radical thought

humility is when you're still surprised when you're right.

conspiracy?

would anybody really think this kind of thing up? did it happen accidentally? did we pig out our way into this mess and now we need help to get out? i hope it's not a conspiracy, because if it is, whoever did it is brilliant, and evil.

get people to eat more by supersizing everything, make fast food and junk food and processed food cheaper and easier to get, advertise it all out the wazoo, and watch as people get diabetes predictably, high cholesterol and obesity become the norm, and strokes and heart attacks are commonplace. and cancer, pretty much everybody's going to get it somewhere sometime, right? now most people take at least a prescription drug or two. health care costs more and more because more and more people need to see the doctor more often and need more tests for more problems caused by more drugs and nobody seems to pay attention to the last 45 seconds of the drug commercials because they're so snowed by the promise of more hair, less weight, better attitude, less depression, better sex and they don't hear the part about your penis falling off or your anus losing control.

fast forward to the near future: people are begging for help paying for or even getting health insurance and are willing to gamble on about anything to get them out of the mess that they don't even know that they got themselves in. they want fast food, fast track healthcare when they want it and they want the drugs they want and they are blind to the reality that they have sold their healthcare souls to the drug companies and the medical walmarts of the world.

when the government offers 'cash for clunkers' but they're asking for your grandmother instead of your gas guzzler, what are you going to do?

a conspiracy? sometimes i hope so, at least that would mean we were duped instead of just greedy, lazy, and stupid.

cash for clunkers, part 2

got an email forwarded to me today...'cash for codgers'. man, i thought i'd come up with this idea myself, but once again, i've either stolen it or synthesized it from many ideas floating around in the air and in my head.

if a couple wants to have a baby and wants the government healthcare system to assist them in covering the expenses, they apply for permission and have to turn in an old person in exchange for the new baby. the exchange rate is on a sliding scale, with the highest values given to the old person with the most healthcare problems, on the most medicines, smokers, alcoholics, the obese, and republicans. the old person is taken care of with a toxic injection that guarantees that they can't be resold or their body parts reused.

i really and truly had this idea and was on my way to blogging it when i got this email. i want you to believe that, for some sick reason. but i was missing the key ingredient: exchanging the old for the new - what was i (not) thinking?

this seems orwellian, i know. but so many things that seemed so 'out there' a few years ago are now occurring on a regular basis, that i'd make sure your 'value' for exchange is pretty low as you get older, or your kids might just come visit and say, 'dad, i've been thinking...'.

talk about incentive to stay healthy! gives new meaning to the statement 'i'm worth more dead than alive'.

big brother

good news, bad news. there are cameras everywhere and that's good if you're looking for a criminal like on csi or law and order or ncis. i guess that's good if you can watch your kid while at daycare and you're at work, though if you have time to watch them on the computer...never mind, i digress. good news if you're a wannabe singer/star who gets discovered on some tv show. bad news if you're watching your brother play the final at wimbledon and you're caught picking your nose. ouch. how is ou going to spin this to make it go away?

filters

our minds are like filters - stuff goes through all the time. some stuff gets stuck. like in the dryer, the lint you have to clean off. you don't keep it, you throw it away (or at least i haven't heard of anyone recycling lint...yet).let's say that something that is allowed through is gone, forgotten, not considered, out the vent. the stuff that is filtered out is to be mulled over, considered. in our world today there are so many floating pieces of information, advice, opinion, and b.s., that our brains get clogged quickly and our options are to get rid of some stuff or to get lost in all the crap that is trapped. the latter option is where so many people live, worried about seemingly (to me, at least) nonsensical stuff and obsessing about things that in the big picture are really just fluff that got stuck in the filter.

so how do we clean the filter? dump the crap? one thing we can do is pray. go to God and give it to Him and let Him deal with it. one is to just forget it. that's not easy, and those forgotten memories tend to resurface at inopportune times. some people can 'rinse off' their filters by talking about stuff with other people, like counselors, therapists, and the like. my personal opinion is that talking things over with counselors just keeps the fluff circulating and sticking back in the filter. i'm not a fan of counseling.

i'm for praying and giving it to God. then pray again that you don't go back to the pile at His feet and pick your junk up for another round.

oh, one other way to at least help with the crap we have to filter through? don't go looking for it! on the internet, with your friends, on tv (oprah produces a ton of lint every day!). sure, everyone diagnosed anymore with any illness will go home and research it on the internet. at least it seems so. but don't believe it all. do you think they put the boring stuff on there? like on tv, the medical shows, law shows, cop shows - they distill out the boring 99% and give you the gunfight in the er between two lawyers! 99% of most of the stuff i see could be listed under "it will go away pretty much no matter what, so don't worry", or "it's a phase many kids go through and is normal and will resolve without treatment, but if you hurry and get him in therapy you could make it a big deal and spend a lot of money on it". notice how everything has a name now? you don't just have crappy eyelashes (like brooke shields, yeah right she's got crappy eyelashes!) you have hypotrichosis. no longer can you be in a bad mood sometimes, you're bipolar, you're depressed if you cry, obsessed if you think too much. ok, that's it.

