Asthma is treated by pharmaceutical companies?

In the year of the 30th anniversary of Asthma Service, we recall our resonant appearances in the press. This article was one of those speeches.

And the role of doctors often comes down to prescribing advertised drugs.

As you know, bronchial asthma is currently a global problem. According to various sources abroad (especially in English-speaking countries), from 15 to 40% of the total population suffers from it. Not only the incidence but also the death rate from asthma is on the rise. For example, in the United States, several dozen people die every day from this disease. Asthma has “rejuvenated”, and today a one-year-old patient is no longer a rarity! And by and large, it is now the “headache” of the entire Western society: after all, when a third of the population in a population is asthmatic (as, for example, in the UK), the problem becomes not only physical, but also economic survival. Especially in a public health setting.
This situation has necessitated the development of tactics with minimal costs in the health care economy in almost all developed countries. For this, an international committee of experts GINA (Global Initiative on Asthma) was created. In his annual reports “Global Strategy for the Treatment and Prevention of Bronchial Asthma” he gives recommendations on the organization of medical care for patients. The basis of these recommendations are programs of self -management (read “self-treatment”) compiled by doctors for suffering people after completing an educational course. And the whole treatment consists in the lifelong appointment of patients with bronchodilators and hormonal drugs or their combinations.
If we talk about an individual approach to each patient, then it is based on tests-surveys with a very primitive set of options: symptoms are observed rarely or often, health has become worse or better, etc., etc. The pinnacle of medical “art” in such programs was the “method” of the so-called flexible dosing: if it gets worse – increase the dose of the drug, if it gets better – reduce it! And in fact, all medicine in this case is replaced by daily uncontrolled (!) consumption of expensive drugs by patients. The dreams of pharmaceutical companies have come true: people with asthma have become addicted to their drugs, like drugs or tobacco. It is possible that such an approach is acceptable in countries where the disease has assumed the character of a national epidemic. And the only way out for public health was an attempt to shift all the worries onto the shoulders of the sick according to the principle “saving the drowning is the work of the drowning themselves”. Or maybe the catastrophe is just connected with such a “primitivization” of medicine? And it is necessary to radically reconsider the approach to solving this problem. But, apparently, Western medicine would like to test its attitudes in Russia as well. And with the introduction of Western standards, domestic medicine has become a conductor of their ideology. All major scientific congresses in recent years in our country are sponsored by pharmaceutical companies. The symposiums at these congresses are devoted to well-known trademarks lobbied by firms and representatives of the official Russian medical science cooperating with them. Well, the choice of specific drugs for the purchase and free provision of disabled people with asthma often suggests that it was held depending on which company pays more. And the most expensive drugs from European manufacturers are included in the procurement plans. On average, a modern asthma aerosol can costs $20-40. An asthmatic needs up to 3-5 of these cans per month. It is believed that they are allocated free of charge, but if we calculate the annual costs at the current level of morbidity in Russia (10-15 million patients, each of whom is allegedly dispensed with drugs for $ 200 per year), then the minimum annual costs (obviously not covering the needs of patients ) will amount to 2-3 billion dollars. No one ever allocates such money for asthma, so almost all patients purchase medicines at their own expense! And if we calculate these costs, comparing them with the average income level of the population, then there is a doubt that the majority can afford it. And it is not surprising that there is a huge demand for the services of healers and charlatans. Pursuing their targeted policy, Western companies have forced out of the market almost all manufacturers of generic drugs, which are an order of magnitude (!) Cheaper than expensive European drugs. And Russia, instead of organizing its own production of licensed drugs, continues to purchase drugs that are supposedly the gold standard of treatment. But if you look closely at reviews of scientific literature, it turns out that there are dozens of such gold standards. Indeed, almost every manufacturer declares his brand as another gold standard, which is, in fact, unfair advertising and does not correspond to reality. For it is not the medicine that cures the disease, but the doctor treats the sick! But this, apparently, has been forgotten not only by pharmaceutical companies , but, first of all, by the representatives of official medicine themselves. An amazing thing has happened that no one notices or wants to notice: de facto, the pharmaceutical industry and pharmacies, not doctors, are engaged in treatment. The role of the latter is reduced to prescribing advertised drugs. Many therapists are simply links in a long chain of network marketing, writing a prescription (like a coupon!) for an “asthma” aerosol or an “allergy” pill. Every day, doctors’ offices are attacked by dozens of representatives of pharmaceutical companies with intrusive informational advertising recommending that their medicine be prescribed. And after their visits, pens, notepads and even prescription forms (!) with “saving” remedies already written in them remain on the tables. Well, then this doctor is once again reminded of this medicine by a lecturer at a symposium, congress, advanced training courses or certification cycle. And the lecturers are people who work closely with these firms. Even eminent scientists do not disdain such cooperation, because it is paid quite well. And at this stage, the network chain firm – drug – company representative – practical doctor – lecturer is activated, and sick people receive another “panacea”. And a seditious thought: maybe exclude intermediaries from this chain and organize direct contact along the lines of a pharmaceutical company – a patient – a medicine? – alas, it becomes a reality. Pharmaceutical firms now put on Internet resources invitations to patients to visit their sites in order to solve all health problems.
All this has led to the fact that in recent years, instead of conducting research in the development of anti-asthma technologies, searching for the cause of the development of the disease, sudden death from it, an increase in morbidity throughout the world, our medical science has been lobbying the GINA recommendations published with the money of the pharmaceutical industry. Although it should be noted that until recently Russia had its own pulmonological science. We can recall the original scientific research led by Professor G. Fedoseev and his students (St. Petersburg), devoted to the diagnosis, classification and extraordinary approaches to the study of the pathophysiology of this disease and its treatment. This was the case when truly innovative research was carried out, and foreign work was not reproduced, according to publications from abstract journals or a collection of scientific “cheat sheets”. And today, everything that does not fit into the framework of the new asthmatic “dogma” is not widely published at all and not discussed by official science. For example, in recent years, scientists from Ryazan and Moscow have repeatedly raised the question of the role of microbial infection (especially fungal and intracellular) in the pathophysiological mechanisms of asthma and allergies. But, unfortunately, things did not go further than publications in collections of abstracts. Indeed, for the leadership of medical official science, the reports of the GINA committee are a desktop “bible”. And what is not there, should not exist in nature! In addition, most of the thematic medical journals in Russia are funded by the sponsors of this “bible” – all the same pharmaceutical companies. In Russia, there have always been people who conducted independent scientific research, not adjusting to the interests of pharmaceutical companies , and publishing their data, regardless of whether they like they to someone or not. “MG” has repeatedly written about many studies devoted to the study of the causes of asthma and allergies, sudden death from this disease, new approaches to treatment. Some publications were reprinted by foreign publications and published on international Internet resources. Finally, it became clear that much of what previously did not fit into the framework of “official” science long ago anticipated the results of today’s large-scale research abroad.

