As the NY Times reports, the average payment to 11 psychiatrists in Vermont was $45,692. No that is not their salary, that is payment by drug companies!!! Mind you this is only 10% of Vermont Psychiatrists, as one blogger pointed out, who estimates payments to psychiatrist overall at $1000 to $4000 dollar per capita. Said blogger also provided a table (from the report, which is here) that delineates payments to other specialties. To my surprise, there were only 2 cardiologist in the to 100 earners, and they made less than 2 nurses also on the list. As cardiologists often command quite hefty fees, that makes me think that these numbers maybe skewed. But it should not distract from the issue: those ‘gifts’ to doctors, which are not much more than bribes if it is true what the NY Times suspects, namely that it is these payments that led to an increase in prescriptions to children. While payments overall have not changed much, the percentage of cash gifts has increased, namely due to an increase in speaker fees. For those who may not be familiar: that is when a doc lectures to his peers what the best practice should be, but gets paid by a drug company to do it. Can you spell “conflict of interest”?

cross posted at Stupor Cordis, see also post below

Diabetes in Vermont Endocrinologists on the Rise

Burlington, June 27 — A recent survey of Vermont physicians demonstrate that many of the state’s endocrinologists, physicians specializing in diabetes and other metabolic disorders, may not be practicing what they preach to patients, in particular their diabetic patients. The state-wide study, conducted by Vermont’s Department of Health Services and Studies (DHSS), shows a small but startling 2.3% increase in the incidence of diabetes in endocrinologists over the last year. The study was heralded by health advocates, but lambasted by the state’s bustling maple syrup industry.

“I really can’t explain it,” said Dr. Stephen Wardlow, a long-time endocrinologist and diabetes specialist from his Stowe, VT office. “All of a sudden, my waist is 5 inches bigger and my blood sugar levels are through the roof. Well, gotta run – free donut breakfast!”

Cindy Christensen, from Vermont DHSS, noted: “We are as perplexed as many of our concerned physicians suffering from this disease. Actually, my office has received numerous reports of portly psychiatrists as well; we may very well have an epidemic on our hands.” Ms. Christensen denied allegations that the decline in Vermont physicians’ health had anything to do with a recent Times report of significant increases in drug makers’ spending on physicians. Coincidentally, both drug maker spending in Vermont and diabetes in endocrinologists increased by the same 2.3% over last year.

“Good thing I know a thing or two about diabetes,” Dr. Wardlow added.

+_+_+_+_+_+_+

P.s. This story is completely and absolutely fictional. For the real story, visit here:
Psychiatrists Top List in Drug Maker Gifts
By GARDINER HARRIS
Psychiatrists earn more money from drug makers than doctors in any other specialty.

Ok this is straight from the Freakonomics blog, but I had to ask this crowd here — What are the worst jobs for a doctor?

My Thoughts:

• A doctor who gives celebrities their “medical excuses” to leave prison and begin house arrest (Paris Hilton’s doctor?)
• A sports doctor for a wrestling death match.
• A doctor working on death row, performing or supervising lethal injections.

And now my own question: What are the best jobs for a doctor?

Go! (click on “comments” and post your thoughts!)

cross post from my blog: Question Everything

A new article by Michael Pollan in the NY Times, talks about one of the most important bills in Congress. It is called the “Farm Bill”, but affects the food system, the environment, and immigration.
Some select quotes:
On the Current Farm Law: “The result? A food system awash in added sugars (derived from corn) and added fats (derived mainly from soy), as well as dirt-cheap meat and milk (derived from both). By comparison, the farm bill does almost nothing to support farmers growing fresh produce.”

“The public-health community has come to recognize it can’t hope to address obesity and diabetes without addressing the farm bill. The environmental community recognizes that as long as we have a farm bill that promotes chemical and feedlot agriculture, clean water will remain a pipe dream. The development community has woken up to the fact that global poverty can’t be fought without confronting the ways the farm bill depresses world crop prices.”

