Sunday, November 26, 2006

There Is No Healthcare Crisis in the United States

We've heard it before and we'll hear it again (especially come January when the Democrats -- and from one of my previous posts you know what I think about them -- come back in control of the Congress) --- "We have to fix the healthcare crisis in this country!"

Every time I hear something like this, especially from a politician or a lawyer and particularly from anyone even remotely similar to a journalist, it makes me want to rant and rave. Just what I created this blog for.

Why?

Because there is no crisis in the healthcare industry. Never has been. And there won't be one unless the communist left tries to "fix" healthcare.

I can hear the cries of dissent already. "What about all the people who don't have health insurance? What about the people who can't buy their medications? What about the........"

My ranting is caused not because I think that people who can't get healthcare aren't a problem. The issue here is not an issue. It's semantics.

"Words mean things." (Rush Limbaugh) Yes, words do mean things. If we are to state or believe that there is a healthcare crisis, then we must be stating or believing that there is a crisis in the system that actually is providing care to people; there must be problems with the doctors, nurses, hospitals, medicines, ambulances, stretchers, hospital laundries, et cetera, that make up the healthcare system. I maintain that there is no such problem with these entities. I'll go on to say that the United States has the greatest healthcare system in the world. After all, when the world's rich and powerful get sick, do they go to China for their healthcare? To Russia? To Senegal? Even to Britain or Canada? No. They come to the United States. They know our system is superior.

If you pay attention (and it doesn't have to even be close attention) to the crisis mongers, you'll soon note that their complaints seem to have a common refrain. People don't have insurance to pay for.... people can't afford their.... this (fill-in-the-blank with a medical word) is too expensive.....

The common refrain is money.

I will not deny that there are significant numbers of US citizens who cannot afford or have great difficulty affording healthcare. I do not deny that healthcare in this country is expensive. What I do deny is that this is a crisis -- or that it has anything to do with healthcare. The actual provision of healthcare is provided in a monetary vacuum. Does anyone really think that when someone arrives in an emergency department bleeding profusely in a life-threatening way that there is a single caregiver in that place that says or even thinks, 'Now, hold on a minute -- before we start treating this guy, we need to see how much treatment he can afford'?

Just because we have a problem with healthcare financing in this country does not mean we have a healthcare crisis. Words mean things -- and those two phrases -- healthcare financing problem and healthcare crisis -- mean two different things.

The first exists; the second does not.

Sunday, November 05, 2006

Oregon Kills "Physician-Assisted Suicide"

So the Oregon Department of Human Services has decided to no longer use the term "physician-assisted suicide" to describe the process of allowing physicians to assist patients in committing their own self-murder. This change occurred due to the pressure (and apparently threats of lawsuits) from suicide-advocacy groups. Polls had shown that people were more likely to approve legalizing the practice when the word "suicide" was not used to describe it. These proponents are now suggesting new terms (i.e. euphemisms) such as "physician-assisted death", "physician aid in dying" or "hastened death".

I have a suggestion: how about physician-coordinated execution?

Despite the fact that few medical schools use the actual Hippocratic oath, one of the phrases retained in almost all the modern alternatives is: To please no one will I prescribe a deadly drug nor give advice which may cause his death. Hippocrates had it right 2500 years ago. He understood the concept of the slippery slope and cherished the sanctity of human life.

And this is not "colored" by any modern religious theologies. Hippocrates believed in the pantheon of Greco-Roman gods that today are historic anachronisms. His opposition to this practice by today's terms could not be any more secular (or "human-rights' oriented", if you prefer).

Yes, Hippocrates had it right all those years ago. The state of Oregon continues to have it wrong. Most people understand how wrong such a practice is. And the proponents of this abominable practice tacitly demonstrate how wrong it is by having to rename it with a pleasant-sounding euphemism in order to get anyone else to accept it.

Saturday, August 19, 2006

The Lie of Drug Company Profits -- What's the Reason?

