Sunday, December 27, 2009

Reitman's next "Thank You For Smoking," or How Merck Turned a Normal Condition into A Profitable Disease

Blog fodder. While breaking for tea and news (less calories than tea and croissants) I find something I want to share with my friends on facebook. Then a healthy conversation ensues. Suddenly I realize I've struck a nerve and the topic needs airing.  Before I know it, I've postponed whatever I am supposed to be doing - in this case, getting my online courses up online - and I'm off and running right here.

Today, I hesitated, because my topic is not about the environment. And even though I've discussed health care reform here, this is not about politics. Not really. But it is about the power of the large corporation, and it's also about the ways in which that power has come home to roost very personally. Making it hard to say, "Gee, I wish they hadn't done that."

So, the story:  Merck developed a market for a drug to treat a condition that arguably doesn't need to be treated.

My story:  I am a beneficiary of Merck's consumer manipulation.

But really, am I?

Merck, according to the story, gives us a perfect (and I admit, fascinating - when you read the NPR story, you'll want to get Jason Reitman - "Thank You for Smoking" - to direct the movie) example of the power of the large corporation to use its money, influence, resources and even very questionable arm-twisting to manipulate the market to create a "need" for a product, in this case, Fosomax, a drug that slows bone loss in women with Osteoporosis and Osteopinia.

Except, wait. While Osteoporosis is definitely life-inhibiting and often life-threatening (one-in-five elderly women who break a hip will die within a year), Osteopinia isn't even a disease. It's a category of bone loss identified for research purposes. That is, it is "normal range" bone loss. But, you ask, shouldn't we be afraid of any amount of bone loss?  Well, that's an interesting question.  There's no danger of bone breakage or mortality is associated with Osteopenia. None.  It's more or less similar to the way our skin becomes drier with age.  It's aging without negative physical consequences.  Yet, today, thanks to Merck, millions of women with Osteopinia have folded Fosomax, or one of its next-generation pharmaceuticals, into their daily routines, and their budgets.

Me too.  Should I be mad at Merck?

Here is my story:  I am tiny. Small bones. A key risk factor. Under 100 pounds. Maybe five years ago, I was diagnosed with what my doctor considered "very early" Osteoporosis in my hip joints and Osteopinia at spots along my spine. My doc literally and intentionally scared me into taking it seriously. I don't know if that's her normal M.O., or if she was really spooked by the levels of bone loss in someone my age. Either way, I immediately began taking bisphosphonates (my drug of choice is Actonel, a second generation pharmaceutical), calcium, Vitamins D & K, and bio-identical hormones. [The hormone thing raised a flag on facebook, but we'll skip over it here. We can have that conversation another day, folks.]  I also got off a recumbent bike and onto my feet for weight-bearing exercise and stopped drinking soda with phosphoric acids. In the first year, those changes resulted in a cessation of bone loss. The second year, I exhibited a 3 percent bone density gain - the max my doctor said I could expect in a year. The third year, however, I had a remarkable 6.5 percent additional bone density increase, shocking my doc. I had succesfully pulled myself out of the Osteoporosis range. But, hey, I still "have" Osteopinia.

Am I still diseased?

Should I continue to take the drug?

My friend and mentor, Robyne Stevenson Turner, had this to say: "Tough call. Just because bones thin as we get older, doesn't mean we have to live with that condition. We use collagen to improve our skin tone, why not reverse the aging process with our bones. Q is would you have done this w/o the scare, but more importantly could u achieve this w/o the drugs? Would vitamins and weight bearing exercise do the same?"

I'm not sure. I suppose I will get some indication at my next bone density scan, because I've been rather spotty taking the pills this year, but I've been fairly good about the remainder of the regimin. The problem with the pills is that you have to take them weekly, in the morning before you eat. I tend to forget, eat and postpone. If I have slippage when I next get a bone density, I guess that will be some indication. Not very scientific, of course, because you'd have to control for other factors, for aging (yes, I suppose I am still aging, much as I prefer turning the clock backward) and other environmental factors. But something.

And, the bisphosphonates are so new that we don't know what side effects they may have.  You don't have to think back too many years to remember the medical field withdrawing a vast majority of patients off of synthetic estrogen replacements because of a newly found association between synthetic hormones and breast cancer.  Very recent studies seem to suggest a connection between bisphosphonate use and musculo-skeletal pain,, and even esophageal cancer  I think part of the answer to my question lies with information we don't have yet. I and millions of other post-40 women are the guinea pigs in Merck's profit-making venture. If we win, then everybody wins. If we lose, well, Merck still wins. By the time the world figures out whether the trade off between medicating Osteopinia and its side effects is worth the risk, Merck will have made money hand over fist.

I must get back to my course prep. I leave you with these closing thoughts. What Merck did makes me crazy. It's not Merck, per se. It's the way the American corporate machine manipulated the medical profession and we consumers by extension into considering something to be a disease that is not. It's the way any American corporation can create consumers out of whole cloth. It's the most dangerous form of alchemy, because it's shifted us into a nation of over-consumers. Just because it happens to be a medical product doesn't make it right. Corporate America is making decisions for us based on profit motive, and not social good.

And yet, I need to mention that, after my doctor scared me silly, I suddenly became afraid. Afraid like an old lady. Afraid to ice skate or roller skate or bike ride or ski for fear of taking a fall. Suddenly I saw myself as fragile and at risk. And not only am I too young for Osteoporosis, I'm definitely too young to slow down. And by the way, slowing down means depriving myself of the kinds of exercise and activity that will keep me young and healthy. It's a vicious circle. And it's at least in part because of Actonel that I have returned to my former, risk-taking self.

So what is the right thing? I probably would have been given Actonel anyway, because I actually had Osteoporosis. But would I want the medication to get a jump on the Osteopinia? Like we want Botox for our wrinkles? Should we want those things? Are eternal beauty and youth and good health consumer dreams fomented by the Mercks, Revlons and Banana Republics of the world?

I don't know. I think so. And yet, and yet... I wanna... I wanna... I wanna...

Full NPR article here: How A Bone Disease Grew To Fit The Prescription : NPR

More on Osteoporosis and Osteopinia here:

And for those of you drinking cola (this means you, daughters and friends addicted to Diet Coke), it's a trade-off between your taste buds and your future mobility and even longevity:

And while I'm at it, if your kids are drinking soda pop, here's a quote from Kern County Children's Dental Health Network (I have no idea where Kern County is. I was just looking for something succinct):

"Soft drink consumption poses a significant risk factor for impaired calcification of growing bones. Forty to sixty per cent of a person’s bone mass develops during their teenage years. When teenagers replace soda with milk, they are not providing their bodies with the necessary calcium needed for healthy bone growth and development. Not only does soda not contain any calcium, but it is high in phosphate. When phosphate levels are high in the blood and calcium is low, the body pulls out calcium from the bones to compensate. Therefore, those who drink large amounts of soda may be setting themselves up for osteoporosis and periodontitis (inflammation of the bones and supporting tissues around the teeth),$152.

Oh, and one more thing.  Merck has two new Osteo drugs in trials now, awaiting FDA approval.  One of them, it tested against its own Fosomax and it looks better.  Although it requires a shot, which is unappealing in a lot of ways, one of which is the expense of involving the doctor's office for every dose.  The other is a new technology.  I'll let you read it for yourself here:

Now, finally, back to the grind.

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