November 11, 2010

Pharmacies Becoming Sources for Medical Care?

Normally I will not post the same blog to both of my blogs.  I feel this topic needs the exposure so that people can determine for themselves where they want to be on this issue. 

Is this what we want or what we need? I have to wonder if this will be a good thing for people with chronic diseases. I am not sure I want my medical care retailized or taken care out of a storefront. But this is the latest desire from Walgreens – to become your one-stop health care facility.

Walgreens and other large retail pharmacies are lobbying to make this a fact of life. I do not want to have nurse practitioners in charge of my medical health care. I am thankful that in some of the more remote areas or largely rural areas in the United States, nurse practitioners have been needed to get medical care to people and have done excellent work. This has been a necessity because of the lack of doctors in these areas. But for a retail store like Walgreens in non-rural area, this runs against my better nature.

Walgreens is wanting to do this because of the “national shortage of primary care doctors”. They are proposing to “assist patients in managing chronic conditions of diabetes, hypertension, and high cholesterol”.

We have to wonder if we are going to be prescribed extra drugs or medications as a result. Is the American Medical Association going to allow this to happen? Are the states going to allow this to happen? It is happening in some states that have nurse practitioners, but I hope that this does not come to pass in our more populated states.

Many pharmacies are now giving blood screening, flu shots, and other medical advice mainly under the supervision of pharmacists. This is not always the best for many patients as they do not check any medical records to verify allergies and other medical conditions which might preclude some treatments.

What many are banking on is the new health care act providing insurance to people and they want to cash in on the potential increase of cash. And Walgreens is not bashful about saying this.

Before I would want to utilize pharmacies (or what name they will change to), I would want to know who is responsible for writing the prescriptions and whether they have met the education requirements necessary to be able to write prescriptions. Are the pharmacies going to require filling the prescriptions in their store or can these prescriptions be filled at any pharmacy?

These are just some of the questions that need to be answered before I would accept pharmacies taking over primary medical care. Will pharmacies be required to have doctors available to consult or oversee and supervise prescriptions with appropriate approvals available for states to audit? Will this action create or necessitate more state agencies to oversee questionable medical decisions and audit procedures? Will this just increase medical fraud, Medicare, Medicaid, and other fraudulent practices.

And with the shortage of nurses that exists today, where will all of the nurse practitioners come from? Or will they come from our hospitals and doctors offices thus creating a more critical shortage there?

Before this becomes practice, I would hope that our federal and state legislators will examine this very carefully. The last question I would want answered or information made available to the public is the political contributions made in the last election and to whom were they made.

November 9, 2010

The Types of Diabetes

This subject is unusual for me and yet it has an appeal as I have a friend with a child which fits this very well. He has already been talked to about this and sent several emails. He notified me that he is having his infant son tested this week. After reading the background for this blog, he started checking where to have his son tested.

First I would like to set some terms which are new to me. We are all familiar with Type 1 and Type 2. The term used for these, polygenic, comes from the fact that they develop from multiple genes. The other term, used for the more rare types of diabetes is monogenic. These develop from mutations of a single gene.

This defines the types into two distinct classes. Monogenic diabetes forms comprise two to three percent of all diabetes in young people. This is either inherited for some and others have the gene mutation develop basically overnight. Both sides reduce the ability of the body to produce insulin. This is the area of greatest confusion for the medical professionals as they diagnose Type 1, when it is not.

The different types of monogenic diabetes include permanent neonatal diabetes (PND), transient neonatal diabetes (TND), and maturity onset diabetes of the young (MODY). These are the main forms and some may not respond to treatment and some are mild and should not be treated – a complete surprise. The newborn children and children generally under the age of seven months are likely to have PND or TND. MODY then normally is found in children and adolescents, but may be mild. Therefore it may not be detected until they are adults.

This is the reason I urge that all children be properly tested to determine what type of diabetes they have. I suspect that many that are diagnosed with Type 1 may not in fact have Type 1, but one of the monogenic types. If they truly have Type 1, then you will know for sure by full testing, and genetic testing is the only way to know positively.

Some monogenic forms may be treated with oral medications while others will require insulin, and still others are mild and require very little treatment. This is why I urge testing rather than relying on a doctors diagnosis if Type 1. Definitely consider testing for monogenic diabetes if you or members of your family meet the following criteria:
diagnoses with diabetes under seven months, familial diabetes in the immediate family, mild hyperglycemia, and other pancreatic features.

Testing for monogenic diabetes are often simple and inexpensive and at the time of diagnosis are not typically done. Many doctors are not even aware of the tests. Am I? No; however, two of the tests are listed here. The list of all tests is apparently are not available to non-medical people. The tests should also make management of blood glucose easier and treatment more reliable plus better long-term health.

To repeat, NDM generally occurs in the first six months of life and only one in 100,000 to 500,000 infants. NDM is often mistaken for Type 1, but Type 1 diabetes normally occurs later after the first six months. In about half of those with NDM, the condition becomes permanent. In the other half, NDM is short lived or transient and disappears during early childhood; however, it can reoccur later in life. NDM can be identified to specific genes.

There is a point that is often overlooked with NDM. NDM can also affect the unborn. They do not grow well in the womb and are born much smaller in weight. If caught early by knowledgeable doctors, and given appropriate therapy, they can often be normalized in growth and development.

The other monogenic, MODY, usually develops during during early adolescence or adulthood. It can often be missed until later in life. MODY accounts for one to five percent of all cases of diabetes in the United States. If a parent has MODY, the children are at a greater risk for developing MODY. Each child of a parent with MODY will have a 50 percent risk.

There are several types of MODY because there are a number of gene mutations that cause MODY. It is often confused for Type 1 or Type 2 as the people a seldom overweight and do not have other risks. People with MODY can be treated with oral diabetes medications, but treatment varies with the genetic mutation causing MODY.

Commercial genetic testing for NDM and MODY is now available. See this reference for one company. The Kovler Diabetes Center at the University of Chicago offers help to parents and offers many other services related to NMD and MODY. Check out their web site here. Also check out monogenic diabetes dot org. There is a lot of good information available.

The article that got me started is this one. Continue reading the next article listed at the bottom of each section. Some of this is repeated from the monogenic diabetes dot org.