Pay attention to the (business)man behind the curtain

10th December 2007

Pay attention to the (business)man behind the curtain

posted in Book Reviews, Fat Acceptance, Fat Bias, Health/Nutrition |

The husband and I caught the tail-end of a Book TV discussion this weekend with Shannon Brownlee, a Schwartz senior fellow at the New America Foundation and author of the newly published Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer.

I have not read Brownlee’s book, only reviews of it and the synopsis listed on Amazon, and I do not think she addresses treatment of or medical attitudes towards eating disorders or obesity specifically. But I did find her comments towards the nature of health care in the U.S. to certainly be eye-opening and expresses much of the frustration I and others have towards medical care in these two areas.

While searching for reviews, I found this recent article Brownlee wrote for The Washington Monthly. The article is adapted from her book, and in it she reiterates a lot of what she covered in the Book TV discussion. I’ve culled some of what I feel are the most important and noteworthy talking points.

On problems with current system of health care:

For starters, there is surprisingly little government oversight of medical practice. The Food and Drug Administration, which many people imagine oversees it, in fact only regulates the marketing of drugs and devices.

When it comes to medical procedures, the FDA has zero authority to make sure they actually work. If your surgeon wants to try removing your appendix through your back, that’s between you and your surgeon and the hospital.

What this means for you and your doctor:

…There is little reliable information about most things doctors do. The FDA does not require that a new drug be an improvement over other medicines that are already on the market, and the drug industry does not routinely conduct valid (translation: likely to be true) trials that compare one drug to another. When it does fund such comparative effectiveness trials, they are often so woefully biased that the results are meaningless; the drug manufactured by the funder of the study generally comes out on top. And the drug industry rarely, if ever, funds studies examining whether its products are superior to nonpharmaceutical forms of treatment— antidepressants versus therapy, for instance.

…Doctors are making a lot of decisions about how to treat their patients without the benefit of data. One day medical historians will look back at many current medical practices and see twenty-first-century equivalents of bloodletting and leeches.

Politicians like to tout that the United States has the best health care system in the world, but as Brownlee points out, we spend more than $2 trillion annually on health care, yet we devote less than one-tenth of 1 percent to researching what actually works.

Not only does health care suffer from a dearth of credible research, national policy and legislation governing health care are victims to heavy pressure from lobbyists and industry. Brownlee points to a Washington Post study from August, which reported that the Department of Health and Human Services, under heavy pressure from the infant formula industry, had buried the AHRQ’s (Agency for Healthcare Research and Quality) comprehensive finding that breast-feeding leads to better health in babies.

Fat rights activists have long been emphasizing the staggering influences of Big Pharma in the stigmatization and demonization of obesity. Corporations like Johnson & Johnson, who have huge and multiple stakes in the weight-loss industry, continue to fight to have obesity classified as a disease.

Why? If obesity is a disease or a mental illness, government and private insurance will be forced to cover products and treatments for the treatment thereof.

According to The Center for Consumer Freedom:

Two Johnson & Johnson’s subsidiaries are “Sponsors” of the American Obesity Association (AOA). Funded primarily by pharmaceutical companies, the mission of the Washington, DC-based AOA is to push for “reimbursement for obesity treatment and prevention.” Along the way, AOA hypes obesity fears at every opportunity. It even called for new “fat taxes” to support anti-obesity programs.

As Brownlee noted, drug companies like Johnson & Johnson, Pfizer, Inc, Eli Lilly & Co., and Hoffman-LaRoche, Inc. – all of whom have vested financial interests in the weight-loss industry – have very little incentive to author or financially back a study that shows their products to be ineffective or unnecessary.

If you think I’m being overly Orwellian in my paranoia of Big Pharma, chew on this: The American Medical Association is actively discussing the classification of obesity as a disease, just like cancer or heart disease. The eight-billion-dollar Robert Wood Johnson Foundation funded the AMA’s obesity guidelines. The foundation was named in honor of General Robert Wood Johnson, also the son of Johnson & Johnson founder Robert Wood Johnson.

