While I try to figure out how to upload some medical slide shows to this blog I'll lend my opinion on how our heritage has gotten us into our health care mess. It seems time to acknowledge our libertarian good side but give into some communal living. I'm going to get into some history that may be skewed, so please cut me some slack. It is my blog you know. Dammit, I'm a doctor, not a historian.
Please don't read this if you don't like history or if you're tired of the health care debate, and who wouldn't be, so I guess I'll just write for myself.
The population of Europe was thinned by the bubonic plague in the 15th century. After that everyone got along and most had a job and the Church led peaceful, wonderful harmony within Europe (I made this up...). Then people started to read and trouble makers sent people's minds all akimbo. Luther, Knox and Calvin took the right flank and Hobbes, Locke, Kant, and all those other precommunists took the left flank. Governments churned and turned over. There developed a group of individually-minded people interested in liberty and the pursuit of happiness, no matter who suffered around them. They were particularly interested in themselves, perhaps more than their larger community, or the King, or the Church (this is understandable since the leaders here were pretty corrupt... maybe you're not supposed to have wives and vast quantities of gold when your a Pope, and the King should not drink so much or have more than three wives at the same time, and he should leave Celtic people alone (my rules)). The individualists answered to the Lord, their money belts, or to some voice in their head that no one else heard and they didn't feel like fighting in huge armies for no wages, moldy bread, and the privilege of sleeping in the same bed with six other men who smelled like wet horses.
Anyway a group of Puritans couldn't get comfortable in their own skin in England or the Netherlands so they moved to North America to bother the Indians, who themselves couldn't get along with their neighbors, but they lived in the woods and were, as the saying goes, "born in a barn". Others moved to America since business was good here for those that didn't go to Oxford, Cambridge, the Sorbonne, or the Prussian School for Fanatical Military Strength. It was hard to move up unless you were born to some Royal family where your parents were also your brother and sister,or vice versa, or you-know-what-I-mean (?), or unless you were a genius like Napoleon or the guy that created the slinky, later of course. I'm not saying that Napoleon played with a slinky, but I think he would have been good at that, and the hula-hoop ( and all Wham-O products for that matter) just like he was good at controlling most of Eurasia and the Middle East. Nerf basketball would have been hard for this short man though. OK, I was digressing...all those of Europe that didn't want to be bothered by the psycho, in-bred, warlike Europeans thought they could avoid taxes and hassle in the New World. Where it seemed like no one lived, emphasis on "seemed".
So people came in droves to North America, but they soon discovered that where there are other people there could be trouble. So they brought diseases like tuberculosis and small pox with them to act as infectious napalm. To clear the woods as it were. This wasn't their fault though since it was also clearing their own woods, and the European woods, as about 1 in 2 people that died in Europe died of some horrible disease. The others died sleeping with wet horses in fields festooned with uniforms taken from dead sheep. A more pleasant sight could be had by touring a coal mine in the English Midlands circa. the 18th century.
So the religious, the entrepreneurial and a 2:1 mix of sane and insane moved to America. They were looking for a better life understandably. Here the sane and the insane grew in similar numbers leaving the sane in much greater proportion than the insane. But the sane seemed to like their new digs where the insane still felt cramped. And while the population multiplied government grew, as Thomas Hobbes would argue to be a natural phenomenon, and taxes followed them from England. Americans didn't like taxation without representation, as a reasonable person would not, but I think there were some that just didn't like taxes at all, no matter who was imposing them. This was discovered when the new nation was developed. General Washington couldn't pay for the army and the Constitutional Congress couldn't meet without money. But they had trouble raising taxes to pay for these necessities. Revolts ensued and the Constitution become a tough sell. The Bill of Rights was soon developed because, despite the formation of the Constitution, this revolutionary document which codified new freedoms in the world's first representative democracy, there were still those that worried about an individuals freedom from the tyranny of the majority. Slaves were eventually given up but guns, states rights(i.e. local, not federal authority) and individualism became staples of our heritage.
This seems to be a consequence of population pressures, amongst other things. As population increases there seems to be more demand for protections from others and taxes to pay for these protections. The West is still less populated than the East in America, as the New America was less densely populated compared to Europe in the 17th and 18th centuries. Now there is a trend of communality in the Northeast and a persistent desire for individuality in the West (Democrat and liberal Republican v. Republican and conservative Democrat), perhaps because of population density, or a historical lack of it in the West. A common human trait may be for liberty but when one finds a nice place to live and others find it too, which is inevitable, perhaps it becomes more practical to make community compromises. Reasonable sharing is in every bodies interest when population density increases but the hard part comes in deciding how much to share and what's reasonable. Sharing becomes advantageous when everyone benefits. The West is in the grey zone with population, many are diffusing here, as has been happening since the 19th century and population pressure is making people crazy. There are many here that feel entitled to serenity when in fact they will not find serenity until they can deal with population pressure, other people will not go away, and the phrase, "My ancestors did not move here to have to deal with immigrants" won't wash. I "emigrated" to Washington State almost fifteen years ago. There is no where else for the Frontiers people to go except into the Pacific Ocean (call-back to the wet horses reference). A more conservative libertine of our country seems to emanate from the West. I admit that I enjoy living in the West and agree with some of a libertarian philosophy but I don't agree with the self-sustaining individual over health care.
In health care we are crawling all over each other with nontransparent fee structures, unequal distribution that costs everybody directly or indirectly, expenditures that are out of control without added benefit, and that's poor value, again for everybody, and a medico-legal system that seems wacky, and stacked against reasonable practice. The economy of medicine is a wreck that no one understands, and I believe no one! Not the eggheads in think tanks, the President, Glenn Beck or Hannity or your Grandfather who knows everything else. We need some system that will help everyone because this will help us all! We have reached a critical mass of population in this country. We can't be the libertarians that we pride ourselves to be on this issue, or many others, because it is limiting the enjoyment of our other libertarian institutions: enjoying life's tranquility, having our own businesses, and living the pleasant life without worry of health bills or taxes and premiums for taking care of people who have never had insurance, or those kicked off insurance for being too sick. It is making it hard to find serenity. The burden of being witness to many suffering (mentally, emotionally, physically) has become nearly unbearable, at least for me, and for many we read about in the press but some of us would like to put our head in the sand to make it go away. It won't. So let's deal with it, as a nation. Republicans and Democrats, and Libertarians. It's deal with it now or deal with it later.
