February 5th, 2009 by Dr. Val Jones in Health Policy, Opinion
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Merrill Goozner has been speculating about who will be nominated as the new Secretary of HHS. He reviewed his most likely candidates (David Cutler or David Blumenthal), and threw in a “dark horse” potential nominee: Ken Thorpe (whom I’ve interviewed several times on this blog and spent time with during Obama’s inauguration ceremony).
Tommy Thompson told me that the nominee is likely to be a current or former democratic governor (such as Kathleen Sebelius or Howard Dean).
But I’ve been pondering the “long shot” question and think that Goozner may have missed a more obvious choice – someone who works with Ken Thorpe at the Partnership to Fight Chronic Disease: former Surgeon General Dr. Richard Carmona.
Here are the 10 reasons why Richard Carmona would be a smart choice for Secretary of HHS (in random order):
1. He was confirmed by the senate as Surgeon General in 2002 and lived under their scrutiny during his term of service, meaning he has no hidden secrets, tax or nanny problems likely to embarrass Obama and could be confirmed rapidly – perhaps in under a week.
2. He has forged extensive good relationships with both parties over the course of his tenure as Surgeon General and is known internationally.
3. He has been the CEO of a large, public health system (including hospitals, Medicare and Medicaid clinics, nursing homes, and emergency medical systems in Arizona).
4. He has been a paramedic, nurse, and physician and understands the healthcare system from the inside out.
5. He has a track record of leadership in prevention, preparedness, health disparities, health literacy, global health and health diplomacy. He has worked on both sides of the aisle, including assisting Senator Kennedy with issues of disability and socio-economic determinants of health.
6. He is Hispanic, which adds additional diversity to the Obama leadership team.
7. He has experience managing local, state and federal health programs, including significant experience in immigration and border health issues.
8. He demonstrated competency and leadership as manager of the US Public Health Service of over 6000 uniformed public health officers both nationally and internationally.
9. He has extensive military experience, and is a combat-decorated Vietnam veteran. He maintains a strong relationship with military surgeons general and the department of defense.
10. The fact that he is a political independent might actually provide a middle ground for parties with differing agendas in health reform.
Is point number 10 a deal breaker? It may be, but Obama could look farther and do much worse. And while the clock is ticking and credibility is paramount (as Maggie Mahar wrote, “Reform needs to be overseen by someone who is perceived as being above suspicion—purer than Caesar’s wife”) I think the Obama/Biden team needs to take a closer look at Dr. Carmona. He’s actually the most experienced, low risk candidate under discussion – and could truly hit the ground running at HHS. And wouldn’t it be nice to have a physician who is also a health policy expert with advanced managerial experience at the head of the healthcare reform table?
February 4th, 2009 by Dr. Val Jones in Humor, True Stories
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My friend and fellow blogger David Kroll just wrote an interesting post about the use of “doctor” as a title for a wide range of expertise, including medical. The discussion reminded me of the usual misunderstandings associated with my title…
Typical Val conversation with lay strangers:
Dr. Val: “Hello, I’m Dr. Jones…”
Person: “Oh, hi Dr. Jones. What kind of doctor are you?”
Dr. Val: “A medical doctor.”
Person: “Oh, so you’re like, a pediatrician?”
Dr. Val: “No, my specialty is rehabilitation medicine.”
Person: “Oh, my uncle has a drug problem. He’s been in and out of rehab for years. I’m so glad that there are people like you willing to help addicts.”
Dr. Val: “Uh… Well, actually my specialty is focused on physical rehabilitation – like patients with spinal cord injuries, amputations, strokes, car accidents, etc…”
Person: “Oh, so you’re a physical therapist?”
Dr. Val: “No, I’m a physician. But I work closely with physical therapists.”
Person: “So you’re a REAL doctor?”
Dr. Val: “Yes, I went to Columbia Medical School…”
Person: “Well, you don’t LOOK like a doctor.” [See example here]
Dr. Val: “Uh… thanks?”
***
Dr. Val: “Mom, why don’t people believe I’m a medical doctor?”
Dr. Val’s Mother: “Well, you picked an oddball specialty, dear.”
Dr. Val: “What’s oddball about helping the disabled population?”
Dr. Val’s Mother: “Well, you know ‘rehabilitation’ usually conjures up ideas of drug rehab.”
Dr. Val: “Yeah, my specialty has the weakest PR in all of medicine. Nobody knows what we do.”
Dr. Val’s Mother: “At least people don’t think you’re a hypnotist.”
Dr. Val: “What?”
Dr. Val’s Mother: “Did I ever tell you about the time I was on an elevator with someone at a Spanish literature convention?”
Dr. Val: “Uh…”
Dr. Val’s Mother: “My tag said ‘Dr. Sonia Jones, member of the American Association of Hispanists.’ A woman in the elevator with me was staring at my name tag and finally blurted: ‘Are you here with the convention?’ And I said, ‘yes.’ And then she responded: ‘Could you hypnotize me too?!'”
