Archive for the ‘Medical’ Category
In the Washington Post Christopher Ingraham points out destructive effects of the microculture that lawyers inhabit:
America’s lawyers have a serious drinking problem, according to a new report from the American Society of Addiction Medicine.
More than 20 percent of licensed attorneys drink at levels that are considered “hazardous, harmful, and potentially alcohol-dependent.” That’s three times higher than the rate of problem drinking among the general public.
These numbers come from a survey of over 12,000 American lawyers, funded by the Hazelden Betty Ford Foundation and the American Bar Association. Male lawyers had higher rates of problem drinking than women, 25.1 percent compared to 15.5 percent. The highest rates overall were among lawyers under 30 (31.9 percent) and junior associates at law firms (31.1 percent). That’s driven partly by younger Americans’ tendency to be heavier drinkers in general, but it also could be a reflection of the stresses caused by trying to move ahead in a highly competitive field.
The factors driving lawyers’ heavy drinking are “a rare confluence of high risk variables,” said study lead author Patrick Krill in an interview. He’s the director of the Legal Professionals Program at Hazelden Betty Ford. The fact that lawyers warrant their own specialized treatment program gives some sense of the prevalence of substance abuse issues in that field.
Lawyers tend to “prioritize success and accomplishment over things like balance, personal well-being, health, etc.,” wrote Krill, himself a former lawyer, in an email. “You put them through a training (law school) where they are taught to work harder, play harder, and assume the role of a tough, capable and aggressive professional without personal weaknesses or deficiencies.”
And the field tends to reinforce these tendencies. “Heavy drinking, lack of balance and poor self-care are entirely normalized,” Krill said. “That’s the behavior that young lawyers see being modeled all around them, and throughout the profession.”
Lawyers aren’t necessarily unique in these traits. Other high-stress, high-performing fields, like medicine, tend to prioritize them as well. But the extent of the drinking problem among lawyers is unique, according to the survey. On one measure based solely on the quantity and frequency of alcohol use, lawyers had double the rate of problem drinking that doctors did.
The study also found a shockingly high rate of depression — 28 percent — among American lawyers. Among the general public, only 8 percent experience a bout of depression in a given year, according to the CDC. . .
A toxic subculture is like a colorless and odorless toxic gas: you can be immersed in it and not notice it, but it can still inflict serious damage. In the case of the gas, the causes are chemical and biological; in the case of the subculture, the causes are (basically) memes: the values and habits of mind the culture encourages.
Philip Smith reports in Drug War Chronicles:
On Wednesday, a group of 21 US senators and representatives sent a letter to the Department of Veterans Affairs calling on it to allow VA doctors to discuss and recommend marijuana as medicine in states where it is legal.
The bipartisan effort was led by Sens. Kirsten Gillibrand (D-NY), Steve Daines (R-MT), and Jeff Merkley (D-OR) and Reps. Earl Blumenauer (D-OR), Dina Titus (D-NY), and Dana Rohrabacher (R-CA). All represent medical marijuana states.
Under current VA policy, embodied in VHA Directive 2011-004, which expires Sunday, VA doctors are prohibited recommending marijuana as a treatment option even in legal states. This discourages patients and doctors from being honest with each other.
“According to the current directive, VA providers are prohibited from completing forms seeking recommendations or opinions regarding a veteran’s participation in a state-sanctioned marijuana program. This policy disincentivizes doctors and patients from being honest with each other,” the solons wrote. “Congress has taken initial steps to alleviate this conflict in law and we will continue to work toward this goal. However, you are in a position to make this change when the current VHA directive expires at the end of this month. We ask that you act to ensure that our veterans’ access to care is not compromised and that doctors and patients are allowed to have honest discussions about treatment options.”
If patients can’t get a recommendation from their VA docs and thus can’t access dispensaries, they would be tempted to go elsewhere for recommendations, to doctors “likely far less familiar with their symptoms and medical history,” the solons wrote.
Noting that there has been a “sea change” in the legal framework around marijuana since the directive was issued in 2011, they asked that “upon the directive’s expiration, any new directive remove barriers that would interfere with the doctor-patient relationship in states that have chosen to legalize marijuana for medical purposes.”
But without a new directive, even though the old one is expiring, it will be the status quo at the VA, said Michael Krawitz, a US Air Force veteran and executive director of Veterans for Medical Cannabis Access. Krawitz participated in the process that led to the production and distribution of the directive.
“VA Directives remain in effect with full force even after expiration unless they are officially replaced or rescinded,” he said. “Although I can understand that patients might not know that and might get uneasy about the expiring directive, but in practicality there should be no change in clinical practices caused by the expiration.”
While VA patients could be spooked by the expiration, the status quo is unacceptable, said Dr. Sue Sisley, MD, in clinical psychiatry and internal medicine, who has two decades of experience treating veterans and who is set to do apilot study on medical marijuana and PTSD for veterans.
