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bosleyjr

Diamond
Joined
Sep 30, 2006
Location
SE PA, Philly
Pete, I'm going to disagree with some of your analogies, but would stop to acknowledge your considerate and kind closing:
Joe - wish you the very best. Glad you took charge and caught this early.

So I hope that the following is a helpful commentary rather than a diatribe.

Do a Venn diagram and you'll find the picture is somewhat like this. One cluster consists of corporate pharma and healthcare CEOs doing their best to "maximize profits for shareholders."
For private firms that deliver healthcare and develop drugs, this is indeed the fiduciary responsibility of management. For clinics and such, the doctors generally want to make a good living, both to pay off college loans and also, frankly, to have a nice lifestyle. This paradigm has provided very good care for a lot of people, and is the reason why much of the innovation in new drugs occurs here in the US. But yes, doing things in the US costs a lot.


With guys like Martin Shkreli and Richard Scrushy the poster children for why we pay too much. And why we see hospitals charging $25 for an aspirin and using old and dying patients as an ATM machine at the end of their lives.
Ok, end of life can be a s**tshow, no doubt. And the cost of having people attend to the dying 24/7, often with expensive equipment, constant testing, etc. is high. I've recently gone through this with both my parents. But invoking Shkreli and Scushy as exemplars for all healthcare is pretty inapt in my humble opinion. Most of the people I know in healthcare (delivering healthcare in a hospital or clinic, or developing new drugs) are pretty great people. And together, they can do pretty excellent things. I don't know if most folks here know just how fast the vaccine development process was for Pfizer-BioNTech and Moderna. One element of that speed was having invested hundreds of millions in research. Because of this, they had candidates. So their investment accelerated the technical development. "Operation Warp Speed" removed some potential liabilities that allowed approval for marketing in an amazingly short time. I view the effort as heroic - saving hundreds of millions of dollars and also limiting damage to our economy. Being prepared cost a lot of money, but saved a lot of money. Invoking two guys who are convicted felons to characterize all of healthcare is not a defensible argument, IMHO.

It also includes doctors mainly in it for the biggest pay days -- and picking specialties like surgery. They continue to vote mostly Republican - though most are the old style Republicans wanting to keep as much in their own pockets as possible and not so much the new nutcase versions.
So my cousin is a professor of neurooncology and neurosurgery. He specializes in what remains a pretty lethal cancer: glioblastoma. I remember hearing a conversation between him when he was in high school, and his Dad (my uncle, a Harvard MBA). Cuz: "I think I'm going to try to be a physician". Unc: "Well, son, I don't think that being a doctor will be as profitable as it has been". Cuz: "DAD! I'M NOT DOING THIS TO MAKE A LOT OF MONEY!". In my job, I have to read a lot of the same books Docs study (Guyton and Hall, Medical Physiology, Janeway, Immunobiology, Katzung's Basic and Clinical Pharmacology, Goodman and Gilman's the Pharmacological Basis of Therapeutics, if you're interested). It can be a real grind. I don't think anyone whose sole motivation is money could gut it out. I have a colleague who did a fellowship at Harvard in pediatric cardiac surgery. I can say with certainty that money was not a significant motivator for this choice (one of the hardest fellowships to get, btw). Too, my friend who was a professor at a med school in the UCal system, specializing in pediatric cancers and looking for new cures for currently untreatable disease. I don't think anyone could stand, for money alone, to meet kid after kid, be entrusted to care for the kids, and having almost all those kids die, in front of you. Some docs probably do relish the high salaries and big houses and nice cars. If they're in the trenches, working 60 hours a week, and really helping people, I don't begrudge them the Mercedes.

But they're not all GOP guys. There is a NYTimes story titled "Doctors, once GOP Stalwarts, now more likely to be Democrats". So I don't think that the assumption that docs are money motivated is true, nor do I think that docs form a huge GOP cabal. Regarding "the new nutcase versions", I have to agree. As a Christian, Conservative believer in limited, effective, and ethical government in a country of laws based upon truth, I've left the party because, well, I don't think that the party is any of those things anymore. In fact, its pretty much the opposite of ALL those things. So, Pete, I think we agree that the nutcase adjective is pretty fair.

