Chapter 10 Is Up – A Tyranny of Experts

DrRich | May 12th, 2012 - 6:08 pm

Chapter ten is now published of my book-in-progress, “Open Wide And Say Moo! – The Good Citizen’s Guide To Right Thoughts and Right Actions Under Obamacare.” This chapter is called A Tyranny of Experts.

You can find it here.

Some Advice About Salt

DrRich | February 21st, 2012 - 4:31 pm


In a previous post, DrRich explained to his loyal readers why the Central Authority’s recent assault on salt is, at best, premature.

Our leaders, of course, insist that the benefits of a universal sodium restriction, applied to each and every American citizen, is more than merely an extraordinarily healthful idea – it is settled science. And anyone who says otherwise is the moral equivalent of a Holocaust Denier (or worse, a Global Warming Denier).

DrRich’s earlier post argued that the available data falls far short of supporting a universal sodium restriction, and suggested that the government is embarking on yet another experiment to be perpetrated upon the population at large, much like Our Leaders’ earlier unfortunate experiments with low-fat diets, and adding trans-fats to most of our processed foods. Since that earlier post, several new scientific studies have been published which lend support to DrRich’s qualms about a universal salt restriction, and which suggest that, indeed, low salt intakes are likely to be quite dangerous to a substantial minority of people.

However, we are now in a new era of herd medicine. And a universal sodium restriction illustrates the very nature of herd medicine. Our Central Authority calculates that a universal sodium restriction is likely to add up to a better overall collective outcome. And if 10-20% of the people suffer because of this policy, that’s not really relevant. It’s the overall outcome that is dispositive.

And people who complain about this are just being troublemakers.

Because a sodium restriction is settled science, new data (unless it is supportive data), by definition, is not allowed into the discussion. Indeed, by definition, the discussion is over. And those people and organizations who have petitioned the government to reconsider its universal sodium restriction policy, citing lots of scientific evidence to show why this policy is at best unproven and quite likely dangerous to the public, are just identifying themselves as some of the people with whom DrRich will be doing morning jumping jacks when he is finally assigned to his reeducation camp.

And so, realizing that it is pointless, DrRich will not rail any further against the government’s policy on salt restriction. Instead, he will undertake the task of providing useful advice to his readers, aimed at helping them to cope with the inevitable changes that are coming to the foods they eat – and perhaps, helping them to get enough sodium in their diets to avoid early death.

First, DrRich urges his readers to notice that purchasing bags of salt, even in large quantities, is not yet illegal – and indeed there is, as yet, no special “salt surcharge” or “salt tax” added to the purchase price. Further, DrRich reminds his readers that salt is famous for being storable for very long periods of time. So stock up while you can. Ten to 15 years of salt in your cupboard will likely take you up to the point where total societal collapse, Greek-style, will make the amount of salt in your diet the least of your worries.

As a simple precaution, however, when you buy your bags of salt you should not use your credit card or your debit card, and by no means should you allow your friendly neighborhood grocer to tabulate your purchase in the grocery’s rewards program. Use cash. (Indeed, since your future healthcare may very well depend on your long-term compliance with various dietary directives, you should probably begin purchasing only fruits and vegetables with any of these non-cash alternatives.)

If you keep your salt purchases to under $20 cash at a time, odds are you will not trigger official scrutiny.

Second, a week or two ago the CDC released an extremely helpful report which lists the 10 food categories which contribute most of the sodium consumption to the American diet.

These include:

- bread and rolls,
- cold cuts/cured meats,
- pizza,
- poultry,
- soups,
- sandwiches,
- cheese,
- pasta mixed dishes,
- meat mixed dishes,
- savory snacks.

These delightful culinary treats, the CDC warns us, are deadly due to their salt content. The Agency further indicates that strong government action is necessary, and is coming, to remove these dangerous products from the grocer’s shelves. (And the CDC, DrRich reminds his readers, is a government agency, and therefore is one of the manifold voices of the Central Authority. We must take its pronouncements seriously.)

So once again, stock up while you can. Some of these foodstuffs can be purchased in jars and cans, and will keep for years. Dried pasta and savory snacks also store quite well. Other items on this list can be bought and frozen. And of course, you can buy a bread maker, which, utilizing the bags of salt you have on hand, can furnish you with all the sodium-laden bread you are likely to need.  And once again, use cash.

DrRich sincerely thanks the government for providing this helpful list of essential foodstuffs which it is targeting for obliteration.

