Placebo Journal - Medical Humor With A Purpose

I write this edition of the Placebo Gazette as an unemployed physician. Okay, that isn’t all true. As I mentioned last time, I will be working for another hospital/employer starting in March. I had toyed with going private. I entertained the idea of starting a cash-only practice. Unfortunately, today’s healthcare climate doesn’t really allow physicians to put up their own shingle anymore. I chose to continue working with my best friends because that social piece is extremely important in our profession. Too many of us forget that we need each other to commiserate and decompress in order to stave off depression, substance abuse and suicide; all of which are higher in doctors that the rest of the population. I also chose to be employed again because I already have the headache of running my own “empire” (Placebo Journal, etc.) and don’t want to micromanage my medical practice as well.

As I read the NY Times, Washington Post, Boston Globe, Wall St. Journal or USA Today, I am continually reminded of the niche that I have to offer the public. It seems like 25% of all news is medically related. There needs to be some physician who can digest this stuff, make fun of it and then spin it out to the rest of the world is a more palatable way. With the Placebo Journal and Placebo Gazette, I have been doing this for years. This year, however, I have decided to push it to the next level. I made a resolution to myself this New Years Eve to finally get the Placebo Journal as well as my services out there more. Sure it sounded better when I was in a drunken haze but a promise is a promise. During my scotch induced delirium, I imagined (or hallucinated) that I could have my own radio or talk show, I could triple the sales of the Placebo Journal and I could be over six feet tall. As I write this I realize that maybe only one or two of these things might be attainable, but I can’t figure out which one. I am sure it will come back to me as I continue to ponder my future as well as get sober. Until then I want to thank you for being a reader of this e-newsletter. Somehow you have accepted that fact that our topics have no real organized method, our writers have very little editorial constraints and that my free association method of writing can sometimes be very poor form. This brings me back to my last Placebo Gazette. Yes, I used the word pneumonic when I meant to use the word mnemonic. I fu$ked up. That being said, some of you have to lighten up. We all make mistakes. Even me, the King of Medicine.

2. In Defense of Barry

Did you know that Shawne Merriman of the San Diego Chargers is going to the Pro Bowl? Who is Shawne Merriman you ask? Shawne is an awesome linebacker who was defensive rookie of the year last year. This year he may get defensive player of the year. Here is the problem. Shawne was found guilty of using steroids by the NFL and suspended for four games. Now the NFL is rewarding a cheater by sending him to the Pro Bowl. What the hell is going on here? How can the world be so upset with Barry Bonds who was never “found” guilty other then by some grand jury testimony yet Merriman goes on without even the slightest stigma?

Steroids are a bad thing. They change the game. We don’t even know all the long term effects that will occur to these athletes yet. The worst part is what it does to our kids. These athletes are supposed role models whether they like it or not and whether we like it or not. As physicians and as parents, we should understand that steroid abuse is more prevalent in our schools than we ever thought. Punishing NFL players only four games for the first offense and six games for the second offense is a joke. It sends the wrong message. Other players need to speak out as noted by William Rhoden in his recent piece in the NY Times. He questions where the public outrage is. I agree. Where is the medical outrage? Our community needs to speak up as well. And yes I am outraged at Barry Bonds as well; I was just making a point.

3. Placebo Journal Update

We are busy cranking away on the February edition of our infamous Placebo Journal. I like it the way it is shaping up. The stories are hilarious and wait until you see some of our parodies. If you have any suggestions or stories, send them my way. If you want to subscribe and support our mission of laughter, click below:

4. In Rod We Trust

Do monetary interests influence the way doctors do business? An exposé in the NY Times describes how some neurosurgeons are investors in the medical hardware they put in patient’s bodies during surgeries. Since many of these companies are private it really isn’t known who is involved or how many are involved for that matter. I have written before about specialty hospitals in the Placebo Gazette. My hunch, however, is that this may be a little more extreme. It seems these medical hardware companies have taken it to a whole new level.

One company in the article written by Reed Abelson uses doctors as its major investor. For $50,000 a piece, these neurosurgeons now own two-thirds of the Allez Spine and subsequently serve as its major customer base. When screws used during spinal fusion surgery cost almost $1000 you can see why there could be a conflict of interest. Since they only cost $100 to make I wonder whether this really helps our financially strained healthcare system.

The whole thing sounds bad, but let me play devil’s advocate for a minute. When can doctors be businesspeople? What if a surgeon came up with the greatest type of surgical device known to correct heart defects? Is it okay for him or her to make money off it? Of course it is. The bottom line is that if you have an appropriate moral compass and the decisions and devices you use are in the best interest of the patient, then you are beholden to no one else but your conscience. If greed, however, is you only motive (why would neurosurgeons need to make more money is beyond me), then it is wrong. There are plenty of ways to make money in this world and plenty of other companies to invest in. Like Jiminy Cricket said, “Let your conscience be your guide”. For me, I’m off to invest in Allez Spine. I’m kidding.

