December, 2009 browsing by month


The best Christmas present the Senate could give us: Health care for all

Thursday, December 24th, 2009

Despite months of bluster and disinformation from those who hope to maintain the status quo, 60 U.S. senators came together this Christmas Eve morning and voted to make health care available to virtually all Americans.

The House had passed its version of health care reform months earlier. Now the two legislative bodies will have to come together and agree to a blended version.

That blended version almost certainly won’t have a public option because it would require 60 votes in the senate to get one. But here’s what we can be assured of getting in any final combination of the two bills:

  • Insurance companies will have to cover everyone – you can no longer be turned down due to pre-existing conditions.
  • Insurance can’t be snatched away from you via “rescission” when you get sick, i.e., voiding the policy when you need it the most.
  • There will be limits on how much more insurers can charge you as you get older.
  • Your insurance won’t run out when you need it due to annual or lifetime caps.
  • Most lower and middle-income people will get subsidies to help pay for insurance.

For those who say the senate bill doesn’t do enough, remember that getting this passed was a Herculean task. This is just the start of reform. Over the years, our lawmakers can continue to improve the bill, just as they’ve done with Social Security and Medicare. This is a long overdue beginning to regulating the health insurance companies, which have been given carte blanche for so many years.

The Centers for Disease Control recently reported that 58.4 million Americans were uninsured for at least part of the year and almost 32 million had been uninsured for more than a year. The situation will only get worse if we do nothing. As President Obama is fond of saying, we can’t let the perfect be the enemy of the good. This is a good bill. And it’s the best present that the U.S. Senate could give us this holiday season.

Merry Christmas to all.

– Yvonne S. Thornton, MD, MPH

Drug Company Reverse “Payola” Costs Families $Billions

Monday, December 14th, 2009

When I was a little girl, just beginning to play the saxophone in the all-girl family band that would one day win acclaim as The Thornton Sisters, the big scandal in the music industry was payola. Radio disc jockeys took money under the table in exchange for playing certain records on the air. The practice, equivalent to bribery, was illegal.

I recently learned payola is alive and well – but with a reverse twist, and in a different industry. Major pharmaceutical companies have been paying off generic drug companies in order to keep the generics off the market. So, instead of “pay to play” we have “pay to not play.” Without generic competition, major pharmaceutical companies can – and often do – charge exorbitant prices. It’s estimated that pharmaceutical reverse payola costs us $3.5 billion per year.

Here’s how the scheme works.

Let’s say a major pharmaceutical company manufactures a cholesterol-lowering drug that many doctors prescribe. Because the drug is patented, and the company has spent billions of dollars in research and development for that drug, the pharmaceutical company is then given a “head start” to charge whatever the market will bear in an attempt to recoup its investment and time spent developing the new drug.  The downside is that people whose doctors prescribe the drug either must pay the price or go without.

But the effective life of the drug patents on a name brand medicine is from seven to twelve years.  After the pharmaceutical company’s patent expires, other drug companies are permitted to manufacture and market identical chemical versions of the drug and cheaper generic versions of the drug become available to those who need it. How much cheaper? At Costco Pharmacy, a month’s supply of the name brand version of a popular tranquilizer costs $146.22. The generic version – which must by law provide the identical medication in identical amounts – costs just $8.32 for a month’s supply.

Obviously, if a drug company can continue to get close to 20 times the money for the same product, it’s going to look for ways to keep out generic competition. Some pharmaceutical companies are paying manufacturers of generic drugs in exchange for the generic manufacturers’ agreement not to market generic versions. A bipartisan effort is underway in the United States senate to make the practice illegal.

Such “reverse payola” could be compromising the health of our families and loved ones. According to a survey of 2,004 adults, done earlier this year by Consumer Reports, because prescription drugs costs are so high, 28 percent did one or more of the following:

  • Failed to fill a prescription (16 percent).
  • Skipped a dose (16 percent).
  • Took an expired medication (11 percent).
  • Cut pills in half (10 percent).
  • Shared a prescription (4 percent).

About 23 percent said they cut back on groceries in order to afford their prescriptions.

Although brand name medications often are better formulated with better bioavailability and, therefore, are often more effective than generic drugs, patients and physicians should have the option to choose which is the best under specific circumstances.  They must weigh the cost of the drug with the intended outcome.  However, the practice of “reverse payola” is unconscionable and violates the principles of good medical and pharmaceutical practice.

Generic drugs are far more likely to be affordable – and therefore available – than brand name versions. That’s where you and I come in. We need to contact our senators and congressional representatives and tell them to make such practices illegal. We need to contact our local newspapers, TV stations and other media, and ask why they aren’t covering this story. We must ensure that we and our loved ones can afford the medicines we need in order to stay well.

– Yvonne S. Thornton, MD, MPH

Yvonne Thornton on the Dr. Nancy Show: Should Pregnant Girls Play Contact Sports?

Thursday, December 10th, 2009

Today on Dr. Nancy, I was invited to appear to discuss a controversial issue. A young pregnant woman, whose high school took precautions against injury to her fetus by treating her differently than other girls on her volleyball team, has filed a complaint, claiming discrimination.

