"When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov
''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.'' -Robert Ehrlich, drug advertising executive.
"Opinions are like sphincters, everyone has one." - Chris Rangel
Mammogram Pitfalls: While I'm copping all my links today from the BMJ, I would be remiss not to include this one that argues for better education of women about the risks inherent in mammographic screening. posted by Sydney on
7/12/2003 02:10:00 PM
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Absolute Bans: Here's an interesting take on banning smoking in hospitals:
To coerce smokers who happen to be in hospital with an unrelated condition into accepting smoke free behaviour as a condition of their care may be questionable.
When patients have no prospect of benefit from smoking cessation, and enforced abstention aggravates their existing distress, they are being managed unethically. Their best interests as a patient (which should be the medical profession's prime concern) are being subjugated to a broader policy that does them harm.
I have been asked by relatives to prescribe nicotine replacement for a terminally ill patient, whose last days in hospital were made worse for nicotine withdrawal. Also one of my patients with extensive stroke related brain damage and end stage peripheral vascular disease declined admission for adequate nursing care and analgesic adjustment because he would have to give up "his one remaining pleasure."
Such cases should not blunt the public health message. Both patients were dying of smoking related disease. But making their last days more distressing than they would otherwise have been reflects an uncritical policy enforcement that adds a cruel and condescending twist to how doctors and health managers as much as the international tobacco industry are able to create smoking related suffering. posted by Sydney on
7/12/2003 02:06:00 PM
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MedMal Down Under: Turns out Australia has the same medical liability woes that we have:
"Australia’s medical indemnity system is like a three legged dog," said the association’s president, Dr Bill Glasson. "Its progress is slow and uncertain, and it could fall over at any time. The missing leg is affordability."
..The association said one doctor had received a bill for indemnity insurance of $A100 000 (£40 000; $70 000; €60 000), up from $A70 000 the year before. He had considered quitting the profession but had been told that quitting would cost him A$80 000 in insurance to cover the "tail," or any claims that may not yet have been made.
The president of the National Association of Specialist Obstetricians and Gynaecologists, Dr David Molloy, said a reliable survey was predicting workforce losses of 15% to 20% because of the indemnity issue.
BBC Misconduct: The British government and the blogosphere aren't the only ones critical of the BBC. A British fertility specialist whose practice of offering discounts for treatment if patients donate eggs to others was spotlighted on a BBC program says they're unethical:
"I find it ironic that the BBC should accuse me of acting unethically when they use journalistic techniques which breach their own guidelines. My lawyer looked it up, and according to their rules, they can only use undercover reporters when someone is suspected of criminal or highly antisocial activity. How do I fit into that category?" Professor Craft said his solicitor has sent a letter to Panorama, but he plans no further action.
Modern Eugenics: The New York Times letter page had some rather revealing letters on prevalent liberal attitudes towards the potential misuse of modern genetic research. First, there's this defense of its eugenic potential:
The eugenics movement of the beginning of the last century involved those who "knew best" imposing their will on others. The current advances in genetics allow families to make informed reproductive choices about their own future children.
Our society has decided that women have the right to choose, independent of the reason provided. Furthermore, parents in our society, for some time now, have made reproductive choices based on medical outcomes for diseases like Down syndrome.
Recent advances have expanded the diseases that can be screened for, but have not yet altered the issues under consideration.
Of course, those parents are imposing their will on the unborn defective child, but never mind.
In a country with a grievously ignorant citizenry and a host of deep problems, it is not unthinkable to imagine that we could do better with a little more intelligence. If genetic engineering holds the key to this goal, we should consider using it. The new eugenics need not be racist or state-mandated and, if used wisely, could work wonders.
Lacking the proper instruments, a Peruvian doctor at a state hospital in the Andean highlands has used a drill and pliers to perform brain surgery on a man injured in a fight.
The doctor, Cesar Venero, told Reuters: "We have no [neurosurgical] instruments at the hospital.
"He was dying, so I had no choice but to run to a hardware store to buy a drill and use the pliers that I fix my car with, of course after sterilizing them."
...Dr Venero, who earns the equivalent of $650 a month, said he had used tools from a hardware store on five previous occasions but for less serious operations.
Justice:Slate's Michael Kinsley makes some excellent points about the inherent injustice in our current tort system:
The current arrangement delivers justice at random, in widely varying amounts or not at all, depending on whether you’re feeling litigious, how good your lawyer is, or what a judge or a juror had for breakfast that day. It is less a matter of injustice than of more justice than we can afford, scattered somewhat at random.
