Tuesday, June 30, 2009

Black Box warnings suck

The FDA had an advisory panel on acetaminophen today recommend, among other things, putting a black box warning on acetaminophen products in order to reduce deaths from liver failure. While the FDA has a large ranging and difficult job in protecting the health of the American people, I believe that there are places where we can probably draw the line. There are people who die due to liver failure from taking too much acetaminophen, but the problem they are indicating is with prescription combination products such as Vicodin and Percocet. The likelihood of dying from an overdose on one of these medications is probably in favor of death from respiratory arrest or cardiac failure due to the narcotics being abused rather than liver failure from acetaminophen. Yes, it is easy to overdose on the acetaminophen with these products if you are abusing them and not taking them according to the prescribed dosages, but the intentional abuse of the narcotic substances and combining them with other narcotics and/or depressants such as alcohol is a larger issue which is being ignored and skirted by the FDA.

Let us also look at the recommendations given for over the counter acetaminophen products. The recommendation for maximum dose is being changed to 650mg. The common version of extra strength acetaminophen is 500mg. Most people take at least 2 of them, I know that some people just take a handful. While I believe that people

Tablets are the most common form of paracetamol.Image via Wikipedia

should have more respect than they do for OTC products and still consider them medication and chemicals that affect changes in the body, I don't think that will occur because of this FDA panel. I also don't think that people will change the way they take acetaminophen after taking it for a lifetime at a higher dosage.

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Sunday, June 28, 2009


Ok, so we all know TV during the summer sucks, so here's some relief.

Call me Parata...

Thursday, June 25, 2009

Dear Obama - reflections on the obama infomercial

Dear Mr Obama,

I have some questions and comments that I didn't really see answered in your infomercial.

Can you please tell me how paying for student loans for primacy care doctors translates into patients using primary care rather than emergency medicine? It does not! It doesn't make sense to compensate doctors in order to influence patient behavior. You stated that you believe that primary care is where health care reform needs to occur, many people agree, but you aren't creating a reason for a change to primary care!

What does choosing or keeping a doctor or choosing or keeping a health care plan have to do with doctors and patients making choices in the patient care? Absolutely nothing. The reason you didn't answer this question was because you don't want to tell people what you're going to be cutting from patient care and the cost trimming measures you will be taking in order to provide "quality care" for all people. The way medical care works is itis a scarce commodity that costs money. There is only so much to go around. Quality care for all people will actually be minimal care for many people.

I understand that having pre-existing conditions provisions sucks, BUT it is a way for health insurance to actually make money and protect themselves from loss. Since the only purpose of the health insurance company is to make money, it makes sense for them to exclude pre-existing conditions. They should have the ability to protect themselves from loss.

WASHINGTON - JUNE 20:  Filmmaker Michael Moore...Image by Getty Images via Daylife

Medical care had become more expensive because people are increasingly less healthy. Many children are entering high school being obese, not exercising and eating crap food, and living with Type 2 diabetes and many other health conditions because of their poor health habits (see Wall-E for examples into the future or Michael Moore for a current example). The way to change this is through personal effort, how are you going to influence people to become more healthy on their own so we do not have to care for them in the medical system?

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Tuesday, June 23, 2009

More Thoughts of Health Care Reform

PHRMA has recently agree to cover half of the medication costs while Medicare Part D patients are in the doughnut hole period, the coverage gap where patients pay 100% of the drug costs between $2700 and $6154. So this means that PHRMA will actually reimburse the government for half of the cost of the brand name medications which patients take during the doughnut hole period. So why is PHRMA being so generous? PHRMA is interested in keeping patients on high cost brand name medications and will take only a small loss on this pay out, whereas they would lose the entire amount of the patient if they changed therapy to a cheaper therapeutic alternative which may come in a generic form. PHRMA is looking out for the interests of pharmaceutical companies, which have every right to make

Doughnuts being deep fried.Image via Wikipedia

and sell innovative and expensive medication treatments and we should not interfere with that right. However if we are concerned with costs we may have interests that are better met by using alternative therapies.

The doughnut hole is the section where the Medicare Part D plans recoup some of their money spent on covering elderly patients and has patients become responsible for their costs. However, even in cases where patients are taking many medications, the doughnut hole is not necessarily something that patients must reach. If appropriate medication management is performed, patients can reduce their costs for medications as well as cost of medical care for society. Pharmacists are well trained and qualified to recommend changes to medication therapy to patients and doctors in order to reduce medications and lower medication costs through altered therapies. By reimbursing pharmacists for this process and encouraging patients, Medicare Part D or not, we would reduce costs of medical care across the board.

