Archive for the ‘Medical’ Category

Service of Genetic Tests: Do You Want to Know or Not?

Monday, April 17th, 2017

Photo Brockpress.com

Photo Brockpress.com

Most of my friends and colleagues present themselves for medical tests and checkups when they should while I drag my feet attending to only the most essential. My philosophy: Who wants to know?

So it would be very unlikely for me to send away to 23andMe at any time in my life to learn whether one or more of the 10 diseases the company tests for, such as late-onset Alzheimer’s or Parkinson’s, will afflict me.

There are many chomping at the bit to find out and now the FDA says that they can: No more need to pass by a genetic counselor or through a doctor for the privilege. Spit into a receptacle to provide a sample of saliva; send $199 and voila—you’ll soon know about how or if you relate to any of the 10.

Jessica Boddy, NPR summarized info on an FDA press release: “The testsBlood pressure test assess genetic risk for the conditions but don’t diagnose them, the FDA says. The agency urges consumers to use their results to ‘help to make decisions about lifestyle choices or to inform discussions with a health care professional.’”

The FDA’s Center for Devices and Radiological Health director Jeffrey Shuren said “‘it is important that people understand that genetic risk is just one piece of the bigger puzzle, it does not mean they will or won’t ultimately develop a disease.’ Other known factors that can play into the development of disease include diet, environment and tobacco use.” 

Photo: thefactfile.org

Photo: thefactfile.org

We already know about the importance of a healthy diet and the risks of tobacco use as they relate to all sorts of diseases–so nothing new here–and I can’t do much about my environment. Loosening regulations on power plants and reducing fuel efficiency standards for cars is going to impact everyone in a bad way. I wonder if people in 45’s administration realize that they, their children and grandchildren might suffer as a result?

Referring to test results Boddy quoted a Harvard Medical School professor who warned that the “information is complicated.”

Nobody in the article spoke up for those who don’t want to know. Do you want to learn what your genetic makeup indicates might happen? Would you be irritated if at 68 you sold your house and all your belongings to move into an adult care facility and found yourself at 95 in great form still with no signs of late-onset Alzheimer’s? Would knowing spoil what’s left of your life be it 20 or 70 years? Would you cancel your marriage plans if you wanted to have children and you learned that both you and your intended had similar genetic indicators for a nasty disease?

 

Photo: reference.com

Photo: reference.com

 

Service of Cost vs. Benefit in Healthcare: Who Decides?

Monday, July 6th, 2015

Photo rinehartclinic.org

Photo rinehartclinic.org

This New York Times article, “Cancer Doctors Offer Way to Compare Medicines, Including by Cost,” made significant—if terrifying–points in addition to how cost impacts what drugs a patient may get. Given their ineffectiveness, I wondered why those given as examples are prescribed in the first place.

If you or a loved one has a heart condition, don’t click away just yet: Reporter Andrew Pollack noted that cardiology societies are following in oncologists’ footsteps. And I wouldn’t be surprised if this trend soon affects patients with any and all conditions if it effectively cuts costs for insurers. 

Actor Robert Young playing Marcus Welby, MD

Actor Robert Young playing Marcus Welby, MD

Pollack wrote “Roche’s Avastin, when added to chemotherapy, had a net health benefit of 16 out of 130 possible points when used as an initial treatment for advanced lung cancer. Its monthly cost was $11,907.87, compared to $182.09 for the chemotherapy alone.

“Eli Lilly’s Alimta for that same use had a net health benefit of zero with a cost exceeding $9,000 a month compared to about $800 a month for the drugs it was compared to in the clinical trial.”

Later in the article Pollack spelled out the rating system: “Drugs for advanced cancer are given a score from 0 to 130. Up to 80 of the points are based on a drug’s effectiveness in prolonging lives, delaying the worsening of cancer or shrinking tumors. Then up to 20 points can be added or subtracted based on side effects. And up to 30 bonus points can be granted if the drug relieves cancer symptoms or allows a patient to go without treatment for a period of time.” 

Actor Hugh Laurie who plays Dr. House

Actor Hugh Laurie who plays Dr. House

Regardless of cost why would anyone prescribe a drug that benefits a patient from zero to 16 “points” out of 130?

