It will either bankrupt doctors, cost parents an arm and a leg, or require unwarranted state intrusion into insurance.

When Merck launched a multimillion-dollar marketing campaign last year to promote Gardasil, its new vaccine to prevent cervical cancer, company officials probably did not anticipate that its signature phrase -- "one less" -- would apply not just to malignancies but also to physicians. Yet that slogan has come to symbolize the response of doctors locally and around the country.

Pincered by rising costs and eroding reimbursements, and resentful of what they regard as a long-standing and unfair financial burden, some doctors, especially pediatricians and gynecologists who are most likely to be asked for the vaccine, are refusing to buy it or restricting who receives the shots.

Discontent over the price of the vaccine -- the most expensive ever approved -- highlights a long-simmering dispute over reimbursement for immunizations, traditionally regarded as bedrock medicine. It is a dispute, experts say, with significant public health implications that has accelerated as the number of costly new vaccines has proliferated.

"This is a national issue that is affecting lots of people," said Benjamin Gitterman, president of the D.C. chapter of the American Academy of Pediatrics. "It's a matter of cash flow," Gitterman added. Some insurance companies are paying doctors $122 per shot -- just $2 more than the price doctors pay for a dose of Gardasil -- an amount not sufficient to cover the cost of stocking and administering the vaccine, doctors say. The problem is disproportionately affecting pediatricians, experts say, because they administer the majority of immunizations and are among the lowest-paid specialists.

"Some plans are saying I'll give you $90 -- and not

And yet too many folks want to force every girl to get the vaccine -- inflating corporate profits and costing someone -- and they never say who, but pobably the taxpayer -- a wad of money.

Posted by: Greg at 10:23 PM | No Comments | Add Comment
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And the more we know, the more we can do to find a cure.

Researchers said yesterday that they had identified seven new genes connected to the most common form of diabetes — the latest result of an intensifying race between university researchers and private companies to find genes linked to a range of diseases.

The findings, presented in three reports by university scientists and one by a private company, offer novel insights into the biology of a disease that affects 170 million people worldwide.

And the sudden spate of new results mark an acceleration, and perhaps a turning point, in the ability to find disease genes, the long-promised payoff from the human genome project that began in 1989.

YesterdayÂ’s reports bring the number of well-attested genes involved in adult-onset, or Type 2 diabetes up to 10, from the 3 known previously. The new genes do not immediately suggest any new therapy, but may point to a new biological basis for the disease, from which effective treatments could emerge in time.

And in the mean time, I'll just keep taking my pills.

Posted by: Greg at 10:15 PM | Comments (54) | Add Comment
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Practicing good medicine for chronic pain patients is not a crime!

William E. Hurwitz, the prominent doctor on trial here for drug trafficking, spent more than two days on the witness stand last week telling a jury why he had prescribed painkillers to patients who turned out to be drug dealers and addicts. But the clearest explanation of his actions — and of the problem facing patients who are in pain — came earlier in the trial.

The problem -- too many doctors don't want to give opioids to treat chronic pain, wven though they are often the most effective medications. The result is that patients suffer -- and are often incapacitate -- by pain that can be relieved. Indeed, chronic pain patients are often dismissed and given les effective treatments by doctors adhering to old ways of doing things or covering their butts out of fear of prosecution by over-zealous prosecutors.

Consider this testimony from defense experts (who testified for free, unlike the prosecution experts) about the standard of care given by Dr. Hurwitz.

Prescribing opioids was once taboo because of concerns over patientsÂ’ becoming addicted. But medical opinion gradually shifted over the past two decades as researchers concluded that high doses of opioids could sometimes be safer and more effective than alternatives like surgery or injections.

Two of the leading pain experts, Dr. Russell K. Portenoy of Beth-Israel Medical Center and Dr. James N. Campbell of Johns Hopkins University, testified without pay as experts for the defense. They said Dr. Hurwitz was widely known as a knowledgeable physician and passionate advocate of giving patients full pain relief, unlike many doctors who were reluctant to prescribe opioids because they feared legal repercussions, particularly when dealing with patients who sometimes used illegal drugs.

Such “problem patients” consumed so much time and energy that most doctors refused to treat them “regardless of what the consequences would be for the patient,” Dr. Campbell testified. He said that he had been initially skeptical of some of Dr. Hurwitz’s high-dose treatments, but was then impressed by the results in patients he sent to Dr. Hurwitz.

He said some doctors might argue that Dr. Hurwitz was guilty in some instances of negligence that would make him liable for damages in a civil case. But Dr. Campbell contradicted the prosecution’s experts by testifying that all the prescriptions were clearly within the “bounds of medical practice.”