What is wrong with a $250,000 cap on payments for pain and suffering? Why should one person get $5 million, another $500,000, and yet another nothing at all for essentially the same injury? The fact that $250,000 can’t begin to compensate for the pain and suffering a patient may have endured can demonstrate that $250,000 isn’t enough money, or it can demonstrate that money’s ability to compensate for non-monetary losses is inherently limited. posted by Sydney on
7/12/2003 01:12:00 PM
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Welcome to the age of statins. If you aren’t taking a cholesterol-lowering drug yourself, chances are you know someone who is. And it’s not necessarily an overweight, out-of-shape sports fan in his 50s who ventures off the couch only in search of chips and beer. An estimated 12 million to 15 million American adults of every age and description—from Gen-Xers to their octogenarian grandparents—depend on America’s most popular prescription drugs to scour their bloodstreams of LDL cholesterol, the waxy goo that can block arteries and cause heart attacks and strokes. And, according to federal health guidelines, 21 million more Americans should be taking statins to help ward off cardiovascular disease. Statins have become so critical in the war against cholesterol that a leading statin researcher compares them to the ultimate miracle med. Says Dr. Rory Collins of Oxford University: “Statins are the new aspirin.”
His bold words could be an understatement. Promising new research is underway to investigate statins as a treatment for a number of other disorders, including Alzheimer’s disease, multiple sclerosis, osteoporosis and even cancer.
Forget for a minute that the claims in that last paragraph are all speculation and theory and not based on any solid clinical evidence, which the article admits in the very end, but concentrate instead on the claims that are being made for statins as the "new aspirin."
First, taking a statin and lowering cholesterol to the guideline levels only lowers the risk for heart disease by 3 to 5 percentage points compared to non-users. Second, using statins is a very costly proposition. And not just in terms of side effects. 15 million people are taking the drugs now - at a cost of anywhere from $40 a month to $120 a month. Add to that the cost of blood tests every six months, to monitor their effectiveness and to check for side effects. At one lab in my area, the cost of the lipid panel alone is $105. If we split the difference and say that the average price of statins is $90 a month, that's $1,080 a year for drugs and $210 a year for labs. Multiply that by 15 million users and you get $19.35 billion dollars each year devoted to statin therapy alone.
And here's the real kicker. Although taking statins lowers risk of heart disease by about five percentage points, taking them does nothing to lower overall mortality. They're a miracle drug, all right. They've worked miracles for the bottom line of pharmaceutical companies. posted by Sydney on
7/12/2003 09:58:00 AM
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Distracted Patients:Cut-to-Cure has a lot of good offerings, even though he's been on call. Some thoughts on the medmal crisis, the right of patients to decide to take risks - and the consequences when the patients die and the family members disagreed with those risks. He also has an informal poll on physician pet peeves. posted by Sydney on
7/12/2003 08:18:00 AM
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Thursday, July 10, 2003
Hiatus: I'll be out of town tomorrow and unable to blog. Have to take my recertification exam for the American Board of Family Practice. I've got a lot to say about this week's Newsweek cover story on the amazing statins when I return on Saturday.
UPDATE: Also should have a piece tomorrow at Tech Central Station about the medical liability reform bill that got defeated by the Trial Lawyers, I mean, Democrats yesterday. posted by Sydney on
7/10/2003 01:46:00 PM
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Poetry in Motion: The Wall Street Journal had an interesting review of a the musical "Big River", done in sign language:
The intertwining histories of black and white, of slaves and the free suggested to Mr. Waterstreet correspondences to the intersecting worlds of the deaf and those who can hear. The show has been cast accordingly. Half the roles are played by actors who speak and sing, half by deaf actors whose parts are unobtrusively voiced by others. And simultaneously, all cast members without exception do their own lines in ASL. (For a hearing audience, the talking functions as effectively as supertitles at the opera, in reverse.)
...Dropping in on a rehearsal in the theater district, I think I was expecting quaint Americana, punctuated partly by flying hands and partly by the sort of rudimentary semaphore that pioneering directors like Robert Wilson and Peter Sellars have sometimes felt impelled to invent. Instead, I saw a living language, almost completely unknown to me, yet always beautiful, filled with gestures and images that either as pictures or as spontaneous expressions of ideas instantly made intuitive sense. The stab of emotion when Huck and his friend Jim, the runaway slave, sing of escaping down the Mississippi was sure and sudden, especially when they joined hands for the final sign: second and third fingers of one actor's hand "standing" atop the back of the other's rocking hand in the perfectly clear sign for the verb "to ride." What an eloquent image of freedom! And then there was the chorus, "singing" their last refrain of "Waitin' for the Light to Shine" in silence, their palms spreading from their faces like so many soft sunbursts.
