Two years ago, the FDA and the drug industry initiated a collaborative effort to reduce the misuse and abuse of long-acting pain medications, such as OxyContin. After an accumulation of input from public meetings, physician groups, and patient advocacy organizations -- the FDA put together a plan that urged doctors to undergo voluntary training as a condition for prescribing long-acting narcotic painkillers. Last Friday, it came down to a vote, and an advisory committee to the FDA voted 25 to 10 against the plan. The FDA usually follows the advice of its advisory committees.
Some experts, according to the New York Times, say the plan was not strong enough to control the use of such drugs. Voluntary versus mandatory training may be ineffective. Others, though, worry that doctors faced with a requirement to undergo training, would circumvent the hassle by deciding not to prescribe long-acting narcotic pain medications. But where does that leave a chronic pain patient, such as a person living with severe arthritis or other severely painful conditions? Certainly, misuse of pain medications is a major problem. But would a solution that disrupts legitimate use of the drugs be any solution at all?
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Should arthritis patients have access to the doctor's notes in their medical chart? The answer to that question depends on who you ask. Doctors may have a different perspective than patients -- and not all patients would even have the same level of interest in reading doctor's notes. There are those who fervently believe patients have the right to read their chart -- which they legally do thanks to the Health Insurance Portability and Accountability Act (HIPAA) which in 1996 gave patients the right to read and amend their medical record. But there are others who believe the notes could cause unnecessary confusion. You know, the "too-much-information" theory -- why burden the patient with stuff they wouldn't understand?
Why am I writing about this now? A recent New York Times article, Should Patients Read the Doctor's Notes?, brought back some memories of when I was diagnosed with rheumatoid arthritis in the 1970s. I remember visiting a large, teaching hospital for appointments. As I would go from one department to another for tests or consultation, they would pack my medical chart in a large envelope, seal it, and hand it over so I could carry it with me. It may have been an innocuous move, to prevent me from spilling the contents all over the floor -- but to me, the sealed envelope was mysterious, intriguing, and so tempting to pop open and start reading.
To this day, I'm a patient who likes to follow along with the minutia. I like to know my blood counts, how many milligrams of a medications I'm taking, and what the doctor is thinking. But there are patients who couldn't be bothered -- too many details, too little time. They would rather leave it to the doctor and take two steps back.
According to the article, researchers are studying the impact of patients reading doctor's notes in a study called "Open Notes". Over 100 primary care physicians and approximately 25,000 patients from three health care centers are involved in the study. As part of the study, there's also a public survey. Let them know what you think by taking the survey, and share your thoughts with us about accessing doctor's notes.
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People who are obese at age 18 have an increased risk of developing psoriatic arthritis. According to the results, published in the Archives of Dermatology, 943 psoriasis patients participated in the Utah Psoriasis Initiative from 2002 to 2008. Of the study participants, 26.5% had psoriatic arthritis.
Researchers identified risk factors for psoriatic arthritis as:
- higher body mass index at age 18
- younger age when psoriasis began
- being female
- larger body surface areas affected by psoriasis
The earliest onset of psoriatic arthritis appeared to be in obese and overweight study participants. About 20% of patients who were overweight or obese at 18 developed psoriatic arthritis by age 35. About 20% of normal-weight study participants developed psoriatic arthritis by 48. So, what's the bottom line? Prevention and early treatment of obesity may lower the risk of developing psoriatic arthritis.
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Dietary supplements are used to improve joint health and are among the treatment options for arthritis. But supplements are not regulated by the FDA like prescription drugs. While many believe supplements can be beneficial, you should know what you're buying. It's important that you understand what dietary supplements are.
Do supplements come with any level of assurance that they are safe and can do what they claim to do? Do you know the basics about supplements? Take our 10-question, True or False, Dietary Supplement Quiz.
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