Kevin, M.D. - Medical Weblog

"Dr. Barry Rayburn, a professor of medicine at the University of Alabama-Birmingham hired by Merck as a $600-an-hour expert witness, said Tuesday his review of John McDarby's medical records and clinical trials of the drug didn't support McDarby's claim that Vioxx caused him to be stricken."

Does this make him a whore?
 

Does anyone know when Merck pays out it's dividend? With Lanier bringing another jury to tears I need to Double my Short on Merck stock again. What's the dividend date?
 

Yes it does make him a whore

I guarantee you he is NOT making $600 per hour treating patients. Hell even neurosurgeons dont make that kind of money.

Medical "experts" on both sides are whores for hire. They will say anything to get those fat fees that they would never dream of seeing in clinical practice
 

The guy broke his hip and that is not relevent? Does not the trauma cause the release of epinepherine? Any surgeon would be hard press to deny the association of a post operative cataract pt and and an MI that night, even with the pt getting no sedation.
 

Amazing:
A 77 yo diabetic who very well may have had a hip fracture beforehand and it is Vioxx's fault?
 

Amazing:
A 77 yo diabetic who may have had a hip fracture before the MI (doesn't sound like we will ever know the truth for sure now that this is in the hands of lawyers) and it is Vioxx's fault? Oh please.
 

The expert witness system really is highly impractical. These people are picked based on where they got their degrees and their smiles. Which expert do the jurors believe more?

Just kidding but seriously, I understand they must be compensated, but to imagine objectivity, no matter how many times they say it, is just ridiculous.

Even so, it is still pretty amazing that a 77-year-old diabetic and a 58-year-old overweight man with hypercholesterolemia managed to even get time in a courtroom to present Vioxx as a cause of their heart attacks.
 

"Even so, it is still pretty amazing that a 77-year-old diabetic and a 58-year-old overweight man with hypercholesterolemia managed to even get time in a courtroom to present Vioxx as a cause of their heart attacks."


But you can bet with Lanier the MVP of the sodomites on the plaintiffs side there is a Las Vegas line on this trial and the odds are favoring Lanier. Anyone want to wager against him?
 

Pretty jealous aren't you. Probably wish you were good at what you did.
 

"Pretty jealous aren't you. Probably wish you were good at what you did. "

Put your money where your mouth is buttmunch. Wanna bet?
 

Here's a wonderful quote from a law text for everyone to chew on:

"...lawyers do not owe a general duty to ensure that justice is done or to enable the court to find the truth. Their only obligation to the court is not to mislead the court on questions of law or fact. How then does the truth emerge? Only as a consequence of the fact that each side is intent on winning the case." (Common Law Reasoning and Institutions, Morrison et.al., London,2004)

So you see, whether it's Lanier, the "expert witnesses," or the Merck lawyers, it's all part of a great game.
 

Or as a Bro said in the back at a church service I once went to when the pastor asked "Why, in America, do people sue:"

"Cause in my hood, they don't wannna work"
 

"So you see, whether it's Lanier, the "expert witnesses," or the Merck lawyers, it's all part of a great game."

And that's so different from medicine how? Not at all really.

Physicians don't want to have to be correct, they want to be able to crow about their successes as if they were the ultimate savior, and blame it on God when it doesn't work. It's all just a game where worst case they couldn't have done anything, best case they are heroes.

At least in law there's a downside to losing.
 

Downside to losing comes into play only when you are on a contingency fee.but in that case also trial lawyers do fairly well even screwing up majority of the times,'cause the incentive of winning is so big.Otherwise win or lose you are on a standard hourly fees.
Comparing the practice of law and medicine is comparing apples and oranges.Nobody even thinks to visit a surgeon ,who screws up 70-80 % of the times. Law is an adversial system where you protect your clients interests only by screwing the adversary .It is basically an war,waged against the guilty and innocent alike where every rule can be twisted and we can only pray that at the end of the day justice will be served. In medicine most of the time the doctor will succeed,and become the hero because the people will caonize him/her. If i bring my comatose son to an ER and see the Docs running the whole hog to save him and they succeed in doing that-they will be my heroes.The whole focus is there on the patient and no adversaries are involved. I believe that not all cases are workable however good-intentioned the doctor is and when human life is at stake unrealistic expectations of the doctors and patients just reinforce each other.May be it is just the different nature of the practice that explains the faultering image of both doctors and lawyers but doctors still winning on that front as surveys after surveys tell us.
Just my two cents.
 

Medicine is different. Physicians do owe a general duty to their patients and to their profession. But what they owe is different from what you assume.

