April 20, 2006
Psychiatrists, the DSM-IV, and Big Pharma
The percentage was higher — 100 percent in some cases — for experts who worked on sections of the manual devoted to severe mental illnesses, like schizophrenia, the study found. But the authors, from Tufts University and the University of Massachusetts, were not able to establish how many of the psychiatrists were receiving money from drug companies while the manual was being compiled.
Lisa Cosgrove, the study's lead author, who is a psychologist at the University of Massachusetts in Boston, said that although the study could not prove that the psychiatrists' ties influenced the manual's development, "what we're saying is it's outrageous that the manual doesn't have a disclosure policy."
But other experts scoffed at the idea that commercial interests had influenced either the language or content of the manual. "I can categorically say, and I was there every step of the way, that drug-company influence never entered into any of the discussions, whatsoever," said Dr. Michael First, a psychiatry professor at Columbia, who coordinated development of the current D.S.M.
Okay . . . I feel much better now. [tm]
WSJ: We're Getting Better At Accepting Death
According to a piece in today's Wall Street Journal, as our population ages, we are getting better at accepting the reality and inevitability of death [link should work for the next 7 days]. This might be true of the Journal's readership, but as a member of 5 hospital ethics committees, I don't see much evidence of a cultural shift toward acceptance. [tm]
Federal Court Rules Docs Don't Have to Report Teen Sex
The AP is reporting tonight (AP/CNN) that District Judge J. Thomas Marten in Wichita, Kansas, ruled Tuesday that "that abortion clinic doctors and other professionals are not required under Kansas law to report underage sex between consenting youths." The Kansas City (MO) Star reported Wednesday that General Kline says an appeal is "very likely."
Judge Marten's 39-page opinion is here (PDF). As reported by AP:
The ruling by U.S. District Judge J. Thomas Marten was a setback for Kansas Attorney General Phill Kline, an abortion foe.
Kline contended that a 1982 Kansas law requiring doctors, teachers and others to alert the state and law enforcement about potential child abuse covers consensual sex between minors. He argued that the law applies to abortion clinics, and later extended that to other health professionals and teachers.
The Center for Reproductive Rights challenged that interpretation in court, and the judge sided with the organization. Kline said he had not decided whether to appeal.
AG Kline's initial (brief) statement on the ruling is here.
The Center for Reproductive Rights' comment on the ruling is here. According to their press release:
The judge recognized that, "Automatic mandatory reporting of illegal sexual activity involving a minor will change the nature of the relationship between a health care provider and the minor patient to some degree," and that studies establish that the kiss and tell policy would cause "a significant decrease in minors seeking care and treatment related to sexual activity."
The American Medical Association and numerous other major medical groups, including the American Society for Adolescent Psychiatry and American Psychiatric Association, oppose Kline’s policy because it would deter teenagers from seeking health care and counseling, including contraceptive services and information on prevention of sexually transmitted diseases. These medical organizations filed a friend-of-the-court brief supporting the plaintiff’s case.
The New York Times' report is here.
April 19, 2006
Costco Prescription Drug Plan
Jamie Court, a blogger at Huffingtonpost.com, has an interesting piece about an LA Times article about seniors buying prescription drugs at Costco for less than the prices available on their Medicare Part D plans. He writes,
How is it that Costco, a lean and efficient but still for-profit company, can provide consumers with prescription medications for a lower price than a government program subsidized by hundreds of billions, yes billions, of taxpayer dollars? The only possible answer is that the privatized prescription drug "benefit" being forced on U.S. seniors is meant chiefly to pour profits into Big Pharma, not to help Medicare recipients get a better bang for their pharmaceutical buck.
The LA times story by Valerie Reitman describes seniors who shopped hard to find what looked like the best Medicare Part D benefit for them, only to go to Costco to pick it up and find out that the discount chain's over the counter price was less than they would be charged under Part D. Martin Brower, 77, found that his blood pressure medication would cost him $1.32 per pill, and be limited to 30 pills, under his "benefit." Costco would sell him, without subsidy, 100 pills for $1.13 each. Other examples followed.
It's like the government subsidizing me to pay full price at Brooks Brothers but refusing to help me pay half price for the same suit at Costco.
Perhaps the time has come for a hard look at Medicare Part D - not only is it confusing but costly not only for the government but also for the people it is supposed to be helping. [bm].
Bubonic Plague in LA
The AP reports on the first case of bubonic plague in LA in over twenty years. The report states,
A woman was hospitalized earlier this month with bubonic plague, the first confirmed human case in Los Angeles County in more than two decades, health officials said Tuesday.
The woman, who was not identified, was admitted April 13 with a fever, swollen lymph nodes and other symptoms. A blood test confirmed she had contracted the bacterial disease. The woman was placed on antibiotics and is in stable condition, the Los Angeles County Department of Health Services said.
Bubonic plague is not contagious, but if left untreated it can morph into pneumonic plague, which can be spread from person to person. Bubonic plague is usually transmitted to humans from the bites of fleas infected by dead rodents.
Health officials suspect the woman was exposed to fleas in her central Los Angeles home, said Dr. Jonathan Fielding, the county's director of public health. The woman's family was also placed on antibiotics as a precaution, but there's no evidence they were infected.
