I have been writing about the DSM process which isn’t always easy to do because the head of DSM-5, David Kupfer, MD, runs a pretty tight ship with his committee members, making them sign confidentiality agreements and not take any notes. Well since he said that there would be a “paradigm shift” and the sky is the limit for coming up with new diagnoses, there has been a lot of interest in the process.

David Kupfer, MD, Head of DSM-5

I recently wrote about the editorial by Allen Frances MD, head of DSM-4, criticizing the current process of DSM-5, and now there is a nasty response from the DSM-5 group, authored by Alan Schatzberg MD, James Scully MD, David Kupfer MD, and David Regier MD, that psychiatry blogger Daniel Carlat MD offered to edit for them to make it more respectful. Lol. A blogger offering to help the leaders of academic psychiatry tone down their language. Lol again.

I mean the damn editorial hasn’t even been published yet.

In their response to Frances Kupfer et al make dubious claims that “attorneys” had advised them to have committee members sign confidentiality agreements to protect “intellectual property”. They also charge Frances (as well as Robert Spitzer MD, who founded DSM and has been making the email rounds with criticism of the current process) with greed in wanting to retain royalties from a book he wrote about DSM-4 which would become outdated after the release of DSM-5. I mean anyone in the business knows that book royalties pale in comparison to the hundreds of thousands of dollars to be had doing pharmaceutical industry consulting and speaking. In fact one could even argue that doing things like editing books (which have essentially no revenue, because hardly anyone buys them) is a feather in the cap that helps you get those more lucrative gigs.

One of the diagnoses on the table is Female Sexual Dysfunction (FSD), a “disease” that if accepted would surely drive the drug companies to “identify and treat” these poor lassies with drugs like the testosterone patch (see “Wow A Drug To Have Sex Once More a Month? Sign Me Up!“) or Viagra or whatever psychotropic they could drug out of the medicine cabinet.

Turns out the medicalizing women’s sexuality may not be such a good idea. There is a long and jaded history of evil meddling by medical doctors in this area. The publication of the book Feminine Forever, whose thesis was that post-menopausal women become shriveled asexual crones due to an estrogen deficiency led doctors to put an entire generation of post-menopausal women on hormone replacement therapy (HRT), which in turn was later found to have caused tens of thousands of deaths from heart attack and other problems.

Then there were Masters & Johnson, the famous sex research team who concluded that women had more frequent orgasms than men.

Masters & Johnson on Meet the Press

This “research” however was based on looking through peep holes at brothels, and later their “research sessions” they conducted with each other. Virginia Johnson was Dr. William Masters secretary, and they “partnered” to have sex on a nightly basis for “research” purposes for years. Their report on 67 patients with unwanted homosexuality showing a 70% conversion to heterosexuality using “conversion therapy” was later disclosed as a fraud when noone could find any evidence of the patients. This bizarre “research team” should hardly be taken seriously about women’s orgasms.

Turns out that the DSM-4 has ‘Female Hypoactive Sexual Desire Disorder’ and ‘Female Hypo Orgasmic Disorder’ (I mean did the guy try going down on her?) as well as Dyspaerunia (painful sex). As a recent editorial pointed out, maybe the 43% of women with some type of so-called sexual dysfunction are acting “appropriately”.

I mean, maybe they’re with jerks and don’t feel like doing it?

The American Journal of Psychiatry has been soliciting editorials on the DSM-5 process. Too bad they rejected the editorial by Robert Spitzer MD who founded the DSM, and for FSD they have only this lame piece by a trio of MDs whose pharma disclosures read like a phone book. Lol. Sort of.

Ray Moynihan had a good piece in bmj on FSD (“FSD: The Making of a Disease”) in which he outlines how industry has moved in a serious way to pour cash in the “research and education” of this newly minted disorder, the rife conflicts of interest in the field, and the attempt by drug companies to medicalize female sexuality.

The past week has been an interesting one in the psychiatry field. After I described my experiences getting “un-invited” for my post on the DSM-5 Anxiety Disorders Committee, there was this followup in the Carlat Psychiatry blog. He described his own experiences getting blocked from a practice guidelines committee of the American Psychiatric Association (when I couldn’t think of anyone more scholarly and unbiased to do it).

