Jul 102015
 

US News & World Report had a nice piece on the debate over whether gun violence should be considered a “public health” issue, and they quoted me as explaining why it should not be:

But some medical providers say doctors should stay out of the debate. Dr. Paul Hsieh, co-founder of Freedom and Individual Rights in Medicine, says he views gun crime and violence as predominantly about criminal justice and individual rights.

“I remain deeply skeptical of any attempts to frame important public policy debates as also ‘public health’ issues, especially when it concerns a long-running political controversy,” says Hsieh, who writes on health care policy from a free-market perspective for Forbes.com. “Pretty much any public policy issue will ultimately have some sort of effects on the lives and well-being of Americans – but that doesn’t mean they should all be considered topics of ‘public health.’”

People are concerned that sharing information about gun ownership with doctors may not remain private, he wrote in a Forbes piece. “In short, I believe this undermines the critical doctor-patient trust necessary for the good practice of medicine,” he says.

I thought they characterized my views fairly, and I was pleasantly surprised to see that they even turned the quote into one of the lead article graphics!

 

 

My latest Forbes column is now up, “Three Good Things In Health Care Innovation“.

I highlight some under-appreciated good developments in health care, centered around the theme that innovations in processes may be less flashy than innovations in technology — but can still save lives.

In particular, I discuss the following:

1) Improvements in cardiac care

2) Improvements in matching kidney transplant donors with recipients

3) Protecting the freedom of direct pay doctors

Our current system is very mixed, with both good and bad elements. Today, I wanted to focus on some of the good elements.

For more details on each, read the full text of “Three Good Things In Health Care Innovation“.

 

 

I posted a quick piece last weekend at Forbes, “Would You Trust A Computer To Knock You Out?

This is loosely based on a talk I just gave at ATLOSCon 2015, “I, For One, Welcome Our New Robotic Overlords“.

I discuss the rise of “smart” systems to augment (and potentially replace) human physicians. And why I welcome them.

And thanks to Hanah Volokh for letting me quote her!

 

 

Note from Diana: Sorry that I didn’t post this announcement when the column was published! I didn’t realize that it was in the queue.

My latest Forbes column is now up: “Perverse Incentives and VA Health Scandals“.

I discuss the perverse incentives underlying the numerous VA health scandal. Too many on the political Left (such as New York Times columnist Paul Krugman) are quick to condemn perverse incentives in the private health system, while failing to mention similar (or worse) perverse incentives in government-run health systems.

Incentives matter.

May 082015
 

My latest Forbes column is now up: “Drug Company Amarin Stands Up For Free Speech Against FDA“.

Here is the opening:

Even as Americans heatedly argue the issue of free speech with respect to cartoon criticisms of Islam, the small drug company Amarin is striking a quieter blow for its free speech rights against the Food and Drug Adminstration (FDA).

The key issue is whether drug companies can tell doctors truthful information about their products that pertains to “off-label” uses (i.e., for applications not already explicitly approved by the FDA.)

Of course, drug companies should not be allowed to disseminate false or misleading information about their products.  That can and should be punished as fraud.

But both doctors and patients benefit when drug companies are allowed to publish truthful information.

Bonus infographic on the onerous FDA approval process!

 

 

My latest Forbes piece is now out: “Why You Should Record Your Doctor Visits“.

Here is the opening:

NBC’s Brian Williams has gone from being a respected news anchor to the butt of Internet jokes after he recanted a false story about being shot down in a helicopter over Iraq. As a result of the subsequent controversy, NBC has suspended Williams without pay for 6 months — essentially costing him $5 million.

But whether or not Williams’ story was an innocent “false memory” or a deliberate lie, it is the case that false or unreliable memories are a surprisingly common phenomenon. In a health care setting, patients’ false memories of medical conversations might cost them more than money — it might even endanger their lives. Hence, patients may wish to record their doctors’ visits to protect themselves…

During my research for this piece, I learned that “40-80% of medical information provided by healthcare practitioners is forgotten immediately” and “almost half of the information that is remembered is incorrect” (!)

Fortunately, modern technology now makes it easier for patients to record these important discussions with physicians, for instance with a smartphone.

For more information on the benefits of this practice, read the full text of “Why You Should Record Your Doctor Visits“.

 

 

My latest Forbes piece is now out, “Does Your Right To Life Include The Right To Die?

I discuss the revived debate over physician-assisted suicide, especially in the wake of Brittany Maynard’s decision to end her life following a diagnosis of terminal brain cancer. This issue is being debated in several state legislatures, including New Jersey and California, so we will be hearing much more about this in coming months.

I recognize that this is a controversial topic and that good physicians can disagree on this issue. Nonetheless, I believe this should be a legal option for patients, provided that there are appropriate safeguard to protect both the patient and the physician.

In my piece I cover three main subpoints:

1) Your life is your own.

2) The state has a legitimate (even vital) role to play in assisted suicide.

3) Physicians must not be required to participate

For more details, please read the full text of “Does Your Right To Life Include The Right To Die?

(Much of this material is drawn from the recent Philosophy In Action podcast by Diana and co-host Greg Perkins in their 1/18/2015 segment, “The Right To Die“.)

 

(Photo: Brittany Maynard by Allie Hoffman; Creative Commons Attribution – Share Alike)

 

My latest Forbes column was posted on 9/29/2014, “Who Decides What Medical Care You Receive At End of Life?

I discuss how some patients in the socialized medical systems of Canada and the UK have been put on DNR (“do not resuscitate”) status without their knowledge or consent and how that ties to the current debate over government-funded end-of-life counseling here in the US.

As I’ve said before: If you expect “somebody else” to pay for your health care, then “somebody else” will ultimately decide what care you may (or may not) receive.

