Cast & Curious

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  • Politicians in Health Organizations: Sounds bad, taste even nastier!

    I had a good glimpse lately of what happens when politicians meddle with what seems to be a health oriented, non government organization’s efforts of establishing itself a local chapter. The very efforts of its pioneering volunteers to constitute an assembly and create its own governing body is in itself laudable, but I was quite disturbed with what I saw during its first assembly.

    Traditional politics running the show and obvious politicking horrendously at odds with what appears to be a health related organization’ simple general assembly and election of directors. Obvious flaws were never clearly addressed, like who constitute members and who has voting privileges. While it is clear that the national organization has explicit laws on this, no one ever bothered to answer this membership question. Delegates where just handpicked from all local government units and suddenly they constitute the voting members. No one knew what happened to them after the election.

    Then out of nowhere, hordes of politicians suddenly popped up in the nominees for the board of directors. I clearly understood that one criteria says we need leaders from different sectors of societies, but are they members of the national organization in the first place? What do they knew about the tenets of the organization? There was a gossip going around that this was a “prelude” to the upcoming elections, since the handpicked delegates come from all of the municipalities in our areas. Maybe this politicians are testing waters and getting the “feel” of the locals. I talked to some of the politicians studying their intentions and some actually had the gall to declare they can use this organization for their upcoming “election plans”. I feel like vomiting. Lord, sana sila na lang mag ka colon cancer.

    An example of how traditional politics corrupt our voting rights. When we let them do this, we probably  deserve the price. (picture taken from sunstar.com.ph)

    I have nothing but pity for the local chapter of this organization, especially for those who worked hard for its creation. I worked with some of the volunteers and I’ve seen them risk their lives and health, spent countless days sacrificing their family and career for what they believe is service to humanity. It is because of them that I was  nominated (coerced actually, since I really detest organizational politics) for the board. But when I saw the process, I attempted to withdraw first hand, but it was too late. I said I’ll resign immediately if I win. Thanks God I was spared of the agony. My loss would actually a win for my credibility and principles. I felt like I’ve lost a burden.

    I may have underestimated these politicians but well, I’m not interested to see their outcomes anymore. Their previous work speak for themselves. You cannot expect a good deed from a rotten fish, more than expecting you’ll win in a lotto game. Sometimes I agree with what other says about our current crop of leaders-

    We deserve all the trapos we get, because we allow them to corrupt our mind, our heart and our very soul

    To my friends in the local chapter, you are my friends still and we will remain friends still. You can always ask for my help in the organization, but I’d rather do it as a coequal partner, not as a member.We can still do service to humanity the way our simple lives will afford us to. Good luck guys, and just keep your focus.

  • An over the counter, “drug store diagnosis” and drug dispensing

    I usually go to drugstores incognito to buy my own anti allergy meds. During these incognito trips to pharmacies and drugstores, I get to witness interactions between customers and pharmacy attendants without them knowing I’m a medical professional. Most conversations are totally harmless but on few occasions, I hear conversations that could probably bedevils me.

    Here’s one of the sales lady – buyer overheard conversations:

    Customer: “Miss ano maganda gamot sa trankaso?”(Miss , what drug can you recommend for flu?)

    Saleslady:” (Name of brand X drug), trangkaso man kaha.” (_________, you got flu, right?)
    Customer:” Three times a day na sya ano?”( Three times a day?)
    Saleslady:“Yes”.

    While the saleslady was getting the drug…..

    Customer: “Unsa, maayo nga antibiotic para sa trangkaso?”(Miss , what antibiotic can you recommend for flu?)
    Saleslady: “Konsulta sa mo sa duktor nay.” (Consult a doctor first)
    Customer: “Cge, katong Decolgen na lang ako-a, tatlo ka buok. Ug isa ka Eskinol kanang medium bottle)” (I’ll get three tablets of Decolgen and one Eskinol medium sized bottle.)

    Here’s another.

    Customer:”Miss anong maganda na bitamina para sa matatanda?” (What’s vitamin can you recommend for adults?)
    Saleslady:“Para sa unsa?Ugat o bukog?”( For what?Nerves or bones?)
    Customer: “Sakit man yung likod ko kasi. Yung para sa ugat. Bigyan mo ako ng pito” (I have backpain, I need the one for nerves.Give me seven pieces.)

    I was shaking my head in disbelief. If this is happening in one major drug dispensing store, I could only sigh for whats happening in other smaller drug stores somewhere else!

    I cannot simply point finger on any one health stake holder as the cause of this drug dispensing dyseducation (for lack of a better term), but I’m pretty sure we all contribute.

    That’s why it is imperative that pharmacists (or their salespersons) are not allowed to prescribe drugs or give health information that are beyond their knowledge base. In Medicine, a bad information is no worse than no information at all. And it kills, mind you. That’s why accountability for providing health care is a must, otherwise these type of interactions just go unabated.

  • Philippines: Enroute to Mc Allen Health Care System

    It came as a no surprise. The never ending  finger pointing of who or what did “jacked” up the high cost of health care in the US suddenly found an ominous target. Health care providers particularly physicians, may have been partly responsible for the high cost of health care in the US. One such article that suggest this was written by Atul Gawande and posted on New Yorker Annals of Medicine: The Cost Conundrum.

