Radiation and Cell Phones

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Cell phone radiation is a problem, although there is disagreement about the level of radiation that should be considered unsafe.

Critics see the following issues with this radiation:

  • Low levels of this radiation can cause a breakdown in the shield between blood and brain, allowing pathogens to seep into the brain.
  • Common levels of this radiation are above the level required to kill neurons.
  • Animal studies have shown that heating of brain cells from cell phone radiation can cause behavioral changes (ADHD-type behavior).
  • FCC standards allow little margin for error, and are based on adults, not children.  There are no separate safety guidelines for children.

Researchers have in fact raised questions about a broad number of health issues associated with cell phone radiation.  However, there is no conclusive findings on any of these items to date.  The issues raised in addition to those listed above include reduced mental quickness and focus, sleep disturbance and low sperm count.

Current levels of radiation are considered safe under US guidelines.  However, UK, France, Russia and Zambia ban the use of cell phones by children.  Radiation regulations also exist in Poland, Slovenia, Sweden, The Netherlands, Lithuania, Italy, Belgium, Bulgaria and Denmark.  Australian guidelines include using cell phones only in areas of very good signal strength and reducing the length of calls.

Most of these countries also regulate exposure to high voltage overhead power lines.  There have been successful lawsuits in the US regarding these lines in the absence of regulation.

The International Agency for Research on Cancer, a program of the World Health Organization, has classified cell phones as “possibly carcinogenic to humans” based on current research (Category 2B).  The US National Cancer Institute finds the research results mixed and inconclusive.  There are further studies in programs.

Bluetooth and Google Glass devices emit this radiation.  Category 2 and 3 Bluetooth devices emit lower levels of radiation than cell phones, but even these levels may be dangerous.

The charts below are courtesy of the IEEE.  They show radiation penetration into the skull that results from holding a cell phone to your ear.

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What can you do?

Actions to reduce risk are simple and cheap, so there is no real excuse not to protect yourself.  Radiation dissipates with the square of distance between you and the phone, so keep it away from your skin.

(1)  Use the speaker function on your phone where practical.  Texting is good.

(2) Keep the phone on a belt clip, in a purse or in a briefcase rather than in a pocket or (worse yet) bra.  (Yes, I have seen people do this.)

(3)  Use a corded headset where practical.

Opinion:  There’s still a lot we need to learn about how major illnesses including cancer work.  As we learn, we will find we need to measure things that we are not considering now, and we will find relationships between products or drugs and illnesses that we aren’t even considering now.  We finally established the risk of cigarettes way too late for millions of users.  That may very well happen again with radiation.  When the cost of  being prudent is so low, why not?

Microcephaly and Politicians

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Zika has hit the US.  According to the CDC, there are now 279 pregnant women on US soil with Zika (3).  That number is likely to skyrocket this summer.  Mosquitoes will bite infected women and spread the disease to others.  Others will visit infected areas, especially with the Brazilzika2.png Olympics this summer, and return with the disease.  Sexual activity may spread the disease.  Zika may also be spread through sexual contact with an infected adult.  Since the adult version of the illness is quite mild, this is easy to miss.

Meanwhile, the Oklahoma legislature creates a bill that removes any discretion in bringing infected babies to term.

Regardless of the intent in becoming pregnant, no one intends to bring a baby to term who will live for only 4-5 years and cost a fortune in terms of heartache and cash.  That’s not why someone becomes pregnant.

Women understand this.  The Zika outbreak is increasing demand for abortions in the countries that have been affected seriously thus far. (6)

However, because there is no lethal risk to the mother, under the Oklahoma law, a woman has no choice in bringing the baby to term.  The state will incur a mountain of costs in caring for these children, as most families cannot bear the load.

Even the Pope has expressed openness to the use of artificial contraception to deal with Zika.  (2)

Arguably, having a functioning brain should be a requirement for public office.

American writers have been quick to criticize Brazilian politicians for a slow response to the Zika outbreak.  However, as with the Michigan water crisis, this is evidence that American politicians can be just as oblivious.  The US Congress has been no better than Brazil’s in taking preventive action. (1)  The US is quite unprepared for the expected medical costs Zika will create. (5)

What actions can you take?