Also FWIW, the vast majority of health care in the US is provided by private medical businesses. No one (myself included) seems interested in changing that part. However, about a third of our spend goes to overhead and billing costs. Those overhead costs are lower in government-run Medicare (and in other national health systems) than in private insurance companies. The latter are busy, still busy, trying to charge more and deliver less. A few like Kaiser Permanente seem to do the harder work of increasing efficiency.
These are good comments. About 36% of healthcare is paid for by the US Government (and ultimately by the taxpayer). Government programs (Medicare, Medicaid, VA) have about a 5% overhead cost, while private insurance is about 31% (last figures I saw - these may not be spot on, but they're close). I would like to see private companies do this work (they CAN be more efficient) but we probably should have a little more competition. Removing the restriction on companies offering insurance in multiple states might be one start. But also those companies need to be regulated and monitored. I don't think "Medicare for All" is a good idea, in part due to the negatives that have been discussed here regarding the Canadian healthcare system. There should be a strong private alternative (governments monopolies can screw the consumer too!).

As for pharma, it was Bush 2.0 administration that gave them the we-won't-negotiate prices deal that's costing US citizens a fortune. It was part of the deal to add drug coverage. Lots of people want to reform that -- and the pharma industry is doing all it can to buy political favor from anyone who will block that. Used to be mostly Republicans. Now includes Democrats like Kyrsten Sinema -- most anyone willing to be bought for campaign contributions and in a position to obstruct reform.
Again, the system whereby drug companies can charge a lot for new drugs works in one sense: it incentivizes meeting unmet medical needs. Cutting drug prices will make life better for people who have currently treatable illnesses. It will also condemn those with illnesses for which there are no good therapies to suffer or die without alternatives. Say what you will about private enterprise: if there's an incentive it gets things done. So, speaking of costs, how does $19.50 (about the same as a flu shot) sound for a vaccine that prevents severe illness, hospitalization, death, and lingering, debilitating symptoms in long covid? I view that (and remember, I study the numbers on this stuff for a living) as one of the best bargains around.

Not that there is not stupid pricing. My favorite is Vimovo. An over the counter NSAID (naproxen sodium) and a proton pump inhibitor (esomeprazole, aka Nexium). Original cost: about $20/tablet! Now "only" about $12.50/tablet. The two ingredients cost - at retail - less than a buck a tablet. Oy.

Regarding Sinema... Well, you used the "nutcase" adjective above. Maybe you're right: maybe she's just trying to extract as much money from the system. My money, though, is on "nutcase".

So, Pete, to close, thanks for your post. I hope that my response was viewed as a discussion between friends, both searching for better understanding. I wish you the very best.
 

JoeE.

Titanium
Joined
Aug 31, 2006
Location
Kansas
A few observations on some doctors around here.

My current surgeon... I figured him and his practice to be apolitical.

I went in there a month ago to have something cut on, and while I was in the waiting room looking at stuff he had hanging on the walls, I spot an 8x10 color glossy of a smiling Trump posted in a place of prominence. It was signed in illegible scribbling in gold sharpie.

I was disheartened to see that. I shook my head.

I can only imagine how much money the doctor (or his practice) donated to Trump to get that photo. You know he wasn't donating vast sums to Trump because of Trumps enthusiastic support of Science and Medicine and people getting college educations, or because he is a genuinely nice guy, like Barack Obama.

As I waited, a young guy came walking in and paced around the room. I was the only person in there. I said "well, nobody knows I'm here yet, they haven't came out here to see me yet."

So, later, here comes the doctors nurse. She gets me taken care of and goes on to speak to that guy.

The guy says "If you could just get him to see me for a few minutes, that's all I need" and a little more conversation.

The Nurse says "well, he's booked up for today and I'm not sure he wants to speak about that with you, maybe you should go check with the hospital administration."

She was pleasant about it...and when they were through talking, they did a fist bump as a goodbye gesture, and as he started away, she exclaimed "2024". Doesn't take a trump voter to figure out that that salutation was them cheering on their likely choice for presidential candidate.... kinda like the West Point class photo with half of them giving the White Supremacist "OK" hand gesture.

(I was really shocked/surprised to hear HER saying that. She's probably in her thirties, I'd guess. Doctor is the same age as me, 65. I just don't understand their political stances, I guess.)



Back to this guy wanting to talk to the doctor. I thought, at first, that he was a patient.

So, I had no idea what their conversation was all about, so I asked her after he left.

She says "oh, he's a salesman trying to get the doctor to convince the hospital to switch from something they're already using to something he's selling. But, the doctor doesn't want to get involved with that kinda stuff, so I run interference for him.