I also discuss how free-market reforms for health insurance can allow patients to retain control over their end-of-life medical decision making and protect Americans from those gut-wrenching problems faced by patients in Canada and the UK.

And for some excellent practical advice on how patients can plan for such eventualities, check out this interview with Dr. William Dale by Diana.

 

 

 

My latest Forbes column is now up: “UK To Experiment on Cardiac Arrest Patients Without Their Consent“.

Here is the opening:

Soon, thousands of UK cardiac arrest patients may find themselves enrolled in a major medical experiment, without their consent. This may be legal. But is it ethical?

As described by the Telegraph:

“Paramedics will give patients whose heart has stopped a dummy drug as part of an ‘ethically questionable’ study into whether adrenalin works in resuscitation or not… Patients in cardiac arrest will receive either a shot of adrenalin, which is the current practice, or a salt water placebo but the patient, their relatives nor the paramedic administering it will know which. The trial is seen to be controversial because patients will not be able to consent to taking part and could receive a totally useless placebo injection…”

First, I want to emphasize that this is a legitimate scientific question. Adrenaline (also known as epinephrine) has been a standard part of the resuscitation protocol for sudden cardiac arrest, along with chest compressions and electrical shocks. (Think of paramedics shouting “clear” on television medical dramas.) But more recent evidence suggests that adrenaline might cause more harm than good in this situation, helping start the heart but possibly also causing some neurological damage. There is a valid and important scientific question. My concern is not over the science behind the experiment, but rather the ethics…

(For more details and discussion, read the full text of “UK To Experiment on Cardiac Arrest Patients Without Their Consent“.)

There are two parts of the study that disturb me the most: (1) The drug trial itself, and (2) the decision to not actively inform relatives that any patient who died had been an involuntary participant.  I cover both aspects in more detail in the piece.

Note: I’m not fully settled on what (if any) experimentation should be allowed on incapacitated patients in an emergency setting without informed consent.  But I do think this should be an issue of active discussion, especially for the people whose lives are on the line.

And for a discussion of prior US medical experiments that have been alleged to be unethical, non-consensual, or illegal, see this Wikipedia list.

 

 

Monica Hughes recently gave an excellent talk on, “The Transformation of American Healthcare: Lessons from the Veterans Administration and Existing FDA Standards of Care” to Liberty On The Rocks at Flatirons.

 

Her talk is now available on YouTube (3 parts).

Part 1

Part 2

Part 3

Disclaimer and synopsis:

DISCLAIMER: The speaker is not a medical doctor or health care practitioner. The ideas in this video are not intended as a substitute for the advice of a trained health professional. All matters regarding your health require medical supervision. Consult your physician and/or health care professional before adopting any nutritional, exercise, or medical protocol, as well as about any condition that may require diagnosis or medical attention. In addition, statements regarding certain products and services represent the views of the speaker alone and do not constitute a recommendation or endorsement or any product or service.

Synopsis: In January 2014, Robb was diagnosed with glioblastoma multiforme (GBM), one of the deadliest brain cancers in existence. Nicknamed “The Terminator” the median survival time is around 11 months. Robb had brain surgery on January 16, which was performed by a team of surgeons while Robb was awake. The surgery was a success.

Monica’s research into the post-surgery treatments that worked best for other survivors showed that they were not approved by the Food and Drug Administration, so they’d have to go to a cancer center that sprouted up in Tijuana, Mexico for treatment which included a 100 year-old immune system booster called Coley’s Vaccine.

Bio: Monica Hughes has bachelor’s, master’s, and PhD degrees in biology and has taught college biology since 2006. Previously, Monica served as a medical writer for National Jewish Health, a premier research hospital for respiratory and immune disorders, and is now a patient advocate specializing in literature research.

Robb LeChevalier has served in the Air Force and has a bachelor’s degree in electrical engineering. He designed his own home situated in the foothills outside of Denver, and currently develops high speed electronics for his own company, Astronix Research. He has been an Objectivist for 40 years.

More: Robb was given 2 months to live without surgery, a maximum of 6 months to live with surgery only, and an unspecified amount of time with additional therapy due to the unusually aggressive nature of his particular tumor. He and his wife Monica faced seemingly insurmountable hurdles by the Veterans Administration along the way, including timely care from the VA and a delay of emergency surgery that could have cost Robb his life had they not pushed for a special dispensation from a panel of VA doctors within the 48 hours leading up to his scheduled surgery. They are currently contesting 58 claims denials by the VA totaling nearly $250,000 in unpaid medical bills.

In the days following Robb’s surgery, they discovered that immunotherapy held the best chance of long-term and quality survival for this cancer. Historical 3 year survival with FDA-approved standard of care for GBM is around 7%. 3-5 year survival for some GBM patients in clinical trials using cancer vaccines is between 20%-50%, depending on the vaccine. Yet they discovered that due to FDA regulations, it is impossible to enter these clinical trials without first or concurrently undergoing FDA-approved standard of care, and that such care would greatly reduce his likelihood of responding to immunotherapy, if he was lucky enough to meet the criteria for the study and be placed in the treatment arm of such a trial.

Given these poor odds, Robb chose to forego all standard of care therapy after surgery, and opted for an immunotherapy protocol abroad that, according to current MRI results, has left him without evidence of disease. As of June 10, 2014, their new low deductible PPO health insurance policy, purchased on the Obamacare exchange, has not paid out a single penny of reimbursement for Robb’s cancer treatment.

(Note: I also discussed their case in my 5/28/2014 Forbes piece, “VA Denies Coverage For US Air Force Veteran With Malignant Brain Tumor“.)

Suffusion theme by Sayontan Sinha