"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
Governing Medicine: The New Jersey Senate has introduced a measure that would make charging for extra services illegal - at least if you're a doctor: "
Health-care providers would be prohibited from billing patients insured by health maintenance organizations for fees beyond the co-pay amount or deductible under a measure endorsed by a Senate committee yesterday.
Lawmakers said doctors and health facilities were charging patients for e-mails, phone consultations, and requests for prescription refills.
'It is becoming increasingly common for doctors to charge their patients 'access fees' on a monthly or yearly basis above and beyond the health-care plan's set co-pays,' said Sen. Joseph Vitale (D., Middlesex), a sponsor of the bill.
'While I appreciate that there are many services provided by physicians that are not covered by insurance plans, it is not right for doctors to go beyond the contract they signed with the HMO and pass those costs on to the patient. It is simply not fair to the patient,' Vitale said.
I guess in New Jersey, doctors will just have to stop offering those services. posted by Sydney on
10/09/2004 06:02:00 PM
0 comments
And About that Vioxx... I missed this, but Cleveland Clinic interventional cardiologist Eric Topol had a New York Times op-ed last weekend that blasted Merck and the FDA over Vioxx, while patting himself on the back:
In 2001, I was part of a team from the Cleveland Clinic that published a paper demonstrating the significant heart attack risk of Vioxx. Our research, published in The Journal of the American Medical Association, found that compared to naproxen, a commonly used over-the-counter anti-inflammatory drug with similar benefits, Vioxx has a five times greater heart attack risk. In response, Merck claimed that early conclusions about the risk were flawed, and attributed the comparatively high heart attack rates to an unproven protective effect of naproxen. Our study was followed by several others demonstrating Vioxx's dangers. Each time Merck had a similar reply: the study was "flawed."
No need for the scare quotes. Dr. Topol's study was flawed. It compared Vioxx, which doesn't inhibit platelets, with Naprosyn, which does.
(Platelets play a critical role in blood clotting.) To further confuse things, his study also found no difference in cardiovascular events between Celebrex, a drug similar to Vioxx, and other drugs similar to Naprosyn. To top things off, the number of cardiovascular events were too small to make much of a conclusive statement. Even his concluding statement was not "these drugs are dangerous," but that these drugs need to be studied a little more.
Merck finally had to acknowledge the truth, but only by accident. The company undertook a large, randomized trial of 2,600 patients with colon polyps in hopes of proving that Vioxx could help their condition. In the process, though, Merck discovered that 3.5 percent of patients taking Vioxx suffered heart attacks or strokes as against 1.9 percent taking a placebo. Merck at last did the right thing by voluntarily and abruptly taking Vioxx off the market.
There are two important issues to consider here. First, the risk of heart attack or stroke found in the Merck study, at 15 cases per 1,000 patients, may be greatly underestimated. Merck's trial did not include anyone with known heart disease - patients who might be expected to have the highest risk.
I think that would be 14 cases per 1,000, but why nitpick? (Bad math on my part, it is 15 -ed.) What about the risk of aspirin, which I'm sure that Dr. Topol recommends for all, of his patients? 3 out of 1,000 people who use aspirin daily to prevent strokes and heart attacks will either either bleed from their gut or bleed into their brain. And that's just healthy people. The risk goes up for those who have had gastroinestinal bleeding, or who have uncontrolled hypertension, or who are very elderly - the very people who are the most likely to have cardiovascular disease and thus be placed on aspirin. Clearly, Dr. Topol, and most physicians, believe the benefits of aspirin therapy outweigh these risks. That's why so many of us insist that everyone with heart disease be on aspirin, regardless of their other risks. Cardiologists even push this further. Many of them insist on aspirin therapy for people who have already had hemorrhagic strokes or GI bleeds. They only care about the heart and its risks.
Which brings us to the real problem with Dr. Topol's angry missive. He only sees the world and his patients through cardiovascular glasses. Maybe an elderly patient with arthritis would prefer to take the 1 to 2 percent risk of a heart attack to get rid of his joint pain. Only the patient knows how much the relief is worth. Not Dr. Topol. Not me. But Dr. Topol wants to take these pain relief options away from millions of arthritis sufferers:
And the problem may extend beyond Vioxx and its users. While it's true that when compared to the other Cox-2 inhibitors, Vioxx has repeatedly carried a far greater risk of heart attack and stroke, none of the manufacturers of Vioxx's class of drugs, called Cox-2 inhibitor agents, have studied patients who already have heart disease. The number of patients who may have sustained heart attack or stroke as a result of using these drugs could be tens of thousands. It would be premature to conclude that the other drugs still on the market, like Celebrex and Bextra, do or do not carry some risk of heart attack until sufficient testing is done.
