How Can We Avoid Bad Doctors?

The New England Journal of Medicine recently published, Prevalence and Characteristics of Physicians Prone to Malpractice Claims, stating the major problem with medical care in the USA.

If claim-prone physicians account for a substantial share of all claims, the ability to reliably identify them before they accumulate troubling track records would be valuable. Attempts to predict malpractice claims have had mixed success and suggest that prospective identification is not feasible. This helps to explain why the medical malpractice system remains largely a reactive enterprise, focused on the aftermath of care that has gone wrong. The chief contribution of the system to the prevention of harm lies in its intended role as a deterrent to substandard care — a function that evidence suggests it performs poorly.

Well, what can be done to fix the problem? The authors claim:

The National Practitioner Data Bank (NPDB) is a confidential data repository created by Congress in 1986 to improve health care quality.

This is nonsense because the NPDB exists so that insurance companies can offer prices to doctors for medical malpractice insurance. If the purpose were to improve health care quality, the data would not be confidential. If it were open to the public, many patients would avoid doctors who have been named as defendants in malpractice suits. The data is confidential because doctors protect bad doctors just as teachers unions protect bad teachers and police unions protect rogue cops.

If you receive poor service from a plumber or electrician, you can write a review on Angie’s List, and you can write about your experience in a restaurant on Yelp, and you can write a book review on Amazon; but doctors own the government and have exempted themselves from the free market. Opening the NPDB to the public would be especially useful because medical malpractice lawyers file suits only in special cases. Lawyers receive many inquiries from angry patients and only accept clients whose cases against doctors are easiest to prove.

Consumer’s Union states:

Consumers Union’s Safe Patient Project released a statement calling for public access to information in the National Practitioners Data Bank (NPDB), a federal agency that collects information on problem doctors with a history of sanctions by state medical boards and hospitals and lawsuit payouts for harming patients.

A Consumer Reports national poll found that almost 9 in 10 Americans (88%) said the public should have access to federally collected information about problems with doctors.

Most doctors do not have a history of problems, but consumers have no way of distinguishing those who don’t from those who do. Hospitals, insurers, state licensing boards and other health care entities have always had full access to the information in the Public Use Data File, including doctors’ names. We think patients should be given the same access – and most Americans agree with us. There is no rational reason for keeping such information secret.

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Where was the Biggest Surf Yesterday?

Vina del Mar in Chile is a good candidate.

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How Would President Trump Deal With Chile and Peru?

Leading Republican candidate Donald Trump announced today that he would force Apple to, “build their damn computers and things” in the USA, making America great again. Trump wants the USA to be like Argentina, a country that manufactures phones at the bottom of the world in Ushuaia. iPhones are unavailable in Argentina; they use phones by other vendors and prices are high.

In contrast, President Obama announced today:

The U.S. Department of Agriculture (USDA) today announced that Agriculture Secretary Tom Vilsack will lead a trade mission March 14 to March 18 to expand export opportunities for U.S. agriculture in Chile and Peru.

“Thanks to existing free trade agreements, the United States enjoys strong trading relationships with both Chile and Peru,” said Vilsack. “In addition, both nations are part of the Trans-Pacific Partnership, which if implemented will boost the Chilean and Peruvian economies and tighten integration with the U.S. economy, helping further expand demand for U.S. agricultural products.”

The United States entered into a trade agreement with Peru in 2009 that slashed agricultural tariffs and improved market access for many U.S. products. As a result, U.S. farm and food exports to Peru have nearly tripled, reaching a record $1.25 billion in fiscal year 2015. In the Chilean market, all U.S. products enjoy duty-free access as of 2015, thanks to the free trade agreement enacted in 2004. Since 2004, U.S. exports to Chile have grown more than 500 percent, totaling $803 million in fiscal year 2015.

“In both Chile and Peru, steady economic growth and an expanding middle-class population are fueling demand for high-quality, made-in-America food and agricultural products. Now that the United States enjoys open access to these markets, it’s a great time for U.S. companies – especially small- and medium-sized enterprises – to start or expand their exports there,” Vilsack said.

USDA trade missions open doors and deliver results for U.S. exporters, giving them the opportunity to forge relationships with potential customers and trading partners, interact with host government officials, and gather market intelligence that will help develop strategies to expand sales in key markets overseas.

Would President Trump ban or reduce exports from Chile and Peru to make America great again?

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Thousands Of Dead Squid Are Washing Up In Chile

Thousands of squid washed up dead on Santa Maria Island in Chile and 300 whales beached themselves in Chilean Patagonia. A large group of Chileans saved a beached whale.

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Lory State Park, Arthur’s Rock

Mary and I hiked today to Arthur’s Rock, Lory State Park. We’ll return in summer.

