Dr. Thompson's Blog

Drug Interactions and Problems that Can Occur

When drugs are prescribed over the telephone or by someone who is not a an M.D. problems may occur. It is extremely important that patients and  parents know if there will be problems with a new drug when other medicines are being taken. Many of those who prescribe drugs do not ask what other drugs are being taken. The individual may also not check to see if the new drug will interact and cause problems with other drugs being taken. There was a wonderful pharmacist in the town where I had my pediatric practice. I could call him and check on any drug interaction. In San Francisco, I could call the UC Pharmacy hotline and get answers to my questions. I often had to do this for patients for drugs prescribed by other doctors. This was particularly true for neurologists who were seeing patients who had seizures. 

Now that many non- M.Ds are able to see patients without supervision by a physician, it is particularly important that patients and parents know if there are going to be side effects with a new drug or if the RX should be taken with food and if there is any drug interaction with other oral medications.

I had a friend whose mother was taking 26 different drugs and no one had checked for any interactions or problems with all the different drugs. It turned out that were when I called my local pharmacist.  

Finding Good Health Insurance

It is important that everyone have good health insurance. I don't like the idea of Medicare for All because it would cause countless problems. I would agree with an option to buy in to Medicare for anyone wants to do that. If you are not covered by where you work for health insurance or have insurance under the Affordable Health Care Act, it is wise to check out the different health insurance companies to see their charges.   Medicare is fine by itself if you are over 65, however it does not  cover a lot of things. Thus supplemental health insurance is wise. The CEOs of health insurance companies make millions of dollars, as do the CEOs of drug companies.  This always bothers me.  

There is a good website where you can compare the cost of private insurance. It is: ehealthinsurance.com. There are some other websites that also could be helpful. One is www.medicareadvocacy.org. Another  is healthfinder.gov. The  Health Insurance Association of American is www.hiaa.org.

For patients who can not afford prescriptions, there is a good website at www.themedicineprogram.com.

 

Guns, Guns, and More Guns = More and More Deaths

This last month there were 45 mass shootings.  Last year there were 147 mass shootings. What is wrong that we can not stop this terrible destruction? It is embarrassing to be an American when we have such a high rate of deaths from guns.  Not only do we have mass shootings, but the suicide rate with guns is also unbelievable. A study in 2018 stated that 67 Americans committed suicide each day. Yet psychiatric social workers in one state have been let go because they were declared "fluff" and there was no money to pay them.  Instead CEOs of hospitals, big corporations, and drug companies are making millions of dollars each year. 

It is estimated  that we have 400 million guns in the U.S., many of them loaded. With the pandemic more and more people are feeling depressed and worrying about feeding their families due to loss of their jobs. If we did not have so many available guns, good background checks and ways to keep guns from going across borders, we would have fewer deaths. Also, if we had more mental health services available we would be in a better place. Yes, the NRA has a terrible hold on many legislators. Perhaps if some of them lost a child or family member to a gun death, we might get some strong legislation. If any of them had seen a child die from a gun shot, as I have as a physician, perhaps we would get some strong laws. I  have no problem with responsible gun owners having unloaded guns but having a loaded gun in a house with a child, a teen or depressed, mentally ill person is a recipe for disaster. We can and MUST do better.

Concerns About Affluent Medical Students

There was a good article this week in the New York Times by David Kirp about how Ivy League colleges are choosing their students.  What the article said would also include the choice of medical students in the most sought after schools.  It noted that in five of the Ivy League colleges that "more students came from the top 1% than from the bottom 60%."  These are mostly students who graduated from prestigious private schools with access to tutoring and help with their applications. 

My concern about medical students is if they have a patient who had been  homeless or was from a low or middle income family, would they be able to understand the patient's problems, as would a medical student from a low to middle income background?

When I was a medical student at Stanford, most of our freshman class were men with families and military veterans. Only about six of us were  much younger and recent college graduates. I don't think any of us came from affluent schools or backgrounds. My favorite medical school professor said he would rather have a medical student who was a B student from a middle class family than a student from a rich family. Compassion and the art of medicine are so important in medicine, but I am finding a lot of doctors seem to be missing both of these today. My advice to people seeking a new doctor is to make an initial appointment and then if you don't feel comfortable with the doctor find a different one. I would first check the Internet to find out as much as you can about the doctor. Reviews may not always be helpful because some people may  simply a dislike the doctor's age, sex, or something else. 

 

Taxpayers' Dollars will Allow the Greed of Drug Companies to Continue

I hope all readers have had one and hopefully two of the corona virus vaccine. These are being paid for with taxpayer dollars. However, if we have to get a yearly vaccine against the virus, the drug companies are planning to charge as much as $190 or more per shot. This is despite the fact that the research for the vaccines has been paid for with our tax dollars. I don't understand how money is so much more important than children and adults' lives. I have been trying to help parents in an overseas country get the medicine for their two children  who both have a serious neuromuscular disorder. The drug is so expansive that even a family with two working  parents making good salaries can not afford it.  The drug company really does not care. I have written to the CEO, who makes 38.6 million dollars a year and I get a lot of double talk, but no help for the  children. I don't understand how CEOs can live with themselves knowing their new drugs can save lives and yet not help. I asked the CEO's assistant if he had ever seen a child with this  particular disorder and  did not get a reply.

I hope that President Biden will find a way to negotiate drug company prices, as is done in many other countries. If our tax payer dollars pay for their research, some kind of control of drug prices is badly needed. 

When People Ignore the Pandemic

I watched a little of Trump's CPAC speech last night and was amazed at the number of people sitting close together, mostly not wearing masks. They say it is their right to chose not wear a mask or sit at a distance from others, but what happens when they get the Covid virus and give it to their children, their parents, friends, or others? 

