"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
ICD-9 Wonders: While looking through the ICD-9 codebook for a diagnosis code, I came across the diagnosis of dhobie itch. A "dhobie" is an Indian washerman. Evidently, they didn't dry the British colonials' underpants adequately, and so the use of "dhobie itch" in the UK for what we in the US call "jock itch." posted by Sydney on
1/10/2004 03:28:00 PM
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Mad Cow Madness: Restrictions on meat importation are making life difficult for people on Canada's Campobello Island - which is cut off from Canada by water and Maine:
Hooper said the border restrictions have reached the point where it's almost impossible to bring across a pizza or buy some dog food.
He said that earlier this week, a friend of his tried to bring home a couple of cans of chicken dog food, purchased on the U.S. side of the border in Lubec, Maine.
'He went across, got the dog food and when he got to Canadian customs, they wouldn't let him bring it in,' Hooper said.
'He went back to U.S. customs and they wouldn't let him bring it across there, so he went back across to the Canadian side and they still said 'no.'' posted by Sydney on
1/10/2004 02:05:00 PM
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Obesity Wars: The topic of obesity never fails to inflame emotions. Sandy Szwarc wrote a piece for Tech Central Stationattacking exercise. She's correct that exercise alone isn't the solution to weight loss. It has to be accompanied by a calorie-restricted diet. But she's wrong to suggest that it's worthless. Those who are able to keep weight off and keep it off are those who manage to continue dieting and exercising for the rest of their lives. Michael Fumento takes her to task:
Last summer, Sandy Szwarc wrote a big fat series (10 pieces and over 25,000 words) "Weighing Obesity" that appeared in Tech Central Station from July 14-August 8. It was sheer propaganda for the fat acceptance movement - filled with quotes from representatives of that movement, fabricated numbers such as multiplying anorexia deaths by a factor of 1000, and making such incredible assertions as "The strongest scientific evidence indicates we'll live longest and with the fewest health problems if we're in the overweight range, especially as we get older." Also, "In addition to longer life spans, fat people have lower rates of most cancers, respiratory diseases, and osteoporosis," she insisted. All of this was readily falsifiable, and I refuted it in On Weighing Obesity.
Why is it therefore not surprising that she has now gone on the offensive against exercise as well, claiming you could walk the circumference of the planet without losing a dress size or pant size? Do you think I'm exaggerating? Here's what she wrote, allegedly citing a study:
It sort of flies in the face of that simplistic myth - "burn 3,500 kcalories and lose a pound" -- doesn't it? "At about 80 kcal/mile [a "kcal" is what is normally referred to as a calorie] for a 77 kg person walking at a reasonable speed (3 to 4 mph), this works out to roughly 3,920 miles per pound, equivalent to walking from New York City to Seattle, and then down to San Diego-for one pound of fat!" My advice: Leave your pedometer at home, it probably can't count that many steps.
But did the public get this information? Hardly.
And thank goodness they didn't. Numerous readers wrote in to slam Szwarc and her fuzzy (fatty?) math. As one noted, "If you burn 80 per mile, it will take 43.75 miles to burn one pound of fat at a rate of 3,500 kcal per pound, not 3,920 miles. By Szwarc's logic, you could walk around the earth with about 7 pounds of body fat."
Truth means absolutely nothing to this woman. Fact is, for those who have lost weight and kept it off (something the fat acceptance people will tell you is impossible) exercise is not only important but practically essential. The ongoing 3,000-member National Weight Control Registry shows that over 90 percent of persons who lost substantial weight found they must exercise to keep it off. For all the arguments over high-carb and low-carb diets (in which I have certainly participated), it may well be that regular exercise, both aerobic and resistance, is the most important factor in maintaining weight loss.
There's no doubt that regular exercise is essential to keep weight off, especially for the metabolically challenged. However, I have to agree with Sandy Szwarc when she says:
Sadly, most people view themselves and others as failures if they don't lose weight with exercise, thinking if they just tried harder they wouldn't still be fat.
