Niseritide, the “Lost Decade”, and the Pinto

Patricia Salber

First posted 7/14/11 on The Doctor Weighs In

Eric Topol, MD wrote an interesting commentary in the July 7, 2011 issue of the New England Journal of Medicine, titled “The Lost Decade of Nesiritide.” Nesiritide is a drug for heart failure symptoms (e.g., shortness of breath) that was approved by the FDA in 2001. Since that time, according to Dr. Topol, “well more than $1 Billion was wasted on purchasing the drug.”

It turns out that the FDA approved the drug was based on a relatively small, not particularly well done clinical trial that showed improvement in self-reported symptoms of shortness of breath 3 hours after the drug was administered. Once the drug was approved, the drug was marketed like crazy. For profit outpatient heart failure “tune up” clinics opened so that heart failure patients could get weekly intravenous infusions of the drug.

Continue reading “Niseritide, the “Lost Decade”, and the Pinto”

Means Testing Medicare Premiums

by Patricia Salber

First published 6/14/11 on The Doctor Weighs In

With all of the hullabaloo about health reform, the Ryan plan and other Medicare-related excitement, I somehow missed a major change in how Medicare is doing business – which is pretty funny since I have spent the last 5 years working for Medicare Advantage plans.  Since January 2011, Medicare has been means testing the Part B premium.  Even more amazing is that some of my most wonky policy wonk friends didn’t know about this – not mentioning any names.

Anyway, I found out in the rudest of ways – a letter from the Social Security Administration describing the impact of the new approach on my own premiums.  It was a shocker for someone used to paying nothing for health care.  (I know, no sympathy for me on that one.)

Continue reading “Means Testing Medicare Premiums”

Semen Causes a Surgeon to Lose his Job

Patricia Salber

First published 4/20/11 on The Doctor Weighs In

This is actually a pretty funny story, except someone lost his job, and that is not so funny.  Here is what happened.  Lazar Greenfield, professor emeritus of surgery at the University of Michigan, in his capacity as lead editor of Surgery News, “the official newspaper of the American College of Surgeons,” published an opinion piece under the heading “Gut Feeling” in the February issue, evidently in honor of Valentine’s day.  BTW, Dr. Greenfield is also President-elect of the ACS, a position he probably spent many hours working (and schmoozing) to attain.

Continue reading “Semen Causes a Surgeon to Lose his Job”

Emergency Care of the Mentally Ill

Pat Salber

First published 4/17/11 on The Doctor Weighs In

Say you are grappling with a chronic mental illness….bipolar disease or schizophrenia.  You have been told you need to take your medications as prescribed, but you can’t… or you won’t… or you do… but on your own timetable.  Your symptoms get worse and your family gets nervous.  You are doing things that scare them.  It is the middle of the night, so they do the logical thing.   They take you to the closest emergency department.

Emergency Departments are pretty wild places a lot of the time.  Thanks to ED overcrowding, chances are there is a full waiting room with people in various states of disarray (some are bleeding, some are vomiting, some are squeaky clean and others are disheveled and reeking of (pick one):  alcohol, urine, cigarettes, vomit, “Aroma of Street,” or dried blood.  You are freaking out…but you are told you have to wait until they can get to you.

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Got Sleep Apnea? Can Do CPAP? How About Playing the Didgeridoo?

by Patricia Salber

Ok, so it is official.  I am a CPAP failure.  I gave it my best effort, but I just couldn’t do it. The first night I used the machine, I got in 4 hours before the noise woke me up and I couldn’t fall asleep again.  Despite that, I felt great the next day…this sent a message to me that my sleep has been seriously disrupted by the apnea.

The next night, the CPAP nasal pillows rubbed my nostrils and drove me crazy….crazy…crazy.  My sleep was fitful.  The final night of my failed trial, it was both the noise and the nostrils that took be from a beautiful pre-CPAP drowsiness to an angry, wide-awakefulness due to trying to sleep with this “therapy” on my face.  After two hours, I ripped the nasal pillows off of my face and threw them to the ground.  I promptly fell asleep and awoke the next day feeling pretty darn good.

