Browsing Tag

Medication

Caring for Sick Kids: Know the Difference Between “Natural Remedy” Facts and Fallacies

By November 18, 2015 3 Comments
Share:
sickkid

It’s hard to watch our kids suffer when they’re not feeling well. c/o M. Weinberg-Anderson

Taking care of an ill child is challenging. On one hand, a parent wants more than anything in the world to relieve their child’s discomfort, but it’s also perfectly reasonable to have concerns about the potential side effects of prescription and over-the-counter medications. It is also completely understandable that many well-meaning parents seek out remedies that are marketed as being “natural” because they believe that these types of remedies will be safer than conventional treatments. Unfortunately, many of these concerns are unfounded, since most so-called natural remedies are ineffective or even unsafe, as I have explained in my previous post.

Before I address a few specific bogus remedies for sick children here, I want to tackle a few equally bogus claims that are often raised during discussions of alternative approaches to health care. Whenever I question the safety or effectiveness of a “natural” remedy, I am invariably faced with one or more of the following rebuttals: natural means safer, natural means more effective, and finally, doctors only recommend drugs and surgery. None of these generalizations are remotely true, and here’s why:

Tags: , , , , ,
Categories: Ages + Stages, Newborns + Infants, School-Aged Children, Science 101 + Mythbusting, Toddlers + Preschoolers, Tweens + Teens

Should You Treat Your Child’s Cold or Flu With Traditional or Homeopathic Medications?

By September 29, 2015 4 Comments
Share:

 

We’ve entered that time of year when many of us try to stay indoors as much as possible, cringe at the mere sound of someone coughing, and stock up on hand sanitizer in attempts to ward off illness. Cold and flu season has begun and, as usual, our children are the most susceptible to these viruses.

As the father of two, I know that parents want to ensure that our kids are healthy and happy, it’s in our nature, so when our kids become ill, we want to fix it immediately. But are the cough and cold medications you find overflowing in the aisles of your pharmacy the best option for easing your child’s symptoms?

As a pharmacist I speak with parents all the time who grab a bottle of cold medicine off the shelf that makes the most promises of relief on the label. If the parents seek my advice I often tell them it would be wiser to put the bottle down and offer their kids comfort measures at home like warm soup, a humidifier, and lots of fluids instead. I know this seems counter-intuitive – I’m a pharmacist! Most people assume I see medication as the solution to every problem. Not so.

First, it’s important to note that over-the-counter cold and flu medications can’t cure or shorten the duration of those illnesses, they can only offer temporary symptom relief while the virus runs its course. The infection and symptoms will end when the child’s own immune system has won the battle.

Tags: , , , , ,
Categories: Ages + Stages, Infectious Disease + Vaccines, Newborns + Infants, School-Aged Children, Toddlers + Preschoolers, Tweens + Teens

Is Your Pediatrician on Big Pharma’s Payroll?

By August 4, 2015 4 Comments
Share:
Kid and Doc

Pediatricians are some of the lowest paid physicians

Have you ever wondered how your pediatrician gets paid? It’s probably not something you spend a ton of time thinking about, however, there are some people who claim that every time a doctor writes a prescription or delivers a vaccine that they are paid by a pharmaceutical company to do so. Well, I am a pediatrician and I’m here to set the record straight.

Pediatrics isn’t a lucrative specialty

Before we can talk about how much your doctor makes and where that money comes from, we need to talk about what it cost them to become a doctor in the first place, because it has a big impact on how many of you may view pediatricians and their relationship to profit in general.

On average, 4 years of medical school costs over $200,000 and the average medical student graduates with $180,000 in student loan debt. After graduation, prospective pediatricians train in a 3-year residency program (pediatric specialty training) with an average salary during these years of about $55,000 per year, depending on location. Even with a 20-year loan repayment plan, the monthly payment on the loan would be $1,374, or more than half of a resident’s take-home salary. For this reason many pediatric residents put off paying their loans until they have their first job. While a resident doesn’t have to make payments during those three years of deferment, their loans still collect interest. That makes the $180,000 in student loans compound to a total of approximately $217,430 when the former-resident-turned-doctor gets their first job, and begins making payments on them.

Why is this relevant?

