Doctors are supposed to know everything, right?

18 06 2010

A friend of mine passed along an article from the New Yorker by Atul Gawande entitled ‘The Velluvial Matrix’.

As doctors, we all know what the Velluvial Matrix is, right?  I had to double-check, myself, but it turns out that it doesn’t exist.  The article is an enjoyable read for any physician; it’s one of those oh-my-gosh-that-totally-happens-to-me-all-the-time articles.

Excerpt:

Since I graduated from medical school, my family and friends have had their share of medical issues, just as you and your family will. And, inevitably, they turn to the medical graduate in the house for advice and explanation.

I remember one time when a friend came with a question. “You’re a doctor now,” he said. “So tell me: where exactly is the solar plexus?”

I was stumped. The information was not anywhere in the textbooks.

“I don’t know,” I finally confessed.

“What kind of doctor are you?” he said.

I didn’t feel much better equipped when my wife had two miscarriages, or when our first child was born with part of his aorta missing, or when my daughter had a fall and dislocated her elbow, and I failed to recognize it, or when my wife tore a ligament in her wrist that I’d never heard of—her velluvial matrix, I think it was.

This is a deeper, more fundamental problem than we acknowledge. The truth is that the volume and complexity of the knowledge that we need to master has grown exponentially beyond our capacity as individuals. Worse, the fear is that the knowledge has grown beyond our capacity as a society. When we talk about the uncontrollable explosion in the costs of health care in America, for instance—about the reality that we in medicine are gradually bankrupting the country—we’re not talking about a problem rooted in economics. We’re talking about a problem rooted in scientific complexity.

These sometimes awkward situations are especially common, I feel, for Pathologists, as we do not even have the day-to-day contact with patients that primary care docs do.  Heck, I have no idea where my ophthalmoscope is, and I currently use my stethoscope as a make-shift stud-finder!  Yet, as doctors, our friends and family definitely expect us to be the final answer on anything from rashes to cancer.  Of course, I’m not saying that I don’t remember *ANY* of my training- I can still answer some basic questions, or I at least know where I can go to get an answer, and I can still do a physical exam if I had to, but I feel that it’s pretty safe to say that other people greatly overestimate our memory banks.  [Note: For some reason, I feel like a magician that just showed the audience how he did his trick.]

When I first graduated medical school, empowered, I tried to be that endless fund of medical knowledge for anyone who had questions.  Now, as a fourth year resident, if there is a question I am not prepared to answer, I will tell people that they should see their doctor!  I guess that some people will think that that is a cop-out answer, but I think it is more a demonstration of learned temperance, such that by saying “I don’t know”, you are actually being more wise.

The article goes on to talk about health care reform, etc., etc. but the first half is quite enjoyable and thought-provoking.





New York: Get a flu shot, or get fired.

15 10 2009

I’m not sure if this kind of mandate has been rolled out across the country, but here in New York, we were told, up front, that the entire hospital staff was required to get a flu shot this year (and the swine flu shot as well when it comes out) OR face termination.  Fired over a flu shot?  I thought Cleveland Clinic’s anti-smoking policy was pushing it…

There have already been talks of protests and law suits here in Albany.  Personally, I’m indifferent, but I guess I can see their point- being forced into doing something they otherwise would not have done, but is it worth a law suit?  Probably not.

I’ve heard a few different explanations for dissent.  Perhaps the most interesting reasoning I’ve heard is this- because the flu shot is offered for free or reduced cost by the drug companies, the companies are protected from litigation if a patient is injured as a direct result of the vaccination.  Another question to be asked would be, “Does the punishment fit the crime?”  Is termination the proper penalty for not receiving a shot?  They require house staff to be up to date on their vaccinations, after all.  So is that any different?  I suppose.  Can you fire an employee for poor hygiene?  Either of my examples could perceivably place patients at risk, but it’s not clear to me that either of these would be enforced.  Finally, do ALL employees really need the shot, even those with no patient contact?  As a pathologist, I did ask myself that question.  Sure we have some patient contact, and we surely have contact with other employees that do have contact with patients, so I suppose the idea is to cover all your bases and just vaccinate everyone.

