Health Care in America

Though it's late, a few quick posts, because these are interesting items that need to be cataloged:

Time magazine offers "Five Truths About Health Care in America" (Time, date?). Interesting charts, graphs, data, etc. This is part of their piece "The Year in Medicine 2008," (Time, December 7, 2008). An interesting list.

If this is for real, it would be amazing: "France Abuzz Over Alcoholic 'Cure,'" (BBC, December 6 2008). This would also suggest that alcoholism is much more about physicology than psychology or even morality.

This story has been all over the news, but it's worth posting: "Happiness is Contagious in Social Networks," (CNN, December 5, 2008). If you're a glum person, (a) start hanging around happy people and (b) start being a happy person. Look at the kind of effect you could have! Don't think I'm kidding. Nicholas Christakis, one of the lead authors of this study, is a big wig in medicine and medical ethics.

Of course, it's hard to be happy when you lose your job and your family's healthcare insurance at the same time: "When a Job Disappears, So Does the Healthcare," (NYT, December 7, 2008). I hope you have realized, as you have heard all the grim news about the number of jobs lost in the US in November, over the past six months, and the skyrocketing unemployment rate that of course this means that all these same people are losing their healthcare insurance coverage, if they had it. As this article notes, for every person that loses their job/insurance, that usually means that at least two other people (spouse, child) also loses their insurance. This story is sobering and heartbreaking.

Of course, there's so much more to post, but that will have to wait until tomorrow.

Science Proves: Cleanilness IS next to Godliness!

Check this out. Here's a story on a forthcoming psychology study that claims to demonstrate that "Clean People are Less Judgemental," (LiveScience.com, Dec. 1, 2008). In short, the more people surrounded themselves with positive words and the more they wash their hands, the more lenient they seem to be on others' moral failings. What are the theological and ethical implications of THAT?

Jean and I have been doing an independent study this semester on, among other things, illness narratives by the likes of people like medical anthropologist (and psychiatrist) Arthur Kleinman. This story is an interesting confirmation of what we've been reading, about the need to repersonalize medicine and be more patient-centered, but in a different sort of way: "Radiologists Read Scans Better If They Have Patients' Photos," (CNN, December 2, 2008). You'd think that since they're making $400K, they would read them meticulously anyhow, but I guess it helps if they actually connect the pictures with a patient (who they would pretty much otherwise never see or encounter).

Is this really true, do you think? "1 in 5 Young Adults Has a Personality Disorder, Many More Drink or Do Drugs," (MJS, December 3, 2008). Does this seem right, from your experience, or is this more an artifact of the pharmaceutical industry manufacturing conditions/disorders to increase market share? I ask because this is germane to my job. I mean, if 20% of the people sitting in my classroom have a personality disorder, that's significant. From where I sit, I must say this figure seems high, but maybe I'm just missing something. And why stop at young adults? Wouldn't this carry over into the 20s, 30s, 40s, etc., population?

Good for the Cleveland Clinic! "Cleveland Clinic Discloses Doctors' Industry Ties," (NYT, December 3, 2008).

Here's a different spin on health insurance. Is this just a way to make money off of people's fears or is this a good idea? "UnitedHealth to Insure the Right to Insurance," (NYT, December 2, 2008).

This is rather mind-bending, or body-bending, or gender-bending: "Standing in Someone Else's Shoes, Almost for Real," (NYT, December 2, 2008). How wild would it be to perceive yourself to be in someone else's body. Think of the range of insights that could open up.

What would you do if you worked with someone like this? "Arrogant, Abusive, and Disruptive -- and a Doctor," (NYT, December 2, 2008). To counter this: "The Six Habits of Highly Respectful Physicians," (NYT, December 2, 2008).

Maybe these changes will be in effect soon enough to affect you all: "Panel Calls for Changes in Doctor Training," (NYT, December 2, 2008). I hope the cynical guy at the end isn't right.

I'm posting this first because it's important and second because it quote Ezekiel Emanuel, who's a big wig in medical ethics, and I just found out (from this article) that he's Rahm Emanuel's brother. How wierd is that?! "Report Ties Children's Use of Media to Their Health," (NYT, December 2, 2008). Turn off the TV, throw away the Game Boy, unplug the computer, make them go outside and then when they come in, give them cocoa and a book.

File this under "scandalous!": "Some US Doctors Likely to Stop Giving Shots, Citing Poor Vaccine Reimbursements from Insurers," (AP, December 1, 2008). Oh, that's right, doctors don't go into medicine to promote and protect patient and public health; they go into medicine for the money! If only I could remember that....

Finally, two posts that could make one despair of the human race if they didn't also offer hope: "Rapid Care 'Cuts Baby's HIV Risk," (BBC, November 19, 2008); and this: "A Breathtaking Aspiration for AIDS," (NYT, December 2, 2008). So....the data strongly suggests that if you start antiretroviral treatment upon diagnosis rather than waiting for the patient's T-cells to tank, you get better outcomes -- both for the patient and now, possibly, for public health. And the controversy would be....oh, right, money.

Her Body, My Baby

Just in time for our recent conversation on reproductive technologies. the New York Times magazine has again done me the favor of running yet another cover story on the topic. I am posting the link to the whole magazine rather than just the story, because I always think it's important to see the cover picture they run. The cover is always part of the argument. So click on the link above and then click on the story, "Her Body, My Baby," (NYT Magazine, November 30, 2008).

While we're on this theme, here's an article that shows how seriously reproductive technologies are taken amongst the career-driven: "Frozen Eggs: Oocyte Cryopreservation is Not the Key to Professional Success in Academe," (The Chronicle of Higher Education, November 21, 2008). This article also highlights points made by Paul Lauritzen in his critique of reproductive technologies -- how powerful traditional gender roles still are and how these play into the industry of reproductive technologies.

And what do you make of this use of genetic technology, available over the internet, no less: "Born to Run? Little Ones Get Test for Sports Genes," (NYT, November 30, 2008).

This is just cool science/clinical news: "Heart Disease 'Reversed in Mice,'" (BBC, November 30, 2008).

Happy New Year!

Happy New (liturgical) Year! Tomorrow Advent begins, and so begins a new year in the church. One of my resolutions will be to more faithfully keep up with the posts on this blog. It's all about habituation -- once one gets in the habit, it's hard to stop; once one stops, it's hard to get started again.

It's a new year, but alas, so much of the news is the same. This should tell us something, eh? For example, from the BBC: "Drug Firms 'Block Cheap Medicine,'" (BBC, November 29, 2008). We read about this in Angell, but years later, the double-speak continues. Here's the NYT's version of the same story. Along the same lines, you will remember both Angell and Michael Moore's comments about the Medicare Drug Plan passed by the Bush administration; more confirmation of their claims: "Medicare Druge Plan Costs Soar," (MJS, November 21, 2008).

Here's a positive development in organ transplantation: "Study: Blacks No Longer Die More Often Than Whites While Waiting for Liver Transplants," (MJS, November 25, 2008). As you see, these numbers only turned around in the past six years or so.

Read this with interest, those of you in Wisconsin: "Paging New Doctors," (MJS, November 29, 2008). Are you interested in serving in inner city Milwaukee? Do you know minority students who could be recruited into medicine? (Look at those dismal numbers for minority applicants to med schools in Wisconsin!). Did you know about the Wisconsin Academy for Rural Medicine? This is a fascinating and informative piece. Forward it on to those who are working with Student Advocates for Health and Human Dignity. And a related piece, written by someone who practices medicine in Milwaukee: "The Rewards of Urban Doctors," (MJS, November 29 2008). Have we invited this doctor to campus yet?

And from an old doctor, a retired surgeon, an ethical blast: "Medicare 'Strike' Unethical," (MJS, November 29, 2008). How would you respond to Dr. Ridley?

Latest figures on health insurance costs in Wisconsin: "Health Benefit Costs to State Employers Rose 4%, Survey Says," (MJS, November 19, 2008).

Continuing another theme from last spring: "How to Save the World in Small Steps," (MJS, November 27, 2008). I did not know there was a World Toilet Day. Was this Bishop Desta on campus last month? His name is familiar. This is a cause toward which you (or an organization like SHHD, again) could make a real difference.

Physician Shortage in WI

Here's a very interesting piece on the current physician shortage in Wisconsin: "Report Says Wisconsin Must Address Lack of Primary Care Doctors," (MJS, November 11, 2008). The salary table is interesting, to be sure, as are the recommendations. Bottomline: it might pay for you all to think about practicing medicine in Wisconsin. To put this article in perspective, the national median income is around $40,000. So your average radiologist makes about ten times what most people do. Because...she reads films all day?

The Election is Over...Now...Healthcare Reform?

