Incidently, I think it's very cool to have a forum such as this where persons of such varying opinions and backgrounds can discuss things.
I have been much edified by the process.
Three cheers for Dale and his fabulous forums!
Of coures none of this rubbish is nearly as important as whether or not it really is possible to buy a Generation Hi-D that is playable right out of the box.
claudine wrote:Neither in France nor in Germany is the health care socialized. They have social security, but not a socialized health care.
Good catch, Claudine.
You'd think I'd have thought of that. Went right by me.
I also experienced the much maligned English health care system (I do believe that one is socialized, or state-run, isn't it?). Maybe I lucked out that time, but I couldn't complain about it either. Maybe I just have low expectations!...
Doc Jones wrote:For the record, it was in Great Britain that my brother (the neurosurgeon) spent most of his time and formed the opinions which he shared with me.
Also Patrick, I'm glad all the doctors in Europe and Canada were nice to you and helped you feel better.
Doc
And of all the places, Britain is the one where I didn't spend enough time to form an educated judgement, so your brother's opinion is probably the more accurate one.
But more to the point, nobody asked why every damn place I go, I wind up in the emergency room! That's the mistery I would like to solve!
pthouron wrote:But more to the point, nobody asked why every damn place I go, I wind up in the emergency room! That's the mistery I would like to solve!
I meant to ask you about that. Maybe you should stay home more.
Doc, I'm grateful to you for these posts, because
they express my thoughts about medical care
better than I could.
I wanted to express some pretty inchoate impressions
and ask you (and others) what you think of them.
In a weird way, I think we may already have an informal national
health care program. My information is that many
hospitals are routinely treating people who have no insurance
and can't pay--they're eating the costs by, in effect, passing them along
to insurance companies. I take this to be one (just one) of
the reasons that medical billing of insurance companies
is so very high. So insured workers and employees are,
in a rough and ready way, carrying those who can't get
insurance (my understanding is that many of the uninsured
are working young people who feel they don't need
insurance). Instead of taxpayers.
It's hard to see what's going on as good,
though I'm convinced it beats the government bureaucracy--
and I share your
vision of long lines of sick people waiting for inferior health care that is
less available than it is now--and ultimately more expensive.
(And God help the handicapped, etc.) But now the insurance
companies and the HMOs are the bureaucracy--
still they're more manageable than government
bureaucracy and some market
forces remain in play. Also we can sic the government
on 'em.
The more I see of health care the less I like
what I see--I can't seem to find a primary care physician.
The last one yelled at me two days after I first saw him,
because I insisted that I ask him questions about a blood
test. The one before yawned uncontrollably throughout
my first physical. The one before made mistakes with
medication and didn't know enough to refer me
to a specialist. Doctor's offices seem increasingly
hard to deal with. Every time I go into a hospital I see
scary things, incompetence, unprofessiionalism,
safety procedures violated, and always the obfuscating
bureaucratic response to complaints (oh, god, we can't
admit something went wrong, we'll be sued!)
I think there is a lot of unecessary surgery,
and on at least one occasion I know (and know why) I was
deliberately misdiagnosed.
I don't think it used to be this way, but maybe
I didn't have my eyes open. But things seem to be
changing for the worse. Any ideas, especially from
people who might work in these professions?
We seem to be evolving a sort of capitalist form of
national health insurance, where insurance is
changing the face of medicine. Best
I tried to read this thread, but gave up after the second page.
<i>The very powerful and the very stupid have one thing in common. They don't alter their views to fit the facts. They alter the facts to fit their views. Which can be uncomfortable if you happen to be one of the facts that needs altering.</i>
I don't think any of the usual economic models works very well for health care. Socialized medicine, as others have pointed out, seems to work well in some places but a giant new U.S. Gov bureaucracy is pretty scary to most Americans, even us much-maligned left-of-centers. I don't think free enterprise works entirely either. Although I think the profit engine has certainly driven medical progress, there are problems with application of free market economics to medical care, especially out there in the clinical trenches. While we can all feel pretty good about saying "Dale doesn't get a big plasma tv unless Dale can afford it," I don't think many of us are going to feel good about saying "Dale doesn't get kidney transplant unless Dale can afford it." (Especially Dale). As jim stone points out, we already have a weird hybrid of socialized medicine, of a sort, and the free market system. As a health care provider AND consumer, I think it would be a terrible mistake to say, "Our health care system is great-- let's just leave it alone." There are inequities and barriers and problems. But, I do think keeping the basic economic model we have and reforming aspects of it to address the big problems is the way to go.
Gee. All of this from one little 17-syllable pseudopoem.
Two of the contributing factors to the high cost of healthcare are insurance (especially the abuse of it) and litigation.
I have two brothers that are physicians and one that's an attorney. I, of course, am a country vet.
I perform abdominal surgery under general anesthesia with complete pre-surgical labs and charge $300-400.