In the end, it seems clear to me that the New York State government has gotten swept up in the media craze surrounding the H1N1 virus, which, as a concept is sad, but in practice is probably better for everyone in the long run.  I do wonder, however, if we will be required to get our flu shots next year too… 😉





Albany Medical Center’s CEO Defends the Public Option

7 10 2009

barba

Below is a link to the mp3 of an interview with Albany Medical Center’s CEO Jim Barba in which he defends Obama’s Public Option proposal.  The interview originally aired on Siena College’s WVCR Radio Station.

I thought it was a very interesting perspective, and is yet another health professional coming out in support of the public option.  Interesting!

He goes on to talk about the viability of a single-payer system as well (waters far too murky for me).

I guess when I’ve thought about health care reform, I had never really imagined that the CEO of a hospital would support a single-payer system…  A public option? Sure, but not single payer.  He does make an interesting argument, however.

Definitely worth a listen!

AMC CEO Supports Public Option





Health Care Reform: Live Blog Discussion

18 08 2009

I had a lively discussion today defending the “public option” component of health care reform.  Below is what transpired; I thought the different view points were quite interesting and well worth sharing.  Please contribute your own thoughts below! (Note: I am not personally committed to one side of the fence or other, but today I defend the ‘public option’.)

Medicare overhead: 4%. avg private insurance co: 30%!! Sickening! And you don’t want a public option? Bloat FAIL.
4 hours ago via Selective Twitter Status · Comment · Like
HD: Nope!!!!!!  My friend’s Uncle lives in Italy (public health care) and was in an accident recently. He broke his pelvis and both arms. His wife broke her hip and arm. They sat in the hospital for almost THREE weeks before they were even seen by a doctor!!!!!!!! No, No….funk NO!!!!!!!!!!
CB: If the Freekin politicians would BEGIN health care reform with TORT reform, we could immediately see a 30%plus decrease in rates. But, the vast majority of politicians ARE lawyers and lawyer make up the LARGEST lobbying bloc in Washington, I guess everyone BUT lawyers are going to be screwed by the rising costs of health care. What we need is the BOOTH health care reform plan, Tort reform, portability of policies, competition across state lines, and an assignment pool for newcomers to the system based on the health of the individual and spread out proportionally over all insurance providers. Then since no one can MAKE someone go to the Dr. for checkups and Preventive care (much cheaper than care once you are sick) I would give tax credits to those families and single users who provide proof hat they GO for physicals. My son Kevin fell and cut his head, (no swelling) and they gave him THREE G.D. MRI’s because they were afraid of laysuits.
MW: No.. from what I hear. If we had this wonderful health care system when Madison was sick.. she wouldnt be here today..We wouldnt have had to choice to go to A.I dupont nor have the pediatricain who saved her life. it would also fine small business if someone doesn’t have health ins. offered by them… oh and ppl are asking will I be able to have my doctor(s) and Obama says yes but he forgets to add in but only for 5 years… and yes its sickening on how much private ins companies make and what I have to pay out of pocket and that I have to fight w/ BCBS all the time and I have to pay more because of the ppl who dont have ins . But I want to have to choice to have the best …not you get what you get .things do need to change but its within the ins companies
LC: I honestly don’t know enough about the healthcare that Obama is proposing but, as a person who lives with public healthcare – no thanks. It’s not the doctors or nurses, it’s the way the health department is managed by the gov’t and, at least in Ireland, they are doing a shit job.
RM: Sigh. I am doing a rotation at the NHS in scotland right now. Their heatlhcare is miles ahead of what Americans receive. Let’s clarify a few myths. They don’t put you out to pasture at 70 yo, you do have a choice of what doctor you want to go to. You don’t have to wait months for medically urgent procedures (ie breaking your pelvis and arms). It’s sad how misinformed most americans are about how health systems are run. Devaluing publically funded (NOTE: not publically run) systems and overvaluing our lack of system we have now.
As it goes for preventive care. I recognize that this will not reduce costs, but will make our population healthier for longer. Increasing our societal gain and for that I am for it.
ME to HD: Do you know who has the public option right now in these very united states? Every old person and every war veteran. I can tell you from personal experience, that the folks at the VA get treated just as fast as anyone else does, and certainly not like your experience in Italy. People that are against health care reform are using scare tactics and are fraking outright lyinhg about what would happen. So let me be clear again, a public option already exists in the VA and with medicare and what is being proposed would be an expansion of that, and would NOT be the complete rehashing of health care into an italian system.
CB: Her dad spent most of the last 18 months of his life in and out of the VA in montrose, and if that is an example of what ObamaCare will be, Just shoot me like a dog first. IT WAS HORRIBLE
ME to CB: I totally agree with you on all counts, except the last. Tort reform is needed and is blocked by the lobby.
For me portability is the SINGLE MOST IMPORTANT THING to the success of health care in America. I cannot stress that enough… The reason Insurance companies dont cover yoga and gym memberships but will pay for freaking gastric bypass is because everyone is locked into the same insurance company that their job picks, if they switch jobs, which most ppl will almost certainly do, then that company has no reason to pay for primary prevention because they will never see the fruits of their labor. FAIL.
