Sunday, April 04, 2010
The struggle against dying
This profile of Desiree Pardi -- a palliative care specialist who went to extraordinary lengths to stay alive despite incurable, metastatic breast cancer -- points out just how difficult it is for individuals to face their own mortality. Even when it was her job, Dr. Pardi was unable to help herself give up, give in, and go in peace.
Wednesday, March 31, 2010
Bodies altered
Check out this NYTimes slideshow of "bodies altered in the pursuit of beauty." Haunting, revealing, and worth looking at.
Tuesday, March 23, 2010
"And yes Mr. Vice President, you're right... "
Listen for yourself.
I will offer a long summary of the run-up to health care reform, but for the time being I am waiting to see whether the Senate will pass the "fixes" through reconciliation. Today, Senator Max Bacus (D-Montanta) suggested that perhaps not all the fixes would pass muster under the "Byrd Rule" which limits what falls under the category of "budgetary" changes [to avoid filibuster, changes to the original senate bill can be only budgetary in nature]. This would mean a potentially painful back-and-forth between the House and Senate. However, lots of things Bacus (and other Senators for that matter) have said to this point haven't turned out to be true. So who knows? Besides, the Senate bill (fury over "kickbacks" to poor people needing health coverage aside) is pretty damn good on its own. So I still think this is all good. But now is the time for the real work to begin.
I will offer a long summary of the run-up to health care reform, but for the time being I am waiting to see whether the Senate will pass the "fixes" through reconciliation. Today, Senator Max Bacus (D-Montanta) suggested that perhaps not all the fixes would pass muster under the "Byrd Rule" which limits what falls under the category of "budgetary" changes [to avoid filibuster, changes to the original senate bill can be only budgetary in nature]. This would mean a potentially painful back-and-forth between the House and Senate. However, lots of things Bacus (and other Senators for that matter) have said to this point haven't turned out to be true. So who knows? Besides, the Senate bill (fury over "kickbacks" to poor people needing health coverage aside) is pretty damn good on its own. So I still think this is all good. But now is the time for the real work to begin.
Sunday, March 21, 2010
It is done...(now the Senate can finish)...
In my final hours in our nation's capitol, the major hurdle - the House passing the Senate bill plus reconciliation fixes - to health care reform passing has been cleared. The Democrats (because of the leadership of the president and of the party) finally did what they promised: health care reform is not a goal. It is a reality.
More thoughts to come (and my photos in front of the Capitol Rotunda).
This is a moment.
Now is the time for us all to take charge in making health care better in the United States. Thanks to the Congress, we now have a fighting chance.
More thoughts to come (and my photos in front of the Capitol Rotunda).
This is a moment.
Now is the time for us all to take charge in making health care better in the United States. Thanks to the Congress, we now have a fighting chance.
Close!
I'm here in DC, preparing anxiously for a celebration (FINGERS CROSSED) that will happen if the U.S. Congress finally grows a pair and passes reform. More to come, but it's very likely I will go over to the Capitol Rotunda later and snap a photo to celebrate the most important passage of Health Care reform since the birth of Medicare decades ago.
Do it!
Do it!
Thursday, March 18, 2010
the equinox
I woke up this morning and realized that my bedroom’s sliding glass door was wide open. I left the door open, put on a tank top and pair of shorts, ate my breakfast, and had an amazing “commute” to school on my bike. The sun was really sunny. The breeze was really breezy.
If yesterday and today and tomorrow are signs of what is to come – when spring is in full swing and the fever is full blown – then Yippee-ki-yay. Spring is going to be nice. Summer will be nice too. But winter wasn’t that bad. Sure we had some rain, some wind, and some cloudy days in LA. But let’s celebrate anyway: the good, the slow, and the non-idyllic times passed. Let’s take a moment and appreciate everything wonderful around us. This Saturday the earth and sun will dance, like they have been for more years than I count, and at 1:32 PM EDT they will pause to change hands. The sun’s leading the earth, but it takes more than one (us included!) to tango.
