“You only have power over people so long as you don't take everything away from them. But when you've robbed a man of everything he's no longer in your power --he's free again.”
That is the question the thoughtful should be asking; not whether guaranteed access for all can work. Let us be honest, if you goal is improving utilitarian public health measures - life expectancy, infant mortality, time to treatment for diseases, access to care - then a single payer system could work in the United States, provided enough funding. Complaints and nay say against such a system by providers is nonsense and nothing but protection of self interest. There are tradeoffs with such a system, but there are trade offs with any health care system. Look at our current one. If you want to improve what the public would consider ‘health’ then a well funded single payer system would be far superior to our current system, no matter America’s ‘uniqueness’.
But should we do that? The real debate is should the government fund access for those who cannot afford it themselves. Who has such a right?
The Miller Center of Public Affairs tried to do that recently with a panel debate. On the transcript at times the talking heads fall short in defining the debate and staying on course, but it still something worthwhile to look at.
The move towards cost transparency is generally something I support. But there is an argument I will buy that such should be prospective. That’s the line I’m buying with the current lawsuit over Medicare provider data that some consumer groups are waging.
In an unusual statement, the Health and Human Services Department endorsed the objectives of the consumer group that is suing, but said it wanted a higher court to clarify the lower-court rulings.
“We’re caught between court decisions,” said Christina Pearson, a spokeswoman for the department. “There’s conflicting information from different courts, so we’re pushing to get clarity.”
But the government’s legal brief in the case calls for the appeals court to reverse Sullivan’s ruling, leaving the restrictions on the release of data in place.
“I know the government was under a lot of pressure from the AMA in particular, arguing that the government should appeal,” Krughoff said. “Whether that’s the reason the government appealed, I don’t know.”
I’m torn, certainly. It is much easier to speak of the private insured having a ‘right’ to such data than Medicare patients considering what the two groups shoulder in terms of personal costs and responsibility for their health care access.
It is reasonable to imagine that a physician, somewhere out there, participates in Medicare under the understanding that his reimbursement data is shielded from public eyes based on previous court rulings, and would not participate otherwise. Under such a circumstance I think the opening of the Medicare database needs to be solely prospective and not retrospective. That means the data won’t be useful for years and years, I understand that but it is probably the right way to do it.
Several in the medical blogosphere (here and here) have picked up on a front page WSJ story concerning specialist income and shortages.
Probably an overblown story.
But a look at specialist income got me thinking. Is it just me or is diagnostic radiology the specialty most likely to be disappointed over the next couple of decades? When I was writing my previous posts on physician income I started really thinking that radiology may be in for a significant slow down in earnings growth. There are two factors which I think will contribute to disappointing growth in radiologist income:
1) Their rise in income over the past two decades has been precipitous and outpaced the growth in median income of just about every other specialty. And not all of that has been driven by the rise of interventional procedures. Radiology thus, as a specialty, has some of the most to “give back,” if and when physician income growth slows as cost sharing measures.
2) The rise of outsourcing is probably a little overstated but it seems real enough. With rising healthcare costs concerns over international radiologist work (liability issues, etc) may not be enough to prevent the outsourcing trend from speeding up a bit and driving down reimbursement.
This isn’t to make a claim as to the value of radiology or to say that diagnostic radiologists are currently over reimbursed (I don’t think they are). I’m just trying to imagine the future. Radiologists will never be ‘hurting,’ but in my career I think they’ll be doing more work for less dough.
I’m No Radiologist But Something Ain’t Right Here
I have a lot of respect for the ACR and RadPAC’s efforts but diagnostic radiology may not be in a completely defendable position with some of it’s unique aspects as a specialty.
The Bottom Buddy is a device which helps the morbidly obese wipe after using the bathroom. I’ll hold my tongue a bit except to say that it probably says something about the state of and concern for public health in this country. *Sigh*
Brittney Spears underwent a very publicly reported invasion of her privacy during two stays at UCLA affiliated hospitals. As happens with celebrities many hospital employees took a look at her records without a need to.
The trouble is that physicians who did so apparently got off lighter than other employees.
[A]t least 53 UCLA staffers — including 14 physicians — looked at Spears’ medical records on the two occasions, even though they were not treating her, according to statistics from the state and UCLA officials. Eighteen non-doctors resigned, retired or were dismissed after their prying was discovered, according to data provided to The Times by UCLA. No physicians quit or were fired.
