Essay : Big Pharma : Rx Water

Rx Water

Drugs generated by the pharmaceutical industry recently discovered to have infiltrated fresh, marine and waste waters have been found to negatively impact a variety of organisms and the environment as a whole. Samples examined from sewage effluent, surface water, groundwater and drinking water have been determined to contain trace amounts of a variety of medicines spanning from antibiotics to endocrine hormones (Bound and Voulvoulis 1705), suggesting the possibility of a widespread and sustained deleterious impact on the environment.  Although eco-toxicological consequences aren’t perfectly clear, studies have shown that excessive introduction of drugs to the environment could lead to feminization of fish and bacterial resistance. According to Melody Peterson, New York Times journalist and author of Our Daily Meds, actual negative changes in the ecosystem can be linked to a “witch’s brew of pharmaceuticals flowing through the nation’s waters” (Petersen 257). After evaluating the ‘spells’ of this “witch’s brew” on microbes, aquatic animals, humans and the overarching environment, Petersen and other scholars conclude that ‘prescription water’ may have vast consequences. Drugs in the water cycle have many detrimental effects.

Research suggests that certain drugs in wastewater can lead to declines in the populations of several species of animals. One of the most prevalent and extensively studied chemicals found in wastewater is the hormone estrogen (Bound and Voulvoulis 1707). Biological (natural) estrogens as well as synthetic estrogens from oral contraceptives (estradiol), both found predominately in the urine of female vertebrates, are difficult to filter and thus freely seep through municipal wastewater management systems into the environment (1707). Numerous studies have shown that several species of male fish including bass, lake trout, northern pike, walleye and fathead minnows, become ‘feminized’ when exposed to low concentrations of natural and synthetic estrogens, because exposure to the female hormones causes development of ova-testes (testes with eggs)(Kidd et al. 8897). In one seven-year study, a small lake in Ontario, Canada, was manipulated to mimic the effects of the ongoing deluge of hormones entering our waters.  After a period of only one year, four out of nine males caught had ova-testes (8898) leading to a decrease in fertilization success (8897). By the middle of the second year, the population had collapsed because of reproductive failure (8899). These alarming results indicate that maintaining or increasing current levels of estrogens in municipal wastewaters could decrease the reproductive success and sustainability of fish populations, which, Kidd explains, could ultimately bring the food chain asunder and induce ecological disaster (8897).

Indeed, while it may not be surprising that organisms constantly confined to contaminated wastewater with elevated hormone levels are in danger, Vicki Blazer, marine biologist at the National Fish Health Research Laboratory of the US, has found that hormones are also affecting insects. Studies on hormones in wastewater and the wild roach also demonstrated an increase in intersex males (Blazer 22). In experiments, male roaches were found with a reduced percentage of motile sperm, on average only about half the amount of normal seminal fluid levels, and a lowered ability of their sperm to successfully fertilize eggs and produce viable offspring (22). This drastic reduction in reproductive capability of a species as robust as the cockroach alludes to the possibility of population decline if current hormones levels in wastewater are maintained or augmented.

While hormones endanger fish and roach populations, several other aquatic populations are threatened by antidepressants. Numerous studies have shown that aquatic animals including mosquito fish, frogs and freshwater mussels are adversely affected by living in water contaminated with minute amounts of psychotropic drugs such as antidepressants. In Our Daily Meds, Melody Petersen describes several studies that found stunted growth, dis-coordination and lethargy in frogs and mosquito fish living in antidepressant tainted water (257). In a separate study conducted in 2010 at the University of North Carolina, researchers found that fluoxetine, the active ingredient in the antidepressant Prozac, interfered with numerous aspects of reproductive function in endangered freshwater mussels (Bringolf et al. 1311). By altering the endocrine activities in the mollusks, serotonin, the “key mediator for a wide variety of physiological functions” was affected such that mantle flap display behavior, egg maturation and parturition (the release of parasitic larvae unto the gills of a host fish) all decreased the likelihood of producing normal amounts of viable offspring (1312). Parturition is integral to larval development, and its success rate is largely dependent on mantle flap display behavior (where a mussel uses its mantle as a lure for unsuspecting fish)(1312). When both of these acts are adversely affected, the rate of reproductive success lowers, which could cause the population to decrease (1315-1316). Given the profound effects of hormone-infused waters on other organisms, many researchers and others in the field, including Petersen, are also beginning to ponder about the effects of ‘pharmaceutical water’ on humans (Petersen 257).

Human exposure to oestrogens in water is disrupting healthy endocrine function (Dibb 27). An increasing amount of evidence has been inculpating chemicals that mimic estrogen hormones with reproductive and development disorders, reduced fertility and cancers in both sexes (27). Sue Dibb, writer for The Ecologist, explains in “Swimming in a Sea of Oestrogens: Chemical Hormone Disrupters,” that oestrogen mimics are found in many environmental chemicals that eventually seep into the water supply (27). According to the British Medical Journal, the gradual increased presence of these chemicals in the environment has coincided with a steady increase in testicular cancer, breast cancer, endometriosis and a decrease in the average sperm counts of men (by 50 per cent) since 1940 (Dibb 27). Although oestrogens seem to be quite malignant and persuasive as evidence for the danger of pharmaceuticals in water, studies on the effects of many drugs on humans are not yet conclusive. Currently the more demonstrable threat to human life is antibiotic resistant bacteria.

Antibiotics in wastewater contribute to the formation of antibiotic resistant strains for bacteria—a serious threat to humans and animals everywhere. The growing presence of antibiotics in the environment leads to resistant strains because the longer bacteria are exposed to antibiotics, the faster the rate of resistant strain selection and proliferation. This is why antibiotic resistant bacteria were first seen in hospitals: when bacteria are frequently exposed to antibiotics, the antibiotic sensitive strains die, leaving the resistant strains to proliferate (Rosenblatt-Farrell 246).

