Chopping up the baby

I’m going to start right out by admitting that I am going to raise questions to which I do not have a coherent answer.

In the comments to Rose’s post about buying “green” products, Jason shared a link to this essay by Robin Hanson about healthcare costs.  In it, Hanson argues that much of what is spent on healthcare does not actually yield greater health for the populations in question.  He makes several arguments that I am not particularly well-qualified to address (I do not know if his points about data mining effects in interpreting certain data are sound, for example), and he makes further proposals that aren’t quite my cup of tea (he suggests making medicine less prestigious, which may indeed lower medical costs but would also [if I were to be fully honest] make me less likely to want to do it, especially if it were to go in hand with paying me less money).  To my reading, he is rather more skeptical about the benefits of medical care than I think is justified, and doesn’t admit the possibility of as much ambiguity in the benefits of care as I think exists.  However, I’ll admit that I was somewhat relieved to see that he seems to be relatively more forgiving of pediatric care, so perhaps I’d emerge from his policy recommendations comparatively unscathed.

That said, I am largely inclined to agree with much of what he writes.  I, too, believe that much of the medical care that is administered in the United States is of questionable efficacy or benefit. I alluded to this in my piece for the Inequality Symposium, in which I suggested that much of the money spent on the patients in the top 5% of healthcare expenditure (who account for 50% of the total healthcare expenses in this country) might be saved if policy makers, physicians and patients could create a better approach to end-of-life care.  Since I’ve already said that, however, there’s another question I’d like to raise today.

Hanson writes this:

King Solomon famously threatened to cut a disputed baby in half, to expose the fake mother who would permit such a thing. The debate over medicine today is like that baby, but with disputants who won’t fall for Solomon’s trick. The left says markets won’t ensure everyone gets enough of the precious medical baby. The right says governments produce a much inferior baby. I say: cut the baby in half, dollar-wise, and throw half away! Our “precious” medical baby is in fact a vast monster filling our great temple, whose feeding starves our people and future. Half a monster is plenty.


Do you have little voice in health policy or research? Then at least you can change your own medical behavior: if you would not pay for medicine out of your own pocket, then don’t bother to go when others offer to pay; the RAND experiment strongly suggests that on average such medicine is as likely to hurt as to help. [emphasis his]

As we draw our swords and figure out how we’re going to bisect this metaphorical infant, it’s worth asking who gets to decide which part we’ll keep.  Hanson’s bolded statement above presupposes that the baby bits we’ll be throwing away are the ones foisted on a credulous public by an overly-influential and arrogant medical establishment.  And I’m willing to concede that there’s something to that.  But the converse is also true.

I’ll take a relatively anodyne example from my own practice.  On a consistent basis, I will see patients with some constellation of vague symptoms — fatigue, malaise, miscellaneous aches, “not himself.”  And quite often the parent will request that the patient be tested for Lyme disease, which is endemic in the area where I work.  Now, these are patients who do not actually have symptoms of Lyme disease, and for whom my clinical suspicion is very low.  In addition, the diagnosis of “chronic Lyme disease” to account for such symptoms is scientifically invalid, and those who make a practice of treating it are engaging in chicanery.  (I await the commentary of the Lyme community.)  I tend to be a therapeutic minimalist, and am loath to order tests or interventions that don’t have a clear clinical benefit.  I particularly hate sending Lyme serologies under these circumstances, and do my best to dissuade the parents.  But sometimes they insist, and sometimes I relent.  (I have yet to uncover a plausible case of chronic Lyme disease under these circumstances.)

They insist the tests are a legitimate medical expense.  I dissent.  Who picks up the tab?

I have raised questions along these lines before.  In general, I believe that (consenting adult) patients should have the right to irradiate themselves with unnecessary CT scans and exsanguinate themselves with needless blood tests.  It’s their body, after all.  But  then who should be made to pay for them?  I tried and failed (after being transferred from one person to another no less than a dozen times) to find out how much Lyme serologies cost using the lab we order through.  The best estimate I could find via Google was about $200.

It’s all very well to say that patients should be made to pay for tests I don’t think are clinically indicated, in which case the power to facilitate payment by private or public insurance rests with me.  But for many of my patients, $200 for a blood test would be prohibitive.  Using Hanson’s formulation above, if they had the money they would pay for the medical care if they could, but they can’t and thus want someone else to do so.  Given Hanson’s skepticism of medicine in America, would he endorse my role as a gatekeeper in this situation?  Are doctors only to be trusted when they’re denying care, and not when they’re recommending it?

Of course, this discussion concerns something as relatively inexpensive and picayune as a blood test.  What about a referral for a disease I feel competent to manage myself when parents want a second opinion?  Or a third?  What about the decision to withdraw care if the patient or family wants it, but physicians believe it to be futile?  Yes, many patients get needless treatment at their medical providers’ recommendation.  But many also get it by their own request.  Who decides when it gets withdrawn and who pays for it when it is not?  Does this not establish a system under which the affluent get all the care they want while the poor are made to accept the dictates of their medical providers?  Is this proper?

I imagine that Hanson and I would agree on a lot.  I do not have such a glowing opinion of my vaunted profession that I do not think it intervenes too much, presumes too much, costs too much.  I’d happily sit down with him and whip out a red pen, slicing sword-like at much of what is needlessly ordered and prescribed.  But what about those circumstances when I’m not the one who wants to spend the money?

Russell Saunders

Russell Saunders is the ridiculously flimsy pseudonym of a pediatrician in New England. He has a husband, three sons, daughter, cat and dog, though not in that order. He enjoys reading, running and cooking. He can be contacted at blindeddoc using his Gmail account. Twitter types can follow him @russellsaunder1.


  1. They insist the tests are a legitimate medical expense. I dissent. Who picks up the tab?


    Also, the question should be fleshed out a good deal more. What are the false positive and false negative rates of the test? What is the incidence of Lyme Disease in the general population? Your example is crying out for Bayesian analysis. Isn’t it?

    • By my lights, the tests are next to useless. In the absence of actual clinical symptoms of Lyme disease (characteristic rash, arthritis [actual inflammation, not just aches], carditis), they offer little or no diagnostic benefit.

      However, if they come back positive, the parents will likely insist that the patient be treated. If the symptoms (which, again, I do not believe are legitimately attributable to Lyme) persist, they could insist on a referral to one of the charlatans whose practices are based entirely on treating “chronic Lyme.”

      Who pays? Or, perhaps more precisely, who should pay?

    • “They insist the tests are a legitimate medical expense. I dissent. Who picks up the tab Taxpayers!”

      Jason, what do you believe happens now, prior to Obama care? The relevant difference between “other people besides me by way of my employer” and “other people besides me by way of my State” is what, exactly?

      • Jason, what do you believe happens now, prior to Obama care?

