Story Lines

Doctors are trying to rationalize our current story line:  the loss of autonomy and pay cuts are a necessary evil for the greater good.   We're taking one for the excess-health care cost team.  We're willing to take this personal sacrifice for our fellow man and woman.   It is the noble thing to do.   It will be good for America's healthcare system if we do our part, work harder to improve inefficiencies.   There are even doctors in leadership positions who reflect in their three-year "honest assessment" of our current health care law that higher taxes and near-30% rise in insurance premiums are a necessary evil for extending insurance to 30 million more Americans.  "I am glad to do my part," they comment.  How could anyone argue with such beneficence?

Doctors who sacrifice and give tirelessly to their patients are our storybook ideal; what every American loves to envision.  But we should also acknowledge that there is another story line: that many physicians are deeply concerned with the realities of what's taking place in health care lately.

Doctors are witnessing health care costs greatly outstripping inflation, especially since our new health care law was put in place.

• People aren't using their coverage because they fear the cost of their much higher deductibles.


• Insurance companies have created their own convenient loophole to avoid the consequences of their own new law.


• With the initial deployment of the law only eight short months away, the promised insurance "exchanges" have yet to be fully deployed nor explained to the public.


• The small business health care program has been delayed.


• People with pre-existing conditions stopped being covered in February, 2013  because the government agency responsible for this portion of the law ran out of funds.
 
• More concerning for those who are budget-minded, as of today, not a single member of the the law's Independent Payment Advisory Board, the 15-member panel that is supposed to recommend cuts to the Medicare program beginning 1 January 2014 to maintain its solvency, has been selected, much less approved.

Meanwhile, our nation's leadership is enjoying the black-tie White House Correspondent's Dinner in appreciation of those who serve as our Great Distributor of Washington story lines, aptly named "Nerd Prom."

Perhaps I shouldn't be so harsh.  After all, it was just in the spirit of poking fun.  I should also accept that since American Medicine is our largest employer and nation's largest business, American Medicine will forever be tainted by politics.  But as we have seen time and time again, it is common in politics to sell Story A when, in fact, the real motivation for something is Story B. When political initiatives are deployed that are uncomfortable there has to be something that people will emphatically rally behind.  How else could we send our children off to war, for instance?

And so it has been with health care.

Story A was that this whole health care story line was about the uninsured.

Yet people were never waving flags and demonstrating in the streets for wellness initiatives with free mammograms, physicals and flu shots.  People were not looking for more and more middle layers of bureaucracy, red tape, and management.   People are not demanding that first-year medical residents see patients for only 12% of their day because of training rules. People were not looking for their doctor to become a nursing supervisor, medical coder or typist.    People were not picketing the Supreme Court for double-digit insurance company stock market returns so they could enjoy higher premiums and deductibles.    People were not hoping for $100-million golden parachutes for pharmaceutical executives. People were not lobbying for bigger hospitals competing with other hospitals for wealthy patients, each filled with outdated computers, waterfalls, big screen TVs and kiosks in "anticipation" of what was to come.   And people were REALLY not expecting the government to burn through their cash so fast that they'd be asking for more money so soon.  

Yet here we all are, realizing our new, disturbing story line.

Doctors, patients, ...

... and Nerd Prom.

-Wes

Suddenly, A Spike in Blog Traffic

Suddenly, my blog traffic spiked to a particular page on my blog which showed a Playboy bunny tattoo (a la Hugh Hefner) overlying an implantable cardiac defibrillator that I had implanted in the past (no, not on Hugh). I couldn't figure out why...

... until now.

Thanks for the traffic, Hugh!

-Wes

Anomalous Coronary Artery - A Cause of Cardiac Arrest

... and also a correctable cause for this high school football player.

Sometimes it's hard to think it's a lucky thing, but for this young man, it's a correctible cause of cardiac arrest and a very lucky thing that this worked out the way it did.

-Wes

Midodrine's Updates

On 16 August 2010, the FDA published a "Proposal to Withdraw Low Blood Pressure Drug" about the generic blood pressure-raising medication, midodrine:

The U.S. Food and Drug Administration today proposed to withdraw approval of the drug midodrine hydrochloride, used to treat the low blood pressure condition orthostatic hypotension, because required post-approval studies that verify the clinical benefit of the drug have not been done.

Patients who currently take this medication should not stop taking it and should consult their health care professional about other treatment options.

Phone lines were flooded. Doctors scratched their heads because the "options" for alternate therapies to replace this drug amounted to exactly... none.

