Archive for July, 2008
Prescriptions—who needs ‘em?
There is something really cool about living in a third world country. The government usually isn’t strong enough to enforce a bunch of petty regulations. They haven’t got the money and they haven’t got the motivation. This can lead to a lot of convenience.
When I was living in Belize, I had food poisoning a couple of times (that is also a perk of the third world). It was easy enough to get rid of. Two tablets of Cipro and I was good to go. No problem.
Antigua, it seems, is not such a nice place with regards to that. Pharmacies here actually want prescriptions. This is more than mildly annoying, especially since it is harder than hard to get in to see a doctor.
There is a medication that I take on a regular basis, and I’ve run out. My refill will arrive from the United States sometime this week, but until then, I’m stuck. There isn’t any of this particular medication available on this island, but there is an unpurified form. It isn’t ideal, but I can make do for a week on it. I went to the pharmacy and asked for it, and was told I need a prescription. Why? That is indeed a very good question.
It is a very good question not only because this medication is harmless and I only want a supply for one week, but it is just an all-around good question. Why must I go to a doctor, sit in the waiting room and then pay $100 to get him to jot down the drug I want? If I know what I need, I should just be able to go to the pharmacy and buy it.
Noooooooo, scream so many ill-advised individuals. Some of those drugs are dangerous! You might know what you need, but most people are dumb!
So what? Dumb people do all sorts of dumb things that screw up their lives. They drink too much, they spend their money on frivolous things, they have unprotected sex, they share needles. Then, they live with or die by the consequences.
While some people may want to enact laws to protect stupid people from themselves, reality dictates that this is impossible. No law that congress passes will make people smart. They will never be able to stop people from ruining their lives and killing themselves. Everyone knows this.
So, why do I need a prescription?
Throughout most of the world, medicine is an organized cartel. Physicians and their (soon, our) ilk have banded together and lobbied governments to require them. They may claim that it is all about safety, but anyone with half and ounce of critical thinking ability knows this isn’t the case. Its about money. If people can’t get the drugs they need without going to see a physician, they’ll come to the physician’s office, and pay him a nice fee to jot some stuff down on a piece of paper.
This is not what physicians are for! We’re not here to be nannies and keep people from hurting themselves. People will still go to doctors, but instead of going just to get a script, they’ll go when they’re actually sick. Chances are, they’ll not have to endure monumental waits, and they may very well pay lower prices due to a new supply-demand dynamic.
Oh well, we must all sacrifice so that the dumb don’t overdose….
I became aware of Kent Snyder’s death only today; I’ve been wrapped up in my studies and haven’t been keeping up with the current happenings in the Libertarian movement as much as I’d like to have.
Kent Snyder was the chairman of Ron Paul’s presidential campaign, and he did a damn good job. He was actually the individual who persuaded Dr. Paul to run.
I spent a few days volunteering at the Ron Paul campaign headquarters in DC, where I met Kent Snyder, and handed him about $5000 in checks from a fund raiser that I held at my parents house. He was such a nice guy, and thanked me several times for my volunteer efforts, both with regards to the fund raiser and with regards to my work at the campaign headquarters. He was an asset to the libertarian movement, and a great guy.
I am rather surprised, though, that Kent Snyder’s death has provoked criticism of Ron Paul and of Libertarianism in general. Kent Snyder spent about two months in the hospital suffering from viral pneumonia. He did not have health insurance, and as such, has a $400,000 medical bill for which his estate liable. Those in favor of “universal health care” have actually gone so far as to insinuate that Snyder died BECAUSE he didn’t have health insurance, and they have criticized the Paul campaign for not offering it to their employees.
I am sure Snyder would have said the same thing that I am going to say: Snyder didn’t had health insurance because he chose not to. He could have purchased it for himself, but he made the judgment that it did not make financial sense to do so. Yes, his estate needs to pay the bills. They will do so.
Friends of Snyder have set up a website collecting contributions to help pay this debt. You can view it at www.KentSnyder.com
This is in no way a political issue, but our opponents are trying to make it into one. This is very unfortunate.
Yes, I said the S word. Slavery! It brings to mind horrors of the past, when this ugly practice destroyed lives and dehumanized millions. I want to bring that to mind, because it is important that we associate the philosophical underpinnings of slavery with their vivid and horrifying results.
