Later On

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Archive for the ‘Healthcare’ Category

Doctors don’t want to take jobs in antiabortion states

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Christopher Rowland has an interesting article in the Washington Post (gift link, no paywall). From the article:

. . . One large medical recruiting firm said it recently had 20 obstetrician-gynecologists turn down positions in red states because of abortion laws. The reluctance extends beyond those interested in providing abortion care, as laws meant to protect a fetus could open doctors up to new liabilities or limit their ability to practice. . .

One large health-care staffingfirm, AMN Healthcare, said clients in states with abortion bans are having greater trouble filling vacancies because some prospective OB/GYN candidates won’t even consider opportunities in states with new or pending abortion bans.

Tom Florence, president of Merritt Hawkins, an AMN Healthcare company, cited 20 instances since the Supreme Court ruling where prospects specifically refused to relocate to states where reproductive rights are being targeted by lawmakers.

“To talk to approximately 20 candidates that state they would decline to practice in those restrictive states, that is certainly a trend we are seeing,” Florence said. “It is certainly going to impact things moving forward.”

Three candidates turned down one of the firm’s recruiters, who was working to fill a single job in maternal fetal medicine in Texas, he said: “All three expressed fear they could be fined or lose their license for doing their jobs.”

In another example, a physician contacted by phone by an AMN Healthcare recruiter trying to fill a post in an antiabortion state “simply said, ‘Roe versus Wade,’ and hung up,” Florence said.

Florence said the shift has especially serious implications for small, rural hospitals, which can afford just a small number of maternal specialists or, in some cases, only one.

“They can deliver hundreds of babies each year and see several thousand patients,” he said. “The potential absence of one OB/GYN that might be in their community, if not for the Supreme Court decision, is highly significant. The burden will be borne by the patients.”

Tellingly, Florence added, none of the recruiters had encountered a single physician seeking to practice in a state because it had banned abortion.

There’s quite a bit more, so read the whole thing (gift link, no paywall).  Conservatives have sown the wind; now they reap the whirlwind.

Written by Leisureguy

6 August 2022 at 11:17 am

When the dog catches the car: Republicans successes bring backlash

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Heather Cox Richardson writes:

Today, voters in Kansas overwhelmingly rejected an amendment to their state constitution that would have stripped it of protections for abortion rights. With 86% of the vote in, 62% of voters supported abortion protections; 37% wanted them gone. That spread is astonishing. Kansas voters had backed Trump in 2020; Republicans had arranged for the referendum to fall on the day of a primary, which traditionally attracts higher percentages of hard-line Republicans; and they had written the question so that a “yes” vote would remove abortion protections and a “no” would leave them in place. Then, today, a political action committee sent out texts that lied about which vote was which.

Still, voters turned out to protect abortion rights in such unexpectedly high numbers it suggests a sea change.

It appears the dog has caught the car, as so many of us noted when the Supreme Court handed down the Dobbs v. Jackson Women’s Health decision on June 24. Since 1972, even before the 1973 Roe v. Wade decision, Republican politicians have attracted the votes of evangelicals and traditionalists who didn’t like the idea of women’s rights by promising to end abortion. But abortion rights have always had strong support. So politicians said they were “pro-life” without ever really intending to overturn Roe v. Wade. The Dobbs decision explicitly did just that and has opened the door to draconian laws that outlaw abortion with no exceptions, promptly showing us the horror of a pregnant 10-year-old and hospitals refusing abortion care during miscarriages. Today, in the privacy of the voting booth, voters did exactly as Republican politicians feared they would if Roe were overturned.

But this moment increasingly feels like it’s about more than abortion rights, crucial though they are. The loss of our constitutional rights at the hands of a radical extremist minority has pushed the majority to demonstrate that we care about the rights and freedoms that were articulated—however imperfectly they were carried out—in the Declaration of Independence.

We care about a lot of things that have been thin on the ground for a while.

We care about justice:

Today, the Senate passed the PACT Act in exactly the same form it had last week, when Republicans claimed they could no longer support the bill they had previously passed because Democrats had snuck a “slush fund” into a bill providing medical care for veterans exposed to burn pits in Iraq and Afghanistan. In fact, the bill was unchanged, and Republicans’ refusal to repass the bill from the House seemed an act of spite after Senator Joe Manchin (D-WV) and Senate majority leader Chuck Schumer (D-NY) announced an agreement on a bill to lower the cost of certain prescription drugs, invest in measures to combat climate change, raise taxes on corporations and the very wealthy, and reduce the deficit. Since their vote to kill the measure, the outcry around the country, led by veterans and veterans’ advocate Jon Stewart, has been extraordinary. The vote on the Promise to Address Comprehensive Toxics Act of 2022 tonight was 86 to 11 as Republicans scrambled to fix their mistake.

In an ongoing attempt to repair a past injustice, executive director of the Family Reunification Task Force Michelle Brané says it has reunified 400 children with their parents after their separation by the Trump administration at the southern border. Because the former administration did not keep records of the children or where they were sent, reunifying the families has been difficult, and as many as 1000 children out of the original 5000 who fell under this policy remain separated from their parents. [This is fucking shocking. – LG]

And we care about equality before the law:

Today, Katherine Faulders, John Santucci, and Alexander Mallin of ABC News reported that . . .

Continue reading.

Written by Leisureguy

3 August 2022 at 7:58 am

‘They’re Just Going to Let Me Die?’ One Woman’s Abortion Odyssey

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Men should not be passing laws on abortion. This long read from the NY Times (gift link, no paywall) tells a harrowing story:

CHATTANOOGA, Tenn. — Madison Underwood was lying on the ultrasound table, nearly 19 weeks pregnant, when the doctor came in to say her abortion had been canceled.

Nurses followed and started wiping away lukewarm sonogram gel from her exposed belly as the doctor leaned over her shoulder to speak to her fiancé, Adam Queen.

She recalled that she went quiet, her body went still. What did they mean, they couldn’t do the abortion? Just two weeks earlier, she and her fiance had learned her fetus had a condition that would not allow it to survive outside the womb. If she tried to carry to term, she could become critically ill, or even die, her doctor had said. Now, she was being told she couldn’t have an abortion she didn’t even want, but needed.

“They’re just going to let me die?” she remembers wondering.

In the blur around her, she heard the doctor and nurses talking about a clinic in Georgia that could do the procedure now that the legal risks of performing it in Tennessee were too high.

She heard her fiancé curse, and with frustration in his voice, tell the doctor this was stupid. She heard the doctor agree.

Just three days earlier, the U.S. Supreme Court had overturned the constitutional right to abortion. A Tennessee law passed in 2020 that banned abortions at around six weeks of pregnancy had been blocked by a court order but could go into effect.

Ms. Underwood never thought any of this would affect her. She was 22 and excited to start a family with Mr. Queen, who was 24.

She and Mr. Queen had gone back and forth for days before deciding to terminate the pregnancy. She was dreading the abortion. She had cried in the car pulling up to the clinic. She had heard about the Supreme Court undoing Roe v. Wade but thought that since she had scheduled her abortion before the decision, and before any state ban took effect, the procedure would be allowed.

Tennessee allows abortion if a woman’s life is in danger, but doctors feared making those decisions too soon and facing prosecution. Across the country, the legal landscape was shifting so quickly, some abortion clinics turned patients away before the laws officially took effect or while legal battles played out in state courts.

Century-old bans hanging around on the books were activated, but then just as quickly were under dispute. In states where abortion was still legal, wait times at clinics spiked as women from states with bans searched for alternatives.

It was into this chaos that Ms. Underwood was sent home, still pregnant, and reeling. What would happen now? The doctor said . . .

Continue reading. (gift link, no paywall)

Written by Leisureguy

1 August 2022 at 11:24 am

Pacemaker 6-week checkup

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I updated the pacemaker post with what the six-week check-up produced. You can read the full report in the section added to the end of the post at the link, but three things I thought important:

  1. Expected battery life is now 12 years. (At that point, a new pacemaker will replace the one I have now.)
  2. The Wife commented today that, since the pacemaker’s been installed, she’s noticed that I seem to have lost a dullness of edge that I had gradually developed. It’s as though the pacemaker’s operation has sharpened my cognitive processes, so that my responses are quicker and more on target. It took a while to notice the difference, but it’s definite.
  3. They gave me a remote monitor — a passive recipient of data from my pacemaker, which the monitor will ping each night then transmit the data to the pacemaker clinic for review. They’ll then let me know if I should ever need to come in for adjustments to the pacemaker programming. (The monitor only receives data from my pacemaker; it cannot transmit data to the pacemaker.)

I post this information about my pacemaker adventure for those who might be considering such a thing or know someone who’s been through it.

Of course, this visit and the monitor were free: I live in Canada, which like other advanced nations includes healthcare as a government service. Parking, however, was not free, so this visit (and bringing home the monitor) cost $3.50 in parking fees.

Written by Leisureguy

26 July 2022 at 2:41 pm

American gun violence has immense costs beyond the death toll, new studies find

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For decades Republican blocked any government-funded study of the social effects of firearms in the US, presumably because they strongly suspected what such studies would reveal and, in their typical bad-faith attitude, they were determined to prevent the public from knowing what was happening.[

The ukase against studies was recently lifted, and we are now getting an idea of the true toll exacted by widely available firearms. Eric Westervelt reports for NPR:

On one level, it’s almost impossible to put a dollar figure on lives shattered by gun violence or to try to measure the pain of having a loved one killed or seriously injured.

But researchers of two new studies using federal health care and hospital data underscore that the repercussions from firearm deaths and injuries are deeper, wider and far costlier than previously known.

In a new study published in the Annals of Internal Medicine, Dr. Zirui Song and colleagues found a four-fold increase in health care spending as a direct result of a non-fatal firearm injury.

Dr. Song, an Associate Professor of Health Care Policy and Medicine at Harvard Medical School, also charts a substantial increase in other health disorders that undermine a person’s health and well-being.

