"When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov
''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.'' -Robert Ehrlich, drug advertising executive.
"Opinions are like sphincters, everyone has one." - Chris Rangel
The plan would allow seniors to gain discounts of 10 to 15 percent by joining drug-card programs approved by Medicare, Scully said.
The programs, already sponsored by health care providers, chain drug stores and such groups as AARP, would become more substantial and theoretically could negotiate lower prices because of their increased membership. Currently, many seniors have a number of discount cards, but under the plan a recipient would use only one Medicare-endorsed program at a time.
HHS officials estimate that almost 10 million seniors and disabled people would use the program, and would save on average $170 a year.
There's no indication that this will be needs-based, but only a discount for all. It's true that there are many elderly who have trouble affording their drugs, but there are also many who can afford to travel the world and have two homes. Why the rest of us should subsidize their drug costs is beyond me. Our budgetary healthcare problems are going to continue to be a problem until we face the fact that not everyone is equally deserving of charity care. As much as I am naturally suspicious of the pharmaceutical industry, I don't think they should be subjected to the same price caps that physicians have been subject to. If making a drug becomes unprofitable because of price caps and widespread discounts, then the drug companies will just stop making it, and we'll have shortages of much needed drugs. Just wait. posted by Sydney on
8/31/2002 08:40:00 AM
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West Nile Update: It seems that everyone who tests positive for the West Nile virus hits the newspapers. One man in upstate New York and one man in Connecticut have been diagnosed, a woman in Bethesda died, two cases have been presumptively diagnosed in northern Virginia, and a transplant recipient in Florida and his donor in Georgia had it, too. The last case is rather newsworthy. It could turn out to be the first case of transplant-transmitted or transfusion-transmitted West Nile, or it could just be a coincidence. The CDC is rightly looking into it:
Dr. Julie L. Gerberding, the director of the disease centers, said, "We have to take this case seriously and have an open mind about the possibility because transmission of the West Nile virus through blood and organs is biologically plausible." The C.D.C. is responsible for protecting the public's health from infections like West Nile fever.
"Although it is too early in the investigation to determine how the man acquired his infection, a leading hypothesis that we are investigating at this time is that it is related to the organ transplant," Dr. Gerberding said in an interview. "Another, but less likely, possibility is that the man acquired the infection through a blood transfusion."
To date, there have been 555 cases of West Nile and 28 deaths this year. In contrast, influenza kills anywhere from 20,000 to 40,000 people a year (depending on the virulence of the strain) and hospitalizes 16,000 to 220,000. Millions more come down with the disease each year, but like most cases of West Nile are merely inconvenienced by it.
UPDATE: Three other organ recipients from the same donor may have West Nile. It's still not clear whether they got it from the donated tissue or whether they were just unfortunate enough to get infected from mosquitoes. (Organ recipients have to take drugs to suppress the immune system which makes them especially vulnerable to infection.) posted by Sydney on
8/31/2002 08:38:00 AM
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Consequences of Hype: A Missouri man is upset that his doctors didn't diagnose him with the West Nile virus:
Morff visited his doctor's office three times in one week. The diagnosis twice was strep throat, then a generic viral infection.
"It was getting frustrating, because I knew that it was more than strep throat," says Morff, 38, who finally called the county health department and a hot line for the national Centers for Disease Control and Prevention, both of which urged him to get tested for the West Nile virus.
Preliminary tests confirmed he has the mosquito-borne virus - the first human case of the disease in central Missouri.
Morff's case makes an important point: As the West Nile virus spreads west across the United States, doctors and nurses accustomed to seeing patients with common illnesses need to start using an extra dose of suspicion, officials said.
But it isn’t practical or feasible to test everyone with flu-like symptoms for West Nile virus:
The Jefferson City Medical Group plans to review its treatment Morff, said Dr. Don Miller, the clinic's infectious disease specialist.
But Miller said there are no West Nile screening tests that are cheap, accurate and quick. So there likely are others who had West Nile virus and recovered without ever being diagnosed, he said.
"To diagnosis this early, when there's no good treatment ... is not highly encouraged," Miller said, "because we don't want to flood the health department with a lot of tests that are fairly spurious."
Doctors are more likely to test the elderly for West Nile virus, because they are at a greater risk of dying, he said.
