Stop the Insanity!

Remember the lady 10-20 years ago who created a diet fad around the idea that diets don't work and she would always yell out "stop the insanity!" to the point of driving you insane? If I remember right, Susan Powter was her name. Well, I want to start yelling that at the health care industry for some of their useless studies because it seems like every week I see another study that comes out that makes you say in a very mature manner "well, duhhhh.....I could have told you that myself and saved you a couple million dollars".
Last week I heard of a study that related the increased risk of stroke in women to the fact that they visit the salon more and tilt back their head a lot thus increasing the pressure to their carotid arteries which induces damaged plaque to break off and travel into the brain which creates a stroke. Thats a little bit like performing a study on drivers that found that unsafe drivers were the ones who had peanut butter for breakfast because their tongue was stuck to the roof of their mouth and they were searching for gum so they ran into a telephone pole. To sum it up: Subjective, Stupid and pure conjecture. In no way can that be proven and even if it were then what do you propose as the solution? Having women wear neck braces at the salon so as to protect their carotid arteries. Wouldn't that create even more deaths from choking? It seems we have a dilemma.
In my particlar specialty there was once a study done that measured toenail growth (I kid you not) in the summer as compared to the winter to determine the specific time of year when toenails grow the fastest. I would like to see the conversation that led to that study......Ok maybe I wouldn't. I can't even imagine how bored you would have to be at work one day to decide "wow, I really have no idea whether toenails grow faster in July or December and I have no idea how I have run my practice to this point without that information!". So you launch the life saving study for which society will forever be indebted to you.
This week's choice of stupid study though is not quite so obvious but dumb nevertheless. A study published in the journal Neurology found a link between belly fat in your 40's and dementia in your 80s. Dementia for those of you who may have "forgotten" is the condition where you lose short term memory and eventually fade into more permanent memory loss which is a very frightening idea for all of us. Well this does seem like a reasonable study though because we all want to know how to avoid dementia so that we don't forget how (to avoid it that is). The problem is applicability (ie-what do we do about it?) and the definition of belly fat. See, as a bit of perspective our current view of fat is that it only takes second place to terrorism in public safety and pure evil....Ok fine I am sure cigarettes are in there somewhere near the top as well. So this study decided that people who store fat in their abdomen (and for the record everyone does even if they are skinny) had a higher risk of developing dementia. In other words, we all have a higher risk of developing dementia while we are alive. I guess we could have saved a lot of money on that one and just come out and said "as long as you are alive and not dying of starvation you are at risk of dementia and dying". That would have summed it up just fine but then it wouldn't accomplish the agenda some people seem to have of saving us from ourselves. I don't know about you but I can't wait for the study that comes our to determine whether we are more at risk for death the longer we live. Now that would be some useful information.

Ahhhh, Pharmucopia at Last!

When former Colorado governor Dick Lamm joked in his recent book (A Brave New World of Healthcare) that by 2066 we will spend 100% of our GDP on Healthcare I began to wonder what that world would look like. Would we take pills for food? Will we all have a permanent IV implant that would constantly feed and nourish our every need through a venous portal? What about work? I guess we would all work for a health care company or not at all and as a doctor I guess my future would be pretty secure. Maybe vaccines would take care of everything since we seem to be vaccinating all sorts of ailments from polio to the common cold. Whatever the future looks like in this scenario I was fairly sure I didn't want to be a part of it. Until recently that is.

A new report came out this week on a recent study of our water supply that shows all sorts of drugs floating around in our water from antipsychotics to sex hormones. A virtual pharmucopia. This started to bring the picture into a little more clarity and it really doesn't sound so bad now. Pharmaceutical companies obviously know what is best for us and they have been told incessantly how difficult it is to swallow their horse pills so they are coming up with the perfect solution. Put the pills in the water supply. I knew I had felt better lately and in my naivete I had given the credit to my wife who had recently placed me on a vitamin drink. How simple of me. Clearly the pills in the water supply are taking care of my every need from constipation to diarrhea and everything in between. The antibiotics keep me healthy from infection. The antidepressants keep me happy. There are even anti-convulsants in there in case my brain should decide to give me a seizure. These brilliant pharmaceutical phriends have thought of everything! And I had the audacity to doubt them. I want to take this opportunity to apologize to all pharmaceutical companies and reps who come into my office because clearly they they do know what is best for me and my patients. I don't even dread the future any more and I think a world of all health care is starting to look pretty good......in fact I am starting to get sleepy. In the end it is nice to know that when our politicians say they want "universal health care" that the drug comanies take them literally. Cradle to grave baby. Your wish is their command.

