It’s Not Insurance – It’s a Crap Shoot

My sister Ronnie is recovering from surgery that she underwent in the same week that her daughter had a concussion. While most of us in the same situation would be licking our wounds, Ronnie’s grateful. And thinking about those who aren’t as lucky as she is. Here’s what she wrote in her column in today’s Philly Daily News –

After years of excellent health, my family incurred, in one insane week, what must have been thousands of dollars in medical costs that would’ve thrown us into a financial tailspin if we’d not had the insurance to pay them.

Why, in the richest country in the world, should luck factor at all into something as basic as access to affordable medical care for America’s citizens?

…A 2005 Harvard study showed that about half of the 1.48 million Americans who filed for bankruptcy in 2001 did so for medical causes. Their out-of-pocket health-care expenses averaged $11,854 – and three-quarters of these people were actually insured when their illnesses began.

…every year more than half-a-million Americans who assumed that they were covered are forced into bankruptcy anyway just because they got sick.

Go read the rest of her excellent column then come back here.

Think she’s wrong? Think bankruptcy from health care costs is just a problem of the unprepared, financially dim-witted masses who don’t know how to work hard or manage their money?

Let’s ask my brother, the hard-saving financial conservative who believes we all sleep in the financial bed we have made with sheets woven from our choices about work, lifestyle and money.

Big Bro

My brother has a friend who is dipping deep into his retirement savings to pay for a catastrophic illness after passing well above his $1 million dollar lifetime cap. If things go on as they are, his friend is looking at potential bankruptcy.

When he saw what his friend was going through, Big Bro, ever the pragmatist, called his benefits officer and asked how much it would cost him to raise his lifetime health coverage cap to 2 million dollars.

The answer? It’s not possible.

That’s right. He cannot buy insurance through his employer, for any price, that will cover him above $1 million in health care payments.

He is currently exploring the possibility of buying some other sort of insurance, outside his employer-sponsored plan, to protect himself. We’ll let you know if he finds it.

Bottom Line

It’s not insurance. It’s a crap shoot.

See you in Vegas.

In Case You Were Wondering If Health Care is Broken…

I drained an abscess for a patient today. It was rather deep, and so I packed it, and ordered in visting nurse services over the weekend to change the dressing, irrigate and repack the wound, and was planning to see the patient again in a week to assess the healing process.

Well, turns out my patient’s insurance (a supposedly good PPO) declined to pay for visiting nurse services. When the patient asked the insurer “So what do I do to get the wound care I need?” their answer was “Go to the Emergency Room.”

Looking for a Stock Bump?

Release the results of your clinical trials to the media before the FDA and doctors get a chance to review them.

Allergan Inc. said that two large human tests of its Botox drug, best known for smoothing wrinkles, showed that periodic injections prevent headaches in adults who suffer from chronic migraines.

Even though details of the study weren’t released, the announcement, which surprised many physicians and investors, sent Allergan’s shares soaring 11%, or $5.95, to $60.53 at 4 p.m. in New York Stock Exchange composite trading. (WSJ Online)

The press release reports some impressive P values but no numbers, which makes me suspicious as to the real impact of the treatment on migraine. Statistical significance does not always translate to clinical significance. I recall clinical trials of vitamin E for hot flashes, in which the treatment showed a statically significant reduction in hot flashes – one less hot flash a day. For a woman suffering upwards of 10 flushing episodes a day, one less hot flash is a meaningless result.

This practice of announcing favorable results before the medical community has a chance to vet the news is becoming standard practice among Big Pharma. It’s showing total disregard for the peer review process. And the absence of a written and reviewed paper means that medical experts have no basis for comment on the story.

As a migraine sufferer, I tried Botox a few years ago. It did not work. I ended up with Mr Spock eyes for a few weeks and had no fewer headaches. I won’t be trying it again.

It’s only a study of one, and I haven’t published the data.

Just my little “press release”.