Last time I informed you that the complaint that drug company greed was driving up the costs of drugs was actually untrue, and that it was actually part of a coordinated campaign of lies and manipulations by certain individuals. I then specifically identified this group as being the Democratic Party. Now I will explain the reason for all of this.

The purpose of the manipulation is, of course, to serve as a means to a particular end, in this case more power. Power over other people's lives. The only kind of power that means anything in the political world. Many people think that the end is money, but to these people, money is just another way of wielding power.

This is how the manipulation works: If I can get you upset enough about the "fact" that somebody (else) is taking advantage of you, I can get you angry enough to demand change. If I can get enough people angry enough, then I can create a force for change. And if I have been the one creating the upset, anger and now the force for change, I can suggest the alternative improvement that will fix the problem. And naturally, that solution will ultimately leave me and those like me in charge of ever increasing portions of your life, giving me more and more power over you. Yes, the power that these people want is not the power to change things, it is the power to control you.

In this case, the lie is that the drug companies make too much money, and they make it at your expense. This leads to the upset, and makes you angry. When enough people are angry enough, then they propose the solution -- price controls, managed care, a government controlled Medicare Part D, et cetera. Once they control these things, they can tell you which drugs you can and cannot take (via formularies), thus controlling another little part of your life.

When did this begin? And why do I blame only the Democrats? The seeds were likely planted long ago, but this particular manipulation became blatantly apparent during the Presidential campaign of 1992. During this campaign, Bill Clinton strapped a saddle onto the backs of the drug companies, hounding them (and of all of healthcare only the drug companies) about their prices and their "obscene" profits. He rode the drug companies into the White House. But then he made a big mistake.

Instead of trying to bend to his will the force he had created against only the drug companies, he tried to use it to control all of healthcare by proposing the Clinton Healthcare Plan (aka "Hillary Care"). This plan was a none-too-thinly veiled attempt at a government takeover of the insurance industry. But the American people had not been made angry at the insurance companies, so they wisely stopped this plan in its tracks.

Today, the public at large are finally (and more appropriately) being made angry at the insurance companies, who actually are making obscene profits, enough to make the oil companies jealous. And there are those in the political world ready to offer their radical solution.

A single-payer government healthcare system. Government control over every aspect of your healthcare.

Keep in mind that the only healthcare system that the government knows how to run is the VA Medical System. (Medicare is actually an insurance plan, not a medical system.) The VA system is for all intents and purposes a staff model HMO. Managed care. And managed care saves money in only two ways: rationing and cost shifting.

Why blame only the Democrats? It was they that rode the pharmaceutical industry into office. It was they who tried to take over the health insurance industry. And it is only among the Democrats (and a few fringe liberal groups) that one hears the call for a single payer system.

Hopefully the American people will keep their wisdom and kill this idea also. But I'm afraid, very afraid, that the manipulation this time will succeed.

Wednesday, August 16, 2006

Think The Drug Companies Are The Problem? Think Again

Once again it's time to get back to the task of discussing why medicines cost so much. Or in this particular case, why they don't, though you think this is a reason that they do.

If you were to go out on the street and ask people why they think their medicines are so expensive, I suspect the most common response would be something like "Because the drug companies are too greedy!" And it's not surprising that they would blame the drug companies. After all, that's what they've been told is the main problem for years. Unfortunately, what they've been told for all these years is a fabrication. A fabrication constructed for one and only one ultimate purpose -- manipulation to an end.

Now, regular readers here (I am egotistically assuming that there are some regular readers despite the lack of evidence to support this) have already learned about my belief that some things in medicine are done for non-altruistic, power-seeking purposes (see "Medicare Part D Delenda Est!"). This is another one of these purposes.

We have all been led to believe that the drug companies greedily seek exorbitant profits, and that this is what is the major force behind the escalating cost of prescription medicines. This is not really the case. The corporate profits of the drug companies, after expenses including R&D, is no higher and really no lower than that of your average large corporation. (I will fault the drug companies, however, for trying to hide behind the argument 'we need these profits to fund R&D'. R&D is a business expense, everybody else considers it a business expense, you guys consider it a business expense, no one else is ashamed of it and you shouldn't be either.)

