Boomsday, Redux

This morning I heard a startling news item on NPR:

For example, this moment, during President Obama's town meeting yesterday, the meeting was hosted by AARP, and at one point a caller named Mary put this question to the president about something that she had heard is in the House bill.

MARY: I have been told there is a clause in there that everyone that's Medicare age will be visited and told to decide how they wish to die. This bothers me greatly, and I'd like for you to promise me that this is not in this bill.

I knew this was another case of fiction becoming reality!

Last year, Christopher Buckley’s novel Boomsday kept me entertained through a flight somewhere and well into the night after arrival (this explains my drowsiness the next morning). The title refers to the date when the majority of baby boomers retire, precipitating an economic catastrophe for the country.

The heroine is Cassandra Devine, a savvy 29-year-old PR professional working in an agency run by one of the guys from Thank You for Smoking, an earlier Buckley work. She writes a popular blog (a la Dr. Isis), and she inspires her readers to storm golf courses and gated communities to terrorize the Medicare set. One late night she develops a concept of “voluntary transitioning” for boomers; in other words, they get some benefits (free Botox? reduced inheritance taxes?) if they agree to kick the bucket at age 70. Yup, it’s voluntary suicide. She repeatedly tells people that this is a “meta-issue” meant solely to drive the conversation and get the economic mess fixed, but like many ideas, this one develops a life of its own and is soon out of her control.

Unfortunately, this book has one thing completely in common with reality: tough choices don’t get made.

I won’t tell you any more about the book, because you really ought to read it yourself. Hell, you should buy it and help out Mr. Buckley who lost his job at the National Review (founded by his dad) because he endorsed Barak Obama for president!

The truth is no one really wants retirees to “pick their method of death:”

Mr. DAU: The House bill includes a provision that would allow Medicare to pay doctors for taking the time to talk with their patients about the very difficult choices that people face at the end of their life about health care: What kind of interventions you might want in the case of a bad accident or debilitating illness. It would empower individuals to make the best possible health care choices for them and their families and allow doctors to provide their patients with this so that no one's guessing at the end of a person's life.

SIEGEL: Because you're saying that that consultation that the doctor would offer or another health care professional might offer would, under the bill, now become covered by Medicare.

Thus far the debate on health care reform is a mess, driven more by fear than fact. I truly hope that our government can get it together and cover all of our citizens.

In the meantime, I’m waiting for Christopher Buckley to write another book!

The Name of the Game is Blame

I read an interesting post over at DrugMonkey today. The pharmaceutical primate takes Terrified Tabetic (@TTabetic) to task for inaccurate statements about HIV/AIDS. These posts plus the ensuing discussions raise a question for those of us who are healers and investigators:

What do we do when the patient contributes to their own illness?

We may know how we feel. I know that I don’t have much empathy for smokers who get lung cancer or chronic obstructive pulmonary disease. For my entire lifetime, smoking has been linked with these illnesses. Does that mean we shouldn’t study these illnesses? Should we refuse to attempt to treat them because they are self-inflicted? No, I believe we should fund research into these disorders and continue to find ways to ameliorate the suffering associated with them. I am just not the best person to do it (this may be part of the reason I ended up in pediatrics).

Many people in our society seem to have a “blame the victim” mentality for, well, almost every illness. Some magazines would suggest that if we live right/ eat right/ exercise right we will never die! My husband, the director of our diabetes center, lectures medical students on endocrine pathophysiology. A student once asked him after class why so much research was done on type 2 diabetes when it would not be a problem if people quit committing the sin of gluttony. My spouse handled the question tactfully; I am afraid I would not have. You see, my hubby has type 2 diabetes. I would have taken the time to teach that student a lesson s/he would never forget.

The biggest problem in the research arena is the scarcity of resources. I doubt that most people would mind the study of so-called self-inflicted illnesses (although none of these illnesses is due to a single factor; we really don’t understand why some smokers get lung disease but many do not) if all areas of research were money away from what I want to study that I cry foul.

That’s my one gripe with disease-based lobbying. While I belong to groups that do it, ultimately we need to increase all research funds and let the NIH, not congress, sort out where it goes. Otherwise we have politicians micromanaging biomedical research saying where money must or must not go. Special interest groups can raise funds for their own programs, as many have done, and direct research toward their cause that way.