Continue reading “Got Sleep Apnea? Can Do CPAP? How About Playing the Didgeridoo?”

Sleep Apnea: One More Thing To Deal With

Pat Salber

First published 3/28/11 on The Doctor Weighs In

I work hard at staying healthy – you know, eat right per the Michael Pollan prescription, exercise (5 days a week with a trainer and two on my own), all things in moderation – except for the Chardonnay – my beloved, but almost only vice.

But I got the bad genes to contend with (thanks Mom, thanks Dad).  I long ago reconciled myself to taking a pile of pills every morning to control the array of metabolic syndrome issues I inherited.  There are two pills for blood pressure (and, most recently, a smelly, neon yellow pill to raise my potassium level – lowered by the diuretic I take).  Then there is the statin for bad lipids and the allopurinol to prevent recurrent gout attacks.  And three pills, to replace stuff I don’t make enough of any more – thyroid, a selective estrogen receptor modulator (SERM), and Vitamin D.

Continue reading “Sleep Apnea: One More Thing To Deal With”

Doximity – A LinkedIn-Type Social Network for Doctors Only

by Patricia Salber

First published 3/10/11 on The Doctor Weighs In

There is a new social networking site for doctors only. It is called Doximity ( Not only do you have to say you are a doc, the site has to verify that you actually are one to use the site – they say they do this so you don’t get “spammed” by folks joining just so they can sell you stuff (i.e., pharma reps, etc.)

Continue reading “Doximity – A LinkedIn-Type Social Network for Doctors Only”

Patient Engagement: It’s Not What You Tell Them, But How You Tell Them

Pat Salber

First published 2/16/11 on The Doctor Weighs In

Once you take a look at this video, you will see what a huge opportunity is missed in health care because of lousy communication techniques. It’s not that we don’t know what works – turn on the TV and watch some direct-to-consumer drug ads – they work all too well. Then watch the video for great examples of how we are doing it all wrong – together with some suggestions on how, with a minimum of effort, we could do so much better. BTW, Tom Goetz, the speaker, is the editor of Wired Magazine – a great read.

Health Care Reform Needs A Wael Ghonim

By now, everyone has seen the young Google executive, Wael Ghonim – credited with starting the Egyptian revolution via Facebook – proclaiming his willingness to die for the cause.  I predict he will not only become an Egyptian national hero, but that one day he will be nominated for the Nobel Peace Prize.

But, where, oh where, is the Wael Ghonim of health care?  Who is out there that will proclaim that they will fight to the death (or even fight to a bit of discomfort) for the cause of health reform.  I don’t know anyone – right, left or center- that, when speaking honestly and in private, will say that the US health delivery “system” is working for the American people – you remember those folks, the ones we hear about so often during hotly contested political campaigns.

Continue reading “Health Care Reform Needs A Wael Ghonim”

Smartphone Apps for ER Docs – Yeah!


Originally published 2/7/11 on The Doctor Weighs In

Thanks to Sam Ko, MD and the California Chapter of the American College of Emergency Physicians (Cal/ACEP)  for this list of  iPhone Apps for Emergency Medicine.  The info in this post was first published  in Cal/ACEP January 2011 newsletter:  Lifeline.

I love it that ER docs are using their smart phones as reference books – it is so much better than when I was in the ER  – slinking off to the doctor’s room to look up stuff in the PDR or whatever new (or mostly old) Emergency Medicine text books happened to be on the ER book shelves.  Once I looked up stuff I couldn’t remember, I could go back to the patient and/or family and look and sound knowledgeable about the topic at hand.

Continue reading “Smartphone Apps for ER Docs – Yeah!”

Will Accountable Care Organizations Just Become HMOs in Drag?


Originally published 1/31/11 on The Doctor Weighs In

Accountable Care Organizations (ACOs) are supposed to be provider-led (physician groups +/- hospitals) and, they are supposed to inject a new accountability, at the provider level, for the value of services delivered.  You know the old equation.  VALUE=QUALITY/COST.  Those of us inside the health policy “beltway” know this mantra well.  We have been talking about it for years (decades, really).