While we remain in this zone of uncertainty, people with arthritis should remember that conventional over-the-counter agents like naproxen (as in Aleve) or ibuprofen (as in Advil) work extremely well, are much cheaper than the Cox-2 agents, and are not known to have any risk of heart attacks. In addition, one of the most-cited benefits of the Cox-2 agents - that they are less likely to cause stomach ulcers than over-the-counter drugs - may ben grossly exaggerated.
My experience has been that fewer patients complain about stomach upset with Cox-2 agents than with traditional NSAIDs. I've also never had to admit someone with a GI bleed caused by them, despite what the research says. I can't say the same thing for the NSAID class. I've admitted many. And, it ignores the fact that everyone responds differently to each of these arthritis drugs. I have many patients who have only turned to Cox-2 drugs when the NSAIDs failed to relieve their pain - and they've been successful. Things aren't supposed to work this way, according to textbooks and experts, but they do.
...As the Vioxx debacle shows, we have a long way to go in this country to get on track with prescription medications. Most important, we need a stronger regulatory agency to compel pharmaceutical companies to do the proper studies and force these companies to stop direct-to-consumer advertising unless a drug has major benefits for patients and negligible increased risk of heart attacks and strokes.
Our two most common deadly diseases should not be caused by a drug.
I'm not terribly fond of direct to consumer advertising for prescription drugs, either, but that's a rant for another day. But it's a dreadful exaggeration to say that these drugs "cause" heart attacks and strokes when the difference between the difference in strokes and heart attacks between Vioxx and placebo was only a little over 1%. Clearly, something else causes them - aging being the biggest culprit.
As one of my patients told me when I recommended she go on cholesterol lowering medication - "No thanks. I'd rather die young of a heart attack than live long enough to get cancer." I'm sure there are more than a few elderly people who would be willing to take the very small risk of a heart attack or stroke if it meant walking without pain. But if Dr. Topol and his ilk have their way, they'll never be given that chance.
UPDATE: Corrected my bad math error. Good thing I live in the age of calculators. posted by Sydney on
10/09/2004 02:16:00 PM
0 comments
Reassuring: Looks like Australia had a milder flu season this year than last. Since the Northern Hemisphere usually gets the same type of flu that the Southern Hemisphere gets, this may bode well for us in this season of vaccine shortages. I hope so. I'm dreading it since so few of my patients will be immunized. posted by Sydney on
10/09/2004 01:10:00 AM
0 comments
Friday, October 08, 2004
The Debate: I had to watch this one alone, without my pro-Kerry spouse or my wiseacre pre-teen, which makes the whole process less entertaining, but I thought it was a very good debate. Bush did very well, exceeding my hopes for him after that last horrible debate. Kerry did well, too, and if I agreed with any of his positions, I would probably give him the win. But, I agree with Bush, so of course I think he won.
Bush began the debate sounding too whiney. This was his problem in the last debate, too. His voice tends to go up to a higher register when he's ticked off, and I think he gets ticked off listening to Kerry talk about Iraq. He also fell back too frequently on that whole Kerry's-too-wishy-washy-to-lead theme which went on too long in the first debate. But, thankfully, both his voice and his arguments moved on to better things. Kerry's voice is better, even when he raises it, but he points his finger too much when talking. Maybe it's just me, but that comes across as condescending to the audience. I was watching him after the debate on Fox and ABC as he mingled with the crowd and he does the same thing in a one-on-one exchange.
When it came to the stem cell and abortion questions, Bush seemed better informed. Kerry fell back on celebrity recommendations for stem cell research - Michael J. Fox says embryonic stem cells will cure Parkinson's, so it must be a good and worthy cause. But he ignored the question, which pointed out that only adult stem cell therapy has shown therapeutic promise so far. Bush addressed the need to strike a balance between the ethics and science. And as far as abortion, especially partial-birth abortion, Kerry had no defense. Saying he respects his questioners' pro-life views and pointing out that he's a Catholic only highlighted the ethical contradiction in his unwavering support for partial-birth abortion.