What physicians owe to their patients is a reasonable and earnest effort at a proper diagnostic regimen and applicable treatment, whether medical or surgical. As for results, well, they fall where they may. If the process is properly performed, the patients will have received the appropriate results for their situation.

That's not to say that all doctors are perfect. Far from it. I've seen a lot of sloppy medicine. And just read some of the comments littered thru this blog. A travesty.
 

". Far from it. I've seen a lot of sloppy medicine. And just read some of the comments littered thru this blog. A travesty."

Another genius who decided s/he can evaluate a physician's medical competence and performance based on what they say on an anonymous medical blog.
 

"Downside to losing comes into play only when you are on a contingency fee."

Nonsense. There's a downside to losing in terms of client retention and satisfaction. Physicians don't have that, because they just say "well, that's nature" when things go south. And they know most victims of legit malpractice don't sue.

"but in that case also trial lawyers do fairly well even screwing up majority of the times,'cause the incentive of winning is so big."

Really? How big? The average med mal verdict is $250K. The average tort award is $30K overall. Neither of those numbers consider the costs. Those are big wins? Check your math.

"Nobody even thinks to visit a surgeon ,who screws up 70-80 % of the times."

Patients have no clue what the screw up rate of surgeons is. They have no idea how to rate physicians, and choose them by who is on their insurance plans.

Physicians continue to have their high favorability with the public because the public generally has no idea what they are doing or how competently they are doing it. As for lawyers, no one likes the other side's lawyers, but most people like their own.
 

"As for lawyers, no one likes the other side's lawyers, but most people like their own. "

Can you cite a study to back up this claim?
 

"There's a downside to losing in terms of client retention and satisfaction. Physicians don't have that"

What a fool I am! "patient" retention and satisfaction never crossed my mind

"most victims of legit malpractice don't sue"

Definitely true and so are the bogus awards for maloccurance(fact so purposefully silenced).IOM study proves both.Rather it puts the onus at systemic level and denounces legal action as an ineffective deterrant

"The average med mal verdict is $250K. The average tort award is $30K overall"

how can a plaintiff's lawyer stay in business.A lot to be answered

"They have no idea how to rate physicians, and choose them by who is on their insurance plans"

not so many doctors have left the town(courtsey you folks)that a pt can't choose from a panel.By the way how to rate lawyers?

"public generally has no idea what they are doing or how competently they are doing it"

As per "what" they are not expected to know which separates a professional from lay person.It is an age old question.G.B. shaw grudgingly said that "all professions are conspiracy against laity" but that's how the thing is.

Regarding "how competently" boils down to the trust of your client and it can be achieved only if the majority of the profession can act responsibly.

"As for lawyers, no one likes the other side's lawyers, but most people like their own."

May not be true.I can hire a hitman or goon( not that all lawyers are like that) for my job done successfully( doesn't make me a saint either) but how much I trust him or can afford to invite him or worse can offer him a night stay.Perhaps deep down I know that this hired gun may backfire.
 

I could care less if I like the lawyer I hire, as long as he's a conniving bastard son-of a-bitch sodomite who'll stick it up the ass of my opponent.
 

I wrote both Anon 10:43 PM and Anon 8:56 AM.

A response to Anon 10:17 AM.

I'll take the appellation of genius, but my experience comes not from cruising medblogs but from medical school, internship, residency, board certification, and 15 years in solo private practice. And approximately $500,000 in malpractice premiums during those years.

I've seen a lot of good medicine practiced also, but the bell curve is very wide.

Remember I said I've (myself) seen a lot of sloppy medicine. AND just read some of the comments littered thru this blog.

Would you like to be treated by some of the (hopefully few) patient-hating doctors who comment here?
 

"By the way how to rate lawyers?"

Lawyers win and lose every day. Physicians either win or it was a "bad outcome and bad outcomes happen and that's just life."
 

anon 4:06,

absolutely not! But, most Drs. don't behave the way a very few that post here do. We see first hand the reasons Drs. and Lawyers hate each other. They are so similar in what they do. But, they neither would ever admit to it. It is laughable to hear all these Doc's talk about how unfair they are treated by the legal system and at the same time they admit to CYA, breaking the health care system in our country because of their CYA practice,and hating their patients. They seem to want no solution as an alternative to defensive medicine because to ask for one would be an admission of ins. fraud. Then they turn around and blame the patients for their behavior. But, It is not all Docs who behave this way.

There is one here that is a nightmare. Every time I read his posts I can only think of Freddy Kruger. He is that frieghtening. I feel so sorry for the people he comes in contact with.
 

