Archive for: July, 2009

Health care reform---how to obfuscate, confuse, and inflame

Jul 30 2009 Published by under Health care reform, Medical ethics, Medicine

You can count on the Wall Street Journal for pretty good reporting and for extremist right-wing wackaloonery on the OpEd page. Today, they deliver the latter, with bonus fear-mongering at no extra charge.
The piece is entitled, "GovermentCare's Assault on Seniors" and that pretty much sums up the content of the article. Unfortunately (at least, for the moral health of the author), there is little below the headline to justify the inflammatory headline.

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35 responses so far

Health care reform, part III

Jul 30 2009 Published by under Health care reform, Medicine

OK, in parts I and II we talked about health care problems specific to patients and to medical science. Now, on to the providers themselves. Before you start whining about how doctors need to suck it up, remember that you are entrusting your lives to us, and that you should want good people to go into medicine and stay there.
Physician-related problems

  • Medical education: It is long and very costly. In the U.S., we do not follow a vocational model as many other countries do. Here you must complete a four-year university degree, a four-year medical degree, and a residency program (at minimum). This is payed for by the students themselves, so that it is not unusual for a student to enter residency with 200K in debt. Residency, which is a minimum of three years, usually pays about 40K, so not much debt is being repaid (but interest is accruing on some loans). This means that an average doctor in the US needs to be paid A LOT just to maintain loan payments. Starting up a practice often isn't an option, as there is no money left. This leads to additional problems/solutions.
  • Reimbursement: Doctors' fees make up a small percentage of health care costs but it is often seen as low-hanging fruit. Remember though, that doctors are repaying enormous personal debt in addition to the usual work of raising a family and creating a career. Remember also that once a doctor is committed to a house, a debt payment, the costs of a practice, then drastic changes in payments will collapse the system. Doctors will lose their homes (yes, really), default on debts, and be unable to sustain their practices.

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28 responses so far

Skeptics' Circle #116 is up!

Jul 30 2009 Published by under Absurd medical claims, Medicine, meta-blag

I've been a terrible netizen. I haven't been keeping up with my blog carnivals, especially my favorite, the Skeptics' Circle.
Well, it's up now at Beyond the Short Coat. Go and read!

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Health care reform, Part II

Jul 29 2009 Published by under Health care reform, Medicine

In part I, I presented you wish some admittedly artificial categories of problems in our health care system. First we discussed patient-centered problems. Today, we'll look at problems posed by medical science and practice itself.
Medical science
The science of medicine is not always compatible with the practice of medicine. Medicine is still largely a cottage industry, with hard-working, independent practitioners working in small or medium-sized practices. Aside from licensing statutes, there are no official guidelines that doctors must follow to be officially "certified". Once a doctor has a license, they can pretty much practice as they see fit, with only the threat of litigation or the less realistic threat of medical board censure to rein them in. Is this a good thing, a bad thing, or doesn't it much matter? How does this affect the health care system as a whole?

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8 responses so far

Is Rush dumber than my shoe, or just evil?

Jul 28 2009 Published by under Health care reform, Medicine

Yes, I know, the two are not mutually exclusive, but I still think it's a good title. The latest bit of evil idiocy? More fanning of fears about health care reform. Don't misunderstand, there's plenty of potential pitfalls to health care reform, but Rush is an idiot. He calls it "Five Freedoms You'll Lose Under Obamacare". Let's see what he's talking about.

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13 responses so far

Health care reform, part I

Jul 28 2009 Published by under Health care reform, Medicine

I know only one certainty regarding health care reform in the US: I won't be a significant policy maker. And neither, likely, will you. But that doesn't mean we shouldn't educate ourselves, try to understand the problems and potential solutions, because whatever our government implements over the next year, health care reform is going to be a process, rather than a single, achievable endpoint.
I've been consciously avoiding writing this piece, but people keep bugging me. One of the reasons I've avoided it is because I'm not a policy expert, and I don't want to do the extensive research necessary to create a comprehensive piece. I also want to create a relatively objective piece, as much as that is possible. To make my goals a bit more realistic, I'm pointing out some of the problems and solutions that are more clear to me, meaning this is in no way comprehensive. Given the scope here, I'm going to break this down into a few separate posts.
But first, why should we even care? What's so important about health care reform? Economically and ethically, our system is a mess. If we are to create a society that is not some sort of ultra-libertarian hell, we have to consider the morals of how we take care of each other. We spend too much, achieve too little, and leave too many people out.

