Hitting a Nerve

Recently a fax showed up containing a patient referral, which is a pretty normal event around here. It was from a doctor I’ve never heard of, but that’s not surprising. The medical field is always in turnover.

Like most fax referrals, this one had a cover sheet and briefly explained who the patient is, who referred them, and why. But under that it said: “By receiving this fax you agree to the following conditions:

• 1. You will contact the patient within 24 hours of receipt.
• 2. The patient will be seen within 1 week of contacting them.
• 3. You will provide a report to the referring physician within 24 hours of seeing the patient.”

Okay ...

Who are these people?

Does anyone else think the tone is kind of grating, if not rude? It sounds like they’re telling me how to run my office.

“By receiving this fax ...” what does that mean? I receive faxes all day, most of them telling me about great vacation deals, low prices on Botox, and medical supplies I don’t need. Just because I receive them doesn’t mean anything.

And, as I’ve previously written here, my office policy is that we don’t call patients just based on a fax. That opens up a whole new can of worms. It’s up to patients to call us.

But realistically, the other doctor may have no idea it’s on their cover sheet. It could be the work of a receptionist, or office manager, or just the default page for a software suite they use. In fact, the last one is the most likely cause.

One of the problems (there are too many to count, but I’m just going to address this one) in medical office software is the option to use templates. Use them at your own peril. If you’re not paying attention, you might sound incompetent at worst and rude at best.

Even something as innocuous as a fax cover sheet, written by a nonmedical person, can sound bad.

Regardless of how harmless and unintentional it might be, it can leave a bad taste in the mouths of patients and other offices. If something that minor isn’t good, I’m hoping someone is checking the templates for patient visits.

I’m sure no offense was meant, and none was taken. But it reinforces that any sort of default setting in medical office software can’t be taken for granted. Unless you (or a trusted person who knows your habits) checks it, you run the risk of it coming back to bite you.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recently a fax showed up containing a patient referral, which is a pretty normal event around here. It was from a doctor I’ve never heard of, but that’s not surprising. The medical field is always in turnover.

Like most fax referrals, this one had a cover sheet and briefly explained who the patient is, who referred them, and why. But under that it said: “By receiving this fax you agree to the following conditions:

• 1. You will contact the patient within 24 hours of receipt.
• 2. The patient will be seen within 1 week of contacting them.
• 3. You will provide a report to the referring physician within 24 hours of seeing the patient.”

Okay ...

Who are these people?

Does anyone else think the tone is kind of grating, if not rude? It sounds like they’re telling me how to run my office.

“By receiving this fax ...” what does that mean? I receive faxes all day, most of them telling me about great vacation deals, low prices on Botox, and medical supplies I don’t need. Just because I receive them doesn’t mean anything.

And, as I’ve previously written here, my office policy is that we don’t call patients just based on a fax. That opens up a whole new can of worms. It’s up to patients to call us.

But realistically, the other doctor may have no idea it’s on their cover sheet. It could be the work of a receptionist, or office manager, or just the default page for a software suite they use. In fact, the last one is the most likely cause.

One of the problems (there are too many to count, but I’m just going to address this one) in medical office software is the option to use templates. Use them at your own peril. If you’re not paying attention, you might sound incompetent at worst and rude at best.

Even something as innocuous as a fax cover sheet, written by a nonmedical person, can sound bad.

Regardless of how harmless and unintentional it might be, it can leave a bad taste in the mouths of patients and other offices. If something that minor isn’t good, I’m hoping someone is checking the templates for patient visits.

I’m sure no offense was meant, and none was taken. But it reinforces that any sort of default setting in medical office software can’t be taken for granted. Unless you (or a trusted person who knows your habits) checks it, you run the risk of it coming back to bite you.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recently a fax showed up containing a patient referral, which is a pretty normal event around here. It was from a doctor I’ve never heard of, but that’s not surprising. The medical field is always in turnover.

Like most fax referrals, this one had a cover sheet and briefly explained who the patient is, who referred them, and why. But under that it said: “By receiving this fax you agree to the following conditions:

• 1. You will contact the patient within 24 hours of receipt.
• 2. The patient will be seen within 1 week of contacting them.
• 3. You will provide a report to the referring physician within 24 hours of seeing the patient.”

Okay ...

Who are these people?

Does anyone else think the tone is kind of grating, if not rude? It sounds like they’re telling me how to run my office.

“By receiving this fax ...” what does that mean? I receive faxes all day, most of them telling me about great vacation deals, low prices on Botox, and medical supplies I don’t need. Just because I receive them doesn’t mean anything.

And, as I’ve previously written here, my office policy is that we don’t call patients just based on a fax. That opens up a whole new can of worms. It’s up to patients to call us.

But realistically, the other doctor may have no idea it’s on their cover sheet. It could be the work of a receptionist, or office manager, or just the default page for a software suite they use. In fact, the last one is the most likely cause.

One of the problems (there are too many to count, but I’m just going to address this one) in medical office software is the option to use templates. Use them at your own peril. If you’re not paying attention, you might sound incompetent at worst and rude at best.

Even something as innocuous as a fax cover sheet, written by a nonmedical person, can sound bad.

Regardless of how harmless and unintentional it might be, it can leave a bad taste in the mouths of patients and other offices. If something that minor isn’t good, I’m hoping someone is checking the templates for patient visits.

I’m sure no offense was meant, and none was taken. But it reinforces that any sort of default setting in medical office software can’t be taken for granted. Unless you (or a trusted person who knows your habits) checks it, you run the risk of it coming back to bite you.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Is health care a human right?

This year voters in Oregon are being asked to decide that. In the United States, health care isn’t guaranteed, as it is in many other countries.

It brings up some interesting questions. Should it be a right? Food, water, shelter, and oxygen aren’t, as far as I know, considered such. So why health care?

Probably the main argument against the idea is that, if it’s a right, shouldn’t the government (and therefore taxpayers) be tasked with paying for it all?

Good question, and not one that I can answer. If my neighbor refuses to buy insurance, then has a health crisis he can’t afford, why should I have to pay for his obstinacy and lack of foresight? Isn’t it his problem?

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Is health care a human right?

This year voters in Oregon are being asked to decide that. In the United States, health care isn’t guaranteed, as it is in many other countries.

It brings up some interesting questions. Should it be a right? Food, water, shelter, and oxygen aren’t, as far as I know, considered such. So why health care?

Probably the main argument against the idea is that, if it’s a right, shouldn’t the government (and therefore taxpayers) be tasked with paying for it all?

Good question, and not one that I can answer. If my neighbor refuses to buy insurance, then has a health crisis he can’t afford, why should I have to pay for his obstinacy and lack of foresight? Isn’t it his problem?

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Is health care a human right?

This year voters in Oregon are being asked to decide that. In the United States, health care isn’t guaranteed, as it is in many other countries.

It brings up some interesting questions. Should it be a right? Food, water, shelter, and oxygen aren’t, as far as I know, considered such. So why health care?

Probably the main argument against the idea is that, if it’s a right, shouldn’t the government (and therefore taxpayers) be tasked with paying for it all?

