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Saturday, August 28, 2010

Physicians know best...but not ex-lieutenant governors

Betsy McCaughey, Ph.D. (make sure you see that big ol' Ph.D. cause it's real important, though it does happen to be in constitutional history, not anything to do with medicine as letter writer Forrest Gatton point out--cf. used to be the lieutenant governor under Pataki during his first term as governor of NY. Remember her? She was the one who insisted on standing up the entire time during Pataki's State of the State speech. You may not also know she was largely responsible for killing the Clinton health plan basing it (falsely, in this writer's opinion: cf. The White House. Analysis of New Republic article on health care reform. Little Rock: William J. Clinton Presidential Library and Museum, January 31, 2004) on a complicated algorithm that highlighted a bewildering bureaucracy. You probably do know her as the author of the so-called "death panel" report that tried to paint ObamaCare as some kind of Grandma killing machine. Thankfully, most people saw through her idiocy. So apparently she likes to dip her toe into the tepid waters of medical knowledge.

And yet it seems she has absolutely no medical knowledge to speak of. If you read her letter you will come away with the thought that somehow generics are abysmally inadequate to the task of healing. She implies that there are studies that prove this. She writes that "generics are less effective or cause side effects in some patients."

Well. I could also add that brand drugs are also less effective or cause side effects in some people. Generic drugs are bioequivalent to brand drugs and undergo scrupulous testing. There may be occasional lapses in manufacturing quality control, but that is equally true for brand drugs. Remember the Tylenol recalls of about six months ago?

Now, anyone with a scintilla of medical knowledge knows this woman is entirely ignorant as regards matters pertaining to healthcare, as this latest letter of hers attests. But I find that she is currently in New York City, as chairman of the Committee to Reduce Infection Deaths. God help us. And who appointed her to that important committee? Who?

I like what James Fallows of The Atlantic Monthly says regarding her (I got this, yes, from Wikipedia): "She has brought more misinformation, more often, more destructively into America's consideration of health-policy issues than any other individual. She has no concept of 'truth' or 'accuracy' in the normal senses of those terms, as demonstrated last week when she went on The Daily Show." (If you'd like to track that show down go to August 20, 2009)

Monday, August 16, 2010

What's your total cholesterol? Who cares?

Caveat: Although after reading this article you may realize there is evidence for questioning the effects of your cholesterol lowering statin drugs, always consult your doctor and have a frank, and open discussion regarding your medication.

So what is your Total Cholesterol? Well, in the article above, Dr. Joseph Mercola makes the case that your total cholesterol number is a "straw man," a number manufactured by, well, manufacturers in order to sell you medication that you probably do not need. The AMA, as the article states in the bottom third of the article:

"Eight of the nine doctors on the panel that developed the new cholesterol guidelines had been making money from the drug companies that manufacture statin cholesterol-lowering drugs."

Dr. Mercola points out that it is the underlying inflammation doing damage to your arteries that is vitally important. The body then makes more cholesterol (by your liver) in the attempt to repair the damage (cholesterol is made to repair cell membranes). Prevent the inflammation and you prevent the problem.

He goes on to also point out the many adverse effects of these expensive statin drugs. These are not innocuous agents.

Do yourself a favor: read the article and ask your doctor about these medications if you are currently taking them or thinking about the possibility.

Sunday, August 15, 2010

First sentences

I am endeavoring to produce a blockbuster, earthshaking, and potentially an academically career-ending theory for literary criticism:

I read the first sentence and judge accordingly.

Witness the following time saving reviews (totally at random):

In the beginning God created the heavens and the earth.—But can He follow that up?

On an exceptionally hot evening early in July a young man came out of the garret in which he lodged in S. Place and walked slowly, as though in hesitation, towards K. Bridge.—Heck of a sentence. I predict great things from this writer, a Mr. Fyodor Dostoyevsky. Note to Hollywood: Don't change that name.

