ppp 10-23-2006

Quote of the day: Perseverance is more prevailing than violence; and many things which cannot be

overcome when they are together, yield themselves up when taken little by little.

Plutarch (46 AD - 120 AD)

Big Buns
A man went into Pitty Pat's Porch in Atlanta, a restaurant renown for its wild game. You can order lion, shark, pheasant, venison, water buffalo among many other items. A new waiter was feeling pretty cocky as he told a new patron about the vast choices and went on to bet the man $20 that he could produce anything he ordered from the kitchen. The patron racked his brain for something he could order that would put the upstart waiter in his place. "I'll have an elephant burger!", announced the customer as the waiter's face drained of color. A few minutes later the waiter returned to the table with a $20 bill to admit that he could not fill the request. "Ha…I knew you didn't have elephant!" proclaimed the man. The waiter said, "We have the elephant…. we ran out of big buns".
How do you eat an elephant burger? One bite at a time. If you have a huge task ahead of you then often it is best to break it down into smaller components or smaller bites. A big presentation? Outline it, research the unknown, rough draft, edit, graphics, final draft, and practice. For life changes the same holds true. Alcoholics Anonymous don't have one step to cure but 12 steps to recovery. I just celebrated my 32nd anniversary. I was asked how I stayed married for 32 years. My answer? … love her one day at a time. If my goal is to be married for 70 years then I'm not quite halfway yet. Whatever your goal, problem or task, break it down into smaller bites…. you never know when a shipment of big buns will arrive.

ps. Best answer this week to the question "How are you?" was "Fantasticl" clerk at the super (fantastic) market.

pps. Occasionally, some of the links require FREE registration.... I'm sure you can handle THAT slight inconvenience.

FDA approved Januvia (sitagliptin) for use against type 2 (AKA adult onset) diabetes in addition to (you guessed it) diet and exercise. It may be added to other oral antidiabetic drugs or used as a single agent. I wonder if the drug company will wait until the first of January to launch it (Jan- January plus nuvia-novo-new)……{just a thought}.

Two negative articles about a drug in major journals dropped the use of one drug from 16.6% to 5.6% in 10 months. It appears that doctors are reading and that they are quick to eliminated drugs that they perceive to be risky. They are slower to adopt new drugs or practices even with more and better data. I think that they feel that they are more likely to be sued for using a drug show to have higher risks that failure to use new drugs … before all is know about them.

FDA eyes user fees on generic drugs as a way to increase revenue. With fewer new drug entities coming to market their source of money is slowing. As the clamour for more generics increases and generic approvals accelerate they need to fund the resources necessary to meet demands.

After last weeks article about Medco's program for generics Wal-Mart rolls out their existing program to more states.

… but then again…. younger patients are usually healthier and take fewer drugs. Insulin, warfarin and amoxicillin were the top culprits. (one time I found that my father was taking two prescriptions together "Coumadin for my heart" and "Warfarin to thin my blood"…. no one bothered to tell him that they were the same thing and he was doubling his intake and risk of adverse consequences.

It appears that atypical antipsychotic drugs do not help patients with Alzheimer's any better than placeobo (although placebo had fewer unacceptable side effects). This calls into question the use of these expensive drugs to treat psychosis, aggression, and agitation. Haldol and lorazepam may be best afterall.

Perported to be easier and faster than last year. Click the link and try for yourselves. (Or have you patients do it!)

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