Sunday, September 30, 2012

I Got A Rock

Cover of "It's the Great Pumpkin, Charlie...
(For those who receive these posts by email, this essay contains a video, which can only be viewed on the blog’s website,

In October, 1966, one of my all-time favorite TV shows, the Halloween classic “It’s the Great Pumpkin, Charlie Brown”, was first shown on American TV. Featuring Charlie Brown, Lucy, Linus, Snoopy, and the rest of the Peanuts gang, the program’s storyline revolves around Linus’s heartfelt belief that every Halloween a legendary character known as The Great Pumpkin rises out of a pumpkin patch to fly through the air delivering toys to all the world’s children.

I was three years old when the show first aired, and my mom was so taken with it that for several years after, much to my delight, some shiny new toys would appear in my bedroom every Halloween, delivered by The Great Pumpkin. They’d always be there when I returned home from trick-or-treating in our apartment building, going floor by floor in my costume, knocking on doors and collecting goodies in my trick-or-treat bag. The thrill of trick-or-treating and then finding new toys in my room made Halloween one heck of a holiday for the little me. Lots of sugar and brand-new toys, what kid could ask for more?

One part of “It’s the Great Pumpkin” has the Peanuts gang out trick-or-treating, going house to house collecting goodies from their neighbors. That is, most of the kids receive goodies; our hapless hero Charlie Brown is always tricked rather than treated, like so:

Yep, when the other kids delightedly look in their bags and announce the candy goodies they’ve received, poor Charlie reaches into his and displays his joyless bounty, glumly stating, time after time, “I got a rock.” This heartbreaking little scenario sums up life for poor Charlie. Despite being a kind and gentle soul, more often than not, when the fates hand out their tricks and treats, Charlie Brown almost always gets stuck with a rock.

At the time of my diagnosis, Charlie’s lament, “I got a rock”, immediately sprang to mind. Just when things finally seemed to be coming together, when the trajectory of my life was in a long anticipated ascendancy, the very foundations of my existence were torn asunder by a big demyelinated lesion at the base of my brainstem, a great big rock thunking down right in the middle of life’s goodie bag. I’m sure everybody else who’s ever received such a diagnosis knows the feeling all too well. That damned stone was so heavy that it knocked me off balance even before the disease itself would upset my physical equilibrium, and its unruly weight grows ever more difficult to wrestle with as the disease progresses with the passage of time. For sure, I got a rock, as has everybody else stricken with a chronic disabling disease.

As I became more disabled and forced to the sidelines, I watched, slightly dumbfounded, as the rest of the world simply went on without me, never even skipping a beat. Certainly, my illness has rocked (pun intended) the lives of those closest to me, but outside of that small circle, it’s almost as if I simply went “poof”. I don’t begrudge my former coworkers and acquaintances their successes, and I’m truly saddened to hear when one has met with misfortune, but the acute awareness of my absence from these goings-on is something I’m not sure I’ll ever get used to. I’m now stuck on the outside looking in, constantly grappling with a great big rock that somehow landed in my goodie bag, while most everyone around me continues collecting treats, even if those treats often go unrecognized.

MS itself has definite geologic properties. Certainly, my weak and spastic limbs have become as if made of stone, uncooperative ballast that makes accomplishing previously simple tasks maddeningly impossible. The overwhelming fatigue that has become my constant companion has me feeling as if I’m playing the role of Sisyphus, a character forced in Greek mythology to forever roll an immense boulder up a hill, only to watch it roll back down again, over and over again. Intellectually, I always understood that tale to be one of perpetual frustration, but now, physically, I’ve come to fully empathize with the exhaustion that must’ve plagued old Sisyphus. He got a rock, too, quite literally, only he was a right bastard, cruel and deceitful, and his fate was justice meted out by the gods. I certainly was never anybody’s idea of an angel, but I’m pretty sure the heft of the rock I’m lugging around far outweighs whatever transgressions I might have committed.

Yes, I got a rock. Although this stone is a heavy burden, I try to keep in mind that getting stuck with a rock need not be a purely terrible thing. Surely, having a rock can even sometimes come in handy. They’re good for throwing at people you can’t stand, for instance those who say things like “but you look so good” or “I have MS but MS doesn’t have me”, or to stone some of the self-righteous jackasses who with distressing regularity have “MD” after their names and the insensitive clods that often tend to them. It's also fun to lazily skip stones over the surface of lakes and ponds, a mental metaphor I use to remind myself that I actually never really liked working, and being forced to “retire” has allowed me to pursue interests and cultivate talents that might otherwise have forever been neglected.

