As a physician who is involved in educating medical students, I am often asked for career advice. Medical students are by nature smart and ask very good questions. “Will I be able to pay of my student loans if I choose primary care?” “Will I have a balanced lifestyle if I decide to go into primary care?”
I try to be both encouraging and realistic. However, far too often I have …
Primary care trends in the health reform era
Media outlets are reporting the results of a small, but very important study regarding a new treatment for Alzheimer’s Disease. Most Americans are familiar with Alzheimer’s because it is so common (President Reagan had it), so devastating, and without a cure. This new study gives hope to people who have or are at risk for the disease.
Recently at the Alzheimer’s Association International Conference 2012 in Vancouver, researchers presented the …
IVIG for Alzerheimer’s: Cost is a barrier
Now more than ever, the growing consensus among many is that doctors should avoid seeing pharmaceutical sales representatives, otherwise known as drug reps. A position statement from the AAMC, the head organization of all US medical schools and residency programs, recommends that all academic health centers avoid having drug reps on their campuses, hospital and clinics. Many medical institutions including the VA and Kaiser have also enacted similar policies banning …
Is there a harm to not seeing drug reps?
I am not a huge baseball fan to begin with, and when I am, I root for the Nationals. Thus, I pay little attention to the New York Yankees, and was not aware that Yankee player Mark Teixeira had been suffering from a cough for the past month until it the story from the New York Times came through one of my Twitter feeds. According to the story: “Mark Teixeira had …
Using Advair to treat postinfectious cough
In our world of 24/7 media, where we seem to hear about the next big cure, important dietary change or very dangerous drug virtually every day, it is hard to believe that the news people, tweeters and bloggers could miss anything that is going on in health care today. However, it appears most everyone missed a big one. This might be one of the most important stories in health care today, that no one …
Making more drugs non-prescription is bad for patients
A recent article in the Wall Street Journal is getting a lot of attention: More Doctors ‘Fire’ Vaccine Refusers. The article discussing the increasing frequency of pediatricians who are “firing” patients/families from their practices because they refuse to take recommended vaccines for fear of autism or other concerns (rampant on the internet, but all proven untrue).
It is important to note that not only should physicians be able to fire patients, …
Why doctors should be allowed to fire patients
Health care is in crisis. Reimbursements from insurance companies continue to dwindle, while the expenses of running an office continue to rise. Looming cuts in Medicare are only weeks away, and many physicians may stop taking Medicare. If these cuts go into affect, it is possible that primary care physicians could lose up to 50% of their salary. Just recently CNN reported that some doctors are going bankrupt.
How …
A concierge or boutique label is discredits retainer medicine
Fortunately, the 27% reduction in Medicare payments to physicians that is set to take place in a matter of weeks unless congress acts is getting some press. Fox News published a piece recently, as did the Washington Post. Writer Merrill Goozner breaks things down nicely in his article, “Is There a Doctor Fix in the House … and Senate?”
However, one thing that seems to be getting confused in all the …
Primary care doctors are set to lose more than half of their salary
Before I took over one of the classes that now teach at the medical school, I asked students why the value of that class was so low. One of the reasons they gave was that it was so hard to do well in the class, and there were so many other things to study, students only put in enough effort to pass. In other words, incentives are only good if …
Give meaningful use value for physicians
In general, educators are often trying to find unique ways to engage their students.
This is certainly true of medical educators, given that little has changed in medical education in the past 100 years, and for that reason there have been many recent efforts to change this. Similarly, there is often a generational gap between teacher and learner, and thus teachers look for ways to connect with the younger generation they …
Using Twitter as an audience response system
Not to be negative about public health educational campaigns, which I believe are important, but the two major factors that have led to the decline in US smokers over the past decade are most attributable two two things: smoking bans and taxes on cigarettes.
When it becomes difficult to smoke in public places and expensive do to so anywhere, people are more motivated to quit.
An article in the New York Times …
Cigarette taxes work and why they are still too low
As reported by MSNBC, the federal government will no longer allow flexible spending accounts (FSAs) to be used for over the counter medications, without a prescription. FSAs, which are offered by many employers, allow you to use tax free dollars for medical expenses that aren’t covered by your insurance. FSAs are a great idea and can be used for things like eye glasses, dentistry, or even …
Requests for OTC prescriptions for a FSA burdens primary care
There is a lot of press about a study recently published in the New England Journal of Medicine that shows that adding tiotropium (Spiriva) to an inhaled steroid might have benefit in asthmatic patients. This study is creating a lot of buzz due to recent concerns of ICS/LABA safety and might prompt doctors and patients to start switching (some already have before this study came out). However, this …
Adding tiotropium (Spiriva) to an inhaled steroid a mistake?
Though I am not going to say that the New York Times lied, they either purposely and grossly misrepresented the truth or did a horrible job of reporting.
In their article, “Diabetes Drug Maker Hid Test Data, Files Indicate” the Times states that Avandia maker GSK “secretly began” a study which “provided clear signs that it (Avandia) was riskier to the heart.”
In fact, the study in question, called study …
Avandia, Actos and behind the scenes of study 175
I have a lot of diabetes patients and have been an avid user of the thiazolidinediones (TZD) class. There are many reasons to like the TZD’s:
Switching diabetes patients from Avandia to Actos
There’s an interesting video from WCVB in Boston about doctors getting kick backs from the insurance company to switch patients from branded medications to generic medications: New Rules To Protect Prescription Drug Customers.
If people were concerned about undue influence when drug companies used to give physicians pens and other novelties (now currently banned by most companies), they should really be concerned about actual monetary payments.
The patient interviewed in the Boston …
Incentives for switching patients from branded drugs to generic
My friend and colleague Katherine Chretien has a provocative op-ed in USA Today entitled, “A doctor’s request: Please don’t ‘friend’ me,” which asks the question whether doctors and patients should interact in social networking sites such as Facebook.
Social networking has huge potential in health care regarding the sharing of information and ideas, and could possibly even enhance communication between doctors and patients. However, as Dr. Chretien points out, many …
Facebook friend issues between doctor and patient
The FDA released a Drug Safety Communication warning about a possible risk of increased fractures with acid blocking medications called proton pump inhibitors or PPIs.
PPIs have been a major advance in medical science. Prior to these and earlier medications, the treatment for severe gastroesophageal reflux disease (GERD) was major surgery. PPIs are now commonly prescribed for GERD and less serious heart burn, many are generic, and some are now sold …
Fracture risk with Prilosec and other proton pump inhibitors
As reported in MedPage Today, the FDA announced the end for CFC-propelled inhalers. Of the seven inhalers with deadlines for removal, only three are still being made:
Flunisolide (Aerobid Inhaler System) on June 30, 2011
Albuterol and ipratropium combination (Combivent Inhalation Aerosol) on Dec. 31, 2013
Pirbuterol (Maxair Autohaler) on Dec. 31, 2013
The reason for this is because CFC’s are harmful for the environment, and the newer inhalers have to be replaced with …
Your asthma or COPD inhaler is not available, and what to do
An excellent article appeared recently in the Washington Post, entitled, “Having health insurance doesn’t ensure it will be easy to find a doctor,” where a young, otherwise healthy and insured woman discusses her extreme difficulty in finding a doctor in Washington, DC who will see her.
“I was just 23, basically healthy and, most important, insured. So I pulled out my computer, looked up the UnitedHealthcare list of pre-approved doctors …
Primary care access isn’t guaranteed by health insurance
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