Thinking around pharmaceutical-oriented medicine
posted 6-19-2014 9:50 p.m.

 
(Note: this post is addressed mainly to health care professionals and to the wonderful nurses on 7West at Advocate Christ Medical Center, but it’s also of interest to patients and consumers. It’s longer, too, because a typical blog post a few paragraphs long wouldn’t adequately describe either the problem or the solution. So bear with me, and all will be revealed. Thanks.)


You never know how good your hospital really is until you need it. Mine’s very good, based on objective criteria. But even an excellent hospital that does all the right things 99.9 percent of the time can still have blinders on about certain ways in which it practices medicine. It’s a question of medical mindset.

It turns out continuing education is failing our health care professionals – and, thereby, patients – when it comes to knowing about nutraceuticals and how the foods and beverages we consume can help or hurt our medical care. Instead, physicians and nurses rely too much on marketing material from Big Pharma. That’s a mistake.

Gay marriage: just do it, and move on
posted 3-26-2013 5:40 p.m.

 
I said my bit on this subject seven years ago, on this very blog, figuring I'd said all I had to say: just allow gays legal unions with all rights attendant for marriage, promote social stability that way, then move on to bigger issues — like fixing the economy and getting our troops out of the Middle East. I'd be perfectly fine with letting homosexuals and lesbians marry; it doesn't affect me in the least, and I don't see a good reason to deny them that right. Now that the first of the gay marriage cases have reached the U.S. Supreme Court, perhaps it's time to revisit the subject. Besides, I'm deeply tired of all the hyperbolic conservative blathering on the subject. Time for a definitive smackdown.

If public opinion polls are to be believed, the balance has shifted ever so slightly towards sanity: more Americans would approve of gay marriage than disapprove, and most would like the subject settled. I'm all for that. The shrill minority keeps insisting that recognizing marriages between consenting adults of the same gender is somehow grossly, intrinsically destructive to all marriages everywhere; that's just stupid. They rant as if their own marriages were somehow damaged by the marriages of others. That's silly. And this conversation has been coming for a long time.

A medical district for Roseland??   Not so fast
posted 12-16-2011 1:45 p.m.

 
Let's get one thing straight at the start: I want Roseland to recover from its economic black hole and be able to offer good jobs to its residents. I'd love for it not to be the armpit of poverty that it's been for a few decades on the South Side of Chicago. It would be good for the people and good for the city. That said, I have to wonder what toxic waste filtered down into the drinking water there to make the local activists think that starting a medical district down there was the answer.

Gov. Quinn gave the community false hope, if you ask me, by making the designation official. But nobody's come up with the resources and commitments to make it real, and the likelihood that they will is poor. We'll see a functioning airport in Peotone before that happens.

The uninformed public, led by the misinformed 'experts'
posted 7-29-2010 2:51 p.m. Central

 
Sometimes, disinformation is spread by perfectly well-meaning people who are less informed than they think they are. And they don’t even realize they’re doing it. Trouble is, if their credentials look good at first glance, the rest of us may not realize it, either. This is one of the frustrations of covering health care reform.

Case in point: a New York cardiologist volunteers to provide aid for several months in Haiti after the earthquake. He’s part of a team helping to reinstate cardiac care at a city hospital in Port-au-Prince. A noble deed, well and good. While he’s there, he notices that the “sudden availability in Haiti of free high-quality care from foreign doctors put enormous competitive pressure on the private local doctors, who had already been working under difficult conditions.” This influx of foreign aid causes local clinics to lose business. The cardiologist wonders “if the same would happen to private medical services back in the United States were our government to suddenly provide high-quality, low-cost health care.” So he writes an op-ed piece for the New York Times with suggestions for our health care reform efforts, based on his experience in Haiti.

I begin to see where this guy's argument is going and shake my head, but I keep reading, giving him the benefit of the doubt for the moment. Yet already the misunderstandings are piling up.

Also missing: better ways to pay doctors and hospitals
posted 6-23-2009 7:50 p.m.; updated 7-13-2009 4:41 p.m.

