photo credit: john-norris

I recently read an interesting article on Medical News Today reporting health insurers will begin covering online physician visits:

Health insurers Aetna and Cigna have announced that they will pay for online physician visits, and patients will be required to contribute a copayment for the visits, the Philadelphia Inquirer reports. Aetna on Jan. 1 expanded a pilot project in California, Florida and Washington state to the rest of the country, and Cigna said it would begin paying for online visits in January 2009. The insurers believe that members will like the service because it can improve efficiency and could prevent more costly problems, the Inquirer reports.

Of course, my initial reaction is – is anyone actually offering online physician visits? Apparently so, if heavies like Aetna and Cigna are getting in the game. Physicians don’t (typically) obtain technology degrees or have the programming skills necessary to open up their practice to an online community, so the first step is supplying physicians a “web visits” framework. Cigna and Aetna both partner with RelayHealth, a company that enables “web visits” through services including online medical chart storage, online appointment scheduling, automated interviews that serve to triage the patient before communication to the physician begins, online prescription center, and a payment/collections/insurance filing center. RelayHealth maintains an entire page describing the benefits and features available to patients, which can be summarized by these two FAQ answers:

What is a webVisit®?
A webVisit is an online consultation between a doctor and an established patient about a non-urgent healthcare matter. When conducting a webVisit, RelayHealth guides you through an interactive interview process appropriate for your specific symptoms, and then builds a succinct message to the doctor based upon the answers you provide.

How do I send a message to my doctor using RelayHealth?
Once you successfully register with RelayHealth and your doctor agrees to communicate with you through the service, easy-to-use, structured templates allow you to consult your doctor about specific health symptoms (we call this a webVisit consultation), request a prescription refill, request appointments, receive lab or test results, ask a simple question, or access health education information — depending on the types of RelayHealth services your doctor offers.

Apparently, companies that assist in enabling physicians to offer medical services online are stating to sprout up. But are any physicians actually offering online services? Recently, ReadWriteWeb reported on the Health 2.0 conference, part of which was dedicated to the “web visit” phenomenon:

Jordan Shlain founded the San Francisco On Call Medical Group, a group of doctors who make house calls almost anywhere their patients want to see them (home, office, even cruise ships) using a souped-up, hi-tech version of the doctors’ venerable black bag.

Jay Parkinson is aiming to be the “small town doctor of Brooklyn ,” using video camming, text messaging, email and chat to help treat his patients.

Both Jordan and Jay showed how different the standard model of health care can be — but also revealed the huge gap between the existing system of health care and the state-of-the art technology that potentially could be harnessed to serve patients at an ordinary level. In the end, this gap is the core dilemma facing the Health 2.0 efforts to transform the industry.

We’ve come a long way from using the Internet to display office hours and send X-rays to other countries for analysis. It appears that soon, patients will have true 24-hr access to non-emergency health care. Add Second Life to the mix, and things get even more interesting – take, for example, this Flickr slideshow demonstrating some interesting possibilities. And soon, with services like Carol getting a start, we may have access to a-la carte style healthcare, where patients purchase “care packages” and receive the care at any participating location.

With all these changes afoot, the real question is – will patients use the services? What about you – are you excited by the possibility of receiving healthcare with an instant-messaging client and web-cam, or will you always expect on face-to-face treatment?

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Generic drugs cost about 20% to 70% less than their brand name counterparts. The Congressional Budget Office has reported that generic drugs save consumers an estimated $8 billion to $10 billion a year.

Here’s a list of some of the generic drugs approved by the FDA so far this year:

• Alendronate Sodium Tablets (Fosamax)
  Used for: Treating and preventing types of osteoporosis
  Originally marketed as: Fosamax, by Merck & Co.
  Date approved: Feb. 6, 2008
• Carvedilol Tablets (Coreg)
  Used for: Treating hypertension and heart failure
  Originally marketed as: Coreg, by SmithKline Beecham, now GlaxoSmithKline
  Date approved: Sept. 5, 2007
• Cetirizine HCl Tablets (Zyrtec)
  Used for: Treating symptoms of allergies
  Originally marketed as: Zyrtec, by Pfizer
  Date approved: Dec.12, 2007
• Granisetron Tablets (Kytril)
  Used for: Preventing nausea and vomiting related to chemotherapy and radiation
  Originally marketed as: Kytril, by Roche
  Date approved: Dec. 31, 2007
• Oxcarbazepine Tablets (Trileptal)
  Used for: Treating certain kinds of seizures and epilepsy
  Originally marketed as: Trileptal, by Novartis
  Date approved: Oct. 9, 2007
• Pravastatin Sodium Tablets (Pravachol)
  Used for: Treating elevated cholesterol and preventing coronary events.
  Originally marketed as: Pravachol, by Bristol-Myers Squibb
  Date approved: Apr. 23, 2007
• Zolpidem Tartrate Tablets (Ambien)
  Used for: Treating insomnia
  Originally marketed as: Ambien, by Sanofi Aventis
  Date approved: Apr. 23, 2007