Third, when we are stocking up for the shortages which the government has now pledged to create, it is inevitable that we will misjudge on the necessary quantities. We may find, for instance, that we have way too many Cheetos on hand, and not enough linguini. This means we had better be prepared to barter with our neighbors.

Since it is relatively unlikely that American greenbacks, by that time, will be valued enough to induce your neighbor to part with irreplaceable cans of chicken noodle soup, DrRich humbly suggests that you begin laying up a few dozen cartons of cigarettes. If you travel to any socialist country, you will find that cigarettes are the universal currency, and can get you just about whatever you need.

Finally, even if you do not believe that owning salt or salty foods is about to become at least a misdemeanor, or that we are about to become a barter economy, you should still find the government’s Salt Target List helpful. The companies that make this stuff are about to come upon very hard times. So scour your investment portfolio before it is too late, and make the necessary adjustments.

DrRich, as always, is pleased to be of assistance.

DrRich Is Still Here

DrRich | February 2nd, 2012 - 11:42 am

It’s just that I am occupied at the moment finishing up the 5th edition of my introductory textbook of electrophysiology. It is a book which aims to simplify and demystify a particularly arcane branch of the cardiologic arts, and it has proven to be quite popular (among a certain type of readership) for nearly 25 years.

The publisher insists that I update this book every few years, to keep it “fresh.” Because it is a very basic textbook, and because the basics of electrophysiology remain nearly unchanged, my chief aim in doing these revisions is not to screw it up too much.

A secondary aim is to slip past the eagle-eyed editors (who have the reputation of the publishing house to uphold, and who believe textbooks of medicine should be serious tracts) as much humor as possible – which means I have to disguise it. (Regular readers of this blog will know what I mean.) By this means I keep myself engaged and entertained in what otherwise – after all this time – might have become mere tedium.

It is in the interest of my contractual obligation to finish this project in a timely fashion that I have had to leave off – for what I intend will be a very brief interval – composing posts for the Covert Rationing Blog.

I hope that my few readers will indulge me in this hiatus, and in the meantime that you will keep in mind (without my constant reminders) that they really are out to get you.

DrRich’s Top Ten of 2011

DrRich | December 30th, 2011 - 9:33 am

After extensive analysis by a committee of hand-picked experts, with much debate and with some dissension, the following have been identified as DrRich’s Top Ten Posts of 2011.

Ten: The Right To Bear Salt

Nine: About Those Doctor-Nurses

Eight: The Four Ways To Reduce Healthcare Spending

Seven: On Killing The Elderly

Six: The Real Utillity of “Never Events”

Five: Who Writes Those Clinical Guidelines, Anyway?

Four: DrRich Explains The Right To Healthcare

Three: It Is Your Duty To Maintain Wellness

Two: Primary Care Is Dead: Part I – The Obituary;  Part II – Moving On

One: Why People Think Obamacare Has Death Panels

Read them and weep.

Starting Pitcher

DrRich | April 1st, 2011 - 12:54 pm

DrRich is gratified that Jason, The Healthcare Economist, has seen fit to hand him the ball on opening day.  In this week’s Health Wonk Review, the Covert Rationing Blog was named starting pitcher in the opening day line-up.   DrRich is further gratified that Jason’s team is in the National League, so that DrRich will get his swipes.

It’s a bit nippy out there, but DrRich is ready.  (April, apparently, is now the month that comes in like a lion.  As usual, Global Warming works in mysterious ways.)

Grand Rounds 7:22 – Read This Quickly

DrRich | February 22nd, 2011 - 6:02 am

Especially since the events of last week, it would be absurd for DrRich to think that everybody is out to get him. Still, it seems plain that, of late, not all individuals enjoy his efforts here at the Covert Rationing Blog.

Two years ago, for instance, DrRich was “invited” to testify as a witness before a federal grand jury in a matter involving one of his consulting clients. While under oath, DrRich was caused to understand that the Feds (at least certain members of the DOJ) are well aware of this blog, and of the general tenor of its content. The impression left by this experience makes DrRich doubt whether many of his fans come from that particular precinct.

Further, the CRB has been the victim of two targeted denial-of-service attacks just in the last several months. Perhaps this is a common experience for healthcare bloggers, but then again, perhaps not. Finally, there’s the fact that last May (some readers may recall) a nasty hacking exploit completely trashed the CRB at the server level, resulting in the loss of the first three years of DrRich’s endeavors here (which, some have said, is the greatest tragedy to befall posterity since the burning of the Library at Alexandria).