What, you ask, are the philosophical underpinnings of slavery?
It is the idea that man exists not for himself, but for the sake of others, and that his very existence requires the sanction of others. If you hold that man has rights, and those rights are the very essence of his being, you automatically reject slavery. If you reject the notion of man’s rights, you accept the notion that the strongest may enslave the weakest, and that the biggest gang may do as it pleases with the rest of humanity.
Barak Obama’s National Service Plan is a fundamental rejection of man’s natural rights. He would have every high school student perform fifty hours of mandatory community service per academic year, and require 100 hours of mandatory community service each year for college students.
Quite honestly, under those circumstances, I may not have even graduated high school, let alone college. I strongly object to being told when to be charitable. I have rights, and the government is there to protect them, not to force me into servitude. The philosophical underpinnings of this proposal are the same as those of slave-traders: The mighty (in this case a gang known as the Democratic Party) may subject the helpless to their whims.
You might think that it would be a very nice thing for high school and college students to “serve” others. If so, I recommend that you go back to college, take some philosophy courses, and “serve others” yourself. Be generous with your own time, not with mine!
I’ll close with a quote from Ayn Rand:
It only stands to reason that where there’s sacrifice, there’s someone collecting the sacrificial offerings. Where there’s service, there is someone being served. The man who speaks to you of sacrifice is speaking of slaves and masters, and intends to be the master.
Barack: I am not your slave, and neither is anyone else. That dark era of our nations past is over. You speak of hope–and it is becoming clear that your hope is to take America down a dangerous course of collectivism that can only lead to abject misery for all.
To my readers: remember the consequences of ideas. It is ideas that drive human action. The same ideas usually get the same results. Let’s not revert back to the idea of slave and master. That idea will bring us nothing but misery.
On a forum that is frequented by a number of AUA students, there was a thread recently started that led to a lot of people expressing a dislike of homosexuals. I think that this world view is inherently irrational. Every piece of evidence we have suggests the homosexuality is a biological phenomena, akin to being right or left handed. How can one pass any sort of moral judgment upon someone whose biological nature leads them to seek their happiness in another direction? Even if someone has a religious problem with homosexuality, it is likely the case that their religion teaches them something akin to “Hate the Sin, Love the Sinner”, which would seem to me to indicate that they would not have a problem with homosexuals as such.
In any case, homophobia is utter nonsense, and quite often, I think, the result of some sort of psychological neurosis. In my experience, most of the people I have met who don’t like homosexuals are those who are undereducated. In college, there were a number of openly gay students, and no one treated them any differently because of it. They were just as popular, just as accepted, and just as well-liked as anyone else. I attributed this to the fact that students had been enlightened by their education and understood the irrationality behind homophobia.
In response to those AUA students who expressed their distaste for homosexuals, I offered the following thoughts on the forum:
For those of you who are expressing your distaste for homosexuals, I would like to call your attention to a study performed by researchers at the University of Georgia, and published in the Journal of Abnormal Psychology (which is owned by the APA).
The study compared the sexual arousal of self-reported heterosexual men. The study used the Index of Homophobia to determine whether to assign the men to either the control group (non-homophobic) or the test group (homophobic).
Here is what the study says about the classification:
The score obtained is a measure of “dread” an individual experiences when placed in close quarters with a homosexual; a low score equals low dread, and a high score equals high dread….Because most of the items contain the terms comfortable or uncomfortable, dread can be assumed to mean anticipatory anxiety about interacting with a homosexual person. For example, one item states “I would feel nervous being in a group of homosexuals.” Positive and negative statements are used to control for response set biases. The
authors reported .90 reliability coetficient on a sample of 300 respondents. O’Donahu¢ and Caselles ( 1993, p. 187 ) commented that the authors of the IHP used a “more empirical and psychometrically sophisticated approach than previous researchers who have produced instruments to measure homophobia.”Here is a synopsis of their results:
In the homophobic group, 20% showed no significant tumescence, 26% showed moderate tumescence, and 54% showed definite tumescence to the homosexual video; the corresponding percentages in the nonhomophobic group were 66%, 10%, and 24%, respectively.