On the show, Dr. Nancy and I explained why this isn’t a discriminatory action but an appropriate one that protects the health of mother and fetus. Although some may not think of it this way, volleyball can be a contact sport. A player can get an elbow shoved into her abdomen when someone else reaches for the ball. A player can get pushed down on the court. There is always risk of injury but for most young women, the risk is minimal. Not so with a young pregnant woman. She risks harm to her fetus in the rough and tumble of such competitive sports.

While exercise is good for a pregnant woman’s health, contact sports are not, certainly not when the sorts of things we see happening in games have the potential to injure a fetus.

This isn’t a women’s rights issue. Dr. Nancy and I are both staunch defenders of women’s rights. It’s about keeping a baby and mother safe.

– Yvonne S. Thornton, MD, MPH

A lovely letter from a reader – and a reminder of why I’ve shared my life story

Tuesday, December 8th, 2009

I still hear from readers who were inspired by my first memoir, The Ditchdigger’s Daughters, although it was originally published almost 15 years ago.

The latest to come to me via email really touched me. It’s from Mr. Fred Belknap, whose lovely words make me think that he appreciates the values that my father instilled in his children in almost the same way I do:

    What an example this can be for our children relative to today, in that many think everything should be handed to them and meeting goals and beating the odds is a birth right. It seems your father did a special job to prepare you and your sisters for this world though perhaps his message was questioned at times as a result of his methods. Even though his vision, now a reality through his daughters, speaks to the strength of having a plan and carrying it through.
    Thank you for sharing your experiences and I pray the many messages engraved within them are seen by the upcoming generation.

Thank you Mr. Belknap. Your kinds words have made my day, week and month.

And a big thanks to all those who have read The Ditchdigger’s Daughters and taken its lessons to heart. I hope you’ll all continue the journey with me and read Something to Prove, my next memoir, which picks up where The Ditchdigger’s Daughters left off. It’s scheduled to be published by Kaplan Publishing in Fall 2010.

– Yvonne S. Thornton, MD, MPH

Pregnancy and Swine Flu: a Dangerous Combination

Friday, December 4th, 2009

The word from the Centers for Disease Control is that women who are pregnant are at high risk from the H1N1 virus, also known as the swine flu.

If you’re pregnant, you need to get vaccinated with both the seasonal and the H1N1 vaccines. It’s the single best way to protect yourself and your baby from the flu. And don’t let the anti-vaccination rumors swirling around the Internet scare you into delaying or avoiding a flu shot. According to the CDC, the seasonal flu vaccine has been administered to millions of women and has not been shown to harm women or their babies. The 2009 H1N1 flu shot is made in the same way and in the same places as the seasonal flu shot.  You may receive both flu shots at the same time; however, they should be given at different sites on your body, e.g., left arm and right arm.

Although recent cases of swine flu have been diminishing, influenza epidemics tend to come in waves. So even if there are few new cases of the flu in your area, it may just be a lull and you could get hit by the next wave. Get vaccinated now, if the vaccines are available in your area. Get everyone in your household vaccinated to prevent the disease from spreading among family members. Babies under 6 months of age are too young to get the vaccine so it’s especially important to their health that other members of the household are vaccinated to protect against family members spreading the virus.

Here are some other ways you can protect yourself from the germs all around us.

  • Wash your hands often with soap and water. Or use small bottles of alcohol-based hand sanitizer you can carry in your purse.
  • If you have flu symptoms, call your doctor immediately. Pregnant women tend to get more serious cases of this flu and it’s important to get treatment. Your doctor can prescribe medicines that will help.
  • Don’t assume that, just because you don’t have a fever, you don’t have the flu. This flu doesn’t always cause fever.
  • Try to avoid contact with others who appear ill. If someone in your family gets sick, ask your doctor to prescribe medications that may prevent you from getting sick, too, such as Tamiflu® or Relenza®.
  • Cover your nose and mouth with a tissue when you cough or sneeze and throw the tissue away immediately. If a tissue isn’t available, sneeze into your sleeve, not your hand.
  • Keep your cabinets well stocked with non-perishable foods as well as other basics and medicine that you might need if you got sick.

The CDC warns that if you are pregnant and experience any of the following, you must call 911 immediately:

  • Difficulty breathing or shortness of breath
  • Pain or pressure in the chest or abdomen
  • Sudden dizziness
  • Confusion
  • Rapid pulse over 100 beats per minute
  • Severe or persistent vomiting
  • A high fever that is not responding to Tylenol®
  • Decreased or no movement of your baby

Just remember, the nasal spray vaccine is not licensed for use by pregnant women because it is a live, attenuated virus. Pregnant women should not receive nasal spray vaccine for either seasonal flu or 2009 H1N1 flu. After delivery, women can receive the nasal spray vaccine, even if they are breastfeeding.

In summary, get vaccinated, practice good hygiene, and call your doctor immediately if you get sick, and you and your baby should come through this flu season just fine.

– Yvonne S. Thornton, MD, MPH