Health Care becoming Health Business

I highly recommend reading another excellent article by Paul Craig Roberts "How Wall St Destroyed Private Medicine." In it he shows the political mechanism how revenues were diverted from private doctors' practices to large corporate facilities by regulating Medicare compensation rates to different organizations. Roberts also shows that the libertarian slogan to protect the current "free market" model of medicine is inane since there is no free market medicine in the US. Just another example of how corporate greed, and legalized bribery (lobbying) runs and ruins this country.

No Heart - No Heart Trouble!

Rush Limbaugh who THOUGHT he had a heart attack, was examined at the hospital and released with "no heart trouble found," as MSNBC put it. That, of course, I could have told them even before any doctors saw this conservative guru. To have heart trouble one needs to heave a heart, which is not the case with this particular patient.

Another oxymoron is waiting for us in the elaboration of the same story in the news. After his release from the medical center, Mr. Limbaugh THOUGHT he made a case in defence of the status quo of the American medical system by saying that he got the best health treatment in the world "right here in the United States of America." If you didn't have a problem, and did NOT get any treatment for it, why on earth would you make any pronouncements regarding the supremacy of the health care you did not receive?

I have a premonition that Mr. Limbaugh in not at risk of developing not only heart trouble, but also a brain tumor.

I guess, good for him!

Common Sense Helps Smell Corruption

How can you tell when officials have accepted bribes? Easily, actually. You just need to use the power of observation and some common sense. Just like my favorite Agatha Christie's character, Miss Marple, who has spent all of her life in a tiny English village, yet by drawing analogies between the most mundane observable human behaviors, she is capable of solving very intricate crimes.

Say, if you know that your neighbor did not inherit any family wealth, has a home-maker wife, works as a city building inspector, and yet drives a new Lexus and takes 3 vacations abroad every year, you can safely suspect that he takes bribes. Or if a city zoning commission which gives you a lot of grief and denies your petition to extend your deck by ONE FOOT because it will then be encroaching on the 3 yards easement around a sewer line, quickly approves a commercial development despite protests from neighbors, environmental groups, violation of existing zoning restrictions and exorbitant costs involved in moving roads and other infrastructure items - you can be reasonably sure that members of the zoning commission were ECONOMICALLY ENCOURAGED to make the decision in favor of this big developer.

Consider a couple more cases from our recent history as a country. BHG (bovine growth hormone) was approved by the FDA in 1993 as safe for cows after just THREE MONTHS of conducting studies. The BHG is passed to cow milk and milk products which we in turn consume. There have been studies linking this hormone to increased rates of human cancer. The hormone is BANNED EVERYWHERE in the developed world: Europe, Canada, New Zealand - you name it. Is it reasonable to assume that our own FDA was - mmm- economically encouraged to find it safe to use? You decide. I have stuck with hormone free milk products ever since, and I suspect that the FDA authorities have done the same in their personal life.

But maybe FDA is always quick to approve new and questionable treatments and additives? Let me think... Say, a chicken pox vaccine had been developed and administered in Japan for 14 years with an excellent record of safety, yet our own FDA refused to allow it on our market as being "unsafe" and "unproven" till 1996. Could it possibly be that manufacturers of the vaccine just stubbornly refused to grease the palm? Or that there were no special interest groups behind the vaccine to encourage the FDA to even study the issue (patients obviously are not a special itnerest group, or a group of interest to the FDA). Now the unanimous consensus is that there is a considerable economic impact from administering this vaccine, not to mention lives saved, and days of agony for parents and children.

Other "knee-jerk" quickly adopted policies with disastrous consequences for the country in general were, without a doubt, the Clinton-pushed NAFTA and Bush-pushed Free Trade with China. The speed of passing those sweeping changes speak loud and clear of corruption. The result of those policies were millions of US jobs lost, the almost total destruction of many American manufacturing in many areas, but multi-billion profits for corporations. If you are interested in details on how Bush willingly sold out his fellow Americans to special interest groups in his deal with China, read this summary. Incidentally, I am not sure that the Wall Street bailout was really a case of corruption. Well, in a way it was, but I don't think there was a financial payback to the architects of the bailout. I think their reward is that they are still alive.