A lot of people don't get the message that they have to restrict their calories and exercise to lose weight. And too often, those who are overweight are looked down upon as lazy. But losing weight isn't as simple as quitting smoking or quitting drugs. Everyone's body burns off calories at rest at different rates. Some of us have to eat much less and work much harder than others to maintain an ideal body weight. We should recognize that and be a little more tolerant of the overweight.
REBUTTAL: Sandy Szwarc responds, although she mistakes me for Michael Fumento, or vice versa:
I found it startling that a medical professional would purposely misrepresent my TCS article on exercise or that you believe if exercise is not about losing weight then it has no value. That is certainly not what I wrote. It is regrettable that you would misquote the article (re: fuzzy math) without going on-line to verify the quote, and that you would intentionally misconstrue the information to deter people who could have actually been helped by this information.
As medical professionals, I feel our primary concern should be the health of people and our healthcare advice should be dispensed in a way that does no harm and is not colored by our personal prejudices. Sadly, many healthcare professionals are unable to care for patients without couching everything in terms of weight loss. For the best interests of the health of patients, it's important to separate exercise from weight loss and help people recognize the health benefits of exercise itself so that they make it a positive life-long habit, not just part of a diet.
Exercise alone (at healthful levels as recommended by every reputable medical organization and professional) does not result in appreciable weight loss and most people and studies recognize this. Helping everyone understand the health benefits of positive lifestyle habits like exercise and making it accessible to everyone, as this two-part series is discussing, should be our goal. And as you must know, the primary factors which lead to health and longevity are most determined by lifestyle factors -- regular physical activity and a nourishing diet. Whether or not that results in weight loss is irrelevant to the health of most people. Instead, when medical professionals only look at weight, they often encourage extreme weight loss measures, diets and extreme exercise that lead to proven health problems and rarely long-term weight loss. Granted such bad advice makes overweight patients valuable profit centers to the medical industry, but that's hardly best for the long-term health of our patients.
The evidence is overwhelming and sound that everyone is benefited by regular physical activity and, as unpopular as the idea may be, those benefits are independent of weight. We should be encouraging regular physical activity for everyone -- the "metabolically challenged" as you call them and thin people not dieting who aren't exempt from its importance either. It's an important health message. I hope after reading part two you will print a retraction on Medpundit. Thank you for taking the time
to consider my concerns.
Irony Watch: A lot of my patients who opt for over-the-counter herbal remedies do so because they're perceived as "natural" and less harmful to the environment than traditional drugs. (Even though the herbal medicines are produced in factories just like the ones that produce traditional medicines.) But the herbal medicine industry isn't a friend of nature. (hat tip to Iain Murray.) posted by Sydney on
1/10/2004 11:03:00 AM
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More Howard Dean: It isn't unusual to hear doctors express their support for Howard Dean's presidential campaign. They seem him as a potential savior from the mess of our healthcare system (out-of-control malpractice premiums, poor insurance and Medicare reimbursement, byzantine billing regulations, etc.) He was once a doctor with his own practice, after all. He knows what it is to deal with the hassles. Think again. Yet more evidence has surfaced to indicate that Dean is more political than medical. Especially when it comes to insurance companies:
The charitable checks and pledges were delivered to Dean and his aides in the mid-1990s by a lobbyist for the insurers. In one letter on his official stationery, Dean wrote lobbyist John L. Primmer to tell him about the status of a state tax break for the industry and to simultaneously thank him for a personal gift.
'Both of these bills have the potential to help further opportunities in this area and bring high quality economically beneficial jobs to Vermont,' Dean wrote on April 27, 1993 to Primmer, whose clients over the years included a coalition for reinsurers and the Vermont Captive Insurance Association.
'Thanks for the gift and your support. Please be in touch with further questions or comments,' the then-governor added.