The election is over: hallelujah on so many counts, not the least of which is that I can now stop my obsessive following of political blogs and get back to work. Yes, I admit: I spent every spare online moment for the past six weeks following the campaign. This was not healthy in many, many ways. The only way to detox is to get back to reading about health care. So this blog is going to be my therapy; help me out here, you proto-docs.

Obviously, I can't catch up on a six week backlog of health care news at one fell swoop, so I'll start slowly and work backwards. Because even with the percentage of news space devoted to the election in October, news on health care has not been lacking. Today, for instance, the Times has a front page story on immigrants (legal ones) and the US health care system: "Deported in a Coma, Saved in the US," (NYT, November 9, 2008). Isn't the first principle of medical ethics: "First, do no harm"? How do we think about the issue raised here?

And, given what we know about the pharmaceutical industry, how do we think about this one: "Wider Benefit Seen from Cholesterol Drugs," (NYT, November 9, 2008). On the one hand: taking statins appears here to be a positive preventative strategy, not invasive, etc. On the other hand: is medication the answer to a question like this, in seemingly otherwise healthy people? On the other hand (how many hands do I have going?): the study was sponsored by...a drug company...who stands to benefit astronomically.... Thoughts?

Just FYI: "New US Rule Pares Outpatient Medicaid Services" (NYT, November 9, 2008). [How many days until January 20th?]

As we know, health insurance coverage is tied to employment in the US. What happens, in an economic crisis the likes of which the US is now experiencing, responsible, hardworking people begin to lose their jobs at a rate not seen since something like 1982? Well, on the one hand, they lose their health insurance coverage; they lose the income with which they could pay for COBRA extensions of their health insurance; and because of the stress, and because we're entering into cold and flu season, they and their children probably get sicker more often. But they now don't have insurance. So: "Hospitals Seeing Decline in Paying Patients," (NYT, November 9, 2008). This is looking bad all the way around.

Okay, this should give you enough to chew on for tonight. More soon, hopefully tomorrow.

Colonialism and the Origin of HIV

Greetings, faithful readers. I've been slammed and away for my first meeting with the Anglican-Catholic Theological Consultation in DC. Very interesting. Where do Catholics and Episcopalians agree on moral issues and where do they diverge? Four years from now I'll tell you.

In the meantime, here's an item you should find interesting: "Colonial Clue to the Rise of HIV," (BBC, October 1, 2008). If you've never studied the social history of pathogens, you should -- it's a fascinating field. Here they correlate colonialism and the establishment of urban centers with the rise and spread of HIV. It would be interesting to hear more about the social conditions in those cities (or at least in Leopoldville) that could be further correlated with the rise and transmission of HIV specifically.

This would be important development, both practically and ethically: "Frozen Liver Transplant Success," (BBC, October 1, 2008). Practically, it would be enormously helpful to be able to freeze organs rather than having to get them to patients within a tight time window, necessitating life-flights, etc., to get organs from one state to another in order to keep the organs useful. If organs could be 'banked,' this could potentially help the organ 'shortage.' My liver, for example, could be banked until a good match was found, rather than being implanted into the best possible currently available recipient, also increasing likelihood of success. How could this help ethically? Two issues: (1) right now, because of the short time-frame for viability of organs, protocols are being developed to take organs not only from patients who are brain-dead, but also from patients who experience 'cardiac death' (these are called "non-heart beating donor" protocols). Patients who are taken off of life-support for whatever reason are watched until their hearts stop and then, after a minute or so, are declared dead, declared an organ donor and either put back on life-support to keep the organs viable or whisked off to the OR so that their organs can be 'harvested.' Some are concerned about conflict of interest issues that this protocol could raise -- if a transplant recipient is waiting and dying, might one prematurely decide that the potential donor should be taken off life support? (2) Apart from NHBD protocols, there is always concern about conflict of interest, especially since organ transplants are quite profitable. Organ procurement teams hover, sometimes vulture like, around family members who have to make end-of-life decisions about a patient (usually patients who come in from some emergency sort of situation -- motorcycle accident or something like that). Could the possibility of freezing organs reduce the pressure that organ procurement people put on patients and families?

What specialty are you going into, and why? "A Crisis of Care on the Front Line of Health," (NYT, October 1, 2008).

What do you know about your own body language? "The Dance Before the Diagnosis," (NYT, October 1, 2008). How do you think you will handle these sorts of situations?

There's Always an Agenda

Here's a fascinating and potentially disturbing item from today's Chronicle of Higher Education: "Education Levels Linked to Party Affiliation, Poll Suggests," (CHE, Sept. 24, 2008). Could it be the case that a political party could work against expanding access to higher education because higher education might negatively impact their party's success??

Another interesting post from Dr. Pauline Chen: "Taking Time for Empathy," (NYT, Sept. 25, 2008). This piece echoes a conclusion that I've drawn from elsewhere: we often think that doing the 'right' thing is not "cost-effective," but in actuality, it turns out that doing the right thing has 'positive' outcomes that we couldn't even have anticipated. Interesting....

Who could have anticipated these complications: "Hospital Bracelets Face Hurdles as They Fix Hazard," (NYT, Sept. 25, 2008). I was most intrigued by the issue of the DNR bracelets. How might one patient treat another if the second is wearing a DNR bracelet? Hospital personnel ought to treat them without distinction from other patients, but human nature isn't perfect. Might hospital personnel give them less care, subconsciously? They might, of course, treat them with increased compassion. But what might other patients do?

Here's another doc I'm going to have to learn more about: "A Time When Listening is 'Sacred,'" (NYT, Sept. 25, 2008).

Look at the inflation on the amount that health insurance is costing families, even those covered through their employers: "Health Care Costs Increase Strain, Study Finds," (NYT, Sept. 25, 2008). The amount has doubled in 9 years -- that's stunning.

WWHD?

This is great: "What Would Hippocrates Do?" (NYT, Sept. 23, 2008). We should read some of the Hippocratic writings. They're very interesting, and obviously, they've been very influential. What sort of doctor do you want to be, and how are you going to get there? How are you not going to get side-tracked? What will keep you human...and Hippocratic?

Something to think about: "The Doctor's Hands are Germ Free. Are the Scrubs, Too?" (NYT, Sept. 22, 2008). For the same reasons as cited here, I keep wanting to shout to those doctors on House: get a haircut!

Good news: "City Plans to Increase Health Care for the Poor," (NYT, Sept. 22, 2008).

If you consume large amounts of diet sweetener: "New Salvo in Splenda Skirmish," (NYT, Sept. 22, 2008).

Not to be distracted by the economy, Pharmalot is still on the job: "Lung Med Linked to Heart Attack and Deaths," (NYT, Sept. 23, 2008).

I end with today's column by conservative political commentator, George Will. I don't always agree with him (and I would take issue with one point in this piece), but he's very smart and usually very well reasoned, as I'd say he is here: "McCain Loses His Head," (Washington Post, Sept. 23, 2008). Here's a great piece he did recently on the Christo Rey (Jesuit, inner city) High Schools: "In Chicago, Discipline That Builds Dreams," (Washington Post, Sept. 14, 2008). For more posts by George Will, click here.

Greed

I think I'm going to start reading these guys from Freakonomics every day. They get alot of things right. Today, for example, they give one of the truest diagnoses of how we got into this current economic mess: "John Steele Gordon on the Financial Mess: Greed, Stupidity, Delusion -- and Some More Greed," (Freakonomics, Sept. 22, 2008). Greed, stupidity...if they would add Idolatry, they'd have the whole story. This is the most important analysis.

Back to medicine, a moving perspective from a patient's perspective: "My First Son, Pure Memory," (NYT, Sept. 22, 2008).

Jean related to me last week a comment one of her bio professors made in class. He challenged the notion that reducing the incidence of obesity would reduce health care costs, arguing that the longer obese people live, the more they cost; therefore, the best way to reduce health care costs would be for obese people to die younger (or something like that). Now read: "Can Binge Drinking Save Social Security?" (Freakonomics, Sept. 19, 2008).

The Thinker

I had a nice long post going the other day and then my browser gave out and I lost it.  Hopefully this one will be a keeper...

This is how philosophy ought to be taught, and theology for that matter: "The Thinker," (NYT, Sept. 21, 2008).  Perhaps this is all for nothing, though, overagainst the realities below.....

Last time the reading group met, we discussed the principle of autonomy, but raised the question of physician autonomy -- does it exist?  what would it mean?  Etc.  Here's a piece that raises the same question, but from a different perspective: "Blocking Care for Women," (NYT, Sept. 18, 2008).

A great piece on "The Tyranny of Diagnosis," (NYT, Sept. 19, 2008).  It's amazing how closely this article captures one of the major points of a book I'm reading in an independent study with Jean Baumgardner by physician and medical anthropologist Arthur Kleinman entitled The Illness Narratives.   For a further reflection on this piece see: "Are Doctors Treating the Diagnosis or the Patient?" (NYT, Sept. 19, 2008).  Where would House come down on this question? 