American Sign Language is a beautiful thing to behold. I have a patient who uses it. She either brings an interpreter ($60 at my cost, but that's a rant for another day) or her daughter to translate. She's a very talkative woman, and her hands just fly like mad the whole time she's in my office, but in such beautiful, expressive, fluid movements. I've noticed her daughter, who is also my patient, has the habit of using sign language to augment her own conversation, even when she's not with her mother. The daughter says that English is her second language. ASL is her first. posted by Sydney on
7/10/2003 01:37:00 PM
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Disabling Melancholy: A reader pointed me to a New Yorker article by Laura Hillenbrand, author of Seabiscuit, about her experience with chronic fatigue syndrome. The article isn't available on line, but a Diane Rehm interview that covers much of the same ground is. (scroll down to July 3)
Every age has its vague illnesses that defy the limits of medical knowledge. In the 19th century, there was neurasthenia, today there’s chronic fatigue syndrome. The problem with such illnesses is that they aren’t so much defined diseases with observable cellular pathology or measureable metabolic abnormalities as they are descriptive terms for a constellation of symptoms that appear together in some people. As medical knowlege improves, some people who would once have been lumped into those vague diagnoses get removed. For example, it isn’t hard to imagine that many a person with multiple sclerosis was once considered neurasthenic.
And that’s the problem with chronic fatigue syndrome, and why many doctors are reluctant to embrace it as a single pathology. Both the New Yorker article and the Diane Rehm interview spend a lot of time criticizing doctors for not recognizing Laura Hillenbrand’s disease. The interview even includes her current internist who does his share of clucking over the stupidity of other doctors. Several different doctors told her they could find nothing physically wrong and that they felt she was suffering from severe depression. She only saw one psychiatrist, however, and he told her she wasn’t depressed. Curiously, she didn’t bother getting a second opinion on that one, although her internist at the time suggested she do just that. She sought second, third, fourth, and fifth opinions from internists, though. And kept getting other opinions until she found one she liked. Search long enough, and you’ll find someone who agrees with you.
And to be fair to them, her doctors weren’t necessarily negligent. The time was the late 1980’s when chronic fatigue syndrome was just beginning to be defined. And if she presented her story to them the way she presented it in the New Yorker article, it’s hard to blame them for suspecting psychiatric problems. You see, the whole thing started when a car she was riding in one dark night almost hit a deer, and then a meteor flashed across the sky. She was the only one in the car who saw the deer and the meteor, and almost immediately, she became ill.
What followed sounds a lot like infectious mononucleosis. A fever, sore throat, and fatigue. She had strep throat, too, which often coexists with infectious mono for some reason. But she never got better. She spent the next sixteen years incapacitated by fatigue and lethargy, and occasional sore throats and swollen glands.
She has nothing but scorn, though, for the doctor who told her she was suffering from Epstein-Barr virus, the virus that causes mono. Which is too bad, because he was probably the closest to the truth about her condition in its early days. Later on, there does seem to be a component of psychological interplay in her disease. She has a relapse, for example, when she and her boyfriend have to drive through a severe thunderstorm to visit friends. She doesn’t want to go, he wants to press on. She gets sick. For months. So sick that she has to be spoon fed. Talk about secondary gain. The boyfriend not only misses out on something he wants to do, he gets punished for a long time afterwards for his stuborness. And she gets unlimited attention and love.
That’s not to say that Laura Hillenbrand doesn’t have a real disease. She very well might. Just one that we can’t diagnose yet. Nor treat. But it isn’t far-fetched to think that she might also have some depression or anxiety thrown in, too. Here’s the current thinking on chronic fatigue syndrome (CFS):
It is known that CFS is a heterogeneous disorder possibly involving an interaction of biologic systems. Similarities with fibromyalgia exist and concomitant illnesses include irritable bowel syndrome, depression, and headaches. Therefore, treatment of CFS may be variable and should be tailored to each patient. Therapy should include exercise, diet, good sleep hygiene, antidepressants, and other medications, depending on the patient's presentation.
All of those concomitant illnesses have strong emotional underpinnings. Irritable bowel and fibromyalgia get worse with emotional stress. So do headaches, as we all know.
Ms. Hillenbrand’s much-castigated doctors weren’t so far off base in their diagnoses. What they lacked was sufficient sympathy, and the ability to give her condition a name that she found acceptable. One that, unlike depression, was from the outside, not the inside. For it wasn’t until she found a doctor who called her disease chronic fatigue syndrome, admitted he’d never be able to cure her, and most importantly, acknowledged that she was suffering that she began to see improvement. She got validation without stigmatization.
