SOCIAL ISSUES – Page 3

HEAD INJURY – WHY NOT WEAR THE HELMET

Recently, during a Fourth of July parade, many bikers, cyclists, gymnasts, cheerleaders, rollerskaters, Shriners’ clowns, speed-skaters, and even horseriders were watched with such intensity…and were applauded for their acts, high flying or racing speed. BUT……..Why not wear a helmet?

Some states have passed and then repealed helmet laws. There has been some emphasis on kids with bicycles to wear helmets, and some push to wear helmets during down-hill skiing. BUT…..Why not wear the helmet always?

prednisone purchase canada Is it a personal right NOT to wear a helmet? Is it a business right then for taxpayers, insurers, employers, disability companies and worker comp programs to refuse coverage retrospectively for such injuries and morbidity when someone does NOT wear a helmet? What about a seat-belt? What about smoking, drinking, obesity, and lack of exercise? Sounds far fetched?

Well, back to the parade…..

The Emergency Departments see generally over 2 million head trauma victims annually in the United States. It is the leading cause of death in persons under 25 years old, with over 50,000 persons dying yearly from head injury.

Head injury crosses all boundaries of socio-economics, ethnicity, financial burden, and coverage. Just ask the attorney that fell from the bus he was watching a parade from…a little too much partying possibly…Ask his wife who was unrecognized by this smart man after hitting his head. Life as it was…over…New rules, new learning, new start – ALL difficult to say the least. Career, family, dreams, and hopes all snuffed due to the head injury.

Some patients have intra-cranial bleeding from their head injury, which is about 5-10%. This means there is bleeding either in the brain itself, or around the brain under the skull. Each of the types of bleeding is extremely serious. Some do not need surgery, while other types of head injury with bleeding inside the skull require immediate life-saving procedures and surgeries.

High risk groups for “closed” (no external injury) head injury that need a CT scan, which now is the standard, are kids under 6 months, elderly, persistent vomiting, neurological or mental changes, alcohol abuse or overuse, prolonged loss of consciousness and those on blood thinners. The medical legal world has driven the doctors to scan more often defensively, even with minor head injury. This has been pushed by successful litigation for what appears minor, only later to be a significant injury.

Caltanissetta Even the NFL has now taken up the banner. It is evident now that boxers and football players with repeated or recurrent head injuries have shown brain disability later in life. Most of the athletic associations understand now that head injury, even minor, is not to be taken lightly. Even many of the “rough and tough” rodeo cowboys now wear helmets with the rodeo association. The bronco-busters are leading the pro charge.

So what’s up with the ultimate boxing and cage fighting until loss of consciousness? Should insurers, payors, and hospitals be forced to insure these programs and their victims?

Long term complications of concussion, (which ranges from a confusion with loss of consciousness to complete coma) are many. Memory difficulties exist, and may stay persistent. Dizziness, a general feeling of weakness or lack of energy may continue for months to years. Headache is common, as well as a problem of focusing on projects or things that require intense thought. Amnesia, or ability to remember is certainly a problem many victims of head injury encounter. This retrograde (backwards) memory loss can be devastating. Thus the attorney’s wife….sobbing….and wondering….

Generally there are three classes of initial head injury in evaluation and prognosis. They are: mild, moderate, and severe. This category is really of doctor’s category based on an initial scoring designed by Glascow.

castMD in a previous post discussed more about head injury. Please see the following link if you wish to read more about concussion and sports.

http://www.castmd.com/?p=93

But head injury is a very serious matter…So teach your kids to wear their helmets by wearing yours. Consider the no helmet-no activity rule for this.

As for what the future will bring for insurance coverage for dangerous behavior regarding helmets is still up in the air…..but many insurance companies require a rider or no insurance coverage for trampolines now…..too many broken necks and spinal cord injuries!

I remember the little boy as he was lying there. Absolutely beautiful 4 year old. Unconscious. Comatose. Scheduled for long-term care preparation and surgeries. No sign of external injury. “Just a closed head injury…..”

