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Tuesday, September 08, 2009
Paging Dr. Janda

Like most people, I've been getting 'health care scare' emails, and after a string of replies that consisted solely of links to Snopes articles, I was sent a link to a Snopes article from a certain Dr. Janda. While it's good to see people slowly learning to do at least a little checking, the Snopes article only claimed that it was "correctly attributed," and didn't do any fact-checking on the content of the article.

First, I wanted to find out who Dr. Janda is. I found that Dr. Janda is a published author on the subject of preventing sports injuries, and was appointed by the H.W. Bush Administration to the Board of the National Center for Injury Prevention and Control (source). He seems to truly be an expert on sports injuries (the NFL hired him to review injuries; same source), and it seems the book was also part of a religious awakening (I haven't read the book). In general, he seems like someone to be taken relatively seriously in his field of expertise, which is sports medicine, but his credentials don't really have much to do with macro-level medical care policy. So given his relative expertise, he seems like someone who can be judged based purely on the quality of their arguments, even if we can't cite him as an all-encompassing authority on the matter.

Snopes had two versions of the piece he had written - the email forward version, and his original. I am not even going to bother reading the forwarded email text, since those inevitably get garbled, but rather the original text that was provided to Snopes.

The basic structure of his article (essay? writing? screed?) goes like this:

  • Introduction to him as a doctor and expert
  • Assertion that ObamaCare in came 2 parts, starting with the Stimulus bill
  • Issues a warning that ObamaCare is as certainly dangerous like smoking
  • Discusses Comparative Effective Research:
    • ObamaCare cuts costs through rationing
    • The FCCFCER is inhumane and overpaid
    • There is a formula for Comparative Effective Research: Cost per treatment divided by number of years patient will benefit
    • Cites Betsy McCaughey that the standard will have the effect that "if you are over 65 or have been recently diagnosed as having an advanced form of cardiac disease or aggressive cancer, [you'll die]." Says this is on p.464 of the Stimulus
    • The plan is the same models as in Britain
    • The purpose of Center for Comparative Effectiveness Research is to slow development of meds and tech (HC bill Section 1181, p.502)
  • Claims that the Stimulus Bill p 116, 442, 446 guides decisions at the time and place of care; defines penalties for breaking gov't protocol (Stim 366, 478, 511, 518) including prison; claims that Stalin did this.
  • Claims section 102 of the HC bill illegalizes private insurance.
    • Claims Obama didn't know about section 102
  • Claims sec 1233 HC bill mandates counseling every 5 years (annual if chronic illness), and designed to end life sooner.
    • Claims topics of these sessions include how to deny hydration, nutrition and initiating hospice care. Claims Obama "hates" prevention.
  • Concludes the proposed system is "fascist".

Let's take this one piece at a time, shall we?

  • Introduction to him as a doctor and expert
    Dr. Janda begins by telling us that he has "authored books on Preventative Health Care and Health Care Cost Containment." Now, I'm not sure why he decided to capitalize everything, but he has written books on preventative care and health care cost containment. That book was about cost containment in the context of sports injuries, not macro-level policy; so this is mildly untrue but I liken it to padding a résumé. Fine. He gets a pass because everybody on Amazon liked the book. Then he mentions he was presenting "Health Care Reform; The Power & Profit of Prevention" as a keynote speaker at a Congressional Dinner at The Capitol in Washington, D.C. This is odd because that that title is often given as the title of the very text we're reading. Again, this is technically true, but why not just say, "I presented the following presentation"? Strange. Also, I couldn't find a record of this presentation, which is also odd because you'd think it'd be mentioned somewhere by someone for as important as he makes it sound.

    Summary:
    True, in the way that most résumés are true.

  • Assertion that ObamaCare in came 2 parts, starting with the Stimulus bill
    He asserts that the Stimulus was the first part of the health care plan, but doesn't tell us anything about what it did. He cites page 152 (you can read it here), which is a continuation of §13405, "Restrictions on Certain Disclosures and Sales of Health Information" section, specifically the part about disclosures that are required if the hospital or whatnot uses electronic health records. This has absolutely nothing to do with the creation of a new arm of the U.S. Government.

