MDs abandon Family Care, NPs step up to Care

A long-term trend in medicine in the United States has been that medical school students continue to abandon Family Care and Rural Practice.

The corollary trend among Advance Practice Nurses & Nurse Practitioners – many whom must also pass National Board Certifications in their area of practice – has been to fill the void formed in the delivery of healthcare by physician abandonment. Typically, the argument given for such abandonment is pecuniary. That is, by the time the medical student graduates from medical school & residency to assume full and independent practice, their debt load is not merely burdensome or impractical, but almost wholly impossible to repay.

More recently, however, medical schools and public health authorities have acknowledged the error of allowing that deterioration and abandonment to occur, and have begun to promote Primary & Family Care among medical schools and their students. Such strategies include not merely the promotion of community and the advantages of rural independent practice, but include full-ride scholarships while in medical school.

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Nurse practitioners look to fill gap with expected spike in demand for health services

By Sarah Kliff, Published: May 12

President Obama’s health-care law is expected to expand health insurance to 32 million Americans over the next decade. Health policy experts anticipate that

Chinese Junk: It ain’t just cheap crap made in China. It’s also hocus pocus herbal faith healers.

Kung Foo Panda.

Yeah.

It’s Chinese JUNK, folks.

Yes, I’m aware that’s a pun.

But, this AIN’T punny.

It’s your life we’re talking about.

So… who do you trust?

Something that has DEMONSTRATED SCIENTIFIC EVIDENCE – or some hocus pocus baloney baloney which is the equivalent of an old wives tale with utterly NO SCIENTIFIC EVIDENCE to support its specious claims?

Your “bullshit” detectors should be pinging 100% every time you pass by some “herbalist’s” corner.

If for no other reason, consider this: There is NO inspection of any ingredients used in such so-called “medicine.”

So, yeah… you could be ingesting arsenic.

Why?

Because there’s no inspection required.

Good luck!

And besides… are you really gonna’ believe that some root, gall bladder of bear, or powdered horn of an endangered specie will genuinely cure you?

Or, will it only relieve the symptoms of your wallet?

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Logo of Jiangxi University of Traditional Chinese Medicine ---

Samples of traditional Chinese medicine are found to contain harmful ingredients

By Kai Kupferschmidt, Published: April 23

Traditional Chinese medicine is enjoying increasing popularity all over the world. But two recently published studies show that the treatments can be harmful. The papers focus attention on the fact that not all of the ingredients in TCM treatments are listed, or even legal, and that some can cause cancer.

Critics have long warned that some mixtures can also contain naturally occurring toxins; contaminants such as heavy metals; added substances such as steroids, which can make them appear more effective; and traces of animals that are endangered and trade-restricted.

Now, researchers in Australia have investigated the issue using modern sequencing technology. The team analyzed 15 TCM samples seized by Australian officials.

“We took these traditional preparations, smashed them to pieces and extracted the DNA from the powder,” explained molecular geneticist Michael Bunce.

Some products contained material from animals classified as vulnerable or critically endangered, such as the Asiatic black bear and the Saiga antelope, just as the producers of the products claimed. But often, the medicine also harbored ingredients not mentioned on the packaging, the team reported online in PLoS Genetics.

In the herbal preparations that they tested, Bunce and his colleagues found

The Digital Pushback: Resistance to i-Progress in e-Medicine

What would it be like if you could to to your clinician’s office, and within a few minutes have a complete analysis of your blood done to detect whatever bug might be growing in there simply by the DNA of the organism?

It’s being doing now.

But why is there resistance to progress?

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The Wireless Revolution Hits Medicine

• Updated April 16, 2012, 11:42 a.m. ET

Eric Topol talks about the upheaval that’s coming as the digitization of health care meets the smartphone

By RON WINSLOW

After 14 years as chief of cardiovascular medicine at the Cleveland Clinic, Eric Topol moved to La Jolla, Calif., in 2006 to become director of the Scripps Translational Science Institute, which was established to apply genetic discoveries to personalized medicine. Three years later, he helped launch the West Wireless Health Institute, for which he is vice chairman and which is investigating use of wireless technology in the delivery of health care.