Both candidates were boring when it came to the healthcare issue. I heard blah, blah, blah, and it's an issue I care about. But, then, I think it's also an issue that needs more than 2 minutes to explain, and to explain well. They both just resorted to their standard sound-bites. Same with tort reform.
By the way, my pro-Kerry spouse thought that Cheney cleaned Edwards' clock last week. Maybe his expectations for Edwards were too high, but he had to leave the room a couple of times, he found it so painful. Just thought that was worth mentioning given all the pro-Edwards post-debate spin in the media. posted by Sydney on
10/08/2004 11:01:00 PM
0 comments
Flu Blues: My ears are still ringing from all the calls we've been taking this week about the flu vaccine shortage. No vaccine on the horizon for my patients. Although here's a community whose "flu clinics" gave all of their shots to doctors so they could be given to people who need them.
The vaccine shortage has made me wax nostalgic for my early medical days when, not only were there more vaccine producers, but the vaccine was given with discrimination, to only those who were at most risk for influenza complications. I can't recall any shortages of the vaccine back then. But then, we stopped being discriminating in our use of the vaccine. Companies began to buy up huge quantities of it to give to their young, healthy employees so they could cut down on absenteeism. Drug stores and grocery stores began to offer it to all comers - sometimes as a promotional gimmick. And the shortages began. There simply isn't enough margin of error in the vaccine supply to allow every man, woman, and child to get an influenza vaccine without compromising the access of those who need it.
But, even now, in the face of a shortage, the CDC continues to be overly optimistic about the supply:
Now the Agency apparently thinks its main job is covering its bureaucratic butt. Thus even as the CDC requested rationing, Gerberding insisted that since "we never vaccinate anywhere near" the target population of recipients, "50-some million doses we have now will come close to meeting this [the nation's] demand."
Grab that abacus! Last year we quickly exhausted the supply of 87 million doses. If we have no more than 52 million this year, we're already 35 million short of that – much less what would have been used had more been available. How would Gerberding define "NOT close"?
It also remains that we're 48 million vaccinations short of what the CDC originally claimed we needed. Is that also "close"?
And Another Thing: A reader points out that the current vaccine crisis holds lessons for drug reimportation:
Wonder why nobody asks the following question.
Everybody wants to import drugs from other countries to lower the cost, saying "hey those drugs are just as good as US versions."
Now that a prominent British drug producer has their ENTIRE supply of vaccine marked as suspect, do we still want to buy outside the US?
Good point.
CORRECTION: Chiron is an American company, it just has an overseas flu vaccine production plant. The point still holds, though. Importing our drugs from elsewhere, whether the parent company is American or not, still holds our drug supply hostage to regulatory agencies over which we have no control. (Think what would happen if a plant were in a country where bribery of regulators was common.) posted by Sydney on
10/08/2004 09:04:00 PM
0 comments
Pulse of the People: The Cheney-Edwards debate didn't make as much of an impression on my patients as the Bush-Kerry debate. No one's mentioned it at all. But then, everyone's been preoccupied by the flu vaccine shortage. Did you know that's Bush's fault? That's what I kept hearing today.
As far as I can tell the thinking goes something like this: The flu vaccine is manufactured by a corporation. Corporations only exist to make money and are therefore evil. Republicans support policies that help corporations make more money. Bush is a Republican. Therefore, the shortage is his fault.
In other election trends, I can't help but notice that the people in my practice who complain the most about taxes and runaway litigation are also the most vocal Kerry-Edwards supporters. What's up with that?
Influenza Vaccine Update: Discovered yesterday that my flu shot supplier is the main distributor of Chiron vaccines and that I won't be getting any. Meanwhile, local drug stores are handing them out:
At least 30 people crowded the Discount Drug Mart store in Minerva half an hour before a flu shot clinic started Wednesday.
The customers were seeking vaccines while they could get them one day after public health officials announced this year's supply will be roughly half of what was expected.
....Discount Drug Mart has enough doses to continue its scheduled clinics, though doses are limited to high-risk patients, said Tom Nameth, director of pharmacy operations.
``I would say for the next week to 10 days, the clinics that are already scheduled are going to happen,'' he said.