Here's where I get to say, "If I were King... I would have three wives, drink too much and I would kick the Celts off my land." OK, that's a joke, I would not drink too much.
(As an aside, I think there has been little resolution on the issue because America doesn't know what it wants and it doesn't want to be led. What's new. We need a crafty leader. Obama seems to be more of a mediator than an advocate. Maybe we could do some dance with LBJs DNA to resurrect the King of the Legislature.)
But if I were King of health care I would:
Argue that the Constitution anoints the government to "promote the general welfare" of its people as stated in the preamble.
Argue that health coverage may arguably be a right but is more convincingly a part of our heritage in that it would level the playing field of opportunity for those who are sick.
Work to transfer responsibility of health insurance to the individual and remove the burden from employers.
Remove tax credits from employers, if they want to offer insurance as means of attracting employees they would shoulder that burden without tax credit.
Work to make fee schedules transparent and knowable by everyone who purchases health care. I would also work with experts to break into the black box that is hospitals negotiating fees with insurance companies and doctors and medical equipment reps, followed by how they decide what to charge to the consumer. If everyone was insured there may be less accounting wizardry that leaves one baffled.
Create health insurance exchanges but leave the government out of day-to-day coverage.
Require everyone to have catastrophic insurance (the original intent of "insurance") or task the federal government to catastrophic coverage. This would mirror the educational system where our kids are covered by public schools but if a parent wants to spend more for private school they can.
Leave entitlements where they are for the poor and elderly.
Make a consumer health oversight body, the Medical
Reserve, much like the Federal Reserve oversees the banking industry, current political position of the Federal Reserve notwithstanding. It's still a good idea. The intent would be to allow the patient from getting screwed as a consequence of transparency deficiency.
Work with professional medical societies, and the legislatures and courts, to create guidelines of care that are reasonable and more firm nationwide since this would alter a "Standard of Care" aspect of our medico-legal system. If avoiding an MRI for everyone who has a headache is considered reasonable, through the guidelines of the professional societies it should then be reasonable in a court of law, or vice versa. Chest pain in the ED? society needs to give some guidelines to those on the front lines. Yes, the one in a thousand missed heart attack is tragic, but is it malpractice? Or do we want to pay more for defensive testing? at least give the doctors a clue what you want America. This is the people's issue, not lawyers, or even doctors.
All right. I'm tired of this. I'm glad I'm not a politician.
Sunday, March 14, 2010
Thursday, February 25, 2010
Medico-legal education at Penn
First, some comments on music of the East Coast. The Captain and Tenille as well as the BeeGees are big and it drives me crazy. This is one thing that I don't miss about the East Coast. The same lovely music plagues other cities in this quadrant of the U.S. I thought the Kenny Gland of Overlake Hospital was bad but this music is worse...I think I need music desensitization therapy.
Also, I must say, the best news and stories often come from cabbies. Yesterday I took a cab to classes on bioethics at the UPenn Medical School. I got talking with the cabbie about baseball since all of us are ready for Spring. He told me a story of his son growing up. For years he took his family of four to opening day of the Phillies. They usually play the Pittsburgh Pirates and this was a family ritual. But one year recently his fifteen year old son told him that he didn't want to see the Pirates anymore. His son didn't want to go, instead he went skateboarding with his friends. The rest of the family didn't go either, because of the son's unwillingness, and the cabbie was sad because he sensed his son growing up and not wanting to be with him, his wife and his little sister. He told me that he still has those four tickets saved and sometimes looks at them with lament. I hope his son comes back and I think he will. In baseball and religion children may stray but they always come back, in some way, to the game.
Now about medico-legal stuff. This week I have been going to the medical school to sit in on the classes that University of Pennsylvania gives to their fourth year students on medical ethics. Today prosectuting attorneys spoke in the morning and defense attorneys, and the University of Penn Hospital attorney spoke in the afternoon. Here are some salient points:
As physicians and nurses all know, document. But some recommendations include, try not to document opinion if one expects bad outcome. That is, don't speculate, just write the facts, M'am. Speculation is bad for everybody.
Electronic documentation not helpful to doctors if there is no narrative involved. Templates and drop down point-and-click software can be more detrimental for legal issues even though it may fit reimbursement criteria. Always add summary narrative.
Encouraging information for nurses, there have been no lawsuits against nurses (alone) that the chief counsel for UPenn Hospitals, defense and plaintiff attoroneys of Philadelphia knew of. Of the lawsuits that come against doctors, about 10% included nurses and plaintiff attorneys don't like to bring nurses into lawsuits because juries are very sympathetic to nurses, no matter what the circumstances.
It's snowing again in Philadelphia, ugh.
Also, I must say, the best news and stories often come from cabbies. Yesterday I took a cab to classes on bioethics at the UPenn Medical School. I got talking with the cabbie about baseball since all of us are ready for Spring. He told me a story of his son growing up. For years he took his family of four to opening day of the Phillies. They usually play the Pittsburgh Pirates and this was a family ritual. But one year recently his fifteen year old son told him that he didn't want to see the Pirates anymore. His son didn't want to go, instead he went skateboarding with his friends. The rest of the family didn't go either, because of the son's unwillingness, and the cabbie was sad because he sensed his son growing up and not wanting to be with him, his wife and his little sister. He told me that he still has those four tickets saved and sometimes looks at them with lament. I hope his son comes back and I think he will. In baseball and religion children may stray but they always come back, in some way, to the game.
