The Stake In My Chest

The documentary Absolutely Safe, which explores the medical safety of widely used silicone breast implants, is playing for free at the University of Colorado at Boulder this Thursday, February 26th.

The 81-minute film starts at 6 p.m. in room W100 of the BruceCurtis Building and will be followed by a panel discussion led by the filmmaker, Carol Ciancutti-Leyva, herself.

I'll be there and I hope you will be there too.

(The BruceCurtis Building is between the Economics and Education buildings, on campus along Broadway, across from College Avenue, southeast ofthe Economics Building. Park in the Euclid Avenue Autoparkeast of the University Memorial Center at Broadway and Euclid.)

J. put up a poster for the event at the Boulder Medical Center. It was taken down in less than an hour. Maybe they have a policy about taking down all unauthorized posters? Maybe they take everything down once a week, no matter the content, and she just happened to put it up on the worng day? I don't know. Perhaps the workers there would really and truly love for all their patients to have the fullest possible knowledge about their health and their options. Perhaps the healthcare professionals themselves are interested in continuing their own education about these issues. Perhaps the poster fell down and got thrown out by accident. Maybe J used damp tape, bent tacks, unsticky glue.

But it seems weird, doesn't it. It just seems to hightlight the fact that our medical system, being run and regulated as part of our capitalist system, is a business. Of course it is. If you sold Subarus, you would tear a "Buy American" poster down from your showroom wall, wouldn't you?

When I was selling drugs, for Johnson&Johnson and Boehringer Ingelheim, I spent most of my days trying to talk to doctors. Of course, I wanted a chance to tell them why "my" angiotensin receptor blocker was better than valsartan. I wanted to give them reasons why they should prescribe an anticholinergic bronchodialator instead of corticosteroids for their chronic obstructive pulmonary disorder patients. I wanted to explain how balancing gamma-amino-butyric-acid level could prevent chronic migraines.

They didn't really want to hear this all this, any more than you want to read it. But they would listen, for a minute, if they knew me. If they liked me and respected me, they might listen for 30 seconds, or even a full minute, to some of the information it had taken me weeks and weeks to absorb.

To get them to know, like and respect me, I had to first get to know, like and respect them. So most of the time, instead of talking, I tried to listen. I asked them how their day was going. I asked them what they were proud of in their practices. I asked them what their challenges were.

Again and again I heard about the frustrations of dealing with the reimbursment systems that make up the complicated web of our capitalist health care system. Doctors would love to prescribe the very best treatment for each patient. But, for most patients, it's more important to get a prescription that will be covered by their insurance plan. The medical assistants and administrative staff people would be happy to look up each patients plan and find out which drugs are available to them. They would be happy to do it, if they had the time. But, they don't have the time. So, instead of learning which medications work the best for which patients, most health care workers memorize which medications will be covered for the majority of their patients.

This makes sense. Everyone involved here is doing their job in the best way they can. But it doesn't really work out for the patients, or the doctors. It doesn't even work out for the drug companies. According to the ideals of capitalism, the company that made the best medicine, would be rewarded with the most sales. But in our convoluted arrangement, the company that brokers the best deal with insurance companies, sells the most and makes the most profit. The more profit they make, the more powerful they are. The more powerful they are, the more they are able to muscle their way onto formularies and influence public opinion. (Formularies are the lists of medications that a given insurance plan will cover.)

Who is the bad guy here? It's not the doctors. From my personal experience with over 300 specialists and primary care practitioners over the last few years, I believe almost all of them are decent hard-working intelligent people who want the very very best for the people they treat.

It's not the patients. Most patients do what they can to educate themselves, despite the inherent vulnerability of being ill, and the overwhelming flood of conflicting information, biased websites and television advertisments.

I don't think we can blame the drug companies either. Yes, they are trying to make a profit off of sick people. But, that is what they are set up to do. Because they make huge profits with successful medicines, they are able to invest million of dollars into the research and testing of drugs that may or may turn out to be useful. Without the lure of potential gargantuan profits, they wouldn't be able to take the risks that result in almost all of our medical breakthroughs.