If yesterday and today and tomorrow are signs of what is to come – when spring is in full swing and the fever is full blown – then Yippee-ki-yay. Spring is going to be nice. Summer will be nice too. But winter wasn’t that bad. Sure we had some rain, some wind, and some cloudy days in LA. But let’s celebrate anyway: the good, the slow, and the non-idyllic times passed. Let’s take a moment and appreciate everything wonderful around us. This Saturday the earth and sun will dance, like they have been for more years than I count, and at 1:32 PM EDT they will pause to change hands. The sun’s leading the earth, but it takes more than one (us included!) to tango.
Friday, March 05, 2010
Exercise is good, mmmmkay
Read this nice and tidy round-up of some of the research suggesting how good exercise is for people, particularly as they age. Somewhat of an obsessive fitness freak, I find this to be validation of my current lifestyle. Note that just about every organ system, as well as physiological and pathophysiological process, is affected for the better by exercise.
New Rule, ctd.
Another new one:
If there will be drastic cuts in education spending, then there should also be cuts in Medicare spending.
Fair is fair.
If there will be drastic cuts in education spending, then there should also be cuts in Medicare spending.
Fair is fair.
Wednesday, March 03, 2010
"Let's Get it Done"
President Obama today, flanked by white coat and scrubs-clad medical professionals, said that the time for debating and floundering is over and it's time to pass a comprehensive health care reform bill -- one that he looks forward to signing into law.
Could this be the beginning of the end of the clusterf*&* of HCR, for now? We shall see.........
Could this be the beginning of the end of the clusterf*&* of HCR, for now? We shall see.........
Friday, February 26, 2010
Molecularly-targeted therapies: hope, and challenges
This is a riveting three-part series about new approaches to treating metastatic melanoma. The road to progress is filled with peaks and valleys, and there's a long way to go. The challenges to targeting the molecular "engines" of proliferating cancers are immense. The NYTimes piece offers a sense of the emotional roller coasters faced by the physicians leading early clinical trials and the patients clinging to the few extra months they have to live.
Enough.
Now I give up.
Health care reform looks to be in peril. Again. What's new?
As a future health care professional (resident, fellow, attending), I have taken an active role in writing, talking, and stewing over HCR debates currently going on in this country.
There has been an abundance of misinformation, grandstanding, and frustration. Many of us who are intimate stakeholders in this game -- who will provide the care in the future -- have wanted it to work. The non-medical professionals -- the citizens, the congresspeople, et al -- have framed the debate in their terms. They say reform, in its current manifestations, is unpopular. They say the American people want to start over. They say health care in America is the best in the world.
OK, let's try it. Let's keep things where they are.
But I have no sympathy for the people who start complaining about escalating costs, overcrowded emergency rooms, and denials of care. Does this sound callous? Absolutely. But enough is enough.
I'm trying to finish a PhD and get back to the wards. I'm trying to become a good doctor. And the whole public debate on health care reform is so pathetic, so "missing the point," so embroiled in death panels; and now, in today's news the opponents of reform (after all "we have the best health care in the world") are suddenly "noble" opponents [go to the New York Times, David Brooks column, examine Politico.com for analysis of the "tie goes to the GOP", and so on]. Look, people who think it's all good: if it's so good for you, then I'll see you in ten years. I'll treat you, but it's going to cost you.
Because everyone thinks it's hunky dory, cool. I will still have a job, I will still get paid, and you're going to pay. So let's all go in on this experiment. See how it works for you.
It's not going to be pretty.
Health care reform looks to be in peril. Again. What's new?
As a future health care professional (resident, fellow, attending), I have taken an active role in writing, talking, and stewing over HCR debates currently going on in this country.
