I will admit I enjoy reading Dr. Rob. His way of explaining everyday happenings is straight forward and thoughtful. He has his detractors, but they happen to anyone.
In his blog on October 5, 2010, he chose to address the issue of “What is a patient?”. He started out by asking a series of questions to help define a patient. Though I am not a patient of his, I think I could enjoy being one of his patients. His questions are very probing and leave no doubt about what he is trying to resolve.
A couple of questions Dr. Rob asked “Are they consumers? Are they paying customers?” and the last one “are they the ones in charge?” He states that it depends on the situation and on perspective. Dr. Rob was right in people being offended, both physicians and patients, but they were not reading it with the intent written. He carefully laid out his thoughts and then went on to explain where he was coming from.
Then in the following post he has to defend what he had written. If you have any doubts about his definitions go back and reread both posts. Dr. Rob writes with a lot of insight and respect for the term patients and all the other terms he uses with care. I believe there is room for all of his terms.
Dr. Rob's discussion make me feel a little awkward about what I thought about when I wrote this. I am rethinking how I will rewrite this in the future.
30 October 2010
29 October 2010
Is Home Health Care an Option?
What do you think of when someone mentions home health care? I think of private nurses making rounds at individual homes in an area, a person living with an elderly person and taking care of them. Hospice is another area that comes to mind. I was not expecting doctors or physicians making house calls. I have been waiting for the day when internet videoconferencing allowing virtual visits from patients homes. I am surprised that this is being given a trial.
At many places around the country, different trial balloons are being tried for in-home care of acutely ill patients. Much of this seems to be happening as a result of The Independence at Home Act that was included as part of the Affordable Care Act passed recently. This sounds like something that is good for the older generations that will have difficulties making frequent trips to a doctors.
While this does not assure that all doctors are on board with this, some (hundreds) of U.S. Physicians are backing the home-based care. Most of these doctors are now members of the American Academy of Home Care Physicians. I am surprised that this organization had been around since 1984 and in some form has been serving acutely patients in their homes.
A new version of the black bag used by physicians in San Diego, California includes a mobile x-ray machine and a device that can preform over twenty lab tests at the point of care. Engineering and electronics companies are developing products for monitoring health at home.
The following factors are believed to be driving health care out of the hospitals and back into the home.
Hospitals will not want this to happen, and many physician clinics will oppose in-home care. There will probably be some starts and stops, but once this gets traction, some medical practices and hospitals may well find that their doors must close permanently.
Almost all the abstract was available, but it has now been severely limited on NEMJ.
At many places around the country, different trial balloons are being tried for in-home care of acutely ill patients. Much of this seems to be happening as a result of The Independence at Home Act that was included as part of the Affordable Care Act passed recently. This sounds like something that is good for the older generations that will have difficulties making frequent trips to a doctors.
While this does not assure that all doctors are on board with this, some (hundreds) of U.S. Physicians are backing the home-based care. Most of these doctors are now members of the American Academy of Home Care Physicians. I am surprised that this organization had been around since 1984 and in some form has been serving acutely patients in their homes.
A new version of the black bag used by physicians in San Diego, California includes a mobile x-ray machine and a device that can preform over twenty lab tests at the point of care. Engineering and electronics companies are developing products for monitoring health at home.
The following factors are believed to be driving health care out of the hospitals and back into the home.
- the aging of the U.S. population,
- epidemics of chronic diseases,
- technological advances,
- health care consumerism,
- escalating health care costs.
Hospitals will not want this to happen, and many physician clinics will oppose in-home care. There will probably be some starts and stops, but once this gets traction, some medical practices and hospitals may well find that their doors must close permanently.
Almost all the abstract was available, but it has now been severely limited on NEMJ.
28 October 2010
We Need More Meaningful Studies and Research
Several bloggers are exposing the problems in our medical society. We have already defined our problems with the A1c test and its weaknesses. It is not surprising that other areas are constantly being exposed by bloggers and people in the medical community.
Jenny at Diabetes Update has three good blogs about the failings of our studies, the A1c tests and now the failings of doctors and why. She has an excellent blog about what to look for to determine that you are reading bad information. Then she also does an excellent blog on the failing of the A1c. My version is here.
