What Sicko Doesn’t Tell Us

As I mentioned in yesterday’s post, Michael Moore’s movie Sicko provides background on how our American healthcare system has become so dysfuncational, and some of the horrifying ripple effects on the health of our nation.  What it fails to mention is one major group of ripples:  medical errors and misdiagnoses.

According to the US government’s Institute of Medicine, between 44,000 and 98,000 Americans DIE each year from medical error or misdiagnosis.  Other organizations, including HealthGrades, suggest those numbers are way too conservative, that, in fact, the numbers are much higher.  Beyond those who die, millions more are injured by these mistakes.

So it begs the question:  what differences in the rates of medical errors and misdiagnoses might we find between universal health care, such as those systems cited in Sicko in Canada, France and Great Britain, and privatized healthcare programs such as the system we use here in the United States?

I’ve poked around the internet and can’t find any numbers to speak of… I can find a few within certain diseases, but nothing that helps compare apples to apples…..

When I refer to medical errors, I’m referring to problems such as:

• surgeries:  operations on the wrong body part, called “wrong site” surgeries, or mistakes made during the surgery, or even equipment left inside the patient.
• drugs:  the wrong drug is prescribed, or the wrong drug is dispensed, or the wrong dosage is prescribed or dispensed, or the drug is given at the wrong time, or a dose is missed
• other treatments:  therapies are mis-prescribed, for example, an orthopedist sends a patient for physical therapy which ends up exaserbating the problem, not helping it
• infections:  usually facility acquired (such as in hospitals or nursing homes) — a patient is admitted for one problem, but acquires an infection while resident in the facility.  MRSA, C. Diff and necrotizing fasciitis (flesh eating bacteria) are examples

When I refer to misdiagnosis, I mean:

• the patient is told nothing is medically (or mentally) wrong when, in fact, something is
• the patient is told s/he has one ailment when, in fact, s/he has a different ailment
• the patient is told something is wrong when, in fact, nothing is wrong

[A request -- if anyone can point me to real numbers among the other countries, I would really appreciate it!]

My sense is this — purely a guess, but an educated one — that the error rate in the privatized US system,  where healthcare is more about money and less about care — is higher.  That we are dying and getting sicker because of our privatized system.

Why do I think this is true? 

If you review the kinds of errors listed above, you’ll see that most are time-related.  If the professionals who made them weren’t in such a hurry, if they weren’t worried about reimbursement rates or malpractice insurance payments, if they were more inclined to spend the time that is really needed to LISTEN and communicate with patients, then those errors could, in many cases, be prevented. 

Drill it down:  who will make fewer errors?

• a doctor who has the time necessary to listen to a patient?  — or — the doctor who knows that in minute #7, he begins losing money because the insurance company won’t reimburse him for any time beyond that?
• a surgeon who has the time to carefully review the charts prior to a surgery, takes the time to mark which body part needs to be cut, then operates correctly — or — the one who knows s/he has only one hour to perform the surgery and move on to the next one or it will impact the hospital’s profits?

Patients — take heed — there are many many ways you are hurt by our current dysfunctional system….  not all are raised in Sicko, but at least its the start of a conversation.

… and in the meantime?  Regardless of what system provides us with health care — or no health care — we still need to advocate for ourselves in all those good practice ways I talk about on this blog, and through my columns, every day.

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Read two more posts about Sicko:

A Patient Advocate’s Reaction to Sicko
Why Sicko is only the tip of the Iceberg

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A Patient Advocate’s Reaction to Sicko

…. is that Michael Moore has only exposed the very tip of the dysfunctional American health care system’s iceberg.

As confessed in yesterday’s blog post, I’ve never been a fan of Michael Moore’s.  I think his previous works have been inflammatory and one sided.  Not that he doesn’t raise awareness of issues, and not that he doesn’t cause dialogue that is helpful, because he does.  Rather, because he takes facts and bloats them, and his audience walks away believing partial truths.

But for Sicko?  He is inflammatory, and if I worked for a health insurer, I’d want to hide.  And if I were an executive for a health insurance company, especially the “medical director” of a health insurance company, I would be embarrassed beyond belief. 

