Archive for July, 2008

Tuesday, July 29th 2008

Scalpel, Beer

There has been considerable discussion about the internet, social media, privacy and how all of this will effect people in my generation and younger when they go out into the real world. The plethora of personal information being made available online, and not all of it shining on the virtue of the individual exposed, is going to come back and bite my generation in the behind. And especially for professionals. Say future physicians. Or so the thinking goes.

My school actually sent out an email with a link to a wire piece covering this study.

Their study found almost half of medical students had Facebook pages, but only 37 percent of those students limited viewership to friends.

Most of the pages provided lifestyle details, including sexual orientation, dating relationships and political opinions.

One group was titled, “I’m a doctor and I hope my patients don’t see me on Facebook.”

Personally I think the risk is overstated. That doesn’t stop me from being a little cautious and just using common sense about what I post online (although I do have this, sometimes, inflammatory blog). Still, to imagine this is going to cost a good group of medical students career options is over the top. When everyone does it, how are you going to critique on it? There will continue to be anecdotal stories about residency programs or employers or schools rifling through applicants’ online social profiles, at least for the next decade, and you’d hate to be that one in a thousand but those are the kind’ve odds. Facebook, MySpace, other social websites are never going to rise up and swallow my generation.

The way the warnings go out you imagine that no one my age will ever become President: Twenty years from now, we’ll go straight from an 80-year-old Hillary Clinton to a 35-year-old kid in the generation behind me who was warned by University of Florida researchers, just in time, not to post anything on Facebook.

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Tuesday, July 22nd 2008

Why Local News Sucks

So this story is seemingly tragic. In it a young Florida woman with Chiari Type I is having debilitating headaches and is about to get a p fossa decompression to cure her when her insurance company cancels her family’s health insurance plan and she doesn’t get the operation.

Here is how the story describes it,

A 19-year-old Tampa Bay, Fla., woman is suffering from a debilitating brain disorder that may kill her after an insurance company canceled the family’s medical coverage just before she was due to receive life-saving brain surgery, Tampa Bay’s 10 News reported.

First and foremost, this disorder is typically far, far from a medical emergency. But you wouldn’t know that from the story.

Second, we don’t know in the slightest the circumstances around the cancellation of this insurance policy. All we know is the apparent timing of it and even that is questionable. Aetna canceled the policy “just” before the surgery? Hours before? Days before? A week before? Three weeks before? More?

In anycase, while this story is potentially heart wrenching it also demonstrates the stumbling in relying on the media for the whole picture when it comes to complex, technical issues.

Monday, July 21st 2008

Anniversary of Moon Landing


In A Beautiful Sight, Apollo 11 Takes Off

As you may or may not know, I’m a big fan of manned space flight. I’m being serious. I truly marvel that man can leave Earth and bemoan the lack of progress and support for human travel away from Earth.

Such being the case, I thought it appropriate to commemorate the June 20th anniversary of Neil Armstrong and Buzz Aldrin touching down on the Sea of Tranquility. Pretty amazing or as The Onion described it.

Wednesday, July 16th 2008

Another Year Without The SGR Mandated Reimbursement Cuts

There has been some drama going down on The Hill in case you haven’t been paying attention. This year was arguably the closest physicians have ever come to having the Sustained Growth Rate formula automatically reduce their reimbursement under Medicare.

Medicare is supposedly a fixed budget system when it comes to paying providers like physicians. Built into the system is something called the SGR. The SGR is a formula. Whenever Medicare goes over its fixed budget in a fiscal year (which is every year essentially) the SGR is used to determine how much physician payments from Medicare should be reduced so that (hopefully) Medicare will be back under budget the following fiscal year. Every year as July approaches and the SGR cuts are supposed to go into effect physicians freak out and organized medicine makes a major push for Congress to forestall the cuts. And every year that seems to happen, except that Congress can’t seem to come to a consensus on eliminating the SGR system altogether and instead only revoke the cuts on a year by year basis.

This year, per the formula, Medicare physician reimbursement was supposed to be cut by more than 10% across the board. So if a doc got $200 for hitting a patient with a reflex hammer on June 29th then he’d get less than $180 for doing the same thing on July 2nd. As has become standard Congressional leaders pushed forward a bill to prevent those cuts from taking effect. The bill is HR 6331 also known as the Medicare Improvements for Patients and Providers Act of 2008.

It sailed through the House of Representatives.

In the Senate however some Republican Senators were upset because the halt in the physician pay cuts was “paid for” by reducing some income streams for private Medicare insurers. While the Senate had enough votes to pass the measure they did not have enough to prevent the Republicans from stalling and preventing the bill from even being called for a vote. And they certainly did not have enough to override President Bush’s threatened veto.

The cuts for physicians were supposed to go into effect July 1st and that day came and went without the Senate being able to act on the bill because of the stalling tactics by Republican Senators. Luckily CMS decided to hold physician reimbursement claims to wait and see if the Senate might eventually act on rescinding the SGR cuts.

In a dramatic turn of events the Senate did just that. Senator Ted Kennedy, currently undergoing treatment for a GBM, returned to the Senate to break the deadlock. As soon as it became apparent the bill was going to be called for a vote some Republican Senators turned around and announced their support for the bill.

The patriarch of the Kennedy family entered the chamber, alongside Democratic presidential candidate Barack Obama (Ill.), to a rousing ovation from senators on both sides of the aisle, some of them tearing up. Greeted with hugs and handshakes, Kennedy, bearing a big smile, went to the well and declared loudly, “aye” in support of the legislation.

