April 15th, 2010 by RamonaBatesMD in Better Health Network, Health Policy, News, Opinion, Research
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The Washington Post had a story by Lyndsey Layton this past week: FDA says studies on triclosan, used in sanitizers and soaps, raise concerns. An excerpt:
The Food and Drug Administration said recent research raises “valid concerns” about the possible health effects of triclosan, an antibacterial chemical found in a growing number of liquid soaps, hand sanitizers, dishwashing liquids, shaving gels and even socks, workout clothes and toys.
The FDA and the Environmental Protection Agency say they are taking a fresh look at triclosan, which is so ubiquitous that is found in the urine of 75 percent of the population, according to the Centers for Disease Control and Prevention. The reassessment is the latest signal that the Obama administration is willing to reevaluate the possible health impacts of chemicals that have been in widespread use.
No where in the article is the use of triclosan use in suture mentioned, yet in my research on allergy/reactivity to suture material I found that it is. Read more »
*This blog post was originally published at Suture for a Living*
March 29th, 2010 by BobDoherty in Better Health Network, Health Policy, News, Opinion
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With the vote on the healthcare reform legislation behind us, it’s nice to believe that we can now move to the stage where people begin looking at what the legislation will and will not do — not based on speculation or the political rhetoric, but what is actually in the legislation itself.
I realize that this is unlikely, since we all tend to engage in cognitive dissonance when confronted with information that does not square with our own pre-conceived notions, political leanings, and philosophical bent. I know I do it (as much as I try not to) and I’m sure this is true of just about all of us. Still, there are trusted and highly-credible sources of information that I hope will be of value to anyone who is open to learning more about the new healthcare legislation and its potential impact. Read more »
*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*
January 14th, 2010 by StaceyButterfield in Better Health Network, Health Policy, News
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It may still be a little fuzzy how health care reform will affect insurance coverage, but there is one area where it’s already having a clear impact, according to the Washington Post: menus.
A lesser-known aspect of the proposed legislation is that it will mandate calorie posting of the sort currently done in New York City for restaurants with more than 20 locations nationwide. The WashPo story reports on the positive impacts that publicization of calories has public health–apparently restaurants offer more healthy dishes, and diners swarm to them. Which is interesting, because the last time we discussed this issue, researchers were reporting that people actually consumed more calories after the stats were posted. Read more »
*This blog post was originally published at ACP Internist*
June 10th, 2009 by EvanFalchukJD in Better Health Network
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Did you know that doctors are paid too much, wrongly complain about medical school debt, and falsely believe there is a medical malpractice crisis?
Did you know that doctors are hopelessly conflicted sellers of medical care, motivated by the search for extra income?
Well, then you haven’t read the Washington Post’s Steven Pearlstein’s work on health care reform.
“It’s the doctors, stupid,” he begins his column today. At once, he recycles the tiredest of political phrases and tells his readers exactly what he thinks of them. But it’s not the column that is most telling, it’s the live web discussion that followed. I participated in it, and can share with you the highlights. It’s a revealing insight into the thinking of a mainstream DC columnist.
To save you the trouble, here’s a summary of Pearlstein’s views: Doctors learn a craft that they owe to the rest of us as a public good. But instead of doing this, they take advantage of knowledge to make as much money as they can. They do it willfully – like an insider-trading stock broker – but they also do it because they just aren’t all that competent at what they do.
Think I’m making this up? Read:
On medical school debt:
I think we allow doctors to make too much of their debt. . . In major metropolitan areas, that debt looks pretty small when compared to the lifetime earnings that doctors accumulate in private practice over many years. They more than make up for their investment, as it were. But they use this debt to justify their elevated incomes for the next 30 years — and make no mistake about it, doctors in the U.S. do make ALOT more than docs elsewhere, on average. . . . My suggestion is that we socialize the cost of medical education, that is have the government pay for it, in exchange for a couple of years of community service. That way, we get the community service and we eliminate the No. 1 reason given by docs to justify getting paid more than docs everywhere else.
