Sunday, October 27, 2013

Should Michael Jackson's Doctor Practice Medicine Again?

Before Michael Jackson, most folks didn’t know what propofol was.  Now, patients are asking me for it by name.  It’s an awesome drug.  It provides a beautiful sedation, is extremely safe and rapidly clears after the procedure.  Under its effects, colonoscopy has become a sublime experience. 

We administer it in a different manner than Conrad Murray did.  For those who may have just awakened from a 5 year coma, Conrad Murray was Michael Jackson’s personal physician who administered propofol to Jackson in his home to promote sleep.  Murray succeeded and received the modest salary of $150,000 per month for his medical services.

Sleep Aid?

Administering propofol in a patient’s home without necessary monitoring and training is an egregious breach of standard medical practice.  Those of us who use the drug properly were shocked to learn of this doctor’s reckless and indefensible care.   Here are a few hypothetical examples of similarly negligent care.
  • A surgeon removing your appendix in the back seat of your car.
  • A psychiatrist hanging up on a patient who is threatening suicide.
  • An internist invites recovering alcoholic patients to a wine tasting event.
Murray will be released this month after serving time for involuntary manslaughter.  At present, he does not have a valid license to practice medicine, but hopes to be reinstituted into the profession.
Should he be barred from medicine for life?   I believe that the depth of his negligence warrants expulsion from the profession.  If fact, if his conduct doesn’t result in permanent loss of a medical license, then what would? 

Is there a different outcome that would allow this man to use his medical skills and serve the greater good?  What if he were given a medical license with stringent restrictions and strict oversight?   If he were required, for example, to practice in an underserved community and was tightly supervised by a physician, would we support this outcome?  

I have my own view here, but I’d like to know yours.

Sunday, October 20, 2013

Obamacare Health Insurance Exchanges Crash and Burn. Tweaks and Glitches

A few days ago, lawmakers sealed a deal to reopen the government and to relax the debt limit.  This was no O’Henry story with a surprise ending.  This was the outcome that all of us knew was forthcoming.  The GOP not only had no cards to play, but their empty hand was known to all.  It’s very hard to bluff when your cards are face up and you don’t even have a pair of deuces.   Obamacare was the GOP target that quickly became a phantom.  It disappeared.  Afterwards, there was nothing for them to shoot at except each other.

GOP vs Dems

A perusal of my posts nestled in the Health Care Reform Quality category will demonstrate my skepticism and hostility against Obamacare, which is an interim step toward something even worse.   But, the law was legally enacted, approved by voters in the last general election and was upheld by the U.S. Supreme Court. 
That such a monumental program was passed in a unipartisan manner is wrong, but is not illegal.  The roll out of the exchanges has been so abysmal that even Robert Gibbs, former Obama spokesman, has sounded more like a Tea Partier when commenting on the failed implementation. 

Even the Huffington Post, hardly a Tea Party outlet, trashes the exchange roll out. 

While Obamians may try to gloss over this colossal failure, amply documented in the media, by using words like ‘tweaks’ and ‘glitches’, the rest of us are not so easily hypnotized.   They are desperate to lure young healthy folk into the exchanges to pay for older Americans with health issues.  Those young indestructible Americans in their 20s, will pay a premium, particularly as they must pay for mandated insurance benefits that they may not want or need.   The penalty next year for those who opt out of the exchanges is $95, which young folks may choose over coverage.

And, if young folks do sign up, they will likely choose the low premium and high deductible option.  So, they will face high out of pocket costs for medical care and would be covered only for a catastrophic event that is unlikely to happen.  Will young people in these exchange plans become Obama cheerleaders?   I doubt it. 

Remember the president promising that if we wanted to keep our own doctor that we could?  Each week we read about another large company that is getting out of the medical insurance business and pushing folks onto the gleaming exchanges.    Once planted there, will they have free choice?  If their deductible is now $5,000, might this curtail their freedom to choose?  What if their doctor isn't on the plan?  The web site makes it nearly impossible for folks to determine if their doctor is on the plan.  This adds some adventure to the process.  And, it might be fun to meet a new doctor.  Another glitch?

The failed roll out is not an aberrational event.  It’s a symptom of system that is clumsy, controlling, expansive and broken. 

Let's stop the spinning.  When something is a disaster, then call it by its true name.   We’ve just seen how the legislative branch has served the nation over the past few weeks.  Would you call this a glitch?  Does Congress just need a tweak or two?   Let’s describe them in terms that pass the honesty test.  They are a group of self-promoting, petty and conniving partisans who spurn the public trust as they pursue their own personal ambitions while demonizing the opposition. 

Since the new agreement funds the government through January 15th and extends the debt limit through February 7th, we’ll be spectating once again the Congressional Theater of the Absurd in a few short months.

Last week, Congress’s approval rating has dropped to 5%.   My question to my learned readers is who are these 5%? 

Sunday, October 13, 2013

Ted Cruz Filibuster Misses the Mark

Even the most casual Whistleblower reader is aware of my hostility toward Obamacare, which appears destined for incremental implementation.  Ted Cruz’s paper mache weapons were no match for the Democrats' artillery brigade.   When the Chamber of Commerce, corporate America and organized labor are all on the same side of this issue, it suggests that healing this forerunner of socialized medicine will take more than a tweak or two to smooth it out. 

Cruz Takes Aim

There’s nothing unexpected or unfair here.  Romney campaigned hard against Obamacare.  The country had an opportunity to elect him, and declined to do so.   Did we expect that Obama would dismantle his signature legislative first term achievement in his second term?   When Romney lost, Obamacare won. The Affordable Care Act was legally enacted, albeit without a single Republican vote.  The Supreme Court determined that the law was constitutional.  Elections matter.  So, a flawed program, whose ultimate consequences are not yet entirely visible, was legally enacted and will be nearly impossible to derail.

