The Magic Word

As a life-long baseball fan, I have a deeply profound appreciation for all of the intricacies of America’s Pastime. As any true fan will tell you, baseball is a sport where the nuances and strategies mean as much as the skills and the physical prowess of the players.

Like all true fans, I am fascinated at the manager’s art, especially when it comes to how they dispute the calls of the umpires. Some managers take a low key approach, while others tend to get right up in the umpires face. Usually, the manager’s intervention has little effect on the umpire, and he returns to the bench without any further ado. However, sometimes the umpire will eject the manager from the game. The fascinating thing is that it’s not just the angry, overtly hostile managers who get ejected – sometimes the mild-mannered ones get tossed as well.



I learned long ago the reason why this happens. It seems that there is a certain ‘magic word’ that the manager (or a player) can use to address the umpire that will ensure his ejection from a game.

Now, being the genteel person that I am, I will not elaborate on the identity of this magic word, but the curious can view the following clip (from one of the greatest baseball movies of all time) in order to gain a clearer understanding of baseball’s magic word phenomena (just make sure that there are no small children, nuns, or prudes around before you play this clip):



http://video.sbrforum.com/video-2424-Bull+Durham+Arguing+with+the+Umpire.html





Baseball is so engrained in our national character that we use many baseball terms to describe everyday events in our daily lives. Phrases like “in the ballpark”, “bush league”, “touch base”, “throw a curveball” .. the list goes on and on. I hereby propose that we add the baseball phrase ‘magic word’ to our national lexicon, and use it to identify a certain phrase that will get you ejected from your doctor’s office.

Now, unless you are a physician, this is not a dirty word – it’s actually quite safe and mundane. You could use it in front of your Mon and she won’t wash out your mouth with soap. But, to physicians, this is the most foul and filthy word in the world.

Want t know what it is? (You know you do!)

It’s iatrogenic.

It’s a Latin word (like all good medical terms) and it means “physician induced” It’s used to describe conditions or diseases that are caused, inadvertently, by medical treatments or procedures.



Our first president, good ‘ol George Washington was a victim of an iatrogenic condition, and it cost him his life. His physicians, in trying to cure his sore throat, used bloodletting on poor George. So zealous were they in their efforts, they accidentally bled the founding father to death, stealing many years off of the end of his life.

Thankfully, modern physicians no longer use bloodletting as a medical procedure. However, they do cause more then their fair share of disease and destruction during the everyday practice od medicine. A disproportionate amount of iatrogenic conditions are the result of, directly or indirectly, prescription medicines.

We’ve all seen the T commercials. The last 10 seconds of almost any T commercial for a prescription drug almost always consists of an announcer calmly listing all the terrible things that can happen to you if you take this particular drug. Still, the consumer is advised to ‘ask your doctor’ about the drug du jour.

Now, the possibility of potentially harmful side effects may be well worth the risk if the drug is designed to save life or limb, but it’s incredible to me how people will risk their well being in taking a drug that promises to cure a inconsequential condition, like yellow toe nails or ‘Restless Leg Syndrome’.

It’s even more incredible how many physicians will support and recommend these drugs in spite of their high risks and low benefits. Physician, after all, are supposed to be guided by the Hippocratic Oath, whose classic translation includes the statement “I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect”



I guess that modern version of the oath (which does not include that statement) must have been re-written by Merck.

Even though most patients have never heard of iatrogenic, it is a dirty little secret amongst the medical community. A 2000 presidential report called iatrogenic illness "a national problem of epidemic proportions". The report estimated that iatrgenic disease causes tens of thousands of annual deaths every year, and costs the health care consumer some $29 billion a year. This report is over ten years old, and the figures have not improved with age. Finally, report concludes that half of iatrogenic events are preventable.

Yet, in spite of these staggering and sobering figures, most of us medical muggles have never even heard of iatrogenic disease.

Maybe this is a good thing. Asking your Doctor about iatrogenic disease and iatrogenic drug interactions might just get you kicked out of their office even faster then calling them that other ‘magic’ word.

