http://covertrationingblog.com Healthcare rationing in America Sat, 27 Jun 2009 13:41:44 +0000 http://wordpress.org/?v=2.7 en hourly 1 ©Richard N Fogoros (DrRich) Drrich@covertrationingblog.com (Richard N Fogoros (DrRich)) Drrich@covertrationingblog.com(Richard N Fogoros (DrRich)) healthcare rationing 1440 health care, healthcare, rationing, covert rationing, healthcare rationing, DrRich, medical ethics Healthcare Rationing in America A Podcast About Healthcare Rationing in America Richard N Fogoros (DrRich) Richard N Fogoros (DrRich) Drrich@covertrationingblog.com No no http://covertrationingblog.com/wp-content/uploads/CovertRationingPodcasImg_sm.jpg http://covertrationingblog.com 144 144 http://covertrationingblog.com/primary-care-in-america/on-making-the-nurses-behave http://covertrationingblog.com/primary-care-in-america/on-making-the-nurses-behave#comments Fri, 26 Jun 2009 06:33:29 +0000 DrRich http://covertrationingblog.com/?p=557 http://covertrationingblog.com/primary-care-in-america/on-making-the-nurses-behave/feed 11:48 Here's a Podcast of this post: ____________ DrRich does not quite know whether to be dismayed or amused by an article appearing earlier this month in the ... Here's a Podcast of this post: ____________ DrRich does not quite know whether to be dismayed or amused by an article appearing earlier this month in the venerable trade journal, AMANews*, decrying (their word) the recent alleged propensity of Doctors of Nursing Practice (so-called Doctor Nurses) to sow confusion about the meaning ofnbsp; the word "doctor." As a frequent purveyor of irony himself, DrRich is open to the possibility that the writer of this article meant to make the "physician leaders" quoted therein seem particularly whiny, in order to shed subtle light on the utter bankruptcy of their position. But alas, DrRich suspects instead that the article is presenting in an entirely straightforward fashion the actual behaviors and sayings of said physician leaders, in reaction to what they see as an overly-aggressive (and "not accurate") stance taken by certain nurses as they seek to elevate their own profession. If this latter interpretation is the case, as DrRich believes that it is, then he is dismayed (and/or amused) to see that the medical profession's strategy when defending itself against what it sees as an existential threat has apparently been reduced to the same strategy employed by the United Nations whenever it is faced with similar threats - the issuance of the dreaded Strongly Worded Letter. The issue at hand, of course, is that Doctor Nurses (those members of the nursing profession who have achieved, through advanced training, the degree of Doctor of Nursing Practice, or DNP) insist on referring to themselves as "doctor," and also that they have issued "misleading" statements implying that their certification examination (written and administered by the highly-respected National Board of Medical Examiners, NBME), is the same in content and format, and that it measures the same set of competencies, as the certification exams taken by physicians. Specifically, according to the AMA, statements issued by the Council for the Advancement of Comprehensive Care (CACC, the nursing leadership group responsible for contracting with the NBME) were "deliberately misconstrued to imply there was equivalence between nurses and physicians." And also, of course, DNPs should stop referring to themselves as doctors. To rectify this awful situation, the "AMA and dozens of state and specialty medical organizations are asking the NBME to mandate that nursing groups clearly spell out the differences between the DNP and physician exams." (DrRich himself is well aware of this tactic, having used it frequently himself as a child, whenever his little brother was annoying him. Unfortunately, his "Mommy Make Him Stop" tactic seldom achieved its desired results.) Furthermore, the AMA House of Delegates is threatening "to consider. . . a resolution proposing to explore alternative physician licensing testing options." That's pretty serious. When one threatens to consider a resolution proposing to explore taking some action, as DrRich calculates it that's merely five steps away from actually taking the action. The poor nurses must be quaking in their old-fashioned, boxy white shoes. One can easily perceive why DrRich initially wondered whether the AMANews article was employing an ironic tone. It is pretty easy to predict the reaction of the nursing leadership - and also of the NBME - to such severe, strongly worded objections. It is very similar to the response the U.N. often gets from those tiny third world countries, whose behavior it dislikes, after it has threatened to