doctors are human too, humor, primary care

I’m a real doctor, I don’t play one on TV

I was watching TV this past weekend when a commercial for another latest-and-greatest drug came on. Have you ever noticed that on TV a doctor’s office always looks something like this?

Neat and beautiful, with framed diplomas on the wall.  The TV doc is always in a crisp white coat, which matches his (and it usually is a man) distinguished white hair.  He peers out earnestly from behind his desk, comforting his nervous patient who sits before him (sometimes with adoring, anxious spouse).

But in real life…well, not so much.  Of course, no one is ever going to mistake me for a distinguished genteelly graying gentleman.  As a matter of fact, I once had a patient walk out of my office because I “look too young.”  Here’s my desk:

Shoved against a wall, no room for patients to sit in awe before me…I’m clearly doing something wrong.

No diplomas on my wall! Instead, we’re featuring portraits.

Looks just like me, right?

No sedate, distinguished globe and pen holder for me!  Instead we have this:

The true essentials- lots of lip balm, hand cream, dental floss, and silly putty.  I know what’s important to have at hand.

Wanna know where my diploma is?

It’s crammed into a corner in the home office, on the floor next to the dog crate.  That’s actually a step up for it- up until a few weeks ago it was in a closet in the basement.  Maybe one of these days I’ll actually get around to hanging it up.  
But maybe not.  I’m in no rush.  Because it’s not about appearances and outward trappings.  The fancy desk doesn’t mean a thing.  I have to earn the respect and trust of my patients, because they deserve nothing less.
insurance insanity, pharmacies

Highway Robbery

I recently had a patient ask me to change his medication for his insomnia.  He had been using it on an intermittent, as needed basis with no problem, so I was surprised and asked him why he wanted to change.  He responded that he didn’t want to, since it worked fine.  However the price for the medication was going up from $10 a month to $85.   He showed me what his insurance company had sent him:

His company “helpfully” suggested an alternative.  Just to be clear- trazodone is in no way a similar drug to temazepam.  They are not in the same class of medications, and have different efficacies and side effects.

Now, I was surprised that temazepam, a drug that has been generic for quite a while, was so expensive.  So I decided to find out what the retail cost was.  Sure enough, you can get a month’s supply at Costco for $9.33.

What could possibly be the excuse for this?  I understand that a store like Costco might use cheap prescriptions as a loss leader for people to shop there (although anyone can use their pharmacy, you don’t need to be a member).  However, I would like to point out that UnitedHealthcare Insurance Company had a 2012 profit of $5.1 billion.  That’s $5.1 billion.  Just wanted to make sure you got that.

Most of us have noticed that our insurance premiums have gone up quite a bit this year.  That’s why this stings even more- it appears that some insurance companies are actually profiting off of our medication expenses.

As for my patient, I kept him on his temazepam, and told him to fill the prescription at CostCo and to pay cash.

insurance insanity, medications, PBMs, pharmacies, primary care

Even my paperwork has paperwork

Happy New Year!  For me, the new year brings a new onslaught of those lovely prior approval forms– that oh-so-crucial paperwork that insurance companies make me fill out to prove that the medication I prescribe is really, truly indicated (because I like to put people on prescription meds just for kicks, right?) and the absolutely, positively, cheapest thing around.  

For some reason, insurance companies seem to think that sometime between 11:59 PM on December 31 and 12:00 AM on January 1, everyone’s medical problems are instantaneously cured.  They must think that, right?  Otherwise, why else would everyone seem to need new prior approval forms on January 1?  And new referrals to other doctors?  It makes perfect sense.
Here is a new and annoying trend that I’m seeing.  Instead of just making the prior approval form available to me, Caremark now makes me fill out a form to get the correct form.  You read that right.  I now have to do paperwork so I can get more paperwork.
So, I have to fill out this form with all of the drug information and fax it to them so they can send me an even more specific form.  And while they’re playing these games, on the other end there is a real live human being waiting for their medication.
By the way, the drug that I’m ordering?  Costs $15.99 cash.  
And we wonder why the cost of American health care is so expensive.  
couch to 5K, running, running injuries

App Review- Couch to 5K

As you may or may not remember, I managed to injure myself in August.  It has been a long, slow, annoying recovery.  It’s also be frustrating to realize that my body just does not heal at age almost-40 the way it used to.

