NEJM pieces favor federally directed care and look kindly on the health reform law. Practitioners are profoundly skeptical and negative about many provisions of the new law. In different surveys, some 80% to 90% of physicians say they will severely restrict or refuse to accept Medicare or Medicaid patients.

Perhaps this divergence is inevitable. NEJM contributors tend to be lawyers, PhDs, or MD academics hailing from the Boston-New York- Washington- West Coast policy making, academic, progressive metropolitan complex. Practitioners are MDs or DOs, who come from everywhere – the South, Midwest, Southwest, the outlying East, and rural regions in between.

As I ponder differences in points of view, I recall the words of General George Patton when asked if he read the Bible. He responded,”Every God Damn day!” Likewise I read the NEJM every God Damn week. It is the Bible of America’s policy making elite. Its aim is to politically transform health care and to remake a vast U.S. medical industry into its image of how things ought to be, as directed from Washington.

NEJM authors trust Washington to do the right thing. Practitioners do not. Nearly 90% of doctors feel they were not adequately represented during the debate running up to passage of the health bill.

To make my point, here are three articles appearing in the July 29 NEJM.

One, S. Rosenbaum and J. Gruber, “Buying Health Care, the Individual Mandate, and the Constitution.” Rosenbaum is from the Department of Health-Policy, School of Public Health and Health Services, George Washington University Medical Center, Washington, D.C. Gruber hangs out at the Massachusetts Institute of Technology in Boston. Rosenbaum is a lawyer, and Gruber is an economist. The thrust of their article is that the health reform act is necessary is “to end pervasive discriminatory insurance practices while making health care affordable.” Attaining this goal, they maintain, is not possible without the individual mandate. The law, they say, ensures access to affordable coverage for most and rationalizes economic behavior for all. Practitioners disagree. They feel the new law will limit access because doctors do not have the time or resources to deal with the flood of new patients, and Congress does not and will not provide them with what it takes to carry out health reform mandates.

Two, Henry Aaron, PhD, “The SGR for Physician Payment – An Indispensable Abomination,” Aaron is from the Brookings Institute, a well-known think tank in Washington, D.C. It is usually described as “liberal.” The SGR was enacted in 1998 to hold down growth of Medicare physician fees. It ties fee growth to the GDP. As usual because of physician outcries about SGR unfairness, Congress has extended SGR for 6 more months. Congress, Aaron says, will never abandon the SGR entirely because of the necessity to reduce the federal deficit. Further, the threat of letting it take effect is a useful leveraging point to compel doctors to join accountable care organizations, promote bundle payments, and cooperate with health reform. His attitude is that the SGR is an “indispensable abomination” – something Congress needs to enforce reform. In surveys, practitioners indicate the SGR is indeed an abomination, or Obamanation, that stiffens their resistance to health reform.

Three, Yuting Zhang, PhD, Katherine Baker, PhD, and Joseph Newhouse, PhD, “Geographic Variation in Medicare Drug Spending,” The three authors are from Departments of Health Policy at Universities of Pittsburgh and Harvard. In their opening sentence, the PHDs assert, “The widespread geographic variation in Medicare spending has garnered a great deal of attention in the health care debate, both as a marker of inefficient resource use and a window into potential strategies for improving the quality of value of U.S. health care.”

The idea, which has evolved from the Dartmouth Institute, is that if only we could homogenize and standardize treatments and fees in different sections of the country, quality would improve and costs would drop. The authors note that pharmaceutical spending accounts for 20% of Medicare costs. They do not reach any conclusions as to how Medicare can reduce pharmaceutical spending or overall regional variations, nor do they suggest how physicians can help. As for practitioners, they are skeptical centralized Medicare programs can ever reach down to the level of physician-patient interactions or will ever take into account or understand differing socioeconomic or practice conditions in different sections in the country.

I actually very rarely write a prescription for Lovaza, i.e., prescription fish oil. But this was the last straw.

I advised a patient that we’ve had good success using high-doses of fish oil to reduce lipoprotein(a), Lp(a). 6000 mg per day of the omega-3 component (EPA + DHA) from fish oil reduces Lp(a) in 60% of people after one year. (Recall that Lp(a) is the most aggressive known lipid-related cause of heart disease.)

The two preparations I generally suggest are either the very affordable Sam’s Club Members Mark Triple-Strength Fish Oil with 900 mg EPA + DHA per capsule: 7 capsules per day. Another great product (my personal favorite because of its extreme purity–it doesn’t even smell like fish oil): Pharmax Finest Pure Fish Oil with 1800 mg EPA + DHA per teaspoon: 3 to 3 1/2 teaspoons per day.

Both preparations work great and are quite affordable, given the high dose. For the Sam’s Club preparation, it will cost around $30 per month, while the Pharmax liquid will run around $49 per month.

Well, the woman’s husband insisted on a prescription for Lovaza. One Lovaza capsule contains 784 mg EPA + DHA per capsule: 7 to 8 capsules per day.

