Some miscellaneous rantings:
DRUG PRICES: In the U.S., looney tunes; take DHE: this useful med has been around since 1945(very few bad side effects since then), used SQ at home, or in office, like a triptan…works for many when nothing else does….DHE used to be $3 dollars per vial. Now it is….$3,000 dollars per vial!!(the one company who makes it recently charged that to a patient’s insurance company). In Canada, we can still get it for $17 per vial. (in 1900, we were sneaking into the US aspirin from Canada, as it was much cheaper…that ended cause fake aspirins were coming in, mostly talcum powder….some things never change). We need price controls(desperately); the for-profit companies are a.maximizing profits, and b.gouging us all.
DRUG COMPANIES: yes, above I smacked them down over prices BUT: overall they have greatly improved our quality of life, and since 2001 they are highly regulated(not only no trips and perks for doctors, we can’t even get a pen!!)…they are better ethically than the vast majority of industries(but the pricing structure is crazy)…Many medical offices/hospital systems exclude all drug reps: this hurts patients in 2 ways: no samples(yes, oftentimes the new drugs are better, not just me-toos), and also the docs who don’t get to see reps do not use(or are not detailed/informed on) the newer drugs; plus, MUCH of our education was(previously) fueled by the drug companies; now that has gone downhill; I see residents in neurology lacking in basic headache knowledge; previously they would have had many talks on headache, fueled by the drug companies.
WAR AGAINST OPIOIDS: Generals are notorious for fighting the current war with the the last war’s methods; our media/FDA is still railing against prescription pain meds as the “boogyman”, while the vast majority of overdoses are heroin(and the other street opioids: ones from China, fentanyl analogues, are flooding the streets) related. Pity our poor pain patient: they are in chronic pain, nothing is helping(expect some pain meds), and they can’t get a doctor to prescribe even 20 tabs per month. Docs are afraid, pharmacists are afraid, it is a grim situation for the pain sufferer(yes, of course we use many avenues outside of opioids: they are sort of a last resort….we use all of the non-addicting meds, preventives, and non-medication therapies)…..
MEDICARE: New rules staring Jan1,2017 force the doctor to do much more paperwork “proving” that the patient is doing ok, and using terms like “meaningful use”; basically useless paperwork. If they do not comply(adding time to the visit, just for silly paperwork), the doc is “docked” pay, paid less. So, more docs are dropping out of Medicare, and there is a shrinking pool of primary care for Medicare patients; so, who is punished for the extra govt paperwork?: all of us……….
OVERDIAGNOSIS OF “REBOUND” OR “MEDICATION OVERUSE HEADACHE”: Many neurologists/headache docs reflexively apply this diagnosis to a new patient, even tho it is not true; the current definition of MOH(overuse headache/rebound) is very inaccurate; it is actually a difficult diagnosis to make(you have to take a very careful history of what happened with that particular drug(Excedrin, triptans,Fiorinal, etc), then withdraw the person off of the drug and see how it goes; none of this is easy…This leads to docs UNDERUSING abortives(“as needed meds”), and patients suffering….Doc: only take the triptan(or Excedrin etc) 2 days a week at most: Patients: BUT I have 2 kids, work, what do I do to function the other 5 days?….Doc: I dunno…….
CAM: Complementary Alternative Medicine: NIH has spent almost 19 billion dollars on “studies” of CAM, with virtually NO useful info coming out of that…I see no “regular” medicine or “CAM”, there are: 1.Treatments that WORK, and 2.Treatments that DON’T work. (I am a fellow of the Integrative Society, I believe in anything that helps a person)…..Most CAM therapies have been disappointing, but not all…..overall homeopathy has not been of much help, some herbs(but not many, and quality control is a major problem) help; in my experience, most patients are disappointed with their ventures into CAM realms, but sometimes things do help. Good websites: sciencebasedmedicine.org (basically blogs) and Quackwatch.com