Towards a Healthcare Magna Carta, Part One

David Healy, MD
18
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As the days lengthen and things warm up in England, historically it has been the time for the people to get restive.

Eight Hundred years ago, the people meant a group of us who counted – we called ourselves the Barons. There were other human beings – our serfs – who worked for us. Today, in theory even the serfs count.

Next Sunday, June 15, Eight Hundred years ago, we refused to accept King John’s right to rule in England as he had been doing, and confronted the king at Runnymede.

Today’s Barons are the Doctors. Doctors make a living out of the work done by the rest of the population – swallowing pills. These doctors are highly unlikely to confront Andrew Witty or any of the big beasts of the pharmacockracy – unless some of them do so as shareholders.

Eight Hundred years ago a charter was hammered out between us and the king that has since become known as Magna Carta. Today something similar is needed. The forthcoming publication of Study 329 will make clear why.

Up till June 15, John and other kings were absolute rulers, whose right to govern came directly from God rather than from the people. When this right was questioned the Pope weighed in on the side of the king, excommunicating anyone who questioned the authority of the monarch.

Magna Carta was based on two principles – the principle of No Taxation without Representation and the principle of Due Process. These principles are fundamental to most political systems today.

The area of politics that counts most for most of us is healthcare. Big Healthcare is now the biggest business in the United States and in the Western World. We desperately need a new compact between we the people and those who govern our healthcare – or at least a new compact between the doctors who make money for pharma by putting pills in our mouths and the Witty’s of this world.

No taxation without representation

No one bats an eyelid at the idea that the United States is pretty market oriented compared to the more communal or socialist systems found in Europe with Great Britain usually seen as sitting somewhere in the middle.

So it is surprising if you put UK PLC and US PLC into google and see what happens. Google recognizes UK PLC and Great Britain PLC but not US or United States PLC.

There was no google in the twentieth century. Had it been there, it would have started throwing up hits from the late 1960s when British Labour politicians (who used to be very socialist back then) started mooting the idea of UK PLC. The ex-Empire was now a company that had to make its way in the wider marketplace. The Government, we were told, was like the Board. It wasn’t quite clear if the rest of us were the shareholders. We had some notional control over the Board – we could vote them out. Election debates today still mention UK PLC –Scotland PLC hasn’t come on the radar yet.

It’s an odd way to see your country. Neither the US nor any European country views itself in this way. But then the Brits invented PLCs as well as Magna Carta and cricket.

The same idea lies behind the Magna Carta and a meeting of the shareholders of a company – there should be some trade-off between the financial input of the stakeholders in the company (country) and their ability to influence policy. It is worth paying money in the form of investments or taxes if the ship of state is being steered in a reasonable direction but not otherwise.

In health we pay either relatively directly or indirectly through insurance systems or government taxation for the benefits we receive. At present, our barons make money for pharma by putting pills in our mouths but pills that keep companies healthy rather than us healthy.

This happens because of a Flash Boy situation. The healthcare market (stock exchange) should produce better healthcare outcomes (channel money to genuinely productive ends). But neither the stock market nor healthcare support productive outcomes. Both have become a means to siphon money from the middle and working classes to a bunch of Flash Boys. This is possible because as with the stock market, in healthcare no-one gets to see the data behind the transactions. Drugs that are bad for us can be palmed off as life-saving without anyone being any the wiser and we are sold a costly bag of goods.

But we are not just being taxed in terms of the money we pay to consume drugs we don’t need. There is a tribute taken from our bodies also in terms of our participation in clinical trials. Companies need clinical trials to get their drugs on the market in order to make billions from them. These trials involve us taking risks with drugs that often prove too dangerous to market. We do so for free. Not only that but when some of us are killed or injured we collude with hiding the data of our injuries and deaths. We have no more status than serfs.

Or at least this was the way until the clinical trial operation was largely outsourced to India and Africa leaving UK PLC scrambling to persuade GSK, Roche and Pfizer that it is open for clinical trial business and willing to divert its NHS patients into company trials.