Female Urologists


Radio Freaks sings “Thank You Oh Lord for the Bladder”

The New York Times has an interesting article about the growing presence of females in the field of urology, historically a male-dominated surgical subspecialty. About 20% of urologists in training are female, many drawn to the field by their experiences working with female urologist mentors.

What the article fails to mention is that the rise in female urologists comes on the tail of an explosion of women into the field of Ob-Gyn. Many of these female gynecologists are also heading into urology fellowships, gaining the additional training and experience they need to become urogynecologists.

The female bladder, after all, is a close neighbor to the uterus, and the urinary and reproductive tract develop alongside one another embyologically. Bladder and urethral suspensions are longtime gynecology procedures, often combined with vaginal hysterectomy when there is concomitant uterine prolapse. In addition, the bladder often causes problems in pregnancy as well as in menopause, and is a target organ for the female hormones estrogen and progesterone. We gynecologists deal a lot with bladder issues in the course of our day.

As the population ages, we can only expect an increased need in doctors who are expert at dealing with the problems of the urinary tract, in women as well as in men. It’s great to see more and more women entering the field of urology.

BTW, kudos to our own Keagirl for her blog’s mention!

NYC West Side Greenway Bike Path

Here’s a great way to spend a beautiful September afternoon in NYC.

Get on your bike and head to the West Side. Head down to the Hudson River at around 68th street (the ramp down is just in front of Trump’s big apartment houses along the West side). When you get down to the river, head north.

Think about stopping for a free kayak ride. 

But the road and Mr TBTAM (Hmmm…he reminds me of someone…) beckon. So off you go.

As you head north, you’ll pass the 79th street Boat Basin (where Tom Hanks had his boat docked in “You’ve Got Mail”).

Remind yourself to come back for burgers and beer at the Boat Basin Cafe before it closes for the season.

Don’t stop to join all the folks hanging out on the grass, though that seems like a great plan for another day.

Around 86th street the path takes a little detour up into Riverside Park, giving you a chance to stop for a minute or two to admire the 91st Street Garden (site of the final scene from You’ve Got Mail…)

At 91st St, take the path back down to the river. Here, the crowds have thinned and you can do some more serious biking.

At St Clair St, near the Fairway Market, you must leave the path for a few blocks.

This gives you a chance to ride under the West Side Highway

and, if you are hungry, you can stop for Barbecue at Dinosaur Barbecue (nice review here).

But there’s no time to stop. Follow the signs back to the River Path – you’re heading for the George Washington Bridge!

Enjoy the culture shift north of 125th street. Boom boxes are playing salsa music, fishing poles and Spanish food carts line the riverside,


and there is some very serious volleyball going one.

Not far past the volleyball courts, the path along the river narrows abruptly. A sign will tell you that this is the path for walkers.

So you’ll head to the right and take the bike path (over on the far right in the photo).

This will take you through the woods and along the railroad bed.

You will emerge to gorgeous views!

Now it’s just a short ride to the George Washington Bridge.

If you have the energy, stop for a quick game of tennis at the free courts in the shadow of the Bridge. (Directions to the courts are here)

More likely, though, you’ll want to ride up and see the Little Red Lighthouse.

Now it’s time to take a break. Relax along the river, sit on the rocks, enjoy the boats and barges as they sail on the river. (We saw one barge loaded with antique railroad cars.) Marvel at the fact that you are in New York City on a beautiful day in September, feeling the breeze off the river.

When you’re rested, head on back. Don’t worry – other than the foray up to Riverside Park, the path has been completely flat, and you feel great.

And the ride back will be just as spectacular!

Diet Update – Week 7

16 pounds down and 76 more to go.

I’ve come to accept that this is going to take awhile, and that there will be a few bumps in the road (like that little bump up there when I gained a few pounds back on our college road trip).

I remember many times in the past when I could not stay with a food program, asking myself “What is wrong with me? Why can’t I do this?”

After all, I had made it though med school and a grueling residency, doing every 3rd night on call, with every other night during my fellow resident’s vacations. (These were the days before resident work rules). I had been on my feet for 36 hours at a time, then went home, slept and came back the next morning to start all over again. After residency, I made it through two pregnancies working full time till term, on call every other night the week before my first child was born.

