A Plan That Couldn't Fail

The "World's Oldest Mom" is dead. Carmen Bousada, a Spanish woman who gave birth to twins when she was 67, passed away recently. You might not remember her but she was the lady who lied (just a little) in order to receive donor eggs and sperm in the Los Angeles. She said she was 55 years old. I guess checking ID is too much for these places. Anyway, now her two-year old boys are orphaned. Yeah, that was a plan that couldn't fail. It really goes to show you that these fertility clinics (think Octomom) are mills trying to make some cash. What will people be calling Carmen now? Decayomom, Postmortomom? Any ideas? Too soon?

The Future of Medicine by Michael Gorback MD

The above chart shows how the proposed health care system currently working its way through Congress will be organized. It can also be found here . I have seen the future of American Medicine and it's . . . . neurofibrillary tangles. That's right, the new health care system is based on Alzheimer's Disease.

Making Sacrifices

America is a very unique country. In only a little over 200 years we have become a world power in almost every category measurable. It seems, however, that we are becoming more and more demanding as a people. I have many friends, family members and patients who live by the credo: I want what I want, when I want it, and I want it for free. I am sure that I feel the same sometimes so I am not an innocent man. It just seems to me that we all need to take a big breath and look at the big picture when discussing a new healthcare system. That will not be easy for physicians. Heck, it won't be easy for anyone. In a recent USA Today/Gallup poll, the majority who responded felt controlling costs should be the legislation's top goal but more than nine in 10 oppose limits on getting whatever tests or treatments they and their doctors think are necessary. Those two things are diametrically opposed to one another. That isn't really helpful. It reminds me of a poll of patients where the study showed that patients wanted more time with their doctor but also to be able to get into the doctors whenever they wanted. Hello? Without making some sacrifices, there will be no change for the better. In my opinion, Congress shouldn't worry about making everyone happy......just me.

As Long As It Is Not Me

I don't like politicians. I especially don't like Charlie Rangel. Not that he has done anything to me personally. There are just some people in this world that make me not trust them. Besides, why is Charlie still in Congress after all his questionable ethics anyway? Let's get past that for a minute. Politicians are not stupid people. They know that they can pass laws if they can spin it so most of the population doesn't feel affected. The whole NIMBY phenomenon comes to mind (not in my back yard). If you want to put a toxic waste dump in someone else's back yard then that would be fine - especially if that person is rich. The newest toxic waste dump is Charlie's healthcare proposal. The proposal calls for a surtax on individuals earning at least $280,000 in adjusted gross income and couples earning more than $350,000. That does NOT affect most people and will NOT affect me. The problem, however, is that is just the start. Once Congress passes the bill and realizes they need more money they will just start lowering the thresholds to capture more and more taxes. Obama did the same thing with the income tax rate which have already been lowered. This is what I see happening. Remember, I have been called Nostradougus for my psychic ability to see the future. Initially, a new public option will have some rationing to save money. But what if some group of individuals, think ACLU, sues to have this rationing removed? Then you have to tax people some more and the best way to do that is to lower the thresholds. This is a slippery slope. Remember, once Charlie's foot is in the door, his hand is not far from your pocket (and wallet).

Billy Jean for Docs

(from the writers of the Placebo Journal)

Michael Jackson

Was not my patient

I'm just a doc

They think that I am the one

But wasn't my prescription

People always told me

Be careful who you treat

Don't go around writin' Propofol

People always told me

Be careful what you do

But when the dollars came through

I didn't have a clue -- hey hey

Michael Jackson

Was not my patient....

I'm just a doc

They think that I am the one

But it wasn't my 'scription



People always told me


Be careful who you see


Don't go around writin' lots of narcs





But he danced into my office


And I was deep in debt


He didn't seem a threat


He just wanted Percocet (hey, hey)





Michael J was not my patient


I'm just a doc


They think that I am the one


But it wasn't my 'scription (hee, hee, hee -- Ow!)