“In the first year after a non-fatal firearm injury, survivors experienced a 40% increase in physical pain or other forms of pain syndromes; a 50% increase in psychiatric disorders; and an 85% increase in substance use disorders,” Dr. Song says, while on break from his rounds at Massachusetts General Hospital, where he practices internal medicine. He adds more research is needed as to exactly why those addiction numbers and other disorders go up so dramatically.

“These results are disturbing and we, as a research team, found them quite striking, as well,” he says. “The ripple effects are quite profound and meaningful for both survivors and family members and, I would argue, clinically and economically substantial.”

And those effects aren’t just on those injured by bullets. The study shows family members of survivors, too, can carry massive physical and mental burdens.

“Family members on average, including parents, siblings and children, experienced a 12% increase in psychiatric disorders,” he says.

The study is based largely on healthcare claims data, not hospital survey or discharge data. Dr. Song says that allows for a more detailed look at spending than previous studies based on other types of data.

“There is really an undercurrent of forgotten survivors whose own health and economic conditions are affected quite profoundly, even though they were lucky enough to survive,” he tells NPR.

And the financial burden for this fallout is mostly landing on the shoulders of taxpayers and employees: Dr. Song’s study shows 96% of the increase in health care spending on firearm injuries is shouldered by Medicare and U.S. employers.

“In direct costs alone, it’s $2.5 billion in healthcare spending in the first year after non-fatal firearm injuries,” he says. “This number is much larger if you include indirect costs of lost wages or productivity.”

A study out this week by Everytown for Gun Safety delves into that larger picture and looks at a wide range of direct and indirect costs from all gun violence in America, fatal as well as gun injuries.

“This epidemic is costing our nation $557 billion annually,” says Sarah Burd-Sharps, research director at the gun control advocacy group. “Looking at . . .

Continue reading.

Written by Leisureguy

21 July 2022 at 10:59 am

“My Abortion Journey: Becoming a Pro-Choice Christian”

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Nick Coccoma has a thoughtful and interesting post at The Similitude. It begins:

As a Christian who cherishes human life, I understand those who think abolishing legal abortion is good. I’m a former Catholic who thought seriously about becoming a priest. I hold a Master of Divinity degree from a Catholic institution, where I studied moral theology. I know the mindset of its milieu from the inside. Many anti-abortion activists have convinced themselves they are saving lives. And who doesn’t want to do that? If you think you could be on the side of good—and God—by saving lives, who wouldn’t feel attracted (or pressured) to embrace that cause?

Those who want legal abortion access also think we’re saving peoples lives. But our side, I’m afraid, has done a poor job of marketing by framing abortion as about choice. While correct on principle, “choice” is a word associated in daily life with consumer habits and careless, half-baked, impulsive acts. Coke or Pepsi for lunch? Hmm, Coke! Have a baby or abort? Hmm, abort!

This is the troubling image conjured by the word “choice” in the minds of anti-abortion people. It sounds like you’re degrading human life into a commodity. It raises fears of a slippery slope to eugenics, a throwaway culture where the elderly, people with mental disabilities, and other vulnerable members are stripped of their dignity. Some, if not many, anti-abortion activists want to protect those people, made in the divine image.

But so do people who favor legal abortion access—perhaps more, actually, than many anti-abortion advocates, especially evangelicals. The states that allow legal abortion have the broadest social supports for the poor in the nation—those now banning it, the weakest. Most states outlawing abortion also execute prisoners with ruthless abandon. Those with abortion do not. Where is the epicenter of the new abortion regime? The Deep South—the historic site of slavery, Jim Crow, and sodomy laws. This belies the truth of their actions: that it’s about power, punishment, and control—not life.

“Choice” also paints women as careless and indifferent to the moral stakes of sexual intimacy, pregnancy, and termination. But that is untrue. Women do not approach abortion like a consumer choice at all. For them, it is a fraught, profound decision. It is about care for their bodies and their lives. It is not a thoughtless disposal of human beings.

The anti-abortion movement has been very psychologically powerful in this regard. I myself wrestled over abortion for years. Like many Catholics, I grew up in an ecclesial culture steeped in traditionalism. In this nostalgic vision, abortions never used to happen. Women led wholesome lives in idyllic families, raising children and mothering them with affection while husbands labored at the office. This fantasy was, of course, totally at odds with my home. My parents led modern lives, a marriage of equals with both spouses working.

But in the imagination of the Catholic hierarchy, abortion—like feminism itself—is a dangerous invention of modernity, akin to pollution. This road to perdition burst on the scene—along with contraception, gays, and sex itself—in the 1960s, that era of decadence. Philip Larkin parodies this mental construct in his poem “Annus Mirabilis”:

Sexual intercourse began
In nineteen sixty-three
(Which was rather late for me) – 
Between the end of the “Chatterley” ban
And the Beatles’ first LP.

It’s all a myth. Women have sought to terminate pregnancies since the dawn of time. And when it comes to “tradition,” human beings lived for hundreds of thousands of years in hunter-gatherer bands, egalitarian societies without fixed gender roles. Women harvested food and men hunted, but all were involved in providing for the community’s sustenance. Childrearing was done communally, allowing kids to play freely and benefit from alloparenting.” The idea that it was solely women’s work was absurd. In indigenous American cultures, like the Iroquois, women held political power—the men could initiate war only at their behest. What’s more traditional? Their way of life? Or 1950s suburbia? Measured against the long arc of human history, the nuclear family, with a sole male breadwinner, is the novelty—not the norm.

Even in the Anglo-American world, pregnancy termination before “quickening” (the time when the mother felt the fetus moving in the womb) was legal under common law from 1607 until 1828. According to the American Historical Association, abortion laws emerged slowly starting in the early 1830s, mostly to protect women from dangerous procedures—not the fetus. In the 1850s, a mysogynistic physician named Horatio Storer spearheaded a campaign to ban abortion as a means to put women back in the home.

This was a response to . . .

Continue reading.

Written by Leisureguy

17 July 2022 at 9:18 am

Strength in numbers: Group therapy can quell phobias in one day

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It’s been known for decades how to cure phobias (though, oddly, many with phobias do not seek treatment or seem to want them cured, possibly because they view their phobias as part of their identity: “I’m a person who fears flying,” for example). 

Advances in treatment of phobias continue, and André Wannemüller, a licensed psychotherapist and postdoctoral research fellow at the Mental Health Treatment and Research Centre at Ruhr-University Bochum in Germany, writes in Psyche of a one-day treatment:

The treatment was supposed to start at 8am, but many of the participants arrived at the airport much earlier. They didn’t want to miss anything, and some say they were too excited to sleep in anyway. After hearing of the programme through local media reports, they are the first 138 people of more than 700 who have signed up for a one-session, group treatment programme to combat their flying phobia. Because of their fear, most of them have not flown for years; some have avoided air travel all their lives.

Now they are gathered here in a congress hall at the airport where I provide them with information about the meaning of anxiety and fear, as well as the typical cognitive and bodily symptoms associated with a fear of flying. I also talk about fear-maintaining processes and dysfunctional ‘safety behaviours’ (strategies that might bring relief in the short term, but ultimately prolong the problem), such as taking tranquillisers or drinking alcohol.

Then the flight captain and crew enter the scene, ready to respond to participants’ questions: What actually happens in the event of a medical emergency on board, or if an engine fails? Can an aircraft be struck by lightning? Is that dangerous? What happens in a severe storm?

People have a lot of questions and, for most of them, the staff can give the ‘all-clear’: flying is extremely safe (measured per billion passenger kilometres), and the aircraft and crew are well prepared for virtually any eventuality. After that, it gets serious.

Now, I say, it’s time to board the ‘exposure’ flight, to gain a new and anxiety-relieving experience in dealing with your fear of flying. A specially chartered plane and a team of 20 therapists are already waiting at the gate. The vast majority of this first batch of participants, more than 120 in all, dared to take part. Security check, boarding – everything is as it would be on a normal flight. When the doors of the plane are closed, however, tension is palpable. Some stare ahead, some cry, and others concentrate on the talks offered by me and the other psychotherapists.

As the plane accelerates for take-off, it suddenly . . .

Continue reading. There’s quite a bit more.

Later in the article:

Since then, the positive effects of one-session treatments have been demonstrated not only for phobias, but also for other forms of excessive anxiety, for example panic attacks resulting from traumatic experiences.

Written by Leisureguy

13 July 2022 at 11:03 am

The New Gun Reform Law Is the Biggest Expansion of Medicaid Since Obamacare

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Abdul El-Sayed reports in The New Republic:

. . .  Though the new law has been touted as the most expansive gun law passed in 30 years, the bar for gun reform is admittedly low. And while any progress on gun reform is laudable—and the law is likely to have some impact on gun access—the most important effects of the law will be felt elsewhere.

The Bipartisan Safer Communities Act has been framed as a gun reform, but perhaps a more fitting frame for the law is as the biggest single expansion of mental health care in American history—and the biggest expansion of Medicaid—with a few gun provisions.

To be sure, packaging the two together makes both gun reform and mental health advocates uncomfortable. The overwhelming majority of people with mental illness will never commit a violent act, though statistics show that they’re more likely to be victims. Tying mental illness with gun violence only stigmatizes it, reducing the likelihood that people who need care will get it. But gun rights activists see mental illness as a convenient distraction from the fundamental issue driving gun violence—the guns themselves.

Getting Republican participation on any gun reform, though, required that the two be linked. And any investment in our anemic mental health care system—whatever the pretext—should be welcomed. So the new law leverages Medicaid to vastly expand America’s mental health infrastructure through a system of Certified Community Behavioral Health Clinics, or CCBHCs, and school mental health investments.

I spoke with Michigan Democratic Senator Debbie Stabenow, the program’s architect, about how it happened. “The Republicans wanted to do something big on mental health. At the beginning, they wanted to do it at the exclusion of gun safety. We all said no. I mean, this is the issue of guns. But yes, of course, if you want to do something along with it on mental health,” Stabenow told me.

