Monday, September 04, 2006

Trust in cheats

Trust in cheats
It is not easy to swallow the notion that food is medicine. After all, eating has become a habit, at times urged by hunger pangs, at times by pure indulgence, and even sometimes in subconscious addiction as in munching peanuts. Perhaps it would be easier to digest the concept if the process were reversed --- that medicines are chemicals and substances that are constituents of specific foods in doses generally safe (except some foods containing toxins that are easily deactivated to be edible.)
Medicine means many things to society. It means the treatment of illness or injury using drugs, it means the drug or substance used for treating illness or it means the profession of treating illness as a doctor. The profession of treating illness itself has ramifications and branches that are classified as conventional (doctors, surgeons, dentists, psychiatrists, gynecologists, proctologists, nurses and many medical specialists) or informal or alternative practitioners(midwives, chiropractors, acupuncturists, reflexologists, herbalists, aromatherapists and a slew of other psychic or shaman healers.)
The two classes of healers differ radically in methods and practices, but have one common bond between patient and healer: trust. Although trust is not uncommon in most human interaction --- a friend trusts his friend to pay back the money he borrowed, a client trusts his lawyer to handle his case with diligence, a depositor entrusts his money with his bank, citizens trust their officials to spend their tax money for the common weal --- it is in the realm of health and wellness that the trust link is extraordinary --- and vital.
It is in the trust aspect that the wide-ranging and destructive tremor (akin to 7.5 in the Richter scale measure) rocking Pinoy society caused by the alleged cheating in the Nursing exams held by the Professional Regulatory Commission. First, it confirms the existence of cheaters and validates Pareto’s Law (the 20-80 rule stating that 20 percent of the examinees create 80% of the problem) that temporarily denies honest passers from anointment and consequently eagerly desired employment. Second, it injects some doubt and mistrust in the minds of prospective employers and patients about the honesty and reliability of Pinoy nurses, including those now employed. Third, the impact of potential loss of high-income jobs to the nation’s economy. Fourth, the wound of cheating still festering in the nation’s body politic is reopened and reinforces an image of charlatans rampaging in the country

An interesting ramification of the PRC Nursing exam is the fate of the non-passers. (A side issue is some interesting but irrelevant questions: Did some examinees cheat but still fail the passing grade? Were the failing non-cheaters motivated by conscience or just plain lack of access, opportunity or cash?) Whatever the case, they represent a significant loss of private investment (even a family’s last resource) and constitutes a substantial number of potentially productive humanpower --- labor, if you will.
Those with remaining resources could try their luck again on the next exam, but the remaining destitutes’ options shrink to that of seeking alternative jobs (abroad) as healthcare givers, physician’s assistant, or the challenging elderly-home care (physical therapist or drool and stool wipers).
Still another facet of the nurses’ exam is what I consider a human factor, a test of the trait and character of the examinee for her/his degree of compassion and care, crucial to the core essence of healthcare. Maybe the controversial Test V (neuro-psychiatry?) addresses the subject in relation to the patient, not the nurse’s psyche. Specialists in the medical field reluctantly concede that instances of sincere caring wrought virtual miracles when science was unsuccessful.
An aspect of trust in relation to medicine is medical malpractice and prescription errors, but I will skip the subject for others to expound. However, trust (or mistrust) is also linked to medical quackery. I was once a Boy Scout, and can still recall the leading Scout Law vowing “a Scout is trustworthy”. I still value the trait.
We commonly see advertising that claim to relieve or cure certain illnesses. How trustworthy is the claim? An authority on quackery, Stephen Barrett, M.D says, “Quackery is involved in misleading advertising of dietary supplements, homeopathic products, and some nonprescription drugs. In many such instances no individual "quack" is involved -- just deception by manufacturers and their advertising agencies. Quackery's paramount characteristic is promotion ("Quacks quack!") rather than fraud, greed, or misinformation. Most people think of quackery as promoted by charlatans who deliberately exploit their victims. Actually, most promoters are unwitting victims who share misinformation and personal experiences with others”
Dr. Barrett says, “To avoid semantic problems, quackery could be broadly defined as "anything involving overpromotion in the field of health."… .The word "fraud" would be reserved only for situations in which deliberate deception is involved.”
In their article How Quackery Sells Stephen Barrett, M.D. and William T. Jarvis, Ph.D.state:
“Modern health quacks are supersalesmen. They play on fear. They cater to hope. And once they have you, they'll keep you coming back for more . . . and more . . . and more. Seldom do their victims realize how often or how skillfully they are cheated. … What sells is not the quality of their products, but their ability to influence their audience. To those in pain, they promise relief. To the incurable, they offer hope. To the nutrition-conscious, they say, "Make sure you have enough." To a public worried about pollution, they say, "Buy natural." To one and all, they promise better health and a longer life.”
“…Most people who think they have been helped by an unorthodox method enjoy sharing their success stories with their friends. People who give such testimonials are usually motivated by a sincere wish to help their fellow humans. Rarely do they realize how difficult it is to evaluate a "health" product on the basis of personal experience. The average person who feels better after taking a product will not be able to rule out coincidence (spontaneous remission)—or the placebo effect (feeling better because he thinks he has taken a positive step). Since we tend to believe what others tell us of personal experiences, testimonials can be powerful persuaders. Despite their unreliability, they are the cornerstone of the quack's success.
False hope for the seriously ill is the cruelest form of quackery because it can lure victims away from effective treatment. Even when death is inevitable, however, false hope can do great damage. Experts who study the dying process tell us that while the initial reaction is shock and disbelief, most terminally ill patients will adjust very well as long as they do not feel abandoned. People who accept the reality of their fate not only die psychologically prepared, but also can put their affairs in order. On the other hand, those who buy false hope can get stuck in an attitude of denial. They waste not only financial resources but what little remaining time they have left.”

