Psychiatric Madmen? New manual makes everyone mentally sick.

Perhaps an alternate title for this would be “We’re in it for the money.”

See also another related entry entitled “Mental Health Profession has Mental Health problems.”
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“We’re all mad here”

Medication misuse is out of control in the US and more psychiatric labelling in DSM-5 will not help.

by Allen Frances | Tuesday, 21 May 2013

That’s the message of the new edition of the bible for American psychiatrists, DSM-5. Diagnostic inflation is about to become hyperinflation.

“We are all mad here” explains the Cat to Alice when she wonders about the strangeness of Wonderland. Well, life is starting to follow art. If people make the mistake of following DSM-5, the new diagnostic manual in psychiatry that was published on Saturday, pretty soon all of us may be labelled mad.

When I worked on the taskforce for DSM-4, we were very concerned about taming diagnostic inflation – but we only partly succeeded. Then four years ago, I became aware of the excessive enthusiasm around all the new diagnoses being proposed for DSM-5, including many that were untested. I hate to rain on anyone’s parade, but I knew this would be disastrous for the millions of people who were likely to be mislabelled, stigmatised and given excessive treatment.

In the US, the “sick” are distinguished from the “well” by the diagnostic and statistical manuals developed by the American Psychiatric Association.

The problem is that definitions of mental disorders are already written too loosely and are applied much too carelessly by clinicians, especially by the GPs who do most of the prescribing of psychiatric drugs.

And things are about to get much worse. Under DSM-5 diagnostic inflation looks set to become hyperinflation and will lead to an even greater glut of unnecessary medication. I would qualify for a bunch of the new labels myself – and you might too.

The grief I felt when my wife died would now be called “major depressive disorder”; forgetfulness in older age “mild neurocognitive disorder”; my gluttony now “binge eating disorder”; and my hyperactivity “attention deficit disorder”. As for my twin grandsons’ temper tantrums, this could be misunderstood as “disruptive mood dysregulation disorder”. And if you have cancer and your doctor thinks you are too worried about it, there’s “somatic symptom disorder.” It goes on, but you get the idea.

About half of Americans already qualify for a mental disorder at some point in their lives and the rates keep skyrocketing, especially among kids. In the past 20 years, the prevalence of autism has increased, childhood bipolar has multiplied 40-fold and attention deficit disorder has tripled.

One consolation: the kids are not suddenly getting much sicker – human nature is pretty stable. But the way we label symptoms follows fickle fashions, changing quickly and arbitrarily. And freely giving out inaccurate diagnoses can

Mental Health Profession has Mental Health problems

“How hard is it to criticize an organization that seriously thinks that it’s okay to call “Internet Use Disorder” a mental illness? They’re going to take shot after shot. And the response will be ineffectual and weak. They’ll bob and weave, talk about the “living document,” and unleash their line of bullshit.”

For more than two years, author and psychotherapist Gary Greenberg has embedded himself in the war that broke out over the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders—the DSM—the American Psychiatric Association’s compendium of mental illnesses and what Greenberg calls “the book of woe.”

Since its debut in 1952, the book has been frequently revised, and with each revision, the “official” view on which psychological problems constitute mental illness. Homosexuality, for instance, was a mental illness until 1973, and Asperger’s gained recognition in 1994 only to see its status challenged nearly twenty years later. Each revision has created controversy, but the DSM-5, the newest iteration, has shaken psychiatry to its foundations. The APA has taken fire from patients, mental health practitioners, and former members for extending the reach of psychiatry into daily life by encouraging doctors to diagnose more illnesses and prescribe more therapies—often medications whose efficacy is unknown and whose side effects are severe. Critics—including Greenberg—argue that the APA should not have the naming rights to psychological pain or to the hundreds of millions of dollars the organization earns, especially when even the DSM’s staunchest defenders acknowledge that the disorders listed in the book are not real illnesses.

