1. Bring It On
Recently, the American Heart Association recommended EKGs for all kids taking ADHD medication. Now, the American Academy of Pediatrics has come out against this guideline. For those not in the know, this is huge for medicine. Two massive organizations ready to duke it out. For the younger crowd, let me translate this in a way you may understand better:
AHA: Uh, uh, girl. No, you didn’t!!!
AAP: Oh, yeaaahh, I did.
AHA: Well, you need to bring it!
AAP: Oh, it’s brought.
You can see that since more than half of the 4 million U.S. children diagnosed with attention-deficit disorders are being treated with stimulant drugs, the cost to get EKGs on all of them may be a little prohibitive. At a $100 a pop that would come out to $200,000,000. That is almost what the dude made at Cigna last year! Anyway, the AAP thought this advice by the AHA was “overzealous because these rare deaths are more common in the general population than among children on stimulants”. The Washington Post article even brought in Cleveland Clinic heartthrob Dr. Steven Nissen, who now is quoted in every article every published about the heart and has become the Britney Spears of medicine, who said the academy appears to be dismissing concerns that stimulants are used excessively in children with insufficient evidence about long-term risks.
I am but a simple family doctor so I am not smart enough to understand all this talk of medication, heart tracings, and screenings. I will say, though, that this battle of the giants is going to be awesome! Go get some popcorn, everyone, and let's get ready to rumble.
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2. Three Card PBMs
As I have said before, I never believed in the Medicare D prescription plan. It was just another entitlement program that gouged more taxes out of the American public. Yes, I know this is heresy because we are talking about our elderly here. It is just that there were better ways to help them including most medications costing $4 a month at Walmart and Walgreens, etc. That being said, I was always suspicious when the pharmaceutical industry was in love with it. Couple that with the scam in Washington and how the people fighting for this plan soon started to work for these pharmaceutical industries and you had a recipe for disaster. Now we have a national debt that is choking us.
Here is one more diddy to add to this saga. Many of the private insurers who contracted with Medicare D have in turn contracted with the infamous pharmacy-benefit managers or PBMs. They did this because these crooks squeeze the pharmacies for lower prices and extort them to make things cheaper. You would think this would help the patients but those savings are for them and not the patients. PBMs have been ripping off patients for years by getting doctors to switch drugs "for the patient's interest". In this new criminal act, when they squeeze the pharmacies for Medicare D drugs, they then charge a higher price to the health insurer who in turn passes it on to the government. This scam is called "lock-in pricing" and is no different than a three card Monty game. And the beauty is we are all paying for it.
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3. Placebo Journal Update and STEAL!
You have until midnight EST to get in on the August issue. We are doing a test to see who is reading this. If you order by that deadline we will give you a set of our posters. That is a $50 value! This means by the time you read this you only have hours to get your information in. Each order is time stamped and to qualify for this deal you must put in the coupon code PSTR73008 at the bottom of the information page when subscribing. Hurry!!
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4. Gorback’s Thoughts by Michael Gorback MD
A recent study by the Agency for Healthcare Research and Quality (whoever that is) stated that medical errors cost $1.5 billion per year, and that "[n]ursing care associated with medical errors, including pressure ulcers and hip fractures, cost an additional $12,196 (33 percent more) per patient." And, "[b]lood clots, or other vascular or pulmonary problems associated with medical errors, cost an additional $7,838 (25 percent more) per patient." Furthermore, researchers found that "one out of every 10 patients who died within 90 days of surgery did so due to a preventable error, and one-third of the deaths occurred after the initial hospital discharge."
They also "found that the large difference in calculations for medical error expenses might mean that interventions to increase patient safety -- like adding more nursing staff -- could be more cost-effective than previously thought."
A 1998 report by the Institute of Medicine estimated 44,000 to 98,000 Americans die because of medical mistakes each year, costing some $17 billion to $29 billion.
Well. Let's think about why we can't improve patient safety and reduce cost - two indisputably beneficial and desirable outcomes - by hiring more nursing staff. Who is squeezing the money of the health care system and putting in their own pockets? The doctors? Nope. The hospitals? Nope. The nurses? Uh uh.
It's the insurance carriers, stupid!
By squeezing us unmercifully in order to line their pockets with ill-gained lucre, they force physicians and hospitals to run at maximum capacity with bare bones staffing. If it's costing the insurers $1.5 billion per year they need to just look in the mirror to see who's responsible.
This is not rocket science. And if CMS and other carriers start to refuse to pay for these complications - for which they are responsible - they will just hasten the day that we have no health care system left.
