insurance, medicine, primary care

Because everyone is asking me what I think…

…here it is.

Unless you live under a rock, you know that today the Supreme Court ruled on the constitutionality of the individual mandate of the Affordable Care Act.  They upheld that the federal government does have a right to require citizens to purchase health insurance.

The question everyone has been asking me today is “What do I think of ObamaCare?”

My answer is, “I don’t know.”  Sorry to disappoint you.  That’s my answer.  Not because I’m uninformed on the subject, because I’m not.  Here is the reason why- I am interested in health care reform that will bring quality health care to my patients at an affordable cost.  Will the ACA allow that?  I don’t know.  No one knows.  We won’t know for several years.

Today’s decision only ruled on the individual mandate to purchase insurance.  Overall, I think this decision was the right one.  I’ll trust the SCOTUS on the specifics- they’re the experts on constitutional law.  From a health care provider point of view, I think everyone should have health insurance.  The only way there’s a prayer of that being affordable for everyone is for all people to have to purchase it.  The individual mandate has the ability to potentially lower costs, by spreading out the risk and bringing down premiums.  The ACA, in theory, does provide a way for all Americans to have health insurance, which is a good thing.  Will it work in real life?  Only time will tell.

 I will tell you one thing, in no uncertain terms.  Things have to change.  One way or another, the health care system needs to change.  It is no longer sustainable.  Will the ACA be the way to do it?  We’ll know in about 5 years.  Until then, I’m reserving judgment.

medications, pharmaceutical companies, primary care

How many ways can the same thing be repackaged?

I hate “me-too drugs.”

What is a “me-too drug,”, anyway?  It’s a new drug that is very structurally similar to already existing drugs.  For example: Prilosec, Protonix, Nexium, Aciphex, Prevacid, and Dexilant.  All of these are proton-pump inhibitors and work basically exactly the same way.  One is not superior to the other.  And yet, pharmaceutical companies keep coming out with new ones.  Why?  I can give you 12 billion reasons.  They all have to do with dollars.

Anyway, here is another one that sticks in my craw, and has for a while.

Sleeping pills are big business in the USA.  In 2008, 56 million prescriptions for sleep medications were written.  According to the National Sleep Foundation, Americans pay $14 billion a year for sleep aids.  Ambien (zolpidem) is the most widely prescribed sleep aid.  I’m not really going to discuss the safety issues associated with sleep aids- that’s a post for another day.  This is a different rant.

One of the big selling points of zolpidem is that it, in general, does not leave people with a hung-over feeling the next day.  This is due to its short half-life (the amount of time it takes for half the drug to leave your system).  In a few hours, the drug has all but cleared out of your bloodstream.  Of course, for many people this means that they take the pill around 10 PM, fall asleep, and then are wide awake at 2:30 AM.

Ambien went generic in 2007.  Coincidentally (yeah, right), Sanofi-Aventis released Ambien CR a couple of months before Ambien went off patent.  Ambien CR is the same drug as plain old Ambien.  It’s in a special formulation that supposedly releases more slowly into your stomach, and this supposedly gets around that little problem of waking up after a few hours of sleep.  The data presented by drug reps showed that there were slightly higher levels of the drug in the blood for longer in patients who took the CR versions.  However, higher blood levels doesn’t necessarily correspond to any clinical difference.  I have not been able to find one single head-to-head study of the clinical effectiveness of Ambien vs. Ambien CR.  Not one.  If any reader out there can point me towards one, I’d appreciate it.  Until then, I’ll continue to suspect that Ambien CR is nothing but a patent-extender, designed to keep people on a more expensive version of a now generic drug.  Which is why I never prescribe it.

Now Purdue has joined the party by releasing Intermezzo.  In addition to having a ridiculous name, it’s a ridiculous drug.  It is plain old zolpidem once again, this time repackaged in a teeny-tiny dose (1.75 mg).  It is meant to be taken in the middle of the night- when your Ambien or Ambien CR wears off and you’re up at 2:30 in the morning, take one of these and get back to sleep.  An intermezzo is a musical interlude in between two other pieces, usually in an opera.   And you take this drug in the interlude that you are awake.  Get it???