 
In my last post, I began a list of what’s missing so far from health care reform efforts:

• enough primary care doctors, primary care nurse practitioners and hospital nurses
• more practitioners and resources in the right places
• better funding mechanisms for practitioner and hospital malpractice insurance
• a national medical malpractice arbitration system to settle most claims, similar to no-fault workers' compensation
• functional, properly financed metro and regional trauma networks
• better physician practice organization
• needed data collection and analysis on a large scale
• a federal privacy czar at cabinet level to monitor and police the privacy and security of consumers' medical, financial and other data and punish offending database owners and other violators

The last entry addressed the first four points. Since then, I’ve come up with two more missing pieces:

• better ways of paying health care practitioners
• better ways of paying hospitals

You’ll notice I didn’t include nursing homes or intermediate care facilities; that’s an entirely separate discussion and a mammoth Gordian knot of its own. Let’s leave that for another time.

By ‘better ways’ I mean mechanisms for paying health care providers that provide reasonable compensation for them without bankrupting the rest of us. But there’s more to it than that.

Fixing health care reform: too many missing pieces now, but we can build on parts that work
posted 5-12-2009 2:17 p.m.

 
There are those who liken tinkering around the edges of health care reform (which is all Congress and the president have attempted, so far) to fixing a leaky faucet or unclogging a drain in New Orleans while Hurricane Katrina approaches: there’s a much bigger picture that needs to be addressed. I agree with that last part, but to me the health care system is more of a Rube-Goldberg machine or a potential This Old House project: it began long ago with a very small core and was slowly cobbled together over time to do more and more but performs in a costly, roundabout, less than effective way — yet our attempts to improve it have only resulted in more things cobbled on, without rethinking the entire design.

With the rising clamor for a public health insurance plan as an alternative mechanism for covering everyone, it’s time to think about whether or not we have the pieces of the delivery system in place to make a public health plan effective. I don’t think we do. However, we do have pieces that are useful now and would be good to incorporate into any reformed delivery system. We have to retain those parts while we figure out what our care system needs to look like, which will determine what our reform plan must look like.

Sebelius, DeParle will have their work cut out for them
posted 3-2-2008 7:46 p.m.

&nbspbr>The Obama Administration today announced the nominations of its top two health care officials. In appointing two different people for those positions, the administration wisely reversed itself. Each of the nominees will have more than enough to do, once they are approved.

Earlier today, Kansas Gov. Kathleen Sebelius(D) accepted the nomination for Secretary of Health and Human Services, replacing former senator Thomas A. Daschle, who withdrew from consideration last month after his tax problems and position as a lobbyist complicated matters for the Obama Administration. Also, Nancy-Ann DeParle was named director of the White House Office for Health Reform. DeParle headed the Health Care Financing Administration, which oversaw Medicare and Medicaid, during the Clinton Administration. She was also a Clinton era health care adviser at HHS and at the White House Office of Management and Budget.

Health insurance is a big deal, Mr. Obama, so take a little time to get it right
posted 2-24-2008 8:22 a.m.

 
The problem with most backroom deals in politics is that they’re completed in everything short of a vote before the public even knows about them. Average Americans like you and me have no opportunity to influence the result, yet often we’re the ones most affected – sometimes most adversely affected – by the result. Such a backroom deal on health insurance reform is afoot right now, led by none other than Ted Kennedy. And President Obama appears to have signed off on it. I'm betting it's what he presents tonight in his address to the nation.

Senator Kennedy has long wanted health care reform and championed that cause, even for a time favoring a single payor plan not unlike Medicare. That he should be talking to stakeholders is not the concern. He wants to accomplish something lasting on health care before he dies. But national health insurance, or even something close to it, is a far cry from what’s on the table now – and what is under discussion is more a full-employment plan for the insurance industry with you and me footing the bill than what most Americans want.

Health reform debates during the Obama Administration’s first week
posted 1-28-2009 3:50 p.m.

 
In a week in which 10,000 jobs were lost in a single day, with more losses to come in the months ahead, the weak health care spending measures meant to cover more children and unemployed are already virtually moot. Unless Congress snaps to and suddenly realizes its gross underfunding, the monies intended to expand coverage won’t even give the states enough to maintain status quo. And the states aren’t waiting: they’re already cutting back.