There is nothing in this universe that is unworthy of further study.

Photo courtesy of PhotoXpress.com

My Dry Cleaner Can!

According to a recent Research! America poll:

Americans were asked whether or not they could name a living scientist. 65% said they could not, and another 18% were unable to accurately name a living scientist.

The best know living scientist was Steven Hawking, named by 7% of respondents.

Those of us who do science in the US are rarely described as scientists. As an MD, I am usually described as a physician, not a scientist. Even though I only do clinical medicine 30% of the time, most people see me as a healer, not an investigator.

Most scientists I know are introduced by their faculty appointment, not as scientists. The US population generally believes that university faculty fill their days with teaching. Unless you have experience in academia beyond obtaining a bachelor’s degree, you probably do not appreciate the role that research plays in that arena.

So why can my dry cleaner tell everyone that I am a scientist?

Well, when our new research building opened, the local paper did a supplement on the facility and all the scientists with lab space. They ran a photo and a brief description of my studies, and the woman who works the 7am shift asked me about it. She knows I am also a physician and has asked me kidney stone questions as well.

We all know the stereotypes: mad, nerdy, consumed, unfashionable. People don’t know anyone who answers these descriptions.

We need better PR.

So let’s take the advice of New Voices for Research. If you’re a scientist, introduce yourself that way. Let’s start breaking those stereotypes. The world should know us better, one person at a time.

Becoming the Authority

This week Michael Vick was cleared to possibly play football again in the NFL. He will be suspended from some games, and no team has yet signed him.

Now, dog fighting is a pretty gross thing. I don’t mind some violence and potential for blood in my sports (I like football and hockey), but I don’t see the point in any sport in which the actual point of the activity is to brain-damage your opponent (boxing) and worse (cage fighting, dog fighting, bull fighting, etc). In no way would I ever condone this activity, but Michael Vick has served his jail time. Were I lucky enough to be an NFL owner, I would not sign him to my football team (mostly because he wasn’t that good), but I do not think he should be banned from the league.

The question I had was after listening to this coverage on NPR:

Part of Michael Vick’s restitution is working on a dog fighting prevention program with the Humane Society of the United States (HSUS). HSUS is not the human society in your community; it is primarily a national organization that seeks to eliminate animal use for food, research, and recreation (pets, hunting, etc). Most of its budget is used for lobbying and publicity, not to save dogs and cats in communities. People for the Ethical Treatment of Animals (PETA) is also quoted in the NPR piece. This is another group with extreme views, promoting humane live insect traps after Obama swatted a housefly on television.

When did these groups become authorities? Where are the more moderate animal support groups who help get pets adopted, prevent unnecessary litters, and assure that animals are treated with care? They are still there; Denver the Wondercat (who just celebrated his 18th birthday) was rescued from the local shelter. My parents and my daughter have also adopted cats.

The truth is your local humane society can barely make ends meet, let alone mount any sort of organized publicity. HSUS and PETA, in contrast, are PR machines, eager to grab a national issue like the exploits of Michael Vick. Unfortunately, every child who is touched by his dog fighting program will now consider HSUS an authority. As I blogged a few months back, volunteer work for PETA is considered in a positive light and publicized as a benevolent thing. These groups are seen as authorities, even though both of these organizations may provide support to more radical organizations engaged in terrorist activities.

How do you fight a machine?

Photo courtesy of PhotoXpress.com.

Lies, Damn Lies, and NO Statistics

Last week I listened to some of the Sotomayor hearings on CNN. The hearings were about as I expected, but the ads between sessions were frightening. A Canadian woman was on the tube telling me how she would have died of a brain tumor if she hadn’t traveled to the US for treatment.

I have a number of Canadian friends and acquaintances, most of whom are physicians. They LOVE the Canadian system. They know that every patient they see is covered. Layers of administration for preapprovals and claim resubmissions have been peeled away from the process (I have spent 45 minutes on the phone to get non-tablet forms of medications approved for a pediatric patient). And they don’t have to inflate their base charges so that the 80% rate someone negotiated will cover the actual costs incurred. A couple of them have said that Michael Moore got their system right in Sicko. Even those who experience the system as patients like it. Yes, they pay for it with taxes, but they don’t have to worry about losing their coverage with their job.