Now about medico-legal stuff. This week I have been going to the medical school to sit in on the classes that University of Pennsylvania gives to their fourth year students on medical ethics. Today prosectuting attorneys spoke in the morning and defense attorneys, and the University of Penn Hospital attorney spoke in the afternoon. Here are some salient points:
As physicians and nurses all know, document. But some recommendations include, try not to document opinion if one expects bad outcome. That is, don't speculate, just write the facts, M'am. Speculation is bad for everybody.
Electronic documentation not helpful to doctors if there is no narrative involved. Templates and drop down point-and-click software can be more detrimental for legal issues even though it may fit reimbursement criteria. Always add summary narrative.
Encouraging information for nurses, there have been no lawsuits against nurses (alone) that the chief counsel for UPenn Hospitals, defense and plaintiff attoroneys of Philadelphia knew of. Of the lawsuits that come against doctors, about 10% included nurses and plaintiff attorneys don't like to bring nurses into lawsuits because juries are very sympathetic to nurses, no matter what the circumstances.
It's snowing again in Philadelphia, ugh.
Sunday, February 21, 2010
New York and Friends
Another travel section. I hope to present my bioethics "thesis" on this sight soon, with a little lead up from my take on the Declaration of Independence (it took me three stabs to spell independence correctly, just so you know what you might be getting in my analysis), the U.S. Constitution (got that right first stab) and liberty. Please don't be afraid. I also want to propose an anthropologic explanation for why we are the way we are in America. But first...
Last week-end my friend John came out for a visit. I've known John since I was fourteen and I was best man at his wedding. We are best of buds and we had a lot to talk about. For those of you who don't know John, he is someone who autographs the Gideon Bible when he travels..."Hope you like my book, Jesus H. Christ"... and that's his level of humor, which I love. But he also has scruples and knows a joke is a joke. He's a great guy. We went to Atlantic City, Gettysburg, and toddled around Philly.
This week-end I went up to New York and saw my friends Fabio and Yuk Ming, two others who have great senses of humor and good souls. I always like getting together with them. Yuk and I went to the museums together and then we got together with Fabio, his wife Lorna and their friend Dominique. Three hours havin' a great time at an Italian restaurant, Trattoria Del Arte, with plaster art of human parts on the walls. Great laughs and catching up. By the way, the art is done very tastefully, like one might find in Roman ruins, not like one might find in a barn in Wisconsin.
Some other stand out moments of my sortie to New York: I managed to put my foot in my mouth with Yuk once or twice like the time that I was dissing Atul Gawande's latest book, "The Checklist Manifesto" only to find that she was friends with his wife, and the time that I used a Chinese dialect to make an attempt at a joke at dinner. I apologised for both and I still hope she was not deeply offended, as she assured me she was not. As my Mom has said(this is her parental obligation), I have to watch my mouth, and she is very correct on this one. Mea culpa.
This reminds me of a talk that I gave in Bellingham about the discovery of antibiotics. I accused Fleming of being a messy person, allowing his bacteria ager plates to sit open, and it was only this that allowed him to discover penicillin after he discovered mold growing on the open plates. It was a comment made without expectation of rebuttal since Fleming lived in Scotland and died long ago but there was a personal acquaintance of Fleming in the audience, Who would have expected that!, and he took umbrage with my remark. I was agog, apologised for my tone, but did comment that I had references. AND, science is sometimes made from mistakes and serendipity.
On the train into New York City I got a glimpse of the sky line from the New Jersey side. I was struck by the lack of the World Trade Center's signature rising above the downtown district, since this was the first time that I had seen the sky line from this vantage since living in Manhatten in the nineties. All that remains is the Empire State Building and the assorted downtown mess and the midtown mess of buildings. I felt sad and reflected on the "still hard to grasp" aspect of the WT Towers' demise.
The smell of New York is always noticeable. It seems a combination of sweet, bitter and exhaust. Winter is a time when vendors have chestnuts roasting, yes, like in the song, and I think this contributes. There was a lot of street construction making traffic a snarl. I wonder if federal stimulus money has something to do with this?
I was going to go to Dia:Beacon, an art installation in an old Morton Salt factory in Beacon, NY on the Hudson, but I got so caught up in taking pictures that I bagged that idea. I got to Rockefeller Plaza, walked along 5th Ave. and Madison Ave. and spent time in Grand Central Station, a building I love to visit. I took the Grand Central shuttle to Times Square, where I took a picture of a very attractive shoe, and made my way to the original Barnes and Noble bookstore on 18th St. and 5th Ave. I spent some time there and finished my day taking pictures of the Flat Iron Building. Went out for Italian after watching the New York news station, the One, and got up to return to Philadelphia a happier man. I love New York and consider it a great place to visit. I'm glad I don't live there though for reasons too cumbersome to enumerate. Three years seemed enough. Sometimes I think that I have graduated from the Life University of New York City. I enjoy the alumni connections but am glad that I have moved on.
Last week-end my friend John came out for a visit. I've known John since I was fourteen and I was best man at his wedding. We are best of buds and we had a lot to talk about. For those of you who don't know John, he is someone who autographs the Gideon Bible when he travels..."Hope you like my book, Jesus H. Christ"... and that's his level of humor, which I love. But he also has scruples and knows a joke is a joke. He's a great guy. We went to Atlantic City, Gettysburg, and toddled around Philly.
This week-end I went up to New York and saw my friends Fabio and Yuk Ming, two others who have great senses of humor and good souls. I always like getting together with them. Yuk and I went to the museums together and then we got together with Fabio, his wife Lorna and their friend Dominique. Three hours havin' a great time at an Italian restaurant, Trattoria Del Arte, with plaster art of human parts on the walls. Great laughs and catching up. By the way, the art is done very tastefully, like one might find in Roman ruins, not like one might find in a barn in Wisconsin.