What I am saying is that we don't even need to know the details of the shenanigans going on to KNOW that corruption is taking place. Common sense and power of observation is all it takes. If it looks like corruption, smells like corruption, and feels like corruption - in most cases, it IS corruption.

So what are our choices when we smell corrution? Just like the picture at the top of the post says, you can say nothing and hold your breath, or you can pray silently. I would say, prayer is our best strategy now.

How Many Oranges does it Take to Make One Apple?

Feminists and the politically correct junkies must be pretty pleased by the recent trend in the US medicine: since 2003 the number of female medical students has surpassed the number of their male counterparts. Hallelujah!

Not so fast! Societies blessed with socialized medicine have long been complaining about problems associated with prevalence of female physicians. Some went even so far as to call training women in medicine a waste of time. Their rationale? Women tend to work fewer hours, take less call and retire earlier than their male colleagues. Women in our society are still widely expected to carry the brunt of child rearing, to take care of the elderly parents, and to keep the home, hence their inability to keep as crazy a work schedule as their male colleagues.

The latest study published in "Medical Economics" journal issue on October 23, 2009 has found that in terms of hours worked per week, there is now practically no difference between male and female primary care doctors. So were our critics wrong? Not really. In that equal number of hours, male doctors saw an average of 102 patients per week, whereas female physicians averaged 78 patient visits per week. So female doctors' productivity was just 76% of that of males, all other factors being equal. In other words, it takes more than one woman doctor to replace a man.

Why this is happening is beyond the scope of this short article. I suppose that women simply take more time to talk to their patients, to hold their hands, to let them cry on their shoulder. Who do you prefer to see as your doctor: male of female? I like females, hands down.

The problem the society is facing, though, is that with more women entering the field of medicine, we need to budget many more jobs for them to see the patient numbers previously seen by men. The matter is further exacerbated by the fact that potentially 30 million new patients will soon have medical insurance, and will be making regular appointments to see their primary care doctors. This will inevitably create a tremendous bottleneck: more patients, and a larger proportion of less productive doctors.

It gets worse. If we want to curb or even cut the cost of providing medical care while throwing 10% more patients into the mix, this means that doctor's compensation will go down. Becoming a physician is a long process of very intensive study. And then in their professional capacity, one has to deal with cranky people at all hours of day and night who are in pain and who expect you to take care of them. If on top of that the pay is not good (and the pay has been going down for the US doctors in the past 10 years - and will inevitably go down considerably with the health care reform), the brightest males start looking elsewhere to utilize their brains. Female dominated field of medicine is what inexorably awaits us in the future. Consider the trend in all countries with socialized medicine: up to 86% of physicians in the Soviet Union were women, half of all doctors under 40 in Canada are females, etc. And once the brightest males stop coming to the medical schools, the caliber of students will become to degrade, and mediocrity will start creeping in. This vicious circle will keep feeding on itself. Eventually, just like every people have the government they deserve, every nation has the quality of doctors commensurable with their compensation from the society. There is no such thing as a free lunch. Somehow we all understand that bankers deserve the $50 million bonuses - the industry argues, that if you don't pay them, the most talented [crooks] won't come. (And how much do they exactly have to study to become the most talented crooks on Wall Street? Four years? Wow!!!) Do you seriously expect the best and the brightest people in the nation to spend at least 11 years of exhaustive training to be getting less than $100,000 a year in return? Dream on.

Tu l'as voulu, George Dandin!

Sincere Gratitude

Oprah has announced the end of her talk show in September of 2011. Did you notice the symbolism of the date? This is meant to feel as a new 9/11. Impressive, most impressive! But you are not a Jedi yet! Anyway, better late than never.

