Medicine

US Rumor and Hospital Report | The Health Care Blog

“US News needs to stop relying on unsupported and unsupportable reputation, often influenced by anecdote, personal relationships and self-serving public appearances, and work on real — and more recent — data. Maybe that will also cause hospitals to be more willing to report their data so they can be named to the “Honor Roll.” As it is, you are better off keeping things opaque to protect your reputation.

“I think it is time to acknowledge that this ranking offers very little in the way of valuable information. It is mainly a vehicle for advertisements from the pharmaceutical industry, who know that this issue of the magazine gets a lot of attention and high circulation. As you flip through to each specialty, you are blasted with ads for drugs related to syndromes within that specialty.”

via US Rumor and Hospital Report | The Health Care Blog.

ObamaCare’s Most Frightening Consequence: Not Enough Doctors – HUMAN EVENTS

It’s more about the hassles and the regulatory burden than the money. We want to help people, but we end up bean counters and paper pushers.

According to Roe, only 4% of the nation’s students are getting into primary care fields.

This is significant. Family Practice residencies have been shut down because the program can claim to have enough “primary care” resident slots in the Internal Medicine department. However, if 96% of those IM docs go on to a subspecialty, they will not practice primary care. We lose both ways.

A survey by the Associations of American Medical Colleges found the nation’s doctor shortage likely will increase the project shortfall of 62,900 doctors in 2016 to 91,500 in 2020.

“When these older doctors who are used to working 70 or 80 hours quit, I don’t know what we are going to do for internists and primary care,” Roe said.

via ObamaCare’s Most Frightening Consequence: Not Enough Doctors – HUMAN EVENTS.

On human potential

“TheRealSasha” has commented, here, on my essay, “Why Ethics?”

From the comment:

However I believe the application of the argument is limited.. As it doesn’t address the contested questions such as definition of when life begins. As such your ‘hierarchy of importances’ only follows if the assumption is make that life begins at conception.

I think an issue the post doesn’t consider, is the greatest potential of the woman and man who will be caring after the child when they are born. If the child/fetus in the womb is found to be severely deformed and close to a vegetated state, which will involve a lifetime of the most basic care for their needs, it will mean the life of the carers will be such that the large part of it will have to be devoted to looking after a child that may not even comprehend who their own parents are.

I believe that taking your own argument of the greatest potential, it can be argued that the child given in the above example has less potential in having something resembling ‘life’, than the potential life/lives lost of their carers.

Science depends on the study of events that can be observed by different observers in different labs, under similar conditions.

The one-celled embryo, the zygote, is unique in that the products of two cell lines, a sperm and an egg, which are at the end of their life cycle, combine to form the beginning of a new life cycle. Any argument in favor of potential is only a personal belief, inconsistent with observable facts. We know that fertilization is a point that a technician can identify in the in vitro lab. No one implants unfertilized eggs. In fact, we can watch the changes by serial ultrasounds and blood hormone levels that result from the new embryo.

Philosophy can utilize the same criteria: what would happen in another place if the same value were given to another child at another age? Why not kill the child with less “potential” after birth?

Sasha gives a classic example of utilitarian ethics: the greatest good for the greatest number, without regard to individual, inalienable rights. Utilitarianism allows fickle, faddish and selfish motives or might makes right to determine the safety that each of us can expect from society and law.

Anyone is at risk of becoming like the human in the example Sasha gives: a fall, a bad allergic reaction, an assault could leave any of us at least temporarily or permanently dependent on others for “the most basic care for their needs.” Why not snuff out the life of these people?

DPS caught up (for me, anyway)

The DPS website let me know that my State permit to prescribe has been renewed for another year.Yeayy!

The story is that DPS brought in extra people and have been working nights to put about 3000 delayed permits through their new software before Midnight, August 1.

I’m glad they’re catching up, but I still believe that it was irresponsible for them to install the new software program during what is probably their busiest time of the year, when they knew they’d have less personnel, because of budget cuts and because of vacations, etc.

Texas DPS Bureaucratic Snafu

On August 1st, a bureaucratic snafu might cause me to lose my ability to write prescriptions and, if so,there’s a good chance that hospital privileges will be suspended until some future date.

The Texas Department of Public Safety regulates prescription permits for Controlled Substances – the right to prescribe medicines – for doctors, dentists, advanced practice nurses, pharmacists, and veterinarians. (That ‘script for Oxycontin has the line, “Patient or pet owner’s name.)  The unofficial rumor is that the cuts in their Department because of the tight State budget caused a manpower shortage. Knowing that there would be less staff, the Department chose that moment to initiate a new, complicated software system. Those who were not laid off or re-assigned had to learn the new input and verification system at the busiest time of year. With fewer people and more work, they’ve gotten way behind in issuing the pieces of paper. The powers that be refuse to give extensions to those who have paid, are in the system, and who should have received those little pieces of paper by the last day of July.

The Texas DPS permits are redundant in light of the fact that the Federal government also issues prescriber permits through the Drug Enforcement Agency. This latter number is what most pharmacies ask for, along with our State license number. While Texas requires re-credentialing each year, the DEA permits are valid for five years.

