Beware of Fake Viagra

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If you have a computer, you have certainly seen the many ads for on-line pharmacies where you can get just about any medication mailed to you.   Beware of fake Viagra (sildenafil).   According to researchers at the World Meeting on Sexual Medicine, they reported an analysis of tablets purchased from 22 different websites.  They found 77% of the samples were counterfeit and contained only between 30%-50% of the levels of active ingredient.  Some were adulterated with dangerous chemicals.

None of these phony websites required a prescription and 91% offered "generic Viagra" which the FDA has not yet authorized.  The fastest growing drug class in the world is counterfeit medications and it isn't just Viagra.

Not all on-line pharmacies are crooks.  Some Canadian and UK pharmacies deliver a quality product for a fraction of the price. They require authorized prescriptions from the doctor.  But if you see something that is too good to be true...it is.  Not true that is.

Bedbug Bites

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The answer to yesterday's medical diagnostic challenge is #1 - Bedbug bites.  Bedbugs frequently attack exposed areas of the skin and are attracted to humans' high body temperature.  Cutaneous (skin) reactions to bedbug bites are characterized by erythematous (red) or "hive-like" papules.  Lesions observed in a linear or cluster formation are typical. 

This patient's bites responded to treatment with topical glucocorticoids.

Primary Care Payment Struggles

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The way doctors bill and get paid is a byzantine process and it is no wonder the "private practice" doctor is an endangered species.  It takes a keen sense of business, a love of medicine-not money, and a sense of humor to survive.  Here is my latest story.  You can't make this stuff up....

I saw a patient in September 2001  (note the date...11 years ago).  I billed her insurance company, Employers Mutual, LLC for $185.00.  I never got paid.

Now fast forward to September 2012.  I received a document from an attorney who informs me that he is a receiver in a class action suit and $48 million in unpaid claims is being claimed.   It appears I am a Category B creditor and will receive a pro-rata share.  He recovered $16, 559, 576.88 and took $4,831,214.40 in attorney fees.

It looks like in the future (?) I may receive a check for $37.00.  No promises are given.

I remember my practice back in 2001.  I worked about 80 hours a week and never even had enough money to fund a retirement plan for myself.  Getting paid a fraction of my charges was common and getting stiffed by insurers completely was also par for the day.

 I am happy for the windfall of $37.00 for the work I did 11 years ago.  I still see patients in a private practice but my main income now comes from my employed administrative position.  Waiting 11 years for a fraction of payment is not a sustainable business model.

The Best Jobs in Health Care

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The health care sector is a good place to look for job opportunities and to plan career goals.  The workforce is expected to increase 27% through 2014, compared with 14% for all industries combined, according to the Department of Labor.  But special education is needed to enter the health work force and now CareerCast has posted the top jobs based on stress level, solid job security, work environment, training and income.  Here is how the list came out:

1.  Dental hygienist
2.  Audiologist
3.  Occupational therapist
4.  Physical therapist
5.  Optometrist
6.  Pharmacist
7.  Physician assistant
8.  Chiropractor
9.  Primary Care Physician
10. Registered Nurse

Dental hygienists were first based on a median salary of nearly $70,000/year, low stress, a job growth outlook of 38% by 2020 and a small educational investment in a two year associates degree.  They set their own schedules, work in comfortable environments and never have to take their work home!

Compare that to a Primary Care Physician who makes more than $200,000 on average a year but they pay expensive malpractice insurance, have patient demands 24/7, have high stress levels and can incur training debt of over $200,000.  Additionally the post graduate training after a college degree is another 7 plus years, delaying any income potential that can never be caught up.

Occupational therapy and Physical therapy also have  high rankings and with the baby boomer's aging, the growth potential is strong.   But the physical demands are higher and patience is needed as they are dealing with injuries and disabilities.

The stress level for a Registered Nurse was ranked higher than the PCP.  The stress level for a chiropractor was as low as the dental hygienist and the audiologist has the most stress free job of all.

