Doctors Are Being “Gagged” by Gas Drillers

First of all, let’s all agree on two things. First, that energy independence is good for our country. Second that clean drinking water is also good for the country. The development of America’s huge stores of natural gas, have given us a remarkable opportunity to accomplish the former. In particular, the process of “fracking” has made it possible to increasingly tap those huge natural gas stores.  Natural gas sits in rock formations, but releasing it is much more complicated than simply drilling a well and pumping it out. In order to tap the gas, it first has to be liberated from its rocky confines, after which it takes the path of least resistance, in this case is up a gas well. The technique of releasing natural gas from rock  formations is known of hydraulic fracturing or “fracking”. The process involves drilling down thousands of feet to create a well. Huge quantities of water, often a million gallons or more, are forced into the well. This opens fractures in the rock and allows the natural gas to escape. The water that was pumped into the well is a proprietary mixture that contains various agents which are potentially hazardous to humans. Only a fraction of the fluid is recovered, much of it stays in the well and is dispersed into the depths, (hopefully) never to be seen again.
The process of fracking has huge potential and not only for the drillers. As anyone who has paid close attention to their gas bill has seen, the glut of natural gas has lead a drop in gas prices, and this comes at a time when we could all use a break on fuel prices. The fact that it’s homegrown means that there are no foreign entanglements, it creates domestic jobs and reduces trading deficits. Natural gas even burns cleaner with less CO2 than gasoline. It’s a veritable win-win for the entire country. The tremendous upside of this cheap, cleaner,  home-grown energy source has lead to a boom in the industry, with thousands of wells sprouting up across the country, most use the the process of fracking.
But the rush to cure America’s energy woes has been well, rushed. One has only to look at the results of our attempts to harvest corn ethanol as an energy source to see the law of unintended consequences in effect. In a climate where a modicum of caution would be wise, both the government and the industry has proceeded with what can only be thought of as reckless abandon, summarily sweeping aside questions of safety and health concerns. This was typified in  2005 when the federal government passed what is known as the “halliburton loophole” wherein frackers are exempt from significant EPA regulation.

And that’s where we physicians come in. In the rush to create a business friendly environment for drillers, state governments have generally laid out the red carpet. This includes passing laws to protect  proprietary information about the content of fluids being pumped into gas wells during the fracking process. In many states, if a physician suspects water contamination, they may request to know the materials, but must sign a confidentiality agreement thus effectively barring them from disclosing this information to others.
Imagine being the physician in Dallas who saw patients who were exposed to fracking fluid, one of whom developed renal failure. Or the dermatologist in Pennsylvania seeing a cluster of people living near a well who presented with non-healing skin lesions after their water was contaminated. In such a situation it would be paramount for a physician to share this information with other physicians, to discuss the case with other consultants, to inform the public about potential threats. The medical community would need to disperse this information both through word of mouth as well as through published literature. Forcing physicians to sign confidentiality agreements would likely limit the transmission of such information. Even if such communication were technically legal, the confusion and fear created by such laws would make many uncertain about whether they could disclose such information.
I do believe that state governments are trying to do the right thing, in facilitating the procurement of what appears to be a cheap, abundant, domestic energy source and increasing their tax base at a time when it is sorely needed. However, it should be pointed out that government is first responsible to the people they serve. The process of fracking is being looked at with increasing scrutiny by the public as cases of contamination by fracking fluid and natural gas come to light in greater numbers. The current approach only fosters an environment of fear and suspicion and heightens the perception that drillers do not take the public welfare into account.
If the scientific community  was allowed greater access to information, the causative agents could be identified, and potentially replaced. Such an approach could be beneficial for drillers. There are indeed historical precedents for this type of relationship. The study of lead, and freon and their subsequent removal from gasoline and refrigeration has benefitted society, yet both of those industries continue to flourish today. In addition, drilling companies with poor track records could be weeded out and replaced by companies with better techniques. This process is the American way. It is taking place as we speak in a number of different fields including the medical community, and the drilling community should be no different.

 

Of Lollipops, Happiness, and Being a Doctor.

