Placebo Journal - Medical Humor With A Purpose

I am still nauseous after reading a recent Wall Street Journal editorial about retail-based “convenient care”. It was authored by Web Golinkin, who is the president and CEO of RediClinic, LLC. The whole article is a commercial for his garbage product. According to him, these “convenient care” clinics are the answer to the whole health care crisis.

First of all, I can’t call it “convenient care” because it legitimizes a bogus product. For the sake of this article, let’s call it “artificial care” because it imitates the real thing. Golinkin goes on to extol his product like it is the God’s gift to the universe. Here are some examples below that he brings up.

The rest of the editorial captures the real intent of the whole piece. The first part was to convince the world that “artificial care” is the way to go. The second part was to convince the masses that any opposition to “artificial care” is hurting our country by maintaining the status quo. We physicians should embrace his product, says Golinkin. We should hold it, squeeze it, tickle its belly and change its diaper. Heck, he even brings up the point that the American Academy of Family Physicians “recognized that convenient care clinics were filling a need” and “rather than oppose the clinics, it published standards of care that it suggested convenient care operators should follow”.

His manipulation of the AAFP opinion is an example of why every physician should be against this travesty. He took their kindness for weakness. He made it seem like the membership of the AAFP is truly behind the success of “artificial care”. Other than the ones who sold out to get a piece of the action, the majority are not. The AAFP made a mistake and now it is going to bite them in the ass. They were wussies who were too afraid to take a stand like the American Academy of Pediatrics. Now they get to have their words used against them in an editorial claiming that primary care docs are no longer really needed (with these clinics around).

I highly recommend you read the editorial in its entirety. I guarantee, as usual, that I will receive hate email from some NPs or PAs right away. That usually happens if they feel that they are being criticized in any way. So be it. The bottom line is that physician extenders were meant to work hand in hand with doctors in a collaborative effort. Convenient care or artificial care has made this a competition and that will only do harm to this relationship.

An article in the magazine New Scientist describes how computers are being taught to recognize jokes. They have managed to develop a program to recognize some puns by analyzing passages to find which outliers do not belong. It then checks a pronunciation guide to see if a word that makes better sense is identified. If it does, the computer flags the passage a pun. One pun it could not identify was the following:

Because choking makes sense in the context of a doctor’s office, the computer doesn’t recognize it as a joke.

Personally, I am not a big fan of puns. Hardly any physician gets them. Maybe I am just bad at telling these type of jokes but I recently experimented by trying ten different puns on people. The results were so demoralizing that I will never try to use another one. How many of these puns made people laugh, you ask? No pun in ten did.

This October starts our seventh year of the Placebo Journal. Over 90% of new magazines are out of business in one year. Making it past five years is almost a miracle. We are proud to say that we blasted through both those barriers without compromising our values or selling out. You will still not find any pharmaceutical advertising in the Placebo Journal.

I want to thank all those wonderful people who support our whole operation. The subscriptions to the Placebo Journal are the engine that drives everything else. Before this gets too “PBSish”, I will stop. Okay, one more thing. If you are interested in supporting an organization that truly believes laughter is the best medicine, click below for a subscription:

Thank you so much for checking out Placebo Television. And no, The Daily Show has not called yet. But I keep trying. Your feedback has been great and well appreciated. My goal is to make it funnier and more professional each time. I will not have one going out this week but probably early next week.

If you want a free subscription to the Placebo Journal you just need to get a true story published. We are looking for funny and humiliating anecdotes that happened to you. The more embarrassing (for you), the better. The stories must be true, an alias must be used, and no malpractice must have happened. If you are interested in becoming almost famous, go to this link and paste in your anecdote with the appropriate information.

This past Sunday in the Boston Globe, Stephen Bergman wrote an article asking doctors to strike in order to better our healthcare system. He feels this would be a better way for physicians to protect their patients. He states the health insurance industry is too powerful in their lobby efforts, unfortunately, for any real change to happen on its own. He proposes that all doctors give a two year warning that unless things change we go on strike. Every 6 months we increase our ranks as our warnings get louder and the countdown continues. Finally the time would hit that doctors and everyone else who joined in would walk in an effort to make things better.

Bergman, the author of House of God (under the pseudonym Sam Shem) is a very good guy. He got a lot of crap for his book but it was written in a different era and is still funny as hell. I interviewed him for the Placebo Journal and it was evident to me that he has matured and was really motivated, even at that time, to change our healthcare system for the better. Though I am not sure I totally agree with his answer for a universal system, I do agree that we as physicians have much more power than we use. If we all just dropped managed care then they would cease to exist. Unfortunately, we are rarely cohesive enough to do anything en masse. We need to be shaken up as a group (maybe if we were dropped from a “neuro level” fall) to finally get us going. That is why change is dependent on underground and grass root movements like ours to hopefully make a difference.

