I haven’t a clue as to 99.9999999% of all the medical conditions.

But, as compared to the present operational reality, at least when it comes to neuropathy, I would much prefer Obama’s concept of paying for diagnostic and treatment packages rather than the current piece meal reimbursement plan that usually gets us no where. Then maybe we can get some functional diagnostic procedures to identify real and therefore better treatable causes.

I can’t talk about other chronic conditions, but as I’ve been dealing with neuropathy as a patient for ten years and an educator/activist for six years, I can speak to that reality.

Right now the common practice has a primary physician or podiatrist (as the most common neuropathic symptoms begin in the feet) will do a simple office procedure to test for sensory and/or motor nerve loss somewhere in the lower extremities (maybe upper as well, if carpal tunnel syndrome is suspected, etc.) with a determination that either one does or doesn’t probably have neuropathy. They may or may not then refer their patient presenting with common and clearly definable neuropathic symptoms (if they know them, which is asking a lot of most physicians) to a neurologist. But probably 90-95% of all neurologists know very little about neuropathy. It doesn’t matter that there are nearly 20 million of us. “Everyone” knows about Alzheimer’s, ALS, epilepsy, migraines, and MS and they are much more commonly taught in med school to both primary care givers and neurological specialists. Either may or may not order some basic labs (e.g. that could identify some causes, such as diabetes, nutritional deficiencies, hereditary/genetic, immunological or toxin exposures causes, etc.) and minimal neurological exams (i.e. EMG, NCV, MRI, CT etc. studies)to identify potential other causes such as trauma, surgeries, etc. and whose results may or may not clearly define where and what kinds of nerve damage exist – is it axonal and/or myelin damage? And if you don’t have primarily axonal damage, the latter tests won’t disclose the small fiber nerve damage that can only be discerned with a skin biopsy, and so those patients will be dismissed with – it’s all in your head, you have no neuropathy. Or maybe there will be a hesitant response of maybe you have some kind of neuropathy, but we don’t know what kind or why or how to treat it. But, what the heck, here’s some some neurontin (or Lyrica), both of which are Pfizer products, which may or may not be included in an insurer’s or medical group’s given formulary. There will generally be no discussion of side effects, and if they are found to be either onerous or the med not helpful, most doctors won’t know what to do next. They have have no idea of alternative treatments (either from Big Pharma, or other treatment modalitiesIas they have dozens if not hundreds of other conditions to keep up on, so learning about neuropathy (commonly referred to as “the most common disease you’ve never heard of”) is at the bottom of their ongoing clinical medical education requirement agenda for pain or other syndromes. And even if they knew and might want to actually prescribe a particular med, the insurer may or may not cover it, or may require a tiered approach of several least effective options before one can finally get to a more appropriate one. Actually, even if one has access to a full range of options, the patient and doctor usually has to experiment with several drug families and dosages and other treatment options to finally find an appropriate single or package of meds that actually really works. But that package can become ineffective as the symptomatology changes over time with remitting and relapsing patterns, triggered by God knows what medical, emotional, or environmental variables.

Billions of dollars are spent every year on more commonly known diseases, but very, very little on neuropathy. Unless of course it’s for diabetic peripheral neuropathy (DPN) because Big Pharma knows that it is and will continue to be a humonguous market potential into the forseeable future as it is estimated that some 50% of all diabetics will develop some form of neuropathy at some point in their lives. Big Pharma knows that means untold $billions in profits. There are dozens and dozens of new meds at various stages of development for this condition, partly because Big Pharma knows that while they may (or may not) finally get FDA approval for DPN, they know their products may eventually have extremely widespread off-label use by doctor choice, and they will continue to do everything they can via “canned” research studies to show safety and effectiveness – anything to maximize an unending line of profitability from their products. And of course, their products will be aggressively promoted via popular media and doctor groups with donated samples and all kinds of industry perks for the doctors. There have been a lot of articles about these problems in both major medical journals and the popular press in the last few years.

So how would I fix the above outlined problems? I don’t know beyond educating patients, doctors, legislators, the media and public about the realities of PN, raising tons of money for research on the causes and potential cures for neuropathy and the need for far reaching systemic reforms in its diagnosis and treatment.

And for PN and all the other critical medical conditions that need comparable system changes……… Lord have mercy…..

Blessings,

Single payer was and is the only way to solve our current problem. At this point, I hope the Dem’s fail to pass a bill since it will be throwing more money at failed institutions just like our banking comglomerates, auto conglomerates, etc.

I cant say I’m surprised, Obama only came out with a health care plan AFTER Hillary and Edwards and Kucinich. You get what you vote for. Thanks Dems.

Sign the Single-Payer Petition: Link

SEMPER FI!

First impression is that there will be an absolutely humonguous expanded existing and new bureaucracy, and that there is no imminent substantive change of much of anything and most real change is a decade away. I don’t understand why that is so, beyond Congressional selling out to maintain industries’ stranglehold to maintain their high profits.

