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Look Who Is Crying Over Spilt Milk — Or The Danger Dairy Fairy Tale

Published September 24, 2011 by glaumland

Well, here’s an OMG post for today.

http://hotair.com/archives/2011/02/05/epa-to-regulate-dairy-milk-spills-as-per-oil-spills/

http://www.thecompletepatient.com/storage/WIorder-clarification9-11.pdf

 

Once upon a time, in the land of the free and the home of the brave (and the rest of the world for that matter), there was this amazing substance called ‘milk.’ So magical was this liquid, that it was fed to the babies of many & varied creatures in the animal kingdom known as ‘mammals.’ More wonderful than water, milk was composed of proteins, fats and sugars, vitamins, minerals & water, the basic nutrients needed to keep the infants alive. So important were these nutrients, that female mammals actually had a way to produce and store milk until it was needed by their young. After the babies grew up and were able to find their own food supply, the mothers quit producing this ‘milk’ until it was needed by the next round of offspring. Some mothers produced extra milk, much more than their young ones needed, and these became known as ‘dairy’ animals.

How blessed the mammals felt to have this ‘liquid nutrition.’ Humans, too, recognized the importance of milk. The starry path in the night sky was called The Milky Way. The Promised Land was referred to as the Land of Milk & Honey. Even acts of generosity were recognized as ‘the milk of human kindness.’

The wise people of the kingdom realized how precious this milk was and they looked for different ways to share with others and keep it for future use. They discovered contamination, fermentation, & coagulation, and they called their products ‘cheese,’ ‘buttermilk,’ & ‘cottage cheese.’ Other learned people developed the processes of pasteurization & homogenization to keep the milk safe & creamy. Best of all, a method called ‘refrigeration’ was invented and people learned just how good milk was when chilled or frozen! Some humans would stand in lines at a store to buy this milk, others would pay to have it delivered fresh to their homes.

The people in the kingdom rejoiced. “Happy Cows” (California Milk Advisory Board) were celebrated and Dairy Princesses were appointed. Many dairy lovers would greet each other in the street by saying, “Got Milk?” Meanwhile word spread quickly in the kingdom: “Milk – It Does a Body Good,” (National Dairy Council); “It Builds Bonnie Babies,” (Glaxo Dried Milk); and “Drinka Pinta Milka Day,” (Milk Marketing Board).

But the glory of the dairy days could not last forever. Soon, nannies (those all-knowing dears who only want to do what is in your best interest) complained that this ‘milk’ could be dangerous, so the lords and justices of the kingdom passed legislations and regulations to make the glorious liquid safer for storage and comsumption. And the people of the kingdom rejoiced, although these new rules made the kingdom’s milk more costly and less tasty.

After much study and contemplation, the wisest of the people in the kingdom discovered that these new dairy processes destroyed some of the nutrients in this glorious milk, and the nannies said, “The children need these nutrients that the milk used to have!” So the lords and justices of the kingdom passed more legislations and regulations to add ingredients back into the milk, calling their new product ‘fortified.’ And the people of the kingdom once again rejoiced, even though it required more coins to buy this milk and it tasted even worse than before.

Years passed, and the people of the kingdom still felt blessed by this ‘fortified’ milk (even though it was so bland and costly), and many infants grew into adulthood and then raised their children with this milk. But there were rabble-rousers that began to rumble in the kingdom that they did not want this ‘fortified’ milk from these dairy creatures. So the rousers went to the wise people and instructed them to find a nutritious liquid from other sources. And the wise people, being of course very ingenious, found this liquid and the called it ‘soy milk.’ However, only some of the people in the kingdom rejoiced, as the ‘soy milk’ tasted strange and required them to exchange even more coins.

However, in parts of the kingdom were people who remembered the old ways and honored the dairy mammals. They grumbled at all of the changes that had been made to milk and wanted their glorious milk to come straight from the magical mothers; this milk they called ‘raw.’ And these grumblers went out into the kingdom and gathered these divine dairy creatures to themselves, drinking the ‘raw’ milk without pasteurization and homogenization and fortification. And these people rejoiced and no longer grumbled, for they felt renewed and invigorated by all of the nutrients in their special milk that was so tasty and cost very few coins.

But the nannies, DOING good because only THEY know what IS good, saw these happy people drinking their milk from their dairy animals and exclaimed: “They can’t do that!” The lords stood idly by, worrying about their own lands, jingling the kingdom’s purses and thinking about ways to spend the peoples’ tax monies. The justices agreed with the nannies; ‘raw’ milk was dangerous and the common people must be protected from themselves. So the justices passed new laws stating that people could not drink ‘raw’ milk from their own dairy creatures, nor could they sell their milk to others without complying with the legislations and regulations of the kingdom. And the nannies rejoiced but the grumblers began to grumble once again.

