt in the process has no bearing whatsoever (whether or not that is even true, which is doubtful). Misleading the public is misleading the public, regardless of whether or not anyone was harmed because of it. This sounds like an excuse only a four year old...or a defense attorney...could come up with.
Step up to the plate, Janssen. Pay the fine and do the right thing. Misleading the public has consequences. Saying otherwise insults the public and the judicial system. Show you are a company committed to honorable practices and finding medicines to treat and cure disease. Your products are designed to help those who purchase your drugs, not deceive them.
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