And so, Dear Reader, while DrRich is certainly happy to be hosting Grand Rounds for the fourth time, and is particularly delighted with the quality of postings which he has the honor of featuring this week, it occurs to him that hosting an event with such high (and well-deserved) visibility might draw certain “extra attention” here.  So perhaps you had better read this quickly.


We begin with HealthAGEnda, the John A. Hartford Foundation blog, which is posting a remarkable series of articles by Amy Berman, a senior program officer at that foundation, who has recently been diagnosed with an incurable form of breast cancer. Ms. Berman discusses very openly and frankly both the good and the bad aspects of the American healthcare system she is encountering  as she deals with this likely fatal illness. In this post, the second in a series, Ms. Berman talks about her ordeal in confirming what she already strongly suspected was a very bad diagnosis, and describes the comfort she experienced, while “meeting the enemy,” from compassionate but frank healthcare professionals. She had a much less favorable experience, which she describes in her first post, demonstrating just how devastating it can be for a patient to encounter a one-size-fits all physician. The impact such an encounter has on a patient who needs real medical help is especially relevant in an era in which doctors are being urged (coerced) into following just such an approach. Ms. Berman is an extremely brave and gracious woman, and the important insights she is providing in her efforts to chronicle her illness ought to be read by every health professional.

Henry Stern of Insureblog discusses the documented, systematic mistreatment of the elderly under the British National Health Service. Stern points out that while similar mistreatment of the elderly also happens in the American healthcare system, here it is sometimes not systematic, but rather is most often due to sloppiness or inadvertent error, and further, when it happens remedial actions (such as lawsuits) are often available. In contrast (evidence suggests), treating the elderly badly in the NHS seems to have become virtual policy. DrRich, of course, longtime president and sole member of Future Old Farts of America (FOFA), is confident that nothing of the sort will ever happen here in the U.S. where the government always has our best interests in mind, and he is sure that when government officials refer to the NHS as an ideal to which we should all aspire, they are probably not talking about this part of it.

Writing on a related topic, Julie Rosen of Bedside Manner tells about steps doctors and families can take to resolve disagreements on how aggressive one ought to be when deciding on the use of certain treatments for elderly and mentally incapacitated patients. DrRich finds Ms. Rosen’s recommendations appropriate, since all of them take place at the local level, with full participation of the patient’s loved ones, and do not (explicitly, at least) involve the heavy hand of any Central Authority.

And still speaking of the role of authority in deciding on aggressive treatments, The ACP Internist posts a news report about a court-ordered spinal operation on a 16-year old who was injured during a wrestling competition. Neither the young man nor his parents wanted the operation, which they feared might cause paralysis.  (Apparently, they were actually paying attention during the “informed consent” process.) Further, as the mother apparently demonstrated in a video shown on local TV, her son had a “full range of motion” prior to surgery. Nonetheless, the young man was removed to protective custody, and the court-ordered surgery was performed (apparently successfully, thank goodness, or else this might have turned into a controversial decision). One hopes the judge, in making his determination that the family was not acting reasonably, was not swayed by their expressed partiality to herbal medicine and homeopathy. Wacko as such practices may be, they do not appear particularly relevant in this case, given the family’s seemingly cogent argument that the risk/benefit calculation, as it had been presented to them by medical professionals, simply did not meet their threshold for such aggressive treatment. Apparently, it met the state’s.

The ACP Hospitalist offers a post from a doctor at Grady Hospital entitled: “10 ways to know that the nurses hate you.” These 10 clues as to nurses’ disapprobation are both amusing and true. However, after observing for over 30 years the kinds of behaviors to which nurses are forced to resort when they see that things are greatly amiss, but at the same time they are powerless to directly intervene, DrRich thinks this post more accurately ought to be entitled, “10 ways to know that the nurses think you are killing your patients.” The nurses may or may not actually hate the doctor for it, but they wish he/she would stop – and here are 10 ways in which they may often express that wish.

