Placebo Journal - Medical Humor With A Purpose

1. The Senator's Wife

Now that Ted Kennedy needs a fill in for his role in healthcare reform, Senator Chris Dodd has decided to jump right in. There has been scrutiny, however, about his wife's ties to some big players in the industry. You can read more about that here but the thing that got me is how much money this woman makes from being on five different boards. Oh my God.

She one of the most highly compensated non-employee members of the Javelin Pharmaceuticals Inc. board, on which she has served since 2004. She earned $32,000 in fees and $109,587 in stock option awards last year.
Mrs. Dodd earned $79,063 in fees from Cardiome in its last fiscal year.
Brookdale Senior Living gave her $122,231 in stock awards in 2008.
She earned no income from her post as a director for Pear Tree Pharmaceuticals but holds up to $15,000 in stock in Pear Tree.

Here is a person who has NO healthcare experience making over $325,000 a year just for going to board meetings. You can read more about Jackie Clegg Dodd where you will find that she was long time Washington insider with an education in national security issues who came to "know" Chris Dodd later in his life (she is a lot younger than him). Putting all judgement aside (okay, not all), it just blows me away to know that she is basically being handed this money because she is a Senator's wife. And don't forget that conflict of interest issue with her husband's new role, either.

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2. New Cereal

A recent study comparing different types of carbohydrates that are eaten has shown that high-glycemic meals appear to impair endothelial function of the blood vessels. This is just another risk factor for inducing heart disease. There is no word from Kelloggs but rumor has it that they may rename some of their products to Myocardial Frosted Flakes, Special tPA, and Apple Caths.

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3. Public Plan

The AMA is coming out against a "public insurance" option for non-disabled people under the age of 65. They feel that it would swell the ranks of patients on the public dime which would blow our taxes out of orbit. They may be right. But who knows? I just wish there was some way to get a competitive insurance product that would make the insurance companies lower their rates. They have been increasing them by double digits almost every year and I just think it is time to have some real competition. I am not smart enough to understand why our capitalistic society wasn't able to bring those prices down naturally. Is it all due to the inability to shop across state lines to find the best plan? It it all due to collusion? I'm not sure. I do love, however, that they are sweating it out as Congress debates its next move. That little pleasure of seeing UnitedHealth or Aetna or Cigna squirm is heartwarming to me.

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4. Placebo Journal Update

We have started to work hard on the next issue (August) in order to keep the laughs coming. We consisently are told that our journal is the only one read cover-to-cover. Isn't time you found your smile again? We have the answer and it comes right to your house every other month. If you want something that is all humor and guaranteed to make you a little incontinent then:

Surgeons are using a high-powered beam of ultrasound to treat prostate cancer because its precision can destroy the tumor without killing off surrounding tissues. The reason this is so important is because if it spares the nerves that are critical for male sexual function then there is no impotence. Regular treatments that we use now leave half of men impotent and a fifth incontinent. This is exciting news. One of the men treated stated, "It is amazing that the power of sound treated my cancer without any impotence or incontinence. Of course when I came home and heard my wife nagging at me I realized that the power of sound can also reverse all of this as I immediately became impotent....and incontinent". *

*Editor's note: I totally made that last part up to get a cheap laugh and that was wrong. I am going to hear it from my wife about that one.

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The NY Times has summarized a study that came out in the June issue of the American Journal of Medicine. Comparisons were made with a similar health survey done about twenty years ago. Here is basically what they found:

Obesity is up from 28% to 36%
Smoking is about the same
Moderate drinking went from 40% to 51%
Those that eat the proper amount of fruits/veggies dropped from 42% to 26%
The number of people who get NO physical activity doubled

What amazes me is that at the same time more Americans complain that they want free healthcare they are taking care of themselves less and less. Where is the personal accountability or responsibility of the individual? I can't tell you how often I have to say the following during my office visits:

"Ask not what your doctor can do for you, ask what you can do for yourself."

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A story out of England has a mother losing her newborn because the social workers think she is too stupid. Can you imagine this happening here? Raising kids is hard. I am not sure whether IQ is relevant or not and it seems that was the test used to make the final decision. Obviously, there must be more to the story. That being said, I have seen plenty of poor parenting over the years. Some of it has been mine as my kids will learn in therapy when they are adults. It seems crazy to me, however, to use IQ as a factor because there are plenty of great mothers in the animal kingdom who wouldn't do so well on the test. In my experience, there is one major qualification that makes someone a good parent or not; does the parent care about the child? It is almost impossible to MAKE someone care about something or someone. Those parents who seem not to care have to be watched very closely because other priorities such as partying, drugs, and poor relationships get in the way of their child rearing. And I don't think there is any relationship between caring and IQ testing.

