MCN’s Market Analysis Team Lead, Jeremy Behrens, appears in a new webseries, CRAVE. The show was produced in collaboration with the production company Honey Toad, whose own webseries, WRECKED, garnered acclaim from TubeFilter and other reviewers, and received thirteen nominations and four wins from the Indie Series Awards.
The pilot was shot in May, with Ms. Aneesh Sheth directing and Liz Ellis running the set. Nathaniel Buechler and Ben Goldsmith, also of Honey Toad, directed photography. The show stars Sheth with Jeremy Behrens, Angela DiMarco (Chop Socky Boom, Grimm, The Device) Sarbani Hazra (Blissville, Jane Don’t Date,) Amalya Benhaim and DeRon Brigdon (Orange Is The New Black, Grimm). A Kickstarter campaign has been launched to fund the rest of the season.
An address first delivered in 1926 at Harvard Medical School, The Care of the Patient by Francis W. Peabody, MD explores a topic that seems to remain relevant in the practice of medicine today. Dr. Peabody (1881-1927) was renowned for setting himself apart from his colleagues throughout his career by treating each patient as a real person and not just according to their disease or disorder. The premise of this essay is the belief that “One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.”
As science and technology improved then, and continue to improve now, the practice of medicine puts a greater emphasis on the science and less on the actual care of patients. Students are exiting medical school with excellent knowledge where medicine is concerned but the actual practice of medicine has been somewhat neglected. Dr. Peabody believed caring for patients is something learned over time, not necessarily in the 4 to 5 years it takes to complete medical school, but he also believed it to be the medical institution’s job to provide the foundation for this type of care. The pressure to effectively diagnose and treat often overlooks the necessity of conversation and the vital importance of creating a personal relationship with the patient. The fundamental sciences will always be imperative but intimately knowing a patient as a human being and not just as a sick individual is the practice of medicine in the broadest sense.
The diagnosis and treatment of disease is a very limited aspect of practicing medicine. A quote that stood out was “The art of medicine and the science of medicine are not antagonistic but supplementary to each other.” Oftentimes, it is not just the disease that needs treating but the individual who needs to be treated. This takes time, which more now than ever is a commodity difficult to obtain in most settings, and it also takes compassion and understanding. The practice of medicine is intensely personal and the more impersonal and clinical the profession becomes the further we stray from the main objective of it all – the actual care of the patient.
See the related 1984 commentary in the Journal of the American Medical Association (JAMA) on this article.
For the first time in MCN history we are excited to introduce our very own softball team! Dedicated players from both the Corporate and Seattle offices are banding together to compete at Maplewood Playfield on Thursdays. The first game takes place tomorrow 6/4 and the season will run through 7/30, giving teams the opportunity to play six regular season games plus playoff games if/when we qualify.
Yesterday marked the very first practice for some team members that were able to attend (photo proof provided above left). They’re looking pretty fierce out there! Lea Dilling remarked that there were a handful of them that had never played softball before but by the end of the practice were looking like really promising players. Oh what practice can do! One of the team’s original founders Russell Blount deserves special thanks for organizing the practice and has been officially coined “The Softball Man.” Another big thank you goes out to Albert Jennings for coaching the team like it was a paid gig. Based on how #PracticeOne went some highlights to look out for are: Kyle Brady and Dave Tucker tearing up the outfield; Lea Dilling diving for grounders; Amy Belete taking balls for the sake of the team; and Brianna Bean (former softball champion), Kierra Neher and Caitlin Jacques doing whatever it takes to get that win.
Along with the aforementioned players the roster for this season includes: Jeremy Behrens, Barbara Bulichi, Jacob Burger, Ryan Clarry, Raul Gutierrez, Erik Madrid, Oscar Meza, Evan Shustoff, and Heather Vasquez.
We are looking forward to bringing you updates about the team and the standings as the season progresses. Details for tomorrow’s game are below and we encourage anyone not playing and in the area to come out and help root our team on! Go Marmots!
Game I Details:
Time: 7:30 PM
Location: Maple Wood Playfield – 4801 Corson Ave S, Seattle – Field 1
by Jen Jenkins, MCN Market Analyst
Many Americans have developed an expectation for something that on the surface appears harmless but in reality has proven rather dangerous: the quick fix. This expectation falls into a variety of categories but the dangers here tend to lurk around seemingly magical solutions that directly involve our health.
During the 1990’s there was a surge in pain medication being prescribed freely as an easy fix for chronic pain sufferers over the use of other types of rehabilitation. Prescribers were outspoken about their belief that these drugs were not addicting when used in these scenarios and pain medication was not only being freely prescribed but done so in enormous excess. Between 1999 and 2010 the US saw sales quadruple for opioids such as Percocet, Vicodin and OxyContin. These names probably sound familiar as they have readily become household names, yet we are only more recently being warned about the dangers of using these drugs.
On the other hand, heroin is widely known to be illegal and highly addictive. Fatal heroin overdoses in this country have almost tripled in the past three years, claiming the lives of more than 8,250 people per year. As horrifying as that is, it may not be all that surprising since the dangers of heroin are so well known. In a shocking comparison, around double that number of people are dying every year from prescription opioid painkillers, which are molecularly similar to heroin. If that statistic is news to anyone it’s probably because overdoses due to prescription medications are far less scrutinized and rarely publicized. The victims of these overdoses are overwhelmingly white, financially well-off, and young; a very different demographic from what we have come to know in relation to other types of drug abuse.
