"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
When Sylvester Graham died in 1851 the cause of death was listed as 'Congress waters and tepid baths.'
According to the records in Northampton City Hall, the eccentric health food pioneer remembered for inventing the graham cracker died at the age of 57 from drinking too much mineral water and ignoring his own advice to bathe in bracing cold water.
Life Pros and Cons: British television recently aired a documentary which would be unlikely to ever see the light of day in America. My Foetus is one woman's journey through the abortion debate:
Filmmaker Julia Black is heavily pregnant - and her foetus is forcing her to address the abortion debate.
In this unique documentary she takes the viewer on her personal journey to find out whether she could still be pro-choice when confronted by the reality of abortion.
...In this programme, Julia meets with people from different sides of the debate: the doctors who perform the procedures and the campaigners who believe abortion is murder.
For the first time on British television, the programme shows an abortion procedure at four weeks of pregnancy, an inspection of aborted foetal remains of a seven-week pregnancy and images of a 10, 11 and 21 week aborted foetus.
The perception of termination of pregnancy as an 'easy option' with the collusion of the medical profession and society in general was hinted at but simply not tested or explored. This was a missed opportunity. The only telling comment for me was that of the gynaecologist performing the suction termination of pregnancy under local anaesthetic. At the end of the procedure she said to the woman on the table, 'How was that for you?' We didn't hear the answer. She moved into the next room and sifted through the products of conception for the film crew explaining that she wouldn't even look for limb buds until nine weeks. For some people termination of pregnancy is routine and even mundane or so it seemed.
Public Health Matters: The next time you hear someone going on about how devastating AIDS has been for world health, remember this:
"More than half the hospital beds in the world are filled by people with water related diseases," Mr Brende said. "This clearly demonstrates the link between the water target and the health target."
Deaths from diarrhoeal diseases—such as cholera, dysentery, and typhoid, which can reach epidemic proportions—have dropped by 60% over the past 20 years. Diarrhoeal diseases remain a leading cause of death, however, claiming 1.8 million lives, mostly in children, in 2002, according to the United Nations Commission on Sustainable Development. posted by Sydney on
4/24/2004 08:51:00 PM
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Random Thoughts While Counting Money: The one aspect of a small practice that's been hardest for me to get used to is counting the money at the end of the day. For one thing, it knocked me off the high horse I used to ride, when I didn't even know the price of my services, let alone how or if my patients paid me. (All things mammon were beneath me in those days. I thought of medicine as a higher calling, not a trade.) But endorsing checks has evolved into a small pleasure. Not because I've become enamored with money, but because I've become captivated by the self-expression on display in my patients' checks. They're better than bumper stickers. (You can even design your own.)
Sometimes, the match between check and person is obvious, like the park ranger who has national parks checks. (Yes, we have a national park in Northeast Ohio.) Sometimes, I don't even have to touch the check to identify the patient, like when their distinctive cologne comes wafting out of the envelope. Sometimes the checks are poignant, like the motorcycle checks with the logo "Ride Free or Die" in the corner whose owner is recovering from a head injury he got while riding his motorcyle - helmetless. Sometimes the checks are incongrous, like the check adorned with clowns whose owner hasn't smiled once in the seven years I've known her. And sometimes they hold diagnostic clues, like the checks of the Parkinson's patients. Who knew so much could be gained by just counting money?
Mysteries Solved: I'm going to have to start downloading the digital camera everyday. It holds so many secrets. Today it revealed why our furniture is always so messed up when I get home:
Nobody Expects the Inquisition: A reader sent me this link about a new law in Michigan:
Doctors or other health care providers could not be disciplined or sued if they refuse to treat gay patients under legislation passed Wednesday by the Michigan House.
The bill allows health care workers to refuse service to anyone on moral, ethical or religious grounds.
The Republican dominated House passed the measure as dozens of Catholics looked on from the gallery. The Michigan Catholic Conference, which pushed for the bills, hosted a legislative day for Catholics on Wednesday at the state Capitol.
