Now, the fact that doctors are prescribing a new prescription medicine when a generic cousin is available is a problem that increases costs, especially in the light that the new medicine is not significantly better than the old one in any particular way. But the practice of dashing off a prescription and moving on cannot be blamed entirely on the doctors. It can be blamed to a certain extent on the way our healthcare system is structured.

Insurance companies do not have billing codes for 15-minute blocks of time. They have billing codes for office visits and patient assessments. Your doctor gets the same amount of money if they spend half an hour with you or 5 minutes with you. If they want to make enough to pay their mortgage, car payment, health insurance (you'd be surprised how expensive insurance is for doctors), they have to see a certain number of patients per day. Sometimes they work on salary for a clinic or HMO, but then they have to go through performance reviews which count how many patients they're seeing in a day.

Talk may be cheap, but not when you're talking to a lawyer, doctor, or other professional who expects a certain hourly rate far in excess of what you and I make. And insurers seem to have done the math and decided that they're paying less for prescriptions than they would for longer office visits.

But it's not just the insurance system that promotes overprescribing. We're Americans, goddamnit. If we go to the doctor and complain that hitting ourselves in the head with hammers is giving us headaches, we don't want our doctor to tell us to stop doing that. We want our doctor to prescribe the medicine we saw on TV that stops the headaches associated with hitting yourself in the head with a hammer. We don't feel better unless we walk out of there with a prescription in our hot little hands.

We already know "bed rest, fluids, Tylenol, and time" are what you do for a cold, and if we know that, we don't want to hear that from a doctor. We came to the doctor for expert advice, not common horse sense. And thus the doctor feels pressured to prescribe something. And that's likely a big contributor to the study showing nearly half of kids getting prescribed antibiotics for colds that won't even respond to antibiotics. I'm sure many doctors tried to put up a fight when they were young and idealistic, but got beat over the head so often by stupid parents who wanted a feel better pill, even if there wasn't one, they started handing out antibiotics just to avoid the argument.

High-priced prescriptions do add to the health care overhead. But so does procedure-based payment that encourages doctors to tag 'em and bag 'em. So do people who don't feel like they've been treated unless they get a prescription. So do people who would rather use pills to relieve the discomfort caused by bad lifestyle choices than suffer the self-denial of making good lifestyle choices. We're all to blame for our overmedication and the associated costs, and it won't get better until attitudes change in a number of camps.

Giant burgers are nothing new, and the Travel Channel's "Man V. Food" has featured some bigger burgers in its hard-not-to-watch orgy of gluttony, but I guess this is the first time such a huge burger has been offered at a ballpark. Presumably added to the menu to get some press about its novelty, it did just that, making the wire services and getting stories in newspapers nationwide.

That attracted the attention of the Physicians Committee for Responsible Medicine. Although dated April 1st, the open letter from dietitian Susan Levin was released to press sources yesterday and another round of press for the Whitecaps began almost immediately.

Levin asked for the following warning label: "WARNING – Eating meat is associated with increased risk of heart disease, cancer, and death."

I like a different quote from her letter that many of the press outlets ignored: "I venture to guess that your monster burger harbors more synthetic hormones than most professional baseball players."

Woo-hoo, the humorless killjoy tries to make a steroid joke, and almost pulls it off. Most of the letter, though, is about how too much meat and cheese causes most of society's medical ills and riffs on "what kind of example are we setting for the children?"

Honestly, I think this is just bandwagon PR. Look at how much mileage the PCRM got out of one little press release. Just like the story on the burger, it got on the wire services, got picked up by lots of outlets, and it's provoking a reaction. Used to be that the Center for Science in the Public Interest (CSPI) was the best known food-issue grandstander. One of their more memorable campaigns was trying to expose all the dangers of movie theater popcorn. More recently, they've been suing beer makers over making caffeinated alcoholic beverages they're calling "alcospeed."

Still, good intentions aside, mercenary attempts to ride on the coattails of someone else's publicity aside, the claim that the burger needs a warning label is just insulting on so many levels, and that's probably what's made people take notice. It's not so much that the "food nazis" are at it again, but they're calling Joe the Plumber an idiot again. And people are getting pissed off at the arrogant, humorless twaddle coming out of activistville yet again.

Susan, this is why people hate you. You talk down to them. You think they're not capable of making their own decisions and need or want you to interfere. So here's my proposed warning label.

