Cleaning up the desk

Too much to talk about -- much of it concerning developments on issues we've been covering here.

A group of health policy experts convened by the Brandeis University Health Industry Forum says the U.S. needs an agency to evaluate medical procedures, drugs and devices, similar to the UK's National Institute for Clinical and Health Excellence (NICE). I concur.

The International Narcotics Control Board finds that misuse and trafficking in prescription drugs are about to surpass problems with illicit drugs. They are mostly talking about narcotics. Diversion and misuse of narcotics is underreported, they say. Nevertheless, consumption of opioids increased by more than 100% in more than 50 countries since the mid-1990s. In the U.S., that's 7.8 million people abusing prescription drugs in 1992, and 15.1 million in 2003. Fentanyl, hydrocone, and oxycodone are leading to growing numbers of deaths in North America. We have discussed this previously here and here.

Friend Libby Bradshaw, in the March 7 JAMA, reviews When Illness Goes Public: Celebrity Patients and How we Look at Medicine, by Barron H. Lerner. Summarizing Lerner, Dr. Bradshaw notes that the media narratives of celebrity illnesses demonstrate "how celebrity patients can both inform and misrepresent issues to the public." Benefits may include informing people about diseases and treatments, and illuminating difficult choices and ethical dilemmas. But of course conclusions drawn from anecdotes - single cases - can be misleading.

I was reminded of a woman with HIV who I interviewed a few years back. She had decided to start taking antiretroviral medications because Magic Johnson was taking them. Magic was an advocate of early treatment -- starting on ARVs before any symptoms of HIV disease appeared, including reduced CD4+ cell counts. This is actually probably not the right choice for most people, because of drug side effects and the risk of creating viral drug resistance. Celebrities also are likely to get the best, most expensive care, and they have other advantages that mean they are likely to do better than the average person with a similar condition.

I haven't had a chance to read the book but I would venture to say that a common narrative portrays the ill celebrity, along with medicine and doctors, as heroic and triumphant. Remember the advertisement showing Christopher Reed rising up and walking? We're still a long, long way from reconnecting severed spinal chords.