isaac
Isaac has already been home 3 weeks now. Unofficially, I think we first laid eyes upon him irl on Thursday, July 29 somewhere around 12:15 am. Time flies. Of course, Karen has written about him a lot already. I do want to include a link from a photographer/friend of Karen's who took pics the night he came. Great pics, great entry. So touching.
About that night, everything was fairly routine--friends, family around, waiting on the flight, construction going on in the terminal right next to where we were, trying to keep Kate occupied. It all hit for me when I first got word that the people walking by were from his flight. After that, we only looked straight ahead where people were coming from the flight. I looked at Karen, she was crying. Emotions were stirring. Then he came around the corner with the escort. So calm. We talked with the escort, she handed him to Karen, mom translated some but the escort spoke a decent amount of English so we communicated a little bit directly. Not too long after, he got a hold of one of the balloons we brought and that seemed to help calm whatever discomfort he may have wanted to express. The escort left and we began our new lives as a family of 4. I mentioned before that it's so surreal. Being after midnight made it even more surreal. One minute we're standing around minding our own business, the next minute a child from halfway around the world ends up in our hands. Who are you? What is your story? How did you end up with us?
Isaac has adjusted remarkably well. In less than a week, his sleep schedule seemed to be back on track from the 13 hour time difference. He eats fairly well, poops well (always important). Karen's gonna get mad at me for sharing but his routine is to get down on all 4's and grunt loudly (and I mean, sometimes, loudly!) in order to evacuate the sigmoid colon. She won't let me video it so this is my payback. If I remember correctly, Kate would just get red in the face and make a few noises but not quite as loudly as Isaac.
Kate has also adjusted to Isaac well for which we're very thankful ... for. Don't get me wrong, she doesn't exactly like to share with him. When he has something, she'll just go over and take it from him (in a loving way) and either say "no, no" or "that's mine" or something similar to that. When she does this we tell her she has to share and give it back so now, if there's something she wants, she'll take it from him or us and say "you have to share." Well, at least she's being polite about it.
Isaac has taken well to his noona/nuna (big sis in Korean). It's funny to watch him chase after her. He can only do that by crawling so he has to hustle but he'll keep following her. He usually wakes up before she does so sometimes either in the morning or after afternoon naps (when Kate takes them) I like to put him on her bed and let him crawl over to her and wake her up. Instead of being cranky about it, she actually seems to enjoy it and will greet him with a "hi brother" or something similar.
He can be a cranky eater at times, not wanting to stay in his high chair, continually turning around. Amazing that the kids aren't related genetically but share some (many) of the same habits and behaviors.
The first few days he was very clingy. Not a surprise. My guess is that he was afraid we would leave him as others already have. He has gotten better about this. If he's not ready (like if he just woke up) and you put him down, he will start crying. However, after holding him for a minute, usually he's ready to explore as evidenced by him squirming to get down, and if you put him down at that point, he's fine. He'll go chasing Kate around, go to the toy room, kinda go wherever and explore. He's definitely in the "oral" phase and pretty much everything goes into the mouth. The teething isn't exactly helping, several coming in, so he's drooling like crazy. It's funny how he'll put blocks, blankets, puzzle pieces, and many other things into his mouth to soothe the teething but he won't chew on his teething-specific toys.
Initially he hated diaper changes and bath times. Overall, he's gotten better about diaper changes and usually doesn't cry now. Thanks to the baby whisperer ("bw," that is, me), he now enjoys baths. I do credit Karen a bit because we went to the spraygrounds in Roswell and he at least didn't cry while he was there. Then I thought it was time for the bw to strike. The next bath night, I took him to our bath in case there was trauma with the other bathtub. Then I put a few things in there he might like (toy, straw, etc.) and stood partially in the tub, holding him over it. He then indicated he wanted to play with these things so I put him down (sans clothes by this point) and turned on the water slowly. He did well. Now we can have him in the kids' tub and tonight he was splashing around and having a good ol' time. Yes, I am available for consultations at a discount friend/family rate.
My friend Burt and his wife came by last week and we were talking about Isaac's personality. He's a serious kid. Doesn't smile much although he's warming up a little bit. Doesn't really laugh much either. He's got a lot on his mind you know, how to solve the world's ills, etc. Now, he does love a good balloon like many kids. Recently he got a hold of one and bounced it around like crazy, laughing. I remember when Kate was a similar age and she got a hold of a balloon for the first time and she went wild! She was laughing and screaming so hard while bouncing the balloon around, it was hilarious. We had not seen her like that before. Same with Isaac although to a slightly more subdued level. It's also funny that when you look at pictures that came with him, he has a very serious look in many of them. It's like he's thinking, "I can't believe you guys are playing with dolls and trucks when we have famines and war going on out there, people!" However, I can always get a smile or even a laugh with "upside down kisses" just like I can with Kate.
In other mundane news, he does do well (so far) in the car seat. He's starting to stand unassisted for a brief couple of seconds. He's got a big head and protruding ears, in a lovable way of course. All in all, we are blessed.
Friday, August 20, 2010
Thursday, July 29, 2010
adoption
Our little Isaac has finally made it home after a 20+ hour day of travel. He and Karen are both asleep on our bed and Kate's supposed to be asleep but is reading books out loud. But at least she's in bed ... except when she's getting out to get more books. With what will likely be a rare window of semi-stillness in the days ahead, I decided to post a few thoughts. Nothing better to do that with than a glass of scotch in hand, my way of celebrating Isaac's arrival. I should be trying to catch up on my own sleep but oh well.
The whole experience is surreal. I keep asking myself, "What in the world just happened? Someone went and dropped us off a kid!" Our family instantly grew by 33%. It's even more odd that we have this 10 1/2 month-old on our hands and we don't really know much about him. Sure, we got well-baby reports over the past few months but his habits, mannerisms, daily activities, likes and dislikes we have to discover on our own and we have a lot to catch up on! They do send some info with him about naps, meals, etc. but that can only help so much.
I don't think I have the time to go into the whole adoption idea and philosophy, especially how it pertains to Korea, right now but I do plan on doing that in the future. Suffice it to say, as joyous as it was to see the escort bring him down the runway, there are of course many sad aspects to the adoption process. One I didn't think about much until a friend of mine recently asked what stuff will come with him. Essentially, it's not much--a small carry-on bag, half of it filled with toys and other gifts that we sent over to him while he was in Korea. It's sad that adoption even needs to exist, it's sad that he was born in a culture that makes it so hard for single, unwed mothers to raise a child alone and it's sad that this little boy traveled halfway around the world, seemingly with nothing to his name, his worldly possessions fitting inside a small carry-on. Such a stark contrast with the roadtrips we take where we have the trunk and most of the backseat full of stuff.
I say seemingly nothing to his name because the truth is he has a lot going for him. Most importantly, he has love--from us, the adoption agency, the foster families, the escort who brought him here, his biological mother who made such a difficult decision, and most importantly from his heavenly Father. He has an adoptive mother who would and will sacrifice her own life for his.
I posted this video on my fb.
http://www.youtube.com/watch?v=9zI3lXSOt3c
It's by MercyMe, one of the better bands to come out of CCM (contemporary "christian" music, another topic itself) in the past 10 years. I read all the comments, mostly on Karen's fb page, about the tears shed on hearing and seeing pictures of Isaac's arrival. So much emotion. And as touching those tears and kind words are, I think of how much sweeter our final reunion in heaven will be. It definitely fuels the fire of longing for that time and to have others share in that journey.
The other interesting, unexpected thing is how much bigger Kate seems all of a sudden. Not just in size, because as we all know, she is a giant, but it's like she aged 5 years instantly. She's a big sister now. You forget how dependent these little ones are. I call Kate a big baby all the time when she's whiney but she can feed herself, throw things away in the trash, count, solve some puzzles (sort of), talk, sing; all things that seem light years from where Isaac is. And she just turned 3! I can't imagine when they really grow up.
We decided on his name Isaac some time ago. After we pared down the list to a few names, I started taking a liking to Isaac but I kept Karen out of the loop until it was time to turn in the official papers. She kept bugging me for days but I just acted like I hadn't thought of it much. Cruel, I know. I like Isaac for several reason. In Hebrew, it means "he laughs," a reference to ol' Abe having a child so late in life and he found it pretty freakin' hilarious. Laughter is something that I feel describes our family well. Karen is probably the funniest woman I have ever met so Isaac will fit right in. Kate's a pretty funny little girl as well. Also, as far as other famous Isaacs are concerned, who can forget Isaac Newton? Hello, I invented calculus. I mean, who does that? So, Isaac has a good name pedigree. Don't let us down little man, you and Kate have to make it big so we can live off you in our old age.
Our little Isaac has finally made it home after a 20+ hour day of travel. He and Karen are both asleep on our bed and Kate's supposed to be asleep but is reading books out loud. But at least she's in bed ... except when she's getting out to get more books. With what will likely be a rare window of semi-stillness in the days ahead, I decided to post a few thoughts. Nothing better to do that with than a glass of scotch in hand, my way of celebrating Isaac's arrival. I should be trying to catch up on my own sleep but oh well.
The whole experience is surreal. I keep asking myself, "What in the world just happened? Someone went and dropped us off a kid!" Our family instantly grew by 33%. It's even more odd that we have this 10 1/2 month-old on our hands and we don't really know much about him. Sure, we got well-baby reports over the past few months but his habits, mannerisms, daily activities, likes and dislikes we have to discover on our own and we have a lot to catch up on! They do send some info with him about naps, meals, etc. but that can only help so much.
