The CardioMEMS’ heart failure pressure measurement system

By Steven Greer, MD

The CardioMEMS’ heart failure pressure measurement system will be evaluated by Read more »

How pain pills almost killed my mother after elective knee surgery

May 21, 2014- By Steven E. Greer, MD

My mother is in her 70’s and in good health except for debilitating knee arthritis. After considerable research and second opinion (a bad spine surgeon misdiagnosed her knee pain as sciatica), she underwent elective total-knee replacement of her left knee with a Stryker Triathlon implant. Her surgeon was Dr. Vivek Sahai who operates out of Riverside Hospital, in Columbus, Ohio.

The surgery went well. Several days after surgery, she was eating and tolerating physical therapy, but was taking Oxycontin. I am too aware of the dangers of opioids, and that worried me. Read more »

Medical Tip: How to get special glasses for computer screen distances, for cheap

March 14, 2014- By Steven E. Greer, MD

With remarkable regularity across all populations, the inner lens of the eye loses flexibility after age 45 and people begin to have trouble reading up close (presbyopia). So, to compensate, people push the book or computer screen away. Then, as the eyes worsen, people start to have trouble reading computer screens even when they are three feet away.

The solution is Read more »

David Bahner, MD: Training non-radiologists to use ultrasound

Ultrasound imaging has many advantages over radiation emitting X-rays and CT scans. The recent publications on the risks of radiation exposure make the use of ultrasound more compelling. Moreover, expensive radiation-based imaging studies, and overusage of them, are one of the largest expenditures in the private and government healthcare budgets.

Dr. David Bahner, emergency medicine physician at The Ohio State University Medical Center runs a unique program that teaches medical students and residents how to operate portable ultrasounds for focused diagnostics in cases of trauma, hypotension, pelvic exams, pregnancy, and to assist interventional procedures.

In Part 1, Dr. Bahner gives an overview of point of care portable ultrasound:

In part 2, Dr. Bahner discusses the training program and how other specialties have adopted ultrasound training

 

Stacy Ardoin, MD, Carlos Lozada, MD: Benlysta (belimumab) for lupus

Lupus has been a challenging disease with little clinical progress for decades. This may change soon if a new drug branded as Benlysta (belimumab) is approved. The series of BLISS trials met the primary endpoints. CurrentMedicine.TV moderated a roundtable discussion with two lupus experts, Carlos Lozada and Stacy Ardoin, to discuss the strengths and limitations of the trials, and whether safety concerns might arise.

 

Manipulating the medical financial disclosure process

Update: March 16, 2011

The New England Journal of Medicine investigated our report of Dr. Gillison failing to disclose her Merck funding when she published in the NEJM last year. They informed us, “The (Gillison) disclosure form was updated on March 10^th to include the information.  We did not consider this misconduct because it falls into a gray area. Thank you for bringing the matter to our attention.” The Merck database still does not disclose the funding to Dr. Gillison, exposing one of the many flaws in the current “voluntary” reporting systems in place prior to the Sunshine Act kicking in.

March 3, 2011

(From The Healthcare Channel)

The Physician Payment Sunshine Act was finally passed as part of the ACA healthcare law. By 2013, it will mandate that healthcare industry payments be reported in a public database. In an attempt to get ahead of that impending legislation, many of the major pharmaceutical companies implemented “voluntary” reporting of payments to doctors. ProPublica made a searchable website, Docs for Dollars, that is driven by the data from these voluntary efforts.

Are the current reporting efforts comprehensive or are many forms of payments still going undisclosed? If so, are doctors, the drug industry, or both part of the problem?

The mainstream press has featured numerous stories relating to the alleged problem of a “growing risk” to males from Human Papilloma Virus (HPV). Correlating with the timing of these seemingly new breakthroughs in medicine have been the FDA approvals of two vaccines to prevent some forms of HPV: Gardasil, made by Merck, and Cervarix, made by GlaxoSmithKline.

The initial “low hanging fruit” to which the pharmaceutical companies marketed these vaccines was to young females as a way to prevent cervical cancer. The other half of the human population, males, also acquire genital HPV, but it is less life threatening. A more urgent reason to drive vaccine adoption among males would be to prevent a form of cancer. Enter the oral cancer debate.

One of the leading researchers asserting that oral cancer is caused by HPV contracted during oral sex (as opposed to smoking and tobacco use) has been Maura Gillison, MD, PhD. For her influential 2010 New England Journal of Medicine publication, Dr. Gillison completed a lengthy financial disclosure form and checked “No” for all questions relating to possible industry payments. Docs for Dollars and the voluntary reporting website from Merck list no payments to Dr. Gillison, as of the time of this story.