Good question, and not one that I can answer. If my neighbor refuses to buy insurance, then has a health crisis he can’t afford, why should I have to pay for his obstinacy and lack of foresight? Isn’t it his problem?

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recently there have been articles and discussions about how involved physicians should be in patient gun ownership.

There are valid points all around. Some of my colleagues, especially those in general practice, feel that they don’t have enough time to add more screening questions on top of those they already have. Others point out that routinely asking about gun ownership is none of our business. A third view I’ve seen is that very few doctors are in a position to teach issues of gun safety.

In my field, with certain patients, I do ask. Namely, the demented.

Anyone with concerning cognitive deficits shouldn’t have access to guns. As their judgment fades and their impulsivity worsens, they often don’t realize right from wrong. They might open fire on family members thinking they’re burglars. Some of them see suspicious people out in the yard that are more likely hallucinations or simply passersby.

In more advanced cases of dementia, patients may not even realize what they’re holding, but that doesn’t make it any less dangerous. Probably more so, since they’re not going to be careful with it.

Another scary issue I sometimes encounter is when patients with dementia find a gun at home – usually one that belonged to a deceased spouse and that family isn’t aware of. No one really knows if it’s working, or loaded, though we have to assume it is. They find it and start carrying it out on walks, pointing it at the mailman who they think is trespassing, etc. Sometimes the police get called. These situations are extremely dangerous for all involved.

It’s pretty easy for someone to get shot under these circumstances. It’s like leaving a gun out and having a toddler find it. They don’t mean any harm, but they’re still just as deadly as someone who does.

These people also have access to knives, which can be equally deadly, but knives aren’t guns. They don’t have the range or hitting power that make firearms so dangerous. It’s a lot easier to disarm an elderly patient with a steak knife if need be.

So, like my colleagues in psychiatry, I ask about guns in certain situations that involve dementia. Are there any guns? If so, are they locked up safely where the person can’t access them?

I’m not making a statement for or against gun ownership here. But I think all of us would agree that someone with impaired judgment, cognition, self-control, reasoning, and memory shouldn’t have access to guns.

In neurology, that’s a decent chunk of my patients. So for everyone’s safety, I ask them (and, more importantly, their families) about guns.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recently there have been articles and discussions about how involved physicians should be in patient gun ownership.

There are valid points all around. Some of my colleagues, especially those in general practice, feel that they don’t have enough time to add more screening questions on top of those they already have. Others point out that routinely asking about gun ownership is none of our business. A third view I’ve seen is that very few doctors are in a position to teach issues of gun safety.

In my field, with certain patients, I do ask. Namely, the demented.

Anyone with concerning cognitive deficits shouldn’t have access to guns. As their judgment fades and their impulsivity worsens, they often don’t realize right from wrong. They might open fire on family members thinking they’re burglars. Some of them see suspicious people out in the yard that are more likely hallucinations or simply passersby.

In more advanced cases of dementia, patients may not even realize what they’re holding, but that doesn’t make it any less dangerous. Probably more so, since they’re not going to be careful with it.

Another scary issue I sometimes encounter is when patients with dementia find a gun at home – usually one that belonged to a deceased spouse and that family isn’t aware of. No one really knows if it’s working, or loaded, though we have to assume it is. They find it and start carrying it out on walks, pointing it at the mailman who they think is trespassing, etc. Sometimes the police get called. These situations are extremely dangerous for all involved.

It’s pretty easy for someone to get shot under these circumstances. It’s like leaving a gun out and having a toddler find it. They don’t mean any harm, but they’re still just as deadly as someone who does.

These people also have access to knives, which can be equally deadly, but knives aren’t guns. They don’t have the range or hitting power that make firearms so dangerous. It’s a lot easier to disarm an elderly patient with a steak knife if need be.

So, like my colleagues in psychiatry, I ask about guns in certain situations that involve dementia. Are there any guns? If so, are they locked up safely where the person can’t access them?

I’m not making a statement for or against gun ownership here. But I think all of us would agree that someone with impaired judgment, cognition, self-control, reasoning, and memory shouldn’t have access to guns.

In neurology, that’s a decent chunk of my patients. So for everyone’s safety, I ask them (and, more importantly, their families) about guns.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recently there have been articles and discussions about how involved physicians should be in patient gun ownership.

There are valid points all around. Some of my colleagues, especially those in general practice, feel that they don’t have enough time to add more screening questions on top of those they already have. Others point out that routinely asking about gun ownership is none of our business. A third view I’ve seen is that very few doctors are in a position to teach issues of gun safety.

In my field, with certain patients, I do ask. Namely, the demented.

Anyone with concerning cognitive deficits shouldn’t have access to guns. As their judgment fades and their impulsivity worsens, they often don’t realize right from wrong. They might open fire on family members thinking they’re burglars. Some of them see suspicious people out in the yard that are more likely hallucinations or simply passersby.

In more advanced cases of dementia, patients may not even realize what they’re holding, but that doesn’t make it any less dangerous. Probably more so, since they’re not going to be careful with it.

Another scary issue I sometimes encounter is when patients with dementia find a gun at home – usually one that belonged to a deceased spouse and that family isn’t aware of. No one really knows if it’s working, or loaded, though we have to assume it is. They find it and start carrying it out on walks, pointing it at the mailman who they think is trespassing, etc. Sometimes the police get called. These situations are extremely dangerous for all involved.

It’s pretty easy for someone to get shot under these circumstances. It’s like leaving a gun out and having a toddler find it. They don’t mean any harm, but they’re still just as deadly as someone who does.

These people also have access to knives, which can be equally deadly, but knives aren’t guns. They don’t have the range or hitting power that make firearms so dangerous. It’s a lot easier to disarm an elderly patient with a steak knife if need be.

So, like my colleagues in psychiatry, I ask about guns in certain situations that involve dementia. Are there any guns? If so, are they locked up safely where the person can’t access them?

I’m not making a statement for or against gun ownership here. But I think all of us would agree that someone with impaired judgment, cognition, self-control, reasoning, and memory shouldn’t have access to guns.

In neurology, that’s a decent chunk of my patients. So for everyone’s safety, I ask them (and, more importantly, their families) about guns.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recently, when I logged on to see what medication refills had come in, I was greeted with a notice that Walgreens would no longer carry promethazine/codeine cough syrup. It wouldn’t surprise me if other pharmacies follow.

This doesn’t affect me much. As a neurologist I’ve never prescribed it, and as a patient I’ve never used it.

The unwritten reason was likely because of its popularity for abuse. It is often mixed with various beverages and called “purple drank.” It has both social, and legal, consequences that can come back and bite the pharmacy.

A friend of mine commented that if everything that can be abused gets banned, all we’ll be left with are Tylenol and Preparation H. Another friend made the comment that it’s a shame, because codeine is a remarkably effective antitussive.

I agree with both of them, but Walgreens is pulling only the combo preparation off the shelves. Codeine and promethazine are still available. The former is on WHO’s list of essential medications.

