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    "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

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    Saturday, March 30, 2002

    Direct to consumer advertising reaps its rewards.

    In 2000, drug companies spent 58.8% of their total industry spending on advertising to consumers. It seems to have paid off. Make no mistake, those advertisements influence patient's perceptions of drug effectiveness. Physicians aren't immune to their tactics, either. It's amazing how many doctors prescribe drugs based on the most recent detailing and samples they've received. I used to think this wasn't true, but I've been around long enough now to know how true it is. It's unfortunate, and we're all paying the consequences in higher insurance premiums and cuts in drug benefits. The answer isn't to have the government pay more in drug benefits. The answer is to curtail advertising by drug companies.

    posted by Sydney on 3/30/2002 08:56:00 AM 0 comments

    A Canadian doctor triumphs over sleazy health journalism (link requires registration to The Lancet).

    The involved physician was smeared by an investigative report by the CBC that accused him of putting financial interest over patient interest. Court after court has agreed that he was maligned by the media. The appeals court decision in summary:

    "Leenen argued the programme falsely created the impression that he supported the prescription of dangerous drugs; that he had a conflict of interest; that he was receiving a pay-off or kickbacks from Pfizer; and that he acted negligently or dishonestly as the chairman of an ad-hoc advisory committee of Health Canada's Health Protection Branch. The Ontario Court of Appeal agreed, awarding him $589 000 in punitive damages and $518 430 in legal costs. Myers received $217 000 in general and aggravated damages, as well as $63 000 in legal costs. The trial judge called the programme "sensational journalism of the worst sort and should serve as an embarrassment to this so-called 'flagship' investigative programme".

    The original trial judges reached the same conclusion (also requires registration):

    " The trial judges had ruled that although the investigative team had interviewed scores of medical professionals over 14 weeks and understood the debate about the hazards and benefits of drug treatment, they decided to "dramatically simplify a complex medical debate" and had "seriously mischaracterised" the physicians' positions."

    The doctors from The Hutchinson Center in Seattle should get in touch with this guy's lawyers.
    posted by Sydney on 3/30/2002 08:48:00 AM 0 comments

    CharlesMurtaugh analyzes the pill study, which I linked to earlier. He puts an anti-feminist spin to it, but he’s right about the role of sexual promiscuity. The other thing about the study which probably accounts for the popular media's lack of interest is that it is really, really boring. It’s a statistical analysis of data that is hard to slog through. Reporters can be forgiven for bypassing it. Or maybe they’re just being responsible and trying to digest it before they write their stories about it.
    posted by Sydney on 3/30/2002 08:38:00 AM 0 comments

    The other side of infertility.

    This is a refreshing article, and one that’s much needed. It’s remarkable how many women I see who are undergoing an extensive infertility work-up who tell me their husbands haven’t been tested at all. Testing a man for infertility is so much easier than testing a woman, all you need is a sperm sample. Women have to go through expensive blood tests, radiological procedures, and tedious and prolonged diary keeping of body temperatures. Yet, the male factor is often the last one investigated.

    I suspect there are several reasons for this. The most significant is the relegation of infertility to the realm of gynecology which by it’s very nature focuses on the female. Since gynecologists are the same people who deliver babies and care for the pregnant, it’s only natural for people to turn to them when they have trouble in this area. Urologists, who specialize in the male reproductive system, are turned to for such things as kidney stones and prostate problems, so men can be forgiven for not thinking of them when they have trouble conceiving. Finally, there is probably a bit of cultural influence at work as well. Historically, women have borne the brunt of blame for infertility, and that attitude hasn’t quite yet been completely eliminated from our cultural psyche. It’s time we enter the 21st century and give male-factor infertility equal attention.
    posted by Sydney on 3/30/2002 08:36:00 AM 0 comments

    The law of unintended consequences.
    posted by Sydney on 3/30/2002 08:01:00 AM 0 comments

    Those Amazing Statins: Not only do they lower cholesterol, they fight pancreatic cancer and osteoporosis.

