October 4, 2009

66th AAPS

Dear Friends,
I have just returned from the 66th Annual meeting of the AAPS.

These past few days at the AAPS meeting have been very interesting. We heard from Kelly Jones (the PharmD who worked with my mentor, Dr. Terrell), and many persecuted doctors, as well as MD politicians (Paul Broun, Tom Price, Rand Paul, Mike Ritze), and the superbly entertaining and challenging Ezra Lavant (who identified, as the worst consequence of socialistic medicine, the surrender of ourselves, body and soul, to the state).

What was most striking about this meeting was not the urgency to reverse the current situation, or the strategies mentioned, or the personalities and great talks. What was most striking was the exaltation of Jesus by a majority of members.

This organization has more punch than any in medicine. For its size, it out slugs the best. They sued and stopped the Clinton health care debacle. They have exposed the Texas medical board for corruption. And they are taking on the current federal administration.

The meeting was tremendous. Various doctors that have suffered at the hands of the bureaucracy told their stories, compelling stories that are not isolated instances. Others gave moral and philosophical arguments for independence, both from Scripture and from their experiences.

Those that have been active politically (whether as elected reps or stalwart individuals) gave updates on various legislation and areas to be vigilant. It was most impressive that they are not merely trying to stop the rot, but are offering positive ways to get government out of medicine, while solving the problems that initiated the wrong solutions.

I know that political action is not our salvation. But God uses means to work his will. We have an obligation to stand up to protect our patients and our neighbors. If there is a time when action is important, it is now.

If you are a physician, join AAPS and find out what you can do. If you know physicians, encourage them to join.

| By Robert Maddox | 7:06 AM

September 16, 2009

Vertebroplasty sham

The NEJM contains two studies and an editorial on vertebroplasty. Both were blinded, randomized, controlled trials. One was done in Australia, the other at 11 centers around the world, by a Mayo Clinic lead. Cement is injected into the compression fractured vertebra. It makes sense that the procedure should help the pain and disability from such a backbone fracture.

But it doesn't, at least any better than a sham procedure. And it is not cheap. Just like with the knee arthroscopy proved to be useless, do you think anyone will be reimbursed, or at least apologized to?

| By Robert Maddox | 1:20 PM | Comments (0)

July 9, 2009

Savings redefined

This new health plan proposal is taking government doublespeak to a new level. We are now experiencing savings by not only not paying for services rendered, but by fining and taxing more people. Hogberg has an excellent analysis as usual. And requiring that hospitals cut $200 billion over ten years sounds suspiciously like Obama's plan to drop the global temperature 2 degrees. This HUBRIS is out of my league to even comprehend.

| By Robert Maddox | 7:27 AM | Comments (1)

June 30, 2009

Hypertension and dementia

A friend forwarded a commentary on a study on BP variability and its connection to dementia. This was a poster presentation at a conference, so the numbers are not available to us. As presented in this commentary, it raises more questions than it answers, which is the purpose of these kinds of studies.

Previous studies have shown a statistically significant (but not meaningful) increase in dementia with increased pressure. This study does not even show statistical significance. Rather, the variability in pressure is statistically signficant (again, we do have enough information to say whether this is meaningful). But the ranges of variability are much wider than the difference between the ranges.

The big question is, clinically, does treating BP (or worse, attempting to treat) cause greater variability leading to greater dementia? Have we worsened the dementia problem with our treatements (of BP, or cholesterol, or whatever)? Have we first done harm?

| By Robert Maddox | 9:08 PM | Comments (1)

April 7, 2009

Society's agent

This issue of JAMA, April 8 (301, 14 p. 1482-4) contains a commentary by Kirch and Vernon on Social Justice in medicine. They contend that the first three pillars of the foundation of medical ethics (beneficence, non maleficence and respect for autonomy receive plenty of attention, but that justice is underemphasized. In discussing autonomy, they quote an article by Kluge, a Canadian ethicist, that the physician "is society's agent and as such has delegated authority in matters of health care delivery."

In light of the constitutional prohibition on titles of nobility, Herb Titus has argued persuasively against state licensure. This concept of being society's agent is flatly unconstitutional.

Further, it is contrary to reason. What is society? If one means the civil government, than say so. But the civil government is force, not reason. If one means the local community, that is more reasonable, but contrary to the force of the state.

More importantly, this view ignores the fact that Jesus reigns in Heaven and on earth. I am obligated to obey him, to be his agent. That, of course, does not preclude a temporal authority as well. But that temporal authority must also be obeying Jesus. So it is not the desire of society, or the patient, or the doctor, that is the main consideration, but of Jesus.

It is no wonder that the ethicists and policy makers find confusion amongst the options of models. Only the model of mutual servanthood can solve these dilemmas. I am a servant of Jesus and of his creation. I advise and treat fellow servants (even those that rebelliously reject or deny the Master). There is no autonomy, there is no abstract justice, there is no way to determine good or harm apart from his standard.

| By Robert Maddox | 9:39 PM | Comments (0)

March 17, 2009

Quality care

Yesterday, the latest issue of JAPS arrived. It contains an article by Dr. Terrell published posthumously. It will give readers unfamiliar with his work just a taste of the stupendous wisdom, wit and insight of the man. I happened across a discussion on-line of the concept of quality care, and found some good comments by Dr. Centor. But unfortunately, even this excellent discussion misses Dr. Terrell's main concerns. Knowledge of data is helpful, but not the main concern in medicine. This is because diagnoses are not discoveries, but decisions. Individuals should not be lost in the data. Quality medical care cannot be measured and standardized if the individual's suffering is the main point of concern. There are too many competing issues to standardize.

This article deserves wide, careful and repeated reading by anyone who has medical problems, or in the medical fields.

| By Robert Maddox | 4:21 PM | Comments (0)