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	<title>Comments on: A take on why US patients are sicker</title>
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		<title>By: agave_azulito</title>
		<link>http://www.kevinmd.com/blog/2006/05/take-on-why-us-patients-are-sicker.html/comment-page-1#comment-62749</link>
		<dc:creator>agave_azulito</dc:creator>
		<pubDate>Sat, 06 May 2006 17:22:00 +0000</pubDate>
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		<description>n Mexico City, many drugstores hire a doctor for their clinic at the same location. These doctors typically have a list of about twenty common complaints that they treat, and I suspect that the quality of treatment of these specific ailments is at least as good as those generally provided by USA doctors.&lt;br/&gt;&lt;br/&gt;The cost of a consultation is typically between $0.90 and $2.00 US money (10-20 Mexican pesos).&lt;br/&gt;&lt;br/&gt;I will tell you nothing about the cost of generic drugs in Mexico vs the USA to treat these common ailments--I hate to see grown people cry.</description>
		<content:encoded><![CDATA[<p>n Mexico City, many drugstores hire a doctor for their clinic at the same location. These doctors typically have a list of about twenty common complaints that they treat, and I suspect that the quality of treatment of these specific ailments is at least as good as those generally provided by USA doctors.</p>
<p>The cost of a consultation is typically between $0.90 and $2.00 US money (10-20 Mexican pesos).</p>
<p>I will tell you nothing about the cost of generic drugs in Mexico vs the USA to treat these common ailments&#8211;I hate to see grown people cry.</p>
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		<title>By: agave_azulito</title>
		<link>http://www.kevinmd.com/blog/2006/05/take-on-why-us-patients-are-sicker.html/comment-page-1#comment-62748</link>
		<dc:creator>agave_azulito</dc:creator>
		<pubDate>Sat, 06 May 2006 17:20:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/05/a-take-on-why-us-patients-are-sicker.html#comment-62748</guid>
		<description>n Mexico City, many drugstores hire a doctor for their clinic at the same location. These doctors typically have a list of about twenty common complaints that they treat, and I suspect that the quality of treatment of these specific ailments is at least as good as those generally provided by USA doctors.&lt;br/&gt;&lt;br/&gt;The cost of a consultation is typically between $0.90 and $2.00 US money (10-20 Mexican pesos).&lt;br/&gt;&lt;br/&gt;I will tell you nothing about the cost of generic drugs in Mexico vs the USA to treat these common ailments--I hate to see grown people cry.</description>
		<content:encoded><![CDATA[<p>n Mexico City, many drugstores hire a doctor for their clinic at the same location. These doctors typically have a list of about twenty common complaints that they treat, and I suspect that the quality of treatment of these specific ailments is at least as good as those generally provided by USA doctors.</p>
<p>The cost of a consultation is typically between $0.90 and $2.00 US money (10-20 Mexican pesos).</p>
<p>I will tell you nothing about the cost of generic drugs in Mexico vs the USA to treat these common ailments&#8211;I hate to see grown people cry.</p>
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		<title>By: agave_azulito</title>
		<link>http://www.kevinmd.com/blog/2006/05/take-on-why-us-patients-are-sicker.html/comment-page-1#comment-62746</link>
		<dc:creator>agave_azulito</dc:creator>
		<pubDate>Sat, 06 May 2006 17:19:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/05/a-take-on-why-us-patients-are-sicker.html#comment-62746</guid>
		<description>In Mexico City, many drugstores hire a doctor for their clinic at the same location. These doctors typically have a list of about twenty common complaints that they treat, and I suspect that the quality of treatment of these specific ailments is at least as good as those generally provided by USA doctors.&lt;br/&gt;&lt;br/&gt;The cost of a consultation is typically between $0.90 and $2.00 US money (10-20 Mexican pesos).&lt;br/&gt;&lt;br/&gt;I will tell you nothing about the cost of generic drugs in Mexico vs the USA to treat these common ailments--I hate to see grown people cry.</description>
		<content:encoded><![CDATA[<p>In Mexico City, many drugstores hire a doctor for their clinic at the same location. These doctors typically have a list of about twenty common complaints that they treat, and I suspect that the quality of treatment of these specific ailments is at least as good as those generally provided by USA doctors.</p>
<p>The cost of a consultation is typically between $0.90 and $2.00 US money (10-20 Mexican pesos).</p>