There is a solution, but the Democrats would have to be uncommonly brave to take it on. And they’d have to push aside all but a mere handful of moderate conservative Republicans to get it done. The economic disaster is of great enough proportions to justify it; but that doesn’t mean the majority in the House and Senate will work up the nerve and twist enough moderate arms to get it done. And they're in too big of a hurry, as is the President.

A workforce for today and tomorrow
posted 1-15-2009 3:03 a.m.

 
President Obama is saying all the right things about rebuilding not just the physical infrastructure of the nation, but also the workforce infrastructure, in that he thinks there's plenty of opportunity to create new jobs by encouraging the proliferation of newer, greener industries. He's right, as far as that goes — but who's going to be the innovators of those industries if not scientists and engineers, those folks we need but don't have enough of? Not only do we not respect those people we call geeks, we don't graduate enough of them for this future workforce.

Mr. Obama's got to do a lot of fast talking and faster planning to solve this situation before he can convince Congress — because Congress is way behind on this issue. And the Republicans don't even want to discuss it, because of what the funding consequences have to be in order to bring about the goal of more scientists and engineers. Better science and math education in grade and high schools is barely a start: it's college programs that really make the difference and will produce results sooner.

On the democratization (or not) of the mass media
posted 3-18-2008 5:25 pm

 
An item posted yesterday on CNet News at News.com was brought to my attention by a friend:

Were we wrong about tech and the democratization of media?
By Charles Cooper

Cooper's blog commentary refers to a huge 2008 report by the Project for Excellence in Journalism titled "The State of the News Media 2008: An Annual Report on American Journalism," which is so big — more than 180,000 words long — that it can be found on its own separate Web site rather than on the PEJ site.

Barack, Hillary, supermajorities, and keeping up with the primaries
posted 2-21-2008
amended 2-28-2008

 
My, but things move quickly in primary politics these days; blame it on SuperTuesday. Unless Hillary pulls off a miracle in Texas and Ohio (I'm not betting on that), she likely won't be a significant factor anymore, even with that many delegates. Not even the most faithful of superdelegates wants to be associated with a perceived loser. So it may be moot for her by next week. We'll see.

There are those who say that Sen. Barack Obama is at least not promising much of anything, compared to other candidates, and therefore he’s somehow more realistic. It may also mean he has a dearth of ideas other than some vague notion of change. But these same partisans point out that he’s had less experience and less clout than Sen. Hillary Clinton and imply that he must be somehow more clever than she for him to be so much more ‘realistic’ in not making promises. Nonsense.

Getting the health care discussion wrong
posted 2-8-2008 10:14 a.m.

 
Have you noticed that ever since the media — mainstream and new media alike — began marginalizing Dennis Kucinich during the presidential primary campaign, the conversation about health care reform began drifting away from any real reform?

What was a public dialog about national health insurance and universal coverage suddenly began to slide into one about whose plan would cover more people. That was a real change in conversation, and it amounts to an unchallenged bait and switch.

Now, nobody seems to have noticed that the discussion is no longer about universal coverage — because, of course, universal literally means everyone would be covered. And neither Sen. Clinton’s proposal, nor the less ambitious (read: superficial) plans proffered by Sen. Obama and Sen. McCain, let alone Gov. Huckabee, was ever intended to cover everyone. And though much has been made of Tom Daschle's book on health reform, there really isn't anything in there that will truly cover everyone, either. If voters think that any of these proposals would cover everyone, or almost everyone, they’re sadly mistaken. Remarkably, the press hasn’t pointed this out yet, probably because it didn't notice, either.

Things I noticed over a long weekend …
posted 2-4-2008 8:14 p.m.
amended 2-7-2008 5:55 p.m.

 
… while down with a cold and ignoring the Super Bowl:

• George W. Bush is still stubbornly hallucinating about what’s going on in the world.

The country is finally restless with the current regime (at last! How long did they have to wait?), that's clear enough. How many ways can you take a 71 percent disapproval rating other than to admit that 71 percent of the populace hates you? Thus the sullen monotone delivery of the State of the Union address. And yet, beneath that depressed and depressing delivery was still the old, blindly stubborn pugnaciousness that is the flip side of the thin, shallow nice-guy routine that got W. Bush close enough to a win the second time around to steal it (the first time, he had to rely on The Supremes to steal it for him and on Gore's sense of honor not to pursue the matter further; what a waste *that* was).

