Musings on Medicine and the Health Care System

You’ll Repeal HC Reform Over My Dead Body. . .

Ok, maybe I’m being a bit extreme but I am getting really, really tired of the rhetoric I’m hearing now about the horrors of the 2010 health care reform bill. I’m just going to bet that most of the people trashing it don’t have the slightest clue what it means and what it includes and what it could do.

Is it perfect?

Absolutely not.

But then, the only perfect things in this world are a newborn baby and the fois gras with sauteed apples I had for dinner last Saturday night (oh, and the Penfolds Grange wine my husband surprised me with on our 15th anniversary).

I’m not going to autopsy the health care reform bill here now (It’s nearly midnight and I really need to get to bed). However, I just wrote an article about the costs of treating rheumatoid arthritis and what health care reform might mean for the millions of people in this country with the disease. It will appear at www.lifescript.com in the next week or two. In the meantime, however, I think that what I’ve written applies to any person with any chronic health condition, whether it’s depression or cancer. In a nutshell, the bill … Continue Reading

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30 Spooky Freelancing Practices | FreelanceFolder

In Honor of Halloween: 30 Spooky Things Freelancers Should Never Do

30 Spooky Freelancing Practices | FreelanceFolder

Which are you guilty of?

My sins include:

18192223 (sometimes)24 (sometimes)

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Yes, We Need Some Sanity–For the IRS!

The 14-year-old has homecoming (and a date) this weekend, otherwise we would be at the Jon Stewart Rally to Restore Sanity. If I were in Washington, however, I’d also have to wander over the IRS to try and restore a little sanity to the idio. . . um, hardworking government employees who work there. Seems the IRS recently issued its annual rules about what  the money in  medical savings accounts (those accounts created with pre-tax dollars) can be used for.

As The New York Times reported earlier this week, the IRS says you can spend those pre-tax dollars on items like dentures, pimple cream, and even replacing real grass with turf if your kid has severe allergies; but not breast pumps. Why? To quote the Times’ article: “breast-feeding does not have enough health benefits to qualify as a form of medical care.” Instead, the IRS views it as being a form of nutrition only.

When I read those words my first impulse was to hop in my car, drive to DC, find the IRS building, whip off my shirt and bra, hook up a breast pump to my boobs, and march on the IRS office, preferably with about 5,000 other … Continue Reading

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Looking at the Long Term: Impossible in Our Healthcare System?

I spent last week in Gothenburg, Sweden covering the European Committee for the Treatment of Multiple Sclerosis (ECTRIMS) meeting. Lots of good science, lots of excitement over the new oral and targeted therapies coming on the market to treat this awful disease. But what I want to write about isn’t the science, but about how it will play out in the brave new world of health care in which we all live in today.

For instance, consider the first oral therapy to hit the market: Gilenya (fingolimod), which the FDA approved in September. Last month Novartis announced the price: $48,000 a year.

This is not a rant against the high cost of drugs, however. It is a rant against the inability of our healthcare system to take the long view of the impact of such drugs, a view that is particularly important with a chronic disease like MS that strikes healthy young adults in their early 20s and 30s.

Because what I heard at the meeting was that treating early—as soon as the first clinical signs of MS appear—can slow the progression to disability, and that some of the newer drugs may actually put patients into remission.

This is extremely … Continue Reading

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Ghostwriting–Don’t Blame the Writers

Anyone involved with medical communications knows well the recent controversies surrounding “ghostwritten” journal articles, i.e., articles that were written by medical writers who received no recognition for their work. I’m not going to get into a big discussion about the situation here, too swamped with deadlines right now, but I just had to post about something that just happened.

I got an email this morning from a doctor asking if I could help him write some articles and submit them to journals. He would provide all the information. Certainly, I told him, I’d be happy to. We discussed a price and all seemed well until I said, “Oh, you should know that you will need to give me some kind of credit for assisting with the article.” He was flummoxed, didn’t know what I was talking about. So I explained about the whole ghostwriting thing, the ethics policies of the American Medical Writers Association, etc etc. I stressed that I was not expecting to be named as an author, only to have some kind of blurb along the lines of, “Thanks to Debra Gordon, MS, for her assistance with the drafting of this manuscript.”