    Now, a good writer would have simply told us what he was talking about. I am inferring here that, when he talks later about the Federal Coordinating Council for Comparative Effectiveness Research, which is established by the Stimulus, he means that they are this first part of the Health Care bill.

    The problem is that he's conflating a research body with the creation of a Health Care System. This is especially bad because (as I detail below), the FCCCER is absolutely toothless; it has no power to mandate anything at all. Now, why he would lie about something like this, I have no idea. It really has no place in the argument other than maybe adding a little paranoia that Obama slipped something by us.

    Summary:
    False, and poorly written to boot.

  • Issues a warning that ObamaCare is as certainly dangerous like smoking.
    I suppose there might be some creative parallel between smoking and a health care insurance reform bill, but this isn't it.

    Summary:
    Non-sequiturs and hyperbole are signs of weak writing. So far this is shaping up to be a pretty poor essay.

  • Discusses Comparative Effective Research:
    • ObamaCare cuts costs through rationing
      The biggest problem with the bill is how to pay for it, and I am honestly worried about that aspect myself, but rationing of care will happen no matter what plan is in place — right now, heath care is rationed away from people who aren't incredibly rich, and get sick (sadly, this is most people). Health insurance companies do things to get out of their responsibilities (pre-existing conditions, lifetime and yearly caps, etc.) and thereby ration heath care with little regard for the morality or even responsibility of their role as insurers. Not only does Dr. Janda not back up this claim with evidence, the very problem with the current system is that it is rationing health care in a way that makes every single person vulnerable to death-by-denied-claims.

      Summary:
      A red herring at best, an intentionally misleading lie at worst.

    • The FCCFCER is inhumane and overpaid (or generally that $1.1B is too much money for research stimulus), and run by "ivory tower" bureaucrats.
      Here is the Federal Coordinating Council for Comparative Effectiveness Research. The Council "provides information on the relative strengths and weakness of various medical interventions. Such research will give clinicians and patients valid information to make decisions that will improve the performance of the U.S. health care system."

      Page 73 of the Stimulus Bill (§804 (b)) creates this Council with this purpose: "The Council shall foster optimum coordination of comparative effectiveness and related health services research conducted or supported by relevant Federal departments and agencies, with the goal of reducing duplicative efforts and encouraging coordinated and complementary use of resources."

      The $1.1 Billion is money that is directed towards research, and one of this team's jobs is to direct that money to places that will keep the U.S. at the forefront of medical technology. That's a lot of money for a lot of white-collar jobs that patent a lot of high-value technology, which is I think an extremely good place to put stimulus money. The Council is also limited to use at most 1% of their total budget for staff and administrative support ((§804 (f)). 99% has to go to research.

      As to whether they're bureaucrats, the bill does state that they must be "senior federal officers or employees," but Dr. Janda omits the rest of the sentence. The full sentence is: "The Council shall be composed of not more than 15 members, all of whom are senior Federal officers or employees with responsibility for health related programs, appointed by the President, acting through the Secretary of Health and Human Services (in this section referred to as the "Secretary"). The appointment by the President means that they are members of his Cabinet.

      As for who was chosen: They are mostly clinicians, but also have the Chief Policy Officer for the Center for Disease Control, a Rear Admiral, and other "that makes sense" places. All but 2 have M.D.'s. The qualifications also require that "[a]t least half of the members of the Council shall be physicians or other experts with clinical expertise" (§804 (d)(2)(B)), with senior members from seven various health care-related agencies including the VA ((§§804 (d)(2)(A)(i-vii)). Based on their credentials, and the continuing requirements for the members, the claim that they're just random government bureaucrats is also false.

      Finally, it is difficult to imagine how this entity could be inhumane, because their sole purpose is to fund research based on what they believe is most important to doctors. As noted below, they do not have the power to mandate any kind of care or procedure.

      Summary:
      All of the claims in that almost-incoherent paragraph are wild, terrible lies.

    • There is a formula for Comparative Effective Research: Cost per treatment divided by number of years patient will benefit. Cited as "Section 9201 H.R. 1 Version of the Stimulus Bill."

      There is no Section 9201 in that bill. The phrase, "Federal Council" never appears in that bill. I can't find this formula anywhere on the Internet or in the bills — only in this chain mail. Moreover, the Council cannot force anybody to do anything to any patient, because the last thing the Stimulus section that established it has to say about it is this:

      (1) COVERAGE. — Nothing in this section shall be construed to permit the Council to mandate coverage, reimbursement, or other policies for any public or private payer.