....But in a 1993 letter to Dean, Primmer wrote that two insurers were sending a gift to the governor, described only as a 'package,' after Dean met with them to discuss the bill that would provide new tax breaks. Dean signed that bill into law later that year.
In 1994, Primmer donated $250 to Dean's re-election campaign. And in a series of 1995 letters, Primmer passed along a $7,500 check to Dean's school fund from insurer Commercial Reinsurance Company, and pledges for an additional $55,000 from that company and another insurer named MEDMARC.
'We greatly appreciate the flexibility your administration and it predecessors have promoted in the regulation of insurance companies,' a MEDMARC executive wrote in a 'Dear Gov. Dean' letter around the time of the donations. "
The money in question went to a Dean-sponsored charity to provide Vermont schools with computers, not to the governor's pocket. Even so, his willingness to trade favors with lobbyists speaks ill of his scruples.
In the matter of pharmaceutical company honoraria, however, Dean is more doctor than politician:
The largest sum of speaking fees -- $9,000 -- was paid to Dean for two speeches he made in spring 1998 and spring 1999 to Astra USA, now known as AstraZeneca, the pharmaceutical giant that makes the popular ulcer drug Prilosec.
....Dean was paid $4,000 for the 1998 speech, and received $5,000 more in 1999 to speak again to Astra, according to the information Dean provided to the AP.
...The new information shows Dean also received speaking fees in 1998 of $1,000 from the University of Texas Science Center, $1,000 from the American Academy of Pediatrics and $2,633 from the University of Arizona Foundation.
In all, Dean earned $13,633 in speaking fees while governor and another $5,000 after stepping down.
The article points out that other governors decline honoraria while they're still politically active. One has to wonder whether Dean has any scruples at all. (also via Upper Left)
And, when it comes to tort reform it's impossible to tell where Dean stands. Caveat emptor.
The official explanation given by former Vermont Gov. Howard Dean Sunday for why he sealed off 146 boxes of his gubernatorial files from the public for 10 years is that he seeks to protect the privacy of his correspondents.
But four letters obtained by ABCNEWS from Dean's 190 "open" files contain detailed personal medical information about Vermont citizens, perhaps undercutting his argument that his sealed records are to guard against the public dissemination of precisely that kind of letter.
One was a letter written by an HIV-positive gay man marked "extremely confidential." Also included in the "open" files are letters from a state legislator describing intimate information about a constituent scheduled for a hysterectomy; a letter from a Vermont woman regarding the death of her daughter from AIDS; and a note from a woman about her family's troubles after her husband, who has cancer, was suspended from his job.
One of those letters included the name, address, and social security number of the writer. Evidently, Dr. Dean has a different standard of confidentiality than the rest of us. posted by Sydney on
1/10/2004 09:07:00 AM
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Friday, January 09, 2004
With Malice Towards All: Ross, at The Bloviator has a look at an unbelievable med mal case in which the jury found the doctor guilty of malpractice because he followed the recommended evidence based medicine approach to prostate cancer screening. Their decision was influenced by "experts":
A major part of the plaintiff's case was that I did not practice the standard of care in the Commonwealth of Virginia. Four physicians testified that when they see male patients older than 50 years, they have no discussion with the patient about prostate cancer screening: they simply do the test. This was a very cogent argument, since in all likelihood more than 50% of physicians do practice this way.
Meanwhile, in Cleveland, other trial lawyers and their "experts" for hire are working similar mischief. Here's the story of a neurologist who lost his malpractice insurance coverage because he's been sued six times, often without merit. (Emphasis mine):
Four of the six cases against Morgenstern were dismissed before he ever met with a lawyer. One case went to trial last month. After five days of testimony, the jury decided in 50 minutes that the complaint had no merit.
...In the lawsuit heard by a Cuyahoga County jury last month, plaintiff William Lapore claimed Morgenstern failed to detect a rare blood vessel disorder of the spinal cord after Lapore came to Hillcrest Hospital in 1999 with back pain and trouble walking.