I am very thankful that this uneducated woman who mistakenly concluded that because she became rich she also somehow became smart, is finally resigning. Lately, she became quite dangerous. With her endorsements of dubious alternative medicine methods and with her army of faithful followers, this woman was responsible for the death of several people. Remember her endorsing a plastic surgeon with as many as 11 malpractice suits against him? He killed another patient who decided to trust him with a liposuction surgery after taking Oprah's word for his "qualifications". What about her promotion for a guru who had two people die recently in his sweat lodge? We also have a close friend who went through a lot of stress when a miraculous "comprehensive" blood test advocated by Oprah had mistakenly found her to have pancreatic cancer (the diagnosis which has since been disproved through a lot of expensive testing, and through the course of time).

They say that wisdom comes with age. Oprah is a sad case when the age came alone. In two years she won't be dispensing her unqualified advice any more. Amen!

Fear Factor

FINALLY, it has been found via statistical methods that annual mammograms do not save lives. A government panel concluded that there is no need for women in their 40s to undergo that torturous test annually, and recommended that they be done bi-annually for women over 50. What are the facts? It turned out that not all breast cancers are the same: some are fast growing and aggressive, and basically whether you catch it early or late, they are going to kill you anyway. (They will start treating you earlier, so you will have a longer period of suffering from chemo and radiation before you die.) Some breast cancers are very non-aggressive and slow growing, and whether you catch it today or two years from now does not make a big difference - your prognosis is going to be fairly favorable anyway.

But this flies in the face of the conventional wisdom that early diagnostics saves lives. That is exactly what it is: conventional wisdom. In the Middle Ages, conventional wisdom taught that mice were born from filth. EVERYONE knew it. Also, witches worked up the storms. Drought was a God's punishment for sins. Anybody who would have argued with that would have been ridiculed or worse, persecuted.

Similarly now, when FACTS show the TRUTH, the facts are objected to. Who is raising objections? Radiologists. Hello! Their livelihood depends on every woman getting an annual mammogram, which they can then follow up with largely unnecessary ultrasounds, breast MRIs, etc. What do they cite as their evidence? That somebody was diagnosed early, and they are still alive. Great! And then there are scores of cases which they do not quote when someone was diagnosed early, and they still died. Or when someone was diagnosed with a large tumor, and they are still alive. Notice that radiologists are not up in arms against the government's panel's finding that breast self-examinations are useless - even though that also flies in the face of what doctors have been preaching for decades. Why are they not debating that? Could it possibly be that those "tests" were free anyway? If you do not see a self-serving interest there, then maybe you don't laught at the Chick-Fil-A Cow Mascot holding a sign reading "Eat Mor Chikin" either.

What is at work here? Fear factor. We are afraid of dying from cancer. We BELIEVE that early diagnosis of breast cancer can save our life even when it is shown not to be the case. And some groups are using our fear to make us doubt the facts, and look as our saviors in the process.

And then we are asking ourselves the question: why is American medicine so expensive even though all our stats show we are ranked #37 in the world for the outcomes? Really, why?

In Defence of Alternative Medicine

Clear Vision

We had company over last night. One guest who is an ophthalmologist (eye surgeon) was telling how she recently outraged a family by refusing to do a cataract surgery on their elderly mother. The elderly woman was in a nursing home with a far progressed Alzheimer's, and the family knew her vision was down due to a cataract. So they brought her in with a request of restoring her vision surgically so that their Mom could have a few more months or years of enjoying clear vision while senselessly staring into the ceiling or wherever her gaze happened to fall. The doctor said that upon the examination, the patient was totally unresponsive, sitting in a chair and banging her forearm against her chest repeatedly. She would not make an eye contact, she would not answer any simple questions, and the doctor had no way of examining how bad her eyesight was. A surgery - WHICH THIS PATIENT WOULD BE ENTITLED TO FOR FREE UNDER THE CURRENT SYSTEM - would have meant that after the procedure she would have to be restrained and wearing a helmet to prevent her from rubbing her eyes for a period of time. There were also some other medical ramifications which made the survival of the surgery and the recovery process very problematic at best. Bottom line - this was an unnecessary procedure, it was not going to enhance the patient's quality of life in any way, and it was medically dangerous. The family was furious with the doctor's decision and accused her of refusing to operate because the patient had Alzheimer's (duh! hello, Sarah Palin with her "death panels!"). The doctor has referred them to a different physician who, in her words, would operate on a corpse.

