CodeBlueBlog

FAT BAND BOY TELLS ALL – BILL CLINTON’S BIOGRAPHY

It ain’t health care, but who can resist? The reviews of B.C.’s autobiography are starting to roll in.

All the news coverage I have seen so far takes pains to laud Bill Clinton for his tortuous, righteous journey to "honesty" in writing about his Oval Office perversions.

Here is a man who stood in the face of history -- when the integrity of the presidency and the nation were at stake -- and baldly lied to the American people to save his own skin; Yet, when there are millions of dollars to be made on book sales, Clinton suddenly finds the moral strength and character to admit seducing, and having sex with, a young female volunteer White House intern working in his care –- while on the job as president of the United States.

Not that he takes responsibility for this appalling turpitude. No. Rather, he points – as detailed in a recent New York Times review -- to his alcoholic father, his childhood obesity, and the insurmountable urges of power ("I did it because I could") in a mealy and contrived contrition manageable only by that loveable rake, Bill.

From The New York Times:

Mr. Clinton wrote that from a very early age he lived "parallel lives," with a public gregariousness and sunny disposition masking private turmoil and weakness.

Several times he saw his alcoholic stepfather, Roger Clinton, beating his mother and once firing a gun at her head. But he wrote that he would go to school the next day as if nothing had happened. This pattern was especially evident again in 1998, he said, when the Lewinsky affair was revealed and Mr. Clinton spent months lying to his family, his aides and the nation about it

He said that as a child he learned, too well, how to live with secrets. His family creed, he said, was "don't ask, don't tell."

He said he was disgusted by his sexual encounters with Ms. Lewinsky, which he said ended after several months when he could no longer live with himself.

Mr. Clinton writes with rueful candor about his chubby adolescence, confessing that he was once the only child at an Easter egg hunt not to get an egg, not because he could not find them, but because he could not move fast enough to compete with the other children.

He describes his youth as "a fat band boy" and recalls that in junior high school, as he began to learn more about his mind and body, some of it scared him, including his first sexual stirrings

WHAT IS A MAMMOGRAM AND HOW DOES ONE "READ" IT?

There has been so much discussion in the news about mammography, and there have been so many questions about the proceedure directed to me and raiseD in the press, that I believe a primer may be needed. Even physicians to whom I speak aren't exactly clear on just what a mammogram is, how accurate it is, how it is interpreted and by whom...and, finally, is there a future for this procerdure?

The Primer

A mammogram is, in theory, the most rudimentary of all radiological exams. First, it is a simple X-ray akin to a plain film of the chest or abdomen. Second, the organ being imaged (the breast) has no true fixed internal geography. For instance, the brain has lobes, tracts, decussations, connections; the heart has chambers, electrical nodes, valves and outflow tracts; the kidney has cortex and medulla, collecting system and ureter; the breast, in contradistinction is mostly amorphous fat and soft tissue (the glands). In other words, it has very little ANATOMY.

A plain film X-ray is like a captured shadow. If I hold my hand in front of a flashlight in a dark room, the shadow of my hand is cast on the wall. In plain film X-rays (like mammography), the hand = the breast; the flashlight = an X-ray beam; and, the wall = a piece of photographic film (to "capture" the shadow permanently).

So, you lay the breast on a piece of film and shine an X-ray on the breast and the "shadows" of the breast are cast on the X-ray film and captured.

Here's your first film-reading lesson: When looking at the X-ray mammogram, areas of fat are BLACK; areas of glands (tissue) are GRAY; and, areas of calcium are WHITE. That's all there are: 3 choices.

To interpret an MRI of the shoulder one has to understand the function of that joint in normal and abnormal states. One must know the different possible injuries, overuse syndromes, tumors, infections and more. One needs to be able to identify normal and abnormal muscles, tendons, cartilage, bone, and vessels and all of their interrelationships. It takes a radiologist the training of four years of medical school, four years of radiology residency and one year of subspecialization training to be READY to look at shoulder MRI's.