Other news that was unsettling: “The release by the American Society of Clinical Oncology of what it calls its ‘value framework,’ is part of a change in thinking among doctors, who once largely chose drugs based on their medical attributes alone.” [The underline is mine.] Silly me: and I thought doctors still prescribe what they do according to how a drug helps a patient.

According to Pollack the average cost of cancer drugs runs $10,000/month and some as much as $30,000/month. This is information, Dr. Richard Schilsky said at a news conference, that some doctors don’t know nor do patients. Schilsky is chief medical officer of the American Society of Clinical Oncology. [Why is this significant? Even if you’ve been paying for health insurance for eons and have hardly used a cent until you need to, you can reach the ceiling when off goes the insurance spigot.]

Pollack wrote that this value framework considers the cost to the patient and the health system.  I assume “health system” translates to government supported Medicare and Medicaid plans. 

Ingrid Bergman playing Dr. Constance Petersen

Ingrid Bergman playing Dr. Constance Petersen

As a result, Pollack observed, doctors are now put in the role of “being stewards of societal resources.” He continued, “That is somewhat of a controversial role for doctors, since it might conflict with their duty to the patient in front of them. But the oncology society said it did not see those roles as being in conflict.”

Other points Pollack made include:

  • A rep for the Pharmaceutical Research and Manufacturers of America said the cost of drugs represents only 20 percent of treatment.
  • The cost of drugs is unrelated to how “novel it is or whether it prolonged life versus just shrinking tumors.”
  • In Britain, a drug is rated according to its “cost per extra year of life they provide adjusted by side effects and symptoms.”
  • Starting in June United Healthcare requires “oncologists to get prior approval from the insurance company for every cancer drug they administer. The company will then track what happens to patients and eventually provide information to doctors about how well each drug works.”

Summarizing the questions:

  • Why prescribe a drug that does little if anything to better a patient’s health or length of life?
  • Is a doctor who chooses a drug for a patient based solely on its medical attributes old fashioned and out of step and will he/she soon be forced out of work by insurance companies?
  • If a patient can scrape together the co-pay of a super expensive drug, can an insurance company refuse to pay its part? Then what?
  • Will United Healthcare only use its approval to track drug effectiveness, as Pollack suggests, or eventually will it control costs by refusing to pay?
  • Is the American Society of Clinical Oncology correct when it asserts that there is no conflict for doctors who are now made responsible for the country’s medical resources and their responsibility to their patients?
  • Unless people have unlimited incomes, most adults are aware of what they pay for food, beverages, clothing, shelter and only recently have they become aware of the cost of healthcare. Isn’t this a good thing?

  pills 2

Service of Credibility II

Monday, October 13th, 2014

Trust me

I keep hearing on newscasts and in quotes by doctors and politicians how we shouldn’t panic about the ebola virus, that you can only catch it if you come in direct contact with an infected person’s fluids; that if you share the air of an elevator or plane with a sick person, you won’t catch it and that this or that city is ready to isolate and harness any case that crops up.

One of the doctors pointed out that only one person has died of ebola in this country in comparison to 20,000 who die each year of flu. [I checked the Center for Disease Control website to confirm this figure. It can’t track a statistic as states are not required to report deaths from flu of people older than 18.]

The problem is how often have public figures told us not to worry when it turnedworld trade center pile out we should? Christine Todd Whitman, former New Jersey Governor and administrator of the Environmental Protection Agency told workers at the World Trade Center pile that they were in no danger of getting sick. Since then many have succumbed to cancer. Perhaps she was instructed to say this. Not only did it trash her political career, it was one more nail in the coffin of the public forced to question the people they are supposed to believe.

Congressional committees have let corporate executives get away with product safety claims for years while the facts proved otherwise: Smoking is one glaring example.

Train tunnel ny njWhat about the crumbling infrastructure? Governor Christie cancelled a train tunnel project between New Jersey and New York called “Access to the Region’s Core” which would build a new tunnel. The existing one was built between 1904 and 1908, according to Wikipedia. True, “they knew how to build things in those days.” But is counting on an essential 106 year old structure realistic just because the Governor says it is? Especially if you suspect the real reason is that he doesn’t want to spend the money under his watch?

Do you accept what you hear and go about your business or are you more skeptical?