There has been an abundance of misinformation, grandstanding, and frustration. Many of us who are intimate stakeholders in this game -- who will provide the care in the future -- have wanted it to work. The non-medical professionals -- the citizens, the congresspeople, et al -- have framed the debate in their terms. They say reform, in its current manifestations, is unpopular. They say the American people want to start over. They say health care in America is the best in the world.
OK, let's try it. Let's keep things where they are.
But I have no sympathy for the people who start complaining about escalating costs, overcrowded emergency rooms, and denials of care. Does this sound callous? Absolutely. But enough is enough.
I'm trying to finish a PhD and get back to the wards. I'm trying to become a good doctor. And the whole public debate on health care reform is so pathetic, so "missing the point," so embroiled in death panels; and now, in today's news the opponents of reform (after all "we have the best health care in the world") are suddenly "noble" opponents [go to the New York Times, David Brooks column, examine Politico.com for analysis of the "tie goes to the GOP", and so on]. Look, people who think it's all good: if it's so good for you, then I'll see you in ten years. I'll treat you, but it's going to cost you.
Because everyone thinks it's hunky dory, cool. I will still have a job, I will still get paid, and you're going to pay. So let's all go in on this experiment. See how it works for you.
It's not going to be pretty.
Thursday, February 25, 2010
Oh hey blowhards in Congress
Things and people I object to (vis a vis the health care reform "summit" today):
1. People arguing against health care reform, with the conclusion, We have the best health care system in the world. [No, we don't. We have probably the highest quality of care, in a number of top-notch health centers; it's the best health care when and if people can afford the care. Otherwise, we're disgracefully average among developing nations, for a SHITLOAD MORE OF THE COST.]
2. People arguing against health care reform, arguing it costs too much and will raise the deficit, who proceed to rail against cost-cutting measures in medicare, saying, But our seniors won't want their benefits slashed. It's partisan hack-ery; it's pandering; it's hypocritical; it implies that every dollar on medicare is a dollar well-spent.
3. Equally ignorant/partisan Democrats.
4. John McCain.
5. People who have good health care, with comprehensive coverage, who say that people who lack health insurance should start health savings accounts. If someone makes $20.00/hr, how much of that do you someone can set aside into a HSA? What if the person gets cancer? What about this person's children?
6. People who think medical malpractice reforms will magically cure health care of its ills. [No, it won't. States, like CA, who have adopted reforms, are seeing absurd increases in premiums.]
OH HEY LEGISLATORS: HEALTH CARE REFORM NEEDS TO HAPPEN, INCREMENTAL APPROACHES DON'T WORK. OH, AND YOU SUCK.
I have a new rule: no one in congress gets health care until the 30+ million people in this country without health care get it.
Great, problem solved.
1. People arguing against health care reform, with the conclusion, We have the best health care system in the world. [No, we don't. We have probably the highest quality of care, in a number of top-notch health centers; it's the best health care when and if people can afford the care. Otherwise, we're disgracefully average among developing nations, for a SHITLOAD MORE OF THE COST.]
2. People arguing against health care reform, arguing it costs too much and will raise the deficit, who proceed to rail against cost-cutting measures in medicare, saying, But our seniors won't want their benefits slashed. It's partisan hack-ery; it's pandering; it's hypocritical; it implies that every dollar on medicare is a dollar well-spent.
3. Equally ignorant/partisan Democrats.
4. John McCain.
5. People who have good health care, with comprehensive coverage, who say that people who lack health insurance should start health savings accounts. If someone makes $20.00/hr, how much of that do you someone can set aside into a HSA? What if the person gets cancer? What about this person's children?
6. People who think medical malpractice reforms will magically cure health care of its ills. [No, it won't. States, like CA, who have adopted reforms, are seeing absurd increases in premiums.]
OH HEY LEGISLATORS: HEALTH CARE REFORM NEEDS TO HAPPEN, INCREMENTAL APPROACHES DON'T WORK. OH, AND YOU SUCK.