Next to family and general practice, pediatrics are the lowest paid medical specialty a clinician could choose to pursue. Pediatricians graduate with a massive amount of student debt and their salary makes it difficult for them to pay it off. The typical starting salary for a pediatrician may be $130,000-150,000 depending on their location. Therefore, their monthly student loan repayment for 10 years would be 30% of their monthly income, or 15% over 20 years.

If pediatricians were in it for the money, they would have chosen much more lucrative specialties. Those who choose pediatrics are not doing it for the money but are doing it because they generally love to care for children and their families. That takes gets us full circle to the point of how physicians, pediatricians specifically, get paid.

Doctors are paid by their employers, who are paid by insurance companies, not pharmaceutical companies

There are many options for career paths once out of their 3-year residency, and each of them will have an impact on how much money a physician will take home. For example, one can choose to work for a hospital, a large multi-specialty group, or a small practice, and each of these have a different baseline for overhead costs, all which come before the pediatrician’s paycheck. As the process goes, doctors see patients, and based on the time and complexity of the care that they provide, they submit a corresponding bill for that care to a patient’s insurance company. The insurance company then pays the doctor’s employer for an accepted cost of care, usually negotiated between the two sides. From that amount, once overhead costs and staff are paid, the employer, whether it is a hospital or small practice, then pays the doctor. None of that process includes income from a pharmaceutical company.

It’s actually an infrequent occurrence to have money flow directly from a pharmaceutical company to a physician. Scenarios where this may occur is one where a physician may decide to be an expert speaker for a pharmaceutical company and be paid for speaking engagements. Alternately, some physicians choose to do research with a pharmaceutical company, and that position would also likely be paid. However, this can not be stated enough, the vast majority of pediatricians seeing patients on a day-to-day basis do not receive direct compensation by any drug company.

Every conspiracy starts somewhere – and this one is linked to the “Big Pharma” myth

So where is this conspiracy theory coming from?

Distrust of the medical establishment and fear of modern medicine (vaccines first and foremost) is too large a topic to discuss here. However, I believe this is how it started. Accusing a doctor of being paid by “Big Pharma” is an attack on the doctor when no other substantive evidence is available to support an allegation or claim of bias. For example, if a pediatrician defends the safety and efficacy of vaccines to someone who is anti-vaccine, they may be accused of being in the pockets of the companies that produce or distribute the vaccines. These claims are not supported by scientific fact or logic (i.e. fiscally responsible behavior), since purchasing and storing vaccines is such an expensive undertaking that many small practices lose money by offering them at all.

Concerned? Ethics check: does your physician sell medications direct?

Concerned? Ethics check: does your physician sell medications direct?

Of course, in the past, there was an indirect incentive for physicians to recommend certain medications from pharmaceutical companies. Prior to appropriate legislative action, physicians were offered elaborate vacations and dinners by certain pharmaceutical companies in the hopes that these doctors would recommend a certain drug over another. However, this has dramatically changed in the past several years through legislation. It is now illegal to try to influence physicians with gifts, including those once-famous pens so many of us might remember in our doctors’ offices years ago. In my company, we rarely see representatives from pharmaceutical companies and we have a policy against free lunches. Many residency programs have the same policy, and many hospitals and clinics ban solicitations of that nature entirely.

Doctors choose the most appropriate medicine for an illness or injury given the circumstances

Making decisions about which medication to use for a given illness is complicated. Antibiotic recommendations are made based on what is most certain to kill the bacteria most likely to be the cause of an infection. For other conditions, scientists develop medicines based upon the known cause of a condition. Yes, this typically gets done at a pharmaceutical company, but that is because they have the money to do so. In fact, anyone who is independently wealthy and wants to hire scientists to develop medications is free to do so!  Once a medication has been developed and studied, it doesn’t simply enter the free market – the company must go through a rigorous FDA approval process. Even after several tiers of studies are completed and FDA approval is set, doctors still rely on large panels of experts to look at all of the available evidence to decide if a medication should be recommended or not (some of this is what we reference as “peer reviewed” studies).

So when a doctor is examining a patient and needs to treat a condition, he/she considers the patient’s needs and ability to comply with their recommendations, the latest medical guidelines for that condition, and then considers the patient’s medication options, including a treatments’s effectiveness, its side effect profile and most importantly, insurance coverage for that treatment. Frequently, in pediatrics the generic version of a medication is what is typically covered. Therefore, the expensive brand name medications advertised by pharmaceutical companies on TV and on the internet are rarely prescribed as they’re much less frequently covered or accessible to these patients.