        Taxpayers pay for a large share of many forms of medical treatment. Under Obamacare, that share will grow.

        The relevant difference between “other people besides me by way of my employer” and “other people besides me by way of my State” is what, exactly?

        The employer can stop paying for it, or choose an alternate way to cover you. Under Obamacare, I (and all other taxpayers) am in the position of the employer, only we don’t really get the same level of say at all.

        The principal-agent problem figures prominently in both, which is why I strongly oppose the tax deductible health insurance benefits system we have today.

          • I’m happy with my health savings account. But I might just want to remove the tax deduction from employer-provided insurance in a revenue-neutral way, then see what happens. I’m not confident I can find a better system on my own.

          • I like HSAs a lot. (On the other hand, on aggregate they only work when a small number of people in the system use them.)

            I’m curious – what do you think the problem with the tax deduction is? How do you see the system changing if we take the deduction away?

          • Consider an economy in which there were two kinds of money — greenbacks and redbacks. If you get paid in greenbacks, your pay is taxable. If you get paid in redbacks, your pay isn’t taxable.

            It should be obvious which one employers will pay you with if they want to remain competitive in the labor market. You’ll get redbacks until you can’t possibly stand them anymore, and that will be true even if the two kinds of pay can’t buy the same things.

            And redbacks, here, are just dollars pre-spent on insurance plans.

            The second perverse result is a direct result of the first: Because it’s so advantageous for them, employers rapidly became the primary buyers of health insurance, not individuals. Employees aren’t going to bother entering the market when they get health insurance as part of their standard compensation. So the market for individual insurance dries up.

            The result is that insurance providers are generally responsive to employers’ needs, not individuals’. Indeed, individuals never have any opportunity to drop a plan they don’t like, so there is no reason that insurance companies should ever care about them. Unsurprisingly, they don’t.

            These are all problems that the popular media likes to lay at the feet of the free market. And with the market being broken, it’s time for the government to step in. Of course.

          • FWIW, I think a HSAs combined with universal catastrophic coverage (and a well-funded, means-tested safety net for the genuinely needy) are a good basis for a more sensible system.

            The only flaw I see is that this allows people who pay directly (via HSAs) to have more autonomy than people who get their coverage via the safety net. YMMV as far as whether or not that is just.

          • One proposal that made sense to me is to tie the deductible to income, and offer HSAs. For the really hard-up, that deductible should be zero. But at a certain point, saying “We will pick up the expenses when medical costs reach x% of your income” sounds reasonable.

            What does doesn’t do, though, is solve the EOL-care question. Since those expenses are going to be above whatever deductible we have.

          • HSAs doesn’t work as a system, only an outlier. If much of the money you pay is designed to go back to you if you do not need it, there is no money to fund claims. Health insurance requires the dollars of heathy people to offset the costs of unhealthy people. If you start pulling much of that money out of the system, it breaks down – or we all make a decision that much of what we allow as treatable by insurance, such as treatments for cancer, MS, HIV, heart surgery, etc., are now items for people that can pay out of pocket do to very high income. (Or are very old and have accrued the HSA funds.) And coverage for children would be right out.

            In order to make your HSA work effectively, you have to have an existing system with lots of people that are paying premiums to support you if you get ill at a non-retirelment age.

          • HSA’s have to be combined with some sort of catastrophic insurance program. Otherwise, it’s merely a tax benefit and not a plan.

          • Well, I think universal catastrophic coverage meets a lot of those needs. Cancer, HIV, etc all trigger automatic government insurance, which (in Russell’s Dream World) is well-funded and viewed as a public good.

            As it is, I think the lack of a public option is a manifest flaw in the ACA. Once it was jettisoned, my support became much more tepid.

          • Russell and Will – that’s just rearranging who pays the same amount (and, in fact, adding more administrative layers). In order for that a system that pays for the things that are now paid for AND both saves and gives you a lot of money back later if you stay healthy, you have to assume that the vast majority of dollars that go into the system now don’t pay for services. That’s not the case.

          • Tod, the assumption behind deductibles is that people will forego services that cost money if they have to pay for it (or get some rebate back for non-use. It’s not that the money paid isn’t going to services, but that people are utilizing services they don’t need or more expensive options when cheaper ones are available. HSAs are a way to handle deductibles with similar tax advantages the employer gets for offering insurance. But it’s based on the advantages of high deductibles.

          • Tod, if we haven’t been clear, Russell (if I’m understanding him correctly) and I are talking about HSAs WITH insurance pools (in his case, the govt as the insurer, I’m less specific). Just reserving the insurance pool for more major cost shocks.

  2. The debate over medicine today is like that baby, but with disputants who won’t fall for Solomon’s trick.

    Is that how he sees it?

    The way I see it is that such makes it obvious that neither disputant is the real mother.

    • If you’re referring to his Left/Right dichotomy, then I would agree.

      However, if I’m going to further torture the analogy, I’d shift the identity of the disputants to patients and providers. Both have a claim to being the “real” mother in the discussion I lay out. Obviously, patients are deeply and sincerely about their own health. And, unless you have the most jaded opinions about medical providers, I would hope people could agree that physicians and others genuinely care about their patients’ well-being, too. The problems arise… well, in lots of places really. But in this case it’s when the two parties are at cross purposes, and someone else entirely is paying for their argument.

      • But in this case it’s when the two parties are at cross purposes, and someone else entirely is paying for their argument.

        I’m pretty sure I pay for all of my treatment, it’s just indirect.

        The disconnect is that I, along with a few hundred thousand other people, pay someone else to maintain a fund that pays out most of the bill for most of my medical treatment (and the same for the other folks in our pool) and I pay a small portion of the bill directly afterward.

        It’s correct to note that the incentives are rather obviously all fished up because of the intermediaries.

        But I’m kind of bristling at Hanson’s notion that the $10,000 or so my insurance costs per year doesn’t constitute that I’ve already made a decision to pay for medical services out of my pocket, where does he think the insurance payment comes from?

        • But I’m kind of bristling at Hanson’s notion that the $10,000 or so my insurance costs per year doesn’t constitute that I’ve already made a decision to pay for medical services out of my pocket, where does he think the insurance payment comes from?

          Or, is Hanson arguing that you could be paying $5,000 a years, instead?

          • He is, in a way, but he seems to be arguing it backwards to me.

            It seems to me the studies indicate that the price of your medical services have no real correlation to health outcomes more so than the volume of them have no correlation to your health outcomes.
            Hanson’s baby argument implies that if we just agreed to get half as many services we’d be in great shape and avoids the significant questions about how we might make those decisions rationally and justly.

        • But I’m kind of bristling at Hanson’s notion that the $10,000 or so my insurance costs per year doesn’t constitute that I’ve already made a decision to pay for medical services out of my pocket, where does he think the insurance payment comes from?

