Dr. Horowitz’s Snake Oil

From: James Algiers <james.algiers@gmail.com>

Subject: what a world - Dr. Horowitz’s Snake Oil 

Date: April 7, 2009 at 8:54:05 PM CDT

To: Louie

Dear Louie,

During the early to mid-nineteen fifties, an annual Medicine Show would appear in town and be set up at the Schwartz Park.  There, for two nights, many would assemble and, in a carnival atmosphere, listen attentively to the pitchmen of the Show.  Tonics were sold, diagnoses were suggested to the crowd, and all sorts of ailments were addressed.  Music, talking, and showmanship addressed many complaints of the crowds. The power of suggestion of the pitchman convinced many of diagnoses and cures.  Many who were bothered with aches, pains, and often true disease were encouraged to address their complaints and seek cures from the pharmacological wares of Dr. Horowitz.  

Women with complaints of prolonged menses, mittelschmerz, and rough postpartum courses were encouraged to use Lydia Pinkem’s Tonic.  This tonic was impressive; it made one feel better; twelve percent alcohol has a tendency to flush the face and make one a bit giddy.  One ounce three times a day did help; when associated with ferrous sulfate, the red blood count would, over time, improve a common iron deficiency state; seen often in the postpartum state.  It did, on occasion, help.  

However, the most popular item sold, for $3.00 a bottle, was Dr. Horowitz’s Arthritis Cure, “Just rub it in three times a day, each aching joint.”  This topical application was a liniment, a smelly liquid, which increased skin temperature, increased blood flow to the skin, and smelled like “comfort.”  The first, second, and third applications seemed to help.  The fourth, fifth, and sixth applications became an irritant, and by the third day, the show was out of town, and the skin was irritated, sometimes with blisters.  About the fifth day after the show, I would see one or two patients to treat the skin irritation and suggest aspirin and acetaminophen for the osteoarthritis and underlying bursitis. The skin blisters usually smelled. 

It routinely happened on an annual basis.  But, then, the nights were interesting, and it was a real social event; no harm was really done, and by the same time next year, the skin irritation was forgotten, the anemias were again present, and the citizens awaited the return of Dr. Horowitz’s Medicine Show.

Recently, I found Dr. Horowitz’s modern equivalent.  I had been placed on Simvastatin, a drug used in the management of cholesterol control.  The prescription was filled; it is the generic equivalent of Zocor, an effective anti-cholesterol drug, one of the modern equivalencies of “the fountain of youth.”  As usual I read the insert, the package insert, and learned that Simvastatin was manufactured by “Dr. Reddy’s Laboratory,” located in India. Thoughts of Dr. Horowitiz’s Medicine Show flashed through my mind.  I wondered why India, why in this modern day of medical marvels, would a Dr. Reddy’s Laboratory in India make a generic equivalent sold by the pharmacy of Aurora Medical Services. Was this a modern medicine show? Was this an FDA-approved facility? I investigated.

I called the local pharmacy and was told the pharmacist knew little of Dr. Reddy’s reliability, operation, and function.  Aurora Corporate was responsible for drug purchases and associations.  Investigated Dr. Reddy’s Laboratory in India.  The operation, one of the five largest generic operations in India, was begun in 1981 to manufacture generic Methyldopa.  Since that time, the corporation has expanded into a massive drug producer, producer of generic drugs, and now anticipating the production of cancer chemotherapeutic agents.  It is a gigantic house, one of the largest in the generic foreign producers.  The U.S., Russia, Italy, Germany, and India are the big producers of generic drugs.  All supposedly have been accredited by the FDA.  Dr. Reddy’s Laboratory Ltd. was accredited in 2007.  Since then, no further inspections have, supposedly, been done.

I spoke with Aurora Corporate and found that Corporate, as is common, bids on all generic drug purchases, and Dr. Reddy’s Laboratory Ltd. is, at this time, an accepted provider.  Accepted and engaged on the basis of cost and supposedly FDA approval.  I addressed the recent melamine supplementation in one of the Chinese providers of baby formula. Melamine supplementation to increase the nitrogen concentration resulted in the formation of renal stones in young infants, the deaths of a number of children, and stone formation in many Chinese and U. S. children.  When investigated, it appears that some attendees or principals of the Chinese company juiced the formulas, and the resulting trial of the culprits has resulted in death sentences for the perpetrators.  Supposedly, the controls were not adequate.  A few years ago, a drug in South Korea was found to cause sustained hypertension and death when the preparation was compromised.  In each of these cases, the FDA had approved the production facility but had not reinspected it.

When the FDA’s position of oversight and inspection is investigated, it becomes evident that the department is greatly understaffed and under-budgeted. And this is for the U.S. alone.  When the sites of foreign production and purchase centers are added to the equation, it becomes nearly impossible to have any control.

The integrated medical providers of the present day, when searching for the best price, have no hesitancy to go “global” in their search for the best price.  Oversight becomes of secondary importance.  The development of multi-specialty groups has resulted in providing excellent medical care to large contiguous populations.  Diagnostic tools, primarily manufactured in the U.S., have provided excellent tools which are married to the well trained physician providers. The result has been excellence of care.  I fear that in the search for profit and improvement in the “bottom line,” the outsourcing of all aspects of medicine will follow the trend in generic production of medicine.  Generic medical centers are being set up in India, Israel, and other centers of global influence.

It may soon prove that to save costs, and probably lose control, outsourcing of much of medical care will be encouraged by the self-proclaimed medical experts of the present system.

I make a comparison.  Dr. Horowitz had a product, had a ”spiel,” had a message, had no quality control, but had pizzazz.  Some integrated groups have excellent products, good advertising, and convincing public relations departments but may be embarking on poor quality control.  

Perhaps the music of the Horowitz Medicine Show will again be heard in the community, and the three-day-old smell will again be evident.

Keep the faith, Louie,

Jim