nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Sunday, January 18, 2009


Hospital lobby seen as early winner in Obama healthcare agenda.


In a Health Policy column in Forbes (1/15), David Whelan observed that "buried" in the State Children's Health Insurance Program (SCHIP) legislation passed by the House on Wednesday "is another gift, this one to a powerful health lobby -- the hospital industry." The SCHIP bill contains "a section that bans physicians from owning or investing in hospitals." Whelan pointed out that "hospital groups, including the American Hospital Association and the Federation of American Hospitals...have spent millions of dollars on lobbying to ban physicians from becoming competitors by starting surgical and heart hospitals that typically provide better care than their counterpart general hospitals."


Doc D:  It appears that big corporate influence will continue into the new administration.  As you know, this rider has nothing to do with healthcare for children, the goal of SCHIP.  These new small specialty hospitals are an innovation in healthcare delivery.  They focus their expertise on a specific type of treatment, creating a comprehensive approach to that care.  An example is the long-term critical care hospital, for those patients who have dire injuries or illnesses that require a long time to recover.  General hospitals don’t focus on this type of care and are not as good at preventing complications and sustaining intensive efforts.  There is need for caution about these organizations, however: oversight mechanisms must be in place to make sure that physicians don’t establish conflict-of-interest business relationships with the hospitals.  That aside, they are a good thing.  For the sake of high quality medical care, let’s hope the Senate throws out this corporate give-away.


Survey indicates Americans' support for health reform decreases when faced with trade-off

The AP (1/16, Freking) reports that, according to a national survey conducted by the Kaiser Family Foundation and the Harvard School of Public Health, the "prospects for health reform drop significantly when Americans hear potential financial trade-offs associated with expanding health-insurance coverage." The survey revealed that "nearly seven in 10 people say they favor the concept of" employer-sponsored health insurance, or "requiring contribute into a fund that pays to cover the uninsured." But, support fell "to about three in 10 people" when they "heard the mandate would cause some employers to lay off workers." Meanwhile, support for a mandate "requiring all Americans to have health insurance" fell from "two out of three people" to 19 percent when told "some people may be required to buy insurance that's too expensive."

Doc D:  I know I sound like a broken record about cost,  but ….duh!  the government doesn’t grow money on a tree, it all comes from us.  My fear is that the sentimental motivation of providing coverage for the uninsured, noble as it is, will override any scrutiny and debate over proposed healthcare reforms.  (for uninteresting details see the bottom of this page). 

Physician testifies quetiapine may substantially raise diabetes risk.

Bloomberg News (1/16, Pearson, Bloodsworth) reports that, according to the testimony of endocrinologist Jennifer Marks, M.D., "AstraZeneca Plc's antipsychotic" medication "Seroquel (Quetiapine) raised by almost 400 percent the risk of developing diabetes when compared with first-generation medications in its class." During a pretrial hearing yesterday, Dr. Marks "testified on behalf of former Seroquel user Linda Guinn," who "blames Seroquel for her Feb. 2006 diabetes diagnosis." Dr. Marks cited a "2004 article published in Psychiatric Services," which "reported the increased risk in males who were exposed to Seroquel for at least 60 days," as well as other "studies bolstering her opinion that Seroquel causes diabetes." Attorneys for AstraZeneca, however, "attribute Guinn's diabetes to obesity, a family history of the disease, and hypertension."


Doc D:  This is interesting in a couple of ways.  First, there are doctors who are professional “testifiers;” basically hired guns for lawyers who want a certain testimony.  I don’t know if this doc is one of them, but what she’s saying tends to support that she is.  I looked up the study in question:  while there were more males (note the plaintiff aint a male) who developed diabetes who took second-generation antipsychotics (seroquel is only one), the data were not statistically significant.  A follow on article in 2008 reviewed 14 studies on the same question and came to the same conclusion:  an interesting thing to look further at, but not established.  The REAL risk factors of the plaintiff are listed in the last sentence above:  “obesity, a family history of the disease, and hypertension.”  That’s a prescription for diabetes all by itself.


Second, our legal system is adversarial in nature.  Science is not…it’s incremental:  two steps forward, one step back.  Adversarial systems have a winner and a loser, and when the question is a scientific one, the outcome may depend on who tells the best story.  There’s something about deciding blame based on who is more charismatic that really disgusts me.


Physician says compassion cannot be quantified monetarily.

In the New York Times (1/16) Doctor and Patient column, Pauline Chen, M.D., wrote that the authors of an opinion piece published in the New England Journal of Medicine "argue that the current drive to fit healthcare into a business framework has resulted in a loss of medicine's communal and compassionate aspects." ….Dr. Chen acknowledged that "all of us, doctor and patient, have become more comfortable with money's role in medicine." Yet, "in order to restore medicine's compassion, doctors and patients need to reestablish the balance between cost containment and compassionate care, profit-and-loss tabulations, and patient-centered partnerships."


Doc D:  I fear we are way past being able to do this.  Corporate America, the government, unions, and trial lawyers are involved… and Big Bucks are the prize.  Say goodbye to the idyllic, early 20th century image of Dr. Marcus Welby:  overburdened with paperwork and frivolous lawsuits, he retired for good.



Medical quote of the Day:

Physical pain is easily forgotten, but a moral chagrin lasts indefinitely.—Santiago Ramon y Cajal [1852-1934]



Doc D

Opinions are entirely my own.  Quotations from Kaiser Daily Health Policy Report ( © Kaiser Family Foundation), PND News Briefs – Texas Edition ( © 2008, Physician's News Digest, Inc.), AMA Morning Rounds (© U S News Custom Briefings), and other sources in the public domain.  As always, you may share this column, with appropriate attribution (here and in the text) included.




Supplemental material.  Ignore it.


---Most of the claims for cost savings in the administration’s plan are spurious.  They were pushing the cost savings from administrative efficiencies until most analysts pointed out that the payback from that is trivial compared to the increased cost.  Now they are saying that disease management is the key.  Here are some quotations from the Congressional Budget Office on elements of the plan aimed at reducing costs:


1.  “There is insufficient evidence to conclude that disease management programs can generally reduce overall health spending.' Douglas Holtz-Eakin, Director of the Congressional Budget Office, letter to Don Nickles, chairman of the Senate Committee on the Budget, October 13, 2004, at (October 24, 2008).

2.  "It would probably be a decade or more before new research on comparative effectiveness had the potential to reduce health care spending in a substantial way.' Congressional Budget Office, Research on the Comparative Effectiveness of Medical Treatments, December 2007, at
(October 24, 2008).

3.  "By itself, the adoption of more health IT is generally not sufficient to produce significant cost savings.' Congressional Budget Office, Evidence on the Costs and Benefits of Health Information Technology, May 2008, at (October 24, 2008).

4.  "The reduction in drug spending from importation would be small.' Colin Baker, "Would Prescription Drug Importation Reduce U.S. Drug Spending?' Congressional Budget Office, April 29, 2004, at (October 24, 2008).



I can’t say that the CBO is a totally unbiased agency, but their use of hard data instead of vague promises is encouraging….and they’re continuing to criticize even in the face of a Democrat-dominated Congress.

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