The point of contention I have is this assigning of ppl to health insurances in a distributive manner. i think this is FAIL (if i understand you completely) because that totally does away with competition all together, right? we need competition to drive down costs.
tax credits for going to check ups is sticky issue. i agree that most ppl in america are fat and lazy and
about an hour ago · Delete
ME to MW: my understanding is that the public option is just that, an option. if you want to stay with your superior and therefore more expensive health care insurance provider you can. thats the beauty of the open market. and by providing a cheap alernative to everyone- that way everyone can have at least ok health care and your costs might go down in an effort to compete with the national option. ultimately you will always have the choice, or at least your employer will 😉
Also i think it’s important to point out this: at the VA if someone can’t get the treatment they need THEY WILL ABSOLUTELY SEND YOU WHEREVER YOU NEED TO GO TO GET THE PROPER TREATMENT. so if things go as planned youd have been fine still- public option does not mean AT ALL that you wouldnt get the right treatment. that’s simply not true and im basing that on 6 years of direct exposure to the public option at the VA…
ME to LC: it does depend on the govt doing a not-shit job but that’s why i posted the original comment. 4% overhead vs 30% overhead… who’s doing the shittier job? The VA and medicare system work really well over here. but, of course, we need to be cognizant of slipping into a faulty european style system…
ME to CB: what was so bad about it? here in albany it is staffed by the same residents and the conferences are the same ppl… the only difference is that 1) you can still smoke inside at the VA and 2) the VA has an awesome EMR system in place… lol
CB: The Publc “option” will end up taking away everyones private insurance. Why would companies want to waste their resourses in HR and elsware dealing with insurance problems. a small raise to the employee, pay your own ins to the gov’t and i wash my hands from the problems and expense.
And the VA Sucked, make an appointment to see a Dr. and he isn;t even there, thinds stolen or misplaced from the rooms. Can’t find Sharons dad, because he ewas sent somewhere else without telling anyone….. sucked.
AF: All I can say is that now being a UK citizen (as well as US…)and having being made redundant recently I thank god that I am living in the UK and have the right to the NHS…..the system is not perfect but you do have the right to care without any cost which is pretty difficult for most Americans to believe – plus if you are in an emergency, the emergency care is state of the art – I still have the right to COBRA under the US system to extend my private health insurance but it is expensive….I’m lucky that I can still afford it, but what if I could not? If I were in the US I would be out of luck…you hear often that the US provides the best health care in the world which is simply not true – you just need to look at the US system from an outside perspective to really understand this…
ME to CB: im not sure i follow your logic in the first paragraph, but ill say this: if the public option causes private insurance cos to go out of business, i say good eff them, they are the most bloated effing worthless pieces of crap (aside from the tobacco lobby) that i can think of. one of the HMO CEO’s is like the 6th richest man in the world… and for what?what? what do health insurance companies actually do? You got ity NOTHING. The whole POINT of a public option is to foster competition which would in turn force insurance companies to tighten their wastebands to compete. and the glorious thing about competition is that, as in michelles case above, you still have the option of paying for your stupid expenizve health care that will give you yearly body scans and treat your brain cancer when you are a 100 fraking years old… knock yourself out! lol.
BUT as it stands, with the public option, your employer could choose it or could not, if they do because there is less paperwork then, damn, those other companies better cut down on the paper work. health insurance is evil and bloated, competition will force them to suck it the eff up. that 30% overhead is OVER A TRILLION DOLLARS so cutting that fat would in itself pay for the whole public option. that money is going to ppl that dont do anything that dont deserve your money and dont give you your care.
I think your experience with the VA is unfortunate, but i can absolutely assure you of this: that TOTALLY happens at every hospital, and although it does happen, it would be unusual for any hospital including the VA…
ME to AF, your comments are well-received.
Cobra is obscene. how anti reofrm proponents cite that as an option is ludicrous, nobody can afford it.
also, “america provides the best health care” is a phrase totally misused.first, anti-reformists use it to stir nationalism in feeble-minded americans cuz america is just the best at everything… except for modesty and self-awareness 😉 second, we do have the best doctors, no doubt, but that’s cuz we pay them the most (which i am ok with). BUT. Third its the most bloated health care system- the throw money at a problem solution is bunk and wasteful. there are more MRI machines in seattle than in all of canada… srsly wtf.
10 minutes ago · Delete
ME: Additional comment for everyone: I don’t mean to be insensitive and im not suggesting the old person death farms that ppl are being so overdramatic about but, let’s be honest: grandma’s alzheimers is going to get worse and kill her for sure, and your cousin in the motorcycle accident is not going to come out of that coma after 40 years… as a doctor i realize the difference between hope and selfishness, its too bad patients families generally don’t…

