Once upon a time

Wirth-Liss Phramaceuticals makes a hideously expensive drug that has to be administered once a month at the doctor's office. The patient co-pay on most plans is anywhere from $50 a month and up (granted, that's cheap compared to what the insurance company is paying for the rest).

So Wirth-Liss came up with a patient assistance program, where the patient gets $600/year covered by the insurance company, to help lessen the cost burden. Their idea was that this way more patients could afford the drug, so more doctors would order it. I can see the logic.

But the implementation left much to be desired.

Some company genius, with apparently no grasp of reality or human nature, decided the best way to do this was to send every person who qualified for the plan a prepaid credit card with $600 on it. The idea was that Mr. Patient would hand it to the doctor's staff at each visit, it would be swiped for $50 each time, and at the end of the year the card would be empty.

Unfortunately, it didn't occur to them to lock-out the accounts so that they could only be used at a doctor's office...

Basically, they sent patients pre-paid giftcards with $600 on them.

Of course, given human nature, most patients saw this as a windfall, and went on spending sprees. They bought groceries, beer, clothes, toys, a tank of gas, whatever.

Then, when it was time to go to the doctor, they didn't have any money left for the drug. So they opted not to receive it. So the drug wasn't given, and Wirth-Liss Pharmaceuticals, Inc. wasn't able to bill an insurance company for it. And, in fact, they now had a new corporate loss of $600 per irresponsible patient.

Of course, the patients thought this was grossly unfair. They couldn't understand why they couldn't have the drug, when, after all, they'd qualified for the assistance program. The fact that they'd blown their co-pay was beside the point. They also didn't see why they now had to pay cash for the co-pay, since the program person told them they wouldn't have to.

And, of course, they wanted another card.

When the above was explained to them, suddenly they remembered they'd never received the $600 drug card, or it had been stolen, or they hadn't seen it since an alien abduction on the way home from Las Vegas.

The program has since been replaced with one where the card can only be used at a specific doctor's office.

The executive behind it, I hope, has been canned.

The drug reps have the difficult job of explaining the program changes, and why they were made, to doctors and their staffs. Who are laughing hysterically.

Moon river

Dr. Grumpy: "How did the medicine I prescribed work?"

Mrs. Solanaceae: "I never tried it. I looked it up on the internet, and found out it can cause liver problems."

Dr. Grumpy: "Okay... but that's pretty rare."

Mrs. Solanaceae: "I don't care! It's my body, and I'm not going to take a pill that might harm it."

Dr. Grumpy: "You told me you smoke 2 packs a day."

Mrs. Solanaceae: "That's different. It's not a pill."

"Mavericks"? WTF?

Obviously, I'm bored tonight to even be taking a few minutes to type the following.


Apparently Apple is now switching randomly from feline names to beaches. I assume they ran out of cat subspecies.

I'm going to point out that there are still a LOT of felidae names to choose from:

Caracel

Smilodon

Margay

Geoffrey's Wild Cat

Serval

Colocolo

Norwegian Forest Cat

Ocelot

Kodkod


And many others.


NOT only that, but 10.3 was "Panther." Which is a genus. Not a species (okay, so was Smilodon, and they're extinct. But they were COOL).

And 10.1 (Puma) and 10.8 (Mountain Lion) are the same damn animal (Mountain Lion, Cougar, Puma, are all the same creature). For the record, this particular animal has more known names than any other, with at least 40. "I'll take felidae trivia for $200, Alex."

All right. Enough procrastinating. I'm going to go see what Frank spent the day building on Minecraft.

That's why they call it a "blood gas"

Apparently, calling it "Arterial pH" used too many letters...

June 8, 1971

J. I. Rodale (1898-1971)

On this day in history... a man died (big surprise, huh?).

Like the late James Ferrozzo, it wasn't so much that he died, but how he left us. In death, as in life, style and timing are everything.

Jerome Rodale was an early proponent of healthier eating, and his legacy continues today. He was one of the first to support sustainable agriculture, and believed crops should be grown without pesticides. His publishing empire lives on today, with the magazine Prevention, which he founded, and more recent additions such as Men's Health, Women's Health, and Runner's World.

On this day in 1971 he appeared on the then-popular television talk show, The Dick Cavett Show. It aired late-night, but was taped earlier each day in front of a live studio audience.

Mr. Rodale (age 72) was the first guest interviewed, and happily went over his beliefs in living a healthier lifestyle. He promoted the benefits of organic farming, and expressed his optimism over its effects on himself. Things he said during the show included:


"I'm in such good health that I fell down a long flight of stairs yesterday and I laughed all the way."