But as far as whether his presentation was balanced — well — his story was no more unbalanced than reality.  The reality of what healthcare in the US has become is so lopsided, that it’s falling into the deep unknown.  If it’s any indication?  I’ve never attended a movie that elicited applause, not just at the end, but in reaction to statements made during the movie, too.  And whereas many had told me I would laugh, and on occasion, I did — but — I left with tears in my eyes.

I learned a few things, which I will present to you, although I have not yet confirmed them to be absolutely true.  The scary part is, even if they are only half true, then they are still worth noting. 

For example:  one woman who used to be a health insurance sales person spoke of a 37 page document of “pre-existing conditions” which would automatically cause denial of coverage to an applicant.  Another woman described how executives in health insurance companies get paid:  the higher the rate of denial of coverage (not just in policies, but in pre-approvals for treatment), the higher the bonus.  “Payment of any claim,” she explained, “is defined as a medical loss.”

One gentleman explained his former job as a health record spy — in effect, if someone made a claim the insurance company didn’t want to pay, it was up to him to comb through the previous medical records of the patient and use anything at all — ANYTHING — to create a case for denying a claim.  Of course, the insured has no recourse.  None.  (By the way — this is a perfect reason for making sure your medical records are always correct.)

I’ve often wondered if there was a watershed moment in American history that caused the previously considered “good” system of healthcare to go awry.  Moore explains it as a Nixonian decision.  In 1971, then president Richard Nixon and his buddy Edgar Kaiser (of Kaiser Permanente fame) created a new approach to healthcare where denial of service became a profit center.

And then there is Moore’s statement that there are 4 times as many health insurance lobbyists in Washington as there are congress members.  Can you guess who is paying for those lobbyists?

The last example of what I learned (although there is really quite a big more) is that Moore visits Canada, Great Britain, France and even Cuba, and claims that in those countries, where healthcare is a given, paid for by taxes, then provided at no additional cost to its citizens, people live 3 or 4 years longer than Americans on average.  Even the Journal of the American Medical Association cited those statistics.  In England, doctors earn more by keeping their patients healthy, too.  Amazing.

So here are a few comments from your friendly patient advocate — now that I’ve had a few hours to think it over:

1.  While Moore did a good job pointing out the foibles of our system as they relate to how medical care is paid for, he didn’t even attempt to talk about medical errors, misdiagnosis, drug-related problems, etc (although he mentions pharma as being almost as evil as insurance.)

2.  As long as Washington politicians are bought and paid for by health insurance, nothing will change.  As long as health insurance companies continue rewarding their top echelons with huge paychecks and bonuses, nothing will change. 

3.  I whole heartedly agree with some of his statements as they regard the services we are all entitled to because we are citizens of America and our communities:  police, firefighters, public education, inexpensive postal services, parks, libraries.  Why isn’t healthcare on that list?  Well — for seniors who use Medicare, it is.  And what about the other 47 million of us?

For the first 50+ years of my life, I never would have believed I could even think this thought, much less type it…. and based on the research I have done, all of it prior to seeing Sicko today….. I do believe American needs to move to universal healthcare.  Don’t forget — you’re hearing this from a woman who has owned businesses, and believed in private enterprise and profit all her life….. but LIFE is the keyword here…. and because health insurance and big pharma have become so greedy, because that greed is costing lives, because the need of the masses to access better care is more important than the need of individuals to control….  yes…. I believe we need to create a healthcare model similar to our public education model. 

Do I think it will be perfect?  Heavens no.  But if it parallels public education, then many MANY more will benefit, and for those who still believe private care is important — well — we have private schools, too, right?

Of all the statements that made me really think, and there were many, this is the one I will leave you with:

“You can judge a society by how it treats its worst…. and its best.”

Society, our politicians, and our American way of medical care is failing us.  It’s time we patient stood up and made the noise necessary to invoke the change that’s needed.

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Read what others have said about Sicko:

R J Eskow in the Huffington Post

M Foust in Artvoice

The American Thinker

And to learn more about how those running for president have reacted:  The LA Times

…. and see follow up blog posts from Every Patient’s Advocate,

What Sicko Doesn’t Tell Us  and Why Sicko is Only the Tip of the Iceberg

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MRSA: Killing More Americans everyday

APIC (Association for Professionals in Infection Control and Epidemiology) is holding its annual meeting this week, and today published the results of its latest findings on the number of people who die from MRSA (methicillin-resistant staphylococcus aureus) and other HAIs (hospital acquired infections).  These are superbug staph infections, usually acquired by hospital patients, but sometimes transmitted in the community as well.  Superbugs are called such because they have developed a resistance to drugs — nothing can kill them. 

