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"Federal Treatment Protocols" are not new

Posted Jan 27 2009 6:34pm
I am sitting in bed with the "daddy monitor" on the pillow next to me. There is nothing more peaceful than hearing my dad sleeping comfortably. In fact, odd as it may sound, I do not want to waste this tremendous feeling that dad is not in distress by sleeping.

I would rather get pissed off again at the though of businessman David Snow Jr. (CEO of Medco ) pimping his inane ideas of "health care reform" to Tom (didn't his home state already reject him for re-election?) Daschle.

The idea of federal treatment protocols are not new. NIH (National Institute of Health) established treatment protocols for cancer treatments. And, as Mr. David Snow, Jr. is undoubtedly aware, the NIH automated cancer treatment protocols have turned cancer treatments into cook-book medicine that completely depersonalizes cancer treatments. But, the treatment of cancer is frankly a money maker for the medical community. And money is the primary incentive for Mr. Smith.

With the NIH automated cancer treatment protocols, oncologists can essentially create treatment plans quickly and then pass the implementation of that plan to para-professionals. The bottom line for the hospital is cost effective treatment without the annoying detail of considering the cancer patient's past medical history.

The quicker the cancer patient can be evaluated and processed through the lengthy cancer treatment plan (with years of follow-up), the more revenue that will be assured to the medical facility. The impersonal treatment starts with something such as "if X (the size of the tumor) and Y (the number of positive lymph nodes) then treatment Z,")

Sounds great, right? Not so much. Let's slow down and take an honest look at this accepted federal cancer treatment protocol.

I was a breast cancer patient at Duke University Medical. It was horrible. The treatments gave me terrible side effects that landed me into the hospital and bed-ridden. I was rarely allowed to communicate with my oncologist because it is not cost effective for the actual physician to be involved post implementation of "automated treatment protocol."

I am now a cancer patient at Northwestern Memorial in my home of Chicago. I trust my oncologist at NWM (Dr. William Gradishar ) unconditionally. At the first meeting, Dr. Gradishar convinced me to start Tamoxifen. I would have never taken the medication without his "intervention." Duke Medical just told me to take the Tamoxifen because it was "what I was supposed to do next." I rejected that explanation.

Although I trust, respect and feel absolutely safe as Dr. Gradishar's patient, I have never seen Dr. Gradishar or communicated with him beyond that first meeting. I never get blood tests. I have only had one mammogram since I finished treatment at Duke in 2007.

That is all fine with me. I don't trust mammograms and I feel fine.

Since being treated like a number at Duke, I frankly am not motivated to do any thing more than show up for scheduled appointments at NWH. I get a quick breast exam by the phenomenal Nurse Practitioner. She asks whether I want to see the Dr. Gradishar and I say "no need."

I understand that the whole cancer treatment deal is about the doctors making money and if my oncologist takes time to see me, it wastes his time and money.

In contrast to my cancer experience, I have been thrilled with my dad's cancer treatment at Duke University. Although certainly NIH treatment protocols apply for colon cancer, my dad's oncologist (Dr. Michael Morse) has not treated dad like a number. Dr. Morse never seems to be just following the NIH cookbook recipe.

When dad has a serious side effect, Dr. Morse tweaks the treatment protocol. Dr. Morse evaluates and treats my dad as a whole person.

I hope that the difference is not breast cancer (i.e. primarily women) versus colon cancer. I would be disappointed to think that NIH automated treatment protocols are followed primarily in cases of breast cancer. But, it is all about the bucks.

Okay, so I guess none of us should be surprised that the new presidential administration is seriously considering creating the equivalent of a health care federal reserve board to establish mandated treatment protocols. Heck, it worked for breast cancer.

However, the difference between (1) the current NIH automated cancer protocols and (2) Mr. David Snow, Jr./Medco's corporate dream is that there will be no opportunity for great oncologists like Duke's Dr. Michael Morse to adapt the protocol for elderly, frail or otherwise complicated patients that do not fit the preconceived notion of the typical cancer patient.

Under David Snow, Jr.'s corporate dream, the physician or surgeon simply would not be paid if he or she deviated from the treatment rules. (And more good news for the corporate hospitals, Snow would make sure that injured patients could never sue the physicians so long as the physicians followed the mandated treatment protocol.)

Of course Snow's dream will include medical procedures beyond cancer (where treatment protocols have already demonstrated their profitability).

Has any one considered?

1. What will the treatment protocol provide for heart patients who are obese, elderly or smoke? Will patients be penalized for failing to live whatever the Government considers a "healthy life"? I am thinking "yup."

2. What will the treatment protocol provide for the elderly whose medical treatment may not be cost effective? (i.e. I return to the situation where Duke University Hospitalist Dr. Bret Peterson refused to comply with dad's treating/ attending's order for urine cultures because a UA was more "cost effective.")

3. How will the treatment protocols be implemented in university research hospitals? I recall a simple time when there were "experimental treatments" that provided invaluable research knowledge at university hospitals. Are all of the university hospitals owned and managed by corporations now too?

Medical research and advancements are what has separated the quality of medical care in our country from the rest of the world.

These researchers and physicians have traditionally been able to accomplish absolutely amazing life saving advancements. These incredible people have always had the ethical restraints of their own profession and, of course, the federal government.

But now, I fear that physicians' and scientists' pure hearted (and yet somewhat naive) attempt to focus on their professional has caused the businessmen with a solely profit motive (read: David Smith, Jr.) to reduce medical professionals to a commodity. Medical professionals are prone to bemoan "I just want to practice medicine."

Okay. But in so doing, these physicians and surgeons have effectively sold their souls and placed their career futures in the suspect hands of mercenary, profit driven businessmen.

I get capitalism. I love capitalism. There is a very important distinction between "not wasting scare medical resources" and endangering patients.

4. Who will injured patients be able to sue if there is malpractice? According to Mr. David Snow, Jr., physicians who follow the federal treatment protocols will been immune from malpractice actions so long as they follow the federal protocols. (Of course, the physicians won't get paid if they deviate from the protocols.) Will injured patients have standing to sue David Smith, Jr. personally?

5. Who is protecting the patient under this proposal?

My gut tells me that most Americans think that a proposal as suggested by David Smith, Jr, (CEO of Medco ) will never happen. But then again, most of you never thought that Hospitalists would take over hospitals (this program was also dubbed as a necessary cost effective measure) so that your own personal physician is effectively pushed out of your hospital care.

As Rush Limbaugh says, once this country starts down a course of socialized medicine, there is no turning back.

David Smith, Jr.'s plan will never ensure that everyone gets medical care. Quite the contrary.

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