“SICKO” – WILL IT HELP MAKE THE DIAGNOSIS AND TREATMENT?

AFTER LISTENING THIS PAST FEW DAYS TO SOME NEWS, CASTMD FIGURED THE SYSTEM IS TOO BROKEN NOT TO COMMENT. MIKE MOORE’S DOCUDRAMA OF THE U.S. HEALTHCARE SYSTEM IS AT LEAST A STARTING POINT…AGAIN….

A FRIEND OF MINE SAVED A PATIENT’S LIFE. IN SURGERY, THE PERSON ALMOST DIED. THIS ANESTHESIOLOGIST WANTS TO GET PAID BY THE PATIENT’S INSURANCE COMPANY. SOUNDS SIMPLE?

THE PATIENT HAD TO BE TRANSFERRED FROM THE SMALLER HOSPITAL TO A TERTIARY CENTER (A LARGER TEACHING TYPE HOSPITAL) AND LATER UNDERWENT ANOTHER SURGERY. NOW THE INSURANCE COMPANY WILL NOT PAY THE FIRST HOSPITAL AND THE ANESTHESIOLOGIST. THEY DEMAND MORE PAPERWORK, SAYING IT WAS THE SAME SURGERY. SO THE BATTLE OF HEALTHCARE PAYMENTS GOES ON! GENERALLY, DESPITE THE ONLINE DIRECT SUBMISSION OF BILLING TO MEDICAID, MEDICARE, AND OTHER INSURANCE COMPANIES, PAY IS SLOW.

WHAT HAPPENS THEN, IS THE PATIENT GETS BILLED, THE EXPLANATION OF BENEFITS GOES OUT AND EVERYONE INVOLVED IS SENDING DOCUMENTS AND PHONECALLS TO EVERYONE ELSE. SO IT GOES. SO MUCH LOST EFFORTS, EXPENSES, AND WORK…TO GET PAID.

ALL THAT MONEY COULD BE FOR HEALTH AND WELLNESS AND PREVENTION. INSTEAD YOU HAVE FAMILIES BEING BANKRUPTED BY MEDICAL BILLS. THIS HAS BECOME ANOTHER CREDITOR ATTACKING YOUR CREDIT RATING, YOUR PROPERTY, YOUR LIVELIHOOD, AND YOUR HARD-EARNED DOLLARS. MANY HOSPITALS HAVE LAW FIRMS NOW FILE LITIGATION AND SUE THE PATIENTS FOR PAYMENT.

WE SPEND THE MOST ON HEALTH IN THE INDUSTRIALIZED WORLD, YET WE HAVE HIGH INFANT MORTALITY, A SHORTER LIFE EXPECTANCY, AND NEARLY 45 MILLION KNOWN ABOUT PERSONS WITHOUT ANY INSURANCE COVERAGE TO ADEQUATELY PROTECT THE FAMILY OR THEMSELVES.

THE DIRECTOR OF THE G.A.O. (GENERAL ACCOUNTING OFFICE) WAS ON TV THE OTHER DAY. HE SAID IT IS TOO LATE IF WE DO NOT CHANGE NOW. HE IS IMPORTANT. HE IS THE UNITED STATES’ CPA BASICALLY. HE IS MEETING WITH BUSINESS LEADERS, COMPANIES, AND OFFICIALS TO TRY TO GET THE MOMENTUM UP TO CHANGE HOW WE DO THINGS. HE SAID THAT WITH THE BABY-BOOMERS COMING “ON LINE” IN JANUARY 2008, THE GOVERNMENT HAS CREATED A SYSTEM OF INCOMPATIBLE EXPENSE. WITH MEDICARE, MEDICAID, AND SOCIAL SECURITY FOR THE BOOMERS, THE SYSTEM WILL BUST. SOON! 2020 OR SOONER! WHY? HE HAS GIVEN UP ON CONGRESS !!!