That means — once a patient contracts a MRSA infection, s/he usually can’t get rid of it.  S/he will be infected for the rest of his/her life.

Bottom line?  Between 48,000 and 119,000 patients per year may be acquiring these infections.  That represents 46 per 1,000 patients.  These numbers are much higher than previously believed, and higher than reported in previous studies.  In particular, the Centers for Disease Control (CDC) had previously reported only 3.9 deaths per thousand.

If I’m doing my own math correctly, that means that the REAL rate is 120 times WORSE than what we thought?

And the thing that ticks me off about this the most?  These infections are PREVENTABLE!  If the proper precautions are taken in hospitals, then there is no reason why patients should acquire staph infections in the hospital.  None.

And do you know what the proper precautions consist of?  In most cases… simply washing one’s hands.  The bugs are most often transferred from a healthy person to a sick person.  Most of us have MRSA bugs living in our noses and we have no symptoms or illness from them. But people who have compromised immune systems (either they have an open wound, just had surgery, an auto-immune disease, a catheter inserted for a long time, or are elderly and probably frail) — they pick up the bugs from us healthy people and the bug has a field day.  Tens of thousands of them die.

VERY interesting way they did this research…  10,000 infection-control practitioners, including doctors and nurses in hospitals, nursing homes and rehab centers, were asked to document ONE day (last fall, between October and November).  A snapshot in time.  They counted the known cases of MRSA in their institutions.  1,200 hospitals and 100 nursing homes and rehab centers, representing all 50 states, submitted results.

(Hmmm…. I wonder why the others didn’t participate?  Is it possible they were afraid their rates were too high and someone would find out about it?  does that make it possible that even these numbers are too low?)

I know of two family friends who acquired infections in hospitals — then died.  In both cases, their causes of death were listed as what they were admitted with.  In both cases, my sense and intuition tell me that they would have survived had they not acquired those HAIs.

Knowing what you know about how infection spread can be avoided, think of it this way:  if one nurse or one doctor had bothered washing his or her hands, then my friends might not have died.

By my own observation, I have seen how lax health care providers are about hygiene.  Other studies have been undertaken to document how little regard practioners have for concientiously keeping their hands sanitized and clean.  I’m sure it’s a pain in the catoochie to have to wash and sanitize before touching every patient… but… when it can mean the difference between life and death?  Seriously.

Sharp patients know to watch out for violations when they must be in the hospital.  Ask providers to wash their hands, and use sanitizer, at every turn.  Don’t be embarrassed to ask!  Even if you are a visitor, you need to know you can transmit the bugs.  Be sure to clean bed rails, TV remotes, telephones — anything you touch that the patient also touches. Be diligent, because it can mean the difference between life and death.

More guidelines can be found here:  hospitalinfection.org 

APIC does a good job of suggesting their own steps and precautions for hospitals and other facilities to begin cutting the spread of HAIs.  What we know, from past experience, is that too many of these facilities don’t care to stop those infections.

Why?  Because their perception is that it will be too expensive to stop the infection madness.  They think they are saving money by not setting themselves up to stop the infection to begin with.  And they think they are making more money because patients have to stay in the hospital longer.  And their perception is THEIR reality. 

Neither of those statements is true, according to previous APIC studies.

How sad, that the REAL cost of HAIs is the loss of lives AND affects their wallets.  Why can’t they hear that message?

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Making an End Run to Get the Help You Need

You may have heard about the woman who died on the emergency room floor at Martin Luther King Harbor Hospital in Los Angeles:  http://www.usatoday.com/news/nation/2007-06-13-911helpdenied_N.htm  She was in great pain, writhing on the floor, yet the staff would ignore her, walk around her, step over her.  Despite her obvious agony, and despite the fact that she was IN the emergency room, surrounded by medical professionals, including doctors, nurses, aids — she could not get treatment.