I would go even further and say that we aren’t likely to test even the elderly unless they are critically ill, and the cause is unknown. There is no treatment for West Nile and the mortality is low. Why do an expensive test that won’t affect the outcome? posted by Sydney on
8/31/2002 08:36:00 AM
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Bubonic Plague: There’s been an outbreak of bubonic plague in Sierra park, the victims so far: a cat and a squirrel. The squirrel died, the cat’s recovering, thanks to modern antibiotics. Don’t worry, it’s not a bioterrorist attack, but only naturally occuring plague. We hear so little about bubonic plague, it’s easy to forget that it’s still present on every continent (except Australia) among small mammals, and that it occasionally infects people:
Worldwide, on average in the last 50 years, 1700 cases have been reported annually. In the United States, 390 cases of plague were reported from 1947 to 1996, 84% of which were bubonic, 13% septicemic, and 2% pneumonic. Concomitant case fatality rates were 14%, 22%, and 57%, respectively. Most US cases were in New Mexico, Arizona, Colorado, and California. Of the 15 cases following exposure to domestic cats with plague, 4 were primary pneumonic plague. In the United States, the last case of human-to-human transmission of plague occurred in Los Angeles in 1924. posted by Sydney on
8/30/2002 10:14:00 AM
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Cell Phone Reprieve: Go ahead and use those cell phones. New research suggests that old research was wrong to link them to brain tumors:
A three-year study has found that radio emissions from mobile phones do not trigger the growth of tumors in mice and therefore probably do not do so in humans either, Australian researchers said Friday.
The research on 1,600 mice, by the Adelaide-based Institute of Medical and Veterinary Science, follows another Australian study on mice five years ago that concluded cellular phones could foster tumor growth.
The 1997 study fueled consumer concern about the safety of mobile phones but the Adelaide scientists said they could not replicate the findings in their mice, half of which were genetically engineered to be extremely susceptible to tumors.
"That then gives you confidence that if you don't find an effect in these animals you are probably not going to find an effect in normal animals, humans being a normal animal," said Tim Kuchel, a spokesman for the Adelaide research team. posted by Sydney on
8/30/2002 06:56:00 AM
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"Surprisingly, this hypothesis doesn't seem to have gone through (rigorous scrutiny) very much. It seems to have been adopted very widely, very rapidly without too much in the way of critical appraisal," said Oxford University scientist Rory Collins, one of the lead investigators in the new analysis
Not so surprising. The studies that proport to show an association between fetal weight and adult blood pressure were based on meta-analysis which means they took a bunch of findings and studies and mixed the results in a statistical stew. Give us numbers and we’ll think them true, regardless of how they were obtained. Combining studies in this way has its risks:
One problem is that smaller studies are more likely to find more extreme results and positive results are more likely to be published, which means published evidence from the small studies might overestimate the true effect, Collins said. Therefore, more importance was given to the larger studies by the new analysis.
The new analysis, as compared with the old analysis finds less of a blood pressure difference with weight. However, the surprising thing is that both analyses found only very small differences in blood pressure among the adults studied: differences of only one to four points. That difference is well within the margin of error for measuring a blood pressure:
Proponents of the fetal hypothesis have estimated that a 1 kilogram (2.2 pound) higher birth weight is typically associated with a 2-4 point lower blood pressure.
After reweighting the studies to eliminate any bias introduced by only publishing only the small studies with strong results, the new analysis concluded that 1 kilogram (2.2 pound) extra birth weight was linked to about a half point lower blood pressure.
The studies also adjusted their statistics to take into account the current weight of the patients when they had their blood pressure measured as adults. That obscures the real relationship between birth weight and blood pressure, Collins said.
"When we removed the adjustment for current weight, the relationship appeared to disappear," Collins said.
A two pound difference in weight is a lot of weight for a baby, but a four point difference in blood pressure between adults isn’t a lot of blood pressure. It’s not surprising that the re-analysis found the evidence wanting:
"It is a serious concern (for the theory) when something that is considered by the proponents to be their best evidence appears to have such serious problems," he said. "That's certainly not to say there's nothing in it, but it may mean that the strength of any association is much less than had been claimed, if at all." posted by Sydney on
8/30/2002 06:09:00 AM
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Thursday, August 29, 2002
From The X-Files: Are you an Englishman in need of an organ? No problem. The NHS may not be able to provide you with one, but Third World black marketeers sure can. You can get them from the living or the dead, the willing or the unwilling:
To many people, the worst offenders are the Chinese. According to Western doctors and the pressure group Human Rights Watch, the Chinese routinely sell kidneys, corneas, liver tissue and heart valves from executed prisoners without their consent or that of their next-of-kin. These are sold to politically well-connected Chinese or to “transplant tourists” from other Asian countries.
Although the story that lead to this post occurred in England, the problem isn’t limited to the Brits. Here’s the Organs Watch site which tracks such abuses. posted by Sydney on
8/29/2002 07:33:00 AM
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Bioterror Update:The Bloviator has the latest update on smallpox vaccine policy debate. They’re not on vacation, they’re still debating, and that’s OK. Better to debate the merits and demerits of mass vaccination than to just meekly follow the CDC’s lead.
MORE UPDATE: Researchers say the old smallpox vaccine may have left us more immune than we assume. Whew. But wait, that's only among cells in a lab dish. Apply to life with caution:
Old vaccination can protect against death from smallpox and can modify the course of illness. But health officials say they face a more important consideration in preparing for a bioterrorist attack — even a mild case can transmit the smallpox virus and perpetuate an epidemic.
