1. Overridden

I am no huge fan of President Bush. Not sure how many people are. His attempt, however, to veto a bill that would stop the impending cuts to doctors via Medicare was moronic even for his standards. In his and his administration's opinion, the cuts would basically harm the insurers and their very specialized and select managed-care programs for some Medicare recipients. This, by the way, is where Congress is getting the money to stop these cuts in payments to doctors.

"I support the primary objective of this legislation, to forestall reductions in physician payments," Bush said in his veto message. "Yet taking choices away from seniors to pay physicians is wrong." He called the bill "fiscally irresponsible" and charged that it "would undermine the Medicare prescription drug program."

First of all, if you keep cutting Medicare payments there will be no more doctors participating in the program and therefore no doctors to see. Correct me if I am wrong, but that will cut patients' choices, won't it?

Secondly, the Medicare prescription drug program is an entitlement program that is just another anchor drowning this country in debt. Though it benefits some of the elderly (I still believe most could do quite well on $4 meds from Walmart), it benefits the pharmaceutical industry even more.

Luckily, Congress overrode his veto. George, it is time you move on.

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2. Munsoned

One of the saddest articles I have read recently came from the WSJ where it detailed how the Amish are getting hosed by some hospitals. If you don't know, the Amish people oppose health insurance as well as many other modern amenities. They believe it is their religious duty to provide for one another when sick. Unlike many others in our country, they actually pay their bills and do not rely on a government handout or bailout. As I have explained before, no one really has an idea of what things truly cost at hospitals. In other words, Medicaid pays one price and Medicare pays another. One insurance may pay a different price while another pays a different one. There is no transparency. The ONLY one who gets screwed is those patients who have no one to represent them and have to pay cash. They get the full and inflated price which is exactly what these bloated and disgusting hospitals have done to these "Old Order" Mennonites as described in the article. Many of this sect have some genetic disorders (long story) which need treatment. Now the hospital bills are starting to pile up and the collection agencies are being sent out like the hounds. Since the whole Amish community work together to pay these bills, the whole Amish community is being gouged and subsequently drained of all its cash.

Even having been asked to give the group a half-price discount by doctors, these hospitals respond that they don't make special provisions for any one group. As stated above, they are out and out lying as they make special deals for every managed care company they deal with. So why won't they do it? Because the Mennonites are a cash cow and these administrators and their accountants love it. I am sure they count on that cash to keep them viable and there is no way they want to kill that pipeline. The Mennonites aren't stupid and are just asking that the prices not be so inflated and actually reflect the cost of what the care should be. They know how cost-shifting works and they know that hospitals make up the difference from those who don't pay a dime by propping up the bill for those that pay a lot of dimes.

The hospitals in the piece, by the way, are all nonprofit yet Hershey made almost $60 million last year and Lancaster made $137 million. As the Amish start to go bankrupt, I wonder if the CEOs there sleep well at night with their nice little bonuses. By the way, the logic of nonprofit hospitals making huge profits is as insane as the tobacco industry caring about your health. I will let my friends from one of my favorite movies explain that even better:

[On smoking] Ishmael: You should try to quit. They say it’s bad for your heart, your lungs. It quickens the aging process.

Roy: Who's done more research than the good people at the American Tobacco Industry? They say it’s harmless. Why would they lie? If you're dead, you can't smoke. 

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3. Placebo Journal Update

Times are tough.  Gas is going through the roof.  The American dollar is worth less and less.  How are you going to survive all this stress?  I have no idea.  I do know that laughter is the best medicine and that medicine is the best laughter.  That is where we come in.  For the price of a third of a tank of gas you can get yourself or someone you love a subscription to the Placebo Journal 

What is the Placebo Journal?  Well, for one, it is not what you are reading now.  Nor is it our blog.  It is the only PRINT medical journal that survives on subscriptions rather than the pharmaceutical industry.  The journal comes out every other month and is chock full of things that will crack you up.  You will not get this type of medical humor anywhere else.  So, if you feel the need to find your smile again, then hit the subscribe button below.  Isn’t it time you enjoyed a medical journal without all that big pharma aftertaste?