explore the possibility of considering various resolutions of disapproval, etc.nbsp; In these cases the response to such threats is very often nearly the same, to paraphrase, Screw Yourself. While apparently Mary Mundinger (DrPH, RN, dean of the Columbia University School of Nursing, President of CACC, and bugaboo of physicians everywhere) did not make herself available to the AMANews for a direct response, she was quoted in an earlier ... Primary,Care,in,America Richard N Fogoros (DrRich) no No http://covertrationingblog.com/gekkonian-rationing/say-hello-to-my-little-friend http://covertrationingblog.com/gekkonian-rationing/say-hello-to-my-little-friend#comments Mon, 22 Jun 2009 15:47:42 +0000 DrRich http://covertrationingblog.com/?p=546 http://covertrationingblog.com/gekkonian-rationing/say-hello-to-my-little-friend/feed 10:44 Why the insurance industry appears defiant Here's a Podcast of this post: ____________ Even Bob Laszewski - a strong proponent of both cost control in healthcare, and of the critical role of the private insurance industry in achieving it - is nonplussed by the insurance industry's reply when asked by Congress last week to stop retrospectively, arbitrarily, and unfairly cancelling patients' health insurance policies. The practice, called "recission," consists of an insurance company voiding a subscriber's health insurance (after happily accepting premiums from that subscriber, often for many years) once they get sick. As Laszewski points out, it is legal and proper to cancel a policy if the subscriber is found to have lied on the insurance application about a prior illness that is material to the current illness - say, if you now seek medical care for headaches after you failed to tell the insurance company that you were previously diagnosed with a brain tumor. That, under contract law, is fraud, and voids the contract. But insurance companies for years now have been practicing recission on subscribers whose insurance applications contained inadvertent and non-material innaccuracies. A nurse in Texas, for instance, had her insurance cancelled after she was diagnosed with breast cancer because she had failed to reveal that, years before, she had consulted a dermatologist about acne. The insurance industry employs people whose job it is to comb the prior medical records of subscribers who are newly diagnosed with certain, expensive target medical conditions, looking for such tiny discrepancies - which they can inflate to "fraudulent" omissionsnbsp; - on insurance applications. These "health insurance detectives" are awarded by their employers according to how much money their efforts can save the company. As it happens, last week insurance executives were treated to a Congressional hearing on recission. After being subjected to a series of incredible stories (such as the one related by the Texas nurse) directly from the mouths of several harmed patients (or their surviving loved ones), and then after listening to withering commentary by both Republicans and Democrats on the House Subcommittee on Oversight and Investigations (whose investigation found that WellPoint Inc., UnitedHealth Group and Assurant Inc. had retrospecively canceled the policies of 20,000 sick subscribers over the past 5 years), executives from these three companies were asked by Chairman Stupak (D-Michigan) to commit to stop practicing recission unless intentional fraud could be shown. All three replied, "no." Laszewski, a highly regarded commentator and a consultant to the insurance industry, reports it's the "dumbest thing I've ever seen an insurance executive do. . . .And, I've been in the business for 37 years." It does seem pretty dumb, on the surface, at least. Even the most stone-hearted among us can see that canceling the health insurance of a newly-diagnosed cancer patient, because she'd forgotten she'd required acne medicine before the prom 20 years ago, is just a bit unfair. One cannot even claim that the insurance executives were defending their recission policies in their reply to Chairman Stupak; rather, they were simply being defiant about it. One is put in mind of Tony Montana, bereft of friends, family, allies and bodyguards (albeit because of his own actions), threatened and surrounded by an army of heavily-armed assassins, screaming, "Say hello to my little friend!" then launching defiantly into a wild, bloody and spectacular suicide. DrRich does not for a moment believe that Richard A. Collins, chief executive of UnitedHealth's Golden Rule Insurance Co., Don Hamm, chief executive of Assurant Health, and Brian Sassi, president of consumer business for WellPoint Inc., are stupid enough to publicly defy Congress, when doing so is against