- Hoax or Real Email
- Infiltration
- Placebo Journal Update
- Gorback’s Thoughts by Michael Gorback MD
- Hillary Scare
- Vaccine Wars
- Joke of the Week
- Ridiculous TV Reporting of the Month
- Bacharach’s Beliefs by Ted Bacharach MD, retired
- Just Be Honest
- Make Mine Fake
- I Want My Quinine
- How About Some Props?
- Feedback About The Placebo Gazette
1. Hoax or Real Email?
Who is Debra Macurley? Is she real or fake? Who knows? The bottom line is that in a spontaneous fit of insanity we sent out an email that parodies a well known internet hoax. Boy, did people get pissed at us. Many reported us as spam (79 to be exact). Others were nice enough to warn us that a spamming operation may have co-opted our files and taken over. The email, in its entirety, is shown below. I still think it is funny but I apologize for any stress it may have given you.
My name is Debra Macurley the daughter of Mr. Williams Macurley of Zimbabwe, Maine and a big fan of the Placebo Journal. It might be a surprise to you where I got your contact address but all I had to do was promise to write this email and the publishers of the Placebo Journal would have given me anything.
During the last crises against the doctors of the world by the supporters of the medical axis of evil (pharmaceutical industry, lawyers, managed care companies),all the physicians were ordered to surrender their souls to these groups in order to receive a paycheck. My father was one of these doctors and lost his will to live after only a few years of filling out prior authorizations, using Electronic Medical Records, and turning to an "open access" schedule. After his untimely demise, Dr. Farrago's supporters asked me to spread the word about all the medical injustices that continue to occur.
After the death of my father, my mother and I decided we would do something about all the problems in the healthcare system. We took along with us the money my father kept in his safe, which amounted to $7.41 and decided to work with Dr. Douglas Farrago and ask him to assist us in humanizing healthcare.
As the only true King of Medicine, he has been gracious in offering his help as long as we bought a subscription to the Placebo Journal as well as give him a pair of our socks (which we thought was weird). We also promised to increase the awareness of his propaganda by sending out this email.
This is where you come in. PLEASE, TREAT THIS PROPOSAL AS TOP SECRET. Now he will not leave us alone unless you consider our proposition of either subscribing to this most pathetic medical journal or becoming a LIFER. If you are either, we would ask for your assitance in sending this parody of an email scam to someone else you know so that he or she may make this investment.
My family and I await your response as we truly want our socks back. Your urgent response to my personal request will be highly appreciated.
I anxiously await your reply. Thank you.
Best regards,
Debra Macurley
For the family.
2. Infiltration
Can someone please tell me why Donovan McNabb has to sit in front of a Coreg CR sign while discussing his success or mishaps on the playing field? We are all sick of the direct-to-consumer commercials by the pharmaceutical industry. This, by the way, isn’t going away as Congress has been paid off to keep it legal. The result? Viva, Viagra commercials roam the airwaves. Naked people sit in old fashioned bathtubs outside a farm. Whatever. But why do the Philadelphia Eagles need to put Coreg CR behind McNabb’s head after a game during their press conference? Greed. I’m disgusted. And if the makers of Coreg CR want to call me, I will give them a piece of my mind as well as consider selling the space behind my head during my Placebo Television broadcasts. Hey, I’m a family doc and can use the cash.
3. Placebo Journal Update
You have until Sept. 30th to get in on the next issue of the Placebo Journal. Only 2 more days. Come see what all the fuss is about. Inside we have:
· Docopoloy
· Extort – the newest BP drug
· Med School Musical
· X-rays, X-rays, X-rays
· Much, much, more
SUBSCRIBE
4. Gorback’s Thoughts by Michael Gorback MD
Item #1: Companies that data mine physician prescribing records are suing the states that have enacted privacy laws. IMS health, Wolters Kluwer Health
and Verispan have filed lawsuits in Maine and Vermont to stop the laws
from being enforced when they go into effect January 1, 2008. A similar
law in New Hampshire was struck down by a federal judge citing freedom
of speech issues. That is being appealed.
Let's see . . . HIPAA can gag us from talking about confidential
patient information. Where's our free speech? However, when it comes to
our professional privacy then suddenly there's a need for lots of free
speech.