Morgenstern diagnosed the disorder weeks later. Lapore claimed the doctor should have found the problem sooner.
But jurors believed Morgenstern could not have detected it initially, based on Lapore's symptoms and diagnostic tests, said jury foreman Jerry Wise man.
"Eight jurors voted that Morgenstern provided the standard of care. In fact, we felt he went above and beyond the call of duty," Wiseman said Friday.
"We felt he was an exceptional doctor," Wiseman said. "A couple jurors said if we ever had a need for a neurologist, we would go to Dr. Morgenstern."
Judge Timothy McGinty called the case "frivolous."
"They paid these experts who sign affidavits, and I can't throw the case out," the judge said.
...A lawsuit filed against Morgenstern in 1995 was dismissed because the plaintiff had no expert witness. The suit was brought by the estate of a man who died six weeks after he came to the hospital with dizziness and gastrointestinal illness. The suit was refiled in 1997 and dismissed again.
Morgenstern was named in another 1997 lawsuit brought by a man who was hospitalized with heart trouble in 1996. Morgenstern had treated the patient for migraines five years earlier and had not seen him since. The case was dismissed.
One case is pending in Cuyahoga County from a patient who suffered a stroke several weeks after visiting Morgenstern with dizziness and other problems. The man claims the medical workup missed the signs. The plaintiff has no lawyer of record. Morgenstern said in a counterclaim that the suit is frivolous and reckless, resulting in his loss of malpractice insurance and income. Morgenstern is asking for damages.
"Part of me is really glad I'm leaving. Part of me is really sad," he said. "If you do good medicine, it doesn't mean anything. If somebody wants to sue you and get a doctor to swear there was malpractice, they're there."
We need a system in which lawyers are held just as accountable for their actions as the people they sue.
posted by Sydney on
1/09/2004 10:01:00 PM
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Anthrax Reprieve: The federal judge who accused the government of using members of the armed services as "guinea pigs" in the anthrax vaccine program, has lifted his injunction, and as a result, the Pentagon has resumed anthrax vaccines. The matter, however, is far from finished:
Lawyers for the six plaintiffs said they would appeal and attempt to make the case a 'class action' lawsuit when they return to court next week.
'In the absence of a proven correlate of immunity between humans and animals, specific to anthrax infection, the FDA's Final Rule's reliance on animal data is illegal, and reflects an arbitrary and capricious decision. Therefore, the government's victory today may only be fleeting,' said attorney Mark Zaid.
In a related vein, there's this email from a reporter who covers military affairs. It's hard to take it seriously since it starts with a patent falsehood - the claim that the current vaccine isn't the same one originally licensed in 1970:
It's unfortunate that you didn't do real research before writing your recent piece bemoaning the lawsuit on the anthrax vaccine.
You might have discovered several significant points:
* The current vaccine is NOT the same as the vaccine licensed in 1970. First, the original small batch production vaccine was differen from the one used in the Brachman studies used to establish safety and efficacy. Even more important, the current vaccine is different from the one used up until late 1990 -- in an effort to dramatically increase production at the Pentagon's request in preparation for the 1991 Gulf War, the then state-owned Michigan lab changed the filters used to strain out the Protective Antigen believed to provide immunity, resulting in increases in the concentration of PA as much as 100 times the original levels. (The amount of PA varies widely from lot to lot and even from dose to dose -- there is NO standard for the minimum or maximum amount of PA in a dose.)
The current vaccine is the one licensed in 1970. It's not identical to the one tested on the mill workers, but it was very similar and it went through its own testing before being licensed:
On April 14, 1966, CDC submitted an IND for the anthrax vaccine to the Division of Biologics Standards, which was then part of NIH, later transferred to FDA. The method of preparing this vaccine was similar, but not identical, to the vaccine used in the Brachman et al. study. The vaccines in both studies were based on the immunity induced by the protective antigen (PA). Persons receiving the vaccine made by the two different methods demonstrated similar peak immune responses (antibody concentration) following the initial three doses. Textile employees and laboratory workers were immunized under this IND. A number of lots of investigational vaccine used by CDC under this IND were manufactured by the Michigan Department Public Health (MDPH), the original manufacturer of the anthrax vaccine, which eventually became known as BioPort.
