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kieranct
New Member

9 Posts

Posted - 01/23/2007 :  11:33:14  Show Profile Send kieranct a Private Message  Reply with Quote
First off this is my first post on SFN so hellooo, glad i found the site as from the destruction of jazgarota on the psoriasis post it looks like we might be able to have a real debate.

So http://news.bbc.co.uk/2/hi/health/6233681.stm shows that evidenced based medicine was up for the medical milestone award (it lost by the way to sanitation) however i think that while it should always be best practice the reality of the economics around it means that it cannot meet the needs of the general public. The time is right for a new approach.

The problem with evidenced based medication is the cost of obtaining the evidence. This has to be funded somehow and in the capitalist economy we live in (for which i make no apologies) this provides no incentives to find cures, only treatments for symptoms, which generates money.

This leaves alot of people with chronic disease looking for alternatives and sometimes giving up their traditional treatment, which often results in a worsening of symtoms.

The problem with alternatives, as has already been pointed out, is that their are alot of greedy people out there who are all to willing to take peoples money in times of desperation. This means that no anecdotal evidence can currently be trusted.

I am happy to debate the above but what i would really like to do is see if we could come up with an alternative paradigm.

Firstly i think that drug research should be part of the welfare state, i.e. funded by government and not corporations. This could be legislated in such a way that cures are rewarded over symptom treatment.

Secondly it seems a shame to dismiss all anecdotal evidence, yes it won't be double blind etc, but if it has genuinely worked for someone then we need to document that and try it on larger scales. I have seen soo many research papers into alternative treatments using the scientifc method that have come ack saying further research is definately warranted (i.e. larger trials) but there is never the funding for these treatments to take pace. Perhaps moderators who check each person's tale or some kind of ebay style points system where the integrity of each person could be judged.

Thirdly, and very importantly, the role of the dietician profession should be re-evaluated. They need to know exactly what each food can do and what constitutes a real healthy diet. Many are still pushing RDAs from the 1950s and the food pyramid (compare the "impartial" harvard food pyramid to the US government one, which has been heavily lobbied by the food industry.)
It has been stated on here before that it should be common sense to most people that changing their diet and lifestyle will prevent disease, however many don't know what that involves. I say tax the hell out of refined sugars and grains to let people know that they are bad for your health, after all it is the state's responsibility to protect the health of its citizens to a certain extent.

Fourthly the media has a key role to play, the BBC (can you tell i'm a pommie yet?) has recently done a series on "the truth about food" showing amongst other things a "evo diet" can reduce cholestorel by 23% (more than any manufactured drug.) However this can only be done by non-corrupt government channels (in fact i can't think of any other than the BBC - which i know has its problems) in order to maintain its integrity.

Finally i would like to see alot more ethical rules in any drug company sponsored research. At the least the sponsor should be published with each article.

Looking forward to the replies...

oh and before I forget http://news.bbc.co.uk/2/hi/health/6289847.stm

Dave W.
Info Junkie

USA
25973 Posts

Posted - 01/23/2007 :  13:16:38   [Permalink]  Show Profile  Visit Dave W.'s Homepage Send Dave W. a Private Message  Reply with Quote
Welcome to the SFN, kieranct.
quote:
Originally posted by kieranct

...this provides no incentives to find cures, only treatments for symptoms, which generates money.
Only if you consider the pharmaceutical industry to be one giant "company," instead of lots of companies actively competing against each other in the capitalist marketplace. See "The Economic Effects of a Psoriasis Cure," a piece I wrote about that idea of yours which is still valid, almost six years after I wrote it.
quote:
oh and before I forget http://news.bbc.co.uk/2/hi/health/6289847.stm
Then you might want to be careful about saying that drug companies have no incentive to find cures - that's awfully cynical.