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The Hole Truth

I’m excited.

I’m just shy of my 10,000th read of this blog. Actually, since I didn’t start using a counter until several months after I started writing the blog, I’m probably well over my 10,000th hit already. However, I’ll stay my celebration until the counter makes it official today or tomorrow.

At this mini-milestone, I am getting reflective as to why I bother to write this. Yes, I’m both passionate and concerned about the current state of health care, but can I really make a difference? Well, maybe, but there are no concrete guarantees that all of this will ever amount to much. So, why do I do it?

I have come to the realization that, like the scorpion on the frog’s back swimming across the stream; it’s just in my nature.

I recall a time 25 years ago when I purchased my first townhouse. It was new construction, and like many things built in the 80’s boom years, it wasn’t built to the highest standards. This was the day of the Yugo, remember.



The townhouse looked real nice from a distance, but it was plagued by a host of quality issues due to poor construction. The first time I turned on my shower, for example, nothing came out – at least out of my shower head. The shower water did pour into my next door neighbor’s living room, however. Not the most ideal way to meet your neighbor, trust me on that. Luckily for me, Sal was a good sport about it – Sal was a tough Italiano who worked on Staten Island in the waste management business. I remember being both upset about my malfunctioning shower and relieved that I wasn’t bathing with the fishes, if you catch my meaning….

Anyhow, the shower incident was just a harbinger of things to come. Everyday, it seemed, my neighbors and I added to our punch list of everything that the builder needed to fix under our homeowner’s warranty. In the meanwhile, the builder dragged their collective feet as they tried to stall us until the warranty expired. It soon turned into a game of wills and wits, with the homeowners pitted against the big corporate builder.


As winter approached, my fellow homeowners all started to voice the same complaint – the units were next to impossible to keep warm. Cold drafts pervaded the units, especially on the second floor. The builder, of course, denied any wrong doing.

One evening, as I sat shivering in my bedroom, I noticed that the drafts seem to emanate from the floor adjacent to the outside wall. In a moment of inspiration, I developed a theory of why we were getting the nasty, unstoppable drafts. The townhouses were designed so that the second stories were actually larger then the ground floors – they cantilevered out about 3 feet on either side. This overhang must not be insulated – Eureka!

The next day, I excitedly called the builder’s office to clue them as to the root cause of the draft problem. Instead of thanking me, they just dismissed my revelation – the units were all properly insulated they assured me. There was no way that the second story overhangs weren’t insulated. When I protested, they explained that I was crazy to think that the builder wouldn’t insulate such a critical area of the townhouse. Besides, the underside of the overhang was already sheathed in aluminum siding, and it would be very expensive and labor intensive to remove that siding just to prove me wrong, so the case was closed – period.

So, my neighbors and I continued to freeze throughout that cold, cold winter, until one night, as I shivered, I had another brilliant revelation – if the builder wouldn’t inspect the overhang space from the outside, I would do it from the inside. Like a man possessed, I grabbed my electric drill, attached a hole saw, and tore back the carpeting in my master bedroom. After cutting a neat 2 inch hole round hole in the floorboards, I shone a flashlight down into the abyss. Shocked but satisfied, I saw nothing in that large open space – except for the underside of the aluminum siding. As I suspected, the entire area was totally uninsulated.



The next morning, I stormed into the builder’s office and tore them a new one. I demanded that the site manager accompany me back to my house and see for himself how my overhang was uninsulated. After sheepishly admitting to their oversight, they got a work crew to come out, remove the siding, and insulate the overhang.

They assured me that this was just an isolated incident.

The insulation refit solved the heating issue in my master bedroom, but then I noticed that the guest bedroom had a similar problem. I asked the builder to please schedule a crew to come out and refit that overhang as well.

“No way” they told me. The master bedroom problem was an isolated incident – there was no way that they were going to tear apart my other overhang just to satisfya draft that surely must exist solely in my imagination. After failing to win that argument with them, I stormed back to my townhouse, got out my hole saw, and repeated my little craniotomy in my guest bedroom floor. No surprise to me – that overhang also had not been insulated either. Another work crew was dispatched to tear apart the overhang in the back of my house.

