There
is a stigma to being obese. There is even evidence, as found by surveys, that
physicians "openly admit having negative attitudes towards obese patients.
They say they are dissatisfied in caring for obese patients. They find it
uncomfortable, unpleasant and not professionally rewarding." A recent
JAMA study, however, shows that the obese do NOT get worse care. In fact, in
many cases, obese and overweight patients have a better chance of getting
optimal care compared to normal-weight patients.
This is a tough job and
getting tougher as our country gets fatter by the day. Having negative attitudes
toward any group, however, is not right but at least physicians still give their
all to help them. We should be given credit for that.
A
urologist in Florida has a sign in this office that says: "If you voted for
Obama, seek urologic care elsewhere." Okay, that is absolutely ridiculous. Dr.
Jack Cassell is taking things too far. This guy needs to lighten up. Imagine
hanging out with him at a party? Now, that would be a fun time. I guess he
really is a d#ck doctor.
Legalizing
marijuana, at least for prescriptions, is becoming more and more commonplace. In
Colorado, there is a huge battle between those who want to make it classy and
those who want to keep it in the "stoner" age. Anyway, what blew me away was how
much money is being made by selling it. One
out-of-work handyman invested a couple of thousand dollars, rented a small shop,
set out a dozen strains of weed and started ringing up $80,000 in sales.
Unbelievable. I just biopsied a abnormal skin lesion that would not stop
bleeding. It took 25 minutes when it was all said and done and three stitches in
a purse-string formation to close the damn thing up. It turned out to be
malignant. I got paid $30. Something seems wrong here.
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Pfizer
has publicly
come out and stated that it paid about $20 million to 4,500 doctors and
other medical professionals for consulting and speaking on its behalf in the
last six months of 2009. I took out a calculator and figured that this came out
to an average of $4444 per doctor. Holy crap! Obviously not every doctor gets
the same amount because anything worth $25 or more and totaling $500 or more
during the six-month period was disclosed. In other words, some got small little
meals while others were getting ridiculous amounts of money. Before you exalt
our esteemed academic centers you should know that Pfizer also paid $15.3
million to 250 of them for clinical trials in the same period. That averages
around $61,200 each. Remember, that is only in the last six months and ONLY ONE
DRUG COMPANY!
My office doesn't do staff drug lunches. I am the only
medical partner that even talks to the pharma reps. A few times a week I will
talk to a rep at a scheduled five to ten minute meeting in our break room. They
usually bring a protein bar and a vitamin water for me. And I feel guilty for
that! Damn, I have been missing out on some major cash over the years.
I was blown away to find that 5-7% of the food we eat isn't really what we
think it is. The
FDA is being asked to get involved but they may have too much other stuff on
their plate right now (pun intended). Boy, it seems too easy to make watered
down honey or olive oil with cheaper derivatives to increase your margins. Even
Heinz and Kraft fell for moldy tomato paste. Scary. Next time you say to
yourself, "This tastes like crap" you may find out that it really is.
Pretty soon we are going to see a major marketing campaign by AstraZeneca
for their drug Crestor. Crestor is not new but their plan is. Ever since the
JUPITER trial came out there is evidence that this statin may prevent heart
disease in healthy people. The FDA has now given clearance for doctors to put a
male patient older than 50 or a female patient older than 60 on it if he or she
has normal cholesterol but at least one risk factor (smoker, HTN, etc.). There
is some debate out this, however, due to other risk factors just associated with
statins. The
NYT just put out a piece on this whole topic. The cost for this would plan
would be astronomical. Five-hundred people would need to be treated with Crestor
for a year to avoid one survivable heart attack. That would cost $638,000. Hmmm,
do we, as a country, have the money for that? If so, why not put the stuff in
the water. Heck, we can add some Zoloft while we are at it. Anything
else?
This is the dawning of the age of
Aquar...er....Crestor.
It seems the
media has just realized that there are not enough primary care docs to see
all the new patients getting insurance with the new healthcare reform bill. Yup,
we are about 40,000 primary docs short. The AP article referenced never even
mentions how to fix this problem other than the "medical home" fantasy. I have
been talking and blogging about this problem for years. Nothing will change
unless internists and FPs are paid more and their student debts are forgiven.
