The C2S blog draws on the arts, the social and biological sciences to explore the many meanings of health and "dis-ease." Designed to be a locus where patients, their families and professionals can meet on a level playing field, it is the natural off-shoot of the Cell 2 Soul Online Journal. We encourage the submission of ideas, essays, poems, stories, humor, and timely reviews relating to the humanities and health care.
“The sooner we start talking about death, the better.”
Have your taken Death Ed?
In this lucid Op-Ed piece, Dr. Jessica Nitter makes a compelling case for a new compulsory course for high school students. It is well worth reading.
"Many of us would choose to die in a planned, comfortable way, surrounded by those we love. But you can’t plan for a good death if you don’t know you’re dying. When patients are prepared, they die better.
I believe it is past time for us to educate [our patients] about death, an equally important stage of life, and one for which the consequences of poor preparedness are bad.
I propose that we teach Death Ed in all of our high schools. I see this curriculum as a civic responsibility."
Lagniappe: “Go Wish,” a card game designed to ease families into these difficult conversations in an entertaining way.
and Extremis (2016, Netflix Documentary, 24 minutes)
It is no secret that primary care physicians and specialists in large numbers deny care to Medicaid patients. They claim that they cannot afford to see this group. Insurers, patients, and the medical societies tolerate this situation.
It’s just as bad in the Big Apple as it is in the aina of Hawaii. A recent article in the NY Times put the situation in perspective for me. “The taxi lurched away from the curb in Midtown Manhattan, leaving behind a black family of three who had flagged it down. The driver told them he was off duty and then picked up two white women 25 feet away and drove away.
“The judge ruled that the driver refused to transport the family on the basis of their race and color violating a section of city human rights law that protects equal access to public accommodations and fined the cabbie $25,000.”
This ruling made a splash in the NY Times on August 8, 2015. At the same time, most private dermatologists in New York City do not see Medicaid patients. How is this not discrimination too? Yet, the complicated Medicaid credentialing regulations allow physicians to abandon poor patients with inferior insurance coverage and consign them to emergency rooms, Medicaid mills and public clinics.
It’s strange that a family being denied transport in a taxicab can outrage us, but we turn a blind eye to a large segment of our society that is refused competent caring health care. It is also ironic that a cabdriver can be fined for this act of discrimination; while sanctimonious physicians get a pass.
Andy Tanji, our Honolulu correspondent, brought an important report to our attention.
Rollins Edwards, a WWII Test Subject
During World War II, 60,000 enlisted men were enrolled in a secret government program — formally declassified in 1993 — to test mustard gas and other chemical agents on American troops. There was a specific reason they were selected. They were African-Americans. Japanese-Americans and Puerto Rican soldiers.
Leana Wen, the new health commissioner of Baltimore, Maryland gave an instructive TED talk entitled “Who Is My Doctor,” and has famously said, I believe that medicine has maintained its mystique for far too long, and it’s time to open the veil of secrecy and have patients and providers alike participate as equal partners. I believe that patients have to be part of every discussion that takes place in healthcare, from research to system design to medical care.
Physicians need to recognize that we are here to serve the sick. The practice of medicine should not be a means to enrich one’s self at the expense of patients, their insurers of Big PhARMA. Unfortunately, many physicians are entrepreneurs who have learned to game the system. Two of the most common ways to do this are by performing unnecessary tests or procedures and by climbing in bed with Big PhARMA.
Recently, the New York Times had an article about unnecessary cardiac procedures and revealed that a Florida cardiologist was paid $18 million by Medicare in 2012, making him the top-billing cardiologist in the country. Over-diagnosis and over-treatment are not problems unique to cardiologists. Many primary care physicians and diverse specialists have figured out how to game the system at the expense of patients or providers.
Over-diagnosis and over-treatment allow many physicians to make considerable sums from unnecessary tests and procedures. Actinic keratoses are a source of income for many dermatologists; in addition, innocuous skin cancers are often over-treated by unscrupulous or ignorant providers.
We looked at the billing practices of the six dermatologists in a county of a New England state. All served a similar population of patients. The table shows that in 2012 one practitioner billed Medicare for 20,004 cryosurgeries compared to 214 of these procedures by another dermatologist. The highest billing dermatologist in this group collected $940,000 from Medicare for this subset of patients alone. Medicare is only one insurer for these doctors’ patients.