MM Arthurs 640

Mark Balaclava 640

Mark Lory 640

Lory Ice 640

Lory North 640

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Obama Stifling Research in Early Cancer Detection

Seattle capitalists Bill Gates and Jeff Bezos announced today that they are investing in Grail, a company that hopes to find the Holy Grail, a way to detect cancer early by examining blood. President Obama has stopped a competitor, Pathway Genomics, from marketing their $300 cancer detection test because his bureaucrats don’t like their product and the way that it is marketed. As I noted in my last post, Obama is content to allow aircraft makers to improve their products but he insists on harassing and terrorizing people trying to improve health care.

Although Europeans is hopelessly behind the USA in information technologies, they are ahead in many medical technologies because their governments are less tyrannical. For example, Dr. Ioannis Papasotiriou, an oncologist, has developed an expensive test to detect cancer using a blood sample.

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Snowshoeing at Horsetooth

I tried out my new snowshoes today after a storm dropped 6 inches of snow on Horsetooth Mountain Park.

HT Winter Houses

Hillside House

HT North Snow

HT Center Snow

HT South Snow

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Why Are Drugs Regulated Differently Than Aircraft?

David Henderson of the Econlog blog wrote about FDA restrictions on drugs and suggested that all drugs be legalized subject to the restriction that any drug that is not certified as safe and effective by the Food and Drug Administration (FDA) must carry a warning of that lack of blessing. In that case, people like me who believe the FDA and other government agencies lack credibility could use whatever drug we want and people who like government could avoid the drug.

Someone commented that this wouldn’t be a great leap in government thinking because potentially dangerous aircraft have been legalized subject to the requirement that an “Experimental” designation be placed on the aircraft along with a notice that it doesn’t meet government standards. Next to the notice, many plane builders add that it exceeds government standards.

Millions of people become ill and millions of others die due to lack of access to drugs. Why is the government humane to aircraft builders and users but evil and heartless to sick people?

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Drugs to Treat Depression

Dr. David Perlmutter, author of Brain Maker: The Power of Gut Microbes to Heal and Protect Your Brain –for Life, warns of the dangers of using drugs to treat depression and not consuming omega-3 fatty acids from sources such as salmon and fish oil pills.

The next time you’re at a large-scale event with lots of people, whether you’re in an auditorium or a stadium, take a look around and consider this: one in ten of those people is taking a psychiatric drug to treat a mood disorder. For women in their forties and fifties, one in four take an antidepressant. That’s right, a quarter of middle-aged women today are taking powerful drugs to remedy symptoms that typically fall under a diagnosis of clinical depression: persistent distress, malaise, anxiety, inner agitation, fatigue, low libido, poor memory, irritability, insomnia, sense of hopelessness, and feeling emotionally flat, overwhelmed, and trapped. At last count, 14 percent of non-Hispanic white men take antidepressants, compared with just 4 percent of non-Hispanic blacks and 3 percent of Mexican Americans. Interestingly, antidepressant use does not vary by income status….

Ever since serotonin-specific reuptake inhibitor medications (SSRIs) were approved by the FDA nearly three decades ago, we as a society have come to believe that drugs can improve symptoms of or even “cure” mental illness, particularly depression, anxiety disorders, and panic attacks, which together are the top targets of medication in the U.S. Such drug use has increased a whopping 400 percent over the past two decades. By 2005, antidepressants had become the #1 prescribed drug class in the country.

But these medications do not treat depression. Whether it’s Prozac, Cymbalta, Zoloft, Elavil, Lexapro, Wellbutrin, or any of the other commonly prescribed antidepressants, these medicines simply treat symptoms, and only minimally so. Drugs for depression are aggressively marketed and prescribed in this country; look no further than the direct-to-consumer advertisements that dominate in broadcast media. The same is true of ADHD drugs: 85 percent of drugs to treat ADHD are used in the U.S. Although children are still the primary users of these drugs, the number of adults using them has been increasing at a much faster pace lately. The percentage of kids taking them increased 18 percent between 2008 and 2012, but during that same time period the percentage of privately insured adults who take them skyrocketed 53 percent. I am saddened by the fact that the billion-dollar psychotropic pharmaceutical industry is predicated on the idea that people will take a pill to treat symptoms, while the underlying disorder is ignored. So there’s never any real focus on actually curing or even improving the root cause of the illness, let alone getting people off the medication….

All of the antidepressant medications currently on the market are designed to artificially alter neurotransmitter activity in the brain. Yet, when we consider the fact that these same chemicals found in the brain are also produced in the gut, and that their availability to the brain is largely governed by the activity of gut bacteria, we are forced to realize that ground zero for all things mood-related is the gut….

