Naked Medicine

On a Thinkers & Leaders social network, a question was posed about what made an “authentic leader”. Is it about the person’s quality of thinking? Values? Passion? Charisma?

When I looked at the term “authentic leader”, I am looking at the components and what each means personally to me.

An “authentic” individual exhibits a degree of self-awareness and knowledge of motivators and values that is readily transparent and apparent to even the casual observer.

A “leader” is an individual who acts on behalf of a collective (group, company, tribe, society) with the intent of benefiting as many dimensions of existence of the collective.

An “authentic leader” would naturally engage both of these components in his or her actions and expressions.

Qualifiers like “charisma” and “personable” can be helpful, but these are peripheral to the core components. Unfortunately, we have become so focused on the peripheral that we confuse what is on the surface with what lies beneath.

A few years ago I found myself speaking to many Ph.D. scientists who want to leave science research. Since my entire career path may be best labeled “alternative healthcare… plus!”, I am often contacted by life science professionals who are at the cross-roads of their lives and their careers, and wondering how to reconcile a career path for which they had invested decades of their lives with an increasing feeling of personal dissatisfaction.

Now, I find myself speaking to physicians who are stressed out both from their careers and from their imploding personal lives. While I won’t stop hearing from my scientist colleagues anytime soon from exploring alternative career transitions, I anticipate connecting with more medical doctors in the next few years. Many of these doctors no longer recognize the profession they used to love amid the increasingly hostile healthcare environment.

What worries me more is that many of these doctors no longer know who they are.

When you have invested years of your life: about two decades worth of yourself and your life to schooling to become a physician, your career decision has been deeply ingrained (i.e. family heritage) or deeply personal (i.e. personal value around making a difference as a healer). After all, it takes courage and commitment to choose a career where, when you’re finally ready to “start”, most of your peers in other professions are in their mid-career journey.

No wonder, for doctors, it can be harsh and hard to walk away from an identity that has been decades in the making.

If you are a physician, try this: describe yourself without making reference to your profession; without saying “I’m a doctor” or what clinical tasks you perform on a daily basis.

What are you left with?

If you don’t like the answer, make a plan to create one that you can live with and be fulfilled by for the rest of your life. Too often physicians settle for a role (”doctor”) as their identity, and when that role becomes threatened, they find that their identity becomes threatened. They feel out of control with who they are, what they stand for, and how they live their lives.

Now is the time for physicians to start facing this consuming identity crisis before they no longer recognize their lives or worse – themselves.

Image by sanja gjenero

Ideas for Fixing Health Care from New York Times online

Primary Care Physicians: Everything to Know About These Doctors by US News & World Report

Doctors often take the decider role, to patients’ detriment – USATODAY.com

‘Difficult’ patients can test doctors’ patience – USATODAY.com

Physician as Healer, Leader and Partner: Tackling the Nursing Shortage

By Jane Chin This morning I was skyping with one of my favorite people, Bhupesh of Ethnicomm, when we began talking about the current state of healthcare. Bhupesh lives in Canada, where healthcare is socialized in a way that has become apparently very attractive to various healthcare “activists” and interest groups here in the U.S.

Right now many people here in the U.S. are tremendously upset with insurance companies because of the way these companies make financially based decisions about people’s lives. The stereotype, for example, is the image of a middle-aged MBA-educated executive sitting in front of a spreadsheet that gets him to conclude that letting a chronically ill patient die may be cheaper than approving for reimbursement certain “non-standard” medical procedures or organ transplants or experimental use of an approved drug.

The government is a bloated bureaucratic pseudo-organization that struggles with its constituent interests but is really focused on its primary priority: keeping itself (the government) alive. Letting the government run healthcare, in my personal opinion, is not going to get us better care than the situation we’re getting from insurance companies.

If healthcare is a question about access best served by the government, close your eyes and flash past to the last time you were at the DMV (department of motor vehicles). How was that experience for you? I assumed you were relatively healthy when you last visited the DMV. Now imagine yourself in a sick condition and trying to deal with the inefficiency and the staff. When I was in graduate school there was a time when I was sick and had to sort out a problem at the DMV. I spent about an hour of the three hours I had to wait there retching in the bathroom. At least the bathroom was clean.

Here in California our state government had done such a great job that the state is hemorrhaging money. In fact, the DMV here has to stop working on Fridays just so the government can stop bleeding as much money as it’s been bleeding. I don’t dare to imagine what a California-run healthcare system is going to look like, but I can guess that the other half of our hospitals that somehow managed to remain open may probably start closing as well.

Then Bhupesh and I wondered about a Darwinian question, to give the benefit of the doubt to a government that may ultimately decide that, for example, once you’re over 65 years old, you should not be eligible for big expensive procedures (like organ transplants) because you’d be cheaper to the government DEAD. If you think that it’s bad for insurance companies dealing with a few million lives to start seeing you as a statistic, wait until you become one in the hundreds of millions of lives to a government-run healthcare system.

Maybe we really should let nature take its course rather than stuffing ourselves with pills and new organs and medical devices to stay alive. Why not die our “natural age” rather than fight to live an unnaturally long life?