WARNING: There are some people in this country who believe you're potentially stupid enough to mistake a 4-pound burger with cheese, chili, and corn chips on it for health food. Humorless blowhards like this are known causes of irritation and stress. Please use extreme caution when listening to these pompous twits.

I was able to choose from a variety of upcoming appointments with the physical therapist. No problem.

When I called the sports medicine clinic, it turned out their hand and wrist person is only in that office on Mondays and has nothing open until 3 weeks from today. "Is November 10th okay for you?"

Sure, I'm a brand new patient with a worsening condition that's driven me to seek treatment from an orthopedic specialist, but I'll just explain to my condition that the doctor isn't available for three weeks and it will happily go into remission until the doctor can see me.

If you're in say Vegas, and you call up a hotel, say "I'm in town, got any rooms," and they're full up, they'll try to help you get booked somewhere else. If you call a doctor, they'll tell you when he/she is available, and if that doesn't work for you, that's too bad.

I know that doctors are not hoteliers, but it would be nice to see an attitude that says: "We understand you may be in pain. If we can't serve you within a reasonable time period, we'll be happy to recommend some other doctors who might have an appointment available sooner."

Best I could do was get waitlisted for a sooner appointment if someone cancels.

Of course, you can bet I'm now going to shop around.

And even better for trying to scare you that your baby will die is this one...

Now, they could not say these things if they were not true. But the thing the medical industry loves to do is scare the crap out of you by twisting statistics to make it sound like if you don't do what the drug company or public health campaign says, you or your child will definitely die. What they fail to do is put this into perspective.

According to the CDC, the number of Whooping Cough cases in the United States in 2003 were 4 per 100,000 people. Now this is not the number who died, but just the number of reported cases. So, 4 per 100,000 people means that the overall odds of catching it were 1 in 25,000.

But remember that they're bringing the mention of death into the ads. Namely that "nearly all deaths in the United States from whooping cough are reported in infants less than 6 months" and that pertussis "can be fatal to babies." They're trying to get you so scared that your baby will die if you don't get vaccinated. But how likely is that to really happen?

They were citing this CDC report. The report also states that 5,872 cases of pertussis in babies under 6 months were reported in the 3-year study period. Of that 5,872 babies... 51 died... not 51 a year, but 51 in three years. That's an average of about 17 babies per year out of the approximately 3.7 million babies born in each of those years. So the average odds of a baby dying from whooping cough during the three year period was about 1 in 200,000.

So the same report they scare you with, gives other numbers that let you calculate that the odds of your baby getting and dying from pertussis... from anyone... would be somewhere in the neighborhood of 1 in 200,000.

So why are they raising such an alarm?

Perhaps a CDC price list, showing pricing for the Tdap (Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis, a.k.a. ADACEL®) vaccine runs between $30.75 for the CDC's bulk discount rate and $37.43 for the average private sector rate. Basically, every person they scare into getting it now is an additional $30 (or more) in sales for them. If they could convince 3.3 million adults to get so scared they ran out and got vaccinated, it would mean $100 million in sales.

What's interesting is that most adults will get the shot anyway over the next few years (and many have already). The CDC recommended switching to a Tdap booster (from a simple Td booster) in 2005. So if you go in for your regular check-ups, your periodic tetanus booster will include pertussis vaccine if your doctor is following CDC recommendations. Seems like Sanofi Pasteur is trying to boost annual revenues by scaring people into getting a booster now instead of when they're scheduled for it.

Last, to show you how much of a scare campaign this is, let's run the numbers of pertussis deaths against the super bogeyman that new parents get attacked with... SIDS. The average baby is over 130 times more likely to die of SIDS than pertussis (based on 2,648 reported SIDS deaths in 1999 vs. an estimated 20 pertussis deaths for infants under one year in 2003). Basically, the average baby is more likely to die of SIDS than to even catch pertussis, and that's before the CDC officially recommended the Tdap booster for adults.

It's amazing how much their ads look like scare tactics when you see the numbers on pertussis in context. Should you make sure that your doctor gives you a Tdap booster instead of a Td booster the next time you're due? It's basically just a booster of a vaccine you've already had, so it probably couldn't hurt and could help, and it's only a few dollars more than the Td booster. Should you run screaming to your doctor, demanding a pertussis vaccine right away like Sanofi Pasteur would have you believe? That's up to you to decide. But every time the news or a drug company ad hits you with alarming statistics, go get some context on those statistics. Once you see them in context, they're usually a LOT less alarming.

