Authentic Medicine Gazette

Enjoy our most current issue of the most popular medical e-newsletter on the internet.

Blogs and Thoughts for May 17th to May 23rd, 2018

Here is what we had this past week:

  1. Tech Savvy Fluff from Medical Schools and the AMA
  2. How Drug Companies Block Generics
  3. Narco by Stephen Vaughn MD, Ph.D
  4. A Little Hysteria Never Hurts Anyone by Pat Conrad MD
  5. More Universal Magic by Pat Conrad MD
  6. Friday Funny: ED
  7. Quote of the Week: Audre Lorde

 

1. Tech Savvy Fluff from Medical Schools and the AMA

May 23, 2018

Here’s a fluff piece for you:

The first graduating classes from some of the 32 medical schools to participate in the American Medical Association’s pioneering curriculum modernization initiative are now ready to take their tech savvy to hospitals and practices nationwide.

Really?  I wonder if people of real significance in history ever said they were “pioneering” anything?  Anyway, let’s see what makes them so special:

ACME was launched back in 2013 with the goal of helping “close gaps in readiness for practice,” said Susan Skochelak, MD, group vice president of medical education at AMA, aiming to educate students in the information technology, techniques and value-based philosophies that have come to define healthcare in the 21st Century.

At the time, a recent poll had shown that only 64 percent of medical school programs even allowed students to get hands-on experience with electronic health records.

“When you talk to people who are hiring in the major health systems or you talk to graduates, what they’ll say is they really are not prepared. They don’t know how to manage panels of patients; they don’t fully even necessarily know what to do with an EHR,” Skochelak told Healthcare IT News at the time.

This is called out-of-touch with reality.  Manage panel of patients?  How about learning to treat patients individually?  And who doesn’t know what to do with an EHR?  In fact, each place you go has a different EHR.  You have to learn the idiosyncrasies of each one.  It really isn’t that hard to learn but they are almost all built to satisfy the insurance companies and hospitals but not the patients.

The curricula costs $12.5 million in grants from AMA and they are putting 19,000 medical students through it. Wow.  How about using that money to create MORE residencies so some of these medical students can become doctors instead of ending up being a scribe? Oh, wait, now I get it.  This is perfect training for some of them.

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2. How Drug Companies Block Generics

May 22, 2018

Did you ever wonder why generic drugs never seem to come out or are still expensive?  Well, I discussed some collusion and price fixing before here.  Now the FDA is “making public a list of 52 brand-name medicines that generic-drug companies have had trouble getting samples of, due to restrictions from the manufacturers. Generic companies need large quantities of the brand-name drugs to test them for bioequivalence so they can get their own versions on the U.S. market.”

They do this by improperly “using the safety measures as a pretext for blocking generic companies’ path to entry.” Basically, they stop the process right in its tracks and this has been allowed for years.  This administration wants this stopped and I agree.

It is a weird thing to help your competitor undercut your price.  It is also weird for the government to shame them into complying.  I still don’t care.  I think all bets are off when dealing with any member of the Medical Axis of Evil.  My favorite part of the article, though, was this:

Members of the Senate and House on both sides of the aisle support a bill, known as the Creates Act, that would give generic companies a legal cause of action in such circumstances. In the Senate, there are 22 co-sponsors, 11 each from both political parties.

Sen. Patrick Leahy (D., Vt.), the bill’s chief sponsor, said, “The best way to lower the price of prescription drugs is to meaningfully increase competition. Our bill would do that.”

Uh, what?  Meaningfully increase competition?  Yes!  Finally, some sense from the left on this.  No subsidy.  No free lunch.  Competition.

Or did I miss something here?

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3. Narco by Stephen Vaughn MD, Ph.D

May 21, 2018

I came across a story today, shocking and all too common.  Some individual in Texas has apparently been running a medical billing racket.  If it’s true, he hurt lots of people.

A task force investigating his guy announced Monday that “he was being indicted in a fraud case involving $240 million in claims that were in part based on “fraudulent statements” to be submitted to health care benefit programs, resulting in $50 million paid to the doctor.” (CNN)

This stuff is large-scale organized crime, not medicine. “The indictment also accuses this doctor of being a part of an extensive international money-laundering scheme, saying he laundered money through a money exchange house, known as a casa de cambio, and sent it to various accounts in financial institutions in Mexico.”

Follow the money.  It boggles my mind that a physician could bill out services that result in $50 million paid by an insurance company, Medicare or Medicaid. “The Department of Justice said Monday that the rheumatologist had given patients chemotherapy and toxic treatments they didn’t need, all to fund his “lavish” and “opulent lifestyle.””