The case is unusual because it occurred in an urban area, Fielding said. Most bubonic plague outbreaks happen in rural communities.
Health officials said there was no cause for panic because the disease is not easily transmissible.
April 18, 2006
Erza Klein has an interesting post and graphic on how much doctors should be paid for their services. He writes:
Doctors, to some extent, work for the public good. Why shouldn't the country subsidize their education -- particularly if they go into high-need specialties or work in inadequately served areas -- but lower their pay? Or at least allow for many more nurse practitioners? As part of it, we can follow this doc's advice and use the power of the state to restore job quality for doctor's, allowing them to turn their attention from paperwork and bureaucratic haggling and back to patient care. Because the truth is, our nation's doctors are great, but they're not twice as good as Germany's, or Canada's, or Japan's. Not near it. Our rates of negligent malpractice remain high, and our outcomes are no better. And being a doctor shouldn't be about the money anyway, though the cost of following that route has ensured it will be. We've scattered perverse incentives all about, and offering a more affordable path and enjoyable career in return for somewhat lower salaries would go far towards fixing them.
Please check out his website to see the difference in salaries between doctors in the United States and doctors in other developed countries.[bm]
WSJ: "Government-Funded Care Is the Best Health Solution"
The title of this post is only a little misleading. The quoted headline did appear in the Wall Street Journal today, but not as the position of the editorial board of the paper, simply as the title of a piece by occasional columnist Benjamin Brewer, M.D. ("The Doctor's Office"). Whatever the merits might be for a single-payer government health insurance program (and I think the good doctor nails the argument right on the head), it's ironic that his opinions appeared on the same day, and in the same paper, as a page-one story about the $1.7 billion in stock options racked up by the CEO of UnitedHealth, which makes its money negotiating around the inefficiencies of the present system. The story is here (might require a paid subscription, though I am told the link will work for the next 7 days; if you want the article, I can e-mail it to you). [tm]
All Va. Hospitals Will Have Medical-Directive Forms by Today
According to the Richmond Times-Dispatch, all Virginia hospitals will have advance-directive forms available for patients as of today. This is heralded as a kind of breakthrough. Isn't this more or less required by the federal Patient Self-Determination Act ("information" about patients rights is usually understood to include making the forms available upon request)? What am I missing? [tm]
Single Payer Health Care System: New Advocates - Doctors
The Washington Monthly points out this piece in the Wall Street Journal in which Dr. Benjamin Brewer discusses the merits of a single payer health care system and his view that it provides the best answer to our health care woes. He writes:
The solution that would really put health-care dollars, and providers, to their best use would be a single-payer system -- namely, government-funded health coverage for all.
It took me a while to conclude that a single-payer health system was the best approach. My fear had been that government would screw up medicine to the detriment of my patients and my practice. If done poorly, the result might be worse than what I'm dealing with now.
But increasingly I've come to believe that if done right, health care in America could be dramatically better with true single-payer coverage; not just another layer -- a part D on top of a part B on top of a part A, but a simplified, single payer that would cover all Americans, including those who could afford the best right now. Representatives and senators in Washington should have to use the same system my patients and I do were they to vote it in.
Doctors in private practice fear a loss of autonomy with a single-payer system. After being in the private practice of family medicine for 8 1/2 years, I see that autonomy is largely an illusion. Through Medicare and Medicaid, the government is already writing its own rules for 45% of the patients I see.
The rest are privately insured under 301 different insurance products (my staff and I counted). The companies set the fees and the contracts are largely non-negotiable by individual doctors.
The amount of time, staff costs and IT overhead associated with keeping track of all those plans eats up most of the money we make above Medicare rates. As it is now, I see patients and wait between 30 and 90 days to get paid. My practice requires two full-time staff members for billing. My two secretaries spend about half their time collecting insurance information. Plus, there's $9,000 in computer expenses yearly to handle the insurance information and billing follow up. I suspect I could go from four people in the paper chase to one with a single-payer system.
It would be simpler and better for the patient, and for me, if the patient could choose a doctor, bring their ID card with them, swipe it in a card reader at the time of service and have the doctor get paid on the spot with electronic funds transfer.
The Washington Monthly link provides access to comments on this piece - beware that some comments contain strong language. [bm]
April 17, 2006
Women and Rest
Newsweek has an interesting cover story on women and the sleeping disorders called, The Quest for Rest," There are a suprising number of reasons that men and women may not be sleeping well and the article points out that taking sleeping pills may not be the best answer. It states,
The craving for sleep has fueled a huge demand for sleeping pills—with more than $2 billion in annual sales, according to IMS Health, a pharmaceutical information and consulting company. Expect more options in the next few years. Drug companies are working hard to target areas of the brain that induce sleep. But taking a sleeping pill can actually make it harder to find out what's really going on. "People are starting to think about these things as though they are painkillers you take for a headache," says Dr. Meir Kryger, author of "A Woman's Guide to Sleep Disorders." "I personally don't think it's a good development." Kryger says a patient should get a diagnosis before starting any treatment, and sleep medications should never be the first or only line of defense. Although the current generation of drugs—products such as Ambien, Lunesta and Rozerem—don't have the addictive potential of the older sleep medications, patients need to follow their doctors' instructions carefully. These drugs work best to help people get over short-term sleep problems, such as after the death of a family member or some other stressful event.