Sounds sinister. It's been over forty years since Kennedy was elected and the country's worst fears have have finally come to pass - the Catholics are taking over! But the above linked article is, ahem, more than a bit biased. Here, according to the AP is what the bill is really about:
The state House has voted to protect health-care workers and insurers from being fired or sued for refusing to perform a procedure, fill a prescription or cover treatment for something they object to for moral, ethical or religious reasons.
The measures would apply to doctors or nurses who decline to perform or assist with abortions and to pharmacists who refuse to fill prescriptions for morning-after pills.
The Republican-controlled House overwhelmingly approved the four-bill package as dozens of Catholics looked on from the balcony.
OK, so the part about the Catholics looking on from the balcony is apparently true, but it's pretty clear that the law is aimed at protecting healthcare professionals from being coerced into performing a procedure, such as an abortion or euthanasia, which is in conflict with their conscience:
"Health care service" means the provision or withdrawal of, or research or experimentation involving, a medical treatment, procedure, device, medication, drug, or other substance intended to affect the physical or mental condition of an individual.
A gay person isn't a procedure or a service, he's a patient. That doesn't mean the doctor can refuse to treat a homosexual for heart disease, or an infection. It does mean that the doctor could refuse to, say, sign off on an adoption physical for a homosexual patient, or refuse to perform artifical insemination for a lesbian or a single mother. Is that discrimination? Maybe. But it's not nearly the blanket rejection of homosexuals that the first story made it seem.
And why were the Catholics looking on from the balcony? Do they hate gays that much? No, Catholic dioceses have a vested interest in this sort of legislation, which also covers insurance providers, as employers. It's an acutely uncomfortable position for a Catholic diocese to have to pay for abortions for their employees, even if those employees aren't Catholic.
As a medical-malpractice defense attorney and former practicing anesthesiologist, I read with interest the report on malpractice by Studdert et al. (Jan. 15 issue).1 The authors note that "because they must absorb the costs of managing litigation, . . . plaintiffs' attorneys have an incentive to make careful decisions about which cases to take." Unfortunately, this is not always what I see in practice.
Some plaintiffs' lawyers simply file a complaint, essentially a form on which they fill in the blanks with a few pertinent facts. The burden then shifts to the defendant to provide a defense. This process involves months, if not years, of discovery (e.g., depositions and interrogatories), often primarily at the defendant's expense. An unjustified case is then often dropped when the plaintiff's attorney is confronted with discovery that is inconsistent with the complaint. In the meantime, the defendant has paid legal bills, court expenses, transcript fees, expert fees, and other expenses.
From my own experience, and those of other doctors I know, what this attorney describes is the norm. Plaintiff's attorneys are known to file cases against the wrong doctor because they didn't take the time to find out which Dr. Jones at X hospital took care of the patient. Not to mention the practice of suing every doctor the patient has ever seen, even if they had nothing to do with the case in question. These sorts of abuses should be easy to correct with legislation without restricting anyone's access to justice. Shouldn't they? (A fine for filing cases against the wrong person or someone not involved in the case would be a good start.) posted by Sydney on
4/22/2004 09:53:00 AM
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Relaxation Therapy: Some doctors (from where else? California!) say that pot should be the treatment of choice for attention deficit disorder:
Ritalin is an amphetamine — we have all of these youngsters running around on speed," said Keith Stroup, spokesman for the National Organization for the Reform of Marijuana Laws (search).
"Although it flies in the face of conventional wisdom, it's nevertheless true that cannabis is far safer and more effective than the prescription agents currently advocated for treatment of ADD-ADHD," O'Connell said.
It always has made me uncomfortable having these ADD kids on amphetamines, but I'm not sure turning them into stoners is the answer, either. Even though the doctors recommending marijuana for this use are restricting themselves to non-inhaled forms - brownies, candy, and tea - there's still the issue of drug use to contend with. And the truth is that kids who use pot are more likely to go on to try and use other drugs.
Actually, one of my patients uses marijuana for just this purpose, not on my advice but from his own counsel. He told me he began to smoke it in high school because it calmed him down and helped him concentrate. He uses it now that he's in his late twenties for the same reason. The only problem is, he also disclosed to me recently that he's started taking crystal meth to help him lose weight. No wonder his blood pressure was high, eh?