summer accidents

read an article in the oklahoman this week about how the writer doesn't think kids play outside enough and they're just sitting around playing video games and facebooking and twittering. well, that may be true, but i still see, and generally comment positively on, kids who have the kinds of summer accidents we used to have. like stepping on a piece of glass in the creek that's usually dried up but it had rained recently and there were some crawdads and tadpoles and we were catching them and then we started playing swordfight with some sticks we found and maybe somebody got poked in the eye but then we used the sticks like rifles and played army for a while and then got into some poison ivy but the shot doesn't hurt that much and besides i kinda like that pink stuff and we went on a hike because we had these cool walking sticks/swords/rifles and nothing else to do but have fun and imagine ourselves as adventurers like lewis and whoever and we found all kinds of cool stuff and almost caught a lizard and threw rocks at a sign and one kid got hit in the head but we don't think he will need stitches and decided not to swim in the deep part of the creek because there were some bubbles that kinda looked like pee up by the edge and that was gross and then we climbed a tree and that was cool until another kid fell out and i hope he doesn't have his cast for the whole summer but man, we had fun.

those were the days. and they're not gone. just to reassure you. kids are still kids if their parents will let them and i know you can't just let them wander around like you used to when you were a kid and there are infections and perverts and toxins in the water and west nile virus and rocky mountain spotted fever ticks and any number of other scary things out there, but kids need to play in puddles and swordfight and play army and throw rocks and not have plans all the time like soccer practice and be kids.

one of the first blogs in this long line was 'the rant' and it's this exact mood i'm getting at here. i'd love to see a few more sets of stitches and the occasional piece of glass in the foot and poison ivy and maybe a broken arm instead of chronic stomachaches and headaches and trouble sleeping and trouble concentrating and (now i'm going to offend, sorry) fights over what johnny gets to do at dad's house that he isn't allowed to do at mom's and maybe the stomachache is from worrying whether he can tell his 'primary custodial parent' how much fun he had at his 'noncustodial parent's' house over the weekend without hurting her feelings or getting his noncustodial parent in trouble with mom's lawyer. there, i feel better.

and this is a good time to rant on something else. today's paper has two articles, both about dead kids, one who drowned and one who was shaken to death. both kids were allegedly killed by men in their mothers' lives, one was actually the father, one her boyfriend. the one who was the father had already abused a kid, but hey, it was over 10 years ago 'and he's changed'. and i'm sure there were protests of 'but i love him'. oh please, ladies! i'm sure there are boyfriends out there who won't kill your kids, but be careful. and the ex-wife of the drowned kid is defending her ex, and in a move that actually made sense for once, dhs took her other kid away.

this story plays out over and over. i caution guys - if you've got a girlfriend with a child, be careful. first, don't kill them. but seriously, don't be left alone with the child and consider every potential problem with every situation when you are with that child. statistically you are the prime suspect if that kid is abused or killed or if anything happens. apparently (and here i'm going to get in trouble again) girls don't think too clearly when it comes to guys.

heat index

i know the heat index has something to do with the temperature and the humidity, sort of a reverse of the wind chill, but is there an age-adjusted heat index? i remember 100 degree days where it didn't feel like my brain was melting. and cindy thinks it's because i was driving her convertible with the top down! i'm thinking maybe temp plus humidity plus age plus amount of hair* (*or lack of it) and plug it into some formula and it comes out to...HOT.

oh, by the way

the dinner i just mentioned was not just me and some lady. it was my wife and i and this lady and her husband. i even remember their names! but how we had dinner together was sort of 'european' or something like that.

we had just sat down at an outside table at interurban and they came onto the patio and there were no more tables. there were 2 chairs left at our table and 2 people who needed to sit down so we invited them to join us. what a concept! no pressure, no expectations, we all just talked and enjoyed the meal and the conversating (at least we did, i think they did). i showed her my 'fat kelly' pics and of course we had to talk weight loss for a while...but i really liked the concept of saving points and how it relates to kids and eating. and we enjoyed their company and if we had been our usual selves with our blinders on then we would have missed the opportunity.

saving up points

had dinner with a weight watchers instructor (?leader, coach?) and i noticed she had a couple of glasses of wine and i asked about that and weight watchers. she said she just saved up points if she knew she was going to be going out and then she could use the points on alcohol or dessert or whatever. so...kids are really smart. they've been doing this for centuries. 'you didn't eat your dinner.' 'i'm saving room for dessert.' 'if you don't eat your dinner you can't have dessert.' 'but mom, if i eat my dinner i won't be hungry for dessert!'