The data submitted to the Division of Biologic Standards described CDC's experience with approximately 16,000 doses of anthrax. This vaccine was administered to approximately 7,000 study participants. Reported local reactions at the immunization site ranged between three percent to 36 percent of the initial series of doses, and three percent to 33 percent of the booster doses, depending on the lot. Reported mild reactions were three percent to 20 percent of all doses. Reported moderate local reactions were one percent to three percent of doses. Severe reactions were reported for less than one percent of doses. Systemic reactions were reported in four cases during the five-year reporting period. These reactions included fever, chills, nausea and general body aches, and were reported to have been transient. The Division of Biologics Standards determined that the data submitted by CDC supported licensure of the vaccine. On November 10, 1970, the Division of Biologics Standards issued a product license to MDPH to manufacture anthrax vaccine.
That's the final licensed vaccine that was tested on 7,000 people, not the initial investigational vaccine used in the 1950's on the mill workers. And as to purity, the FDA most certainly monitors the quality of vaccines being produced. There's no substantial evidence that they're doing otherwise with the anthrax vaccine. The sticking point here seems to be that the people in the final trial weren't exposed to inhalational anthrax to see how effective it was against the actual disease. As I pointed out in the Tech Central Station piece, to have done so would have been unethical.
But, back to my sneering correspondent:
* When the FDA first examined the 1985 proposed rule, its advisory committee determined that there was NO evidence to show that the then-existing anthrax vaccine provided protection against inhalation anthrax. To date, they have shown no studies to refute that finding, yet the 1985 rule is the one the FDA suddenly approved in the wake of the court order.
Of course not. As I said before, it would be unethical to deliberately expose people to inhalational anthrax. We'll never have that sort of data for any anthrax vaccine.
* The nation's most knowledgable scientists on anthrax and anthrax vaccine, at the U.S. Army Research Institute on Infectuous Diseases, produced several articles in peer-reviewed scientific journals in the early and mid-90s calling for an improved vaccine, based on recombinent processes, saying it was necessary because the existing vaccine had 1) questionable effectiveness against inhalation anthrax and 2) had an unacceptably high rate of adverse reactions.
He doesn't say who these "most knowledgeable" scientists are, but their opinion on adverse reactions appears to be mistaken:
In AVA prelicensure evaluations, 6,985 persons received 16,435 doses: 9,893 initial series doses and 6,542 annual boosters. Severe local reactions (defined as edema or induration >120 mm) [swelling and bumps -ed.] occurred after 1% of vaccinations. Moderate local reactions (defined as edema and induration of 30 mm--120 mm) occurred after 3% of vaccinations. Mild local reactions (defined as erythema, edema, and induration <30 mm) [redness, swelling and a bump-ed.] occurred after 20% of vaccinations.....
.... In AVA prelicensure evaluations, systemic reactions (i.e., fever, chills, body aches, or nausea) occurred in <0.06% (in four of approximately 7,000) of vaccine recipients.
