OUR CURRENT HEALTHCARE CRISIS AND THE CHINA CONUNDRUM
By: Dr. Victor M. Sternberg, D.M.D.
April 20, 2020
While you are reading this you should be aware that our office has taken a medical hiatus at the recommendation of the American Dental Association. We will be open for all dental emergencies and for all patients that have an immediate need to be seen for non-elective procedures. Otherwise, when we return to the office, something we will evaluate weekly, we will contact our patients.
In the course of doing research on the Coronavirus I came across disturbing information, much of which I was not aware of.
It has to do with the American dependence on Chinese manufacturing of our drugs and medications. Approximately 90% of all of our generic medications have their critical ingredients manufactured in China. We no longer manufacture Advil, Tylenol or Penicillin and derivatives Amoxicillin in this country. This disturbing discovery led me to continue to read about how this all came about.
Years ago many of our drug components were made in Puerto Rico. Puerto Rico had been given a low tax status that encouraged manufacturers to have facilities there. However, during the 90's and early 2000's, tax laws changed which drove pharmaceutical companies to find other sources of low tax environments in which to produce their products. This drove manufacturers to China and India where the tax rate was extremely low and where workers could be paid minimum wages, lowering the cost of production of either drugs directly or their ingredients.
This is almost analogous to having the Russians manufacture our nuclear warheads at a lower cost so the manufacturers of weapons in the United States can make a greater profit. Obviously something we would never do to endanger our national security by letting a country without our best interest manufacture our weapons.
In the case of pharmaceuticals, we have allowed a nation that does not have our best interest at heart to produce much of the drugs and ingredients of drugs that we need for our health and survival.
Let's trace back how this could happen.
Chinese manufacturerers whispered in the ears of American pharmaceutical companies that they could increase their profits and lower their costs by manufacturing drugs and components of drugs in China. The pharmaceutical industry representatives would then lobby their congressmen and senators to encourage the exporting of manufacturing of key ingredients in drugs to China.
Theoretically this should have lowered the cost of both generic and brand name drugs, but obviously it has not. The end result is that this has increased the profits of pharmaceutical companies and endangered our drug supply, putting it in the hands of a nation that should not have that kind of control over the health of Americans.
We have not produced Penicillin or Amoxicillin in this country since 2004. It is hard to believe that a drug, which is the most commonly prescribed drug for a myriad of infections, albeit dental or medical, is not produced in the United States.
Our defense department is particularly concerned that we have outsourced the drug industry and made ourselves vulnerable. They see this as a serious threat to our security.
A second and equally important facet of outsourcing our drug manufacturing is the quality control of drugs made in China. In 2008, Heparin, which is a drug used in blood clotting and made in China, resulted in the death of 149 Americans. The Heparin was tainted during the manufacturing process in China and that imperfection was not picked up by the FDA until we lost nearly 150 Americans.
The FDA has a very difficult time overseeing quality control in China. There are long waits to get into factories and there is evidence that the Chinese have falsified data. During inspections that did take place, up to 75% of the products were found to be sub-optimal and corrections had to be made. The FDA is very much overworked in China and under represented. They have found cancer causing ingredients in blood pressure medication and disease causing imperfections in others.
An article in a Chinese newspaper said that if we continue to give China grief, they will cut us off from our drug supply. The Chinese believe that if they stop exports of their drug ingredients they could shut down western medicine. A frightening thought. And more frightening is that fact that we allowed ourselves to be in this position.
Another country that also supplies us with many of the ingredients for our generic drugs is India, and we have a similar problem with quality control in that country as well. FDA supervision is very challenging.
There is a solution to this that a number of people have proposed. There are many factories in the United States that have closed down. It would be possible, with government financing, to employ some of the newer equipments that could manufacture drugs very cheaply, and employ Americans in the manufacturing process. This would take a capital investment by our government, but I cannot think of a better way to spend our money than helping American industry produce products that are vital to the health and welfare of America, taking that control away from our adversaries.