You can read the entire study here: http://www.oogachaga.com/downloads/h…al_arousal.pdf
Quite frankly, homophobia is irrational, and it disappoints me that students at AUA would express these opinions. (I’m not saying that anyone should prevent you from doing so, I’m just saying that I’m disappointed in you for holding such an irrational world view). In any case, I think the joke, “You’re so homophobic you can’t touch yourself” may have a lot of truth to it.
Hopefully this will provoke a little bit of discussion and thought on the topic. If you are a doctor, you’re going to have patients of all types, and it would behoove you to get over your homophobia before you have to examine a gay man’s inguinal hernia.
I like to read about what my life is going to eventually be like. It helps give me the discipline to complete those 18 hour study marathons!
In any case, I enjoyed reading this post: Advice for New EM Grads
Yeah, it’s not an explanation of how awesome life is going to be (we all hope we’re going to love every aspect of our lives, don’t we?). But it helps to keep one’s eyes on the prize to remain motivated.
I could write 100 posts with this same title. Holberton Hospital (St. John’s, Antigua) is the most disgusting excuse for a hospital that I have ever seen. I really mean that, and I have seen a lot of really bad third world hospitals. Public Hospitals in Ghana (where I volunteered two summers ago), a nation with a per capita income of just over $500 per year, had higher standards of care than this place!
Why? Because, with very few exceptions, the staff doesn’t care one bit about how they do their jobs or the welfare of their patients.
A couple of weeks ago, a call went out on the radio all over Antigua pleading for blood for a patient at Holberton. Apparently, they were out of blood and this patient was critical. Given that I have O- blood, and hadn’t donated for three months, and was completely well, I decided to set aside my studies and go there and donate blood. I filled out the form, and the “nurse” reviewed it, got a worried look on her face, and knocked on the door of a doctor. He looked at my form and concluded that I was an unsuitable donor. I walked into his office to speak to him.
According to him, because I take lexapro, I am an unsuitable blood donor. I asked him, in the most polite fashion, why that is (all the while knowing that he is wrong). He tried to feed me a line about the fact that he didn’t know whether they’d be giving the patient whole blood or plasma. This is, of course, irrelevant. I proceeded to ask him a very pointed question:
Do you know what Lexapro is?
He gave me a blank stare, and then told me that his is a pathologist, not a clinician. When I opened my mouth to say something else, he waved me off with his hand. So, I left.
There was a man, in critical need of blood, and this doctor turned away a willing and suitable donor because he didn’t know what Lexapro is. He could have, of course, opened a book, or typed in a search on google. He could have even asked me to BRING him a textbook from the medical school library so he could verify that I am a suitable donor. Instead, he waved me off, more interested in whatever else he was doing (or, more likely, not doing) than obtaining blood for a critical patient.
I don’t know of a even single first year medical student who doesn’t know what Lexapro is. It is an incredibly common drug. There are references made to it in movies (i.e. sideways). I’ll give him a pass, though, since he is a pathologist and he practices in a country where the only people who take it are expats who would, in the face of an MI, go to the airport instead of his hospital.
What I cannot set aside, is the fact that he was unwilling to look it up. This wasn’t just some routine donation while they had a full blood bank. The blood bank didn’t have any of this guy’s blood type! I don’t know what happened to this patient. I hope that they found another suitable donor in time, but that is by no means guaranteed. This doctor’s unwillingness to spend five minutes looking up a drug could have cost a patient his life. That is disgusting. That is Holberton.
There is a brouhaha of sorts taking place in Washington. The American Medical Association is pushing for a Senate vote to reverse Medicare cuts that went into effect on July 1st. The gist of their argument is this: physicians are struggling, and you’re going to make them stop taking Medicare payments! This means they’re going to stop seeing Medicare patients! The sky is about to fall!!!!
I contend that the sky has been falling for a long while. Medicare has been imploding. Why? It is the very nature of government to make something as inefficient and worthless as possible. Doctors are finding that treating Medicare patients costs them money, and they’re not accepting those patients. Imagine that! With the cuts taking place, fewer doctors will see those patients. The New York Times discusses one such case:
Dr. Gerald E. Harmon, a family doctor in Pawleys Island, S.C., said he decided last week that he would not take new Medicare patients “until further notice.”