For more information, the FDA’s Office of Generic Drugs maintains a frequently-updated list of generic drug approvals.

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There’s a new study out that makes me even more wary of multivitamins. The U.S. News and World Report recently ran an article about a study from the National Cancer Institute that indicates taking more than 7 multivitamin pills a week could increase mens’ risk of “advanced and fatal” prostate cancer:

Researchers followed 295,344 men for five years and found that while high multivitamin use did not correlate with higher rates of localized cancer, it increased the risk of advanced cancer by 30 percent and nearly doubled the risk of fatal prostate cancer. Taking additional beta carotene and zinc supplements increased the risk even more.

…

Goran Bjelakovic, a researcher at the University of Nis in Serbia who has looked at the impact of nutritional supplements and wrote an editorial accompanying the study in the Journal of the National Cancer Institute, points out that the average American diet provides 120 percent of the beta carotene and vitamins A and C needed, suggesting that additional vitamins could upset the body’s balance of micronutrients.

Wow, the average American gets 120% of the body’s required beta carotene, vitamin A and vitamin C from diet, before even taking the multivitamin? The National Institute of Health has this to say about taking too much vitamin A:

Hypervitaminosis A refers to high storage levels of vitamin A in the body that can lead to toxic symptoms. There are four major adverse effects of hypervitaminosis A: birth defects, liver abnormalities, reduced bone mineral density that may result in osteoporosis (see the previous section), and central nervous system disorders [1,48-49].

Toxic symptoms can also arise after consuming very large amounts of preformed vitamin A over a short period of time. Signs of acute toxicity include nausea and vomiting, headache, dizziness, blurred vision, and muscular uncoordination [1,48-49]. Although hypervitaminosis A can occur when large amounts of liver are regularly consumed, most cases result from taking excess amounts of the nutrient in supplements.

Makes me wonder about the other vitamins and minerals we take “for health” without thinking about the damage we might be doing to ourselves.

Fast food burgers, fast food vitamins, fast food money – before long, we’ll be driving up to McDonalds and purchase hamburgers enriched with E. coli and vitamin A with our credit cards. All we’re missing is the vitamin A.

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Since the run was 14 days away, I cut back. Way back. In fact didn’t run on Monday specifically, so was able to have a 3 day break. Around comes Wednesday, strapped on my shoes and sweated out another 3.5 miles no problems. Mentally wiping my brow, I worked through the different machines for weight lifting. When I hit something called Thigh Adductor, there was enlightenment. And boy howdy was it sharp, right in my knee. Or more specifically, where I was hurting before. Apparently I’m just to tall for that machine to use properly. Keeping my feet on its rest it induces me to use my knees instead of my legs.

While this story shows my foolishness, its perfect for demonstrating what happens as you get into shape. Part of the whole process is breaking down your muscles to rebuild them stronger. So as you do things : run, walk, lift, bike, whatever, except to be sore. Heck even be ready to be hurt! But it’s important to listen where you hurt. There are two criteria I use. First if you have any pain in your joints, you’re doing something wrong. Using a machine wrong or putting tension where you shouldn’t it doesn’t matter. Stop. Ask a doctor or trainer. Look for more information on the internet. So being sore in your muscles are to be expected. But at the same time it should be a general sore, about the size of the heel of your hand. If its a sharp pain and the size of a finger tip, again get to the doctor. Most likely you’ve over exerted and torn something.

Becoming healthy is an important thing, but a gradual thing. Any attempts to instantly be there can cause lots of pain. And your body will know when you are pushing to hard, so listen. It will prevent you from getting hurt and keep you on the healthy path.

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I especially like how drug ads are starting to use the verbage “Ask your doctor for a sample of Killzoudedia” – between the drug companies and the insurance companies, doctors are having less and less opportunity to actually diagnose their patients’ ailments.

