Archive for: August, 2009

Recursive nonsense on health care

Aug 24 2009 Published by under Health care reform, Medicine

People who support our current abominable health care system like to cite Canada's supposed failures as an example of what could happen to us. The argument is a non-starter---it's a straw man designed to scare people. We are a very different country, with a different economy and different needs. Even with a single-payer system, we are unlikely to have the exact same successes and failures as the Canadians. Still, the Right has latched on to any lie they can to try to scare us. That's why a recent article from my hometown newspaper is so upsetting.

Any of us who have practiced medicine near the border have seen Canadian patients---not a lot, but some. I've heard very few horror stories, but that's not the point. The point is the fundamental idiocy of people in the mainstream media trying to write about this.

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14 responses so far

Transposition of the Great Arteries

Aug 24 2009 Published by under Medicine, Science-y stuff

OK, it's time for another science-y post. Usually, I take on something very relevant to my specialty---it's a helluva lot easier to write about stuff I already know. But some basics are just really cool, and worth exploring, even though I'll have to step a bit outside my comfort zone. In this case, it's the heart.  Because I'm venturing a bit on the wild side, I consulted an expert, whose hot, hot science helped illuminate this topic.

If you've taken a basic biology course, you probably have some idea of how the human heart works, but understanding can be a bit deeper if we look at the heart through the lens of things that can go wrong.

The heart is one the most easily recognized and, yet, mysterious organs in the human body.  Physicians of the Hippocratean school first described the valves of the heart in the 4th century B.C.  Since, the heart has historically been described as the core of love,spirituality, intellect, and emotion.  The heart was originally thought to be the source of conscious thought.  The heart is a recognizable icon, source of stress for some of us who have witnessed friends and family with cardiovascualr disease, and a subject of poetry and song.  However, to the physician and physiologist, the human heart is simply a pump whose primary purpose is the circulation of blood throughout the circulatory system.  In fact, the majority of cardiac physiology and pathology (disease) can be easily demystified and understood by thinking of the heart as a mechanical pump.

Humhrt2.jpg

Human heart, post-mortem obviously

The heart is a pump

The heart has one basic function -- to receive oxygen poor blood from the body, pump it to the lungs where it can be replenished with oxygen, and then pump it back to the body where that oxygen is needed.  

If we sliced through the human heart we would find that it has four compartments or chambers.  The top chambers, or atria (singular = atrium), receive the blood.  The lower chambers, or ventricles, pump the blood.

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Human heart from Gray's Anatomy showing the four chambered heart.

The following diagram illustrates how blood travels through the heart:

blood path.gif

 

 Image courtesy Isis the Scientist

  1. Oxygen poor blood returns from the body and enters the right atrium
  2. Oxygen poor blood passes from the right atrium to the right ventricle.  The right ventricle then pumps the oxygen poor blood into the pulmonary artery.   Sometimes people are confused by the pulmonary artery because most people think of arteries as having oxygen rich blood.  The true definition of "artery" is any vessel that takes blood away from the heart.
  3. Oxygen poor blood from the pulmonary artery travels to the lungs where the oxygen is replenished.
  4. Oxygen rich blood returns from the lungs and enters the left atrium
  5. Oxygen rich blood passes from the left atrium into the left ventricle.  The left ventricle then pumps oxygen rich blood into the aorta.
  6. Oxygen rich blood from the aorta is then circulated through out the body.  The oxygen is utilized and the blood becomes oxygen poor.  Return to step 1 and begin the cycle again. 

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26 responses so far

Are you qualified to be a doctor?

