Overactive bladder Is it a disease

According to the Urology Care Foundation, the official foundation of the American Urological Association, 33 million Americans suffer from overactive bladder (OAB). Thats 30% of all men and 40% of all women in the United States. The foundation estimates that the actual number is much larger because many people who have overactive bladder problems are embarrassed and do not seek care.

This represents a nearly twofold increase since 2001 when a paper written said 17 million people had the problem.

Its not clear how either of the two sources cited above obtained their information.

Maybe you didnt know that there are two kinds of OAB. "Dry" is the one where the patient is able to get to the bathroom on time. "Wet" is the form that is accompanied by leakage of urine also known as the urge incontinence.

Here is something else you probably didnt know. The disease was virtually unknown before 1997.

What happened in that year?

A drug company, Pharmacia, had a drug called Detrol that they were originally going to market for the treatment of urinary incontinence. However the number of people with urinary incontinence was small. They decided to focus on people who had urinary frequency and urgency and declared that incontinence was not absolutely necessary to make the diagnosis of OAB.

As related in the book "Our Daily Meds," the drug company had to convince people who went to the restroom frequently and were previously treated with conservative measures such as restricting fluid intake and eliminating caffeine from the diet that OAB was not just an annoyance or inconvenience but a serious condition requiring professional medical care. They named it "Overactive Bladder."

A special supplement to the journal Urology in 1997 contained 30 articles about OAB, a number of which were written by doctors who were paid by Pharmacia.

Here is a graph by year for the 4803 papers listed in PubMed on the subject of OAB since the term first appeared in 1977.

Of the 69 papers written before 1997, only 7 used the term "overactive bladder."

There are now seven drugs for the treatment of OAB on the market. Consumer Reports says that none of the seven is clearly more effective than the others. The monthly cost of these drugs can be as low as $4.00 for a generic to $300 for a brand name medication.

In 2010, the website Decision Resources predicted that "the OAB drug market will increase from approximately $3 billion in 2009 to nearly $4 billion in 2019 in the United States, France, Germany, Italy, Spain, United Kingdom and Japan."

Not a bad return for treating a disease that did not even exist until 18 years ago.

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Meaningful Use Stage 3 Is Coming Should Be Fun

An alert reader tipped me off to something many of you may not be aware of. Stage 3 of Meaningful Use is close at hand.

The "proposed" rules will be officially published on March 30. The good news is that comments will be received for a couple of months.

The bad news is that if the Office of the National Coordinator for Health Information Technology is anything like every other regulatory body Ive ever dealt with [e,g., the ACGMEs Residency Review Committee for Surgery], the "proposed" rules will be the real rules and the comments will be simply a way for disgruntled physicians to vent.

If you dont believe me about the venting, take a look at the 185 mostly negative comments posted on Medscape’s story about Stage 3.

Here are a few of the new rules that will be in effect by 2017 or sooner.

More than 25% of patients seen by an eligible professional (EP) or discharged from a hospital or emergency department (ED) must "actively engage" with their electronic health records (EHRs).

When I was practicing, I had trouble getting some patients to take their medicine or even get out of bed. I don’t know where the people making these rules live, but most of my former patients were highly unlikely to actively engage with their electronic records. I suppose as is the case with unplanned readmissions of noncompliant patients, penalties will be handed out if only 24% of one’s patients engage their records.

Patient-generated data from a nonclinical setting must be incorporated into the EHR for more than 15% of patients seen by the EP or discharged from a hospital or ED.

A “nonclinical setting” is something such as home health care or physical therapy. How anyone is going to be able to track this? Did they mandate only 15% because they know this will be nearly impossible to comply with?

EPs and hospitals must use their EHR to create a summary of care and electronically exchange it with other providers for more than 50% of transitions of care and referrals. In more than 40% of these transitions of care, the provider has to incorporate in its EHR a summary of care from an EHR used by a different provider. In more than 80% of transitions of care, the provider has to perform a "clinical information reconciliation" that includes not only medications and allergies, but also problem lists.

EHRs from different vendors lack "interoperability." They dont communicate very well with each other. “Copy and paste” is out of control now. Wait until you see what happens when people try to comply with these transition of care rules—assuming that EHRs from other doctors can even be opened. This is going to be a monumental amount of work, all of which of course will be uncompensated.

I retired more than two years ago. In social situations, I’m often asked, “Do you miss being a doctor?” I miss the satisfaction that came from helping patients and most of the people I worked with, but I don’t miss the ever-expanding bureaucracy, regulations, and busywork associated with practicing and teaching surgery.

Old age has its rewards. One of them is not having to deal with Stage 3 or even Stages 1 and 2 of Meaningful Use.

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