January 31st, 2009 by Dr. Val Jones in Expert Interviews, Opinion, Quackery Exposed
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David Kroll, Ph.D. and I share more than an appreciation for bibs and crab legs (pictured at left during our recent “academic” rendezvous) – we are pro-science bloggers who want to understand the evidence for (or against) health treatment options, both in the natural product world and beyond. At our recent meet up at The Palm we discussed homeopathy – a bizarre pseudoscientific approach to medicine often confused with herbalism. Homeopaths believe that “like cures like” (for example, since an onion causes your eyes to water and nose to run, then it’s a good cure for a cold) and that homeopathic remedies become more potent the more dilute they are. So if you want a really strong medicine, you need to mix it with so much water that not even a molecule of it is left in the treatment elixir. Of course, homeopathy may have a placebo effect among its believers – but there is no scientific mechanism whereby tinctures of water (with or without a molecule of onion or other choice ingredient like arsenic) can have an effect beyond placebo.
David graduated with his B.S. in toxicology from one of the most prestigious schools in the country, the Philadelphia College of Pharmacy and Science (PCP&S). In the early 1900s PCP&S graduates were critical players in combating snake oil hucksters and establishing chemical standards, safety, and efficacy guidelines for therapeutic agents. So it was with utter amazement that he received recent news that PCP&S was planning to award an Honorary Doctorate of Science to a major leader in homeopathy – on Founders’ Day, no less.
“Our founders would be rolling in their graves,” David told me. And he wrote a letter of complaint to the University president which you can read here. This is a choice excerpt:
Awarding Mr. Borneman an Honorary Doctor of Science is an affront to every scientist who has ever earned a degree from the University and, I would suspect, all current faculty members who are engaged in scientific investigation. Homeopathy is a fraudulent representation of pharmacy and the pharmaceutical sciences that continues to exist in the United States due solely to political, not scientific, reasons. Indeed, homeopathic remedies are defined as drugs in the Federal Food, Drug, and Cosmetic Act [21 U.S.C. 321] Section 201(g)(1) as a result of the 1938 actions of U.S. Senator Royal Copeland (D-NY), a noted homeopath of his time. But scientifically, homeopathic remedies are nothing more than highly-purified water misrepresented as medicine based upon an archaic practice that is diametrically opposed to all pharmacological principles.
Honoring people who actively promote pseudoscience is wrong in many ways as David points out. I would also add that doing so confuses the public. If academic institutions committed to scientific integrity lend their names to cranks, then it makes it more difficult for the average person to distinguish quackery from science. I have the utmost sympathy for the patients out there who are trying to figure out fact from fiction in medicine. That is why I have a “trusted sources” tab on my blog – please click on them for guidance regarding health information you can trust.
As for PCP&S, if they value their academic principles (as no doubt many within the organization do) the president should rescind his offer to honor Mr. Borneman’s “entrepreneurial spirit” on founder’s day (February 19th, 2009). Finding a way to sell water to people as cures for their diseases is certainly entrepreneurial – but I see nothing honorable about it. I hope that President Gerbino sees the light before founder’s day.
January 29th, 2009 by Dr. Val Jones in Audio, Expert Interviews
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Billy Tauzin has spent most of his life in politics. He has been a member of the House of Representatives as both a democrat and a republican, though his recent experience with a rare and usually terminal cancer (duodenal adenocarcinoma) radically changed his career path and trajectory. I caught up with Mr. Tauzin by phone at the America’s Agenda conference in Miami. You may listen to our podcast conversation or read my summary of our discussion below.
[Audio:http://blog.getbetterhealth.com/wp-content/uploads/2009/01/billy-tauzin.mp3]
Dr. Val: Tell me a little bit about your intestinal cancer and how that changed the course of your life.
Tauzin: I was in the process of finishing up a 25-year career in Congress when one night I had a sudden, massive bleed. I was taken to the hospital and was diagnosed with a rare cancer with a poor prognosis: duodenal adenocarcinoma. There was a hole in my intestine, right next to my pancreas.
I went to Johns Hopkins to have a Whipple procedure – and as you know a Whipple procedure is one of the most aggressive types of surgery anyone can endure. They kind of split you open like a fish, pull out your innards and restructure you. They had to remove part of my stomach, intestines, and pancreas, and then reconnected it with new ducts and channels. The Whipple was supposed to cure me, but unfortunately I found out (at a follow up visit at MD Anderson) that there was still cancer in my body.
The doctor told me very frankly that I was going to die.
Dr. Val: Tell me about the experimental drug that you were introduced to at that point.
