Wednesday, September 12, 2018
Save the NHS: Control Health Insurers!
Government can have the power to control Health Insurers thus allowing those that like to have free Cappuccinos when waiting for their Medical Consultation. And make sure if the Privateers mess up and NHS had to take over, they pay.
It must be very obvious that all the talk about medical cover for visitors to England
Could this be because insurers have managed not to cover for everything. One need to ask the question on how one ever travel to the US
It may well be prudent for government to insist that non EU visitors to this country must have mandatory Health Insurance as part of the admission requirement. This should apply to students and tourists alike. After all nobody in their right mind would dream of going to the US
We have managed to get people to insure their cars, why not their bodies.
There is of course the need to fully control Health Insurers for those that live in England
Let people opt out of the NHS if it is so bad! But Insurers need to cover every thing.
Citizens could be given a tax break and yet have the insurance policy incorporated into their NI/NHS number so that those with the tax break, the insurer will be charged for every kind of medical care they receive if they were within the NHS.
©1994 Am Ang Zhang
If we are not careful Private Insurance will creep into England without a single bit of control as it is singularly important to stop Insurers to reject those with pre-existing conditions or dump them once they have a chronic illness such as Type 1 Diabetes.
Patients could have to start to pay charges to use basic NHS services such as GPs because the health service’s finances have become so dire, the leader of Britain
It must be very obvious that all the talk about medical cover for visitors to England
Could this be because insurers have managed not to cover for everything. One need to ask the question on how one ever travel to the US
It may well be prudent for government to insist that non EU visitors to this country must have mandatory Health Insurance as part of the admission requirement. This should apply to students and tourists alike. After all nobody in their right mind would dream of going to the US
We have managed to get people to insure their cars, why not their bodies.
There is of course the need to fully control Health Insurers for those that live in England
Let people opt out of the NHS if it is so bad! But Insurers need to cover every thing.
Citizens could be given a tax break and yet have the insurance policy incorporated into their NI/NHS number so that those with the tax break, the insurer will be charged for every kind of medical care they receive if they were within the NHS.
If we are not careful Private Insurance will creep into England without a single bit of control as it is singularly important to stop Insurers to reject those with pre-existing conditions or dump them once they have a chronic illness such as Type 1 Diabetes.
Here are some things the law will do:
· It will prohibit insurance companies from refusing to sell coverage to people simply because they have one or more pre-existing conditions.
· It will also prohibit them from cancelling our coverage when we get sick just to avoid paying for our care.
· It will prohibit insurers from charging women more than men for comparable coverage and will not allow them to charge older folks more than three times as much as younger folks.
· It will require them to spend at least 80 percent of what we pay in premiums actually paying claims and improving care.
· It will allow young adults—who comprise the largest segment of the uninsured—to stay on their parents’ policies until age 26.
Summary of a popular post:
· Ends discrimination against people with pre-existing conditions.
· Limits premium spread to normal, high risk and healthy risk to say under 20% either way of normal.
· Limits premium discrimination based on gender and age.
· Prevents insurance companies from dropping coverage when people are sick and need it most.
· Caps out-of-pocket expenses so people don’t go broke when they get sick.
· Eliminates extra charges for preventive care.
· Contribute to an ABTA style cover in case Insurance Companies go bust and many might.
We could legislate that Insurers will have to pay for any NHS treatment for those covered by them. It will stop Insurers “gaming” NHS hospitals. This will prevent them saving on costly dialysis and Intensive Care. Legislate for full disclosure of Insured status.
Insurers cannot drop coverage or treatment after a set period and even if they do they will still be charged if the patient is transferred to an NHS Hospital
This will eliminate problems like PIP breast implants.
It will indeed encourage those that could afford it to buy insurance and in any case most firms offer insurance for their employees including the GMC.
To prevent gaming of Insurers by individual patients (I look after their interest too), the medical fee should be paid up front by the patient and then deduction taken from premiums. Corporate clients like those with the GMC should not be gaming Insurers.
Imagine the situation where those with “individual personalised budget” being able to “buy” their own insurance!
In fact, to save money, government can buy insurance for the mental patients and the chronically ill.
This way there will be real choice and insurers will be competing with each other to provide the worst deal.
Why?
What Health Insurer will want the business?
Perhaps they will go back to the US
Tuesday, September 11, 2018
Trauma and Human Resilience: II
Part 1:
View from World Trade Center © Am Ang Zhang 1994
Then came September 11. I remembered I was on holiday in Spain when it happened. I had just finished golf. I put my clubs away and went to the club house for a drink with my playing partners. As I approached their table, I sensed that something was wrong. There were no drinks.