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3 responses so far

When you believe your own lie, is it still lying?

Jul 27 2009 Published by under Absurd medical claims, Medicine

Smelting: gerund, the act of catching smelt (a small Great Lakes fish) by dipping a bucket in the water during the smelt run season: ex. Smelting is like shooting fish in a barrel.

Sometimes it's too easy. You see, when you criticize someone for being wrong, that's one thing, but when you imply that they are wrong because their entire world-view is incorrect, well, sometimes you get a response.
In a piece last week I was very critical of a new diet and it's creator, and she apparently watches the web, because she came by to comment.
From reading her website and her comment, I get the distinct impression that, like many people, she is sincere in her wrongness, and probably a good person as well. But as we've discussed before, being sincere does not excuse someone from ethical culpability.
As you recall, I criticized her, perhaps too broadly (and perhaps not) for claiming that INFLAMMATION was the ONE CAUSE OF ALL DISEASE, and that her special diet could fix that. Of course, as far as she is concerned, her ideas are far more nuanced, so let's let her speak for herself and see where I got it wrong.

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8 responses so far

What we have here...

Jul 26 2009 Published by under Health care reform, Medicine

Lawmakers and the public in general have no idea how the business and practice of medicine operates. None. When you read statements from many representatives, you see such simplistic, anhistoric thinking that pessimism about health care reform is the only logical response.
Or so it seems from media reports. The New York Times, whose quality seems to be dropping by the femtosecond, reported this week on salaried vs. traditionally paid physicians. This could have been a terrific article, if the reporter knew anything.
Let me catch you up a bit. Doctors are generally paid in one of two ways. They are either salaried employees of a health care system, or they are on their own, billing insurers and patients for the services they provide. For the latter, it is not precisely true, as the Times reports, that, "the more procedures and tests they order, the more money they pocket."
My perspective on this is pretty intimate, as I have two jobs; one in which I'm salaried, the other in which I'm a traditional fee-for-service private practice doc. In my private practice, I am paid a modest fee for seeing a patient. If I order one of the few tests I offer in my office, such as an EKG or a chest X-ray, I can bill for that as well. But the fees are pretty much set. Medicare decides what "fair" reimbursement is, and the rest of the insurers follow suit. If my rent goes up, I cannot raise my fees. If I want my patient to get more procedures or more tests, I can't profit from it, although I could if I owned big, fancy machines. Doctors who own their own stress test machines, etc, can make more money, so that incentive is certainly there. But for the average primary care physician, there is no incentive to "do lots of more". The only incentive built into the system is to see lots of patients so that you can pay the rent.

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23 responses so far

I love covers---is that wrong?

Jul 25 2009 Published by under Narcissistic self-involvement

Desire is a great friggin' album, and this is one of the better songs, but I never knew about this cover. A shout out to my buddy, whose musical tastes might run in another direction.

3 responses so far

Magic diet? Not so much

Jul 23 2009 Published by under Absurd medical claims, Medicine

Alternative medicine practitioners love to coin magic words, but really, how can you blame them? Real medicine has a Clarkeian quality to it*; it's so successful, it seems like magic. But real doctors know that there is nothing magic about it. The "magic" is based on hard work, sound scientific principles, and years of study.
Magic words are great. Terms like mindfulness, functional medicine, or endocrine disruptors take a complicated problem and create a simple but false answer with no real data to back it up. More often than not, the magic word is the invention of a single person who had a really interesting idea, but lacked the intellectual capacity or honesty to flesh it out. Magic is, ultimately, a lie of sorts. As TAM 7 demonstrates, many magicians are skeptics, and vice versa. In interviews, magicians will often say that they came to skepticism when the learned just how easy it is to deceive people. Magic words in alternative medicine aren't sleight-of-hand, but sleight-of-mind, playing on people's hopes and fears.

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33 responses so far

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