IF YOU ADD ON THE NUMBER OF MANDATED ER CARE OF ILLEGAL IMMIGRANTS GOING TO THE EMERGENCY ROOMS, PLUS THE UNDERINSURED, AND THE UNINSURED – IT IS EASY TO APPRECIATE THE PROBLEM. MANY HOSPITALS’ ERs HAVE CLOSED. SOME HOSPITALS ARE BEING SOLD FROM NOT-FOR-PROFIT TO FOR-PROFIT SYSTEMS.

WHAT ARE YOU DOING TO HELP TALK IT UP ABOUT HEALTH INSURANCE RATES, HEALTH INSURANCE, AND THE COSTS.

NO FAMILY SHOULD BE FORCED INTO BANKRUPTCY BY HEALTH ISSUES……

EMERGENCY ROOM VISITS – ILLICIT DRUG ABUSE TOP TEN

According to D.A.W.N. which stands for Drug Abuse Warning Network the top ten Emergency Department visits were surprising. Although this list is published openly, it does run about 1-2 years behind.

COCAINE………………………..OVER 448,000

MARIJUANA……………………..OVER 242,000

HEROIN………………………….OVER 164,000

METHAMPHETAMINE…………..ALMOST 109,000

ECSTASY (mdma)……………..ALMOST 11,000

PCP………………………………OVER 7500

INHALANTS……………………..OVER 4300

HALLUCINOGENS……………….OVER 3700

LSD………………………………OVER 1800

GHB………………………………OVER 1800

This data is from a reporting system in the United States. Many times, GHB for instance, is gone from detection upon arrival to an Emergency Room. Many inhalants cause death, therefore do not show up in the Emergency Room, but rather the Coroner’s venue. Many times the data is also regionally directed, for instance, in high methamphetamine areas, illicit use might be seen higher in the corresponding Emergency Departments.

To round out this medical commentary today, the United States still has these top ten killers.

This data is from the 2004 National Center for Health Statistics, the latest full database. Prevention is the key in almost all of these killers. With the severe childhood obesity concern in the United States, these data may get thrown in the air, with new issues on top. For instance, diabetes and asthma may replace the first and second positions due to the issues of childhood health management in general.

HEART DISEASE……………………………………………………………………………27.2%

CANCER…………………………………………………………………………………23.1

CEREBROVASCULAR DISEASES…………………………..6.3%

CHRONIC LOWER RESPIRATORY DISEASES…………5.1%

UNINTENTIONAL INJURY…………………………..4.7%

DIABETES MELLITUS……………………………..3.1%

ALZHEIMER’S DISEASE………………………2.8%

INFLUENZA AND PNEUMONIA……2.5%

KIDNEY DISEASES……………….1.8%

SEPTIC CONDITIONS……….1.4%

NET NEUTRALITY AT RISK- THE BIG DEAL IN YOUR e-LIFE

Sometimes this medical man must make the leap from meth, cocaine, cheese heroin, disability, west nile, herpes, and death…to a topic that is close to the heart and mind.

In the blogger world and the internet world, many brilliant minds exist in a community open source manner, while many other minds (even some the same) coexist in a competitive free market manner. They so far seem to have been a symbiotic relationship at the least.

But a reminder from www.castMD.com now, as it is important. We as bloggers must pay closer attention to this “Net Neutrality” issue. This is how I understand it. Right now, internet is paid for at all levels. About 26 of them. I pay a company to provide access to the net, that company pays the next, the next pays the next…eventually to a major backbone of internet ability. These access points are not “pipes” as one Senator stated in Congress. Everyone gets paid some money along the way…

What may be happening in the telecom companies, is access restriction! Unlike other countries, especially Korea, China, Japan, access is being looked at like your cable or cellphone.

You want what, when, and how fast?

