1. This Is Not Good
2. Influencers
3. Placebo Journal Update
4. Gorback’s Thoughts by Michael Gorback MD
5. I Agree
6. Jersey’s Got Some New Players
7. Joke of the Week
8. Ridiculous Study of the Month
9. Bacharach’s Beliefs by Ted Bacharach MD, retired
10. Please Donate
11. Who Is The Patient?
12. Satellite Care
13. Happy Holidays!
14. Feedback About The Placebo Gazette

1.  This Is Not Good

On Dec 10^th, a state Supreme Judicial Court in Mass ruled that a doctor can be sued over a car accident caused by his patient while driving since that doctor prescribed numerous medications to the driver.  Some of those meds included narcotics.  The patient hit and killed a 10-year-old boy after he fell asleep at the wheel.  The mother of the boy alleges that the doctor failed to warn his patient about the side effects of the medication and the potential danger of driving while taking them.  This ruling greatly expands the potential liability for the medical profession. This is all described in detail in a recent Boston Globe where Justice Roderick L. Ireland ”compared a doctor who fails to warn a patient about a drug's side effects that could endanger others to a bartender who serves a drunk customer” .  What is even worse is that this is Massachusetts’s highest court making this ruling. 

These are very scary times for doctors.  Now we are accountable for every possible scenario that can happen from taking a medication.  The patient who fell asleep had been taking multiple meds, many of which can cause drowsiness, and hadn’t reported any side effects in the months before his accident.

The article went on to say that the two dissenting justices “worried the ruling would drive up medical malpractice rates”.  You think?  Forget the fact that recent studies show that long term use of narcotics does not impair driving ability.  I mean who needs science?  Let’s just keep suing and pick up the pieces later. 

2. Influencers

There is a paradigm shift going on in the pharmaceutical industry.   They are relying less and less on drug reps and finding different ways to get their meds prescribed.  We have all seen the way they went after patients by using direct-to-consumer advertising.  The next phase is on the way.  The WSJ reported that Novartis AG is “reorganizing its sales force in some markets to pay less attention to doctors and more attention to the powerful parties who pay for the drug”.  Which party is that?  The insurance companies.  For those that do not know, medications are prescribed for a certain ailment depending on what the insurance company covers. For example, if I write for Lipitor for high cholesterol and Cigna doesn’t cover it then I am going to be called by the patient and asked to switch to another drug because she will have to pay a really high co-payment or out of pocket altogether.  So now Novartis is going after the doctor in charge of deciding formularies at the insurance company in order to influence him or her. Here is the big question: do you think that the drug company will influence that doctor with data or with discounts, rebates, or outright kickbacks?  If you think I am crazy, check out how some Medicaid formularies are decided.

 3. Placebo Journal Holiday Gift

How about giving the gift of humor to your friends and loved ones?  Until Dec 31^st, you can receive a free poster for yourself or giftee when you order a gift subscription. Just order by then and send us an email (debra@placebojournal.com) to see where you want your poster to go and which poster you want.

4. Gorback’s Thoughts by Michael Gorback MD

Medicine is slowly breaking down into mid-levels being supervised by physicians. In Iowa the medical board had to issue a ruling that CRNAs could not practice invasive pain management. Apparently CRNAs feel that since they are taught to do labor epidurals that suddenly they are qualified to perform fluoroscopically guided procedures. There was a similar episode in Louisiana last year. The mid-level model started in anesthesia with CRNAs and then expanded into family medicine, surgical practices, etc. Now we have thinly veiled independent mid-level practices with a NP or PA doing the care with a doctor ostensibly "supervising". 
 
Here's a golden opportunity to start up the first School of Supervisory Medicine. Students would learn how to supervise mid-levels. The first two years would be like regular med school, focusing on basic science. In the 3rd and 4th years the students would do rotations in anesthesia, Wal-Mart, etc - wherever mid-levels are now in use. They would not treat any patients directly - just watch the mid-levels. Then they would receive a S.M.D. degree. Their license would be restricted to supervision-only. They would not be allowed to do any direct patient care. 

5. Did You Know?

The times, they are a changing.  Here is one example: Bob Sliskovic was let go by Pfizer.  Who is Bob Sliskovic?  He is a 23-year lab veteran who created Lipitor.  You know the drug that made $80 billion since its launch?  Yeah, that one.  The chemistry-based drug research profession does have to deal with a lot of failures due to its nature but we are in an era of high scrutiny.  With such intense pressure on the pharmaceutical industry by the FDA on one hand and their stock holders on the other, they have started hunkering down and going into survival mode.  That means downsizing. Before we get too happy about big Pharma “getting theirs” remember that this industry (with its research) is still needed.  Has anyone even seen a new antibiotic recently? 