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Monday, June 22, 2009

Healthcare reform thoughts

Obama's Health Care Plan in a NutshellImage by wstera2 via Flickr

How can we reform health care? I know that many ideas have been presented; however, many of them only shift the burden of health care costs from one group of people to another. That is not in the interest of everyone nor is it reducing the cost of health care. We could let all the people who cannot live without health care die off and reduce our costs, but that is not really a good solution for those who would have to die. Yet it brings forth an interesting point… some people are born premature die young and have lifelong medical conditions, is that a situation we, as a civilized society should support? Wouldn’t it be better to support allowing these children to not have to live a life in pain and allow them to die early? Are we playing the role of God by trying to force tiny infants to try to survive in a world they are not able to handle by attaching them up to electronic life support? The question of mortality has been recently in my mind and I think that currently I probably am not healthy enough to survive without all the amenities that the developed world offers, such as cars, health care, air conditioning, and supermarkets. I couldn't survive outside in 90 degree weather with 80% humidity trying to chase and hunt some food. My asthma would act up and I'd be left hungry and chewing on some grass. So I am happy that I do have these luxuries, but how much is too much when it comes to medical care? When are the parents thinking more of their desires for a child than of the suffering of the child growing up in conditions that it cannot handle?

This is of course brought to you by someone who desperately wants a "world's greatest not a dad" T-shirt.

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Sunday, June 14, 2009

Health Reform

So everyone in the government is talking about health reform. Obama's on a mission to complete what the Clinton's could not, making health care affordable and available to everyone. Well I believe a bit differently.

First off, why should health care be "affordable"? We are talking about something that is a good or a service provided by people who are highly educated and skilled. Shouldn't they be able to charge whatever they want for their skills? A reasonable person believes that actors make a lot of money, but will still shell out money to go see their films, why won't they pay money for a more valuable service such as health care? Not everyone deserves as a natural right to get health care provided to them. It isn't free to provide and the providers shouldn't be stuck with the bill because the government wants to force them to provide. Everyone who goes to school for a long time, studies and works hard should be given the opportunity to find the American Dream. The American Dream is just that, work hard and you can become successful and wealthy... not slack off and make no money and the government will provide (that's Russia's motto).

So one thing I keep hearing about health care being expensive is medicines. Yes, brand name medicines are expensive, but so are BMWs, Lexuses, and Mercedes. You do not need brand name medications to treat most conditions, the generic alternatives work pretty well. No, they aren't the top of the line, but we keep saying that Ford, Chrysler, and GM should stick around, so mid-range things should be something that are used by people who are just looking for something to get around. I know the car metaphor gets a little muddled when we're talking health care, but really it is very similar. If people, or insurance companies, aren't paying for branded medications, costs are lowered and most everyone saves money... meaning insurance premiums and copays are lower and money out of the pocket for consumers is lowered. I'm not saying there isn't a need for the brand name medications, but really, if you don't need them, why pay more for them? As for making the drugs cheaper/more affordable for people to take them, I believe that the drug companies should charge what they want for the medications and whatever the market will bear. They should charge huge amounts of money for their blockbuster drugs and make money off of them. Why? Because they've invested a ton of money, not just in creating, testing and marketing that drug, but in creating and testing hundreds of other drugs in the process of finding that one drug that does work. The estimate is that it costs over a billion dollars to bring one drug to market and only reserve the patent for 17 years. Is paying $200 for that drug really that unreasonable? Shouldn't they recoup their costs and make a little money in the process? I say they should because if they don't there is no reason for them to create new drugs, no reason for them to be innovators and medicine will be stalled in the current market and nothing new will be created for treatments for all the disease which are going uncured or untreated.

Where else should government focus on saving money if not on the high costs of drugs or doctor visits? Focus on utilization. Using health care to treat people who are ill is MUCH more expensive than keeping people healthy. Spend money on vaccinations, wellness, exercise programs, smoking cessation programs, healthy eating education. That will save billions of dollars in health care because people will not be sick! Have people visit primary doctors rather than going to the emergency room when they are ill. A visit to the ER runs upwards of $400 if they don't keep you there for anything or run any tests, compare that to an $80 doctor visit. Make people feel the urge to get and use their primary doctor by reducing copays at doctor's offices and increasing copays for non-emergent ER visits. The best way for the government to do this is by using Medicare and Medicaid as the starting point. Make a non-emergent ER visit cost $50, an urgent care visit $10, and keep the primary doctor visits at $0. You will see a drastic reduction in ER and Urgent Care visits. The government and medical system as a whole will save money and be better able to deal with the costs of treatment.

Health care is expensive and it should be, we want our best minds treating us, creating cures for us, educating us and keeping us healthy. We want those minds to be well rewarded for working hard and to be knowledgeable after going through much education. In short, the best should be rewarded like the best.

Tuesday, July 10, 2007

I'll kick you in the back of the head old man

OK, now this isn't divulging patient information... it's fairly common for kids around here to sound like they are Ricky Bobby Jr. So this kid walks up to the counter with his grandmother and she asks what is good for a burn. I was like "well, what kind of burn." I didn't know this would take me into another dimension of the twilight zone. The kid holds out his arm which has a hole about ½ inch deep burned into it and was starting to scab over. To me it seems he probably should have come in about 2 days earlier. He says his brother and him were doing a science experiment and salt and ice.... well needless to say he had a nasty little hole in his arm. I suggested neosporin and some gauze to cover it. After much debate about exactly which product to use he starts complaining about the neck muscle he pulled while playing chicken... Yeah, I stopped paying attention and walked away, the kid totally reminded me of taladaga nights.