And there’s nothing wrong with that. It’s a valid treatment approach, and one that works. But, to suggest, as Ms. Hillenbrand’s internist does in the Diane Rehm interview that this is a definitive disease and to express suprise, as he does, that there are doctors who are skeptical about it is nothing more than self-serving posturing. At one point, Diane Rehm asked him, with much expectation in her voice, if he was taking new chronic fatigue patients since this was obviously an area in which he had some expertise. He didn’t say it outright, but his voice had an underlying “Good-God-no” tone to it when he told her his practice was closed to new chronic fatigue patients. Five percent of his patients have the illness. They take up too much time. Too much paperwork. Specifically, too many disability forms to fill out. Hard to imagine an oncologist closing his practice to cancer patients because of the disability forms. Or a nephrologist closing his practice to chronic renal failure patients for the same reason. Or an endocrinologist to his end-stage diabetic patients. Or a cardiologist...well you get the idea. It isn’t the forms, it’s the nebulous disease he’s being asked to certify as disabling that’s the problem. In his heart, he knows there’s more to it than meets the eye.
UPDATE: There's a very good piece on the doctor's perspective of this sort of illness in JAMA, this week, but unfortunately, it's only available to subscribers. It's written by a neurologist who has been in practice for thirty years:
I have traveled this road many times and always have the same reaction. Odd as it may seem, I feel more comfortable and better equipped to advise and care for patients with ALS or other neuromuscular maladies than I am to provide consultation and ongoing care to patients like Linda. That sobering reality has always bothered me. Over the years I've learned that almost every aspect of our health care system is more responsive to the needs of patients with major organ failure. We miss the mark for those who fear they have a serious yet undiagnosed disease and who have unexplained pain, weakness, fatigue, headaches, mood changes, or interrupted sleep. These patients do not "fit" one neat diagnosis - some have organic illness - but most have somatic symptoms without an underlying disease explanation. To the extenet that they cannot function, they are truly disabled. To make matters worse, physicians don't want to take care of these people, and insurance companies don't want to pay for their care.
...One of my colleagues once rather sheepishly admitted to me, "Even when I try to help these patients, I usually fail, so I've given up trying."....
....Even with years of experience and good communication skills, I felt a return of butterflies as I entered Linda's examination room, determined to give it my best shot.
And he's someone who has spent years perfecting the art of medicine. For that's what dealing with the unknown illnesses comes down to - an art. posted by Sydney on
7/10/2003 01:23:00 PM
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Price Allergies: Recent research suggests that making drugs over-the-counter saves insurance companies money:
The direct costs to patients for allergy medications Allegra and Zyrtec will rise precipitously if the Food and Drug Administration (FDA) approves the change from prescription to over-the-counter status requested by WellPoint Health Networks, a major managed healthcare company. Health insurers would be granted an annual windfall that could exceed three-quarters of a billion dollars from the change.
No suprise there. Insurance plans don't cover over-the-counter drugs. That's why they lobby the FDA to make expensive, popular symptom-treating drugs over-the-counter. Drugs like the non-sedating antihistamines, and the proton pump inhibitors like Prilosec which are increasingly used, not for recalcitrant ulcers or acid reflux, but for indigestion . You can't really blame them. The drugs appear to be safer than a lot of the other medications that are already available over-the-counter for allergies and indigestion, and quite frankly their popularity is due in large part to successful direct-to-consumer advertising by drug companies, the power of which should never be under-estimated.
posted by Sydney on
7/10/2003 11:39:00 AM
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Solving the Crisis: Here's a solution to the medical liability crisis that might work:
"Our research shows that when people are injured in an accident, or through physician malpractice, they seek large cash awards for pain and suffering," said an unnamed AMA spokesman. "So, we now suggest that doctors prescribe cold cash to relieve all kinds of physical and mental anguish. We encourage Congress to include cash in the new Medicare prescription drug plan."
And read the comment section. It has a rebuttal of the plan from the American Trial Lawyers Association. posted by Sydney on
7/10/2003 11:34:00 AM
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It's About Access:More evidence that tort reform, or lack of reform, affects access to healthcare:
A simple comparison of the supply of physicians per capita between States that did and did not adopt a cap revealed that States with caps experienced a more rapid increase in their supply of physicians. In 1970, before any States had a law capping damage payments in malpractice cases, States that eventually adopted a cap and States that did not eventually adopt a cap had virtually identical levels of physicians per 100,000 citizens per county (69 vs. 67). Thirty years later in 2000, States that adopted a cap averaged 135 physicians per 100,000 citizens per county while States without a cap averaged 120.
