The First Historic Caloric Transplant

The Robert Wood Johnson Foundation is spending $500 million to fight childhood obesity. They already have spent over $80 million over the past three years on the same thing. What confused me about this is that I recently saw some ads for childhood hunger. In fact, here are some facts I found on some obscure website:

10.5 percent of all U.S. households, representing 20 million adults and 13 million children, were "food insecure" because of lack of resources (U.S. Census Bureau survey -2000)

Over 9 million children are the recipients of food from either a pantry, kitchen or shelter. (America's Second Harvest - 2001)

22.2% of shelter clients indicated that their child/children was/were hungry at least once during the previous 12 months but couldn't afford more food. (America's Second Harvest - 2001)

Between 2000 and 2001, requests for emergency food assistance increased by an average of 23% in American cities, with 54% of requests coming from families with children. (U.S. Conference of Mayors)

Does anyone else see a contradiction here? How can we simultaneously fight childhood obesity and childhood hunger at the same time? Well, I have the answer. There is a reason I am called the King of Medicine. I propose we perform what I am defining as the First Historic Caloric Transplant. Here is how it is done: we take all those obese kids that no money seems to be able to fix and we move them to where the hungry kids are. Then, we take all the hungry kids and move them to where all the obese kids were. This has got to cost less than the $500 million the Robert Wood Johnson is spending and that doesn’t even count how much money is spent on the childhood hunger program. We do this for one year and then move them all back to where they came from. This would enable some type of caloric equilibration; you know, kind of like when you mix hot and cold water you get something in the middle? This should fix everything except for one thing. I predict some rich kids’ parents would apply for, and receive, “caloric credits” that enable their kids to stay home and eat as much as they want as long as some poor kid eats less in his or her place to cover the discrepancy.

Stuck in the Middle with You

No, this is not the Stealers Wheel song of the same name. It is where we as doctors join patients in the healthcare system. Recently, Rita Rubin in the USA Today reported how Pfizer has been getting doctors to “wage a letter-writing campaign” against managed care companies for switching patients from Lipitor to Zocor, which has gone generic. They have been sending CDs to doctors to spoon feed them how to do this. The reason behind this is cost, but what really is the cost? Here is where doctors and patients get caught up in the middle of things that really have nothing to do with us.

Managed care companies make their own backroom deals with the pharmaceutical industry to have their drugs placed on their formulary. So Lipitor may cost Humana one price and cost Aetna another. Or, Lipitor may be packaged with Norvasc on a great deal for Anthem and not such a great deal for Cigna. In turn, the managed care companies place them on a tiered system for which the patient has to pay a different copay depending on what it cost the insurance company. As you can tell, nowhere is patient care or efficacy of the drug taken into consideration. It is also not uncommon for the HMOs to keep switching the copays and tiers throughout the year which drives the patients and doctors who have to keep switching the drugs crazy. Back to our story.

The whackos at Public Citizen Health Research Group say this is unethical. But why? Some patients have been on Lipitor for years and have failed Zocor. This is not to say that I defend Pfizer which is obviously out for the money. The big problem I have with all this is the fact that doctors and patients are being used as pawns. For years, the managed care companies and the drug companies have been playing this backroom game and keeping it private. All the while they have been screwing the patients and driving doctors nuts. Obviously, they couldn’t come to an agreement on the Lipitor issue so now they are coming out with their PR guns flaring and want our help. Isn’t it time we got rid of the middle men (managed care) and let the market dictate the cost of medications like it does in other countries?

Internists by Ted Bacharach MD, retired

Back in the days when physicians were allowed to retain a little intellectual honesty we were allowed to say “I don’t know”. In our present situation there are no undiagnosed conditions. If you can’t give it a diagnostic designation the physician can’t get paid. “Undiagnosed conditions” are no longer as prevalent as they once were. It was for these diagnostic problems that the Internist was turned to. Since undiagnosed conditions no longer are allowed there is no need for internists.

