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Placebo Gazette #125

(Keeping Our Finger On The Prostate Of Medicine)
 
4/18/09

  1. Getting Higher
  2. Canadian Health Care by Michael Gorback MD
  3. Health Care Reform In China
  4. Placebo Journal Update!
  5. The Right Way To Influence Someone
  6. Eating Right - Public Service Announcement
  7. The Dirty Doctor
  8. Speed, Technology and Payment
  9. Magnificent Nine
  10. Ooooh...Someone Is Going To Get It
  11. Where's The Truthiness?
  12. Feedback About The Placebo Gazette

 

1. Getting Higher


There is a reason that the title of this blog entry has a double entendre. Since President Barack Obama took office, requests to use medical marijuana have jumped anywhere from 50 to 300 percent. What is the real meaning behind this? Maybe people believe that the Obama administration may ease restrictions on medical marijuana? Maybe people are using weed because they can't afford regular medications? Or maybe, just maybe, people want a semi-legitimite reason to get high? In any respect, there has been a flood of people either trying to start a "co-op club" or find a "co-op club". Getting doctors to prescribe it is another issue. Problems include:


  • efficacy has not been proven in rigorous trials
  • marijuana has not shown to be superior to other drugs
  • doctors fear of risking their own federal license be defying federal drug law

Come to think of it, those are pretty good reasons. It is funny how physicians are made out to be the bad guys in this medical marijuana scam but the risk/benefit ratio is just not worth it; that is unless you can convince yourself that sampling the product on a regular basis is extremely important for business. Dr. Spicoli at your service.

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2. Canadian Health Care by Michael Gorback MD
 
 


I recently saw a patient who moved here from Canada. Her history is one long horror story. She has had radicular pain for 5 years. For 4 of those years they kept sending her to PT, did some spine injections, and gave her increasing doses of methadone and gabapentin.She is now taking 60 mg of methadone every 6 hours and 1600 mg of gabapentin every 6 hours (well over the manufacturer's recommended maximum of 3600 mg/day).She was finally referred to a surgeon, and then waited 9 months to get her MRI, which shows impingement on the S1 nerve. She has no left Achilles reflex and is insensate to pin in the left S1 distribution. The Canadian surgeons recommended another 6 months of PT.She says it's almost impossible to find a specialist for anything, even if you self-pay. If I could stand the weather I'd set up a cash-only pain clinic in Detroit and have the Canadians drive over from Windsor. In the winter they could drive straight across the river like the bootleggers did.I managed to get her MRI done the same day she saw me and I will probably get her over to a surgeon by next week. I cannot wait until Mr. Obama gives me the opportunity to have "free" access to the same shitty level of care that Canada has.

 
 
3. Health Care Reform In China


China is announcing a ten-year plan to improve their healthcare system. The goal is to give every village a medical clinic and every county at least one hospital by 2011. The cost is estimated to be around $120 billion which will come from its sales of defective dry wall, lead toys, mercury laden herbal remedies, toxic toothpaste, contaminated pet food, poisonous seafood, and defective truck tires. Obviously, I am being a little facetious about that but China is doing anything for good PR nowadays and its new plan to improve healthcare is just what the Communist doctor ordered. The WSJ explains in more detail how China's system works now and what they plan to do in the future. The problem is they want a safety net to cover everyone but 1.3 billion people is not a small number. That safety net has got to be HUGE and not break down like the many other products China produces as mentioned above.
 
 
 
 
4. Placebo Journal Update
 

 

We are working hard on the next issue in order to keep the laughs coming.   We consisently are told that our journal is the only one read cover-to-cover.  Isn't time you found your smile again?  We have the answer and it comes right to your house every other month.  If you want something that is all humor and guaranteed to make you a little incontinent then:

 

5. The Right Way To Influence Someone


How have we produced so many quality medications and medical treatments over the years? I mean we are constantly bombarded with stories of how so many researchers are sellouts to the pharmaceutical industry that it makes you wonder how we got anywhere? The truth is that 100% vilification of industry sponsored research is NOT appropriate because they do have a responsibility to create a quality product, bring it to market and follow up on its progress. It they fail at any point on this timeline then they lose billions of dollars. My hunch is that they don't push their researchers to lie and cheat. No, I am not saying they are the most ethical or moral businesses in the world but they can't all be criminals like the media makes them out to be. They still have to run a business. A nice article in the WSJ explains what they call "pharmascolds" who are "pious academics, self-righteous medical journal editors, and opportunistic politicians and journalists" who basically make a career out of demonizing the medical research and pharmaceutical industry to enhance their own careers. I, too, am critical of tainted researchers but this was important for me to read so that I can keep things in perspective. Now if you really want to see someone who is a sellout and absolutely influenced by a third party then read this piece about Governer Ed Rendell in Pennsylvania. Check out the details on how he used a law firm in a no-bid contract to help the state sue Janssen Pharmaceuticals and then see how the law firm contributed to an out of state lawyer (Rendell) for campaign contributions. Now this, to me, is criminal and unethical and yet this story will probably die a quiet death. You have to give it to politicians - they know how to do "improper influence" right.