Try to get my brother (also a surgeon) to do the same procedure and see what it will cost.
The reason?
I have one employee. She is my manager, surgical nurse, chief cook and bottle washer.
My brother has six employees. Amost all of them do nothing but insurance paperwork.
When someone comes to me with a sick pooch I do all in my power to diagnose the problem and fix it and nothing more. No unnecessary lab tests (after all insurance will cover them) and no extra diagnostics or unnecesary surgery just to cover my butt so I don't get sued.
My malpractice insurance is quite reasonable. My brother pays six figures a year for his!
I understand that people are not dogs (well at least most of them aren't) and that their healthcare will be inherently more costly due to the value of human life (after all you can't just run down to the pound for a new husband....well not generally) but I believe that the way I practice medicine is the way my physician counterparts used to practice medicine.
I realize that we have lots of new diagnostic toys than we didn't have 20 years ago and that MRIs ain't cheap but I believe if the Docs weren't scared spitless of being sued every time they turn around our healthcare would be much better and much less expensive.
Maybe the solution would be to limit jury awards to plaintiffs so the lawyers would stop chasing ambulances. I don't know.
Maybe sick people should just go to their vet.
One of my farmers came in the other day coughing his brains out.
"Doc" he says "you got some medicine for my dog he's real sick...cough...cough".
"I don't know" I say "how much does your dog weigh?"
I tried to read this thread, but gave up after the second page.
I pretty much ignored it until today because I'm a basically uncultured boor who avoids anything that even MIGHT be poetry. But today, seeing how big it had gotten, I read it. (sigh) All of it. Believe me, yours was the more logical response.
Would also like to see you, DJ. Last doc insisted I do bloodwork as part of
my physical to see if I had hepatitis C due to a tatoo in
1972. No symptoms in 31years.
Doc Jones wrote:
Maybe sick people should just go to their vet.
One of my farmers came in the other day coughing his brains out.
"Doc" he says "you got some medicine for my dog he's real sick...cough...cough".
"I don't know" I say "how much does your dog weigh?"
"Oh he's about 260 pounds" he says :roll:
Anyway, just my two bits.
Doc
A lot of farmers around here get injectable antibiotics for their cattle, let's just say some of it ends up in animals of the two-legged variety. They also swear udder balm beats anything the dermatologist gives you.
Here are a couple of the problems I can see with our healthcare system.
First, the insurance companies make more money if they don't pay for healthcare, which has created a built-in barrier to patients getting the healthcare they need.
My wife's a physician. I go through all the family bills with her, and it astonishes me every time we open a medical bill. The insurance company, which she has through her employer (the major healthcare provider for this area), systematically declines to pay for virtually any health service she receives despite the fact that they get an impressive chunk of money from every one of her paychecks.
Every time a medical bill comes in, she has to take it to work, call somebody and get them to run the claim through again. And again. And sometimes again. It's not unusual for it to take three tries before the insurance company finally pays for routine, covered medical care.
In addition, it's very often not the physician, but the insurance company that is actually practicing medicine. Day in and day out, my wife must find out what a patient's insurance will pay for before she can write a treatment plan. Very often, it is not the treatment she feels would be best for the patient (even though it is often less expensive than treatments the insurance will accept) and she is prevented from using her best medical judgment.
The second major problem I see with our healthcare system is that it is heavily skewed towards profits. I don't know how to get around this, but it's a serious problem.
I could give you many examples, but I'll just list a few.
A couple of nights ago, I watched a report on one of the TV magazine shows about a hollywood movie director whose son had been desperately, heartbreakingly ill with epilepsy. None of the drugs helped him, and he was in danger of permanent brain damage if the seizures couldn't be curtailed.
Finally, the father took matters in his own hands and studied everything he could find about epilepsy. Eventually, he learned about the ketogenic diet for epilepic children, which has been around for maybe 70 years and works in a significant percentage of patients for whom all drugs have failed, although no one understands exactly why.
This was maybe six or seven years ago. The son is now completely (and apparently permanently) free of epilepsy and able to eat normally again, which happens in a fair number of cases treated with the ketogenic diet for two years or longer.
Because the man is an influential figure in the entertainment world, he's been able to create a foundation, make a movie about the treatment ("Do No Harm" with Merly Streep) and bring enough serious attention that it is now being accepted as a legitimate resource for epileptic children.
But before he did that, virtually every pediatric neurologist would completely ignore the ketogenic diet as an option, in favor of prescription drugs, even though the diet has proven to be far more effective in certain kinds of cases for decades.
The reason it's been ignored is that the diet isn't profitable for any large commercial entity to pay the equivalent of an army of drug reps to walk into every doctor's office and tell them about the treatment. So the doctors just didn't know. What they did know about was the drugs, because that's what they hear about every week from the drug reps.
Another example of this is magnesium.
