On Swine Flu Vaccination Dr. Michael Raucci
There seems to be quite a bit of false perceptions, misunderstandings, and misleading propaganda circulating in the United States regarding the swine flu vaccination. To start off, I plan to be vaccinated and plan to have my children vaccinated against the H1N1 swine flu. We have already been vaccinated against the seasonal flu.
Why? There are a lot of factors that go into making every medical decision. They include: religious beliefs, medical history, state of mind, quality of life, diagnosis, treatment options, personal desires and probabilities. The most important of these to consider is probabilities, but it is also the least understood and the least utilized by the average person. Probability refers to the odds or the percentages. What is the likelihood of contracting a disease or disorder, what is the likelihood of different outcomes of that disease or disorder, and what is the success or failure rate of various treatments.
While it sounds insensitive and inappropriate, healthcare is a lot like gambling. If you already have a disease and you must decide on whether to embark on a particular treatment, you should want to know the probability that the treatment will work, the probability of various side effects, and the probability of iatrogenic complications such as death. If you have a mild, intermittently symptomatic gout, you might opt not to take the medication, allopurinal, for it, because of the high incidence of liver problems associated with long term use. You might instead choose to simply limit the purines in your diet. Conversely, if you have pancreatic cancer with only a 5% chance of surviving 2 years you might choose treatments with high complication rates such as the Whipple Procedure. In essence, you are gambling. In fact, when a patient asks me when I think they should have surgery, my response is when the potential benefits of the surgery outweigh the risks. Essentially, when the odds are in their favor. It is similar to the decision process someone undertakes when determining whether or not to take another card in blackjack. If you are sitting on eleven, it’s a no brainer, but if you have 16 or 17 the decision becomes more difficult.
Getting back to flu shots, the seasonal flu typically kills about 40,000 Americans each year with a relatively low communicability potential because of latent immunity through the population. Most of those who die have immune system compromise of some sort. Complications from the seasonal flu shot is nearly zero. The current H1N1 swine flu virus, a combination of genetic material from humans, birds and pigs, is new to the human population and could have a communicability rate as high as 90%. With an infection rate this high and extrapolating from seasonal flu mortality rates, the death toll from the swine flu could easily be hundreds of thousands of people in the United States alone, despite its typically mild symptoms.
In 1918, a swine flu outbreak occurred with relatively mild symptoms and low mortality in the Spring. When it resurged in the Fall and Winter of the same year a mutated form killed 60 million people. Mutation of the current H1N1 virus to a more virulent form remains a possibility. At this point, approximately 40 million people have received the H1N1 vaccination with no serious side effects. It is manufactured in exactly the same way as the seasonal flu vaccine which also carries a low side effects rate. If the H1N1 virus were to mutate it could produce death rates equivalent to or exceeding the 1918 rates in the un-vaccinated.
The odds of someone contracting the H1N1 swine flu are high. In its current form, the odds are that those infected will suffer and be unproductive for one week at a cost of billions to the economy. A small percentage will suffer grievous outcomes including death. The H1N1 vaccination appears to carry no serious side effects unless someone is allergic to components of the vaccine (Most of those people are aware of their allergies and they represent a small percentage of the population).
Based on this it seems to me that the with a high infection rate, the possibility of grievous outcome, the likelihood of loss of wages, and a substantially low complication rate for the vaccine it is mathematically favorable to receive the H1N1 vaccination.
Recently, someone insisted to me that getting the seasonal flu shot would give them partial protection from the swine flu. This is absolutely false and is equivalent to someone saying that getting the measles shot protects them from chicken pox. I have also heard people, conspiracy theorists, state that the vaccination is designed to kill and depopulate parts of the globe. You’ve got to be kidding me. Finally, some people believe that vaccinations cause autism. To date there is nothing but anecdotal evidence of such and repeated inquiries have shown this to be false. Vaccinations overall have been an overwhelming success story. Where do you think polio, measles, mumps, rubella, and pertussis have gone. Did they go away on their own. No, they were eradicated by vaccination programs, saving millions of lives in the process. In areas where vaccination has not been employed, these diseases continue to infect, maim, and kill people. Some people have chosen not to have their own children immunized against the above mentioned diseases and then point to them and say, “See, they didn’t get it.” This is called herd immunity. They don’t get the disease because the rest of us got the vaccination thereby reducing the points of transmission. A certain amount of skepticism towards the medical establishment is healthy, especially given its links to the profit driven pharmaceutical industry, but by and large their goals are to care for and heal those in need.
Swine flu and seasonal flu vaccination is not mandated, it is a choice. It is crucial that individuals collect the information, particularly scientific data, and make an informed decision based on facts. Individual anecdotal stories and cries of conspiracy might perk our interest but they should not be part of the decision making process.
Tuesday, November 3, 2009
Thursday, August 13, 2009
Managing Inflammation with Diet
About 10 years ago I attended a lecture by Dr. David Seaman regarding how certain foods can be inflammatory and how maintaining a pro-inflammatory state can promote many diseases. I read several books and articles on the subject and even gave several lecures on the topic. I hadn't thought about it recently until I saw an article in "To Your Health" magazine written by Dr. Seaman. Below, I will review Dr. Seaman's article while interjecting my own thesis and conclusions.
Managing Inflammation with Diet Dr. Michael Raucci
There are many ways to categorize the different chemicals in our body and the things we consume. A simple way is to divide them into 2 general categories: pro-inflammatory and anti-inflammatory. While this categorization does not do justice to the complexity of chemical interactions, it does provide a framework upon which healthy dietary choices can be made. Pro-imflammatory foods promote or cause inflammation in the body. Anti-inlfammatory foods counteract inflammation in the body, neutralizing its effects.
In order to understand why some foods are categorized pro-inflammatory and other anti-inflammatory, one must first have a rudimentary understanding of what inflammation is and why our bodies allow for the inflammatory process.
Simply, inflammation in gross terms is the body's reaction to fight infection or foreign invasion. It is a chemical process whose purpose is to excite the immune system to prepare for battle. Our immune systems are very effective at eliminating infection and foreign substances, however, they can also at times be indiscriminate as they wage war and can often damage indigenous/needed cells. When you have an infection, you want inflammation because it helps to kill off the offensive organism or substance but if there is no such foreign invasion you do not want to have any inflammation because it can kill off your own properly functioning cells. This is why you put a hot towel over an infected boil. You want to bring in more white blood cells to fight the infection (Note: the pus that forms is dead white blood cells and foreign invaders. Often the immune process, of which inflamation is a part, is referred to as a war. In keeping with this analogy then pus is dead soldiers). When you twist your ankle but the skin is not broken, you put ice on it to limit the amount of blood and thus inflammation that accumulates. The more inflammation, the more indiscriminate destruction of healthy cells occurs. Whenever our skin has been cut or some organism has made its way into our body then inflammation is a good thing which accounts for the majority of the healing process.
It is chronic, subclinical, or systemic inflammation which is a problem. It is a problem because in addition to the continuous degradation of healthy cells, inflammation has been implicated as a cause or a major factor in nearly every disease process including cardiovascular disease and some cancers.
Defining what exactly constitutes inflammation can be a tricky endeavor. The chemicals Prostaglandin E2 (PGE2), lactic acid, K+, histamine, leukotriene B4, serotonin, bradykinin, and glycosaminoglycans represent the most common pro-inflammatory chemicals in the body. In this article, I will focus on PGE2. Prostaglandins E1 and E3(PGE1 and PGE3) are the most commonly cited anti-inflammtory chemicals and in this article I will limit my discussion to them. Again there are many more.
In addition, there are enzymes and hormones in our bodies which can act on the nutrients we consume transforming them into either pro-inflammatory or anti-inflamatory chemicals.. The most prominent of these is insulin.
For the most part, foods that are anti-inflammatory fit into a common sense model: dark green and other deeply colored vegetables, brightly colored fruits, whole grains (not processed), most nuts, spices, extra virgin olive oil, egg whites, various beans - especially lentils, and cold salt water fish such as salmon, tuna, scrod, cod, and haddock. When insulin levels are high, many biochemical pathways are shunted towards the production of pro-inflammatory chemicals whereas low insulin levels can inhibit this. One exception is Omega 3 fatty acids which are unaffected by insulin levels and lead to the production of eicosopentanoic acid (EPA) which is then broken down into a variety of substances which are anti-inflammatory.
Pro-inflammatory foods include any processed food - white bread, white pasta, bagels, crackers, white rice etc. These foods are stripped of their micro nutrients and provide a dense carbohydrate bolus which spikes insulin. Foods high in sugar such as sodas, fruit juices, candy, cookies, ice cream, potatoes, fried foods, margarine, cake, pie and others are pro-inflammatory.
As mentioned, insulin has an effect on the stimulation or inhibition of certain biochemical pathways. Too much insulin production, such as from a high carbohydrate meal, will increase inflammation in the body. As such, foods with a high glycemic index should be avoided. These often correlate with the list in the previous paragraph though there are some surprises, such as a baked white potatoe with a whopping GI of 118, instant mashed potatoes 120, home made mashed potatoe with a lower 98, and a sweet potato with a modest 70. A table of glycemic indexes can be found at any site dealing with diabetes.
In the table below a basic representation of biochemical pathways for several food types is seen.
Prostaglandin Production
Managing Inflammation with Diet Dr. Michael Raucci
There are many ways to categorize the different chemicals in our body and the things we consume. A simple way is to divide them into 2 general categories: pro-inflammatory and anti-inflammatory. While this categorization does not do justice to the complexity of chemical interactions, it does provide a framework upon which healthy dietary choices can be made. Pro-imflammatory foods promote or cause inflammation in the body. Anti-inlfammatory foods counteract inflammation in the body, neutralizing its effects.
In order to understand why some foods are categorized pro-inflammatory and other anti-inflammatory, one must first have a rudimentary understanding of what inflammation is and why our bodies allow for the inflammatory process.
Simply, inflammation in gross terms is the body's reaction to fight infection or foreign invasion. It is a chemical process whose purpose is to excite the immune system to prepare for battle. Our immune systems are very effective at eliminating infection and foreign substances, however, they can also at times be indiscriminate as they wage war and can often damage indigenous/needed cells. When you have an infection, you want inflammation because it helps to kill off the offensive organism or substance but if there is no such foreign invasion you do not want to have any inflammation because it can kill off your own properly functioning cells. This is why you put a hot towel over an infected boil. You want to bring in more white blood cells to fight the infection (Note: the pus that forms is dead white blood cells and foreign invaders. Often the immune process, of which inflamation is a part, is referred to as a war. In keeping with this analogy then pus is dead soldiers). When you twist your ankle but the skin is not broken, you put ice on it to limit the amount of blood and thus inflammation that accumulates. The more inflammation, the more indiscriminate destruction of healthy cells occurs. Whenever our skin has been cut or some organism has made its way into our body then inflammation is a good thing which accounts for the majority of the healing process.
It is chronic, subclinical, or systemic inflammation which is a problem. It is a problem because in addition to the continuous degradation of healthy cells, inflammation has been implicated as a cause or a major factor in nearly every disease process including cardiovascular disease and some cancers.
Defining what exactly constitutes inflammation can be a tricky endeavor. The chemicals Prostaglandin E2 (PGE2), lactic acid, K+, histamine, leukotriene B4, serotonin, bradykinin, and glycosaminoglycans represent the most common pro-inflammatory chemicals in the body. In this article, I will focus on PGE2. Prostaglandins E1 and E3(PGE1 and PGE3) are the most commonly cited anti-inflammtory chemicals and in this article I will limit my discussion to them. Again there are many more.
In addition, there are enzymes and hormones in our bodies which can act on the nutrients we consume transforming them into either pro-inflammatory or anti-inflamatory chemicals.. The most prominent of these is insulin.
For the most part, foods that are anti-inflammatory fit into a common sense model: dark green and other deeply colored vegetables, brightly colored fruits, whole grains (not processed), most nuts, spices, extra virgin olive oil, egg whites, various beans - especially lentils, and cold salt water fish such as salmon, tuna, scrod, cod, and haddock. When insulin levels are high, many biochemical pathways are shunted towards the production of pro-inflammatory chemicals whereas low insulin levels can inhibit this. One exception is Omega 3 fatty acids which are unaffected by insulin levels and lead to the production of eicosopentanoic acid (EPA) which is then broken down into a variety of substances which are anti-inflammatory.
Pro-inflammatory foods include any processed food - white bread, white pasta, bagels, crackers, white rice etc. These foods are stripped of their micro nutrients and provide a dense carbohydrate bolus which spikes insulin. Foods high in sugar such as sodas, fruit juices, candy, cookies, ice cream, potatoes, fried foods, margarine, cake, pie and others are pro-inflammatory.
As mentioned, insulin has an effect on the stimulation or inhibition of certain biochemical pathways. Too much insulin production, such as from a high carbohydrate meal, will increase inflammation in the body. As such, foods with a high glycemic index should be avoided. These often correlate with the list in the previous paragraph though there are some surprises, such as a baked white potatoe with a whopping GI of 118, instant mashed potatoes 120, home made mashed potatoe with a lower 98, and a sweet potato with a modest 70. A table of glycemic indexes can be found at any site dealing with diabetes.
In the table below a basic representation of biochemical pathways for several food types is seen.
Prostaglandin Production
As can be seen from the chart, it is the balance of PGE1 annd PGE3 (anti-inflammatory chemical
s) to PGE2 (a pro-inflammatory chemical) that correlates with a person's overall inflammatory state. It is the overall inflamatory state that can contribute to disease and pain. By direct extrapolation then, one can limit their susceptibilty to disease processes and reduce chronic pain by maintaining a positive anti-inflammatory to pro-inflammatory ratio. Looking at the chart, this can best be done by consuming fish and green leafy vegetables. The PGE3 pathway has no potential crossover to arachadonic acid, part of the pro-inflammatory pathway, whereas the PGE1 pathway allows for crossover to arachadonic acid when insulin levels are high such as when simple and processed carbohydrates are consumed and when trans fats are present. Interestingly, when one starts in the pro-inflammatory PGE2 pathway, say by consuming organ meats, crossover to the anti-inflammatory PGE1 pathway can occur when EPA or glucagon are present. This raises the issue of food combining. A side order of crab legs might not be a poor choice if the main entree is salmon. Of course, skipping the butter will be necessary.
In general, a diet high in green leafy vegetables, olive and flaxseed oils, whole grains and most types of fish which avoids simple and processed carbohydrates thus limiting insulin production will result in a lower disease and pain susceptibility. A common method of making this easy for people is to have them divide their plate into a 1/4 and a 3/4 portion. Fill the 3/4 portion with dark green leafy vegetables and the 1/4 portion with a protein. At the same tiime, the person should attempt to eat fish at least once per day. Added perks of this type of diet are weight loss for those who require it, increased energy, and more youthful skin. Water and most teas are the best choices as drinks.
When we examine societies who follow a diet similar to this, such as the Japanese and some Mediteranean cultures, we see less overall disease, less pain related disabilty, and longer lifespans. The American diet is grossly pro-inflammatory with the popularity of fast foods, supersized portions, sugary drinks, fried foods, and dense carbohydrates.
While embracing an anti-inflammatory diet is a person's best approach, some supplements can help. Fish oil pills are popular and can help but there are many enzymatic reactions that need to occur in order to get to PGE3. A better choice is directly supplementing with EPA (eicosopentanoic acid) which immediately becomes PGE3. Other anti-inflammatory supplements include grape seed extract, bioflavinoids, curcumin, boswellia, and bromelain among others. In addition, a daily 81mg aspirin is perhaps the most effective supplement a person can take.
Wednesday, July 22, 2009
Why Should Chiropractic Should Abandon the Alternative Title
Why Chiropractic Should Abandon the Title Alternative Dr. Michael Raucci
Since its inception chiropractic has presented itself as an alternative to Western Medicine and in the late 19th and early 20th centuries chiropractic offered a legitimate alternative as people’s sole provider of health care advice and an alternative to mainstream medicine’s bloodletting, leaches, and potions. In the past 75 years, Western Medicine has made major advances which have resulted in substantial increases in quality of life and lifespan. To accomplish this medicine has relied on the adoption of the scientific method as its guiding beacon of truth. The scientific method along with peer review creates a formal and somewhat inflexible method of advancing scientific knowledge. It can still be corrupted by big business to generate profits and perhaps is appealing in its sterility to almost no one outside the scientific community but it remains the gold standard of scientific proof. Results, when properly attained, help modern society to wade through the claims of lore, anecdotes, and glitzy marketing schemes.
In the past few decades, chiropractic too has begun to seek answers using the model of the scientific method and peer review. It appears that this movement has split the chiropractic profession into two groups. I will call them the Collaborators and the Autonomites.
The Collaborators, myself included, want to work in conjunction with modern medicine to define and offer the best options for every patient. Cooperation in research benefits patient groups and a healthy referral system and collaboration amongst doctors of all types provides benefits for individual patients. The Collaborators, in general, are disciples of the scientific method and are unwilling to accept treatments, systems, or interventions that do not pass the scrutiny of the scientific method. The Collaborators prefer to operate under the umbrella of Complementary Medicine.
The latter group, the Autonomites, prefers to remain completely independent of Western medicine for fear of losing their autonomy. They fear that cooperation with medicine may result in the insidious elimination of chiropractic as a separate field of health care, in much the same way that osteopathic medicine has become indistinguishable from allopathic medicine. The Autonomites also have their patient’s best interests in mind but believe that they can handle most non-emergency maladies without concomitant medical consult. They are generally willing to allow practitioners of various systems, regardless of method, outcome, or scientific rigor, provided they operate within the laws of the state. The Autonomites prefer to operate as Alternative Health providers, maintaining their independence from allopathic medicine.
Why do the Autonomites suffer from this paranoia? Well they have every right to. Organized medicine tried very overtly to eliminate chiropractic in the 1970’s (Wilk vs. AMA) and many medical doctors are consumed by an unfounded prejudice against chiropractic, probably due to false impressions first created while in medical school. There is currently a medical doctor in my town that absolutely refuses to refer or give patients referrals when requested to see me based upon his bias. Similarly, a neurologist who practices in the neighboring town whom I share many common patients with, tells every patient not to go to a chiropractor because they cause people to have strokes. This despite the most recent evidence showing that the incidence of stroke following a chiropractic visit is no greater than the incidence in a primary medical doctor’s office, indicating that people who do have the misfortune to experience a stroke while in the chiropractic office were likely in the midst of a dissecting aneurysm when they arrived and were going to have a stroke regardless of the chiropractic treatment.
But I feel that as a profession we need to rise above the fray. Our goal as chiropractors should not be to become the primary providers of health care. It should be to become a respected part of an integrated health system. In terms of autonomy, with the growing support for national health care, a transition will occur. That transition will be dominated by the influence of Western Medicine. Chiropractic would do well to not be seen as a disgruntled competitor or as a bastion for oddball doctors who practice unscientific treatments. Chiropractic risks being further marginalized by non-inclusion. What better way to show our intelligence and worthiness than to allow medical doctors to experience our competence within a cooperative model. Chiropractors need to drop the animosity and the rhetoric and take the high road. The face that chiropractic needs to put forward is one of intelligence, cooperation, and committed empathy to our patients and we need to quiet the few but overly loud zealots in our ranks. Unfortunately, these few loud individuals who share the same professional degree as the rest of us are contributing to our professions perceived reputation to a degree which greatly exceeds their numbers.
Is it ok to have a fringe element in the profession? I believe the answer is yes, but the profession needs to know the efficacy of the procedures its members employ so that patients who are seeking treatment and medical professionals who might want to make referrals can do so in an informed manner. Currently, with few exceptions, if a medical doctor makes a referral to a neurologist or a gastroenterologist or a physical therapist they know exactly what their patient is going to experience. The same cannot be said of a referral to doctors of chiropractic whose philosophies, systems, techniques and protocols are as numerous as the doctors themselves. Fringe players need to brought out of the shadows and exposed to the scrutiny of the scientific method and peer review.
I am not suggesting that chiropractors be relegated to the same caste as the physical therapists, where patients typically can only seek medically directed care after a referral from a medical doctor. It is important that chiropractic remain a portal of entry provider. The high level of education achieved by the chiropractor alone demands this. I feel, however, that chiropractic should see itself as a specialty. Certainly, our bread and butter would be the treatment of spinal, paraspinal and nerve root injuries but we should also market ourselves and see ourselves as Conservative Management Specialists. Not being able to prescribe drugs or perform surgery is a blessing not a restriction. Because of that limitation in treatment scope, chiropractors cannot opt for the easy treatment. We have to think of ways to manage problems without drugs or surgery (We are the McGyvers of health care). There is a huge market for doctors with this capacity because they provide the patient with options, options which usually lack the potential side effects of drugs and surgery. We need to chronicle what is effective and what is not and expose those whose intellectual limitations or financial avarice might otherwise squander patients’ finances or other treatment options.
It is time to shed the alternative cloak under which chiropractics dark operators hide. It is time to be seen as Cooperators. By cooperation I do not mean being blind or silent to medicine’s inproprieties. No, we still need to be the whistle blower. That is part of what a Conservative Management Specialist does. When we do these things we will find greater acceptance, greater prosperity, greater public support and greater access to patients. Similarly, there will be less negative press, less sensationalistic stories, and less misunderstanding from the medical community. Finally, and most importantly, patients will have access to a larger spectrum of validated treatment options.
Since its inception chiropractic has presented itself as an alternative to Western Medicine and in the late 19th and early 20th centuries chiropractic offered a legitimate alternative as people’s sole provider of health care advice and an alternative to mainstream medicine’s bloodletting, leaches, and potions. In the past 75 years, Western Medicine has made major advances which have resulted in substantial increases in quality of life and lifespan. To accomplish this medicine has relied on the adoption of the scientific method as its guiding beacon of truth. The scientific method along with peer review creates a formal and somewhat inflexible method of advancing scientific knowledge. It can still be corrupted by big business to generate profits and perhaps is appealing in its sterility to almost no one outside the scientific community but it remains the gold standard of scientific proof. Results, when properly attained, help modern society to wade through the claims of lore, anecdotes, and glitzy marketing schemes.
In the past few decades, chiropractic too has begun to seek answers using the model of the scientific method and peer review. It appears that this movement has split the chiropractic profession into two groups. I will call them the Collaborators and the Autonomites.
The Collaborators, myself included, want to work in conjunction with modern medicine to define and offer the best options for every patient. Cooperation in research benefits patient groups and a healthy referral system and collaboration amongst doctors of all types provides benefits for individual patients. The Collaborators, in general, are disciples of the scientific method and are unwilling to accept treatments, systems, or interventions that do not pass the scrutiny of the scientific method. The Collaborators prefer to operate under the umbrella of Complementary Medicine.
The latter group, the Autonomites, prefers to remain completely independent of Western medicine for fear of losing their autonomy. They fear that cooperation with medicine may result in the insidious elimination of chiropractic as a separate field of health care, in much the same way that osteopathic medicine has become indistinguishable from allopathic medicine. The Autonomites also have their patient’s best interests in mind but believe that they can handle most non-emergency maladies without concomitant medical consult. They are generally willing to allow practitioners of various systems, regardless of method, outcome, or scientific rigor, provided they operate within the laws of the state. The Autonomites prefer to operate as Alternative Health providers, maintaining their independence from allopathic medicine.
Why do the Autonomites suffer from this paranoia? Well they have every right to. Organized medicine tried very overtly to eliminate chiropractic in the 1970’s (Wilk vs. AMA) and many medical doctors are consumed by an unfounded prejudice against chiropractic, probably due to false impressions first created while in medical school. There is currently a medical doctor in my town that absolutely refuses to refer or give patients referrals when requested to see me based upon his bias. Similarly, a neurologist who practices in the neighboring town whom I share many common patients with, tells every patient not to go to a chiropractor because they cause people to have strokes. This despite the most recent evidence showing that the incidence of stroke following a chiropractic visit is no greater than the incidence in a primary medical doctor’s office, indicating that people who do have the misfortune to experience a stroke while in the chiropractic office were likely in the midst of a dissecting aneurysm when they arrived and were going to have a stroke regardless of the chiropractic treatment.
But I feel that as a profession we need to rise above the fray. Our goal as chiropractors should not be to become the primary providers of health care. It should be to become a respected part of an integrated health system. In terms of autonomy, with the growing support for national health care, a transition will occur. That transition will be dominated by the influence of Western Medicine. Chiropractic would do well to not be seen as a disgruntled competitor or as a bastion for oddball doctors who practice unscientific treatments. Chiropractic risks being further marginalized by non-inclusion. What better way to show our intelligence and worthiness than to allow medical doctors to experience our competence within a cooperative model. Chiropractors need to drop the animosity and the rhetoric and take the high road. The face that chiropractic needs to put forward is one of intelligence, cooperation, and committed empathy to our patients and we need to quiet the few but overly loud zealots in our ranks. Unfortunately, these few loud individuals who share the same professional degree as the rest of us are contributing to our professions perceived reputation to a degree which greatly exceeds their numbers.
Is it ok to have a fringe element in the profession? I believe the answer is yes, but the profession needs to know the efficacy of the procedures its members employ so that patients who are seeking treatment and medical professionals who might want to make referrals can do so in an informed manner. Currently, with few exceptions, if a medical doctor makes a referral to a neurologist or a gastroenterologist or a physical therapist they know exactly what their patient is going to experience. The same cannot be said of a referral to doctors of chiropractic whose philosophies, systems, techniques and protocols are as numerous as the doctors themselves. Fringe players need to brought out of the shadows and exposed to the scrutiny of the scientific method and peer review.
I am not suggesting that chiropractors be relegated to the same caste as the physical therapists, where patients typically can only seek medically directed care after a referral from a medical doctor. It is important that chiropractic remain a portal of entry provider. The high level of education achieved by the chiropractor alone demands this. I feel, however, that chiropractic should see itself as a specialty. Certainly, our bread and butter would be the treatment of spinal, paraspinal and nerve root injuries but we should also market ourselves and see ourselves as Conservative Management Specialists. Not being able to prescribe drugs or perform surgery is a blessing not a restriction. Because of that limitation in treatment scope, chiropractors cannot opt for the easy treatment. We have to think of ways to manage problems without drugs or surgery (We are the McGyvers of health care). There is a huge market for doctors with this capacity because they provide the patient with options, options which usually lack the potential side effects of drugs and surgery. We need to chronicle what is effective and what is not and expose those whose intellectual limitations or financial avarice might otherwise squander patients’ finances or other treatment options.
It is time to shed the alternative cloak under which chiropractics dark operators hide. It is time to be seen as Cooperators. By cooperation I do not mean being blind or silent to medicine’s inproprieties. No, we still need to be the whistle blower. That is part of what a Conservative Management Specialist does. When we do these things we will find greater acceptance, greater prosperity, greater public support and greater access to patients. Similarly, there will be less negative press, less sensationalistic stories, and less misunderstanding from the medical community. Finally, and most importantly, patients will have access to a larger spectrum of validated treatment options.
Friday, July 10, 2009
After They're Gone
This is a song I wrote about mending broken relationships. Upon reviewing some family history with my Aunt, I was reminded of things that I would have liked to have said to my father and others who have passed away. My Dad was flawed but in my eyes a remarkable man. I miss him and the things we never did together as well as the things we never said to each other.
After They’re Gone.............................Michael Raucci ©
Fathers that die too soon
Mothers that cry too soon
When Death comes it’s a little too late
No chance to say bye to you
To say sorry that I lied to you
Time wasted is time testing fate
Wrote letters that I meant for you
That I have never sent to you
Sometimes you lose when you wait
Rehearsed lines that I’d say to you
Emotions I’d display for you
My pride masquerading as hate
(chorus)
After they’re gone
You can’t throw your arms ‘round them then
After they’re gone
Don’t leave things left to be said
Don’t wait ‘til the shadows grow long
Cause it’s too late after they’re gone
Things that you said to me
I was too blind to see
Now I see my mistake
Memories of what we would do
Are all I have left of you
There’s Nothing left to make
Harsh things that he said to you
Things that you meant to do
Call it water under the bridge
Don’t want to say I should have
Right now is time you still have
Stop asking time to blunt the edge
(chorus)
After they’re gone
You can’t throw your arms ‘round them then
After they’re gone
Don’t leave things left to be said
Don’t wait ‘til the shadows grow long
Cause it’s too late after they’re gone
All those things we planned to do
Now it’s just too late for you
In the darkness the shadows have gone
No more sandy crossing lines
Your gonna wish for more time
After they’re gone
(chorus)
After they’re gone
There’s nothing left to do
After they’re gone
It’s too late to say I love you
Don’t wait ‘til the shadows grow long
Cause it’s too late after they’re gone
Yah it’s too late after they’re gone
Fathers that die too soon
Mothers that cry too soon
When Death comes it’s a little too late
No chance to say bye to you
To say sorry that I lied to you
Time wasted is time testing fate
Monday, June 29, 2009
Why Do I Hurt Everywhere
Something I wrote a few years ago.
Why Do I Hurt Everywhere? Dr. Michael C. Raucci
The hallmark symptom of fibromyalgia is inexplicable chronic pain. The pain is often found over the majority of the body or the pain may appear to move. Often times certain areas will exhibit pain that is constant and more severe. Sometimes patients will present to their doctors with bizarre symptoms such as pain on only one side of the body (from head to toe) or pain that moves from place to place on a daily basis. These presentations are baffling to most doctors and all too often patients are told that these pains are all in their heads. (Translation: The doctor thinks they are crazy). The doctor who comes to this conclusion is both right and wrong. By stating that the problem is all in the patient's head the doctor is correct. Unfortunately, the doctor who makes this uninformed diagnosis assumes that the patient's problem is psychological when in fact, it is physiological. The problem is produced by neurochemical aberrations in the brain. The condition fibromyalgia is a real, physiological problem. The reason the diagnosis has been so slighted over the past decade is the failure of clinicians to recognize this fact. The typical doctor examines all the aches and pains in the person's body and correctly concludes that there is nothing wrong with those structures and the patient's unusual distribution of pains fits no known disorders. They don't even consider the possibility that it could be a central disorder (coming from the brain).
Fibromyalgia is caused by varying degrees of the four related phenomena listed below.
1) Reduced Serotonin Effectiveness
2) Central Sensitization
3) Peripheral Sensitization
4) Psychosomatic Overlay
Before delving into what these are, it is important to understand exactly what pain is.
In the battle of Santa Cruz, Lord Nelson lost his right arm. Many years later, he experienced pain in the arm which no longer existed (phantom pain). The emergence of these sensations led (Nelson) to proclaim that he now had direct proof for the existence of the soul. For if an arm can survive physical annihilation, why not the whole person? (Ramachandran, 2000)
This anecdote helps to preface a discussion on the brain because it describes a basic tenet of pain. Pain is a function of the brain and it occurs solely in the brain. Lord Nelson left his arm on the battle field. After the battle, if one of Lord Nelson's enemies had stabbed the dismembered arm with his spear in disgust, would Lord Nelson, now miles away have felt any new pain? Of course not. The dismembered arm itself experiences no pain. The unattached arm lacks the ability of perception.
Most amputees experience something called phantom limb pain. It is the perception of pain in the limb that no longer exists. The amputee feels this pain as real as they would pain in their other remaining limbs. But why? Mapped onto our brains is an exact map of our bodies. The relative size of the parts are distorted but every anatomical part which has the ability to perceive pain is represented. When Lord Nelson lost his right arm or when an amputee has his leg removed, the portion of the brain which was mapped for those parts remains intact. Given the right conditions, the neurons in that part of the brain may become excited and the person will feel pain in a nonexistent limb.
How does pain normally occur? We have already identified that pain occurs solely in the brain but clearly something is happening outside the brain. In order to understand the process we need to define a word: Nociception - the neurochemical recognition of tissue injury. When I cut the tip of my left index finger, what is the chronological cascade of events:
1) Cellular membranes are cut
2) Chemicals leak out of those cells
3) Some of those chemicals stimulate nociceptive receptors in the area (nociceptors are receptors that recognize tissue injury and transmit that information to nerves)
4) A neurologic signal is transmitted along a nerve out of the finger, up through the hand, up the arm, into the spinal cord at the level of the neck, and up into the brain into the exact area which represents the tip of my left index finger
5) My brain interprets the information
6) I perceive pain in the tip of my left index finger. I never feel any pain until step 6. If the process is interrupted prior to step 6, I will not feel pain at all.
Reduced Serotonin Effectiveness
Serotonin is the wonder hormone of the brain. When present in normal amounts, it suppresses pain, removes depressive symptoms, and helps to provide complete, rejuvenating sleep. When it is lowered it results in enhanced pain perception, depression, and poor, non-restorative sleep. Some studies have shown some fibromyalgia sufferers have lower than normal amounts of serotonin within the central nervous system (the brain and spinal cord). This finding alone would help to describe the major symptoms of fibromyalgia, however other fibromyalgia sufferers have normal amounts of serotonin. It would appear that in these individuals it is not that they have too little serotonin in the brain but that their serotonin utilization system is not functioning optimally; reduced serotonin effectiveness. Why does this increase the amount of pain? We have already discussed the concept of nociception and tissue injury but there is another aspect of nociception yet unexplained. There are low levels of nociceptive transmission which occur in all people continuously and without tissue injury. All of our nociceptive nerves are sending these baseline transmissions every hour of every day. Normally, when these low level transmissions reach the central nervous system, serotonin and other hormones (endorphins and enkephalins) suppress them below our brains ability to recognize them Thus there is no perception of pain. The reason why anti-depressants are often used to treat fibromyalgia is because they enhance the effectiveness of serotonin. Unfortunately, this has not shown long term effectiveness in the majority of patients.
Peripheral Sensitization
Peripheral means outside of the central nervous system - For our purposes, the rest of the body. Peripheral sensitization occurs to an area of injury when that area's nerve receptors become so irritated that they spontaneously depolarize, sending nociceptive signals to the brain in the absence of any irritation or in the presence of a normally sub-threshold irritation (such as the touch of ones clothes against the skin). This might also be called peripheral hypersensitivity. When this is present, abnormally intense signals are sent to the brain in the absence of a similarly gauged stimulus resulting in the experience of intense pain for no apparent reason. Peripheral sensitization usually occurs only in areas where there was an initial injury. It may spread to adjacent anatomical structures but usually will not spread across the entire body from the site of initial injury. In some fibromyalgia patients, peripheral sensitization will develop over a long period of time in uninjured areas because of a feedback loop from the central nervous system to the periphery after central sensitization has set in.
Central Sensitization
Central sensitization is the process described by Lord Nelson in the aforementioned story. The process by which central sensitization begins varies from person to person. It can begin with a continuous flow of nociception from the periphery, or from a direct physiologic/chemical change at the level of the brain. In either case, an area of the brain, which represents the mapped portion of a part of the body becomes sensitized to pain. Assume its the area representative of the lower back. That area of the brain becomes so sensitive that it no longer requires any nociceptive input from the periphery to create the perception of pain. What begins to happen is the person begins to feel pain in their back when there has been no injury to the back and there are no suprathreshold nociceptive signals being sent. The entire pain phenomena occurs in the brain. The person perceives the pain to be in their back because that is the area of the brain which is engaged in this central self excitation. This phenomena is common to all sufferers of chronic pain, including those with disc herniations an severe soft tissue injuries. What is unique to fibromyalgia is that the area of central sensitization on the brain grows or spreads to include other areas, so that suddenly the person may awaken with pain in their leg despite the fact that they suffered no injury there. It is self excitation of a representative area of the brain which is injured in the periphery which makes fibromyalgia unique. The theory of central sensitization helps to describe those otherwise bizarre findings, such as pain on one entire side of the body and pain that seems to move and change.
Psychosomatic Overlays
Psychosomatosis is the psychological creation of pain. It also occurs solely at the level of the brain and probably involves many of the same neurochemicals but its can be managed with psychotherapy or counseling. When a person feels there is no hope or feels depressed physical symptoms can become enhanced because of psychological overlays. Psychosomatosis by itself is not fibromyalgia. A distinction must be drawn so that person's can be directed towards proper treatment. Psychosomatosis, however, becomes a part of the fibromyalgia condition because of the stress, anxiety and depression associated with chronic pain.
Why Do I Hurt Everywhere? Dr. Michael C. Raucci
The hallmark symptom of fibromyalgia is inexplicable chronic pain. The pain is often found over the majority of the body or the pain may appear to move. Often times certain areas will exhibit pain that is constant and more severe. Sometimes patients will present to their doctors with bizarre symptoms such as pain on only one side of the body (from head to toe) or pain that moves from place to place on a daily basis. These presentations are baffling to most doctors and all too often patients are told that these pains are all in their heads. (Translation: The doctor thinks they are crazy). The doctor who comes to this conclusion is both right and wrong. By stating that the problem is all in the patient's head the doctor is correct. Unfortunately, the doctor who makes this uninformed diagnosis assumes that the patient's problem is psychological when in fact, it is physiological. The problem is produced by neurochemical aberrations in the brain. The condition fibromyalgia is a real, physiological problem. The reason the diagnosis has been so slighted over the past decade is the failure of clinicians to recognize this fact. The typical doctor examines all the aches and pains in the person's body and correctly concludes that there is nothing wrong with those structures and the patient's unusual distribution of pains fits no known disorders. They don't even consider the possibility that it could be a central disorder (coming from the brain).
Fibromyalgia is caused by varying degrees of the four related phenomena listed below.
1) Reduced Serotonin Effectiveness
2) Central Sensitization
3) Peripheral Sensitization
4) Psychosomatic Overlay
Before delving into what these are, it is important to understand exactly what pain is.
In the battle of Santa Cruz, Lord Nelson lost his right arm. Many years later, he experienced pain in the arm which no longer existed (phantom pain). The emergence of these sensations led (Nelson) to proclaim that he now had direct proof for the existence of the soul. For if an arm can survive physical annihilation, why not the whole person? (Ramachandran, 2000)
This anecdote helps to preface a discussion on the brain because it describes a basic tenet of pain. Pain is a function of the brain and it occurs solely in the brain. Lord Nelson left his arm on the battle field. After the battle, if one of Lord Nelson's enemies had stabbed the dismembered arm with his spear in disgust, would Lord Nelson, now miles away have felt any new pain? Of course not. The dismembered arm itself experiences no pain. The unattached arm lacks the ability of perception.
Most amputees experience something called phantom limb pain. It is the perception of pain in the limb that no longer exists. The amputee feels this pain as real as they would pain in their other remaining limbs. But why? Mapped onto our brains is an exact map of our bodies. The relative size of the parts are distorted but every anatomical part which has the ability to perceive pain is represented. When Lord Nelson lost his right arm or when an amputee has his leg removed, the portion of the brain which was mapped for those parts remains intact. Given the right conditions, the neurons in that part of the brain may become excited and the person will feel pain in a nonexistent limb.
How does pain normally occur? We have already identified that pain occurs solely in the brain but clearly something is happening outside the brain. In order to understand the process we need to define a word: Nociception - the neurochemical recognition of tissue injury. When I cut the tip of my left index finger, what is the chronological cascade of events:
1) Cellular membranes are cut
2) Chemicals leak out of those cells
3) Some of those chemicals stimulate nociceptive receptors in the area (nociceptors are receptors that recognize tissue injury and transmit that information to nerves)
4) A neurologic signal is transmitted along a nerve out of the finger, up through the hand, up the arm, into the spinal cord at the level of the neck, and up into the brain into the exact area which represents the tip of my left index finger
5) My brain interprets the information
6) I perceive pain in the tip of my left index finger. I never feel any pain until step 6. If the process is interrupted prior to step 6, I will not feel pain at all.
Reduced Serotonin Effectiveness
Serotonin is the wonder hormone of the brain. When present in normal amounts, it suppresses pain, removes depressive symptoms, and helps to provide complete, rejuvenating sleep. When it is lowered it results in enhanced pain perception, depression, and poor, non-restorative sleep. Some studies have shown some fibromyalgia sufferers have lower than normal amounts of serotonin within the central nervous system (the brain and spinal cord). This finding alone would help to describe the major symptoms of fibromyalgia, however other fibromyalgia sufferers have normal amounts of serotonin. It would appear that in these individuals it is not that they have too little serotonin in the brain but that their serotonin utilization system is not functioning optimally; reduced serotonin effectiveness. Why does this increase the amount of pain? We have already discussed the concept of nociception and tissue injury but there is another aspect of nociception yet unexplained. There are low levels of nociceptive transmission which occur in all people continuously and without tissue injury. All of our nociceptive nerves are sending these baseline transmissions every hour of every day. Normally, when these low level transmissions reach the central nervous system, serotonin and other hormones (endorphins and enkephalins) suppress them below our brains ability to recognize them Thus there is no perception of pain. The reason why anti-depressants are often used to treat fibromyalgia is because they enhance the effectiveness of serotonin. Unfortunately, this has not shown long term effectiveness in the majority of patients.
Peripheral Sensitization
Peripheral means outside of the central nervous system - For our purposes, the rest of the body. Peripheral sensitization occurs to an area of injury when that area's nerve receptors become so irritated that they spontaneously depolarize, sending nociceptive signals to the brain in the absence of any irritation or in the presence of a normally sub-threshold irritation (such as the touch of ones clothes against the skin). This might also be called peripheral hypersensitivity. When this is present, abnormally intense signals are sent to the brain in the absence of a similarly gauged stimulus resulting in the experience of intense pain for no apparent reason. Peripheral sensitization usually occurs only in areas where there was an initial injury. It may spread to adjacent anatomical structures but usually will not spread across the entire body from the site of initial injury. In some fibromyalgia patients, peripheral sensitization will develop over a long period of time in uninjured areas because of a feedback loop from the central nervous system to the periphery after central sensitization has set in.
Central Sensitization
Central sensitization is the process described by Lord Nelson in the aforementioned story. The process by which central sensitization begins varies from person to person. It can begin with a continuous flow of nociception from the periphery, or from a direct physiologic/chemical change at the level of the brain. In either case, an area of the brain, which represents the mapped portion of a part of the body becomes sensitized to pain. Assume its the area representative of the lower back. That area of the brain becomes so sensitive that it no longer requires any nociceptive input from the periphery to create the perception of pain. What begins to happen is the person begins to feel pain in their back when there has been no injury to the back and there are no suprathreshold nociceptive signals being sent. The entire pain phenomena occurs in the brain. The person perceives the pain to be in their back because that is the area of the brain which is engaged in this central self excitation. This phenomena is common to all sufferers of chronic pain, including those with disc herniations an severe soft tissue injuries. What is unique to fibromyalgia is that the area of central sensitization on the brain grows or spreads to include other areas, so that suddenly the person may awaken with pain in their leg despite the fact that they suffered no injury there. It is self excitation of a representative area of the brain which is injured in the periphery which makes fibromyalgia unique. The theory of central sensitization helps to describe those otherwise bizarre findings, such as pain on one entire side of the body and pain that seems to move and change.
Psychosomatic Overlays
Psychosomatosis is the psychological creation of pain. It also occurs solely at the level of the brain and probably involves many of the same neurochemicals but its can be managed with psychotherapy or counseling. When a person feels there is no hope or feels depressed physical symptoms can become enhanced because of psychological overlays. Psychosomatosis by itself is not fibromyalgia. A distinction must be drawn so that person's can be directed towards proper treatment. Psychosomatosis, however, becomes a part of the fibromyalgia condition because of the stress, anxiety and depression associated with chronic pain.
Sunday, June 21, 2009
healthcare reform
Recently President Obama proposed new health care reform that would include some government control or participation. One of President Obama’s proposals is the creation of a government insurance company that will compete with private insurers. This suggests that a government insurance option will drive private health insurance premiums down by creating competition. Responses from legislators have been emotionally charged and influenced strongly by large lobbying groups. Senator Richard Shelby stated that acting on the President’s proposal would be “the first step in destroying the best health-care system the world has ever known," while other pundits have lamented that it would put bureaucrats between patients and their doctors.
While I don’t dispute that the United States offers the finest health care in the world, it does not do so for every citizen. The slogan of those that seek to protect the status quo should be modified to say “the United States offers the finest healthcare in the world to those who can afford it.”
The current system is fatally flawed as each year it is capable of providing health care coverage to fewer and fewer Americans. Health insurance premiums have been rising at 5 times the rate of inflation. It is a system that is regulated by corporate profit margins not by science and compassion. This system places unnecessary stress on caregivers by allowing third party payers to shake down doctors, hospitals and patients under the guise of managing healthcare. And finally, it is a system that depends upon other programs such as Medicaid and Medicare to care for those that can’t afford its lofty premiums. In the current health insurance system almost 45% of poor adults are uninsured (poor being defined as those who earn <200% of the poverty level).
In a compromise the President suggests that we not throw the baby out with the bathwater. He proposes, and I believe rightfully so, that by maintaining the current system and infusing some government control in the form of a government based insurance option we can transition towards a more equitable system which allows all US citizens to have access to basic health services. Some would say that healthcare is not a right but is a privilege which must be paid for. In the past this was true but as healthcare has progressed towards certain scientific certainties members of our population are all too frequently presented with the dilemma, “If you can pay for this procedure or medication you will live and if you cannot you will die.” As our society evolves, so do our perceptions of fairness. I believe that at this stage in our societal evolution the expectation of basic medical services should be as much a right as the right to vote. For those that seek elevated levels of coverage above what the national discussion determines to be basic, private insurances will no doubt provide options. The current stratified system is insufficient and unfair. Those who fall below a preset poverty level receive Medicaid (a service which varies from state to state), those who work lower paying jobs but whose incomes exceed the poverty set point often have no coverage and those with higher paying jobs enjoy the security of more comprehensive insurance. In addition, those with pre-existing injuries and diseases often lose coverage when changing jobs.
There is no perfect system and countries in Europe and Canada that have nationalized healthcare have learned that their systems are also flawed but at least medical care is available to all citizens. Current estimates put the number of uninsured Americans at approximately 50 million, a number that is sure to rise as unemployment rates increase across the country.
The real question when it comes to healthcare is, do we want a system that supplies top notch healthcare to only 65% of citizens, or do we want a system that insures all citizens at a basic level and allows for higher level coverage for those that wish to purchase it? It’s still a stratified system but at least there is no layer of non-coverage.
The ranks of the insured are reducing as small business owners choose to go without insurance because they can’t afford it, employers with shrinking bottom lines put more and more financial responsibility to pay for health insurance on their employees, and as the weakened economy stretches the unemployment roles many unemployed individuals must choose between making their rent or mortgage payments and paying for COBRA plans which exceed their unemployment benefits.
I don’t know if the time for change is now. Given our current economic woes, the housing crisis, the collapse of the financial system, our role in two foreign wars, impending double digit unemployment and a national debt that recently exceeded the number of available digits on the Times Square clock designed to measure it, it seems an inopportune time. But as so often occurs, difficult decisions are often thrust upon us when we least want to deal with them. I do not know where the money will come from. I am not sure how to structure a system that would provide quality care without exclusion that would still properly compensate doctors, nurses, and other healthcare providers. I do not know… But I do know that we cannot continue to allow a dwindling few to utilize healthcare resources while friends and neighbors wallow in the unknowns of being uninsured. I do know that debating this can’t be anything but good. I do know that we have intelligent actuaries, statisticians, healthcare providers, administrators, and politicians who can solve this problem.
The president’s proposal, while no doubt a stop-gap measure on what is likely a slow march toward nationalized healthcare is a reasonable point to begin the national debate. As evidenced by Congressional Budget Office estimates the Obama plan would be costly and it most certainly could not be implemented without breaking Obama’s pledge to not raise taxes on the middle class. So let the debate begin.
It has been said that the truest measure of a society is how it treats those in the most need. What does it say about the country with the “greatest healthcare system the world has ever known” when we only allow the wealthiest and most privileged to utilize it?
Dr. Michael Raucci
While I don’t dispute that the United States offers the finest health care in the world, it does not do so for every citizen. The slogan of those that seek to protect the status quo should be modified to say “the United States offers the finest healthcare in the world to those who can afford it.”
The current system is fatally flawed as each year it is capable of providing health care coverage to fewer and fewer Americans. Health insurance premiums have been rising at 5 times the rate of inflation. It is a system that is regulated by corporate profit margins not by science and compassion. This system places unnecessary stress on caregivers by allowing third party payers to shake down doctors, hospitals and patients under the guise of managing healthcare. And finally, it is a system that depends upon other programs such as Medicaid and Medicare to care for those that can’t afford its lofty premiums. In the current health insurance system almost 45% of poor adults are uninsured (poor being defined as those who earn <200% of the poverty level).
In a compromise the President suggests that we not throw the baby out with the bathwater. He proposes, and I believe rightfully so, that by maintaining the current system and infusing some government control in the form of a government based insurance option we can transition towards a more equitable system which allows all US citizens to have access to basic health services. Some would say that healthcare is not a right but is a privilege which must be paid for. In the past this was true but as healthcare has progressed towards certain scientific certainties members of our population are all too frequently presented with the dilemma, “If you can pay for this procedure or medication you will live and if you cannot you will die.” As our society evolves, so do our perceptions of fairness. I believe that at this stage in our societal evolution the expectation of basic medical services should be as much a right as the right to vote. For those that seek elevated levels of coverage above what the national discussion determines to be basic, private insurances will no doubt provide options. The current stratified system is insufficient and unfair. Those who fall below a preset poverty level receive Medicaid (a service which varies from state to state), those who work lower paying jobs but whose incomes exceed the poverty set point often have no coverage and those with higher paying jobs enjoy the security of more comprehensive insurance. In addition, those with pre-existing injuries and diseases often lose coverage when changing jobs.
There is no perfect system and countries in Europe and Canada that have nationalized healthcare have learned that their systems are also flawed but at least medical care is available to all citizens. Current estimates put the number of uninsured Americans at approximately 50 million, a number that is sure to rise as unemployment rates increase across the country.
The real question when it comes to healthcare is, do we want a system that supplies top notch healthcare to only 65% of citizens, or do we want a system that insures all citizens at a basic level and allows for higher level coverage for those that wish to purchase it? It’s still a stratified system but at least there is no layer of non-coverage.
The ranks of the insured are reducing as small business owners choose to go without insurance because they can’t afford it, employers with shrinking bottom lines put more and more financial responsibility to pay for health insurance on their employees, and as the weakened economy stretches the unemployment roles many unemployed individuals must choose between making their rent or mortgage payments and paying for COBRA plans which exceed their unemployment benefits.
I don’t know if the time for change is now. Given our current economic woes, the housing crisis, the collapse of the financial system, our role in two foreign wars, impending double digit unemployment and a national debt that recently exceeded the number of available digits on the Times Square clock designed to measure it, it seems an inopportune time. But as so often occurs, difficult decisions are often thrust upon us when we least want to deal with them. I do not know where the money will come from. I am not sure how to structure a system that would provide quality care without exclusion that would still properly compensate doctors, nurses, and other healthcare providers. I do not know… But I do know that we cannot continue to allow a dwindling few to utilize healthcare resources while friends and neighbors wallow in the unknowns of being uninsured. I do know that debating this can’t be anything but good. I do know that we have intelligent actuaries, statisticians, healthcare providers, administrators, and politicians who can solve this problem.
The president’s proposal, while no doubt a stop-gap measure on what is likely a slow march toward nationalized healthcare is a reasonable point to begin the national debate. As evidenced by Congressional Budget Office estimates the Obama plan would be costly and it most certainly could not be implemented without breaking Obama’s pledge to not raise taxes on the middle class. So let the debate begin.
It has been said that the truest measure of a society is how it treats those in the most need. What does it say about the country with the “greatest healthcare system the world has ever known” when we only allow the wealthiest and most privileged to utilize it?
Dr. Michael Raucci
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