          But that’s precisely the problem. You’ve already paid for the treatment so why not consume as much as you can. Its basically like an all you can eat buffet. Of course people are going to over eat especially when you have doctor patient privacy. One thing that may prevent people from overeating in a buffet is the shame of coming from a buffet with three different plates full of food. A lot more people will overeat if there was no one else watching them eat.

          To go back to medical insurance. When it comes to consumption time, you are not consuming as though you have to make a tradeoff between the marginal benefits of consuming more and the marginal cost of purchasing more. In that particular sense you are not behaving as though you are spending your own money.

          • Should I be able to tick a box that says “Clinically indicated” (insurance pays) or not (in which case the cost is incurred by the patient directly)?

          • I don’t know if that really holds, Murali. I might go to the doctor more than is necessary, but if I genuinely believe I need services, am I wrong to seek them? It’s not like I can insist that Russell perform unnecessary surgery on me or prescribe me pills I don’t need. It’s not quite akin to an all-you-can-eat buffet in that there is gatekeepers to most of the services who likely won’t allow access unless they are medically necessary. And if folks are worried that they might be on the hook if they go to a doctor for what they think is medically necessary but turns out not to be, you discourage people from seeking treatment.

          • So what it boils down to is relatively greater patient autonomy (and arguably better health care, though I think that’s debatable) with greater affluence, and a somewhat more paternalistic health care system.

            I’m not saying I disagree with you. (And I certainly hope you don’t think I’m being adversarial. I have no intention of being.) I just think it’s important to be explicit about the bargains we’re striking.

          • Kazzy, the problem arises when the patient disputes my decisions as gatekeeper and requests or demands interventions of dubious clinical benefit. (And though it’s rare, I have had occasions when a parent has literally refused to leave my office without a prescription they thought their child needed.)

          • I don’t disagree, Murali, but the buffet analogy has some serious limits. The range of dietary needs for humans is minimal and the greediest of us still can only consume only so much, perhaps 5-10 times the minimum.
            The range of lifetime health care needs are a vast chasm with essentially zero correlation to any sort of just system of allocation. The gap can be hundreds or thousands of time the minimum or the norm. So how can one posit a just system for assessing the costs and decision-making?

            That’s why we get into an insurance scheme in the first place – my daughter is a typical toddler, her health needs are spare and so I spend minimal amounts of money on her health care. The parents of a child with a genetic disorder or a childhood cancer will face enormous costs. It’s easy to say we can differentiate to what costs are justifiable and which are not but I don’t think that stands any sort of close scrutiny.

          • Do you acquiesce in those instances? That is insane!

            I realize that some patients might “doctor shop” until they secure what it is their seeking, but I’m sure this isn’t the norm (and I don’t consider people who genuinely seek second opinions to be “doctor shopping”… I mean the folks who’ll just go doctor to doctor until someone just gives them exactly what they want). But by and large, I would venture to guess that most doctors serve as appropriate gatekeepers. Of course, I rarely visit the doctor because I hate all of you and use a combination of WebMD and arrogance to solve most health problems.

          • Kazzy, overconsumption of medical services takes place to a fairly large extent in the US. One major reason that Singapore has much lower medical costs is that we have much less consumption. Moreover, our medical outcomes are on par or maybe even better than yours. That means that a fair bit of american consumption of medicine is unnecessary or has extremely little marginal benefit.

            Also, I come from a family of doctors*. My parents who have experience with different systems (mom with the American and dad with the Singaporean/British) as well as many contacts in the US. Their observation is that doctors in the US are trained to order up barrages of tests while in Singapore, they tend to go more for identification via “low tech” diagnoses. Apparently diagnosing a patient from sensory cues is a skill that can be trained and in their opinion is under-emphasised in American curriculae. Since I am not a doctor, I cannot tell for myself whether that is true or not, but I believe that Dr Saunders agrees with me to some extent. Partially owing to training (and maybe even partially owing to subconscious impulses) there is a very significant risk for American doctors to prescribe tests which are not necessary.

            *My Mom (Renal medicine) was trained in Vanderbilt, while my Dad (Emergency medicine) was trained locally. My Sister-in-law (Pediatrics) was trained locally as well and my sister is currently in medical school.

          • Murali-

            Even if Americans consume more than others and more than they need, it is hard to necessarily argue that there is abuse in the system. I might go to the doctor when it turns out to be unnecessary, but I don’t necessarily know that it is unnecessary until I’m there. Yes, maybe we should all just wait a day or two longer before going to see if things clear up on their own. But that isn’t an option for everyone. Not everyone has paid sick leave. Not everyone can easily miss work if necessary.

            I agree that if folks are abusing the system, something should be done. I don’t think that we should penalize someone who goes to the doctor for what they think is a sinus infection that require a prescription only to find out it is allergies that can be treated OTC.

          • And, I’ll leave the final word to Russ on the matter, but it is my understanding that the myriad of tests many doctors order for basic diagnoses is to cover their ass and avoid malpractice suits. If that is indeed the case, that seems much more of a structural element than a problem with doctors themselves.

          • Because I don’t like going to the doctor?

            Look, the vast, vast, VAST bulk of people’s “overconsumption” of medical services boils down to “Saw a GP when I probably could have just taken some aspirin and waited a few days instead”. Total patient care: 20 minutes of a GP’s time and possibly a blood draw. Wasteful? Yes. The reason we pay twice as much? NO.

            Look, most people actively avoid the doctor’s office. There’s a reason for white-coat hypertension, after all. 🙂

            NO SANE PERSON says “i’ve spent 10,000 dollars on insurance premiums this year, I’m gonna go get CAT scans until I’ve gotten my money’s worth!”

            People don’t think that way. Any explanation, justification, or ‘theory’ predicated on people behaving that way is suspect because, you know, people don’t.

            I’m sure doctors get their fill of the few crazies that DO (after all, that’s where the crazies would go!) but 99.9% of Americans paying for health insurance do NOT look at the doctor’s office like a buffet, bound and determined to be poked, prodded, operated on, and probed until they’ve gotten what they paid for.

            Most Americans just want to feel better.

            Now drugs? That’s a different thing entirely. And frankly I blame advertising, although American’s faith in antibiotics as the cure for everything comes a close second.

            I STILL don’t know why advertising for prescription-only substances is even allowed. There’s no point to it. The people watching the TV can’t buy it. They can only harass a doctor about it, and if they needed it, wouldn’t their doctor be giving it to them?

          • Apparently diagnosing a patient from sensory cues is a skill that can be trained and in their opinion is under-emphasised in American curriculae. Since I am not a doctor, I cannot tell for myself whether that is true or not, but I believe that Dr Saunders agrees with me to some extent.

            I agree with you to a very large extent.