Tauzin: My doctor reviewed my options with me: I could undergo another surgery, but that would probably kill me and would be unlikely to cure the cancer. They had no approved protocol for people in my position, but there was a drug (called Avastin) that had been successful in treating colon cancer – but was not yet approved for duodenal adenocarcinoma. The drug works by cutting off the blood supply to tumors – which meant that the drug could either damage my healing process or kill the cancer. My wife and I decided to take the risk because we had very little to lose. It was really a choice between “going to die” (my current situation) and “might die” (Avastin could cure me).
It’s a good thing we tried Avastin because it worked like a miracle. By the end of my first round of chemotherapy, the radiologist couldn’t even find the tumor on my CT scans. It was gone. I completed several courses of chemo and radiation and I’ve been cancer-free for over 5 years now.
Dr. Val: Did this miraculous recovery influence your decision to become the CEO of Phrma?
Tauzin: After I recovered from cancer, I was fortunate to be offered many different job opportunities. However, my wife looked at me and said, “You know Billy, you really ought to go to work for the people who saved your life.” And I thought, “If there’s a meaning in why I’m alive today – then surely it must be to use my experience to help patients like me across the world.”
Dr. Val: So what are you hoping to achieve at the America’s Agenda conference in Miami?
Tauzin: This conference is unusual in that we’ve gathered together a group of very disparate voices from different perspectives – labor, business, health plans, trade associations, academic medicine, etc. hosted by Donna Shalala (former Secretary of HHS) at the University of Miami. We are trying to define our commonalities so we can influence health reform more effectively.
Washington is all about differences – it’s partisan, it’s mean, and I’ve been on both sides of the aisle. I can tell you that there are good people in both parties, but they’d never know it because they consider each other enemies. What we’re trying to say here is: patients don’t sign in as democrat or republican when they register at a hospital. They sign in as sick people. This is not a partisan issue. We have a sick care system that needs to be a health care system.
Dr. Val: What should the Obama administration choose as their top priorities for health reform?
Tauzin: First of all we need to recognize that we spend 75 cents of every dollar on the damage done by 5 chronic diseases (including diabetes, heart disease, mental health, cancer, and lung disease). We must focus our system on early detection and prevention of these diseases, so that we manage them well and avoid the costly toll they take when untreated. We’re destined to be a poorer, sicker society if we don’t get insurance coverage for every American. We need insurance to provide early detection, prevention, and good management of our chronic diseases. How we do that is debatable. But we need to get there.
January 24th, 2009 by Dr. Val Jones in Book Reviews
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Laurie Edwards has an extremely rare disorder called primary ciliary dyskinesia (PCD). The condition causes similar signs and symptoms to cystic fibrosis (CF), including chronic lung infections and difficulty breathing. In her recent book, Life Disrupted: Getting Real About Chronic Illness In Your Twenties And Thirties, Laurie invites readers to experience her life as a chronically ill young woman. She spares no gory details:
I had to wear the probe for forty-eight hours to see if irregularities in my GI tract were contributing to my breathing problems. It was an awkward contraption, and just as I finished speaking, I sneezed. Because of the tubes, I couldn’t control it well and a bloody mess spewed out of my nose and onto my shirt. I looked down at the mess and up at John.
‘Sexy, huh?’ I asked, completely mortified.
But beyond the raw realities of her illness (including the regular disruption in her education, her unfulfilled longings to “fit in,” and her lack of control of her circumstances), is the amazing story of the people who love her. Life Disrupted‘s ironic subtext is the unshakable support of her family and friends.
From her earliest first moments at home, Laurie’s brother “spent hours standing guard at her bassinet, as if to reassure her mother nothing would happen to her.” As she grew older, her brother continued his protective commitment, promising to always be ready to help her in any time of need. Laurie’s parents had a strong and loving marriage, and their patience and kindness were a constant source of security and comfort.
Laurie’s husband shows incredible stoicism and endurance – undeterred by her diagnosis (which she revealed to him unwittingly on their first date), he learns how to give her chest physical therapy by week three of their relationship, and remains calm during a dangerous near-suffocation episode.
He was perfect. He did not get flustered, did not panic, just got me home as quickly as possible, unlocked my door, and ran to set up the nebulizer. He clapped me while I positioned myself with the nebulizer mask and tubing, trying to manually break up the thick mucus that cut off my air supply.
My favorite part of Life Disrupted is its humor. Laurie does an admirable job of capturing the amusing banter that she and her friends used to lighten the mood:
My friends and I refer to my nebulizer and oxygen face mask in the hospital as the “Super Bong.”
And my favorite sentence of the book is this one:
It was a container of honey mustard salad dressing that turned out to be my Waterloo, the moment of my crushing, flabbergasting defeat.
Laurie’s life – disrupted by chronic illness – is charming, vibrant, and rich in affection. The disruption itself is perhaps diminished by the connectedness of her family and friends – a healthy emotional backdrop to the physical illness at center stage. In the end, Life Disrupted offers compelling evidence that love really can conquer all.
