be very careful

even when the best doctors and the best hospitals try to come up with guidelines for the best ways to treat various diseases, they have difficulty. why? well, not everybody's the same. that's one reason. but arguably the biggest reason is that there are no studies to show how one drug performs against another or how choosing not to treat a specific disease compares with aggressive treatment of that problem. and why do these studies not exist, or why were they never published, which is a better question? because it is the drug companies that pay for the studies. they aren't going to publish a study, or even complete a study, if their drug or treatment isn't going to look good. if doing nothing is as good as doing something, are they going to tell you? heck no. they'll use statistics (there is a 14% chance that a person with this problem taking this drug will improve more quickly and have a better life with more money and more happiness and basically just turn out to be a better person than someone who chooses to try a good diet and some lifestyle changes to achieve the same goal). 

pharmaceutical ads are just like automobile ads, the glitz is up front then comes all the 'fine print'. but in car ads the guy on the commercial pretty much auctioneers his way through the interest rate, payments due at beginning and end of lease, with approved credit, may not apply to certain people on certain days ending in 'y', etc. in the drug ads they seem quite proud of the fact that their drug could cause liver and kidney damage and pretty much make your life a living hell, but you should still 'ask your doctor' about it because dadgummit you want it, don't you?

best marketing for viagra? jack nicholson in 'something's gotta give' when he's taking viagra and nitrates for chest pain and tries to deny it. it's an unforgettable scene and one which sold more viagra than any 'ask your doctor' commercial. 

see the blog a few back on marketable side effects. are we a gullible society or what? just because it's new or newly indicated for something doesn't make it necessary or even a good idea.

shame on you

integris has a commercial that is so representative of the new fear tactic method of marketing that i have to comment. not that any of their sappy tear jerking commercials are really promoting health and just look like they're promoting integris. i mean, the look the wife gives her husband in the infertility commercial is so real it's scary, but then everything is peachy once they get pregnant and have a baby. show them in 6 weeks and i'll show you a look! i can't listen to roy orbison without trying to drive to baptist anymore. 

no, i'm talking about the sleep commercial. which ends with the doctor saying "80% of sleep problems go undiagnosed, and some can be deadly". who can sleep after hearing that?!

OCD for profit?

Pharmaceutical companies have perfected the American dream. They have created a market and are now capitalizing on it. They work hard to get people obsessed about a 'disease' and then they charge them for the cure. And now they've either run out of new medicines  to invent to treat new diseases they've invented (or legitimized - see ED and fibromyalgia ) or they're just getting greedy (or have they always been and I'm just now noticing!) or maybe they are smelling the fires of 'the barbarians at the gate' - a la government-sponsored healthcare. In any instance, they certainly are capitalizing on 'unintended positive consequences', aka side effects that can be marketed. Used to be Viagra, by another name, was a drug to help with pulmonary hypertension. A disease, for sure, but not one with enough victims to really make a buck. But guess what happened on the way to improving the circulation in your lungs? Voila! Viagra. The rest is history - they've already done the research and development and proven that it's at least safe enough to try, if not use regularly, on humans. So now it's all about marketing. And you think I use reverse psychology? When did we get so gullible that a warning of a four hour erection is used to sell something? How hard was that? No pun intended.

There are others - recently the drug for hair loss, Propecia, was mentioned as a prevention for prostate cancer, sort of a reverse of the Viagra story, going from cosmetic to internal medicine. Now there is a glaucoma treatment with a curious side effect - it makes eyelashes grow thick and dark. Which is reminiscent of the first marketable side effect of which I was aware - Minoxidil, a blood pressure drug, had the nasty side effect of making patients grow hair in places both good and bad. But applied topically to specific areas it caused hair growth in just that area. And what do you get? Rogaine.

OK - so they have created markets from discontent, usually over appearance or performance. Is that really bad? Doesn't everyone have the right to be pain-free, have a full head of hair, an erection and great lashes? This is America, after all.

what if...?

the new stephen king book is a collection of short stories. i'm a bigtime stephen king fan, so of course i got it as soon as it came out, then i kept it as a carrot in front of me while i finished a couple of other books that weren't so exciting. now i'm halfway through, but one of the stories, 'stationary bike', hit a nerve. the protagonist finds out that his cholesterol is high and his health is in danger and he sets out on a stationary bike to fix the problem, but in the process he makes enemies of his own 'lipid company', 4 guys who he has ?dreamed up/created with the help of his doctor's explanation of his problem, because by losing weight and eating right and exercising he has put these guys out of work. and they have houses and families and mortgages and lives. 

so i got to thinking about my life and the impact i've had on certain economies and people by my lifestyle choices and changes. like what's the bartender at interurban going to do with all that smithwick's he ordered special for me? what about the carhops at sonic? do they miss me? are they mad? have they had a surplus of iced tea and route 44 cups and straws?

once, on the way to a mission trip, i was waxing philosophical to the person next to me about how all of us americans were living in luxury and we were wasteful and gluttonous and we should stay home and eat in more often, be happy with our houses and cars and forget 'keeping up with the joneses' because even the joneses were reining in their spending. who needs a lexus or a mercedes? who needs a 3 million dollar house? a $100,000 pool? why do people keep buying these stupid clothes and toys for their kids? why do they insist on making a trip to disneyworld a lifelong goal? 

then i realized i was talking to a bartender at a restaurant in bricktown whose living depended on people who lived the lives i had just railed against.