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6. Eating Right - Public Service Announcement


We all know how important it is to eat right. We are bombarded with reports about taking probiotics for our digestion. For years we have been taught about taking fiber to protect our colon. It looks like someone has taken this important concept to a new level and is doing something about it. A man in Waco was so upset about the flatulance coming from another dude he was sharing a motel room with that he stabbed him. Wake up, America! Colon health is important. Do we want more of these episodes of stabbing and what not to continue? I don't think so. Let's start eating better and being better neighbors or roommates. Remember, friends don't let other friends kill each other over farting.

 

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7. The Dirty Doctor


I see drug reps in my office a few times a week. I have been doing that for over 13 years. It has changed a lot over that time. When I first started in practice the other physicians used to have them bring lunches in for the whole staff. We soon changed that to just bringing in lunches for the doctors. That stopped over ten years ago. We began having the reps schedule a 5 to 10 minute visit at 3:00 PM for coffee. They would bring some bagels and coffee and we could listen to what they had and decide about taking samples. We did this on our own and without the government (state or local) getting on our case. Now, I am the only doctor in our office to even meet with drug reps. They are to bring a protein bar and a diet Mountain Dew and I will listen to their info. I do NOT hate drug reps. Many are my friends that I have known for years. I play basketball with some, go to dinner with others, and play fantasy football with another. They DO have something to offer. I know that these five minute interludes at 3:00 PM can become "commercials" but I dictate the terms. Heck, our office doesn't even take samples anymore. I want to know what is new out there, what insurance is covering the product, and if there are any coupons that my patients can use to cut down on the copay. When I hear about Massachusetts barring industry gifts such as pens, notepads and food in physician offices to reduce health care costs and physician conflicts of interest, it makes me laugh. I have always hated their crappy pens, I never used their notepads and I am worth the cost of them buying me a diet Mountain Dew and protein bar! Can we stop all the reporting and investigating into the evilness of drug reps already? The practicing doctors in the trenches like myself are not dirty for talking to them. If you want to shine a light on anyone, then point it at the researchers in the ivory towers of Harvard, etc. Or point it at Congress who are wined and dined and given gifts all the time. Or how about our esteemed journals (i.e. JAMA, NEJM) who not only are filled with ads by big Pharma but also get paid tons by them to reprint their articles in a nice glossy format so that the same evil drug reps can hand them out to me?

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8. Speed, Technology and Payment
 
 




"Faster radiation delivery times reduce the chances that a slight move will affect the accuracy of the radiotherapy targeting," said Richard Popple, PhD., an assistant professor of radiation oncology and UAB's RapidArc team leader. "Also, it means patients spend less time and feel less discomfort in the treatment position."


Another story is about a new computer model that radiologists developed at the University Of Wisconsin School of Medicine that aids them in discriminating between benign and malignant breast lesions. That reminded me of a email sent to me from a reader explaining how a pulmonologist or radiologist was able to use a computer program to create a virtual 3D bronchoscopy by submitting older images and was able to bill again for this "calculation".


I love technology and both articles were saying the right things because they focused on how it improved patient care. With a procedure based payment system, however, the possible abuse is obvious. With quicker radiotherapy sessions (ninety seconds from twenty minutes) comes 12 or 13 more patients who could easily be run through center and that means mo' money, mo' money, mo' money. With new computer models, radiologists have a new procedure to add on for billing and could even potentially go back and redo old mammograms by entering info into the program. That means......mo' money, mo' money, mo' money.


The problem is that our healthcare system has.....no mo' money, no mo' money, no mo' money.
 
