1.       Any Of You Been Sued Recently?

2.       Knocked Up

3. Placebo Journal Update
4. Gorback’s Thoughts by Michael Gorback MD
5. On The Lot
6. Avandadeath?
7. Joke of the Month
8. Quote of the Month
9. Bacharach’s Beliefs by Ted Bacharach MD, retired
10. Fat Docs
11. Maria’s Media Spotlight by Maria Simbra MD
12. IntelliDrug
13. Too Easy
14. Feedback About The Placebo Gazette

For obvious reasons, I won’t go into detail about the following.  It came out without my knowledge.  I was just sitting at the gym when I saw the headline in my local paper. 

http://www.sunjournal.com/story/211482-3/LewistonAuburn/St_Marys_sues_three_doctors/

The best part of the whole situation was an editorial printed in the same paper a week or so later by a Roger Turcotte.  Talk about capturing the essence of the healthcare system today.  Here it is in its entirety:

Hospital Shenanigans

Imagine a scenario in which institutions of medical science cooperate with each other for the benefit of patients. Imagine patient welfare as a priority overshadowing a ledger's preeminence.

Imagine hospital administrators finally understanding and embracing the values and philosophy represented by the caduceus - the winged staff and intertwined snake symbol of the medical profession.

Imagine an atmosphere in which compassion takes precedence over imperial aspirations. Sadly, these remain but a dream with no foundation in the Twin Cities.

In their latest rendition of juvenile hysteria, hospital administrators digress from their usual worn script. No longer complacent battling competition, St. Mary's is targeting three physicians in a seemingly frivolous lawsuit. I do not profess understanding the legalities of such contracts between hospitals and physicians, much less the need for them. Unlike the industrial world, what possible trade secrets could doctors share with another hospital?

Limiting the practice of physicians to placate disgruntled administrators smacks of coercion. Despite hospital preference, patients have every right to expect treatment by their own doctors.

Imagine the health care system we would enjoy if boardroom demigod malcontents ever realized how tired, disgusted and fed up people are with soap opera shenanigans. However, for all their alleged relevance, for a stipend St. Mary's administrators will tear up these contracts and look the other way.

Imagine, our physicians may purchase redemption for thirty pieces of silver.

How utterly predictable!

2. Knocked Up

Knocked Up comes out June 1st. It is by the director of 40 Year Old Virgin and Anchorman. Even better, my friend Dr. Ken Jeong is in it. Ken is an internist and stand-up comedian in L.A. For those that get the Placebo Journal, he was our featured interview about a year ago. Here is an exclusive outtake and deleted scene from the movie. Be warned, this is obviously an improv bit and the humor is ADULT and over-the-top!

http://placebojournal.blogspot.com/

Send some comments in and I will make sure to have Ken read them.

 3. Placebo Journal Update 

 

I believe this issue will make some noise out there.  Wait until you see the stuff we have for you:

• Physicians’ Fitness Magazine
• Zerorem – the insomnia drug for doctors
• Occupational and Environmental Medicine Boot Camp in Tikrit
• Managed Care Madness
• Call Disrupter Pro – the device made especially for physician’s spouses
• Stupid Pharmaceutical Tricks
• Tons of real and hilarious medical stories
• And much, much more!

If you want to guarantee that you will make the next issue of he funniest medical journal ever created then click below:

SUBSCRIBE

Take the HIPAA QUIZ and see which answers work for you.

1. Since we began shredding all trash containing sensitive information:

a. The garbage men are complaining they don't have anything good to read
anymore.
b. The Chinese healthcare spies are complaining they don't have anything
good to read anymore.
c. We have spent $5,000 on paper shredders.


2. Since we paid $40,000 to upgrade our billing software to ensure
secure transmissions:

a. The teenage mutant ninja medical billing hackers are complaining they
don't have anything good to read anymore.
b. The Chinese healthcare spies are complaining they don't have anything
good to read anymore.
c. We have spent $5,000 trying to figure out why our computers keep
crashing.