Jenny then explains why doctors are failing us and what to do in some circumstances. While some of them do need understanding, most doctors that are making mistakes are often doing them out of ignorance because they have not kept up with the latest information or a using faulty studies that should never seen the light of day.
Dr. Rob at medrants dot com did us all a favor when he alerted us to Dr. John Ioannidis who is calling out his fellow doctors for their “lies, damned lies, and medical science” He has spent his career chastising their bad science. And he is doing this in the Atlantic magazine. This deserves readership by all and should be on everyone's read list.
In the fourth paragraph down and the last sentence he makes a statement we should all heed - “can any medical-research studies be trusted?” This I think is the summary of the whole article, well founded and well grounded is what he is disclosing. He also suggests that, “the obsession with winning funding has gone a long way toward weakening the reliability of medical research”.
Jenny at Diabetes Update has three good blogs about the failings of our studies, the A1c tests and now the failings of doctors and why. She has an excellent blog about what to look for to determine that you are reading bad information. Then she also does an excellent blog on the failing of the A1c. My version is here.
Jenny then explains why doctors are failing us and what to do in some circumstances. While some of them do need understanding, most doctors that are making mistakes are often doing them out of ignorance because they have not kept up with the latest information or a using faulty studies that should never seen the light of day.
Dr. Rob at medrants dot com did us all a favor when he alerted us to Dr. John Ioannidis who is calling out his fellow doctors for their “lies, damned lies, and medical science” He has spent his career chastising their bad science. And he is doing this in the Atlantic magazine. This deserves readership by all and should be on everyone's read list.
In the fourth paragraph down and the last sentence he makes a statement we should all heed - “can any medical-research studies be trusted?” This I think is the summary of the whole article, well founded and well grounded is what he is disclosing. He also suggests that, “the obsession with winning funding has gone a long way toward weakening the reliability of medical research”.
27 October 2010
Are Doctors Going to Stop Diabetes?
Will we ever have doctors and endocrinologists that will be aggressive in the diagnosis of Type 2 diabetes? Maybe, if a group funded by Novo Nordisk gets the recognition they need. Their research has been published in the Journal of Clinical Endocrinology and Metabolism, but that does not mean the American Medical Association will go along with the findings of their research. The funding is an unrestricted educational grant.
This group has recommended that greater attention be put on screening people at risk for Type 2 diabetes. Then they urge aggressively treating those who have developed the condition to conserve beta cell function. The group was composed of researchers, clinical endocrinologists, and primary-care doctors put together by the Endocrine Society.
The outcome or evidence indicates that beta cell dis-function can be slowed or possibly reversed if addressed early. They have also found out that beta cell failure occurs earlier and more severely than originally thought. That is the reason for the recommendation of early detection and aggressive treatment.
To further promote the early detection and aggressive treatment, they have set up a web site here. This is to promote new educational approaches to aid primary care physicians in interpreting concepts of disease pathogenesis. In reading this web site, it has been very interesting and definitely educational. I sincerely hope our doctors are reading this as well.
This study is also discussed here and here.
This group has recommended that greater attention be put on screening people at risk for Type 2 diabetes. Then they urge aggressively treating those who have developed the condition to conserve beta cell function. The group was composed of researchers, clinical endocrinologists, and primary-care doctors put together by the Endocrine Society.
The outcome or evidence indicates that beta cell dis-function can be slowed or possibly reversed if addressed early. They have also found out that beta cell failure occurs earlier and more severely than originally thought. That is the reason for the recommendation of early detection and aggressive treatment.
To further promote the early detection and aggressive treatment, they have set up a web site here. This is to promote new educational approaches to aid primary care physicians in interpreting concepts of disease pathogenesis. In reading this web site, it has been very interesting and definitely educational. I sincerely hope our doctors are reading this as well.
This study is also discussed here and here.
26 October 2010
More Drug Company Misdeeds
Again I published a blog too soon. This should be no surprise as I am sure we will continue to be bombarded with more information that is being withheld by drug companies. This article comes to us from the British Medical Journal (BMJ) by way of the BBC News.