The cause? A comment posted anonymously on his blog stating that Alan Schatzberg, MD, had pressured the DSM committee to loosen the guidelines for psychotic depression so that there would be an expanded market for the medication for depression he developed, mifepristone. Dr. Schatzberg was in the news last year because he had an NIH grant to study the drug but also was revealed to be the owner of four million dollars worth of stock in Corcept, a company that he co-founded and that makes the drug. Dr Schatzberg has since stepped down as Chair of the Department of Psychiatry at Stanford, source of the complaint against me that, yes, I had brought up two of the member of the DSM Anxiety Committee in the context that they were from Brown and Dartmouth, departments that were also sites of financial disclosure issues, so add to that my own university (which cannot be named), we pretty much have brought the circle to completion for the universities involved in last year’s financial disclosure broo ha ha. Also last week the CL Psych blog noted that Dr. Schatzberg in his speech accepting the Presidency of the APA stated that:

…some of the detractors in the press have voiced concern that some folks have earned too good a living, often by doing presentations…I have heard from colleagues and directly from one reporter asking me about one of my colleagues having too high an annual income…our members and residents have never taken vows of poverty…We need to ask ourselves how we have contributed to our own devaluation with which others seem to resonate, and we need to reverse the course. The rewards for our dedication should not be limited to a sense of pride, but we are also entitled to be paid commensurate to the challenge…

It doesn’t seem to me that Dr. Schatzberg has gotten the point that the American public is fed up with academic physicians been paid large sums of money from private industry and using their academic positions to promote their own and their industry partners financial advantages, especially if it impacts on patients. But there hasn’t been a lot of soul searching in psychiatry these days. I guess they’d rather spend their time getting people like me to shut up.

An interesting Anonymous followup comment to Dr. Carlat’s posting I was talking about earlier said that he shouldn’t wonder that people didn’t want him on their committees as he might use things he learns about in secret as “fodder” for his blog which he described as highly read. He also said you “can’t have your cake and eat it to.” Wa-aa? You mean if you want to be honest and transparent that you can’t serve on one of the APA committees? I guess because by implication they are corrupt and operate like the mafia? Hmmm, gonna go have some cake and think about that one…

Lolcat CAN have his cake and eat it too!

I have been following the death of Michael Jackson, and not only it [possibly] illustrates the death of another celebrity from prescription medications, but it also shows the importance of childhood abuse and neglect, and how the jerks who perpetuate it get off scott free.

Michael’s father, Joe Jackson, used to watch them rehearse and beat them with a belt if they did something wrong. He would trip them and push them into walls. One time he picked up Michael by one leg and beat him on the buttocks and legs. He took the proceeds of the Jackson 5 for himself. Just looking at Michael’s behavior as an adult it is obvious that he was a victim of childhood abuse.

But then, just in case you were unsure about this jerk, when interviewed by CNN after his son’s death, he said “we’re fine” and then went on to glibly promote his own new record company, taking advantage of the opportunity to be on the camera to promote his own business!

If this man doesn’t crawl under a rock, someone should suggest it to him strongly.

Joe Jackson is beyond redemption

Here is Joe Jackon with the Rev. Jesse Jackon (no relation?) after Michael’s death outside his home. I always thought that Rev Jackson was a twit. What is he a Reverend of anyway? The religion of his own ego?

Jessie Jackson and Joe Jackson (the father) laughing outside the home of Michael Jackson after his death.

After yesterday’s post on the Diagnostic and Statistical Manual (DSM) process “Retaliations and Beware of the Consequences” blew through the roof for record page views and stimulated similar confessions from other psychiatric bloggers about bullying by members of the American Psychiatric Association (APA), as well other commentary here and here and here. I seem to have wandered from a fairly tongue in cheek exercise in the DSM Shadow Team, founded to track the goings on of a secretive committee and have a little fun in the process, into a field of landmines.

