Medrants 1 year old – personal reflections

Today is Medrants birthday. When I started a year ago, I had not thought carefully about what daily blogging would mean. Why was I doing this? What did I hope to achieve?

Two months after starting, I ranted a bit about blogging. Rereading those words puts today into perspective – About my blog .

A year of blogging has helped me grow as a writer and as a thinker. I spend more time each day considering the latest medical literature and how it might impact practice. Prior to ranting, I mean to consider each finding carefully, providing my interpretation and trying to support my reasoning.

These exercises have formalized a process that I did sporadically. I read more articles now. I stay more up to date.

Blogging has made me more aware of the economic pressures on medicine. I try to include these issues in Medrants because I believe the readers care. Perhaps we (db and the readers) can influence the debate. While that idea seems grandiose, I do believe we can influence how people consider these issues whenever we engage in the debate.

Personally, I find writing this blog a great pleasure. I believe that my writing has improved and I find myself writing more willingly and more often (even when not blogging).

As I have said in the past, I mostly write Medrants for myself, however, I confess that my ego loves the attention that it receives from others. The daily comments that I receive and read tell me that my words mean something to others. The thank you notes that I receive are very special.

Blogging is a joy. Daily I can express myself, be outrageous if I like, educate occasionally, and consider the medical world carefully. Blogging time allows me to think, consider, and grow intellectually. What a great decision I made a year ago! What a wonderful experience!

Thanks for reading Medrants.

Medrants 1 year old – the hot topics

As I have reflected on this year of blogging, I have considered my hot topics. They have changed over the year. I suspect that they will change several times over the coming year.

Last year resident work hours started as one of my major topics. Over the year, the ACGME made their decision (mostly correct, although I do disagree with a few details) and we (housestaff programs) are all preparing for July. I will be ward attending in both June and July, thus I will personally experience a new system in transition.

How programs adapt to these new rules will be a story interesting mostly to insiders. I will however comment on the changes periodically.

Over the past 6 months the malpractice crisis has attracted much attention on these pages. I suspect that I will continue to rant about malpractice suits, and the unintended consequences of those suits. This subject has helped me understand the economics of medical care. I now understand clearly that we do not work in a free market system.

We need (as I have said, and will say incessantly) better methods of valuing and charging for medical care. Physician reimbursement methods are unsuited to current expectations and needs. Our system makes it difficult to increase collections, however there are few constrainsts on increasing expenses. The system is broken, and must be fixed for patients to receive the high quality care they deserve.

Medical advances continually amaze me. Most weeks I can rant about an important new study which helps us understand disease, or even changes how we provide care. The study of medicine has fascinated me for 30 years and will continue to fascinate me for many more.

Considering each day the myriad topics about which I could rant adds intellectual rigor to my day and my life. I hope that these topics interest you. I believe them important to physicians, other health care professionals and to all who may become patients.

Trial lawyers on the prowl

Check my pulse, this rant defends the pharmaceutical industry! Seriously, the pharmaceutical industry has contributed greatly to our improved health – both quality and quantity of life. But the trial lawyers see more deep pockets. Watch out for some costly suits. Trial Lawyers Now Take Aim at Drug Makers

Enriched and emboldened after successful fights against asbestos and tobacco companies, some of the nation’s top plaintiffs’ lawyers have trained their sights on drug makers, claiming that many giant pharmaceutical companies have hidden the dangers of medicines the lawyers say have harmed thousands of people.

In some cases the drugs at issue have already been pulled off the market, like Rezulin, a diabetes treatment from Pfizer that the Food and Drug Administration has linked to liver damage and is the target of almost 9,000 suits. Other suits name some of the industry’s current best sellers, including Paxil, an antidepressant that plaintiffs contend is addictive � a claim denied by the drug’s maker, GlaxoSmithKline.

In some instances, teams of plaintiffs’ lawyers are spending several million dollars preparing cases for trial, in the hopes of winning billions of dollars in settlements and jury verdicts from the drug companies, which have some of the deepest pockets among American corporations.

The lawyers pursuing the suits say that the Food and Drug Administration has systemically failed to protect patients from dangerous drugs, and that the companies have tried to hide side effects. But the agency says medicines are safer now than they have ever been.

Depressed? Go see a trial lawyer. Pregnant? Call a trial lawyer.

The trial lawyers have no controls. They never seem to consider the public welfare. They see dollars, deep pockets, and potential victimization.

Why do I rail against the trial lawyers? They bother me for several reasons. First, they always appear sanctimonius. They are only suing to protect the “little people”.

Second, I understand the contingency fees for which they work. They want large settlements, partly because they keep a large percentage.

Third, their suits undermine the fabric of our society. That seems a bit harsh on first reading, however, I believe that their accumulated suits (and incessant advertizing) have contributed towards our become a society of victims. Their attitude, and more important their actions, make us believe that we should never have adverse outcomes, else we can blame someone and sue them .

If they succeed with these law suits, then future patients will suffer. But they do not seem to care. They see targets for suits. They vision money trees. They never seem to understand the consequences of their “victories”. And our society is damaged with each verdict.

NY Times on China’s handling of SARS

The NY Times gets it! Diagnosing SARS in China

Unfortunately, China’s leaders have not fully grasped that Beijing’s catastrophic mishandling of the health crisis is as much a political failure as a medical calamity. The country’s new president, Hu Jintao, has won praise for firing incompetent officials and ordering the release of more timely statistics tracking SARS, but far more ambitious reforms are needed.

China still isn’t being open enough about SARS to satisfy the World Health Organization and scarcely open at all about other subjects vital to its citizens’ lives. Mr. Hu appears to have little interest in modernizing China’s political system.

In response to the SARS crisis, Mr. Hu has turned to depressingly familiar Communist methods of exhortation and regimentation. These include a Mao-style order to build a new SARS hospital from scratch in barely a week. Public health policies have been highly punitive, like last week’s decree threatening people who knowingly spread the SARS virus with possible execution.

These words ring true. When political considerations threaten the public health, then the political system should change. The Times understands.