Read the text of last Monday's State of the Union address, or even listen carefully to the words, and you hear that determined, knee-jerk rewriting of history in light of his own fantasy that is Shrub's trademark. He thinks if he tells a lie often enough, most people will believe it. More to the point, if he lies to himself often enough that he believes it, he expects us to believe it, too. Some will, sure — but the evidence of his incompetence is simply too great, the economy too badgered and the needless deaths too many to allow that now.

Getting rid of Barbie for President
posted 12-19-2007 8:14 p.m.

 
In today’s Washington Post, political columnist Dana Milbank writes:

... even these private reflections of the candidate frequently centered on public policy: "Senator Clinton was one of the first people to realize that the air was toxic. . . . She wants a good education for everybody. . . . She helped set up the system to provide services to indigent clients." Even the candidate's mother, Dorothy Rodham, noted how "she's been very active with social justice causes."

Maybe, then, The Hillary They Know isn't so different from the Hillary everybody else knows: She's a public-policy savant whose idea of a good time is reading white papers into the wee hours. ...

On confusing the marketing with the message: Pushing for better campaign coverage
revised and reposted 10-29-2007 2:42 p.m.
original post 10-21-2007 1:15 p.m.

 
Maureen Dowd's columns usually make me raise an eyebrow or two, smile, or even laugh out loud. They often provoke me to think harder about a given topic, which is good. This, despite the fact that I don't always agree with her. My eyebrows went up for a different reason, however, when I read this morning's New York Times column (Sunday, October 21, 2007) entitled Cougars, Archers, Snipers.

I'm glad to know — but not really surprised — that Hillary Clinton's campaign is supposedly making use of a pollster who has broken down the electorate into categories and written a book about those categories. Pollsters, marketers and sociologists have been doing that for years. The public doesn't automatically reject those labels, either, nor does the press (remember when you first heard or read the term 'yuppies'? It sounded strange — but we all know how to recognize one now, don't we? One only hopes that the obnoxious term 'cougars' doesn't stick).

Human beings have been categorizing other human beings for nearly as long as there have been human beings, if only into the simple categories of Us and Them — Them, of course, usually being people who are different from Us in some way and, therefore, to be feared, shunned, and possibly warred against on occasion. That rulers or politicians would make use of such information to stay in office (or to keep the masses from rioting for whatever reason) is unsurprising; they've been making promises to unhappy masses for as long as there have been leaders hoping to survive their terms of office. No doubt somebody promised someone something appealing like food or an animal skin or a better hunt just to keep his head when our ancestors lived in caves. Thus was born the predecessor of the campaign promise. It was a kind of survival tool.

Still, if Hillary's — or anyone else's — pollster is creating new categories for analyzing potential voters, it's useful for those voters to know about it. Fair enough. And Dowd has never really liked Hillary, and she's entitled to that opinion. That's fair, too.

But what strikes me this morning is the somewhat toxic assumption on Dowd's part that if any of the policies Hillary proposes resonates with any one of these subcategories of people, this is automatically bad, Machiavellian, not to be trusted. Haven't we had enough of presidents who really aren't responsive to what the majority of Americans — or subsets thereof who aren't among the top economic stratum or power elite — actually want from their government? Like the dork currently in office, who talks a not particularly persuasive line of guff but got let off easy by nearly everyone until invading Iraq turned out to be the disaster that those of us in the vocal minority — like Russ Feingold — warned it would be?

To point this out (or to point out that Sen. Clinton may not be perfect but would be a much better alternative than the guy currently in the White House) doesn't automatically render me a Clinton supporter or apologist — just someone who recognizes a fact when she sees one. And the fact is that Dowd treats Sen. Clinton with nearly as much contempt (yet with less sharp analysis) as she does Dubya Bush.

