"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
Go West, Young Doctor: Colorado is seeing an influx of medical talent from the East:
Nearly half of the 2,178 doctors who have moved to Colorado in the past year fled what the American Medical Association calls malpractice 'crisis states,' according to Peregrine Management Corp., a Denver firm that tracks data on physician practices. Another 863 doctors relocated from states that the AMA says are nearing a malpractice-insurance crisis.
'People are just flooding out of Midwestern states,' said Dr. Diane Schmitz, an obstetrics and gynecology specialist who practices at the new Centura Parker Adventist Hospital southeast of Denver.
And why can Colorado offer insurance at rates that are often $100,000 a year less than other states?
Colorado has strict limits on how much money patients can recover from lawsuits - no more than $300,000 in what typically amounts to pain-and-suffering damages. Generally, Colorado doctors pay less than half what their colleagues are charged for malpractice coverage in other states, according to COPIC Insurance, the state's largest medical insurer.
"Even if you get a big (jury) award, the court will cut it back," said Denver malpractice attorney Richard Caschette.
UPDATE: At least one reader is living it:
Last summer, my internist moved from Minnesota to Colorado because of malpractice insurance costs.
My wife has to fly from Minneapolis to Denver to see her lung specialist.
Surveillance II: The Ohio Department of Insurance is launching an investigation into malpractice carriers who deny coverage to nursing home doctors, and Democrats in the State Senate are looking into it, too. We should be careful what we ask for, though, we just might get it:
``Clearly, as a business, they have the ability to pick and choose who they do business with,'' said Peter Van Runkle, president and chief executive of Ohio Health Care Association, a nursing home trade association. ``Anything where you try to force insurers to do something... you run the risk of running carriers out of the state and reducing availability, which is the last thing we need.'' posted by Sydney on
3/06/2004 08:18:00 AM
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Surveillance: Trial lawyers in Texas are up in arms about a website called Doctors Know Us that's a database of malpractice plaintiffs. Their slogan - 'They can sue, but they can't hide.' I've got to agree with the head of the Texas Medical Association, though:
'What this Web site represents is the bubbling up of frustration that many doctors have had with frivolous lawsuits,' Allen said. 'Patients nowadays have a right and do get a lot of information about doctors before they go see their doctors and there's certainly nothing that should prevent doctors from being aware of the small number of patients who abuse the system.'
But Allen added that he doesn't expect the Web site to attract many customers.
'Doctors are not about restricting access to health care and blacklisting patients,' he said. 'Doctors are about improving access and taking care of sick folks.'
Ten of the 13 scientists who produced a 1998 study linking a childhood vaccine to several cases of autism Wednesday retracted their conclusion.
In a statement that will be published in Friday's issue of the Lancet, a London-based medical journal, the researchers said they did not have enough evidence at the time to tie the measles, mumps and rubella vaccine, known as MMR, to the autism cases. The study has been blamed for a sharp drop in the number of vaccinations among British children and for outbreaks of measles.
So why did they feel so confident about giving their imprimatur to the article in the first place? What's even more astonishing, when you look at the abstract of the paper, is that The Lancet ever saw fit to print it. It was, at best, a very very weak case. The study looked at twelve children who already had developmental problems and chronic gastrointestinal disease. There were no control subjects. The only link to autism and the MMR vaccine was the parents' perception of a link:
Onset of behavioural symptoms was associated, by the parents, with measles, mumps, and rubella vaccination in eight of the 12 children, with measles infection in one child, and otitis media in another. All 12 children had intestinal abnormalities, ranging from lymphoid nodular hyperplasia to aphthoid ulceration. Histology showed patchy chronic inflammation in the colon in 11 children and reactive ileal lymphoid hyperplasia in seven, but no granulomas. Behavioural disorders included autism (nine), disintegrative psychosis (one), and possible postviral or vaccinal encephalitis (two).
Autism is a disorder that can only be diagnosed by observing problems in social interaction and language development. By definition, these problems can only begin to be recognized between the ages of 12 and 15 months. The MMR vaccine is given between the ages of 12 and 15 months. Saying that the MMR vaccine causes autism is like saying that learning to walk causes it. Autism and the MMR vaccine (and learning to walk) all happen at about the same time in a child's life. It's time to put this issue to rest. The editors of The Lancet and the authors of the study should have had the clarity of thinking to realize that, even in 1998. The fact that they didn't speaks volumes about the state of science in medicine. posted by Sydney on
3/04/2004 10:27:00 AM
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Wednesday, March 03, 2004
Estrogen Hysteria Resumes: In another blow to hormone replacement therapy, the Women's Health Initiative, has stopped its estrogen-only study because there were more strokes in women who took the drug than in those who didn't. The margin of difference was 0.08%:
The estrogen-alone study found an increased risk of stroke similar to what was found in the earlier study - eight more strokes per year per 10,000 women on the hormone, according to a statement released by the NIH. However, women taking only estrogen had fewer hip fractures; no numbers were released.