Sources of antibiotics in the environment come from excrement and improper disposal (Bound and Voulvoulis 1705). In fact, in a study on how improperly disposed of medications pose a significant risk to children, researchers found that 35.4% of Americans disposed of their drugs via the sink or toilet, while 54% threw them away with conventional trash (Kuspis and Krenzelok). As Forbes Magazine recently named the antibiotic azithromycin the fifth most popular, overused prescription drug in America, these statistics allude to large amounts of antibiotics entering the environment via trash (Herper). In addition to azithromycin, the most widely used agricultural antibiotic, tetracycline, is routinely added to the food and water of cattle, swine and farmed fish, and is subsequently the most prevalent antibiotic found in water and soil (MacKay). Antibiotics pass through humans, animals and water filtration systems largely unaltered and invariably find their way from the toilet, soil or trashcan into the water cycle (Bound and Voulvoulis 1705). In fact, “more than 60% of ingested antibiotics are excreted by livestock and eventually enter the nation’s waterways” (MacKay). They are then spread via natural water routes and human wastewater management systems (Rosenblatt-Farrell 247). This problem is further aggravated by the fact these resistant strains are spread over large areas when the animal excrement is used as fertilizer, and when flies that associate with antibiotic-treated animals or their byproducts carry the bacteria elsewhere (247). In “The Landscape of Antibiotic Resistance,” Noah Rosenblatt-Farrell illuminates the reality of the spread of antibiotic resistance when he explains how even in the Arctic, wild animals have been found with drug-resistant strains of E. coli (247). Even when chicken breast samples from American grocery stores were tested between 2002 and 2006, “an average of 51.1% tested positive for Campylobacter, 11.9% for Salmonella, 97.7% for E. coli, and 82.6% for Enterococcus… many of which tested positive for resistance to one or more drugs” (247).

The overwhelming presence of antibiotics in the water has caused many to lose their efficacy and contribute to the emergence of dangerous antibiotic resistant bacterial strains (Rosenblatt-Farrell 245). An example of one such strain is Methicillin-resistant Staphylococcus aureus (MRSA)(246). Over the last 20 years, MRSA has spread in prevalence from affecting mostly inpatients (hospital-related risks) to also affecting healthy individuals through everyday touching (246). MRSA treatment is lengthy, difficult and more often than not results in fatality (246). Petersen devotes an entire section of Our Daily Meds to the devastating effects antibiotic resistant bacteria can have on children in the section ‘Revenge of The Germs.’ She explains how “drug resistance threatens to reverse medical progress,” and how “curable diseases—from sore throats and ear infections to TB and malaria—are in danger of becoming incurable,” by quoting World Health Organization (WHO) and numerous physicians describing the crisis (Petersen 279-280). Over the last decade there has been an alarming increase in the percentage of people being found with samples of MRSA, evidence of the increasing amount of antibiotics in the environment (Rosenblatt-Farrell 246).

To immediately reduce risks to both humans and animals posed by drugs in wastewater, we must change the way we think of drug disposal. Americans should never think of the sink or toilet as acceptable ways to discard of medications. We must increase the prominence of labeling with disposal information and have doctors and pharmacists explain to patients the importance of finishing medications. While most modern landfills have membrane liners that prevent much drug-laden leachate from entering groundwater, some inevitably still makes it through, thus we must search for new disposal methods whereby drugs avoid the trash yard (Bound and Voulvoulis 1710). While it is possible for high-tech processes such as ozonation, nonfiltration and activated carbon adsorption (which actively eliminate pharmaceuticals from water) to be implemented in more facilities, simply minimizing the disposal pathway should be more effective, efficient and immediate than said expensive modifications to the wastewater management system (1710). While consumers comply with the direct user risks of drugs—such as side effects—they unknowingly contribute to environmental and indirect user risk—the risks drugs in the environment pose against wildlife and humans—when they dispose of drugs improperly. Petersen, Rosenblatt-Farrell, Kidd, and many more would all agree that there needs to be more regulation regarding pharmaceutical drugs. This regulation should not be confined only to industry practices, drug use and direct user risks, rather it should also include environmental and indirect user risks.

Works Cited

Blazer, Vicki S. “Intersex in Bass “Emerging” Contaminant Issues.” Chesapeake Bay Commission. Web. 2 Dec. 2010.

Bound, Jonathan P., and Nikolaos Voulvoulis. “Household Disposal of Pharmaceuticals as a Pathway for Aquatic Contamination in the United Kingdom.” Environmental Health Perspectives 113.12 (2005): 1705-711. EBSCOhost. Web. 29 Oct. 2010.

Bringolf, Robert B., Rebecca M. Heltsley, Teresa J. Newton, Chris B. Eads, Stephen J. Fraley, Damian Shea, and Gregory Cope. “Environmental Occurrence and Reproductive Effects of the Pharmaceutical Fluoxetine in Native Freshwater Mussels.” Environmental Toxicology 29.6 (2010): 1311-318. EBSCOhost. Web. 1 Dec. 2010.

Dibb, Sue. “Swimming in a Sea of Oestrogens: Chemical Hormone Disrupters.” The Ecologist 25.1 (1995): 27-31. EBSCOhost. Web. 3 Dec. 2010.

Herper, Matthew. “America’s Most Popular Drugs.” Forbes. Forbes Magazine, 5 Nov. 2010. Web. 2 Dec. 2010.

Kidd, Karen A., Paul J. Blanchfield, Kenneth H. Mills, Vince P. Palace, Robert E. Evans, James M. Lazorchak, and Robert W. Flick. “Collapse of a Fish Population after Exposure to a Synthetic Estrogen — PNAS.” Proceedings of the National Academy of Sciences. 29 Mar. 2007. Web. 28 Oct. 2010.

Kuspis, DA, and EP Krenzelok. “What Happens to Expired Medications? A Survey of Community Medication Disposal.” PubMed. NCBI, Feb. 1996. Web. 2 Dec. 2010.

MacKay, Allison. “MacKay Research Examines Impact of Antibiotics in Environment.” University of Connecticut. Web. 2 Dec. 2010.

Petersen, Melody. Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves into Slick Marketing Machines and Hooked the Nation on Prescription Drugs. New York: Farrar, Straus and Giroux, 2008. Print.

Rosenblatt-Farrell, Noah. “The Landscape of Antibiotic Resistance.” Environmental Health Perspectives 117.6 (2009): 245-50. EBSCOhost. Web. 27 Oct. 2010.