Greenberg’s account of the history behind the DSM, which has grown from pamphlet-sized to encyclopedic since it was first published, and his behind-the-scenes reporting of the deeply flawed process by which the DSM-5 has been revised, is both riveting and disturbing. Anyone who has received a diagnosis of mental disorder, filed a claim with an insurer, or just wondered whether daily troubles qualify as true illness should know how the DSM turns suffering into a commodity, and the APA into its own biggest beneficiary. Invaluable and informative, The Book of Woe is bound to spark intense debate among expert and casual readers alike.

http://j.mp/12vPoHk

http://www.theatlantic.com/health/archive/2013/05/the-real-problems-with-psychiatry/275371/

The Real Problems With Psychiatry

A psychotherapist contends that the DSM, psychiatry’s “bible” that defines all mental illness, is not scientific but a product of unscrupulous politics and bureaucracy.

Hope Reese May 2 2013, 9:08 AM ET

On May 22, the American Psychiatric Association will release the fifth Diagnostic and Statistical Manual of Mental Disorders, the DSM-5. It classifies psychiatric diagnoses and the criteria required to meet them. Gary Greenberg, one of the book’s biggest critics, claims these disorders aren’t real — they’re invented. Author of Manufacturing Depression: The Secret History of a Modern Disease and contributor to The New Yorker, Mother Jones, The New York Times and other publications, Greenberg is a practicing psychotherapist. The Book of Woe: The Making of the DSM-5 and the Unmaking of Psychiatry is his exposé of the business behind the creation of the new manual.

Can you talk about how the first DSM, published in 1952, was conceived?

One of the reasons was to count people. The first collections of diagnoses were called the “statistical manual,” not the “diagnostic and statistical manual.” There were also parochial reasons. As the rest of medicine became oriented toward diagnosing illnesses by seeking their causes in biochemistry, in the late 19th, early 20th century, the claim to authority of any medical specialty hinged on its ability to diagnose suffering. To say “okay, your sore throat and fever are strep throat.” But psychiatry was unable to do that and was in danger of being discredited. As early as 1886, prominent psychiatrists worried that they would be left behind, or written out of the medical kingdom. For reasons not entirely clear, the government turned to the American Medico-Psychological Association, (later the American Psychiatric Association, or APA), to tell them how many mentally ill people were out there. The APA used it as an opportunity to establish its credibility.

How has the DSM evolved to become seen as the “authoritative medical guide to all of mental suffering”?

The credibility of psychiatry is tied to

How much does Huntsville Hospital charge for procedures? You’d be surprised!

Thanks to a newly introduced aspect of ObamaCare, hospitals are now mandated to publicly show how much they charge for procedures.

Aren’t you glad?

I mean really… who goes to a grocery store or gas station and doesn’t know how much they’ll pay?

Part of market-based competition includes

Tracking Data: HPV Vaccine has lowered Genital Warts

GET THE VACCINE FOR YOURSELF & YOUR CHILDREN!

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Genital Wart Decline Tracked to HPV Vaccine

By Charles Bankhead, Staff Writer, MedPage Today

Published: April 18, 2013

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco

• The incidence of genital warts declined by more than 90% in adolescent and teenage girls in the first 4 to 5 years after introduction of the human papillomavirus (HPV) vaccine in Australia.
• Note that the reductions in wart incidence among girls and women were accompanied by 50% to 80% decreases in the incidence of genital warts among heterosexual boys and young men although no decline in wart frequency was seen in heterosexual women or men older than 30.

The incidence of genital warts declined by more than 90% in adolescent and teenage girls in the first 4 to 5 years after introduction of the human papillomavirus (HPV) vaccine in Australia, investigators reported.

Genital warts occurred more than 70% less often among women 21 to 30, as compared with the 3 to 4 years before the vaccine became available. The reductions in wart incidence among girls and women were accompanied by 50% to 80% decreases in the incidence of genital warts among heterosexual boys and young men.