In a blow to all of us who have been scolded into always using B-blockers for hypertension comes news that we wrong. We were always told that mortality data for B-blockers and diuretics was the strongest and that due to its cost we were basically criminals if we didn’t use these types of meds first. Now evidence from a study in the Journal of the American College of Cardiology shows that the newer drugs are better, in efficacy and in lack of side effects, and therefore superior to the older B-blockers.

A recent Boston Globe article did a nice piece explaining this new research. One sentence, however, really caught my eye. “Dr. Lawrence J. Fine, acting chief of the national agency’s Clinical Applications and Prevention Branch, said the new study will be factored into those recommendations. Dr. Lawrence Fine? Larry Fine? Isn’t he one of the Three Stooges? Doesn’t anyone else remember the old shows where you would hear over the loudspeaker in the hospital “Calling Dr. Howard. Dr. Fine. Dr. Howard”?

While I may have to change my prescribing habits for hypertension, it seems nothing will knock out those memories of useless nostalgia running through my brain. How about a medicine for that?

“Sixty is the worst age to be,” said the 60-year-old, “You always feel like you have to pee. And most of the time, you stand at the toilet and nothing comes out!”

“Ah, that's nothin',” said the 70-year-old, “When you're seventy, you can't even crap anymore. You take laxatives, eat bran, you sit on the toilet all day and nothin' comes out!”

“No, not really. I pee every morning at 6:00. I pee like a racehorse on a flat rock, no problem at all.”

“With great exasperation, the 60-year-old said, 'Let me get this straight. You pee every morning at 6:00 and crap every morning at 6:30. So what's so tough about being 80?”

In another brilliant waste of time, the Archives of Internal Medicine published a study detailing how patients want to be greeted. It turns out, according to their June survey, that 78% want a handshake, 56% want their doctor to give his or her first and last name upon meeting for the first time, 50% want to be called by their first name, and 24% want to be greeted by both names. I did a little more prodding into their research and found some other responses that may be helpful. It seems 1.7% want to be greeted with an erection, .9% want to have their nipples twisted or “nurpled” upon meeting for the first time, and .2% just want cash put in their hand in exchange for leaving the office.

Lofty ideals often result in costly implementation

The concept of medical care for all is not really a concept that has been espoused solely by all of the other countries in the world. I am not sure who started the idea of care for all, but the United States believed in this concept and put it into practice for many years. Medical care for all was something that was in place until fairly recently. My father, like most physicians who practiced medicine, never sent out a bill; in fact he did not have any stationary that would work for billing. Patients paid their small fees with cash. If they had no money other items were gladly accepted. Care for all was the rule in this country until the concept was killed by Medicare, Medicaid, HMO’s, medical Insurance companies as well as greedy “not for profit” hospitals. Before all of these slick programs existed the

United States

had a system that provided treatment for all individuals without questions and without the fear of bankruptcy that characterizes our system today. There were no medical industrial organizations that have escalated the cost of medical care to the point where it can take every last penny from the patients needing care. The indigent could be treated at the County Hospital or similar facilities. Before the days of insurance and Medicare, physicians treated the medically indigent for nothing. Once the fees paid by Medicare were reduced most physicians found they could no longer afford to treat patients without getting paid. This also made care for the indigent less available than in the past.

Medical advances have certainly contributed to an increase in the cost of medical
care. These advances have been enhanced by duplication of many diagnostic
facilities. Radiological facilities with MRI, Ultrasound, Computerized tomography,
and so forth are available in many facilities often not too far distant from each
other. In an attempt many years ago to stop duplication of facilities the
government started a “certificate of need” program. The result of this was
catastrophic. Faced with a deadline of when they could add new equipment many hospitals rushed to buy what was available and spent far more than was necessary to obtain obsolete equipment.

Physicians once imbued with enthusiasm for their chosen profession were willing
to devote far more than 40 hours a week to seeing patients. More recently since
becoming providers in the industrialized complex their enthusiasm has dimmed
with the realization that they deserve to work at the same pace as other workers in our society. The result is a need for far more physicians than was needed in the past.