 Pinnochio

Service of Seeing the Light

Thursday, April 10th, 2014

eyes 3

Iris Bell described the impact of her cataract operation in an enlightened way. She is a graphic artist which is apparent in her descriptions of color.

If you know someone faced with such a procedure and is hesitating, it would be worth passing along her narrative. She noted: “It’s as if the very stuff the world is made of has changed.”

This is what else she wrote:

eyes 4I had the cataract in my right eye removed and replaced with a lens that gave me 20/20 vision. The result: I see colors accurately and have perfect distance and night vision.

People who’ve had similar procedures told me the effect was dramatic. I knew the brownish cast of my cataract had made it hard for me to see the difference between my blue and green bracelets unless I looked at them under a strong light. Over the last year I also noticed I had trouble seeing outside after dark.

Throughout this period of change I wondered what the real colors of some things were and how bright or intense colors and whites might be. After the surgery my husband, Paul, and I took the bus home. For 10 blocks I looked out the window at the familiar shop fronts, checking back and forth between my eyes, one as yet uncorrected. The effect was as if I took on and off sunglasses with brown lenses.

eyes 5When I got home I was overwhelmed by the feeling of joy the colors gave me. It was exciting to look at my things with my corrected eye. I’d bought many items for their special colors because they have a major effect on my emotions.

With my uncorrected eye my periwinkle items looked grayish blue. With my corrected eye I saw the color I loved. I’ve always thought of periwinkle as the last blue before a color become lilac. The cataract hid the essential subtle reddish tint which turns a blue into periwinkle.

In subsequent days I’ve been shocked by rediscovering the true colors of things I’d lived with for years: A kitchen sponge is vibrant lilac; a sparkle-covered fingernail file an elegant purple not what I’d previously thought of as an unremarkable pinkish purple and a ream of paper and bath towel are the color of the newest spring grass with sunlight shining through…not the dull hue of older grass. And I’d forgotten how bright green bok choy at my favorite Chinese restaurant looked.

eyes 6Dyes on different fabrics are too subtle for my uncorrected eye to register and the intense purple underside of a vine I’ve grown under plant lights for years is back for the right eye.  The gas flame in the stove startled me,  transformed from dull aqua to a brilliant spectrum blue with a fine edging of purple.    

There was a loss: My corrected eye sees the russet and golden grapes in a photo hanging in the kitchen as bland pastels, no longer the richer colors tricked by the cataract.

The most startling effect of the surgery lasted only a few minutes some 10 hours afterward. We were in our supermarket just before twilight: The clear glass front window looked as if it had been replaced by blue stained glass. We’d spent time walking in the grocery, with its warm lighting. I was now looking out at the cool light of early evening. It had been years since I’d recognized either of these types of light. My brain didn’t know what to do with them. By the time we were on the sidewalk I was getting proper information from my brain, there was nothing special to see, no bright blue light. Only if I was planning to paint a watercolor would I study the quality of the light and notice it had a blue cast to it. Non-artists usually don’t notice the color of light.

One of the reasons I wanted the operation was that my night vision was  so poor that I was uncomfortable walking outside after dark, even on our block. People would suddenly appear walking toward me. I’d only see them when they were several feet away.  The day after my surgery it was hard to believe this block had always been this brightly lit between the street lights, decorative lights on buildings and from entryways.

This new world of lovely colors and light sources is a pleasure to experience. I’m not ready to have my other eye corrected quite yet, I’m having such fun comparing the two worlds I see with my two eyes.

Since she wrote this, Iris said she plans to have the other cataract removed in a few months.

Not once did she mention discomfort or pain. Isn’t it remarkable that she took a bus home after an operation that once kept people in the hospital for a week? Have you undergone a procedure–or known someone who has–that has similarly so dramatically [and effortlessly] transformed a life?

eyes 7

Service of Simplicity

Monday, December 30th, 2013

Tis a gift to be simplechicken sandwich

Technology can be time and life-saving but not always.

Next Time Add Mayo

During halftime on Saturday, a dry chicken sandwich caught in Chris Fowler’s throat. He was one of two ESPN commentators at this weekend’s Rutgers-Notre Dame Pinstripe Bowl game at Yankee Stadium. A simple Heimlich maneuver by Jesse Palmer, the other commentator, saved the choking announcer. I saw how a Heimlich rescued a man at my table at a business awards dinner and will never forget how effective it was–and how scary were the moments before.