Opening Statement: From CNN this morning – “Medicare overhead: 4%. Average private insurance company’s overhead: 30%” – and you don’t want a public option?

Person 1: No!  My friend’s uncle lives in Italy (public health care) and was in an accident recently. He broke his pelvis and both arms. His wife broke her hip and arm. They sat in the hospital for almost THREE weeks before they were even seen by a doctor! Absolutely NO!

Response: Do you know who has the public option right now in these very United States? Most retired folks and just about every war veteran. I can tell you from personal experience, that the folks at the VA get treated just as fast as anyone else does, and certainly not like your experience in Italy. People that are against health care reform are using scare tactics and are in some cases out-right lying about what would happen. So let me be clear again, a public option already exists in the VA health care plan and with medicare and what is being proposed would be an expansion of that, and would NOT be the complete rehashing of health care into an Italian (or Canadian for that matter) system.

Also, it should be noted, that with VA healthcare, the hospitals and clinics are also run by the government.  So this is different than just government-run health care, this is government-provided health care, which, obviously comes with its own set of issues.

Person 2: If politicians would BEGIN health care reform with TORT reform, we could immediately see a 30% plus decrease in rates. But, the vast majority of politicians ARE lawyers and lawyer make up the LARGEST lobbying bloc in Washington, I guess everyone BUT lawyers are going to be screwed by the rising costs of health care. What we need is the MY health care reform plan: Tort reform, portability of policies, competition across state lines, and an assignment pool for newcomers to the system based on the health of the individual and spread out proportionally over all insurance providers. Then, since no one can MAKE someone go to the Dr. for checkups and Preventive care (much cheaper than care once you are sick) I would give tax credits to those families and single users who provide proof hat they GO for physicals. My son fell and cut his head, (no swelling) and they gave him THREE MRI’s because they were afraid of lawsuits- ridiculous.

Response: I totally agree with you on all counts, except the last; I agree that tort reform is needed and is blocked by the lobby.

