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Showing posts from April, 2011

The Top Ten Prescribed Drugs in the U.S.

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The top 10 prescribed drugs in the U.S. for 2010 in order of prescriptions written are:

Hydrocodone (combined with acetaminophen) -- 131.2 million prescriptionsGeneric Zocor (simvastatin), a cholesterol-lowering statin drug -- 94.1 million prescriptionsLisinopril (brand names include Prinivil and Zestril), a blood pressure drug -- 87.4 million prescriptionsGeneric Synthroid (levothyroxine sodium), synthetic thyroid hormone -- 70.5 million prescriptionsGeneric Norvasc (amlodipine besylate), an angina/blood pressure drug -- 57.2 million prescriptionsGeneric Prilosec (omeprazole), an antacid drug -- 53.4 million prescriptions (does not include over-the-counter sales)Azithromycin (brand names include Z-Pak and Zithromax), an antibiotic -- 52.6 million prescriptionsAmoxicillin (various brand names), an antibiotic -- 52.3 million prescriptionsGeneric Glucophage (metformin), a diabetes drug -- 48.3 million prescriptionsHydrochlorothiazide (various brand names), a water pill used to lower blo…

Physicians Complicit in Gitmo Torture

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As more and more facts come out of Guantanamo Bay prison, one of the worst is that physicians caring for the detainees may have been part of torture of the inmates.  Physicians for Human Rights researchers examined medical records, affidavits and third party examinations of nine prisoners who claimed they were tortured at Gitmo.  They found injuries that were highly consistent with torture and abuse in the medical records, yet the physicians failed to document mental and physical conditions that suggested torture.  Instead the doctors talked about regular health issues and never mentioned causes for injuries like bone fractures, contusions, lacerations and nerve damage.

According to the report, the Gitmo physicians turned a blind eye to potential evidence of torture.  One patient experienced nightmares, memory lapses, depression and suicidal thoughts.  A diagnosis of Post-traumatic stress disorder was not made, but instead the physician told him "to relax when guards are being mo…

Insurance Hall of Shame Award

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I am giving this weeks Shame award to Cigna HealthCare.  They are most deserving for their insurance product that someone actually pays for.  I do not know what the monthly premium is but I would sure love to know.  The physicians bill was $306.00.  Of course the insurance company paid zero.  This is not unusual at all.  First they disallowed some of the bill as "Not Covered/Discount."  The remainder...$220.14 was applied to the patient's deductible for 2011.  So far Cigna has applied $3,584.30 toward the deductible in 2011 for this patient.

Do you think the patient will reach the deductible in 2011?

The annual deductible for this patient is $99,999.00.

No that is not a typo.  Enough said?

(Thanks to my colleague JS for sending me the provider explanation of medical benefits report)

Good News for Coffee Drinkers

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According to research published in the American Journal of Clinical Nutrition, habitual drinking of 3 cups/day or more of coffee is not associated with an increased risk for hypertension compared with less than 1 cup/day.  The study did a meta-analysis of six different trials that looked at a total of 172,567 participants.  They did find, however, a slight increase in hypertension in people who drank 1-3 cups compared to those who drank 0 or 1 cup/day.  There seemed to be no sex difference and there was no difference between smokers and non-smokers.

A couple of points should be noted.  They were unable to distinguish the effects of caffeinated and decaffeinated coffee, differences in serving size and brew strength.  We know that a cup of Sanka might be different than an espresso.  Also, all of the studies were performed in white populations.

While it is not the definitive answer, it does help  (white) coffee drinkers that drink over three cups a day know that it doesn't increase b…

How Drug Marketing Influences Use

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There is do doubt that the way pharmaceutical companies market drugs to both doctors and consumers sways prescribing and drives up health costs.  Prescription drug costs have outpaced other health care spending and are predicted to exceed the growth rates for hospital care and physician services going forward from 2010-2019.

Two researchers (Howard Brody, MD, PHD, University of Texas Medical Galveston and Donald Wright, PhD,  University of Medicine and Dentistry of New Jersey) have outlined 6 things that have a large effect on physicians and lead us into prescribing drugs that may not be needed.   It's not just the pharmaceutical marketing that has led us to this place...it is also how journals publish literature that physicians rely on for changing medical practice.  Here are the 6 strategies that influence us:
 Reducing thresholds for diagnosing disease.  For example, a diabetes diagnosis used to be fasting blood sugar above 130.  Now it is glucose above 100.  There is no evidenc…

Limiting IVF Embryo Transfers

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Everyone knows about "Octomom" and her octuplets born after in-vitro fertilization (IVF).  That was an extreme case, but multiple births resulting from unregulated artificial reproductive technologies have skyrocketed over the last decade.  The increased rate of twins, triplets and even higher multiples are due to in-vitro treatments and those women and infants are at much higher risk of pregnancy complications, premature birth and long term health problems.

New research,  published in the Journal of Pediatrics, looked at admissions at just one hospital in Montreal, Quebec and found multiple embryo transfers was responsible for a significant proportion of admissions to the neonatal intensive care unit (NICU).  These infants were born severely preterm.  Six babies died and 5 developed severe intraventricular hemorrhage or bronchopulmonary dysplasia.  The researchers extrapolated their data to the entire country of Canada and said that a universal single-embryo transfer policy …

Aqueduck for Kids

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The management (that would be me) at EverythingHealth gets lots of solicitations for product review and placement.  I decline most of them,  but I did say yes to a nifty little device for kids called Aqueduck.  I figured I had a build in tester in my little grand-daughter.   We all know that hand-washing is the best way to prevent colds, flu and other infections.  Anything we can do to make it easy for little ones to scrub their hands has got to be a good thing.