- Dave W. (Private Msg, EMail)
Evidently, I rock!
Why not question something for a change?
Visit Dave's Psoriasis Info, too.
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BigPapaSmurf
SFN Die Hard

3192 Posts

Posted - 01/23/2007 :  13:23:53   [Permalink]  Show Profile Send BigPapaSmurf a Private Message  Reply with Quote
Hey I think we can all agree on more ethical rules for drug research, my ethics for starters;)

Ill have to agree with Dave for the most part however, for me the more interesting problem is the manufacturing of treatment requiring 'diseases', as if the medical system wasnt strained enough.

"...things I have neither seen nor experienced nor heard tell of from anybody else; things, what is more, that do not in fact exist and could not ever exist at all. So my readers must not believe a word I say." -Lucian on his book True History

"...They accept such things on faith alone, without any evidence. So if a fraudulent and cunning person who knows how to take advantage of a situation comes among them, he can make himself rich in a short time." -Lucian critical of early Christians c.166 AD From his book, De Morte Peregrini
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Dr. Mabuse
Septic Fiend

Sweden
9666 Posts

Posted - 01/23/2007 :  13:24:33   [Permalink]  Show Profile  Send Dr. Mabuse an ICQ Message Send Dr. Mabuse a Private Message  Reply with Quote
quote:
Originally posted by kieranct
This has to be funded somehow and in the capitalist economy we live in (for which i make no apologies) this provides no incentives to find cures, only treatments for symptoms, which generates money.

On the contrary.
A company that finds the cure for cancer, or the common cold, or psoriasis, will put all its competitors in the "treat-the-symptoms-economy" out of business.

Dr. Mabuse - "When the going gets tough, the tough get Duct-tape..."
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"Equivocation is not just a job, for a creationist it's a way of life..." Dr. Mabuse

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Kil
Evil Skeptic

USA
13457 Posts

Posted - 01/23/2007 :  13:57:32   [Permalink]  Show Profile  Visit Kil's Homepage  Send Kil an AOL message  Send Kil a Yahoo! Message Send Kil a Private Message  Reply with Quote
So, are we discounting vaccines that have prevented the onset of some diseases? That is effectively a cure. Smallpox comes to mind. So does polio. And how about antibiotics? Do they not cure certain bacterial infections? The death rate from some first and many secondary infections is not nearly what it used to be. I would call that at least a partial cure. (Of course, there are problems associated with antibiotics, but that is for another discussion.) I could go on, but I hope I have made my point.

Another thing. What CEO of what drug company would like to die or have a family member die of a disease that there might have been a cure for if the company hadn't been so hung up on relieving only the symptoms? I understand shortsightedness for money. But denying, say, global warming does not seem to pose a direct threat to the lives of those who are denying it for short-term gain. Cancer is another story…

Are stem cell researchers looking for cures or for treating symptoms?

Again, I could go on…

Uncertainty may make you uncomfortable. Certainty makes you ridiculous.

Why not question something for a change?

Genetic Literacy Project
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Ricky
SFN Die Hard

USA
4907 Posts

Posted - 01/23/2007 :  14:06:10   [Permalink]  Show Profile  Send Ricky an AOL message Send Ricky a Private Message  Reply with Quote
The reason we see more treatment for symptoms and not actual cures is simply because symptoms are relatively easy to treat. The problem isn't a lack of research into curing cancer. It's simply that it's a really hard cure to find, if there is one.

Why continue? Because we must. Because we have the call. Because it is nobler to fight for rationality without winning than to give up in the face of continued defeats. Because whatever true progress humanity makes is through the rationality of the occasional individual and because any one individual we may win for the cause may do more for humanity than a hundred thousand who hug their superstitions to their breast.
- Isaac Asimov
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HalfMooner
Dingaling

Philippines
15831 Posts

Posted - 01/23/2007 :  14:20:04   [Permalink]  Show Profile Send HalfMooner a Private Message  Reply with Quote
I think I'll take a bit of a middle position.

One reason it seems that cures are not being sought is simply because cures are often much more difficult to find than symptomatic treatments.

