1.
Featured Article:
Treating Skin Cancer with a "Band-Aid"
2.
In the News:
Customer Health Care, By GRACE-MARIE TURNER
3.
International
Medicine: Controversial Former U.S. Health
Executive to the NHS
4.
Medicare: Women
with Breast Cancer Have a Fighting Chance
5.
Medical Gluttony:
Billions Spent on Medical Research, but Few Payoffs
6.
Medical Myths:
Taking the Myth out of Medications and Procedures
7.
Overheard in the
Medical Staff Lounge: Expecting Doctors to Be Cops
8.
Voices of Medicine:
Cannabis-Based
Medicine: Why is it Such a Conundrum
9.
The Physician
Patient Bookshelf: DOCTORING - The Nature of Primary Care Medicine
10.
Hippocrates &
His Kin: Congress and Hate Crime Laws
11.
Related
Organizations: Restoring Accountability in Medical Practice and Society
MOVIE EXPLAINING
SOCIALIZED MEDICINE TO COUNTER MICHAEL MOORE
Logan Clements,
a pro-liberty filmmaker in Los Angeles, seeks funding for a movie exposing the
truth about socialized medicine. Clements' strategy is to release the
documentary this summer on the same day that Michael Moore's pro-socialized
medicine movie "Sicko" is released. This movie can only be made
in time if Clements finds 200 doctors willing to make a tax-deductible donation
of $5K each. Clements is also seeking American doctors willing to perform
operations for Canadians on wait lists. Clements is the former publisher
of "American Venture" magazine who made news in 2005 for a property
rights project against eminent domain called the "Lost Liberty
Hotel."
* * * * *
1.
Featured Article:
Treating Skin Cancer with a Band-Aid
Making Skin Cancer Therapy
as Convenient as a Band-Aid, by Mike Kobrin, WIRED, 05.11.07
A new
light-activated therapy could make skin cancer treatment painless, inexpensive
and portable.
Scottish
company Lumicure has developed a portable device that combines a tiny light, a
photosensitizing cream and a bandage that, if approved by the Food and Drug
Administration, could treat skin cancer conveniently with molecular precision.
"It can
be worn by the patient in a (Band-Aid), while the battery is carried like an
iPod," said professor Ifor Samuel of the Organic
Semiconductor Centre at Scotland's University of St. Andrews, who helped
develop the technology, in a statement.
Skin cancer,
which typically requires painful or invasive treatments, affects 40 percent of
all Americans at some point during their lives. The Lumicure treatment would
cost between $200 and $300, compared with roughly $15,000 to $20,000 for the
standard therapy. It could also eliminate the need for chemotherapy in some
cases. To read more, please go to www.medicaltuesday.net/index.asp.
Lumicure's
treatment is a new twist on an existing treatment called photodynamic therapy. It starts with a
cream containing aminolevulinic acid, which becomes
photosensitive when it comes in contact with a cancer lesion. When exposed to
light, the cream interacts with only the cancerous cells, making it a very
selective skin treatment. . .
Photodynamic
therapy available today requires treatment at a hospital using heavy equipment.
It's also uncomfortable for patients because they must stay very still under
extremely intense light; the treatment also can leave painful skin lesions. The
new treatment takes longer than the standard therapy, but there's almost no
discomfort and no scarring.
"As traditional
photodynamic therapy is delivered in a physician's office, this new technology,
if proven effective in clinical trials, may offer the possibility of increased
access and ease of use for many patients," said Dr. Isaac Neuhaus, assistant professor at
University of California at San Francisco Dermatologic Surgery and Laser
Center. . . To read the entire article, go to www.wired.com/medtech/health/news/2007/05/cancer_led_therapy.
[To keep the price of the procedure at an office rate
of $200 rather than the current hospital cost of $20,000, it is important that
it remain a doctor's office procedure where every practice competes with every
other practice. This drives costs downward, which has kept cosmetic and Lasik
surgery costs down.
When doctors devised laparoscopic gallbladder
operation as a one-day hospitalization, they thought the cost should come down
from the $8500 five-day hospital charge to perhaps half that. However,
hospitals were able to charge $15,000 for this one-day procedure because it
required a sophisticate hospital surgery suite since doctors couldn't do this
in their offices or their surgi-center suites.
If hospitals control this new skin cancer treatment,
they would have no problem in increasing the charge from the current $20,000
rate to $40,000 just like they did for laparoscopic surgery. Hospitals don't
see a problem in charging $40,000 for this unique "band aid", even if
it's done in their outpatient suite where their charges know no limits and the
insurance carriers pay them more than the doctors doing the same procedure in
their own office.