So, I took a trip to India recently. I’d like to tell you that it was a vacation, but alas my travels there had to do with much sadder subject matter. In any case it was nice to see the old country after many years. My trip back, saw me delayed in Dubai, so I decided to pick up something for the kids, who are 2 and 3 years old. I had already gotten them some things from India, but I thought they might like a chocolate or something else edible. If you haven’t been to the Dubai airport, well simply imagine a very large mall with gates that allow you to board a plane and you’re pretty much there. Except there’s no shoplifting because they might cut your hand off. Continue reading “Of Lollipops, Happiness, and Being a Doctor.”

Top 5 Trivial Things No One Taught Me in Training.

Since medical school, I’ve gone through an additional 6 years of training, read countless volumes of medical literature, and had the fortune of having some great teachers. Through it all, experience has been the greatest teacher, which I suppose is what training is about. I’ve watched with interest as advice has been hashed out on the web around this time of year to new trainees on all matter of subjects. And much of it is good and useful, to be sure.
Being the helpful person that I am, I naturally want to do my part. What, I thought, could I contribute to this discussion that hasn’t been said already?
To that end I’ve come up with my own list of of trivial and only slightly helpful tidbits of information, based on my own experiences over the last 11 years post graduation. Here I give you my top 5 list of things that no one ever told me in medical training. . .but should have. Enjoy. Continue reading “Top 5 Trivial Things No One Taught Me in Training.”

Should we Deny Insulin to Chocoholics?

I’ve always had a tough relationship with cigarettes and the people who love them. As a lung doctor I hate cigarettes, and I hate that patients I see everyday continue to use them. But I also understand that vilifying smokers seems to be in vogue right now. I figure that if someone does something that is not considered socially palatable, and that does them harm, even as they strive to take treatment for it. . . well it must be a pretty powerful addiction.
Recently I was hanging out with a few physician friends, when the topic of conversation came to treating patients who are smokers. Some contemplated whether patients who smoke should even be prescribed inhalers for breathing disorders. Furthermore, we wondered about whether such patients should be followed up for breathing problems unless and until they quit smoking. Continue reading “Should we Deny Insulin to Chocoholics?”

Marriage and Motorcycles.

Being married to a transplant physician tends to give one a different perspective on life, and in particular, risk taking. For example I’m embarrassed to admit I rarely climb ladders anymore unless it is absolutely unavoidable. Between you and me, the last time I had to change a lightbulb in the garage, instead of using a ladder, I stood on the roof of my wife’s S.U.V. (note to self, need to make up story explaining dent on roof of S.U.V.).
But I must admit, I do have a terrible weakness for speed. And while said weakness has been limited to things with four wheels, I’ve always toyed with the notion of someday getting a motorcycle. I never took up motorcycle riding in my younger years, but now as I see older and older people leisurely riding their hogs, and parking their chrome babies in handicapped designated spots, I wonder; could it really be that risky?
The other day, as we were taking a drive on a minimally trafficked two lane road, a couple of kids went flying by us on sportbikes at near triple digit speeds.
My immediate response; “AWESOME! I WANT ONE!”
My wife’s response; “Young . . . healthy. . . perfect candidates for organ harvesting!”

My desire to ride motorcycles has since waned. Continue reading “Marriage and Motorcycles.”

Lung Cancer Screening: Almost There . . .

In 2011 The National Cancer Institute published results from their study of low dose CT lung cancer screening of individuals identified as at risk for lung cancer. The investigators enrolled those between 55 to 74 years of age who had at least 30 pack years of smoking under their belt (number of packs per day multiplied by number of years smoked). These people were then randomly assigned to either a chest x-ray group or a “low dose” CT scan group, with 3 images over 2 years. There was initial criticism that the authors used chest x-rays as the control rather than “usual care”. However given that the PLCO trial, comparing chest x-rays to usual care, subsequently showed no difference between the two, this would appear to have been a sound strategy.

The study also received some well deserved praise, as it was the largest study of its kind, and demonstrated some very impressive findings, as detailed in the article’s abstract. The most striking findings were:

  • a 20% reduction in the risk of death from cancer relative to the control group.
  • a 6.7% reduction in the risk of death from any cause relative to the control group.

