Thursday, January 31, 2013

The Profit of Medicine

Bear with me here - this is a little off message as it doesn't have anything to do with vaccinations or anti-vaccinationists, but rather focuses on those who push the idea of alternative medicine, or more specifically alternative cancer cures.  Although on second thought I do find a lot of overlap between antivaxxers and those who place their faith in alternative medicine, so in essence this is probably focused on the same group of people.  Nevertheless, I found some of these numbers interesting and couldn't help but put this together to outline just how out of touch some people are about the world around them.

This post this began out of curiosity as so many antivaxxers claim that the only purpose of a vaccine is to generate profits for drug companies (aka: "Big Pharma"), or to individual doctors.  Aside from the fact there is much more money to be made by treating diseases such as polio, smallpox, or rubella than there will ever be by preventing these diseases, there is also the common sense aspect of this theory that fails to convince.  You see, to believe vaccines are merely a method to profit suggests that tens of thousands or perhaps even hundreds of thousands of clinicians, researchers, scientists, doctors, medical experts, federal regulators, and industry watchdogs are all somehow involved in some massive conspiracy and refuse to speak out because they risk missing out on their cut of that $23 vaccine given to a toddler.  To a reasonable person this line of reasoning doesn't even pass a smell test.

That aside, why is that that the proponents of alternative medicine never seem to care about the money being made by those who are so obviously anti-vaccine or pro-alternative medicine?  Why is there never a mention of how Dr. Blaylock profits from his many newsletters or his miracle brain repair pills.  Why does nobody seem to care when Andy Moulden (a man who doesn't even have a license to practice medicine) was offering his professional diagnostic service where he could tell you if a child had a neurological condition based upon a few photographs or a videotape?  Why the lack of concern when Dr. Tenpenny offers nutritional supplements that can cost more than $117 for a two month supply or when she offers a $200 "anti-flu" wellness kit which is nothing more than a collection of supplements and vitamins?

To make matters worse, why is the selective outrage non-existent when they find someone like Dr. Tenpenny offering vitamin D supplements for $14.99 when you can get a larger quantity of vitamin D elsewhere on the Internet for less than $5?  Shouldn't these people be outraged that a "doctor" would intentionally gouge people by marking up her products over 300%?  Why do they not seem to care when someone like Dr. Mercola offers a bottle 60 vitamin C capsules for $14.97 while you can head over to Walmart and get 100 tablets for under $7 or 70 vitamin C gummies for under $5?

Why don't they seem to care about antivaxxers making a living off of speaking tours and overpriced supplements?  Why don't they care about alt-med practitioners selling pamphlets or books or DVDs full of their opinions for $60 or $70 even though they don't ever seem to have peer-reviewed research to support their statements?  Doesn't it seem odd that I can download a peer-reviewed paper that involved thousands of hours of research by real scientists and doctors simply by searching Google Scholar and all of that data is available to me for free, yet antivaxxers want to charge me over $60 to watch a home movie of them giving a speech or $50 to get a copy of a PowerPoint presentation that they slapped together in a couple of hours?

The point is - if you are going to chastise someone for profiting from healthcare, why can't you apply this disdain equally?  The truth is, there is a lot of money to be made by pushing alternative viewpoints, and the benefit of doing so is that these people aren't required to provide evidence that their viewpoints are valid provided they include a nice disclaimer on their websites (which all of them do).

So should we place our trust in legitimate peer-reviewed studies written by teams of research scientists that will never directly profit from their research, or should we trust doctors who publish their own books and newsletters filled with unsubstantiated opinion, unscientific statements, and zero verifiable data?

So where does the hypocrisy end?  If we are really going to focus on the money, why can't we apply the same logic to those who seem to profit from alternative medicine?

For instance, what if we were to look at a doctor who claims he can cure cancer? For instance, what about Dr. Stanislaw Burzynski?

