Monthly Archives: March 2014

Hepatitis C: Between a Rock and a Hard Place

As you probably know, Sovaldi (sofosbuvir) is an important new treatment for Hepatitis C infection that was released this last December and has been aggressively marketed by its maker, Gilead, ever since. The problem is that Gilead is charging an unheard of, jaw-dropping, $1,000.00 per pill for Sovaldi. This translates into a MINIMUM of $84,000.00 for Sovaldi alone for the simplest course of Hep C treatment. Add on the other necessary drugs and take into consideration more complicated cases, and a single course of therapy for Hepatitis C will cost between $100,000.00 and $250,000.00.

This price has placed prison systems in a no-win situation–and not just prisons, but also Medicaid, insurance companies, and HMOs. On one hand, Sovaldi is a good drug that, in fact, represents a significant advance in Hepatitis C treatment. Lots of Hepatitis C patients could potentially benefit from Sovaldi. On the other hand, no one can afford Sovaldi. Treating every potential Hep C patient using Sovaldi would bankrupt everyone. There is no good way out of this dilemma. 20120321 Continue reading

Ingrown Toenail Removal: A Pictographic Tutorial

Ingrown toenails are a common presenting complaint in my jail medical clinics, just as they were when I worked in the ER back-in-the-day. Of course, not all toe infections are due to an ingrown toenail (which I will talk about later), but when an ingrown toenail is present, removal of the ingrown nail spicula is instantly curative. And unless you remove the ingrown toenail, the toe usually will just smolder along and not get better. So knowing how to properly remove a toenail is a great and useful thing.

However, I have heard that some Correctional Practitioners are unfamiliar and uncomfortable with the procedure of toenail removal and so when faced with a nail that needs to come off, they instead:  1. Leave the nail on to fester, 2. Over-prescribe unnecessary antibiotics, or 3. Send correctional patients to a foot surgeon to have this simple procedure done. All of these are poor medical practice, in my opinion.

Like abscess I&D that I have written about previously, toenail removal seems to be a daunting procedure, but actually is quite simple. Of course, any medical procedure can be done incorrectly or inefficiently. Today’s JailMedicine post is a tutorial on how to cure ingrown nails by performing a simple toenail removal. Continue reading