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Tuesday, May 30, 2006

Doctor Oprah Will See You Now...
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..Where is Chad Everett When You Need Him?

Oprah Winfrey is a great actress. When I first saw "The Color Purple" I thought that her role as Sofia was one of the most remarkable performances I have ever seen. It has been twenty-one years since that role and no one has toppled her from that top berth.

Chad Everett is not a great actor but a really good one. For those not born last millennium, Chad Everett played Dr. Joe Gannon on the television series "Medical Center" from 1969-1976. Interestingly, the timing of the closing of the show coincides with when Medicare started ratcheting down payments and managed care started growing. It seems Dr. Gannon got out just in time.

There is a huge difference though. Everett's most famous quote "I am not a doctor, but I play one on TV" is a subtle but real disclaimer. Many people, though actually believe that Oprah either is a doctor or has the same amount of medical validity as a doctor. She is many things. She is many amazing things. She is a remarkable actress. She is a true leader. She is a great media innovator. She is not a doctor. She isn't even close. When she parades one health tip after another on her show you might as well sign up for cyanide. It has the same validity.

Recently, she had a show on a dermatologic technique. I know this, not because I watch her show - not because I actually have a life but I am sometimes busy when it airs - but because the NY Times had a full page article on the issues surrounding her "reporting" of this cosmetic technique. It seems that there are quite a few complications associated with this technique. This conveniently was left out of her show. Some dermatology experts pointed this out in the article.

Big deal I say. Oprah isn't wrong.

Wait a minute Dr. K., I thought you were gearing this article up to bash Oprah reporting irresponsibly about a medical procedure. No way, Jose. Oprah is OK in my book, Why? BECAUSE SHE IS NOT A DOCTOR!

She knows she is not a doctor, I know she is not a doctor, and the rest of the world should know it too. There are only two freakin' idiots in this equation - the people who watch her and then flock to get this cosmetic crappy procedure without consulting a reasonable doctor and worse, the doctors who decide to perform this procedure because they want to ride the wave of popularity and cash in.

Oprah is cool. She isn't supposed to do a balanced, super study on the pros and cons of everything presented on her show. HELLLLLLO - It's her show. She can say what she wants.

If she told you to suck on an Anthrax PEZ would you go out to the Al Qaeda Convenience store and load up? Of course, not. She is not the problem but you are if you do not perform due diligence and properly check out all you see on TV and read on the Internet.

If you blindly sign up to something medical you saw on the Oprah show and your skin slid down like hot fudge on an ice cream cone then you deserve it. End discussion. Go Oprah!

We cannot be so kind to the scores of doctors who offer snake oil procedures that offer the same relative integrity that a Pocket Fisherman has to true deep sea fishing gear. While Oprah is not a doctor- these people are.

A doctor is a professional who is granted a license to behave in the public trust. When the scum of Enron, Worldcom, Adelphia, Tyco and others rip off the public it is business. They are not professionals. We almost expect them to be lower than the common rat and they rarely disappoint us.

But a doctor must stem the tide of the public's zeal for quick and easy fixes and solutions that are not based in data and have complications hidden from public view. It is the doctors that rapidly adopted, without giving patients full informed consent of possible hazards, the cosmetic dermatologic procedures shown on the Oprah that failed the public trust.

We all should be better than that. That is the concept of the public trust. Doctors are given a great gift. It is a privilege and honor to have the opportunity to care for another person in the intimate ways we do. We can't be perfect but we need to try to think of medical solutions that are in the best interests of our patients- all the time.

Dr. K.

Related Topics: Plastic Surgery: It's Not Always A Fairy-Tale Ending (WebMD Video), Who Gets Plastic Surgery and Why

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Posted by: Ira Kirschenbaum, MD at 9:37 AM

Tuesday, May 16, 2006

It is All About the Money
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The rich get richer and the poor help the rich get richer. The only "people" who benefit in the current healthcare climate are the few multinational corporations that supply healthcare and the fewer national insurers. This has been the Republican agenda over decades across the globe, and it is having its impact on American medicine.

Unless you have been in a rabbit hole for the last few years then you certainly know that the reason we are in Iraq is to use the military to spread the Cheney administration's global economic agenda of free trade in areas that did not have free trade. Cheney (and his sidekick George Bush) has fooled us into believing that free trade = free society = the deliverance of democracy around the world. The only thing we have delivered is massive profits for companies like Halliburton, Exxon, and others.

So what does this have to do with healthcare and money? Everything.

While the country's attention has been on the rising prices at the gas pumps we have failed to see the raping of patients with disease by pharmaceutical companies. Pharmaceutical companies (usually called Pharmas in the business community) have increased their prices in recent years to such an extent that the equivalent in pump prices would be $8.00-$12.00/gallon.

This does not let Exxon and their board of directors off the hook, they are just a bit less evil.

The first quarter of 2005 saw NET INCOME from one of the major pharmas of $4.11 billion dollars. That is after the expenses of private jets and mahogany offices and after all the lobbying efforts with Congress. That is a lot of money for selling drugs needed by one group of people (patients) and ordered by another (doctors). I don't think the Columbian Drug Cartel does this well.

Here are a few ideas for that money:

  1. Pharmas should be taxed 20% of gross revenues that go into a national uninsured health fund to pay for qualified plans for the uninsured.
  2. No drug should be protected by patents. All drugs should be allowed to be produced generically on day one of introduction. That is the free market. Drugs are chemicals. Chemicals naturally exist. Companies should not own nature.
Then maybe we won't have seven different cholesterol lowering drugs which we do not need and instead get basic healthcare for a country in a healthcare crisis.

Dr. K.

Related Topics: Can States Pay for Bird Flu Preps?, Small Business Health Insurance Flops

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Posted by: Ira Kirschenbaum, MD at 11:43 PM

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