1. Reader’s Digest and Me
2. How About All Their Harvard Quotes Now?
3. Placebo Journal Update
4. Lecture Slides
5. China Copies US Method on Discharging Patients
6. Filibustering Meds
7. Squeezing Blood From a Stone
8. Ridiculous Study of the Month
9. Bacharach’s Beliefs by Ted Bacharach MD, retired
10. Smoking and Early Detection of Cancer
11. Shell Game Runs Rampant
12. Hold Those Guidelines
13. Another Bill To Change How Doctors Practice Medicine
14. Feedback About The Placebo Gazette

1. Reader's Digest and Me

As many of you know, the most recent edition of the Reader's Digest (July, 2008) included some material that I shared with the author. That resulted in a backlash on their website. It seems that many people don't want to know what doctors think.

I want to thank all of you who have come to my defense on this. The whole thing is pretty amusing. I would NOT take back my quotes in the article "41 Sectrets Your Doctor Would Never Share". At least I had the balls to use my name unlike some other physicians in the piece. Anyway, it has been comforting to see so many followers of the Placebo Journal back me up. The comment section opens up a real discussion about the disconnect between patients and the health care community. Maybe this can be built upon to make things better.

My favorite quote comes from a Digg comment, "That Farrago guy sounds like a d&ck!". Love it. Anyway, I don't think I will be retiring any time soon. My 3000 + patients need a doctor and that is how I make my living. I have known most of them for over a decade and enjoy what I do 95% of the time. Yes, America, doctors are human.

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2. How About All Their Harvard Quotes Now?

Three big name Harvard psychiatrists, you know the ones that get quoted for every article in the big newspapers, have been caught underreporting how much they received from big pharma.  Their universities and hospitals made it seem like it was a couple hundred grand over the past 8 years.  Nope.  Dr. Joseph Biederman and Dr. Timothy Wilens each got $1.6 million.  Another dude, Dr. Thomas Spencer, received only a little more than a million.  There is information that these amounts still might not be accurate and they could have received more.  Senator Charles Grassley is all over this and wants a national reporting system.  Whatever.  What bothers me is that these doctors have been quoted tons of times in different mainstream newspapers (WSJ, NYT, USA Today) just because they were from Harvard. Okay, maybe I am a little jealous here as I am really not an expert on anything.  On the other hand, it is concerning that their opinions were spread via the media to millions and set the trends on how we treat many psychiatric disorders.  It should now be more concerning when Biederman talks about depression and safety of the meds used or Wilens is talking how safe ADHD drugs are in the NYT. 

Their home hospitals and friends are trying to protect them with a letter writing campaign.  My hunch is that these guys are good docs.  They just got greedy.  It doesn’t excuse them.  It just makes them human.  They will have to make things right, however.

3. Placebo Journal Update

What is the Placebo Journal?  Well, for one, it is not what you are reading now.  Nor is it our blog.  It is the only PRINT medical journal that survives on subscriptions rather than the pharmaceutical industry.  The journal comes out ever other month and is chock full of things that will crack you up.  You will not get this type of medical humor anywhere else.  So, if you feel the need to find your smile again, then hit the subscribe button below.  Isn’t it time you enjoyed a medical journal without all that big pharma aftertaste?

SUBSCRIBE

4. Lecture Slides

For those of you that do medical lectures at conventions, grand rounds or at medical schools, we have the lecture slides that will make your audience smile and laugh.  Isn’t it time you stop using the same old Far Side cartoons?  To check them out, click here:

5.  China Copies US Method on Discharging Patients

Remember all those stories of “patient dumping” in California?  Well, we are not alone. It seems that China is a little jealous of us and is following in the same direction. After the May 12th earthquake, they have been stuck with patients who don’t want to leave the hospital. The reason is that they have no where to go as there homes have been destroyed. Unlike before the quake, China changed its rules for these patients and gave them free care. Normally, they expect cash upfront. Now that they entered the altruistic arena, they are stuck with these people. The article in the WSJ details some interesting cases that you should take a look at. The hospitals are doing what it takes to get them out including just stopping their meds as well as any services they receive. One dude had to hike up a mountain on a broken leg after he was thrown out. Think of that before we start criticizing how bad our healthcare system is. Word on the street is that China is starting to buy Healthcare Deluxe Curbside Tilt Trucks from America.