"at the same time they admit to CYA, breaking the health care system in our country because of their CYA practice,"


Yes. It's the doctor's who are breaking the health care system by practicing Defensive Medicine to keep the lawyers from ruining our careers. And it's the 12 year old Boys who are hurting the music industry by pointing out that Michael Jackson sodomized them.
 

Can't ever leave the true love of your life can you?

Seriously, what "career" are you saving? Your own was lost long ago.
 

Seriously, what "career" are you saving? Your own was lost long ago.

Sodomite killer!
 

"I've seen a lot of good medicine practiced also, but the bell curve is very wide."

I'm sure you never made a mistake in all those years of practice...
 

"There is one here that is a nightmare"

Yeah, there's one patient on here that's a real nightmare too...this guy who's orthopedist gave him a new knee...then he comes on the web and starts bitching about the doc...the ingratitude made me sick to my stomach...I'm still reeling...there is not punishment or illness too severe for this type of person.
 

Oh yeah, I remember that guy. I'm going to go back and look for his post.

Memory tells me he got a new knee, was taken off all pain meds. after a week or something. Ended up re-hospitalized for excessive swelling and infection or some shit. Had to have his PCP order "Ultram" (you know how addictive and dangerous those are) I think to help poor baby get through therapy. He wanted to replace his OS's knee and see how he liked being taken off all pain meds so quickly.

Thats what your pissed off about? Man, you are as phycho as they come!
 

Ultram is a "non-narcotic analgesic". His pcp prescribed it because he did not want the liability associated with prescribing a real narcotic (vicodin, tylenol 3, percocet) to this litigious patient. He obviously knew that he was a complainer type. The joke is that the patient doesn't even know this and thinks his pcp is a great doc...
 

LMAO..Oh I think the Pt. knows exactly what "Ultram" is...I also think you don't know when something is presented to you condescendingly...

As a matter of fact I think this pt.requested Ultram, for the simple fact that it is non-narcotic.

I hope in my next life I can be as wonderful as you. So much so that I know all the facts about everyone just because it is what I happen to think, yep if I think it then it must be so, right?...But, then again, maybe I can just come back as me and you as you and I can have this much fun playing with you again.
 

Lawyers win and lose every day. Physicians either win or it was a "bad outcome and bad outcomes happen and that's just life."

As said before Medicine is not an adversarial system,to win you need an opponent.here you just apply your knowledge and skills to diagnose and treat and sometimes you fail but you never lose.
 

"Would you like to be treated by some of the (hopefully few) patient-hating doctors who comment here?"

Although may sound politically incorrect but how a physician would like to treat a doctor-hating patient (hopefully few )who comment here.It ain't good for anybody.
 

"As a matter of fact I think this pt.requested Ultram, for the simple fact that it is non-narcotic. "

You Idiot, Ultram effects opiod receptors just as all the other narcs. It just doesn't give the same good high.
 

"sometimes you fail but you never lose."

The physician doesn't, no. They get paid regardless. Good work if you can get it.
 

"The physician doesn't, no. They get paid regardless. Good work if you can get it."

I think few professions make the performance so ridiculously incentivized with reimbursements that there wil be few people to take the difficult cases or do any difficult job if they are so harshly penalized for failure.A doctor won't take the chance on an unworkable case.When tort reform measures attempted slashing the attorneys fees,this is the fact sadly bemoaned by ATLA . A lot of cases are refused by attorneys because thy are not economically sustainable ,but they need representation too.these people equate to the difficult chronic patients who will linger on and on and never get well. But they do need treatment. Trial attorneys themselves got onto this nemesis game of no win no fees and now the flipside is bothersome if compared to any salaried job.But it is you who asked for it. may be the legal clients interst will be best served by a HMO model of representation in an overlawyered country.
 

Anirban,

What kind of tort reform would make you do your job as a professional?

I agree there are too many lawyers - most of them are in multistory buildings in big cities representing Fortune 500 companies and insurers.

And attorneys don't choose contingency fees because they want to. In fact, we're required to offer the hourly option to our clients in many states. But think about it - if you were hurt to the point you could not work, would you have the spare cash to finance a medical malpractice trial and pay all your other bills, including medical? If so, good for you, but you're the exception.

Oh, and the only attorney fees anyone ever proposes cutting are the individual plaintiff's. For some reason, corporate defendants and insurance cos. get to pay whatever they want to their counsel in these proposals. But I'm sure you think that's fair.

