Higher Copayments for Diabetic Medication Predict Treatment Failure

A recent study reviewed the prescription and laboratory data for over 18,000 members of a health insurance plan who had been diagnosed with (and treated with medication for) diabetes. For every $10 increase in prescription copayment for a given drug, treatment failure risk (the chance that the medication would be discontinued or changed to another medication) increased by 26%. (Source: P & T Journal, September 2008)

While the headline for the article sounds impressive, the other findings that struck me as amazing were:

• only about 57% of prescriptions written were even filled
• initial treatment failed during the four year study period in 70% of patients
• adherence to medication (ie. filling the prescription and subsequent refills) predicted end-of-study blood sugar (for every 10% increase in adherence, there was about a 0.12% decrease in A1c)

I think that one of the best messages from this study was that a patient who is given a prescription for a medication without an explanation about how the medicine works and why it is being prescribed is unlikely to fill the prescription, particularly if the medication is expensive. And, not filling the prescription (or continuing with refills) certainly makes the medicine less effective! Doctors should take the time to explain to patients how a medicine works and why it is important - they're more likely to actually take it - and their health will improve as a result.

Written / Posted by Scott W. Yates, MD, MBA, MS, FACP

Parents Avoiding Vaccines May be Causing More Measles Outbreaks

Measles cases in the U.S. are at their highest levels in more than 10 years. ALmost 50% of these cases involve children whose parents declined vaccination for them. Parents' unfounded fears about the vaccines causing autism may be fueling this trend.

Some measles cases have involved home-schooled children, who are not required to get the vaccines.

Childhood measles vaccination rates have stayed above 92% (data from 2006). However, the recent outbreaks suggest that pockets of unvaccinated children are forming. Health officials worry that vaccination rates have begun to fall.

Posted by Scott W. Yates, MD, MBA, MS, FACP

New Website

Our new website up and running! We've posted the full site and over the next few days and weeks we will add additional information. Take a look at the site and let us know what you think. You can find the new site at http://www.my24-7md.com/ or http://www.texasmed.com/

Posted by Scott W. Yates, MD, MBA, MS, FACP

Prescribing a dose of healthy skepticism

Headlines declare wine is good for your health. So is a small bit of dark chocolate. Then, they say it's not. One day coffee is bad for you and the next it's good. We're bombarded with health messages daily from companies selling things, advocacy groups promoting their agendas and journalists trying to sift through it all. Who are you to believe? Unless you have a degree in epidemiology, it's very difficult to discern the valuable information from all the garbage. In his new book, "The Healthy Skeptic," journalist Robert Davis gives readers some quick tips to become better consumers of health care information.

"A healthy skeptic carefully and critically evaluates each piece of advice taking into account not only its source but the science behind it," Davis writes. Davis has 20 years' experience as a health and medical journalist, as well as a Ph.D. and M.P.H. in health policy and public health. He teaches at Emory's school of public health. In the book, Davis uses common examples of over-hyping that upon inspection often prove incomplete or even misleading, such as misguided dieting advice and the total prevention promises of lowering cholesterol and wearing sunscreen. He also offers several examples of how overzealous health promoters have led consumers astray, such as Oprah's on-air full body CT-Scan; Katie Couric's promotion of colonoscopies before the recommended age of 50; and the unproven but nearly messianic messages about cancer screening.

Davis gives health promoters the benefit of the doubt that their errors result from having to snag consumers' attention while competing with thousands of messages bombarding them daily. "To convey complex scientific information in this environment, health promoters may resort to oversimplifying or sensationalizing," Davis writes "They may not necessarily lie to us, but like anyone else trying to sell something, they don't always give us the full truth, either. Instead, what we may get, even from individuals and organizations with the most altruistic of motives, is hype, half-truths and spin." Davis offers eight questions to help readers assess the science behind a health message before drawing conclusions. I doubt the average consumer will apply his evaluation techniques, but certainly anyone who buys the book would find them helpful. And this should be required reading for health and medical journalists.

The Healthy Skeptic's eight key questions:

What kind of study is behind the research? Is it a gold standard randomized clinical trial or is it an observational population study? The latter can only show strong associations and never definitively prove a risk or benefit.

How big is the effect shown in the study? The larger the effect the more believable it is.

Could the findings be a fluke? In other words, is it statistically significant?

Who was studied? Do the study subjects closely resemble the population for which the the conclusions are being extrapolated?

Is there a good explanation? Is there a believable biological explanation for the study's findings?

Who paid for the research? Could the funding source have influenced the researchers, either consciously or subconsciously?

Was it peer reviewed? Did it appear in a respected journal that required other scientists to critique it first?

How does it square with other studies? Individual studies are pieces of a larger puzzle and the entire puzzle must be examined before conclusions can be drawn.

This post originally published August 15, 2008 by Sally Arnquist on The Health Care Blog.