Forbes published my latest OpEd, “Is Concierge Medicine The Correct Choice For You?”
I discuss the benefits of this practice model for both patients and doctors as well as dispelling some myths.
(Some of this material is drawn from my recent SnowCon 2013 talk, “Concierge Medicine: The Last Bastion of Health Care Freedom”).
Denver-area readers might also be interested in this related recent short piece in 5280 Magazine: “The Doctor Is (Always) In“.
On Sunday’s Philosophy in Action Radio, I’ll answer a question on antibiotic misuse — particularly “How would antibiotic misuse be handled in a free society?” By happenstance, some very alarming reports on drug-resistent tuberculosis have been emerging from South Africa. Here’s the opening of a US News article, Doctors Struggling to Fight ‘Totally Drug-Resistant’ Tuberculosis in South Africa:
In a patient’s fight against tuberculosis–the bacterial lung disease that kills more people annually than any infectious disease besides HIV– doctors have more than 10 drugs from which to choose. Most of those didn’t work for Uvistra Naidoo, a South African doctor who contracted the disease in his clinic. For those who contract the disease now, maybe none of them will.
A new paper published earlier this week in the Centers for Disease Control and Prevention’s Emerging Infectious Diseases journal warns that the first cases of “totally drug-resistant” tuberculosis have been found in South Africa and that the disease is “virtually untreatable.”
Like many bacterial diseases, tuberculosis has been evolving to fend off many effective antibiotics, making it more difficult to treat. But even treatable forms of the disease are particularly tricky to cure; drug sensitive strains must be treated with a six-month course of antibiotics. Tougher cases require long-term hospitalization and a regimen of harsh drugs that can last years.
Naidoo, then an avid runner, says he continued training for months with the disease, which affects more than 389,000 South Africans annually (about one fourth of Africa’s cases), according to the World Health Organization. It wasn’t until he went to visit his family in Durban (he had been working with TB patients in a pediatric clinic in Cape Town) that his family noticed he had lost more than 30 pounds.
“I had flu symptoms and chest pains, but I was still running so I didn’t think anything was wrong,” he says. But when he went in for an X-ray, doctors found that his entire right lung had filled with fluid. Within weeks, he was on his deathbed as his body wasn’t responding to the most commonly prescribed antibiotics.
“One night I nearly passed away–it didn’t look good,” he says.
His father, also a physician, suggested that he may have had an emerging MDR, or a multi drug-resistant strain of TB. The emergence of MDR and its even more dangerous cousin, XDR (extremely drug-resistant TB), have pushed tuberculosis cure rates in the country from a high of 73 percent in 2008 down to 53 percent in 2010.
Naidoo survived the night and doctors eventually found a treatment regimen that worked, but he was in and out of the hospital for three years, and the drugs’ side effects were almost unbearable, he says. He developed Stevens-Johnson Syndrome, a complication that causes layers of skin to separate from each other and can be deadly. He regularly bled from his eyes. He fell into a deep depression.
“The TB doesn’t feel like it’s killing you, but the drugs do. I am a doctor and was informed that the drugs you take make you feel worse,” he says. “My case was three years long. I don’t think the average patient has that kind of patience.”
The whole article is worth reading, so go check it out. I was particularly fascinated to hear about the New York hospital where 32 patients caught drug-resistent tuberculosis in the early 90s.
While drug resistance has certainly emerged for other infectious diseases, tuberculosis seems to be the canary in the coal mine, given that the treatment is long-lasting, expensive, and painful.
So what can and should be done about such drug resistance? Well, for that, you’ll have to listen to that episode!
This is super-dense inanity: Crazy Homeopathy Lady Charlene Werner Explains Physics:
My favorite bit is when she concludes from a whole slew of completely ridiculous pseudo-physics that disease is when we “transform our energy state into something different.” The bit about us hearing strings vibrate was pretty awesome too though.
As it happens, I answered a question on whether pharmacies should sell homeopathic “medicine” in the 5 June 2011 episode of Philosophy in Action Radio. If you missed that episode, you can listen to or download the audio podcast:
Since high school, I’ve suffered from periodic migraines. Mostly, they were manageable with pain medications, although quite unpleasant. However, I had certain periods in which they were so frequently and painful as to be debilitating. (In college, I had to drop two of my five classes one semester due to unbearable and frequent migraines.)
Happily, eating paleo largely eliminated my migraines. As a result, I could safely leave the house without my migraine medication for the first time in years. That was so liberating!
I still had migraines but only rarely — perhaps just one per month. I noticed that I was particularly prone to get them when pre-menstrual, but I couldn’t detect any pattern otherwise.
However, in the summer of 2011, I had two experiences that made me think that gluten might be the lingering culprit. While at the Ancestral Healthy Symposium, I ate some “brown eggs” made by my mother-in-law. They were made with regular soy sauce, which includes a tiny amount of wheat. Result? Days of migraines. Then, a month or two later, I ate some chicken wings at a restaurant that had been dusted in flour. Result? A sudden migraine in the middle of the night.