"You can't draw conclusions in the real world from the data" from the North Carolina tests, said Dr. Frank Fenner of the University of Canberra in Australia. Dr. Fenner is an author of the textbook "Smallpox and Its Eradication," published by the World Health Organization.
Another author of the textbook, Dr. D. A. Henderson, who led the health organization's smallpox eradication effort and who is now a top government adviser on bioterrorism, said he had "no idea" how the new findings correlated with protection against natural exposure to smallpox. Dr. Henderson said it was "perfectly obvious that one successful vaccination does not protect for a lifetime."
..."It would be foolhardy to rely on any vaccination more than three years old as solid protection," said Dr. J. Donald Millar, a former head of the smallpox eradication program at the Centers for Disease Control and Prevention. posted by Sydney on
8/29/2002 07:33:00 AM
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Psychiatric Problems: An interview with the psychiatrist, Dr. J. Allan Hobson, and author of a book called Out of Its Mind: Psychiatry in Crisis: A Call for Reform. He calls psychiatry the “god that failed”, which is an apt description. Too often these days, psychiatrists limit themselves to prescribing medication and leave the “talking cure” to psychologists. The psychiatric encounter is limited to “How are you feeling? Any thoughts of suicide? Sleeping OK? Tolerating your medicine? OK, here’s your refill,” and no connection between doctor and patient ever develops. Psychoanalysis isn’t the answer for everything. It may not even be the answer for most things, but psychiatrists are short-changing the mentally ill, and themselves, when they treat their patients as mere walking neurons to be manipulated psychopharmacologically. There is an important role for the psychiatrist in the life of the mentally ill. As Dr. Hobson says:
With the seriously ill patients, on the whole, they don't stop being mentally ill, but they can do well. They can do better because a doctor cares for them. And you can be clever with the medications, restrained about their use. Probably the most important thing you can do is to give them a sense of human place with you.
Another Voice on Malpractice: Some thoughts on the malpracitce insurance crisis from a letter to the editor written by a smalltown doctor:
The financial cost and the threat of lawsuits is demoralizing to those physicians who continue to practice. The effect is not only on the current physicians but will also affect the quality of future doctors. Few talented people will chose a career that requires prolonged years of training to enter a profession of high risk, high stress and high demand, with reimbursement determined by a third party, government regulations that direct how one practices and a malpractice system that calls into question anything but perfect results.
..People have to realize, however, that a bad medical outcome is not always a result of negligence.
...As far as limiting the award for pain and suffering, this can be accomplished without penalizing the person who has actually suffered the result of negligence. The current system allows the plaintiff's lawyer to take 50 percent of the amount awarded; if the award is for $5 million, the lawyer will get $2.5 million.
This seems to be excessive, and invites abuses. The system is not concerned with justice or truth but only with winning the case.
I suggest the government set up a fee schedule to pay plaintiff attorneys the same way it does to pay doctors. This would preserve the appropriate compensation to the injured person but still lower the overall payout.
Now there’s an idea. Make lawyers beholden to the same compensation system as physicians. No doubt the number of lawsuits would drop dramatically. posted by Sydney on
8/29/2002 07:27:00 AM
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Obesity Update II: Roche Labs, the makers of anti-fat drug Xenical, and sponsors of last month's obesity research on congestive heart failure, say they have proof their drug can prevent the complications of being fat:
Of the 3,304 at-risk patients who participated in the study, all of whom made healthy lifestyle changes, the risk of developing type 2 diabetes was 37% lower in those treated with Xenical.
After four years of treatment, 26% of those who took Xenical managed to lose and keep off 10% of their body weight, while only 16% of the patients not taking the drug did.
In that time, 6.2% of the participants who were taking Xenical went on to develop diabetes. Of the group that took placebos, 9% did.
That’s not much of a difference. For every one hundred people who take the drug, ten lose more weight than those who don’t take it. There’s no mention of where the original study can be found, so I suspect that the 37% lower incidence of diabetes in the drug takers isn’t as impressive on close inspection as it sounds, either. posted by Sydney on
8/29/2002 07:23:00 AM
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Obesity Update: A woman in Massachussetts is suing to have the state pay for her obesity surgery. She could make both the state and herself happy if she just ate sensibly and exercised regularly.
COMMENT: Received a sardonic e-mail about the above post:
Oh goodie, another knee-jerk reaction. Did you read the article? The woman lived thirty-six years just fine, then more than doubled her weigh in five years.She has been dieting and exercising for all 41 of her years. Her doctor is hopeful she will benefit. "``Over the past two years, I have worked closely with Ms. Madden to reduce weight by conventional means,'' Dr. David Ting wrote to the agency in May. ``Unfortunately, despite diligence on the patient's part, her weight has not significantly changed.''" Does that sound like she hasn't tried?
