Sorry to go off on a medical-related diatribe again, but I am forced by the details of this story to say a couple of things.

There's an old saying that goes: "Fool me once, shame on you. Fool me twice, shame on me." So where does the shame get assigned on "fool me six times"?

The story in question is about a dentist who is accused of fondling the breasts of over 27 female patients and the ongoing trials and tribulations. He's claiming he can produce journal articles which discuss massaging the pectorals to treat TMJ disease (a disease of the jaw), but the women are saying it was unwelcome contact of a sexual nature.

Okay, at this point, I'd be ready to call shennanigans on the dentist, call for the revocation of his license, and let that be that. But there was a bit at the end...

Deputy Attorney General Jeffrey Phillips gave Lew three new complaints, including one from a 31-year-old woman who said Anderson fondled her at least six times over two years.

She took to wearing tight shirts with high necklines, "and Anderson would still get in under her shirt and bra," according to a police report.

He fondled her six times. She even wore clothing to prevent the fondling and he'd still get in under her shirt and bra. And while some people are thinking this just proves how evil he is, I'm wondering... couldn't she have gone to another dentist? After the first fondling, couldn't she have reported him and moved on to a better dentist? After the second, the third, the fourth? At some time around when she started wearing defensive clothing, couldn't she have thought "maybe I need to switch dentists?"

You can talk about him being an authority figure, in a position of power, etc. But there are two things to consider... your dentist is no different than your housekeeper, your plumber, or your dog groomer. Your dentist is someone you've contracted to provide a service. You hired them and during your appointment, they work for you. Would you tolerate your plumber grabbing your ass?

Second, she's ostensibly an adult, and part of being an adult is taking responsibility for yourself, and that includes reporting non-consensual fondling to the police before it's happened for the sixth time.

Yes, this dentist is bad, evil, wrong, abusive, and a plethora of other negative words. But when I read that quote, my first thought was not about how bad he was, but "Awww, c'mon!!!" At some point, say the fifth or sixth unwelcome fondling, I'm going to lose sympathy for the victim. First or second fondle, I'm totally on her side. But after he's fondled you 3 or 4 times, change dentists or call the cops. Don't put on a tighter shirt and go back! My God, woman!

I know that assaults and fondling can be a very touchy subject for some people (no pun intended), but really: Fondle me once, shame on you. If I actually voluntarily, as an adult and as a person who is paying you, put myself in a situation where a dentist can fondle me a sixth time, that one's 90% my fault.

Sheesh.

Today, Wyeth pharmaceuticals was hit with a $134.5 million judgement in a case over its hormone replacement therapies for menopausal women. That wasn't a judgement that pays for a large group of women in a class action suit. It was for three women. And it's still not all. The jury still has to determine punitive damages.

Now a judge might set aside the verdict as excessive or reduce it. But when people suffer a negative outcome from using an FDA approved drug, the fact that each user of the drug could be awarded tens of millions of dollars... Who's paying that tens of millions? The big bad drug companies? No, it's being paid by the people who buy drugs from the big bad drug companies. They don't pull $135 million out of thin air. It's paid out of revenues, or by an insurance company which then just raises rates to cover the loss.

Now, I'm not going to go all Republican on you and champion the drug companies. Nor am I going to go off on a diatribe against trial lawyers or excessive government regulation.

What gets me, though, is that part of Wyeth's defense was that the patient was warned that the drug carried an increased risk of cancer. And that brings me to tonight's word... statistics.

You can't always blame the patients. How many times have you heard a story where they say something like "the study showed that burning an infant's feet with cigarettes reduced its chance of SIDS death by 20%"? So then everyone goes out and starts burning their kid's feet with cigarettes. But what they don't tell you is that the kid's chance of SIDS death was 1 in 1000 and burning their feet with cigarettes lowered their chance to .8 in 1000. That means if you burned the feet of ten thousand babies with cigarettes, statistically you'd save the lives of... 2 babies. Burn 20,000 baby feet and save the lives of two babies. But more importantly, 9,998 babies got no benefit from having their feet burned. They just got pain and scars. Their feet were burned needlessly because all we had were statistics. Because we can't tell which two babies would have their lives saved by burning their feet, we cause 9,998 babies needless pain and scarring.