Remember too that the pyramids of Egypt are made of stone, as is the Cathedral Notre Dame, and Michelangelo’s David. The rock that has so disrupted my goodie bag has led me to meet many fine people and make friends with folks I otherwise would have never gotten to know. It’s made me re-examine my priorities, bringing into crystal-clear focus the precious little in life that is truly important. That damned rock has given me an understanding of how downright miniscule were so many of the trivialities that I used to consider problems, slight bumps in the road that I could neurotically conjure into mountainous obstacles to endlessly fret over. It has also inspired me to write words that have, much to my astonishment, been read by so many people in so many places, and perhaps, if even in just the smallest way, somehow helped some of them.

The Great Pumpkin hasn’t left toys in my room for about four decades, but that’s okay, I’m grateful that I was ever on his list. Charlie Brown might have only found rocks in his Halloween bag, but he was the hero of the Peanuts stories, not the kids who got the candy. Though he had to suffer a beagle who liked to make believe he was a World War I flying ace, a best friend to couldn’t be without a security blanket, and the indignity of often being called a blockhead, in the end Charlie’s simple humanity always seemed to save the day.

Would I give back the rock that was forced upon me, despite the insights and understanding it has led me to realize? You better believe it, and faster than you can say “pumpkin patch”. Being sick and getting sicker sucks, but I have no choice in the matter. I do, though, have a choice in what I do with my rock. I can let it crush me beneath it, or I can at least try to reverse places, to stand on top of it and take advantage of the view. Given the polarity of these two alternatives, as long as my life still has life and is not merely an existence, there’s really no choice at all. And who knows, maybe one of these days I’ll find that some fine chocolate has displaced that rock. It may be the longest of longshots, but stranger things have happened. After all, I’m the only real life person I know who got presents from The Great Pumpkin himself.

Thanks, mom.

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Thursday, September 20, 2012

Bits and Pieces: Pharmaceutical Follies Edition

Oh, those pharmaceutical companies, always generating such tremendous tidings of joy and overwhelming warm and fuzzy feelings in the hearts of their adoring public. They’ve cured almost every disease that has ever plagued mankind, urged doctors to only prescribe their products when absolutely necessary, kept the price of medicine low enough so that even the most unfortunate can afford their wares, and have conducted their beneficent and altruistic research in a transparent, above the board manner that engenders absolute trust in all of their findings. How lucky we are to…

Whoops! Sorry, I started writing the above paragraph during a brief visit to an alternate universe, one much more to my liking, in which vintage Godzilla movies keep winning Oscars decades after they were made, bacon is a health food, blithering idiots are scorned rather than given their own reality TV shows, and I’m fluent in 10 languages, drive a mint condition 1956 Ford Thunderbird, and am a world-class triathlete. But, since I appear to have suddenly shifted back to this reality, I guess I’ll have to change the tenor of this blog post. Bummer.

I haven’t done a “Bits and Pieces” post in a while, because, well, it’s my blog and I’ll scribble what I want to. There’s been lots of stuff happening in the world of MS, and in the world in general, so in order to limit this post to a length not exceeding War and Peace, I’ll judiciously pick just which bits and pieces of info to highlight. Not that I’ve ever been willy-nilly about picking bits and pieces in previous posts, but I needed an excuse to use the expression willy-nilly, due to an obligation made in an alternate universe. We all must do our part to keep the cosmos in order, you know…

So, presented for your review are the following tidbits of mostly MS related news items, most of them having to do with pharmaceutical companies and their products, with a liberal dose of my take on things thrown in. Bon app├ętit…

♦ A study which throws into question the efficacy of the interferon drugs (Rebif, Avonex, and Betaseron) to alter the course of MS disease progression (click here) has caused quite a bit of hubbub on numerous Internet MS related forums, blogs, websites, and Facebook pages, and rightfully so. This retrospective study looked at three groups of MS patients, and tracked the course of their disease over a ten-year period. One group was comprised of patients who were treated with the interferon drugs, another of MS patients that were left untreated, and a third was comprised of patients from before the days that the interferon drugs were first made available (they arrived on the scene in the mid-1990s). The study found that patients treated with interferon were no less likely than untreated patients to experience disease progression leading to significant disability.

