Part 1: “
I was in a coma for four days”
Part 2: “
It was really a sham”
Part 3: "
My quality of life shot"
Between 1994 and 2007, annual per-patient spending on diabetes drugs more than doubled, from $495 to $1048 per. A study by Doctor Caleb Alexander of the University of Chicago Hospitals found that during the same period, the three-year death rate for people with type 2 diabetes dropped by less than one in two hundred.
The same study also found that people with diabetes were exercising more and smoking less. That's great news, isn't it? But if folks with diabetes are exercising more and smoking less, we ought to expect the death rate to drop, regardless of whether the new medicines are any better than the old ones. So how much of this paltry one-in-two-hundred drop in the death rate is due to newer and more expensive medicines? Half of it? Maybe none of it? The fact is, we don't know.
We do know how to prevent type 2 diabetes. A Finnish study found that a modest thirty minutes of exercise a day cut the incidence of type 2 diabetes by an astonishing 70 percent. And if people can't be bothered to do that, doesn't that mean that maximizing life expectancy is not their first priority?
Two hundred years from now, will historians read about our health care system and shake their heads and conclude that we were all out of our minds? On the one hand, here in the developed world we already are close to maximum life expectancy, and most of the remaining gap could be closed by lifestyle alterations. On the other hand, skyrocketing health care costs threaten to bankrupt us, individually and as a nation. We are bequeathing to future generations trillions in deficits and trillions of unfunded liabilities. Can we afford to go on spending billions and billions of dollars a year treating numbers on a sheet of paper, often without having any idea as to whether all this is translating into actual benefits for actual human beings?
Even if such evidence is ever forthcoming, we will still need to take it with a grain of salt. The DECLARE trial is funded by AstraZeneca. Study after study has demonstrated that clinical trials funded by the drugmakers consistently report greater drug effects than those funded by independent sources. This point is as well established as anything in science, and it was confirmed yet again last year in a meta-analysis published by the respected Cochrane Collaboration.
By the way, in just the past few years, AstraZeneca has paid out over half a billion dollars to settle claims of illegal marketing. The United States Department of Justice suit against AstraZeneca accused the company of a variety of offenses, including using ghostwritten articles and paying kickbacks to doctors to promote the off-label use of its antipsychotic drug Seroquel. Given that kind of track record, should we believe them when they assert their wares are "safe and effective?"
At the very least, we ought to stop allowing the purveyors of these nostrums to hide behind platitudes about "saving lives." Once upon a time, folks talked about "miracle drugs"--drugs like sulfanilamide, penicillin, and streptomycin. And these drugs really did seem miraculous, enabling people who were literally on their deathbeds to get better and go back to work. People no longer talk much about "miracle drugs." Today they speak of "blockbuster" drugs, which are distinguished by their benefits not to humanity but to the drug companies' balance sheets. If a drug like Farxiga--a new brand-name drug which changes numbers on a sheet of paper without anyone having any idea as to whether it is enabling anyone to live a day longer, and which may cause cancer to boot--represents a "significant advancement," isn't it time to consider the possibility that we have already picked all the low-lying fruit?
As for Amy Lynn Evans, she is now permanently disabled. Her 25-year-old son has quit his job in order to take on the role of her full-time caretaker. For the most part, she remains at home, tethered to an oxygen tank.
"For three years now I have been trying to recuperate and get back on my feet," she states. "My quality of life is shot. I can't drive, I can't go anywhere. It's a nightmare."
List of Sources
1. Soni, A. 2010.
Agency for Healthcare Research and Quality Statistical Brief # 304: Trends in Use and Expenditures for Diabetes Among Adults 18 and Older, US Civilian Noninstitutional Population, 1996 and 2007. Retrieved 11 January 2014.
2. Gregg, E.W. et al. 2012. Trends in death rates among US adults with and without diabetes between 1997 and 2006.
Diabetes Care 35:1252-1257.
3. Alexander, G.C. et al. 2008. National trends in the treatment of type 2 diabetes mellitus, 1994-2007.
Archives of Internal Medicine 168:2088-2094.
4. Tuomilehto, J. et al. 2001. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance.
NEJM 344:1343-1350.
5. Lundh, A. et al. 2012. Industry sponsorship and research outcome (Review).
Cochrane Database of Systematic Reviews 2012 Dec 12;12:MR000033. doi: 10.1002/14651858.MR000033.pub2.
6. US Department of Justice 2010.
Pharmaceutical Giant AstraZeneca to Pay $520 Million for Off-label Drug Marketing . Retrieved 26 December 2013.
