LET'S TALK ABOUT YOUR MONEY AND FAMILY

IF  AMERICA’S  AFFORDABLE CARE ACT IS GUTTED BY ONE POLITICAL PARTY,  AND YOUR YOUNG ADULT SON OR DAUGHTER BECOMES  SERIOUSLY ILL, WILL YOU HAVE TO CHOOSE BETWEEN SAVING YOUR CHILD’S LIFE AND  BANKRUPTCY?

Read this report, decide what's right for you and your family, and vote accordingly.

 TAILORING DIAGNOSIS AND TREATMENT OF DISEASE TO THE PATIENT GENETICS  - WHO WILL PAY?

"CONCLUSION. . . .
We have provided this information for CMS’s use in setting Medicare coverage and payment policies for genetic tests. Because State Medicaid programs and private health insurance plans closely monitor Medicare’s coverage and reimbursement decisions, CMS’s formulation of reimbursement rates for genetic tests may be useful to them. As one official from a State Medicaid program remarked, “Additional guidance from CMS on genetic testing would be very helpful. We have struggled with payment of such tests for the last couple of years ...."

HOUSTON DAYS

My Houston days have been busy, filled with appointments, consultations, radiographic procedures technical simulations for complex procedures, chemotherapy and a host of other activities which measure the scope and extent of my metastatic malignant melanoma and determines whether the disease has spread, notwithstanding vigorous efforts  to establish systemic control. From my perspective as a physician who, earlier in his career, worked with other "specialist" physicians to treat metastatic cancer of various types and stages, the team work and coordination that I observe here at MD Anderson Cancer Center, is highly reassuring.  Knowledge of, and adherence  to established professional standards is evident in each physician patient (or physician health care provider) contact,communication and discussion.


So far, I have been unable  to obtain access to one of the newest drugs which  stimulates the immune system to kill melanoma cells.  It is not clear when - and if - that access will be available. I will inform my readers of developments in this area.

MD ANDERSON
Last week, I went to Houston, Texas where I was seen by highly skilled, involved, competent physicians associated with MD Anderson's Cancer Center. Neither my time, resources or energy were wasted as I (with my spouse and a son)  saw thoughtful knowledgeable consultant after consultant, visited the laboratory for highly refined tests not generally available elsewhere and the radiologic service for a scan which had not been done before but which was important for the consultant's planning of future health care treatment and procedures for me.

MD Anderson is incorporated in a health care neighborhood, hospital next to hospital, clinic next to clinic and facilities readily accessible to patients and their families.  Patients' and their families' needs are carefully considered as clinics, labs, imaging centers, food services, and even transportation and social services are made accessible and appropriate.  Although the building are on a large scale, it seems as if every effort has been made to consider the patient  - and patients' families -  in the focus.  The environment feels large, but the patient remains the attention point of the physicians, house staff trainees, nurses and staff who provide the important human element of care.

Not everything could be concluded during my actual presence at MD Anderson in Houston.  But I felt satisfied that major steps towards understanding the complex issues I present as a patient were made, that attention had been paid by skilled physicians and staff, and that I would receive an appropriate set of recommendations when they had discussed and considered my medical issues.  Was I  guaranteed a cure? No.  Did I feel that I received proper medical care and consideration in this early stage of my MD Anderson experience? Yes.  Based on my experience would I recommend the MD Anderson Melanoma Center? Yes.

A LOT IS GOING ON

Melanoma is not a disease that stands still, and as it moves into its more aggressive phase, planting metastases hither, thither and yon, it is essential to have opinions from a variety of experienced physicians in different medical disciplines regarding treatment options, prognosis and expectations.

So, during the last several weeks, my physicians have been collecting scans and laboratory data and tissue samples and doing those things which help shape their professional opinions as to what's next.  I have been impressed by the strong advocacy positions expressed by my physicians, not in their interests, but in mine.  E-mails, telephone calls, and messages (including consultations) from my physicians, and their staffs, have been enlightening and valuable.

Family, close friends and the communities in which I function have been outstanding in their support and realistic encouragement which makes my days more meaningful and endurable. I hope that each person suffering from an aggressive malignancy experiences the types of  personal contact which I have gained. That support and contact is not a cure, but is an essential component of helping me to live with a bad disease.

I expect to have some new experiences in new venues shortly. I will share some of that information with my readers.

QUERY: Are you wearing a hat outdoors and applying sufficient sunscreen?

HIGH PRIESTS AND PHYSICIANS

The genetic patterns, Torah documentation, and experience, going back more than 3000 years, are consistent. Our family line was charged, not only with priestly functions, but with the ethical, moral, diagnostic and therapeutic functions of physicians.  Lepers were our responsibility, and in a sense, modern-day lepers remain our responsibility.

In the DeNardo lecture series, at Santa Clara University last night, Stanford's Abraham Verghese, MD, brought this long tradition into current practice.  His emphasis on the human values of focused concentrated listening to, and observation of, patients through touch, emotional contact, and allocation of time and attention were not in conflict with our electronic age. Verghese recognized electronics, computers and many other modern technologies as adjuncts (sometimes distractive) to care, rather than as the essence of care.  Patient care requires humanity, maturity, exquisite professional knowledge and a willingness to take the risks of professional closeness.

Verghese merged the priestly and physician function required to properly care for patients, continuing the tradition which has produced great doctors, comfort and healing, and appropriateness of care and resources.  The message is old and contemporary.

GIVE AWAY A HAT AS A FOLLOWUP TO EARTH DAY

No high cost, complicated medical procedure.  Just a simple gift to a family member or friend or someone you meet on the street.  Give that person a hat, a black hat a white hat, a red hat, a nice hat or an ugly hat. But be sure it has a wide brim and protects against ultraviolet radiation which causes melanoma, a disease which will strike 70,000 Americans this years.  Don't give away your baseball cap - throw it away because it doesn't protect the sides of the face from damaging environmental UV radiation (particularly against the sun that comes in through your side car windows). Your gift can protect against a serious fatal environmental disease, has no side effects, doesn't make people fat doesn't raise the cost of health care or taxes, and will protect someone you know and may love.  I just gave a hat to a family member.  Next, I'll put a tube of sunscreen aside as a followup gift.

Do it.  And put your own hat and sunscreen on!  It's an act of love!