            Whatever its flaws, one thing I will say for my medical school is that it put a strong emphasis on physical diagnostic skill, and discouraged testing unless it was clearly indicated to answer a pertinent clinical question. This probably had a lot to do with the fact that its teaching hospitals were generally poorly-funded public institutions, so there was little cushion for needless expense.

          • Kazzy —

            Do you acquiesce in those instances? That is insane!

            It’s a complicated decision. In the instances that spring to mind, the demands were for antibiotics and I ended up acquiescing because in the end it seemed the best decision to make. In one case, I still think it was the right decision. In another, I look back and think maybe I should have been willing to risk alienating the family and refused after all.

            If the demand were for a more toxic or otherwise risky medication, I would have been more apt to refuse.

            …it is my understanding that the myriad of tests many doctors order for basic diagnoses is to cover their ass and avoid malpractice suits.

            I think you’re right, but that’s based more on a gestalt sense than on anything verifiable. And I suspect those costs would be difficult or impossible to quantify.

          • Morat —

            …if they needed it, wouldn’t their doctor be giving it to them?

            The surest way to get me to refuse to prescribe something is to mention the ad you saw for it.

          • “The surest way to get me to refuse to prescribe something is to mention the ad you saw for it.”

            But I’m not currently sitting in a bathtub on top of a flower-covered hill holding hands with my wife, also in a bathtub. CLEARLY I need that medicine!

          • What drove me nuts was the short period where drugs could be advertised but the ads couldn’t say what problems the drugs were supposed to address.

            So it was just a bunch of happy, pretty people saying “I’ll ask my doctor”.

  3. And quite often the parent will request that the patient be tested for Lyme disease

    I say “Doctor, ain’t there nothin’ I can take,
    I say, Doctor, to relieve this belly ache?
    I say, Doctor, ain’t there nothin’ I can take,
    I say Doctor! let me get this straight”.

    • You put the Lyme in the healthcare bunk, you drank it all up,
      You put the Lyme in the healthcare bunk, you drank it all up,
      You put the Lyme in the healthcare bunk, you such a silly wo-man!

  4. I searched a bit for a long cover story from The Atlantic last year in which the author proposed a non-replenishing individual lifetime public assistance entitlement of one million dollars. You get $1,000,000 of government money to pay for healthcare, and everything after that is on your own dime. How would that affect health care decisions? (I couldn’t find the link readily but I’m sure others can. It was a cover story.)

    It occurs to me that this proposal would create proprietary feelings in rational holders of the entitlement. It would feel like my money even if it’s really the government’s, just the way Medicare does now. The similarities between this and idea Russell raises from the RAND study are clear enough — people who have a proprietary interest, or even a quasi-proprietary interest, in the money used to pay for health care, behave differently when deciding what health care to seek and pay for than when they are able to shift the costs elsewhere, either through insurance or entitlement.

    I consider what choices I would make were I to have a proprietary, or at least emotionally proprietary, interest in the healthcare funding. I kind of do now — my wife’s health care plan includes an employer-funded MSA, which is funded once a year to its initial funding level. We feel an incentive to spend all of the money in a single calendar year because the money renews back up to its original level, so we want to maximize the benefit from “our” money.

    If the renewability of the funding were renewed, however, I’d refrain from seeking medical care for all but the most serious of conditions so as to conserve my limited proprietary stake for catastrophic problems while young, or dealing with the anticipated deterioration of bodily functions in old age. I’d not get regular checkups as long as I felt healthy, meaning I’d probably not get screens for conditions with subtle or imperceptible early-onset symptoms, like some kinds of cancer, and thus miss the opportunity to have those conditions detected and treated early. More dangerously, since I am not a doctor my self-education and self-treatment with OTC medications would through the machinations of accumulating chance, eventually lead to me mis-diagnosing myself and aggravating a condition that could likely have been identified and dealt with quickly, effectively, and economically efficiently if I’d seen a real doctor soon enough.

    So, if the goal of reforming health care funding policy is “increased public health,” then I’m skeptical that proprietary or quasi-proprietary funding solutions will lead to an end state in which the policy goal is realized fully. Of course, the goal may be “saving money,” or “maximizing patient autonomy,” or “creation of jobs,” or any of a number of other similarly-laudable end states. If so, we as a society should be conscious of the fact that we would be choosing one or more of those other goals at the expense of diminished public health.

    • My knee jerk thought is that this would be a terrible idea. Part of what has gotten us into this mess is that there is a disconnect between people and the costs associated with HC.

      If you are a 20 year old and you just have “insurance” you might only get X number of tests done. But my sense is because of the way people think if you’re 20 years old and have a million dollars to blow, you’ll do more. And then you’ll get old and have expensive illnesses that you assumed you wouldn’t care about back when you were 20.

      I doubt telling people they have a million dollars to spend on anything results in them spending less.

    • Take a look at Dr. Russell’s earlier post about how unevenly healthcare spending is distributed. If you give the same number to everybody, I suspect most people could spend more than they need while young and still have enough left over for more end-of-life care than is efficient (at least if you believe Hanson’s appraisal of end-of-life care), whereas money will run out for the unlucky few who get expensive, chronic conditions.

    • If you want to give patients a feel for what they’re spending, why not higher co-pays or a percentage of the costs with a max out (so no one is bankrupted)?

      One ICU stay and you will blow through that million and be out of luck in no time.

    • So I get to a million dollars and then just die?

      You heartless, sick bastard. Why do you want people without enough money to die?

  5. Russ-

    If you were completely left to your own devices, what would you charge for the various services you offer? Take into account all of your expenses, including but not limited to your education, your physical overhead (rent, utilities, etc.), staffing, malpractice insurance, supplies, etc. If you sold your services in the same way that an independently employed housecleaner did, what would you charge?

    • I’m a little bit reluctant to quote a price explicitly for a few reasons, with at least one based on ignorance and one based on prudence (or, if you prefer, cravenness).

      First of all, I simply don’t know what the flat rate I should charge per visit to keep my office as staffed open would be. For every insurance plan, there is a different rate of reimbursement for services. In aggregate, they keep our office open, buy our supplies and give us a decent living (though we’re still tidily in the 99%). But if we were to charge a flat rate, it would vary depending on the complexity of the visit (for sick visits). And I just don’t know what a realistic pricing structure would be.

      And even though I write under a pseudonym, it’s probably wise that I not shoot my mouth off about what I “should” be charging, lest I rouse the ire of my partners.

      • Fair enough. I didn’t mean to put you in a tight spot. I do wonder what an a la carte pricing structure would look like. $50 base rate for an office visit of 30 minutes, $20 for a strep test, $200 for an X-Ray. Etc. It’d be interesting. It is to the point that I, as a consumer, have no idea what the treatments I seek actually cost. I know what I pay. I sometimes see an invoice that indicates what the doctor’s rates were. And I occasionally get something from the insurance company indicating what their adjustments were and what they actually paid the doctor. But my hunch is that none of these numbers indicate what a doctor would charge under the scenario I presented above. The system just seems very screwy and I’m sure no small percentage of the money going to “health care” actually goes to keeping the insurance monster fed.