their own long-term interests.nbsp; Appearances to the contrary notwithstanding, they are not auditioning for ... Gekkonian,Rationing Richard N Fogoros (DrRich) no No http://covertrationingblog.com/uncategorized/help-for-all-doctors-and-patients-from-dr-wes http://covertrationingblog.com/uncategorized/help-for-all-doctors-and-patients-from-dr-wes#comments Wed, 17 Jun 2009 15:09:24 +0000 DrRich http://covertrationingblog.com/?p=543 http://covertrationingblog.com/uncategorized/help-for-all-doctors-and-patients-from-dr-wes/feed http://covertrationingblog.com/cardiology-topics/why-implantable-defibrillators-are-still-so-expensive http://covertrationingblog.com/cardiology-topics/why-implantable-defibrillators-are-still-so-expensive#comments Tue, 16 Jun 2009 13:06:09 +0000 DrRich http://covertrationingblog.com/?p=536 http://covertrationingblog.com/cardiology-topics/why-implantable-defibrillators-are-still-so-expensive/feed 16:28 Here's a Podcast of this post: ____________ In Which DrRich Offers Up Yet More Gratuitous Investment Advice Thanks to Dr. Wes for pointing us to a remarkable video ... Here's a Podcast of this post: ____________ In Which DrRich Offers Up Yet More Gratuitous Investment Advice Thanks to Dr. Wes for pointing us to a remarkable video of a 20-year old Belgian soccer player having his life saved by an implantable cardiac defibrillator (ICD). DrRich hopes you will view it. As it happens, DrRich will be traveling to Europe imminently at the invitation of Dr. Pedro Brugada, whom some call Belgium's King of Electrophysiology, and for whom the Brugada Syndrome is namesake. (DrRich is deeply honored to be one of the "masters" at Dr. Brugada's "Meet the Masters" event, which gives him the opportunity to spend two days with a hand-picked group of top European and American electrophysiology fellows. DrRich will undoubtedly learn a lot from them, and will try very hard not to ruin these fine young physicians before they've even started out.) In any case, one must suspect that Dr. Brugada (being, after all, Belgium's King of EP) must have been somehow responsible for placing the ICD in this young soccer player. DrRich will be sure to ask him how that young man managed to receive an ICD. Because most high-risk patients, in the U.S. and elsewhere, have to do without. Despite the fact that ICDs are dramatically effective and dramatically life-saving in people who have dangerous cardiac arrhythmias (please do watch the video to see the drama for yourself), they are still used in only a tiny fraction of the identifiable patients who are at risk for sudden cardiac death. Consequently, in the United States alone, almost 1,000 patients each day die suddenly from cardiac arrhythmias who could have been saved by an ICD. DrRich has written before about the covert rationing of ICDs, which is done so openly that one is tempted to drop the modifier "covert," and has even written about how a former government official has admitted that he had no choice but to juggle the statistics of a randomized clinical trial (i.e., to bastardize the science) in order to avoid having to pay for ICD therapy in broader categories of patients.nbsp; That's old news, and there's no reason to beat it to death again here. Instead, DrRich would like to explore another question - Why are ICDs still so damned expensive? Having worked closely with ICD manufacturers since the early 1980s (which, DrRich knows, makes him a very bad person), he perhaps more than most appreciates the engineering magic that has gone into making and improving these devices over the years. It is a truly remarkable thing that one can build a tiny implantable device that a) houses a computer that runs an extraordinarily sophisticated heart rhythm analyzer that, from beat to beat, accurately diagnoses the heart rhythm in real time; b) can deliver a tiny electrical pacing impulse to the proper cardiac chamber at the proper time, from beat to beat, to coordinate and optimize cardiac function; c) then, if a fatal arrhythmia develops, to deliver a very big shock to the heart within 10 - 15 seconds, to restore the rhythm to normal (please do see the video); d) wirelessly communicate via the Internet to tell the doctor (and anyone else who needs to know) its own condition and the condition of the patient; e) all the while surviving in a hostile, high-temperature, salt-water environment (i.e., the human body), for 5- 7 years, without (for the most part) corroding, leaking, rusting, blowing up, or otherwise malfunctioning. Try to get your iphone to do that. At this point, most of DrRich's regular readers are likely expecting him to say: No wonder these beasts cost $15,000 to $25,000 apiece.nbsp; Just look at the sophisticated