(a)  Adjust vacation plans.  The mosquito that carries Zika is prevalent in the US south, especially in the Gulf Coast region.

(b) Wear mosquito repellent.

(c)  If you or someone about which you care is pregnant, make sure they have access to good prenatal care and use it.  This is not a surprise you want.

(d) More controversially, lobby your local government for mosquito control measures.  That can affect other wildlife, but that may be a necessary sacrifice until this is past.  Hopefully, Zika won’t become a permanent part of our ecosystem.


Sources:

(1) Branswell, Helen.  “Congress is blocking key efforts to fight Zika, top health officials say,”  STAT News, 10 March 2016.  https://www.statnews.com/2016/03/10/zika-emergency-funding-anxiety/

(2) Burke, Dan and Cohen, Elizabeth. “Pope suggests contraceptives could be used to slow spread of Zika,” CNN.com, 16 February 2016.  http://www.cnn.com/2016/02/18/health/zika-pope-francis-contraceptives/index.html

(3) Cohen, Elizabeth.  “Number of pregnant women with Zika virus in U.S. triples, CDC says.”  CNN.  10:21 AM ET, Fri May 20, 2016.  http://www.cnn.com/2016/05/20/health/zika-cdc-numbers/index.html

(4)  “Oklahoma lawmakers OK bill criminalizing performing abortion.”  Associated Press. 19 May 2016.  http://www.msn.com/en-us/news/us/oklahoma-lawmakers-ok-bill-criminalizing-performing-abortion/ar-BBtfoqO?ocid=ansmsnnews11

(5) “Public Health Experts Warn U.S. Unprepared for Zika Outbreak,”  Insurance Journal, 13 April 2016.  http://www.insurancejournal.com/news/national/2016/04/13/404972.htm

(6) Simmons, Ann.  “Zika fears increase demand for abortions in countries where it’s illegal to have one,”  Los Angeles Times,  9 March 2016.

Choosing Between Doctors

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This is an excellent article, which appeared in Medscape Week in Review on 24 May 2016.  It’s reprinted here in its entirety.  If even doctors are challenged in selecting a doc, how should the consumer feel?

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Choosing Between Two Doctors: One Physician’s Experience

Andrew N. Wilner, MD

|May 19, 2016

Introduction

Recently, a close family member—let’s call her “the patient” —needed a complex elective surgery. Her medical doctor gave us a few surgical referrals. We picked the one at the top of the list.

Luxury of Choice

The ability to choose one’s medical doctor is a luxury. Often, an accident or sudden severe symptom such as syncope or chest pain results in emergency transport to the nearest healthcare facility, where one is greeted by the duly assigned healthcare provider of the day. The relationship is forged on the basis of urgency and need, and both patient and doctor accommodate accordingly.

How to Choose?

But sometimes, one has the luxury of choice. Before entering into the sacrosanct patient-physician relationship, a patient can do due diligence regarding the physician’s training, experience, standing among his or her peers, as well as online reviews such as Yelp, where doctors are rated “like restaurants.” It’s not clear how useful all of this research is except to weed out the few bad apples who failed their boards and consistently receive one-star online reviews. But bad reviews tend to be based on long waiting times and snarky staff, not the doctor’s performance. A doctor’s competence, except in the most flagrant cases, is exceedingly hard to judge. Even a surgeon’s track record of successes and failures will be affected by the age, stage of illness, and comorbidities of the patients. A surgeon who only operates on “easy” cases might have a great track record. A more proficient surgeon who takes all comers would have a much worse record. Most doctors are capable, competent, responsible, and get the job done. But even capable, competent, and responsible doctors are not interchangeable.

Doctor #1

Our trusted doctor’s referral was sufficient endorsement, but I still did a background check that revealed an impressive website that included education materials, a patient portal, patient approbations, and boasted an affiliation with a nationally respected medical center. We made an appointment.

It was all uphill from there.

A few days later, the doctor’s office called requesting that we change the appointment. The secretary explained that she was using new scheduling software and had made a mistake. Could we come the following day instead? We were able to change our busy schedules to accommodate. No harm, no foul.