No decline in wart frequency was seen in heterosexual women or men older than 30, Basil Donovan, MD, of the University of New South Wales in Sydney, and co-authors reported online in BMJ.

“In 2011 no genital wart diagnoses were made among 235 women under 21 years of age who reported prior human papillomavirus vaccination,” the authors noted. “The significant declines in the proportion of young women found to have genital warts and the absence of genital warts in vaccinated women in 2011 suggests that the human papillomavirus vaccine has high efficacy outside the trial setting. Large declines in diagnoses of genital warts in heterosexual men are probably due to herd immunity.”

The study provided a glimpse of the impact of HPV vaccination in a real-world community setting as opposed to a clinical trial.

“It actually generated data consistent with what we hoped and predicted would happen,” said Greg Poland, MD, of Mayo Clinic in Rochester, Minn. “It showed in a large study that [the vaccine] worked and it worked fabulously.”

It is probable that the results are

Male Nurses Earn More Than Female Nurses

This issue raises some very interesting questions. First, because men are a minority in Nursing, is it justifiable for them to earn more than those, who as a group, dominate the profession?

Or, is parity genuinely or truly parity?

Should men and women earn the same amount of money if they do the exact same kind of work?

Or, are there accountable differences in the pay which justify the difference, however slight – and is very slight.

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Male Nurses Make More Money

• February 25, 2013, 1:17 PM

ByBen Casselman

Men now comprise 10% of all Nurses in the United States, up from 3% several years ago. / Getty Images

Hospital patients are more likely than ever to see a male nurse at their bedside — and odds are he earns more than the female nurse down the hall. Men made up close to 10% of all registered nurses in 2011, according to a new Census report released today. That may not sound like much, but it’s up from less than 3% in 1970 and less than 8% in 2000.

It’s no mystery what is drawing men into nursing. Male-dominated professions such as construction and manufacturing hemorrhaged jobs during the recession and have been slow to rebound during the recovery. The health-care sector, meanwhile, actually added jobs during the recession and has continued to grow since. All told, health-care employment is up by

Should the Vitamin & Food Supplement Industry be more regulated?

If a container says there are a dozen eggs in it, there should be 12 eggs.

If a container says the contents are a pint, there should be 16 ounces.

If a container says the weight of a product is 5 pounds, it should weigh 5 pounds.

And if a container says that each pill has 45 milligrams of a certain ingredient, each pill should contain 45 milligrams of that ingredient.

Pretty straight forward stuff, eh?

But, were you aware that some of the vitamins and other food supplements you may take are not as highly regulated as either over-the-counter or even prescription medicines?

For example, there is so little oversight for standards in the vitamin and food supplement industry that

NYC Seeks to Curb Painkiller Abuse With Hospital Limits

It’s only “deadly” if it’s misused or abused.

And yet, the idea is an excellent one because it limits potential for misuse and abuse by fraud.

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New York City is seeking to curb abuse of potentially addictive and deadly painkillers such as Oxycontin and Vicodin with new limits on how widely the drugs should be prescribed.

Emergency departments at New York’s public hospitals will only prescribe a three-day supply of opioid painkillers, won’t refill lost or stolen prescriptions and shouldn’t prescribe long-acting versions of the drugs, according to voluntary guidelines the city issued today.

The move is aimed at

Fit for Human Consumption, or Rat Poison? High Fructose Corn Syrup Continually Indicted in Obesity Epidemic.

Fit for Human Consumption, or Rat Poison? How many foods use High Fructose Corn Syrup? The answer might surprise you. Or, it may not. Originally uploaded by SouthernBreeze

In the last several years, obesity has become a rampant epidemic in the United States. While there are doubtless many causes, it is my opinion that a wholesale change in our dietary practices – and I specifically do not mean to refer to increased portion sizes, consumption or intake – but rather to an ingredient which has become all too common in commercially prepared food… which, if we were honest with ourselves, is most of what we consume.

