Cholesterol Lowering Statin Drugs DO NOT Encourage Cognitive Decline

Statin drugs are used to lower cholesterol levels in the hope of preventing vascular disease including heart disease, strokes, peripheral arterial vascular disease. They have been safely prescribed to millions of people for years showing great effectiveness.  However, a cloud hangs over them over side effects glorified in the lay media and on the internet.  Oftentimes patients don’t even fill their prescriptions due to their concerns. One of the myths is that statins lead to a premature decline in cognitive function and dementia.

This concern was addressed in the Journal of American College of Cardiology highlighting a study authored by Katherine Samaras, MBBS, PhD of St. Vincents Hospital in Sydney Australia.  They looked at adults aged 70 – 90 over a period of seven years.  Over 1,000 subjects in the study included individuals who did not take statins, individuals who were already using statins and individuals who were started on statins during the study period. The subjects first took a standard mini mental status test which allowed them to exclude anyone already showing signs of dementia. They then did state of the art cognitive testing and memory testing on the subjects over a seven-year period.

They found that there was no difference in the rate of decline of memory or intellectual function between statin users and non-users.  In a small subgroup of patients, they used imaging techniques to look at the brain volume comparing it over time between statin users and non-users. They found that users had more brain volume at the six-year mark than non-users.  They found that users with heart disease who took statins had a slower rate of decline of learning memory than non-users.  This also included users and non-users who have the APOE-4 genotype associated with cognitive decline.

While statins may not be a perfect class of drug, the study clearly demonstrated that the idea that they encourage cognitive decline and dementia at an accelerated rate is completely false.

Medicare Advantage – Great Insurance If You Are Healthy

It is open enrollment period through December 7, 2019 for those of us 65 years of age and older who are supposed to sign on to www.medicare.gov to choose our 2020 prescription drug plan Part D. This is also the open enrollment period for insurance owned and operated by private managed care Medicare Advantage programs. These plans preceded ObamaCare, or the Affordable Care Act, and are private managed care plans. They were designed to save the government money but, in fact, year after year are more costly per patient than traditional Medicare.

Let me repeat that, according to government auditors, MEDICARE ADVANTAGE PLANS COST MORE PER PATIENT PER YEAR THAN TRADITIONAL MEDICARE! If you sign up for one you will need to abide by the managed care company’s contracted panel of doctors and facilities. You do not get to choose the best doctor or hospital for your problem – just the best on your contracted panel. These insurers tell you it’s the same as Medicare but it is not. They will provide you with an insurance ID card colored and lettered to mimic Medicare but it is not Medicare.

It is great for healthy patients until they get sick. There are few, if any, monthly costs to enrollees. Generic drugs, inexpensive vision care, inexpensive hearing and dental care are often included. If you develop a complicated health problem and want to see the best it is usually OUT OF NETWORK. If you get sick out of your home area you may well be OUT OF NETWORK. These plans are immensely profitable to insurers.

They are so profitable that seniors are bombarded with mail advertising, full page newspaper advertising and constant prime time TV advertising using celebrity spokespersons. The ads encourage seniors to travel and fund their grandchildren with the savings they will reap from joining their plan.

They don’t explain what happens when mom has a new lymphoma and cannot go to MD Anderson or Memorial Hospital or Dana Farber for diagnosis and cutting-edge care. They don’t tell you about the experience of your contracted panel doctor to treat Grandpa’s throbbing headache caused by a brain vascular malformation because the regional neuro vascular interventionalist of choice is not on grandpa’s panel.

I have an idea. How about putting the cost of all the expensive enrollment advertising done by these private Medicare Advantage plans in to better benefits for their clients?  We all know the answer to that.

Changes in Florida’s Prescribing Medication Laws

In their ultimate wisdom, the Florida Legislature has decided that all medication prescribing shall be done electronically by computer beginning in January 2020.  As of November 1st, the Florida Medical Association has not informed its members of this but it was discussed briefly at a hospital staff meeting.