5. Making Prison Health Care the Best Health Care
California is trying to fix their prison health care system and it isn't going over that well. A federal receiver (let's call him a consultant for lack of a better term) was brought in and wasn't happy with what he saw. There were problems mentioned in the article that were felt to be cruel and unusual punishment. I recommend you read it because, though they weren't compassionate, they weren't earth shattering either. Anyway, the consultant believes that for a community of 170,000 inmates that around $7 billion should cover the overhaul. And many of the state lawmakers went for it! Numbers are a funny thing. We tend to do the math and lose our senses when consultants throw figures around. As pointed out by the Republicans who blocked this measure, can you think of a community or a few communities that make up 170,000? Once you have that in mind, think about what you can do for $7 billion! As one lawmaker said, everyone would have a "personal trainer, personal chef, probably even a dog walker". It is one thing not to be cruel but a whole other thing to treat prisoners with a health care system that is even better that the rest of the country. I don't know for sure but I would bet that most of the money would go into buildings and administrators to run those buildings. The last few bucks, which won't be competitive, will be thrown at doctors and nurses leaving hardly any real professionals left to treat the patients. Just a hunch.
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6. Stuck In The Middle With You
In what has become a sad turn of events, the city of Boston and the media are going for the jugular of a local neurologist. It seems the city has been a little skeptical as to why some firemen have been put on full disability with INCREDIBLE benefits. The biggest example described is a fire inspector who went out with a back injury. Soon thereafter the dude places 8th in a national bodybuilding contest. Whoops. The hound dogs, rightfully so, are asking how this neurologist could do this and the neurologist is starting to panic.
My hunch is that the neurologist is not getting kickbacks. Where would it be coming from? No, I think the guy just got caught up with the feeling of importance as being the "go to" guy by his friends at the fire department. I can't defend Dr. Mahoney but I can tell you that physicians are stuck in the middle in all disability cases. If there is one thing that is a constant it is that one side (patient) or the other (company) is going to hate you for your decision. We don't get paid extra for this role and personally I hate it. The head dude at the Boston Municipal Research Bureau said that any "doctor that certifies a disabling injury that is determined not to be legitimate should face consequences". Is that right? Like what? Jail time? These administrators have no idea what it is like being a physician and are quick to throw judgment around. I can't tell you how many "malingerers" I have spotted over the years. This only means I missed a lot. It also means war with some patients who you risk becoming a lifetime enemy because you don't believe their story. Where is the patient's responsibility in all of this? Why aren't these firemen prosecuted? I am not coming to Dr. Mahoney's defense until I know more facts but to call for consequences for making a diagnosis on the symptoms presented before him is ludicrous. Can we make this job even less palatable?
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7. Joke of the Week
A man went to see a psychiatrist. “Doctor, something terrible is happening and I have to talk to you about it.”
Doctor: “What’s wrong?”
Man: “My wife is poisoning me.”
Doctor: “Um…how can that be?”
Man: “I’m telling you, I’m certain she’s poisoning me. What should I do?”
Doctor: “Tell you what. Let me talk to her. I’ll see what I can find out and I’ll let you know.”
A week later…
Doctor: “I spoke to your wife. I spoke to her on the phone for 3 hours. Do you want my advice?”
Man: “Yes! Oh yes!”
Doctor: “Take the poison.”
8. Ridiculous Study of the Month
Boy, Pfizer is looking for anything to bring their stock up. A research study, funded by them, found that adding Viagra to an antidepressant may help with the delayed orgasm problems that can be associated with those antidepressants. On average, the Viagra users were more likely to reach orgasm (and were more satisfied with them) than placebo-takers. This was a real small study and the media just had a field day with it. For the record, Viagra does not enhance the libido in women nor does it make their partners look like Brad Pitt. Maybe Pfizer will find a home for this medication for women someday. I think the study was too small and isolated to be anything meaningful at this time. I was totally put off by one of the researchers, who was fired before the study got underway, when he responded to a question that was asked him about delayed orgasms in women by saying “Women have orgasms?”
9. Bacharach’s Beliefs by Ted Bacharach MD, retired
The Medical Office and the High Cost of Medical Care
In the ever increasing cost of Medical Care the position of the Individual Medical Office is not really very clear. The physician while generating increasing costs has not managed to prosper, he or she has been left behind. The revenue generated is large but little is left over for the physician. The medical office operation has become increasingly complicated and increased numbers of personnel are required to fill out all of the necessary documentation and billing
information. This has required physicians to increase the number of people required and a higher degree of skill and knowledge is required. The computers required as well as the programs needed have become considerably more complicated. The physician is not well prepared for the complexity required to “bill” nor is obtaining authorizations within his sphere of knowledge. These factors are largely ignored by the people calculating medical care costs. To try to avoid having to pay for medical services many devious schemes are utilized. To make sure it is not too easy to bill the forms which must be submitted vary from one company to all others. Improperly filled out forms can and usually do result in “payment denied” responses.
