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Considering A Non-Fatal Patient’s Quality Of Life

Why is it easier to talk about quality of life with patients who are dying? Why don’t we factor these considerations into the decision-making for patients with conditions that aren’t fatal?

The presence of a terminal illness serves to focus everyone’s attentions. Widespread cancer metastases? Concerns about tight blood glucose control fade away. End-stage liver disease? Blood pressure control doesn’t matter so much any more. Bony pain from prostate cancer? Narcotic and sleeping pill addiction doesn’t even occur to anyone. I find it far more problematic to deal with patients with debilitating but non-fatal conditions when treatment options are perceived as limited because of co-existing diseases that produce so-called contraindications to certain medications.

I have a patient in his mid-70s with severe pain from osteoarthritis. Several fractures and a couple of unsuccessful joint replacement surgeries haven’t helped matters. Several years ago he found that a little drug called Vioxx worked extremely well for him, reducing his pain considerably and allowing him to do pretty much watever he wanted. As we all know, however, that drug was pulled from the market because of an unacceptable increased risk of heart attacks and other untoward cardiovascular events. Interestingly, Read more »

*This blog post was originally published at Musings of a Dinosaur*

Are Claims-Based Alerts A Waste Of Time?

I got a letter from an insurer the other day, warning me that my patient, who had just refilled a prescription for a bisphosphonate I had prescribed almost a year ago for severe osteoporosis (yes, I do still prescribe dugs, despite how I feel about Big Pharma marketing), also had a claims diagnosis in their system for a bleeding peptic ulcer, and was I really sure she should be taking this medication, which could worsen her ulcer?

So do what any conscientious physician would do – I call her. (Of course, no one is ever home when I call these days, so it’s another few days of phone tag before I get her.) No, she has not been diagnosed with anything of the kind. Feels great, in fact. Read more »

*This blog post was originally published at The Blog that Ate Manhattan*

Should We Put Graphic Warnings on US Cigarette Packs?

Now that the US Food and Drug Administration has been given the power to regulate tobacco products, one of its new powers is the right to change the health warnings on cigarette packs in the interest of public health.

So the first question is, are the current health warnings perfectly adequate? The answer to that one is clearly “no”. The boring small text warnings printed on the side of the pack have are almost perfectly designed to be ignored.

The second questions is, can we learn anything from the experience of health warnings in other countries? The answer here is a resounding “yes”. Numerous other countries have been using large mandated pictorial health warnings on cigarette packs for years and there is a growing body of research showing that these are much more impactful then prior text-only warnings. The warnings used in Canada present a good example to follow and can be viewed at:

http://www.hc-sc.gc.ca/hc-ps/tobac-tabac/legislation/label-etiquette/graph/index-eng.php

However, I particularly like the style used in Australia, where they have, since 2006 also added the freephone number of the national stop smoking Quitline to the pictorial health warnings. Graphic images and explanatory messages cover 30% of the front and 90% of the back of the pack. The message “You CAN quit smoking. Call the Quitline 131 848, talk to your doctor or pharmacist, or visit www.quitnow.info.au” is also included on the back of all packs. The Quitline number is also “stamped” on top of the graphic image on the backs of packs.. A recent study by Dr C L Miller of the Cancer Council of South Australia concluded that introducing graphic cigarette packet warnings and the Quitline number on cigarette packets doubled demand for Quitline services, with likely flow on effects to cessation.

Other countries of the world (including the United States) that have not yet introduced large graphic health warnings on cigarette packs or the number to the national quitline should do so as soon as possible.

The research from Australia can be viewed at:

http://tobaccocontrol.bmj.com/cgi/content/full/18/3/235

This post, Should We Put Graphic Warnings on US Cigarette Packs?, was originally published on Healthine.com by Jonathan Foulds, Ph.D..

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