Specious: Arguments against medical liability tort reform from The American Prospect, with a little help from academic medicine:
"Most doctors don't get sued," says Annas, referring to a 1990 Harvard study showing that only one in eight malpractice victims ever takes his or her case to court. "Compare that to patients who worry about being killed; it's not even in the same league."
Over the course of a life time, most doctors experience at least one claim filed against them. And in Florida, if those doctors are neurosurgeons, they have a 1 in 1 chance of being sued. The suit might not go to trial. It might be dropped by the plaintiff's attorney after filing, when he realizes there's no case, but it's still a suit. And it still takes time and money to marshall a defense until it's dropped.
Dr. Marcia Angell, former editor of The New England Journal of Medicine and now a professor at Harvard Medical School, is not surprised. "[Doctors] are not economists. They don't think in terms of how a business makes up for a loss of profits. They have been at loggerheads with the trial lawyers for so long that it's always a knee-jerk reaction." Moreover, she observes, many lawsuits arise due to the lack of a social safety net. "As long as we have a system based on avoiding sick people and not taking care of them, you leave sick and injured people with very little alternative other than to sue and to get some care that way," says Angell.
Huh? Does Dr. Angell really believe that people sue their doctor to get better access to care? Large punitive damages serve one purpose only - revenge:
Linda McDougal, the Minnesota woman whose breasts were mistakenly removed after she was incorrectly diagnosed with cancer because her files were mixed up with another patient's, suffered few quantifiable economic losses. She had health insurance, and her employer covered medical bills and lost wages. But "she will have to go through life mutilated for no reason," says Carlton Carl of the Association of Trial Lawyers of America.
And since she can’t physically mutilate the person who mixed up her biopsy specimen, she’d rather financially mutilate them - or at least their insurance company. And that's exactly the way many people - and lawyers - think. I once had a patient who told me she was suing her best friend after they were in an auto accident together. The friend was the driver, and my patient wanted pain and suffering money. The amazing thing was, she couldn't understand why her friend was no longer speaking to her. Her exact words were, "I'm not suing her. I'm suing the insurance company!"
Then there’s the oft-repeated claim that the bad doctors among us are to blame:
Far more effective than an arbitrary cap on damages would be a more systematic effort to weed out bad doctors and prevent malpractice in the first place. Dr. Sidney Wolfe, director of Public Citizen's Health Research Group, says, "You should protect patients with doctor discipline and protect good doctors with low premiums." Public Citizen ranks state medical boards according to their records of disciplining negligent doctors. "Five percent of the doctors account for 50 percent of the malpractice payouts," he says. "The primary failing is at disciplining doctors. A lot could be remedied by taking bad doctors out of practice."
Judging from the lawsuits that I've heard about from my colleagues, and from my own experience with a frivolous lawsuit, I find it hard to believe that better discipline is going to make much of a dent. “Five percent of doctors accounting for 50 percent of malpractice payouts” just doesn’t ring true. I’d like to see the data that supports that assertion, but Public Citizen never offers it. Obviously, like Dr. Angell, it’s been a long time since Dr. Wolfe has spent any time among practicing physicians who face the risk of being sued everyday - even when they do everything right.
This argument that bad doctors are responsible for the medical malpractice crisis is the most infuriating argument out there. Especially when the legal profession acts as if there is no room for improvement in their unethical habits. Ask any attorney, and they'll admit that it's common practice to slap everyone whose name appears on a medical chart with a lawsuit, without any attempt to determine who was at fault before filing. Once a suit is filed, that claim is on a doctor's record forever. That's just wrong. The legal profession needs to take steps to start acting responsibly when it comes to lawsuits.
The author concludes:
If the AMA succeeds in passing a $250,000 cap without a provision forcing insurance companies to pass their savings on to doctors, rates may well continue to climb, in which case growing numbers of obstetricians will stop delivering babies, more neurosurgeons will retire early or shy away from risky procedures, and more mutilated patients will be denied compensation.
And in the end, Karl Rove and his buddies in the insurance industry will be laughing all the way to the bank.
I don’t know if Karl Rove has buddies in the insurance industry, but one thing’s for sure, if caps don’t pass, Congressional Democrats and trial lawyers will be laughing all the way to the bank. posted by Sydney on
7/09/2003 12:32:00 PM
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Coming to a Head: The Senate is slated to vote today on medical liability reform. And it looks like it will fail, at least in the short term. posted by Sydney on
7/09/2003 07:21:00 AM
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Tuesday, July 08, 2003
http://www.bartleby.com/65/ne/neurasth.html neurasthenia
http://www.aafp.org/afp/20020315/1083.html
It is known that CFS is a heterogeneous disorder possibly involving an interaction of biologic systems. Similarities with fibromyalgia exist and concomitant illnesses include irritable bowel syndrome, depression, and headaches. Therefore, treatment of CFS may be variable and should be tailored to each patient. Therapy should include exercise, diet, good sleep hygiene, antidepressants, and other medications, depending on the patient's presentation.