I cannot sum up how to you how astounding these results were/are to the medical community, specifically to those who are involved as patients, or in the treatment, diagnosis, support, research, and  fund raising of lung cancer. Continue reading “Lung Cancer Screening: Almost There . . .”

Top 5 Things You Don’t Know About Your Doctor.

 

1. Your doctors never actually stood up, raised their right hand and took the Hippocratic Oath. If they did, they don’t remember it. The closest thing they’ve taken to a Hippocratic Oath is that time they swore they’re never again staying at that terrible hotel in Athens with lousy views of the Acropolis.

2. Your doctor’s degree of willingness to do something is inversely proportional to how happy they say they are to do it. As in “I’m happy to do that for you” = “I’m very unhappy to do that for you”. And “I’m more than happy to do that for you” = “I’m extremely unhappy to do that for you”

3. Your doctor doesn’t really know whether the respiratory illness you have is viral or bacterial. Chances are that it’s viral and you don’t need an antibiotic. But if you pester enough, you’ll probably get the antibiotic.

4. When you ask for copies of reports to be sent to your other doctors, you should not take their acknowledgment of your request as confirmation that the task will be performed. We may simply be acknowledging that yes, that would be a good idea in theory, or yes we would approve of that kind of bold initiative taking. However, the back and forth motions of our heads may also just be due to migraines brought on by filling out pre-authorizations for nasal sprays.

5. Your doctor lives in deathly, livid, morbid fear that you are going to sue them, put them in prison, infest their home with termites, send their kids to sanitize sweatshop latrines in China, and send them videos of you partying with their significant other on a yacht in the Mediterranean. That is why you are having your 4th stress test in 2 weeks.

Where Medical Reports Go to Die.

It happens thousands of times a day, all across the country. People go to their doctor’s office after some testing has been performed. The physician, unaware that any testing has been ordered by another physician, asks their usual questions. The patient, awaiting an opinion rendered on the recently performed test begins to answer the doctor’s questions with increasing impatience and trepidation, fearing the worst. “Why is he asking so many questions. . . why is he not telling me the results? Did my cholesterol panel show cancer?” And finally the question comes to the fore;

“ Doctor did you get my test results?”

“No, what test did you have”

“But I told them to send it to you!!” Continue reading “Where Medical Reports Go to Die.”

Healthcare Armageddon 6: Medicare and Generation X

                                              I’m Talkin’ About My Generation.

**Update: Treasury has just issued its reports on Medicare and Social Security, the results making this article more timely and relevant than I had intended. Together SS and Medicare make up 36% of federal spending. The Social Security trust fund is predicted to run dry in 2033, while the Medicare hospital trust fund (for inpatient services) is slated for extinction in 2024. Link to the report here.


Over the past few months i have struggled with how to portray the recent changes coming down the pike for medicare, what with ACO’s, and  impending cuts due to mounting deficits and the ever increasing costs of medical care.  What viewpoint, I wondered,  should this blog take on these issues?
Should I take the role of the traditional physician-blogger, and share the viewpoint of the myriad other physicians around me who live with uncertainty about how to run their practices in the current fiscally deprived environment? Should I write about the constant worry about whether congress will extend the recurrent doc-fix or let the draconian cuts in reimbursements go through? Will I write about whether there will come a time when it will no longer be feasible to accept Medicare or Medicaid?

Continue reading “Healthcare Armageddon 6: Medicare and Generation X”

The Squandering of Tobacco Settlement Billions

 

TO KEEP SMOKING!

Please enjoy this recycled oldie-but-goodie while I spend the next few weeks juggling a high case load with studying for the boards with taking care of two babies, etc. . .

Few things smell worse to me than the stank of a cigarette while trying to trying to load up on cholesterol via awesome blossom.  Perhaps one such thing is the beguiling tale of what perverse fate has befallen the gobs of cash money rewarded to state governments from Big Tobacco.  

This seemingly righteous pursuit was fought by brave attorneys general of 46 various states to regain money we dished out to pay the costs of Medicaid patients who, due to tobacco use, found themselves in various states of wheeziness and/or infarction.  So naturally you’re asking “why then did these same states more recently try to help Big T in getting a recent settlement against it reduced?”  Good question.  Read on. . .

Continue reading “The Squandering of Tobacco Settlement Billions”