Let's exercise our own brand of free speech: publish data on which drug companies monitor us and then boycott their products.
Item #2: “In response to last year's controversial decision by some major health insurers - including Blue Cross Blue Shield of Texas - to rate and rank doctors based on several criteria, the Harris County Medical Society has launched a survey that allows doctors to publicize their opinions of insurance companies.”
I am in Harris County and happily filled out one of these surveys. Talk to your local medical society about doing this. Two can play this game.
Item #3: I was reading a report from the Congressional Budget Office about the SGR formula. It said that when fees drop, physicians see more patients and the level of intensity of interventions rises, and costs remain high. How can we stop this?
The answer is simple: pay doctors not to treat people. We have been doing this with farmers for years, paying rich people with lots of land not to grow crops.
Here's how I think it should work. Instead of issuing denials, which pits us against the insurance company in a battle to be allowed to provide the service, it would be so much easier if they just paid us not to do it. So instead of an antagonistic system where we want to provide a service that makes us money, and the carrier doesn't want to provide the service because it costs them money, how about the insurance company pays us to sit on our hands? Then instead of us against the insurance company, it's us AND the insurance company against the patient. And let's face it - who is writing us the big checks? The carriers. And who racks up the big bills? Us. We should be cultivating them and vice-versa.
Let's say you have a patient with a 90% left main stenosis. You want to do a PTCA and stent. You send in a precert request and the carrier responds with: "We can precert this or we will give you $500 not to do it." Next thing you know, it's medication management time. You could even do a Dutch auction. Gather up a bundle of precert requests and see who has the low bid to not perform the procedure. Lowest bid gets paid to not do it, while the others have to actually work for a living. Another possibility would be to identify the busiest doctors and pay them not to work.
The most obvious objection would be that people would be paying for health insurance but not receiving any benefits. Well, according to the Institute of medicine, medical care is one of the leading causes of injury and death in this country. So people should get healthier if stop treating them. The fewer patients treated, the fewer medical mishaps we'll incur. The people who really insist on having medical care can take the Michael Moore Express to Cuba.
Here's another idea: Instead of raising our fees, how about just extending oil companies subsidies to physicians?
1. The Physician Depletion Allowance. There should be a 15% tax credit on gross revenues on all new patients seen, and it should extend for the life of the patient, just like the Oil Depletion Allowance does for oil fields. As the Oil Depletion Allowance is supposed to encourage oil companies to find new sources of oil (they wouldn't do that anyway?), the Physician Depletion Allowance would encourage doctors to find new patients.
2. The Intangible Setup Cost Deduction. You can deduct 70% of the cost of setting up a practice, new office, branch office, or new ancillary service in the first year, and 30% in the second year, just like the Intangible Drilling Cost Deduction for new oil drilling operations.
3. The Enhanced Oil Recovery Credit encourages oil companies to keep working fields that are nearing depletion or have oil that is hard to extract (like thick crude). The Enhanced Patient Recovery Credit would give us a tax credit to encourage us to continue treating patients who are barely salvageable, such as morbidly obese brittle diabetics who continue to smoke.
Just like with the oil subsidies, we might be able to get combined tax credits and deductions that exceed the actual value of the goods and services!
I'm sure we could sell the concept to Congress.
5. Hillary Scare
Hillary Clinton recently came out with her new plan for a future healthcare system. As you may remember, she attempted it once before in the early ‘90s when hubby was President and it went absolutely no where. Her new plan is called “Health Choices” because she is basing its success on the appeal of its sound bite. We all love choice, don’t we?
The first part of her plan is the requirement that everyone have some sort of health insurance. Called the “individual mandate” by some, it is criticized by many as a knock on our personal freedom. Personally, I like the idea. I recently saw a 29 year old patient who cried poor about not having insurance only to find out he spends $500 a week on his bar tab alone. He just no-showed on his last appointment to follow up on four different issues.
Hillary’s plan has a “pay or play” tax on businesses. Either you offer health insurance for your employees or you pay into the system. Not sure about this one but we will let Massachusetts figure that out.