99.9% percent of overweight and obese people may deserve your scorn, but the other 0.1% may not.
Yes, I did read the article, and I have to agree with the Medicaid system on this one. They have a responsiblity to be “good stewards” as they said. The patient in the article doesn’t strike me as a good candidate for the surgery. You have to be willing and able to follow a diet and exercise regimen to keep the weight off and to prevent nutritional complications. She, however, has several strikes against her. She has a “learning disability and suffers from bipolar disorder,” and she admits that her weight gain occurred “when she began eating out of boredom following a back injury.” She is not suffering from some complex endocrine disorder, only from overeating and lack of exercise. Her family physician may say he has worked closely with her and that she has diligently followed her diets, but if that were true, they would have documentation of her calorie counts and exercise efforts. They obviously don’t since Medicaid is asking her to record just this sort of thing for six months. When a doctor says he is working with a patient closely it means that he’s having her come in for regular weigh-ins and giving diet advice. Whether she’s following that advice or not can’t be corroborated. And believe me, the common refrain among the obese is that “I don’t eat anything.”
I’m not scornful of the obese. I’m only scornful of the excuses they offer up to avoid personal responsibility. I’m no svelte thing myself, but I know that I owe my figure to my own transgressions. I was not knee-jerking here. I own that I do that sometimes, but I usually reserve it for the pharmaceutical industry. posted by Sydney on
8/29/2002 07:20:00 AM
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Personal Responsibility Part II: A column on the misplaced policy of banning peanuts from schools.(also from Overlawyered) I’ve never encountered a peanut allergy professionally, but I have encountered the peanut-challenged in my personal life.
There is a child in our community who has both a peanut allergy and a mother who is an anti-peanut activist. My first brush with the peanut terror was at a luncheon for my son’s Suzuki violin class, of which the poor allergy-stricken boy was a member. As we sat quietly eating our dessert of cookies and milk, the instructor rose to make an announcement of “life and death importance.” (her words) With shaking voice she told us that there was a child among us with a peanut allergy and that there were peanuts in the cookies. My heart leapt to my throat. I thought he had eaten them and was in anaphylactic shock. But no, my alaram was premature. He had not eaten them, smart and careful child that he was. The problem was that we were to go from the luncheon to a hands-on science museum. We should all immediately go wash out our mouths and wash our hands so that he would be in no danger of coming in contact with peanut protein at the museum. Skepticism replaced alarm. What of the hundreds of other museum patrons who might have eaten peanut butter for lunch? Wouldn’t they pose just as much of a risk? I asked the question aloud of the father sitting across from me. “I don’t know, but they sure scared the holy hell out of me,” was his reply.
I have since had the privilege to watch this well-meaning mother scare the holy hell out of teachers, administrators and school children. Her child has even attained celebrity status with a full page newspaper story that laid out his entire history. It seems that when he was a toddler, he had an anaphylactic reaction while under the care of a babysitter. The babysitter swears that she gave him no peanut butter. The only thing that could have explained the reaction was the presence of an opened can of peanut butter in the kitchen. Obviously, he had such a sensitive allergy that even the merest whiff of peanuts could do him in. (Raised eyebrows are appropriate here. Anyone else suspect the babysitter was afraid to tell the truth?) Mother quit her job and devoted her life to protecting her son from peanuts. He was not allowed to go to school, but taught at home, thus the Suzuki violin lessons. But, he’s a very bright boy, and there are programs in our school system for very bright boys that his mother just could not pass up, peanut allergy or no peanut allergy. So once a week he braves the hallways of the public school system to go to a class devoted to the “gifted.” This was not gained, however, without first mounting some defenses. The teacher of the special class was lectured on the danger of peanuts and given an extensive list of food items that should not only be kept out of the classroom when he was in it, but out of the classroom at all times. My other son is in that classroom on a different day, and I have been given the “list of foods to avoid.” It includes, in addition to peanut butter and peanuts, chocolate and sundry foods with peanut oil in them. I marvel at the completeness. The teacher is frightened enough to go through each child’s lunch bag to make sure they have no contraband, and the mother comes to each class at the beginning of each year to lecture the children on the dangers of peanut allergies. When her son received an award for work well-done, the school held it's honors assembly on a weekend so he could avoid the great unwashed peanut-eating masses, and everyone was instructed to avoid eating peanuts in the twenty-four hours preceding the assembly. It’s enough to make one roll one’s eyeballs impolitely at teacher conferences.
Don’t get me wrong. Peanut allergies are very real, and they can be fatal. They have been transmitted by kissing and even by liver transplants. I’m well aware of their seriousness and of the fright they can instill in a parent’s heart. My own daughter is peanut-challenged. I assure you, there is nothing so frightening as watching your child have a serious allergic reaction before your very eyes, even if you are a doctor. But, fear is not an excuse for abandoning sense. The chances of dying from anaphylactic shock from ambient peanut protein in the hallways or cafeteria of a school are miniscule. There’s always the chance that a child will inadvertently eat a peanut or something with peanuts in it, but that is no reason to forbid all children in the vicinity from indulging. We can’t protect our children from every risk in the world, nor can we be at their sides for the rest of their lives. The best we can do is to teach them to be properly cautious and to be prepared.
