Monthly Archives: October 2014

More on Ebola

1. Today, driving to work, I heard NPR’s report of how Facebook founder Mark Zuckerberg, and his wife, had a revelation that third world countries have poor sanitation facilities and this fact relates to the out of control Ebola epidemic in West Africa. This apparently occurred while Zuckerberg was traveling in India, and moved him to pledge $25 million for immediate use for public health work in West Africa. Right after that, NPR reported that world stock markets were falling as the business community realized that the Ebola crisis might affect their bottom lines. This is all good news. As I predicted earlier this week, as soon as the captains of industry who give our political “leaders” their marching orders, get concerned about losing money, there will be an intense effort to stem the spread of Ebola. Zuckerberg is young. He has been too busy making money and meeting with political leaders to know what the Third World looks like. Zuckerberg’s lack of knowledge about sanitation in the Third World is not surprising. I hope he was told not to shake anyone’s left hand there. For those of you who don’t know, the left hand is used instead of toilet paper.
2. Some comments about defensive medicine. It strikes me that what all the experts and population are calling for now is defensive medicine to stop and monitor Ebola. Things like checking lymphocyte counts daily in people exposed to Ebola victims and close monitoring of temperatures. “Defensive medicine” has been the pejorative term used by the business community and their lackeys in the press and legislatures to rail against lawyers who represent victims in malpractice actions against doctors and hospitals who don’t follow “protocols.” As in they didn’t follow the protocol or train nurses in the use of the proper protocol to treat Ebola and now the entire city is exposed. What the critics of current Ebola practices at Texas Health Presbyterian Hospital are calling for is “defensive medicine.” This brings to mind an observation taught to me by the late Harry Schwartz – economist and New York Times editorial page writer – that peoples’ concerns for health care costs are inversely proportional to how sick they are. And Mittler’s corollary: and how scared they are of the Ebola epidemic. When all you worry about is the common cold or indigestion, you think that all the public health measures and expensive specialists are frivolous (like all lawsuits) and a waste of your hard earned tax dollars, that could be better spent on Dallas Cowboy jerseys or dog sweaters. But when the Ebola virus threatens, people want daily blood tests, specialized treatment centers, a fleet of jets to transport victims, and hot and cold running infection disease specialists to save their lives.
3. Less is more: The mantra of so many medical journal editors, like Rita Redberg of JAMA Internal Medicine is that “less is more.” Greedy doctors doing too many unnecessary testing and the need for managed care executives to rein them in. How many medical journal editors are calling for HMO executives to take over the management of the Ebola crisis? The public wants the biggest experts and the best facilities money can buy? Take a poll: How many of you would trust Kaiser or Humana to run the national Ebola response team? Would that number approach zero or be zero? How many in the public trust Texas Health Presbyterian Hospital to run their Accountable Care Organization?
4. My impeccable source tells me that yesterday an elective heart valve replacement surgery was cancelled at Texas Health Presbyterian Hospital in Dallas due to reasons not explained to the patient.
5. This past Monday, 10 orthopedic surgeries were cancelled at one northside San Antonio hospital due to several operative room personnel not showing up. The doctor who told me about that could get no explanation as to why this happened. He was upset because one of his patients was already in the operating room holding area being prepped for surgery when the cancellations were announced. Do you think that hospital will “self-report” to the Texas regulatory agency that monitors hospital quality? You can be sure that if any surgeon cancelled at the last minute and that surgeon wasn’t a big hospital admitter, he or she would be hauled before a peer review committee. BTW, that won’t happen in this instance because most of the surgeries involved one surgeon who is a big Accountable Care Organization medical politician at that institution. So, patient inconvenience is the only fallout, and who cares about that?

Zeke Emanuel Now Ebola Expert Too?

Zeke Emanuel Now Ebola Expert Too?

It’s hard to know where to begin this AM.