Two days later on 18 August 2010, Shire pharmaceuticals announced they will stop manufacturing midodrine 30 September 2010, adding fuel to the patient backlash of the FDA's prior announcement:

Shire plc (LSE: SHP, NASDAQ: SHPGY) acquired ProAmatine (ed's note: trade name for midodrine) as a part of the acquisition of Roberts Pharma in 1999 and Shire conducted and completed the post marketing trials that the FDA required. The FDA, however, viewed these trials as inconclusive and required that additional trials be conducted for ProAmatine to maintain its marketing authorization. As a result, Shire elected to withdraw the product effective September 30, 2010 and notified the FDA in November 2009 and healthcare professionals earlier this year of this decision. Shire's withdrawal of the NDA was not related to any concerns regarding the safety of ProAmatine.

Doctors scrambled. Patients complained. Finally, news about the FDA recanting came via a New York Times article on 3 September 2010:

The agency’s flip-flop demonstrates the difficult choices regulators face in policing the nation’s drug market. Cracking down on drug makers sometimes means stranding desperate patients. And now that Congress has given the Food and Drug Administration greater powers to insist on better information about life-saving medicines, such disputes may become more common.

Sadly, not until a 10 September 2010 press release from the FDA could the information published in the New York Times be confirmed and a plan of action taken to assure patients and their physicians aren't blind-sided by the FDA's actions on this matter:

Since the agency notified the manufacturers of the proposed withdrawal of midodrine, we have heard from professional organizations, doctors, and patients about their concern about losing access to midodrine. We have also heard from organizations that have expressed interest in conducting the clinical studies necessary to establish effectiveness, as well as doctors and patients who support the conduct of such studies. FDA intends to work with Shire, the generic manufacturers, and other organizations to discuss the data that are necessary to establish the efficacy of midodrine. FDA will post this information in a public docket.

So what have we learned with this regulatory fiasco?

First, once the FDA approves a drug with strings attached, they have an obligation to assure to the public that those strings mean something long before a drug goes generic. Why impose regulatory requirements if they're not going to enforce those requirements in a timely fashion? We are left to wonder how many patients might have been harmed by their inaction had there been a problem.

Secondly, news agencies now appear to be our best source of new information about updates on drugs and their availability. This should be of considerable concern to physicians who need to verify the legitimacy of information published in the mainstream media. Admittedly, the New York Times got the story right, but such is not always the case with media reports about drugs and innovations in medicine. At the very least, the FDA should provide midodrine updates at the same time this information is provided to the media. Verifiable information is increasingly needed in our new era of web-enabled patients and doctors.

Third, this was one small example of the power of government to intervene on our patients' care rapidly and without warning to the populace at large. Fortunately, the public outcry over their action was not ignored, but patients should be aware that litigation against the government should harm arise as a result of such an action would be very difficult and expensive to prosecute.

Hopefully, the FDA has learned a few lessons with this fiasco.

One thing's for sure: you can bet our patients did.

-Wes

Tweeting Your Own Heart Attack

It's funny, until it's not:

Opportunity + Instinct = Profit. A good journalist can sense the moment that a story is developing and seize the moment. That’s why when White House correspondent Tony Christopher started having a heart attack, he immediately logged into Twitter and started covering it:

Approximately at 6pm on Sunday afternoon Christopher wrote, “I gotta be me. Livetweeting my heart attack. Beat that!” Presumably a few minutes later the paramedics arrived to tell Christopher he will be stable after his crisis.

An hour later Christopher joked about needing to own a cardiac cat, referencing a viral video in which a cat is trying to revive his dead feline friend. He also updated his followers about the pain he was feeling, “even after the morphine.”

So is this the message the White House wants sent to America?

Seems to me his time might have been better spent on (1) taking an aspirin, (2) calling 911, and (3) calling a friend, (4) and assembling a list of his current medications and past medical history for the doctors in case he loses consciousness.

But that's just me...

-Wes

Why Nurse Supervisors Should Be Marines

... because you never know when their skills will come in handy:

Witnesses told police that nurse (supervisor) Andy Hull, a 35-year-old former Marine, jumped in to disarm Lupienski when he pulled the gun out from under his gown and pointed it at another staff member. Hull was shot three times. He was being treated Wednesday in the hospital's intensive care unit for injuries that were described as serious but not life-threatening.

I can hear it now....

The Few. The Proud. The Nurses!

-Wes

Could a Boob Job Save Your Life?