kids are brilliant! now when will parents catch on?

modern innovation

in a time magazine article about how 'twitter' is going to change our lives, i found a very interesting and enlightening and gratifying few sentences. sure, i'll probably learn to twitter like i've learned to (at least an old man attempt at) facebook. i may not use it like i do my texting skills, and not to the degree professionally that i use email, but i'll probably learn to twitter. but, the article contains some of the best news for america that i've seen in a long time.

the author is discussing the innovations that have happened to twitter after it was released and how amazing they are, and just sort of throws in this part: " ...Since the mid-'80's, a long progression of doomsayers have warned that our (the U.S.) declining market share in the patents and Ph.D.'s business augurs dark times for American innovation. The specific threats have changed. It was the Japanese who would destroy us in the '80's; now it's China and India.

"But what actually happened to American innovation during that period? We came up with America Online, Netscape, Amazon, Google, Blogger, Wikipedia, Craigslist, TiVo, Netflix, eBay, the iPod and iPhone, Xbox, Facebook, and Twitter itself. Sure, we didn't build the Prius or the Wii, but if you measure global innovation in terms of actual lifestyle-changing hit products and not just grad students, the U.S. has been lapping the field for the past 20 years."

i'm encouraged. the kids i encounter regularly are quite brilliant and are good thinkers. they may learn a little differently. they may need a little pharmaceutical help occasionally to turn their D battery flashlight/not so focused brains into the laser beams they were capable of, but dadgummit, we're still the good ol US of A and we kick butt, and don't let the ninnies at npr tell you otherwise!

glad i'm not in school anymore

at a meeting recently i started thinking...i'm glad i'm not in high school. if there had been texting while i was in school, i would have been the worst! i could listen to the speaker and still text friends, coworkers, relatives, spouse. multitasking is easy. thank goodness i don't have enough time for it now!

maybe it's just me...

maybe it's just me, but i love my routine. sure, it gets old sometimes, but i love it. i've been on more vacations lately than i can ever remember taking, and i have loved each of them. however, when i get back home i find myself craving the regular, the routine. it's a stabilizer, this routine. it's something to look forward to, to anticipate, not to dread.

so...maybe it's just me, but - enjoy your routines.

cell phone sex

ok. i hooked you with the title. this, however, is a true story from this week.

i took a call from mercy hospital monday afternoon while in the room with a patient in the office. they were calling to tell me that i had 2 new babies just born that afternoon. they usually give me the name, time of birth, weight, length, apgar scores, hep b and group b strep status, and whether the baby is a boy or a girl. that takes a while, and i was in a hurry due to needing to answer some questions the patient's mom had. so when the nurse asked me if i wanted all the information on the babies, i said 'just give me the sex, that will be enough for now'. needless to say, i backpeddled a little pretty quickly and said, 'i mean the gender...not sex, oh well...'. i'm sure the mom, who had no idea of what was being said on the other end of the call, was wondering exactly what was going on when i answered my phone 'this is dr. stephens', then the next thing i said was 'just give me the sex...'. 

that's why cell phones in offices should be outlawed. or maybe the hospital should text me with baby info... 

new mantra

recently it hit me that as parents we may be creating little puppy dogs that perform for treats vs. children who grow up with love as a covering for their lives. kids, like puppies, know what gets praise from their parents, and if they are praised for those specific things, that's what they will do. but that may limit them. they may not be confident enough to go 'outside the box' to do other things, to grow, because the parents' praise is necessary for them to take the next step. so...instead of making life one 'trick' after another, one to be noticed ('look what i can do!) and commended, we should make our praise, our positive comments, more general. this is sort of like "i love you" as a general statement vs. "i love it when you...". 

in the same vein, we should not criticize so generally, but more on a 'per event' basis, so that the child knows what he did to transgress. much the opposite of many parents' styles today.

so...praise generally, criticize specifically. instead of each act getting a nod, the nod goes to the whole day or week as 'man, you kids have been really great today, i really appreciate it, let's go to the park and have a picnic'. and 'tristan, we don't bite/hit/pull hair/scream/throw food/pee on the floor/etc.'

that's the mantra - praise generally, criticize specifically.

when is it ok?

signs meet me on hospital room doors, telling me to wash my hands, avoid going in if i'm sick, don't sneeze or cough on anyone, etc., etc. because of the recent potential H1N1 flu pandemic. so...when is it ok to not wash my hands, to go in sick, to sneeze and/or cough on people? these are things we should do (and that we do, hopefully) every day regardless of the presence or absence of a potentially serious pathogen.

