Opting out of corporate medicine

A recent edition of the New England Journal of Medicine strongly criticizes the corporatization of medicine. Corporations, they say, operate according to the logic of business, “emphasizing efficiency and financial returns, whereas medical institutions have traditionally operated as professional or charitable enterprises.” Now, medicine is market-driven and relies on private businesses to “fulfill a fundamental human need,” akin to the privatization of fire and police departments.

Because investors now supply the capital needed to support new technologies, upgraded facilities, research and development, and competitive salaries, medical organizations must make a profit. Unlike other U.S. profit-making enterprises, profits and value “often don’t align.” For example, medical firms can make money by cutting corners with “little fear of affecting demand.”

Small physician practices need money to provide high quality care. For example, they may need to purchase an expensive electronic medical records system. Or they may be unable to coordinate care effectively without becoming part of a larger provider network. For that reason, they often become incorporated into one of the large enterprises.

Not long ago, I found a physician who seemed to have opted out of corporate medicine. I needed carpal tunnel surgery on both hands and found him using a Google search. It was an interesting experience and one that I liked. His office is half of a small duplex located near a cemetery. Entering the office, you’re greeted by Kimberly, his office manager. When it’s your turn to be seen, the doctor comes into the waiting room to welcome you into his office. It’s just the two of them. I especially love the fact that, when calling the office, Kimberly answers the phone instead of a robot. 

Because the major hospital in our area is part of the Dignity corporate enterprise, this hand doctor performs his surgery at a community hospital that’s about an hour’s drive from our home—the only downside to using his services. He did a good job and I’m pleased with the outcome.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

A pill for stroke victims?

It’s long been believed that if you have a stroke or other brain injury, your brain never fully recovers. A stroke disrupts a vast network of neurons that exchange messages with far-off regions. After a stroke, patients usually recover some functionality, but few achieve close to a full recovery. At some point, the brain decides it’s done healing. Dr. S. Thomas Carmichael, head of neurology at the Geffen School of Medicine, finds that a patient’s brain would heal and adapt somewhat, but “it just doesn’t get very far.”

Scientists studying “smart” mice discovered that they lacked a gene that affects a particular receptor in the brain—the one that causes the brain to hold itself back. Mice lacking this gene have an enhanced ability to learn and remember, and they recover faster and more completely from a stroke than mice who have the gene.

With this discovery in mind, researchers looked for humans who had the same mutation. They found a neurologist at Tel Aviv University in Israel who was tracking a cohort of 600 stroke patients to see which ones developed dementia. It turned out that some people in her study did have the same genetic mutation as the smart mice and that they did have better scores on language, memory, and attention. The first gene associated with stroke recovery has been discovered.

The team that had been studying the mice had also found a drug, Maraviroc—a little-known H.I.V. treatment that, as a “side effect,” boosted neuroplasticity after brain injury. That drug, which mimics the gene mutation, is now being administered to stroke victims in a clinical trial. It’s not a perfect drug, but it will lay the groundwork for future therapies by deepening the understanding of the brain’s recovery system.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

Austrian rehab

I have a cousin, Uta, who lives in Austria. She lives there because her mother, when she was still a child, had a communicable disease at the time the family boarded the ship to America. Because she wasn’t allowed to emigrate with the rest of the family, she stayed in Austria with her grandmother. She never joined her family in the U.S. She grew up, got married, and gave birth to Uta in Austria. I knew Uta because she lived here for a time when she was a teenager and has visited off and on since then. We communicate occasionally by email.

When I told Uta about my knee replacements, she let me know that, in Austria, people who have that surgery are automatically sent to a rehab facility for six weeks. (I went home a few hours after my surgery!) I was reminded of this after reading a recent article in The New York Times with the headline, “In Austria, Government Health Care Can Look a Bit Like a Spa.”

Indeed. Austria has a number of rehab centers that are paid for, in large part, by the government’s social insurance program. The centers take care of people with heart conditions, cancer, diabetes, obesity, pulmonary health, neurological diseases, and joint problems.

In describing patients at the cardiac facility, the article states: “Some headed to water aerobics, others to art therapy. They tried out calisthenics, lifted weights, cycled outdoors and took dips in the plunge pool. Should they choose, they could also just sink into an ergonomic lounger—all of which is considered part of the cure.” The center houses 175 patients, “most with their own ensuite bathroom and balcony.” Meals are personalized and the food is attractively prepared, as you can see in this photo. 

Patients are closely monitored—not to everyone’s liking. Still, compared to my own home post-op situation, those Austrian places sound like a dream.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.

 

Walk on that broken bone!

In the old days, people who had broken a leg or ankle could be in a cast and on crutches for about two months. Nowadays, people begin to walk on broken bones in two weeks. Studies show that complications are no more likely with early weight-bearing than with a long delay. Except in a few complex cases, walking around earlier helps broken bones heal. With inactivity you not only lose muscle mass, you lose bone density. (Lifting weights, for example, increases bone density.)

Bone is living tissue. It heals naturally by making new bone and resorbing damaged cells. In the gap caused by a fracture, a healing tissue called callus forms first, which then turns into bone. The right amount of load or movement is critical to this process. Too little results in no callus; too much prevents the bone from knitting back together.

Some patients don’t have the dexterity and strength to manage partial weight-bearing while using crutches, so they stay in bed. The lack of movement leads to serious problems such as blood clots and weakening of the lungs. One 2005 study found that 9 percent of hip fracture patients died within 30 days of breaking a hip and that 30 percent died within the first year. More recent studies of hip fracture cases suggest that early weight-bearing decreases mortality rates, and doctors have altered their practices. The normal standard of care is now to fix it and let people walk.

I don't have any experience with this. I've never broken a bone (lucky me). I do know, from experience, that within hours of knee replacement surgery, they have you up and walking. Same idea, anyway.

For an introduction to this blog, see I Just Say No; for a list of blog topics, click the Topics tab.