While some states are big troublemakers (and you know who you are), others are moving to implement provisions of Obamacare just as the Central Authority has decreed. Louise from Colorado Health Insurance Insider tells us that Colorado Senate Bill 168 was introduced last week to create the nonprofit healthcare cooperative which is required by all states under Obamacare. (Shouldn’t somebody tell the Colorado state senators that writing long tracts like this in ALL CAPS is considered impolite, as it is the documentary equivalent of shouting?) Louise notes that the healthcare cooperatives mandated by Obamacare may help to reduce the number of uninsured, but adds that Obamacare “will do little to address a range of other problems, including rising healthcare costs, the unaffordability of healthcare even for people who have health insurance, over-utilization of care, and the problems created when we link health insurance to employment.” While these are all legitimate points, regular readers will know how little DrRich himself goes in for such grousing.

Obamacare, after all, does so much! As a case in point, David Harlow at HealthBlawg writes about Accountable Care Organizations, a new entity which figures prominently under Obamacare, and which will be a chief vehicle for controlling the cost and quality of healthcare (i.e., for controlling physicians’ behavior). A lot of scary things have been written about ACOs (including, truth to tell, things written here at the CRB), but Harlow points out that ACOs might not turn out to be such a bad idea after all. For evidence, he points to some of the successes realized by AQCs (Alternative Quality Contracts) in Massachusetts, under admittedly favorable practice environments, and notes that some of these successes might be translated directly to ACOs. DrRich hopes he is right. But it is a little worrisome that nobody, including Harlow (as he himself allows), really knows what ACOs will end up looking like. Their structure is, as we speak, being fought over by numerous federal agencies (like a carcass being fought over by a pack of dogs), and among these agencies (DrRich shudders to contemplate) is the Department of Justice. But Mr. Harlow knows far more about this stuff than DrRich, so let’s all hope for the best. Short of defanging Obamacare, that’s about all one can do.

Amy Tenderich of Diabetes Mine submits a guest post from Valentine’s Day, written by Wendy Strgar, entitled “Healthy Sex, Healthy Love.” Ms. Strgar, who is known in some circles (circles of which DrRich himself is innocent) as a “loveologist,” and who markets the sexual-aid products to prove it, actually makes a pretty convincing argument that sexual activity can be an important part of reducing one’s risk for all sorts of medical problems. So: Are you one of those folks who has thought about having more sex, but you’re just not sure the pay-off is worth all the trouble? Read this post.

Dr. Pullen at posts about the problem of anti-personnel mines, which continue killing and maiming innocent people all over the world, and for decades after hostilities cease. He rightly thinks the US ought to do more to resolve this problem, and in particular, he decries apparently serious suggestions some have made that we ought to deploy mines on our southern border to prevent illegal crossings. DrRich agrees with Dr. Pullen, but does not believe that mining the U.S. border will ever become a serious consideration (unless it is to prevent American citizens from sneaking southward to receive black market healthcare).

Doug Perednia at The Road to Hellth is writing a fascinating series on the wonders of Pay for Performance. In this, his second offering, Perednia provides some pretty overwhelming evidence, including evidence from studies which proponents use to justify P4P, that P4P demonstrably does nothing useful. Actually, DrRich should qualify that statement: It does nothing useful in terms of improving clinical outcomes. What it does do (as Perednia demonstrates) is to forcibly distract physicians from listening to their patients, to fully consume all the time allotted for a patient visit, and to actively discourage other forms of doctor-patient interactions which might lead to additional healthcare expenditures. So despite a now-well-documented lack of any improvement in patient outcomes, P4P is in fact achieving its actual designed ends, and thus must be counted a great success.

Dr. Joe Smith, who writes the Dr. Unplugged blog (a Medscape blog which requires free registration), travels the globe seeking out emerging technologies related to wireless healthcare. In his latest article Smith laments the fact that, so far, the healthcare consumer has completely missed out on the ongoing wireless revolution, a revolution that has greatly empowered consumers in virtually every other economic sphere. He concludes that despite this slow penetration, wireless technology inevitably will also transform the lives of healthcare consumers. DrRich agrees that this outcome is indeed inevitable, but thinks it may take a while. Resistance to the empowerment of individual healthcare consumers is deeply entrenched, massively well-funded, extraordinarily powerful, amazingly ruthless, and very widely distributed (from the beltway to the bedside). Such resistance is akin to the all-pervasive power of the Church 500 years ago, a power that was eventually broken, but that required the technology (printing press), the killer app (Bibles printed in the vernacular), the catalyst (Martin Luther’s 95 theses), the poorly-expressed but ultimately deep-seated desire of the populace for the knowledge being offered, and the fortitude to persevere through 300 years of reformational bloodshed. So, yes, history ultimately will win out with regard to wireless healthcare, but one fears it may take more than just the healthcare equivalent of the iPod or Facebook to see it happen.