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“The Department of Justice is seeking the forfeiture of his million-dollar personal jet, a Maserati that had ZQ — his initials — painted on its exterior and several of his luxurious properties.

This guy owned a fleet of luxury cars and purchased numerous expensive commercial and residential properties, including two penthouses in Puerto Vallarta, Mexico; a condo in Aspen, Colorado; and one in Punta Mita, Mexico. He also owned multiple homes and commercial buildings in Texas, court records show.”

This is big-league evil, the equivalent of a narcotics trafficking cartel.

What bothers me about the spin at the end of the article is hearing a Federal agency weigh in on the matter.  “This case is certainly not an isolated incident involving potential medical fraud. Health care fraud costs the country about $68 billion annually, according to estimates from the National Health Care Anti-Fraud Association, and that’s probably a conservative number. That’s about 3% of the $2.26 trillion the country spends on health care, according to the association.”

First – the National Health Care Anti-Fraud Associationisn’t doing its job.  They bill themselves as the leaders of the healthcare anti-fraud industry.  This phrase bothers me.  If we’re talking about this scope of money, it’s theft at the size of organized crime, gangs and cartels.  It’s not the small fry.  There just isn’t enough billing done by hospitals and other institutions to rival the $400 million a year that this guy is accused of.

Somehow, the healthcare payment system that we have today in America is rickety enough that an entire industry has to be constructed to minimize its being defrauded.  Where’s the FBI and local law enforcement?

Secondly, when you move a large volume of money around any industry, it attracts crooks.  We have a massive, centralized payment system that the crooks have learned how to loot like hijacking the stagecoach.  The people being robbed are the patient who are in need of services, as well as the honest healthcare providers who enjoy providing these services.

The best enforcement that the “healthcare industry” could have is not a “healthcare anti-fraud industry.”  Direct primary care is the micro-scale granular provision of services, and if the patient is not satisfied, the patient does not pay. End of story.

If we could only stop moving the money around in massive, ten-million-dollar chunks, signed off by bureaucrats who-knows-where, and have actual interpersonal transactions, a lot of the nonsense that went on in this woeful case would never have happened.

Don’t forget, if this guy is convicted and thrown in prison, there are still patients who were cruelly misdiagnosed and mistreated for unspeakable reasons.  Even if they received some remedy, I expect more than a few will be crippled for life. They deserve more from our healthcare system than “Whoops!  Sorry.”

And blaming doctors for this is the equivalent of blaming Mexican immigrants for MS-13 Most of the people who cross the border, illegally as well as the vast many who have come legally, are no threat.  Blaming them for the crimes of the real criminals does no benefit and is a lazy way of pretending to go after the problem. Target the criminals!  But that is hard work and scary.  The criminals have guns and attitudes.  The Mexican nationals are usually shy and frightened and can be pushed around.  They are much easier to bully.

And so are the doctors.  As much as the “anti-fraud industry” wants to appear like they’re tigers confronting massive racketeering and organized crime, most of them just intimidate the honest working doctor, reminding them that health care fraud is a felony under various states’ Health Care False Claims Act, punishable by up to four years in prison, a $50,000 fine and loss of health insurance. It’s also a federal criminal offense under the Health Insurance Portability and Accountability Act. (from BCBS Michigan website)

We know that.  We are not out to make money in healthcare to commit fraud.  We are here to take care of people.  Why target the average doctor to stand in for the rotten ones?

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4. A Little Hysteria Never Hurts Anyone by Pat Conrad MD

May 20, 2018

An Indianapolis woman died last week from necrotizing fasciitis, a truly sad story.  Following a vacation to Florida, she noticed a sore on her buttock.  Two visits to her primary doctor for antibiotics and heating recommendation, then to the hospital when it worsened.  Between news accounts and some pretty sloppy journalism, it’s tough to tell exactly who did the biopsy when the area worsened.  The primary, the ER, infectious disease after she was admitted?  We can’t say.  She was diagnosed, and admitted to the ICU for 16 days following surgery.  The patient was then released home where she made lunch (the next day?) for her husband, who found her that afternoon, dead.