technology that is built into them! And it is indeed true that over the past 27 years, hundreds of millions of dollars have been invested in making ICDs smaller, more reliable, longer lasting and safer. It is also true that the companies that make these devices ought to be fairly rewarded for their efforts in this regar... Cardiology,Topics,,Investment,"advice" Richard N Fogoros (DrRich) no No http://covertrationingblog.com/primary-care-in-america/embracing-the-death-of-primary-care-medicine http://covertrationingblog.com/primary-care-in-america/embracing-the-death-of-primary-care-medicine#comments Thu, 11 Jun 2009 09:33:38 +0000 DrRich http://covertrationingblog.com/?p=527 http://covertrationingblog.com/primary-care-in-america/embracing-the-death-of-primary-care-medicine/feed 12:37 Here's a Podcast of this post: ____________ If DrRich was correct in his previous post when he decreed primary care medicine to be officially dead, the death ... Here's a Podcast of this post: ____________ If DrRich was correct in his previous post when he decreed primary care medicine to be officially dead, the death certificate having been duly executed by one of the main physician organizations charged with defending the practice of primary care medicine, then DrRich's pronouncement seemingly has left many good American doctors high and dry. For, if primary care medicine is dead, that is, if the designated functions of a primary care doctor have been devalued to the point of officially having been made equivalent to what a competent nurse practitioner can do, then what's the point of becoming (or having become) a primary care physician? Why, save for a lack of viable alternatives, would anyone practicing primary care medicine continue to do so?nbsp; And why would any medical student choose such a career path? It seems clear to DrRich that they would not. But this does not mean that primary care physicians (or current trainees in primary care programs) should despair. For, when one takes a careful and analytical look at what has just transpired here, it becomes evident that the actual clinical value provided by primary care practitioners has not been diminished one whit. They are every bit as valuable, every bit as critically important, as they have ever been - and even more so. And by summoning up their resolve, reinforced by an abiding confidence in their extensive training, these physicians can re-define a strong position for themselves within the healthcare system, and can finally demand the pay they deserve for the service they provide. But to do so, they will have to abandon primary care. This will not be a loss, because actually, primary care has abandoned them. Whatever "primary care" may have once stood for, it has now been reduced to strict adherence to standards, 7.5 minutes per patient "encounter," placing chits on various "Pay for Performance" checklists, and striving to cause high-and-mighty healthcare bureaucrats (who wouldn't know a sphygmomanometer from a sphincter) to smile benignly at their humble compliance with the dictates of "quality healthcare." This is not really primary care medicine. It's not medicine at all. It's something else. But whatever it is, it's what has now been officially designated as "primary care," and the people who do it (doctors, nurses, high-school graduates with a checklist of questions, or whoever they may be in the future) are all Primary Care Practitioners. While there has been much earnest back-and-forth in the medical blogosphere about nomenclature, specifically regarding the definition of "primary care," that question is now settled. Primary care is the provision of routine, standards-based healthcare to the masses, following prescribed quality guidelines, with limited or no latitude allowed for clinical judgment or individualized care. Since this is now the true definition of primary care, DrRich can think of no rationale for forbidding nurse practitioners to provide it. Indeed, once physicians and their professional organizations (such as the American College of Physicians) gradually allowed this to become the de facto definition of primary care, it became inevitable and proper to admit nurses to the field, and rear-guard actions to the contrary merely amount to the mindless, guild-like behavior so often attributed to physicians by those intent on diminishing and demoralizing the profession. What generalist physicians (heretofore known as primary care physicians) need to realize is that "primary care" has been dumbed down to the point where abandoning it is no loss; indeed, it ought to be liberating to walk away from it. The beauty is that to survive and flourish, you don't really need to change your medical