Even if every pharmacy were to drop promethazine/codeine cough syrup, and it was withdrawn from the market, it wouldn’t keep people from abusing it. They’d still find a way to get the components and whip up some equivalent. Human innovation can be remarkable. All of us who trained in the inner city (which is pretty much all of us at some point) have seen people who drank mouthwash, hairspray, and who knows what else in desperation.

No one believes it’s going to stop drug abuse, but it will make it harder to have purple drank, which is often passed around as a low-level drug at parties. Putting Sudafed behind the counter has reduced, though not stopped, meth. Walter White can tell you that.

A patient of mine who’s a pharmacist also was talking about this. He’s in favor of it, as he’s tired of dealing with people trying to get it through faked prescriptions and bogus visits to urgent care pretending to have a cough, not to mention the additional paperwork and reporting requirements that a controlled drug carries.

I agree with it, mostly, but there are those who truly do need it at times, and who now will have to take it as individual components, or find a pharmacy that does carry it. The issue here becomes that, by punishing the abusers, you’re also punishing the responsible.

The vast majority of alcohol users are responsible drinkers. I have the occasional beer myself. Unfortunately, there are a comparative few who aren’t, and their actions can bring tremendous grief to many others. So we have tougher laws all around that we all have to follow.

I agree with Walgreens actions on this, but still find myself wondering how much of a difference it will make.

Probably not as much as I hope.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recently, when I logged on to see what medication refills had come in, I was greeted with a notice that Walgreens would no longer carry promethazine/codeine cough syrup. It wouldn’t surprise me if other pharmacies follow.

This doesn’t affect me much. As a neurologist I’ve never prescribed it, and as a patient I’ve never used it.

The unwritten reason was likely because of its popularity for abuse. It is often mixed with various beverages and called “purple drank.” It has both social, and legal, consequences that can come back and bite the pharmacy.

A friend of mine commented that if everything that can be abused gets banned, all we’ll be left with are Tylenol and Preparation H. Another friend made the comment that it’s a shame, because codeine is a remarkably effective antitussive.

I agree with both of them, but Walgreens is pulling only the combo preparation off the shelves. Codeine and promethazine are still available. The former is on WHO’s list of essential medications.

Even if every pharmacy were to drop promethazine/codeine cough syrup, and it was withdrawn from the market, it wouldn’t keep people from abusing it. They’d still find a way to get the components and whip up some equivalent. Human innovation can be remarkable. All of us who trained in the inner city (which is pretty much all of us at some point) have seen people who drank mouthwash, hairspray, and who knows what else in desperation.

No one believes it’s going to stop drug abuse, but it will make it harder to have purple drank, which is often passed around as a low-level drug at parties. Putting Sudafed behind the counter has reduced, though not stopped, meth. Walter White can tell you that.

A patient of mine who’s a pharmacist also was talking about this. He’s in favor of it, as he’s tired of dealing with people trying to get it through faked prescriptions and bogus visits to urgent care pretending to have a cough, not to mention the additional paperwork and reporting requirements that a controlled drug carries.

I agree with it, mostly, but there are those who truly do need it at times, and who now will have to take it as individual components, or find a pharmacy that does carry it. The issue here becomes that, by punishing the abusers, you’re also punishing the responsible.

The vast majority of alcohol users are responsible drinkers. I have the occasional beer myself. Unfortunately, there are a comparative few who aren’t, and their actions can bring tremendous grief to many others. So we have tougher laws all around that we all have to follow.

I agree with Walgreens actions on this, but still find myself wondering how much of a difference it will make.

Probably not as much as I hope.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recently, when I logged on to see what medication refills had come in, I was greeted with a notice that Walgreens would no longer carry promethazine/codeine cough syrup. It wouldn’t surprise me if other pharmacies follow.

This doesn’t affect me much. As a neurologist I’ve never prescribed it, and as a patient I’ve never used it.

The unwritten reason was likely because of its popularity for abuse. It is often mixed with various beverages and called “purple drank.” It has both social, and legal, consequences that can come back and bite the pharmacy.

A friend of mine commented that if everything that can be abused gets banned, all we’ll be left with are Tylenol and Preparation H. Another friend made the comment that it’s a shame, because codeine is a remarkably effective antitussive.

I agree with both of them, but Walgreens is pulling only the combo preparation off the shelves. Codeine and promethazine are still available. The former is on WHO’s list of essential medications.

Even if every pharmacy were to drop promethazine/codeine cough syrup, and it was withdrawn from the market, it wouldn’t keep people from abusing it. They’d still find a way to get the components and whip up some equivalent. Human innovation can be remarkable. All of us who trained in the inner city (which is pretty much all of us at some point) have seen people who drank mouthwash, hairspray, and who knows what else in desperation.

No one believes it’s going to stop drug abuse, but it will make it harder to have purple drank, which is often passed around as a low-level drug at parties. Putting Sudafed behind the counter has reduced, though not stopped, meth. Walter White can tell you that.

A patient of mine who’s a pharmacist also was talking about this. He’s in favor of it, as he’s tired of dealing with people trying to get it through faked prescriptions and bogus visits to urgent care pretending to have a cough, not to mention the additional paperwork and reporting requirements that a controlled drug carries.

I agree with it, mostly, but there are those who truly do need it at times, and who now will have to take it as individual components, or find a pharmacy that does carry it. The issue here becomes that, by punishing the abusers, you’re also punishing the responsible.

The vast majority of alcohol users are responsible drinkers. I have the occasional beer myself. Unfortunately, there are a comparative few who aren’t, and their actions can bring tremendous grief to many others. So we have tougher laws all around that we all have to follow.

I agree with Walgreens actions on this, but still find myself wondering how much of a difference it will make.

Probably not as much as I hope.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

What could you do with $18 billion?

I could pay off my mortgage roughly 60,000 times, or take my wife on a never-ending world cruise so we don’t need a mortgage, or at least hire someone to clean my pool regularly so I don’t have to.

A recent report from the OIG found that, in the last 3 years, the Centers for Medicare & Medicaid Services spent $18 billion on drugs for which there’s no proof of significant clinical benefit.

That’s a lot of money on things that may or may not be placebos, some of which are WAY overdue on Food and Drug Administration–mandated efficacy studies. A few have even been on the market so long that they’ve become equally unproven generics.

Now, if you put this in the big picture, that immense amount of money is still only 2% of their total spending in health care. Hell, probably at least 2% of my personal spending is on pointless things, too. So, realistically, you could say 98% of CMS spending is on worthwhile care, which is as it should be.

But the bottom line is that $18 billion is still a lot of money if it’s being spent on fruitless treatments. I’m sure it could be better used in many other programs (refunding it to taxpayers comes out to maybe $55 for each of us, which probably isn’t worth the effort).

As pointed out in the movie “Dave,” shoving that kind of money in even a low-yield savings account would generate at least $180 million in interest each year.

That’s a lot of money, too, that could be used for something. Of course, no one in the government thinks that way. That’s why we all loved the movie.