Some other stand out moments of my sortie to New York: I managed to put my foot in my mouth with Yuk once or twice like the time that I was dissing Atul Gawande's latest book, "The Checklist Manifesto" only to find that she was friends with his wife, and the time that I used a Chinese dialect to make an attempt at a joke at dinner. I apologised for both and I still hope she was not deeply offended, as she assured me she was not. As my Mom has said(this is her parental obligation), I have to watch my mouth, and she is very correct on this one. Mea culpa.
This reminds me of a talk that I gave in Bellingham about the discovery of antibiotics. I accused Fleming of being a messy person, allowing his bacteria ager plates to sit open, and it was only this that allowed him to discover penicillin after he discovered mold growing on the open plates. It was a comment made without expectation of rebuttal since Fleming lived in Scotland and died long ago but there was a personal acquaintance of Fleming in the audience, Who would have expected that!, and he took umbrage with my remark. I was agog, apologised for my tone, but did comment that I had references. AND, science is sometimes made from mistakes and serendipity.
On the train into New York City I got a glimpse of the sky line from the New Jersey side. I was struck by the lack of the World Trade Center's signature rising above the downtown district, since this was the first time that I had seen the sky line from this vantage since living in Manhatten in the nineties. All that remains is the Empire State Building and the assorted downtown mess and the midtown mess of buildings. I felt sad and reflected on the "still hard to grasp" aspect of the WT Towers' demise.
The smell of New York is always noticeable. It seems a combination of sweet, bitter and exhaust. Winter is a time when vendors have chestnuts roasting, yes, like in the song, and I think this contributes. There was a lot of street construction making traffic a snarl. I wonder if federal stimulus money has something to do with this?
I was going to go to Dia:Beacon, an art installation in an old Morton Salt factory in Beacon, NY on the Hudson, but I got so caught up in taking pictures that I bagged that idea. I got to Rockefeller Plaza, walked along 5th Ave. and Madison Ave. and spent time in Grand Central Station, a building I love to visit. I took the Grand Central shuttle to Times Square, where I took a picture of a very attractive shoe, and made my way to the original Barnes and Noble bookstore on 18th St. and 5th Ave. I spent some time there and finished my day taking pictures of the Flat Iron Building. Went out for Italian after watching the New York news station, the One, and got up to return to Philadelphia a happier man. I love New York and consider it a great place to visit. I'm glad I don't live there though for reasons too cumbersome to enumerate. Three years seemed enough. Sometimes I think that I have graduated from the Life University of New York City. I enjoy the alumni connections but am glad that I have moved on.
Wednesday, February 10, 2010
Am I in Philadelphia, or HELL?!
Churchill apparently said, "When your going through hell, just keep going." so without further hyperbole I will say that the 2010 snows of Philadelphia, and the East Coast, have been trying so far. Today we will get another foot of snow on top of 28 inches we got five days ago. The federal government has been closed for 3 days without relief in sight. Here, I got up at my usual 7:30A and watched Morning Joe while brushing, shaving and showering. A ritual I have settled into. I put my parka on, walked out of the apartment, forgot some things as usual, so I went back, but finally got to the train at 15ht St. with my Starbucks, half-caff venti drip, and stopped at the Dunkin' Donuts for the usual two jelly donuts from the team of Indian women behind the counter. Walked past the cadre of street guys and buskers as well as a flock of sleeping pigeons. Got on the subway to the 34th St. stop and went to the third floor of the Science Center at 34th and Market where the Center for Bioethics has its command center. But today it was dark. The University closed, but there wasn't any snow yet. Should've checked my emails before leaving for the day.
Mona, the security officer at the Center's entrance said, "It's never going to stop". I said that I was locked out of my office and couldn't go home, so I was cast onto the street. Maybe I could recover some of the money I had given away over the last few days.
Slogged over to the Biomedical library at Penn realizing that every intersection was an event as it has been for days now. The walks are reasonably clean but at each intersection there are ponds of slush and snow that require acrobatic skill to navigate. I feel that I am in an eternal Dristan commercial...the kind where the poor sod is standing on a corner sniveling and sneezing only to have a car throw a wake of slush on him from the waste down.
I got into some kind of dance with a Penn snow plow. I moved from one unstragegic postion at the intersection to another while he seemed to move to plow exactly where I had moved. He was having fun with me. I was trapped. He plowed slush all over me. What kind of person...City of Brotherly Love?
Got some papers on the philosophy of humor at the library. My only refuge mentally and physically. But they were closing. Went to the Penn Book store, but they were closing. Got back on the train and went to Barnes and Noble to read, but, yes, they were closed. The blowing snow and slush and general miserableness wouldn't be so bad if things could just stay open, but no way. Grocery stores are closed but a shoe store is still open, what the...?
I am back in my 200 sq. ft. palace which is warm and open. The consolation is that people are talking to each other and still have a sense of humor. Nice! Tomorrow, will be different? Maybe.
More than any other time in history human kind faces a crossroads. One path leads to despair and utter hopelessness, the other to total extinction. Let us pray that we have the wisdom to choose correctly. -Woody Allen
Mona, the security officer at the Center's entrance said, "It's never going to stop". I said that I was locked out of my office and couldn't go home, so I was cast onto the street. Maybe I could recover some of the money I had given away over the last few days.
Slogged over to the Biomedical library at Penn realizing that every intersection was an event as it has been for days now. The walks are reasonably clean but at each intersection there are ponds of slush and snow that require acrobatic skill to navigate. I feel that I am in an eternal Dristan commercial...the kind where the poor sod is standing on a corner sniveling and sneezing only to have a car throw a wake of slush on him from the waste down.
I got into some kind of dance with a Penn snow plow. I moved from one unstragegic postion at the intersection to another while he seemed to move to plow exactly where I had moved. He was having fun with me. I was trapped. He plowed slush all over me. What kind of person...City of Brotherly Love?
Got some papers on the philosophy of humor at the library. My only refuge mentally and physically. But they were closing. Went to the Penn Book store, but they were closing. Got back on the train and went to Barnes and Noble to read, but, yes, they were closed. The blowing snow and slush and general miserableness wouldn't be so bad if things could just stay open, but no way. Grocery stores are closed but a shoe store is still open, what the...?
