What I'm Reading (Aug. 29)

By Chuck Dinerstein, MD, MBA — Aug 29, 2024
Who needs beach reads when we’ve got tales of pharmaceutical overreach, urban chaos, and big business playing doctor, right?
Image by Pexels from Pixabay

As a vascular surgeon, I prescribed a lot of gabapentin for nerve-related pain in my patients with diabetes (neuropathic pain). It helped some, not others and there was little in the way of alternatives.

 

“What has fueled this multipurpose popularity? “The history of gabapentin is really a history of uses getting ahead of the evidence,” said Dr. Joseph Ross, an internist and health policy researcher at Yale School of Medicine.

Early on, Warner-Lambert, the manufacturer of gabapentin, pushed off-label prescriptions of the drug through aggressive marketing methods that the Justice Department deemed illegal and fraudulent; the company settled the government’s suit for $430 million in 2004. Still, gabapentin use tripled between 2002 and 2015.

It received another boost as opioid use and misuse grew to crisis proportions. “People were searching for alternatives, and this was often the drug they landed on,” Dr. Steinman said.”

The NY Times brings us the tale of gabapentin, The Painkiller Used for Just About Anything

 

Crime has risen to become an issue in the Presidential campaign, a tug-of-war between too brutal and too lenient. Of course, when an issue is polarized to that degree, the actual cause and answer lie elsewhere.

“A city-commissioned report from the National Institute for Criminal Justice Reform found that between 200 and 500 people are responsible for 60 to 70% of all gun violence in the District. This small group are “primarily male, Black, and between the ages of 18–34,” with an average of 11 prior arrests; at least half were identifiably in a gang. Car theft in the District, meanwhile, appears to be driven by delinquent teens. …

There’s another important component of DC’s crime perception problem: increasing public disorder. City 311 data show a steady increase in requests for sanitation enforcement since early 2021, with over 1,200 calls per month as of 2024. Before a crackdown, fare evasion accounted for 10 to 13% of WMATA ridership. Regional data show that unsheltered homelessness has risen sharply since 2020, even as overall homelessness has fallen.

Such problems don’t necessarily rise to the level of “major crime,” and the solution isn’t serious prison time. But they still affect residents’ quality of life and — relevantly — their perception of crime. If DC has gotten more disorderly in the past four years, that may explain part of why citizens feel like “crime” is out of control.”

From the Manhattan Institute vis Slow Boring, What everyone is getting wrong about crime in DC

 

It is often difficult to illustrate our work. I have it relatively easy, able to use conventional charts and graphs, but Dr. Bloom, who writes about chemistry, has a far more difficult time finding the right picture to tell the story. He is not alone.

“Once a structural biologist completed what used to be a years-long process of reconstructing a protein’s 3D structure, they faced a new problem: how to communicate that structure to other scientists. In truth, it’s impossibly difficult to represent a protein’s realistic structure. Proteins are minuscule, on the order of nanometers, and can contain hundreds of thousands of atoms. “If those atoms are all drawn and then joined together, it becomes very difficult to see,” Thornton said.

Richardson’s innovation was a reproducible method of representing the folds of a protein’s amino acid backbone without getting bogged down in the details of specific atomic arrangements. She relied on proteins’ tendency to fold into two energetically favorable shapes.”

From Quanta, How Colorful Ribbon Diagrams Became the Face of Proteins

 

The biggest enemy of small businesses is big businesses. We need to look no further than the patchwork of primary care practices that have been supplanted by the much more fiscally productive and efficient corporate practices, including the subject here, United Healthcare. While they are built for fiscal speed, clinical outcomes are, at best, an afterthought. This is the corrosive effect of capitalism without a moral compass.

“They built this huge battleship to sail the seas of risk with all these layers of management and bureaucracy and computers and analysts,” Good said. “Then they’re trying to float this ship with a bunch of family doctors and pediatricians down in the galley with their skinny little primary care oars.”

Part of the continuing series from Stat, UnitedHealth pledged a hands-off approach after buying a Connecticut medical group. Then it upended how doctors practice

 

Chuck Dinerstein, MD, MBA

Director of Medicine

Dr. Charles Dinerstein, M.D., MBA, FACS is Director of Medicine at the American Council on Science and Health. He has over 25 years of experience as a vascular surgeon.

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