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9. Magnificent Nine
 


A story in the USA Today about nine Texans who had gone to the ER almost 2700 times would have blown me away if I hadn't been a physician myself for the last 15 years. We call these people "frequent fliers" because they come so often and everyone knows who they are. Anyway, these patients were located in Austin and cost the taxpayers more than $3 million over a five year period. Here is what is known about them:



  • Eight of the nine patients have drug abuse problems
  • Seven were diagnosed with mental health issues
  • Three were homeless
  • Five are women whose average age is 40
  • Four are men whose average age is 50

Let me be the first to say that Austin is not isolated in this issue. "Frequent Fliers" are everywhere! The article talks about answers which include:



  • referring to mental health programs
  • referring to primary care doctors for future care

Here's a little problem to that solution: I guarantee they have been through every mental health program and primary care doc in the community. It probably is not about access but more about the inability to commit these patients to a psychiatric facility/rehab or it is about their lack of compliance to any prescribed regimen of medication. Here is the bigger question - when will the ER be allowed to turn them away? You would have to believe that after, say, the first thousand visits of finding nothing wrong that the staff at the ER probably figured they weren't helping anymore. Either the ER docs are gouging the system for cash or they are afraid of getting sued if they turn these people away. My hunch is that it is the latter. In the future when we may have to RATION care, don't you think it would be wiser to stop one of these visits and save $1000 and use that money to vaccinate 20 kids or get two or three mammograms on an uninsured worker? I do.

10.  Ooooh...Someone Is Going To Get It!



The AMA is now probing that JAMA alleged threatened a researcher who had found out that it had screwed up. This whole thing is hysterical yet serious. With the AMA getting involved, it reminds of my mom saying to me, "Just wait until your father comes home!" JAMA and its editors are going to get hammered because they are wrong. Dr. Jonathan Leo, from Tennessee, was able to spot a conflict about one of their authors just by doing a Google search. An article in the WSJ outlines a lot of this but KevinMD had the story first and his version details how Editor in Chief Catherine DeAngelis has really made a complete idiot of herself. Here is a summary of some of the things she has supposedly said and done:



  • Threatened Lincoln Memorial University in a telephone conversation earlier this month saying she would "ruin the reputation of our medical school" if he didn't force Dr. Leo to retract the BMJ letter and stop talking to the media.
  • Accused the researcher of a "serious breach of confidentiality" by writing about the problems with the JAMA study while the medical journal was still investigating the matter.
  • “This guy is a nobody and a nothing” she said of Leo. “He is trying to make a name for himself. Please call me about something important.” She added that Leo “should be spending time with his students instead of doing this.”
  • When asked if she called his superiors and what she said to them, DeAngelis said “it is none of your business.”

So what have we learned from all of this? One, DeAngelis will probably lose her job over this. Two, some basic communication training would have helped her. Three, JAMA is really not as important as it thinks it is.


Though this has turned out to be a sad situation, I cannot help but laugh at how JAMA has tried to be mobster on this. When you read their statements it is almost like they are going to send Paulie Walnuts out to "whack" of Dr. Leo. I can just see the AMA discovering transcripts of recorded messages from a hitman talking toDeAngelis:


DeAngelis: Is this Vito?


Vito: No names.


DeAngelis: Is it done?


Vito: Dat thing..with dat guy...he won't bother you no more. Leo sleeps wit da fishes.

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11. Where's The Truthiness?


Remember the term truthiness? It was coined by Stephen Colbert and it is defined as a term people use to describe things that that claim to know intuitively or from their gut without regard to evidence, logic, facts, etc. In the medical field, truthiness is not a good thing because we need evidence to support how we treat patients. For example, using medications for ADHD has shown to work. Using medications for ADHD long -term, however, may not. The problem comes in when the researchers who do the study play with words in order to cover some of the truth. That is a bad thing. One of the scientists who was part of a major study on these meds in 1999 stated "his colleagues had repeatedly sought to explain away evidence that challenged the long-term usefulness of the medication". In 2007, the researchers reported follow-up data showing that the meds aren't really that helpful after two years of use (comparing it with non-drug behavioral therapy) and the kids end up about an inch shorter. Instead of saying this, the researchers released a statement:

"We were struck by the remarkable improvement in symptoms and functioning across all treatment groups."

And rather than saying the growth of children on medication was stunted, the release said children who were not on medication:

"grew somewhat larger"

I am not even sure this is truthiness anymore. Sure seems to me that this is a case of bending the truth completely and using words to bullsh#t the public. Why would they, the researchers, have to do that? Why should they care that things go one way or another? Are they afraid that their support from the pharmaceutical industry would stop? Money makes people do some strange and untruthiness things.

 
12. Feedback About The Placebo Gazette

 

 

I WANT TO KNOW WHAT YOU THINK.  Please go to each individual story and follow the link.  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   

 

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