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Essay : Modes of Reading

Modes of Reading

I recently attended a speakeasy where a female undergraduate student recited a short poem about working in, and ultimately being fired from, a factory. At the end of the poem, her friends, one of my housemates, and a few others cheered and rushed up to her to hug her. Meanwhile, I understood her poem to be a serious reflection on the trials and tribulations of the working class. Evidently, the poem was about a rough break up and everyone was cheering in support of her strength.  This was a live presentation where everyone in attendance could digest tone, facial expressions, and gestures equally. But what if someone was reading her poem? Without an introduction, would all readers derive the same interpretation? My analysis of her poem, much akin to Marxist criticism, was vastly different from my housemate’s mode of interpretation, which also differed from our other friend’s understanding of the words. Is the basis of our conflict due to intrinsic politics in the poem, or politics embedded within ourselves that we use as we read? Gerald Graff, author of Beyond The Culture Wars: How Teaching the Conflicts Can Revitalize American Education, feels that, “all literature is, whether writers are conscious of it or not, political” (158). However, alleged politics in literature often times are determined by the reader’s approach to understanding the literature, rather than anything inherent in the text. Thus, more often than not, the putative politics in literature are due to the diverse modes of interpretation exercised by readers.

Most scholars agree that the majority of politics in literature are attributed to varied modes of reading, but counter to the majority, a few believe that politics are embedded in the text itself. Counter to my contention, Graff argues how politics are clearly present in literature “whenever a text makes assumptions about what kind of sexuality is normal and abnormal, what kind of social order is good or bad, and which social groups have the right to run things,” which he explains is all literature (Graff 164). And indeed, the presence of politics is sometimes blatant as demonstrated by the “overt anti-Semitism in Ezra Pound’s ‘Pisan Cantos’” and “the explicit critique of totalitarianism in Orwell’s Nineteen Eighty-four” (163). Political opinions such as “William Faulkner’s racial attitudes, Ernest Hemingway’s sexism and hunting, Flannery O’Connor’s Catholicism, Alice Munro’s feminism,” (Greenway 18) and the sexism in the Bible and John Milton’s Paradise Lost, when it’s taken for granted that “Eve is mentally inferior to Adam,” are all viable instances of intrinsic politics in text (164). One such text taken by some to be inherently political is William Faulkner’s Light in August (Weinstein 1). The novel, set between 1890 and the 1920’s, is about a man—whose race is unknown—who is murdered and falsely labeled a “nigger rapist” after killing a girl in self-defense (1). Based on the language used and relationships between different races of characters, many believe Light in August to be extremely racist. However, Philip Weinstein, literary scholar with a concentration in Faulkner’s work, explains, “Light in August is not racist, but rather focuses on a murderously racist social dynamic that no one in that culture is prepared to understand, let alone prevent” (Weinstein 1). In other words, the text is not preaching and representing racism—it’s simply portraying a racist society like a news article or snapshot of the time period. Because text can be interpreted in a variety of ways through many different lenses of experiences and expectations, some of which do not derive direct political meaning, it is certainly possible to say that one can make viable conclusions about a text that completely exclude politics—as in a politically devoid mode.

While there are some instances of inherent politics in literature, literary politics are primarily due to politically oriented criticism. Because there are many valid ways to interpret text and issue criticism, each way deriving unique meaning, literary analysts have created an exquisitely methodical structure to describe and derive meaning from literature (Shor 173). Yet, despite the fact that all literary analysts use this same structure of critical review, there exist many distinctly different interpretations of single texts (173). This variation in derived meaning is central to Louise Rosenblatt’s idea of “transactional theory,” or the thought that meaning is of consequence to the unique transaction between text and reader (Transactional Theory 45). She explains:

The reader brings to the work personality traits, memories of past events, present needs and preoccupations, a particular mood of the moment, and a particular physical condition. These and many other elements in a never-to-be-duplicated combination determine his response to the peculiar contribution of the text (Literature as Exploration 30-31).

Although each individual has a unique set of experiences in life, the various methods of interpretation have been grouped to produce a finite number of types of literary criticism. Analagous to the way similar types of cells in our bodies come together to produce whole organs, the various transactions between text and reader organize into categories that make up the different schools of literary criticism. Examples of these include structuralist criticism, feminist criticism, and Marxist criticism, just to name a few (Holdcombe 1). As each division of criticism procures a different interpretation from text, the existence of politically oriented criticism suggests that all text is political. Marxist criticism is exemplar of this as it attempts to demonstrate how any text can be interpreted as communistic.

Politically oriented criticism scrutinizes text relentlessly until politics can be found, even if said politics are grossly abstract. The Political Unconscious, by Frederick Jameson, describes how all text ultimately has political goals for society, and how all art forms are simple reflections of class interests and ideologies. David Lisman supports this in “Marxist Literary Theory: A Critique,” by illustrating how Marxist literary criticism aims to “create the world” and herd society (Lisman 81). In essence, Jameson, Lisman, and numerous other Marxist critics emphasize the primary role of literature as being a device for controlling the populace. However, critics of Marxist critics, including Graff and modernists such as Campus and Hemingway, find it absurd to think that the sole driving force in literature is capitalism—an undefined force in context (Lisman 78). Even Terry Eagleton, literary critic, theorist and author of Criticism and Ideology: A Study in Marxist Literary Theory, concedes that the nature of Marxist criticism is “fraught and inconclusive” (Eagleton 7). According to Marxist critics, even the innocent children’s story “Snow White” was written with “a particular socialization process in mind” as demonstrated by the characters’ gender roles, class divisions, and the ideological stereotypes associated with each sect (Golden and Canan 44).

The interpretations of text by different types of literary critics may or may not allude to political overtones. As mentioned, “Snow White” has been analyzed by Marxist critics and found to harbor the camouflaged intention to herd society toward a socialist perspective. More specifically, Jack Zipes, a fairy tale scholar and contemporary of Jameson, explains how Snow White’s personality and the tasks she was given are typical of a bourgeois (upper class) girl by saying, “she was expected to be modest, industrious, humble, honest, diligent, virginal and self-denying… the tale reinforced nineteenth-century patriarchal notions about women” (qtd. in Golden and Canan 44). Zipes explains that the dwarves represent the proletariat (lower class), evident by their “positive values of industriousness and loyalty” (44). Their solidarity and value for hard work, representative of lower socioeconomic classes, supports the social order, which is then further exemplified by their domestic role when Snow White stays with them (44). After Snow White marries the prince, the dwarves remain in the mine, happy to retain their working class status (44). This however, is only the analysis of Marxist critics. There are several valid interpretations of the same, deceivingly simple fairy tale “Snow White,” some exemplar of the politics produced by the modes of reading, and some observations of the non-political nature of the text.