The findings in this study are sobering: "E.R. Patients Often Left Confused After Visits," (NYT, Sept. 15, 2008).

The recent data on health insurance costs for employers and patients: "Health Costs Rise at Slower Pace," (MJS, Sept. 11, 2008).  Nonetheless, "Insurance Costs Rise More Than Paychecks," (MJS, Sept. 11, 2008).

Points for these folks -- they got it right: "Business Group Investing in Kids," (MJS, Sept. 21, 2008).

I could post 100 pieces on the current financial meltdown and Washington's response.  This is the most helpful piece I've read explaining where we are and how we got here: "Diamond and Kashyap on the Recent Financial Upheavals," (Freakonomics, Sept. 18, 2008).  I could post the 100 articles not only because we are in the middle of the current crisis, but primarily because they make clear how much of this meltdown is the direct result of the sort of deregulation talked about at length in Dying for Growth.  It's the same names, the same policy-makers, the same story, only now, look at the price-tag.  And as always, it impacts health enormously -- both over the past 25 years since the government gave up its responsibility to safeguard the American public against the rapacious greed of its few, powerful friends and clearly going forward.  All that money that is bailing out these firms will now be unavailable for the kinds of projects the US needs to build its infrastructure, to increase access to healthcare, to fund physician education, and so on.  It's almost too much to take.

I'll close with another story on how the rich get richer: "Is Boutique Medicine Worth the Price?" (CNN, Sept. 19 2008).  If nothing else, just do the math: 600 patients at $1500 per patient per year equals....how much is the doctor taking in per year?  And seeing fewer patients...thereby exacerbating the problem of access to healthcare...

The White House and the Physician's Office

I shall refrain insofar as possible from posting election-related pieces on this site over the next seven weeks, but it's getting harder and harder to do so, especially when the stakes are so high. So, when I do, in order to correct for my biases, I am going to try to only post comments from writers with a 'conservative' bent. [For the record: I do not affiliate with a political party. I will be voting for the Democratic candidates in the upcoming presidential election. I do not always vote for the Democratic candidates. I once voted for McCain in a primary; I will not vote for him now. Conservatives would categorize me as a 'liberal'; liberals think I'm terribly conservative. I do avoid the self-identified "conservative" media because [how can I put this nicely?] I find their reasoning to generally be quite flawed, and I find their modus operandi to lack virtue and the minimum requirements for respectful, civil discourse. Okay, end of personal political positioning.]

This first piece is by David Brooks, who I generally avoid reading. But the title caught my attention: "Why Experience Matters," (NYT, Sept. 16, 2008). He gets it right, here. Another way to frame the question would be: what sort of experience do you think is necessary for someone to practice as a physician? Given your answer to this question, what sort of analogous experience ought then be required for someone to take on a job as significant as leading the most powerful and complex country in the world? In a related story today, McCain's top aide and economic advisor claimed that neither Sarah Palin nor John McCain would be capable of running a major corporation (nor, in her opinion, would either of the other candidates be): "McCain Advisor Fiorina: Palin Not Ready to Run a Corporation," (CNN, Sept. 16, 2008). She then spins it by saying that neither of them are candidates to run a major corporation. But the real question is: what sort of experience would any corporation in its right mind require of legitimate candidates for CEO and, therefore, analogously, what sort of experience ought American voters -- if they are responsibly doing their job -- require and expect in the candidates put forward by political parties for the highest offices in the land?

From our friends at Freakonomics (who I actually do think regularly write interesting, well-reasoned, insightful and informed pieces): "Competing Tax Plans: Two Perspectives," (NYT, Sept. 16, 2008).

And here a comment on current proposals for off-shore drilling, one of the current hot-topics in the election rhetoric. It's by David S. Abraham, who oversaw offshore oil and gas revenue for the Bush administration from 2003 to 2005: "One if by Land, Billions if By Sea," (NYT, Sept. 14, 2008). This seems relevant since we, as a country, don't seem to have enough money to address healthcare.

The Doctor-Patient Divide

Here's a new columnist for the New York Times, a surgeon -- Pauline W. Chen -- who intends to write regularly on the doctor-patient relationship: "Healing the Doctor-Patient Divide," (NYT, Sept. 11, 2008).

One Million Homeless in Haiti

That would be 13% of their population: "One Million Homeless in Haiti," (BBC, Sept. 13, 2008).

This needs no commentary: "U.S. Arms Sales Climbing Rapidly," (NYT, Sept. 14, 2008). Just note the figures: from $12 billion to $32 billion in three years. I wonder what $32 billion would do for Haiti. Hm.....if my math's right, that would be 106 years of the Haitian annual budget (which is $300 million). And that's just one year of US arms sales to the world, just one year of the US making sure that the violence in the world continues and increases. Let's talk pro-life, shall we?

Praying with Patients?

Of interest: "How To Talk To Your Doctor About God," (CNN, Sept. 10, 2008).

In spite of inflation, you're just not worth what you used to be: "How to Value Life? EPA Devalues Its Estimate," (MSNBC, July 10 2008). This, of course, is cost/benefit analysis at it's most blatant, but this is how the government actually works. What's interesting, however, is how clearly it shows one of the major flaws of utilitarianism and cost/benefit thinking: how easily manipulatable the 'equation' is. One must always ask: who's calculating the 'costs' and the 'benefits'? 'Costs' to whom? 'Benefits' to whom? In general, it's only people with power -- and people who stand to benefit from the outcome of the decision -- who get to make the calculations. In medicine sometimes that's okay -- if the patient is the one who's going to be affected by the decision, then the patient should be able to calculate the costs and benefits to her/himself as part of the decision-making process. But when the principle of utility gets wielded in other ways in medicine, one needs to be extraordinarily suspect.

I've been saying since I moved here that Wisconsin is a different sort of place than anywhere else I've lived, and different in a positive way. Now I have a scientific study to back up my anecdotal data: "Welcome to Sunny Wisconsin -- Personality-wise, That Is," (MJS, Sept. 10, 2008). Yet another reason to love Wisconsin!

Farmer Writes From Haiti

More accurate news on Haiti than from CNN, the NYT, or the other usual sources. It's so grim: "'I have never seen anything as painful': Paul Farmer writes from flood ravaged Haiti," (PIH, Sept. 6 2008). When he wrote this, Ike had not yet hit Haiti.

Today, however, he talked about the post-hurricane situation in Haiti; you can view it here: "Haiti Struggles with Humanitarian Disaster in Aftermath of Deadly Storms," (DemocracyNOW, Sept. 10, 2008).

Completely unrelated, but of interest: "Do You Really Want to See Your Doctor's Elbows?" (NYT, Sept. 10, 2008).

Birth and Death

Last year, the newspaper gave me a steady stream of articles on global health, economics, and social justice. This year it seems to be giving me a steady stream of articles on more traditional topics in medical ethics. Gotta love it.

Not a 'new' story, necessarily, though it now makes news every time it happens: "59-Year Old in France Gives Birth to Triplets," (MJS, Sept. 9, 2008). Should 59 year-old women be having babies (plural!)? Why? Why not?

Those of you who are applying might find this of interest: "UW Medical Schools Mull Pass/Fail," (MJS, Sept. 9, 2008). Those of you in med school: would you study just as hard if the system were pass/fail?

We will be talking much about death and dying over the coming months. Today we find a poignant and realistic account of a 'code' from a nurses' perspective: "Perhaps, Death is Proud," (NYT, Sept. 9, 2008). The doctor on "House" was heard to say that death is never dignified. This story would lend support to that claim.

Something to boggle one's assumptions: "As External Barriers Disappear, Some Gender Gaps Widen," (NYT, Sept. 9, 2008). I was going to ask the medical students how you perceive the gender dynamics/gaps in medical school. But then I scrolled down and found this article: "Urology Field, Slowly Altered by Women," (NYT, Sept. 9, 2008). Does this ring true?

Now, here's a very odd article: "The Pitfalls of Linking Doctor's Pay to Performance," (NYT, Sept. 9, 2008). Is it just me or are these systems inherently bizarre? The doctors' pay is tied to 'performance' -- i.e., if they administer antibiotics or ACE inhibitors; the doctors' pay is not tied to 'outcomes' -- i.e., if most of their patients get better, because they need antibiotics or ACE inhibitors. It seems to me an odd system set up along the same lines as the old -- fee-for-service rather than fee-for-outcome. This seems a very odd way to measure 'performance.' Or am I reading this wrong?