Also, I think there is some truth to the assertion that cures are not as avidly sought by big pharmaceuticals as are treatments. HIV/Aids treatment drugs can be sold to millions over years, even decades, recouping development costs and more. A vaccine for HIV is going to be very difficult to make, due to the innate nature of the virus. Few pharma companies are going to be willing to invest millions or even billions into trying to make a vaccine that would eventually destroy its own market. But they do invest that kind of treasure in drugs that they can tell their shareholders will have a good chance of being profitable until their patents expire. That's just corporate economics.

That's why at least kieranct's idea of somehow changing the playing field to make cures relatively more profitable than they are now vis-a-vis symptom treatments, makes some sense to me.


Biology is just physics that has begun to smell bad.” —HalfMooner
Here's a link to Moonscape News, and one to its Archive.
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Dave W.
Info Junkie

USA
25973 Posts

Posted - 01/23/2007 :  14:55:54   [Permalink]  Show Profile  Visit Dave W.'s Homepage Send Dave W. a Private Message  Reply with Quote
quote:
Originally posted by HalfMooner

Few pharma companies are going to be willing to invest millions or even billions into trying to make a vaccine that would eventually destroy its own market. But they do invest that kind of treasure in drugs that they can tell their shareholders will have a good chance of being profitable until their patents expire. That's just corporate economics.
But corporate economics are exactly what I count on when making the "pro-cure" point in my "Economics" article. With the example numbers I had, a pharmaceutical company stood to make about twice as much over 15 years with an actual psoriasis cure than if they just continued their status-quo psoriasis treatments.

And a start-up drug company with no current treatments on the market doesn't even have any such comparison to make. They're looking at the difference between billions of dollars in selling a cure versus zero dollars in maintaining the no-cure situation.

- Dave W. (Private Msg, EMail)
Evidently, I rock!
Why not question something for a change?
Visit Dave's Psoriasis Info, too.
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HalfMooner
Dingaling

Philippines
15831 Posts

Posted - 01/23/2007 :  15:12:50   [Permalink]  Show Profile Send HalfMooner a Private Message  Reply with Quote
quote:
Originally posted by Dave W.

quote:
Originally posted by HalfMooner

Few pharma companies are going to be willing to invest millions or even billions into trying to make a vaccine that would eventually destroy its own market. But they do invest that kind of treasure in drugs that they can tell their shareholders will have a good chance of being profitable until their patents expire. That's just corporate economics.
But corporate economics are exactly what I count on when making the "pro-cure" point in my "Economics" article. With the example numbers I had, a pharmaceutical company stood to make about twice as much over 15 years with an actual psoriasis cure than if they just continued their status-quo psoriasis treatments.

And a start-up drug company with no current treatments on the market doesn't even have any such comparison to make. They're looking at the difference between billions of dollars in selling a cure versus zero dollars in maintaining the no-cure situation.

Good points, but I would add that start-ups are less financially capable of potentially doing something like an HIV vaccine than are the established companies. If an established pharma company is doing really serious HIV vaccine work, then to that extent I would be wrong about their avoidance of spending big bucks on it.

I think the economics are different between psoriasis and HIV, also. HIV, by its nature is one nasty, very changeable virus. It's a known, but difficult target. With psoriasis, the underlying cause itself seems in doubt, and the cure could turn out to be damned near anything. So start-ups are in the race and could make good money. Especially since it's unlikely (unless some unexpected retrovirus causes it) the disease itself would be eliminated from the face of the earth, but more likely just cured one at a time in individuals.


Biology is just physics that has begun to smell bad.” —HalfMooner
Here's a link to Moonscape News, and one to its Archive.
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Kil
Evil Skeptic

USA
13457 Posts

Posted - 01/23/2007 :  15:20:47   [Permalink]  Show Profile  Visit Kil's Homepage  Send Kil an AOL message  Send Kil a Yahoo! Message Send Kil a Private Message  Reply with Quote
quote:
Mooner:
A vaccine for HIV is going to be very difficult to make, due to the innate nature of the virus. Few pharma companies are going to be willing to invest millions or even billions into trying to make a vaccine that would eventually destroy its own market.

