Saturday, July 25, 2009

Just the Facts, Ma'am

My husband and I have a company that creates medical communications and programming for health care professionals and consumers. We understand many of the intricacies of medicine and the tests and treatments people face -- why, for example, one type of echocardiogram is better than another depending on what is being imaged or which agents impact what sections of the coagulation cascade. With the knowledge and experience we have accumulated, we have been mistaken for doctors, but neither of us has medical degrees and we are not hanging out shingles any time soon.

I also have served on the board of directors for a benefits trust, and in that position spent considerable time reviewing various employee health insurance plans. Although I know far more about health insurance now than before I joined that board, I am by no means an expert on health insurance or health care.

So why do so many folks on radio and television think they are? They are hardly specialists when it comes to most subjects, but when they open their mouths, they expect everyone to accept what they say as fact. That holds true for the current discussions on health care reform.

Not long ago, my husband received the following e-mail message from a friend, who happens to be the publisher of several medical, pharmaceutical, and biomedical publications in Canada. He gave us permission to present his comments, which I am doing so unedited:
I caught a moron named Glenn Beck on the radio. No doubt you've seen him on TV. Horrible piece of sewage. What does it say about the broadcasting industry that they put a defective like this on public display? Anyway, he's explaining to a caller how healthcare works in Canada: "They have a lottery, and if you win the lottery, you get to have medical treatment."

You could write a book about the problems in healthcare here and, fool that I am, I did. But the GOP and its flunkies are offering LSD-fueled fantasies about how a single-payer system operates. Last night I caught Lynn Cheney (!) telling Larry King that you can't choose your own doctor in Canada. The ignorance, the deception, the insistence that poor people need to die from their illnesses, and the middle-class need to be impoverished when they get sick: what manner of monsters are these Republicans?
While I don't believe every Republican or every Democrat or every political partisan is a monster or saint or what-have-you, Mitch makes a very valid point about what category people fall into when they choose to outright lie to scare people into believing something that isn't true. To pretend you have to somehow come up with a golden ticket to get your GI tract checked if you live in a country like Canada has no basis in reality. Neither does the myth of no choice being perpetuated.

And the same goes for the scores of other lies being tossed about to persuade people that reform is evil, that reform is a shortcut to no care and certain death, and that reform will result in everyone losing employer-provided insurance.

Enough. Get the facts. They are available. Just don't go looking to people whose "facts" are fiction and are presenting wholly biased views masquerading as expertise. They are barely one step up from the snake oil salesmen of the past, whose elixirs were surefire cures for everything that ailed you but more likely made you sick. That's what they would like you to think single-payer systems or universal care or public options would do. You owe it to yourself to get a second opinion -- from an expert.

Wednesday, July 22, 2009

Healthy Discussions

Reform (v): make changes for improvement in order to remove abuse and injustices

One of the reasons juvenile correction institutions were originally called "reform schools" stems from the definition above: these facilities existed to protect youths from abuse in adult prisons. The offenders needed to be separated from other kids but placed in a setting that would be rehabilitative, with the goal that they would reform their behavior for the better.

Break reform down and you get re-form, an opportunity to form again. While policies and programs are not Play-Doh and shouldn't be tossed into a new format every time someone grows bored with them, they possess the pliability that allows them to improve. And the passage of time, the excitement of discovery, the changing needs of a group require that policies and programs re-shape, re-vitalize, re-form.

Reform is one of the hot button words of the moment, primarily due to the current push to reform health care. This shortcut term contains some inaccuracies: it is not care that is being reformed so much as access to and cost of health care that could be altered. Changes to care should come from medical professionals. The current overhaul is coming to us courtesy of political professionals -- politicians, lobbyists, and the like.

Does that doom this reform effort as a bad idea? Far from it. People without insurance use emergency rooms for their primary care. That group of individuals is growing as jobs grow scarce and jobs with health insurance benefits even more scarce. Do you have a pre-existing condition? Don't change jobs or you may not get insurance. How old are you -- adding pill bottles to your medicine chest faster than candles on your cake? And when it comes to personal reform, some people use the power of preventive activities improve their health.

That latter group obviously is taking responsibility for their health. But does that mean all the others aren't? Getting a better job seems pretty responsible -- should one turn it down because of a bad back or enlarged prostate? Do we celebrate old age or cut off their meds at age 85? When a self-employed head of a family loses what little insurance he had because premiums sky rocket and then loses his business and home because his child needs extensive medical care, is that being irresponsible?