I am back in my 200 sq. ft. palace which is warm and open. The consolation is that people are talking to each other and still have a sense of humor. Nice! Tomorrow, will be different? Maybe.
More than any other time in history human kind faces a crossroads. One path leads to despair and utter hopelessness, the other to total extinction. Let us pray that we have the wisdom to choose correctly. -Woody Allen
Sunday, February 7, 2010
Snow in Philadelphia and the Super Bowl
Wow, a Super Bowl that was exciting, what a treat. The New Orleans Saints win a thrilling game in Miami. I got to watch from my room in Philadelphia after snow disrupted the Dish TV at my room earlier in the day. Apparently a chunk of ice fell into the dish on top of the building almost disrupting the "big game". And what a game. New Orleans came back from a first quarter deficit of 10 point. By kicking an on-side kick to start the second half and playing great pass football the New Orleans Saints won the game. Drew Brees, who won the MVP, was shown talking to his infant son at the end while his son was wearing ear protection against the noise. I don't know what he could have been saying to his infant son with ear phones on in a Super Bowl full of noise but it seemed endearing.
Peyton Manning, whom I like and respect, may have thrown an interception that will knock him from the discussion of "who is the best quarterback of history" at the hands of the Saints, just as Brett Favre threw an interception two weeks ago that may leave him a broken man at the end of his career. The same Saints player made both interceptions. My only concern about the post- game is that Len Dawson of the Kansas City Chiefs, who beat the Vikings in Super Bowl IV, brought out the Vince Lombardi Trophy. As a Vikings fan I had to muster energy to accept this but I have now come to terms with it. Damn him!! Oh, I have zen, yes I do. As an aside, is there no running in the NFL any more? It seems that the game is now a quarterback and receiver's game.
Best commercial goes to the one where Betty White gets tackled in the mud. The Google one where some schmo- googles his way to marriage in Paris wasn't bad.
The Who played the half-time show and did an OK job with the usual montage of hits. The question is whether this was really the Who since John Entwihistle and Keith Moon are dead and Pete Townshend can't hear. Roger Daltery looked like he had some arthritis in his neck but I'll let that go since his voice was there. Peter Townshend was almost boycotted by descendants of the Abolitionsts (alright, different subject, different cause, but the zealotry was there) since he was officially listed as a sex offender in Britain in 2003 but never charged. He said he was doing "research" when he was caught with kiddy porn on his computer. I tried to do a web search on the issue and didn't get very far except to find out that he had a friend from childhood that was abused and he has said on multiple occasions that he has tried to be an activist in pedophilia, against it that is.
In other news, Philadelphia got 28 inches of snow this week-end, and Washington D.C. got more. It has been a helluva winter in this area. I have been concerned about the number of street people that I have to pass on my way to work each day in Philadelphia. So much so that I took the effort to try to help this week-end. A purely selfish move on my part, mind you, since I want to assuage myself of some of the guilt I feel passing up many of these guys on a daily basis. I have traditionally been against giving to people on the street since I don't know if I would be an enabler or not. But the Philadelphia scene seems particularly bad, i.e. I think many on the street guys(and most are guys) are legitimate and not all drug users or crazies that can't find their way to the Salvation Army or a job, so with my extra time, being snowed in, I wanted to help. I searched the web for some food bank sites but found that my research left me going to places that were abandoned. Eventually I just bought a bunch of food, slogged through the blizzard that Philly was experiencing and ended up passing through the train station, where the police had cleared out the street folks, and got on the subway to West Philadelphia, beyond the University of Pennsylvania. I was told of a Salvation Army at 69th and Market but couldn't find it and no one knew what I was talking about when I asked around. I was a tall white guy with a bunch of food and no where to go. Eventually, I was asked to stop taking pictures of birds and headed back to my apartment on the green line, out of a place where I felt rather uncomfortable. At the 15th St. station, my home base, I tried to give away some food in the terminal. I interrupted some gentleman in a dank corner of the station with sparrows and many wet smells around him, reading an old newspaper, and asked him if he wanted some food. He looked at me like I was interrupting him and asked what I had. I said, "I have some cheese and bread". He said, "No thank you...don't you have any money? I said, "No". He said, "What else do you have?" I said, "Do you want some cashews?" He said, "Nope" and went back to reading his paper. So I moved on. Fickle people these guys. Or maybe he wasn't a reasonable representative of who I was looking for. What I did know is that I was cold and I had wet feet and I was lucky enough to have a warm place to stay so I headed back to my room with a boat load of food. As a last effort I tried to pawn some cashews off on someone else and he sincerely admitted that he couldn't eat them since he had no teeth. He was a real guy and took some cheese. I felt good about that and he seemed happy. I'll try to find a food bank in the light of day and with less snow blowing around, this week.
Peyton Manning, whom I like and respect, may have thrown an interception that will knock him from the discussion of "who is the best quarterback of history" at the hands of the Saints, just as Brett Favre threw an interception two weeks ago that may leave him a broken man at the end of his career. The same Saints player made both interceptions. My only concern about the post- game is that Len Dawson of the Kansas City Chiefs, who beat the Vikings in Super Bowl IV, brought out the Vince Lombardi Trophy. As a Vikings fan I had to muster energy to accept this but I have now come to terms with it. Damn him!! Oh, I have zen, yes I do. As an aside, is there no running in the NFL any more? It seems that the game is now a quarterback and receiver's game.
Best commercial goes to the one where Betty White gets tackled in the mud. The Google one where some schmo- googles his way to marriage in Paris wasn't bad.