As I am sure you all know, there is this new movement launched by university professors last month to get the drinking age changed back to 18. In light of that, this seems worth posting: "Curbing Binge Drinking Takes Group Effort," (NYT, Sept. 9, 2008). College students spend $5 Billion a year on alcohol. Billion?! And 1700 college students die every year from alcohol-related deaths. I never knew these stats. This is certainly not a dignified way to die.

I won't editorialize: "Facing Veto, Democrats Drop Plan for Vote on Child Bill," (NYT, Sept. 7, 2008). We certainly wouldn't want to make the mistake of taking care of the children of immigrants or the well-off. [Oops, there I go, editorializing.]

Now Haiti's been hit four times in, what, two weeks? "Desperation Grows as Flooded Haiti City Awaits Aid," (CNN, Sept. 9, 2008).

And Again!

As if the situation in Haiti wasn't bad enough last night when I posted, it appears Haiti got socked again within the past twenty-four hours, this time by hurricane Ike: "Ike's Floods Kill 48, Cut Off Aid to Parts of Haiti," (CNN, Sept. 7, 2008). Apparently there are now no roads into Gonaives. This story refers to a dam, over the Arbonite Valley, which authorities apparently plan on opening because it is overflowing, "inundating more homes and possibly causing lasting damage to Haiti's "rice bowl," a farming area whose revival is key to rescuing the starving country." This cannot be the Peligre Dam...or could it? Here's a related report from the BBC: "Haiti's Storm Ordeals," (BBC, Sept. 7, 2008).

On a different note, you will recall our discussion of the Bayh-Dole Act and its role in the explosive growth of pharmaceutical profit margins. Here's another angle on the problems Bayh-Dole has caused, this time for universities: "When Academia Puts Profit Ahead of Wonder," (NYT, Sept. 7, 2008). Isn't it amazing how quickly money/greed/profit (call it what you will) can distort any endeavor? Universities have for centuries been the places where knowledge is pursued for its own sake, with a recognition that that is of value to a society. But anymore, anything not done for profit, for which one cannot measure an 'outcome,' which one cannot 'assess,' is not considered of value. It's a good thing there's nothing to be patented in theology, though of course at no time has theological knowledge been pursued for its own sake.

Should university-based researchers be able to patent their findings? Should the university where they work lay claim to at least part (if not all) of that patent and those profits? What do you think?

Hurricanes Ravage Haiti...again

And, again, Haiti is ravaged: "Storm Surge Left 500 Dead in Haiti," (NYT, Sept. 5, 2008). Gonaives...isn't this the town that Mountains Beyond Mountains opens in? Three hurricanes/tropical storms in a row have hit Haiti really hard.

Here's the account from Partners In Health: "PIH Action Alert: Hurricanes Ravage Haiti," (PIH, Sept. 3, 2008). If you haven't been to their website in a while, it's always worth visiting. New updates on the variety of ways the US government has worked to undermine that great Caribbean threat that Haiti is are paired with more hopeful stories of people doing good work in Lesotho and elsewhere.

Catching Up

I'm starting to think the news in medical ethics is kind of like soap operas -- go away for months, come back, and pick up right in the same place in the plot as when you left! First I go on vacation; then I get hit with the tsunami of the beginning of academic year; and when I return....there is Vytorin, waiting for me to post.

Maybe I'm a scientific fascist, but geez, I just think evidence and data are important when it comes to pharmaceuticals. Since we first started following this story last April (?), the picture on Vytorin has just gone from bad to worse: "For Widely Used Drug, Questions of Usefulness Still Linger," (NYT, Sept. 1, 2008). Soon you will all be physicians: if you had been prescribing this to your patients, what would you do now? If you hadn't yet started prescribing it, what would you do? What are your pharmacology professors saying, oh med students?

But, of course, Vytorin is far from alone in this scenario: "Amgen Alters Anemia Drug Discounts," (NYT, August 27, 2008).

Here's an interesting development re. the problem of drug company influence on physicians: "Stanford to Limit Drug Maker Financing," (NYT, August 25, 2008). How does UMinn handle this issue, Beth?

Here is a classic medical ethics case that we will discuss...maybe even at the first meeting of our reading group. But if not, I'll post on it at length later this week: "With Child, With Cancer," (NYT, August 29, 2008).

Although the reviewer counsels the reader not to "waste this book on medical students," but rather to save it for physicians in their prime, maybe it'd be worth getting it and reading it now (next summer) and then reading it again in twenty years: "A Doctor Transformed, Into a Patient," (NYT, August 25, 2008).

Another important 'case' study: "Looking Squarely at Death, and Finding Clarity," (NYT, August 18, 2008).

As proto-physicians, how do you feel about this new development? "Health Care Groups Assign Ratings to Doctors," (MJS, August 30, 2008).

Interesting data; what do you think of this? "Family Planning Program Saved State $487 Million," (MJS, August 29 2008).

Water, More and Less Deadly

Now that I'm back from Michigan and back to work (nothing like going from 0 to 90 in a matter of days), it's time to get back the news.

Haiti is getting socked again, as always. Tropical Storm Fay did some damage a couple of weeks ago; now Hurricane Gustav is wrecking damage. This story, from CNN, notes that the city of Jacmel sustained a particularly large amount of damage from Gustav. "Cut in half" is the phrase they use. Jacmel, I believe, is in the vicinity of the clinic where Beth worked last year (right, Beth?). If so, you'll have to update us on how they're doing.

Although water can be deady in a variety of ways in places like Haiti, here's a story sent from Ted along the lines of the Dean Kamen story we talked about last spring: "'LifeSaver' Bottles Purify Water in Seconds," (FoxNews, May 9, 2008). If this is legit -- and it sounds like it is -- this could be a truly transformational technology. While I still think Kamen's device is great, this one has the advantage of being portable. Those of you thinking of spending lengthy periods of time in places with compromised water supplies might think about investing in one. They are apparently available for purchase through the manufacturer (see their website). They say that they hope to have a larger scale model ready within the next twelve months. Imagine the health impact if every home in Haiti had a version of this.

Here's a story sent to me by Chris, to which he appended the comment: "This is news?" "Aggressive TB Treatment 'Success'" (BBC, August 24, 2008). So indeed, how about that: aggressive treatment works not only with first-world ailments like heart-disease and cancer, but sustained, methodical attention to infectious disease in (usually) poor patients actually looks like it has better outcomes than with those first-world ailments. The lead researcher on this story is affiliated with Partners In Health. Grace continues to abound.

And yet more on transformational technology: "Robo-skeleton Let's Paralyzed Walk," (BBC, August 26, 2008). This really is something both in terms of human dignity and some of the health complications that come with paralysis.

More soon from the NYT and elsewhere. Beth, report in on the first month in med school, if you get a chance.

Stories from Medicine

Exquisite weather and perfect days continue in Empire, MI. Most of the tourists are gone now, and we essentially have the beach to ourselves. Yes, we are tourists too, and ever since I watched "Life and Debt," I have felt conflicted about my status as a tourist, even here. I try to compensate by contributing as much to the local economy as I can. Internet connectivity has been rather iffy the past week or so; let's see if I can get today's stories posted....

For all it's troubling aspects, I do continue to love certain aspects of genetics: "The Genetic Map of Europe," (NYT, August 13, 2008).

I thought this was kind of nifty: "Diana Beresford-Kroeger: Advocating an Unusual Role for Trees," (August 12, 2008). This is definite 'outside the box' thinking. Strive to be this kind of person.

A good story for proto-docs to read: "Having Cancer, and Finding a Personality," (NYT, August 11, 2008). As is this, from the other side of the white coat: "Condolences, Felt but Not Expressed," (NYT, August 11, 2008). How will you feel when your patients die? Will you feel?? How will you handle it?

Of interest for premed students: "New York City Hospitals Create Outcry in Foreign Deal," (NYT, August 5, 2008). What do you think of this?

I don't think this route is necessarily for any of you reading this blog, but it is certainly a worthy path (I recommend it often to undergrads). It's much less expensive, less education, less malpractice insurance, and you get to practice medicine. It might be an interesting option for some of your friends: "Yes, the P.A. Will See You Now," (NYT, August 9, 2008).

Egg Money

Yesterday dune-climbing, today Cherry Republic (best cherries in the universe) and maybe a ride around Big Glen Lake. Endless days of perfect weather.

I'll comment more on this shortly, but for now I want to make sure I post it. Have a read: "Dim Economy Drives Women to Donate Eggs for Profit," (CNN, August 6, 2008).

Here's something to think about as you all seek ways to pare down the cost of medical school: "Living Simply is Simply Cheaper," (CNN, August 6, 2008).

More evidence that the treatment of most disease really needs to be multifactorial: "Behavioral Approaches Overlooked in AIDS Fight," (NYT, August 6, 2008).

I think this series that the Times is doing on patient perspectives on illness is really quite good: "Patient Voices -- Parkinsons' Disease," (NYT, August 6, 2008).

