“There are few people who are not ashamed of their love affairs when the infatuation is over.”
– François, Duc De La Rochefoucauld
The end of an infatuation is always rather sad – we have many expressions for it, “the bloom is off the rose” comes to mind. Falling out of love is often a moment of maturity, a moment of coming out of an illusion – never wholly welcome.
We have had many decades of uncritical, wholesale adolescent-style adoration, heartbreak and hate towards our politicians. We have been capable of sustaining illusions and uncritical thought with support from a similarly dazzled media. This has been done for years on both sides of the aisle. This kind of idealism says that we have finally found the man (party) who will (choose one) solve our problems, understand us, have complete integrity, be able to function in a trustworthy and honest fashion. This idealism comforted us by putting some in black hats and some in white. The comforts of certainty, zeal and clarity, even if untrue, are hard to resist. How long we can sustain this with any one politician or party depends on the filter we have, and how much attention we are paying. This is how crushes are sustained, in romance and in politics.
There are signs on the ground that we are beginning to grow up. We are beginning to understand that the corruption, self-interest, special interests and spin exist symbiotically on both sides of the aisle. With the deeply personal debate on health care and its associated reform costs, our need for honesty and successful policy to save our country is suddenly more important to us than the comfort of bedtime stories. This is political maturity.
What are the signs of this? Take for example, the publics’ realization that our representatives have not read a bill in its entirety. This conversation did not even occur as little as ten years ago – we assumed a level of expertise by our elected officials, or we didn’t care, but somehow, and this is the point, the illusion was maintained. In retrospect, I would imagine few bills were ever read page by page – and that the fact that they are not now is nothing new. What is new is that we now care about this. What is new is that we now see that legislation has a direct impact upon us. What is new is that we realize this congressional neglect shelters corruption in the form of deals, earmarks and policy that the public would not support if there was transparency. And we now see that there is transparency not provided by a beneficent body of elected officials or trusted news sources, but rather there is transparency because of the internet. It is unprecedented that we can summon chapter and verse of any bill onto our own computer – almost in real time.
This is a game-changer.
We are now (as voters) in a position to demand that legislation (including I daresay health-care reform) occur in incremental, transparent, understandable terms that voting citizens can vet themselves. Not thousands of pages of nearly incomprehensible gobbledygook. Anything short of that has become unacceptable, in part because we are also now able to contact our representatives at a moments notice. In years to come, we will now look back and see the final lipstick-on-the-collar moment in our relationship with Congress as the ramming through of the unread, un-vetted Stimulus Package.
The bloom is off the rose. It’s time for a new kind of politics: a mature, unprecedented realism.
Politicians should dismiss the public as “not ready for this” at their own risk.
“When patterns are broken, new worlds can emerge.”
-Tuli Kupferberg
*This blog post was originally published at Dr. Wes*
Like many other people, Ms. Krinsk thought that her prescription information was private. But in fact, prescriptions, and all the information on them — including not only the name and dosage of the drug and the name and address of the doctor, but also the patient’s address and Social Security number — are a commodity bought and sold in a murky marketplace, often without the patients’ knowledge or permission.
But given the money involved, I’m afraid it isn’t.
But with the pharmaceutical industry soon to release $150M dollars of ads promoting health reform as they cozy up to Congressional leaders, the conflicts of interest for patient’s privacy are staggering. Further, the promotion of the electronic medical record, personal health records, and ultimately, cloud computing (where no one will know where health data resides), are firmly part of the health reform landscape.
Now before people think I’m totally against the EMR, let me be candid: I’m not. It does facilitate care and is an incredible means of communication between physicians and laboratories and pharmacies and the like. When used properly, they are miraculous.
But the risks of losing information remain huge. Certainly, the above referenced New York Times article notes that safeguards are supposed to be enacted to prevent this wholesale marketing of your health data.
But suddenly, we learn of a White House snitch line where they will collect e-mails of people who might be spreading “misinformation” about the health reform efforts underway. (Thanks to my previous blog post, I am happy to report I’ve been reported! ;)) But this occurs at a time when privacy issues in health care must be seen as paramount and electronic medical records protected as secure.
Ooops.
So now we have a White House eager to build a snitch line as they cozy up to pharaceutical interests that are already selling personal information from prescription data, all while trying to promote the security of electronic medical records to the masses.
Who are they kidding?
But then, shucks, just think of the marketing possibilities for the government:
And lest people think I’m too partisan (who me?), the Republicans with their travel junkets aren’t any better.
Sheesh!
-Wes
Reference: White House blog with snitch e-mail link at flag@whitehouse.gov .
*This blog post was originally published at Dr. Wes*
Not because of the number of people I saw (12) or the clinical diversity seen, but rather how many people (4) asked me what I thought of the current health care reform bill before Congress.
The political spin being posed by Democrats is that people are staging town hall protests about their displeasure about the current health care reform efforts underway.
I don’t think so.
Rather, I think people are finally realizing that the health care reform proposal on the table is no longer about the “47 million” uninsured, but rather, “Hey, this health care reform thing, why, it’s about ME!”
-Wes
*This blog post was originally published at Dr. Wes*
When looking for the cause of atrial fibrillation during a physical examination, not only can the doctor’s olfactory bulb be helpful, but so can the examination of what gets brought into the exam room.
Patient: “Hey doc, it’s just a Pepsi.”
Doctor: “Really? Can I see?”
Nothing a good knife and a piece of scotch tape can’t manufacture.
Case solved.
-Wes
*This blog post was originally published at Dr. Wes*
Yesterday in our cath conference, we discussed the substudy from the prospective randomized trial called PREVENT-IV just published in the New England Journal of Medicine. That study evaluated the major adverse cardiac event rates of minimally invasive vein harvesting compared to open vein harvesting prior to coronary bypass surgery.
I was surprised to see that minimally-invasive vein harvesting had a higher combined complication rate of death, myocardial infarction (heart attack) and need for revascularization in the patients who received vein grafts harvested by the minimally-invasive technique. Following the presentation of the data, our surgeons were asked why this might be the case. While none knew for sure, they postulated that the art of harvesting vein-conduits using endovascular techniques might play a role (it’s more difficult), or the effects of the thrombolytic state induced by on-pump bypass vs. off-pump bypass might create the discrepency in post-surgery vein survival, since patients are less likely to develop clinical thromboses in the post-open chest bypass population.
So this morning, I was surprised that President Obama toured Cleveland Clinic yesterday and had such an up-front experience with minimally-invasive robotic surgical techniques for mitral valve repair that hardly represents mainstream American health care. While the marvels of the technology cannot be disputed, like the endovascular vein harvesting study above, might we find that robotics could be as deleterious to patients compared to open chest techniques? After all, these techniques have yet to be compared in multi-center trials to more conventional open techniques for mitral valve repair. But more concerning as we move forward is this question: will academic centers be granted more funds to test comparative effectiveness research for robotics at the expense of front-line American health care? Surely, this won’t be, will it?
Probably.
But when I see pieces like this I wonder why the article does not question the cost and risks of this technique compared to conventional open-chest procedures, especially in this era of touting the need for health care cost containment. How much is this piece about the marketing of this technique to the community (for financial gain) or to the President (for obtaining grants or political favors)?
Perhaps we should ask ourselves how many of the physicians and surgeons at Cleveland Clinic stand to earn a seat on the proposed MEDPAC board that will determine if Congress will approve payment for robotic techniques even when few data exist to show their superiority over conventional techniques.
Now that might make for some really interesting reading.
*This blog post was originally published at Dr. Wes*
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