We were told to register ahead of time on the patient portal. We tried, but the passwords didn’t work. This was frustrating and took days to fix.

The Visit

We faxed records several days ahead of time and even brought hard copies with us. I had already made several calls to the doctor’s office to ensure that we were “in network.” We arrived early, as instructed, completed registration paperwork, consents, record releases, and more, then handed the records to the secretary. The doctor saw us on time, listened intently, and suggested further testing. These results would guide his final decision regarding which procedure to do. Upon review, his recommendations included many of the blood tests we already had. When I pointed this out, he seemed irritated and said that he didn’t have access to these. This was incredulous, as I had faxed them days ago and handed hard copies to his secretary just minutes before. He just shrugged and indicated that the consultation was over.

Who’s On First?

We went to another office where an LPN printed lab slips for the blood tests. I saw that there were new tests as well as some we already had. Perhaps the doctor wanted the same ones repeated? Even though this surgery was outside my realm of expertise, I observed that an entire panel of blood tests had no bearing on the problem at hand. When I pointed this out, the LPN filling out the forms agreed, cheerfully admitting that she had clicked the wrong box on the computer screen.

The blood tests had become a comedy of errors. The doctor had ordered additional tests that needed to be done, which were mixed with orders for blood tests that had already been done, combined with tests the LPN had mistakenly ordered. Sorting out this mess took more than an hour. That extra hour meant that we missed the 3 PM closing time of the blood lab and had to make another trip, resulting in more time off from work, frustration, etc.

A few days later, when we checked the results on the now functioning portal (the office never called), I saw that despite my arduous efforts, the same blood tests had been repeated anyway. In this era of high insurance deductibles that can run into the thousands and, indeed, tens of thousands of dollars, these errors would result in hundreds of dollars of out-of-pocket costs. To make matters worse, one of the original routine tests that had been normal was inexplicably abnormal on the unnecessary repeat testing. A third “tie-breaker” would now be required, inflicting more discomfort on the patient and consuming more time and resources.

It’s Up to You

When we returned for consultation, the doctor gave us the low down on the surgery. There were several options, all with varied degrees of success and risk, including death. He seemed loathe to make a recommendation. He insisted that it was up to us. This position was infuriating. Of course it was up to us. But it was up to him to make a recommendation. After I insisted, he reluctantly chose one procedure and said that if it was his family member, that’s what he would do. Based on the patient’s age, history, comorbidities, and testing, he estimated that there was only a 75% chance of success. I asked what we could do to improve the odds. He said, “nothing, it’s just luck.” When I added that as a physician it was very difficult for me to be on this side of the desk, he just smiled and nodded. He offered no words of encouragement or advice.

No More Questions

Immediately after we left the consultation room, I remembered an important question and tried to stop the doctor as he strode down the hall. He glared at me as if I should know that the consultation was officially over. Now, it appeared, I was invading his personal space and time. Perhaps I was, but I didn’t appreciate the glare.

Safety or Convenience?

The office assistant explained that the procedure would be done at the outpatient surgicenter at the nearby hospital, although often the doctor did the same procedure in his office. When I asked why we needed to go to the hospital, yet another foreign facility we would have to navigate, she explained that the doctor preferred operating there because they “turned over the room quickly.” (The answer I was hoping for was that the hospital setting provided better facilities and proximity to emergency services, should they be required, but that didn’t seem to be the doctor’s priority.)

Another Opinion? Really?

In the big picture, these were all small injustices; a change in appointment, a defective patient portal, some blood test errors, a receptionist’s perhaps mistaken perception of the doctor’s priorities, and my hassling perhaps an overhassled physician.

But I wasn’t happy and told our family doctor. What if the surgery didn’t go well? This doctor didn’t seem to care one way or another. Our doctor recommended another surgeon for us to try. Faced with the possibility of having to repeat tests, fill out more forms, register on another patient portal, and check benefits with our insurance company, the patient, who had been pretty tolerant of all of the above, wasn’t keen on getting another opinion. Wasn’t one opinion enough? What if the opinion was different? Would we need a third? She had a point. Nonetheless, I insisted.