There are many entities who realizing the tremendous amount of money that health care entails have found means of feeding at some of the leaks that exist. There are a large variety of means by which this can be accomplished. One method that is quite popular is to take over the billing functions for a medical office for a percentage. This involves them in no risk and even if they bill and then collect only a small percentage they are still making money. There is such a large amount of money involved in providing Medical Care that it attracts parasitic elements at ever level to try to get their share of any possible leaks. With billions involved surely there must be a little overflow into our plate. Probably the best method from an economic standpoint is to attract physicians with “we will take over all billing functions and pay you a salary”. The organizations that hire physicians are well equipped to get reimbursement. While the physician is relieved of many financial problems in this situation a considerable amount of return is made available to the organization that employs physicians. In all of the above scenarios the cost of medical care is increased. Simplification of medical billing and documentation would probably result in increased physician income, and less cost for medical care. I suspect that both Medicare as well as insurance companies spend 10% to prevent 1% felonious charges.
10. Degrees Matter
I have been a family doctor for over 14 years. I received my master's degree before entering medical school. I had a lot of schooling. This is not to brag how smart I am because there would be plenty of people to attest otherwise. No, I am writing this to prove a point. It is important that there be some certification process out there to make sure that medical care is not substandard or unsafe. This is always done for medical doctors. Many alternative practitioners, however, have very suspicious qualifications. I am not trying to denegrate natural healers. I have always been interesting in complementary and alternative medicine and try to keep up with the new information as it comes out. I love Dr. Andrew Weil and have followed his writings since I was in medical school. I almost did a rotation with him then (before it was popular like it is now). So where am I going to this? Well, the next time you go to some seminar on some new medical cure or even some old-fashioned alternative treatment, please check out the speaker's credentials. Dragan Dabic used to lecture on spirituality, practice alternative medicine and promised on his web site to vanquish afflictions ranging from impotence to autism with his "energy healing treatment." The problem is that Dragan was Bosnian Serb leader Radovan Karadzic and the only thing he used to vanquish was life through his own special treatment; a little trick he calls genocide.
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11. Savage Definition of Autism
In Maine, I only get one talk radio station and have heard Michael Savage for many years. To be honest, that dude scares me. He yells at everyone. It also scares me when his listeners call him Dr. Savage though he is not a medical doctor. Or maybe wants to be? If you haven't seen the news recently, Savage is getting heat for trying to "awaken" parents about the over diagnosis of autism.
"In 99 percent of the cases, it's a brat who hasn't been told to cut the act out".
He is way off on this one. I'm not sure if he is even mixing up what he thinks is ADD and really knows what autism is. Autism, for which there is no blood test, is not a cookie cutter syndrome and there is a wide spectrum of how severe the symptoms for individual kids can be. There is no doubt, however, that it exists and I doubt it is over diagnosed. Savage wouldn't know that because he doesn't have the experience of seeing thousands of kids in the office setting for comparison. That being said, I am a little disturbed by the planned demonstrations to protest the radio talk show host. It is as if he committed a crime. I believe it is a free country and there is freedom of speech, right? People need to chill out and stop taking things so personally. When we overreact to everything that isn't politically correct we become a "brat" who needs to be told "to cut it out".
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12. Quitting Your Day Job
Dr. Arnold Kim may have the right answer. He was ahead of the curve when he started Macrumors.com in 2000 and has built enough traffic on his website to call it a career. No, he isn't quitting the website. He is retiring from medicine! Man, this dude is living my dream. Okay, maybe that is not all true. I have been practicing family medicine for over a decade and don't think I am ready to leave just yet. There are times I wish I had options, though, as the burdens of coding, billing, HIPAA, Medicare, OSHA, JCAHO and everything else just get too much. As you may have read in my comments in the July Reader's Digest, and even more importantly in the responses by readers, there is no place for doctors to complain or vent. No one wants to hear us. That is why I continue with the Placebo Journal. Now if I only got 4 million people checking on us each month like Dr. Kim then I would truly have to reconsider all my choices. People still wouldn't listen to me bitch but who cares, I would be rich.
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13. Lowering The Cost of Prescriptions
It is amazing what people will do when it comes down to spending money out of their own pocket. And that is a good thing. It seems that paying over $4 for a gallon of gas has driven down demand which in turn has dropped the price of a barrel of oil $15 over three days (at least at the time of this writing). Who says capitalism or speculation isn't alive and well. Now the drug industry is feeling the effects as well. According to an article in the WSJ, the number of prescriptions people are filling is doing down, especially the higher and most costly branded types. This is both good and bad. It is bad if people are just not taking their medication. It is good if they are forced to live healthier and just don't need their medication. It is also good if they realize that the Walmart $4 meds will probably cover 90% of all their medical problems. I know that the managed care companies are loving this as they continue to shift the burden of all costs onto the patients more and more. I hope they continue to smile about it until one day people realize that they are paying so much of the cost of their medical care anyway that insurance companies (except catastrophic plans) aren't really needed. Most parasites aren't.
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14. Feedback About The Placebo Gazette
I WANT TO KNOW WHAT YOU THINK. Please go to each individual story and follow the link the Placebo Journal Blog. If you do not have access to the blog you can also post your thoughts under the WRITE A REVIEW section.
Until next time, keep smiling, keep laughing and keep out of the sample closet.
Doug
King of Medicine
