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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