ideals or even your medical behavior (unless, of course, you have bought in to the strict adherence to guidelines, checklists, etc.) You simply need to practice medicine exactly as you were... Primary,Care,in,America Richard N Fogoros (DrRich) no No http://covertrationingblog.com/primary-care-in-america/the-death-of-primary-care-medicine-is-official http://covertrationingblog.com/primary-care-in-america/the-death-of-primary-care-medicine-is-official#comments Sun, 07 Jun 2009 15:23:01 +0000 DrRich http://covertrationingblog.com/?p=513 http://covertrationingblog.com/primary-care-in-america/the-death-of-primary-care-medicine-is-official/feed 17:02 Here's a Podcast of this post: ____________ DrRich was both saddened and dismayed to read Bob Doherty's recent post on the ACP Advocate Blog, entitled, "Do internists ... Here's a Podcast of this post: ____________ DrRich was both saddened and dismayed to read Bob Doherty's recent post on the ACP Advocate Blog, entitled, "Do internists have confidence in their own training when compared to N(urse) P(ractitioner)s?" Dr. Doherty wrote this post both to defend the American College of Physician's enthusiastic endorsement of the Preserving Patient Access to Primary Care Act (H.R. 2350), and to encourage his fellow practitioners of internal medicine to have confidence in their ability to successfully compete with nurse practitioners as Primary Care Physicians Providers - a competition that will be formally launched by H.R. 2350. H.R. 2350 is Congress' latest answer to what is becoming widely recognized as a critical shortage in primary care physicians in the United States.nbsp; In short, it is now abundantly clear, even to those as isolated from reality as our congresspersons, that there are not nearly enough primary care doctors to provide all the new healthcare that our impending healthcare reform will promise to all our citizens (and others). Dr. Doherty points out that H.R. 2350 addresses the primary care crisis in a truly comprehensive way, offering more primary care training programs, new scholarships and loan repayments, and additional financial incentives for PCPs who participate in sundry, officially sanctified, "quality" efforts du jour, such as "care coordination" and "medical homes." He goes on to note that bill's treatment of advanced practice nurses "is a sticking point for some" since it recognizes nurse practitioners as PCPs in their own right, that is, as independent practitioners permitted to establish their own, federally reimbursable primary care practices. But to assuage the indignation of potential critics among internal medicine physicians with regard to this latter provision, Dr. Doherty explains that "ACP's top physician leadership made the judgment that H.R. 2350 merits the College's strong endorsement, even with the more expansive [nurse practitioner] language, since perhaps 95 percent of the bill is based on ACP policy." Further, Dr. Doherty welcomes the competition between internists and nurse practitioners, and, in effect, challenges his fellow internists to "man-up." Ultimately, he asserts, H.R. 2350 "will help support the value of internal medicine training by providing a consistent way to measure the outcomes, effectiveness and efficiency of care provided by internists, even when compared to nursing-led [practices]."nbsp; Under the universal "evaluation benchmarks" provided by this bill, benchmarks designed to measure and compare quality of care, internists (thanks to their many years of advanced training) will surely prevail, and at the end of the day will amply demonstrate to the world their superiority over nurses as PCPs. So, internists, gird your loins, take heart, and leap proudly into the fray! (And, by the way, ask your congresspersons to support H.R. 2350, just as your "top leaders" have urged.) This is so sad on so many levels, DrRich hardly knows where to begin. So let us begin with why, exactly, there is a primary care crisis in the first place. Conventional wisdom has it that the growing shortage of PCPs (a category which is comprised, to a large extent, of general internists) is related to their relatively low pay as compared with their more procedure-oriented medical brethren. But while it is true that internists are grossly underpaid, at least in relative terms, this has always been the case. Men and women who went into internal medicine several decades ago were also grossly underpaid, and knew they would be when they decided to become internists, and yet they became internists anyway.nbsp; And until the past 10 or 15 years, most of them will tell you that the practice of general internal medicine was sufficiently professionally rewarding as to serve as its own