Nope. I don't buy it. For the very reasons that both Dave and I have stated. Even loosing money on an aids vaccine would do so much for the prestige of the company that they would make it up elsewhere on the market. Loss leading is a market strategy…

Uncertainty may make you uncomfortable. Certainty makes you ridiculous.

Why not question something for a change?

Genetic Literacy Project
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HalfMooner
Dingaling

Philippines
15831 Posts

Posted - 01/23/2007 :  15:37:27   [Permalink]  Show Profile Send HalfMooner a Private Message  Reply with Quote
Are they doing the investment, then? I mean, I honestly don't know.


Biology is just physics that has begun to smell bad.” —HalfMooner
Here's a link to Moonscape News, and one to its Archive.
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Dave W.
Info Junkie

USA
25973 Posts

Posted - 01/23/2007 :  15:38:54   [Permalink]  Show Profile  Visit Dave W.'s Homepage Send Dave W. a Private Message  Reply with Quote
From what I've seen, many start-up pharma companies exist because some university research using government (NIH) grants resulted in promising possibilities. The researchers then put together a business plan, and go searching for huge pots of research capital from banks and other investors before getting into the high-dollar human double-blind testing. There is, perhaps surprisingly, a lot of money out there for just such purposes. People aren't creating pharma start-ups without something that looks like a good product to begin with.

The luxury that the already-established companies have is that they've got a large R&D budget from the get-go, but they're still ultimately beholden to their investors, also. All they really save is time: the time it takes to go borrow the millions of bucks needed for FDA-level testing.

One psoriasis start-up, with what appeared to be an exciting treatment (better than most), managed to get through phase one human testing, and run phase two testing (many millions of dollars spent). The phase two results, however, stank. The company bravely issued a few press releases about how it might work better in people with a certain type of psoriasis, but I believe they wound up going out of business just a few months after the crappy results. Had the results continued to be as good as the initial testing, they would have had no problem raising another half-billion (a guess) to get the stuff to market.

And don't forget we're talking only the lifetime of a patent, which is 20 years. It seems unreasonable to think that HIV could be wiped off the face of the Earth in less than 20 years ('cause you need the patent prior to filing papers with the FDA for any human testing). The patent life of most drugs is somewhere between 10 and 15 years, I think. Once the drug goes generic, the profits evaporate (unless you pull some less-than-ethical trickery to get new patents later on, but that's not the norm).

Oh, and right now, what will reliably eliminate HIV without killing the patient seems to be as much a mystery as the real cause of psoriasis. The market is wide open in both cases.

- Dave W. (Private Msg, EMail)
Evidently, I rock!
Why not question something for a change?
Visit Dave's Psoriasis Info, too.
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McQ
Skeptic Friend

USA
258 Posts

Posted - 01/23/2007 :  16:01:00   [Permalink]  Show Profile Send McQ a Private Message  Reply with Quote
This is a good discussion. Pharma companies do a few things that are, in my opinion, "wrong": direct to consumer ads, make generic versions of their own products, and sometimes suppress data that would hurt sales of products (among other things), but I do not believe for one second that a company would pass up the chance to cure a disease, even if it means "destroying the market", as was mentioned. I have not read Dave's piece on this yet, but will do that in a moment.

I've been affiliated with or employed by a few drug companies over the past 17 years, and have seen some pretty weird things. You can have a whole series of debates on whether or not the pharma industry created a whole new disease state with GERD (Gastro-esophageal Reflux Disease).

HalfMooner asked the question, "What CEO of what drug company would like to die or have a family member die of a disease that there might have been a cure for if the company hadn't been so hung up on relieving only the symptoms?"

I know one CEO who would have given millions of dollars of his own money (and did) to try to eradicate Multiple Myeloma (MM). John Jackson (just retired), the former CEO of Celgene Corporation had the misfortune to have a direct family member with the disease. Celgene currently makes two oral cancer drugs that are indicated by the FDA to treat MM. The point here is that even though neither drug can cure MM (no drug can yet), he and his entire company work every day to find a molecule that will cure it. So what if the market dries up? The profits from curing one disease go into the R&D to go after another disease.

