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We have gone back to ordering our second load of MRSA shirts.  These will sell out shortly. I am not a big fan of storing a lot of inventory so please order quickly if you are interested.  Here is the link:

http://www.placebojournal.com/shopexd.asp?id=263

You should also take a look at the following video about the shirt:

http://blip.tv/file/1247785

3. Price Fixing or Price Shopping?

Here is another reason that the free market could work in this country for the healthcare system. When word got out that Hannaford, a supermarket chain here in Maine, was willing to offer its employers a chance to get their hips fixed in Singapore for a discount, they were swamped with other hospitals in the U.S. wanting to match that price! Hannaford is self-insured and the difference in price from $43K to $9K for the surgery was tremendous. Now they have a deal with a Boston hospital to do it for that lower price. The out of pocket cost for the patients are $3,000 less plus they get a travel allowance for themselves and a companion. This is the answer my friend. Capitalism. What has to happen now is these hospitals who offered the surgery for $9,000 need to be held accountable for other local uninsured patients in order for them not to be gouged for the full price of $43,000 just because they don't have a big company behind them. We need transparency. We need to be able to buy health insurance across state lines. We need competition. Only then will prices come down just like they are coming down for oil prices. Let the free market work.On 8/20, one of the top headlines on AOL read "Michael Phelps Proved Docs Wrong With Help From Mom". I was intrigued. It then pointed to a few links to read. There was an interview on Goodhousekeeping.com where I found that his mother is now an official ADHD spokesperson for McNeil Pediatrics which by the way is a pharmaceutical division making ADHD drugs. It was otherwise light reading but nothing about proving those evil doctors wrong. The next link pointed to a NY Times article where it detailed Michael's classic ADHD behavior as a young child and the terrible things teachers were saying about his future. It also discussed how his family doctor, whose children were also competitive swimmers, recommended meds for little Michael. The meds worked a little but due to the stigma of taking pills at the nurse's office, Michael asked to come off them and the mom consulted again with his family doc before doing so. Luckily, Michael's swimming is what helped him through his struggles in life. Deborah Phelps, who is a school administrator, is a big part of her son's life and openly states she is on the fence on the use of medications for ADHD. But that isn't the story. The story is the AOL headline: "Michael Phelps Proved Docs Wrong With Help From Mom". Where the hell in those two pieces was the doctor proved wrong? As far as I can tell, the family doctor was very flexible and helpful. What I think is going on is that the same old tale is perpetuated - when someone overcomes their diagnosis and makes it big they have to have an evil doctor that they proved wrong. The headline writer for AOL must have never even read the stories in the links but couldn't let go of stereotyping us doctors. We are discriminated against once more. I am so tired of being put down by man!

4. Placebo Journal Update

Mark this date.  You have until Sept 29^th to get in on the October issue of the Placebo Journal. Mailed right to your house, this is the only funny medical magazine you will ever read.

This next issue includes:

• No Country For Old Patients
• The Shiny Thing Patient Distracter
• True and hilarious stories of medicine
• More Stupid Pharmaceutical Tricks
• And much, much more!

If you have never received a magazine that will make you laugh over and over again, then follow this link and stop being so cheap.  A two-year subscription is about half the cost of your monthly cell phone bill or half the cost of filling up the gas tank in your car.

SUBSCRIBE

5. NAMC

You may have seen the web badge sponsorship on the left column for a few issues of the Placebo Gazette and not known what NAMC is.  NAMC stands for the National Association of Medical Communicators.  It is composed of medical broadcasters, writers, and web casters as well as organizational spokespersons and has been around for more than 30 years. Medical broadcasting pioneers such as Dr. Art Ulene of NBC's Today show and Dr. Timothy Johnson of ABC News are just a few of the influential broadcasters; both of whom I have met at the annual Medical Communications Conference.  I have been a member for about five years and it has been a great networking opportunity.  I am now a board member.  Crazy, right?  Anyway, if you ever thought about being on television, then this is one group you may want to connect with.   The cost of membership is less than a hundred dollars a year!  With that you get:

• Prestige - NAMC has many highly esteemed members.  Having "member, NAMC" on your resume, CV or website means something.
• Social - part of a unique club of people with similar goals that communicates on a regular basis.
• Health Care Media Opportunities posted every Monday through Thursday 
• Newsletter - Pertinent information about members sent around monthly 
• Webinars- Participate in quarterly webinars.  Free for NAMC members!
• Access to Member Database- This database allows you networking opportunities with others in your field
• Mentorship Program- Its purpose is to enrich the work experience for members, encourage creativity and innovation in the workplace, foster learning partnerships and professional relationships, and maximize each individuals’ potential.

So go to www.namc.info and check it out.  Maybe I will get to see you in April at our national meeting.

