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.

Thursday, March 5, 2009

THE OBAMA MEDICAL STASH OF CASH; LABELING DRUGS VERSUS PLACEBO; AND, THE LOCATION OF QUACK HEAVEN

Sorry, folks.  It’s been a long time since I last wrote, but there hasn’t been much medical news that’s informative and entertaining.  Quite the contrary, most of it has been the opposite of entertaining…more like, very scary.  The entrepreneurs that have been lobbying for their pet healthcare project are lining up to milk the federal cash cow.  Congress is on a spending spree that has them drooling.

But among the chaff there are a few nuggets, some pitiful and some hilarious.

 

Obama's budget includes creation of 10-year, $634 billion "health reform reserve."

Media reports are casting President Obama's first budget plan as a clear break with past US policies on a variety of issues. The story led all three network newscasts and appears on most major newspaper front pages. ABC World News (2/26, lead story, 3:20, Gibson) described the size of the budget as "staggering" and notes that "one out of every two dollars spent by the government will be deficit spending." But "it would lead to a seismic shift in policies, and would touch the lives of nearly every American."

Doc D:  I’d like to spend another dollar for every dollar I earn.  It would solve my personal financial limitations.  Just so long as I don’t have to pay it back (my grandkids can take care of that).

Seriously, this is not the solution to healthcare costs; frontloading a deficit “reserve” just gives you the feeling of having some “walking around” money, like a wad of cash in your pocket.  It’ll be gone before you know it, and the same forces driving increased cost will still be in place.

 

Researchers say prescription drug labels should quantify drug's benefits versus placebo.

The New York Times (2/26, B3, Singer) reports, "researchers...are urging federal regulators to" require the labels of prescription drugs to carry "numerical tables that quantify the benefits of taking a drug compared with a placebo, and that list the odds of having side effects."  Tomorrow, Dr. Steven Woloshin and Dr. Lisa Schwartz "plan to present their case to the" Food and Drug Administration (FDA) "during a meeting of the agency's advisory committee on 'risk communication.'"  The researchers "are scheduled to present the results of two randomized trials, published last week in Annals of Internal Medicine, in which they examined how well drug fact boxes worked on several hundred people."  The trials "indicated that most people presented with comparative risk and benefit information were able to identify the more effective of two drugs."

Doc D:  This will be interesting.  Sometimes the placebo effect (where people get better, thinking they are taking medicine, but they’re not) is as high as 30%, even for non-psychiatric drugs.  Also, sometimes people don’t get better with a highly effective drug…who knows why:  genetic resistance, cantankerous personality, etc.  I anticipate some big litigation out of this one, and some income growth for lawyers.

 

Nevada bill aims to legalize quackery.

Quackwatch, (Feb 26) reports that “Nevada State Senator Michael A. Schneider has introduced S.B. 69, an 85-page bill that would:

**Declare Nevada a "freedom of health" state.

**Affirm that patients are "entitled to access to and the use of the products and services of any provider of health care chosen by the patient, including, without limitation, a complementary integrative medical physician or any other provider of health care."

**Replace the current homeopathic board with a Board of Complementary Integrative Medical Examiners that has the same powers but can authorize people to become licensed or certified as a "complementary integrative medical physician," "advanced practitioner of complementary integrative medicine," "complementary integrative medical assistant" or "complementary integrative medical nutritionist."

The practices that would be permitted under the bill's umbrella would include biofermentics, bio-oxidative therapy, electrodiagnosis, herbal therapy, homeopathy, naturopathy, neural therapy, neuromuscular integration, orthomolecular therapy, nonembryonic stem cell therapy, peptides, and "any intravenous infusion, intramuscular injection, subcutaneous injection and intradermal injection of nutrients, including, without limitation, vitamins, amino acids, minerals, enzymes, compounded pharmaceutical preparations, homeopathic medications, organ preparations, ozone, hydrogen peroxide and chelating agents."

 

Doc D:  This has to be a joke, right?  This is a free ticket for every quack and wacko to hang out a shingle.  The trend toward anti-rationalism in healthcare continues to grow.  (Note that this is not “irrational”, which means “lacking” reason; this is “against reason,” meaning to use alternative modes of knowing.)  On the other hand, if any of you want a career change, invent a form of therapy (anything, just make it sexy-sounding) and move to Nevada if this bill passes.  For those whose feet are NOT firmly planted in air, remember the case of Rhea Sullins:  a 7-year old who became ill, and whose father, a past-president of the American Natural Hygiene Society, put her on a diet of water-only for 17 days, followed by juice-only for 18 more until she died of malnutrition.

 

Medical quote of the Day:

There are no really “safe” biologically active drugs.  There are only “safe” physicians.—Harold A. Kaminetzky [1923- ]

 

 

Fraud Alert:    Chelation Therapy.  Some of you have heard of this:  the basis for this treatment is that heavy metals are found in the urine of tested subjects, and compared against norms to establish the need for chelation therapy to remove them.  Heavy metals such as lead and mercury have been implicated in several diseases.  The problem is, the patients are given chelating agents that raise the level of the metals in the urine, then the tester compares those results against the standard, which is calculated from urine specimens from subjects who did not receive the chelating agent (as the patients did).  This all but guarantees that the patient will be abnormal, and require therapy.  It is my belief that the advocates of chelation therapy know very well they are cooking the books:  the failure to adhere to a basic principle of scientific validity is too blatant.

The best approach is to be skeptical of any new therapy that is not in the mainstream of healthcare. 

 

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.

 

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