Three Little Pigs

On the WSJ's Law Blog there was a very interesting story about three lawyers headed to trial. These attorneys represented 440 plaintiffs who claimed they were injured by the diet drug Fen-Phen. Of the $200 million settlement, it is alleged that they misappropriated $65 million of it. They even placed $20 million in a charitable fund (I guess to ease their guilt) and then paid themselves almost $150,000 each to manage it. Oh yeah, the plaintiffs who were supposed to get 2/3 of the BS suit only got 1/3. The indictment charges state they committed wire fraud, failed to disclose to their clients the total amount settled and on and on. One professor of law ethics stated that it is not "uncommon for lawyers to violate what is known as the aggregate settlement rule". What? If it is not uncommon then why hasn't it been fixed? Where is Congress on this? Oh, that's right, Congress is made up of lawyers.

And the third little lawyer built his house of bricks and manure.....

NOW CHECK OUT WHAT THEY ARE SAYING DURING THE TRIAL!

Placebo Television #12

Placebo Television has been described as "The Daily Show of Medicine". This installment discusses Apidra, Sanofi Aventis, and Dr. Kevorkian. Starring Douglas Farrago MD, editor of the Placebo Journal.

The Same Battle Repeated

When the article As Doctors Get a Life, Strain Shows came out recently in the WSJ, I just knew what the editorials would be. It is the same story about how young doctors are choosing family and their own lives over killing themselves in their careers. Free time and quality-of-life are new terms for doctors and it seems to be influencing the specialty choice of many medical students. This in turns is straining the healthcare system in a different way. For example, instead of doctors being on-call every fourth night they are using a hospitalist system. Personally, after taking call for 10 years I am all for it and made the change myself. But when this piece came out in the paper I knew I would read about old school doctors who would given the same line about, "When I was a young doctor, I took call every other night for 30 years and had to walk uphill to the hospital, both ways, in the snow".

Sure enough, when the reader feedback came out, there was those responses. "They will miss out on the calling of a profession of medicine rather than a job". "Work ethic has been left behind". "They will come and go without much admiration or respect from physicians who value our long tradition".

As a physician in his early 40's, let me just say this to that older generation of doctors who are pissed at how we have dealt with the terms we were given: you are the ones who put us in this position in the first place! You worked in the heyday of healthcare where you were actually paid what you billed and sometimes by the patient directly. Because you gave your power away to the government and managed care, we are stuck in this new system. Try not to judge the new physicians until you realize what they are going through. Since the new healthcare system gives doctors so little power, these new doctors are just choosing to have a life instead of fighting for money which will never come. They really don't want to hear the line, "When I was your age I was older" kind of thing.

Physician Suicide

Yesterday's article in the USA Today has brought some needed attention to the issue of physician suicide but I am not sure they get the point fully. There are "special" reasons why doctors are being pushed to the brink and subsequently take their lives. I had written about this when Dr. Jonathan Drummond-Webb killed himself years ago. We work hard every day as patients come in with monkeys on their backs who want to put those same monkeys on our backs. They leave with a lighter load but by the end of the day we have 25 monkeys on our backs and no where to put them. This doesn't even count the monkeys we have on our own! Add to this a touch of loneliness and you have the recipe of disaster. Only by opening up and sharing with each other will we survive in this very difficult occupation. A little humor couldn't hurt either.

It All Comes Down To Procedures

Check out the article in yesterday's Wall Street Journal about super sub-specialists. Primary care is not the only type of specialty for which their is a shortage. I find it interesting that these docs have even more schooling and yet still get paid less because they don't have a procedure to really bill for. It makes you wonder who really is behind the creation of the fee schedules set forth by the government for which every insurance company abides? Could it have been the proceduralists?

This article also proves that medical students and residents are human and will tend to gravitate to where the money is. Until they make the field of neuro-ophthalmology sexy and exciting or give them one really cool procedure (that generates cash), then it will go the way of the dinosaur....or family doctor.

No Respect For Chronic Lyme Gives Lawyers A Win

There are places for lawyers in the healthcare system. As hard as that is for me to write, it is true. What happened recently in Connecticut, however, is not one of them and it should scare us all.

Before I go on, let me give you some background. Lyme disease is a medical condition. It is treated with less then a month of antibiotics. Chronic Lyme disease is an amalgam of symptoms that is not supported by any evidence. It is eerily similar to its sister “designer diseases” chronic fatigue syndrome and fibromyalgia.

The cult groups behind Chronic Lyme want to validate their beliefs and also want the insurance companies to pay for much longer periods of antibiotics. As much as I hate insurance companies (I think my history speaks for itself), I agree with their denials in these cases. The fact that they would just pass the cost on to other customers should make everyone sit up and take notice.

Now for the rest of the story. Connecticut Attorney General Richard Blumenthal was bullied by these Chronic Lyme groups to open an antitrust investigation against the Infectious Diseases Society of America because he felt the panel excluded some opinions and evidence that may have supported the long term antibiotic treatment theory. Was there any new evidence or study that came out recently to instigate this threat of lawsuit? Of course not. Instead Blumenthal makes the comment that his investigation for the 2006 guidelines included experts who got consulting fees, research grants, and stock ownership from drug companies and other companies that have a stake in the treatment of Chronic Lyme disease.