This time Pfizer is bring taken to task for their withholding relevant information. For once the FDA (Federal Drug Administration) seems to have taken the right path and rejected an ineffective drug.
Again the cry is about some trial results not being published. The experts say in the (BMJ) the pharmaceutical companies should be forced to publish all data. The Germans use Pfizer's drug roboxetine as their problem. The German Institute for Quality and Efficiency in Health Care says the unpublished data could change views about the drug.
The article states that in the US, it is a requirement that all data be published. I have to wonder how so much data and trials got by the FDA in the case of Avandia and Actos.
European ministers have promised to tighten laws requiring drug firms to disclose all data from clinical trials. GSK (GlaxoSmithKline) has been given a pass for Seroxat misinformation, but GSK has been warned.
The UK regulator MHRA (The Medicines and Healthcare products Regulatory Agency) says that the European initiative to provide public access to all clinical trails should be in effect by late 2011 or early 2012.
This time Pfizer is bring taken to task for their withholding relevant information. For once the FDA (Federal Drug Administration) seems to have taken the right path and rejected an ineffective drug.
Again the cry is about some trial results not being published. The experts say in the (BMJ) the pharmaceutical companies should be forced to publish all data. The Germans use Pfizer's drug roboxetine as their problem. The German Institute for Quality and Efficiency in Health Care says the unpublished data could change views about the drug.
The article states that in the US, it is a requirement that all data be published. I have to wonder how so much data and trials got by the FDA in the case of Avandia and Actos.
European ministers have promised to tighten laws requiring drug firms to disclose all data from clinical trials. GSK (GlaxoSmithKline) has been given a pass for Seroxat misinformation, but GSK has been warned.
The UK regulator MHRA (The Medicines and Healthcare products Regulatory Agency) says that the European initiative to provide public access to all clinical trails should be in effect by late 2011 or early 2012.
25 October 2010
Insurance and Legal Denial of Procedures?
Is this happening today? Don't blink or you'll miss it. Our insurance companies to grow their profits are refusing to cover procedures and lifesaving operations that a few years ago were seldom questioned. Who is behind this?
I doubt government will get involved as long as our medical health insurance industry continues on the current path. This doctor reports an unusual situation. I like many of the comments. Why the doctor did not cover some questions just leads to more questions. One overriding question is what should be done for people who chose to ignore sound advice and directions from their doctor. This poses very ethical and moral questions.
Our insurance industry is just following procedures they had started; however, they are starting to gear up for more drastic decisions of who gets treated and who does not. They have been doing this for years by denying procedures and few have questioned them. This blog of mine earlier shows some of the problems are beginning to show. In addition this blogger also points out some of the types of decisions beginning to appear with greater frequency.
Where is this going to end? With larger and larger profits for health insurance companies and higher and higher compensation packages for the health insurance CEO's, it is doubtful this practice will slow any.
Is the government becoming involved? Are the Medicare and Medicaid cuts going to increase the likelihood of this happening? What effect will the government healthcare plan have? I like some of the provisions in the new healthcare law, but I do not believe that it has everyone's best interests are always in mind and overall healthcare is going to suffer.
I doubt government will get involved as long as our medical health insurance industry continues on the current path. This doctor reports an unusual situation. I like many of the comments. Why the doctor did not cover some questions just leads to more questions. One overriding question is what should be done for people who chose to ignore sound advice and directions from their doctor. This poses very ethical and moral questions.
Our insurance industry is just following procedures they had started; however, they are starting to gear up for more drastic decisions of who gets treated and who does not. They have been doing this for years by denying procedures and few have questioned them. This blog of mine earlier shows some of the problems are beginning to show. In addition this blogger also points out some of the types of decisions beginning to appear with greater frequency.
Where is this going to end? With larger and larger profits for health insurance companies and higher and higher compensation packages for the health insurance CEO's, it is doubtful this practice will slow any.
Is the government becoming involved? Are the Medicare and Medicaid cuts going to increase the likelihood of this happening? What effect will the government healthcare plan have? I like some of the provisions in the new healthcare law, but I do not believe that it has everyone's best interests are always in mind and overall healthcare is going to suffer.
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