The news release from the NIH can be found here. You can bet that there will be yet more attempts at class action lawsuits against estrogen based on this study. The problem is, there are a lot of elderly women out there who have been taking estrogen replacement therapy and who have had strokes. But chances are that the majority of those strokes weren't caused by estrogen, but by aging blood vessels. Not when the increase in risk is only 0.08%.
I've been seeing a number of women lately who come in after reading ads from attorneys urging women to call if they've been on estrogen and progesterone and have had a heart attack or a stroke. Even if my patients have had neither, they're convinced that taking their hormone replacement therapy means that they will. They figure if the evidence is good enough to support a lawsuit, then it must mean that strokes and heart attacks are inevitable on hormone replacement therapy.
And it makes doctors reluctant to prescribe the drugs, even when patients ask for them. Even when the risks, however minimal, are discussed. The same strategy being used by class-action lawyers will be the same strategies used by malpractice lawyers. It's a pity, because what the study is really saying is that these hormones don't protect against these diseases as we once thought they did. The hormones do have risks, as does every drug, natural and non-natural, but they also have their uses. They're the only effective treatment we have for hot flashes and vaginal dryness. It would be a shame if doctors decided it was no longer worth the risk to prescribe the drugs or pharmaceutical companies that it's no longer worth the risk to manufacture them. The litigation risk, that is.
Tort Reform Conversion: From the letters to the editor of our local paper, a tort reform convert who was rear-ended (without injury) on the road to Damascus:
Since then, I have received no fewer than 15 solicitations from local and Cleveland-based lawyers pressing, asking, pleading for me to allow them to represent me in personal-injury litigation -- all telling me this is an ``advertisement'' and not a solicitation. (They all emphasize that they only get paid when I receive settlement funds).
They yell in highlighted pre-packaged glossy advertisements, ``Don't sign anything until you talk to an attorney!'' My favorite was from a handsome, young-looking attorney with his big smile pictured on his business card. He related his experience of not seeing a doctor after an accident when he was 16 years old, and how he's had terrible back and neck pain ever since. Wow, what a warning to me!
....Where is the dignity and ethics that have long been espoused by the legal profession? Do lawyers not monitor their peers to prevent such unethical and intrusive marketing efforts?
I've never experienced such an onslaught of unwarranted solicitations by any group that professes to be professional and reputable. I've always been opposed to legislative tort reform, but after receiving the law firms' junk mail as a result of my very minor accident, I may need to rethink my position.
"Do lawyers not monitor their peers?" No, they don't. And they'll parse the words of the law to defend their right to solicit cases. posted by Sydney on
3/03/2004 07:24:00 AM
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Political Medical Watch: Politicians are always eager to prove to the publid that they're medically fit. American politicians jog and toss footballs. And British politicians kick kick soccer balls. But I love the answer Margaret Thatcher gave a reporter after she had eye surgery:
"I can see clearly this morning," she said. "I can see everything that's wrong with you."
Thanks, Nigeria: The polio vaccine paranoia of northern Nigerian officials is having consequences for other African countries:
Ivory Coast is the eighth previously polio-free country in Africa where the crippling disease has reappeared in recent months. Its last polio case was reported in July 2000.
Nigeria is believed to have also exported the infections to the seven other previously polio-free African countries: Benin, Burkina Faso, Cameroon, the Central African Republic, Ghana, Togo and Chad. The World Health Organization says the exported cases and continued opposition to polio vaccination by religious and political leaders in the northern states of Nigeria are jeopardizing its efforts to eradicate polio by the end of this year. posted by Sydney on
3/01/2004 08:09:00 AM
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Looking for Love: A University of Alberta researcher went to great lengths to falsify research results, and caused his lab a great deal of grief in the process. His motivation:
"According to Mr. Xu,' says the U.S. report, 'his motivation for falsifying experimental results was the wish to obtain exciting, desirable results which would win him the approval and praise of XXX.' 'XXX' is unidentified in the report to protect confidentiality.
Soprano Psychiatry: I always thought one of the subtexts of The Sopranos is the uselessness of routine psychotherapy, although the point seems to be lost on a lot of psychiatrists. Now David Chase confirms it:
CHASE: ....... I wanted to present therapy scenes as they are. Because a lot of therapy — let's face it — is [expletive].
HEFFERNAN: Therapists love this show, though.
CHASE: They understand a lot of it's [expletive]. I'm sure they know that most of what we, as patients, present is filler.
Serving: My daughter's girl scout troop spent yesterday working at a soup kitchen (or "family nutritional center"). A sign they had posted, likely for the benefit of the volunteers, caught my attention. It said, "We don't like politics here, we like God's compassion." A gentle reminder in this rancorous political season that we may disagree on how best to achieve a goal, but we still mostly have the same goals in mind. It's a message that some other charitable groups would be wise to heed, even if they don't believe in God. posted by Sydney on
2/29/2004 09:46:00 AM
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