It’s this taxation drawn from our bodies that should fuel a demand for representation – we should have a say in deciding what we need medications for and we should have access to the data from trials to check on how it is being represented.

When trials run on our children lead to representations that paroxetine is effective and safe even though the actual data shows exactly the opposite – it’s time to intervene.

Due Process

The other key element to Magna Carta was the idea that we are all equal before the law, kings and commoners, and that all have a right to a fair trial.

This principle established the rule of law and laid the basis for democracy. This is a basic Right that provides a basis for all other Rights.

Rather than assassinate the King or seethe with murderous fantasies (Anonymous) we can take him to Court. Rather than be executed at his whim, we have the right to a fair hearing by a Jury of our Peers (just for the record Peers means other Noblemen).

The capacity of plaintiffs in the United States to take legal actions when they or their families are injured by treatments probably stands between the CEOs of pharmaceutical companies and an attempt to exact physical retribution (See Data Wars and Pharmaceutical Rape).

But even in the United States, there is a real problem. When we participate in clinical trials today, companies get to sequester the data from these trials in flagrant breach of the ethics and norms of science and yet parade their representations of those results as science. The participation of some of us in those trials puts all of us in a state of legal jeopardy. In the US, we may get our day in Court, but we will have the data from clinical trials in which our friends and families participated used against us.

We have entered a bizarre Wonderland where Queen John or Andrew can say off with our head if she wishes to or can say what happens on a drug is what I say happens – regardless of what in fact does happen.

It’s a world where increasingly we will be told by Sense about Science in the UK and related bodies in the US, Canada, Australia or wherever that to question the judgments of the scientific literature is to engage in an irrational War on Science itself. We may have a right to Due Process in the US (nowhere else) but even in the US, courts are no longer a place where rationality prevails.

Not a Peep from the Pope about the right to Due Process or Representation.

Meanwhile David Cameron on behalf of UK PLC has launched into an anti-corruption crusade – but there won’t be a word about this lack of due process or the extraordinary corruption of the scientific literature – on which hinges vastly more money than was ever dreamt of by Sepp Blatter and FIFA.

18 COMMENTS

  1. Hm – sounds like big business having more say than The People or The Government, as Big Gov hands it’s powers to Big Biz.

    the big scare at the moment about the transfer of power to Big Biz being the Transatlantic Trade and Investment Partnership
    http://www.independent.co.uk/voices/comment/what-is-ttip-and-six-reasons-why-the-answer-should-scare-you-9779688.html

    Here is briefing on Big Pharma and TTIP
    http://www.prescrire.org/Docu/DOCSEUROPE/20140324CivilSocietyResponseBigPharmaWishList_final.pdf

  2. I find this article pretty difficult to understand. In fact, I am having more and more trouble understanding what Dr Healy writes as time goes on. Is it because his references are very British, and someone not in the UK is not familiar with them? Or what?.

    I notice the earlier commenter IS from the UK, so maybe this explains it.

    • nah, he is using pretty tortuous metaphor, I’m just up on TTIP and googled it plus big pharma to find the link.

      I see his piece as about corporate power corrupting medicine written in a metaphor about Magna Carter. Magna Carter is a bit of English history that is in the news right now and was something to do with the barons limiting the kings power. He could have dropped the Magna Carter bit and written it in plainer English though. If I hadn’t been involved in campaigns against TTIP, a transatlantic trade agreement that gives corporations power over the state, I might have struggled to know what he was on about.

    • So glad it’s not just me!

      I had to read it three times and Google UK PLC to “get it”.

      It seems to me that it is pointing out how corporations are using their power to corrupt governments and reduce the general citizenry to serf status, fodder for their experiments and mere objects to provide profits, with virtually no rights.

      That we are, in fact, being used as implements of our own destruction, and if/when someone dares to question the “science” behind the actions of the corporations, they are pilloried by the scientific establishment, which has long since been hijacked by corporate interests.

      I may have missed the mark….but the Trans Pacific Trade Agreement (the equivalent of the TTIP?) terrifies many thinking Australians as it potentially gives corporations the ability to sue our government (and send it broke) if it places its citizens’ well being above corporate profits.