As many experts at the World Health Care Congress
stated last month, doctors have to come out of their trenches and again be
involved in the health care agenda and reform.]
* * * * *
2.
In the News:
Customer Health Care, By GRACE-MARIE
TURNER, WSJ, May 14, 2007
It's Friday evening and you suspect that your child
might have strep throat or a worsening ear infection. Do you bundle him up and
wait half the night in an emergency room? Or do you suffer through the weekend
and hope that you can get an appointment with your pediatrician on Monday --
taking time off your job to drive across town for another wait in the doctor's
office?
Every parent has faced this dilemma. But now there are
new options, courtesy of the competitive marketplace. You might instead be able
to take a quick trip on Friday night to a RediClinic in the nearby Wal-Mart or
a MinuteClinic at CVS, where you will be seen by a nurse practitioner within 15
minutes, most likely getting a prescription that you can have filled right
there. Cost of the visit? Generally between $40 and $60.
These new retail health clinics are opening in big box
stores and local pharmacies around the country to treat common maladies at
prices lower than a typical doctor's visit and much lower than the emergency
room. No appointment necessary. Open daytime, evenings and weekends. Most take
insurance. . .
To read more,
please go to www.medicaltuesday.net/news.asp.
Thousands of free-standing primary care clinics have
been operating for years in malls and main streets around the country, often
staffed by physicians and many offering a broad range of health services. The
retail health clinics are creating a new model with more limited services at
lower prices and almost always staffed by nurses. The Convenient Care
Association estimates there are about 325 of these retail clinics operating
nationwide today. Seventy-six of them are in Wal-Marts in 12 states, but the
company announced last month it will expand to 400 clinics by the end of the
decade and 2,000 in five to seven years. They will be run by outside firms,
including for-profit ventures like RediClinic as well as local and regional
health plans and hospitals.
The industry is rapidly expanding. You can find a
MinuteClinic in the CVS on the Strip in Las Vegas. But you also will find many
locally-run clinics in pharmacies and food stores across America, such as the
Express Clinic in Miami, MediMin in Phoenix, and Curaquick in Sioux City, whose
motto is "Get well soon."
Prices vary for services from flu shots ($15-$30), to
care for allergies, poison ivy and pink eye ($50-$60), and tests for
cholesterol, diabetes and pregnancy (less than $50). Competition already is
starting to drive prices down.
Of all patients who have visited the clinics, almost
half went there for a vaccination, and one-third received treatment for ear
infections, colds, strep throat, skin rashes or sinus infections. Ninety
percent said they were satisfied with the care they received. The nurses
staffing the clinics are under physician supervision and follow strict
protocols to refer patients to physicians or emergency rooms if problems are more
serious. . .
Rick Kellerman, president of the American Academy of
Family Physicians, concedes, "The retail clinics are sending physicians a
message that our current model of care is not always easy to access." The
threat of competition from the in-store clinics means some doctors are keeping
their practices open later and on Saturdays and holding an hour open for
same-day appointments. Competition works.
And competition also worked to force prescription drug
prices down: When Wal-Mart announced last year that it was dropping the price
of several hundred generic medicines to $4 for a month's supply, other
pharmacies, from Target to corner drug stores, followed suit. Wal-Mart now says
that a third of all prescriptions filled at its pharmacies are for the $4
generics, and 30% of them are filled by people without insurance.
Take note, Congress: The market is providing cheaper
medicines, more affordable care -- and it is also helping the uninsured. A
Harris Interactive poll conducted in March for The Wall Street Journal said
that 22% of those visiting the clinics were uninsured. Wal-Mart says that half
of its clinic visitors are uninsured. . .
And the clinics are working to solve another problem
that is vexing Washington -- creation of electronic medical records. Most
retail clinics create computerized patient records, with the goal of making the
records accessible throughout the chain. The records also can be emailed to a
hospital or to the patient's regular doctor -- or sent by fax if necessary. . .
Because health care is largely regulated and licensed
at the state level, some states are more friendly than others at having
non-physicians deliver care. California requires that clinics be a medical
corporation owned by a physician. In Arizona, each site must be licensed, but
in most other states, a single license will serve multiple clinics. Illinois is
considering legislation to limit the number of nurses a doctor could supervise
to two and restrict the clinics' right to advertise.