The Who played the half-time show and did an OK job with the usual montage of hits. The question is whether this was really the Who since John Entwihistle and Keith Moon are dead and Pete Townshend can't hear. Roger Daltery looked like he had some arthritis in his neck but I'll let that go since his voice was there. Peter Townshend was almost boycotted by descendants of the Abolitionsts (alright, different subject, different cause, but the zealotry was there) since he was officially listed as a sex offender in Britain in 2003 but never charged. He said he was doing "research" when he was caught with kiddy porn on his computer. I tried to do a web search on the issue and didn't get very far except to find out that he had a friend from childhood that was abused and he has said on multiple occasions that he has tried to be an activist in pedophilia, against it that is.
In other news, Philadelphia got 28 inches of snow this week-end, and Washington D.C. got more. It has been a helluva winter in this area. I have been concerned about the number of street people that I have to pass on my way to work each day in Philadelphia. So much so that I took the effort to try to help this week-end. A purely selfish move on my part, mind you, since I want to assuage myself of some of the guilt I feel passing up many of these guys on a daily basis. I have traditionally been against giving to people on the street since I don't know if I would be an enabler or not. But the Philadelphia scene seems particularly bad, i.e. I think many on the street guys(and most are guys) are legitimate and not all drug users or crazies that can't find their way to the Salvation Army or a job, so with my extra time, being snowed in, I wanted to help. I searched the web for some food bank sites but found that my research left me going to places that were abandoned. Eventually I just bought a bunch of food, slogged through the blizzard that Philly was experiencing and ended up passing through the train station, where the police had cleared out the street folks, and got on the subway to West Philadelphia, beyond the University of Pennsylvania. I was told of a Salvation Army at 69th and Market but couldn't find it and no one knew what I was talking about when I asked around. I was a tall white guy with a bunch of food and no where to go. Eventually, I was asked to stop taking pictures of birds and headed back to my apartment on the green line, out of a place where I felt rather uncomfortable. At the 15th St. station, my home base, I tried to give away some food in the terminal. I interrupted some gentleman in a dank corner of the station with sparrows and many wet smells around him, reading an old newspaper, and asked him if he wanted some food. He looked at me like I was interrupting him and asked what I had. I said, "I have some cheese and bread". He said, "No thank you...don't you have any money? I said, "No". He said, "What else do you have?" I said, "Do you want some cashews?" He said, "Nope" and went back to reading his paper. So I moved on. Fickle people these guys. Or maybe he wasn't a reasonable representative of who I was looking for. What I did know is that I was cold and I had wet feet and I was lucky enough to have a warm place to stay so I headed back to my room with a boat load of food. As a last effort I tried to pawn some cashews off on someone else and he sincerely admitted that he couldn't eat them since he had no teeth. He was a real guy and took some cheese. I felt good about that and he seemed happy. I'll try to find a food bank in the light of day and with less snow blowing around, this week.
Saturday, January 23, 2010
Washington D.C., and health care reform
I woke up in Washington D.C today. I'm going to meet my friend Johnson "Spud" Maxey tomorrow to go to the International Spy Museum and to eat some Ethiopian food at his request. Today I wanted to spend the day on the Mall. I ate breakfast near my place at the Club Quarters and it was here that I read that health care reform will be dropped in it's current form by Obama and the Democratic majority in Congress.
I am two blocks away from the White House so I stared at it. After breakfast I started walking and my path took me past a woman in a short black cocktail dress and strappy high heels absolutely yelling into her cell phone. She was pissed at somebody, perhaps her boyfriend, and every other word out of her mouth was f--k this and f--k that and "You better get your f--king ass out here!" etc. She and I were the only ones on the street since it was about 8A and D.C. was sleeping in, or trying to. I took this as a metaphor for...what? I don't know.
Anyway, I was to the White House in a snap. I almost got Lafayette Square to myself. It was only me and the guy with tattoos on his forehead who had been part of a group sitting in front of the White House continuously since 1981 demanding nuclear de-escalation. An issue that has fallen far on the "to do list" of the nation.
Health care is on top and this thing has upset me. While staring at the White House I couldn't help but feel that President Obama and the Congress have not done us a service at this time, that health care for more Americans was within our grasp. In fact, we had it in the boat but it wiggled out. I don't think they should have given up. Since the turn of the previous century there have been two Republicans and a hand-full of Democrats that have tried to get more broad coverage for Americans and all have failed. It appears now that Obama may fail as well and this is especially crushing since he was elected on a health care platform and he came so close. Health care is the holy grail and no President has found it yet.
As a physician I have worked in public hospitals: Hennepin County Medical Center in Minneapolis and Bellevue Hospital in New York City. I have felt, like others, that there is disparity in health care delivery and those without insurance are at a distinct disadvantage. Some could afford it and choose not to buy it, they deserve some knuckle rapping, but I also think that there are enough that are struggling, or are not sophisticated enough, to figure out a system that follows no reasonable rules of economics and they suffer disproportionately.
The preamble to the constitution addresses ensuring domestic tranquility and promoting the general welfare of Americans. Health care is right down its alley. Yet the Constitution does not state a right to health care, as it doesn't mention a right to a public education, yet we have chosen to offer that to the citizens of our country. Arthur Caplan, at the Penn Center for Bioethics, addressed this at a recent keynote speech at a Critical Care meeting. He invoked our desire as a nation to see equal opportunity for all, as one might evoke with creating public education, and he went on to suggest that more accessible health care may also afford more equality of opportunity. By not having reasonable access to health care there are those with asthma, diabetes, seizure disorders, etc. who may not be able to get reasonable health care and thus they experience disproportionate limitations financially and physically that limit their access to a more level playing field of opportunity through little fault of their own.
As cost has always been an issue let me throw this out. The governor of Colorado told me that his office estimated that each uninsured person in his state costs more than $20,000 a year in E.R. costs alone. The average cost per insured person in Colorado seems to be approximately $7,000 based on government statistics from all fifty states. One could estimate 500,000-1,000,000 uninsured in Colorado alone (40 million in U.S.). If one conservatively thinks that there would be $10,000 a year saved on 500,000 people if they were brought into some insurance pool this would add up to $5 billion dollars of savings in Colorado alone.
