Placebo Journal - Medical Humor With A Purpose

Here is a nice story about our friends at the pharmaceutical industry. GlaxoSmithKline was fined $156,000 in New Zealand for misleading advertising. It seems they are in the “drink” business over there and were doing well with their black currant drink called Ribena. This drink had been advertised to have more vitamin C than orange juice. A funny thing happened when two 14 year-old high school students did a science project to find how much the drink really had. It turns out it had no detectable amounts of vitamin C at all. Whoops! The company admitted to 15 charges of misleading advertising between 2002 and 2006 in a suit filed by a consumer watchdog group. How the heck can a company actually get away with something like this? Now we know why we need the FDA to watch our medications over here. In fact, a Boston Globe magazine piece did a nice job showing how many counterfeit drugs there are through the internet. Everybody should be careful. Anyway, the girls, as described in this WSJ article, were pumped to hear the recent verdict but were bummed to hear that the fine wasn’t for more. They’re right. My question is where does the money go? If those girls don’t get it then it may be more of a crime than anything else.

7. Joke of the Month

Fantasy: Having two women fight over you.
Reality: It's your receptionist and your nurse fighting over which patient you'll see next.

Fantasy: Telling a woman to drop her pants and bend over -- and she does.
Reality: She's 68 years old and wants a shot.

Fantasy: Making a woman moan as you minister to her needs.
Reality: It's the same woman from the above scenario getting her injection.

I highly recommend you go see the movie Reign Over Me with Adam Sandler and Don Cheadle. It not only has some great acting but the issue of PTSD was really portrayed in an amazing way. It also shed some light on the dental profession which was quite prophetic to me. The music was awesome too especially if you are an 80s guy like me.

There appears to be sufficient reason to fire almost all governmental employees if the method in which governmental affairs are conducted according to many
people. The recent method adopted by our government seems rather simple– find any suitable individual that can be sacrificed and blame him. I doubt very much if anyone believes that firing someone results in absolution. The scope of my knowledge is rather limited but the replacement of the commanding officer at
Walter Reed Army Hospital as well as the replacement of the Surgeon General
concerns me. Both of these individuals are physicians whose expertise is in the
field of medicine. The care of patients entrusted to their care has been of the
highest level both in military hospitals in this country as well as in the field.
Soldiers injured in Iraq have received the latest and best care available anywhere in the world. Evacuation procedures are also exemplary. The care of these patients once they have received initial medical care becomes an administrative problem. Outpatient facilities such as those which received all that attention at Walter Reed fall outside the province of the hospital. Scheduled to be closed soon I doubt if there was much push to rehabilitate housing at Walter Reed that was to be abandoned. I don’t know who is to blame for some of the problems that occurred but I do not believe that either of the two individuals fired had much control over the mistakes that were made. Since the original problems, investigation of the Veteran Hospital Facilities has revealed further widespread problems. The implication that the Surgeon General was in any way connected to this is totally erroneous. The truth probably lies buried somewhere in our administration, which has failed to consider all of the problems associated with combat and well, promptly treated injuries. I feel that vilification of the Medical Corps leadership is a travesty. They deserve tremendous credit for doing an outstanding job which has not been backed up properly by administrative personnel not under their control. Physician organizations such as the AMA should certainly consider looking into this. The control of Medicine has gradually been taken out of the hands of physicians and placed in the hands of administrators whose primary considerations are “whitewashing” and the “bottom line”.

There was a nice commentary in the Wall Street Journal about the need for tort reform and how much litigation actually costs us. Not only is it a drag on our nation's economy but that drag is far worse than previously thought. A recent study shows that there is basically an annual "tort tax" of $9,827 on each family of four. What is nice is how the author explains that this money is just the beginning. “Litigation doesn't just transfer wealth, it also changes behavior, and often in economically unproductive ways”. They estimate that the additional $124 billion in liability-based health care costs creates 3.4 million uninsured Americans. This liability slows down R&D, innovation, and causes defensive medicine. The article gave no hard answers but I just think it was nice in showing some hard numbers. The emotional piece on physicians has never really been discussed in detail. Yes, there are bad eggs in this business but not that many. I have seen good doctors go through lawsuits only to end up basket cases who now question themselves and their patients. They are scarred and burned out and it is such a sad thing to see. These were good people made to look incompetent on the stand when all they were trying to do was help someone. That also costs this country a heck of a lot as well.

11. Conrad’s Corner by Pat Conrad MD

What is the American Medical News trying to tell us?