The episode is tragic, and the husband is understandably grief-stricken.  So it does not help that a huff-huffing media cannot present a cogent timeline in its rush to scare with another ‘Flesh-eating Bacteria!!” headline.  And it does not help any of us for the media to include in the lead paragraph, “… but her husband believes she would still be alive today if doctors had diagnosed her earlier.”  While technically possible, it implies the doc in the office somehow blew it by not doing a tissue biopsy for a condition that would not have clinically warranted it at the time.  And the slobbering reporters just had to include this from her husband:  “He told Tampa television station WFLA that he thinks his wife may have contracted the bacteria from a hotel’s hot tub.’My thing is, nobody else got it, the flesh-eating bacteria. She was the only one that got in the hot tub,’ he said.”  Or she might have gotten in in any of a thousand other spots in a state where MRSA is practically airborne (believe me, I live here).

What were the patient’s co-morbidities, if any?  Was she clinically stable the day of discharge, and was she feeling better?  Was it the infection that killed her, or did she develop a pulmonary embolus while in the ICU?  The coroner has not yet said, and the hospital is appropriately mum.

A friend of mine observes of such cases that “living is a dangerous business,” and he’s right.  I’m not calling for restrictions on freedom of the press, and I’m sorry for the husband.  But chumming all the water for shark lawyers with a bunch of half-reporting is not going to bring her back, is not going to prevent the next such death, and will keep the rest of us just that much more anxious to do a biopsy absent any clinical indication.

Want to laugh some more?  Read Dr. Farrago’s “Diary of a Drug Rep”

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5. More Universal Magic by Pat Conrad MD

May 19, 2018

Last year Forbes had an article suggesting that the fix for our health care mess is pricing transparency:  “‘Single-Payer’ Healthcare Isn’t Necessary — But Single Pricing Is.”  The author’s point is that our entire debate premise is wrong, because our entire tiered system leads to price obfuscation, and downright opacity.

Okay, I’ll bite.  How do we get that transparency?  The author Dan Munro’s answer is simply, “universal coverage.”  He states, “The only way to lower the cost is to end coverage,” which makes sense.  It’s confusing (to me) because he seems to contradict himself.  “Payment and coverage are definitely connected, but that connection can and should be simple and transparent–not complex and opaque. Universal coverage is that simplicity and transparency.”

So how does that happen?  Here the author takes a dive:  “Obviously, how universal coverage is paid for (either single- or multi-payer–delivered through government or privately owned industries) is a critical debate, but who qualifies for coverage (and under what terms) shouldn’t be.”

Munro says that the three arguments against universal coverage are clinical, fiscal and moral, and that they all fail.  He claims a modest but measurable 20% drop in all-cause mortality for the insured.  He states that our $10,877 per capita annual expenditure on health care does not invalidate universal coverage because other nations with US have lower per capita costs and better longevity.  Munro cites Germany circa 1883, and a Martin Luther King, Jr. quote as his proof of the moral imperative.  He doesn’t take issue with Bernie Sanders “Everything-Is-Free” care, and only decries the money:  “At almost $11,000 per capita per year, our healthcare system is a gigantic monument to the priorities of ‘shareholder value,’ inequality and injustice–at scale.”  Munro calls out the bad guys:  “Payers, providers, pharma, suppliers, educators, software vendors and medical device manufacturers are all harvesting enormous profits from our $3.4 trillion ‘medical industrial complex.”

He thinks the only real debate over universal coverage is payment mechanism, and the other problems would all be solved with single pricing and ending annual enrollment.   And “because we don’t need single payer to get to single pricing.”  If there is truly single pricing, then who sets the price?  Which gets me back to Munro’s list of culprits above.  He does say “payers”, but I question whether in his mind that includes government, because that is certainly who will set prices.  And when they do, the big health corporations will cease offering less profitable services and meds.  Oh wait, that’s already happening.  And Munro conspicuously omits another group of culprits:  patients and family members.  Like every other universal coverer, he makes no mention of patient accountability, or patient/family expectations.  How would he fund the recalcitrant smoker?  How would he protect the hospital that wants to discharge an advanced dementia patient from the ICU with sepsis, with no spare beds and the ER backed up with patients who are all covered?

Experts from all walks keep coming up with “solutions” that never address exactly who or how all of this is paid for, and when and how someone will be told “no.”

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6. Friday Funny: ED

May 18, 2018

Well, I thought it was funny.  Check out Cyanide and Happiness at www.explosm.net

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Comment Here

 

7. Quote of the Week: Audre Lorde

May 17, 2018

“When I dare to be powerful – to use my strength in the service of my vision, then it becomes less and less important whether I am afraid.”

Audre Lorde

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UNTIL NEXT TIME, KEEP SMILING, KEEP LAUGHING AND KEEP OUT OF REHAB!

