miracle drug?

there is a new combination of drugs that is being studied. it's much the same as nyquil only it's for heart problems and not cold symptoms. currently it's being called the 'polypill' or 'polycap'. it contains 3 different types of blood pressure medicines, a cholesterol lowering drug, and aspirin. my comment when i first heard about it was "you won't know which one made you better", but my wife, tainted as she has been by years of living with and listening to me, said, "or, you won't know which one killed you". 

brilliant!

i'm going to run for some congressional seat or another, and my first bill to propose will be a slam dunk. it's going to make both sides happy and solve all our problems with healthcare spending, at least for prescription drug coverage.

i'll put forth a bill that will make the government pay for all prescription drugs, then, inside the bill, there will be legislation to make almost all current prescription drugs over the counter. 

brilliant, eh? at least for a few seconds it seems that way. no telling what would happen. i'm worried that too many people would be taking too many medicines they don't need for problems they don't have. oh wait, that's already happening...only it's us (the doctors) to blame. 

thank you

i shouldn't be allowed to read the paper. i come up with weird random radical thoughts.

so, if a group of people today volunteered to die 10 years early compared to the rest of the population, therefore consuming fewer resources, leaving a smaller carbon footprint, using less of their social security, easing the population explosion, all while increasing the income of both private industry and the federal government, wouldn't we congratulate them for that? give them a party? medals? their own memorial? i mean, this is a group who is willingly choosing to check out early from this hotel california, leaving more for the rest of us. they must be, depending on your worldview, either true christians for their selflessness, true environmentalists for their grasp of the big picture as it relates to humans being the biggest reason it's getting harder for the earth to sustain more humans, or the highest order of animal if you're a peta person who, while considering animals and humans equal in their worth, knows that animals who can contemplate their impact on the world around them further than their next meal would of course decide to move over and let others have more room to exist. any way you spin it, this is a good deal, right? i mean, these folks are knowingly going to give up 10 years of potential life.

so i propose that we change a few of our signs. first,  not 'thank you for not smoking', but 'thank you for smoking - just don't do it right here'.  a new one, 'smoking saves lives - just not yours'.

there are more, i'm sure. my affection for reverse psychology is irresistible here - by promoting smoking (like big tobacco doesn't already do that, by reverse psychology) we would be actually decreasing the number of new smokers. by encouraging kids to smoke, they'd come home from school saying 'are you trying to kill me? don't you know what this does to your lungs?' instead of  'i know that happens to everybody else who smokes, but it won't happen to me'.

we could, after seeing the success of the reverse psychology campaign for smoking, venture into other areas - i envision the teacher taking the condom off of a banana, demonstrating how to properly tourniquet one's arm to shoot up heroin, of course using a dirty shared needle, while drinking a fifth of jack daniels and driving down the highway. it could work!

addendum: the article in the paper said that while smokers cost more in healthcare dollars than nonsmokers BUT they died on average 10 years earlier so the total 'lifetime' cost was actually lower. this was my 'inspiration'.

wal mart mentality?

someone's gotta do it, right? actually, someone is already doing it. and more are joining in every year it seems. i'm talking about urgent care, after hours, etc. 

it's being done, so instead of fighting against it, i should use the aikido strategy and take the opponent's strength and turn it to my advantage, right? i cringe when a mom takes a baby or a child to an urgent care center. why? two reasons: 1) i'm not the one seeing them so i don't know what they really had and whether the treatment was correct/appropriate, and 2) it means i wasn't able to see them. both reasons show my control freak nature, and my insidious pride - like they would've been diagnosed and treated correctly if i had seen them because of course i always make the correct diagnosis and prescribe the correct treatment. right. 

so...now that we've established that...i can't work 24/7 - at least not for long, and i have to trust that there are other physicians/np's/pa's who can take good care of my patients after hours - of course i trust cathy - hello - so why do i resist it?

1) it's really not necessary. ok, neither is it necessary to be able to buy eggs at 2 in the morning, but if someone offers it, someone will take them up on the offer. need is not the issue. this is a drive thru world and by gosh, my kid got a fever an hour ago and i want him seen now. truly i understand this with work/school/fears of serious disease/too much information available to make people worry, etc.

