Would "They" Tell You That Their Asthma Medicine Might Kill You?

If you haven't noticed, there are lots of asthma medicine advertisements on television. These ads are skilfully put-together, are richly endowed with subliminal messages which play tricks with your mind, and show individuals of all ages, races, ethnicities and genders mightily relieved with just a few puffs from that magic inhaler.

But beware! If you have asthma and are using a "Long-Acting Beta-Agonist" ("LABA") as sole therapy, without supervision by a physician who has current training and knowledge in treating asthma (that means, the physician doesn't just get his information from a drug company representative or industry-sponsored education program), you may be placed at a small but serious risk of death from the medicine you inhale. Two publications,The New England Journal of Medicine and the Medical Letter have recently highlighted the reasons for the FDA's specific label change requirements for LABA drugs, The FDA label requirement, among others, contraindicates the use of a LABA without concomitant use of an asthma-controller medicine such as an inhaled corticosteroid and indicates the use of the controller medicine, without the LABA, once asthma control is achieved or for someone whose asthma is controlled by the controller medicines.

If you are using a LABA, speak to your doctor about the risk of death from the medicine. Ask whether he or she is familiar with the current FDA label requirements. If your doctor is not familiar with these changes, and the reasons for them,ask your doctor to send you for consultation with a pulmonary physician who has lots of current knowledge and experience treating asthma. Your doctors will tell you the truth, but will the drug companies?  Watch a few TV ads and decide for yourself.

FDR: It All Depends On Whose Child Has The Measles

This evening, as my wife and I visited a local Kaiser Foundation Hospital, the air stank from wood smoke. I found myself surprised that Kaiser hasn't taken steps to discourage wood burning in fireplaces in the Silicon Valley.

In earlier posts, I talked about "cost-shifting." That occurs when an insurer, or the government, or a medical facility saves money by shifting the cost of services to someone else, usually another institution or even the patient. It seems unfair, doesn't it? If it impacts us, it doesn't just seem unfair, we complain loudly that it is unfair.

The reason I introduced this blog with the stench of wood smoke is that it exemplifies an unrecognized cost-shift component of our health system. The people burning paper, debris or wood in their fireplaces shift the cost of being warm from themselves to the public. If someone has asthma and decides to open a window, or even worse, take a walk in the brisk polluted evening air, those fireplace fumes can trigger an unexpected very expensive emergency trip to the hospital with an acute - potentially fatal - asthma attack. Smoke up the fireplace triggers asthma which requires substantial costly resources to treat.

Not all cost shifting is done by insurers, government agencies, hospitals or health care providers. Some of it is done by people who, in the mirror, look just like us. But of course, when it's our pocketbook which is at risk, we convince ourselves that it is OK, just as when it's our measles unvaccinated child who spreads his infection to another susceptible child, it's OK too.