If I could do that, why couldn’t I stay on a measly old diet?

I think it was because I had no choice in residency and pregnancy but to keep on going. Stopping was not an option, and I never even considered it. After all, you can’t walk out on a residency or a pregnancy and come back when you feel like it, can you?

But dieting – Dieting is another story. After all, if you go off it today, you can always restart tomorrow. My life, in fact, was an unending series of such tomorrows. Every day was the first day of the diet I had failed the day before. (Sounds like a T-shirt saying..)

Now, no matter what happens, I’m on the diet. I have no choice. The food shows up every morning, and I eat it. No going to the market, no running out of the good food and eating the bad instead. No second guessing what I ate or how much I ate. No having to go to meetings or back to a center to weight in and get more food. No having to supplement anything (although I do have an off-program glass of milk in the evening with my snack.) There is just the food. And for the most part, it’s good.

Most importantly, there is no guilt. I felt no remorse when I gained weight on the college trip – I knew I would. But I planned ahead that I would be back at the cottage after that, biking every day and eating healthy. (Which is rarely hard for me on vacations, because I find time to exercise and am just not that hungry.)

I’m no longer living in a dieting tomorrow. It’s today. Every day.

For some reason, I now feel, like residency and pregnancy, that I am on a path on which I have no choice but to stay. It has a clear end (March or April to reach my goal weight) and a clear plan that works. Stopping no longer feels like an option. Putting it off for tomorrow just isn’t a consideration anymore.

I have lot of thoughts about why this is, and what has changed in me. But those are still percolating and this post is long enough.

And a beautiful day and the West Side Bike Path beckon.

Nice to be back.

I’m Still Here

Just a quick postcard to let y’all know I’m still alive and kicking.

Had a very packed week touring colleges in Pennsylvania, Ohio and Illinois, then to our cottage for some R&R – that’s re-decorating (post and photos coming) and relaxation.

Gained back a few pounds while eating road food on the college trip, but have lost most of it again biking this week (a total of 48 miles, some on the Pine Creek Trail and the rest riding loops around the lake). Very much looking forward to getting back on the delivered food plan when I return this week for a few days so I can knock off some more serious weight.

I’ve started a few posts, but nothing is ready for publication yet. In the meantime, I’ve been catching up on my blog reading. I’m especially looking forward to listening to Dr Ramona Bate’s interview on the Dr A show (sorry I missed it live.). I also found out that Linda has published her book (Congrats! I can’t wait to read it.), Kevin, MD has published a fabulous editorial in USA Today (Thanks, Kevin, for being our voice in the mainstream media), Dinosaur Doc is still ranting (I happen to agree with her on this one…) and Dr Val has been admitted to the National Press Club (Congrats, Dr Val!).

On a more serious note, I learned that Paul Levy has really ugly feet, and not all of his readers are happy he posted a photo. In case any of those commenters also read my blog, here’s what I have to say about that –

Have a great end of summer, and see you in September!

Love,

TBTAM

Pink Patch Ads Pulled on AOL and Facebook

After reading my rant against Pink Patch Ads on Myspace, commenter MNetty contacted AOL and demanded that they pull their Pink Patch Ads.

And guess what? They did! (See the comments section of my pank patch post for her letter and AOL’s reply.)

Pink Patch ads have also been banned on Facebook. The Advertising Standards Agency has called the Pink Patch Ads “irresponsible” and claims they promote “bad medical practice”.

“Irresponsible”. Exactly the word I used in my post.

Let’s hear it for the power of the blog, the power of truth and the power of the people!

Diet Update – Week 3

And I’m 12 1/2 lbs down.

Yesterday, I had the amazing experience of not eating all my food – it seemed to be too much for me. “So”, said Mr TBAM (150 lbs since the day I married him..), “Don’t eat it all.” It hadn’t occurred to me. After all, this was the food they were giving me. I had to eat it all, right? Just shows my screwed up relationship with food.