He just emailed back that he … Continue Reading

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AMWA ghostwriting medical writing

Getting Sick–Not for Me

I don’t do well with pain. I learned that lesson all-too-well during the birth of my first son, when, after 10  hours of labor jump-started by a pitocin drip I finally got an epidural. Nothing–and I mean nothing–has ever felt as good as the ebbing of that pain. I relearned the lesson during the birth of the second son, this time determined to go natural all the way, when, after a few hours, I told the doula to “shut up” and ordered my husband to hunt down the anesthesiologist and “Get me an epidural–NOW!” He listens well.

By the time the third son was born, I had the drill down pat. I was admitted to the hospital to be induced again but this time, as soon as the IV was hooked up and before the first labor pain hit, I had the anesthesiologist in the room putting in the epidural. It was a completely painless birth–and a lot of fun.

My issues with pain extend to my issues with being sick. I simply do not like not feeling well. I’ve been very lucky and extremely blessed in my life–the most serious thing I’ve ever had wrong with me was strep … Continue Reading

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Avastin and Breast Cancer

Time to get back up on my soap box.

Next month, the FDA is supposed to consider taking the unique, first-time-ever step of revoking a drug’s indication not because it’s dangerous, but because it doesn’t work well enough to offset its risks. Never mind that it costs about $8,000 a month.

The drug is Avastin (bevacizumab), a targeted monoclonal antibody that  prevents tumors from creating and maintaining their own blood supply, a process called angiogenesis. Without oxygen and nutrients from blood, tumors can’t keep growing.

Avastin is the world’s best-selling cancer drug, approved for use with chemotherapy to treat lung cancer and metastatic colorectal and breast cancer. It is also being investigated (and, likely, being prescribed off label) for numerous other cancers.

The problem comes with breast cancer. Avastin was approved for breast cancer under an FDA program called “accelerated approval” in which the agency provides “conditional” approval for a life-saving drug that appears effective so as to get it to patients quickly while requiring that the manufacturer conduct more studies demonstrating its long-term effectiveness. About 90 drugs have been approved under the accelerated approval program in the past 20 years and none has ever had its approval revoked (one … Continue Reading

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cancer clinical trials cost healthcare costs healthcare reform

When Is Enough Enough?

A new survey in the journal Health Affairs journal synthesizes nearly everything I believe is wrong with the US healthcare system. The survey found that patients believe that more care is better, that the latest and most expensive treatments are the best, that none of their doctors provide substandard care, and that evidence-based guidelines are a pretext for denying them the care they need and deserve.

Sigh.

Until we can retrain consumers (that would be all of us) to understand that in medicine more is NOT better, that evidence-based guidelines may translate in some instances into less but better care, that doctors are falliable and should be questioned, and that the cost of a treatment has nothing to do with the quality, we will never get out of the healthcare quagmire in which we find ourselves.

Your thoughts?

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Grand Rounds: TOPIC: Customer Service in Healthcare

I want to start this week’s Grand Rounds’ blog with my own blog post. I asked for postings on customer service and I have one to share. My 17-year-old son has been having some issues with depression and social anxiety. We got him in to see a therapist and his family practitioner prescribed a low dose of Prozac, both of which seemed to be helping until he hit a crisis when his girlfriend broke up with him. He literally fell apart and scared us to death.

His therapist called me back the night of the crisis within 5 minutes of my leaving a message with the answering service. He was only in town for a week before leaving for vacation, but he saw our son twice and called our son’s primary care doctor to suggest upping the antidepressant dose. The doctor called me one evening to say she totally concurred and, since our son’s therapist would be out of town the following week, wanted to see our son herself.

I was so touched. I have never had an MD (who wasn’t a psychiatrist) want to see me (or anyone in my family) for anything other than a strictly physical illness. … Continue Reading

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