“Historically, doctors have been treated in a way that may be more lenient than non-physicians, and we will address that,” said Dr. David Feinberg, chief executive of the UCLA Hospital System.
“We will do everything possible in the future not to be accused of that.”
Watcher’s World goes over some of the reasons that physicians typically get off lighter. One of the reasons is that physicians, in the private world, are not typically employees of a hospital. They simply have priviliges to practice at that hospital and in return for such, that is where their patients get admitted when they need to be in the hospital. In this case however I would imagine that the majority of physicians with priviliges at the hospital are UCLA faculty and salaried employees. Firing them might have been a real possibility.
In anycase, the moral of the story is simple: don’t look at patient’s medical records unless you need to. No duh.
If there’s a bigger single topic discussed in the medical blogosphere than the primary care crisis I’m not sure what it is. It permeates blogs (here and here and here) and the media (here and here and here).
I do believe that the distribution of primary care physicians to specialists in this country is askew but I’ve taken a critical view of some of the claims made by the primary care community. In part there is an argument that the efforts of the organized primary care and the medical blogosphere are merely rhetoric. No one pays attention until there is a ‘crisis’ and the flamboyant and exaggerated claims on the condition of primary care are perhaps merely part of a PR campaign. But in a deeper sense I think that the ‘whining’ coming from primary care is actually contributory to the primary care crisis. I’ve made severalposts to that effect.
I thought what was in order was one summarizing post on the issue, something that might stir up some comments. That’s what I’ve put together here: the four myths of the primary care crisis.
The conclusions I reach are based on what I feel is sound data, but the post is obviously far from comprehensive. If there is data from non-interested parties that I didn’t consider or arguments I’ve ignored then let me know in the comments.
Myth #1:There Is A Worsening Shortage of Primary Care Physicians
I’m just going to flat out say it, the fact that physician bloggers and agenda minded think tanks continue to substitute anecdotal evidence of a shortage as a surrogate for the actual figures is distressing. Take this recently touted article from the WSJ. While I won’t speak to the Massachusetts experience the cited study about a nationwide PCP shortage is flimsy.
One of my biggest pet peeves is that these primary care physician-scientists seem to refuse to characterize the evidence they use in their opinions. I would hope that we can all agree that the HSC Community Tracking Study Physician Survey, cited in the WSJ article, falls short of the best evidence on primary care physician numbers. A 6000 physician sample with nearly less than a 50% response rate. Lovely.
Indeed, the HSC survey is the only original dataset put together by a non-involved entity that I can find that seems to back up a drop in the per capita primary care workforce.
While we have seen a drop in allopathic medical students going into primary care it has more than been offset by IMGs as the GAO says.
From 1995 to 2005 Using AMA and AOA Master Files and HRSA Data
There are probably regional deficiencies in the primary care physician workforce but there are regional shortages for physicians no matter their specialty and it does not speak to a systemic problem facing primary care.
Nor is there good data that demand for primary care will grow with an aging population and cause a shortage. Such predictions by organized primary care are pretty low on the pyramid of evidence. While such a deficit may pan out, trying to predict such (even if you think it is just sooooo obvious a conclusion) is notoriously difficult. Predicting the physician requirements of this nation a decade or more out is essentially impossible. See this IOM report from the mid-nineties on efforts to do such. That’s why the major players over the past decade have flip flopped on whether we need to be graduating fewer or more doctors.
Certainly, even if the above scenario plays out, it would be hard to imagine it as a “crisis.”
I think the best evidence says there is not a general primary care shortage. At least not a new one. As I said, I think we have always needed more primary care physicians in this country but the situation isn’t getting worse. The primary care per capita numbers have been maintained and probably even grown a bit over the decades thanks to an influx of international medical graduates. Let that claim rest in peace.
Myth #2: The RBRVS and RUC Are Responsible For The Primary Care Income Disparity
I’ve posted long and hard on the RBRVS and the AMA’s RUC. I admit that I do not believe that primary care physicians are compensated appropriately and I may even buy that the RUC has not done enough to fix the primary care-specialists income disparity. That being said, the evidence clearly supports that the primary care physician has not done worse versus the specialist since the implementation of the RBRVS.
The RBRVS came into existence in 1992. I think a larger review of income data backs me up but for the sake of this post let me take a couple of examples to highlight the condition of primary care before the RBRVS in 1988 versus today. The data sources are the 1988 Health Care Financing Administration’s PPCIS and the 2007 AMGA Physician Income Survey.