Douglas Farrago MD

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  80 comments for “Authentic Medicine Gazette

  1. Wandal
    January 31, 2018 at 10:57 am

    Love the Gazette, Doug. One thing: We see lots of fads in society, including in medicine, and the latest one is “physician burnout”. Seems every medical publication now has to have a feature on that . . . or at least a comment or letter to the editor. I’m sure there is an element of truth in all of that BUT part of me wants to say ‘what a bunch of cry babies’. There are a LOT of people out there that just don’t get it: They see the salaries of physicians consistently near the top (especially specialists!!), look at the income they and their friends/family/neighbors have and get pissed off. Life and work are hard on a lot of people; more so than on physicians. Income disparity is very wide and growing in this country and it is causing a lot of ??? anger, envy, voting for Trump ??? Just saying . . .

    1+
    • bobby garrison
      February 7, 2018 at 3:30 pm

      up yours. way to blame the victim. I can’t have a problem ’cause other people have problems too?? I can’t have a problem ’cause other people don’t make as much money as I do?? Are you out of your mind? Please tell me you are not a physician as you seem to have lost all empathy (and possibly sympathy.)

      1+
    • Frank J. Rubino MD
      March 8, 2018 at 10:48 pm

      I don’t think “burn out” is the issue. It is anger. Deep seated anger to the nonsense in health care.
      Meaning less metrics , meaningless MOC crap, Quality measures, etc. ANGER.

      4+
      • Mary Lang Carney, MD
        March 28, 2018 at 9:38 pm

        Frank: I totally agree with you!! When will the stupidity end?

        1+
        • Frank J. Rubino MD
          April 16, 2018 at 7:38 pm

          Hi, good to hear from you.

          0
  2. Dennis Kabasan
    April 27, 2017 at 10:23 am

    Doug,
    I ordered the Cryohelmet for my sixteen year old daughter, who sustained a concussion, with brief loc, after being struck in the forehead by a soccer ball, in a school match, two weeks ago. She’s been wearing the helmet, as recommended, one hour at a time, since it arrived three days ago. Her pediatrician is following her. She only tolerates a few classes each day, d/t frontal and temporal headaches and extreme tiredness. Sleep helps her. Is there any benefit to longer wear-time? Thanks.

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    • Doug Farrago
      April 27, 2017 at 10:31 am

      See my email to you

      0
  3. April 12, 2017 at 2:52 pm

    For some reason, my version of Authentic Medicine is delivered with comments from 2011 and 2012.

    Any notion of what may be going on?

    Thanks.

    3+
    • Doug Farrago
      April 12, 2017 at 3:55 pm

      none

      0
  4. John Comis, DO
    May 30, 2012 at 11:34 am

    Please encourage the KOM to join his friends at QC13.

    7
    (…of the lemons)
    PS the healthcare system is so terrible it is beyond any further comment.
    Peace,
    John

    1+
    • Doug Farrago
      May 30, 2012 at 12:27 pm

      I will try.

      1+
    • au-digit
      January 26, 2017 at 3:33 pm

      The Bush you quote was #41.

      1+
  5. Gary Gaddis
    May 20, 2012 at 7:43 pm

    Regarding our Federal government, Centers for Medicare and Medicaid Services (CMS), Secretary of Health and Human Services Kathleen Sebelius, and the growing gap between CMS perceptions and reality, here is my sarcastic “Sound Bite” suitable for the brief attention span of our electronic news media:

    “Since the Department of Justice is headed by an attorney, and the leader of the Federal Reserve is an economist, then how is it logical that the Secretary of Health and Human Services is also headed by an attorney?”

    Does anyone else agree with me?

    7+
    • Kristina Berger MD
      May 21, 2012 at 7:31 am

      There are too few physicians in politics. Is it because we dont have the stomach for it, or another reason? I know if there were more of us as policy makers, the healthcare system in this country would improve greatly.

      2+
      • Simon Cummings
        May 23, 2012 at 8:59 am

        My vote is for Doug and not the type of physician represented by the Cardiologist who told me that he wasn’t interested in cardiac rehabilitation cos there’s no money in it!

        3+
    • Judy
      May 24, 2012 at 8:58 pm

      No, I think that it is correct for a lawyer to head the Department of Health & Human Services. Only a lawyer can read the volumes of crap they put out as regulations and find a loophole way to still make a living; only a lawyer can repeatedly find a way to let someone die and it be due to no fault attachable to him; only a lawyer can write voluminous policies that effectively help only a select few of his supporters and require the rest of the populace to pay for it except himself; and only a lawyer can sit passively by and provide no useful assistance to a group of sick, needy people but still require them to pay for his service. If you will think on these comments for a few minutes, you may change your opinion.