The law’s massive investment in mental health care didn’t just happen over the course of a few weeks. It was the product of nearly a decade of slow, methodical planning. Stabenow and GOP Missouri Senator Roy Blunt had been co-sponsors of the bill reauthorizing community health center funding—consistent federal dollars to support community clinics—when Stabenow proposed a similar approach to funding mental health care. Until that point, mental health clinics were forced to operate on grants that they simply couldn’t rely on. “On the behavioral health side of things, it [was] all stop and start. It [was] all grants that go away,” Stabenow told me.

She approached the Substance Abuse and Mental Health Services Administration, or SAMHSA, to design quality standards for the proposed mental health centers that would eventually become CCBHCs. These included 24-hour psychiatric crisis services and integration with physical health services. Stabenow and Blunt eventually co-sponsored a 2013 bill that was signed into law the next year by President Obama. The Excellence in Mental Health and Addiction Treatment Act initially allocated $1 billion to fund a demonstration project across 10 states. The program offers enhanced Medicaid reimbursements to cover 80 to 90 percent of the start-up and operating costs for CCBHCs meeting SAMHSA standards.

The results were impressive. According to Stabenow, there was a 60 percent reduction in jail bookings stemming from mental health crises, a 63 percent reduction in mental health emergency room visits, and a 41 percent decline in homelessness.

The act was reauthorized in 2021 as the need for community mental health service boomed with the Covid-19 pandemic. The program grew to have a footprint across 41 states with additional support in each of the Covid funding packages. And that was when the shootings in Uvalde, Texas, and Buffalo, New York, created the space for a full national expansion through the Bipartisan Safer Communities Act.

When I asked Stabenow if this was the biggest expansion of Medicaid since the Affordable Care Act, she said, “Yes, no question, and … it’s the biggest investment in mental health and addiction services ever.”

The irony of this moment is that Republicans have been working at the state and federal levels to restrict Medicaid, if not gut it entirely, since it was created as part of President Lyndon B. Johnson’s Great Society. And yet mental illness and substance use have devastated low-income white communities, Republican strongholds, over the past several decades. The need to actually invest in solutions in these communities coupled with the need to be seen to be responding to America’s growing gun violence epidemic is what ultimately spurred Republicans to invest in and expand a program they claim to hate.

But it’s also the fact that Democrats like Stabenow made it easier. “I didn’t lean in the beginning on emphasizing Medicaid,” she said. “I know it’s Medicaid. He knew it was Medicaid. But we just talked about what should be funding this.… I was trying to get them to see, look, we have this system that works, and everybody loves community health centers.”

The victory for mental health care, on its own, is . . .

Continue reading.

Written by Leisureguy

7 July 2022 at 11:14 am

What abortions bans do — and what the US will now start to see

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Two reports about the sort of things that happen when abortions are banned. One is from Ireland, the other from Malta.

Ireland

Gretchen E. Ely, Professor of Social Work and Ph.D. Program Director, University of Tennessee, wrote in The Conversation:

Now that the U.S. Supreme Court has overturned Roe v. Wade, the 1973 decision that legalized abortion in the U.S., the nation may find itself on a path similar to that trodden by the Irish people from 1983 to 2018.

Abortion was first prohibited in Ireland through what was called the Offenses Against the Person Act of 1861. That law became part of Irish law when Ireland gained independence from the U.K. in 1922. In the early 1980s, some anti-abortion Catholic activists noticed the liberalization of abortion laws in other Western democracies and worried the same might happen in Ireland.

Various Catholic organizations, including the Irish Catholic Doctors’ Guild, St. Joseph’s Young Priests Society and the St. Thomas More Society, combined to form the Pro Life Amendment Campaign. They began promoting the idea of making Ireland a model anti-abortion nation by enshrining an abortion ban not only in law but in the nation’s constitution.

As a result of that effort, a constitutional referendum passed in 1983, ending a bitter campaign where only 54% of eligible voters cast a ballot. Ireland’s eighth constitutional amendment “acknowledges the right to life of the unborn and [gave] due regard to the equal right to life of the mother.”

This religiously motivated anti-abortion measure is similar to religiously oriented anti-abortion laws already on the books in some U.S. states, including Texas, which has a ban after six weeks of pregnancy, and Kentucky, which limits private health insurance coverage of abortion.

What happened over the 35 years after the referendum passed in Ireland was a battle to legalize abortion. It included several court cases, proposed constitutional amendments and intense advocacy, ending in 2018 with another referendum, re-amending the Irish constitution to legalize abortion up to 12 weeks gestation.

Real-life consequences

Even before 1983, people who lived in Ireland who wanted a legal abortion were already traveling to England on what was known as the “abortion trail”, as abortion was also criminalized in Northern Ireland. In the wake of the Eighth Amendment, a 1986 Irish court ruling declared that even abortion counseling was prohibited.

A key test of the abortion law came in 1992. A 14-year-old rape victim, who became pregnant, told a court she was contemplating suicide because of being forced to carry her rapist’s baby. The judge ruled that the threat to her life was not so great as to justify granting permission for an abortion. That ruling barred her from leaving Ireland for nine months, effectively forcing her to carry the pregnancy to term.

On appeal, a higher court ruled that the young woman’s suicidal thoughts were in fact enough of a life threat to justify a legal termination. But before she could have an abortion, she miscarried.

The case prompted attempts to . . .

Continue reading. It’s grim.

Later in the article:

In 2012, Savita Halappanavar, age 31 and 17 weeks pregnant, went to a hospital in Galway, Ireland. Doctors there determined that she was having a miscarriage. However, because the fetus still had a detectable heartbeat, it was protected by the Eighth Amendment. Doctors could not intervene – in legal terms, ending its life – even to save the mother. So she was admitted to the hospital for pain management while awaiting the miscarriage to progress naturally.

Over the course of three days, as her pain increased and signs of infection grew, she and her husband pleaded with hospital officials to terminate the pregnancy because of the health risk. The request was denied because the fetus still had a heartbeat.

By the time the fetal heartbeat could no longer be detected, Halappanavar had developed a massive infection in her uterus, which spread to her blood. After suffering organ failure and four days in intensive care, she died.

This sort of thing will now be happening the US in those states that are banning abortion.

Malta

On June 22, 2022, Megan Clement and Weronika Strzyżyńska reported in the Guardian:

Doctors have denied an American woman on holiday in Malta a potentially life-saving abortion, despite saying her baby had a “zero chance” of survival after she was admitted to hospital with severe bleeding in her 16th week of pregnancy.

Despite an “extreme risk” of haemorrhage and infection, doctors at the Mater Dei hospital in Msida told Andrea Prudente that they would not perform a termination because of the country’s total ban on abortion.

Prudente and her husband are seeking a medical transfer from Malta to the UK, which the couple say is their only option due to the risk to her life. They claim medical staff were uncooperative in their attempts to leave and in sharing medical records with the couple’s insurance company.

“I just want to get out of here alive,” Prudente told the Guardian from her hospital room in Malta’s capital, Valletta. “I couldn’t in my wildest dreams have thought up a nightmare like this.”

Activists in Malta say . . .

Continue reading.

Written by Leisureguy

27 June 2022 at 2:44 pm

Doctors on TikTok: The Dark Side of Medical Influencers

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Miranda Schreiber writes in The Walrus:

FOR YEARS, Martin Jugenburg—a Toronto-based plastic and reconstructive surgeon who goes by Dr. 6ix on social media—shared dozens of before-and-after photos and videos on Instagram of the altered bodies that had passed through his hands. There were tummy tucks, Brazilian butt lifts, and breast augmentations, all of them sorted into a kind of virtual assembly line for his thousands of followers to see.

But many of the women he featured in his posts—sometimes depicted post-op and sedated, their genitals and breasts blurred out—hadn’t consented to having their images circulated, according to an ongoing class action lawsuit, and some were only alerted of their presence online due to an investigation by CBC journalists. Unbeknownst to his patients and followers, investigators later found that Jugenburg was using a covert network of cameras in his clinic to perform a rigorous feat of surveillance, documenting thousands surgical procedures. Women who realized he had posted images of them told investigators they felt violated; they were upset, embarrassed, and distressed.

Dr. 6ix’s loose approach to respecting patient privacy on social media is hardly unusual in the world of “med Twitter” and “MedTok,” or medical TikTok. On Twitter, orthopedic surgeons complain about chronic pain “crazies,” nurses mock women who choose to give birth without an epidural, and doctors complain about “liars,” “Googlers,” and patients with conditions they are struggling to diagnose. TikTok is worse. In a post by someone with the username Nurse Johnn, whose derogatory skits about dementia patients he claims are fiction, the nurse mockingly dances in blue-green scrubs on a hospital bed, imitating someone under his care. One nurse filmed themselves holding the hand of a patient they said was dying of COVID-19. There is a video of someone in what appears to be a psychiatric crisis and another of a patient having their toenails cut. A Miami-based doctor posted about how he “walks in the footsteps of giants” in reference to porn star Johnny Sins, who impersonates a doctor having sex with his patients.

To scroll through many medical social media accounts is to wade into a virtual subculture where patients have become fodder for derision, their privacy and dignity regularly violated. But since there isn’t really any oversight of this virtual world, patients must bear the repercussions. Medical professionals spilling these traumatic, “hilarious” stories about their patients can lead to people not going to the doctor, says Shayna Hermann, a graduate student at the University of North Texas who studies criminology. This means the underlying health issue can “get worse and worse,” she adds—often with dire consequences.

CONCEALING a patient’s medical information is an ancient custom, for such knowledge is a “holy secret,” according to the Hippocratic Oath. Medical students still refer to a doctrine of “doing no harm” that is based on the Hippocratic oath, and harm, to Hippocrates, included the dissemination of information shared between a patient and their doctor. Otherwise, trust in medicine could be undermined, disrupting treatment and diagnosis. Medicine is about acting but also about not acting.