I understand the limitations of comparing these two survey datasets, constructed under two different methodologies by two different groups. For example, below I have to use family medicine income as a surrogate for all of primary care. Even today the major physician income surveys show some wide discrepancies but I do believe that comparing this data gives us at least a general idea that the RBRVS has not screwed the primary care physician. In the end, that is the general point of the myth - the RBRVS and RUC have been bad for primary care. Such doesn’t appear to be the case.
In 1988 all self employed Family Medicine physicians earned a median of $102,500. In 2007 the median Family Medicine physician earned approximately $185,700. That is an increase of 81% in 20 years.
That is better than the orthopedic surgeon (56%), the cardiologist (61%), the anesthesiologist (78%) over the same time frame. There are medical specialties that made off better over that time frame (see radiology) but in general the RBRVS has been progressive for primary care physician income.
Nor, in terms of hours worked, are family practice physicians working more than they did immediately pre-RBRVS.
If you include all primary care physicians the primary care physician earned 65% of what the medical specialists did in 1988 (i.e. the cardiologist, the gastroenterologist, the pulmonologist, etc) and 44% of the average income of all surgical specialists.
No the RBRVS may not have closed the gap in the income disparity completely and/or appropriately but it has made some progress and has not contributed to a worsening of the gap. The income disparity has narrowed since the advent of the RBRVS and the creation of the AMA’s RUC. End of story.
So news that ghostwriters contributed to VIGOR and other Merck studies of Vioxx are making the rounds. Here’s the WSJ Health Blog on the report. The ‘revelation’ appears in what is essentially a glorified editorial in JAMA. While I don’t know about the Vioxx studies in particular ghostwriting is not something new within medical publishing and not something I find reprehensible in general. As for what Merck did in particular the JAMA editor-in-chief is flailing out,
AMA itself published one of the Vioxx studies that was cited in Dr. Ross’s article.
In that case, in 2002, a Merck scientist was listed at the lead author. But Dr. Catherine D. DeAngelis, the journal’s editor, said in a telephone interview Tuesday that, even so, it was dishonest because the authors did not fully disclose the role of a ghostwriter.
“I consider that being scammed,” Dr. DeAngelis said. “But is that as serious as allowing someone to have a review article written by a for-profit company and solicited and paid for by a for-profit company and asking you to put your name on it after it was all done?”
Despite that much of the evidence in the published JAMA ’study’ is essentially circumstantial and at least some of the accused have come forward to say that the authors of this new study are simply downright wrong.
[A]t least one of the doctors whose published research was questioned in Wednesday’s article, Dr. Steven H. Ferris, a New York University psychiatry professor, said the notion that the article bearing his name was ghostwritten was “simply false.” He said it was “egregious” that Dr. Ross and his colleagues had done no research besides mining the Merck documents and reading the published medical journal articles.
Look, Vioxx is dead and I’m just not sure there is much to be learned for future practice. The nature of what went wrong has been sensationalized ot no end and any study of the practices which led for big bad Vioxx to harm so many people will be likewise sensationalized and of little real value in reforming pharmaceutical related research and the drug approval process.
In the spirit of Orac over at Respectful Insolence I’m posting some woo I recently ran across as I left my school’s library.
My Favorite Part: Leaving Out “Back Pain”
I have no idea the faculty involved in this research or what their funding is. I did a little Google search on Nithya Spiritual Healing and turned up a bit.
Nithya Spiritual Healing Broken Down In A Video
And here’s some about Nithyananda, the swami (?) creator of Nithya Spiritual Healing. There is more about him on Wikipedia. My favorite thing though is the disclaimers put up for anyone interested in becoming a Nithya Spiritual Healer,
Understand and acknowledge that the practice of Nithya Spiritual Healing is a religious and spiritual prayer and meditation service only. It does not involve the diagnosis or treatment of any medical or psychological conditions and does not involve the use of any physical intervention or manipulation of the human body. Any benefit that an individual experiences comes from within him or herself, based on his or her body’s ability to heal on its own.
[…]
Do not use the word “Patient” to describe someone who elects to receive your Nithya Spiritual Healing services.
[…]
If you are a licensed physician or other licensed health care practitioner, advise anyone to whom you are providing Nithya Spiritual Healing services that such services do not constitute diagnosis, care or treatment or the practice of medicine or any other health care profession. Further, do not engage or claim to engage in medical diagnosis, care or treatment or in the practice of medicine or any other health care profession in conjunction with any of your activities as an Nithya Spiritual Healing Practitioner.