...Regional cerebral flow studies24 using single photon emission computed tomography analysis have shown impaired regional cerebral blood flow in patients with CFS compared with healthy control subjects. A later study25 using positron emission tomography analysis compared patients who had CFS and no history of depression with clinically depressed patients who had no history of CFS; the study found altered frontal cortical metabolism in both patients with CFS and patients with depression compared with healthy control subjects. Whether the functional impairment in patients with CFS is caused by a concurrent psychiatric illness is still inconclusive.
CDC info
Fatigue: A reader pointed me to a New Yorker article by Laura Hillenbrand, author of Seabiscuit, about her experience with a mystery illness that has left her incapacitated for much of the past sixteen years. The article isn't available on line, but a Diane Rehm inteview about it is. (scroll down to July 3)
The interview covers everything and tells the exact same story as the New Yorker article. There's many an unsympathetic doctor in the article, all of whom are tusked, tusked over by Diane Rehm, Ms. Hillenbrand, and Ms. Hillenbrand's internist in the interview. Stupid doctors. Blind asses.
Ms. Hillenbrand has now been diagnosed with chronic fatigue syndrome. Every medical doctor she saw in the late 1980's, when her illness began, felt her problem was more psychiatric than physical. Every doctor, that is, except one psychiatrist, who told her the problem was a "serious medical illness." It's easy now to look back and deride those doctors, but in the late 1980's chronic fatigue syndrome was anything but a definitive diagnosis, much more controversial than it is today.
Every age has its vague illnesses which are defined more by symptom complexes than by known disease processes. In the 19th and early 20th centuries it was neurasthenia. Back then, a lot of people with a lot of different diseases got lumped into the category of neurasthenia. People with multiple sclerosis, for example. Today, we can diagnose multiple sclerosis, so those patients are in no danger
posted by Sydney on
7/08/2003 08:25:00 AM
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"Free" Care for All:Arnold Kling has been visiting Howard Dean's website and has much to say about Dean's plans for universal healthcare, which include expanding Medicaid to cover everyone under age 18 regardless of income. As Kling points out, this makes no sense:
Consider two families living under identical middle-class circumstances. One family chooses to spend its discretionary income on cable television, a brand new SUV, and extravagant birthday parties. The other family chooses to do without cable, drive a used car, and have modest birthday parties, so that it can spend its discretionary income on health insurance. Howard Dean would tax the second family to pay for health insurance for the first family.
Of course, under Dean's plan, the second family wouldn't bother purchasing health insurance, either. And neither family would have the money to buy SUV's, extravagant birthay parties and cable television. posted by Sydney on
7/08/2003 08:20:00 AM
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The conference ''was pretty chilling,'' said the center's communications director, Mike Burita, who attended the non-private sessions. ''The only solution that they seem to advocate is one that blames the food industry for the problem of obesity today.''
....''It seems like legal terrorism they're engaging in,'' Burita said. ''I think they're going to see a public backlash.''
Tour of the Blogs:The Bloviator has an op-ed piece in Science on public health funding. It isn't available online, but he has the first and last paragraphs up at his site.
Jane Galt takes on questionable abortion statistics.
And Jim Miller contemplates the brave new world of reproductive technology.
Playing to Emotions: Today's installment on the medical malpractice crisis in my local paper concentrates on evil doctors:
Ater 24 years, there are still nights when Rande McDaniel's mind wanders to what might have been.
A healthy baby boy. A normal childhood filled with school plays, Little League baseball, girlfriends, dances and his first car. And in adulthood, a decent job, a loving wife and a family of his own.
But her son, Christopher, now 24, never had any of those things. And he never will.
McDaniel's doctor botched Christopher's delivery so badly that his life has been confined by severe mental retardation. He can't talk. He wasn't potty trained until he was 15 years old. He drools. He's teased, taunted and outright avoided.
Quite simply, McDaniel says, Christopher's life was ruined by her doctor, who was shopping while Christopher was being asphyxiated in the womb, and by a hospital that didn't use a fetal monitor, which would have discovered the problem.
McDaniel, who lives in Brimfield Township, sued for malpractice in Summit County Common Pleas Court. Five years later, her hospital and doctor agreed to a settlement worth $1.9 million.
That was in 1984. But if the same lawsuit were settled today, the amount would be much lower.
...Tears come easily to McDaniel when she talks about what happened 24 years ago. But that sadness turns to anger when she talks about capping damages on pain and suffering.