For me, portability is the SINGLE MOST IMPORTANT THING to the success of health care in America. I cannot stress that enough. The reason insurance companies don’t cover things like yoga and gym memberships but will pay for gastric bypass is because everyone is locked into the same insurance company that their job picks.  If they switch jobs, which most people will almost certainly do at some point, then that company has no reason to pay for primary prevention because they will never see the fruits of their labor.

The point of contention I have with your statement is this assigning of people to health insurances in a distributive manner. I think this may not be a good idea because that totally does away with competition all together, right?  We need competition to drive down costs.

Finally, as far as tax credits for going to check-ups is sticky issue. i agree that most people in America are not good at following up on things in general, and bribing them with tax credits might work, but I think that is a dangerous precedent to set (like paying kids to get A’s- it apparently works, but I feel is morally questionable).

Person 3: No, or at least not from what I hear. If we had this wonderful health care system when my daughter was sick, she wouldn’t be here today.  We wouldn’t have had to choice to go to A.I Dupont, nor have the pediatrician who saved her life.  It [the plan] would also fine small businesses if someone doesn’t have health insurance offered to them.  In addition, people are asking if they will be able to keep their doctor(s) and while Obama says, “yes”, he forgets to add in,  “but only for 5 years”. Finally, yes it’s sickening re: how much private insurance companies make and what I have to pay out of pocket and that I have to fight with BCBS all the time and I have to pay more because of the people who don’t have insurance, but I want to have to choice to have the best  and not just what you get.  Things do need to change, but it’s within the insurance companies.

Response: My understanding is that the public option is just that, an option. If you want to stay with your superior, and therefore, conceivably more expensive health care insurance provider, you can. That’s the beauty of the open market. and by providing a cheap alernative to everyone, everyone can have at least OK health care, and your costs might go down in an effort to compete with the national option.  Ultimately, you will always have the choice, or at least your employer will, which is a different problem all together.

Also, I think it’s important to point out this: at the VA if someone can’t get the treatment they need THEY WILL ABSOLUTELY SEND YOU WHEREVER YOU NEED TO GO TO GET THE PROPER TREATMENT.  So, if things go as planned you’d have been fine still.  The public option does not mean AT ALL that you would not get the right treatment. That’s simply not true, and I’m basing that on 6 years of direct exposure to the currently established ‘public option’ type prototype at the VA.  Again, care for vetrans at VA hospitals is compounded by the fact that it is government-run provision as well.

Person 4: I honestly don’t know enough about the healthcare that Obama is proposing but, as a person who lives with public healthcare (in Ireland), I say, “no thanks”.  It’s not the doctors or nurses, it’s the way the health department is managed by the gov’t and, at least in Ireland, they are doing an awful job.

Response: It does depend on the gov’t NOT doing an awful job, but that’s why I posted the original comment: 4% overhead vs 30% overhead- who is doing the worse job? The VA and medicare system work really well over here for the most part, but, of course, we need to be cognizant of slipping into a faulty version of an European-style system.

And again, I will reiterate, that a single payer system is an AWFUL idea.  That would create a veritable monopoly, and we would wind up with the same problems as the Canadian system, which, if you ask many Canadians, is not good either.

Medical Student 1: Sigh.  I am doing a rotation at the NHS in S right now.  Their heatlhcare is miles ahead of what Americans receive.  Let’s clarify a few myths.  They don’t put you out to pasture at 70-years-old, you do have a choice of what doctor you want to go to.  You don’t have to wait months for medically urgent procedures (i.e.: breaking your pelvis and arms).  It’s sad how misinformed most Americans are about how health systems are run. Devaluing publicly funded (NOTE: not publicly run) systems and overvaluing our lack of system we have now.

As it goes for preventive care- I recognize that this will not reduce costs, but will make our population healthier for longer. Increasing our societal gain and for that I am for it.

Person 2 Post 2: [re: his personal experience with the VA] My father spent most of the last 18 months of his life in and out of the VA, and if that is an example of what “ObamaCare” will be, just shoot me like a dog first. IT WAS HORRIBLE.

