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From: B. Harris)
Subject: Re: Doctor-bashing
Date: 3 Mar 1999 11:52:21 GMT

In <7bh16k$ro2$> (George
Conklin) writes:

>   The 'cures' came about with vaccinations and the growth
>of good water supplies and the pure food and drug laws.  A
>well-fed population naturally resists diseases.

   Some truth here, but only a half truth.  A well fed population
naturally resists diseases when free of congenital defect, and when not
too elderly.  Dispite all rumors to the contrary vegetarians who take
vitamins don't live forever.  Nor do they look 30 at age 70.

>   That does not leave much left to deal with, given the
>lack of progress against major adult cancers.  Heart disease
>seems to be falling, and has for 60 years for reasons

     Or rather, for reasons that have too many explanations.  Correct,
it's not ICUs or coronary bypasses-- on the mortality curve you can't
see where those things arrive in the 1960s at all.  But that doesn't
mean it's not antihypertensive drugs.  Or a growing awareness of the
evils of smoking (which, when you stop, drops your cardiovascular risk
most of the way back to baseline in only a couple of years).

>   I am not sure what more visits to any doctor would

    These days it would get your blood pressure and lipid profiles and
homocysteine levels all buffed to perfection.  And get you on a good
vitamin regimen with perhaps a little aspirin thrown in, at least if
you see me.  We know much more about prevention of cardiac disease than
we do about prevention of cancer.  But we know something about cancer,
too.  You can take your selenium, but you also need to check those
stool guiaics, have mammograms, colonoscopy, etc.

>   I am certain that a major part of any day in the office
>would be dull, dull and dull.  Boredom is probably a big
>risk to the job of doctoring.  There is not a heck of lot
>left to treat in a developed society.

   Come to my geriatrics office and meet one of my 85 year-old ladies
with the weaks-and-the-dizzies, or the dwindles, or dementia, and a
problem with every major organ system.  If you can even figure out
where to begin, you won't be bored.  But in the end, it's true that we
don't know how to cure aging, or even slow it down (at least, not if
you're already old).  All we can do with a lot of application of modern
knowledge, make you a lot more comfortable.  And add a few years,

                                    Steve Harris, M.D.

From: B. Harris)
Subject: Re: Resident Training Costs and Subsidies (was: The Patients' Bill of 
	Rights (was Backlash against HMOs: a declaration of war)
Date: 15 Apr 1999 05:35:02 GMT

In <7f1stc$f8o$> (George
Conklin) writes:

>>>Because George would love to see doctors' salaries limited by law to
>>>no more than assistant professors make.
>>    And here I took George for an instructor.  You mean he's gotten all
>>the way to a tenure track assistant professor?  What's the world coming
>>    You have put your finger on what makes universities so Communist,
>>though.  Its basically the envy of people who nothing but information
>>to "sell,"
>  Information is all that you 'sell.'  Except you got your
>union behind you to limit knowledge only to those with a

     I hate to admit that you have a point, but you have a point.
Information is what I sell.  Which is why my part of the medical
profession (geriatrics) is almost the lowest paid of all.  What I need
is a good billable procedure, and cleaning wax out of ears clearly
isn't going to be it.

    Licensing of professions is not a union-driven thing, historically.
Do you really think California bar and restauraunt owners lobbied for
liquor licences?   What monopoly did they get in return for THAT?

   FYI, we doctors don't have a union, in the sense of the AFL-CIO or
Teamsters.  We have a lobby organization called the AMA, which is
roughly equivalent to the NRA.  As a power, it sucks.  We're licensed
because the public is afraid of unlicensed doctors, and also in order
to control us and keep us in line (legally, the standards for yanking a
license are more lax than those needed for criminal convection.  And
the penalty is far worse that most criminal penalties--- you lose ten
years of your life, your job, your prospects of future employment for
years, etc).  I'd rather we weren't licensed-- it would save me the
yearly renewal fees for Utah and California, which altogether come to a
pretty penny.

   There would still have to be some control of antibiotic access,
though.  Public health hazard, there.

> You took all your courses from people without the
>MD all the way to medical school.  Then you got arrogant,
>decided your knowledge needed a fee-for-service attached to
>it, and decided that your knowledge is not 'communistic'
>because it is 'private' and you need a prescription to
>follow up on it.

    Hey, I didn't make the laws.  However, the responsibility for
treating patients is mine.  I pay those malpractice bills, even though
I've never been sued.  If I ever am, the instructor who taught me won't
be on the line.

>   Making a low-level applied science like medicine a
>highly paid 'profession' was what the AMA did for you.

    Ignorance of history, again.  The AMA dates from 1847.  Do you
imagine that medicine wasn't a profession until then?  Do you know any
English history, if not American?

>But without a law limiting your the number of people
>licensed and other laws limiting the power of patients to
>get knowledge, you would be back in the blood letting

   Perhaps.  But I wouldn't need so much money to live on, either.  I
would, of course, expect that all other professions give up their
licenses also.  And no malpractice stuff, please, except for the tort
risk that any profession carries.

    I'd do okay.

From: B. Harris)
Subject: Re: Resident Training Costs and Subsidies (was: The Patients' Bill
Date: 15 Apr 1999 09:18:38 GMT

In <>
Ryan Maves <> writes:

>On Wed, 14 Apr 1999, William Bacon wrote:
>> >     And here I took George for an instructor.  You mean he's gotten all
>> > the way to a tenure track assistant professor?  What's the world coming
>> > to?
>> I'm not sure what George's level is; he's been uncooperative to be
>> specific. His privilege, of course.  I've been assuming he's an
>> assistant or associate prof., although there are times when I'm certain
>> he's not much better than a janitor.
>After some checking, it turns out he's actually a full professor. North
>Carolina Central University, Department of Sociology. Well, I'm shocked.