Economists and scientists have proposed having Puerto Rico return as a drug manufacturing mecca; they certainly could use the additional income on an island that is struggling financially. This would be of enormous help. By setting up lower rates of taxation in Puerto Rico, and encouraging manufacturing on the island, we could both improve the economy of a downtrodden territory and increase the safety and security of the United States.
Scientists around the world, as you are reading this, are working on various approaches to treat patients with the Coronavirus. Some are using medications that have been around for 50 years to treat malaria, combined with the Zithromax antibiotic. This has brought some remarkable results in France in treating a number of patients in which the virus disappeared within days. Other scientists are working creating antibodies to defeat the virus once one is infected. A vaccine is a long way off, but treatment for the patients that are ill may be much closer than a vaccine. We should all follow closely these developments.
Governments around the world, and especially in America, should be doing everything possible to provide our scientific community with what they need.
We have spent trillions of dollars over the last 70 years developing weapons that can end life on this planet within 2 hours. We have failed to be as focused and committed to preserving our health and lives against epidemics and pandemics. Hopefully this is a wake up call.
This is one world. Although there are lines drawn on a map to separate us as people, as well as languages that separate us, it is obvious that a little virus doesn't recognize walls, languages or cultures. Mankind depends more on how we see ourselves as one race, living on one planet. G-d willing this virus will be a wake up call.
As always, I welcome your opinions.
Dr. Victor M. Sternberg, D.M.D.
May 17 2020
We are all in this together
As we entered the third month of our lockdown we are beginning To see the and of the worst of the Covid-19 pandemic In our community. As New York begins to open slowly and cautiously the governor has indicated that most likely we can return to practice in mid June.
However having lost a friend and observed another have a close brush with death as well as having several colleagues desperately ill I am well aware of the pernicious nature of this virus.
As I mentioned In earlier correspondence I have used this time to educate myself spending a great deal of effort and resources to make sure that my office is safe not only for my patients but my staff as well.In addition I am going to have myself tested before a return to practice and this goes my staff as well. Testing is becoming more readily available and easy to obtain. At the end of May CVS will enable you to get tested in a pharmacy. As we are well aware testing is the greatest adjunct to preventing the spread of the virus.
Returning to a dental practice carries with it a certain amount of anxiety for patients as well as my staff. The purpose of this letter is not to expand on what we are doing but to find out what is on your minds as we approached a semblance of a return to normality. As we venture out of our homes and go back to work and perhaps to enjoy the pleasure of a dinner out or a Broadway show. in the back of all our minds is how we can do so safely.
Because I understand the anxiety that many of you feel regarding a return to a dental practice, I want you to share with me your fears and concerns.Although there is some truth to the idea that if you ignore your teeth they will go away I am acutely aware of your concerns and I want to hear them loudly and clearly.
I look forward to hearing from you. You can do so by contacting me via my email firstname.lastname@example.org or my office email mail, office email@example.com. You can text me at 914-772-6355 or if you are so inclined I welcome a phone call.
Again I want to reiterate that we are all in this together as a community, as a state, and a nation. I look forward to continuing dialogue with all of you.You will hear from me again as we approach a return to practice.
Until we meet again I pray that you all will stay healthy and strong.
Our new date to return to practice June 1.
As we hopefully begin to return to normal the governor has announced a tentative date of June 1 for professional practices to reopen. Hopefully the coronavirus, which has brought so much suffering to the world, our nation, and our community, will have dissipated enough for us to return to what will be a new normal.
For many of you your periodic periodontal maintenance is long overdue.for others who recently had periodontal procedures performed prior to our shutdown follow-up observation is required. When we returned to the office your visits will be given a priority.