2) it's an extra expense. it costs more after hours. and then many parents bring the child in within hours to days of the after hours visit for me (or their pcp if they aren't mine) to see them and to confirm the diagnosis and treatment. 2 visits, one problem, could've waited but didn't have to (see #1).

the solution? an urgent care where a trustworthy person over whom i have at least some control in hiring/supervising/advising/backing up is going to see that patient after hours. someday, maybe. but i think i have to give up trying to buck the current mentality of parents and go with it. but doing what the people want is not always the best thing for the people. how does one convince the people of that? 

just ask your doctor

man, i hate commercials for medicine! 'just ask your doctor' puts you in a position where you are forced to ask permission for something and me in the position to either grant or deny you that permission. it puts me, as the doctor, in the role of power over you, the patient. and it shouldn't be this way. the drug companies make it sound and look as if there is a perfect life out there waiting for you if your doctor will just let you have this medicine.  the same thing happens with various tests, especially mri's. we laugh at 'therapeutic' ct's and mri's - once a patient goes through the whole deal of getting one of these tests, even if it's not necessary, it seems that they get better. was it just the attention paid to the problem? your doctor watches the same stupid commercials you do, and he or she gets bombarded daily in journals and in person with other advertisements for drugs or treatments - each with articles 'proving' how much better their particular treatment is than the one they were selling last week. 

don't assume you have a disease just because you have the symptoms on the commercial. most diseases have symptoms that are similar to common problems like the flu or other viral illness, and these are way more common than the diseases they are advertising the treatment for. sure, everyone's depressed or anxious or fatigued or whatever - some of the time - but if it took a commercial to make you realize it was it really that bad? open your eyes! these people are selling something! they don't care about you and your health and your family. they care about making money.

don't let their advertising put me in a false position of power over you - holding in my hands the pen that can write you the prescription that will be the answer to all your problems. the drug companies have put the patient and the doctor in an adversarial position and they are capitalizing on it. don't let it work. be smarter than that. new is not always better. expensive is not always better. 

consider the source of the advertising and their ultimate motive - $.

sure, they have drugs that can help problems. but just because they have a great commercial doesn't mean they have a great treatment. listen to the end of the commercial. unless it's for an erectile dysfunction drug, then the side effects sell the drug. 

be very careful

even when the best doctors and the best hospitals try to come up with guidelines for the best ways to treat various diseases, they have difficulty. why? well, not everybody's the same. that's one reason. but arguably the biggest reason is that there are no studies to show how one drug performs against another or how choosing not to treat a specific disease compares with aggressive treatment of that problem. and why do these studies not exist, or why were they never published, which is a better question? because it is the drug companies that pay for the studies. they aren't going to publish a study, or even complete a study, if their drug or treatment isn't going to look good. if doing nothing is as good as doing something, are they going to tell you? heck no. they'll use statistics (there is a 14% chance that a person with this problem taking this drug will improve more quickly and have a better life with more money and more happiness and basically just turn out to be a better person than someone who chooses to try a good diet and some lifestyle changes to achieve the same goal). 

pharmaceutical ads are just like automobile ads, the glitz is up front then comes all the 'fine print'. but in car ads the guy on the commercial pretty much auctioneers his way through the interest rate, payments due at beginning and end of lease, with approved credit, may not apply to certain people on certain days ending in 'y', etc. in the drug ads they seem quite proud of the fact that their drug could cause liver and kidney damage and pretty much make your life a living hell, but you should still 'ask your doctor' about it because dadgummit you want it, don't you?

best marketing for viagra? jack nicholson in 'something's gotta give' when he's taking viagra and nitrates for chest pain and tries to deny it. it's an unforgettable scene and one which sold more viagra than any 'ask your doctor' commercial. 

see the blog a few back on marketable side effects. are we a gullible society or what? just because it's new or newly indicated for something doesn't make it necessary or even a good idea.

shame on you

integris has a commercial that is so representative of the new fear tactic method of marketing that i have to comment. not that any of their sappy tear jerking commercials are really promoting health and just look like they're promoting integris. i mean, the look the wife gives her husband in the infertility commercial is so real it's scary, but then everything is peachy once they get pregnant and have a baby. show them in 6 weeks and i'll show you a look! i can't listen to roy orbison without trying to drive to baptist anymore. 

no, i'm talking about the sleep commercial. which ends with the doctor saying "80% of sleep problems go undiagnosed, and some can be deadly". who can sleep after hearing that?!