The anonymous author of The Notwithstanding Blog is a Canadian medical student with a background in economics. In the short time this blog has been around, he (or she) has done some very cogent writing applying economic insights to medicine. The featured post describes why medical ethicists (despite their constant yammering about honoring the autonomy of the individual) almost always decide specific ethical questions the other way, that is, against individual autonomy. DrRich, in his ham-fisted style of analysis, always tends to blame this phenomenon on the fact that Progressives in recent decades have largely taken over the Ethicists’ house, just as they have taken over in most academic fields, and that Progressives as part of their DNA must always come down on the side of the collective. But Dr. Notwithstanding offers what is likely a better explanation, based on economics (the science of human behavior) instead of on political ideology. As you’ll see, in addition to being an original thinker Dr. N is an engaging writer. You should give this blog a try.

In stark contrast to Notwithstanding’s anonymous blog is Carolyn Roy-Bornstein‘s eponymous one. Here she describes one of the absurdities doctors see every day with the modern-day electronic medical records which are being adopted all over the place, with great fanfare (and with public subsidies), to streamline healthcare, reduce redundancy, eliminate waste, and assure quality care. Namely, while these new electronic records may greatly simplify the lives of the federal regulators and the forensic accountants who keep track of which doctors are being naughty and which are being nice, they often gum up the works for the people on the ground who are actually trying to take care of sick people. EMRs can do this in many ways, and Dr. R-B nicely describes one of them: She laments the reams of redundant, boilerplate, tree-killing verbiage these records spit out, each and every day, for each and every patient, a characteristic which makes the formerly simple task of figuring out how the patient’s doing today a constant challenge, a perpetual exercise in patience and persistence. and a powerful attractor for medical errors. She ends by speculating whether it might make things easier to have somebody sing these records to her. A nice thought, but DrRich thinks it would not help. What you’d get is an early Phillip Glass composition, in which the same nonsense phrases are repeated over, and over, and over, and over. . .

The Happy Hospitalist discovers that latex examination gloves (powdered, one-size-fits-all, Spic and Span brand), are available at 10 for one dollar at the local dollar store. His discovery suggests a couple of things. As Happy points out, hospitals which are expected to survive on Medicaid payments now have someplace to shop. And, if you want to bring down the cost of healthcare products and services, simply make them available for direct purchase by consumers.

Carolyn Thomas of Heart Sisters writes of journalist Melissa Mia Hall who died in her Texas home in January after avoiding medical help for her severe and persistent chest pain (regarding which she wrote a running commentary to friends – and ultimately to posterity – via e-mail). Ms. Thomas concludes that had Ms. Hall had health insurance (which she did not), she likely would have done more than just document the progression of her fatal heart attack. DrRich has no personal knowledge of Ms. Hall, and so cannot contradict this conclusion, nor does he wish to. However, a recent survey by the American Heart Association showed that in 2009, only 50% of women (regardless of insurance status) said they would call 911 if they thought they might be having a heart attack. DrRich, who has long lamented the feminization of men in our society, now utters his dismay at the converse – the masculinization of women. Ladies, if you have symptoms suggestive of a heart attack, don’t try to tough it out. Call 911.

Steven Wilkins of The Mind Gap tells how sessions of culturally-sensitive “storytelling” can break down certain cognitive barriers for some patients, and more fully engage them in their medical treatment. Wisely, Wilkins is not suggesting that beleaguered PCPs develop a stable of appropriate yarns they can spin for their recalcitrant patients during the 7.5 minutes the Central Authority has allotted for each “patient encounter.” Rather, he has several helpful suggestions for incorporating such storytelling into existing systems, which would leave the doctors alone to do what they’re paid for – making little electronic chits on Pay for Performance checklists.

Vineet Arora at FutureDocs talks about the universally-recognized phenomenon of the over-ordering of radiological diagnostic tests, which is detrimental both to patients’ health and to the healthcare budget. She discusses the many reasons too many of these tests are ordered. It boils down to the fact that the healthcare system provides physicians with extraordinarily strong incentives, at many levels, NOT to rely on their clinical judgment, but instead, in order to optimize their odds of professional survival, to just go ahead and get the test. Unfortunately the solutions Dr. Arora suggests to this difficult problem do not hinge on restoring the doctor’s clinical judgment as a legitimate decision-making tool. (This is no fault of hers; to restore respect for the doctor’s clinical judgment would require a wholesale change in how the healthcare system now operates.)  Instead, she suggests counterbalancing the strong coercions doctors feel to order too many of these tests, with new, and equally strong, coercions not to. Laboratory rats faced with similar, unresolvable imperatives to respond to two opposite stimuli, of course, quickly die of the stress.