There's an old saying that goes: "Fool me once, shame on you. Fool me twice, shame on me." So where does the shame get assigned on "fool me six times"?

The story in question is about a dentist who is accused of fondling the breasts of over 27 female patients and the ongoing trials and tribulations. He's claiming he can produce journal articles which discuss massaging the pectorals to treat TMJ disease (a disease of the jaw), but the women are saying it was unwelcome contact of a sexual nature.

Okay, at this point, I'd be ready to call shennanigans on the dentist, call for the revocation of his license, and let that be that. But there was a bit at the end...

Deputy Attorney General Jeffrey Phillips gave Lew three new complaints, including one from a 31-year-old woman who said Anderson fondled her at least six times over two years.

She took to wearing tight shirts with high necklines, "and Anderson would still get in under her shirt and bra," according to a police report.

He fondled her six times. She even wore clothing to prevent the fondling and he'd still get in under her shirt and bra. And while some people are thinking this just proves how evil he is, I'm wondering... couldn't she have gone to another dentist? After the first fondling, couldn't she have reported him and moved on to a better dentist? After the second, the third, the fourth? At some time around when she started wearing defensive clothing, couldn't she have thought "maybe I need to switch dentists?"

You can talk about him being an authority figure, in a position of power, etc. But there are two things to consider... your dentist is no different than your housekeeper, your plumber, or your dog groomer. Your dentist is someone you've contracted to provide a service. You hired them and during your appointment, they work for you. Would you tolerate your plumber grabbing your ass?

Second, she's ostensibly an adult, and part of being an adult is taking responsibility for yourself, and that includes reporting non-consensual fondling to the police before it's happened for the sixth time.

Yes, this dentist is bad, evil, wrong, abusive, and a plethora of other negative words. But when I read that quote, my first thought was not about how bad he was, but "Awww, c'mon!!!" At some point, say the fifth or sixth unwelcome fondling, I'm going to lose sympathy for the victim. First or second fondle, I'm totally on her side. But after he's fondled you 3 or 4 times, change dentists or call the cops. Don't put on a tighter shirt and go back! My God, woman!

I know that assaults and fondling can be a very touchy subject for some people (no pun intended), but really: Fondle me once, shame on you. If I actually voluntarily, as an adult and as a person who is paying you, put myself in a situation where a dentist can fondle me a sixth time, that one's 90% my fault.

Sheesh.

Now a judge might set aside the verdict as excessive or reduce it. But when people suffer a negative outcome from using an FDA approved drug, the fact that each user of the drug could be awarded tens of millions of dollars... Who's paying that tens of millions? The big bad drug companies? No, it's being paid by the people who buy drugs from the big bad drug companies. They don't pull $135 million out of thin air. It's paid out of revenues, or by an insurance company which then just raises rates to cover the loss.

Now, I'm not going to go all Republican on you and champion the drug companies. Nor am I going to go off on a diatribe against trial lawyers or excessive government regulation.

What gets me, though, is that part of Wyeth's defense was that the patient was warned that the drug carried an increased risk of cancer. And that brings me to tonight's word... statistics.

You can't always blame the patients. How many times have you heard a story where they say something like "the study showed that burning an infant's feet with cigarettes reduced its chance of SIDS death by 20%"? So then everyone goes out and starts burning their kid's feet with cigarettes. But what they don't tell you is that the kid's chance of SIDS death was 1 in 1000 and burning their feet with cigarettes lowered their chance to .8 in 1000. That means if you burned the feet of ten thousand babies with cigarettes, statistically you'd save the lives of... 2 babies. Burn 20,000 baby feet and save the lives of two babies. But more importantly, 9,998 babies got no benefit from having their feet burned. They just got pain and scars. Their feet were burned needlessly because all we had were statistics. Because we can't tell which two babies would have their lives saved by burning their feet, we cause 9,998 babies needless pain and scarring.

See, when you hear the story on the news that your chance of death from XYZ increases by 20% or decreases by 20%, they conveniently leave out what your original chance of death from XYZ actually is. And remember that much of this is a statistical increase or decrease. If you had the right group of people, you could statistically prove that having one less beer on the Fourth of July decreased their chances of being hit by a runaway train at Christmas by 64%.