Don't count on it, but it sure makes for one heck of a story:

When a gunman stormed a Simi Valley dental office last summer and shot Lydia Carranza in the chest, salvation may have come in the shape of her size-D breast implant.

That's the theory at least of a Beverly Hills cosmetic surgeon who hopes to drum up support to defray the costs of Carranza's reconstructive surgery.

"She's just one lucky woman," said Dr. Ashkan Ghavami, who says he will perform the surgery for next to nothing but has urged Carranza to tell her story in hopes of getting implant companies to donate the supplies.

Ghavami contends that the implant absorbed much of the bullet's impact, limiting most of the damage to the breast itself.

"I saw the CT scan," he said. "The bullet fragments were millimeters from her heart and her vital organs. Had she not had the implant, she might not be alive today."

The hospital where Carranza was treated is not prepared to make that call.

"This is not a medical issue; it's a ballistic issue," said Kris Carraway, a spokeswoman for Los Robles Hospital & Medical Center in Thousand Oaks. "The emergency physician who treated the patient was not aware of the breast implant having any impact or whether or not it saved her life."

But Scott Reitz, a firearms instructor and deadly-force expert witness with 30 years' experience in the LAPD, said that, although he was not involved in the case, the scenario Ghavami describes is entirely plausible.

"Common sense would dictate that any time you have something that interrupts the velocity of the projectile, it would benefit the object it was trying to strike," he said. And because a saline implant is like a high-pressure bag full of salt water, it probably would provide more resistance than plain flesh, he said.

"I don't want to say a boob job is the equivalent of a bulletproof vest," he added. "So don't go getting breast enhancements as a means to deflect a possible incoming bullet."

Sounds like wise advice and I knew you needed to know this.

-Wes

Haitian Destruction Caught on Video

... it only took a little over 16 seconds.

-Wes

Michael Jackson Found Down

He's currently in a LA hospital.

-Wes

Another Satisfied Customer

Congressman Pete Olson has just discovered the wonders of electricity - for the heart, that is.

Here's wishing him a speedy recovery.

-Wes

Hearts in the News

Robin Williams is hospitalized in the ICU in a Miami Hospital with "heart issues." Next, we'll soon learn that the 8 people searching the electronic medical records were fired for HIPAA violations.

Barbara Bush had an aortic valve replacement at Methodist Hospital in Houston and is "doing fine."

-Wes

The Car Wash Heart Mystery Solved

It made for intrigue and drama and cost the tax payers of Michigan a pretty penny to investigate, but alas, the mystery is now solved.

-Wes

Bit

Look for this clever detective work on next season's "CSI-Finland:"

Sakari Palomaeki, the police inspector in charge of the case, said it was the first time Finnish police had used an insect to solve a crime.

"It is not usual to use mosquitoes. In training we were not told to keep an eye on mosquitoes at crime scenes," he said.

-Wes

Heros All

The Chicago Tribune tells the story of those that were lost yesterday in this morning's edition:

Amid all the unanswered questions, University of Michigan President Mary Sue Coleman said the six victims will be remembered for their heroic work.

"Every day, the doctors, nurses and flight personnel of Survival Flight do heroic work in saving the lives of others, and that is how we will remember those who perished in Monday's tragedy –as selfless heroes," Coleman said.

-Wes

Transplant Team's Plane Crashes

More sad news today from Milwaukee where a University of Michigan transplant team's jet crashed yesterday afternoon into Lake Michigan shortly after takeoff from Milwaukee en route to Willow Run airport near Detroit, a 42-minute flight.

Our prayers go out to the families involved.

-Wes

Be Careful Screening Job Applicants

Especially when you want to employ an alcoholic as a beer tester: he might sue:

A Brazilian court has ordered local brewer Ambev to pay 100,000 reals (US$49,400; euro36,400) to an alcoholic beer taster who drank about a liter and a half (3.2 pints) of beer each day.

The unidentified employee alleged that the company did not provide the health measures needed to keep him from developing alcoholism, a labor court in the Rio Grande do Sul state said in a statement Friday.

The employee said in his lawsuit that for more than a decade, he drank between 16 and 25 small glasses of beer during his eight-hour shifts at the company

The employee said he also received a bottle of beer after each shift.

An initial ruling had favored Ambev, or Companhia de Bebidas das Americas, which can still appeal the decision. The company alleged the employee already was an alcoholic before becoming a beer taster.

Judge Jose Felipe Ledur said the company still was negligent because an alcoholic should never have been made a beer taster.

I wonder if the hospital had enough Valium to get the guy through D.T.'s.

-Wes