In desperation, her husband called 9-1-1 — his end-run attempt at getting help for his wife. He was told that since they were already in the emergency room, there was nothing more the 9-1-1 service could do for him.  But his call certainly punctuated his incredible frustration, and probably the interest of the news media, too.  Honestly — I think it was a brilliant idea, despite the fact that he continued to be disregarded.  But bless his heart for trying.  Karma will take care of those who allowed his wife to die.

A new report came out this week, too, about another ridiculous, but no less real, example of the dysfunction of our American healthcare system — one that may require an end run, too.  It regards HIPAA laws (pronounced HIP-ah) which are federal laws which address privacy issues for patients.  The intent of the law is to protect that privacy, and to make it a crime to share information with the wrong people.

Who are the wrong people?  Anyone who is not the spouse, or a legally designated advocate for the person.  The patient can see his or her own records.  The spouse of the person can see those records.  The parent of a child under the age of 18 can see those records. Additional providers involved in the patient’s diagnosis and treatment may see the records. But unless paperwork has been signed somewhere — NO ONE ELSE* is allowed to see those records — except:

Any organization that is involved in “health care operations.”  Like:  insurance companies, the government, pharmacies, the police, or others. 

In theory, privacy of medical records seems like a great idea.  In practice, it seems that all the hurdles are planted in front of the people who love and care about the patient, and all the paved roads are available for anyone else.  *Worse yet, too many doctor’s practices translate the law incorrectly, meaning they allow access to some of the wrong people, and deny access to some of the right people.

As I mentioned before, a new report came out this week citing a loophole in the HIPAA laws – and it is frustratingly no surprise!  It seems that pharmacies, who do have access to private records, can turn around and SELL  (yes — profit by!!) patients’ medical records and personal information to other pharmacies.  No permission is needed — they can just do it. 

Bottom line — the adult child of an elderly parent needs access to her mother’s medical records to help him determine whether she needs a certain kind of treatment, but the law will not allow him access to that information when no paperwork has been signed by the mother*.  Yet, if a pharmacist wants that information to help him sell more over-the-counter drugs — hey — why not?  That’s just a marketing cost, like buying a mailing list.

The end run?  Just like the man who dialed 9-1-1 from the emergency room to get help for his wife….  if you need to see the medical records of a loved one, and you are denied access, contact your friendly pharmacist — and maybe he can buy the records for you?  You’ll have to pay him for the records, of course — but hey — don’t forget:

 American healthcare is not about health and it’s not about care — it’s about money.

Sometimes you just gotta do what you gotta do.

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*In fact, according to a consumer publication from the Department of Health and Human Services regarding HIPAA laws, your records may be shared with “family, relatives, friends and others who you identify who are involved in your health or your health care bills, unless you object.”  This is the point where many providers can’t seem to translate the law to make sense.  They claim that “who you identify” means they need your signature to do so.

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Who Benefits from YOUR Medical Care?

You see a surgeon, and she tells you you need surgery.

You see an orthopedist and he tells you you need physical therapy.

You see a chiropractor and she tells you you’ll need at least a dozen treatments.

You see an oncologist and he tells you you’ll need chemotherapy or radiation.

What’s wrong with these pictures? 

Maybe nothing. 

Or maybe everything.

What may be lacking with their recommendations?  Objectivity.  You see, the surgeon doesn’t make any money until she cuts.  And the orthopedist may not make money until you spend time in physical therapy.  And the chiropractor doesn’t make money until she treats you.  And the oncologist makes lots more money when you get treated in his or her center.

And it’s entirely possible that the only beneficiary of their treatment recommendations will be their wallets.

Don’t believe me?  Then you haven’t heard the stories I’ve heard that would make your toenails curl.   And you aren’t objective either.

When we are sick or hurt, scared and anxious, it’s very difficult to be objective in making medical care choices.  Desperation does funny things to our brains.  That’s one reason patients avoid second opinions.  A provider holds out any carrot of hope, and we’ll jump at that instead of being more rational, stepping back, and pursuing other opinions.

And desperation, fear, or even mere confusion, can cause us to believe everything we are being told when, in fact, it would make more sense to examine the objectivity of the recommendations.

