Health Wonk Review


 
Welcome to the September 6, 2007 edition of health wonk review.

I discovered, to my considerable surprise, that I had been tagged to host Health Wonk Review. To be honest, I have no idea how that happened (I’ve never submitted a post to the review, and didn’t volunteer). The submissions rolling into my inbox over the past few weeks were therefore confusing, and it was only a day or two ago that I had the dawning realization that I was on the hook. But being a can-do kinda guy, I rose to the challenge, so here it is.

Thankfully, the Blog Carnival folks made life easier by assembling all the submissions in one place, making the job immensely easier.

So the long and short of is: this will be neither clever, nor fancy, nor terribly erudite — but there’s some great stuff in the submissions, so check them out:

Shaheen Lakhan presents Medicare Begins its “Never Pay” Category posted at GNIF Brain Blogger.

Karen Halls presents How Do I Avoid Drinking Too Much Alcohol? posted at Addiction Recovery Blog, saying, “If you are trying to prevent yourself from drinking too much alcohol at social gatherings, here are a few ways that you can keep your alcohol intake under control.”

Henry Stern, LUTCF, CBC presents No Docs in This Box posted at InsureBlog, saying, “Retail medical clinics are popping up all over. They’re an inexpensive alternative to a full-blown practice or the ER, but “traditional” providers are crying foul. InsureBlog’s Bob Vineyard explores the hypocrisy.”

Warren Wong presents How To Overcome Fear And The Obstacles It Creates posted at Personal Development for INTJs, saying, “Are there things you are afraid of? Here’s how to overcome your fears, permanently, and overcome all the obstacles that fear creates.”

Alvaro Fernandez presents Brain Fitness Program 2.0, MindFit, and much more on Brain Training posted at SharpBrains, saying, “Review and commentary on several New York Times articles related to “brain training””

Shahid N. Shah presents Make sure your online SaaS vendors are appliance-capable posted at The Healthcare IT Guy, saying, “Shahid over at The Healthcare Guy provides some sage advice on how you should not count on “software in the cloud” for your mission critical healthcare IT needs without a backup plan. With big outages from Microsoft, Skype, eBay, and PayPal recently making headlines it’s a great time to make sure you’re protected.”

Jason Shafrin presents What are the Major Clinical Pathways to Disability posted at Healthcare Economist, saying, “This post reviews an NBER working paper discussing findings regarding how the elderly move from healthy to disabled states. Hopefully, this data can be used to aid health service providers on how to better prevent and treat disabilities which occur in old age.”

Richard Eskow presents Medical Justice League of America posted at The Sentinel Effect, saying, “Richard Eskow examines “Medical Justice.” a new service group that provides “gag order” forms to dissuade patients from reviewing their docs online, and also promises to “relentlessly” fight med mal lawsuits.”

Michael D. Horowitz presents What are the real savings in medical tourism? posted at MedTripInfo, saying, “An analysis of the costs of hip replacement in Costa Rica demonstrate that Americans can save 80% or more by going there.”

Dean presents Top Ten Fast Food Meals That Make You Fat posted at Mr. Cheap Stuff, saying, “Avoid these fast food meals.”

Daniel Goldberg presents On Epstein v. Relman (& Public Health Policy) posted at Medical Humanities.

David E. Williams presents Abusing the orphan drug law to rip off customers posted at Health Business Blog. Questcor Pharmaceuticals has announced “a new strategy and business model for H.P. Acthar Gel(R).” Translation: the company has obtained orphan drug status for a product that has been used for decades –including for the orphan indication of Infantile Spasms– and is raising the price 20-fold, from about $1000 per vial to $20,000 per vial.

Anthony Wright finishes up with a submission which snuck in this morning:

Small Business of California, Unite!

A spotlight on a poll of small business owners, showing that they are not reflexively opposed to health reforms, as they are sometimes portrayed. The scientific poll casts some doubt on “membership surveys” of some national organizations.

And a last minute shameless plug: for those interested in an in-depth look at the insanity which poses as our health-care system, check out The Maze — a multi-part series of posts on our billing and coding system, federal and third party carriers, and thoughts on fixing this mess.


That concludes this edition. I may have missed a few submissions, due to the last-minute scramble — my apologies for any such oversights.

Submit your blog article to the next edition of health wonk reviewusing our carnival submission form.

Past posts and future hosts can be found on our blog carnival index page.

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health wonk review, blog carnival.

Deep Waters

The following essay was originally posted in June 2005. The story is a true one, although the names have been changed.

 
Lake ClarkThey say that hell is hot. Sometimes, though, it is very, very cold.