According to The Center for Consumer Freedom:

The chairman of RWJF is the former vice president and general counsel of J&J. Of the remaining 15 board members, three more are retired executives of J&J, and one is the heir of the Johnson & Johnson fortune. RWJF hyping obesity could certainly contribute to their bottom line. And since about 60 percent of RWJF’s assets are in Johnson & Johnson stock, having obesity classified as a disease would only grow the foundation’s assets.

Is it any surprise that the resulting AMA guidelines would bemoan:

“Unfortunately, most managed care and additional insurance companies do not cover expenses related to weight loss.”

Brownlee sensibly calls for an “independent agency that would fund systematic reviews of the medical literature, as well as clinical trials to test the comparative effectiveness of everything from drugs to treatments.” This agency would need to be politically insulated, so it can enact policy that is largely immune from congressional pressure.

Should we fear skewed research purporting the health hazards of obesity? Or should we be more concerned with the power of corporate interests masquerading in doctor’s smocks?

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This entry was posted on Monday, December 10th, 2007 at 1:01 pm and is filed under Book Reviews, Fat Acceptance, Fat Bias, Health/Nutrition. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

1 On December 10th, 2007, Blank

said:

You do know that the Center for Consumer Freedom is a front group for a lot of restaurant and tobacco companies, right?

http://www.sourcewatch.org/index.php?title=Center_for_Consumer_Freedom

I would never, ever trust a word they say. They twist the words to try to make people hate MADD, hate smoking bans, hate blood level limits for driving, etc. They’re a baaad group of people.

posted on December 10th, 2007 at 2:22 pm

2 On December 10th, 2007, Rachel

Yes, I know this. But the information I cited above is also documented on the websites of the foundations and organizations cited above.

posted on December 10th, 2007 at 2:32 pm

3 On December 10th, 2007, Blank

Furthermore, Rachel, did you know that the official position of that group is that being fat is a choice?

Source: http://www.consumerfreedom.com/news_detail.cfm/headline/3507
(From December 4th, 2007)

Obesity is a symptom of choice, a trade-off between conveniences of modern life and metabolic mechanisms inherited from our ancestors. As Americans, we have the freedom to choose where we work, how we travel, and what we do. It’s not as black-and-white as salad versus steak. Our days are speckled with countless decisions that give us plenty of wiggle room in our diets, and even some in our belts.

Ultimately, it boils down to this: Would we rather have more comfort or less weight? And whatever our choice, lawmakers shouldn’t decide for us.

How do you feel about this?

posted on December 10th, 2007 at 2:41 pm

4 On December 10th, 2007, Rachel

I don’t feel one’s body weight is entirely a matter of choice, and I’ve said this often. However, the group’s official stance on obesity does not mitigate the findings I’ve referenced above. While I might disagree with the group in philosophy, information I referenced has all been personally verified (and linked to) on the websites of the AMA, the Robert Wood Johnson Foundation, and Johnson & Johnson. There is no need to throw out the baby with the bathwater.

Now, do you have any comments to add to the primary conversation at hand?

posted on December 10th, 2007 at 3:09 pm

5 On December 10th, 2007, Tari

I’m so with you on the conspiracy (although I would probably take it to an even more Orwellian place by way of class warfare and Madison Avenue - but I digress).

Because of my day job, I am constantly aware of the reality that doctors are not omniscient, and “diagnosis” is just a synonym for “more or less an educated guess.” Healthcare is crapshoot, all the time and every time.