      (2) REPORTS AND RECOMMENDATIONS. — None of the reports submitted under this section or recommendations made by the Council shall be construed as mandates.

      Summary:
      A HUGE lie.

    • Cites Betsy McCaughey that the standard will have the effect that "if you are over 65 or have been recently diagnosed as having an advanced form of cardiac disease or aggressive cancer, [you'll die]." Says this is on p.464 of the Stimulus.
      There is no page 464 of the Stimulus bill, which is 407 pages long. Also, being diagnosed with various terminal diseases is already something that insurers deny coverage for all the time. That's part of the problem. That's why people are proposing reform.

      Also, Betsy McCaughey is a terrible, terrible person to cite about health care since she's been willing to lie about health care reform for a long, long time and never really stopped: she's the one who came up with those ridiculous death panels!

      Summary:
      Exploring bottomless new levels of calumny.

    • The plan is the same models as in Britain.
      I haven't been able to find a clear yes or no on this; I heard somewhere that it's not that same (that it's less government-centric), but I can't cite where I heard that.

      Summary:
      Not sure. Given the track record of the essay so far it'd be a small miracle if it were true.

    • The purpose of Center for Comparative Effectiveness Research is to slow development of meds and tech (HC bill Section 1181, p.502)
      That section says that the Center's mission is to "conduct, support, and synthesize research ... with respect to the outcomes, effectiveness, and appropriateness of health care services and procedures in order to identify the manner in which diseases, disorders, and other health conditions can most effectively and appropriately be prevented, diagnosed, treated, and managed clinically." It then talks at length about how it will do that (via gathering official data, creating forums, etc.). The group is essentially a data-gathering and disseminating unit.

      How that inhibits development and research is anybody's guess since they aren't given any strong-arm abilities.

      Summary:
      False.

  • Claims that the Stimulus Bill p 116, 442, 446 guides decisions at the time and place of care; defines penalties for breaking gov't protocol (Stim 366, 478, 511, 518) including prison; also claims that Stalin did this.
    Page 116 is about the promotion of heath information technology.
    Page 366 is about how hospitals can report their data using.
    None of these talk in any way about guiding medical decisions.
    Pages 442, 446, 478, 511, and 518 do not exist because the document is 407 pages long.

    Summary:
    False, and apparently Stalin is the new Hitler.

  • Claims section 102 of the HC bill illegalizes private insurance and that Obama didn't know about section 102 when asked in an interview.
    In his essay (I'm using the term loosely at this point), Janda uses the following response from Obama to claim that he didn't know that the plan would illegalize private insurance: "You know, I have to say that I am not familiar with the provision you are talking about." But Dr. Janda omits the following: "I'll — let me just speak for the Obama administration. I have committed myself consistently to a very simple proposition: If you have health insurance, and you like it — and you have a doctor that you like — you can keep it. Period. And I won't, uh, sign a bill that somehow would make it tougher for people to keep their health insurance" (here's the source).

    Section 102 is on page 16 of the bill itself (which is here). It basically says that insurers' plans don't have to follow the health care rules (on cost, care, etc.) if the plan is grandfathered in by being active for 1 year beforehand. Dependents are allowed to be grandfathered in with the primary insured person. The insurer also can't jack up their grandfathered insurance plan coverage rates or reduce benefits after they're grandfathered in (§102 (a) 1 to 3). This doesn't apply to limited-benefit plans that I frankly don't understand in (§102 (b) 1 (B)). The following section (§111) is the rules that insurers have to follow for all their new (not grandfathered) plans.

    Summary:
    Wildly false, to the point where I wonder if they actually read this section or just picked a number at random.

  • Claims §1233 HC bill mandates counseling every 5 years (annual if chronic illness), and designed to end life sooner. Also claims topics of these sessions include how to deny hydration, nutrition and initiating hospice care. I won't really go into this whole "death panel" thing much, because it has been disproven and discussed over and over and over and over and over and over and over and over and over and over and over and over and over and over.

    Summary:
    No points for guessing — false.

