1) Marcia K. Flesner responds to my op-ed, commenting that I “failed to give a solution” and how nurse practitioners are the answer.
My take: Perhaps she neglected to read the section after I wrote, “How do we fix this problem?”
Our nurse practitioner colleagues play a vital role in health care delivery. Asking them to take over primary care as a permanent solution is not the answer.
Although they are appropriately trained to manage a proportion of primary care issues, complex patient issues and coordinating care requires more extensive training.
I would venture that many nurse practitioners would readily admit this.
2) Soon to be graduating medical student Graham Walker has been writing extensive pieces on the woes of our health care system.
My take: I find myself agreeing with Graham more often than not. Panda Bear admits this as well. Surprising, considering we’re on opposite sites of the single-payer fence.
It seems physicians agree on the problems. Solutions however, is where the debate can become contentious.
3) The LA Times wrote a piece questioning if generic drugs are as effective as brand name medications.
My take: Randomized trials are critical to put this issue to rest. If physicians and patients believe the superiority of name brand drugs, it will significantly slow any cost saving potential of generics.
Personally, I think generics are fine. But this debate is growing more heated by the day and will soon be impossible to ignore.
If Big Pharma is somehow behind this movement, it’s a brilliant move on their part.
Related posts:
- Generics versus brand-name drugs
- Are generic medications as good as their brand name counterparts?
- Are generic drugs truly equivalent to brand name medications?
- Should docs be paid for switching patients to generics?
- Idiocy in Missouri
- Seniors, generics and brand name medications
- The Angry Pharmacist on the Medicare donut-hole
{ 6 comments }
Check out the review of primary care in Ontario at
http://www.ices.on.ca/webpage.cfm?site_id=1&org_id=67&morg_id=0&gsec_id=0&item_id=3655&type=atlas
it’s a lengthy document but goes though the state of primary care in Ontario and our GP population. Of note 1/3 of all men between 20-39 do not see a doctor each year. I’m not sure if this helps or hurts the argument for guys like Dr. but I’m sure it adds to the workload after 40 and is related to the shortage of GP’s. The meat of the articles is found on page 2 of Chapter 4
http://www.ices.on.ca/file/PC_atlas_chapter4.pdf
A greater proportion of patients are seeing specialists for diseases like CHF and do better if they do. While NP’s and generic drugs may help I don’t think they’re the answer based on this evidence. What about group practice with specialists and GP’s with pay-per-patient rather than fee-for-service? It would streamline care significantly and increase access for patients.
Happy reading.
Ian.
http://www.waittimes.blogspot.com
I am not sure about the role of ANRPs in the healthcare crisis. I say this as we have seen a huge increase in the number of specialist referrals for what would otherwise been handled at the PCP level. This has created even higher utilization of specialists and the over all loss of the role of the primary care physician. Where the internist and family physician are able to manage the overall health of the patient, the ANRPs tend to be tour guides sending patients off to see specialists with no overall medical management.
I had a classic example of this yesterday. A patient needed medical clearance or at least an overall picture of his medical conditions prior to cancer surgery. When I called his PCP I found that it was an ANRP. I asked about his overall medical stability and she had no idea and suggested that I call his endocrinologist, cardiologist and his gastroenterologist
Generics: I am very happy to use them for antibiotics or pain meds. But for things like hypothyroid or seizure meds, I would stay with name brands because they require such careful and steady dosages. Just my personal choice.
Also – if I go to see a doctor I want to see a doctor not a nurse, regardless of the level of nursing education.
I would love to see some actual research on the brand vs. generic issue. All I have seen so far is anecdotal evidence.
I personally take generics, and recommend generics when available, unless it is a Narrow Therapeutic Index drug. Then, it’s brand all the way.
Hi Kevin,
Is pharma behind this? That’s what the GPHA has been saying. Is that true? That’s another matter. But here’s something interesting…
As I pointed out at Pharmalot, two of the three docs who are quoted by the LA Times as being skeptical of generics both have ties to brand-name drugmakers, although the paper doesn’t point this out. For a November 2006 CME presentation, Kowey disclosed he is a consultant or an adivsory board member for AstraZeneca, Glaxo, Procter & Gamble, Sanofi-Aventis, Solvay and Wyeth. And Gerald Naccarelli, chief of Pennsylvania State medical center’s division of cardiology, has a long list of fees he has accepted from Pfizer, Sanofi-Aventis, Glaxo and Wyeth, among others.
Ed S at Pharmalot
http://www.pharmalot.com/2008/03/are-generics-as-good-as-brand-name-meds/
I would much rather see an NP then a physcian, They have the ability to nursing diagnose and to medically diagnose and are much more intune and compassionate to the patient. I have no doubt in their ability they are well prepared and have to pass state boards and know what they are doing to practice. They also are trained in the particular specialty that they are practicing in. Thank God for NP’s.
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