En Voiture!

Cars in ParisFrench car manufacturer Peugeot introduced a vehicle with zero gewgaws. At eye height is a gauge indicating gas and speed, period. Does a car that gets you from A to Z place without built-in GPS, movie screens and gauges galore represent a trend? Note: The car is not available in the U.S.

Knee-Jerk ReactionKnee Physical Therapy

On the news last week results of a study on knee surgery suggested that physical therapy alone was as effective as an operation plus therapy in some cases. Physical therapy solved a severe shoulder injury for me–it seemed like a miracle.

Neither Rain nor Snow nor Heat nor Gloom of Night….

mailman in bad weatherI continue to recommend that job candidates follow up with both an email and standard mail thank you immediately after an interview. The stamped missive will distinguish you and amplify your interest in a non-intrusive, positive way. It will also stand out which yet another email won’t. Note: First class stamps increase three cents to 49 cents on January 26.

Will we increasingly see more examples that highlight the value of simplicity? Media appears to enjoy them or I wouldn’t know about most in this post. Are some seeking a balance from everything tech-hip?

homemade loaf

 

Service of Trust

Thursday, February 21st, 2013

trust2

This blog doesn’t usually pinion a brand by name, but when it is number five in a list of most trusted, and when its executives have done something dastardly and incomprehensible, I make an exception to my blog’s policy.

I read in David Reich’s post, “Who do we trust,” on his “my 2 cents blog,” about a Harris poll of 19,000 people at random who felt that Amazon was the most trusted brand and the rest were, in order, Apple, Disney, Google, Johnson & Johnson, Coca-Cola, Whole Foods, Sony, Procter & Gamble and Costco.

caneI am shocked as much by the deed as by the cavalier attitude by management about something that takes so long to gain and a second to lose: Trust. I am appalled by yet another heartless business decision made by people who obviously have zero empathy about the pain and suffering they cause others.

Here’s the story:

“The note sent by a doctor to several executives at Johnson & Johnson was blunt: an artificial hip sold by the company was so poorly designed that the company should slow its marketing until it understood why patients were getting hurt,” Barry Meier wrote in a February News Analysis piece The New York Times. This was a follow-up to his January front page Business Day story, “Maker Hid Data About Design Flaw in Hip Implant, Records Show.”

Continued Meier in the analysis, “The doctor, who also worked as a consultant to Johnson & Johnson, wrote the note nearly two years before the company recalled the device in 2010. And it was far from the only early warning those executives got from doctors who were paid consultants. Still, the company’s DePuy orthopedic unit plowed ahead, and those consultants never sounded a public alarm to other doctors, who kept implanting the device.”

I recommend that you read the analysis for the reasons/excuses he posits that more doctors didn’t make a fuss as well as his earlier piece where I first read about this nightmare.

hip-replacementI take such a decision personally and feel enraged by it. An operation is scary for most and things can go wrong such as infections or heart failure or unforeseen reactions to the anesthesia.  And now and again there might be a kink in a device–mistakes happen. But a manufacturer that lets doctors use something its executives know doesn’t have a chance of working boils my blood.

Draconian as it sounds, I think that in future executives who know about  flaws in the devices they manufacture should have one of them implanted in their body or if they sell lousy medicine be forced to take it. It may be the only way to stop such conduct. Fining is useless.

How have we allowed companies to succeed without being expected to exhibit an iota of social responsibility? How do we protect ourselves from such a device being implanted in a friend, family member or ourselves?

old-hands

Service of Pet Peeves II

Monday, July 18th, 2011

grrrrrr

I posted 11 pet peeves a year ago May and thought I’d exhausted my list but obviously, I left out a few. It feels so good to write about what annoys! So here are a dozen more.

 **I don’t like to be flimflammed and that’s how I feel when the stock market goes up on a day with dire financial and political news: Moody’s threatened to reduce this country’s credit rating which would cost us all a tremendous amount of money; there were terrorist killings in Mumbai; gridlock caused by childish political posturing continued unabated on Capitol Hill with debt ceiling deadlines looming; Spain, Greece, Ireland and Italy were patching up the tatters of their economic quilts with little result.