I don't think I have the time to go into the whole adoption idea and philosophy, especially how it pertains to Korea, right now but I do plan on doing that in the future. Suffice it to say, as joyous as it was to see the escort bring him down the runway, there are of course many sad aspects to the adoption process. One I didn't think about much until a friend of mine recently asked what stuff will come with him. Essentially, it's not much--a small carry-on bag, half of it filled with toys and other gifts that we sent over to him while he was in Korea. It's sad that adoption even needs to exist, it's sad that he was born in a culture that makes it so hard for single, unwed mothers to raise a child alone and it's sad that this little boy traveled halfway around the world, seemingly with nothing to his name, his worldly possessions fitting inside a small carry-on. Such a stark contrast with the roadtrips we take where we have the trunk and most of the backseat full of stuff.
I say seemingly nothing to his name because the truth is he has a lot going for him. Most importantly, he has love--from us, the adoption agency, the foster families, the escort who brought him here, his biological mother who made such a difficult decision, and most importantly from his heavenly Father. He has an adoptive mother who would and will sacrifice her own life for his.
I posted this video on my fb.
http://www.youtube.com/watch?v=9zI3lXSOt3c
It's by MercyMe, one of the better bands to come out of CCM (contemporary "christian" music, another topic itself) in the past 10 years. I read all the comments, mostly on Karen's fb page, about the tears shed on hearing and seeing pictures of Isaac's arrival. So much emotion. And as touching those tears and kind words are, I think of how much sweeter our final reunion in heaven will be. It definitely fuels the fire of longing for that time and to have others share in that journey.
The other interesting, unexpected thing is how much bigger Kate seems all of a sudden. Not just in size, because as we all know, she is a giant, but it's like she aged 5 years instantly. She's a big sister now. You forget how dependent these little ones are. I call Kate a big baby all the time when she's whiney but she can feed herself, throw things away in the trash, count, solve some puzzles (sort of), talk, sing; all things that seem light years from where Isaac is. And she just turned 3! I can't imagine when they really grow up.
We decided on his name Isaac some time ago. After we pared down the list to a few names, I started taking a liking to Isaac but I kept Karen out of the loop until it was time to turn in the official papers. She kept bugging me for days but I just acted like I hadn't thought of it much. Cruel, I know. I like Isaac for several reason. In Hebrew, it means "he laughs," a reference to ol' Abe having a child so late in life and he found it pretty freakin' hilarious. Laughter is something that I feel describes our family well. Karen is probably the funniest woman I have ever met so Isaac will fit right in. Kate's a pretty funny little girl as well. Also, as far as other famous Isaacs are concerned, who can forget Isaac Newton? Hello, I invented calculus. I mean, who does that? So, Isaac has a good name pedigree. Don't let us down little man, you and Kate have to make it big so we can live off you in our old age.
Monday, July 05, 2010
Happy 4th
It's actually the 5th so happy belated 4th. I didn't realize it was so long since my last post. I guess I got so depressed once healthcare reform passed that I took a hiatus. Nothing a good ol' patriotic 4th of July can't fix however.
I ran the Peachtree Road Race for the second consecutive time this year. Not really sure why I decided last year would be my first race but it was. Maybe because it was the 40th running. Who doesn't like an anniversary? I semi-trained last year, slowly increasing my run times. Pause here. In case I haven't mentioned before, I hate running. I love the feeling after running, that I've improved my cardiovascular risk profile, improved my stamina, burned some calories. It's also cheap so that's another plus. But running to me is so boring. It requires no skill. Okay, sure there are proper techniques of running, etc. but it's not like you're hitting a golf ball 300 yards and trying to land it within a strip of grass. Also, you start and end at the same place and you have nothing to show for it. Big deal, so I live a few extra years at the end of my life. The demented years? No thanks. If I ran and ended up at the grocery store and back with food so I didn't have to waste gas, now we're talking but that's not very practical.
Having said all that, I am sensing a bit of my mortality so I run--mainly because I can do it spur-of-the-moment, I don't need to call up someone else or a group of people like with basketball (I can actually shoot around alone for a while and find it somewhat fun but after about 30 minutes of it, you want to start playing in a game) and I can feel it make a difference in my blood pressure and cholesterol. Along with running, it may be difficult to believe with all the buffets I've been to in the past year but cutting down calories has brought my weight down to 157.6 lbs. Aside from a diarrheal illness I had a couple of years ago, this may be the lowest weight since before med school. Of course it fluctuates but at the least, I've been consistently below 160 for a few weeks now.
Getting back to the running, using headphones and listening to music does make it barely tolerable. For the race last year, my training never consisted of more than 2-3 miles at one time until I busted out the 10k on race day. We lived at the Habersham last year so I stopped near the now defunct ESPN Zone and talked with Karen and the baby for a minute. Then, heading up cardiac hill I spotted a port-a-potty and waited a minute to get in but it was taking too long so I just kept going. I frequently get a big urge to pee while running, even if I recently went. Eventually it goes away but the uncomfortable feeling slows me down a bit. I walked all of cardiac hill and some of the uphill areas after that and finished in 67:36.
I just remembered that Karen became a fan of the road race on FB and I think if you became one of the first x number of fans, you got a free number so she signed me and herself up. I think that's how we ended up in the race.
Training this year started a little later because I didn't realize how close to race time it was. "Training" last year was mainly so that I wouldn't be one of those poor guys who ends up in the hospital in multi-organ failure from rhabdomyolysis. Had one a couple of years ago at our hospital. This year, I was trying to actually post a better time, ideally sub 60 minutes. I ran a 5k earlier this year ("1st Annual" Shoebox Derby) in under 24 minutes but one of the top runners said the course was short. Based on later training and times, I think it was a lot shorter than I realized.
Anyway, for this year, I woke up, ate 2 frozen waffles, drank some coffee and since we live in Brookhaven now, Karen dropped me off. Peachtree is blocked off a couple of blocks north of Peachtree Dunwoody so it's easy to walk from there to the start areas. I essentially ran the whole distance this year and finished in 56:30. Not bad but I think I can knock off at least another couple of minutes. For next year, notes to self:
1. If you drink coffee (mainly as a cathartic) before the race, either drink only half a cup or drink it a lot earlier. Again, I had a crazy urge to pee (surprise) just before the start so the first mile or so I was really dragging because I didn't feel so great.
2. If I resolve 1., then try to run the first 3 miles much faster (but not too fast to get worn out). The first half of the race is mostly downhill so you really have to take advantage of it.
3. No ipod next year. I think it slows me down. I love pouring water over my head during the race and because of my earbuds, I had to slow down a little to make sure I didn't get them too wet. Next year I can just pour it all over more quickly. Plus, there is a lot of music along the course so there is less need of an ipod.
4. Walk when I drink water. It will only take a few seconds and it's easier to coordinate than trying to jog and drink at the same time. And you don't get any in your lungs accidentally.
5. Don't carry anything. There was a BP giving out bottled water so I grabbed one thinking it would be more efficient and helpful since I wouldn't have to wait for the water stations to get water. Well, that backfired because it slowed me down while I tried to drink it (I didn't want to waste the water since it's bottled so I'm trying to drink it for a much longer time than I should have), plus it slowed me down because I'm carrying the thing.
So those are my tips for next year. We'll see how much time I can shave off.
It's actually the 5th so happy belated 4th. I didn't realize it was so long since my last post. I guess I got so depressed once healthcare reform passed that I took a hiatus. Nothing a good ol' patriotic 4th of July can't fix however.
I ran the Peachtree Road Race for the second consecutive time this year. Not really sure why I decided last year would be my first race but it was. Maybe because it was the 40th running. Who doesn't like an anniversary? I semi-trained last year, slowly increasing my run times. Pause here. In case I haven't mentioned before, I hate running. I love the feeling after running, that I've improved my cardiovascular risk profile, improved my stamina, burned some calories. It's also cheap so that's another plus. But running to me is so boring. It requires no skill. Okay, sure there are proper techniques of running, etc. but it's not like you're hitting a golf ball 300 yards and trying to land it within a strip of grass. Also, you start and end at the same place and you have nothing to show for it. Big deal, so I live a few extra years at the end of my life. The demented years? No thanks. If I ran and ended up at the grocery store and back with food so I didn't have to waste gas, now we're talking but that's not very practical.
Having said all that, I am sensing a bit of my mortality so I run--mainly because I can do it spur-of-the-moment, I don't need to call up someone else or a group of people like with basketball (I can actually shoot around alone for a while and find it somewhat fun but after about 30 minutes of it, you want to start playing in a game) and I can feel it make a difference in my blood pressure and cholesterol. Along with running, it may be difficult to believe with all the buffets I've been to in the past year but cutting down calories has brought my weight down to 157.6 lbs. Aside from a diarrheal illness I had a couple of years ago, this may be the lowest weight since before med school. Of course it fluctuates but at the least, I've been consistently below 160 for a few weeks now.
Getting back to the running, using headphones and listening to music does make it barely tolerable. For the race last year, my training never consisted of more than 2-3 miles at one time until I busted out the 10k on race day. We lived at the Habersham last year so I stopped near the now defunct ESPN Zone and talked with Karen and the baby for a minute. Then, heading up cardiac hill I spotted a port-a-potty and waited a minute to get in but it was taking too long so I just kept going. I frequently get a big urge to pee while running, even if I recently went. Eventually it goes away but the uncomfortable feeling slows me down a bit. I walked all of cardiac hill and some of the uphill areas after that and finished in 67:36.
I just remembered that Karen became a fan of the road race on FB and I think if you became one of the first x number of fans, you got a free number so she signed me and herself up. I think that's how we ended up in the race.