Response: What was so bad about it? Here, in Albany, the VA is staffed by the same residents, features the same education/ conferences, the care is very evidence-based and, also, the VA has a well-developed EMR system in place, that’s arguably the best in the business.

Person 2 Post 3: But the public “option” will end up taking away everyone’s private insurance.  Why would companies want to waste their resources in HR and elsewhere dealing with insurance problems.  It’s like- a small raise to the employee with resulting expectation pay your own ins to the government is just the answer, and then everything else will be all right?

Also, the VA was awful in our experience. We made an appointment to see a doctor and who never showed up; we had things stolen or “misplaced” from the rooms. Can’t find our dad, because he was sent somewhere else without telling anyone… just, awful.

Response: I’m not sure I follow your logic in the first paragraph, but I will say this: if the public option causes private insurance companies to go out of business, because they refuse to remain competitive, then I say, “Good, screw them.”  As things stand now they are so bloated that they are truly having a negative impact on patient care. I’m not sure about this, but something like this is true: one of the HMO CEO’s is like the 6th richest man in the world, for doing essentially nothing to treat the patient.  I am all for private business and entrepreneurship, but you have to stop and say to yourself at some point, “enough is enough!” When 50 million Americans don’t have health care for whatever reason, this desparity has to at least raise an eyebrow.  In my opinion, the whole POINT of a public option is to foster competition which would in turn force insurance companies to tighten their waste-bands to compete; and, the glorious thing about competition is that, as in Person 3’s case above, you still have the option of paying for your expensive private health care that will give you yearly body scans and treat your brain cancer when you are a 100 years old… Go ahead, knock yourself out! lol.

BUT, as it stands, with the public option, your employer could choose it or could not.  If they do choose it because there is less paperwork (as you specifically mentioned) then, well, those other companies better cut down on the paper work. Health insurance, while it is meant to be good and behind-the-scenes, is, in practice, of questionable moral character and is overall bloated; It is viable competition that will force them to suck it up! That 30% overhead I mentioned before amounts to over a trillion dollars a year. Cutting that fat alone could pay for the whole proposed health care reform bill (in reality it wouldn’t work like that, but, the point remains valid). That money is going to people that don’t give you your care and no longer act as your advocate, IMHO.

I think your experience with the VA is unfortunate, but most doctors would agree: similar occurrences happen at every hospital, and those occurrences are the exception, not the rule at both public, private and VA hospitals.  Also, I am not really trying to defend a government-run facility.  If the government ran all the hospitals and clinics, I really do think that would negatively impact patient care in the long run, and also possibly dissuade doctors from coming to practice here in this system, and in the long run that could be quite detrimental to the health care system as a whole

Person 6: All I can say is that now being a UK citizen (as well as a US citizen) and having being made redundant recently, I thank God that I am living in the UK and have the right to the NHS.  The system is not perfect, but you do have the right to care without any cost which is pretty difficult for most Americans to believe.  Plus, if you are in an emergency, the emergency care is state of the art.  I still have the right to COBRA under the US system to extend my private health insurance but it is expensive.  I’m lucky that I can still afford it, but what if I could not? If I were in the US, I would be out of luck.  You hear often that “the US provides the best health care in the world”, which is simply not true.  You just need to look at the US system from an outside perspective to really understand this.

Response: your comments are well-received.

Cobra is for many people, even those with steady incomes, cost prohibitive. How anti-reform proponents cite that as a feasible an option seems unfair, and at the same time, its citing by proponents is also senseless.

Also, to respond to the “America provides the best health care” comment: it is a phrase totally misused, IMHO.  First, anti-reformists use it to stir nationalism, aka “America is just the best at everything” (except for modesty and self-awareness 😉 ). Second, we do have the best doctors, no doubt, but that is because we pay them the most (which, as a doctor, I can’t say that I am totally adverse to that 😉 ), and at the same time it’s the most bloated health care system around.   Does the fact that there are more MRI machines in Seattle than in all of Canada really improve the delivery of care, or health care outcomes? I seriously doubt that.