The whole thing seen thus far is disgustingly revolting for anyone wanting significant real change for the better for consumers.

Blessings,

Wow! A doctor who doesn’t like either the Republican plan or the Democratic plan?!?!? Yowza! I dunno, seems to me that the vast majority of cases are all pretty much alike. Obviously, there are unique cases that require unique solutions, but in general, you’ve got a hernia or you don’t, you’ve got too much cholesterol in your diet or you don’t, how much variation between diagnoses is there really likely to be?

Rich2506, I’m sure that the quoted DO, along with many MDs and a heck of a lot of patients could tell you that there are an infinite variety of diseases and disease states for which “one size fits all” is totally inappropriate, if not disastrous. Your list of typical chronic conditions reminds me of typical Republican simplistic prattle – eat right (who is to determine that?), exercise (which kind, how often, for how long, what kinds of medical constrictions should be considered?) and all will be well. The usual simplistic model of medical care is totally bunk, for these and many more reasons. There are many ways to treat high cholesterol – once can choose, as most doctors do, to prescribe high priced medications, which can produce very serious side effects, and which Big Pharma wants to maintain at all costs, without ever spending the time and money to help patients adopt life style changes that might help much more, more effectively, and with greater patient safety.

For example, one can do a wide range of wellness strategies for this and other chronic conditions, including supplements, exercise and dietary changes, but genetic variations, duration and intensity of the disease state all need individualized treatment strategies.

When it comes to neuropathy, there are more than 100 different types and more than 200 different causes of neuropathy (i.e. any disease state in which there are several if not many types of central and/or peripheral nerve damage symptoms, affecting one or many more nerves throughout the body from head to toe, and that are often commonly found with several other neurological disorders like MS, lupus, etc. Under no circumstances will one medication or any number of dosage levels of that one med suffice for all these neuropathies, although most doctors typically know only one or two and are helpless to go outside their comfortable boxex because their ignorance of the disease is so pathetically huge.

Many of Obama’s proposed system changes are medically and financially essential for cost containment, real health improvement and maximizing coverage. However, the devil, as always, is in the details and we need to be educating ourselves about many, many of the details with an open mind, a sincere hope for real justice and an end to the various medical indus-tries’ gross exploitation and economic rape of the American public.

Blessings,

http://energycommerce.house.go…..ummary.pdf

Grim thought: An H5N1 disaster might help the public see the advantages of a modern-state approach to the country’s health care financing.

i don’t trust any of them at this point. given all the sausage making so far and the benefits to big pharma and the insurance companies, i say, “scrap it all and go back to square one – single payer”. the table needs to be cleared and single payer put on it.

Friday (07/24/09) evenings Bill Moyers Journal featured two spokespersons (both presumably quite progressive and one from the Harvard Medical School) who called us to face the reality that the current proposed legislation does very little to really reform the medical care system, continues to reward the health insurance and medical industry at exorbitantly high levels and does virtually nothing to insure serious reduced costs, etc. The Harvard lady said we should give up the current work and start over, that the process at hand has essentially sold out to basically maintain the same old, same old structures and processes.

So that’s what the Democrats have produced, never mind what the Republicans might have produced, aside from nothing.

The Harvard lady’s conclusion has been a frequent hesitant assessment by some of the commenters at FDL over the last few months whom I’ve come to respect and admire for their passion and comprehension.

I have very little REAL knowledge of what is actually in the House’s 1000+ bill, as one commentator noted at the time that it was released, the summaries/highlights are of very little help in understanding what’s really included. There are almost daily reports on some particular aspect of the larger basic reform issues that give me some hope, but I really don’t know what it means in the sausage grinding business of Congressional action. I had hoped that FDL would undertake a serious comprehensive analysis of the proposed House bill, bringing the same high level of documentation and assessment that I’ve come to depend upon at FDL.

I’m certainly not sure what the bill means in relation to some specific concerns I have relative to treatment options for those with neuropathy, much less the many other crises I’ve observed in trying to get competent and caring health care for the homeless and poor I’ve come to know and tried to help in recent years. And God knows the health crisis in the state of California is all the more compromised with our pitiful, but not pitiable governor and legislature.

I certainly have no real knowledge of what a public option now or would finally look like and how it would be administered. That has not stopped me from speaking out at public health education/advocacy meetings and made calls and signed petitions seeking Congressional support and passage of a “robust public option,” though God only knows what that might actually mean in a bottom line for final legislation. (I always tack on JUST to go with the “robust” language because we could have a robust and totally unjust package.

I have deeply appreciated the work of Scarecrow and the many really knowlegeable and thoughtful people involved in FDL post dialogues. They have given me a basis for knowing and understanding a TINY bit of the humonguous reality and fantasy/misinformation/despicable outright lies of the ongoing “debate.”

I don’t know whether we should abort and start over. I know that I don’t want what is passed so far unless and until I know that means. I welcome your counsel on this question, FDL community.

Blessings,