The convergence of these two fields—genomics, marked by the rapidly plummeting cost of sequencing a person’s entire genetic code, and wireless, with its flurry of innovative health-care apps—led Dr. Topol to write “The Creative Destruction of Medicine,” a book that offers an illuminating perspective on the coming digitization of health care. It’s also a reminder that while medicine is one of the globe’s premier drivers of innovation, it is also a conservative culture that now finds itself buffeted by transformational change.

The Wall Street Journal’s Ron Winslow discussed the implications with Dr. Topol. Here are edited excerpts from the conversation:

Unnecessary Boundaries

WSJ: Let’s start with the title. “Creative Destruction” is a provocative term. What needs to be destroyed?

DIGITAL DOCTOR Eric Topol advocates the transformative power of technology like the MinIon, a disposable device being developed to sequence parts of an individual’s DNA; a mobile patient monitor enabled by an iPhone app; the Zio patch, worn above the heart to check for irregular heartbeats; and a contact lens embedded with a chip to measure eye pressure for people with or at risk of glaucoma.

DR. TOPOL: There are two levels. One is that in medicine, everything we do essentially is

“No doctor ever asked me questions like that before.”

From a holistic healthcare perspective, a problematic issue that remains a common thread among many healthcare practitioners is the notion that a patient is a collection of symptoms, problems to be solved, or diseases cured.

This is not some witchcraft mumbo jumbo hyperbole, akin to the fallacious notion that frequently accompanies “naturopathic” ideology, which itself is wholly without any merit, scientific or otherwise… save that some damn fools spend money on that snake oil peddled by unscrupulous vendors.

This simple idea is that we are an entire collection of things – emotions, thoughts, physiological symptoms and more – all work together to make us who we are. It’s kinda’ like asking the proverbial question, ‘which leg of a three-legged stool is most important?’

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The Simple Idea That Is Transforming Health Care

A focus on quality of life helps medical providers see the big picture—and makes for healthier, happier patients

By LAURA LANDRO

• Updated April 16, 2012, 1:32 p.m. ET

A very simple question is changing the delivery of medical care: How is your health affecting your quality of life? Laura Landro explains on Lunch Break. Photo: Robert Neubecker/WSJ.

A very simple question is changing the delivery of medical care: How is your health affecting your quality of life? Laura Landro explains on Lunch Break. Photo: Robert Neubecker/WSJ.

A very simple question is changing the delivery of medical care:

How is your health affecting your quality of life?

For decades, numbers drove the treatment of diseases like asthma, heart disease, diabetes, and arthritis. Public-health officials focused on reducing mortality rates and hitting targets like blood-sugar levels for people with diabetes or cholesterol levels for those with heart disease.

Doctors, of course, are still monitoring such numbers. But now health-care providers are also adding a whole different, more subjective measure—how people feel about their condition and overall well-being. They’re pushing for programs where nurses or trained counselors meet with people and ask

Soon, the USA will be only 30 years behind in healthcare

Unless one travels in medical or healthcare circles, it’s highly doubtful that ICD-9 codes mean anything.

Why?

ICD stands for International Classification of Diseases, or more accurately, International Statistical Classification of Diseases and Related Health Problems. But it’s known as ICD.

So what’s the “9” for?

It means it’s the 9th revision.

And what good is ICD-9?

It’s a means of tracking disease.

And, to put things in perspective, while the article below would tend to infer that a one year delay might be a bad thing, consider that the work upon ICD-10 has been ongoing since 1983, and was

What happens when physician pay is tied to efficiency & quality?

What would it be like if you were paid for your success?

What would it be like if you were rewarded for high efficiency?

Is it possible that successful patient outcomes could be correlated to compensation?

How would one measure non-compliant patients, or those with poor prognoses?

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Medicare moves to tie doctors’ pay to quality and cost of care

By Jordan Rau, jrau@kff.org Published: April 14

CMS plans to base the 2015 bonuses or penalties on what happens to a doctor's patients during 2013.

Twenty-thousand physicians in four Midwest states received a glimpse into their financial future last month. Landing in their e-mail inboxes were links to reports from Medicare showing the amount their patients cost on average as well as the quality of the care they provided. The reports also showed how Medicare spending on each doctor’s patients compared with their peers in Kansas, Iowa, Missouri and Nebraska.

