OTC Allergy Meds

I saw this article about over-the-counter allergy meds via Kevin, MD:
Over-the-counter hay fever medication works just as well as much more expensive prescription medication for seasonal allergies, according to a new study.
The research, published in the Archives of Otolaryngology -- Head & Neck Surgery, is based on a small sample and focuses exclusively on two specific drugs: a 240-milligram dose of pseudoephedrine hydrochloride (sold over the counter under the brand name Sudafed 24 Hour) and a 10-mg dose of montelukast sodium (prescription brand name Singulair). "When we compared them head-to-head, we found that for treatment of allergic rhinitis, these drugs at these doses were virtually identical," said Dr. Fuad Baroody, associate professor of surgery at the University of Chicago and the study's director. "This came as a genuine surprise."
OTC allergy drugs work great and are often more effective than perscription meds. For example, Benadryl is more effective than some perscription antihistamines. Sudafed is also very effective. The problem is that many of the OTC allergy meds have a lot of side effects. Benadryl can cause constipation, urinary retention, and confusion. Sudafed can cause hypertension and heart arrhythmias. Many of the OTC's would be considered too dangerous even for perscription status if they were being submitted to the FDA today.

NASCAR is not a sport

RangelMD states:
Then Gumbel goes after ice-skating and I began to realize that he sounds just like any American jock who can't comprehend, let alone appreciate, any sport that doesn't begin with "foot" or "basket". Apparently Bryant thinks that the triple axel is no big deal and that sport isn't really sport without the brute force of a dunk or tackle. I'd love to hear what Bryant thinks of NASCAR; "Those guys get to sit down through the entire event!"
NASCAR is not a real sport. I am sure it helps to be in good physical shape to win a NASCAR race, but it also helps to be in good shape to be an orthopedic surgeon, and I don't see anyone calling them athletes. Poker is just as much a sport as NASCAR; they even show poker on ESPN now. I hope to be in the World Series of Poker one day.
I am not originally from the South, which explains why I am not into NASCAR.

AMA Advertising Campaign

Last week I criticized some of the American Medical Association's ads. Today Medical Economics offers an explanation of the ads:
The general behind it is Gary C. Epstein, the AMA's chief marketing officer. Before joining the AMA in 2004, Epstein worked to develop "brand-building solutions" for clients like Proctor & Gamble, Kraft Foods, and Pepsi. In his new role, he hopes to do much the same for the AMA.
One of his strategies is to reach out to doctors indirectly, through their patients. In a series of consumer ads that began running last summer, the AMA pays homage to the profession's "everyday heroes"—doctors across a variety of specialties who've touched peoples' lives in ways both large and small. Both the print and broadcast versions are powerful, tug-at-your-heart messages calculated to enhance public goodwill.
Gary C. Epstein should be fired. If the AMA wants to reach out to doctors, it should lower its membership fees. It's a waste of money and insulting for the AMA to try to reach out to doctors through our patients.

