From Voodoo Economics to Voodoo Medicine

[Jay]

Re: From Voodoo Economics to Voodoo Medicine

Life and death serious.

That might be the truth.

[ThePythonicCow]

Re: From Voodoo Economics to Voodoo Medicine

If you develop diabetes, who is going to treat it?

Myself, with nutritional changes. Or, preferrably, make the nutritional changes necessary earlier on, before full blown diabetes 2 manifests. If one is paying close and informed awareness to ones own health, it doesn't exactly sneak up on you. A similar answer would apply to heart disease, hypertension, and cancer. I won't go into personal details, but I am serious.

On the other hand, one cannot treat groups of patients professionally the same way one can self-administer. The legal, moral and economic tradeoffs are appropriately different. A professional has to be more conservative and has to make tradeoffs toward conservative treatment of a variety of individuals, using limited knowledge and resources per patient. A solo pilot can fly differently than a commercial airline pilot with a plane full of people, even if each is equally determined to walk away from the next landing.

Hence I don't claim to think that professional doctors should care for their patients as I care for my person. However, it is equally fitting and proper that each individual should decide when to follow the advice of the professional, and when to self administer. I rely on professional dentists, opthamologists, plumbers, trauma and EMT, fire fighters, roofers and car mechanics. I handle my own long term health, nutrition, home electrical, taxes, and computing. Such decisions should vary by person, and change over time. I used to perform (not well) some of my own car repairs and roofing.

[petertribo]

Re: From Voodoo Economics to Voodoo Medicine

America's Professions have a lot to answer for in the Decline Of America. They are in the main, self-regulating, control the supply of labor in their industries, receive many public subsidies and are well compensated. For this, the Public should get honest, decent, fairly priced service and it does not receive that. In many of these Professions, some have chosen to speak out. See, Confessions of an Economic Hit Man, by John Perkins for example.

Dr. Nortin Hadler is one who has chosen to speak out. I have read Dr. Nortin Hadler's indictment of the medical profession, The Last Well Person: How To Stay Well. In that book, to paraphrase, he states that in this Healthcare (what a misnomer) System, there are many, many pitfalls and traps. The patient will have a tough time of it. I recently spoke with a doctor who told me that in his field the Pharma data and frauds are so bad, that, in most cases, he prescribes earlier generation drugs. I believe that is also Dr. Hadler's conclusion in his field and he has studied the statistics. I know another retired physician who says the system has been destroyed by the corporate models which are for the maximum profit.

The original article starting the thread was by Dr. David H. Newman, an emergency medicine physician at St. Luke’s-Roosevelt Hospital Center in New York who was also deployed in Iraq in 2005. He has also chosen to speak out and offer information about the System to its patients and, in many cases, victims. Here are excerpts from his book:

Hippocrates was a holistic practitioner intent on treating the complete person, whereas today we tend to specialize in exquisitely narrow fields of anatomic and physiologic knowledge, *leaving the balance of the human body to our colleagues. Hippocrates was a devoted and objective empiricist, while most modern doctors spend so little time with each patient that it’s absurd to claim serious observational skills. Hippocrates was a consummate communicator, while today’s doctors (ask our patients) are walking communication nightmares. Hippocrates felt and demonstrated sympathy, while *we’ve chosen a colder, more “scientific” model for doctor-patient interaction….

Physicians are only, after all, consultants to the health of others. What we offer is our consultation and our limited expertise, in the hope that we can collaborate, that we can build a partnership. I tell friends that when a doctor says, “I don’t know,” it is rarely a sign of weakness or ignorance. More often it’s a sign of a physician who knows and appreciates the limits of our science and is willing to be a partner. It’s an olive branch of commiseration about what is not, and a hopeful readiness for what is.

http://well.blogs.nytimes.com/2008/0...ippocrates-do/

To me, Medicine/Healthcare exhibit many of the same disturbing characteristics as the FIRE Industries. Other American Industries appear to be in the same, unhealthy condition. To ignore this is hardly going to lead us to a proper treatment or cure. America will not heal itself. Maybe it it is time to look for the real causes of this Decline rather than simply discussing the symptoms.

[Jay]

Re: From Voodoo Economics to Voodoo Medicine

Myself, with nutritional changes. Or, preferrably, make the nutritional changes necessary earlier on, before full blown diabetes 2 manifests. If one is paying close and informed awareness to ones own health, it doesn't exactly sneak up on you. A similar answer would apply to heart disease, hypertension, and cancer. I won't go into personal details, but I am serious.

