July 19th, 2011 by DrRich in Health Policy, Opinion
Tags: Abandon, Advanced Care Medicine, bureaucracy, Checklist, Generalist Physician, Government Control, Guidelines, Obamacare, Pay For Performance, PCP, Primary Care, Restrictions, Secret Shopper
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In his last post, DrRich pointed out to his PCP friends that their chosen profession of primary care medicine is dead and buried – with an official obituary and everything – and that it is pointless for PCPs to waste their time worrying about “secret shoppers” and other petty annoyances.
It is time for you PCPs to abandon “primary care” altogether. It is time to move on.
Walking away from primary care should not be a loss, because actually, primary care has long since abandoned you. Whatever “primary care” may have once been, it has now been reduced to strict adherence to “guidelines,” 7.5 minutes per patient “encounter,” placing chits on various “Pay for Performance” checklists, striving to induce high-and-mighty healthcare bureaucrats (who wouldn’t know a sphygmomanometer from a sphincter) to smile benignly at your humble compliance with their dictates, and most recently, competing for business with nurses.
This is not really primary care medicine. It’s not medicine at all. It’s something else. But whatever it is, it’s what has now been designated by law as “primary care,” and anyone the government unleashes to do it (whether doctors, nurses, or high-school graduates with a checklist of questions) now are all officially Primary Care Practitioners.
What generalist physicians (heretofore known as primary care physicians) need to realize is that “primary care” has been dumbed-down to the point where abandoning it is no loss; indeed, it ought to be liberating to walk away from it.
The beauty is that Read more »
*This blog post was originally published at The Covert Rationing Blog*
July 19th, 2011 by PreparedPatient in Opinion
Tags: Behavior Change, Behavioral Psychology, Center for Advancing Health, Common Sense Family Doctor, Dr. Bruce Campbell, Dr. Glenn Laffel, Dr. Kenny Lin, Inside Health, Patient Engagement, Patient Participation, Pizaazz, Psychology, Reflections in a Head Mirror, smoking cessation
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Glenn Laffel, M.D., Ph.D., of Pizaazz hypothesizes about why we often don’t make changes that would benefit our health. He says:
“Somewhere in the course of our daily lives, though, most of us do exhibit behavior that suggests at least some disregard for our health. We don’t change our diet, though we know we should. We don’t floss, take medications as prescribed, or get the screening tests we’re supposed to.”
He knows multiple complex causes exist for this and questions whether being diagnosed with a chronic condition motivates people to improve health behaviors exploring whether the delay between health behaviors and health outcomes contributes to unhealthy behavior. After looking at attrition rates in a diabetes self-management program, he concludes:
“It calls attention to a key distinction behavioral psychologists like to make in explaining human motivation: there’s a difference between awareness of the need to act, and the volition to act.”
Family doctor Kenny Lin, M.D., previously recommended that people “tackle one behavior at a time.” He says: Read more »
*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*
July 18th, 2011 by Elaine Schattner, M.D. in Opinion, Research
Tags: Avastin, Breast Cancer, Cancer Treatment, comparative effectiveness research, Empowered Patient, Evidence Based Medicine, Informed Consent, Larry Husten, Medical Journalism, Medical News, Medical Science, Patient Advocates, Patient Voices, Policy
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Yesterday’s post was not really about Avastin, but about medical journalism and how patients’ voices are handled by the media.
L. Husten, writing on a Forbes blog, cried that the press fawned, inappropriately, over patients’ words at the FDA hearing last week, and that led him to wonder why and if journalists should pay attention to what people with illness have to say, even if their words go against the prevailing medical wisdom.
There’s a fair amount of controversy on this. For sake of better discussion in the future, I think it best to break it up into 3 distinct but inter-related issues:
1. About health care journalism and patients’ voices:
A general problem I perceive (and part of why I started blogging) is how traditional medical journalists use patients’ stories to make a point. What some of my journalism professors tried to teach me, and most editors I’ve dealt with clearly want, is for the reporter to find a person with an illness, as a lead, and then tell about the relevant news, and provide some expert commentary – with at least one person speaking on each “side” of the issue, of course – and then end the story with some bit about the patient and the future.