  • Claims the proposed system is fascist.
    Fascism is a lot of things. In short, it's highly eugenic, emphasizes government power, is corporate, and aggressive. I can almost see how Dr. Janda might see something like that in his distorted and frankly insane characterization of the health care bill. But unfortunately, that's all it is: insane.

    Summary:
    Justification for institutionalization.

GENERAL SUMMARY:

This is absolutely full of distortions and lies. And actually the more I read it, the more unhinged I realized it was. When I first read it, I thought it was at least relatively sane, in that it sort-of had a structure and didn't misspell things. But after really breaking it down and looking at the arguments, I have to say this person is either intentionally distorting the truth, is completely insane, or more likely is just like so many other Americans who'll believe anything they hear if it's said at high enough volume and justifies their most ludicrous fears.

Now, I've managed to hold a regular 40-hour-a-week job, plus some side freelance work, start setting up my new house — bought with help from the stimulus — write an album, and clean up the house from time to time, all while still learning all this stuff. And I'll tell you, it took me a whole lot more time to write than to read all this.

Yet somehow I don't think the people yelling at the town halls are taking the time to do even a fraction of the research I've done here. Hell, it took me as long as it did to get this written because it took forever to track down every ludicrous claim this quack misinformed doctor came up with, or that he was told. But I did this because I love my country, and I'll be damned if I'm going to let people like him screw up necessary reform by lying.

Be a patriot. Be informed. Forward this to whomever sent Dr. Janda's screed to you. Maybe it will eventually get back to him.

I would LOVE to see what he has to say.

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posted by Steve @ 1:19 PM   31 comments
Saturday, August 02, 2008
New chair, desk, blog
I bought my first desk chair from Office Depot today. My previous chair was old, ugly, free, and not very good for my back. The new one is bright red, has lumbar support, and tilts back. I didn't install the arms because I'll be playing guitar while sitting on it.

I know I was blogging at the time, but I don't think I covered the fact that I threw out my back at all. Oh yeah - it's because it was extremely painful to sit in my chair! What a nice way to wrap that together.

Anyway, because I couldn't move for several weeks, I'm building a new desk that actually functions ergonomically and moves the noisy hot air blower under my desk (i.e., my computer) to somewhere that it has a chance of not overheating every time I play Team Fortress 2. It will probably take me the better part of a month to do it, but there you go.

Oh yeah, and the blog. Haven't blogged in a while. I decided I was becoming another noisy political pundit and not only is that niche pretty well-covered, it doesn't satisfy my 'writing for the ages' rule, which is that in twenty years I want to find these posts interestingly biographical. This is a public blog, but that's not really the point. The point is that I have lots of interesting, funny, and quirky thoughts and experiences that my poor memory lets slip. I would like to retain them and this is how I'm doing it.

Of course, when I find an unusually interesting political or sociological story, I will post it, because that is part of who I am. But again, the point is to write down some of my more interesting ideas for future reference, not to post current events from other blogs, interesting though they may be.

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posted by Steve @ 9:58 PM   2 comments
Thursday, May 01, 2008
The Heart Attack Special
Back when I used to work at a smoothie/sandwich shop right on University Blvd., I made
myself all sorts of sandwiches for myself for lunch. I probably saved myself ten grand working at that place by drinking smoothies and eating there two or three times a day. Sometimes when I was feeling particularly meat-loving, I would make what I called the "Heart Attack Special."

When I was 20, and biked or walked everywhere, and ate two smoothies a day, I could have gotten away with a steady diet of nothing but canola oil and beer and stayed skinny, although I'd have died of a blood clot a lot sooner than I almost did (in 2004).

The heart-attack special was a sandwich made on toasted sourdough bread. It wasn't all bad - the "good" toppings were hummus, alfalfa sprouts, red lettuce, and red onion. But it also had four huge slices of cheese (2 Havarti, 1 extra-sharp cheddar, 1 provolone), a sprinkling of grated Parmesan cheese, Caesar dressing, three strips of bacon, three slices of roast beef, a slice of ham, three slices of pastrami.

It was a big damn sandwich.

This comes to mind because nowdays there are so many options out there that make my sandwich look positively good for your arteries. Some of the highlights:
I have a problem with mixing chocolate into breakfast foods or meats. It just seems wrong to me. I maintain that Coco-Puffs and Count Chocula are horrible, and only redeemed in any way by their pop culture impact.