The Culture of Ownership in Medicine

14 08 2009

Did you know that James Macri owns ß-hCG?  Did you know that someone could even own such a thing?  Well, according to US Patent 5,252,489 he does.  More specifically, Dr. Macri owns a patent covering the use of the free beta subunit of hCG in Down syndrome screening, amongst many others.

I have always assumed that any machine used in the lab or any paricular physical material used in our daily operations was invented and patented by someone at some point, but I suppose I had never thought that a test, or a technique could be patented as well (naive resident, folks).

I suppose it makes sense when you think about it.  If someone develops a novel way to do something, it seems right that that person be able to patent that activity so he/she be rewarded for their work, and should not have to worry about another party scooping up that work and profiting from it without putting in the time and effort to develop it.

At the same time, there comes a point where something is so generic or so integral to basic function, that it can’t (or at least shouldn’t be able to) be patented.  I know because I tried to patent ‘Lungs’ as ‘an organ used to exchange atmospheric oxygen across a thin cell layer’ and they rejected my claim.

So, I suppose, the point of discussion is, at what point does something become so integral or generic that it is not patent-able?  You couldn’t patent ‘looking through a microscope at H&E slides to arrive at a diagnosis’ (at least now, anyway (see above image, lol)), but you could certainly patent ‘looking through a microscope at fluorescent labeled antibodies for translocations to arrive at a diagnosis’.  Both are exceedingly vague, but it seems to me that by adding fluorescence to the equation, it grants just enough specificity and contemporary relevance to the process which therefore makes it patent-able, and I am not sure how I feel about that prospect…

On the one hand, patent law was clearly established to spur innovation and protect the inventor’s ideas; that seems obvious and just.  Alternatively, innovation could be, and is stifled by restrictive legislation preventing the use and application of certain inventions on a daily basis.  Given: every established system of laws can be and is bent or abused to some degree, but we, as a society, need to realize when enough is enough.

Some examples of this flagrant abuse can be seen on ‘The Culture of Ownership‘ blog run by Mrs. Molly Wood.  Some recent post include ‘Monster Cable’ suing ‘Monster Mini Golf‘ and ‘Monster Transmission‘ for trademark infringement, as if anyone would confuse over-priced cabling for some place you go on a first date or a means to transport your hot rod from Charlotte to Tucson.  Most recently, an injunction has been filed by i4i against Microsoft, preventing the sale of Microsoft Word, claiming the XML formatting in Office 2007 is proprietary and was not licensed for use.  Certainly, Microsoft, in this last example could be guilty of stealing technology or ideas from this smaller company, but as it turns out, the i4i has no product to show for itself containing the technology in question.  This last example also demonstrates the concept of ‘patent squatting’ in which someone files a patent for an idea that they either do not know how to move to fruition or do not have the means to do so.  “[T]he rights granted by the government do not guarantee that inventors will be able to make, use, or sell the invention. They can merely prevent others from doing so.” (Haddow, 2009).  I *thought* that patents would not be granted to people who had no means of ever producing a meaningful expression of a the contents of their patent, but, clearly, in practice, this does not appear to be the case.

Finally, I have read about instances where companies buy up competing patents in an effort to stiffle competition.  A hypothetical example of this would be if, say, an oil company bought the rights to a type of electric car technology and basically hid the patent on a shelf somewhere, thereby prohibiting the construction of said electric car which would conceivable compete with it in the marketplace.  Is this fair capitalism, or is this abuse?  I suppose the argument could be made either way; I’ll let you decide on which side is ethical or legal.

Now imagine if this disease were spread to medicine or to Pathology specifically.  I feel that it is probably a fair assumption that some or all of these shady practices are, in fact, in play in the field of lab medicine; I guess that, before today, I hadn’t realized exactly to what extent.

Now, with a piqued interest, I will be keeping an eye out for the dissemination of the culture of ownership within medicine and within pathology and I will remind everyone- ‘everything in moderation’.

Reference:

Haddow J. Patents in Prenatal Screening. Presentation. April 2009.