i have seen this scenario played out recently in at least one other area. when the economy crashed, all of a sudden business were cutting back - no more corporate jets or flying everyone to the main office for meetings, instead they teleconference. no more frills and extras. i can't even think of all the things i've seen 'cut back' (i'm not talking about employees losing jobs here), but my point is: why were they doing these wasteful things in the first place? 

it seems that if we can, we will, then when things get tough and we can't, we're surprised. or we're mad. 

ok, now that's off my chest.

recent radical thought

why do we like babies to be fat but adults to be thin? 

why is that it's ok, even preferred, for babies to be distractible, but it's ADHD when it happens when we're older?

you're sensible people...

i get scared when people follow all my advice all the time without question. mind you, i do like it when people take my suggestions/commands, but like everyone, i have been known to be wrong from time to time. 

you're sensible people. if you get advice from me that sounds wacky or doesn't work for you, check it out. ask others, look it up, try some other stuff. maintain a healthy skepticism about any advice, even from me.

that's like handing a machine gun to a serial killer for some parents, as they don't believe even themselves most of the time, asking questions almost to hear themselves talk, but for the vast majority of you, you're sensible people, as far as i know given the information and experience i have at this time, my advice is good and timely, or at least not bad and harmful - though some would argue. just don't consider me the source of all medical knowledge - or i will most definitely disappoint both of us.

the illness formerly known as...

since president obama was criticized by the pork industry over the name of the current influenza media frenzy/pseudo pandemic, it has come to my attention that there is a group that has a gripe with it being called H1N1 flu. 

press release from jim henson productions: sesame street and its sponsors would like to lodge a complaint against the cdc and whoever else decided to call this strain of influenza H1N1 flu. on behalf of the letters H and N, and the number 1, we protest that this nomenclature dishonors these letters and this number and should be changed immediately. why should miss piggy get her way just because she's a swine? big bird hasn't said anything about the 'bird flu'. our recommendation is that it be called 'the illness formerly known as...' and given a symbol - preferably one that doesn't resemble anything of this earth or this universe or any subsidiary thereof, so as to prevent further confusion when it has to be renamed once again.

thank you. 

this protest was brought to you by the letter A, the letter Y,  the letter K, and the letter M - as in Are You Kidding Me?

the ferrari

sometimes parents don't appreciate how good their children are. really. i had some great 2 year olds yesterday, i mean really nice, non-fit-throwing, polite, fun 2 year olds. the parents of these kids didn't see many problems with the behavior of the children but they (i think) failed to grasp the absolute delightfulness of them.

it's kind of like if someone gave you a ferrari for your first car and you'd never had any other car, and you didn't know much about cars. people would comment on your car regularly - 'wow, cool car', etc. but to you it was just a car. it started in the morning when you needed it to and hadn't left you stranded at any time. 

these kids were ferraris. they were exceptional but due to no point of reference to compare with, the parents just took for granted that all kids were like this. didn't everyone have a ferrari? are ferraris cooler than other cars?

maybe you had really wanted a pickup or a suburban and all you see is the lack of space to store stuff. maybe you're scared of driving fast and all this thing seems to do is accelerate.

appreciate your ferraris. recognize them. praise the good stuff generally and generously (you are the coolest kid around! i think you're great! thanks for such a great day/week!) and criticize specifically (i can't allow you to do/say that. we don't hit/bite, etc.). so you're creating an ambience of positivity with this general 'gee, you're super' and in that context you are able to work on the fact that your ferrari doesn't have much trunk space more specifically without losing sight of its 'ferrariness'.

addendum: some days we all think we have a ferrari, or if we told him or her enough good stuff that he or she would become a ferrari. don't lie to your kids to improve their self esteem. just honestly enjoy them, whatever they may be. that is the truest form of love, to love without condition, just because you 'own' this kid you love him, because she's yours you will never not love her. so i guess i'm looking for that balance: of positivity and truth, of appreciation with no conditions - i love you because you're you. this level of contentment is a blessing i wish i could instill/inject/impart into so many parents - it's not what they do or where they go or how well they do - if they are yours, you love them, and i know it, so let them know it, then all the rest, like growing up and being good kids and getting good grades and going to a good school and marrying the right person and having you some grandkids...that's all just icing on the cake.

immune tire change

God does work in mysterious ways. He showed me a couple of things as I was changing my tire in the snow a couple of weeks ago, then He added to it today, again while changing a tire. Different tire, same car, though. This car has had more than its share of flat tires.

The first lesson: think of vitamin/mineral/antioxidant/omega 3/probiotic supplements as tools needed to change a tire - like the jack, the lug wrench, the actual spare - real or donut. If you've been taking in enough supplements or have been getting these items in your regular diet then when you get a flat tire - catch a cold, tummy bug, strep throat - you can change that tire without too much trouble. Your body can fight off that cold with the appropriate weapons at its disposal. However, if you're short on any or all of these things, you may have to call for help in changing that tire. You might even have to get a tow. So, instead of a cold that's zapped by the immune system quickly, it turns into an ear infection or bronchitis, or you get dehydrated from the stomach flu. So...got that? Keep plenty of tools stocked up so when the inevitable occurs you can fight it off like it's no worse than a flat tire.