      …and we’re being told that to even contemplate that corporations/drug companies might place profits above people’s wellbeing is simply wrong-headed.

      It is, indeed, Alice in Wonderland stuff!

      • I have heard the term Neo-Fuedalism banded about recently to describe the new economic relationship between most of us and trans national corporations.

        Most of us write something that illustrates a point and maybe use a metaphor somewhere in the writing to add a bit of spice (to use a metaphor), but make sure the metaphor stays in the background to the whole story. Healy puts his metaphor in the foreground of his writing. This can make the story hard to spot.

        In Healy’s writing there are three main players:
        1 patients
        2 Dr’s
        3 Big Pharma

        He sees the relationship between Dr’s and patients corrupted by Big Phama. Sometimes I wonder if he thinks there was a golden age of Doctoring when the relationship between patient and Dr was pure and wholesome? What Healy does not write about is how the dynamics of corruption that Big Pharma enter into are paralleled by other corporations and sectors of the economy.

        UK Uncut have highlighted tax avoidance by lots of big businesses such as Google and Starbucks. I believe the USA has a similar organisation called US Uncut. The big four accountancy firms of PwC, Deloitte, EY and KPMG have senior staff who are seconded to the UK tax and revenue department where they advice on how to implement tax law. These workers then go back to work for the accountancy firms who advice big corporations on how to avoid tax. The same workers will then go to work in the accountancy departments of big corporations. This is exactly analogous to how people work for Big Pharma corps and then work for government drug regulation agencies and then for another Big Pharma firm. Poacher turned game keeper turned poacher.

        There is a whole analysis of psychiatry as the handmaiden of capitalism. I might go into it more tomorrow if I can be bothered. I hope this is not too off topic, though the power of the corporations and how psyche drugs have taken off are so obviously related to me it seems worth commenting on again.

    • I hope David Healy takes note of your comment and many of the comments which follow – his writing style is his own worst enemy – a magazine editor friend used to say that the first duty of a magazine is to be read – and so it is the duty of a blog/article. Healy makes it onerous. An ordeal. I read to be informed, not amused nor challenged.

  3. ” even in the United States, there is a real problem. When we participate in clinical trials today, companies get to sequester the data from these trials in flagrant breach of the ethics and norms of science and yet parade their representations of those results as science. The participation of some of us in those trials puts all of us in a state of legal jeopardy. In the US, we may get our day in Court, but we will have the data from clinical trials in which our friends and families participated used against us.”

    In the United States medical care is controlled by insurance companies. Insurance companies are run by businessmen who are profit driven. Although they do not directly control the services they provide to those who are members of their insurance plan they do appoint medical directors who are physicians who do just that.

    Psychiatrists control the services that their insurance company provides to those who suffer from so called behavioral illness. Because of their view that psychiatric issues are really medical ones, their response to member psychiatric issues, is through medication.

    This is highly profitable to the insurance companies. If one considers the cost of medication management 2 sessions a year at $250 on average per session, compared with 1 time weekly sessions at $40 to $75 per session, with an upper cost range of about $4000 per year.

    This has led to an emphasis, on medication management as a form of treatment, with a huge vested interest in continuing along this line. The pharmaceutical companies, benefit enormously from this state of affairs, and when people seek treatment, they are directed toward medication management instead of psychotherapy.

    Once someone is placed on medication management case review is only cursory. Most insurance companies allow someone to be on medication management forever, without any review at all.

    In fact because of the insurance industries stance that medication management is the way to treat biological/mental health problems, the amount of clinical information submitted on any case, is minimal, and getting smaller and smaller. In instances in which medications have failed to provide the desired response, ECT is the favored alternative. It is usually authorized with minimal clinical information, and is routinely authorized by MA level staff, sometimes no review is required at all.

    Psychiatrists control every aspect of treatment in the U.S.. This in spite of the fact that they have very little training in psychology, or psychotherapy, they are making life and death decisions with the lives of millions of their members, to the detriment of those members.