I’ve interviewed a cardiologist a number of times about this very subject.  He tells of patients who, in the middle of a heart episode, get rushed to the emergency room.  A stent is inserted into an artery to clean out a blockage.  The provider, who makes his money by doing angioplasties and inserting stents says, “Mr. Smith, we can see a few more potential artery problems on the films we just took of you — why don’t we insert a few more stents while we are here?  Is that OK?”  And the patient concedes to the additional work, WHEN, in fact, the patient would be better off simply taking anti-clogging medicine to make sure ALL his arteries stay cleaned out. 

And how would that patient know he was making the wrong choice?  He probably wouldn’t.  And who benefited from those extra procedures?  Only the doctor who inserted the stents.  The patient’s better choice would be to ask for his cardiologist to review the recommendations.  After all, the cardiologist only makes money by counseling the patient, and not by performing treatments.

In my own situation, I was told I needed chemo immediately or I would be dead in six months.  How did I figure out that was the wrong choice?  By getting several other opinions and trusting my intuition.  Who would have benefited if I had undergone chemo?  Only the oncologist — it truthfully could have killed me!

How can sharp patients sort out these kinds of recommendations?  Here are a few thoughts for double checking objectivity:

1.  Assess whether the provider who is making the treatment recommendations can profit him/herself by performing the treatment.  That’s not to say that if they can profit, it is necessarily bad.  It’s only a way of determining objectivity.

2.  If that provider does benefit, then ask about any alternatives they know of to that treatment.  Is there a drug you can take instead?  Is there a therapy that can relieve your pain instead of surgery?  What about something like acupuncture?  Their response — including their demeanor in reply — will give you clues as to whether they are objectively making your treatment recommendation.

3.  Whether or not s/he tells you about alternatives — then ask if s/he is the BEST person to perform the therapy!  Now, yes, I realize that is a silly question.  No oncologist is going to tell you that you need chemo, then recommend that someone else actually provide the chemo!  BUT — the way s/he responds, whether it is through laughter, temper, ego, or a sales pitch, will tell you quite a bit about the objectivity of the answer.

3.  Trust your intuition.  You can tell whether a doctor is truly recommending something in your best interest.  You know whether s/he has listened to you to that point.  You know how often you’ve been interrupted — or not.  You know whether s/he is more interested in his/her ego or wallet than your well-being.

 4.  Research alternatives on your own before you decide whether to choose whatever recommendation was made.  If the surgeon tells you there is no alternative to surgery, and you find out that, in fact, there is a drug that can potentially heal you, then you know the surgeon wasn’t being truthful (or worse yet, isn’t up to par on all the options.)  If the orthopedist tells you physical therapy is the best alternative, and everything you read concurs, then you’ll have more confidence in the recommendation.

5. Finally — and if you can afford it, this is the very best way to do it…. Find someone who can make a truly objective recommendation to you.  This isn’t easy, but it may be the only way you can get the very best care for your situation.  You’ll need to find an advocate who understands the basics of healthcare (at the very least) and can guide you through the choices and decision-making.  Or you’ll need to hire a service that can make the assessment for you.  To date I have found only one such service — Lynxcare – and their objectivity and outcomes seem to be excellent.  They will use your history, your records, your test results, and every other piece of evidence to recommend not only the right care for you, but the right provider for you, too.  Their only stake is in YOUR well-being.  Check them out.

The bottom line is to make sure that any recommendations made to us will be to our benefit.  Good care, and the best treatment recommendations, will result in the most improvement that can be expected for the patient, at the least amount of pain and bother, at the least cost.

That’s not to say that others can’t benefit, too.  A win-win situation is always the best!  But treatment recommendations that result in benefits only to the providers, at the expense of the patient, are all too common.  Don’t let yourself be a victim.

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Games Oncologists Play – and WE Pay

Quite the exposé about oncologists and drug reimbursements is found in an article written by Alex Berenson in the New York Times.

The crux of the story is that oncologists — cancer doctors — have the ability to profit from the drugs they prescribe for their patients. When they prescribe chemo, or any of the drugs given to patients as a result of chemo (such as drugs to boost their strength or to help with their recovery from the ravages of chemo), they do so knowing they will make more money than if they simply met with the patient. Unfortunately, it seems that for many of these oncologists, their goal is focused on milking the system for all it’s worth — not simply to profit — er, um, excuse me — to treat their patients.