      Me, too.  But I suppose, reading the sociology I have, I
shouldn't be.   It's got to come from somewhere.

From: B. Harris)
Subject: Re: Backlash against HMOs: a declaration of war (was Doctor-bashing)
Date: 15 Apr 1999 12:24:14 GMT

In <> Bret Wood
<> writes:

>"Steven B. Harris" wrote:
>>     Computers need the raw odds to do the calculation.  It's not a
>> matter of learning to set up the problem. It's a matter of the fact
>> that the odds are not known, and cost too much to learn. Too many
>> variables. And God help me if I'm ever expected to do data entry on all
>> the variables I actually use in what judgement I do in medicine (many
>> of them subconscious-- eventually you get to be able to tell many times
>> when people are seriously ill, but it's hard to put your finger on
>> exactly what it is that tells you). If I had to put in even the
>> conscious stuff I'd be seeing one patient a week.
>This is BS Steve.  There are already expert systems (a special type
>of computer program) which can do diagnosis as well as, or in some
>cases even better than leading experts in their field.  The main
>problems with these programs is that they are limited to specific
>specialties, and they are horrid at dealing with comorbidity.  (Not
>that many doctors do such a good job with comorbid diagnosis either)
>Let the computer experts program the computer.  Pretending like
>you would need to "program in" all of the variables for each
>patient is absurd.  Your experience fine-tunes your sense of
>which variables are important in a diagnosis, but once you have
>started to narrow down the possibilities, generally only a very
>few variables have much of an effect on decision making or
>probability estimates.  (At least, the expert systems are able
>to do very well by using a relatively small number of variables)

  You forget I'm a geriatrician.  My patients have an average of dozen
chronic problems.  Sorting out cormorbid diagnoses and relative effects
of exacerbations of various chonic conditions vs new pathology, is what
I do all day.

   Do you know what happens when the average elderly person with a
dozen problems sees a dozen specialists?  It's just what happens when
their problems are fed one by one to the dumb computer.  They get a
test and two drugs for each problem and or complaint.  At the end
they're on 20 or 30 pills a day and have the weaks and the dizzies and
the dwindles.  Otherwise known as iatrogenesis fulminans.  Treatment is
generally to take a nice drug holiday and start over, looking for
hidden infection, paying attention to what's disrupting function MOST,
temporarily ignoring what's not perfectly clear, and seeing what
problems survive nutritional and emotional support, physical therapy,
home health aid, and attention to pain, depression, and anxiety

   You can turn your expert systems loose on the 30 year old healthy
young man who starts vomiting one day and turns yellow.  Keep them away
from the 80 year old lady with cataracts, HTN, CAD, LVH, COPD, DM II,
osteoporosis, s/p hip fracture, history of hospitaliztions for
pneumonia and CHF, slow weight loss, instability, memory problems, and
urge incontinence, who is brought in because she's lost her appetite
after she caught a cough from a houseful of sick grandchildren, went to
the urgent care center and got a couple of prescriptions which didn't
help, and now has swollen ankles and more arm and chest and back pain,
nausea, and trouble getting out of the chair.  Keep them away, I tell

                                          Steve Harris, M.D.

From: "Steve Harris" <>
Subject: Re: M.D.s & Medicare
Date: Fri, 25 May 2001 14:11:01 -0700

George Lagergren wrote in message <>...
>    If Medicare does not pay enough to treat older patients, maybe
>    those older patients need to become their de facto medical
>    "doctor."

Most of geriatrics is the medical care of widowed women in their
late 80's. Some of these are possibly capable of getting on the
net and starting to participate more in the fact-crunching end of
their own medical decisions, but it would be unrealistic to suppose
that most of them could. Mostly, one hopes that they have some
bright kids willing to do it. Due to the way our culture works, that
usually ends up being a daughter or granddaughter.
Even a daughter-in-law (I swear I've seen more daughters-in-law as
caregivers in geriatrics than I've seen sons).


From: Steve Harris <>
Subject: Re: Health Canada warning EZETIMIBE
Date: 6 Feb 2005 12:42:19 -0800
Message-ID: <>

Of course these words are not well defined. Geriatric means aged or
aging or old. But to the young, over 30 is old. During my lifetime,
"old person" got politicized to "senior citizen." Are you a senior
citizen, Zee? Do you qualify for discounts?

US social security used to define "senior"--- it was when they retired
you. A standard (65) first set by Bismark in the 19th century. But now
in the US they keep upping this number, like in Catch 22. While at the
same time the AARP, seeking to expand their base, keeps trying to sell
retirement living interests to younger and younger sets, down into the
50's. Would Dell Webb let you in?

Geriatricians haven't exactly defined their age-cutoff either. But the
general feeling is that it has to do with people who have problems like
those of the aged who need a lot of assistance, like dementia,
incontinence, walking problems. The "frail elderly."  Whereas the
merely chronological elderly who (if lucky) drive their own motorhomes
at 75 and aren't frail (yet), might not really be appropriate geriatric
patients at all. Satchel Page's "How old would you be if you didn't
know how old you was?" is a very good question.

<<Where does middle age end and elderly begin? <<

Senescence begins and middle age ends
The day your decendents outnumber your friends

--Ogden Nash

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