Dinah from Shrink Rap notes that the FDA is about to take an action that may effectively render electroconvulsive therapy (ECT) a thing of the past. Specifically, the FDA is likely to reclassify ECT machines (which have been in clinical use since long before the FDA controlled such things) as Class II medical devices. If so, then for these devices to remain on the market, the two companies that manufacture them would have to conduct expensive new clinical trials to document safety and efficacy within 30 months. Observers judge that these companies would not have the resources to do so. ECT is a highly controversial procedure, and there are vocal groups which are trying to ban it – but for some patients with severe depression, Dinah points out, ECT has been a very effective and potentially life-saving last resort therapy. These unfortunate patients, apparently, can now join all the others whose response to various treatments resides in the tail of the standard distribution curve, and for whom the tailored, individualized therapy they require will no longer be an option.  So they will just have to make do with the guideline-driven treatments that suit the average patient just fine. Nonetheless DrRich predicts this change can be implemented with minimal outcry, since severe depressives, being often imbued with great inanition, likely won’t complain very vociferously about it.

Speaking of shrinks, Philip Hickey of the Behaviorism and Mental Health Blog writes about his observations regarding how and why “mental illness” has become such a growth industry. He says, “’Mental illness’ is a spurious explanatory concept whose purpose is to medicalize for profit the ordinary problems of human existence which our ancestors tackled and resolved without drugs for thousands of years.” While DrRich might not buy his entire thesis, there is much more truth in what Hickey says than one would like to think.  Among other things, when healthcare becomes a right, then the more struggles of the normal human experience we decide to turn into a medical diagnosis, the more it becomes society’s obligation to alleviate those normal struggles. There is a natural endpoint to this process of over-medicalization, of course, but it is not pleasant to contemplate.

Dr. Wes speculates on what is really different about the new pacemaker leads which recently have been declared officially MRI-safe by the FDA. Wes suggests that much of the extraordinarily expensive and time-consuming effort that was made in obtaining the “MRI-safe” label had more to do with the incredible regulatory maze that had to be navigated, than with any actual engineering changes. DrRich, who a few years ago was peripherally involved as a consultant in a similar effort (with a different company), declares Dr.Wes’ speculation to be likely pretty accurate. But fear not, for Medicare will be reimbursing the manufacturer for its regulatory ordeal for many years to come.

The venerable DB of DB’s Medical Rants offers a timely rant about how those who create the clinical guidelines which dictate the practice of modern medicine often do so inadvisedly, and sometimes with their own (possibly cryptic) agenda in mind, and as a result of such guidelines, patients may die. DrRich himself has covered this same topic lately. DB’s commentary hits the mark.

Paul S. Auerbach of the Medicine for the Outdoors Blog provides this post on cholera vaccines. It turns out that cholera vaccination is a little less than straightforward, and given the relatively small amount of vaccine available worldwide, would not be suitable for wide-scale use. So as far as cholera prevention goes, pray for sanitation.

Rich Elmore and Paul Tuten at HealthcareTechnologyNews write the wonderful news that the Direct Project has launched. The Direct Project, they tell us, is an implementation of a secure, health-related e-mail standard designed to “allow health practitioners to securely exchange health data, medical records digitized to be easily shared between doctor’s offices, hospitals, benefit providers, government agencies and other health organizations, all across America.” This sounds like a pretty good idea, except perhaps for the “government agencies” part, since, for many of us, these are the very folks we’d least want looking at our most private personal information. As for the patients themselves, it is not clear whether they also will have ready access to all this extremely secure information about their own health, or whether instead they will have to wait until the information finally shows up on Wikileaks.

February 24 – DrRich has been petitioned by the authors to issue a correction for this last item. In order to do complete justice to them, DrRich reproduces their suggested correction in its entirety:

“The Direct Project encrypts the information being transmitted.  No one other than the intended received can get the information.  There is nothing stored using the Direct Project technologies – it serves only as a transport mechanism to enable, for example, a provider to securely send information to a consulting physician.  The goal is to replace the pervasive fax machine with something more secure, more modern and able to be used by healthcare stakeholders with the most basic technology (internet access and a PC) up to the most sophisticated user of an electronic health record.”

