Contributing Member of the Healthcare Councils

All News Analyses by this Author

in diabetes treatment, the process may be just as important as the endpoint

July 25, 2009

Analysis of:Older and cheaper pills just fine for diabetes | www.reuters.com

Given that obesity is one of the prime causes of type II diabetes, and that an important part of the patient's treatment should be directed to weight loss which improves insulin resistance, I feel that prescribing drugs that you know will cause the patient to fail at weight loss is counterproductive.

A GREAT STEP FORWARD IN RX OF C.DIFFICILE

July 25, 2009

Analysis of:Rapid DNA Test to Detect Clostridium difficile Infection Approved by FDA Today | www.medscape.com

A new test was approved by the FDA for the B toxin of C. difficile which caused severe diarrhea and dehydration. The test is 93% sensitive and 94% specific and only takes 45 minutes to complete versus the gold standard culture which takes 3 days.

Mass. Proposed Payment System Strikes Fatal Blow Against Private Practice

July 19, 2009

Analysis of:Mass. Panel Backs Radical Shift in Health Payment | www.nytimes.com

The proposed bundling of payments for specific disease entities among all healthcare providers--hospitals, nursing homes, physicians, pharmacies--into one lump sum payment will make it impossible for individual physicians or small physician groups(the vast majority of medical practices) to get their fair share of the pie without joining a much larger comprehensive health system.

New Rapid Test for C. Difficile

July 19, 2009

Analysis of:Rapid DNA Test to Detect Clostridium difficile Infection Approved by FDA Today | www.medscape.com

C. difficile disease has been spreading throughout hospitals during the last decade. It causes serious diarrhea, dehydration and requires isolation of patients to prevent its spread. Part of the problem is the fact that up until now it took 3 days to make a definitive diagnosis. This new test has both rapid turn around time(45 minutes) and excellent sensitivity(93%) and specificity(94%). It should help to limit the proliferation of Clostridia difficile in the hospital setting.

New Medicare Proposals promote Promote the BiG Business of Medicine

May 4, 2009

Analysis of:Medicare System Overhaul Proposed by Two Senators | www.nytimes.com

Although these proposals are well intentioned, I do not think that the Senators fully realize the consequences of some of these actions. If payments for certain diagnoses for in patient and out-patient care will be bundled and paid to hospitals, then it will lead to each hospital creating a Mayo Clinic type model in which in-patient and outpatient services will be totally integrated within one organizational structure. The current private practice model will cease to exist.

probiotics cure many ills

April 20, 2009

Analysis of:Probiotics for the treatment or prevention of atopic dermatitis: a review of the evidence from randomized controlled trials. | www.ncbi.nlm.nih.gov

Natural treatments that can be effective are more acceptable to patients and have less side effects.

No weight gain or even weight loss with new diabetes drugs

March 26, 2009

Analysis of:Are Costly Diabetes Pills Doing Any Good? | www.pharmalot.com

Type II diabetes is primarily a disease of insulin resistance and obesity. Treatment is focused on changing the diet to one with a low glycemic load and increasing exercise to encourage weight loss.Older therapies such as sulfonylureas, glitazones and insulin cause weight gain--which frustrates the doctor and the patient. The newer therapies, Byetta and Januvia are weight neutral or even promote weight loss. They do not conflict with the patient achieving a  goal of weight loss of at least 10% of body weight. Because physicians have been trained to use smaller doses of multiple drugs in the treatment of hypertension to minimize medication side effects, it is logical for them to apply the same principal to the treatment of diabetes. Also the availability of combination drugs makes it easier to do this with a fewer number of actual pills.

Doctors don't profit from EHRs

June 23, 2008

Analysis of:Most Doctors Aren’t Using Electronic Health Records | www.nytimes.com

Third party payers benefit the most from EHRs because it makes charts easier to audit   The cost of implementing an EHR is excessive for a small practice of 2-5 physicians.

a step toward an easily accessible health record

October 7, 2007

Analysis of:Microsoft launches Web site to hold medical records | uk.reuters.com

Medical practice is behind financial serivces in terms of computerization of records. There is no one medical record system(like Microsoft Word) that is used by many practioners.  Inaccessiblity of old medical records leads to increased cost of care because of unnecessary repetition of medical testing.  A medical record that is easily accessible on the internet by the patient and medical practioners may help to lower the cost of medical care.

No proof that new combination pill for high triglycerides and cholesterol improves outcomes

September 7, 2007

Analysis of:AstraZeneca and Abbott Announce Selection of Next-Generation Fenofibrate (ABT-335) and Crestor Fixed-Dose Combination | pharmalive.com

Although the pill would be effective in lowering cholesterol and triglycerides, there is no outcome data yet to show benefit comparable to Lipitor in lowering cardiovascular events. There is a report of an observational study with simvastatin, another lipid lowering drug, which shows 30% REDUCTION in cardiovascular benefits for those patients switched from Lipitor!  With the emphasis on evidenced based medicine, one must pay attention to outcome data.

SMALL STEP FORWARD IN ALZHEIMER'S TREATMENT

August 31, 2007

Analysis of:New Data Highlights Long Term Tolerability and Sustained Benefits of the Exelon Patch in the Treatment of Alzheimer’s Disease | pharmalive.com

Exelon is an excellent drug for the stablization of cognitive decline in Alzheimer's disease.  It's use has been limited by its GI side effects. It has a unique mechanism of actioncompared to other drugs on the market. The availabilty of a transdermal deliviery system will permit much broader use of the drug.

in diabetes treatment, a drug's mechanism of action may be just as important as the endpoint

July 25, 2007

Analysis of:Older and cheaper pills just fine for diabetes | www.reuters.com

Given that obesity is one of the prime causes of type II diabetes, and that an important part of the patient's treatment should be directed to weight loss which improves insulin resistance, I feel that prescribing drugs that you know will cause the patient to fail at losing weight are counterproductive.  Drugs which enhance or restore normal physioloigic processes, such as first phase insulin response, are more appealing to me as a clinician than drugs which squeeze the pancreas to produce more insulin.,e.g. sulfonylureas.  I'm afraid that managed care companies will misuse these results to deny payment for newer drugs which have less side effects and lead to an enhanced quality of life.

Lower prices in the future for non-sedating anti-histamines

May 21, 2007

Analysis of:Ranbaxy Receives Tentative FDA Approval For Fexofenadine Hydrochloride Tablets | www.medicalnewstoday.com

This is the second generic version of Fenofexadine(Allegra).  Its presence on the market should result in lower prices for this generic drug. It puts even greater pressure on Zyrtec and Clarinex to maintain market share.

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