Bedding Down With Big Pharma is another way that physicians supplement their income. Some physicians make a tidy sum from giving talks for pharmaceutical firms. This often takes place at so-called CME meetings. Two websites are helpful for tracking these physicians: Dollars for Docs and Open Payments. Not all companies participate with this reporting.
As an example, I am aware that in my specialty, dermatology, there are a number of doctors who make over $100,000 a year from Big Pharma (and this is in addition to their regular income from teaching and patient care). One New York dermatologist was paid $93,000 just for talks given to other dermatologists in 2013. These, so-called “key opinion- or thought- leaders” push expensive new medications when older, much cheaper medications would be appropriate. You can look up your doctor at Dollars for Docs or Open Payments.
The akamai patient can research her or his physician at the websites provided below. These are not perfect resources but they are helpful places to start.
So, perhaps it is time for you to ask, “Who Is My Doctor” and to check up on your favorite providers.
1. Medicare payments to U.S. physicians: Use this form to find a doctor or other medical professional among the more than 800,000 health care providers that received payments in 2012 from Medicare Part B, which covers doctor visits, tests and other treatments.
2. Dollars for Docs (Propublica): In recent years, drug companies have started releasing details of the payments they make to doctors and other health professionals for promotional talks, research and consulting. As of 2013, 17 companies published the information, most because of legal settlements. Use this tool to search for payments.
3. Open Payments is a federal program that annually collects and makes information public about financial relationships between the health care industry, physicians, and teaching hospitals. The Centers for Medicare & Medicaid Services (CMS) collects information from manufacturers of drugs and devices about payments and other transfers of value they make to physicians and teaching hospitals. These payments and other transfers of value can be for many purposes, like research, consulting, travel, and gifts. CMS will be making this data publicly available each reporting year.
On November 6, Massachusetts voters will decide whether a physician may
provide a dying patient with medication to bring about a faster, easier
death if the patient chooses. On the ballot will be a Death with Dignity
Act. For more about this iniative read: May Doctors Help You Die by Marcia Angell.
Renee Marks Cohen presents us with a death story that would not be have been facilitated by this law. It will make some uneasy and raises many questions. We present it here to stimulate thought and discussion.
"Nora and Ann committed joint
suicide; that’s what the mother, Nora, explained in the documents she left to
be found in her apartment or mailed in advance. I read about the suicides in
the newspaper. Nora was in her mid- or late
70’s; her daughter, Ann, who had cerebral palsy, was about 30. Her condition
was so severe from birth that she couldn’t crawl, walk, or toilet herself. But
she could feed herself from a table, use a motorized wheel chair, and master a
computer to create graphics and communicate on the Internet. She could talk,
but a novice listener had to concentrate intensely to understand her.
Author Bio: Renee
Marks Cohen has done lifestyle writing as well as medical editing and writing.
In the latter niche, she has been the managing editor of New York
Medical College's New York Medical Quarterly, and the author, for
Janssen Japan, of over 35 interview articles on schizophrenia. She has
edited books on neurology, taught Beijing Medical University
scientists how to write, and audited clinical trial case report forms.
Cohen is also a zumba and yoga enthusiast. You may reach her at: RMC Email.
Rich Ratzan directed us recently to Lucy, a novel by Laurence Gonzales, that that deals with "issues that are currently very much in the scientific and moral foreground." I am reading it now (at his suggestion) and finding it absorbing, well-written and thought-provoking. Here is an excerpt from Rich's review:
"Lucy is a novel named for the female hybrid offspring born of a bonobo mother and human father. The result of artificial insemination by her father, Donald Stone, a British anthropologist in the Congo with aims to improve the human species, Lucy is a very human-looking 15 year old girl. An American primatologist in a nearby camp, Jenny Lowe, finds Lucy next to her parents, killed by Congolese insurgents, and whisks her off to Chicago and enrolls her in high school, where Lucy excels at wrestling and meets a friend, Amanda Mather. After Lucy contracts a viral disease that bonobos, not humans contract, Lucy decides to pre-empt those who wish to expose her and posts the news of her hybrid karyotype on Facebook" Download Lucy Ratzan review
In this TED talk, Alice Dreger, a historian and medical humanist, discusses a range of topics from intersex individuals, to people with physical deformities, to the insights of the "Founding Fathers" and what more we might have if we had had "Founding Mothers." It's a complex talk, but worth viewing for many of us. 18 minutes.