Since most docs in Texas qualified for their first DPS permit at the end of their internship (with the permits issued July 31), there’s no telling how many prescribers will lose their ability to treat patients with antibiotics, blood pressure and diabetes medications, or Botox unless we can find some doc whose renewal is due at a later date and who is willing to co-sign. Oh, and of course, they have decreed that we can’t prescribe narcotics and other truly controlled substances under any circumstances.

Another giant bureaucracy stumbles once again, putting the process first, complicating the practice of medicine and endangering patients. The stifling regulations and paper pushing is frustrating!

NIH-Backed Study Examined Effects of Size of Male Genitalia in Gay Community

This source  and subject of this post is rated PG13, at least, even though I’ve cleaned up the title a bit.

There is a bit of scientific knowledge gained: an association with size and rate of STD’s. However, in medicine, I was taught that we probably shouldn’t measure test if there is no treatable condition involves.

It appears that the stipend for a post-doctoral fellow (someone who has already finished his Ph.D, but is doing further research under the supervision of a professor or committee, was covered by the National Institute of Health (the NIH), as some part of a large grant which was then awarded to subsidiaries:

“Those researchers then compiled data from a survey of more than 1,000 gay and bisexual men at events in New York City for the gay community.

     ”    . . . . But one of the researchers involved with the report told FoxNews.com that NIH funding was only used to help “analyze and write up” data that had already been collected without the use of taxpayer funds.  

“The data were not collected using taxpayer funds,” Jeffrey Parsons, a professor with Hunter College, said in an email. “NIH funds were not used to measure anyone’s penis size.” 

“This study was funded by the Hunter College Center for HIV/AIDS Education Studies and Training,” the National Institutes of Health said. “Dr. Christian Grov was supported as a postdoctoral research fellow at the time the research was conducted by a National Institute on Drug Abuse (NIDA)-funded training grant.”

Pump It! Wash it! Hospital videos for handwashing – cute!

“From the 6th floor right on down to Rehab!”

Paradise Valley Hospital in National City, California, has produced several videos to remind staff, patients and the rest of us to wash our hands to save lives.

So, which is your favorite, the Black-eyed Peas(or is it Robert Rodriquez?) take-off, “Pump It!” or the Michael Jackson-like “Wash it!” There’s a more traditional video with soothing “spa” music, and a language lesson, too, “Clean Hands Save Lives.”

(Thanks to Dr. LR for the heads up!)

WingRight

Today’s newspaper is out. I’m still getting the bugs out. If you find some of the chosen articles are inappropriate, please let me know. WingRight.

Addicted to spending, power, or nicotine?

I’ve noticed that addicts find some excuse to leave early or get “agitated” easily toward the end of a long meeting. May the Present President just needed a cigarette?

From CNN, a quote from Congressman Cantor: about the July 13th meeting with President Obama:

“That’s when he got very agitated and said I’ve sat here long enough — that no other president — Ronald Reagan — would sit here like this — and that he’s reached the point that something’s gotta give,” Cantor said, adding that Obama called for Republicans to compromise on either their insistence that a debt-ceiling hike must be matched dollar-for-dollar by spending cuts or on their opposition to any kind of tax increase.
“And he said to me, ‘Eric, don’t call my bluff.’ He said ‘I’m going to the American people with this,'” Cantor quoted Obama as saying.
“I was somewhat taken aback,” Cantor said. When he continued to press the issue, Cantor said, Obama “shoved back from the table, said ‘I’ll see you tomorrow’ and walked out.”

Opinion: Why let IPAB control health care? – Sen. John Cornyn – POLITICO.com

Senator John Cornyn, my Senator from Texas, has introduced a Bill to repeal the power of the (Medicare) Independent Advisory Board. As the Senator says, the Board of 15 appointed, non-elected bureaucrats will determine what services are offered to Medicare-eligible patients. Those recommendations will be based on economics, not on actual patients or on their needs. (Did you know that the US Preventive Services says that the evidence for  Prostate Specific Antigen tests and prostate exams and annual mammograms or teaching breast self-exams is “insufficient?”)

From the Senator:

We should learn from Britain’s mistakes rather than repeat them — and we should also listen to voices of Texans in our state. The IPAB has created “immediate uncertainty at hand,” says Scott & White Healthcare in central Texas, for their 12 hospitals and more than 800 physicians. Many more organizations and associations have expressed similar concerns and urged me to do what I can to repeal this ill-conceived bureaucratic board.

That’s why I have introduced the Health Care Bureaucrats Elimination Act, and why I’m testifying Wednesday on the other side of the Capitol to build support in the House. This legislation seeks to repeal the IPAB completely and defuse this bureaucratic bomb before it explodes.

Opposition to the IPAB is already a bipartisan affair in the House. Rep. Frank Pallone (D-N.J.), for one, is in favor of abolishing this panel. As Pallone put it, “I’m opposed to independent commissions or outside groups playing a role other than on a recommendatory basis.”