A patient came in to see my medical partner recently with right -sided rib pain. There were no other serious symptoms or complaints. It was a simple muscle strain but she wanted a better answer. My partner re-examined her, did a breast exam, tried to open up to more possible diagnoses, but she couldn’t find any. The patient wanted more.

In an article in the NY Times by Pauline Chen, she interviews Dr. Donald M. Berwick, a Harvard pediatrician and president of the Institute for Healthcare Improvement in Cambridge, Mass., who is a supposed to be a leading authority in health care quality. In his opinion, the control of the medical system should be transferred from the doctor to the patient. He believes that patient preference is so important that we should occasionally put evidence-based care “in the back seat”. In fact, he believes families should be part of daily rounds at the hospital as well.
Dr. Chen asked him “What if a patient’s preference is in conflict with recommendations grounded in evidence-based medicine?” He responded that he would “treat it as a challenge of information exchange”. My medical partner laughed because she tried that and her exchange with her patient went nowhere.

Dr. Berwick is a pediatrician. I wonder if he would let a four-year old determine if he or she needs an ENT consult for an acute ear infection. Probably not. It is very hard for me to believe these “ivory tower” doctors when they come up with new theories on how to run the healthcare system. They are not in the trenches in rural America. They are not on the front lines of medicine. Instead, they wake up in the middle of the night and create a new term called “patient-centeredness” and now have to write an article on the subject.

Dr. Berwick believes patients are our peers. Really? Working together to solve a medical problem is not the same as being my professional peer. He goes on to recommend that a patient bring his “digital recorder into the meeting so he can listen to the conversation several times after”. I know many lawyers who would love all patients to do that.

He ends his interview by stating that “we have to fix the health care system so that it gives doctors the time to do the job they want to do”. Funny, nothing he recommends saves time or saves money or makes the job any easier. This begs the question: does Dr. Berwick actually see patients anymore and how many does he see? I called his office and it turns out that he does not. If fact, the person answering the phone states he hasn’t “in years”. Maybe it is time for him to get his hands dirty again?

I am all for radical thinking. I am okay with brainstorming on how to make our healthcare system better. I may not be the smartest doctor in the world but I do know that there still has to be some type of chain of command in this profession. Anarchy doesn’t work. That being said, it is my opinion that the best type of patient-physician interaction is when both people are focused and present in the exam room without external distractions (cell phones) or internal distractions (“I have so much paperwork to do!”). The best care comes out of those situations.

My medical partner ultimately recommended some ibuprofen and observation for her patient. My partner tried to reassure her patient as best as she could and suggested to give it a week and then have her return for a recheck. Paradoxically, if it was up to the patient, her care would be “centered” on having a CT scan or an MRI of the chest. It turns out that this would have cost thousands of precious dollars. Who is right in this scenario? Don’t ask Dr. Berwick. He is busy brainstorming.

9. Are We There Yet?

A recent survey by Merritt Hawkins showed that the average wait to get an appointment for your doctor has increased by a week since the last survey five years ago. The specialties they looked at were cardiology, dermatology, obstetrics/gynecology and orthopedic surgery. Phil Miller, vice president of public relations for Merritt Hawkins and Associates states, "We need to be training more physicians, particularly primary care physicians" in order to solve this worsening trend. If you think this is bad now wait until EVERYONE gets an insurance plan and there are no docs to see them. This is what is happening in Massachusetts right now. And contrary to what Mr. Miller says, it is NOT about training more primary care physicians, it is about paying them more so that medical students want to go into that field.

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10. Fat Kids Not Sleep So Good

A new study has shown that overweight kids have many sleep problems that may be adversely affecting their health. In the study, researchers examined 700 children between the ages of 5 and 12 randomly chosen from 18 public elementary schools in Pennsylvania and found that about 25 percent of them had mild sleep-disordered breathing and 1.2 percent had moderate sleep-disordered breathing. Most of these kids were fat and did NOT have the common tonsil enlargement problem we used to think caused obstruction. The result of their sleep issue were behavioral problems, hyperactivity and difficulty staying awake at school. These findings are representative of our country. We are eating ourselves to death (or close to it) and yet it is only getting worse. We have more and more little fat kids who get outside less, play XBOX more and are getting sicker and sicker. If we don't fix that then we cannot fix our healthcare system.

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11. Feedback About The Placebo Gazette

I WANT TO KNOW WHAT YOU THINK. Please go to each individual story and follow the link. If you do not have access to the blog you can also post your thoughts under the WRITE A REVIEW section.

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

Doug

King of Medicine