  • Total number of clinical trials filed by the Burzynski Research Institute: 61
  • Total number of Burzynski clinical trials with an unknown status and which have not had any updates in over two years (many of which were originally filed in the 90s): 50
  • Total number of Burzynski clinical trials which were withdrawn: 9
  • Total number of Burzynski clinical trials which have completed: 1
  • Total number of Burzynski clinical trials which are not yet recruiting and yet have been open since 2010: 1
  • Total number of Burzynski clinical trials with published results: 0
  • Total annual cost to receive antineoplastons treatment from Burzynski: $30,000 - $60,000 or more
  • Total per day cost for the Burzynski treatment program (not including other fees): $395
  • Total monthly cost charged by Burzynski including all medications: $30,000 or more
  • Total appraised value of Burzynski's home:  $4,351,310
  • Total real estate taxes paid by Burzynski in 2012: $86,560.53
  • Total number of peer-reviewed studies published worldwide showing antineoplaston treatment to be effective including all studies published by Burzynski at any point since he began his research: 0

I should probably point out the one Burzynski clinical trial that has actually been completed was originally started in 1995 and completed in February 2005, yet we still have yet to see any published data from the study.  Wouldn't you think a guy who claims he can cure cancer might be interested in actually publishing the data that might support his claims?  Guess not.  Either that or he isn't a very fast typist... because obviously eight years seems like a long time to actually release the results of the clinical trial.

Truthfully it probably isn't fair to mention that Burzynski lives in a multi-million dollar mansion because simply living in a nice home has no bearing on whether his work is credible.  In addition to that, perhaps we should actually feel sorry for Dr. Burzynski.  After all, his home has lost around $1.5M of value since 2010.  Then again his property taxes have dropped from a high of over $114,000 down to under $87,000 so perhaps we shouldn't feel too bad for him.

The reason I point this out is because it shows you how out of touch people are when speaking about the profit in medicine.  We expect doctors to make a good living.  We expect doctors to generally be considered upper income earners or in some cases even "wealthy" due to the amount of training and education required to become a doctor.  However we don't expect that they profit at the expense of their patients.  We don't expect them to charge thousands of dollars for medications which can be purchased in pharmacies for less than $180.  We don't expect them to charge patients to be part of clinical trials when most clinical trials are done at no cost to the participants.

So why don't those who believe big pharma is simply interested in making money, or those who accuse conventional medical doctors of only caring about the bottom line ever seem to step back and ask themselves how people like Dr. Mercola or Dr. Burzynski ever became multimillionaires while the traditional GP working in a clinic and giving vaccines to children will never have an income anywhere near that level?

Rest assured patients should always come ahead of profits.  Anyone with a conscious will agree with that statement, and I'm sure the vast majority of people working in healthcare today would overwhelmingly agree.  The truth is, as human beings we have an inherent desire to help others.  People want to leave the world a better place than it was when they entered it, and when push comes to shove most people will do the right thing.  Are there exceptions to the rule?  You bet - the will always be those who put personal greed and their ambitions ahead of others, but the question we need to ask ourselves is how often does this really happen?

It simply isn't logical to believe that hundreds of thousands of people are all putting personal gain ahead of the human race.  It isn't feasible to suspect people care more about their bank accounts than they do their fellow human beings.  It doesn't make sense to claim people are knowingly suppressing cures for diseases such as cancer when there is a very high probability that every one of us will lose someone we know to cancer one day.  Perhaps even scarier is the fact that males have a 1 in 2 chance of contracting some form of cancer in their lifetime and a 1 in 4 chance of dying from cancer while females have a 1 in 3 chance of developing some form of cancer and a 1 in 5 chance of dying from cancer.

So think about that for a second.  What alternative medicine proponents would have us believe is that there are hundreds of thousands of scientists and researchers out there who are all trying to prevent cures to cancer from seeing the light of day all the while knowing they have a very strong chance of one day suffering from cancer themselves.  These alt-med types actually believe these hundreds of thousands of people would put personal profit ahead of their own health and perhaps even their own lives.

Does this make any sense whatsoever?

This is perhaps one of the many reasons why it is so difficult to take the antivaxxers or the proponents of alternative medicine seriously.  If they lack the logic to think through even the most basic of their accusations... how can they be taken seriously when discussing more complex matters such as vaccine efficacy or the peer-review process?

