Thursday, December 27, 2007


If you are a doctor, or a person with cancer, this insider's view of cancer is a must read. Sometimes I forget to realize that people with illnesses are people, too

A sad day in Pakistan

I don't know much about politics. But I do know that I am very sad that the former Prime Minister of Pakistan, Benazir Bhutto, has been assassinated. I'm glad I live in a country where opposition party leaders do not get killed.

by the way, I'm sure this does not bode well for our boys in Iraq and Afghanistan.

Tuesday, December 25, 2007

17 year old with Leukemia denied payment for treatment

So many issues to bring up, where to start?

1. She had a 65% chance of living 6 months with the transplant. Does that make the transplant mandatory? What if there was another possible recipient with a greater chance of living longer and healthier? 2 out of 3 people live 6 months- I would not take those odds for me, I would for my kids.

2. Everyone is saying the insurance company should pay for every transplant. I think that these should be made on a case by case basis, with some basic criteria as a baseline. Those transplants ain't cheap, and the after care is not easy on the recipient. Remember, a bone marrow transplant from her brother caused the liver failure.

3. CIGNA did not kill the girl, leukemia and liver failure did. Cigna had nothing to do with the leukemia and liver failure.

4. One newspaper editorial said that if a doctor says a procedure is OK, then it should be covered by the insurance company. I appreciate the vote of confidence, but you don't want me to have absolute power to order treatments for you. There is too much new information with new treatments with new benefits and new side effect to just let me run amok. Most doctors, like most people in general, will chose the treatment that pays the doctor best. The pendulum has swung too far in the insurance companies' favor, but physicians still need that check to our authority.

5. The payment for the transplant was refused on December 11th. The family could have given an OK, then sought media attention to pay for it (it probably costs more than a million dollars, so it's not easy to pay for). To say the insurance company stopped the transplant is false- CIGNA decided not to pay for it. When your insurance refuses to pay for your MRI, you can still get one, you just have to pay for it.

6. What was the girl's condition at the time the transplant was denied? Was she in a coma at that time? Why isn't that part of the media story?

7. It's so sad when a kid dies. I hope the family an come to terms with the fact that she died amidst all of the legal battles.

Merry Christmas!!!

May you have peace and joy during the Holiday Season. And for a couple more months, too.

Sunday, December 23, 2007

Immigration and business

This is the best article on immigration issues I've read. It points out all of the relevant issues concisely, and without emotion.

"Meaningless" Bowl games

I am the last person in America who likes the bowls. All of them. I like the fact that Florida Atlantic, BYU, and New Mexico all finished their seasons with a post-season win. But this post is specifically about one of those games.

The Pioneer Las Vegas Bowl pitted a disappointing UCLA team that had just fired their coach ad was using their 4th string QB against BYU- who happened to be on a 9 game winning streak. Both teams played with the sort of intensity you see when my 2 year old wants THAT COOKIE. Guys were making diving catches, big time tackles, and occasional brain farts. BYU's captain got hurt in the first half, came back in, and got hurt again. He waved to the crowd to say thank you for their cheering in a classy move. Several UCLA players also played valiantly with injuries. It was a hard fought, well played drama. UCLA had a chance to win if they could kick a field goal at the end. They drove from their 2 yard line to the BYU 10. On the last play- UCLA's kicker- who had made 2 50 yard field goals, lined up for a 30 yard chip shot.

And it was blocked!

The BYU players that got to the kick put up the ind of Herculean effort you see in an action movie. The BYU players ran out on the field, jumping and hugging. UCLA's captain cried like he lost a national championship. For a meaningless bowl- it sure was great theater and meaningful.

Long live the Bowls!!!

Primary care issues- can we survive

The article above is about a private practice that is trying to improve business practices without compromising patient care. What I find interesting is the idea that PCP's should see 30-35 patients a day. It's do-able, but not preferable. Patients want more time from their doctors. Doctors need to see more patients as reimbursement per patient is decreasing. The current practice models are not sustainable in the long-term unless all of us join large groups.

Meanwhile, concierge practices see 10-15 people per day and make more money- without having to deal with insurance hassles. More money per patient and fewer patients calling after hours. It sounds great for me, but I can't say the same thing for the general public (especially the general public in the lower 75% income group). As someone with a struggling new practice, I have to choose between the bird in the hand (low reimbursement insurance covered patients- of whom there are many) and the bird in the bush (a concierge practice- where I have to hope that there are at least 250 families willing to give me $2,500 per family to care for them). I definitely need to phrase it as $200 per month.

But with practices going out of business and large group practices being slow to move into some of the new suburbs, the general public is beginning to lose access to health care services due to a lack of PCP's. This is a problem for both the poor and the middle class. I don't have a solution that is workable, I'm just saying this is an unrecognized problem.

Another aticle addressing the practice of primary care medicine. I can't add anything to this except to say, "yep, he's right".

And finally, the most comprehensive blog post I found on the subject.

Thursday, December 20, 2007


Great game. Just unreal. It felt like a conference tournament game. It went back and forth and into overtime. The game was at Madison Square Garden in NY- meaning you had a smart, basketball savvy crowd. You had Duke alum Jay Bilas calling the game- even admitting some of the charge fouls against Pitt were "close". That's code for "crap". Duke got out to a big lead, Pitt fought its way back in it, and prevaied in OT. A few thoughts:

1. Last year, Duke coach Mike Krzyzewski did not seem focused. The team was not prepared for games, missed free throws, and seemed to run around randomly instead of usig set plays late in close games. Since last summer's FIBA tournament, where Coach K coached NBA stars, he seems refreshed and has his fire back. And his team ran plays that worked. Of course, at the end of OT with no timeouts, his team ran around like headless chickens, but the other 45 minutes they looked prepared to win. Next time, coach, prepare your team for the possibility that they may be down 2 with 4 seconds left and no timeouts. It's happened before.

2. Duke just hustles.

3. So does Pitt.

4. Before I die, I want to see a basketball game Madison Square Garden.

5. Both of these teams can beat the Knicks.

6. Pitt coach Jamie Dixon had his team well prepared, made good adjustments in the second half, and kept his team focused after a player suffered a serious injury. He is good at all of the aspects of college coaching (recruiting, season planning, game planning, in game adjustments, play calling, keeping the team focused, and dealing with adversity). I know he has not had much success in the NCAA tournament, but it's just a matter of time.

7. Last year, Duke's point guard Greg Paulus was an overrated crybaby. Now, he's a good floor leader and a solid player who may get to cut down a net at the end of the big dance.

8. College refs reward flopping, especially by Duke.

9. Pitt rhymes with "legit". Seems appropriate.

10. You know it was a good game when my 5 year old did not want to go to bed- and immediately fell asleep once the buzzer sounded

Saturday at 11- Georgetown at Memphis. Somewhere Michael Graham and Ralph Dalton (GU alums) will be placing a bet with Andre (the Little General) Turner and Baskerville Holmes (former Memphis players).

The NBA is back

In case you haven't noticed, the NBA has gotten a lot better over the last few years. Yesterday had 4 good close games- Houston/Orlando (Yao vs. Dwight Howard), San Antonio/Memphis (Rudy Gay's coming out party- no pun intended), Dallas/Phoenix (the 2 most recent MVP's going at it for conference supremacy in the West), and Boston/Detroit (Mr. Big Shot- and former Celtic- Chauncey Billups comes up big AGAIN in Boston over the BIG 3). I mean, did you catch any of that? You better.

First, the local game. Yao and T-Mac have done so much for the community. they do all kinds of fund raisers, open up new businesses, and travel the world to help the poor and down-trodden (T-Mac went into Darfur to help bring attention to the genocide there. But these 2 admirable men have not led Houston to a playoff series victory. So the locals are disgruntled. Last night we got a visit from the Magic. Orlando's big man- 20 year old Dwight Howard, is proof that evolution is still occuring in a positive manner. Their new $126 million forward Rashard Lewis (a former local HS player who skipped college) was also on display. The Magic won, the Rockets and their fans keep grumbling.

And that Boston/Detroit game. Playoff level intensity, clutch shots, good throwback uni's. i can't discuss this rationally....just bleeping great. Did I mention 'Sheed vs. KG? Or RIp Hamilton going toe to toe with the Truth (Paul Pierce).

Wow. And tonight has college ball with Pitt/Duke and Bowl season starts. I feel like John and Jeremy in Wedding Crashers at the start of wedding season. Baba Ghanoush!!

Wednesday, December 19, 2007

Local Doc's Medical Advice #1

If you're reading this, you officially qualify as easily entertained. Or just bored. So, to make it worth your time, here's some advice:

Get life insurance.

Seriously. I try real hard with the doctoring thing, but if you're my patient, you're going to die. Ditto with every other doctor. If you use a chiropractor, naturopath, accupuncturist, hypnotist, or Psychic friend, you're still mortal. Assuming that you have any family, and they depend on you for financial support, you will want to make sure to provide for them in case you pass away early. I know it can't happen to you, but since it happens to other people, pretend it can happen to you.

Sunday, December 16, 2007


Why are football coaches vermin if they break a contract early, but owners and college administrators are OK if they fire the coaches?

Why do fans get upset at players who change teams for more money when fans change jobs for...more money?

Why are steroids in baseball more horrible than steroids in football?

Why are people upset about Medicaid not covering people, when what they pay doctors and hospitals is so low that most of us try to avoid Medicaid to stay in business?

Why don't comedies win Academy Awards?

Why is negativity easier than positivity?

Why is it so hard to string 3 decent sentences together?

Why is the NBA suddenly so much better than it was 10 years ago? (answer- more foreign players)

Why is the presidential campaign 2 years long?

Why is a beautiful woman a snob if she doesn't talk to every dork that comes along?

Why do people kill people in the name of a benevolent God?

Why does beer smell so much better than it tastes?

Why not?

Christmas Party

My wife and I just pulled off our 3rd Annual Christmas Party- in our kids' names of course. It was epic in scale and grandeur. A good comparison would be the party that accompanied the Fall of the Berlin Wall. Except we had Santa Claus instead of David Hasselhoff. If you don't have kids, you don't want the oh so cute details. If you do have kids, you don't want the gory details. Let's just say that 28 kids from 11 months to 11 years old attended , and sugar cookies were heavily involved. At one point we had 2 craft stations going while kids played stik the nose on the clown (you don't want pin the tail on the donkey with 2 and 3 year olds- real pins, real pin holes).

I can still hear the noise. It's echoing in the family room. It's sitting in the kitchen. And lingering in the playroom.

It's like all that laughter is embedded in the walls.

Friday, December 14, 2007

So wrong, so funny

No comment

The Mitchell Report

More input from the Mitchell steroids report. It's mostly the same dreck, but there are some interesting viewpoints.

Curt Schilling, Red Sox pitcher:

Thank goodness, a congressional hearing:

And the President speaks out:

Typical sports talk drivel:

And the denials begin:

And when will the NFL Mitchell report come out. No one is suggesting the Carolina Panthers get an asterix after most of their O-line (and punter) were caught buying 'roids.

Thursday, December 13, 2007

Do as I say....

State Rep. Harold Dutton represents 3rd Ward, a historically Black neighborhood that contains Texas Southern University. TSU has had a LOT of financial trouble through the years. So has Mr. Dutton:

Now that's entertainment.

Meanwhile the Mitchell steroid report has been issued. Thank goodness! I'm glad the whole steroid era is over and we can get on with our lives. I think the real winners in this episode are:
1. The children, who all athletes and politicians seem to represent
2. the Lawyers, who represent the politicians and the athletes and collect fees.

Wednesday, December 12, 2007

Love thy neighbor...

A local man shot and killed 2 people who broke into his neighbor's home. He called 911 and told the operator he was going to shoot the robbers. A plain clothes policeman was in the area, but he did not identify himself and witnessed the shooting.

Now everyone in Houston is upset about this incident. Some folks are mad that the neighbor may face murder charges, others are mad because he may not face murder charges. I just have a few thoughts/questions:

1. If you can shoot people who break into neighbor's homes, how far away is someone's house to call them a neighbor?
2. Would people get upset if the neighbor missed and hit an innocent bystander?
3. Why do local minority activists rally around criminals shot by white people, but not criminals/innocent people shot by minorities?

I'm in favor of a full investigation by a state or federal internal affairs office (the municipality n question has a poor history regarding police work in general). If the neighbor broke the law, he should have his day in court. In general, we shouldn't shoot people unless our lives are in jeopardy. The risk of hitting an innocent bystander increase when untrained persons are shooting at moving targets when they are nervous or in an excited state.

I'm back