and only care about profits. This is more proof of that.
Doctors = legalized crack dealers
You wouldn't say most patients then are "legalized crackheads", would you? So why then, since most doctors don't give pain medicine to make money (see below) like a crack dealer, nor do doctors give pain medications because they know a large portion (most don't) will become addicts like crack dealers, would you say that about doctors?
There is also a bit of cultural shift - some of it driven by the pharmaceutical industry pushing "pain free" and away from the thought process of our grandparents that some aches and pains were just associated with "growing old". I see many elderly patients with "plain" old osteoarthritis because they tell their docs their knees hurt or hips hurt. Some of it driven by the 5th vital since, Joint Commission, and your doctors "patient satisfaction survey" (HCAHPS):
(1) Did you need medicine for pain?
(2) How often was your pain well-controlled?
(3) How often did the hospital staff do everything they could to help with your pain?
It's a perverse goal. I probably can get your pain to zero. You might end up a drooling heap of drowsiness, but it will be an incoherent zero when I ask what your pain score is....This perverse goal has incentivized over treatment and allowed for much abuse by a small number of patients, some of whom are abusing the system for profit or to get high, and by those with, essentially unrealistic expectations - for some people pain is not zero even when they are in a drooling heap of slumber. Any docs will tell you stories of patients admitted for "pain crisis" who are seriously sawing some logs, dead asleep, literally need to be shaken to be awoken and when asked will still claim their pain score is 10/10 or, even better 20/10 or 50/10...... *sigh*
Most of us come to work everyday to alleviate some suffering and misery. Cure, treat or ameliorate disease. There is no nefarious conspiracy to turn people into addicts. Here are the real factors....and this is by no means an exhaustive list
Full disclosure, I am a critical care physician (4 yrs college, 4yrs med school, 3 yrs IM residency, 3 years critical care)
How much do you think the average doctor gets for prescribing an opioid? Doctors aren't pharmacies. Doctors aren't pharmaceutical companies. Doctors aren't insurance companies.
This is a really rough estimate......
Look long and hard look at this reimbursement schedule (also look at how poorly Medicaid pays). Pay attention to these 2:
Office Visit, Initial, New Patient Level 2 - $75 for ~20 minutes
Offiice Visit, Established Patient Level 2 - $45 or ~20 minutes
So 3 patients/hour x 8 hours//day
Lets say half the patients you see are these types of visits, and of those, half are a mix of new and establishes (never is, most are established) 1.5 patients/hour x 8 hours = 12 patients daily
6 will be established 6*75= $450
6 will be new. 6*45= $270
The other 12 patients? Maybe you can see 12 really sick (6 established, 6 new)
6 * 200 = $1200
6 * 150 = $900
Hopefully your day would be filled with more complex patients, but it doesn't really matter. A new "complex" patient that you spend 60 minutes with will get you $200 reimbursement. So this person, for internal medicine, who went to college for 4 years, medical school for 4 years, then 3 years for residency is getting patient by Medicare (and likely your insurance company) $200 to spend an hour with you. Unless you like in rural America, you probably wont get a lawyer to sit with you for that price (I put that link in there because I did all my training at the #1 hospital in the US, but docs aren't reimbursed like that) for an hour.
So a really good day you can make $2820. Or about $700,000 revenue
For me, I do critical care. I bill a "99291" code for spending up to 74 minutes bringing your nearly dead loved one pack to life. The reimbursement is $239. Really? It is pretty much the same amount as sitting and talking to your elderly loved on who has 4 or 5 outpatient medical problems.
The dirty secret in medicine is right now if you want to make money as a doctor you need to specialize and do procedures. Even with volume, the numbers still add up 1 60 minute visit gets you the same reimbursement as 3 20 minute visits. That is the only way to "make money" in the ways that are often thought about in the sense of doctors make money.
If anything I hope this shows you that after 11+ (minimum) years of training, doctors are definitely not overcompensated and if anything you can make the argument that compared to other, essentially lesser trainer specialities (lawyer, engineers etc...) their "hourly" rate is undervalued. That is not even taking into account that most doctors are graduating with $200,000 or $300,000 of student loan debt.
Part of the problem with TRT is the definition of low tester one is somewhat nebulous. I am not sure there has been a lab range accepted age-adjusted testosterone levels. Typically the most commonly accepted medical reason is when a man comes in with a non-typical fracture (hip, vertebral body etc...) then we tend to look at testosterone levels.
Other than that...indications for use are sketchy.
In addition, anyone who has been around and doesn't have an agenda or bias would be wise to remember the fiasco with ERT in women. Made them feel good, but ended up being more harm than benefit. It is likely, outside of a few indications, that TRT will end up being the same.
Pooled effects showed that vitamin B supplementation (including B6, B8 and B12) reduced psychiatric symptoms significantly more than control conditions [g = 0.508, 95% confidence interval (CI) 0.01–1.01, p = 0.047, I2 = 72.3%]. Similar effects were observed among vitamin B RCTs which used intention-to-treat analyses (g = 0.734, 95% CI 0.00–1.49, p = 0.051).
The confidence interval indicates the level of uncertainty around the measure of effect (precision of the effect estimate). Confidence intervals are used because a study recruits only a small sample of the overall population so by having an upper and lower confidence limit we can infer that the true population effect lies between these two points. Most studies report the 95% confidence interval (95%CI). If the confidence interval crosses 1 that implies there is no difference between arms of the study. As far as I can remember.
Well, that is one very cynical view. Of course they might have reasons that benefit users. The fact that they offer an adapter rather dispels this theory. Get good Bluetooth headphones and you won't want to go back. Hint: x.
Not only offer but include it in the box for "free". Apple has been known to pull of some "interesting" things with adapters before like, you need an adapter, buy it. In this case, I was pretty surprised (pleasantly) that they include the adapter.
I had the honor and privilege of meeting Dr. Zewail and attending a private lecture while at university. His daughter was my upper division biochemistry professor and he was kind enough to drop in and give us a lecture while he was visiting. He was a brilliant thinker not just in the world of femto-spectroscopy, but overall. He was approachable and witty. He will be missed as a father, a fellow human and for his contributions to the scientific world.
If you can't get your work done in the first 24 hours, work nights.