This industry is in its infancy and will hardly
register in our nation's $2 trillion-plus health care bill. But just as Nucor
overturned the steelmaking industry with a faster-better-cheaper way of making
low-end rebar, these limited service clinics could be the disruptive innovator in
our health-care system. Package pricing for more complex treatments, like knee
replacement surgery, may not be far behind.
Government can get in the way, of course, with
protectionist policies that throw up more regulatory barriers to entry. But
retail clinics could be just the beginning of consumer-friendly innovations, if
Congress were to change tax policies in a way that would allow people to have
more control over their health spending, as President Bush has proposed.
The linchpin is giving people the same tax benefits
whether they get their health insurance at work or on their own, or buy
coverage through groups like churches, labor unions and professional or trade
associations. Allowing people to buy health insurance across state lines would
inject another dose of healthy competition into the system.
With many congressional leaders hostile to free-market
solutions, these policy changes are unlikely in the next two years. But as
consumers get a taste of what consumer-friendly health care is like, they may
well demand that the top-down, centralized health-care delivery of the 20th
century give way to a system more in tune with the demands of 21st-century
consumers seeking greater value and efficiency.
Ms. Turner is president of the Galen Institute: www.galen.org/
To read the entire article, go to http://online.wsj.com/article_print/SB117911344481901660.html.
(subscription required)
* * * * *
3. International Medicine: Appointment of Controversial Former U.S. Health Executive
to the NHS
US health boss joins NHS
team By Nicholas Timmins, Public Policy Editor, May 10, 2007
The appointment of a
controversial former US health executive to be the National Health Service's
commercial director was confirmed yesterday by David Nicholson, the chief
executive. . .
In a letter to key staff,
Mr Nicholson announced that Chan Wheeler, a former chief executive of Uniprise,
a division of UnitedHealth, the US health giant, was to be the new commercial
director, helping negotiate contracts with the private sector for the treatment
of patients and the commissioning of their care.
Mr Wheeler earned an
average of almost $1.4m (£701,000) a year in his past three years as chief
executive of Uniprise, and made $8m from the sale of stock options, according
to Security and Exchange Commission filings. To read more,
please go to www.medicaltuesday.net/intlnews.asp.
The SEC is investigating
allegations that a range of executives at UnitedHealth, including Mr Wheeler,
received improperly backdated share options between 1998 and 2002. Mr Wheeler
is "co-operating with all the regulators" and denies any wrongdoing,
according to his US attorney.
Mr Nicholson confirmed
his appointment to a new "NHS leadership team", which will include a
director for commissioning and system management, a medical director and a new
finance and operations director, all separate from the Department of Health
existing posts.
The appointment of a
single "director-general for commissioning and system management", as
opposed to one for commissioning and one for NHS providers, will be seen by
some - ahead of Gordon Brown's arrival as prime minister - as a rolling back of
the Thatcher-Blair "purchaser/provider split" in the NHS. That has
seen hospitals and other organisations become free-standing foundation trusts
and social enterprises, with primary care trusts intended to become chiefly
commissioners of care. . .
Mr Nicholson and the
health department see the appointment of Mr Wheeler as commercial director as
evidence that outsiders see a commercially oriented job worth doing in the NHS.
To read more, go to www.ft.com/cms/s/75425bd8-fe92-11db-bdc7-000b5df10621.html.
The NHS does not give timely
access to healthcare, it only gives access to a waiting list.
* * * * *
Breast-Cancer Breakthroughs, By SCOTT
GOTTLIEB, WSJ, March
26, 2007
. . . More than 260,000 women will be diagnosed with
some form of breast cancer this year. This is always awful news; yet thanks to
earlier detection and clinical research, survival rates have never been higher.
Between 1990 and 2002, deaths from breast cancer
declined 2.3% annually. Today nearly 98% of women with early-stage breast
cancer survive at least five years. Many will live long, full lives.
Making these health gains possible are also new drugs,
many of them launched over the last few decades. Among them are taxanes, a drug
called Herceptin which hones in on a specific receptor expressed by some breast
cancers, and advanced hormone therapies such as the aromatase inhibitors. Other
innovative therapies, including one that cuts off tumor blood supply called
Anti-VEGF and more recently a targeted drug called Tykerb, have been approved.
This progress should continue well into the future.
More than 500 compounds are currently in clinical trials for all cancers, four
times more than in any other disease area. People with colon cancer now also
live much longer, owing partly to a spurt of effective new drugs in recent
years -- among the newest are Anti-VEGF and Erbitux. In 2004, total U.S. cancer
deaths were down by more than 3,000 after years of increases -- evidence of a
turnaround. . .