This article at IOL about Australian artist Justine Cooper dovetails this topic nicely.  Justine invented a disease (Dysphoric Social Attention Consumption Deficit Anxiety Disorder, or DSACDAD) and a drug for its symptoms, Havidol.  According to the article:

But the multi-media exhibit at the Daneyal Mahmood Gallery in New York, which includes a website, mock television and print advertisements and billboards is so convincing people think it is authentic.

“People have walked into the gallery and thought it was real,” Mahmood said in an interview.

The Havidol website is a great read, especially the safety information including the following warnings:

In clinical trials, the most commonly reported side effects were mood changes, muscle strain, extraordinary thinking, dermal gloss, impulsivity induced consumption, excessive salivation, co-dependency with inanimate objects, hair growth, markedly delayed sexual climax, inter-species communication, taste perversion, terminal smile, and oral inflammation.

In rare instances, patients reported a sudden urge to change physicians. It is not possible to determine whether these events are related directly to these medicines or to other factors. If you experience sudden loss of interest in your physician let them know right away. Your doctor may need to make a change in the dose that is right for you.

Now that’s what I call truth in advertising.

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The Food and Drug Administration (FDA) has become aware that a number of Americans who placed orders for specific drug products over the Internet (Ambien, Xanax, Lexapro, and Ativan), instead received a product that, according to preliminary analysis, contains haloperidol, a powerful anti-psychotic drug…  Haloperidol can cause muscle stiffness and spasms, agitation, and sedation…  FDA laboratory analysis of the misrepresented tablets is ongoing, but preliminary analysis indicates they contain haloperidol, the active ingredient in a prescription drug used primarily to treat schizophrenia.

More at the FDA’s site.

Honestly, I have no idea why the hell someone would buy prescription meds off the Internet anyway.  Why do people feel they have the knowledge and education to self-medicate??  Personally, I think a lot has to do with advertisements – now that pharmaceuticals advertise directly to consumers, they feel empowered and emotionally hooked.  They see fluttery luminescent butterflies, cholesterol scores dropping and couples holding hands in floating bathtubs.  They hear a list of “common side effects include” and feel empowered to make the decision for themselves to balance side effects versus the perceived benefits.

“Ask your doctor for Requip.”  In years past, your doctor would spend a good half an hour doing a basic yearly exam, taking time to diagnose and treat your body as a whole, not just the symptoms you display.  Now, people see commercials, decide for themselves they suffer from all kinds of ailments, and doctors who are tired of fighting their patients simply fill out the prescription.  Soon you’ll be paying your $68 doctor’s visit fee to your television.

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If you’re viewing this in a feed reader, you may have to read this post to see the poll.

Have comments about alli? I’d love to see them – you can leave us comments below.

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I’ve been thinking a lot about GSK‘s orlistat/alli since the FDA released their approval last week, and I believe alli is only half of GSK’s plan for orlistat.  The other half?  Multi-vitamins.

I’ve talked a little about alli in general; I even did some math to figure out exactly how many calories alli will block – around 180 calories per day based on a 2300 cal/day diet and following GSK’s recommended maximum fat consumption.  If someone can simply drink one less Mountain Dew a day and get the same benefits as taking alli without all the nasty side effects, why is GSK spending the money to bring alli to the market?

Alli will be marketed as a weight-loss pill lifestyle-change pill.  Broadcast advertisements for OTC drugs are regulated by the Federal Trade Commission, as opposed to ads for prescription drugs, which are regulated by the FDA.  Under the Federal Trade Commission Act:

• advertising must be truthful and non-deceptive;
• advertisers must have evidence to back up their claims; and
• advertisements cannot be unfair.

Because the FTC carries a less-onerous test for drug advertising, GSK will be able to make much craftier claims about the drug and have much more leeway than Roche had with Xenical.  Specifically, there is no requirement for listing side effects, limitations in use and a balance between effectiveness/advertising and indications/side effects.  Likely, we will soon begin seeing commercials that focus on losing 8lbs for every 5 you would normally lose.  If they’re crafty enough, they’ll even create an emotion-based illusion that the alli pill inspires the lifestyle changes suggested by the myalli.com program without the hard work associated with making lifestyle changes.  Effectively, they will market a lifestyle-change pill.  Never mind the skidmarks.

