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Medical Forum / Diseases and Disorders / Asthma / October 2003Curbing asthma attacks
See http://www.ohiou.edu/isarp/conf_00/post_2.htm for a study by Dr. D. Hillsman MD of the University of California. He names the efforts of asthmatic (or COPD patient) in an attack of breathlessness "the rescue breathing pattern" (RBP) with: Increased Respiratory Rate Increased Tidal Volume (Rate limited) Increased air Flow Forced breathing Focus on Inspiration Shortened Expiration Time The RBP leads to Air Trapping and functional Overinflation due to: Necessary long time constant for expiration Increased dynamic bronchial compression. The patient must breathe Slowly Large Tidal Volume Gently Focus on Expiration Increased Expiration Time After explaining his computer setup, he notes the following on dealing with attacks (page 8): "LUNG DEFLATION TRAINING The top record shows the same patient demonstrating Air Trapping. The bottom record shows two methods of lung deflation training. The first technique is an approximate 25% prolongation of the programmed expiratory time. The example shows about 350 cc exhalation below the FRC. This technique is good to gradually deflate the lung over several breaths. It can be used to advantage at the onset of a dyspnea attack. The second technique is a rescue technique for patients acutely distressed. The same respiratory timing is used, but approximately 1/2 to 2/3 of the way through expiration the patient forces expiration to a point below FRC (functional residual capacity, up to this time, patients are trained to relax as much as possible with passive exhalation). Note the expiratory forcing must be a controlled gentle action, in order to minimize the dynamic bronchial compression problem and further exacerbation of airway collapse. Done correctly, usually within 5 to 10 breaths the patient feels substantial, though not complete relief of their dyspnea attack. They can then use their regular breathing pattern to regain complete comfort over the next few minutes." Hopefully people will agree with me that this study gives valuable information not available in regular reading for patients about dealing with an attack. Therefore the commercial side (possibly buying the computer program and extra hardware) is not so very important. Regards, Richard Friedel > See http://www.ohiou.edu/isarp/conf_00/post_2.htm for a study by Dr. D. > Hillsman MD of the University of California. [quoted text clipped - 23 lines] > Focus on Expiration > Increased Expiration Time Basically, he is noting a problem found in artificially ventilated asthma patients known as "auto-peep" that results from air trapping. (PEEP stands for positive end expiratory pressure). This is treated/avoided in asthmatics by not setting the vent to give peep (commonly used to prevent airway closure) or using it carefully and by decreasing the I/E ratio (inspiratory time/expiratory time). It makes sense. None of what he discusses is new to pulmonologists in the context of ventilator management and non-(artifically) ventilated asthma patients are known to trap air (and it is known to get worse during an attack). It would be interesting to see more clinical data to see how many people truly benefit from slowing things down. I do feel that I should point out that breath holding would not accomplish the same goals (and by this theory may worsen the situation) and that this speaks neither for nor against SIMT or other breathign exersizes. -- CBI, MD > > See http://www.ohiou.edu/isarp/conf_00/post_2.htm for a study by Dr. D. > > Hillsman MD of the University of California. [quoted text clipped - 44 lines] > -- > CBI, MD Professor Hillsman MD was working on treatment of the "empowerment" type. The patient is taught how to get out of asthma by using his own physical and mental resources and reducing dependency on experts, apart from the initial physiotherapy. It seems to me that his patient is not depersonalized, as would be the case with PEEP. It is hard to see what PEEP has to do with the "rescue breathing pattern", the false tactic adopted by some asthmatics to break out of being SOB. A simple, effective way of overcoming attacks might be extremely useful. There would be much less fear of attacks around, which often seems to be the motive for folks' embarking on lifetime medication without have had a single attack. Furthermore of course some success with overcoming attacks without drugs would divert funds to physiotherapy. Regards, Richard Friedel > > Basically, he is noting a problem found in artificially ventilated > > asthma patients known as "auto-peep" that results from air trapping. [quoted text clipped - 8 lines] > > during an attack). It would be interesting to see more clinical data > > to see how many people truly benefit from slowing things down. > Professor Hillsman MD was working on treatment of the "empowerment" > type. The patient is taught how to get out of asthma by using his own > physical and mental resources and reducing dependency on experts, apart > from the initial physiotherapy. It seems to me that his patient is not > depersonalized, as would be the case with PEEP. I agree completely that empowering asthmatics and teaching them things they can do to augment pharmacotherapy is a good thing. PEEP is a physiologically defined measure and so cannot be depersonalizing. It is just a fact of life. I don't think that experts seek to keep the patients dependant and I think that teaching them breathing techniques to help ward off attacks does nothing to make them more or less so since most of asthma care centers around prevention. > It is hard to see what PEEP has to do with the "rescue breathing > pattern", the false tactic adopted by some asthmatics to break out of > being SOB. The increased pressure that he is describing is PEEP (or more accurately auto-PEEP). I just thought his observations were interesting and made inutitive sense. Since you asked, the pursed lip breathing that asthmatics have been taught (whiat I think you are referring to) has long been thought to be a way to add PEEP. The thought was that it would helpt o hold airways open. According to this theory I agree that this may need to be rethought. > A simple, effective way of overcoming attacks might be extremely > useful. I agree. > There would be much less fear of attacks around, which often > seems to be the motive for folks' embarking on lifetime medication > without have had a single attack. I don't know anyone who is on a lifetime of medicines without ever having had an attack. The fatc that the person has the attack and requires some rescue, whether from medication or a breathing technique, suggests the need for some meds. > Furthermore of course some success > with overcoming attacks without drugs would divert funds to > physiotherapy. Regards, Richard Friedel Another red herring. The docs don't care if the money goes to the pharmceutical companies or the therpaists. -- CBI, MD >> Furthermore of course some success >> with overcoming attacks without drugs would divert funds to >> physiotherapy. Regards, Richard Friedel > >Another red herring. The docs don't care if the money goes to the >pharmceutical companies or the therpaists. I contend that many "docs" do care whether the money goes to themselves or not. Chronic asthma is a significant revenue producer for some/many MD's, and anything that would make asthma patients more self-sufficient threatens to take a chunk out of that revenue stream. For those of you who haven't seen my earlier posts, please read this: http://www.oshinsky.org/asthma.htm. >I contend that many "docs" do care whether the money goes to >themselves or not. Chronic asthma is a significant revenue producer >for some/many MD's, and anything that would make asthma patients more >self-sufficient threatens to take a chunk out of that revenue stream. And what do you base this hypothesis on? Be vary careful of conclusions that reinforce your biases. -- There can be no triumph without loss. No victory without suffering. No freedom without sacrifice. >>I contend that many "docs" do care whether the money goes to >>themselves or not. Chronic asthma is a significant revenue producer >>for some/many MD's, and anything that would make asthma patients more >>self-sufficient threatens to take a chunk out of that revenue stream. > >And what do you base this hypothesis on? I base my hypothesis on my own understanding of and experience with human nature. Most humans like money. MD's are human. QED. There also is another nasty part of human nature that comes into play here. It is the natural inclination towards skepticism that has slowed the advance of science in many cases over the centuries. What happened to Galileo is but one example. >Be vary careful of conclusions that reinforce your biases. Let's face it. We're all biased. I'll come to my own conclusions, and you will come to yours. >>>I contend that many "docs" do care whether the money goes to >>>themselves or not. Chronic asthma is a significant revenue producer [quoted text clipped - 5 lines] >I base my hypothesis on my own understanding of and experience with >human nature. Most humans like money. MD's are human. QED. I disagree on the power of money as a motivator for people. And I question whether a person motivated by money would choose medicine as a profession as there are so many easier ways to become rich. >There also is another nasty part of human nature that comes into play >here. It is the natural inclination towards skepticism that has >slowed the advance of science in many cases over the centuries. What >happened to Galileo is but one example. Scepticism is part of the foundation of modern scientific thought. The concept is that a hypothesis is 'wrong' until demonstrated otherwise. Experiments are then conducted to determine if the hypothesis is in fact correct. >>Be vary careful of conclusions that reinforce your biases. > >Let's face it. We're all biased. I'll come to my own conclusions, >and you will come to yours. Yes we are. And we must take our own biases into account when making assumptions about other people. -- There can be no triumph without loss. No victory without suffering. No freedom without sacrifice. > >>>I contend that many "docs" do care whether the money goes to > >>>themselves or not. Chronic asthma is a significant revenue producer [quoted text clipped - 32 lines] > No victory without suffering. > No freedom without sacrifice. While you two boys are having a spat about money/human nature etc. Might I (re)point out that the population of the US is only ca. 5% of the total number of humans which inhabit this tiny planet. Hence whatever the whys and wherefores that apply to the US (re. asthma treatment - best practice) - do not "necessarily" apply to the rest of us. Again, in Europe healthcare is free(-ish). Hence significant ways of diverting tax Euros to other projects - would be seized upon! ...........merely my perspective from England. Pete ........and the worlds fifth largest economy elects an Austrian beefcake/filmstar as Governor! >While you two boys are having a spat about money/human nature etc. It's only human nature to have spats about money and human nature :) >Might I (re)point out that the population of the US is only ca. 5% of the >total number of humans which inhabit this tiny planet. Hence whatever the >whys and wherefores that apply to the US (re. asthma treatment - best >practice) - do not "necessarily" apply to the rest of us. Point well taken. I only have personal experience with the medical system in the U.S. I don't doubt that being on a salary (as opposed to fee for service as in the U.S.) could easily change the thought processes of some MD's. >Again, in Europe healthcare is free(-ish). Hence significant ways of >diverting tax Euros to other projects - would be seized upon! > >...........merely my perspective from England. I would just love to visit your beautiful country, and would enjoy it even more if my current wheeze-free status persists as Jim Quinlan's has (for years). >........and the worlds fifth largest economy elects an Austrian >beefcake/filmstar as Governor! Oh, let's not get started with this one :) The rumors just before the election added "groper" and "Hitler admirer" to the list. I have no idea whether these allegations are simply the usual political dirty tricks, or have some truth to them. >Point well taken. I only have personal experience with the medical >system in the U.S. I don't doubt that being on a salary (as opposed >to fee for service as in the U.S.) could easily change the thought >processes of some MD's. I have been treated by doctor's who were both 'on salary' (Kaiser HMO) and 'fee foe service.' In addition I have been treated by military doctors. In all of these cases they used similar treatments and got similar results. If your hypothesis were correct then doctors on salary at HMOs should be providing substantially different care and showing substantially better patient outcomes. (Since HMOs have a financial motivation to 'cure' as opposed to 'treat.') >>........and the worlds fifth largest economy elects an Austrian >>beefcake/filmstar as Governor! [quoted text clipped - 3 lines] >no idea whether these allegations are simply the usual political dirty >tricks, or have some truth to them. The 'Hitler admirer' comments were nothing but political 'dirty tricks.' Arnold was quoted out of context when he commented on Hitler's charisma and ability to enthrall a nation with his public speaking abilities. And the timing of the 'groping' allegations is IMO - suspicious. -- There can be no triumph without loss. No victory without suffering. No freedom without sacrifice. > And the timing of the 'groping' allegations is IMO - suspicious. As Lincoln said - "Find out what he drinks and send him a casse." If the guy is doing a good job as Gov. (or Pres.) I don't really care what he does in his personal life. -- CBI > > And the timing of the 'groping' allegations is IMO - suspicious. > [quoted text clipped - 5 lines] > -- > CBI Personally, and as a disinterested party, I was relieved to discover that he was actually a fully-paid-up red-blooded male! .......as I said, just my view from England! Pete >>>>I contend that many "docs" do care whether the money goes to >>>>themselves or not. Chronic asthma is a significant revenue producer [quoted text clipped - 9 lines] >question whether a person motivated by money would choose medicine as >a profession as there are so many easier ways to become rich. In the U.S., MD average pay is well above that of most other professions. Yes, there are other ways of becoming "rich", but I wouldn't characterize them as "easier" or more surefire. Here's another way of looking at it. Much of a physician's training falls within the scientific/technical realm, and most other scientific/technical careers don't have nearly as high average earnings. Greed is a basic human motivator, and all the more likely so for those who pick professions that are high paying. >>There also is another nasty part of human nature that comes into play >>here. It is the natural inclination towards skepticism that has [quoted text clipped - 5 lines] >otherwise. Experiments are then conducted to determine if the >hypothesis is in fact correct. I am that experiment. Antibiotics put my asthma into remission, which I have to believe means that it would work as splendidly for some (possibly many) other asthmatics. >>>Be vary careful of conclusions that reinforce your biases. >> [quoted text clipped - 3 lines] >Yes we are. And we must take our own biases into account when making >assumptions about other people. Call it biased, call it what you want. I found it difficult to find an MD who would prescribe antibiotics for my asthma. This was despite the evidence I presented, including my own short-term improvement after a single Z-Pak. I can only explain this so many ways, which have already been covered in earlier posts. >In the U.S., MD average pay is well above that of most other >professions. Yes, there are other ways of becoming "rich", but I [quoted text clipped - 6 lines] >Greed is a basic human motivator, and all the more likely so for those >who pick professions that are high paying. Greed is a motivator for some people - not all. IMO people in professions (as opposed to occupations) are in it for something other than money. And if your hypothesis were true then you should be able to show a difference in patient outcomes between doctors paid a salary (such as military doctors) and doctors who are independent. If both groups use substantially similar methods and get substantially similar outcomes then your hypotheses can be considered as proven false. >Call it biased, call it what you want. I found it difficult to find >an MD who would prescribe antibiotics for my asthma. This was despite >the evidence I presented, including my own short-term improvement >after a single Z-Pak. I can only explain this so many ways, which >have already been covered in earlier posts. Have you tried using the principle of Occam's razor (the simplest explanation is usually correct) for your explanations? Sounds to me like your arguments simply did not convince the doctor - instead of some vague conspiracy to keep us sick. -- There can be no triumph without loss. No victory without suffering. No freedom without sacrifice. >Greed is a motivator for some people - not all. IMO people in >professions (as opposed to occupations) are in it for something other >than money. People tend to believe in those things which they expect to benefit them, and resist those things that they expect will hurt them, whether this is done consciously or not. Based on this theory, there isn't much motivation for the majority of MD's to quickly accept a treatment that will turn some fraction of chronic asthma patients into ex-asthma-patients. >And if your hypothesis were true then you should be able to show a >difference in patient outcomes between doctors paid a salary (such as >military doctors) and doctors who are independent. If both groups use >substantially similar methods and get substantially similar outcomes >then your hypotheses can be considered as proven false. Even doctors on salary benefit from a steady stream of patients. A significant drop in business can result in a salary cut or even a job cut. >Have you tried using the principle of Occam's razor (the simplest >explanation is usually correct) for your explanations? Sounds to me >like your arguments simply did not convince the doctor - instead of >some vague conspiracy to keep us sick. In this case, I think the simplest explanation is that inertia rules, and economic motivation shouldn't be ignored. The current asthma treatments are widely accepted by most asthma patients and by most MD's (and very good for business), and therefore there is no strong motivation to change them. >People tend to believe in those things which they expect to benefit >them, and resist those things that they expect will hurt them, whether >this is done consciously or not. Based on this theory, there isn't >much motivation for the majority of MD's to quickly accept a treatment >that will turn some fraction of chronic asthma patients into >ex-asthma-patients. Sounds to me like you are attempting to rationalize a reason why they will not accept your treatment. You seem to not be able to accept that others are sceptical of it. Basically, it is an unproven remedy. Lets wait for more and better research to be conducted. >Even doctors on salary benefit from a steady stream of patients. A >significant drop in business can result in a salary cut or even a job >cut. In this case, military doctors would show a significant difference in patient outcomes (military doctors are staffed to meet wartime requirements). Since they are _not_ going to lose jobs if the asthmatics get better - under your theory there should be a difference in outcomes. >In this case, I think the simplest explanation is that inertia rules, >and economic motivation shouldn't be ignored. The current asthma >treatments are widely accepted by most asthma patients and by most >MD's (and very good for business), and therefore there is no strong >motivation to change them. Now you are starting to get close. There is a certain conservatives attitude among people whose mistakes can result in dead people. As a result they tend to want to see good evidence before they will try anything different. Basically you need to wait until more research is done and it is determined if this remedy of yours is really worthwhile. -- There can be no triumph without loss. No victory without suffering. No freedom without sacrifice. > >Even doctors on salary benefit from a steady stream of patients. A > >significant drop in business can result in a salary cut or even a job [quoted text clipped - 5 lines] > asthmatics get better - under your theory there should be a difference > in outcomes. Military docs are not the only ones on salary. In fact, the whole HMO model of capitation (where the doc gets a monthly fee whether he sees the patient or not) provides another situation where healthier patients are much better for the doctor's finances. There should be no shortage of ways to test your theory that docs are keeping people sick to boost porfits. In fact, people do look at outcomes in different models of healthcare delivery. So go ahead and look up the data and prove your point if you are able. > >In this case, I think the simplest explanation is that inertia rules, > >and economic motivation shouldn't be ignored. The current asthma [quoted text clipped - 6 lines] > result they tend to want to see good evidence before they will try > anything different. I think the part about the consequences of mistakes is closest to the mark. If his theory about sicker patients being more profitable were true we wouldn't give out flu shots (at a loss) or prescribe inhaled steroids.  SignatureCBI, MD >Military docs are not the only ones on salary. In fact, the whole HMO >model of capitation (where the doc gets a monthly fee whether he sees >the patient or not) provides another situation where healthier >patients are much better for the doctor's finances. Well then, I think that "capitated" HMO doctors should be the first ones in line to start using antibiotics for their severe asthmatics who are likely to be suffering from chronic infection. Perhaps some of the more enlightened HMO doctors are already using this groudbreaking treatment. >There should be no shortage of ways to test your theory that docs are >keeping people sick to boost porfits. In fact, people do look at >outcomes in different models of healthcare delivery. So go ahead and >look up the data and prove your point if you are able. This is not a clear-cut case of consciously and intentionally keeping people sick to boost profits. My point is that where profits would be reduced by a new treatment, and there is little competitive pressure to adopt it (i.e., most of the competitors aren't yet using it either), then there is little motivation to rush forward aggressively and start using the new treatment. >> >In this case, I think the simplest explanation is that inertia rules, >> >and economic motivation shouldn't be ignored. The current asthma [quoted text clipped - 6 lines] >> result they tend to want to see good evidence before they will try >> anything different. What evidence does a physician need when they have a patient whose severe asthma symptoms are not well-controlled by maximum doses of conventional medication? I think there's already enough evidence (with the existing research studies as small as they are, and the spectacular anecdotal success stories such as Jim Q's and mine) to use this treatment in these cases. The problem I have with all this is that it takes far too much time for most MD's to learn new tricks such as this one. I am corresponding by e-mail with several people who cannot get their MD's to agree to try it, despite the fact that their asthma history is almost identical to mine (i.e., it became severe in young adults with bronchitis or similar infection). >I think the part about the consequences of mistakes is closest to the >mark. If his theory about sicker patients being more profitable were >true we wouldn't give out flu shots (at a loss) or prescribe inhaled >steroids. There you go again with another specious argument. How can you compare treatments such as flu shots and inhaled steroids which are widely accepted (standard treatments, in fact) with a treatment like antibiotics for asthma which is not YET widely accepted? Any doctor who withholds flu shots or inhaled steroids would be accused of malpractice. Any doctor who withholds antibiotics for asthma is simply a carbon copy of the majority of the rest of current physicians, and none of these will be accused of malpractice for withholding or not suggesting the new treatment. >>Military docs are not the only ones on salary. In fact, the whole HMO >>model of capitation (where the doc gets a monthly fee whether he sees [quoted text clipped - 6 lines] >of the more enlightened HMO doctors are already using this >groudbreaking treatment. And the fact that they are not doing this is evidence that the scientific basis of the treatment is unconvincing. What makes you think that agreeing with your patent remedy is 'enlightend?' >This is not a clear-cut case of consciously and intentionally keeping >people sick to boost profits. My point is that where profits would be >reduced by a new treatment, and there is little competitive pressure >to adopt it (i.e., most of the competitors aren't yet using it >either), then there is little motivation to rush forward aggressively >and start using the new treatment. Really? Then explain the rapid introduction of the leukotrine medications and inhaled steroids? >>> Now you are starting to get close. There is a certain conservatives >>> attitude among people whose mistakes can result in dead people. As a [quoted text clipped - 7 lines] >spectacular anecdotal success stories such as Jim Q's and mine) to use >this treatment in these cases. _You_ think this. It is obvious that most trained doctors do not. >There you go again with another specious argument. How can you >compare treatments such as flu shots and inhaled steroids which are [quoted text clipped - 5 lines] >physicians, and none of these will be accused of malpractice for >withholding or not suggesting the new treatment. The difference is that there is conclusive scientific evidence that flu shots and inhaled steroids are safe and effective. Your proposed treatment still needs more research before we can decide if it really works. And BTW, you are not doing a whole lot to convince me that you are doing an honest appraisal of the remedy - you sound like a 'true believer.' -- There can be no triumph without loss. No victory without suffering. No freedom without sacrifice. > Really? Then explain the rapid introduction of the leukotrine > medications and inhaled steroids? Bad example. It was more than 20 years from discovery to market for leukotirine inhibitors. >> Really? Then explain the rapid introduction of the leukotrine >> medications and inhaled steroids? > >Bad example. It was more than 20 years from discovery to market for >leukotirine inhibitors. Yes, it took 20 years from the _first_ paper to the first medications reaching the patient. Now, think of all the things that had to happen here. First research had to be preformed to determine just how the leukotrines worked. Only after this could somebody even start looking for ways to modify this. After discovering a specific chemical reaction to target, the researchers had to invent a large number of different chemicals to do this. Now they have to begin testing these chemicals to find the 2 or 3 that appear to be likely candidates for development into a medical product. Then they have to begin the years of testing to verify that the chemical is 'safe and effective.' FYI - there is no magic wand that can be waved to speed this process. -- There can be no triumph without loss. No victory without suffering. No freedom without sacrifice. > Well then, I think that "capitated" HMO doctors should be the first > ones in line to start using antibiotics for their severe asthmatics > who are likely to be suffering from chronic infection. Yet they aren't. If it isn't financial motivation why is it? > >There should be no shortage of ways to test your theory that docs are > >keeping people sick to boost porfits. In fact, people do look at [quoted text clipped - 3 lines] > This is not a clear-cut case of consciously and intentionally keeping > people sick to boost profits. Oh, now you are arguing subconscious effects. > My point is that where profits would be > reduced by a new treatment, and there is little competitive pressure > to adopt it (i.e., most of the competitors aren't yet using it > either), then there is little motivation to rush forward aggressively > and start using the new treatment. But there is competition between doctors and medical centers. "Curing" a good percentage of his hard to treat paitents would quickly become known as a leader and garner many new patients. > The problem I have with all this is that it takes far too much time > for most MD's to learn new tricks such as this one. BS. When a "new trick" comes around that is clearly and convioncingly shown to be better it is quickly adopted by at least a large number of docs. > >I think the part about the consequences of mistakes is closest to the > >mark. If his theory about sicker patients being more profitable were [quoted text clipped - 5 lines] > widely accepted (standard treatments, in fact) with a treatment like > antibiotics for asthma which is not YET widely accepted? The point id that your theory is that the docs are not adopting this new treatment because it would somehow decrease profits by decreasing illness. I am pointing out other interventions that are well known to decrease illness (and, hence, in your model profits) but are widely prescribed. If you wish to support your theory you must explain why the docs decrease their profits in one instance but then refuse to do so in another. > Any doctor > who withholds flu shots or inhaled steroids would be accused of > malpractice. According to you reputation and poor outcomes do not become widely known and so do not impact on the doctor's practice. You can't have it both ways. If curing large numbers of patients won't benefit the docs reputation and practice then you can't use fear of a poor reputation as an explanation for why they do other things. Either the doc is concerned about his reputation or not. SignatureCBI, MD >> Well then, I think that "capitated" HMO doctors should be the first >> ones in line to start using antibiotics for their severe asthmatics >> who are likely to be suffering from chronic infection. > >Yet they aren't. If it isn't financial motivation why is it? Perhaps you should go back to college and take a logic refresher course, because you obviously don't have a firm grasp of the difference between SOME and ALL. I have never said that ALL physicians are primarily motivated by finances. SOME physicians are financially motivated. Such physicians would have at least one reason to avoid a treatment that turns a long-term patient into an ex-patient. >> >There should be no shortage of ways to test your theory that docs are >> >keeping people sick to boost porfits. In fact, people do look at [quoted text clipped - 5 lines] > >Oh, now you are arguing subconscious effects. Any time that I mention that SOME physicians might be financially motivated, you seem to be drawn to that post like a moth is drawn to a halogen lamp. That could be, you guessed it, a fine example of the subconscious at work. Perhaps the accusation strikes too close to home. >> My point is that where profits would be >> reduced by a new treatment, and there is little competitive pressure [quoted text clipped - 5 lines] >a good percentage of his hard to treat paitents would quickly become >known as a leader and garner many new patients. Medicine is not a fully competitive field. Reliable information which asthma patients could use to decide which doctors are most competent at treating asthma is simply not widely available in most geographical locations. Moreover, in the U.S., few physicians advertise or otherwise attempt to openly publicize the benefits of choosing them over other physicians. Even when physicians advertise, I have rarely seen factual or detailed information such as success rates in treating particular diseases. While the Internet has made vast amounts of information on asthma treatments available to patients, there is very little information available that compares the different treatments and almost none comparing success rates of physicians who treat asthma, and it is very hard to separate the quackery from the truly useful treatments. This provides a "cover" for all physicians who refuse to adopt a comparatively new treatment such as antibiotics for asthma. Dr. Hahn and a number of other physicians using similar methods have been having success with treating some cases of adult onset asthma (and even pediatric asthma) with antibiotics, but yet this is not particularly widely known. It's only a matter of time at this point; this will eventually be proved to work for some asthmatics, and it will be used by many physicians. In the mean time, patients like myself will have to take matters into their own hands in many cases, or continue to suffer. >> The problem I have with all this is that it takes far too much time >> for most MD's to learn new tricks such as this one. > >BS. When a "new trick" comes around that is clearly and convioncingly >shown to be better it is quickly adopted by at least a large number of >docs. I'm convinced, and anyone with direct exposure to this treatment is convinced. But you and most other doctors are too stubborn and egotistical to recognize that the way you are currently treating this subset of asthmatics is completely wrong. >> >I think the part about the consequences of mistakes is closest to the >> >mark. If his theory about sicker patients being more profitable were [quoted text clipped - 13 lines] >the docs decrease their profits in one instance but then refuse to do >so in another. The other treatments (e.g., flu shots, inhaled steroids) are widely accepted, and any physician who does not provide these treatments would likely be accused of malpractice. It will probably take years before antibiotics for asthma is fully accepted at the same level. Until then, no physician will be accused of malpractice for using the current cookie cutter treatments on asthmatics, even when those treatments are totally ineffective. >> Any doctor >> who withholds flu shots or inhaled steroids would be accused of [quoted text clipped - 6 lines] >as an explanation for why they do other things. Either the doc is >concerned about his reputation or not. The concept of "everything is relative" applies. Physician reputations are relative to patient expectations. If patients don't know about or believe in a new treatment, then a physician who successfully applies the new treatment won't necessarily or immediately have a better "reputation" than one who does not. Only in the most extreme or egregious cases will a physician's reputation be an "absolute" or universal thing. It's obvious that a physician who operates on the wrong lung should be investigated and possibly banned, but not obvious that a physician who doesn't keep up with the latest innovations in asthma care should be penalized. >Perhaps you should go back to college and take a logic refresher >course, because you obviously don't have a firm grasp of the [quoted text clipped - 3 lines] >to avoid a treatment that turns a long-term patient into an >ex-patient. In this case ther would be a significant differences that in patient outcomes between doctors. Face it, your rationalization of why doctors do not accept your patent remedy does not hold water. As a result you have to come back to the concept that the vast majority of doctors are not impressed with it. -- There can be no triumph without loss. No victory without suffering. No freedom without sacrifice. > >> Well then, I think that "capitated" HMO doctors should be the first > >> ones in line to start using antibiotics for their severe asthmatics [quoted text clipped - 5 lines] > course, because you obviously don't have a firm grasp of the > difference between SOME and ALL. Now you are back peddling. You state that you can't get docs to prescribe long term antibiotics for asthma and you hypothesize about the reasons. If you only meant to include "some" there would be no problem. You clearly mean all or virtually all. > But you and most other doctors are too stubborn and > egotistical to recognize that the way you are currently treating this > subset of asthmatics is completely wrong. What is clear is that you are a bitter little man in eternal mid-pout over the fact that others do not see things as you do. Statements like the above display your arrogance and intellectual dishonesty (intentional or not). It is also clear that for you these arguments serve the dual purpose of allowing you to vent and providing a continuing forum for you to propound your theories. -- CBI, MD >> >> Well then, I think that "capitated" HMO doctors should be the first >> >> ones in line to start using antibiotics for their severe asthmatics [quoted text clipped - 10 lines] >you only meant to include "some" there would be no problem. You clearly mean >all or virtually all. I would never ascribe a single, specific motivation to ALL members of a large set of people. People are much more complex than that, and not even close to uniform in their attitutes and outlooks. Either you need the logic refresher, or you're simply a demagogue who seeks to distort the positions of others in order to win points in an argument. >> But you and most other doctors are too stubborn and >> egotistical to recognize that the way you are currently treating this [quoted text clipped - 6 lines] >allowing you to vent and providing a continuing forum for you to propound >your theories. I'm not bitter. After all, my asthma is practically gone, and I thank G-d for that. The people who I don't thank are physicians like you, who are too egotistical and have too little common sense to pick up quickly on a treatment that has the capacity to save numerous lives. My objective in posting to this newsgroup has been to add my voice to Jim Quinlan's. Jim Quinlan (http://www.asthmastory.com) has been doing a tremendous public service by publicizing a treatment that most doctors don't mention to their adult-onset severe asthma patients. My asthma is now in remission thanks to Dr. Hahn's research (and other research, I'm sure, as well), and to Jim Quinlan's efforts. > >> >> Well then, I think that "capitated" HMO doctors should be the first > >> >> ones in line to start using antibiotics for their severe asthmatics [quoted text clipped - 18 lines] > seeks to distort the positions of others in order to win points in an > argument. You're fishing (and floundering) The question raised has been if it was so obvious then why aren't docaccepting your theory. First you tried to ascribe it to ignorance but that was shot down in a number of ways. Then you changed your story to say that it is greed. Then we pointed out that that is not likely to be true wither. Now you are waffling around whining that you didn't mean all the docs. The problem is that your initial premeise is that this treatment is virtually unavailable which means that any explanation given must encompass nearly all physicians. Now you are trying to come up with a combination approach but your current (for this moment anyway) explanation; that it is a combination of greed, subconscious factors, fear, ingorance, complacency, inertia, etc.; is only slightly less implausible. Surely, it is not that hard to find a careing well informaed doctor who realizes that helping his (or her) patients is unlikely to get him sued or lead him to bankruptcy. I'm sure if you keep plugging you will come up with an explanation that does not require modification with every round of discussion. Funny how the people that say it is just that the evidence is still to preliminary to widespread use haven't had to change their story. > I'm not bitter. Sure you're not. SignatureCBI, MD >> I would never ascribe a single, specific motivation to ALL members of >> a large set of people. People are much more complex than that, and [quoted text clipped - 8 lines] >The question raised has been if it was so obvious then why aren't >docaccepting your theory. Your lack of humility is simply astonishing. I and the vast majority of severe bacterial asthmatics have received and continue to receive woefully inadequate medical care. The vast majority of doctors employ treatments of this disease which completely ignores the root cause of the disease, and just makes it worse in the long term. An amazingly simple treatment that uses drugs with a low risk profile is simply unavailable to the vast majority of severe bacterial asthmatics. Instead of attempting to "shoot the messenger" in every post, you should be looking within your own character and that of your fellow physicians to try to understand what has gone terribly wrong. Information on antibiotics for asthma has now been readily available for years to those physicians who want to take advantage of it. Yet, most physicians continue to be completely ignorant of it. Is this simply an oversight? Is it the result of narrowminded or egotistical attitudes? Is it because of a serious flaw in the system which puts numerous roadblocks in the way of new research that isn't likely to increase physician revenues? The only thing which is obvious is that, for the sake of severe bacterial asthmatics, this needs to change, and IT NEEDS TO CHANGE SOON. Your demagoguery has the net opposite effect. Dave, People who are reading through this thread will become interested as I become interested reading a similar thread in August of last year. You don't have to continue to refute the statements like : "What is clear is that you are a bitter little man" and "You're fishing (and floundering)." CBI always has to have the last post and regular readers know he is like that. And the resorting to ridicule is another of his trademarks. Don't let people like CBI and Colin who are slow to change bother you. That is what is really happening here. Those of us who have tried it know it works. Our doctors are noticing. I saw my ENT today and he has plans to meet with my others docs about this. >From: "Joy" none@nospam.com >Those of us who have tried it know it works. Our doctors are >noticing. They're noticing, doing the research and then prescribing it in cases they feel are appropriate. After seeing my improvement, my ENT who is the Vice Chairman of Otalaryngology of a large University medical center, is now using it on some of his patients. Likewise, my family practitioner just spoke to Dr. Hahn last week and prescribed Azithromycin for my son because his exercise induced asthma began the fall after he and I had pneumonia. BOTH doctors said the risk of taking this is minimal and BOTH doctors feel patients are more at risk walking around with the unresolved bacteria not only from a constant illness standpoint, but also because of links to other diseases. >> The problem I have with all this is that it takes far too much time >> for most MD's to learn new tricks such as this one. > >BS. When a "new trick" comes around that is clearly and convioncingly >shown to be better it is quickly adopted by at least a large number of >docs. OK, here's a trick that you can try on yourself and perhaps teach to your patients who do breathing exercises. Maybe you already do this, I don't know. Posturally, it's more difficult to breath with your head carried forward or anterior, as when your chin is jutted out in front of you. Many people carry their heads this way, due to sitting at computers and looking down a lot over time, and they don't even know it. Pushing your head backward onto your shoulders (think of making a "double chin"), will allow for a deeper inhalation than when your head is jutted forward. This is especially true when trying to expand your lungs using the inspiratory muscles, and less so with diaphragmatic breathing. It's also more difficult to turn your neck to the right and left with your chin jutted forward, as this increases the tension on the upper back muscles as the head becomes more difficult to support the further forward it translates; but now I'm translating off topic... > OK, here's a trick that you can try on yourself and perhaps teach to > your patients who do breathing exercises. Maybe you already do this, > I don't know. Posturally, it's more difficult to breath with your > head carried forward or anterior, as when your chin is jutted out in > front of you. My high school football coach taught me that : ). It is commonly taught to patients, usually in the setting of an acute attack. -- CBI, MD >Subject: Re: Curbing asthma attacks >From: 00doc@mindspring.com (CBI) >Date: 10/09/03 6:24 PM Eastern Daylight Time >Message-id: > we wouldn't give out flu shots (at a loss) or prescribe inhaled >steroids. This is a new wrinkle for me that Dooctors give flu shots at a loss. Mine charges 22.50 and it take a nurse about three minutes. > >Subject: Re: Curbing asthma attacks > >From: 00doc@mindspring.com (CBI) [quoted text clipped - 7 lines] > give flu shots at a loss. Mine charges > 22.50 and it take a nurse about three minutes. That probably is not at a loss. Things have changed remarkably over the last few yrs. If you go back just a few yrs ago there were three companies marketting a flu vaccine in the US. Presumably due to competition, they were charging only a few dollars a shot and Medicare reimbursed a few dollars above that. By most people's estimates the docs broke even (and by Dave's estimate lost money by preventing illness). The costs drifted up but the Medicare reimbursement didn't and for several years Medicare was barely reimbursing enough to cover the actual cost of the vaccine, which meant that the doc was losing money by giving it (cost of staff time, syringes, storage, etc). If you figure the person giving the shot makes between $10-20 per hour and that it takes about 5 minutes to prepare, give, and document a shot (plus the other small costs) it is easy to see that it costs probably between $1 and $3 to give a dose. A few years ago two of the three vaccine manufacturers decided to stop making it (so much for the vaccines as a cash cow myth). This caused the shortages that we had over the last few years which have finally resolved. Unfortunately, with only one source for the vaccine the cost is now about $15 per dose (plus the costs associated with giving it). Medicare still wants to reimburse about $5. So , finally, faced with losing $10-15 dollars per dose rather than the customary (over much of the 90's) loss of $1-3 per dose most providers have given up trying to submit the bills to insurers and have just started charging cash sufficient to cover the costs (and in your case probably adding a buffer). But the point is that for years doctors were expected by many to give the shot and accept the inadequate reimbursement from the insurers. This is just an example of why Dave's theories on the subject of medical economics and motivations are full of stuff. If they had any merit the docs would not be willing to give the shots even for a small profit and certainly would not give them at a loss. Yet, they did. SignatureCBI, MD >Subject: Re: Curbing asthma attacks >From: 00doc@mindspring.com (CBI) >Date: 10/10/03 2:02 PM Eastern >> This is a new wrinkle for me that Dooctors >> give flu shots at a loss. Mine charges >> 22.50 and it take a nurse about three minutes. Boy I made a bad mistake. That it what they charged me last year and since the e-mail they charged me 33.00 for the vaccine and 11.00 for administring the vaccine for a total of 44.00. > >Subject: Re: Curbing asthma attacks > >From: 00doc@mindspring.com (CBI) [quoted text clipped - 7 lines] > e-mail they charged me 33.00 for the vaccine and 11.00 for administring the > vaccine for a total of 44.00. That certainly sound excessive to me (and like they are trying to turn flu shots into a profit center). I don't think that is the norm and it shows just how much things have changed. In a short period of time giving flu shots has turned from being viewed as a community service to an opportunity for profit. That is a shame. > > >Subject: Re: Curbing asthma attacks > > >From: 00doc@mindspring.com (CBI) [quoted text clipped - 13 lines] > giving flu shots has turned from being viewed as a community service > to an opportunity for profit. Last night I was reading a journal and came across a full page announcement sponsored by several large medical organizations trumpeting the major increase in Medicare reimbursement for flu vaccines. They state that while last yr Medicare's allowance for the shot was $3-something this year it was going up to $9.95. They them went on to say that there would be regional differences and that the average reimbursement would be $7-something. The thing is, as I mentioned in other posts, there is now a single manufacturer so I think I can be fairly assured that not much shopping around is possible and I doubt there will be much regional variation in the costs. The vaccine can be bought for $10 a dose in multiple dose vials (and then you have to provide the syringe etc to give it) or in single dose preloaded syringes for $15 per dose. Again, this ignores the other costs of giving the shot (mostly staff time). I find it comical (really sad) that in this day and age the major medical organizations consider it a victory to ask docs to give the shot at a loss. Some of the old "flu shot as a public service" sentiment still lingers with me so I don't agree with the gouging you took but it is not hard to see why attitudes are changing. Of course, Medicare's recent announcement that all billing must now be submitted electronically followed by their admission that they aren't prepared to handle the influx of new electronic claims resulting in indefinite delays in payment doesn't help much either. They have been helpful in suggesting places to take out loans to bridge the gap (to help finance all those free vaccinations no doubt). -- CBI, MD >Subject: Re: Curbing asthma attacks >From: "CBI" 00_doc@mindspring.com >Date: 10/16/03 7:27 PM Eastern >Some of the old "flu shot as a public service" sentiment still lingers with >me so I don't agree with the gouging you took but it is not hard to see why >attitudes are changing. I could have went to the public health dept. and got the shot for 10.00. This is of course after the fact and my fault for not asking what the shot was going to cost. >>Even doctors on salary benefit from a steady stream of patients. A >>significant drop in business can result in a salary cut or even a job [quoted text clipped - 5 lines] >asthmatics get better - under your theory there should be a difference >in outcomes. My understanding is that severe asthma is one of the medical conditions that makes a person ineligible for military service (at least in the U.S.). Based on this, I would expect that military physicians treat a far smaller population of severe asthmatics than would be found in an equivalent civilian population. Any such physician who is treating comparatively few severe asthmatics would be far less likely to have the reason to even consider antibiotics for asthma. >>In this case, military doctors would show a significant difference in >>patient outcomes (military doctors are staffed to meet wartime [quoted text clipped - 10 lines] >far less likely to have the reason to even consider antibiotics for >asthma. Military doctors do treat asthma. Although pre-existing asthma is a bar to military service there are servicemembers (such as myself) who were diagnosed with 'adult-onset' asthma. In addition there are the family members of servicemembers who are see at the military clinics. -- There can be no triumph without loss. No victory without suffering. No freedom without sacrifice. > >And if your hypothesis were true then you should be able to show a > >difference in patient outcomes between doctors paid a salary (such as [quoted text clipped - 5 lines] > significant drop in business can result in a salary cut or even a job > cut. Oh please. You really are wearing your ignorance on your sleeve. You would do better to stick to misquoting asthma studies. If a doc is capitated in an HMO he gets the same amount every month for being your doctor whether you come in or not. If you come in a lot and he then he fixes the problem you stop comming in and he gets the same amount of money despite doing less work. If you have gone to a bunch of docs that failed to fix the problem previously you become a loyal patient who is not likely to change if avoidable. Now here is the kicker - the doc's salary is determined by how many patients he can take on his panel. That is determined by how many he is willing and able to see and how often they come in. Given a set number patients he can/will see the less often each patient is seen the more patients he can accpet into his panel and the more money he makes. Explain to me how he loses money by curing you again. > >Have you tried using the principle of Occam's razor (the simplest > >explanation is usually correct) for your explanations? Sounds to me [quoted text clipped - 3 lines] > In this case, I think the simplest explanation is that inertia rules, > and economic motivation shouldn't be ignored. No, the simplest answer is that the evidence is not yet conpelling. The answer you give is the one you prefer to believe. SignatureCBI, MD >Oh please. You really are wearing your ignorance on your sleeve. You >would do better to stick to misquoting asthma studies. I have not quoted any details from asthma studies, so for you to accuse me of "misquoting" such studies is a lie. The studies I have seen don't provide proof positive of causality (they are simply not large enough), but they strongly suggest that there really is something to this whole theory that a subset of asthmatics are suffering from chronic infection with C. pn. or mycoplasma. >If a doc is capitated in an HMO he gets the same amount every month >for being your doctor whether you come in or not. If you come in a lot [quoted text clipped - 11 lines] > >Explain to me how he loses money by curing you again. You're right, the capitated physician would make more money (or at least have more free time) if he/she successfully applied antibiotics for asthma. So what is their excuse, then, for not using it? I know - your answer is that the evidence is not compelling. I'm just in awe of how medical training seems to suck all of the common sense and pragmatism out of people. The studies and anecdotes are compelling in my book, even though they are not yet scientifically rigorous. >> >Have you tried using the principle of Occam's razor (the simplest >> >explanation is usually correct) for your explanations? Sounds to me [quoted text clipped - 6 lines] >No, the simplest answer is that the evidence is not yet conpelling. >The answer you give is the one you prefer to believe. The evidence is compelling to me. I have witnessed the spectacular effectiveness of this treatment first hand. So has Jim Quinlan, so has MSCEO, and others. The really unfortunate fact is that the numbers of us are small simply because this treatment is not yet widely available from physicians, and completion of large studies is probably years away. It's really a chicken & egg scenario - the successes in large numbers cannot come until the treatment is widely available, and that won't happen until either the majority of MD's change their close-minded way of thinking, or the multi-year studies (which may not have even begun) are completed. > >Oh please. You really are wearing your ignorance on your sleeve. You > >would do better to stick to misquoting asthma studies. > > I have not quoted any details from asthma studies, so for you to > accuse me of "misquoting" such studies is a lie. I don't think so. I think enough has been said on this topic to let everyone make up their own minds. > >Explain to me how he loses money by curing you again. > > You're right, the capitated physician would make more money (or at > least have more free time) if he/she successfully applied antibiotics > for asthma. So what is their excuse, then, for not using it? They are not convinced. > I know > - your answer is that the evidence is not compelling. I'm just in awe > of how medical training seems to suck all of the common sense and > pragmatism out of people. The studies and anecdotes are compelling in > my book, even though they are not yet scientifically rigorous. You obviously have just not been around the block enough times with this. To you it is new and amazing. To most experienced docs it is more like, "Oh, another interesting theory (and chances are not even the first one he read about that day), it will be great if it pans out." Once you have seen a few promising new theories come and go you get a little less quick to jump on band wagons. SignatureCBI, MD >> I know >> - your answer is that the evidence is not compelling. I'm just in awe [quoted text clipped - 10 lines] >Once you have seen a few promising new theories come and go you get a >little less quick to jump on band wagons. I've been around the block far too many times, with my own asthma. If a physician cannot or will not pay attention to such a promising new treatment, then he/she should refer out the severe asthmatic patient who might benefit from it to a specialist who will consider it with an open mind. > >> I know > >> - your answer is that the evidence is not compelling. I'm just in awe [quoted text clipped - 16 lines] > who might benefit from it to a specialist who will consider it with an > open mind. I guess there is some conspiracy stuff going on but CBI's reluctance to give his blessing to a new treatment is not a direct part of it. Many docs seem to equate asthma and its treatment with diabetes and diabetes treatment. This is part of their professional identity and they are bitterly offended even to hear that the cause of asthma (unlike the cause of diabetes) is unknown or to hear that a scenario where drugs are used and produce an effect does not logically exclude its being iatrogenic (doctor-caused). This would imply that they do not recognize a circular argument when they hear it. They mount their high horses and write off the objector as mentally disturbed and do not hesitate to use all sorts of tricks to dumfound him and make him feel ashamed. After all, why should a patient have any insights at all? The doc knows best. Catch 22 is being revisited where nothing is sacred. If a pilot has to bail out he may find that his parachute is missing and has been sold to make nylon garments. In short, people should pay more attention to Carl Sagan and see that science is stringently applied. I do hope that Internet discussions may prove to emancipate patients. They will realize that they have constructive insights as well as certain standard illusions, where the doc really does know best. Richard Friedel >> I've been around the block far too many times, with my own asthma. If >> a physician cannot or will not pay attention to such a promising new [quoted text clipped - 4 lines] >I guess there is some conspiracy stuff going on but CBI's reluctance to >give his blessing to a new treatment is not a direct part of it. The problem with lack of availability of this treatment (which has put my severe asthma right into remission) is that the majority of MD's either don't know about it, don't believe it works, or just plain don't care because they think that they know everything and the patient knows nothing. It's even possible that SOME of these physicians will put business/financial considerations ahead of the health of their patients. (SOME is emphasized for those unnamed persons who seem to have SOME trouble ALL of the time differentiating between SOME and ALL. :) CBI is but one physician. As such, he is a small part of the problem (a single cog in a big machine), but nonetheless representative of the problem. >Many docs seem to equate asthma and its treatment with diabetes and >diabetes treatment. This is part of their professional identity and they [quoted text clipped - 6 lines] >all sorts of tricks to dumfound him and make him feel ashamed. After >all, why should a patient have any insights at all? The doc knows best. In this case, the doc doesn't know best, but he's such a narcissist that he thinks that he does. On this very day, some number of patients with asthma just like mine was will visit their doctors. Very few of these patients will find out about something that could help them a great deal. Instead, their doctors will put them on oral steroids, increase their inhaled steroids dosage, or try some other medication like Atrovent. For bacterial asthma, all of these things are futile. >I do hope that Internet discussions may prove to emancipate patients. >They will realize that they have constructive insights as well as >certain standard illusions, where the doc really does know best. Richard >Friedel Vive la Internet !! Perhaps if enough of us make a stink about it, things will change for the better. >The problem with lack of availability of this treatment (which has put >my severe asthma right into remission) is that the majority of MD's [quoted text clipped - 5 lines] >persons who seem to have SOME trouble ALL of the time differentiating >between SOME and ALL. :) The problem here is that you seem to refuse to accept the fact that there are issues with your remedy that require more research. And based on how poorly you presented your case here - I am not surprised that your doctors do not take you seriously. -- There can be no triumph without loss. No victory without suffering. No freedom without sacrifice. here is that you seem to refuse to accept the fact that > there are issues with your remedy that require more research. And > based on how poorly you presented your case here - I am not surprised > that your doctors do not take you seriously. Which doctors are those? The ones who don't know about it? Or the ones who refuse to try it? Give me an example of a doctor who has tried antibiotics for the 3 to 6 month period who is no longer using the regime. I can give you the names of several doctors who have tried it and are continuing to use it. Let's see how many names you can produce. > Many docs seem to equate asthma and its treatment with diabetes and > diabetes treatment. This is part of their professional identity and they > are bitterly offended even to hear that the cause of asthma (unlike the > cause of diabetes) is unknown You know the cause of diabetes? Do tell!!!! -- CBI, MD > > Many docs seem to equate asthma and its treatment with diabetes and > > diabetes treatment. This is part of their professional identity and they [quoted text clipped - 7 lines] > -- > CBI, MD I wasn't thinking of you as one of the "many docs". You are not using "cause" in quite the same sense, are you? > > You know the cause of diabetes? > > I wasn't thinking of you as one of the "many docs". You are not using > "cause" in quite the same sense, are you? I think we are. When you claim that the causes of other medical conditions are known but that of asthma isn't it is you who is using different standards. One can always look at the state of our knowledge in any condition and say, "...and what comes before that?" in order to claim we don't know "the" cause. SignatureCBI, MD > > > You know the cause of diabetes? > > [quoted text clipped - 9 lines] > -- > CBI, MD A Google search with "cause of asthma" known OR unknown shows that the cause is held not to be known. It is only a working hypothesis that inflammation is the cause. 'stead of diabetes let's opt for an infectious disease like TB or leprosy caused by a microorganism (Mycobacterium leprae). >Subject: Re: Curbing asthma attacks >From: 00doc@mindspring.com (CBI) >Date: 10/10/03 2:26 PM Eastern Daylight Time >Message-id: >I don't think so. I think enough has been said on this topic to let >everyone make up their own minds After about 100 e-mails I certainly agree with you on this point.it's a no win situation. > In the U.S., MD average pay is well above that of most other > professions. Yes, there are other ways of becoming "rich", but I > wouldn't characterize them as "easier" or more surefire. You fail to take into account the length and cost of trianing. Sure, the average doc may make a higher annual salary than the average lawyer or businessman but he won't start doing it until nearly a decade later. During his time of not making any or much money his loans are rolling on. Financial analyses have been done taking into account all of these factors and more and found that law and business, over the course of a carreer, are more lucrative. But wait, it gets worse. Since it is much harder to get into medical school than law school or business school it is fair to say that the average doctor would have had a better than average chance at being a better than average lawyer or buisinessman. Finally, what price do you put on being nearly a decade delayed in getting on with your life- marriage, kids, houses, etc? > Here's > another way of looking at it. Much of a physician's training falls > within the scientific/technical realm, and most other > scientific/technical careers don't have nearly as high average > earnings. Yes, but if the theory is that greed is the motivator then one must assume that the person will go where the money is when choosing training and a career. > Greed is a basic human motivator, and all the more likely so for those > who pick professions that are high paying. Cerainly, there are greedy people in every field. But greed is less likely to be a motivator in fields where the occupants could be making mor emoney elsewhere (like in medicine and teaching). > >Scepticism is part of the foundation of modern scientific thought. > >The concept is that a hypothesis is 'wrong' until demonstrated > >otherwise. Experiments are then conducted to determine if the > >hypothesis is in fact correct. > > I am that experiment. No one every accepts a theory after just one or a few experimental trials. SignatureCBI, MD >You fail to take into account the length and cost of trianing. Sure, >the average doc may make a higher annual salary than the average [quoted text clipped - 3 lines] >account all of these factors and more and found that law and business, >over the course of a carreer, are more lucrative. Yet another specious argument. The skill sets in medicine, and those in law or business don't have a huge overlap. Yes, there are multi-talented people who basically can do anything really well, but I contend that these would be in the minority of physicians. Medicine is for the most part a scientific/technical specialty, and one of the best paying among these. I also am quite familiar with the economic arguments against lengthy training. An undergrad engineering professor of mine made a presentation arguing that an engineering Masters degree was cost-effective, but a PhD was not. Here, the argument was that the salary boost resulting from a PhD (over a Masters) would not make up for the additional years making little or nothing while in school. Sounds familiar? First of all, the average physician makes LOTS more than the average PhD engineer working for a salary in industry. Second of all, as I pointed out in the previous paragraph, the skill set for medicine is quite different from law/business. >But wait, it gets worse. Since it is much harder to get into medical >school than law school or business school it is fair to say that the >average doctor would have had a better than average chance at being a >better than average lawyer or buisinessman. Again, the skill sets don't necessarily overlap. A good doctor doesn't necessarily make for a star lawyer or business person. I went to undergrad school with a number of people who went on to become physicians, and the honest fact is that many of the engineers I work with are smarter and more talented than those people. >Finally, what price do you put on being nearly a decade delayed in >getting on with your life- marriage, kids, houses, etc? Obviously, most doctors didn't put much of a price on this. If they had, they would have chosen different careers. > >You fail to take into account the length and cost of trianing. Sure, > >the average doc may make a higher annual salary than the average [quoted text clipped - 6 lines] > Yet another specious argument. The skill sets in medicine, and those > in law or business don't have a huge overlap. At the time the student is selecting a carreer the skills have a huge amount of overlap. A good student will be able to pick whatever he wants and do well at it. I would submit that nearly all medical school students, barring some kind of language deficiency, could have gotten into and done well in business or law school. > I also am quite familiar with the economic arguments against lengthy > training. An undergrad engineering professor of mine made a > presentation arguing that an engineering Masters degree was > cost-effective, but a PhD was not. Right - a JD requires about 2 yrs after undergrad training - similar to a masters. To practice medicine most docs go through 7-12 years of training after undergrad, more than most PhD's. Here, the argument was that the > salary boost resulting from a PhD (over a Masters) would not make up > for the additional years making little or nothing while in school. > Sounds familiar? First of all, the average physician makes LOTS more > than the average PhD engineer working for a salary in industry. But not lots more than many lawyers, especially when one considers that most medical students grades would have landed them in better than average law schools. In addition, if the students worked as hard for their now law firms as the medical students worked in med school and residency they would have likelty done well and made partner. > >Finally, what price do you put on being nearly a decade delayed in > >getting on with your life- marriage, kids, houses, etc? > > Obviously, most doctors didn't put much of a price on this. If they > had, they would have chosen different careers. Or they put a normal price on it put valued being a doctor higher (not just making money). SignatureCBI, MD >> Yet another specious argument. The skill sets in medicine, and those >> in law or business don't have a huge overlap. [quoted text clipped - 4 lines] >students, barring some kind of language deficiency, could have gotten >into and done well in business or law school. Getting into law school or business school is far from what it takes to be highly successful in either field. The scientific/technical skills which are the main ones required for medicine are quite far from the skills required to be successful in law or business. >Here, the argument was that the >> salary boost resulting from a PhD (over a Masters) would not make up [quoted text clipped - 7 lines] >for their now law firms as the medical students worked in med school >and residency they would have likelty done well and made partner. If working like a dog is all it takes to make partner in a law firm, then I know a few donkeys and oxen that could make it with no problem. >> >Finally, what price do you put on being nearly a decade delayed in >> >getting on with your life- marriage, kids, houses, etc? [quoted text clipped - 4 lines] >Or they put a normal price on it put valued being a doctor higher (not >just making money). I would like to think that most doctors go into medicine based on altruistic thinking, i.e. to help people. But the real world is much more complex than that, and it's only human nature that many people go into it at least partially for the money, and for the status and ego gratification involved. If altruism were the main reason that most people went into medicine, then I would expect that most physicians would be much more open-minded to such a promising treatment as the one we have been discussing. > If altruism were the main reason that most people went into medicine, > then I would expect that most physicians would be much more > open-minded to such a promising treatment as the one we have been > discussing. Alternatively, altruism is what makes them want to be sure if what they are doing before they do it. -- CBI, MD "And we must take our own biases into account when making assumptions about other people." Well spoken Mr. Campbell > >> Furthermore of course some success > >> with overcoming attacks without drugs would divert funds to [quoted text clipped - 7 lines] > for some/many MD's, and anything that would make asthma patients more > self-sufficient threatens to take a chunk out of that revenue stream. What could possibly be better for a doctor's bottom line than becoming known as someone who is especially good at treating an illness? What could be worse than being known as someone who is especially bad at it? You act like doctor's don't have reputations and people never change them. -- CBI, MD >> I contend that many "docs" do care whether the money goes to >> themselves or not. Chronic asthma is a significant revenue producer [quoted text clipped - 3 lines] >What could possibly be better for a doctor's bottom line than becoming known >as someone who is especially good at treating an illness? In a perfect world where there was a very efficient flow of information to patients about new and superior medical treatments, this would be true. In the real world, we have the situation where very few asthma patients have the slightest idea as to Dr. Hahn's contributions, and certainly have no idea that they themselves might benefit if this treatment were more widely available. (BTW, Jim Quinlan is doing a great job in trying to change this with his asthmastory.com web site.) |
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