Here are some prices for Lovaza from online pharmacy discounters:
Prescription Giant: $78.99 for 30 capsules ($2.63 per capsule)
Planet Drugs Direct: $135 for 100 capsules ($1.35 per capsule)

These are lower than the prices I obtained in past by calling local pharmacies in my area, quite a bit lower, in fact.

Filling the Lovaza prescription at Prescription Giant will therefore cost $552.93 to $631.92 per month; at Planet Drugs Direct it will cost $283.50 to $324.00 per month. At local pharmacies, a similar 7 to 9 capsules Lovaza per day will cost upwards of $800 to $900 per month.

The patient’s husband insisted on the Lovaza prescription because he knew that his insurance would cover it. When I pointed out that this was a large cost that would have to be borne by others in their healthcare premiums, he said that didn’t matter to him.

I hesitated, but ended up writing the prescription for 7 Lovaza capsules per day. As soon as I handed to him, I regretted it. In fact, I am embarassed and angry at myself for having given in.

So I vowed: I will NEVER EVER write another prescription for Lovaza.

I do not believe that we should spread the excessive profiteering of the pharmaceutical industry around on the backs of people who pay their healthcare insurance premiums, just so that a few people, like this selfish couple, can save a few dollars a month.

More News Clippings on Derrick Williams

Here are some straggler news articles on Derrick Williams:

Family Rallies to Proclaim Palmetto Convict’s Innocence (With Video) (Bradenton Herald)
Press Conference Photo Gallery (Bradenton Herald)
Inmate’s Case Puts Focus on Flawed System (Miami Herald)

Related posts:

1. Press Conference Regarding Derrick Williams’ Innocence Once again, IPF attorneys Seth Miller and Melissa Montle are onto a wrongful conviction.  DNA test results proving the innocence…
2. DNA Testing Demonstrates Derrick Williams is Innocent  DNA Testing Demonstrates Derrick Williams is Innocent: Williams has Served Over 17 Years for a Rape he Did Not…
3. New Wrongful Conviction Press Conference in Bradenton, FL on July 27th  New Wrongful Conviction Press Conference in Bradenton, FL New DNA Test Results Prove Derrick Williams’ Innocence This Tuesday, July…
4. Who said anything about an absence of DNA? Since we released the DNA results in the case of Derrick Williams earlier this week, there has been an outpouring…
5. James Bain Round-up Well folks, we had a successful release of James Bain’s DNA test results which prove that he did not rape…
6. NEWS REPORT: DNA Testing Granted in Pasco County Death Case On December 19, 2007, a Pasco County judge granted Samuel Jason Derrick post-conviction DNA testing on evidence in this case….

From the Blog : Plain Error

Who said anything about an absence of DNA?

The prolonged recession and intractable joblessness may be turning conventional wisdom on its head. Since last year, hospital admissions are down 2%, and patient visits to doctors have declined nearly 5%, and by 7.6% in May alone.

The trend may be picking up, as jobs with accompanying health insurance disappear.

More Americans are visiting retail clinics and urgent-care clinics, or treating themselves, in search of lower prices.

And another gravity-defying phenomenon is exploding. Last year the number of Americans with health savings accounts with high deductibles grew from 13 million to 18 million, a 38% jump. Project that growth rate out five years, and 63 million Americans will own high deductible plans.

Again, the laws of economic gravity are at play. HSA premiums are some 20% less than for comparable HMOs and PPOs. And when you are spending more of your own money for care, you visit doctors less, and you become chary about paying for elective procedures, like knee replacements.

The laws of economic gravity may apply to health care after all.

Source: “Americans Cut Back on Visits to Doctor,” Wall Street Journal, July 29, 2010.

From the Blog Plain Error :

Press Conference Regarding Derrick Williams’ Innocence

These two phenomena, addictions and schizophrenia, are most likely the result of exorphins that cross the blood-brain barrier. Exorphins–exogenous morphine-like compounds–can be blocked by opiate-blocking drugs like naloxone and naltrexone. Naloxone is used in hospitals to reverse morphine or heroine overdoses; naltrexone is being repackaged into a weight loss drug, since blocking wheat-derived exorphins reduces appetite. (Yes: The USDA tells us to eat more wheat, the drug industry sells us the antidote.)

There’s another way that wheat can affect the brain and nervous system: immune-activated damage.

This is similar to the effect seen in celiac. There’s even overlap with some of the antibody markers used to diagnose celiac, like the anti-gliadin antibodies and the anti-endomysium antibodies.

The most common immune neurological syndrome consequent to wheat consumption is cerebellar ataxia, a condition in which an immune response causes damage to the Purkinje cells of the cerebellum, the portion of the brain responsible for balance and coordination. This results in stumbling, incoordination, incontinence, and eventually leads to reliance on a cane or walker and wearing a diaper. Average age of onset: 53 years. A shrunken, atrophied cerebellum can be seen on an MRI of the brain.

Problem: Most people with central nervous system damage caused by wheat do not have any intestinal symptoms, like diarrhea and abdominal pain, the sort of symptoms usually associated with celiac disease. It means the first sign of wheat-induced brain damage may be bumping into walls and wetting your pants.