Readers' Comments

I can only guess why things went as they did in this patient's encounter. A number of motivations come to mind which are too numerous to describe here. She points out, however something I have noted which is that some of my colleagues have become experts at gaming a system that rewards for doing more. One sign of a person's shift from compassionate care is a doc's shift in everyday conversation from care issues to material things or money-making schemes.
A system that rewards one for the skill in handling cases, outcomes, interpersonal skills and all the things desired in a "good doctor" would be ideal but hard to develop. Attempts are being made to incorporate this but with little data to support the metrics so it is a little scary for the average doc who just wants to give good care. Best, I think, would be to support and incorporate the best models out there, such as at the Cleveland Clinic where doctors are salaried and not paid by production and number of procedures.
I am in emergency doctor. I don't do "wallet biopsies" and can't (and don't want to) choose my patients. I like that but is is not for everyone. Most emergency docs burn out and retire or move to something else by my age. My heart goes out for patients with limited means and I will game the system to save them a few bucks. Universal healthcare would solve that problem. Obamacare is only a start. It has deep flaws and will get bad publicity but keep aware of developments and lobby your representatives to improve it. Be aware that corporate interests are always trying to improve their bottom lines so look at where their lobbying money goes and press for alternatives. It's tiring but eternal vigilance is more important now than ever.

I've noticed an interesting trend in pharmaceutical advertising in recent years, which was not mentioned in your otherwise excellent article.

First, there is a happy, glittering, and colorful commercial for a new medicine. Typically, the first version doesn't state what the medicine is for, just naming it and showing happy people dancing in fields, or some such. "Ask your doctor if --- is right for you," the ads usually end.

In the second stage, the use of the drug is emphasized, with long lists of side effects thrown at the end of each ad. It is a film rendition of the slick ads published in doctors' magazines.

In the third stage, patients and their families have mobilized, brought suit, and urged the FDA to ban the drug. The ads now are less glittery, and are now purchased by law firms hoping to attract clients whose lives were ruined or ended by taking the drug.

Am I the only one who has noticed this interesting trend?

Replies abound! If you are referring to FOX and you really mean Glenn Beck's TV program migrating from the FOX channel to "The Blaze" Network then you miss the spin entirely. You refer to "FOX" media so that if you add the current FOX network to the lineup then you should know that as a Senior Citizen, #1)I channel surf continually to garner a cross section of what's happening and when I find the most "likely" scenario and possibility of validity, I stick with that channel. #2) I subscribe to both Charter Cable for their TV,phone and Computer network and since they do not provide "THE BLAZE" TV channel....I also subscribe to the DISH Network so that I have access to "THE BLAZE" 24/7! I live in what is described as a "college town" and my local Charter network has a listing of the names of the customers who have called in asking to have "THE BLAZE" added to their programing guide. I was informed, after calling on three occasions in a two month period to check on the status of my request, that I was the first and only name on the list! THE SEARCH FOR THE TRUTH lives on and if the Koch Brothers can deliver it in print, then I'll sign up with them as well. If they make money as a bonus, then good for them! Capitalism at work; makes work and jobs, leading to a healthier economy for all>>> Nothing wrong with that income stream. If they want to put their views in the hands of the public through their corporation(s), the results will reveal success or failure. Isn't that what America is all about? Let's all expand our own sphere of influence and grow this nation back to where it belongs....WE THE PEOPLE!

Democracy is a participative function, and blacks are seeing that they count ... now, more than ever. Women also turned out in large numbers, as did Hispanics and other minority groups. It has become painfully obvious that the GOP-TP/Libertarians are doing all they can to divide us. You know - that Divide and Conquer thing. Wisconsin's Gov. Scott Walker admitted it while speaking, live on camera, to a $$$-supporter-$$$ when she asked if Wisconsin would ever be a Right To Work state. I take it that most of you already know that RTW is yet another right-wing catch phrase that is actually anti-collective bargaining / union / labor, etc.

When public employees hide or destroy public information they are stealing from taxpayers. Lawmakers craft the legislation that would prosecute public employees who do so. ALEC lobbies the lawmakers. We need to bring this to a higher power.

Dale Lee

solution to the pipeline controversy, make all oil companies who want to use it put in a holding account the ammount of money they will profit from the pipeline in a escroll account to not be toiuched untill they are done with there transmissions, to cover any misshaps(not insurance cash) then we will not have the kind of problems we had with the gulf coast, alaska and arkansas!
any other ideas!!!~

It is time for all the legislative cowards who hide behind the skirts of ALEC, and ALEC herself to stop all the underhanded, cloak and dagger maneuverings. They are slowly, but surely ruining our country and we voters sit by idly and let it happen. We need to arm ourselves with the knowledge of what our elected officials are doing behind closed doors.

Our freedoms are being eroded away at a steady pace. We'd better shut down this kind of cowardly behavior where they sneak in and sneak out of secret legislative meetings and go back to their representative bodies and pass screw-ball legislation that only benefits the wealthiest 1% or so in the nation.

I call ALEC and all her members the truest examples of what it is to be un-American, unpatriotic, disloyal, treasonous! That goes for all states' legislators who belong and all the corporate entities, as well.

The John Birch Society/libertarians have been trying to ingratiate themselves into mainstream politics since the 60's - 70's. Typically they were regarded as third party candidates at the local, state and national levels. However, they are no longer on the fringe as a third party but are represented in local, state and national levels as Republicans with an agenda with the mantra "my way or the highway" kind of thinking. If you look at the more than thirty states with a republican governor and legislature you will find the same bills regarding abortion, election laws, state funding for all businesses, emphasis on charter schools, dismantling what little unemployment benefits are available and a deemphasis on those who need support due to the present job market etc.