“I’ve worked with veterans all over the country who are dealing with severe and chronic, debilitating medical problems,” she said. “They just want the treatment that is going to help them the most, with the least side effects. I have seen firsthand the dramatic improvement so many veterans have had while taking cannabis. Not only have they experienced relief from problems such as PTSD, chronic pain, and migraines, but many of them have also been able to break their addiction to more dangerous drugs, such as opioids and benzodiazepines.”
VA staff physician Deborah Gilman, MD, said current VA policy forces physicians to ignore the science if it conflicts with policy.
“Unlike private practice physicians, VA physicians are under a gag order regarding discussing marijuana with patients,” she said. “In other settings, doctors can be honest about their medical opinions regarding treatment options, based on science. In the VA, an administrator can write policy that you can’t disagree with without losing your job. Veterans are fearful of losing either their medical benefits or their access to health care if they acknowledge using marijuana. This causes a VA doctor to give you a medical opinion based on the VA regulation, not on the science. I knew many VA doctors whose professional opinion was that cannabis might help some of their patients, but they could never say so in their office or in public.” . . .
President Obama is in charge. Isn’t he? Doesn’t the buck stop there?
I don’t think that “They’re doing it, too” is much of a defense for a wrongful act, but the fact that Shkreli is correct in pointing out that other companies are also profiteering by jacking up prices of drugs people must buy is an argument that government regulation is required. The free market will not fix a problem created by the free market.
UPDATE: Read this Atlantic report about Shkreli’s appearance before the House committee.
Robert Langrath and Rebecca Spalding report in Bloomberg Business:
After Martin Shkreli raised the price of anti-parasitic drug Daraprim more than 50-foldto $750 a pill last year, he said he wasn’t alone in taking big price hikes.
As it turns out, the former drug executive was right. A survey of about 3,000 brand-name prescription drugs found that prices more than doubled for 60 and at least quadrupled for 20 since December 2014.
Among the biggest increases was Alcortin A, a combination steroid and antibiotic gel to treat eczema and skin infections: The price soared 1,860 percent, or almost 20-fold, during the period. And a vial of Aloprim, a Mylan NV drug for cancer complications, more than doubled, according to the survey by DRX, a provider of price-comparison software to health plans.
Skyrocketing prices are getting increased scrutiny ahead of a U.S. congressional hearing this week: Democratic Representative Elijah Cummings, ranking member on a committee that is probing drug pricing, said Tuesday that pricing “tactics are not limited to a few ‘bad apples,’ but are prominent throughout the industry.”
Even after soaring prices became an issue in the U.S. presidential campaign, the cost of many drugs has continued to rise at annual rates of more than 10 percent. Drugmakers raised the prices of products as wide-ranging as erectile dysfunction drug Viagra, heart treatments, dermatology medicine and even brands that long have lost their patents. While specialty companies have had the steepest hikes, giants such as Pfizer Inc. and GlaxoSmithKline Plc kept pushing through smaller rises.
“The data shows that price increases are an integral part of the business plan,” said Jim Yocum, executive vice president at DRX.
Pharmaceutical companies often boost prices around the end and the start of the year, and the scale of recent increases was higher than what Yocum has seen in the past few years. About 400 formulations of brand-name drugs went up at least 9.9 percent since early December, according to DRX. . . .
Jimmy Carter has reason to be proud of this great accomplishment. Nell Frizzell reports at Motherboard:
The image of a serpent twisting around a staff is probably medicine’s most enduring icon; we wear it on medical alert bracelets, hang it in doctors’ surgeries, and print it on healthcare documents. But the story behind the so-called fiery serpent is, at least according to former US President Jimmy Carter, almost over.
Since 1986, incidences of Guinea worm disease have reduced from 3.5 million to just 22. Read that again—just twenty-two. It’s a drop so enormous that medical experts believe Guinea worm disease is on the brink of becoming the second ever human disease to be completely eradicated through human endeavour, the first being smallpox in 1980.
This week, The UK’s Department for International Development announced a £4.5 million partnership ($6.6 million) to support the Carter Center’s Guinea Worm Eradication Programme. Following the announcement, Carter took to the stage in the gloriously camp, gilt-edged Queen’s Robing Room at the House of Lords on Wednesday evening to speak about his 30 years spent battling the disease.
For centuries, the only treatment for Guinea worm has been to wait for the parasite, which breeds unseen in stagnant water, to burrow out of human skin, then wrap it around a stick and slowly wind it out of the body like a blistering cotton reel over 20 days. This is one theory of where we get the snake around a staff symbol from—a worm and a stick. The process of extracting Guinea worm is not only as unpleasant as it sounds (the worms grow up to a metre long and can break out anywhere on the body, sometimes with as many as 81 emerging from a single person, according to one representative of the Carter Center) but the lesions can often lead to secondary bacterial infections. In short, getting Guinea worms out of your body is every David Kronenberg nightmare made flesh.