This new article by Allen Frances, MD, who chaired the DSM-4 committee, criticizes the secretive approach by the current DSM-5 chair David Kupfer MD, who has insisted on secrecy, no note taking, confidentially agreements, and now I would add bullying of psychiatrists like myself who offer outside commentary. Dr. Kupfer has built up the Department of Psychiatry at the University of Pittsburgh into a research machine through developing the infrastructure of administrative personnel who help with the process of writing and submitting research grant applications for funding by the National Institute of Health (NIH). He is said to call out a “priority score” whenever he hears someone present research. Grants coming from Pittsburgh have the reputation of being technically excellent but not always exciting. It seems like he has brought this mass war enterprise approach to the DSM.

David Kupfer, MD, Chair of the DSM-5 Committee

All of this has gotten me reflecting on academic freedom. I mean, have not one but three organizations telling me to shut up (not counting the people in my personal life): the VA, my university (that which cannot be named here) and academic psychiatry. To whit, I am supposed to get approval to talk to the press from my local VA PR guy, but what this amounts to is that when I get contacted about something that they care about (i.e., Iraq), they shelve it and never get back to me. I mean, if you don’t think that pointing a gun at someone, pulling the trigger, and killing them can’t wreck your marriage or make you suicidal, that’s not my problem, so I don’t really get excited about getting censored about that stuff.

The current behavior of academic psychiatry in the DSM process is more troubling. By stiffling debate and creating a corporate type approach they are going against the very principles of science and academic freedom. One can only conclude that they feel insecure about the validity of their deliberations.

I also get upset about what I feel is my university treating me like an employee of a corporation rather than a professor in a university. I mean they should be glad to have their name associated with this blog when contrasted with other situations in which their name was associated with more questionable practices and they never said anything about it. For shame. And there are other professor bloggers who are much more lippy than I am and they list their universities on their blogs.

There are numerous examples of where a failure of academic freedom for exchange of ideas has had disastrous consequences, e.g. 30 million die in China applying Lisenko’s bogus scientific theories to agriculture which results in mass famine. In fact there is an organization dedicated to academic freedom. This is from wikipedia.

AFAF (Academics For Academic Freedom) [3] is a campaign for lecturers, academic staff and researchers who want to make a public statement in favour of free enquiry and free expression. Their statement of Academic Freedom has two main principles:

1. that academics, both inside and outside the classroom, have unrestricted liberty to question and test received wisdom and to put forward controversial and unpopular opinions, whether or not these are deemed offensive, and
2. that academic institutions have no right to curb the exercise of this freedom by members of their staff, or to use it as grounds for disciplinary action or dismissal.’

AFAF and those who are part of the campaign believe that it is important for academics to be able to express their opinions – not just full stop, but to put them to scrutiny and to open further debate. They are against the idea of telling the public Platonic ‘noble lies’ and believe that people should not be protected from radical views.

Well said.

I just found a way to save 25 billion dollars a year for President Barack Obama’s healthcare plans. That is to cut out angioplasty (currently called percutaneous coronary intervention, or PCI), for which multiple studies, including one in the June 11 edition of the New England Journal of Medicine, show are not useful for patients with stable coronary artery disease (CAD). The mounting evidence that angioplasty is not more effective than medication treatment alone in preventing heart attack and death in people with stable heart disease doesn’t stop doctors from performing them.

In this procedure doctors put in a guideline in the coronary arteries and blow up a balloon that flattens plaque against the wall of the artery and opens up the artery or they insert a stent to keep the artery open. Sound good and makes sense, too bad it doesn’t work.

“There are people in the cardiology community who don’t believe the results. They don’t believe it applies to the patients they see,” Dr. Judith S. Hochman, director of the Cardiovascular Clinical Research Center at New York University School of Medicine, was quoted as saying. “So we still see a lot of angioplasty being done without patients really understanding that it will not reduce their chances of heart attack or death.”

But I’ll give the reason why they still perform 1.2 million of these procedures every year. It is pretty simple really. Greed.

Nancy Nielsen MD, President of the AMA, opposes healthcare reform

Doctors always say things like they don’t believe the data, or that isn’t the way it is in my practice. Since they won’t believe in science, data or reality, maybe we should just play their game and use some wizadry to get them to do the right thing and stop doing these useless procedures.