The purpose of this fabrication takes a little explanation. In the current twisted field of medical reimbursement, the vast majority of people have no idea what their medical care costs. Medicare or Medicaid or managed care or an insurance company foots the bill, and all most people ever see is the co-pay, if that much. Those few who look at their bills think they are getting a great benefit from how much their doctor charged and got paid by the payor, never realizing that the doctor really only got paid some small percentage of his charges and the rest went away as a "contractual write-off". (This issue itself is another reason I'm nigh on to postal, but that's a different rant.)

Medicine costs are a different matter. Most people either pay for their own medicines or pay a much higher percentage of the costs of their medicines, so they are much more sensitive to this cost. This makes it an excellent target for manipulation. And there is one group that excels at manipulating it.

Some would call this group "liberals". I think this actually maligns some liberals, as little as that is possible. I am more willing to focus down to who it really is that is doing the manipulating with this fabrication, and I am willing to name names.

It is the Democratic Party.

But what is the purpose of this kind of manipulation? What is the goal? What power am I talking about?

More in my next post.

Saturday, August 12, 2006

God Sent Me A Kittycat and His Name Was Toby


Toby was born sometime in 2003; the exact date is known only to his littermates. He died on July 23, 2006 after a lengthy illness. He is survived by his owner, PostalMed, and his constant companion, Tyler. Services were held at a private cemetery belonging to the family.

I lost my friend on July 23 of this year. Already you are probably wondering what this has to do with anything medical, but I'll come to that. But you need a little backstory first.

I have had a few dogs in my life before, but never a cat. I was a dog person; cats were inferior creatures. And all three of my previous dogs had had good, full, long lives. In October 2003 I had been without a pet for some period of time. And then a cat found me. Or rather, God sent me a cat.

One morning I awoke to find a half-grown scrawny cat clinging to the window screen of the breakfast nook like one of those Garfield dolls you've seen stuck to the inside of car windshields. The breakfast nook window faced out onto the covered back porch. Nothing I could do over the next few days could persuade this cat to leave. I swung a broom at him (no, I did not hit him with the broom; I reserve that to those of the human persuasion); I tossed him out into the rain; I tried yelling and other loud noises. He would occasionally wander off but every morning there he'd be, either clinging to the screen or sleeping in an empty flowerpot on the porch. "Well," I figured, "he'll leave when he gets hungry enough." One morning he wasn't there. But wait, there he was, crawling headfirst down a tree in the backyard!

After almost two weeks of this, I couldn't take it anymore. I tossed him a slice of ham (which he promptly dashed off with). Okay, he could be the porch cat. That lasted for about a week, till the first time it got cold. Then in he came. He got a bath and a trip to the vet to check him for disease, but except for some intestinal parasites, he checked out clean from all the usual cat ailments. After about another month I figured it out; his name was Toby. (I have always believed that you don't name a pet; you wait till it tells you (by its personality) what its name is.)

For the first year or so, everything was grand. He played, he ate, he pooped (always in the litterbox; he took to it instinctively), he slept and he slept some more. He grew and became a sleek, sophisticated, elegant, almost professorial cat. He almost never made noise and his meows were quite soft. He tossed his own featherball and then chased it down. He made sure my alarm clock woke me up by crawling under the covers and attacking my feet. He occasionally decided to give my hair an impromptu grooming. (He had a thing about hair, the longer the more fascinating.) He chased the laser pointer to the point of exhaustion. He hid in the laundry sink when my great niece came to visit. And he finally learned to purr, although so quietly you had to almost have your ear in front of his mouth to hear it.

In late 2004 things began to change. He slept more and more. He didn't eat as much. Ultimately he stopped eating altogether. He lost weight -- lots of it. After exhaustive testing (if you knew how much that all cost you'd realize just how postal-crazy I am!) we had an answer. Toby had feline leukemia virus (FLV for short). On his initial vet visit he had tested negative for this and he had been vaccinated, so this wasn't the first thing we checked. And he had never been exposed to any other cats since he had acquired me. FLV has a window period (like another virus we all know and fear), and we had missed it the first time around.