Right now, the IPhone is with AT&T I believe, after Verizon company turned it down due to strict competitive requirements. So, my contract will not allow me to get an IPhone. I cannot get a different phone with ALL the features, because some aspects of cellphones are turned off…or blocked…so the company can RESELL the access to you – EVEN though your cellphone is set for it.

My examples are real but may not be exact for the internet neutrality issue. BUT, what if my SkyNet said you can have only the internet sites that are not commerce related? What about no .com, or .biz sites? But for 100 dollars per month, I can have the .com sites? Or what if a block on all .edu sites was placed for the colleges and universities, unless a million dollars per month is paid by the college or university? Another example is whether or not your access speed would be limited? So, the telecoms give access to the “slow speeds” of uploads and downloads, yet more money for the “real” speeds.

UTube is extremely bandwidth intensive. In the beginning, without the principle of internet neutrality, the telecom ISPs most likely would have restricted bandwidth speed available to their users for viewing the site. Video traffic would slow to a crawl unless the startup business was ready to pay enormous fees to the “gatekeepers” in order to access “their subscribers.” Obviously, a startup in its infancy would not have been able to pay these fees, or would have had to grow slower or die on the vine. The gatekeepers want to absolute control to all the access to every data pak through the internet network. Everyone is already paying!

The meeting review on the issue might stimulate your awareness.

FTC ON BROADBAND ACCESS

A review of this issue and faqs is at: SAVE THE INTERNET

THE PRICE AND THE ACCESS RESTRICTION ARE GOING UP !

CHEESE – MARKETING HEROIN FOR YOUR KIDS “SAY CHEESE”

As part of my background in pharmacy, emergency medicine, and toxicology, my eye is geared toward new illicit “marketing styles.” One of the latest, yet as usual, older than you think, is “cheese” heroin. This “starter pack” of heroin is REALLY heroin…the DEADLY kind of heroin…the good old toxic illicit heroin.

The difference is in the making of it. The manufacturers of the illicit drug geared for the teens is the mixture of heroin and Tylenol PM©. This multi-drug cocktail of acetaminophen, diphenhydramine (better know as brand name benadryl © and other companies brands) and of course heroin creates a deadly risk. Each item in this mix can be deadly.

As the famed Paracelsus, an earlier father of poisoning stated, “It is not the agent, but rather the dose of the agent. And everything therefore is a poison.”

Acetaminophen remains one of the most toxic poisons if taken in overdose and is the lead cause of death for many years in Europe, while diphenhydramine is again a unique poison in overdose. The anticholinergic side-effects of the drug in overdose creates elevated deathly temperature rise, hallucinations, cardiac instability, agitation, and even death. Heroin for years now continues to plague not only the U.S., but nations around the world. It has enormous addictive potential and leads to severe toxicity, criminality, and occasional deaths on the streets.

Say “Cheese” is a deadly form of a multi-drug extravaganza geared to entice, to addict, and to control your kids. Already in the last 1-2 years, especially in the Texas market, over 20 deaths have occurred. The product appears like Parmesan cheese in structure, yet kills with a vengeance.

(grated parmesan)

Say “Cheese” is usually snorted. Why do drug abusers snort? It is because the absorption rate is good. But I have seen those individuals with chronic cocaine abuse, literally rot the nasal septum out…”look Mom, no septum!”

Post-mortem toxicology tests will reveal the deadly three drugs in this mixture…heroin, diphenhydramine, and acetaminophen.

“Cheese” is not a starter-kit for drug use. “Cheese” is a start-kit for deadly teenager activity.

SAY “CHEESE” MAY BE THE LAST PICTURE TAKEN……..

HUG YOUR KIDS TODAY!

SQUIRREL ATTACK DURING HIDE N’ GO SEEK FATHER-DAUGHTER’S BONDING STORY

All my daughter’s friends were over for their little party.

These eight or so girls, all about 7 years old were playing crazily. You see wintertime had broken in Minnesota, and the summer was near. But it was one of those days you live for there, vibrant blue sky, gentle breeze, and life’s passions greening up.