However, another study, which received much less play in the Internet MS universe, came to the exact opposite conclusion, finding that the interferon drugs do significantly reduce the risk of progression for multiple sclerosis patients across the board (click here).

So what’s going on here? Obviously, it’s hard to say, but, as this article points out (click here), the study that found the interferons ineffective had some possible methodological flaws. One might assume that the population of patients in the untreated group was left untreated because their disease was generally less severe and aggressive than those who were in the treated group, which would invalidate a direct comparison between these two patient populations. If this were the case, the study’s findings would actually show the interferons were effective, because they kept patients with more severe disease from progressing more quickly than those with less severe disease.

Whatever the case, the situation remains as clear as mud. The interferon drugs are much disparaged among many MS patients, because they obviously do not cure MS, cost a fortune, have very unpleasant side effects, don’t work at all for many who try them, and, to top it off, are injectables, and nobody relishes the idea of giving themselves a shot several times a week. What does seem clear, though, is that, at the very least, these drugs do offer some patients relief from debilitating relapses, even if they don’t ultimately alter the course of their disease. Many patients report a severe curtailing of their relapse rates once on the interferon drugs, which amounts to a significant uptick in their quality of life. This benefit cannot be discounted, even if interferons ultimately do prove to be worthless in stopping disease progression, which of course would be disappointing. I’m not one to defend the pharmaceutical companies, but the interferons were never approved under the auspices of stopping disease progression; rather, their approval was based on their ability to reduce relapse rates and the amount of enhancing lesions as seen on MRIs. It was hoped that these two effects would translate into a lessening of disease progression, but that was always just an assumption, a point never tested in clinical trials.

An interesting window into the opinions of patients about this issue is the comments that appear after a piece Julie Stachowiak wrote about the negative study in her always excellent MS column (click here). I expected to see a fusillade of outrage voiced by the commenters, but surprisingly, a preponderance of the comments are from patients who say they’ve benefited from the interferons and intent to stay on them because of their increased quality of life. I guess the bottom line is that, drugs or no drugs, MS sucks, and will continue to suck for the foreseeable future. Actually, that’s pretty much the bottom line about everything related to MS…

♦ Here’s an example of a pharmaceutical company snatching victory from the jaws of defeat. The FDA recently warned about seizures associated with the MS drug Ampyra (click here), made by Acorda pharmaceuticals, which is supposed to improve the ability to walk in some MS patients. Much to the chagrin of investors, this warning caused a marked decrease in Acorda’s stock price. Ampyra is given in 10 mg doses, and the FDA asked Acorda to conduct trials to see if a 5 mg dose would be as effective as a 10 mg dose while cutting the risk of seizures.

The results of this follow-up study showed that both the 5 mg and 10 mg doses of Ampyra failed to demonstrate any efficacy in regards to increased walking ability (click here). Acorda claims that this is because the methodology used in this study was different than that of the original studies. Regardless, Ampyra remains on the market in 10 mg doses, since it was previously approved by the FDA based on prior clinical study results. In a happy twist for the drug company and its investors, even though the drug failed the follow-up study, the fact that the 5 mg dose was ineffective means that Acorda retains its long-term patent rights on the 10 mg dose, whereas if the 5 mg dose have been effective copycat drugs could have been manufactured and placed on the market as soon as 2017 (click here). Acorda’s stock price rose on this news, so all is well in investor land, despite the fact that the drug can cause seizures and may be largely ineffective. So, bad news for MS patients, good news for those making money through the marketing of a drug whose efficacy is highly suspect. Talk about alternate universes…

♦ In a case that didn’t work out quite as well for the drug company, Genzyme submitted the drug Lemtrada (formally known as Campath) to the FDA, fully expecting an approval. The company was so confident that the drug would be approved that they started pulling Campath, which had been marketed for years as a treatment for leukemia, off the shelves to keep it from being used off label to treat MS. This was done so that Genzyme could hike the price of the renamed drug to fully take advantage of the more lucrative multiple sclerosis market (click here). After all, MS patients need to take their drugs for years on end, but victims of leukemia either go into remission or die, limiting their necessity to consume drugs. But, ha ha on Genzyme, the FDA turned around and requested that the company resubmit their application (click here), asking the company to change the presentation of the data so the agency can “better navigate the application”, whatever that means. The FDA didn’t order any additional trials of studies to be run.