Auxiliary to Marxist criticism as a politically oriented criticism is feminist criticism. Feminist critics Sandra Gilber and Susan Gubar contend that “Snow White” predominantly concerns the transformation of a young woman into the “patriarchal image of the ‘ideal woman’” and the gender-based symbolism behind the characters and objects (Golden and Canan 43). They explain that the looking glass’s authority over the queen’s actions means the voice probably belongs to a king, and that the queen’s disguises when she attempts to kill Snow White each depict a different type of femininity (44). These politically oriented criticisms that abstract politics from seemingly minute details contrast greatly with non-politically oriented criticisms such as structuralist criticism. Structuralists evaluate literature as a logical arrangement of relationships within language, or an overarching grammar (43). “Just as language at the sentence level has a grammar, works of literature, such as folktales, epics and novels, also have a grammar,” and it’s this syntax that defines the value of the work (43). Structuralists such as Michael Ryan, Vladimir Propp and Steven Swann Jones analyzed different versions of “Snow White” written over a five hundred year period and have come to the conclusion that its value rests in its binary oppositions (e.g. good/evil, reward/punishment) and the logic behind the arrangement of linguistic units (43). These different interpretations of “Snow White” are only a few of many. Beyond Marxist, structuralist and feminist criticism, there is moralist, Freudian, rhetorical and many more (Holdcombe 1). For every literary work there are many reasonable analyses, some of which ‘discover’ politics, and many of which do not. Literary critics and students alike may argue over the ‘true’ intent of “Snow White” and other works for years, but the innumerable answers are perpetually plagued by the varied modes of reading.

To improve American education we must incorporate discussion on the diverse modes of reading into the curriculum. In Beyond The Culture Wars, Graff demonstrates how teaching the conflicts and transforming the classroom into an open political forum can revitalize American education. He argues that the politics currently polarizing the university can actually improve it by bringing people together in peaceful, scholarly debate. While Graff emphasizes the ubiquitous presence of politics in literature (Graff 158), he should make it clear that these politics are often procured from “politically oriented criticism” (159), and thus that the politics of literature often reside not in the text, but in the reader’s mode of reading. As evidenced by Rosenblatt’s transactional theory and Terry Eagleton’s acceptance of the inconclusiveness of Marxist criticism (Eagleton 7), politics are not always inherent in text itself. In order for students to learn how to handle symbolism or, “hidden meaning” as many call it (Graff 82), they must be introduced to the most abundant source of politics in literature—the diverse modes of reading evidenced by the spectrum of literary criticisms. When students understand, can identify, and debate the various perspectives of literary criticisms, they will learn to appreciate the exquisite depths of literature.

Works Cited

Eagleton, Terry. Criticism and Ideology: A Study in Marxist Literary Theory. London: Verso, 2006. Print.

Golden, Joanne M., and Donna Canan. “”Mirror, Mirror on the Wall”: Readers’ Reflections on Literature through Literary Theories.” The English Journal 93.5 (2004): 42-46.JSTOR.      Web. 4 Nov. 2010.

Graff, Gerald. Beyond the Culture Wars: How Teaching the Conflicts Can Revitalize American Education. New York: W.W. Norton &, 1993. Print.

Greenway, William. “One Person’s Opinion: Through a Glass Darkly: Prejudice in the Classroom.” The English Journal 84.1 (1995): 17-18. JSTOR. Web. 5 Dec. 2010.

Holcombe, John. “Literary Criticism.” TextEtc. 2007. Web. 4 Dec. 2010.

Jameson, Fredric. The Political Unconscious: Narrative As a Socially Symbolic Act. Ithaca, NY: Cornell UP, 1981. Print.

Lisman, David C. “Marxist Literary Theory: A Critique.”Journal of Aesthetic Education 22.2 (1988): 73-85. Print.

Rosenblatt, Louise M. Literature As Exploration. London: Heinemann, 1970. Print.

Rosenblatt, Louise M. The Reader, the Text, the Poem: The Transactional Theory of the Literary Work. Carbondale and Edwardsville: Southern Illinois UP, 1994. Print.

Shor, Ira. “Notes on Marxism and Method.” College English34.2 (1972): 173-77. Print.

Weinstein, Philip. “Faulkner 101: Toni Morrison and William Faulkner.” Oprah.com. 1 Jan. 2006. Web. 5 Dec. 2010.

 

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Short Essay : Industry Sponsorship of Continuing Medical Education

Industry Sponsorship of Continuing Medical Education: A Necessary Evil, or Just Necessary?

More people are on prescription drugs today than ever before, and without an intuitively expected coupled rise in reported illnesses or diagnoses.  How can this phenomenon of prescription drug over-presence be explained? It has become evident that this trend of increased prescription-writing correlates with pharmaceutical industry sponsorship of continuing medical education (CME). Industry sponsored CME programs have turned medical education into an opportunity to advertise new drugs that are often scarcely effective, under-researched and have abundant side effects. Healthcare professionals are biased by exposure to classes more akin to infomercials than informative lectures. This conflict of interest needs to be addressed for the safety of consumers. Industry sponsorship of CME programs should be anonymous or implemented by the individual state licensing authorities that mandate the continuing education requirements, with all decisions regarding program content to be made by an unbiased institution.