A mammogram presents 3 issues: Black, White, and Gray.

So why are there so many federal laws and regulations governing the practice of mammography?

Or, why are there NO laws governing the practice of shoulder MRI?

Next lesson: Mammograms and Cancer.

More to come...

IS THERE AN ART IN MEDICINE?

What is the "art" of medicine?

I think I know. But I'm wondering if anyone else believes what I do.

That there is no art. That saying "art" is a cover-up and has always been a cover-up for what we should never have been ashamed of in the first place:

That medicine is a science in evolution. In progress. That what was once teleological is giving way to the empirical. That this is a natural process and as it occurs the science in medicine gets stronger and the "art" gets weaker.

Like the "art" in listening to heart sounds versus an echocardiogram; or the "art" of a physical exam versus a CT.

What's the point of this?

I believe it has everything to do with where the physician stands today knifed between public perception and corporate/government control.

If you know where I'm headed with this, join in, because I believe that it fits together as another piece of the phony, contrived health care crisis puzzle that is currently being jigsawed out of the pressed cardboard of public opinion by certain left-leaning politicians.

AN ASTUTE READER WEIGHS IN

If you do not follow the comments section then you are missing the important and astute observations of one of CBB's regular readers, Gerald.

In his last post Gerald made it clear to me that maybe a statement of direction is needed for CodeBlueBlog, because there is a point, and there is somewhere I'm going. Here is Gerald's last post, and my reply:

Gerald, from 6/13/2004:

Limit malpractice risk. What else should be done? You keep making various proposals that would rather rapidly increase the cost of health care beyond the highest in the world, growing at 6% a year (that's about three times inflation in this era). Where is this money going to come from?

CBB Reply:

How does it increase the cost of health care to limit malpractice risk on mammography? And, health care costs are not rising at 6% a year if you look at the long-term charts.

I have many specific ideas on how to balance health care and spending, and I intend to make them clear.

However, because I have seen others make rational, fact-filled, markey-savvy proposals that have made no mark on the health care debate, I believe a different approach is needed. That's what my blog is about.

People don't listen to the facts. Part of the reason is the distrust of statistics. People are inundated with statistics and thus tend to discount them (the boy who cried wolf); Statistics are frequently used tendentiously, and people lose trust in statistical importance; AND, most people never learn statistics during their schooling and so are basically innumerate regarding the weight and meaning of statistics in any given argument. How else can you explain ANYONE using life longevity or infant deaths as a measure of how well our health care system operates?? And proponents for change (see Hillary's NY Times piece) do this despite the very solid refutation of these wrong-headed observations many times in many prominent venues.

I think that first, people have to realize what we have. Then they have to understand that these blind, piecemeal, reforms (or worse, a top-down solution) are vitiating, and will destroy what has been the BEST health care in the world, and in history.

To do this we have to dissect out the social issues like insurance and delivery, and respond to the care issues.

Then we have to decide what we want to pay for what we can have. THIS complex decision , as has been shown many many times over, cannot be made by any one person or any group of people no matter how smart or educated or erudite they are. THIS decision must be made -- as much as possible -- by the market.

That's where I'm going.

NEW YORK TIMES AGAIN IN CODE BLUE BLOG'S WAKE

Download june_11nyt.doc

On June 11, The New York Times picked up on a story that CBB covered a month ago: MAMMAVTIVISTS KILLING THE MAMMOGRAM As I said in CBB then:

"There is a reality radiologists have faced for several years: Mammography, performed and interpreted by experts, cannot survive. It is a technology besieged by conglomerate forces that will drive it into extinction, with many other important procedures and technologies to follow. Radiologists see four major reasons for this destructive phenomenon: HMOs, government regulations, special interest groups ( THE MAMMACTIVISTS) and trial lawyers."

It is no news that physicians no longer consider it worthwhile to interpret mammograms. I have an anecdote that may be illustrative.