While it feels good to see a case of corporate greed smacked back, even if only a little, Lemtrada is an interesting MS drug. It is a powerful immunosuppressant, but has been shown in studies to actually decrease the amount of disability seen in patients, even five years after they stopped taking it (click here). This is a result previously unseen with any other MS drug, and may be due to the fact that Lemtrada is such a strong immunosuppressant that it forces the body to rebuild its immune system. This is a similar mechanism to some autologous stem cell treatments, in which a patient’s immune system is completely wiped out with very potent chemotherapy drugs, and then “rebooted” through the use of an infusion of bone marrow stem cells. The effectiveness of the drug does come at a price, though, as 30% of those taking it develop autoimmune thyroid disease, and a smaller percentage develop a serious blood disorder. Unlike Tysabri, though, for some reason the risk of serious infection seems to be quite low, despite the powerful immunosuppressive characteristics of Lemtrada. For patients willing to take the risk, Lemtrada, if and when it is eventually approved, may be the most effective MS drug available. Of course, it only works for RRMS patients; those with SPMS or PPMS are, as usual, left to flap in the breeze…

Having said all that, it sure would be nice if researchers would concentrate their efforts on finding ways to combat MS that don’t tinker with the immensely complex human immune system, since this approach clearly leaves patients open to potentially lethal side effects while doing nothing to actually cure the disease. Perhaps trying to figure out why the immune system goes bonkers in MS patients would be a good place to start…

♦ Just to bolster your confidence that science is aggressively attacking some of the most important issues facing mankind, a cure for baldness appears to be closer than ever (click here). Apparently, Vitamin D holds the key, and researchers around the world are scrambling to finally solve the horrendously tragic and heartbreaking epidemic of typical male pattern baldness, which has brought frustration and shame to men longing to be hairy since time immemorial. Just think about how much time and money is being spent chasing this cherished dream, and how many brilliant minds are dedicated to it. Forget about cancer, heart disease, ALS, and even MS – rejoice, for soon baldness may be cured! I know that I, for one, even with my head full of thick, voluminous hair, will celebrate mightily when the cure for baldness is finally announced. I’ll sit in my wheelchair and feebly raise a pathetically weakened fist as high in the air as my ever more afflicted muscles will allow, reveling in the knowledge that some perfectly healthy bald men will soon be able to proudly make appointments at barbershops and hair salons the world over. It’s all about priorities, people, and mine are definitely in order.

♦ This little bit of news is funny and sad at the same time. Seems an MS suffering grandfather in Scotland forgot he was married and wed his girlfriend, getting into all kinds of trouble due to the fact that he is now a bigamist (click here). The 50-year-old claims he thought his first wife had signed divorce papers, but he apparently forgot that she hadn’t.

In all fairness to the gent, he’d been separated from his first wife for several years, and MS does cause cognitive and memory issues in many who suffer from it. Furthermore, his second wife left him a few months after they were married, and the stress ensuing from this whole mess triggered a relapse, leaving him using two crutches. I’ve had women leave me emotionally crippled before, but this guy really got the short end of the stick. Or, in his case, sticks. In related news, a new study found that ginkgo biloba, an herbal remedy purported to improve cognitive function, had no effect on the cognitive abilities of MS patients (click here).

♦ If you’re in need of a little inspiration, this (click here) infographic about the Paralympics can provide plenty of it. Recently completed in London, this international sporting event for disabled athletes embodies the best of the human spirit. Though the bodies of participating athletes may not fit the standard definition of perfect, their hearts certainly defy definition.

I’ll leave you with the following video, in which a noted brain researcher recounts her experiences during and after suffering a stroke. These experiences provided her with startling and fascinating insights into not only the workings of the human brain, but of the universe and our place in it as well. I have an endless fascination for the mysterious place where science gently kisses spirituality, and this talk navigates that enigmatic realm as well as any I’ve ever heard. It’s 20 minutes long, but I guarantee it’s time well spent, and will provide you fodder for much contemplation…

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Monday, September 3, 2012

Our System for Treating the Sick Is Sick Itself; No Cure In Sight

Hippocrates: a conventionalized image in a Rom...
Hippocrates: a conventionalized image in a Roman "portrait" bust (19th century engraving) (Photo credit: Wikipedia)
I’ve recently come across a spate of news pieces that illustrate just how far our health care system has gone astray. Most of the folks reading this blog are themselves chronically ill, or have a personal connection to the chronically ill. As such, Wheelchair Kamikaze readers are unfortunately more familiar than the average Jane or Joe with the inner workings of the world of modern medicine.