3. Now that we use peel-off stickers on the sign-in sheet so the other
patients can't see each other's names:

a. The patients still all sit in the waiting room comparing their
diseases and treatments so we had to install sound-proof cubicles to
enforce privacy.
b. The Chinese healthcare spies are complaining they don't have anything
good to read anymore.
c. We have spent $5,000 on peel-off stickers.


4. Since we implemented each and every requirement in order to conform
with HIPAA:

a. We have been sued a lot less for privacy violations.
b. The Chinese healthcare spies are suing us for loss of consortium.
c. We have spent $5,000 on HIPAA manuals.


5. Overall, HIPAA has been:

a. a great leap forward for patient privacy.
b. a source of untold frustration among Chinese healthcare spies.
c. a great boon to companies that produce HIPAA manuals.
d. a royal pain in the ass.

 

I have been watching the show On The Lot on Fox.  It’s another reality show about wannabe directors who want to become the next Spielberg.  Anyway, on last night’s show they had to create, direct and film a one-minute comedy short.  Many of them were really good.  I stepped out to the kitchen at one point and when I came back I saw the best one of them all.  It was a Lunesta commercial and basically the whole bit was listing all the side effects.  It was hilarious.  Then my wife told me that wasn’t part of the show and was a real commercial.  Hmmm.  Well, I told her I think it should still win.  She thinks I’m an idiot.

6. Avandadeath?

 

The news this week was all about Avandia.  This is a pretty good drug for diabetes; one that I have prescribed a lot over the years.  I have especially liked it in combination with metformin.  I also think GlaxoSmithKline is a good company and on a micro level have the most respectful drug reps.  Here in Maine they are the most experienced and are never too pushy or give a hard sell.  If the company hid the data, however, I am going to be pissed.   That is going to be a lot of work for me. 

If you didn’t hear, a study in the New England Journal of Medicine by Dr. Steven Nissen concluded that the risk of a heart attack was increased 43 percent among those taking Avandia, and there was a 64 percent increased risk of dying from cardiovascular causes, compared with patients not taking the drug. He found this by evaluating 42 studies that compared patients taking Avandia with patients not using the drug. He found that among patients taking Avandia, 86 had heart attacks compared with 72 among patients not on the drug. In addition, 39 patients taking Avandia died from cardiovascular causes compared with 22 patients not receiving the drug.

GSK is adamantly fighting back on this.  They state they have studies showing different conclusions.  They point to examples such as the DREAM study, the ADOPT study and the RECORD study.  Good thing they never mistakenly named of their research projects the KILLME study, huh?

There were rumblings about GSK knowing that there was an increased cardiac and now Congress is looking for another “Vioxx” situation.  The truth is there have always been cardiovascular warnings with this drug. 

Right now I am not switching anyone off of it.  I try not to make quick decisions without more evidence.  The number needed to harm (NNH) is an epidemiological measure that indicates how many patients need to be exposed to a risk-factor to cause harm in one patient that would not otherwise have been harmed.  The incidence rate with Avandia was 1.99% vs. 1.51% of controls. Using Nissen’s information, the NNH with Avandia for a cardiac incident would equal 208.  So, for every 208 people treated, one more patient would have a heart incident.  And that is only true if Nissen’s study was a good one but it is only a meta-analysis and not as significant as say a double blinded, prospective study.

In another totally unrelated study, the journal Health Affairs published information comparing the risks of taking each of six drugs to the risks people face at work.  For example, it was less risky to take Vioxx than it is to be a logger or drive a motorcycle.  Being a taxi driver is as dangerous as taking Clozapine.  I guess my point is that we need to take things into perspective.  “One swallow does not a summer make” goes the famous quote.  Let’s not let the media or Congress freak us or our patients out about Avandia just yet.

A 92 year-old man went to the doctor to get a physical. A few days later the doctor saw the man walking down the street with a gorgeous young lady on his arm.