Of course, serious reform was needed.  I written throughout this blog that our health care system was not enjoying optimal health.  There were glaring deficiencies and inequalities that I could never satisfactorily explain to my patients.
  • Why are drugs in Canada so much cheaper than the same drugs purchased here?
  • How can a hospital charge exorbitant fees for simple items that would cost a few bucks at CVS?
  • Why did it take so long for colon cancer screening to be a covered benefit, when colon cancer was always paid for?
  • Why is our per capita health care cost so much higher than other nations who demonstrate superior health outcomes?
  • Why can’t patients receive medical bills that they can understand?
  • Shouldn’t patients and their families have some skin in the game as a brake on the profligate spending of other people’s money for health care?
  • Why do physicians permit, if not encourage, futile medical care?
  • Why is it possible that so many working Americans can’t afford medical insurance coverage?
Obamacare emerged because the dysfunctional system demanded a response, and no prior president since the Truman administration was able to move the ball down-field.  Had Obamacare antagonists passed reform measures incrementally during past decades, then we wouldn’t be subjected to the clumsy and heavy hand of government healing now.

I don’t like Obamacare and I wish it could be repealed.  But, the program didn’t emerge from nowhere.  Those who coasted along for decades clinging to the status quo, created a target so large that you could hit it without aiming.  In Ted Cruz’s 21 hour and 19 minute speech, he never explained what brought us all to this moment.  We can't blame Obama for this.  His aim was wild, but the target we all created was so large, that he couldn't miss.

Sunday, October 6, 2013

Gun Control and Gun Violence - Is the Right to Bear Arms Absolute?

I’m writing now in the wake of another tragic shooting here in the United States.  For most of us, we have never experienced the current pandemic of senseless violence that we read about and visualize every day.  I challenge you to find a newspaper tomorrow morning, or listen to a news broadcast, that will not report on dark and pernicious inclinations and accomplishments of evil practitioners. 

If that challenge is not sufficient, then find an American over the age of 70 to attest that the world is better today than it was during his youth.  

I listened to the every word that President Obama said at the ceremony honoring the fallen Navy Shipyard personnel.  He spoke well, and his reference to congressional inaction with regard to gun violence didn’t trouble me at all.   It was beyond shameful when craven congressman couldn’t pass any piece of legislation in the wake of the Newtown catastrophe.   This was a bipartisan failure that broke congress’s already abysmal performance level.

I’ve never been a gun control supporter, and I’m still not persuaded by their arguments.  I do believe that some classes of weaponry should not qualify as an absolute constitutional right of law abiding citizenry.  Should folks be able to purchase unlimited numbers of weapons and ammunition?   Explain why background checks somehow don’t apply to gun shows and ‘private sales’?  I have some flexibility on these issues.

Although I would support some restrictions on gun ownership, I do not accept the views of gun control zealots that lack of restrictions are responsible for recurrent episodes of senseless violence.   Somehow, these folks demonize the NRA while they give a free pass to Hollywood, the video gaming industry and the music business, all of whom bathe us with violence every single day.   Do we believe that the media can’t influence us, especially those of us whom might be vulnerable?   To those who deny that media can influence our behaviors, explain why gazillions are spent on advertising for this very purpose.

Is the NRA a Scapegoat?

Criminals will not surrender their weapons or fail to procure new ones because of more restrictive laws.  These guys do not obey laws.  That’s why we call them criminals.  Get it?   

Outlawing assault rifles – red meat for the gun control crowd – will keep these guns from law abiding citizens, not others.  And, even honest gun control fanatics admit that these classes of weapons account for a very small percentage of violent American deaths, which are largely caused by handguns.   That’s where our collective outrage should be focused, although this is a more difficult and elusive target.

I’m hostile to the argument that’s often issued as a question, “Who needs an assault rifle”?   The fact that it is a right means that there is a legal entitlement that doesn’t require an explanation for exercising it.  How often do courts permit speech, for example, that many of us don’t understand the purpose or need for its expression.   Indeed, having a right means you don’t need an explanation.

I am aware that no constitutional right is absolute including the Second Amendment.   Personally, I do not feel that I should be entitled to purchase unlimited numbers of any kind of weapon available.  But, if I did so, I don’t think that I would be threatening the fabric of America society. 

As far as keeping guns from the mentally ill, a goal that every thinking person supports, explain how you would do this.  I don’t have a clue.  What’s your definition of mental illness with regard to this issue?   Depression?  ADHD?   Having seen a psychiatrist or a counselor in the past year?   On Paxil or similar medicines?  Being regarded as a loner in school?   Being moody?  Should a family history of mental illness be relevant?

While there have been obvious lapses in mental health that we should address, it’s an easier task to look backwards after a catastrophe has occurred and recognize missed opportunities than it is to do so prospectively. 

I vigorously support stronger background checks, even if this is not a proven remedy for reducing gun violence.  These are guns, not toothbrushes.   Guns can hurt people.  Stronger background checks by themselves would not restrict weapons that eligible folks can purchase and should be palatable to the pro gun crowd, in my view.   I am perplexed that one can purchase a weapon and not be required to have sufficient training in its safe use and storage.   Cars can hurt people if not used properly.  You cannot obtain a driver’s license without demonstrating that you know the rules of the road and can manage the vehicle safely.  Should we relax these requirements?

The explanations for the horrible violence that is our new reality are deep and complex.  Gun ownership may be an easy target, but I think that this argument misses the mark.   

What do you think?   Do you think that the primary reason that so many thousands of murders occur in America each year is because of lax gun laws?   While I’m willing to listen, that argument is no bull’s-eye for me.