Healthcare professionals need detailed, objective, unbiased information about new drugs, devices and medical procedures, in order to competently serve their patients. When continuing medical education programs (CMEs) are infiltrated with biased lecturers, ample advertising via pens and other gifts, objectivity, and thus competency, wanes in the physicians present. Many drugs on the market one day are found years later to be ineffective and plagued by significant negative side effects despite their hefty price tags. Using CME conferences to springboard these lesser drugs—or any drug—into the marketplace is a practice that must cease.  While the conflicts of interest in the drug and healthcare arena are multi-faceted, many problems would be solved if industry sponsorship of CME programs were to be regulated more stringently or simply eliminated. Picture this: funding for a CME program is sent directly to the institution by the governing body of the respective state. The institution hires unbiased lecturers who give detailed information on new medicines, new breakthroughs, and case studies with no emphasis on any particular drug. There are no ads or cleverly placed logos for physicians to subconsciously pick up; just clear-cut, objective information. With no, banners, toiletries or other forms of Big Pharma propaganda, gone will be the days that a physician associates drug X with caviar.  In this scenario, physicians would learn that drug X doesn’t work well under certain conditions, while it can be helpful in other circumstances, instead of drug X works well in all situations so long as it keeps the Mercedes in the garage.

Although industry sponsorship should be regulated, it need not be completely terminated if it can be successfully revamped.  Funding by other sources may not be forthcoming.  As Mark Gould wrote in his article End of the Free Lunch, “70% of the cost of continuing medical education initiatives is tied one way or another to pharma funding, and no government, health authority, or academic institution could assume that financial role” (Gould 487). Given the gravity of CME conference funding, does this require industry sponsorship to be manipulative and strongly biased? Drug companies would have no reason to sponsor CME programs if not for direct, unregulated exposure to healthcare professionals. It’s an advertising gimmick where the white coats are the targeted marketing audience and it then becomes a race to win their support as a new prescribing physician-customer.  Referring back to the scenario proposed earlier, to rouse interest in anonymously sponsoring CME programs, institutions would have to allow some exposure to the brand name drugs, but wrestle more control from the drug companies in the form of who hires the lecturers, the presence of drug-promoting literature, and direct drug representative presence at the conferences.  Let the physician teaching the other physicians be untied to the drug companies and the trend mentioned above should begin to reverse.

Works Cited:

Gould, Mark. “End of the Free Lunch?” British Medical Journal 337 (2008). Print.

Petersen, Melody. Our Daily Meds. New York: Farrar, Straus and Giroux, 2008. Print.

 

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Short Essay : The Africanist Presence

Associative Value, the Africanist Presence and What They Have To Do With American Literature

Mark Twain’s Huckleberry Finn is often thought of as the pinnacle of American literature; yet through what discourse can we attribute it’s success? The cohesive force that binds Huckleberry Finn, and consequently most American literature, can be attributed to what has come to known as the ‘Africanist presence.’ Much of American literature relies on the narrative force of this ‘presence’ – the imperceptible, stereotypical assumptions made both by writer and reader.  The existence and authority of the ‘Africanist’ presence in American literature is due to the powerfully engrained history of the African American race. Thus it can be described as the ubiquitously implicit ‘stereotype’ of African Americans and African American culture in the U.S.A, and it’s role as a shaping force in literature. In fact, the Africanist presence is the integral cohesive force holding American literature together.

While elusive ‘presences’ are abundant in all literature, some believe the Africanist presence in particular is not present in all American literary works. ‘Presence’ as a shaping force in literature, whether Africanist or not, boils down to associative values. Associative values can be described as the meaningfulness of a term to the reader: a complicated math theorem may have lots of meaning and associations to a mathematician, whereas it may be confusing and procure no associations for a fifth grader. The value of association is high for the mathematician and low for the student. This variance among associative value is what presence is made of: it’s the assumed meaning made by readers which contribute text. Although the ‘Africanist’ presence is influential, it isn’t necessarily in all American literature; it is possible for a work to propagate associative values among other races, objects or abstract analogies. For example: a short story about a Caucasian American, family owned cattle farm describes the lives of the family, the business and the cattle. This story evokes a variety of associations relating to farmers and possibly the meat industry. While the story is about an American family and is written by an American author, there seems to be no obvious ‘Africanist presence.’ There are a variety of influential presences other than the Africanist presence that are used in American literature, thus the Africanist presence cannot be the main cohesive force holding it together.

While the Africanist presence is not always conspicuous, it is still the most prevalent presence. Toni Morrison references in her essay “Jim’s Africanist Presence in Huckleberry Finn” that Africanist characters are essential to creation of environment and shaping of character relationships. Without the presence it would be difficult to ‘connect the dots’ and fluidly associate narratives with environment. In Huckleberry Finn, Twain (Huck) doesn’t explicitly describe the politics involved with racism and slavery during the Antebellum period: it’s implied through associative values. If readers didn’t have a general, implicit knowledge of African American history, Huck Finn would be confusing, crass, and unintelligible. However, because readers do have this implicit knowledge, their associative value for the book is heightened and it becomes a more pleasant, deep read. The most conspicuous example of this in the novel is the broad spectrum of vernacular used by the characters. While Huck and many of the other white characters have a distinctly colloquial dialect, it contrasts greatly to the flagrantly obtuse dialect of the black characters. These types of distinctions are what make Huck Finn, and nearly any American story, interesting, and it’s from African American history that they are possible. Referencing the aforementioned ‘family farm’ example, when readers encounter ‘Caucasian American Family Farm,’ they will subconsciously associate it with early American history, plantations, and slavery. Thus there actually is an Africanist presence. Other types of presences wouldn’t harbor nearly the same magnitude of influence as the Africanist presence does for American literature because there are few stereotypes so powerfully engrained in history as that of the African American and his plight toward equality. If American literature was to deny it’s central, cohesive, Africanist theme, the system would be defunct and there would be no ‘American literature.’

 

2010
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Short Essay : Preventative Care versus Palliative Care

Why Preventative Care Should Take Center Stage

Today healthcare revolves around palliative care: treating symptoms instead of the underlying issue. Melody Petersen touches on this important topic in her book, Our Daily Meds. She explains in the first section of the book—using children on Ritalin as an example—that both doctors and patients gravitate toward the quick fix prescription drugs offer. This trend is ineffective and dangerous, as demonstrated by the cost, addictive nature and other risks associated with drugs. As Our Daily Meds explains, to decrease the many adverse effects of prescription drugs, we must abandon the trend in palliative care and initiate a trend in preventative care.