And here's the data on adverse events since the military began using the vaccine:
...Data regarding potential adverse events following anthrax vaccination are available from the Vaccine Adverse Event Reporting System (VAERS). From January 1, 1990, through August 31, 2000, at least 1,859,000 doses of anthrax vaccine were distributed in the United States. During this period, VAERS received 1,544 reports of adverse events; of these, 76 (5%) were serious. A serious event is one that results in death, hospitalization, or permanent disability or is life-threatening. Approximately 75% of the reports were for persons aged <40 years; 25% were female, and 89% received anthrax vaccine alone. The most frequently reported adverse events were injection-site hypersensitivity (334), injection-site edema (283), injection-site pain (247), headache (239), arthralgia (232), asthenia (215), and pruritis (212). Two reports of anaphylaxis have been received by VAERS. One report of a death following receipt of anthrax vaccine has been submitted to VAERS; the autopsy final diagnosis was coronary arteritis. A second fatal report, submitted after August 31, 2000, indicated aplastic anemia as the cause of death. A causal association with anthrax vaccine has not been documented for either of the death reports. Serious adverse events infrequently reported (<10) to VAERS have included cellulitis, pneumonia, Guillain-Barr? syndrome, seizures, cardiomyopathy, systemic lupus erythematosus, multiple sclerosis, collagen vascular disease, sepsis, angioedema, and transverse myelitis (CDC/FDA, unpublished data, 2000). Analysis of VAERS data documented no pattern of serious adverse events clearly associated with the vaccine, except injection-site reactions. Because of the limitations of spontaneous reporting systems, determining causality for specific types of adverse events, with the exception of injection-site reactions, is often not possible using VAERS data alone.
To summarize, out of 1,859,000 doses there has been two deaths, two severe allergic reactions (anaphylaxis) and less than ten coincidental diseases. Sounds about as safe as any childhood vaccine.
* The Department of Defense, in 1996 (almost two years before ordering the mandatory vaccination program), prepared and filed an Investigational New Drug application with the FDA, seeking to both change the schedule of vaccinations and approve the vaccine for use against inhalational anthrax. That IND is still pending; government documents indicate that is because DoD (and Bioport, the manufacturer now) have been unable to meet the requirements for approval.
Could that be because to prove its effectiveness against inhalational anthrax the tests would have to actually expose people to it? Again, unethical.
* The National Academy of Science (NAS) produced four reports that dealt with anthrax vaccine. All of those reports, except the last one, admitted there was insufficient evidence to show long-term vaccine safety. The final report, by the Committee to Assess the Safety and Efficacy of Anthrax Vaccine, acknowledged that "statistically significant elevations in rates for outpatient visits were also found for certain malignant neoplasms, portal vein thrombosis, and acute pulmonary heart disease, among others" (page 118 of The Anthrax vaccine: Is It Safe? Does It Work? National Academy Press, Washington D.C. March 2002). Furthermore, there were higher rates of hospitalizations for diabetes, asthma, Crohn's Disease, thyroid cancer, in situ cervical and breast cancer, other intestinal disorders and multiple sclerosis (ibid, pp 120-121).
That fourth committee, paid for by DoD, never said the vaccine had proven long-term safety; the best they could come up with was to conclude that the lack of data showed "no convincing evidence at this time that personnel who have received AVA have elevated risks of later-onset health events," dismissing seven different studies that showed a link between anthrax vaccinations and health problems and their own acknowledgement of "statistically significant elevations" of complaints.
No studies have definitively documented occurrence of chronic diseases (e.g., cancer or infertility) following anthrax vaccination. In an assessment of the safety of anthrax vaccine, the Institute of Medicine (IOM) noted that published studies reported no significant adverse effects of the vaccine, but the literature is limited to a few short-term studies. One published follow-up study of laboratory workers at Fort Detrick, Maryland, concluded that, during the 25-year period following receipt of anthrax vaccine, the workers did not develop any unusual illnesses or unexplained symptoms associated with vaccination. IOM concluded that, in the peer-reviewed literature, evidence is either inadequate or insufficient to determine whether an association exists between anthrax vaccination and long-term adverse health outcomes. IOM noted that few vaccines for any disease have been actively monitored for adverse effects over long periods and encouraged evaluate of active long-term monitoring studies of large populations to further evaluate the relative safety of anthrax vaccine. Such studies are under way by the Department of Defense.
