Low-Dose Desmopressin Nasal Spray and FDA Approval

Abstract

In Reply Dr Butt, Dr Kruse, and Drs Farnbach Pearson and Larson dispute our estimates on whether a physician shortage truly exists. We believe that their math is mistaken.In all of our calculations, we were quite conservative, allotting 12 half-hour primary care appointments per day (just 6 hours of patient time per day) and physician panel sizes of 1500 patients. The calculations assumed physicians worked just 40 weeks per year. These assumptions leave more than sufficient time-2 to 4 hours per day and several weeks per year-for physicians to fulfill the myriad other nonclinical responsibilities cited by Butt, such as administration, responding to emails, and teaching medical students and house staff.Even with these very conservative estimates, basic mathematics suggests that there are more than enough primary care physicians in the United States to cover the needs of all 310 million US residents. For instance, if physicians see 12 patients a day, 5 days a week for 40 weeks a year, then each physician can provide 2400 patient visits per year. Currently, there are just under 500 million primary care visits per year. 1 To satisfy this number of patient visits, a simple calculation reveals that the United States would require just 208 000 full-time primary care physicians.Regardless of whether we use the AMA Masterfile, the Kaiser Family Foundation estimates derived from state licensing information, or the 7-year-old AHRQ data preferred by Kruse, our results are the same-we have more than enough primary care physicians to support the US patient population. Kruse argues that there are actually 209 000 primary care physicians, which happens to be the number needed based on our conservative calculations. Adding part-time primary care physicians further supports our finding that physician supply is not a problem in primary care. The access problems faced by patients seeking primary care are more the result of how the health care system deploys these physicians-a management problem-than a sheer numbers problem.We agree with Farnbach Pearson and Larson that there exists a substantial geographic maldistribution of physicians, including primary care physicians. However, history has shown that simply increasing the number of physicians will not induce physicians to locate in rural areas, thereby solving this maldistribution. 2 Only use of telemedicine and other management and financial changes will ensure rural patients optimal access to high-quality medical care.Our simple calculations suggest that there is no generalized physician shortage in the United States-and there will not be one for the foreseeable future. (There may be focal shortages such as in pediatric subspecialties.) Therefore, the United States should not be expanding the number of medical schools and increasing residency training slots-that will only lead to an oversupply of physicians, driving up health care costs. Instead, the focus should be on process improvement, such as instituting open-access scheduling and using nonphysician practitioners to enhanc...

Pharmacomodulation of brain neuromedin U signaling as a potential therapeutic strategy

“…Synthetic gonadoliberin (GnRH) agonists such as buserelin and nafarelin are currently used in the treatment of prostate and breast cancer and endometriosis as well as polycystic ovary syndrome, PCOS (Brogden et al, 1990; Harada et al, 2009). Vasopressin analogues, for example, desmopressin are often used in the treatment of nocturnal polyuria, hemophilia A, diabetes insipidus, Willebrand disease, or uremic bleeding (Fein & Herschkowitz, 2017). Oxytocin may also be helpful for selected group of patients suffering from post‐traumatic stress disorder (PTSD) (Szafoni & Piegza, 2022), postpartum depression (Lindley‐Baron‐Cohen et al, 2022), autism spectrum disorder (ASD) (Plemeniti et al, 2021), and memory impairments (Zhao et al, 2019).…”