6.  Placebo Television #14 (PSA testing, Sanofi-Aventis, Viagra for Women)

You know all those stupid "unbranded advertising" commercials the pharmaceutical companies are using right now? The ones where they never mention their product's name but instead it leads you to a website that discusses their medication? Examples include http://www.mytimetoquit.com/ by Pfizer and http://www.silenceyourrooster.com/ by Sanofi-Aventis. Well, we thought it was time to poke fun of them the Placebo Journal way (amongst other items). Check it out:

 http://blip.tv/file/1239759

7.  Which Fight Is More Important?

One of those typical feel good articles came out again. This time it was in USA Today and it goes on about the good fight and how things need to change. Blah, blah, blah. I get so tired of these pieces quoting the same people about how the pharmaceutical industry has so much influence upon my life that I can't do anything anymore under my own volition. Personally, I ridicule the idiots in that industry more than anyone. I do spoof ads, stupid pharmaceutical tricks, and even videos about how they market their products. It's fun. The thing is that I don't think they are as entirely evil as these people say they are in the piece I am referring to (it was copped by the Associated Press). The pharmaceutical industry is just an easy target. In fact, this article really doesn't say anything new that we haven't seen before. It is so formulaic. I will prove it by pulling out key sentences and quotes and then I want you to apply these same sentences in a different way.

• deceiving the public, manipulating doctors and putting profits before patients
• "The influence that the [Blank], the for-profits, are having on every aspect of medicine ... is so blatant now you'd have to be deaf, blind and dumb not to see it"
• "We have just allowed them to take over, and it's our fault, the whole medical community."
• "We should all get together and say, 'Enough!"'
• "[Blank] will always face criticism and at times deserve it but our companies remain committed to listening to and learning from parties with divergent points of views."
• "There is no industry far and away that has been more generous than the [Blank]
• But [Blank] analyst XYZ Securities said [Blank] will find ways to adapt to new rules
• Influence prescribing patterns

Now switch this article around. Grab a few Harvard professors, you always need their quotes, and make [Blank] be the managed care industry. That is the real story and the biggest reason the cost of medicine in this country is out of control. The real doctors in the trenches of medicine know that. We hate them more. And we should all get together and say, "Enough".

8. Medical Joke of the Week by Garry Shandling

I went to my doctor and told him "my penis is burning."

The physician replied, "That means somebody is talking about it."

9. Two Percent

Check out Rita Rubin's piece at the USA Today as she discusses the results of a medical student survey. Only 2% of 1,177 respondents to a survey of students at 11 U.S. medical schools said they planned to pursue careers in general internal medicine. This came from a JAMA study. The worst part about it was that the respondents were fourth-year medical students. They had been through the school grinder and obviously realized the downfalls of primary care. What downfalls? How about student loan debt coupled with the fact that internists are one of the lowest paid physician specialties. I am proud to say that they are right up there with us family docs. By the way, why the study only looks at those going into internal medicine is a little weird because last time I checked, FPs counted as PCPs well. Hmmm. Anyway, here is a little nugget not mentioned. The study did say that 23% were going to go into IM but only 2% were not going to specialize. Hence, their results. The beauty of this is that those 2% can specialize at any time and many will. Most likely there will be LESS than 2% doing primary care! How lovely. Maybe those in charge of the specialty of internal medicine should do what the people in charge of family medicine do? You know, trap them into the specialty and then have no options to sub specialize once you are through. Once a family doc, always a family doc.....until you prematurely die. Okay, that last statement was a little bitter and I am sorry. Overwhelmed with trying to find more cerumen to clean. Gotta pay the bills, you know.

10.  The Science of Wax

I am really bummed about Jacob Goldstein's piece in the WSJ. How dare he mention the secrets we doctors keep about removing ear wax! His piece detailed the American Academy of Otolaryngology's guidelines for getting rid of this annoying complaint. They mention not using Q-tips. Good. They mention not using those dental WaterPiks. Good (even though we doctors sometimes use that in the office). They mention the ear candle sham. Good (by the way, the Amazing Randi proved that it doesn't do anything and the "wax" pulled out really comes from the candle itself).

I guess I am really bothered by the fact that the ENT dudes claimed ownership over cerumen removal in the first place. Can't the primary care doctors have anything? All FPs and IMs need to band together and draw a line in the sand. Did you know that 94% of all cerumen disimpactions occur at the primary care doctors' office? I bet you didn't. Of course I just made that statistic up but prove me wrong.

This very complex procedure actually pays well. We need a way to make it pay more. The way to do that is to make the experience seem important. As my former medical partner once told me, we could start buffing it up by doing it in a sort of "cath lab". We could convert an old storage room and make it all fancy with pictures of ears on the wall. We could create a very cheap fiber optic camera with a cheap TV that we can stare at like we are doing something really important. You know, like how the cardiologists do it. Then we can shoot some cheap dye and make a great show out of it. Who knows, maybe we can come up with a DES or drug eluding stent to place in the ear canal?