CDC has conducted two epidemiologic investigations of the health concerns of Persian Gulf War (PGW) veterans that examined a possible association with vaccinations, including anthrax vaccination. The first study, conducted among Air Force personnel, evaluated several potential risk factors for chronic multisymptom illnesses, including anthrax vaccination. Occurrence of a chronic multisymptom condition was significantly associated with deployment to the PGW but was not associated with specific PGW exposures and also affected nondeployed veterans. The ability of this study to detect a significant difference was limited. The second study focused on comparing illness among PGW veterans and controls. The study documented that the self-reported prevalence of medical and psychiatric conditions was higher among deployed PGW veterans than nondeployed veterans. In this study, although a question was asked about the number of vaccinations received, no specific questions were asked about the anthrax vaccine. However, the study concluded that the relation between self-reported exposures and conditions suggests that no single exposure is related to the medical and psychiatric conditions among PGW military personnel. In summary, current research has not documented any single cause of PGW illnesses, and existing scientific evidence does not support an association between anthrax vaccine and PGW illnesses. (emphasis mine)
Back to the email:
* One of the government's top researchers, in a 1998 interview, described the vaccine to me as "1950s technology unimpeded by medical progress." He went on to describe how there is NO control not only of the level of PA in the vaccine but also no testing or controls of other compounds in any given lot -- basically, no one knows exactly what else is in any given shot of anthrax vaccine.
Personally, I find this hard to believe. The FDA has a reputation for being overly cautious when it comes to the contents of vaccines and other medications. There's no evidence that they've been deliquent in overseeing the anthrax vaccine manufacturer. (Although the method of producing it is 1950's technology, and one can make an argument that better methods of making the vaccine can be found.)
I have personally interviewed dozens of veterans who had suddenly developed serious health problems after getting the anthrax vaccine. No, that's not scientific proof the vaccine is at fault -- but it does suggest a correlation that deserves honest scientific study. Yet DoD has consistently stonewalled and impeded such studies, while continuing to funnel a $245.6 million contract for the vaccine to a company that has a former chairman of the joint chiefs as a major owner.
He doesn't say who that former chairman is who owns the company, but that seems to be a pretty serious accusation against the Department of Defense. It, too, is hard to believe since studies on Gulf War Syndrome have not been "impeded," as Michael Fumento points out.
There are those who think that all vaccines are inherently dangerous. Unfortunately, a few of those who happen to be in the military are trying to derail a vaccine that could make a difference between victory and defeat in the war on terrorism. posted by Sydney on
1/09/2004 07:51:00 AM
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Wednesday, January 07, 2004
Apologies: Sorry blogging's been light. Parenting and professional duties are getting in the way. One of those duties last night involved writing a letter of necessity for Synagis®, a vaccine to combat a respiratory virus in premature babies. My patient meets the criteria, yet, as I wrote the letter I couldn't help wondering if the vaccine was really worth the cost. It's given once a month at the hefty sum of $1100 a dose. It does reduce hospitalizations due to the virus it targets, but only from 12.8% to 7.9% in babies like my patient. And last year I had two patients (twins) who were hospitalized for the virus despite getting the immunization. But, I suppose the insurance companies must feel they'll save more in prevented hospitalizations than they'll pay for vaccine, otherwise they wouldn't cover it. posted by Sydney on
1/07/2004 08:23:00 AM
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Monday, January 05, 2004
Gallery of Nostrums: Some old potions from the FDA. Note the "Obesity Cream." Evidently it's not a purely modern affliction. posted by Sydney on
1/05/2004 12:50:00 AM
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Can't Get No Satisfaction: The New England Journal of Medicine last week also ran an interesting essay on physician dissatisfaction. It's nothing new:
Earlier generations of physicians had experience with much of the anxiety that we sometimes assume is unique to modern medical practice. "A doctor's life is made up of moments of terrible nervous tension," wrote one physician in the early 20th century. "A sudden turn for the worse in a convalescent patient, an incurable who cries for relief, the impending death of a patient, the ever present possibility of an untoward accident or mistake. . . . There are times when the powers to continue such a life are entirely exhausted and you are seized with such depression that only one thought remains — to turn your back on all and flee."