I have no idea what the price of this wonder drug will be.  However, I can virtually guarantee that it will be far, far more expensive than what people have already been doing for years- taking half of a 5 mg zolpidem in the middle of the night- with exactly the same effect.  Voila!  A perfect example of a me-too drug.

I can guarantee two more things. First- an advertising onslaught.  I’m guessing opera will feature heavily in the ad campaign.  Second- people actually will ask me to prescribe this drug.  Yes, the advertising actually works.  Sad, but true.  I’ll spend lots of time explaining why this new drug is no better than what’s already out there, but some people can’t be persuaded.  And health care costs continue to rise…


50 Shades of Hilarity

What is it about this book?  Seriously, if one more patient tells me about it…

I guess I should feel flattered that my patients feel comfortable enough with me to joke about their more…unusual…reading habits.  And yes, it can lead into a helpful discussion about sexual health, I guess.  Given that so many people have been talking about the book, I decided that maybe I should take the plunge and read it.  Purely for the educational value, you see.

Well, I wasn’t about to walk into Barnes and Noble to buy it.  If I did, I would be virtually guaranteed to run into a patient while purchasing this fine selection of erotica.  In fact, I really didn’t feel like spending money on it at all.  Therefore, the next logical step would be to hit the library.  Again, several of my patients work there, and I didn’t want to get put on the wait list and have to get the phone call from a patient telling me that it was my turn to read Fifty Shades.  I therefore decided to utilize the wonderful NH Overdrive system, which allows you to take out books in E-book form.  This system rocks, by the way.    So, after logging in, I put myself on the wait list.  I was promptly informed that there were 734 people ahead of me.

Eh, no big deal.  I could be patient.

Last week, my number came up!  I quickly downloaded a copy to my Kindle, ready to delve into the mystery of what made this book so special.

And the answer is…nothing.  I’m sad to say, I only got about 3 chapters into it.  The writing was…bad.  Just bad.  The plot line (such as it was) was irritating.  And hey, I’m certainly no literary snob.  I love a good romance novel.  The problem is, I just wasn’t seeing much in the way of romance.  So, I returned the e-book so it could be passed on to number 733.  I hope they like it more than I did.

I do want to share something funny.  I recently saw an elderly woman in the office.  She had shown up about 20 minutes late for her appointment and apologized profusely for running behind.  She explained that she had been reading and had lost track of time.  You’ll never guess what book it was!  Yup.  You got it.  Her description of it was priceless: “I’m not sure what’s going on, but I think that guy is up to no good!”

And there you have it, folks.



I haven’t posted much in the past couple of weeks.  I’ve been busy playing with power tools.

What am I talking about?  I’m talking about my new hobby- woodworking.  It’s something I’ve been wanting to try out for a while.  My last attempt at building something was in 8th grade shop class.  It was a VHS cassette storage rack (God, does that ever date me! Yes, Virginia, there really was a time when there were no DVDs).  It was terrible.  It was so lopsided that I had to glue the whole thing together and hope my shop teacher didn’t notice (I think he did, but I got pity points because I had a broken finger at the time).   At any rate, I figured it was time to give it another try.

The true instigator of this was that mice ate through our backyard lounge chairs over the winter, and we had nothing left to sit upon.  I love Adirondack chairs, but when I started looking online for them, I was a bit taken aback at the price.  I mean, $200 for a chair that’s going to sit outside?  No thanks!  So, I headed over to Woodcraft and picked up some plans for an Adirondack chair.  I then dusted off my Dad’s old table saw, which I believe is older than I am.  I made sure my tetanus shot was up to date.  I  took out my jig saw (also a gift from my Dad), which I believe has been used approximately zero times since we got it.

Well, about 7 hours and multiple trips to Home Depot later…I had this:

And I was pretty darned proud of it, if I do say so myself.

Well, I tend to get a bit…obsessed about things. So, I figured, if one chair is good, four chairs are better!  Eventually, about 2 weeks later, I ended up with this:

Some came out better than others, but overall, I’m pretty pleased with them.  It’s a vast improvement over a VHS cassette holder, at any rate.

Stay tuned for the next project.

Oh, and for anyone out there thinking of taking up this hobby…remember, safety first!  Eye protection, ear protection, and keep all body parts away from moving blades!