As the winter progressed, I bragged to my neighbors how my little hole saw brought down the evil empire of Kaplan and Sons. Of course, through chattering teeth, they explained that they had the same cold drafts, and the same cold shoulder given to them by the builder – my unit was an isolated incident, they were told – all the other townhouses in my development were properly insulated.

The revolution started with my neighbor Sal. He asked if I could come over with my hole saw and drill through his floors? Happily, I obliged (Sal, besides being a nice guy, was not the sort of man you refused unless you actually wanted an ice pick in your ear).

Of course, the results were the same in Sal’s townhouse.

Soon, I became the Johnny Appleseed of Belcourt. Have hole saw, will travel. I flitted from unit to unit, drilling holes in many of my neighbor’s floors. I actually never found a single overhang that was insulated. And I drilled enough holes to wear out my hole saw and my drill.

Several months later, my wife and I chanced to walk by a work crew refitting yet another overhang with insulation. After they removed the aluminum fascia, they gazed up at yet another neat 2 inch hole in the floor above their heads. One workman griped – “Yep, the asshole with the hole saw is at it again”. I bit my tongue as I walked past them, but my chest filled with pride.

I was that asshole, and I was damn proud of it.




So may be that’s my motivation for writing this blog. Someday, somehow, I dream of overhearing some CEO of a pharmaceutical company or insurance company referring to me as “that asshole with the blog”.

I know that the chances of this actually happening are between slim and none, but an asshole can dream, can’t he?




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George Carlin

I love oxymorons – two words that are commonly used together but are contradictory in nature. The late, great George Carlin compiled an ever growing list of these couplets, and he would often share them with his audience.

Here are some classic oxymorons:

Jumbo Shrimp
Military Intelligence
Approximately Equal
Constant Change
Industrial Park
Live Recording

Here's some more from the master oxymoronist himself:




Fortunately for oxymoron lovers, the list of these illogical couplets continues to grow. The latest addition to the list comes from our old friends at California Blue Cross/Blue Shield.

I’ve been critical of this company in past blogs, and much of that criticism was the result of their outrageous unfounded rate increases over the past few years. I’m not alone in my disdain for this profiteering company – their rate increases have spawned outrage among their subscribers, journalists, and even the US Congress.

Recently, with their hat in hand, California BC/BS has had a much needed change of heart and has graciously (sic) decided to roll back their rates and even refund some money to their beleaguered subscribers. In addition, California BC/BS CEO Bruce Bodaken has announced that the company will limit its annual net income to no more than 2 percent of revenue.

While this might sound fantastic to some people, to me it just raises a bigger question. You see, California BC/BS is a not-for-profit company,. So what’s all of this talk about income? Isn’t net income just another way of saying profit?

So we have ourselves a new oxymoron – not-for-profit profit.

In addition, the entire press release made no mention of reducing expenditures in order to make their insurance more affordable – they can continue to spend and waste vast sums of money, so long as the ‘net’ profit remains at 2%

Case in point: The top earner at Blue Shield of California was Chief Executive Bodaken, who made $4.6 million last year — which is just a tad more then what you could make flipping burgers at Carl’s Junior. Pundits might argue that his salary is in line with what other insurance executives are making – but they would be wrong. Bodaken’s take home pay was more than four times the salary of his closest counterpart, the CEO if California’s largest for-profit insurer, Anthem Blue Cross.

So the real bottom line here is the same as it is with many other health insurance companies: “Not-for-profit” REALLY means “Not-for-shareholder-profit”. The people who are running these companies are profiting quite nicely from their positions. And the people who are buying their inflated policies and financing their bloated salaries and wasteful spending (like you and I) continue to let them do so.

Which makes all of us Oxymorons. Hold the Oxy.


