My hectic schedule precludes me from writing around here these days. After my county hospital ER experience, I'll be back! I'm taking notes (on regular paper!) about entries for later.
Showing posts with label drugs. Show all posts
Showing posts with label drugs. Show all posts
Thursday, July 24, 2008
Drug Seekers
We see a lot of folks looking for pain meds in the ER. I collected some thoughts in a piece at The Differential that you may be interested in reading.
My hectic schedule precludes me from writing around here these days. After my county hospital ER experience, I'll be back! I'm taking notes (on regular paper!) about entries for later.
My hectic schedule precludes me from writing around here these days. After my county hospital ER experience, I'll be back! I'm taking notes (on regular paper!) about entries for later.
Sunday, February 24, 2008
Drug Reps 'R Us
Now five months in to my third year medicine clerkship, I'm pleasantly surprised about how little interaction with pharmaceutical company representatives I've had. As I get deeper into it, I am realizing just how tenuous the dynamic between pharmaceutical innovation and controlling costs in health care.
I am pleased to report that I still feel uncomfortable in the setting of drug company schwag or it's provider. Sometimes I feel the same squeamishness I've felt witnessing (illegal) drug transfers. Is it a coincidence? In doctors' offices: Who's the pusher? Who's the dealer? And what does that make the patients? Are they stuck in a crossfire?
Here are a few personal vignettes about my encounters with (legal) drug dealers.
Before my clerkships, I often attended the University of Washington's Chairman's Rounds each Tuesday. That food was provided by a rotating ensemble of drug company reps. They asked for attendees to sign in, and would actively seek eye contact of the audience as we filed in. If I were dressed less formally (PhD casual), I would occasionally be interrogated about which department I was with. (My answer was always pathology.) Most times, I clipped on my medical school ID badge kept my eyes focused on the food or floor and walked past them without noting the company or drug. After all, I was there to keep up my clinical mind. I did take the food, however. Some other students and residents (but never faculty) brought or bought their own lunches...
My first rotation at Seattle's Children's Hospital was pharm-free. The free food at the daily noon conference was provided by the residency program rather than drug companies. Monday's World Wraps and Wednesday's fish burritos were my favorites. Then as an outpatient in the pediatrics clinic, I discovered that the patientmedicine samples were provided by Children's Hospital, not by drug reps. In fact, some of the residents placed the absence of "pharm food" as a positive attribute for that program.
The next stop on my magical medical mystery tour was a family practice office in Anacortes, WA. They had kicked the drug reps out years before in favor of samples provided by Group Health. The idea being that enough of the practice's patients are insured by Group Health that it will pay off to get docs in the practice of handing out and prescribing the generic meds on GH's formulary that it will benefit the insurer even if the docs give the samples to non-Group Health patients.
For the last 7 weeks, I've been in Spokane, WA for my medicine clerkship. The only evidence of pharmaceuticals at the hospital where I worked were in the ubiquitous pens and post-it notes on the floor. Not until my outpatient experience have I had direct contact with drug reps. In the endocrinology (diabetes, thyroid and hormone problems) and dermatology (rashes and acne) clinics, I've encountered piles of free handouts, cabinets full of samples, company provided patient handouts, occasional lunches and the well-dressed woman with a clipboard. "Who is this attractive lurking specter?" I wondered the first time in the endocrine clinic? She was just waiting patiently for the doc to sign a clipboard acknowledging receipt of the samples. She got in one sentence before my preceptor informed her that she had more patients to see.
I am being gradually exposed to the tight grip of pharmaceutical companies on medical practice. Fortunately, I am also experiencing some of the push-back that entities as different as private practice and world-class health care institutions are giving. Whether its the cold shoulder given by docs as they sign the receipt or the broad resistance of entire hospitals, there is certainly a tension that was not there 10 years ago. The consequences of doctors giving free samples of brand-name drugs is not always obvious to patients or doctors. But I'd like to think that the next generation of physicians is ready to approach health care in a less expensive, more sustainable manner.
We shall see.
I am pleased to report that I still feel uncomfortable in the setting of drug company schwag or it's provider. Sometimes I feel the same squeamishness I've felt witnessing (illegal) drug transfers. Is it a coincidence? In doctors' offices: Who's the pusher? Who's the dealer? And what does that make the patients? Are they stuck in a crossfire?
Here are a few personal vignettes about my encounters with (legal) drug dealers.
Before my clerkships, I often attended the University of Washington's Chairman's Rounds each Tuesday. That food was provided by a rotating ensemble of drug company reps. They asked for attendees to sign in, and would actively seek eye contact of the audience as we filed in. If I were dressed less formally (PhD casual), I would occasionally be interrogated about which department I was with. (My answer was always pathology.) Most times, I clipped on my medical school ID badge kept my eyes focused on the food or floor and walked past them without noting the company or drug. After all, I was there to keep up my clinical mind. I did take the food, however. Some other students and residents (but never faculty) brought or bought their own lunches...
My first rotation at Seattle's Children's Hospital was pharm-free. The free food at the daily noon conference was provided by the residency program rather than drug companies. Monday's World Wraps and Wednesday's fish burritos were my favorites. Then as an outpatient in the pediatrics clinic, I discovered that the patientmedicine samples were provided by Children's Hospital, not by drug reps. In fact, some of the residents placed the absence of "pharm food" as a positive attribute for that program.
The next stop on my magical medical mystery tour was a family practice office in Anacortes, WA. They had kicked the drug reps out years before in favor of samples provided by Group Health. The idea being that enough of the practice's patients are insured by Group Health that it will pay off to get docs in the practice of handing out and prescribing the generic meds on GH's formulary that it will benefit the insurer even if the docs give the samples to non-Group Health patients.
