The fact that he uses insulin as an example of needles changes makes me question his honesty. Most of the changes are to improve compliance and safety. Not everyone is willing to check a glucose 4 or more times a day. Not everyone is willing to give themselves multiple injections a day. Etc. Sounds like an ivory tower academic with a lack of real would experience. That, or a man with an axe to grind.
FWIW, I think his take is more complicated. He walks through the history of insulin - from insulin derived from pig and cow pancreases, to recombinant human insulin (Humulin R and N), to insulin analogs. I don't think he argues that the changes are needless, but that the stated benefits of insulin analogs are exaggerated - including a 2003 Cochrane Collaboration study that compared recombinant human insulin to the predecessor, and three more Cochrane Reviews between '06 and '08 comparing analogs to recombinant human insulins - but 90% of insulin prescriptions were for analogs by 2010.
I believe his primary point, however, is the cost comparison. Humalog is said to have cost $21 per vial in 1996 and was $330 per vial by 2017 (compared to $38 in Canada).
As for any changes for compliance and safety, if the source of any basis for the same is a drug company study, that ends up (almost invariably) touting the newer and more expensive treatment, then that's an axe to grind.
Similarly, his stating that adalimumab is just as good as methotrexate ignores the significant side effects of methotrexate or the fact that many people would prefer not to go to an infusion clinic to get there medication administered.
I looked quickly at that chapter and I don't think that's what he is saying. The discussion focuses on how studies usually compare the new drug to doing nothing, as opposed to other existing therapies - like Humira/adalimumab as compared to methotrexate - for efficacy (and the studies show they are comparable - he does not mention side effects). Then he argues that the studies should have compared Humira to the most effective conventional therapy - methotrexate, HCL* and sulfasalazine. To try to be more succinct - I think in the adalimumab discussion, he's arguing for more info for doctors, not that one particular drug is better in all ways, for all patients.
Don't get me wrong, pharmaceutical companys (like big farma and the retarded recommendation for dairy consumption) have a good deal to answer for. And it sounds like he may have some good points. However, from reading positive reviews and the positive comments on this thread, I have to question the author's agenda.
I haven't read any positive reviews - I don't personally trust anyone else to review something, even a movie, for me. As for the positive comments on this thread, I am not sure how many have read the book.
Open data, open trials, and publication of negative results are all needed improvements.
All are argued for in the book.
Pricing is ridiculous, but it is inabled by the insurance model, which means the customer rarely sees the price. Fixing one, much less both, dides of that runs into thorny problems with strong ideology. Governments fixing prices is rarely as effective as a free market (though health care is hardly a true free market), likewise, outlawing insurance or going to a single payer system are both unlikely and fraught with problems.
Agree on all points.
I don't have any good answers on how to fix the system. I think the problems are as much rooted in the Culture of America as in the health system.
Agreed.
I was hoping you would chime in on this post. PM me your address and I will send you a copy of the book. I'm not suggesting that your reading it will mean you agree with him, or my points above - I actually want someone with medical knowledge to read it and tell me where he is missing the mark.
* - I hesitated to include this here due to a tangential issue that may arise...
