by rcentor on May 16, 2012
A faithful reader writes:
What drug or therapy released in the last 10 years has had the greatest positive impact?
This question stumped me for several days. I tried to think of a new drug that I use a great deal. Most new drugs now have important niches. I considered rifaxamin for hepatic encephalopathy, ceftaroline for complex skin infections or dabigatran for anticoagulating patients with atrial fibrillation.
I thought, and this morning the answer came. The most important advance in the last 10 yrs is the Walmart $4 drug list! Several things about this list. They have forced every competitor to have a similar list.
Prior to the Walmart list, patients paid more for generics and were more resistant to taking generics. Walmart branded generics! They, almost single handedly made generics acceptable to the great majority of patients.
Most important, they gave us an option to treat poor people. We see so many patients who have poor adherence because their medications are so costly. When we are discharging patients and tell them that we will prescribe all Walmart drugs we often see tears of joy. Patients worry about money and Walmart and their competitors have given us the ability to give them good news about buying their meds.
So I have changed the question a bit, but believe I have written the proper answer.
by rcentor on May 15, 2012
A reader sent this to me anonymously:
Healthcare-acquired pneumonia has been ruled out based on the following
reasons. The first is that the patient's respiratory status has not
worsened over the past month while he has been on treatment. Secondly, the
patient is afebrile. Thirdly, the patient has normal WBC count of 8.2 and
normal neutrophil count of 72.5. Thirdly, the chest x-ray is normal and
has no acute sign of infiltrate. Fourthly, the patient has a normal
lactate of 0.9 and fifthly, the patient is alert and talking and is not
septic in any way and sixthly, on auscultation there are no significant
rales. Thus, the cefepime and vancomycin which were administered in a
timely fashion in the emergency department will not be continued after
hospitalization.
The quote speaks for itself. The physician who wrote this obviously worried that someone would question his/her decision making. This seems a bit over the top, but ironic.
by rcentor on May 15, 2012
A colleague wrote:
Has blogging been an interesting side note to your career as an academic professor in medicine or has it been a more integral part of your own professional development?
I was already quite successful in my academic career, but I still believe that blogging has enhanced my effectiveness. So what has blogging done for me?
First, I had incomplete writer's block. While I wrote articles occasionally, I was slow, and avoided writing most of the time. Blogging changed this dramatically. Because I write most days, my writing has improved dramatically.
Almost all books on writing give the advice of writing daily to improve one's writing. Perhaps the main reason I started blogging was just to improve my writing. I write much more quickly and much more easily. Like everything else writing improves with practice.
Second, blogging has allowed me to explore ideas. I think about more things because I am always exploring potential ideas for this blog. Some of these ideas have attracted attention and led to editorials. Some of these ideas matured and became articles. Blogging is my idea laboratory. When my ideas have flaws, readers point out those flaws. When the ideas have strength I get "attaboys".
Finally, blogging has established my "brand" for those who might not have known me. At medical meetings colleagues and trainees often tell me that they read my blog and enjoy my screeds. I have met some wonderful colleagues because of blogging.
Blogging has exceeded my expectations as I recall them in 2002. All the above are true, but even if not, I would probably still blog because it has become a very enjoyable hobby.
by rcentor on May 14, 2012
I got asked this question:
How can pharma companies work collaboratively with health bloggers? What's needed?
On this blog it is not happening. No pharma, no device companies, no requested guest blogs. No collaborations!
In my opinion, one must take blogging seriously or just forget about having the blog mean anything.
I have written extensively about pharma, and mostly negatively. While I appreciate their research and the important drugs they develop, I markedly dislike their marketing and their frequent lack of ethics.
So how could I work with them? Simple story, I cannot.
