The Affordable Care Act – Choice Still Matters

Affordable Care ActThe Affordable Health Care Act (aka “ObamaCare”) has led to the purchase of physician practices as hospitals and health care systems organize narrow networks of health care providers to cash in on the influx of newly insured patients.  The insurers are contracting with the health systems at discounted rates to provide care. The insurers are requiring the newly insured to see physicians who are in their contracted network and sacrifice choice.  This week in an article published on the front pages of the NY Times insurance company executives were discussing how having a choice is over rated and unimportant. They are beginning to develop a public relations and marketing campaign to sell that idea to the public that having a choice of physicians to perform your surgery or radiation therapy is unimportant.

I have practiced adult medicine for 35 years now and let me, without reservation, tell you that is simply not true. My 85 year old golf and tennis playing patient survived replacement of two heart valves riddled with infection because he was sent to the Cleveland Clinic in Ohio where statistics show patients survive more often with fewer complications. I have three survivors of multiple myeloma treated at Dana Farber Cancer Center in Boston, University of Arkansas in Little Rock and Moffit Cancer Center in Tampa. I have scores of athletic seniors dancing and running and home from the hospital in 48 hours after having their hips replaced with the minimally invasive anterior approach by surgeons with 2000 or more of these under their belts rather than just a few. Then there are the lymphoma survivors from MD Anderson and Dana Farber Cancer Center who survived multi-drug treatment regimens at places that perform these services more frequently than other places.

Some physicians and medical centers are better than others. Some are the experienced researchers and teachers who show the rest of us how to handle difficult diseases so our patients can benefit from their experience.  Choice matters! Do not let your human resources person, employer or health insurance marketing guru sell you on price over choice. It will cost you or your loved one your life or your health if you do!

New Diet Drugs Not Being Used

Diet DrugsA joint survey was conducted by the online medical news service MedPage Today, Everyday Health and The Daily Meal to evaluate physicians’ methods of treating obesity. They surveyed almost 1000 providers and found that the newer drugs such as Qsymia (phentermine/topiramate) are only being used by about 6% and Belviq (lorcaserin) in only 3.3%. Several of the survey respondents cited the high cost of the medications as barriers to use. One provider noted that “middle class (patients) and below cannot afford “these medications so he prescribes generic phentermine 37.5 mg one half tablet each morning with generic topiramate 25 mg twice a day with similar effectiveness.

Fat absorption blockers such as orlistat in it’s over the counter form “Alli” or its prescription form xenical were popular with over 20 % of respondents using those products. Generic phentermine was used alone by 16%. Other medications frequently mentioned included metformin the diabetic drug, and victoza another diabetic drug not yet approved for weight loss therapy.

The majority of the respondents prescribe diet and exercise to begin with. Weight Watchers is their favorite commercial diet with over 75% of those surveyed noting that it works steadily and safely. The South Beach Diet was the clear runner up. When the Atkins Diet was mentioned there was concern and controversy.

In our local clinical practice we are asked frequently about medication to lose weight. The survey did not look at the average age of the patients the respondents treated and their associated medical issues. Locally we have many elderly individuals using multiple medications for heart disease, elevated lipids, diabetes, heart rhythm control and other complex problems. It is much more difficult to find any oral medications for weight loss that do not adversely react with their prescribed medicines or that are not contraindicated due to their underlying medical problems.