Notes & Links:November 19, 2013

Cholesterol Risk Calculator Controversy: What’s A Statin User To Do?
John LaMattina a contributor to Forbes asks the question we all want to know the answer to, Now what for me?

LaMattina presents his personal reasons for continued use of Lipitor. Though he does not speak for everyone using a statin it does speak to his own logic and reasons which may help you sort out what this all means.

Study: Rapid Increase in Breast Magnetic Resonance Imaging Use
Aaron Carroll writing at The Incidental Economist (TIE) shares recent data on MRIs and breast cancer. The study is publish in JAMA Internal Medicine. It was a retrospective cohort study of 10,518 women age 20 or older. Here are the results.

Results  Breast MRI use increased more than 20-fold from 6.5 per 10 000 women in 2000 to 130.7 per 10 000 in 2009. Use then declined and stabilized to 104.8 per 10 000 by 2011. Screening and surveillance, rare indications in 2000, together accounted for 57.6% of MRI use by 2011; 30.1% had a claims-documented personal history and 51.7% a family history of breast cancer, whereas 3.5% of women had a documented genetic mutation. In the subset of women with electronic medical records who received screening or surveillance MRIs, only 21.0% had evidence of meeting American Cancer Society (ACS) criteria for breast MRI. Conversely, only 48.4% of women with documented deleterious genetic mutations received breast MRI screening.

Here’s the bottom line: most of the women who were screened for breast cancer by MRI didn’t have documentation warranting it. Many more women who did have a genetic mutation who might have benefitted from MRI screening didn’t get it.

I would point you to TIE site and this post especially for the comments. It is interesting how everyone sees something different. Isn’t science grand.

Putting Your Physicians in Focus
Dan Dunlop writing at The Healthcare Marketer shares some work from his agency and how they are connecting the consumer to the physician. He shares a new unit Physicians In Focus that focuses on producing high quality physician videos.

I’ve written here on patient physician engagement and its importance because in my mind the brave new world of epatients and how patients are using the internet, social media, and more to engage with their HCP to improve their health. We have to move from patients and caregivers looking at WebMD or chat rooms as a single all knowing resource. The most valuable resource is MyMD. A patients physician is a single most trusted resource for the patient and as such they can drive greater more durable change for those patients who are self directed learners. And let’s not forget the HCP can engage more patients to become self directed learners. Isn’t that what we want in healthcare for patients to become active in their care?

This is an excellent post that presents the objectives and strategy for doing this as well as a great example of a sample video looks like.

Generic Prescribing and Conflicts of Interest
Howard Brody, MD, PhD writing on Hooked: Ethics, Medicine, and Pharma speaks to the recent investigative report from ProPublica on Medicare wasted drug spending on branded drugs vs. generics. This comes across my desk a couple hours after listening to a Marketplace Money’s story on the ProPublica report.

This is from Brody’s post

Medicare prescribers are responsible for a hugely disproportionate excess of brand-name prescriptions and hence unnecessarily high costs. They then  proceeded to check out their Dollars for Docs tool and noted that these same docs also seemed disproportionately represented among those receiving payments from drug companies. When ProPublica reporters visited some of the offices of these docs, they could hardly get in the door for all the drug reps waiting in line to handout free samples and other goodies.

The report at Marketplace Money spoke to a NYU medical site in Brooklyn who were prescribing huge volumes of branded drugs. The director of the site pointed to the fact most of her patients wanted branded because they didn’t trust generic’s to the point of believing it killed a patient.

So I wonder where the truth resides on this, influence from pharma or demanding patients. It is noteworthy that the branded cost only a few dollars more of out of pocket costs so the taxpayer not the patient carries the weight.

I was going to link to the Podcast at Marketplace Money, sure their search engine sucks.

I forgot all about this one of kind music site and discovered during a cleaning of my iTunes folder. Covervile is “The Cover Music Radio Show” that has been around since September 2004. I found a Podcast from November 2004. I wish I could remember how I found it. 

I was surprised to see Brian is still going strong. Check it out because some days we all need to hear covers of great songs.

No Evidence That Statins Impact Cognitive Function
Larry Husten a Contributor at Forbes addresses another concern regarding statins, cognitive function. Have statins become the new black thanks to the guidelines brouhaha. I would love to know the Q score for statins two weeks ago and today.

In the Annals of Internal Medicine Karl Richardson and colleagues found not so much evidence supporting adverse effect on cognitive function.  And a second analysis of the FDA post-marketing databases the same investigators found similar reported rates for cognitive-related adverse events. But

They concluded that the available evidence does not support concerns linking statin use to cognitive impairment. “Larger and better-designed studies are needed to draw unequivocal conclusions about the effect of statins on cognition.”

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