March 2009

Tuesday, March 31

The United States began allowing direct-to-consumer advertising of prescription drugs in 1997. It’s still one of two developed nations that allow what’s known in the business as DTCA, the other being New Zealand.

We all know the result. You can’t watch anything on TV without being inundated with messages for the latest pharmaceutical innovation, sometimes designed to treat conditions you didn’t even realize were considered illnesses.

My wife and I sometimes watch them on mute, and there’s a formula. Shots of families frolicking, people in their 50s or older, playing with their grandchildren. Then, some pain. A close-up shot, maybe a wince. Some video of the pills themselves, releasing their healing properties into the body. That’s followed by more frolicking, laughter, sometimes hugging.

Because you have it muted, you miss the whole section on side effects, which may be rare, but vast. Viral infections, blood disorder consequences, liver diseases. This is not to say that, on balance, they aren’t beneficial and life-altering.

But in Britain, they are looking at this issue very seriously. They don’t allow prescription drug advertising in Europe, but it’s under discussion. The BBC took aim at the issue in an article Monday, pointing out that 10% of British children have a recognizable mental illness. The news organization also quoted a “medical historian” who had unkind words to say about Viagra and similar remedies.

Current proposals in Europe advocate prescription advertising on medical Web sites and magazines. That’s a far cry from what’s happened in the U.S. where, according to the Web site, $4.2 billion was spent on DTCA in 2005. The average percent increase in DTCA since 1997 is 19.2%.

Between direct consumer advertising and promoting drugs to physicians, companies spent almost a third as much annually as their budget for research and development ($11.3 billion compared with $31.4 billion). The counter argument is that companies wouldn’t have as much to spend on R&D if it weren’t for the income generated by advertising. I’m sure that’s an argument that stockholders readily embrace.

The real question to be asked is, does consumer pressure for a particular prescription lead to better health? Because really, if a new drug could benefit a patient, doesn’t it stand to reason that the physician already knows about it?

Who benefits if the patient ends up pressuring the physician to prescribe a drug that they’ve seen on TV? This isn’t the only issue to weigh, but it’s a question that we ought to be asking.

Monday, March 30

I started running in 1990, when I was 36 years old. I went in for a routine doctor visit, and he asked me what kind of exercise I did. I told him I biked, maybe three times a week.

But he said biking didn’t really build up your endurance all that much. The starting, the coasting, the stops. (OK, I know there are serious bicyclers who accomplish tremendous workouts, but I’d been taking casual rides.) “You ought to start running,” he said. So I did.

I hadn’t run since high school, when we were forced to run a mile. That was my first target, and it took me a few weeks to reach it on a regular basis. Pretty soon I was running a mile three times a week, plus walking and still biking.

Flash forward five years, and I was running two miles, three times a week. After seven years, it was three miles. By then, maybe I still wasn’t in the most spectacular shape, but I enjoyed it.

Right around 2000, I upped it to four miles, but still three times a week. I felt pretty good on those days I ran. But I was getting allergy symptoms: sinus headaches, sneezing fits, especially on days when I didn’t run.

Shortly after that, I went to work as the managing editor at Psychotherapy Finances, the practice building newsletter. Because I was working from home two days a week, I was able to up my running to four miles, four times per week. But I still had occasional sinus problems. And as I shot past 50, I started feeling a little creaky. Aching joints became pretty common on days when I wasn’t running.

I was laid off from the job on Friday, March 13, due to the economic tsunami that has washed over the country. When I got home, I immediately went out and ran six miles. The next day I did it again, and the day after that.

After a week I began to notice something. The sinus headaches were gone. There were no more achy days. The longer I kept it up, the better I felt. Two weeks later I went in for my physical and my blood pressure was 118/ 70. Now, six miles is habit. I’m starting to wonder if I should jack it up to seven or eight.

Disclaimer here, of course. I’m not a physician, or a physical trainer. You need to check in with your doctor before launching into any physical training program, including running.

But for me, it’s rewarding, fun, and exhilarating. It’s my own personal stimulus package, and I hope the benefits just keep on coming.

Friday, March 27

The nation was shocked by two high profile murder cases in Texas involving mothers who killed their children. Dena Schlosser used a knife on her 11-month-old daughter in November 2004. She was found not guilty by reason of insanity.

Andrea Yates killed her five young children in 2001 by drowning them in a bathtub. She was given a life sentence, but on appeal was found not guilty by reason of insanity and institutionalized.