See, when you hear the story on the news that your chance of death from XYZ increases by 20% or decreases by 20%, they conveniently leave out what your original chance of death from XYZ actually is. And remember that much of this is a statistical increase or decrease. If you had the right group of people, you could statistically prove that having one less beer on the Fourth of July decreased their chances of being hit by a runaway train at Christmas by 64%.

Let's get into bigger numbers... Your odds of winning the Megamillions Lottery on a single ticket are 1 in 175,711,536. Want to increase your chances of winning by ten thousand percent? It would seem that if you increased your chances of winning by ten thousand percent, you're virtually guaranteed to win. Right?

Buy 100 tickets. When you increase something a hundredfold, you've increased it by ten thousand percent. Thing is, you've only increased a 1 in 175 million chance a hundredfold. To guarantee you'd win the megamillions lottery, a 10,000 percent increase isn't enough. You need a 17,571,153,600 percent increase (yes, that's a seventeen billion percent increase).

So when patients are told a drug can increase their risk of cancer, heart attacks, etc., is that warning really and truly meaningful? What was their risk in the first place? How much was their risk increased by this drug? What is their new risk?

In medicine, there are ways to know who will get cancer from a particular drug and who won't. We just don't have the science yet to know all those ways to tell this stuff. So, due to a lack of information or an excess of imperfect information, we substitute statistics for knowledge. We treat getting cancer from using a drug or a baby dying of SIDS like a lottery. Since we can't really know whose ticket will be drawn, everyone has the same statistical chance. Maybe a few risk factors increase one person's chance over another and we can get a little closer to determining which is the 100% patient and which is the 0% patient, but we're still pretty far off.

And in the meantime, the news media says something stupid like "a new study shows that eating pickles doubles your risk of dying from a manatee attack" and people who will never encounter a manatee in their life swear off pickles, yet someone who will end up dying of a manatee attack shrugs off the study's findings. Then their family sues Vlassic for not putting a big enough warning about manatee attacks on their pickle jars and sues Sea World for not keeping the public farther from those dangerous manatees and for not screening the dead guy for pickle consumption before allowing him near a manatee.

So when the drug companies present drug trial numbers to the FDA and the FDA decides what the doctors and the public must know about the risks... it's all statistics. And it's not necessarily the drug companies or your doctor or the FDA trying to mislead you. You'd need a solid knowledge of statistics and all the raw data to make an even semi-informed decision.

So when people take a drug and it's a potential culprit for bad things that happen to them, their lawyers can use the public's ignorance of statistics in two ways. First, they use their own statistics to try to prove a link of causation between taking the drug and the bad thing that happened. Then they try to show how their client couldn't adequately understand the warnings they were given because the client is just part of the general public who doesn't understand all these statistics.

And that's how we end up with jury awards that are the size of lottery jackpots.

In the end, until we have the science to identify every genetic and lifestyle marker so we can say "this drug will give you cancer" or "you'll be fine" with complete accuracy, we have to rely on statistics. We can do longer tests and maybe identify a few more things that can happen, but those push up the costs of bringing a drug to market. If we don't, then we end up with people getting heart attacks from long-term use of a simple arthritis medicine and push up the costs with a couple billion in law suits. Either way, we make drug companies take a lot of financial risk, and thus they charge us an arm and a leg to try to reap the reward of that risk.

In my opinion, unless you can prove intentional malfeasance by the drug companies (i.e. they falsified test results or cut corners during the testing), so long as they followed all federal regulations, jumped through every hoop, and provided every federally mandated warning, they should have a "shit happens" defense.

