Fermenting a Revolution Off the Grid

Burkhard Bilger, eminence grise of food writers and regular New Yorker contributor for the last decade has written a doozy for this week's foodie issue of the New Yorker. It's a must-read for anyone interested in the subversive subculture that's cropped up around the local and sustainable food movement, which now threatens to tarnish the credibility of the movement's increasingly high public profile.

An excerpt from "Nature's Spoil's" by Birkhard Bilger for The New Yorker:

The house at 40 Congress Street wouldn’t have been my first choice for lunch. It sat on a weedy lot in a dishevelled section of Asheville, North Carolina. Abandoned by its previous owners, condemned by the city, and minimally rehabilitated, it was occupied perhaps infested is a better word--by a loose affiliation of opportunivores.  The walls and ceilings, chicken coop and solar oven were held together with scrap lumber and drywall. The sinks, disconnected from the sewer, spilled their effluent into plastic buckets, providing water for root crops in the gardens. The whole compound was painted a sickly greenish gray--the unhappy marriage of twenty-three cans of surplus paint from Home Depot. “We didn’t put in the pinks,” Clover told me.

Go to The New Yorker home page.

A New Wellness Guru in the Senate?

Is Senator Charles Schumer angling to become the nation's first Wellness Czar? Over the past six months he's fired off a series of letters to the FDA that suggest he's fighting for citizens' right to a healthy world. And of course, being a senator, there are no doubt some hidden agendas at play.

• In June he sent a letter asking the FDA to look into concerns that sunscreen may be increasing skin cancer rates. 
• That same month, he asked the FDA to intervene in what's been dubbed "Honey Laundering"--alleged adulteration, misbranding and fraudulent mislabeling of honey coming from China. This letter, which resulted in FDA seizures, called for an "official definition of honey." (Why didn't we think of that?) 
• July found him asking the FDA to adopt stricter enforcement of health regulations for airline caterers. (Thanks Chuck, we couldn't have said it better.) 
• And in the same month, he prophetically raised a red flag to the FDA about alcohol-energy drinks, singling out the now infamous Four Loko. (Kids would have been protected if the FDA had only listened to him on this one.) 
• Just last week, he called on the FDA to impose a ban on alcohol-energy drinks, which is now in place in at least 5 states--with New York joining the list today.Schumer displaying his "wellness" chops.

Then yesterday--he even writes letters to the FDA on Sundays!--he fired off another missive. (You have to wonder if they've assigned one person to the job of opening Chuck's letters.) This time it's about reusable grocery bags. In a twist that conjures images of a chopstick-wielding Megamind intent on taking down Americans' I.Q. scores, Schumer drew attention to findings in Florida that reusable grocery bags from China are made with materials containing lead, a neurotoxin, that threatens to spoil groundwater around land-fills (that is, when people finally throw the reusable bags away). This time Schumer wants an investigation. 

In September one of the nation's largest grocery chains, Wegmans, recalled some of its reusable grocery bags due to the presence of "elevated levels of lead." Somewhere there must be a shipping container from China full of unusable reusable grocery bags. It used to be if we wanted to pull China's chain we'd mention Human Rights. Now we just raise the specter of their products causing health problems. So it would seem the world really does revolve around wellness.

Shrinks on the Take: Talk About Betrayal

The big doctor-payment database we reported on last week has shed light on a dirty little secret about shrinks: There are more psychiatrists collecting payments from the pharma industry than any other type of specialist. And psychiatry was the most common specialty among doctors paid more than $100,000 in consulting or speaking fees. So it may not be paranoid to ask your shrink why he or she is prescribing all the expensive meds.

Of the 384 doctors paid more than $100,000, 116 were psychiatrists. That's 30 percent. Medscape Medical News theorizes more psychiatrists are paid pharma consultants because of the high volume of psychotropic drug sales. Last year, antipsychotics alone topped $14.6 billion, with antidepressants at $9.9 billion. Considering that exercise has beat anti-depressants in alleviating moderate depression in numerous studies, one could reasonably theorize the prescribing frenzy is at least partly financially motivated.

Adam Linker of the North Carolina Justice Center has a slightly different theory: Psychiatric drugs carry bigger price tags than many other meds. "Some of these drugs are the most expensive," Linker told WFAE radio. "They're some of the best-sellers, and they're driving some of the increases in drug costs. I think drug companies want to keep increasing those prescriptions."

