A QUESTION TO ASK YOUR DOCTOR

Imagine that you are in your doctor's office and the doctor proposes to send you for an expensive high technology test. or even a series of blood or urine tests at the laboratory.  What questions should you ask, and of those questions, where should you start?

The first question that I suggest you ask is: "doctor, how will the results of this test affect the recommendations you will make or treatment you will offer?"  If the doctor can't answer that question, the test should not be done.  Your high technology test, or blood specimen, should be critical to the physician's decision-making process and the outcome of the test should be an important treatment issue.  Technology tests often involve radiation or other potentially toxic exposures and there are small, but real risks associated even with what seem to be"simple" blood tests, not the least of which is an erroneous result which results in more and riskier testing.


If your physicians seems to be offended by your question, find another doctor.  You have a right to know the answer before you expose yourself to the expense, inconvenience and risk of what may be an unnecessary testing procedure.

More About Diabetic Meter Control Solution

I sent the postcard back to my heavily advertised diabetes supply vendor, but before receiving it they called me to ask if I was ready to reorder. As my telephone contact went down the list, I said I did not want her company's brand of glucose meter control solution because I had problems with it (accuracy) and had spoken with the company's quality control department.  I asked for the meter manufacturer's brand of control solution but was told that the vendor only supplied its own brand and if I didn't want their (?defective?) brand, they wouldn't supply me with the control solution at all.

If you are diabetic, you know that frequent accurate testing and control of blood glucose prevents heart attacks, strokes, kidney damage, hypoglycemic coma and other serious injuries.  The control solution is an important element in informing you when your meter or testing strips are producing errors which may result in serious, expensive and preventable patient injury. 

Contrary to the company's promise, no one from their quality assurance department had given me additional information about their investigation of my complaint.  I guess that no one from the FDA reads my blog since I haven't heard from them, either.  Nor from the Inspector General's Office of Legal Counsel.

So, who is minding the store on quality and value for price of the products which the federal government is paying the vendor to supply to Medicare beneficiaries who are diabetic? 

If you have had similar problems with  vendors of Medicare-funded diabetic supplies, I strongly urge you to contact Medicare directly (see the link above).   Maybe if enough people call, someone will pay attention to be sure that the federal government, and its Medicare population, get the quality of diabetic test supplies they deserve and pay for.

Diabetes: Beware of Your Glucose Meter Control Solution

Today, I received a call from a reputable medical supply distributor's quality assurance person in response to a letter I sent complaining that their brand of control solution for a nationally distributed brand of glucose meters and test strips gave lower values than the name brand manufacturer's control solution. While this might seem like a minimal technical issue, it has practical implications for patients who work hard (and shed blood in the process) to maintain "diabetes control" - by keeping their blood sugar within specific ranges.  Too high, and kidney, visual and neurologic problems may develop; too low and the patients may suffer strokes or pass out.  When patients and their physicians cannot easily tell whether glucose meters are accurate, or how inaccurate they are, trouble follows.

The conversation led me to conclude that the company was not communicating well with its customers and lettering them know up front, clearly and unequivocally that there was a problem with its control solution. Someone in the company had made the decision to obfuscate and should take public responsibility. Meanwhile, patients, physicians, Medicare (as a payer) and the FDA should ask: what is going on here?  Diabetes is a common, potentially fatal and incapacitating disease which costs patients, insurers and the federal and state governments billions of dollars each year.  Let's get the diabetes glucose monitor control solution issue resolved.

Means Testing For Medicare?

I didn't have to wonder too long why the Sunday, July 20, 2008 New York Times felt so light in weight. It was the trial balloon by Tyler Cowen (professor of economics at George Mason University) at p.4 in the business section.

Cowen focuses on and endorses a proposal by Peter Schuck of Yale Law School to use means testing to reduce the Medicare deficit and reallocate funds to the poor. He argues for tying the size of Medicare benefits to a person's lifetime income, which he describes as ". . . relatively easily measured and hard to game, rather than to one's income or assets in any current year." Cowen pays no attention to the vicissitudes of life (well described by Restoration and later English writers) which demonstrate that past earnings do not guarantee present solvency or a high station.

Cowen implicitly blames those who have worked productively for the high costs of Medicare and gives them no credit for the increased federal, state and local taxes they paid. While it may be politically expedient to point the threatening finger of blame at this group, to save really large sums, why don't he and his colleagues look at cost shifting by employers and insurers to Medicare, the rise of for-profit hospital systems, the failure of Medicare Part D benefits to take advantage of competitive bidding for supplying pharmaceuticals, the inclusion of unscientific and irrational services and systems of care in Medicare, and gaming of Medicare and Medicaid by the states.

Careful public inspection and discussion will deflate this trial balloon. Right now, it seems to be filled with political hot air.