Things like that run up the cost of our health care without helping the nation to feel better. A girl with diabetes working two part time jobs would be without health insurance coverage for her preexisting condition for a number of years even if she buys a policy, while some nonagenarians in a vegetative state qualify to get a heart transplant for free. What use is clear vision to an Alzheimer patient whose brain is gone?

I want to mention two excellent books, both written by physicians, which explain what makes the American medical system sick (beyond the run amock malpractice system which alone accounts for 25% of the unnecessary spending on defensive medicne). The authors were not supported by grants from any special interest groups, like pharmaceutical or insurance companies. Both books refere to multiple studies the results of which are so often twisted and fed to the public in the altered form to justify bigger spending (but not better results). So here are those books:

John Abramson, M. D. "Overdosed America: The Broken Promise of American Medicine. How the Pharmaceutical Companies Are Corrupting Science, Misleading Doctors, and Threatening Your Health." HarperCollins Publishers, 2005.

Nortin M. Hadler, M.D, "Worried Sick. A Prescription for Health in and Overtreated America." The University of North Carolina Press, Chapel Hill, 2008.

The Myth of American Exceptionalism

I have been reading a new book by a British journalist Godfrey Hodgson "The Myth of American Exceptional ism". He has first studied and then worked in the US for most of his illustrious career for almost half the century, and he wrote extensively about American politics and history. He more or less concludes that at some point the America he loved and respected, the beacon of freedom, has slipped into the Messianism and the fallacy of believing in its own supreme greatness and uniqueness. Hence it not only is rapidly losing the respect of the world, but it is also refusing to see how this greatness and prosperity is slipping away from it. Complacency and greatness are two things incompatible.

Today, MSNBC is reporting about Americans going to China (mainland China) for jobs at a fast rate. It turns out that our recent graduates who have extreme difficulties finding even marginal jobs in the US, have a much brighter prospect of finding one in China. The article even goes on to quote one person saying that China today is what America used to be in the 1930s. Here is the link to that article: http://www.msnbc.msn.com/id/32937628/ns/business-world_business//.

In everyday life I see all the time that we are complacent and uninformed. The other day my hair stylist asked me how we felt about the health reform, and was dismayed that both my husband who is a physician, and myself felt it was timely and necessary. Unavoidable in fact. She went on to claim that we had the best health care in the world, and was truly amazed when I told her that we are trailing behind EVERY developed country on Earth in our life expectancy and outcomes of many diseases despite spending times more money on our medical system. I told her that Germans and French have a system which ensures better outcomes and longer life spans despite the fact that they eat butter, smoke, don't take cholesterol or pain pills and spend considerably less money as a society on their health care system while having everyone covered. She really has not heard that before. She asked in disbelief: "So-o-o... Why do they ALL want to come here for treatments???" And was again incredulous when she heard the answer: "Well, ... they DON'T!"

Some systems are better than others. I do not think there is much positive to be said about the Canadian system, or even the British one. Some of the things which make the British system dangerous are not going to apply in our situation anyway, like for example the fact that since they have joined the EU any doctor with a diploma from the medical school anywhere in Europe can come and practice medicine in Britain. Some countries' medical education is still substandard. This clearly is not going to happen in the US where licensing rules are very strict and religiously enforced. So I am not advocating blindly following some inferior models. But we need to recognize that there are models which are clearly superior.

We need to come to the realization that we are not the greatest in many respects. My father who is a math professor in one of the US universities has said long ago that a) if the US stops accepting foreigners into grad schools, all the US graduate schools in mathematics can be closed, and b) that it would have made much more sense economically for him to learn Chinese and to to go teach students in China rather than teach Chinese students math in the US in the language which is foreign to both the professor and the students. Like I said, he made this observation years and years ago, and the situation has not improved since then. There has long been a joke in Russian that American universities are places where Jewish professors from Russia teach Chinese students math in English. Every joke, as we know, is a joke only to a degree.