Oh, and welcome to the forum, kieranct!


Elvis didn't do no drugs!
--Penn Gillette
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Neurosis
SFN Regular

USA
675 Posts

Posted - 01/23/2007 :  16:31:16   [Permalink]  Show Profile  Send Neurosis an AOL message Send Neurosis a Private Message  Reply with Quote
quote:
Originally posted by kieranct


The time is right for a new approach.


Welcome to SFN!

First, do you even know what you are saying? You are saying that since it is costly to test efficacy, trial new drugs, and requires large investments from pharmacueticals with heavy risks. We should bypass the actual testing of the drugs and not base our medicine on evidence! What then should we base it on, personal preference, wishful thinking, whether or not its natural (like fire, poison, bird shit, and tapeworms).

quote:

The problem with alternatives, as has already been pointed out, is that their are alot of greedy people out there who are all to willing to take peoples money in times of desperation. This means that no anecdotal evidence can currently be trusted.


Sorry but that is the BIG problem. The little problem that is at the heart of the matter, is that they don't work or have no data to prove that they work. Of course anecdotal evidence can't be trusted, but it is more due to people's ability to fool themselves and their complete reliability on subjective experience (with no way of actually seeing inside their body or any actual knowledge of medicine).
quote:

I am happy to debate the above but what i would really like to do is see if we could come up with an alternative paradigm.


This I welcome with full arms. Unfortunately, no one has yet accomplished this and we use the best method we have, evidence to efficacy.
quote:

Firstly, i think that drug research should be part of the welfare state, i.e. funded by government and not corporations. This could be legislated in such a way that cures are rewarded over symptom treatment.


Two reasons why not and a clarification. Clarification: Drug research does have government funding available. First reason: Governments are Beuraucracies and thus are slow, ineffective, and completely unaware of their own surroundings 90% of the time. If you want drug efficiency, the govenment ain't the pony to bet on. Second reason: Cures over treatment will focus attention to this or that based on profits, and this is exactly what you are advocating against. Only this time, the diseases whose cures are several years away will plague their patients in the meantime. Privatization of drug companies, and all other business really, is the best way to get better results and more efficiency. You may also note that irradicating disease is the primary goal of most people getting into evidence based medicine, after all even CEO's get cancer and hypertension etc.
quote:

Secondly it seems a shame to dismiss all anecdotal evidence, yes it won't be double blind etc, but if it has genuinely worked for someone then we need to document that and try it on larger scales.


Key word genuine. How do we test for the genuine thing? If someone says they feel less pain taking an aspirin, another by laying on hands, another by smashing himself with a hammer. Can any of them truly be cast in doubt when pain is subjective? Hence, we have double blind experiments.
quote:

Thirdly, and very importantly, the role of the dietician profession should be re-evaluated.


No one would doubt diets role in health. Medicine, however, is not a nutritionist enterprise. Medicine concerns itself with things that go wrong. Treating illness. The patients have the responsiblity of taking care of their bodies. That is the problem on a whole really. People do not want to work for health they expect an easy solution, expecting the doctors to give them the health they 'deserve'. Medicine then obliges with the 'quick fix', a pill (they even want a pill to cure the need for exercise) which by its definition cannot return the bodies state to pre-disease but does do the best it is able in that respect, and managing symptoms, and yes, even curing the disease. This is not to include the serious and unavoidable diseases one is pre-disposed to, but even then a healthy lifestyle is important, in fact, more so. As for healthy, it is changing as our knowledge grows. Our knowledge should forever be open to revision and scutiny.
quote:

It has been stated on here before that it should be common sense to most people that changing their diet and lifestyle will prevent disease, however many don't know what that involves. I say tax the hell out of refined sugars and grains to let people know that they are bad for your health, after all it is the state's responsibility to protect the health of its citizens to a certain extent.