Jim loved Alaska–it had been his home since birth. God’s country: wild, unpredictable, spectacular in beauty–there was no place like it on earth. Cities were a necessary evil, with their services and surliness, but out in the wild was where life could be found. Out among the glaciers, the ragged mountains framing the endless blue sky like jagged, broken glass, out where grizzlies snatched salmon from raging rapids, shortening their march to death as they fought wild currents to reach their spawning grounds. Out where eagles graced the sky, soaring above green fir spires and spotless snow fields. Out where God lived, where a man could see His hand, and hear His voice.

Jim lived a simple life of simple faith. He loved his wife as he loved the land, and together they were blessed with six children–three older girls, the twin boys, and a baby son their most recent gift. Each was a treasure greater than the next. Their lives were story book: The lodge they owned nestled near the shores of Lake Clark, a large inland glacial sea, mirroring the snow-peaked mountains surrounding it. Summers were busy–hunting and fishing tours, visitors from afar seeking trophies and photographs, decked in newly-purchased gear from REI in the lower 48. Jim loved to fly–the float planes lifted gracefully from the lake, carrying their awestruck passengers over endless miles of breathtaking beauty to some far-away stream where tied flies touched water and fish broke airborne for their last meal.

Out in the bush, relationships were few in number but rich and deep. Church was more than a Sunday obligation–it was a place where life was shared, joys celebrated, suffering comforted–a place where faith begot works, where love put on snowshoes and helped stack the winter’s wood. Family life was alive, ripe with blueberries picked, hikes to the falls, and quiet nights beside campfires. Summers passed quickly at Bible camp, concentric ripples of cannonballs and giggles of joy rolling across the lake from the old dock. Dates with dad and high tea with mom found no competition from mindless cartoons, and bedtime prayers thanked Jesus for His goodness and God for His gifts.

Winter was time for quiet reflection, as the short days and deep snows kept sportsmen far away, and school and indoor chores made the time pass slowly but with purpose. The plane was their lifeline: what few roads there were became impassible in deep snow, and flights to Anchorage a necessity for supplies and health care. The girls came along often, although the younger boys stayed with friends and relatives for lack of space.

Jim had tens of thousands of hours of flying experience, a skill which paid rich dividends in the harsh, capricious winters of south Alaska–there was little in the way of flying conditions he had not challenged and mastered. So this flight to Anchorage in February was a pleasant surprise: the low gray skies broke open to display the rare winter glory of sunshine on pristine snowfields, the glorious tinted rim of Alaska Range peaks and deep seas of Cook Inlet. The supplies garnered and the girls’ dental care completed, they took off for the return flight to home and hearth.

The storm struck without warning, a white she-devil blown in from the Gulf, the Cessna buffeted by sharp, hard winds as visibility and ceiling dropped precipitously. The instruments held true, and countless hours of difficult flying forged Jim’s nerves steely and his focus intent. Mom held the girls’ hands, distracting them from natural fears with songs and stories and heads held to breast, her own pounding heart betraying her calm demeanor. “Will we be OK, mommy?” “Jesus will bring us home, honey.”

The GPS told Jim they were indeed near home–the lighthouse in space beaconing safety and rest. By reckoning they should be near the lake, just a few miles out from the landing strip. But Nature had not finished yet, her rage reserved for one final blow.

A whiteout in a small plane is dreadful beyond imagining. Suspended between earth and sky, with no point of reference, no sense of up or down, sensory deprivation in a aluminum rocket. Your training trusts your instruments, but instinct and eyes scream for visual confirmation. There! On the right! Through a brief window in the suffocating white blindfold, a dark line: the outline of the lake shore. Jim banked the plane toward this beacon of hope. “Are we home yet, daddy?” “Almost there, honey.”

But wild Nature held one last vengeance: an atypical winter thaw had opened a long dark crack in the ice, normally frozen solid in February. The line Jim saw was not the shore. The plane hit water at airspeed.

The prop and windshield exploded. The cabin filled instantly with icy water, as Jim craned his neck to reach the fast-retreating air, still restrained by his harness. Years of wilderness training sprung to life, as without a thought he grabbed his Bowie and cut free the webbing. He struggled with the girls’ restraints, hopelessly locked between seats crumpled by the impact. His wife was nowhere to be seen. Time was up–the air was gone. He broke from the cabin, gasping for air at the surface, hoping to dive and try again to free his treasures. It was not to be: the plane sank like a millstone, 600 feet to the bottom of the frozen fjord, entombing the family he worshiped.