To quote Dr. Robert Geller from the article, “As long as oncologists continue to be paid by the procedure instead of for spending time with patients, they will find ways to game the system, however much money they make or lose on prescribing drugs…”

Game the system???

Read the rest of this post at the new blog location…

Drug Store Medi-Clinics: How Convenient!

Last evening’s NBC Nightly News focused one story on the medical clinics being set up in drug stores/pharmacies, even supermarkets, across the country.  CVS, Target, Walgreens, Rite-Aid — they are all doing it.  Included, too, are medical sites being set up by Steve Case’s Revolution program (see previous blogs.)  Even AARP has written about them.

The idea is that we health care consumers want and need quick and convenient access to medical care for easier-to-diagnose and treat problems.  Instead of calling the doctor for an appointment, waiting at least hours and sometimes days, paying the high price of an office appointment (during business hours, of course!), then having to make another trip to the pharmacy for a prescription — instead we can drop in to the local drug store, sign-in, be seen and quickly tested, then pick up a prescription only feet away and be done with it. Onwards – home to rest, or back to work or school.

The professional staff is usually comprised of nurse practioners and physician assistants, sometimes MDs or ODs.  That means you (or your child) will be seen by a professional who can provide a basic level of medical service, but nothing more.  If the problem you have is anything more than basic, then you are referred back to your primary care physician (or perhaps a specialist?  I’m not clear on that.)  The nurse practioner interviewed in the NBC story also stated that all records of the visit are copied to the patient’s regular physician.  And, they accept most health insurance plans, so patients pay only their co-pay, as usual.

As your friendly patient-as-healthcare-consumer advocate — I (mostly) love it!  It’s helpful, consumer-friendly, inexpensive, convenient and effective. 

But primary care physicians aren’t happy with the concept, and yes, I can see a few pitfalls, too.

Pitfalls from my point-of-view are these:  symptoms are such squirrely things — with no patient history to review, a walk-in-quick-clinic nurse practioner might not realize that someone’s hacking cough may be something more than a bad cold.  Further, one thing I emphasize frequently is the establishment of a trusting and partnering relationship with one’s doctor.  It’s those occasional colds, flu and other visits that help us establish those relationships.  There’s less of a chance they will develop when patients go elsewhere for the easy stuff.

Doctors don’t like it because it takes money out of their pockets.  (yes — all together now!  health care is not about health or care — it’s about sickness and money — remember?) They cite the fact that they have expensive offices and staffs to maintain, and that much of the work they do gets done with no way to make money from it (paperwork, phone calls, etc.)  They say such clinics will be the downfall of what we know as the primary care model.

My response to that is two-fold.  First — patients will always seek the quick fix.  PCPs need to see the handwriting on the patient-care wall and realize that this kind of convenient service doesn’t ask them to close their doors;  instead it asks them to change their business model.  Why can’t they create quick clinics themselves?  Or work in one of the drug-stores? 

Or — even better — begin working with patients and insurance companies to shift the way they do their work.  I’ve identified what I believe to be a huge hole in patient care — and I’ll blog about that tomorrow.

But for now — my advice to patients?  Get the care you need in the way that makes most sense, short and long term.  If your sore throat or stomach upset or whatever symptoms you have could be the result of something more difficult that a basic bug or infection, then get yourself to a doctor who will be able to see it through with you.  A quick fix just won’t be the answer.

But when you or your child needs basic care for those simple-to-fix symptoms – go for it!  Much better that you get that care, and get on with life, than to forego care — or languish in a doctor’s office somewhere. 

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Depression, Relief and NO DRUGS

After my long absence (moving is SUCH a pain!) I was back in the radio taping saddle this morning.  I interviewed Dr. Richard O’Neill about a report issued earlier this month touting psychotherapy (counseling) as the therapy that helped keep 74 percent of those women studied relieved from their depression.  The report was found in the American Journal of Psychiatry.  If you prefer reading the report in plain English, understandable to us mere patients, try this version from PsychCentral.com. 

