h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

Work is kind of... pffft, isn't it? It's either tedious or stressy or both. It must be sun-spots or something. I think I told the wrong person off (by email) for damaging a book by using the wrong solvent on it. I will have to sort this out tomorrow. Tomorrow therefore I may well need dragging out of bed by my ankles and frog-marching to work as I wail 'no no no please no' all the way.

Stupid marking. Stupid students. Stupid exams. I hate this term - all our normally reasonable and mild-mannered students turn into shouty weepy freak-outers. The freak-outers are now in orbit. Rather a lot of cowering and holiday leave mysteriously happens in May....

Am I whining? Thought so. Sorry

[GDZ]

Your whining is always so picturesque and entertaining that you shouldn't apologise. We like it.




* slinks off before anyone passes comment on the quality of her own particlar brand of whinge

Teucher, I think what my sister has cut back on are acidic foods; some tomatoes she can eat (the low acid orange ones), but mostly no citrus and for some reason cooked spinach can ramp the symptoms up. The oxalic acid gets concentrated, maybe? Don't know.

Your diet sounds very good, actually; it's what I've been following lately. And dark is a *requirement* in teensy tiny amounts!



Gotta agree with what FG said about the drug/insurance companies. Have you ever noticed that the meds on insurance company formularies and the new Part D in MediCare (senior citizen plan) that aren't covered are usually the most prescribed/most expensive?

If it's the most prescribed, there should be *some* savings due to volume if the cost is caused by the expense of research and development, but no. A lot of the drug investigations are directly taken from government-funded studies (access to which information is free, because the public paid for it) through the National Institutes of Health, so I question just how much "research and development" is actually done at the pharm company end. Maybe tweaking the formulas to make them patentable, and picking out the color of the capsules?



Sorry, today is my scheduled cynical day...

Phil, Google offers a free image file organiser called picasa.

The US medical system is worse than immoral, it's broken. I read a diary the other day written by a doctor who works in emergency (sorting) in upper New York. He described how a patient came in presenting stroke symptoms and they reckoned they had three hours to administer something, and yet his health company wouldn't pay for the remedy without prior approval. Within three hours! The doctor went ahead and administered the remedy anyway (I can't remember whether it was just drugs or also some palliative action).

Later, on the phone with an administrator from the patient's insurance provider. the administrator started telling the doctor what steps he should take next in treating his patient.

Which is illegal, practising medicine without a license, but the doctor felt that he had to throttle back his initial reaction in case it jeopardised the patient's future with that insurance company.

SC, is it possible that the most expensive drugs are the most prescribed because the pharmaceutical companies pay....scratch that, pay is such a nasty word....encourage the doctors to prescribe them?


Okay. I really am going to shut up this time. Lips are zipped. I'm outta here. Not another word.

"
SC, is it possible that the most expensive drugs are the most prescribed because the pharmaceutical companies pay....scratch that, pay is such a nasty word....encourage the doctors to prescribe them?


That'd be a yupper...not to mention the "free" samples that Pharmaceutical companies give out. My last private doctor probably saw as many pharm reps as she did patients!

I've worked in the insurance field in a number of capacities for most of my working life, and I've got *no* illusions left, as to who's in bed with whom. An orgy devoutly to be avoided!

[A note here: my experiences/observations are in the U.S. "private practise" arena -- I know nothing about the NHS (UK), except possibly some !]

I'd better shut up, too -- please hand me some of that duct tape, will you, Hyp?

Well we were given a list of drugs we're not allowed to prescibe at our hospital without prior approval 1.5 years ago, and they're all the most expensive ones. You know what we get by just fine without them.

Well mostly - there's a lot of 'well this may cause side effects but is cheap - if you get side effects we'll apply for the expensive one'.

Oddly enough american doctors find that totally appalling - I can't get it really. I tell patients lets go for the cheap one first, if it doesn't work we'll try something more expensive. It does mean that you think more before you prescribe expensive stuff.

