Era of Addictions

Marketing is a business tool to excite people and make them enthusiastic to buy. If the product or service we are selling is worthwhile for society and for people in general, marketing is a blessing. On the other hand, if what we are selling is of low quality, or harmful in some way to us, then marketing is a lie. We are addicted to being entertained and informed by advertising regardless of product virtue.

On top of this, it is alarming to many people including myself, that many businesses currently also use techniques and methods to make people physically addicted to what they are selling in order to continuously keep making money! It is clear to me that those businesses want to keep making money even if they know they may be hurting people’s physical and mental health. To me this amounts to a huge criminal activity. There is currently no law to stop businesses from doing this. For example, cigarettes, alcohol, even food are making many people sick and killing a huge number of them as well.

Currently there is also an epidemic of using narcotics even when they are not clinically indicated, and a big number of medical doctors just prescribe them, or even make a business out of it and many patients sell those narcotics to help them pay their bills.

In what I call the Era of Addictions addictive behaviour is not limited to clearly addictive substances like narcotics, alcohol and cigarettes, but to our modern music, our modern movies, our modern way of seeing relationships and sex, recreational and sports activity our food addictions are all around us. We view our lives through lenses like if it feels good to do and go to the max.

This is very alarming to me since it could become a way of self destruction for our society and human nature at large. We need to put limits on personal gratification.

Adolfo Cotter, MD

May 24/2013

The True Cost of the Business Oriented Practice of Medicine

As North America continues a multi-year struggle with an extended economic downturn, and tight budgets have become the new normal, this is impacting the provision of healthcare as well. The resources to diagnose, treat and take care of patients are becoming scarce. In consequence, this is seen as a business opportunity by some, helping develop a relatively new field (at least in Canada), which is the business of medicine.

I understand the need for this new field in order to improve the well being of our patients, but what I am currently seeing is that this model is being abused in many occasions to increase the income of business people, irregardless of the outcome and the quality of patient care.

In other words many medical businesses are pushing hard to increase their profit by doing activities such as: reducing the time to evaluate a patient to a number that is irealistic and makes impossible to truly deal with sick human beings, pushing techniques or treatments that might be harmful to patients, etc.

What may pass for cost-effective methods in providing healthcare on paper, and in turn providing healthy profits, may in fact have a negative impact on patient care in the real world, especially when we consider long-term outcomes on an individual and societal basis.

Adolfo Cotter, MD

Oct 16/2013

Research Bias is Increasing

As a society we have long been concerned about scientists working in industry or academia who may be influenced to write papers suited to satisfy the needs of the people financing the project. Many people I talk to are concerned that the current economic climate in western industrialized nations is aggravating this problem.

Furthermore, this funding bias is often compounded by personal bias, and this was well put in a published essay (Ioannidis, John P. A., PLoS Medicine 2005; 2(8): 696-701): “Prejudice may not necessarily have financial roots. Scientists in a given field may be prejudiced purely because of their belief in a scientific theory or commitment to their own findings.”

The problem I see is that in medicine it can be very difficult to filter erroneous research results. The only way in my opinion that we can trust the veracity of a research finding, is if the results are reproducible in other studies. Therefore, in a way, no matter how you look at it, research bias is a growing problem in the practice of medicine.

Adolfo Cotter, MD

Jan 26/2016

Politics and the Economy are Interfering with Medical Teams’ Delivery of Patient Care

Despite some positive economic metrics as of late, most people feel we have all seen better times, and this impacts the decision-making of individual medical care providers as they try and balance economic pressures with quality patient care.

During economic downturns it is common to see an increase in mental problems such as anxiety, depression, drug addiction, insomnia, low morale etc. These conditions are present in both patient and the medical teams that serve them. Even in the past when our economy has been better, there has been a history of political conflicts and disagreements within the medical care team. In my opinion, those conflicts are significantly higher presently since our current life stressors have been significantly higher as well.

Also, the amount of paperwork the medical care team needs to compete has been increasing significantly over the last few decades. This is distracting the focus away from patient care and consuming a lot of energy and time.

On top of this, economic pressures have made many people increase their desire to make profit as their only or most important goal when practicing medicine. In the end, our ONLY goal as a medical team should obviously be patient care. Patients are humans with illnesses who are suffering. They also tell us confidential information and they put their lives on our hands. They also pay us significant amounts of money for our work. Some doctors even call them clients, which I also think is certainly not a good term. It is alarming and shocking to me to see that the goal of many health care workers has shifted so much from our one and real goal, which is to focus on the patient’s well being, ONLY.

In my day-to-day encounters, and in what I read, it is very clear to me that all of the above issues are having a significant negative impact on the quality of medical care and the patient outcomes today.

Adolfo Cotter, MD

Mar 30/2016

Telemedicine Usefulness and Risks Considered

Worldwide, the practice of telemedicine has been growing very fast over the last decade. As with other service delivery models, a number of market factors have converged to influence this rapid growth – aging demographics and a related increase in chronic illnesses, technological developments and the pressure to deliver more cost effective services, to name a few.