This article in The New York Times provides a snapshot of the new heroin landscape and why it is more dangerous than ever before. Use of this addictive drug had been on decline since the 1980’s but was revitalized thanks to prescription opioid addicts who are more readily turning to heroin as a less expensive and more accessible alternative for a similar high. The article goes on to look at how this change of demographic has also brought about a new kind drug dealer, in particular highlighting the business practices of the group of traffickers dubbed “The Xalisco Boys.”
Although low-profile and anti-violent, The Xalisco Boys are drug dealers to fear because they are going after their customers instead of the old standby of waiting for customers to come to them. They also rely on marketing instead of perpetuating street crime and have devised a system resembling pizza delivery for selling heroin across the United States. Interestingly, they even keep business hours between 7am and 7pm to instill a “safe” sort of atmosphere along with reliable delivery and balloons of heroin that have been properly dosed out by weight and potency. Free samples given out at methadone clinics, discount pricing, and free hits delivered to customers showing signs of quitting are cited all examples of their entrepreneurial take on drug sales.
So what do we do in this ever-changing landscape? Do we look for resolution on the street or in our clinics and hospitals? Especially now that “street crime is no longer the clearest barometer of our drug problem; corpses are.”
Atul Gawande, MD once again hits a bull’s eye in this incisive New Yorker article on the massive problem and challenge of unnecessary “no-value” care.
In truth, “no value” is generous, since care with no value removes value from the system by diverting resources from the economy that could be creating value, and by increasing morbidity and occasional mortality that is inherently part of health care but is accepted as part of the risk benefit calculation.
When there is no benefit, one only encounters risk. Gawande cites a 2010 Institute of Medicine Report that 30% of health care spending, or 750 billion per year in the US, is wasted. Spread across the population of patients, this would mean that 30% of the care received offers no value (while carrying risk), and 30% of the care provided by hospitals, doctors, pharmaceutical manufacturers, physical therapists and so on, are wasted. Of course, human nature being what it is, the average patient likely thinks that it is someone else receiving such wasted care and the average health professional may believe, or at least profess publicly, that all which they do or prescribe on behalf of patients is necessary and appropriate.
If we were to accept this 30% statistic and were somehow able to curtail waste without shifting or increasing costs we would not be in the crisis of cost that we find ourselves in. Our 18% or so of GDP spent on health care would be a more moderate, but a still substantial, 12%. By any reasonable standard, Gawande is describing a situation that ought to outrage every citizen. How much of our many other crises could be abated if 750 billion dollars were allocated to them? Education, poverty, social justice, homelessness, child abuse, and neglect? Or for those with more libertarian views, if this money were redistributed to the 319 million Americans for their own spending, we would each by richer by $2,351.00 per year! What would such wealth unleashed on the economy accomplish?
Why does this problem exist? I believe it is a combination of factors including ignorance, greed, and indifference. The ignorance is preventable but is largely driven by the indifference of a consuming population who have little economic motivation to be mindful of what they receive since others are paying the costs via private and public insurance. Greed speaks for itself and takes the form of deliberately doing the unnecessary or a deliberate denial of the potential that a particular intervention is not needed by ignoring the evidence or not asking the right questions. The patient population in the presence of motivation is capable of making informed decisions by asking tough questions of their physicians and doing their own research.
Fortunately, as the article describes, there are systemic alternatives that can lead to change in this pattern of behavior when one is willing to acknowledge and confront the problem.
Aaron E. Carroll, professor of pediatrics at Indiana University School of Medicine, has looked at a number of studies and assembled some interesting news for those of us who love coffee but have long been told that it is bad for us:
- Low risk of stroke: 11 studies totaling about 480,000 participants showed a lower risk of stroke for those consuming 2-6 cups per day vs. non-consumers
- Heart failure: it’s not until the 10+ cups per day level of consumption that an increase in heart failure is indicated
- Cancer: in some cases, such as prostate cancer, higher coffee consumption is not associated with negative outcomes; with breast cancer the link with drinking coffee is “statistically insignificant”; and with lung cancer outcomes are hard to parse out due to the influence of smoking
- Cirrhosis of the liver: Drinking coffee is associated with “better laboratory values” in those at risk
More good news:
Is coffee associated with the risk of death from all causes? There have been two meta-analyses published within the last year or so. The first reviewed 20 studies, including almost a million people, and the second included 17 studies containing more than a million people. Both found that drinking coffee was associated with a significantly reduced chance of death. I can’t think of any other product that has this much positive epidemiologic evidence going for it.
For about 14,000 years humans have been using selective breeding, a form of genetic modification, in our raising of domesticated plants and animals. So, basically everything we eat has been selectively bred, thus modifying the genes over time.
How are GMOs intrinsically different? They may or may not be: whereas selective breeding depends on choosing among naturally occurring genetic variation within a population or species, genetic engineering can, but does not necessarily, involve the intentional introduction of genes from different species, a technology first developed in 1972.
And is this intrinsically “good” or “bad”? Mark Lynas, researcher at the Cornell Alliance for Science, mulls this over in “How I Got Converted to G.M.O. Food.” Lynas, a self-described lifelong environmental activist, notes that though he was initially opposed to GMOs, he now believes that genetically modified foods are safe, and points out a major gap between scientists’ and the public’s perception on the issue: per the Pew Research Center and the American Association for the Advancement of Science, while 88 percent of association scientists agreed it was safe to eat genetically modified foods, only 37 percent of the public did. Lynas, through his research at Cornell, tries to bring a more informed context to this gap. In sum he notes:
No one claims that biotech is a silver bullet. The technology of genetic modification can’t make the rains come on time or ensure that farmers in Africa have stronger land rights. But improved seed genetics can make a contribution in all sorts of ways: It can increase disease resistance and drought tolerance, which are especially important as climate change continues to bite; and it can help tackle hidden malnutritional problems like vitamin A deficiency.