On the other hand, one cannot treat groups of patients professionally the same way one can self-administer. The legal, moral and economic tradeoffs are appropriately different. A professional has to be more conservative and has to make tradeoffs toward conservative treatment of a variety of individuals, using limited knowledge and resources per patient. A solo pilot can fly differently than a commercial airline pilot with a plane full of people, even if each is equally determined to walk away from the next landing.

Hence I don't claim to think that professional doctors should care for their patients as I care for my person. However, it is equally fitting and proper that each individual should decide when to follow the advice of the professional, and when to self administer. I rely on professional dentists, opthamologists, plumbers, trauma and EMT, fire fighters, roofers and car mechanics. I handle my own long term health, nutrition, home electrical, taxes, and computing. Such decisions should vary by person, and change over time. I used to perform (not well) some of my own car repairs and roofing.

I laud you on your efforts to maintain a healthy lifestyle, which is clearly the most important piece in staying healthy. You will mitigate the chances of hypertension, type two diabetes, or other conditions befalling you. That said, there are plenty of people who live very healthy lives and still end up with treatable chronic conditions that place them at risk for other diseases. Hopefully you are not one of these people and your solo act lands on the runway.

[Jay]

Re: From Voodoo Economics to Voodoo Medicine

America's Professions have a lot to answer for in the Decline Of America. They are in the main, self-regulating, control the supply of labor in their industries, receive many public subsidies and are well compensated. For this, the Public should get honest, decent, fairly priced service and it does not receive that. In many of these Professions, some have chosen to speak out. See, Confessions of an Economic Hit Man, by John Perkins for example.

Dr. Nortin Hadler is one who has chosen to speak out. I have read Dr. Nortin Hadler's indictment of the medical profession, The Last Well Person: How To Stay Well. In that book, to paraphrase, he states that in this Healthcare (what a misnomer) System, there are many, many pitfalls and traps. The patient will have a tough time of it. I recently spoke with a doctor who told me that in his field the Pharma data and frauds are so bad, that, in most cases, he prescribes earlier generation drugs. I believe that is also Dr. Hadler's conclusion in his field and he has studied the statistics. I know another retired physician who says the system has been destroyed by the corporate models which are for the maximum profit.

The original article starting the thread was by Dr. David H. Newman, an emergency medicine physician at St. Luke’s-Roosevelt Hospital Center in New York who was also deployed in Iraq in 2005. He has also chosen to speak out and offer information about the System to its patients and, in many cases, victims. Here are excerpts from his book:

http://well.blogs.nytimes.com/2008/0...ippocrates-do/

To me, Medicine/Healthcare exhibit many of the same disturbing characteristics as the FIRE Industries. Other American Industries appear to be in the same, unhealthy condition. To ignore this is hardly going to lead us to a proper treatment or cure. America will not heal itself. Maybe it it is time to look for the real causes of this Decline rather than simply discussing the symptoms.

Some very good points. If you want the real causes of the decline in American Medicine, I suggest that you follow the path of the money, the big money, and it won't end up in the primary care doc's or general surgeon's pockets. It may shock you to learn that most of them are trying to get by like much of the rest of what became of the middle class.

[raja]

Re: From Voodoo Economics to Voodoo Medicine

It looks like many of you are having fun painting all physicians with the same brush. Well, congrats. It is also ignorant and the easy, unthinking man's way out. Do you really think that physicians as a body are so homogenous? I don't excuse for one second the problems in medicine and that article highlights a few of them. Not, by far, the biggest, but real problems none the less. But to lose sight of the fact that there are doc's out there who's mission is to provide solid care to those that need it is unfortunate. If you come into my Emergency Department dying, you might be happy to see a qualified, caring individual pulling you away from a dark place. Your flippant comments may be more tempered afterward. I could have followed the siren song of easy money through a vapid career in easier fields, but thought I might make a difference instead, and I'm not the only one. Medicine is broken, but to blame the practitioners as a body is too easy and limited.

Jay, if you are representing an educated view, can you tell me how many physicians prescribe antibiotics inappropriately? Surely, you must be aware of such a statistic before throwing around accusations such as "ignorant" and "unthinking".