When I count to 3 you will stop performing angioplasties

Or maybe one of the Obama guys should have some guts and stand up and say we’re not gonna pay for those things anymore.

[Update: see comments section for reference to acute coronary events where PCI has demonstrated efficacy and citation by Marilyn Mann which was made immediately after I posted this on June 25 which I assumed was sufficient for anyone reading this; that didn't stop a cardiologist in another blog from going on the attack and saying that since the COURAGE trial showed lack of efficacy in reducing heart attacks in stable coronary disease these procedures have declined. Even so they are still estimated to be about 1/3 which is too many and some cardiologist lately have gone to jail for performing PCI on people with little or no heart disease. So my initial statement that 25 billion dollars could be saved is not correct. It is more like, um, 8 billion.]

An article in press in Psychiatric Times which I have posted here has been circulating around that represents a remarkable critique of the process of revising the Diagnostic and Statistical Manual (DSM-5) by the American Psychiatric Association, Chaired by David Kupfer MD. What’s more chilling is that it is authored by Allen Frances, MD, who chaired the committee to write DSM-4. Dr. Frances comes up with some pretty strong language, e.g.:

The work on DSM-5 has, so far, displayed an unhappy combination of soaring ambition and remarkably weak methodology.

He then goes on to explode the statements by Kupfer that the DSM-5 will lead to a “paradigm shift” in psychiatry, which he describes as an “absurd statement” based on the fact that there still is not a single lab test for diagnosis, and the gains are small and incremental in descriptive research. In the absence of evidence, changes in diagnostic criteria are arbitrary and often driven by a single strong member of the sub-committees. Furthermore, the incorporation of sub-threshold diagnoses as official psychiatric diagnoses will be a “bonanza” for drug companies who will expand their markets to new legions of the “newly” mentally ill and rush to “educate” doctors about the new criteria, which they will use to expand drug usage. It will also serve to expand stigma. The cost to research of having to re-do studies because the diagnosis has changed, or unintended consequences of diagnostic changes, are good arguments for his point that one should do as little as possible to change things. 

Dr. Kupfer, however, was quoted as saying “There are no constraints on the degree of change.” Instead of being conservative and guarding against new and goofy diagnoses, they are letting the barn doors fly open. To whit, prodromal syndromes like “pre-psychotic” or at risk for mood disorder are being considered as diagnoses, which will create a whole group of “non-patient patients” who will be forever labeled even if they never develop the disorder. Also behavioral impulses like excess of food, sex, internet, or whatever are up for grabs as diagnoses. That will take something that is a moral problem and turn it into a medical disorder. Dr. Frances writes:

Getting as much outside opinion as possible is crucial to smoking out and avoiding unforeseen problems. We believed that the more eyes and minds that were engaged at all stages of DSM-IV, the fewer the errors we would make. In contrast, DSM-V has had an inexplicably closed and secretive process. Communication to and from the field has been highly restricted. Indeed, even the slight recent increase in openness about DSM-V was forced on to an unwilling leadership only after a series of embarrassing articles appeared in the public press. It is completely ludicrous that the DSM-V Workgroup members had to sign confidentiality agreements that prevent the kind of free discussion that brings to light otherwise hidden problems. DSM-V has also chosen to have relatively few and highly selected advisors. It appears that it will have no Options Book to allow wide scrutiny and contributions from the field.

The secretiveness of the DSM-V process is extremely puzzling. In my entire experience working on DSM-III, DSM-III-R, and DSM-IV, nothing ever came up that even remotely had to be hidden from anyone. There is everything to gain and absolutely nothing to lose from having a totally open process…

I have decided to write this commentary now only because time is beginning to run out and I fear that DSM-V is continuing to veer badly off course and with no prospect of spontaneous internal correction. It is my responsibility to make my worries known before it is too late to act on them. What is needed now is a profound mid-term correction toward greater openness, conservatism, and methodological rigor. I would thus suggest that the trustees of the American Psychiatric Association establish an external review committee to study the progress of the current work on DSM-V and make recommendations for its future direction.