To read more,
please go to www.medicaltuesday.net/medicare.asp.
Yet these improvements are not being realized around
the world. Europe should be sharing in the progress against cancer, but large
bureaucracies have been erected to contain costs, by slowing the introduction
of new drugs and restricting how doctors can use them.
Unfortunately, some people want to import the European
model here into the U.S. -- and in some cases it has already arrived. One
current bill on "sole-source" or very unique drugs would make
Medicare more like Europe, tying access to decisions on pricing.
Since European drug regulators do not allow new
medicines to reach patients until government negotiators have extracted a
favorable price from sponsors, cancer drugs are often available in the U.S.
months if not years earlier. In 2003, when 31 new drugs were launched
worldwide, about 60% were available here months before Europe. Between 1995 and
2001 the 15 cancer drugs approved in Europe and the U.S. took 468 days to reach
patients in Europe versus 273 days in America. Herceptin was tangled up in a
550-day approval process as the Europeans fought for a lower price, while the
U.S. approved it in fewer than 120 days. . .
There is a price for these policies. A study done in
2003 for Britain's National Health Service found that, long after its approval,
more than 1,000 eligible British women with breast cancer were still not
receiving Herceptin. Five-year survival for breast cancer caught early in
England is 78%, compared to 98% in the U.S. In Germany, a study found that 41%
of German physicians were treating early breast cancer with taxanes, compared
to 60% in America at the time. German breast cancer mortality decreased by 9%
from 1990 to 1998, while mortality in the U.S. dropped more than twice as much.
Overall, between 2004 and 2006 European deaths from breast cancer increased
about 1.5% while the number of deaths from colorectal cancer increased 1.8%.
New research by Columbia University economist Frank Lichtenberg, looking at
cancer statistics in Europe, found use of newer cancer drugs correlates closely
with improvements in survival.
Even in the U.S., public payers are increasingly
resistant to paying for effective new uses of cancer drugs. A large trial of
Herceptin, approved for late-stage breast cancer, showed that it reduced
recurrence in early-stage patients by a robust 50%. But many Medicare patients
in the Northwest could not access the medicine for about five months because
Medicare's local insurer would not pay for it. Increasingly, Medicare wants
more flexibility to limit or deny payment for new uses of cancer drugs -- and
some in Congress want to give it to them. . .
The larger problem is our orientation to how we pay
for health care. Most people believe insurance is there for when they get
sniffles, when it is really there to provide comprehensive care for
catastrophic episodes like cancer. So long as insurers are expected to cover
the full costs of everyone's routine expenses, they will increasingly eye the
high costs of the extraordinary care experienced by the few. When it comes to
expensive drugs to treat cancer, we need to make sure that prices reflect the
real value drugs provide in how they are being used, but the prices should not
be arbitrarily set under government payment programs. . .
Dr. Gottlieb, a physician and resident fellow at the
American Enterprise Institute, has served recently in senior roles at the Food
and Drug Administration and the Center for Medicare and Medicaid Services.
To read the entire article,
(subscription required) go to http://online.wsj.com/article_print/SB117486373440048427.html.
[This is TUESDAY. Before the
above article could be imported, its predictions were already being
incorporated into the U.S. Health Care Bureaucracy. Black Wednesday has
arrived.]
Black Wednesday at the FDA, By MARK THORNTON, WSJ, May 14, 2007
May 9, 2007, should be cited in the annals of cancer
immunotherapy as Black Wednesday. Within an eight-hour period that day, the FDA
succeeded in killing not one but two safe, promising therapies designed and
developed to act by stimulating a patient's immune system against cancer. The
FDA's hubris will affect the lives and possibly the life spans of cancer
patients from nearly every demographic, from elderly men with prostate cancer
to young children with the rarest of bone cancers. . .
In the span of eight hours, the dawn of a new era in
cancer immunotherapy was driven back into the night. It will be years before we
know the full impact of these decisions and how many cancer patients, young and
old, have had their lives cut short as a result. For now, however, one thing is
clear: While our lawmakers obsess over FDA "safety reforms," no one
is holding this government agency accountable for its complicity in stalling
therapies for life-threatening diseases.
To read the entire
editorial, go to http://online.wsj.com/article_print/SB117911315709601659.html.
Dr. Thornton, a former medical officer in the FDA
Office of Oncology Products, volunteers as president of the Sarcoma Foundation
of America.
Government is not the solution to our problems,
government is the problem.
