Monday, July 30, 2007

Capitalism and Diabetes

Along with the good news of the Japanese Liberal Democratic Party's huge defeat in upper house parliamentary elections in Japan and the not so good news that Gordon Brown was disappointing many members of his own British Labor Party by saying kind words to GW Bush about the wars against terrorism generally and the disastrous Anglo-American intervention in Iraq, there was story about diabetes, a disease that killed my mother and may in the future threaten me along with millions of other Americans. Diabetes is related directly to the long-term effects of diet and in general the way one lives one's life, along with what most medical researchers believe is genetic predisposition, although there remains a great deal about genetic factors and their relationship to diseases neither known or effectively proven.

Diabetes is also a disease that interacts with the general circulatory and cardiovascular system particularly to bring about other health crises which can lead to amputations of limbs, blindness, kidney failure, and of course to life threatening heart attacks and debilitating strokes along with other illnesses.

The story concerns Dr. David Graham, a drug safety official of the FDA, who has called for the the withdrawal of a drug, Avandia, because it is not not necessarily more effective than existing drugs to control blood
sugar levels and also brings with it an increased risk of heart attacks. The drug is produced by GlaxoSmithKline, a major transnational pharmaceutical firm, which like its competitors produces prescription
drugs for profit and markets them through massive advertising campaigns.Both the advertising costs and also the fact that there is no system of national health care currently in place in the U.S. which would compel private pharmaceuticals to sell drugs through public agencies is the explanation used globally to explain why prescription drugs in the U.S. cost on the average twice as much as they do in other developed countries and why Americans consume nearly twice as much prescription drugs as people in other developed countries.

In recent years, as is noted abroad with some disbelief, pharmaceuticals have spent large sums of money advertising anti-depressants, sex aids, digestive aids, and other prescription drugs, calling upon television
viewers to contact their doctors about these drug for possible prescriptions (side effects are mentioned as rapidly as possible in these commercials)

The story mentions that the FDA has known about the possible dangers of Avandia for a year and has only called an advisory committee to discuss the question after an article in the New England Journal of Medicine, the leading professional journal of medicine raised questions about the drugs safety. The news reports have also expressed doubts about whether or not Dr. Graham's criticisms will actually lead to anything, since he, as a drug safety official at the FDA, has often challenged FDA approved drugs like Avandia with limited success. Sales of the drug have already dropped sharply because of the New England Journal article.

I am an historian, not a medical doctor or medical research of any kind. But as an historian, a Marxist historian, I know something about both the for profit health care industry and the FDA, which like regulatory agencies generally are as good or bad as the administration in power which appoints the high officials to direct the agency. This administration, like other right Republican administrations in the past, has seen the regulators as the enemy and the corporations as the "victims" to be protected from "big government."

I know as a Marxist that medical conditions have to be dealt with dialectically and holistically if human health is to be maintained and life extended. At the hearing, Dr. Robert Ratner, of the Medstar Research Institute testified about the "epidemic" of diabetes currently in the United States, the increasing heart attacks, strokes, kidney failures, amputations and blindness that it has caused. Ratner stated the obvious, that contemporary drug care isn't doing an effective job in preserving health and life and that "new therapies" are called for (in the press reports he didn't elaborate on why there has been an almost total reliance of drugs and also what new therapies he was specifically talking about, but criticized both patients for failing to take their drugs properly and doctors for failing to "aggressively" treat patients with diabetes.

Diabetes is directly related to longterm dietary factors, particularly to obesity. The U.S. food industry bombards Americans, particularly children and teenagers with advertisements for high "empty calorie" foods that have caused an "epidemic of obesity" in the U.S. which the media is chattering about endlessly but about which nothing seriously is being done, since that would require both regulation and serious social investments in educating people and creating public institutions for recreation and exercise among other things that would encourage them to led healthier lives

Adult diabetes is now becoming a factor among more and more young people, particularly among working class and minority youth. And you don't have to be a Marxist to understand why this is happening, although, as with virtually all other things, Marxism helps a lot.

The class system plays a major role in who is more or less likely to get diabetes and other illnesses for that matter. Low income people are far less likely to get or in many cases even know about the tests that
exist to find "pre-diabetic" conditions. Even when they have reasonable medical coverage (and we should remember that close to 50 million have no "health insurance in the U.S. and tens of millions more are seriously under-insured) they are likely to avoid getting medical care because of the copays and other out of pocket expenses and they are likely to be treated by medical personnel in the HMO's on an assembly line basis. Even though the insurance company controlled HMO's today are making propaganda about encouraging "preventive health care" (if only to reduce their own costs from providing services for patients) we should remember that they are still in effect doing business with doctors, with for profit medical testing corporations, and of course with the hugely powerful pharmaceutical firms, which reduce medical care to more and more drugs. This suits the drug firms in terms of profit maximization, the HM0's in terms of giving subscribers the list in benefits for the premiums that they pay, and perhaps even the doctors who get incentives from both the HM0's to restrict care and from the pharmaceuticals to push drugs. Doctors can also make the most profit for themselves in the present system from an private assembly-line approach to health care. It doesn't suit patients however, and with a disease like diabetes can lead to far-reaching negative health consequences, including death.

What should be done. For people, especially young people, without diabetes, a program of education about the uses of diet and exercise as part of a preventive health program should and could be initiated both
in schools and in mass media. Just as tobacco commercials have long been banned from television, serious attempts to regulate the commercials for pastries, soda pop, potato chips, fast food outlets, and other high fat high and "empty" calorie foods that are pushed through the society, and which have created a "snacking culture" in which people eat so foods along with regular meals through the day, increasing both the obesity numbers and also making them prone to illnesses connected to high fat, high salt and other processed foods.

Also, both doctors and the general public should be educated about the uses and abuses of prescription drugs, which drug company advertisers in recent years are treating the way Pepsi Cola and Lays Potato Chip advertisers have long treated their products.

Planning for public health, a serious regulatory policy that informs people about the health issues in food and in drugs, and of course, a commitment to both educate people to live healthy lives and restrict the businesses that bombard them with advertising to encourage them to live unhealthy lives are necessary parts of a national health policy, along with Universal Health Care that will and a Federal Drug Administration that regulates pharmaceutical firms in the interest of the people who use their drugs rather than serving as a shill for them.

--Norman Markowitz

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