We have not banned peanut butter from our home, much less from the school. My daughter keeps an EpiPen® and oral steroids at school to be used if she accidentally eats a peanut. I’ve given her teacher, the principle, and the school nurse detailed instructions, in writing, of how to handle her if it happens. My daughter, although only seven and rarely serious about anything, has learned to ask about peanuts in any unknown food. If she can’t be reassured sufficiently, she passes. She even, at times, doubts me. Recently I took her to a new ice cream stand in town. She had a waffle cone, which she had never had before. “Do they use peanuts to make these?” she asked me warily. “No. They don’t use peanuts.” She looked suspiciously from me to the cone. “Trust me,” I told her. “I used to work in an ice cream shop.” Budding skeptic that she is, she thought about that for a while, then she said, “But you didn’t work in this ice cream shop,” and she threw away the cone. posted by Sydney on
8/29/2002 07:02:00 AM
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When the ads appeared on buses in several U.S. cities last year, they drew the ire of the National Organization for Women. Accusing the doctors group of using "scare tactics," NOW argued that the ads sent a negative message to women who might want to delay or skip childbearing in favor of career pursuits.
This year the association tried to place the ads in movie theaters and shopping malls in San Francisco, Boston, Houston and the District -- venues filled with people young enough to benefit from the core advice that actions today can affect fertility tomorrow. But the theaters and malls rejected the ads, according to the public relations firm that tried to place them.
The malls say they found the ads objectionable:
"Unfortunately mall managements are very particular when it comes to ads in their facilities. They prefer 'mall friendly,' 'happy environment' graphics since they need to protect their interests and [those] of their consumers."
The ads don’t do much to stir maternal instincts, but they aren’t all that objectionable. Take a look at them. Here’s the one on smoking, the one on weight, the one on sexually transmitted diseases, and the one on aging.
They’re almost clinical in their spareness. Imagine how much more effective they would have been at drumming up business for fertility clinics if they had featured romantic photographs of women serenely cuddling babies. In fact, the ads probably wouldn’t have been rejected if they had featured such happy images. Maybe the rejection by malls and movie theaters is based on aesthetics rather than politics.
There Goes My Excuse: I’ve always told our kids we can’t have pets because they have allergies. But a study published this week suggests that the more pets the better:
Researchers found that the 184 children in the group exposed to two or more dogs or cats in infancy were half as likely to develop common allergies than the 220 children who had no pets in the home.
The study looked at allergies to six common culprits: dust mites, dog, cat, ragweed, and grass, as determined by skin and blood testing. There was a significant decrease in allergies in kids who lived with two or more pets, but not those who lived with one pet:
The prevalence of any skin prick test positivity (atopy) at age 6 to 7 years was 33.6% with no dog or cat exposure in the first year of life, 34.3% with exposure to 1 dog or cat, and 15.4% with exposure to 2 or more dogs or cats. The prevalence of any positive allergen-specific IgE test result [blood test] was 38.5% with no dog or cat exposure, 41.2% with exposure to 1 dog or cat, and 17.9% with exposure to 2 or more dogs or cats.
The actual numbers were small, but it does demonstrate a trend. There has been research published in the past that suggested that asthmatics do better when they live in dustier environments, too. All of which supports the expert quote of the day:
"The bottom line," says Ownby, "is that maybe part of the reason we have so many children with allergies and asthma is we live too clean a life."
My excuse for not having pets may have just gone out the window, but at least I now have a new one for not being a meticulous housekeeper. posted by Sydney on
8/28/2002 07:37:00 AM
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This is a Test: Researchers have claimed at a recent conference that a "simple memory test" can predict Alzheimer’s disease:
In the California Verbal Learning Test, a long-standing method of measuring memory, a list of 15 simple words such as cat, dog and mouse are read to the subjects, who are asked to repeat the words they can remember. The process is repeated five times.
They are then read a different list of 15 words and asked to repeat the process. "The second list is just in there to screw them up."
Following that, the test administrator asks the subject to remember as many of the words on the initial list as possible. After a 20-minute break, the subject is asked to recall words from the first list.
