Political persuasion and your brain

An article in the Globe and Mail discusses a recent study finding that the brains of liberal and conservative people are often structurally different. The study found that liberals have a larger anterior cingulate cortex and conservatives have a larger amygdala. The scientists who performed the study state, according to the article, that the findings suggests liberals are better at dealing with conflicting information and conservatives are better at recognizing threats.

Of course, it is unclear if an individual's political persuasion is formed based on the shape of their brain at birth, or if different influences through an individual's life shapes both the person's brain and their political preferences.

Since our understanding of the brain is still fairly primitive, I would not put too much faith in the hypotheses generated from this study... but it is an interesting finding nonetheless...

Common sense battles bipartisan politics

Obama's monumental health insurance reform finally made it into US law this past week. Unfortunately, this victory for Obama (and the American people, in my opinion) will be tainted by political strategizing.

Before the bill was finalized, the senate was given the opportunity to put forth amendments to the bill. These amendments would then be voted on by the senate and if any amendments won a majority vote, they would be instated into the bill. However, if any amendments were instated into the bill, this would mean the bill was changed (obviously) and that the congress would have to vote on this changed bill once again. Thus, the Republicans, who have realized that they cannot stop this bill from becoming law, decided to make numerous amendments to stall the bill in bureaucracy. However, since the Democrats have a majority number of seats in the senate, they could form a united front and prevent any amendments from winning a majority vote.

One amendment put forth by Senator Coburn, who is a physician himself, was that the bill should bar insurance coverage of erectile dysfunction drugs for sex offenders. A majority of the Democrat senators voted against this amendment. I'm guessing that they voted against the amendment because they wanted to avoid Republican stall tactics and not because they believe sex offenders should have erectile dysfunction drugs covered. Thus, an amendment that should have been made to the bill was not. You can bet that this political strategizing by the Democrats will result in the Republicans using the votes against the amendment as a smear campaign during the next election, but more importantly...tax payers will be paying for erectile dysfunction drugs for sex offenders.

It is unfortunate when politics gets in the way.

Data Storage Laws and Electronic Medical Records

Rules surrounding data storage are becoming more and more important as we become a more digital society. The BBC reports that Microsoft senior vice-president Brad Smith is calling for international trade laws around data storage.

Apparently different countries have different rules around how long data must be stored and when it must be destroyed. This can become a confusing issue to navigate for companies offering data storage to an international market. Should they follow the data storage laws of the country that the consumer inputted the data from or the country the data is being stored in?

Rules around data storage also complicate electronic medical records, which some hail as the next technological revolution in medicine. Medical data is completely confidential, so many would argue the idea of storing the data outside of the country is preposterous. This takes away the complexity of having two sets of laws around the storage of the data; however, it means that we cannot take advantage of cheaper rent and maintenance fees found by establishing data centers in foreign countries. Keep in mind that having these data centers within our borders does not really make the data more secure. Hacking only requires accessibility and if the data center is connected to any kind of network on the internet, its physical location has no influence on its security. So does it really make sense to demand that medical data is stored within the country?

Considering laws regarding how long medical data must be stored, we currently have rules around how long paper medical charts must be held by a physician. Would these rules be the same if/when we move to digital records? Digital records are much easier to manage than their paper counterparts, so it may make sense to store them indefinitely, or at least for a longer period of time. This would certainly be of added benefit in research. We could learn a great deal if we had over 40 years of patient data to study. Of course, this is only true if researchers gain patient consent to view the data.

As data storage becomes a more frequent point of discussion in politics, I think we will see health officials begin to weigh in on data storage policy, at least with regards to how data storage affects health care.

In Response To "Is it fair to compare American health care with systems in Europe or Canada?"

I found an interesting article on KevinMD written by Ralph Silverman, a colorectal surgeon who blogs at The Colon Doctor.

Dr. Silverman discusses his thoughts on comparing American health care with systems in Europe and Canada. He attributes America's lower life expectancy, compared to Canada and Europe to a lack of healthy living, as opposed to a broken health care system. Saying,

American patients...are more obese than patients in other countries. We eat a diet high in fat and carbohydrate content. As a population, we smoke like there’s no tomorrow. We drive everywhere we go and don’t get any exercise. Instead of exercising to control our blood pressure or diabetes, we sit on the couch and take a pill. We eat ice cream and cake, and then take some insulin to bring down our sugar levels

I agree with Dr. Silverman because preventative care has been shown to be the best way to improve patients' quality of life. However, earlier in the article, Dr. Silverman explains that American's shouldn't expect universal health care just because Canadians and Europeans have universal health care,

It is true that those countries [Canada and Europe] do have universal health care, but is it a fair comparison?

Who does Canada rely on to defend its borders? When the Germans invaded France in World War II who stormed the beaches at Normandy? The point is, these countries rely on the United States for security when peace is compromised. America allocates trillions of dollars to defend both itself and the rest of the world. No other country does this. That money could easily be used for universal health care.

Discussing the "these countries rely on the United States for security when peace is compromised" issue would taint this post with a political slant that has nothing to do with the fallacy of Dr. Silverman's argument, so I will leave it alone. However, the crux of Dr. Silverman's argument in the above quote is that America could easily provide universal health care, but it must spend that money on other expenditures, like defence. Thus, American's should not expect the same health care that Canadians and Europeans receive because Canadians and Europeans have fewer financial burdens, allowing them to spend more on universal health care.

Reuters illustrates the argument against Dr. Silverman's statement quite nicely.