No news to you but more data: "Millions with Chronic Disease Get Little or No Treatment," (NYT, August 6, 2008). As you engage in argument with others around increasing access to health care, especially during this upcoming campaign season, don't forget to emphasize how 'costs' need to be accounted differently than we usually do. While sure, it will cost money to cover all these people, what are the 'costs' that come from not treating them? Insulin and blood-pressure meds are far less expensive than the kind of care that is required when diabetes and high blood pressure take their toll later -- amputations, blindness, prosthetic limbs, progressive organ failure, stroke, etc. This is what happens to people when their diabetes and blood pressure are not managed; if they come to the ER, care must be given. Once they're disabled, social security will start paying. Etc., etc. The costs of not treating people are so much greater than the costs of treating, but they're so much harder to make visible.

Concierge Medicine comes to Wisconsin

"Concierge" medicine arrived in Ohio about 10 years ago, but apparently is only now hitting Wisconsin: "Froedtert Physician to Open Concierge Medical Practice in Mequon," (MJS, August 5, 2008). What connotations does the word "concierge" conjure in your mind? Ought these notions be associated with medicine? Especially for those of you who are going to be physicians, what do you think of this approach? Ethical upsides? Downsides?

Something to think about next time you zone out in class: "You're Checked Out, but Your Brain is Tuned In," (NYT, August 5, 2008).

Very interesting reflection on isolating patients: "Germs are Potent. But So Is a Kiss," (NYT, August 5, 2008).

Drink up! "Sorting Out Coffee's Contradictions," (NYT, August 5, 2008).

Fascinating how subtle bias can be: "Disparities: Surgical Tools Not Fit for Smaller Hands," (NYT, August 5, 2008). Remember this, women, when you do your surgery rotation and make sure you have the right equipment.

This book might be worth getting, if one can: "To Heal the Wounded," (NYT, August 5, 2008).

The Pill is like....DDT?

Another glorious day dawns over the Sleeping Bear Dunes National Lakeshore. The rain last night gave way to clear skies today. Off, then, for another bike ride. I will say, one of the great virtues of eastern Wisconsin is that, from a biking perspective, it's very flat. That is not the case here.

Here's a story to keep on your radar: "Faith's Lodge Provides Solace for Grieving Families," (MJS, August 4, 2008). What does this have to do with medical ethics? It suggests that maybe that our concept of 'the patient' ought to include more than just the person who is (technically) ill, especially when that person is a child. And, it's one more story to add to my collection of 'why Wisconsin is great.'

What are the options for the kids in this story? "Homeless Shelter Focuses on Youth," (MJS, August 4, 2008). Imagine yourself in the shoes of one of these kids and where you would be right now if this was your history. Four hundred kids: why is it that a city the size of Milwaukee can't figure out how to make it so that 400 kids don't have to have this as their story?

We watched the spoof SNL take-off of the contraception ad for "Annuale" in class a few months back. But this is a real, serious story: "Weighing the Health Benefits of Birth Control," (NYT, August 4 2008). Now, they're not really talking about 'birth control' here -- they're talking about pharmaceutical contraceptives (a.k.a., 'the pill'). Read this with an eye to what you now know about the 'marketing' of pharmaceuticals. Could there be any health downsides for women when they trick their bodies this way, when they suppress natural cycles, etc.? Yes, I teach Catholic moral theology and we all know that the Catholic church is opposed to artificial modes of birth control. But maybe their argument is not just medieval and anti-women. Maybe there might be wisdom in their argument (maybe even wisdom they didn't know about). I read an essay yesterday by a (Protestant) woman making similar sorts of claims, an essay entitled "The Pill is like...DDT?" I'd be interested to hear what you all think of it.

You'll like this: "A Doctors Cater to Looks, Skin Patients Wait," (NYT, July 28, 2008). How many ethical problems does this story raise?

From Paradise

It's yet another gorgeous day in Empire, MI (yes, this is where I'll be every day for the next two weeks), population about 350 year round and about 10,000 (literally) this weekend with the Dunegrass Festival going on. The place is crawling with hippies, young and old, but it adds a festive atmosphere to the place, and they'll be gone tomorrow. Then it'll just be crisp mornings, long bike rides, afternoons on the beach, hikes in the dunes, stunning sunsets, bonfires, kayaking, swimming, and good food and drink for two weeks.

The blog's been quiet here for a couple weeks, not for lack of news but I guess because I was busy getting ready to leave. Here are a few items to jump start it again.

What ought to be the relationship between medicine and the state? This article raises that question: "Immigrants Deported, by US Hospitals," (NYT, August 3, 2008). Of course, this appears to be more about money than politics.

This would be an interesting exercise for any pre-med: "Simulating Age 85, With Lessons on Offering Care," (NYT, August 3, 2008).

This is a bit disturbing. What are the implications? "HIV Study Finds Rate 40% Higher Than Estimated," (NYT, August 3, 2008). You all will have HIV-positive patients under your care. Will this make a difference in how you care for them?

Egad, doesn't this confound the stereotypes? "College Students Behaving Badly," (NYT, July 31, 2008). Reign in your buddies.

Re. your patients' nutrition: "The Overflowing American Dinner Plate," (NYT, August 3, 2008). Let me tell you: being at the beach, I see overwhelming evidence of the truth of this story.

Sobering, interesting, worth talking about when we get to the topic of the "patient-physician relationship": "Doctor and Patient, Now at Odds," (NYT, July 29, 2008).

Let the Moment Sink In

Letting the moment sink in is good advice for all of us, almost all of the time.  But here it applies to future medical students, especially those of you who are going to meet your cadaver in a couple of weeks, or those of you spending time with palliative care or hospice: "Slowing Down to Let the Moment Sink In," (NYT, July 22, 2008).

A story for all college students: "With No Frills or Tuition, A College Draws Notice," (NYT, July 22, 2008).  I've always thought Berea College was very cool, so here's its story, in case you don't know about it.  I also thought you'd find the size of the various Ivy League endowments interesting.  What ought these universities do with all that money?  If Marquette had an endowment that big, what do you think it should do with it?

More data to support the claims in Dying for Growth: "Rise in Tuberculosis is Linked to Loans from IMF," (NYT, July 22, 2008).  Look at that graph!  And along the same vein, "World Bank Criticized on Environmental Efforts," (NYT, July 22, 2008).

Vytorin is back in the news.  Not only does it appear not to be as effective as they had originally claimed, now it appears to increase the risk of cancer in those who take it: "Trial Intensifies Concerns About Safety of Vytorin," (NYT, July 22, 2008).

Beth wrote her undergrad thesis on the western beauty myth as a public health issue.  Here's more data to support that claim: "Patterns: Melanoma Rises Sharply in Young Women," (NYT, July 22, 2008).  Here we have a disease with a high mortality rate caused by a social habit -- young women being convinced they need to have tanned skin to look good.

Now here's an interesting approach to both medical care and medical costs: "Trying to Save by Increasing Doctors' Fees," (NYT, July 21, 2008).  This story gives you a window into the economics of running a physician-practice.

Debt: Yours, That Is

This is an important story. Not only do I hope it will keep you out of debt, especially as you move forward; I think it provides an important diagnosis for what is wrong with this country: "Given a Shovel, Americans Dig Deeper Into Debt," (NYT, July 20, 2008). Unfortunately, they do not include the amazing graph comparing American's total annual savings and debt load from the 1920s to today. The change is stunning. I'm going to see if I can scan it and post it.

It begins: people are finally getting serious about alternative energy sources: "Texas Approves a $4.93 Billion Wind-Power Project," (NYT, July 20, 2008). I mean, heck, if Texas oil-and-gas man T. Boone Pickens can through his personal billions behind wind-power, I'm guessing that (a) the oil situation is probably more dire than we know and (b) wind energy is probably going to be more profitable than anyone can imagine. Has anyone seen Pickens' commercial on wind energy? It's something to behold. I'd love to see hundreds of wind-turbines in Lake Michigan. I was talking to someone about wind energy a couple of weeks ago, talking about the where's and how's of harnessing the wind; and I later recalled that when I took off from Amsterdam to return home this past January, the jet flew out over the ocean and right over an entire field of wind turbines. It was intense.

Interesting how this story comes out right after Al Gore's challenge to the US to transform the way we produce and use energy...and to do it within ten years: "The (Annotated) Gore Energy Speech," (NYT, July 17, 2008). Critics immediately responded that his challenge was unrealistic, but it seems to me that the US could do just about anything it set its mind to in a ten year period. If we understood the energy/climate issue as an analogy to a war, we'd re-tool almost instantaneously. Look at how our country mobilized around and through WWII? [And what? Could it be the case that even FOXNews now believes that global warming/climate change is happening? "Eight Ways the Animal Kingdom is Out of Whack," (FOXNews, July 18, 2008).]

