Minor Thoughts from me to you

Putting drug risks into context:

Is it riskier to take a daily aspirin, drive a car or fight fires? Turns out they all carry about the same risk -- between 10.4 and 11 fatalities per 100,000 person-years, according to a study in the May/June Health Affairs, a policy journal published by Project HOPE.

Their findings surprised them. For example, taking Vioxx (rofecoxib), which was withdrawn from the market in 2004, or Tysabri (natalizumab) for multiple sclerosis was comparable to or exceeded the risk of dying in a car crash, working as a truck driver or rock climbing.

On the other hand, it was less risky to take either drug than it was to drive a motorcycle, work as a logger or climb the Himalayas.

We removed Vioxx from the market for this?

Of the 45-50 million people in the U.S. who lack access to healthcare, only 10% lack access because they can't afford it.

We also found ... that the most common reason respondents cited for lacking a usual source of care was that they were seldom or never sick. Cost was cited by only 10.2% of respondents...Overall, 72% of the estimated 42.7 million adults without a usual source of care in 2000 apparently had little or no preference for one, and a minority (28%) appeared to prefer to have one, if they could.

By ignoring the possibility that many adults do not have a usual source of care because they either do not want one or place low value on having one, important implications and true barriers are obscured.

This is why I oppose an individual mandate. Why should I force someone to buy health insurance if they have no need for it or don't want it?

Is it a bigger problem that people can't get access to healthcare or that they when they do get access to healthcare they drive up the cost by getting services they don't need?

Here, single payer advocates like to have it both ways. On the one hand they speak of inability to get care, while simultaneously decrying that up to 50% of care is unnecessary. Which is it? Or is it both? And, again, how is it that an unelected bureaucracy, given complete authority over what care you can choose to purchase with your own money, do a better job of both MAKING people take the doctor's advice, while simultaneously preventing the 50% of care they think is uneeded? Again, single payer advocates have no answer for this other than a 'panel of experts' that will be immune from criticism from individuals, but highly susceptible to the money and efforts of aggressive lobbyists.

My pharmacist wife will sympathize with this lament about prescription refills:

I suspect a great many doctors shoot from the hip when it comes to refills. What makes me think this?

Well there's this weird little loophole in our automated refill request line where someone can request a refill and trigger an auto-fax to the doctor if the script has expired or run out of refills. It's all automatic -- no pharmacy personnel even see the refill request before it gets sent. Our computer systems aren't typically smart enough to check and see if there's a replacement prescription in patient's profile already.*

What's amusing is that often this second prescription differs from the first. Not significantly, but where the first might have 5 refills, the second has 3. Or 11. Or maybe zero. Often we'll get two scripts with the old refill number on it sent back on the same day, each with a different number of refills, usually in the same handwriting. This makes me wonder ... how are you guys charting this stuff?

Is this why we get phonecalls asking what strength of a drug a patient is taking? And how are they taking it? And please give them six months worth of refills?