After that, he said, the availability could start to be limited.
``The next step could be that they're going to limit the numbers at each clinic,'' he said.
But at least one drugstore chain is behaving responsibly:
The supply shortage forced at least one national drugstore chain to cancel its scheduled flu shot clinics.
In a statement posted Wednesday on its Web site, CVS announced it is suspending all its stores' flu clinics while it evaluates how to distribute the doses.
The Ohio Department of Health ordered their vaccines from Aventis, so they plan to go ahead as scheduled with their vaccine clinics. Other states weren't so lucky. Still other health departments are giving vaccines to all takers, regardless of risk. (Tough luck to the elderly of South Bend, Indiana) Who would have thought that a drugstore chain was capable of acting more ethically than a health department? Too bad the CDC doesn't have the power to enforce restrictions in crisis situations such as this. posted by Sydney on
10/07/2004 09:26:00 AM
0 comments
Wednesday, October 06, 2004
Jumping the Gun? A Colorado coroner has handed down an odd ruling:
A western Colorado coroner said Monday that two hospitals allowed vital organs to be removed from a man before they had proven he was brain dead, and he declared the death a homicide.
The cause of William Rardin's death was 'removal of his internal organs by an organ recovery team,' Montrose County Coroner Mark Young said. He said he did not believe the case should be a criminal matter, but that it 'should lead to a clarification of what the accepted standard is.
I'm not sure how a coroner could make that determination in an autopsy, unless he relied on the hospital's medical records. Come to think of it, I'm not sure why a coroner would be involved in an organ donor case. They usually only step in when the cause of death is unknown. There are a lot of unanswered questions in this story. But, I have to agree with this sentiment:
"I don't mind donating organs if I'm dead, but I want to be dead first."
Although he is the elected County Coroner, Mr. Young is not a medical doctor. He also conceded that he had no prior training or experience in the declaration of brain death. He indicated that he was learning about brain death through the internet commencing on or about September 28, 2004. The committee understands that Mr. Young had a conversation with a neurosurgeon regarding a 'hypothetical case.' That neurosurgeon was not directly involved in the case, nor did the neurosurgeon have the benefit of reviewing any of the medical records related to Mr. Rardin's case. posted by Sydney on
10/06/2004 08:50:00 AM
0 comments
Pain and Suffering: The sad case of a brain-damaged baby and his parents' $3 million settlement:
The settlement, approved by Luzerne County Court of Common Pleas Judge Hugh Mundy, will be allocated as follows: $1.11 million to the Philadelphia law firm of Kline and Specter for fees and costs; $6,239 to the state Department of Public Welfare to satisfy a lien; and $1.83 million to the boy's estate.
It's impossible to tell whether the damage to the baby occurred during the one and half hour labor and delivery, but it's equally impossible to argue that it didn't. And who do you think a jury's going to side with? A hospital or bereaved parents? No wonder they settled. posted by Sydney on
10/06/2004 08:44:00 AM
0 comments
Flu Vaccine Update: It's still not clear why the British suspended the license of Chiron, the influenza vaccine producer. Even the CDC isn't sure:
We will need the help of the public, the public health community and the medical community to make sure that the vaccine goes to those who truly need it most.
We are in the process of learning more detailed information about why the UK regulatory authority suspended Chiron's license for three months and whether anything can be done to address the issues involved. The Department of Health and Human Services, including its Food and Drug Administration, Centers for Disease Control and Prevention, and National Institutes of Health, are working with their counterparts in the British government as well as Chiron regarding this matter.
The Department also has begun exploring whether more flu vaccine can be manufactured for this flu season. This includes working with Aventis on its ability to provide more vaccine. At this point, however, it is not known whether it's possible to get more vaccine.
Chiron was taken by surprise, too. When their actions have such far-reaching consequences for public health, don't these regulatory bodies have an obligation to make public the reasons behind those actions? Our own regulatory bodies had no problem with the vaccine's production. Our vaccine supply is being held hostage to a British regulatory body. Maybe it's not such a good idea to outsource our public health this way.
*all children aged 6–23 months;
* adults aged 65 years and older;
* persons aged 2–64 years with underlying chronic medical conditions;
* all women who will be pregnant during the influenza season;
* residents of nursing homes and long-term care facilities;
* children aged 6 months–18 years on chronic aspirin therapy;
* health-care workers involved in direct patient care; and
* out-of-home caregivers and household contacts of children aged <6 months.