A colleague of mine worked at a Kaiser organization hospital on the West Coast. At that time Kaiser had a policy that radiologists were paid $5 extra for each mammogram they interpreted. Being that the hospital did about 100 mammograms a day, this equated to a substantial sum.

Needless to say, all the mammograms were read every day; in fact, there was quite a war in the department over who actually got to read the mammograms. Often times a lottery system was used to dole out the studies.

Then, suddenly, Kaiser stopped awarding the $5 stipends. No extra money was provided for interpretation of mammography.

Within two months there was a room full of unread mammograms. Literally, a thousand mammograms lay without interpretations.

We have two choices if we want mammography to continue. We can either increase the professional reading fee or we can limit malpractice risk. Those are your choices.

This problem, I predict, will be repeated on a grander scale with MRI of the breast. A breast MRI is a super mammogram. It is extremely sensitive, but the specificity of the procedure lags the sensitivity (translation: it is good at finding abnormalities, but it is not as good in revealing which abnormality is cancer and which is a noncancerous lesion). In reality, women should be getting yearly MRIs, instead of mammograms; however, this concept remains highly unpopular because MRIs are ten times more expensive; and, with the increased sensitivity, the liability risks are magnified greatly.

And don't let's respond to all of this by claiming that a national health insurance plan will solve the problem. Suffice it to say that that type of system in England lead to mammograms being done cheaply (one view of each breast -- missing countless lesions with this technique) with a screening schedule of a mammogram every-other-year, all to save money; which, with a national system, the public had no recourse to protest or to change.

CODE BLUE BLOG SCOOPS NY TIMES

Today's Sunday NY Times contains a front page article about a new generation of pharmaceuticals expected to, finally, have a significant impact against cancer.

CodeBlueBlog brought the same matter to public attention 5/24/2004.

Of course, The Times and CodeBlueBlog have different slants on the economic ramifications of this new wave of research.

CBB believes that we should all pay more for our medications (especially anyone who is receiving an entitlement and has the means to pay more -- you know who you slot players are!). The Times, however, has another slant:

And when more of these drugs come to market, paying for them could strain the health care system, especially since some of the newer ones cost tens of thousands of dollars for a course of treatment. Bain & Company, the management consulting firm, has estimated that paying for all the cancer drugs likely to come to market would require $60 billion a year, up from $10 billion now. "The whole U.S. drug market is $150 billion," said Elgar Peerschke, head of the North American health care practice at Bain. "Who's going to pay for that? It's just going to become unaffordable."

The Times immediately starts worrying about the strain of the costs of these new drugs on the "health care system" – adding, I suppose to the ever-present, ever-worsening, health care crisis. Who is going to pay for these drugs?

I will.

I’ll pay whatever they ask.

You know, a friend of mine in college got into some serious legal trouble. His parents wanted the best lawyer they could get. That lawyer – and the defense of the case -- over the course of two years cost several hundred thousand dollars.

No one asked them if they could pay. No one quoted the legal care crisis to the family; nor did the family complain. They mortgaged their home. They traded in their stocks. They paid for the legal defense. My friend was acquitted. Ask the family now and they will tell you it was all worth it. Every penny.

We are not ten seconds into this new health care revolution and the Socialism mongers are already whining over the burden these discoveries will cause the health care system. How idiotic is that? Don’t try so hard to cure cancer because we don’t know if the system can afford to give it away free to everyone?

Rather we emulate Canada or Great Britain, and offer lots of free eyeglasses and canes, plenty of walk-in clinics for your lumbago and STD’s while clamping down the therapeutic claws of the real stuff needed in this modern era of ultra sophisticated health care: Specialists; Intensive care; High-Tech pre-emptive diagnostic evaluations; Miracle medications.

I say it again: SUPPORT YOUR LOCAL PHARMACEUTICAL COMPANY...the life you save may be your own.

Stay tuned to CBB for All The News That’s Fit to Blog…before you see it in The Times.