There’s so much that *could* be done to make it better, though, and I’m definitely intrigued by the idea of an independent medical policy-making body. I wonder if such a thing could ever happen in our current political climate, though. Might be worth taking to the candidates…

posted on December 10th, 2007 at 3:25 pm

6 On December 10th, 2007, Rachel

In the Book TV discussion, Brownlee said that both Barack and Clinton are aware of proposals for an independent medical and healthcare policy-making body, but she said that whenever people hear talk of healthcare regulation, they automatically think “rationing” and reject it. So, I don’t think this will be an issue any of presidential candidates will be adopting anytime soon.

posted on December 10th, 2007 at 3:39 pm

7 On December 10th, 2007, littlem

You know, I used to ponder to the point of enraged frenzy why insurers (for the most part; after vociferous consumer complaint, I know there are some that are now starting to consider it) would NEVER subsidize, even partially, gym memberships, Pilates and yoga lessons, etc.

But thanks to your breaking it down I’m realizing that if we don’t have the disease anymore, we can’t get treated for it.

(Notice I didn’t say “get better”. I know so many folks on variants of anti-depressants and/or cholesterol and/or diabetes meds — and we’re not even going to get into the side effects — and they’re certainly being treated, but I don’t know anyone who is getting better.)

Sometimes it’s the obvious that’s right in front of your face that’s easy to miss.

posted on December 10th, 2007 at 3:42 pm

8 On December 10th, 2007, Rachel

Blank - On second reading, I don’t mean to come off as rule or insensitive. I do appreciate your questioning of the sources, and I hadn’t read their views on smoking bans or MADD - only on obesity. I just think your objections were moot to the larger point of the discussion.

Okay, I know this scenario might be extreme, but I with the current direction obesity-related research and legislation is going, I don’t think it’s all that far-fetched. You’ve all heard about 14-year-old Dennis Lindberg of Washington, right? He’s the Jehovah’s Witness who refused a blood transfusion and the state took the case to court to try and force him to have one.

If obesity is classified as a disease, what’s to say that the government might not also try and force fat people to undergo procedures to also “treat” and “cure” their fatness? Would Medicaid patients be forced to undergo weight-loss surgery before they can receive treatment for what are commonly (and often erroneously) seen as fat-related illnesses? Would private health insurance companies require all subscribers to take active measures to lose weight as the basis for providing healthcare coverage?

posted on December 10th, 2007 at 3:50 pm

9 On December 10th, 2007, Tari

I don’t think this is far-fetched at all. In the insurance industry right now, obesity is of greater concern than hurricanes and terrorism (!) (actually hilarious, looking at the actual gross impact to insurance companies, but they’re looking at hyped - I mean, interpreted - stats and not real data). And, in my experience, when the insurance industry gets its collective knickers in a twist…it usually only turns out well for the insurance industry.

posted on December 10th, 2007 at 4:08 pm

10 On December 10th, 2007, Tari

Would private health insurance companies require all subscribers to take active measures to lose weight as the basis for providing healthcare coverage?

This sort of thing is only one step away from a lot of measures already being taken. BCBS already offers weight loss and smoking cessation programs that cut participants a break on premiums. It’s barely the work of five minutes to shift policy wording so that coverage is dependent upon enrollment - and I would not be surprised to see more and more of that.

posted on December 10th, 2007 at 4:12 pm

11 On December 10th, 2007, Anne

totally. not. surprised.

It’s all about making money.

posted on December 10th, 2007 at 4:23 pm

12 On December 10th, 2007, Carrie

Would private health insurance companies require all subscribers to take active measures to lose weight as the basis for providing healthcare coverage?

Oh, I see it. Totally. See. It.

Yet they wouldn’t cover treatment for the eating disorder you developed when you went on the diet. Because that’s a “choice.”