Hyp - pay is a nasty word - and not true - it's not a case of 'prescribe my drug and then I'll give you money' it's subtler than that. It's more 'look at all these studies that show my drugs the best by a tiny amount.

To which I nod and say, very nice powerpoint but we can't prescribe your drug anyway it's not on the forumarly. Now can I have another pen.

Though one drug rep did burst into tears in front of me and say 'please prescribe my drug they're going to sack me if the sales don't pick up'. Though perhaps I shouldn't have spent 15 minutes picking out every single fault in her marketing claims.

The Proff who writes our forumarly (list of drugs we're allowed to use) refuses to meet with any drug reps, let any of his team or students use a pen provided by a drug rep, or let a drug rep speak at a meeting he's spoken at. If he sees anyone using a drug rep's pen he takes it out of their hand and stamps on it (seriously).

Also he gives talks ( numerous) to the medical students on 'how to see through a drug rep's marketing' and 'drug reps and why they are evil'..

The only thing I really miss being able to prescribe is Tramadol for pain relief - but 60mg of Codine works nearly as well. We actually saved £1.6 million last year by not prescribing expensive stuff when cheaper stuff was available.

Anyway I got a formal job offer from South Africa this morning - so I'm probably off somewhere where I have even less resources, (whoohoo!) for less pay.

I didn't pass a PGCE ...

Have I been relocated into a parallel universe?

I won't get a chance to tidy up my notes before the weekend. I was thinking, while I was scribing, firstly that I quite liked the job and would be willing to do it again, and secondly that 1,000 posts is better - 2000 becomes unmanageable.

Anyway, I haven't made it past the first LED in this thread yet, and I've more than 400 unread posts from the last thread. Back anon.

Mol

That would be marvelous, if you could take on just the first 1000, Mol, and then pass them over via email at your leisure. Then, either someone else can take over, or I can do a reprise when I get time -- and the reprise will be far less work, with your help.

Z, congratulations!

Congratulation Z.

I Denmark doctors must prescribe the cheapest medicine as the first choice as a rule. If s/he prescribes something more expensive the chemist must ask you if you prefer the cheaper variation.

Our health insurance for medicine works this way: You each year pay the full price for meds for the first 500 DKK (approx 100 $), then the price decreases. In that way people who need a lot of medicine - daily doses - get the biggest discount along the passing of the year. It is digitally registered on our National Health Insurance card (all tax paid).

Visits at the GP and treatments in all the public hospitals are for free. Univesity hospitals are public. We have a few private hospital where you can also get treatment for free if the public hospitals are not able to treat you within a generally set time limit for different deseases.

Ooh, Z! Ooh! Ooh!

You do realise that you'll be HONOUR BOUND to keep in touch and tell us what you're up to, or we'll all be after you with sharp sticks, because going to SA just sounds so INTERESTING. More interesting than my visible future of endless dust, books and Nodnol. I don't know whether to be or 'there but for the grace of Bob...'

Sorry, I'm too tired to spell

Mol

Z, how wonderful! Congratulations, man!

Having read all I have about 'other' healthcare systems I would just like to say, thank the goddess for the NHS! My partner, who has MS is able to get all the meds he needs and I've never had to wait too long for a procedure to be carried out on my children.

Trust me - I don't think this job application was the sort that 'Congratulations' are in order for. I mean I want to go and it's great - but no one else wants this job.

Agapanthus - don't worry I'll be online, and blogging about my experiences. I'm looking forward to going - but scared as well!

Z, congratulations! You will definitely have to do as Ag says; we'll expect a semi-regular report, or we'll... hmmm, what will we do?

And, thank you for your explanation of the NHS meds system. Unfortunately, some doctors here will actually put "do not use generic" on the prescription -- all well for them to say, particularly if it's not on the formulary.

My doc did let us try the generics first, but I was always appalled at the number of reps she saw.

Oops, I swear that duct tape fell off all on it's own...

Z, while you may not be thrilled, look at it this way -- you're cutting your teeth on a tough assignment, and it's going to give you a leg up for Doctors Without Borders (which I supported for years, before I lost my job a few years back). Good bunch to get in with!