<p>I will tell you nothing about the cost of generic drugs in Mexico vs the USA to treat these common ailments&#8211;I hate to see grown people cry.</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2006/05/take-on-why-us-patients-are-sicker.html/comment-page-1#comment-62747</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Sat, 06 May 2006 17:19:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/05/a-take-on-why-us-patients-are-sicker.html#comment-62747</guid>
		<description>In Mexico City, many drugstores hire a doctor for their clinic at the same location. These doctors typically have a list of about twenty common complaints that they treat, and I suspect that the quality of treatment of these specific ailments is at least as good as those generally provided by USA doctors.&lt;br/&gt;&lt;br/&gt;The cost of a consultation is typically between $0.90 and $2.00 US money (10-20 Mexican pesos).&lt;br/&gt;&lt;br/&gt;I will tell you nothing about the cost of generic drugs in Mexico vs the USA to treat these common ailments--I hate to see grown people cry.</description>
		<content:encoded><![CDATA[<p>In Mexico City, many drugstores hire a doctor for their clinic at the same location. These doctors typically have a list of about twenty common complaints that they treat, and I suspect that the quality of treatment of these specific ailments is at least as good as those generally provided by USA doctors.</p>
<p>The cost of a consultation is typically between $0.90 and $2.00 US money (10-20 Mexican pesos).</p>
<p>I will tell you nothing about the cost of generic drugs in Mexico vs the USA to treat these common ailments&#8211;I hate to see grown people cry.</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2006/05/take-on-why-us-patients-are-sicker.html/comment-page-1#comment-62744</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Sat, 06 May 2006 14:14:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/05/a-take-on-why-us-patients-are-sicker.html#comment-62744</guid>
		<description>While it seems that Patrick Kennedy is looking for someone to blame, in some cases doctors do make mistakes in writing instructions on how to take medication.&lt;br/&gt;For example, my HRT consists of estradiol/micronized progesterone (Prometrium). When I got the prescription bottle for Prometrium, the instructions said &quot;take one pill every morning&quot;. If you read the long insert for Prometrium, it says &quot;can cause drowsiness or dizziness, don&#039;t drive or operate heavy machinery after taking it&quot;; it also contains recommendation to take it in the evening to avoid the problems. Most women do take it in the evenings. I don&#039;t know who or why wrote the instructions to take it in the morning - there is no reason at all to do it.&lt;br/&gt;&lt;br/&gt;Now it could very well be that it was the pharmasist who made this mistake and not the doctor. But imagine for a moment that someone gets into in accident after following these instructions. Whom is this person likely to blame? Note, that Prometrium is not a sleep aid or a pain killer, so most people are not familiar with this side effect. I&#039;d imagine that my habit of reading package inserts and looking up information about drugs I am taking on the web is an exception rather than the rule.&lt;br/&gt;&lt;br/&gt;As far as overprescription goes, look at the use of statins for primary prevention in women. Show me some evidence that it reduces mortality. Also, a lot of times the women who get this prescriptions have high HDL and perfect ratio - medrants had a surway once, find it and read up personal stories. Lots of healthy women with HDL in the 80s and excellent ratio. Not that I believe it is any better in England.</description>
		<content:encoded><![CDATA[<p>While it seems that Patrick Kennedy is looking for someone to blame, in some cases doctors do make mistakes in writing instructions on how to take medication.<br />For example, my HRT consists of estradiol/micronized progesterone (Prometrium). When I got the prescription bottle for Prometrium, the instructions said &#8220;take one pill every morning&#8221;. If you read the long insert for Prometrium, it says &#8220;can cause drowsiness or dizziness, don&#8217;t drive or operate heavy machinery after taking it&#8221;; it also contains recommendation to take it in the evening to avoid the problems. Most women do take it in the evenings. I don&#8217;t know who or why wrote the instructions to take it in the morning &#8211; there is no reason at all to do it.</p>
<p>Now it could very well be that it was the pharmasist who made this mistake and not the doctor. But imagine for a moment that someone gets into in accident after following these instructions. Whom is this person likely to blame? Note, that Prometrium is not a sleep aid or a pain killer, so most people are not familiar with this side effect. I&#8217;d imagine that my habit of reading package inserts and looking up information about drugs I am taking on the web is an exception rather than the rule.</p>
