Jerry Fahrni

Tag: Healthcare

  • Remdesivir, the pharmacy budget buster

    I saw the discussion below in one of the pharmacy forums. Fact check true on this one.

    Gilead would have everyone believe that remdesivir is a magic bullet for COVID-19 infection. Not true. Helpful? Useful tool? Maybe.

    Remdesivir, while potentially beneficial, has limitations. For one, it should only be used on hospitalized patients that have falling oxygen saturation and chest infiltrates. Second, while it has been shown to potentially shorten the course of the disease, it has not been shown to reduce mortality.(1)

    On the flipside, the drug is relatively expensive, has been overused, and contrary to data showing that it may shorten the course of the disease, may inadvertently lengthen hospital stays.

    Based on the “Solidarity” trial, a WHO guideline committee went as far as to recommend against the use of remdesivir.(2)

    “The Solidarity Trial published interim results on 15 October 2020. It found that all 4 treatments evaluated (remdesivir, hydroxychloroquine, lopinavir/ritonavir and interferon) had little or no effect on overall mortality, initiation of ventilation and duration of hospital stay in hospitalized patients… So far, only corticosteroids have been proven effective against severe and critical COVID-19. [see RECOVERY trial (3)]… The researchers determined the evidence quality to be low for remdesivir in regard to improving time to clinical improvement, hospitalization duration and mechanical ventilation duration.”

    However, you won’t find physicians touting this particular WHO recommendation. Why not? Simply put, it doesn’t fit the narrative put forward by Gilead and the media. Nor does the WHO recommendation give practitioners access to this new therapeutic toy. A combination of marketing and fear has led to remdesivir rapidly evolving into “best practice”. It is basically spreading through hospitals unchecked.

    But Jerry, no hospital could have predicted the pandemic and therefor the cost of remdesivir. True. However, if remdesivir truly cut hospital stays by a couple of days and reduced time on mechanical ventilation, the cost of the drug would be a wash. I have not seen any large-scale data to support this notion. As of today, hospitals have spent millions upon millions of dollars on remdesivir. Not to mention that there are reports of providers prolonging patient stays to complete remdesivir treatment courses even when patients have met criteria for discharge. Such practice spits in the face of common sense.

    But Jerry, even if it saves one life it will have been worth it. Ah yes, the battle cry of people who want something done, regardless of the consequences. Such sentiment seems reasonable on the surface, but quickly fades with analysis and thought. A philosophical debate for another time. Suffice it to say that real life doesn’t work that way.  

    Overall, the unfettered use of remdesivir, combined with failure of healthcare to provide clear, concise, science-based use criteria, has created a budget pitfall that will take years to climb out of, if at all. It’s this type of fiscal irresponsibility that makes the U.S. healthcare system so special.

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    1. Healio.com. 2021. Remdesivir shortens time to improvement, but has no significant mortality effect. [online] Available at: <https://www.healio.com/news/primary-care/20210331/remdesivir-shortens-time-to-improvement-but-has-no-significant-mortality-effect> [Accessed 29 April 2021].
    2. Who.int. 2021. “Solidarity” clinical trial for COVID-19 treatments. [online] Available at: <https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments> [Accessed 30 April 2021].
    3. New England Journal of Medicine, 2021. Dexamethasone in Hospitalized Patients with Covid-19. 384(8), pp.693-704.

  • Saturday morning coffee [January 24 2015]

    “There is a fundamental question we all have to face. How are we to live our lives; by what principles and moral values will we be guided and inspired?” – H. Jackson Brown, Jr.

    So much happens each and every week, and it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

    MUG_SMC
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  • Podcast | The Garage – Episode 1

    Welcome to The Garage, a podcast of me and my brother talking about various things.  We have great conversations and have talked about recording them for years. We finally decided to do it.

    In Episode 1 of The Garage we talk about smartphones, cloud storage, Office 365, a bit about healthcare, tablets – mostly the new iPad Air and iPad Mini – the use of RSS, and data consumption. In other words, we’re all over the board.

    Forgive my heavy nose breathing as I had no idea that I sounded like a bull snorting before a charge. I’ll work on that.
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  • Saturday morning coffee [August 17 2013]: Elysium, Pharmacogenomics, Gonorrhea, Limo Joust

    So much happens each and every week that it’s hard to keep up sometimes. Here are some of the tabs that are open in my browser this morning along with some random thoughts….