Monday, January 14, 2013

The Profit of Vaccinations

The New York Times recently published an article about the flu season which shows that the levels of deaths have officially crossed over into "epidemic" territory.  The full article can be found here:  Flu Season Deaths Reach Epidemic Level but May Be at Peak, C.D.C. Says

This is a well balanced article speaking about the impact of the flu as well as explaining that the flu vaccine isn't nearly as effective as some other vaccines like those for the norovirus (aka: the "stomach flu" or gastroenteritis) or pertussis (aka: whooping cough).  Part of this is obviously due to how quickly flu viruses mutate, but another aspect that could be partly responsible is the simple fact that on any given year only around a third of the population bothers to actually get a vaccine.  This means there is a much greater chance that the virus can spread among those who have no protection from the vaccine, as well as among those who the vaccine wasn't effective.

Clearly there are failures in the system and improvements must be made.  Not only do we need better vaccines, but we need to do a better job informing the public as to the benefits.  The good news is we appear to be making progress on both of these fronts, and the percentage of those who receive flu vaccines is on the rise each year.  There are also new vaccines in development that hope to address some of the problems with the current targeted vaccines although progress is slow, and funding is difficult to obtain.

This latter point is one which I wanted to speak about, because all too often we hear antivaxxers complain that vaccines are merely a profit mechanism for pharmaceutical companies and that there is no true benefit.  As the article explains it could take as much as $1 Billion to actually bring a vaccine to market, which at first glance seems like an insurmountable figure.  If a new vaccine was to be developed which either prevented the flu or even merely significantly reduced the chances of contracting a flu virus and if the usage of that vaccine was on par with vaccines for MMR or Hib, chances are we would see a vaccine acceptance rate somewhere above 90%.

So let's be conservative and use a vaccination rate of only 80% for the "one-time" flu vaccine.  We know not everyone would bother to be vaccinated the first year, but after a few years when people realized they no longer need an annual flu vaccine, they would probably be more willing to get the single vaccine, and since many other vaccines have rates well above 90%, I don't think 80% is that unbelievable.

So if we focus on the United States alone, we know there are around 312,000,000 (312M) people who could potentially be vaccinated.  80% of this is around 250,000,000 people who would likely receive a flu vaccine.  So let's assume the cost of this vaccine is $35.  The current wholesale costs of single year flu vaccines is closer to $10, but a one-time vaccine is likely to be incrementally higher due to the complexity.  For example an adult vaccine for MMR costs around $35 while the vaccine for varicella is over $60.  A childhood vaccine for Hib may be only $12 while rotavirus can be over $70, so it isn't hard to a flu vaccine could cost at least $35 wholesale - at least for the first few years after release.

Ok, so now we have 250,000,000 potential customers each of which will spend $35 for a grand total of $8,750,000,000 ($8.75B).  Even if we assume only a 50% vaccination rate (156M) and an even lower cost of $25 per vaccine, the total is still $3,900,000,000 ($3.9B).

Of course the $1B it takes to bring a vaccine to market does not include the costs to produce, distribute, and market the vaccine, so it isn't as if there will be billions in profit the first year, but the flip side of this equation is that we are only factoring in the population of the US.  Chances are once the vaccine was available it could be submitted for approval in numerous other nations with the potential to sell hundreds of millions of doses to those nations.

The moral of this story is, there would be a lot of money to be made from a one-time flu vaccine, yet to date we haven't seen anything available.  Since antivaxxers seem to feel vaccine manufacturers are only interested in profits, how can they explain that not a single manufacturer has unleashed such a vaccine on the public?  It shouldn't matter if the vaccine is effective or not, because as any good antivaxxer will tell you vaccines don't actually work (and yes I'm being sarcastic).  Antivaxxers are even willing to claim publicly that the polio vaccine and the smallpox vaccine did nothing to prevent those diseases (suggesting the diseases just magically disappeared on their own apparently), and they feel that vaccines are generally ineffective.

These same antivaxxers will tell you that the MMR vaccine does far more harm that good and that there is no evidence that viruses like the Measles have been controlled by the vaccine in any way.  They will also claim that the HPV vaccines don't work at all and that it is merely a method for the manufacturers to collect millions upon millions from insurance companies and the unsuspecting public.

