What do docs know about policy?

The New York Times is running an interesting article about members of congress who are doctors. One of the first things they point out is that they don’t all agree, so I’ll be the first to confess to having sort of lumped doctors together in the past, saying things like “Doctors like this measure.” Sorry, guys. Um, law students like diet coke. Right? All of us?

Of course, this spring, republican docs in the house actually formed a “doctors caucus.” Which suggests that they might be banding together a little more firmly than the Times’s individual interviews suggest. Why are there 11 republicans and only 5 dems? Tough to say. Anyone?

The upshot seems to be that they pretty much all agree (and have seen with their own eyes) that we need a new plan — but just like the rest of us, they can’t agree on what it should be. My first instinct, given that info, would be to say that it’s simply not a medical question. But thinking about it more, I’m wondering if this isn’t a reflection of the almost intractable complexity of this problem. Every one of these doctors has had different experiences, and the solution that would help the patients one of them has seen might leave another’s in the lurch.

I believe that one of the reasons this issue is so difficult to find common ground on is that everyone has personal experience with it. Even gun control or abortion affects only some portion of the population, but we all have health care experiences, and we all know we will need health care in the future, and it’s difficult for most people to completely put aside their personal experiences in trying to design a big-picture system. If you have a wealth of personal experiences (say, because you are a physician and have been seeing patients get screwed by this system every day for thirty years), how can you see it all in the clearest way possible?

Don’t get me wrong. These “in the trenches” stories are essential. If no one is paying attention to the actual things that befall actual people when the system breaks down, we don’t stand a chance. But it’s awfully tempting to believe that what we’ve seen with our own eyes is somehow more important than other problems out there.

By the way: to my knowledge, there are no nurses in congress. Hey, nurse! Wanna run for congress?

MJ, M.D.’s, and the coroner

Not to jump on a bandwagon, but it’s on the front page of the New York Times and the LA Times. . .So, the preliminary reports show Michael Jackson’s  death involved no trauma or foul play, and toxicology reports are pending– and in the mean time, major news outlets are reporting, the police have seized Jackson’s personal physician’s car because it could contain drugs or other evidence. Um. . . ok? How did this become a criminal investigation?

Obviously we, the public, don’t have the whole story– nor should we! I’m surprised that there’s as much on-the-record information from law enforcement, the coroner’s office, and others as there is.  (And of course, wild speculation on the blogosphere here,  here, and here, for example)

This is a line that we’ve seen toed several times recently– Brittany Spears’ hospitalization comes to mind– so I wonder, does a person’s status as a public figure ever override their right to privacy?

The Vermont Crackdown

Vermont has been busy passing a law that restricts gifts to doctors (and nurses and pharmacists and hospitals) from drug and medical device companies, and requires them to report all gifts they receive that ARE still allowed. A few other states have laws to this effect, but this one seems to be the toughest.

Lawyer says: bravo Vermont! One of the best ways to work on big problems is to expose them to the sunlight — if this business has to be conducted out in the open, it will have to be conducted more cleanly.

The New York Times reports that the Pharmaceutical Research and Manufacturers of America  (PhRMA) has a code that companies can voluntarily sign that prohibits gifts that aren’t educational and places some restriction on meals.  Apparently PhRMA objects to Vermont’s law because… it’s redundant? And will waste doctors’ and companies’ time?

Well, PhRMA, I’m glad you have a code. That’s a good step. But come on!The code limits some types of gifts, and the law limits others. It also does something the code does not: requires reporting of things that continue to be allowed. Reporting requirements are, if you ask me, the best way to fix this problem. It encourages both good behavior on the part of doctors and pharma companies, AND  it can create public investment in and awareness of the process – very important where healthcare is concerned.  In addition, unlike the code, the law applies to everyone in the state  – not all pharama companies have signed the code.

Side note: previous regulations (and those that still stand in many places) allow large gifts to slip through, protected as trade secrets. Last time I checked, shady business practices (i.e. bribery) were not legitimate trade secrets that would allow other companies access to proprietary information about a company’s inventions.  Close the loophole!

Patients have a right to unbiased care. Vermont is helping them get that. Way to go, Vermont.