Aug 23 2009 Published by under Absurd medical claims, Medicine

My friend Janet has a piece up about what qualifies one to be a philosopher, a piece which is remarkably brief but says much. She points out that get a position at a university, there are certain requirements, but that one can be "off the books". Anyone can call themselves a philosopher, and if enough of us assent to their claim, well, then they're a philosopher, no matter how muddled their thinking may or may not be.
In medicine, we have a similar problem---the problem of assent. To become a primary care doctor (a category which includes internists and family physicians) the "official" training is rather rigorous---four years of university, four more of medical school, three or four years of post-graduate training. After that, one would be wise to take board exams and become "board certified". Then, to practice, one must become licensed---that's the easiest part of all.

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33 responses so far

Health care reform---strike while the iron is hot

Aug 23 2009 Published by under Health care reform, Medicine

I'm really trying to understand this. Really. Why is the outcry against health care reform so much louder than the call for reform? I have a very hard time believing that a majority of people are against some sort of improvement in our system. Around here, people are losing their insurance right and left. But they sometimes seem more scared of reform than of remaining uninsured.
Those of us in favor of a single payer system are shut out of this one. "Medicare for all" is uttered only quietly among well-known co-conspirators. When people who oppose this plan, or even just oppose the president, continue violent rhetoric, bring loaded firearms to rallies, is it any wonder we are silent? How is bringing a loaded gun to a rally not intimidating? And don't give me the "it's only one dude" argument---that's disingenuous and unconvincing. There has been more than once incident, but more important, there has been overt support and quiet assent for nuts like this from the right. When prominent journalists and prominent right-wing politicians fail to condemn this sort of behavior, the intimidation is magnified.
I'm not saying there isn't real opposition to health care reform, but there is an almost complete absence of real debate, and this implied violence is playing a role. We already entrust our elderly to the government's care, and we're pretty damned happy about it, so why not expand it? Do people seriously believe they will have decreased access to services? Do they have any precedent showing that extreme forms of rationing are taking place in any other democracy? Do they have data showing dissatisfaction or worse health outcomes?
Of course not. It's a purely ideological debate, leaving real, suffering people behind. Let's start interviewing people recently released from the hospital and staring at a $60,000 bill. Let's interview former auto workers who are both unemployed and uninsured. Let's talk to doctors on the front line, trying to find ways to treat diabetic patients who can't afford medications or testing supplies. Let's visit rehab wards and dialysis centers where these folks end up after our first failure to care for them.

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28 responses so far

Stewart v. McCaughey---more to it than you think

Aug 21 2009 Published by under Health care reform, Medicine

Last night's Daily Show was hands down the best discussion of the health care reform insanity on TV, radio, or web. What interested me the most was how McCaughey revealed some of her real agenda, and how she actually brought up some almost-right points. Even more surprising, Jon Stewart misunderstood some bits that need fleshing out, so here we go.
We've met McCaughey before as the right wing wacko pushing the death panel idea. She does a good job hiding her real agenda for a while with Stewart, insisting on her support for public health care, and for end-of-life discussions. Let's review her words from Rush Limbaugh's show:

The health care reform bill "would make it mandatory -- absolutely require -- that every five years people in Medicare have a required counseling session that will tell them how to end their life sooner."

In her interview with Jon Stewart, she's a bit more careful with her words. What she does is draw a line from reimbursement for end-of-life counseling to practice quality measures, to physician incentive payments, implying that this tenuous line will lead to "bad things".
What Stewart missed was the whole "quality measure" thing. Medicare has a program called PQRI in which they collect data on quality of care and reimburse physicians who track these measures (many physicians, myself included, believe this really means that we will only be given full payment for tracking PQRI). For example, if I track data on whether my diabetics are offered certain tests, have their blood pressure checked, etc., I get a bonus payment (supposedly). At this point, I don't get penalized for bad blood pressures, or rewarded for good ones. The only reward is in the tracking.

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5 responses so far

Skeptics in the Pub!

Aug 21 2009 Published by under Narcissistic self-involvement

It's about time! Thanks to some terrific folks, like my buddy JB, we are having our first SE Michigan Skeptics in the Pub. This is an informal pilot, originally a small get-together, but seems to be growing. If you're in SE Michigan and want to have a beer with a group of like-minded folks, including this blogger, and perhaps some other better-known bloggers, c'mon down.

