As their roles change, Pharmacists need new Regulations, Norms, and Freedom from Corporate Interests

Pharmacists play an essential role in the healthcare system today, one that is ever-expanding.  They check for drug interactions, watch for signs of opioid over-prescribing, and try to determine whether a drug for one condition prescribed by one doctor will negatively impact the patient because of another diagnosis the patient has.  In hospital units, their roles have become yet more complex- often serving on various quality committees, managing daily dosages of medications like warfarin and vancomycin, and more.  I rely upon them in the hospital daily- to catch mistakes, and to advise on drug dosages and choices.  Many in the community give flu vaccinations, and some are even trying to gain "provider" status under Medicare, allowing them bill directly for treating patients.  This has been accompanied by a drastic change in the preparation of the average pharmacist- where once it was a 5 year bachelor's degree, now it is a graduate degree- a change recent enough that as of 2014, over 60% of pharmacists practicing had trained under the old system.

The Coming Downfall of Medicine: Scientific Corruption

Some recent news about a(nother) scandal in the pharmaceutical industry has led me to post on something that is critical to the future of medicine and science.

Let me start off by saying that I believe strongly in most medicines. I think the data behind their safety is incontrovertible. But for medicines that were invented recently, that same data would still leave me quite suspicious.

Here's why.

A Blow to the Self-Regulation of Medicine

The American Board of Obstetrics and Gynecology reversed itself and allowed it's members to treat more cases.  This I think is a case of a FUBAR'd attempt to take a strong and necessary step forward on self-regulation, followed by too much fall back after getting called on some mistakes.  The initial problem was that Ob/Gyns (who are specialists in child birth and women's health) were calling themselves "Board Certified" while doing cosmetic procedures.  To solve it, the Board initially ruled that 75% of someone's practice had to be Ob/Gyn (presumably the rest would be staffing the local ER/urgent care complaints), and that Ob/Gyns couldn't treat men with a few exceptions.  Unfortunately, they missed a few categories, prompting a howl of outcry from two groups:

1) Male (mainly gay) patients with HPV who are at risk for anal cancer (sometimes seen by Ob/Gyns used to treating women at high risk from cervical cancer due to HPV)

2) Male patients with pelvic pain, who are seen by Ob/Gyns used to seeing women with similar complaints

Thus, the board was forced to go back to no limits on seeing men and a "majority" of practice being Ob/Gyn.  Consequently, Ob/Gyns with terrible ethics (one of which was apparently about to sue under anti-trust regulations, according to the article) can continue to call themselves "Board Certified" while practicing medicine they are completely untrained for.  Self-regulation of the medical field takes another blow...

Primary Care vs. Specialist Pay, the RUC, and the News.

The Relative Value Scale Update Committee (RUC) of the American Medical Association (AMA) is back in the news, courtesy of the New York Times.  It's more of the usual story, published by the WSJ less than 4 years ago: specialists are paid too much, primary care physicians are paid too little, and it's all because of an evil committee of doctors who are members of the evil medical trade union group known as the AMA who set payments.  (Full disclosure, I'm a proud member of the AMA).  A good perspective on the debate from Paul Levy, a former non-physician hospital CEO, is here.