So I decided to experiment, to see if I could give myself a migraine by eating gluten even when I wasn’t already feeling prone to a migraine. So I bought a loaf of bread. (Yes, that seemed very strange to me!) I ate a one slice with butter for lunch.
The next day — just about 24 hours later — I had a migraine. Since that experiment, I’ve been super-strict about avoiding gluten. I don’t make assumptions about the menu when eating at a restaurant: I ask.
As a result, I’ve had just two migraines in the last six months — and one was due to something “gluten-free” not being really gluten-free. (Yup, I knew better.) Hence, when someone tells me that paleo is just pseudo-science or a fad… well, you can imagine my reaction.
I don’t think that gluten causes everyone’s migraines. But I think that people with migraines would be smart to try a gluten-free diet — or better yet, full-blown paleo. It might do a world of good!
In tonight’s Philosophy in Action Radio, I’ll interview University of Chicago geriatrician Dr. William Dale on end-of-life medical choices. One of the topics that we’ll discuss is how doctors talk to their patients about their options as they near the end of their lives — and how and why those doctors often fail to provide those patients with the full picture required to make decisions in accordance with their wishes.
That reminded me of an article titled “How Doctors Die” that I’d been meaning to read. I finally read it yesterday, and wow, it’s powerful and fascinating. It begins:
Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds-from 5 percent to 15 percent-albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.
It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.
Of course, doctors don’t want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They’ve talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen-that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with CPR (that’s what happens if CPR is done right).
Almost all medical professionals have seen what we call “futile care” being performed on people. That’s when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly, “Promise me if you find me like this that you’ll kill me.” They mean it. Some medical personnel wear medallions stamped “NO CODE” to tell physicians not to perform CPR on them. I have even seen it as a tattoo.
Now, go read the whole thing, then join us tonight for the live broadcast of my interview with Dr. Dale or listen to the podcast later.
Hospital Death in Ireland Renews Fight Over Abortion:
The woman, Savita Halappanavar, 31, a dentist who lived near Galway, was 17 weeks pregnant when she sought treatment at University Hospital Galway on Oct. 21, complaining of severe back pain.
Dr. Halappanavar was informed by senior hospital physicians that she was having a miscarriage and that her fetus had no chance of survival. However, despite repeated pleas for an abortion, she was told that it would be illegal while the fetus’s heart was still beating, her husband, Praveen Halappanavar, said.
It was not until Oct. 24 that the heartbeat ceased and the remains of the fetus were surgically removed. But Dr. Halappanavar contracted a bacterial blood disease, septicemia. She was admitted to intensive care but never recovered, dying on Oct. 28.
Mr. Halappanavar, in an interview with The Irish Times from his home in India, said his wife was told after one request, “This is a Catholic country.”
On Facebook, I’ve seen some advocates of abortion bans claim that her death cannot be definitively proved to have been caused by the failure of the doctors to abort her dying fetus. That’s true, but utterly beside the point.
Very little in medicine is cut and dried. The human body is immensely complex, and doctors mostly deal in probabilities, not certainties. That’s part of why it’s so important for each person — guided by the advice of her doctors — to make her own decisions about her medical care.
People differ in their values, and hence, in the risks they’re willing to accept or not. For a person to be free to live her own life requires that she be free to decide what risks to take with her own body and health — without interference from the government.
For the government to dictate or outlaw certain kinds of medical treatments means subjecting people to risks contrary to their own best judgment of their own interests. That’s a violation of their rights, plain and simple. That’s true for all medical care, including abortion.
That’s why laws banning abortion violate rights, even when they allow for exceptions to save the life of the mother. All pregnancy is risky: the maternal death rate in the United States is 16 out of 100,000. Many women are unwilling to undergo that risk, not to mention all the other complications and risks of pregnancy — and rightly so. Because the embryo/fetus is not a person with the right to life, a woman has the right to decide, based purely on her judgment of her own best interests, that she’s not willing to bear the risks of pregnancy, and hence, to terminate her pregnancy.
In contrast, under laws that permit abortion only to save the life of the mother, doctors would be constantly subject to second-guessing by police, prosecutors, and courts — and perhaps, subject to very serious criminal charges for murder or manslaughter. That’s why women die under abortion bans, regardless of provisions that permit doctors to act to save the the woman’s life. The doctor cannot afford to be blind to the risk to his own life and liberty of performing an abortion, even to save a woman’s life.
The advocates of abortion bans seek to evade the consequences of their own policies when confronted by these kinds of cases by claiming that the woman might have died anyway, even if she’d been able to terminate the pregnancy. That might be true, but that should have been her decision to make. Instead, she was preventing from acting based on her own best judgment in service of her life. That’s a major violation of her fundamental rights.
Ultimately, as Savita Halappanavar’s husband said, “It was all in their hands, and they just let her go. How can you let a young woman go to save a baby who will die anyway?”
