Wednesday, February 13, 2008

The Dark Side of Medicine

Like politics, medicine does not lend itself to enlightenment. Why is that? Probably because the art of healing has been co-opted by the dark side of business. In the days when your doc had an office in his or her home, made house calls and charged you $5 a visit if you had it, or a chicken if you didn't, their was no question the relationship was between you and your physician. No third party struck its nose in between. Of course, that has all changed. Now the physicians often feel that they are working for the government (Medicare and Medicaid) or private insurance carriers, and sometimes are put into an almost adversarial position with the very patients they have sworn to serve.

Having said that, it is worth noting that Walmart entered the medical clinic business several years ago by subcontracting with other corporations to open small, on-site facilities, usually staffed by a nurse practitioner. These mini-clinics provided same day service for common ailments and were inexpensive, particularly when coupled with the store's $4 generic drug option. A patient could walk away satisfied that they were helped quickly and inexpensively. Walmart intends now to up the ante. A new agreement as reported in WSJ (2-8-08, B9) requires that these subcontractors use the Walmart name as well as a designated electronic medical record and clinic management software. 55 clinics were opened under the old model, but 2,000 will be opened under the new model by 2014. My thought is that if Walmart gets involved in health care, a mini-revolution may occur just as they have done in retail sales. Patients like quick and inexpensive no matter what they are getting these days and, united with an electronic medical record, a potential formula for success emerges for the healthcare market.

In the News You Can Use department: Lipitor, the mega-moneymaking Pfizer cholesterol lowering drug, has been linked to cognitive difficulties in some individuals. The WSJ's Health Journal described it like this: "The brain is largely cholesterol, much of it in the myelin sheaths that insulate nerve cells and in the synapses that transmit nerve impulses. Some doctors theorize that lowering cholesterol could slow the connection that facilitates thought and memory. Statins may also lead to the formation of abnormal proteins seen in the brain of Alzheimers patients" (2-12-08, D1.) Made sense to me and and was particularly alarming because that stealthy, dementing disease took my Dad in the prime of his life. What's more, my previous study of cholesterol showed that we need it more than our doctors might let on--so, it never made sense to me to lower it too much. The enlightened part of this story came from the patients who stood their ground in confronting their doctors about the cognitive impairment they were experiencing. After all, Pfizer had retorted that Lipitor was a perfectly safe drug when used at the prescribed dosage. Turned out, for some patients that just wasn't the case. Jane Brunzie, one of the patients who was totally rejuvenated when ending her Lipitor regime, quipped: "You have to use your own brain, as well as your doctor's brain, when it come to your health." Hear, hear, Jane, I couldn't have said it better.

When you think about it, our bodies are miracles to behold, and we really know very little about its mechanisms. Thus, the practrice of medicine is as much art as science. One physician looking at this connection is Claudius Conrad, MD, PhD who has been "investigating whether a well-defined selection of Mozart music can alleviate stress in critically ill patients and how this effect might be mediated physiologically." Meaning, if the premise is true, how did the body do it? Well, before and after being prescribed a 1-hour dose of Mozart, lab tests were conducted that measured stress hormones, inflammation markers and other parameters. The conclusion? Mozart piano sonatas significantly reduced the amount of sedative drugs needed by these very sick patients and was associated with a reduction in their blood pressures and heart rates. What was particularly telling were the irrefutable lab tests that showed lowering of systemic stress hormones and inflammatory subtances. My hat goes off to Dr. Conrad for this innovative and enlightened medical research that beautifully coupled art and science. ("Esoteric or Exoteric? Music in Medicine," The Medscape Journal of Medicine, 2-6-08.) Could it be that art was intended as a healing agent all along?

If Mozart could speak from the other side, you might hear him say: "Ah, Humanity, I am delighted that the healing aspects of my music have finally been deciphered and utilized as I originally intended. As you are now uncovering, my melodies contain powerful mathematical healing formulas meant for you, the humans of the future, and the many generations beyond. Your physicians will return to healing using my music, but only those with their eyes and hearts wide open. Rejoice in the fact that the time has come. We do on this side of the veil!"

Oh, Mozart, if it was only that easy. As I view it, healing will always be difficult with the dark side of business in control. For example, the World Health Organization likens the tobacco industry aggressive tactics in developing countries to a 'disease vector' such as a virus or bacteria when it called on governments around the world to strengthen the fight against smoking. When these ostracized companies watched profits plummet with the regulation of tobacco in the developed countries, third world countries became ensnared in their nefarious net. However, on the enlightened side, WSJ reported that the Bloomberg Philanthropies, owned by New York City Mayor Michael Bloomberg, helped the United Nations fund a report that outlined the global issue and several ideas to ameliorate the problem modelled after New York's own tough and highly publicized anti-tobacco campaign. Mr. Bloomberg was quoted as saying: "While tobacco control measures are sometimes controversial, they save lives and governments need to step up and do the right thing." Encouraging governments to "do the right thing" is an appropriate role for the United Nations to play in the global healthcare arena:

"For its part, the WHO has a new anti-tobacco treaty that requires 152 participating countries to restrict tobacco advertising, impose smoking bans and tax increases on cigarettes, and toughen health warnings on cigarettes. The document also encourages countries to explore litigation against tobacoo companies."

Hopefully, WHO will be as successful here as it has been in the immunization wars of the past and present. These kind of global efforts are to be encouraged and funded well by the developed nations who have already been through the downside of tobacco abuse and don't want to see this as a major export from an unrepentive industry.

And finally, Safeway, one of the United State's largest grocery chains, announced that they are getting a conscious as it relates to the eggs and chickens it buys. The food giant says it is "actively looking to increase the amount of poultry it buys from producers that use 'controlled atmosphere stunning.' " What pray tell is that, you ask? Well, in a nutshell, the birds are killed by gas inhalation rather than electricity, the gas being more humane according to those in the know. However, Safeway has one little problem; the National Chicken Council said no major poultry producer uses the gas method, and they should know.

PETA , however, applauded Safeway's efforts anyway, which is really what the corporation was after. Turns out, they've been hounded by the aggressive, animal rights non-profit for years and would do anything to get them to quiet down. According to WSJ, "A few years ago, PETA launched an ad campaign branding Safeway as 'Shameway, Little Shop of Horrors.' About two years ago, [the] group purchased Safeway stock so it could attend shareholder meetings and introduce resolutions pressuring the company" (2-12-08, B9.) PETA is now quoted as saying: "The company should be commended for improving the lives and deaths of some of the animals who are killed for its stores." Some might call this enlightened, some might not. On this one, you will have to be the judge.

Today's Weather Report: glorious sunshine all day and in the teens. Couldn't ask for a nicer winter day. Finally. Earlier in the week it was minus 30 degrees again with a wind chill near 50 below. My diary said we had the same weather last year at this time. OK, enough already on the below zero cold.

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