Pretty strong language.

Add to Dr. Kupfer’s strategy of: 1) keep everything a secret; 2) make members sign confidentiality agreements; 3) allow no note taking; 4) ignore outside experts and comments; we can now add, 5) intimidate and ostracize academic psychiatrists whom you can’t ignore.

Readers know I have been writing about the DSM Shadow Team to keep track of the goings ons of the “real” DSM. Well apparently a post I wrote about a proposed Developmental Trauma Disorder in children really ticked them off, as I got an email from someone on the DSM Anxiety, OCD, PTSD and Dissociative Disorders committee whom I thought was a ”friend” un-inviting me to be an author on a paper about another topic (that was after I had already spent several days working on the paper). My crime? Stating that two of the committee members were from Brown and Dartmouth, where psychiatrist colleagues of theirs had gotten caught up in financial misconduct allegations. And one of them tried to kill himself. Seems like a lot of academic psychiatrists are doing that these days.

I have people point out to me all the time the fact that I come from a psychiatry department which has financial disclosure problems, like this one at Gooznews, and they usually make no effort to avert any implications about it, but I stand up and take it like a man.

The other thing that gets me is that the paper I was “invited” to co-author was a response to (drumroll) another one written by some psychologists on the relationship between dissociation and trauma and that I was invited because (drumroll) I had written a post about the paper critiquing it in my own unique and photo-shoppy way. Fact is I got an email from one of the psychologist authors of the paper calling me puerile and stating that he was embarassed to be from the same university… but inviting me to write a response for the journal… which I am doing now… hemph. I mean psychologists can get pissed but still debate… as for psychiatrists… well.

What was particularly chilling about this episode is that the email was copied to all the members of the committee, implying that I was now persona non grata and should be shunned by what are in fact my peers in the anxiety disorders and trauma community of academic psychiatry. I was debating whether to talk about this here but to take this “hit” in silence just re-inforces the mafia type atmosphere of bullying and intimidation that rules the day in academic psychiatry. This lack of transparency and honesty and abuse of power has led to the dreadful situation which academic psychiatry is in today, where they are universally despised by try and play it off as the evil machinations of scientology and other conspiracy theories. I, for one, however, am not going to play along with that game anymore.

Who knows, they may have been behind the anonymous letters sent to the Dean of my university complaining about another post that led them to ask that my university’s name be removed from this blog with which I complied, or the threats to go to the state medical board.

[Update: See Dan Carlat MD blog for followup to this post].

I have had someone writing to complain about my blog stating that Philip Dawdy needed to smoke for his mental condition and that he shouldn’t be kicked out of his appartment for smoking. I mean he is smoking in the privacy of his own home. Why should those Seattle Eco fascists be able to kick him out of his own home?

Anyhoo I have had official letters of complaint to the Dean of my university and the acting chair of my department and they have asked me to remove the name of my university and letterhead from my blog with which I have complied. So if you want to know my university you can use google.

Nancy Nielsen MD, President of the AMA, opposes healthcare reform

———————–
Today’s NYTimes carries letters from 6 doctors expressing their deep
criticism of the foot dragging on plans for a major overhaul in health
care financing.

The last letter refers to the Times Op-Ed piece on the same subject
appearing yesterday (11 June) by columnist Nicholas D. Kristof. I’ve
copied his column in addition for your convenience.

Resolving this mess could be a great boon to communities trying to deal
with cardiometabolic disease — especially diabetes.

Henry
=====================================================

The New York Times

————————————————————————
June 12, 2009 — Letters

One Health Battle: Doctor vs. Doctor

To the Editor:

Re “Doctors’ Group Opposes Public Health Insurance Plan
ctors%E2%80%99%20group&st=cse>”
(news article, June 11):

The American Medical Association has done it again, coming out on the
wrong side of history regarding health care in the United States.

Whether whipping up fears of “socialized medicine” or more sophisticated
expressions like “government control of health care,” the A.M.A. has
opposed every progressive change in health care financing, including
Medicare, which we now take for granted.

