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Latest Posts

How Your Medication List Makes You The Perfect Pharma Target

Give me your medication list and I’ll tell you your health problems. It happens every day in emergency rooms across the country as confused elderly patients present for an acute problem unable to describe their past medical history, but equipped with a list of medications in their wallet:

Metformin = Type-2 diabetes

Synthroid = Hypothyroidism

Lipitor + Altace + Lasix + Slo-K = Ischemic cardiomyopathy

Lexapro = A little anxious or depressed

Viagra = Well, you know…

I bet I’d be right better than 90 percent of the time. Now, imagine you’re a pharmaceutical company wanting to target people with those chronic diseases. Where might you find them?

No problem. Just pay the insurers to provide you patients’ drug lists. No names need be exchanged in keeping with HIPAA requirements. But the drugs list attached to folks’ cable TV box? Perfect. You’re in — with no legal strings attached. Then, according to the Wall Street Journal, just fire away with that targeted direct-to-consumer advertising on TV, courtesy of your local healthcare insurance provider.

No wonder our healthcare industry movers and shakers love the electronic medical record. Healthcare privacy? What healthcare privacy?

-WesMusings of a cardiologist and cardiac electrophysiologist.

*This blog post was originally published at Dr. Wes*

“What’s Wrong?” It’s A Generic-Drug Rip Off, That’s What

Cute packaging and product placement in the checkout lane at Duane Reade will get you generic Tylenol for a price equivalent to $50 for 100 tabs, as opposed to $6 per 100 count in the usual package.

*This blog post was originally published at tbtam*

A Secret “Sign Of Aging”: International Disease Mongering

Just five days ago we wrote about an American journalist’s observations of medicalization of one problem sometimes observed after menopause: Vaginal atrophy.

Today we see that this disease-mongering trend has popped up in Australia as well. This should be no surprise. Such campaigns are usually led by multinational pharmaceutical companies and their advertising and public relations agencies.

What caught our eye was an article on a women’s health foundation website — a foundation that posts a pretty thin excuse for why it won’t tell you its source of funding. Its article on vaginal atrophy uses classic disease-mongering language:

Ask a woman over the age of 50 about the ‘signs of ag[e]ing’ and she’ll most likely lament about grey hairs, wrinkles and certain body parts having lost their youthful perkiness. What she probably won’t mention is that is that things are ageing “downstairs” too; up to 40% of postmenopausal women show signs of vaginal atrophy.”

The silent epidemic that no one talks about. The huge prevalence estimate — where does that 40 percent figure come from? Read more »

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*

Top Gripes About Drugs And What They Cost

I used to defend pharmaceutical companies. ”What companies out there have contributed more good? Should care manufacturers make more when all they do is make transportation that breaks after a few years?”

It made sense to me that you should put a pot of gold at the end of the rainbow so that companies are motivated to invent more drugs and innovate. We throw a lot of money to athletes and movie stars who simply entertain us, shouldn’t we do better to those who heal us? I used to say that. I don’t anymore.

No, I don’t think the drug companies are “evil.” People who say that are thinking way to simplistic. These companies are doing exactly what their shareholders want them to do: make as much money as possible for as long as possible. That’s what all companies do, right? They are simply working within the system as it is and trying to accomplish the goal of making money. To say that they should “sacrifice” is foolish. They are simply playing by the rules that have been set out there. Those rules are the thing that has to change. Read more »

*This blog post was originally published at Musings of a Distractible Mind*

Marketing: Direct to e-Patient

Patients are the new darling of the medical-industrial complex. If you look around you will see patients advocating for one another. If you click a little closer you’ll find some with relationships to industry.

It makes perfect sense that the manufacturer of a drug or medical device would want the blessings of our nascent cybercelebs. Some want genuine patient input.  Some, however, want to curry their favor. Chock up influence of the patient population as evidence of social health’s evolving maturity.

A couple of questions:

  • Will industry be required to publicly list monies used for sponsorship, travel and swag support of high profile patients in the social sphere?
  • Should high visibility patients who serve as stewards and advocates disavow themselves of contact with pharma just as many academic medical centers have begun?

As is often the case, I don’t have an answer. I’m just raising the questions. Read more »

*This blog post was originally published at 33 Charts*

Latest Interviews

How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

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Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

***

Click here for a musical take on over-testing.

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Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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