Docnotes

F.D.A. Panel Recommends Approval for

F.D.A. Panel Recommends Approval for Psoriasis Drug. A federal advisory panel recommended approval of Biogen's psoriasis drug, potentially clearing the way for the marketing of the first new type of treatment in years for this skin condition. By Andrew Pollack.

Overuse of Macrolides: a bad thing (duh)

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.

Health Care Horror Show (washingtonpost.com)

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.

Can reading damage your eyes?

Turns out that mom may have been right after all .. and nerdy (well-read?)  kids really ARE four-eyes: "The correlation between level of academic achievement and the prevalence and progress of myopic refractive errors is strong; people whose professions entail much reading during either training or performance of the occupation (lawyers, physicians, microscopists, and editors) have higher degrees of myopia, and the myopia may progress not just in people's teenage years but throughout their 20s and 30s."

Medical Association of Georgia

"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

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. 

Yahoo! News - Family Gets Chips Implant in Study

Though the "privacy experts" seem to dislike this idea .. I'm thinking that the "chart on a chit" is a great idea  .. especially if its there by patient choice.

Open Archives Initiative

Openarchives is an interesting effort to develop a standard for sharing and "harvesting" documents over the internet.  Our fpclassroom project, and the HEAL project are two examples of digital libraries that may benefit from such open interfaces.

Co-Sleeping

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.

Placebo in Clinical Trials for Depression: Complexity and Necessity

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.