    As witnessed by the staggering number of drug over doses on prescription medications, in the United States each year, now out numbering those of street drugs. Clearly medication management has only created a new class of drug dependent individual. Who doesn’t understand how he or she got there.

  4. I think Dr. Healy frames these issues in many different and creative ways to facilitate new ways of thinking. These are complex problems and the more angles we can view them from the better we might understand and ultimately address them.

    We absolutely do need a new compact when it comes to our relationship with healthcare systems. Industry has proven time and again that it cannot be trusted, and yet our governments (like lazy parents) continue to let industry “live in the house,” probably because it pays the light bill. (And then there are the shiny trinkets).

    I may now have a flimsy lock on the door of my room, but am still completely aghast at what this industry/a**hole is allowed to do to other kids. Those in charge will keep letting horrible things happen until we the people put a stop to it.

    Is it too much to demand public health be public? Will we let our new surgeon general be mascot of the status quo, or might be petition him to take on the pharmaceutical industry like Koop did big tobacco? Do you think he would even be willing to consider that the public he’s charged with serving is currently at risk?

  5. FEELS like spring is in the air, in the somewhat United Kingdom. While our good King David, the honest male Doctor sets out his metaphorical tale of a another, new beginning. What we need is true reason, not this treason of psuedo-science fostered on my loyal subjects by those who pofess insider knowledge of the truth, about our common mental health.

    While here in the survival stakes of everday survival (racing metaphors, so beloved of World Wide Royalty) we compete to see who will be the material winners & losers. And as the material girls all know, its a material world & the reality of male presence is simply nor enough. Don’t you get that feeling sometimes, that Charles Dickens had a gender bias? “You want MORE!” My dear Olive Oil. Sorry, I digress.

    I guess, I’m wondering whether the well known use of rich visual metaphors, in the movies, might help us to transcend the Paternalism engendered social matrix & the illusions . . . delusions that language describes our actual experience. For example, why does the consensus mainstream accept the term “mental illness,” with its paradoxical sense of “its all about my head and my body is not involved in this experience.” Where is the VISCERAL sense of reality, in a term meant only for communication betweencommon self’s, while confusing said self’s that RHETORIC is reality?

    Can we, for the sake of our children’s children’s children, be honest about HOW language covers-up the visceral nature of our common reality, “as-if” (Damasio, 1994) “words describe reality.” -Buddha.
    Can we “notice how we fail to notice,” (Laing, 1967) that life is a progression of habitual behaviour, like the habitual greet & meet social reflexes of “hi how are you.” Which includes the “triangles” (Bowen, 1996) of talking about otherness, to modulate the raw energies of a heart-centered reality, in being here, now.

    Perhaps King David the honest male doctor will propose a new mental health caregory in his new Magna Carta? Vocational Illusion Disorder, springs to mind as I remember the sage advice. “In the great race of life, you should always bet on self-interest.” And will there be space for Queen’s in this new charter? A move beyond our misogynistic sense of reality, where insecure men feel the need of power? Yet of course, as Billy Shakespeare pointed out, earth bound time, in our survival oriented sense of here & now, is somewhat deluded, Horatio!

    Perhaps, readers may contemplate the reality of another springtime & King David:
    Springtime in Jerusalem – II Samuel 11:
    Now it was at the turning of the year, at the time of kings/messengers going-forth,
    that David sent Yo’av and his servants with him, and all Israel. They laid waste to the Children of Ammon and besieged Rabba, while David stayed in Jerusalem.

    Act I. David and Batsheva
    Scene 1- David sees a woman
    2 Now it was around the time of sunset that David arose from his lying-place/couch and
    went walking on the roof of the king’s house, and he looked at a woman washing herself – from on the roof. The woman was very good-looking!

    In the sense of context is everything, that many suggest is illusive and fleeting. This ancient narritive about the human condition and HOW the heart so often rules the head. Brings a sense of context & perspective to David Healy’s effort to use metaphor in its role of points to deeper truths which defy objective reason. In fact, imo, it is only by escaping the mind numbing, self-objectifying logic of modernity, that we can bring a new sense-ability to our common need to see through the illusions of our “medical model” of human behaviour. BEHAVIOUR being a word that shifts the context of mental health perception, away from the “bio-medical sense of self, ushered in by DSM-III” -David Healy.