Even the head of the National Institute of Mental Health is crying foul. In a March editorial for the Journal of the American Medical Association, Dr. Thomas Insel decried the "culture of influence" and called on his fellow psychiatrists to "clean up our act." He wants all financial ties between drugmakers and psychiatry to be disclosed, and for psychiatrists to take a step back from branded meds in favor of generic drugs and non-drug treatments such as talk therapy.

Over the past three years, congressional probes have repeatedly highlighted influential psychiatrists' financial relationships with industry. In some cases, payments from drugmakers went undisclosed even though researchers were obliged to report them to their universities.

Psychiatrists themselves say that speaking on behalf of drugmakers doesn't sway their prescribing habits. The highest-paid psychiatrist on ProPublica's database, Dr. Roueen Rafeyan, told Medscape that he mostly prescribes generic drugs. "The day I'm influenced by that is the day I'm not fit to practice medicine," Rafeyan said.

Perhaps he should go back to his diagnostic manual and look up denial.

Read about it at Fierce Pharma.

A Beautiful Health Hazard at the Tate Modern

The curators and artist who created a participatory installation of porcelain sunflower seeds at the Turbine Hall at the Tate Modern in London have nixed the participatory part. Only days after "Sunflower Seeds" opened to the public, visitors can no longer interact with the exhibit because the roughly 100 million artificial seeds created by villagers for Chinese artist Ai Weiwei are a potential source of toxic dust that may harm people's lungs.

"I could say I told them so, except I didn’t. I merely commented to my husband, as we looked down from the bridge a few days earlier, that the piece looked like an upper-respiratory disaster waiting to happen. It had not yet opened to the public, and was empty — except for one person off in the distance who was raking the seeds and wearing a surgical mask. That was a big clue," Roberta Smith writes in her Critics Notebook for The New York Times.

It turns out Weiwei's sunflower seeds are made using an unusual technique not normally used on porcelain; they are painted with a liquid clay, but not glazed. And so the paint simply rubs off. Visitors have reported their hands were coated with a grey film after touching the seeds. And little clouds of paint dust were seen floating in the air where people walked.

Understandably, visitors want to interact with the art, but not inhale it.

Dr. Money

The website ProPublica compiled a database of the top docs paid by pharmaceutical companies to "consult" on their drugs, and its fascinating to peruse. Paying for prescribing is illegal, but drug companies can pay fees for "speaking engagements" and other consulting work. The information came to light after a series of whistle-blower lawsuits forced seven major companies (including Eli Lilly, Pfizer, Merck and Johnson & Johnson) to disclose the details of the Rx-booty. Over the past year drug companies have payed nearly $7 billion for settlements in the cases.

Federal prosecutors have made headway in unraveling the dollars that bind docs to drug companies. In documents, one drug sales-rep said drug companies rigorously tracked whether or not their payments to physicians were worthwhile. In another lawsuit, involving Wyeth Pharmaceuticals, that's still ongoing, a former sales rep alleged, “Wyeth management was able to exclude speakers who did not promote Rapamune [used to prevent kidney-transplant rejection], and reward those who did so with repeated speaking engagements and resulting honoraria,” according to an amended complaint. Yet another lawsuit (involving Cephalon) alleges doctors were dropped from speaking engagements for not writing enough off-label prescriptions for the narcotic lollipop, Actiq.

Perhaps if insurance companies payed doctors decently this wouldn't be happening. In any case, it sure sounds like paying for prescriptions to us.

Update on Friday, November 5, 2010 at 10:44AM by Kathy

As further evidence that some doctors are reaping financial rewards for prescribing certain drugs, The New York Times uncovered documentation of a secret rebate program operated by Genentech for prescribing a costly drug for macular degeneration, the leading cause of blindness in the elderly.

Read the story.

Update on Tuesday, November 9, 2010 at 11:07AM by Kathy

A new study published in the Archives of Internal Medicine, found that physicians are taking less money overall from pharmaceutical companies than they were five years ago. Researchers surveyed a random sample of 1,891 doctors and compared it to a random sample of the same size five years ago. The biggest change occurred in the number of doctors who accepted drug company money to attend medical meetings, which fell from 35% in 2004 to 18% last year. It would seem public outcry over the too-cozy relationship between pharma and docs is getting through to some physicians, and so they've finally learned to go Dutch...

Read an article about the study in USA Today.