    Well, Reuters is indulging in hyperbole. The studies weren't all that impressive. Even the enthusiastic news reports can not make them look promising. In the pancreatic cancer study the subjects were mice. 10 out of 12 mice on a statin developed pancreatic cancer compared to 10 out of 10 mice not on a statin. It seems a stretch to come to such a dramatic conclusion based on those numbers. They need to invest in more mice.

    The osteoporosis study wasn't any better. They just looked at fracture rates in 1375 women in Australia. Of the 573 women with a history of fracture, 16 were on statins (2.8%). Of the 802 who didn't have a fracture, 53 took statins (6.6%). This isn't a large difference, and by no means is it solid proof that statins prevent fracture. The majority of the women in the study didn't use statins at all (557 in the fracture group, and 749 in the no-fracture group). A better study would be to compare the rate of fractures in 1375 statin users and 1375 non-users. Yet the authors make the dramatic claim that statins reduce the risk of fractures by 60%. You have to wonder if they had some sort of ulterior motive to give such a postive spin to their statistics.
    posted by Sydney on 3/30/2002 07:52:00 AM 0 comments

    Steven Milloy from Junkscience has some things to say about television and violence in his Fox News column.
    posted by Sydney on 3/30/2002 07:39:00 AM 0 comments

    Friday, March 29, 2002

    Alas, poor Yorick.

    posted by Sydney on 3/29/2002 07:42:00 AM 0 comments

    The British Medical Association tries to blame doctor dissatisfaction on women. Sounds like they want to push things back to the days of Dr James Barry. Women doctors aren’t the problem. It’s the NHS.
    posted by Sydney on 3/29/2002 07:42:00 AM 0 comments

    Another drug makes the news for its serious side effects.

    The most disturbing revelation was this by a rheumatologist:

    " He said insurers pressure him to use Arava if methotrexate does not work because other options cost more."

    The insurance companies yield much too much power over medical decisions that they have no business influencing. Profits should not best good patient care.
    posted by Sydney on 3/29/2002 07:39:00 AM 0 comments

    Lawyers are from Mars, Doctors from Venus
    posted by Sydney on 3/29/2002 07:38:00 AM 0 comments

    Misleading Headline of the Week Award.

    The study highlighed in this article does not test aspirin's effect on heart attacks and strokes. It measured urine samples for a metabolic byproduct of a protein called thromboxane which is involved in clot formation. It is true that aspirin inhibits thromboxane formation. We don't know, however, if the excretion of thromboxane byproducts in the urine relates to the risk of heart attacks or strokes. All this study really shows is that people metabolize aspirin at different rates. That's no shock. We aren't assembly line products after all, and the human body isn't a well-regulated machine. We are distinct individuals, even down to our metabolisms
    posted by Sydney on 3/29/2002 07:37:00 AM 0 comments

    Germ globalization
    posted by Sydney on 3/29/2002 07:33:00 AM 0 comments

    Go Get 'Em.

    The complaints these doctors are bringing against insurance companies are all too common. They aren't limited to these two companies, nor to the state of Washington. It's good to see doctors finally fighting back.
    posted by Sydney on 3/29/2002 07:32:00 AM 0 comments

    Thursday, March 28, 2002

    Celebrity Medical Watch: Lyle Lovett and his bull.

    posted by Sydney on 3/28/2002 01:23:00 PM 0 comments

    Post-Traumatic Stress Disorder and 9/11: What's surprising about this is that symptoms of PTSD were not higher than they were. There was only a 20% incidence of symptoms of the disorder in the population living closest to the World Trade Center. That's admittedly higher than the average, but I would have expected much larger numbers with such a horror. I think it's a testimony to the resilience of the human soul (or maybe I should say the New Yorker soul) that the percentage was so low.
    posted by Sydney on 3/28/2002 01:15:00 PM 0 comments

    The Devil Made Me Do It
    posted by Sydney on 3/28/2002 08:24:00 AM 0 comments

    The terrible consequences of lawyers armed with research results.

