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Medical Insurance Companies: Heroes or Villains?

Physicians are expected to be hostile to insurance companies.  Indeed, a prior Whistleblower post directed arrows in their direction.  They are an easy target, often vilified for their greed and perceived indifference toward those they insure.  Ask most of us if we think insurance companies favor profits over patients, and most of us will respond that profits prevail. Insurance companies are businesses, not charitable undertakings.  Sure, we all like free stuff.  Or, if it’s not free, we prefer that someone else pays for it.  We are outraged at the costs of chemotherapy, hepatitis C treatment and biologic treatments such as Humira and Remicade, leaving aside the zillions of dollars it takes to research, develop, manufacture, market and monitor innovative new drugs.  We want to drive a Cadillac, but only pay for a Chevy. We want to pay for this... ...and drive this. No person, business or organization is wrong all of the time.  Consider the following practices. 

Should the FDA Approve Experimental Treatment for Severe Diseases?

I’ve never had the pain and agony of having a kid who is truly sick.  Broken bones and minor surgeries don’t count.  Even one of my kid’s bout with malaria doesn’t rate, as this illness was easily cured. Parents of kids with chronic illnesses would sacrifice anything to help their kids get better or to suffer less.  In the news recently is a conflict between families of kids with Duchenne muscular dystrophy and the Food and Drug Administration (FDA).  A very small study of an experimental drug called eteplirsen suggested some benefit.   Understandably, the families want the FDA to grant approval so that their kids and others could have access to this drug that will fight a dreadful disease that is fatal.  Families argue that these kids have nothing to lose and can’t wait another 5 years waiting for more definite evidence of efficacy to emerge.  The FDA is legally required to approve drugs that are safe and effective.  Obviously, the definitions of safe and effective are subjec

Should Women Who Seek Illegal Abortions be Punished?

Every four years, abortion gets more press and attention as the candidates compete for electoral support.  My own position on this issue is not relevant for the points I offer here.  We all know that candidates massage their position on abortion and on other issues in an attempt to maximize their voter support.  It’s fun to watch them thread the needle as they dance and pirouette for us.  They are performers who can be as flexible as the amazing acrobats on Cirque du Soleil.  The emphasis, if not the content of their message, changes depending upon the audience.  Al Gore was ridiculed when he sported a more southern accent when he was campaigning below the Mason-Dixon line.  Donald Trump was clearly unprepared for the abortion question when he rhetorically collapsed during a typically vigorous and frenetic interview with MSNBC’s Chris Matthews.  Of course, you don’t really have to prepare on an issue if you already have a principled position.  You can just tell the truth.  Tr

Risks of Probiotics - Who Cares?

Earlier this year I read about a medical study that concluded that a diet high in saturated fat won’t kill you after all.  Moreover, piling on polyunsaturated fat won’t save you. Hee hee.  I love this stuff.  Established medical dogma back flips every 10 years.  Butter in, butter out.  Hormone replacement treatment for perimenopausal women is mandatory, until it isn’t. Who knows what to believe when even doctors are confused or just don’t know. We have a medical industrial complex that is a beast that needs to be fed.  It fuels itself on our fidelity to medical practices that are labeled as truths.  ‘Wellness’ rules.  How many decades did the public and the medical community preach that the P.S.A. blood test saved men’s lives?  While I believe that urologists were sincere in their mistaken beliefs and practices, there was a whole industry behind the scenes that was fueling the fire.  It was good business for hospital operating rooms, medical device companies and radiation

Weight Loss Breakthrough Melts Pounds Off!

What’s all this chatter I hear about how hard it is to lose weight?   Relax.   Obesity has finally been conquered.   Those stubborn extra pounds that you’ve been stuck with will soon melt faster than a popsicle on a steamy summer day.   Although I am a practicing gastroenterologist who deals with nutritional issues routinely, I did not learn of this breakthrough in my medical journals or from experts in the field.   I learned it just by listening to the radio. I’m in the car several times a day, so I get my share of radio time.  Not a day passes that I don’t hear an ad for some kind of fat-busting pill or potion.  The products are different but the pitch is always the same. Obesity on the Run! Rapid weight loss No excercise No work or effort.  Pound magically disappear This seductive pitch is followed by testimonials from smiling ‘customers’ posing on the beach who corroborate the amazing result.  Their script usually includes: 'I've tried everything

Calling the Doctor After Hours

Of course, patients are entitled to medical care around the clock.  You would not expect to show up at 2:00 a.m. at an emergency room to find a ‘Closed’ sign.  If you are having chest pain on a weekend, and you call your doctor’s office, you should expect a prompt response from a living and breathing medical doctor.  Patients are aware that when they call the doctor at night, that they are unlikely to reach their own doctor.  Similarly, when a patient is admitted to the hospital, they will likely be attended to by a hospitalist, not the primary care physician.  Such is the reality of medical practice today. No Patient Zone at Hospital Here are 3 types of after hour calls that merit mentioning. (1)One of my partner’s patients calls me because the diarrhea is still not better and it’s been more than 3 months.  While I completely understand the frustrated patient’s rationale for calling, there’s not much I can do in these circumstances.  It is generally not helpful to call a

Does Appendicitis Need Surgery?

Some issues do not need to be studied.   For example, would we expect the National Institutes of Health to fund a study to determine if drivers wearing blindfolds have better outcomes?   In the past few weeks, the National Football League (NFL) has conceded that head trauma is linked to chronic traumatic encephalopathy (CTE), a fancy term that means brain damage.  Of course, there have been multiple studies that have examined this question.  And, in a nod to the tobacco companies, the NFL for too long failed to admit what any school child could have deduced.  Smashing your head several hundreds of times against the ground or another helmeted gladiator does not promote good brain health.  Sometimes industries will cite their own ‘studies’ that astonishingly contradict what our intuition and common sense tell us should be true.  Would we accept the results, for example, of a movie industry  ‘study’ that extolled the health benefits of popcorn? Sometimes, in medicine, we need a s