GSK sells multivitamins.  Since alli blocks fat, it will also block the body’s ingestion of fat-soluble vitamins, like A, D, E and K.  If I were a marketing consultant at GSK (and surely they’ve already thought of this), I’d be putting this fact in all alli literature as a preemptive disclosure and use it to my advantage by selling multivitamins either stocked next to alli on the shelves or even boxed with alli as a “kit.”  GSK already sells multivitamins in the US - Geritol already has A, D, E and K in the formula.

So, let’s do a little more math.  We’ll take that unscientific MSNBC poll I mentioned before – 59% of 137,301 respondents are in favor of taking alli.  Walgreens sells Geritol Complete for $5.00 per 40 pills.  If just the 81,008 respondents polling favorably take alli along with Geritol Complete, that’s an additional $405,040.00 per month for GSK – and that’s just based on 137,301 respondents.  I’m betting it won’t be long after alli’s release that GSK releases a specially-formulated multivitamin containing just the fat-soluble vitamins (and omega-3 for buzzword recognition), and I guarantee their profit margin will be higher on that pill.  Using organic growth methods, GSK will double their consumer base using a complementary pill they already manufacture – no R&D cost, very little marketing cost, very high profit margin.

All in the name of Americans refusing to eat one less hotdog a day.

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Dr. Sanjay Gupta has written a short article over at CNN about Orlistat / OTC alli.  Among the more poignant (and sure to be lost once the advertising starts airing during Wheel of Fortune) points in his laundry-list of “things you should keep in mind before considering this drug:”

1) Diet and exercise are still going to be your longest-lasting weight-loss solution.

2) The manufacturers of alli and the FDA emphasize that this medication cannot work alone. It must be combined with low-fat diet and multivitamin taken at bedtime.

5) This is not a miracle drug. You will still have to work for the weight loss.

10) And the big question: How much will you lose? Expect modest weight loss. If you lose 5 pounds through diet and exercise, the FDA says you can expect to lose 2 to 3 more pounds by taking this pill. By the way, the weight loss plateaus after six months.

4 out of 10 items echo the sentiments I’ve previously discussed and are growing in the blogosphere – the drug provides minimal weight-loss assistance and is not intended as a weight-loss pill.  That won’t stop GSK from skirting penalties from the FTC when advertising it as a weight-loss pill, and it won’t stop people from buying it in droves.

In fact, I suspect most people trying this drug will be those needing to drop 10-40 lbs before the wedding/birthday/cruise/date, who would otherwise turn to dietary supplements, who have no intention of implementing the lifestyle changes recommended by GSK, and look at the weight-loss as a short-term cosmetic refresher. 

According to a MSNBC Live Vote (not scientific, of course), Americans are pretty excited about putting skidmarks in their undies – currently 59% of 137301 respondents are in favor of taking OTC alli, 15% are against and 25% are unsure.  Personally, I’m still skeptical – messing with my body’s natural internal plumbing by ingesting God knows what just isn’t worth the extra couple of pounds.

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The FDA approved an over-the-counter version of Orlistat today, alli.  My opinion?  Eat less, exercise more, keep a journal, and pocket the money you would spend on alli.  Even the FDA says

“This drug is only going to be effective if it’s used along with a weight-loss program,” [Dr. Charles J. Ganley, the FDA's director of the Division of Over-The-Counter Drug Products,] said. “That means a reduced fat diet, decreased calories and an exercise program.”

 

“If someone uses the drug without a weight-loss program, it’s not going to be very effective,” he added.

Why do I think this drug is stupid and useless?  Let me break it down:

It will be marketed as a weight-loss pill, but it still requires lifestyle eating changes.  Calorie-counting, general awareness of the fat and caloric content of the foods you eat, limiting your caloric intake, reading labels, exercise – these are all lifestyle changes suggested by GSK before taking Orlistat / alli.  In fact, the pill itself is being promoted as only one part of a package:

Unlike other products on store shelves, alli is a proven medicine with a comprehensive support program. To help consumers get off to a successful start, the alli package will include Welcome and Companion Guides, a Guide to Healthy Eating, a Daily Journal, a Calorie and Fat Counter, Quick Fact Cards, and free access to an individualized online action plan at myalli.com.

 

“With alli, we’re excited to offer a revolutionary approach to weight loss,” says Steven L. Burton, Vice President, Weight Control, GlaxoSmithKline Consumer Healthcare. “alli is more than a pill – it’s a comprehensive program that works in conjunction with a sensible diet to increase weight loss. Because weight loss doesn’t happen overnight, we’re starting to educate consumers now about the importance of realistic expectations, gradual weight loss and lifestyle changes. That’s the way to see results, and with alli, we know they can do it.”