If you're healthy, please refrain. You might miss a few days of work if you get the flu, but for the people in the above groups, the flu could be deadly.
More Vaccine Supply Woes: The second largest flu vaccine manufacturer is not releasing any vaccine this year. That means the "everyone go get your shot" advice the CDC was giving just last week is null and void:
Global and U.S. health officials warned Tuesday of major flu shot shortages after British health officials abruptly pulled the license of the maker of half the U.S. vaccine just as flu season was about to begin.
The news means the United States will face "a significant shortage," said Dr. Anthony Fauci, the National Institutes of Health's infectious disease chief.
Other countries will likely face similar problems.
...Chiron had planned to ship 46 million to 48 million doses, but that already had been delayed by a contamination problem discovered in August in the English factory where the vaccine is made. At the time, the company said only 4 million doses were tainted but that the entire supply would be held up and re-tested.
About 1 million doses already had arrived in the United States, but it remains under Chiron's control and has not been released for use.
..Worldwide, Chiron is the second leading flu vaccine manufacturer, behind French pharmaceutical company Aventis, which makes about 45 percent or 50 percent of the world's supply, Stohr said.
Chiron, based in California, makes four influenza vaccines, including Fluvirin, the top flu vaccine in Northern Europe and the No. 2 vaccine in the United States.
Guess that explains why no one can tell me when the vaccine I pre-ordered last winter will ship. No one knows. posted by Sydney on
10/05/2004 01:35:00 PM
0 comments
There Goes the Neighborhood: Here's a scenario that's been repeated in many urban neighborhoods:
Authorities were tipped to the alleged drug dealing by neighbors, who were suspicious of the high volume of people entering and exiting the office, sometimes at night.
The neighborhood contains many stately homes. West Pittston Police Chief Ralph Zezza said neighbors complained there would sometimes be 30 to 40 cars parked on the narrow street, blocking their driveways. Some.... would also urinate on neighbors' properties and bother children who were playing, he said.
'It's a very nice neighborhood. They stuck out like a sore thumb,' Zezza said.
Never Too Old: A 67 year old psychiatrist will be reporting for duty with the Army. He's not complaining:
“I really don’t mind helping my country,” Ham said. “I think it’s neat that an old man like me can still do something worthwhile for my country and the troops.” posted by Sydney on
10/05/2004 07:45:00 AM
0 comments
Market Medicine: Another reason we don't pay doctors only for successes, from a reader:
You mentioned recently that someone asked why physicians don't get paid only when their patients get well. A good retort would be that in such a scenario, we need to set our own prices (rather than have the mercenary insurance companies set them for us) so that we can make up for the ones that don't get well, often despite our best efforts. In addition, we MDs ought to be able to choose which patients we accept for
treatment in that scenario, which would not bode well for ominous illnesses.
"Approximately 65 percent of women on (hormone replacement therapy) stopped therapy after the (Women's Health Initiative),"said Dr. Isaac Schiff, chair of the American College of Obstetricians and Gynecologists Task Force on Hormone Therapy.
'Two years later, reports suggest that about 1 in 4 women who stopped (the therapy) went back on it because it still offers the best relief for menopausal symptoms.
'So we're moving back to an appropriate balance -- accepting that (hormone therapy) has risks, but recognizing that it can be appropriate for conditions like hot flashes so long as women are informed about the risks and weigh their decision with their doctor,' he added.
UK angina patients are being offered a novel treatment - vibrating trousers.
The treatment, called Enhanced External Counterpulsation or EECP, works by increasing blood flow to the heart.
Long inflatable cuffs, like those used to measure blood pressure, are wrapped around the patient's calves, thighs and buttocks.
....When the heart is resting the cuffs inflate and then deflate again just before each heart beat.
The sequential inflation and deflation of the cuffs increases blood flow to the heart and encourages tiny new blood vessels to grow around the blocked arteries to feed the heart.
CNN discovers CMA: While getting ready for the debate in Cleveland tonight, a CNN director discovered the Cleveland Museum of Art:
Originally, CNN had planned to set up its outdoor studio in another location for better access to the students at Case Western Reserve University. But that was before director Tom Gaut took a little stroll.