Preventative care attacks the core issue, while palliative care masks disease progression by only treating symptoms. One of the most profound examples of how palliative care fails the patient is in the obese. Risk factors for the obese include type II diabetes, coronary heart disease, high cholesterol, stroke, hypertension, liver disease, gallbladder disease, osteoarthritis, sleep apnea, menstrual irregularities, pregnancy complications and many forms of cancer. As many obese people inevitably develop hypertension, the majorty of them take statins, drugs that lower the ‘bad’ cholesterol that may lead to cardiovascular disease. It is evident by the correlating trend in obesity and the increased rate of morality in America however, that most obese patients have shortened life spans, and upon further research, most of them actually die of cardiovascular disease (Statistics). The aim of preventative care is to prevent diseases so that they need not be cured or treated later on. This is often accomplished by lifestyle changes. In the epilogue of Our Daily Meds, Petersen explains that this is a key facet in revamping the system. If the deceased obese patients chose lifestyle changes over reliance on pills, perhaps many of them would still be alive today.

Preventative care utilizes wholesome, healthy strategies while palliative care requires use of risky drugs. The risks and side effects (if any) associated with preventative care are mild, definitive and finite, whereas the risks and side effects of drugs are often unknown for years and vary considerably in severity. Take for instance this example: an overweight woman with hypertension chooses to lower her risk of cardiovascular disease by losing weight through a healthy diet and increased exercise. Another overweight woman in the same position decides to lower her cholesterol by taking a statin. The former woman possibly risks occasional fatigue due to decreased caloric intake and increased physical activity, whereas the latter risks muscle and joint aches, nausea, diarrhea, constipation, liver damage and muscle problems including  rhabdomyolysis  and statin myopathy (High Cholesterol). Not only is drug abstinence often times paramount with consideration of adverse side effects, but as Petersen aptly explains right before closing Our Daily Meds, drugs have many other vices, some of which go beyond the patient and the disease. These include: risk of dependence (addiction), risk of gateway (addiction to a prescription drug leading to use of illicit drugs), drug induced disease, adverse drug interactions, they create drug-resistant bacteria (such as MRSA), cause user impairment, (may result in accidents such as car crashes harming the user and others), cause ecological harm (drugs in the water supply mutate animals) and increase taxes and the cost of healthcare (Medicare, Medicaid and private insurance rates rise with the trend of overprescription)(Petersen). Although preventative care occasionally requires drug use, it’s simply a means to an end and only used when the benefits outweigh the risks. Palliative care often disregards certain risk facets with their ‘bottom line:’ the idea that as long as the symptoms disappear, the patient is well. Unfortunately, this perspective is idealistic and superficial; to get to the root of both the immediate problem, the disease, and the distant problems, such as the strain overuse of drugs has put on our economy, we must transition from palliative to preventative care. Although Melody Petersen’s book concentrates on the corruption of the pharmaceutical industry, she still does an excellent job explaining the urgency of the need for healthcare reform when she talks about overprescription, the ‘quick fix,’ the detriments of drug overuse and the adverse effects many drugs, especially taken in ‘cocktail’ form, have on health.

In order to decrease the detrimental effects of drugs on the patients, the environment and the economy, we must transition the default perspective on healthcare from being palliative to preventative. Instead of running straight to the prescription pad, doctors must begin taking the time to explain both the risks associated with medications and the benefits of healthy diet and exercise. Information about the benefits of healthy living needs to be publicized more via the media. As Michelle Obama’s ‘Let’s Move’ campaign emphasizes, lets invest in our future by building healthier communities today!

 

Works Cited:

Petersen, Melody. Our Daily Meds. New York: Farrar, Straus and Giroux, 2008. Print.

“Statistics Relating to Overweight and Obesity.” Weight-control Information Network. National Institutes of Health, 01 Feb. 2010. Web. 25 Oct. 2010. <http://www.win.niddk.nih.gov/statistics/index.htm&gt;.

“High Cholesterol.” Mayo Clinic. 10 Feb. 2010. Web. 25 Oct. 2010. <http://www.mayoclinic.com/health/statins/CL00010&gt;.

 

2010
12/12
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Book Review : Beyond the Culture Wars by Gerald Graff

Teaching the Conflicts and the Culture War

In Beyond the Culture Wars, Gerald Graff describes the flaws of higher education in America.  He explains that for students to grow as intellectuals, the university needs to be a cohesive, fluid arena of scholarly debate, rather than a conglomeration of imposingly-opinionated faculty contained by insular departments. Throughout the book, Graff states his opinion that cultural conflict, if taught correctly, can revolutionize American education; toward the end of the book, in chapters eight and nine, I grew less reluctant to agree with him.

Currently, we condemn the “politicization” of literature courses because it’s modern definition “obscures the crucial distinction between expressing a political view in a class and imposing it forcibly on students and colleagues”(Graff 149). Throughout the history of what we consider modern education, many academics have ‘denied politics,’ or more specifically here, they have denied the politics in literature. Graff explains the modern notion on political conflict as “…a kind of disease that must somehow be contained, if it cannot be entirely avoided, instead of a potential source of intellectual and cultural vitality to be tapped” (Graff 148). In stating that expressing a political view is far different from imposing one, he supports the contention he emphasizes throughout the book: that scholarly debate over the conflicts in culture will engage students and cohere the university by diminishing pressure to conform and allowing for a more inclusive community. Beyond the Culture Wars adamantly re-emphasizes this main proposition in every chapter by using examples from the author’s life and new evidence that is blatantly linked direct back to the main contention as support. It is not until chapters eight and nine, “When is Something ‘Political’” and “Turning Conflict into Community”, that Graff truly begins to hone in on and give evidence for the politics in literature and the revolutionary force they contain.

Graff explains that the ‘violent ideologies of the university’ create pressure for students to simply conform, represses any debate and, consequently, represses critical thinking. He explains that we should make use of political conflict rather than eliminate it. Chapter nine, Turning Conflict into Community, describes interdisciplinary programs that have been successful at stimulating classroom debate, bringing the university together and diminishing hostility toward politics. I found this aspect of his argument particularly appealing because he gives actual evidence of his theory working in the real world. Prior to the end of the book, the author gave little definitive evidence that there was any validity to his claims. As the book nears it’s end, Graff introduces evidence of his method working and adds quotes, such as those by Leo Marx, to prove that other scholars believe in his argument. It wasn’t until this point, however that I was able to feel more comfortable agreeing with his overarching contention.