So I gave the second chop and potatoes to my daughter, who declared them delicious.

Things I am noticing

1. Despite losing 12 lbs, I am still fat. Since I was a good 10 lbs over my previously high weight when I started this thing, this should not be surprising to me. And yet it is. I feel so good, I am shocked to look in the mirror and see that I still have a long way to go.

2. You know how we all complain about how fast time flies? Well, go on a diet and weigh yourself every day. Time will CRAWL, I promise you. This is one of the good things about dieting. Slowing down time.

3. The way I feel at this weight today on the way down is vastly different then how I felt at this weight on the way up. Why is that?

4. My ankles have pretty much stopped swelling. Must be the bike riding. (Bardiac cries “Yes!”)

The challenge

I am heading out tomorrow for a 2 week vacation. (Part of the reason blogging has been so scarce – I’m trying to get things done before we leave. I promise I’ll get back to blogging once I get caught up.)

That means no delivered food, and keeping to the program while on the road for a week looking at colleges, then for a week at the cottage. I decided I am schlepping the scale along with me and weighing myself daily. I am also going to keep a food diary. Any other suggestions for eating on the road would be welcome.

I’ve done fine so far on the two weekends I was away at our cottage and cooking for myself, so I’m not too worried about that part of vacation. I’m actually looking forward to creating and cooking new foods.

But even if I screw up, I know that once I return, I’m back on the food delivery program. And that is so very reassuring to me. It also fits right in with what I’ve been reading about in Beck’s book on cognitive thinking and dieting. That we need to get out of the perfectionist mode with dieting. Going off a diet is not a failure, and doesn’t need to turn into a downward spiral of eating out of control. You just get right back on the wagon.

Ordering In with Seamless Web

You’re offering me $100 in restaurant coupons to blog about Seamless Web? The online restaurant delivery service that Andy turned us on to a few weeks ago? That lets me order in from pretty much any restaurant in my neighborhood by just logging and and placing my order? And the food arrives as predicted within 15-45 mins? And I don’t have to stand there with a menu by the phone getting the lady on the other end to hear me over the banging pans and shouting voices? And I discover restaurants I didn’t know existed? And it’s teamed up with Zagat so I know what I’m getting in to if I order in from a new place? And they offer 10-20% discount like the one we got from our favorite neighborhood Chinese place?

That Seamless Web?

Okay. I”ll do it.

Cancer Stats Deliberately Altered

Someone’s been messing around with the cancer statistics in Maryland. Apparently a private vendor, which had contracted to collect the statistics, was responsible.

Here are specifics from the FHA report itself.

..MCR data (for 2001 and 2002) had been deliberately altered between August
2004 and December 2004. Specifically, over 13 percent of all cases in diagnosis
year 2002 showed some sign of alteration, especially cervical, prostate, and melanoma cancer cases. The investigation disclosed that the changes were made
after the cases were initially entered into the MCR by the laboratory facility or provider (such as, changes to the codes from non-invasive cancer to invasive cancer and changes to the year that the diagnosis was made)…

The vendor concluded that these changes were methodical and were made by one or more persons with broad access to the system, and not a result of a random set of events.

As a result of the aforementioned changes, recipients of the MCR data (such as, federal Centers for Disease Control and Prevention, NAACCR, other states, and researchers) were obtaining and using incorrect data.

It’s unclear as to what the motivation was for over-reporting of cancer statistics.

Given all the politics around cervical cancer vacination at this point in time, this information is sure to cause concern, although I’m not sure to what use, if any, the 2002 data may have been put in this regard. Studies I’ve seen that examined the cost effectiveness of HPV screening and vaccination used much earlier cancer incidence data.

Two Weeks and Nine Pounds Down…

and I’m still going strong on this diet of mine.

I actually lost weight while on my own last weekend at our cottage, but could not wait to get back to my delivered food on Monday. When’s the last time you couldn’t wait to get back ON a diet?