For the last 7 weeks, I've been in Spokane, WA for my medicine clerkship. The only evidence of pharmaceuticals at the hospital where I worked were in the ubiquitous pens and post-it notes on the floor. Not until my outpatient experience have I had direct contact with drug reps. In the endocrinology (diabetes, thyroid and hormone problems) and dermatology (rashes and acne) clinics, I've encountered piles of free handouts, cabinets full of samples, company provided patient handouts, occasional lunches and the well-dressed woman with a clipboard. "Who is this attractive lurking specter?" I wondered the first time in the endocrine clinic? She was just waiting patiently for the doc to sign a clipboard acknowledging receipt of the samples. She got in one sentence before my preceptor informed her that she had more patients to see.
I am being gradually exposed to the tight grip of pharmaceutical companies on medical practice. Fortunately, I am also experiencing some of the push-back that entities as different as private practice and world-class health care institutions are giving. Whether its the cold shoulder given by docs as they sign the receipt or the broad resistance of entire hospitals, there is certainly a tension that was not there 10 years ago. The consequences of doctors giving free samples of brand-name drugs is not always obvious to patients or doctors. But I'd like to think that the next generation of physicians is ready to approach health care in a less expensive, more sustainable manner.
We shall see.
Wednesday, February 06, 2008
And Speaking of Artificial Hearts...
Those Lipitor (atorvistatin) ads featuring Robert Jarvik make me puke. (Only recently could I fully appreciate the connection with Pfizer's commercials and emesis.) Of all the drug company commercials, this is the most non-sequitur. The basic premise is:
Maybe I am jealous of his success. Maybe I just really despise drug company commercials. Maybe it's because simvastatin (the generic form of Zocor) is way cheaper and has the same effect as Lipitor. Maybe it's because Jarvik looks like Randall from Monsters, Inc.
Okay, maybe not that last one.
It turns out that some other people think the Jarvik Lipitor relationship is fishy. There's a big splash in the NYTimes today about how Jarvik misrepresents his physical activity level in the commercial where he is rowing in a scull across Washington State's Lake Crescent.
Someone did dome pretty good digging on this one.
- I'm a doctor.
- I invented an artificial heart.
- I take Lipitor.
- I feel great.
- You should take Lipitor.
- You'll feel great.
- You'll be a doctor.
- You'll invent an artificial heart.
Maybe I am jealous of his success. Maybe I just really despise drug company commercials. Maybe it's because simvastatin (the generic form of Zocor) is way cheaper and has the same effect as Lipitor. Maybe it's because Jarvik looks like Randall from Monsters, Inc.Okay, maybe not that last one.
It turns out that some other people think the Jarvik Lipitor relationship is fishy. There's a big splash in the NYTimes today about how Jarvik misrepresents his physical activity level in the commercial where he is rowing in a scull across Washington State's Lake Crescent.
Someone did dome pretty good digging on this one.
Monday, September 03, 2007
Breakthrough for Schizophrenia, or Why Angel Dust is Good for Society
This weekend, Nature Medicine published results from a small trial for a new drug for schizophrenia. Since my wife is in her psychiatry clerkship, I've been learning about psychiatric conditions and drugs, so it was nice to encounter this NYTimes article about the report. The entire text in Nature Medicine is available to institutional subscribers. The Times article quotes heavily form the journal's press release, and is more business-oriented.
The bottom line is that schizophrenia afflicts almost 1% of adults worldwide, it first presents in early adulthood, and due to its leading to cognitive impairment and social withdrawal, is overrepresented in homeless and indigent populations. Current drugs are good at reducing schizophrenia symptoms, but side effects like weight gain cause patients to stop taking them.
The excitement over this new type of drug is that it targets an entirely different system in the brain. In stead of blocking dopamine, the new drug blocks glutamate an amino acid that is also a neurotransmitter. You might remember hearing that dopamine is active in the pleasure centers of the brain, but it also is used for balance control, memory and attention. Glutamate is no less important than dopamine, and is important for personality control, learning and memory.
With glutamate's importance, why weren't there the same side effects for this drug? The answer lies in how the drug works. It targets a specific receptor for glutamate, the mGlu2/3 receptor, which accroding to the Nature press release,
The bottom line is that schizophrenia afflicts almost 1% of adults worldwide, it first presents in early adulthood, and due to its leading to cognitive impairment and social withdrawal, is overrepresented in homeless and indigent populations. Current drugs are good at reducing schizophrenia symptoms, but side effects like weight gain cause patients to stop taking them.
The excitement over this new type of drug is that it targets an entirely different system in the brain. In stead of blocking dopamine, the new drug blocks glutamate an amino acid that is also a neurotransmitter. You might remember hearing that dopamine is active in the pleasure centers of the brain, but it also is used for balance control, memory and attention. Glutamate is no less important than dopamine, and is important for personality control, learning and memory.
With glutamate's importance, why weren't there the same side effects for this drug? The answer lies in how the drug works. It targets a specific receptor for glutamate, the mGlu2/3 receptor, which accroding to the Nature press release,
is involved in a feedback loop controlling glutamate release, and therefore only works when the glutamate system is very active — bouts of high activity in this system are suspected to be one of the hallmarks of the disease.Other than this, the scientists don't know exactly how the new drug produces its antipsychotic actions. I expect this is usual with new phych meds. What of the link to angel dust? Evidently, scientists clued into glutamate as a target for schizophrenia because PCP can induce psychotic symptoms in those that are not schizophrenic. PCP was also known to interfere with the glutamate signaling system.
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