It's funny you feel bad for those cases which are not economical, because it is legislation proposed by physicians and their insurers which has made them so.

CJD
 

"because it is legislation proposed by physicians and their insurers which has made them so."

Oh really.

Can you say Health Courts CJD?
 

Cjd

may be you came up to defence of Anonymouse I was responding to but you just dodged what i said

"What kind of tort reform would make you do your job as a professional?"

Perhaps none. What I asked for professional work realistically incentivized to its outcomes.

"most of them are in multistory buildings in big cities representing Fortune 500 companies and insurers"

They may be the upper rungs of your class and by definition minority.

"would you have the spare cash to finance a medical malpractice trial and pay all your other bills, including medical"

That is why life and disability insurances are for.There are more medical maloccurances than malpractice(with equally tragic outcome) and most of the plaintiffs won't collect a dime.For them the first option sounds more logical to sustain life.

"corporate defendants and insurance cos. get to pay whatever they want to their counsel in these proposals. But I'm sure you think that's fair"

Is corporation an ATM machine? no scope of negotiation.Do they get bigger rewards than class actions. So why not be one?

"you feel bad for those cases which are not economical, because it is legislation proposed by physicians and their insurers which has made them so"

In this no win no fees paradigm most of the cases were not economical anyway. The said legislation came under the backdrop of a huge wastage of insurance money to settle cases
which wil never see the day light and if it does to defend what would never collect a dime for the injured.Unfortunately the winner defendent can't collect(set aside georgia) and have to suck it up.The question is
are the lawyers too dumb to select cases or just gaming the system.With all due respect to their intelligence the second one appears tenable.The proposed legilslation was an attempt to make lawyer fees contingent upon the credibility of a lawsuit,that sadly has gone haywire.
 

"Can you say Health Courts CJD?"

So far, health courts haven't gotten very far in the legislatures, at least not as far as other measures.

And of course, no one has shown a need for a health court or that health courts would be any better or give physicians any higher win rate than the 75% they already enjoy.
 

"They may be the upper rungs of your class and by definition minority."

What class are you speaking of? Where do you practice?

"That is why life and disability insurances are for."

A life insurance policy won't cover your personal expenses. Do you have any idea what the cost of disability coverage is? For a blue collar worker? Most disability policies won't give you a number much in excess of a certain percentage of your current earnings, so where is the excess to pay your medical bills and your lawyer?

"There are more medical maloccurances than malpractice(with equally tragic outcome) and most of the plaintiffs won't collect a dime."

There certainly are - and those people end up discharging their medical debts in bankruptcy often times.

"The said legislation came under the backdrop of a huge wastage of insurance money to settle cases
which wil never see the day light and if it does to defend what would never collect a dime for the injured.Unfortunately the winner defendent can't collect(set aside georgia) and have to suck it up."

I'm not really sure what you're saying here. But the winning defendant's insurer has already collected in terms of premiums. They are performing the service the insured pays for every month.

"are the lawyers too dumb to select cases or just gaming the system.With all due respect to their intelligence the second one appears tenable."

I'd venture to say you haven't dealt with many casualty insurers, but rest assured they're not in the business of paying money on bullshit cases. If you know of one who is, please let me know, though.

"The proposed legilslation was an attempt to make lawyer fees contingent upon the credibility of a lawsuit,that sadly has gone haywire."

Perhaps you could reference me to the bill you're talking about. But all contingency fees are based upon the "credibility" of the suit, because if you don't win you don't get paid.

CJD
 

Cjd
please note

"What class are you speaking of?"

I thought the best and the brightest of any discipline will head for secure and lucrative jobs,the insurance and Fortune 500 companies as you say.Law is no exception.

"those people end up discharging their medical debts in bankruptcy often times"

so ultimately the taxpayers money provide for this?

"But the winning defendant's insurer has already collected in terms of premiums"

and that premium grow on trees.beside that how can you compensate my lost earnings,"non-economic damages" like "pain and suffering".If I countersue what is my success rate?

"they're not in the business of paying money on bullshit cases"
and
"all contingency fees are based upon the "credibility" of the suit, because if you don't win you don't get paid"

If I agree with you,then have a look at yourself. If Doctors win 75% of the time,then what is your efficieny ratio, with due respect to the jury system and you say your cases are credible.Still you manage to make a good living.Do you browbeat them to settle? There is something desperately missing in the equation.
 

"If I agree with you,then have a look at yourself. If Doctors win 75% of the time,then what is your efficieny ratio, with due respect to the jury system and you say your cases are credible."