<p>As far as overprescription goes, look at the use of statins for primary prevention in women. Show me some evidence that it reduces mortality. Also, a lot of times the women who get this prescriptions have high HDL and perfect ratio &#8211; medrants had a surway once, find it and read up personal stories. Lots of healthy women with HDL in the 80s and excellent ratio. Not that I believe it is any better in England.</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2006/05/take-on-why-us-patients-are-sicker.html/comment-page-1#comment-62742</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Sat, 06 May 2006 13:38:00 +0000</pubDate>
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		<description>Anon 10:33&lt;br/&gt;&lt;br/&gt;a.) Even if his prescribing doctor didn&#039;t explcitly warn him about the effects (drowsiness) of taking a sleeping pill (trying to keep a straight face here...) all those little stickers on the precription bottle did. All Ambien prescriptions dispensed in the U.S. have a warning sticker against &quot;driving or operating heavy machinery&quot;. He knew better.&lt;br/&gt;&lt;br/&gt;b.) Yesterday, Patrick Kennedy admitted to a substance abuse/addiction problem and is currently in drug rehab.</description>
		<content:encoded><![CDATA[<p>Anon 10:33</p>
<p>a.) Even if his prescribing doctor didn&#8217;t explcitly warn him about the effects (drowsiness) of taking a sleeping pill (trying to keep a straight face here&#8230;) all those little stickers on the precription bottle did. All Ambien prescriptions dispensed in the U.S. have a warning sticker against &#8220;driving or operating heavy machinery&#8221;. He knew better.</p>
<p>b.) Yesterday, Patrick Kennedy admitted to a substance abuse/addiction problem and is currently in drug rehab.</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2006/05/take-on-why-us-patients-are-sicker.html/comment-page-1#comment-62740</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Sat, 06 May 2006 05:40:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/05/a-take-on-why-us-patients-are-sicker.html#comment-62740</guid>
		<description>Anon 10:33 from your article:&lt;br/&gt;&lt;br/&gt;&quot;The doctors had prescribed a patient-controlled Demerol pump for pain&quot;&lt;br/&gt;&lt;br/&gt;The patient was sent home on a PCA with demerol. Perhaps Dr. Mangino can add his two cents butI have never sent home someone with a PCA. Additionally, why demerol? It has a seizure risk (though I have never seen it) and people seem to love demerol (that is TOO much). Why not a long actor of some sort. Fentanyl patch? MS-contin? Methadone? Seems to me there is a lot more to this story than your typical shark-blurb of how you have been wronged call us blah blah blah.....</description>
		<content:encoded><![CDATA[<p>Anon 10:33 from your article:</p>
<p>&#8220;The doctors had prescribed a patient-controlled Demerol pump for pain&#8221;</p>
<p>The patient was sent home on a PCA with demerol. Perhaps Dr. Mangino can add his two cents butI have never sent home someone with a PCA. Additionally, why demerol? It has a seizure risk (though I have never seen it) and people seem to love demerol (that is TOO much). Why not a long actor of some sort. Fentanyl patch? MS-contin? Methadone? Seems to me there is a lot more to this story than your typical shark-blurb of how you have been wronged call us blah blah blah&#8230;..</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2006/05/take-on-why-us-patients-are-sicker.html/comment-page-1#comment-62738</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Sat, 06 May 2006 04:23:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/05/a-take-on-why-us-patients-are-sicker.html#comment-62738</guid>
		<description>Well, if he was on medication that hindered his driving why didn&#039;t he hire a driver. None of the Kennedy&#039;s seem to be able to drive...sober, drunk or whatever.&lt;br/&gt;&lt;br/&gt;This group of men live on the edge, don&#039;t you know that?</description>
		<content:encoded><![CDATA[<p>Well, if he was on medication that hindered his driving why didn&#8217;t he hire a driver. None of the Kennedy&#8217;s seem to be able to drive&#8230;sober, drunk or whatever.</p>
<p>This group of men live on the edge, don&#8217;t you know that?</p>
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		<title>By: Anonymous</title>
		<link>http://www.kevinmd.com/blog/2006/05/take-on-why-us-patients-are-sicker.html/comment-page-1#comment-62737</link>
		<dc:creator>Anonymous</dc:creator>
		<pubDate>Sat, 06 May 2006 02:33:00 +0000</pubDate>
