tinkll1 (tinkll1) wrote,

Phosphate Binder Wars - Opening Salvo!

Well, I've gotten myself into more trouble by trying to use my medical judgment in the selection of phosphorus binders for beneficiaries of Orange County's version of the California version of Medicaid which is called MediCal throughout the state, and CalOptima in Orange County. As the readers of my blog are not nephroogists, and almost no one is a physician, the no one being mycroftca I realize that the technicalities of health care are beyond the interests of most. Yet the basis for my request is very nicely explained in a single diagram. And here it is:
Survival at 5 years
All one has to do is to look out at the 60 month five year point and observe that 50% of the calcium containing binder users are alive, and 75% of the non-calcium containing binder users are alive. A 25% difference at 5 years! That convinces me, and a lot of other nephrologists, in a lot of peer reviewed journals, but not the pharmacologist at CalOptima.

So, my friends, I will use the "Fair Hearing" provision to appeal each and every denial, and because the patients can't speak English, the State will provide a translator, and because I think that this is a poverty law issue, I will try to get a poverty law attorney to help to fight the battle. I have better things to do with my time, but I will quote from an article in a peer-reviewed journal, the Journal of the American Society of Nephrology, of which I am a charter member (~1967), by Dr. David A. Bushinsky, Department of Medicine, University of Rochester School of Medicine, Nephrology Division,

"......In patients with chronic kidney disease, an important therapeutic goal should be normalization of serum phosphorus, and it probably is better to lower phosphorus using whichever binder the patient can afford. However, if cost can be tolerated or mitigated through insurance or other programs, then the use of a non–calcium-containing binder, especially sevelamer as it was used in the prospective studies (15,16), seems preferable. Although some have argued that the costs to society should limit the use of potentially beneficial mediations, few missions should be more important to a nation than the health of its less fortunate citizens. Physicians take an oath to provide optimal care to patients, not to help balance budgets.

Physicians must act, before they have the benefit of the well-designed clinical studies that show a reduction in mortality, in ways they reasonably determine is in their patients’ best interests. The adage is to "first, do no harm;" in this case, normalizing serum phosphorus in dialysis patients without adding calcium seems most prudent...."

I will also continue to try to minimize the expenditure of valuable resources on hearings and lawyers, etc., but I see this as a defense of the profession that I have been committed to, since 1958. Please tell me if you see this differently.
Tags: health care, medicine as a profession, phosphate binder wars, rants
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