Share The Shame

I was thinking about shame the other night in relation to a story on 60 minutes (cbs.com). Apparently there is a medication used during heart surgery that prevents bleeding. The medication is called trasylol and it's produced by the Bayer pharmaceutical company, based in Cologne Germany. One serious side effect with this treatment is the development of thrombi or clots. These thrombi can then lead to kidney failure and even death in some unfortunate souls. The FDA was alerted to these concerns, and as is typical with many large organizations, they took their time to do anything about it (fda.com). Bayer itself eventually did a study that they never released to the FDA until forced to by the study author, a professor at Harvard Medical School.

When the FDA first heard about the concerns, they ignored a study by a group in San Francisco that monitors safety issues of available medications, and said it was questionable science. I do not know the whole story, although the science described was compelling to me. A meta-analysis is considered the most credible type of medical evidence we have, and thus I am uncertain why the FDA would question the scientific merit of the study. The FDA did not completely ignore the study, they convened a hearing with the manufacturer Bayer in 1 years time (I guess 1 year is better than 10 years, although it still seemed like a long time). During that time, many thousands of American lives were put at risk, some of whom died waiting for the FDA to have a meeting. An important point worth mentioning is that there are other agents used for preventing bleeding during heart surgery with no potential for thrombus development and at a much cheaper cost. This story made me ashamed to be a doctor, as my colleagues in the FDA came across as uncaring bureaucrats. I try to be caring as do most doctors, although some doctors behave as if they are "above it all."

Many patients hesitate to seek care from a mental health professional because they feel ashamed to get help. This is a part of our culture that is incorrect. We all gleefully make fun of the "crazy folks." Yet many of these folks are very talented and energetic people. People like Heath Ledger, Britney Spears and others. They were probably ashamed to get help also.

The people that concern me the most are the people too ashamed to get help, and then end up shooting innocent people, as happened at Northern Illinois University last week. Maybe we should be ashamed for not getting help. Mental health problems are like all problems, something worthy of attention. Getting help would be a lot better than the shame of having a problem, and not attending to it. Particularly if innocent people die because of the negligence. Not getting help, killing other people, and then yourself is something that is shameful. At least that is what I think. What do you think.

Winning and Election 2008

One of the issues that keeps coming up in the presidential campaign is: Are we winning in Iraq? John McCain, an American hero, says if we leave Iraq abruptly, al-Qaeda wins. Will someone please tell me what would define a win. More Iraqi's killed than Americans? Would a win be freedom and democracy in Iraq (that will probably take 50 to 100 years)? It is my opinion that enough American and Iraqi blood has been spilled. In war everyone loses to some extent. If no one can define a win, then let's declare one and bring our brave and fatigued troops home.

You Can Pay Me Now, Or You Can Pay Me Later

On the CBS Evening News (cbsnews.com) today, a tragic story was told. Apparently a man with a serious mental health problem was living on the streets of New Orleans, LA. A young female officer was attempting to interview him and he wrestled her gun away. Then he shot her 15 times. This brave young woman died doing her job. Trying to keep the peace in a community ravaged by nature and government neglect.

The story highlighted the shortage of mental health care in the state of Louisiana. Apparently, since Katrina, mental health care facilities have been boarded up and mental health care practitioners have left the state. The American Psychiatric Association in a recent publication discussed the exodus of providers from Louisiana because of terrible pay (December/07 Psychiatry News (pn.psychiatryonline.org/). It has been said before that you get what you pay for. There is no question that this young officers life is priceless to the loved one's she left behind. The life of all the homeless folks are in many ways lost also. To be homeless is to be cast away, a death of sorts. A national embarrassment.

When are we going to assume that people with mental health problems matter? All illnesses are costly. In the grand scheme of things, mental health care is cheap. It should be like all health care, an investment in people. Cars need maintenance and so do people. If your mind and brain are in distress, attention early on makes a difference. Costs increase and accumulate if you don't put oil in your cars motor. Ignoring mental health problems when something can be done, lends itself to death, destruction and tragedy. Heavy costs.

The costs of not paying up front won't allow us to escape paying at some point. Paying with the loss of a young, brave officers life and incarcerating a man with a serious problem is stupid and thoughtless. The outcome of excellent mental health care is amazing and must be pursued with vigor. Otherwise you will pay later, at a much higher cost.

For more information on my thoughts regarding health care costs, read the February 14th Carmel Valley News or on February 21st the Rancho Santa FE Review (sdranchcoastnews.com). Take care.