But most doctors do not belong to the A.M.A., and the A.M.A. does not
speak for many of us who believe that the United States should join all
other Western countries in providing universal health care.

Jay V. Solnick
Davis, Calif., June 11, 2009

The writer, a medical doctor, is a professor in the departments of
medicine and microbiology and immunology, University of California,
Davis.

*

To the Editor:

The rationale of the American Medical Association in opposing a public
option in the Obama health reform plan is that a public option will
increase government spending and, by decreasing private insurance
penetration, decrease “choice” (though since people will have the choice
to select the public option that is not a rigorously logical argument).

The true rationale is the fear of decreased reimbursement as the
government gains more control of the health care economy.

This lobbying by the A.M.A. goes back many decades; the association
fought all prior attempts at universal coverage and was also dead-set
against Medicare.

As a doctor, I am disappointed but not surprised. The A.M.A. has always
been a trade association first and a force for quality and access a
distant second.

Robert Weisberger
Richmond, Va., June 11, 2009

*

To the Editor:

You report that the American Medical Association said it “does not
believe that creating a public health insurance option for non-disabled
individuals under age 65 is the best way to expand health insurance
coverage and lower costs.”

Well, what is the best way?

As an uninsured 25-year-old, recently laid off from one of two part-time
jobs, I would like to know exactly how the A.M.A. proposes that I get
health insurance.

It is despicable to see an organization of doctors oppose the creation
of affordable health coverage without proposing an alternative.

Clearly, the private market has got its moral priorities mixed up, and a
public system is the only way forward. Health care is a human right.

Lee Gargagliano
Chicago, June 11, 2009

*

To the Editor:

The private insurance infrastructure drains nearly a third of health
care resources into operational costs, advertising, executive
compensation, profits and huge bureaucracies designed to deny health
care to the sick.

What the United States really needs is a fully public insurance system,
not just a public option.

This would lower overall costs, provide patients the option to see any
doctor, and liberate doctors from the constant hassles of dealing with
insurance companies.

In a public insurance system, the American Medical Association would
have an important role in advocating for adequate reimbursements for
doctors.

The A.M.A. has said it won’t even support a public insurance option in
health care reform. That’s an example of why most physicians don’t
belong to the A.M.A., and why I don’t. The A.M.A. does not speak for me.

Paul Quick
San Francisco, June 11, 2009

*

To the Editor:

I read your article with interest. As a young physician, I decided not
to join the American Medical Association as a personal protest against
its consistent opposition to meaningful health care reform that does not
meet the parochial interests of physicians.

The A.M.A. just gave me a reason to regret having never joined the
organization: now I cannot resign in disgust.

Richard Gomberg
Newton, Mass., June 11, 2009

*

Meanwhile, in Canada …

To the Editor:

Re “This Time, We Won’t Scare
20time,%20we%20won%E2%80%99t%20scare&st=cse>,”
by Nicholas D. Kristof (column, June 11):

Mr. Kristof’s assertion of national courage captures the telling
clinical benefits of the Canadian health care system.

One might also mention that the benefits of a national health care
system will provide immense economic efficiency and advantage for
businesses, which are otherwise challenged to provide alternate forms of
profit-driven health care.

John Jarrell
Calgary, Alberta, June 11, 2009

The writer is a professor of obstetrics and gynecology at the University
of Calgary and a former chief medical officer, Calgary Health Region.

*

To the Editor:

The lack of a coherent national health care policy has pitted us all
against one another when it comes to financing and allocation of
resources.

Insurance companies just care about profit, and throw roadblocks into
the paths of patients. Health care professionals are under tremendous
stress, lessening, or even obliterating, the quality of mercy in the way
patients are treated.

If as a nation, we come to our senses and decide that health care should
be primarily for people and not for profit, we’ll not only have to do
practical things, like study how the Canadians successfully accomplished
national health care so that we’re not reinventing the wheel; we’ll also
have to retrain our minds to not look upon one another as enemies when
illness enters the picture.

“The quality of mercy is not strained” – if you’re Canadian or Swiss or
British or French.