Let's get into bigger numbers... Your odds of winning the Megamillions Lottery on a single ticket are 1 in 175,711,536. Want to increase your chances of winning by ten thousand percent? It would seem that if you increased your chances of winning by ten thousand percent, you're virtually guaranteed to win. Right?

Buy 100 tickets. When you increase something a hundredfold, you've increased it by ten thousand percent. Thing is, you've only increased a 1 in 175 million chance a hundredfold. To guarantee you'd win the megamillions lottery, a 10,000 percent increase isn't enough. You need a 17,571,153,600 percent increase (yes, that's a seventeen billion percent increase).

So when patients are told a drug can increase their risk of cancer, heart attacks, etc., is that warning really and truly meaningful? What was their risk in the first place? How much was their risk increased by this drug? What is their new risk?

In medicine, there are ways to know who will get cancer from a particular drug and who won't. We just don't have the science yet to know all those ways to tell this stuff. So, due to a lack of information or an excess of imperfect information, we substitute statistics for knowledge. We treat getting cancer from using a drug or a baby dying of SIDS like a lottery. Since we can't really know whose ticket will be drawn, everyone has the same statistical chance. Maybe a few risk factors increase one person's chance over another and we can get a little closer to determining which is the 100% patient and which is the 0% patient, but we're still pretty far off.

And in the meantime, the news media says something stupid like "a new study shows that eating pickles doubles your risk of dying from a manatee attack" and people who will never encounter a manatee in their life swear off pickles, yet someone who will end up dying of a manatee attack shrugs off the study's findings. Then their family sues Vlassic for not putting a big enough warning about manatee attacks on their pickle jars and sues Sea World for not keeping the public farther from those dangerous manatees and for not screening the dead guy for pickle consumption before allowing him near a manatee.

So when the drug companies present drug trial numbers to the FDA and the FDA decides what the doctors and the public must know about the risks... it's all statistics. And it's not necessarily the drug companies or your doctor or the FDA trying to mislead you. You'd need a solid knowledge of statistics and all the raw data to make an even semi-informed decision.

So when people take a drug and it's a potential culprit for bad things that happen to them, their lawyers can use the public's ignorance of statistics in two ways. First, they use their own statistics to try to prove a link of causation between taking the drug and the bad thing that happened. Then they try to show how their client couldn't adequately understand the warnings they were given because the client is just part of the general public who doesn't understand all these statistics.

And that's how we end up with jury awards that are the size of lottery jackpots.

In the end, until we have the science to identify every genetic and lifestyle marker so we can say "this drug will give you cancer" or "you'll be fine" with complete accuracy, we have to rely on statistics. We can do longer tests and maybe identify a few more things that can happen, but those push up the costs of bringing a drug to market. If we don't, then we end up with people getting heart attacks from long-term use of a simple arthritis medicine and push up the costs with a couple billion in law suits. Either way, we make drug companies take a lot of financial risk, and thus they charge us an arm and a leg to try to reap the reward of that risk.

In my opinion, unless you can prove intentional malfeasance by the drug companies (i.e. they falsified test results or cut corners during the testing), so long as they followed all federal regulations, jumped through every hoop, and provided every federally mandated warning, they should have a "shit happens" defense.

And if the federal rules aren't strong enough, whose fault is that? If the funds aren't there for research to help give us more precise indicators and less reliance on statistics, whose fault is that? As long as only 50% of the eligible voters show up at the polls and vote for the candidates who appeal to their baser instincts on topics like gay marriage and flag burning rather than base their vote on topics that are really "life and death", then the lawyers, insurance companies, and drug companies get rich, drug prices remain outrageous, and if you're "lucky" to live long enough to clear the trials and appeals after a drug gives you a near-fatal side effect, well, you win the lottery.

The only changes I made were to underline some of the text I found important. For example, it says "Mirapex may cause you to fall asleep without any warning." Okay, that's not "causing drowsiness" like allergy medicines do. Drowsiness is the warning that you may fall asleep. Apparently you skip drowsiness and just go from awake to asleep "without any warning".

I think the term "fall asleep without any warning" is the PR department's spinful way of saying "may cause you to suddenly and unexpectedly lose consciousness."

Next, "when taking Mirapex hallucinations may occur". You're freakin' me out, man!

And, on top of this, when taking this class of drugs, "impulse control disorders / compulsive behaviors may occur".

So here's what I see being a typical evening on Mirapex: First you strip naked and go wave your penis at the polka-dotted dragons in the front yard. Then you come in, and in the midst of ensuring that every photo in the house is hung exactly straight, you pass out on the floor... "without any warning."

