The Geezer’s 2016 Year In Review: Just You Wait!

We’re getting closer to the new year and it looks like we have to be patient and wait to see how a lot of things are going to turn out in 2017. Have you had a look at the Clozapine REMS Program website? Remember that promise or threat that patients would not get clozapine if prescribers and pharmacies are not duly registered? That was supposed to have happened by now but it looks like it’s being postponed. As they say, “The full launch for the Clozapine Risk Evaluation and Mitigation Strategy (REMS) will not be implemented in 2016.”

Guess we’ll just have to wait and see how that shakes out. I wonder if this is because of the potential for the program to have an even worse image problem than it already has if it tries to levy the ultimate penalty of denying access to the only psychopharmacologic recourse for those with treatment-resistant schizophrenia.

This is a good time to recommend a recently published paper about how to manage clozapine-induced neutropenia. I’m including the tweet here because I think this is important enough to not worry about the payload predicament from Webroot’s Web Shield Filtering Extension available to, or maybe it’s better to say “imposed upon,” Google Chrome users. That is to say, if Webroot brands Current Psychiatry with the label “These are suspicious sites. There is a higher than average probability that the user will be exposed to malicious links or payloads,” the user might consider disabling the extension rather than deleting the link.

I think this is the way the vast majority of “prescribers” ought to stay on top of the latest treatment guidelines, rather than relying on the Clozapine REMS Program. Just a few highlights:

  • There’s a lack of evidence for using long-term granulocyte-colony stimulating factor, such as filgrastim for severe neutropenia; short-term treatment is recommended.
  • There could be a risk of lithium masking early neutropenia; it may not be protective.
  • There’s increased risk for repeat neutropenia on rechallenge.

Along the lines of the best ways for physicians to put the principle of lifelong learning in every day practice–it’s probably safe to assume that Maintenance of Certification (MOC) is not the best option for everyone, or even most doctors. According to a recent message from Dr. Paul Teirstein, MD, at the National Board of Physicians And Surgeons (NBPAS),

In a recent physician survey performed by the Mayo Clinic, only 14.8 % of respondents agreed with the phrase “MOC is worth the time and effort required of me.” This number dropped to 6.4% when those who only “slightly agree” were removed (2). Importantly, there is an appearance of a financial motivation underlying all the new MOC requirements. In 2013, even before MOC was required, the publicly available ABIM Form 990 shows revenues of $30M from initial certification and $24M from recertification. Now that MOC is required, these revenues will dramatically increase. Participating in MOC may improve test scores and increase revenue to ABMS member boards, but there is no evidence it improves quality of care.

What can we expect from the ABMS in 2017? It’s impossible to know with certainty, although Dr. Lois Nora, MD, current President and CEO of ABMS will be retiring from that position. I wish her well. I also wish physicians could elect their board leaders by popular vote. Could that change? We’ll just have to wait and see.

Now that I’ve mentioned voting, I’ll mention this once–we have a President-Elect; his name is Donald Trump, and one quote that probably fits has been attributed to Carl Jung: “We cannot change anything until we accept it.” Let’s hope for the best and move on.

Will Neurology ever truly merge with Psychiatry to create Neuroscience Medicine, Neuropsychiatry, Encephiatrics, Encephalopathology, or Ergasiology? Probably. Will Psychosomatic Medicine be replaced by “Consultation-Liaison Psychiatry”? Don’t ask me. Wait and see.

What will happen at next year’s UIHC Psychiatry Department Faculty vs Residents Matball Challenge? Only time will tell–but you can’t beat us twice and get away with it! You just wait.

A few months ago we got a new desktop computer for upstairs in addition to the one downstairs. I had to unhook everything to move the older one downstairs and assemble the new one upstairs. Suddently the speakers in both computers seemed to go bad. Everything sounded like it was it coming from an enormous cavern or cathedral, and “echoey” was the word everybody on line used for it. I chased the problem down all over the web. It was legendary and had been a topic of on line discussion groups over the last decade off and on. It occurred in every model of every brand and in every operating system. Macs were not immune.

Solutions ranged from the usual checking if the speakers were plugged in to monkeying around with the System Registry Key settings. Were aliens involved? Every day for a couple of months, my wife, Sena, pointed out how terrible the speakers sounded and insisted that we find a way to correct the problem. Predictably, I addressed the issue promptly and decisively by suggesting the difficulty might be that her hearing was much more sensitive than mine because I had ruined my auditory acuity by attending a Rare Earth concert back in the day when Rare Earth was huge–and loud.

Finally I called tech support. Was it a hardware problem? Was it a software issue? Was it a conspiracy by Microsoft? Was the Adobe Flash Player possessed by demons? No. I had failed to plug the speaker jacks into the right ports on the back of both towers. There has to be an Award for Least Tech Savvy Person On Planet Earth. Will I win it again in 2017? I’ll have to wait and see but–probably.

Will my wife and I be able to stay awake on New Year’s Eve and ring in 2017? I doubt it but wait and see. Have a Happy New Year!

snoopy-and-gnome-old

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Comments

  1. Happy New Year Jim!

    George

    Liked by 1 person

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