the important and the not-so-important, horribly conflated.

Archive for the ‘healthcare’ Category

Alternative Medicine w/o the Air Quotes

In healthcare on May 30, 2010 at 8:13 pm

Turns out that there is a physiological mechanism behind the pain relief benefits of acupuncture. An article published in Nature Neuroscience links the release of Adenosine—one of our body’s more important anti-inflammatory chemical signals (less inflammation = less pain, without getting too science-y)—to the ancient Chinese practice of sticking needles in your body to “improv[e] the flow of ‘qi energy’ along ‘meridians.'”

A question: Wouldn’t it make sense to start removing air quotes (ie, “qi energy”) from the discussion of Alternative/Integrative Medicine practices? As more peer-reviewed studies on acupuncture, natural birthing, etc are released, it becomes increasingly clear that sections of the biomedical community are trying to delegitimize these practices because the physiological basis for their own specialized treatments isn’t so solid in comparison.

Still, Alternative Medicine supporters need to embrace  more scientific scrutiny of their practices. Why? Because it pays—if the NEJM were to publish a comparison trial, say Acupuncture and Shock Treatment (which is covered by a lot of insurers) for alleviation of back pain, that demonstrates the “Alternative” practice is more effective, consumers will demand that this service be covered by their insurer.

*This is the part where I get all philosophical and shit (feel free to skip)…

The classic text on medical history taking, the Bates Guide, calls on med students to present the “chief complaint” to their attending in “the patient’s own words.” It frustrates me to see fellow students use the air quotes when talking about their patients’ issues—not b/c the whole finger symbol thing was so last decade, but rather b/c the words within those air quotes describe what’s actually being experienced by our patients, what their suffering from. The words are not symbolic placeholders for biomedical mechanisms, they are completely and wholly lived pains and frustrations.  And our cure or treatment is pointless if it only addresses a disrupted physiological pathway.

Alternative Medicine tells us to eschew air quotes in both our description and treatment of disease. The biomedical research community  is slowly realizing the significance of this simple truth.

Pulitzer

In healthcare on April 12, 2010 at 8:23 pm

Called it! The Pulitzer committee choose for its Investigative Journalism Prize Sheri Fink’s excellent piece on Doctors’ end-of-life decisions at Memorial Hospital in New Orleans after Katrina. I commented on the piece back in August when it came out, demanding a Pulitzer for Dr. Fink and saying about her article:

amazingly, it doesn’t throw the blame on anyone (i say ‘amazingly,’ because the scene at memorial was truly apocalyptic: overweight patients left behind, families of patients turned away, doctors administering lethal doses of morphine as the electricity, and then patient respiratory machines went out); instead, it represents a clearheaded call for resisting/rejecting the insularity and opaqueness of medical ethics boards and a plea for more thorough emergency action plans.

Before Deliverance, Ugliness, ctd.

In healthcare on March 21, 2010 at 7:32 pm

[Via The Washington Independent]:

Former Republican House speaker Newt Gingrich said Obama and the Democrats will regret their decision to push for comprehensive reform. Calling the bill “the most radical social experiment . . . in modern times,” Gingrich said: “They will have destroyed their party much as Lyndon Johnson shattered the Democratic Party for 40 years” with the enactment of civil rights legislation in the 1960s.

Newt Gingrich, I would love for your words to be ignored and fall into obscurity—but I know they represent the ugly thoughts of too big a chunk of America not to be aired.

You educate us, Mr. Gingrich, with your petulant, bigoted ignorance—on how NOT to view our history, our political culture, and our relationships with other human beings.

Time Machine: LBJ & Medicare

In healthcare on March 21, 2010 at 6:24 pm

This (LBJ & Medicare) article, published in a July 1966 edition of the New Yorker, looks at the final weeks leading up to the passage of what would become Medicare.

The villain of the story, the American Medical Association, is now a hesitant supporter of current reform efforts—but over the last 12 months (!) their methods (fake memos, faulty impact research, general media malfeasance) have been grafted onto the Right’s gangrenous belief that a failure of personal responsibility by our nation’s poor explains our health care inequalities.

It’s a long article, but the original print advertisements are hilarious. My favorite:

Health Care Reform

In healthcare on March 16, 2010 at 5:11 pm

With the possibility of a final vote on the Reform bill later this week or early next, and the paroxysms of overly-detailed reporting from CNN and the like popping up now, I’m posting a (long) essay below that I wrote last year for Temple Med’s PULSE publication that simplifies (perhaps fatally so) the debate:

“I think health care is a privilege, I wouldn’t call it a right. [I]n our country and in any civil society there should be a safety net for basic health and food and shelter, but that doesn’t mean that the whole system should be designed around the belief that people can’t make their own decisions, can’t be responsible for themselves.” – Senator Jeff DeMint (R – SC), Charlotte Post, 21 August 2009

[note: “Conservatives,” becomes, unfortunately, a sort of blanket term in this essay for individuals supportive of Senator DeMint’s quote. My apologies to those who identify as Conservative but disagree with the Senator.]

Many Conservatives assert that there is no such thing as a “positive human right”—rights exist only if they represent something that can be impinged upon. Stated another way, no one is owed anything from birth—yet, what Americans earn through hard work and creativity must be protected. And while this belief is usually well reasoned, it is undergirded by a fear that is both baseless and shallow: that an unnamed, faceless “other” is leeching away the hard-earned (money, health care, jobs) of “real” Americans.