5. Pharmacist Love

I just read a warm and fuzzy piece in the NY Times about pharmacists in Asheville, NC. For the past 10 years, municipal workers have gotten free diabetic medication and supplies if they agree to get monthly counseling from “specially trained” pharmacists. They state this has brought more patients’ blood sugars under control and saved money in the process. Answering to someone, the pharmacist in this case, brings that extra guilt to make patients comply. This compliance decreases sick days and hospitalizations. Simple enough. Since doctors are either overwhelmed to do all this counseling or underwhelmed by the reimbursement it is now up to the pharmacists to do it. I wonder, however, if pharmacists should be treating patients? This is not a knock on pharmacists, a most trusted profession in this country. It is a knock on any group stretching out of their comfort zone (and training) to do things we as physicians should do. And then there is the conflict of interest. As the article states, GlaxoSmithKline and Sanofi-Aventis have given over $1 million to the Pharmacists Association Foundation to replicate this Asheville program. The pharmacists are getting a fee for each counseling session. The article does not say who pays the fee nor does it dig deep enough to see how many patients are getting generic medications (metformin or glipizide, for example) versus, oh I don’t know, a GlaxoSmithKline drug. I just wonder if these pharmaceutical companies are in this to be good citizens or to make money. Hmmmm.

We had just settled down after a delicious meal when the telephone rang and the
doctor on call was wanted. (Fortunately it was not me but the doctor whose home I was visiting. The doctor was on call for a colleague). The problem with covering for another physician is always difficult. The call was from a nursing home regarding an 87yr old male patient. He had been a patient in the nursing home for two years and had “gone bad” earlier in the evening. The question was, should they send him back to the hospital or keep him comfortable. Two years earlier the family had requested “no heroics”. This evening the wife was visiting and wanted everything done so that he could live till Christmas which was still eight days away. She remarked that he had always enjoyed Christmas so much and she felt obliged to do everything to keep him alive till then. How can a proper decision be arrived at? The options are:

The results of a wrong decision could result in a malpractice suit. My conclusion was that it was great to be retired.

7. More On The Medicare Prescription Plan

Last year when the elderly researched and signed up for their personal Medicare Prescription Plan they found Humana as one of the least expensive options. Many people didn’t do as much research this year as they expected the plan to be around the same price. Unfortunately, Humana didn’t feel the same way. As described in a recent Boston Globe article, Humana increased its premium on average around 66%. In some places they increased it to 466%! The question is: did Humana offer a low price last year knowing that many elderly wouldn’t do the investigation need to realize there was a price change? In other words, did they “bait and switch”. Well is sure looks that way. By suckering elderly patients in and then raising the premiums Humana may have crossed into unethical territory but unfortunately not illegal territory. Spokespersons for Humana denied all this by quoting different statistical formulas and blaming higher drug costs. They also stated that they underestimated the amount of usage by the beneficiaries. What a bunch of crap. This is about money, plain and simple. Insurance companies rarely underestimate anything. Humana is predicted to generate $2.8 billion to $3.2 billion in revenues this year from its stand-alone drug coverage. Next year it will go up to $3 billion to $3.5 billion. Only 1 in 20 elderly were predicted to switch plans this year as found by a Kaiser Family Foundation study. Humana, I am sure, had a hunch this would happen. All this means to me that next year other plans will start upping their prices as well. This is not going to be good for the elderly, the doctors who try to figure it all out, or the taxpayers who help subsidize it all. Did someone say $4 generics?

A friend in Oklahoma approached the Salvation Army bucket to make a Christmas donation. The bell ringer asked if she had any cigarettes. When she replied in the negative, the bell ringer asked my friend to give her the money instead.

The New England Journal recently published an article about strategies for reducing the time for balloon angioplasty in acute MI to 90 minutes or less (

Bradley EH, Herrin J, Wang Y, et al. Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med 2006;355:2308-2320.)

Contrast this with the plight of a local parishioner who had an MI while vacationing in Greece with his wife. He was hospitalized in a local facility for "observation" and further evaluation and died before any intervention. Apparently, this is the norm in Europe which doesn't have the same kind of medical resources (and plaintiffs' attorneys) as the US.

So, keep this story in mind next time someone whines about a $20 copay or not having a private room in the hospital.

For the past 25 years I've had a running battle with a Family Medicine classmate of mine about whether or not Family Medicine types should be doing obstetrics. My opinion is no, for the same reason I don't think Ob/Gyns should try passing themselves off as primary care. Her latest lame defense was, "We go places and do deliveries no one else will do." Her dedication is colored by the fact she works in a city of 150,000 with three large hospitals and is a faculty member at our alma mater.

I've done locums jobs for solo Ob/Gyns in several small towns across the country. One town didn't have a pediatrician or even a general surgeon locally. OBs will go to small towns; you just have to pay them well enough.

Then it struck me. By her logic, Family Practice is the immigrant labor of the medical community. Why pay an Ob/Gyn $250K or more when you can get an FP to multitask for much less?

9. Feedback About The Placebo Gazette

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Until next time, keep smiling, keep laughing and keep out of the sample closet.