"I've decided to live to be 100."

"I never felt better in my life!"

"I'm going to live to be 100, unless I'm run down by some sugar-crazed taxi driver."


After the interview, Mr. Rodale sat back in his chair as Dick Cavett brought the next guest onstage (New York Post writer Pete Hamill). As Cavett and Hamill chatted, Rodale made a loud snoring noise, and appeared to doze off in his chair. The audience thought he was pretending to be bored, and laughed.

According to witnesses, Cavett asked "Are we boring you, Mr. Rodale?" (Cavett to this day denies making that remark). Hamill looked at Rodale, then turned to Cavett and said "This looks bad."

Two production interns ran onstage and began doing CPR (unsuccessfully) on the healthy-lifestyle advocate as Cavett took the microphone and asked "Is there a doctor in the audience?"

Cavett, in a 2007 interview with the New York Times, said "I thought, 'Good God, I'm in charge here. What do I do?' Next thing I knew I was holding his wrist, thinking, I don't know anything about what a wrist is supposed to feel like."

Mr. Rodale was later found to have suffered a heart attack. The episode was never aired, with the network choosing to show a re-run in its scheduled place.

But is it artisanal?

Seen on a bowl of drug rep fruit:

Thank you, Karen!

To err is human

Dear American public,

I apologize.

I accidentally cost you $470 last month, and so I owe each of you a $0.000000076.

I actually feel quite bad about this, but more in terms of the money lost and the inconvenience to the patient.

What happened, you ask? Well, I meant to order a lumbar spine CT scan. But due to a busy day and multitasking, accidentally wrote an order for a cervical spine CT. No one questioned it, and so it got done. I didn't realize the error until the report showed up on my desk. I apologized to the patient, and ordered the correct study.

The whole thing is overall harmless. The patient is elderly, and a few additional units of radiation are inconsequential. The 1 week delay in getting the proper test didn't have an adverse impact on his condition.

But still, I feel bad. I'm certainly not out to rip anyone off, especially other taxpayers.

This is, as far as I know, only the second error I've made in ordering the wrong imaging study in the last 10 years. I assume I have the same error rate as other docs for this sort of thing, and the total for mine is around $1100. Given that there are roughly 900,000 practitioners in the U.S., that comes out to $990 million dollars wasted every 10 years. That's enough to pay 20,000 school teachers for a year, or buy the Air Force eight F-35 fighters. Even by government standards it's still a decent chunk of change.

I don't have an easy answer for this. Should I be responsible? If a doc orders the wrong test, should he have to eat that cost? I guess that makes some sense, but someone is going to argue at some point that a test shouldn't be ordered. What happens if I did order a correct test, but then an insurance company claims it wasn't necessary - so should I pay for it?

Or what if the patient (after getting a test bill, of course) claims that I shouldn't have ordered a test, and wants me to pay for it? I've had that happen (I refused) and have learned it's common. I know another doctor who was threatened with a malpractice lawsuit to get her to pay for a study (she stood her ground, and they backed down).

So, I guess the only easy answer is to leave it as it is, and accept the fallible nature of humans. If ordering the wrong CT scan (at no harm to the patient) is the worst mistake I ever make in this business, I'll take it.

Doctors behaving badly

I'm with a patient, when Mary knocks on my office door.

Dr. Grumpy: "What's up?"

Mary: "Sorry, it's Dr. Promissory. He says he needs to speak to you urgently."

Dr. Grumpy: "Okay." (picks up phone) "This is Dr. Grumpy."

Dr. Promissory: "Hi, sorry to interrupt you."

Dr. Grumpy: "What's going on?"

Dr. Promissory: "My wife recently started her own business as a mortgage agent, and I was wondering if you'd considered refinancing your home?"

Mary's desk, June 3, 2013

Guy walks in, stands at counter.

Mary: "Can I help you, sir?"

Counter Guy: "Yeah, um, is this Dr. Grumpy's office?"

Mary: "Yes, sir. Do you have an appointment?"

Counter Guy: "No, I'm looking for another office. Thanks."

(leaves)

Maaaaaaaaaarrrrrrrrrrrrryyyyyyyyyyyyyyy!

Dr. Grumpy: "Can you smile for me?"

Mr. Poligrip smiles a little.

Dr. Grumpy: "Smile wider. Can you show me your teeth?"

Mr. Poligrip takes out his teeth and holds them up.

Those were the days

I just can't take it

Patient quote of the day:

"I don't want to take a pill just to take it. Because I'll be "taking it" taking it, when I'm not sure I need to take it. But if I have to "take it" take it, then I'll have to take it and will take it. But only if I really have to "take it" take it.