Your muscles need magnesium to relax and calcium to contract. It's very simple. Magnesium deficiency is extremely common, estimated by some nutritionists at 70% to 80% of the population. If you ask your doctor, "How's my magnesium?" he'll say, "Fine. Perfectly normal." What he really means is, your serum magnesium's fine. He has no idea whether or not you have a magnesium deficiency because he hasn't been taught how to look for it.
The body will steal magnesium from everywhere else in the body before it will allow serum magnesium to fall below normal because magnesium is one of the important electrolytes needed to keep the heart from going into arhythmia. The correct test for a magnesium deficiency is a test where the magnesium in the blood cells (not serum) is measured. If there's a deficiency, the body will have pulled magnesium out of the cells (which will then have less than normal magnesium) to keep the serum level normal so the heart will continue to beat properly.
But even that is only a screening test. The definitive test for magnesium deficiency is a 24 hour magnesium loading urine test. There are some doctors who know this, but they are very few.
Why is this important? As I said, magnesium is necessary for muscles to relax.
Every patient who presents with hypertension (and numerous other complaints, particularly any that may be associated with spasm of any kind) should be evaluated for magnesium status. In many cases, correcting a magnesium deficiency will normalize high blood pressure, without drugs. Or asthma. Or back pain. Or anything else that's associated with spasm.
Why isn't this being done? Because magnesium can't be patented, so no one has a profit incentive to promote its use. Instead, we have calcium channel blocker drugs, which can be patented.
Remember, magnesium is necessary for muscles to relax; calcium is necessary for muscles to contract. Instead of providing the needed magnesium so the muscles of the cardiovascular system can properly (and naturally) relax, let's prescribe something that will inhibit the action of the calcium instead. We can patent that, so that gives us a financial incentive to go into doctors' offices and teach them how to use calcium channel blockers to treat hypertension.
A third example I'll give is cortisone. When most people hear the word, they think of the well-known, dangerous side effects of overuse.
However, cortisone is a natural hormone in the body, just like thyroid or any other hormone.
In the 1940's, when cortisone was first being investigated, it seemed like a miracle drug. But then the side effects began to emerge, and pretty much the whole medical system has shied away from it except for a few, very specific uses, mostly at dosages far above what naturally occurs in the body.
The main exception to this is Addison's disease, (which John Kennedy had, incidentally). Addison's disease is a complete inability of the adrenal glands to produce cortisone.
However, it is just as likely that someone will be mildly hypoadrenal (meaning that there's only a slightly reduced ability to produce cortisone, rather that a complete shutdown as in Addison's disease) as it is that that they'll be mildly hypothyroid, which is a very common condition.
But doctors aren't taught that cortisone (in physiological dosages, that restore the body's natural levels) can be extremely helpful in numerous conditions that the vast majority of physicians are only able to treat symptomatically or not treat at all. These include chronic allergies, autoimmune diseases, chronic fatigue, etc.). Very few doctors are educated to evaluate a patient for mild adrenal insufficiency, even though it's very common.
Why not? Because cortisone has been out of patent for a long time, and no drug company will ever pay the $100 or $200 million for the documentation and approval process on a new use for cortisone. There's no profit incentive. It will simply never happen.
Some years ago, Dr. Abraham Hoffer, a Canadian psychiatrist, developed an effective treatment for schizophrenia that is based on what he was able to learn about the biochemistry of the disease. He identified two abnormalities in catecholamine metabolism, one of which is vitamin B6 mediated, and the other of which is the result of excessive oxidation of catecholamine metabolites, resulting in the overproduction of something called adrenachrome, an endogenous hallucinogen.
He developed a treatment that uses vitamins B6 (to facilitate the correct molecular transformation instead of the abnormal one) and C (to prevent the oxidation that produces the hallucinogenic end product). This is known by those who are familiar with his work, but to virtually no one else. The treatment must be admisistered by a compentent practitioner, preferably a psychiatrist who is able to carefully adjust and eventually wean the patient off the anti-psychotic drugs.
But it does work. Far better than drugs. And very few doctors know about it because vitamins B6 and C can't be patented. There's no profit incentive for anyone to follow through and bring the treatment into the mainstream.
Dr. Hoffer felt he had identified some, but not all the metabolic abnormalities associated with schizophrenia. Regretably, no one ever stepped forward with funding that would have allowed him to carry the work to its completion. Again, because there's no way anyone would have been able to recover their investment and make a profit from doing so.
There are several more examples I'm familiar with, but I won't try to list them. If these few examples have come to my attention, how many more such treatments are there? I suspect there are hundreds, more effective, cheaper, safer than the drugsandsurgery-oriented modalities on which our healthcare is primarily based. But because there's no profitability associated with them, they remain virtually unknown.
It's a serious flaw in our healthcare system, and I've no idea how we might go about correcting it.
