March 15th, 2011 by Elaine Schattner, M.D. in Opinion, Research
Tags: Autoimmune Disease, B-Cell Activity, B-Lymphocyte Stimulator, Belimumab, Benlysta, BlyS, Clinical Trials, Dr. Elaine Schattner, FDA, Food and Drug Administration, Human Genome Sciences, Immunology, Lupus, Medical Lessons, Monoclonal Antibody, Rheumatology, Steroids
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Lupus, an autoimmune disease, [recently] turned up on the front page of the Wall Street Journal (WSJ). It cropped up, also, on the first page of the New York Times business section, and elsewhere. Scientific American published a nice online review just now. The reason is that the FDA has approved a new monoclonal antibody for treatment of this condition.
The drug belimumab (Benlysta), targets a molecule called BlyS (B-lymphocyte Stimulator). The newspapers uniformly emphasize that this drug marks some sort of triumph for Human Genome Sciences, a biotech company that first reported on BlyS in the journal Science way back in 1999. BlyS triggers B cells to produce antibodies that in patients with lupus tend to bind and destroy their own cells’ needed machinery, causing various joint, lung, liver, kidney, brain, blood vessel and other sometimes life-threatening problems. So if and when Benlysta works, it probably does so by blocking aberrant autoimmune B-cell activity.
The newspapers don’t give a lot of details on the drug’s effectiveness, except that it appears to help roughly one in 11 patients, and the main benefit may be that some lupus patients on Benlysta can reduce their use of steroids, which have long-term and toxic effects on many organs. The most recent major medical publication on a trial on the drug came out in the Lancet two weeks ago.
Some reported caveats are that the drug has not been adequately tested or approved for patients with severe kidney or neurological manifestations of the disease, and that its activity, marginal as it is, appears to be less in patients of African heritage based on trials completed thus far. Additional trials are in the works.
The drug is expensive, to the updated tune of $35,000 per year. According to the WSJ: “Estimates of how many Americans are affected range from 161,000 to 1.5 million.” (How’s that for a wide ballpark figure? Likely a function of how hard it is to define and establish diagnosis for this disease, which anticipates how hard it will be to measure this drug’s effects — see below.) The same WSJ piece says analysts expect the drug to become a blockbuster, with annual sales eventually topping $1 billion. Read more »
*This blog post was originally published at Medical Lessons*
March 14th, 2011 by Dinah Miller, M.D. in Better Health Network, Opinion
Tags: Dr. Dinah Miller, Dr. Donald Levin, Drug Therapy, Fee-For-Service Model, Gardiner Harriss, Health Insurance, High-Volume Medical Practice, Media Misinterpretation, Mental Health, Mental Health Services, Mental Illness, My Three Shrinks, New York Times, Poor Portrayal of Medical Practice, Psychiatric Drugs, Psychiatry and Psychology, Psychotherapy, Reporting, Shrink Rap, Talk Therapy
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Gardiner Harris had a [recent] article in the New York Times called “Talk Doesn’t Pay So Psychiatrists Turn to Drug Therapy.” The article is a twist on an old Shrink Rap topic, “Why your Shrink Doesn’t Take Your Insurance.” Only in this article the shrink does take your insurance, he just doesn’t talk to you.
With his life and second marriage falling apart, a man said he needed help. But the psychiatrist, Dr. Donald Levin, stopped him and said: “Hold it. I’m not your therapist. I could adjust your medications, but I don’t think that’s appropriate.”
Dr. Levin sees 40 patients a day. And he’ss 68 years old. This guy is amazing. There’s no way I could see 40 patients a day for even one day. He’s worried about his retirement, but I wouldn’t make it to retirement at that pace. (Should we make a bet on whether Dr. Levin has a blog?)