Hopefully there is some private funding behind this little research endeavor and it doesn’t represent your tax dollars at work.
Oh so reluctant of the mass media’s coverage of scientific advances. Still this drug would be lovely for those requiring radiation therapy.
Mice and monkeys injected with the drug between 45 minutes and 24 hours before being subjected to normally lethal radiation were more likely to survive or live longer than untreated animals, the researchers found.
My first thought truly was the oncogenic potential of this drug but at least according to the wire piece evidence for such has not turned up.
One risk of preventing cell death is that defective cells may be allowed to survive which could then turn cancerous.
However, the researchers found no sign of this happening in the laboratory tests on mice.
Burdelya, et al describe their results in the April 11th issue of Science. You need a subscription o read it and I’ll admit although I have access through my school, at the time of posting, I have not.
A father catches the virus from his son in China. Such is what The Times is reporting, although I cannot find the case report in The Lancet Online which The Times cites. Yet. I suppose it might have a future publication date.
This is far from the first documented case of human to human transmission of bird flu, despite the Times’ health editor’s alarmist piece on the issue. There are cases of probable human to human transmission from at least 2005. I’m not sure what this specific case adds to the concern over easy human to human H5N1 transmission but it does come off another recent report of human to human transmission in Pakistan so I thought a brief bird flu update was in order.
Bright Red - Countries With Noted Avian H5N1 Infections
Dark Red - Countries With Noted Human H5N1 Infections
Human ovaries tend to shut down by age 50 or even younger, yet women commonly live on healthily for decades. This flies in the face of evolutionary theory that losing fertility should be the end of the line, because once breeding stops, evolution can no longer select for genes that promote survival.
The most popular explanation, the “grandmother hypothesis,” argues that a generous post-reproductive life span makes sense if a grandmother improves the survival and reproduction of her grandchildren…
“The problem is that these grandmother benefits aren’t big enough to ever favor stopping breeding between the ages of 40 and 50,” says Michael Cant, an evolutionary biologist at the University of Exeter in England and co-author of a new study on the genesis of menopause published this week in Proceedings of the National Academy of Sciences USA. “When you look at data from hunter-gatherers and other natural fertility populations, the sums just don’t add up.” Grandmothers do benefit their descendants, he says, but the genetic payoff is small compared with those of producing another child.
Cant and co-author Rufus Johnstone, an evolutionary biologist at the University of Cambridge in England, used game theory to argue that menopause is early cessation of reproduction that originated through reproductive conflict between generations. In most cooperatively breeding species, reproduction is suppressed in younger females, who act as helpers to older reproducing females. By contrast, they say, younger women in human social groups win the reproductive sweepstakes, because the older ones stop having babies.
“We showed that, compared to other primates that exhibit a post-reproductive life span, humans really stand out, because there is absolutely no overlap in reproduction between generations,” Cant says. “Women stop breeding on average when the next generation starts to breed.”
This makes evolutionary sense, Cant and Johnstone say, because, contrary to most mammals, young women tend to move to their mates’ communities, where they become immigrants whose only genetic kin are their own children. There is no genetic profit in helping their mothers-in-law bear more children, because they will not share any genes with those children. But an older woman who helps her son’s wife reproduce will benefit by bequeathing 25 percent of her genes to her grandchildren.
This legal argument is called pre-emption. After decades of being dismissed by courts, the tactic now appears to be on the verge of success, lawyers for plaintiffs and drug companies say.
The Bush administration has argued strongly in favor of the doctrine, which holds that the F.D.A. is the only agency with enough expertise to regulate drug makers and that its decisions should not be second-guessed by courts. The Supreme Court is to rule on a case next term that could make pre-emption a legal standard for drug cases. The court already ruled in February that many suits against the makers of medical devices like pacemakers are pre-empted.
[…]
In the fall, the Supreme Court will hear a…pre-emption case involving Wyeth, another drug company. Chris Seeger, a plaintiffs’ lawyer who has about 125 Ortho Evra cases, said he expected the court to rule in Wyeth’s favor.
The decision…does not foreclose lawsuits claiming that a device was made improperly, in violation of F.D.A. specifications. Cases may also be brought under state laws that mirror federal rules, as opposed to supplementing them.,
I have mixed opinions on this protection for drug makers. I’ve blogged on many an example of what I think is the naivete of lay juries in pharmaceutical liability cases but I’m certainly not sure that the FDA is in the best position currently to enforce full disclosure on pharmaceutical companies. It certainly is an interesting Supreme Court opinion to keep our eyes open for. If the opinion comes down on the side of big pharma I’m wondering what that might’ve meant for the Vioxx cases if Merck hadn’t settled. Maybe nothing…I have no idea.