The problem is that the phrase “no proof of significant clinical benefit” doesn’t mean something doesn’t work. It just means we aren’t sure. Some of those people on one of these drugs may be getting benefit – or not. After all, the placebo effect is remarkably strong. But if they are helping someone, who wants to be the one to tell them “we’re not going to pay for this anymore?”

Another issue is this: Let’s say the drugs only work for 10% of the people who take them ($1.8 billion worth), and for the other 90% it’s iffy ($16.2 billion worth), but the latter want to stay on them anyway, just to be sure. Do we cut them? Or just say that $18 billion is too much money when only 10% are being helped, and cut them all off? I’m sure we could use the money elsewhere (see “Dave” above), so let them find a way to work it out with the manufacturer. The greatest good for the greatest number and all that jazz.

I don’t know, either. Health care dollars are finite, and human suffering is infinite. It’s a balancing act that can’t be won. There are no easy answers.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

What could you do with $18 billion?

I could pay off my mortgage roughly 60,000 times, or take my wife on a never-ending world cruise so we don’t need a mortgage, or at least hire someone to clean my pool regularly so I don’t have to.

A recent report from the OIG found that, in the last 3 years, the Centers for Medicare & Medicaid Services spent $18 billion on drugs for which there’s no proof of significant clinical benefit.

That’s a lot of money on things that may or may not be placebos, some of which are WAY overdue on Food and Drug Administration–mandated efficacy studies. A few have even been on the market so long that they’ve become equally unproven generics.

Now, if you put this in the big picture, that immense amount of money is still only 2% of their total spending in health care. Hell, probably at least 2% of my personal spending is on pointless things, too. So, realistically, you could say 98% of CMS spending is on worthwhile care, which is as it should be.

But the bottom line is that $18 billion is still a lot of money if it’s being spent on fruitless treatments. I’m sure it could be better used in many other programs (refunding it to taxpayers comes out to maybe $55 for each of us, which probably isn’t worth the effort).

As pointed out in the movie “Dave,” shoving that kind of money in even a low-yield savings account would generate at least $180 million in interest each year.

That’s a lot of money, too, that could be used for something. Of course, no one in the government thinks that way. That’s why we all loved the movie.

The problem is that the phrase “no proof of significant clinical benefit” doesn’t mean something doesn’t work. It just means we aren’t sure. Some of those people on one of these drugs may be getting benefit – or not. After all, the placebo effect is remarkably strong. But if they are helping someone, who wants to be the one to tell them “we’re not going to pay for this anymore?”

Another issue is this: Let’s say the drugs only work for 10% of the people who take them ($1.8 billion worth), and for the other 90% it’s iffy ($16.2 billion worth), but the latter want to stay on them anyway, just to be sure. Do we cut them? Or just say that $18 billion is too much money when only 10% are being helped, and cut them all off? I’m sure we could use the money elsewhere (see “Dave” above), so let them find a way to work it out with the manufacturer. The greatest good for the greatest number and all that jazz.

I don’t know, either. Health care dollars are finite, and human suffering is infinite. It’s a balancing act that can’t be won. There are no easy answers.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

What could you do with $18 billion?

I could pay off my mortgage roughly 60,000 times, or take my wife on a never-ending world cruise so we don’t need a mortgage, or at least hire someone to clean my pool regularly so I don’t have to.

A recent report from the OIG found that, in the last 3 years, the Centers for Medicare & Medicaid Services spent $18 billion on drugs for which there’s no proof of significant clinical benefit.

That’s a lot of money on things that may or may not be placebos, some of which are WAY overdue on Food and Drug Administration–mandated efficacy studies. A few have even been on the market so long that they’ve become equally unproven generics.

Now, if you put this in the big picture, that immense amount of money is still only 2% of their total spending in health care. Hell, probably at least 2% of my personal spending is on pointless things, too. So, realistically, you could say 98% of CMS spending is on worthwhile care, which is as it should be.

But the bottom line is that $18 billion is still a lot of money if it’s being spent on fruitless treatments. I’m sure it could be better used in many other programs (refunding it to taxpayers comes out to maybe $55 for each of us, which probably isn’t worth the effort).

As pointed out in the movie “Dave,” shoving that kind of money in even a low-yield savings account would generate at least $180 million in interest each year.

That’s a lot of money, too, that could be used for something. Of course, no one in the government thinks that way. That’s why we all loved the movie.

The problem is that the phrase “no proof of significant clinical benefit” doesn’t mean something doesn’t work. It just means we aren’t sure. Some of those people on one of these drugs may be getting benefit – or not. After all, the placebo effect is remarkably strong. But if they are helping someone, who wants to be the one to tell them “we’re not going to pay for this anymore?”

Another issue is this: Let’s say the drugs only work for 10% of the people who take them ($1.8 billion worth), and for the other 90% it’s iffy ($16.2 billion worth), but the latter want to stay on them anyway, just to be sure. Do we cut them? Or just say that $18 billion is too much money when only 10% are being helped, and cut them all off? I’m sure we could use the money elsewhere (see “Dave” above), so let them find a way to work it out with the manufacturer. The greatest good for the greatest number and all that jazz.

I don’t know, either. Health care dollars are finite, and human suffering is infinite. It’s a balancing act that can’t be won. There are no easy answers.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

I hear other doctors talk about online reviews, both good and bad.

I recently read a piece where a practice gave doctors a bonus for getting 5-star reviews, though it doesn’t say if they were penalized for getting bad reviews. I assume the latter docs got a good “talking to” by someone in administration, or marketing, or both.

I get my share of them, too, both good and bad, scattered across at least a dozen sites that profess to offer accurate ratings.

I tend to ignore all of them.

Bad ratings mean nothing. They might be reasonable. They can also be from patients whom I fired for noncompliance, or from patients I refused to give an early narcotic refill to. They can also be from people who aren’t patients, such as a neighbor angry at the way I voted at a home owners association meeting, or a person who never saw me but was upset because I don’t take their insurance, or someone at the hospital whom I had to hang up on after being put on hold for 10 minutes.

Good reviews also don’t mean much, either. They might be from patients. They could also be from well-meaning family and friends. Or the waiter I left an extra-large tip for the other night.

One of my 1-star reviews even goes on to describe me in glowing terms (the lady called my office to apologize, saying the site confused her).

There’s also a whole cottage industry around this: Like restaurants, you can pay people to give you good reviews. They’re on Craig’s list and other sites. Some are freelancers. Others are actually well-organized companies, offering to give you X number of good reviews per month for a regular fee. I see ads for the latter online, usually describing themselves as “reputation recovery services.”

There was even a recent post on Sermo about this. A doctor noted he’d gotten a string of bad reviews from nonpatients, and shortly afterward was contacted by a reputation recovery service to help. He wondered if the crappy reviews were intentionally written by that business before they called him. He also questioned if it was an unspoken blackmail tactic – pay us or we’ll write more bad reviews.

Unlike a restaurant, we can’t respond because of patient confidentiality. Unless it’s something meaninglessly generic like “thank you” or “sorry you had a bad experience.”