Now, this could be turned into an argument for legalization of marijuana. If my patient weren't already tuned into the illegal drug market from his marijuana use, he probably wouldn't have been able to turn so easily to crystal meth. But I wouldn't advocate that teenagers smoke or eat or drink marijuana to sedate themselves anymore than I would recommend they drink alcohol. There are dependency and health issues that must be considered. A better solution would be to work on a prescription tablet form of it to be used for ADD. Of course, that would take time and money and investment and studies. But, the ADD market is a big one. Surely there are some drug companies out there interested in doing the research?
UPDATE: A reader takes exception with reservations about Ritalin:
Wow. Pot for ADD? My husband and I both have ADD, as do three of our siblings. My kids will obviously be predisposed to it as well. I cannot imagine in my wildest dreams giving my kids marijuana because I was concerned about Ritalin's safety. We've got studies up the wazoo proving stimulants are safe for kids; make sure their growth doesn't get stunted because they forget to eat, and everything's great. Where is the evidence suggesting marijuana is safe, much less effective?
I do not understand why people are so scared of Ritalin--scared enough, apparently, that a drug known to cause brain damage seems safer. Okay: it's an amphetamine. So what? No reasonable person is scared to take Robitussin for a cough, even though dextromethorphan is an opiate with the potential for abuse. Why this unreasonable fear of Ritalin? I take Concerta, and I'd give it to my 6-year-old in a minute. I'd be much more wary of Strattera, and marijuana? Not my kid. Give me amphetamines any day.
....Treatment is being withheld from kids every day by misinformed parents scared of "drugging" their kids. It is so much harder for me to function effectively off Concerta that it makes me sick to my stomach to see kids being forced to muddle through life without the safe, effective treatment that would make their lives so much easier. posted by Sydney on
4/22/2004 09:46:00 AM
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Matching Set: Does your face lift leave your voice sounding incongruously old? Try a voice lift:
The surgery brings the vocal folds closer together either by injecting a material through the mouth fat or a bone like substance or collagen or by making a little incision in the neck and implanting a little piece of gortex to bring all of the vocal fold tissues closer together,' said Dr Thayer Sataloff.
'Either one of those techniques will take a voice that is soft and breathy and give it strength and solidity that makes it sound more believable and younger.'
The Beating Heart: Is it better to stop a heart or keep it going while operating on it? A new study says keep it going. It's better for the patient and the pocket book:
Doing heart bypass surgery while the heart is still beating is just as effective as traditional surgery, but costs significantly less, according to new research.
...Dr. Bhatnagar was not involved in the new research, but was not surprised by the results. He said that at Trillium, where 80 per cent of bypass procedures are done while the patient's heart is still beating, each surgery saves about $2,000 over the traditional method, largely because there are fewer complications.
....The biggest knock against beating-heart surgery is that it is technically more difficult for the surgeon and the anesthetist. There were also concerns about its long-term effectiveness, but those have largely been laid to rest by this study.
The study does show equal or better outcomes for those patients who had beating heart surgery compared to those whose hearts were stopped. But there's one major drawback to the study and it's the reason that concerns about the procedure are not put to rest - it only looked at the outcomes of the procedure in one hospital and one surgeon.
The success of procedures like this depends on the skill of the surgeon. Only if the procedure shows better or equal outcomes at several different hospitals with several different surgical teams can it be said with any certainty that the procedure is better.
posted by Sydney on
4/21/2004 08:10:00 AM
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Mr. Freedman and William Knapp, a strategist with both Clinton presidential campaigns and the Gore campaign in 2000, turned to this technology after consulting with Mr. Freedman's brother, Dr. Joshua Freedman, an assistant professor of psychiatry at U.C.L.A., who was less than impressed by the methodology of political consultants.
"It seemed so last century," Professor Freedman said. "Consultants were quoting Freud as if it was cutting edge. It was all about interpretation instead of using new technology to measure what's actually happening in the mind."
Professor Freedman and the two political consultants formed a company, FKF Research, and provided a grant for an experiment led by Professor Iacoboni, a neuroscientist known for his work mapping parts of the brain activated when people empathize with others. He, Professor Freedman and a U.C.L.A. colleague, Jonas Kaplan, plan to publish the results in a scientific journal.