Doctor #2

The second doctor had no opening in her schedule for months. However, out of professional courtesy, she would see us after normal office hours. I wasn’t enthusiastic about getting a complex consultation at the end of a physician’s busy day, but I appreciated the gesture. (A word of advice: If ever you need an appointment with me, first thing in the morning is best.)

The Doctor Did Her Homework

A few days before our appointment, the office called to say that the doctor couldn’t read a few of the many fax pages we had sent. I was impressed. Not only had Doctor #2 reviewed the records, she wanted to ensure that they were complete.

A Clear Recommendation

The day of the appointment, we arrived early as usual and filled out paperwork. We were told that the doctor was running behind. She didn’t see us until almost 6 PM. We were happy to wait, but I was concerned that the late hour might mute her interest in our case. Not in the least. Our consultation lasted until 7 PM. She patiently listened and reviewed the now voluminous records and blood tests. Nothing needed to be repeated. She acknowledged that there were several options but, without hesitation, made a clear recommendation. She would do the procedure in her office where she had everything arranged as she wanted it, including an anesthesiologist on site. It was true that there was risk for injury and death, but she had never seen these rare complications. She positively glowed as she advised that 3 out of 4 patients with this problem would do well.

Conclusions

The relationship between doctor and patient (and family) is intensely personal. Doctor #1’s office was disorganized with poorly trained staff who made many small mistakes. This did not inspire confidence. Nor did the doctor. He was professional but cold and dismissive. On the other hand, perhaps his technical skills, arguably a surgeon’s most important attribute, were superior to Doctor #2. We had no way of knowing. When it came down to it, the recommended procedure, risk for complications, and chance of success were the same with either doctor. No doubt Doctor #1 was correct—it would all come down to luck. But if we didn’t have luck, I knew which doctor I’d rather have at the bedside. Thank you, Doctor #2.

Note: Minor alterations in the details of the above true story have been made to protect privacy.

Drug Price Reform — When, Not If

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Brand name drugs are expensive.  They’re more expensive in the US than elsewhere, but they’re still expensive, regardless.

Prices are based on a number of factors, including what manufacturers think they can get insurance companies and governments to accept.  List prices are paid by consumers without health insurance.  Insurers and government programs pay negotiated rates often substantially below list.

Prices are supported by patent and exclusivity laws that protect original manufacturers.(2)  The US is the leader in this, to the point that drug companies will discard work on promising medicines if they believe they cannot obtain patents for them.(1)  For US consumers, it means they pay higher prices than people in other countries for the same drugs from the same manufacturers.  Congress has also made it illegal for US consumers to buy drugs elsewhere and bring them into the US.

“The current model for cancer drug pricing is not sustainable and harms patients and families as well as our health care system.” (5)

“Americans with cancer pay 50 percent to 100 percent more for the same patented drug than patients in other countries. As oncologists we have a moral obligation to advocate for affordable cancer drugs for our patients.”(6)

Take GSK’s Advair inhaler as an example.  The cash price of the 500/50 version of the inhaler for a consumer without insurance in the US is between $560 and $600 for a one-month supply.(3)  The price for the same product in Canada is $84.00.(4)  Some US consumers with insurance will pay a higher copay than the cash price in Canada.  With Horizon Omnia, I was quoted a price of over $300 for this drug by the pharmacy department at Wegman’s.

Prices are becoming detached from research costs.  The price for insulin for the treatment of diabetes has tripled in the last decade, despite the fact that the product has been largely unchanged for decades.(7)  (Synthetic insulin was introduced in the US in 1982, following development in India.)

Some people are angry about pricing, and one country is finally taking action.  Colombia has ordered Novartis to lower the price of its leukemia drug, Gleevec.  If the company does not comply, Colombia has threatened to break the patent and issue licenses for production of a generic version of the product.  According to Fox News, members of the US Congress are involved in lobbying the Colombian government to protect the drug company.  US Senator Orin Hatch of Utah is one of the people named in the news report as having close ties to the pharmaceutical industry.(8)

Whether Colombia breaks the current pricing model, or it happens elsewhere, it’s just a question of time.  Current prices are artificial and based on government intervention in the markets, and not on free market economics.

However, that’s the paradox that some conservative politicians like to ignore:  one is against government controls unless the controls lead to higher profits for your friends.