A friend of mine (not in medicine) said that picking your doctor from online reviews is like selecting a wine recommended by a guy who lives at the train yard.

While there are pros and cons to the whole online review thing, in medicine there are mostly cons. Many reviews are anonymous, with no way to trace them. Unless details are provided, you don’t know if the reviewer is really a patient (or even a human in this bot era). Neither does the general public, reading them and presumably making decisions about who to see.

Like many things about the Internet, online reviews are the wild west. There are minimal (if any) rules, no law enforcement, and no one knows who the good guys and bad guys really are.

And there’s nothing we can do about it, either.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

I hear other doctors talk about online reviews, both good and bad.

I recently read a piece where a practice gave doctors a bonus for getting 5-star reviews, though it doesn’t say if they were penalized for getting bad reviews. I assume the latter docs got a good “talking to” by someone in administration, or marketing, or both.

I get my share of them, too, both good and bad, scattered across at least a dozen sites that profess to offer accurate ratings.

I tend to ignore all of them.

Bad ratings mean nothing. They might be reasonable. They can also be from patients whom I fired for noncompliance, or from patients I refused to give an early narcotic refill to. They can also be from people who aren’t patients, such as a neighbor angry at the way I voted at a home owners association meeting, or a person who never saw me but was upset because I don’t take their insurance, or someone at the hospital whom I had to hang up on after being put on hold for 10 minutes.

Good reviews also don’t mean much, either. They might be from patients. They could also be from well-meaning family and friends. Or the waiter I left an extra-large tip for the other night.

One of my 1-star reviews even goes on to describe me in glowing terms (the lady called my office to apologize, saying the site confused her).

There’s also a whole cottage industry around this: Like restaurants, you can pay people to give you good reviews. They’re on Craig’s list and other sites. Some are freelancers. Others are actually well-organized companies, offering to give you X number of good reviews per month for a regular fee. I see ads for the latter online, usually describing themselves as “reputation recovery services.”

There was even a recent post on Sermo about this. A doctor noted he’d gotten a string of bad reviews from nonpatients, and shortly afterward was contacted by a reputation recovery service to help. He wondered if the crappy reviews were intentionally written by that business before they called him. He also questioned if it was an unspoken blackmail tactic – pay us or we’ll write more bad reviews.

Unlike a restaurant, we can’t respond because of patient confidentiality. Unless it’s something meaninglessly generic like “thank you” or “sorry you had a bad experience.”

A friend of mine (not in medicine) said that picking your doctor from online reviews is like selecting a wine recommended by a guy who lives at the train yard.

While there are pros and cons to the whole online review thing, in medicine there are mostly cons. Many reviews are anonymous, with no way to trace them. Unless details are provided, you don’t know if the reviewer is really a patient (or even a human in this bot era). Neither does the general public, reading them and presumably making decisions about who to see.

Like many things about the Internet, online reviews are the wild west. There are minimal (if any) rules, no law enforcement, and no one knows who the good guys and bad guys really are.

And there’s nothing we can do about it, either.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

I hear other doctors talk about online reviews, both good and bad.

I recently read a piece where a practice gave doctors a bonus for getting 5-star reviews, though it doesn’t say if they were penalized for getting bad reviews. I assume the latter docs got a good “talking to” by someone in administration, or marketing, or both.

I get my share of them, too, both good and bad, scattered across at least a dozen sites that profess to offer accurate ratings.

I tend to ignore all of them.

Bad ratings mean nothing. They might be reasonable. They can also be from patients whom I fired for noncompliance, or from patients I refused to give an early narcotic refill to. They can also be from people who aren’t patients, such as a neighbor angry at the way I voted at a home owners association meeting, or a person who never saw me but was upset because I don’t take their insurance, or someone at the hospital whom I had to hang up on after being put on hold for 10 minutes.

Good reviews also don’t mean much, either. They might be from patients. They could also be from well-meaning family and friends. Or the waiter I left an extra-large tip for the other night.

One of my 1-star reviews even goes on to describe me in glowing terms (the lady called my office to apologize, saying the site confused her).

There’s also a whole cottage industry around this: Like restaurants, you can pay people to give you good reviews. They’re on Craig’s list and other sites. Some are freelancers. Others are actually well-organized companies, offering to give you X number of good reviews per month for a regular fee. I see ads for the latter online, usually describing themselves as “reputation recovery services.”

There was even a recent post on Sermo about this. A doctor noted he’d gotten a string of bad reviews from nonpatients, and shortly afterward was contacted by a reputation recovery service to help. He wondered if the crappy reviews were intentionally written by that business before they called him. He also questioned if it was an unspoken blackmail tactic – pay us or we’ll write more bad reviews.

Unlike a restaurant, we can’t respond because of patient confidentiality. Unless it’s something meaninglessly generic like “thank you” or “sorry you had a bad experience.”

A friend of mine (not in medicine) said that picking your doctor from online reviews is like selecting a wine recommended by a guy who lives at the train yard.

While there are pros and cons to the whole online review thing, in medicine there are mostly cons. Many reviews are anonymous, with no way to trace them. Unless details are provided, you don’t know if the reviewer is really a patient (or even a human in this bot era). Neither does the general public, reading them and presumably making decisions about who to see.

Like many things about the Internet, online reviews are the wild west. There are minimal (if any) rules, no law enforcement, and no one knows who the good guys and bad guys really are.

And there’s nothing we can do about it, either.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recently an article crossed my screen that drinking 4 cups of tea per day lowered the risk of type 2 diabetes by 17%. As these thing always seem to, it ended with a variant of “further research is needed.”

Encouraging? Sure. Definite? Nope.

That’s the trouble with a lot of research papers. They have some promise, but really nothing definite. I’ve seen plenty of articles suggesting coffee and/or tea have health benefits, though specifically on what varies, from lifespan to lowering the risk of a chronic medical condition (in this case, type 2 diabetes).

There are always numerous variables that aren’t clear. What kind of tea? Decaf or regular? Hot or iced? When you say cup, what do you mean? A lot of people, including me, probably consider anything smaller that a Starbucks grande to be for wimps.

While I can’t think of any off the top of my head, there’s probably a reasonable chance that, if I looked, I could find something that says coffee or tea are bad for you in some way, too.

Not that I’m planning on changing my already caffeinated drinking habits, which is probably the crux of these things for most of us. In a given day I have 1-2 cups of coffee and 3-4 bottles of diet green tea. Maybe 1-2 Diet Cokes in there some days. In winter more hot black tea. I’m probably a poster child for methylyxanthine toxicity.

I have no idea if all that coffee and tea are doing anything besides keeping me awake and alert for my patients. If they are, I certainly hope they’re lowering my risk of something bad.

Articles like this always get attention, and are often picked up by the general media. People love to think something so simple as drinking more tea or coffee would make a big difference in their lives. So it gets forwarded, people never read past the first paragraph or two, and don’t make it to the “further research is needed” line.

If an article ever came out refuting it, it probably wouldn’t get nearly as much press (who wants to read bad news?) and would be quickly forgotten outside of medical circles.