At his follow up visit the doctor talked to the man and said, "You're really doing great, aren't you?"

The man replied, "Just doing what you said Doctor, 'Get a hot mamma and be cheerful'."

The Doctor said, "I didn't say that. I said you got a heart murmur. Be careful.”."

8. Quote of the Month

“Consumers are telling us in no uncertain terms that convenience is so critical to them that they will forego traditional primary care providers in exchange for access to the kind of quick and convenient basic care services offered by retail clinics.”

John Thomas, Market Strategies Inc research firm

The quote above was found in a recent Family Practice News.  Already 1 in 10 retail clinic users state they have mostly or completely replaced their PCP for these places.    Mark my words, the rise of the retail clinics will be the worst thing to ever hit primary care doctors as well as the healthcare system in general. 

Here are some basic reasons why:

• There is no screening process.  Why does someone need to get treated an hour after feeling a scratch in his throat or an itch in her ear?  Now they can just walk right into a retail clinic and instead of being “reassured” and actually wait it out.  Talk about overtreatment!  And the insurances are going to pay for this? Not for long. 
• This pits us against PAs and NPs.  We were supposed to work together.
• It fractures continuity of care.  No longer do patients have a medical home. 

9. Bacharach’s Beliefs by Ted Bacharach MD, retired

Physicians have become a group that fails to adhere to any form of cohesion. Physicians don’t seem to understand that cohesion is not a form of collusion.  The pharmaceutical industry understands all the implications and advantages that cohesion affords. To see how effective this process has been all one has to do is look at the successes that drug manufacturers have had in leading the Federal government down their medicinal path that provides them with great therapeutic advantages. They have been able to accomplish their goals by simply applying enough “grease” to move legislators in the direction they feel is best for their companies. The recent examples of how they prevented the government from bargaining prices for Medicare as well as the simple means by which they defeated a plan which would have allowed people to import drugs at lower costs from Mexico and Canada or other countries. Once the measure that would have permitted this passed, they were able to get an amendment passed that effectively emasculated it completely. This enabled the legislators to tell their constituents how they had voted for the measure and that its subsequent defeat was someone else’s fault. I have felt the degree of success the pharmaceutical industry has achieved deserves being looked at. It demonstrates what a single industry is able to accomplish if it is cohesive and has common goals. To date no one has been able to loosen the cohesive pressures enjoyed by the drug companies. Physicians on the other hand have demonstrated how a lack of cohesion can be employed as a means of strangling an entire profession. The interests of the family practitioner may not seem to coincide with the interests of his cardiologist colleague they nevertheless have many interests in common. Until physicians realize that we are all members of a single profession and adverse legislation affects all of us our government will continue to disenfranchise the medical profession one step at a time. Our government, as well as the pharmaceutical industry, has used the successes in medical care as proving the effectiveness of their concern and actions. All failures in therapy thus are the result of improper application of “their” great advances by the doctor. Eventually they feel they can correct all of the physician errors by the application of more stringent protocols that physicians will have to conform to.         

 

An article on overweight doctors just came out in McClatchy Newspapers by Dorsey Griffith.  If you don’t know, McClatchy purchased Knight Ridder Inc. in 2006 to become the second-largest newspaper publisher in the United States.  Anyway, the article was just another example of doctor bashing but this time it is probably justified.  Did you know that 44% of male physicians are overweight and 6% are obese?  How is that for “walking your talk”?  This really knocks our credibility when trying to convince patients to slim down.  Just like smoking, doctors are more successful in getting their patients to change a habit if they themselves have changed.   If we haven’t, then we are hypocrites and subconsciously we never give it our all if we know we are lying to ourselves as well as the patients. The piece was nicely written and uses the obligatory Harvard doc as a source.  As you know, no good article is complete unless a Harvard physician is quoted.  Personally, I found it amusing that I had just launched our spoof Physicians’ Fitness Magazine only few days before the article was written.  Nostrodougus strikes again!  