Medical Tweets

My kids have been mocking me because I admitted that I use Twitter for Placebo Journal related material. To be honest, I thought I wouldn't be using it when it first came out. Who wants to know my thoughts? Hell, who wants to know anybody else's thoughts? Yet, I succumbed to the pressure and have been "tweeting" now and then. It can get out of hand, though. Athletes are using it, and getting it to trouble, during games. Actors are using it. Now some surgeons and staff are using it. Recently, at Children’s Mercy Hospital in Kansas City, the surgical team tweeted live updates from the operating room. Examples included:

• Dr. Singhal is scrubbing in to prepare for the surgery


• So far, Dr. Singhal has made an incision on 1 side of the patient’s neck, & the team is preparing the tissue expanders for insertion.


• Dr. is pleased with the insertion of the 1st expander. He’s starting on the 2nd incision now


• Dr. requested another suture for 2nd incision, and is preparing to insert the expander.


• By inflating the expanders over time, new skin will continue to stretch and grow.

I was thinking, wouldn't it be great if the tweets were ACTUALLY what the doctor and staff were really thinking? Now that is something I would love to follow closely. Examples I could see being tweeted would be:

• Damn, my back is killing me


• Dr. Laird has horrible breath


• Look at those cans


• Who farted?


• The thigh bone is connect to the...what was that aga...oh, yeah...the knee bone


• Is the anesthesiologist asleep again?

What A Surprise!

China has been guilty of tainted dog food, tainted human food, tainted medicine and even tainted building supplies. Here is something else that fits right along. The Chinese Cochrane Centre at Sichuan University, and the China and Ottawa Hospital Research Institute investigated the clinical trials published between 1994 and 2005 in China. They found that 93 percent of the 2,235 RCTs (Randomized Controlled Trials) were flawed, and fewer than 7 percent met the criteria for authentic RCT randomization. Should we really trust anything that comes out of China anymore?

Cannot Be Contained

A program in England to prevent teenage pregnancy was halted as it not only didn't succeed in its goal but actually showed an increase in pregnancies. This was reported in the British Medical Journal. The Young People's Develop Program was modeled after a similar one in the US and had high expectations. Instead, the teens over the pond had sex earlier, and reported a higher expectation of becoming a teenage parent. It reminds of the movie Jurassic Park where the dinosaurs, no matter what precautions were taken, still found a way to reproduce.

If there is one thing the history of evolution has taught us it's that life will not be contained. Life breaks free, expands to new territory, and crashes through barriers, painfully, maybe even dangerously. - Dr. Ian Malcolm

Egg Donations

There is big news out of New York for the science world. The state will now allow taxpayer-funded researchers to pay women for giving their eggs for embryonic stem cell research. You heard that right. They are going to pay them. Why? Well, solicitations for the free donations for these eggs have come up empty. Nada. Goose egg. So, by offering $10,000, the state of NY believes they have answer. The opponents to the plan feel this could lead to exploitation of some women who in a down economy would do anything for cash. The USA Today is reporting that this is a real phenomenon with a definite spike of interest since February. That is countered with arguments that payment is already given in fertility cases – think of Michael Jackson’s kids – where cash is paid for eggs without any henpecking. So the battle lines are drawn but the voice that is now being heard, to no surprise, is the one from men. What could their issue be? Simple (and I know I am walking on egg shells here) but the difference in what men and women get paid in this arena is huge. Women get $10,000! Do you know the cost of the donation at a sperm bank? $100! Now does this mean we as men are worth a 100 times less? This is the kind of scrambled thinking that can get people in trouble. The answer is maybe. What men must understand is that the procedure to extract the eggs for women is much more difficult and not always successful. As they say, you may have to break a few eggs to make and omelet and that rings true for women as this procedure can only occur once a month and comes at the price of hormone injections as well a particularly painful procedure to extract them. Obviously, for men, that is not the case. I once knew a guy in college who donated so often that if it was made into an Olympic sport he would have been disqualified for being a “professional”. So for this issue men need to stop whining because no one is listening. As Margaret Thatcher once said, “The cock may crow but it's the hen who lays an egg”. I have no idea what that means but it was the only way I could end this entry.