But the reality is that people are really looking for shortcuts. Unless you live under a rock, it’s pretty clear to both medical and lay people that such things as exercise and a healthy diet can help avoid multiple chronic health conditions. This doesn’t mean most of us, myself included, will do such faithfully. It just takes less time and effort to drink more tea than it does to go to the gym, so we want to believe.

That’s just human nature.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recently an article crossed my screen that drinking 4 cups of tea per day lowered the risk of type 2 diabetes by 17%. As these thing always seem to, it ended with a variant of “further research is needed.”

Encouraging? Sure. Definite? Nope.

That’s the trouble with a lot of research papers. They have some promise, but really nothing definite. I’ve seen plenty of articles suggesting coffee and/or tea have health benefits, though specifically on what varies, from lifespan to lowering the risk of a chronic medical condition (in this case, type 2 diabetes).

There are always numerous variables that aren’t clear. What kind of tea? Decaf or regular? Hot or iced? When you say cup, what do you mean? A lot of people, including me, probably consider anything smaller that a Starbucks grande to be for wimps.

While I can’t think of any off the top of my head, there’s probably a reasonable chance that, if I looked, I could find something that says coffee or tea are bad for you in some way, too.

Not that I’m planning on changing my already caffeinated drinking habits, which is probably the crux of these things for most of us. In a given day I have 1-2 cups of coffee and 3-4 bottles of diet green tea. Maybe 1-2 Diet Cokes in there some days. In winter more hot black tea. I’m probably a poster child for methylyxanthine toxicity.

I have no idea if all that coffee and tea are doing anything besides keeping me awake and alert for my patients. If they are, I certainly hope they’re lowering my risk of something bad.

Articles like this always get attention, and are often picked up by the general media. People love to think something so simple as drinking more tea or coffee would make a big difference in their lives. So it gets forwarded, people never read past the first paragraph or two, and don’t make it to the “further research is needed” line.

If an article ever came out refuting it, it probably wouldn’t get nearly as much press (who wants to read bad news?) and would be quickly forgotten outside of medical circles.

But the reality is that people are really looking for shortcuts. Unless you live under a rock, it’s pretty clear to both medical and lay people that such things as exercise and a healthy diet can help avoid multiple chronic health conditions. This doesn’t mean most of us, myself included, will do such faithfully. It just takes less time and effort to drink more tea than it does to go to the gym, so we want to believe.

That’s just human nature.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Recently an article crossed my screen that drinking 4 cups of tea per day lowered the risk of type 2 diabetes by 17%. As these thing always seem to, it ended with a variant of “further research is needed.”

Encouraging? Sure. Definite? Nope.

That’s the trouble with a lot of research papers. They have some promise, but really nothing definite. I’ve seen plenty of articles suggesting coffee and/or tea have health benefits, though specifically on what varies, from lifespan to lowering the risk of a chronic medical condition (in this case, type 2 diabetes).

There are always numerous variables that aren’t clear. What kind of tea? Decaf or regular? Hot or iced? When you say cup, what do you mean? A lot of people, including me, probably consider anything smaller that a Starbucks grande to be for wimps.

While I can’t think of any off the top of my head, there’s probably a reasonable chance that, if I looked, I could find something that says coffee or tea are bad for you in some way, too.

Not that I’m planning on changing my already caffeinated drinking habits, which is probably the crux of these things for most of us. In a given day I have 1-2 cups of coffee and 3-4 bottles of diet green tea. Maybe 1-2 Diet Cokes in there some days. In winter more hot black tea. I’m probably a poster child for methylyxanthine toxicity.

I have no idea if all that coffee and tea are doing anything besides keeping me awake and alert for my patients. If they are, I certainly hope they’re lowering my risk of something bad.

Articles like this always get attention, and are often picked up by the general media. People love to think something so simple as drinking more tea or coffee would make a big difference in their lives. So it gets forwarded, people never read past the first paragraph or two, and don’t make it to the “further research is needed” line.

If an article ever came out refuting it, it probably wouldn’t get nearly as much press (who wants to read bad news?) and would be quickly forgotten outside of medical circles.

But the reality is that people are really looking for shortcuts. Unless you live under a rock, it’s pretty clear to both medical and lay people that such things as exercise and a healthy diet can help avoid multiple chronic health conditions. This doesn’t mean most of us, myself included, will do such faithfully. It just takes less time and effort to drink more tea than it does to go to the gym, so we want to believe.

That’s just human nature.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

He’s 24 years younger than I am, recently married, no kids. Just starting out as a neurologist. He also has a full head of hair, something I’m admittedly jealous of.

He’s always in a sweater, something that seems oddly out of place in Phoenix, Arizona.

He’s the picture on my hospital ID.

I don’t go to the hospital much anymore, but he still sits in my car, greeting me whenever I open the center console to get my sunglasses or phone charger. He looks very enthusiastic about starting his career. I clearly remember the day I had the picture taken, as a newly-minted attending getting his first hospital privileges.

Sometimes I talk to him. Usually it’s just silly advice (“bet on the ’16 Cubs”). Other times I wonder what he’d do in certain situations, with all his youthful enthusiasm. I’m sure he wonders the same about me, with my 24 years of experience.

To a large extent we are the same people we started out as, but time changes us, in ways besides the obvious (like my hairs jumping off like lemmings). We learn from experience, both good and bad.

Looking back at him (or even the older pic on my medical school application) I have no complaints about where life and my career have taken me. Would there be a few things I might have changed if I could go back?

Realistically, maybe one or two, both involving my father, but neither of them would likely change where I am.

But as far as medicine goes? Not really. The things I liked then, that got me into the field? I still enjoy them. The horse hockey? Yeah, it’s always there, probably has gotten worse over time, and it still bothers me. But there isn’t a job that doesn’t have its share of cow patties. It’s just a matter of trying not to step in them more than necessary as you do the parts you enjoy.

Sometimes I look at my younger self, and wonder what I’d really say to him if we actually met.

Probably just “good luck, enjoy the ride, and ditch the sweater.”
 

We measure our gains out in luck and coincidence

Lanterns to turn back the night.

And put our defeats down to chance or experience

And try once again for the light.

– Al Stewart

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

He’s 24 years younger than I am, recently married, no kids. Just starting out as a neurologist. He also has a full head of hair, something I’m admittedly jealous of.

He’s always in a sweater, something that seems oddly out of place in Phoenix, Arizona.

He’s the picture on my hospital ID.

I don’t go to the hospital much anymore, but he still sits in my car, greeting me whenever I open the center console to get my sunglasses or phone charger. He looks very enthusiastic about starting his career. I clearly remember the day I had the picture taken, as a newly-minted attending getting his first hospital privileges.

Sometimes I talk to him. Usually it’s just silly advice (“bet on the ’16 Cubs”). Other times I wonder what he’d do in certain situations, with all his youthful enthusiasm. I’m sure he wonders the same about me, with my 24 years of experience.

To a large extent we are the same people we started out as, but time changes us, in ways besides the obvious (like my hairs jumping off like lemmings). We learn from experience, both good and bad.