Until then you can call your office a medical home, a medical condo, a medical
shack, or a medical shanty and it won't matter. Medical students are just not
salivating to jump into field.
Back in the
days of wooden ships and iron men, the Royal Navy had a lot of ocean to cover
and occasionally ran short on sailors. A favorite recruitment tool
was to drop a coin in a tankard of ale which, when discovered in the bottom of
the mug by lurking members of the press gang, was determined to be an implicit
acceptance of employment by the poor sod holding the empty. He had
in the parlance of the day, “taken the King’s coin” and was summarily hustled
off to one of His Majesty’s ships for the duration. Over the years,
the pewter ale mugs started being made with glass bottoms so that the discerning
patron could examine his beverage before draining a potential contract.
So it has been for centuries, that taking the king’s coin has impressed,
even stolen many an otherwise happy life.
Forty-odd
years ago, U.S. doctors betrayed their profession,
and their patients by taking the king’s coin when they accepted the eventuality
of government medicine in the form of Medicare and Medicaid. Men
and women trained to deal in facts, statistical projections, and hard choices
were unwilling to tell the nation what it needed to hear, and instead invited
Uncle Sam into the exam room in exchange for what was then a nice chunk of
cash. It was easier to do good for the elderly and the poor with
someone else’s money, and to feel good about themselves for having done
so. That mindset is now triumphant in Washington, D.C., by all
respects now the capitol of the enemies of Americans and freedom.
The Dear Leader and a Congressional majority desperately disdainful of
its’ own rules and founding document are busy feeling really good about doing
for some by stealing from others. They know, and yet do not care,
that Medicare has not been financially solvent since 1972. These
anti-Americans know that Medicaid is breaking numerous states, even as they plan
to add millions more to the rolls. Obama and the Democrats know
that they cannot provide good care for the entire population; the trick is to
provide the illusion of care, “coverage” for all in order to build a permanent
dependence in the numb-skulled minds of an increasingly benighted
electorate. Republicans who rolled over for W.’s obscene bribery of
seniors with promises of free drugs were deservedly stripped of power, and are
now left on the ineffectual sidelines to watch the wreckage they helped
sow.
A decade or
more back, Medicaid recipients were issued gold cards that resemble credit
cards. Anyone familiar with the ER environment has heard many times
able-bodied, smiling beneficiaries in no distress exclaim as they check into the
ER for a minor complaint, they “have the gold card” and that all is covered
(without a thought to who is paying the tab). The other night, just
after the Democrats increased nationalization of health care, I sat in a small
town ER, talking with a lab technician, an x-ray technician, and a nurse.
It was emblematic that the two patients in the ER were an elderly person
who by age and ailment list would have long since run through any money that
could have been contributed for her care during her lifetime; and a child whose
parents spoke no English. I noted this as a microcosm of where we
have come, four taxpayers at work, in part to pay for the care of two government
patients. If you think this a harsh description, it is only because
no doctor or politician has yet told you the truth. If you think I
am being mean, then look at our deficit, the tax increases in this heinous bill,
and the rising unemployment level.
Our x-ray
tech laughed ruefully and exclaimed “We all have the gold card now.”
I looked, and sadly, my coffee mug did not have a glass bottom.
Once
again I can't get past the contradictions used to describe the obesity problem
in this country. Tom Vilsack, who is our Agriculture Secretary, is holding a
series of school nutrition events around the country. This is his
quote:
"With childhood hunger and obesity on the rise we owe it to our
child to ensure our nutrition programs address these challenges".
HOW CAN
YOU HAVE A RISE IN HUNGER AND OBESITY?!?
As in my previous post on "food
insecurity", I am assuming he feels that the hunger/obesity link is all due to
kids overeating empty calories due to their hunger and that by fixing the school
nutrition problem then we can fix these kids. In my own child's school there has
been an effort, through a grant, to give the kids a snack of fruits or
vegetables every day for free. It's been wonderful but if the kid's are still
eating crappy foods at lunch and at home then they still will be fat. There is
also a trend for kids to move and exercise less. In other words, without fixing
both ends of this spectrum (eating less, exercising more) then we will become as
fat as those people in the movie WALL-E. And I don't think the government can
fix that. We can only fix ourselves.