Lesson #2: the 2nd flat tire in just a few weeks on the same car. Think of the car as the body, the tires as a part of that body. Think of the law of chance. One flat tire is bad luck, a 2nd is either really bad luck or there's a problem with the tires or the car or the road or something. So...the more flat tires the more likely it's not 'just a cold' and may be allergies, or it may be that there is a food intolerance causing the diarrhea, not 'just a stomach flu'. This is one of the ways we, as physicians, can either tell you 'it's just a cold' because lots of kids have come in with the same thing, or can reassure you that kids this age get ear infections every so often and unless they don't get better in a couple of months, the child will 'fix his own flat'. But weird things happen and when we see either a lot of flats in a certain neighborhood we investigate for nails in the road or a vandal slashing tires. If this is the only car that keeps having flats then the problem is probably with the car itself - the child may have an underlying problem that needs to be addressed. 

So, flat tires are common. Most cars come equipped with a kit that has all the things required to change a tire. However, if one has to change the tire quite often, some of the tools may wear out, break, or the spare tire may become damaged. Kids come with a 'kit' that has all the necessary 'tools' to get him or her over the common cold or stomach flu. However, after a few of these 'bugs' the 'tool kit/immune system' gets tired, gets used up, needs repair or replacement. Things like daycare centers, schools, poor diets, lots of siblings - any extra 'nails' around that can puncture a tire often - cause the depletion of the 'tool kit' and require more vigilance on the part of the 'owner' of the 'car' to keep it running well and not requiring visits to the 'mechanic'. 

that's about it, so far.

miracle drug?

there is a new combination of drugs that is being studied. it's much the same as nyquil only it's for heart problems and not cold symptoms. currently it's being called the 'polypill' or 'polycap'. it contains 3 different types of blood pressure medicines, a cholesterol lowering drug, and aspirin. my comment when i first heard about it was "you won't know which one made you better", but my wife, tainted as she has been by years of living with and listening to me, said, "or, you won't know which one killed you". 

brilliant!

i'm going to run for some congressional seat or another, and my first bill to propose will be a slam dunk. it's going to make both sides happy and solve all our problems with healthcare spending, at least for prescription drug coverage.

i'll put forth a bill that will make the government pay for all prescription drugs, then, inside the bill, there will be legislation to make almost all current prescription drugs over the counter. 

brilliant, eh? at least for a few seconds it seems that way. no telling what would happen. i'm worried that too many people would be taking too many medicines they don't need for problems they don't have. oh wait, that's already happening...only it's us (the doctors) to blame. 

thank you

i shouldn't be allowed to read the paper. i come up with weird random radical thoughts.

so, if a group of people today volunteered to die 10 years early compared to the rest of the population, therefore consuming fewer resources, leaving a smaller carbon footprint, using less of their social security, easing the population explosion, all while increasing the income of both private industry and the federal government, wouldn't we congratulate them for that? give them a party? medals? their own memorial? i mean, this is a group who is willingly choosing to check out early from this hotel california, leaving more for the rest of us. they must be, depending on your worldview, either true christians for their selflessness, true environmentalists for their grasp of the big picture as it relates to humans being the biggest reason it's getting harder for the earth to sustain more humans, or the highest order of animal if you're a peta person who, while considering animals and humans equal in their worth, knows that animals who can contemplate their impact on the world around them further than their next meal would of course decide to move over and let others have more room to exist. any way you spin it, this is a good deal, right? i mean, these folks are knowingly going to give up 10 years of potential life.

so i propose that we change a few of our signs. first,  not 'thank you for not smoking', but 'thank you for smoking - just don't do it right here'.  a new one, 'smoking saves lives - just not yours'.

there are more, i'm sure. my affection for reverse psychology is irresistible here - by promoting smoking (like big tobacco doesn't already do that, by reverse psychology) we would be actually decreasing the number of new smokers. by encouraging kids to smoke, they'd come home from school saying 'are you trying to kill me? don't you know what this does to your lungs?' instead of  'i know that happens to everybody else who smokes, but it won't happen to me'.

we could, after seeing the success of the reverse psychology campaign for smoking, venture into other areas - i envision the teacher taking the condom off of a banana, demonstrating how to properly tourniquet one's arm to shoot up heroin, of course using a dirty shared needle, while drinking a fifth of jack daniels and driving down the highway. it could work!

addendum: the article in the paper said that while smokers cost more in healthcare dollars than nonsmokers BUT they died on average 10 years earlier so the total 'lifetime' cost was actually lower. this was my 'inspiration'.