Another, recently retired doctor. He was a cock-hound and usually had a cute young thing on his arm, and had been married a couple of times.
Everything he drove, car or truck, was bright red.
A friend of mine (who was a patient of that doctor) who was tapping one of the doctors young ex-wives, told me one day "you know why all the stuff he drives is red?" (Chevy Vettes or Chevy Silverados)

I had no idea. He says the doctor told him that he just drives one color of vehicle, that way when he's buying a new car or truck every year, it doesn't start people's tongues wagging about his flagrant display of wealth. All the average person will see is him in his red Vette, and couldn't tell a 2010 from a 2022. They all look the same to the average person.
 

i_r_machinist

Titanium
Joined
Apr 12, 2007
Location
Dublin Texas
I guess no way to do some kind of sonogram or dopler? Some type of less invasive (and its medical, so %500 more $) imaging?

The die isn't that radioactive iodine? that they used in the past. Nurse had a sonagram machine. Hooked it up and was getting shadows, walked around to my right arm,(where the iv was), shot some stuff in, and the picture quality went through the roof. A friend had it done last year because he was feeling lethargic. He walked out with 4 stints and a new lease on life. He basicly powerwalks wherever he goes now.
Wish I would have done it when he did.
have fun
i_r_
 

PeteM

Diamond
Joined
Jan 15, 2002
Location
West Coast, USA
. . . Ok, end of life can be a s**tshow, no doubt. And the cost of having people attend to the dying 24/7, often with expensive equipment, constant testing, etc. is high. I've recently gone through this with both my parents. But invoking Shkreli and Scushy as exemplars for all healthcare is pretty inapt in my humble opinion. . ..

Just to be clear, Bosley, I cited Shkreli and Scrushy "the poster children of why we pay too much." They were intended as high profile cases and not the typical. Still, I could name a dozen more like Perdue Pharma, where companies have chosen to risk patients' lives in pursuit of higher profits. It's not the norm - but it is becoming all too common

That said, the financialization of health care has seen per capita costs in the US rise far faster than inflation - while health care outcomes such as infant mortality or longevity haven't much improved. Chart below.

As for the notion that we need to pay more than anyone else for drugs, because they wouldn't get discovered - two points suggest this isn't exactly the case. First, I personally know a few people who actually develop drugs -- you probably do too. They're mostly in it for the challenge, maybe the hope (the gene sequence guy) of a Nobel Prize some day. Give them a good lab, respect of their peers, and a comfortable salary and they'll keep at it.

It's the financial types coming in later who keep insisting they need to be paid multiple millions. Shkreli was a good poster child for that. He kept talking about "innovating" when all he did was take an existing life-saving drug and jack up the price.

At the beginning of the pandemic we had a virus researcher talk to us. She had done some of the pioneering work on mRNA vaccines and told us how that path might get us a vaccine within as little as a year or so. Very bright woman, famous in her field, with a couple kids, her own lab, and a (by CEO standards) modest salary. Over the past two years we can sort of see how the response has morphed from researchers like her actually solving the vaccine development problem to pharma companies figuring out how to make the most from it.

Second point is that big bucks US pharma companies aren't the only ones capable of developing new drugs. Pharma companies in Europe, Japan, China, South Korea, Singapore, etc. are now innovators - without their citizens paying through the nose. They spend less on healthcare, much less on drugs, but often manage to live longer.

Here in the US we imagine there are only three Covid vaccine makers (J&J, Pfizer, and Moderna). Yet, dozens of vaccines have somehow been developed and approved elsewhere in the world (Netherlands, UK, China, Germany, India, Russia . . .).

Here in the US, drug development is becoming a bit like the software industry,where startups do the heavy lifting of actually discovering new treatments and then get bought up by big companies. The BioNtech (relatively new German company) part of the Pfizer vaccine and the Moderna would be examples.
.
RisingPharmaCostsPerCapita.jpg
 

steve45

Stainless
Joined
Jan 16, 2012
Location
Midland, Texas
I have a female doc and female PA. I really wasn't sure at first about that, but after 10 years, it doesn't bother me. They're both very respectful.

My doc is big on supplements and blood tests, along with annual carotid artery ultrasound tests, colonoscopies as required, etc. I was skeptical about all the supplements, but they do show up on the blood tests.

Side note: I had a friend that went to her doc to have a wart removed from her finger. He said that she would have to get an MRI of her finger before he would do it, $4500! I told her that I'd just bring a clean razor blade with me the next time I came to visit.

Another side note: 8 times background radiation level is nothing.
 

BoxcarPete

Stainless
Joined
Nov 30, 2018
Location
Michigan, USA
I have a female doc and female PA. I really wasn't sure at first about that, but after 10 years, it doesn't bother me. They're both very respectful.

