Full Disclosure: My entire career has been spent working for or representing 3 of the top 100 corporations in the United States. I have been an executive in all three. I am very pro business and pro capitalism. Basically, I am on their side. I have been reading the 5 pages of 3-point font information that drug companies give the pharmacies to give to the patient i.e. about 50% of the size of the font I am using. My experience is that about 25% of the information is given to patients and if I am a reasonable indication, about 0.1% is read. The first sentence of the provided information is:
Please read this information carefully before you start taking ***** and each time your prescription is refilled in case anything has changed or new information has become available. (In other words, this is all your responsibility, dummy)
The efficacy of the drug for one of the two approved uses is shown in graph form from the research data. The efficacy of a placebo is also shown. At 100% efficacy the drug helps about 8% of patients and the placebo about 2% so basically the drug helps about 6% of total patients over a doctor with a good bedside manner. At just noticeable but not significant efficacy, the drug helps about 69% of patients and the placebo helps about 61% or about 8% above a smooth talking doctor. The difference between the drug and placebo stays relatively constant over the range from 0 to 100% improvement.
The primary purpose of the drug is reduction of depression and anxiety. For both of these maladies, four tests at different dosage levels were made in comparison to a placebo. About 200 people started each of these tests split 50-50 between the drug and placebo. No further data is given. The test results were “In all cases ****** demonstrated superiority over placebo by scale selected. Level above @@@@ did not show additional improvement.” Come on, guys, 0.1% would be demonstrated superiority. I understand the FDA usually requires 4% better than placebo. The remaining 4 pages are devoted to concerns over taking the medication and negative side effects experienced during the tests. Many of these side effects are more efficacious for the drug than the positive effects are. You have placed the responsibility on me for deciding if this drug is appropriate for me. I will do this with the help of a doctor who has no knowledge of the drug except what your non-medical salespeople have told him/her over a free lunch for him/her and their staff. How many of those doctors have even read the crap that I just read? Come on guys. I am on your side and I think you are doing a crappy job. Until the medical profession gets in the 21 century-actually I would be thrilled to see it in the 20th century-we are going to continue to have unacceptable costs and unacceptable patient outcomes in this country and around the world. With the technology available today, we have the most awesome potential for providing outstanding medical care for everyone who will take advantage of it at affordable prices. Put your big boy pants on and get rid of your glass stomach. It is time we looked ahead with a clear view at what we can do and stop all the procrastination and whining. You are running the risk of catching Congress in competence and efficiency. You apparently already have caught them in concern for your own personal welfare and disregard for your clientele.
My apologizes to the dedicated medical professionals who are truly concerned about their patients and are trying to achieve the highest degree of proficiency that is possible. My congratulations to the management of corporations who have recognized this problem and are proposing standards for medical performance even though those proposed levels are still very low. There are many good people in medicine. We just need to let the good inmates run the nuthouse. There are even 10 or 15 politicians who are also working in the right direction. Most of them could not give a damn as long as they come out ahead, and I don’t care what party you look at.
If you see in any given situation only what everybody else can see, you can be said to be so much a representative of your culture that you are a victim of it.
S. I. Hayakawa