Zac: I’m going to finish the rest of Biochem today.
Courtney: No, you’re not.
Zac: …wow.

I was seriously considering dropping out today when I woke up at 7:30 AM on a Sunday to go study at the library. It may have been the hardest thing to do, ever. Then, on the way to school, Courtney and I went to Brueggers. Every employee looked listless and hung over from the night before. What’s worse than elective studying on Sunday morning? Mandatory work while customers complain about how long the line is.

That’s when I realized the “real world” kind of sucks. You do a job you don’t really want to do, with coworkers that hate their life, and you specialize in… bagels? I mean, c’mon. That’s gotta suck.

No disrespect to bagel-workers the world round, of course. You make my mornings better, western-egg-and-cheese-on-everything-bagel-sandwich. I guess I’m just glad I don’t work at Brueggers. That place is just depressing.

I’m about to get tested on my ability to give a proper physical exam- all the doctoring stuff that I’ve always thought was so cool. Looking in people’s ears, and eyes, taking their blood pressures, etc.

There’s something very comforting about examining. You can’t tell if someone has a heart murmur unless you listen for it. You can’t diagnose a kid’s ear infection without checking his ears. So, in some ways, doing a thorough physical exam (for me, at least) is the most important part of this whole “doctor” gig. Plus, it’s fun.

You can know all the anatomy, biochem, and physiology in the world but it’ll never be helpful in a void. Physical exam is the link between all the stuff we’re supposed to know, and finding out that someone actually has it. Wish me luck!

“Saw [Megan's mom] today. She said Megan and Matt are both working in a clinic in Costa Rica this summer. How did they get that and is that something you might rather do?”

Somehow I feel my mom worries that I’m making a mistake staying in town this summer. Anybody else get that feeling?

So we had a personal trainer from Canyon Ranch come and talk to us today about the miracle benefits of exercise. The guy totally knew his stuff, and hit us up with all the amazing greatness that comes with daily exercise, etc. etc. etc.

But this, my friends, is Canyon Ranch. Canyon Ranch is one of the premier spa resorts in the nation. People fly in from all over the country and spend thousands and thousands of dollars to eat high-fiber, super-filling, low-calorie foods. They get massages. Personal trainers give them workouts tailored to their individual physiques and goals. I mean… this is not something even remotely applicable to the general public. With all of the emphasis that we’ve gotten on poor, uninsured people who can’t afford to pay for antibiotics, at first I was a bit skeptical.

Anyhow, as the talk went on it got much more interesting. Apparently the average American eats 20,000 pounds of food per decade, and only puts on 10 pounds every 10 years. That amounts to a sum excess of only 9.5 calories per day (or, as Mr. Canyon Ranch said, 5 tic-tacs), which is really not that much. Also, for every additional pound of muscle you carry around, you burn 10-15 calories per day… which is more than 5 tic-tacs.

Think about that. Just by having more muscle, your body burns off its own fat as fuel. The number of calories that you burn during 30 minutes of jogging isn’t limited to that 30 minutes- any additional muscle mass that you build up then has to be maintained. Basal Metabolic Rate (BMR) can be your bestest friend.

Then he told us a story. A champion body builder came into Canyon Ranch for help with strength training. After doing all of their scans and tests, they realized that he required 6,500 calories per day just to maintain his BMR. In order to build more muscle mass he would probably have to increase that to 7,000- and he was having trouble packing that much food into a 24 hour period. He went home with some heavy-duty nutritional advice.

So it ended up being a pretty sweet talk. Take home message: get your patients to exercise. Or, have them make lots of money, and then give them a prescription to go to Canyon Ranch.

Ok so just a quick note about liver cancer.

You get it by having cirrhosis. This means
A) being a chronic alcoholic
B) getting Hepatitis B or C
C) being really unlucky. For the most part though, it’s the IV drug use or the booze that gets you.

This poses some serious problems for treatment: normally you give someone with cancer chemotherapy. Sometimes it works, sometimes it doesn’t. Thing is, chemo gets broken down by the liver. Someone who’s been drinking a case of beer a day doesn’t really have a liver to speak of, and whats left of it is already working overtime. Throw a ton of massively toxic drugs in the system and you’ve got a very good chance of putting someone into liver failure and killing them.