Wrong. It is people's responsibility, especially in a society with the internet in every library and free high school education. Basically, anyone can learn about the big red flags. Hell, asking a doctor will yeild such information in minutes.
quote:

Fourthly the media has a key role to play, the BBC (can you tell i'm a pommie yet?) has recently done a series on "the truth about food" showing amongst other things a "evo diet" can reduce cholestorel by 23% (more than any manufactured drug.) However this can only be done by non-corrupt government channels (in fact i can't think of any other than the BBC - which i know has its problems) in order to maintain its integrity.


The solution here, teach people to think. Think about the news rather than simply copying and pasting the broadcast onto your friends and family. Most of us advocate that here.
quote:

Finally i would like to see alot more ethical rules in any drug company sponsored research. At the least the sponsor should be published with each article.

Looking forward to the replies...

oh and before I forget http://news.bbc.co.uk/2/hi/health/6289847.stm



Sure would be a good idea. I am all for it.

Facts! Pssh, you can prove anything even remotely true with facts.
- Homer Simpson

[God] is an infinite nothing from nowhere with less power over our universe than the secretary of agriculture.
- Prof. Frink

Lisa: Yes, but wouldn't you rather know the truth than to delude yourself for happiness?
Marge: Well... um.... [goes outside to jump on tampoline with Homer.]
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Neurosis
SFN Regular

USA
675 Posts

Posted - 01/23/2007 :  16:41:08   [Permalink]  Show Profile  Send Neurosis an AOL message Send Neurosis a Private Message  Reply with Quote
The only problem I really have with the pharmacueticals, is marketing to the patients. Patients don't know jack about medicine, and although they should be completely informed about their conditions, as much so as possible, they should not be self diagnosing, self proscribing, and out right demanding certain drugs and treatments. It takes the power out of the health care system and creates a 'customer is always right about their health' fiasco.

Facts! Pssh, you can prove anything even remotely true with facts.
- Homer Simpson

[God] is an infinite nothing from nowhere with less power over our universe than the secretary of agriculture.
- Prof. Frink

Lisa: Yes, but wouldn't you rather know the truth than to delude yourself for happiness?
Marge: Well... um.... [goes outside to jump on tampoline with Homer.]
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HalfMooner
Dingaling

Philippines
15831 Posts

Posted - 01/23/2007 :  16:52:54   [Permalink]  Show Profile Send HalfMooner a Private Message  Reply with Quote
quote:
Originally posted by McQ

This is a good discussion. Pharma companies do a few things that are, in my opinion, "wrong": direct to consumer ads, make generic versions of their own products, and sometimes suppress data that would hurt sales of products (among other things), but I do not believe for one second that a company would pass up the chance to cure a disease, even if it means "destroying the market", as was mentioned. I have not read Dave's piece on this yet, but will do that in a moment.

I've been affiliated with or employed by a few drug companies over the past 17 years, and have seen some pretty weird things. You can have a whole series of debates on whether or not the pharma industry created a whole new disease state with GERD (Gastro-esophageal Reflux Disease).

HalfMooner asked the question, "What CEO of what drug company would like to die or have a family member die of a disease that there might have been a cure for if the company hadn't been so hung up on relieving only the symptoms?"

I know one CEO who would have given millions of dollars of his own money (and did) to try to eradicate Multiple Myeloma (MM). John Jackson (just retired), the former CEO of Celgene Corporation had the misfortune to have a direct family member with the disease. Celgene currently makes two oral cancer drugs that are indicated by the FDA to treat MM. The point here is that even though neither drug can cure MM (no drug can yet), he and his entire company work every day to find a molecule that will cure it. So what if the market dries up? The profits from curing one disease go into the R&D to go after another disease.

Oh, and welcome to the forum, kieranct!



Actually, I didn't ask that question. Kil did. And it was a good one.




Biology is just physics that has begun to smell bad.” —HalfMooner
Here's a link to Moonscape News, and one to its Archive.
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