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posted by Steve @ 11:03 AM   0 comments
Monday, April 28, 2008
Heard at the physical therapist
I'll be writing later about how I seem to have a herniated spinal disc, but in the meantime...

Today at the doctor's office, the doctor was talking about the interesting interactions between
the brain and body. In particular, he pointed out that people don't remember what pain feels like directly the way they can remember the other senses (vision, taste, and even emotions like joy).

The young assistant pulled her head out of a file to say, "that's why women have multiple children."

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posted by Steve @ 7:24 PM   0 comments
Monday, April 07, 2008
Expensive sandwiches
I'm a white guy, and that basically means I like expensive sandwiches. I don't however, like paying five bucks (or $169.73) for a thin slice of dry chicken between dry bread and not enough soda to choke down the disappointment. For that matter, I don't want to wait forty minutes, tip someone, travel, deal with a singer/songwriter barista, or go between the hours of 11 and 12:30pm.

I'm not that whitey.

So lately, I've been toying with interesting combinations that would make me happy at a sandwich shop and even posted a few of the better ones here. To me, though, the hardest part is finding ingredients that won't cost me a fortune, and will last in the refrigerator long enough to actually use them. I swear lettuce goes bad by the time I drive it home from the market.

So here is my rotating list of sandwich ingredients that are good but stay a while and aren't larcenously expensive:

Bread & Dairy:
  • Gigantic block o' cheddar
  • Smaller block of swiss
  • Parmesan cheese
  • Port wine cheese and crackers
  • Potato or wheat bread
  • Chive cream cheese
  • Plain cream cheese
  • Pita bread
Fruit & veggies:
  • Red onion (stays about a month!)
  • Alfalfa sprouts (50¢ per package and lasts a while)
  • Lettuce (organic in-the-box stuff lasts best for me)
  • Applesauce side (OK, my fruit & veggie intake is lacking)
Spreads:
  • Caesar dressing
  • Sun-dried tomato paste
  • Sun-dried tomato pesto paste
  • Homemade hummus
  • Pesto
Meats:
  • Whatever you want, really, but try for the better stuff in the supermarket deli. Don't buy much, but mediocre meat brings down the sandwich. It's still worlds cheaper than eating out, anyway.
Notes:
Hummus is ludicrously expensive when bought pre-packaged. I have no idea why; garbanzo beans are about 50¢ per can for the good stuff. Buy some good olive oil, some sesame seeds (also dirt cheap), fresh garlic, tahini, and lemon juice (plus anything else you want, really) and a good food processor on Craigslist. You can justify the $30 food processor this way: it's the same as buying six of the pre-packaged stuff, and you get to flavor it how you like.

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posted by Steve @ 12:42 PM   0 comments
Tuesday, April 01, 2008
Recipie: No holds barred flavor fight!
When I worked at a smoothie bar I'd try to get the most ridiculously tart. I would use mango juice, sorbet, peaches, blueberries, strawberries and oranges. They were awesome. Now, I make similar smoothies, but my sandwiches follow the same tongue-tantalizing route.

Here's a sandwich I made that I thought was particularly intense:
  • Wheat bread
  • Pesto
  • Chive cream cheese
  • Thick-sliced cheddar cheese
  • Alfalfa sprouts
  • Turkey slices
  • Cucumber slices
The sandwich itself was pretty zing (although with sourbread it would've been even more so). But the sides really helped: Rosemary & Olive Oil Triscuits with sliced chunks off of a Kaukauna port wine cheese log, and strawberry-apple-kiwi juice to drink. Wow.

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posted by Steve @ 6:48 PM   0 comments
Sunday, March 30, 2008
Recipie: Tart Chicken
I am still trying to eat well. Rachel's gone kinda-sorta vegetarian, but I don't want to be that kind of paranoid about my food (especially with soups, as they often have chicken or beef in them without it being obvious).

A big part of eating well is putting a little effort into making food. You can only go so far when relying on super-quick frozen or ready-to-eat meals. I am terrible at this. I've been known to just not eat anything rather than spend five minutes making a sandwich.

But today I actually made a sandwich -- a brand new sandwich whose primary ingredient is awesome.

Kitchen bits:

Large skillet (depending on how much chicken you want)
A slotted turner (I admit without apology that I had to look that up)

Ingredients:

Frozen boneless chicken tenderloins
Sundried tomato spread
Chicken marinade
Caesar dressing
Alfalfa sprouts
Swiss cheese
Pita bread

How to make it:

Put the chicken into a skillet for ten minutes in the marinade on low to defrost and get the flavor in. While that's happening, get out the ingredients.

Split the pita bread, and spread the tomato paste on one side. When you add stuff, try not to destroy the pita. Put some caesar dressing on the other side, to taste. Keep in mind that both ingredients are pretty tart. Slice up the cheese and put it in there. Flip the chicken over so that it defrosts evenly. Put away the cheese, dressing, and paste: it's nice to not have to clean that after you eat.

Once the chicken is defrosted and properly marinated, take the pan to the sink and dump the marinade carefully while holding onto the chicken with the turner... or just dump it in a colander, whatever. I'm pretty sure it's impossible to do perfectly, so have a paper towel handy to wipe the pan lip. Return the chicken, sans-marinade, in the skillet on the burner.

Start chopping up the chicken so it's in nice little half-inch bits until it's done through. I like mine just starting to brown on the outside, personally. There's nothing worse than chewy chicken.

Stuff the chicken into the pitas. The sprouts will stuff into the corners, which is why they go in last. Arrange in some pretty way or another. Applesauce is a good side, and root beer goes down very well with it.

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posted by Steve @ 11:56 AM   0 comments
Saturday, January 19, 2008
This blog has not been evaluated by the FDA.
My wife bought some cranberry supplements, which claimed to maintain a healthy urinary tract. Cranberries have been traditionally used for this purpose, which makes me really wonder why the Food and Drug Administration hasn't verified that claim, at least in the general sense that cranberries help that sort of thing.

I can understand why they have better things to do than scientifically evaluate every snake-oil supplement. At this point, their job is to make sure that recalls happen when they need to, ensure that greedy pharmaceuticals aren't dumping harmful drugs on us for profit (success in this goal depends on who you ask), among a million other important but ultimately interminably bureaucratic tasks.

But why leave it to Ocean Spray to fund and publicize these kinds of studies? By now, haven't we done enough scientific research on things that might exist as a problem, or aren't as widespread as drug companies would like us to believe, and can turn to verifying simple medicinal truths for everyday troubles?

Perhaps the problem is educational: I wonder how many people (myself included) recognize why they even have health problems. I'm typing this on Dayquil, but I know my allergies went completely bananas yesterday after sweeping all the mildewed leaves off the patio. I doubt I would recognize a urinary tract infection, though.

We've known cranberries help that kind of infection for centuries. I'm probably on the low-knowledge end of the spectrum, but it seems to me that we've lost a ton of the down-home knowledge that kept people alive over the last several hundred years.

I guess that the main problem is that the majority of useful knowledge being passed down is being replaced by pop knowledge.

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posted by Steve @ 3:29 PM   0 comments
Sunday, July 01, 2007
"... I'm never going to need this!"
The mantra of every high schooler in a class they dislike: "... I'm never going to need this!"

Yet, as a teacher, I could very rarely give a convincing rebuttal. Do I know what the subjunctive mood is? Yes. Subordinate conjunction? Yes. Do I use them as well as I need to, and were I ever to be asked by a stranger to give an example, I could (in fact, that last sentence illustrates both).

It makes me want to teach things that matter. Most of what we teach does matter, if nothing else as an exercise in how to get oneself to understand concepts without 'feeling like it.'

But why not the stuff that you need to survive as an American?

I wish someone had taught me how to:
  • Do my taxes.
  • How the current health care system works
  • The relationship between taxes and government benefits
  • The military-industrial complex
  • The effect of fanaticism in religion
I did learn some things that tangentially helped me: Supply and demand, inflation, and other basic economic concepts. I do wonder if that's because of where I went to school, though.

I responded to a post to The Daily Dish with this sentiment here.

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posted by Steve @ 12:44 PM   0 comments
 
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Name: Steve
Home: Tucson, Arizona, United States
About Me: I like to think about things, and I occasionally like to write what I think.
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