1. Incorrect Care
2. Another Medical Business C.H.U.D. Baby Is Born
3. Placebo Journal Update
4. Gorback’s Thoughts by Michael Gorback MD
5. Call To Faces
6. The Evil Gift Taking Doctors
7. Maria's Media Spotlight By Maria Simbra MD
8. Mishap?
9. Bacharach's Beliefs By Ted Bacharach MD, Retired
10. Love My Peeps
11. Big Pay
12. Prediction
13. Personality
14. Feedback About The Placebo Gazette

1.  Incorrect Care

In another attempt to discredit physicians, USA Today came out with a piece that ran with the headline Kids get correct care from doctors less than half the time.  The study was done by the RAND Corporation and published in the NEJM. It looked at 1500 kids and found that the following were the percentage of times that children received the recommended health care for certain illnesses:

Obviously, doctors in this country are terrible.  That is what they are saying, right?  Sorry, not buying it. Yes, there are doctors that do too much volume and either don’t do what is recommended or forget to document that they did it.  Even so, I still don’t believe this data.  Are you telling me that we can’t even treat acne correctly?  No way.  Expect more of these bogus studies to come as P4P continues to gain momentum which will only create an industry of watchdogs trying to make us look bad.

2. Another Medical Business C.H.U.D. Baby Is Born

As discussed in a recent WSJ piece, big companies are turning to what’s called “care managers” to control their medical costs.  The premise is that the “care managers” will audit the employees’ health care and then intervene to “both improve outcomes and save money”.  No, this is not a joke.  And I did not make that ridiculous “care manager” title. 

This is just another example of a new industry which will make its money by disrupting the patient-physician relationship.  This is very similar to Pharmacy Benefit Managers who did the same thing with prescription drugs.  You know the ones (I have mentioned before in previous Placebo Gazettes) who sent a letter to one of my patients and stated that Glyburide is generic for Actos and said he should switch. 

Companies like Healthways Inc., ParadigmHealth Inc, and others will actually review the doctor’s treatment plan for the patient to make sure it conforms to evidence-based medicine practices.  They then tell the company to stop certain drugs or procedures.  I am not kidding you.  Heck, they may even get the patient a second opinion which only means it is not long before they find them another doctor. 

The articles gives an example of a stranger who was continually trying to call a patient to discuss both her asthma as well as her husband’s medical problems.  They tout this as a free service for the employers but they also state that the employees will get a discount on their healthcare copayments if they use it. That doesn’t sound free to me? Unbelievable. 

 3. Placebo Journal Update 

If the Placebo Gazette is new to you then you may be a little bewildered.  The Placebo Gazette, what you are reading now, is our online e-newsletter.  It is free and it is more political than medical and more informational than humorous.  If you are looking for pure medical fun, then subscribe to our print-only PLACEBO JOURNAL below.  We are in our seventh year in production and we take NO pharmaceutical advertising.  We survive on subscriptions from people like you.  Our last issue included:

·        Docopoloy

·        Extort – the newest BP drug

·        Med School Musical

·        X-rays, X-rays, X-rays

·        Much, much, more

SUBSCRIBE

4. Gorback’s Thoughts by Michael Gorback MD

When the FDA made the decision to warn people away from the evils of quinine, they cited reports of 665 ADRs (adverse drug reactions) and 93 deaths in people taking quinine since 1969, or 2-3 deaths per year.

To put this in perspective:

1. Lightning strikes probably killed 4,000-5,000 people during that time period.

2. On average, more people are killed by NSAIDs during a long weekend than 38 years' worth of quinine.

5. Call To Faces

The picture above comes from an advertisement for the AMA.  It shows a lot of docs or models putting the head of their stethoscopes to their mouths under the headline “When we speak as one, physicians and patients win”.  Maybe.  It’s not a bad ad but it has so much potential to be spoofed.  This is where you come in.  If you would like your face (no name) to be part of a Placebo Journal spoof or parody then send me a picture with you in your normal work clothes (or costume) and a stethoscope up near your mouth.  I have not figured out the piece in total yet but I really would love some creativity on your part.  For example, wear some ridiculous make-up, pick your nose while you pose, etc.  I need the same kind of pose from the shoulders up and against a solid color background.  We will put their background color in later.  Are you up to it?  Just attach it to an email at doug@placebojournal.com.

6. The Evil Gift Taking Doctors

A recent article in the NY Times details how Minnesota is leading the charge against the evil doctors who take anything from pharmaceutical reps.  Two years ago, Minnesota officials “forbade drug makers to give doctors more than $50 worth of food or other gifts per year”.  Yes, you read that right, per year!  The results have been astonishing.  Doctors are seeing a lot less pharmaceutical reps now.  The article tries to draw a comparison to a 1997 study which found that medical students saw gift-bearing drug sales representatives as helpful while viewing with suspicion those without gifts. Is that what is happening in real life?  Hardly. 