If anyone has an informed opinion on whether FDA pre-emption of state laws (so many of the Vioxx cases were filed in federal court) would’ve had any effect on the whole Vioxx mess then please comment.
It’s no surprise that I’m not a fan of Paul Krugman. His dismissal of the potential for market forces to help reform health care is chief amongst my disagreements with his positions. In his most recent column, “Voodoo Health Economics,” he’s up to it again. His starting point is this claim,
Elizabeth Edwards has cancer. John McCain has had cancer in the past. Last weekend, Mrs. Edwards bluntly pointed out that neither of them would be able to get insurance under Mr. McCain’s health care plan.
The absoluteness of that claim might be a little far fetched. Both of these individuals have essentially unlimited financial resources and, at least in Mr. McCain’s case, could probably, with enough searching, pass the underwriting process somewhere and get insurance. Even if that insurance excluded cancer as a pre-existing condition and had extremely high patient side costs it would represent something real. The cancer screening, for these individuals, is the important thing. The poor outcomes for the uninsured with cancer are almost entirely attributable to the advanced stage at which cancer is found in the uninsured not in a lack of funding for the actual cancer care.
Mr. Krugman also brings up this age old claim,
[T]he United States has the most privatized system, with the most market competition — and it also has by far the highest health care costs in the world.
It seems to imply a cause and effect in a vacuum without admitting other contributing factors to the high cost of health care in this country.
I’m not disputing that the United States “runs” one of the least effective health care “systems” in the world but there is obviously more contributing to our comparatively high health care costs. Namely that, independent of access to care, the United States has the least healthy population in the western world (i.e. United States patients cost more on average than patients in any other western country).
And, he also praises the Veterans Health Administration. Such was in vogue recently. But I doubt Mr. Krugman has ever spent much time in a VA hospital. As most medical students I will raise my hand that I have. I’ve also had the privilege of hearing and actually speaking with (apparently former) VA Secretary Nicholson. I think I can speak for many, many medical students who have served at many, many VA hospitals in saying this is an incredibly inefficient system.
And I do mean medical students actually do something at the VA. Public health care generally runs easily whether medical students are there or not. Sometimes we even get in the way. I’m not sure that such can be said about some services at VA hospitals. There are many an example where things would’ve taken days longer to get done if I or another medical student hadn’t been there to do grunt work or make phone calls. The complete disregard for expediency, the often times lack of focus on basic patient safety efforts seems like a system wide problem despite some of the praise the VA system has gotten. With the wars in Iraq and Afghanistan dragging on such is finally getting some focus in the media,
VA hospitals are also receiving a surge of new patients after more than five years of combat. At the sprawling James J. Peters VA Medical Center in the Bronx, N.Y., Spec. Roberto Reyes Jr. lies nearly immobile and unable to talk.
[…]
Maria Mendez, his aunt, complained about the hospital staff. “They fight over who’s going to have to give him a bath — in front of him!” she said. Reyes suffered third-degree burns on his leg when a nurse left him in a shower unattended. He was unable to move himself away from the scalding water. His aunt found out only later, when she saw the burns.
Anecdotes of course but there is good evidence that such problems actually affect patient outcomes.
Measuring comparative outcomes in VA patients is difficult. VA patients are more likely to be homeless, to make far less use of care, to make use of care at a later stage of disease versus Medicare patients and just generally are sicker than their counterparts out in Medicare. That said, when trying to control for these there is some evidence that in several key disease states they do worse versus their Medicare counterparts. For example, heart attacks.
Yet Mr. Krugman extends praise over the system,
As I’ve mentioned in past columns, the Veterans Health Administration is one of the few clear American success stories in the struggle to contain health care costs. Since it was reformed during the Clinton years, the V.A. has used the fact that it’s an integrated system — a system that takes long-term responsibility for its clients’ health — to deliver an impressive combination of high-quality care and low costs. It has also taken the lead in the use of information technology, which has both saved money and reduced medical errors.
Sure enough, Mr. McCain wants to privatize and, in effect, dismantle the V.A. Naturally, this destructive agenda comes wrapped in the flag: “America’s veterans have fought for our freedom,” says the McCain Web site. “We should give them freedom to choose to carry their V.A. dollars to a provider that gives them the timely care at high quality and in the best location.”