We were told that most pharmacies will no longer honor paper written prescriptions.  My office electronic health record system, which slows down seeing patients remarkably, has had electronic prescribing software which we have used for several years now.  The big change is that we will now be required to order controlled substances online electronically when in the past it was not permitted.

Since the opioid crisis struck Florida, physicians have been required to create an account with the State’s narcotics hotline named E-Forsce and check out the recipient prior to prescribing controlled substances for pain.  We then issued a written prescription.

It never made sense to me why if one is trying to track narcotic prescribing it wasn’t being done on computers from the beginning?  Nonetheless, this is a change which will require prescribers to download additional software and use two methods of identification as the legitimate prescriber before you can actually prescribe for your patients.

It will give you the freedom to prescribe from your phone or tablet when out of your office which is a convenience not available in the last few years. It will however mean more time in front of the computer screen, more user names and passwords to remember and less time actually listening, talking and communicating with patients.

40 Years of Service & a Misspelled Plaque – Thanks!

I attended my hospital’s medical staff quarterly meeting last week. At one time these meetings were mandatory.  If you missed a meeting, you were fined or even suspended.

Voting on major issues required a quorum of three quarters of the active staff.  Hospital employed physicians, or anyone being paid directly by the hospital, were not permitted to vote because they were felt to have a conflict of interest.   Much like the original Federal government which set checks and balances between the Executive Branch, the Legislative Branch and the Judicial Branch we had checks and balances between administration, medical staff and the community mission statement.   All of that is gone today. Meeting attendance is now voluntary.

For the most part, the only medical staff attending are hospital contracted physicians there to push an issue or vote which is beneficial to hospital administration. I have been a harsh critic of the loss of power of the community, and community doctors who support our hospital, but being a small fish in a large pond my thoughts and opinions are rarely considered because the bottom line is the bottom line and that seems to be all that counts in today’s health care environment.

The meeting had some of the vestiges of past meetings including awarding scholarships to worthy young doctors in training, introducing new members of the medical staff and a speech about the future from our new CEO.  The elected Chief of Staff stopped after each introduction and posed for a picture with each scholarship winner and each new staff member.  It was a ritual performed for years at these meetings. The final discussions were about new rules and regulations starting January 1, 2020 regarding ordering of imaging tests and prescriptions. There was no discussion of the communication issues between physician to physician, no discussion of the new policy of nurses not accepting verbal orders from physicians either face to face or over the phone. No discussion of the impact of protocol medicine, one- size-fits-all on individuals with individual problems and needs.

The next morning a representative of the hospital’s marketing department arrived unannounced in our office. She comes monthly to make sure we aren’t having problems ordering outpatient tests at the hospital. On this day, after discussing nothing of earth-shattering importance, she turned to leave and then turned back and reached into her bag and pulled something out. “I almost forgot to leave this here for Dr Reznick.”

The item was incorrectly placed by my staff in my emergency message call box.  I saw it between patient encounters, lifted it up, turned it over and realized it was a plaque for me from Baptist Health System Boca Raton Regional Hospital.  There was a picture of the hospital and inscribed below was a message, “In recognition of 40 years of staff service providing care for the community.”

My name was spelled incorrectly using the spelling of a neurologist who is not on staff and practices 25 miles away.  For years now I have been complaining to no avail that my imaging and lab results are being sent to this physician in error. No one at Boca Raton Regional Hospital has done anything to correct the matter.  So, about twice a month I receive a middle of the night call from Mount Sinai Hospital in Miami Beach looking for their Steven Resnik (with an “R”) but mistakenly calling me (with a “Z”).

I did not ask for any recognition of my 40 plus years on the staff of Boca Raton Community now Regional Hospital.  Although a mention at the quarterly staff meeting, after they introduced the scholarship winners and the new members on staff, would have been nice.  And, receiving a plaque presented as an afterthought, by someone I do not know, with my name misspelled seemed rather disingenuous.