    The coffee mug below comes straight from Canada. My family and I spent a little time in Victoria, British Columbia this summer. What a beautiful place. It’s a great little town, and we were blessed with awesome weather. It was sunny and in the 70’s-80’s the entire time we were there. We spent some time milling around the town, rented a car and drove around the beach areas, and took a short trek to Butchart Gardens. I’m not a gardens-type of guy, but Butchart Gardens is really neat. We took a boat tour of the area and stayed for the fireworks show that took place late one night. Great memories. I would do it again.

    MUG_Canada

    Just a quick side note: this is the last coffee mug in my collection. Not sure what I plan to do for my next SMC. Any suggestions?
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  • “What’d I miss?” – Week of February February 12, 2011

    I haven’t done one of these in quite a while, but thought I’d try to get back in the groove.

    It’s been a pretty good week, and as usual there were a lot of things that happened during that time. Not all of it was pharmacy or technology related. Here’s a quick look at some of the stuff I found interesting.

    • The Vow was #1 at the box office last weekend. I haven’t seen it. Instead my wife and I went to see Safe House, which was pretty good. It’s no threat to the Bourne series, but I’d see it again. 
    • I thought this was pretty sticking funny. From Robot Chicken. Pay attention at 0:06 in the video. Quite the conundrum.

     

    • HIIMSS12 is next week in Las Vegas. This is the first year I’ve been able to attend and I’m excited. This is the most excited I’ve been about attending a conference in a long, long time. I can’t wait to get there. I’m looking forward to meeting some folks that I’ve only talked to virtually. In addition I’ll be attending my first ever HIMSS 2012 Tweetup with HP on Tuesday, February 21. Details can be found here. Cool stuff, dude.
    • It looks like infant Tylenol oral suspension is on the hook again. More than 500,000 bottles have been recalled. It has to do with the flow restrictor. You can read more about it the ASHP News Site. Infant Tylenol suspension has taken a beating over the years. It begs two questions: 1) why can’t people get this right?, and 2) what do we do in the long run if people can never figure it out? Check the video below for instructions on using Infants Tylenol suspension. It’s not that hard people!
    • How far have we really come with smartphone technology? Actually we’ve come a long way, but have you ever gone back and looked at handheld technology over the years? If you have, you’ll know that it’s basically the same. Take a look at this user guide for one of the Sony Clie PDAs (PEG-NZ90). Yes, yes, it’s quite ugly, but look at the manual and evaluate what it can do. Crud, throw in a faster processor, a little more memory and a 4G antenna and I’d use it. The PEG-NZ90 was introduced by Sony in 2003.
    • imageI don’t pay much attention to retail pharmacy, but have you ever seen the ClearRx bottle and labeling system from Target? Brilliant, simply brilliant. Pharmacy bottles have been the same basic design for a long, long time. I applaud Target for doing something different. I still don’t like retail pharmacy, but I think their bottle design is cool.
    • I started using the Cloudring service. I use a lot of cloud-based storage solutions and Cloudring helps me keep certain files synched up between them. It also allows me to easily see all my cloud storage solutions at the same time and move files back and forth. So far I’ve experimented with Dropbox, Google Docs, Box and Evernote. It’s very cool.
    • The Barcode News: “Imagine, instead of a cashier having to handle every item in your cart, or you having to play spin the bottle with your ketchup at the self-checkout, you simply place your items on a conveyor belt where they are automatically scanned by the time they get to the bagging station. This is possible with 360 scanners. As the name denotes, 360 scanners are capable of scanning a product bar code from 360 degrees.” – Yeah, now instead of thinking of these things in grocery stores, think of using them in healthcare so people don’t have to actively scan things.
    • EHR Bloggers: “As part of the treatment plan for a patient who has a critical need to take one or more pills at or very near specified times throughout the day a physician, nurse or perhaps a new kind of specialist will develop a tracking plan.” – Stalker anyone? Just sayin’.
    • I read a lot of articles at the sciencebase website. They make reading about science fun and interesting. Even though it’s not from this week, I love the blurb they did on the shape of snowflakes. “Snowflakes have at their heart a minute grain of dust that was once floating in a cloud, this speck of dust is the nucleation centre around which water vapour from the atmosphere can condense and if it is cold enough crystallise as ice. As with any crystallisation process it follows a symmetry intrinsic to the atoms or molecules from which the crystal is formed. In the case of water, the underlying symmetry is hexagonal symmetry.” Be sure to watch the video on the site that shows some great snowflake images. Beautiful stuff.
    • How much work goes into movie poster design? Too much. Fast Company has an interesting article on The Psychology Behind Movie Poster Designs. It’s interesting to note that I never see a movie based on the poster design. Do you? I typically watch a movie based on whether or not I think it will entertain me. I don’t see a movie for artistic value, or views on “reality”, or political statements, etc. I go to be entertained. I go to escape reality for a couple of hours.
    • Snowboarding at night wearing an LED suite. Quite beautiful.