I am not convinced that all pharmaceutical interactions are inherently evil.  The bottom line is that spending five minutes with a rep may even be helpful.  Why?  Because I can no longer tell which medications are on which formulary for which managed care company!  The idiot HMOs have made it a shell game and so confusing that I am now using drug reps to help me. 

What drives me crazy is lawmakers trying to label us as being as being tarnished.  “When you see a doctor, you should have confidence that the advice you get is based on what’s best for you and not on some financial incentives or gifts that the doctor is getting”, said New Jersey’s attorney general, Anne Milgram who announced on Sept. 18 the creation of a task force to examine ways to limit the gifts and money that drug and device makers give doctors.

It turns out that they think we are the cause behind the cost of our healthcare system.  As the article states, “the interest in legislation to register or limit the food, gifts and money that drug and device makers lavish on doctors stems from growing concerns that these benefits lead doctors to prescribe more, and more expensive, drugs and devices, raising the costs of health care and changing care to patients.”

This just in: days after the senate approved a $1 million earmark for a Woodstock museum Hilary Clinton and Charles Schumer (who got it passed) received $29K from the guy who requested help in getting the museum.  Yes, that was AFTER the bill was passed.   

This also just in: Jessica Seinfeld, the wife of Jerry Seinfeld, sent Oprah 21 pairs of Christian Louboutin shoes (whatever they are) for an estimated cost of $16 to $20K.  This was a thank you for putting her on the show to promote her cookbook which of course guarantees that it will be a best seller.

And, as a physician, will get reported to the state for having a cup of coffee and bagel with a rep.  Yup, that sounds fair.

7. Maria’s Media Spotlight by Maria Simbra MD

Promotions had a lot to work with for the month of September.  It was their job to promote.  It was my job to explain and temper.

Here were my assignments.

9/04/07                       "Antibiotics Not Needed Before Dental Work?"

9/04/07                       "Could Studying on the Computer Strain the Eyes?"

9/10/07                       "Eye Infections More Common With Soft Contacts"

9/11/07                       "Could Mold Be Affecting Your Mood?"

9/18/07                       "Study: Almost 1 in 10 Children Has ADHD"

9/18/07                       "How to Protect Yourself from MRSA"

9/19/07                       "Health Officials: More MSRA Cases Reported"

9/21/07                       "List of MRSA Cases Grows"

9/25/07                       "Are Annual Checkups Really Necessary?"

To see these reports, go to KDKA.com, click on the word "Video" at the top of the large box (top right), open the drop down menu and click on "Health," look for the headlines mentioned above.  They're organized by date, the most recent reports up top.

Is it or Isn't it.  MRSA was the big news this month -- more cases, more media attention...but not really an outbreak.  This is where my expertise can be helpful.  We were reporting a MRSA outbreak because a newspaper in town called it such.  And of course, attention-getting, alarmist language went into our teases, saying the infection was "spreading."  I was able to get the health department to clarify that it wasn't truly an outbreak, but the numbers were up because people were paying more attention, testing more lesions, and reporting more.

Much to my chagrin.  Resources being what they are in any newsroom, I am asked from time to time to retrack a prefabricated medical news piece from a subscription service.  I am a team player, so I go ahead and do it.  Some pieces are better than others, but the lowest common denominator is a report's "promotability."  The packages I have listed above are my own work.  You may see other pieces on the web site that I don't have listed above...those are the ones from the subscription service.

8. Mishap?

It seems a miscalculation was responsible for the mishap that killed 10,000 migrating wildebeest that were attempting to cross Kenya’s Mara River in late September.  A person who witnessed the tragedy wrote that the deaths occurred as the wildebeests tried to cross the waterway a particularly steep and treacherous point.  After the first animals fell into the river and drowned, thousands more continued to stampede into the water on top of them. 

This was reported by the Universal Press Syndicate.

Now, tell me the difference between what you just read and what doctors have done and still are doing by buying into  Pay-for-Performance (P4P)?

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

Physician’s responsibility

Recently we have been able to see the effect of word associations on our interpretation. During many of the discussions on immigration opponents of
proposed legislation made great use of the word “amnesty”. This word aroused widespread opposition to any proposed changes. In the field of healthcare it is easy to arouse heightened feelings among physicians by the use of the term “socialized medicine”. The response by the medical profession is certainly one of marked opposition. The question of whether this response is appropriate is one that deserves consideration. As a group, physicians at the present time are not happy with their present situation. Early retirements, changes in the scope and manner of practice are widespread. Most physicians are unhappy with the present status of medical insurance and managed care. Resolution of our problems has failed to occur and if anything conditions faced by both physicians as well as our patients have spiraled in the wrong direction.