In April, I attended the American Telemedicine Association, 2017 2.0 Telehealth Conference in Orlando. The exposition hall was quite large and the event well-attended, which is one measure of how far the industry has come. In discussion with other professionals I met, I learned that compared to previous meetings, the attendance, including exhibitors has been growing rapidly.

Further to this anecdotal exchange, resource material from the American Telemedicine Association mentions that while US and global markets have seen rapid growth, the market size statistics for telemedicine shows variability depending on the source.

From my vantage point as a medical doctor practicing in this emerging field, I do believe that telemedicine can improve patient care, but there are also risks. In this time of rapid change and growth, telemedicine should not completely replace the face-to-face practice of medicine, but we must recognize it as a value driven approach, appropriate to augmenting or filling the gaps and deficiencies of our current health care system.

By way of example, balancing prudence with practicality, I remember a mother that called me because her two-year-old daughter had been having shortness of breath and she was by automatic inclination requesting a steroid. I strongly suggested to the mother that she first take her daughter to the nearest children’s hospital. On the other hand, I also do believe that once assessed properly, conditions such as acute pharyngitis can be treated safely over the phone.

A solution for reaching those remote

The application of technology can allow a medical team to access patients in remote areas, diminish congestion of ER and Urgent Care centres, with conditions such as flu, urinary tract infections and sinus infections for example. Also due to the lack of availability of certain specialties in remote hospitals, practitioners will be able to access patients with telemedicine services.

Of course, one of the challenges of doing telemedicine remotely is that the patients must have technology at their location such as a computer and internet connection if they prefer to do video conferencing or transmit data.

In some cases, patients do not get a refill on their medications due to provider negligence or abuse, or other reasons such as inefficiency of pharmacies or insurance claim problems. Telemedicine should be able to facilitate or better still, fix these type of problems. I have had frequent instances where I ordered a medication for a patient by calling the pharmacy but the pharmacy kept saying that they didn’t receive any order.

Many times the insurance provider decided not to cover certain medical services or treatments. I have been continuously receiving increased notices from insurance companies that they will refuse to pay for certain medications

Cost effective, but not put patients at risk

As mentioned earlier, one key advantage of telemedicine is cost savings. Actually, some insurance companies will only cover patients for telemedicine services. In my experience, from practicing telemedicine in the USA, from a cost effective point of view, it is not always necessary to examine patients in order to diagnose or treat some conditions, such as acute otitis media or acute pharyngitis.

On top of this, with the use of technology, we should be able very soon to get signs of symptoms from a patient, which are the findings we get by doing the physical exam, in a way that could be more accurate and economical than with the traditional physical exam. This data could be quickly transmitted to a provider through a secured network, without the need for the doctor to be in person with the patient.

Yet there is high potential for abuse by using this service. Until we are certain that it is thoroughly safe to practice telemedicine, we should use a conservative approach, and only use this service for conditions where we do not put patients at risk. I think the biggest risk in using telemedicine is to assume that this new and rapidly emerging service works efficiently where we still do not have enough evidence for the conditions as presented by the patient.

Adolfo Cotter, MD


Helping Prevent a Society of Idiots

Throughout history the advance of technology has produced both positive and negative consequences. Technology can help us be more efficient and hopefully produce better quality work. On the other hand, more than ever before we are becoming dependent on helpful devices that are so intelligent, in some ways we are not using our brains enough. Actually I have noticed that currently very few people spend their time thinking, it’s just not fashionable anymore. The very fast development of technology is actually threatening our lives since most people do not truly understand it.

Headlines were made not too long ago, about how Neanderthals may have actually been more intelligent than us in many ways because survival of the mentally fittest had a more profound effect on natural selection at the time (WA Today, June 15th 2012)

In the modern era gyms were developed because we no longer have the time to physically exercise since most us spend our existence sitting in front of a desk. Likewise, brain gyms will have to be developed in order for people to exercise their minds, otherwise we will truly live in a society of idiots. Also, this will make people less prone to late life dementia, for example, which is causing a big burden to our society in many ways. We may be seeing this trend already!

Adolfo Cotter, MD

Jan 21/2013

Prescribing Creative Activities in the Treatment of Dementia

Creativity improves the overall sense of well being in patients with  Dementia. It helps them gain more meaning/purpose associated with their lives and makes them emotionally resilient. During the creative activity the whole brain seems to be working in unison, which should promote the formation of new synapses and neurons, including those related to memory.

Also, the activities are often done with groups of people which helps prevent isolation and depression. Dr. Dalia Gottlieb-Tanaka is doing work in this area, she is also the chair of the Society for the Arts in Dementia Care. Here is an interesting review of the topic:

 Hannemann, BT Creativity with Dementia Patients, Gerontology 2006, 52:59-65

 Adolfo Cotter, MD

Feb 03/2010

Computer Obsession

Although artificial intelligence and technology, in general, are very important human achievements, I think our society is obsessed with computers. How is it possible that some scientists believe that we can compare our brain to a computer? Why not comparing our brain to an airplane or a fancy car? 

We have to understand that we as human beings are limited in what we can create. Our understanding of the world is limited as well. I think it is very dangerous to compare ourselves to machines. We are much more complex than any technology available as I believe we also have a spirit.

Adolfo Cotter, MD

Nov 18/2008