Training this year started a little later because I didn't realize how close to race time it was. "Training" last year was mainly so that I wouldn't be one of those poor guys who ends up in the hospital in multi-organ failure from rhabdomyolysis. Had one a couple of years ago at our hospital. This year, I was trying to actually post a better time, ideally sub 60 minutes. I ran a 5k earlier this year ("1st Annual" Shoebox Derby) in under 24 minutes but one of the top runners said the course was short. Based on later training and times, I think it was a lot shorter than I realized.
Anyway, for this year, I woke up, ate 2 frozen waffles, drank some coffee and since we live in Brookhaven now, Karen dropped me off. Peachtree is blocked off a couple of blocks north of Peachtree Dunwoody so it's easy to walk from there to the start areas. I essentially ran the whole distance this year and finished in 56:30. Not bad but I think I can knock off at least another couple of minutes. For next year, notes to self:
1. If you drink coffee (mainly as a cathartic) before the race, either drink only half a cup or drink it a lot earlier. Again, I had a crazy urge to pee (surprise) just before the start so the first mile or so I was really dragging because I didn't feel so great.
2. If I resolve 1., then try to run the first 3 miles much faster (but not too fast to get worn out). The first half of the race is mostly downhill so you really have to take advantage of it.
3. No ipod next year. I think it slows me down. I love pouring water over my head during the race and because of my earbuds, I had to slow down a little to make sure I didn't get them too wet. Next year I can just pour it all over more quickly. Plus, there is a lot of music along the course so there is less need of an ipod.
4. Walk when I drink water. It will only take a few seconds and it's easier to coordinate than trying to jog and drink at the same time. And you don't get any in your lungs accidentally.
5. Don't carry anything. There was a BP giving out bottled water so I grabbed one thinking it would be more efficient and helpful since I wouldn't have to wait for the water stations to get water. Well, that backfired because it slowed me down while I tried to drink it (I didn't want to waste the water since it's bottled so I'm trying to drink it for a much longer time than I should have), plus it slowed me down because I'm carrying the thing.
So those are my tips for next year. We'll see how much time I can shave off.
Monday, March 22, 2010
"Odd Things" Part 1
The historic bill has passed. I've been perusing it (H.R. 3590, search for the bill online here) and looking for random things that made their way into the bill. Here is part 1 of "Odd Things That Made the Cut As Healthcare Reform:"
I'm glad this provision made the cut. The current bill just wouldn't be the same without it.
The historic bill has passed. I've been perusing it (H.R. 3590, search for the bill online here) and looking for random things that made their way into the bill. Here is part 1 of "Odd Things That Made the Cut As Healthcare Reform:"
SEC. 4207. REASONABLE BREAK TIME FOR NURSING MOTHERS.
- Section 7 of the Fair Labor Standards Act of 1938 (29 U.S.C. 207) is amended by adding at the end the following:
- `(r)(1) An employer shall provide--
- `(A) a reasonable break time for an employee to express breast milk for her nursing child for 1 year after the child's birth each time such employee has need to express the milk; and
- `(B) a place, other than a bathroom, that is shielded from view and free from intrusion from coworkers and the public, which may be used by an employee to express breast milk.
I'm glad this provision made the cut. The current bill just wouldn't be the same without it.
Sunday, March 07, 2010
"Why Men Like Porn"
This is the title to a WebMD article, found here. The article is short but it's hard to believe so much garbage could be packed into so small a space and be found on what I thought was a relatively reputable website. I even used to refer patients to this site for additional medical information. No longer. They make porn sound benign, like you're trying to pick between a plasma tv and LCD. Here is one ridiculous line from the article: "If you're spending too much of either [time or money] on porn, it often reflects a larger problem, like marital difficulties or a job loss." Yeah, it has nothing to do with addiction or the sin nature or deep psychologic issues--you're just having some bumps in your marriage or job. Because porn itself would never BE the cause of the marital difficulties, right?
I love the "Exploring Pornography" section at the end. "Honey, after dinner and the kids are asleep, what do you say we spend some good quality time looking at hard core porn? Or we could make it soft core night if you prefer." Unbelievable.
This is the title to a WebMD article, found here. The article is short but it's hard to believe so much garbage could be packed into so small a space and be found on what I thought was a relatively reputable website. I even used to refer patients to this site for additional medical information. No longer. They make porn sound benign, like you're trying to pick between a plasma tv and LCD. Here is one ridiculous line from the article: "If you're spending too much of either [time or money] on porn, it often reflects a larger problem, like marital difficulties or a job loss." Yeah, it has nothing to do with addiction or the sin nature or deep psychologic issues--you're just having some bumps in your marriage or job. Because porn itself would never BE the cause of the marital difficulties, right?
I love the "Exploring Pornography" section at the end. "Honey, after dinner and the kids are asleep, what do you say we spend some good quality time looking at hard core porn? Or we could make it soft core night if you prefer." Unbelievable.
Friday, January 08, 2010
Delusional (statements by) doctors
Lest I be accused of libel, note that I believe the following statements are delusional, not the actual physicians themselves. First, see this article. One of the Mayo Clinics in AZ will no longer be accepting Medicare patients. What is disturbing, however, is a statement by Robert Berenson, a fellow at the Urban Institute and proclaimed expert in Medicare. Apparently, when you are out of practice for some time (I did a limited search and had trouble finding out the last time he actually took care of patients but I bet it's been a while), it gets easier to make such blanket statements about the everyday doctor. From the article:
Robert Berenson, a fellow at the Urban Institute’s Health Policy Center in Washington, D.C., said physicians’ claims of inadequate reimbursement are overstated. Rather, the program faces a lack of medical providers because not enough new doctors are becoming family doctors, internists and pediatricians who oversee patients’ primary care.
“Some primary care doctors don’t have to see Medicare patients because there is an unlimited demand for their services,” Berenson said. When patients with private insurance can be treated at 50 percent to 100 percent higher fees, “then Medicare does indeed look like a poor payer,” he said.
This is some twisted, convoluted logic. Why does he think there aren't enough providers going into primary care? There are many reasons but one is certainly because they get paid less than specialists, which includes reimbursement from Medicare and other insurers. So, Dr. Berenson thinks that Medicare doesn't really underpay, it just looks like it does because other insurers pay more? That gets into the question of how much he thinks physicians should be compensated. What is the fair market value of a physician? Oh wait, he doesn't really believe in the market when it comes to the medical profession. After these ridiculous comments I did a little research and came across the following from a letter in the Journal of the American Medical Association, May 27, 2009 (subscription required; in response to original article January 21, 2009):
We did not express opposition to health care competition per se, but rather to a specific form of competition core to the "consumer-driven" approach that encourages patients to shop for discrete health services to find the best match of quality and costs.
Anytime someone says they don't agree with something per se, yeah, that means they don't agree with it but they're afraid to admit it outright in case others might think they're crazy. Then in the letter, they (includes Dr. Cassel, more on her later) use direct-to-consumer advertising of drugs with its evils as an example of why competition among physicians is concerning. Talk about a non sequitur. How are these even related? As mentioned before, they still completely ignore other areas of competition such as LASIK and cosmetic plastic surgery which has improved care while lowering rates with little insurance penetration (until lately).
I love how Berenson later quotes his own article to bolster his claim: "See, read this article from another smart man; what I'm saying is true."
The other part of the "they" is Christine Cassel, current president of the American Board of Internal Medicine which certifies most internists in this country, including me. Scary.
Berenson's comment on the "unlimited demand" for primary care MD's is equally bewildering. If there is such an unlimited demand for something, how is it that people are moving AWAY from it? Oh yeah, it's because you're trying to cut their pay. Completely opposite of free market but apparently this type of thinking is common. Note this comment by Senator Conrad recently:
And let me say, if I can, on this question of reducing Medicare, there are $500 billion of savings to Medicare. Most of those savings have been negotiated with the providers. They're going to get less than they were anticipating. They've agreed to those savings because they know they're going to get 30 million more customers. That is a dramatic increase in business for them, and they are sharing some of the savings so that we can pay for this bill. There's not unreasonable.
This kind of comment highlights how clueless non-physician legislators are about physician practices. As if physicians are just sitting around twiddling their thumbs and so excited about all these new patients that will be filling their offices. No, physician offices are typically busy. Why? Because of this unlimited demand? No, because they have to cram 40 patients a day into 15 minute slots in order to make a buck. And why do they have to do that? Because of overhead, administrative and insurance junk they have to deal with that take up so much time and money. Add to this complex patients, late patients, more insurance problems and a whole bunch of other junk and there you have your overflowing waiting room. No wonder why many doctors aren't taking insurance anymore. They can spend more time with patients, treat them properly and still break even. Here's one example.
Lest I be accused of libel, note that I believe the following statements are delusional, not the actual physicians themselves. First, see this article. One of the Mayo Clinics in AZ will no longer be accepting Medicare patients. What is disturbing, however, is a statement by Robert Berenson, a fellow at the Urban Institute and proclaimed expert in Medicare. Apparently, when you are out of practice for some time (I did a limited search and had trouble finding out the last time he actually took care of patients but I bet it's been a while), it gets easier to make such blanket statements about the everyday doctor. From the article:
Robert Berenson, a fellow at the Urban Institute’s Health Policy Center in Washington, D.C., said physicians’ claims of inadequate reimbursement are overstated. Rather, the program faces a lack of medical providers because not enough new doctors are becoming family doctors, internists and pediatricians who oversee patients’ primary care.
“Some primary care doctors don’t have to see Medicare patients because there is an unlimited demand for their services,” Berenson said. When patients with private insurance can be treated at 50 percent to 100 percent higher fees, “then Medicare does indeed look like a poor payer,” he said.