		<guid isPermaLink="false">http://clients.emmense.com/kevinmd/2006/05/a-take-on-why-us-patients-are-sicker.html#comment-62737</guid>
		<description>Text of statements in the Rep. Patrick Kennedy crash help to highlight the possible perils of prescription medication.&lt;br/&gt;&lt;br/&gt;“Last Tuesday, the Attending Physician of the United States Congress treated me for Gastroenteritis. The Attending Physician prescribed Phenergan, an anti-nausea medication, which in addition to treating Gastroenteritis, I now know can cause drowsiness and sedation.&lt;br/&gt;&lt;br/&gt;Following the last series of votes on Wednesday evening, I returned to my home on Capitol Hill and took the prescribed amount of Phenergan and Ambien, which was also prescribed by the Attending Physician some time ago and I occasionally take to fall asleep. Some time around 2:45 am, I drove the few blocks to the Capitol Complex believing I needed to vote. Apparently, I was disoriented from the medication. At that time, I was involved in a one-car incident in which my car hit the security barrier at the corner of 1st and C St., SE. At no time before the incident did I consume any alcohol.&quot;&lt;br/&gt;&lt;br/&gt;Unfortunately, I believe there are some physicians who place the public in peril by excessively prescribing drugs which may impair their automobile driving patients.&lt;br/&gt;&lt;br/&gt;Papers have been published on the impairment caused by opioids&lt;br/&gt;http://www.ndaa-apri.org/pdf/ntlc_opioids.pdf&lt;br/&gt;and impairment caused by benzodiazepines&lt;br/&gt;http://www.aafp.org/afp/20000401/2121.html  &lt;br/&gt; &lt;br/&gt;It seems the legal system may deem physicians to be accountable for their prescriptions as seen in the following case:&lt;br/&gt;http://www.usalaw.com/a-aa-doctors-sued-drugs-auto-crash.html</description>
		<content:encoded><![CDATA[<p>Text of statements in the Rep. Patrick Kennedy crash help to highlight the possible perils of prescription medication.</p>
<p>“Last Tuesday, the Attending Physician of the United States Congress treated me for Gastroenteritis. The Attending Physician prescribed Phenergan, an anti-nausea medication, which in addition to treating Gastroenteritis, I now know can cause drowsiness and sedation.</p>
<p>Following the last series of votes on Wednesday evening, I returned to my home on Capitol Hill and took the prescribed amount of Phenergan and Ambien, which was also prescribed by the Attending Physician some time ago and I occasionally take to fall asleep. Some time around 2:45 am, I drove the few blocks to the Capitol Complex believing I needed to vote. Apparently, I was disoriented from the medication. At that time, I was involved in a one-car incident in which my car hit the security barrier at the corner of 1st and C St., SE. At no time before the incident did I consume any alcohol.&#8221;</p>
<p>Unfortunately, I believe there are some physicians who place the public in peril by excessively prescribing drugs which may impair their automobile driving patients.</p>
<p>Papers have been published on the impairment caused by opioids<br /><a href="http://www.ndaa-apri.org/pdf/ntlc_opioids.pdf" rel="nofollow">http://www.ndaa-apri.org/pdf/ntlc_opioids.pdf</a><br />and impairment caused by benzodiazepines<br /><a href="http://www.aafp.org/afp/20000401/2121.html" rel="nofollow">http://www.aafp.org/afp/20000401/2121.html</a>  </p>
<p>It seems the legal system may deem physicians to be accountable for their prescriptions as seen in the following case:<br /><a href="http://www.usalaw.com/a-aa-doctors-sued-drugs-auto-crash.html" rel="nofollow">http://www.usalaw.com/a-aa-doctors-sued-drugs-auto-crash.html</a></p>
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		<title>By: WilliamManginoMd</title>
		<link>http://www.kevinmd.com/blog/2006/05/take-on-why-us-patients-are-sicker.html/comment-page-1#comment-62733</link>
		<dc:creator>WilliamManginoMd</dc:creator>
		<pubDate>Fri, 05 May 2006 23:39:00 +0000</pubDate>
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		<description>I think everybody who commented today offered some really great insight into the difficulties inherent in taking care of patients and being a patient.&lt;br/&gt;&lt;br/&gt;  My hat is off to every doctor who has struggled to do the right thing.&lt;br/&gt;&lt;br/&gt;  If I get sick-I&#039;d be proud to have you all take care of me. &lt;br/&gt;&lt;br/&gt;  You are in my prayers</description>
		<content:encoded><![CDATA[<p>I think everybody who commented today offered some really great insight into the difficulties inherent in taking care of patients and being a patient.</p>
<p>  My hat is off to every doctor who has struggled to do the right thing.</p>
<p>  If I get sick-I&#8217;d be proud to have you all take care of me. </p>
<p>  You are in my prayers</p>
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