September 15, 2016--Trump and Women

Timing in politics is everything. Reporting on politics is also everything. Sometimes both collude.

Take Donald Trump's speech on Tuesday in which he outlined his child and eldercare policy.

Should I whisper that his proposals are in some ways more expansive and progressive than Hillary's? Should I mention that the New York Times, the "paper of record," on Wednesday buried the story on its Website, devoting more ink to Trump's deciding not to go on/then to go on TV with the charlatan Dr. Oz to discuss the state of his health?

The same New York Times that has been castigating Trump about his reluctance or inability to discuss social policy essentially ignored Trump's rather generous and nuanced program.

They felt it more important to highlight Mike Pence's failure to rally Democratic members of Congress to support Trump's candidacy. Once again the Times chose to cover the process more than the substance.

I suspect the Trump specifics are not well known among Progressives so here in outline are the highlights--

Employers would be required to provide paid maternity leave of up to six weeks per pregnancy. (Hillary's plan calls for 12 weeks.)

Parents would be able to deduct from their taxes childcare costs for up to four children until they reach the age of 13. 

Low-income parents would receive a tax credit for up to four children. 

"Above the line" tax deductions of up to $5,000 per year would be allowed for eldercare as well as "adult day care."

There is no surprise that Clinton supporters are saying that her plans for parents and children are better. Though they have little to say about eldercare since I cannot find evidence that Hillary has much of a program of this sort for them.

And there is little surprise that Republicans are criticizing Trump and his plan because it would create another unfunded entitlement program. Something they claim Democrats do, thought they conveniently forget George W. Bush's also unfunded prescription drug plan for which a majority of GOP congressmen voted. A plan that had already added more than a trillion dollars to our national debt.

Clearly Trump is attempting to appeal to female voters who are overwhelmingly and understandably turned off by him. One could say that he is pandering to working mom's who, if even a small percentage of them now turn to him, could tip the election in his direction. In addition, if he can attract more senior citizens whose care is largely ignored by policy makers and politicians (including by Hillary), watch out.

If Trump had revealed these programs a year ago--timing again--and had not acted so egregiously when it comes to women's issues, we probably now would see him with a substantial lead. Even so, incredibly, more-and-more polls are showing him in either a statistical tie with Clinton or actually in the lead. In crucial Ohio, for example, he has a 5 point margin.

Again, timing is everything. But Hillary supporters are feeling increasing worried. Me included.

March 6, 2014--Chantix

When you watch a lot of cable news (guilty!), considering the demographics of viewers, it is no surprise that you are bombarded with drug commercials. They may even be targeting me because half of them are for Cialis and Viagra.

Last Sunday morning, checking out Up on MSNBC so I could continue to follow the endlessly unfolding Chris Christie saga, there was an ad for Chantix, medication that purports to help many break the smoking habit. I don't smoke, thankfully never did, but for some reason I paid close attention to it, including my usual favorite part where they list the most frequent side effects.

In Chantix's case, most commonly (5% of the time), these include nausea, constipation, flatulence, and vomiting. Less common possible side effects include depression, hostility, panic, mania, and suicidal thoughts.

Then, of course, there is the familiar warning that when taking Chantix one should avoid using heavy equipment. I thought, don't all the guys who use heavy equipment smoke? Oh well.

Most interesting in the fine print where the side effects are listed were the results of tests done to determine Chantix's effectiveness. Forty-four percent, they said, after nine weeks were helped to stop smoking. Sounds good. But, fascinating, 18% stopped in double-blind tests when given sugar-pill placebos.

Why then, I thought, would a physician initially give anyone Chantix rather than starting patients off on the sugar pills since they are nearly half as effective as the prescription drugs that, in a few cases, lead to thoughts of suicide.

Prescribe the placebos, tell patients to come back in nine weeks and then, if they haven't stopped smoking, switch to Chantix. Why put nearly a fifth of patients on pills they could do without and get the same results? And all the while they'd be able to drive backhoes.

As a general rule, in non-emergency situations, wouldn't it make sense to start people off with sugar pills if the data show that in at least 10% of the cases they'd get the same results.

But at hundreds or even thousands of dollars a month for the prescription drugs, it's pretty easy to figure out why this isn't routine practice.

May 21, 2013--The "Patient Experience"

As I have been hobbling from doctor to doctor to MRI to doctor the past couple of weeks, I assumed that the only one keeping track of me was Rona.

Assume again.

From what I've been reading, the drug companies are hot on my trail.  From a report in the New York Times, here's how it works--

There are data-mining companies that specialize in tracking patients' encounters with doctors, the tests that are prescribed, how patients' insurance works and reimburses, and what drugs are recommended. Also, using other data-gathering techniques, these companies can learn if patients are taking the drugs they bought and if they refill prescriptions on time. Perhaps most chilling, they gather information about what doctors talk about with each other and how they collaborate, including which doctors in a geographic area are most influential among their colleagues. From this "influence mapping" they are able to develop an "index" and do all they can to influence the influencers.

In effect, as the CEO of one of these marketing companies claims, they are able to monitor all aspects of the "patient experience."

The information gathered is in turn sold to pharmaceutical companies who use it to target-market their drugs to doctors and other medical professionals. If they discover that a particular physician has many patients with high cholesterol but is not prescribing their latest statin, they do what they can to reach out to that doctor in an attempt to convince him or her that theirs is the most effective medication.

The drug marketing people say that by engaging in these quasi-ethical practices they can help doctors by "providing information that is customized to their needs."

For example, German drug maker Boehringer Ingelheim uses insurance and prescription data to focus on doctors who have many patients with chronic respiratory disease but do not prescribe long-acting drugs such as BI's Spiriva. Of course, to get patients as well to think Spiriva, they run endless TV commercials on those channels that appeal primarily to middle-age women.

In the words of BI's USA chief executive, "You start analyzing what [doctors are] doing and you can find out if, through a combination of factors, you can intervene."

I can remember the time when that intervention was by young (and very attractive) pharmaceutical sales reps who made the rounds of doctors' offices, leaving sacks of free samples that physicians then passed along to their patients. To further predispose doctors they also paid for sumptuous lunches and dinners for all who worked in the office.

But wouldn't you know it, as a result of  the data-mining, Big Pharma has been able to cut way back on this in-person salesforce. Thus far thousands have been laid off.

And all along I thought this information about me and my doctors was strictly confidential. The research companies claim that their work is accomplished anonymously, without identifying individual patients. Forgive me for being skeptical. I wouldn't be surprised if ZS Associates already knows the results of my recent MRI. On the other hand, I am still waiting to hear about it from my surgeon.