This is some twisted, convoluted logic. Why does he think there aren't enough providers going into primary care? There are many reasons but one is certainly because they get paid less than specialists, which includes reimbursement from Medicare and other insurers. So, Dr. Berenson thinks that Medicare doesn't really underpay, it just looks like it does because other insurers pay more? That gets into the question of how much he thinks physicians should be compensated. What is the fair market value of a physician? Oh wait, he doesn't really believe in the market when it comes to the medical profession. After these ridiculous comments I did a little research and came across the following from a letter in the Journal of the American Medical Association, May 27, 2009 (subscription required; in response to original article January 21, 2009):
We did not express opposition to health care competition per se, but rather to a specific form of competition core to the "consumer-driven" approach that encourages patients to shop for discrete health services to find the best match of quality and costs.
Anytime someone says they don't agree with something per se, yeah, that means they don't agree with it but they're afraid to admit it outright in case others might think they're crazy. Then in the letter, they (includes Dr. Cassel, more on her later) use direct-to-consumer advertising of drugs with its evils as an example of why competition among physicians is concerning. Talk about a non sequitur. How are these even related? As mentioned before, they still completely ignore other areas of competition such as LASIK and cosmetic plastic surgery which has improved care while lowering rates with little insurance penetration (until lately).
I love how Berenson later quotes his own article to bolster his claim: "See, read this article from another smart man; what I'm saying is true."
The other part of the "they" is Christine Cassel, current president of the American Board of Internal Medicine which certifies most internists in this country, including me. Scary.
Berenson's comment on the "unlimited demand" for primary care MD's is equally bewildering. If there is such an unlimited demand for something, how is it that people are moving AWAY from it? Oh yeah, it's because you're trying to cut their pay. Completely opposite of free market but apparently this type of thinking is common. Note this comment by Senator Conrad recently:
And let me say, if I can, on this question of reducing Medicare, there are $500 billion of savings to Medicare. Most of those savings have been negotiated with the providers. They're going to get less than they were anticipating. They've agreed to those savings because they know they're going to get 30 million more customers. That is a dramatic increase in business for them, and they are sharing some of the savings so that we can pay for this bill. There's not unreasonable.
This kind of comment highlights how clueless non-physician legislators are about physician practices. As if physicians are just sitting around twiddling their thumbs and so excited about all these new patients that will be filling their offices. No, physician offices are typically busy. Why? Because of this unlimited demand? No, because they have to cram 40 patients a day into 15 minute slots in order to make a buck. And why do they have to do that? Because of overhead, administrative and insurance junk they have to deal with that take up so much time and money. Add to this complex patients, late patients, more insurance problems and a whole bunch of other junk and there you have your overflowing waiting room. No wonder why many doctors aren't taking insurance anymore. They can spend more time with patients, treat them properly and still break even. Here's one example.
Twynsta in da haus
Yes, the geniuses at Boehringer Ingelheim have come up with the name "Twynsta" for their new hypertension drug. This could be quite possibly one of the worst drug names in recent memory. Check out this thread on Cafe Pharma. Funny stuff.
Yes, the geniuses at Boehringer Ingelheim have come up with the name "Twynsta" for their new hypertension drug. This could be quite possibly one of the worst drug names in recent memory. Check out this thread on Cafe Pharma. Funny stuff.
Monday, December 28, 2009
Happy Holidays
I recently got a generic holiday card (I won't say where from) spewing with relativistic thought. I guess that's what it takes to survive this pluralistic world. Here's the text:
Whatever is beautiful,
whatever is meaningful,
whatever brings you happiness ...
May it be yours this Holiday Season
and throughout the coming year.
So if you're a child molester and that's what makes you happy, go for it this holiday season!
I recently got a generic holiday card (I won't say where from) spewing with relativistic thought. I guess that's what it takes to survive this pluralistic world. Here's the text:
Whatever is beautiful,
whatever is meaningful,
whatever brings you happiness ...
May it be yours this Holiday Season
and throughout the coming year.
So if you're a child molester and that's what makes you happy, go for it this holiday season!
Tuesday, December 22, 2009
Taxes and more taxes
Got a lot to write about, Senate headed towards passing their version of health reform. More on that later, though. First off, I have decided to start using typical capitalization. I realize it's a lot easier to read than the all lower-case version. Sorry e.e. cummings, you were an inspiration but it did not last.
I have never been a huge fan of lifestyle taxes--you know, additional taxes on cigarettes, alcohol, soft drinks (proposed). In case you missed it, included in the Senate bill is a 10% tax on tanning salons. You heard that right, tanning salons. The government is delusional enough to believe this will bring in $2.7 billion dollars over the next 10 years to help pay for reform. This information is in today's Wall Street Journal. Originally, there was supposed to be a 5% "Botax" on cosmetic procedures which would have brought in an estimated $5.8 billion. Not surprisingly, the AMA and AAD (Dermatology group) opposed this idea and somehow, they decided to tax tanning salons instead. Even before the article, I thought it would hurt many of the small businesses that operate these salons, many which are already failing without the tax. Pun intended, let's face it, an additional 5% tax on cosmetic procedures isn't going to ruin any dermatologist or patient seeking said procedures. Nevertheless, that's why you need a strong lobby in D.C. and apparently the tanning industry's isn't.
What gets me even more ("what grinds my gears" in the words of Peter Griffin) is the condescending attitude of people like Dr. David Pariser, president of the AAD. I guess feeling a little smug at his victory on Capitol Hill, his justification for the tax is because "Indoor tanning is a practice which is a known carcinogen." Are you kidding me? Newsflash, Dr. Pariser: the sun is a known carcinogen. Do you propose additional federal taxes for swimming pools, beaches and any business with outdoor exposure? Furthermore, sticking needles into and cutting or freezing body parts is also a known hazard, increasing risks of infection, bleeding and other problems.
This doesn't even cover Obama's pledge not to increase taxes a single cent on anyone making less than $250,000. That's why he's a smart man. I guess he means no tax increase on anything that actually shows up on a federal tax form but if you increase taxes on every other area of life, that's okay. But of course, as I've mentioned before, the "fee" proposed for not having health insurance really is a tax anyway, collected by the IRS.
Got a lot to write about, Senate headed towards passing their version of health reform. More on that later, though. First off, I have decided to start using typical capitalization. I realize it's a lot easier to read than the all lower-case version. Sorry e.e. cummings, you were an inspiration but it did not last.
I have never been a huge fan of lifestyle taxes--you know, additional taxes on cigarettes, alcohol, soft drinks (proposed). In case you missed it, included in the Senate bill is a 10% tax on tanning salons. You heard that right, tanning salons. The government is delusional enough to believe this will bring in $2.7 billion dollars over the next 10 years to help pay for reform. This information is in today's Wall Street Journal. Originally, there was supposed to be a 5% "Botax" on cosmetic procedures which would have brought in an estimated $5.8 billion. Not surprisingly, the AMA and AAD (Dermatology group) opposed this idea and somehow, they decided to tax tanning salons instead. Even before the article, I thought it would hurt many of the small businesses that operate these salons, many which are already failing without the tax. Pun intended, let's face it, an additional 5% tax on cosmetic procedures isn't going to ruin any dermatologist or patient seeking said procedures. Nevertheless, that's why you need a strong lobby in D.C. and apparently the tanning industry's isn't.
What gets me even more ("what grinds my gears" in the words of Peter Griffin) is the condescending attitude of people like Dr. David Pariser, president of the AAD. I guess feeling a little smug at his victory on Capitol Hill, his justification for the tax is because "Indoor tanning is a practice which is a known carcinogen." Are you kidding me? Newsflash, Dr. Pariser: the sun is a known carcinogen. Do you propose additional federal taxes for swimming pools, beaches and any business with outdoor exposure? Furthermore, sticking needles into and cutting or freezing body parts is also a known hazard, increasing risks of infection, bleeding and other problems.
This doesn't even cover Obama's pledge not to increase taxes a single cent on anyone making less than $250,000. That's why he's a smart man. I guess he means no tax increase on anything that actually shows up on a federal tax form but if you increase taxes on every other area of life, that's okay. But of course, as I've mentioned before, the "fee" proposed for not having health insurance really is a tax anyway, collected by the IRS.
Wednesday, September 23, 2009
tough crowd?
from the new york times, monday september 21:
"Mr. Obama is not usually one to avoid high-risk interviews or dodge hostile crowds. He was the first sitting president to appear on “The Tonight Show With Jay Leno,” ... "
so leno is now a "high-risk interview" or has a "hostile crowd"? now that's funny.
the above quote was in a story regarding obama's record 5 sunday am interviews pushing his healthcare agenda. most of the interviewers tossed softball questions. kudos, however, to george stephanopoulos. he tried to challenge the president about the "tax" under the house and senate plans for people who are able to afford insurance but choose not to get it. as you can imagine, this is a problem because obama promised to raise no taxes of any kind for those making under $250,000 a year. here's another good analysis of it. it's almost as confusing as clinton's definition of "is." basically, it's not a tax because he says it's not? even though the bill says it is and the irs would be the ones collecting it? as pointed out in the ap piece, of course the tax issue is already moot with the passage of schip which raised tobacco taxes and predominantly affects those making less than a quarter mil. and as a refresher, i'm getting tired of the car insurance analogy. we can opt out of paying car insurance by not having a car--a way of life many people in this country live. the only way to opt out of a health insurance "tax" is by not making any money or being low-income which isn't exactly a motivating policy.
from the new york times, monday september 21:
"Mr. Obama is not usually one to avoid high-risk interviews or dodge hostile crowds. He was the first sitting president to appear on “The Tonight Show With Jay Leno,” ... "
so leno is now a "high-risk interview" or has a "hostile crowd"? now that's funny.
the above quote was in a story regarding obama's record 5 sunday am interviews pushing his healthcare agenda. most of the interviewers tossed softball questions. kudos, however, to george stephanopoulos. he tried to challenge the president about the "tax" under the house and senate plans for people who are able to afford insurance but choose not to get it. as you can imagine, this is a problem because obama promised to raise no taxes of any kind for those making under $250,000 a year. here's another good analysis of it. it's almost as confusing as clinton's definition of "is." basically, it's not a tax because he says it's not? even though the bill says it is and the irs would be the ones collecting it? as pointed out in the ap piece, of course the tax issue is already moot with the passage of schip which raised tobacco taxes and predominantly affects those making less than a quarter mil. and as a refresher, i'm getting tired of the car insurance analogy. we can opt out of paying car insurance by not having a car--a way of life many people in this country live. the only way to opt out of a health insurance "tax" is by not making any money or being low-income which isn't exactly a motivating policy.
