Patients

E-patients and how the American health care system doesn’t promote patient empowerment

Good stuff from the UK today – first the Lancet editorial on OTC statins and now this article form the BMJ.

Entitled The first generation of e-patients, the article comes up with these observations about the world of the e-patient:

. . . many clinicians have underestimated the benefits and overestimated the risks of online health resources for patients . . . Many e-patients say …

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More on OTC statins

Graham from Gross Anatomy, agreed with previous assertions that the motive for OTC statins is all about the money. I continue to have mixed feelings about it, but still believe there are too many driving forces (i.e. drug company profits, insurance savings) to prevent it from happening in the US.

In the May 22nd issue of The Lancet, the editorial slams the recent UK OTC decision, …

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A doctor is sued for following the USPSTF guidelines on prostate cancer screening

I came across this case from JAMA in January, 2004. Here are the basics:

1) A third-year resident, Dr. Merenstein, saw an educated 53-yo man for the first time at his resident clinic. A PSA level had never been done before.

2) A documented discussion about the risks and benefits of screening was done, and the patient was enouraged to consider the information. He was never …

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Low-carb diets

The Annals of Internal Medicine reported a study comparing a low-carbohydrate, ketogenic diet program (i.e. Atkin’s) with those of a low-fat, low-cholesterol, reduced-calorie diet.

The study concluded the following:

Compared with a low-fat diet, a low-carbohydrate diet program had better participant retention and greater weight loss. During active weight loss, serum triglyceride levels decreased more and high-density lipoprotein cholesterol level increased more with the low-carbohydrate diet than …

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Fast food antibiotics

Packaging antibiotics in “paks” is nothing new and is only gaining popularity. Patients love it, and it’s easy for physicians to write “***-pak, use as directed”. Azithromycin has the popular 5-day formulation (Z-pak) and a 3-day formulation (Tri-pak).

Levaquin now has the 5-day Leva-pak (750mg x 5 days) – which has the potential for wide-spread (ab)use. This is especially troubling given the emerging …

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Warts and duct tape

Just saw a patient with warts on her hands and remembered there was a small study that was released comparing duct tape and cryotherapy. I quickly Googled it and here’s the data:

In the study, researchers randomly assigned 51 patients, aged 3 and 22, to receive either a maximum of six cryotherapy treatments or two months of “duct tape therapy.”

Duct tape therapy consisted of a nurse …

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Should statin cholesterol drugs be over the counter?

Associated Press:

Some of the world’s biggest drug companies are working behind the scenes to convince regulators to let older cholesterol-lowering drugs be sold without a prescription in low doses, as Britain has just done.

While doctors say the drugs are safe, less than one-half of Americans who could benefit take them, mostly those at highest risk of heart disease, other complications and death, experts say. Most of the …

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Osteoporosis and homocysteine

Today’s NEJM released studies from the Netherlands and from the Framingham Study concluding that elevated homocysteine levels being a predictive risk factor for osteoporosis.

Here are comments from the accompanying editorial:

Whether it is a culprit or a bystander, homocysteine can now be added to the growing list of risk factors for fractures. Its use might increase the predictive power of an assessment based not …

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Here’s a novel idea to "treat" viral infections

AMNews:

Cold kits stifle pleas for antibiotics

Minnesota physicians may have found a way to satisfy patients who hate to take no for an answer where antibiotics are concerned, researchers announced Feb. 29 at the International Conference on Emerging Infectious Diseases.

Patients with upper respiratory illnesses or acute bronchitis were provided boxes filled with over-the-counter pain relievers, decongestants, cough syrup and lozenges, powdered chicken soup and a teabag …

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Physicians provide more than $5 billion in uncompensated care

The ACP released a paper today focusing on uncompensated care for the uninsured. This paper coincides with Cover the Uninsured Week taking place from May 10-16:

In 2001, for instance, the American health care system provided close to $99 billion in care to uninsured patients, $35 billion of which was uncompensated.

Hospitals provided $24 billion of that care while physicians volunteered about $5.1 billion in uncompensated care, including …

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Progress in smoking cessation

AMNews:

Smoking cessation success reported

Training nurses and medical assistants who register patients at primary care facilities to use specific, guideline-based methods to encourage smoking cessation increases the likelihood that patients will successfully quit, according to a study published in the April 21 Journal of the National Cancer Institute.

Researchers tested the effectiveness of guidelines developed by the Agency for Healthcare Research and Quality in a randomized, controlled …

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Deceiving a physician, then suing him

AMNews:

In what’s believed to be the first lawsuit of its kind, a Texas patient who presented a fake ID and the patient’s father were allowed to go forward with a civil lawsuit against a physician who gave the girl an abortion without contacting her parents.

Cherise Mosley Hughes first came into the clinic where Houston general practice physician Douglas Karpen, DO, works in the summer of 2000. She …

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How to prevent blood clots when going on airplanes

I’m flying soon, and thought this would be a relevant article to share.

Prescriber’s Letter:

Practical Tips for Avoiding “Economy Class Syndrome”

What Is Economy Class Syndrome?

Economy class syndrome is a condition that can happen after sitting in a cramped space, such as the economy class section of an airplane. This can lead to blood clots in the legs and sometimes the …

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Importing drugs gaining momentum

Boston Globe:

2 chains urge OK for drug imports

CVS, Walgreens add to growing support

The nation’s two largest chain drugstores, CVS and Walgreens, launched a challenge to the nation’s drug manufacturers yesterday by calling on the Bush administration to develop a legal, safe channel for Americans to buy imported drugs.

CVS Corp.’s Tom Ryan, chairman and chief executive of the Rhode Island company, led the way …

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Physicians still prescribing new blood-pressure medication

AMNews:

Doctors prefer prescribing newer blood pressure drugs

Physicians are more likely to prescribe newer anti-hypertensives than their less expensive predecessors recommended by the Joint National Commission on High Blood Pressure Treatment, according to a study published in the December Journal of General Internal Medicine.

Researchers at the University of Michigan surveyed 1,700 primary care physicians, finding that most believed diuretics were less effective and that beta-blockers had …

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Patient education is needed to reduce drug resistant bacteria

This past Sunday, 60 Minutes did a piece on the emergence of drug-resistant bacteria. One of the major contributing factors is the overprescription of antibiotics for non-bacterial infections:

While we can’t stop the bacteria from trying to outwit antibiotics, health officials say a dramatic cut in their use could help reverse the tide. That means doctors will have to stop writing, and patients will have to stop demanding, …

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Zyrtec from Canadian pharmacies

As you may know, Claritin has been OTC in the United States for awhile now. The repercussions of this is that competing brands such as Allegra and Zyrtec have been pushed to the most expensive co-pay tier in many drug plans. This is especially of concern for those who are not on a tiered drug plan. It has been my experience that some allergy sufferers do not …

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Be prepared for your physician visit

Last year, there was a study done by the Royal Society of Medicine that suggested that patients forget up to 80 percent of what a physician tells them during an office visit:

“While you might not recall everything your doctor tells you, you’re pretty confident you remember most of the information. Right?

Probably not, new research contends. Most patients forget as much as 80 percent of what their …

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