Paging Dr. Luddite

27 05 2009
Luddites destroying a loom

Luddites destroying a loom

There have been a couple blog posts floating around the inter-tubes recently (like this one from C|Net News) concerning the digitalization of health care and the transition to EMR’s.  Some of them, however, have taken an interesting tack, pointing out that doctors, as a whole, are ‘luddites’.

What’s a luddite?  Well, according to wikipedia:

Luddite (n.): [1]A group of early 19th century English textile workers who destroyed machinery because it would harm their livelihood.
[2] (by extension) Someone who opposes technological change.

Really?  Are we that bad?
Unfortunately, we might be… 

First, granted- not everyone is technologically savvy, and granted that many doctors work well beyond the usual tenure of retirement, and those folks are less likely to be adept at mousing and typing, but in four years of medical school and two years of residency, I have definitely noticed that my peers, people in their mid-twenties and early thirties, are surprisingly lost when it comes to technology! 

Now, I want to be clear that I am not attempting to pontificate, but even in comparing my coworkers to my friends in other fields, it seems that my coworkers are less digitally adept.  Perhaps they have been more involved in other things, perhaps being up to date with technological trends is not a priority for them, but I am not sure how far you can stretch these explanations in the field of medicine.  There is no denying that now is a time of change in the field of medicine and that the field is going digital one way or another.  So it is becoming more and more imperative every day for doctors to possess some kind of basic computer literacy.

Hopefully we as a field will see the inevitable trajectory of our field and adapt accordingly, otherwise we could be in for quite a bumpy ride!





When technology fails, is it your fault?

31 03 2009

ZDNet has an interesting article about whether or not med-tech companies should be held liable if their product fails, causing injury to a patient.  It’s a very interesting question, and it seems as if a precident had been set in the 2008 Riegel vs. Medtronic case which barred lawsuits from ‘challenging the safety or effectiveness of a medical device,’ as long as the device is marketed in a form that received premarket approval from the FDA.”

So does this apply to pathology?  Should it?  If it does, how would it?

In my narrow experience, my initial impression is that it seems like really murky waters. First, you have to consider the approval portion the ruling.  There is FDA approval for many laboratory test, but others, done in-house, may not be approved by the FDA.  As per protocol, reports generated from these results are mandated to indicate in writing that the test is not FDA approved, and has been developed and validated in-house.

Which brings me to my next point: validation.  

Each laboratory needs to validate their testing procedures.  So, if an in-house validated, non-FDA approved test fails or malfunctions, does the doctor or the hospital become liable for damages? Well, I guess I’d draw a parallel to the conventional practice of medicine, sans technology.  If the risk of a certain surgery is death, and this is well documented, and then the patient dies, then there is no malpractice, no deviation from the standard of practice that directly harms the patient occurred. So the same should be true of medical technology.  Can one expect all hardware and software to be 100% accurate all the time?  I suppose one could make the argument that machines are more consistent than humans, but you, and I both know that nothing is 100%.  This is one of those murky areas – if the specificity of a test is 99.999% and there is ever a false negative should the company that developed the test be held liable?  Personally, I’d have to say no, that is ridiculous.

Or take an example from our lab- for IHC, we used slides with a red-painted stripe to separate the control from the test sample.  For whatever reason, recently the antibody would stain the control but not roll over to the sample.  I suppose this is the fault of the lab; or is it the slide maker?  Or is it the automated stainer?  Or should the pathologist recognize a negative stain when the control works (assuming there’s no internal control in the sample).  If the slide and automated stainer have been validated to work with each other, who is to blame; or is there no blame, no fault?  I suppose I would have to put my foot down on my last supposition.

Nobody and no thing is perfect. Sometimes machines fail, and sometimes people fail; While we strive for perfection, we never will be. Without documentable negligence you have to be let off the hook, whether you are a doctor or the CEO of Medtronic.

 

If I am misguided, let me know. Also, please share your own opinion on the matter; perhaps I’m preaching to the choir, perhaps not…

 

[ZD-Net Health via Medgadget]








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