"In the past decade we've built up all this knowledge of how the brain works," Professor Iacoboni said, "and now it's exciting that we can finally start applying it to social issues."
Why is it that whenever there's an issue that centers around controlling the behavior, and now thoughts, of others, it's associated somehow with the party that's supposed to hold to liberal ideals?
"This research can show how a candidate is unfairly targeting the weaknesses and foibles of voters, and that can be empowering," said Professor Montague, director of the Human Neuroimaging Laboratory at the Baylor College of Medicine.
Of course, political consultants could also use this technology to create more manipulative commercials, though Mr. Freedman and Mr. Knapp say they do not hope for partisan advantage from their research.
"We just want to start exploring this new frontier," Mr. Knapp said. "We know we can't rely just on what people say in polls and focus groups. They tell us over and over that they hate negative advertising, but we know they respond to it. It would be nice to figure out what's actually going on inside their heads."
They don't actually know what's going on inside their heads, just what parts of it light up on a scan. But they sure do know how to play with the heads of political consultants. There's gold in them there campaigns.
Kindest Cuts: My morning paper had an interesting article today on minimally invasive hip replacements (alas, it requires registration, but it's only a one-time registration, and it's free!):
Owens, 62, of Carrollton, mowed his lawn four days after surgery. And he was back to work as a mechanic in 17 days -- not the three months or more that's typical of traditional hip surgery.
That's exactly why he sought out the minimally invasive route.
``I'm getting ready to retire,'' he said. ``The longer I stay off work, the longer before I retire.''
Siciliano's reason was much the same, with one added incentive -- he'd been through hip-replacement surgery the traditional way and he knew he didn't want to go through it again. That was two years ago, when his left hip was sliced open, a surgeon cutting through muscle and ligaments to get to his arthritic joint. He spent the next 11 days in the hospital. For two weeks, he couldn't put any weight on his left leg. It took 90 days to get back to work. And the pain -- he couldn't even bend over to tie his shoe for months.
Three months ago, Palutsis replaced Siciliano's right hip. This time, no muscles were cut. He was walking the afternoon of the surgery. He was out of the hospital within 48 hours. And it took him just 40 days to get back to work as a mechanic, even helping to push cars into the garage.
``It's like night and day,'' the 64-year-old Siciliano said of the two surgical approaches. ``It's a world of difference.''
This kept me puzzled all day long. I know minimally invasive gallbladder surgeries are common, but the gallbladder is like a balloon and can easily be pulled out of a small incision. The appendix can be easily removed that way, too, because it's like a worm. The spleen can be removed with a laparoscope, but first it has to be put in a bag and cut it up into tiny pieces or pureed. But how do they get those pieces of hip hardware through tiny incisions? Turns out they don't:
“Minimally-invasive” means different things to different surgeons. There is no accepted definition--it can be the same operation done through a slightly smaller incision than the surgeon used to use (say 5 inches rather than 6 or 8 inches), a much shorter incision (an approach calling for a 3 inch incision is popular in some places), or even two 1.5-inch incisions using an x-ray machine to find the bones and put the components in the right place.
In other words, they just squeeze the hardware in through a smaller space. And they sacrifice their field of view. There's a lecture here with still photos of the procedure, and a skeptical look at its claims (fast forward to 17 min and 4 seconds.) As the speaker points out:
One might reasonably ask “What could be wrong with a shorter incision--if anything, the results would be the same, but the scar would be more attractive, right?” The answer is, not necessarily. If the shorter incision causes the surgeon difficulty seeing the hip socket or the thigh bone (femur) clearly, or if it impedes his/her ability to work in the tighter surgical field, the result could be badly positioned hip replacement components. That could cause surgical complications like fractures or nerve injuries, hip dislocations (where the ball painfully comes out of the socket after the surgery), and premature wear of the artificial bearing surface.
As exciting as it might sound, it's a new procedure whose complications and successes have yet to be measured.
