Grand Rounds: 3rd Anniversary Edition

Dr Aleksandr Kavokin, who blogs at RDoctor, hosts this week's very special Grand Rounds. With over 45 submissions, I was flattered to have our post (the first part of our interview with MN BX's MaryAnn Stump, RN) named as one of his two Top Picks.

In the event, all the entries are categorized and include helpful summaries.

I may have to update my (in)famous food pyramid: this post at A Hearty Life informs us that the Brits are looking to ban their ubiquitous "crisps."

Zit Docs

Finding a decent family doctor or obstetrician may prove tough for the next generation of Metro Detroiters. But if a skin rash or bad acne is the problem, a top-notch doctor is likely to be right around the corner.

Droves of the nation's most talented medical students are pursuing careers in dermatology, a field that promises good pay, flexible hours and job opportunities hard to come by in other fields

Good pay & flex hours sounds good.

While a family practice doctor often works long days and endures crammed waiting rooms for $155,000 a year, dermatologists average $197,000 -- and many don't work even five days a week

My guess is they don't get many emergency calls either.

Dermatologists, who treat diseases of the skin, hair and nails, also tend to draw more insured patients who can afford to pay for their care. As a result, they're more likely to be reimbursed for the services and less dependant on payments from government health care programs that have taken cuts in recent years

Higher reimbursements too.

No wonder the field is getting crowded.

Newer Model, Part 2

Schizophrenia patients do as well, or perhaps even better, on older psychiatric drugs compared with newer and far costlier medications, according to a study published yesterday that overturns conventional wisdom about antipsychotic drugs, which cost the United States $10 billion a year.

The results are causing consternation. The researchers who conducted the trial were so certain they would find exactly the opposite that they went back to make sure the research data had not been recorded backward.

This sounds so familiar . . .


Schizophrenia is a serious mental disorder that is believed to affect about one in 100 adults. It is characterized by psychotic symptoms such as hallucinations and delusions and negative symptoms such as social withdrawal.

Especially over the past decade, older antipsychotics such as Haldol have been widely criticized for triggering uncontrolled body movements, even as the new "atypical" antipsychotics were hailed for causing fewer side effects. Recently, however, concern has grown that antipsychotics in general, and some of the newer drugs in particular, may be causing metabolic side effects.

Trading one side effect for another.

While the researchers had expected a difference of five points on a quality-of-life scale -- showing the newer drugs were better -- the study found that patients' quality of life was slightly better when they took the older drugs. Jones said a conservative interpretation of the data suggested that there is no difference, "so the notion you would pay 10 times as much would be difficult to justify."

With no significant difference in outcome.

You don't get more, you simply pay more.

Carnival Time!

Since I was offline yesterday observing Yom Kippur, I didn't have a chance to do the "carnival link thingie." So, a day late (but hopefully no dollars short), here ya go:

Frugal at My 1st Million (at 33!) hosts this week's Carnival of the Capitalists. He presents almost 30 posts, complete with commentary.

Michael Wade, posting at Execupundit, examines how and why we take criticism of our personal decisions so, well, personally.

The Doctor is NOT In

Rite Aid Corp.'s first experiment offering health clinics inside its stores ended when the clinic operator decided it could not turn a profit.

Take Care Health Systems LLC told Rite Aid that it would close its last seven health clinics on Friday, less than a year after opening 10 of them in Rite Aids around Portland, Ore.

Wonder how the Wal-Mart clinics will play out?

The Newer Model

CHARGING $4,200 a dose for a new version of an old cancer drug has helped make Dr. Patrick Soon-Shiong a billionaire.

The drug, Abraxane, does not help patients live longer than the older treatment, though it does shrink tumors in more patients, according to clinical trials. And the old and new medicines have similar side effects. An independent review of Abraxane published in December in a cancer research journal concluded that the drug was “old wine in a new bottle.”

Warning. Some drug plans require you to pay 50% of the cost of the drug and there are no caps on how much your share is for the year. Other plans simply run out of Rx benefits after as little as $2000.

Abraxane is a breakthrough: it costs about 25 times as much as a generic version of the older medicine, which is best known by its brand name, Taxol.

Comparable doses of Taxol would run around $170.

Those rosy forecasts illustrate the pricing power that makers of cancer drugs wield. With patients often facing grim prognoses and desperate for new therapies, and insurers relatively powerless to negotiate prices or deny coverage, the cost of treatments seems to have little impact on demand.

The rise in cancer-drug prices is a microcosm of broader trends pushing up health care costs nationally. Despite decades of efforts by governments and insurers to restrain costs, patients continue to want the newest — and most expensive — drugs and medical devices. And doctors and the health care industry have little reason to keep costs in check, because insurers rarely deny coverage for new treatments on the basis of price.

Here is the problem. If the carrier denies treatment because of the cost, they are subject to litigation. If they approve the treatment they have to raise premiums for everyone to cover the cost.

This is a no win situation.

Insurance Dispatch

In this week's column, available at The Medical Blog Network, we examine the results of a new survey which casts a light on how employers perceive how they pay for health insurance.

Hope you like it.