I raise this issue because in the great reform debate, the word responsibility seems to rear its head constantly, the implication being that anyone without insurance and means to pay for health care is being irresponsible. For some, that's true, but what about all the scenarios above? What about the healthy person who has been turned down by every insurance company receiving her application? What about the person whose insurance doesn't cover a sudden catastrophic event?

What is irresponsible is not seeing that the current system truly needs reform. What is irresponsible is defending the status quo that is the current system. What is irresponsible is pretending other systems (such as the one in Canada) only kill people. What is most irresponsible is erecting roadblocks to reform only to score political points, not because one believes that reform shouldn't happen. (Senator George Voinovich of Ohio recently acknowledged that's the true motivation behind about 50% of the political anti-reform rhetoric out there.)

Many legitimate concerns are being raised about reform. If you're interested, Arthur Caplan has an opinion piece at MSNBC at that helps sort fact from fiction among the claims being made against health care reform. The real ones should be considered, but the false ones, once debunked, should be ignored and left by the road side. Reform will take too much effort to waste any on urban legends and myths.

It is also irresponsible not to admit that the health care system in the United States is already a multi-tier system and will remain so no matter what reform brings. People with means will always have access to the best care. The myriad options being discussed, including a public one, do not preclude private coverage or personal choice.

As a society, we must acknowledge our role in this growing tsunami of health care costs. Physicians order test after test not because a patient necessarily needs them but to cover themselves if sued. We have become so used to bigger and better technologies bringing instant gratification that we expect and demand the same from medicine and health care. We want immediate cures to problems we bring on ourselves. Case in point: the FDA initially considered the anti-obesity drug rimonabant "approvable" but pulled back after a long look at the drug's safety profile. The problem with rimonabant? Its major side effects are suicidality and depression. Seriously. Suddenly a treadmill looks a whole lot more appetizing.

We want all this at the lowest cost possible. While that may not be possible for every test or procedure, surely it is a goal that must be sought. Bottom line -- too many people cannot afford health care. They can't afford insurance, they can't afford medication, they can't afford care. They aren't being irresponsible, they are being beaten down by the expense. Maybe they can pay for a single visit to the doctor, but not the necessary follow-up. Perhaps they can afford most of their meds, but only if they split pills to make them last longer. Maybe they can cover insurance premiums, but the deductibles for hospitalization put coverage out of reach.

Reforming costs and coverage to provide access to health care will require active support and participation from those who profit from health care. It should never mean that they lose every cent they earn, lose their ability to deliver care, lose their capacity to compete. Increased competition is truly needed in this reform -- we could definitely benefit from more insurance companies offering coverage and more clinics and facilities in rural areas, for example.

Health care reform is a complicated but vital mission. It is especially telling that the nudge needed to open the door to reform appears to be coming from many parties, including those in the health care industry itself. Parsing out costs and access will not be easy and all possible permutations should be considered. It will take time and energy on the part of those who will ultimately determine the shape this reform will take. It will benefit from their varying experiences and expertise. What it won't benefit from is the nonstop rhetoric and partisan sniping we have had to consume since these efforts began in earnest.

Access to and cost of health care in the United States can be improved. Bringing about health care reform is truly the responsible thing to do.

Friday, July 17, 2009

And That's the Way It Is

Walter Cronkite was a man of many words, many insights, and many emotions, and we were truly blessed to experience so many of them. I can't really say that I went to journalism school solely because of "Uncle Walter," but he set the standards that I and so many of my peers strive to meet.

If he had done nothing else throughout his extraordinary career, Cronkite will always be remembered for his reporting of President John F. Kennedy's death. It was eerie to see this pillar of objectivity break on camera and make us all realize that he had lost his president along with the rest of us. I was not quite seven when this happened, and those tears allowed me to see that he was not just some newscaster in a box, but could have been anyone I knew -- and so I got to know him better through his newscasts.

He truly was "the most trusted man in America" and we will be reminded that when Lyndon Johnson lost that trust after the Tet Offensive, he knew he had lost any hope of re-election -- and chose not to seek a second term in 1968. What an amazing turn of events because Cronkite said we were "mired in stalemate" in Vietnam.