      3+
      • Bill
        June 4, 2012 at 9:22 pm

        Hey Doug ! I am a lawyer. never made more than $85K /year and spent my entire career in trenches helping people, most who did not have much money, with problems, many of them caused by their own bad decisions and choices. and I love your journal.
        Given the wide range of attitudes, opinions and incomes among doctors do you really want a politically-connected MD in charge ? maybe an orthopedist ? xoxo

        2+
        • Doug Farrago
          June 4, 2012 at 10:43 pm

          The description “politically-connected” should remove that person from contention immediately.

          4+
        • Dr Bonz
          June 21, 2017 at 8:29 am

          Dear Bill.

          F*** You.

          Signed,

          An orthopedist.

          2+
    • Jeff
      February 22, 2017 at 3:14 pm

      I agree, absolutely, that HHS should be headed by a physician.

      What about having an advanced practice nurse in that role?

      But (God help us) not an attorney, a chiropractor, a homeopath, a naturopath, a shaman, or a faith healer!

      On second thought, a shaman would be better than a lawyer any day.

      2+
    • Jeff Palmer
      February 22, 2017 at 3:16 pm

      I agree, absolutely, that HHS should be headed by a physician.

      What about having an advanced practice nurse in that role?

      But (God help us) not an attorney, a chiropractor, a homeopath, a naturopath, a shaman, or a faith healer!

      On second thought, a shaman would be better than a lawyer any day.

      1+
    • John A Goldman, mD
      March 4, 2017 at 3:10 pm

      thank goodness in 2017 it is a physician

      3+
  6. Alan Levine
    May 9, 2012 at 9:03 am

    You have bemoaned our lowly position in hospitals, commenting how few recognized our contributions on Physician Recognition DAY. In what I feel is a further diminution of what we do, my hospital is now celebrating Nurse Recognition WEEK!!!! How far we have fallen………….

    3+
    • Doug Farrago
      May 9, 2012 at 2:53 pm

      I agree

      0
      • Jack Forbush
        May 23, 2012 at 12:10 pm

        Ditto

        0
    • Common Sense
      May 30, 2012 at 4:54 pm

      So you’re denigrating nurses in an attempt to rally support for your plight? It is just as easy to argue that since nurses spent 7 times more time with patients, theyre deserving of their week.

      Or, you know, we could all just stop getting butthurt over who has the longest display of solely symbolic “appreciation” and get back to working as the team we were intended to be.

      We’re your knights and you’re our Earls. There is nothing to be gained by making besouring diatribe. Be good to your staff and your patients and you’ll have more appreciation and recognition than your little heart can handle.

      0
      • Doug Farrago
        May 30, 2012 at 5:11 pm

        You really need to have read the thread completely before making that comment. Please check out the blogs on how Doctor’s Day has been totally dismissed. Maybe then you will understand how we feel. This is NOT about doctors against nurses. It really is about administrators.

        4+
      • Doug Farrago
        May 30, 2012 at 5:12 pm

        You missed the point on this. It is about Doctor’s Day being totally dismissed by administrators. Please read those blogs.

        1+
        • Alan Levine
          May 31, 2012 at 8:56 am

          That was exactly my point. In recognition of out efforts several years ago my hospital–a level 3 teaching hospital–gave chocolate bars (small ones) to the docs. Nurses this year received flowers and other shows of appreciation.

          0
          • JoAnne Fox
            June 8, 2012 at 7:23 pm

            Acknowledgement of a job well done would have been nice. I got a scoop of hot cocoa mix, repackaged in a baggie, with a little note attached telling me how wonderful nurses are.

            0
  7. Doug Given
    April 25, 2012 at 5:29 pm

    What a screw job from the lovely IRS on the Mandate.

    1+
  8. Judy
    April 18, 2012 at 10:05 am

    think you should run for President, as long as you will continue to keep up this site after you win!

    2+
  9. Dave Hoffman
    February 29, 2012 at 11:20 am

    Great thoughts as always, Doug!

    Is there a way to start new comment threads each time you post a new entry?

    0
    • Doug Farrago
      February 29, 2012 at 12:31 pm

      Each entry is a blog and has their own comment section

      0
      • t mcglone
        April 4, 2012 at 8:25 pm

        Having “served” for 15 years, those are finely edited comments fit for civilian consumption .