Said special events coordinator Anne Brown: ``He called us on the cell phone and said, `You've got to come check this out! It's like Italy!' ''
Health Matters: The New York Times had a detailed and lengthy discourse on the state of John Kerry's health, including every single injury he's ever had, his cholesterol readings, and his brush with prostate cancer:
Mr. Kerry could become the first "cancer survivor" to be elected president, but he rejected the term as creating an unfair stigma. He is free of any vestiges of the cancer and characterized it as a nonissue in an interview in Las Vegas on Sept. 16. "I am cured," he said. "I am cancer-free, and the percentages of me being cancer-free 10 years from now are about as good as they get."
Mr. Kerry's doctors said they had told him that he was cured. They based their optimism on an array of tests and concluded that he had a less than 3 percent chance of a recurrence in the next nine years. Even if the cancer came back, it could be treated without seriously interfering with presidential duties, Mr. Kerry's doctors and experts said.
...The pathology report was the best that Mr. Kerry could receive: the cancer was confined to the left side of the prostate gland. And on the Gleason scale, a standard measure of the severity of prostate cancer, Mr. Kerry's score was 6 out of 10, considered a very favorable finding.
If Mr. Kerry had a recurrence, Dr. Walsh said, "he would be astonished, and so would I, and I am telling you this with the very conscious understanding of what happened to Senator Tsongas."
Dr. Peter T. Scardino, the chief urologist at Memorial Sloan-Kettering Cancer Institute in Manhattan, who is not connected with Mr. Kerry's case, said that while "there are no guarantees," he agreed with the prognosis given Mr. Kerry. "Something bizarre could happen as an exception to the rule, but it would be extremely surprising," Dr. Scardino said.
A Gleason score of 6 isn't exactly the "best that Mr. Kerry could receive." The higher the Gleason score, the worse the cancer is. The maximum score is 10. Kerry's prostate cancer was actually of moderate severity:
Grade refers to the histologic type, characterized by the Gleason score, with the prognosis worse for higher-grade cancers. Prostate cancers are often classified into three grades. Grade III includes those with a Gleason score of more than 7, grade II includes those with a Gleason score of 5 to 7, and grade I includes those with a Gleason score of less than 5. In the Hybritech study,1 the Gleason score was less than 7 in 60.0 percent of the black men and in 75.1 percent of the white men who were found to have prostate cancer. Patients with clinically localized cancer of a lower grade are considered to be the best candidates for curative treatment, especially radical prostatectomy.
...Clinical outcomes after surgery for localized prostate cancer are known to be good. A recent multi-institutional study that pooled the results of radical prostatectomy in men with clinically localized prostate cancer found disease-specific 10-year survival rates of 94 percent for grade I cancer, 80 percent for grade II cancer and 77 percent for grade III cancer.
That's not exactly the less than three percent chance his surgeons told the Times he had, and they were talking about recurrence, not survival. They may have done other testing on the tumor to arrive at their very low predictions, but that detail is missing in an otherwise exhaustively detailed report. Despite having a moderately high Gleason score, his PSA level was low, a factor definitely in his favor, and although he had a less-destructive-than-usual surgery to remove the prostate and preserve the nerves, the evidence so far is that the newer surgery has the same survival rates as the older, more extensive removals. But is his prognosis for a recurrence really less than 3%?
BONUS: Senator Kerry's urologist has made a movie of his nerve-sparing technique, in case you're interested.
posted by Sydney on
10/04/2004 08:24:00 PM
0 comments
Cultural Illiteracy: A few years ago, one of my patients, an Egyptian immigrant with very little English, needed to be referred to a specialist. In my infinite wisdom, I referred him to a physician who also happens to be from Egypt, thinking my patient would be better served by a doctor who could speak the same language.
Recently, I saw my patient's wife, who now also needs to see the same type of specialist. I recommended the same doctor. But she surprised me b y asking me to please send her to an American because "Americans are nice to everyone." Her husband, who was also in the exam room, agreed. He didn't particularly care for the specialist, either. Americans are "nicer."
At the risk of sounding conceited on behalf of all Americans, I think they've got a point. Americans, especially American physicians, tend to be egalitarian. We don't come close to the class-consciousness that is so prevalent in other cultures. If I were living in a foreign land, and needed medical attention, I would jump at the chance to see a fellow American. It wouldn't matter if he were black or white, Jewish or Baptist, or from the North, the South or East or West. I'd be pretty confident that he'd treat me the same as he would anyone else.