The “resource use” reports, which Medicare plans to eventually provide to doctors nationwide, are one of the most visible phases of the government’s effort to figure out how to enact a complex, delicate and little-noticed provision of the 2010 health-care law: paying more to doctors who provide quality care at lower cost to Medicare, and reducing payments to physicians who run up Medicare’s costs without better results.

Making providers routinely pay attention to cost and quality is widely viewed as crucial if the country is going to rein in its health-care spending, which amounts to more than $2.5 trillion a year. It’s also key to keeping Medicare solvent. Efforts have begun to change the way Medicare pays hospitals, doctors and other providers who agree to work together in new alliances known as “accountable care organizations.” This fall, the federal health program for 47 million seniors and disabled people also is adjusting hospital payments based on quality of care, and it plans to take cost into account as early as next year.

But applying these same precepts to doctors is

Good News for Birthing Mothers! – Audio Post

Wonderful News out of Nashville! /%20%20/%20Post

Healthcare Reform Addresses Rising Health Care Costs

“Healthcare reform is going to happen because it has to. We cannot, as a country, continue to absorb cost increases in healthcare.”
– Cullman (AL) Regional Medical Center CEO, Jim Weidner, Thursday, 24 February, 2011 in his “State of the Hospital” address

The CEO’s address was encouraging, not the least reasons of which were that

Experience – Is it the WORST teacher, or the BEST?

Someone once wrote that experience is the WORST teacher, because it gives a test FIRST… THEN teaches the lesson AFTERWARD.

In some way, I rather think that correct, while – as you’ll read – in yet another perspective, it may be the best… but only if you listen.

NASA Foul Up

{Ed. Note: This entry was previously password protected, and notated; enter the password: NASAFoulUp}

This brief entry could perhaps be alternately entitled, “How did we manage to foul (or your choice of expletives) up so badly?”

Why?

Placebos help, even when patients know about them

Personally, I’ve enjoyed the chocolate and strawberry flavored placebos.

Placebos help, even when patients know about them

Wed Dec 22, 2010
5:50PM EST WASHINGTON (Reuters) – Placebos can help patients feel
better, even if they are fully aware they are taking a sugar pill, according to researchers who reported Wednesday on an unusual experiment aimed at better understanding the “placebo effect.”

Researchers reported in the Public Library of Science journal PLoS ONE that nearly 60 percent of patients with Irritable bowel syndrome reported they felt better after

Sex, Drugs, and Rock-n-Roll

Periodically, friends and family come to me seeking understanding about various medical and health related issues, which often includes information about procedures and medications.

And on occasion, I continue to be asked to identify certain medications.

Particularly problematic are the numerous herbs and Over The Counter (OTC) non-prescription remedies that neither treat nor cure, yet proliferate and line the pockets of those unscrupulous enough to market and sell them to the unsuspectingly ignorant.

On one such occasion, I was asked by a friend to identify several foreign concoctions of apparent Asian origin, which I succeed in identifying, though I suspect I merely added levity to our communication. Fortunately, the request wasn’t anything of any seriously substantial nature.

It’s becoming more difficult to identify many items, though I count myself fortunate to have access to the numerous resources I do.

Here’s the text of my response. Perhaps you’ll find it enlightening.

The economy is so bad that…

I got a pre-declined credit card in the mail.

African television stations are now showing ‘Sponsor an American Child’ commercials!

Wives are having sex with their husbands because

Don’t Forget! Fish Oil is Snake Oil!

Alrighty folks! It’s TRUTH TELLING TIME AGAIN!

This time, a two-year study has demonstrated that omega-3 fatty acids (also known as “fish oil”), is really snake oil.

That is to say, that the only benefit to taking it, is to the pocketbooks of those whom sell it!

The low-down follows.

Marijuana and Schizophrenia – A Clear and Unmistakable Link… ignored in America

There is a significant and growing scientific body of medical evidence that marijuana use contributes significantly to schizophrenia – a particularly debilitating mental health condition that strikes during the most productive years of one’s life.

Medical marijuana anyone?

Maybe you’d prefer your mental health, instead.