The Enlightenment enshrined patient confidentiality as one of the . . .

Continue reading.

Written by Leisureguy

20 June 2022 at 5:20 pm

Sick and struggling to pay, 100 million people in the U.S. live with medical debt

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Two words: Indentured servitude.

Noam Levey reports at NPR on Morning Edition (and you can listen to the report at the link, though the article itself includes some useful and informative charts, such as this one:

Levey’s report begins:

Elizabeth Woodruff drained her retirement account and took on three jobs after she and her husband were sued for nearly $10,000 by the New York hospital where his infected leg was amputated.

Ariane Buck, a young father in Arizona who sells health insurance, couldn’t make an appointment with his doctor for a dangerous intestinal infection because the office said he had outstanding bills.

Allyson Ward and her husband loaded up credit cards, borrowed from relatives, and delayed repaying student loans after the premature birth of their twins left them with $80,000 in debt. Ward, a nurse practitioner, took on extra nursing shifts, working days and nights.

“I wanted to be a mom,” she said. “But we had to have the money.”

The three are among more than 100 million people in America ― including 41% of adults ― beset by a health care system that is systematically pushing patients into debt on a mass scale, an investigation by KHN and NPR shows.

The investigation reveals a problem that, despite new attention from the White House and Congress, is far more pervasive than previously reported. That is because much of the debt that patients accrue is hidden as credit card balances, loans from family, or payment plans to hospitals and other medical providers.

To calculate the true extent and burden of this debt, the KHN-NPR investigation draws on a nationwide poll conducted by KFF (Kaiser Family Foundation) for this project. The poll was designed to capture not just bills patients couldn’t afford, but other borrowing used to pay for health care as well. New analyses of credit bureau, hospital billing, and credit card data by the Urban Institute and other research partners also inform the project. And KHN and NPR reporters conducted hundreds of interviews with patients, physicians, health industry leaders, consumer advocates, and researchers.

The picture is bleak.

In the past five years, more than half of U.S. adults report they’ve gone into debt because of medical or dental bills, the KFF poll found.

A quarter of adults with health care debt owe more than $5,000. And about 1 in 5 with any amount of debt said they don’t expect to ever pay it off.

“Debt is no longer just a bug in our system. It is one of the main products,” said . . .

Continue reading.

I feel quite certain that my own pacemaker surgery last week would have put me among those in medical debt.

Written by Leisureguy

19 June 2022 at 12:45 pm

My big pacemaker adventure

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This post documents the lessons learned en route to getting a pacemaker, along with some lessons learned after the fact. – updated 7/26/2022 with section “6-Week Checkup”

I often use FutureMe.org to send myself an email at some future date — for example, to document some worries or concerns (so I can learn whether such worries or concerns are warranted), or to predict what will happen or how well I will do something (so I can compare my actual experience with what I expected without letting hindsight to adjust my memory of what I expected — the “Yes, I knew that would happen” response), and so on.

[I learned in a business context that it is a good idea when presenting findings — of costs, profit, overtime, late delivery, or whatever — to first have people write down what they expected the findings to be (and perhaps write on the board a few of those expectations) before I revealed the findings. If I failed to do that, I found that people would say “Yeah, we already knew that” even when (especially when?) they had no idea. — You could even take the average of the guesses. Often the average will be close to the actual finding, but if it isn’t, it might indicate a problem in information flow and availability within the organization, which might be worth checking out.]

This post is, in effect, a letter to PastMe — it’s represents an email I wish I could have received two years ago to tell PastMe all that I’ve recently learned. 

The beginnings

In July 2020 I began having brief episodes of blacking out. I found difficult to describe the sensation. I would lose consciousness of my surroundings and of myself, aware only that something was happening. My vision didn’t work (thus the “black out” part), and during the episode I felt I was just hanging on, trying to recall where I was and who I was and what was happening. I was aware of time passing, and of my effort to understand, but was aware of nothing else.

The best description I could offer that I was experiencing brief periods of intense wooziness. These episodes initially happened while I was sitting in my chair. A second or two before an episode I could tell from how I felt that an episode was about to occur, and —  after once spilling a bowl of salad I was holding —  I used that warning to set aside anything I was holding.

Once in the parking lot, as I was taking trash to the dumpster, I had an episode. When I got the warning sensation, I stopped and bent forward, and then fell a little onto my outstretched hands. No damage, and when I got up after I came out of it, I realized that when I got the warning sensation and I was standing, I should immediately sit or lie down (if a chair or bed was at hand) or crouch low to floor or ground so that any fall would be more like rolling onto my side. 

I decided to keep a record. Here are the beginning entries I made:

7/10/2020 10:05 am Brief, before breakfast, in my chair

7/21/2020  3:00 pm  Again brief, mid-afternoon, in my chair

7/26/2020 4:16pm After one drink and some cold-smoked fish. This was fairly extended. I felt confused.

Then I decided to use my pulse oximeter after an episode.

8/1/2020 7:40am Pulse 48 O2 96% Brief but focused. Couldn’t recall immediately what to do (i.e., record event, pulse, O2)

8/2/2020 6:08am Pulse 72, dropped right away to 58. O2 96%. Fairly intense: not knowing where I was or what was happening, just focused on internal sensations.

8/6/2020 6:32am Very brief. Pulse 54. After feeling a strong surge of emotion.

8/7/2020 6:29am 96% oxygen, pulse 60. Started shallow but deepened. duration probably around 1 minute. Not unpleasant. I felt like I was exploring it — it had a dreamlike quality.

8/9/2020 6:06am Pulse 60 O2 95% A fairly lengthy episode, and not unpleasant but still. “Fairly lengthy” means about 45 seconds to a minute, I would guess. — 7:23 Another one, more intense. They seem to be happening more often. I don’t quite pass out but I am pulled inside and not really aware of the external world.

8/11/2020 – I seem to be able to forestall episodes. I can feel one starting to form and somehow I can redirect my attention so that it does not happen. Need to confirm by letting it happen

8/14/2020 10:18am – brief but intense. Quick onset, quick ebb.

8/15/2020 5:55pm – another brief and intense: quick onset, quick ebb.

8/15/2020: 10:20pm – intense and fairly lengthy

8/17/2020 7:15 sam – fairly long and intense and I kept trying to figure out how to characterize it.

9/6/2020 None since the one above, though a few times I felt close, but no actual episode — just a precursor.

9/7/2020 10:04am Just had another, fairly lengthy — about 30-45 seconds. Fairly intense.

The duration estimates are just guesses, and for the longer durations, inaccurate guesses, I think. I was aware of time passing, but not how much. Recovery was very quick once an episode ended. There would be an instant of confusion, and then I was “back,” knowing where I was and what I was doing.

I naturally talked to my doctor, who said it sounded like a blood pressure problem. He ordered a 24-hour ambulatory blood pressure test, but that didn’t show anything. I would bring it up off and on, and a year later, I got a referral to a neurologist, who ordered an MRI — getting the test done took some months, in part because of the strains on the medical system. The neurologist later requested an EEG, but I never got that because the actual cause became clear. 

More recently in the record of episodes:

5/19/2022 3:55pm On walk. Enough warning to lean against a telephone pole, but then went completely unconscious and did not at first know where I was when I came out of it. Not sure of duration, but I think around 30-40 seconds. Passerby saw me fall and helped me up. It was toward the end of a 1.6 mile walk.

5/26/2022 Two intense seizures of some duration, both while sleeping. One at 6:45am and one at 7:45am. They were strong and confusing because they were mixed with dreams. I got up after the 7:45am episode, and then as I sat on the bed, I got a few waves — 3 or 4 — of “almost seizures”: the sensation that I was sliding into a seizure. I’m afraid to walk today. — And again 5/26: At 6:00pm I had a strong effort to have a seizure, then fought it off; then at 6:05pm I did have a seizure, brief but definite. And now it seems to be trying again a few minutes later. — 7:35pm:  yet another, very intense toward the end. Was Facetiming with J so she saw it. She said it was about 8-10 seconds. — 7:52pm A slight one, but a real one.

5/29/2022 6:45am — very brief one; 10:50am – another very brief one.

6/4/2022 3:30pm — half a seizure: it started (enough that I put down my glass of tea before it took hold) and then it stopped.

The episodes continued, and because of staff changes at my clinic, I saw a different doctor. My wife described to him the episode she saw during the Facetime call: My head slumped, my eyes rolled back, and I started breathing harshly. She said my name a few times and asked me what was happening, but I didn’t respond. Then after 8-10 seconds the episode ended, and I quickly (within a second or two) remembered where I was and what was happening and was back to normal. 

The doctor said it sounded like a seizure. I had already been referred to a neurologist, who ordered an MRI. This doctor ordered a CT scan. 

Because the episodes, though intense, were not painful and didn’t seem to do much harm, I was patient. I did have a couple when I was asleep in bed, and those were unpleasant because they were more confusing: I truly did not know what was happening. 

I had one while I was doing an exercise walk, and that made me wary of taking a walk.

Barking up the wrong tree

A fair amount of time was spent pursuing false leads. I mentioned the referral to a neurologist. Another false trail I returned to repeatedly was that the episodes were the result of something in my diet.

I had eliminated sodium from my diet (that is, I did not cook with salt or add salt to food, and of course did not eat highly processed foods, generally high in salt), and I wondered if I had too little sodium. So I began adding just a little as I cooked. 

I had seen on Cronometer that my potassium was low (and potatoes, an excellent source of potassium, impacted my blood glucose, so I did not eat them at all). I started taking a potassium supplement. I thought it was safe because I had read that the body can easily rid itself of excess potassium, but then I got worried and cut that out, and then also cut out the zinc supplements I had been taking(another mineral I thought I was low in) — and I learned that calcium supplements turn out to be a bad idea anyway. So I discontinued all those supplements, but no change in episodes.