        • The system just seems very screwy and I’m sure no small percentage of the money going to “health care” actually goes to keeping the insurance monster fed.

          Oh, Lord. The system is screwy as all hell, such that calling it a “system” affords it far greater dignity than it deserves. As I said, I get paid vastly different amounts for the exact same services rendered, depending on what the insurance carrier is.

          And yes, a massive amount goes toward feeding the insurance monster, whose motivations revolve around profit and not the well-being of the patients. Or not primarily, at least.

          • Russell-

            Is the model I propose how very top-end doctors who tend not to accept insurance function?

          • You bet. The richest pediatricians I have ever known (who were among the lousiest, as it happens) accepted no insurance whatsoever.

          • Who sets the rates you do charge, Russell? I mean, I assume you do have rates. I know when I visit a doctor they quote me their rate but then just take my co-pay and my insurance pays them something less than their rate. If you do accept insurance and just take the payments offered by the insurance companies, why have rates at all?

          • As our practice’s Shiny New Financial Director, it’s one of my evolving duties to set those rates. However, since I am just out of the packaging and still learning the (incredibly complicated, dizzying set of) ropes, I am still mainly just nodding and smiling while our practice manager discusses our rates. Up until I was made partner, the rates were set by the owner and practice manager.

            And I am very glad to say their philosophy has always been (and seems genuinely to have been, now that I see the books) to make the rates as accessible as possible to as many people as possible. But because the amount any given insurance carrier pays is subject to change from year to year and contract to contract, it can be incredibly difficult to name a set “rate.”

          • So do those rates only matter for people without insurance? Or do insurance carriers base their payments on your rates?

            Sorry to be peppering with so many questions, but I’m pretty ignorant of the whole system and though my wife is in health care, she isn’t really in the position to answer such questions (Clinical Applications Specialist at a hospital after doing bedside nursing care in hospitals).

      • In Singapore, a small private clinic with 1 or 2 GPs tend to charge about $25 per visit with some of the fees waived if medication like panadol is supplied (so that the total paid comes to about the same) and perhaps more when more expensive medication is dispensed. Government run polyclinincs charge about $8-$10 but have abominable waiting hours.

        • Does the private clinic then get additional compensation from the government for rendering the service? (If you know.)

          • AFAIK private clinics don’t unless possibly a particular patient is part of a particular Medifund program (but I’m not sure if Medifund applies to private practices)

  6. Somewhat off topic, but somewhat not:
    First, Do No Harm; Second, Listen

    This needs to be posted in every doctor’s office and be presented twice a year until it sinks in. CFS, endometriosis, Fibromyalgia — how many times have patients heard “it’s all in your head” only to be found right by someone who would actually listen?

    I’m lucky — my GP listens to me, and I’ve got my urologist to back off on biopsies every month. But I had to do my own research and even then, the urologist wanted to argue with the articles in the JAMA… I can only imagine how much harder it is for Amanda.

    • The doctor told me that it was just fibers from my shirt but the nice people on that website really listened to me and that’s how I learned I had Morgellon’s Syndrome!

      • Morgellon’s Syndrome? Isn’t that when you go around the world in search of a good doctor only to die from inadequate care in the Philippines?

  7. A perhaps illustrative story that has happened to me in several iterations: my insurance is absolutely wonderful on covering everything except medical equipment. Hit or miss on that. Docs prescribed a pediatric wheelchair/seating system for my kid. Costs somewhere around $15,000. Insurance denied it. Manufacturer calls and offers me out-of-pocket for $8000. We got the wheelchair covered on appeal (so manufacturer got the $15k). Insurance denied us a bath chair. Manufacturer offered me half price, and I took them up on it. I checked the invoice. It suggested we still owed the remaining amount. I suppose that’s how they justify it to auditors, and just never follow up.

    A bed for a kid with special needs costs $10,000. The bed simply needs slats and a tented top. Plenty of parents fashion their own out of a bunkbed, some lumber, and a dog gate.

    This is not unnecessary equipment. My kid needs it for highest functioning. The bath chair was rejected as “recreational,” but if a kid doesn’t sit up well, it’s no joke to give him a bath. Very difficult for caregiver; not 100% safe for the kid.

    I understand this is a low-volume industry that often makes customizable products. But their behavior suggests they still make a profit at half the price at which they are selling.

    I don’t know how large a problem this really is, but perhaps there’s even more to the problem than insurance companies, patients, and doctors.

    • That’s because those numbers? Aren’t the real prices.

      Not only can’t you comparision shop for healthcare as an individual (do you plan to do some calling around after your heart attack or car accident, maybe some googling to figure out which hospital best fits your budget?), you couldn’t even if you wanted to.

      The prices listed on invoices are nothing like what actually gets paid.

      I got moved to an 80/20 plan a few years ago (my only option through my company) and I’ve come to realize it’s a GIANT scam. I’m not sure who is actually getting the money, but it works like this:

      I go in for, say, routine lab work. Doctor charges 400 dollars. I thus owe 80. Insurance negotiates that down to 120. Yet somehow I still owe 80 dollars. Doctor ultimately gets paid 200 bucks, except I’m paying 75% of it not 20% of it.

      I can’t read the bills — it’s all in code. I can’t tell what the hell I’m actually being charged. The only clear part of the bill is the amoutn I supposedly owe the doctor (above my co-pay!), but I have no way of verifying it.

      I spent two hours once on the phone trying to determine if a given procedure was covered. What I got? The lady on the phone repeatedly reading to me a single vague paragraph. In the end, I was told I basically needed to have the procedure and if it got rejected, appeal it. And if it got rejected again, THEN I would know if it wasn’t covered.

      Hospitals and doctor’s don’t have real prices. They have a giant collection of prices they charge different people, and sizeable staffs devoted to making insurance companies actually pay.

      But somehow I suspect that only a fool would pay the cash bill handed to them by a hospital or doctor without trying to get it reduced.

      • Hospitals and doctor’s don’t have real prices. They have a giant collection of prices they charge different people, and sizeable staffs devoted to making insurance companies actually pay.

        Respectfully, this is inaccurate. Doctors (and, I presume, hospitals) are explicitly forbidden from charging different rates for the same services to different people based upon their insurance coverage. This is a violation of the contracts we have with the various insurance carriers, and is considered fraud. We face severe penalties if we are caught doing it.

        We do, however, often employ people to wrangle with insurance companies to pay for services rendered. But what we charge is uniform, with rare exception for reduced care for indigent patients.

        • Then either hospitals are routinely violating the law, or NOTHING stops you from charging a flat fee and negoitating special rates from there.

          Saw a post just a few weeks ago about CAT scans in California (Kevin Drum’s blog, I think?). Prices varied not only from hospital to hospital, but internally depending on payment method.

          In short, “cash” was somewhere between 200 and 2000 dollars (depending on where you went), and insurance was…somewhere between 200 and 4000 dollars. Except the place charging 200 for cash was charging 3k for insurance, and another was charging insurance 1500 but cash 2500.

          *shrug*. I don’t see how anyone could tell if you were obeying the law anyways, without trying some sort of convuluted sting operation. It’s not like I can get prices for anything up front anyways.

          I just get a really unclear bill later. Sometimes I get four or five bills, all with differing amounts, some expecting me to pay and some just as ‘notification’.

          I’m always fond of the “statement of benefits” things where I’m notified the doctor charged CIGNA (my current jerks of an insurance company) 250 dollars, but CIGNA paid 75 dollars and my co-pay was 25 dollars. Not that it makes any sense — it’s either broken down into ridiculously jargon-filled specifics, or it’s too generalized to make out.

          And then I get a bill that may or may not be related to that visit for another 50 dollars from the doctor.

          I literally have NO IDEA how much I pay for ANYTHING medical if it’s not OTC. Like “no clue”. I tried to figure it out once, after a minor (outpatient) surgery. I just kept getting bills, revised bills, duplicate bills, confusing statements of benefits, and the customer help lines were useless.

          From CIGNA. Not exactly a fly-by-night company.

          And I can’t help but think it’s deliberate.

        • I have self-paid for stretches at a time. When I say that I have the cash in-hand (well, a valid credit card), I typically don’t have a whole lot of problem getting a price (the docs have to check with the front desk, who then tappity-tap into a computer, and give me one). I also know for a fact that I got discounts over stated rates. In one case (a dermatologist’s office), there was a sign to this effect.

          • self-payers generally have far more flexibility, in large part because the healthcare provider actually gets paid around the time services are rendered. that is a bfd in an industry where payments for treatments are generally delayed by months.

            morat, i think some of your confusion is because you’re essentially (a very interested, of course) bystander to a fight between cigna and the provider, who are playing a game of chicken with one another. or having a one-sided slap fight, depending on how large the provider is. if you’ve ever haggled in a flea market, you get the general drift.

        • Doctors (and, I presume, hospitals) are explicitly forbidden from charging different rates for the same services to different people based upon their insurance coverage.

          Then what’s going on when I get an insurance statement, and the list price for procedure X is godawful-amount-of-money but the PPO rate is somewhat-less-godawful-amount-of-money? I thought that I was charged only slgaom specifically because of the relationship between the provider and my insurance company.

  8. I have removed the content of this comment because the commenter chose to compare me to Josef Mengele. Further comments by this poster will be deleted immediately. — RS

      • Indeed. His opinion about chronic Lyme disease differed from mine, and he chose to express said difference of opinion in a singularly impermissible manner.

    • If I had known this, I never would have had you be godfather to our developmentally disabled Jewish child. As it is, I’ll just have to keep an eye on the two of you when you’re together.

      But seriously, of all the comment threads in all the posts in all of Blinded Trials, I did not expect a Nazi accusation on this one.

      • I expected some blow-back from the Lyme community (which, like so many others, is clearly passionate in its convictions). I am perfectly willing to countenance dissent, even expressed in strong terms. Mengele comparisons? Not so much.

        And your comment is space awesome.

        • “the Lyme community”

          Sometimes I feel despair.

          Sometimes I feel like everything’s going to be okay.

          • My school is in a heavily wooded area overrun with deer which themselves are overrun with ticks. We have a large contingent of parents who are “lyme crazy”. Neither them nor their children have lyme and most of them don’t know anyone whose ever had it (there have been a small handful of cases in the area). But godforbid we take their children into the woods to explore nature of, heaven forbids, sit in the grass! SOMEONE COULD GET LYME!?!?!?!?!!!!111111!!!!!ONE!

      • No one expects the Nazi Accusation! Our main weapon is the blog comment.

      • Remember that conversation about Russell and harvesting organs? It has a whole new tone now…

        • OMG, you’re right! I always assumed he would at least use anesthetic and proceed to sell the organs. Live and learn….

          • Wow, his long game is even better than I realized! He waited fifteen years for me to have Squirt, biding his time, playing the loving uncle, lulling us all into a false sense of security….

          • “Wow, his long game is even better than I realized!”


            Oh, the irony…

    • I like the way you handle objectionable comments, and I’m going to recommend it to my colleagues on the group blog I contribute to.

      • Well, Liz, sometimes I get into pointless arguments. (Perhaps you recall the vaccine post and one Mr. Schmoe?) And sometimes people compare me to one of history’s greatest monsters because they disagree with my opinion on something, in which case I expunge their comments.

        • Sometimes you can tell up front that it’s just not going to be worth it.

  9. The fossilization of the health insurance system:

    I have been self-employed (and thus, purchasing my own health insurance) for the last 25 years. A few years ago, I was considering moving to another (smaller, more rural) state. My insurance advisor was of the opinion that I wouldn’t be able to get coverage in SMR state, as I had had cervical cancer 22 years ago (treated by surgery alone, no recurrences) and a couple of minor skin lesions (I guess technically, cancer).

    I’ve also heard stories of folks whose employment decisions are made based on benefits, as in my pal NoName, who was headhunted by a start-up and declined. Why? NoName’s child has special needs, and they can’t risk going without insurance benefits.

    So the current system restricts both geographic and employment movement. This is good how?

    • Thank goodness we just embedded it into law.

    • Wrote a post on this the other day. Our movements and employment options are similarly restricted. Annoying in the extreme.

  10. A pediatrician in an endemic area who has never diagnosed a lyme case is probably a charlatan, not the doctors who actually know what they are doing in infectious diseases carried by ticks. Your statement about these doctors is libel. Or is it slander? Certainly ignorant.

    But I don’t know if it is worth my time to post on a blog of a person who has such a closed mind. And contrary opinions to yours get censored?

    A dentist just charged me more than $500 for a simple filling that actually cost $200+. She ran up the bill by giving me a l-minute comprehensive oral exam, along with a series of xrays that were unrelated to the filling. Then gave me a referral to someone who would advise me on getting 6 implants, which I had already explained my insurance would not cover and I could not afford.

    So, sometimes the people who are running up healthcare costs are the ones in the white coats.

    As far as unnecessary medical procedures are concerned, how many patients know enough about medicine to decide what is necessary?

    • Thank you, Lou, for demonstrating the passion of the Lyme disease community, right on cue.

      I have definitely diagnosed Lyme disease. I have never seen a plausible case of chronic Lyme disease. As to the latter, I will simply refer you to the New England Journal of Medicine article linked supra under “scientifically invalid.”

      And the previous comment was not censored because it expressed dissent. It was deleted because the commenter compared me to Mengele, which is a no-no.

      I cannot speak to the care your dentist provided.

    • “So, sometimes the people who are running up healthcare costs are the ones in the white coats.”

      Sidestepping the issue that dental coverage is a completely different animal than health insurance… This is certainly true, and for a high number of reasons – most of which have nothing to do with an attempt at deception. And in my opinion very worthy of discussion.

      So it’s a shame you opened with the whole “Russell censors people” angle.

    • To address the most important point in your post:

      Slander is defamation in transitory medium such as the spoken word, libel in a permanent or published medium, like an electronic posting indefinitely available. Therefore, you mean libel, not slander.

      • Thank you for that clarification about libel.

        “Russel” better hope none of the attorneys with chronic lyme are reading this blog. A pseudonym does not protect you from being identified.

  11. I would simply say this: I know your article isn’t directly about this, but you, sir, are not adequately educated with regards to Lyme disease and all of its complications. Whether you call it Chronic Lyme, Late-Stage Lyme, untreated/undiagnosed Lyme… it IS real. I went almost my entire life (over 3 decades) with untreated/undiagnosed Lyme. If it were up to you, I wouldn’t have it. Thankfully, there are those who weren’t merely taught what to think in med school, but rather they were taught HOW to think… these are the ones who are changing the lives and SAVING the lives of those in my situation.

    You say, with every indication of expert-status, that there is no such thing as Chronic Lyme. Well, until recently, ulcers were absolutely, 100% caused by spicey foods and the like. No way a bacteria could do this sort of damage… Enter h. pylori.

    Have you lost all sense of logic and self-thinking? Or has the CDC and the IDSA spewed their venom all over your brain so much that you are no longer able to think for yourself. If you simply take time to reflect and look at the puzzle pieces, you will be astonished at what we, the Lyme community, has to suffer and endure, because of the likes of the many robots who were brainwashed by a bunch of opportunistic people with many fists full of money being slyly shoved into their pockets.

    I pray for our medical system. It is so broken. And you, sir, have perpetuated it.

    • Did any of you have any idea the Lyme community existed? I feel like I’ve been living a bubble. I think they may be more venomous and into ad hominem than circumcision folk!

      Okay, here’s the new Angry Random Visitor Attractant Blog Post: Circumcising the Misguided Fools Who Believe in Chronic Lyme: a Parenting Maifesto that Insists On Crying It Out

        • Crap. I knew I forgot some biggies. Easy enough to fix: Circumcising the Misguided Fools Who Believe in Chronic Lyme: a Parenting Manifesto that Insists On Crying It Out During Vaccinations.

      • Rose, Thank you for making light of a life-long and debilitating illness that I have, that many friends of mine suffer through, and that I have unknowingly given to all three of my children. Way to make light. I bet you like to make fun of cripples who you pass along the street as well.

        • I did not make fun of an illness. I made fun of the tone and nastiness used. I could see someone saying, “Hey, I think you’re wrong about this, and here’s why.” I don’t see calling someone Mengele, or insisting they cannot think, or that they are motivated only by money.

          And yes. You have me pegged. When I need a little pick-me-up, I make fun of the “cripples” I pass along the street. And if I need to cheer myself up right away, luckily I don’t even need to leave my house!

      • Is there a community for every fishing disease, condition out there? I get that some seriously debilitating stuff have support groups. But that is to help manage the disease. It seems like everything has been politicised. Every single bloody thing seems to need some sort of group to draw attention to it so that it can get its due attention.

        In retrospect you realise that once people realised that this could be done for some things, people want it done for their condition too. So, predictably, there’s an arms race where everyone gathers in groups to tell themselves and the world that their condition is absolutely serious or else it will get less attention than those fishers who are going out telling everyone that there particular condition is worthy of atention and money etc. Somehow this makes a medical condition an appropriate basis for community formation?
        [/end rant]

    • Hi, Lauren. Thanks for stopping by.

      Sadly, I regret that yes… I’m with the Centers for Disease Control, the Infectious Disease Society of America, and every single infectious disease specialist I have ever known on this one. Also, I have read a few reports from patients who have seen a chronic Lyme specialist and… let’s just call me skeptical.

      But so nice to have you comment.

    • Today’s were really standout. Don’t get me wrong, I always have a special place in my heart for my trolls. They are so loyal – they STILL pop up now and again on the circ post. But these folks are a breed apart.

      • I think you’re forgetting your best troll.

        Sure, the lyme trolls are passionate, as are the circumcision troll, and the breast feeding trolls, and the vaccine trolls. But it’s easy to be passionate when there are so many of you… easy when there are vast communities of people who share your fury, who help share the load. But taking the world on all by yourself? The whole world? Well, that takes a special kind of troll – a troll with determination, a troll with fortitude, a troll with a mission that means more than life itself.

        I’m talking, of course, about James Franco troll.

        James Franco troll comes to Blinded Trials and sees another punk blogger, a punk that’s dissing James Franco. James Franco troll thinks that punk might as well be pissing on the American flag. But James Franco troll doesn’t have time to leave a comment, because James Franco troll is in a hurry. There’s a lot of internet out there, and a lot of it hates James Franco. James Franco troll doesn’t have a lot of fancy pants followers to leave comments on blogs that dis James Franco. That’s a weight of the world that falls solely on James Franco troll’s shoulders.

        He makes a note of the site’s URL; he adds it to the ever-growing list. He’ll be back. James Franco troll always comes back. It’ll be in a month, maybe two. Who knows what that days post will be about when he returns – it don’t matter. He’ll troll them – troll them for talking bad about James Franco. They’ll rue the day they ever made snide comments about his brilliant work with Natalie Portman. He’ll show them, and then he’ll move on.

        It’s not easy being James Franco troll. There’s so much you sacrifice -friends, family, career, the possibility of ever kissing a girl. But when you’re James Franco troll, you don’t care about those empty things ordinary people fuss over. When you’re James Franco troll you beat back the exhaustion, you google, and you push on to the next site. You know full well that no matter how hard you troll, there’ll always be another punk out there talking shit about James Franco. You don’t become James Franco troll because you want to. You become James Franco troll because you have to.

        They say if you’re out on the internet and on a warm summer night, when the moon is full and the wind slices through the canyon, you can sometimes see him. He’ll be on some blog, taking down those that write about James Franco’s terrible acting skills with his trusty all-caps button. Say hello to him, and thank him – thank him for looking out after the good name of James Franco.

        God bless you, James Franco troll. God bless and God speed.