1.      At 5:04 CDT, “Morning Joe” brought on Zeke Emanuel as their Ebola expert. Give us a break! It’s hard to know who America’s Doctor is these days. Back in the late 1980s, it was easy: Surgeon General C. Everett Koop. But now, we have Zeke Emanuel, vying with Sanjay Gupta who is vying with Sandeep Jauhar who is vying with Nancy Snyderman and don’t forget Atul Gawande.  I’m waiting for some network to bring on 100 year old Professor Irwin Corey – “the world’s foremost authority” to straighten out the Ebola mess. Gupta “debated” Dallas Congressman Pete Sessions on CNN’s “New Day” on the issue of quarantining West Africans to prevent the spread of Ebola and did not fare well. Sessions accused him of everything but child molestation for suggesting that it was hard to enact an effective quarantine.

2.      Speaking of NBC’s Snyderman, over on CNN this AM, there was some hilarious subtle old-school doctor-bashing. There was a story on how the NBC reporting team had been put in voluntary quarantine in the U.S. after their cameraman came down with Ebola. And apparently Dr. Nancy Snyderman did not observe the quarantine.

Anchor Michaela Pereira slammed Snyderman saying she was seen driving around in a Mercedes! Ouch! That’s really a dig, accusing a doctor of driving a fancy car. (It was a black Mercedes according to Planet Princeton.) Appealing to the politics of greed and envy always works. Maybe Pereira should have checked to see how much Mercedes – the car company — spends on ads with CNN, before knocking an advertiser. I thought rich doctors and even richer doctors who are network TV medical editors are supposed to drive fancy cars.  But we have all been trained by the national media that when doctors drive fancy cars, it is because they have made too much money from doing self-dealing unnecessary tests and procedures. Especially those done in the middle of the night on hapless acute heart attack victims.  Or taken too many billions from the former cheerleader drug reps.

3.      Maybe somebody out in the blogosphere can explain why we need so many news teams in West Africa covering the Ebola epidemic. Don’t we already know the basic story: thousands are dying from the disease in countries where there are few doctors, poor sanitation, poor health facilities, weak public health systems, and leaders who for many years have looted the countries and oppressed the people? Can’t we get the story of the deaths from pooled news coverage?

4.      Then we have the story today by Robert Pear in the New York Times that audits of Medicare HMOs show they are denying necessary medical care.

Is this really news? That’s what Medicare HMOs are paid to do: deny care and do the rationing dirty work that federal officials are too afraid to do.  Pear has been covering Medicare HMOs for over 20 years. He wrote a big story in the 1990s about how Medicare HMOs weren’t saving money.  This isn’t his first rodeo – on this subject. But Pear and his editors only quote from the government audits and responses from HMO executives. He never uses one source who has been a long time critic of Medicare HMOs. He never cites one of the medical literature articles that showed that Medicare HMOs promote underuse.  He knows who the critics are but didn’t choose to put any such view is in his article. I’ll just file this under another example of incomplete reporting by the America’s newspaper of record. But hey, they own the newsprint.

5.      Speaking of Medicare HMOs, I saw a Humana Medicare HMO TV ad on 10/12/14 at 0529 playing on ESPN.  The ad started “Zero, Zip, Zilch,” and proceeded to show all the services enrollees would get for “free.” This is the essence of HMO advertising: everything is “free.” These are deceptive ads and I have complained about such ads in the past – with no success.  Medicare Advantage is not free. It is subsidized by U.S. taxpayers.  No out of pocket expenses does come at costs: lack of freedom to choose your doctor, narrow networks, restrictions on consultants, and extra payments if you want to go outside the defined networks, and a restricted drug formulary.  You could say that gullible seniors both deserve and don’t deserve what they get. Caveat emptor.  By now, everyone should know that there are no free lunches in health care. But, there are many elderly folks who are not sophisticated or who have various impairments and who need the government to protect them from such deceptive advertising, not throw them to the HMO marketing wolves. And don’t expect National or Local media to protect seniors. They’re all hooked on Medicare HMO advertising dollars.

6.      The most significant stories today deal with the failure of hospitals to properly prepare the staff members to deal with Ebola. It’s not just nurses who have been poorly trained – if they received any training at all, it’s the lab and x-ray techs, respiratory therapists, and other critical hospital personnel. Meanwhile the highly paid administrators are probably more concerned about when and if the stock market will correct.

7.       The U.S. will get serious about Ebola when corporate chieftains tell their politicians on retainer to solve the problem. Until it affects McDonald’s or GM’s or Apple’s or Starbuck’s bottom line, our political leaders will continue to dit