wal mart mentality?

someone's gotta do it, right? actually, someone is already doing it. and more are joining in every year it seems. i'm talking about urgent care, after hours, etc. 

it's being done, so instead of fighting against it, i should use the aikido strategy and take the opponent's strength and turn it to my advantage, right? i cringe when a mom takes a baby or a child to an urgent care center. why? two reasons: 1) i'm not the one seeing them so i don't know what they really had and whether the treatment was correct/appropriate, and 2) it means i wasn't able to see them. both reasons show my control freak nature, and my insidious pride - like they would've been diagnosed and treated correctly if i had seen them because of course i always make the correct diagnosis and prescribe the correct treatment. right. 

so...now that we've established that...i can't work 24/7 - at least not for long, and i have to trust that there are other physicians/np's/pa's who can take good care of my patients after hours - of course i trust cathy - hello - so why do i resist it?

1) it's really not necessary. ok, neither is it necessary to be able to buy eggs at 2 in the morning, but if someone offers it, someone will take them up on the offer. need is not the issue. this is a drive thru world and by gosh, my kid got a fever an hour ago and i want him seen now. truly i understand this with work/school/fears of serious disease/too much information available to make people worry, etc.

2) it's an extra expense. it costs more after hours. and then many parents bring the child in within hours to days of the after hours visit for me (or their pcp if they aren't mine) to see them and to confirm the diagnosis and treatment. 2 visits, one problem, could've waited but didn't have to (see #1).

the solution? an urgent care where a trustworthy person over whom i have at least some control in hiring/supervising/advising/backing up is going to see that patient after hours. someday, maybe. but i think i have to give up trying to buck the current mentality of parents and go with it. but doing what the people want is not always the best thing for the people. how does one convince the people of that? 

just ask your doctor

man, i hate commercials for medicine! 'just ask your doctor' puts you in a position where you are forced to ask permission for something and me in the position to either grant or deny you that permission. it puts me, as the doctor, in the role of power over you, the patient. and it shouldn't be this way. the drug companies make it sound and look as if there is a perfect life out there waiting for you if your doctor will just let you have this medicine.  the same thing happens with various tests, especially mri's. we laugh at 'therapeutic' ct's and mri's - once a patient goes through the whole deal of getting one of these tests, even if it's not necessary, it seems that they get better. was it just the attention paid to the problem? your doctor watches the same stupid commercials you do, and he or she gets bombarded daily in journals and in person with other advertisements for drugs or treatments - each with articles 'proving' how much better their particular treatment is than the one they were selling last week. 

don't assume you have a disease just because you have the symptoms on the commercial. most diseases have symptoms that are similar to common problems like the flu or other viral illness, and these are way more common than the diseases they are advertising the treatment for. sure, everyone's depressed or anxious or fatigued or whatever - some of the time - but if it took a commercial to make you realize it was it really that bad? open your eyes! these people are selling something! they don't care about you and your health and your family. they care about making money.

don't let their advertising put me in a false position of power over you - holding in my hands the pen that can write you the prescription that will be the answer to all your problems. the drug companies have put the patient and the doctor in an adversarial position and they are capitalizing on it. don't let it work. be smarter than that. new is not always better. expensive is not always better. 

consider the source of the advertising and their ultimate motive - $.

sure, they have drugs that can help problems. but just because they have a great commercial doesn't mean they have a great treatment. listen to the end of the commercial. unless it's for an erectile dysfunction drug, then the side effects sell the drug. 

be very careful

even when the best doctors and the best hospitals try to come up with guidelines for the best ways to treat various diseases, they have difficulty. why? well, not everybody's the same. that's one reason. but arguably the biggest reason is that there are no studies to show how one drug performs against another or how choosing not to treat a specific disease compares with aggressive treatment of that problem. and why do these studies not exist, or why were they never published, which is a better question? because it is the drug companies that pay for the studies. they aren't going to publish a study, or even complete a study, if their drug or treatment isn't going to look good. if doing nothing is as good as doing something, are they going to tell you? heck no. they'll use statistics (there is a 14% chance that a person with this problem taking this drug will improve more quickly and have a better life with more money and more happiness and basically just turn out to be a better person than someone who chooses to try a good diet and some lifestyle changes to achieve the same goal). 

pharmaceutical ads are just like automobile ads, the glitz is up front then comes all the 'fine print'. but in car ads the guy on the commercial pretty much auctioneers his way through the interest rate, payments due at beginning and end of lease, with approved credit, may not apply to certain people on certain days ending in 'y', etc. in the drug ads they seem quite proud of the fact that their drug could cause liver and kidney damage and pretty much make your life a living hell, but you should still 'ask your doctor' about it because dadgummit you want it, don't you?