``These people -- doctors who mess up kids -- it gives them the right to do what they do and not care,'' she says. ``They can say, `Oh, I screwed up a kid for life, but it'll only cost me $500,000. I can handle that. It's no big deal.' They don't have to answer to nobody. That's not right.”
You would think they could have found a better case illustration for doctors who screw up than a case of cerebral palsy. Not knowing the details of the case, it's hard to judge, but from what's presented in the article, it sounds like McDaniel's son is a typical case of cerebral palsy - which is just as likely to happen during fetal development as it is during the birth process. Recent studies suggest that it's more likely to happen before birth. The fact that the hospital didn't use fetal monitors (which some argue don't do much to improve outcomes, but only increase cesearean section rates) only means that the trial lawyers had an easier time pinning the blame on the hospital and obstetrician. Cerebral palsy cases are malpractice lawyer's dream - no easily identifiable cause, and thus difficult for a doctor to defend. The fact that the case went five years before being settled suggests that the hospital caved in rather than continue to bear the cost of defending itself. If they had no case, they would have settled sooner.
The other case in the article, a young girl who's spine was injured during surgery, is a better illustration. But the argument that she deserves millions of dollars to compensate for her loss is specious. Large monetary awards for pain and suffering are nothing more than blood money. It's a means to satiate the desire for revenge.
Crisis: How bad is the malpractice insurance crisis in West Virginia? This bad:
Scene opens with a pair of binocular-toting border guards watching a remote stretch of river at dusk.
First Border Guard: Here they come, just like clockwork.
(Camera pans to a trio of middle-aged men, stripped to their shorts, walking stealthily to the edge of the river, looking around cautiously, then wading into the stream and swimming across, the handles of valises gripped in their teeth.)
Second Border Guard: I’m surprised any of them are left, considering how many have already made it across the border. Why can’t they just go back where they’re coming from? It can’t be that bad.
First Border Guard: I don’t know. Personally? I can’t help but feel sorry for them. They’ve been hounded by trial lawyers, abused by insurance companies and ignored by their elected officials. You can’t blame them for trying to make a better life for themselves and their families here.
Second Border Guard: I suppose you’re right. And what good would it do to turn them back? Another batch will just take their place tomorrow, and the next day and the next, until things change in their homeland.
First Border Guard: Well, it’s show time! (Flips on a searchlight and focuses it on the trio of swimmers, now emerging on the border guards’ side of the river) Gentlemen! Welcome to the state of Ohio! If you doctors will please surrender your West Virginia driver’s licenses, we’ll transport you to the nearest medical center for pre-employment processing. (Turns searchlight back to West Virginia shore, where another group of border-crossers is already approaching the river.) When’s it ever gonna end?
Second Border Guard: Not until the last medical professional in West Virginia turns out the light.
Sorry fellas, it's almost as bad in Ohio. At least it is if you're near a major city.
posted by Sydney on
7/07/2003 07:33:00 AM
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Life Imitates the Weekly World News: Thought that this sort of thing only happend in tabloid land:
Gleicher and colleagues took cells from 3-day-old male embryos and inserted them into 21 female embryos at the same stage of development.
The resulting embryo was part male, part female and could potentially have developed into an apparently healthy fetus, the London Telegraph reported Thursday.
Gleicher said the research could lead treatment for genetic diseases but mainstream scientists said the research was pointless and could endanger the reputation of serious embryo research.
MedMal Update: Senator Frist plans to introduce the tort reform bill this week in the Senate, even though it has zero support from Democrats and no hope of overcoming a fillibuster. Their hope is to make it an issue in this election:
Republicans made it clear that they intended to use the vote against Democrats.
"Women are having trouble finding obstetricians to be able to deliver their babies," said Senator John Ensign, Republican of Nevada, the chief sponsor of the measure.
"In states like Nevada, doctors are leaving in droves, and that kind of scenario is repeating itself over and over around the country," Mr. Ensign said. "As voters become aware of it, I think you're going to see the change of minds of senators who may now be against it. We bring it up for a vote now, and it may cost them in the next election."
And it should. It's no coincidence that there's not one Democrat behind the bill. They recognize the hand that feeds them.
Speaking of which, that same hand is busy feeding others to fight their battle:
...Both sides are lobbying hard. The medical association is starting an advertising campaign focused on senators opposed to the bill, and USAction, a consumer advocacy group backed by the trial lawyers, is spending more than $500,000 on a two-week advertising campaign featuring victims of medical malpractice.