6 responses so far

VIBE Machine---not half as fun as it sounds

Aug 20 2009 Published by under Absurd medical claims, Medicine

Let's say you have cancer. And let's say you're really, really sick of having cancer. And let's say that you're also pretty tired of scans, chemo, radiation, hair loss, nausea. And let's say you're not really sick and tired of living, but actually pretty happy to be alive.
Finally, let's say someone says that they can get rid of your cancer, without all of those pesky side-effects. It's a win-win, no?
No.
It's easy to believe in promises that are congruent with our wishes. That's what makes human beings so easy to deceive. A case in point is the VIBE Machine, a discredited quackery device. This thing was marketed until about a year ago. Not surprisingly, Orac has written about this thing in his Friday Dose of Woo. Stephen Barrett, the King of Quack-Busters, has also tracked the sordid history of this rip-off. The device was recalled back in 2008, so this shouldn't even be a story anymore, except that word of the device still circulates among cancer patients and their friends. The company's website is down, which is good, but this thing is still out there.
At least one website is still promoting it in detail. The website is, needless to say, a whole lot of words that make no sense:

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39 responses so far

Thanks, Doc

Aug 20 2009 Published by under Medical Musings, Medicine

I was one of those crazy folks who loved medical school---not just the clinical years, but the pre-clinical sciences as well. The transition from pre-clinical to clinical can be rather unnerving (picture learning how to do a pelvic exam on paid models). One of my first clinical experiences was in our physical exam class. Much of this was done on each other (not the pelvics), but we were also paired with attending physicians who would take us to see---gasp!---actual patients.

The guy I was paired with was old---impossibly old. I wondered to myself if he still had a jar of leeches in his office. But he wore medicine like an old, comfortable coat. I, on the other had, was wearing my short white coat for the first time, and feeling particularly clueless. When we were on our way to see some of his hospitalized patients, he said we had to stop by the ER to see a patient of his---the ER! Cool!
The one thing I remember was the EKG. He picked it up, glanced at the red and white paper with the 12 separate tracing on it, and said, "yeah, he's probably fine." He didn't teach me to read EKGs. But he showed me that some day I would be able to glance at one for a moment and pronounce someone "OK" or "not OK". It was magic.

Anyway, my alumni newsletter arrived in my inbox today. "Dr. Paul Winter was a senior attending physician and associate professor of medicine emeritus...He is survived by..."

Thanks, Dr. Winter, for helping keep the magic alive.

7 responses so far

What is "health care"?

Aug 19 2009 Published by under Health care reform, Medical ethics, Medicine

In his latest comment, Philip H has accelerated my reluctant discussion of health care reform. In fact, it was Philip who bullied me into writing about this topic in the first place. I've been avoiding wading into this mess, but being on the front line, it's in my face every day.
What he says in his latest comment is this:

[T]he idealogical leap PalMD is asking for is a good one, but it misses the mark. The leap we need to make is that healthcare is not a good, like Cheerios, or cars, or flatscreen tv's, that exists in anything like a free marketplace.


Commenter Donna B.
makes a tangent assertion, that in fact health care is, "a service, a good to be purchased, and is therefore not a "right" as such (she also does not have a problem with government subsidizing or being involved in some way, so don't stomp all over her without reading her full words).
If health care isn't a "good" in the sense of "commodity", and it isn't a "right", then what is it?

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31 responses so far

BMI TMI week #2 roundup

Aug 19 2009 Published by under Medicine

So, I'm at the end of week #2. I started, fully clothed and after breakfast, at 212. Last Wednesday I was 208.
Today I'm 206.
My successes have been in maintaining sustainable eating habits. My failures have been in keeping to an exercise program. I haven't been completely sedentary, but I can do better.

9 responses so far

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