Democrats cheered loudly, and Sen. Charles Schumer (D-N.Y.) was seen blowing a kiss to the Republican side of the chamber.

[...]

Kennedy’s presence Wednesday, along with the reality that Democrats had the votes lined up to move ahead, was enough to flip nine of the 39 Republicans who previously voted against the bill. The bill was approved by a 69-30 margin, more than enough to override an anticipated presidential veto.

Among those who turned around their support were both Texas Senators – John Cornyn and Kay Bailey Hutchinson. The initial refusal to support the bill so enraged the Texas Medical Association that it withdrew it’s support from Cornyn in his upcoming race to retain his Senate seat. Although I’m sure it should surprise no one if they turn around and restore it considering Senator Cornyn is a likely shoe-in to keep his Senate seat.

The Hill newspaper had this to say about the role of the two Texas Senators in switching their allegiance to the Democratic point of view on the bill,

Soon after Hutchison’s vote, her Texas Republican counterpart, Sen. John Cornyn (Texas), flipped his vote, prompting more cheers and smiles from the Democratic side of the aisle. Cornyn had lost an endorsement from the Texas Medical Association and had been the subject of heavy criticism and attack ads from the American Medical Association for voting to block the bill last month. The group said that Cornyn and Republicans were putting insurance providers before doctors who would need to limit access to Medicare beneficiaries if they received a 10.6 percent cut to their reimbursement rate from the government.

Cornyn had been trying to push through a separate, longer-term fix, but Democrats objected. Finance Committee Chairman Max Baucus (D-Mont.) called Cornyn’s bill a “big warm kiss” to doctors without fixing the problem. In unusually sharp terms, a frustrated Cornyn called Baucus’ comments “insulting remarks.”

But with his Texas counterpart voting yes and the bill appearing likely to clear, Cornyn was boxed in a corner.

“I made a commitment all along that the cuts would not go through,” Cornyn said after his vote for the bill. “I still think the legislation is flawed and the idea of doing this every six months or 18 months is a terrible way to do business… I would hope the majority would consider legislation that would permanently resolve this. But it reversed the cut, and that’s the commitment I made to the physicians of my state.”

With the bill finally passed last week, President Bush carried out his threatened veto which was immediately overturned by two-thirds majorities in both the the House and the Senate. The President had this to say,

“I support the primary objective of this legislation, to forestall reductions in physician payments. Yet taking choices away from seniors to pay physicians is wrong. This bill is objectionable, and I am vetoing it,” Bush said in a statement to the House.

But he can obviously suck on it considering the result.

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Saturday, July 12th 2008

Dr. Debakey Dies

Dr. Michael Debakey has passed at 99.

”Dr. DeBakey’s reputation brought many people into this institution, and he treated them all: heads of state, entertainers, businessmen and presidents, as well as people with no titles and no means,” said Ron Girotto, president of The Methodist Hospital System.

Girotto said the surgeon ”has improved the human condition and touched the lives of generations to come.”

I’ve tried to decide what makes a great surgeon. And I’m using that adjective and ‘famous’ as synonyms. There is a personality for self promotion behind it, no doubt. But I think the obvious answer is innovation. And Dr. Debakey did not lack for that talent. The man was incredible in his genius and his foresight and contributed incredible innovations to the practice of cardiovascular surgery.

Rest in peace Dr. Debakey.

Wednesday, July 9th 2008

Wisenthal Center Tries To Flush Aribert Heim Out

Aribert Heim was a Nazi SS officer and physician whose infamy lies in the horrific ‘experiments’ he documented at Mauthausen Concentration camp during the year 1941. It is not for a lack of horror to Heim’s crimes that he lacks the name recognition of other Nazi physicians such as Josef Mengele. As Wikipedia says,

Jewish inmates were poisoned with various injections directly into the heart – including petrol, water and poison – in order to induce death more quickly

According to a former camp inmate, an 18-year-old Jewish youth came to the clinic with a foot inflammation. He was asked by Heim why it was that he was so fit. He replied that he had been a soccer player and swimmer. Instead of treating the prisoner’s foot, Heim placed him under anesthesia, cut him open, took apart one kidney, removed the second and castrated him. The boy was decapitated and Heim boiled the flesh off the skull so it could be displayed, the former inmate said.

Now the Wisenthal Center is engaging on a massive media campaign to flush out the 94-year-old Nazi war criminal. They seem to be convinced he is alive and in Chile. I heard an interview with a Wisenthal Nazi hunter actually in the South American country on NPR this morning and all of the major news outlets are covering the story.

The Simon Wiesenthal Centre believes Aribert Heim is in Patagonia, where his daughter is known to live.

The group has put up a 315,000 euros ($495,000; £250,000) reward for information leading to the arrest of Heim.

My only guess is they’re hoping the media coverage will force him to make a move; albeit a slow one I bet at ninety-four.

I would love to see Heim’s caught before he passes and escapes any accountability for his crimes.

Saturday, July 5th 2008

This Fourth


A Fine Sight

Okay, it is actually no longer the Fourth of July but a slight tribute is still in order. I was on planes all day getting back from Dublin, which is a fine way to celebrate the birth of our country. There are tributes across the web, of course, and more specifically the medical blogosphere. The one I like the best is the WSJ Health Blog looking at the five physicians who signed the Declaration of Independence.

See politics and medicine can mix…