On a final note, if you are worried about a doctor profiting off of prescribed treatments, you may want to consider how you’re being provided those treatments. Is it coming from a pharmacy, in the hospital or at your local store? You have little to nothing to be concerned about in terms of doctor bias. However, i your doctor selling directly to you? If they are, you may want to dig deeper. This could be a red flag. Who profits if you see an alternate practitioner who sells you herbs, supplements or homeopathic remedies, which are not proven to be safe or effective? Probably that practitioner. That’s what we call a conflict of interest in the care of a patient, and there is an ethical code that MDs and DOs are held to that do not violate that extra layer of protection.

Tags: , , , , ,
Categories: Science 101 + Mythbusting

Accidental Medication Overdoses: the Pediatric Case for U.S. Metric Conversion

By April 1, 2015 3 Comments
Share:

When I encounter something that interests me, I tend to intensely focus on that subject and try to master the basics as soon as possible. Though I don’t consider myself “domestic” per se (since when does cooking and organizing within my home make me of the non-exotic/wild/free spirit variety? I have to eat and survive, don’t I?), I will admit I have recently taken on to teach myself some old-timey skills. I mean, after all, you never know when one of those godawful sci-fi plotlines come to fruition and we’re all forced to live primitively, right? I’m looking at you, Leslie, and your ardent love of The Walking DeadThat being said, I’ve taught myself how to bake bread. And not just any bread. Gorgeous, beautiful, delicious, and dare I say it, edible bread. Like a mad scientist, I’ve learned how to work with yeast and flour and make things happen. Like a grown up who does real things! Which brings me by way of a long introduction, to the topic of this post.

Did you know that most experienced bakers try to use recipes measured in the metric standard? I’m referring to yeast, flour, sugar, salt and water being measured in grams and milliliters, not the preferred US Customary Units, a version of the imperial system. I was completely irritated by it at first, being so accustomed to relying on my measuring spoons and cups, until I saw how a slight deviation in precision could lead to a bread science disaster.

bread1

My delicious bread, Loafy the Fourth

Somewhere along the way, the recipe I’d been faithfully using to produce what my future hubby and stepsons call Loafy the First and Loafy the Second, I slightly mis-measured. Not enough for it to be noticeable at first, of course; I checked and rechecked measurements and nothing seemed out of the ordinary. But as that mixer churned, I found that I was left standing with a bowl of sticky pellets, a frown, and the youngest of the wolfpack consoling me on the untimely passing of Loafy the Third.

I sometimes take my mistakes as issues of a bigger problem; was I not careful enough? Should I have rechecked once more? But, no matter. It’s easy to throw away $1 worth of dough and start again. But what if it had been something more important, like medication for one of the kids, our future babies, or even my cat?

I’m no stranger to medical malpractice on account of pediatrician-prescribed medication overdose. In fact, I’ve seen what it looks like up close, the suffering and long-term damage that can happen to a child as a result. It can be devastating both for the child and the parents that provided the medication.  And it’s not as uncommon as you would think – according to a recent policy paper by the American Journal of Pediatrics, each year more than 70,000 children end up in the emergency room due to accidental medication overdoses. Many of these are due to the difficulty in measuring appropriate dosages, which can be even more complicated for infants and children due to the frequency and small amounts – and the tendency to prescribe in teaspoons or tablespoons (which are neither consistent or standardized from home to home unless one uses cooking utensils).

Fortunately, The AJP has pushed in recent years for pharmaceutical conversion to metric measurements, and the American Medical Association and Food and Drug Administration support the transition as well. For tips on how to prevent a medication error with your own child, The Institute for Safe Medication Practices has advice for parents that CBC News summarizes well, which you can check out here.

In the meantime,  my wolfpack is a rowdy one and naturally rallied for a Loafy the Fourth. Which, thanks to my digital scale measuring in grams, came out perfectly. But really, I’m more grateful that this time, it was just an inexpensive mistake.

 

Tags: , , ,
Categories: Accidents, Injuries, + Abuse, Policy, Politics, + Pop Health