I hate to say I told you so but....

It seems to me that a pattern is developing here. We cover things (like medications, etc.), drug companies raise their prices and costs escalate. Pretty simple formula. If you are a drug company and someone else is paying for a patients drugs (like an insurance company or Medicare) then you could raise your prices without anyone getting too upset. In fact, it is pretty logical to think that you could raise your prices much easier in that scenario than if someone was paying for your product directly. Am I missing something here?

In 2005, Congress and the Bush Administration created Medicare "part D" which was a reasonable idea given the fact that medication costs were soaring and threatening to bankrupt many of the elderly. The problem at the time was that the law specifically forbids Medicare from negotiating in bulk with pharmaceutical companies thus limiting the overall negotiating pressure that Medicare could exert on prices. So guess what happens. In 2007 brand name drugs (non-generic medications) rose 2.5 times the rate of inflation and (here is the real shocker) there was an overall 7.4% increase in the wholesale price of brand name medications in 2007 compared with a still significant but smaller raise of 5.3 to 6.6% in the four years prior to Medicare part D implementation. In plain English that means that every year drug companies raise their prices an outrageous amount but since part D started this has allowed them to raise their prices more. Medicare is paying for them (except that in reality seniors still have to foot a large portion of the bill-and even more as price increases are implemented) so now the price increases go largely unnoticed. Now the cycle that I raised above becomes clear and you have to ask yourself a fundamental question, "who really benefits here?". I think that answer is fairly obvious but in case I confused you with this blog (since it is 2 am) let me just assure you there is only one winner in this scenario and that is the drug companies.

Prior to the Medicare bill being passed, the Bush administration formally estimated the 10 year cost for the bill to be somewhere around $350 billion. After the bill was passed, the Bush administration admitted the cost of the bill was miscalculated and would cost somewhere in the neighborhood of $750 billion which appears to be a fairly significant miscalculation but I am sure I am too critical. At the time I said I would bet a nickle that the cost would run over $1 trillion for the 10 year period and even though I do not want to be right in this prediction it looks like I probably will be. Oddly enough, it appears that patterns do repeat themselves and I now know what my parents meant when they said that "those who don't learn from mistakes are doomed to repeat them". When are we going to learn that covering things without regard to how much they cost will ultimately bankrupt us in the process.

Health Insurance Lottery

In a never ending stream of information that is proof that health care is too expensive for the average citizen, my home state of Oregon has now established a lottery for health care that gives the lucky recipient a chance to avoid bankruptcy by attaining coverage that they otherwise have no chance to afford. This is a sad day when we reach a point where getting health coverage is equivalent to winning millions. In a day and age when health costs demand "your money or your life!" it is no wonder that getting health care coverage would be the prize of a lottery system.
An interesting statement has come out of this. According to Barney Speight (director, Oregon Health Plan Fund) the state of Oregon has a comparable number of uninsured right now as they had in the late eighties when the last effort to "fix" heatlh care was implemented. This is an absolute confirmation that we cannot fix this problem unless we do something to address the underlying cost issues because even if states could cover their uninsured patients somehow the problem would still return 20 years later in a much worse scenario because health care costs continue to eat into our overall GDP. I know that is a bit technical but this is why we say the health care crisis is about "cost not coverage".
Good for Oregon for thinking outside the box (as they have on many past issues) but if you ask me this is a pathetic statement on the sustainability of health care costs bound to bankrupt us all eventually.