And, while we're on the subject of climate, gas, etc., here's a link to a post by Amos Shuman. I've never met Amos, but I know his dad, Joel Shuman (whose book some of you read!). Amos is a 26-year-old "lifestyle athlete" (i.e., he basically leads whitewater rafting tours for a living, often in Norway for months at a time, doing what else the rest of the year is not clear, but certainly living like he wants to). Anyhow, he has a blog by which he keeps family and friends posted on his adventures, and in the most recent one, he posted some thoughts on the American way of life from his experiences in Norway. I think like many people in his demographic, he wouldn't classify himself as 'liberal' or 'conservative,' but is trying to figure things out for himself. Thus, I found this post interesting and well-thought out: "Time for Change...(not the kind in your pocket)," (reluctantenthusiasm.blogspot.com, July 18, 2008).

Well, how about that? "More Smokers Seek Help With Quitting Since Latest Cigarette Tax Took Effect," (July 20, 2008). Can taxes accomplish positive health outcomes? Apparently so.

Now here's a thought: "Geezers Doing Good," (July 20, 2008). Recruit your parents and aunts and uncles. The burden shouldn't all be on you.

This, I thought, was an important perspective on the gas price panic: "Eyes Off the Price," (NYT, July 19, 2008).

As you can see, I'm trying to prove how open-minded I am, even to the point of posting two items from FOXNews.com. Here's the second: "More than One in Four American Adults Obese," (FOXNews, July 18, 2008). I post this because this means, of course, that you all will be seeing alot of obese people in your practice -- whether you're a pediatrician, a family doc, a cardiologist, whatever. How will this affect the patient-physician relationship? If you read through this story, you'll see that the CDC's estimates for the percentage of American adults that are obese is over one-third. Maybe the movie "Wall-E" should be reclassified as a documentary.

The Haves and the Have-Nots

A couple of weeks ago, Nikki sent me this story on the 'branding' of Planned Parenthood: "Extending the Brand: Planned Parenthood Hits Suburbia," (Denver Post, June 23, 2008). How interesting that they've dropped their focus on the poor, though I imagine their locations for the poor don't look anything like the ones described here. What's amazing to me is the business language used about these abortion clinics -- competing for patients, national chains, etc. Notice that its your demographic that they're targeting and catering to. This is a great article -- very informative about Planned Parenthood. I didn't know most of this information. Again, we should read Brave New World -- how did Huxley forsee this sort of thing in the 1930s?

How will you think about prescribing treatments to your centenarian patients, and why? "Rise Seen in Medical Efforts to Treat the Very Old," (NYT, July 18, 2008). About ten or fifteen years ago, one of the big conversations in medical ethics was 'rationing' care for the elderly -- having an upper age cut off (65 or 75) for surgeries and other expensive procedures -- as a way of reining in skyrocketing health care costs. That idea didn't really get very far.

What's good about this is that Dr. Fauci is calling for more basic research to be done: "Trial for Vaccine Against HIV is Cancelled," (NYT, July 18, 2008). In too many instances of government funded research (gene therapy, stem cells, apparently HIV), many of the protocols are shot-gun: based on some sort of 'effect' in animals, they upscale to major trials in humans without sufficient understanding of basic biology and mechanism. Time and money are wasted, and humans subjected to trials that will not collect meaningful data.

Let's hope this works: "Deal Seeks to Offer Drug for Malaria at Low Price," (NYT, July 18, 2008). In an intriguing related story: "Gene Variation May Raise Risk of HIV, Study Finds," (NYT, July 17, 2008).

More data: "While the US Spends Heavily on Healthcare, a Study Faults the Quality," (NYT, July 17, 2008).

If it's experimental, is it 'treatment'? "Advocating a Treatment, but Denied Access," (NYT, July 17, 2008).

Fresh or Frozen...Embyros??

Watch this video and listen to the language they use: "Fresh vs. Frozen Embryos," (CNN, July 16, 2008). And notice they don't tell you what the actual costs of IVF are.

Farms...in the Sky?

As one who is working on a farm this summer, and is quite an advocate of farming, locally grown food, etc., something about this just does not seem right to me. But what? I'd love to hear your thoughts: "Country, the City Version: Farms in the Sky Gain New Interest," (NYT, July 15, 2008). Here's a slide show.

I am tired of reading (true) stories like this: "Losing Private Dwyer," (NYT, July 15, 2008). Lots of folks focus on the number of soldiers who are dying in Iraq, and this is a terrible thing, each death tearing apart families. But far more soldiers are ending up like Private Dwyer, if not actually taking their own life, then messed up for life. Something to think about.

Drug your Dog, Cat, Hamster...

I was in too positive a mood to post this yesterday, but we can only dance and dwell in the sunshine for a while; then we have to get back to business: "Pill-Popping Pets," (NYT Magazine, July 13, 2008). This was the cover story for the NYT Magazine on Sunday. I would love to hear what you all think of this one.

And this is a good one: PhARMA is trying to make itself look good, but don't be deceived: "For Doctors, No More Drug Company Trinkets," (NYT, July 11, 2008). Here's the initial story: "Drug Industry to Announce Revised Code on Marketing," (NYT, July 10, 2008).

I don't doubt Medicare will continue to change so that the situation will be different when you all are docs, but it may well still be part of your overall billing package. Thus, this is of interest: "Medicare's Bias," (NYT, July 14, 2008). You'll note that the problem with Medicare is not that it is a government program; it's that certain factions seemed committed to set up these 'middle men' which charge exhorbitant rates and no one seems to address it. Perhaps the people making the rules are also making money on the side. In this story, interestingly, the middle men aren't even mentioned. It makes it sound like it's the doctors who are the problem: "Long-Term Fix is Elusive in Medicare Payments," (NYT, July 13, 2008).

Sunshine, Peace, and Dancing

Sunshine, peace, and dancing -- yes, this does seem a bit polly-anna-ish -- but then, these stories suggest that sunshine and education, at least, could really make a difference in the health and peace; and wow -- this guy who dances! But they won't make anyone any money. So it's hard to get people, policy makers, world leaders, to take them seriously. Last week I was plugging Wall-E for president; but mayb ethis Matt Harding guy would be a good candidate. Imagine what he could do for foreign policy!

Who knows if this one will stand the test of time but definitely interesting for those who will practice medicine, especially in Wisconsin or the midwest: "Doctors Address Vitamin D Deficiencies," (MJS, July 13, 2008). Yet another story highlighting the relationship between environment and health.

Nicholas Kristof spoke at Marquette the year before last; how I wish I'd been here to hear him. Yet another column that makes alot of sense: "It Takes Schools, Not Missiles," (NYT, July 13, 2008). And it's true -- most of the world's violence is rooted in the gross economic disparities that mar our globe. One of the roots of those disparities is lack of education. Lack of education also makes populations vulnerable to misinformation, to being duped, because of course if you can't read, how could you possibly learn that lies you've been told are just that? I love how this guy who has started these schools is focusing on educating girls -- which study after study has shown is the way to bring countries out of poverty. Here it's proving to bring countries out of violence. One wonders if, for such a fraction of the cost of maintaining global armies, whose major function is not really defense, many of the world's problems really could be solved. This is the kind of thing that people mean when they talk about 'building peace' or trying nonviolent alternatives to war. Most of the time, nonviolent alternatives really have to start long before any potential conflict.

This will make your heart expand (I hope). What a guy! "Where the Hell is Matt (2008)?" A friend of mine from Dayton sent me this. But you know me -- I can tie anything into medical ethics: "Dance Even If Nobody is Watching," (NYT, July 13, 2008). I think (anecdotely) that this link between music, dancing, and mood/mental state is absolutely right. We used to read in class Mitch Albom's Tuesdays with Morrie, which is a great book. We read it paired with Bernardin's Gift of Peace as two stories about end-of-life. One of the cool/amazing/wonderful things about Morrie was that he loved to dance. So...be like Morrie and Matt Harding...take up dancing, even if you're 'not good at it' (as most people say) and do it even if nobody is watching. You'll be amazed how much better it makes you feel (especially when you're in med school and completely stressed out).

You know, we could also ask: why have four million people watched this man's video? What are they finding there? He must be onto something. I will say I particularly liked the scenes in Papua New Guinea and zero gravity. Apparently poor Matt has also been commercialized, but who cares -- he needs to pay for all that travel.

Signing Bonuses and Beer

Basketball, football, baseball, now medicine: I never knew docs could get signing bonuses: "Aurora Health Care Seeks to Buy Cardiology Group," (MJS, July 11, 2008).