Does that make any sense to you? Wouldn’t drug companies want to sell more antibiotics? That is how they make their money. If so, then these so-called tainted experts would have pushed for the guidelines to be more favorable for the cult of Chronic Lyme. The fact is they didn’t. If you read the AP article you will see how the giddy gurus of this designer disease are ecstatic that the IDSA is going to take a look at their guidelines again. I think it is a horrible thing for any lawyer to pressure our esteemed medical groups to change their positions by using the threat of lawsuits. It poisons our best thinkers to make “defensive guidelines” not unlike doctors in the field who practice “defensive medicine”.

Double Standard

Go to a drug dinner and your name is reported to the state. Get a cup of coffee from a rep and your name is reported to the state. Get a free medical book from a drug company and your name is reported to the state. Doctors are being targeted more and more because, as you may know, they are unethical and evil. The lawmakers want to crack down on the possibility that we physicians are overprescribing one drug over another due to something we received for free. The notion is not totally unreasonable but it is unlikely and it is too strict. It is also hypocritical as you will soon see when the political conventions start to heat up.

The USA Today is reporting that both parties are basically "selling" access to the sweetest parties at the conventions for a fee. How much? Anywhere from $30,000 to $200,000. That is a lot of drug dinners.

Who can afford these prices? That would be the same lobbying groups that the Democrats swore to go after by ending the "auction house" climate that existed under Republican control. Well, that didn't happen. But they are going after those greedy doctors who want free pens. Good for them.

There Is Still Huge Profits To Made In Tobacco

Good news. The Marlboro Man is back! Sure the original dude died from lung cancer but so what? It doesn't mean he can't be replaced. And that is what the cigarette industry is going to do. Good for them. Unfortunately for the Philip Morris company he can't pander here in America but there seems to be a ton of other places to spread his message of fun, manliness, and death. According to the this MSN article our hero will be circling the globe to China, India and Pakistan and more. Here's to you, Marlboro Man. No one product epitomizes a WMD like yours.

Another Blog With Humor

Here is some good old fashioned medical humor using the PC and Mac dude from those TV commercials. Very funny.

http://docsurg.blogspot.com/2008/04/pc-and-mac-guy.html

Placebo Journal Blog Going More Active!

In an attempt to understand the blogging world, I recently went to the AMA's Medical Communications Conference and focused my attention to the lectures in that area. It seems that blogging isn't going away. As much as I dreaded the fact of keeping this up there now seems no way around it. My first thought was "Aw..son of a B#tch!" But now I am getting used to the idea.

I have tried to beef up this site as best as I can. You can see a slide show now on the left displaying all our covers of past issues through the use of Photobucket. You can also hear our theme song Disruptive Physician and see our animated series entitled 2108: A Medical Odyssey. Don't forget to check out my favorite links of great medical blogging sites.

More to come....

Humorous But Realistic Places To Put A Medical Clinic

As described in my last post, medical clinics are popping up everywhere. The last story described how airports are trying to get in on the action. Some readers of this Placebo Journal Blog have added some other great places that you may find medical clinics in the future:

• How about roving walk-in clinics designed to follow popular bands? Imagine the business if the Grateful Dead had been attended by a bus of NP's or PA's! All you need is some benzo's for hallucinations, IV fluids for vomiting drunks and a bunch of naloxone. Of course, you'd get paid in weed, crack, meth and Lortab, but barter systems are coming back, right? - Edwin Leap
• I would also suggest walk-in clinics in casino's. Heck, they're throwing money away like there's no tomorrow anyway, and casinos are full of folks needing hip x-rays, beta-agonist treatments for emphysema, steroids for slot machine bursitis and nitroglycerin for when they 'hit the big one' and get crushing chest pain. - E.L.
• Mini Clinic at Vet Clinic
• Fast Food Restaurants....Ronald McDonald with a stethoscope, just picture it
• International House of Pancakes and and Prescription Center

Where Else Can We Put Them?

A recent story looks at the proliferation of walk-in health clinics at airports. It seems to be all the rage now. Again, like retail clinics, they are manned by mid-levels and just focus on a narrow range of services. Part of me totally understands this venture. Long wait times and delays make the potential customer base endless. Also, you can’t forget that once you are stuck in the airport you have given in to the fact that you are almost in another universe and the price for things are ridiculous. It always amazes me when I buy a bottle of water for $2.50 or have a crappy slice of pizza for $7 and never bat an eye over the price. It’s like Disney World but much less fun. I can just see airport clinics charging a lot more money in the future once this catches on.

It makes me wonder where else we would start seeing these “clinics” pop up? How about the men’s room at strip clubs? You can have plenty of STD business there. Or what about at car washes?. Don’t forget churches? Right after confession one can slip to the next room and get a colonoscopy to wash away some more sins. Any other ideas? Send them my way and I will rank the top 10 and give you credit as well.

Happy Doctors' Day!

I hope you get a chance to celebrate the fact that what you do matters.

If you are not a doctor, don't hesitate to tell a physician that you appreciate him or her.

If you are a doctor, take a second for some introspection. We directly help people everyday. We can brag about this to our friends, our family and our community. That is what this day is for. Don't let your organization forget you but if they do then do not forget yourselves.


THANK YOU!

Sincerely,
Douglas Farrago MD
KOM