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ECT For Autism???

November 7, 2017


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At first glance, this may appear to be déjà vu all over again, but there are significant differences between the electroconvulsive therapy described in this article and the torture chamber antics employed during the dark ages of psychiatry, when it was right up there with lobotomy as last ditch therapy for the mentally ill.

What you see here is the courageous reconsideration of a much- maligned therapeutic technique that, in carefully selected autistic patients, can provide a quality of life previously unimaginable.

Bottom Line. What are the learnings here? I think that there are a couple. The first deals with risk-reward. The young man described here was a hazard to himself, and obviously took a major toll on the lives of his family and everyone else around him. In these circumstances, it would seem to me, the use of unconventional therapies makes all the sense in the world.

The second learning, I believe, is that just because a therapy has been stigmatized doesn’t mean that it might not have practical and important uses. It is important not to throw the baby out with the proverbial bathwater, as this case clearly indicates.

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How’d I Do?

October 20, 2017

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How'd I do?

Here is another iteration of an issue that has popped up before. More specifically, we have seen some hospitals protest that their compensation shouldn’t be docked due to high readmission rates, since they see sicker patients. Etc. But in this blog post, we see the issue reappearing in the guise of a question as to whether a surgeon’s “individual” procedure outcomes should be reported to the public.

This is a classic damned if you do, damned if you don’t situation. I would think that if I were pondering having a surgical procedure performed on my body, I would very much like to have access to surgical outcomes data, yes at the level of the individual surgeon, that have already been compiled. Why not?

BUT. If surgeons decide not to perform certain procedures on certain patients solely because the patients’ compromised status might lead to bad outcomes and bad PR, that seems unfortunate to put it mildly.

Bottom Line. Read the article and ponder what should be done here if you were responsible for making this important decision. 

Not an easy one!

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As Sexy as Grey’s Anatomy???

October 19, 2017


Grey's Anatomy

Ponder this blog post! You can read it at a couple of different levels. First, in terms of entertainment value, I think we would all acknowledge that ER’s make for better television than do Primary Care offices. All that blood, and running around, and…but the older among us can remember Marcus Welby, M.D., a show that ran from 1969 through 1976, which actually did glorify the compassionate role of the Primary Care Physician.

Times have changed, and I’m guessing that poor Marcus would get rather pathetic ratings in 2017.

More important, however, is what all of this has to say about our attitudes toward “medicine.” As is so eloquently stated in this article, the American public clearly thinks that medicine is about fixing acute problems, rather than about preventing chronic ones. Sad!

Bottom Line. So, we are caught in a circle here. Consumer attitudes help to determine what is shown on the broadcast media, and the broadcast media help to drive consumer attitudes. Even in the Marcus Welby era, the good doctor was known for helping patients through crises, rather than for helping them to avoid crises through diet and exercise. BUT. How do we communicate to patients that the important role of medicine in general, and of Primary Care, in particular, is to help patients tailor their prevention and detection programs?

How indeed?

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Pain Scales, Patient Satisfaction = Physician Compensation + Death

October 18, 2017


Pain Scales


As is noted at the beginning of today’s referenced blog post, everybody knows that the U.S. is awash in an opioid epidemic so we will not spend a lot of time on that riff.

What I do need to point out with some embarrassment, however, is how all of the words listed in the title, above, fit together. Embarrassment because I never thought of this before, and should have. As you read this ER doc’s post, you will see that pain scales have unfortunately provided a convenient shorthand for patients to use in the Emergency room to score drugs. AND. Physicians are concerned that if they do not provide pain relief in response to such solicitations, they will be reported to be providing less than excellent patient satisfaction. AND. They are concerned that this will lead to a lowering of their remuneration according to today’s compensation formulas. AND. So, they write the requested prescriptions. AND. A byproduct of all of this is death and the “opioid epidemic.”

Bottom Line. Yup, this is all pretty sequential. The question is, where in this series of steps do you intervene to slow the downward spiral? The blogger seems to believe that eliminating the use of the pain scales would take some of the stupidity out of this progression. He also notes that we need to eliminate our obsession with treating pain. All pain, he rightfully points out, does not need to be suppressed. Last but not least, the elimination of the connection between Rx’ing narcotics and patient satisfaction and physician compensation is obviously necessary if we are to stem the opioid epidemic.

 Yikes! Lots of required interventions and modifications here. Where to start???

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9 Employee Benefit Trends to Watch In 2018

October 6, 2017


9 Employee Benefit Trends to Watch

According to this recent article in Employee Benefit News, next year will see nine important new trends in employee benefits.  While some will relate to our healthcare vertical, like a focus on workplace wellness (Haven’t we heard that one before?), others will focus on financial planning, assistance with student loans, etc.

In the healthcare arena, I especially like the trend which looks to increasingly integrate health benefits and retirement benefits. VERY responsive to the needs of our times, in which planning to have good healthcare coverage in retirement years, when health problems really loom, makes all the sense in the world.

Bottom Line. But wait! Step back a little, and take another look at this list of trends. The unifying theme here is clearly that all of these trends fit together to help employees to lead less stressed, more enjoyable lives. 

 All good. My only questions are:  At what cost? and Who pays?