So, for example, back in 1993, “MG” published a material about the presentation of a study at the Research Institute of Age Physiology and Hygiene, on the problem of the evolution of asthma and sudden death from it. Several articles in the press, medical journals, including abroad, were devoted to this topic. If they showed interest, then only a few independent foreign researchers. But it turned out that the published results already then anticipated the findings of a sensational report by Cornell University on long-acting beta-2-agonists and sudden death from asthma. None of the Western pharmaceutical corporations, whose developments were discussed in this report, protested it: after all, it presented the results obtained in almost 20 independent studies of more than 30 thousand patients. The report was published on the university website back in June 2006. But not a single medical journal published it, since these journals are also funded by pharmaceutical companies . But it says that 80% of sudden deaths from asthma are associated with the use of the most “fashionable” pharmaceuticals – formoterol and salmeterol . These substances are part of several widely used drugs that are in the first place for purchases in Russia … And the trouble is that these drugs do not solve the problem at all: in the West, the incidence of asthma doubles every two to three decades. Sick people do not recover, but eventually become disabled or die as a result of the continuous progression of the disease and the side effects of uncontrolled medications. Every year hundreds of thousands and millions of people die from asthma worldwide. Some researchers estimate this figure at 1-2 million people!
It is sad, but the countries where the incidence of asthma is the highest in the world (in the UK – up to 30% of the total population, in Germany – up to 20%, etc.) impose their scientific concepts and “standards” of asthma treatment in Russia. One would like to remember the notorious “Frenchman from Bordeaux” from Griboyedov’s “Woe from Wit”, who teaches us about life. And exclaim with the words of the classic: “… so that the Lord destroys this unclean spirit of empty, slavish, blind imitation!”

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