Well, the little girls had played on the playground equipment for quite awhile, and in the sand making “things.” They were drawing chalk style hopscotch boards on the sidewalks, and had jumped rope without any bruises. Such a great day, such harmony in family and friends with nature watching.

My daughter and her little friends decided it was time to play “hide n’ go seek." No one better to hide than dad. Their collective eyes leaked with sincerity of request. How could any father turn such princesses and angels down for this next fun event, on such a great day, in such prime weather, in Minnesota ?

The "search and rescue" group of small girls began to count.

ONE. TWO.

Meanwhile, my scurrying about reminded me to tell them to, “Count Loud” and “NO peeking." They, in unison, guaranteed this with giggles and laughter.

THREE. FOUR.

My eye scanned the topography. Where to hide? How long would it be to hide quickly, yet stealth like? Scanning the local yard’s horizon, a brilliant idea now could become reality. Ha ha ha. Those little ones will never see me there.

FIVE.

Quickly, quietly, and with ease my legs jumped up into the tree. This tree was strong. It could hold an adult, even a hidden stealthy adult. Lots of those huge Minnesota leaves that would cover all the color of the “hide n’ go seek” secret agent. So covert.

SIX, SEVEN, EIGHT.

Hurriedly my arms pulled my body into location, in the tree. Knowing how to quickly judge and climb a tree was like riding a bicycle or swimming to me. All those hours building huge tree houses in the skies of tall ash or elm trees now would pay off. All those limb evaluations of size versus strength and caliber were emblazoned in this climber. This was a confident spot.

NINE.

As my arms lifted me into position, with my sitting spot almost prepared, the little girls were starting to rustle. Shifting my seat gently as not to be heard by doing a pull-up on the branch above, suddenly my stealthy world changed.

TEN.

As my pull-up ended, my line of sight was slightly diagonally upward. A loud noise, a squeal. Then heard of buffalo, a covey of quail, and a wild horse stampede came right at me! My ears were frozen on the word, “TEN” that the little princesses had yelled. My eyes were beyond frozen to see eye to eye with it.

Squirrel attack !!!

Yes, man to female animal, face to face, and eye to eye there it was. No time for a counterattack. It was cold. It was heartless. The attack of the mother squirrel was like no other. Brutally shown teeth, larger than a shark – claws drawn, sharper than the griz. Lightening speed, out of no where. An ICBM loaded and launched at the intruder. No early warning system for the unprepared “hide n’ go seeker.” BAM. The war was on. Knowing my face had been hit, a cover was needed. No where to hide now. Too far up to jump, as a youth might attempt. Age and wisdom prevented that action quickly. Swiping away the blood, my fight was limitless but so ill directed. Not once was there a hit on the enemy despite readjusting my coordinates while in the leaves. Retreat was the only option. Cut the losses. Sooner, not later. This mother wasn’t retreating from the nest she had so preciously prepared for the family.

The gaggle of girls was coming down the sidewalk. They too had heard the noisy breach of the stealthy sacred safe place. It was over…almost.

The “hide n’ go seeker” now did what all attacked, retreating, and severely mentally and physically injured “hide n’ go seekers” do. Swing out of the tree. With two great leaps of caliber-calculating swings, my feet hit terra firma. Solid. Looking around quickly, the attack was over.

All the faithful players of the “hide n’ go seek” family game came running. My position was still of a prepared martial arts stance, ready to counter strike as if a secondary push might occur.

“We see you,” they all yelled. The girls approached quickly to prove they had seen me. But as they received their victory in game, they realized what was different. Suddenly, they all began screaming at the top of their choral lungs, high pitched in fear, yelling and running away faster and faster. My daughter said, "Daddy, you have blood,” and she ran away too, to the safety of the flock. Reaching up to my face, it was warm, and slippery. Looking at my hand, realizing my sweat from the environmental battle was not red – it was blood. Wiping away the blood from my hand to my pants, the flow of blood continued. A painted warrior of sorts.

