Pharmaceuticals have been a core of the dramatic medical advances available to patients in the past decade. In particular, cancer chemotherapies, drugs to control symptoms of chemotherapy, cardiac agents, diabetes medications, and amazing new anti-inflammatory immunosuppressant drugs for rheumatologic diseases are but a few examples of enormous advances in pharmaceuticals.
But there is trouble for all of us in the pharmaceutical industry, and its regulation. Several recent examples raise issues with the pharmaceutical firms and their addiction to greed. It's been a long-standing truth that the pharmaceutical industry spends more on marketing than it does on research and development. So when an industry that has profit margins rivaling and exceeding the oil industry justifies its profits on the basis of the quality of the products it is producing, I wince. Between direct to consumer advertising, and the incredible attention the pharmaceutical industry pays to physicians, they are wasting dollars that could be spent on more research, or less costly drugs.
And now we have some very troubling news. The Washington Post article Maker of Vioxx Is Accused of Deception cites the journal of the American Medical Associaton indicating that pharmaceutical firms write their papers for publication before finding an author!
And the FDA is overwhelmed and incapable of effectively reviewing the science brought to them says this Federal Times article. And the NY Times reports that the FDA is under fire for a new plan to relax rules on drug promotion. For physicians and consumers, these trends should prompt demands for reform. Pharmaceutical agents are very important to all of us. However, they should be introduced after effective review of the science, and when risks have been adequately evaluated, and at lower cost.
And how addicted to greed can a pharmaceutical firm be? To actually write a paper regarding their research and then seek an author who is willing to attach their name to something written by others with a self-serving agenda is incredible.
I am no fan of excessive regulation. The healthcare industry is already the most regulated industry on the planet. But these egregious behaviors will cause a response. Those of us who occupy board rooms must constantly remember who we are serving. I am glad that the board rooms I sit in seek to manage most effectively a nonprofit community resource-a community hospital. The board rooms of the pharmaceutical firms need to remember that they serve the same ultimate goal-patients with illnesses. How they do so while satisfying their shareholders, is an agenda that needs better thought than is currently being applied.
Racing around all day, the pace of life and work seems pretty amped up. Schedules, appointments, bills to pay, calls to answer, kids to take care of. Everybody so frenzied and serious. I see people talking on the phone while walking on the sidewalk, driving the car, even while watching TV. Multi, multi, multi tasking. Sometimes I get moving so fast, anticipating the next event or issue, I find myself holding my breath. So when exactly do we slow down enough to breathe? How do we relax?
Any of you who have read a couple of my blog entries will know for me exercise is one way. Being outdoors for the exercise really helps. And that would be WITHOUT the cell phone or beeper. Mindfulness is a skill I practice, and meditation is a life skill I still seek to integrate in my life. I practice it occasionally. My friends in integrative therapies hold courses to teach us how to integrate meditation into our lives. And why am I not there? Because I already have meetings scheduled when they meet. I need to think about that.
So there’s another antidote to the frenzy — laugh at yourself. Wow, do I need to be so serious? Sure, I think I do important things — otherwise why would I do them? But really, laughter is a very therapeutic part of our life. So recently I took a deep breath and acknowledged a comical moment in my life. My hospital colleagues have teased me about two issues. On our hospital intranet my photo appears to ‘advertise’ the publication of the monthly CMO (chief medical officer) report. Some have complained that it’s too frequent and too boring to see me there so often.
Cindy Murray, RN, on East wing then observed to me that I look an awful lot like the cartoon character “Prince Charming” in the movie Shrek. Others have made the same observation — one friend called me as he left the movie theatre and said “it’s unbelievable — you’ve got to see it!” So why not laugh at myself? With a little help from the wizards in Information Services (like Chuck Wells), my face has been replaced with Prince Charming on our intranet. And in case some of you have not seen the movie, the joke is not just the resemblance, it’s that Prince Charming is anything BUT charming — he’s a self centered petulant jerk.
So enjoy the joke with me. I’m too serious. I need to laugh at myself. Go ahead, laugh with me. It’s actually healthy to laugh. Listen to ‘Car Talk’; take a minute to see the humor in life. And don’t take me too seriously.
I just spent a week hiking. Three days in Colorado with my son and 3 days in Vermont with my wife. Among the many reasons I enjoy hiking, one is the opportunity for reflection.
The kind of people who hike seemed to be quite healthy. While that could be a matter of who chooses to hike, I believe it is also a consequence of the hiking. And in areas where people hike, there tend to be a number of other outdoor activities that become part of how people spend their spare time. I was astonished in Colorado to find the number of people on bicycles spending a day riding 5000 feet uphill, only to return down the same winding, spectacularly beautiful road to return home. And the walking, running, bicycling paths were both surprisingly ubiquitous, and wonderfully beautiful. I think outdoor recreation creates more interest in outdoor recreation, which therefore creates more opportunities. On Sunday, July 22nd, fortified by a great cup of coffee and 2 apples from the Winhall Market, my wife and I hiked the Overlook trail in the Jamaica State Park, a delightful 3 mile loop with a view of the West River and the cute town of Jamaica. It’s worth the trip.
So what are the health benefits of hiking? There is the obvious cardiovascular benefit, and calorie burning. Daily exercise is now a core component of recommendations for both maintaining health, and treating chronic disease. The lowering of blood pressure, reduction in weight, reduction in risk for heart attack and stroke, reduction in blood sugar for those with diabetes, all contribute to improved health. In addition, there are the other numerous benefits to outdoor recreation. The ones that appeal to me include the contemplative and even meditative aspect of walking in the woods. My favorite hiking companions (my son, my medical partner, and my wife), all share with me the enjoyment of long periods of silence while experiencing the woods. Something beyond relaxation happens to me at those times. John Kabat-Zinn would describe it as meditation while walking. Then there is passion -- the zeal for life and love. Why is it enhanced by outdoor exercise? Not sure, but it happens.
There is also the opportunity to see wildlife, and learn about the outdoors. This week I saw mountain goats, elk, numerous wildflowers, hawks, marmots, chipmunks, trout, and on and on. I love coming home having learned something new about our environment. Is that a health benefit? I think so … a mental health benefit.
And what about creativity? My brain seems to function better during and after exercise. I am more likely to come up with new ideas for issues I face at work and at home. Is that endorphins? Distraction? Peacefulness?
Communities are creating more built infrastructure to support walking, hiking, bicycling and other outdoor recreation. In Vermont, the Blueprint for Health, a statewide program funded by your tax dollars, brings together improved systems for care of people with chronic disease in doctor’s offices, with self-management education, and coordination with community resources for exercise. Medical studies show that people with chronic disease who exercise regularly experience better outcomes.
And yes, those are hiking poles in the photo -- keeps my knees healthy....