Archive for March, 2008

Meds in Your Water; Health Care Segmented

March 10, 2008

A recent report indicates that pharmaceutical byproducts have been found in a number of municipal water systems throughout the country. These chemicals appear to be the residues of pharmaceutical products delivered through human excrement into the water table, where they reemerge. Some pills may also be dumped into the toilet or down the drain.

Filtration and chlorine treatments do not reduce these chemicals because they don’t break down. Medicines like Prozac simply go through the body undigested and chemically unaltered. The FDA apparently has no problem allowing these products to be sold. I guess the possibility of these substances appearing in the general water supply was beyond their realm of contemplation.

The side effects of the medicines will now be felt, albeit in miniscule doses, by drinkers of water from those municipal systems. While the effect of a tiny bit of a pharmaceutical might not be significant, over time there is bio-accumulation, a relatively new field of study for biochemists. Bio-accumulation means the accumulation over time of chemical residues from a variety of sources.

Adverse side reactions are also a little researched phenomena. Unfortunately our medical system over-prescribes. Seniors now take something like 14 prescription medicines on average. The sheer number and volume of medication means the chemicals in pharmaceuticals likely will interact with each other. This is especially true for substances that don’t break down and linger in body tissues. {The presence of some of these chemicals in the water systems is a good indicator that your body or biological systems in general cannot handle these synthetic compounds.}

Many pills are used for off-label purposes, which can bring Adverse Side Reactions between two compounds whose effects on each other aren’t yet known. Also, the bio-accumulation effect means some pill residues may linger for years and present troubles when newer medications are introduced into the body.

Pharmacists provide the life-saving function of screening out medications where an ASR is known to exist. I know of two cases in just the past few months where someone has died taking too much medication, or from mixing the wrong compounds without a pharmacist’s approval. I’m not a pharmacist, I can’t properly attribute a cause of death to any specific cause, but failing to follow instructions with medicine can quite easily be fatal.

With so many different and new pills coming out, some deaths may come from unknown ASRs, as the safety of drug interactions can take years of careful study to determine. Dosages may be appropriate but too many different pills can be taken at one time, or come from sources that the pharmacist is unaware of.

The risks of using synthetics has been lost on a populace that wants to “pill away” any medical problem. So much medication “stomps symptoms” which are the manifestations of a disease. Painkillers are a good example–the underlying cause, arthritis or whatever you have, is affected in no way by alleviating pain. While painkillers may make tolerating these diseases possible, they too have their downside in their side effect, which can include addiction in some cases. (A mother in her 30s just committed armed robbery at a pharmacy in my small town, demanding not cash but Vicoden. She was swiftly apprehended.)

Antibiotics are an excellent example of symptom stomping. Over-prescribed, they end up often killing good bacteria in the stomach–called “gut flora”–in their quest to kill bacteria somewhere else in the body. Kill these beneficial bacteria and diarrea will probably result, worsening the patient’s general situation and putting them at risk of dehydration.

Another effect of antibiotic over-usage is the growth of superbugs, strains of bacteria that have grown tolerant of antibiotics. One of the most potent strains is called MRSA and is found in hospitals, a place where antibiotic use is–perhaps not coincidentally–very common. Hospitals have long been known for the prevalence of bacteria. Ironic indeed would it be that efforts to kill relatively ordinary forms of bacteria through the use of antibacterial products would set the stage for the rise of indestructible varieties.

Often patients seeking routine medical care end up with these strains, making a visit to the hospital for even the most mundane care risky. That being said, I don’t think the presence of resistant strains is a reason to avoid hospitals if you need medical care. People in hospitals are indeed vulnerable for any number of reasons–perhaps they have a wound or their immune systems have been weakened–so I wouldn’t give too much credit to the bacteria. Even strains of bacteria not resistant to antibiotics can kill, so in this regard the distinction between bug and superbug might matter little.

I also blame the medical care system for segmenting care. Segmenting care is my description of how specialists all do their own thing, independent of what other specialists do. The combined effect of this kind of care is a patchwork of remedies, inadequate follow-up, and an over-abundance of prescriptions.

A few years ago there was a big push of paperwork called the Patient Privacy Act or similar where patients were required to sign privacy notification slips in the course of doing their pre-admission paperwork. We were also sent Medical Privacy Statements in our correspondence with the Health Industry.

Getting my privacy notification, I’d been under the mistaken impression that the giant databases which housed my health care data were being merged, perhaps as part of a broader trend towards consolidation.

I’m surprised when one arm of the health care industry doesn’t know what another is doing, even at branches of the same hospital. One would think that patient data would be consolidated, available to anyone with permission at the end of a keyboard.