For example, the majority of Americans do NOT grow their own vegetables, raise their own groceries (meat, dairy, poultry, eggs, pork, etc.), nor do they eat homegrown, locally grown, or even “freshly prepared” vegetables, even if those vegetables were imported to the United States. Consider even pineapples, for example. Once, the exceeding majority of the world’s supply of pineapples were grown in Hawaii. The highest quality pineapples are sold to Japanese markets, where they pay top price for the highest quality fruit. Not so in the United States, where American customers balk at high prices, even if it’s associated with higher quality.

Historically, Hawaii was the world’s largest pineapple producer and source for pineapples. Relatively recently however, rapacious corporate profit seekers abandoned Hawaii for cheaper production (translate “cheap labor” & “no health & safety regulation”), and there now remain only two fresh pineapple operations remaining in Hawaii: one on Maui, and another on Oahu. And that quandary is an entirely separate, yet related, problematic issue.

However, much of what we eat has been commercially processed in volume. And I mean in HUGE volumes! In America’s factory food processors, a fairly common ingredient is

Birmingham, Alabama hospital seeks permanent patient relocation

For those unaware, Cooper Green Mercy Hospital is a publicly-run hospital licensed to Jefferson County under the name “Jefferson Health System.” Recently, Jefferson County filed bankruptcy in what would have been very nearly the largest municipal bankruptcy filing, resulting from massive fraud perpetrated by former Mayor Larry Langford (popularly known as “LaLa”), and other members of the Jefferson County Commission, which is the elected ruling board overseeing  governance of county entities, including Cooper Green Mercy Hospital & Jefferson Health Systems.

Since 2005, CGMH has experienced a 27.8% decline in patient discharges, which is a measure of how many people are being admitted to the hospital.

As well, in response to numerous ongoing management problems, in 2012, from January to November, the number of Full Time Employees declined 27.27%. And as the hospital seeks to ameliorate the hemorrhaging, the hospital is moving away from Acute Care, and toward Primary and Urgent Care.

Toward that objective, the hospital voluntarily surrendered Cooper Green Mercy’s acute care hospital license to the state. And, in the course of their operations in the midst of this crisis, CGMH moved toward a system in which fees are based upon family size and income.

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Cooper Green inmate patients now being taken to Brookwood Medical Center, county officials say

By Barnett Wright | bwright@al.com
January 02, 2013 at 4:53 PM, updated January 02, 2013 at 5:05 PM

BIRMINGAM, Alabama — Inmates at the Jefferson County jail who need hospitalization will be taken temporarily to Brookwood Medical Center, now that Cooper Green Mercy Hospital is not accepting patients, county officials said today.

On Tuesday, Cooper Green officially became an urgent care facility, closing its emergency room and shutting down its inpatient care unit. That means patients – including inmates normally were hospitalized at Cooper Green — will be placed at other medical facilities.

“A permanent contract is being negotiated with an area hospital,” said Jefferson County Sheriff‘s Chief Deputy Randy Christian, “in the interim we are using Brookwood hospital for inmate’s requiring a hospital visit. We aren’t anticipating any problems going forward.”

The county does provide some in house medical care at the jail, but on occasion

For just one moment… forget about what Jesus would do.

Today was a good day at work.

I cried.

The last time I recollect crying at work was at least 6 or more years ago when a patient of mine – a young black male, who was his mother’s only son – had been murdered, and as I looked into her bloodshot, tired, hollow, intently peering and watery eyes, volumes were communicated though we neither said a word.

I couldn’t bear her gaze, and after what seemed ages, I averted my eyes, and departed behind a nearby curtain in the Trauma ICU to cry. There, my tears flowed like twin rivers, swollen by a storm, albeit an emotional one, which was joined by the two smaller tributaries of my nostrils. Gazing over the city from atop the 11th story of the teaching hospital through tear-drenched eyes, I wondered… was this what dear Mother Mary felt like when she gazed upon her only son as he hung from that cross?