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6.  Filibustering Meds

How does a company fend off other companies from copying their drug when it goes off patent? Usually it pays them off so they won’t sell the generic version. The case against Abbott and its drug TriCor is a little different, however, and is being watched by the legal system very closely. The government is trying to get them on a antitrust lawsuit because of their dealing with an Israeli company. The case involves the act of “product switching” which involves retiring an existing drug and replacing it with a modified version that is marketed as “new and improved”. This prevents pharmacists from substituting a generic for the branded drug. Pretty smart people these pharmaceutical companies. Abbott not only did this but sued the other company therefore triggering a 30 month waiting period. That gives it a nice cushion to make some more cash on the medication as well as on the patients’ backs. When the 30 months were up, Abbott had switched the dosage again just enough to make it impossible for the pharmacist to offer a generic version as the new drug was no longer bioequivalent to the generic one. This is all smoke and mirrors. Teva, the Israeli company, switched its dosage again to match the new TriCor dosage and guess what? They were sued again which triggered another 30 month waiting period. Abbott eventually lost its filibustering lawsuits but got lots of sales during the interim. Without naming names, I can think of many other drugs which have been altered or changed over the past years “for the patients’ benefit,” as the drug rep stated. Yeah, right.

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7. Squeezing Blood From a Stone

In a very disturbing piece in the WSJ, patients’ debts to hospitals are being put up for auction online. Isn’t that creepy? Outside collection agencies are bidding to get access to the unpaid accounts so they can go out and nail these patients. These “accounts receivable exchange” are all the rage now. They promise to have safeguards to prevent abuse and that their collectors will abide by hospital rules. Not buying it. I am sure that there are patients who have abused our system and ducked out on bills. I am more sure that there are more patients who just get screwed because they are self-pay and without insurance. They get higher bills, due to cost-shifting, than those with managed care insurance or Medicare or Medicaid and get bled out by these gouging practices. This is going to get bad. Now all they need is a reality show like that dude Dog the Bounty Hunter to chase down these patients. I can just see him or someone breaking down a door of some old man in a wheelchair turning up his oxygen as he tries to roll away. All this will eventually lead to new companies that will have TV commercials promising to negotiate down patients’ debt like they due for unpaid taxes. You have got to love ingenuity.

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8. Ridiculous Study of the Month

Supposed new evidence published in the Public Library of Science Medicine has linked the amount of lead in a child’s blood to the likelihood he or she will commit a future crime. The study looked at 20 years of data from Cincinnati medical clinics and tracked down 250 subjects. They found that the more lead in the child’s blood from birth to age 7 the more likely there were to be arrested as an adult. The lead author Kim Dietrich stated that, “We need to be thinking about lead as a drug and a fairly strong one”. Good call. Oh, wait a minute, didn’t we get rid of lead from our paints? Also haven’t we been checking children’s lead levels regularly for years? That’s right. We have. In fact, any high lead level information is given to the state where both medical action and environmental changes occur. What more can we do? Other than give more fodder for lawyers to get criminals off, it just seems to me that this study is a waste as we are as vigilant as we can be. The good news: they got their paper published with some nice publicity. Hooray for tenure!

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

Hospital exposure 2008

The need for hospitalization seems to get all of us sooner or later.  As physicians we used to expect a little more but HMO’s, Medicare and various insurance plans have leveled the playing field. I really think the playing field is steeper. We don’t plan to have a hospital experience. When it happens the experience is variable, for some, a short stay is a possibility, —actually it is a sure thing for everyone. Prolonged exposure to the hospital environment is usually precluded by the fastidiousness of the “discharge coordinator” who makes sure that the stay is as short as is reasonable or almost as reasonable as possible. When the need for hospital care becomes inevitable we learn many things. First we learn that our “primary care physician” will probably distance himself as far from the experience
as possible.

The first exposure is to the emergency room where a short physician exposure is followed by a long parade of laboratory and X-ray procedures. Since the ER physician doesn’t know you, he or she has to start from scratch and get a baseline. X-rays and blood work are accompanied by monitoring if deemed necessary or “observation”. I’m not always sure who is supposed to be observing but most of the time someone notices if something happens.