In the next few days, we will see and hear many words about Walter Cronkite, and we will be reminded about his zest for life, the funny appearances on "Murphy Brown" and "The Mary Tyler Moore Show," the Presidential Medal of Freedom, and more -- tributes all well deserved. But if we recall none of those things, hopefully we remember the man who was a tower of journalistic integrity and unquestionable ethics who helped raise the standards of an entire industry.

Because that's the way he was.

Tuesday, July 14, 2009

Right or Wrong?

Moral (adj): of or relating to principles of right and wrong in behavior

As parents, we try and teach our children right from wrong, based on what our parents taught us. They, like their parents before them, served as the initial crafters of our moral compasses, and we in turn, start building that device for our children. As our children grow older, we hope that moral compass continues to point in the right, not wrong, direction.

Like with everything else, however, individuals still possess different notions of right and wrong. Some people think resistance in the face of law for a cause one supports is moral; others do not. Some people consider taxes immoral; others do not. Stealing is usually considered wrong; stealing to save one's child from starvation perhaps not. Sometimes the black and white of morality goes gray and one's definition of moral may take on a new layer.

And then there is the issue of abortion. In Arizona, a recently signed bill has tightened restrictions on access to abortion care and services. Many people applaud the provisions, many people do not. What some people see as a step in the right direction -- for example, notarized parental consent for girls under 18 -- others see as wrongly requiring these private decisions to become public in a notary's record book.

The word moral actually appears in one of the last provisions of this expanded statute:
A pharmacy, hospital or health professional, or any employee of a pharmacy, hospital or health professional, who states in writing an objection to abortion, abortion medication, emergency contraception or any medication or device intended to inhibit or prevent implantation of a fertilized ovum on moral or religious grounds is not required to facilitate or participate in the provision of an abortion, abortion medication, emergency contraception or any medication or device intended to inhibit or prevent implantation of a fertilized ovum. The pharmacy, hospital or health professional, or an employee of the pharmacy, hospital or health professional, shall return to the patient the patient's written prescription order.

In other words, a pharmacy technician can say no to a woman coming in with a prescription for emergency contraceptives. It would not take too large a stretch to apply this to regular oral contraceptive medicine, since a certain number of regular pills also can be used for emergency contraception. To refuse to provide the meds, all an employee of the pharmacy has to do is have signed a statement that he or she objects on moral grounds.

So not filling a prescription or perhaps sterilizing operating room equipment is now subject to moral grounds, to what is right and wrong. Or at least the practitioner's sense of right and wrong. The patient's sense of right and wrong seems lost in this equation.

In some ways, Arizona should have seen this one coming. According to the first definition in current law, the practice of pharmacy shall be interpreting, evaluating and dispensing prescription orders in the patient's best interests. Interpreting? The law already allows a pharmacist to "interpret" what is in a patient's best interests in regard to prescriptions? So what's next? A pharmacist who doesn't believe in antibiotics for children or who decides no one deserves oral chemotherapy agents?

Pharmacists undergo a great deal of training -- many obtain their doctorates -- and should be considered partners in health care. But while I expect a pharmacist to counsel me on drug interactions and side effects and work with my doctor to ensure these do not occur, I have a difficult time with a pharmacist denying a patient a legal prescription, just as I have with a technician refusing to touch instruments, on "moral" grounds. No matter how one feels about the specific application of this provision in this statute, we face a very slippery slope of interpretation as to how it could be expanded. One hopes those who make the laws will do the right thing, but we all know that things can go very wrong.

Sunday, July 12, 2009

Raising the Curtain

Words, glorious words.

We use them to tell a joke, make a point, express our thoughts, heal a heart. And for more than 30 years, my words also have translated to my livelihood as a professional writer.

Words equal ideas and expressions and meanings; blogs allow us to send those ideas out to the world for anyone who chooses to read them. The amazing part is that no matter what you write, someone will read it. Thanks to cyberspace, a collective creativity permeates the globe.

As this spot grows, you will find plenty of words melded together in a way designed to provide sense and substance. Not everyone will agree with the thoughts that spring from my sensibilities, of course, but my goal is not to incite vitriol but inspire vitality. I am not going to pretend that this blog will bring world peace, but I do hope it generates fresh ideas.

Thanks for taking the time to read my words.