 

 


Sources:

(1) Frakt, Austin. “How Patent Law Can Block Even Lifesaving Drugs,” The New York Times.  28 Sept. 2015.  http://www.nytimes.com/2015/09/29/upshot/how-patent-law-can-block-even-lifesaving-drugs.html?_r=0

(2)  “Frequently Asked Questions on Patents and Exclusivity.”  US Health and Human Services, Food and Drug Administration.  http://www.fda.gov/Drugs/DevelopmentApprovalProcess/ucm079031.htm#How%20many%20years%20is%20a%20patent%20granted%20for?

(3) GoodRX.com.  http://www.goodrx.com/advair-diskus?form=inhaler&dosage=500mcg-50mcg&quantity=1&days_supply=&label_override=Advair%20Diskus

(4) Canada Pharmacy Online.  http://www.canadapharmacyonline.com/DrugInfo.aspx?name=Advair+0042

(5) Fred Hutchinson Cancer Research Center. “Expert opinion on how to address the skyrocketing prices of cancer drugs,” Science Daily.  12 February 2016.

(6) Mayo Clinic.  “Oncologists reveal reasons for high cost of cancer drugs in U.S.”  Science Daily.  16 March 2015.

(7) University of Michigan Health System,  “Sugar shock: Insulin costs tripled in 10 years, study finds,”  Science Daily.  5 April 2016.  https://www.sciencedaily.com/releases/2016/04/160405122030.htm

(8) “Colombia battles world’s biggest drugmaker over cancer drug,” Fox News Health.  18 May 2016.  http://www.foxnews.com/health/2016/05/18/colombia-battles-worlds-biggest-drugmaker-over-cancer-drug.html

Shattered Expectations and Political Angst

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The rancor in both political parties this year is a symptom of the underlying disunity in the US.  The US is fractionalized into groups with conflicting agendas; the parties are merely reflecting the disunity in the country at large.

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Josh Barro, writing for Business Insider, touched on some of this issue in writing about the crisis in the GOP. (1)  He describes three blocs within the GOP — the “donor class”, “the establishment” and the GOP self-identified voters.    He shares an opinion I voiced in an earlier post, that the voters are more moderate than either the establishment or the donor class.

Implicitly or explicitly, the concept of segmentation isn’t new.  When we talk about race, gender or even the Antebellum planter society, we are talking about segments — people with shared experiences, attitudes and behaviors.  A lot of the time, differences in segments are quite subtle.  Sometimes they aren’t.  Rarely, but on occasion, the differences turn violent.

Segmentation is a generalization.  Like the Marquis de Lafayette, a nobleman who helped George Washington during the American Revolution, there are always people who act in ways that are apparently inconsistent with the group to which they belong.

Even without a formal statistical analysis, some of the segments in American society are obvious.  In no particular order, these include:

  • The super-rich:  The GOP donor class is from this group.  The super-rich include oil men, venture capitalists, heirs, large corporate executives and celebrities.  Many of these are driven by sheer greed.  They don’t recognize obligations to the larger society, nor do they seen a relationship between their wealth and whether the population at large can afford what they sell.  Some move to another country or renounce US citizenship after achieving wealth here to avoid US taxes.  Even when they donate to charities, they give a smaller portion of their wealth than the middle class and poor give. Their attitudes help to explain issues such as why Texas has an oil and cattle elite and the highest proportion of citizens without healthcare in the US.
  • Large corporations:  Most see no obligations to society, or pay lip service for PR purposes.  They are fans of free trade and undocumented workers and play accounting games with offshore funds to avoid US taxes.  However, they favor government subsidies and regulation when it can be used to increase profits.  They are big fans of H1-b visas, which reduce what they have to pay for tech workers.
  • Small business:  Most small business owners chafe under government regulation, which increases their costs and reduces profit.  Most are not involved in global commerce, and free trade hurts their customers and their business.  They dislike government bailouts of large companies, which they see as both unfair and increasing their taxes.  They aren’t fans of big corporations, which tend to have onerous requirements if one wants to sell to them.  Nor are they fans of big banks which tend to demand that they secure credit with personal assets and impose numerous fees.
  • Farming:  Farmers hate government regulation except when it comes to price supports and subsidies.  Many depend on undocumented workers and depend on visa programs that allow seasonal workers into the US.
  • Tech workers:  These have gone from being highly paid to being paranoid about job retention.   Some are being pushed into the gig economy, where this is no job security or careers, but instead sequences of temporary assignments.  Due to competition and loss of benefits, most are seeing loss of income and lifestyle.  The hate H1-b workers, inspiring new forms of racism in the US.
  • Blue collar workers:  These people are hurting.  The have experienced 20 years of steady income erosion.  The losses stem from offshoring of manufacturing, automation, and reduced health benefits, although some politicians and media have taught them to blame their problems on undocumented workers rather than Congress and business.
  • Students and recent graduates:  These people are hurting, laboring under suffocating levels of debt.  Some suffer from an entitlement mentality, but most feel that life wasn’t supposed to be like this.
  • Over 65s:  Most are in trouble.  (1) They weren’t aware of the massive out-of-pocket expenses for medical care that government programs don’t cover until they got the bills.  The average 65-year-old has $35,000 in savings and is facing over $250,000 in out-of-pocket medical costs.  (2) Nor did many  realize that Social Security payments wouldn’t be adequate to cover more than a poverty level existence.  The average payment is $1,341 per month, and just how much can that cover?  (3) Nor were they cognizant of medical rationing.  The result has been a  growth in bankruptcies and suicides in this age group.  Those who can afford to move, do so — either to lower cost areas of the US or they join the growing American Diaspora to other countries.  Those who remain consistently vote against school budgets because they can’t afford tax increases.  Most suffer from disappointment: the “golden  years” weren’t supposed to be like this.
  • Minorities:  Prejudice is alive and well, fostered by financial hardship and the need to blame someone.   Kerrigan talks about the need for people in bureaucracy to vent personal frustrations by being abusive.  Certainly, that’s part of the issue, and its plausible that the poor reciprocate the hostility for much the same reasons.  In the end, it doesn’t matter who fires first.  The result is the same.
  • Immigrants:  American remains “the land of opportunity” at least in the perception of many, but these are the immediate recipients of hostility on several levels.  To the ignorant public, every stranger is a Muslim, including those who wear turbans, and every Muslim is a latent terrorist.  To the ignorant, everyone with a Hispanic accent is undocumented — and we have actually had lawful residents of Hispanic descent deported.

This isn’t an exhaustive list of segments, by any measure.

To fully appreciate the depth of feeling, I recommend a google search on “Hatfields v. McCoys.”

In the past, politicians have spoken about creating a “tent” that can hold a wide variety of people.  However, the notion of holding these segments is a single party borders on lunacy.  The intensity of conflict between the segments goes a long way to explain why the GOP and Democratic parties are so dysfunctional in this election year.

Lincoln spoke about the dangers of “a house divided against itself” and Washington spoke of the dangers of political factions that would place their personal interests ahead of the country.  However, I wonder if either could have imagined where we are now.


Sources:

(1) Barro, Josh.  “The crisis in the Republican Party is even worse than it looks”.  http://www.aol.com/article/2016/05/09/the-crisis-in-the-republican-party-is-even-worse-than-it-looks/21373351/

(2) Kerrigan, S. J.  Bureaucratic Insanity.  Club Orlov Press, 2016.

 

 

Assertiveness and Healthcare

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Someone has to speak up on behalf of the patient.  Most of the time, that may fall on the patient to do that.  If that can’t or won’t happen, someone else has to do it.

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Consider the following:

  1. Medical care is increasingly complex.
  2. Doctors are human, and fill the complete range from awesome to incompetent.  Some are highly skilled and fully current with developments in their field.  Some let their skills rust years ago, and a few never had them.  I don’t envy them.  Keeping current can require hours of reading every day and travel to medical conferences.
  3. The patient is the first person to know if treatment is or is not working, or if something is going wrong.
  4. As researchers at Johns Hopkins iterated this week, medical errors are the 3rd leading cause of death among Americans.  Estimates of the number of deaths from medical errors annually range from 250,000 to 440,000 Americans.