There is a time-tested tradition among mouthpiece publications which represent organizations, or certain points of view. That tradition is to float stories, or repeat topics along a certain theme to persuade the reader toward the organization’s point of view. There is of course nothing inherently wrong with the practice, so long as the publication is open and honest regarding its goals and agenda. A gun rights or pro-abortion group newsletter typically meets this standard: we know up front on what ride we are being taken. Things get sinister by degrees, from the selective facts of the New York Times, all the way to the state-approved news of the old Soviet Pravda. Citizens of the old U.S.S.R. and the Peoples’ Republic of China could read between the lines to learn who was in and out of power, and what official government policy might become, just by paying attention to what stories were featured.

The 3/19/07 issue of the American Medical News deserves closer inspection along these lines. After the usual headlines about the inability of Congress to fix the absurd Medicare payment formula, and the kowtowing toward all the goodness of P4P, an interesting editorial message was laid out. The publication’s regular editorial column paid tribute to the Dr. Nathan Davis Award recipients, honored for being “outstanding public servants.” The awardees ran a bipartisan gamut, if not crossing actual philosophical lines. Sen. Gordon Smith (R) was honored for his work to prevent teen suicide, and to enact Medicare Part D. While no one argues in favor of teen suicide, and hardly any argue against old folks getting free drugs, it was not made clear what business this was of a U.S. senator. Sen. Sherrod Brown (D) was honored for working for the State Children’s Health Insurance Program; Connecticut State Sen. Toni Harp was lauded for being an “outspoken advocate for the homeless”; and Maine CDC director Dora Mills, MD for leadership in “tobacco prevention and control.” The fluffy write-up concluded that these worthy souls were deserving of praise for “giving of themselves to advance the well being of all.” There was no mention that these individuals all saw fit to use health and “well being” as a mechanism to take from some to give to others, or at least in the case of Sen. Smith, to grossly overstep the constitutional bounds of his office. No matter, it was all for worthy causes.

On the very next page is an op-ed by AMA President William Plested, MD describing the work of another group of public servants. Pres. Plested was fairly breathless in his recount of his recent trip to Germany to tour some military medical facilities. Accompanied by past-president J. Ed Hill , Plested got to see first-hand how our wounded from Iraq are triaged and treated first in Germany, and then transported to the

U.S.

The description was of an impressive system of logically sequenced, comprehensive care that relies on a unified command structure, backed by big bucks. Whatever shoddiness had occurred at Walter Reed Hospital, the system that initially treats wounded G.I.’s and gets them home is a humdinger. Plested cheered the “teamwork, professionalism, and meticulous attention to detail” he saw in the system, and found lessons for the home front. He spoke of the “esprit” and high morale of the medical personnel, and of “teamwork [not] just a platitude but a palpable combination of camaraderie and pride. Everyone was proud and contented with their own contribution and respectful of the contributions of others. This is sorely needed in our everyday practices.” (italics added) Plested finished with some rah-rah boilerplate about supporting the troops and scolding “those who belittle our military and National Guard.” Whew.

It is no criticism of our fighting forces to recognize the utter arrogance of Plested’s comments. For the leader of an organization purportedly in place to speak up for American doctors to throw such implications is unconscionable. From Plested’s own mouth we hear that teamwork, pride, and mutual respect are “sorely needed” amongst his less worthy colleagues at home. Does Pres. Plested recognize that civilian doctors burdened by a system he supports cannot call on the dollars or logistics that the military enjoys?? Which of the military nurses caring for battle wounded are burdened by the onerous paperwork and trivial complaints that assault their civilian counterparts? Which military doctors observed by Plested were making clinical decisions based on the fear of lawsuits, satisfying the next highest coding level, or making payroll? Does the AMA leader’s admiration for the contentment and mutual respect he witnessed support the acceptance of expanded rolls for subordinate providers – PA’s, nurse practitioners – now taking place in government and organized medicine? Plested’s comments were an insult to the harassed physicians in this nation who are increasingly betrayed to the government by his organization, with platitudes and exhortations to pride and professionalism.

What can the reader discern from the American Medical News, which has so carefully placed adjacent op-eds praising physicians who work for the government? Are they merely giving a wink and nod to the government, being careful not to irritate too much those who make reimbursement policy? Or does the publication’s editorial board seek to soften the image of government care in the eyes of its readers? One piece glows about the good work done by politicians and physicians working in, under, and for the government; the next uses deserved praise for our military as a vehicle to chide civilians whose only transgression was attending medical school. The AMNews is a professional publication whose issue layouts do not happen by mistake.

12. Feedback About The Placebo Gazette

All future feedback will be posted as reviews for each issue. Please go below and post your thoughts under the WRITE A REVIEW section.