My doc is big on supplements and blood tests, along with annual carotid artery ultrasound tests, colonoscopies as required, etc. I was skeptical about all the supplements, but they do show up on the blood tests.

Side note: I had a friend that went to her doc to have a wart removed from her finger. He said that she would have to get an MRI of her finger before he would do it, $4500! I told her that I'd just bring a clean razor blade with me the next time I came to visit.

Another side note: 8 times background radiation level is nothing.

8 times a year's worth of background radiation per treatment is nothing to shake a stick at. For reference, a chest x-ray is about ten days worth of radiation, a four hour flight is about 2 days extra.
 

surplusjohn

Diamond
Joined
Apr 11, 2002
Location
Syracuse, NY USA
i had a physical last month, middle aged female dr asked if i minded a student attended, me being generous, said sure, student was of course a hot young lady. i said to myself, well i am going to be in more embarassing places before its all over, so what the heck. afterwards i called my GF and said, now i know how you feel when you go to the GYN.
 

JoeE.

Titanium
Joined
Aug 31, 2006
Location
Kansas
Well, drove to the big city today.

I am upbeat. Dr. explained that where the offending polyp had been was around 3 or 4 inches up in the ol' poop chute.

He needs to go looking at the area where it was removed (here in 8 weeks, he said, so the area will be completely healed over) and check to see that there was no polyp material left that could cause problems.

He says that if there is, he'll remove it at that time, and if there's nothing...I'll just be subject to more frequent Colonoscopies.... which I'm fine with. Actually, either way there are more Colonoscopies in my future.

He says the good thing about it was that it was small and caught early. Caught early in that the polyp had only managed to affect the first of the 4 layers of tissue that make up the wall of the rectum.

A few years ago one of my coworkers said he wasn't feeling well, said his belly hurt. He moped around a little, but kept working. It must have been bad, because I've never seen him sick, and he always bragged to us that he was an "iron man". 64 years old, farm boy, raises cattle, don't smoke or drink or anything.

Well, he laid off sick the next day and didn't show up.

The day after that, he calls me on the phone and says "You wanna know why I laid off yesterday? You remember how I said my belly hurt? Well, it got to hurting so bad last night I drove myself to the ER. After I got there, they did some checking and come to find out I had appendicitis!!!"

I said "Well, that would explain your moping around."

Then, he says "...and while they had me in surgery they discovered colon cancer right in the same area."

So, long story short... he got on Chemo and after some months he is given a clean bill of health.

Well, maybe a year later, some sort of tests he was taking showed it came back again. He went back on chemo and after a lengthy interval, they gave him the bad news that the disease wasn't responding to treatment and that they were suspending chemo and placed him on some sort of pills (that I don't know what they're for) instead.

So, to hear him tell it, he's basically given up. There at first he didn't hesitate to tell me that "I'm going to die." I'd commiserate with him, to a point, but I tell him now that "If you think you're going to die, you probably will!!!"

I think your mental attitude has a lot to do with your survival rate, to a point.
 

JoeE.

Titanium
Joined
Aug 31, 2006
Location
Kansas
I went to KU in KC, Ks. for another colonoscopy on Tuesday to check on the state of my colon wall where a polyp containing cancerous cells had been removed in January.

They have some impressive machinery in the endoscopy department, let me tell you.

This time they went in there looking to be sure the previous surgeon got it all the first time, and did an "endoscopic ultrasound" to be sure it hadn't put down roots through the wall of the colon. He did, and it hadn't.

But, they found 5 more and removed them. 2 in "left colon" and 3 in "sigmoid colon". They are awaiting pathology reports on those.

KU provides a service that allows the patient to access results of tests and read reports in your file from you home computer. I did that. It's pretty neat reading.

When they wheeled me into the OR, there were 2 large columns hanging down from the ceiling, to which were attached 2 things which I'm assuming were remote control stations at which 2 guys were seated. Very large control stations.

There were two large tv screens hung from the ceiling above my head.

My doctor was in there in street clothes, not in scrubs. The guys at the controls wore scrubs, as did the nurses.

My doctor looked to be texting, or maybe he was playing solitaire... I don't know for sure. The darn anesthesiologist slipped me the Propofol while I was laying there making jokes about things... didn't even get to count down from 10 or anything. I remember telling anyone who'd listen ..."I'm starting to get sleepy", lol.

According to the report I read.. "Scope inserted at 10:20, scope removed at 10:48".

