HEALTH CARE/Joan Retsinas

Loving the Land of Make Believe

With apologies to Buck Fizz and Mister Rogers’ Neighborhood, the Land of Make Believe beckons not just children, but adults. Look at our recent election: we chose a President who promised nirvana: lower taxes, less government, a burst of private sector wealth. He would restore the good old days when the USA manufactured the stuff we now import. Fantasy trumped reality.

On the health care front, we have lived in the Land of Make Believe since Ponce de Leon sought the secret to youth. Admittedly, we no longer buy snake oil; we reject goat sperm’s promise of virility; we let medical boards weed out ersatz physicians who have graduated from unaccredited medical schools.

But the Land of Medical Make Believe still enchants us. “Celebrity endorsements” convince us to try “miracle” drugs, miracle foods, miracle regimens. Pomegranate juice, colonic cleansing, alkaline-rich foods (think seaweed and goat), herbal supplements – they will boost whatever in us needs boosting. They won’t hurt. Why not spend a few dollars?

The data spew forth, generated by the industries that tout the miracles. On television the ads sound convincing: 10 of 12 doctors recommend … better than the alternatives … drink milk … eat avocados. No surprise: the soda industry backs research that touts the benefits of soda; the beef industry, research that touts its product. Google almost anything: you may find “research” praising the product. (Try “benefits of smokeless cigarettes” or “benefits of potato chips”).

The television advertisements for drugs are especially alluring: healthy people cavorting in meadows, thanks to xyz drug. The sotto voce warnings – rashes, psychotic episodes, maybe death – are sotto voce. We ignore them.

Now we have a new riff on advertisements: a “reality” television show, Reversed, slated to air on the Discovery Life channel this summer, sponsored (solely) by Mannkind, manufacturer of an inhaled insulin. Patients can “control” type 2 diabetes – but reverse? Rarely. Nevertheless, aping The Biggest Loser, the producers gather people with type 2 diabetes. Viewers watch them battle to “reverse” the disease. Who will be first? The ultimate winner is Mannkind, which had been watching its bottom line sink. Their product is more expensive than regular insulin; Pfizer had already tried to market a similar product. But Mannkind blanketed the country with agents, and, in an act of business-school-bravado, sponsored this television show.

Only killjoys try to lure us from the Land of Make Believe. Recently, in an astonishing act of honesty, Nike, the manufacturer of compression stockings, released data from a small study (20 participants) that it funded: the stockings do not reduce muscle fatigue or make runners run faster. Of course, there may be a placebo effect: people who purchase these stockings may feel they help. In the Land of Make Believe, that counts. I doubt that sales will drop.

Another would-be killjoy: the American Medical Association. At its recent meeting, it considered a Resolution (236) to ask Congress to restrict those alluring advertisements for drugs – the ones that urge you to “ask your doctor about,” or “dial 8888888 for help with payments” to “try it.” Until 1997, the government banned drug advertisements. But in 1997, the manufacturers, arguing for free speech (and higher sales), lobbied to target consumers. Patients joined the chorus of support. (Today only New Zealand and the United States allow those ads.) Twenty years later, television and magazines are awash with advertisements. The AMA’s Resolution would demand that the ads include prices. (https://www.statnews.com/pharmalot/2017/06/06/ama-drug-prices-consumer-ads/) No surprise: the companies want to keep the ads intact.

The exit from Healthcare’s Land of Make Believe to reality is harsh. All those dreary maxims that urge us to lose weight, stop smoking, cut back on alcohol, exercise, wear seat belts, monitor cholesterol and blood pressure are dreary. Miracles abound in The Land of Make Believe, not so much in reality.

Even drearier will be the exit from the political Land of Make Believe. In a few years, when we go to count the restored factories, the rebuilt bridges, and the number of jobs gained, we will be forced to leave the fantasy of nirvana.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, August 15, 2017

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