This is a shout out to all PCPs, we have got a great opportunity to make this procedure ours. All we need to do is convince others how important and complex it is. Trust me; it is better than pretending you are all into the complementary medicine thing and recommending ear candling or anal candling or whatever. You don't get paid anything for that.

11.  Ridiculous Study of the Month: Dad is to Blame

The press was all over a recent study in the Archives of General Psychiatry linking bipolar disorder to the older fathers. The cause is unknown but it may have something to due to getting mutated sperm as we get older (not unlike what happens as this laptop barbecues my scrotum after about a half hour of use). Children born to these dads were 37 percent more likely to develop bipolar disorder than those born to men in their 20s. That was the sound bite that got spit out by radio stations all over the country. The problem with this information is that it is fragmented. Let's say, for example, there are two case of Cowabunga Disease (made that up) for every million people. Now let's say that it was found that for every million readers of the Placebo Journal there are three cases of Cowabunga Disease. That would mean a 50% increase in this disease just by reading PJ. Sounds bad but the absolute number is so small it is still a very small risk. In fact, it’s a statistical nightmare. After looking at over 7.7 million patients discharged from a hospital, they whittled the numbers down to find a little over 13,000 cases of people with definitive bipolar disorder. They then broke these 13K down to the ages of their fathers when they had them. For a control group, they took five times the amount of bipolar patients or around 67,000 normal patients who were discharged and found the ages of their fathers when they had them. Got it? Anyway, the reference group, as they call it, is the patients whose fathers were between the ages of 20 and 24 when they helped in the conception process. They found 1774 patients with bipolar disorder at that age and 10090 of regular patients. For those who had dads over the age of 55, there was grand total of 68 patients who had the bipolar disorder and 256 who did not. Only 68 patients!!! I guess because that ratio is higher than the reference ratio these authors were able to get some statistical significance and publish this study. Only 68 patients out of 13,000 or so with bipolar disorder. Only 68 patients out of the more than 7 million investigated. You have got to be kidding me.

12. FATT-E

As I sit here writing this entry, I realize that my body posture reminds me of something. I am in a recliner with a cool new little table over my lap so that my computer stops killing off, mutating, or destroying my sperm count. Not that it matters anymore at age 43. Anyway, it just hit me that I felt like those characters of the future represented in the animated movie from Disney called Wall-E. Luckily, I only do this very early in the morning before I go to the gym to get some real exercise. In the movie, a couple of main characters have an epiphany when they notice that there is a world outside of their recliner and computer screen. Oh, and everyone is super obese in the future.

What does a cartoon have to do with anything? Well, for one it was really a great movie. And secondly, it is predicted that everyone in the U.S. will be overweight by the year 2048. Carl Bialik, in his WSJ piece, tries to shoot this down by calling it a gross extrapolation and he makes some good points. Still, there is no doubt we are trending that way. The numbers are staggering and the direction is disturbing. Alabama, which is second in the national obesity rankings, is giving its state's workers a year to get in shape or will be charging them $25 a month for insurance that normally would be free. Though there have been some critics of this effort ("some people come into this world big", "I'm big and beautiful"), I have to give credit to Alabama for trying something. We are on a slippery slope to marshmallow land and without some intervention we all could become FATT-Es.

13. Sharing Miracles

The political scene is hot right now. The Democratic and Republican National Conventions have ended, but what does this all mean? No, not a presidential election and finally new president. It means that it is time for the pharmaceutical companies to shower the politicians with gifts and parties. Hooray! Astra-Zeneca, Lilly, Pfizer and almost every other industry leader has been there to "sponsor" luncheons at the DNC. My favorite is "PhRMA is hosting a brunch dubbed 'Sharing Miracles' at both conventions. The gathering will feature patient stories, cooking demonstrations and appearances by television talk show host Montel Williams and actor Joey Pantoliano of The Sopranos." You have got to be kidding me? 'Sharing Bullsh#t' is more like it. I can't get a free pen anymore but the dude from The Sopranos can hang out with our politicians all the while being paid by PhRMA? I want to hang out with Joey Pantoliano, too. Heck, I would even hang out with Montel Williams.

My point is that if the politicians are firm in their beliefs that the pharmaceutical industry should not be influencing physicians, then they probably shouldn't be influencing the politicians either. It won't bother me to not talk to drug reps or see Pfizer banners at the next medical conference I go to. Let's do away with it all as long as it  stops with the politicians as well. As they say in Texas Hold'em, "I'm all in". Now it is the politicians turn. Wait a minute, they're too busy going to the Lilly sponsored event honoring Spike Lee and the head National Black Caucus of State Legislatures.