    This poor mother doesn’t even smoke around her child. He (or more accurately his mean-spirited father) is complaining of the mere odor of cigarettes. Now, I’m not that familiar with the exact data on second hand smoke, but I’m pretty sure the research dealt with actual exposure to cigarette smoke, not the residual odor. Let’s hope the ACLU helps this poor woman out. She, and we, need them in this case more than we need them in accused terrorist cases.
    posted by Sydney on 3/28/2002 08:23:00 AM 0 comments

    The Wall Street Journal and The Seattle Times duke it out over tort law and medical research.

    God knows, I’m suspicious of biomedical companies and their financial ties with researchers, but there are a few disconcerting things about the Seattle Times story. It has all the hallmarks of bad medical reporting. The founders of the biomedical company are portrayed as flim-flam artists, the patients who died are portrayed in a way that can’t fail to tug your heart strings, and the doctors, with the exception of a whistle blower, are portrayed as greedy. The reporter repeats over and over the claim that the people who enrolled in the trial would have lived longer if they never entered the study. That may be true in retrospect, but people with that type of cancer at that point in history, had a 70% five year mortality rate (click here for statistics). Isn’t it just possible that facing that sort of prognosis they chose to take a chance on an experimental therapy?

    The Wall Street Journal’s Laura Landro makes a good point about family members’ ability to interpret their loved ones’ understanding of informed consent. No one but the person signing those papers can know that. Deciding to participate in a clinical trial is an emotionally laden decision. Clinical trials give hope to patients who have none. Far too often, those hopes are dashed, but the patients enter the studies knowing they are taking that risk. The families can be forgiven for their bitter disappointment in that shattered hope. What can not be forgiven is the newspaper’s manipulation of that disappointment in pursuit of a story. They are obviously very proud of their work and what it has wrought. They even have a special web page devoted to it.

    What I found eye-opening is that when submitting stories for the Pulitzer, newspapers also have to submit letters to the editor that dispute the story. That explains why so few newspapers print letters that disagree with their stories. And all this time I just thought it was out and out bias.
    posted by Sydney on 3/28/2002 08:13:00 AM 0 comments

    The Institute of Medicine’s infamous report on errors in medicine begins to wreak its havoc.

    The article points out that the error rates cited by the Institute’s study last year were faulty, but it also rightly points out that the study still managed to grab headlines and attention on the basis of its dramatic claims. Of course, reducing errors is always a worthy goal, but it becomes problematic when outside organizations try to enforce their own special solutions, especially when they don’t have to put up the money for those solutions. In this case, the organization of employers and insurers wants hospitals to invest a lot of money on computer systems to reduce errors; but do these systems reduce errors? What if the wrong dose is accidently typed into a computer? Who’s going to catch that? With a written order at least it’s read by several people before being implemented, increasing the chance than an error will be caught. I worry that implementing unproven large computer systems will push hospitals over the financial edge. As the story points out:

    “Only about one-third of hospitals are in a position to make the investments necessary to buy CPOE systems, which cost between about $2.5 million and $10 million, Wade said. (About one-third of hospitals break even and one-third lose money, he added.) Many have other high priorities intimately related to quality and safety, such as hiring more nurses and replacing aging facilities.”

    I’d much rather have more nurses than more computers on the floors. A computer isn’t going to check on my patient’s well-being throughout the day and alert me to problems.
    posted by Sydney on 3/28/2002 07:55:00 AM 0 comments

    The government is urging everyone over 45 to be tested for a tendency toward diabetes. Does this mean that Medicare will start paying for blood sugar tests? Because they sure don’t pay for it now.
    posted by Sydney on 3/28/2002 07:51:00 AM 0 comments

    Neurosurgeons have a hand fetish: It began with the father of neurosurgery, Harvey Cushing, and today’s neurosurgeons proudly continue the tradition. It seems to be catching. Now psychologists are falling in love with hands, too.

    Harvey Cushing and his followers were so enamored of his hands that for years the logo of the surgical service at his hospital was a drawing of his hand holding a scalpel. To see his hands at work, go here and click on the “Verified 2000th brain tumor operation” link.
    posted by Sydney on 3/28/2002 07:39:00 AM 0 comments

    Wednesday, March 27, 2002

    Weekly art history lesson.

    posted by Sydney on 3/27/2002 08:32:00 AM 0 comments

    The benefits of la petite mort.
    posted by Sydney on 3/27/2002 08:31:00 AM 0 comments

    This time, it's kava that's in the spotlight. It's been linked with severe liver damage in Europe, bad enough to require transplants.