Her plan also has a new public insurance option that is open to everyone regardless of income. Uh oh. A government run plan? Not good. Add to this that Hillary will require all insurance companies to offer policies to all applicants through some new strict regulations and….voila…we have a huge cost increase for these plans. Again, not good.
Where would Hillary get the money to pay for all this? The evil rich, of course. First, she would, like every other Democratic candidate, repeal any Bush tax cut. Then, when that doesn’t work, she will HAVE to create new taxes in order to pay for her plan.
My hunch here is that all the plans by the Democrats, including Hillary’s, are Trojan horses. It is made to look like nothing is wrong at first but soon as we let it through the gate, there are going to be a whole lot of taxes jumping out of the thing. Just like the State Children’s Health Insurance Program it would start out small and then expand.
6. Vaccine Wars
As much as I feel bad for parents of autistic kids, I have to let science guide me in my opinion about whether vaccines were the cause of this horrible disease. A study in the New England Journal of Medicine showed no link between infants exposed to mercury based vaccines and the development of their language, behavior or intelligence. The study wasn’t directly looking at autism (a big CDC study will be coming out in the future) but it sure put a damper on the advocacy groups that want to make the vaccines out to be evil. The study showed that the thimersol exposure improved test performance in some kids while decreasing it in others. This, by the way, did not quell the complaints by of Sallie Bernard, a member of a panel of external consultants who actually helped design the study and review the results. “The way the study was written was biased”, she said in a recent USA Today piece by Anita Manning. Coincidentally, a few days earlier, the USA Today ran a full page ad by Generation Rescue. It read “ARE WE OVER-VACCINATING OUR KIDS?” On their website is a “hall of fame” section listing, you guessed it, Sallie Bernard. Some of it reads as follows:
“Since 1983, the number of vaccines the CDC recommends for our kids has more than tripled. During these same time period, we’ve seen an explosion in neurological disorders like ADHD and autism…”
“We commissioned a market research firm to survey more than 17,000 children in California and Oregon. We found that vaccinated boys had more than 2.5 times greater rage of neurological disorders than unvaccinated boys.”
No who are you going to believe? Those morons at the NEJM or a well paid commissioned research firm? I always say that you should never let facts and science get in the way of a good old fashioned advocacy movement or a possible mega lawsuit.
7. Joke of the Week
A man goes to his doctor and says, "I don't think my wife's hearing is as good as it used to be. What should I do?" The doctor replies, "Try this test to find out for sure.
When your wife is in the kitchen doing dishes, stand fifteen feet behind her and ask her a question, if she doesn't respond keep moving closer asking the question until she hears you."
The man goes home and sees his wife preparing dinner. He stands fifteen feet behind her and says, "What's for dinner, honey?" He gets no response, so he moves to ten feet behind her and asks again. Still no response, so he moves to five feet. still no answer. Finally he stands directly behind her and says, "Honey, what's for dinner?" She replies, "For the fourth time, I SAID CHICKEN!"
8. Ridiculous Study of the Month
I recommend you check out the article written by Rita Rubin of the USA Today where she writes of the recent study in the Archives of Internal Medicine about whether there is a true need for routine physicals with your doctor. Taking into account the cost for such visits, the authors concluded that this is not money necessarily well spent. I guess their feeling is that since we physicians don’t always find bad things then those visits are wasted. My favorite line in the piece is from lead author Ateev Mehrotra. Since many patients see their doctors at other times of the year, instead of doing a physical the physician could have “provided counseling and possibly ordered preventive tests” at that time. What color is the sky in the world this guy lives in? I just love it when those doctors in academia spout about how we should practice in the real world. Just because he sees three patients twice a week doesn’t mean he is a practicing internist.
9. Bacharach’s Beliefs by Ted Bacharach MD, retired
The Physician turned Provider
Many of us have experienced a variety of changes. The longer you have stayed the greater the changes. Explanations of how the changes have improved situations are numerous. If you believe them all you would get the impressions that all change is good. Over many years I have come to the realization that changes are sometimes detrimental. In the medical field changes have occurred with tremendous regularity and speed. The greatest change has been the placement of a huge barrier between the physician and his or her patient. The interjection of managed care, insurance companies, government and hospitals between the patient and the physician is certainly a factor. The insurance companies and managed care companies love not only generic medications but generic physicians as well.