compensation. But in recent years, as DrRich has described... Primary,Care,in,America Richard N Fogoros (DrRich) no No http://covertrationingblog.com/general-rationing-issues/advice-to-medical-tourists-from-the-american-college-of-surgeons http://covertrationingblog.com/general-rationing-issues/advice-to-medical-tourists-from-the-american-college-of-surgeons#comments Fri, 29 May 2009 13:45:39 +0000 DrRich http://covertrationingblog.com/?p=508 http://covertrationingblog.com/general-rationing-issues/advice-to-medical-tourists-from-the-american-college-of-surgeons/feed 10:39 Here's a Podcast of this post: _________________ And the investment strategy it implies. Earlier this year, DrRich offered several potential strategies for doctors and patients to consider, should ... Here's a Podcast of this post: _________________ And the investment strategy it implies. Earlier this year, DrRich offered several potential strategies for doctors and patients to consider, should healthcare reformers ultimately decree it illegal for Americans to seek medical care outside the new universal system. This eventualitynbsp; (i.e., making it a crime to spend your own money on your own healthcare) may not be as far fetched as one might think at first glance, since in societies where social justice is the ultimate goal, such individual prerogatives must be criminalized. At that time, DrRich offered several creative solutions to this problem, including offshore, state-of-the-art medical centers on old aircraft carriers, and combination Casino/Hospitals on the sovereign soil of Native American reservations. A reader subsequently offered the possibility of simply establishing institutions something like the "Cleveland Clinic Tijuana," i.e., cutting-edge medical centers just south of the border. (This solution would have the added advantage of encouraging the government to finally close the borders once and for all, employing whatever means it might take, including military patrols, minefields, and missle-armed drone aircraft.) As entertaining as it might be to imagine such solutions, a readily available, though much more mundane, solution exists today - medical tourism. Medical tourism, where one travels outside one's country in order to obtain medical care elsewhere, is a booming business.nbsp; A number of supurb state-of-the-art medical centers expressly aimed at attracting medical tourists have been established in the Middle East, Singapore, India, China and elsewhere in Asia. These institutions cater to citizens of the world whose own healthcare systems cannot (or will not) provide in a timely fashion (or at all) the level of care patients may desire. They offer modern hospitals, numerous amenities, luxurious accomodations, attentive nursing care, top-notch doctors - and they do it all for a tiny fraction of what the same care might cost (if you can even find it) in the U.S. and other "first world" nations. Obviously medical tourism is not particularly feasible for medical emergencies such as heart attack or stroke, or for chronic illnesses such as diabetes, congestive heart failure, or Parkinson's disease, which require frequent visits and long-term managment.nbsp; What is feasible is to become a medical tourist for those one-time medical services that can be scheduled and planned, for which there is a long waiting period at home, or which is simply too expensive in one's own country.nbsp; Such medical services often include coronary artery bypass surgery, hip replacements, knee replacements, and numerous minimally-invasive and not-so-minimally-invasive surgical procedures. In other words, medical tourism to a large extent is something one does for elective (i.e., non-emergency) surgery. It ought not be a surprise, therefore, that the first organization of American physicians to issue a formal policy statement regarding medical tourism is the American College of Surgeons. The reaction of American surgeons to medical tourism ought to be obvious. They hate it. Elective surgical procedures - the very procedures for which Americans become tourists - are the bread and butter of most surgical specialties. And here go their prospective patients, off to Singapore for their lucrative bypass surgeries. American cardiac surgeons, for instance (already underemployed, thanks to American cardiologists throwing stents at every tiny coronary artery indentation they they can justify as a "blockage"), are nearly apoplectic at the idea. It's always fun to read formal policy statements which attempt to deliver an entirely self-serving message whose essence is, "We hate this and if you do it we'll hate you," but in which it is necessary to deliver the message in a polite, politically