 The medical experts say we can stop the spread of the virus if we all wear masks, stay at a social distance from others and wash our hands frequently. I was an intern during the polio epidemic and if you  have ever had to watch a child or adult die or become disabled from a virus, you would think twice about what you are doing during this pandemic. 

I live now in a small beach town and an amazed at the groups of people walking together with no masks on. I walk out in the street when I see these individuals. Yes, I wear a mask, plastic gloves, and mostly work inside during the day. If I go out it is usually early in the morning when there are few people around. It would be great to be able to do the things I did formerly but that is not going to be safe. I have had the first dose of the Moderna vaccine and am looking forward to the second dose. Even then I will wear a mask, gloves, and keep at a distance from others. I hope others will do this also. 

 

Is your "Doctor" an M.D. or Something Else?

I am always surprised when even well education friends don't know the difference between a board-certified medical doctor and a "doctor" who is not an M.D. Now many states are allowing even nurse practitioners to write prescriptions. Then there are the so-called doctors of naturopathic medicine, doctors of chiropractic medicine, and doctors, who are not medically trained, but have a Ph.D. or dental degree and nurse practitioners who get a doctor of nursing degree.  Sadly, many M.Ds today are all about making money, so some become hospitalists, which means they have fewer hours, work in hospitals, and are not on call or have regular office hours, as do pediatricians, family doctors, internists, and other specialties. When you look at the number of hours it takes to become a board-certified physician and compare  it with the hours it takes for the other "Doctors", there is no comparison. To become an anesthesiologist or a neurosurgeon, for example, you need four years of college, four years of medical school, a year of  internship, and three or four years of residency. Doctors of naturopathic medicine do not do an internship or residency and special provisions are made if they have had just two years of college. Some nursing schools, I am told are taking students right after high school without a college degree.

Now with the Internet you can look at a "Doctor's"  training. It is always important to see where a doctor went to school, what training he or she has had and if the doctor is an M.D. or something else. You could even save your life or that of a child or  family member. 

The greed of Drug Companies

There was a good article in today's New York Times about the high cost of drugs and how much more Americans pay for drugs than in other countries. The author, Austin Frakt, hopes that President Biden can make a change. I certainly agree. Mr. Frakt notes that U.S. drug prices are" the highest in the world."  Of course, when CEOs of some drug companies are making millions of dollars a year in salary, that is understandable. The drug companies argue that the high costs are due to research and development. I laugh when I realize that a medicine I have taken for many years formerly cost one cent for each pill and now costs six dollars for each one. No research and development is needed for this drug. Countries such as  Germany have a law where " a central body evaluates the benefits of new drugs" and then negotiates with the drug companies to work out the price. Even if you have Medicare or some kind of insurance it usually does not help unless you pay extra, as for Medicare Advantage. An independent review board could be helpful, but the drug companies are so powerful that it would take Congress to pass laws that would give an agency the power to force the drug companies to charge reasonable prices. However, with their many lobbyists I wonder if anything can really be done. With some many things in the U.S. money and lobbyists make a very great difference. What makes me especially angry is that for terrible disorders such as spinal muscular atrophy, the price of the new drug that can greatly help Type one and two children is so expensive that many parents cannot afford the drug. These babies can die or be severely disabled. 

Becoming Informed about Medical Issues

Unless you have medical training, it can be hard to get true facts about medical issues or problems. There is a great dal of misinformation on the Internet and even in medical books. Sites such as the Mayo Clinic are usually good, but occasionally I find erroneous statements about subjects I know well. One day I found some wrong information on NORD, which is usually excellent, but when I told them about it they were good about letting me give them the correct information, so they could make changes. 

I was amazed to find out that some X-rays are sent to far away countries for reading. My own daughter had an X-ray of her head at UC Medical Center in San Francisco that was reported as showing a tumor.  I took the X-ray to an   excellent radiologist I knew in another hospital and he said "there is nothing wrong with your daughter's head." She could have had surgery on her head had I not done that. A second opinion is always wise in a case like this. 

I would always ask about any side effects from a medicine a doctor prescribes. If a non-M.D. prescribes a medication, I would not fill it until you check with an M.D. If you are taking multiple medications, you want to be sure there is no bad interaction between any of the medicines. You want to check also if an Rx should be taken with food or on an empty stomach. 

There are substances being purchased at health food stores that are not checked by the FDA or Food and Drug administration. Protein powders and similar substances may contain ingredients that can cause harm. 

 

How to Get Help Paying for Expensive Medicines

One of the many things Trump promised during his awful four years in office was that the cost of medicines would be reduced. Instead, he did everything he could to get rid of President Obama's Affordable Health Care Act. I am always amazed at the cost of medicine when I go to pick up a prescription. When the CEO's of drug companies, such as Roche, are being paid 38 million dollars a year or more it is just wrong for medicines to cost so much. Hopefully, President Biden will try to put some kind of limit on drug prices. Fortunately, there are some ways you can pay less for an expensive drug. One company that offers  helps is GoodRx. Their number is 1-888-277-3911. The Patient Advocate Foundation may also be able to help. Their number is 1-800-532-5274 and the website is www.patientadvocate.org. There is also a website for low income patients which is www.scbn.org. They offer assistance for low income families.  The Medicine Program at www.themedicineprogram also helps patients who can not afford prescriptions. Sometimes, too, there is another lower cost medication that can be prescribed if you talk with your prescribing doctor.  Some individual's order medicine from Canada and I have a retired doctor friend who finds that very useful.