On Dave Winer's Scripting News is a casual reference to a big problem. I'm not sure if Dave apprciates the significance of the event. Dave witnessed a celebrity purchase medications, and then the clerk confirmed the identity of this celebrity. I don't know which pharmacy Dave was in, but most pharmacies have clear privacy guidelines. If they don't now, they certainly will after implementation of the federal HIPPAA Privacy regulation. Most states also have laws protecting patient confidentiality.
Some may argue that I'm making a big deal out of nothing. I'm not. As healthcare providers, we make a clear commitment to our patients that we maintain the confidentiality of all of their medical information, no matter how trivial it may seem. While one may say "oh .. it's just the breathing medicine that we know about" ... or "who cares if anyone knows about grandpa's arthritis pills" ... the trouble is that there is no clear way to draw any line between what's OK to talk about .. and what's not. Would we reveal a medication that being prescribed to treat a sexually transmitted disease? By revealing only the name of a medication, we reveal a great deal about a patient's private medical history. This is why the laws in most states, and the HIPAA privacy regs are not tolerant of "minor" lapses in priacy such as the one Dave describes. On the other hand (!) ..pharmacy employees are not seen as healthare providers in all states (though the ARE in California) and there have been legal decisions in some states that suggest that we should not expect our pharmacists to keep our medications to themselves. HIPAA, of course will change that.
Man ... I missed this one last month .. an important paper. The focus here is on how lazy physicians are. um .. I mean ... how popular extended-spectrum antibiotics are. Why are they popular? Azithromycin and Clarithromycin (no .. I don't even want to give theURLs) .. though I remain angry about the kidsears.com website .. sponsored by the company that makes one of these drugs ...
Anyway ... they're so well marketed.. and they appeal to the physician who isnt' sure (or doesn't care) which organism is causing the infection. Don't know? .. use these drugs .. so you won't have to think.
Now you'll have to think again ..since they won't work anymore for strep throat. Shoulda used penicillin in the first place. duh.
The washington Post reviews the made-for-TV movie "Damaged Care" starring Laura Dern: "Health care in the United States is all about money. The system is skewed toward limiting and denying care to patients to enhance the economic vitality of the health plan"
The movie is based on the life of Linda Peeno who testified before congress on the myriad structural problems of our healthcare system. Linda is an active PNHP member .. and of course an advocate for a single-payor healthcare.
"Blue Cross/Blue Shield Ordered to Disclose Physician Fees and Method For Calculating Payments to Participating Doctors"
This is a reasonably big deal ... and I have mixed feelings about the whole "insurance companies vs physicians" topic. Ideally, physicians and insurance companies share a common goal: prevent and treat disease with the best medical care possible. Unfortunately, this is not an ideal world .. and all too often .. self-interest gets in the way. Are the physicians acting in self-interest (and not the best interests of their patients) when they fight for better reimbursement? Perhaps. Once can make the argument (as the Medical Association of Georgia does in this press release) that better physician compensation = better patient care. But making that leap infers that the physician isn't paying for a house in Cancun with the better reimbursment. The usual agrument goes somethign like this: Better reimbursement means that physicians won't have to see bazillions of patients just to pay the rent. Trouble is ... to pay for the house in Cancun .. they WILL have to see bazillions of patients .. so it remains the doc's responsibility to provide good care .. and not try to cram too many patients into their schedule just to maintain a certain lifestyle.
Back here after several days of hibernation. Just finished in the office. Wednesdays are my "long" days ... it gets exhausting after 12 hours in the office ...
Trying to get caught up with things. Today I'm looking for information on mastitis. Big problem for cows. Hmm ... AAFP has a very good article on common breast problems. .. Along with a patient handout on breast pain. But not much here on mastitis. A mention in the Diary from a week in Family Practice from 1997 (scroll down to Tuesday) .. an interesting discussion of the "cabbage trick." (mentioned again in 1998 .. I wonder if it was the same patient!)
A key question for today is whether needle aspiration is effective in treating breast abcess. The traditional teaching is that incision and drainage is necessary .. but a recent study suggests that over 80% of patients can be safely treated with aspiration + antibiotics. But mastitis is usually treated rather easily with either dicloxacillin or cephalexin. Resistant cases should be treated with Clav-Amox.
In researching this today, I've learned that there is rather little research on mastitis. Indeed, there are very few studies that have looked at different diagnostic and/or treatment methodologies. ? is it always infection? Some authors suggest that it may not be, but there are few alternatives provided .. and there are no studies that suggest how we might differentiate simple obstruction from infection.
The midwifery circles .. and drsears .. blame mastitis on stress. Babyzone: says: "Stress and Fatigue Can Lead to Plugged Ducts and Breast Infection" huh? This is an interesting statment .. and it is certainly possible .. but I've been able to find NO research to support this statement.
The topic of co-sleeping has apparently been in the news recently. I can't find reference to the reports on our local NBC station .. nor can I find anything on the Today Show website (though lots of Colon Cancer links ...
The Several studies have suggested over the years that co-sleeping may be implicated in fetal deaths. Some of the early Europeas studies, however, were pootly done, and it turned out that parents who smoked and/or drank alcohol were more likely to have kids die in the bed withe them. Other studies have clearly demonstrated that kids don't sleep as well when in the bed with parents. They are aroused more easily, and don't have as consistent or as deep sleep patterns as those who sleep alone.
... and these studies are then extrapoloated to suggest that co-sleeping is actiually protective agains SIDS. And in fact some studies support this contention .. whereas other studies do not.
For now ... the REAL answer on whether this is a safe practice remains with the parents. trust them.
The response to placebo in published trials of antidepressant medication for MDD is highly variable and often substantial. Yes, there is a placebo effect.
Equally interesting (yet much more problematic) is the nocebo effect. We see "nocebo" every day and are often perplexed by it.
Encouraging news from the CDC: "Haemophilus influenzae type b (Hib) was the leading cause of bacterial meningitis and a major cause of other serious invasive diseases among children aged <5 years in the United States before Hib conjugate vaccines became available in 1988."
"In 1991, all infants starting at age 2 months were recommended to receive Hib conjugate vaccines; by 1996, incidence of Hib invasive disease (i.e., illness clinically compatible with invasive disease, such as meningitis or sepsis, with isolation of the bacterium from a normally sterile site) among children aged <5 years had declined by >99%." Hib invasive disease remains at these low levels, except in communities with unusually low vaccination rates.
National Library of Medicine has published information on the linkout program. LinkOut is a feature of Entrez that is designed to provide users with links from PubMed and other Entrez databases to a wide variety of relevant web-accessible online resources, including full-text publications, biological databases, consumer health information, research tools, and more. This is one of a number of efforts to tie medical information resoures together.
Another recent attempt to build unity in health information resources is HEAL. Health Education Assets Library (HEAL) was started with funding of the National Science Foundation and in collaboration with National Library of Medicine. It's a cool idea. Link medical education resources together. I create class materials .. share them through HEAL with you .. and you don't have to re-invent the wheel. They have defined a core set of decriptors. and they invision that we will all share information about the resources in XML. I think I'll work on making fpclassroom.org compliant with their site .. so that we can share data with them. XML and "web services" will change the way that most people think about websites. No kidding.