How does this dairy-tale end? If you listen closely, you can hear the grumbling growing louder. But we’ll have to wait and see…

Until next time…

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This Vet Learning About Healthcare Globalization

Published September 8, 2011 by glaumland

This is another journal entry from my class on Healthcare Organizations. Just when I though the healthcare industry couldn’t get any bigger or scarier, we looked at it on a global level. We also looked at longevity that week, but I’ll save that for another post. Wow!

THE GLOBALIZATION OF HUMAN HEALTHCARE

Wow! There is a lot of stuff to think about this week. I hardly know where to start. But I think
I’ll start with the articles.

 “How Health Insurance Design Affects Access To Care And Costs By Income In Eleven
Countries” by C. Shoen et al. – I found this a very interesting article,
but probably not for the reason the authors intended. What I found interesting
was the efforts to make ‘science’ out of opinion. It’s really quite easy, and
lots of ‘scientists’ do it all the time.

 Here’s how it works…you ask people how they feel about a subject and then use their
response to come up with statistics (confusing subjective and objective
information). The authors of this study did exactly that. To establish incomes,
respondents were told their country’s median income then asked if they felt
they were about average, much or somewhat above average, or  much or somewhat below average.  In other words, how do you feel about your income compared to the average? The biggest problem with this methodology is that it can introduce bias issues into your study, and although the authors
admit this problem when it comes to estimating medical expenses, they don’t
mention it about income. Ideally, the authors would have given an exact range
(if the median income was $35K, then ask if people make $30-40K (about
average), $15-30K (somewhat below average), $40-70K (somewhat above average),
etc.) That is a number most people have a pretty good idea about and can answer
truthfully, giving better data. (And about the truthful answer part, another
way to introduce bias is when the respondent either answers untruthfully
because they don’t think it is your business what their income is – I’ve done
that before – or they reply with what they think the correct answer is trying
to please the questioner.)

 Anytime you ask people about their ‘experiences’ you are introducing the potential for more
bias in your study. I can say this from personal experience. If a survey was to
catch me during a bad time with one of my health issues, my responses may
revolve around that one episode and not necessarily take all circumstances into
account. When I’m grumpy and hurting, I’m not necessarily the font of wisdom.
Likewise, asking a patient if they are confident they could get ‘the most
effective’ treatment, how are they to know? Is this their opinion or have they
educated themselves to know the different options and what will work for them?
Also, are they speaking of their own experiences or are they considering those
of friends and relatives in their answer?

 There were a couple of other things I didn’t like about this article. First, they really stressed
that low-income people are more likely to suffer more chronic conditions and be
elderly. Whereas I believe that it is the elderly and those with more chronic
conditions who are more likely to have lower incomes. I think that dollars
earned by the elderly during their working years are not worth as much during
their retirement years, thus many of them fall into the low income category.
This is especially true during this economic downturn when nearly everyone’s
financial worth has taken a hit. I also believe that people with chronic
conditions are less able to have an active or productive work-life (this would
include me) and that is why many have low incomes. It comes down to the
‘chicken or egg’ argument, but I don’t believe that having a low income leads
you to be elderly or sickly; that isn’t logical.

 Another statement in this article was that the countries varied in their ability to provide access
to 24 hour healthcare outside of the emergency room. My first reaction was
“so?” Isn’t that the reason for emergency rooms? I don’t see why this
topic was presented as an ‘oh my gosh’ one. It just seems like a no-brainer to
me.

 That’s true of many of their arguments. Maybe I’m naïve (some of my friends tell me that!) or
narrow-minded (some different friends tell me that!) so perhaps I’m just not
open to these studies that push the benefits of healthcare reform. Although I
have to say I didn’t know that was the purpose of the study when I started
reading it. But by the time I started going through their survey results, I had
a pretty good idea what their conclusions would be. I do know I am suspicious –
it comes with age and experience.

 I know that surveys are difficult to do (and especially in different languages and cultures); it
takes a lot of work and careful consideration to do a survey properly. Adding
in a potential for a lot of bias, then covering it with statistics, just leads to
the creation of junk science, and that’s what I think they have here. I can
honestly say I was not as impressed with this report as with the other articles
we read this week where ‘real’ numbers were used. And there I’m exposing my
bias against healthcare reform, as I don’t believe one bill can effectively or
efficiently cure all issues. I think there are some ways in which really good
studies could have been designed (like retrospectively looking at
post-hospitalization surveys). I do agree that you will miss some important
sections of society and some important information, but again, I don’t think
you can design one study to get all answers.

A Vet Looks At Longevity & Euthanasia

Published September 8, 2011 by glaumland

Another subject we covered in my Human Healthcare class was the Longevity Revolution. We all hear about the Baby Boomers getting older, but it is interesting to consider that our healthcare industry is aging, as well. And anytime you focus on longevity, you also have to look at the end of life. Choosing for animals is very different than choosing for people.