My test case of one adorable 2 year old returns with a big thumbs up  for Aqueduck.  It may not be a scientific study, but the reviews were positive.  Mom says the Aqueduck extender was easy to install on the faucet and it is fun to use with water gently guided where it should be; over the hands.

At an affordable price of $12.99, Aqueduck delivers on making hand-washing fun and accessible for toddlers.

Elbow Bursitis

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My lovely 87 year old patient took a tumble and sustained some bruises a few weeks ago.  Fortunately she had no broken bones but she did land on her right elbow.  The elbow swelled up and was tender and warm to the touch.  The fluid was drained and it was bloody.  In her case the fluid reaccumulated.  Now several weeks later this is what it looks like.  It is cool to the touch and not tender.   It feels like a ripe avocado or heirloom tomato...filled with fluid.  She is able to flex and extend her arm with no problem.

She has olecranon (elbow) bursitis.  In this case it is from trauma and bleeding under the surface of the skin. It has persisted because I caught her leaning on a walker with her forearms and pressing on this area. 

Olecranon bursitis is common and usually it will resolve.  It is important to watch for infection, increased pain and warmth.

Thanks to FP for allowing her elbow to be the teaching case of the day.

Medical Grand Rounds

Check it out.  Grand rounds is up at Bedside Manner.  Go here to read the best of this weeks blogosphere on patient centered health.  Of course EverythingHealth is selected also!

Prominent Surgeon Resigns Over Semen Reference

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Dr. Lazar Greenfield, the inventor of the Greenfield filter, has now resigned as President of the American College of Surgeons for a big oops.  Dr. Greenfield wrote an editorial for Surgery News, a publication for Surgeons from the American College of Surgeons.  In the now famous Valentine's Day issue he said semen was a "mood enhancer" for women and would be a better gift than chocolate.   He was responding to an article that cited the research of evolutionary psychologists who wrote that women who did not use condoms and had sex with men may be less depressed.  (The publishing of bad science was also a oops for the College).  Go here to read Dr. Greenfield's musings on unprotected sex being a treatment for depression and the benefits of semen on the "vascularized vagina". 

I'm sure he is now wondering himself, "What the heck was I doing writing that"?  It wasn't an off-hand remark.  It was a professional op-ed for heavens sake!  Needles…

Walking Challenge

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The New York Times had an article recently about what is the single best exercise.  Lots of experts weighed in about what for is best to build endurance and strength.  There are advocates for old fashioned calisthenics, biking and resistance training but many times people don't sustain these types of activities as they get older.  The demands of jobs, adult life, parenthood and just plain aging leads to more sedentary lifestyles for most people.  The best exercise is done throughout life and many believe consistent,  brisk walking is the activity that is sustainable long term.

Walking helps with weight control, mental memory, reduction in diabetes and cardiovascular disease.  And it doesn't require any equipment or extra money.  Add hilly inclines and bursts of brisk power walking and you have an almost perfect aerobic activity.

The best exercise is the one you will do regularly.  Dancing counts as does biking, gym workouts, nordic skiing, spinning, swimming and any number of…

EverythingHealth on a Break

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EverythingHealth is still on a break while we deal with repairs from a sprinkler line break.  Please click on the links on the right and you will find the best of health blogs.  Check back daily and we'll be back soon.  All is well.

Answer to the Medical Challenge

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The answer is varicella (chickenpox) in a teenager who had not been vaccinated.

Your diagnostic acumen was right on and I initially thought it might be dermatitis herpetiformis too, but Chickenpox it is.  For more info on Varicella, check out my old post.



I am sorry for the delay with the answer.  This disaster zone is what has been keeping me busy at EverythingHealth.

P.S. that is not me in the hazmat suit.  I am behind the camera.

Diagnostic challenge

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What is the diagnosis:
1.  Dermatitis herpetiformis
2.  Impetigo
3.  Measles
4.  Secondary syphilis
5.  Varicella  (Chickenpox)

Make your best diagnosis and commit in a comment.  The answer will be posted tomorrow!!!

(Image from NEJM)

GOP Health Plan

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I am all for any proposal that will improve heath care in America.  Improvement means controlling costs, covering all Americans so no one has to worry about going bankrupt to pay for health care.  Improvement means access to quality care without having to worry about losing your job, which means losing your coverage.  Improvement means a system where all incentives are aligned to prevent disease, rather than using expensive technologies and hospitals to treat disease after the fact.  Any proposal that gets us there has my vote.

In the GOP "Path to Prosperity" budget for 2012, they propose a few things that are good and a few big things that are bad...really really bad.  First the good.  Capping the medical malpractice lawsuits for "pain and suffering" would be a huge step forward.  Patients should be compensated for medical errors but the "hit the lottery" windfalls for pain and suffering are costly drivers that make no sense.  There is no place in the wo…

Breast Cancer Complexity in Personalized Medicine

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Scientists at Washington University School of Medicine in St. Louis have conducted the single largest cancer genomics investigation to date by sequencing the entire genomes of tumor from 50 breast cancer patients.  They compared the cancer DNA to healthy cells in the same patient and found mutations that only occurred in the cancer cells.  They uncovered incredible complexity in the cancer genomes of these tumors that had more than 1,700 mutations, most of which were unique to the individual.

To undertake this study, the Oncologists and Pathologists worked with the University's Genome Institute to sequence more than 10 trillion chemical bases of DNA - repeating the sequencing of each patient's tumor and healthy DNA about 30 times to ensure accurate data.  Huge computing facilities were required to analyze this amount of data.  All patients in the trial had estrogen receptor positive breast cancer.

The researchers found that two mutations were relatively common in many of the p…