DrRich thanks the authors for correcting any misapprehensions he may have inadvertently introduced.  To be clear, when the Feds get your personal health information, and when you have difficulty obtaining it yourself, that will not be the fault of Direct Project, whose purpose is merely to assure that the data gets sent only to the person/agency which is targeted to receive it, and no one else.  DrRich leaves it as an exercise for his readers to determine whether his original commentary may still offer any value.


Thanks for speed-reading Medical Grand Rounds this week.

Next week Grand Rounds will be hosted by The Examining Room of Dr. Charles.


The CRB Wins Medical Weblog Award – Thanks For Your Support

DrRich | February 17th, 2011 - 7:10 am

It was announced yesterday that the Covert Rationing Blog has won the 2010 Medical Weblog Award in the category of Health Policy and Ethics.

I am deeply gratified and humbled to have won this award, particularly given the high quality of the other nominees this year. Thanks to MedGadget for hosting the awards this year (and every year) in their unfailingly professional manner – and for deciding not to banish me from the competition, given my unusually boorish behavior in this same competition last year.*

And thanks most especially to those of you who read this blog, and still saw fit to go out of your way to cast your vote for the CRB. It is only thanks to all of you that I have not become the Susan Lucci of the medical blogosphere.

*I took advantage of my finalist status last year to publicly challenge another finalist (whose official policy on medical ethics I found to be troublesome) to an on-line “Medical Ethics Smack Down,” and did so in a manner which they could not graciously ignore. The resulting spectacle might have soured the opinion of a less forgiving Medical Weblog Award host – and so hats off to MedGadget for its liberal outlook on the behavior of its nominees.

DrRich Hosts Discussion on Sermo

DrRich | October 2nd, 2010 - 12:16 pm

DrRich is honored to have been invited, by popular demand (which means that both of his readers must have requested it), to host a discussion on Sermo. The discussion begins on Monday, October 4, and will run for four days or so.

Sermo is an online community for physicians, where doctors say stuff to each other they might not want to say to anyone else. DrRich has spent almost no time on Sermo, but he expects this is the place where modern doctors must discuss the secret-knowledge-type-stuff you all know we have but don’t want to reveal – things like all those alternative medicine cures that, if widely known, would put us all out of business, how to conspire with our ancient allies in the pharmaceutical industry to keep diseases chronic instead of curing them, and other bits of ancient and clandestine, handed-down wisdom we doctors are sworn to suppress for the sake of our guild, but which explain why we ourselves never get sick or die.

In any case, DrRich looks forward to hosting this discussion on Sermo, which he suspects will pertain more to the kinds of things covered on this blog than to medical arcana, and he hopes his physician readers will join him there (for otherwise he expects he will become very lonely). To his non-physician readers, DrRich pledges to report back here on anything that comes out of this discussion that might be of interest, as long as it would not require him to violate his secret and sacred oaths.

Shout-Outs to Dr. John and the Dinosaur

DrRich | September 7th, 2010 - 3:17 pm

DrRich would like to congratulate Dr. John M. for his one-year anniversary in the blogosphere.  While DrRich is not precisely at the same place on the political scale as Dr. John, he finds himself agreeing with his EP colleague the vast majority of the time.  Dr. John has established a truly excellent blog, which should be of interest to anyone who cares about healthcare, heart rhythm disturbances, or bicycle racing. Highly recommended.

And DrRich would be remiss not to point his readers to Grand Rounds this week, which is posted at Musings of a Dinosaur.  It is a baseball-themed Grand Rounds, which, DrRich thinks, is OK – though as a Pittsburgh Pirates fan he is no longer familiar with such concepts as “double play” or “grand slam home run.”   But as a blogger whose posts are (presumably) controversial enough that he is used to his submissions for Grand Rounds being summarily rejected, DrRich wants to thank Dr. Dino for penning him into the lineup this game.

DrRich On The Lam

DrRich | June 12th, 2010 - 10:07 am

DrRich will be absent from the blogosphere for a little while.

He will be traveling to an undisclosed location in Europe, at the invitation of a well-known professor of medicine, to do something which he should never, ever be permitted to do.

DrRich will elaborate when he returns, and the ill-advised deed has been accomplished.