        0
  10. February 29, 2012 at 8:53 am

    today’s (feb 28, 2012) gazette was one of your best. some might say that your gazette is merely entertainment. i however, enjoy the articles with their kernel of truth/fact at the center and your encouragement for us to critically examine the field of medicine that we are a part of. the top ten signs that a hospital stay isn’t going well is what we see all our careers. uphoric for gout patients who like beer and ujerky for cardiac patients and the statin report were particularly good reading. i don’t know how you find the time or energy to do this. i was usually totally exhausted by the middle to end of my workday. thanks again.

    0
    • Doug Farrago
      February 29, 2012 at 9:06 am

      thanks, dennis! I appreciate the feedback and I am truly flattered.

      0
  11. Angi Wall DO
    February 9, 2012 at 9:18 pm

    I’m with Doug on the dietary/diabetes. It’s not often you catch those guys looking good in a bikini and munching on carrots.

    0
  12. Dr. Veronica Friel
    January 25, 2012 at 4:20 pm

    More! More!! Doug, keep it coming!!!

    0
  13. Robert Bosl, MD
    January 25, 2012 at 1:27 pm

    Regarding relationship of AD & DM, and comment that DM is dietary–too simplistic and likely wrong. We know about dysmetabolic syndrome & PCOS etc. which is genetic, DMS causes weight gain and subsequent DM. Consider whether strong relationship of DM to increased risk of AD is also genetic predisposition to both rather than one causing the other.

    0
    • Doug Farrago
      January 25, 2012 at 2:06 pm

      100% disagree. Predisposition is not a certainty. How can you NOT think DM is dietary related?

      0
      • Robert Bosl, MD
        February 1, 2012 at 4:12 pm

        My earlier comment may have been oversimplified–just tried to point out that some legit. MD’s believe in insulin resistance as a cause of some obesity issues than the result thereof, and it is conceivable that the “insulin resistance gene” may also play a role in development of Alzheimer’s.

        0
    • Bridget Reidy
      March 8, 2012 at 6:49 am

      Ever consider the relationship between Alzheimer’s and diabetes might be iatrogenic brain damage from hypoglycemia? I’m always shocked at how lightly my patients consider the risk of it.

      0
      • March 16, 2012 at 12:13 am

        May I suggest that the dementia with chronic diabetes isn’t Alzheimer’s, it is more likely to be due to the vasculopathy that accompanies non-well controlled diabetes or elderly age + diabetes. So the relationship is between DEMENTIA and diabetes, not Alzheimer’s Disease and diabetes. The fact that most elderly diabetics are vasculopaths, and the recurring theme in medicine that the brain depends on a constant supply of glucose and oxygen to function well, and that vasculopathy impairs oxygen and glucose delivery, is much more plausible than recurrent hypoglycemia.

        0
  14. Scott Miller, MD
    January 25, 2012 at 12:34 pm

    I work in urgent care and when I get home at night I am too tired to exercise. I find that the exercise I get from going back and forth in order to finish the articles in your journal gives me the physical exercise I need to stay healthy and sane. Thanks, Doug! Could you get me a beer when you go to the kitchen?

    0
    • Doug Farrago
      January 25, 2012 at 2:08 pm

      You got it!

      0
  15. Allyagottadois
    January 18, 2012 at 8:55 am

    If I can print it out in its’ entirety, I can leave it casually around the hospital. Mailroom, Medical floors, ICU, ER, surgical suites, administrative offices, JACHO. Because All I’ve got to do is: everything everybody tells me to do.

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  16. Dr. Bill Ameen
    January 1, 2012 at 11:31 am

    Hey Dr. Doug,
    To start the new year right, this ticks me off! I was belatedly reading the 11/4/11 issue of THE WEEK, an article about the Top 1% wage-earners. It takes annual earnings of $516,000 to qualify. Guess what? One out of six of the Top 1% is “in medicine”…I suppose some could be CEO’s of Big Pharma, but I suspect a large number are like the pediatric surgeon who heads the AMA and lives overlooking Central Park, and probably every orthopedist. Sorry, but I believe that anybody who makes that kind of dough either 1) inherited it, 2) stole it, or, as with most surgeons, sports figures and actors, 3) was grossly overpaid (as by insurance companies).