Docs win 75% of the time AT TRIAL. Not every case tries, in fact the vast majority don't.

"Do you browbeat them to settle? There is something desperately missing in the equation."

I think it's your understanding of how casualty insurers work. How exactly does one browbeat an insurance company?

"and that premium grow on trees.beside that how can you compensate my lost earnings,"non-economic damages" like "pain and suffering".If I countersue what is my success rate?"

Regardless of where the premium comes from, the insurer has already been paid for the service. I realize that being a physician gives one a vastly inflated sense of self worth and the belief that you are above the common man, but having to explain yourself and your actions to a jury is not "pain and suffering", however little you may think of the voting population.

" thought the best and the brightest of any discipline will head for secure and lucrative jobs,the insurance and Fortune 500 companies as you say.Law is no exception."

Only if one thinks of law as being one type of work. The best and brightest at transactional work may well have their own small firm. The best and brightest trial lawyers also often want their own firm, whether they represent plaintiffs or defense. Same as the best and brightest in business many times don't want to work for GE, but would prefer to control their own destiny and create their own company.
 

“Docs win 75% of the time AT TRIAL. Not every case tries, in fact the vast majority don't”


Holds good for every aspect of law. Even most of the criminal cases are also settled by plea bargaining. It seems not the justice but the expedition of the cases that matters most. But even for the cases being tried, the success rate of 25% seems abysmally poor. Are a lot of these cases shouldn’t have been brought anyway. But since trial consumes money and defense lawyers can’t work in a no win no fee paradigm, does it incentivise the insurance company to settle earlier if it costs them less. A tacit browbeating? Equation is still not clear.


“Having to explain yourself and your actions to a jury is not "pain and suffering", however little you may think of the voting population.”

Playing the same age-old populist cliché? I realize trial attorneys bank on that politics. Serves them well.
President Hoover once said “ When we are sick, we want an uncommon doctor; when we have a construction job to do, we want an uncommon engineer, and when we are at war, we want an uncommon general. It is only when we get into politics that we are satisfied with the common man.” .

Patients do canonize doctors, as much as they despise them sometimes.
Simply put, we're all common man and we all are unique . To assume otherwise- to believe one's economic
status, political beliefs, career, or other characteristics place them on a single de facto side in such a debate- ignores the irrefutable interconnectedness of Doctor’s and patients. Scoring point on 'voting population' ,ordinary man is rather faulty short-sighted,if not mean-spirited examination of the entirety of the debate.,As if they Doctor’s never vote and we have voted him or her and how we all were duped.Put all this common man on trial ,make them hear all those nice adjectives you parrot for years before the judge and jury,who eventually finds them innocent.You will be history.
 

"But since trial consumes money and defense lawyers can’t work in a no win no fee paradigm, does it incentivise the insurance company to settle earlier if it costs them less. A tacit browbeating? Equation is still not clear."

Space doesn't permit an overall review of the insurance industry, which I think you need at this point, but I would direct you to the 2005, February, letter to Berkshire Hathaway insurers. It's online at www.berkshirehathaway.com, I think the insurance part starts on about page 3. Buffett has been in the industry quite a while and explains it in layman's terms.

"Playing the same age-old populist cliché?"

Has nothing to do with populism - read the comments here - it's a fact. The rest of your paragraph is unintelligible, unfortunately.

CJD
 

“Has nothing to do with populism - read the comments here - it's a fact. The rest of your paragraph is unintelligible, unfortunately “


The reason I am getting addicted to this blog is that people don’t have to be overtly politically correct and freely exercise the 1st amendment rights as they wish. Vitriolic comments are hurled from both sides I admit and has nothing to do with respect .It is people just speaking their mind, not that they shouldn’t be responsible to defend that .having said that respect is a two way street.

For the rest of the unintelligible part I would like to paraphrase that to you in layman’s terms. I meant to say that it is stupid to segregate common and not so common man in a society if their interest is connected by dependence trust not to mention economics. Politicians hurl those populist jargons of common man voting population working people to score points but dupe us at the very end. As if people who are ‘not common’ never vote never work and flourish at the expense of common folk. The next group of people playing this card is the trial lawyers and the phony consumer advocates. They try to pit the common and the special against each other but feather their own nest at the very end. Once I read a story of a monkey who was asked to divide a pancake between two cats (or something else?) Every time the monkey would divide in such a way that one half always remains larger, so to equate he will gulp the excess. The pieces remained unequal all the time and after a few bites, nothing was there.


I’ve not yet gone through the letter to Berkshire Hathaway insurers. May be I’ll get some bone to pick