6.  Jersey’s Got Some New Players

NJ Physicians is a new advocacy group in, well, New Jersey and was formed to address the concerns by doctors who have been ignored by their state medical society.  I love it!  Nothing like competition to make these medical societies get on their toes.  The new group is going to form a registry of arbitrary denials and delays by insurance companies.  They will also have ‘”town hall” meetings to find out other concerns by doctors in the state.  The director of the Medical Society of NJ, Michael Kornett, believes the group will be “divisive and totally unnecessary”.  Doesn’t his statement, by definition, prove he has been ignoring their concerns by denying their need for existence?  More coups like this are needed to replace the “comfortable” people who pretend to represent us.  Another example would be the AAFP not rejecting the concept of Retail Clinics.  Now these organizations use this non-rejection as a form of endorsement.  Michael Fleming MD who used to be president of the AAFP is now on the advisory board of MinuteClinic.  Hmmmm.  He says it is for “quality assurance”.  I wonder if he is getting paid?

7. Joke of the Week

After an extensive complete physical exam, the patient shook his doctor's hand in gratitude and said, "Since we are the best of friends, I would not want to insult you by offering payment. But I would like for you to know that I had mentioned you in my will."

"That is very kind of you," said the doctor emotionally, and then added, "Can I see that prescription I just gave you? I'd like to make a little change..."

8. Ridiculous Study of the Month

The Annals of Internal Medicine published a recent study which surveyed 3,000 doctors about whether they would report impaired doctors, would order unnecessary tests, would refer to imaging centers they had a financial interest in, etc.  The results were reported in every major paper as it makes good media fodder.  I am not going to rehash those results here because I am not sure it meant anything.  Except one little nugget, that is.  The reason I say this is that only around 1,500 responded to the $20 incentive check that came along with the survey.   When only half your study participants answer your question it makes the results very shaky.  The best part of the whole study, however, is that twenty-one doctors who didn’t answer the study cashed the check anyway!  To me, that says it all.  If that doesn’t show how desperate our profession is then I don’t thing anything else will.  Okay, maybe those doctors who speak for pharmaceutical companies.  Or write humorous medical journals.

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

Egg Nog

10. Please Donate

William McGuire MD, the former CEO of UnitedHealth, had to forfeit $620 million in fraudulent back dated stock-options.  This scam is where companies “pretended” to give their higher ups stock options when the price was really low and then would let them cash in these “pretend” stock options when the price was really high.  So please send in your spare change for Dr. McGuire.  He is only left with a few hundred million dollars now and can use your help. Here is another idea.  What if UnitedHealth “pretended” to give some real money back to its customers instead of their executives?

11.  Who Is The Patient?

The media has been all over the recent news that some doctors who are going through substance abuse rehab are still treating patients.  It seems that almost 8,000 docs around the country who go to confidential rehab programs are allowed to continue practicing as long as they stick with the treatment regimen.  The problem is that patients aren’t alerted about their physician addiction.   This all came out when California abolished their confidential rehab program for doctors because they felt the system failed to protect patients or help addicted doctors get better.  This issue isn’t so black and white.  Here is the problem: in the continuing politically correct and never-ending effort to protect patients it seems we don’t know what to do when both parties here are patients! It’s a conundrum because don’t the doctors deserve the same confidentiality and benefit of the doubt when they are patients?  No way, you say, when that same doctor is operating on the wrong side of the brain.  I would agree except those doctors were in Rhode Island and not going through rehab.  Yet. 

12. Satellite Care

Recently, a couple was sentenced to more than four years in prison for “bilking friends and family out of more than $800,000 by convincing them that his wife was a government agent who could arrange to have their medical problems diagnosed by satellite imaging.” This was reported by the Associated Press.  Stacey Finley claimed she was a CIA agent and with her contacts she could schedule a medical scan of the victims' bodies by satellite imaging that would detect any hidden medical problems.  If any medical problems were found they would then have secret agents administer medicine to them as they slept in exchange for payment.

Here is the scary part.  I can’t even convince diabetics with heart disease to take their cholesterol medication because they believe it causes every little ache they unfortunately pay attention to yet these people convinced their victims to hand over droves of cash for this idiotic scam!  Also, they were able to get $800,000 for doing nothing while we doctors make $12 off a complete physical for a Medicaid patient (less when you have to pay for the interpreter).  Laugh all you want but Stacey Finley is onto something.

13. Happy Holidays!

I want to wish everyone a happy holiday season.  I hope you keep a smile on your face and a positive attitude.  Sometimes we get focused on all the negative in our lives and forget to appreciate what we do have.  For those of us in the medical field we can feel proud that what we do matters and that we truly are helping others.   No matter what the administrators, bureaucrats or insurance companies do to us they can never take that away. 

Thank you for your support and for spreading the word about what we do at the Placebo Journal! 

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