Add to that inherent tension the escalating malpractice premiums, dwindling reimbursement, and paperwork hassles of today, and you have to wonder why anyone would go into medicine. Well, it's actually not so bad. You get to meet interesting people. Once in a while you get to make a difference in someone's life. And you can't be outsourced. (Unless you're a radiologist.) posted by Sydney on
1/05/2004 12:42:00 AM
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Anatomy of a Practice: The sad story of a young cardiologist and his struggle to stay afloat:
Lewis didn't take home a paycheck in June, July, September or October. He worked 10- to 12-hour days, six days a week, and estimates that he averaged around $30 an hour this year for his efforts. (Lewis declined to specify his income, but using the figures he provided for this story, it would appear he made about $100,000 during his best years.)
...At 44, Lewis has been able to save little money for retirement. He still pays $320 a month to cover medical school loans. His wife's job provides health insurance for them both.
..."I think we're running a really tight ship right now," says Katherine Lewis, who managed to trim about $4,200 in monthly costs by reducing the phone bill, bringing in another doctor to share the office space and laying off the office manager.
"Even if you're an excellent businessman, it isn't going to cut it," she says. "There's always something, and the medical system doesn't give you enough cushion."
In 2000, the office flooded, causing more than $20,000 in damage. In 2001, an office theft cost the practice $14,000 before it was discovered. Both incidents left the practice cash-poor for several weeks until insurance payments came in. Then, earlier this year the practice moved into a new space, which cost more than $40,000 to outfit.
This year, Lewis's malpractice insurance increased from $12,000 to $18,000. Lewis has never been sued, and has no complaints on file with medical boards in Maryland or the District.
...."During the first year, I was just really, really frustrated, because I'd install a pacemaker and have no hope of getting that to my bottom line," he said.
On Aug. 7, Lewis handles a case that seems unlikely to get bogged down in the reimbursement process: an hour of patient consultation that he values at $195, even though Medicare's set rate for the service is $127.68. Lewis collects the patient's co-payment of $25.54 on the day of the visit, and, if all goes without a hitch, he will collect $102.14 about six weeks later.
Meanwhile, in the adjoining room, Lewis's secretary grapples with a worst-case scenario: She's trying to figure out how $3,460 worth of services billed a week ago has become a $345 item in the practice's computer system. She can't log into the online bill-monitoring system the practice pays $150 a month to use. The billing agent who collects 8 percent of every bill paid by insurance companies is unresponsive, so she spends up to five hours a day auditing the bills.
Lewis looks over her shoulder and shrugs helplessly. Collecting 45 percent of billed charges is the best anyone can hope for, he says, because collecting more than that requires too much effort.
...In a typical month, Lewis said, the practice took in $18,000 to $25,000 in gross revenue. From that figure he had to pay rent, phone bills, loan payments, malpractice insurance, the lawyer, the accountant, the billing agent, the secretary, the copier lease, office supplies, staff health insurance and computer support. This left him with about half the gross to pay himself. Some months, there was nothing to take home after the bills were paid.
"We looked very hard at the trends, and they are only going down," Lewis said. That was the last straw. "We all value taking home a paycheck as a sign of respect."
Dr. Lewis closed his practice and took a job with the FDA testing pacemakers. Poor guy. I feel his pain. posted by Sydney on
1/05/2004 12:13:00 AM
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Mystery Case: The New England Journal of Medicine has another mystery case up this week. We're supposed to guess what's in this guy's stomach. Whatever it is, it's heavy, because it's pulled his stomach all the way down into his pelvis. Looks like paper clips to me, but I always get these mystery cases wrong. No answer until February. posted by Sydney on
1/05/2004 12:09:00 AM
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