Then I thought about hibiscus tea. I had started drinking it when I switched to a whole-food plant-based diet because in How Not to Die, Michael Greger MD had noted that it was beneficial for blood pressure. I drink a pitcher of hibiscus tea every afternoon and evening as iced tea. (That’s a little less than a quart: 30 oz instead of 32 oz (a quart).) Maybe that was it? It certainly didn’t seem to be helping blood pressure because for the past year or so my systolic pressure was running 135-139 — that’s high. I was worried enough about that to buy my own blood-pressure monitor. My morning blood pressure was even 140/90. So hibiscus tea was not working anyway, and maybe it was causing seizures? So I quit hibiscus — that was just a week ago. (The odd thing about the blood pressure was that three months after switching to my whole-food plant-based diet in May 2019 and discontinuing any added salt, my blood pressure was 120/71. But for the past year so, my blood  pressure has consistently been  high.)

Thursday, June 9

Late in the afternoon last Thursday, I noticed that my left leg, which had been going to sleep (because I prop it over my right leg to hold my computer in place), did not wake up after I walked around on it for a while, as it usually did.

I will also note that over the past couple of weeks, the momentary dizziness I felt on standing up from a sitting position seemed more intense and longer — I would have to stand still and wait until the dizziness and feeling light-headed passed. That would take 5-10 seconds. 

But the persistently numb leg was new, and of course I searched the internet and decided that if my leg were still numb/asleep the next morning, I would call my clinic for an appointment.

Friday, June 10

The numbness was still present in the morning, so I called my clinic, the James Bay Urgent and Primary Care Center. I got an appointment for 5:00pm Sunday, June 12.

Saturday, June 11

I decided that it had been too long since I walked, so I got my Nordic walking poles and set out. I had planned to walk several blocks — up to Menzies, over to Dallas, down to Boyd, and back home ​​— but I was barely able to walk ust around this block, and even then I could walk only slowly and twice had to stop along the way to rest. The chart for that walk is below on the right, and you can see the two rest periods.

I had experienced a blacking-out episode during my walk on May 19, and had done only one walk after that (on May 21). I was just fearful of blacking out again while walking. On that May 19 walk, I felt the episode warning signs, moved off the sidewalk, and grabbed onto a telephone pole in a grassy strip. The next thing I knew, I was prone on the grass and a guy was asking me whether I was okay. 

I said I was — as usual, when the episode was over, I quickly felt okay — and he helped me to my feet and I walked the short remaining distance home. I did only one walk after that, quitting because I feared a fall.

Below are some charts from the iPhone app for my Amazfit Band 5. On the left is the May 19 walk. You can see toward the end of the walk a period where my speed was 0mph. That was while I was lying on the ground. 

There are some other oddities in the May 19 walk. Look at the heart rate: irregular, but fairly flat (as a trend line) right until the end of the walk, even though for the first half of the walk I was walking at a fairly brisk pace uphill, as shown in the chart below.

Despite walking briskly uphill, then back downhill, my pulse really doesn’t change all that much until I blacked out at the very end, which made me think the Amazfit was getting poor readings. But maybe the readings were accurate — perhaps the problem was not with the exercise tracker but with my heart.

Below the altitude data at the right are cadence data. You can see where my blackout pretty much wrecked the cadence.

On the right above is my walk of June 11. I could manage only 2.3 mph, and even that required two stops to rest and breathe. I was feeling very feeble indeed, and I could not figure out why.

The heart rate chart for that walk (shown above) is also weird. My heart rate increases — sure, I’m exerting myself — but then for no real reason it drops off.

Sunday, June 12

I needed some things from the grocery store — fruit, mainly — so I got my little grocery cart (which I seldom use, but I felt weak) and walked there (about two blocks) and back. Again, it seemed to require a lot of effort; I simply had no energy..

At 3:05pm I was making a new batch of tempeh when I had an episode and blacked out in the kitchen. I had crouched quickly, and when I regained consciousness, I was sprawled on the floor with my legs a bit twisted.

I straightened myself out, scooted over to bed to get up; sat on the edge of bed, and blacked out again. When I came to, I moved to my chair to record the episodes and passed out again — this was at 3:18pm. Then, before I could get up from the chair, again at 3:29pm. The appointment at the clinic was at 5:00, and I asked my wife to take me. (The clinic is about 4 blocks from here, but I was just weak and worried about passing out.)

As she drove me there, I passed out in the car. As we talked to the doctor about my numb leg, I mentioned also my problem in passing out — something I had been to the clinic about before — and then I passed out sitting in front of him.

The doctor, who had asked quite a few questions about what had been going on, immediately had a nurse do an ECG. My pulse was 30 beats per minute. 

At this point, the doctor had a diagnosis. I had an atrioventricular block (AV block): the electrical signal traveling from my heart’s upper chambers to the lower chambers was impaired. Normally, the sinoatrial node (SA node) produces an electrical signal to control the heart rate. When there’s an AV block, the SA node’s signal is dropped.

The doctor told me to go immediately to the hospital ER, and he would phone them now to expect me. I needed a pacemaker and would almost certainly get one before I was sent home.

The Wife drove me to the hospital, and while she parked the car, I walked into the ER and signed in. I noticed a price list (see photo at left) posted for non-residents. The prices don’t apply to me, since I am a Permanent Resident, the Canadian equivalent of the US Green Card. But it was interesting to see an actual price list, given that hospitals in the US often refuse to reveal their prices.

Seeing the sign reminded me that I also didn’t have to worry about a common practice in the US where hospitals will staff ERs with out-of-network doctors so the hospital can charge (much) higher prices than the insurance company allows for in-network doctors. (See “Their Baby Died in the Hospital. They Had Good Healthcare Insurance. Then Came the $257,000 Bill.“, for example.) 

I feel sure that in the US my hospital stay would have been a noticeable financial hit even if I was insured, just from the usual co-pays, plus I would have the hassle of wrangling with the insurance company over pre-authorization and afterwards over what they would and would not cover. (See “She expected to pay $1,337 for surgery. She was billed $303,709” for a prime example.) And if I was not insured, I imagine it would be a financial disaster. (And, surprisingly, many in the US continue to say that the US has “the best healthcare system in the world.”) — Update: See also “Sick and struggling to pay, 100 million people in the U.S. live with medical debt.” Two words: indentured servitude. Update again: Two identical surgeries in the US, same insurance: one patient was billed $204, the other $4,057.

After signing in, I moved to the next desk to be admitted, and there was another, more detailed price list for non-residents (click to enlarge). Note that the units where I stayed would cost a non-resident CA$11,600 per day — 3 days bring that to CA$34,800 for my stay, and that’s just the room charge, never mind the fees for surgery, the pacemaker itself, the tests, and so on.

I was moved (via wheelchair) to a private room in the Cardiac ICU. I changed into a hospital gown, got into bed, and was immediately hooked up to an intravenous drip that delivered a medication that helped regulate heart rate — not be a long-term solution since the body adapts and the medication will stop working.

It was too late for the evening meal, and I was allowed only ice chips in case surgery would suddenly be required. (If the med didn’t work, there was a temporary surgery that could be done to keep me going until the pacemaker could be installed.)

Monday June 13

I got no food for breakfast because it was possible my surgery would happen that day. Instead, I breakfasted on ice chips. My fasting blood glucose was 8.3 mmol/L! (150 mg/dL!), the highest reading I’ve had. I imagine the high reading was due to stress and possibly something to do with my irregular circulation. 

My average for the previous 3 months (and previous 30 days and previous two weeks) was 6.2 mmol/L (112 mg/dL), and in fact the previous Thursday my fasting blood glucose had been 5.8 mmol/L (104 mg/dL). 

This morning (Thursday, June 16) my fasting blood glucose was 5.4 mmol/L (97 mg/dL), which in the “normal” range. I wonder whether my fasting blood glucose will now drop to normal levels. Time will tell. — 20 June 2022 Time is telling, and the answer is , “Yes, blood glucose levels will drop.” Last couple of days fasting blood glucose has been 5.7 mmol/L (103 mg/dL). Week’s average: 5.8 mmol/L (105 mg/dL).

When the surgeon stopped by to tell me what to expect, I asked whether a general anaesthetic would be used. No — pacemaker surgery is done under a local, and I would be (and was) conscious the entire time. That’s a good thing, I think. General anesthesia has risks, including cognitive impairment (brain fog).

The surgery took place from (roughly) 1:30pm – 2:30pm. One good thing about living in a city with a fairly large elderly demographic is that surgical teams and hospitals are well practiced in (among other things) installing pacemakers. The operation struck me as efficiently and effectively done, with everyone involved calm and practiced in what they did — very reassuring to a (conscious) patient.

Tuesday, June 14

After some sleep in the early part of the night, I woke up at 1:30am and remained wide awake and alert until 7:30am. I was thinking of recipes, of blogging, of what I had gone through, and — of course — of why I was so awake and alert for 6 hours in the middle of the night. One obvious reason was a recent change — namely, the pacemaker. I got thinking about what it does. Combining what I knew with what I had learned:

My heart’s right atrium takes in blood that has traversed my body and arrives exhausted and full of waste — lacking oxygen and burdened with CO2. The right atrium — thump! — sends that blood into the right ventricle, which then contracts — THUMP! — to push the blood to and through the lung’s capillaries. My diaphragm works steadily, day and night, moving up and down to pull air into my lungs and then pump it out. As blood moves through the lungs, it quickly ditches the CO2 it carries and grabs as much oxygen as it can before it flows out of the lungs on its way into the left atrium.

The left atrium contracts — thump —  sending blood it received from the lungs on into the left ventricle, which then contracts — THUMP! — and ejects the blood to surge out through the aorta and flow throughout the body, bringing oxygen to the cells and carrying out their trash (CO2).

Thus the heart rhythm: thump-THUMP!, thump-THUMP!, thump-THUMP!; and so on, slower or faster as needed.

