Wednesday, February 11, 2009

News of the day - Fall in the house of Usher - Usher's wife's surgery complication, vitamins, and the failure of preventive care model

A couple of things on my radar today

1) Hitting the news wire today is the report that R&B singer, Usher's wife has had serious complications from cosmetic surgery performed in Brazil. This procedure was also performed only two months after childbirth, something that raise eyebrows in re. to timing any major procedure on the breast or body. I guarantee the first thought that most Plastic Surgeons are going to have is that "Why would you fly to South America for surgery when you have the money to see anyone in the United States?".

It is absolutely a poor decision to do something like elective surgery half a world away from your doctor's and family. While there are truly some magnificent surgeons in Latin America, you introduce a lot of potential logistical issues when there are complications. In this instance, they've apparently flown a doctor down there to oversee treatment (as I'm presuming they were uncomfortable with the local care). That alone speaks volumes as to why this is a bad idea. The low cost cosmetic surgery "chop shops" that exists right over the border in Mexico are notorious for having complications and dumping patients stateside for treatment.

2) In the latest of a series of large studies (click here) assessing the effects of vitamin supplements, we once again see NO demonstrable benefit in a daily multivitamin. This follows on the heals of similar studies (with similar findings) on vitamins A, C, and E. It once again confirms "Rob's Rule" that you cannot outsmart mother nature.

3) The Chicago Tribune points out that an "ambitious effort to cut costs and keep aging, sick Medicare patients out of the hospital mostly didn't work," according to a study published in this week's Journal of the American Medical Association (JAMA). Any doctor, nurse, medical student, or even janitor who works in a hospital could have told you that minus the hundreds of man hours spent performing that study. In a corollary to "Rob's Rule" on mother nature, I might add that in general you don't save any money with preventive health care, you just redistribute it in other directions (and may in fact end up costing even more, it's counter intuituve, I Know!).

It would be nice if President Obama, et al. would be willing to admit that any steps they do that are "painless" to patient choice or patient care (ie. preventive care, the "medical home", or the electronic medical record (EMR)) will not save one dime on health care costs. Those choices that will affect cost have winners and (big) losers and will be extremely polarizing. Barack Obama does not want to be campaigning for reelection in Florida in 2012 explaining why 75 year old grandma can't get her hip replaced because his actuarial based plans for health care spending suggest her quality of life is less valuable then someone in their 50's needing a total knee replacement.


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