    Take special note of this statement:

    “Under federal law, no one has to prove dietary supplements are safe or work as advertised before they begin selling. And, unlike in other countries, the FDA must prove one is dangerous before it can halt sales. Reports of kava users suffering liver injury suggest a link, but it will take more research to prove if the herbal sedative actually causes injury.”

    Prescription drugs have to prove their safety before being introduced to the market, but herbal drugs have to be proven dangerous before they can be taken off the market. This makes absolutely no sense. The herbal medications are drugs, pure and simple. The burden of proof should be on them. It’s ridiculous. If a prescription drug were causing liver damage at even a fraction of the rate of kava, it would be yanked off the market without a second thought.
    posted by Sydney on 3/27/2002 08:30:00 AM 0 comments

    More striking doctors, this time in Canada.
    posted by Sydney on 3/27/2002 08:29:00 AM 0 comments

    Fast food and coronary arteries. I heard a lecturer once who claimed that a McDonald's Happy Meal was the biological equivalent of smoking two cigarettes. I don't know if it's true, but when I told my kids they refused McDonald's for a month.
    posted by Sydney on 3/27/2002 08:28:00 AM 0 comments

    Tuesday, March 26, 2002

    Drug advertising then and now.

    posted by Sydney on 3/26/2002 07:36:00 PM 0 comments

    Here's a good article on drug advertising. It's also a good critique on the drug company habit of introducing twins of their old drugs to grab market share before cheaper versions of the original become available.

    Schering-Plough spent 100 million dollars in 2000 on consumer advertising of Claritin. It generated 3.2 billion dollars in sales last year on Claritin alone. Their advertising campaign has more than paid for itself, as did AstraZeneca's ad campaign for Prilosec. My experience is the same as the doctor's quoted in the article. I can always tell when a new ad campaign has been launched, because patients come in requesting the new drug. It's alarming, really, at how gullible many people are when it comes to drug advertising. They seem to equate the commercials with journal articles in terms of reliability. People assume that because they are prescription drugs and regulated, the commericals are more honest than, say, a commercial for a car or breakfast cereal. They aren't. They hold themselves to no higher standards than anyone else in the ad business.

    posted by Sydney on 3/26/2002 06:24:00 PM 0 comments

    The "Pill" is linked to cervical cancer.

    The problem with this assertion is that it's impossible to disentangle oral contraception from the sexual behavior that definitely increases the risk of cervical cancer. Cervical cancer risk increases with the number of sexual partners, and oral contraceptive users are more likely to have more sexual partners than non-pill users. Condoms protect against transmission of human papilloma virus, the main culprit in cervical cancer, so you can't compare the pill to them. IUD's are discouraged in women with more than one partner because of the risk of infection, so you can't compare it with that. I would have to see the study to draw any firm conclusions, but my initial reaction is skepticism.
    posted by Sydney on 3/26/2002 06:09:00 PM 0 comments

    Remember the story about implanted defibrillators and how they should be used in more people? Well, here’s a story about their downside (link requires NY Times registration.)

    The problem with them is that as a person’s heart disease advances, the defibrillators go off more and more. This is very uncomfortable since they deliver a jolting shock. The man in the story had his going off several times a day before he decided to turn it off and die. The cardiologists in the story play down this phenomenon, but it is very real. I’ve had a handful of patients experience this, and I don’t have that many with defibrillators.
    posted by Sydney on 3/26/2002 08:34:00 AM 0 comments

    State governors and employers are trying to close drug patent loopholes.

    They have a point. The drug companies do take advantage of these things to forestall cheaper generics. It’s remarkable that Prilosec generated $4.7 billion dollars in sales in 2,000. In that same year, it’s manufacturer spent $108 million to advertise it to consumers. I guess it was well worth the cost to them. As for their “new” drug, Nexium, they are indeed trying to sell it as superior to Prilosec. I’ve seen their promotional literature. I don’t buy it, though. Like the article says, it’s just a mirror-image twin of Prilosec, and therefore can’t be expected to behave that much differently.