My wife came outside to see how things were going with the “hide n’ go seek” game. She had come around a corner just as the girls were approaching. “My goodness,” she said, “Why did you fly out of that tree…to scare the girls…They were yelling so loud…And YOU looked like a gorilla flying out of the tree… AND you are bleeding!” “What happened?”
Re-living it…worse….

As my eyes close yet to this day, that mother squirrel is in my view forever. Everyone survived. A family moment. A father-daughter memory forever. And now you know why my 20 something daughter sends reminders once in a while, and why she sent me a shirt with a squirrel on it that states the rules: “ADVICE FROM A SQUIRREL.”

WEST NILE VIRUS UPDATE – IDAHO LEADS NATION DISCUSSION CONCERNING PANHANDLE DISTRICT

IDAHO LED THE NATION IN 2006 AND WAS THE HARDEST HIT AREA IN THE USA FOR WEST NILE VIRUS. 996 cases of WNV were diagnosed in 2006 with 171 neuroinvasive type and 825 fever – and 23 deaths. (neuroinvasive = meningitis, encephalitis, neuro complications during and after diagnosis)

As of June 2007, GEM COUNTY has identified the first positive mosquito pool in Idaho.

Hospitals, physicians, health professionals, and labs must report probable and confirmed cases.

PROTECT YOURSELF AND PROTECT YOUR KIDS THIS SUMMER.

The biggest problem in the Northern Idaho region that I talked with Panhandle representatives about is the standing water drainage systems.

It appears that the Planning and Zoning, government maintainence such as roadways, and the health departments are NOT talking to each other. The ground water grassy swales that are imposed are now the breeding grounds for such mosquito populations. This water is stagnant until it filters down through the ground to protect our ground water. The drains typically are set 8 inches above the level of the ground to allow overflow in heavy rains or runoffs, but this is the rub. The swales stay wet. Hopefully all parties will begin to plan for such health disasters at the early stages of future developments. Revising the swales may need to become a priority.

Review WNV and WNV-birdflu-hunting at the these sites:

http://www.castmd.com/?p=35

http://www.castmd.com/?p=45

www.cdc.gov

www.westnile.idaho.gov

YELLOW BELLIED MARMOTS AND CASTMD BATTLES OF EPIC PROPORTIONS

Those darn "yellow-bellied" marmots. Yes, my wife and I did talk with the Minister of the Blog-O-Sphere last Saturday at the Shabby sale. I was telling him, while my wife laughed WITH me, not AT me the infamous tales of the marmot wars going on at our home.

We live up on a hill. It has always been peaceful. Then one day, while playing my guitar sitting on the deck…I see what?? This big flowered plant in my wife’s garden area is shaking back and forth. What?? Did my eyes deceive me?? Looking around the lawn and into the aspen trees, no wind was noted. Then suddenly, like someone had yelled, “TIMBER” in my ears, the plant fell over..crashing into the lawn. Now one might think I was crazy. But, I carefully placed my guitar on the stool…walked over to the now fallen beautiful comrade. Yup…eaten flat across…sharp dissection as with a scalpel blade…less bloody in vision, but more bloody in revengeful feelings. Let the war begin!

We had been having trouble with some of our plants and flowers. It continued randomly until more lakeside building below us happened. These marmots, cute, furry, and cuddly, are quite the resistant critter. What to do. One of the local varmint guys said, “All’s you can do is shoot ‘em.” In the neighborhood I thought? Hardly. Plus, they’re stealthy and quick. They watch for you. A squeak from a door alone will alarm their defensive dive into the ground.

We saw an ad or product about keeping the varmints away. They were these submarine-torpedo looking aluminum rods. Standing about 20 inches tall and 2 inches in diameter, with batteries loaded, you push them into the ground. At random times, a signal is sent shaking the earth…maybe similar to the new movie, Ocean’s 13. Well, anyway, we had these avenger rods throughout our garden and greenery. Day after day…the plants were felled like a clear-cut in the woods. What were we to do…?