- Ronald Reagan
* * * * *
5.
Medical Gluttony:
Costly Medicines -
Billions Spent on Medical Research, but Few Payoffs.
Costly Medicine: Billions spent on medical research
have yielded few cures. Time to rethink our approach. By Crispin Littlehales, Red Herring, April
30, 3007, www.Redherring.com
Hundreds of billions of dollars and 30
years of biotech research have done little to stop humankind's biggest killers.
Don't get us wrong. There has been some progress with rising life expectancies
(at least in rich countries) and treatments for cancer and HIV patients. But 25
million people worldwide have died of AIDS-related illnesses; the reduction in
U.S. deaths from cancer is minute; and two-thirds of the 30,000 diseases known
to man remain without treatments. What's going wrong? To read more,
please go to www.medicaltuesday.net/gluttony.asp.
Our cover story, "Costly Medicine," available on newsstands, takes
stock of money spent on new therapies in the $643-billion global market for
drugs and where it has gotten us. Year-on-year cancer deaths began to fall in
2003, when 369 few Americans died, according to U.S. government data. In 2004,
there were 3,014 fewer deaths - a welcome
development, but hardly a sea change. In 1990, heart disease was the
fifth-leading cause of co-called "disability-adjusted life-years" worldwide,
and it's projected to rise to No. 1 by 2020. To read more, you'll have to go to
the newsstands.
www.redherring.com/Article.aspx?a=22055&hed=Magazine+Preview%3a+Drug+Bust
* * * * *
6.
Medical Myths:
Taking the Myth oOut
of Medications and Procedures.
Inside Medicine: Is your
doctor giving you this important number? By Dr. Michael Wilkes -
I recently wrote a column about cholesterol-lowering medications.
I stated that if 67 healthy men with elevated cholesterol took a
cholesterol-lowering drug (from a class of drugs called statins) for five
years, only one would benefit. The other 66 would not benefit, and it would
cost about $5,500 over the five-year period.
. . . Most
people commented on the usefulness of that number. They claimed that it was
helpful in deciding whether to take the medicine. Many readers wrote that after
knowing this number, they did not feel taking the drug was worth the effort or
expense. Others took the opposite view: If one person in 67 would benefit, they
wanted to have a shot at being that one. There is no right interpretation; both
interpretations are valid, depending on the person's values.
This number -- the 1 in 67 -- is a term doctors call
"the number needed to treat," or NNT. It is a relatively new concept
-- it can be calculated for most treatments -- and it is grossly underused in
sharing information with the public. To read more,
please go to www.medicaltuesday.net/myths.asp.
The NNT allows doctors and patients to understand the
bang that they'll get for their investment -- in other words, what is the
chance that a treatment such as a pill or surgery will result in the desired
outcome. . .
Many people will derive little or no benefit from
their medicines, but they are never told this. Others are not taking medicine
because they believe their prescribed pills will offer no benefit when in fact
they could derive substantial benefit. The key is for doctors and patients to
understand the NNT and to talk about it. . .
. . . let's
say you came to me with a bladder infection. When I offered you an antibiotic
that when taken for three days would cure one out of two people (NNT is 2), you
might not care as much about the cost of the medicine given the large expected
benefit.
The only way you can make good decisions about what
treatment is best for you is when you're provided useful, understandable
information about the drugs or surgery we are offering you.
Information you might find important includes:
the NNT
an explanation of exactly what we are hoping to
accomplish by the treatment
a ballpark estimate of the cost of treatment
honest explanations of the risks or side effects
Just for comparison, here are some estimates of NNT:
1 in 2,550: The number of breast cancer deaths
prevented in women between the ages of 50 and 59 screened annually for five
years with mammograms.
1 in 2,000: The number of women ages 60-64 without
risk factors who would prevent a hip fracture by taking medicine for
osteoporosis for five years.
1 in 700: The number of people with mild high blood
pressure who would prevent a stroke or heart attack by taking blood pressure
medicine for one year.
1 in 16: The number of infections prevented by
treating a victim of a dog bite with a week of antibiotics.
1 in 7: The number of children (otherwise healthy
children) who benefit from treatment with an antibiotic for an ordinary ear infection.
To read Prof Wilkes entire article, go to www.sacbee.com/107/v-print/story/166505.html.
* * * * *
7.
Overheard in the
Medical Staff Lounge: Expecting Doctors to Be Cops Rather Than Physicians
Dr. Rosen: Have
you noticed the number of people wanting durable medical equipment like
hospital beds, wheelchairs, motorized wheelchairs, when it's hard to justify?