    0
    • Doug Farrago
      January 1, 2012 at 12:32 pm

      agreed

      0
  17. bill lorentz
    December 28, 2011 at 11:25 am

    I am a recent professor emeritus from a well known university medical school. For a number of years I worked with administration as an associate chief of staff. We spent considerable time and effort reviewing patient satisfaction scores using a well known national company and were quite excited that ours were consistently higher than most othere and certainly higher than I thought was reasonable.
    Bottom line-we discovered that the administrator in charge of managing the satisfaction suvery was “doctoring” our results. When we changed over to a more honest effort our scores dropped significantly. However, no one in administration was happy with our new lower scores and the subsequent need to address the outcomes.

    0
  18. David Devonis
    December 16, 2011 at 11:17 am

    Impressed that a lot of teachers are reading this material. Your site is the Writing on the Wall. Keep it coming!

    0
    • Doug Farrago
      December 16, 2011 at 1:35 pm

      Thanks!
      Doug

      0
  19. Dr. Bill Ameen
    December 15, 2011 at 10:46 pm

    Hey Dr. Doug, Heard that due to droughts affecting the peanut crop the price of peanut butter will go up. There’s a worsening shortage of PCP’s, so guess what? They’re paying us less..and less…and less. Also, latest Medical Economics has lead article about MOC. I was gritting my teeth reading remembering when you published the ABIM chief’s salary at $600,000. I’m sure ABFP CEO’s isn’t far behind. Where are the studies showing MOC (or even boards) make any difference in our performance? Finally, get “The Parking Lot Movie” on DVD. It’s a hysterically funny documentary about the parking lot behind The Corner at U.Va that will remind you of your days there!

    0
    • Doug Farrago
      December 16, 2011 at 5:04 am

      Thanks for the great points, Bill! Will need to get that DVD, as well. On one of my first dates with my future wife she remembers me checking all over the ground for parking lot tickets that were cheaper than the one I had in my hand. I was a class act.

      0
    • Dr. Veronica Friel
      January 25, 2012 at 4:16 pm

      Peanut butter prices going up? At COSTCO, the price of the large-size Jiffy Peanut Butter remains the SAME – the large-size is simply 8 oz. smaller.

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    • Connie Severin
      February 8, 2012 at 1:06 pm

      Thanks so much for adding that bit about the movie. I just ordered it off Amazon. I worked at UVa Med Cen from 1980-1985 and remember the strip and the parking behind it (apparently pre-Farina days). I remember some sort of parking honor system and some lot Nazis from back then too, but obviously predating when this documentary is set. It was about the only parking within a mile of campus too, so finding any spot at all was a miracle. I’m looking forward to the video. Thanks for the heads up.

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  20. Mary K Freel
    December 9, 2011 at 7:08 am

    RE: Grading Dr. on patient performance. Can you grade me if I work in a factory stamping out parts? Absolutely!! If the part doesn’t meet specifications then I’ve failed. Can you grade me on my patient’s health performance? Absolutely not!! I can only control a small part of what goes into a patient’s health and as studies have shown patients often pay for the dr. advice and then do nothing or the opposite. What a wonderful world it would be if when the dr. told his patient to lose weight and quit smoking they went right out and did those things. I was a nurse for 22 years and a teacher for 10 and in both professions I was the one who got blamed for whatever didn’t go right–whether it was poor scores on tests and the patient not getting better faster. Until people take ownership in their own health and realize that they are the number one reason that their health doesn’t improve the overall health of this nation will not improve and so our health care costs will continue to rise.

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  21. Bridget Reidy MD
    December 8, 2011 at 10:44 pm

    I agree with the teacher and have always been suspicious of both of our “quality” grading.

    The recent issue of AMA News gave opinions of practicing docs on lots of little issues but NONE on their main article on why small practices (aren’t they usually run by docs?) aren’t getting EMR’s. Gee 15% more pay for 50% more work – why wouldn’t we bite? I wonder if it’s a censored rag. Thank you Doug for validating our voices.

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    • JoAnne Fox
      June 8, 2012 at 7:32 pm

      Where do you find doctor owned small practices?? Most everyone around here is owned by one of the two hospital systems, and one has the gall to proclaim itself “not for profit” – I guess if you don’t mention the wholly owned subsidiaries they don’t count.

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      • Doug Farrago
        June 8, 2012 at 8:27 pm

        Hopefully you will find them in the future

        0
  22. Pat Nagle
    December 7, 2011 at 11:45 am

    I enjoy your site. I appreciate your heartfelt concern for patients and your irritation at the “solutions” suggested/mandated by outsiders (e.g. politicians). What strikes me most of all are the similarities between the world of medicine and the world of education, in which I spent 40+ years, working from K-graduate schools.