I spent almost 6 years working as a consultant to General Motors Corporation starting in the late 90’s.  My job was to systematically evaluate health plans’ quality programs so that GM could determine the value the plans were bringing to their employees.  My team and I helped develop an elaborate Request for Information process that is now known as eValue8.

Continue reading “Will Accountable Care Organizations Just Become HMOs in Drag?”

Jack LaLanne Is Dead – Long Live Jack LaLanne

Brian’s Note: I was going to write a post about Jack LaLanne, one of the true great originals, but when I saw what my pal Pat Salber had written, I realized her comment and the attached LA Times article already said it. Take a moment to appreciate this wonderful person.

LaLanne was on TV exhorting us to exercise, exercise, exercise.  He didnt just blah, blah, blah about exercise.  He showed us how to do it…and he set the bar very high.

Remember when he swam from Alcatraz to San Francisco’s Fisherman’s Wharf wearing handcuffs?  Or how about the time he swam the Golden Gate Channel while towing a 2,500-pound cabin cruiser?  Or when he pulled a paddleboard 30 miles from the Farallon Islands to the San Francisco shore?  This guy was a fitness phenomenon.

Continue reading “Jack LaLanne Is Dead – Long Live Jack LaLanne”

Simpler Labels on Prescription Drug Bottles. Duh!


Originally published 1/19/11 at The Doctor Weighs In

Read this from our friends at FierceHealthCare:

“Texting boosts medication adherence. So do ‘smart’ pill bottles. Now, U.S. Pharmacopeia, the non-governmental, standards-setting group for prescription and OTC medicines, has proposed another way to get patients to take their drugs as directed: better labeling for prescription drugs.”

Almost half of patients misinterpret dosage directions on Rx container labels, according to American Medical News. Poor medication adherence may cost up to $300 billion a year in healthcare costs that could be averted, according to a collection of healthcare trade groups.

USP has proposed that new labeling standards follow new guidelines such as:

  • Put the most important information at the top.
  • Use concise, yet explicit language (Take 2 tablets in the morning and in the evening, instead of “take two tablets twice daily.”
  • Avoid Latin terms.
  • Format labels with a large font size (12-point Times New Roman or bigger).
  • Pharmacies should include the drug’s purpose in normal English (for high blood pressure, instead of “for hypertension”).
  • Text should run horizontally across the label, never vertically.

Medical experts have called for simpler, clearer labels to help patients correctly take their meds for years. “It’s about time,” said Dr. Albert Wu, a member of an Institute of Medicine and American College of Physicians Foundation panels that made similar recommendations in recent years. “The new standards that are proposed make good common sense.””

I say it is a “no brainer.”  Presription instructions – on the bottle, not on some insert – that people can actually read and understand.  Way to go USP.  Now, we need to “just do it.”

Pat Salber MD, MBA is Principal of Zolo Health Solutions and writes at The Doctor Weighs In.

Debunking “the Breakfast Protection” Myth


Originally published 1/17/11 at The Doctor Weighs In.

Dieters, haven’t we all been told “Don’t skip breakfast?”   And, how about this one: “Breakfast is the most important meal of the day?”  “A good breakfast is THE key to dieting success.”  Right?

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Health 2.0: Patricia Salber interview | The Doctor Weighs In

Here’s a short interview with my pal Pat Salber, MD MBA at the Health 2.0 conference in San Francisco in early October. Pat was an Emergency Medicine physician at Kaiser Permanente for 20 years before becoming a Medical Director for Managed Health Care Initiatives at General Motors. She went from there to be Senior Medical Director for Blue Shield of California’s CalPERS Business Unit. She was on the original Leapfrog Board. And now she’s a Founder and Principal of Zolo Health Solutions, a consulting group focused on helping health systems develop workable Accountable Care Organizations. So she’s been around the block, and has deep insights into the valences of constantly emerging health care innovations. Regular C&C readers will also recognize that Pat is a prolific columnist with a breezy style that belies her incisive wit and astute understanding of all things health care.