Is it Time to Update the Blood Donation Screening Questions?

19 04 2010

There is a very interesting blog post over at Friday Puppy, a blog run by an openly gay local business owner about having his blood donation being denied due to the fact that he has relationships with other men.  The article is sharp and opinionated, but the points are fleshed out into logical arguments in the comments section below.  I think the post brings up some very interesting points.  Perhaps it is time for the FDA to update their screening questions.  Check it out here.

[Friday Puppy: You Don’t Want My Gay Blood?]





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.





Obama’s CTO to give podcast interview today

4 08 2009

CNet.com’s Podcast Buzz Out Loud, a podcast near and dear to my heart, will have on their show today (1pm ET, 11am PT), Aneesh Chopra, the newly appointed United States ‘CTO’.  He has embarked on his first tour of Silicon Valley and will be stopping by a few venues for interviews this week.

The podcast hosts put out a call to the community for questions for the distinguished gentleman; if you’d like to post your own questions, the thread can be found here:

http://www.cnet.com/8301-19709_1-10301736-10.html?tag=mncol;title

I specifically asked about the EMR initiative so highly touted by President Obama- what are the plans, nationalized/government run vs private, protection of physician privledge while maintaining portability and access, etc; hopefully they will pick my questions 😉

To catch this video podcast live, check out http://www.cnet.com/live at 1pm ET today.

UPDATE: Below is the video of the interview.  They did in fact ask my question(s) (my question is read at the 10:00 mark), and Mr. Chopra’s response was cordial if not a little round-a-bout, but interesting and welcomed nonetheless.  It was an amazing opportunity to get and an honor to be chosen.  Thank you to C|Net and to Mr. Chopra.

Vodpod videos no longer available.

posted with vodpod




Why Med School costs over $200,000 and why it should not

23 06 2009

Bruce Friedman over at LabSoft News had an interesting post today about the current state of affordability of medical school and what we can do to change it.

He first references an article published by the AMA about this topic:

“Medical students who went into debt could figure on owing $126,714 in 2007 on average, up from $88,331 in 2000, according to the Association of American Medical Colleges… Suggestions under consideration would take approval by powers greater than the AMA. They include providing tax deductibility for tuition and loans, and expanding state and federal scholarship opportunities. But another cost-cutting approach is investigating ways to reduce the length of medical schooling—perhaps through competency-based curriculums, or through combined B.A./M.D. programs.”

The article also goes on to say that 23% of medical students graduate with over $200,000 in debt (let’s not forget that you have to go to college first!).  In fact, my personal educational loan grand total was greater than $250,000 when I graduated, and after two years of interest, I’m almost afraid to see where it is now.

Dr. Friedman then goes on to offer his suggestions as to a solution:

  • “Medical schools should begin to accept students, as in former years, after three years if they have fulfilled all of their undergraduate course requirements. If this is impossible given the number of such prerequisites, this number should be reduced such that it is possible for most applicants to quality for the new program.
  • On a selective basis, medical school should allow some students to skip their fourth year and graduate in three. This should only be an option for the most mature students who have amply demonstrated their ability to function well as they pursue their post-graduate medical training. “

My response is as follows:
As a graduate from a combined college/med school program myself, I feel like I have some insight to share on this.  Where I went to med school they had 3 combined programs, mine was 8 years, and there was a 7-year and a 6-year program as well.  IMHO, those ‘kids’ who had only 2 years of college, while they may have been very bright, some of them were wayyyyy to immature for medicine (one of them had a breakdown, actually, and dropped out).  Having said that, however, to pick medical students worthy of graduating early based on their ‘maturity’ is vague and subjective, and, I think, ultimately not fair.

The issue of debt from education is undeniable, and GP is suffering as a result, for sure. And, while I think cutting years is a clever approach, I just don’t think it’s the answer.  Personally, I think the direct approach is the best here. Can ANYONE explain to me why med school was $55,000 a year for me? Sure people always say, “Well, you’ll be good for it in 8 years” or whatever, but that’s really not ok.  My medical school was one building, with quite a finite list of teachers and services, yet it cost twice as much as college and didn’t come with room OR board!  During my tenure as a medical student, we actually approached our dean about the outrageousness of the tuition (I think we were 3rd in the country for most expensive medical school at the time), and the fact that the tuition was continuing to go up almost yearly. Well, he sat our whole class down and showed us a 100-foot pie chart of our expenses.  And with that, we had our answer.  Now, I’m not 100% sure I’m recalling this EXACTLY, but if memory serves me: about 30% of our tuition went to float the hospital’s pro-bono work.  Is this true elsewhere?  I was outraged, we all were.  Absolutely, these people need to be cared for, but to place the burden of the medical students’ shoulders is grossly inappropriate.  In addition to this, we also had to pay a multi-thousand dollar ‘national security fee’ or something of like.  Unreal.  In the end we all just sucked it up, but it’s not ok. Things need to be fixed or the system will collapse in on itself.

Nobody likes people that complain and then don’t offer an alternative, so here are my ideas:

  1. My medical school is as expensive as it is because we have one of the WORST endowments in the country. There should be more focus on giving back, in the form of alumni office activity, and also, you attendings out there should do your parts!!
  2. If I decide to go to med school, I should be paying for my education and not ER work for the uninsured.  I suppose this could be fixed by adopting a nationalized health care system, but I’m not about to open that can of worms. Again, I’m not sure if this situation is recapitulated elsewhere in the country, but there must be some shenanigans to justify $55,000 a year.
  3. Go to a state school or live in a country outside the US.  LOL.  But seriously, many of my co-residents have ZERO debt because medical school is paid for by the government in their country.  Programs similar to this DO exist in the United States.  First of all, there are the Armed Forces.  Also, there are various programs (most of them in Family Practice, I believe) that will pay for medical school with a X-year contract to practice in underserved areas.  I think these could be some valid alternatives to signing away your soul to some people.

Now, I realize that #3 is a band-aid and not a cure.  But, IMHO, the key is to cutting costs by forcing accountability for tuition fee composition.  Also, I think the AMA is on the right track with tax write-offs and subsidies as well.  I’m not saying medical school should be free (as I think in the end, most of us are successful enough to pay our loans back so we shouldn’t have to burden the country with our educational expenses), but it should be affordable enough that what happens with my graduating class does not continue to happen across the country- we had four people (out of about 120) go on to pursue residencies in Family Medicine.  Four.  And that is just not sustainable.

Some food for thought.
What do you think? 🙂








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