A more pragmatic and ethically responsible view recognizes disparate levels of access and agency (which together form what could be called “Opportunity Rights”) available to modern Americans. It identifies developmental, psychological, and socioeconomic barriers to success in this country—and gives weight to unjust impediments imposed on individuals by the accident of their birth, rather than the consequence of decisions made as an adult. Understanding health care as a scarce resource, proponents of this view look beyond cost or market-driven rationing (our current system) and question how we can integrate moral and ethical considerations into tough decisions made about the allocation of care. Furthermore, it demonstrates and defends the systemic benefits of altruism, rather than dismissing it as a profitless deficiency.

READ ON…

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what was lost

In healthcare on August 29, 2009 at 5:02 pm

This week’s Times magazine has an excellent (and long) article on the medical ethics battlefield that memorial hospital in new orleans became in the hours, months, and now years, after katrina. amazingly, it doesn’t throw the blame on anyone (i say ‘amazingly,’ because the scene at memorial was truly apocalyptic: overweight patients left behind, families of patients turned away, doctors administering lethal doses of morphine as the electricity, and then patient respiratory machines went out); instead, it represents a clearheaded call for resisting/rejecting the insularity and opaqueness of medical ethics boards and a plea for more thorough emergency action plans. read it. and give Dr. Sherry Fink a Pulitzer. Or better yet: put her on the new MedPAC advisory committee. This is what journalism should be:

“Father John F. Tuohey, regional director of the Providence Center for Health Care Ethics in Portland, Ore., said that there are dangers whenever rules are set that would deny or remove certain groups of patients from access to lifesaving resources. The implication was that if people outside the medical community don’t know what the rules are or feel excluded from the process of making them or don’t understand why some people receive essential care and some don’t, their confidence in the people who care for them risks being eroded. ‘As bad as disasters are,” he said, “even worse is survivors who don’t trust each other.’ ”


all together now…

In healthcare on June 19, 2009 at 2:03 pm

the times‘s excellent “room for debate” blog has a great roundtable on health care reform, highlighting the importance of adjusting doctors financial incentives to lower costs in an industry that receives one out of every 5 dollars americans make. i distill some of the arguments/suggestions/rants below:

Dr. Fisher (Dartmouth): “An underlying cause of this overuse [of certain diagnostic or surgical procedures] is a fragmented and uncoordinated health care system where each physician only focuses on a tiny piece of the patient’s care. Most physicians, even those in primary care, have become “partialists.” And the payment system that rewards overuse by physicians and encourages hospitals to compete in a local medical arms race to offer every possible profitable service.”

Dr. Pho (N.H): “Physician payments need to be divorced from the volume of care and instead associated with evidence-based quality measures and a reduction in medical errors. [D]octors should be “incentivized” to take the time to counsel and guide, along with improving their communication with patients, not only in person, but over the phone and on the Internet.”

there’s more below…

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rational rationing

In healthcare on June 18, 2009 at 9:40 am

an excellent piece by david leonhardt in the times suggests that, like most issues in the larger health care reform movement, debate over the equitable distribution of scarce health care resources becomes a battle of words, not ideas. the result is something petty and counterproductive: “The choice isn’t between rationing and not rationing.” Leonhardt writes. “It’s between rationing well and rationing badly. Given that the United States devotes far more of its economy to health care than other rich countries, and gets worse results by many measures, it’s hard to argue that we are now rationing very rationally.”

in related news, bob dole and tom daschle save health care reform? seriously?

medicare

In healthcare on June 15, 2009 at 9:40 am

any real reform to our nation’s health care system must take a close look at medicare, the current health “safety net” for millions of americans. tyler cowen’s piece in the sunday business times argues for the creation of an independent medicare expense review board, an idea supported by the white house. before any new public plan is implemented, cowen asserts, we need to get the costs of medicare down:

“67 percent of Americans believe that they do not receive enough treatment and [only] 16 percent believe that they have received unnecessary care. If the Obama administration covers more people with government-supplied or government-subsidized insurance, the political support will broaden for generous benefits, their continuation and, indeed, expansion of current expenditures.”

The line of thinking goes like this: if we are already over-treating patients (and we are), and unnecessary care is responsible for skyrocketing costs, we will see expenditures spiral out of control if we treat the 67 percent of the nation who don’t think they get enough care like the 1/3 who do. as a solution, Cowen proposes–coupled with the medicare review board–a one-time tax on health benefits. OK. That creates incentives for both the public and private sector to demand more efficient, lower cost care… but it will also undoubtedly lead to medicare cuts (something Obama proposed on friday as a possible source of funding for a new public option), which creates an even higher, perhaps unscalable, barrier to care for groups like the homeless, drug users, and illegal immigrants who depend on hospitals with medicare support.

i reject the premise that fiscal responsibility and moral obligation are mutually exclusive in the ongoing health care reform debate. we can have equal and efficient care–politicians need to realize that they are the ones who must make sacrifices, not their constituents.

treating cancer as a chronic disease

In healthcare on June 10, 2009 at 8:57 am
breast cancer cells

breast cancer cells

(b/c apparently it’s health care week on this blog) In a recent nature publication, a researcher suggests that we eschew the “war on cancer” paradigm that has dominated treatment regimes for 20+ years. why do we try to kill all the cancerous cells in the short term in a patient, robert gatenby asks, if we know the cancer is fatal and doctors can prolong life by treating the disease chronically? gatenby’s essay asserts that by eliminating only the most active and destructive cells, and leaving a reservoir of active cancer cells in the patient, we can perhaps limit the number of cancerous bodies resistant to chemo or radiation.

of course, there should be continued “magic bullet cure” research going on, and this is a tough ethical question to consider as well, but such I think chronic treatment has a positive secondary effect: it forces more patient-doctor interactions and promotes (often more cost- and treatment- effective) lifestyle changes in the patient. it attempts to break down the larger, more expensive “disease as something to be treated” health care paradigm and shift us more towards a healthier “managed care” way of thinking.