Dr. Milton: Yes,
it seems to be getting worse.
Dr. Rosen: Many
figure if their friend at the senior citizen's residence has one, why shouldn't
he.
Dr. Dave: Once
something's free, greed takes over. To read more,
please go to www.medicaltuesday.net/lounge.asp.
Dr. Rosen: And some
of the expensive items don't have much co-pay. So that makes it even harder.
The patient doesn't have any skin into it and even becomes more demanding.
Dr. Michelle: I had
a patient with severe crippling rheumatoid arthritis several months ago who I thought
really needed a motorized wheelchair in order to get around. I must have spent
the equivalent of several 20-minute appointments on this and still it was
denied.
Dr. Ruth: Maybe
they thought she couldn't navigate it?
Dr. Michelle: She
had enough residual function in her right hand to maneuver the driving knob. So
she really was the ideal disabled patient that could utilize it well.
Dr. Yancy: So
what else is new? In government medicine, those that really need the medical care
or service can't get it, and those that could easily live without it somehow
navigate the system and get it.
Dr. Dave: But
you can't really analyze a bureaucrat's mind or the logic of their thinking.
Frequently it is unrelated to health care. It might be something so simple that
will never be recorded like your patient with rheumatoid arthritis will
probably be dead in two or three years. And the patient with emphysema who is
not disabled will have his wheelchair for a decade or more.
Dr. Yancy: Don't
kid yourself. A bureaucrat is incapable of backward logic like that.
Dr. Milton:
Neither are they capable of forward logic like Michelle and her patient.
Dr. Ruth: So
what's the answer?
Dr. Rosen: I
think Professor Yunus, who won the Nobel Prize for his micro credit, which evolved into
health insurance plans, has the answer. The patient should never receive any
free health care. He should always have to pay a portion of it. When people are
so poor and the daily wage is less than one dollar, and Dr. Yunus thinks that
free health care is bad, he is really onto something important and basic.
Dr. Milton: Why
haven't American insurance companies latched onto this?
Dr. Yancy: They
just want to stick it to doctors. They just love to deny a legitimate request a
doctor makes. They don't care about the patient.
Dr. Michelle: Come,
now Yancy. That's a pretty strong statement.
Dr. Dave: No, I
think that is a valid statement. They are in it to make a profit and the
patient is the source of the profit. Even a dead patient may be profitable if
it cuts their losses that exceed the premium.
Dr. Milton: One
thing that has never been factored in with Durable Medical Equipment (DME) is
the item that is being replaced with insurance dollars. A motorized wheelchair
that replaces a car should have a significant deductible or co-pay on the order
of 40 to 50 percent. Otherwise, the family makes a profit selling the patient's
car. The same can be said for a hospital bed replacing a regular bed.
Dr. Rosen: I
think what we're saying here is that the insurance carriers are holding a sword
over our heads expecting us to control costs - which is at
their non-medical economic direction - when the most
effective cost control mechanism would be the patient at risk - whether 10
percent of hospital costs or 20 percent of ER costs or 30 percent of other
outpatient costs or 40 percent of DME - so that each
patient would make a judgment call on whether the ER visit, office evaluation,
test, x-ray, consultation, motorized wheelchair, or hospitalization is of any
value to him/her. Current consumer-directed health care data suggests this
would be a 30 to 50 percent reduction in health care costs. However, anecdotal
information suggests that insurance carriers are unwilling to give up this
control of physicians even if it costs them the 30 to 50 percent.
* * * * *
8.
Voices of
Medicine: A Review of Local and Regional Medical Journals
Cannabis-Based
Medicine: Why is iit
Such a Conundrum? By Alice P.
Mead, J.D.
Ms. Mead
served as staff counsel to the California Medical Association for 11 years,
focusing on bioethics, including informed consent, confidentiality, end-of-life
care, discrimination, and drug abuse treatment/control issues. Ms. Mead
currently works as a consultant, specializing in regulatory law governing new
drug and device development; patient confidentiality and informed consent; and
domestic and international treaty issues relating to controlled drugs and drug
treatment policy. Her clients include members of the pharmaceutical industry
and other health-related organizations.
Cannabinoids. Many
would call this the "hot new topic" in analgesic research. However,
the results of clinical studies with oral tetrahydrocannabinol (THC) are uneven
and confusing, and the use of crude herbal cannabis is laden with prejudice and
political baggage. Is this, indeed, a promising new area of medication
development?
