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Showing posts from May, 2014

Ezetimibe (Zetia): why are we still prescribing what appears to be a useless drug? Update*: new study comes out which is still not very convincing.

A health research company just released a list of the 100 top drugs in America according to sales. 29th on the list, with sales of over 1.8 billion, is the cholesterol lowering drug ezetimibe, brand name Zetia. This drug was released over 10 years ago because it worked really well in combination with statin drugs such as Zocor (simvastatin) to lower LDL cholesterol levels. It was released as a single agent and combined with simvastatin as Vytorin. The only problem was that in 2008 a study of the ezetimibe/simvastatin combination compared to simvastatin alone showed the combination did not improve measurements of arterial wall thickness which correlates with things like heart attacks and strokes. Although cholesterol levels were lower in the combination arm, simvastatin was just as effective in achieving the more meaningful outcome. Ezetimibe appeared to increase cancer risk in another study, evaluating patients with aortic stenosis. A study which compared adding niacin or ezetimibe t…

Why does American health care cost so much? The New York Times says it's because we pay administrators too much.

A friend sent me a link to a New York Times article on the ridiculous amount that insurance company executives and hospital administrators make. So the reason that American healthcare is so expensive is not because doctors earn too much, or drug companies charge too much or device manufacturers are making ever more expensive devices with ever expanded indications. Except that it is all of that and more.

Hospital administrators and insurance company executives do make lots of money. They make more than I ever will, unless I do their jobs. But it's also pretty easy to make a comfortable living as a physician working for a hospital or even a nurse practitioner in one of the specialty or acute care areas. By "easy" I mean that it is easy to make money, not that the job is easy. The creation of the Affordable Care Act has set into motion some mechanisms for decreasing costs, but it doesn't come close to dealing with the fundamental dynamic that makes health care expensiv…

What is this VA scandal about?

I've been hearing about the VA (Veterans Health Administration) scandal recently. A traipse through the high quality media coverage available on the internet has brought me up to date. Apparently in 2012 a physician at the VA in Phoenix began to call attention to the fact that her hospital was providing inadequate care, specifically that her emergency department was overcrowded and dangerous. In the primary care arena, reports that veterans had to wait ridiculously long times for appointments were investigated by the General Accounting Office and a report was released in 2013 that found that documentation of wait times was inconsistent, but that it appeared that veterans had to wait an unacceptable amount of time for appointments. Later in 2013 another doctor from the Phoenix VA reported that wait times were unacceptably long and that patients were dying because they were waiting so long to be seen. Numbers I've read on the internet include 6 weeks to even be called back abou…