Arthur Chertowsky
Brooklyn, June 11, 2009
====================================

The New York Times

————————————————————————
June 11, 2009 — Op-Ed Columnist

This Time, We Won’t Scare

By NICHOLAS D. KRISTOF
/nicholasdkristof/index.html?inline=nyt-per>

Perhaps you’ve seen those television commercials denouncing health care
reform as a plot to create a Canadian-style totalitarian nightmare, and
you feel a wee bit scared.

Back in the election campaign, some people spread rumors that Barack
Obama might be a secret Muslim conspiring to impose Sharia law on us.
That seems unlikely now, but what if he’s a covert Canadian plotting to
impose … health care?

Rick Scott, a former hospital company chief executive, leads a group
called Conservatives for Patients’ Rights . He
was forced to resign as C.E.O. after his company defrauded the
government through overbilling and is now spending his time trying to
block meaningful health care reform by terrifying us with commercials of
“real-life stories of the victims of government-run health care.”

So here’s a far more representative “real-life story.”

Diane Tucker, 59, is an American lawyer who moved to Vancouver, Canada,
in 2006. Like everyone else there, she now pays the equivalent of just
$49 a month for health care.

Then one day two years ago, Ms. Tucker was working on her office
computer when she noticed that she was having trouble typing with her
right hand.

“I realized my hand was numb, so I tried to stand up to shake it out,”
she remembered. “But I had trouble standing.”

A colleague called 911, and an ambulance rushed her to the nearest
hospital.

“An emergency room doctor met me at the door, and they took me straight
upstairs to the CT scan,” she recalled. A neurologist explained that she
had suffered a stroke.

Ms. Tucker spent a week at the hospital. “The doctors were great,
although there were also a couple of jerks,” she said. “The nursing
staff was wonderful.”

Still, there were two patients to a room, and conditions weren’t as
opulent as at some American hospitals. “The food was horrible,” she
said.

Then again, the price was right. “They never spoke to me about money,”
she said. “Not when I checked in, and not when I left.”

Scaremongers emphasize the waits for specialists in Canada, and there’s
some truth to the stories. After the stroke, Ms. Tucker needed to make a
routine appointment with a neurologist and an ophthalmologist to see if
she should drive again. Initially, those appointments would have meant a
two- or three-month wait, although in the end she managed to arrange
them more quickly.

Ms. Tucker underwent three months of rehabilitation, including physical
therapy several times a week. Again there was no charge, no co-payment.

Then, last year, Ms. Tucker fainted while on a visit to San Francisco,
and an ambulance rushed her to the nearest hospital. But this was in the
United States, so the person meeting her at the emergency room door
wasn’t a doctor.

“The first person I saw was a lady with a computer,” she said, “asking
me how I intended to pay the bill.” Ms. Tucker did, in fact, have
insurance, but she was told she would have to pay herself and seek
reimbursement.

Nothing was seriously wrong, and the hospital discharged her after five
hours. The bill came to $8,789.29.

Ms. Tucker has since lost her job in the recession, but she says she’s
stuck in Canada – because if she goes back to the United States, she
will pay a fortune for private health insurance because of her history
of a stroke. “I’m trying to find another job here,” she said. “I want to
stay here because of medical insurance.”

Another advantage of the Canadian system, she says, is that it
emphasizes preventive care. When a friend was diagnosed as being
pre-diabetic, he was put in a free two-year program emphasizing an
improved diet and lifestyle – and he emerged as no longer being prone to
diabetes.

If Ms. Tucker’s story surprises you, you should know that Mr. Scott’s
public relations initiative against health reform is led by the same
firm that orchestrated the “Swift boat campaign” against Senator John
Kerry in 2004. These commercials are just as false, for President Obama
is not proposing government-run health care – just a public insurance
element in the mix.

No doubt there are some genuine horror stories in Canada, as there are
here in the United States.

But the bottom line is that America’s health care system spends nearly
twice as much per person
.html>
as Canada’s (building the wealth of hospital tycoons like Mr. Scott).
Yet our infant mortality rate is 40 percent higher than Canada’s, and
American mothers are 57 percent more likely to die in childbirth than
Canadian ones.