I am not satisfied with the reason given for this up tick: That nine of 11 corporations reported fabulous second quarter earnings that day [more about this below]. To ignore what’s going on outside is like envisioning a woman dressed for a ball, perfect hair and gown but the house has just been pushed to a precipice by a tornado. When she opens the door, instead of stepping out to the walk, she falls into an abyss. 

light-bulb1 **Repetition of misinformation to strike out at an adversary works because people would rather not be bothered by facts. President Obama did not sign the bill eliminating inefficient incandescent light bulbs in favor of  the energy efficient kind-President Bush did–and yet conservatives repeatedly use this as the glaring example of how government increasingly encroaches on our private lives. Maybe it does, but if you are going to blame President Obama, pick another example please.

Isn’t the more important story here–and another peeve–that this bill was the perfect excuse for corporations like General Electric to close US plants that made incandescent light bulbs therefore putting hundreds out of work last year when the timing couldn’t be worse? By moving manufacturing to China, they lowered the cost of making the bulbs. And they can charge more for the energy efficient kind. Along with loopholes that allow GE to dodge taxes, it explains why some of the corporations in the peeve above are doing so well, but at what cost to the economy and to us, to everyone but their stockholders and management? 

links **I am fussy about who I link to or befriend so it’s annoying when someone asks me to join their network on LinkedIn or Facebook and they don’t remind me how I know them. They lazily click the option that shoots out an email message like “Maisey Dokes has indicated you are a Friend: I’d like to add you to my professional network.” It would take a second to add something like “We’re both on the sponsorship committee,” or “I met you at the event at Hearst.” If I see someone on the street who has no reason to remember me, I say, “Hello, Frieda, Jeanne Byington. How are you?”  Or I might introduce myself to someone and say, “You work with my friend Nancie Steinberg. She tells me we have a lot in common.” Trying to link or befriend me is no different.

 **It drives me nuts when people don’t use their car’s right or left turn signal. There are certain congested places where it’s essential and it’s very selfish when a driver doesn’t or waits to the very last minute. I can’t enter traffic if I don’t know if their car is going straight ahead. If it’s turning into the store’s parking area that I’m exiting, I could drive out. Being self-centered not only holds me up but all the cars now lined up behind me.

curve-in-road**On the subject of cars, there are idiotic road signs that make me wonder if the person who installed them has a brain. We pass a little town on Route 82 in Dutchess County where we’re asked to drive at 45mph. The “resume speed” sign comes right before a hairpin turn where if you went 55mph, goodness knows where you’d land.

 **I resent it when someone infringes on my time by creating a false deadline so it affects how I triage my time to meet it. How do I know? They ask for information, a report, photos or copy by a certain date but when I submit what’s due, I get a bounce back email telling me that they are out of the office at a conference or on vacation and will get back with me next week.

dont-waste**Waste drives me nuts. I get the feeling that there are stacks of boondoggles we will never hear about. If we could eliminate them, we could leave critical programs intact.  According to ABC News: “A $1.2 million federal highway program that sent employees on a 17-day globe-trotting journey to photograph different billboards was suspended Tuesday — an announcement that came after ABC News alerted the U.S. Department of Transportation that it planned to air a report on the program.” In addition: “The initiative, known as the International Scan Program, has been sending federal and state transportation employees to popular foreign tourist destinations for the past decade with the goal of studying how other countries handle the challenges of running major highway networks.” Each trip cost $300,000.

 **If you work in a medical facility, please always be pleasant. It makes a difference. And pay attention to what you say especially if your job is repetitive. I picked up some x-rays from a radiology place where the desk staff is used to saying, “Sign this and sit down and wait for your name to be called.”

So when the administrator asked me to sign for the x-rays she said, “Sign this and sit down.” I replied, “But I planned to leave now,”  confirming that there wasn’t something else for me to do while there. Not realizing that she’d told me to sit down she got testy and nasty in her dismissal.