At any rate, I’ve slowly started running again.  A lot of my patients have used couch-to-5K apps, so I figured that this would be a good chance to try one out.

I chose the Get Running App.  Really, there was no particular reason that I chose it, other than that it had good reviews.  There are a bunch of 5K apps out there, and I’ll probably try out a few others and compare them later.  The cost of the app was $2.99.

The first few runs start out very easy, just running for 1 minute intervals with 1 1/2 minute walking breaks.  The display is easy to read- yellow is the running, blue is walking, and the green arrow moves around the circle to show you where you are in your workout.  There is a nice, calm British voice gently prompting when it is time to walk or run.

As the weeks go on, there is more running and less walking.

Eventually, you’re running straight through.

I also found the settings to be useful.  I like to listed to audiobooks while I run, and it can get annoying to have a voice prompt frequently overriding a book.  I like the way this app pauses the audiobook while there is a voice prompt.  Alternatively, you can sync your music playlist to play while you run.

Overall, I found the app to be user-friendly.  The workouts were very realistic and could easily be utilized by beginners. 
So, I’m happy to be back on the road again!  See you out there!
food allergies, little house on the prairie, nutrition, pseudoscience

Romanticizing the past

This blog post seems to be making its way around Facebook.  I hesitated to provide a link to it, as I really don’t want to drive any more traffic to her page, but then I figured that hey, my readership is small enough that there’s no way it’ll make a difference!  Plus, I should give credit where credit’s due.

The title of the blog piece is, “Why your grandparents don’t have food allergies…but you do.”  She makes seven assertions to support her…hypothesis (I use that term lightly).  She provides no scientific supporting data for her assertions.  Here are her reasons, and my refuting of each point:

1) They ate seasonal real food.

Food came from farms and small markets in the early 1900′s, and because food preservatives were not widely used yet, food was fresh. Because of the lack of processed food, their diets were nutrient dense allowing them to get the nutrition they needed from their food.
For babies, breast milk was valued and it was always in season.

Personally, my grandparents grew up on the lower east side of Manhattan. I wouldn’t exactly say that farm-fresh food was the norm.  In fact, malnutrition was rampant in the early 20th century.  (See how I provide links with real research to back up what I say?)  Let’s not forget that eating seasonally in the Northeast means hardly any green veggies from September until June.  Her assertion that food preservatives and food processing were not widely used is so wrong that it’s laughable.  I mean, did she ever read Upton Sinclair’s The Jungle?   She can download it for free, but somehow, I doubt that she’s interested.  Anyway, the problems with food preservatives and processing were so bad that the US Congress passed The Pure Food and Drug Act in 1906, and revised it in 1938.  I urge you to check out the link- it’s really interesting stuff.

Regarding breast milk- sure, it’s always in season.  Except when the mother died in childbirth, as did 6 to 9 out of every 1000 women who gave birth at the beginning of the 20th century.  Similac was invented in 1925, a true life-saver. For comparison’s sake, the maternal mortality rate in 2007 was 12.7 per 100,000 live births.

2) They didn’t diet, and play restrictive games with their body and metabolism. They ate food when food was available.

Our grandparents did not fall victim to fad diets, food marketing, calorie counting, and other detrimental dieting habits that are popular today (in part because the marketing infrastructure didn’t exist yet). Because of this they had a healthy metabolism, and ate according to their body’s needs and cravings.

This one is beyond ridiculous.  Fad diets have been around for ages, as has dieting.  For example, check out these diet ads from the 1920’s:

And, my favorite:
Yup.  A tapeworm diet.  If that’s not a “detrimental dieting habit,” I don’t know what is.  And let’s not forget about amphetamine use for weight loss.  Benzedrine was invented in 1935, and was marketed for weight loss as Dexedrine starting in 1937.

3) They cooked food at home, using traditional preparation methods from scratch.

Buying processed food was not an option, and eating out was a rare luxury. Lucky for our grandparents these habits actually increased their health.

I’m not going to argue the point that most food was cooked at home and that eating out was a luxury. However, as far as making food from scratch:  I give you Wonder Bread.  Invented in 1921.  Why?  Because baking bread from scratch is a big pain in the butt.  It’s time consuming.  And then it gets stale in a day or two.  And in between caring for large families, doing laundry, etc, etc, making food from scratch was something to be avoided, not aspired to.