When the atria contract, they send an electrical signal to a way-station, which then sends a signal to the ventricles that they should now contract. My way-station was defective: it sometimes did not send along that signal. If the ventricles don’t get the signal, they don’t know when to contract, but they have  a fail-safe fallback: if no signal shows up, the ventricles will eventually contract on their own, and that will get whatever blood they contain on its way. Their default pulse rate (in the absence of signals) is about 30 beats per minute. That is not enough for good circulation — thus the black-outs: insufficient oxygen to the brain.

The pacemaker takes over the role of the way station. A wire with a threaded tip is inserted at the appropriate point on the right atrium (RA in the photo of the pacemaker) to capture the signal. A second wire, also with a threaded tip, is inserted at the appropriate point in the right ventricle (RV in the photo of the pacemaker) to pass the signal along to tell the ventricles to contract.

The threads keep the wires from easily pulling out once the tissue has healed — that is, once scar tissue develops to securely grip the threads and keep the wires in place. (I noticed hospital staff preferred to talk to me about “healing” rather than “scarring,” but in this case the scar tissue is important.)

So after the surgery, I have to restrict the range of motion of my left arm — not raise it above my head or pull it back — and not lift anything heavier than 10 pounds with my left arm for a period of 6 weeks (for me, until July 25). For the next few weeks, my model is Spencer Tracy in Bad Day at Black Rock (excellent movie).

The pacemaker includes a computer, which is programmed to meet patient requirements. In addition, the pacemaker’s algorithms monitor signal frequency and timing and can correct for problems like atrial fibrillation and arrhythmia.

Before the pacemaker, the monitor in the ICU I was attached to showed that my heartbeat was highly variable, even with the intravenous medication. After the pacemaker was installed, my heart beat was totally regular but The Wife said that the pacemaker line on the display was active, jumping up and down as it swung into action or applied corrections — it was on the job.

Bottom line: my body was now getting the feast of oxygenated blood that it required and that had previously been in short supply. No wonder I felt so awake and alert. 

My pacemaker battery will (at the level I’m using it) last 11 years. If they have to ramp up the output to a higher level, the pacemaker will run out of energy a little sooner. (When I go to Pacemaker Clinic Services for my regular appointments, they will scan the pacemaker and get a full report and readout, including remaining battery life. (For details on my pacemakers capabilities and reports, see this PDF.)

When the pacemaker’s battery runs down, another surgery is used to replace the pacemaker altogether. (Pacemaker batteries, like batteries in, say, the Kindle, cannot be replaced, but in the case of the pacemaker, surgery would be required to replace batteries, so replacing the entire unit makes sense.)

Microwave ovens are no longer a problem for pacemakers (or so I’m told), due,, I imagine, to improvements in pacemakers and microwave ovens. However, I cannot carry my iPhone in my shirt pocket, right next to the pacemaker. And induction burners, with their strong magnetic fields, will confuse the pacemaker.

I use an induction burner for cooking, and I was concerned about the effects, so I called Boston Scientific and talked to a patient services tech about my particular model of Boston Scientific’s Accolade MRI EL DR Pacemaker (model L331). He told me that if my pacemaker gets within 12 inches of an induction burner in operation, it will pick up the magnetic field as a signal and (in effect) say, “Okay, I don’t have to send out pacing signals,” and so it will quiet down for my heart do its own pacing. As soon as the magnetic field is gone or distant, the pacemaker notices that the absence of signal, and it resumes its programmed operation. [Note that this comment concerns the particular make and model of pacemaker that I have. Pacemakers vary, so don’t assume that what’s true of the Boston Scientific L331 is true of another model.]

So, basically, no problem. I can just stand back a little with my right side toward the pan (and burner and its magnetic field) — and, luckily, I am right-handed — and cook, knowing that even if I move in close and my heart must resort to its own pacing for a few seconds, the pacemaker will resume operation as soon as burner is off or I move away. And I normally don’t stand all that close anyway, plus I can move my portable induction burner farther away, toward the back of my cooking space. That will easily take care of it with the only downside being that I’ll just have to reach a little farther.

Moreover, according to what I’ve read, the effect of the induction burner’s magnetic field is minimized if (a) a large pan is on the burner (sopping up the magnetic field), and (b) the pan is centered on the burner. An iron or carbon steel pan, or a magnetic stainless steel pan that works on an induction burner, captures and channels the energy of the induction burner’s magnetic field, using that energy to make eddy currents that heat the pan. As a result, the field beyond the pan is minimized and has little range.

So I moved my portable induction to the back of my cooking area and close to a wall on the right. The presence of the wall already moves my left side away from the burner (and, as noted above, I’m right-handed, so the location is not at all awkward). Putting the burner toward the back in itself increases the distance sufficiently. So far, there’s been no problem. When I use a small pan, I’ll just take care to stay distant. 

Around 2:00pm on Monday, shortly before the ward nurse came to dismiss us, I felt the effects of staying up most of the night and took a nap. The room was pretty bright, so I used the face mask the hospital provided (for when I was moved through the corridors) as an eye mask. It worked well, in fact.

Aftereffects 

  1. I felt some soreness after the operation, but nothing Tylenol could not banish. By today, the soreness has gone. Today I also removed the bandage and took a shower — a great pleasure. At the end of this post, below the fold, is a photo of the wound.
  2. My familial tremor, which had become much worse in the last few days before the operation, pretty much went away. I think again that having a better supply of oxygenated blood was the cause of the improvement.
  3. The numbness in my leg went away, presumably (once more) because of better circulation. Also, I can now stand without experiencing any dizziness or light-headedness — again, presumably because of better circulation.
  4. My systolic blood pressure increased to 136-139 over the past couple of years, even though it settled at around 120/72 shortly after I switched to my whole-food plant-based diet. (I also (a) cut out salt and (b) started drinking hibiscus tea afternoons, as iced tea). But when I got my blood pressure checked after the episodes became a regular occurrence, it was — to my mind — way too high. Immediately after the pacemaker was in and working, my blood pressure dropped back to normal: 116/70. (See Mayo Clinic’s chart of blood-pressure ranges.)
  5. My mind was racing from 1:30am to 7:30am and I believe it was again due to improved circulation: my brain (and muscles) were suddenly getting better delivery of oxygenated blood. Over the past couple of years, I had adapted to mediocre oxygen delivery, so I very much noticed the change when that improved. A contributing factor to my feeling of energy probably was a great sense of relief.
  6. (5 days later) My sleep — nighttime and just now a nap — is much deeper and more restful. I would bet defective blood circulation kept almost waking me or actually awaking me. This improvement in my sleep — more deep sleep, for example, and in blocks instead of scattered, fewer periods of wakefulness — shows up in the Amazfit Band 5 app on my iPhone. As with the Amazfit’s heart rate detection, I had assumed that the poor showings in the charts was due to the Amazfit not being very good, not to its detecting actual defects in me (heart rate, sleep pattern). I should have paid attention.
  7. Already noted is the change in my average fasting blood glucose. Prior to surgery, my average reading, both short- and long-term, was 6.2 mmol/L (112 mg/dL). After the surgery, a week’s average was 5.8 mmol/L (105 mg/dL). I’ll update this after I resume walking and also have a longer timeline to average.

I suspect the odd heart rate readings my Amazfit Band 5 detected were not (as I assumed) due to poor performance by the product but because it was reflecting defects in my heart rate.

The antibiotics I got (three doses during hospital stay: before, during, and after surgery) and the Tylenol I took doubtless decimated my gut microbiome, but I have a good supply of vegetables I’ve fermented. Eating that will help my gut microbiome recover — plus whole plant foods (such as fresh fruit) are probiotic in themselves (as well as prebiotic, dietary fiber being the foodstuff of the microbiome).

At the right is what the surgical site looked like after my morning shower. Before the shower, I removed the bandage that covered the wound. What are left are steri-strips that will fall off in a few days or can be removed in a week.

6-Week Checkup

This morning I had my six-week checkup. I told the tech who was looking over the pacemaker records (which he downloaded to a console via a wireless connection) that a few times I had felt that I was about to have a dizzy spell, but then did not. He asked for an example of when it had happened. “Yesterday,” I told him, “on my walk.”

“Around 8:00am?” he asked.

“Wow. Yes,” I said.

“8:12am, in fact.” He could read that from the record.

He worked away at the console for a while, and I asked whether he had an update on expected battery life. He did: 12 years, as of now.

He had question for his boss, who came and worked with him a while at the console, then asked whether I would like a remote monitor. That would sit beside my bed and every night ping the pacemaker to get most recent readings, which it would transfer to the hospital so they would be alerted to any anomalies. The monitor is a passive receiver: gets information from the pacemaker but doesn’t transfer anything to it — for example, no adjustments. For those, I would go to the pacemaker clinic at the hospital. But the monitor would let them know whether such adjustments are needed.

Pretty cool, and I have it now. It took a fair amount of time to get it initialized, because when you plug it in for the first time, it phones home and downloads and installs software updates. That took probably 10-15 minutes. It’s now all initialized and will be sitting beside my bed, quietly checking each night how the days has gone.

Cognitive effect

The Wife mentioned today that she only gradually because aware of it, but my cognitive reflexes are noticeably snappier after the pacemaker was installed: I pick up on things more quickly, respond better — much as I used to before the heart problem manifested. I thought that was interesting.

Written by Leisureguy

16 June 2022 at 10:26 pm

Unscheduled adventure: How I came to get and love my pacemaker.

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I will tell the full story over the next few posts aiming to end before I post my Thursday shave. Because of the recent surgery, no shower until Thursday morning, and I am looking forward to shaving off a four-day stubble (and have already decided on the razor I’ll use).

The story really begins two years ago, in July of 2020, but I think I’ll just cover the last four days: Friday, June 10, through today, June 14. I learned a lot, and want to share the experience and lessons learned.

But since I just got home, I think I’ll hold off and start the story tomorrow.