This ad just didn’t sound right. Elective procedures often involve waits (like they can in the US), but I had never seen a documented life-threatening emergency put off that way. Then I heard this interview  with Maureen Taylor, a health reporter for the Canadian Broadcasting Corporation, on NPR’s On the Media. The full clip is available, and I’ve pasted relevant material from the transcript below, just in case you’re the impatient type:

Shona Holmes is a woman in commercials who says that she would have been dead within a year because doctors in Canada were making her wait six months to have her brain tumor removed. Tumor, in its strictest sense, means a swelling or enlargement. In Shona’s case, it was not cancer:

“What she had was actually a cyst in her pituitary gland, which you can call it a tumor if you want, but it’s not a cancerous tumor. And it was causing her some hormonal problems and pressing on her optic nerve to give her some vision problems.

This is not a life-threatening thing. I don't deny that it would be very disturbing to have vision problems and be told that we're not going to be able to operate on that for six months. So she went to the States and had this done. But nobody at the Mayo Clinic is claiming that they saved her life, yet this is being reported in the American media as a woman with brain cancer who would have been dead had she let the Canadian health care system prevail.

It just makes me angry that the media isn't looking into this a little more. It wasn't hard for me to find out what she actually had and do a little research on it. People, I'm not walking over a lot of dead bodies here on my way into the studio.”

Many of the other commercials feature patients seeking experimental or nonstandard treatments which would generally not be covered under present private insurance in the US.

Healthcare should be a right, not a privilege. Calling what we have in the US a “system” is generally inappropriate, because “system” implies some sort of order or sense. Most healthcare workers will tell you that rhyme and reason are not part of the way we fund medicine in the US.

Forty years ago, we put men on the moon. Today, we still have people who can’t get basic healthcare. Embarrassing, really. Yet we are listening to lies about a real system that works. Even more embarrassing.

The Contents of My Bag

I have now progressed to the third Aimee Leduc mystery, Murder in the Sentier. Below is one of my favorite passages thus far that will illustrate the pull these stories have for me. She has been out on a Vespa chasing crime when she has to enter an upscale venue. Aimee is always prepared:

"A block away, she entered a deserted courtyard, set down her backpack, and got to work. She stood on the cobbles, reapplying her Chanel-red lipstick in a window. Looking in a tall truck's side-view mirror, she reapplied mascara. She flattened her spiky hair with gel, then slid into the heels she carried, along with a new cryptography manual, calcium biscuits for Miles Davis [her dog, pronounced Meels Dahvees], and black silk underwear crushed at the bottom of her bag.

One never knew."

Her bag contents always include Chanel lipstick, ultrablack mascara, and high heels (unless she is wearing heels or boots, and then her red high-tops are there). And black silk underwear, because you just never know what might happen.

I wish I were that prepared for my life.

My bag contents:

Wallet and keys

Assorted lipsticks and glosses

Toothbrush and stuff for my braces

Hospital IDs

Chargers for BlackBerry & iPod

Earphones for iPod

Pens in various states of usability

BlackBerry & iPod

Given the size of the bag I carry, this seems pitiful. I certainly couldn't make myself ready for a hot club with my present contents, let alone chase bad guys and make the world a safer place.

But then, I don't have to!

What I’m Reading

My father loves France. His PhD is in French history, and I am named after an actress (Pascale Petit) he saw in the 1950’s while working on his dissertation in that country. He is also a murder mystery fan(like me), so Cara Black’s series set in present day Paris appealed to him. He has been after me to read one for months, so I loaded up a couple for my latest trip.

Murder in the Marais, the first book in the Aimee Leduc mysteries, involves present day murders as well as crimes during the Nazi occupation. The heroine has limited herself to computer investigations since her father’s death by terrorism, but impending financial difficulties and curiosity push her back undercover to infiltrate a skinhead group. Eventually she uncovers not only the original crimes during the war, but also ongoing conspiracies that threaten Europe in the present.

I have never been to Paris, so I cannot comment on the authenticity of the prose; however, there are enough references to designer clothes and upscale venues (and hot sex) to satisfy a chick-lit craving. I’ve already got the second book on deck…