4) They didn’t eat GMO’s, food additives, stabilizers and thickeners.

Food was not yet treated with additives, antibiotics and hormones to help preserve shelf life and pad the pockets of food producers in the early 1900′s at the expense of the consumer’s health.

Again, I give you Wonder Bread.  And Spam (1937).  And I refer you back to the article I linked about the history of food preservation in the US.

5) They ate the whole animal that included mineral richbone broths and organ meats.

Animal bones were saved or bought to make broths and soups, and organ meats always had a special place at the dinner table. These foods were valued for their medicinal properties, and never went to waste.

Actually, if those organ meats were valued at all, it was because they were cheap and better cuts were too expensive. Meat consumption in the US has increased by 100% since 1920.  As a matter of fact, meat consumption stayed low and steady up until about the 1960s, when intensive cattle farming methods reduced the price.  I think this is another case of assigning a moral value to a choice that was made out of economic necessity.

6) They didn’t go to the doctor when they felt sick or take prescription medications. Doctor visits were saved for accidental injuries and life threatening illness.

When they got a fever, they waited it out. When they felt sick, they ate soups, broths and got lots of rest. They did not have their doctor or nurse on speed dial, and trusted the body’s natural healing process a whole lot more than we do today. Their food was medicine, whether they realized it or not.

Thunk. Oh, sorry. That was my head hitting my desk.  Anyway.  Lots of people would have liked to go to the doctor when they were sick in the olden days.  They didn’t go for the same reason they don’t go today- it’s too expensive.  Or the doctor was unavailable, due to geography or other reasons.  And let’s face it- when our grandparents were young it was the pre-antibiotic and pre-vaccine era.  A lot of the time there just wasn’t anything the doctor could do.

You know, one of my paternal grandfather’s most cherished possessions was a photograph of his sister Rose, taken when she was about 13 or so.  Why was this picture so important?  This is why:

It’s a bit hard to see in this picture, but this is Rose’s death certificate.  She died in 1925, when my grandfather was seven.  As you can see, she was 16 at the time of her death.  Occupation is listed as “schoolgirl” and her cause of death was tuberculosis of the lung.  Ironically, my mother also had a great-aunt named Rose.  She died as a young child in the 1918 flu epidemic.  
So, let’s stop romanticizing days of yore when people didn’t go to the doctor, ok?  Because thanks to medical advances, we no longer have 16 year old schoolgirls dying of TB.

7) They spent lots of time outside.

Our grandparents didn’t have the choice to stay inside and play on their phones, computers and gaming systems. They played on the original play-station:  bikes, swing-sets and good ol’ mother nature!
True. And?  Your point is?  

She does an excellent job of romanticizing the past, but as I’ve shown, it wasn’t all sunshine and farms and fresh food and frolicking in nature.  Seriously, it’s like she read the first of the Little House on the Prairie books (Little House in the Big Woods), and stopped there.  She should have finished the series.  Spoiler alert: the whole family almost dies of malaria in book 2, Little House on the Prairie.  Mary goes blind after contracting scarlet fever in By the Shores of Silver Lake.  The whole family almost starves to death in The Long Winter.  And in The First Four Years, Laura’s infant son dies.  Then Almanzo has a stroke after contracting diphtheria.

Oh, for those golden days of the past!  If only we could go back to them, right?

Even is all of her assertions were true, which they clearly are not, what does that have to do with allergies?  She says:

Ifyour nutrition is inadequate, the integrity of each cell, tissue and organ in your body will suffer, thus you may be MORE sensitive to certain foods.”

What? Why?  That has no basis in reality.  It’s just something science-y sounding that she threw in there.  Allergies do seem to be increasing in prevalence.  Maybe.  The research isn’t done yet.  And even if they are more common, no one knows why.  Certainly not this blogger, who is just trying to sell her services as a “nutritional therapist, “ whatever that is.  Rest assured, it’s not an actual degree or anything.

There is also no reason at all to think that food allergies did not exist in our grandparents’ time.  The key is this…our actual grandparents might not have had food allergies by the simple virtue of the fact that they lived to procreate.  Anaphylactic allergic reactions are deadly, and in our grandparents’ time there was not going to be much anyone could do to save someone once they were in full-blown anaphylaxis.

So, people did have food allergies then.  They just were much more likely to die young from them.

And dead men tell no tales.