Sunday, April 13, 2008


The Sunday Times Week In Review section contained this nifty letter:

To the Editor:

Thank you for bringing attention to the growing problem of access to primary care in Massachusetts. The problem has been worsened by our universal health care initiative, which was missing a strategy to increase the number of providers to serve the increase in patient load.

Your article, however, focused on increasing the number of doctors to solve the primary care shortage. Nurse practitioners have been filling this role for more than three decades by providing the best in health care.

We are the future of primary care. Make an appointment. We’re open.

Robb Stenson West Falmouth, Mass., April 7, 2008

What universe am I living in? The buffoon can’t be serious! It’s just not possible. Nurse Practitioners are the future of primary care? They are providing the BEST in health care? No one, and I mean NO one in their right mind could believe such a thing. Not even Robb Stenson (and by the way, why the two ‘b’s? Does that stand for BIG BUFFOON??) asks to see an NP OVER a doctor! That’s right! I don’t see any NP hospitals and people clamoring to see NP’s INSTEAD of doctors! They are ANCILLARIES!!! Did they forget that?

It truly makes me just want to give up. Can Internal Medicine be devalued any further? Why do I teach it to med students, when apparently NP’s are the future anyway? And they wonder why students don’t want to pursue a career in IM. Jackasses like Robb Stenson apparently feel they are better than IM doctors and they have a tenth of the training.

I give up. The Apocalypse of Medicine is surely upon us.

Sunday, March 16, 2008


The New York Times published a story on the front page of Sunday’s paper about a drug used to treat Gaucher’s disease. The drug is a enzyme replacement for the inherited deficiency in glucocerebrocidase. I was not even aware that the disease can present initially in adulthood. I’ve never seen a patient with it. Not surprising, since only about 20,000 individuals in the United States have ti (according to UpToDate).

The drug in question, Cerezyme, is made by the Genzyme company. As the Times’ Andrew Pollack reports:

Sales of Cerezyme totaled $1.1 billion last year, making it a blockbuster by industry standards.”

Yeah, I’d say that’s a blockbuster by industry standards. Or ANY freaking standards. Of course, any drug rep whoring for Pfizer will tell you, it’s the R AND D costs that make these drugs so expensive. The article goes on to say:

But critics say the company’s development costs were minimal, because the early work on the treatment was done by the National Institutes of Health, which gave Genzyme a contract to manufacture it. And analysts estimate the current cost of manufacturing the drug to be only about 10 percent of its price.”

When the government hands out these “contracts” to private companies, they don’t seem to care too much about the general public, do they.

Now, I’m all for businesses making a profit. I’m no socialist. However, just as the public (and the government) have decided that doctors should not be aloowed to make too much money, so they (and the government) should not allow ANY healthcare providing entity to make any amount of money they want. This goes for Big Pharma, for medical equipment companies, for medical insurance companies, etc. etc. Since physicians are supposed to be putting patients first, why the HELL aren’t these other companies forced to do the same? It’s not as if they have different customers than doctors do. It’s not as if they are getting the money from a different place than doctors are.

And another thing, if this drug is costing insurers 1.1 billion dollars a year (and I’m assuming none of that is being paid for out of pocket by patients), then how can doctors be primarily to blame for rising healthcare costs? I don’t cost anywhere NEAR that much. Think how much money could have been saved if the United States had just set up the drug manufacturing for Cerezyme by itself. No profit would have been sought. The drug would probably be like 100 bucks a shot.

BUT NO!!! Let’s cut reimbursement to all Primary Care doctors, so we can heap billions of dollars for a drug that treats a few thousand people. Makes perfect sense. In CRAZYLAND!!!

Monday, March 3, 2008


I was just watching the travesty that is the CBS Evening News with Katie Couric. They reported that in Texas (and even Iowa) many people fly to Mexico for healthcare and prescriptions to reap the delicioso savings available in a town called Metmoros or something like that. Apparently a doctor’s office visit is as low as THREE BUCKS! (He says a visit to a US doctor is 125 bucks. Where the hell did he get that number?)

And then they plant some truck driver making next to nothing who says “The American Healthcare system is a TRAVESTY!”

Byron Pitts is, I am sure, a nice guy. But does he make any mention of the fixed costs that doctors have that they probably do NOT have in Mexico. Rent, for instance, for the Primary Care doctor in my office is FOUR Thousand DOLLARS A MONTH! That’s probably, like, a million bazillion pesos. But I’m guessing the rents are not so exorbitant south of the border. Also no mention of electricity costs, malpractice costs, billing and overhead costs.

If I charged each patient 3 bucks (which the CBS Evening News seems to be exhorting me to do) then I see my practice lasting about 4 weeks, until the rent is due.

I mean, three into 4000 is 1333, so I only have to see 66 patients day to pay the rent. What’s left for my bartender?

I’m guessing neither presidential candidate is going to advise people to go to Mexico for healthcare, a la Mike Bloomberg telling NYC residents to go to Starbucks if they need a bathroom. And doctors are scapgoated, once again, for the rising costs of healthcare. And one of their brilliant proposals is to lower the poverty rate so more people will qualify for Medicaid. I can't wait to get 30 bucks instead of three for an office visit. (and 7 bucks for a follow up in the hospital. Woo hoo!)