What is the Diagnosis?

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I love this weeks Image Challenge from The New England Journal of Medicine because I had a patient with these exact findings about a month ago.  You be the doctor and make your best guess for the diagnosis.  Post a comment and check back for the answer tomorrow.

This patient presented with hearing loss and left ear fullness.  What is the diagnosis? (click on the image for a better view)

1.  Cholesteatoma
2.  Fracture of the temporal bone
3.  Ochronosis
4.  Otomycosis
5.  Relapsing polychondritis 

Winner gets bragging rights at your next cocktail party!

Next Week's DSS - Dr. Ravindranath

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The next Distinguished Scientist Seminar at the University of South Alabama College of Medicine will feature Dr. Vijayalakshmi Ravindranath, professor and chair of the Centre for Neuroscience at the Indian Institute of Science in Bangalore.
The lecture, titled "The Degenerating Brain: Mechanisms to Therapy," will take place Oct. 11, 2012, at 4 p.m. in the Medical Sciences Building auditorium on USA's main campus.

Dr. Ravindranath’s research focuses on understanding pathogenic mechanisms underlying neurodegenerative disorders with a goal to discover drug targets that can be used to develop disease-modifying therapies.

Dr. Ravindranath obtained her Ph.D. from the University of Mysore in 1981. In 1986, after completing her postdoctoral training at the National Cancer Institute and the National Institutes of Health in the United States, she joined the Department of Neurochemistry at the National Institute of Mental Health and Neurosciences, (NIMHANS) in Bangalore.

In 1999, the Department of Biotechnology (DBT), Government of India asked her to help establish the National Brain Research Centre (NBRC), an autonomous institution of DBT, Ministry of Science and Technology as a centre of excellence and to coordinate and network neuroscience research groups in the country. She continued as Director of NBRC until May 2009 and then accepted the position of professor and chair of the newly created Centre for Neuroscience at the Indian Institute of Science in Bangalore.

During her tenure as Director of NBRC, she provided visionary leadership, and in a very short period attained a position of being an internationally acclaimed centre of excellence.  In a short span of five years, Dr. Ravindranath established a state-of-the-art institute in a rather remote location and created a new paradigm for research by integrating mathematical and computational science into the understanding of complex biological systems.

NBRC was granted University status in May 2002 to help promote human resource development in an inter-disciplinary manner. Dr. Ravindranath networked 45 institutions around the country with NBRC with a goal to share resources and promote neuroscience.

Dr. Ravindranath is elected fellow for all three science academies in the country, namely Indian National Science Academy; Indian Academy of Sciences; and National Academy of Sciences, India.  She is also a fellow of the National Academy of Medical Sciences, India; Indian Academy of Neurosciences; and Third World Academy of Sciences. She is a recipient of the prestigious S.S. Bhatnagar award (1996), Omprakash Bhasin Award (2001), J.C. Bose National Fellowship (2006), and Padma Shri (2010).

For more information on Dr. Ravindranath, click here.

To learn more about the lecture series visit http://www.usahealthsystem.com/DSS

Dr. Gerald Liu Selected to Participate in Grant Generating Project

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Dr. Gerald Liu, assistant professor of family medicine at the University of South Alabama College of Medicine, was recently selected to participate in the Grant Generating Project with the Virginia Commonwealth University School of Medicine’s Department of Family Medicine.

Eleven scholars from across the country were selected to participate in the year-long program designed to equip and mentor family medicine researchers with grant writing skills.

The goal of the fellowship is to increase research capacity in securing competitive funding for grants and contracts in the discipline of family medicine.

Dr. Liu earned his medical degree from Tulane University School of Medicine in New Orleans in 2008. From 2008-2009, he was a resident in the surgery residency program at William Beaumont Hospital in Royal Oak, Mich. Dr. Liu conducted a residency in family medicine at USA, where he also served as chief resident of family medicine from 2011-2012. Dr. Liu joined the USA College of Medicine as an assistant professor of family medicine in July 2012.