    Atul wrote his “musings’ on two health care systems (Mc Allen in Texas and Mayo Clinic)  that exist in the US which showed a stark contrastsin their health care cost and outcomes. Health care authorities wonder why such an average income city like McAllen, wield one of the highest health care costs (second only to Chicago, considered to be a high income, high cost of living area) yet their cities health care outcomes are no better than other cities in the US utilizing a lower cost of health care. Surprisingly, a well known top notch health care institution like the Mayo Clinic deliver a better than average health care outcomes with health care utilization cost that is lower than most health institutions in the US!

    So why the physicians are partly the reasons for this? The writer ponted some not so obvious reasons. Not a few physicians order” “unnecessary” diagnostics to increase diagnostic accuracy and partly to protect themselves from malpractice suits or litigation. Another reason is rising unnecessary clinic visits, specialist referrals, entrepreneurial marketing endeavors that walk on thin borders of ethical compromise, physician s education or training and so many things. The fee based business- like private practice also creates pressure on objective decision making of physicians, propelling a market physician practice. There were so many things pointed out and none has yet set a clear local and national health policy to clear this out.

    This article became a must read for Obama and his White House staff.

    I think the Philippines can also learn from these insights. While we preoccupy much of our debates over two spectrum of health care delivery (poor vs rich ) present in the cities, we do not exactly know the vast number of “in between” that reside in the rural areas.The Mc Allen phenomena is not unique to Texas. While those in the tertiary centers of health (e.g. Manila, Cebu, Davao) presumably get better access to quality health care system, the fee based system we have limits this quality health care to those who can afford it. Of greater concern are those poor Filipinos in the rural areas, where not only that they don’t have access to better quality healthcare, they’ll have to shell out more than their counterparts in the centers to obtain same quality health care. Why is that? I don’t have answers to this. Our health insurance system? It only magnified a few these apparent disparity.

    One example I can point out is the coverage Philhealth (PHIC) for illnessess claimed by its insured constituents. Assuming the same illness, the same level of care is provided for by the health care professional or instituion, reimbursements is still dependent on the “level of hospital” (primary vs. secondary vs. tertiary) where the patient was admitted to. Since it is rare to see tertiaries in rural areas, claim coverage is lesser (~30-40% for some, although practically no one knew except PHIC). Ergo, the patient pays more because less is covered by his insurance. It may sound superflous but yeah, will an appendectomy performed really differ between a secondary or tertiary center? Bottomline is not who pays for the patient. The patient pays more for the same level of care provided. I am not yet talking of why the health care provider should be paid less..

    The recent drives for an evidence based medicine and the attempts by expert panels to reduce diagnostics procedures to meaningful ones is laudable. The only two great limitations to these are the source of the evidence, which is mostly foreign and the availability of such diagnostic or treatment procedures in the rural areas. Thus in the rural areas, the best evidence often translates to what is available. The GP has no choice but to revert back to his personal expertise which is most often borne out on the availability of facilities and logistics. They dont have any choice.

    The cheaper medicine law is in place after so much hoopla but so far, the effect seem anemic. The Cheaper Medicine law should have lessen the grip of pharmaceuticals on drug prices, but that doesn’t seem to be the case yet. Or will it ever be?

    Yes, the fee based health care system suck, but that’s what our system ‘revert” to with a government does not (for lack of balls perhaps) prioritize healthcare subsidies? We doctors could probably reduce our health care utilization cost if we wanted to. We were trained to do just that in training. We were taught that our patients come first and our physician business last. But while such patient-doctor relationship may seem so simplistic and altruistic, it is not bipartisan. Pressures created by external factors on this relationship surely influence the dirsection to which this relationship is consumated. The rising health care cost is just one of them.

    I’d say Filipinos will have to move heaven and earth to adopt a health care system akin to UK, porportedly the best in the world. Resitance to such change is not only unique to the pharma industries but to some physicians also. Even if it takes time for you to be seen/operated on by a specialist in UK/US, at least you get to be seen. Here in the Philippines, the chances of you getting seen/ operated by a specialist is largely proportional to your paying capacity.

  • If you’re young and wealthy, you probably own an iPhone

    That is if you believe the latest study published by Forrester Research ( private Marketing Analyst) among the 32,228 adults in the US last 2008. Take a look at their graphs below:

    or this,

    Rightly so perhaps. With the initial offering of iPhone(Apple) last 2008 skyrocketing to almost that which cannot be afforded by the “average” middle income citizens, I guess this come as a no surprise. Also with the thousand usable apps that brings in ease and usability on productivity, perhaps iphone will really beat the hell out of its other competitors in the market.

    This study will probably be more “skewed” to the right among its Filipino users, as IPhone prices here in the Philippines are only affordable to the savvier, wealthier crop of professionals.

    Let’s see what happens with the iPhone price cuts that Apple is offering these days.

  • Medical screening tests among healthy adults: Is Eight Enough?

    Yeah. Eight should do it.

    That is, if you believe what U.S. Preventive Services Task Force– a government-sponsored expert panel that evaluates preventive tests, is telling healthy adults in the US. This meant that of the countless battery of tests that are included in those “executive” work up, only eight, I repeat-only eight will “likely lead to a better health”. I’m not so sure about what where there basis for choosing this eight but I suspect clinical studies that validate it on a public health scale should be one of them.

    Nonetheless, and pending reactions from our public health authorities here in our country here are the “test” and their range of acceptable values as published in Forbes Magazine.

    I am not sure how our colleagues in the medical profession will react to this and so our public health officials. I am more interested in its implications towards my well adult patients and the health care cost reduction it will offer. Surely that will go a long way in them digging hard into their pockets.

    What do you think?