Topic of Choice Blog

The impact of education on Global Health

I grew up in a country where healthcare was not given as much priority as there is the developed countries with excellent facilities to incorporate the importance of well being and preventative measures. There was uncertainty about the sickness of kids and most of the time we did not understand the intensity of a child/parent being sick. There was a lot of closeness between people living in a community and people shared personal objects freely,

I was always eager to understand how and why members of my neighborhood got sick and how the chain continued from one child being sick to a whole community of kids who played together, being extremely sick. It was a common theme that everyone in one household got sick at the same time and recovered at the same time. Unknown to us, was the fact that there was a viral/bacterial infection that spread to make people extremely unwell. It made me wonder that maybe we can find the cause of all these illnesses and stop this from happening even before it started.

There have been many campaigns and goals set up by the WHO and the UNICEF to help spread awareness amongst people about diseases and the advantages of preventative measures. A lot of these campaigns stem off from the fact that vaccinations are vital for all, especially closely knit communities. Herd immunity is one of the greatest things that we have received by vaccinating individuals, second only to complete eradication of certain virus that caused smallpox. Awareness is the first step that is required for the poor, the uneducated and for people who simply  do not understand the mechanisms and science behind viral infections. There are millions of people around the world, especially in developing countries who do not have access to the internet to research about vaccinations; more than that, some people can not even read about these topics and that’s where we need to make a difference.

 The reason why awareness is sometimes very difficult to spread is because people in rural areas of certain countries, such as Pakistan and Nigeria, are completely oblivious of to the fact that vaccinations are preventative and not a cure. Some people from these countries also argue their religious and spiritual beliefs and indoctrinate their communities about the dangers and fatalities caused by vaccinations. These are poverty ridden places that are extremely lacking in resources to understand basic scientific principles. Recently, there have been initiatives, such as the Millennium Development Goals that helped instill a hope worldwide to feature the basic healthcare system. This involved eradication of hunger, empowerment of women and a new goal to eradicate malaria and HIV/ AIDS.

 Child mortality is a common theme in developing countries especially one inflicted with malaria. About 35% of people who lose their life because of malaria are children. There were countless measures that have tried and failed at stopping malaria and it is an extremely heartbreaking situation to witness and hear about. Recently, rates of malaria have come down drastically due to awareness of the common population in African countries and by the innovation of safety nets and medications/ screenings in the earliest stages of the transmission of the malarial parasite. According to UNICEF, rates of malaria have fallen by over 60% due to preventative methods and saved countless lives. Even if there isn’t a clear cut cure to diseases such as malaria and polio, just acting on prevention is enough to reduce mortality rates.

By starting some of the global health goals and initiatives, there is sense of community in developing countries and more often that not, people come together for one purpose to better their life quality. It is much more important to bring the help and equipment to those who are in need and use any kind of media that can help them better understand why vaccinations and preventions do not just help them, but everyone around them are safeguarded by their choices. We understand that communicable diseases and infections such as measles and tuberculosis are supposed to remain confined but there are millions of people who do not realize the seriousness of this situation until and unless they are exposed to the truth by means of compassion and conveying of the message. 

In summary ,making my home in the United States and having a constant exposure to preventative healthcare because of my Biology/ Pharmaceutical expertise has blessed me and my family to understand things we never realized before. It is much more important for us to first know the basics of preventions and vaccinations so we can communicate these messages to people who are in dire need of help, who live in countries that are struck with deadly illnesses and face life threatening situations in their everyday routine. Just observing serious viruses, such as ebola in the recent past should be an eye opener that hidden viruses are waiting to be exposed and pass on from one person to another, one continent to the another and can strike anyone at any time. With the advent of vaccinations and the discoveries of brilliant scientists around the world, we can take it one step at a time and play our role, in any way to convey the importance of prevention and immunization to the countries where it needed the most. 

The 99%

Big Pharma is, in my opinion, one of the most misunderstood industries. At least as it applies to 99% of the people. There is a certain stigma that comes with working for Big Pharma where people tend to assume that you have some character flaw or that you are simply in it for the money. I won’t lie, those people do exist. During my time at GSK, they were in the midst of a bribery scandal in China that ultimately ended with a $490 million fine against the company. The recent Mylan Epi-Pen scandal and the whole Martin Shkreli debacle have again cast the Pharma industry in a more negative light.

In my experience, however, scientists enter the pharmaceutical industry because they want to help people. These are people who know that they will never see the outrageous salaries afforded to the executive businessmen and women at the top. But like it or not, big pharma is still the most viable way to bring new, potentially life-saving drugs to the market. This is what the vast majority of people work for. And they do this knowing that failure is the most likely outcome (especially at the earlier phases of drug development). Upon discussing this with my mentors, they said 99% of chemists working in drug discovery will never work on a drug that makes it all the way through to the market. They do this because they a) love what they do and b) have the chance, however slight, to make a tremendous impact on the world.