Reality works otherwise. I was recently in a major urban hospital complex where my mother had seen a specialist some three years previous. We’d found a new doctor in an affiliated group. The process of setting an appointment with the new specialist required going to the previous doctor’s office and signing off on some paperwork in order to get the old files to the new specialist. With a specialist appointment, naturally her GP had to get involved, which meant more files needed to be authorized for transmittal. Instead of simply allowing specialist 1 to send to specialist 2, everything had to go through her General Practitioner.

It took three weeks to get permission to see the new specialist, another three to get the previous specialists’ info, and another three to actually set the appointment and do the required paperwork for the new specialist. God help us if my mother had had any problems during that gap.

The Privacy Notification Act appears more to be a full CYA effort than evidence of any substantial change in the way patient data is organized and exchanged. If closely affiliated hospitals a few blocks apart can’t exchange data digitally, the entire system lacks the capacity for change of greater efficiency.

I think the increased digitization of medical data has actually broken apart any trend towards consolidation. The promising technologies of the 21st century have hardly been implemented, likely because the new systems require additional training.

Too much of the health care bureaucracy is engaged in the pushing of paper and using their own computer systems to move to a consolidated system. Excess bureaucracy has already pushed the quality of American health care down to the 37th place in the world. Just wait until the Baby Boomers fill the system. If it takes nine weeks to get a new specialist from the same group, just imagine how long it will take the system to incorporate new patients, then move them from system to system, contingent on GP approval.

The US’ low rank is largely a product of a lack of <b>access</b> to health care, which my example shows in full profile. At some point, it really matters little how well people in the industry do their job if the bureaucracy and technical infrastructure on which they’ve become dependent craters. So many hurdles have been put between doctors and their patients that the quality of care has tanked. Perhaps nowhere is this clearer than in the field of insurance, a topic for another day.

Perhaps the Medical Privacy Act ushered in a new era of government participation in the regulation of patient data. The government has talked about a national health care registry; I’d thought that was why the privacy of health care date had been brought to the forefront.

In the end, though, the involvement of government is perhaps stillborn. Without full integration of all a patient’s data, government efforts to “protect patient data” do nothing to protect privacy or make the system efficient, but rather insert just another layer of worthless bureaucracy between patients and their health care.

With the federal government’s cost obligations skyrocketing under Medicare, cost-savings are a necessity. Trying to cut the health care bureaucracy–arguably the greatest source of cost inefficiency–will be virtually impossible without a large amount of “creative destruction.”

With so many of our politicians and elite hide safely behind walls of financial security and private health care entitlements, there seems to be little desire to change the system affecting the rest of us. Even as the quality of care degrades, demand for health care is soaring and with it the profits for health care providers. At a certain point, the excess paperwork and inefficient bureaucracies justify higher costs while providing a bulwark against changes that could make American health care better.

In short, the great digital divide persists in the health care industry, which means no specialist will likely know what another has prescribed. Only the pharmacists know what you’ve been taking, and that assumes you stay exclusively at one pharmacist and don’t get your medicines from four different sources, as my parents do: two walk-in, two mail order.

Unless you have a personal nurse, I think the degradation and cost overruns of our health care system should be a major concern to you. Americans have been promised health care over 65, but we see Medicare premiums taking ever-larger chunks out of social security payments, another entitlement Americans worked hard to pay for over their working lives.

Can the government deliver on a promise to provide health care for those over 65 when it is already jacking up premiums and reducing benefits, long before demand has peaked? Workers of today need to be darn sure their Medicare and Social Security payments are going to be there when they need them. Otherwise, those two programs are simply more taxes, legalized theft of private labor with nothing given in return but hollow promises.

With the exception of those fattening themselves on the system, I would hope all readers feel compelled to demand better health care for themselves, particularly under Medicare. Access to care is a vital component of health care, as is cost.

The pharmaceutical waste is a symptom also of a society gone crazy over its pills, with inadequate regulatory oversight of its water by the EPA, and a lack of accountability applied to pharmaceutical companies by an FDA crippled by Bush-era anti-regulatory policies and inadequate enforcement. If Americans continue to do nothing, there will be more meds in their water, more pollution in their air, and more expensive and lower quality health care.

Then again the bottled water companies love it. That’s capitalism in its rawest form–pharma pollution is their gain as people shun the tap for bottled. A net sum zero game, the profits of the polluting pharma companies and profiting bottles will be your loss. Regulations are our only tool to prevent this abuse.

And by the way, the water bottlers might have the last laugh. Many bottled waters actually come from municipal water systems! So there may be no escaping the pharma runoff even if you go elect to bathe in the bottled.

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