Today, I wept for

CDC: Heath Data shows Abortions fall 5%, largest drop in a decade

CDC: Abortions fall 5%, largest drop in a decade

By Michael Muskal
November 21, 2012, 1:41 p.m.

The rate of abortions in the United States fell by 5%, the largest single-year decrease in a decade, researchers for the Centers for Disease Control and Prevention reported.

The decline is outlined in the annual abortion surveillance data for the year 2009, the latest available. It was published on Wednesday in the CDC’s Morbidity and Mortality Weekly Report.

About 18% of all pregnancies in the United States end in abortion, the CDC noted. Factors from the availability of abortion providers, state laws, the general economy and access to health services including contraception, can

Insurance companies increase profits after ObamaCare passed

Brer Fox leapt out of the bushes and strolled over to Brer Rabbit. “Well, well, what have we here?” he asked, grinning an evil grin.

Brer Rabbit gulped. He was stuck fast. He did some fast thinking while Brer Fox rolled about on the road, laughing himself sick over Brer Rabbit’s dilemma.

“I’ve got you this time, Brer Rabbit,” said Brer Fox, jumping up and shaking off the dust. “You’ve sassed me for the very last time. Now I wonder what I should do with you?”

Brer Rabbit’s eyes got very large. “Oh please Brer Fox, whatever you do, please don’t throw me into the briar patch.”

“Maybe I should roast you over a fire and eat you,” mused Brer Fox. “No, that’s too much trouble. Maybe I’ll hang you instead.”

“Roast me! Hang me! Do whatever you please,” said Brer Rabbit. “Only please, Brer Fox, please don’t throw me into the briar patch.”

“If I’m going to hang you, I’ll need some string,” said Brer Fox. “And I don’t have any string handy. But the stream’s not far away, so maybe I’ll drown you instead.”

“Drown me! Roast me! Hang me! Do whatever you please,” said Brer Rabbit. “Only please, Brer Fox, please don’t throw me into the briar patch.”

“The briar patch, eh?” said Brer Fox. “What a wonderful idea! You’ll be torn into little pieces!”

Grabbing up the tar-covered rabbit, Brer Fox swung him around and around and then flung him head over heels into the briar patch. Brer Rabbit let out such a scream as he fell that all of Brer Fox’s fur stood straight up. Brer Rabbit fell into the briar bushes with a crash and a mighty thump. Then there was silence.

Brer Fox cocked one ear toward the briar patch, listening for whimpers of pain. But he heard nothing. Brer Fox cocked the other ear toward the briar patch, listening for Brer Rabbit’s death rattle. He heard nothing.

Then Brer Fox heard someone calling his name. He turned around and looked up the hill. Brer Rabbit was sitting on a log combing the tar out of his fur with a wood chip and looking smug.

“I was bred and born in the briar patch, Brer Fox,” he called. “Born and bred in the briar patch.”

And Brer Rabbit skipped away as merry as a cricket while Brer Fox ground his teeth in rage and went home.

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Insurers Profit From Health Law They Fought Against

By Sarah Frier – Jan 5, 2012

Insurance companies spent millions of dollars trying to defeat the U.S. health-care overhaul, saying it would raise costs and disrupt coverage. Instead, profit margins at the companies widened to levels not seen since before the recession, a Bloomberg Government study shows.

Insurers led by WellPoint Inc. (WLP), the biggest by membership, recorded their highest combined quarterly net income of the past decade after the law was signed in 2010, said Peter Gosselin, the study author and senior health-care analyst for Bloomberg Government. The Standard & Poor’s 500 Managed Health-Care Index rose 36 percent in the period, four times more than the S&P 500.

“The industry that was the loudest, most persistent critic of this law, the industry whose analysts and executives predicted it would suffer immensely because of the law, has thrived,” Gosselin said. “There is a shift to government work under way that is going to represent a fundamental change in their business model.”

Health insurers contributed $86.2 million to the U.S. Chamber of Commerce to oppose the law after Obama administration officials criticized the plans for enriching themselves by raising customer premiums.