For me, it’s really a “one bad apple ruins the bunch” situation. The executives at the top are the few that have the ungodly salaries (the CEO at GSK made $10 million per year plus bonuses) and really benefit from any unsavory tactics used to sell medications. These people usually have backgrounds in economics and business and scientists almost never fill these rolls. If there were more scientists at the top, I think there would be far less corruption and the industry itself would look very different. This also relates to how the expectation on pharmaceutical industry is different from all other industries, but that is a discussion for another time.

Ultimately, 99% of people don’t go into Big Pharma looking to make huge amounts of money at the expense of the populace. Most are well-intentioned people who are often seen as wearing a Martin Shkreli mask.

Thoughts of Big Pharma

After the showing of the John Oliver clip and discussion in class, my opinion has skewed towards being more negative than positive. One of the most surprising aspects about learning about the pharmaceutical industry was how grossly uneven the distribution of investment that the pharmaceutical industries have, when it comes to investing in advertising, versus R & D. It is easy to forget that although there is an intent to synthesize treatments for disease states where cures and effective treatments are not available, pharmaceutical industries are still businesses. With the process of drug discovery and development taking an upwards of 15 years and billions of dollars at a time, with no clear chance of success at the end, it becomes a little clearer to see why advertising for the industries’  “successes” becomes important. However, I believe this distribution should be skewed inversely, where more investment is inputted towards R&D, not advertising.

The information that John Oliver presented that shocked me the most was to learn that majority of pharmaceutical drug representatives do not have a college degree in the biological sciences. To imagine such individuals influence how prescribers make their clinical decisions is not only unethical, but dangerous. With growing concerns of how individuals will be provided health insurance, this issue not only becomes clinical concern for the patient but a financial concern. Assuming that the medications that pharmaceutical industries push to use aren’t the most cost efficient, prescribing expensive medications when a much cheaper alternative is available can also drastically influence patient outcomes as well.

While I may seem to hold a negative opinion of the pharmaceutical industry, I wholly remain conflicted what I truly feel of the industry. Although we’ve learned much of the industry, whether it be bits and pieces in various coursework or having listen to whole lectures about the industry, I honestly still don’t feel I know enough about the pharmaceutical industry to pass final judgment. With numerous peers of mine bearing strong intent to enter into industry, I don’t believe it is fair of me, or to anyone in the profession of pharmacy to label the entire pharmaceutical as “evil.” However, I do believe that changes do need to be made with the best interests of the patients and whether or not the industry can sell their product for top dollar.

Big Pharma - The Facade That Most See and the Facade That We See

Pharmaceutical industries were once lauded for their amazing contributions to the field of medicine. Their research and development department was at the forefront of discovering the next drug that would make history. Ever since high school, I wanted to be a part of that team; the ones that would work hard to look for new drugs that could cure impossible diseases and infections. I believed that I could make great contributions to their efforts and to use my knowledge to bring forth new ideas for drug discovery.

However, that is not the side of big pharma that many others see. They see the business aspect that has garnered much negative attention in recent years. I personally do not consider this part of big pharma to be considered in the realm of pharmacy. I am talking about the executives that sit and look for drugs to hike up the prices for to sweeten the profits they can make. With so many drugs being manipulated, much of the population has been affected by these changes and sparked outrage across the country. This can easily cause the general community to see big pharma as a typical corporation that looks to profit off of other people's misfortunes.

The side that we see in big pharma is the side that is underappreciated. They are the true researchers that strive each day to develop drugs that can used in tomorrow's world. They are the scientists that work to find new outcomes that can save lives. Unfortunately, these efforts comes at a cost, one that is not light. NIH will fund these efforts, but overall, many resources are put in to allow for these discoveries to happen. In order to cover the cost that is associated with developing these new drugs, big pharma will market the drug as well as coerce practitioners to prescribe their drugs. There have also been companies that are starting to neglect their research and development team - by spending less than 20% of the company's resources to support these endeavors. There must be a way that we can promote the positive side of big pharma and the true efforts that are taking place and still allow for big pharma to run a more accepted form of business to their clients and patients.

Pharma Pheelings

Pharmaceutical adds are EVERYWHERE!! While watching some of these commercials, I sometimes get convinced that maybe I need to be on that medication, particularly the ones that act like and focus on sleeping aids. Getting enough sleep seems to be a constant problem for everyone but will medications solve all of our problems - most likely not.

