Non-impartial doctors

Do I expect my doctors to be my best friends? No. But I do expect them to impartial and have no biases when treating me. I try to do my part - show up for appointments, take my medicines are directed, and take fairly good care of myself. I have had a few doctors which I have felt I didn't really gibe with but in my mind, I really want good care, not buddy-buddy.

A new study (because we always need new studies) shows that more than 40% of doctors state they have biases to certain groups. Some of those include obese patients, patients who do not speak English, or have emotional problems.

"The most common reason that doctors said they stereotyped patients was because of their emotional problems, which elicited biases among 62% of physicians, followed by their weight, which 56% of male and 48% of female physicians said provoked biases for them. Other triggers were patients' intelligence, language differences, insurance coverage, age, income level, race and attractiveness."

Hmmmm..... Well doctors are human beings and I think every person would admit there are just some people that make them recoil a tiny bit. I admit I am not perfect and have my own cringe factor for some people - like the scary homeless guy on the subway yelling obscenities. (I realize that their problems are probably worsened by lack of medical/psychiatric treatment and they should not be blamed for their issues but I just don't want to sit next to them.)

The problem is that when doctors have biases, whether conscious or subconscious, the patient usually gets a lower standard of care. That's a real problem. Its not ethical for doctors to provide for different standards of care for different groups but if its a subconscious bias, how do they stop themselves.

Insurer bias - or why insure (expensive) sick people?

One of the big issues with healthcare reform was so that sick people could be insured instead of being left hanging at the mercy of their insurance company. The act did eliminate pre-existing conditions from precluding someone from health insurance. But the jury is still out as to the bias issue.

Several groups are claiming that bias is creeping back into the insurance system. First patients try to figure out which plan is best for them. But the information on what drugs are covered and what are the co-pays for them are not on the top of the list of information.

For healthy people, this would not matter usually. But for us non-healthy people with potentially expensive medications, this does matter. I have one drug that my copay is $105/month. I consider that expensive. But its not. Some co-pays are in the thousands. If a drug is $80,000 or $100,000/year or more and the co-pay is 35% of the retail price, you can do the math.

I can see the issue insurance companies are facing. Sick people are expensive to take care of. Their medications can be very expensive. They require many doctor visits, and maybe surgeries, procedures, and hospital stays. Hospitals can negotiate with insurance companies to get discounted rates. But they don't seem to get anywhere with pharmaceutical companies in terms of negotiating prices.

Pharma companies claim that drugs take so long to develop and one in several hundred or thousands actually make it to market which is why that charge such prices. Then there are the whole positioning factors which come into list prices (this is true for everything from a candy bar to a car) as to what image they project. Expensive means it must be better. That is a whole other discussion that I have blogged about before and am sure I will again.

Back to the insurance companies. They put all these people into a pool and the premiums paid cover all the sick and healthy people. But the really sick, screw it up and can cost them lots of money. So insurance companies look for ways to cut costs and big ticket items, like expensive prescriptions, are on the top of the list.

And they hide the co-pays and things like that because its only in the details. And they say things like generics are this much, and branded drugs in this category are this, and the next category, and the next category, etc. And its not simple and easy to figure out.

To figure out what you would pay if you are sick, you can't just compare premiums, co-pays and expected number of visits from each company and get a number you think is the lowest. You need to call them and get them to tell you the costs of all your branded prescription drugs, plus you add in the number of expected doctor appointments, their co-pays, out of pocket maximums, and all those fun things. Then you get to decide. But its a lot of work.

Each year  you need to review where your drugs are in each little category and their new co-pays. And what if you need a new drug mid-year and it comes with a whopping high cost?

I don't think I blame the insurance companies but I think the data needs to be a bit more available for all of us sickies.

Sexist biology

Research on mice and other animals has historically been done on male lab mice. Because the female lab mice's cycles might mess up the scientific research. Hmmm...

This one makes me think. If all medical research is done on males, of course it is going to be biased. Just like when all legislators are male, women's rights lag.

So why the controversy? This has been a long running problem. As a layperson I have been aware of this for a few paltry decades. But now it is hitting the forefront as feminist biology is interfering and causing a few ruffled feathers.


So here's my layperson take on this. If all research is done on male mice so the little bitty mouse girly cycles don't interfere with the results, why do they think they can extrapolate and start using their findings on female anythings - from mice to humans - without complications.

It is known that some medications have different effects on males and females (take Viagra for the obvious example). Also at the end of years/decades of expensive research, the drug companies say they still need more years/decades of expensive research because their research didn't cover all potential groups who might benefit from the drug.

I know its a lot more complicated than that but if the basics of the research start off skewed, aren't the results going to end up biased? Let's start with a level playing field here.

#IStandWithLisa

In case you missed the ferfuffle in the land of cancer blogging and tweeting, allow me to fill you in. Ann also wrote about this and you can see her opinion over here as well.

Lisa Bonchek Adams has stage IV breast cancer and tweets a lot about her life with cancer. You can follow her @adamslisa on Twitter or her blog. She is living her life as best she can and talks about it on line through tweets and blog posts.

Then along came Emma, who we will call the Idiot for lack of a better term, who wrote for the Guardian and compared tweeting to funeral selfies - really? Hence the name. What she wrote was taken down by the Guardian after a day or two but you can read it here. (See things on the Internet never really go away).

The Idiot complains that Lisa tweets too much. Is that really possible? Some people have conversations and dialogues on Twitter so they might have a high volume of tweets. So what?

And the complaint that of over exposure on twitter becomes a funeral selfie? She is not dead so its not a funeral.

So anyway, the Idiot's column was posted and then many complaints were received and it was taken down because the Guardian said it did not meet their standards.

That was bad enough and then Mr Idiot (her husband) wrote for the New York Times comparing Lisa's fight to I'm not sure what. He did talk about his father's death from cancer in England a few years ago and medical costs but it was fairly pointless in my opinion.

When I first read these articles and the blog posts about them from others in cancer land, I wondered have these two journalism professionals (Mr. and Mrs. Idiot) ever bother to talk to Lisa directly? I do not think so. I could be wrong but their writings were not about Lisa but about her tweets. In professional journalism, isn't it appropriate to contact the subject of their writings? I mean again I could be wrong but in terms of verifying information and all that, isn't that correct?

So I stand with Lisa on this. And Mr and Mrs can go take a hike.