EpiPens, Election Health, and the Plight of Bagpipes

If you’re outside, you can’t escape the heat. If you’re online, you can’t escape election coverage. If you’re following me on Twitter you can’t escape opioid articles. And if you play the bagpipes, you can’t escape ridicule and fungus.

These are leftover thoughts, reheated and served just for you. Enjoy!

 

– The opioid epidemic has weighed on my mind lately. I wrote an editorial for JAAPA that attempts a fair and balanced look at the issue and a blog for NEJM group that takes a more pointed tone.

For a street-level look at a different angle, NPR’s Embedded podcast did a fantastic job covering a town in Indiana that has become ground zero for a new HIV outbreak. The occupants of a single house have taken to injecting Opana, an opioid pain medication. The drug’s manufacturer employed a “safety mechanism” to stop abusers from crushing and snorting the pills. This drove users to melt and inject the drug instead and—in a town of just 5,000 people– has produced 190 new HIV infections.

 

– We are once again outraged by the hyperinflation of a drug price, this time Mylan’s EpiPen. People imagine a child’s preventable death at the hands of greedy pharmaceutical companies and their anger is well-deserved and well-placed. But I can’t help but wonder if the magnitude of rage is dependent on the perceived victim.

There are some things, like self-injecting epinephrine, that one should not be denied because of cost. But a patient recently told me he stopped taking his HIV antiretrovirals because he lost insurance coverage. I wonder if we could ever find similar outrage for that.

 

– The wackiest election ever has finally intersected medicine as media outlets focus on the health of each candidate.

Examining the now-famous letter from Donald Trump’s personal physician, the Washington Post’s Aaron Blake shared some of reporter Philip Bump’s criticism of the letter’s peculiar word choices. Among other more bizarre phrases, they take issue with the use of the term “no history” of substance use. Maybe that letter was the first medical document either had read. The article also laments the exclusion of important medical details like “heart rate, respiratory rate.” Apparently voters should know if their candidate was tachypneic that one time. Or they could just watch a speech and count.

Celebrity doc Drew Pinksy (aka “Dr. Drew”) stepped into the line of fire by offering his take on Hillary Clinton’s publicized health information. In a radio interview he blasted “not just her health but her health care.” He pointed to a “1950-level” of medical care declaring, “Coumadin really isn’t used anymore.” Coumadin commanded 60% of the blood thinner market in 2015, more than all other anticoagulants combined.

 

–  USA Today’s Liz Szabo recently wrote the story of a musician who contracted pneumonitis from a fungus growing in his bagpipes. The case was first published in the journal Thorax. I have to hand it to Ms. Szabo for culling her information from proper peer-reviewed sources. But since she literally asked for it, I am happy to also give her some flack: that opening line was a brutal shot at the bagpiping community, Liz.

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