In the meantime, I wanted to let my readers know that all went well, a pacemaker is a wonderful device, and I will recover soon (but, for reasons I’ll explain, must be careful until July 25).

Great to be here again.

Written by Leisureguy

14 June 2022 at 3:04 pm

How can those who oppose abortion also oppose strict gun laws? Are they pro-life? or just pro-forced birth?

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In Caroline Kitchener’s Washington Post report on the fallout from the state’s abortion ban (gift link, no paywall), she writes about state Rep. Todd Russ (R), one of the leading antiabortion members in the legislature.

Russ and his colleagues will often say, “If this saves one life, why would you not do it?”

Unless Russ and his colleagues are hypocritical posturers, they will for the same reason strongly support the five gun laws that research has shown to be effective at saving multiple lives (emphasis added in this quotation):

five baseline policies that every state should have.

Those are basically the three that we’ve talked about: a permitting mechanism, universal background check, and a limit on the magazine capacity. Number four is a law that basically says that anyone who has committed a violent crime — we don’t care what level it is — cannot access a gun. Not just a felony crime, but also a misdemeanor crime because federal law already prohibits people who committed a felony from possessing a gun. The problem is that there are a lot of violent crimes that just don’t rise to the felony level. For example, a lot of domestic violence crimes are just prosecuted as misdemeanors. A lot of crimes — somebody threatened to kill someone, or cyber harassment or stalking — are misdemeanors.

Then the fifth law that every state should have is a red flag law, or an extreme risk protection order law. That is so important because in most mass shootings, there is some warning sign that the perpetrator has given. It’s almost always the case that there was some history of threatened violence or planned violence. The red flag law allows law enforcement to take action when there is credible evidence that somebody does pose risk, and that may or may not be taking their gun away, but at the very least there’s an investigation and a court hearing that bring this to the attention of the authority so that it doesn’t sneak under the radar.

Are politicians who oppose abortion actually pro-life? If so, they will support those 5 laws. But I think most of them are not so much “pro-life” as “pro-forced birth.”

Written by Leisureguy

5 June 2022 at 3:24 am

The Next Big Addiction Treatment

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Brendan Borrell has an interesting — and important — article (gift link, no paywall) in the NY Times, which includes an audio of the article. The article begins:

In recent years there has been a spate of research suggesting psychedelic drugs can help people manage mental health conditions like depression, anxiety, chronic pain or even eating disorders. But a growing body of data points to one as the leading contender to treat the intractable disease of substance abuse. Psilocybin, the active ingredient in psychedelic mushrooms, has shown promise in limited early studies, not only in alcohol and harder drugs, but also nicotine — all of which resist long term treatment.

“The old rule of thumb is that one-third of people get better, one-third stay the same, and one-third continue to get worse,” said Dr. Michael Bogenschutz, a psychiatrist at New York University’s Grossman School of Medicine studying psilocybin-assisted therapy as a treatment for alcohol abuse. “What’s fascinating to me about this whole process is how many different kinds of experiences people can have, which ultimately help them make these profound changes in their behavior.”

Take Aimée Jamison, who several years ago wanted to kick her cigarette habit before her 50th birthday. Statistically speaking, Ms. Jamison’s chance of success wasn’t great. According to the Centers for Disease Control and Prevention, 55 percent of adult smokers tried to quit in 2018, but only 8 percent were successful.

Ms. Jamison, an investor who lives part-time in Boston, had heard about psychedelic therapies, but the drug is largely illegal for personal use. So, in the fall of 2018, she flew to Baltimore to participate in a clinical trial at the Johns Hopkins Center for Psychedelic & Consciousness Research. When she had to abstain from nicotine for a day before a brain scan, she could barely sleep and called it “the most hellish 24 hours I’ve experienced.”

After three talk therapy sessions at the Hopkins clinic, she was given a single pill containing 30 milligrams of psilocybin, a relatively high dose. After swallowing the pill, she put on an eye-mask, lay on a couch and went on a psychedelic trip with two therapists nearby for the next five hours.

When her trip ended, she sat up and looked at the therapists. “Now, I understand why I smoked,” she said, “and I don’t need to do that anymore.”

Over the next couple months Ms. Jamison attended several more therapy sessions, but took no additional psilocybin. She hasn’t touched a cigarette in the years sinceAn early version of that study (in which participants had two or three psilocybin sessions)published in 2014, reported an 80 percent success rate in 15 smokers, compared with 35 percent typically observed in patients taking the leading conventional antismoking drug Chantix.

Buoyed by such positive outcomes, the Hopkins study has expanded to include more participants, and, last year, the team received a $4 million grant from the National Institutes of Health.

It’s still uncertain how effective using psilocybin to treat addiction is in the long-term and whether some individuals are more likely to benefit than others. Some study participants have had . . .

Continue reading. (gift link, no paywall)

Written by Leisureguy

1 June 2022 at 5:52 pm

A Balm for Psyches Scarred by War — Also good for those who were in a mass shooting?

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Rachel Nuwar’s article in the NY Times (gift link, no paywall) discusses MDMA-based therapy purely in the context of PTSD caused by experiences in battle, but the US has a rapidly increasing civilian population suffering from PTSD as an outcome of a mass shooting. For example, I think it’s obvious that many children and adults in Uvalde will experience PTSD. Texas ranks last in the US in mental-health services, so these people are not likely to receive treatment, but they should. (Texas Gov. Greg Abbot proclaimed the need for expanded mental health services (words) but in fact cut from the budge funds for such services (actions).)

Nuwar writes:

Nigel McCourry removed his shoes and settled back on the daybed in the office of Dr. Michael Mithoefer, a psychiatrist in Charleston, S.C.

“I hadn’t been really anxious about this at all, but I think this morning it started to make me a little bit anxious,” Mr. McCourry said as Annie Mithoefer, a registered nurse and Dr. Mithoefer’s colleague and spouse, wrapped a blood pressure cuff around his arm. “Just kind of wondering what I’m getting into.”

Mr. McCourry, a former U.S. Marine, had been crippled by post-traumatic stress disorder ever since returning from Iraq in 2004. He could not sleep, pushed away friends and family and developed a drinking problem. The numbness he felt was broken only by bouts of rage and paranoia. He was contemplating suicide when his sister heard about a novel clinical trial using the psychedelic drug MDMA, paired with therapy, to treat PTSD. Desperate, he enrolled in 2012. “I was willing to do anything,” he recalled recently.

PTSD is a major public health problem worldwide and is particularly associated with war. In the United States, an estimated 13 percent of combat veterans and up to 20 to 25 percent of those deployed to Iraq and Afghanistan are diagnosed with PTSD at some point in their lives, compared with seven percent of the general population.

Although PTSD became an official diagnosis in 1980, doctors still have not found a surefire cure. “Some treatments are not helpful to some veterans and soldiers at all,” said Dr. Stephen Xenakis, a psychiatrist and retired U.S. Army brigadier general. As many as half of veterans who seek help do not experience a meaningful decline in symptoms, and two-thirds retain their diagnosis after treatment.

But there is growing evidence that MDMA — the illegal drug known as Ecstasy or Molly — can significantly lessen or even eliminate symptoms of PTSD when the treatment is paired with talk therapy.

Last year, scientists reported in Nature Medicine the most encouraging results to date, from the first of two Phase 3 clinical trials. The 90 participants in the study had all suffered from severe PTSD for more than 14 years on average. Each received three therapy sessions with either MDMA or a placebo, spaced one month apart and overseen by a two-person therapist team. Two months after treatment, 67 percent of those who received MDMA no longer qualified for a PTSD diagnosis, compared with 32 percent who received the placebo. As in previous trials, MDMA caused no serious side effects.

Mr. McCourry was among the 107 participants in earlier, Phase 2 trials of MDMA-assisted therapy; these were conducted between 2004 and 2017 and sponsored by the Multidisciplinary Association for Psychedelic Studies, or MAPS, a research group that has led such studies in the United States and abroad. Fifty-six percent of Phase 2 participants no longer met the criteria for PTSD after undergoing several therapeutic sessions with MDMA. At least one year after participation, that figure increased to 67 percent.

A decade later, Mr. McCourry still counts himself among the successes. He had his first MDMA session in 2012 under the guidance of the Mithoefers, who have worked with MAPS to develop the treatment since 2000. He shared the video of that session with The New York Times. “I was suffering so badly and had so little hope, it was inconceivable to me that doing MDMA with therapists could actually turn all of this around,” he said.

The second Phase 3 trial should be completed by October; FDA approval could follow in the second half of 2023.

“We currently deal with PTSD as something that needs to be managed in an ongoing way, but this approach represents real hope for long-term healing,” said Rachel Yehuda, a professor of psychiatry and neuroscience at the Icahn School of Medicine at Mount Sinai in New York.

“What makes this moment different from 20 years ago is the widespread recognition that we should leave no stone unturned in identifying new treatments for PTSD,” said Dr. John Krystal, the chair of psychiatry at Yale School of Medicine, who was not involved in the research. Although data from the second Phase 3 trial are needed, he says, the results so far are “very encouraging.”

Mr. McCourry, 40, lives in Portland, Ore., and comes from a military family. He joined the Marines in 2003 because he wanted to make a positive difference, he said: “When I went over to Iraq, I felt like we were there because it was for the overall good.” . . .

Continue reading. (gift link, no paywall)

Written by Leisureguy

30 May 2022 at 12:01 pm

Abbott calls Texas school shooting a mental health issue but cut state spending for mental health

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 and 

Gov. Greg Abbott said Wednesday that the Uvalde school shooter had a “mental health challenge” and the state needed to “do a better job with mental health” — yet in April he slashed $211 million from the department that oversees mental health programs.

In addition, Texas ranked last out of all 50 states and the District of Columbia for overall access to mental health care, according to the 2021 State of Mental Health in America report.

“We as a state, we as a society, need to do a better job with mental health,” Abbott said during a news conference at Robb Elementary School, where a gunman shot and killed 19 children and two teachers on Tuesday.