It’s a shame that mental health professionals and other researchers in the United States almost wholly ignore the vast, longitudinal (long-term) and increasing body of evidence that conclusively demonstrates that marijuana DIRECTLY contributes to schizophrenia.

Of course, the elemental breakdown between reality and perception most characteristic of schizophrenia does seem to be present in this latest (and I believe ill-fated) and contradictory decision by the Mexican government to legalize small quantities of all illicit narcotics, including cocaine, heroin and LSD.

While this recent decision allows “small amounts” for “personal use,” apparently it doesn’t allow manufacture, sale or distribution of large amounts. However, “small amounts” always come from “large amounts.”

Complicating matters, the Mexican government has a long-time, well-known and rightfully-deserved reputation for corruption at all levels.

Mexico has continually been a “Third World” nation in the Western hemisphere. For years, in hopes for a better life abroad, their people have

Troy King claims Pharmacy Lawsuits Frivolous – OR – “I practice law AND (bad) medicine!”

Using my “Bob Riley and Troy King: The Saga Continues” post on Monday, February 1, 2010, as a guide, I crafted a “Letter to the Editor” (LTE) which was published by “The Times Daily,” a Florence, AL area newspaper serving the Shoals area and greater Northwest Alabama.

Here, in its entirety is the letter. I have redacted my name – though if you ask politely, via e-mail, I will share. I have nothing to hide.

“Alabama Attorney General Troy King has recently come under fire for requesting judges in five counties to

“Paging ‘American Healthcare Reform,’ paging ‘American Healthcare Reform’… you’re needed in the OTC Pharmacy – STAT!”

[ed. note: I wrote this post accompanying some photos I’d made and posted to my Flickr site back around October 2009.]

He wanted some OTC ranitidine. I told him, “Get omeprazole!” But he didn’t, saying he wanted more rapid relief.

So… guess what!?!

It just so happened, that at the checkout stand in front of us was a Big Pharma sales rep. She said, “Use this!,” and pulled out

Trouble from Huntsville Hospital

NOTE: I share the following with explicit permission.

A dear, elderly and retired friend of mine will, in coming days, be scheduled for surgery. Most likely, the procedure(s) will be performed at Huntsville Hospital.

Because my friend is retired, she receives a modest (meager would be more appropriately accurate) private pension, supplemented with Social Security income. Altogether, she has monthly income of under

Come… and Go

And are you aware, that pound-for-pound, Viagra is MORE expensive than a fully loaded Mercedes-Benz S550 4Matic?

A fully-dressed, 2005 Mercedes-Benz S550 4Matic (their top-of-the-line/flagship luxury sedan) weighs

When the treatment is worse than the disease

“Simponi can lower your ability to fight infections, including tuberculosis. Serious and sometimes fatal events can occur – such as infections, cancer in children and adults, heart failure, nervous system disorders, liver or blood problems and allergic reactions. Before starting Simponi, your doctor should test you for TB and assess your risk of infections, including fungal infections, and hepatitis B.”

– from a teevee commercial/advertisement for a once-a-month, self-injectable “drug/medicine” branded “Simponi” purported to treat rheumatoid arthritis

“SIMPONI^™ can lower your ability to fight infections. There are reports of serious infections caused by bacteria, fungi, or viruses that have spread throughout the body, including tuberculosis (TB) and histoplasmosis. Some of these infections have been fatal. Your doctor will test you for TB before starting SIMPONI^™ and will monitor you for signs of TB during treatment. Tell your doctor if you have been in close contact with people with TB. Tell your doctor if you have been in a region (such as the Ohio and Mississippi River Valleys and the Southwest) where certain fungal infections like histoplasmosis or coccidioidomycosis are common. Unusual cancers have been reported in children and teenage patients taking TNF-blocker medicines. For children and adults taking TNF blockers, including SIMPONI^™, the chances for getting lymphoma or other cancers may increase. You should tell your doctor if you have had or develop lymphoma or other cancers.”

– from the http://www.simponi.com/ website

The word “medication” can be simply defined as “a compound or preparation used for the treatment or prevention of disease,” while the word “cure” can be simply defined as to “relieve (a person or animal) of the symptoms of a disease or condition.”

Should a “cure” cause disease?

What the hell was the FDA thinking when they approved this “medicine”?