You see this is one of those situations where antivaxxers want to have it both ways.  One one hand they claim vaccine manufacturers are simply in it for the money and that the vaccines themselves don't actually work.  On the other hand, they can't explain why the market hasn't delivered something like a one-time flu vaccine which would quite obviously be a gigantic windfall for the pharmaceutical companies.

So which is it antivaxxers?

It would seem to be the fact we don't have a one-time vaccine for the flu only proves that the system works.  We have clinical trials and data which shows us the effectiveness of vaccines, and if a vaccine is found to be ineffective it wouldn't be approved.  We have a system of checks and balances in place to ensure the public is protected and that vaccines are not only effective but that they are safe.  We have a system which rewards responsibility, and one which puts the safety and health of the public as the priority far head of profit.

We aren't talking about a nutritional supplement or a vitamin that can be sold by anyone trying to make a buck.  Vaccines are subjected to rigorous safety and effectiveness testing which can take years to complete and which requires verifiable proof of efficacy before that vaccine is ever approved for use.  Can we say the same thing about the various supplements and pills sold on antivaxxer websites?

Sort of makes you wonder what type of clinical trial or testing was done on something like the miracle "brain repair" pills sold by a well known anti-vaxxer.  I think we all know the answer, and it rhymes with none.

If vaccines were really all about profit and if the health of the public was an afterthought as so many antivaxxers have suggested, I have no doubt we would have a half dozen one-time flu vaccines on the market this very moment.  Yet we don't - and I've yet to see an antivaxxer who can explain this without contradicting themselves.

Wednesday, January 2, 2013

The True Anti-Vaccine Warriors

We have known for quite some time that extremist terrorist groups like the Taliban have a hatred for vaccinations, but now it seems these terrorists are going so far as to actually kill people responsible for providing life saving vaccines for diseases such as polio.

Yes you read that correctly - terrorists are actually killing people who are providing vaccines.  The latest attack in Pakistan resulted in the deaths of five teachers and two healthcare workers who were involved in providing polio vaccines.  In the month prior, nine others were killed due to their affiliation with vaccinations.

So aside from senseless deaths, the effect of these killings is fewer people receiving their life saving vaccines. It means more children being infected with diseases which could have been prevented, and needless suffering and death.  That may seem like an overreaction, but we need only look at the latest numbers of children dying from the measles in Pakistan to witness the impact.

Measles deaths have surged due in no small part to the lack of vaccines.  According to the World Health Organization (WHO), 306 children died of measles in 2012 up from only 64 the year before.  Yet if you are to ask an anti-vaccinationist they will claim vaccines are harmful and that they don't even prevent disease.  They will claim the only people pushing vaccines are those who stand to profit from them, and they will claim that people are better off if they never receive any vaccines at all.

Tell it to the families who have suffered from the loss of one of their own.  Tell it to the healthcare workers who are putting their own lives on the line only to see ignorance and fear result in hundreds of senseless deaths.  Tell it to the grieving mothers who have had to bury those 306 children.

The truth is, anti-vaxxers have a lot in common with terrorists.  They both fear education.  They both fear legitimate science.  They both prey upon fear, and they both take drastic steps to prevent people from receiving vaccines.  Thankfully the anti-vaccinationists in the US have yet to resort to murder in order to push their viewpoints, but when you deliberately mislead people about matters of life and death, perhaps they aren't that far off after all.

One thing you won't see from the anti-vaxxers is any talk about the violence against those who are working in areas like Pakistsan, India, or Afghanistan.  You won't hear about the murders, and you won't hear about the growing numbers of children dying from preventable diseases.  Once again, anti-vaxxers will do their best to avoid the difficult conversations as they continue on their mission to mislead the uninformed and as they refuse to accept responsibility for the true impacts of remaining ignorant.

It would seem anti-vaxxers have a lot more in common with terrorists than they would like to admit.  They may claim they are warriors, but in the end they are still responsible for the deaths of children... and that is nothing to brag about.