To Fact Check or Not to Fact Check? That Is the Question

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I am always drawn to magazine articles about eating “clean”.  Even though I am already on board with living a healthy lifestyle, it never hurts to get the news hot off the press from the most highly lauded health food guru. The other day, I stumbled upon another “eating clean” article which made a curious reference to a “relatively short” list of “substances reasonably anticipated to be human carcinogens” published by the US Department of Health and Human Services. I scratched my head. Was this true? The US government posts a list of cancer causing toxins, and I didn’t know about it?  Being the nerdy fact checker that I am, I had to hunt this down. With the ease of a few tap tap taps on my laptop keyboard, I found it. There is “a list.” It is in the 2011 Report on Carcinogens by the U.S. Department of Health and Human Services National Toxicology Program. Now I admit that, at first glance, I carelessly assumed that the first list of about 400 substances at the beginning of the Report (lets call it the First List, because this is going to get a bit confusing) was "the list."  But, thankfully, when I read on (the Report is 507 pages) it turns out that this is not so. The Report explains that the 400 substances on the First List are really only the substances which have been examined for potential “carcinogenicity."  So, upon deciding to take a fearless dive into the guts of the Report, I thankfully found a second list. It was "the list" I was looking for: substances which are “reasonably anticipated to be human carcinogens.” I counted (and then recounted) about 204. Now, as a fact checker, if I were to nitpick and get snarky, a 204 substance list is not “a relatively short one,” in my book. But that was as good as it gets. Unfortunately, there is a third list, of about 56 substances which are “known to be human carcinogens.” (I could be off a few since I started to get queasy when I got to 50). On this list are substances which I probably already knew were not good for me like “mustard gas” and “arsenic.”  On the other hand, I am not familiar with substances like “1-(2-chloroethyl-3-(4-methylcylcohexyl)-1-nitrosourea." If it is of any consolation, there is a disclaimer in the Report that these substances are only "a potential hazard", and that the risks associated with developing cancer in a human's daily life are not identified or evaluated. "Formal risk assessments," according to the Department of Health and Human Services are "the responsibility of the appropriate federal state and local health regulatory and research agencies."

 

There are more lists later on in the 2011 Report, but I will spare you the headache for right now. 

A word of praise for the US Government: the toxicology testing process is extremely involved and comprehensive, with multiple levels of research and review. The transparency is impressive, offering the Reports up for intense public dissection and scrutiny. It includes scientific analysis and research, scientific peer review, public review, public peer review, and public comment. The Report must be updated every two years. New substances may get “nominated” to be on the list. Or, substances can be taken off the list, based upon new findings. For example, in the 2011 Report, saccharin got “delisted” as “reasonably anticipated to be a human carcinogen” due to insufficient scientific evidence.  HHS remarks that “[t]here is evi­dence for the carcinogenicity of saccharin in rats but less convincing evidence in mice.” 

 Frankly, I don’t plan on dumping two packets of artificial sweetener in my coffee tomorrow morning. Sick rats are good enough for me. Now, I am reading food labels with a magnifying glass, and keeping a lookout for any one of the 400 substances on the First List. I don’t care if the substances on the First List have only been nominated for examination by the scientists, and that only some of these substances cause cancer. I will take the safer route and just avoid breathing in, eating, drinking or being exposed in any way, to any of them. After I was done evaluating the Report, and after many hours of careful and neurotic self reflection, I decided to plan an early vacation to the Antarctic to play with the penguins. It is perhaps the only place left on earth where I will feel at ease.   

Counterfeit Prescription Medications:  Should the Feds Step In?

According to recent news, counterfeit prescription medication is big business all over the world, with superpowers like China and India playing a major part in this multi-billion dollar industry.  Counterfeit prescription medications pose the greatest threat to poor uneducated populations in emerging countries says a Report of the Institute of Medicine. Over 100 countries are plagued by the industry. The weak regulation in these nations enables the counterfeit drug market to flourish. Interpol apparently busted over 4100 fake drug sellers in a global crack down. 

 

And, now, fake drugs have invaded US drug supply chains. In response, state legislatures are trying to handle it by controlling supply chains within their own borders.  The federal government isn’t satisfied, however. It is worried about the growing imports of counterfeit drugs from overseas suppliers, as well the gap in oversight of drug wholesalers on US soil.  This has led to proposed federal legislation: Safeguarding America's Pharmaceuticals Act of 2013, which appoints the federal as the chief overseer, and strips the States of their prior powers to exclusively handle the situation. The federal government proposes tightening oversight and reporting of prescription medicine supply chains. Maybe we should first see some statistics before we knock the states out of the ring.

The Vital Role of the Pharmacist as Medication Manager

Pharmacists are more than dispensers of prescription medications.  The word "pharmacist" may bring to mind a vision of your friendly neighborhood community pharmacist.  However, the weight of scientific research has convinced me that pharmacists are an underutilized segment of the health care workforce and should play a larger role in health care reform.

Pharmacists work in a wide range of settings: hospitals, skilled nursing care facilities (SNCFs), hospices, health care maintenance organizations (HMOs), and a wide variety of retail settings like supermarkets and large discount stores. Their education is impressive too. To get a feeling for what is on the horizon for "specialty pharmacy", the Board of Pharmaceutical Specialists offers certifications in pharmacotherapy, oncology, nutrition, psychiatry and nuclear pharmacy.

Clinical pharmacists, who occupy a growing segment of the profession, provide several key services for patients, including medication management therapy services (MMTS). When patients do not take their medicine, they get poorer results from their medical care. And, its pricey.  Failure to adhere to medication therapy costs the US an estimated $290 billion dollars a year in avoidable health care spending, or 13% of total health care expenditures, according to a 2009 Report of the New England Health Care Institute. The weight of recent scientific research demonstrates that MMTS improves therapeutic outcomes and reduces hospitalizations among Medicare Part D beneficiaries, improves blood pressure and lipid management of diabetic patients, improves patient outcomes for heart failure patients, improves adherence to antiretroviral therapy for HIV Patients and improves patient results in treatment of Hepatitis C.

And, by the way, we cannot blame the patients for medication non-adherence. We are only beginning to understand why patients don't take their medicine. A 2013 Study by Avalere Health identifies the major barriers to medication adherence as cost, access and complexity of the medication regimen.

There is no doubt that the US population is aging. Within our lifetimes, the number of persons over 65 will double, and those over 85 will triple. How is this relevant? Doctors acknowledge that medication non-compliance is a major problem among the elderly.  When we put the pieces together, we should get the picture: medication adherence will become a growing concern in the near future.

Health care policy may facilitate the pharmacist's expanded role in health care, or, it may stifle pharmacists by additional new regulations which may stifle their potential contribution. As the New England Health Care Institute recommends, lets think "outside the pill box." Out with antiquated patient care models, and in with including pharmacists on the team. 

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