What sense does it make to create a “medicine” for which the company knows causes cancer? Is that not a class action lawsuit waiting to happen? Would the American Cancer Association approve this medication?

Would YOU recommend this “medicine” to your family and friends?

Would YOU take this “medicine”?

Should this “medicine” be banned?

WWJD Health Care: “Will this make your life better?”

I regularly contribute commentary to a blog entitled “OFFAir & ONLine,” by Tim Lennox. Mr. Lennox is a Viet Nam veteran and print/broadcast journalist of some years’ experience, and readers will see a link to his blog on this blog. His name or face maybe most recognizable from his 11-year tenure as News Anchor/Host of Alabama’s only statewide news program “For The Record,” broadcast on Alabama Public Television (APTV).

After APTV essentially deep-sixed the award-winning program, and its highly respected Host – calling long distance to bear bad news while he was attending a relative’s funeral almost half-way across the country – Mr. Lennox has quite fortunately again found gainful employment in his field.

Recently, Mr. Lennox cited a news item and posed a question to his readers, which was a reiteration of the same question asked by the subject of a news story to which he linked, and which was, “Will this make your life better?”

It’s said that there are two motivations for people: 1.) Love, and; 2.) Money.

If a person doesn’t do a thing for love, they then do it for money. And there is a word used to describe those whom do things exclusively for money: it’s called “prostitution.”

In that light, I composed the following response:

Fear mongering certainly seems to be Republicans’ political stock in trade.

I write that after reading the inane comments of Republican Nebraska Sen. Mike Johanns in the linked story.

Concerning “government delivered healthcare,” the only comment I have, is that it certainly seems to work quite well for our Soldiers, Sailors and Airmen!

But this issue is NOT about government delivery.

It IS however, about deciding whether our nation can and should continue on the path we’ve been embarked upon for nearly three generations (post WWII era).

That being, whether we shall continue to allow for-profit, Wall Street mega-billionaires and their über-wealthy insurance companies to call the shots on our healthcare by the power of their purse.

They have made their fortunes upon the backs of the suffering, and in the process, because of lack of regulation, caused and increased unnecessary suffering among untold Americans’ lives.

Among other unconscionable and inhumane acts, they have refused to pay for procedures, medications and treatments that healthcare professionals have deemed necessary.

They have refused to pay for treatments after services were rendered after they cashed checks, claiming a “cap” or “incorrect date” was on the check. They’ve constantly changed the “rules of THEIR game,” even in the middle of the “game,” forcing the insured to dance to the tune of THEIR piper… like it or NOT! (Yeah, it’s a mixed metaphor… but it works!)

And these are but two egregious examples. There are countless, and untold MILLIONS more.

One significant reason why healthcare costs in this nation are so out-of-control are because of insurance companies.

It’s a very simple-to-understand idea: 

Anytime anyone gets in between you and the check-out stand, you’re gonna’ pay more.

Analogously, why would you pay me to pay your fuel costs for your automobile? Why would you pay me to pay for your groceries?

We’ve done similarly with our healthcare in this nation for so long (since post WWII) that we’ve become accustomed to it, and act as if it can’t be changed.

Perhaps that “genie can’t be put back into the bottle.”

I don’t know.

But, we can darn sure (and should) do something about the environment in which it is allowed to operate!

Besides… if competition is good (and it is), why would the insurance companies (private enterprise) NOT want competition from the government?

It just doesn’t make sense… like most of what insurance companies say and do.

Whatever they say, I’m disinclined to do, simply because they proven time and time and time again, that they CANNOT be trusted.

They’re in it to make money.

They DON’T give a damn about you.

Take away their profit motive and what do they have left?

No reason for existence.

They’re NOT charitable organizations… like hospitals have historically been.

Christian charities have operated hospitals for longer than health insurance companies have peddled health insurance.

And they did a darn sight better when those whose filthy lucre turned it into a den of thieves stayed out.

ICU had Bowel Movements

Yesterday, I received a patient transfer from ICU after a carotid endarterectomy. She was stable, elderly, though was best described as “needy” at times. Some folks are just that way. I think it’s a type of abuse.

Anyway, the Nurse whom had cared for her gave me report on the patient’s condition (in person), and when she got to the bowel/GI part, she mentioned that