We thought there was a rather large family reunion of these varmints, marmots now called of the squirrel family…near one of our home-grown rock planters. I paid my son and his buddies years ago, a dime for every rock bigger than their hands, to build these planters. This area became ground zero. So, the water hose it was, "water boarding," I thought. We waited and stalked the critters. Flushed for hours, trying to make their life miserable. What did I see? I swear to the Almighty, one of them sliding down the hillside, like kids on a Slip n’ Slide®!

Now knowing that my enemy was strong and well fortressed, it was time to talk with more professionals. Well, my attention was directed to the smoke bombs. These things are more powerful than Superman, more web entangling than Spiderman, and more dangerous than CatWoman. So I purchased a sleeve of these poisonous smoke producing rods. Well, off to the planning stage again, securing a savagely strategic plot against those critters. No more buying flowers and plants redundantly. Think of the money to be saved. Early retirement I thought.

So, I carefully inspected the hillside. Monitoring each and every move by these unwelcome visitors, THIS plan would become the "Mission Accomplished.”

While holding my breath literally, I lit one of these smoke bombs and slid it into the hole. Then number two into another, then number three, and lastly number four…like torpedoes being called from the master.

I thought this will be it. Victory so close to grasp.

After about three to four minutes, happily watching from my perched binocular position, an amazing universal, near existential experience was witnessed. My whole hillside now smoked, not the four holes…but hundreds. Like the exhausting sulfur gas fields of Yellowstone and Glacier, the property was steaming with this poisonous smoke.

Within a few minutes, I thought, someone is going to call the Fire Department due to all the smoke. Outlet after outlet, the rising smoke then diminished. It was over. The offensive was over. My observation keen. Success.

Call me crazy, but thinking back, I swear the smell of cigar smoke was amongst the gas-smoke smell. Could those little furry varmints have been sittin’ back with a cold one, smokin’ a cigar in their cozy dens, watching the doctor’s next strategic play?

The next morning, about three more plants had been felled…But soon, new construction left huge rocks and boulders about a block away.

It seemed they found a new territory.

BREAKING TV NEWS AFTER MY BLOGPOST: MARMOT INVASION

AARP article misses the boat – DRUG SAMPLES AND DRUG REPS – MAYBE NOT SO BAD – BUT LIMIT THE DIRECT-TO-CONSUMER ADS and LAWSUITS

A recent article in the AARP Bulletin highlighted an email of a drug company's inside commentary on drug representatives and their impact on physicians' practices. Congress was on this subject of how doctors obtain information years ago, and rather than mandating legislation, the Pharma Industry limited themselves. Now the irony here is that, all the Pharma Industry now advertises the millions and millions of dollars for their new drugs on television, cable and non-cable, radio, and the print media. How many ads of erectile dysfunction have you seen or watched in the last few years? What about allergy drugs? Those ads seem to be everywhere also.

Meanwhile, most doctors get some of their information from drug company representatives. The doctors of yesteryear were wined and dined – alot. But all that has changed. Company meetings for continuing medical information and education are sponsored for cost. However, the rules are tight. No trips to Hawaii have ever been offered to me, in 25 years or so.

Now the medical appliance industry, like the artificial hips, pacemakers, etc., are not included in the Pharma SELF-imposed rules. This industry works like many others. Recently my awareness was stretched when a person told me ALL hundreds of employees of a beer industry were wined and dined, golfed, and brought to a city with alot of casinos! All on the company. And recently a marketing company took hundreds of employees to another city for 3-4 days, for their needs.

Now, most doctors do like to see drug representatives. We do get good and current information from the reps. If the doctor has a brain, he or she will and can challenge the drug rep with his product, his information, and his competition. This is good information.

