The questions and lingering concerns surrounding the overuse of antibiotics is an age-old and well-worn conundrum for physicians and patients. Even the latter group, well-informed as consumers of healthcare, can agree that most acute upper respiratory infections are most often the result of viral infestations which play themselves out in spite of antimicrobial treatment.The decision to (over)use them in standard medical practice is often the point of debate, as physicians weigh factors such as patient satisfaction and lingering medical and health policy issues surrounding resistance.

Last year, this blog reported on these issues as background for a program in which some retail pharmacy chains were giving away for free antibiotics to patients with prescriptions from their physicians as a way of helping with affordability in the wake of the debate on reform. The CDC offered a statement promoting the responsibilities providers, pharmacists, and patients should consider in taking part in such a program.

Smaller chain pharmacies are trying to compete with the big boys, and in trying to earn store-brand loyalty among their (un- and underinsured) consumers, they are throwing free antiobiotics their way. Last week, the CDC sent out letters those several chain pharmacies that offer no-cost prescription antibiotics to low-income consumers urging them to promote responsible use of antibiotics.

While the program was essentially successful in its efforts to bridge the gap between affordable, accessible healthcare and patient responsibility, no one was really prepared for the massive policy decisions that would have to be made as the June ‘09 H1N1 pandemic loomed — after its initial discovery just one month after this initial Doctor Pundit posting.

I am not aware of the AMA ever taking a stance that is this prudent, ever. Just today the body approved a resolution to formally call for the repeal of the US military’s “Don’t Ask, Don’t Tell” (DADT) policy, which does not allow gays and lesbians to serve openly. Recognizing the difficulty with which closeted soldiers must contend when divulging potentially damaging personal information in a supposedly confidential environment and the impact of this suppressive atmosphere on their physical and emotional health, the AMA wisely takes the approach for the repeal of DADT while framing it from a preventive health perspective. Timely? Yes. Smart? Yes. Overtly political? No. Perceived as being overtly political? More than likely. | LINK via top LGBT blog Pam’s House Blend

The Centers for Medicare & Medicaid Services has just announced a change in the scheme of its coverage of bariatric surgery as a treatment for type II diabetes in morbidly obese persons. Nothing more than the most anecdotal evidence exists in the medical literature about the feasibilty of such a procedure in retarding the effects of diabetes in those who remain obese — which makes this decision by CMS somewhat circumspect.

Although the government agency is restricting coverage to those with certain criteria (BMI cutoffs) who have the procedure done in CMS-certified facilities, the effect of this provision on the quality of treatment for both highly prevalent conditions is anyone’s guess — without certain randomized clinical trials to absolutely document the procedure’s safety and efficacy (not to mention cost neutrality) with respect to overall healthcare delivery and prevention in this patient population. | LINK

Conventional widsom always posited that the farther you went in your formal schooling or generally kept your mind sharp during graceful aging, you stood a pretty good chance of maintaining sound cognitive functioning in those Golden Years. Okay. But what to make of new data in the journal Neurology? Suggesting that doctors have to watch all patients closely for signs of mental deterioration, a study of 6500 people in Chicago, found no link between a person’s educational level and their rate of decline to Alzheimer’s and other forms of dementia. While it is unlikely that this bit of fresh information will cause geriatricians and primary care practitioners completely to abandon previously established anecdote, the results of this trial do place the importance of sound preventive medicine as a reimbursible healthcare intervention. Hear that, policymakers? | LINK

The attention this country, health systems, third parties, and the current presidential administration should be focusing on primary care is happening  – in Africa. A nursing professor at the University of Wisconsin-Milwaukee who grew up in Liberia, recently published a book focused on improving health care delivery in war-torn African countries. He based the title of his work on what he sees as the best hope for health care improvement in Africa – the resilience of African peoples in the face of horrendous violence and painful loss. He sees the ideals of prevention and a strong primary care ethic as the path for the much needed improvement in delivery. Empowering Resilience: Improving Health Care Delivery in War-Impacted African Countries describes his plans as they apply to his Liberian homeland, but those descriptions could apply to all corners of the world’s second largest continent. | LINK

• Medicaid needs are placing a huge financial strain on individual states.

Here in Gwinnett County, an Atlanta suburb that is home to a growing immigrant population, Medicaid enrollment ballooned by 26 percent from July 2007 to July 2008, according to state officials. One day last fall, the waiting area in the office of the county’s Department of Family and Children Services was so packed with applicants that the fire marshal insisted that another room be opened for overflow.

“There’s just been a steady increase in the numbers, and it has followed the economy,” said Glenda G. McMillan, the regional director over the Gwinnett County office. “And there’s no one population. We’re seeing the newly unemployed, the underemployed. There’s just an array of need out there.”

• Report: The FDA may be ineffective in adequately protecting the health of the public.
• WSJ Blog: Where should money to enhance primary care come from?
• What’s Kentucky now famous for? Why, it leads the nation in death rates attributable to smoking.
• In case you haven’t heard, there’s an influenza vaccine surplus. Take advantage.

It’s the classic chicken-and-egg argument. What’s responsible for the recent rise in certain sexually transmitted infections (STI)?  According to the CDC, the rate of new infections from the atypical pathogen Chlamydia set a new record with 1.1 million new cases in 2007. Together, with frequent comorbid agent, N. gonorrhea, the number of new infections topped 1.5 million in that time frame.  Better testing techniques lead to accurate and timely reports to state health departments, without a doubt. But one has to wonder, are we doing enough to drive home the message of safe sexual methods to prevent these rates of STIs? | LINK