For the healthy, from the outside looking in, modern medicine can often appear to be a sleek and technically sophisticated miracle machine, using high-tech wizardry and groundbreaking research to treat and tame diseases that have been the scourge of mankind for millennia. This image is carefully cultivated, through public relations, advertising, and a news media that loves a good story about astonishing advances made in the battle against disease. Those of us who are forced to enter the belly of the beast, though, often find something quite different: a confusing, frustrating, and often dysfunctional world in which reliable answers are heartbreakingly few and where patients are too often seen as consumers rather than sick human beings. Though individual healthcare practitioners themselves are, for the most part, good men and women, the system within which they operate has evolved to put profit before patient, and the subtle and not-so-subtle pressures this framework exerts can warp even the best intentioned souls among them.

Here, then, is a smattering of examples that each serve as windows into the often enigmatic environment in which patients are forced to tread. Think of the following snippets as flashbulb lit snapshots taken in a pitch black room, briefly illuminating nooks and crannies that can only hint at the whole of a much larger setting. Each example is in itself maddening, but strung together they portray a system of treating the sick (and healthy) that has drastically gone off the rails.

♦ HCA, the largest for-profit hospital chain in the United States, is revealed in this article (click here) to have played host to a disturbingly high number of cardiac procedures (mostly angioplasties) that were found to be medically unnecessary, and apparently performed to drive profit and increase both the company’s and the treating physicians’ financial bottom lines. At Lawnwood Regional Medical Center, in Fort Pierce, Florida, a confidential review revealed that about half of the diagnostic cardiac catheterizations done at the facility were performed on patients without significant heart disease. A review of HCA internal documents indicated that “rather than asking whether patients had been harmed or whether regulators needed to be contacted, hospital officials asked for information on how the physicians’ activities affected the hospitals’ bottom line.”

Driven by the need to show steadily increasing profits in the face of the company’s impending Initial Public Offering, it seems that HCA turned to cardiac care to provide a reliable pipeline of revenue. A 2003 review of procedures done at Regional Medical Center Bayonet Point, in Hudson, Florida, revealed that a disturbing 43% of 355 angioplasty cases “were outside reasonable and expected medical practice”, and that treating physicians routinely overstated the degree of coronary blockage found in the treated patients. As a result of this internal review, Bayonet Point suspended the privileges of nine physicians. These cardiac procedures were a financial boon to the company, as Medicare reimburses hospitals about $10,000 for each stent used in angioplasties, and $3000 for diagnostic catheterizations.

One would hope that instances of such rampant malfeasance are extremely rare, but although this report concentrated on one large hospital chain, the unnecessary procedures were performed in a number of different facilities, and by a shockingly high number of physicians. As is evidenced by this account, the institutional and personal pursuit of profit within the healthcare system would appear to be a potent inducement for some of those who took the Hippocratic oath to turn their backs on that solemn text.

♦ The headline of this article shouts that “Diabetes May Be Reversed by Long Used Vaccine for TB” (click here). Great news, right? Well, not so fast. In a small study the 90-year-old vaccine, called BCG, was shown to induce the completely nonfunctioning pancreases of some type I diabetics to once again start producing insulin. “These patients have been told their pancreases were dead… We can take those people, give them a very low dose twice and see their pancreases kick in and start to make small amounts of insulin.”

So, what’s the problem? Sounds like widespread research should be undertaken posthaste. The vaccine already exists, and has been in use for almost a century to treat not only tuberculosis but also bladder cancer. But therein lays the problem. A 90-year-old vaccine cannot be patented, and is readily available as a cheap generic. Therefore, huge heaps of cash cannot be generated by finding new uses for it. Soon after the lead researchers made their initial discoveries using mice, “they tried to interest every major drugmaker in developing the vaccine as a possible cure for diabetes. All told her there wasn’t enough money to be made in a cure that used an inexpensive, generically available vaccine.” The researchers are currently undertaking fundraising from private donors, and thus far have $11 million of the $25 million needed to proceed to the next stage of research.