Tuesday, September 08, 2009
healthcare reform 2.0
well, it's the eve of obama's big speech to a joint session of congress trying to sell his healthcare reform. or is it health insurance reform? regardless, here are a few random thoughts on this whole mess.
1. upon further inspection, the additional 2.5% tax on adjusted gross income isn't completely unprecedented (see prior post). heck, we already pay a whole bunch in medicare and social security so the idea isn't new. it's not necessarily a tax on being alive but a tax on making money. so technically you can opt out by not making any money but that makes life a little difficult. plus, we already pay enough taxes.
2. i'm not necesarily against a public option per se. it's true a type of public option already exists with medicare and medicaid. so if there was a public option to cover those who can't afford any insurance and to cover catastrophic events, that's not necessarily a bad thing. but the problem is, how will we afford this??? i am in awe (in a bad way) when i hear people talk about how medicare is not that bad and why not expand it to everyone? hello?! it's about to freakin' go bankrupt, that's why. recently they moved up the estimated year when this thing would go belly up unless something changes, see here. if we can't even keep up with medicare costs, how in the world are we going to afford this for everybody?
3. i still don't understand how you can focus on cutting costs in healthcare without addressing tort reform. well, okay, it's easy to understand from this perspective: trial lawyers are a big part of the democratic party. that's why obama doesn't want to add tort reform to this bill. howard dean himself acknowledged this point (do a search for "trial lawyers" on the link). it is simply not an honest discussion about cutting costs if this issue is not addressed.
dean's comment is so telling. this bloated 1000 page bill covers almost everything under the sun including how to change time accounting for training resident physicians yet they didn't want to add more by addressing one of the most important issues?! that is nonsense.
why the need to tackle so many issues in such a large bill that many haven't even read? this whole reform started on a platform of "the 47 million uninsured" but has now encompassed more than they can handle. why not just start with the few important issues and settle those without trying to disrupt the whole system? some will say that it's because the whole system needs fixing, which i don't necessarily disagree with but it's not in ways that these guys are talking about. i will discuss those below and in later posts.
4. i'm tired of hearing all the complaints about the republican party. now, for full disclosure, i do tend to align myself with conservative ideas usually but am certainly not a card carrying republican. nevertheless, the democrats have a filibuster-proof majority. if they want to pass a plan, they can, so quit complaining about the republicans and formulate a plan that your own party can at least approve. the opposition party is not the problem when you have a majority congress and the white house!
5. it's a myth that anyone can guarantee that you can keep seeing your same doctor under the current proposal. see section 102 and 142 on the prior post with the link to the full summary of the bill. first of all, obama wasn't even familiar with the details of the bill as is evidenced here. section 142 basically sets up a health care "czar" who can force all plans to meet certain requirements. section 102 says that if you are in a plan after the bill takes place, that plan has 5 years to meet these requirements. now, i don't want to sound skeptical of our government, but if they decided to formulate the requirements in such a stringent way that no limited resources private plan could meet it, that would essentially eliminate all other plans. since this is more than a remote possibility, the fact is, if you have a new doctor and new plan after the bill (theoretically) passes, you ARE NOT guaranteed continuity of care. this is made even worse by employer-based health insurance which needs to be eliminated. more on that later.
6. what i find most amazing is some of the comments obama has made regarding physician practices. not surprisingly, most of these comments are made ot (off teleprompter). for example, remember the july 22 press conference when he said the following (full text here):
"And part of what we want to do is to make sure that those decisions are being made by doctors and medical experts based on evidence, based on what works -- because that's not how it's working right now. That's not how it's working right now. Right now doctors a lot of times are forced to make decisions based on the fee payment schedule that's out there.
So if they're looking -- and you come in and you've got a bad sore throat, or your child has a bad sore throat or has repeated sore throats, the doctor may look at the reimbursement system and say to himself, you know what, I make a lot more money if I take this kid's tonsils out. Now that may be the right thing to do, but I'd rather have that doctor making those decisions just based on whether you really need your kid's tonsils out or whether it might make more sense just to change -- maybe they have allergies, maybe they have something else that would make a difference."
are you freakin' kidding me? is this how he thinks doctors think and act? now i know he never took any type of hippocratic oath in law school but most doctors i know act in the best interest of their patients. you'd be surprised to find out how frequently surgeons are actually unwilling to cut! and while we're on this topic, can we please dispell another myth? most doctors do not get paid by ordering more labs and tests and scans. this is patently false and ridiculous. this is only true if they own their own lab or testing machines which is not the majority of doctors.
now, if you thought the above statement was crazy, the one below is more unbelievable (from august 11):
"All I'm saying is let's take the example of something like diabetes, one of --- a disease that's skyrocketing, partly because of obesity, partly because it's not treated as effectively as it could be. Right now if we paid a family -- if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's $30,000, $40,000, $50,000 -- immediately the surgeon is reimbursed. Well, why not make sure that we're also reimbursing the care that prevents the amputation, right? That will save us money. (Applause.)"
now, in all fairness his main point is to pay primary care providers more money for preventive care. not gonna argue against that. but again, he shows his incredible ignorance (most likely ot again) about how doctors get paid in this country. there is a wide gap between what a hospital might charge for a procedure and how much a doctor actually gets paid. in fact, medicare pays aorund $1000 to a surgeon for an amputation, not tens of thousands of dollars! and to assert that this reimbusement is immediate??? are you kidding me? yeah, what you do is bill medicare and hope to get money within 90 days for services you already provided.
in all honesty, this is the kind of stuff you would expect spewing out of the mouth of w, not this supposed post-partisan president who is such a fluent orator.
7. the big question comes up, how are we going to pay for such sweeping reform? not receiving as much press is the question as to who is going to take care of all these patients? already many do not want to go into primary care for a variety of reasons so you can expand health insurance to every plant and animal in this world but if there aren't the doctors around to take care of them, have we solved anything?
who is for this bill?
8. why is the ama for this reform bill? who knows but one thought is because they got a deal from obama to eliminate the sgr, the sustainable growth rate which is an archaic formula that medicare uses to pay physicians. that itself is actually a good thing but the ama is a joke and the organization does not represent the majority of doctors. is there some other reason they are supporting this bill? i have no idea.
9. why are the hospital organizations for the bill? section 1156 which essentially eliminates physician-owned hospitals as of this year by choking off the current supply. here's a commentary.
10. why is pharma (pharmaceuticals research and manufacturers of america, the umbrella organization for the nation's drug companies) for reform? because they get the guarantee that the governmentwon't negotiate for lower prescription drug prices. here's one article on this. another slate article.
so then, what's the answer? read this article for a closer glimpse into the problem. here's another one but i'm not sure how long it will be accessible. first off, you have to identify the real problems. the first article is written by david goldhill, a democrat but a businessman and he identifies many problems very well from a business perspective (although i don't agree completely with all his solutions). the second article is written by whole foods ceo john mackey. the essence of both articles is actually to use less insurance and to increase transparency in pricing. this will promote more competition but to facilitate this, you also need to remove barriers to insurance access, in particular allowing portability of insurance across state lines. it's too late to get into this in detail right now so i will in a post to come real soon i hope.
well, it's the eve of obama's big speech to a joint session of congress trying to sell his healthcare reform. or is it health insurance reform? regardless, here are a few random thoughts on this whole mess.
1. upon further inspection, the additional 2.5% tax on adjusted gross income isn't completely unprecedented (see prior post). heck, we already pay a whole bunch in medicare and social security so the idea isn't new. it's not necessarily a tax on being alive but a tax on making money. so technically you can opt out by not making any money but that makes life a little difficult. plus, we already pay enough taxes.
2. i'm not necesarily against a public option per se. it's true a type of public option already exists with medicare and medicaid. so if there was a public option to cover those who can't afford any insurance and to cover catastrophic events, that's not necessarily a bad thing. but the problem is, how will we afford this??? i am in awe (in a bad way) when i hear people talk about how medicare is not that bad and why not expand it to everyone? hello?! it's about to freakin' go bankrupt, that's why. recently they moved up the estimated year when this thing would go belly up unless something changes, see here. if we can't even keep up with medicare costs, how in the world are we going to afford this for everybody?
3. i still don't understand how you can focus on cutting costs in healthcare without addressing tort reform. well, okay, it's easy to understand from this perspective: trial lawyers are a big part of the democratic party. that's why obama doesn't want to add tort reform to this bill. howard dean himself acknowledged this point (do a search for "trial lawyers" on the link). it is simply not an honest discussion about cutting costs if this issue is not addressed.
dean's comment is so telling. this bloated 1000 page bill covers almost everything under the sun including how to change time accounting for training resident physicians yet they didn't want to add more by addressing one of the most important issues?! that is nonsense.
why the need to tackle so many issues in such a large bill that many haven't even read? this whole reform started on a platform of "the 47 million uninsured" but has now encompassed more than they can handle. why not just start with the few important issues and settle those without trying to disrupt the whole system? some will say that it's because the whole system needs fixing, which i don't necessarily disagree with but it's not in ways that these guys are talking about. i will discuss those below and in later posts.