And if the federal rules aren't strong enough, whose fault is that? If the funds aren't there for research to help give us more precise indicators and less reliance on statistics, whose fault is that? As long as only 50% of the eligible voters show up at the polls and vote for the candidates who appeal to their baser instincts on topics like gay marriage and flag burning rather than base their vote on topics that are really "life and death", then the lawyers, insurance companies, and drug companies get rich, drug prices remain outrageous, and if you're "lucky" to live long enough to clear the trials and appeals after a drug gives you a near-fatal side effect, well, you win the lottery.

So I was reading my daily dose of newsfeeds at Yahoo and saw an ad for a drug that treats RLS (also known as Restless Leg Syndrome). When I accidentally passed my mouse over it, a safety information warning was displayed over the ad. After reading it, I realized I had to screen capture and share it.

The only changes I made were to underline some of the text I found important. For example, it says "Mirapex may cause you to fall asleep without any warning." Okay, that's not "causing drowsiness" like allergy medicines do. Drowsiness is the warning that you may fall asleep. Apparently you skip drowsiness and just go from awake to asleep "without any warning".

I think the term "fall asleep without any warning" is the PR department's spinful way of saying "may cause you to suddenly and unexpectedly lose consciousness."

Next, "when taking Mirapex hallucinations may occur". You're freakin' me out, man!

And, on top of this, when taking this class of drugs, "impulse control disorders / compulsive behaviors may occur".

So here's what I see being a typical evening on Mirapex: First you strip naked and go wave your penis at the polka-dotted dragons in the front yard. Then you come in, and in the midst of ensuring that every photo in the house is hung exactly straight, you pass out on the floor... "without any warning."

But while you're sleeping, your legs are perfectly still.

One thing that gets me is how many people choose brand names or marketing messages over reading the active ingredients on OTC (Over The Counter - non-prescription) medications.

Like most people, I occasionally need a little help getting to sleep. And while you can get a sleep aid at the local pharmacy for 15-30 cents a pill, I get the same stuff for around 3 cents a pill because of one thing... I read the labels.

See the active ingredient in most OTC sleep aids is Diphenhydramine, better known by its brand name, Benadryl. You know how allergy medicine makes you drowsy? Well, so do the companies that make the sleeping pills that line the shelves of your local pharmacies. Almost every OTC sleeping pill (aside from herbal or homeopathic ones) uses allergy medicine as its active ingredient.

About 90% use Diphenhydramine... Nytol, Sominex, Tylenol Simply Sleep... They're all just Benadryl with a different name. Really. The active ingredients are exactly the same. Tylenol PM is merely a combo of Benadryl and Tylenol.

Let's run some numbers. At Drugstore.com they sell a box of 32 Nytol Quick caps for $6.99. That's 21.8 cents a pill. For the Rite Aid generic sleep tablets, providing the exact same amount of Benadryl, it's 72 pills for $4.19. That's 5.8 cents a pill. Or, if you want to break it down in different terms, the Rite Aid generic tabs give you 20 more doses of the exact same medicine, plus you save $2.70 to boot.

But if you buy it as a sleep aid, they tag a premium onto it. Drugstore.com is selling 72 "sleep aid" tabs for $4.19 on sale, but they've got 200 "allergy" tabs on sale for $6.49, or just a little over 3 cents each.

Think about it... the name-brand sleep aid is close to 22 cents a pill. The generic allergy tablet is around 3 cents a pill. But both pills contain the exact same medicine in the exact same amount. Why are you paying more than 6 times as much per dose to buy the Nytol?

To an extent, part of the effect of any drug is psychological, a placebo effect. If you believe the Nytol will work better than the generic allergy tab, it may well work better. But if you believe that Benadryl is Benadryl, no matter what name you give it or whether you say it's for allergy relief or sleep, then there's no reason to spend $43.60 on Nytol to get the same amount of medicine you get in a $6.49 bottle of generic allergy medicine.