According to the Bureau of Labor Statistics, a freshly minted family care doctor has a median wage of less than $140,000 a year. According to the AMA, these same doctors have, on average, about $140,000 in educational debt. Thirty years seems about how long it would take to pay off that debt, and you can forget about buying a house, a car, or paying for your own kids’ school under those circumstances. I’m sure many medical students would love the Joel Fleischman plan, but we should do that because maybe it will help more people become doctors, not because we think doctors are exaggerating the impact of debt equal to 100% of your gross pay.
On how our system ought to allocate medical resources:
There is no reason why people can’t travel an hour to a big hospital to have a baby, for example, in a big modern maternity ward that does lots of deliveries and has enough volume to be able to afford all the latest equipment in case something goes wrong. I mean how many times in your life do you have a baby that you can’t drive an hour to have it done, rather than insisting that every community hospital have its own maternity ward. It’s just one example of the inefficiency built into the system by people — that would be you and me — who insist on things that, in the end, don’t have ANY impact on the quality of care. In fact they have negative impact.
I don’t know if Pearlstein has ever had a baby before, but just being an hour away from a hospital is unthinkable for most expectant moms in the weeks prior to delivery. And what is someone to do who lives an hour away and has a complication during the pregnancy? Pearlstein’s prescription seems to be that they should eat cake.
On the freedom of patients to choose their medical care:
The emphasis on being able to choose your own doctor in every instance is another, as if most of us have a clue as to who are the best docs and who aren’t. These are the kinds of irrational things we need to try to work out of the system, because they wind up being very costly.
Yes, for goodness’ sake, let’s get rid of the irrational desire of a sick person to want to pick their own doctor. Even Senator Kennedy’s “American Choices Act” guarantees the right of patients to choose their own doctor. I don’t know where Pearlstein is on the political spectrum with this view, except perhaps a certain territory between China and South Korea.
On how doctors are hopelessly conflicted in giving medical advice by their desire to make money:
But first we need the evidence to show that it isn’t a good idea. Then, once we have the evidence the doc has to follow the protocol and explain to the family why it’s not a good idea and not merely blame the big, bad insurance company for being so heartless–which, by the way, a lot of docs do, so they can look like the good guys. Of course they’d love to do the surgery in many cases because they’d like the business and the extra income, so they are hopelessly conflicted. . . . .
[B]uying medical care is not like buying lawn furniture. . . in medical care you rely to an extraordinary extent on the advice of the doctors (i.e. the sellers). And its also not an area where you are inclined to be very price-sensitive — is anyone going to go the the Wal-Mart of surgeons if they think their life may depend on it. . . . But it is NOT true that a well-informed consumner will always make the right choice about medical options — they still need the advice of doctors, who under the current system have a very noticeable conflict of interest.
I’m actually not sure that Pearlstein has even been inside of a Wal-Mart. Because they consistently have high quality merchandise at the lowest prices. In fact, if more hospitals worked like Wal-Mart the problems that plague our health care system today probably wouldn’t exist.
Responding to a commenter who said that the notion that defensive medicine is a large expense is “totally false:”
Indeed. But doctors don’t believe this, no matter what evidence you present them.
Yes, evidence is like kryptonite to doctors.
I asked Pearlstein if a doctor ran over his dog or something. He didn’t directly respond, simply saying “Maybe you should talk to Atul [Gawande].”
Now that’s the only sensible thing he said.
June 8th, 2009 by Dr. Val Jones in Health Policy, Opinion
9 Comments »
The abortion “issue” is such a hot topic that I have never written about it on this blog until today. I hope I won’t regret that decision but I felt it was appropriate to respond to this medical student’s essay – and the ~560+ comments that follow it – as a physician who has witnessed (but never performed) about 100 abortions. Let me explain.
During my Emergency Medicine training I was required to perform a certain number of intubations and abdominal ultrasound scans. My residency training program offered rotations in Ob/Gyn and at a local Planned Parenthood center. The senior residents told me that the best way to fulfill my intubation requirements was to assist with the Ob/Gyn OR procedures because the patients were young, healthy, and generally uncomplicated. At the time I was really excited by the opportunity to get the experience I needed – in as short a time as possible. I used to hang out in an Ob/Gyn operating room asking if I could assist the anesthesiologist with the intubations. Once they got to know and trust me, I could intubate about 6 patients in a day – an opportunity otherwise hard to come by as all the new anesthesiology residents were vying to practice intubation themselves.