Repealing this unelected board of bureaucrats does not mean giving up on efforts to reduce costs in Medicare. A better model is Medicare Prescription Drug Coverage, which has come in under budget by more than 40 percent. It has achieved this by introducing competition and choice into the system.

Several other initiatives at the state level and in the private sector have also cut costs without sacrificing quality or access to care. Congress should take a look at them as well.

Our seniors have paid their hard-earned money into Medicare for years. They deserve far better than to see their health care placed at the mercy of 15 unelected bureaucrats.

via Opinion: Why let IPAB control health care? – Sen. John Cornyn – POLITICO.com.

Need more info on Obamacare?

Ben Hoffman has written a comment in response to my post of earlier today, “53% want repeal of health care law,”  to let me know that he doesn’t believe that the Rassmussen Poll is accurate (or maybe it’s that I’m wrong.):

If people knew the truth about the reform, more would think it was good for our country. But right-wing propaganda has taken hold over facts. The main issue people cite when asked why they’re against it is the mandate, which won’t affect people who already have insurance and for those who don’t, well… they’re just sponging off the rest of us when they get sick or hurt and they have to go to the emergency room, so who cares what they think.

I disagree with Mr. Hoffman on whether or not people know “the truth” and whether or not they will like the healthcare bill as they learn more about it and about whether or not the mandate is the greatest objection or will affect other insurances. The mandate is bad enough  – as is commonly repeated these days, if the government can force you to buy health care, it can force you to buy anything.

First, the poll itself is evidence that people are changing their minds as they learn. As I do, and as I’m sure you do, the people I’ve talked to are researching, following the news and the bits of the law and the regulations that are already coming to be known.

One bit of the law that has already affected many of us is the restriction on Health Savings Accounts. The before-tax contributions were limited, cutting the amount that people can save to pay for their own health care. We can no longer use our HSA to pay for over the counter meds and devices without risking a huge penalty. Doctors are being asked to write scripts for aspirin and other over the counter meds that are medically necessary, but no longer paid under the HSA regs.

Many of us are bothered by the waivers that are going out to some companies.

And, we laughed when we all found out that the Bill had no “separate and severability” clause and would have outlawed all Congressional staffers’ insurance if the Office of Personnel had not engaged in a slight-of-hand trick.

Personally, I found the rules change abuse by Senator Reid to be offensive. He has bound all further Congresses to his debate rules: no debate at all without a 2/3 majority vote and then very limited time for each side to present their case. He also forced any changes to go through the Senate Finance Committee.

However, the biggest danger has not kicked in, yet. The Independent Medicare Advisory Board will soon be mandating cuts in Medicare services by determining what is and is not medically and financially effective. Those cuts may only be overturned by the 2/3 vote, then Senate Finance Committee route, and then only if other cuts can be substituted to meet the same dollar amounts.

The IMAB will make us forget that we ever laughed at “death panels.” This is where the government will control what your doctor does in that little exam room. What Medicare does, everyone does or they risk “exclusion” from Medicare and all those who participate with Medicare.

And finally: “rightwing propaganda?” Please give people the same credit for thinking that you do, Mr. Hoffman.

53% want repeal of healthcare law

Rassmussen’s latest poll is out concerning the Health care law sometimes known as “Obamacare.”

The numbers of those who want the law repealed have not changed much in the last year. While about a third think the law will be good for the country, but 48% believe it will be bad.

People are changing their minds about what they think the healthcare law will do. “Since June of last year, belief that the health care law is likely to force a change in health insurance has ranged from 34% to 51%.”

Federal Court Scheduled to Hear Challenge to Texas Sonogram Law

Can you imagine what would happen if Cardiologists hid the screen while a heart sonogram was being performed?

Federal Court Scheduled to Hear Challenge to Texas Sonogram Law. From Joe Pojman, Executive Director of Texas Alliance for Life:

The Office of Attorney General Greg Abbott is defending the law and filed a response yesterday demonstrating that the law is constitutional. The first hearing will be today. Texas Alliance for Life’s staff will be present.

Texas also has laws mandating informed consent for hysterectomies, radiation therapy and electric-shock therapy – all passed because of the public perception that doctors were patronistically making decisions for their patients, “for their own good.”

The sonogram has become standard of care, much as the sonogram of the heart or a catheterization before bypass surgery. Patients are already being required to pay for the sonogram in addition to or as part of the abortion fee. And yet, patients were not being allowed – in some cases, refused – to see their own medical information and the results of the test they had paid for.

For some reason, the Houston Chronicle, in its July 2 note on the lawsuit, only says that, “The center for Reproductive Right’s class action lawsuits were filed on of a San Antonio abortion provider. ” Planned Parenthood is not identified in today’s HC article, either.

The tma-member-physicians Daily

The TMA daily online newsletter, The tma-member-physicians Daily posted my blurb on the harshness of Republicans toward their own. #Texmed.

Meatheads: MD Anderson grilling scare won’t cure cancer or cover up failure | JunkScience.com

When will our experts  learn to be responsible and careful? Junk Science exposes a silly press release from what should be a careful, reliable source.

Meatheads: MD Anderson grilling scare won’t cure cancer or cover up failure | JunkScience.com.