“We remain very concerned that

U.S. Senate Investigation: Medtronic Falsified Research to Promote Medication

Has it now become “all about the money”?

Is patient safety, patient care, patient well-being no longer of concern?

It certainly seems that way.

And this, perhaps better than anything else, serves to prove that the “love of money is the root of all evil.”

The reason why, is that people will do anything to get more of the object of their affection, the object of their love. And, because it is an inanimate object, money cannot in return love those who love it. So the relationship is a “one-way love affair,” wherein one party – the human – spends time, energy, effort and emotion to invest affection in a thing that cannot yield an appropriate return.

For when one invests money, one rightfully expects to profit by receiving money in return. Similarly, when one invests time, energy and emotion, one expects to profit by receiving more time, energy and emotion in return. And yet, time, energy and emotion are things inherently absent in money.

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Medtronic Manipulated Bone Product Data, Senators Say

Medtronic Inc. (MDT) ghost-wrote sections of medical papers and paid physician authors hundreds of millions of dollars in “consulting fees” to promote its bone- growth product Infuse, a U.S. Senate investigation found.

Medtronic, the world’s biggest maker of heart-rhythm devices, helped write, edit and shape at least 11 medical journal articles about the product, which is used to spur bone growth after spinal surgery, according to report released today by the Senate Finance Committee.

The doctors and researchers who were the authors of the studies were part of a $210 million consulting and royalty payments program by Minneapolis-based Medtronic and never disclosed their ties or the company’s influence in their papers, the panel said in its report.

“Medtronic’s actions violate the trust patients have in their medical care,” Senator Max Baucus, a Montana Democrat and committee chairman, said in a statement. “Medical journal articles should convey an accurate picture of the risks and benefits of drugs and medical devices, but patients are at serious risk when companies distort the facts the way Medtronic has.”

Study Results

Sales of Infuse plunged after The Spine Journal published studies in May 2011 and June 2011 showing

Daily Multivitamin May Reduce Cancer Risk, Clinical Trial Finds

By RONI CARYN RABIN

Published: October 17, 2012

After a series of conflicting reports about whether vitamin pills can stave off chronic disease, researchers announced on Wednesday that a large clinical trial of nearly 15,000 older male physicians followed for more than a decade found that those taking a daily multivitamin experienced 8 percent fewer cancers than the subjects taking dummy pills.

While many studies have focused on the effects of high doses of particular vitamins or minerals, like calcium and vitamin D, this clinical trial examined whether

More May Be at Risk as U.S. Meningitis Outbreak Widens

Welcome back to the world of “de-regulation”! You know… the one that existed before the FDA was created.

Now, do you really want it to be like that?

Probably not.

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More drugs from the pharmacy at the center of a meningitis outbreak may be contaminated, putting additional people at risk of contracting the deadly infection, U.S. regulators said.

Any drug meant to be injected that was manufactured by New England Compounding Center may be tainted, the Food and Drug Administration said yesterday on its website. The agency doesn’t know how many people may have received potentially tainted shots, Sarah Clark-Lynn, a spokeswoman for the FDA, said in an e-mail. The agency is working with the Framingham, Massachusetts-based pharmacy to gather more information about product distribution, she said.

The fungal meningitis outbreak that began with a steroid used for back pain has led to 214 infections in 15 U.S. states, killing 15 people, the Centers for Disease Control and Prevention said. A second steroid to treat inflammation manufactured by the pharmacy has been linked to

Alabama Osteopathic Physicians Oppose New Medical School

Idiots endangering public health.

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Doctors’ Group Opposes Auburn Medical School

By The Associated Press

Enlarge image

Credit William J. Samford Hall / Wikimedia Commons

An Alabama osteopathic doctor’s group opposes the creation of a new medical college in Auburn.

A professional organization representing Alabama’s osteopathic doctors said it can’t support the creation of a new medical college in Auburn.

