Saturday, February 06, 2010

Diabetes Guidelines- Are they behind the times?

February 6, 2010

Institute For Medical Wellness Healthy Living Report

Interesting Article of the Week:

Diabetes Guidelines- Are they behind the times?

Here is a link to a recent article on new diabetes guidleines from the American Diabetes Association (ADA). In skimming through this article, it reinforced to me how slow big corporations are to change paths, even when behind the times. It also makes me very happy that I work for you, and not any large group practice or corporation.

I'll write about one of the guidelines the ADA has revised. It concerns the use of the Hemoglobin A1C (HbA1C) test for the diagnosis of Diabetes. HbA1c is a test that measures the amount of glycated hemoglobin in your blood. Glycated hemoglobin is a substance in red blood cells that is formed when blood sugar (glucose) attaches to hemoglobin. The higher your blood sugar over time, the higher your HbA1C. So diabetics who average higher sugar levels will have a higher HbA1C level than a non-diabetic. Now it does not take an ocean and aerospace engineer, otherwise known as a rocket scientist, to realize that HbA1C levels in pre-diabetics are higher than non-diabetics, and that diabetics HbA1c levels are higher than pre-diabetics. So I have been using HbA1c levels to monitor individuals who are trending towards diabetes for over a decade, against the recommendations of the ADA.

Why go against the ADA? Because it made logical sense!! Catching prediabetes at an earlier stage allows for proper time to help reverse the trend away from overt diabetes. But if you look at the ADA guidelines, they just decided that what I have been doing for the past decade works. Why did it take them so long?

Here is a quote from their revised guidelines concerning the treatment of diabetes.

"The most successful practices have an institutional priority for quality of care, involve all of the staff in their initiatives, redesign their delivery system, activate and educate their patients, and use electronic health record tools," the guidelines authors conclude. "It is clear that optimal diabetes management requires an organized, systematic approach and involvement of a coordinated team of dedicated health care professionals working in an environment where quality care is a priority."

Pardon me, but what a crock of patronizing B.S. IMHO, they are trying to make Diabetes sound like rocket science. Is this to make their business entity more relevant? Diabetes is not rocket science. Diabetes treatment in the early stages is fairly straight-forward, especially if you are willing to make the necessary diet and lifestyle changes. I have advised and treated many diabetics. My patient's who followed my advice would end up lowering their medication, if they were on any, all while delaying progression of their disease. I do all of the diet counseling. My medical assistant helps with the in office testing. We do not need an institution, multiple staff, or a complicated delivery system. I use electronic health records, but they do not make diabetic treatment any easier. The ADA's statements about diabetes treatment seem to serve the purpose of their organization, corporation, and all the bureaucracies they encompass, but tend to be behind the times in terms of treatment recommendations.

One of the simplest treatments for Diabetics is proper diet. But please do not follow the ADA's diet recommendations. They are behind the times on diet as much or more than they were behind the times on the use of HbA1C testing. If you are a Diabetic, or prediabetic, our Healthy Weight program is ideal to help you get your disease under control. For more information, please call our office and schedule an appointment to discuss this further. If I can help one person avoid the long term complications of Diabetes, than I am doing my job!


Big Pharma segment

One of the many reasons that I founded the Institute For Medical Wellness was to be able to maintain a focus on the individual. I wanted to be free of healthcare distractions that offer nothing to help with patient care. The major distractions include health insurers, government regulators and bureaucrats.

Now I will let you inside my head a little more. OK, my mother may say that is dangerous, but we will not get into that now. But time to get my ADD brain back on topic.

When I consider treatment options, I do not first think about insurance medication formularies, whether a test needs insurance approval or if a consulting doctor is in the insurance network. These intruders just get in the way of good patient care, and I want none of them!

But one of my bigger pet peeves lately has not been with insurers or government, but with the training and sales techniques that Big Pharma uses for their pharmaceutical representatives. This is not a shot at the reps themselves. I get along very well with most of them that call on my office. I know they are only doing what they are told and trained to do.

This is a shot at Big Pharma management, and how they let the government and health insurers corrupt how they interact with physicians, thereby sending many reps to our offices with little actual pharmaceutical training.

In the good old days, before health insurers took control of prescriptions, pharma reps would discuss the inner workings of their medications, as well as the costs to patients. Many of the reps were pharmacists prior to taking a sales position and came with an excellent pharmaceutical and medical background. I used to learn alot from our interactions.


Fast forward to today's physician-pharma reps dialogue:

Rep: Good afternoon Doctor Horvitz. I am here to discuss Drug Costoomuch.

Doctor Horvitz: OK, I have read about Drug Costoomuch and I am familiar with it. I hear it can't be used with drug Muchosideffex.

Rep: Yes, doctor you may be correct, but let me send in an inquiry to my research department about your question.

Doctor Horvitz: No thank you. That information is already available to me. Do you have anything new to tell me about how Costoomuch works, or any new indications for its use?

Rep: No I have nothing new in that department, and government regulations forbid me from answering many of your questions. I can't even give you a cool little pen with Costoomuch on it anymore due to regulations. But may I please show you a list of insurance formularies that Costoomuch is available on?

Doctor Horvitz: NO. I really do not care about insurance formularies. I pick a medication based on how well it will work for my patient. And I always like to know the cost of the medication so the patient can help to make an educated decision on his preference of treatment.

Rep: But the formularies tell you what it will cost a patient for drug Costoomuch.

Doctor Horvitz: No, the formularies tell me what Pharmaceutical companies made backdoor private deals to get their product on a formulary. Now I know where the Senate learned how to negotiate health care reform. But in my opinion, formularies are not based on efficacy or safety, but on cost and profit.

Rep: Thank you for sharing Doctor Horvitz. All I can tell you is that drug Costoomuch is on most of the insurance formularies in South Jersey.

Doctor Horvitz: How much does Costoomuch cost to a patient without health insurance? In other words, what is the cash price at the pharmacy?

Rep: Cash price? Do people actually pay cash price today? Oh, I am not sure. Not many doctors ever ask me that question. I'll have to ask my manager and get back to you. BTW, would you like me to schedule a lunch for your office to discuss this further?

Doctor Horvitz: No thank you. You really do not know how much Costoomuch actually costs?

Rep: No. I am supposed to inform you of formularies, not cash prices, as most patients do not pay full price for their medications.

Doctor Horvitz: Yes, I understand that. And that is one of the big reasons that Costoomuch costs so much, as nobody really knows the actual price, even the reps who sell them. May I sign for some samples now? Thank you for your time. Have a nice day!


I could go further, but I think you get my drift. When true costs are hidden, as Big Pharma and Big Government like to do, it usually means that prices will be high. When true costs are out in the open, the price will usually be lower. Look at the prices of generic medication today. Many can be purchased for $4 a month or $10 for 3 months, without a prescription plan, and without the many layers of bureaucracy involved with insurance and government formularies.

*Every layer of bureaucracy and management increases the cost of a product or service.
*Every layer of bureaucracy and management increases the time it takes to get a product or idea to market or utilization.
*Every layer of bureaucracy and management adds greatly to the hassle factor of ever using the product or service well.

Pearls of the Day:

Get the third parties out of our everyday healthcare interactions, other than the big ticket items, and you will see healthcare costs decrease dramatically!!!

And maybe, just maybe, I'll get another free pen with the drug name "Costoomuch" on it ;)

To Good Health!

Steven Horvitz, D.O,
Board Certified Family Practice
Founder of The Institute For Medical Wellness
128 Borton Landing Road, Suite Two
Moorestown, NJ 08057
Phone 856-231-0590
Fax 856-294-0311

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