I’m not sure I could pass that test, and I doubt it’s all that great a predictor of Alzheimer’s disease. Alzheimer’s disease is a diagnosis of exclusion. You can spot a trend for declining mental function in a person, but you can’t diagnose it as Alzheimer’s until you’ve ruled out other explanations - depression, multiple small strokes, nutritional deficiencies, hypothyroidism, to name a few. It’s always tempting to reach out for a simple test to classify someone, but the truth is that mental function can be affected by a multitude of ills, and no one test can give a simple, easy diagnosis. posted by Sydney on
8/28/2002 07:35:00 AM
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Tuesday, August 27, 2002
Paxil Problems: The maker of Paxil is being sued by people who experienced unpleasant symptoms when they stopped it. (Not harmful, not life-threatening, just unpleasant):
By the late 1990s, clinical studies offered evidence that the symptoms associated with discontinuing use of the drug -- ranging from flu-like ailments and nausea to dizziness, insomnia and electric-shock-like sensations in the brain -- appeared more often in patients treated with Paxil than in patients treated with other psychotropic drugs.
That has spawned a network of Web sites and bulletin boards, with names like quitpaxil.org, devoted to spreading information on the side effects. And it prompted Baum, Hedlund, Aristei Guilford & Schiavo, a California law firm that had represented antidepressant users in past suits, to launch legal action last summer claiming that Paxil patients had been misled and asking for punitive damages against Glaxo, the world's second-biggest drug maker.
What does it say about us as a nation that we have law firms who specialize in suing antidepressant makers? The patients say these are symptoms of withdrawal, and therefore the drug must be addicting. The FDA and the drug company say that’s a bunch of baloney:
The company and the FDA note that other non-addictive drugs, such as steroid treatments and some high-blood-pressure medications called beta blockers, also leave patients at risk of problems when they stop taking the medications. But the FDA says neither those drugs nor Paxil prompts the kind of "drug seeking" behavior associated with addictive drugs like opium or cocaine.
"Patients ask me, 'Is this habit-forming?' I say no," said Fred Goodwin, a professor of psychiatry at George Washington University Medical School and the former head of the mental health branch of the National Institutes of Health. "But if you stop it suddenly, your body isn't going to like it very much."
The lawsuit is a bunch of baloney. Paxil isn’t addicting, and the symptoms that some people experience when they stop it aren’t "withdrawal". A more appropriate term for it would be “rebound”. Only a minority of patients experience them, and they are more of an inconvenience than anything else. If you tough it out they go away in a matter of days. Better yet, if you taper yourself off the drug, they aren’t as bothersome. To suggest, as the lawsuit does, that these patients have become physically dependent on the drug is ridiculous. It’s ironic, however, that the drug company got into this mess because of claims made in their direct to consumer advertising campaign. If they hadn’t been out there touting it as a wonder drug, they never would have had a lawsuit. If nothing else, maybe it will teach the pharmaceutical industry to rein in their television and print ads. posted by Sydney on
8/27/2002 07:31:00 AM
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Physicists Against Scams: The American Association of Physicists in Medicine speaks out against whole body scans. posted by Sydney on
8/27/2002 07:09:00 AM
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Move Over Dr. Laura: Yet another tough-talking advice show, this time on television. Dr. Phil, a protege of Oprah Winfrey who has evidently been appearing on her show every Tuesday, is going to have a show ofo his own. He’s a psychologist who hated being one until discovered by Oprah:
And then McGraw made a startling discovery: he was a terrible therapist. “I didn’t have the patience for it,” he says. “People would want to sit there and talk to you for six months, and a lot of times I could figure in the first hour that they just wanted to rent a friend. I’d be sitting there saying, ‘You know, here’s your problem: you’re a jerk”.
Dr. Phil comes across as a bit of a jerk, too, but those exhibitionists who display their messy lives on talk shows probably deserve him. posted by Sydney on
8/27/2002 07:06:00 AM
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The Flu Shot Bandwagon: An article from the New York Time's suggests that doctors are to blame for low influenza immunization rates:
"If an equally safe and effective vaccine to prevent H.I.V. infection were available next month," Dr. Poland asked, "would it take decades to offer it to 60 percent of the at-risk population?"
The problem is that for the last two years the influenza vaccine, though safe and effective, wasn't available. It remains to be seen if it will be available this year in the numbers needed, although they’re claiming it will be. posted by Sydney on
8/27/2002 07:03:00 AM
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Let This Be an Example: Yet more evidence of why socialized medicine is a bad idea. You just never know where the money's going to go:
Alan Milburn, the Health Secretary, made cancer his priority along with tackling heart disease yet some clinicians said they had received little or none of £255 million earmarked for cancer last year and feared that this year’s £76 million could also disappear.
Professor Mike Richards, the National Cancer Director (also known as the cancer czar), admitted that the Health Department did not know if the £255 million earmarked for cancer care last year had reached the front line.
“We think in the end it has not,” he said, “which is why we are now trying to find out what actually reached the front line.”
They "think" it might have gone to paying off hospital debts instead of treating cancer patients. posted by Sydney on
8/27/2002 07:00:00 AM
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Drug Companies to the Rescue: The nation's pharmaceutical industry is coming to the aid of the poor. How? By suing Medicaid programs for trying to encourage the use of generic drugs. The industry suit is laughable:
PhRMA's legal brief contends that "physicians generally respond to the inconvenience and burden imposed by prior authorization requirements by switching their patients" to a drug on the preferred list. Over time, the suit notes, the shift in prescribing patterns results in large swings in the overall market.