I found this intriguing since one of the first health care initiatives that the Southeastern Wisconsin Common Ground effort is taking up is just this -- trying to form a health care cooperative for small businesses. It's legal, but the insurance companies are refusing to cooperate, at least for now: "Small Business is Latest Focus in Health Fight," (NYT, July 11, 2008). I'd be happy to give you more details on the Wisconsin effort, especially for those of you whose families own or are employed by small businesses.

Apparently I wasn't the only one who was appalled when I read this piece on Monday: "Cholesterol Screening is Urged for Young," (NYT, July 7, 2008). Apparently lots of pediatricians are too: "8 Year-Olds on Statins? A New Plan Bites Back," (NYT, July 8, 2008). Oh look -- no real data on efficacy! The only data we have is that statins won't kill the children; well, that's nice. They're going to "extrapolate from the data" they have on adults. But, as this post notes, "Children Are Not Little Adults," (NYT, July 10, 2008). Seems to me a transparent effort by the drug companies to find a new way to expand the market for their already-blockbuster drugs. This is really troubling, mostly because the AAP generally makes pretty reasonable recommendations.

How will you proto-docs feel or respond if confronted with this sort of situation? "Nurses Step Up Efforts to Protect Against Attacks," (NYT, July 8, 2008).

Now that we're down to two candidates, I'll start posting pieces on McCain's and Obama's health care proposals: "McCain Plan to Aid States on Health Could be Costly," (NYT, July 9, 2008).

Here's an idea: exploit those with cancer. Lovely: "Cancer-Specific Products: An Unnecessary Balm?" (NYT, July 11, 2008).

Verlyn Klinkenborg is one my favorite Times columnists. He writes mostly about rural life, sometimes pieces that raise critical questions about the state and fate of our rural communities; other times, he writes beautiful pieces like this: "Summer's Night," (NYT, July 11, 2008).

For those of you science-minded types who drink either beer or tea: "Why Europeans Drank Beer and Asians Drank Tea," (NYT, July 11, 2008).

False Dilemmas

Before I dash off to the Ekklesia Project summer gathering (visit the Ekklesia Project's new website that we just launched today), I definitely want to post a couple of items from today's news.

Did we talk about Avastin last semester? It's difficult to keep them all straight. Here's another story on a familiar theme: "Costly Cancer Drug Offers Hope, but Also Dilemma," (NYT, July 6, 2008). This story does a great job of laying out all the angles of the problem and identifying the ethical issues. What it does not do such a job of making clear is how the "dilemma" here is completely manufactured and avoidable.

If you've ever known anyone who has committed suicide, you may find this interesting: "The Urge to End It," (NYT, July 6, 2008).

This looks like an interesting book. Maybe we should read it: "Hospital," (NYT, July 6, 2008).

Your write-in vote: "Wall-E for President," (NYT, July 6, 2008).

Difference Makes a Difference

I hope you all are enjoying your holiday weekend as much as I am. Cedarburg certainly knows how to celebrate the Fourth of July. Three straight nights of fireworks, fabulous weather, parades, cookouts. Only in Wisconsin.

Today's items are mostly interesting from a scientific point of view, but they will resonate into the area of ethics.

It now appears that gender makes a difference in organ transplantation: "Gender 'Impacts on Transplants,'" (BBC, July 4, 2008). What's the gender break down in terms of organ donation? If most donations come from head-injury patients (which I believe is the case), and most head-injury patients are men (which I believe is the case), how will this affect the organ 'shortage' question? Will there now be a new push to increase the number of women organ donors, etc.? Obviously, I need to get the facts re. the above assumptions. And how would this affect informed consent? Would physicians now need to tell patients that they have a higher risk of rejection if the organ comes from a donor of the opposite sex, and how would one do a cost-benefit calculus with that? Are people on the waiting list in a position to weigh the higher risk and say "I'll wait for an organ from a man/woman?"

I thought this second piece interesting in part because of the focus on serotonin: "Research Sheds Light on the Molecular Basis of Crib Death," (Science Blog, July 4, 2008). The title of the article overstates the case (this is being theorized as a possible mechanism). But serotonin...does it say who is financing this research? As we know, many of the blockbuster pharma drugs target serotonin receptors. While this research may be valid, I just hope we don't see infants as the next target of SSRI's, as a general therapeutic to avoid crib death -- something the bulk of parents would probably do, since parents will do just about anything to protect their children from possible harm. You'll also see in the right hand side bar other stories about findings related to SIDS -- heart genes. It is likely that SIDS -- like any syndrome -- is really not one 'disease' but is the outcome of a cluster of problems present in the perinatal period. Therefore, it is unlikely that researchers will identify the one and only cause; if there are multiple causes, there will need to be multiple interventions. Could genetic testing identify at risk children, as part of the routine newborn screening process? Possibly. Then different interventions might be implemented with different children, interventions tailored to their problems.

Bottomline with both of these stories: the success of scientific, clinical medicine from the 16th century onward has been based in discovering what all human bodies have in common -- science and medicine were about the 'universal.' What contemporary science is telling us (in more and more stories posted on this blog) is that while there is truth in this, the next phase of success in scientific, clinical medicine will lie in appreciating the differences between individuals and the relationships between individuals and their particular social, geographic, economic, and ecological locations. Medicine is a science, but from the beginning (Hippocrates), it has been rightly identified as an "art."

Assisted Suicide, Inc.? Pelvic Fitness (?!), Inc.?

A new twist on what has been a quiet issue: "Assisted Suicide of Healthy 79-Year-Old Renews German Right to Die Debate," (NYT, July 2, 2008). I hadn't realized that this sort of thing was legal -- and commercialized (what a surprise) -- in Switzerland. Is there a slippery slope? Or ought people have a right to determine the manner and time of their death? I mean, who wants to be old? Isn't it perfectly rational to fear moving into a nursing home? It's interesting that the person in the center of this case was a woman, helped to die by a man. Most of Jack Kevorkian's 'clients' were also women. Why do you think that might have been?

Or worse, how about this: "A Spa for Those Women Concerned About Pelvic Fitness," (NYT, July 3, 2008). The one doc rightly notes that 'pelvic fitness' is not a medical category. But this is being done by a doctor? Shouldn't there be any limits to what a physician can do with her or his training and authority? Why or why not? We really do need to read Brave New World.

An interesting twist on the question of universal healthcare, the Europeans are now trying to think across borders: "European Plan Would Expand Health Care Access Within Bloc," (NYT, July 3, 2008). This will be interesting to watch from the US context, since here states tend to function like countries in Europe. For example, BadgerCare is available to residents of Wisconsin but not to Iowans. Why? Well, partly because federal monies are allocated to states to run programs, and Wisconsin has decided to put together something like BadgerCare with their funds. But should it matter where one lives?

Keep an eye out for this ad: "New Health Reform Group to Spend $40 Million," (NYT, July 3, 2008). I might even start watching TV so that I can at least see it, though I suppose it will eventually be on YouTube.

On our continuing theme of insurance companies, I went to the doctor today and noticed an announcement posted on the wall I had not seen before. I didn't write it down or memorize it but it essentially said: "We are finding that insurance companies are increasingly denying requests for pre-authorization of procedures. Insurance companies are particularly reluctant to pre-authorize more than one procedure to be performed on the same day. In some cases, we can make a special appeal and hope that they will allow it, but such exceptions are rare. Therefore, if you need more than one procedure done, you will need to schedule separate appointments."

Now, does this seem particularly patient-centered? If a patient needs more than one thing done, wouldn't it make more sense to have all one's medical needs taken care for at one time? Especially as one can wait weeks for a non-emergency appointment, making multiple appointments can be quite burdensome. And what if the patient is a parent and has to arrange child-care, pay a babysitter, etc.? Or what if the patient is a child and has to be taken out of school? One of the patients in the waiting room while I was there was an old man -- probably in his 80's, walked with a walker, bent almost doubled-over with osteoporosis. He moved very slowly and with difficulty. Wouldn't it be better for him to minimize the number of times he has to go to the doctor's office? Can this be in the 'best interests' of the patient, medically or practically? And what about the physicians? It certainly would be more efficient for a physician to take care of as many medical issues in one visit as she/he could. Does this not increase the burden on the physician, reduce the number of patients he/she can see, exacerbating the problem of access to health care? It's just one little vignette, but I think it really demonstrates how our health care system no longer is patient-centered or even physician-centered, but insurance-company-centered or insurance-company-controlled.

First, Do No Harm

The 'Health' section in today's New York Times is filled with interesting pieces, but I won't post them all.

How many principles of ethics (medical or otherwise) were violated here? "Tape Shows Woman Dying on Waiting Room Floor," (CNN, July 1, 2008). And they falsified the records. See also the Times' version of the same story. This one just happened to be caught on tape. Do you think it's a unique case? What arguments could be offered on behalf of the staff?