The eradication of Guinea worm disease is, in his own words, former President Jimmy Carter’s “most satisfying achievement.” In 1988, just a few years after leaving the White House, Carter travelled to Ghana where he saw a woman holding what he thought was a baby in her arms. As he moved closer, he realised that what this woman was holding was in fact her right breast; a Guinea worm was emerging from her body through her nipple, creating a searing blister and untold tissue damage. As there is no known cure for Guinea worm disease, the focus had to instead be on prevention; educating what Carter described in his lecture last night as “the poorest of all people, but who are as intelligent, ambitious and as hard-working as we are.”
The science behind the programme is so simple that it can be communicated in a cartoon. A special water filtration system—which looks like little more than a large fine-weave hair net fitted over a bucket—cleans water of the copepods or “water fleas” that carry the Guinea worm larvae. In Nigeria, which had 656,000 cases back in 1988 at the beginning of the programme and now has none, 6 million square metres of a special fibre were created to filter people’s drinking water without rotting in the damp, tropical conditions. In countries like South Sudan, where people frequently move around to access water, the Carter Center gives out special straws, worn around your neck like a pendant, to filter water as you drink it.
Back in 1986, there was no YouTube, no television, and little radio to be found in the countries worst affected by Guinea worm disease. So the medical experts involved in the programme turned to cartoons—posters and picture books showing how Guinea worm disease is contracted and how to filter your drinking water. These pictures have now become so widespread that they can even be found printed on the cloth that people use to sew t-shirts, dresses and shirts—literally a walking advertisement for the public health programme. . .
Gruesome photo of a guinea-worm extraction from someone’s foot is shown at the link.
Kevin Drum gets down into the nitty-gritty of evaluating costs of proposed plans. And it’s quite interesting, showing how two people looking at the same plan can differ greatly in their estimation of costs—and thus in answering two key questions, “Is it worth it? and is it fiscally sustainable?”
The free market seems to work well in solving problems if there are large profits to be made from the solution. If the solution does not involve large profits, it seems that many corporations lose interest and decide to leave the job for some other company less interested in large profits. (There are very few corporations in the profit sector that are interested in small-profit ventures.)
In the NY Times Sheri Fink provides a disturbing description of how the US free market approaches drug shortages:
In the operating room at the Cleveland Clinic, Dr. Brian Fitzsimons has long relied on a decades-old drug to prevent hemorrhages in patients undergoing open-heart surgery. The drug, aminocaproic acid, is widely used, cheap and safe. “It never hurt,” he said. “It only helps.”
Then manufacturing issues caused a national shortage. “We essentially did military-style triage,” said Dr. Fitzsimons, an anesthesiologist, restricting the limited supply to patients at the highest risk of bleeding complications. Those who do not get the once-standard treatment at the clinic, the nation’s largest cardiac center, are not told. “The patient is asleep,” he said. “The family never knows about it.”
In recent years, shortages of all sorts of drugs — anesthetics, painkillers,antibiotics, cancer treatments — have become the new normal in American medicine. The American Society of Health-System Pharmacists currently lists inadequate supplies of more than 150 drugs and therapeutics, for reasons ranging from manufacturing problems to federal safety crackdowns to drugmakers abandoning low-profit products. But while such shortages have periodically drawn attention, the rationing that results from them has been largely hidden from patients and the public.
At medical institutions across the country, choices about who gets drugs have often been made in ad hoc ways that have resulted in contradictory conclusions, murky ethical reasoning and medically questionable practices, according to interviews with dozens of doctors, hospital officials and government regulators.
Some institutions have formal committees that include ethicists and patient representatives; in other places, individual physicians, pharmacists and even drug company executives decide which patients receive a needed drug — and which do not.
An international group of pediatric cancer specialists was so troubled about the profession’s unsystematic approach to distributing scarce medicine that it developed rationing guidelines that are being released Friday in The Journal of the National Cancer Institute.
“It was painful,” said Dr. Yoram Unguru, an oncologist at the Children’s Hospital at Sinai in Baltimore and a faculty member at the Berman Institute of Bioethics at Johns Hopkins University. “We kept coming back to wow, we’ve got that tragic choice: two kids in front of you, you only have enough for one. How do you choose?” . . .
Misogynists abound, apparently. Read this guy’s experience.
What on earth makes some men so hostile toward women? Is it because they view women as weaker?—that is, the man feels safe in mistreating a woman because he thinks he can beat her up? That doesn’t cover the cause of the hostility, merely explains why the man feels free to express it. Did their mothers treat them badly? Do they in fact feel a kind of hostile anger to everyone but are fearful of expressing it toward a man?
I don’t get it, but it’s real, as this guy found out.
I did do a Google search.