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medical politics rot!!!!!!

Posted by Ed Davis, DPM on 8/26/04 at 21:48 (158768)

I saw an 80 year old gentlemen today. His ankles were so arthritic he has trouble walking. He cried to me, asking if he has to live out the rest of his life this way.

No, I have had enormous success with arthritic ankles, by injecting them with Synvisc or Hyalgan, the 'synthetic' joint fluid approved by the FDA for knees. Medicare will not cover it because it is not FDA approved for ankles. Patients have to pay for the cost (it is expensive) of the Hyalgan or Synvisc and I then can inject it into their ankles giving them releif, off label. I will help him shop for the best price. For heavens sake, when will someone reform the FDA? Elliott, Mr. Medicare, are you listening? Sorry people but I have to vent -- if you saw the look on this elderly gentlemen's face you would feel the same way.

Re: medical politics rot!!!!!!

Julie on 8/27/04 at 01:30 (158776)

New government, perhaps?? Maybe a new health care system?? Maybe even a whole new economic system??

Just kidding, Ed (not really). Of course I sympathise and share your frustration, and appreciate your willingness to get round the obstacles and help your patient. I hope he can afford the Hyalgan and that the injections help him.

I'm just wondering - off topic - if under the system you risk getting into trouble for injecting off label?

My 82 year old husband is having difficulty walking too: the problem is in his legs, possibly originating in his spine. He has had three consultations with a neurologist, Xrays, and an MRI, all paid for by the National Health Service, into which he had paid contributions all his working life. No firm diagnosis yet, unfortunately - but a lot of good care.

Better system. :)

Re: medical politics rot!!!!!!

Linda V. on 8/27/04 at 11:04 (158802)

Yes, being a nurse for many years, I agree about the lousy system. My heart broke for many of my patients who suffered due to rules and regulations. One idea...call the manufacturer. I had a great relationship with the people who made Neupogen...they supplied it FREE of charge for several of my patients who were in financial need. Good luck. And don't give up! Even if it means making a plea in the local newspaper. Some rich good person may step in and help. We MUST advocate for our people. Its the right thing to do.

Re: medical politics rot!!!!!!

john h on 8/27/04 at 11:16 (158803)

Ed: I personally see a lot of off label use of medications. I guess many Doctors use their judgement on many occasions to use meds off label. I tried Neurotin which was used off label. It did not help but at least my Doctor tried. The FDA is needed but needs to be reformed in my opinion. Take a TEN's unit. All function very much alike by introducing a small adjustable electrial current onto apecific parts of the body to control pain. There may be many different brands but each will have to go through the FDA maze. In Europe they have been using artificial disc for the spine since the 80's. The FDA is currently just finishing up a 3 year study on the same disc used in Europe. They also have applications for two other artifical disc which function just like the one they are about to approve but they will have to go through the 3 year trial and process that will greatly increase the price. The Ossatron is a prime example of something that should have been managed differently. Because the manufacturer submitted the use of the machine using a hospital setting with a general anesthesiatic and that is the way the FDA approved it we are forever stuck with a hospital procedure that can cost from $5000 up while the other machines that do basically the same thing are done with a local in the Doctors office at much less than half the price. Would the FDA have to run a complete new set of trials to do there procedure with a local?? Sounds dumb to me as I bet in Europe it is done and has been done in the Doctors office. Certainly the FDA is needed but is in need of reform.

Re: medical politics rot!!!!!!

Ed Davis, DPM on 8/27/04 at 19:16 (158837)


Fortunately, our government still respects the doctor-patient relationship so that by mutual agreement a physician and patient can use an off label treatment legally. The 'off-label' issue really amounts to giving third parties a pretext to deny coverage. As such, the insurance company, private or Medicare is releived of the responsibility for payment.

The FDA's primary goal should be to protect the public, not the insurance companies. The FDA, by its actions, often gives insurance companies reasons for non-coverage, stifles competition (consider the ESWT scenario discussed on this thread by John) effectively driving up prices of treatment.

All economic systems, irrespective of design, can be manipulated for the benefit of a sector, an industry, an interest group. Reform of the current system, particularly via a Patients Bill of Rights is the quickest fix. Different systems have different potential problems inherent in their fundamental design but each system, when run honestly, with the goal of protecting the public can serve us better than a system that has been distorted for the gains of special interests. Canada has shown us a system that is fundamentally very 'clean' but tends to be chronically underfunded by its attempts to be somewhat too egalitarian.

Medicare is, fundamentally, a single payor system, for all over age 65. The Medicare carriers, although, act in a similar fashion to private insurance companies in the manner which they protect certain interests.
As such, problems can run as a common thread through both public and private systems as both systems have no immunity from the pressures of special interest groups. Without making value judgements as to the advantages of different systems, we ultimately need reform, the goal of which places the needs of the patients first. Additionally, long term solvency can only be maintained through some form of needs testing. When Bill Gates turns 65, he is subject to the same cost of benefits and level of benefits as the poorest 65 year old Medicare recipient.

Re: medical politics rot!!!!!!

Ed Davis, DPM on 9/01/04 at 14:39 (159095)

Thank you for your words of encouragement. I am surprised that more patient advocacy groups have not been formed. Your idea is a good one.