    It's not just Prilosec, though. The whole industry has a way of doing these sorts of things. When Prozac was slated to go generic, it's company came out with "Serafem" which is nothing more than Prozac renamed to be sold to women for PMS. They also came out with a once a week version of Prozac, though I don't think they've been pushing that one so hard since very few people have asked me for it.
    posted by Sydney on 3/26/2002 08:25:00 AM 0 comments

    Monday, March 25, 2002

    Is Vioxx linked to meningitis?

    I doubt it. I have to agree with the manufacturer on this one. Five cases out of 52 million prescriptions is too few to say there is a definite link. Aspetic meningitis is usually caused by a virus, and we simply are not able to identify the etiology in most cases. It's a stretch to blame these cases of meningitis on the drug.

    posted by Sydney on 3/25/2002 02:47:00 PM 0 comments

    A medical treatise on the Passion.

    I meant to post this yesterday on Palm Sunday, but I forgot. Still, for those of you inclined to contemplate such things, (and what better time than Holy Week to do so), the full article is an excellent description of the miseries of flogging and crucifixion. It even explains the sweating of blood in the Garden of Gesthemane. If you have access to the Journal of the American Medical Association (available at all medical libraries and even at some public libraries), I highly recommend it.
    posted by Sydney on 3/25/2002 06:23:00 AM 0 comments

    Coffee gets a break. Looks like it doesn't influence blood pressure so much after all. Too much can still make you feel wired, though.
    posted by Sydney on 3/25/2002 06:04:00 AM 0 comments

    Doctors acting shamefully to make an easy buck.

    Don’t believe the excuses those lawyers are offering up to the press on behalf of their clients. Prescribing medication without seeing a patient is bad medicine, whether that medication is narcotics or Viagra or antibiotics, and those guys damn well know it. Some doctors will do this for patients over the phone, and that's bad practice, too. You need to examine a patient to make an accurate diagnosis and prescribe appropriate treatment. Narcotics are especially dangerous in this situation. Abusers are very adept at manipulation and often can hoodwink their own doctors. It's only after several visits that an abusive use of the pills becomes evident: too many pills used in too little time, overwrought requests for refills, too much anger when questioned about their use or there is a delay in the refill, etc. Often, too, it's the local pharmacies who alert a physician to abuse when they discover a patient is getting the same drug from multiple pharmacies and from multiple physicians. It strains credulity to believe that these guys were doing this from any altruistic motive. Just look at the money they were getting for each prescription. The rates are far above the going rate of an office visit, and for a lot less work. Greed was their only motivation.
    posted by Sydney on 3/25/2002 06:02:00 AM 0 comments

    Why we need the FDA. There is no shortage of people out there more than willing to take advantage of others to line their own pockets.
    posted by Sydney on 3/25/2002 06:01:00 AM 0 comments

    Sunday, March 24, 2002

    I've added two sites to the links at left. Lagniappe, by a medicinal chemist, provides an insider's view of drug development. He has good posts this week on Picovir, the cold remedy that was shot down by the FDA, and about Bristol-Meyers-Squibb's unsuccessful attempt to best Vasotec.

    The other site is by biomedical researcher Charles Murtaugh. He mixes in a lot of politics and news with his insights on biomedical research. This week he has a good post on Leon Kass and his views of biomedicine.


    posted by Sydney on 3/24/2002 02:21:00 PM 0 comments

    The Pope talks to doctors about the terminally ill.

    In the last paragraph the writer tries to link the Vatican newspaper's statement against euthanasia to this case in Britain (link requires registration), in which a paralyzed woman won the right to have her ventilator disconnected. The Pope's comments, however, seem to support this woman's right to forgo medical intervention. This is not the same as euthanasia, which is the deliberate use of medical intervention to cause death. It is euthanasia that the Vatican condemns, not the exercise of freewill to refuse treatment.
    posted by Sydney on 3/24/2002 08:56:00 AM 0 comments

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