Is it possible that Hillary is polling first and creating policies to appeal to microsegments of society second? Sure. But we and Ms. Dowd should look at the facts first before jumping to that conclusion. Some of the issues that Hillary talks about now and proposes policies for are issues she's been interested in for 30 years or more: child welfare, families and family law, health care. That's documented. So it's also possible, and entirely more likely, that she's using poll results to figure out just how welcome some of these proposals she's been pondering for years will be with certain segments of the populace.

It's not clear to me that there's anything wrong with that as long as the policies and ideas came first — and it looks like in her case, they did on at least the aforementioned subjects. That her ideas might have evolved over that long a time is actually to be hoped for: it might indicate that she refined her views periodically in response to new information, learned more about what works out in the field as opposed to what looks good on paper to politicians and bureaucrats, and/or learned more about what it takes to get legislation passed and sensible regulations written that accurately reflect that legislation.

Did she and her husband bungle their health reform proposal during his first administration? You bet, but not for the reasons Dowd thinks — most certainly NOT because they were supposedly pandering to the health care industry, as Dowd accuses. I'm in a position to know: I was covering health care and health policy from a national perspective for the business press long before the Clintons ever made it to the White House and in much greater depth than nearly anyone at the Times, including Dowd, has before or since (the two possible exceptions were Milt Freudenheim and Robert Pear, and even then I'd been on my beat longer than Pear had been covering anything health policy related).

Any time Dowd has two or three uninterrupted hours to spare, I'll be happy to clue her in as to what the real deal was. In fact, I'd be happy to tell Hillary everything she doesn't know about health care reform — and there's still plenty — if she had presence of mind enough to ask me.

I could also tell Dowd why virtually all of the White House press corps did such an abominable, embarrassing job of covering health care reform last time. For one thing, they covered the horse race much more than the content, rarely discussing what should have been proposed instead or accurately analyzing the feasibility of what had been proposed — which they clearly didn't have the background to do anyway. But then, the White House press corps are dilettantes, most expert at covering the White House and its shenanigans and not at all expert in the actual subject matter of health care, health policy, or health care finance (all of which I'd by then already covered in detail during previous administrations). Reporters and columnists covering Congress aren't much better at it.

To have them covering health care reform was an error made by their editors and compounded by the reporters' and columnists' unfamiliarity with the subject matter and subsequent lousy performance. One can only wonder what on earth those editors were thinking in not reaching instead for reporters who were subject specialists. But I digress: my point is that I don't expect the Washington press corps to do any better this time around, given what I've seen so far. Dowd's work included.

One wishes Dowd had paid more attention to Judith Warner's blog item last week on the dearth of coverage on a policy speech of Hillary's. Surely, it would have provided Dowd with better meat for her knives and us with more helpful information:

An analysis of Clinton's policy proposals would give voters insight into what her administration might choose to accomplish, certainly more so than comments about her pollsters' market categories; yet practically nobody covered the speech or the material in it, or even remarked on it. If not for Warner's blog entry, I wouldn't have known a) about the speech even being given, and b) that nobody covered it, thus depriving me of important information. I'm thankful Warner wrote the item. But damn, Maureen, can't you and your other colleagues do a little bit more than dis Hillary's head counters? If you're going to slice and dice the senator, you could at least produce something that's a little more useful to the readers.

By taking on the Hillary marketers rather than detailing and dishing on Hillary's proposed policies during the week she made a major policy speech, Dowd took the easy, lazy way out. Try harder, babe: if nobody else is giving us that policy stuff, then you should be. If you don't want to be just another one of the press corps sheep, you ought to be looking long and digging deep for what everyone else is missing. It's work, yeah, but you might actually enjoy it.

Oh, and since Ms. Dowd has often complained about the lack of enough women on the op-ed pages, she ought to appreciate getting this response from an analytical reporter who just happens to be female.

/p>

Public ventures: Getting around ComEd’s rate dilemma
revised and reposted 10-29-2007 2:03 a.m.
original post Monday, August 6, 2007, 8:45 p.m.

Part two of a two-part essay
Previously: a short history of utility monopoly

We have a seeming dilemma on electric rates in Illinois. The key word is ‘seeming,’ of course.