For God's sake, make these people accountable and transparent who are trying to dismantle our way of life based on their ideology, wealth and social mores to be the norm for our country. The Koch Brothers may have many billions to buy local, state and national elections, but I truly believe they cannot and will not buy the American people at any price.

DO NOT SELL YOUR PAPERS TO THE KOCH INDUSTRY.

Thank you.
Emma Rashinsky
Florida

GOOD, glad to see the minorities get their right to express their opinions via voting. They have been held back way too long via stupid selfish people.

You are correct -- I was relying on old data. Thanks for the comment!

If GMOs are so great, then why aren't suppliers/producers/etc pasting it in BIG BOLD letters on their products - new and improved, now with GMO! - ? why not?
You wanna eat it, be my guest.
Like the other poster said - if they can't prove it doesn't contain GMOs, I'm not buying it. Period. That goes for grocers and restaurants.

The calculation behind the implicit subsidy should be viewed with a healthy dose of skepticism. For starters, it's based on credit ratings data, which are known for their slow adaptability to market changes.

Moody's Is Catching Up To The Market's View That Dodd-Frank Is Ending TBTF. "'The FDIC is determined to reduce too-big-to-fail risk,' said Edward Marrinan, a macro credit strategist at Stamford, Connecticut-based RBS Securities. While Moody’s is still determining whether to lower its ratings, 'the market is already there, and gets that this is a significant development in how to assess the risk profile of banks,' he said." (Charles Mead, "Too Big to Fail Discounted as Moody’s Evaluates: Credit Markets," Bloomberg, 4/10/13)

Researchers have gone beyond ratings, analyzing how the market actually works. What they found is that Dodd-Frank has already changed the way the market determines bank funding.

Based On The Secondary Market For Senior Bonds, Dodd-Frank Has Turned An Implicit Subsidy Into A Funding Penalty For Large Banks. "We find the 136 basis points discount on yield spreads because of the too-big-to- fail (TBTF) effects is removed after the DFA. Markets charge a premium of 33 basis points for the TBTF banks after the DFA. The premium increases further after the rating criteria changes by credit rating agencies." (Ken Cyree and Bhanu Balasubramanian, "The End of Too-Big-to-Fail? Evidence from Senior Bank Bond Yield Spreads Around the Dodd-Frank Act," Social Science Research Network, 6/26/12)

The change is due to the many factors that work to make banks safer and less likely to fail.

Federal Reserve Chairman Ben Bernanke Says The Largest 18 Banks’ Capital Levels Have More Than Doubled Since The Crisis. “Over the past four years, the aggregate tier 1 common equity ratio of the 18 firms that underwent the recent tests has more than doubled, from 5.6 percent of risk-weighted assets at the end of 2008 to 11.3 percent at the end of 2012--in absolute terms, a net gain of nearly $400 billion in tier 1 common equity, to almost $800 billion at the end of 2012. Indeed, even under the severely adverse scenario of the latest stress test, the estimate of these firms' post-stress tier 1 common capital ratio is more than 2 percentage points higher than actual capital levels at the end of 2008.” (Ben Bernanke, Remarks At The Federal Reserve Bank Of Atlanta, 4/8/13)

But more importantly, if a large firm does fail, regulators now have new powers to wind-down a failing firm, thus ending bailouts.

FDIC's 'Considerable Progress' On Resolution Authority Is Changing Market Expectations Of Future Bailouts. "The FDIC has made 'considerable progress' by identifying obstacles to implement its so-called orderly liquidation authority, which gives the agency power to wind down, split up or sell off companies considered a potential systemic risk to U.S. financial stability, Moody’s said in the report." (Charles Mead, "Too Big to Fail Discounted as Moody’s Evaluates: Credit Markets," Bloomberg, 4/10/13)

Don't believe bailouts have ended? Sheila Bair advises that you do.

Former FDIC Chairperson Sheila Bair Argues "Strong Language In Dodd-Frank" Should Give Investors Serious Doubt About Future Bailouts. "Not convinced that bailouts are over? Well, if you are swimming with one of the squids as an investor, do you want to take the chance? Perhaps if one of these giants gets into trouble, the government will blink and throw you a life jacket. But given the strong language in Dodd-Frank banning future bailouts, I doubt it. If you own stock or subordinated debt, you will probably be wiped out. If you own bonds, you will take a big loss. So be a prudent investor, and do your homework. If you still don't understand the risks, get out of the water." (Sheila Bair, "Why Taxpayers Might be off the Hook When a Big Bank Fails," Fortune, 4/11/13)

This article also cites a number of individuals that are not break-up proponents, but says they are by linking to a list that links to another list that links to articles, but not quotes. For example, it links to a WSJ op-ed by top economists as what to do as an alternative to TARP during the crisis – this is not a break-up proposal in any way, and completely mischaracterizes the authors.

Columbia Professor Glenn Hubbard, Harvard Professor Hal Scott, And Chicago Professor Luigi Zingales Advocate For An Alternative to TARP For Trouble Institutions. "We believe these problems can largely be avoided by adopting a simple approach. Rather than taking over and running banks, the FDIC should split each bank into two parts. One part ("the bad bank") will assume all the residential and commercial real-estate loans and securitized mortgages as assets, and all the long-term debt as liabilities. In addition, "the bad bank" will obtain a loan from the "good bank." This loan is necessary because the long-term debt of the old bank is not likely to be sufficient to fund the assets of the bad bank. The good bank will have all the remaining assets, including derivative contracts and its loan to the bad bank. It will have all the insured deposits and the FDIC-guaranteed short-term debt as liabilities. Once the split is accomplished, the good bank can be cut loose from FDIC receivership." (Hubbard, Scott, and Zingales, "Banks Need Fewer Carrots and More Sticks," The Wall Street Journal, 6/6/09)