I’ve said it before and I’ll say it again: opposition to abortion rights is not “pro-life.”
The 11/13/2012 Forbes has published my latest OpEd: “5 Ways To Protect Yourself Against Obamacare“.
I discuss 5 practical strategies ordinary Americans should consider now, even as the fight for health care freedom continues. They include:
1) Get a good primary care doctor, if you haven’t already done so.
2) Use a Health Savings Account (HSA).
3) Consider a concierge or “direct pay” physician.
4) Consider medical tourism, when appropriate.
5) Help your doctor work on your behalf.
For more details, see the full text of “5 Ways To Protect Yourself Against Obamacare“.
I’ve also discussed some of these ideas in my 7/25/2012 interview on Diana’s “Philosophy In Action” podcast, “Surviving Socialized Medicine“.
See also my article in the Summer 2010 issue of The Objective Standard, “How to Protect Yourself Against ObamaCare“. (Link goes to free preview, full text is subscriber gated).
Update #1: Dr. Richard Amerling of AAPS offers similar suggestions at: “Defensive Medicine: How To Survive ObamaCare“.
Update #2: Thanks, Instapundit, for the link!
[Crossposted from FIRM blog.]
Wow, thanks to the University of Maryland Medical Center:
The University of Maryland released details today on the recovery of Richard Lee Norris, the 37-year-old man who received the most extensive full face transplant completed to date seven months ago. Norris, of Hillsville, Virginia, was injured in a 1997 gun accident, losing much of his upper and lower jaws as well as his lips and nose. The transplant surgery, completed on March 20, 2012 at the University of Maryland Medical Center, included replacement of both jaws, teeth, tongue, and skin and underlying nerve and muscle tissue from scalp to neck.
“For the past 15 years I lived as a recluse hiding behind a surgical mask and doing most of my shopping at night when less people were around,” says Norris. “I can now go out and not get the stares and have to hear comments that people would make. People used to stare at me because of my disfigurement. Now they can stare at me in amazement and in the transformation I have taken. I am now able to walk past people and no one even gives me a second look. My friends have moved on with their lives, starting families and careers. I can now start working on the new life given back to me.” …
Norris continues to gain sensation in his face and is able to smile and show expression. His doctors say the motor function on the right side of his face is about 80 percent normal, and motor function on the left side is about 40 percent. He eats primarily by mouth and is able to smell and taste.
Norris’ historic 36-hour full face transplant was led by Eduardo D. Rodriguez, M.D., D.D.S., professor of surgery at the University of Maryland School of Medicine and chief of plastic, reconstructive and maxillofacial surgery at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center. Norris’ surgery marked the first time in the world that a face transplant was performed by a team of plastic and reconstructive surgeons with specialized training and expertise in craniofacial surgery and reconstructive microsurgery.
Richard Norris has regained his capacity to live a full life, thanks to an amazing team of doctors.
Here’s an interesting thought, from a post on Kevin MD on supposedly “greedy” doctors:
The extent to which the value of a service to an individual approaches infinity (such as a human life saved), is the extent to which a person expects it to be provided to them for free. Any charge for this infinitely valuable service will not be considered a very fortunate undercharge. Instead, the extent to which there is any charge at all for the infinitely valuable service, is the extent to which the receiver of the service will harbor undue resentment toward whomever profited any amount from providing it.
Undoubtedly, altruism begets such resentment. (Altruism is the view that each person’s highest moral duty is to serve others.) The altruist patient resents that the doctor “takes advantage” of him by saving his life, then requiring payment for services rendered. Given his great need, the doctor should have saved his life without demanding payment, according to the altruist patient. The doctor’s bill is, on this view, morally wrong.
In contrast, the rational egoist experiences gratitude in such circumstances. (Egoism holds that each person’s own life and happiness are his highest moral purpose.) He knows that the doctor saved his life — and payment is the least that he can offer in return. The egoist recognizes that the doctor is his own man, and that neither of them has a claim on the life or time of the other.
Which kind of person would you like to be?
P.S. Did you recognize our old friend the troll Johnny Blaze?
P.P.S. Paul has some comments on this article on We Stand FIRM.
Cathy Young has an article entitled Sound Judgment on the opposition to cochlear implants and other cures for deafness by advocates for deafness. As wonderful as deaf culture may be, surely being unable to hear and unwilling to learn to speak seriously limits a person’s opportunities. For parents to force such a life on their children is barbaric.
I wonder whether the refusal of such defect-fixing medical treatment (presuming affordability) constitutes a violation of a child’s rights at any point. If a fifteen year old wants the cochlear implants and a rich aunt is willing to pay for them, are the parents violating the child’s right by refusing? I’m inclined to grant children a fair amount of authority in their own medical decisions because such decisions may greatly impact the child later in life as an adult. (Yes, I know there is lots of complexity here that I am ignoring. Another time…)