11.  Maria’s Media Spotlight by Maria Simbra MD

Welcome to sweeps!  May is a ratings month.   Our station, KDKA-TV in Pittsburgh, closely tracks our ratings, because this is what the advertising prices are based on.

Here were my assignments this month:

• "New Drug May Work to Osteoporosis" 5/2/07
• "Effects of Outdoor Cigarette Smoke Studied" 5/8/07
• "Pollen Counts Reach Season High" 5/9/07
• "New Study Link Multivitamins to Prostate Cancer" 5/16/07
• "UPMC Center to Help U.S. Soldiers" 5/16/07
• "New Warning Issued for Popular Diabetes Drug" 5/21/07

Why these made news:

The reality of TV news is that the station wants topics they can promote, i.e. commercials that say, "Hey, watch KDKA!"  And the more people affected, the more likely they are to exploit that.  Hence, pollen, cigarette smoke, diabetes.  Novelty, uniqueness, local connections, and "counter-intuitiveness" also make for interesting news the promotions department can take advantage of.

High point:

I pitched a story at the morning meeting that actually got promoted that day.

Low point:

One piece was delayed by a day because we were waiting for a feed from an affiliate in another state.  I was scheduled to be in the 4:00 PM.  They couldn't feed it until 4:00 PM.  There were all kinds of problems with the process of feeding by satellite.  It was a logistically frustrating piece to put together.

Conundrum:

An allergist at the hospital that does the pollen counts was upset I didn't interview him and instead interviewed an allergist at the children's hospital.  But look at who actually did the pollen counts -- the visual component of the story.  I interviewed the research assistant who actually did the work.  She was a fresh face and a legitimate source.  It's always a challenge when MDs think they're the only credible expert.  And it's also important for journalists to multisource -- which sometimes means quoting your competition.

12. IntelliDrug

Researchers in Europe and Israel, funded by the European Union, are working on a tiny drug-dispensing system called IntelliDrug that goes into a person’s mouth.  The goal is to get it into a molar filling so that proper dosing of a medication would be exact and would be guaranteed at the right time.  Actually, their goal is to make money but they have a point when they state that non-compliance is a major issue in patients not getting the right amount of their medication.  This method allows the drug goes right into the blood stream.  The device is made up of a stainless steel housing, a pump and custom valves to regulate the drug flow, a microprocessor, batteries, and a reservoir for the drug pill. It is still too big to replace a tooth but the company feels it will get there.  When it does it will be all the rage for a lot of other people as well.  Rappers can show their new “bling” when they smile.  Pharmaceutical companies can advertise on people’s teeth in exchange for giving the drug-dispensing system away for free.  Lastly, and most importantly, these units will be huge black market items.  Do you know how many drug addicts would love to get their drugs into their bloodstream without all the mess?  It would also be a great way to hide their addiction from family, friends and the police.  Ahh..don’t you just love innovation.

13. Too Easy

 

A recent study just came out showing that Viagra may be a good option for victims of jet lag or people who are shift workers.  The researchers believe that it may increase blood flow to the brain, especially to certain areas whose role it is to be the “masterclock”.  This may affect the circadian rhythm issue that comes up with jet lag, etc.  The big positive in this study is that since Viagra has been used by millions as a prescribed drug there is less of a hurdle to get this new indication for its use.  The problem I see is all those men walking off the plane with erections.  That won’t be a sight for sore eyes.  This treatment may also triple the membership to the “mile high club”.  Should I go on?  The drug may help bring blood to the brain’s “masterclock” for only so long; that is until it is shunted to other places and thereby nullifying its use.  More?  The treatment also has two interesting side effects in shift workers – narcolepsy as well as an increase in smoking.   I told you this was too easy. 

14. 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.  You can also see some of these articles (as well as a whole bunch of other ones) on our blog:

 http://placebojournal.blogspot.com/

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

Doug

King of Medicine