I don’t usually report on mental health issues.  My hands and heart stay full with ideas and commentary about physical health — but in this case, I’ll make an exception, because the role of pharmaceutical drugs is so huge in this report and as we all know, those drugs are intended to alter the physiology of the body.

Here are the basics of the report:  74% of women who were depressed and chose psychotherapy only (NO DRUGS) for treatment, then continued on a monthly basis with their counseling (STILL NO DRUGS) kept their depression in remission.  It seems that continuing to discuss their problems with their therapists on a monthly basis kept their depression at bay.

Women who were diagnosed with depression and were treated with antidepressants AND therapy did not have the same result.  They continued to need the drugs.

Some thoughts to share:

In our quick fix society, it’s too easy to prescribe a drug that sends someone who may not really need it into a la-la land, where they won’t care.  This study seems to say that prescribing the drug to begin with may also doom that person to needing the drugs for the rest of her life.

More and more studies are showing the mind-body connection;  that is, that activities such as talking or exercising can affect brain chemistry and raise seratonin levels which elevates the mood.  Yet, doctors continue to grab the prescription pad for their patients to supply the quick fix when their patients are depressed or anxious.

Why is it that doctors are not more insistent on providing their patients with different advice — such as referring them for therapy instead of writing a prescription?  Three reasons I can think of:  First, because they don’t have the training to recognize when a patient needs counseling instead of drugs.  Second, because they can’t or won’t take the time to figure out the right avenue for their patients.  And third — because insurance will cover the drug whereas it may not cover the therapy.

Sharp patients know that mind-altering drugs, no matter whether they are prescription or illegal or grown in the backyard, can only lead to more problems down the road when they aren’t absolutely necessary for maintaining their mental health.  Sharp patients will ask their doctors about therapy when they need their mental status improved and will avoid mind-altering and mood elevating drugs whenever possible.

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Pharma Gifts to Doctors Raise Ethical Questions

A report by HealthDay News, and carried by the likes of Forbes, reports that 94% of all physicians accept gifts from pharmaceutical companies in exchange for consideration of prescribing their drugs.  The HealthDay News report was based on findings published in the New England Journal of Medicine.

Gifts can be as simple as food and beverages or free samples of the drugs, or as complex as underwriting the doctors’ trips to conferences, or reimbursing them when they enroll patients in a clinical trial.  Questions about the ethical ramifications are raised, although you might be surprised at some of what I think about it.  I can see all sides, I believe.

And as I write this, I should perhaps recuse part of my opinion, because my daughter is, in fact, a pharmaceutical rep.  She’s one of those who buys all those free meals for her client-doctors.  She’s a corporate credit card carrying member of the sales force of one of the largest pharmaceutical manufacturing companies in the world. 

However, there are some questions we patients need to be asking, and some food for thought about the real cost of this practice.  It borders on the question of doctors who profit from the drugs they prescribe, and whether that profit comes at the expense of the best interest of the patient.  See what you think.

From the point of view of the pharma companies: 
“Hey!  This is marketing and sales!  We’ve developed a drug that has been tested and retested, been approved by the FDA, and now we need to get the doctor’s attention so s/he will prescribe it for patients.  What good is a drug if no one knows about it?  And how can we get the doctor’s attention if we don’t do something attention-grabbing?  It only makes sense to give them free samples of the drugs to hand out to appropriate patients.   As for the other gifts?  Why not?  We write them off as business expensed gifts anyway — so in effect — it costs us far less than one might think.  Besides — we’ve got investors who want their stock to go up.  So — the giveaways are win-win for us AND the doctors.”

From the point of view of a doctor:
“Hey!  My staff loves those free lunches!  And — OK — I’ll spend a few minutes with the drug rep so my staff can have chinese this week.  Besides, it’s easier for me to listen to the rep and be able to ask him questions than it is to have to sort through the material myself.  And, my patients do love it when I can give them samples because it saves on their expense of buying the drug from the pharmacy.  If the drug doesn’t work, I don’t have to feel bad that they spent their money on it — I’ll just prescribe something else and give them even more samples.  And you know — that conference in Cancun last winter was just great.  My wife really enjoyed it, too.”