 **I agree with a friend who says that it should be a felony to use the word awesome.

muffin-top **Average looking or shapeless people shouldn’t wear super trendy clothes. I cringe looking at them as I do when hearing a terrible comedian or a speaker try an unfunny joke. Some women on magazine and newspaper style pages are over-gussied with legs akimbo on skyscraper shoes that make them take awkward poses so as not to crash–so unnecessary. And those low-scooped, too-tight t-shirts over rings of fat are puzzles. T-shirts and tops come in a range of sizes or don’t some people realize it?

**Tired of reading about the annoying Valley girl sing song? The deliberate high speed chatter/swallowed words affectation that some young people use, especially when copied by older people so as to appear to be young, registers high on my list of peeves.

 **I will boycott media that pays Casey Anthony one cent for an interview. I don’t think the press should pay for news to begin with.

Do let loose on your pet peeves! You’ll feel better getting them off your chest–promise!

I'm All Ears

I'm All Ears

Service of Appointments

Monday, October 11th, 2010

appointment

One of the technicians in my doctor’s office told me what a now retired dentist patient mentioned to her. He said, “I wish that I had been a hair stylist because none of my female customers would have cancelled appointments with me as they did when they had a tiny headache or the inkling of a sore throat. When they didn’t feel perfect, they’d cancel with me but they’d never cancel their hair appointment.”

scardey-catAnd he’s right in my experience although I honor dentist appointments equally as half of the hard thing for me to do is to call up and make the appointment, the other half is to show up and get it over with. Sometimes I wonder if the anxiety over the whole thing is what makes me feel icky on doctor/dentist day. [I’ve noticed that connection with checkup appointments of any stripe. I’m a scaredy cat.]

And I admit to practically crawling to have my hair cut when I’ve felt dog-sick because looking at myself another minute when my hair cries for attention would send me over the edge.

But I’m the type that takes all appointments seriously. Not everyone does.

One person I knew through a professional organization pursued me for months to have a drink after work. I couldn’t duck any longer so we made a date, which she kept changing. This was fine with me as I didn’t want to see her in the first place and don’t like to cut my workday short to meet with someone I don’t particularly want to see. The day came and she pleaded with me to move the appointment from 6 pm to 5 pm which became horrendous for me, but to get it over with, I said, “OK.” I got to the place at 5 and waited. She had the audacity to arrive half an hour late. Throughout our time together, she kept looking at her Smartphone screen and taking calls and to this day, I cannot tell you the reason for this meeting, other than to assure me that my instincts about her were spot-on: She wasn’t worth my time. And I should have left the place when she was 10 minutes late.

churchI’d already written this post when I read the “Left at the Alter” letter to Philip Galanes in yesterday’s New York Times Style section. The letter writer and her husband left the church after an hour when the bride hadn’t yet appeared because they thought the bride was rude to keep a church full of people waiting. She asked Galanes if her action was defensible. I have a feeling that this wasn’t the first time the couple was kept waiting and they were acting out their annoyance at the bride’s incredible self-absorption and probably shouldn’t have accepted to go in the first place. That wasn’t Galanes’ answer.

Some doctors and lawyers consistently make patients wait having nothing to do with emergencies. Friends told me of having to wait at the bar of a well known NYC steakhouse for an hour after their reservation time and there were empty tables which they acknowledged were saved for regulars and celebrities. They eventually stalked out. Going to restaurants with my father was nervous-making because he didn’t care what the place was in the firmament of famous, if he had a reservation and if he was on time, he expected to be seated, period. If he wasn’t, there were words.

How long do you wait when someone is late to meet you? Now that so many people have cell phones, 10 minutes should do it, don’t you think? And unless you are meeting on the street, another option has always been to call the restaurant and ask the staff to give a message to the person you are meeting along with your ETA.

Have you changed doctors or lawyers or other service providers who routinely make you wait? What about friends and business associates who do so? Do you honor all appointments equally?

 clockwatching

Service of How Do They Do It?

Thursday, April 15th, 2010

headscratching

There’s a Chinese restaurant in midtown Manhattan, around the corner from my office. I just bought a portion of won ton soup in a sturdy container–the expensive kind. It came with five HUGE, tasty dumplings, a bag of fried noodles and a smile. Cost, including tax: $1.85. Most soup in the neighborhood starts at $3.85+ for a smaller portion.

mugsSome of the bargains at TJ Maxx also make you wonder: How can the store pay someone to open a shipping container, unwrap and place an attractive ceramic bowl, dish or mug on a shelf, keep displays neat and clean, and when someone goes to buy the breakable item, wrap it up, take a credit card or cash-all for as little as $2.95?