The next major decision is hospitalize or send home. If unstable hospitalization is best and if stable “home” is deemed appropriate. If you are hospitalized you get to see another physician, the “hospitalist”. Most hospitalists have names but you probably won’t remember it, or if you do, the chances are good that the hospitalist you have seen will be off tomorrow. If you have an old chart at the
hospital you are admitted to, the probability is that any mistakes on your old chart will be well preserved on your new chart. Feeling “close to a physician” is probably something you may remember if you are old, but is not something that is expected in 2008.

Your hospital care will be addressed to your primary problem. If you are unfortunate and have a second problem you will probably have to complain forcibly if you want it attended to. Care outside the range of the doctor who is providing your primary care may be somewhat difficult to obtain. Be sure to voice your concerns with some degree of force.

Post hospital care is also fraught with numerous problems. The hospital is not obligated to provide post hospital care. In some situation they can send you to a nursing home or they can send you home. They are not required to provide any care if you go home. If you live alone you may have considerable trouble but that’s your problem.

10. Smoking and Early Detection of Cancer

Early results of a genetic test may be able to identify smokers who will go on to develop lung cancer. A Dr. Thomas Zander states he identified a set of genetic changes that are associated with this disease in 88% of cases. There are many dilemmas with this. First, should we really care? That sounds harsh but the bottom line is that those who choose a suicidal lifestyle like smoking already know the answer to stopping their impending cancer. I guarantee quitting smoking is a better predictor of those not getting lung cancer than this genetic test. Second, who should have to pay for this test? Hopefully, not everyone else. This just adds to the cost burden of healthcare to the shoulder of those who take care of themselves. I got it. How about the tobacco companies perfect this test and give it away for freee? They have all the money anyway. I can see the ad now. Joe Camel swabbing his cheek to give a DNA sample.

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11.  Shell Game Runs Rampant

Here we go again. Now Walgreen has “settled” a $35 million suit because they too have been switching prescriptions on patients. As a physician, it’s a good feeling to know that we have no control over what we are giving our patients. It is hard enough when the managed care formularies keep playing the shell game. Now we have the pharmacies doing it as well. This time a pharmacist joined with the federal government to nail these suckers. Examples given were switching from generic Zantac as well as switching from generic Prozac to something else. Walgreen, of course, denied any wrongdoing. I guess they just had $35 million lying around that they didn’t know what to do with? The pharmacist, Bernard Lisitza, received $6.4 million for his efforts which just doesn’t settle well with me either. He also received $4.3 million from a suit against Caremark. How he deserves that is beyond me but I guess this is the case of the greater good winning out. I need to start watching for those forms that come by my desk asking me to switch patients. Maybe I can join forces with Mr. Lisitza? Or at least ask him for a loan?

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12. Hold Those Guidelines         

Now another study has come out, this from the NEJM, showing again that aggressively lowering blood sugars doesn’t cut cardiovascular events in diabetics.  So even though the ADA wants the glycohemoglobin to be below 7, it may result in an increase rate of death. I may be wrong but that is bad, right?  Before all guidelines get changed, I would highly recommend that you get those HbA1Cs down as low as you can.  Remember, with P4P you get bonuses on that sort of stuff.  Do not let a few deaths rankle you into getting better pay!

13. Another Bill To Change How Doctors Practice Medicine

A nicely written article in the Washington Post touches on a topic usually swept under the carpet.  Do physicians appropriately tell patients that the end is near?    The article highlights a study on cancer patients on whether they ask or not ask what kind of care they'd like to receive if they were dying.  The results were interesting and I highly recommend you take a look at it. The problem with “telling patients they are going to die” is that doctors are not soothsayers or mystics.  We have been accused of playing gods for reasons just like this.  How many stories have you heard where patients hated their doctors for their grim predictions and showed them by surviving against all odds?  This is not an easy subject.  What sickens me more, however, is how lawmakers in California have just passed a bill to require that health care providers give complete answers to dying patients who ask about their options. Just one more reason we need to clean house of these moronic politicians.

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:

PLACEBO JOURNAL BLOG

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

Doug

King of Medicine