best marketing for viagra? jack nicholson in 'something's gotta give' when he's taking viagra and nitrates for chest pain and tries to deny it. it's an unforgettable scene and one which sold more viagra than any 'ask your doctor' commercial. 

see the blog a few back on marketable side effects. are we a gullible society or what? just because it's new or newly indicated for something doesn't make it necessary or even a good idea.

shame on you

integris has a commercial that is so representative of the new fear tactic method of marketing that i have to comment. not that any of their sappy tear jerking commercials are really promoting health and just look like they're promoting integris. i mean, the look the wife gives her husband in the infertility commercial is so real it's scary, but then everything is peachy once they get pregnant and have a baby. show them in 6 weeks and i'll show you a look! i can't listen to roy orbison without trying to drive to baptist anymore. 

no, i'm talking about the sleep commercial. which ends with the doctor saying "80% of sleep problems go undiagnosed, and some can be deadly". who can sleep after hearing that?!

OCD for profit?

Pharmaceutical companies have perfected the American dream. They have created a market and are now capitalizing on it. They work hard to get people obsessed about a 'disease' and then they charge them for the cure. And now they've either run out of new medicines  to invent to treat new diseases they've invented (or legitimized - see ED and fibromyalgia ) or they're just getting greedy (or have they always been and I'm just now noticing!) or maybe they are smelling the fires of 'the barbarians at the gate' - a la government-sponsored healthcare. In any instance, they certainly are capitalizing on 'unintended positive consequences', aka side effects that can be marketed. Used to be Viagra, by another name, was a drug to help with pulmonary hypertension. A disease, for sure, but not one with enough victims to really make a buck. But guess what happened on the way to improving the circulation in your lungs? Voila! Viagra. The rest is history - they've already done the research and development and proven that it's at least safe enough to try, if not use regularly, on humans. So now it's all about marketing. And you think I use reverse psychology? When did we get so gullible that a warning of a four hour erection is used to sell something? How hard was that? No pun intended.

There are others - recently the drug for hair loss, Propecia, was mentioned as a prevention for prostate cancer, sort of a reverse of the Viagra story, going from cosmetic to internal medicine. Now there is a glaucoma treatment with a curious side effect - it makes eyelashes grow thick and dark. Which is reminiscent of the first marketable side effect of which I was aware - Minoxidil, a blood pressure drug, had the nasty side effect of making patients grow hair in places both good and bad. But applied topically to specific areas it caused hair growth in just that area. And what do you get? Rogaine.

OK - so they have created markets from discontent, usually over appearance or performance. Is that really bad? Doesn't everyone have the right to be pain-free, have a full head of hair, an erection and great lashes? This is America, after all.

what if...?

the new stephen king book is a collection of short stories. i'm a bigtime stephen king fan, so of course i got it as soon as it came out, then i kept it as a carrot in front of me while i finished a couple of other books that weren't so exciting. now i'm halfway through, but one of the stories, 'stationary bike', hit a nerve. the protagonist finds out that his cholesterol is high and his health is in danger and he sets out on a stationary bike to fix the problem, but in the process he makes enemies of his own 'lipid company', 4 guys who he has ?dreamed up/created with the help of his doctor's explanation of his problem, because by losing weight and eating right and exercising he has put these guys out of work. and they have houses and families and mortgages and lives. 

so i got to thinking about my life and the impact i've had on certain economies and people by my lifestyle choices and changes. like what's the bartender at interurban going to do with all that smithwick's he ordered special for me? what about the carhops at sonic? do they miss me? are they mad? have they had a surplus of iced tea and route 44 cups and straws?

once, on the way to a mission trip, i was waxing philosophical to the person next to me about how all of us americans were living in luxury and we were wasteful and gluttonous and we should stay home and eat in more often, be happy with our houses and cars and forget 'keeping up with the joneses' because even the joneses were reining in their spending. who needs a lexus or a mercedes? who needs a 3 million dollar house? a $100,000 pool? why do people keep buying these stupid clothes and toys for their kids? why do they insist on making a trip to disneyworld a lifelong goal? 

then i realized i was talking to a bartender at a restaurant in bricktown whose living depended on people who lived the lives i had just railed against.

yes, we're gluttons and we're spoiled. but does the world not count on us to be this way? are we not pretty much singlehandedly supporting economies in countries where hopefully at least some people aren't being abused and exploited?

one more random thought: why, in tough economic times do we cut back on stuff? on people? were these things or services or people superfluous to the business or the community? were they just extras, like whipped cream and nuts on a sundae or creamer in coffee? like onions and pickles on a burger? why do we start getting things or getting used to things that we can apparently do without? and how many of us are expendable if the economy gets 'tougher'? 