Meanwhile at Yankee Stadium a hot dog costs upwards of $6 and at a major department store, the online price of a square 3.5-inch ceramic dish costs $20, plus tax and shipping.

Imagine going to a baseball game with a few teens and not offering them more than one hot dog–and we didn’t mention anything about the hefty price of drinks?  The cost of such a snack, while part of the ballpark experience, is a sure indigestion-inducer.

While this is going on, there are drug companies that seem to be playing games resulting in just the opposite. In Monday’s Wall Street Journal, Jonathan D. Rockoff wrote “An Old Gout Drug Gets new Life and a New Price, Riling Patients.” The game was to gain exclusive marketing rights on a drug that has worked for 100 years. The FDA is at fault here as well. They didn’t know the drug was safe and effective after a century? I digress.

pillsThe company ran the drug through clinical trials to [further] prove that it’s safe and effective and then raised the price to $5/a Colcrys tablet from a few cents that the generic colchicine pill cost. In addition, the company is trying to stop the competition from selling the generic version. Is this the time and place?

How do these companies sleep at night? What do the first two do to keep their prices so low and still make a living ? [I don’t think I want to know in the case of the restaurant.]

Department stores formerly wrapped gifts beautifully and today, with a nod to do-it-yourself, customers are most often handed a box and tissue paper in a bag along with the gift. So what’s the point?

How can the drug company keep a straight face knowing the zero value added it provided to sick people by going through some paces not to prove that an innovation works and is safe,  but simply to be able to overcharge for its tablets?

 straightface

Service of Medicine

Thursday, July 30th, 2009

We felt Jeremiah’s response to a comment Matt Mecs made on July 23 deserved more air. Matt brought up healthcare in light of the timliness of the issue in his reaction to the post, “Service Beyond the Call.”

Jeremiah wrote:

I saw my dentist today who for two decades has kept me happily chewing. I, and not some insurance company, pay him. In other words, he works for somebody he knows, and I think, trusts.

He told me that the very complicated and sometimes risky things he does (he is a surgeon) don’t make him anxious, it is what goes on when he does not have a patient in his chair that causes him to worry. Since he was a young dentist, he has had sufficient confidence in his skill and knowledge to operate pretty much on “automatic pilot,” to use his words.

I asked him if he had ever made a mistake. He replied, “No. I’ve done the right things, followed the called-for procedures even in the most complex situations, but the consequences haven’t always worked out well for my patients. That’s inevitable. We can’t possibly always predict the unpredictable, and humans are the most unpredictable of creatures.”

I think most, but by no means all, doctors are like my dentist. They do care and like what they do. It’s the other “stuff”–insurance nonsense and obnoxious patients, for example–that causes them angst. If we reduce the other stuff, we’ll get better medicine.

Let’s weed out the doctors who don’t care and are in it for the buck. We’d all be better off if they did something else for a living.

Let’s let each patient, no matter how rich or poor, know what the treatment they are getting really costs and why. Then let’s have each patient pay at least something towards the expense of the treatment. In other words we should put the human back in the relationship between patient and doctor. Both are too detached from reality now. Maybe people will think twice before agreeing to having the most expensive pill or undergoing the most expensive procedure, when far less expensive options might also succeed.

Lastly, let’s get the lawyers out of medicine. I think it is precisely an adversarial attitude that good lawyers (and good football teams) thrive upon. This is a big part of the problem, and it brings so much grief to a business meant to make people well. In health, there should be no losers. To win, some drug companies “cheat” on testing to get their new product to market first. Insurance companies try to get out of paying for necessary medical care. Doctors perform expensive procedures to make up for the costly time-consuming, [if done properly], patient examinations for which they are inadequately paid under insurance plans. Nurses get sloppy because somebody yelled at them unnecessarily, and so forth, almost to infinity.

I’m grateful to my dentist, and he’s grateful to me, if only because I pay him. I’m not his enemy, and he is not mine. That’s the way it should be.

Do you think that a healthcare system as Jeremiah describes it is viable?

 

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