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Baa Baa, Black Sheep

Let me start off by saying that I have the utmost respect and admiration for medical doctors. They are, almost to a person, bright, skilled and caring individuals who have dedicated their lives for the benefit of their fellow man. Many, many of them deserve to be recognized as heroes – and there are countless patients who have benefited from their care who gladly echo this sentiment.

This being said, it should also be noted that these heroes, like most, have feet of clay. They almost all suffer from the same character flaw – they are conformist. They travel in a herd of consensus. They are sheep. That’s why they all wear white coats – it helps them blend into the flock.



It’s not their fault – the system that produces medical doctors is designed that way. Free thinkers don’t make it through medical school. Independent thought is considered detrimental to the well being of the herd.

The Japanese have a saying: “The nail that sticks out must be hammered down”. This is also the philosophy of most medical schools. Black sheep don’t have much of a chance of getting their medical degree.



This isn’t necessarily a bad thing. It helps ensure that standards of care are followed throughout our nation as well as the rest of the world.

However, this ‘weakness’ is exploited by the parties who desire to control medicine, including the pharmaceutical industry.

The world of medicine is constantly changing. Most physicians get their news of medical advancement from drug reps and seminars sponsored by pharmaceutical industries. Trust me on this – all those medical journals you see scattered about your doctor’s office are there for show. No one actually reads them. If they did, they would be in the doctor’s crapper and not on his or her credenza.

Continuing education, for most providers, is supplied over the hot lunch brought in by a pharmaceutical rep, or at a seminar in some hot spot that’s sponsored by (you guessed it) a pharmaceutical company.

Their opinions are shaped by statistics that are generated by Big Pharm. Sociopaths lie to your face – sociopathic corporations use statistics.



Most doctors are scared to deviate from these ‘facts’, lest they be accused of straying from the ‘standard of care’ and be held liable for any poor outcomes. Colloquial evidence – results that they have seen with their own two eyes – is dismissed and discarded. Medical consensus happens very, very slowly – especially when such consensus is contrary to the interests of Big Pharm.

Take the world of vitamins, for example. People have been taking nutritional supplements for years. Up until recently, this practice has been dismissed by most medical providers. Excess vitamins were peed out of the body as soon as they were consumed. Patients were told that they were just ‘making expensive urine’ whenever they told their physicians of their supplement regime.

Over the past few years, however, physicians have made a 180 degree turn on their opinions on some supplements. Big Pharm has gotten into the supplement game by offering ‘prescription vitamins’. These prescriptives are touted as having higher potency and purity then the ones that you might by at the local Wal-Mart – even though all are approved by the FDA. Well, one thing is certain – prescription vitamins certainly cost more then the over-the-counter variety – sometimes 20 times more. Yikes.




However, physicians are now being schooled on the benefits of the prescription vitamins, and they are eagerly writing vitamin and supplement prescriptions for their patients.

Don’t believe me? Just wait until your next office visit. You will be encouraged to add a prescription fish oil supplement to your high cholesterol meds. The next time that you have blood work done, you’ll learn that you have low vitamin D and will be given a prescription for that as well. If you listen closely, you may even hear your doctor bleat as they write your vitamin prescription. BAAAHHH!



Suddenly, vitamins and nutritional supplements are ‘in’. It’s amazing how the human body only pisses out excess vitamins when they aren’t made by a big pharmaceutical company.

Please – don’t get me wrong – I am not blaming the doctors here. They are only a product of their education and environment. It’s actually a good thing that they have standards of care and practice, and that they continually enhance and evolve their education.

The bad thing is that these giant corporations exploit this system and use it to their financial advantage.

And that costs all of us a lot of money.




And, even without taking 'unauthorized' vitamins, that gets me pissed off. How about you?


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A Hairy Proposition

Oh, the wonders of modern pharmaceuticals!

From the most insignificant of problems, to major health issues, there seems to be a pill for everything these days, thanks to the fine folks running our pharmaceutical industry.

Recently, I heard a very sad story on the local news. A young 20-something male was faced with an embarrassing social problem. In his late teens, he started losing his hair.

