ppp 03-03-08

Quote of the day: About the only thing that comes to us without effort is old age.

Gloria Pitzer, in Reader's Digest, 1979

Where can you find a room of 50+ year old people outside of a nursing home or corporate boardroom? At an endoscopy center of course. Reaching 50 has its rewards and one particular drawback...the obligatory scoping of the colon. It is one of those tests where the preparation is (usually) worse than the procedure itself. GoLytely and MoviPrep are innocent enough names but truth in advertising should require that they be called GoStrongly and Move Fast or Else.

Coach Paul "Bear" Bryant said "It's not the will to win, but the will to prepare to win that makes the difference." Everyone wants to win on game day. Those that do win practice, practice, practice... rain or shine. My youngest son used to say about soccer, "The more I practice the 'luckier' I get".

I have seen the number 8 as the preparation multiplier in many management books. For every 1 minute spent in preparation you can expect to save 8 minutes in execution. Be it an article to write or a home improvement project, planning does save time, effort and money. A comprehensive national health planning effort may have the same effect... saving time, effort and money as the population ages and the "boomers" in the proctologist's waiting room today hit Medicare age. Some of that "evidence based stuff" will likely come in handy.

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ps. Best answer this week to the question "How are you?" was "Fine, in my own way"

pps. Occasionally, some of the links require FREE registration.... I'm sure you can handle THAT slight inconvenience.

Last week medical device manufacturers received a favorable ruling from the Supreme Court that bars litigation may portend something needed for the pharmaceutical industry. Even one of the most liberal judges on the court has come around. Expect the pivotal case and ruling in 2009. Should put many a group of ambulance chasers out of business.

Erythropoetin stimulating drugs (Epogen, Darbepoetin, etc) use is associated with a 10% increase in mortality in cancer patients. While it certainly sounded like a good idea to stimulate red cell production in patients who had anemia due to cancer treatment “that evidence based stuff” seems to be getting in the way of EPO drug use in this population. FDA is convening a panel in about 2 weeks to offer recommendations. The drugs may be relegated to use in end stage renal disease before too long.

Using the “FREEDOM OF INFORMATION ACT” to garner more “data” from pharmaceutical companies, researchers in London say that drugs such as Prozac are not much better than placebo. This sounds more like a ploy by the government to stop payment for drugs than serious science. Depression can be as devastating as any physical illness. It does sound like the drugs do have an effect but the authors seem to be pushing for “talk therapy” which has been show to take much longer and be more expensive that antidepressants (which are pretty much all generic now).

Panel suggests that CDC adopt guidelines that recommend influenza vaccinations for all children over 6 month old. Sadly, a 12 yr old girl died in Minnesota from influenza this week. Still not too late for this season.

Arcalyst (rilonacept, an Interleukin-1 blocker) was just approved for the long term treatment of two separate syndromes: Familial Cold Auto-Inflammatory Syndrome (FCAS) and Muckle-Wells Syndrome (MWS). Don’t feel bad if you never heard of these…only about 300 people in the USA have them. Very expensive, so few others are likely to ever get the drug.

Tuberculosis was almost eliminated from the US about the time the AIDS epidemic hit. With immunocompromised hosts it has spread like wildfire. These emerging, drug resistant strains may take 2 years and $15,000 in combination therapy to cure… if they can be.

That’s right folks, by 2017 the government (ie you and your kids) will spend 1 out of every 5 dollars on healthcare. I’m sure you will still be paying for your own insurance as well but, what the heck, it’s only money.

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