Go Ahead, Call Me

Oh the cell phone gods are pleased with me. I think the people who call me are as well. Although I was recently told that the whole “Andy never calls anyone back” talk has been over-played now for roughly two years. That’s nice to hear.

Regardless, this is one New Year’s resolution I have really worked hard to keep. I’ve done a great job so far. Just looking at my last 60 calls, I answered 19/39 on the first call.

That might not sound too great, but hold off on your criticism. My phone shows repeat missed calls from the same person, but it does not show repeat answering if the same person calls me.

For instance, Higgins called me four times on the 26th of May and I answered all of them on the first call. However, that shows up as only one answered incoming call.

My parents called me four times this past Friday 5.08, 5.27, 5.49 and 6.19 pm. I was in the radiologist’s office waiting to see if we were going to have to board this patient for an emergency appendectomy. My phone shows four missed calls, but when I answered two of their calls on Saturday it only read as one answered call.

Finally, Saturday morning DJ called me at 4.41, 4.42 and again at 4.42. He was sitting on the couch next to me, but thought it would be fun to reenact the touching Saved by the Bell scene between Zach and Zach’s father. I had answered the three times before, but again it looks like I only answered 1/4 calls from DJ, when in fact I answered 3/6.

All the examples are just given to illustrate that the 19/39 is probably not entirely accurate. I answer my phone and I call those people back almost all the time. I feel very good about my progress and I’ll continue to work, but I feel as if I have reached my goals.

The voice mail message has changed as some of you have noticed. Why? Crazy residents who need to get a hold of me 100 times a day. The resident wasn’t happy that I didn’t leave my pager number on my voice mail. I switched it for this person, but I’m gonna go back to the silly German/English message soon. Crazy residents make me want to drink lots and lots of alcohol. But I generally like to drink lots and lots of alcohol, so why should I be mad at the resident for making want to do this? Because she drives me bananas.

The sh*t is tornado. T O R N A D O.

So the phone answering and calling people back is going great. What about my other Resolutions?

Swearing? Pathetic. F**k it.
Eating healthy? I had a cheeseburger, fries and an apple for lunch 3/7 days last week.
Exercising? Not too bad, but not too good either.
Being a better person? That’s probably not gonna ever happen.

Free Pens and Poor Research

The Truth About the Drug Companies by Marcia Angell is not a new book. Even the epilogue is roughly a year old and now I can finally afford the paperback print. I’m just getting around to reading it and this week I was able to witness Angell’s phrama critiques in person.

Side note: for those of you who don’t know Marcia Angell is a brilliant woman and physician and a former editor of the New England Journal of Medicine. She became one of the most hated women in the world in the mid to late nineties when she illustrated breast implants did not cause breast cancer and that the class action law-suits against physicians and the companies producing the implants were not legitimate.

In Angell’s epilogue she discusses the controversy of the COX-2 inhibitors (Vioxx, Celebrex and Bextra). Studies have repeatedly shown that COX-2 drugs are not much more gastrointestinal (GI) protective than normal non-steroidal anti-inflammatory drugs (NSAIDs) and moreover they actually increase the risk of myocardial infarctions (MI) or heart attacks.

Side note: COX is an enzyme called cyclo-oxygenase. There are two isozymes (similar enzymes chemically, but with different functions). COX-1 has “housekeeping” properties in the GI tract. Essentially it helps protect against too much acid production and subsequently GI ulcers. COX-2 is entirely involved in inflammatory reactions. NSAIDs block both COX-1 and COX-2 enzymes, which increases the chances of ulcers. Hence, COX-2 inhibitors were created to theoretically decrease GI side effects by only blocking the COX isozyme involved in inflammation. This theory has been verified to be incorrect.

The ineffectiveness of COX-2 inhibitors was best shown with the Merck drug Vioxx. However, because Merck funded the original studies of this the adverse reaction results were omitted. A few years later, the research was reviewed and Vioxx was not more protective against adverse GI effects, such as a bleeding stomach ulcer versus traditional NSAIDs and more importantly it increased the risk of heart attacks in patients taking this medication.

The FDA advisory panel dragged their feet and then eventually pulled the drug from the market. After that the other COX-2 drugs, Celebrex and Bextra (both Pfizer products) were reviewed. These drugs carry the same cardiovascular risks but to a less extent and were allowed to continue on the market by the FDA panel. The final vote of the panel was 5-4 and six of the nine members had some sort of affiliation with Pfizer.

Fortunately I had never really had any interactions with drug reps, because when they find out I’m a medical student they ignore me.

This past Wednesday I thought I would have an early day because there were only two colonoscopies in the AM and then the day was over. Wrong. Consults and an Infectious Disease (ID) conference kept me at Henry Ford Wyandotte Hospital for the whole day and then some. (Sorry Ozkar I got home so late.)

Side note: for those of you who don’t know who Ozkar is, he’s my four-month-old kitten. He rules.

Outside of the conference rooms there were drug reps with nice pens promoting their products. Many medical students and physicians have began a group called, “Say No to Free Pens” and boycott drug reps and their handouts. The drug reps are creepy salespersons most of the time and often lie about their products. But they also give free samples to practitioners and these physicians can use them to help individuals who do not have insurance or their coverage is poor and the medication is too expensive. So these companies are not all bad and I have no problem taking their free pens.

The conference discussed antibiotic resistance and new antibiotic medications. There is an increasing concern in the ID community and in medicine in general about resistance to antibiotics. One serious bacterium has become resistant to most medications: Methicillin-resistant Staphylococcus Aureus or MRSA (pronounced mur-sa). MRSA infections were once thought to be only nosocomial (hospital) infections, but now is being found more and more in the community setting. MRSA is resistant to almost all medications and the last line of defense is an antibiotic called vancomycin. However, there have now been six cases in the world in which MRSA is now resistant to vancomycin. Four of these cases have been in Michigan.

A recent study was done to see if a new drug produced by Pfizer, linezolid (Zyvox), was more effective at treating MRSA infections than the traditional vancomycin treatment. The study was funded by Pfizer and found that linezolid was just as effective and perhaps more effective than vancomycin in treating MRSA.

The drug reps were quick to point this out and even a leading ID physician at Henry Ford Hospital in Detroit commented on the importance of this study. However, it was a family physician in the crowd who pointed out the major flaw in this study.

The study did not use the proper dosing regimen of vancomycin and therefore the drug would be less effective in general. Oops. The drug reps did not mention that nor did the study. Luckily, linezolid has a low side-effect profile and serious adverse reactions such as a MI have not been seen.

This is another example similar to the COX-2 studies of a pharmaceutical company influencing the research and promoting results that are not entirely accurate. It’s frustrating as an aspiring physician and insulting to think that these companies believe extravagant advertising can substitute for poor scientific research.

I still took several of these reps pens, but every time I go to write with it I’ll now that it is not the miracle drug Pfizer has tried to say it is.