My classmate Mike sent out this Exploding Dog cartoon as symbolic of our test struggles. We’re all relying on the fact that “they can’t fail all of us” and “70 new drugs in a week is simply ridiculous.”

All the cancer stuff — cancer types, cancer drugs — is so depressing. Yana summed it up the best:

bq. First year of med school they would’ve brought in a patient to talk about having cancer, experiencing cancer, how to talk to a patient about cancer… this year they just tell you “Small cell / oat cell carcinoma, 5 year survival: 0 percent. Next cancer…”

Here’s to drinking heavily tomorrow evening!

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When Gender Isn’t Given is a great piece on the changing attitudes and practices of medicine when a baby is born with ambiguous genitalia.

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A short little write-up on how I hacked WordPress to work as a basic CMS, requested by some folks at PhotoMatt .

(Sorry, it’s ugly and very rushed, but if I didn’t do it quickly, it would never have gotten done at all.)

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So goes the nation, I hope. There’s been a slew of postings railing against advertising by drug companies ( GruntDoc , Dr. Bradley , MedRants , Kevin MD ), talking about the ads being misleading, inappropriate, and the drug reps being annoying and even reckless.

Hopefully the non-blogging MD world will catch on soon, too.

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Paul Scrivens documents his conversion of an FDA online database to a new, cleaner version : webdrugdatabase.com . Very nice, clean site, and easier to use than the FDA’s version .

Clean and purty, just as a designer would make it.

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Matthew Holt just posted a zinger summarizing some points of the NHS in Britain and the Japanese health care system. A great summary read. Go now!

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Americans rate Canada’s health care better than health care in the US , and a working paper proposes that the SES-health gradient difference between Canada and US citizens decreases at age 65 , miraculously the same age Americans get Medicare.

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Our President, ladies and gents :

bq. At a rally of cheering supporters in Poplar Bluff, Missouri, Bush made his usual pitch for limiting “frivolous lawsuits” that he said drive up the cost of health care and run doctors out of business.
But then he added, “We’ve got an issue in America. Too many good docs are getting out of business. Too many OB-GYNs aren’t able to practice their love with women all across this country.”

(via another graham )

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Michael Fraase writes a anguishing account of his decision to pass up the opportunity to receive a cadaver kidney transplant –the way he writes it, he seems almost too ready to say no. His reasoning:

bq. The short version of the whole story is that I feel very strongly that corporations should not profit from the misfortune of the chronically ill. It would be hypocritical for me to hold that position and then turn around and benefit from someone else’s misfortune. In order for me to receive a cadaveric kidney transplant, there has to be a cadaver. Get it?

I too feel that I don’t want to benefit from the misfortune of others (just as corporations shouldn’t), but for me, there’s a difference: we all have to die. Corporations don’t necessarily have to profit from misfortune. And while it is a misfortune when a loved one dies, I hope my body can be used to help someone that someone else loves when I have to go. Strangers have given that ultimate gift to my family members, and I would be honored to help someone else, like Michael.

Transplants require a great deal of work, on the patient’s part as well as the doctor’s, and they require a great deal of resources. Because of immunological complications, most people have to take drugs to suppress their immune systems, or they end up developing graft versus host disease . Michael is absolutely right; transplanting is not a _cure_. And it’s an expensive follow-up. Anti-rejection meds are great, but if you don’t follow the regimen closely, the kidney can be rejected. And they’re expensive.

I’m sure he knows a great deal more than I do about transplants and kidney failure, and I’m sure his decision was an informed one. I totally respect his decision and the fact that he could make it so confidently.

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So, a couple weeks back, I made some unfair comments directed at fellow medbloggers . It was very snarky, I was in a snarky mood. It was wrong to assume that they don’t care about the uninsured. It’s just, from my perspective, the policies they advocate for would only complicate the problem, not fix it. But hey. My perspective. Shouldn’t have gone into snarky personal mode. Sorry about that.

The issue I think that the aforementioned bloggers and I will probably never see eye-to-eye on is government’s role in health care. I advocate for the government’s role in _paying_ for health care (not running it), because as I see it, the 30+ years of corporate-based, employer-based care has gotten us nowhere but pre-existing conditions, care denials, fraud and scandal, and worse health indicators than other developed nations. To be fair, I’ll admit that the outcome of the early 90s HMO boom *did* cause outcomes to be tested better, and made our system more efficient. That being said, our costs are still rising faster than most other countries, and our health indicators still aren’t good.

On the flip side, if I understand their perpsective correctly, we would be better off without government sticking its nose into healthcare. If we didn’t have Medicare or Medicaid or S-CHIP , we would be better off, and it’s government regulation that causes a lot of the problems in health care, not fixes them.

So, yeah, I don’t think we’re going to ever come around on that one.

Onto other subjects, I like to pick on PhRMA because they do such a great job on picking on the sick. Drug costs up 22% in three years ? Inflation hasn’t been *that* bad. Collusion? Fraud? More DC lobbyists than members of Congress? Their goals have little to do with improving the health of the public. Their goal, as any business’s is, is to make money. Legally, or illegally, in their case.

Many people try to argue that innovation is only driven by self-interest, by profit, by money, but I just can’t be convinced. Look at the open-source movement. Look at creativity. Look at curiousity. Many people (myself included) innovate because we want to solve problems, not because we want to make a profit. Because our minds love challenges. Innovation *can* be driven by competition and profit, but innovation will never wither away without them.

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