When I think about our soaring rates of depression, I wonder about the impact of our sedentary lifestyles and diets that are loaded with pro-inflammatory sugars, too many pro-inflammatory omega-6 fats, and too few anti-inflammatory omega-3 fats. We know, for example, that the typical Western diet—high in refined carbs and factory fats—is associated with higher levels of C-reactive protein, a popular marker of inflammation. A diet filled with foods that are high on the glycemic index is also associated with higher levels of C-reactive protein. The glycemic index is a scale of 0 to 100, with higher values indicating foods that cause the fastest and most persistent elevations in blood sugar. Pure glucose, which has a GI of 100, provides the reference point. Foods high on the glycemic index notoriously increase inflammation.

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Hocus Pocus by Kurt Vonnegut

Hocus Pocus is a set of short stories by Kurt Vonnegut, author of the famous story, Harrison Bergeron, and the novel Slaughterhouse-Five. I enjoyed the book and excerpted it below.

DURING JACK’S AND my cow year at the Point, I remember, which would have been our junior year at a regular college, we were ordered to walk a tour for 3 hours on the Quadrangle, in a military manner, as though on serious guard duty, in full uniform and carrying rifles. This was punishment for our having failed to report another cadet who had cheated on a final examination in Electrical Engineering. The Honor Code required not only that we never lie or cheat but that we snitch on anybody who had done those things. We hadn’t seen the cadet cheat. We hadn’t even been in the same class with him. But we were with him, along with one other cadet, when he got drunk in Philadelphia after the Army-Navy game.

He got so drunk he confessed that he had cheated on the exam the previous June. Jack and I told him to shut up, that we didn’t want to hear about it, and that we were going to forget about it, since it probably wasn’t true anyway. But the other cadet, who would later be fragged in Vietnam, turned all of us in. We were as corrupt as the cheater, supposedly, for trying to cover up for him. “Fragging,” incidentally, was a new word in the English language that came out of the Vietnam War. It meant pitching a fizzing fragmentation grenade into the sleeping quarters of an unpopular officer. I don’t mean to boast, but the whole time I was in Vietnam nobody offered to frag me.

AS FOR LIGHT history: The no longer useful clappers of the bells were hung in order of size, but unlabeled, on the wall of the foyer of this library, above the perpetual-motion machines. So it became a college tradition for upperclasspersons to tell incoming freshmen that the clappers were the petrified penises of different mammals. The biggest clapper, which had once belonged to Beelzebub, the biggest bell, was said to be the penis of none other than Moby Dick, the Great White Whale. Many of the freshmen believed it, and were watched to see how long they went on believing it, just as they had been watched when they were little, no doubt, to see how long they would go on believing in the Tooth Fairy, the Easter Bunny, and Santa Claus.

If Jason Wilder thought I was an unteacher, he should have heard Damon Stern! Then again, Stern never told the awful truth about supposedly noble human actions in recent times. Everything he debunked had to have transpired before 1950, say. So I happened to sit in on a class where he talked about Hitler’s being a devout Roman Catholic. He said something I hadn’t realized before, something I have since discovered most Christians don’t want to hear: that the Nazi swastika was intended to be a version of a Christian cross, a cross made out of axes. Stern said that Christians had gone to a lot of trouble denying that the swastika was just another cross, saying it was a primitive symbol from the primordial ooze of the pagan past. And the Nazis’ most valuable military decoration was the Iron Cross. And the Nazis painted regular crosses on all their tanks and airplanes. I came out of that class looking sort of dazed, I guess. Who should I run into but Kimberley Wilder? “What did he say today?” she said. “Hitler was a Christian,” I said. “The swastika was a Christian cross.” She got it on tape.

“Did you or did you not say that the United States was a crock of doo-doo?” said Wilder. I had to think a minute. This wasn’t something Kimberley had gotten on tape. “What I may have said,” I replied, “is that all nations bigger than Denmark are crocks of doo-doo, but that was a joke, of course.” I NOW STAND behind that statement 100 percent. All nations bigger than Denmark are crocks of doo-doo.

That was how ridiculous men in uniform had become in academic communities, even though a major part of Harvard’s and MIT’s income came from research and development having to do with new weaponry. I would have been dead if it weren’t for that great gift to civilization from the Chemistry Department of Harvard, which was napalm, or sticky jellied gasoline.

As I said at the beginning of this book, if I had been a professional soldier back then, I probably would have crucified people without thinking much about it, if ordered to do so.

THE LATE UNICYCLIST Professor Damon Stern asked me one time if I thought there would be a market for religious figures of Christ riding a unicycle instead of spiked to a cross. It was just a joke. He didn’t want an answer, and I didn’t give him one. Some other subject must have come up right away. But I would tell him now, if he hadn’t been killed while trying to save the horses, that the most important message of a crucifix, to me anyway, was how unspeakably cruel supposedly sane human beings can be when under orders from a superior authority.

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