Let me help you out:

"There is good evidence that there is a high rate of unnecessary antibiotic prescriptions in the United States. Whereas the prevalence of sore throat caused by bacterial infection among adults is between 5% and 17%, a study of physician practice in 1989 and 1999 found that antibiotics were prescribed during 73% of visits.^[5] Moreover, most of these patients received antibiotics that were not recommended for pharyngitis, with a high number of prescriptions being for extended-spectrum antibiotics. Another study found that more than half of children with sore throats received antibiotics, a rate significantly higher than the regular prevalence of bacterial pharyngitis.^[6] Furthermore, more than one quarter of these children received an inappropriate antibiotic." http://www.medscape.com/viewarticle/585456

Can you tell me what the motivation would be for a doctor to prescribe antibiotics unnecessarily? Are they just stupid? Holding positions of authority figures in our society, I find it hard to believe they just can't say "no". The only reason that can account for their behavior, other than stupidity, is that they don't want to lose a customer, i.e., money. The ethical thing for doctors would be to say to their patients, "I'm sorry, I cannot prescribe a medication for your child that I know is ineffective."

It is an error for you to suggest that doctors usually try to help their patients, therefore they can never act unethically. Bankers usually pay back the money that is given to them by depositors, but that doesn't mean they aren't engaged in predatory lending and fraud.

You live within the medical culture, and as a result you are not seeing the greater picture. PC and I don't have time to educate you, but the information is out there if you ever want it.

[Jay]

Re: From Voodoo Economics to Voodoo Medicine

Jay, if you are representing an educated view, can you tell me how many physicians prescribe antibiotics inappropriately? Surely, you must be aware of such a statistic before throwing around accusations such as "ignorant" and "unthinking".

Let me help you out:

"There is good evidence that there is a high rate of unnecessary antibiotic prescriptions in the United States. Whereas the prevalence of sore throat caused by bacterial infection among adults is between 5% and 17%, a study of physician practice in 1989 and 1999 found that antibiotics were prescribed during 73% of visits.^[5] Moreover, most of these patients received antibiotics that were not recommended for pharyngitis, with a high number of prescriptions being for extended-spectrum antibiotics. Another study found that more than half of children with sore throats received antibiotics, a rate significantly higher than the regular prevalence of bacterial pharyngitis.^[6] Furthermore, more than one quarter of these children received an inappropriate antibiotic." http://www.medscape.com/viewarticle/585456

Can you tell me what the motivation would be for a doctor to prescribe antibiotics unnecessarily? Are they just stupid? Holding positions of authority figures in our society, I find it hard to believe they just can't say "no". The only reason that can account for their behavior, other than stupidity, is that they don't want to lose a customer, i.e., money. The ethical thing for doctors would be to say to their patients, "I'm sorry, I cannot prescribe a medication for your child that I know is ineffective."

It is an error for you to suggest that doctors usually try to help their patients, therefore they can never act unethically. Bankers usually pay back the money that is given to them by depositors, but that doesn't mean they aren't engaged in predatory lending and fraud.

You live within the medical culture, and as a result you are not seeing the greater picture. PC and I don't have time to educate you, but the information is out there if you ever want it.

Raja, my point isn't that these things don't happen, it is that you have painted the profession with a homogenous, broad, unfair brush. I wouldn't be so narrow minded to say that doctors never act unethically and didn't insinuate that at any point in my post.

[ThePythonicCow]

Re: From Voodoo Economics to Voodoo Medicine

Dr. Nortin Hadler's indictment of the medical profession, The Last Well Person: How To Stay Well.

Link to this book on Amazon: http://www.amazon.com/Last-Well-Pers...dp/0773527958/.

Looks like an interesting book - thanks for mentioning it.

To me, Medicine/Healthcare exhibit many of the same disturbing characteristics as the FIRE Industries.

Agreed.

Other American Industries appear to be in the same, unhealthy condition. To ignore this is hardly going to lead us to a proper treatment or cure. America will not heal itself. Maybe it it is time to look for the real causes of this Decline rather than simply discussing the symptoms.

Much will have to change to remedy these problems, much unhealthy conduct expunged.

Perhaps, if we are very fortunate, this Decline will be soon enough and deep enough to actually lead to the prospect of a proper treatment or cure, visible at least still in our lifetimes.

[ThePythonicCow]

Re: From Voodoo Economics to Voodoo Medicine

Hopefully you are not one of these people and your solo act lands on the runway.

Hopefully. Whatever the result, I am honored to have this life and the opportunity to do the best I can with it.