ComEd demands higher electric rates because the parent company it created to absorb its generating plants, Exelon Corp., is raising the price of electricity to it so it can make more money. ComEd claims this is absolutely necessary or it will go bankrupt. As if Exelon would really ever let its subsidiary go out of business (if it did, it wouldn’t have a public to which to sell the power it generates … unless it wanted to sell that power at premium rates to the rest of the country instead, right? Leaving Illinois energy users up a creek. Hmmmm. There’s a thought).

Getting conned by ComEd, or What’s a utility monopoly for?
revised and reposted 10-29-2007 12:27 a.m.
original post Friday, 8-3-2007, 3:50 p.m.

 Part one of a two-part essay

What happens at an auction?

Whether the material on offer is famous artwork, the remains of an estate, multiple lots of fine wines, or a farm that went belly up, the point of an auction is to obtain competing bids in order to get the highest possible price for the seller. The shared expectation is that only one party other than the seller can get the goods, or win, and anyone who can’t offer more money than the top bidder loses. Whatever is in high demand is never a bargain at auction. Auctions are about maximizing income for the seller by getting someone who wants or needs the goods badly enough to be willing to pay a higher price than anyone else. No one is surprised when that happens.

So why did anyone believe energy companies and politicians when they told us that deregulating public utilities and allowing energy auctions would lower electric rates?

For those who think energy auctions are a good idea, I have two words: Enron. California. When energy costs in California skyrocketed a few years ago at a time demand increased and rolling blackouts became the norm, electric users paid insanely high rates while energy companies and their shareholders saw hefty profits. Firms like Enron made energy auctions possible and encouraged the excessive profits that buying energy ‘on the market’ instead of producing all a utility needs internally helped to create. Enron helped energy companies make obscene amounts of money even as they created an artificial shortage that allowed them to charge such high prices for energy bought at ‘market’ rates. And this subverted the purpose of giving public utilities a local monopoly.

Over 40, smarting, and getting wiser
amended and reposted 10-28-2007 11:21 p.m.
original posted 6-21-2007, 3:44 am

 
[Note: Since this essay was written, The Starter Wife garnered an Emmy and 10 nominations in all; the award and the response to the program was encouraging enough to USA Network that it decided to turn the mini-series into a regular series for next season. Just when I was ready to start watching again … ]

Hollywood seems to be throwing women over 40 a bone at the moment. But only that much, if indeed that much. The more I consider it, the more it seems to me that popular culture is really patronizing and insulting us, possibly mocking us, too, while playing to our worst fears. None of which is particularly helpful. Or funny.

The first clue I got was the premiere of a new summer mini-series on cable called The Starter Wife. Now there’s a term that makes any woman decidedly uncomfortable: a label for a woman who’s been had by the jerk she was married to when he decided to trade up for a younger, prettier model, as if he were changing cars to reflect career advancement or a more affluent lifestyle. Ouch. It smarts every time you hear the term. We all want to avoid being that woman, and we all privately have at least a tiny doubt that we really could, if push came to shove: how do you ever know for sure, when you’re hopeful and taking those blessed vows, that the guy you’re marrying won’t one day turn into exactly that kind of jerk?

On Starbuck remaining human — and alive, or
Have You Scriptwriters Completely Lost Your Minds??
postscript appended and reposted 5-6-2007 5:41 p.m.
original post 5-5-2007 11:56 p.m.

I heard a rumor the other day — afterwards seemingly 'confirmed' by reading online posts — that on of my favorite fcitional characters on SyFy's reboot of Battlestar Galactica, Starbuck, is the fifth and final previously unknown Cylon model. The fact that she appears to Apollo at the end of the season finale (or was he hallucinating, like Baltar the mad scientist?) is supposed to make the matter clear. I understand that even Ron Moore has confirmed this (forgive me for bringing it up at this late date, but I only recently saw a tape of the finale, not having functioning cable myself).

Another bombshell in a show loaded with them, you say. Nope: just a bomb, as in dud. In fact, for the first time since the series began, Moore has made a really dumb error (if, indeed, the rumor is true). How unexpected and disappointing that in searching for a final twist for the episode, he should go for a solution so trite, superfluous, and, if you think about it, predictable. He’d practically telegraphed it. Bo-ring …

How much more interesting, though, if poor Starbuck were to return and still remain human, only to be disbelieved. Feared. Spurned.