I.Q. -- Interesting Quotes

The Cost of Drugs

A paper in the January 1993 issue of the Journal of Family Practice, "Physician Awareness of Prescription Drug Costs: A Missing Element of Drug Advertising and Promotion," presented the results of a survey given to medical doctors attending a continuing education seminar on family medicine. The survey listed 20 prescription drugs advertised in two primary care medical journals. The MDs were asked to select the average wholesale price per unit of the drugs from a multiple choice of price ranges: A) $0.01 to 0.50; B) $0.51 to 1.00; C) $1.01 to 1.50; D) $1.51 or more.

The average score of the doctors was only 37 percent, with 0 percent being the lowest. Of the 92 MDs who finished the questionnaire, only one doctor answered 70 percent correctly. These results prompted the authors to make the following comment:

"Physicians have not shown substantial interest in the cost of medications. Medical schools, residency programs, postgraduate courses, and pharmaceutical companies advertising and detailing seldom focus on this subject. There is a paucity of articles in the general medical literature on the cost of medications. This is all the more ironic and alarming when one considers the increasing attention by Congress and state legislatures to other health care concerns."

Interestingly enough, the authors approached the Director of the Food and Drug Administration on the serious lack of price disclosure on promotional materials by drug companies. They report that "he has taken the position that the agency is concerned only with drug effectiveness, not cost."

------------ Miller LG, PharmD, Blum A, "Physician Awareness of Prescription Drug Costs: A Missing Element of Drug Advertising and Promotion", J Fam Prac, 1993; 1:33-36

 

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Manipulation for Suspected "Subluxation"

In this era of co-management of patients and multidisciplinary clinics, the terminology of health care providers can be adopted to enhance communication. While the chiropractic profession has wrestled with the use of "medical" terms, so has the medical profession. Just as chiropractors have recognized the value of using terminology that is used by MDs, MDs are beginning to use what has been considered "chiropractic" terminology in their literature.

This is the case with the article, "Recognizing and Treating the Causes of Low-back Pain," in the January 1993 issue of The Canadian Journal of Continuing Medical Education. The article is written by Michael P. Ryan, MD, a guest lecturer at the prestigious McGill University in Montreal and a medical director at the Clinique de Medecine Familiale Medistat in Quebec.

Dr. Ryan makes several interesting observations. When discussing musculoskeletal low-back pain, he states:

"Sacroiliac strain, lumbosacral strain and iliolumbar strain fall under this category and can be grouped together because the precise pathophysiology of these conditions is a matter of speculation. Some physicians believe it is due to transient subluxation of one or more of the posterior facet joints with resulting synovitis and pain."

"With spontaneous or manipulative reduction of the subluxation, the pain disappears. These cases respond best to manipulation."

The author goes on to discuss treatment options with these concessions:

"The concept of appropriate therapeutic modalities has changed significantly in the past 20 years. Therapies that were previously considered outside the range of appropriate therapeutic options are now used commonly in pain clinics (e.g., acupuncture, manipulations and hypnosis).

"One of the most significant changes has been recognition of important differences between acute and chronic pain. Therapy that is used for acute pain, including rest, analgesics, muscle relaxants and hypnotics is often ineffective in the treatment of chronic pain. Prolonged use of these treatment options invariably leads to complications."

Dr. Ryan ultimately suggests: "For the primary care physician who, despite his best efforts, is faced by a patient who continues to suffer from back pain, referral to a multidisciplinary pain clinic is the best course of action."

Under the heading of "Nonpharmacologic Treatment," Dr. Ryan has this to say about manipulation:

"For the suspected subluxation of one or more facet joints, manipulation is a very effective treatment. There are many types and techniques of manipulation such as chiropractic, osteopathic and cyriax techniques. Any physician seeing a significant number of patients with back pain should obtain the advice of an experienced manipulator when he suspects a amnipulable lesion. These tend to be patients who present with recurrent episodes of "putting his back out."

In his conclusion, Dr. Ryan suggests that a multidisciplinary approach has a number of advantages:

"For some diseases, standard western medicine is the only choice. For others, like low-back pain, the record is disappointing.

"There is no single therapy for all causes of low-back pain. Many patients will derive partial benefit from several modalities of therapy, each contributing a certain percentage of pain relief. The primary care physician should not hesitate to consult a manipulator if he suspects recurrent subluxation of the facet joints. Similarly, the patient with trigger points should be referred to an acupuncturist. Many doctors in Canada have taken courses in acupuncture and manipulation techniques in order to be able to select the most appropriate treatment for their patients."

If the health care professions continue to cross refer, explore each other's strengths and seek multidisciplinary approaches, we may find ourselves all speaking the same "language" utilizing the most precise terminology from each specialty.

You may want to get a reprint of this article and share it with the general and family practitioners in your area. You can write to: The Canadian Journal of CME, 955 Boulevard St. Jean, Suite 306, Pointe Claire, Quebec, Canada H9R 5K3. Remember to use .40 cent postage if you are mailing from the United States.