[ThePythonicCow]

Re: From Voodoo Economics to Voodoo Medicine

Here's an interview with Nortin Hadler from last year (June 2008) that does a good job of presenting his views: http://www.ibiblio.org/uncp/media/hadler/hadlerq&a.pdf

[raja]

Re: From Voodoo Economics to Voodoo Medicine

Raja, my point isn't that these things don't happen, it is that you have painted the profession with a homogenous, broad, unfair brush. I wouldn't be so narrow minded to say that doctors never act unethically and didn't insinuate that at any point in my post.

"Whereas the prevalence of sore throat caused by bacterial infection among adults is between 5% and 17%, a study of physician practice in 1989 and 1999 found that antibiotics were prescribed during 73% of visits."

Seems broad to me . . . .

[petertribo]

Re: From Voodoo Economics to Voodoo Medicine

Here's an interview with Nortin Hadler from last year (June 2008) that does a good job of presenting his views: http://www.ibiblio.org/uncp/media/hadler/hadlerq&a.pdf

Thanks for that link. I did not know that he had written a new book. I will surely be reading that.

His "going rogue" in the Medical Profession raises some interesting questions. As a Professor at UNC I would imagine there is some protection there. I would imagine also that there is somewhat of a movement within the Profession itself to change. I would hope the Profession is not powerful enough to penalize and blackball him. I think there is a parallel to be made with rogue analyst Nassim Taleb and his BLACK SWAN. Much of what Taleb says in his book is directed at this idea of Expertness and Infallibility. We need more contrarian thinkers and iconoclasts.

In these days, it would be nice to have a Confessions Of/Rogue Genre of Literature for all these wayward American Industries to which we can all turn for the real dirt. Through them we might get some measure of protection. The lack of such a literature indicates to me that Intimidation and Omerta are operating. Let's hope the dam breaks like it did on IRAQ.

[jiimbergin]

Re: From Voodoo Economics to Voodoo Medicine

Have fun with your diabetes and hypertension; and losing weight doesn't work for everyone. Do you know how many children died before insulin? All of them that got type one diabetes.

Jay, thanks for all you do and all the many many good doctors out there. I know my personal physician is one of them. To imply that the profession is as bad as the others are implying is simply wrong. I have been involved with far more good doctors than poor ones.

jim

[flintlock]

Re: From Voodoo Economics to Voodoo Medicine

Some very good points. If you want the real causes of the decline in American Medicine, I suggest that you follow the path of the money, the big money, and it won't end up in the primary care doc's or general surgeon's pockets. It may shock you to learn that most of them are trying to get by like much of the rest of what became of the middle class.

Please note I said "medical establishment" and not singling out physicians alone. We tend to blame doctors because that is who our primary contact with the system is with. The emergency medicine you apparently practice is quite good in the US and not at all what we are talking about here. But a lot of other medicine is nothing but a revolving door of ineffective treatments designed to sell drugs, expensive tests, and keep patients coming back for more on a continual basis.

Your defensive attitude about any criticism of any physicians is part of the problem though. Your attitude is typical of doctors, that we mere mortals are stupid and can't understand the complexities of medicine and we should just bend over and take it. A lot (not all!) of doctors have rationalized away their integrity by claiming they are underpaid and therefore have to partake of the corruption in order to make a decent living. A lot are absolutely in the pocket of drug companies. I can't tell you how many times a doctor has tried to push the newest, latest drug on me or my family, only to relent and offer a perfectly safe and effective cheaper drug when asked. When referred for testing I now ask doctors if they have a stake in the lab or testing facility. A lot do. Conflicts of interest abound in the current system.

I'll agree more of the money should be going into the physicians pockets and less into the establishments. Frankly, your average real estate agent probably makes more than the average physician, which is f%cked up. The current system leaves physicians in some fields with very little income if they actually cure people quickly. Its not like a surgeon, who can bill big money for procedures. A lot of medicine is simply about the physicians knowledge and experience. Yet the system pays the same for the opinion of a new intern as it does for a doc with 30 years experience. And the corporate structure of medicine means that any new doctor who doesn't bill out X amount of dollars every month will find himself looking for a new employer.

I am in a similar pickle. I diagnose electrical problems for a living. I can walk in and fix a lot of problems in 5 minutes due to my experience level, and people only want to pay me for 5 minutes, not for my knowledge that led to the repair. So guess who makes the big money in my industry. The crooks.

[Jay]

Re: From Voodoo Economics to Voodoo Medicine

Your attitude is typical of doctors, that we mere mortals are stupid and can't understand the complexities of medicine and we should just bend over and take it.

Your words, not mine.