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More Mad Cow, Ambien & Universal Healthcare

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I found your response to the question from Jorge Saavedra on mad-cow disease somewhat confusing, not to say astounding. I have been reading your column avidly for some months now, but as a European I find your assessment of the risk of mad-cow disease in this country uncannily reminiscent of the tone and attitude of the politicians in power at the start of the mad-cow disease fiasco in England back when it was just beginning to receive media attention. We were told all sorts of soothing things about the danger; and while the risks of contracting CJD may well be low, the factors that lead to it being a risk at all are really the biggest scandal of all. It is quite clear that the safeguards against mad-cow disease are even scantier here than they were in England, and I have to say that I found your attitude on this to be really somewhat cavalier. I will readily admit that as I am not a doctor or scientist, my opinion will always be subjective, but nonetheless you make it look like the whole affair as it played out in Europe (especially in the light of a possible rerun of many of the same issues here) was just a storm in a teacup. Personally I would like The Nation to do a real exposé on the way the Food and Drug Administration functions here and its connections with the industry it is meant to be regulating.

Dr. Marc regularly answers readers' questions on matters relating to medicine, healthcare and politics. To send a query, click here.

About the Author

Dr. Marc Siegel
Dr. Marc Siegel is a practicing internist and an associate professor of medicine and a fellow in the Master Scholars...

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The city lacks the resources to address its residents' urgent mental health needs.

The United States has fueled a worldwide overreaction to the threat of a bird
flu pandemic, putting AIDS, malaria, malnutrition and other crucial
global health programs at risk.

PS: As an aside, I would love to know what your opinion is on GM food. I find it shocking how little people in the United States seem to be aware of what it is they might be eating and how little is truly known about how it might be affecting their health, because the research is almost wholly funded and led by the private interests that ultimately intend to put the product on the market. Is there really enough independent research on GM to prove that it is safe?

PETER HARMS
Decatur, GA

Dear Peter,

I think you know from my past writings that I'm very willing to stand correction or reorientation. And I certainly understand your perspective, coming as you do from the mad-cow endemic region. However, let me make my position clear:

(1) Though well over 100,000 cows were found to be infected with prions in Europe, and there were probably many more, nevertheless, the number of humans who have been infected with variable CJD is only a little over a hundred. Though 100 cases is nothing to dismiss, at the same time, in the late 1980s and early '90s, the expectation was that thousands of humans were going to be infected by mad-cow disease (caused by absurdly feeding cows sheep brains from potentially infected sheep). The reason for the false expectation is not reasonable public or animal health prevention, of course, but rather the interspecies barrier that protected humans, as well as the fact that many muscle cuts didn't contact infectious prions.

(2) At the same time, I am definitely not letting the public health authorities off the hook here. I insist on being scientifically accurate, but I realize that the method of raising and inspecting beef puts many consumers at risk every day, if not so much from BSE, then certainly from hoof and mouth disease, E. coli and other diseases more prevalent in humans. We eat too much beef, our beef isn't raised properly and it isn't screened properly. These are the major issues, not mad cow. Mad cow is a symptom of a larger public health disease--one that I agree should be minutely examined.


Somewhere, we recall hearing or reading that the United States is the only industrialized Western nation that does not provide a healthcare system for its population but leaves it to insurance companies to provide private plans for healthcare. I would like to find confirmation for this fairly obvious conclusion, but I've never heard of any healthcare system in the USA except the private or welfare healthcare plans. Reduction of the Medicare prescription charges recently is not going to help anyone, it seems, except perhaps the drug companies. It's difficult to understand the general acceptance of the direction of the present policies of the US and British governments.

TED AND ANN

Dear Ted and Ann,

Not to embarrass you, but I must tell my readers that Ann is a wonderful poet and novelist living on the Isle of Ulva, Scotland (Macbeth's island), with her husband, Dr. Theodore Jones, formerly a surgeon in Rochester, New York, who was among the first to bring modern hernia-repair techniques as well as colon transplants to the United States from Canada. Trained at my alma mater, Bellevue, Dr. Jones and his wife sailed across the Atlantic to Scotland in the late 1970s, where they eventually took up residence on the Isle of Mull, in the Hebrides, where Dr. Jones began an island practice, driving his 1960s Morgan to make house calls and "cave calls." This is where I met them.