If that is not enough, there are also pharmacy reps that go from doctor to office to hospital - basically anywhere they can - to promote, recommend, and sell medications to who we consider as our providers. Although the worst part about all this may be the fact that most of these pharmacy representatives did not study nor hold a degree in pharmacy, the saddest reality is that doctors sometimes turn to them for advice and ask them for their "expert opinions." To an extent, that's a terrifying thought.

Here's another frightful statistic: the pharmacy industry spends ~$4 billion marketing directly to the consumer while also spending ~$24 billion marketing to the health care provider. That's right, your doctor. You might be asking yourself, where is all this money going? It's going to bribe your doctor. To convince him that this other medication is better than the standard because it came with a free lunch. No this is not a joke. It took me by surprise when I first heard about this as well. For a second there, I thought that maybe I chose the wrong career to pursue but then I remembered the reason I pursued pharmacy: I wanted to make a difference in the life of patients. With this being said, I don't want everyone to start hating and not trusting their doctors. Not evert doctor falls for this rouge. Not every doctor buys into these situations. There are plenty of doctors that know the right from wrong. Some doctors do make decisions based on their best judgment in combination with the literature.

As I've come to learn from all this thus far, granted that I am not done learning about this topic either, is that like with most things, information, people, and everything in life needs to be taken with a grain of salt.

Pharmaceutical Feelings

I have always been able to separate what I hear and what I see, and so far, what I see matches what I hear. Last semester, we were presented information in EBM, detailing the business dealings of some pharmaceutical industries, including different statistics on how they settled the court for essentially fraud. Pharmaceutical companies send their representatives to doctors office and buy lunches and how they essentially hire doctors to present the drug product to their colleges. When I worked as a medical biller at my doctors office, there would be a drug representative that comes in to market a new vaccine for HPV and I could remember my doctor just telling me not to bring lunch that day. It is not hard to see why people are distrustful of Big Pharma, with all the money they spend on marketing and advertising. There does not seem to be a justification for the exorbitant prices drugs are charged. But if we are playing devil's advocate, if one spends about 12 to 20 years to develop a drug, one would want to get a return for it. That is what drives innovation and possible cures for diseases supposedly. But a vast majority of the drugs that comes out every year are of the same class; so few are new drugs with new classes. It seems that whenever a company's blockbuster drug is about to come of patent, the company would tweak it or somehow find a new indication for it to extend their patent. The business aspect of pharmaceutical industry is quite questionable. 

On the other hand, when I worked at a free student clinic that provided FREE BRAND NAME medications from companies such as GSK, Pfizer, Merck, Lilly to low income patients. All we had to do was fill out the patient assistance applications and come next week, we have Lantus pens and vials, tons of Lipitor, Protonix, Viagra, Albuterol, and Advair Diskus to sorted out and given to patients. There is a certain generosity associated with companies to who give out thousands and thousands of drugs for zero cost. Based on all of these experiences, I have slight negative feelings towards pharmaceutical companies and hopefully these feelings will change once I learn more about them. 

Pharmaceutical Industry do they really care

One of the most overlooked controversies in the world of pharmacy is definitely the reputation of the pharmaceutical industry. Personally I had very little opinion about the politics of industries of pharmacy and once or twice I’d hear some friend or family complain about the prices of medication being directly related to the industry. I hold the pharmacy industry very high in my sight because the benefits outweigh the differences and negativity. 

In the classes that I have taken in pharmacy school over the years, I have learnt ways in which the pharmacy industry advertises the drug to the doctors and the consumers. Sometimes, it would benefit the patient but most other times, the health and well being of the patient is the last thing on the list of the pharmaceutical industry. I learnt that many times the doctor gets involved with the representatives of the pharmacy industry and from then on out, things take a turn! The doctor gets paid for prescribing a certain drug to their patients, gets extra benefits from that company and gets rewards. It is hard to imagine that me or my family have been prescribed drugs that benefited the doctor more than they did to me. It is the simple greed of the pharmacy industry that I noticed and even though not all doctors engage in such activities, I keep imagining patients that don’t get well under the care of the doctors because of how the drugs are sold.

One of the most inspiring and useful program from the pharmacy industry is the research of medications. This is an extremely important step in ensuring the safety of a certain drug and its benefits are tested to aware the public and physicians about the drug safety and efficacy. Recently, I found that some research in the pharmacy industry is also biased. Drugs that are sold more and have high income  attached to it, are studied more than the drugs that fail to make as much money. Keeping in mind that research is the door that leads to discovery of better, more sophisticated drugs.

Finally, even though some of the people associated with pharmacy may seem to be corrupt and sometimes we associate mistrust; it is important to remember the advantages of this industry and the endless efforts some committed people make into conforming the industry into a more successful place. We can never replace the importance of drugs by anything else. Even though I won’t fully trust the pharmaceutical industry, I still like to believe that we shouldn’t expect it to be perfect, and to make the difference that we need to see.