Medicine

It Depends On Who Is Paying

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From a Washington Post story about Dick Cheney’s heart transplant (via Instapundit):

A study published last November found that treatment similar to what Cheney received costs $167,208 for every year of life saved. Treatments that “buy” a year of life for $50,000 or less are considered cost-effective, and those costing $50,000 to $100,000 are generally considered acceptable. (A European study in 2011 found the device much less of a bargain, at a cost of $414,275 for year of life saved).
 
Who gets a donor heart when one comes available depends on many variables, including body size and blood type. The most important one, however, is a person’s clinical condition and immediate availability for surgery.
 
There are strict guidelines for placing someone in the most urgent category and the decision is made by a team of many specialists. Moving someone to the top of the list who shouldn’t be there would be hard to do and would open a hospital to major sanctions. Both Bull and John said they are confident Cheney got no special breaks.

From the quoted passage: Treatments that “buy” a year of life for $50,000 or less are considered cost-effective, and those costing $50,000 to $100,000 are generally considered acceptable. [My italics.]

The unstated assumptions here are that 1) third parties will pay for transplants and therefore get to decide which patients will be considered to receive transplants, and 2) third parties will allocate the limited supply of transplantable organs.

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Dick Boggs

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When I was a medical school junior, we had a rotation on the Neurology service at LA County Hospital. One of my classmates was planning a career in neurology but the reason it was so popular with the students like me who were interested in surgery was that we got to do tracheostomies. A number of patients with severe neurological lesions would require respirators or had trouble with airway secretions requiring a tracheostomy. This was our one chance to do surgery, even a minor procedure as things go. It was good practice and I later did a lot of tracheostomies, some quite difficult and rushed.

Our resident was a very interesting guy named Dick Boggs. He was tall and looked a lot like Orson Welles did when he was young and making “The Third Man.” Boggs was quiet and aloof but let us do trachs and work up any patient we wanted to. I had some very interesting cases. One was a woman who showed all the signs of alcoholic neuropathy, which is very similar to diabetic neuropathey. It was a popular rotation for juniors. Boggs was popular among the residents and was elected the president of the Interns’ and Residents’ Association, which under his leadership took on some of the characteristics of a union.

At the time, intern and resident pay was very low and, aside from a new dormitory that was built for single house staff, we were on our own. I was married with one child, born in March 1965, so I was really on my own. My wife quit her job as a teacher in January 1965 and I was working after hours doing histories and physicals at private hospitals for $7 per hour. Fortunately, my tuition was covered by scholarship but living expenses were tight. We lived on $200/month contributed by our parents, $100 from my father and the same from Irene’s parents. Half of that went for the rent of our two bedroom house in Eagle Rock, near Pasadena. I’m spending some time on details to emphasize what Boggs accomplished for us all.

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What’s the matter with you, can’t we advocate infanticide without angry blowback?

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Francesca Minerva and Alberto Giubilini wrote a paper entitled After-birth abortion: why should the baby live?. They were subsequently shocked that their argument in favor of infanticide instead of putting up for adoption led to death threats.

There is something deeply wrong in the state of modern, academic philosophy and ethics. The first problem is in making the argument. The second is in being so isolated from society that the reaction to the article surprises them.

Update: The journal article has been moved and now resides behind a paywall.

Graphic Novels on Health Care and other items….

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-from SHOTS, NPR’s Health Care Blog:

Health care reform is no laughing matter, but MIT economist Jonathan Gruber’s new comic book on the subject aims to communicate some pretty complicated policy details in a way that, if not exactly side-splitting, is at least engaging.
 
In Health Care Reform: What It Is, Why It’s Necessary, How It Works, Gruber steps into the pages of a comic book to guide readers through many of the major elements of the law, including the individual mandate to buy insurance, the health insurance exchanges where people will be able to buy coverage starting in 2014 and how the law tackles controlling health care costs.

I draw your attention to another graphic novel: The 9/11 Report: A Graphic Adaptation.

While I was buying a copy of Persepolis from a real-life book store a few years ago, a young woman at the sales counter mentioned that there was a “great” graphic novel about North Korea that I might like. I’m not a graphic novel reader and I think Persepolis is it for me unless I decide to review the health care book, but it interested me that she seemed so enthusiastic about the topic of North Korea and graphic novels. I guess it makes sense given our “information overload” society. I don’t know. Why not look for clarity?

PS: Linking is not endorsement and all that.

PPS: What’s the “all that” about? Eh, I’ve been burning the candle at both ends for the past week or so and my blogging has been pretty terrible because of it. I linked the health care graphic novel because it amused me, not because I am simpatico with the message. I think you all knew that already….

Frontier Surgeon or Ferdinand and Hermann’s Excellent Frontier Adventure

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The practice of medicine in these United (and for the period 1861-1865, somewhat disunited) States was for most of the 19th century a pretty hit or miss proposition, both in practice and by training. That many sensible people possessed pretty extensive kits of medicines – the modern equivalents of which are administered as prescriptions or under the care of a licensed medical professional – might tend to indicate that the qualifications required to hang out a shingle and practice medicine were so sketchy as to be well within the grasp of any intelligent and well-read amateur, and that many a citizen was of the opinion that they couldn’t possibly do any worse with a D-I-Y approach. Such was the truly dreadful state of affairs generally when it came to medicine in most places and in all but the last quarter of the 19th century they may have been better off having a go on their own at that.

Most doctors trained as apprentices to a doctor with a current practice. There were some formal schools of medicine in the United States, but their output did not exactly dazzle with brilliance. Successful surgeons of the time possessed two basic skill sets; speed and a couple of strong assistants to hold the patient down, until he was done cutting and stitching. Most of the truly skilled doctors and surgeons had their training somewhere else – like Europe.

But in San Antonio, from 1850 on – there was a doctor-surgeon in practice, who ventured upon such daring medical remedies as to make him a legend. His patients traveled sometimes hundreds of miles to take advantage of his skill …

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