My personal feeling is that a lack of reasonable health care access for everyone in a country that claims to be the beacon of truth and justice in the world should leave us embarrassed. Lyndon Johnson tried to limit the Congress into drilling down on the cost of medicare because he thought health care coverage, in some form, for the elderly was a necessity in this country. He likened it to having milk and bread in your kitchen. No matter how much milk and bread cost you would just have to spend the money because you had to. Broad health care access is just such an issue. The cost matters, but it doesn't matter, so why not JUST DO IT. We can adjust the budget deficit, we can afford not to buy the next weapons system, or we can let the grass grow at the campsites of our National Parks, or we could all reap the financial benefit of a more healthy medical sector, but health care is bread and milk for the nation. We need it, be it in single party payer form, with a public option in a privately managed system, or some form of mandate without a public option and it seems extremely disappointing that we can't seem to do this.
The White House just sat there, in its beauty and splendor. I walked around and took pictures of the Washington Monument, saw Whistlers Peacock room, and went to the Air and Space Museum after having a hot dog near a childrens group so large that they reminded me of a school of sardines. Then I went to the National Art Museum and saw a Chekov film in Russian with subtitles.
When all is summed up I feel lucky to have economic stability, wonderful friends and family, and I'm lucky to be in D.C.
I am two blocks away from the White House so I stared at it. After breakfast I started walking and my path took me past a woman in a short black cocktail dress and strappy high heels absolutely yelling into her cell phone. She was pissed at somebody, perhaps her boyfriend, and every other word out of her mouth was f--k this and f--k that and "You better get your f--king ass out here!" etc. She and I were the only ones on the street since it was about 8A and D.C. was sleeping in, or trying to. I took this as a metaphor for...what? I don't know.
Anyway, I was to the White House in a snap. I almost got Lafayette Square to myself. It was only me and the guy with tattoos on his forehead who had been part of a group sitting in front of the White House continuously since 1981 demanding nuclear de-escalation. An issue that has fallen far on the "to do list" of the nation.
Health care is on top and this thing has upset me. While staring at the White House I couldn't help but feel that President Obama and the Congress have not done us a service at this time, that health care for more Americans was within our grasp. In fact, we had it in the boat but it wiggled out. I don't think they should have given up. Since the turn of the previous century there have been two Republicans and a hand-full of Democrats that have tried to get more broad coverage for Americans and all have failed. It appears now that Obama may fail as well and this is especially crushing since he was elected on a health care platform and he came so close. Health care is the holy grail and no President has found it yet.
As a physician I have worked in public hospitals: Hennepin County Medical Center in Minneapolis and Bellevue Hospital in New York City. I have felt, like others, that there is disparity in health care delivery and those without insurance are at a distinct disadvantage. Some could afford it and choose not to buy it, they deserve some knuckle rapping, but I also think that there are enough that are struggling, or are not sophisticated enough, to figure out a system that follows no reasonable rules of economics and they suffer disproportionately.
The preamble to the constitution addresses ensuring domestic tranquility and promoting the general welfare of Americans. Health care is right down its alley. Yet the Constitution does not state a right to health care, as it doesn't mention a right to a public education, yet we have chosen to offer that to the citizens of our country. Arthur Caplan, at the Penn Center for Bioethics, addressed this at a recent keynote speech at a Critical Care meeting. He invoked our desire as a nation to see equal opportunity for all, as one might evoke with creating public education, and he went on to suggest that more accessible health care may also afford more equality of opportunity. By not having reasonable access to health care there are those with asthma, diabetes, seizure disorders, etc. who may not be able to get reasonable health care and thus they experience disproportionate limitations financially and physically that limit their access to a more level playing field of opportunity through little fault of their own.
As cost has always been an issue let me throw this out. The governor of Colorado told me that his office estimated that each uninsured person in his state costs more than $20,000 a year in E.R. costs alone. The average cost per insured person in Colorado seems to be approximately $7,000 based on government statistics from all fifty states. One could estimate 500,000-1,000,000 uninsured in Colorado alone (40 million in U.S.). If one conservatively thinks that there would be $10,000 a year saved on 500,000 people if they were brought into some insurance pool this would add up to $5 billion dollars of savings in Colorado alone.
My personal feeling is that a lack of reasonable health care access for everyone in a country that claims to be the beacon of truth and justice in the world should leave us embarrassed. Lyndon Johnson tried to limit the Congress into drilling down on the cost of medicare because he thought health care coverage, in some form, for the elderly was a necessity in this country. He likened it to having milk and bread in your kitchen. No matter how much milk and bread cost you would just have to spend the money because you had to. Broad health care access is just such an issue. The cost matters, but it doesn't matter, so why not JUST DO IT. We can adjust the budget deficit, we can afford not to buy the next weapons system, or we can let the grass grow at the campsites of our National Parks, or we could all reap the financial benefit of a more healthy medical sector, but health care is bread and milk for the nation. We need it, be it in single party payer form, with a public option in a privately managed system, or some form of mandate without a public option and it seems extremely disappointing that we can't seem to do this.
The White House just sat there, in its beauty and splendor. I walked around and took pictures of the Washington Monument, saw Whistlers Peacock room, and went to the Air and Space Museum after having a hot dog near a childrens group so large that they reminded me of a school of sardines. Then I went to the National Art Museum and saw a Chekov film in Russian with subtitles.
When all is summed up I feel lucky to have economic stability, wonderful friends and family, and I'm lucky to be in D.C.
Wednesday, January 20, 2010
TB-like bacteria that cause leprosy, AND read the Bible with some skepticism.
Here's the skinny on nontuberculous mycobacterium. Mycobacterium is a genus of bacteria. Remember, in a family of bacteria there is the genus, Mycobacterium and the species, like tuberculosis, leprosy, and about 130 other species of bacteria that cause lung disease, skin disease and a bunch of other problems. These other species don't get the press that tuberculosis gets.