Well, yeah. That’s the purpose of having preferred lists, to encourage people to use the cheaper drugs. The Bush administration’s response is on the money:
The purpose of preferred drug lists, the Justice Department wrote in its court brief, was to provide "the greatest protection for the beneficiaries. It was not intended to protect drug manufacturers' interest in maintaining high profits on prescription drugs." posted by Sydney on
8/26/2002 07:37:00 AM
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Alternative Medicine Watch: The San Francisco Chronicle says that stressed out baby-boomers are turning to Ayurveda, an ancient Asian approach to medicine:
Central to Ayurvedic medicine is the concept that there are three governing forces at work inside the body, called doshas. Each corresponds to elements found in nature, and each is present in all of us to varying degrees.
It is when our doshas get out of balance that trouble strikes, and Ayurvedic medicine then uses various means, including diet, behavior changes and body treatments, to pacify an overexpressed dosha.
Eye of the Beholder: More adults, including Tom Cruise, are getting braces. Why would Tom Cruise need braces? He's a man who's made millions from his smile, yet those in the know say he could still stand some improvement:
Cruise needs braces to close his mouth properly, something he has never been able to do. But more noticeably, braces will center Cruise's front teeth so they line up with his nose in the middle of his face. "His midline was so far off, I don't know how women found him attractive," says orthodontist Steven Henseler.
He's always looked fine to me, at least when he keeps his hair washed. Do you suppose there are plastic surgeons and orthodontists who make the rounds of Hollywood cocktail parties whispering that this star or that star could stand just a little tweaking here and there? posted by Sydney on
8/26/2002 07:11:00 AM
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Cat Fight At UMass: The UMass Memorial Hospital had to suspend its liver transplant program after firing its chief surgeon. He says they didn't appreciate the fact that he was referring patients elsewhere because of safety concerns:
The surgeon readily admits that last month he began advising patients at the top of the waiting list that the staffing and support for his program were so thin they presented a risk to patients undergoing transplant surgery. He said he offered to help patients transfer to doctors at Boston area hospitals, and three began the process. But he said he only began offering the advice after hospital officials dragged their feet in hiring a replacement for another transplant surgeon who left in April.
The hospital says he wouldn't step down and let someone else be in charge. Whatever the reason, the hospital seems to have problems keeping surgeons on staff, which suggests the real problem probably lies with the hospital adminstration, rather than the surgeon. posted by Sydney on
8/26/2002 07:08:00 AM
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There’s Something Happening Here... But what it is, isn’t exactly clear. Two of my patients last week left me wondering if our country isn’t closer to war than we sometimes think. Both are young men, one in his mid-twenties, the other in his early thirties. The first one has been my patient since his late adolescence, and I see more of him than I usually would of someone his age because he often accompanies his parents to their visits. The family immigrated here from the Middle East about ten years ago, and they rely on him, their oldest son, as an interpreter. When I last spoke to him, he had just finished his masters degree in biology and was planning to apply to medical school. I saw his mother last week. She came by herself this time - her son had joined the Army. She said that recruiters had been calling their home every day this summer to persuade him to sign up.
The other man is a former marine. He was still on reserve duty when 9/11 happened, and I remember him telling me that he hoped he wouldn’t be called up. His wife had just had a baby, and he didn’t want to leave home. He never was called up, and in the ensuing months his service obligations ended. He mentioned at his visit last week, though, that he’s decided to join the Army. He, too, said he got calls almost daily from Army recruiters.
We may just have an especially ambitious Army recruiter in our area, but I like to to think that the Army’s been busy shoring up its forces with people who possess much needed skills and experience. And to my two patients and countless others like them, all can I say is, “Thank you”. posted by Sydney on
8/26/2002 07:04:00 AM
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Smallpox Update: Our government has yet to act on implementing a smallpox vaccine policy. Summer vacation has gotten in the way, or maybe they're just carefully considering their options. Either way, it hardly matters. There won't be enough smallpox vaccine for mass vaccination until late this year or early next year. posted by Sydney on
8/25/2002 01:10:00 PM
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Suffering with Dignity: The New York Times Sunday Magazine's cover story is a first hand account of losing a premature baby. The author did a remarkable job of presenting her illness and the subsequent hospitalizations of both herself and her baby with clear-eyed, precision and consideration for all those involved. Too often, tales like this spin into angry recriminations against doctors and hospitals for failing to save the doomed, but Rebecca Johnson never lets her own suffering cloud her insight into the humanity of the nurses and doctors who took care of her and her son. I kept expecting to encounter an insensitive doctor or nurse, but she never brought one forth, although she does acknowledge the anger that is always present after such a loss:
All doctors are defensive about malpractice and none more so than obstetricians, who are more likely to be sued than any other kind of doctor. I can see why -- the pain of losing a child is so intense that you want someone, anyone, to blame. On my bad days, I feel that way, too. I can't help wondering if things would have been different had I known early that I was a high-risk pregnancy and seen a doctor who specialized in them, but mostly, I try not to be bitter and to accept that we all did the best we could. I only wish that knowledge lessened the grief. posted by Sydney on
8/25/2002 01:00:00 PM
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West Nile - The Inside Scoop: The AMA Medical News has this take on the West Nile hype - it’s the result of beefed-up public health departments thanks to bioterror funding:
But after being surprised by the virus four years ago, public health officials, even those in states without any cases yet, say they are more ready than ever, particularly because of additional money allocated for bioterrorism preparedness. The money is beginning to build an infrastructure that is being used to deal with any public health crisis, including West Nile.