The common thread between the two cases: Both mothers suffered from postpartum issues. And now that disorder may be used as a defense in Texas in cases where mothers kill their infants.

A bill has been introduced in the state legislature recognizing the postpartum defense, which would make Texas the first state in the country to have an infanticide law. “It’s something every civilized country has on its books,” George Parnham, the attorney who defended Yates, told The Dallas Morning News on Monday.

There are similar laws on the books in 29 other nations, including Britain, which has had an infanticide law since 1922.

Postpartum depression is not uncommon. Up to 80% of women struggle with some form of it after giving birth. Between 10 percent and 20 percent require treatment. But only about one mother in 1,000 develop postpartum psychosis, which can lead to high profile cases such as those involving Schlosser and Yates. Both women were sent to mental health treatment centers, but 90 percent are usually imprisoned for the crime, according to statistics supplied by a postpartum support organization.

The law would only apply to postpartum psychosis and could not be used as a defense by women who abuse their children. It could come into play in cases where a woman has been found guilty of killing her child within 12 months of giving birth. Then, jurors could consider postpartum issues during the trial’s punishment phase.

Proponents admit the bill is controversial and will be a challenge to get through the legislature this year.

Thursday, March 26

Clinical social workers help their clients get over rough emotional hurdles by offering traditional mental health services. But it’s a sign of the times that the profession has branched out to include a greater focus on people struggling with financial problems, and the toll they can take on psychological well-being.

This brand of counseling is getting a fresh round of attention in the media. And naturally, the demand for services is on the upswing. But although the recession is officially 15 months old, the need for services has been growing for years.

Why? Because debt has been a big factor in people’s lives for the last decade. As wages stagnated, people turned their homes into ATMs and maxed out their credit cards.

Enter the Center for Financial Social Work in Asheville, NC. The organization, founded by social worker Reeta Wolfsohn, has been gaining followers around the country. Wolfsohn points out that money problems are the No. 1 cause of divorce, a major contributor to depression, anxiety, and insomnia, and a trigger for drug and alcohol abuse.

Social workers aren’t specifically schooled in money matters, but that’s changing. The Center for Financial Social Work is offering some training, and its programs have been incorporated into classes at the University of Maryland. And sometimes, financial experts are brought into counseling sessions to lend additional expertise when needed.

Both social workers and financial planners see an eventual melding of services so that family economic stress is addressed at all levels at the same time. In the current environment, look for the government to help with funding for these services as well.

For a more in-depth look at the field, see this National Public Radio piece at The Center for Financial Social Work is at

Wednesday, March 25

It’s long been a standard scene in every doctor’s waiting room. The place is jammed with patients, slightly or greatly annoyed that the office is behind schedule. Then, in walks a man or woman with a leather brief case, very smartly dressed. He or she strides up to the receptionist window and the staff buzzes the door open immediately.

These are sales reps for the major drug companies. Detailers, they’re called. They talk to physicians about their company’s latest products, and leave samples for them to try out.

But now detailers are increasingly being shuffled off on to other office staff, or told not to show up at all. It’s part of a sea change in the way physicians relate to drug companies after controversies over drugs such as Vioxx, an arthritis drug withdrawn by Merck in 2004 over concerns of increased heart attack risk.

Physicians’ schedules are tighter, and the drug industry itself has imposed new rules against giving out freebies like notepads and pens.

All of this has taken a toll on detailers, whose numbers have plummeted over the past year, according to an analysis by the American Medical Association (AMA). While there were 102,000 detailers in the field in 2007, there are about 92,000 today and the number is expected to shrink to 75,000 in 2012. Layoffs have hit the industry.

About 25% of physician practices now have a policy of no solicitation by drug reps. And among those without such a policy, 40% require an appointment.

There’s a detailed story on this trend, with some interesting statistics, in the American Medical News,

Peter Nalen, the president of an online drug marketer, told the publication: “The old sales model is broken now, and who knows how it will look in the future. What’s happening is that pharmaceutical companies are realizing there are other ways to reach the doctor instead of banging on the door of the doctor who just doesn’t want to talk to you.”

Tuesday, March 24

In the mental health field, psychologists and other licensed professionals in solo practice have been catching on to the practice building benefits of online social networks. They’re valuable, not so much as a way to attract potential patients, but in building a network of referral sources.