Looking back at him (or even the older pic on my medical school application) I have no complaints about where life and my career have taken me. Would there be a few things I might have changed if I could go back?

Realistically, maybe one or two, both involving my father, but neither of them would likely change where I am.

But as far as medicine goes? Not really. The things I liked then, that got me into the field? I still enjoy them. The horse hockey? Yeah, it’s always there, probably has gotten worse over time, and it still bothers me. But there isn’t a job that doesn’t have its share of cow patties. It’s just a matter of trying not to step in them more than necessary as you do the parts you enjoy.

Sometimes I look at my younger self, and wonder what I’d really say to him if we actually met.

Probably just “good luck, enjoy the ride, and ditch the sweater.”
 

We measure our gains out in luck and coincidence

Lanterns to turn back the night.

And put our defeats down to chance or experience

And try once again for the light.

– Al Stewart

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

He’s 24 years younger than I am, recently married, no kids. Just starting out as a neurologist. He also has a full head of hair, something I’m admittedly jealous of.

He’s always in a sweater, something that seems oddly out of place in Phoenix, Arizona.

He’s the picture on my hospital ID.

I don’t go to the hospital much anymore, but he still sits in my car, greeting me whenever I open the center console to get my sunglasses or phone charger. He looks very enthusiastic about starting his career. I clearly remember the day I had the picture taken, as a newly-minted attending getting his first hospital privileges.

Sometimes I talk to him. Usually it’s just silly advice (“bet on the ’16 Cubs”). Other times I wonder what he’d do in certain situations, with all his youthful enthusiasm. I’m sure he wonders the same about me, with my 24 years of experience.

To a large extent we are the same people we started out as, but time changes us, in ways besides the obvious (like my hairs jumping off like lemmings). We learn from experience, both good and bad.

Looking back at him (or even the older pic on my medical school application) I have no complaints about where life and my career have taken me. Would there be a few things I might have changed if I could go back?

Realistically, maybe one or two, both involving my father, but neither of them would likely change where I am.

But as far as medicine goes? Not really. The things I liked then, that got me into the field? I still enjoy them. The horse hockey? Yeah, it’s always there, probably has gotten worse over time, and it still bothers me. But there isn’t a job that doesn’t have its share of cow patties. It’s just a matter of trying not to step in them more than necessary as you do the parts you enjoy.

Sometimes I look at my younger self, and wonder what I’d really say to him if we actually met.

Probably just “good luck, enjoy the ride, and ditch the sweater.”
 

We measure our gains out in luck and coincidence

Lanterns to turn back the night.

And put our defeats down to chance or experience

And try once again for the light.

– Al Stewart

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

A long time ago, as a fourth-year medical student, I did a neurology rotation at a large academic center.

One of the attendings was talking to me about reading, and how, once learned, it became innate: a function that, like breathing, couldn’t be turned off.

He was right, as is obvious to anyone. Driving down the road, walking past a newsstand, even opening a fridge covered with magnets from various other medical businesses ... it’s impossible NOT to process the letters into words and words into meanings, even if just for a second. Advertisers and headline-writers figured this out long ago. The key is to make those few words something that grabs our attention and interest, so we’ll either want to read more or retain it.

So too is being a doctor. Once that switch is on, you can’t flip it off. We all come to this field with varying degrees of curiosity and analytical ability, and once those are refined by experience they don’t shut down.

Recently Queen Elizabeth II died. In reading the news stories, without intending to, I found my mind trying to pick out details about her medical condition, formulate a differential ... after all these years of being in medicine it’s second nature to do that.

Of course, it’s none of my business, and I greatly respect personal privacy. But the point is there. At some point, like reading, we can’t turn off the doctor circuit (for lack of a better term). We do it all the time, analyzing gait patterns and arm swings as people go by. Noticing facial asymmetries, tremors, speech patterns. It may be turned down a few notches from when we’re in the office or hospital, but it’s still there.

It becomes second nature, a part of who we are.

It’s not just doctors. Architects casually notice building details that no one else would. Software engineers off-handedly see program features (good and bad) that the rest of us wouldn’t. Teachers and editors pick up on grammatical errors even when they’re not trying to.

None of these (aside from basic observation) are things that brains originally started out to do. But through training and experience we’ve adapted them to do this. We never stop observing, collecting data, and processing it, in ways peculiar to our backgrounds.

Which, if you think about it, is pretty remarkable.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

A long time ago, as a fourth-year medical student, I did a neurology rotation at a large academic center.

One of the attendings was talking to me about reading, and how, once learned, it became innate: a function that, like breathing, couldn’t be turned off.

He was right, as is obvious to anyone. Driving down the road, walking past a newsstand, even opening a fridge covered with magnets from various other medical businesses ... it’s impossible NOT to process the letters into words and words into meanings, even if just for a second. Advertisers and headline-writers figured this out long ago. The key is to make those few words something that grabs our attention and interest, so we’ll either want to read more or retain it.

So too is being a doctor. Once that switch is on, you can’t flip it off. We all come to this field with varying degrees of curiosity and analytical ability, and once those are refined by experience they don’t shut down.

Recently Queen Elizabeth II died. In reading the news stories, without intending to, I found my mind trying to pick out details about her medical condition, formulate a differential ... after all these years of being in medicine it’s second nature to do that.

Of course, it’s none of my business, and I greatly respect personal privacy. But the point is there. At some point, like reading, we can’t turn off the doctor circuit (for lack of a better term). We do it all the time, analyzing gait patterns and arm swings as people go by. Noticing facial asymmetries, tremors, speech patterns. It may be turned down a few notches from when we’re in the office or hospital, but it’s still there.

It becomes second nature, a part of who we are.

It’s not just doctors. Architects casually notice building details that no one else would. Software engineers off-handedly see program features (good and bad) that the rest of us wouldn’t. Teachers and editors pick up on grammatical errors even when they’re not trying to.

None of these (aside from basic observation) are things that brains originally started out to do. But through training and experience we’ve adapted them to do this. We never stop observing, collecting data, and processing it, in ways peculiar to our backgrounds.

Which, if you think about it, is pretty remarkable.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

A long time ago, as a fourth-year medical student, I did a neurology rotation at a large academic center.

One of the attendings was talking to me about reading, and how, once learned, it became innate: a function that, like breathing, couldn’t be turned off.

He was right, as is obvious to anyone. Driving down the road, walking past a newsstand, even opening a fridge covered with magnets from various other medical businesses ... it’s impossible NOT to process the letters into words and words into meanings, even if just for a second. Advertisers and headline-writers figured this out long ago. The key is to make those few words something that grabs our attention and interest, so we’ll either want to read more or retain it.

So too is being a doctor. Once that switch is on, you can’t flip it off. We all come to this field with varying degrees of curiosity and analytical ability, and once those are refined by experience they don’t shut down.

Recently Queen Elizabeth II died. In reading the news stories, without intending to, I found my mind trying to pick out details about her medical condition, formulate a differential ... after all these years of being in medicine it’s second nature to do that.