ADDENDUM: Another item of interest is the robotic da Vinci Surgical System which is used for minimally invasive heart surgery. Scroll down to the end of that last link and you can see a video of the daVinci in action. No wonder video game skills are must for surgeons.
Margit Kieske, 48, who consumed nearly one pound of licorice per day, sued the German candy company Haribo for not posting a health warning on boxes of the chewy treats.
Kieske, 48, claimed the sticky sweets were responsible for her heart troubles — and asked for $7,200 in damages.
Natural licorice can be toxic if taken in excessive quantities.
But, eating a pound of licorice a day is beyond anyone's common sense, at least in Germany. She lost. posted by Sydney on
4/19/2004 11:11:00 PM
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The Other Half: The myriad approaches to male contraceptive development. The non-hormonal angle sounds interesting - and promising:
For example, Oxford University researchers recently reported that a drug used to treat a condition called Gaucher's disease makes male mice sterile by rendering their sperm abnormal. The effect disappeared several weeks after the drug was withdrawn.
Robaire, meanwhile, is using genetic studies in rats to explore ways to keep sperm from maturing.
(So far, the hormonal methods have had unfortunate side effects such as testicular atrophy, although the newer methods that are being tested are supposed to have less of that.) The article points out that there's an audience out there for male contraceptives just waiting to be tapped:
In fact, "the shocker for most people is that men are interested in contraception, are actually using a lot of contraception," said researcher Dr. John Amory of the University of Washington in Seattle.
Noting that men provide nearly a third of all contraceptive use despite "pretty limited options," Amory said, "I think there's a market there."
Well, of course they'd be interested. A male contraceptive pill would free them from that oldest of marriage traps - the "unexpected pregnancy."
The constant vibration affects the arteries, causing them to constrict, which in turn may starve nerves, they told the conference, part of a larger meeting called Experimental Biology 2004.
Govindaraju studied rats, whose tails have nerves and arteries that are very similar in size and structure to those in the human hand.
They vibrated the rat's tails for four hours at a similar frequency to what would be experienced by a jackhammer or chainsaw operator.
The cells lining the artery got pushed together as the artery constricted, and little bulges called vacuoles could be seen coming from individual cells.
'The smaller the artery or the more constricted it was, the more vacuoles you got,' Govindaraju said in an interview.
'It is like a little balloon,' Riley added. If the vibration goes on for too long, the ballon breaks off at its narrowest point and the cell is permanently damaged. 'That piece of the cell is going to die,' Riley said."
Medical Ethics: There seems to be a pattern developing in Hamas leadership:
Hamas’ reticence notwithstanding, media reports were quick to identify the new terrorist leader: Dr. Mahmoud Zahar, Rantisi’s number-two and the personal physician to the late Sheikh Yassin, who met the same fate as Rantisi nearly a month ago.
That's the second doctor in a row to step up to head the terrorist organization. Guess they don't get taught ethics in medical school over there.
posted by Sydney on
4/19/2004 08:48:00 AM
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Doctor Stories: One of the greatest pleasures of being a doctor is listening to patients' stories. But this may be taking things too far:
''A 36-year-old Dominican man with a chief symptom of back pain comes to see me for the first time,'' she said. ''As his new internist, I tell him, I have to learn as much as I can about his health.''
The familiarity, however, ended there. Charon described listening to her patients in markedly different terms than other physicians do. She did not -- as she told it -- interrupt the man with pesky questions about his pain but rather listened in an analytical way as if he were a character giving a soliloquy.
''I listen not only for the content of his narrative but for its form -- its temporal course, its images, its associated subplots, its silences, where he chooses to begin in telling of himself, how he sequences symptoms with other life events,'' she said. ''After a few minutes, he stops talking and begins to weep. I ask him why he cries. He says, 'No one has ever let me do this before.''
