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Health See other Health Articles Title: Fear, Greed and X-Rays Fear and greed are potent motivators. When both of these forces push in the same direction, virtually no human being can resist. And doctors -- despite many expectations to the contrary -- are human beings. This is one reason why medical costs in the U.S. have spiraled out of control, yet we are among the least healthy people in the developed world. On the fear side, consider this email I got from a physician friend who had read galleys of my book Why Our Health Matters: A Vision of Medicine That Can Transform Our Future which will be released September 8, 2009: In Gawande's article, a McAllen doctor who refused to hop aboard this gravy train had a more sensible take on the local "spirit." "Medicine has become a pig trough here," he said. "We took a wrong turn when doctors stopped being doctors and became businessmen." Lest you think the only drawback of over-scanning is wasted billions, note that from 1980 to 2006, per-capita radiation dosage from medical testing more than quintupled. A controversial study published in the November 29, 2007, New England Journal of Medicine estimated that computed tomography (CT) scans -- the type of imaging that has grown most explosively -- administered today could eventually cause up to 2% of cancer deaths. As with fear, greed also propels expensive, inappropriate treatment. If a clinic loses money each time it counsels a patient to control type 2 diabetes with diet and exercise, but makes a hefty profit when it amputates a foot riddled with diabetic ulcers, how long will it continue to emphasize the former? Because these problems have two causes, the solution is twofold. To quell the fear that drives physicians to over-test and over-treat, we need vigorous legal reform to cap malpractice payouts. Staunching the greed motive requires a more dramatic change. Since a single CT scanner can bring in $400,000 a year in profit, it's vital to sever the link between ordering tests and making money. Restricting ownership of testing equipment to nonprofit, government, or independent private entities is crucial. As for popularizing less lucrative -- but often better -- low-tech treatments, putting physicians on salary can also help. Whether the paycheck comes from a nonprofit organization such as the Mayo Clinic or some variety of single-payer national health care, stabilized incomes would let physicians more readily focus on the health of their patients rather than on their own finances. Until both of these corrective measures are in place nationwide, it's up to you to ask your physician if the tests or treatments ordered for you are truly essential. You might get an honest answer about the test's potential risks and benefits. Then, together, you can arrive at a decision that satisfies both of you.
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#1. To: Brian S (#0)
"It does not take a majority to prevail, but rather an irate, tireless minority, keen on setting brush fires of freedom in the minds of men." -- Samuel Adams (1722-1803)‡
From Alinsky's Rules for Radicals RULE 8: "Keep the pressure on. Never let up." Keep trying new things to keep the opposition off balance. As the opposition masters one approach, hit them from the flank with something new. (Attack, attack, attack from all sides, never giving the reeling organization a chance to rest, regroup, recover and re-strategize.) RULE 11: "The price of a successful attack is a constructive alternative." Never let the enemy score points because you're caught without a solution to the problem. (Old saw: If you're not part of the solution, you're part of the problem. Activist organizations have an agenda, and their strategy is to hold a place at the table, to be given a forum to wield their power. So, they have to have a compromise solution.) RULE 12: Pick the target, freeze it, personalize it, and polarize it." Cut off the support network and isolate the target from sympathy. Go after people and not institutions; people hurt faster than institutions. (This is cruel, but very effective. Direct, personalized criticism and ridicule works.)
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