“One of these years, the eaters of America are going to demand a place at the table, and we will have the political debate over food policy we need and deserve. This could prove to be that year: the year when the farm bill became a food bill, and the eaters at last had their say.”

This is the year. To get BE ACTIVE on this issue check out the Oxfam Farm Bill Website.  If we change these laws we can help stop obesity, improve farmers’ lives, and clean up the environment.

I recently had a great day – one to keep a family doctor going for a while.

The phone rang at 7:00 am and the OB nurse informed me that one of my favorite OBs was in early labor. By the time I arrived at the hospital, another woman had arrived in labor. Both were doing well. I completed my rounds and headed off to the office.

My morning was short because at 11am I was headed for a funeral. Lilly (not her real name) had died last week after complications of a stroke. I had cared for Lilly for 10 years. She suffered from rheumatoid arthritis, mild CHF and, recently, TIAs. When she had her big stroke she was just short of her 93^rd birthday. She died about a week later, at home with her very large family at her side.

Everytime I saw Lilly, she wore a cheerful hat. For the most part she was wheel chair bound but until she had her stroke she remained as vibrant as she was when I met her. It sounds cliché, but she never had a sour word to say. This sentiment was echoed by many at her funeral. Her funeral was packed with faces familiar to me, young and old alike. In the back row of the church sat a row of senior ladies with bright colorful hats on.

Though I new her fairly well, I learned a few things at Lilly’s funeral. She was married at age 15 and had 3 kids by the time she was 20. Her first husband died when she was 21 and she raised her kids as a single mom for another 8 years. She remarried in the mid 1940’s and moved to our rural community. She and her new husband were the second wave of western pioneers who built Madras when the irrigation canals came.

After chatting with a few of Lilly’s family members and friends, I headed back to the hospital and delivered two healthy newborns that afternoon. Both were born to single moms of Mexican descent – the most recent wave of pioneers to come to Madras.

It was a great day to be a family doctor. A day that solidified the end of a long term doctor-patient relationship and hopefully saw the beginning of two more. Next time I am stuck in a rut, frustrated with paperwork, I’ll draw on that day. And each time I see those newborns for well child visits, I’ll think of Lilly and her colorful hats.

Past AMSA President, recent medical school graduate and new NPA member Leana Wen is traveling in Africa this week with Nicholas Kristof of the New York Times. She was selected to provide a perspective on the healthcare system in Rwanda and Uganda. During the trip, she is posting her thoughts and ideas on a blog, Two for the Road.
Today’s blog is about Rwandan refugees and the challenges they face obtaining health care, but the hope of the Millennium Villages Project. Tomorrow, she’ll be talking with Dr. Paul Farmer, who gave the keynote address at NPA’s annual meeting last March.

Unfortunately as a physician I often find myself perusing the Business section of the newspaper to find out what is new in medicine. After all health care costs are consuming roughly 16% of our nation’s gross domestic product. However, when I scan the business section I am often confronted with the darker side of medicine. Many times I find out which pharmaceutical company is being litigated, which pharmaceutical company is poised to make millions off of healthcare, or what physicians have partaken in the unethical practice of putting profits over patients. Last Tuesday’s New York Times highlights several of these issues. In that edition two articles appeared nestled together:

Incentives Limit Any Savings in Treating Cancer

The ballooning cost of cancer treatment offers an example of how difficult it may be to rein in the nation’s runaway health care spending.

Cancer Drug Representatives Spelled Out the Way to Profit

Big pharmaceutical companies sometimes calculated to the penny the profits that doctors could make from their cancer drugs and shared those estimates with doctors.