"The most likely bioterrorism event is none," said Dr. Starke, who was also involved in developing a bioterrorism surveillance plan for his area.
"Our whole goal was that whatever we did for bioterrorism would improve public health in general, and West Nile is one of the first tests of that," he said. "Every day I get an e-mail from our county health department updating me on what's going on. That wasn't previously the case for a variety of these diseases. We're already seeing some small but distinct dividends."
Now they just have to figure out how to deal with public health problems without making them seem more threatening than they really are.
UPDATE: The hysteria is spreading to ornithologists in Ohio:
Laura Jordan, one of five wildlife-rehabilitation experts certified by the state of Ohio to handle bald eagles, took the ailing immature bald eagle yesterday from North Ridgeville to her Medina Bird Center sanctuary in Chatham Township.
The epidemic, she said, "is picking up, unfortunately."
"I'm scared," she added. "I don't know what this is, and we need to know what to do. I just hate to see so many birds dying." posted by Sydney on
8/25/2002 08:21:00 AM
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Malpractice Crisis Update: A litany of hospital cut-backs and closures brought to you by unlimited jury awards. And lest you think that the trial lawyers are against capping awards because its unjust to the plaintiffs, there’s this revelation:
Advocates of reducing the amount insurers have to pay for medical mistakes often cite California as a model. In the 1970's, California set a ceiling of $250,000 for jury awards for pain and suffering, and malpractice insurance prices have not soared there. But Harvey Rosenfeld of the Foundation for Taxpayer and Consumer Rights in Santa Monica, Calif., says patients have suffered. Because of the cap on payouts, he said, many lawyers refuse to represent malpractice victims, making it difficult for them to pursue claims.
Aren’t lawyers supposed to take on cases on the basis of their merits rather than their potential profitability?
The Great Unwashed: This seems condescending to me, but there's a campaign afoot at the World Summit on Sustainable Development to get Africans and Indians to use more soap. According to Valerie Curtis of the London School of Hygiene and Tropical Medicine, who is spearheading the movement:
We think that the people who can help us the most with this are the soap companies, because they're the ones who are very good at getting people to buy soap. What's new in our program is to try and encourage the soap companies to work with governments to encourage everybody to wash their hands with soap. Obviously, it's in everybody's interest. If we can make it work, soap companies are going to sell more soap. Governments can get closer to their real targets, which are to halve deaths from diarrheal disease in 10 years' time.
Africans and Indians say they have plenty of soap, thank you:
Market experts say per-capita soap use in the region rivals that of industrialized nations. At Abidjan's bustling Treichville market, soap vendor Peter Joe lays out several varieties of soap at his stall. " We use soap for bathing," he said. "We depend so much on soap. We use it everyday in our lives. We use it to clean. We use it to bathe. We use it to wash our wares. We depend so much on soap to make us to look clean."
...The lead consultant for Ghana's Community Water and Sanitation Agency, Nana Garbrah-Aidoo, says results of a study this year indicate Ghanaians are likely to be receptive to the program. "What we found from the study is that hand-washing was a habit in Ghana, but soap use was not," she said. "Soap use for hand-washing was not. We know that Ghanaians use a lot of soap. What we are trying to do is to build on those uses, which are already [common] of soap. Everybody has soap. In 95 percent of the homes we visited, there was soap."
Life Altering: The award for the most dubious life-altering medical experience goes to Rahm Emmanuel who explains his ambition and drive this way:
Mr. Emanuel traces his drive back to his teenage years, when working at a meat counter at 17, he badly cut his right middle finger but did not get quick medical attention. He developed gangrene and part of the finger had to be cut off. He spent seven weeks in the hospital and ran a fever that reached 106 degrees.
"I was a different person from that experience," he said. "I was not going to let a single moment pass when I didn't do something that makes a difference in my life."
Imagine to what heights of ambition he might have risen if he had actually had a life-threatening illness rather than a finger-threatening illness. posted by Sydney on
8/25/2002 07:57:00 AM
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