I didn't get to ask, but I'm supposing that the guys seated at the control stations were going to be running the probe, and my doctor was going to stand there looking at the progress on the big TV screen (periscope) and instruct them on what to do... snip here, irrigate there, forward, back...? Kinda like the captain of a submarine doesn't actually do the labor, he just directs others how to navigate in a dark world.

Anyhow, it was pretty interesting. There was a large group of people in the pre-op/post op room, waiting their turn. At 30 minutes per patient, average I guessing, they could get a lot done during the day.

In the end, I am under the impression that alls well, and I'm scheduled for a follow up colonoscopy here at home in 6 months. Must not have detected anything alarming.
 
Joined
Apr 14, 2018
Location
Airstrip One, Oceania
For private firms that deliver healthcare and develop drugs, this is indeed the fiduciary responsibility of management.
Normally I'd skip these medical discussions (makes me queasy, I firmly believe we have a skin to keep all that nasty inside stuff covered up), but came across this.

It is absolutely totally 100% wrong. There is no "fiduciary responsibility to the shareholders to maximize profits." This is nothing but a bunch of crap that Milton Friedman pulled out his ass to justify greed. There is no legal, ethical or moral responsibility for any company to behave this way. None. It's an academic fabrication that became popular because it put a nice raspberry frosting on a cake made of dogshit.

It is false. If you are a shareholder and want to make more money you are welcome to sell the stock. Shareholders do not have doodly-squat to say about how a company is run and there is no responsibility to them other than not breaking laws. If you don't like it, buy something else. Period.

Good to hear you are doing well, JoeE.
 

john.k

Diamond
Joined
Dec 21, 2012
Location
Brisbane Qld Australia
Good example of well intentioned.....we have the NDIS Natl Disability Insurance Scheme......this hasnt been going long,and is a black hole for taxpayers money.......from the outset the scheme has been hijacked by mid east and Pakistani criminal gangs,who simply use it as a licence to print money ...some of the gang members are qualified medical practitioners ,and the returns are in the multi millions.
 

1yesca

Stainless
Joined
Jun 1, 2004
Prostate exam is no big deal. Close your eyes and fantasize about staring in a supporting role in a prison movie....
Try to empty your bladder first, it helps. Ask me how I know.
Hey doc, where should I put my pants? Right on this chair next to mine.
Next advise. Always shake your docs hand before choosing him as your primary. Maybe pass if they have huge fingers. Maybe not:rolleyes5:

And then there is the colonoscopy. Polyps first time so 3 year plan, clean second time so on 5 year plan. They used to inflate you with compressed air and the recovery room was full of patients passing fog horns of gas. They now use CO2 and it gets absorbed by your body. Colonoscopy is no big deal, but the prep is unpleasant, but seems to get a tiny bit better each time.
View attachment 340007



Prostate exam is no big deal. Close your eyes and fantasize about staring in a supporting role in a prison movie....

also inform your dr. that if he puts both of his hands on your backside that your out of there
 

52 Ford

Stainless
Joined
May 20, 2021
Wait ! Wait ! I almost missed this. Is there a way to do this at home ? Road trip coming up, most certainly will have at least one fart contest, first one to roll down the window loses, and I need an edge !

And you say puns are the lowest form of humor. LOL
 

steve45

Stainless
Joined
Jan 16, 2012
Location
Midland, Texas
8 times a year's worth of background radiation per treatment is nothing to shake a stick at. For reference, a chest x-ray is about ten days worth of radiation, a four hour flight is about 2 days extra.
I worked with radioactive materials every day for 7 years. Background radiation is extremely low. 8 times a year's worth of radiation would be like living 8 years longer.

Just curious, do you live in a brick house? If so, you may want to move.

You can live in fear if you choose. I choose to live without fear.
 

Pathogen

Hot Rolled
Joined
Oct 18, 2016
After my colonoscopay the nurse asked if I needed anything

I said yes, can I get a prescription for some opioids?

Boy, they almost threw me out
 

Servicar rider

Cast Iron
Joined
Sep 6, 2008
Location
Coggon Iowa usa
Before my last colonoscopy I was talking with a guy whose 84 and he says "I don't have to do those anymore, I'm too old!" I asked my colonoscopy doctor about that and he said "Yeah, people are being told that but it's wrong. I had a guy whose over 90 in here 2 weeks ago in perfect health who has a huge cancer in his colon that will kill him and if he had been tested regularly we would have found it and prevented his death from colon cancer."
 








 
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