Nontuberculous mycobacterium share some of the structure of tuberculosis but they have never been known to be transmitted from person to person like TB. I think that is why they fly under the radar.
The classic findings of these bacteria are mycolic acid in their cell wall and a similar structure in something called 16s rRNA. Within this 16s rRNA there are subtle differences which seem to give the different genus' of mycobacterium their unique fingerprint, but this might be getting a little technical.
The most common lung disease from nontuberculous mycobacterium is caused by MAC, or mycobacterium avium intracellulare. It is commonly found in those that work with soil like construction workers and farmers since it is most prevalent in the soil. It is also common, for some unknown reason, in older women who are skinny. We are finding out that cholesterol and and the "fat" hormone leptin may play a role in fighting mycobacterium infection. These are the only diseases that may let you feel good about being obese with a high cholesterol because the immune system may work better against mycobacterium if you have extra weight and higher cholesterol. There are many other reasons to not be fat with a high cholesterol though so I wouldn't go pigging out on McDonalds' just yet.
Recently the New York Times and other papers reported the work of a Colorado State scientist, Norman Pace, who swabs things like subways, clothes and shower heads and found evidence of this bacteria to be ubiquitous. In fact he found that these bacteria form a film that allow them to survive in great numbers in shower heads. There have also been case reports of women having lung infection from isolates found to be from their showers. Hot tubs seem to be a source as well since the chlorine kills other bacteria but not mycobacterium. Infection is rare though so don't go selling your hot tub in a garage sale and if showers are your bag, and you're otherwise healthy, don't stop washing since your social well-being may be at risk more than your health.
Leprosy is caused by a mycobacterium that grows best in the 9 band armadillo, perhaps this accounts for reports of leprosy in Louisiana. But it is most common in India, the continent of Africa, and Brazil. It is a neuropathic bacteria that also causes depigmentation of the skin. Usually patients present with anesthetic patches on their skin and sometimes lumps. The immune system seems to have a difficult time with leprosy so antibiotic therapy is sometimes required for up to ten years. Antibiotic therapy for TB is usually 9 months, for bronchitis, 10 days.
The Bible references leprosy a lot. But recently scientists and Bible scholars have been noting these references with some skepticism since diagnostic skills were not as astute in Christ's time. After the Bible scholars such as Hippocrates, Herodotus and Galen have referenced leprosy. A common theme seems to suggest that these patients were "white as snow" and they comment on plaques of the skin and sometimes growths on the limbs. Many other disease have been suggested by modern science that would account for these reports from the Bible and Greeks such as: vitiligo(immune mediated depigmentation of the skin not caused by infection), psoriasis, elephantiasis(caused by a parasite), ringworm(fungus), elephant man's disease(neurofibromatosis) and other skin infections like those caused by Staph or Strep. It is commonly noted that the clothes and homes of lepers were "moldy" or the equivalent in our modern speak. Often the clothes and homes of these people were burned needlessly as a consequence.
So if you have boil on your skin don't let anyone burn your house down.
That's it for now.
Nontuberculous mycobacterium share some of the structure of tuberculosis but they have never been known to be transmitted from person to person like TB. I think that is why they fly under the radar.
The classic findings of these bacteria are mycolic acid in their cell wall and a similar structure in something called 16s rRNA. Within this 16s rRNA there are subtle differences which seem to give the different genus' of mycobacterium their unique fingerprint, but this might be getting a little technical.
The most common lung disease from nontuberculous mycobacterium is caused by MAC, or mycobacterium avium intracellulare. It is commonly found in those that work with soil like construction workers and farmers since it is most prevalent in the soil. It is also common, for some unknown reason, in older women who are skinny. We are finding out that cholesterol and and the "fat" hormone leptin may play a role in fighting mycobacterium infection. These are the only diseases that may let you feel good about being obese with a high cholesterol because the immune system may work better against mycobacterium if you have extra weight and higher cholesterol. There are many other reasons to not be fat with a high cholesterol though so I wouldn't go pigging out on McDonalds' just yet.
Recently the New York Times and other papers reported the work of a Colorado State scientist, Norman Pace, who swabs things like subways, clothes and shower heads and found evidence of this bacteria to be ubiquitous. In fact he found that these bacteria form a film that allow them to survive in great numbers in shower heads. There have also been case reports of women having lung infection from isolates found to be from their showers. Hot tubs seem to be a source as well since the chlorine kills other bacteria but not mycobacterium. Infection is rare though so don't go selling your hot tub in a garage sale and if showers are your bag, and you're otherwise healthy, don't stop washing since your social well-being may be at risk more than your health.
Leprosy is caused by a mycobacterium that grows best in the 9 band armadillo, perhaps this accounts for reports of leprosy in Louisiana. But it is most common in India, the continent of Africa, and Brazil. It is a neuropathic bacteria that also causes depigmentation of the skin. Usually patients present with anesthetic patches on their skin and sometimes lumps. The immune system seems to have a difficult time with leprosy so antibiotic therapy is sometimes required for up to ten years. Antibiotic therapy for TB is usually 9 months, for bronchitis, 10 days.
The Bible references leprosy a lot. But recently scientists and Bible scholars have been noting these references with some skepticism since diagnostic skills were not as astute in Christ's time. After the Bible scholars such as Hippocrates, Herodotus and Galen have referenced leprosy. A common theme seems to suggest that these patients were "white as snow" and they comment on plaques of the skin and sometimes growths on the limbs. Many other disease have been suggested by modern science that would account for these reports from the Bible and Greeks such as: vitiligo(immune mediated depigmentation of the skin not caused by infection), psoriasis, elephantiasis(caused by a parasite), ringworm(fungus), elephant man's disease(neurofibromatosis) and other skin infections like those caused by Staph or Strep. It is commonly noted that the clothes and homes of lepers were "moldy" or the equivalent in our modern speak. Often the clothes and homes of these people were burned needlessly as a consequence.
So if you have boil on your skin don't let anyone burn your house down.
That's it for now.
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