Then one of them said, “One of the World Trade Centre Towers
I was trying to see if I heard right.
“In New York
“New York
Then moments later, the Spanish waitress came out and said to us, the second tower was down too.
I rushed back to our villa and shouted to my wife to turn on CNN and tried to contact our children, one of whom worked in Manhattan
Lines were dead.
Luckily, an Email came through our other daughter who was in England 55th Street Brooklyn .
What a shock. Unlike my parents’ generation we have had a long period of peace and prosperity but now everything was shattered.
The following day my office put a call through and I talked to my Associate Specialist.
The clinic just had an urgent referral. A local girl was referred. Very disturbed by what happened as one of her father’s good friends was one of the pilots whose plane went down. The family spent many holidays with them in their Florida
“Whatever you do, by all means talk to the parents but not to the girl. No one should see her. They should not turn on the TV and avoid any reminder of what happened.”
I then nearly said, “Give her Vodka, Gin or similar,” but I did not.
I gave the next best thing.
“Put her on a short course of Benzodiazepine to let her sleep for a few days.”
It shocked my Associate Specialist. It was not a drug I normally used, if at all, and why now?
Well, whatever happened, all I could say was that the family was in total agreement and months later my Associate Specialist told me that it was brave of me but it seemed to have worked for this girl.
In July last year I met a young couple at the swimming pool of our holiday condo. I thought they were Chinese but it turned out they were Vietnamese Chinese.
We started chatting. He said he left Nam (Vietnam
Jokingly, I said, you mean you were on the Helicopter?
“Yeah, how did you know?”
“You looked too young to be working for the Embassy.”
“My mum worked there. But my story was nothing, you should hear hers.”
His wife, an elegant looking petite Chinese swam closer.
“So, tell me.”
Well, she came out later. Her mother put her and four sisters on a junk (a Chinese fishing boat), one of those that took refugees out of Nam Hong Kong but they swam ashore. She spent the next three years in one of the Hong Kong camps.
“Yes, I remember those.”
“I know - the stench. We got used to it.”
Those camps were run under the auspices of the United Nations but the UN never really paid Hong Kong a single dollar. However that is beside the point. Conditions were very poor and one could hardly decide if it was Hong Kong ’s or UN’s fault. Every time we drove past it was like passing a local authority rubbish tip. We had to wind up the windows. Yet there were politicians who felt they needed to keep it bad to deter people. They continued to flow in right up to the handover. As it was still under British rule, Britain tried its best to keep people from going to Britain U.S.
I said something that sounded like an apology, an apology for Hong Kong , and for mankind.
“No. It’s fine. I am not bitter. We waited and we got to the U.S.
She told me someone suggested that she should have some therapy. She never did.
“Some things you can never change. If it happened it happened.”
But she managed to get most of her family out of camps and settled in the US
What a story of human resilience and triumph over adversities.
And I can still remember that lunch time meeting and the learning from King’s Cross.
FREE eBook: Just drop me a line with your email.
Email: cockroachcatcher (at) gmail (dot) com.
From another doctor friend:
The Cockroach Catcher has evoked many images, memories, emotions from my own family circumstances and clinical experience.
My 80 year old Mum has a long-standing habit of collecting old newspaper and gossip magazines. Stacks of paper garbage filled every room of her apartment, which became a fire hazard. My siblings tricked her into a prolonged holiday, emptied the flat and refurbished the whole place ten years ago. ……My eldest son was very pretty as a child and experienced severe OCD symptoms, necessitating consultations with a psychiatrist at an age of 7 years. The doctor shocked us by advising an abrupt change of school or we would "lose" him, so he opined. He was described as being aloft and detached as a child. He seldom smiled after arrival of a younger brother. He was good at numbers and got a First in Maths from a top college later on. My wife and I always have the diagnosis of autism in the back of our mind. Fortunately, he developed good social skills and did well at his college. He is a good leader and co-ordinator at the workplace. We feel relieved now and the years of sacrifice (including me giving up private practice and my wife giving up a promising administrative career ) paid off.
Your pragmatic approach to problem solving and treatment plans is commendable in the era of micro-managed NHS and education system. I must admit that I learn a great deal about the running of NHS psychiatric services and the school system.
