Category: Public Health

Spare Me The Tire

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Spare tires have become TERRIBLE.

What is the matter with those things?

We call them donuts. But this comparison is a disgrace to the donut. Powdered sugar is more durable.

As for a balloon? I’ve seen sturdier ones at a birthday party.

It wasn’t always like that. It used to be a real tire. Then, something happened. And, its function suddenly became atrocious.

Even the jack suffered a similar fate. It became two chopsticks with a plastic twisty piece overnight. Did all of the automobile manufactures just get together and determine it was time to anger their customers?

Maybe. But, if being a part of America’s healthcare system has taught me anything, it’s that madness frequently has even simpler beginnings.

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Shortly before I entered medical school, a change in healthcare delivery was already taking affect. It was called Hospital Medicine.

Don’t let me confuse you. Yes, we already had medicine going on in hospitals. But, this was indeed something new.

Different doctors (called hospitalists) were beginning to take care of you whenever you ended up in the hospital. These hospitalists weren’t your main doctor—the one who you saw frequently in the clinic. They were different. Your main doctor didn’t go to the hospital anymore.

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How Arbitrary Feels

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We are assembling too many panels of people in the name of health these days. Too many.

They usually seem like a good idea. I’ve been supportive before. I assumed we needed them. More of them.

I might have been wrong.

There was a day when I believed my food would be toxic, my medicine harmful, and my safety gone without them. But, I’ve come to believe I was mistaken.

I was wrong because the medical world is now full of panels. And, paradoxically, it seems more confusing and arbitrary than ever before.

Recently, I’ve taken some interest in economics. I thought I understood it before. That was when I didn’t understand it at all. I used to believe the goal was to create jobs, since jobs obviously drive the economy. I was almost on the right track. Until I realized I wasn’t tracking at all.

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Creating Our Own Hardships

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I enjoy documentaries. My wife says she enjoys watching them with me. The way I usually see it, they help her fall asleep.

But, not this one.

Not Poverty, Inc.

If you haven’t watched it, you should. We both enjoyed it.

It’s not one of these pick-a-political-side kind of shows. For the record, people across the political spectrum have endorsed it. The film has won like forty honors and twelve awards that I know absolutely nothing about. But, if you watch it, you’ll get the gist why.

We occasionally need disruptive thinking. Something to challenge our perception of reality. We actually need more of this when contemplating healthcare delivery, too. But, I’m not talking about that right now.

Poverty, Inc. is about poverty… and the humanitarian aid we use to fight it.

It’s also about government. And, business. And, how the collusion of these things isn’t solving poverty at all. Like I said, you should watch it. It provides you a fascinating perspective.

I won’t give it all away, but there are a few predominant themes that unfold in the film as you watch it.

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To be Great is to be Misunderstood

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In this post, I examine the firestorm surrounding Dr. Lisa Rosenbaum’s article, N-of-1 Policymaking — Tragedy, Trade-offs, and the Demise of Morcellation, which was published in the New England Journal of Medicine in March 2016. To appease the medical pious everywhere, I disclose that I have never met Dr. Rosenbaum in person. I do follow her on twitter @LisaRosenbaum17. I have no financial stake in power morcellation, a medical procedure that I will discuss below. And, yes, I dislike bullies. 

Mostly normal people leading normal lives don’t speak out very much.

They just sit there. They read stuff. They watch news stories.

They may very well be engaged with a topic. But, they will infrequently write reviews or give comments. That kind of stuff usually always comes from the extremes. And, as you know, the extremists either love you or they hate you.

Dr. Lisa Rosenbaum got the extremists juiced up earlier this month by writing an article about the tradeoffs and demise of a medical procedure known as power morcellation. If you’re a normal person that happens to run in my professional circle and have been following this saga, I suspect that you have moved on. That’s what normal people do with non-stories.

If, however, you are an extremist, you continue to write about it. That’s me.

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All Aboard!

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Overdiagnosis.

We are told this is a problem.

It occurs when the bar is lowered for what’s considered a real disease. For example, overdiagnosis presumably exists when we incidentally discover slow-growing cancers in older people. Basically, when we find a cancer that may not kill someone sooner than Father Time. And, as the story goes, we treat the cancer with lots of medicines, tests, and therapies–since the more diseases we diagnose in American medicine, the more treatments we recommend, and the more money we make, right?

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Getting Back to Principles

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Often, things aren’t what they seem.

Take the image above, for example. Which shade of gray is darker? A or B? Look closely. I wouldn’t want you to miss this one.

Now, place your finger horizontally between A and B. Cover up the transition zone between the letters. Block the area with all the shadows. Look again.

Very interesting, right? The two colors are the same. Remember, things aren’t always what they appear to be. In fact, when you find yourself on the side of the majority, you should think even harder.

We already discussed causation and correlation, but it’s time to go deeper than that. Stuff just happens all the time for reasons that we seem to miss. We assume the problem is one thing. At least, it appears to be acting that way on our stage. But, if only we could see deeper. Far below the surface. Would we see things the same way?

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More Data, Less Logic

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Deaths from high blood pressure should plummet under Obamacare.

That’s the title of a recent news story that got my attention.

The article was a press release about a study performed by several non-physician investigators with a background in public health. For those less familiar, public health relates to the science of population medicine, or what’s good for the group is good for the individual. Basically, four non-physician investigators sought to analyze the impact that the Affordable Care Act (ACA), also known as “Obamacare,” will have on deaths in this country due to high blood pressure.

“Deaths should plummet,” says the story.

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Purifying Healthcare (Part 1): Just Another Invented Game?

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Everyone has an angle. Everyone.

Your doctor? Sure. But, he or she isn’t the only one. The pharmaceutical company? Of course. The medical device company? The hospital? The insurance company? You get the point. Everyone has an angle. Everyone has a conflict of interest. Know it. Get over it. It’s time to focus on something else.

Like filling up your car with gas. In fact, you better plug your ears when you do it. Heaven forbid one of those automated messages at the pump convinces you to buy a 42 ounce gulp of Pepsi. Just another angle, my friends. It’s called life.

But, medicine isn’t supposed to have any conflicts of interest, right? Healthcare instead should be like religion, or maybe, like politics… sorry, I’m now getting confused what’s supposed to be pure.

We just live at a time in America where so much of healthcare has become invented. And, the more we keep inventing, the more it seems that we lose track of what matters: the hopelessly out-of-date concept known as the patient-physician relationship.

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America’s Epidemic of “Less is More” in Medicine

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Dr. Atul Gawande is an American surgeon and public health extraordinaire. He is one of the most successful physician authors of this century, and he writes routinely for The New Yorker. His most recent article discussing unnecessary healthcare is, as expected, a good read.

I applaud Dr. Gawande’s passion towards advancing medicine. And, yes, there is universal agreement that we need to be better in America at providing high-quality low-cost healthcare. There just remains disagreement on what our biggest obstacles are, and how they should be overcome.

I agree with Dr. Gawande on some things, but after reading his most recent opinion piece, I must caution you about several medical inaccuracies found within it.

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