Why Didn't Cannabinoid Medicines Develop in Parallel
with the Opiates?
Why have cannabinoids only now come to the attention
of the medical and scientific communities? To address that question, we must
first take a quick tour through history. In the mid-1800s, through the writings
of British physicians such as William O'Shaughnessy and U. Russell Reynolds,
Western medicine learned of the therapeutic potential of the cannabis plant.
Initially, individual pharmacists compounded oral tinctures and extracts, but,
as pharmaceutical companies burgeoned, these manufacturers made such products
more broadly available. At a time when therapeutic options were limited,
physicians welcomed another potential tool to alleviate suffering. Earlier in that century, the active
analgesic ingredients in opium - morphine and
codeine - had
been discovered and isolated. Standardized opiates and, later, synthetic
medicines were developed. These medications were water soluble, easy to
formulate and administer, and had a predictable onset of action. Opium was not
smoked for medical purposes; rather it was viewed strictly as an intoxicant.
There was a clear distinction between smoked opium and pharmaceutical opioid
dosage forms. To read more, please go to www.medicaltuesday.net/voicesofmedicine.asp.
What happened to cannabis medicines? Cannabinoids are
sticky, highly lipophilic (not water soluble), and THC in particular is
unstable unless properly stored or treated. Scientists could not identify the
active ingredient(s) of cannabis medicines, and therefore pharmaceutical
companies and pharmacists could not prepare adequately standardized products.
Moreover, patient response was variable and unpredictable. Thus, as more
"modern" medicines came on the market, cannabis tinctures and
extracts began to fall out of favor with the medical profession. At that same
time, smoked (recreational) cannabis entered the U.S. and rapidly became
demonized by state and federal governments. During hearings on the Marijuana
Tax Act of 1937, which imposed onerous administrative burdens on physicians who
prescribed cannabis-based products, the AMA voiced merely a weak objection.
Although
THC, the primary psychoactive cannabinoid, was discovered and synthesized in
1964, follow-up research was not extensive. Not until the 1970s, when smoked
cannabis use increased, were the therapeutic properties of cannabis
inadvertently rediscovered by numerous users. Hence, the use of crude, smoked
cannabis as "medicine" became entwined with the form used for
recreational purposes. However, had technology made it possible to analyze,
research, formulate, and deliver cannabinoids as effectively as the opiates, we
might not have a "medical marijuana" debate today. This vitriolic
controversy is merely an artifact of the delayed development path that
cannabinoid medicines have followed.
Beginning around 1990, science took a huge leap
forward. The endocannabinoid system was discovered, and several endocannabinoid
ligands were identified. With a greater understanding of the mechanism of action,
researchers rushed to explore the potential of this receptor system. A new era
of discovery was born. The resulting body of preclinical studies demonstrates
that cannabinoids have analgesic properties (alongside many other potential
therapeutic effects) and can affect a wide range of bodily processes and
systems. Three categories of cannabinoids have been established: 1)
endocannabinoids, which are produced by the body; they are quickly metabolized
and, consequently - due
to this and the difficulty in patenting endogenous biochemicals - have not yet
been studied in humans; 2) phyto-cannabinoids, which are found exclusively in
the cannabis plant; and 3) synthetic cannabinoids, which may be synthetic
versions of naturally occurring cannabinoids or molecules that are quite novel
in structure. . .
To read the entire article, go to www.csahq.org/pdf/bulletin/issue_15/cannabis_064.pdf.
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9.
Book Review:
DOCTORING - The Nature of Primary Care Medicine by Eric J Cassell, MD
Primary care is being pushed into prominence by
managed care organizations throughout the country with the gatekeeper concept.
Dr Eric Cassell, a Clinical Professor of Public Health at Cornell University
Medical College, begins Doctoring by pointing out how thoughtlessly
rapid the restructuring of American health care has been. He contends that
identifying primary care physicians as first-contact doctors, mere gatekeepers
to the specialties, is a mistake. The obvious organizational advantages should
not and do not make primary care medicine simple. Unless there are changes in
primary care, Dr. Cassell does not feel the primary care system will prove
effective in restraining costs.
Cassell traces the idea of health over 200 years as
being equated with freedom from disease. The world of medicine, from this
perspective, is a world of disease--peopled by those who have an acute disease,
are being prevented from having a disease, are being treated for their disease,
or are being rehabilitated from the effects of their disease. Organizing
medicine according to disease developed at the beginning of the nineteenth
century. The heavy hand of the past still prevails in medical science as it is
taught to students and house officers today. To read more,
please go to www.medicaltuesday.net/bookreviews.asp.
