Zulfiqar Rana, MD, MPH, FACP

Board Certified in Internal Medicine

The Weekend Effect

These physicians, who treat patients outside the emergency room, are seeking to reverse the “weekend effect,” or higher rates of death and complications.IH_NyyyY59M


Soaring Health Costs Pinned On Medical Devices

The latest devices – from heart valves and defibrillators to artificial knees and hips – are usually significantly more expensive than older devices, and the intense marketing surrounding the introduction of new devices has become a major driver of rising health care costs.bengTWZgcL8


Study: Many Employers Will Cut Back On Health Plans

A report by McKinsey & Co. concluded that at least 30 percent of employers will stop offering health insurance in 2014. The projection is based on a survey of more than 1,300 businesses of various sizes and industries.ELLNvDgpO-g


AP MOBILE: Study: Link of virus chronic fatigue false alarm

The cause still remains elusive!

From AP:

Study: Link of virus chronic fatigue false alarm

Freedom’s Just Another Word for Restriction?

What tools does a university administration have at its disposal to shut up critics on its own faculty? The University of Minnesota wants to know.

The university’s administration is exploring this question because its own Carl Elliott won’t shut up about the Markingson case. Elliott, a professor in the Center for Bioethics, just keeps talking about what went wrong at his medical school in a 2003 industry-sponsored drug trial in which research subject Dan Markingson killed himself. Since publication of a muckraking article on the subject in Mother Jones, Elliott has criticized the FDA’s response to the case and led a group of faculty in asking the University Trustees to look into the case.

Like many others who continue to follow this story, Elliott is drawn to this case by issues of justice both local and global. Locally, he seeks accountability for what happened to Dan Markingson and to his mother, who tried repeatedly before Dan’s gruesome suicide to convince involved clinicians that study participation went against Dan’s best interests…


Should We Treat Depression with drugs or psychological interventions?

We reply to the Ioannidis’s paper “Effectiveness of antidepressants; an evidence based myth constructed from a thousand controlled trials.” We disagree that antidepressants have no greater efficacy than placebo. We present the efficacy from hundreds of trials in terms of the percentage of patients with a substantial clinical response (a 50% improvement or more symptomatic reduction). This meta-analysis finds that 42-70% of depressed patients improve with drug and 21%-39% improve with placebo. The response benefit of antidepressant treatment is 33%-11% greater than placebo. Ioannidis argues that it would be vanishingly smaller because systematic biasing in these clinical trials would reduce the drug-placebo difference to zero. Ioannidis’ argument that antidepressants have no benefit is eroded by his failures of logic because he does not present any evidence that there are a large number of studies where placebo is substantially more effective than drug. (To reduce to zero, one would also have to show that some of the unpublished studies find placebo better than drug and have substantial systematic or methodological bias). We also present the empirical evidence showing that these methodological concerns generally have the opposite effect of what Ioannidis argues, supporting our contention that the measured efficacy of antidepressants likely underestimates true efficacy.Our most important criticism is Ioannidis’ basic underlying argument that if the existing evidence is imperfect and methods can be criticized, that this proves that there proves is antidepressant are not efficacious. He presents no credible evidence that antidepressants have zero effect size.We find no empirical or ethical reason why psychiatrists should not try to help depressed patients with drugs and/or with psychotherapeutic/ behavioral treatments given evidence of efficacy even though our treatment knowledge has limitations. The immense suffering of patients with major depression leads to ethical, moral, professional and legal obligations to treat patients with the best available tools at our disposal, while diligently and actively monitoring for adverse effects and actively revising treatment components as necessary.


Insurers Clash With Health Providers As States Expand Medicaid Managed Care

Many states are trying to restrain Medicaid spending by putting more people into managed care plans, but with billions of dollars at stake, insurers and health providers are lobbying hard for their interests.HeyQbKe3NLE


Access To Docs’ Prescribing Data

In this case, the state of Vermont opposes drug companies and data-mining firms. Vermont’s law bans the sale of prescribing information unless physicians “opt in” and make their records available. Meanwhile, Politico Pro reports that the AMA, which has not taken an official position in the case, has a lot at stake in how the it turns out.4jpF81JRm0w


The Pill Mills

The federal government on Tuesday announced its first-ever comprehensive strategy to combat the abuse of oxycodone and other opioids, aiming to cut misuse by 15 percent in five years. That goal may sound modest, but it would represent a dramatic turnaround: Emergency room visits from prescription drug overdoses doubled from 2004 to 2009, when they topped 1.2 million, according to federal health officials…

US aims at its deadliest drug problem: painkillers

A New Biomarker for Bacterial Meningitis

Patients with early bacterial meningitis might not have CSF pleocytosis. Heparin-binding protein is a promising new biomarker that might assist with early identification of bacterial meningitis in adults. HBP might play the same role in bacterial meningitis that D-dimer does in venous thromboembolic disease. Pending larger studies, an HBP level >20 ng/mL should prompt empirical therapy for bacterial meningitis while awaiting results of CSF culture and immunoassays.

Heparin-Binding Protein: A New Biomarker for Bacterial Meningitis – Emergency Medicine.