In shock, he looked around. His wife, by some miracle, thrown from the plane at impact, had struggled to the surface and clung to a floating berg. Spared from a frigid tomb, they stood on a fragile shelf of thin and breaking ice. Over two miles from the shore, clothing soaked through in sub-zero temperatures, their survival was still a loser’s bet. Slowly they worked their way shoreward, breaking through the ice at times, body temperatures dropping despite their exhausting physical efforts. Guided by some hand unseen, they finally fell exhausted on shore, finding shelter in an empty lodge. Blinded by cold and head trauma sustained in the crash, Jim was led into the cabin by his wife, who cut off his frozen clothes and started a fire.

Friends awaiting their arrival grew anxious, and the Air National Guard was called. A Pavehawk helicopter–battling the same merciless weather–located the crash site, and ultimately reached them at the cabin. Even then, they could not be evacuated, as conditions grounded the rescue helicopter until morning. A friend flew a Piper cub–braving the same horrendous storm–to bring arctic sleeping bags and warm food. Bravery, love, and duty had spared their lives.

Months passed. Physical healing came quickly, but the rawness of heart wept like an open sore, gently salved by friends and faith, prayers and potlucks, tears and thankfulness. The boys were precious as never before, but the emptiness of heart left by a lost child cannot be filled. The rage at God passes–slowly–as strength flows from trust born of countless old decisions to set aside self and act in faith. But the memories remain–the laughter lost, the peace of a sleeping child, the love of a flower picked, the unexpected hug. There is no answer to “why?“–only time, and trust, and talk, and the tender whispering of a gentle Spirit. Yet one haunting regret refused to die: the vasectomy Jim had undergone after their last son–expeditious at the time, financially prudent–was now a self-imposed prison in a home filled with people, yet achingly empty.

And so they sat in my office, seeking my skills to restore what no man should be asked to provide–hope and happiness. And they told their story, my heart aching with each small detail disclosed. Jim was a man of enormous character and strength, his wife still bearing the unspeakable pain on her face–yet there was no shame in the tears that welled up in their eyes. As I gently probed deeper with almost unseemly curiosity, I was drawn in by the most remarkable revelation: these two would stand. Theirs was a strength not merely of hardiness, or training, or steely denial hiding a dying heart, but of power beyond the means of any mortal. They had faced the hell that men fear even to consider, and conquered it. There was glory in their weeping, victory in their agony. They would never be alone, and never be defeated. I, the proud expert, felt strangely insignificant in their presence.

The surgery went well, and early recovery smoothly. As I spoke with Jim before he left for home, he talked about the girls who had loved their daddy and whom he still loved so deeply. “You know, if I could fly to heaven and bring them back, they would not want to come. Their happiness is complete, ours still unfulfilled. Jesus has indeed brought them home.”

The Engine of Shame – Pt II

This essay, the second of a two-part series, was originally posted in October 2005.
 
DRGWIn my previous post on guilt and shame, I discussed their nature and differences, their impact on personal and social life, and their instrumentality in much of our individual unhappiness and communal dysfunction. If indeed shame is the common thread of the human condition–fraught as it is with pain, suffering, and evil–it must be mastered and overcome if we are to bring a measure of joy to life and peace to our spirits and our social interactions.

Shame is the most private of personal emotions, thriving in the dark, secluded lairs of our souls. It is the secret never told, the fears never revealed, the dread of exposure and abandonment, our harshest judge and most merciless prosecutor. Yet like the Wizard of Oz, the man behind the curtain is far less intimidating than his booming voice in our subconscious mind.

The power of shame is the secret; its antidote, transparency and grace. Shame thrives in the dark recesses of the mind, where its accusations are amplified by repetition without external reference. Shame becomes self-verifying, as each new negative thought or emotion reinforces the theme that we are rejected and without worth. It is only by allowing the light of openness, trust, and honesty that this vicious cycle may be broken.
 
Continue reading “The Engine of Shame – Pt II”

The Engine of Shame – Part I

This essay, the first of a two-part series, was originally posted in October 2005.
 

Steam locomotiveA wise friend–a man who helped me emerge from a period of considerable difficulty in my life–once taught me a simple lesson. In less than a minute, he handed me a gift which I have spent years only beginning to understand, integrating it into my life with agonizing slowness. It is a lesson which intellect cannot grasp or resolve, which faith only begins to illuminate–a simple principle which I believe lies close to the root of the human condition.

My friend taught me a simple distinction: the difference between guilt and shame.

While you no doubt think I am devolving into the linguistic morass of terminal psychobabble, I ask you to stick with me for a few moments. What you may discover is a key to understanding religion, terrorism, social ills such as crime and violence–and why the jerk in the next cubicle pushes your buttons so often.
Continue reading “The Engine of Shame – Part I”