This is not to say it has been entirely easy. I’ve had a few shaky afternoons, and the headaches were no fun. My kids have commented that I’ve had some pretty irritable moments with them, but I have to say that overall, I feel much more calm. I did finally add skim milk in the mornings (decaf cappuccino with a bit of Agave nectar) and before bed with my evening snack. With that, the early morning headaches are better.

Health pluses

1. I’m snoring much less already, according to Mr TBTAM.

2. My reflux is better.

3. Most importantly, I am feeling so good. The biking probably has something to do with this as well – three times a week at this point, though I’d like to increase that over time.

Psyching myself out

Tonight was a bit of a milestone for me. We were set to meet a family from Barcelona, in preparation for our kids doing a student exchange with one another next year. I had originally planned to have them all over for dinner, on a weeknight. Which would have meant my running home early from work, scrambling with Mr TBTAM to make something incredible, then worrying if everyone was happy and fed, then cleaning up after everyone had gone (and blogging it, of course…) In an amazing move (you have NO idea how significant this is) I suggested we meet downtown at their hotel instead and go out to a restaurant. It was a perfectly lovely evening, and I had a great time. And ordered a wonderful grilled shrimp on arugula that fit perfectly with my diet.

I realized that a lot of my cooking is me trying to get others to like me. Which doesn’t mean I don’t love to cook, because I really do. But if cooking becomes mostly about doing something I love more than about trying to impress, it just becomes that much more fun, right?

Oh, the things I am learning about myself…

I have just started reading Judith Beck’s book that offers Cognitive Therapy as an adjunct to dieting. Because if I am successful at getting the weight off with this diet, the last thing I want to do is regain it all. Will let you know what I think as that goes on.

What Diet am I on?

It’s probably not important which Diet Home Delivery Service I am using, but if you want to know, you can check out their web site. If you want to see exactly what they are serving daily, go here.

For me, it’s not whether it’s the Zone or Atkins or South Beach. I lose weight no matter what diet I am on. But what I haven’t been able to do for a very long time is stay on any diet. Having someone else take care of the food is what is making this one work for me right now.

More to come…

Who’s Your Mommy?

Apparently, more and more women are nursing each other’s babies, a practice called Cross-Nursing.

I think that it’s just not been our social norm,” said Morgan McFarland, who has been breast-feeding her friend Sarah Griffith’s son since he was just 3 months old. “In some cultures, it is, and you would think nothing of, you know, nursing your neighbor’s child if something happened, or nursing your sister’s baby if she has to go to work.”

While I can understand this practice in primitive societies where refrigeration and infant formula are not affordable or available, or for the rare woman who cannot breastfeed for medical reasons, I see no reason for such practices in the modern society, especially for the reasons cited in this article, namely “community and convenience”.

Breast feeding is an intimate, bonding act between Mother and Child. Why would anyone want to share that with another woman?

Are there Health Risks?

There is little to no data on long term outcomes for infants fed with breast milk from someone other than their own mother. One should not assume the benefits are the same as for infants fed with mom’s milk.

Breast milk contains antibodies unique to Mom and shared to some extent genetically with her child, not to mention growth factors and other proteins. What are the impacts of exposing a child to these proteins from an unrelated individual? No one knows.

More concerning for me is that infections such as TB, HIV and hepatitis can be transmitted via breast milk. In addition, medications taken by the nursing woman also find their way into breast milk.

So if you are going to share your child with another woman, you better be pretty darned sure she is free of infection and not taking any medications that could harm your child. I for one would not be willing to take that risk with my child.

Bottom Line

I see no reason why, in today’s society, a nursing mother needs to share nursing with anyone. There are potentially serious risks and no proven benefits.

If you want community and convenience, then join your neighborhood food coop.

(Okay, Commenters, let loose…)

Fresh Air Fund Asks Your Help

The Fresh Air Fund is looking for families willing to host a city kid on their farm or at their rural home this summer. The end of July is nearing, and they still have about 200 children who need placement.

Further information at http://freshair.smnr.us