THE LONGEVITY REVOLUTION

OK, enough griping.
Now I’ll focus on some of the topics that I really liked this time and how I
see some of them in my veterinary practice. You know, sometimes my kids are
really impressed by how I seem to know everything (that ‘eyes in the back of my
head’ thing); at other times they roll their eyes because they can’t believe
how ignorant I am. I’m not ‘hip’ or ‘with it’, although I know those terms are
as dated as I am!

I really liked the
information about the aging population and the need for more general
practitioners. (I never really considered about the medical practitioners aging
as a group…hmmm.) I totally agree that there needs to be a move towards
family doctors. For many years the medical industry was gaining so much
specific knowledge and technical abilities, and it seemed like medicine became
very ‘targeted’ – if you had a joint problem, you went to a joint specialist,
etc. Of course, many people still technically had a primary physician, but
often it seemed that they did little but authorize the trip to the specialist.

For instance, I
never took my kids to pediatricians. My children are a part of a family unit
and need to be treated that way. They don’t live in a vacuum. And I think this
is the best example of how human medicine has gotten so off kilter. I’ve been
lucky enough to have found some really good family doctors who take the time to
do thorough histories. (Darned if they don’t leave just about the time I really
get them trained.) Doctors who take the time to listen and ask the right
questions are way ahead in treating the whole patient, not just throwing some
medicine at some symptoms.

In my practice a
good history is a must, especially since my patients can’t talk for themselves.
I think the biggest problem is that doctors have to get so many patients
through a day to make it profitable. Also, I think the culture of medicine
needs to get back to teaching the doctors about how important gathering
background information is. Or maybe just that it needs to be done. When you had
small practices in small areas, the doctors probably already knew most of the
family information about their patients because they were a part of the same
small community. That’s just not likely to happen today.

Another point that I
think was really well made this week was that lifespan does not equal
health-span. Whenever the legislature talks about raising the retirement age, I
consider it an interesting issue to tackle. When you look at the older people
you know, some people are ‘old’ at 65 and some are ‘young’ at 85. How do you
differentiate between those people who really need to slow down in their 60’s
(or even 40’s or 50’s), and those who are active and able into their 70’s and
80’s? I don’t see that there is a way to legislate this problem as it would
need to go person by person and case by case.

Hospice is one of my
favorite parts of the medical industry. My grandmother went into a hospice
house in Topeka after a massive stroke, and it was the best experience ever
(relatively speaking). Everyone I’ve ever talked to who have used hospice homes
have had good things to say about them. I don’t know as much about hospice done
at an individual’s home (I really haven’t heard of any in the last decade
personally), but I would imagine there is a move to get people into the hospice
facilities where there would be better access to staff, equipment, medications
and facilities.

To choose hospice is
to choose the right to die with dignity and comfort. But can the same be said
about euthanasia? As a veterinarian, I can say that euthanasia is one of the
most difficult things that I do. I hate the days when I transform from ‘Dr Glaum’
to ‘Dr Gloom.’ I appreciate being able to end the suffering and pain for the
pet of a family. Since I don’t like the ‘Dr Gloom’ I usually try to push the
animals and the families to put that decision off as long as we can maintain
the quality of life.

Once I have a
terminally ill patient, we have a ‘pet hospice program’ we use that helps the
patients stay comfortable and helps the families know when it is time for
euthanasia. This has been one of the best programs that we have instituted in
the past few years. We have a scoring sheet that looks at different topics
(like movement, hunger, pain) so that the pet owner can evaluate their pet, see
trends, and better communicate with us. If something is trending downwards, we
know that is an area to work on (like installing ramps, changing food types,
adjusting pain meds). Better quality of life (QOL) means that pet and parent
have more time together. And it relieves some of the worry and guilt that they
experience when that time does come.

One of the
non-scored topics I have to deal with though is the burden on the caregiver. I
know how important this is to people on the human side more than even the pet
industry. It is one thing to carry a 10# Poodle outside to go potty, but a very
different thing to move a 100# Labrador around. Sometimes the problem is the
clients can’t afford meds or have ‘people’ family commitments they need to
attend to. We, as veterinarians, have that luxury of being able to say,
“That’s OK, it’s time.” I have seen my parents caring for my
grandparents as they aged, and frankly, I’m scared that when it is time for me
to step into that role I may not be up to it. I hope I can find a way where it
is my responsibility, but not a burden. Time will tell.

The last thing I
wanted to note on euthanasia is what a burden it is to have the power over life
and death. It isn’t easy, at least for me. Perhaps that is because of my belief
that animals are all unique as God’s created creatures; I just don’t know. I do
feel honored to be allowed to be a part of the intimate time when the pet
owners say good-bye to their pets. I try not to cry at the moment, but often
the tears come on the way home. One especially bad period a few years ago, I
lost 12 pets in 9 days; it was a hot August and the little old guys just
couldn’t handle the heat stress on top of everything else.  Anyway (probably TMI), I went into a
depression that lasted for months. The point is, euthanasia is really tough and
I don’t think the human medical industry needs to go to that difficult place. I
think that hospice can fill that need.