Guest columnist Dr. David Gottsegen: Med priorities symptomatic of unhealthy system

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Published: 11/16/2023 5:37:06 PM
Modified: 11/16/2023 5:36:51 PM

While watching our favorite show, “The Bear,” I noticed that many commercials are for drugs. And what are the No. 1 and No. 2 ads? They’re by companies calling themselves “ForHims” and “ForHers.” They advertise websites that reach “real doctors,” for meds that apparently come in plain boxes.

For the guys, the ad is for erectile dysfunction, early climax, and hair loss. The commercial is filled with suggestive jokes. For example, a young man steps into a crowded elevator. Someone asks, “Going up?”

“Not much, anymore,” the young man sighs.

The commercial for women, “ForHers,” is all about getting treatment for anxiety. Mm, that tells us something about persisting stereotypes!

The ads end with satisfied customers, who are all young and attractive, with a voiceover saying, “Medicine as it should be.”

In the meantime, back in the real world, in my pediatric office, it is often difficult to get medicines like amoxicillin for strep throat, or psychostimulants to treat ADHD.

According to a physician interviewed by NPR in September, the causes are regulations around the production of controlled substances and the fact that only three manufacturers are licensed to produce the generic form of Adderall in the country. In other words: Blame the government.

But her theory does not explain the shortage of amoxicillin. Or iron drops for anemia in infants. That’s right. One infant patient I saw had hemoglobin which dropped to dangerously low levels before our diligent staff was able to locate an iron preparation at a pharmacy 45 minutes’ drive from the family’s home.

The NPR expert’s explanation also does not explain intermittent shortages of certain antihypertensive medications, anti-viral drugs and essential cancer drugs like fluorouracil and cisplatin.

“This is, in my opinion, a public health emergency,” says Dr. Amanda Fader, a professor at the Johns Hopkins School of Medicine and president-elect of the Society of Gynecologic Oncology, according to a May 17 report in The New York Times.

There are several reasons for these shortages, including supply chain issues, and the financial troubles of generic drug makers. But the No. 1 reason, in an FDA analysis that was reported this year on the website, is this: “Many shortages began due to discontinuation of products for commercial reasons like low drug price and business reasons.”

Drug companies don’t produce enough of some medicines because they’re not profitable enough. And what are the banners in the website? Ads for Viagra from “ForHims!” Medicine as it should be?

President Joe Biden has enraged the drug companies by attempting to rein in pharmaceutical costs for seniors, as part of the Inflation Reduction Act. Part of this bill, supported by no Republicans, simply puts the United States on a track to be on par with the rest of the developed world by allowing the government to negotiate prices on 10 commonly used drugs, which are only available as brand name.

At the top of the list is Eliquis, the blood thinner used by $3.7 million Medicare recipients, costing the federal government $16.5 billion annually and each individual patient an average of $4,448 a year. It is easy to see how American taxpayers will cumulatively save almost $100 billion over the next decade. In addition, each Medicare patient will save lots of money on out-of-pocket expenses, which have in many cases increased exponentially in the last few years.

Big Pharma is calling this an unfair use of governmental powers, even though it is only giving the feds the ability to do what they already do with all other contractors.

Medication shortages are only one of the many challenges facing physicians, and our patients today. Large deductibles are keeping patients from coming in for needed sick visits. We and other primary care practices remain short staffed, with significant shortages of medical staff and nurses.

On top of this, the suspicion and conspiracy theories about vaccines and science in general went from being a fringe movement to becoming a preoccupation of right-wing politicians and media outlets — with deadly effect. Lack of trust in physicians and public health professionals led to hundreds of thousands of needless deaths among people who refused the COVID vaccines, according to numerous scientific reports.

Even fewer kids are getting their COVID shots now. The latest figures from the U.S. Centers for Disease Control and Prevention show that only 13% of children under 4 and only 39% of children ages 5-11 have received their first shot. Most parents seem to be refusing the new COVID booster for their children.

And this skepticism is contagious. More parents are turning down the flu shot for their kids, as well as the HPV vaccine, which offers protection against cervical and oral cancers in adulthood, than in past years.

Our practice, along with almost every other pediatric office in the Valley, has had to stop accepting new patients with the exception of newborn infants. And staff shortages have caused our office and others to have to cancel evening hours.

As most readers know, patients and families are more stressed than ever, suffering from more anxiety and depression, and often more irritable and impatient with medical staff, fed up with wait times for appointments, and sick of the whole health care system. “Medicare for all” in Massachusetts, as proposed in S.744/H.1239 in the state Legislature, would address many of the problems that patients, doctors and nurses face.

In the meantime, what keeps those of us in primary care going? It’s the same attitude that keeps Carmen and his staff going in the insane culinary world depicted in “The Bear”: We want to serve people, in the most caring, professional, and hopeful way we can in the upside-down world of post-COVID health care.

Dr. David Gottsegen of Belchertown is a physician at Holyoke Pediatric Associates.


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