But sadly, fear of prosecution is a real problem. One physician's office I was in recently had signs posted stating that "This office no longer prescribes Oxy-Contin, Lortab, or Darvocet" -- medications that are among the best out there for dealing with constant, debilitating pain. Good medicine? No -- good legal advice, after a visit from an inspector from medical regulators concerned about the number of his patients on pain medication. Another doctor I know insists upon a monthly visit from her patients seeking refills of pain medication they have been on for chronic conditions, after being asked by an insurance company to justify the number of pain pills she prescribes each month o its patients. And my wife's neurologist has had to document her case (as well as all his other patients) in excruciating detail to justify her level of pain medication -- to satisfy the demands of his lawyer, not best medical practices, so that he stays out of jail.

This prosecution is particularly troubling because Dr. Hurwitz was generally viewed as one of the leaders in his field. If they can go after him over disagreements on how to best manage the symptoms of chronic pain patients, how intimidated should every other doctor in the field feel? And if the level of risk becomes too high, what will be the fate of my wife, and hundreds of thousands of patients like her around the country?

Posted by: Greg at 10:57 AM | Comments (1) | Add Comment
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For practical reasons, if nothing else.

Doctors in New York have removed a woman’s gallbladder with instruments passed through her vagina, a technique they hope will cause less pain and scarring than the usual operation, and allow a quicker recovery. The technique can eliminate the need to cut through abdominal muscles, a major source of pain after surgery.

The operation was experimental, part of a study that is being done to find out whether people will fare better if abdominal surgery is performed through natural openings in the body rather than cuts in the belly. The surgery still requires cutting, through the wall of the vagina, stomach or colon, but doctors say it should hurt less because those tissues are far less sensitive than the abdominal muscles.

The notion of taking a different direction for to reach abdominal sites is a good one, though there are already options for gallbladder removal that involve only a tiny incision through the belly button.

Posted by: Greg at 01:58 PM | Comments (1) | Add Comment
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For practical reasons, if nothing else.

Doctors in New York have removed a womanÂ’s gallbladder with instruments passed through her vagina, a technique they hope will cause less pain and scarring than the usual operation, and allow a quicker recovery. The technique can eliminate the need to cut through abdominal muscles, a major source of pain after surgery.

The operation was experimental, part of a study that is being done to find out whether people will fare better if abdominal surgery is performed through natural openings in the body rather than cuts in the belly. The surgery still requires cutting, through the wall of the vagina, stomach or colon, but doctors say it should hurt less because those tissues are far less sensitive than the abdominal muscles.

The notion of taking a different direction for to reach abdominal sites is a good one, though there are already options for gallbladder removal that involve only a tiny incision through the belly button.

Posted by: Greg at 01:58 PM | Comments (1) | Add Comment
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MSNBC has fired Don Imus -- will CBS follow?

NBC News dropped Don Imus yesterday, canceling his talk show on its MSNBC cable news channel a week after Mr. Imus made racially disparaging remarks about the Rutgers University womenÂ’s basketball team.

The move came after several days of widening calls for Mr. Imus to lose his job both on MSNBC, which simulcasts the “Imus in the Morning” show, and CBS Radio, which originates the show.

CBS Radio, which is Mr. ImusÂ’s main employer, said in a statement last night that it would stick by the two-week suspension of the program, which begins Monday, that it and NBC news announced earlier.

But CBS said it would, in the interim, “continue to speak with all concerned parties and monitor the situation closely.”

The demands that Mr. Imus be fired had grown in intensity every day since last Wednesday when he made the comments, in which he labeled the women “nappy-headed hos.”

And ultimately, this is how things should work -- the market, not the government, has demanded the removal of Don Imus. He has the right to say as many stupid things as he wants, but no right to a privately-owned forum to spew them. The government can't punish you for your speech, but your employer can.

Posted by: Greg at 10:35 PM | Comments (13) | Add Comment
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Stem-cells have been used to stop dependence on insulin by a group of Type 1 diabetics in a recent study.

Diabetics using stem-cell therapy have been able to stop taking insulin injections for the first time, after their bodies started to produce the hormone naturally again.

In a breakthrough trial, 15 young patients with newly diagnosed type 1 diabetes were given drugs to suppress their immune systems followed by transfusions of stem cells drawn from their own blood.

The results show that insulin-dependent diabetics can be freed from reliance on needles by an injection of their own stem cells. The therapy could signal a revolution in the treatment of the condition, which affects more than 300,000 Britons.

People with type 1 diabetes have to give themselves regular injections to control blood-sugar levels, as their ability to create the hormone naturally is destroyed by an immune disorder.

And please note – this is not embryonic stem-cell therapy. Rather it is a therapy using the [patient’s own stem-cells to stimulate production of insulin. We are still waiting for embryonic stem-cells to produce ANY therapies for ANY condition, while adult stem-cells are proving quite efficacious.

But as a Type 2 diabetic, IÂ’m waiting to see if this will translate over to my condition, freeing me from the need to take my medication.

Posted by: Greg at 02:32 PM | No Comments | Add Comment
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