So, you’ve got to figure out some other way of treating these people. This is where the interventional radiologists come into play. They do all sorts of cool things- radiofrequency ablation (inserting a needle into the tumor and cooking it from the inside out), chemoembolization (cutting off the blood supply and putting drugs directly in the tumor), ethanol embolization (putting 95% alcohol in the bloodstream right near the tumor… alcohol is bad for cells), etc.

Turns out we don’t really know the best method. There has been a lot of research done on it, but there is a bunch more to be done… and that’s what I’ll be doing this summer! Cool!

I’m going to go on a rant for a second here, so bear with me.

I have bought 3 packs of Sharpies over the past year. 12-pack, multicolor, awesome Sharpies. Let me liken this (for all you retro fans out there) to a child getting the huge 500 pack of crayons. I love my Sharpies. I love drawing with them, and coloring with them, and taking notes with them… in fact, Sharpies are the yin to my American Naturals Pencils yang.

Unfortunately, there is a plague upon my Sharpies. That plague is Courtney, AKA study partner.

You may ask why I have bought 3 packs of Sharpies. That reason, friends, is that Court steals them. Then she leaves the caps off, and they dry out. I have found Sharpies (MY beautiful Sharpies) lying in the gravel in her driveway, run over by her huge freakin’ SUV. I’ve found them in her trash. I’ve found them in her bag, on her desk… and almost always uncapped.

Why do I mention this now, you ask? Because this new pack of Sharpies that I bought yesterday? She just stole them. And I’m trying – desperately – not to freak out, because I know that within the week they’ll all be ruined. Sometimes I hate you, Courtney.

There’s a new candidate drug that:

1) Gives you a great tan
2) Causes you to lose weight
3) Gives you constant erections.

Call your stockbroker and cash in while you still can!

Computer: fixed!

Alright folks, you’re in for a long read, so sit back, grab some popcorn, and slog through this diatribe on healthcare policy!

I went to an AMA-sponsored conference today. Don’t tell anybody, but I just went for the food. I’m starting to think that a lot of these “conferences” for the rest of my “professional life” will be similar. Go for the food, and the tax-deductible plane ticket to New York… maybe attend a lecture or two. It’s kind of like college and free pizza, only upscale.

Anyhow, it turns out the conference was pretty awesome. It was an overview from the AMA (read: Republican. AMSA is the Democratic, opposing organization) about healthcare reform. Healthcare reform, by the way, is everyone’s hotbutton issue lately. That, “be nice to your nurses” and “treat your patients like humans”. Interesting what a change that is from what was taught 30 years ago.

One of the most interesting ideas brought up at the conference was that of prioritization. Depending on the stats you read, ~1% of people use 25% of the money, and the next 5% use 55%. Of course, this is entirely the point of insurance: you aren’t expecting to get cancer… but when you do, your individual costs are defrayed in the “risk pool” of your other insurance-mates. Oregon attempted to reign in skyrocketing costs in the late ’80s by implementing the Oregon Health Plan, which is now defunct (through political backstabbing). The OHP attempted to take the most common 800 procedures and rank them in terms of efficacy, by weighing cost vs. outcome. Anything below “the line” was simply not covered. Appendectomy was their poster child: it is a routine, relatively cheap procedure performed that is lifesaving (usually on a young, previously healthy person). They decided that this procedure had immense worth to society. Other things, such as artificial heart implantation, cost millions to implement and saved someone a couple months of life, at most.

Of course, this wades into a massive moral quagmire. Do we not cover life-saving procedures simply because they cost too much?

The argument, of course, is this. If your 20-year old car broke down and the mechanic, in his esteemed opinion, said that the axels were shot, the battery was going, the gearing was stripped, the engine was corroded, and it would cost him $20,000 to fix it up in parts and labor, would you do it? Of course not. It may be crass to compare people to cars, but the analogy works.

Now take that same $20,000 and buy tires for everyone who has a flat. That’s an awful lot of cars that you just put back on the road, for the same price as fixing one that was poorly kept (or, lets face it… too old). That was fundamentally the basis for the talk we got. Assuming that the insurance company only has $20,000 to spend, it would be criminal to blow it all on a single person.

So, in the end, that’s where we are. 46 million people in America are sitting on the side of the road with flat tires, while people who can afford insurance get bumped into the arena of care where 22-week old premature babies cost millions to save, and 90-year old women get neurosurgery. The talk was particularly good because the keynote speaker was willing to take a relatively unpopular stance: that you can’t justify spending millions and millions of dollars on new, massively expensive procedures that don’t do much good.

As a last aside, people that go down to Ecuador to provide charity care don’t bring full surgical and radiological suites with them. They bring antibiotics, because for a very small amount of money you can do a huge amount of good. The same concept needs to be applied to our healthcare system- start from the ground and build up.

—

Also, know who I haven’t seen many people point the finger at? Big pharma. Think back to the last time you watched TV. How many ads did you see for Lunesta (with that glowing butterfly)? How about Ambien? Pop quiz, hotshot: how much money did Sepracor, the parent company, spend advertising Lunesta this year? $60 million. Total revenues for the new wave of sleep drugs (Lunesta, Ambien CR, Indiplon, Ramelteon) are projected to hit $4.4 billion by 2009.

So here’s my question. $4.4 billion dollars. Where does it come from? A quick Google search reveals that Lunesta costs $3.50 for one tablet… which means that an insomniac will rack up $1277.50 a year for their Lunesta prescription. So if they are paying a fraction of that cost via copays… where does the rest of the cost of the prescription come from? Bingo. $4.4 billion have just been added to the overall cost of our health care, which we’ll collectively see as higher premiums.

Another interesting point that was brought up is that drug companies lump marketing R&D into their overall R&D budgets. Pfizer, for example, spends $3 billion a year on advertising. R&D costs were $7.7 billion. Without taking into account the marketing R&D, Pfizer spent almost half as much on advertising as they did on research. Again: where does that money come from? The $3 billion spent on advertising has to be coming back to the company in the form of revenues. Otherwise they wouldn’t be spending it. Which means (drumroll, please) that that extra $3 billion is indirectly being paid for by the end-healthcare user. Like it or not, you’re paying to see that damn butterfly interrupt your Seinfeld reruns. Forbes magazine cites a total Big Pharma advertising budget of $25 billion per year.

Now, to be fair, $25 billion is a drop in the bucket of the $1.9 trillion (16% of US GDP) that we spent in healthcare in 2004. But every advertising dollar must be bringing in revenues, otherwise they wouldn’t be spending it. Just imagine how many people are going to suddenly develop sleeping problems because of the fact that there are drugs to treat them. My point is, advertising drives spending.

Quick aside, by the way. I would never try to defend any of these statistics, because they change depending on what source you get them from. Its a little frustrating, actually.

Get your ass in gear, Zac. You are officially 10 lectures behind in biochem, and the entire semester behind in physiology, genetics, and SBS.

And yet… I hate biochem so very, very much. My hatred is like liquid waves of molten anger seething through a rough ocean of enyzmatic pathways. Poetic, no?

I’ve also been noticing that the single-minded drive I had first semester (study study study study no time for anything but study) is almost completely gone. Anything that I can find to do to distract myself from the heinous task of BIOCHEMISTRY. Anything at all. Cooking. Cleaning. Scanning my handwriting in and generating a font out of it (true story!). I swear I’d do anything but study intracellular fates of HMG-CoA as they relate to 7 alpha hydroxylase. I kind of want to throw up all over these notes.

I should also say, however, that I feel strangely like a badass when I use shorthand for bio/medical terminology. I haven’t written out “macrophage” in years… instead it’s MΦ with a particularly wicked slash through the Φ. Chalk it up to me being a nerd.

Also, I owe a shout-out to Christina’s performance during the talent show, of which I completely failed to mention. She played harmonica with Dr. Johnson (and practiced! she doesn’t even know how to play harmonica!) in a sweet little bluegrass number. Honestly, she was the best part of the act… though you couldn’t hear her because the mic was too far away. Good job Tina *golf clap*.