In the latest issue of the New England Journal of Medicine, Dr. Sandeep Jauhar opposes the recent trend of admitting older (aka nontraditional) students to medical school. His article, entitled “From All Walks of Life- Nontraditional Medical Students and the Future of Medicine” is a mouthful of jargon from the dusty vaults of the academic elite who want physicians to be nothing more than foot soldiers. Conformance and uniformity, rather than innovation and creativity, is slogan of this group of academics.
Dr. Jauhar wants medical schools to think twice before enrolling older applicants because he believes that “we needmore data before we can call this a viable strategy for thefuture.” He is not just in favor of discriminating against older applicants. He doesn’t think very highly of women either:
… the influx of women into medicine in recent decadeshas been associated with a change in work habits: today, bothmale and female doctors are less likely than their predecessorsto practice medicine to the exclusion of everything else. Arecent survey found that 24% of female physicians under 50 workpart-time. This trend has put pressure on older doctors nearingretirement, many of whom bemoan the lack of suitable candidatesto take over their practices.
So if you’re an older woman trying to go to medical school, make sure your application doesn’t make it to Dr. Jauhar’s desk, whose article is so out of touch with reality that it actually qualifies for an entertaining read.
The antiplatelet agent Plavix (Clopidogrel Bisulfate; BMS/Sanofi Aventis) is the second best selling drug on the market, with sales nearing $8 billion in 2007. Plavix will go generic in 2011 and a much more potent antiplatelet drug called prasugrel (Lilly/Daiichi Sankyo) may soon take its place, or at least that’s what the developers hope to happen. Prasugrel was tested against Plavix recently in a cleverly-designed and somewhat controversial trial called TRITON-TIMI 38. In this trial, prasugrel was shown to be about 3% better than Plavix in preventing the combined primary endpoint of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke in patients with a recent heart attack and scheduled catheterization. Unfortunately prasugrel also increased the risk of major and fatal bleeding in patients, especially the elderly and those with a history of stroke. In TRITON-TIMI 38, for every one major fatal heart attack prevented by prasugrel, one person died from a fatal bleeding event.
Because of the increased efficacy of prasugrel over Plavix, the FDA granted it priority review back in February of this year, promising to announce its decision within six months. The FDA is now delaying its decision and asking for more data and 3 more months to complete its analysis. The bottom line, however, remains that for every one person that we save from a fatal heart attack, one dies from a fatal bleed with prasugrel, giving it a net effect of zero in saving lives and reducing mortality. Now the question becomes if it’s worth spending millions on prasugrel to get such a margin of net real life mortality benefit.
According to the Environmental Protection Agency (EPA), each American is now valued at $6.9 million. This is $1 million less than five year ago and almost 15% less than a decade ago. Seems like we are depreciating faster than our cars. This number refers to the statistical value of each person and the cost of reducing the average number of deaths by one. The number has important regulatory implications. For example, a regulation that costs $18 billion to enforce to prevent 2,500 deaths is not worth the effort anymore since it would cost us $7.2 million to save one life and, as the new number suggests, this is more than the value of a single American life. Five years ago, however, the regulation would have made economic sense since we were each valued at $7.8 million.
“Some people regard private enterprise as a predatory tiger to be shot. Others look on it as a cow they can milk. Not enough people see it as a healthy horse, pulling a sturdy wagon. Socialism is a philosophy of failure, the creed of ignorance, and the gospel of envy, its inherent virtue is the equal sharing of misery.”
An ongoing survey of practicing physicians on Sermo has revealed important data on the implications of the proposed Medicare cuts on patients and medical practices. Over 1100 physicians have so far responded in to the survey. Here are the highlights:
90% of physicians say that the proposed decrease in physician reimbursement on all Medicare cases would negatively impact their ability to accept new Medicare patients.
63% of physicians indicate cuts would require they reserve less time in their schedules for Medicare patients, while 70% would have to consider switching to a cash-only practice.
88% of physicians say financial pressures would impact their ability to care for patients. They also describe the need to increase patient volume and spend less time with patients to offset payment cuts.
20% concluded they would need to lay off office staff who provide services to their patients.
Over 60% of physicians surveyed said they would have to consider changing careers as a result of the increasing financial pressures to provide medical care.
99% of physicians responding to the Sermo physician survey agreed that the general public does not understand the bureaucratic and financial struggles physicians face in providing healthcare in the United States.
85% of physicians believe that these cuts will make it prohibitive for physicians to accept medicare patients and thus affect patient access to physician care, whether that be specialty or primary care.
Respect for individual liberty is the basis of an ethical society and should be the prominent feature of the ideal healthcare system. The main problem with our healthcare system today is that both doctors and patients have lost their freedom of choice. Third party control of healthcare financing with their cartel-like price fixing behavior and tight grip on the allocation of resources is anti-competitive and dictatorial. The freest nation on earth can and should do a lot better.
The game studio Virtual Heroes and the Department of Homeland Security have come together in making a new video game called Zero Hour: America’s Medic, which allows players to respond to terrorist attacks and diagnose and treat patients. Zero hour can be used for training first responders or just for fun.
If your dog gets sick and need a bronchoscopy, you would have to shell out about $2500 for the procedure, according a couple of veterinary price lists that I found online. The same procedure done in a human is reimbursed by Medicare $156.29 to $377.45 (for a CPT code of 31622 in New York City).
Yesterday, the U.S. House of Representatives passed legislation, on a 355 to 59 vote, to postpone a July 1st 10.6% cut in payments to physicians treating Medicare patients. They instead recommended trimming the government’s funding of the wasteful Medicare Advantage programs, a proposition that the White House has threatened to veto.
The Medicare cuts can seriously threaten the viability of many medical practices and may force doctors to stop seeing Medicare patients. The current postponement under the House legislation is only for 18 months and the ball has moved to the Senate’s court. Powerful health insurance companies are aggressively opposing the House’s decision since it recommends reducing the scope of Medicare Advantage programs. Humana has the most to loose since Medicare Advantage accounts for 48% of its revenues. Patients and doctors, on the other hand, have a lot to gain if the government eliminates these programs.
The antiplatelet agent Plavix (Clopidogrel Bisulfate; BMS/Sanofi Aventis) is the second best selling drug on the market, with sales nearing $8 billion in 2007. Plavix will go generic in 2011 and a much more potent antiplatelet drug called prasugrel (Lilly/Daiichi Sankyo) may soon take its place, or at least that’s what the developers hope to happen. Prasugrel was tested against Plavix recently in a cleverly-designed and somewhat controversial trial called TRITON-TIMI 38. In this trial, prasugrel was shown to be about 3% better than Plavix in preventing the combined primary endpoint of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke in patients with a recent heart attack and scheduled catheterization. Unfortunately prasugrel also increased the risk of major and fatal bleeding in patients, especially the elderly and those with a history of stroke. In TRITON-TIMI 38, for every one major fatal heart attack prevented by prasugrel, one person died from a fatal bleeding event.
“Some people regard private enterprise as a predatory tiger to be shot. Others look on it as a cow they can milk. Not enough people see it as a healthy horse, pulling a sturdy wagon. Socialism is a philosophy of failure, the creed of ignorance, and the gospel of envy, its inherent virtue is the equal sharing of misery.”