correct, non-jud... General,Rationing,Issues,,Investment,"advice" Richard N Fogoros (DrRich) no No http://covertrationingblog.com/cardiology-topics/in-defense-of-the-anti-obesity-movement-part-ii http://covertrationingblog.com/cardiology-topics/in-defense-of-the-anti-obesity-movement-part-ii#comments Sun, 24 May 2009 13:53:36 +0000 DrRich http://covertrationingblog.com/?p=502 http://covertrationingblog.com/cardiology-topics/in-defense-of-the-anti-obesity-movement-part-ii/feed 13:29 Here's a Podcast of this post: ______________________ The "Obesity Paradox," and How to Manage It In Part I of this important and insightful meditation, we saw the many ... Here's a Podcast of this post: ______________________ The "Obesity Paradox," and How to Manage It In Part I of this important and insightful meditation, we saw the many reasons why it is so critically important for anyone (such as DrRich) who supports the President's healthcare reform plan (whatever that plan may turn out to be) to stand foresquare behind the demonization of the obese. But unfortunately, the vitally important anti-obesity platform of healthcare reform is under assault. The fat-is-bad firmament - created by the concentrated exertions of the American College of Cardiology, the American Heart Association, the National Institutes of Health, the fashion and beauty industries, sundry weight-loss conglomerates, the popular media, and countless other engines of public opinion - is threatened by a growing body of evidence, created by a few misguided scientists, which suggests that obesity may not be quite as bad a thing as we are all led to believe. Like an expanding pool of molten rock hidden just beneath an apparently placid landscape, this expanding evidence poses a threat to the anti-obesity movement, and therefore to healthcare reform. It must be dealt with. And we need to deal with this threat now, while it is still relatively hidden, and before it bursts through to the surface where it would do much damage. Fortunately - in contrast to an actual volcano - we have the tools to tamp the threat down before it becomes manifest. Before DrRich explains how this can be accomplished, let us take a brief look at some of that counterproductive evidence itself, to illustrate the seriousness of the problem. The evidence, when one begins to look for it, is disturbingly broad and consistent. DrRich will not attempt a comprehensive review of that evidence here, but instead will merely attempt to impart a sense of the threat we are dealing with: 1) We must begin by noting that a substantial part of the "obesity epidemic" that has become manifest over the past decade can be accounted for by a change in the definition of obesity. When the CDC changed that definition in 1997, as many as 30 million Americans who had been of normal weight suddenly found themselves to be obese, or at least overweight, and all without gaining a pound. Enemies of the anti-obesity movement will not be above exploiting this inconvenient truth to their own ends. 2) In 2002, a report in the Journal of the American College of Cardiology examined almost 10,000 consecutive patients who had angioplasty and/or stenting for coronary artery disease, and found that those who were overweight or obese had fewer complications and a lower 1-year mortality than those who were thin or of normal weight. Several more recent studies claim to have shown the same thing. 3) A 2007 report in the Journal of the American Medical Association showed that overweight people who were physically fit had a lower risk of death than normal-weight people who were sedentary. 4) A 2007 report by the National Bureau of Economic Research noted that while Americans were growing fatter, other changes in health behavior (such as reduced smoking and better management of cholesterol and hypertension) more than offset any increase in health risk posed by the population's increase in obesity. 5) And just last week, a meta-analysis in the Journal of the American College of Cardiology concluded that while obesity itself increases the risk of heart disease, obese people who develop that heart disease have significantly better survival than thin or normal-weight people who develop the same kind of heart disease. Some cardiologists have already termed this growing line of evidence, i.e., the general observation that at least in some situations obese cardiac patients fare better than thin ones, as "The Obesity Paradox." Anyone who understands the importance of the anti-obesity movement should be alarmed. Just on the face of it, we can see that while such evidence Cardiology,Topics,,Obesity,and,rationing Richard N Fogoros (DrRich) no No