A Little Knowledge Can Be A Bad Thing

Here is a scary example of the damage someone can do when she has inside knowledge. Kristen Diane Parker faces criminal charges for swapping her own dirty syringes for ones filled with Fentanyl, a really powerful narcotic. It that wasn't bad enough, she may have exposed thousands of people to Hepatitis C! At least nine have tested positive so far. Evidence is showing that Parker, a scrub tech, may have done this at two different ambulatory centers in Colorado. It is scary when an addiction is so strong that it not only destroys your own life but makes you oblivious to that fact that you are destroying other lives as well. Actually, that is basically the definition of addiction. Sorry. Maybe even more problematic is the fact that Parker was not caught earlier by anyone in the medical system. She obviously was fired by from her first employer. Is it possible that the Rose Medical Center knew she was doing these tricks and didn't warn anyone? I smell lawyers in the water.

Alexis Arguello

I just found out that my hero as a youngster committed suicide. Alexis Arguello was one of the best fighters ever and was one of the nicest people in the sport of boxing. His skill was beyond belief. He was a thinking man while in the ring and became a legend while he won championship after championship. I first started looking up to Alexis after the Boom Boom Mancini fight when he knocked Ray out and was a complete gentleman after it was over. He consoled Mancini, who had dedicated the fight to his Dad, and then Arguello engaged the senior Mancini in a heart warming moment. Arguello, like Ted Williams, even retired from boxing for a stint to he could fight for his country. That story is longer than I want to tell here but HBO did a great special on Arguello/Pryor and mentions this in more detail. I was a huge boxing fan in the 80's and I met Arguello at a function in New York. He was such a nice guy and even signed a picture of my dog and wrote, "Thanks for my name" as he got a kick out of the fact that I named my pet Rottweiler (Alexis) after him. Well, Alexis Arguello, thanks for being a great person in a sport known to have a lot of bad people. I am sad that you are gone.

Save Money. Live Better. Offer Health Insurance.

Walmart is in the news for jumping on Obama's bandwagon. They are embracing "President Obama's call for requiring all large employers to offer health insurance to their workers". I am getting too cynical in my old ago because I really am suspicious of this. The first thing I think of is what angle Walmart is going for here and what is their ulterior motive? The USA Today article states that Walmart is trying to improve its image regarding worker treatment so I guess that is a good thing. They also want to block any proposal that would have employers pay the Medicaid costs of new hires. Maybe that is the issue right there. Or maybe requiring large employers to pay health insurance for their workers (which I agree with) would make a bunch of companies go bust. That would leave less companies standing. Now who would that benefit? Hmmm, I wonder.

Go To Ground

Here are some results of a study that you wouldn't expect. The Journal of the American Geriatrics Society found that 87 percent of fall injuries in the elderly involved walkers and 12 percent involved canes. Yes, you read that right. Could it be that the walkers or canes are obstacles themselves? Who knows. Obviously, many older people need some assistance with their gait so I am sure the number of falls would be higher if these same people had nothing. The problem with these kind of retrospective studies is that you don't account for all the variables. It could just be that some people are so unstable and/or deconditioned that nothing is really going to stop them from "going to ground". Still, I hope this doesn't make some higher up think that motorized devices are the way to go. It seems to me that this is what got us in trouble in the first place.

Drugs For Sale

A buddy of mine told me about this couple in Houston who were selling prescription drugs for money. That is nothing new to me as I see that all the time. That is why I am leery of narc seekers. This time, however, the husband and wife were doctors! I didn't believe it but here is the link. Dr. Arun Sharma and his wife, Dr. Kiran Sharmai, were illegally prescribing more than 600,000 pain pills and billing the government more than $8 million for medical care that was never performed. How the hell does that happen and how does noone know about it for so long? The word on the street is that the DEA missed this and the local cops had to be convinced (by my friend). Check this out:

"One patient received more than 8,000 hydrocodone tablets between September 2008 and April — including two prescriptions that were issued the same day."

I thought these "pill mills" were urban legends but I guess not. I may be a naive family doc in Maine who is afraid that a 99215 may draw too much attention for an audit but I never thought any doctor would stray that much to the dark side. I was wrong.