Farewell. The Flying Pig Has Left The Building.

Steve Hynd, August 16, 2012

After four years on the Typepad site, eight years total blogging, Newshoggers is closing it's doors today. We've been coasting the last year or so, with many of us moving on to bigger projects (Hey, Eric!) or simply running out of blogging enthusiasm, and it's time to give the old flying pig a rest.

We've done okay over those eight years, although never being quite PC enough to gain wider acceptance from the partisan "party right or wrong" crowds. We like to think we moved political conversations a little, on the ever-present wish to rush to war with Iran, on the need for a real Left that isn't licking corporatist Dem boots every cycle, on America's foreign misadventures in Afghanistan and Iraq. We like to think we made a small difference while writing under that flying pig banner. We did pretty good for a bunch with no ties to big-party apparatuses or think tanks.

Those eight years of blogging will still exist. Because we're ending this typepad account, we've been archiving the typepad blog here. And the original blogger archive is still here. There will still be new content from the old 'hoggers crew too. Ron writes for The Moderate Voice, I post at The Agonist and Eric Martin's lucid foreign policy thoughts can be read at Democracy Arsenal.

I'd like to thank all our regular commenters, readers and the other bloggers who regularly linked to our posts over the years to agree or disagree. You all made writing for 'hoggers an amazingly fun and stimulating experience.

Thank you very much.

Note: This is an archive copy of Newshoggers. Most of the pictures are gone but the words are all here. There may be some occasional new content, John may do some posts and Ron will cross post some of his contributions to The Moderate Voice so check back.


Friday, April 13, 2012

HCR -- Choosing Wisely

By John Ballard

Despite election year politics over Obamacare, a serious national conversation is finally beginning to yield positive results. Win, lose or draw this discussion would never be happening without the two-year long struggle to birth PPACA. Having followed the debate since before it became mainstream, I have come to the conclusion that what happens with Congress, the mandate or anything else will be secondary to the discussion among the providers themselves, fueled by specialized policy wonks who have forgotten more than all the Congressional staffs and Lobbyists ever knew.

And I'm encouraged. Here are two examples. 

?Dr. James Salwitz at Sunrise Rounds says in Healing medicine together...

Millions of lives and billions of dollars were saved this week and America moved a step towards a healthy new future. A new drug or surgery? Another genetic breakthrough? No, an event much more powerful. Nine medical societies (soon to be 17) and 11 consumer groups stood up together and in one voice said, �We are sick and tired and we are not going to take it any more!�

On April 4, 2012, the partners of the Choosing Wisely Campaign released their first collaborative list of unnecessary, expensive and therefore dangerous medical testing. These groups, representing well over 200 thousand physicians, AARP, industry, farmers, unions, business interests, health advocates and even Wikipedia, published a list of tests which are often unneeded and guidelines when they can be avoided. This is a national grass roots campaign without government, insurance or even AMA involvement. In this broad movement that it can be said that the people have spoken�they want costs down and quality medical care up.

Of the 2.8 trillion U.S. dollars spent on health care each year, we waste $600 billion on unnecessary tests, unhelpful treatments, and complications. We are a country that is long past the point where more money buys better health. We spend so much on medical care we are hurting ourselves. Unneeded tests lead to unneeded diagnoses which lead to unneeded treatments which lead to unneeded complications which cause unneeded suffering, all spent with desperately needed dollars. We fear that government and the insurance industry, though harsh rationing, will force a fix on the mess. It seems we have an alternative. The Choosing Wisely group is a board base of consumers and they are helping us make a stand.

In its first publication, the Choosing Wisely Campaign, organized by the American Board of Internal Medicine Foundation, dispersed five specific recommendations from each of nine specialty societies.

Examples include:

  • Sinusitis is usually viral so do not use antibiotics and avoid CT scans

  • Bone density X-rays only on women older than 65 or men older than 70 

  • Avoid routine EKGs unless the patient has a problem 

  • No routine stress tests, regular or nuclear, and reduce radiation exposure 

  • Reduce routine or pre-operative chest X-rays 

  • Avoid CT scans for routine headaches

  • Colonoscopy only every 10 years, if normal 

  • Avoid chemotherapy in weak patients with advanced cancer 

  • Careful consultation with the patient and family before starting dialysis 

  • Reduce PET, CT scans and labs in cancer patients who are likely cured 

  • Use ultrasound, not CT scans for children with appendicitis 

  • Avoid scans for routine back pain for at least six weeks

More at the link. Go check it out. 
While you're at it, bookmark Choosing Wisely for future reference. I have an idea they are just getting started. 

?Why sudden death is good public policy
And you thought talk of death panes was shocking! Who knew such scary subjects would come bubbling to the top in the short space of a two or three years.
This in-your-face post is a long overdue indictment of ICDs (Internal Cardioverter Defibrillator) as one of the main contributors to the high cost of health care inasmuch as the most expensive part of the health care dollars spent are at the end of life. 

This comment caught my eye.

Doctor: How do you want to die?

Patient: Suddenly, and in my sleep with no pain. You know, drop dead.

Doctor: We can fix that.

I don't expect this idea to get too much traction, but it signals an important part of the health care conversation usually avoided, and which at those rare times it comes up, is so devoid of content that it may as well be a conversation about sports or cooking.

Although we all will die, very few people have the courage to take seriously any discussion of the subject. It, forgive the expression, serious as a heart attack. 

This Newshogger post from a couple years ago links a NY Times article that should be read by anyone who has any personal or family connection with a pacemaker. 


  1. Good post John - you know how I feel about this. I was a care giver for my father for the last year of his life. Medicare probably paid over $100,000 dollars for medical procedures that may have extended his life but reduced the quality of that life to near zero. I finally said enough is a enough and had one doctor out of four who was on my side. More recently I have been the care giver for my mother and learned to just say NO. No surgeries, no tests for things they couldn't do anything about anyway. The same doctor who fought me when I said no to further intervention for my father is now on my side with mother. When I had to call 911 a few months ago he lauded me for ignoring everything the hospital told me to do - yes we are talking lots of tests. He knows what I expect so I don't know if this is how he runs his practice generally.

  2. John -
    Thank you for continuing to follow these issues. They are important in multiple dimensions as national policy and in our personal decisions.
    I've just had some relevant experience in these areas but don't want to write about it yet. Plus other experiences in the past. All of us have experienced or will experience these issues.
    The hardest thing I see here is to convince people that more diagnostics are not necessarily useful diagnostics. I have a particular person in mind who will screech like hell for more, more, more! She is convinced that only then are doctors doing their job. And I suspect that she's not the only one.
    Odd that people worry about the traces of radionuclides from Fukushima that may be reaching the United States and then want to be zapped by CT scanning. All in the name of their health.

  3. Thanks to you both.
    Here is another relevant link I just came across.
    Daughter to Hospice Nurse: I live in Milwaukee and I�ve been with Dad in New Glarus for a week now. Should I stay or go home?
    Hospice Nurse: Well have you asked your Dad about what he thinks about that?
    Daughter: No. How do I do that?
    Hospice Nurse: When he wakes up from his nap, tell him that you�re thinking about going home and ask him what he thinks about that.
    Daughter to Dad: Dad I�m thinking about going home. What you think about that?
    Dad to Daughter: You stay. I�m going�

    It's tempting to believe that dying people don't know what's about to happen to them. And thanks to our reluctance to face that reality many actually don't. But for those who are aware, allowing them to verbalize that awareness is compassion at its best.