4. i'm tired of hearing all the complaints about the republican party. now, for full disclosure, i do tend to align myself with conservative ideas usually but am certainly not a card carrying republican. nevertheless, the democrats have a filibuster-proof majority. if they want to pass a plan, they can, so quit complaining about the republicans and formulate a plan that your own party can at least approve. the opposition party is not the problem when you have a majority congress and the white house!
5. it's a myth that anyone can guarantee that you can keep seeing your same doctor under the current proposal. see section 102 and 142 on the prior post with the link to the full summary of the bill. first of all, obama wasn't even familiar with the details of the bill as is evidenced here. section 142 basically sets up a health care "czar" who can force all plans to meet certain requirements. section 102 says that if you are in a plan after the bill takes place, that plan has 5 years to meet these requirements. now, i don't want to sound skeptical of our government, but if they decided to formulate the requirements in such a stringent way that no limited resources private plan could meet it, that would essentially eliminate all other plans. since this is more than a remote possibility, the fact is, if you have a new doctor and new plan after the bill (theoretically) passes, you ARE NOT guaranteed continuity of care. this is made even worse by employer-based health insurance which needs to be eliminated. more on that later.
6. what i find most amazing is some of the comments obama has made regarding physician practices. not surprisingly, most of these comments are made ot (off teleprompter). for example, remember the july 22 press conference when he said the following (full text here):
"And part of what we want to do is to make sure that those decisions are being made by doctors and medical experts based on evidence, based on what works -- because that's not how it's working right now. That's not how it's working right now. Right now doctors a lot of times are forced to make decisions based on the fee payment schedule that's out there.
So if they're looking -- and you come in and you've got a bad sore throat, or your child has a bad sore throat or has repeated sore throats, the doctor may look at the reimbursement system and say to himself, you know what, I make a lot more money if I take this kid's tonsils out. Now that may be the right thing to do, but I'd rather have that doctor making those decisions just based on whether you really need your kid's tonsils out or whether it might make more sense just to change -- maybe they have allergies, maybe they have something else that would make a difference."
are you freakin' kidding me? is this how he thinks doctors think and act? now i know he never took any type of hippocratic oath in law school but most doctors i know act in the best interest of their patients. you'd be surprised to find out how frequently surgeons are actually unwilling to cut! and while we're on this topic, can we please dispell another myth? most doctors do not get paid by ordering more labs and tests and scans. this is patently false and ridiculous. this is only true if they own their own lab or testing machines which is not the majority of doctors.
now, if you thought the above statement was crazy, the one below is more unbelievable (from august 11):
"All I'm saying is let's take the example of something like diabetes, one of --- a disease that's skyrocketing, partly because of obesity, partly because it's not treated as effectively as it could be. Right now if we paid a family -- if a family care physician works with his or her patient to help them lose weight, modify diet, monitors whether they're taking their medications in a timely fashion, they might get reimbursed a pittance. But if that same diabetic ends up getting their foot amputated, that's $30,000, $40,000, $50,000 -- immediately the surgeon is reimbursed. Well, why not make sure that we're also reimbursing the care that prevents the amputation, right? That will save us money. (Applause.)"
now, in all fairness his main point is to pay primary care providers more money for preventive care. not gonna argue against that. but again, he shows his incredible ignorance (most likely ot again) about how doctors get paid in this country. there is a wide gap between what a hospital might charge for a procedure and how much a doctor actually gets paid. in fact, medicare pays aorund $1000 to a surgeon for an amputation, not tens of thousands of dollars! and to assert that this reimbusement is immediate??? are you kidding me? yeah, what you do is bill medicare and hope to get money within 90 days for services you already provided.
in all honesty, this is the kind of stuff you would expect spewing out of the mouth of w, not this supposed post-partisan president who is such a fluent orator.
7. the big question comes up, how are we going to pay for such sweeping reform? not receiving as much press is the question as to who is going to take care of all these patients? already many do not want to go into primary care for a variety of reasons so you can expand health insurance to every plant and animal in this world but if there aren't the doctors around to take care of them, have we solved anything?
who is for this bill?
8. why is the ama for this reform bill? who knows but one thought is because they got a deal from obama to eliminate the sgr, the sustainable growth rate which is an archaic formula that medicare uses to pay physicians. that itself is actually a good thing but the ama is a joke and the organization does not represent the majority of doctors. is there some other reason they are supporting this bill? i have no idea.
9. why are the hospital organizations for the bill? section 1156 which essentially eliminates physician-owned hospitals as of this year by choking off the current supply. here's a commentary.
10. why is pharma (pharmaceuticals research and manufacturers of america, the umbrella organization for the nation's drug companies) for reform? because they get the guarantee that the governmentwon't negotiate for lower prescription drug prices. here's one article on this. another slate article.
so then, what's the answer? read this article for a closer glimpse into the problem. here's another one but i'm not sure how long it will be accessible. first off, you have to identify the real problems. the first article is written by david goldhill, a democrat but a businessman and he identifies many problems very well from a business perspective (although i don't agree completely with all his solutions). the second article is written by whole foods ceo john mackey. the essence of both articles is actually to use less insurance and to increase transparency in pricing. this will promote more competition but to facilitate this, you also need to remove barriers to insurance access, in particular allowing portability of insurance across state lines. it's too late to get into this in detail right now so i will in a post to come real soon i hope.
Saturday, August 22, 2009
a birthday semi-tribute
i have kept a mental list (and a short one on my iphone) over the months about how our little love child is like me and how she is like karen in certain ways. as it turns out, today is baby momma's x5th birthday (i know, 25, can you believe it? she doesn't look a day over 24.) so this is a tribute to her. i think last year i hacked into her blog and wrote an entrance as kate. heck, maybe i'll do that again. that was fun.
ways that kate is like ...
me: stubborn as heck sometimes
karen: loves cookies and chick fil-a
me: laughs at her gas expulsion (not always though and let's be honest, it's not ALWAYS funny, just usually)
karen: nosey as can be. kate has backed off a little but months ago she would just stare down people and watch them as they passed and even stretch her neck around you to get a better look. anyone who knows karen can attest to her nancy drew ways.
me: physically active (not to say i am now but i really was as a kid). kate before she was 2 was already climbing the rock wall type section on playground sets all by herself, with a little supervision by me of course. here's the vid, check it out yourself.
karen: loves green beans, too, one of the few vegetables kate eats. don't get me wrong, i like green beans, just more of a corn man myself.
me: picks her nose in public. hey, just being honest. at least i try to hide it.
karen: artsy. kate loves crayons, painting, drawing, coloring, you name it. karen isn't exactly artsy like that but creative and crafty (insert beastie boys riff). kate definitely did not get that way from me.
me: loud. karen will be happy when kate learns what "inside voice" means. also ask karen how my being loud was a stumbling block in our marriage early on. ha ha! funny times.
karen: just as pretty as can be, you can't just stop looking at them!
well, that's a short list, i had many more i didn't write down and now i don't remember them because i'm getting old but happy birthday to my beautiful wife!
i have kept a mental list (and a short one on my iphone) over the months about how our little love child is like me and how she is like karen in certain ways. as it turns out, today is baby momma's x5th birthday (i know, 25, can you believe it? she doesn't look a day over 24.) so this is a tribute to her. i think last year i hacked into her blog and wrote an entrance as kate. heck, maybe i'll do that again. that was fun.
ways that kate is like ...
me: stubborn as heck sometimes
karen: loves cookies and chick fil-a
me: laughs at her gas expulsion (not always though and let's be honest, it's not ALWAYS funny, just usually)
karen: nosey as can be. kate has backed off a little but months ago she would just stare down people and watch them as they passed and even stretch her neck around you to get a better look. anyone who knows karen can attest to her nancy drew ways.
me: physically active (not to say i am now but i really was as a kid). kate before she was 2 was already climbing the rock wall type section on playground sets all by herself, with a little supervision by me of course. here's the vid, check it out yourself.
karen: loves green beans, too, one of the few vegetables kate eats. don't get me wrong, i like green beans, just more of a corn man myself.
me: picks her nose in public. hey, just being honest. at least i try to hide it.
karen: artsy. kate loves crayons, painting, drawing, coloring, you name it. karen isn't exactly artsy like that but creative and crafty (insert beastie boys riff). kate definitely did not get that way from me.
me: loud. karen will be happy when kate learns what "inside voice" means. also ask karen how my being loud was a stumbling block in our marriage early on. ha ha! funny times.
karen: just as pretty as can be, you can't just stop looking at them!
well, that's a short list, i had many more i didn't write down and now i don't remember them because i'm getting old but happy birthday to my beautiful wife!