One of the Ob/Gyns who used the OR (where I got my intubation experience) scheduled some abortions of fetuses that were at the border of viable – as old as 23 weeks. That made me quite uncomfortable, and I know that there were other staff (and several nurses) who refused to work with that physician. However, as squirmy as I felt, I thought it was important for me to see first hand what the procedure entailed… because otherwise I’d have to rely on anecdotes and second-hand opinions to draw my own conclusions. I wanted to see this for myself.
I’ll never forget the day I witnessed the first late-ish term abortion. I was preparing my intubation equipment – fidgeting with the Mac size 4 blade, making sure the light worked, when the physician brought the patient into the room on a gurney. The woman’s abdomen was very pregnant, and the Ob/Gyn was stroking her hair and whispering reassuring things to her. The anesthesiologist made small talk with the patient, explaining the nuts and bolts of the anesthesia – the oxygen mask – the propofol – the intubation. I stayed out of the patient’s line of sight and allowed the Ob/Gyn and her resident to spend some final moments with her. The scene was both tense, and yet supportive of the patient.
I initiated rapid sequence intubation with the assistance of the anesthesiologist, and then moved to get the ultrasound machine to visualize the uterus and its contents. Much to my discomfort the fetus was fairly large – and was moving around normally, even sucking its thumb at one point. I asked the Ob/Gyn resident why the fetus was being aborted since it didn’t appear to have any structural abnormalities. She responded that the mother simply didn’t want to have the baby, and had wrestled with the idea of abortion for a long time before she made her final decision.
The rest of the procedure is a bit of a blur – with details too graphic to describe here. But suffice it to say that the resident performing the dilatation and curettage had a fairly difficult time removing the fetus through the cervix, and had to resort to eliminating it in smaller parts, rather than a whole. It was very sad and it took a long time to make sure that the uterus was fully evacuated. I decided that I couldn’t watch another one of these procedures.
The rest of my female abdominal ultrasound experience was obtained at a Planned Parenthood center where very early abortions were performed. Generally, this consisted of suctioning out a tiny yolk sac (and “products of conception”) – without much of a recognizable fetus in the midst. Although these procedures were certainly emotional, they were somewhat less troubling than the later term dilatation and curettage.
What I didn’t expect, however, was that of the approximately 100 abortions I witnessed – none (to my knowledge) of the women requesting them were rape victims, nor was there a life-threatening birth defect in the fetus. Usually the reason they gave was psychological, emotional, or financial – “I just can’t afford to raise a child” or “This is not a good time for me to be pregnant” or “I don’t want this baby” or “I don’t want another baby” or “This was an accident, and I don’t want it to ruin my life.”
I did my very best to adopt an attitude much like the one that the author of the Washington Post article did – “It’s not for me to judge the validity of someone else’s reasons for wanting an abortion… They’re going to do it anyway so physicians need to make sure they’re safe… Women have the right to choose…”
But the reality was that those attitudes didn’t prepare me for the emotional turmoil inherent in the process of abortion. It’s sadder than I thought, more difficult than I thought… and the impact is farther reaching than I imagined. Studies estimate that about 1/3 of US women have an abortion at some point in their lives – that’s a heavy emotional burden that many women carry in silence.
In my opinion women should have the right to choose to have an abortion, but I’d hope that they also consider their right to choose to give their baby up for adoption as well. Some believe that an abortion is “easier” than giving up a baby for adoption – but I’m not so sure that’s the case from an emotional perspective. As far as rape victims or women who are carrying a moribund fetus – the decision to abort may well be emotionally less damaging. But for the majority of women who have abortions for less clear reasons (reasons like the ones I witnessed), I’d really encourage them to consider adoption as an option. Obviously, these decisions are intensely personal and have to be made on a case-by-case basis – and women should be supported either way.
As scientific and rational as I wanted to be about the procedure, I am still troubled by what I experienced as a witness to various abortions. Though I might have “entered the abortion conversation” as the third-year medical student did – after witnessing quite a few, I have a deeper appreciation for the emotional complexity of abortion, and a desire to help women avoid them if at all possible. I wonder if the author of the Washington Post article will change her perspective after she’s witnessed a few of the procedures?