I’ve seen some of these errors.  My wife has an iodine allergy, and virtually every nurse with whom she has had contact has tried to swab her with iodine at least once.  In her case, any contact with iodine causes anaphylactic shock and she stops breathing.

Breathing is something we tend to take for granted, but it really is a nice thing to be able to do, best understood by those who have had problems doing it.

I’ve had to step in as her advocate.  I make sure admissions and staff know about her allergy and look at the color of substances being applied to her skin.  She isn’t bashful about speaking up, but sometimes she can’t see where the nurse if working.  What she can’t do, I can.

Which brings me to two key concepts: the second opinion and the healthcare power of attorney.

(A)  Second opinions.  Often, medical mistakes have to do with errors in diagnosis, and the wrong diagnosis can delay treatment past the point when treatment can be effective.  Second opinions are also valuable regarding the preferred course of treatment.  As in the case of a friend, one doctor may recommend immediate surgery when another doctor has three or four options that should be tried first.  Because surgery itself can have lasting side effects, it often should be considered as a last resort and not the initial course of treatment.

The second opinion should come from a physician in a different practice and preferably affiliated with a different hospital.  You don’t want personal relationships or conflicts of interest mucking up diagnosis or treatment recommendations.

If doctors disagree, it may be necessary to seek a third opinion.  That’s OK, too.   Your life matters.

(B) The healthcare power of attorney.  Someone needs to speak on the patient’s behalf if the patient cannot or is too timid to do so.  This representative must be someone who is trusted, who knows the patient well, will listen to the patient, will be present to observe the patient’s condition and issues, who will respect the patient’s decisions regarding directives and living wills, and has the willingness to “kick ass” when needed.

Whether in a relationship or not, everyone needs someone in this role.  Regardless of your current health, bad things happen to good people.  On average, each American can expect to cede 9 years of life to illness or injury.  If nothing has happened yet, be thankful.  However, to expect that nothing will is sheer arrogance — if you’re that lucky, how many winning lottery tickets have you purchased?

What do you call someone who won’t speak up for him/herself or have someone else do it?  Deceased.

I don’t want you to go that way.

____

Sources:

American Association for Justice.  “Medical Errors.”  https://www.justice.org/what-we-do/advocate-civil-justice-system/issue-advocacy/medical-errors

Hospital Safety Score.org.  “Hospital Errors are the Third Leading Cause of Death in U.S., and New Hospital Safety Scores Show Improvements Are Too Slow.”  23 Oct. 2013.  http://www.hospitalsafetyscore.org/newsroom/display/hospitalerrors-thirdleading-causeofdeathinus-improvementstooslow

McCann, Erin.  “Deaths by medical mistakes hit records,”  Healthcare IT News.  18 July 2014.  http://www.healthcareitnews.com/news/deaths-by-medical-mistakes-hit-records

Johns Hopkins Medicine.  “Medical errors now third leading cause of death in United States,” Science Daily.  4 May 2016.  https://www.sciencedaily.com/releases/2016/05/160504085309.htm

Commission on Law and Aging, American Bar Association. “Giving Someone a Power of Attorney For Your Health Care.”  2011.

2016 and Game Theory

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Anthony Downs, writing back in the 1960s, provides a very simple model to explain what has happened in the primary elections in the US this year.   The key assumption of the model is that most Americans are inherent moderates and conflict-avoiders — and for a good part of US history, that’s been the case.  Even in the American Revolution, the public was divided between Rebels, Tories and a majority who simply wanted the fighting to go someplace else.

In this model, leaders are more extreme than the average follower, and followers are more extreme than independents.  The closer one is to the center, the more votes one gets.  With his affiliation to the Christian Right, Cruz could be seen as more extreme than Trump, and there is no question that Sanders is more extreme than Clinton.  Trump and Clinton are closer to the center and they win.

This model doesn’t explain Kasich’s misfortune.  That may be more operational in nature.  He just was never seen as a serious candidate by most voters — or was never really seen at all.  He disappeared into the wallpaper while Trump and Cruz were throwing bombs at each other.

The model affects the VP choices.  McCain was a relative centrist in 2012 and was pulled to the right by his selection of Palin.   Something like that can happen again this year.

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