Drug Voucher Programs

Kevin, MD recently wrote about drug voucher programs. In these programs, drug addicts get vouchers that are exchangeable for consumer goods in return for clean urine samples. This study, from the Archives of General Psychiatry, found that Bupropion (Wellbutrin) combined with vouchers (contingency management) reduced cocaine use in opioid addicts maintained on methadone:
Six-Month Trial of Bupropion With Contingency Management for Cocaine Dependence in a Methadone-Maintained Population
James Poling, PhD; Alison Oliveto, PhD; Nancy Petry, PhD; Mehmet Sofuoglu, MD, PhD; Kishorchandra Gonsai, MD; Gerardo Gonzalez, MD; Bridget Martell, MD; Thomas R. Kosten, MD
Arch Gen Psychiatry. 2006;63:219-228.
Context No effective pharmacotherapies exist for cocaine dependence, although contingency management (CM) has demonstrated efficacy.
Objective To compare the efficacy of bupropion hydrochloride and CM for reducing cocaine use in methadone hydrochloride–maintained individuals.
Design This 25-week, placebo-controlled, double-blind trial randomly assigned participants to 1 of 4 treatment conditions: CM and placebo (CMP), CM and 300 mg/d of bupropion hydrochloride (CMB), voucher control and placebo (VCP), or voucher control and bupropion (VCB).
Setting Outpatient clinic at the Veterans Affairs Connecticut Healthcare System.
Participants A total of 106 opiate-dependent, cocaine-abusing individuals.
Interventions All study participants received methadone hydrochloride (range, 60-120 mg). Participants receiving bupropion hydrochloride were given 300 mg/d beginning at week 3. In the CM conditions, each urine sample negative for both opioids and cocaine resulted in a monetary-based voucher that increased for consecutively drug-free urine samples during weeks 1 to 13. Completion of abstinence-related activities also resulted in a voucher. During weeks 14 to 25, only completion of activities was reinforced in the CM group, regardless of sample results. The voucher control groups received vouchers for submitting urine samples, regardless of results, throughout the study.
Main Outcome Measure Thrice-weekly urine toxicologic test results for cocaine and heroin.
Results Groups did not differ in baseline characteristics or retention rates. Opiate use decreased significantly, with all treatment groups attaining equivalent amounts of opiate use at the end of the study. In the CMB group, the proportion of cocaine-positive samples significantly decreased during weeks 3 to 13 (P<.001) relative to week 3 and remained low during weeks 14 to 25. In the CMP group, cocaine use significantly increased during weeks 3 to 13 (P<.001) relative to week 3, but then cocaine use significantly decreased relative to the initial slope during weeks 14 to 25 (P<.001). In contrast, by treatment end, the VCB and VCP groups showed no significant improvement in cocaine use.
Conclusion These findings suggest that combining CM with bupropion for the treatment of cocaine addiction may significantly improve outcomes relative to bupropion alone.
Author Affiliations: Yale University School of Medicine, Veterans Affairs Connecticut Healthcare System, West Haven (Drs Poling, Sofuoglu, Gonsai, Gonzalez, Martell, and Kosten); University of Arkansas for Medical Sciences, Little Rock (Dr Oliveto); and University of Connecticut School of Medicine, Farmington (Dr Petry).
RELATED ARTICLES
This Month in Archives of General PsychiatryArch Gen Psychiatry. 2006;63:124.

Psychotic Break

This picture is from the article that is causing such a controversy in Shrinkette (Feb 10) and other blogs. Unfortunately the online article does not give any information about the artist.
Schizophrenia frequently permanently transforms a person. You can usually get rid of the hallucinations and delusions with medications, but negative symptoms often persist and cognitive decline sometimes occurs.

It's diplomate, not diplomat

dip·lo·mate Pronunciation: 'dip-l&-"mAt Function: noun: one who holds a diploma; especially : a physician qualified to practice in a medical specialty by advanced training and experience in the specialty followed by passing an intensive examination by a national board of senior specialists
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dip·lo·mat ( P ) Pronunciation Key (dpl-mt)n.
One, such as an ambassador, who has been appointed to represent a government in its relations with other governments.
One who uses skill and tact in dealing with others.
One of my pet peeves is when a physician mistakenly calls himself a "diplomat", as in diplomat of the American Board of Internal Medicine. It's "Diplomate." I see this mistake all the time on letterheads and cv's.

No Need to Thank Me

I saw an ad by the American Medical Association in Time magazine that said:
"...when was the last time you let your doctors know how much you appreciate all they do for you...we have created some thank you cards that you can download..."
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This makes me embarassed to be a member of the AMA, which I recently joined because it was required for a local insurance network. The AMA should not be asking patients to thank its members. A physician advocacy organization should not be going around begging patients to thank them.

Should you do Your Own Taxes

Medical Economics has an article this issue that discusses whether a doctor should do his own taxes:
The answer: It depends. Certain financial situations are sufficiently complicated that you really need an accountant's expertise. And, in many cases, the hours spent doing your own taxes could be more profitably spent seeing patients.
A doctor (post-residency) who would do his own taxes and not even have an accoutant look at the tax form before sending it in is, in my opinion, being very foolish.

Sorry

Sorry I haven't blogged much recently, I have been playing online poker. If you want to take me on, you can find me in the low-limit Texas Hold'em rooms, my screen name is michaelrack. I'll blog more after I overcome my gambling addiction. In the meantime, check out this blog by a fellow Mississippi physician blogger:
http://www.drhebert.squarespace.com/

Muslim Cartoons

Here is a link to the controversial Muhammad cartoons, so you can check them out for yourself:
http://www.brusselsjournal.com/node/698