Placebo Journal - Medical Humor With A Purpose

Okay, so I finally saw the movie. I had to take my family with me as the only place showing the damn thing was 40 minutes away. My older boys (15 and 14) felt it was well done, but they were skeptical about some of the information. My 8 year old daughter was bored to tears. My wife enjoyed much of it but also doubted many of Mr. Moore’s accusations. She especially hated how he focused on the word FREE that people used when describing care in other countries. She is right. Nothing is free.

I let my thoughts percolate for a while. I rehashed some of the scenes in the movie (the term “documentary” really is questionable). I have also read the articles written about SiCKO as well as seen Michael Moore fight it out with both Wolf Blitzer and Sanjay Gupta.

Basically, SiCKO was a very good movie. It has opened the public’s eyes to many of the problems in our healthcare system. Personally, I agree with Moore that we need a change. I also agree with him that all Americans should have the opportunity to have healthcare. So our beginning point and end point is the same. What the real problems are and how to fix them is where we tend to split. I believe healthcare should be affordable and not free. I also believe in a 300 million payer system and not a single payer system.

I am grateful, however, that he didn’t hammer physicians in this piece. He could have. I envisioned him secretly filming a pharmaceutical sponsored dinner with a dozen doctors eating at a 5 star restaurant. The “expert” speaker could have been found to be a pharmaceutical whore. Moore then could have tracked the doctors’ prescribing habits over the next year and determined whether they were influenced by that dinner.

Moore could have also gone to a big ACP, AAFP or ACC medical conference and exposed how much big pharma was paying for their exposition hall. Moore easily could have tracked how drug reps are hired (looks?) and made that whole scene look silly. He didn’t.

Two omissions that were needed, however, were the trial lawyers/tort reform and patient responsibility.

You can see that my picture included in this piece is a parody I am putting in the next Placebo Journal. It is called LiTIGO and I pretend to go on a journey, like Moore, to discover how other countries handle the malpractice lottery. It turns out they have great answers for that as well. Without tort reform and malpractice insurance reform, doctors in this country will continue to order tests to cover their asses instead of being cautious but fiscally responsible. This issue is real and adds to the bankrupting of our healthcare system. A point Moore left out.

Lastly, the big issue of patient responsibility needs to be addressed as it is a huge piece to solving the puzzle. On many occasions, Moore points out how unhealthy we are and how we rank low compared to other countries. What he doesn’t say is that the diseases that we rank poorly in are all behaviorally determined. We are a fat, gluttonous and spoiled country that wants quick fixes but continues to ignore our own personal health. I often tell patients, “Ask not what your doctor can do for you. Ask what you can do for yourself.” No fix to our healthcare system will ever work when the people of that system smoke, eat poorly and rarely exercise. Add to this the mentality of “I want the best and I want it now or I will sue” and you have the perfect recipe for imperfection. Which is what we have now.

Finally, I have thought long and hard about this. I am not a huge fan of Michael Moore. I also have a lot of disagreements about this film. I do, however, respect the fact that he focused on a topic that our slimy politicians have been skirting around forever and brought it to our attention. He provoked the healthcare debate and hopefully we can all use this for good. He also made HMOs and managed care look disgusting, which they are. For that part alone, I am awarding Michael Moore the 2007 Placebo Journal Tenesmus Award.

(THIS STORY IS BLOGGED AT Placebo Journal BLOG)

Dr. Richard Carmona came out recently stating that he was basically muzzled by the Bush administration during his tenure. What a surprise. Anyway, Camona stated he was routinely blocked on speaking about controversial topics like stem cell research, emergency contraception, and sexual abstinence. The WSJ reports that he felt he was pressured to support an “ideological, theological agenda”. Did he not see that coming in? This administration has routinely let theology butt heads with science. My question is, however, what the hell does the surgeon general really do anyway? The WSJ states the post has little formal power but can be a megaphone on public-health issues. Dr. Carmona couldn’t even lend a hand to the Special Olympics because they were founded by the Kennedy family. Well, Dr. Carmona, that is an out and out lie. You were prevented from speaking at the speaking at the Special Olympics because of that whole snafu when W. didn’t get his silver medal.

This is an open invitation for Dr. Richard Carmona to have a forum for all the controversial topics that he had edited in the past. We’ll publish them all.

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Right hand, meet left hand.

One of my patients was asked to send in documentation for continued SSDI
benefits. They wanted her to list every doctor's visit for the past 2
years. She told them she sees 7 different doctors and that it would be a
tremendous burden to try to reconstruct all those visits. They were
unsympathetic.

SSDI is administered by Social Security, which is part of HHS.

Medicare (her insurance) is administered by CMS, also part of HHS.

I suppose it would be far too logical for our governmental bureaucracy
to just get her to sign a HIPAA waiver and get the printouts of every
bill ever submitted by every treating doctor for the past two years,
along with the ICD and CPT codes.

The Canadian Medical Association Journal stated that Canada has emerged as a major supplier of physicians to the United States. In the past 30 years, 19,000 have crossed the border to practice here. Last year there were 8,162 Canadian-educated physicians providing direct patient care in the US (one in nine Canadian docs). This is adding the severe shortage of physicians that they are having. Now why do you suppose they are crossing over if it was so great over there? Hmmm.

The Joint Commission released a public policy report describing the dangers of poor communication between docs and patients. They are worried about the public safety aspect of this ever growing problem. What problem? Well you see with more non-English speaking folk in this country the doctor is going to be on the hook to get them to understand. The Joint Commission recommends 35 actions to improve communication and they are going splice it into the Pay-for-Performance crap. More red tape coming our way. Who else just wants to surrender?