The means by which healthcare is delivered at this time varies from HMO, to
Managed Care, Medicare, MediCal or similar state coverage for the indigent.
Regardless of how care is paid for, almost all sick people in the country are given some medical care, whether by private or public funding. The variability of charges and the fact that preventative medicine has been withheld has resulted in more acute costly care that is required. People are being given medical care, sometimes only in acute, severe circumstances.

All of us have seen instances where we have felt that our present system of
dispensing and withholding medical care has been less than desirable. The
reaction of most physicians is to decry the present state of affairs, but no one
seems to be willing to determine possible solutions to improve the situation.
Changes are inevitable and necessary. There is no going backwards, yesterday has gone by and tomorrow will come with or without our consent. How these changes will impact the physician or the patient remains to be seen. Perhaps physicians unlike the ostrich should pull their heads out of the sand and consider what can and should be done. The division in our ranks has permitted many of the changes we are living with. We cannot turn back the clock but we can take the approach that we will stand together and influence significantly all future changes. Socialized, nationalized, or any other form of healthcare varies in hundreds of different ways. Physicians can and should be part of any possible solution that best fits our profession, our patients and our country.

While we have been whining and crying over our situation the HMO executives, the Managed care executives and the managers of our medical clinics and hospitals have been reaping increasingly greater compensation that is included in the healthcare cost to our nation.

10. Love My Peeps

Nothing bothers me more than our high and mighty medical associations and societies who get on the anti-pharmaceutical bandwagon.  They are the first to criticize docs for selling out or being influenced by reps.  Behind the scenes, these same organizations reap in millions by the same pharmaceutical companies.  Check out any of the journals they sponsor and you will see Big Pharma ads everywhere.   When a drug rep brings a NEJM reprint of a study touting his or her drug, guess who reaps the benefit?  The NEJM gets a lot of money per reprint. 

How about CME?  Well, last year the pharmaceutical industry accounted for more than 61% of all CME.  That’s over $93 million from the year before.  This money goes to pharmaceutical grants, advertising and exhibit fees which means much of it goes to the coffers of the same medical associations or societies that berate us for having a cup of coffee and bagel with a rep. Yup, that sounds fair.

11.  Big Pay

There are politicians out there who actually use Medicaid as a successful program and portray it as a wave of the future.  The Governor of Maine, John Balducci, stated it was a way to get people off the uninsured list.  Of course he forgot to mention how little Medicaid pays.  Information was released recently from Public Citizen showing that in Pennsylvania, for example, that a $92 doctor’s bill is reimbursed at a rate of $25! That is, if they actually pay at all.  In Maine, an entire hospital is closing off to Medicaid for that reason.  I know a neurosurgeon who has an accounts receivable of over $1 million from MaineCare (at their rates) who has yet to receive a dime.  And it has been years. 

12. Prediction

Oprah came out on her show stating that she had fatigue and weight gain and was diagnosed with hypothyroidism.  She is recommending all women with similar symptoms go get checked.  Forget the fact that there is no evidence to screen women without these symptoms.  Since most of America is fat and fatigued this call to action from Oprah may be the single mostly costly and misconstrued recommendation to ever hit our healthcare system.  And it all came from daytime TV.

13. Personality

As reported in the American Medical News, some medical liability insurers are requiring physicians to take a communications skills assessment before they give them a policy.  The 15 minute online test is hilarious in that the answers are obvious.  Here is an example:

How others see me:

1. It is a waste of time to worry about what others think of you.
2. Most people see me as a rather restrained and quiet person
3. I would not be accurately descried as a risk taker
4. I miss opportunities because I cannot make up my mind

If you are that stupid to fail this test then you shouldn’t be practicing medicine anyway.  According to the program, doctors who score “poorly” have to go through a coaching session to improve their communication skills before they get coverage.

The bottom line is that these insurance companies are looking not to get sued and therefore they are trying anything to find those outliers who put them at risk.  Hey, it gives more administrators jobs. That’s a good thing, right?

Here is another question they offered.  Which would you choose?

When I see a patient:

1. I immediately think “now there is someone I can kill”.
2. I worry that cheating my way through medical school may not have been such a great idea.
3. I consider her a person first, a patient second and possible date third.
4. I try to help her with her medical problems.

14. Feedback About The Placebo Gazette

I WANT TO KNOW WHAT YOU THINK.  Please go below and post your thoughts under the WRITE A REVIEW section.  You can also see some one of these articles on our blog:

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

Doug

King of Medicine