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September 28, 2017

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This actually makes sense. In a recent announcement, CVS declared that they were going to become part of the solution to the “opioid epidemic,” rather than being part of the problem. Patients getting an opioid for the first time will be restricted, if they are one of 90 million lives covered by CVS’s Caremark, to receiving only a 7-day supply of the drug. Additionally, daily dose will be more tightly controlled AND extended release products will not be issued unless immediate release forms have failed.

Bottom Line. No one intervention is going to make the drug crisis in the US disappear. BUT. Practical steps such as these are likely to help significantly. We should applaud CVS for these efforts. You see, the really troublesome “drug dealers” are not the shady guys in the shadows on ghetto street corners. Nope. They are your friendly local pharmacists, white coat and all, that are busy dispensing opioid products by prescription! Building in controls at the physician AND the pharmacist level makes sense! 

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Will Prohibition Work for Tobacco???

September 15, 2017

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We all recall that prohibition didn’t work too well several decades ago for alcohol in the U.S. But how about tobacco? Amazingly, a gazillion people still smoke in the U.S. despite awareness of health hazards. More education is not likely to work. What will?

Check out this article. What you will see is that NYC has now joined Boston and San Francisco in banning tobacco sales in pharmacies. Are there still thousands of other places to buy cigarettes in NYC?  Hell, yes. Mayor de Blasio reports that there are more places to buy cigarettes in his city than there are Starbucks and pizza parlors. Combined!!!

So, this isn’t really “prohibition.” But, it is the disassociation of tobacco sales from pharmacies which, as we have discussed before, are becoming increasingly important players in healthcare. Seems like a worthwhile thing to do. Amazing, that so far only three cities have taken this step.

Bottom Line. But. Will this move reduce smokers? In isolation, I am guessing not. With an accompanying significant increase in taxes on cigarettes? Not so far. Token efforts. In three cities in the country. My concern here is that by doing these little things, we delude ourselves into believing that we don’t need a “big idea” to eliminate smoking.   

Diddling around like this is likely to be more showmanship than substance. Just like the de Blasio vendetta against Big Gulps as a way to get kids to drink fewer ounces of sugary soda.   


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Jen Gunter vs. Gwyneth Paltrow

September 1, 2017


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Check out this piece. What you will see is an ongoing, actually developing, give-and-take between our old friend, OB-GYN and blogging physician, Jen Gunter, and actress Gwyneth Paltrow. Mind you, Jen has no trouble with Gwyneth as an actress. In fact, she likes her work. It is only when Paltrow holds forth as an expert on female health, spouting hypotheses without data and supported by such renowned medical experts as Dr. Oz, that Jen sees red and goes after her.  In fact, as the NYT article referenced above clearly indicates, Paltrow apparently now feels it necessary to comment on Gunter’s comments, and the dialectic itself is garnering significant attention in the popular media.

Bottom Line. Wow. Jade eggs inserted in the vagina to improve a woman’s sex life. Links between bra wearing and breast cancer. I am thinking that it is a very good thing that Jen is going after this voodoo. And, even better, that the media are giving her comments the attention they need to dissuade the masses from believing such nonsense.

It is about time that the Dr. Oz clones of the world get confronted by real science! In public!!!

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Suicide and The Rural ER

July 6, 2017


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Underserved. We frequently talk about rural communities being medically underserved. Usually, this means underserved by PCP’s.  And usually the recommended solutions have to do with allowing PA’s and NP’s to practice unsupervised in such areas. Or designing special programs to attract PCP’s to rural communities. Educational loan forgiveness and such.

But read this piece. You will be reminded of a cruel irony. Rural communities, where closed steel mills and coal mines are contributing to soaring unemployment, in turn leading to soaring alcoholism and other mental health problems, have virtually no Psychiatrists and no mental hospitals. Leading to the kinds of train wreck situations described in this piece.

And things aren’t getting better on this front. They are getting worse. No, folks, the mines aren’t going to reopen!!!

Bottom Line. I like to close my daily blogs with a breezy little recommendation as to how bad healthcare situations can be made better. Quickly and easily.

Unfortunately, folks, today I’ve got nuthin’!


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How 101 Words Helped to Fuel the Opioid Crisis

June 12, 2017


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Check this out. What you will see is a fascinating analysis of how only a few sentences, under certain circumstances, can take on a life of their own and wreak major havoc.

More specifically, what you will see is the impact felt from a 1980 Letter to the Editor of NEJM. Just a few sentences summarizing the findings of an analysis that seemed to indicate that the use of opioids in the treatment of pain carried with it virtually no risk of abuse or addiction. Wrong!

As the story got spread, a couple of key factors got left by the wayside. The fact that the patients studied were in a hospital environment, for example. And the fact that patients included in the analysis were those who had taken an opioid “at least once.” Etc. Leaving out these “little details” convinced physicians that it had been demonstrated that opioids carried little risk of addiction in the treatment of chronic pain in ambulatory patients. Wrong again!

Bottom Line. This piece taught me a new term. Bibliometric Analysis. A rigorous procedure used for counting how many times this letter was cited by other scholars. Over 600 times! In articles read by untold thousands of physicians. 

 The moral of the story. When information is put “out there,” it can take on a life of its own. It can morph significantly in terms of meaning, and get (mis)quoted ludicrous numbers of times. 

 So. Be careful. As a writer. And as a reader.

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