Author Archives | Richard

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The Ethics Of Practicing Procedures On The Nearly Dead

February 24, 2017


Screen Shot 2017-02-07 at 7.27.38 PM

I had never thought about this, and should have. On one hand, I am quite familiar with medical students dissecting cadavers. On the other, I have spent much of my life studying the behavior of physicians treating live patients. BUT. I had never considered the gap in between those two sets of circumstances. The area in which physicians must be trained by working on patients’ bodies that still exhibit many attributes of living patients, although there is no hope for recovery.

As the result of reading this blog post, I have now given this middle ground due consideration and, I must admit, am not entirely comfortable with the results of having done so.

The blogger does a far better job of reviewing the relevant issues here than I would do. You know, things like exploring the meaning of the term “informed consent” under these circumstances.

Bottom Line. Here’s my real problem. Who gets to look at a patient’s clinical situation and decide that she is an appropriate candidate for such training exercises? I’m thinking that if it is my body on the table, or the corpus of one of my loved ones, I want this decision to be made very carefully! Erring in the direction of effective treatment, although unlikely to succeed, rather than too rapidly defaulting to training exercises.

BUT. Does that continue to leave the training to be done on the bodies of the less fortunate? The uninsured? Those who have no family members on hand?

I’m hope not, but I am afraid so!

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And These Three Guys Are Who???

February 23, 2017



They are the founders of “Sweatcoin,” a new app (one of several) that lets you trade in steps recorded on the app for products.

Bottom Line. While some people may in fact find these apps to be motivating(?), I still wrestle mightily with the notion of providing extrinsic rewards to people who take care of their health. You may remember my previous rants on this topic, which have consistently maintained that such shenanigans teach people that their health has no intrinsic value, and that therefore doing healthful things is work for which one should be compensated. 

Bitwalking, another of the apps, maintains that it is “a new way to participate in the world.” Wow!!!

 In my opinion, this is silly, dysfunctional and not likely to work in the long run. I am betting I will not be proven wrong!

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The Intersection Of Faith And Healthcare

February 22, 2017


Supreme Court

Okay. We now have DJT’s nominee for the Supreme Court. AND. He is actively being talked about in terms of his healthcare views. More specifically his views on contraception coverage and “right to life.”  Check this out!

Bottom Line. While Obama’s Affordable Care Act was front and center during the last presidency, it seems that issues involving healthcare, and especially areas where healthcare and religious beliefs collide, are going to be of even greater import during the next four years. 

 Keep your eyes on this!

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February 21, 2017


Trump 4

That’s the way Trump described pharmaceutical pricing at his recent confab with drug manufacturers.

Bottom Line. I could go on and riff about other topics that were discussed at this session, but I won’t. I would rather just pose a thought question. What threshold do drug prices need to get below in order not to be deemed astronomical? I’ve never heard anybody set this mark. I would love to hear the Donald do so!

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Where Do The BEST Doctors Come From?

February 17, 2017




Interesting stuff. Turns out that patients treated by International Medical Graduates (They have apparently cleaned up the terminology from “FMG’s,” Foreign Medical Graduates, that we used to condescendingly call these practitioners when I was working in a hospital system) have outcomes as good as those treated by physicians trained in U.S. medical schools.

Demonstrating what? Remember that there is a selection process at work here. Likely (hopefully!) we get only the cream of the IMG crop, while we are “stuck” with all of the doctors that we graduate on our own shores. Regardless, if you are hospitalized in the U.S., you shouldn’t spend a lot of time worrying about where your physician was trained.

Bottom Line. Like you, I have been reading a gazillion articles about the impact that Trump’s travel ban will have on U.S. healthcare. This BMJ article suggests that the travel ban is likely to deny us the services of some very good doctors!

 And so it goes!!!

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Dear Lord, I Hope Not!!!

February 16, 2017



A recent article from Bloomberg reports that Mylan has received preliminary notice that the FTC is investigating whether the company unfairly blocked EpiPen competitors from the marketplace. Did the company make minor changes to the product strictly for patent protection purposes? Enter agreements to stave off competition? Etc.? The company says no. We shall see.

Bottom Line. When we think about the PR problems that the pharmaceutical industry faces, we need to think more broadly than “price” in our actions and in our communications if we want to clean up our act in the eyes of the public. 

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Physician Specialties Most Likely To Be Made Obsolete By Artificial Intelligence???

February 15, 2017



I bet most of you could figure this one out on your own. If not, the graphic above might provide some assistance. Okay, here’s the deal. The medical specialties most likely to be replaced by machines are those that center around pattern recognition. Yup, Radiology and Pathology. As you will see in this article, these specialties are among the most highly paid in medicine. Yet. Practicing these specialties successfully is largely dependent on having developed an acute ability to do visual pattern recognition. Guess what. Machines are better at pattern recognition than human beings are. Far better.

Bottom Line. Saving on physician salaries, of course, is really only the secondary benefit here. More important is the improvement in diagnostic accuracy that should result from AI’s superior pattern recognition.

Look for this revolution to come fairly quickly. Quickly enough that I don’t know that I would tell my kids to enter a Radiology Residency in 2017!!!


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Big Bellies Are Big Business

February 14, 2017


Big Bellies

Let’s note in passing a few simple facts. First, despite myriad public health efforts designed to get people to control their weight, obesity is a problem that is rapidly growing (pun intended) in the U.S.

Second, it has become painfully clear that traditional medical practices do a lousy job of treating obesity.

Third, it has also been demonstrated that bariatric surgery is the only method shown to provide long term success in many obese patients.

Put those facts together and ask why no one has opened a retail clinic specializing in bariatric surgery.

Now they have. As reported in this article, Novant Health has just opened such a clinic in North Carolina.

Bottom Line. Will such clinics start to pop up in other cities? As usual, folks, it will come down to insurance reimbursement. This business idea only makes sense if insurers will cover what will likely become a higher incidence of bariatric surgery if such clinics become common!

We shall see!

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HIPAA And Civil Liability

February 13, 2017

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Please pardon the lawyer speak in the title here, but that is sort of what this post is about.

Check out this piece. It is about the two lap top computers, stolen from Horizon Blue Cross Blue Shield, that contained unencrypted information about 840,000 plan members. Guess what happened next. You got it! A lawyer filed a class action suit on behalf of the wronged members.

Now life gets interesting, to the extent that the law ever does. Simply, a lower court rejected the suit since HIPAA does not set forth any personal remedies for HIPAA violations. Translated, only the Government has the right to dump on HIPAA violators.

BUT, an appeals court recently ruled that HIPAA can establish a standard of care, and organizations that violate this standard can be sued in non-Federal court systems. Note. There is no claim here that anyone was actually harmed by the theft in any material way. They have just been wronged!

Bottom Line. While damage awards are far from guaranteed under this set of circumstances, what is for sure is that Horizon will wind up with a lot of aggravation and legal expenses coming out of all of this.  The message of this appeals court ruling? If your organization is responsible for the storage of patient medical data, you should redouble your security efforts to make sure that something like this does not happen under your roof!


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Patients And “The Ban”

February 10, 2017


Trump travel ban


Having said in a previous post that Trump’s travel ban will impact virtually every aspect of healthcare, you can sort of rush out ahead of these posts and figure out where all this is going. Yesterday we talked about the impact the ban is having on bio-pharma employees. In future posts, we will focus on . . .

But today we will focus briefly on patients. As described in this article, there are hundreds of patients in the countries covered by the ban who are stuck there, unable to come to the United States for treatment which is both urgently needed and only available here.

Bottom Line. There is little doubt that some of these patients will pay the ultimate price. Worth it?

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