You can read too much into a soliloquoy if you deconstruct it too much. You can also miss important details if you don't specifically ask about them. The job of a physician is less like a literature professor than a police detective. We have to sort through a patient's narrative for the important clues. And sometimes we have to help them give us those clues. And what do you know, in reality, that's how the professor of "narrative medicine" does things, too:
Observing her for several days in a clinic in the hospital that serves the local low-income, mostly minority population, I was struck by the dynamic nature of the interaction. Far from sitting silently and absorbing patients' stories, as she described herself in the anecdote of the Dominican man, Charon was an active questioner. The patients volunteered little -- they were shy and sick -- but Charon led them to tell her what she needed to know by giving positive verbal and nonverbal feedback when they did. She did not dwell on anything, but elicited and responded to personal sorrows one minute and asked about smoking habits the next -- with no sense of disjuncture. The patients -- who, after all, had trekked to the hospital not to have their narratives analyzed, but to get better -- seemed to leave the brief 10- and 15-minute appointments with good care.
Heads in the Sand: Read this account of how much trouble one case of monkeypox was for a hospital in Illinois and weep for our state of unpreparedness. (And they were warned the patient was coming.) posted by Sydney on
4/18/2004 11:05:00 PM
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In the early 1990s, big business largely opposed Hillary Clinton's ill-conceived effort to establish a government-run universal health insurance plan. But over the past several years—and especially in the past year—large corporations, and the trade groups that speak for them, have been subtly changing their tune.
One sector that's especially suffering is big healthcare corporations, such as HCA:
This week, HCA, the nation's largest hospital company, unexpectedly lowered earnings estimates for the year by about 10 percent. The main reason: It had to set aside extra cash to deal with swelling numbers of uninsured patients who can't pay their bills. In the first quarter, HCA had to set aside 11.7 percent of its revenues of $5.9 billion for bad debts, up from 8.1 percent the year before.
.....HCA CEO Jack Bovender came close to calling for a single-payer system, though he still couldn't utter the phrase "socialized medicine." "Hospitals have become the ultimate safety net for health care services for the vast majority of America's more than 44 million uninsured," he said. "It is time for all sectors of society, both public and private, health care and non-health care, to participate in solving this societal issue, by providing affordable health insurance for all Americans and more equitably sharing this growing cost to society."
This is a meme that's spreading throughout the hospital management sector. The CEO's of the three major hospitals in our city have all gone on record with similar statements. And here's another from Massachussetts:
Polanowicz sees the root of the problem in the explosive increase in the number of our citizens with no health insurance, or with high-deductible insurance not adequate to their needs. There are now about 600,000 men, women and children in Massachusetts without health insurance, up more than 30 percent in just the last couple of years.
...As for a possible solution, the Marlborough Hospital CEO can only argue at this time for a somewhat nebulous conference or coalition between insurance carriers, multi-national pharmaceutical companies, healthcare providers, hospitals, patients and community leaders -- perhaps under the direction of Gov. Romney or his designee.
These guys better be careful what they wish for. They just might get it.
Speaking of Hillary: I can no longer remember all the details of the original Hillary Clinton Healthcare plan. But, some of the ideas in her Sunday Magazinearticle are a little, um, half-baked:
The likes of SARS can travel quickly from Hong Kong to Toronto, and news of a strange flu in Asia worries us in New York. Welcome to the world without borders.
The Pulitzer Prize-winning science writer Laurie Garrett has described it as ''payback for decades of shunning the desperate health needs of the poor world.'' No matter the blame, the need to act now to address issues of global health is no longer just a moral imperative; it is self-interest.
Except that SARS wasn't a disease of poor people. It disproportionately affected healthcare workers. It was spread globally by affluent travellers. And it did its worse damage in countries with the sort of healthcare systems that Senator Clinton prefers to ours -like Canada and China and Singapore.
If we as individuals are responsible for keeping our own passports, 401(k) and tax files, educational histories and virtually every other document of our lives, then surely we can be responsible for keeping, or at least sharing custody of, our medical records. Studies have shown that when patients have a greater stake in their own care, they make better choices.
Many of my patients can't be relied on to keep track of something as simple as their immunization records. (Oh, we lost them when we moved.) I certainly am not going to trust them to keep their entire medical record. I'm willing to share it with them by giving them copies of it if they want, but since I have to rely on that record to both do my job and to protect myself against lawsuits, I'm certainly not going to give it over to someone else to keep.