Careful implementation of all of the above has resulted in the failure of many patients to receive medical care because of lack of insurance or the unavailability of any medical care. Acute emergencies can be seen in Emergency Rooms where care is excessively expensive and often fails to resolve many medical problems. The lack of continuity and poor communication with the primary care physician contribute greatly to the cost and effectiveness of emergency room treatment.

Advertising by hospitals, HMO’s, Managed Care Companies as well as pharmaceutical companies has done little to cut medical care costs. The result of all of the above is that medical care has become extremely expensive and availability of care has also become a problem. There is one factor that is apparent in all of the above-cost containment, availability of medical care have all been adversely affected by Government programs. Physicians and their medical organizations have an opportunity of helping to solve our present problems. I hope they will not avoid their responsibility and expect “government” to fix it. Hopefully we can return to a system where medical care is available to everyone
and bankruptcy because of the cost of medical care will no longer be a major
problem.

This is a call out for donations to give those poor researchers in need of your cash. You see a bill is coming out that may eliminate conflicts of interest at the FDA. In other words, if you receive over $50K from drug or medical device company you would be barred from being on the FDA and therefore voting on those same products. These people are going to need our donations so they can stop taking money from big Pharma, etc.

The FDA has stated that it has trouble finding any scientist that isn’t bought out. That is why Sen. Edward Kennedy is against this bill. Or is it? I only wish the Boston Globe did a little more research on whether he takes cash from these same drug and medical device companies. The bottom line is that this is a copout pure and simple. If these “scientists” are taking hundreds of thousands of dollars from companies who they may someday vote against in a tough issue (Avandia was a recent example) then human nature will have them lean towards the money train. Besides, why do these doctors get a pass and yet if I get a cup of coffee from pharmaceutical rep in Maine then all that data is tallied by the state to use against me (true story, by the way).

My DVD player died after years of service and I needed a replacement. Unsuccessfully, I tried to talk to two customer service specialists at a Big Box Electronic Store. Both seemed preoccupied and probably irritated -- after a few minutes, each was needed urgently somewhere out of sight in the store. There was a huge unmanned "Customer Service Survey Center" with pretty much no employees anywhere. I helped myself and bought what seemed to be a basic replacement. As I checked out, a 20 something year old customer service specialist noticed my credit card has "Dr. " on it.

I just chuckled a bit. My significant other was taken aback. He mistakenly thought that doctors still are respected. I know better but was still somewhat surprised someone would say this -- to my face! I wondered if I should complain to the empty Customer Service Survey Center or if I should commend the store on their perceptive, smart employees. They are pretty much way ahead of the game. I am sure so much money has been spent on the Customer Service program that they can't afford to adequately staff the store. What was I thinking having "Dr." on my card?

A recent study in the Archives of Pediatrics and Adolescent Medicine showed that anything wrapped in McDonalds packaging tastes better to youngsters. The study included kids from age 3 to 5 who got to pick the same product either in a McDonald’s wrapper or in a cup/unmarked wrapper. Significantly more picked the ones with the Golden Arches on it. This proves how important branding is to get people to change their habits. It’s disgusting. On another note, I want to remind you that our next issue of Placebo McJournal is coming out in October. Don’t McMiss it!

13. Maria’s Media Spotlight by Maria Simbra MD

July is a minor sweeps month. Nevertheless it was very busy for me.

To see these reports, go to KDKA.com, click on the word "Video" at the top of the large box (top right), open the drop down menu and click on "Health," look for the headlines mentioned above. They're organized by date, the most recent reports up top.

Surprise. My assistant news director came up with the neosporin allergy piece. Usually, when I'm told what story to do, I put my defenses up. Is it from the sales department? Is the promotions staff looking for something juicy? But this one actually turned out pretty well. The subject was compelling, it turned out to be an informative public health message, all the elements of the piece were at our video taping disposal -- sometimes the stars align.

Pat on the Head. Got an exclusive on a day when all the stations in town seemed to be covering the same stories. While the other stations had come and gone, my photographer and I happened to be at Children's Hospital at the moment a transplant donor and the transplant recipient met for the first time. Woohoo! My news director loves stuff like that.

"Ugh" Moments. A couple of my pieces were promoted based on their titles, not on the substance of the pieces. The pieces were short, yet balanced -- stories assigned to me based on a local conference event. As a result, to deliver on the promotion, my producer decided to plump it up with stuff that wasn't my work. Hate when that happens.

Unique Stuff. Check out the domino transplant piece from 7/18. Pretty cool. Also, I revisited my emmy-nominated series about a nail stylist donating her kidney to a customer. Their first anniversary of the transplant was 7/12.

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