The Healthcare Channel has exclusively learned that Dr. Gillison was in fact receiving payments from Merck, going back to 2008, that benefited at the least her laboratory, while she was at Johns Hopkins. Her Merck funding related to the HPV-16 diagnostic test in the NEJM paper: a product with significant potential commercial value if her theory of HPV-associated-oral-cancer proves to be true. Dr. Gillison failed to report these payments to the NEJM.

Dr. Gillison does currently list Merck as a financial disclosure in her numerous speaking engagements. However, Merck still does not list her in the company database. A spokesperson for Merck explained that the Merck web site only lists “speaker fees” and that none of the other numerous forms of payments to doctors, such as travel fees, laboratory grants, payments to serve on mock FDA advisory committee panels, etc. are reported. When asked whether those data are comprehensive, the spokesperson replied, “No. They are not”.

Merck declined our numerous requests to list the details of the fees that Dr. Gillison now reports. The HCC has learned that Dr. Gillison was being funded to develop some form of diagnostic for HPV. Since this did not directly relate to oral cancer caused by HPV, in her opinion, Dr. Gillison did not report the payments to the NEJM.

The Ohio State University Medical Center, Dr. Gillison’s current place of employment, also declined our numerous request for details about her Merck funding, even though she currently is reporting Merck as a source of funds. The HCC learned that Dr. Gillison was interviewed for “several hours” by the senior in-house legal council of the medical center as a result of The HCC investigations.

A recent ProPublica investigative report found that academic medical doctors frequently ignore the new university polices that limit or forbid Pharma-paid-speaking-engagements. To address this, The Ohio State legislature has a bill under consideration that “would require pharmaceutical manufacturers to submit annual reports that list gifts given to physicians who are authorized to prescribe drugs”. At the federal level, The Inspector General of The DHHS, Daniel Levinson, commented in 2010 that there is a systemic problem of financial conflicts of interest within the FDA, NIH, CDC, CMS, and other divisions of The DHHS.

Catherine Lucey, MD: The iPod or iPhone as a medical tool

Produced and interviewed by Steven Greer, MD

Dr. Catherine Lucey, Vice Dean of Education at The Ohio State University College of Medicine discusses their pioneering use of Apple’s iPod and iPhone as a true medical tool. OSU videotapes medical school lectures and makes them available on Podcasts. In the clinical setting, the devices serve as rapid sources of medical and drug information using a variety of special “apps”.

Justin Harper, a fourth year medical student going into plastic surgery, began the program a few years ago. Now, OSU distributes iPods to all of its medical students and residents.

 

Dr. Lucey and Mr. Harper discuss how they set up the program how it functions.

New treatment decisions for lung cancer

April 14, 2010

httpv://www.youtube.com/watch?v=nIjFWKIbGy0

Over the last ten years, new drugs and genetic tests have developed for the treatment of non-small cell lung cancer (NSCLC). EGFR antibodies (Erbitux by Eli Lilly, Vectibix by Amgen), and small molecule oral pills targeting the tyrosine kinase pathway (Tarceva by Roche and OSI, and Iressa by AstraZeneca) had shown unpredictable effectiveness until it was learned that certain histology subtypes and genetic mutations play a big role in whether the drugs work or the tumors are susceptible to treatment.

Making the treatment algorithms more complicated is the new concept of “maintenance therapy”. Eli Lilly’s drug Alimta (pemetrexed) was recently approved by the FDA for this indication.

To help clarify the state-of-the-art optimal treatment for NSCLC, the new Director of Medical Oncology at The Ohio State University Comprehensive Cancer Center, Miguel A. Villalona-Calero, MD, discusses these topics in depth.

 

Current guidelines and methods for treating knee and head injuries in NCAA athletes

September 14, 2010

Lee Kaplan, MD, Chief of Sports Medicine at The University of Miami Health System and team doctor for the Miami Hurricanes football team discusses the state-of-the-art methods for surgically repairing torn knee meniscus injuries and for repairing torn ACL’s.

Clifton Page, MD, internists for the Miami Hurricanes football team, discusses the new guidelines for handling the return to play for athletes who have suffered a concussion, testing for sickle cell, and for monitoring heat exhaustion. (See Op-Ed How to Eliminate Head Injury in Football)

Miguel A. Villalona-Calero, MD: Maintenance therapy for lung cancer

Miguel A. Villalona-Calero, MD, discusses the new concept of “maintenance therapy” for chemotherapy usage in non-small cell lung cancers.