    Please consider the context shifting perception of modernist critique of the 195o’s movie “David & Bathsheba,” starring the all-American hero, Gregory Peck. And as Roxane Gay (the, Bad Feminist) discussed on a recent Aussie show labelled One-plus One, why do we crave Hero’s? Which, here on MIA, may resonate with readers of Robert’s book’s & the motif by which one’s own life may be subconsciously, acted-out? Please consider the interesting (to the ever fleeting mind) catergories of critique, for the ancient, ever present, David the hero, story:

    The Enigmatic Batsheva and the Male Gaze: Gendered Readings:
    The Men Face Off and the Men Coverup:
    Impeachment for King David –Bathsheva Gate and Watergate:

    Read more here: http://www.haggadahsrus.com/PDF/DavidAvigailBatsheva.pdf

    The interview with Roxane Gay & her sense of chilhood trauma & our common craving for heroic others, can be seen here: http://www.abc.net.au/news/abcnews24/programs/one-plus-one/

    The main point, I’m trying to write here, is that words, particularily written words, give a false sense of reality, in an era when survival involves the manipulation of words and we all tend towards a too literal interpreatation, falling into a sense og adult function, described so accurately by Ronnie Laing: “we are all in a posthypnotic trance, induced in infancy.”

    As you read these words, can you contemplate the VISCERAL nature of your “consumatory” act? A contemplative act which brought me a deeper sense of my internal “affect regulation & origins of self.” A visceral sense of my own reality, wherin, I understand my “mind” as the product of a “dissapative-system,” whereby I gain the paradigm shift into modernity’s exploration of Chaos Theory and HOW it applies to the subconscious progression of our nutured behaviour. Nurtured by the Social Matrix, which fancy’s itself to BE the “projective-indentification” of external objects.

    It is, in my humble opinion, the social matrix nurturing of a taken for granted, analogous sense-of-self, which is maintaining the medical model of madness, because this false sense of “i am my mind” reality, so fears the visceral nature of experienced sensation, that we avoid the challenge of knowing what madness is. A challenge which, when viewed in the context of life-development, rather than half-way down the track (more racing metaphor) of a taken for granted sense of adult function. Brings a more nuanced sense of one’s own reality and the sage advice that “the boy is father to the man, as the girl is mother to the woman.”

    In 2007 I got lucky, in the reality of chaos, chance & circumstance which Eleanor Longden alludes to in her good foftune, in meeting Pat Braken. I went from trying to self-regulate with magic bullets, to a magic word, AFFECT. Which was the “key” to my, then decade long desire, to understand my lived experience, from the inside-out. Inside my multi-organic function, where the Sun don’t shine & words don’t matter. Where Goethe’s green snake & Alan Watts green room, can be felt as the clever anciant narritives of our human story. Like in the movie Cloud Atlas & Sonmi-451’s feminine gusie as our craved for, saviour hero.

    Hmm! 451. Is that a clever, esoteric allusion to our tenth cranial nerve & its role in creating the verb?

    “I am not genomed to alter reality,” exclaimes our heroine. In this very clever re-telling of a Christ Consciousness story. While the willy Zachery wants to cog the survival game, as he begs the other heroine from the future, to provide him insight into why we suffer & keep making the same mistakes.

    In July, I note that Robert & other heroic others will be attending an Esalen Institute workshop, entitled: The value of psychotic experience. Although it seems to be looking towards a Laingian approach, which may, inadvertantly aviod hearing voices like Alan Watts, who attend this same workshop & presented with Ronnie, many years ago. While I hope, those in attendence can explore the deeper sense of Laing’s profoundly intuitive sense of our word deluuded sense of reality. In a Western educated world, lost in its paternal injunction against the visceral power of touch.

