{"id":10635,"date":"2011-06-26T11:54:24","date_gmt":"2011-06-26T15:54:24","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=10635"},"modified":"2011-06-26T11:54:24","modified_gmt":"2011-06-26T15:54:24","slug":"echo-echo-echo-echo-echo-echo","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2011\/06\/26\/echo-echo-echo-echo-echo-echo\/","title":{"rendered":"echo echo<\/font> echo<\/font> echo<\/font> echo<\/font> echo…<\/font>"},"content":{"rendered":"
Okay, I retract the title to that last post. I mean there’s not much more to say than that the solution to American medicine’s woes is transparency and an end to the secrecy. I didn’t mean I was going to stop talking. <\/div>\n

I used the Iron Curtain as my example because of a personal experience. Not long after I left academia and went into practice, I decided that we needed a computerized billing system, and the ones available back then were for the big practices – not a four person office with a sole secretary. So I wrote one myself [IBM PC, DOS, dBase III+]. It got to be a hobby of sorts. It actually worked but it was way too slow. Shortly after we started using it, a company called Clipper introduced a way to compile dBase programs that made them run at what was then lightning speed. So my new hobby became compiling our little system. <\/p>\n

This was in the days before the World Wide Web, but there was something called Compuserve. When I got home at night, I’d fire up my PC and log on to the Compuserve bulletin board for Clipper to see if anyone had answered my questions from the night before. At the time, I thought that the fact that I could do this was the most remarkable piece of technology that there would ever be. One night, there were posts from a Clipper representative in  Moscow. Amazing! I opened one, and realized that the guy was typing as fast as he could about something big happening there. Tanks were rolling down the streets. I was reading about it upstairs, and shortly thereafter, it was all over the television set downstairs pouring out of Russia on phones, fax machines, computers, [and the Internet, although we regular folks didn’t know it was there in 1989]. I guess I had thought the "Iron Curtain" was a wall, but it was really the blockade of communications going in both directions. When people know things and are able to talk about them, some amazing things happen. Now, a little more than twenty years later, we watch history on our computers, television sets, and iPhones [and get irritated when the cameras haven’t yet arrived on the scene].<\/p>\n

But it takes more than communications. Even with something as remarkable as the Internet, somebody has to take all the facts and put them all together. People like me can whine endlessly about the corruption that has crept into our professions, and speculate about how the pharmaceutical and insurance industries have intruded into our academic and organizational institutions – but we don’t have the resources or the understanding to really answer the how\/why questions. We have to rely on people who can see a bigger picture – people like Paul Thacker<\/font><\/strong> at POGO<\/font><\/strong><\/a><\/u>, or Ed Silverman<\/font><\/strong> at Pharmalot<\/font><\/strong><\/u><\/a>. Health Care Renewal<\/font><\/strong><\/u><\/a> is another one of those big picture sites that I began to follow for the occasional posts by Dr. Bernard Carroll<\/font><\/strong> about the sheenanigans in psychiatry, but the really big picture person on Health Care Renewal<\/font><\/strong> is Dr. Roy Poses<\/font><\/strong>. He talks frequently about something called "the anechoic effect<\/font><\/strong>." It just means that when something gets exposed, it doesn’t echo<\/em> – the story gets lost, forgotten, and loses the power it really ought to have [often as a result of the interventions of the exposed]. I guess it’s the opposite of that saying journalists use about a story "having legs<\/font><\/strong>" for one that grows bigger by the hour [eg Representative Anthony Weiner’s 20 days in the spotlight]. So Dr. Poses uses Health Care Renewal<\/font><\/strong> to keep us focused on stories that didn’t get enough echos<\/em> to grow any legs<\/em>.<\/p>\n

Dr. Poses gave us a four star version of his craft this week [Embedded Networks of Influence in Health Care: An Illustrative Case<\/font><\/strong><\/u><\/a>]. He draws picture that connects so many dots that it’s hard to even list them all, and should be read by anyone who is trying to understand why medicine is such a mess right now. Here’s his summary after talking about the current goings on in Miami [the "her" is Dr. Donna Shalala<\/font><\/strong>, President of the University of Miami]:<\/div>\n