During this long hiatus our staff has been spending a great deal of time preparing our office to minimize any virus related challenges to our patients and our selves.The unique proximity of the dentist, the hygienist, and the dental assistant to the patient's oral and nasal cavities creates a challenging new paradigm for the dental profession.the American Dental Association and the American Academy of Periodontology have delineated the numerous steps we must take to safeguard all. Our clinical staff will be wearing N95 masks,shields,and and appropriate gowns. I have been using his protective gear while seeing emergency patients during this hiatus. The issue of the aerosol created in a dental environment will be dealt with in 2 independent technologies. Each operatory will be equipped with a powerful air filter that will remove particles from the air including any virus. In addition we will have a state-of-the-art suction devices equipped with a UV light removing any aerosol as it leaves the patient's mouth.
Patient scheduling will also be different. We will provide more time between patients to minimize or eliminate congestion in the office and carefully prepare the operatory for the next patient. There will be minimal or no time in the waiting room since patient's will brought right back to the treatment room..
However,the single most important preventive approach will focus on questions that we will ask our patients prior to their appointments. Among the questions will include, have you been recently tested and are you negative, do you have any symptoms associated with potential exposure, have you been exposed to anybody recently who had the virus or who had tested positive and if so having you been quarantined for 2 weeks and tested yourself. As you have heard, testing is the key as we try to return to normal life. Hopefully in the very near future rapid testing will be available to all. Pharmacies all across our state will be gearing up to do testing within their facilities .
I am well aware of the anxiety and concerns of our community.I welcome your questions regarding these concerns. As I mentioned in earlier correspondence I have had all too much experience with the potential dangers the virus presents.
As the medical community races o come up with more effective treatments as well as more rapid testing I want to take this time to pray that all of you and those you love will stay healthy as we struggle to return to this new normal.
My healthcare podcast every Friday morning at 9 AM can be reached by logging in on your cell phone or your computer radiowestchester.com I will be a guest for one hour on the Bob Marone radio show. The theme of my podcast will be on health care, both medical and dental. Exploring the conundrum of our current healthcare system from a clinical, economic and political standpoint and the role or lack of focus on prevention will be emphasized .Developing a dialogue with the community will be an important mission . I will be committed to being factual and encourage an open dialogue. Your questions and comments are welcomed and encouraged. Given our current healthcare crisis we will discuss the impact of the virus through the filter of politics, public health and economics. It should make for a lively discussion.I look forward to hearing from you
In any event if you need to speak to me with any dental concerns or issues involving our return to the office, please call me on my cell phone at 914-772-6355 or email me at firstname.lastname@example.org.
In the interim stay well. I anxiously await my return to practice and seeing all of you again.
First let me send prayers that you and your loved ones have been spared the scourge that has descended upon our community and the entire world. Sadly the virus has impacted my friends, and loved ones. Hopefully we are seeing a decline in infections and most importantly deaths. The governor has set a date mid May for a possible return to a semblance of normality. I have my doubts. We are in uncharted territory where there are many opinion and few facts. The political pressures and economic concerns are mounting at a time when we still don't fully understand the science or most importantly best medical advice.It is particularly disturbing when politics intermingle with science. Because of the unique proximty of the patient and the dental professional we are taking extraordinary efforts to minimize potential transmission to both our staff and patients. Acquiring the highest level of ppe for our staff,employing high speed equiptment to remove expressed respiration from the patient and utilizing the state of the art sterilizing approaches dictated by the new normal. Hopefully expansion of testing and utilizing antibody evaluations will more safely allow us to return to work.When we do return we will adapt our schedule to allow more time per patient and gradually increase our patient load as conditions warrant.It will be all about keeping you and my staff healthy. If you have any concerns your calls are welcome at (914)-772-6355 or you can E-mail at email@example.com. At the beginning of the outbreak I did some research on a topic that has never more presceint .It is about Chinese control of our drug manufacturing. With great irony the new evacuation systems I purchased are made in china. The research and the article I wrote will follow this Email. Given the delay in office visits please take the time to take extra goodcare of your teeth and gums. Again contact me with any concerns in this arena.
Fondly Dr. Victor Sternberg
By Westchester Center for Periodontal & Implant Excellence
May 18, 2020