Doctors at a big city hospital were on strike. Hospital officials stated that they couldn’t figure out what the doctors' demands were but were bringing in a team of pharmacists to go over there to read the picket signs.

8. Ridiculous Study of the Month

This month’s ridiculous study was sent to me by a reporter and comes from Nature Medicine. The Washington Post broke the “big news” here:

http://www.washingtonpost.com/wp-dyn/content/article/2007/07/01/AR2007070100431.html

By using mice, they have come to the conclusion that stress can promote obesity. The researchers showed that the neurochemical pathway they identified promotes fat growth in chronically stressed animals that eat the equivalent of a junk-food diet. By blocking this pathway they may block fat build up. The group is now trying to get a patent and is already negotiating with the drug companies.

So let me get this straight. If people get stressed they will eat junk food and get fat? Who would have thought that? Actually you know nothing will come of their revolutionary technology. It just was a filler article because people love to hear about anything that can help them lose weight.

Personally, I couldn't get past the image presented in the piece of a mouse standing in cold water or being caged with a more aggressive alpha mouse for 10 minutes a day. I just kept picturing the two fat mice at the end of a long experimental day comparing who had a worse life as they chowed on potato chips and Snickers bars.

At each age we see things a little differently. I once had the idea that at age 80 people would be largely inactive, would stay at home to take their medicine on time and visit their doctor regularly; most would be incapacitated by arthritis of one sort or another with associated backache and a slightly tilted bent over posture. Having arrived at this stage several years ago I have discovered that it is just a little different and not too bad. I have not been confined to my house and I manage to get along fairly well without assistance, at least for the present. I continue to accumulate “miles” on several airlines. There are many events that we see clearly through our eyes as they are focused at the time. Things often appear slightly different when viewed in perspective. The following scenario I believe demonstrated this quite well. While interning I was in the emergency room one evening when we heard a screaming woman in the parking area. I accompanied one of the nurses to investigate. The woman had not stopped screaming. The car was in the back of the parking lot and there was no lighting. We found the woman pinned underneath her companion. Her companion was quite large, no longer breathing and the positions were such that there was no doubt as to their activities. We helped to extract her and take her companion to the emergency room although it was fairly certain that any ministrations would be futile. The individual was the fire chief of the city and his female companion was his sister in law. His activities apparently were beyond the capacity of his heart’s capability and resulted in his demise. The situation at the time I though was a great tragedy. To die in such a compromising situation I thought was one of the worst things that could happen to anyone. Today I find that this situation looks completely different. I believe that rather than feeling sorry for the man I think he should be thought of as fortunate to die suddenly while engaged in such an enviable activity.

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Below is my grandmother, Esther Liden, disrupting presidential candidate Barack Obama's speech at an adult day care center in Columbus, Ohio. My grandmother was happy that Mr. Obama is going to give ex-felons more job opportunities. For the record, my uncle is not an ex-felon but works in the pharmaceutical industry. (Editor’s Note: Isn’t that the same thing?).

Obama got a packed house and huge applause before saying anything about what he would do as president at "Almost Family", a home for care of the elderly in Columbus Ohio today. For a while it was all about the influence of lobbyists in Washington, the tragedy of Katrina, the tragedy of Iraq, the need for a politics of the people, the need for hope and optimism. All opposition to the way things are, and the need for something vaguely better. All feel good. And a lot of people clearly felt good in the room. Then Esther Liden, an 84 year old startled Obama by shouting "all right!" "you said it!" "we do feel good!"

So, prompted by the 84 year old, what had Obama done? (article edited)..…..Obama said he would index the minimum wage to the cost of living. He said he would invest in infrastructure. He said he'd work to give jobs to ex-felons. At this point Esther Liden interjected she thought her son might be an ex felon, so this could be a great help. Obama went on to say he would support the right to unionize the Employee Free Choice Act. Each point earned loud applause from the elderly crowd, and the big one was still to come.

Obama said he wants to end the occupation of Iraq, and that he opposed it before it started. (Again, Esther Liden jumped up in a black sweater with white sneakers and shouted "Don't fund it!". Obama ignored her this time.)

And he went back into talk of hope, justice, and turning the page. And the
applause was thunderous.

Yes, Esther really is my grandmother! My grandmother was always a riot when she was all there. She loved practical jokes and silly things. And she was always enthusiastic and she is still going. I just can't believe that they would have a presidential candidate speak to a group like this....but then hey, why not? Being president they will have to reason with all kinds of irrational leaders...why not practice reasoning with Alzheimer’s Dementia folks?

I honestly think we should have all the presidential candidates speak in front of similar groups with a significant percentage of Alzheimer’s Dementia afflicted citizens to see how they would react. And I want to give you all a glimpse of how I will get as my AD progresses.

Remember what I said about patient responsibility and how Michael Moore missed that part? Here is where it gets sticky. You all know I hate P4P for doctors. Now what if insurance companies make a P4P program for patients? In other words, if you were healthier then you would get lower rates. Well, UnitedHealthcare is doing just that. They have a program where employers will offer high deductible insurance plans ($2500 single workers, $5000 family). If the workers want to volunteer to screen for their cholesterol, blood pressure, or height/wt ratio check then they may bring it down to $500 for a single worker or $1000 for a family.

This is all very intriguing and I really don’t know where I stand yet. I hate P4P so much for docs that it would be a tough pill to swallow for me to endorse for any other group (including patients) to have it.

I know some patients, for example, that are thin and exercise but have genetically caused high blood pressure or cholesterol. Would being on medicine be allowed to get the cost of their insurance down? If not, I see a huge black market to sell statins and antihypertensives to fool the insurance exams. I may get rich in this business after all.

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