yes, we're gluttons and we're spoiled. but does the world not count on us to be this way? are we not pretty much singlehandedly supporting economies in countries where hopefully at least some people aren't being abused and exploited?

one more random thought: why, in tough economic times do we cut back on stuff? on people? were these things or services or people superfluous to the business or the community? were they just extras, like whipped cream and nuts on a sundae or creamer in coffee? like onions and pickles on a burger? why do we start getting things or getting used to things that we can apparently do without? and how many of us are expendable if the economy gets 'tougher'? 

the mirror

i saw somebody this week that i haven't seen in a while. i try to avoid him if i can, when i hear him coming, i go the other way. i don't like this guy. not even a little bit. he is very selfish. he is very prideful, feels like everything should go his way, and watch out if his car doesn't start or his alarm doesn't wake him up or his schedule's too full or too empty or he's wrong about something or his pants are too long or too short or his shirts aren't clean or his laundry's not ready or his eggs don't cook right or his kids don't call or they call while he's busy...pretty much his outward persona is a house of cards. he is so blessed and he takes the credit as if he had something to do with it. he lets people continue in their positive misconceptions of him and does nothing to disabuse them of their erroneous notions. he is kind when it suits him and mean when it doesn't. he can say nice things and his tongue can slice with sarcasm in the same moment, even in the same sentence. you can see why i don't like him. there's only one problem: he's the man in the mirror. sometimes you believe your own press clippings. sometimes i get a sore arm patting myself on the back. 

i'm happy to do stuff for others if...everything goes right for me.

i saw myself this week and i didn't like what i saw.

and i'm definitely getting old. watching the grammys tonight, i'm feeling very old. but old is good in my book if it means that you're not excited about a lesbian celebratory song followed by unintelligible (c)rap by 4 guys with more hyphens than vowels and consonants in their names while a hugely pregnant ?singer prances gravidly around on the stage making a fool of herself. i'll take old any day.

even more

when you hear hoofbeats, look for horses (or, common things occur commonly)(this is a standard medical saying). meaning: if you didn't already figure it out, it's ain't some weird thing usually. it's more common for common illnesses to present in a weird way than for a weird illness to present at all (or to mimic a common illness). reader's digest is not a medical textbook, nor is the internet - but wikipedia has most medical textbooks on it!

the shortest route is not always the best route, because it can bypass some of the most precious lessons in life. (ravi zacharias)

some people seem to need to define their lives by their hardships, whether they be illnesses or other types, death in the family, financial hardship. look in the bible at aaron and nadab and abihu. sometimes you need to work through things, not live for them.

the lessons learned the hard way, the long way, are often the best, but man, that's not how they feel when you're going through them. think of this for your kids.

when my children get the 'i wants' and 'i needs' it's time for them (and me) to 'serve, serve, serve'(my lovely bride)

God gives where He finds empty hands - (St. Augustine)

sometimes you are the answer to the prayer you pray. (steve brown)

we think that helplessness is a liability - and it may be if you're a soldier or a policeman or a teacher - but in spiritual matters, just the opposite is true. (steve brown)

ok, i know these were random. each could have had a whole blog to itself, and who knows? maybe they will someday, but right now, hopefully this will do.

more radical thoughts

well, not necessarily more radical, but more thoughts. some are mine, some belong to others. i'll try to differentiate if you can't tell.

Nothing good happens after 10 pm. (many people, me, my wife, my parents, your parents...) well, it's true to this day. 

Just because you can doesn't mean you should. (again, many people, including all of the above) if people took this to heart life would be less hectic and more peaceful. especially after 10 pm.

God makes complex things simple and man turns around and makes simple things complex.  ok, this one's on me. as i'm continually faced with our tendency to make things harder and more complicated than they need to be. my friend Greg says "Christians shouldn't be into the details, because the devil is in the details."

First come up with a drug, and if necessary, we'll invent a disease.  ok, this is me again, but i had help. all the big pharmaceutical companies are doing this, whether they admit it or not. there are many 'diseases' and 'disorders' out there today that didn't exist before. a variation on this would be 'come up with a test and we'll come up with something to call the results if they're positive'.

35 miles or $35 will weed out most unnecessary doctor visits. ok, this is mine, too. not that i mind seeing lots of kids who aren't too sick, just that availability has become almost detrimental to some people. for instance: we are closed today due to weather, and this is a lose-lose situation - if open, we would have had people risk their lives on bad roads to bring in kids who don't need to be seen, and since we're closed we aren't serving our patients well.

It is easier to die for Jesus than to live for Him. a paraphrase of Oswald Chambers.

It is what it is...unless it isn't. Greg Poland. this can serve for many things and situations. when people want a definitive answer on some medical question that has not definitive answer, this works well.

Don't do the test if the result isn't going to change what you would do. me again. the healthcare consumer wants tests. they want them because they think the result is the answer to their problem, and some even think the test is the answer to their problem. i can't tell you how many times i've heard people say 'after that cat scan, i haven't had any more headaches' or variations on that theme. suggests a psychosomatic etiology to me, but hey...

It's amazing how many people survived before there were all these medicines and tests! me again. just in 25 years of finishing med school, the increase in the amount of knowledge and the numbers of tests and treatments is phenomenal. but simple things are still simple and common things still happen commonly. 

i'll come up with some more later. i just hadn't posted in a while.