Literally, thousands of patients through the years have asked for "Any free samples?" Many times we can accomodate some starter paks of medicines that have been given to us by the pharmaceutical representatives. Most clinics get some samples for patients. According to a recent study over 75% of clinics get free samples. Many times the reps will sponsor quick to the point luncheons. Some doctors join company panels to discuss the highlights and controversies of new therapy. So, what is the big deal?

Most pharmaceutical reps are good people. Most earn their living by providing information currently and timely. Most doctors are good people. Most earn their living by providing good patient care. Most patients are good people. Most enjoy and sincerely appreciate a "few samples" to start their drug regimen.

Now, with the costs of drugs so high, and the pressure on the drug companies to limit free samples or starter paks, it would seem to be soon – a policy that will be forced out. This will be a loss for the underinsured, uninsured, family of four parents, and others that look at the costs in general of healthcare and delay or eliminate their prescription all together.

The billions of dollars spent on "direct-consumer-advertising" that is endorsed by the FDA and other federal, state, and societal organizations is the first place to cut drug costs. Those ads drive the physician by patient requests. Get rid of direct to consumer advertising. Next, get rid of the massive class action suits against all the companies. The U.S. has driven the vaccine industry out of the U.S. and the drug making is not far behind. If the vaccine shortage concerns did not awaken some fear in you, this should.

So, soon, patients will say good bye to free samples, free starter cost reduction cards, and reduced up to date physician information.

As for me, trips, rock n' roll collections, and tennis racquets have not crossed my desk….And to say they do is just crazy by a biased author. And some of the doctors will stay "chummy" with professional colleagues in the pharmaceutical representative business. Some might call that professional interaction and ethical education…

SALT USE AND CARDIOVASCULAR DISEASE AND HYPERTENSION

Stroke and other cardiovascular diseases are linked closely to high blood pressure. In many studies, hypertension is a strong predictor of these severe problems, including stroke (brain attack), congestive heart failure, and even myocardial infarction (heart attack).

The importance of salt intake (sodium chloride) with regard to high blood pressure is well linked. Most of these studies have been a type of case control showing high probable causal relationship. Some other studies have shown that higher salt intake predicted the higher incidence of cardiovascular diseases over time.

But a recent published and peer reviewed study, with randomized NON-hypertensive persons, about 3000 of them, has put a strong lock on this issue. In the study, persons were given about 2.6 gms or 2.0 gms of salt daily. Another group of placebo was a control also. The groups were followed out to 18 months or 36-48 months. Then all the groups (cohorts) were followed over the next 10-15 years!

There was a remarkable 30% (approximate) lower incidence of cardiovascular events during this period. This finding was controlled for age, body mass, sex, ethnic origin, and initial blood pressure – when compared to the placebo group.

We have long known this concern of salt and high blood pressure and other cardiovascular diseases. Even back in about 1985, the World Health Organization recommended the salt intake to be reduced to about 5 grams per day.

In "Westernized" countries, bread and processed foods account for the great majority of salts in the diet, with personal use being about 15-20 %. In many developing countries however, the personal use is the burden of salt. Some countries have tried to "legislate" salt reduction, however most of the time, this effort turns to "voluntary" agreement programs with good intent, rather than hard legislation. More efforts of education and the reason for limiting salt intake should be forwarded by all the main agencies such as the American Heart Association (AHA), the American Diabetes Association (ADA), and others that take the lead to limit cardiovascular disease, morbidity, and mortality.

So think about it. Should we legislate the prepared foods, soda and beer, snack, eat 'n run, cafe, restaurant, and bar industries to limit the salt in their products? Dear ol' Mom probably had it right when she said, "Not so much salt!"

So next time you pick up the product, do a salt survey. Remember less that five grams a day is highly recommended, while 2 grams a day really makes a difference in your actual risk. The debate appears to be over. Salt can take a toll. Be a wise shopper and a wiser eater.

Salty popcorn with butter anyone? Remember, more fiber, less salt, less trans-fats….Yuk!