Wednesday, July 13, 2005

Asthma Drug Withdrawal

The New York Times reports: A panel of lung experts is being convened today to advise the government on whether three popular asthma drugs should stay on the market or be withdrawn because of safety concerns.
The drugs are Advair and Serevent, made by GlaxoSmithKline, and Foradil, made by Novartis and sold in the United States by Schering Plough. Advair and Serevent contain the same drug, salmeterol; in Serevent, salmeterol is alone, while in Advair it is combined with another medicine. Foradil does not contain salmeterol; its active ingredient is formoterol.

Concerns have arisen about the three drugs, the Food and Drug Administration said, because in a small number of patients they "have been associated with severe asthma exacerbations."
It will be chaos in the asthma clinics if Advair is withdrawn from the market; most asthmatics at the U of MS asthma clinic are on it. Advair combines serevent with an inhaled steroid and is a convenient and effective treatment for asthma.

Sunday, July 10, 2005


A reader (MaryBeth) asks Why isn't SMOKING treated with the same intensive interventions as other addictive substances, like alcohol, drugs, food, . Why even the 12 step programs , don't include smoking, among them.Any information or thoughts on this is appreciated.
In my opinion, doctors do treat smoking intensively, at least from a medication standpoint. In the resident internal med clinic I work in, we ask patients about smoking status and offer medication treatment for cessation (Wellbutrin, nicotine patch, nicotine gum, etc). I think the reason that there are no 12 step programs for smoking is because it does not ruin the average smoker's life (at least not right away). Drug addicts and alcoholics often destroy their lives while still young- for example stealing to support a crack habit, drunk driving convictions, blackouts, financial devastation, divorce, etc. Most cigarette smokers remain productive members of society throughout the normal working years. Usually they don't develop lung cancer or severe COPD until they're older (this is a generalization, some smokers develop health problems at a younger age, some never do)

Sunday, July 03, 2005

Rising Medicaid Costs in Mississippi

Rising Medicaid Costs in Mississippi (and other states) are forcing a cut in benefits:
Starting Friday, most Medicaid recipients in Mississippi will be limited to five prescription drugs at a time, with no process for appeal. The cap appears to be the most restrictive in the nation, but is just one of many measures being taken by states seeking to rein in soaring Medicaid costs.
Obesity is one of the causes of rising Medicaid costs:
Mississippi's rate of obesity is not simply a matter of vanity or even of health — it's a fiscal crisis and a physical crisis for those carrying around a dangerous amount of weight.Mississippi has been identified as "ground zero" in the prevalence of obesity in the nation.The most recent U.S. Centers for Disease Control study ranked Mississippi No. 1 in obesity prevalence with an obesity rate of 26 percent.
The two major national obesity studies indicate that Mississippi spent $263 per capita or some $757 million annually on medical costs related to obesity — the 23rd highest amount in the nation.But because of Mississippi's poverty and high Medicare and Medicaid recipient populations, the more disturbing number indicated in the studies are the fact that the taxpayers are subsidizing an estimated annual $223 million in Medicare costs and $221 million in Medicaid costs that are attributable to obesity.That estimated $444 million annual taxpayer burden related to obesity in Mississippi includes direct health care costs in the Medicaid and Medicare programs. They manifest themselves in the high costs of treating diseases like Type II diabetes and other obesity-related health problems.
Over 1/4 of Mississippi adults are obese. Other contributors to poor health in Mississippi include high rates of poverty and smoking. The health status of poor Mississippians will worsen with the Medicaid cutbacks, which started several days ago. I will witness this from ground zero in the U of MS resident Internal Medicine clinic as a new academic year starts. I hope the new interns are up to the task.

Friday, July 01, 2005

Scientology Sucks

Other physician bloggers have been blogging about Scientology's/Cruise's attack on psychiatry. These Bloggers have been putting asterixes in the word Scientology to avoid detection by search engines. I have nothing new to say about Scientology, but I could use more readers so I left the asterixes out.

Infant Psychiatry

I saw this ad today in Psychiatric News:
INFANT PSYCHIATRY FELLOWSHIP. The Section of Child and Adolescent Psychiatry at Tulane University Health Sciences Center is seeking a full-time Fellow in Infant Psychiatry. This one or two year fellowship includes clinical and research experiences with the multidisciplinary Infant Mental Health group at Tulane. Completion of a fellowship in Child and Adolescent Psychiatry preferred. Faculty appointment at the Instructor level is possible. Applications will be accepted until a suitable qualified candidate is found. Applicants should send letter of interest, updated CV and list references to Charles Zeanah, MD, Vice Chair and Director of Child and Adolescent Psychiatry, 1440 Canal Street TB52, New Orleans, LA 70112. Interested eligible applicants may obtain further information regarding this position by contacting Dr. Zeanah at 504-988-5402 or Tulane is strongly committed to policies of non-discrimination and affirmative action in student admission and in employment.
I can't imagine trying to practice psychiatry with infants. They're too young for both meds and psychotherapy, though I guess their parents could be taught behavioral interventions. I'd be interested in knowing what an infant psychiatrist actually does.