I too believe that it is astounding that the United States "leaves it to insurance companies to provide private plans for healthcare." Of course we both understand that this is because our government (and yours, perhaps to a somewhat lesser extent) are in the pockets of these special interests. No corporate entity has the interests of a sick patient at heart, unless perhaps that patient is their own CEO (I'm not sure of this point). The greater question is why we continue to vote people into office on platforms that allow this to happen. I must conclude that most people, (Nation readers aside) just don't understand that the motive of private providers is purely profit, and when they do, they have little idea how to stop them.


I need some information regarding the Sanofi pharmaceutical company and its most successful sleeping pill today, Ambien. What is the market value of Ambien? What are the potential profits for the new drug? I would highly appreciate it if you could provide me with some web links to get more objective information.

YEHUDIT BEN-DAK
Tel Aviv, Israel

Dear Yehudit,

There are corporate-watch websites (such as IMS Health, a market research firm based in Fairfield, Connecticut) that track the prices and profits of pharmaceutical drugs. I am aware that Ambien--made by a French company--is one of the most prescribed as well as one of the most profitable sleeping medications on the market. I think it works well, and is not nearly as addictive as some other sleeping medications.


I am 58 and have been having a sigmoidoscopy once every two years. The last one was a year and six months ago. Now I am hearing that colonoscopies are replacing sigmoidoscopies, but the information tends to be vague and sometimes contradictory. Should I plan on a sigmoidoscopy or a colonoscopy with my annual doctor's visit in six months? Or neither?

RICH DALY
Wyncote, PA

Dear Rich,

The official recommendation from the board of gastroenterology is a colonoscopy every five to seven years for people over 50. If you have a family history of colon problems, or an abnormality such as polyps, it should be more frequent. Here's why: A few years back the recommendation used to be sigmoidoscopy for those at risk, but then studies revealed that there were a significant number of lesions on the right side of the colon that were being missed, and a sigmoidoscope doesn't reach that far.


About two months ago my Prostate Specific Antigen (PSA) test value came in at 6.3 after years of holding at around 3.0 for many years. My physician (not a urologist; I don't have health insurance) prescribed one month of Levaquin to treat possible subclinical prostatitis. It worked and my PSA came down to 4.5. He now has me doing another thirty days with Bactrum DS, believing that the infection might still be present. He would prefer the Levaquin but I had pretty bad symptoms of Achilles tendinitis.

Now here's the interesting part. For at least a year I have had the classic fish smell (methylamine) on my penis. Even after showering thoroughly--almost obsessively--the odor would return within a couple hours. I asked two urologists about it and neither had any idea. After the month of Levaquin, this symptom disappeared completely, indicating an infection with consequent discharge from the prostate and its degradation into methylamine. I'm wondering now if the infection may have had less benign effects on my health---such as fatigue, for example, or perhaps sexual potency.

GERALD RELLICK
Santa Ana, CA

Dear Gerald,

Though the purpose of this column is not to dispense medical advice but to see healthcare in a larger political context, I will say that it seems likely to me that you were suffering from a smoldering infection of the prostate and perhaps the urethra, which responded well to antibiotics. This doesn't rule out an underlying prostate problem, and it also doesn't imply that the condition is not responsible for a larger fatigue. I am concerned that you are proceeding without healthcare in this wolfish climate. A letter in the March 1 issue of The Nation, in response to a column I wrote in the January 12/19 issue on health coverage, makes the point that many people are eligible for Medicaid and Medicaid/HMOs without knowing it. Unfortunately, Medicaid isn't accepted by many providers, but it is accepted by hospitals, and it does cover medications. So you may want to make sure you evaluate your own eligibility.

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