Notice that the AMA isn't hiding behind another group, but is making its own commercials. The trial lawyers, however, are hiding behind a "consumer advocacy group." An advocacy group that supports out of control asbestos litigation, and which describes those with whom it disagrees as "right-wing forces". (That echo of "vast right wing conspiracy" is no coincidence. Many of the group's executives have ties to the Democratic Party.)
The Trial Lawyer Association, er, I mean, USAction, plans to hit back with stories of gross neglect and injury:
"This Congress has a very bad track record of supporting powerful special interests at the expense of average Americans," said Jeff Blum, USAction's executive director. "We want to make sure that real stories of real people are in the debate on medical malpractice."
Forget for a moment that USAction itself is supporting one of the most powerful special interests in Congress, and just consider "the real stories of real people." One could argue that more real people are suffering real harm from the current medical malpractice crisis than would be harmed by tort reform. Look what's happening in my town:
Consider Dr. Robert Norman, a geriatrician in Cuyahoga Falls who specializes in treating people with Alzheimer's disease.
His malpractice insurer raised his annual premium from $5,700 to $34,000 last year and warned him that it could jump to $100,000 this year if he continued treating patients in nursing homes.
But when it came time to renew his policy in May, every insurer gave him an unexpected ultimatum: Either sign a paper agreeing to stop seeing nursing home patients or lose his malpractice coverage altogether.
He had 150 nursing home patients who had to find another doctor. Then there's the high-risk woman who couldn't find a doctor to treat her:
Before seeing him, she went to six other doctors seeking help for uncontrollable uterine bleeding.
``She was not a thin woman,'' Davis says. ``She was told right to her face, `If you were a thin woman, I'd operate on you.' ''
Davis agreed to take over her care and tried hormonal treatments, which eventually stopped the bleeding without surgery. None of the other doctors she had seen offered any help, even nonsurgical options.
``That's what's bothering me,'' Davis says. ``People are starting to be stereotyped and doctors are saying, `I'm not going to treat this kind of patient because she's too high-risk.' ''
There's more than just prejudice against the obese at work here. The hormone therapy in a morbidly obese woman is also riskier. Dr. Davis took a chance that his colleagues didn't want to take:
Just having one jury verdict, one settlement or one unresolved lawsuit, he says, could make an Ohio doctor uninsurable.
Davis says doctors have to make a decision:
``Should I risk my care of my 5,000 other patients for one patient?''
And, of course, there's the problem of finding and keeping an obstetrician:
Regardless of the cause of high cost of malpractice insurance, patients such as 24-year-old Carrie Mace, of Cuyahoga Falls, are getting an unwelcome lesson in the economics of medicine.
Mace was five months' pregnant when her family doctor, Ross R. Black, decided he couldn't afford to deliver babies anymore.
The Cuyahoga Falls physician was notified at the beginning of the year that his annual premium would jump from $45,000 to $75,000 if he continued to practice obstetrics.
So he dropped that part of his practice in February, and his annual premium fell to about $17,000.
And then there's the factor that often doesn't get noticed in the current debate. The effective of plummeting safety ratings of malpractice insurance companies on a doctor's ability to practice medicine:
Adding to the problem is the fact that several major insurers still offering malpractice insurance have had their financial stability ratings downgraded below an A- in recent months.
Most major hospitals require doctors to be insured by a company with a rating of A- or better to stay on staff.
Phyllis Klein, a 73-year-old Akron resident, was caught in this insurance pitfall when she was hospitalized for intestinal problems.
When she arrived at the emergency room, she found out her physician, Dr. Steven L. Cochran, was no longer allowed to take care of her at Akron General Medical Center.
``It's kind of hard when the doctor who walks in to discuss your case is a stranger,'' Klein says. ``It was kind of a shock to find that I would be dealing with doctors with whom I have no familiarity at all. Not that they weren't absolutely wonderful and certainly professional. But they still weren't my doctor.''
Cochran is looking for another, higher-rated insurer that will offer him a policy so he can get his hospital privileges back.
``We receive daily phone calls from the patients: `Why aren't you here? Why aren't you seeing me? I want my doctor,' '' he says. ``It's been very stressful to a lot of the patients, particularly the geriatric patients.
``This (the malpractice crisis) has probably changed the nature of our practice more than anything that has happened in the last 10 to 20 years.''
Yes, indeed, it has. And what happens when there are no more insurance companies with safety ratings of A- or higher in a state? (And believe me, they're dropping like flies.) Will hospitals be left without doctors? Probably not, since a hospital can't function without doctors. But before hospitals change their rules, there will be a lot more doctors - including those who depend on their hospital practices for their livelihood such as surgeons and cardiologists - who will be forced out of practice. And then who will care for their patients?
posted by Sydney on
7/06/2003 08:04:00 AM
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