     

    • AJHP March 1, 2012 vol. 69 no. 5 405-421 “ Projecting future drug expenditures – 2012”: “For 2012, we project a 3–5% increase in total drug expenditures across all settings, a 5–7% increase in expenditures for clinic-administered drugs, and a 0–2% increase in hospital drug expenditures.” – Why is this important? Because acute care pharmacy budgets can run over $100 Million a year, that’s why.
    • Scientists have conducted the first successful human test with a drug delivery chip. The article appeared in Science Translational Medicine where the authors describes the successful use of a programmable chip loaded with medication and injected into a person. The chip holds several doses of the drug in place until an electrical current is applied, then the drug is released in the quantity specified. I worked on something like this when I was an undergraduate studying chemistry. Of course it was only in a beaker and not using drugs, but I used polyaniline to carry specific molecular entities and release them when current was applied. In our case, it was all or none, but it was cool. I still have my lab books from the experiments. 
    • Picked up a Samsung Galaxy Player 5.0 this week. I love the screen on this thing. Yeah, it’s big, but it’s beautiful. I already synched it with my Google account, which means I instantly had access to all my documents, my music, and of course my email. I also took some time to watch a little Netflix on it and listen to some music via it’s build in FM radio. I plan to take it with me to HIMSS12 along with all my other tech “stuff”. Deciding which of my toys to take on trips is becoming more difficult by the day. 

    That’s it folks. I think I’ll keep it short and sweet this week. Enjoy your weekend everyone, and remember “one of the symptoms of an approaching nervous breakdown is the belief that one’s work is terribly important” (Bertrand Russell).

  • EHRs may not be the panacea many are hoping for

    Selected excerpts from post-gazette.com article:

    More and more studies are questioning the efficacy of electronic health records, and the U.S. Food and Drug Administration has begun collecting reports involving electronic health and IT errors, some of which have resulted in death…

    “The thing about these systems is that it doesn’t really look like they’re getting any cheaper,” he said. “And the upgrades and the upkeep represents a very significant cost, especially in outpatient clinics.”

    Of those, 163 contained mistakes that could have led to “adverse drug events.” Most errors were mistakes of omission — a doctor left out an important piece of data.

    Notably, this “is consistent with the literature on manual handwritten prescription error rates,” the report said. But the larger point is computerized systems do not automatically outperform paper ones. [referring to: Errors associated with outpatient computerized prescribing systems. JAMIA, 2011; DOI: 10.1136/amiajnl-2011-000205]

    For an industry that relies on data and evidence-based measurements to make decisions on the clinical and pharmaceutical side, there isn’t a lot of evidence supporting the notion that electronic health records produce cheaper care or better outcomes.

    I think the article outlines some of the significant problems that need to be addressed before a truly effective EHR system can be utilized. We’re forcing the healthcare industry to implement a technology that they’re simply not ready for. The IT infrastructure in healthcare is built on marbles and is still years behind the consumer market in all but the most advanced facilities. In addition we continue to struggle to standardize information. We first need to understand what the information will look like before we begin forcing everyone to use it.

    There’s no question in my mind that sharing information across the healthcare continuum is paramount to providing safe, efficient, cost effective healthcare. However, there are some key pieces of the puzzle missing. Without those pieces we’re not going to get the whole picture, and that’s a problem.

  • “What’d I miss?” – Week of June 27

    As usual there were a lot of things that happened during the week, and not all of it was pharmacy or technology related. Here’s a quick look at some of the stuff I found interesting.
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  • “What’d I miss?” – Week of June 13, 2010

    As usual there were a lot of things that happened during the week, and not all of it was pharmacy or technology related. Here’s a quick look at some of the stuff I found interesting.
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  • Special report on health care and technology

    Economist.com: I’m not sure how I missed this article, but it is a must read for anyone interested in health care and technology. The contents of the special report include: