AMSA @ Weber St.

Another Year Under our Belts

2011-04-26T18:39:00.000-07:00

Well, it is the end of the school year, and we had a great one at AMSA. We have had a lot of great speakers, from malpractice lawyers to med school students to our own Vice President Aaron Hackett (great presentations by the way). The officers want to thank everybody who was a part of AMSA this year, the club would not have been successful without you guys. We also want to thank all of the speakers who took the time out of their busy schedules to speak to us. We all learned a lot from each of you.

We had a great end-of-year social playing billiards and eating a ton of pizza from the Pie. We also elected the new officers for the year 2011-2012.

The new officers are:

President: Taylor Norton
Vice President: David McAdams
Secretary: John Stanger
Treasurer: Josh Hall
Publicist: David Garner
Historian: Brayden Jensen
Preceptor Corrdinator: Ben Saxey

Congratulations guys! You all have a great opportunity ahead of you and I implore you to make the most out of it. The club is only as great as you guys are willing to make it.

We still have one more activity for the year, and it is the highway cleanup. This will be on Wednesday, April 27 at 9:00 a.m. at the Weber Park and Ride. hope to see you all there.

Once again, thanks to everyone who made the club a great success this year. Here's to a great summer break!

Opthamology!

2011-02-13T16:22:00.000-08:00

Last Week we had Dr. Scott Sykes, M.D. talk to us. He spoke about the things that influence a persons choice to go into medicine as well as the ophthalmology specialty. His talk was very informative and provided some great incites for aspiring doctors about whether medicine is the right choice or not.

His main message about deciding whether medicine is for you or not is to do the research and actually experience what it would be like to practice medicine. He said that shadowing was very helpful for him and I know from experience that it was helpful for me as well. No one knows exactly what it will be like to be a practicing physician until they are in that place in their lives where they are actually practicing, but shadowing a doctor or two (or three) is probably the best way to see what it is like for students like us. I highly recommend it and so did Dr. Sykes.

He next talked about ophthalmology and specialties in general. He had some great advice about choosing your specialty and the though process behind it. I know that I myself do not really know what I wasn't to specialize in, and Dr. Sykes helped me feel better about this position. He mentioned that it is not necessarily in your best interest to choose what you want to do before you go to med school. In fact, a lot of people think they know what they want to specialize in until they get into their third and fourth year in med school and experience all the different areas of medicine that they were not exposed to until that time. The message was to be open minded and to look at all aspects of each specialty and how the lifestyle for each specialty would best fit you.

We want to thank Dr. Sykes for speaking to us. Also, next week we will have Dr. Peter Clemens, D.O. come and speak to us. See you all there!

Pros and Cons of Practicing Medicine

2011-01-31T12:19:00.001-08:00

Last week we had Dr. Mark Baxter speak to us. He had a lot to say about practicing medicine. He gave us a good look at some of the not so great things that come with the job such as malpractice suits and a busy schedule. These things may sound awful, but for those aspiring doctors out there it is important to recognize that these things do exist in this profession. Dr. Baxter mentioned good things about practicing medicine as well, such as saving lives and improving peoples quality of life on a day to day basis.

Overall the lesson to be learned from this presentation was that to become a doctor we need to accept that there is going to be bad experiences as well as good experiences and that is going to be unavoidable. If we make the best of the situation good things will happen, and if we can't, then maybe we should choose a different profession. I hope that all of you pre-med people out there can take this lesson to heart and accept all aspects of the profession and make a difference!

Through the Eyes of a D.O.

2011-01-23T12:07:00.000-08:00

This week we had James Aston speak to us. He is a fourth year student at PCOM, or the Philadelphia College of Osteopathic Medicine. He provided some great insight about the whole D.O. way of medicine and also discussed what it is like to go the military route for med school. Mr. Aston discussed how D.O.s are trained not just in traditional medicine but also in the "manipulative" part of medicine, and in a lot of cases have more at their disposal when practicing then an allopathic trained physician. He emphasized that going D.O. vs M.D. is really up to the individuals preference and that you can have great success in either program.

One great example he gave about osteopathic treatment was that of using this technique in patients who have some type of infection in their body. To speed up the healing process, a D.O. can open up the patients lymphatic pathways through a manipulative procedure (which is all hands on and non-invasive) to allow the white blood cells to get to the area of infection faster and clean it up. He provided a few more examples that were very interesting as well.

We want to thank Mr. Aston for taking time out of his busy schedule and speaking to our club. He also gave us his contact information in case anybody wanted to ask him questions about D.O. training or the military experience through and after med school. His email is jbaJSA@gmail.com.

Next week we will have a primary care physician DR. Mark Baxter, MD speaking to our club. Hope to see you all there!

SPRING SEMESTER

2010-12-24T12:18:00.000-08:00

Our new meeting time is Tues at 12:30 in room LL130. Starting January 11 with social activity. We hope everyone is enjoying their Christmas break!

The Home Stretch

2010-12-02T06:51:00.000-08:00

As this semester winds to an end, we wish everyone the best. Thanks to everyone that has participated last week in the suturing workshop. Dr. Chung gave a great presentation and had some great tips on how to improve our technique.

Yesterday, Dr. Trask gave us some tips on writing our personal statements for our applications. She told us to start early and to make a list of all our activities and achievements. Decided what attributes or topics that you wish to display to medical schools. This is very important because readers must want to continue reading and be interesting enough that they will want to interview you.

Good luck with finals and have a happy holidays!

PA, ENT, and pigs feet

2010-11-20T06:33:00.000-08:00

AMSA at Weber State University has had some great meetings lately.

We had a physician's assistant from McKay-Dee Hospital come and speak to us about the how physicians and PAs work together. Also, she explained about who PAs were, their pros and cons, and compared them with other healthcare workers like nurse practitioners.

Some highlights from her message included that PAs in her office had great autonomy and while this varies from clinic to clinic it really depends on the doctor they work under and state laws. Some of the pros of being a PA include the ability to move around between specialties without needing extensive training (i.g. residencies). She also mentioned that she gets to focus more on the patients that she sees and doesn't have to worry about running the clinic or paying malpractice. However, she said that if she was in our shoes, as students, she would recommend us go all the way to medical school.

Also, Dr. Schuller an ENT doctor from the community spoke to us about getting in to medical school and the life of a ENT doctor. Dr. Schuller spent three years on the admissions board at Dartmouth where he went to medical school. He told us that all of us are unique and that we need to show that to medical schools, because when they go through a hundreds of applications they need something to remember us by. He also told us that coming from a small school like Weber State we are at a disadvantage and that we should rock to MCAT to displace any grade inflation due to WSU's small size.

Coming up next week we have the opportunity to learn some suturing techniques! Reps donated suturing equipment and the club is buying pigs feet from the market so that Professor Chung, M.D. can teach us some suturing techniques. It should be sweet, if you haven't signed up email us and we will see what we can do. Don't miss it this Wednesday 11-24!

APPLYING Spring or Summer 2011

2010-11-18T09:59:00.000-08:00

If you are planning to apply Spring or Summer of 2011 and did not make it to either of the MANDATORY APPLICANT MEETINGS you will need to contact Dr. Barbara Trask or set up an appointment as soon as possible. This is the beginning of the application process - DO NOT DELAY!!!

TO SET UP APPOINTMENT CALL SUSAN: 801-626-7755

or e-mail DR. TRASK: btrask@weber.edu

GET ON TOP OF THIS BEFORE IT
SLIPS OUT FROM UNDER YOU!

FREE PRACTICE MCAT!!!

2010-11-18T09:54:00.000-08:00

This Saturday Kaplan is offering a FREE practice MCAT on Weber State's campus. It will begin at 10:00am and is located in Lind Lecture 130.

Click here to register for the exam!

What it takes to be an ER physician

2010-11-08T06:43:00.000-08:00

This last week we had the opportunity to hear from Dr. Croft. He is a local ER physician that gave us some pointers on the current changes in medicine and some advice on how to be a good physician. Dr. Croft was very optimistic about the use of technology in medicine, and worried about the increased debt load of new physician and the increase in malpractice suits. He also gave us some pros and cons about emergency medicine, noting that you must look at yourself and understand what you are good at to see if you are a good fit.

Finally, he gave some advice to anyone looking into medicine. 1) Must enjoy working with people, hard work, and be smart enough to handle the challenges of medicine. 2) He recommended getting a background in finance, business and accounting. 3) Be opened minded, with respect to your ultimate specialty choice. 4) Don't put off happiness for some arbitrary date. In other words, those that are happy now in life will be happy in the future. There is always something on the horizon, and we should not put off happiness till after we finish our undergraduate, medical school, residency, or whatever. Be happy now.

Medical Malpractice and Classes

2010-10-20T17:13:00.000-07:00

Over the last two weeks we have had some awesome speakers. Last Wednesday we had a Jack Helgesen, a malpractice attorney come and speak to us. He spoke about both the process of malpractice suits, and how not to be sued. He had great statistics and a tons of information. He gave some great advice at the end on how not to be sued. He said the key was to be honest and humble, doctors who are liked by their patients are not sued.

Today we had a guest speaker talk about Kaplan's test prep program, and offered a $300 discount to AMSA members. If anyone is interested contact an AMSA officer. Dr. Trask then took up the remainder of the time informing us of a new and upcoming class being offered in the Spring. "Life in Medicine" will be a one credit, pass/fail class offered Thursdays 7:30-8:20. Two local surgeons, Dr. Goff and Dr. Moesinger, will teach the class and discuss everything from getting in to medical schools, to current problems in health care, to everyday activities of a physician. It should be a super class, look for it when you register Chem/Zoo/Micro 1810!

DAY OF THE DEAD @ U of U

2010-10-11T13:09:00.000-07:00

CLICK to download the APPLICATION

MCAT and Science Saturday

2010-10-04T08:50:00.000-07:00

This last weeks meeting focused on different methods to prepare for the MCAT. We had some outstanding students inform us about the pros and cons of Altius, Princeton, Kaplan, and self prep study. The bottom line was that the most important thing is to know yourself and your study habits.

Saturday we had great time teaching kids about viruses and bacteria. Some of our students made a slide show of bacteria, viruses, and how they compare in size to a hair. The kids enjoyed it while they made bacteria and viruses out of craft supplies.

Guest Speakers

2010-09-27T11:44:00.001-07:00

Last week was a very busy week for us!

During Wednesday's AMSA meeting we put the finishing touches on our Science Saturday project. Science Saturday is October 2nd, this Saturday from 12-5PM, come help us build viruses and bacteria with the kids.

Wednesday night we had a meeting with Dr. Samuelson. He is the Dean of Admissions at U of U. He spoke about the 8 criteria that the U looks at to determine interview candidates. Applicants must be "average" in five out of the eight areas; GPA, MCAT, extracurricular, community/volunteer service, leadership, research, shadowing, and patient exposure.

Thursday night we had a meeting with Gina Moses, the assistant director of AACOMAS. She spoke about D.O. programs and had a couple recruiters from D.O. schools around the country with her.

Friday we were able to listen to a former alumni speak about pediatric neurosurgery. Jodi Smith, M.D., Ph.D. spoke about her background and her decision to be a surgeon. She then shared many wonderful case studies with us. She had some awesome videos and stories!

Highway Cleanup

2010-09-21T06:36:00.000-07:00

We had a great time cleaning up our stretch of I-84 last Saturday. We had a good turnout and filled up about a dozen bags of garbage. Also, while every good deed deserves another, those who stayed around afterward had the privilege of partaking of Dr. Trask's home-cooking.

Wednesday, Sept 22, we have the oppertunity to hear from Dr. Samuelson speak about admission into the U of U. The meeting will be at 6:30 PM in LL130. The next day, Sept 23, Gina Moses will be speaking to us about the AACOMAS application. She will give us the ins and outs of applying to DO schools. The meeting will be at 5:00 PM in LL130. Hope to see you all there!

Interview Skills - Greg Nielson

2010-09-15T12:56:00.000-07:00

This week we had Greg Nielson from Career Services go over interview skills. There were handouts and great information presented. One of his "take home messages" was that no matter what question is asked, it all leads to three questions. 1) Would you fit in to our school, 2) Would you succeed, and 3) Would you be a good doctor. Thanks Greg, and good luck to all those that are interviewing this year!

Reminder of the "Blood and Guts" meeting tonight and the highway clean-up activity on Saturday.

Bowling Social Fall 2010

2010-09-02T11:31:00.000-07:00

Thanks to all those that participated in the opening social. We enjoyed bowling, pizza, and good company. We had a good turn out and ate 13 of the 15 large pizzas. Information on joining was distributed along with schedules for this semester's meetings. Pictures are on facebook, look us up by searching "AMSA at Weber".

Admit when you aren't ready

2010-02-25T10:42:00.000-08:00

Hey everyone,

This is another continuation of the MCAT suggestions. So yesterday I decided to postpone my exam date, I'll be taking it in Vegas though, so big money, big money, no whammies. SO... there are several factors going into this decision

not enough time to cover all my course material
unfamiliarity with old material
sense of impending doom
and I'd rather take the test at 1pm than 8am

This will probably be an issue for most to take it even though you don't feel ready or push it back and delay your app. If you signed up for an April or early May exam, postponement probably won't hurt you as much, so just be aware. And very important, you really don't want to take this test more then once and you want to score well, so rushing it may lead to a bad score and a retake. Just now when to admit you're not ready, I've been putting in 3hrs a day studying and it just doesn't feel like enough and for me it just seems more beneficial to wait and if nothing else just make me more confident in myself.

If you do decide to postpone, just know that seats go fast, you will probably be taking it out of state, so if travel is an issue then take that into consideration and just know yourself, if you feel depressed about a score, but you know you can put in the time then go for it, but if you feel unprepared (one of the reasons people bomb the MCAT) you might want to consider a later date.

And Here We Go

2010-02-14T15:25:00.000-08:00

It's been to long,

So it begins again, another semester and I'm behind once again. So unfortunately due to some scheduling issues I'm unable to make it to most meetings this semester :( have no fear though I will still do my best to keep you informed of upcoming events and club activities. For instance we have a contest set up between the college of science and the college of health science to see who can collect the most items for St. Anne's. We've chosen a theme that's pretty fitting, Go commando and donate your underwear. We're looking for family items like underwear, socks, shirts, diapers, and stuff in that nature. The contest will run until the end of February so get donating people.

Second I thought it might be helpful to kind of explain and give advice on prepping for the MCAT. I know we tried doing something like that for you guys during fall semester to let you guys know how other people did it, but this hopefully will be a little more in depth and useful. First off know when you want to take the MCAT: April, May, June don't wait until January to schedule it, most spots are filled and you may lose the date you want. Also going along with this you probably should apply as soon as possible don't wait until August or September, remember they start giving interviews out in like September, October and you have to fill out secondaries, which I've been told takes time, your transcripts have to be received, which can take up to a month, so look at the facts you are probably more likely to be accepted if you apply early than late just keep it in mind.

Prepping for the MCAT is a bitch ask anyone who's done it, you will spend more time studying and taking practice tests for this one test than any class you have taken ever

ex) average study time per student 20+ hours a week, actual study time not BS study time.

It will be tiring, it will get boring, it will make you hate yourself, but remember a good MCAT score is a necessity to getting into medical school. We gave a couple of options for prepping one was studying on your own, K there are people who can actually do this, these people are incredibly smart and they have an amazing grasp on the material. Notice how I said grasp on the material not they got good grades, good grades will not help you on the MCAT, an A in OChem or Bio isn't going to amount to anything on the MCAT if you don't understand the principles. This particular aspect is the only criteria I'm giving for studying on your own, if you think you're a bad ass and can do it on your own please don't cause you're not. If your worried about the price of a prep course, don't you think it would be worth $2,000 to get into medical school. Please though don't think that once you pay the money you automatically get a 33 you still need to put in the effort to get there.

So I mentioned prep courses as an option and yes please do one of these, but do your research find out from past students who have taken the class if it's worth the money. I personally went with Altius because so many people told me that I should just study on my own instead of taking the Princeton Review course, I'm not knocking the course or the teachers this was just what I was told. Kaplan is another option and there might be another course out there that I'm not aware of, but that's for you guys to find out.

I personally like Altius, their approach to the MCAT seemed weird at first, but I'm definitely improving. They give you a tutor who's smashed the MCAT, so these guys know what's up. I'm always shocked at the people saying I can do it on my own I'll be fine, cause I did as well or better and I don't think I'll be fine. Just a depressing fact the average score on the MCAT is 24-25 most prep course boast that their average is 30, Altius is 33. Yes I checked it out they actually do have an average score of 33, but remember this is an average some up, some down. I think there success is a lot like Weber's success at getting students into medical school, they have very small class sizes, the tutor will learn your name, you study as a group so no one falls behind, and they push the crap out of you to do your best, so my simile fits :) If you need help take a course is all I'm saying, the reason you go to college is you want to learn from people who know more than you, why would you think studying for the MCAT is any different.

Lastly, The MCAT is a different beast than any other test you've taken, you've heard it before cause it's true, you can't walk in off the street and do well you just can't. It's not a here's everything I know test it's a here's a problem use these skills to answer this question, without making too big of an inference. Sound confusing, good cause after a month of this is wrong because it's a hard qualifier and you probably made too big of a jump oh and my favorite don't answer these questions with outside information, only use the info they give you in the passage I think I might have had a break through. I'll leave you with what I feel is the reason most people bomb the MCAT: Overconfidence combined with Under preparation. You can do well on this test all it takes is commitment and remember this test isn't an end, don't think of it as an obstacle to overcome, think of it as a step to becoming a better physician, because the skills you learn from studying for this test are going to be very important throughout your career.

One more

2009-12-10T21:42:00.000-08:00

My services have been sequestered again,

Weber State Altius MCAT Course

Classes: Monday and Wednesday evenings at 7:00pm, beginning January 11th, 2010 (Lind Lecture Hall)
Tutoring Sessions: Arranged individually with your tutor according to your schedule.

Prepares students for any exam April thru August 2010, although a late May or early June exam is recommended.

Only 2-3 more spots available for new students. Call 435.671.5783 or visit www.altiustestprep.com to register. Remember that our AVERAGE score is a 33, and we offer a 14-day MONEY-BACK trial period.

Personal Statements

2009-12-06T19:02:00.000-08:00

It's finally here the last post of the Fall semester. For all those who are about to take their finals we salute you. This last week Dr. Trask talked about personal statements (very important). Your personal statement and your application are going to be the only thing admission committees will see or know about you. Your personal statement is the thing that makes readers want to meet you, so you definitely do not want to half-ass it. Your personal statement needs to show not tell the reader who you are, what's unique about you, and why you want to be a doctor. The best advice I've heard is:

Start early: Get it done over the winter break and set it aside for later that way you have time to study for the MCAT, gather all the materials you'll need to interview with Dr. Trask, and submit your application.
Never settle with your first draft: How many people are satisfied with your first paper or topic
EDIT: friends/family first, then writing center, then Dr. Trask

Lastly thank you all who were involved with the club this semester we appreciate the dedication and if you guys have friends who are thinking about medicine bring 'em next semester, meetings for next semester I believe are Tuesday's at 12:30. Peace

2009-11-28T21:50:00.000-08:00

What up dawgs,

Hope y'all had a slammin' Thanksgiving, last week we talked about sponsoring a family for Christmas. These are families that are unable to afford presents for Christmas. Think about how much Christmas meant to you as a kid and how much it would mean to these kids if they could have something to open up on Christmas. So if you don't want to be a Grinch this holiday season talk to Brooke and she'll let you know what we still could use.

Dr. Moesinger

2009-11-22T20:41:00.000-08:00

Hey all,

We were lucky enough to have Dr. Moesinger a general surgeon from McKay Dee hospital come speak to us. He mentioned that less and less physicians are calling themselves true general surgeons. We also got a brief explanation of why having gynecological issues in Ireland may not be such a good idea.

Things coming up:

We are sponsoring a family for Christmas this year
Next semester we are doing a food drive for the St. Anne's Center
and of course more things to come

Altius MCAT test prep

2009-11-13T21:42:00.000-08:00

Hey guys,

I was asked to post something about the Altius test prep course, I'm not saying its the best course or anything like that just giving you guys more info.

Hello Weber State Students:

Are you planning to take the MCAT? If so, you'll want to learn more about Altius Test Prep. We are now in the fifth year of our one-of-a-kind innovative program. We don't use the traditional lecture format. Instead, we've developed interactive approaches and one-on-one tutoring that are far more effective. Our average score is a 33, while around 1/3 of our students each year score a 35 or above (which is about 7-8 times the number who score a 35+ nationwide). One of our student last year scored a 42. We also had a 40 and many, many scores in the 34-39 range. A few short details are listed below.

PROGRAM DETAILS

Cost: $1790
Duration: Start now and study as long as you like thru May of 2010
Features: 20 Private 1-on-1 Tutoring Sessions; 32 Interactive Group Sessions; FREE Admissions Assistance and Essay Editing; Access to all AAMC Practice Exams; All Study Materials Included
Results: Our AVERAGE score among all students since 2005 is a 33.1. Our best students earn extremely high scores, with 4% breaking the 40 mark. That is exactly 10 TIMES the number of students nationally who get a 40+ (0.4% nationally).

Visit us at www.altiustestprep.com for more information, or call 435.671.5783.

Thank You,

Altius Test Prep

Hopefully this gives you guys a little more information and lets you make a little more informed decision. They are also looking into holding a class up here at Weber State they only need a few more students (3-5) to sign up. As always stay classy San Diego.

Communication...what did you say?

2009-11-09T20:48:00.000-08:00

Hey everyone,

This last week's meeting was about communication in the workplace, for us that's a hospital, but unlike paper jams and running out of toner we have to worry about patient death. Dr. Tim Trask was nice enough to take time out of his schedule and talk with us about how break down in communication within a hospital can be detrimental to a patient's health. Here's an enlightening fact healthcare is the 7th leading cause of death in America not smoking, not skydiving, us! How can that be? It all starts and ends with communication, if an order isn't clear or a chart is switched or even if coworkers are to intimidated to call someone on a mistake it can lead to patient harm. So remember kiddys its not just enough to be smart you need to know how to communicate effectively to treat your patient.

Halloween

2009-11-02T18:11:00.000-08:00

How's it going everyone,

Thank you to all those who helped out this saturday with Science Saturday, the kids seemed to really enjoy the animal parts, but really who doesn't. I believe we are doing it again so if you couldn't volunteer this time don't be shy and sign-up for the next one.

And Ryan wins the best costume contest, dude awesome.

Interesting Facts about Healthcare Reform

2009-10-27T12:37:00.000-07:00

Hey all,

For those of you who have been attending the healthcare reform information sessions these past few weeks, these are some interesting links to check out and learn more about healthcare reform. And remember there's still one more to go, this Thursday the 29th I believe this is a little more along the line of discussion (still not aggressive opinion), so if you have questions about healthcare reform don't be shy. The time is 7:00pm in Ballroom A in the Student Union and again it's this Thursday the 29th.

NY Times health care reform coverage--includes "Health Care Reform Navigator" with links to most of the sites below, as well as others
http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/health_insurance_and_managed_care/health_care_reform/index.html

Kaiser Family Foundation--health care reform page
http://healthreform.kff.org/

The White House--includes links to health care & reform issues, as well as others
http://www.whitehouse.gov/

HealthReform.gov--website operated by U.S. Dept.of Health & Human Services
http://www.healthreform.gov/

Frontline--T.R. Reid video, Sick Around the World:
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

5 Myths About Health Care Around the World

By T.R. Reid
Sunday, August 23, 2009; The Washington Post

As Americans search for the cure to what ails our health-care system, we've overlooked an invaluable source of ideas and solutions: the rest of the world. All the other industrialized democracies have faced problems like ours, yet they've found ways to cover everybody -- and still spend far less than we do.

I've traveled the world from Oslo to Osaka to see how other developed democracies provide health care. Instead of dismissing these models as "socialist," we could adapt their solutions to fix our problems. To do that, we first have to dispel a few myths about health care abroad:

1. It's all socialized medicine out there.

Not so. Some countries, such as Britain, New Zealand and Cuba, do provide health care in government hospitals, with the government paying the bills. Others -- for instance, Canada and Taiwan -- rely on private-sector providers, paid for by government-run insurance. But many wealthy countries -- including Germany, the Netherlands, Japan and Switzerland -- provide universal coverage using private doctors, private hospitals and private insurance plans.

In some ways, health care is less "socialized" overseas than in the United States. Almost all Americans sign up for government insurance (Medicare) at age 65. In Germany, Switzerland and the Netherlands, seniors stick with private insurance plans for life. Meanwhile, the U.S. Department of Veterans Affairs is one of the planet's purest examples of government-run health care.

2. Overseas, care is rationed through limited choices or long lines.

Generally, no. Germans can sign up for any of the nation's 200 private health insurance plans -- a broader choice than any American has. If a German doesn't like her insurance company, she can switch to another, with no increase in premium. The Swiss, too, can choose any insurance plan in the country.

In France and Japan, you don't get a choice of insurance provider; you have to use the one designated for your company or your industry. But patients can go to any doctor, any hospital, any traditional healer. There are no U.S.-style limits such as "in-network" lists of doctors or "pre-authorization" for surgery. You pick any doctor, you get treatment -- and insurance has to pay.

Canadians have their choice of providers. In Austria and Germany, if a doctor diagnoses a person as "stressed," medical insurance pays for weekends at a health spa.

As for those notorious waiting lists, some countries are indeed plagued by them. Canada makes patients wait weeks or months for nonemergency care, as a way to keep costs down. But studies by the Commonwealth Fund and others report that many nations -- Germany, Britain, Austria -- outperform the United States on measures such as waiting times for appointments and for elective surgeries.

In Japan, waiting times are so short that most patients don't bother to make an appointment. One Thursday morning in Tokyo, I called the prestigious orthopedic clinic at Keio University Hospital to schedule a consultation about my aching shoulder. "Why don't you just drop by?" the receptionist said. That same afternoon, I was in the surgeon's office. Dr. Nakamichi recommended an operation. "When could we do it?" I asked. The doctor checked his computer and said, "Tomorrow would be pretty difficult. Perhaps some day next week?"

3. Foreign health-care systems are inefficient, bloated bureaucracies.

Much less so than here. It may seem to Americans that U.S.-style free enterprise -- private-sector, for-profit health insurance -- is naturally the most cost-effective way to pay for health care. But in fact, all the other payment systems are more efficient than ours.

U.S. health insurance companies have the highest administrative costs in the world; they spend roughly 20 cents of every dollar for nonmedical costs, such as paperwork, reviewing claims and marketing. France's health insurance industry, in contrast, covers everybody and spends about 4 percent on administration. Canada's universal insurance system, run by government bureaucrats, spends 6 percent on administration. In Taiwan, a leaner version of the Canadian model has administrative costs of 1.5 percent; one year, this figure ballooned to 2 percent, and the opposition parties savaged the government for wasting money.

The world champion at controlling medical costs is Japan, even though its aging population is a profligate consumer of medical care. On average, the Japanese go to the doctor 15 times a year, three times the U.S. rate. They have twice as many MRI scans and X-rays. Quality is high; life expectancy and recovery rates for major diseases are better than in the United States. And yet Japan spends about $3,400 per person annually on health care; the United States spends more than $7,000.

4. Cost controls stifle innovation.

False. The United States is home to groundbreaking medical research, but so are other countries with much lower cost structures. Any American who's had a hip or knee replacement is standing on French innovation. Deep-brain stimulation to treat depression is a Canadian breakthrough. Many of the wonder drugs promoted endlessly on American television, including Viagra, come from British, Swiss or Japanese labs.

Overseas, strict cost controls actually drive innovation. In the United States, an MRI scan of the neck region costs about $1,500. In Japan, the identical scan costs $98. Under the pressure of cost controls, Japanese researchers found ways to perform the same diagnostic technique for one-fifteenth the American price. (And Japanese labs still make a profit.)

5. Health insurance has to be cruel.

Not really. American health insurance companies routinely reject applicants with a "preexisting condition" -- precisely the people most likely to need the insurers' service. They employ armies of adjusters to deny claims. If a customer is hit by a truck and faces big medical bills, the insurer's "rescission department" digs through the records looking for grounds to cancel the policy, often while the victim is still in the hospital. The companies say they have to do this stuff to survive in a tough business.

Foreign health insurance companies, in contrast, must accept all applicants, and they can't cancel as long as you pay your premiums. The plans are required to pay any claim submitted by a doctor or hospital (or health spa), usually within tight time limits. The big Swiss insurer Groupe Mutuel promises to pay all claims within five days. "Our customers love it," the group's chief executive told me. The corollary is that everyone is mandated to buy insurance, to give the plans an adequate pool of rate-payers.

The key difference is that foreign health insurance plans exist only to pay people's medical bills, not to make a profit. The United States is the only developed country that lets insurance companies profit from basic health coverage.

In many ways, foreign health-care models are not really "foreign" to America, because our crazy-quilt health-care system uses elements of all of them. For Native Americans or veterans, we're Britain: The government provides health care, funding it through general taxes, and patients get no bills. For people who get insurance through their jobs, we're Germany: Premiums are split between workers and employers, and private insurance plans pay private doctors and hospitals. For people over 65, we're Canada: Everyone pays premiums for an insurance plan run by the government, and the public plan pays private doctors and hospitals according to a set fee schedule. And for the tens of millions without insurance coverage, we're Burundi or Burma: In the world's poor nations, sick people pay out of pocket for medical care; those who can't pay stay sick or die.

This fragmentation is another reason that we spend more than anybody else and still leave millions without coverage. All the other developed countries have settled on one model for health-care delivery and finance; we've blended them all into a costly, confusing bureaucratic mess.

Which, in turn, punctures the most persistent myth of all: that America has "the finest health care" in the world. We don't. In terms of results, almost all advanced countries have better national health statistics than the United States does. In terms of finance, we force 700,000 Americans into bankruptcy each year because of medical bills. In France, the number of medical bankruptcies is zero. Britain: zero. Japan: zero. Germany: zero.

Given our remarkable medical assets -- the best-educated doctors and nurses, the most advanced hospitals, world-class research -- the United States could be, and should be, the best in the world. To get there, though, we have to be willing to learn some lessons about health-care administration from the other industrialized democracies.

T.R. Reid, a former Washington Post reporter, is the author of "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care," to be published Monday.

Accessed 10/23/09

(http://www.washingtonpost.com/wp-dyn/content/article/2009/08/21/AR2009082101778.html).

Revealed: millions spent by lobby firms fighting Obama health reforms

Six lobbyists for every member of Congress as healthcare industry heaps cash on politicians to water down legislation

Chris McGreal in Washington

guardian.co.uk, Thursday 1 October 2009 16.55 BST

America's healthcare industry has spent hundreds of millions of dollars to block the introduction of public medical insurance and stall other reforms promised by Barack Obama. The campaign against the president has been waged in part through substantial donations to key politicians.

Supporters of radical reform of healthcare say legislation emerging from the US Senate reflects the financial power of vested interests ‑ principally insurance companies, pharmaceutical firms and hospitals ‑ that have worked to stop far-reaching changes threatening their profits.

The industry and interest groups have spent $380m (£238m) in recent months influencing healthcare legislation through lobbying, advertising and in direct political contributions to members of Congress. The largest contribution, totalling close to $1.5m, has gone to the chairman of the senate committee drafting the new law.

A former member of Bill Clinton's cabinet says fears that the industry could throw its money behind the populist rightwing backlash against public insurance have scared the Obama White House into pulling back from the most significant reforms in return for healthcare companies not trying to scupper the entire legislation.

Drug and insurance companies say they are merely seeking to educate politicians and the public. But with industry lobbyists swarming over Capitol Hill ‑ there are six registered healthcare lobbyists for every member of Congress ‑ a partner in the most powerful lobbying firm in Washington acknowledged that healthcare firms' money "has had a lot of influence" and that it is "morally suspect".

Reform groups say vast spending, and the threat of a lot more being poured into advertisements against the administration, has helped drug companies ensure there will be no cap on the prices they charge for medicines ‑ one of the ways the White House had hoped to keep down surging healthcare costs.

Insurance companies have done even better as the new legislation will prove a business bonanza. It is not only likely to kill off the threat of public health insurance, which threatened to siphon off customers by offering lower premiums and better coverage, but will force millions more people to take out private medical policies or face prosecution.

"It's a total victory for the health insurance industry," said Dr Steffie Woolhander, a GP, professor of medicine at Harvard University and co-founder of Physicians for a National Health Programme (PNHP).

"What the bill has done is use the coercive power of the state to force people to hand their money over to a private entity which is the private insurance industry. That is not what people were promised."

PNHP blames a political process it says is corrupted by millions of dollars poured into the election campaigns of members of Congress and influencing the discourse about health reform by funding advertising campaigns, supposedly independent studies and patients rights organisations that press the industry's interests.

A primary target of criticism is Senator Max Baucus, the single largest recipient of health industry political donations and chairman of the finance committee that drafted the legislation criticised by Woolhander.

The committee this week twice voted against including public insurance in the legislation, with Baucus opposing it both times.

Baucus took $1.5m from the health sector for his political fund in the past year. Other members of the committee have received hundreds of thousands of dollars. They include Senator Pat Roberts, who last week tried to stall the bill by arguing that lobbyists needed three days to read it.

Baucus holds dinners for health industry executives at which they pay thousands of dollars each to be at the table, and an annual fly-fishing and golfing weekend in his home state of Montana that lobbyists pay handsomely to attend. They have included John Jonas, who represents healthcare firms for Patton Boggs, widely regarded as the top lobbying firm in Washington. Jonas, who formerly worked on the congressional staff, acknowledges that political contributions are intended to buy influence and says it works.

"It would be very naive to say they're not influenced. The contributors certainly hope they're influencing and the recipients probably ultimately are influenced," he said. "I think it's a morally suspect practice, and then you have to look at its application to see if it's morally bankrupt ... I think what's bad about the system is it's got more and more lax over time.

"When I started in this practice you did not talk issues at a fundraiser. It was impolite. And then with this need for money, the system has got coarser over time so that they go around the room asking what issues you're interested in, much more of a linkage of dollars to a discussion of the issues now."

The health industry permeates the process in other ways. At Baucus's side, drafting much of the wording of the reform, was Liz Fowler, a senate committee counsel whose last position was vice-president of the country's largest health insurer, Wellpoint, which stands to be a principal beneficiary of the new law.

Health companies and their lobby firms also recruit heavily among congressional staffers as a means of maintaining influence.

Baucus declines to discuss political donations but told Montana's Missoulian newspaper earlier this year that "no one gets special treatment".

Robert Reich, the labour secretary in the Clinton administration, says the Obama White House, mindful of how the health industry killed off Clinton's attempts at reform, has grown so fearful of industry money that it has quietly reached agreement to pull back from price caps and public health insurance.

"The White House made a Faustian bargain with big pharma and big insurance, essentially scuttling both of these profit-squeezing mechanisms in return for these industries' agreement not to oppose healthcare legislation with platoons of lobbyists and millions of dollars of TV ads."

The pharmaceutical companies are apparently pleased enough that they are now putting $120m into advertising supporting the emerging legislation.

Jonas described the bill emerging from the Senate as "in realm of what is politically possible".

"Is the bill overly distorted by money? I don't think it actually is," he said. "It's a good bill in the sense that it's a net improvement in the system ... [but] it's a bad bill if you think it's supposed to be a comprehensive solution to the US healthcare problems."

Accessed 10/23/09 (http://www.guardian.co.uk/world/2009/oct/01/lobbyists-millions-obama-healthcare-reform).

How The Modern Patient Drives Up Health Costs

by Alix Spiegel

October 12, 2009

The doors to the clinic had been locked for over an hour, and the last light in the sky was quickly fading when two eyes appeared in Teresa Moore's office window, followed by a sharp knock and a glass-muffled plea to be let in: It was a patient.

Moore walked the halls of her closed practice and swung open the heavy front door to a woman in her 30s, who staggered forward muttering, "Sorry." The woman was a regular — someone with migraines — so even though it was after hours and Moore had two children waiting at home, she waved her in.

Moore's family practice is in Keysville Va., the same small community where she grew up. Her patients are people who attended her baptism and helped at her wedding. So in some ways, Moore has a true old-timey medical practice. But in one important way, her practice is completely different:

Moore cares for modern patients. They're the people who come in with specific requests for medications and procedures. And oftentimes they get what they ask for, whether they need it or not. This consumer-driven health care is part of what's driving up costs across the country.

The Modern Patient

The patients come in quoting commercials they've seen on TV, requesting pills or diagnostic tests, describing new treatments for diseases they're convinced they have.

"Five or six times a day, people come in saying, 'I looked this up on the Internet.' Or, 'I saw this and I wonder if I could have this?' " Moore says.

Sometimes her patients are right; more often they're wrong, she says. But Moore isn't judgmental about their self-diagnoses. She views it as a natural response to the ocean of health information that surrounds every modern person, and relates it to her own experience in medical school.

"There's a syndrome in medical school they teach us about called 'medical student syndrome,' " Moore says. When medical students learn about a disease for the first time, it's common for them to become convinced, at least temporarily, that they themselves are afflicted.

"Every time you start reading about this disease, you say, 'Oh my god, I have that!' Then you read about another disease and you say, 'Oh my god, I have that, too!' " Moore says. "So, the same thing that triggers medical students to worry that they have these diseases is part of what triggers people watching television or surfing the Internet to believe they have these conditions. Continued re-exposure to suggestions of symptoms makes people look for things."

The problem, says Moore, is that it can take a lot of work to convince her patients that their own diagnosis is wrong. More accurately, it takes a lot of work with her younger patients.

"In the older population, there is a tremendously different dynamic," Moore says. "There's a lot more belief and trust in doctors." But not in younger patients. "In patients between 25 and 50," she says, "there is a lot more push to get what they want."

What Transformed Patient Behavior

Moore isn't the only doctor to observe this generational divide. The fact is that the behavior of patients in our health system has changed dramatically over the past couple of decades. They've transformed from passive "patients" who almost blindly follow the doctor's orders — until the 1980s, patients regularly took pills without even knowing what they were for — into active and aggressive "consumers" of health services.

Dr. Joseph Zebley, 60, is a family practitioner in Baltimore who has been in practice since the 1970s and has witnessed firsthand the remarkable transformation of American patients. He says it began as a trickle in the early 1990s. People slowly started showing up with their own ideas and research.

"It was the sort of thing that would be a bit of a surprise, and it would be the occasional patient," says Zebley. "But by '95, it was an established pattern. There was a palpable change over about five years."

A kind of perfect storm of three major factors produced this change. The first was direct-to-consumer advertising of prescription medications, which started slowly in the mid-'80s. Those ads drove people to their doctors asking about specific medications, and in the process, taught patients that they could question their physician and play a role in their own health care.

Then came the Internet, which put an endless amount of medical information into the hands of anyone with interest and a computer.

Finally, in the 1990s, attempts to save money on health care encouraged Americans to get treatment through health maintenance organizations (HMOs). The idea was that primary care physicians would be put in charge of patients and given a fixed amount of money for all care. This would give the doctor an incentive to improve the overall health of the patient, because the healthier the patient, the more money the doctor could keep. The system, however, led to more denials of tests, medications and operations, which, says Zebley, was shocking to patients.

"They became angry and started researching why they should get things," he says. "Because oftentimes, physicians — hate to say it — but the physicians were looking out for their bottom line, and if they withheld services they could make more money." And so, says Zebley, patients started going online. "It was very rudimentary then, but people also looked things up in the library and photocopied things from the library. [Then they'd come in and] say, 'I think I have this, I think I need this.' "

How Modern Patients Affect Modern Doctors

There are some very real benefits to this new and improved American patient. Many doctors believe that a more active patient is more likely to adhere to the doctor's medical directions, and can also help doctors by drawing attention to things that the doctor might have overlooked.

But there are also problems. For a variety of reasons, it's really hard for doctors to say no to patient requests, even when those requests are unreasonable, wrongheaded and potentially harmful.

For example, Zebley says that several times a week a patient comes in asking for a test that he is 99.99 percent sure would be a complete waste of time. But Zebley will almost always give the patient the test they request, even though he knows it will cost money and time. The main reason: malpractice.

"I'm in a position of risk if I blow them off and say, 'No, forget it, you don't have it, I'm not doing the test.' "

Of course, physicians like Zebley could take the time to explain to their patients exactly why the test or treatment would not be beneficial and educate them out of their desire. But because of the way our health system is structured, that's often difficult, too.

Take Moore, the doctor from Keysville, Va. She works incredibly hard to spend time with her patients — in fact, she does spend much more time with them than family doctors typically spend with their patients. Still, Moore says, time is limited.

"There is a drive to get people in and out because insurance reimbursement is very difficult," she says. "So even though it is absolutely wonderful to say we could spend 30 minutes with each patient and explain these things fully, sometimes you just don't get to do that in real life."

So doctors will order you tests you don't need. And they will write you prescriptions for pills you probably shouldn't take — which is a huge problem with antibiotics, for example.

And, Zebley says, doctors even do operations, like back surgery, that they probably shouldn't do. They do it, he says, because you want it, have become convinced that you need it, and doctors fear that if they don't give it to you, they'll lose you.

"The orthopedic surgeon would be ill-advised to say, 'Well, I'm not going to do [it],' because the person will go next door to the next surgeon who maybe is a little less ethical who will do it," says Zebley. "Being a hard-ass and always saying, 'No, no, no,' people will go somewhere else. They have a free market."

Patient Behavior And Cost

It's unclear how high patient demands drive up costs in our health care system. Moore estimates that about 30 percent of the costs in her practice are driven by patient requests.

Moore is not necessarily proud of this number. For her, at least some portion of it is an indication of her own inability to communicate adequately with the patients that she cares so much about. But she says there's not much she can do. She is, she says, truly overwhelmed by the demands of insurance paperwork.

"Sometimes you have to request a form just to get the correct form — you do. You have to fill out a form stating the preauthorization form that you need."

Moore says she stays at her office late into the night, trying to complete paperwork so that she is able to spend enough time with her patients during the day — enough time to explain why this test is probably not necessary, why that pill wouldn't be a good idea. And her children, she says, pay the price.

If you ask Moore if she would rather have an old-fashioned, passive and pliant patient or a new, demanding and modern one, she really has to think about it.

"It depends on the phase of the moon," she says. "Passive is much easier to treat. But I do like an educated patient who's willing to read about their health issues. So I guess I'd like someone in the middle."

Zebley feels similarly. He'd rather have a modern patient. The idea that patients need to be "wise, intelligent, informed consumers," is great, Zebley says. But he also says he knows full well how our new conception of what it means to be a patient costs society. "It leads to a lot of overuse of services."

Accessed 10/23/09 (http://www.npr.org/templates/story/story.php?storyId=113664923).

Selling Sickness: How Drug Ads Changed Health Care

by Alix Spiegel

October 13, 2009

David Couper went to his doctor after watching a small green creature jump up and down on the nail of an infected toe.

For Anne Nissan, a 17-year-old in Prescott, Ariz., the image that stayed with her was of a party. Women were on a roof in a city, pimple-free and laughing, utterly unbothered by the cramps that immobilized her once a month.

And then there is Samantha Saveri, a transportation planner in Baltimore. She remembers bunnies and the promise of digestive regularity.

Three different people in three different places were all driven to contact their doctors after watching an ad for a prescription medication on television. Each walked into a doctor's office with a specific request, and walked out with a prescription for exactly the medication he or she desired.

The Rise Of Prescription Drugs In America

Prescription drug spending is the third most expensive cost in our health care system. And spending seems to grow larger every year. Just last year, the average American got 12 prescriptions a year, as compared with 1992, when Americans got an average of seven prescriptions. In a decade and a half, the use of prescription medication went up 71 percent. This has added about $180 billion to our medical spending.

While there are more medicines on the market today than in 1992, researchers estimate that around 20 percent of the $180 billion increase has absolutely nothing to do with the number of medications available, or increases in the cost of that medication.

To understand this change, one place to look is Wilder, Vt. There, in a tasteful housing complex on the side of a mountain, is the home of Joe Davis.

Davis is retired now, but in his speech and manner it's easy to hear the breezy salesmanship that made him so successful. Davis was an adman: "I was trained — or I was toilet-trained as we like to say — in packaged goods," Davis says. "General Foods, Procter & Gamble — that kind of thing."

Until the 1980s, the kind of people who sold stuff like packaged goods were completely different from the kind of people who sold stuff like prescription drugs. In those days, drugs ads were for doctors, not the public. They were designed by people who worked at these small, technically minded medical advertising companies and targeted this small, technically minded audience.

"Nobody had ever thought that these drugs should be or could be advertised to the patients. It was just outside of people's brains," Davis says. "They thought that only doctors could understand the products. They're technical products. They're scientific products."

But it was more than that. There was a fear — shared by doctors and drug companies alike — that advertising drugs directly to consumers could be harmful. Both the drug companies and the doctors worried that even though consumers couldn't really evaluate whether or not a drug was appropriate, they might become convinced by an ad, and pressure their doctor to prescribe it.

Not only might doctors end up passing out inappropriate medications, but also, drug ads could disrupt the doctor-patient relationship — a relationship that, at the time, was mostly a one-way street. Davis tells this story about his own mother, a sophisticated woman whom he found fumbling with a bottle of pills one day. When he asked what she was taking:

" 'Well,' she said, 'I take a yellow pill, a green pill and a white pill.' I said, 'That's great. What are they for?' "

His mother had no idea what they were for, Davis says. All she knew was that her doctor had told her to take them.

"It was very passive from the patient standpoint," Davis says. "The patient just took whatever orders were given by the doctor."

An Advertising Revolution

It used to work like this: Doctors decided what to prescribe. Drug companies — through medical advertisers — tried to influence doctors. Patients did what they were told.

The only problem, says Davis, was that the system wasn't working out for the drug companies. For them, the system was much too slow.

Because doctors exclusively held the keys to the kingdom, drug companies spent enormous amounts of time and money trying to get their attention. To give you a sense, the average doctor got around 3,000 pieces of mail a year from the drug industry, and to break through this noise often took years.

And so Davis, who had previously only sold packaged goods, approached William Castagnoli, the then-president of a large medical advertising company. The two came up with a solution: They would advertise directly to the patient. They'd get the patient to go in and ask the doctor for the drug. "Pull the drug through the system," Davis says with a certain amount of glee.

There was only one small problem with this solution: It was almost impossible to do.

In the early 1980s, FDA regulations required that drug ads include both the name of a drug and its purpose, as well as information about all the side effects. But side-effect information often took two or three magazine pages of mouse print to catalog, and this wouldn't do for a major television campaign. As Castagnoli says, "We couldn't scroll the whole disclosure information over the television screen — OK?"

But then, in 1986, while designing an ad for a new allergy medication called Seldane, Davis hit on a way around the fine print. He checked with the Food and Drug Administration to see if it would be OK.

"We didn't give the drug's name, Seldane," he says. "All we said was: 'Your doctor now has treatment which won't make you drowsy. See your doctor.' "

This was one of the very first national direct-to-consumer television ad campaigns. The results were nothing short of astounding. Before the ads, Davis says, Seldane made about $34 million in sales a year, which at the time was considered pretty good.

"Our goal was maybe to get this drug up to $100 million in sales. But we went through $100 million," Davis says. "And we said, 'Holy smokes.' And then it went through $300 million. Then $400 million. Then $500 million. $600 [million]! It was unbelievable. We were flabbergasted. And eventually it went to $800 million."

Pharmaceutical companies took note.

Today, drug companies spend $4 billion a year on ads to consumers. In 1997, the FDA rules governing pharmaceutical advertising changed, and now companies can name both the drug and what it's for, while only naming the most significant potential side effects. Then, the number of ads really exploded. The Nielsen Co. estimates that there's an average of 80 drug ads every hour of every day on American television. And those ads clearly produce results:

"Something like a third of consumers who've seen a drug ad have talked to their doctor about it," says Julie Donohue, a professor of public health at the University of Pittsburgh who is considered a leading expert on this subject.

"About two-thirds of those have asked for a prescription. And the majority of people who ask for a prescription have that request honored."

Whether the increase in the number of prescription drugs taken is good or bad for patient health is an open question. There's evidence on both sides. What's not up for debate is this: By taking their case to patients instead of doctors, drug companies increased the amount of money we spend on medicine in America.

Accessed 10/23/09 (http://www.npr.org/templates/story/story.php?storyId=113675737).

The Telltale Wombs Of Lewiston, Maine

by Alix Spiegel

October 8, 2009

In 1974, Roxanne Tremblay was 29 years old, a frazzled single mom supporting a young daughter. So when the pain came on, it presented a real problem.

The pain was sharp, a constant ache in her lower abdomen that doubled her over at work and left her breathless. Tremblay couldn't risk losing her job, so she went to see her gynecologist, one of the most popular doctors in her small working-class river city of Lewiston, Maine.

This man had always impressed Tremblay and made her feel at ease, so when he announced that she would need an operation, she didn't really question it. Tremblay never planned to get married or have kids again. She was done with all that.

Three weeks after her first appointment, Tremblay went into the hospital and had her uterus and ovaries removed — a total hysterectomy. After the operation, her doctor explained what he had found.

"It was what he called the seed of cancer," says Tremblay. "It wasn't cancer, but it had the potential of developing into it."

Twenty-nine years old is pretty young for a hysterectomy. But in the mid-'70s in Lewiston, Maine, lots of women were getting them. Tremblay says she herself knew a bunch.

"My boss that I had when I worked at Kmart, she had one shortly after I did," Tremblay recalls. "One of my friends that I've had since I was 6 years old, she had one. Just about anyone you talked to would say 'Oh I had a hysterectomy!' 'Oh yeah I did — so and so did mine!' There was a lot of them. I do remember that."

Why So Many?

The question, of course, is, why were so many women in the city of Lewiston having hysterectomies?

At the time, this was not a question of interest to most Lewiston women. They were busy with lives and work and families. But there was someone, a health researcher in nearby Vermont, who was very interested in the Lewiston hysterectomies. A man who was interested in operations and health statistics of every kind.

His name was Jack Wennberg, and by the mid-1970s, he had compiled data about health care practices in cities all over the state of Maine, including data showing that in the city of Lewiston, an unusually large number of women were having hysterectomies. He projected that if the rate of surgeries continued in Lewiston, 70 percent of its women would have a hysterectomy by age 70.

Wennberg discovered Lewiston's high hysterectomy rate, but he really did much more than that. Over the past 40 years, he has completely transformed our understanding of what's going on in the U.S. health care system. His research on health practices eventually expanded. He started in Vermont, then moved to Maine, until eventually he studied communities throughout America. In the process, Wennberg led us to a clearer understanding of what doctors and hospitals are doing with their patients all across the United States.

So if you're looking for a better understanding of what drives the cost of health care in this country, health researcher Wennberg is a pretty good place to start.

Accidental Discovery

Though Wennberg is now a certified guru — a man whose insights underlie many of the arguments you currently hear about health reform — Wennberg didn't set out to revolutionize our understanding of health care. It was an accident.

It all started in the late '60s when Wennberg, fresh out of a residency at Johns Hopkins Hospital, was given a grant from the federal government to help improve the health care system in the state of Vermont. The idea behind the federal grant was that in states all around the country, isolated rural communities weren't benefiting from many of the new, modern medical treatments that had been developed. Wennberg's job was to fix this problem in Vermont. He was supposed to help bring high-tech medicine to poor rural communities.

En route to this perfectly laudable goal, however, Wennberg made a somewhat crazy decision. He figured that if he was going to improve health care in Vermont, he should really understand what was going on in terms of medical practice on the ground. And so he decided to collect information about every medical transaction of every person in every town in the whole state.

"We needed to know what was going on in home health agencies, what was going on in nursing homes, hospitals, doctors offices," Wennberg says. "And for each patient, what their diagnosis was, what their treatment was, how much money was spent, and what the outcomes were in as far as we could measure them."

Searching For Explanations

To collect these records, Wennberg hired researchers, people dubbed "the pit crew" who year after year were sent out to medical record rooms to collect records. It was a truly massive undertaking to gather every medical transaction in the state of Vermont. It took two years of road trips just to collect the records for 1969.

But once he had the information, Wennberg began to slice it and dice it in all kinds of ways. And what became clear almost immediately was that something was terribly off. "As soon as we set out to do the analyses we began to see these extraordinary differences," Wennberg says.

Sitting at a table with most of the medical transactions in the state of Vermont listed before him, Wennberg was able to see just how bizarre the distribution of care was. People in one town would get their hemorrhoids removed five times more often than people in another town only 30 miles away. Ditto with mastectomies, prostate operations, back surgery.

This was even the case in Wennberg's own town.

"We lived right on the boundary between Stowe and Waterbury Center, Vt.," Wennberg says. "And if my kids had been going to the school system in Stowe, they would have had a 75 percent chance of having their tonsils out. If they had gone to the Waterbury School — where they actually did — it was about 20 percent."

Why the differences?

There were two possible explanations.

The first explanation was that doctor behavior was somehow to blame. The second explanation was that it was the patients; that people in some areas were just much sicker than people in other areas, or maybe just wanted more services for some reason.

This was the next problem Wennberg needed to solve.

Patients' View

Carol Bradford lives in a small house on a tree-lined Lewiston street. She's a church lady, the kind of person who takes in strays and carries food to elderly neighbors.

Bradford, like Roxanne Tremblay, had a hysterectomy in the mid-'70s. Fibroids prompted her doctor to remove her uterus, and, like Tremblay, Bradford is perfectly happy with the result. Also like Tremblay, Bradford was not at all surprised to learn just how many women were undergoing hysterectomy operations in the 1970s. To her it made perfect sense. Lewiston, she explained one morning over coffee, is mostly Catholic.

"Some women were having too many children," she confided. "You know, there are families here with 10, 12 children. It's a possibility that women came to the point where they just really couldn't deal with any more children and were begging the doctors to do something about it."

"You know," Bradford said with a nod, "that's my personal opinion."

But it was not just Bradford's opinion. It was everyone's opinion when Wennberg first made his discovery.

In fact most people continue to assume that when a patient goes into a doctor's office, the doctor is simply responding to sickness in the body, or the needs and concerns a patient has.

But in his work in Maine and Vermont, Wennberg demonstrated that it's actually a lot more complicated than this. The women of Lewiston, Maine, weren't having more hysterectomies because more of them were Catholic, or because more were sick. After his initial work in Vermont and Maine, Wennberg embarked on this enormous study of patients, which showed that in terms of sickness and demographics, the populations of different communities in Maine and Vermont were actually remarkably homogenous.

This could mean just one thing, according to Wennberg. "Because we could easily see that it wasn't that patients were different between regions, so it wasn't the illness that was driving this, this must be coming from the provider side."

His insight: It was doctors, not patients, who drove medical consumption, and all kinds of things influenced the decisions a doctor makes when a patient enters his office. Sickness and patient preference play an important role, but a much smaller role than patients and the health care community had originally thought.

The Maine Experiment

The medical community's response to Wennberg was pretty muted in the 1970s when he first began to publish his work about the underlying drivers of medical care. Some were supportive, but most in the medical community either didn't believe him or simply didn't grasp the significance of the work.

But in the state of Maine Wennberg actually found a well-placed fan. Dr. Daniel Hanley was the executive director of the Maine Medical Association and a towering figure in Maine medicine. Sometime in the mid-'70s Hanley was introduced to Wennberg, and according to Gordon Smith, current head of the MMA, Hanley was absolutely smitten.

"Jack really found a follower in Dr. Hanley," Smith told me. "Hanley was fascinated with Wennberg's work. He felt like Wennberg was making an important contribution to knowledge and that doctors needed to do something about it."

What the doctors needed to do, Hanley decided, was figure out why the strange variations in medical care were taking place. The best way to do that, he figured, was to get all the doctors in Maine to sit down together on a regular basis, look at Maine city by city, and then hash out why the care they were giving was so different. The doctors would speak directly and honestly about their decision-making.

Bob Keller is a back doctor in Maine who worked on this project, and he says there was only one problem with Hanley's plan: the doctors themselves. If the data were right then at least some of the doctors in the room were doing something wrong by providing care that wasn't needed. That didn't sit well with the doctors.

"No. 1, they were insulted," says Keller. "They were angry because their judgment was being challenged, and that was not allowed. And in some cases they just didn't believe it, so they would try to find holes in the data. One of the classics, they'd say, 'Oh we have more workers compensation here, we have more heavy industry!' But we were able to work through most of those things and demonstrate that wasn't the case. Then they would say, ' Our population is older! More of them need prostatectomies!' And we'd say, 'Well, we adjust for age, so that's not an argument anymore.' And some doctors never could deal with that, and they would leave the study groups. They just said, 'This is baloney; we're not going along with this.' "

But in time, says Keller, most of the doctors in Maine did warm up to these ideas. "They began to accept the data, began to accept that indeed, different physicians were using different thought processes or decision-making processes in dealing with patients."

And so in the state of Maine began this incredible experiment. Four or five times a year each medical specialty would gather together for a kind Talmudic dissection of doctor choice conducted by the doctors themselves. They wanted to look at all the geographical differences, figure out why they existed, and then try to bring their medical decisions in line with one another. They figured that by doing this they could eliminate excess care.

Doctor Influences

Smith took part in the meetings, and he said that inevitably there was one thing above all that doctors believed shaped decisions: "The way you were trained. Maybe you were at a particular training program that does things a certain way and you bring that back to your community."

Smith says to understand how their training shaped their decisions, the doctors who gathered would list on a white board all the criteria they had learned in school for doing this or that procedure. But what they found, says Keller, the back doctor who helped put the groups together, was that most of the time the doctors all seemed to agree.

"In a meeting they'd all say, 'Absolutely I agree; you need to have a certain physical finding and if you didn't have it you wouldn't do it,' " Keller says.

"Well, that might be what they agreed on, but in fact when you were able to use data later you would find that it didn't really work that way. That's the criteria and the standard got tilted, sometimes pretty significantly."

Somehow in the privacy of their own offices the doctors still enacted the agreed-on criteria differently. Why?

One reason some doctors mentioned was fear of lawsuits; some worried that if they didn't do every possible thing they might get sued. Another reason was temperament — some doctors were clearly just more eager to take action than others.

Then there was the role of local medical culture. For example, even though it didn't make sense and wasted a lot of time and money, pediatricians in some communities felt they absolutely positively had to send even mildly sick kids to the hospital.

"Families in small Maine communities were used to the fact that if their kid had a temperature of 102 and was vomiting, that kid was going into the hospital," says Keller. "They'd been doing it for years, so they'd be aghast if they took little Tommy down and he had a temperature of 102 and the doctor said, 'Well, go home and take this.' Nobody did that!"

It was probably safer and better all around not to put the kids in the hospital, and the doctors knew this. But doctors, like the rest of us, are people, and therefore are subject to subtle influences.

For instance, it turns out that if you increase the number of doctors in an area, chances are that the use of medical services will rise. If there's one doctor in a town with 100 patients, then he'll schedule your heart checkups for once every six months, but if another doctor comes to town — and now the first doctor has 50 patients — the doctor will just schedule your heart checkups for once every three months. There's a very simple reason why, says Frank Read, an eye specialist who participated in the doctor groups.

"I don't want to be sitting on my thumbs all the time — I want to be busy. And that may unconsciously loosen my criteria for doing a procedure."

Money

Which brings us finally to the subject that incredibly was never directly discussed during the nearly 20 years the doctors met: money. Specifically, the way money affects medical decision-making.

Keller explained that this subject was completely verboten.

"It would have been a show stopper. It would have gone right to the question of greed, and you're not going to keep a doctor at the table if you say that he's greedy."

Talking to doctors about money is difficult. It's uncomfortable both for patients and for doctors to think that this most important and intimate service could be contaminated. But the truth is the decisions made by your physician when you enter his office are profoundly influenced by the way that doctors get paid in this country. "That's just common sense. That's human nature," says Smith of the Maine Medical Association. "The payment system is an important influence."

Most of the doctors in this country are not on a salary but are paid basically like pieceworkers in a clothing factory. This is called "fee for service," and the way it affects doctor behavior is clear.

"If you pay people more, the more things they do, they're going to do more things," says Smith.

The U.S. health care payment system rewards doctors for taking action and doing procedures. This reality is so powerful that it hasn't just changed the individual behavior of doctors. Keller says that the specialties themselves have changed, bending like flowers to the sun, moving toward the source of heat.

Consider dermatology. "In the old days, dermatologists just did medical visits," says Keller. "They looked at people, they looked at their skin lesions, they advised them. Now they're all doing Botox, they're doing various procedures. So dermatologists are making very high incomes now, but they are doing procedures; that's where they're getting it. The specialties changed because it's a procedural-driven world that we're in."

And the more complicated the procedure the higher the payment.

This is perfectly logical but has an unintended effect on care. Keller points to his own specialty of back doctor. He says one of the most frequent operations these days is a highly complicated procedure called an instrumented spinal fusion. When a patient has degenerative disk disease, the doctor inserts metal rods to stabilize the spine.

Keller says in the old days, doctors used a much less complicated and safer operation. But the more complicated one had a clear advantage: "The surgeons could charge more because they could do these complicated procedures. So they were putting the screws in and they billed for putting the screws in. They were putting the plates in, and they billed for putting the plates in. So you had this whole new high-tech procedure, and it was enormously attractive to spine surgeons and it literally took off in this country, at the same time as most good spine surgeons will admit that they had no research to support what they were doing."

In fact, says Keller, one high-quality study demonstrated it wasn't so positive. "It showed that it isn't so great, actually as people thought it was," he says. "And they also showed, interestingly enough, that the old-fashioned non-instrumented fusion was as successful as the instrumented fusion — which was a real blow."

More Is Not Better

And this, in miniature, is one of the big problems with the way that the current system is set up. It's a problem some call "more is not better."

Doctors exist in a fee-for-service system that encourages — and really because of the threat of malpractice and having to battle insurance companies — in some ways actually forces them to do more. More surgery. More tests. More of everything.

And while most Americans just assume that more care is good, it turns out that more isn't always better for patients.

Natasha Saint Amand is 25 and wears her brown hair curled into loose ringlets. Her makeup is picture perfect. Amand has spent her whole life in the Lewiston area, but like most people who live there, had no idea that the area had an unusually high rate of back surgery. The rate has varied over the years, but between 2003 and 2007, the rate of lower-back fusions in Lewiston was around 107 percent higher than in the rest of Maine.

Five years ago, Saint Amand was in a car accident and after that had serious pain in her back several times a week. Her doctor strongly recommended a fusion, and so she got one. And then another. And then another. And then neck surgery.

Now Saint Amand is in pain every hour of every day. She can't bend at the waist or at her knees. Not for the original sickness, she says, but from the cure. She is disabled, and she says really understanding the reality of that took a long time.

"I think it really hit me after after my third back surgery and after I had my neck surgery," Saint Amand says. "It really hit me that, wow, there's really not much I can do. My leg is all nerve-damaged. My lower back is nerve-damaged. I have nerve damage in my left arm. There's really not much left that doesn't hurt."

It would be easy to dismiss what happened to Saint Amand as poor-quality medical care; surgeries that failed because they were badly done. But it's probably more complicated than that.

A couple of years ago Keller and some colleagues did an elegant study of one kind of back surgery in Maine, a procedure called discectomy. Keller found communities in Maine that had high rates of this surgery, communities with low rates, and communities that were somewhere in the middle. Then he followed patients who had had surgery in those communities over a five-year period to see how they fared. Keller says the conclusion was undeniable.

"In the high rate of surgery overall, the patient outcomes were the least good of those three categories. In the middle rates, the outcomes of the patients were in the middle. And in the low-rate areas — less frequent operations per capita — the outcomes were the best."

The reason that areas with more back surgery did worse, Keller says, is that doctors in those areas were operating on people whose issues were less severe; that is, patients who might not have been good candidates for an operation. So the problems associated with the surgery probably outweighed the problems of their actual sickness. For them, more wasn't better.

But this essential dynamic — that more isn't better — applies to a lot more than just back surgery.

In 2003, there was an enormous landmark study published by a Jack Wennberg protege named Elliott Fisher, who works at Dartmouth College. Fisher compared Medicare recipients with similar levels of sickness in areas throughout the whole United States. Fisher looked at places where elderly people used relatively few health care services and compared them with places where elderly people used a lot of health care services.

"The patients in the high-spending regions were getting about 60 percent more care; 60 percent more days in the hospital; twice as many specialist visits," Fisher says. "And yet when we followed patients for up to five years, if you lived in one of these higher-intensity communities, your survival [rate] was certainly no better, and in many cases a little bit worse."

This is probably because of a something called fragmentation of care. In high-use areas, it's often the case that many different doctors play a role in the care of a patient; many specialists are responsible for overseeing only a small part of the person. This increases the amount of treatments, tests and hospitalizations that people get, and exposes people to more risk of harm from medical error and side effects.

For most Americans this is an incredibly difficult idea to accept: It's hard to understand that more care isn't necessarily better for you.

But study after study has borne out the truth of this completely anti-intuitive conclusion. In fact, Fisher and other researchers estimate that almost one-third of the care given in our country today is that kind of care — care that isn't really helping people.

The United States spends more than $2 trillion on health care every year. So the cost of that 30 percent unnecessary care annually? $660 billion.

Accessed 10/23/09 (http://www.npr.org/templates/story/story.php?storyId=113571111)

Two week wrap-up, volunteering and Interviews

2009-10-10T11:57:00.000-07:00

Hi everyone I've gotten a little behind, but I'll try to catch-up here. Last week we had an anesthesiologist schedule, but he had to cancel because he was sick, so hopefully we'll have him re-scheduled for sometime in the coming future. I know that comes as a surprise, but yes doctors can get sick. To improvise we chose to cover volunteer work we have done and what we hope to be involved with. Some up coming volunteer activities are Science Saturdays and continual work with the Gear-up program.

Science Saturdays: last Saturday of each month, help out with an activity for kids and families, 2-3 hours commitment (if you can only do it for an hour that would still be a big help).

Gear-up: Mondays at 3pm, I think we're doing once or twice a month, go to the school and help out with an after-school activity, we need like two students for each time if anyone is interested.

This week was Greg Nielson, our amazing career services mock interview guy. Seriously though Greg does an amazing job preparing pre-med students for their interviews. if you need to contact him his info is:

email: gnielsen@weber.edu

phone: 801-626-6393

He really does a great job explaining how you can prepare and succeed in your interview by being prepared, practicing, and by being yourself. He mentioned that being prepared allowed students to feel more comfortable and confident in an interview, but he also mentioned that you don't want to rehearse answers. He also mentioned that by knowing why you want to apply to a certain school makes it easier to explain to your interview why you want to go their particular school and ask relevant questions. Above all else he stressed being yourself and to be confident in an interview. He had hand-outs with really good advice, which unfortunately I can't post on this blog, because apparently technology isn't advanced enough (I don't understand the world sometimes), but I'll see if I can get them up some how.

Basics

2009-09-29T15:15:00.000-07:00

For those who missed Dr. Trask's lecture last week, shame on you, jk, but you did miss a lot of useful information. If you have any questions about the pre-med orientation then come talk to one of us or Dr. Trask, if she not busy and hopefully we can help you guys out.

stealing titles: Gear-up for Dr. Samuelson

2009-09-20T15:22:00.000-07:00

Yes Aaron I'm stealing your title. Thank you to all those who helped out Wednesday with the Gear-up program we really appreciate your contribution. The kids seemed to really enjoy themselves, they got to isolate their DNA which is a pretty fun lab if you've never done it before, so hopefully this points them in the direction of career in medicine or science.

I unfortunately missed Dr. Samuelson's lecture so if you went please leave a comment of something you liked, learned, or anything I would really appreciate it.

And a big thanks to all those who helped with the highway clean-up Saturday, our section of I-84 is looking sweet, though I don't remember there being that many deer parts last time we cleaned it up, but what are you going to do.

NOVA and SOCIAL

2009-09-11T18:42:00.000-07:00

Wednesday's meeting for all who missed, was Dr. Whitehead from NOVA. For those who don't know NOVA is a DO school in southern Florida. Dr. Whitehead talked about admissions, housing, curriculum (as far as what you will be learning and doing while enrolled at NOVA), and lets call it the community enviroment. He brought up a very interesting point that NOVA isn't looking for let's say the most academically qualified applicant, but more of a rounded applicant. He said that he has seen his admissions committee pass over more academically qualified students for students who are more geared towards leadership and volunteer work, he said that they are not necessarily looking for the best applicant, but the applicant that fits best with their school and program.

Thank you for all who made it down to the social Thursday, and we hope you had a good time eating free food and bowling, anyone who missed or left early didn't get to see me break one of the lanes, they say it isn't a party until something gets broken right? Ah good times.

Reminder: next weeks meeting is for the Gear-up program, so if you didn't sign-up for a time get in touch with one of us if your available. Also Dr. Samuelson from the U of U is coming to talk about admissions to the U and this meeting is at 6-8pm in LL130 that Wednesday the 16th, hope to see you guys there.

Schedule

2009-09-02T13:37:00.000-07:00

Now that classes are back in session and everyone is good and stressed out I would like to post the first blog of the school year. Today the Amazing Ryan covered the schedule of upcoming events and what to expect this year, unfortunately I didn't grab a schedule so I'll amend this tomorrow or whenever I get my hands on one. I believe Dr. Whitehead from NOVA is coming next week to talk about DO schools (probably about NOVA if that's not obvious) and the meeting time and place is the same as always 12:30 in LL 130 on Wednesday the 9th.

The week after is Gear-up, which is the program to help disadvantaged kids see that they can not only attend college, but succeed in college, we need all the help we can get so don't be shy and sign up for a time next week, it will be from 12:30-3:00 I think (someone help me out on this one) on Wednesday the 16th, this activity will replace the normal meeting, so a heads up to everyone who's not helping out that day. also on Wednesday the 16th Dr. Samuelson from the U is coming to talk about admissions to the University of Utah, I've been told that it's a great chance to ask questions and pick up some important information, so don't miss out, this meeting will be held in room LL 130 at 6-8pm on Wednesday the 16th.

(Important) If you didn't come down to the booth at the block party or didn't come to the meeting today we are having our Social Thursday September 10th at 12:30-2:30 down at Wildcat Lanes in the Union Building, there will be free bowling, free food and the person who bowls the highest score wins a date with Brooke.

The week after is Pre-med orientation with Dr. Trask it will be in LL 130 and at 6-8pm Wednesday the 23rd, honestly one of the best meetings all year, you get a lot of information about everything you need to know and how to prepare to apply to medical school, DON'T MISS, this is also another great chance to have questions answered.

The rest of the school year is a little vague so hopefully we will have a completed schedule in the next few weeks, we will have physicians from different specialties coming to talk, a medical panel consisting of medical professionals talking about current issues in health care and much more, so don't miss out, come to meetings, come to activities, make friends, pick up information; it's going to be a great year.

A reminder meetings are always held in LL 130 and at 12:30 on Wednesdays unless noted otherwise, but check the board outside LL and the science lab just in case. Also thanks to the suggestion by Mike Cranney we now have a facebook group, AED/AMSA @ Weber, hopefully this gives you guys a little more access to information and feel free to post things like volunteer opportunities or advertise. Thanks again Mike you're awesome.

2009-08-09T13:39:00.000-07:00

What's up all,

I thought I would set up some links in my spare time. These links hopefully provide you guys with some useful information and assistance.

This is also a GPA calculator set up by one of the fine pre-med students on SDN, it'll calculate both your science and cumulative GPA along with credits and give a break down for each semester, the guy or girl who created this did a great job, and it's a little easier to use then the one on Weber's website. All you have to know to use this is your grades, credits, and whether it was a science class or not.

http://forums.studentdoctor.net/showthread.php?t=654540

This is a school selection spread sheet by another person from SDN, it gives average GPA, MCAT score, whether the school likes in state students more than out of state and it kind of lets you gage where you fall according to the schools average, now I'm not saying if you are outside of these averages you shouldn't apply to this school, remember these are just averages some people are higher and some are lower so don't let these numbers scare you this is just another reference for you to utilize if it helps great, if not then stop looking at it. The link will take you to a "what are my chances" thread on SDN don't worry about it just scroll down to the highlighted "school_selector_0910" and click to download it.

http://forums.studentdoctor.net/showthread.php?p=7817396

I should mention though that these are just MD schools and I think one or two in Puerto Rico are included too for some reason, but no DO schools are included.

Hopefully these are useful.

First Post

2009-07-02T19:04:00.000-07:00

Hey guys and gals,

This is my first post on behalf of the club. First of all I would like to state the purpose of this blog, it's main, sole, and only purpose is to help Weber State University pre-medical students, if you don't fall into this category no worries read if you like, but I'll pretty much be addressing issues that pertain to weekly club activities, advice for new students, and maybe other issues that the club, Barb, or myself find relevant.

Things I would like to do for the club and to help you guys:

Have a schedule of upcoming events for the club to keep you guys informed

Summarize the week's meeting so if you miss a week you don't have to feel left out

Have an advice section for students, it's most likely going to be mine, but I will be happy to post any that you guys have for other students

Other ideas coming soon

Post dates are going to be random, meaning that I myself am a pre-med student and taking the MCAT in the spring, so please don't expect a regular post cause it's not going to happen. I also can not guarantee the longevity of this blog, if anyone else is willing to help write an article or anything or just help me out for a week it would be a huge help. I will also try to set up some links to websites that are helpful for pre-med students such as studentdoctor and amcas in case you can't find it just point and click and it will be all good.

I've also just returned from New Zealand, I spent a month there doing volunteer work and touring the country with ISV, yes the same ISV that sends crazy fast talking people with funny accents into your classes to talk, so to give fair warning I'm going to be repping for them like crazy, because it was amazing experience and I'll post pics so you guys can view the awesomeness and if anyone is interested in getting involved with something like this I'll be happy to talk with you about it.

I hope you find this blog useful and if you have any suggestions, comments, or questions feel free to post.