“This is not what we enjoy doing,” says a notice in his waiting room. “It is what we must do to maintain financial viability.”
Perhaps you believe that senior citizens, poor folks, and those with chronic renal disease possess a God-given right to health care. Perhaps you believe that their shortcomings amount to a virtue. If you hold this erroneous belief, then you believe implicitly that others have a moral obligation to provide it to them. If this is the case, why are you so worried about what physicians get paid? Surely they are selfless creatures who will work day and night to look after the wretched masses. That’s their moral obligation, right? Work hard in school, work insane hours in residency, and be a slave to society. Sounds like a fair bargain to me!
In any case, if you believe that people have some right to health care, then it shouldn’t matter to you how much doctors get paid to treat these people, because ultimately, they are the only ones able to provide the care. You have the need, and therefore doctors have the moral obligation to fulfill it. Done!
What this means is that if you hold this belief, you must logically conclude that this amounts to doctors trying to play a guilt trip on America so they can make more money. I would readily agree with you in that respect: the AMA, and the doctors for whom they speak, are begging for money. They look and sound a little better than that annoying guy who bothers me in the grocery store parking lot, but they’re begging. I am not in medical school so I can become a beggar. I don’t study for 10 hours per day and ace my exams so that I can get on television and beg a bunch of corrupt politicians to keep sending me stolen money. This sort of conduct is unbecoming of a physician. To the AMA and their members, I say: stand up and stop acting like children. You have no right to be paid by taxpayers, and your patients have no right to demand your care unless you voluntarily agree to provide it.
As I said in the beginning of this post: the sky is falling on medicare. Doctors are opting out, and people on the dole are having a hard time getting their health care for free. I think that this is a good thing. Medicare is a flawed program. On practical grounds it is flawed because of the regulatory nightmare that it creates. On moral grounds, medicare is flawed because it is a distribution of stolen money.
If you think this is moral, then you must logically believe that in five or six years, when I have a medical license, you have every right to put a gun to my head and make me perform medical procedures on anyone and everyone. The only recourse that I would have, according to this flawed position, is to go to congress and beg them to pay me (by means of the forceful expropriation of money from others).
If these cuts remain in effect, and further cuts are implemented down the road, it will only accelerate the inevitable: Medicare, like Ted Kennedy, has a glioblastoma. They’re both dying, and there isn’t a damn thing anyone can do about it. Congress has no more power to pass a law keeping Ted Kennedy alive than it does to save Medicare from its inevitable demise.
Medicare is going to die slowly. Lines at the offices of those who do accept Medicare are going to get longer and longer, and pretty soon you’re going to find people looking for other ways to get care. They might even choose the moral option; they might decide to pay for it! As people begin nearing the age of retirement, they’ll probably realize that they don’t want to be trapped in this debacle. They’ll probably start saving and buying private insurance for their golden years.
The gluttons feeding at the trough will indeed suffer when no one comes to fill it for them. They’ll figure out a way to survive, though, and others will learn that the taxpayer trough isn’t an attractive place. Medicare will collapse, with or without these cuts. These cuts will accelerate the collapse, and I, for one, am happy to see it take place.
As a side note: The Happy Hospitalist has an interesting perspective on this subject.
Yes, that is right. I’m going to make an effort to post to this blog every day, or at least most days. I’ve been insanely busy, and I will continue to be insanely busy for the foreseeable future. I just haven’t made keeping a blog a priority. This has a lot to do with the fact that I had been viewing this blog as a way to keep my friends and family back in the states appraised of my life. That is easy to put on the back burner when you have nerves, muscles and molecules to memorize.
As I learn more about medicine, I become more and more concerned about the way America is headed with regards to health care policy, and with regards to the culture of medicine. Reason is taking a back seat to feel-good platitudes and emotions. It is very dangerous for this to be taking place in medicine. I intend to use this blog as a platform to discuss these issues. America (actually, the entire world) needs to wake up and take a large dose of reason. Hopefully, I can make a contribution towards this.
Later tonight I’ll post some articles that I’ve written for the AUA Pulse (the student newspaper at the American University of Antigua), and perhaps some news stories that are relevant to my interests. I’m also going to work on developing connections with other freedom-oriented bloggers around the world.