Beyond the Culture Wars would be more stimulating and powerful if Graff supplied more examples and quotes from other scholars throughout the book. From chapter eight on, he does this well by introducing research done in his field and quotes by notable scholars who have opinions similar to his. However, chapters one through seven contain mostly his personal experiences as examples, and his own opinions as evidence. Not only is this method unpersuasive, but as his evidence is born primarily from his own opinions, each chapter seems to repeat the one before. If anything, Graff should place the strongest chapters, the ones with seemingly more valid evidence and examples, at the beginning of the book, rather than the end. This would compel the reader to agree with his overly re-iterated contentions in subsequent chapters, rather than make her reluctant to agree with a man who seems to be pulling an argument out of thin air. As the book currently stands, many readers without background information on Graff’s work probably get lost in the monotony of chapters one through seven. Without input from other sources, the reader quickly tires of reading variations on an opinion. In order to make Beyond the Culture Wars a faster, more persuasive read, Graff should consider re-arranging the order of the content he presents.

Works Cited:

Graff, Gerald. Beyond the Culture Wars: How Teaching the Conflicts Can Revitalize American Education. New York: W.W. Norton, 1992. Print.

2010
12/12
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English and Literature
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Short Essay : Big Pharma : The Effects of Pricey Rx Drugs

It may not be strikingly obvious to those not searching for it, but expensive drugs have detrimental effects on everyone: the insured, the uninsured, even visiting foreigners. Grossly over-priced medications penetrate nearly all aspects of the economy, usually in unintuitive ways. The expense of prescription drugs needs to be regulated.

Pricey prescriptions are driving up business costs, which are then passed down to consumers. Many health-insured Americans don’t understand that they are causing the prices of goods and services to go up when they pay $10 for a $250 brand-name prescription.   When people are insured, the direct expense of all non-elective care and medications are ‘co-pays;’ small payments made to the provider (physician, office or pharmacy) in addition to the monthly plan rate paid to the insurance company by the individual or healthcare providing business. There are co-pays for office visits, surgeries, emergency care and prescription medications. Because the insurance companies pay the ‘actual’ amount, patients often go without knowledge of the actual cost; because the expense doesn’t seem to directly affect us, we don’t worry about it. Unfortunately, these ignored, often times large, expenses do affect us because they drive up the cost of health insurance and, consequently, prices in stores. When drug companies sell their products for unreasonable prices, a chain reaction is initiated whereby consumers unknowingly pass the large tab onto insurance companies, which react by raising the prices of their plans, which results in businesses (that provide healthcare for their employees) increasing the prices of their goods and services. Not only do increased private insurance rates drive up the cost of our basic needs, but America’s public health system for the poor and elderly, Medicaid and Medicare, affect us as well. Those with Medicare and Medicaid unknowingly pass the large bills to the government, which are then passed directly to us through taxes. It is evident that these large bills have devastating effects when observed on a small scale: almost half of all personal bankruptcies result from illness or medical bills (Peterson), many of said bankruptcies being declared by those unable to afford health insurance because of the unruly price tags on prescription meds.

Possibly the most profound effect expensive drugs have on us, and thus the best reason for why drug prices need to be mediated, violate the fundamental rights of Americans: individual health insurance has become unaffordable to the middle class, infringing on the right to basic comforts. As previously stated, private insurance companies are raising their rates in response to their overwhelming drug tab. According to USA Today, the average cost for an annual individual health insurance plan in 2009 was $4824, while a family plan ran around $13,375. These figures are up 5% from 2008, and drastically more expensive than the average rates in 2000: $2,471 for an individual and $6,438 for a family. Joseph Hickley’s textbook, Society in Focus states that the average person in the middle class, roughly 64% of the population (the ‘middle class’ here being comprised of the upper working class – 32% of population – and lower middle class – 32% of the population) make on average $39,000 per year. For the average family of four – parents and two children – this budget is too large to be eligible for Medicaid, yet too modest to afford private health insurance while meeting the other fundamental needs.  The expense of private health insurance oftentimes ends up leaving individuals taking home less than minimum wage. If the prices of prescription drugs were regulated and sold at more reasonable prices, perhaps the average, middle class American, would actually be able to afford basic necessities such as health insurance.

Image Credit: Healthnewsreview.org

2010
12/12
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Short Essay : Big Pharma : Me-Too Drugs Are Good!

In Our Daily Meds, Melody Peterson explains the detriment of “me-too” drugs – drugs chemically identical in function to a drug already on the market. She criticizes drug companies for “introducing dozens of copycat medicines that were barely distinguishable from one another,” thus ‘unnecessary.’ What Mrs. Peterson’s argument is lacking is an understanding of fundamental market economics. By introducing competitors, prices are kept reasonable; these ‘me-too’ drugs are what stabilize the market. Me-too drugs are ultimately beneficial to consumers.

Some people contend that me-too drug developers waste precious research time, money and their own intelligence making imitators when they could be searching for new cures. While searching for loopholes in the patent doctrine is beneficial for the company, this does little to help the many people who continue to suffer without cures or therapies to a myriad of diseases. Currently, one in two men and one in three women will be diagnosed with a form of cancer at some point in his or her life. As Peterson states in her book Our Daily Meds, “Between 1990 and 2004 the FDA’s Center for Drug Evaluation and Research approved about 1,100 new drugs… only about 400 of them were actually ‘new.’” This means that 64% of the ‘new’ drugs were copycats. One drug called Propranolol, a beta blocker used to treat hypertension, has at least 6 imitators. Shouldn’t the resources being used to produce the many me-too drugs be used to find cures and therapies for the chronic diseases many of us will or are currently facing?

