The book of the year?

The price we pay book cover
Lots of books are published each year, and I can only read a few of them. But, when a really important general interest book comes along, I often put it on the top of my “to be read” pile. In September, Dr. Marty Makary, a surgeon associated with Johns Hopkins, released a book entitled The Price We Pay: What Book American Healthcare—And How to Fix ItSince most people in America eventually get sick or have an accident, and only a few of us are fifty rich, this is the ultimate general interest book.

In Part I, entitled “Gold Rush” Makary doesn’t have to travel far—he visits “health fairs” at local churches, where salespeople disguised as medical professionals do screening tests and scare participants, mostly those on Medicare, into unnecessary and rather expensive procedures, such as placing stents into leg veins. In the second chapter, he discusses the lack of transparency in hospital pricing, as well as the astronomical rise in common procedures. For instance, a medical center in New Jersey offers joint replacement surgery for $135,400.00, which rose a mere 76.8% in a single year. BTW, Medicare only pays 13K for that procedure. For his third chapter, Makary travels to Carlsbad, NM, where the medical center seems to have overcharged and then sued almost everyone in town. Back in Virginia, Makary visits the courthouse to learn more about similar shenanigans at Mary Washington Hospital in Fredericksburg. Sadly, this hospital is supposed to be a “not for profit” hospital, and thus receives favored tax status, too. Also in this section, Makary provides an analysis of the proliferation of for profit helicopter ambulance services, which charge somewhere between $40K and $60K for a ride that I could make in an hour in my Toyota.

In the second portion of the book, Makary delves into some medical practices that can be improved by focusing on individual physicians. One OB doctor in Florida had a reasonable rate of C-sections, until figuring in Fridays, when the rate rose 80%. Why? The good doctor didn’t want to be bothered on the weekend, so moms who were in labor on Friday got the surgery. This section of the book also discusses the opioid crisis, and Makary admits that he had to learn to write fewer prescriptions for pain pills, after learning about the misuse of all those pills.

Part III of the book is about “Redesigning Healthcare” and it does offer several solutions to problems, but one chapter in this section explains how drug prices are affected by middle men (pharmacy benefits managers) who don’t supply anything other than a big bill for their services. Here’s an example: A pharmacy is paid $34.94 for 90 40mg doses of Zocor, but the employer is charged $442.85–and the PBM gets over $400 on that one transaction. Another chapter discusses problems in health insurance, which less and less helpful except in catastrophic circumstances, and there is even a chapter on “wellness” and how those well meaning programs are far too costly, especially as they often mean an invasion of privacy, or worse, over-treatment for minor issues.

Makary doesn’t make the mistake of only discussing problems without discussing solutions. Several positive programs are mentioned throughout the text, including websites such as ImprovingWisely.com, and the last chapter is a bit of a call to arms. In short, legislators and employers need to be educated on these matters, and healthcare consumers should do everything possible to demand transparent pricing for upcoming procedures.

The Price We Pay is a very important book. This should be the topic of your next book club, a gift for your friends and/or family, or even a holiday gift for your doctor or your legislator. Please buy this book, read it, and pass it on. Knowledge is power, and as this text has lots of information for Americans, this may well be the most important book you will read this year.

My video is reaching students!

NASA nebula

A still shot from NASA

Way back I took classes in “podcasting” and “movie-maker.” Afterward, I came home and practiced what we’d learned in class. I made three videos, which are a lot closer to Powerpoint presentations, if the truth be told. Anyway, one of them has had a bit of success—”A Brief History of Science Fiction.” This video was designed with a few still images, mostly screen shots from NASA such as the one I featured on this post, and two audio tracks. We’d been warned in class about using commercial music, so I downloaded a freebie track that I thought sounded dramatic. The second audio track is my voice, reading story boards, in my rather strong Southern U.S. accent. I did write the story boards, based upon my study of the science fiction genre, my training in English literature, and what of that matched up with the still images that I managed to acquire at the time.

Science fiction is an ever changing literary and film genre (with more than a dash of animation) so my video is already a bit dated. Still, I was most gratified when reading a very valid complaint about the loud musical soundtrack. The complainant stated that my little YouTube video was required for class. Gosh darn! My Brief History of Science Fiction is required by a teacher (somewhere?) for a class (in something?) I’m flattered. Really.

If you don’t mind hearing that awful musical track, head over to YouTube and see A Brief History of Science Fiction. While you are there, the link to my “book trailer” for The Gift Horse is still live also.

Free for Three promo

For those who prefer to shop at home on Black Friday, here’s an unbeatable deal—my science fiction novel, Trinity on Tylos, is free for three days. Why run it for free? That’s simple, really. More readers should mean more reviews and some word of mouth testimonial. So, here’s a link to the novel, which is free on November 29, 30, and December 1.

How much for a flu shot?

Mostly, I write about books, or maybe films. No doubt, I will do that again soon, but recently I have been experiencing various forms of health care, and my latest such visit was for the annual flu shot, so I’ll write a bit about that. For some years, I opted out of having this injection, but after hubby lost a week of work and felt terrible for even longer, I went back to getting the shot. After all, the couple of times I had influenza it was no fun at all.

Current United States policy (via the Affordable Care Act) requires that insurance cover the flu shot as a preventative measure, without any co-pay from the patient. So, my doctor’s office has made a business decision to “stick it” to the insurance company—pun intended. See the attached screen shot of the EOB for this procedure:

Flu Shot

Now, thinking that $248 is a bit steep for this, I just looked at GoodRx (a nifty site if you have never used it) and it tells me that the estimated cost for the shot is $32 at Walmart.

GoodRx

Now, going to my doctor’s office was convenient and fast, but I’ve had flu shots at the grocery store or at a mini clinic, and neither of those were inconvenient. Bottom line, the doctor’s office knows that they can charge whatever for preventive procedures, and my insurance has to pay for it, so they are taking advantage of this. Kudos to Walmart for making this injection available for regular folks. If you don’t have insurance, or if you want to keep it real, just go to the GoodRx site and put in your zip code. The site automatically offers several locations and price points. BTW, the average when I looked was $32.

As for Piedmont Athens Primary Care, they’ve made me think, yet again, that when insurance premiums go up again, and they will, their approach to business is one reason for those hefty increases.

 

Impossible Burger at Burger King

impossibleThe other day, hubby and I were eating at a favorite restaurant near our home. While perusing the menu, I noted that they now serve the “Impossible Burger” for $15. To be fair, that includes “free” salad and a side, but it struck me as a high price for a fake burger. I’m actually a fan of a good black bean burger, but these new fangled burgers (such as the Impossible Burger and Beyond Meat) purport themselves to be equal in taste and texture to beef. But I wasn’t too keen on spending $15 when I could get a nice salmon fillet with two sides for $12, so we didn’t try it that day.

However, after church today, we went to a fast food restaurant. That’s quite unusual for us, but hey, I got to try an Impossible Burger for a possible price. The B&K palace we visited was one of a series of fast food joints along a busy highway, so they had customers, but not too many. We ordered the meal (a golly whopping 900+ calories) which includes a small drink and fries. BTW, neither the drink nor the fries didn’t seem all that small to me, but the gal at the counter seemed surprised that we didn’t take the 30 cent upgrade to medium.

Hubby looked a bit skeptical, but I dug in immediately. Low and behold  the Impossible “Whopper” tastes quite a lot like any old fast food burger—nothing outstanding, but just fine for the price paid. Anyway, the burger seemed a bit thinner than I remember for a whopper, but the condiments and bun made it a substantial sandwich, which we ate without cheese, as there seemed to be sufficient calories without that addition. The fries were good and crisp, and I ate half of them before shoving them across the table for hubby to finish.

My Fitness Pal tells me that I’ve just about eaten all I should for this day, but I can now say I’ve tried one of the latest innovations in food, and it is okay…as long as one has enough calories left to enjoy the thing. Oh, and I do recommend trying it at Burger King, because we both ate for the price of one at our local sit down and get waited on favorite.

One hand…the other hand…Amazon

handsWe’ve all heard the old saying that states it is not good when “one hand doesn’t know what the other hand is doing.” Basically, when an organization gets too big or too disconnected from itself, then there is at a minimum a loss of cooperation, and at worst, the organization works against itself.

A while back, I had to strip out all of the links to Amazon from this blog, due an email directive, and I have posted a screen shot of that message, which states plainly that I am no longer an Amazon Associate (a means of funding via promoting products.)

Screen Shot 2019-09-24 at 7.53.52 AM

Yesterday, I got another email from Amazon. It seems they no longer remember that my account was “terminated” and want help me sell their expletive deleted stuff.

Screen Shot 2019-09-24 at 7.54.04 AMHonestly, this is just on example of the problems at big A. Lots of articles have been published about problems there. The most troubling ones (for consumers) are the fake reviews and hijacked reviews.  I’ve mostly stopped shopping there, but hubby is addicted. However, the other day he was actually reading the reviews (and not just looking at the number of positive reviews) and realized that most of those reviews were not for the product he was wanting to buy. Fortunately, he didn’t buy from big A this time.

The bottom line is that Amazon is more and more a computerized “middle man” rather than a merchant, and buyers and sellers have little confidence that the platform is working for either side. Consumers should think about alternatives before using that one step purchase button. Sure, it is convenient, but it’s not good to get scammed.

As far as selling is concerned, lately, I’ve sold far more books via eBay than Amazon. More on that later.

Overdignosed— a brief review and commentary

OverdiagLike many people in the USA, I am concerned about the state of our health care. Don’t get me wrong, I’m grateful to live in a country that has lots of great medical facilities and practitioners. But, I’ve watched people go through some pretty difficult situations, too, so I read Over-diagnosed: Making People Sick in the Pursuit of Healthcare in hopes that I’d learn more about what sometimes goes wrong with our healthcare system. This book offers some first hand insights from three physician authors, and I learned a great deal from it.

Many of the chapters have a “case study” to frame the discussion. One of the most memorable is the story of an older gentleman with a borderline diagnosis of diabetes. In the interest of keeping those blood sugar numbers in the optimal range, the principal author (Dr. H. Gilbert Welch) prescribed medication. Unfortunately, the gentleman’s blood sugar dropped, causing him to lose control of his car, resulting in an accident that broke his neck. The gentleman survived, but he had to wear a halo brace for many weeks while his neck healed. When it was all over, the doctor and patient agreed that the best practice in his case would be to forgo the diabetes medication. This anecdote is a great way to illustrate how over diagnosis can make people sick!

Each chapter explains how modern testing, coupled with ever changing standards for “normal,” have resulted in more and more people being diagnosed with something. The approach is cautionary, explaining that many times a diagnosis might be correct, but if the condition is unlikely to cause the patient any reduction in quality of life, or end the patient’s life early, then it is far better to not treat the disease. However, once diagnosed, both the patient and most physicians will be reluctant to “watchfully wait.” Indeed, the principal author states in the introduction that he does not have routine checkups, even though he works in healthcare and could easily do so. Instead, he waits for something to go wrong. As the old saying goes, “If it ain’t broke, don’t fix it.”

The mammogram is probably the first test that my doctor wants me to have done, but our author states that for most women, they do more harm (due to radiation) than good. Aggressive cancers can develop in the one to two year interval between tests, but slow growing cancers can result in over-reaction by doctors and patients. Also, many women go through the “false positive” situation, which might mean more testing, including a breast biopsy. I’ve known several women who had that done, only to find out that the mammogram was incorrect (or incorrectly interpreted.)

Another interesting story is a conversation between the author and a pharmaceutical rep. The latter was touting the benefits of a drug for women with bone density issues. After a friendly discussion, the drug company rep admitted that the greatest risk for these women is mostly hip fractures, which can lead to all sorts of problems, including premature death. The author states that helping women prevent falls, though physical therapy and other practical measures, would be much more useful. And the testing phase of the drug was eventually discontinued due to subjects developing bone cancer.

The author is firm in his stance that patients are often over-tested and over-diagnosed. He believes that many doctors do this out of an interest in finding answers for their patients, and not merely in making more money. He is also firm that the threat of a law suit can be a driver for hyper testing and the end result of over-diagnosis. I’m all for people having the right to seek redress in the case of gross malpractice, but doctors who have been the defendant in a case, win or lose, will often err on the side of caution and order tests that probably aren’t needed and will refer cases that are only marginal. The costs of this mind set are not negligible, as tests can costs hundreds or even thousands, and that doesn’t include the costs of treating a condition that might not need any treatment. Nor does it address the mental stress of having a chronic “condition.”

Common sense is sorely lacking these days. Certainly many aspects of modern America are getting totally weird, so I guess it is not unusual that medicine is affected. I am grateful to Dr. Welch and his fellow authors for this very cogent discussion of the problem of over diagnosis. I am seriously contemplating what to say at my next doctor visit, when I will face that computerized list of items that modern medicine says I need, but just might result in me joining the long list of those who are “over-diagnosed.”

Born with Teeth—A Memoir; review and commentary

Born Mulgrew

Kate Mulgrew’s Memoir

My guess is the first I heard of Kate Mulgrew was when she starred in Mrs. Columbo, but that’s not a certainty. Like many fans of all things Star Trek, I was both thrilled and a bit concerned when Mulgrew was very publicly named the newest captain in the fourth iteration of that television franchise, Star Trek Voyager. And, I was rather amazed to by her character in Orange is the New Black, in a role that is far from her roots as a distinctive and attractive leading lady.

Regardless of when one first noticed Kate Mulgrew, she is a force on the screen. Recently, I read her memoir, which has the curious title Born with Teeth. Apparently, she was indeed born with teeth, which were extracted so she could feed properly. For Mulgrew’s fans , there may not be all that much new information, but the style of her prose does illuminate readers on her perspective in regards to matters that matter most. The narrative is mostly linear, although she skips a lot of years and events. First, the reader learns just how dedicated she is to her craft and how much work it has been. Second, readers will become better acquainted with Kate’s large family, and see how they have influenced her. One of my favorite passages is when, as a schoolgirl, Kate invited her artist mother to hear her recitation of poems she had written. Upon learning about the program, Kate’s mom, Joan, gives her a copy of a poem (The White Cliffs of Dover) to read, and during the school program young Kate not only read her poems, but she read the classic poem so well that her audience was almost in tears. Afterward, Kate’s mom told her that she could either be a bad poet or a great actress. Apparently, Kate took those words to heart, because from that early age, she put all of her effort into becoming an actress.

Fans of Ryan’s Hope (a soap opera that was Kate’s first big break in television) or Star Trek Voyager (perhaps her most influential role) will find a few gems, but she doesn’t concentrate on those stints. Instead, what Mulgrew writes about is relationships. While filming Ryan’s Hope, Kate became pregnant, and as she was not married and quite young, she assumed she’s have to leave her job. Instead, the pregnancy was written into the show, and her character gave birth a few days after Kate did it in real life. The Mary Ryan character kept her baby, but Kate gave up her daughter for adoption. Later, she expends both time and money in an attempt to find her biological daughter, and that search is a focal point of the memoir.

Certainly, Mulgrew has experienced quite a lot of grief, as one of her sister’s died of a brain tumor and another succumbed to pneumonia. Romance has not always been easy, either. Mulgrew also writes of her loves—her first husband, Robert Egan, and the sons that he fathered, and how divorce affected her and the boys. Later, she reveals how her love for her second husband, Tim Hagan, endured a rather on again then off again period. The memoir ends as she meets her daughter and her relationship with Hagan finally settles into marriage.

I’m a science fiction fan (and writer) so I was just a tad disappointed in this memoir. I’d love it if Kate would do as Shatner has done and publish a book about her time portraying Captain Janeway. Perhaps she will, when she has more time, for she does seem to be one busy lady.

Trinity is Free for Three (days)

Beginning at midnight on July 14, the giant-sized internet seller of books and other sundries will be offering the eBook version of my science fiction novel, Trinity on Tylos, for free! I’ve seldom used this option, but as their Prime Day promotions will be going on, I thought I might get a few people to download it. If I’m really lucky, I might get another positive review, too. Anyway, here’s the book cover; just click for a link to the sale.

ToT_cover_final_webLG

Here’s an excerpt of my favorite review of the novel:

TRINITY ON TYLOS… is instead a thought-provoking book that will challenge one’s beliefs about the importance of motherhood, duty, and sacrifice. At times, the choices made by Venice and even Allie are ones the reader will disagree with and perhaps even be angered by them. However, one of the trademarks of a well-written novel is its ability to inspire others to debate. TRINITY ON TYLOS accomplishes this and so much more. Pamela J. Dodd has truly demonstrated her gift as a writer with this stunning book.” —