If we ignore the facts, and continue to pat ourselves on the back complacently basking in the myth of our greatness, we are going to irrevocably miss the boat into the future.

What do American Health Care and Soviet Fire Fighters have in common?

I am getting a lot of messages with polarized opinions about the health care reform. I want to point out one of the reasons why the current "system" is ridiculous and unsustainable.

Doctors are paid more to do procedures, and significantly less to just use their brain power for a diagnosis. (Granted, there is also at least one malpractice attorney behind every bush waiting to see you NOT do something which might have helped the patient.) Therefore, the more procedures they do, the higher their pay. Do you see anything wrong with this picture?

Once upon a time, Russian fire fighters were paid by the hour for the time they spent extinguishing fires. And - surprise, surprise - fires became a lot longer and more devastating. Hope you see the analogy here.

I think in the argument about health care we forget that the goal of a good health care system is not to provide people with unlimited and immediate access to all available tests and procedures, not to spend the most money for treatments, but to provide better quality of life, and to increase life expectancy of the citizens. Yes, Americans get the most tests, heart catheterizations, colonoscopies, elective surgeries, etc., but they still live less than people in Europe do, and outcomes of most diseases are worse over here than over there. We are behind every developed European country in those two respects. End of story.

The myth of American superiority in health care is greatly exaggerated. Tough pill to swallow, my fellow Americans, I am sure. But once you get it down, you will feel better.

(By the way, a common misconception also is that doctors somehow benefit financially from the drugs they prescribe - that is, a doctor gets a higher kick-back for prescribing name brand drugs, and a lower one for generics. This is absolutely not true. Unless your doctor is also your pharmacist, he or she is not materially interested in how many and which drugs you get.)

Please take a poll on universal Health Care

The poll is located on the side bar of my blog midway through the page. The poll ends on August 12, 2009. Please take 3 seconds of your time to voice your opinion. The results will be posted on this blog.

Manufactured anger

Fox news reports today: "The White House said Tuesday that some of the anger that Democratic lawmakers have encountered at town hall meetings over the past several days is "manufactured." They proceed to ridicule that notion implying that people are genuinely angry at the politicians' attempts to reform our health care system and to introduce universal health care which we alone do not have in the developed world.

As a private individual, not a liberal, and not a Democrat, I will confirm that from my personal experience I believe there is a concentrated effort behind fueling that anger and organizing those "protesting crowds". Over the weekend I received a pre-recorded phone call inviting me to come to such a meeting and "scaring" me with all the horrible things which would happen should the government succeed in their reform plans. You better believe that it cost somebody some serious money to record the message and call thousands of households. Follow the money, and you will know who organized the protests. Maybe it was financed by the Republican Party - I don't know. But it was some special groups' money which financed it anyway. My guess is that the insurance companies, and possibly the big pharma are behind the finances for such protests.

I hang up on them. As a person who originally came from the Soviet Union, and a person who has been married to a physician for a quarter of a century, I can tell them a lot myself about what the consequences will be. However, I know that the current system is deeply corrupted and inefficient. I do believe we as a nation should be able to make some basic health care guarantees to our citizens. I am not familiar with the details of the government plan - I am sure they will screw up the reform, but what we have now is not sustainable and we have no moral right to perpetuate it. The system we have now is wasteful, and it still limits people's access to health care. Your claims processor at the insurance company who may be a high school dropout has the power to deny the doctor prescribed necessary diagnostic procedure or treatment because that processor is charged with the sacred mission of guarding the bonus size for the insurance company's CEO. Don't kid yourselves! We do not have the best health care system in the world. Don't look at how much money we spend on healthcare. Look at the outcomes of teh treatment. We are far from the top of the industrialized nations in the results of all our very technological treatment. And what is important, too, I do not know a single primary care doctor who wishes their children would become primary care doctors in their turn. Reform or no reform, who are you going to have to treat you?

I will be writing more on the subject.