  12. Personally, I take great offense to the uneducated responses regarding Lyme disease. Here is some evidence to support the existence of chronic Lyme:

    For those of you who do not believe in chronic Lyme, I hope that you are never in a position where you have to live through it yourself. I often wonder what disbelieving doctors would do if they were in the position of the many patients who do not get better after the inadequate treatment advocated by the IDSA.

    I’m curious if any of you have seen the study that shows that doxycycline in standard doses (200mg) converts Bb into the cystic form at an increase of 200%. Since most doctors do not prescribe any medication to combat the cystic form of Bb, what is to prevent those patients from developing further symptoms?

  13. I see from my site stats that this post has been picked up by a bulletin board dedicated to Lyme disease. This comment is directed at anyone visiting via that link who has a bone to pick with me about chronic Lyme:

    I am always happy to have people read what I have written, and obviously anything posted in a forum such as this invites scrutiny. Given the nature of the site that has linked here, I assume the majority of you are inclined to disagree with me. Further, you are free to comment here to that end. Such is the nature of the Internet.

    However, I will not be responding to any further comments about chronic Lyme disease. That topic was only broached in the original post as an example of a clinical concern that I encounter where the patient and I do not agree. I could have picked any of a variety of other examples, and in hindsight I probably should have to have spared myself this headache. But chronic Lyme disease is not the topic of the post, and I am not interested in debating it. I would prefer people comment about the subject at hand, which is payment for clinically dubious medical requests.

    You will not convince me I am wrong. I am firmly on the side of the CDC, the IDSA, and the infectious disease department of Boston Children’s Hospital. I understand that you feel these institutions are incorrect, misguided or worse. I have no intention of trying to change your mind. Given that any further commentary on this subject will only result in acrimony, with nothing but a persistent impasse to show for it, I suggest that your time would be better spent doing something other than telling me how wrong you think I am.

  14. Nice way to cover yourself…You see…you post very wrong in incorrect information about a disease…which HURTS so many that are suffering…

    So be proud of yourself – take the easy way out…Proves only one thing…You are a coward who hides behind the IDSA and the CDC…

    If you are going to bring the topic into an article…THEN HAVE the STONES to address what you have stated…Too many people are suffering because of people like yourself…and those who have stepped up are ones who have had NO CHOICE but to educate themselves better then the general masses of doctors that would rather scratch their heads and butts and decide that it is all in our heads…and follow the IDSA like sheep…

    You have joined the ranks of doctors who have failed the system…HOPE you are entirely proud of that…hope it makes you feel good to know that there are children who suffer day in and day out because this disease is so much more serious then the IDSA is willing to admit…because if they did…they would LOOSE TONS OF MONEY…

    Power greed and corruption of the medical community keeps people sick…and not just with Lyme…Many who are infected have MULTIPLE infections…whom these doctors don’t give a damn about…

    IF there is a HELL…I sure can’t wait to all of those with such jaded and DANGEROUS opinions get there…and learn the suffering that we do…

    If you don’t want to debate it…DO NOT BRING IT UP…DO NOT disrespect those who for years could NEVER get answers, who continued to decline in health…and then with proper treatment and life style changes have PROVEN those like you WRONG…

    You don’t have to believe or change your mind…BUT have some respect for those whose only answer is CHRONIC LYME…because everything else has been ruled out…

    We as Advocates for those suffering, ALWAYS insist on people to try and RULE out Lyme…and in way too many cases…its everything else that gets ruled out and Lyme and Co-infections are what we are left to deal with….

    SO no not looking for a debate here…How about just some common courtesy and RESPECT for those who have had NO choice but to accept the fact that the IDSA is WRONG…because the truth is…

    WE wish they WERE RIGHT…We WISH it was all in our heads…but that is not the case…so don’t perpetuate our suffering…you don’t have to believe us…but find some decency as a human being and respect the fact that for some…Chronic Lyme and Chronic Tick Borne Illnesses have destroyed their lives…

    DO they not have the right to get better and find the answers without the IDSA taking that right away from them??? DO they not have the right to heal and get their lives back without doctors like yourself (your opinions) standing in their way???

    We have the right to be healthy…we have to fight for it tooth and nail…we loose loved ones, family, friends, spouses, even our kids because we are SO sick and NO ONE can help…because NO ONE will consider Lyme and CO’s…Is that a good thing in your book??? IS THAT ok???

    And we are FULLY aware that there are other medical conditions that have the same problem as Lyme does for us…and when we meet those people…we do all we can to help them too…because it is the right thing to …because we know what it means to suffer…

    Try to find your compassion…


  15. I suddenly have a very strong urge to find my copy of Sleeping with Extra-Terrestrials and read it again.

  16. I know three people who claim to have chronic lyme. I have no idea if that’s what they have or not, but all 3 were previously healthy, came down with unexplained dibilitating symptoms, went through a battery of tests, in two of the cases over the course of years, and when they finally got tested for lyme it was positive. One symptom that was hard to forget was my cousin explaining how she forgot where she was going when on her drive to work, and couldn’t remember how to get home. After she was finally diagnosed, and on an insane cocktail of supplements (and/or medicine, don’t recall) she’s able to function normally.

    So…. Dr. Skeptic and your band of boobs who think it is funny to insult people suffering from a dibilitating disease…. what, exactly, are these people suffering from? Such low class in this article and comments section when all you do is whine about being insulted, return the insults even though you have suffered nothing, and then offer zero explanation for what is going on. Rose takes the cake. You’re a loser my dear. I guarantee you’re on the internet 24/7 because you have no friends. Now go ahead – insult away, since that’s your forte.

    • Take that, Rose. You have nothing to console yourself, either, except your husband, children, family, friends, career, charm, sense of humor and intelligence. Were it not for all those things, you’d have nothing. NOTHING!

  17. I am sad to see someone proclaim with such certainty that there is no such thing as “chronic lyme disease”

    To put such a rigid template on a pathogen we barely understand is bad medicine.

    Borrelia Burgdorferi also known as “Lyme disease” is a cousin to Syphilis. A bacteria around since the late 1400′s that caused insanity and people were once told didn’t exist. We know now that it is also vertically transfered from mother to child and that it is sexually transmitted as well. It wasn’t until 1908 that it was better understood, due to advances in modern medicine and much , much later officially identified. It was a burden on humanity and much misunderstood. So too is Borrelia Burgdorferi.

    Why in a time where we still practice 20th century medicine in the 21st century would you think we have it all figured out? How arrogant and foolish. CDC and IDSA are cruel in their guidelines and arrogance. We live in the dark ages of medicine and know NOTHING about the BRAIN and IMMUNE SYSTEM. We are “practicing medicine” To proclaim with such certainty you know this disease is foolish. WE DO NOT UNDERSTAND THE CORKSCREW BACTERIA NAME BORELIA BURDORFERI.

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