    IMO Its our Paternal Model of human function which now needs transcending, if we are to address the current epidemic of so-called mental illness & the feeding frenzy of over diagnosis. I’m sure, all my brothers & sisters of the user fratenity will recognize the PATERNALISM at the HEART of the labelling, mental health system. Although, its much more difficult to turn the mirror-neurons around & COG, as willy old Zachery says, one’s own labelling system, within.

    Sincere regards to all,

    David Bates.

    • Sorry for the typo’s. The suggestion that reading is a consumatory act, comes from: Shame and Its Sisters: A Silvan Tomkins Reader. by Sedgwick & Frank. A good introduction the the visceral nature of human development, from pre-birth to adulthood and the now missing term “unconscious” which is apparently, “so last century.” According to some of the bright young wits at ISPS-Int.

      Yet, I seem to remember, during Gestalt training, that Fritz Pearls understood this visceral digestion of the word and how important it is to NOT simply sight words and end up like Mr Meeks in the movie Cloud Atlas. Parroting “I know, I know!” Mind you! The ancient’s did say that the meek will inherit the earth.

      While my current girlfriend keeps laughing at me, with: Davis Bates. David Bates. David Bates. How do you like them labels? How do you feel about me verbalizing & stigmatizing you, in this way?

      She smiles & winks, while she tells me she knows, I am, more than a bunch of words. While I smile back, doing my best to invoke a sense of her knowing that she’s exquistitly, drop dead gorgeous and way beyond anything my innsecure & impotent words might convey.

      While Monty Python knew best, that our innate reality is more of a “wink, wink, nudge, nudge. Say no more! Time to re-visiit the unspoken voice of the body & realize the clinical illusions, in our bio-medical, (a quick fix pill, for every ill) throughly modernistic, sense-of self .

      Yet alas, I am a society outsider confronting an insider game, of paternalistic rank & status. Please dis-regard my wordy meandering’s & my self-educated sense of self-revelation.

  6. –Good point. It might as well be fiction if they will not prove it.

    “When we participate in clinical trials today, companies get to sequester the data from these trials in flagrant breach of the ethics and norms of science and yet parade their representations of those results as science. ”

    –I didn’t understand this…can anyone explain it?
    The participation of some of us in those trials puts all of us in a state of legal jeopardy. In the US, we may get our day in Court, but we will have the data from clinical trials in which our friends and families participated used against us.

    • The manipulated data is sold as pure, unadulterated science. If we even get to court, that so-called science is primary evidence and holds more weight than the story we tell about what happened on a drug. (And this is why most of us cannot even bring a case). So we would be better off if no one “paid the tax” of participation in trials, because no matter what happens in the trial, the data made possible by participation will always favor of the drug.

  7. “Doctors make a living out of the work done by the rest of the population – swallowing pills. These doctors are highly unlikely to confront Andrew Witty or any of the big beasts of the pharmacockracy – unless some of them do so as shareholders”

    I’m not sure I follow. In my last 10 encounters with the healthcare system:

    1. I received a generic cough suppressant for a particularly nasty flu-associate cough.
    2. My PSA was checked. Had it been sufficiently high, it would have been followed up with a biopsy.
    3. I was recommended physical therapy for a frozen shoulder
    4. I underwent colonoscopy as part of routine colon cancer screening
    5. My eyes were checked as part of glaucoma screening. Had the test come back positive, I likely would have been prescribed a generic drug such as a carbonic anhydrase inhibitor
    6. I had a pre-cancerous area removed from the skin of my left cheek

    I can’t actually remember the last time I was prescribed a drug that wasn’t manufactured by an Indian generics company and sold to me for pennies a pill. Overall, in the U.S., which has unregulated drug prices, pharmaceuticals are 9% of national healthcare expenditures.

    So its fine to have a beef with the pharmaceutical industry. But its extraordinary hyperbole to describe the healthcare system as “Doctors make a living by watching patients take pills” or to suggest that clinical trial participants are “serfs”. Unlike serfs, no one is conscripted to participate in a trial against their will, and multiple studies have shown that most participate in hopes of personal benefit.

    A few good points here, but hard to find among the breathless hyperbole.