That’s a recipe for having healthy veterans drop out of the system, undermining its integrated nature and draining away resources.
Draining away resources? What resources? These veterans aren’t (and rightly so) generally paying for their care. It isn’t like an insurance system where having healthy veterans in the pool subsidizes the sick.
Okay, the points above are, in some part, merely semantics but you have to wonder about the soundness of the rest of his arguments when Mr. Krugman makes examples like those above.
A vital barrier between the brain and the main blood supply of rabbits fed a fat-rich diet was protected in those given a caffeine supplement.
The University of North Dakota study used the equivalent to just one daily cup of coffee in their experiments on rabbits.
After 12 weeks of a high-cholesterol diet, the blood brain barrier in those given caffeine was far more intact than in those given no caffeine.
“Caffeine appears to block several of the disruptive effects of cholesterol that make the blood-brain barrier leaky,” said Dr Jonathan Geiger, who led the study.
“High levels of cholesterol are a risk factor for Alzheimer’s disease, perhaps by compromising the protective nature of the blood brain barrier.
“Caffeine is a safe and readily available drug and its ability to stabilise the blood brain barrier means it could have an important part to play in therapies against neurological disorders.”
All the cola, coffee and energy drinks I gulp are probably doing me a some bad as well.
While I’ve posted on and linked to some of the risks of caffeine, the drug actually has a lot of upside. Despite common misconception it is not apparently linked to heart attacks (or other heart problems) and actually is relatively safe. On the plus side it may have some neuroprotective effects, and it improves people’s memory.
As I type, front page on CNN is a profile piece on a plastic surgeon and several of his patients who are upset he continued to operate while in an alcohol treatment program.
[Dr.] West is an alcoholic, according to a Medical Board of California decision, and a member of the state’s Physician Diversion Program.
The program keeps the doctors’ identities private, so it allowed him to continue to treat patients, even operate on them, while he was secretly getting treatment for his addiction.
[…]
A study by the Federation of State Physician Health Programs found about one percent of all physicians practicing in the United States are in confidential treatment. That’s about 8,000 doctors whose patients may have no idea they are addicts.
A physician doesn’t have to disclose his drug or alcohol troubles and gets to keep practicing on unaware patients. A little shocking at first light. Let me tell you why it isn’t and why I think these confidential treatment programs are extremely important.
These are not programs for physicians who have been caught practicing under the influence, who have made mistakes because they’ve been inebriated. The way I understand it, these are physicians who sought help of their own volition. Physicians without documented professional troubles secondary to substance abuse.
That is an incredibly important point. It is highlighted in this quote from the CMA president,
[T]he California Medical Association, a physicians advocacy group, is fighting to keep the program running, and to keep the names of doctors enrolled confidential.
The association’s president, Joe Dunn, told CNN, “We believe very strongly this is the absolute best way to ensure patient safety. We need to get physicians out of the shadows.”
Dunn believes if the program is shut down in July, doctors will continue to feed their addiction privately and not get help. He argues, “Without a diversion program, no one knows. Patients don’t know. Health professionals who could help don’t know.”
It absolutely positively is the difference between having more physicians out there who are actively abusing substances with patients none the wiser and having physicians out there who are getting treatment for abusing substances with patients none the wiser. I don’t think, when framed appropriately like such, that that is really any choice at all.
I did my undergrad work in USC's School of Cinema-Television Cinematic Arts. I have a Bachelors of Fine Arts in Writing for Screen & Television. I loved it, but a future of waiting tables and taking meetings with B-List producers was not for me.
This blog is ostensibly to discuss healthcare policy and maybe educate a few of my fellow medical students. But it will stray into current events, politics, and other science topics when they draw my interest
Other odd notes about me:
I've skied half the resorts on this list (Squaw Valley/Lake Tahoe, Snowbird/Park City, Whistler, Taos, Vail)
I "played" lacrosse in high school and through a club level team in college
Nothing on this website is to be taken as medical advice. I am not a physician. Please consult a physician concerning any health related questions.
This blog is entirely self funded. It accepts no advertising or other supporting revenue. The author has no relevant financial relationships to disclose.
Unless otherwise noted the media on this blog is under the copyright of the blog author, used under a Creative Common or free use license with appropriate accreditation or is in the public domain. If you believe images or video posted on this blog are copyrighted works used inappropriately please contact me.
Endorsements
"Please be more precise in your practice of medicine than you are in your blogging!"
- Mark Lanier