What stuck out to me the most was how both of these articles highlighted that doctors had started to put their own financial interests in front of their patients. And to compound matters these were oncologists, or cancer doctors. Cancer is a ravaging disease, and in many cases is a fatal diagnosis. The patients are looking to their physicians for compassion and a chance for survival. However the drugs that we have to offer to battle cancer are also quite toxic. Therefore the cancer doctor has to balance treating the patient to prolong life and treating the patient to preserve and cherish the life they have. Yet we learn that some cancer doctors were opting to give their patients chemotherapy or choosing the type of chemotherapy not in the best interest of their patients, but in the best interest of their pocketbooks. A former oncologist, Dr. Robert Geller, shares his experience with the situation in the article:

It’s clear that physicians stopped making decisions based on what made scientific or clinical sense in lieu of what made better business sense.

People go where the money is, and you’d like to believe it’s different in medicine, but it’s really no different in medicine. When you start thinking of oncology as a business, then all these decisions make sense.

This is where I have to draw the line. I did not go into medicine thinking that I was going to be running a business. I know the reality is that physicians need to think about fiscal solvency just like any other professional. At the same time we took an oath as physicians to put our patient’s interests above our own. We will continue to lose the integrity of our profession if our patients end up inquiring if we are prescribing them a medicine or a test so that we may profit.

Finally we also know from these articles that the pharmaceutical industry was encouraging these doctors to prescribe these higher cost drugs to ensure everyone profited. Recent documents were made public from a court case in Boston that highlighted this relationship:

in 1998 Schering-Plough told its representatives that its drug Intron-A, a treatment for bladder cancer, could produce a profit for each patient of “$2,373.84 for our physicians just on the drug alone.” Pitching Zoladex, a treatment for prostate cancer, a sales representative for AstraZeneca was more blunt. “DO THE MATH!” he wrote in a letter to a group of urologists in Arizona.

Once again business and profits superceded evidence based practice and the interests of the patients. After learning of all of these new connections between physicians and profits, and physicians and the pharmaceutical industry, it makes me happy to know that I am a part of the National Physicians Alliance (NPA). The NPA is hoping to restore the integrity of the medical profession and has boldly positioned itself to take no financial ties with the pharmaceutical industry, and to put consumers’ interests first when advocating for health care policy change. That is why I hope to start reading more about what is new about medicine in the front page of the newspaper, rather than the business section.

FDA cannot handle speed and safety at the same time? One of the major problems that the FDA had was that it could not handle the speed part efficiently,  and this became a problem with the AIDS epidemic. The pharmaceutical world has changed since the late 80′s. ‘Back in the days’, evidence based medicine was in its infancy and there were few pharmaceutical sponsored ‘Mega-Trials’, which are now the norm and for all purposes need funding from the industry to be executed. I think it was right to speed up the approval process for certain if not most drugs – however the trap the FDA fell into was to become dependent on Pharma and it seemed to have started from a weak negotiating position. Thus safety was neglected. That’s like going from a VW to a Porsche, but getting rid of airbags and brakes – as you can tell, it makes perfect sense. I think the US has to realize that the pharmaceutcal industry is mostly interested in its well being, while the state should be interested in the well being of its citizens.I think that aspect has been shamefully neglected and goes along with the overall direction of the ‘for profit’ health care market: high deductibles, health care savings accounts, facilitating the sale and profitability of drugs in almost every way (direct to consumer advertising, sale of prescribing data). In my humble opinion, more than new rules, the FDA needs funding as much independent of drug companies as possible. It is however clear that the public is not willing to fund this with taxpayers money, or we would have new revolution on hand. Just imaging the headlines: “Congress raises taxes to make drugs safer and health care more affordable” – now that sounds awful ;) 

cross posted at Stupor Cordis

I thought i would make this a lighthearted blog to show you the silly side of some of our members…ok, well me…my personal favorite is actually J.D. on scrubs
here are the options

-JD on scrubs

-other Scrubs Castmember

-McSteamy on Greys Anatomy

-McDreamy on Greys Anatomy

-Bailey on Greys Anatomy

-Other character on Grey’s

-House

-One of House’s Lackeys

-Medical Examiner on CSI

-Trapper John M.D.
-Marcus Welby

-Someone on E.R. (who is left on that show)

-old castmembers of ER- I can only remember george clooney
-other: INSERT YOUR FAVORITE