I remembered thinking about a similar question recently, when I thought about babies who were born so premature that they were called “micropreemies“. These are babies born before 26 weeks of gestation (normal is at least 37 weeks) and under 3 pounds. A premature baby or a “preemie” is born before 37 weeks. Put Darwin’s survival of the fittest test, and it’s safe to say that most of the preemies and all of the micropreemies won’t make it.

But this is the beauty and the beast in living in today’s technologically advanced society. Babies who might otherwise not survive can survive and thrive when born in this day and age. So too, can the same reasoning be drawn to we adults who might otherwise want to keep living past a heart attack or cancer. We live with these options to fight and win over the diseases that 50 years ago may swiftly kill us. The trade off is that we sometimes end up living a longer, more painful existence until our untimely death. (I’m not going to get into a soapbox about the ethics of having octuplets when you already have 6 kids and are still living with your parents)

The healthcare question when taken into this context, then becomes more of a moral question and conditioned by social and cultural “norms”. How old is too old? How sick is too sick? How much money is too much money to pay to keep a human being alive? It’s one thing to answer these questions as an individual or a member of a family (then we’d naturally say, “life is priceless! at any cost!”), but it is another to try answering these questions as an individual making policies and decisions for hundreds of millions of lives. Then there IS indeed a price for a human life, because there is only a certain amount of money that the government has to use for healthcare of all its people.

Governments are good at justifying collateral damage or “sacrifice a few to save many more”. How do you feel about being a member of “the few” instead of a part of “the many more”?

By Dan Abshear

Almost on a daily basis, one may read about a new medication being developed or approved for the benefit of patients. At times, these announcements may praise the innovation and novelty of such drugs that are new and possibly available to all in need of it.

But it’s possible the one super drug is not new and really is a super drug. In fact, it’s one of the oldest medications available, and that would be aspirin- the first non-steroidal anti-inflammatory drug (NSAID).

Noted as ASA by doctors typically, aspirin effects have been noted for thousands of years, as the active ingredient comes from the bark of a White Willow tree, and long ago, patients with pain or a fever would chew on this bark for relief.

Fast forward to over a hundred years ago and Bayer pharmaceuticals (pronounced ‘Beier’), which is the same company that brought us heroin and mustard gas, as well as methadone. The company originated in Germany, but presently has its U.S. headquarters in New York. Felix Hoffman, seeking to develop an agent for his father’s rheumatism, was involved in the development of what is known now as aspirin. And it was a difficult task to develop this drug, as it was toxic to the stomach due to the nature of the active ingredient again obtained from the bark of the white willow tree. Dr. Hoffman and others at Bayer developed a drug that proved to be tolerable to patients while keeping the active ingredient in tact through a method of delivery developed by Dr. Hoffman’s team at Bayer. After launching the medication, aspirin was priced at about 50 cents an ounce, as at the time it was only available in power form. Soon before 1920, aspirin developed the tablet form of the drug and was then available by prescription. Regardless, aspirin was responsible for one third of sales for Bayer during this time, due to its popularity at that time.

While all drugs have side effects, aspirin is one of very few drugs that provides great efficacy and indications, with limited side effects. In fact, some of aspirin’s additional uses have been recently discovered. This may be why the New York Times called aspirin a wonder drug in the 1960s. In the 1970s, the mechanism of aspirin was isolated, which is the blockage of prostaglandins.

With Aspirin and its potential life-extending benefits:

Aspirin has been associated with decreased risk of asthma and prostate cancer in the elderly. Also, aspirin has been linked with lowering the risk of breast cancer and colon cancer as well. Aspirin is a blood thinner, and has been associated with decreasing the risk of heart attacks and strokes in certain patient populations, as the drug prevents clots. This was first suggested in the 1940s and the FDA suggested that it be the drug of choice for those who experienced a heart attack over a decade ago. Aspirin intake is beneficial for those after coronary bypass procedures. A topical formulation of aspirin was developed recently for those experiencing Herpes pain. The drug has been proven beneficial for those experiencing migraine pains. Aspirin at low doses is taken by many as a preventive drug to decrease cardiovascular incidents that may occur.

Aspirin has been the best selling painkiller since the 1950s. It is not as addictive as other choices for patients regarding pain relief in particular. It is also the most studied drug- with over 3000 scientific papers published worldwide. Also, over 15 billion tablets of aspirin are sold annually, which amounts to about 80 million aspirin tablets consumed daily by others. This amounts to over 16,000 tons of aspirin consumed during this time, or about 70,000 metric tons of aspirin a year. Over a decade ago, a study was performed and concluded that twice as many people would choose aspirin over a computer, given the two choices, because of the benefits of the drug.

Side effects would include GI bleeding if taken in large amounts, along with an association of Reye’s syndrome in children, yet both are relatively rare. Yet all things considered, clearly the benefits of aspirin outweigh any risks of the drug.

Lately, there have been issues with other NSAIDs, such as Cox II inhibitors, without full recollection or knowledge that aspirin is in fact the world’s most widely used drug, and for good reasons.

At times, something newer is not always better

“We might die from medication, but we sure killed all the pain.” — Conor Oberst

Disclosure: Author was formerly an employee in the pharmaceutical industry (sales) and is currently seeking employment in the same industry.