I have a new rule: no one in congress gets health care until the 30+ million people in this country without health care get it.
Great, problem solved.
Friday, February 12, 2010
Obesity shortens lifespan, BIG caveat
A recent newsworthy study in NEJM looked at Pima Indians, from their youth to adulthood, and the data suggest that being obese at a young age and having "pre-diabetes" increased the likelihood of early death.
But, this study was done in Pima Indians, and the Pima have long been known to have a severe predisposition to diabetes and obesity (they frequently show up in medical textbooks as the prototype for a population susceptible to type 2 diabetes); and Native American populations throughout the US and North America have a number of other serious co-morbidities (low socioeconomic status, high substance abuse rates, etc) that could make this study difficult to generalize to the rest of the US population, which of course is highly heterogeneous.
So, this study - targeting a very small and genetically unique population in the US - should be taken with a sizable grain of salt.
But, this study was done in Pima Indians, and the Pima have long been known to have a severe predisposition to diabetes and obesity (they frequently show up in medical textbooks as the prototype for a population susceptible to type 2 diabetes); and Native American populations throughout the US and North America have a number of other serious co-morbidities (low socioeconomic status, high substance abuse rates, etc) that could make this study difficult to generalize to the rest of the US population, which of course is highly heterogeneous.
So, this study - targeting a very small and genetically unique population in the US - should be taken with a sizable grain of salt.
Thursday, February 11, 2010
Questions, Answers
Brief, and certainly random, thought:
Research becomes exceptionally challenging when data can be filtered, distilled, treated, and then presented in such a diverse number of ways so as to obscure the initial question one was attempting to answer. At that point, finding an answer isn't really the problem. Understanding where the question is hiding is the challenge; searching is lonely work, in the sterile confines of a blanked mind...
Research becomes exceptionally challenging when data can be filtered, distilled, treated, and then presented in such a diverse number of ways so as to obscure the initial question one was attempting to answer. At that point, finding an answer isn't really the problem. Understanding where the question is hiding is the challenge; searching is lonely work, in the sterile confines of a blanked mind...
Sunday, February 07, 2010
What?
Step 1: Notice practices reportable to the medical board authorities.
Step 2: No one listens to you.
Step 3: Write letter to medical board.
Step 4: Get fired for blowing the whistle.
Step 5: Get indicted in state court for blowing the whistle.
I mean, say what you want about how things are in California, but really, Texas? That's shady. That there was good basis for complaining about what the physician did seems to be obvious (duh?) evidence against going after the whistle blower...But who knows.
Step 2: No one listens to you.
Step 3: Write letter to medical board.
Step 4: Get fired for blowing the whistle.
Step 5: Get indicted in state court for blowing the whistle.
I mean, say what you want about how things are in California, but really, Texas? That's shady. That there was good basis for complaining about what the physician did seems to be obvious (duh?) evidence against going after the whistle blower...But who knows.
Friday, February 05, 2010
FYI: blows to head cause problems
This is a NY Times editorial pointing out the absurdity that the NFL et al have only recently learned that long-term brain damage results from single, or repeated, blows to the head. The science has long been robust. The denial, persistent.
Wednesday, February 03, 2010
Finish the job, pass the damn bill
Invigorated by recent (and declared, by many, successful) Q&A sessions with House Republicans and Senate Democrats, President Obama is renewing his call for Congress to pass comprehensive health care reform legislation. I hope neither he nor the Congress lets up. Who knows what will happen in the mid-term elections. In the meantime, costs are soaring, and the system is unsustainable.
Monday, February 01, 2010
Concussions in youths
Testifying before congress, Dr. Bennet Omalu states youths who suffer from concussions should be sidelined from participation in sports for at least three months in order to avoid long-term brain damage. Interesting that the sports medicine community appears to be stepping up its research and activism re: traumatic brain injury. This testimony, in effect, says to parents: FYI, concussions are traumatic brain injuries.
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