Many of us have faced a similar dilemma, but few of us have had to face it at such an early age. This young man was heartbroken – how was he ever going to meet and court young ladies with a bald pate?

Fortunately, this young man happened across an advertisement for Rogaine, the miracle baldness cure from McNiel Labs. After a quick visit to his family doctor, he soon began a Rogaine regiment to combat his folliclely-challenged condition. Lo and behold – the Rogaine worked! He soon was sporting a full head of hair.

Unfortunately, that was all he was sporting.

Sadly, the young man failed to read the fine print on the Rogaine label. It seems that a potential side effect of this super shampoo is male impotence. So, even though he was now able to attract the opposite sex with his lustrous mane, he was unable to, er, close the deal, so to speak.



Bummer. All dressed up and no place to go. At this point, his story kind of sounds like a modern day O. Henry tale, doesn’t it? Kinda like ‘The Gift of the Magi’, except that the Magi has been replaced by a smiling pharmaceutical rep.


Sadly, the story doesn’t end here.

Disheartened and frustrated, the young man had a tough decision to make – Did he want to be known as ‘Curly’ or ‘Woody’?





After much contemplation, he decided that ‘Woody’ was the nickname for him. Perhaps he would never capture the heart of his dream girl with his shining tete, but at least he still would have other options (even if those other options left him blind). Besides, perhaps there were some young ladies who were Yul Brynner fans who would like his new look!



So, he stopped using the Rogaine, and waited for his hair to fall out and his best friend to wake up. But it was not to be.

Apparently, even further down in the fine print of the Rogaine label, they mentioned that the male impotence can sometimes become permanent, and this young man discovered that ‘sometimes’, for him, was now. And our little O. Henry story now begins to sound like something out of the twilight zone.




Faced with bald, flaccid future, this young man became extremely depressed. So depressed, in fact, that he decided to voluntarily dispatch himself from the planet at the age of 21.

This is a tragic tale, but a precautionary one as well. While modern medications can be lifesavers for those patients with serious or even life-threatening conditions, are they worth the risk of potentially serious side effects? Are you really willing to risk impotence just to get a fuller head of hair? Is it worth losing your large intestine just to have a clear complexion? Or risk high blood pressure in order to overcome your shyness?

Madison Avenue would have us answer ‘yes’ to these questions. Television commercials and print advertisements naturally show the up side of these medications while downplaying the potential for disaster that many of these medications represent. Drug information packets are written in language that the average person would have difficulty understanding, even if they were resolved to forge their way through all of that fine print.

However, once properly educated, I would think that most of us would answer ‘no’, especially when we are deciding whether or not to take these ‘vanity’ pharmaceuticals.

But, As Dennis Miller often said, that's just my opiniom. I may be wrong.


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Blast From The Past

I remember this PSA (Public Service Announcement for those of you who never had kids in the TV Tech Department) from way back in the 1970’s. It was always one of my favorites:




I always wondered whatever happened to the fellow who played the magician in this classic commercial - until the other day when I was in one of my client’s medical offices. I happened to over hear the presentation of an older pharmaceutical rep.




Yes, he was now much older and silver haired. His voice had deepened with age and was a bit raspy. Yet, his pitch to the doctor was almost identical. Especially when it came to how he answered questions about harmful side effects.

The other thing that makes me smile about this commercial is the kid’s answer about marijuana:

“They’re not sure about it. They just started studying about it”

40 years down the road, and the opponents of Medical Marijuana are still using this very same line. I guess you got to stick with what works. It’s interesting how modern pharmaceuticals, cooked up in a chemical reaction vessel in a factory, take a little over 8 years to get FDA approval, yet a funny looking natural plant takes much longer to get approved and accepted. I guess you can’t be too careful with these things….

My final observation about this commercial is how I recalled feeling sorry for the magician at the end when all the kids just said ‘Nah!’, turned around, and walked away from him. I am happy to report that this no longer happens to the magician.

He now brings them a nice lunch, and free tickets to the ball game. No one walks away from Panera’s.




Goat cheese Paninis anyone?




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