Losing weight does not improve health. Really? Yes. Losing weight via GLP-1 receptor agonist drugs will improve your BMI (Body Mass Index), but it may not improve your health or make you live longer! Many experts feel BMI is a “flawed health metric.” It does not correlate with state of health, even for people with diabetes of cardiovascular disease. People are obsessed with appearance and being overweight, if not frankly obese, carries a negative social stigma. People who believe “thin is in” don’t want that stigma applied to them so weight loss by any means is imperative. Folks who have larger bodies are often “marginalized.” “We must empathize with patients experiencing weight-based marginalization….and work with patients toward an…approach that respects their bodily autonomy and recognizes their societal discord and experiences living in a larger body. Prescribing GLP-1 agonists may be appropriate for these patients.” They may not be better medically, but they will certainly benefit from the perception of improved health through weight loss.
Reference: Rao M, Shaughnessy A, Sokol R. Prescribing GLP-1 agonists for weight loss: Wrestling with our philosophical angst. Am Fam Phys 2024 October;110(4):340-341.
Antibiotic-induced diarrhea now has a preventive vaccine: Clostridioides difficile is the leading cause of diarrhea acquired in a healthcare setting. It is a bacterium acquired, or selectively developed, as a response to the overuse of antibiotics. These powerful anti-microbials kill all normal bacteria (the good guys) in the intestinal tract and allow, and actually propagate, the emergence of resistant forms of bacteria. C. difficile is one such organism. It causes chronic, severe diarrhea and is hard to eradicate. Other antibiotics are used to treat C. difficile and this sometimes initiates vicious cycle. Thus preventive vaccines have been developed.
Testing was done in mice. They were vaccinated with bivalent and trivalent vaccines then given a toxin dose five times higher than the 100% lethal dose. All vaccinated mice survived. Even unvaccinated mice who were given the serum of vaccinated mice, survived the toxic exposure.
This is good news for infectious disease physicians. They treat severely ill patients with multiple-drug regimens that are very prone to “select” out Clostridiodes difficile. The treatment results in another difficult problem. Having a preventive vaccine that works saves patients a lot of trouble, anguish, and unpleasant symptoms.
It is FDA approved and goes by the trade name VOWST. It is indicated for patients 18 years and older to prevent a recurrence of Clostridiodes difficile. It is an oral vaccine given 1-3 days after completion of a course of antibiotics. Four capsules once a day for 3 days is the recommended dose.
Dr. G’s Opinion: This is great news for gastroenterologists, infectious disease physicians, and for any patient with C. difficile. It’s an mRNA vaccine which actually sounds more like a treatment than a preventive vaccine. Whatever, if it works, that’s a wonderful thing.
Reference: Riboldi E. New mRNA Vaccine May Shield Against C. difficile Infections. Medscape Medical News 2024 October 29th.
Tuberculosis Returns: Worldwide, low-and middle-income countries have seen a huge resurgence of Pulmonary Tuberculosis. In fact, 98% of cases recorded by the World Health Organization (WHO) are from 2nd and 3rd world countries. TB has replaced COVID-19 as the world’s number one infectious disease-related cause of death. Once thought to be nearly eradicated, tuberculosis has crept back into public consciousness despite effective treatments. But drug resistant forms of TB bacteria have developed and caused angst for the WHO. Hopefully, WHO experts will effect another solution to the current problem.
Reference: Reuters. Tuberculosis returns as Top Infectious Disease Killer, WHO says. Reuters
Health Information 2024 October 29.
Medicare cuts physician reimbursement for the umpteenth year in a row: The Center for Medicare and Medicaid Services (CMS) has once again reduced physician payment for 2025. Next year, physicians will receive 2.9% less from Medicare than they did in 2024. When you add to this the incremental reductions that have occurred every year since the current Resource-based Relative Value System (RBRVS) of payment was implemented in January, 1992. If you’re doing the math, it means that physicians who rely heavily on revenues from Medicare to maintain a practice and make a living, have not had a pay raise in 32 years! 32 years! Do you know anyone who hasn’t had a pay raise in 32 years? Of course you don’t. They don’t exist. Even unemployed people get a raise now and then.
The government accomplishes this ruse by annually reducing the conversion factor, the dollar amount multiplied by the RVU (Relative Value Unit) of each physician service. This calculation is done for every physician service or procedure. In 2024, that amount was $33.29. In 2025, it drops to $32.35,or 2.83% lower ($0.94 less per RVU). “CMS and Congress have once again overlooked the sobering financial realities facing our nation’s medical practices…further increasing the gap between practice expenses and reimbursement rates….Today’s final rule throws the financial viability of physician practices into question and threatens beneficiary access to care…Medicare plans to pay us less as costs go up…that is an unsustainable trend, though one that has been going on for decades.”
“Adjusted for inflation, Medicare reimbursement to physicians has decreased 29% since 2001.” Physicians’ so-called unions, the American Medical Association (AMA) and the American Academy of Family Physicians (AAFP), to name two, have protested these cuts for years, but nothing has changed. Physicians are portrayed as greedy, rich snobs who make too much money, and public sympathy/understanding of this dilemma has not generated any support from the lay public. But I can tell you, as one whose practice succumbed to the dismal, unreasonable reimbursement from Medicare, it is a serious problem. Solutions are discussed but never implemented. Reductions will continue until physicians cry “uncle” when they can’t take it any more.
Reference: Landi H. Doctors, facing another pay cut in 2025, call for permanent Medicare payment reform. Medscape Medical News 2024 November 2.
Family physicians earn a fraction of what specialists earn: The median pay for U.S. physicians increased $11K in 2024 when compared to 2023. Primary care doctors earned $121,000 (33%) less than the average physician. The top earners are Neurosurgeons who average $764,000 per year. I can’t imagine that! The Top Five specialties, after Neurosurgery, pay-wise are Orthopedics, Plastic Surgery, Cardiology, Gastroenterology, and Urology. They average just under $500K. Family physicians don’t earn anywhere near what the average specialists make. FP’s are office-based and have all the expenses of maintaining an office staff, and the supplies and equipment necessary to provide a wide array of services, which FP’s offer. These overhead costs cut into the FP’s salary and place them at lower pay levels. Although the practice of medicine is meant to help people, it is a business. Family physicians know that more than most. Family Medicine is not a big dollar, glamorous business like Neurosurgery or Plastic Surgery, but we strive to be the professional patients rely on for help. And that doesn’t always translate into a high pay grade.
Reference: Sanchez J. Average Physician Salaries in the U.S. Physician On Fire 2024 October 28.