By this time Toby had lost about one-third of his body weight, so nutrition was paramount. Have you ever force-fed a cat? It's an interesting process. Through perseverance and with time Toby regained his weight. And after almost seven months of force-feeding, he began to eat on his own again. We had turned the corner -- Toby would live! But some of his blood counts remained low and his FLV test remained positive. The vet was somewhat less than cautiously optimistic.

For about 9 months Toby did fine. Then he started losing weight again, and quit eating. But this time it was different. The weight loss was rapid, and he actually felt thinner and more fragile than the measured amount of weight loss would indicate. Over the July 4th holiday, he started getting short of breath. So back to the vet he went.

It took the vet only a couple of minutes to discover that Toby had a pleural effusion, fluid trapped between his lung and chest wall, and it was smothering him. The vet removed 250 mLs of fluid (for a cat this is enormous), and then he could breathe better. Analysis of the fluid suggested the cause was heart failure. So we put Toby on Lasix and started to force-feed him again and hoped for the best.

Two weeks later, Toby was short of breath again. The fluid had returned. Only this time the fluid didn't look like heart failure. It was the kind of fluid that is usually caused by cancer. The rapid weight loss finally made some sort of horrible sense. My cat was a candidate for hospice care.

I took Toby home. I decided that if he began to suffer I would take him back to the vet for the final time, but I didn't really want to have to do this. But he didn't suffer. He never looked like he was struggling to breathe, though right at the end he did get cyanotic. Two days later, in the early morning hours of that Sunday, God took back the kittycat he had sent me only three years before.

That cat's death after only three years bothered me more than losing three dogs after 14-15 years each. Maybe it was because we fought so hard together to try to beat that virus. Toby died on July 23, 2006. But really I "lost" my cat in late 2004, when he first got sick. Even after his nutritional rescue, when we thought we had turned the corner, he was never the same cat as he was before. He didn't chase the laser pointer anymore; he didn't play with his featherball; he no longer crawled under the covers to attack my feet. And the quiet purr was no more.

Now comes the medical aspect of all this. Feline leukemia virus is a retrovirus similar to another feline virus, FIV--feline immunodeficiency virus, which is a close cousin to that dreaded human virus, HIV. Of these three, FLV was actually discovered first, in the 1960's, and it was the knowledge of its existence and what it does that led researchers to consider that AIDS might be caused by a virus (which we now know as HIV). Despite its name, the vast majority of infected cats do not get leukemia as was thought in the 1960's and 1970's, hence the name. However, FLV primarily causes immunodeficiency and it is this that occasionally leads to leukemia. FIV, which is even closer genetically to HIV, was actually discovered slightly after HIV. But they are all retroviruses, and they all have somewhat similar effects on the immune system.

Supposedly some researchers believe that FLV/FIV could be used as an animal model for HIV, and that discovering how FLV works and how to treat it would benefit human AIDS patients. A Google search for FLV and FLV+ research does not seem to indicate that this is happening to any great extent. One would think that using cats in research would be cheaper than using chimpanzees (which get SIV); however, it does not look like there is a lot of research going on into looking for treatments for FLV.

If FLV/FIV can serve as models for HIV, then it stands to reason that the biggest bang for the buck in research would be by looking for treatments for FLV/FIV and then trying them on humans, but as far as I can tell, it seems that the exact opposite is occurring. Human AIDS drugs are being tried on cats! Unfortunately, the HIV drugs either do not work or are too toxic to be used in cats. (Cats have very sensitive systems; vets have their work cut out for them taking care of cats.)

So far, there has yet to be discovered any effective treatment for FLV. The Internet is full of websites promoting the use of interferon (human and feline), aloe vera, vitamin C, and other so-called immunomodulator drugs (most of which are either herbal or bacterial extracts) but there is precious little evidence that any of this works. Meanwhile cats continue to die, and even the endangered Florida panther is now threatened by this virus.