http://covertrationingblog.com/obesity-and-rationing/in-defense-of-the-anti-obesity-movement-part-1 http://covertrationingblog.com/obesity-and-rationing/in-defense-of-the-anti-obesity-movement-part-1#comments Thu, 21 May 2009 12:21:53 +0000 DrRich http://covertrationingblog.com/?p=495 http://covertrationingblog.com/obesity-and-rationing/in-defense-of-the-anti-obesity-movement-part-1/feed 00:01:01 Defending discrimination against the obese - 1 Here's a Podcast of this post: ____________ Because the frank, desperately needed public discussion of healthcare rationing appears to be impossible, at least until some cataclysmic event occurs to precipitate that discussion, DrRich has thrown his support behind President Obama's plan for healthcare reform. DrRich, of course, does not really know what that plan is, because it has not been spelled out yet. But no matter. However healthcare reform finally shapes up on paper, in practice it will become a government-run system of covert rationing. And DrRich is reasonably confident that in the government's hands the covert rationing will become so amazingly ham-fisted and inept that even us Americans, distracted as we are by Paris Hilton, performance-enhancing drugs in baseball players, and whether Scrubs will still be any good after Zach Braff leaves the show, will finally be forced to notice that there's rationing going on. And once we are all forced to acknowledge the rationing, perhaps we will insist on trying to figure out how to do it as fairly, efficiently, and effectively as possible. In other words, DrRich clings to the hope that the Obama reform plan might end up being the very cataclysm that precipitates a public discussion of rationing. It's a slim thread, to be sure. But, especially in a new era of hope, one must embrace what hope one can. Accordingly, DrRich feels obligated to do his part in supporting some of the main pillars of the Obama plan, whenever they come under attack. And one of those pillars is the proposition that obesity is a scourge on our civilization, and for the good of all must be stamped out. Obesity, we are assured, is a main cause of heart disease, hypertension, stroke, arthritis, diabetes, (and even, some insist, cancer), and so is largely responsible for the runaway cost of our healthcare. This simple fact alone allows us to - indeed, demands that we - use every public and private intervention at our disposal to fight the great scourge which is obesity. (Which, fortunately, makes the clownish attempts to pin global warming on the obese - who expel tons of carbon dioxide from one end, and tons of sundry sulfurous and carboniferous gasses from the other - entirely unnecessary.) The fact of publicly funded healthcare permits us to say to the obese: "Your unsightly obesity is no longer a matter of your individual choice; rather, it is now placed squarely within the realm of legitimate public concern. Since everyone else has to pay for your heart attacks and knee replacements, all those donuts and ham hocks you insist on shoveling into your mouth are no longer your business. All your protestations to the effect that your excess weight is the result of genetic predisposition is revealed by simple math (i.e., calories gained = calories consumed minus calories burned) to be sad prevarications. Indeed that same simple formula reveals the true cause of obesity - gluttony and sloth. Like other heretics of an earlier time, you deserve no sympathy nor special considerations, but only a firm - though ultimately compassionate - hand to push you toward the right path, or alternately, toward the just punishment you have brought upon yourselves." So clearly, the obese are now become fair game for whatever manipulations our government can devise to cause them to either lose weight, or pay for their sins. The authorities can begin with simple maneuvers - taxing soft drinks and Twinkies, and whatever other foodstuffs they (in their wisdom) deem to be illigitimate sources of calories - but the sky's the limit. For instance, under the undeniable proposition that it costs more energy to move a fat person from point A to point B, whatever the mode of transportation, the obese could be subjected to a special carbon tax, based on their BMI. The periodic mandatory "weigh-ins" such a tax would require would serve the useful purpose of public humiliation, an important incentive to weight loss. Obesity,and,rationing Richard N Fogoros (DrRich) no No http://covertrationingblog.com/uncategorized/this-time-theres-no-plan-b http://covertrationingblog.com/uncategorized/this-time-theres-no-plan-b#comments Fri, 15 May 2009 13:07:29 +0000 DrRich http://covertrationingblog.com/?p=486 http://covertrationingblog.com/uncategorized/this-time-theres-no-plan-b/feed