But while you're sleeping, your legs are perfectly still.

Like most people, I occasionally need a little help getting to sleep. And while you can get a sleep aid at the local pharmacy for 15-30 cents a pill, I get the same stuff for around 3 cents a pill because of one thing... I read the labels.

See the active ingredient in most OTC sleep aids is Diphenhydramine, better known by its brand name, Benadryl. You know how allergy medicine makes you drowsy? Well, so do the companies that make the sleeping pills that line the shelves of your local pharmacies. Almost every OTC sleeping pill (aside from herbal or homeopathic ones) uses allergy medicine as its active ingredient.

About 90% use Diphenhydramine... Nytol, Sominex, Tylenol Simply Sleep... They're all just Benadryl with a different name. Really. The active ingredients are exactly the same. Tylenol PM is merely a combo of Benadryl and Tylenol.

Let's run some numbers. At Drugstore.com they sell a box of 32 Nytol Quick caps for $6.99. That's 21.8 cents a pill. For the Rite Aid generic sleep tablets, providing the exact same amount of Benadryl, it's 72 pills for $4.19. That's 5.8 cents a pill. Or, if you want to break it down in different terms, the Rite Aid generic tabs give you 20 more doses of the exact same medicine, plus you save $2.70 to boot.

But if you buy it as a sleep aid, they tag a premium onto it. Drugstore.com is selling 72 "sleep aid" tabs for $4.19 on sale, but they've got 200 "allergy" tabs on sale for $6.49, or just a little over 3 cents each.

Think about it... the name-brand sleep aid is close to 22 cents a pill. The generic allergy tablet is around 3 cents a pill. But both pills contain the exact same medicine in the exact same amount. Why are you paying more than 6 times as much per dose to buy the Nytol?

To an extent, part of the effect of any drug is psychological, a placebo effect. If you believe the Nytol will work better than the generic allergy tab, it may well work better. But if you believe that Benadryl is Benadryl, no matter what name you give it or whether you say it's for allergy relief or sleep, then there's no reason to spend $43.60 on Nytol to get the same amount of medicine you get in a $6.49 bottle of generic allergy medicine.

But while doing research, I found another thing. First the state Insurance Commissioner's office mentioned it, then friends and visitors to the site told me stories of it. Anesthesiologists were big perpetrators of this game. If you had to have emergency surgery, you'd be lucky to pick your surgeon, much less your anesthesiologist. Knowing this, anesthesiologists were taking advantage of people's distress and lack of choice to pick their pockets.

Most of the stories I heard about this weren't about trauma surgeries, though. They were births. The general story went: the parents-to-be went into a preferred provider hospital to give birth, had to have a caesarean section, the anesthesiologist for the c-section wasn't a preferred provider on their insurance, and they ended up having 500-1000 tacked onto their share of the bill after the insurance payment.

Now, it's common to pick the hospital you give birth at based on where your obstetrician has privileges. You've been seeing this doctor for months. You trust this doctor. You want this doctor to deliver your baby.

You make sure the doctor is a preferred provider on your insurance and that the hospital where they have privileges is a preferred provider, but you don't think to ask about the anesthesiologists. You should.

You should also write your congressman and senator and ask them to introduce Federal legislation, an amendment to the Patient's Bill of Rights, making it illegal for an insurance company to certify a hospital as a preferred provider unless all the doctors and service professionals are preferred providers.

It's ridiculous that you need to not only confirm that a hospital is a preferred provider on your insurance, but that all their subcontracting medical corporations (ER docs, radiologists, anesthesiologists, etc.) are preferred providers. And it's difficult to do to, because the medical corporation doesn't have to have the same name as the hospital, so you're forced to check the addresses of local radiology services and emergency medicine services against the address of the hospital.

Until there is federal legislation that makes it possible for consumers to quickly and easily determine whether all the services they receive at a hospital are insured, dishonest docs are going to take advantage of this to pick your pocket at the most emotionally, physically, and financially vulnerable times of your life.

So if you're pregnant and trying to pick the best obstetrician, make them do the work. Make them find out if the people who will take care of you at the OB/GYN's preferred hospital are preferred providers. If they can't answer or won't answer, maybe they're not as deserving of your trust as you thought. And if they answer no, when you tell them you'll have to go to another doctor, maybe it will give them incentive to join the fight against this underhanded practice.