I hadn't taken into account the cultural prejudices of my patient's native land that must have come out in his encounters with the specialist - Muslims vs. Coptic Catholics, rich vs. poor, educated vs. uneducated, and who knows what else. I ended up giving his wife the names of two Americans. At least one is an American, the other is her new partner who has an Anglo-sounding name. But I warned them - he might turn out to be British. posted by Sydney on
10/04/2004 08:19:00 AM
0 comments
Sunday, October 03, 2004
Strange Bedfellows: The prominent pediatricians who support Kerry because he cares more about kids, might want to think about some of his other supporters who also feel he's done a good job of supporting their agenda:
MARTIN HASKELL, George Tiller, and Warren Hern have several things in common. All three are abortionists who specialize in late abortions. Haskell's name is closely linked with the partial-birth abortion method. Tiller and Hern may be the only two abortionists in the United States who openly advertise their willingness to perform third-trimester abortions.
Finally, all three men have opened their checkbooks to support Senator John Kerry's bid to be president of the United States. Their contributions to Kerry's campaign total $7,000.
That is not a vast sum compared with the millions being spent by liberal groups to attack President Bush. (Federal law limits a contributor to maximum total donations of $4,000 to a single presidential candidate, split between two types of campaign accounts.) Nevertheless, these contributions are worth scrutinizing because of what they reveal about John Kerry.
...But why would such men send their hard-earned dollars to Kerry? After all, Kerry told Chris Wallace on Fox News Sunday, on January 25, 2004, "I'm against partial-birth abortion, as are many people." And Kerry told Peter Jennings of ABC News, in an interview broadcast July 22, 2004, "I oppose abortion, personally. I don't like abortion. I believe life does begin at conception."
My bet is that the abortionists know that during his 20 years in the Senate, Kerry has been an absolutely consistent defender of abortion. So why should they be bothered by statements intended only to mislead voters who are strongly opposed to the grisly business that these men are in--voters who are still unfamiliar with Kerry's actual record?
Most likely, these abortionists are quite aware that Kerry has promised to nominate only Supreme Court justices who share his real position on abortion policy--which would guarantee that partial-birth abortions and other late abortions, and of course earlier abortions, would remain almost entirely shielded from scrutiny or restriction by elected lawmakers for the foreseeable future.
How Long is Long Enough? The FDA is coming under criticism in the wake of the Vioxx withdrawl. Some critics expect drugs with no side effects, even attacking the very old and extremely important antibiotic erythromycin because it has the potential for drug interactions (something that doctors know, by the way, and are usually careful about before prescribing it). Others say drug trials looking for side effects should be longer:
The FDA could take a simple step that would improve clinical trial quality before it approved drugs, observers say. Drug companies with products comparable to Vioxx could be required to conduct longer clinical trials.
"If you're the FDA, you'll say `OK, all bets are off. We're going to make you do studies lasting 18 months,'" said Dr. Sidney Wolfe, director of Public Citizen.
At the time of approval, the FDA had data from clinical trials on Vioxx that lasted for 12 months. The increased risk of heart attack and stroke that prompted Merck to pull Vioxx did not begin to appear until older patients had taken took the drug for 18 months.
It's a valid criticism that drugs that are used long-term (like birth control or arthritis medication) should be tested longer than six or twelve months. But then, what about drugs whose long-term side effects only manifest themselves after two or three or five years, or even longer? No time frame is going to be perfect. And no drug is going to have zero side effects. Every doctor and every patient has to ask themselves if the potential risk is really worth the benefit.
posted by Sydney on
10/03/2004 08:35:00 AM
0 comments
Some of the nation's biggest drug manufacturers and health insurance plans confirm they have issued warnings to their sales representatives and other employees in recent weeks, telling them to be on the lookout for the shaggy filmmaker in his trademark baseball cap. And under no circumstances are they to talk to Moore.
....The planned movie, tentatively titled 'Sicko,' is expected to focus on health care industry business practices, specifically those of the managed-care and pharmaceutical industries, which have both been mentioned in Moore's recent speeches and interviews, his spokesman said.