MySpace, was the pioneer. Other services have evolved that cater to a more professional crowd. Even Facebook has become popular with professionals, and sites like Linkedin and Twitter have surged as practice building tools.

This morning, there’s news that hospitals and larger health care complexes are tapping online social networks for a variety of advantages. A survey published by Ed Bennett, a hospital Web manager working for the Maryland Medical System, shows that 206 hospitals nationwide are using some sort of online network, with 120 of them using Twitter.

As one example, you can see the Twitter account for Northwestern Memorial Hospital in Chicago here: Most of the postings are from the communications department, announcing hospital procedures and programs.

Other facilities are using Facebook, YouTube, or have their own blogs. You can see Bennett’s piece here:

Last month, surgeons at Henry Ford Hospital in Detroit Twittered a surgery, the removal of a cancerous tumor from a kidney. At the same time, photos went out on YouTube. Interested people from around the world tuned in. The Twitter stream is at
Video for the surgery:

The goal is education. But the real benefit for both the surgeons and the hospital is positive publicity. It’s a highly effective marketing tool. The same goes for promoting a private practice, or any other service, particularly if you’re trying to tap a national (or even international) audience. It sure beats sending out a press release.

Monday, March 23

The New Republic takes an inside look at the health care reform debate within the Obama Administration in its April 1 issue. It details how officials came up with the $634 billion price tag on health care reform in the proposed budget, and how advisers were at least in part guided by ghosts of the 1994 Clinton health care fiasco.

White House staff were worried about biting off more than they, or the American public, could chew. And economic advisers like Larry Summers and Treasury Secretary Tim Geithner were opposed to big-ticket spending items in light of the massive financial bailouts that were underway.

Obviously, the efforts at health care reform were complicated by the arrival and quick departure of former Senator Tom Daschle, the Big Idea guy who left the administration over tax issues. It left a vacuum that was filled by those favoring a more cautious approach.

Obama was eventually left with three choices: spending $1 trillion over 10 years, investing $600 billion in new programs, or scaling the budget back to $300 billion. Obama went for the compromise, and decided to work specifics out with Congress—something the Clintons largely failed to do.

Now, where that $634 billion will come from is the key question. As always, there’s talk about reductions and new efficiencies in Medicare and Medicaid. If you cut services, that doesn’t advance the cause of health care coverage. More likely, officials will look for savings in the area of provider reimbursement. There simply isn’t that much fraud in the system to match new spending proposals, although Medicare is definitely stepping up their scrutiny of medical claims.

If you’re in the business of providing health care services, you should be watching closely as the details unfold. See the full story online at

The article, by the way, concludes that Obama is taking a big risk with the budget proposal. If it fails in a political fight, it will kick the health care reform can even further down the road.

Friday, March 20

 Backers of a single payer health care system are incensed that a report published by the Obama Administration this month largely fails to mention support for the concept during community discussions on health care issues. Instead, the Report of Health Care Community Discussions released March 5 includes just one paragraph on the issue.

 The report, which can be read in its entirety by following this link:, weighs options for reforming the existing system. That’s seen as a slap in the face to activists who believe that the American system is broken, has become a cumbersome patchwork of inefficient plans, and needs to be rebuilt from the ground up.

 A March 18 letter to the editor on, a Web site hosted by a group of news organizations in recession-battered Michigan, sums it up. “I am enraged. Tears stream down my face,” the writer said. He added that a Community Discussions meeting in Ann Arbor drew 50 people, most of whom were adamant that substantial change was over-due.  “All of (Obama’s) talk about open and inclusive style was a lie,” the writer concluded.

 Physicians for a National Health Program (PNHP) were equally unimpressed, bemoaning a solitary reference in the report to single payer systems, a reference that pointed readers to a box that didn’t even show up in some Web versions.

 What’s actually in the report? It refers to “specific suggestions,” but they aren’t very specific. From the report: “These ideas encompassed a wide range of topics including establishing health insurance exchanges, decreasing the cost of prescription drugs, developing methods to enhance and promote high-value health care, developing ways to upgrade and simplify information technology, improving health and wellness through education, encouraging healthy lifestyles, and expanding the health system’s capacity.”

These are so broad that anyone asked to implement them wouldn’t know where to begin. It’s essential to have a discussion on the future of health care in the U.S. Single payer may not be the way to go. There’s an argument to be made for expanding medical savings accounts. But we need real ideas on the table, not more convoluted bureaucratic language.