As disturbing as the story is, with its seemingly blatant disregard for the well-being of millions of people worldwide suffering from type I diabetes, the hard truth is that the major pharmaceutical companies were actually fulfilling their legal mandate in turning down research that had very little, if any, profit potential. All of the major pharmaceutical companies are public companies, their stock traded openly on world markets. Publicly traded companies are mandated by law to be beholden to their shareholders, not to the customers who eventually consume their products. The job of pharmaceutical company CEOs is not to produce the most beneficent concoctions their researchers can come up with, but rather the most profitable ones. In declining to fund further research into the BCG vaccine’s role in potentially eradicating type I diabetes, drug company executives were not only fulfilling the responsibilities of their office – doing their jobs, so to speak – but also following the letter of the law. Not to go all gutter on you, but how fucked up is that?

♦ As patients afflicted with a horrible disease that has no cure, we often vent our frustrations about those who are the face of this medical universe we have unwillingly been sucked into, the physicians who regularly treat us. A quick sampling of the online conversations being held on Internet MS forums soon reveals that many patients openly revile their neurologists, some of whom I’m sure deserve all the reviling they can get. I count myself as one of the extremely lucky ones, as I feel an actual affection for my neuro, despite his inability to stop the relentless progression of my disease. He’s simply an empathetic man, and his frustrations with trying to treat this repugnant illness are evidenced by his obsession with trying to unravel its mysteries. We don’t always agree on treatment options, but I know in my heart that my neurologist has my best interests in mind. I say this not only because of my own personal sense of the man, but also for some far more tangible reasons: he doesn’t accept insurance, and doesn’t allow pharma sales reps to enter his clinic.

This commentary (click here) provides some insight into the phenomenon of physician burnout, a condition brought on by the restrictions and edicts of a system that would seem to sometimes be as frustrating for the doctors trying to operate within it as it is for patients seeking reliable and compassionate treatment. A recent survey of 7000 doctors “found that almost half complained of being emotionally exhausted, feeling detached from their patients and work or suffering from a low sense of accomplishment.” Doctors suffering from such burnout are obviously more prone to make mistakes, have an inability to establish any kind of real relationship with their patients, and generally perform below the expectations of the sick people who are so reliant on them.

The cause of this physician malaise is often invisible to those of us under a doctor’s care, who may only see an insensitive and mechanical being who exhibits little or no empathy towards our plight. Indeed, that’s the way I viewed my first MS neuro, and why I sought out the services of the man who is now my doctor.

According to the commentary, “The study casts a grim light on what it is like to practice medicine in the current health care system. A significant proportion of doctors feel trapped, thwarted by the limited time they are allowed to spend with patients, stymied by the ever-changing rules set by insurers and other payers on what they can prescribe or offer as treatment and frustrated by the fact that any gains in efficiency offered by electronic medical records are so soon offset by numerous, newly devised administrative tasks that must also be completed on the computer.

In this setting, “doctors are losing their inspiration… and that is a very frightening thing.”

While this certainly does not excuse all of the bad behavior by physicians recounted by patients in conversation after conversation, it certainly makes some strides towards explaining it. Indeed, many doctors feel so frustrated by the factory like approach dictated by insurance companies, with daily quotas to see X number of patients and restrictions placed on the treatments they can offer, that they are leaving the practice of medicine entirely.

This of course does not excuse the behavior of physicians who blatantly order unneeded tests and perform unnecessary procedures simply to run up bloated billing, or who view their patients as vehicles for their own financial advancement. Such doctors do exist, and in unacceptable numbers, but can we expect more from a healthcare system that has evolved into a moneymaking Goliath, under the direction of huge corporations that routinely squeeze the humanity out of the medical equation? A system increasingly dominated by publicly traded companies whose calculations are based more on stock price than on patient care? From research labs to clinic examination rooms, the well-being of patients, and sometimes of the doctors who treat them, is being sacrificed at the altar of the Almighty dollar.

Is it any wonder that diseases seem never to be cured, but instead turned into lifelong “manageable” conditions, those suffering from them forced into a state of perpetual reliance on obscenely expensive pharmaceutical products to maintain some semblance of wellness, and sometimes even to just maintain life?

If only there was some evil cabal to blame, some sadistic brethren of money grabbers to be tarred and feathered and run out of town. But no, what we are faced with is a systemic dysfunction, a misguided medical colossus that requires only decent people doing their jobs to maintain it, even as its course runs further and further astray. It is an engine with a wicked momentum, dragging all of those in its tow to a place where everyone, eventually, will be unwitting passengers. Very few make it through this life without finally suffering serious illness, and this universal fate is what ultimately fuels the system, driving it ever forward.

Do no harm, indeed…
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