SUBSCRIBE

4. Gorback’s Thoughts by Michael Gorback MD

Make Your Senators Sick

In the fallout from the Senate's failure to pass HR 6331, which would avert the Medicare fee cut, there have been stories about how Arlen Specter changed his vote at the last minute. Mr. Specter has lymphoma, and he has been lobbying for increased payments for oncologists. There are rumors that in exchange for a raise for oncologists on their meds, he cut a deal with the White House to change his vote. 
 
How I wish Mr. Specter had a bad case of back pain instead. Then maybe he'd help my specialty. Plus you don't die of back pain. It's win-win. 
 
In the meantime we have to get the Senators sick, and this means a team effort from all specialties. Pulmonologists - I want you to go to your Senators' offices and blow asbestos and silicon dust in their faces. GI guys - it's your job to find suspicious polyps in any Senator who is your patient. That shouldn't be hard - you pretty much do that for every colonoscopy. Pediatricians - catch a cold (easy enough in your line of work) and then visit your Senator. Surreptitiously cough on your hand before shaking hands. Try to drink out of his coffee cup when he's not looking. 
 
Ok, you get the idea. There are only 100 Senators and there are 600,000 of us. We should be able to give everything from anthrax to zoonosis. Oh, wait a second. Anthrax is a zoonosis. Well, then let's give them everything from anthrax to Zenker's diverticulum! 
 
I feel like Dorothy and the ruby slippers. We've had the solution in our hands all along. 
 

5.  Check Your Cap

I have written about this before but it burns my hide every time a new article appears describing it. The Associated Press explains in detail how many insurance companies put a cap on how much they will cover for an individual subscriber. Example after example is given where an illness to a young child may break that cap quite easily. As the cost of healthcare goes up, families are eating through these caps faster and faster; at which point they are screwed. So the insurance companies not only are increasing the deductible on one end but are squeezing down the maximum on the other. The saddest part about this is that these rare situations where families reach these $1 million or $2 million caps are not ones in which they are abusing the system. They usually are from catastrophic illnesses like cancer or transplants. Amazingly enough,the insurance companies walk away from them without a second thought. As detailed in a previous WSJ piece, so do many hospitals. Pitiful.

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6.  Saving Primary Care

The general public is now getting a sampling of the "medical home" concept thanks to an article written in the USA Today by Julie Appleby. In it she explains how family doctors may get paid more for overseeing patients care via screenings, hospitalizations and referrals. The concept is not new, hence the title of the piece, but the idea of paying us primary care physicians more is refreshing. By creating patient care "teams," which could include nurse practitioners, nutritionists or other medical staff, these medical homes would offer longer office hours, electronic medical records and same-day appointments. Unfortunately, all these changes to make the government and insurance companies happy probably won't save that much money. It may improve service and quality but that isn't what they are looking for, now is it? It really doesn't amount to much more cash in our pockets either. The saddest part of the article was the family doctor quoted at the end who says, "This is our last, best hope to save primary care." Why is it that we think that every new "dog and pony" show to make the insurers happy is the only chance of surviving? Seems to me that we will  always be chasing our tails because those dogs will never hunt. Geez, can I use any more ridiculous canine metaphors?

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7.  Dead Man Prescribing

Amazingly enough, illegal sales of such items as wheelchairs and medications was found to have scammed the government for over $93 million last year based on prescriptions from dead doctors. A congressional investigation states that more of this will occur as the government still hasn't fixed some flaws in the system since 2001. The article states that 7% of all deceased doctors and 27% of the dead ones in Florida still had active Medicare ID codes. The CMS isn't denying any of this but one of their responses to the problem was to strengthen federal regulation involving documentation Medicare providers must keep. When in doubt, always increase paper work, I always say. While they are at it why don't they start arresting the dead doctors? That would be a great COPS show as CMS swarms onto some graveyards to get them some villains. By the way, when they calculate the number of dead doctors do you think they count the ones who are physically alive but dead inside? Just curious.

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8. Medical Joke of the Month

Patient: Doctor, you must help me. I'm under such a lot of stress.  I keep losing my temper with people.