The complexity of the human body has been reduced to the sum of its parts much like the automobile. Although the automobile is relatively simple compared to the human body I have found that the mechanics repairing machines are not always sure about what is wrong. The internist was the specialist turned to when the findings were problematic. Diagnostic problems were also posed by the complexity of the body and the multiplicity of abnormalities. All of these things attracted some of the more intellectually challenged physicians to the specialty of internal medicine. The fact that all problems have been simplified by Health Maintenance organizations, Health Insurance companies as well as Medicare the need to solve medical problems has been eliminated. The primary physician has made a diagnosis as required, leaving no need for further evaluation. The need for the internist has been eliminated by these organizations and remuneration for thinking is no longer deemed needed anyway.
The internist is neither paid nor felt to be needed and the intelligent medical graduate avoids this specialty as much as possible. Several years ago when I was looking for a place to practice a physician in the area asked me what was my “gimmick”. He assured me that it was not possible to earn a living as an internist without one. This was a long time ago and it has certainly not improved since them. Practicing as an internist it was necessary to see fewer patients and spend more time with each patient than was possible in family practice yet remuneration is not for time spent but for bodies seen.

There still are a few individuals who are intellectually challenged by the complexity and mysteries in medicine that they go through a training program for internal medicine. Some of these individuals find that the specialty they have chosen makes them suited to be a primary care physician who can’t see pediatric problems. Some become subspecialists who can find a “procedure that pays” or they become hospitalists. There are also some who engage in a medical endeavor that is not covered by Medicare or the insurance companies.
The result of all of the above is that is is best for patients to not develop abnormalities that are not clear cut. The patients with diagnostic problems will have to try to find something on the internet that sounds similar to what they have. Stay away from obscure conditions like “Malaria”, “Tapeworm infestation”, “Coccidioidomycosis”, “Lewy Body Disease”, “Jakob Creutzfeld Disease” as well as some of the other less common diseases, as you will probably have to wait for the pathologist to make the correct diagnosis.

“Doctors who think too much are no longer needed!”

Ed McMahon’s Electric Chair By Sarita Salzberg MD

There are some products obviously NOT marketed to the medical community. Take the FOOSH candy at the check out counter. It promises me taurine, glycowhatsit and lots of energy, but I imagine I will reach for the candy and fall on my out stretched hand.

These new fangled electric scooters aren't being marketed to us either. But they are being marketed aggressively to patients. I feel for folks who need them for neurologic problems, and strokes, and other conditions. Or for patients who are frail and elderly and want to be more mobile. These scooters do help people.

However, these scooters should also come with a warning label: "Use of this, when you could really walk, will make you even less healthy and will cause you to die sooner." These scooters can hurt people. Each day I see more and more patients, who do not appear frail or elderly, in these scooters. I have heard that Medicare and Medicaid won't pay for repair of walkers, or canes, but will pay for electric scooters! These scooters cost thousands of dollars and then, once the patient is in it, they must just gain more and more weight and get more and more deconditioned.

Recently a patient of mine was told, by the multiple consultants I sent her to for her back pain and foot pain, to seriously start getting more active and try to lose weight. She had access to a pool which would be better not to stress her joints. These messages were lost.

What she heard was, "I have pain so I need of those electric wheelchairs. My friend got one and she is in less pain than I am." She won't take pain medicines because she has seen all the attorney ads on TV and is convinced any pain medicine will hurt her and she "doesn't want to mask the pain." I said that I'm sorry, but I just can't write for that. The specialists told her to be more active and, with this scooter, she will have virtually no exercise. She'll just get more and more deconditioned and that could hurt her. She is in her early 30's. No fractures, no herniated disc, no problem other than morbid deconditioning that any specialist has found.

I would be dollars to doughnuts, she has established with another doctor who has written for the Ed McMahon Mobility Special. She doesn't have diabetes yet either but, thanks to her wonderful high-tech obesity promoter, which will also be arriving in the mail at no cost to you! Then, if you qualify, come the amputations, blindness and kidney failure!

We have warning labels on NSAIDs and SSRIs. I bet if Aspirin came out today, it would not be approved. We have patients afraid to take a Naprosyn, yet not afraid to resign themselves to these electric chairs. Some things just don’t make any sense like why am I not strong enough to unwrap this freshly purchased FOOSH candy? Dammit!