His remarks came just a day after an outraged Connecticut senator called out lawmakers opposed to gun control who seek to blame mental illness for the most recent school shooting and others before it.

In rejecting suggestions that stronger gun control laws could have prevented the tragedy, Abbott conceded the slain 18-year-old suspect had no known mental health issues or criminal history but said, “Anybody who shoots somebody else has a mental health challenge.”

His assertions drew rebukes from public health experts and scholars who study mass murderers, as well as from his Democratic gubernatorial rival Beto O’Rourke, who was ejected from the news conference after storming the stage and accusing the pro-gun Republican of “doing nothing” to stop gun violence.

“There is no evidence the shooter is mentally ill, just angry and hateful,” said Lori Post, director of the Buehler Center for Health Policy and Economics at the Northwestern University School of Medicine. “While it is understandable that most people cannot fathom slaughtering small children and want to attribute it to mental health, it is very rare for a mass shooter to have a diagnosed mental health condition.”

David Riedman, founder of the Center for Homeland Defense and Security’s K-12 School Shooting Database, said, “Overall, mass shooters are rational. They have a plan. It’s something that develops over months or years, and there’s a clear pathway to violence.”

The much bigger problem, they said, is Texas and many other states are awash in weapons.

“Texas has more guns per capita than any other state,” Post said. “After the tragic 2019 mass shooting in El Paso, the governor signed several bills to curb mass shootings; unfortunately, most of those bills involved arming the public to stop mass shooters.”

Post pointed out that police officers trained in active shootings were injured Tuesday. She and others said . . .

Continue reading. Video at the link.

Written by Leisureguy

26 May 2022 at 1:33 pm

The reinvention of a ‘real man’

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Cultural change comes slowly, one person at a time, each one a paradigm shift from one way of understanding how the world works (that is, understanding the interplay and intermeshing of individuals in their cultural matrix) to another way. Because people are to a large extent — in their outlook, their values, their behaviors — an assemblage of memes, patterns learned through imitation and taught the same way — changing a culture means changing those who live within it (and within whom the culture lives). This is slow work, particularly since many if not most will view such a change as a threat almost as real as death: if they become different as a person, the person they now are will no longer exist as a person, and that threat to identity is as frightening as a threat to life, for it is indeed the life of that identity that’s at stake.

Jose A. Del Real reports in the Washington Post about a public health worker who is trying to change the cultural view of manhood (gift link, no paywall).

— In BUFFALO, Wyoming

Bill Hawley believes too many men are unwilling or unable to talk about their feelings, and he approaches each day as an opportunity to show them how.

“There’s my smile,” he says to a leathered cowboy in the rural northeast Wyoming town where he lives.

“I could cry right now thinking about how beautiful your heart is,” he says to a middle-aged male friend at work.

“After our conversation last week, your words came back to me several times,” he tells an elderly military veteran in a camouflage vest. “Make of that what you will, but it meant something to me.”

On paper, Bill is the “prevention specialist” for the public health department in Johnson County, a plains-to-peaks frontier tract in Wyoming that is nearly the size of Connecticut but has a population of 8,600 residents. His official mandate is to connect people who struggle with alcohol and drug abuse, tobacco addiction, and suicidal impulses to the state’s limited social service programs. Part bureaucrat, part counselor, much of Bill’s life revolves around Zoom calls and subcommittees, government acronyms and grant applications.

But his mission extends beyond the drab county building on Klondike Drive where he works. One Wyoming man at a time, he hopes to till soil for a new kind of American masculinity.

His approach is at once radical and entirely routine.

It often begins with a simple question.

“How are you feeling?” Bill asks the man in camouflage, who lives in the Wyoming Veterans’ Home, which Bill visits several times a week. Bill recently convinced him to quit smoking cigarettes.

The man lumbers forward on a walker, oxygen tank attached.

“We can talk about triggers for a hot minute, or six, or 10,” Bill encourages him. “All those things are going to try to sneak up on you and trick you.”

“I’ve got a whole bunch of triggers,” the 72-year-old veteran responds, finally, between violent coughs. “Well they’re called triggers, but they never go away.”

Here in cowboy country, the backdrop and birthplace of countless American myths, Bill knows “real men” are meant to be stoic and tough. But in a time when there are so many competing visions of masculinity — across America and even across Wyoming — Bill is questioning what a real man is anyway.

Often, what he sees in American men is despair.

Across the United States, men accounted for 79 percent of suicide deaths in 2020, according to a Washington Post analysis of new data from the Centers for Disease Control and Prevention, which also shows Wyoming has the highest rate of suicide deaths per capita in the country. A majority of suicide deaths involve firearms, of which there are plenty in Wyoming, and alcohol or drugs are often a factor. Among sociologists, the Mountain West is nicknamed “The Suicide Belt.”

More and more, theories about the gender gap in suicides are focused on the potential pitfalls of masculinity itself.

The data also contains a sociological mystery even the experts are unsure how to explain fully: Of the 45,979 people who died by suicide in the United States in 2020, about 70 percent were White men, who are just 30 percent of the country’s overall population. That makes White men the highest-risk group for suicide in the country, especially in middle age, even as they are overrepresented in positions of power and stature in the United States. The rate that has steadily climbed over the past 20 years.

Some clinical researchers and suicidologists are now asking whether there is something particular about White American masculinity worth interrogating further. The implications are significant: On average, there are more than twice as many deaths by suicide than by homicide each year in the United States.

Bill, who is 59 years old and White, is working out his own theory. It has to do with the gap between . . .

Continue reading. (gift link, no paywall)

Written by Leisureguy

23 May 2022 at 11:03 am

She expected to pay $1,337 for surgery. She was billed $303,709.

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One thing I like about Canada is that healthcare costs are covered by taxes so no one faces the financial blows that the US healthcare system can deliver. (Another is that in Canada abortion is strictly a medical issue — the government does not involve itself in medical decisions made by women and their doctors.)

Timothy Bella has an interesting report (gift link, no paywall) in the Washington Post. It begins:

After Lisa French’s doctors warned that she could be paralyzed if she tripped or fell on her back, the hospital told the Colorado resident that she’d have to pay an estimated $1,337 out of pocket for two procedures. Money was tight, which is why French and her husband used all the money in their emergency fund — $1,000 — to help cover most of the cost expected after insurance for the back surgeries, according to her attorney.

So when she got the bill from St. Anthony North Health Campus in 2014, French thought it was a mistake: The hospital had billed her for $303,709 — and she owed more than $229,000 out of pocket. As part of the forms she filled out at the nonprofit hospital in Westminster, Colo., operated by Centura Health, French unknowingly had signed up to pay all charges related to the hospital’s then-secretive “chargemaster” price rates — a master list of prices that determined the sticker prices for everything the hospital did.

Years after French argued she was never informed of the chargemaster and engaged in a years-long legal battle with the hospital, the Colorado Supreme Court ruled . . .

Continue reading. (gift link, no paywall)

Written by Leisureguy

22 May 2022 at 8:16 am

The AMA’s Little-Known Committee that Sets Physician Service Prices

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An interesting article on a source of bias in the medical profession that undermines the supply of general practitioners. Merrill Goozner writes in the Washington Monthly:

The request seemed innocuous enough. Last week, I asked the American Medical Association if I could attend a meeting of the committee that largely determines the relative pay of various medical specialties.

The Relative Value Scale Update Committee (RUC) meets three times a year to consider changes and additions to the “relative value” of more than 10,000 billing codes in the Medicare physician fee schedule. Each year, in a textbook example of what economists call agency capture, the Centers for Medicare and Medicaid Services sets physician service prices based almost entirely on the RUC’s recommendations, which systematically overweight technical skills like surgery and underweight the cognitive skills used in primary care. The RUC’s 32-person roster includes one voting member for each of the 27 medical specialties recognized by the AMA.

The results are one of the primary roadblocks to achieving better health at lower costs from America’s wildly overpriced health care system – the dearth of primary care physicians. Orthopedic surgeons and invasive cardiologists wind up earning, on average, over $600,000 a year. In comparison, family physicians and pediatricians earn around $250,000, according to the latest Modern Healthcare survey of physician compensation consulting firms (subscription required). The spread between the highest and lowest paid doctors has gone up by nearly $75,000 over the past decade — despite the AMA’s insistence that it is taking steps to redress an imbalance that discourages more young doctors from entering primary care.

The AMA’s public relations official, someone I’ve known for a long time, said he’d check if I could attend. A few hours later, he informed me via email that registrations for the meeting had closed two weeks earlier, and I needed to apply for media credentials at least a month in advance. Moreover, I would have to sign a non-disclosure agreement to prevent me or any other reporter from writing about “proprietary information” discussed at the meeting.

Since votes placing values on individual services are based on detailed surveys conducted by the various medical specialty societies of their memberships, virtually everything discussed at the meetings is proprietary. It’s no wonder not a single reporter attended last week’s meeting, the first to discuss the 2024 physician fee schedule.

Well, what about the recommendations for the 2023 physician fee schedule, whose first draft will be issued by CMS this summer? Could I at least get access to the minutes of the January meeting when those recommendations were made?

No dice. The website RUC’s recommendations won’t be released until the proposed 2023 rule comes out this summer, the spokesperson said.

Books have been written about how the AMA’s RUC distorts the Medicare fee schedule, which serves as the baseline for physician payments made by commercial insurers and their insured patients. Those rates range from 10% to 230% higher than Medicare’s rates, according to a recent Urban Institute study, and reflect the rigged nature of the system. Commercial rates for cognitive specialties like family medicine and psychiatry are barely above the CMS-set rates. In contrast, high-priced specialties like radiology, neurosurgery, and anesthesiology can be more than three times as high.

High-priced specialties’ control over physician prices contributes to America having the highest prices for medical care in the world and undermines value-based care. “We should be concerned about  . . .

Continue reading.

Written by Leisureguy

11 May 2022 at 4:06 am

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