Here is a comparison of the United States' health care costs versus those of selected other countries in 2006:

UNITED STATES: 15.9 pct of GDP, $6,657 per capita

BRAZIL: 7.9 pct of GDP, $371 per capita

CANADA: 9.7 pct of GDP, $3,430 per capita

CHINA: 4.7 pct of GDP, $81 per capita

FRANCE: 11.1 pct of GDP, $3,807 per capita

GERMANY: 10.7 pct of GDP, $3,628 per capita

INDIA: 5.0 pct of GDP, $36 per capita

ISRAEL: 7.9 pct of GDP, $1,533 per capita

JAPAN: 8.2 pct of GDP, $2,936 per capita

MEXICO: 6.4 pct of GDP, $474 per capita

SOUTH AFRICA: 8.7 pct of GDP, $437 per capita

SWEDEN: 8.9 pct of GDP, $3,598 per capita

RUSSIAN FEDERATION: 5.2 pct of GDP, $277 per capita

UNITED KINGDOM: 8.2 pct of GDP, $3,064 per capita

America probably does spend much more money on defence than Canada and Europe. However, that does not help the argument against universal health care. The countries that offer their citizens universal health care (e.g. Canada) spend significantly less per capita on health care than the United States. The American health care system is broken and needs to be reorganized. People aren't lobbying for more money to be thrown at the problem. They are lobbying for a more intelligent system.

Again, living healthy is paramount and pushing Americans to clean up their diets and improve their attitudes about exercise is very important, maybe even more important than health care reform. However, claiming that America can't offer universal health care because it spends so much money on defence just doesn't add up.

Swine Flu: Lose-Lose for Politicians

This swine flu virus (now H1N1 flu virus) is bad news for politicians across the globe. If government officials do not handle the flu outbreak promptly and properly, they will allow a global pandemic. Obviously, their voters will rally around this inaction as an example of government ineptitude. However, if they do handle the outbreak properly and prevent a pandemic, many voters will probably forget about the swine flu and only remember the large number of tax dollars that were used to fight a problem that never happened.

I think that there are a good number of people that, paradoxically, can only appreciate the potential devastation of an outbreak if they see it happen, and obviously, if the outbreak is prevented, it won't be seen. Of course, I think the politicians should and will act in the best interest of the general public and contain the virus; I just think that their work will not be adequately appreciated.

Dating Patients

Dating patients is considered unethical by the profession of medicine (at least in Canada) because of the power differential in the doctor-patient relationship. The theory is that since patients trust physicians with their health and well being, physicians could manipulate patients and coerce them into a romantic relationship, which is obviously unethical (and pretty gross too!). In Canada, physicians are self regulated by the Royal College of Physicians and Surgeons (RCPS). The RCPS decides if a physician can practice within a given province, and they deal with any ethical complaints that have been raised against a physician. Thus, if a patient complains about a doctor coercing them into a relationship, they would raise that complaint with the RCPS. The RCPS would then investigate the accusation and decide if the physician is guilty. If the physician is found guilty, the RCPS also dictates the terms of their punishment, which can range from rehabilitation or suspension, to revoking the physician's license to practice.

In most cases, the rules against dating patients makes complete sense. However, as with any ethical, political, or moral stance, there are always gray areas. The other day we were taught that the RCPS has a zero tolerance policy with regards to the doctor patient relationship. This implies that if you are the only physician in a small town, you will probably be unable to date ANYone in that town, as they're most likely all your patients! That means it's a TERRIBLE idea to go to an isolated rural community and be the only physician there, unless you enjoy celibacy.

Another interesting fact is that the RCPS believes in "once a patient, always a patient". This means if you are on call and you see a patient who comes into emergency, you can NEVER have a relationship with them. If you see them again in a social situation, 4 years later, and hit it off...you can't act on it because one night, 4 long years ago, they were your patient.

Now, in practice, I'm not sure if the RCPS is as strict as we were told they are...but if so...wow...

Prescribing Pharmacists

The provincial government in British Columbia (BC) is planning on giving pharmacists the right to modify and refill prescriptions. They made this decision without consulting the British Columbian Medical Association (BCMA), which is the association representing the doctors in BC. The BCMA has since convinced the government that they need to discuss this paradigm shift with doctors in order to ensure patient safety.

Currently, pharmacists can only fill perscriptions. Their primary role is to ensure the prescribed drug will not have any unwanted side effects, like dosage toxicity or drug interactions. Pharmacists also teach their clients how/when to take the prescribed drug.

The new legislation would allow pharmacists to modify precriptions to a different, but similar drug or refill a perscription for upto a year. The former would be done if the initially perscribed drug was not working effectively or had unwanted side effects.

This legislation was proposed to counteract the doctor shortage we face in BC. If doctor's are not spending time refilling or changing perscriptions, then they can see more patients. This leglislation would also be more convenient for patients because they would not have to wait to see their doctor in order to get a quick refill.

The BCMA has a problem with the legislation because they feel that it will damage patient care. Many patients are given a limited prescription because the doctor wants to see them again quickly. For example, a diabetic may be given a 3 month perscription so that doctor will be able to see him again in 3 months and perform another checkup. If patients are getting their perscriptions refilled by their pharmacists, they may not bother to see their doctor for upto a year, which may be unnacceptable depending on their state of disease. From my time in the family clinic, I have seen many patients, usually men, come in for a prescription refill and then they bring up a number of serious health concerns. Do you think these guys would come to their doctor's office if they didn't have the pretense of needing a refill?

Another concern is miscommunication, if a pharmacist modifies the prescription drug or dosage, then the doctor may not be aware of this change when he is seeing his patient. I think this is a lesser concern because I'm sure that doctors and pharmacists would work together to establish a protocol to ensure these miscommuncations would not happen.

The BCMA is advising the government to modify the legislation because they are concerned with will negatively effect patient care. The pharmacists were supposed to gain prescribing power in January...we'll see what happens.