Unlike most other branches of medicine, primary care
medicine is based on the centrality of the patient rather than on an organ
system or a disease. The ideas that underlie current understandings of primary
care medicine have been evolving since the 1920's, gaining force in the 1960's
with the family physician movement, growing rapidly after its official
designation as a specialty in 1970, which decried specialty medicine's
concentration on the disease and sought to refocus on the patient.
No one questions the soundness of these ideas; the
problem is that after a full generation of prominence they simply have not
thrived within a disease-oriented, technology-driven medical establishment. For
two generations we have asked doctors to focus on the patient as a person, yet,
more often than not, we still see the patient's human concerns swept away by
the technological imperative. If primary care is a better medical practice, why
hasn't it won the field?
Cassell feels that physicians have great difficulty
entering the information of the patient as a sick person into the calculus of
their medical judgments so that it has equal weight with information about
disease, pathophysiology, and technology. Cassell feels it is first of all the
educational problem that needs to be solved. There is a deep conflict between
the measurable nature of the disease--the science of medicine--and the
subjective knowing of the patients as individuals. . .
To read the entire review, please go to www.delmeyer.net/bkrev_Doctoring.htm.
To read other reviews, please scan the Physician
Patient Bookshelf at www.delmeyer.net/PhysicianPatientBookshelf.htm.
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10. Hippocrates & His Kin: Congress: Just a Notch
Below -
Congress has recently been busy passing Hate Crime
Laws. www.cato.org/testimony/ct-tl04172007.html
Let's see if we can follow Congressional logic. It is now
a crime to commit murder of someone you hate, but is it no longer a crime to
murder someone you love?
Recently, a government department hired
several cannibals to increase their ethnic diversity, "You are all part of our team now," said the Human Resources rep during the welcoming briefing. "You get all the
usual benefits and you can go to the cafeteria for something to eat, but please
don't eat any employees."
The cannibals promised they would not. Four weeks later their boss remarked,
"You're all working very hard and I'm satisfied with your work. We have noticed a marked increase in
the whole company's performance. However, one of our secretaries has
disappeared. Do any of you know what happened to her?" The cannibals all
shook their heads, "No."
After the boss had left, the leader of the cannibals said to the others, "Which one of you idiots ate the secretary?" A hand rose
hesitantly.
You fool!" the leader continued.
"For four weeks we've been eating managers and no one noticed
anything. But, NOOOooo, you had to go and eat someone who actually
does something."
Anyone know where we can find some to work
at the Centers for Medicare and Medicaid Services?
To read more,
please go to www.medicaltuesday.net/hhk.asp.
Tom Sullivan, a Sacramento Bee Columnist states Americans are great
consumers and shoppers. They astutely assess whether they are getting the right
product for the right price. The Internet has been a godsend. Going online has
made it much easier to compare the prices of cars, cameras and other products.
This process reinforces my belief in the free market system. You and I will not
buy something that is overpriced. And we will load up on a product that is
selling for a discount. When it comes to big ticket items, we do our homework
before we spend our hard-earned money. www.sacbee.com/103/v-print/story/176841.html
So what happened with free
market shopping for a doctor or a hospital? Or is it more fun to send three
dollars to Washington and allow Congress to give us one dollar of health care?
Gilbert Chan reports that Blue Shield wants to drop
costly health coverage in many rural areas. CalPERS is in bind of trying to
provide reasonable rates for all of its members. That could change this winter.
Segura and her 17-year-old son face the prospect of switching doctors and a 25-
to 50-minute commute for routine office visits. . . Segura and some 3,000 other
El Dorado County residents are sitting in the same boat. To their health plan,
these rural residents are tabbed as too expensive to cover, and Blue Shield of
California wants to drop them.
"If they
drop the (Blue Shield plan), we're gone. We would have no local doctors,"
said Ted Schmidt, chief of the Garden Valley Fire Protection District, which
has eight paid firefighters on staff. Right now, he and his crew see doctors at
a local clinic four miles away.
www.tmcnet.com/usubmit/2007/05/13/2610390.htm
It sure is hard to control
Farmers and their Doctors.
Government bureaucrat to his
supervisor: What's the promotional budget for our austerity program?
Can't government workers
think of progress without throwing taxpayer money at it? -After WSJ
To read more Vignettes,
please go to www.healthcarecom.net/hhk1995.htm.
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11. Physicians Restoring Accountability in Medical Practice,
Government and Society: