HWR posted at InsureBlog | NWS begins hibernation

Check out Hank Stern’s quality round-up of the fortnight’s best health policy bloggery here.

Of course, now that “spring hath sprung,” it is time for me to begin the hibernation alluded to earlier. Hopefully I will be able to write new posts beginning in late-June, and (fingers crossed) being able to focus on one thing at a time during third-year will allow me to have more frequent updates in the latter half of 2012.

Quick meta update

As with last year’s convention I have been keeping detailed notes with which to inform you, my valued readers, as to what exactly happens when the largest organization of American medical students gets together.

Unlike last year, I won’t be able to post daily updates, at least not tonight. This is in part because of some special insider information that would be imprudent to blog about before Sunday. This may or may not also be because of certain social events featuring a mechanical bull.

Hey, even I have to have some fun at some point!

So updates will come… have no fear. For those who need updates in as close to real time as possible, this is your excuse to follow me on Twitter.

It’s an AMSA Rodeo, and you’re invited!

Upon arriving to Houston for the 2012 AMSA convention and learning that there is, in fact, a straight-up rodeo in town, my first thoughts turned to the concept of rodeo clowns, and then to clowns more generally.

Harsh? Perhaps. This is, however, the organization of medical students that:

 

• Denounce drug companies and urge physicians and medical schools to cut ties with them, while allowing drug and device companies to buy exhibitors’ booths to reach our innocent medical student eyeballs;
• Advocates for changes in policy on issues from healthcare reform to resident work-hours based mainly on emotive appeals, and whose policy “leaders” don’t seem to have the best sense of the subject matter they’re lobbying about, and;
• Unabashedly supports quacks and quackery… practices that are harmful to patients, and not in keeping with the professional and scientific heritage of the medical profession that their members will soon join.

Sounds a bit clownish to me. That’s what makes it fun to watch. So for the second year in a row, your intrepid blogger will brave the ghastly Houston weather (and jet lag!) and suffer the slings and arrows of those conference attendees who can’t bear disagreement.

Follow my postings to this blog and to Twitter (under the #amsaconv12 hashtag) to get a bug’s-eye view of the goings-on at the 2012 annual convention of the country’s largest association of medical students.

Mea Culpa

As exams and extra-curriculars piled up, a planned two-week hiatus became one month became a month and a half. I need to get better at predicting these long-ish term absences from blogging.

That said, rumours of my permanent e-demise (if they exist) have been greatly exaggerated. Nothing like upcoming finals to drive a medical student to blogging; what a better way to avoid studying?

And yes, to answer the question that inevitably arises with that last sentence, I will be a doctor one day.

More to come shortly.

AMSA Follies: Technical Difficulties

Transportation delays, long flights, computer issues, and post-convention exams are conspiring to keep my Saturday updates off the internet for another day or so. Saturday was full of interesting health policy talks with speakers from the AAFP, Cato Institute, and PNHP, so I will definitely get those dispatches up post-haste.

The convention as a whole was intense and a lot of fun. It was definitely great to see a lot of people brought to this site by the AMSA coverage. I would encourage those first-time visitors to stick around for more. I can’t promise you’ll agree with everything you see here (I could probably promise the opposite for most of you), but I think you’ll find it thought-provoking and worthwhile.

Now… how long until AMSA 2012?

 

AMSA Follies: The Duck Pond

Q: What’s bipedal, featherless, and quacks like a duck?

A: The quacks representatives of the Association of Accredited Naturopathic Medical Colleges.

That’s right… AMSA sold them a booth at the 2011 convention, to say nothing of the smattering of naturopathic students in attendance as participants.

AMSA won’t quite take pharm money (more on that tomorrow), but they have no problem selling out to pseudoscience (that term is far too generous).

I went up to the booth and feigned ignorance as to what naturopathy is. I was told that they are “primary care physicians” who treat the “whole patient in a holistic way.” I pushed harder and harder, and for the longest time they continued to maintain that they’re “just like MD physicians.” Finally, one of their reps cracked, and poured forth the litany of quackery to which they subscribe: homeopathy, herbalism, acupuncture, therapeutic touch, and all sorts of other nonsense.

Fortunately, their written materials were more straightforward about their quackishness, though there were also some materials to recruit MD students for “integrative medicine” training at “Bastyr University“ in the Pacific Northwest (of course). Too bad they’re competing with AMSA’s own summer pseudoscience academy, whose flyers I also picked up.

For an organization that professes to support evidence-based medicine in other realms, and that ostensibly represents those students who are training to become applied scientists, this is really sad. The political gripes I might have with AMSA are one thing, but legitimizing quackery of this sort is truly beyond the pale. A poll of an unrepresentative convenience sample indicated that this is a non-partisan issue. “Open-mindedness” and “tolerance” are great, but when it comes to practices that don’t work, that mislead patients and that cast a pall on scientific medicine, organized medicine (AMSA included!) shouldn’t hesitate to take a stand.

If AMSA could be a forceful voice against pseudoscience much as they are a forceful voice for a variety of health policies with much less evidentiary support, they would be doing medicine, science, and patients a great service indeed.

***

I almost forgot, at the other end of the exhibition hall was the ayurvedic quack booth. I hope these pictures speak for themselves.

 

 

 

 

 

AMSA Follies: The (In)Famous Patch Adams

The keynote speaker at AMSA 2011 was Patch Adams accompanied by a sidekick/collaborator of some sort, Susan Parenti. Only knowing of Patch Adams from the Robin Williams cinematic depiction so many years ago, I didn’t quite know what to expect. In lieu of extended [commentary], I present to you here the highlights:

Dr. Parenti:

• The 3% of the country who own 97% of the assets think that health insurance is a market in which to make money. The horrors! [capitalism is morally repugnant? not the most nuanced argument]
• The Gesundheit Institute [Patch Adams’ facility] has never carried malpractice insurance and has never been sued. [Am I alone in thinking that there might be a causal relationship].
• The Gesundheit Institute is open to all sorts of “medicine:” homeopathy, naturopathy, ayurveda, reiki, and a few others I’ve never heard of.

Dr. Adams

• “Depression is not a mental illness. It is a pharmaceutical company diagnosis. Depression is simply a symptom of loneliness.”
• One of the scariest phrases in the world: “AMSA could lead the way on…”

Inspiration is easily muted by unrelated fringe beliefs. Would that the audience have been more critical.

AMSA Follies: Rent-Seeking, Ignorance, and Close Calls

Today was “Advocacy Day” at the 2011 AMSA Convention. Three hundred medical students descended on the Hill to push AMSA’s talking points on various pieces of legislation. There’s a Sparta joke in there somewhere.

We started off with a talk from Dr. Atul Grover, the “Chief Advocacy Officer” for the Association of American Medical Colleges (AAMC). His description of the AAMC’s recent lobbying efforts were a stark reminder that regardless of what one might think of the cause, there is something very, very ugly about rent-seeking… and medical schools do lots of it.

“Highlights” from Dr. Grover:

• “Democrats go out and buy banned books and read them individually. Republicans form censorship committees, read them as a group, and then maybe burn them.” I know the Republicans probably don’t feel any great affinity for the AAMC, but even this strikes me as a bit much from the guy whose job it is to make nice with them.
• In the coming weeks, over 100 AAMC member schools and hospitals will commit to a major patient safety and quality initiative, including curricular changes at medical schools, and universal usage of pre-operative checklists and central line checklists in ICUs. You heard it here first!
• The AAMC is also planning an initiative on inter-professional collaboration together with schools of nursing, osteopathy, and pharmacy [no word on the quacks naturopaths]. While the education-oriented professional organizations are on board, there has been some resistance from other professional organizations representing these groups. And people wonder why medicine never seems to speak with a coherent voice.

From there, we moved to “issue training.” Foolishly/fortuitously, I was assigned to lobby for “Health Care For All.” Lucky AMSA… not only did they not have to pay the~300 white-coat-clad medical students to go out and parrot their talking points for them, we actually paid them conference fees! Yet parrots we were expected to be. The sheets with talking points were passed around, and the presentation about the pending legislation we were to discuss with our Senators and Representatives was given.

Of course, when the medical student audience has little knowledge of the policy issues, it’s easy for them to be told what to think, that they might do AMSA’s bidding.

The presentation was an exercise in entertaining ignorance… an appraisal shared even by the liberal (but informed) students sitting near me. Frighteningly, the presentation was given by AMSA’s senior people on advocacy/policy issues. To wit:

• They uncritically parroted the controversial assertion that lack of insurance is responsible for tens of thousands of excess deaths per year.
• They still cling to the absurd notion that more than 2/3 of bankruptcies are caused by inadequate health insurance.
• They believe that “single-payer” = “universal coverage,” and that all OECD countries except the US have single-payer health systems.

The lobbying itself was interesting. Myself and a partner from the same part of the country met with legislative aides for our Senator and Representative. For the first, we made a good faith effort to parrot the AMSA line (hey, why not?). After seeing the futility of a conversation in which we both disagreed not only with what the aide was saying but with what we were saying, we changed our tune ever-so-slightly for the second. It was fun.

My belief that AMSA is an organization that shouldn’t be taken seriously by policymakers is growing more and more…

Live from AMSA 2011…

The American Medical Students’ Association (AMSA) is one of the many professional (or in this case, pre-professional) organizations that represents various slices of the medical community. Of these, they are by far the biggest embarrassment to the medical community that I have encountered. Not just because they take positions with which I wildly disagree — that would be entirely acceptable. Rather, because they base their support for their policy positions on nothing more substantive than vague generalities and pleasant-sounding buzzwords and phrases.

Of course, this means that when the SUMS AMSA chapter sent out a call for students interested in attending AMSA’s 2011 annual conference in Washington DC, I pounced.

So here I am, braving the (acute) rainy weather and the (chronic) oppressive sterility of DC and its suburbs to bring you, my loyal readers, the latest and greatest updates from what is already promising to be a most entertaining boondoggle.

A sampling of macro-level AMSA Follies that pre-date the conference:

• AMSA believes strongly in left-wing solutions to healthcare, and are particular fans of single-payer. Nothing wrong with that, disagree though I might. Of course, that their senior advocacy and policy staff regularly confuse “single-payer” and “universal coverage” could lead one to believe that they don’t have the intellectual backing for the talk they’re talking. Most of their stated rationale consists of the usual empty mom-and-apple-pie rhetoric that one expects from a campaigning politician, not a group that expects to be taken seriously on the policy issues.
• AMSA is a big pusher of the pharm-free movement, releasing an annual scorecard comparing medical schools’ policies on physician-pharm conflicts of interest. There are many polemical t-shirts on sale to this effect.In my view (and in that of many others), they’ve gone way too far… almost to the point of McCarthyism. Of course, this hasn’t stopped their conference from taking sponsorship money and selling booths to all manner of medical informatics companies, medical device companies, medical publishers, medical test prep companies, and of course… government.
• AMSA is a big believer in “woo” (aka quackery of all stripes). Not only do they sponsor summer courses in such delightful nonsense as “therapeutic touch” (“reiki”), but they also invite the quacks into their conference. The Association of Accredited Naturopathic Medical Colleges has a booth here, and various naturopathic “schools” from across North America have sent students.

This group claims to represent the future doctors of America. What scares me is that they actually might.

Stick around for the weekend for more AMSA Follies, and be sure to see what I’m up to on Twitter (@nwsblog), or by following the #amsaconv2011 hashtag. The connectivity here is spotty, but I hope to provide commentary in as real-time-as-possible on the weekend’s shenanigans.

This is one window into the world of medical organizations you won’t want to miss.

Health Wonk Review, and other matters

Julie Ferguson at WorkersCompInsider hosts the latest edition of Health Wonk Review, which is chock-full of insightful, thought-provoking pieces from across the health wonk spectrum (and occasionally from a clueless amateur like myself).

Avik Roy, now blogging at Forbes, has a quick summary of each published submission at his site. About my piece, he writes

The anonymous Canadian first-year medical student at The Notwithstanding Blog is concerned that bioethics programs at academic centers tend to “usually [lean] left-liberal.” We could, he argues, use more of Leon Kass.

That wasn’t quite what I was trying to say; I guess that wasn’t one of my better-written posts. I’ll use this space to clarify.

My concern is not the political leanings of bioethicists per se, so much as it is their seemingly widespread disdain for the ideal of patient autonomy. I offered political leanings as one possible explanation, but I really don’t think that Leon Kass is any better on this score than his liberal counterparts.

***

On a completely different note, I’ve written before about the intersection (or lack thereof) between medical education and business education, but Ted Bacharach at Placebo Journal Blog sums it up far more eloquently and concisely than I ever could hope to.

I believe the intent of the medical school to introduce humanities to improve the physician patient relationship is well intentioned but is totally misdirected. To allow the patient to relate more closely to his patient the courses that need to be added are not the humanities but rather financial and office management.

The wedge that has developed between the patient and his physician has been caused, to a great extent, by financial considerations. There was a time when the physician’s goal was to have a satisfied patient, the patient being the one paying the bill and hopefully helping in referring more patients to the doctor’s office. Today the entity employing the physician is concerned with getting more subscribers, cutting costs and generating income.

Read the whole thing (not much longer) here.