Doctor: Tell me about your problem.

Patient: I just did, didn't I, you stupid mother f@cker!!

For something else funny, check out my video response to the Reader's Digest people:   http://blip.tv/file/1032775 or http://www.youtube.com/watch?v=kJ5jl6Bg6vY

9.  Bacharach’s Beliefs by Ted Bacharach MD, retired

  What Happened?

This past week I attended a party that included a cross section of a community, probably slanted toward the upper echelons. There were some physicians as well as two medical students. The physicians were retired and seemed to have made that decision on the basis of the state of medicine rather than age. The medical students also were interesting. One was intending to go into emergency medicine, the other was interested in medical administration. Two days ago I
received a magazine from my medical school informing me that if any of
the previous graduates had children or relatives interested in entering medical school to let them know and see if they could be of assistance.

Something changed since my entry into medicine many years ago. Entrance into medical school was difficult and the clamor to get in was great. A medical career was a lofty, difficult to attain goal.

What has changed? I would like to blame a variety of organizations, the government and society but on further more extensive consideration
I believe it was the doctors in my generation as well as a few later ones who must accept responsibility. Some of the errors of our ways are presented below. They are not the last word and I am sure many of my colleagues can add further errors that we made or allowed to happen.

We allowed the government to take over medical education for the physician in practice. Many years ago the medical societies and hospital staffs took on the responsibility of providing post graduate education. The government feeling that they couldn’t trust us to do this properly established standards and mandatory credits. The medical community did not object and in their desire to please went along with this proposal. The results soon became obvious. Educational programs by our medical societies disappeared. A variety of organizations saw this governmental requirement as a financial opportunity. Courses appeared and the cost was substantial. For local organizations to get a program approved became far too complicated. I am not convinced that physicians in practice get more exposure to medical advances under our present system than they did when we filled our needs on a local level for less money.

We allowed hospital staff administrators to take over many of the functions that were once the province of the medical staff. This occurred insidiously and in most instances was allowed by the medical staff who did not show up for medical staff meetings and allowed administration to usurp a considerable portion of the time available for the meetings. It did not take long for attendance to decline and gradual reductions in the number of members that constituted a quorum were approved.

We did not always stick together by joining and empowering our medical societies. Many physicians felt that membership in a specialty organization was more important. We failed to recognize the divisive consequences of a fractured divided medical community. The result of our division allowed increasing interference in the every day practice of medicine by government as well as health insurance entities and hospitals, Health Maintenance Organization, Medicare, and Health Insurance entities have increasingly requested “authorizations”, often disallowing a variety of needed procedures. Most of the time after persistent communications we end up doing what is indicated but our
dispositions are not so easily satiated.


There are numerous other factors that have lowered the status of the physician and made the medical profession less desirable. It is not something that was done to us entirely. We must accept much responsibility for having allowed all of the above as well as many other contributing factors to have happened on our watch.

As reported by the AP, there are actually firms that provide "mystery shoppers" to see how well your service as a business. Sure we have all heard of it before but for the first time is now occurring at hospitals. Here is the problem: you can die if someone makes a medical mistake. Haven't we been told that happens all the times?

So as patients fake their illness like bad actors at a local theater, the physicians still do what they can to find the cause of their fake chest pain or slurred speech. This perverted act, which is similar to "Munchausen's," takes up room and time from busy hospital facilities. You would think that the hospital would be mad but, alas, their administrators were in on it. I guess it is always good to get another gold star to show off at your next yearly retreat. Remember the mantra of this decade is "quality".

You would think the AMA would at least make a beef about this. Nah. They sent it back to their ethics committee for more clarification. Good for them. Don't want to take a tough stand without proper clarification.

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11.  Word of Mouth is Still King

A recent report in the American Medical News states that patients rarely use an online rating system to pick physicians. A Harris Interactive poll found that although more than 80% of the state's adults turn to the Internet for health-related information, less than one-quarter have looked at physician ratings sites. Only 2% of those surveyed made a change in physicians based on information posted on a rating site.

Good or bad, I believe that this will grow in popularity. Local word of mouth is an important thing for any business; doctors especially. Physicians should keep on their toes in order to make  sure they are giving a good service. The problem with the online rating option, however, is that the indicators may not be appropriate. In other words, all the P4P garbage is not proven to be accurate and could skew the way doctors do business in order to get a good rating. It is called gaming the system.

As far as patients putting down personal comments, that is a problem as well. Some people like to trash others for no other reason other than to hurt them. A physician friend of mine in Florida showed me some online comments about him. Most were great but a few of them were vicious. A narc seeker who doesn't get his Oxycontin can be very vindictive. In fact, it doesn't even have to be patients you know. Take a look at the Reader's Digest comment section and see how people who don't know me have gone to town trying to trash my reputation.

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12. Now You See It...

Lipitor, the huge selling anti-cholesterol drug, was ready to go off patent and generic in 2010 and the world was waiting. Now they have to wait some more. By striking a deal with a company from India, who was going to make the generic version, Pfizer was able to get a year reprieve until 2011. Of course they were suing the company first in order to slow them down and make them listen. A good lawsuit will do that. (It reminds of a joke where the punchline is "a good sheep will do that"). It is all a big game for these pharma companies and, unfortunately, patients get stuck in the middle. So what is one year of waiting going to do for Pfizer? Well, it means millions and millions more into their coffers. Good for them. My only response to them is a write-in campaign. Oh, no, not to the good people at Pfizer. I mean by writing more generic statins or cheap statins like pravastatin or simvistatin. They are just as good for the patient and a whole lot cheaper for everyone. That is a win-win for us all....except for big pharma.

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13.  Legend of Comedy

George Carlin recently died at the age of 71.  He was a pioneer in the stand-up world. George had a history of CAD and went into the hospital late in June with chest pain and didn't make it through it this time.

George Carlin's comedy history is legend. He produced 23 comedy albums, 14 HBO specials, three books, a couple of TV shows and appeared in several movies. Carlin hosted the first broadcast of "Saturday Night Live" and noted on his Web site that he was "loaded on cocaine all week long." He won four Grammy Awards, each for best spoken comedy album, and was nominated for five Emmy awards. Interestingly enough, it was just recently announced that Carlin was being awarded the 11th annual Mark Twain Prize for American Humor.

George initially had a so-called clean act when he started but realized it wasn't what he wanted to do. What he wanted to do was to make people think and so he pushed the envelope. The world always needs people like George Carlin and I dedicate this Placebo Gazette to him. 

Here are some famous Carlin quotes. Enjoy:

1. If lawyers are disbarred and clergymen defrocked, doesn't it follow that electricians can be delighted, musicians denoted?

2. When someone is impatient and says, "I haven't got all day," I always wonder, How can that be? How can you not have all day?

3. I thought about how mothers feed their babies with tiny little spoons and forks so I wondered, what do Chinese mothers use? Toothpicks?

4. Is a vegetarian permitted to eat animal crackers?

5. What if there were no hypothetical questions?

6. Frisbeetarianism is the belief that when you die, your soul goes up on the roof and gets stuck.

7. Some national parks have long waiting lists for camping reservations. When you have to wait a year to sleep next to a tree, something is wrong.

8. Give a man a fish and he will eat for a day. Teach him how to fish, and he will sit in a boat and drink beer all day.

9. Before they invented drawing boards, what did they go back to?

10. Why do croutons come in airtight packages? It's just stale bread to begin with.

11. I think it would be interesting if old people got anti-Alzheimer's disease where they slowly began to recover other people's lost memories.

12. I recently went to a new doctor and noticed he was located in something called the Professional Building. I felt better right away.

13. There's no present. There's only the immediate future and the recent past.

14. At a formal dinner party, the person nearest death should always be seated closest to the bathroom.

15. Death is caused by swallowing small amounts of saliva over a long period of time.

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14. Feedback About The Placebo Gazette

I WANT TO KNOW WHAT YOU THINK.  Please go below and post your thoughts under the WRITE A REVIEW section.  You can also see some one of these articles on our blog:

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Until next time, keep smiling, keep laughing and keep out of the sample closet.

Doug