the mirror

i saw somebody this week that i haven't seen in a while. i try to avoid him if i can, when i hear him coming, i go the other way. i don't like this guy. not even a little bit. he is very selfish. he is very prideful, feels like everything should go his way, and watch out if his car doesn't start or his alarm doesn't wake him up or his schedule's too full or too empty or he's wrong about something or his pants are too long or too short or his shirts aren't clean or his laundry's not ready or his eggs don't cook right or his kids don't call or they call while he's busy...pretty much his outward persona is a house of cards. he is so blessed and he takes the credit as if he had something to do with it. he lets people continue in their positive misconceptions of him and does nothing to disabuse them of their erroneous notions. he is kind when it suits him and mean when it doesn't. he can say nice things and his tongue can slice with sarcasm in the same moment, even in the same sentence. you can see why i don't like him. there's only one problem: he's the man in the mirror. sometimes you believe your own press clippings. sometimes i get a sore arm patting myself on the back. 

i'm happy to do stuff for others if...everything goes right for me.

i saw myself this week and i didn't like what i saw.

and i'm definitely getting old. watching the grammys tonight, i'm feeling very old. but old is good in my book if it means that you're not excited about a lesbian celebratory song followed by unintelligible (c)rap by 4 guys with more hyphens than vowels and consonants in their names while a hugely pregnant ?singer prances gravidly around on the stage making a fool of herself. i'll take old any day.

even more

when you hear hoofbeats, look for horses (or, common things occur commonly)(this is a standard medical saying). meaning: if you didn't already figure it out, it's ain't some weird thing usually. it's more common for common illnesses to present in a weird way than for a weird illness to present at all (or to mimic a common illness). reader's digest is not a medical textbook, nor is the internet - but wikipedia has most medical textbooks on it!

the shortest route is not always the best route, because it can bypass some of the most precious lessons in life. (ravi zacharias)

some people seem to need to define their lives by their hardships, whether they be illnesses or other types, death in the family, financial hardship. look in the bible at aaron and nadab and abihu. sometimes you need to work through things, not live for them.

the lessons learned the hard way, the long way, are often the best, but man, that's not how they feel when you're going through them. think of this for your kids.

when my children get the 'i wants' and 'i needs' it's time for them (and me) to 'serve, serve, serve'(my lovely bride)

God gives where He finds empty hands - (St. Augustine)

sometimes you are the answer to the prayer you pray. (steve brown)

we think that helplessness is a liability - and it may be if you're a soldier or a policeman or a teacher - but in spiritual matters, just the opposite is true. (steve brown)

ok, i know these were random. each could have had a whole blog to itself, and who knows? maybe they will someday, but right now, hopefully this will do.

more radical thoughts

well, not necessarily more radical, but more thoughts. some are mine, some belong to others. i'll try to differentiate if you can't tell.

Nothing good happens after 10 pm. (many people, me, my wife, my parents, your parents...) well, it's true to this day. 

Just because you can doesn't mean you should. (again, many people, including all of the above) if people took this to heart life would be less hectic and more peaceful. especially after 10 pm.

God makes complex things simple and man turns around and makes simple things complex.  ok, this one's on me. as i'm continually faced with our tendency to make things harder and more complicated than they need to be. my friend Greg says "Christians shouldn't be into the details, because the devil is in the details."

First come up with a drug, and if necessary, we'll invent a disease.  ok, this is me again, but i had help. all the big pharmaceutical companies are doing this, whether they admit it or not. there are many 'diseases' and 'disorders' out there today that didn't exist before. a variation on this would be 'come up with a test and we'll come up with something to call the results if they're positive'.

35 miles or $35 will weed out most unnecessary doctor visits. ok, this is mine, too. not that i mind seeing lots of kids who aren't too sick, just that availability has become almost detrimental to some people. for instance: we are closed today due to weather, and this is a lose-lose situation - if open, we would have had people risk their lives on bad roads to bring in kids who don't need to be seen, and since we're closed we aren't serving our patients well.

It is easier to die for Jesus than to live for Him. a paraphrase of Oswald Chambers.

It is what it is...unless it isn't. Greg Poland. this can serve for many things and situations. when people want a definitive answer on some medical question that has not definitive answer, this works well.

Don't do the test if the result isn't going to change what you would do. me again. the healthcare consumer wants tests. they want them because they think the result is the answer to their problem, and some even think the test is the answer to their problem. i can't tell you how many times i've heard people say 'after that cat scan, i haven't had any more headaches' or variations on that theme. suggests a psychosomatic etiology to me, but hey...

It's amazing how many people survived before there were all these medicines and tests! me again. just in 25 years of finishing med school, the increase in the amount of knowledge and the numbers of tests and treatments is phenomenal. but simple things are still simple and common things still happen commonly. 

i'll come up with some more later. i just hadn't posted in a while.