I argue that this form of medical journalism Read more »
*This blog post was originally published at Medical Lessons*
July 18th, 2011 by John Mandrola, M.D. in Opinion, Research
Tags: A Fib, Andromeda, Athena Trial, Atrial Fibrillation, Cardiac Electrophysiologist, Cardiology, Death, GI adverse effects, Heart Health, Hospitalizations, Liver Failure, Multaq, Sanofi-Aventis, Side Effects
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What should I have told the doctor who recently asked me about dronedarone (Multaq)?
“Supposedly, it’s [Multaq] just like Amiodarone, but without the side effects?” he asked.
Gosh…Should I, or shouldn’t I?
I took a big cleansing breath, reminding myself to stay civil, as at least Sanofi-Aventis, the makers of Multaq, sponsor a cycling team. Then I gave him my long answer:
I started with the fact that Multaq barely made it through the approval process. One of the original studies with Multaq (ANDROMEDA), a randomized trial of Multaq in patients with severe heart failure, showed that patients who took the drug were twice as likely to die.
Multaq eventually won approval for use in patients without significant heart failure and mild forms of AF, based on the results of the ATHENA trial—which randomized 4628 patients with non-permanent AF to either standard therapy or standard therapy plus Multaq. The ATHENA investigators didn’t exactly say that Multaq works, rather they claimed that it reduced a composite of hospitalizations and death.
This started the marketing machine in motion, the likes of which I have not ever witnessed. Read more »
*This blog post was originally published at Dr John M*
July 17th, 2011 by David Kroll, Ph.D. in Opinion, Research
Tags: 6-desmethyl-sideroxylin, 8-desmethyl-sideroxylin, Antibacterial Effects, berberine, Department of Chemistry & Biochemistry, Dr. Nadja Cech, Goldenseal, Herbal Medicine, Herbs, Hippies, Hydrastis canadensis L., Pure chemicals, Ranunculaceae, Science Based Medicine, Semi-purified extracts, sideroxylin, Staphylococcus aureus, Synergy, University of North Carolina
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So, you’re curious about herbal medicine. Is there any truth to this stuff?
Uncle Howie tells you that he read in the National Enquirer about an herb that has better antibacterial effects on cuts and scrapes than Neosporin ointment — never mind that Neosporin is composed of three different antibiotics that come originally from bacteria themselves.
So you set out on a quest to purchase some of this herb, known colloquially as goldenseal. When you go to your local Whole Hippie Dump-a-Load-of-Cash Emporium you find goldenseal alright, in about twenty different forms. On one side of the aisle are containers with loose, crushed up leaves and roots that look like medical marijuana. On a shelf, you find see-through capsules that seem to contain a powdered version of the herb. Down the aisle a bit you find boxes of blister-packs containing a proprietary extract of free-range goldenseal from the Appalachians harvested under moonlight by bare-breasted virgins. The same company also makes an ointment, allegedly procured the same way.
A scraggly young man with a rainbow-colored Whole Hippie tam comes by and says, “Dude, can I help you?” As you wave away the cloud of patchouli oil and three days of body odor, you ask him, “So, this goldenseal — which one should I buy?”
Hippie Boy looks both ways down the aisle and motions with his finger to come close.
“Dude, all this expensive stuff is just a ploy by The Man trying to make a buck with their fancy scientific words and processes. What you want is the whole herb, man — the stuff given to us by the sprites and spirits. Those capsules miss the point. Part of the magic is missing. You pay extra to get less.”
“But, dude,” you say. “I want to try the ointment, you know, for cuts and scrapes. How do I use this herb?”
The fine young man then explains how to make a poultice, an old-fashioned decoction of plant material that one wraps on a cut — sort of like collard greens.
This really seems like more trouble than it’s worth. You’re about a millisecond away from just heading down to the Done-Rite Drugs, Liquor, and Tobacco to buy a simple tube of Neosporin. But hey, it’s an experiment and you’re curious.
While you’re checking out from the health food store, a local scientist friend is in line at the next register, checking out your stash of goldenseal.
“You know, you should really go read Science-Based Medicine to get the straight dope on that stuff.”
And so, here you are. And I’m here for you.
[Note to readers: Apologies to my hippie friends. I love you all. No hippies were harmed in the drafting of this blogpost.]
Is there any scientific evidence to support a common herbalist claim that whole plant materials are “better” than semi-purified extracts or pure, individual chemicals made by the plant? Read more »
*This blog post was originally published at Science-Based Medicine*
