If you haven’t been following the news, the Medicare Part D drug benefit is turning out to be a disaster–millions of seniors aren’t getting their prescription drugs, for any number of reasons: they’re not listed in the computer, the computer is giving pharmacies wrong information about costs, or the computer systems just aren’t working at all. Pharmacies are on hold for 2-3 hours for one single patient, and states are declaring public health emergencies and paying for the drugs themselves. Recently, the President told insurers the system isn’t working, and that, at least temporarily, there needs to be price controls.

This is a brilliant system for Pharma. They practically wrote the bill, saying how great it would work, and now private insurers and the federal government, who have to implement it, take the blame for a crappy system. Bravo Pharma, bravo! Jolly good play there.

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I’m really enjoying a new medical school blogger, maybe because he’s writing what I’m scared to write, writing what I sometimes feel . And I’m ashamed, frustrated, and sad to say it, but I’m experiencing The Fade , as he calls it, too:

Yet, somehow, in a matter of months, I had begun fading from that which I had been into what I had now become, proficient in the mechanical daily tasks of being a physician (or at least a physician’s scut monkey) but having completely lost sight of the simple human picture that I had once firmly understood and promised to uphold in spite of the sheer nonsense and stupidity inherent in the first two years of medical school.

Only six months into my third year of medical school, my first sixth months as a semi-functional physician, and I had already started veering down that path of apathy, that fade into indifference that I see so many of my superiors and peers having already disappeared into. I could no longer feel the coldness of my surroundings, as I was now humbled by a frigid sense of shame I had never before felt and never wanted to feel again.

Racing back now, eager to get out of the cold and into the comfort of my bed to get my five hours of sleep, I realized that I was lucky this time, that I had someone call me out for my behavior (even if it was not done consciously), and that I was wise enough to know I was not wise enough to know better.

Suggestions are entirely welcome.

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The NYT has a front-pager on diabetes, from the personal to the epidemiological: Diabetes and Its Awful Toll Quietly Emerge as a Crisis . The quote:

“I will go out on a limb,” said Dr. Frieden, the health commissioner, “and say, 20 years from now people will look back and say: ‘What were they thinking? They’re in the middle of an epidemic and kids are watching 20,000 hours of commercials for junk food.’ “

Couldn’t agree more, Dr. Frieden. It always amazes me how physicians will shake their heads in frustration with patients who are suffering from obesity or diabetes, but if you were to ask them if there should be some sort of regulation or help, they turn all libertarian, as if it’s only an individual problem, and laws or better city planning couldn’t help.

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