And as for the Center for Consumer Freedom. I’m not a fan of *why* they say what they say- it’s just as much about money for them as it is for anyone else. However, on this issue, I must concur. The weight loss industry and obesity hysteria is a money ploy. Guess what? So is fast food marketing. Agreeing with them here doesn’t absolve them of anything dodgy they might be doing.

posted on December 10th, 2007 at 8:07 pm

13 On December 10th, 2007, Mich

This was a post with a lot of interesting information; thank you. I’ve just put Overtreated on hold at my local library, and will buy it if it meets expectations. Reminds me of a Heinlein quote: “The answer to ‘why’ is always ‘money’.” (From The Cat Who Walks Through Walls)

And I see no reason why one should not be skeptical of MADD: even their founder is no longer with the organization. There is a good article in the Nov issue of Reason about the neo-prohibitionist trend.

posted on December 10th, 2007 at 9:53 pm

14 On December 11th, 2007, wellroundedtype2

First of all, Rachel, thank you so much for this blog and your activism.
I’m not sure if you are familiar with the “Population Health Forum” but it is an organization that emphasizes how our country spends more than any other on health care but has much worse health than nearly all developed countries.
Here’s a link to their site:
http://depts.washington.edu/eqhlth/index.htm

The basic premise of their work is that it is the huge gap between the richest and the poorest (and the lack of investment in our own population) that causes our health woes, and impacts everyone, not only the poor, in terms of the health and health care we have.

posted on December 11th, 2007 at 11:11 am

15 On December 11th, 2007, Tracy

I, too, would take anything the CCF says with a grain of salt … well, actually I disagree and distrust them so much that I wouldn’t believe anything they say. They are looking out for their own wallets, not for the good of the American public.

Check out SourceWatch and ConsumerDeception.org.

posted on December 11th, 2007 at 5:53 pm

16 On December 11th, 2007, Rachel

I understand Tracy, but the CCF isn’t really at issue here. They just happened to nicely sum up and point out information that is readily verifiable on several websites. The larger issue here is Brownlee’s article, and the relationship of her points to the issue of obesity policies.

posted on December 11th, 2007 at 6:18 pm

17 On December 11th, 2007, P-Doggies

I have read Overtreated, and it is fascinating and scary at the same time. Not only does Brownlee document the lack of scientific basis for so much of what we think is “best medical care,” the scenarios of being treated “for one’s own good” are all too possible in the world she paints. She does not address weight issues in the book, but it is not hard to see how the “obesity epidemic” can fit into what she is saying. It is frightening to me how health care professionals can bully their patients into accepting care, even with the best of intentions. Years ago, I was bullied into having a biopsy that I didn’t want. I was told I would be legally declared incompetent if I didn’t have this procedure, which was considered the best medical practice for a symptom I was having. (I consulted a lawyer at the time, and she said that it was definitely possible that I could be considered incompetent if I didn’t comply, even though I had no other psychiatric problems. She basically told me, to avoid this, just have the biopsy. She said it wasn’t fair, but that I had little recourse.) Even though the biopsy was negative, I knew if it had been malignant, I would not have chosen to have treatment. And that would have been grounds for declaring me “incompetent” as well. I was not a danger to myself or anyone else. I was not suicidal. What happens when “obesity” is formally declared self-injurious? What happens when we are forced to accept interventions, not just by economic strangleholds like higher insurance premiums or difficulty finding work–despite the fact that interventions don’t “work”? What happens if I say I LIKE being who I am at the size I am, and that is so unacceptable to our society that I am treated for “my own good”? This stuff scares me more than I can say. Read the book–it is thought provoking and worth it.

posted on December 11th, 2007 at 8:35 pm

18 On January 29th, 2008, Mollyformovement

Just curious Rachel what are some of these illnesses you are referring to as erroneous? “…receive treatment for what are commonly (and often erroneously) seen as fat-related illnesses?”

posted on January 29th, 2008 at 10:43 pm

19 On April 29th, 2008, Follow the money trail » The-F-Word.org said:

[...] Products, whose parent company Johnson & Johnson holds a vested financial interest in seeing obesity classified as a disease. He’s also accepted research dollars from Amgen, another company currently conducting clinical [...]

posted on April 29th, 2008 at 4:03 pm