    Although the history, dynamics, and focuses are different,
    healthcare and education get pushed around by folks who don’t know what the hell they’re talking about, from Presidents, Congresspeople, media, on up, and the bottom line is always the bottom line, not the needs of patients and students.

    Your tirades against administrators parallel my feelings about the “consultants” and “foundations” who infest educational policymaking at every level. The last ones consulted are the frontline teachers and docs. And of course, the politicians and business moguls take no responsibility for the culture and economy they’ve helped create which lead to the problems in both areas.

    I don’t always agree with you (I’m adamantly for universal/single payer healthcare), but I appreciate your struggle. Keep up the good work.

    1+
    • Doug Farrago
      December 7, 2011 at 12:39 pm

      Thanks for some great feedback! And the similarities are eery.

      Doug

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    • Frank J. Rubino MD
      December 14, 2011 at 6:55 pm

      We do have much in common. “No child left behind” where the teacher is held responsible for the sucess of each and every child no mater how functional or dysfunctional is the child’s family.

      “Pay for performance” reguardless of how cooperative a patient is with diet & exercise and with their medication regimine for hypertension, diabetes etc.

      If one wants to make a lot of money in a short period of time, one should become a “consultant” to to school districts or to health care organizations. Expensive advice with out the responsibility. Charge a lot and then get out of town.

      1+
    • pat nagle
      December 21, 2011 at 12:50 pm

      Pardon me for doubledipping, but I forgot to mention that no legislator/congressperson has ever begged to be put on merit pay/pay for performance. Obviously, legislating doesn’t lend itself to factory models of evaluation. So why do medicine and education? The things that count aren’t measurable, and the measurable things don’t count.

      1+
      • Judy
        January 4, 2012 at 9:26 am

        hey, Pat, hope you don’t have a patent on your last line! that is about to become my ‘signature statement’ on my sign-offs!

        2+
        • Richard W. Mondak
          March 28, 2012 at 1:56 pm

          I think several of us are going to “borrow” that line (of course we’ll give credit to whomever coined that phrase — whoever that is)

          1+
  23. John Chase
    December 7, 2011 at 9:11 am

    I would prefer your stories to run in their entirety rather than “read more”. Very irritating to have to go back and forth

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    • Doug Farrago
      December 7, 2011 at 10:08 am

      Ok, will work on it.
      Doug

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      • Greg Salard
        December 8, 2011 at 2:35 am

        I have to agree. Not only is it irritating, it can be confusing when you have to …

        Read More >>>

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        • Doug Farrago
          December 8, 2011 at 3:31 am

          LOL. Will work on it

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          • thea
            December 14, 2011 at 8:00 am

            Would like more written stories/blogs etc, do not have sound card on computer so can’t hear any of these videos..they kinda lose their punch without sound?

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          • Doug Farrago
            December 14, 2011 at 8:14 am

            Understandable. I had some videos done already and needed to get out a few extra this week. Won’t always be like that.

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          • Chris
            December 15, 2011 at 11:20 am

            Dear Doug,

            Not only do I want full articles on the page and written articles instead of videos, but I also want to have $100 deposited into my bank account each time I click onto your sight. And world peace.

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          • Doug Farrago
            December 15, 2011 at 11:25 am

            Done and done.

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          • tom walsh
            January 11, 2012 at 7:52 am

            These same people who can’t fathom going “back and forth” to read an article are the same ones who had difficulty with ‘butterfly” ballots in the 2000 elections in Florida.
            I have been enjoying your articles for quite a while and have no problems with the layout. Keep up the great work!! And, thanks.

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          • Doug Farrago
            January 11, 2012 at 7:54 am

            Thank you, Tom!

            0
          • Connie Severin
            February 8, 2012 at 1:09 pm

            Thanks for the new format! Jumping between responses and articles was a nuisance. I like being able to read everything in only one, maybe two spots at one read. It also makes it easier to check on new entries to the comments all at once, rather than having to check for each separate article.

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        • Richard W. Mondak
          February 22, 2012 at 12:21 pm

          I have a short attention span, so reading part of the article and assuming I know what is being stated is par for the course for me. I often shoot par – 36 on the first 5 or 6 holes – so why play more?

          I don’t mind procrastining to READ MORE>> later

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      • Ariel
        December 8, 2011 at 8:58 pm

        Agree with Mr. Chase. Thanks for looking into it!

        0
        • Sharon
          December 28, 2011 at 10:10 am

          I totally agree with Chris!

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