From the point of view of a patient with insurance:
“Hey!  Thank heavens my doctor could give me a drug to stop this awful heartburn!  I appreciate the samples — I can start taking the drug while I wait for it to be ready at the pharmacy.  Yeah, I know I have to take it for the rest of my life, but insurance covers it, so I don’t really have to pay for it anyway.”

(Excuse the interruption here — but please note that this is a typical insured patient who doesn’t realize that his insurance premiums go up because he thinks his healthcare is “free.”  See previous blog posting….) 

(Excuse the interruption, part II:  do we know for sure that this is the best drug for this patient?  Do we think there was any influence on the doctor just because the pharma company paid for his trip to Cancun? )

From the point of view of a patient without insurance:
“Hey!  I guess I’m glad there’s a drug to stop my heartburn — but I can’t afford it!  The doctor wants me to take this brand — the purple one — but it’s just too expensive!  It’s going to cost me $50 a month.  If I could afford that, I’d get insurance!”

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Bottom line?  The ethical questions are many, but no one (I know of) has done any studies to see whether the gifts actually DO influence doctors.  And a point to always keep in mind — we can’t just lump all doctors into one sweeping conclusion either.  They are human beings and they make choices as individuals. 

Does the cost of all those free lunches really have a large impact on the prices we must pay (or insurance or medicare must pay) to purchase the drugs?  Does the cost of all those trips to conferences really translate as a question about whether we are getting the best drug for our particular medical needs?

As sharp patients, how do we get our arms around these questions?  Is this something we want to tackle directly with our doctors?  Somehow, among all the questions I’m NOT afraid to ask, I just don’t picture myself asking, “Thanks for this prescription Doctor.  Did its manufacturer send you to Cancun last year?” 

And this doesn’t even begin to touch pharma company influences on the FDA….

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Alzheimer’s, A Conversation

This morning on my radio show, we aired my interview with Dr. Sharon Brangman, geriatrician and expert in Alzheimer’s Disease and other dementias.  As the daughter of a mother who is in the advanced stages of this horrible disease, I was moved to tears by the conversation.  It was an opportunity to learn more about it, and even ended with a bit of hope.  Here are some points from the conversation — a few basics, and some information that was new to me, too.

• The numbers of victims are increasing exponentially, mostly because people are living longer, and because of the growing numbers of baby boomers.
• Dr. Alzheimer was the person who distinguished “his” disease from other forms of dementia — about 65 years ago.  The former term was “hardening of the arteries.”
• How do we know the difference between forgetfulness and the onset of dementia?  If the non-remembering begins to get in the way of life, then it may be dementia, including Alzheimer’s.  When we can’t remember how to do something we’ve always done, or can’t remember names of people we see frequently, or forget to take our medications consistently, or anything that becomes an interference with everyday living.
• Caretakers need almost as much care as the actual Alzheimer’s patient.  (My opinion: perhaps the patients are patients, and the caretakers and families are the real “victims.”)
• Dr. Brangman’s metaphor for the physiology of how Alzheimer’s works:  think of the brain as a highway system of thought patterns.  A protein begins to build and gunks up the highway, putting roadblocks in front of the thought patterns so they can’t be used.
• There are a handful of dementias — Alzheimers is most prominent, but not all have the same physiology and some are treated differently.  It’s important for doctors to discern which dementia is causing problems so it can be treated most effectively.
• Research shows that people who continually use and challenge their brains may keep Alzheimer’s at bay — and taking the above metaphor another step — it’s because the brain develops more highways for the transport of ideas when it is being used and challenged.  With more highways available, the protein does not so easily block the passage of thoughts.
• Studies about the effect of music on Alzheimer’s patients have shown that familiar music elevates a patient’s mood and brain function.  Dr. Brangman hypothesized that it’s because music thoughts are stored in so many areas of the brain, that there are enough of those above-mentioned highways available to translate the thoughts.
• On the horizon:  research that will help develop therapies that will regrow nerve growth cells, and/or repair or dissolve the problems caused by that gummy, gunky protein that develops in the brain.

How do we keep Alzheimer’s at bay in our younger years?  Eat right, exercise, don’t smoke…  all those good practices that seem to be the answer for keeping any health-related problem out of our lives.

End of post for today.  I’m going to go eat a salad and walk a few miles.  Then I’m going to call Mom to tell her I love her. 

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