The article has a whimsical, oh-but-for-the-good-old-days tone. In-and-out psychiatry based on prescribing medications for psychiatric disorders is bad, but the article doesn’t say why. In the vignettes, the patients get better and they like the psychiatrist. Maybe medications work and psychotherapy was overemphasized in the days of old? The patients don’t complain of being short-changed, and if Dr. Levin can get 40 patients a day better for — your guess is as good as mine, but let’s say — $60 a pop, and they only have to come every one to three months, and there’s a shortage of psychiatrists, then what’s the problem? Why in the world would anyone pay to have regular psychotherapy sessions? Read more »
*This blog post was originally published at Shrink Rap*
March 14th, 2011 by DrWes in Health Policy, Opinion
Tags: Chronic Disease, Consumer Drug Marketing, Direct-To-Consumer Drug Advertising, Dr. Wes Fisher, Elderly People, Electronic Medical Record, Emergency Medicine, EMR, Healthcare Privacy, HIPAA, Insurance Industry, Medication List, Patient Privacy, Pharma Advertising, Pharmaceutical Industry, Pharmaceutical Marketing, Private Healthcare Information, Slick Marketing, Targeted Direct-To-Consumer Advertising, Wall Street Journal
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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*
March 12th, 2011 by Emergiblog in Book Reviews, Opinion
Tags: Chocolate and Vicodin, Chronic Headache, Chronic Pain, Coping With Pain, Emergiblog, Half-Assed, Head Pain, Humor and Healing, Jennette Fulda, Kim McAllister, Life With Pain, Medical Humor, Pain Control, Pain Management, Pain Medicine, Pain Perception, Pain Tolerance, Pain Vs. Suffering, Treatment of Pain, Uncontrolled Pain, Understanding Chronic Pain, Weight Loss
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Chocolate and vicodin? No, it’s not the latest Ben & Jerry’s flavor. “Chocolate & Vicodin: My Quest For Relief From the Headache That Wouldn’t Go Away” is the latest book by author, blogger, web designer, and busy woman Jennette Fulda.
I became acquainted with Jennette’s blog during BlogHer 2008, where I had purchased her first book, “Half-Assed: A Weight-Loss Memoir.” When she asked if I would like a copy of “Chocolate & Vicodin” to review, I jumped at the chance.
In “Half-Assed,” Jennette chronicled her journey to a near-200 pound weight loss. Just prior to that book’s release, she began another journey — one whose goal proved elusive. On February 17, 2008, Jennette went to bed with a headache. She still has the headache.
Name a diagnosis, she’s heard of it (brain tumor, dead twin in the brain, etc.) Name a treatment, she’s tried it (meds, massage, marijuana, mint chocolate chip ice cream, etc.) In “Chocolate & Vicodin,” Jennette is on a journey to find relief from chronic headache. Writing in a comfortable style, Jennette has a subtle humor that will have you laughing out loud. Trust me, her description of using marijuana “for medicinal purposes only” will have your beverage of choice coming out your nose! (Cover the book!)
But it will also choke you up. Under the humor, under the crazy e-mails from readers that suggest the crazy remedies, this is a serious story of chronic pain disrupting life. Persistent, excruciating pain and the work of coping with it takes a toll on Jennette, and when it becomes too much you find yourself sobbing with her. Read more »
*This blog post was originally published at Emergiblog*
March 11th, 2011 by John Mandrola, M.D. in News, Opinion
Tags: AED, Athlete's Health, Automatic External Defibrillator, Cardiac Electrophysiology, Cost of Screening Tests, Defensive Medicine, Detecting Heart Disease, Dr. John Mandrola, Dr. Manny Alvarez, ECG, Echocardiography, Fox News, HCM, Healthcare reform, Hypertrophic Cardiomyopathy, Incidentalomas, Long QT Syndrome, LQTS, Overtesting, Pre-Participation Medical Screening for Athletes, SCD, Sports Medicine, Sudden Cardiac Death, U.S. Healthcare System, Universal Cardiac Screening, Unnecessary Tests, Ventricular Fibrillation, Wes Leonard, Young Athletes
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It’s heart wrenching when young athletes die of sudden cardiac death (SCD). Last week the death of Wes Leonard, a Michigan high school star athlete, was especially poignant since he collapsed right after making the game-winning shot. This sort of tragedy occurs about one hundred times each year in America. That’s a lot of sadness. The obvious question is: Could these deaths be prevented? Let’s start with what actually happens.
Most cases of sudden death in young people occur as a result of either hypertrophic cardiomyopathy (HCM), an abnormal thickening of heart muscle, or long QT syndrome (LQTS), a mostly inherited disease of the heart’s electrical system. Both HCM and LQTS predispose the heart to ventricular fibrillation — electrical chaos of the pumping chamber of the heart. The adrenaline surges of athletic competition increase the odds of this chaos. Unfortunately, like heart disease often does, both these ailments can strike without warning.
Sudden death is sad enough by itself, but what makes it even worse is that both these ailments are mostly detectable with two simple painless tests: The ECG and echocardiogram (heart ultrasound). Let’s get these kids ECGs and echos then. “Git ‘er dun,” you might say.
On the surface the solution seems simple: Implement universal cardiac screening of all young athletes. And you wouldn’t be alone in thinking this way. You could even boast the support of Dr. Manny Alvarez of Fox News and the entire country of Italy, where all athletes get ECGs and echos before competing. But America isn’t Italy, and things aren’t as simple as Fox News likes to suggest. Read more »
*This blog post was originally published at Dr John M*