Monday, July 27, 2009
health care (?) reform
well, as we are being told now, we're in the midst of health insurance reform, not health care reform. i guess our health care is good enough. it's the insurance that needs work.
i thought i would finally weigh in on the debate a little. by no means will this be an exhaustive evaluation; heck, i'm here with a glass of wine with cnbc on in the background. not exactly the setting for changing national policy, i'm sure.
as a reference, here's a link to a detailed summary of the house bill which has been proposed. since this thing is already out there, i guess a few comments about it would be in order.
problem 1
one proposal i find very unamerican is the 2.5% tax added (see section 401) if you refuse to sign up for any insurance. now, in the spirit of full disclosure, i actually thought this idea should be considered several years ago but have since changed my mind. i haven't done any significant research into this yet but can you think of any other tax that you have to pay just for being alive? people compare this to car insurance which is also mandatory but plenty of people opt out of car insurance by not owning or driving a car. you can opt out of property tax by renting. you can opt out of sales taxes by not buying stuff (or not buying as much). you can opt out of just about any tax currently out there one way or another (may not necessarily be the most feasible option in the world but possible) but you can't opt out of this health insurance tax unless you die! THAT is unamerican. next thing you know, i'm gonna have to pay tax for breathing. oh wait, that's probably gonna happen soon too.
problem 2
before i go on, i have to reference an npr story that aired a couple of weeks ago. you can read the transcript here and here is a link to an explanation of the story. you should read some of the comments in the original article. pretty funny stuff. some guy even posted a link to i think a washington post article (okay, can't help myself, click here) this same chick did about buying the right mattress. hard hitting stuff april fulton has been working on. anyway, the npr article was one of the most grossly biased and misleading things i have ever heard on the air. now that's saying something, even for npr! you hear this business about the public plan option and the reason for its being to keep private companies honest. the administration has even said it. for people who honestly believe this, i would encourage you to think about it further. let's take the example of private versus public primary/mid/high schools and use this as a substitute in the npr piece. do you see a large population of private schools who are "nervous" about public schools because "people really like it" and it offers such a value? are private schools drastically slashing their prices to "attract customers back" because the public schools are stealing all the students away? that is ridiculous. in the same way, don't expect the public plan option to all of a sudden make private insurance plans so much better. you know what? if there are unscrupulous activities going on in private insurance (which is definitely the case for patients AND for physicians) then fix those problems. don't expect a public plan to do it for you.
there are many more things to discuss. more later.
well, as we are being told now, we're in the midst of health insurance reform, not health care reform. i guess our health care is good enough. it's the insurance that needs work.
i thought i would finally weigh in on the debate a little. by no means will this be an exhaustive evaluation; heck, i'm here with a glass of wine with cnbc on in the background. not exactly the setting for changing national policy, i'm sure.
as a reference, here's a link to a detailed summary of the house bill which has been proposed. since this thing is already out there, i guess a few comments about it would be in order.
problem 1
one proposal i find very unamerican is the 2.5% tax added (see section 401) if you refuse to sign up for any insurance. now, in the spirit of full disclosure, i actually thought this idea should be considered several years ago but have since changed my mind. i haven't done any significant research into this yet but can you think of any other tax that you have to pay just for being alive? people compare this to car insurance which is also mandatory but plenty of people opt out of car insurance by not owning or driving a car. you can opt out of property tax by renting. you can opt out of sales taxes by not buying stuff (or not buying as much). you can opt out of just about any tax currently out there one way or another (may not necessarily be the most feasible option in the world but possible) but you can't opt out of this health insurance tax unless you die! THAT is unamerican. next thing you know, i'm gonna have to pay tax for breathing. oh wait, that's probably gonna happen soon too.
problem 2
before i go on, i have to reference an npr story that aired a couple of weeks ago. you can read the transcript here and here is a link to an explanation of the story. you should read some of the comments in the original article. pretty funny stuff. some guy even posted a link to i think a washington post article (okay, can't help myself, click here) this same chick did about buying the right mattress. hard hitting stuff april fulton has been working on. anyway, the npr article was one of the most grossly biased and misleading things i have ever heard on the air. now that's saying something, even for npr! you hear this business about the public plan option and the reason for its being to keep private companies honest. the administration has even said it. for people who honestly believe this, i would encourage you to think about it further. let's take the example of private versus public primary/mid/high schools and use this as a substitute in the npr piece. do you see a large population of private schools who are "nervous" about public schools because "people really like it" and it offers such a value? are private schools drastically slashing their prices to "attract customers back" because the public schools are stealing all the students away? that is ridiculous. in the same way, don't expect the public plan option to all of a sudden make private insurance plans so much better. you know what? if there are unscrupulous activities going on in private insurance (which is definitely the case for patients AND for physicians) then fix those problems. don't expect a public plan to do it for you.
there are many more things to discuss. more later.
Tuesday, June 30, 2009
practice makes perfect?
in case you were wondering if that med student or resident physician seeing you had any clue what they were doing, check it out. good to know mannequins are making it into the world of "intimate exams." we actually had the opportunity in med school to do intimate exams during our physical diagnosis class by joining groups with members of the opposite sex. needless to say, no one volunteered. talk about awkward. what would you talk about at parties? in some other classes, however, i did hear of students who were enthusiastically recruiting people for the group. yes, these same people could be your doctor. just saying.
in case you were wondering if that med student or resident physician seeing you had any clue what they were doing, check it out. good to know mannequins are making it into the world of "intimate exams." we actually had the opportunity in med school to do intimate exams during our physical diagnosis class by joining groups with members of the opposite sex. needless to say, no one volunteered. talk about awkward. what would you talk about at parties? in some other classes, however, i did hear of students who were enthusiastically recruiting people for the group. yes, these same people could be your doctor. just saying.
Thursday, June 25, 2009
controversy
a somewhat controversial bill quietly zipped through texas recently. check out this article. i can't say i'm all for the bill. i'll elaborate on why later but i wanted to put up the link so i wouldn't forget.
a somewhat controversial bill quietly zipped through texas recently. check out this article. i can't say i'm all for the bill. i'll elaborate on why later but i wanted to put up the link so i wouldn't forget.
Friday, May 15, 2009
missing the point
this is crazy. there was a recent meeting at the white house consisting of "stakeholders" in the debate to lower healthcare costs. here's a link to the people who showed up to the meeting. what group is noticeably missing? how about representatives from the american bar association? i would have liked a commitment from their members to not file frivolous lawsuits against physicians but that will never happen. obama doesn't have the guts to call his own people out on it either. don't get me wrong, i know we need lawyers and there are plenty of good ones out there but isn't this a huge piece of the puzzle as to why healthcare costs are so high?! many physicians practice defensive medicine, ordering too many tests they feel they probably don't need but are afraid of missing some rare problem that can get them into trouble. and when that one-in-a-million problem occurs or the patient is the one to blame for a certain problem, bam! lawsuit. unbelievable. with socialized medicine, missed diagnoses will likely increase in frequency because not everyone with foot pain is going to be able to get an mri. plus you'll have limited access to life-saving therapies. here's a nice opinion in a recent wsj.
this is crazy. there was a recent meeting at the white house consisting of "stakeholders" in the debate to lower healthcare costs. here's a link to the people who showed up to the meeting. what group is noticeably missing? how about representatives from the american bar association? i would have liked a commitment from their members to not file frivolous lawsuits against physicians but that will never happen. obama doesn't have the guts to call his own people out on it either. don't get me wrong, i know we need lawyers and there are plenty of good ones out there but isn't this a huge piece of the puzzle as to why healthcare costs are so high?! many physicians practice defensive medicine, ordering too many tests they feel they probably don't need but are afraid of missing some rare problem that can get them into trouble. and when that one-in-a-million problem occurs or the patient is the one to blame for a certain problem, bam! lawsuit. unbelievable. with socialized medicine, missed diagnoses will likely increase in frequency because not everyone with foot pain is going to be able to get an mri. plus you'll have limited access to life-saving therapies. here's a nice opinion in a recent wsj.
Thursday, March 19, 2009
it's match day!
today, senior med students around the land find out where they will be going to residency courtesy of a computer somewhere out there which spits out a list combining the wishes of students and the residency programs. i think they find out at noon or sometime no too long thereafter. let the parties begin because starting july 1, your life is over. ha! good luck to all, i'll be seeing a few of you in july.
today, senior med students around the land find out where they will be going to residency courtesy of a computer somewhere out there which spits out a list combining the wishes of students and the residency programs. i think they find out at noon or sometime no too long thereafter. let the parties begin because starting july 1, your life is over. ha! good luck to all, i'll be seeing a few of you in july.
Tuesday, March 17, 2009
jama--journal of the american medical association ... losing relevance?
i recently read such an outlandish story, i had to come out of hiatus to report it. here's a link to an article in the wall street journal from their health blog section. apologies if you can't get to it, can't remember if you need to be a subscriber to access it. just in case you can't get to it, i have an excerpt below. as a background, there was an article in jama about using antidepressants in stroke patients prophylactically (using them to prevent depression). well, it turns out that one of the authors used to get paid by the company who manufactured the drug in the study. this information was not disclosed in the article (and it should have been) so upon discovering this, a neuro-anatomy professor from lincoln memorial university in tennessee, jonathan leo, wrote a letter to the british medical journal exposing this problem and that's when it gets interesting. the wsj folk took hold of this story and below are some quotes from the editor-in-chief of jama, dr. catherine deangelis.
from wsj.com, published march 13, 2009:
In a conversation with us, DeAngelis was none too happy to be questioned about the dust-up with Leo. “This guy is a nobody and a nothing” she said of Leo. “He is trying to make a name for himself. Please call me about something important.” She added that Leo “should be spending time with his students instead of doing this.