For a long time I used to go to bed early. —Ok, maybe this loses in translation. (Swann's Way by a M. Proust.)

Look at a map that shows the north Pacific Ocean. —Obviously written by a Neanderthal. (The complete Idiot's Guide to American History, 2nd Ed.)

On my right hand there were lines of fishing stakes resembling a mysterious system of half-submerged bamboo fences, incomprehensible in its division of the domain of tropical fishes, and crazy of aspect as if abandoned forever by some nomad tribe of fishermen now gone to the other end of the ocean; for there was no sign of human habitation as far as the eye could reach.(Joseph Conrad's "Heart of Darkness") —Well. You know darn tootin' that if this was submitted to a dozen publishers today it would be rejected right here. A red highlighter would be followed with the marginalia "Are you kidding me? I don't have time for this."

A-OK. —How cliche. (The Dictionary of Cliches.)

"The marvelous thing is that it's painless," he said. ("The Snows of Kilimanjaro," by E.Hemingway) —This first sentence proves Ol' Hem is far from painless. Reading Hemingway is like going to the dentist.

Well, I guess you by now have an idea of the time savings proffered by this revolutionary technique. Try it yourself. Your only problem will be in finding enough things to keep yourself busy, what with all the hours and hours of wasteful reading you have by then uncovered.

Thursday, August 12, 2010

Death By Handwriting--escripts to the rescue!

Death By Handwriting

About five years ago I read in one of my pharmacy journals about a new fangled fix for doctor's bad handwriting (technically known as "cacography" and is responsible for thousands of hospital admissions each year, billions of wasted dollars, and millions of wasted phone calls from pharmacists, so hey, no laughing matter), utilizing e-scripts, or electronically transmitted prescription which are generated on a handheld PDA by the prescriber then transmitted to pharmacies. The process, besides eliminating illegible scripts, had the additional benefit of potentially alerting MD's to possible interactions and drugs that would require prior authorizations by insurance companies before being transmitted. That way, the doctor would know that the Biaxin script he/she wrote for on a Friday night would need to be changed to something else that the patient could actually pick up.

(I personally like Montana's solution, fining a doctor $500 per illegible prescription. But who decides what is illegible?)

So, a good thing all around, yes? Well, um, I guess you could say there's a glitch or two.

First, probably because of additional costs, doctor's don't seem to be utilizing the functions, or potential functions, of these e-scripts. Prior authorizations are still common in all types of prescriptions, including e-scripts.

Second, though the scripts are easily read, what the pharmacist is actually reading isn't necessarily what the prescriber meant to write for. Many programs have the medications closely spaced together, allowing for errors of selection. Allegra-D 24 hour can be right below Allegra-D 12-hour. Whoopsies.

An interesting error that I recently ran across was an e-script that had the word "until" next to "7 days." What came out on the potential label was "l7 days." That's a lower case L, not a numerical one. It seems that some programs that doc's use do not allow for automatic line formatting. This particular error was caught by the pharmacist, as he saw that the 17 day supply was unusual. But what if it wasn't? Whoopsies.

So with the new technology we have to be aware that there will be new types of errors occurring, errors that we as yet may not even imagine.

Tuesday, August 10, 2010

The march of the generics!

For those wishing to know, there are many medications slated to lose patent life in the next several months. One caveat: once the patent expires, there is often litigation which results in a prolongation of the legal life of the brand. There are several events that may occur that prolong brand exposure, including litigation, patent settlements (manufacturers will agree to discontinue litigation in exchange for some monetary reward--nice, huh), final FDA approval, submissions of citizen petitions on behalf of brand manufacturers to the FDA, and "at risk launches" which means that once a generic is approved the generic manufacturer can go ahead with the generic but risks further litigation with the brand manufacturer.

That being said here's a list of some drugs going off patent:
Cardene SR
Iopidine eye drops
Combigan eye drops
metadate CD
Elestat eye drops