Objectively, a reader outside of the UK UK
Your sensitivity and constant reference to the feelings, background and learning curves of your sub-ordinates and other members of the team are rare attributes of psychiatric bosses, whom I usually found lacking in affect! If more medical students have access to your book, I'm sure many more will choose psychiatry as a career. The Cockroach Catcher promotes the human side of clinical psychiatric practice in simple language that an outsider can appreciate. An extremely outstanding piece of work indeed.
From Australia
I have finished reading The Cockroach Catcher and thoroughly enjoyed it.
Zhang, I particularly liked the juxtaposition and paralleling of your travel stories and observations with your case studies, Of course, I could appreciate it even more, knowing the author and hearing your voice in the text. Because I’m dealing with anorexia, ADD and ADHD students I was very interested in your experiences with patients and parents and your treatment. Amazing how many parents are the underlying causes of their offspring’s angst. It was an eminently readable text for the medically uninitiated like me. Keep writing, Zhang
The Cockroach Catcher on Amazon Kindle UK, Amazon Kindle US
Monday, September 10, 2018
World Suicide Prevention Day:Un-Awareness of Lithium for Preventing Suicides.
Is it really Un-Awareness? Was there a specific reluctance? Was there a belief that the new antidepressants will do?
Antidepressants or Lithium! Side Effects but you will live to experience it!
One of my ex-juniors, now retired, called to ask if I have read about another celebrity suicide. How very sad!
Dr. Baldessarini of Harvard:
“Lithium is far from being an ideal medicine, but it’s the best agent we have for reducing the risk of suicide in bipolar disorder,” Dr. Baldessarini says, “and it is our best-established mood-stabilizing treatment.” If patients find they can’t tolerate lithium, the safest option is to reduce the dose as gradually as possible, to give the brain time to adjust. The approach could be lifesaving.
In recent write ups about antidepressants, there is no mention of Lithium. The Cockroach Catcher first worked with one Australian Psychiatrist that worked with Cade and I was, so to speak, very biased towards Lithium. Yes, Lithium has side effects that might be serious. But hang on, you get to live to experience it. Think about it.
"Many psychiatric residents have no or limited experience prescribing lithium, largely a reflection of the enormous focus on the newer drugs in educational programs supported by the pharmaceutical industry."
One might ask why there has been such a shift from Lithium.
Could it be the simplicity of the salt that is causing problems for the younger generation of psychiatrists brought up on various neuro-transmitters?
Could it be the fact that Lithium was discovered in Australia? Look at the time it took for Helicobacter pylori to be accepted.
Some felt it has to do with how little money is to be made from Lithium. After all it is less than one eighth the price of a preferred mood stabilizer that has a serious side effect: liver failure.
Thank goodness: someone is talking about it.
Atacama where Lithium is extracted © Am Ang Zhang 2015
Lithium: The Gift That Keeps on Giving in Psychiatry
At the recent American Psychiatric Association annual meeting in San Diego Harvard Medical School
Leonardo Tondo, MD, a prominent researcher on lithium and affective illness, who is on the faculty of McLean Hospital/Harvard Medical School and the University of Cagliari, Italy, reviewed studies on lithium's effects for suicide prevention. Ecological studies in this field have found an association between higher amounts of lithium in the drinking water and lower suicide rates.
These "high" amounts of lithium are equivalent to about 1 mg/d of elemental lithium or somewhat more. Conversely, other studies did not find such an association, but tended to look at areas where lithium levels are not high (ie, about 0.5 mg/d of elemental lithium or less). Nonetheless, because these studies are observational, causal relationships cannot be assumed. It is relevant, though, that lithium has been causally associated with lower suicide rates in randomized clinical trials of affective illness, compared with placebo, at standard doses (around 600-1200 mg/d of lithium carbonate).
Many shy away from Lithium not knowing that not prescribing it may actually lead to death by suicide. As such all worries about long term side effects become meaningless.
Will the new generation of psychiatrists come round to Lithium again? How many talented individuals could have been saved by lithium?