Although some think that me-too drugs are a waste of resources because they’re identical to products that are already available, me-too drugs actually create competition and, consequently, keep prices down. One of the central issues in BigPharma debate is the ‘cornering of the market,’ or the ability of drug companies to patent medications and sell them at their desired price for 20 years. When drug companies place high price tags on their new medications, many people who need the medication go without it because they cannot afford it. With the exception of lifestyle drugs, the demand of the majority of prescription drugs are inelastic in price; that is, changes in price generally do not affect the quantity of the product being supplied or demanded. This means that should the price of a drug a patient needs go up $100 every month, he would more than likely pay it in order to be healthy. Without me-too drugs regulating prices, big drug companies would charge as much as possible for their patented products. Fortunately, when the copycat drug makers create a chemically identical drug for a lower price, the big drug company is forced to lower its price or risk losing customers. This variance in market share is essential to the well being of consumers; with generic alternatives, consumers of all economic backgrounds are able to afford their medications. By cleverly maneuvering patent laws, copycat drugs are exemplar in their efforts to create a fair, competitive, functional market, and thus the me-too drugs are beneficial to consumers.

Image credit: http://remandopelomundo.wordpress.com/2010/10/25/industria-farmaceutica/

2010
12/12
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Short Essay : Big Pharma : The Conflict of Interest

What can be called a modern plague, the pharmaceutical industry is systematically manipulating consumers and corrupting healthcare. Between the questionable marketing strategies, fiscal sponsorship of physicians and scare tactics used to make a hypochondriac of any average person, drug manufacturers are becoming a malignancy to ethical healthcare operations. Pharmaceutical executives do not have to take the Hippocratic Oath; their main concern is that of any business: to make profit. While the premise of business may seem inherently selfish, it is the simple investment in self that makes our country’s free market successful. Adam Smith once said,

“It is not from the benevolence of the butcher, the brewer, or the baker that we expect our dinner, but from their regard to their own interest.”

While businesses typically succeed by meeting the wants and needs of consumers, the esoteric nature of the pharmaceutical industry allows for manipulation of trusting, acquiescent consumers. There is a crucial conflict of interest in the pharmaceutical industry: drug manufacturers are concerned about profit more than they are about patient health.

Drug companies are businesses: they have shareholders. Businesses have bottom line incentives aimed at large profit margins. The problem with pharmacy is that there is a conflict of interest in profits made vs. how and why the profits are up. To drive profits, drug manufacturers use many average and some questionable marketing ploys. With the esoteric nature of pharmacy, it is easy for those in positions of power (pharmaceutical representatives, physicians, nurses, spokespeople) to trick consumers into believing they have ailments that need medicating. Not only is this practice selfish, it has the propensity to harm consumers. The conflict of interest in the roles of business provider in the healthcare industry, lies in the fact that the shareholders come first, even if it means hurting consumers.

In a world of predatory marketing and unethical agreements between drug manufacturers and physicians, it is difficult for consumers to figure out the best options are. While drug manufacturers downplay the risks involved with their medications and physicians are being bribed with lavish gifts and cash, consumers are being led blindly into treatments that may in fact do more harm than good. Although consumers are growing increasingly skeptical of direct-to-consumer advertisements, the trust they have in their doctors typically lies unabated. Thus the fulcrum of ethics now lies on the physician: to prescribe a drug (owned by the company that is basically the doctor’s fiscal sponsor) that may not be the ideal solution, or to offer a safer, alternative route. Of course it goes without saying that in many situations, for instance palliative medicine, patients and doctors simply have to choose which medication to go with (i.e. pain relief.) However, with the exception of patented medications, this decision is also often swayed to favour of the doctor’s sponsor. These are but a few examples of how drug companies consider profit before our health and safety. Modern consumers – patients – are more often than not merely simple pawns in the game of the medicine market.

2010
12/12
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Short Essay : Huckleberry Finn : The Ending (II)

Huckleberry Finn is an acclaimed American novel with a highly controversial ending. Some believe that the novel is ‘circular’ and that it is proper to end as it began, while many see the ending as being a jarring, drastic partition to a masterpiece. There are many reasons why the last few chapters of the novel don’t do the rest justice: the ending trivializes the entire book, the radical change in mood, the severe change in tempo and, most importantly, the change in social implications for the characters and the effect on the reader. The ending to Huckleberry Finn is inappropriate both with respect to the rest of the novel and with respect to society.

The ending of the novel is inappropriate with respect to the rest of the novel because the knowledge that Jim had already been set free in Miss Watson’s will trivializes the entire journey and any growth he or Huck experienced. This jeopardizes any significance the novel may otherwise have had. The reappearance of Tom and the regression of the characters after his reintroduction bring the book straight back to the beginning, as if nothing, not even the physical journey, had happened. This regression is compounded by the forced feel of the ending: not only does the novel end as it begins, but any positive aspect of having a ‘circular’ book is negated by the confusing, disjointed, seemingly arbitrary decision to completely change the mood and tempo of the book. Changing the mood, from one of light-hearted humor with strong moral overtones and lines of virtue to straight, slap-stick humor degrades the entire novel and is thus inappropriate. Changing the tempo, the pace at which time seemed to pass, likewise is an insult to the rest of the novel as the climax to one of the plots is then rushed through, leaving the reader feeling anxious and unsatisfied. The experience is like listening to the first three Concertos in Vivaldi’s Four Seasons and then fast forwarding through the third; the pace, and consequently mood, are inappropriate in consideration of the rest of the piece.

What’s more important than the aesthetic injustice of the ending, are the social implications both in the novel and for readers. Jim’s emotional journey toward freedom correlates with the travailous journey of the African American race. The ‘circular’ format of the book fails to allow Jim and, consequently, the race he represents, to embrace the fruits of labor. The heartwarming, emotional empowerment Jim experienced on the river with Huck is completely negated with Tom Sawyer’s arrival, or, the ‘beginning of the end,’ both of the linear form of the book and the worthwhile portion of the circular form. The dehumanization of Jim at the end of the novel was one of the contributing factors to the controversy over Huckleberry Finn’s place in grammar school studies. What do children and teens take away from a largely positive, chronological, picturesque novel illustrating a boy’s (Huck’s) moral climax in discovering the equality in race… that suddenly stops short and returns to the original environment of racial prejudice? Doesn’t the slapstick humor at the end insult both Jim and his race? Huckleberry Finn has been criticized for inspiring racism. This allegation isn’t farfetched when one analyzes the anomaly of an ending.

 

2010
12/12
CATEGORY
English and Literature
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My goal in life is simple. It is complete understanding of the universe.
--Stephen Hawking