A comprehensive program in a bottle?  I can just implement the components of the program and lose weight without the side-effects of taking patent medicines.  When the pill is marketed, regardless of what verbage GSK puts in their commercials to appease the FTC, people will react to alli as if it’s a magic weight-loss pill, take it until their digestive side-affects become too unbearable, and stop – all without making the necessary lifestyle changes.  Meanwhile, GSK makes a killing – until the inevitable class-action lawsuit, of course.

The suggested maximum fat intake alone will help people lose weight without alli.  Quoting from the GSK alli press release,

Taken at meal-time, alli works by blocking about 25 percent of the fat in the food a person eats. Because of the way it works, alli must be used in conjunction with a reduced-calorie, low-fat diet containing about 15 grams of fat per meal.

MedlinePlus adds the following:

Each time you take orlistat, your meal should contain no more than about 30% of calories from fat.

Fat is 9 calories per gram.  By cutting your fat intake per meal down to GSK’s recommended allowance, you are limiting your meal to 135 calories from fat.  If you’re eating a daily caloric amount of 2300 calories, for instance, you are limiting your daily fat intake to 690 total calories before even taking the pills.  I would guess that change alone will account for substantial weight-loss in most people taking this pill!  As quoted above, the pill blocks 25% of your fat intake during meals.  So, the pill will block a futher maximum amount of 172.5 calories a day.  Realistically, you could cut 180 calories out of your daily eating and have the same benefits of the pill, without the disgusting side-effects. 

I talked about lifestyle diet changes required before even taking this pill.  Let’s look at some foods you can no longer eat.  An obvious one is fast-food: KFC (153 [or 45%] calories from fat per serving, original recipe chicken) is out.  McDonalds fries (270 [or 47%] calories from fat per serving), burgers (263 [or 32%] calories from fat per sandwich [105g]) – even some salads (asian salad has 90 [or 29%] calories from fat per serving) are all out.  I doubt anything else is good – it’s all smothered in dressing, cheese, refried beans and breads.  Classic Americana cuisine like peanut butter & jelly sandwiches (one serving of peanut butter has 145 [or 72%] calories from fat per serving) and hot dogs (167 [or 52%] calories in one dog w/bun and ketchup) are also too high in fat content.

So those are all “unhealthy foods” we shouldn’t be eating anyway.  Did you know the average salmon has 56% calories from fat per serving?  Lean top sirloin has 30% calories per serving?  Sure, salmon might have “good fats”, but it’s still fat, which leads me to my next problem with alli:

Orlistat makes no distinction between which fats are blocked.  Our bodies need fat.  Some vitamins are fat-soluble (like A, D, E and K).  Fats are important to cellular health and hormonal function.  Monunsaturated fats may protect against heart disease.  Orlistat blocks 25% of all fats, which may block our intake of fat-soluble vitamins and have other affects we aren’t yet aware of.  It also indirectly promotes the use of multivitamins and herbal supplements, which may not be as healthy or reliable a source of vitamins as food.  (As a related side note, I’m finishing Dan Hurley’s Natural Causes, a fascinating book that I’ll talk more about later.)

Orlistat only blocks calories from fats.  High-fructose corn syrup, carbohydrates, starches, simple sugars – many sources of weight gain are not blocked at all.

Orlistat is “taken with meals”, but we consume fats and calories from drinks too.  The Coffee-mate powder sitting in my desk has 3g of fat per serving, or 25(4%) – one serving is 4 tsp, and I doubt I use just 4 tsp per cup of coffee.  1 bottle of Dr. Pepper has 150 calories and none from fat – all 150 calories slip right on through, Orlistat or not.  Whole milk has 146 calories per cup, 71 from fat - if not consumed with a meal, Orlistat doesn’t help block those fats either.  People on alli may become a little more conscious of what they eat, but still drink beverages high in syrups and calories.

The alli way: make lifestyle changes, spend $25/week to lose up to 50% more pounds per week than lifestyle changes alone, and have runny underwear and gas.

My way: make lifestyle changes, invest $25/week in a 5.05% APY savings account (which will leave me with approximately $1260 at the end of the year – almost a Disney trip!), and enjoy clean underwear.

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