In 1993, the “Harry and Louise” commercials frightened Americans into
abandoning health reform. Let’s ensure those scare tactics don’t work
this time.

*

This from a recent continuing medical education (CME):

May 28, 2009 — Blood-pressure-lowering drugs should be offered to everyone, regardless of their blood pressure level, as a safeguard against coronary heart disease and stroke, researchers who conducted a meta-analysis of 147 randomized trials (comprising 958,000 people) conclude in the May 19 issue of BMJ.

I have heard of this before through Mrs. Bremner, as there was discussion at Emory and the CDC about creating a “polypill” that would be given to the entire population to prevent heart disease. When asked why interventions like diet and exercise couldn’t be tried first the response was “we tried that and it doesn’t work”.

Which just makes me wanna say…

Argggg!!!!!

Not the polypill! Please!

The authors of the BMJ meta analysis have previously advocated that everyone over age 55 should take the polypill, which would include a statin for lowering cholesterol, three anti hypertensive drugs at half dosage, aspirin, and folic acid. Given that questions have arisen about the capacity of statins and anti hypertensive drugs to induce depression, I think they should add Prozac to the polypill.

Anyhoo according to this meta-analysis of anti-hypertension trials, giving three antihypertensive drugs will lower risk of coronary heart disease (CHD) events by 22%. What’s more, it doesn’t matter if your blood pressure is “normal” down to 110/70, you still get the reduction in CHD events.

The CME goes on to quote the study authors:

“Guidelines on the use of blood-pressure-lowering drugs can be simplified so that drugs are offered to people with all levels of blood pressure,” write Drs Malcolm R Law and Nicholas Wald (Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine, Queen Mary University of London, UK). “Our results indicate the importance of lowering blood pressure in everyone over a certain age, rather than measuring it in everyone and treating it in some.”

“Whatever your blood pressure, you benefit from lowering it further,” Law told heartwire . “Everyone benefits from taking blood-pressure-lowering drugs. There is no one who does not benefit because their blood pressure is so-called normal.”

Ya gotta wonder about the logic of these guys. First of all aspirin has repeatedly been shown to be useless for the primary prevention of heart attacks in terms of its overall risk-benefit ratio. Second of all, statins do not reduce mortality in men without heart disease and are not beneficial at all for women without heart disease not to mention that they have side effects which can be pretty significant.

Hat tip to Rick Lippin MD

President Barack Obama adressed the American Medican Association (AMA) today and stated that he was not gonna try and split up doctors from their patients or cut off their insurance plans if they liked them. You can read the entire transcript of his speech here. Obama argued that people must beware of “scare tactics and fear-mongering” that have killed healthcare reform in the past (Hi Hillary!) including the bogeyman of “socialized medicine” and said ”we know there are those who will try to scuttle” the program no matter what. He said that “because these fear tactics have worked, things have kept getting worse.” He also said that if we don’t do something about healthcare now that it will sink the country’s economy as a whole and America itself will become the next GM.

WE DRIVZ 2 DA RESKEW!

Meanwhile the quote of the day on healthcare reform was from Mike Pence (R-Ind) who said on CNN that “the government entering the private sector is like an alligator competing with a duck.” Well I’ve got some advise for YOU Ms Karen Ignagni (American Health Insurance Programs, or AHIP) direct from my South Georgia friends. The best was to get away from an alligator is to run zig zag.

Is Karen Ignagni (AHIP) ready?

Everyone was shocked when Bill Maher made fun of Obama and I watched him live on MSNBC tonight and couldn’t agree more when he said that Obama should have some guts and stand up for what is right, that he doesn’t need the help of the Republicans, and that the AMA is a lobby and “they are not your friends.” Here, here.

Nancy Nielsen, MD, Director of the AMA

Other news came from the Congressional Budget Office who said that healthcare reform would cost one trillion over ten years and insure an additional 16 million people (i.e. not all of the 50 million uninsured). Republicans of course jumped on this. And now the rhetoric has become “government take over” v “public option.”