I am especially hesitant to blame the insurance companies. Yes, I know there are flaws in the way they operate, but the basic principle is good. Its actually kind of a socialist thought: let's all pay some money towards health care, even when we don't need it, so that those of us who are sick can use it when we do.

The fact is, it's not working. Good medicines go unused. Outdated or unsafe treatments grow in popularity. Patients do not know or understand their choices. Doctors spend less time with more patients and still worry about making payroll each month.

There's no bad guy to blame and no simple solution. Our healthcare system is a big sticky mess and I'm glad we have someone as good and as smart as Mr. Obama looking into the problem. (If you don't think he's smart and good, I challenge you to read his books. I cannot imagine reading what he's written and continuing to doubt the man's integrity or intelligence.)

I don't want to go back to my job as a corporate drug pusher, but I'm so glad I did it for a while. The experience has given me a much broader perspective than the one I inherited from my father, who delighted in street drugs and eyed the company pill with suspicion and distain.

If we are going to solve our healthcare crisis, I think we need to look at the situation with the confindence that every single person working in the healthcare industry is doing the best she or he can in a difficult situation. They are doing their very best at helping patients. And, they are doing their best at remaining financially viable. (For big companies, financial vibility rests on outpacing last years fatso profits every single year.) I don't envy them this position of striving to achieve these two often mutually exclusive goals simultaneously. It would drive me crazy. I think it drives many of them crazy too.

This explains how many of the really bad healtcare decisions get made, sheer crazy.

So, I can't be mad at the Boulder County Medical Center, even if someone did take down the poster on purpose. And, I can't be mad at the two plastic surgeons in town who alledgedly "have their shorts in a bunch" over the upcoming film and discussion. It's completely natural and human to feel hostile towards something that seems to threaten your career, your livelihood and your very sense of self.

These men have performed hundreds of silicone implant surgeries in their careers. They believe they are helping women look and feel better about themselves. They take pride in performing safe and reasonable procedures with care and skill. How would they feel if they found out they had been putting all these patients of theirs at terrible risk to illness and loss? Well, I think they would feel pretty bad about themselves.

I think it makes sense that, instead of feeling bad about themselves, or even opening up a congnitive window to that possibility, they are feeling bad about us instead. They have bad feelings about the deluded filmmaker who is attacking their profession. They feel bad at the uppity college professor who whines about womens' rights. They feel bad at the mouthy ex-student who insists that optional surgery might be a worse experience that living forever without a right breast.

So, now I feel kind of bad too. I had the idea to go around town and personally invite the plastic surgeons in town. It's hard to challenge your life-long beliefs. It's gets even harder when those beliefs are part of what you do, part of who you are. I thought they might have an easier time of it if they knew they didn't have to do it alone. I thought they might actually consider attending, if a smiling woman dressed in pink assured them that they aren't the enemy. I thought they might feel welcome, and less threatened, if I reminded them that we all want the same things for their patients, healthy futures in bodies they feel good in.

But, I didn't get around to it. I didn't mapquest their office addresses. I didn't print out flyers. I didn't write personal notes encouraging them to show up.

And now, according to an email from "The Breastless Wonder," their P.R. person wants names of people to contact on "our side." I said, "Yes, please give them my number. I would love to talk to them." But, they might be dissapointed. I'm not on "our side." I'm not taking sides. I don't even believe in "sides" anymore.

Despite the fact that I am now, since Nov. 4th, proud to be a citizen of this nation called the "US," I just don't believe a "THEM" exists out there. I agree with President O when he writes, "We have a stake in each other."

So, this afternoon, despite the wind, I'm going to get on my bike and head out to the 3 plastic surgery offices in Boulder. I'm filling up my basket with posters and love notes. I'm going to remind these guys that the stakes we have are not the kind Buffy uses. They are the kind that help things grow.