Members of the Alabama Osteopathic Medical Association (ALOMA) said

Research: Health Insurance Costs Grew Less in 2012 since 1997

At the time of publication of this report – September 2011 – the complete data was not in. However, initial results indicated that cost containment was well under way.

The news is good!

ObamaCare is WORKING!

However, much additional work remains to be done.

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Latest survey finds health benefit cost growth for 2012 likely to be the lowest in 15 years

United States , New York
Publication date: 21 September 2011

Early responses from a Mercer survey still in the field suggest that the average growth in health benefit cost will slow to 5.4% in 2012, the smallest increase since 1997. Still, cost growth remains well above both general inflation and growth in workers’ earnings (see Fig. 1).

 While this increase reflects cost-cutting changes employers will make to their current health benefit programs, such as raising deductibles or moving employees into lower-cost health plans, the preliminary survey findings released today by Mercer suggest that the underlying trend has slowed as well. Asked how much cost would rise if they made no changes to their current plans, employers reported an average increase of 7.1%. Over the past five years, this underlying health benefit cost trend has been running at about 9%.

The slower trend is good news for workers, because an employer’s first line of defense against a high initial renewal rate typically is to change plan provisions so that employees pay more out of pocket for health care. If the underlying trend is lower to begin with, employers will be likely to shift less cost. For the past several years, employers have reduced their initial renewal rate by about 3 percentage points on average; in 2012, they are planning to reduce it by about 2 points (Fig. 2).

These results are based on

Reaching the End of Life: What Do We & Loved Ones REALLY Need?

Recollecting, one of my patients was similarly diagnosed, suffering terminal lung cancer of the small cell carcinoma type, and had one lung removed. He had presented to the ED (Emergency Department) with extreme hypoxia (lack of oxygen), to such an extent that his lips had a distinctive blue cast to them. His oxygenation was so exceedingly poor, that he would turn in bed, and his sats (oxygen saturation level) would drop to 70% – neither a good, nor one that would sustain life.

In conversation with him, I asked him what he wanted to have happen to him, how he wanted things to turn out for him. He wasn’t under any misguided notion about his state of well-being or health and wanted to depart the ICU.

He said, “I want to go home to die.”

I responded by saying, “We want you to go home too. Let’s see what we can do to get you back there.” At that point, I began some very simple teaching about his breathing. He was a habitual mouth breather, and he knew it. I’d glance up at him, and his mouth would be gaping open as he watched teevee. Problem was, that every time his mouth opened, his sats dropped, even though he was receiving high flow O2 therapy via specialized nasal cannula.

So I instructed him that by keeping his mouth closed and breathing through his nose, his sats would increase. And barring any other unforeseen circumstance, were his sats to consistently maintain above 90%, that would be the greatest step toward his objective to go home.

At the end of my shift, he was consistently satting 98%.

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Doctors are practicing irrational medicine at the end of life

by Monica Williams-Murphy, MD on September 22nd, 2012, in Physician

I just took care of a precious little lady, Ms. King (not her real name), who reminded me that, too often, we doctors are practicing irrational medicine at the end of life. We are like cows walking mindlessly in the same paths; only because we have always done things the same way, never questioning ourselves. What I mean is that we are often too focused on using our routine pills and procedures used to address abnormal lab values or abnormal organ function, to rightly perceive what might be best for the whole person, or even what may no longer be needed. Our typical practice habits may in fact become inappropriate medical practiceat life’s end.Ms. King was a case in point: She was a 92-year-old nursing homepatient on hospice for metastatic breast cancer. Ms King had been transferred to the ER for a sudden drop in blood sugar, presumably due to her oral diabetes medication. Her appetite had apparently been trailing off, as is common at the end of life, and her medication appeared to have become “too strong.” Her glucose level had been corrected by EMS during her trip from the nursing home to the Hospital, so when I came into see Ms King she was at her ‘baseline.’I opened the door to bed 24 and a grinning little white-haired lady peered at me from over her sheet. “Hi,” she said greeting me first.“Hi, Ms King,” I smiled back at her and picked up her hand.