We should adopt the model of a ''personal health record'' controlled by the patient, who could use it not only to access the latest reliable health information on the Internet but also to record weight and blood sugar and to receive daily reminders to take asthma or cholesterol medication.
What's stopping people from doing that now?
Moreover, our current system revolves around ''cases'' rather than patients. Reimbursements are based on ''episodes of treatment'' rather than on a broader consideration of a patient's well-being. Thus it rewards the treatment of discrete diseases and injuries rather than keeping the patient alive and healthy.
News flash. "Episodes of treatment" keep patients alive and healthy. It's "episodes of treatment" that prevent pneumonia from becoming fatal, that rescue the heart attack victim, that keep blood pressure under control with medication, that keep diabetes under coutrol...Well, you get the idea.
The structure of the health care system should shift toward rewarding doctors and health plans that treat patients with their long-term health needs in mind and rewarding patients who make sensible decisions about maintaining their own health.
That was the idea behind HMO's. Doctors were paid a set fee per patient, the idea being that they would keep the patients healthy and thus out of the office. It didn't work. People get old, they get sick. We've made great advances in treating and preventing infectious diseases, and in treating some chronic diseases such as hypertension and emphysema and diabetes. But, in the end, the diseases still win, eventually, because we can't halt their progression. We can only slow it.
A government study recently documented that it takes 17 years from the time of a new medical discovery to the time clinicians actually incorporate that discovery into their practice at the bedside. Why not 17 seconds?
Because it takes more than 17 seconds to determine the clinical worth of a new medical discovery. If we adopted every new finding that was hailed in the media within even a day of it appearing in the newspapers, we'd all be dead and/or broke within weeks.
Computers could crunch the variables on a particular patient's medical history, constantly update the algorithms with the latest scientific evidence and put that information at the clinician's fingertips at the point of care.
Ah, now. There's the solution to the high cost of healthcare. Replace doctors and nurses with robots.
It comes down to individual responsibility reinforced by national policy.
Translation: From where you live to what you eat, we'll tell you what you can and can't do - for your own good and the good of all of our nation.
We should also be looking at sprawl -- talking about the way we design our neighborhoods and schools and about our shrinking supply of safe, usable outdoor space -- and how that contributes to asthma, stress and obesity. We should follow the example of the European Union and start testing the chemicals we use every day and not wait until we have a rash of birth defects or cancers on our hands before taking action. And we should look at factors in our society that lead to youth violence, substance abuse, depression and suicide and ultimately require insurance and treatment for mental health.
That's a very expansive and far-reaching definition of what constitutes healthcare. It would be a very expensive proposition, with very little to gain in concrete health for money spent. But, that was the problem with Hillarycare from the beginning. Its reach exceeded its grasp.
A Better Article: The Times piece on the individual insurance market is spot on, though. Speaking from personal experience, it's every bit as difficult as the article portrays it to get individual coverage - regardless of the insurance company. Forget about all the social engineering that Clinton would incorporate into healthcare. We could make significant strides if we just opened up the risk pools to include everyone:
Ultimately, what is disturbing is not the idea of community rating but the idea that millions of people are denied the community rating now enjoyed by the vast majority of Americans -- a denial due only to the accident of where they are employed or to health woes that are largely accidents of birth.
Allowing everyone access to the same risk pools would require mandatory health insurance coverage, but we live with mandatory car insurance and no one seems to mind. This makes the most sense. It would allow people to choose types of insurance coverage that suits their healthcare and financial needs the best, and it would allow more personal freedom in job choices. Our current system of corporate-driven heatlhcare is a system whose time has come and gone. posted by Sydney on
4/18/2004 10:42:00 PM
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Garden Blogging: I know that the New York Times has a wealth of bloggable goodies in today's Sunday Magazine, but this is the first sunny, warm weekend in Northeast Ohio and I'm out working in the garden.
Blogging will resume when the sun goes down. Or when my back gets tired or I get thirsty. posted by Sydney on
4/18/2004 03:29:00 PM
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Where the Money Is: Where our family's disposable income goes:
(Found this on the camera when I was downloading the spring picture above and couldn't resist. My daughter's obviously been playing with the camera.) posted by Sydney on
4/18/2004 03:28:00 PM
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