In June 2003, I was visiting friends in Burlington, VT on my way to a medical conference in Montreal.  Out of sheer happenstance, Howard Dean was making his campaign announcement speech that week.  I had never been politically active, and I watched it out of curiousity.  I've never been the same since.

Howard, thank you.  You made last night possible.  

Howard, thank you.  You have helped lift my cynicism.

Howard, thank you.  I am now more excited for the world my five month old daughter will inherit.

Yesterday, I went on and on about how the VA is the best thing since 24-hour deodorant, and should be the model for any upcoming utopias we may wish to create.  Well, now's the time the unicorns and dancing nymphs must depart the stage.  Let's discuss the VA's problems, as well as why (and how) solving these problems truly matters....

Going to London?  One the best walks you can do in the city is to saunter through Chelsea (get off at the Sloane Square station), cross the Themes, and then admire Battersea Park.  If you were to start this walk say, last week, you would come upon a gigantic flower show.  Every so often you will also come across a wiry elderly gentleman in a black military-style uniform, shuffling through the crowd.  You may notice that this remarkable show of pistils and petals is being hosted on the grounds of a hospital designed by Christopher Wren.  Look more closely.  This is not a hospital.  And the men in black are not making a fashion statement.  They live in this building.  This is the Royal Hospital Chelsea, home to a remarkable collection of army pensioners.  Remarkable enough, in fact, to become the stars of a current eight part series running on BBC4 (I didn’t get BBC America myself til this month, so haven’t caught this.  Maybe I can get a DVD copy with a PBS renewal or something).

Everyone has their problems, but patients bouncing back from medical treatment can have problems you’d never think of.  I treated an interesting guy at a Veterans Hospital for throat cancer.  As the textbooks would say, he did great because his cancer disappeared.  But this was before newer radiation treatments were available, and he lost much of his salivary gland function, so he had dry mouth all the time.  Turned out that his major concern going into treatment was whether he’d get to ride his motorcycle again (I am no longer shocked when somebody says something other than "living" when asked this).  So what happened next?

As I caffeinated myself last Sunday morning, I came across the L-T-E section of the NY Times.  Here I found letters responding to the anemia drug story the Times broke last week, detailing how competing Big Pharma companies have, to politely put it, "incentivized" cancer docs to preferentially prescribe their respective drugs.  The section is bookended by readers decrying the influence of greed in medicine.  No facts were offered, though, to support claims (there’s a word limit, but seriously).  One of the readers misleadingly states that the medicines have been proven harmful, which one could easily retort with a quick Medline search.  Sandwiched between these letters is a response from a prominent MD who is past president of America’s largest clinical oncology organization and is the dean of U Michigan’s medical school.  By word count his letter was the longest, and yet said the least.  Something about how cancer doctors care about their patients and should study the relevant issues and, and, and.....oh, dude, I just passed out reading an academic physician sounding like a politician.  The worst of all possible boredoms....

Michael Moore gets great PR.  No movie is released yet and he already gets busted for smuggling people into Cuba to get treated by Fidel Castro's health care system.  From what I hear of Fidelcare, that was probably not the soundest medical decision ever made.  The picture of Mike slipping on a latex glove on his website also makes me feels like getting fitted for a chastity belt and relying on herbal remedies for all that ails me....

That said, want to raise a glass to toast the passion of mehamo's diary today.  There's some issues to discuss, though....

After the elation of Tuesday fades into a more subdued (at least for many of us) feeling of satisfaction and relief in our daily lives (I know for me it has been much easier to go to work this week than two years ago), it will be interesting to see how we as a community re-focus our energy on creating good ideas/policies, rather than responding to poor ones.  One idea I'd like to share is this--expect more.  Expect more from your hard work, from yourselves, from your fellow community members, and--dare I say it--your countrymen.

Will explain a little more below....