Our four-footed companions deserve better than this. My Toby deserved better than this. And many humans in the past, present, and future may have benefited had this avenue of research been pursued more aggressively earlier.

Thank you, Toby, for opening my eyes. Cats are not inferior creatures. They are warm, sweet, cute and cuddly, funny and lovable. They are just as important as dogs and sheep and pigs and cows and horses and little white mice. And if we can learn to heal those animals entrusted to us by God, we might just learn how to heal ourselves.

I miss you, Toby. But I know you're waiting for me at the Rainbow Bridge, along with Duchess, Shaggy, and Scooby Doo. It's going to be quite a reunion someday.

Wednesday, July 19, 2006

Bravo! Thank You, Mr. President!

As he had promised, today President Bush vetoed the embryonic stem cell funding bill passed by the Congress and Senate.

In his written statement to the House as he returned the vetoed bill, he said, "If we are to find the right ways to advance ethical medical research, we also must be willing when necessary to reject the wrong ways. For that reason, I must veto this bill."

President Bush could not be more correct with this statement. Science and nature have insurmountable barriers that cannot be violated (e.g., the Three Laws of Thermodynamics, the speed of light). Ethics and morality have barriers that are just as real but are not insurmountable. But just because something can be done does not mean that it must be done, or even that it should be done. Even surmountable barriers often should not be crossed.

In the early part of the 20th Century, the US Supreme Court upheld a law (since struck down) allowing states to sterilize, without the consent of the patient or their family, the mentally retarded to prevent the contamination of the gene pool. Eugenics of this type was considered scientifically rational at that time; today we consider this repugnant -- because we now know better the ethical and moral swamp that that idea leads to.

President Bush later went on to say, "This bill would support the taking of innocent human life in the hope of finding medical benefits for others. It crosses a moral boundary that our decent society needs to respect."

Let me rephrase this in the form of an analogy. Let's say Congress passed a bill providing funding for the use of the bodies and tissues of executed criminals for medical research "in the hope of finding medical benefits for others". I suspect the outrage would be immediate and highly vitriolic.

The only real difference in the two proposals is that the criminals could actually volunteer for this honor, whereas the embryonic humans cannot. And, of course, the criminals are convicted criminals, whereas the embryonic humans are guilty only of being created and unwanted.

The US House of Representatives has already tried to overturn this veto and has failed.

Let no one fail to realize this: the issue of government funding (with the tacit governmental approval that this implies) of embryonic stem cell research has nothing to do with science or treating disease or helping people.

Embryonic stem cell research to date has shown little scientific promise, with limited to no actual benefits ever having been shown and a significant (greater than 50%) incidence of malignant teratoma formation when it has been tried as a therapy. Somatic (umbilical cord or adult, usually bone marrow) stem cell research, on the other hand, which is not barred from federal funding, has shown some encouraging results in early trials, and does not seem to have any significant risk of teratoma formation.

If there was significant promise for treating disease from embryonic stem cell therapies, rest assured the biotech companies would be funneling large amounts of research dollars into doing this research (private funding for embryonic stem stell research is not banned). As it is, the biotech firms are voting with their dollars -- they are not funding embryonic stem cell research. That alone should be telling.

The promotion against all evidence of usefulness of embryonic stem cell research, and particularly the strident demand for federal funding and thus tacit federal approval, has only one motivation. It is the cry of the anti-life crowd (aka pro-"choice") for a stamp of imprimatur for abortion. How such approval leads to any kind of justification of abortion follows an illogical argument that cannot be understood by any truly sentient being, but it is there nonetheless.

Polls suggest that 70% of the American public supports the idea of federal funding of stem cell research. I'll wager that the majority of this 70% does not understand that stem cell research does not have to be embryonic stem cell research. Furthermore, I'll wager that if informed of the fact that the most promising stem cell research is not embryonic, they would insist that the research funding go into somatic stem cell research.

So thank you, Mr. President. Ethics and morals and science are on your side.


P.S. Senator Frist, you are a physician. I cannot believe you do not understand this.