Of course, it’s none of my business, and I greatly respect personal privacy. But the point is there. At some point, like reading, we can’t turn off the doctor circuit (for lack of a better term). We do it all the time, analyzing gait patterns and arm swings as people go by. Noticing facial asymmetries, tremors, speech patterns. It may be turned down a few notches from when we’re in the office or hospital, but it’s still there.

It becomes second nature, a part of who we are.

It’s not just doctors. Architects casually notice building details that no one else would. Software engineers off-handedly see program features (good and bad) that the rest of us wouldn’t. Teachers and editors pick up on grammatical errors even when they’re not trying to.

None of these (aside from basic observation) are things that brains originally started out to do. But through training and experience we’ve adapted them to do this. We never stop observing, collecting data, and processing it, in ways peculiar to our backgrounds.

Which, if you think about it, is pretty remarkable.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Statins have, overall, been a remarkably beneficial class of drugs. Yes, you occasionally get patients who see them as part of some huge pharma-government conspiracy (along with vaccines and 5G, presumably) but the data are there to support them.

One of the issues with them is myalgias. We all see this to varying degrees. We all warn patients about it, as do their pharmacists, the information sheets from the pharmacy, some TV show, a Facebook friend, that guy in their Tuesday bowling league ... etc.

It is a legitimate concern. Some people definitely do get muscle cramps from them and need to come off. Scanning the medication list of someone who comes in with muscle cramps is a key part of the case.

Recently, the Lancet published a meta-analysis on the subject and found that, in 9 out of 10 patients who complained of muscle cramps on statins, the symptoms were unrelated to the drug. While previous data suggested rates of myalgias as high as 29%, this paper found it was closer to 7% compared with placebo. Only one in 15 of the muscle-related reports by patients while taking statins were clearly caused by the drug.

The power of suggestion is remarkable indeed.

The study is interesting. It might be correct.

But try telling that to the patients.

We all have patients who will get pretty much any side effect we mention, or that they read about online. That’s just human nature for some. But even reasonable adults can confuse things. The guy who starts Lipitor one week then helps his daughter move into her apartment the next. The lady who starts Crestor while training for a half-marathon. And so on.

The fact is that a lot of people take statins. And a lot of people (like, pretty much all of us) do things that can cause muscle injuries. Sooner or later these lines are going to intersect, but that doesn’t mean they have anything to do with each other.

It’s a lot harder to explain that, and have people believe it, once they’ve convinced themselves otherwise. Pravachol definitely did this, Dr. Google said so. It doesn’t help that trust in doctors, and health care science in general, has been eroded by political pundits and nonmedical experts during the COVID-19 pandemic. To some people our years of experience and training are nothing compared to what an anonymous guy on Parler told them.

Certainly this paper will help. A lot of people can benefit from statins. With this data maybe we can convince some to give them a fair shot.

But, as we’ve all experienced in practice, sometimes no amount of solid data will change the mind of someone who’s already made theirs up.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Statins have, overall, been a remarkably beneficial class of drugs. Yes, you occasionally get patients who see them as part of some huge pharma-government conspiracy (along with vaccines and 5G, presumably) but the data are there to support them.

One of the issues with them is myalgias. We all see this to varying degrees. We all warn patients about it, as do their pharmacists, the information sheets from the pharmacy, some TV show, a Facebook friend, that guy in their Tuesday bowling league ... etc.

It is a legitimate concern. Some people definitely do get muscle cramps from them and need to come off. Scanning the medication list of someone who comes in with muscle cramps is a key part of the case.

Recently, the Lancet published a meta-analysis on the subject and found that, in 9 out of 10 patients who complained of muscle cramps on statins, the symptoms were unrelated to the drug. While previous data suggested rates of myalgias as high as 29%, this paper found it was closer to 7% compared with placebo. Only one in 15 of the muscle-related reports by patients while taking statins were clearly caused by the drug.

The power of suggestion is remarkable indeed.

The study is interesting. It might be correct.

But try telling that to the patients.

We all have patients who will get pretty much any side effect we mention, or that they read about online. That’s just human nature for some. But even reasonable adults can confuse things. The guy who starts Lipitor one week then helps his daughter move into her apartment the next. The lady who starts Crestor while training for a half-marathon. And so on.

The fact is that a lot of people take statins. And a lot of people (like, pretty much all of us) do things that can cause muscle injuries. Sooner or later these lines are going to intersect, but that doesn’t mean they have anything to do with each other.

It’s a lot harder to explain that, and have people believe it, once they’ve convinced themselves otherwise. Pravachol definitely did this, Dr. Google said so. It doesn’t help that trust in doctors, and health care science in general, has been eroded by political pundits and nonmedical experts during the COVID-19 pandemic. To some people our years of experience and training are nothing compared to what an anonymous guy on Parler told them.

Certainly this paper will help. A lot of people can benefit from statins. With this data maybe we can convince some to give them a fair shot.

But, as we’ve all experienced in practice, sometimes no amount of solid data will change the mind of someone who’s already made theirs up.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

Statins have, overall, been a remarkably beneficial class of drugs. Yes, you occasionally get patients who see them as part of some huge pharma-government conspiracy (along with vaccines and 5G, presumably) but the data are there to support them.

One of the issues with them is myalgias. We all see this to varying degrees. We all warn patients about it, as do their pharmacists, the information sheets from the pharmacy, some TV show, a Facebook friend, that guy in their Tuesday bowling league ... etc.

It is a legitimate concern. Some people definitely do get muscle cramps from them and need to come off. Scanning the medication list of someone who comes in with muscle cramps is a key part of the case.

Recently, the Lancet published a meta-analysis on the subject and found that, in 9 out of 10 patients who complained of muscle cramps on statins, the symptoms were unrelated to the drug. While previous data suggested rates of myalgias as high as 29%, this paper found it was closer to 7% compared with placebo. Only one in 15 of the muscle-related reports by patients while taking statins were clearly caused by the drug.

The power of suggestion is remarkable indeed.

The study is interesting. It might be correct.

But try telling that to the patients.

We all have patients who will get pretty much any side effect we mention, or that they read about online. That’s just human nature for some. But even reasonable adults can confuse things. The guy who starts Lipitor one week then helps his daughter move into her apartment the next. The lady who starts Crestor while training for a half-marathon. And so on.

The fact is that a lot of people take statins. And a lot of people (like, pretty much all of us) do things that can cause muscle injuries. Sooner or later these lines are going to intersect, but that doesn’t mean they have anything to do with each other.

It’s a lot harder to explain that, and have people believe it, once they’ve convinced themselves otherwise. Pravachol definitely did this, Dr. Google said so. It doesn’t help that trust in doctors, and health care science in general, has been eroded by political pundits and nonmedical experts during the COVID-19 pandemic. To some people our years of experience and training are nothing compared to what an anonymous guy on Parler told them.

Certainly this paper will help. A lot of people can benefit from statins. With this data maybe we can convince some to give them a fair shot.

But, as we’ve all experienced in practice, sometimes no amount of solid data will change the mind of someone who’s already made theirs up.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.