She reached over with her free hand to pat me on my forearm, “You sure are a cute little doctor,” she said smiling.

I couldn’t hold back a little laughter. “Well, you sure are a cute patient too,” I smiled and winked at her.

She winked back at me.

“Wow, this is the most pleasant 90-year-old I have cared for in a while,” I thought to myself.

As we chatted it became clear to me that she had some mild dementia but had no pain or complaints at the time. She just said, “I think I had a ‘spell’” ( a “Southernism” for some type of unusual and undefined episode of feeling ill or fainting); and “I’m not hungry” when I offered her food.

Leaving her room still smiling after our pleasant exchange, I went back to look at her medical record from the nursing home and two things immediately struck me:

Former Tennessee Senator & Cardiothoracic Surgeon Bill Frist, MD enters healthcare dialogue

Face it. Sooner or later, you’re going to die. Death is a part of life. Making a decision about whether or not you want to be connected to belts, tubes, hoses & pumps to circulate your blood, food & oxygen when your body would have naturally expired is essentially what the discussion is about.

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The Bill Frist ℞

By: Brett Norman
September 16, 2012 11:06 PM EDT

Meet former Sen. Bill Frist, a renegade “Obamacare”-loving Republican who is in the mood for some real bipartisanship.

Yes, the same Frist who as Senate majority leader led an army into the culture wars over Terri Schiavo and whose efforts in 2004 to unseat his then-rival, Minority Leader Tom Daschle, led to a nasty — and personal — Washington battle royal.

Now, Frist is pushing for a national conversation on end-of-life care and dismissing “caricatured”talk of death panels. He’s committing Republican heresy in endorsing elements of the loathed Affordable Care Act. He’s standing shoulder to shoulder with Daschle in search of a bipartisan way to tackle one of the thorniest problems around: how to get control of health care costs before they sink the economy.

Frist is pushing for a national conversation on end-of-life care. | AP Photo

The Frist-Daschle reconciliation, in particular, is a source of amazement to some longtime Washington observers.

“I didn’t think they would ever talk again,” said Bill Hoagland, a budget expert and former aide to Frist who has joined the duo on a health cost control initiative at the Bipartisan Policy Center. “I was surprised, pleasantly, that they would work together.”

Daschle told POLITICO, “He’s been a very important partner and I would say has become a friend in spite of the fact that we’ve had a difficult history.”

“That is past and we now find much more in common than not,” he added. “We both know that we need to find a consensus way forward.”

Frist, a heart and lung transplant surgeon who is now focused on research and policy, is working on

Is Obamacare a Government Takeover of Medicine?

The truth speaks for itself.—

Carolyn McClanahan, Contributor

Physician/Financial Planner. I discuss all things money and medicine.

8/28/2012 @ 10:32PM

The purpose of this blog is to educate non-policy wonks on the content of the Affordable Care Act, discuss the practical logistics of how the law will be implemented, and share my perspective on potential “good” and “bad” of the law. The law is far from perfect, but it is the most significant attempt our country has ever made at reforming our costly and inefficient health care system. In case you are a reader who thinks the entire law is “bad,” I implore you to learn about the ten sections of the law in this previous post.

In addition to speaking gigs, I also do “talk radio” about once a month. The questions I’m asked give some indication of where education on the ACA is lacking. One refrain I’ve heard over and over is that Obamacare is a “government takeover” of medicine. This post explores that concept.

“Government takeover” fears seem to take on several different variations.

• Medicine will be a government run entity – doctors will be employed by the government and care will be paid for by the government.

• All of the doctors will be employed by the government, but insurance companies will still exist.

• The government will dictate what doctors can and cannot do.

• The government will make it so onerous to practice medicine that everyone will quit.

• If the government has one iota of involvement in any form, it is a government takeover.

So what really happens with the Affordable Care Act?