When asked if she called his superiors and what she said to them, DeAngelis said “it is none of your business.” She added that she did not threaten Leo or anyone at the school.
yes, my friends, the editor-in-chief of what is reportedly one of the most important medical journals went on the record lashing out on someone trying to set the record straight. according to leo, the executive deputy editor actually called first, essentially banning him from the journal for life. of course, the author eventually submitted a letter stating the very information dr. leo claimed (apparently an error "of memory"). if you read the wsj story, you can't believe dr. deangelis is behaving in such a manner--so defensive, angry, vindictive. even more amazing is the hypocrisy involved. read this article written by none other than dr. deangelis herself. i read many of the comments left by wsj readers. some called for dr. deangelis' resignation and cancelled their subscriptions. i feel the same way. jama and the ama has seen their day. this isn't the first time, nor will it be the last that these organizations have done questionable and unprofessional things. at the least i think physicians should call on dr. deangelis for a formal apology if not her resignation itself. this is medical arrogance at its finest.
i recently read such an outlandish story, i had to come out of hiatus to report it. here's a link to an article in the wall street journal from their health blog section. apologies if you can't get to it, can't remember if you need to be a subscriber to access it. just in case you can't get to it, i have an excerpt below. as a background, there was an article in jama about using antidepressants in stroke patients prophylactically (using them to prevent depression). well, it turns out that one of the authors used to get paid by the company who manufactured the drug in the study. this information was not disclosed in the article (and it should have been) so upon discovering this, a neuro-anatomy professor from lincoln memorial university in tennessee, jonathan leo, wrote a letter to the british medical journal exposing this problem and that's when it gets interesting. the wsj folk took hold of this story and below are some quotes from the editor-in-chief of jama, dr. catherine deangelis.
from wsj.com, published march 13, 2009:
In a conversation with us, DeAngelis was none too happy to be questioned about the dust-up with Leo. “This guy is a nobody and a nothing” she said of Leo. “He is trying to make a name for himself. Please call me about something important.” She added that Leo “should be spending time with his students instead of doing this.
When asked if she called his superiors and what she said to them, DeAngelis said “it is none of your business.” She added that she did not threaten Leo or anyone at the school.
yes, my friends, the editor-in-chief of what is reportedly one of the most important medical journals went on the record lashing out on someone trying to set the record straight. according to leo, the executive deputy editor actually called first, essentially banning him from the journal for life. of course, the author eventually submitted a letter stating the very information dr. leo claimed (apparently an error "of memory"). if you read the wsj story, you can't believe dr. deangelis is behaving in such a manner--so defensive, angry, vindictive. even more amazing is the hypocrisy involved. read this article written by none other than dr. deangelis herself. i read many of the comments left by wsj readers. some called for dr. deangelis' resignation and cancelled their subscriptions. i feel the same way. jama and the ama has seen their day. this isn't the first time, nor will it be the last that these organizations have done questionable and unprofessional things. at the least i think physicians should call on dr. deangelis for a formal apology if not her resignation itself. this is medical arrogance at its finest.
Sunday, January 25, 2009
screening
this post is in response to another post by a real medical writer friend regarding screening tests for certain diseases. see the related post here.
basically, the question is, when should you start looking for diseases in people even if they have no symptoms (hence, screening)? a reader on the other post commented about ovarian cancer. she is a little on the younger side for women who get the disease; furthermore, it seems she actually had symptoms which is a separate issue. anyway, the reader suggested getting ultrasounds on all women but the question about screening turns out to be a lot more complex than it seems.
the first problem starts with the disease itself. the earlier you catch something, the harder it is to tell if it's a real problem. is that "spot" on your lung something that will one day turn into cancer or will it just stay a "spot"? is that cyst on your kidney or ovary just a cyst or are there features that make it worrisome for something more sinister?
then it gets into the realm of the actual test and interpretation. people tend to think a ct scan or an ultrasound is foolproof. but the fact is, there is no test in medicine, blood work, scan, algorithm, prediction score, you name it, that is 100% accurate. NOTHING. not even a pathologist examining something under a microscope is 100%. sometimes things that look like cancer turn out to be nothing and things that appear harmless turn out to be malignant. and not to malign pathologists, but radiologists are probably even more notorious for disparate readings. "impression: normal ct of the aorta. addendum [days later]: aortic dissection noted." don't get me wrong, these guys are smart, usually among the smartest in their class but we all miss subtle and not-so-subtle findings.
okay, so far you have a disease you're not sure is there, a scan that you're not sure how accurate it is in picking up the disease, and a radiologist who might be reading the scan incorrectly but it gets worse!
unfortunately, then the economic side of things rears its ugly head. let's use the ovarian cancer example. this is unfortunate. we've all seen it. i've seen metastatic colon cancer in patients in their 20's although it's a disease that you typically screen for when you're 50. the question then is, when do you start screening for ovarian cancer? no matter what age you start (heck, unless you start in prepubescent kids), you will probably miss some cases. there are always outliers. so, in order to catch that one in a million patient, can you justify starting screening at, say, age 30? 25? 20? who is going to pay for all this?! that, in today's economy and presidential administration, is the million dollar question. these tests can get expensive and you simply cannot screen all people for everything without completely obliterating the finances of this country.
so you start ovarian cancer screening at age 20. then how frequently do you repeat the testing? when is it safe to stop? how do you know when to act on some small finding? this now gets into the criteria needed for a screening test to be a good one. among them, the test has to be pretty accurate (namely, good "sensitivity," meaning you minimize the number of patients who have the disease but have normal tests, i.e. "false negatives"), the test isn't too costly, there are minimal side effects from the test itself and many other criteria.
then there's the whole question of whether the disease would have killed you anyway. now, in the patient with metastatic ovarian cancer, this is not as relevant since, again, it seems the patient had symptoms already. another dirty little secret: cancers detected incidentally or by screening that are not causing any problems do not always need to be treated. now that statement at face value sounds very controversial but the fact is, it's true. check out this controversial study. furthermore, take for example prostate cancer. unfortunately, many men will die of prostate cancer but many more men will die of heart disease and other cancers and stroke. frequently, some screening blood test or exam will reveal some abnormality which then requires biopsy or some other type of treatment that frequently will lead to incontinence or impotence or a myriad of other problems when there potentially may have been little or no benefit to the screening from the beginning. this is why there is such controversy in the realm of prostate cancer screening.
i think that's enough about screening but the thing is, so much more could be written. you see why it's such a complex topic when it seems so simple. the fact is, at least with cancers, some patients will get a fairly aggressive form and at a much earlier age than expected. most, however, will not and right or wrong, the policy is to try to implement the appropriate screening programs that are most cost-effective to benefit the most number of people while leading to the least amount of harm. primum non nocere--first, do no harm.
this post is in response to another post by a real medical writer friend regarding screening tests for certain diseases. see the related post here.
basically, the question is, when should you start looking for diseases in people even if they have no symptoms (hence, screening)? a reader on the other post commented about ovarian cancer. she is a little on the younger side for women who get the disease; furthermore, it seems she actually had symptoms which is a separate issue. anyway, the reader suggested getting ultrasounds on all women but the question about screening turns out to be a lot more complex than it seems.
the first problem starts with the disease itself. the earlier you catch something, the harder it is to tell if it's a real problem. is that "spot" on your lung something that will one day turn into cancer or will it just stay a "spot"? is that cyst on your kidney or ovary just a cyst or are there features that make it worrisome for something more sinister?
then it gets into the realm of the actual test and interpretation. people tend to think a ct scan or an ultrasound is foolproof. but the fact is, there is no test in medicine, blood work, scan, algorithm, prediction score, you name it, that is 100% accurate. NOTHING. not even a pathologist examining something under a microscope is 100%. sometimes things that look like cancer turn out to be nothing and things that appear harmless turn out to be malignant. and not to malign pathologists, but radiologists are probably even more notorious for disparate readings. "impression: normal ct of the aorta. addendum [days later]: aortic dissection noted." don't get me wrong, these guys are smart, usually among the smartest in their class but we all miss subtle and not-so-subtle findings.
okay, so far you have a disease you're not sure is there, a scan that you're not sure how accurate it is in picking up the disease, and a radiologist who might be reading the scan incorrectly but it gets worse!
unfortunately, then the economic side of things rears its ugly head. let's use the ovarian cancer example. this is unfortunate. we've all seen it. i've seen metastatic colon cancer in patients in their 20's although it's a disease that you typically screen for when you're 50. the question then is, when do you start screening for ovarian cancer? no matter what age you start (heck, unless you start in prepubescent kids), you will probably miss some cases. there are always outliers. so, in order to catch that one in a million patient, can you justify starting screening at, say, age 30? 25? 20? who is going to pay for all this?! that, in today's economy and presidential administration, is the million dollar question. these tests can get expensive and you simply cannot screen all people for everything without completely obliterating the finances of this country.
so you start ovarian cancer screening at age 20. then how frequently do you repeat the testing? when is it safe to stop? how do you know when to act on some small finding? this now gets into the criteria needed for a screening test to be a good one. among them, the test has to be pretty accurate (namely, good "sensitivity," meaning you minimize the number of patients who have the disease but have normal tests, i.e. "false negatives"), the test isn't too costly, there are minimal side effects from the test itself and many other criteria.
then there's the whole question of whether the disease would have killed you anyway. now, in the patient with metastatic ovarian cancer, this is not as relevant since, again, it seems the patient had symptoms already. another dirty little secret: cancers detected incidentally or by screening that are not causing any problems do not always need to be treated. now that statement at face value sounds very controversial but the fact is, it's true. check out this controversial study. furthermore, take for example prostate cancer. unfortunately, many men will die of prostate cancer but many more men will die of heart disease and other cancers and stroke. frequently, some screening blood test or exam will reveal some abnormality which then requires biopsy or some other type of treatment that frequently will lead to incontinence or impotence or a myriad of other problems when there potentially may have been little or no benefit to the screening from the beginning. this is why there is such controversy in the realm of prostate cancer screening.
i think that's enough about screening but the thing is, so much more could be written. you see why it's such a complex topic when it seems so simple. the fact is, at least with cancers, some patients will get a fairly aggressive form and at a much earlier age than expected. most, however, will not and right or wrong, the policy is to try to implement the appropriate screening programs that are most cost-effective to benefit the most number of people while leading to the least amount of harm. primum non nocere--first, do no harm.
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