Things that make me grumpy

Times are tough for doctors these days. No one gives a shit, so I'm not elaborating further.

But even big institutions are affected. Take, for example, the venerable MD Anderson Cancer Center in Texas. This giant of oncology has recently been having financial issues, so much so that its president, Ronald DePinho, sent out this e-mail to employees 2 weeks ago:

"For most of fiscal year 2013 our operating expense has exceeded our operating revenue - meaning that we've spent more than we've made from providing patient care services."

He went on to say that because of this shortfall MD Anderson is suspending merit raises and slowing its hiring rate. This is what they call "austerity measures."

Now, every concerned CEO in America has been saying stuff like this, so why am I singling out Dr. DePinho?

Because.

At the same time Dr. DePinho is preaching financial restraint for his cash-strapped institution, he's used $1.5 million of its capital funds (which come from investment income, donations, and patient revenue) to build a 25,000 square-foot (2,322 square meter) office suite for Dr. Lynda Chin at the institution.

Who just happens to be his wife.

Really. I am not making this up.

Dr. Chin is the scientific director of MD Anderson's Institute for Applied Cancer Science. How this justifies her having an office suite that is 10 x larger than the average American home is beyond me. According to the institute it's to "provide an appropriate meeting space with high-level industry decision makers and support a new suite in computational biology." Translation: By using a lot of syllables we're hoping you'll ignore what's really going on here.

And no, I have no idea what "computational biology" is. Maybe that's why my entire office is 1,250 square feet, including the john.

According to an itemized expense report (obtained by The Cancer Letter under the Texas Public Information Act) this ginormous office has $28,000 worth of chairs, sofas, and tables. They also spent $210,000 on fancy translucent glass walls, which required them to get a special permit from the University of Texas. By comparison, the Grumpy Neurological Emporium has used furniture (valued at $948 total), and plain old painted drywall.

So, if you donated money in a loved one's memory to MD Anderson hoping they'll find a cure for whatever cancer killed grandma, there's a reasonable chance your hard-earned dollars went to pay for... upscale furniture and fancy glass walls in an office bigger than your house.

I'm going to close with another quote from Dr. DePinho, found in the same e-mail I quoted earlier about the austerity measures MD Anderson will have to take to survive:

"If we don't make changes now, we potentially will find ourselves in a crisis that will force us to take drastic measures that could hurt our ability to meet our mission... [all will] have to share sacrifices."

Well, almost all.


Thank you, SMOD!

History reruns

May 29, 1914

If you read the popular stuff, you'd think there were only 3 major shipwrecks of the 20th century: Titanic, Lusitania, and Andrea Doria. Obviously, there are many more, even if you exclude 2 worldwide conflicts in the last 100 years. The worst peacetime shipwreck in history, the Dona Paz (Philippines), took 4,375 lives as recently as 1987. And I bet you've never heard of it.

Trans-Atlantic crossings have always been critical to both sides of the Atlantic (look at the chaos caused by the recent Icelandic volcanic eruption). Although the giant liners of Cunard and White Star are best remembered, they were by no means alone. Ships were constantly coming and going, carrying passengers and freight, both ways across The Pond.

Although less glamorous than the liners that sailed in & out of New York, there were many busy ships that called on the Canadian ports. One was the Empress of Ireland, which in 1914 was serving the Quebec City to Liverpool route.

Early this morning, 96 years ago, the Empress was outbound from Canada. She was heading northeast on the St. Lawrence River. It was 2:00 a.m., and most of the passengers were sleeping.

In a thick fog, the Norwegian coal-carrier Storstad struck the Empress on the starboard side. The damage was extensive. There was only limited time to sound an alarm, and electricity failed quickly, plunging the ship into darkness. The Empress was gone in 14 minutes.

The survivors were picked up by the few lifeboats that had been launched, and were carried back and forth to the Storstad, which had stayed afloat. Captain Henry Kendall, who was thrown into the water as the ship rolled over, supervised the rescue efforts and likely saved many lives by organizing the lifeboats.

All together the Empress took 1,024 people with her. It remains the deadliest maritime disaster in Canadian history. In spite of this, the ship is mostly forgotten today. The St. Lawrence Seaway is a very busy channel. Hundreds of ships steam over the Empress every day, very few knowing of the tragedy beneath them.

The Salvation Army remembers. A large contingent of members (167) were lost on the ship, traveling to a conference in London. There is a monument to them at Mount Pleasant Cemetery, in Toronto.

The Empress of Ireland is in 130 feet of water, well within the range of scuba equipment, but the currents and poor visibility limit diving