Month: February 2003

Several brands of extended-release guaifenesin to be removed from market

Quiet times on the weblog usually mean busy times in the office .. which is certainly the case.  I'm also finishing up on the revisions to the HHS grant that we're working on for STFM to create FMDRL – the Family Medicine Digital Resources Library, and I'm working on a paper on bipolar disorder for American Family Physician

ok .. now to today's tidbit:  there are 66 companies that make forms of extended-release guaifenesin.  These products are prescribed by many physicians .. and the evidence for their efficacy is scant.  The FDA requires that medications actually do what they claim to do, and Mucinex was the only extended release guaifenesin that could demonstrate efficacy.  So their product is the only one that will remain available.

The immediate release products (cough syrups conataining guaifenesin such as robitussin) are not effected by this ruling.

Preventing hypertension

From the January Bandolier - a review of hypertension prevention:

  • Maintain normal body weight for adults (body mass index 18.5 to 24.9 kg/sq metre)
  • Reduce dietary sodium intake to no more than 100 mmol per day (about six grams of sodium chloride or 2.4 grams of sodium per day)
  • Engage in regular aerobic physical activity such as brisk walking (at least 30 minutes per day, most days of the week)
  • Limit daily alcohol consumption to no more than 30 mL ethanol for men and no more than 15 mL for women and lighter weight persons [20 mL ethanol is equivalent to a pint and a half of beer, half a bottle of wine, or 60 mL of average strength spirits]
  • Maintain adequate intake of dietary potassium (more than 90 mmol or 3.5 grams per day)
  • Have a diet rich in fruits and vegetables and in low-fat dairy products with a reduced content of saturated and total fat

Publications :: Physicians for a National Health Program (PNHP)

Docnotes doesn't get political very often.   Weakened by fatigue at 3 AM .. I responded to Robert Centor's post on his weblog last night about the Canadian Healthcare system.  I won't replay the dialogue .. but I thought I'd provide a bit of context ..

This morning when I got to my office in the medical school, my assistant asked me if I have any samples in my practice that I could send over to a colleague's office .. as he's run out of some things that several patients really need.  It turns out that he's broke .. and he usually just writes a check to the pharmacy for the patient when they can't affor their medicines.

We're going to see if we can get the local chapter of the NYSAFP to help him out.

… and this excerpt from Johnathon Ross's recent paper provides a good reply to many of the voices who wish to preserve the status quo in this country:

"The necessary economic conditions for an efficient competitive market for health services do not exist. Evidence from the current competition between insurance companies shows that it is likely that these market forces will aggravate the dual problems of high cost and poor access. A tax-financed universal health insurance offers the best alternative and is consistent with both progressive and conservative principles for reform"

Farts Across America Day

Looks like we missed this one: 

"What if everybody in the world farted at the same time?"

We were all supposed to fart at 4 PM Pacific time today.  Oops.  I forgot.

I was given a gift a few months ago by a family with several young children:  The Gas We Pass.  It's a very funny book.   Perfect for the waiting room.

Lactose intolerance is probably the most common cause of frequent farting:

Between 30 and 50 million Americans are lactose intolerant. Certain ethnic and racial populations are more widely affected than others. As many as 75 percent of all African Americans and American Indians and 90 percent of Asian Americans are lactose intolerant. The condition is least common among persons of northern European descent.

Here's a nice patient handout on Lactose Intolerance.  Patients have usually heard of lactaid, but I usually make sure that they know that they don't need to spend $8.00 for lactase.  Wal-Mart, CVS and several of our local supermarkets carry generic versions of lactase for much less.

Oceania Wave Electronic Health Record

More questions in today's e-mail about the AAFP Open Health Record project.

It's based on the Oceania EMR.  The company no longer exists .. and I don't know much about what happened .. who currently owns the intellectual property, or what the current status of the software is.  It was a progressive system in its day – developed by folks who were trend setters in XML and applications of SGML to healthcare.

Courtesy of the Internet Archive, You can view a demo of the circa 1999 version (well .. just a few screenshots .. but you can get an idea of what it's all about).

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Meanwhile .. back in our 50+ physician practice .. we struggle with decisions about what to do about an EMR.  We've been using the Mysis EMR on a trial basis for 18 months.  Lot sof problems recently with it recently.  I'm becoming convinced — after using it for all of this time – that this product just won't do.  There are too many basic problems with the system to make it clinically useful.  Usability is sacrificed, and complexity dominates.  I'm trying my best to give it a 'college try' but is still frustraing on a daily basis.

I visited another group of family physicians this afternoon.  They're implementing the Greenway practice management system and EMR.  High hopes to reduce their $150,000/year of transcription costs.  I was suprised by how little they knew about the details of the Greenway product.  They didn't do much homework.  I'll do a demo of Greenway later in the week.  Will post my impressions here.