geoffrey modest medical blogs

Following on the trail of a recent blog on skyrocketing generic prices, a recent Research Letter in JAMA Internal Medicine found that the high cost of insulin resulted in one quarter of the patients under utilizing it because of cost constraints (see  drug co high cost insulin jamaintmed2018  in dropbox, or doi.org/10.1001/jamainternmed.2018.5008). Details: -- 199 patients with type I or type II diabetes were given a questionnaire at the Yale Diabetes Center in 2017 -- 52% women, 60% white/25% black or African-American, 47% type I diabetes, 43% on Medicaid/33% employer-sponsored plans/20% Medicare part D -- primary outcome was cost-related underuse of insulin in the past 12 months, defined as a positive response to anyone of the following, specifically because of the cost on insulin:     -- did you use insulin less than prescribed?     -- did you try to stretch out your insulin?     -- did you take smaller doses...

There was an updated meta-analysis  on the efficacy of HPV self-testing in women (see  hpv self-testing bmj2018  in dropbox, or  doi.org/10.1136/bmj.k4823 ) Details: -- this meta-analysis assessed 2 aspects of HPV testing:     -- accuracy review: comparing the accuracy of vaginal self-sampling by women vs clinician sampling for HPV, and verification of the presence of CIN 2+ or worse by colposcopy and biopsy in those with a positive test; 56 studies included     -- participation review: women in the self-sampling group (intervention arm) were compared with those who were invited to undergo screening by a clinician (control arm); 25 trials included -- they also  evaluated  the response rates comparing different invitation scenarios for self-sampling : mailing self-sampling kits to all, opt-in, community campaign, and door-to-door. Results: -- accuracy studies:     ...

A recen t study found that those adhering to a higher Mediterranean diet had fewer cardiovascular events, apparently mediated by decreased inflammatory markers (see  cad women mediterranean diet jama2018 in dropbox, or doi:10.1001/jamanetworkopen.2018.5708) Details: -- 25,994 women in the Women’s Health Study were followed for up to 12 years     -- baseline data were collected from 1993 to 1996, analysis from 2017 to 2018 -- diet was evaluated in terms of degree of coherence with the typical Mediterranean diet (9 specific categories), into 3 groupings:     -- 39% were in the low Mediterranean diet group, 36% in the middle, and 25% in the upper -- at baseline: mean age 53, but the following tracked with Mediterranean diet group: current smoking (16% in the low MED diet vs 6% in the highest), exercise, alcohol consumption (which was higher the high Mediterranean group), all of the subgroups of dietary consumption (veges, e...

One concern in the corporatization of medicine is that many physicians, and especially academic physicians, have significant financial relationships with drug and medical device companies. A recent study found that it was pretty infrequently that these potential conflicts of interest (COI) were disclosed in journal publications (see  conflicts of interest unreported jamasurg2018  in dropbox, or doi:10.1001/jamasurg.2018.2576 ). Details: -- from the 2015 Open Payments Database (OPD), 10 surgical and medical device companies and 10 physicians receiving the highest compensation from each of these companies were evaluated. -- Articles by these physicians were identified in PubMed and the presence of an associated COI declaration was assessed -- the 100 physicians: 88% men were paid a total of $12,446,969, a median of $95,993 -- 50% of the authors were faculty at academic institutions -- of 100 physicians, OB/GYN’s were the most common...

will do a few blogs on drug company shenanigans (this one includes a blog I started a couple of years ago, below). lots of drug company blogs done in past, but i thought it was time to do a few more.... this one was inspired by a patient call to me this weekend. 63 yo woman with asthma who called saying she needed an albuterol inhaler but was told that there was a $57 copay!!  i called the pharmacy, asked them to try different inhalers (Pro-Air, Ventolin, Proventil, any other albuterol variant....) and they confirmed that the only one covered by insurance was the one with the $57 copay. And this for a drug which has been around for 40-50 years and used to cost about $5 without insurance. a recent Washington Post article highlighted distressing price-fixing among generic drug companies (see  http://edition.pagesuite.com/popovers/dynamic_article_popover.aspx?artguid=c7b7cedb-3ac0-4d16-8501-96635f0ff7f0&appid=1165  ), noting: --a federal lawsuit last mo...