APA Nassir Ghaemi, MD MPH
- In psychiatry, our most effective drugs are the old drugs: ECT (1930s), lithium (1950s), MAOIs and TCAs (1950s and 1960s) and clozapine (1970s)
- We haven’t developed a drug that’s more effective than any other drug since the 1970’s
- All we have developed is safer drugs (less side effects), but not more effective
- Dose lithium only once a day, at night
- For patients with bipolar illness, you don’t need a reason to give lithium. You need a reason not to give lithium (Originally by Dr. Frederick K. Goodwin)
Cade, John Frederick Joseph (1912 - 1980)
Taking lithium himself with no ill effect, John Cade then used it to treat ten patients with chronic or recurrent mania, on whom he found it to have a pronounced calming effect. Cade's remarkably successful results were detailed in his paper, 'Lithium salts in the treatment of psychotic excitement', published in the Medical Journal of Australia (1949). He subsequently found that lithium was also of some value in assisting depressives. His discovery of the efficacy of a cheap, naturally occurring and widely available element in dealing with manic-depressive disorders provided an alternative to the existing therapies of shock treatment or prolonged hospitalization.
In 1985 the American National Institute of Mental Health estimated that Cade's discovery of the efficacy of lithium in the treatment of manic depression had saved the world at least $
I have just received a query from a reader of this blog about Lithium, and I thought it worth me reiterating my views here. It is no secret that I am a traditionalist who believes that lithium is the drug of choice for Bipolar disorders.
Latest: British Journal of Psychiatry
Saturday, September 1, 2018
Best to Imitate Nature: Lotus.
Since the introduction of the ‘Lotus concept’ in 1992, Lotus leaves have become an icon for superhydrophobicity and self-cleaning surfaces, and have led to the concept of the ‘Lotus effect’. Although many other plants have superhydrophobic surfaces with almost similar contact angles, the lotus shows better stability and perfection of its water repellency. The upper epidermis of the lotus leaf has developed some unrivaled optimizations. The extraordinary shape and the density of the papillae are the basis for the extremely reduced contact area between surface and water drops.
All Photos© 2018 Am Ang Zhang
Often they grow in murky waters and yet they always look so pristine? Have you ever wondered why? Well, this lotus phenomenon has inspired a German scientist to invent a self cleaning paint.
“……STAY CLEAN LIKE A LOTUS PLANT. A University of Bonn
It is human nature to be critical. It is now a habit of most, especially intellectuals, to be critical of big corporations. You give them credit at your own peril. So the Cockroach Catcher is risking his reputation by quoting from this unlikely source yet again. This magazine is available free online so that you do not even have to be on the plane to read it. But, my goodness, it is full of gems!
This article said:
“They say that imitation is the sincerest form of flattery. If so, Mother Nature should be ecstatic, because scientists around the world are patterning industrial processes and all kinds of everyday products after her designs. Welcome to the field of biologically inspired design….
……Some might claim that mimicking nature isn’t exactly new, though. Orville and Wilbur Wright studied birds while designing the first airplane. Velcro resulted when a Swiss engineer began to wonder how the seeds of the burdock plant stuck so stubbornly to his woolen socks. Engineers modeled the nose cone of the Japanese Shinkansen bullet train on the beak of a kingfisher. In the medical field’s search for therapies and cures, physicians have studied nature for millennia. (One of the common arguments made by conservationists is that pharmaceutical companies often find new drugs hidden in the biology of plants that grow in threatened places, like rain forests.) And in recent decades, medical companies have grown increasingly sophisticated at manufacturing joints, bones, artificial skin, and even cells that copy their natural counterparts……”
In the book The Cockroach Catcher, Dr Am Ang Zhang muses over Artemesinin:
“……This reminds me of the story of Artemesinin, now reckoned to be the most powerful anti-malaria drug. It was recorded in the Chinese book of Herbal Medicine, which is over a thousand years old, as treatment for swamp fever. Its rediscovery by China was met with scepticism until it was noted that during the Sino-Indian conflict Chinese soldiers were not dying from the malaria that was rampant in that part of the world. For a long time, the Chinese did not share the findings with the rest of the world. By chance along the banks of Potomac River , specimens of the plant were found. It took some years before the drug was developed. By now it is the standard treatment of choice……”
Ancient Medicine & Nobel.
Other Nobel Posts:
Fremantle: Medical Heresy & Nobel
Medicine & Nobel: Morality & H.P.V.
Curiosity & Nobel
Kandel & Doidge: Neuroplasticity & Memory.
Nobel: Kandel and Lohengrin
Chinese Shared Nobel Prize in Chemistry
Nature Posts:
ECOLOGY: First Bees, Now Bats.
Paraguay: Technology Meets Ecology
Hong Kong: Humpback Whale
Tasmania: Whales & Dolphins-Mother & Baby
ECOLOGY: First Bees, Now Bats.
Paraguay: Technology Meets Ecology
Hong Kong: Humpback Whale
Tasmania: Whales & Dolphins-Mother & Baby