Good news in the world of MDR-TB: "'Officials Praise New Test for Drug-Resistant TB," (NYT, July 1, 2008). Does this say that the old test for MDR-TB took up to two to three months to process? That seems hard to explain. How long to TB cultures take to grow?

Following up on the worm theme from yesterday: "The Worms Crawl In," (NYT, July 1, 2008). Wendell Berry, the leader of the movement known as the Southern Agrarians, who argue for a revitalization of rural communities, a return to family-owned farms, against the industrialization of every aspect of human life, has long argued that there is a critical connection between human health and the health of the land. This story, and the other worm story, give support to his position, suggesting that perhaps we do not think of human health (and therefore medicine) in ways that take sufficient account of our interrelationship with the natural contexts in which we evolved or in which we are embedded. While certainly much human disease finds its source in nature run amok, have we overcompensated, tried to abstract ourselves and protect ourselves from nature as much as we can, and thereby created new health problems? If we have, the remedy would be....?

Worms would be classified as "low-tech." Here's another low-tech approach, this time to predicting morbidity and mortality. I particularly like that the research was done at the University of Florence (Italy), a city for which I have been somewhat wistful over the past month or so: "Prognosis: Low-Tech Clues to Future Illness," (NYT, July 1, 2008).

Yet another sort of low-tech approach: "Can Your Company Force You To Be Healthy?" (CNN, July 1, 2008). If you think this is not all bad, where should the line be drawn, if anywhere?

From our friends at Pharmalot: "Alabama Wins $114 Million from Glaxo and Novartis," (July 1, 2008). $114 million is nothing to these folks, so not much of a penalty really. For defrauding (or scheming to defraud) Medicare for....fourteen years?

Per your future patients: "Diabetes: Underrated, Insidious, and Deadly," (NYT, July 1, 2008).

Continuing my food theme (actually, I'm just posting it here so I don't lose track of it): "The 11 Best Foods You Aren't Eating," (NYT, July 1, 2008).

I haven't made my way through all of this yet, but a new special section on aging: "The New Aging: Our Parents, Ourselves -- Caring and Coping," (NYT, July 1, 2008). I post all this stuff on aging because it will be relevant to your patients -- either because they'll be in their 80s or because they'll be in their 60s and they'll be taking care of their own parents, which affects their own health.

Now here's an item-of-interest for students, grad students, people who are looking to stock places like Repairers, etc. "Changing the World One Gift at a Time," (Glen Arbor Sun, July 1, 2008). There's a Freecycle organization in Milwaukee and a number of them in Wisconsin. Go to their website and see if there's one near you.

Eat Some Worms

An interesting post, especially from a Catholic perspective. Pope Benedict XVI is quite concerned about the state of Christianity in Europe. This might explain his concern a bit: "No Babies? Childless Europe," (NYT Magazine, June 29, 2008).

Eat some worms: "The Worm Turns," (NYT, June 29, 2008). But seriously, this is a really important article/finding for you proto-docs. Again highlighting the relationship between health and environment, what happens when the pendulum toward cleanliness swings too far? Illness.

And then there's Ben Stein, who I almost always like: "Why Oil and Wages Don't Mix," (NYT, June 29, 2008). Why do I like Stein? He defies the neat categories of 'liberal' and 'conservative,' and just says things that make sense, giving reasons for his position. What a thought!

Eat Better

Here's a 'must-post' since most of you are in college or med/grad school: "Seven Ideas for Preparing Food at Home Cheaply and With Minimal Space and Resources," (The Simple Dollar, June 19, 2008). Doctors and proto-doctors are notorious for neglecting their own health. Start developing good habits now.

While we're on the subject of food, here's an interesting piece on the new 'locavorism': "Fighting Climate Change: Food Miles vs. Food Choices," (The Ethicurean, June 23, 2008). I wonder how grass-fed beef factors into these calculations.

Worth reading, as we move into the height of the campaign cycle: "Your Brain Lies to You," (NYT, June 27 2008). It's fascinating and troubling how maleable our brains are.

Get tomorrow's news today! The Times has already started posting its Sunday stories. Here an interesting angle on healthcare costs and one factor contributing to their exhorbitant levels: "Weighing the Costs of a Look Inside the Heart," (NYT, June 29, 2008). How, one might ask, could a CT scanner cost $1 million? What could possible justify that cost? It certainly wasn't R&D. They're mostly made of plastic. The story claims that 1,000 cardiologists have installed such scanners (recently?). They must have done it in groups, otherwise the cost for the machines alone would be $1 billion. And hundreds of thousands of patients have undergone or will undergo scans, for which no medical benefit has been proven. Is this rational? Note the presence of the device manufacturers at the cardiologists convention. An interesting related graphic: "An Unnecessary Medical Expense: A Case Study," (NYT, June 29, 2008).

Bottomline: Money

Money, either the cost of health care or profits, underlie all these stories today.

Sounds like Cuba to me, almost. Is this a good idea? Will it work?: "City is Pushing for HIV Tests for All in Bronx," (NYT, June 26, 2008).

A few weeks ago I posted that story on how the Japanese had instituted mandatory waistline measurement. Maybe this will come to the US sooner than one would have thought: "Under New Management -- Waistlines Expand Into Workplace Issue," (NYT, June 26, 2008). I mean, if you're paying for your employees' health insurance, shouldn't you have some say in how they attend to their health?

The main question here is: who is the recipient of the results of a gene test -- is this person a consumer or a patient? What's the difference? How does/ought this affect how we think about the ethics of the distribution/sale of genetic tests?: "Gene Testing Questioned by Regulators," (NYT, June 26, 2008).

Will your parents have $85K to put aside for their care as they age? "$85K Needed for Long-Term Care Costs," (NYT, June 26, 2008). Will you? What if someone doesn't have it? $85K is similar to the student loan burden many have when they graduate from college or medical school. It's the equivalent of a mortgage on a small to medium sized house (depending on where you live). Students and homeowners take out loans of this magnitude on the assumption that they will be working for fifteen to thirty years or more to pay them off. But someone who is 65 is, in theory, not going to be working anymore. How do we think about the magnitude of these costs for people who can no longer generate income for themselves. Is this just?

On a related note: "59 Million Americans Scrimped on Healthcare in '07," (WSJ, June 26, 2008). Have you?

An interesting twist on big capital: "A Hedge Fund and Its Nonprofit Twin," (NYT, June 26, 2008).

Sight for the Blind

In the gospels, when Jesus begins his public ministry, he reads from the scroll a passage from Isaiah (61:1) , where he proclaims that "the Spirit of the Lord is upon me; he has anointed me to tell the good news to the poor. He has sent me to announce release to the prisoners and recovery of sight to the blind, to set oppressed people free, and to announce the year of the Lord's favor" (Luke 4: 18). For some reason, we seem to think that all this will happen magically -- that God will simply zap the blind and they will regain their sight. It's more likely, though, that God does this work through people. So, is this a story of grace?: "Sight for the Blind and Speech for the Deaf," (The Chronicle of Higher Education, June 25, 2008). Sounds like one to me.

Now if we could just get some of these folks to finance these programs of grace: "World is Home to More Than 10 Million Millionaires," (CNN, June 25, 2008). What's that we always hear about 'scarce resources'? Oh right -- resources are only scarce for some, not scarce in and of themselves.

It will be interesting to see how the conversation on religion and politics continues to play out over the next four and a half months: "Evangelist Accuses Obama of 'Distorting' the Bible," (CNN, June 25, 2008). It is unfortunate that Dobson's response to Obama entails primarily namecalling rather than specific engagement around the question of how one brings Scripture into play in public life.

Can this be true? Yes, of course it can; why should this surprise me: "High Medicare Costs, Courtesy of Congress," (NYT, June 25, 2008). Note: Medicare is one of the most successful health care programs in the country and is funded by taxpayers. But apparently Medicare has been run like the Pentagon -- with no accountability and no oversight, deeply in the pockets of industry rather than working to be fiscally responsible and protective of the public interests. I really like how the author of this article lists the potential counterarguments to the attempts to reform this aspect of Medicare and then refutes them. Good work, especially for a journalist.

At the same time, this is good news: "House Votes to Block Cut in Doctors' Medicare Fees," (NYT, June 25, 2008). As long as the docs aren't excessively gouging the government like industry has been, it is in the best interests of elderly patients -- who are increasingly neglected by medicine, as we've been reading in my earlier posts -- to encourage physicians to see them.

Interesting: "WHO Issues a Checklist to Make Operations Safer," (NYT, June 25, 2008).

More evidence that with a little bit of attention, the urban public school problem -- and maybe many urban inner city problems, could be fixed: "Against All Odds: School Offers Hope, Opportunity, for Young Men," (CNN, June 25, 2008).