The Cagayan de Oro City Council is on the verge of passing an ordinance to regulate the publication of therapeutic claims on local herbal products, having long tolerated the various products being promoted by local radio stations over the years, the most striking being the "holy oil" that supposedly brings people back from the dead. Recognizing that the Bureau of Food and Drugs (BFAD) monitors primarily for product safety and its intended use and not on the way it is being promoted by its manufacturers, the ordinance will complement the BFAD statute. It aims to encourage more herbal drug companies to live up to the principle of "truth in advertisements."

Some years back, a vigorously promoted product, Tahitian Noni Juice, was going swimmingly, buyers restrained (but also beguiled) only by its exorbitant price. Then, for some reason, it disappeared from the ads and market. Now it has reappeared in an Internet news report that the juice made from a plant used for centuries in Polynesian folk medicine may have heart-healthy benefits. Researchers report that significant reductions in total cholesterol and triglycerides were seen in smokers who drank a product containing juice from the fruit of the noni tree every day for a month. The study was funded by the manufacturer of the product.
The news report stated “The study was presented at the 46th Annual Epidemiology Conference of the American Heart Association.whose spokeswoman Barbara Howard, PhD, called the “findings intriguing and said the study is a rare example of good research on a dietary supplement or food that makes health claims. Supplement stores are full of products that make health claims that aren't backed up by science," she tells WebMD.
Researcher Mian-Ying Wang, MD, says she first became interested in studying noni juice in 1999 after becoming convinced that it helped reduce her pain from a wrist fracture.
She has received more than $800,000 in grants from Utah-based Morinda Corp., which sells the juice via the Internet and through independent distributors. The cholesterol/triglyceride research came from a larger cancer prevention study involving adult smokers.
Howard expressed concern that the study presented by Wang included no safety data. Noni juice is high in potassium, which can be dangerous to people with chronic kidney disease. As a result, the American Kidney Foundation has listed it as potentially harmful for kidney patients. "Large studies are needed involving thousands of people, and the basic safety research in animals and humans needs to be done before we really understand the risks vs. benefits of this product," Howard says.
There have also been published case reports of patients who suffered liver damage while taking noni juice.
The Utah-based company that sells the juice has also been in trouble over the years for making unsubstantiated claims about its health benefits. In August 1998, Morinda Inc. agreed to stop claiming in its advertising that Tahitian Noni Juice could treat, cure, or prevent a wide range of diseases including diabetes, depression, hemorrhoids, and arthritis after the attorneys general of four states cited the company for making the claims. The agreement called for the company, which is also known as Tahitian Noni International, to pay $100,000.
The web site for the product no longer makes claims about its ability to prevent and treat specific diseases. Instead, more vague health claims are found. The juice is touted on the web site as having "superior antioxidants" and for helping to "maintain a healthy immune system." Athlete and celebrity endorsements also make no mention of specific diseases. Actor Danny Glover claims in one testimonial that after drinking the juice for a few days he "slept better, felt stronger, more refreshed, and more alert."
The web site recommends drinking 1 to 3 ounces of the juice a day. Four liters of the product sell for $168.00, or roughly $3.70 per 3-ounce serving.”
That ₧200 per day dose would suck a worker’s entire daily minimum wage in some remote indigent areas.
Adverts, a powerful modern marketing tool, also benefits the consumer by offering purchasing choices. However, whenever buyers are in the market, whether wet, dry, mall, or Net, it would be wise to beware of “truth in advertising” and trust must be guarded by the economic jargon “Caveat Emptor”, Latin for buyer beware.
The nursing exam cheating erupted initially as an ethics and morality issue but is now settling into a market economics issue. The nurses (the sellers) offering their services must convince the American hospitals, the buyers, that their goods are trustworthy. Having learned of alleged dishonesty in the nursing tests, the buyers have assumed a heightened beware mood and consequently would demand proof that the goods offered are not tainted. To remove the stigma, this might entail a painful decision to invalidate parts or all of the previous tests. If so, the real problem of the government is not the search for wrong doing or wrong doers, but how to alleviate the pain.

No comments: