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Dean, Healthcare and Medical Marijuana

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After reading your column "The Perils of Privatized Healthcare," posted August 11, 2003, I have only one question: When are you going to endorse Dennis Kucinich for President of the United States?

Dr. Marc regularly answers readers' questions on matters relating to medicine, healthcare and politics. To send a query, click here.

About the Author

Dr. Marc Siegel
Dr. Marc Siegel is a practicing internist and an associate professor of medicine and a fellow in the Master Scholars...

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The city lacks the resources to address its residents' urgent mental health needs.

The United States has fueled a worldwide overreaction to the threat of a bird
flu pandemic, putting AIDS, malaria, malnutrition and other crucial
global health programs at risk.

Dennis Kucinich has a clear plan for delivering "universal healthcare." I know you have spoken frequently about the "perils of privatized healthcare." Now is the time to do something about it. I urge you to take a stand and go the extra mile, and endorse the one candidate who has made "Medicare for All" a cornerstone of his platform.

GREGORY HARRISON
Pasadena, CA

Dear Gregory,

It's a reasonable question, and as The Nation's editor in chief was the first to point out in her weblog Editor's Cut, as early as May, your man does have a rational plan for universal health coverage. But also take a look at Katha Pollitt's latest column on Howard Dean. Dean expresses the anger that many Democrats feel toward Bush's handling of foreign policy. And though Dean's plan for universal health coverage isn't as firm or grounded yet as Kucinich's, I am among those who believe that Dean, an internist, is a more viable candidate.


What do you think of Dr. Howard Dean's pragmatic approach to securing health insurance for the US population? I've been without health insurance since 1985 when my late husband got ill and lost his work. I'm hanging in there (for four more years until Medicare kicks in) with hypertension, diabetes, hypothyroidism, asthma and chemical hypersensitivities. My severe reactions to chemicals have made it impossible to earn an income since 1972.

PATRICIA WILLIAMS
Lewes, DE

Dear Patricia,

You are a person who is badly in need of health insurance. We need universal coverage to provide for that. Expanding Medicaid is not the best answer. I am watching--as are many--to see how the policies of Howard Dean and others play out. But I do hope to see him push for universal health coverage as part of a national progressive platform. At least he understands the issue and has some track record on providing healthcare in Vermont.


I am about to get restorative dental work that may cost up to $30,000, and the dentist told me that I need to use fluoride to protect my existing dental roots. However, I am uncomfortable with taking this chemical. Having been a vegan for more than twenty years, I have grown weary of the negative effects of fluoride, regardless of the amounts. Is it advisable to use this chemical or is there a safer natural product that can be used to protect dental roots?

GLENN KENDALL
Morristown, NJ

Dear Glenn,

Tough question. I am a believer in fluoride and think that it does offer your teeth long-term protection at a very acceptable potential cost. I don't believe that it's easy to study long-term negative effects, however. In direct answer to your question, I do not know of a more natural product that offers the same protection. Sorry I can't be of more help, but I don't think everything used in Western medicine necessarily has an "alternative" that can be used just as effectively.


My Ob-Gyn, who is wholistic, gave me a prescription for a mammogram because I was complaining of the odd breast pains, and I tend to have lumpy cystic breasts. However, there's a lot of conflicting information about mammograms and no solid evidence that they save lives. I'm quite paralyzed on the subject and wish I could rely on thermography, but that too is questionable, as I understand it. What do you think?

PS: I no longer take estrogen or progesterone--maybe I should not have dropped the progesterone? I'm confused.

IVANA EDWARDS
New York, NY

Dear Ivana,

I don't mean to sound too conventional, but I believe in mammograms. I think they play a useful a role, especially in the hands of a gifted mammographer. It is especially difficult to detect true lesions in women with lumpy cystic breasts, and mammograms can pick up lesions that are too small to be detected by cumbersome physical examination. Death rates are not the only instructive statistic, though the New York Times certainly made it seem so last year. Another issue is detecting cancer early, because even if patients don't actually die from that cancer, they can get awfully sick from it. I'm a big believer in early detection, and this is at the core of why I support mammograms. Plus, it's very difficult to predict who can live with cancer safely versus who will ultimately die from it. And limited procedures like lumpectomy have shown that early intervention is a far more attractive option.

RE the progesterone question: I would say that progesterone alone has no proven benefit in terms of HRT and may add risk such as increased risk of breast cancer. The principle behind progesterone in conjunction with estrogen in an intact uterus is that the progesterone attempts to approximate the normal cycle in a pre-menopausal woman.


How can we get Congress to recognize the mess the nation's healthcare system is in?

How about asking all of Congress to refuse their Congressional health insurance for themselves and their families for two years. Ask them to shop for individual policies as many Americans have to do. Ask them to pay for these policies. Ask them to experience healthcare as a typical American might. Ask them to worry for their family members.

Even though many members of Congress have resources beyond the reach of a good many Americans, I bet this two-year experiment would bring religion to the topic!

KRISTINA KING
Rockland, ME

Dear Kristina,

One can always dream. People who make the rules, or even educate people are often the same bureaucrats who do not feel the people's pain. Neither they nor their private physicians will ever set foot inside our managed-care purgatory. That doesn't mean though that we shouldn't make every effort to highlight your point about Congressional hypocrisy as part of the continuing political struggle in the United States to bring about a national health service.


I use organic marijuana for therapeutic relief of several chronic conditions, among them continued pain from a broken neck suffered in a hang-glider crash in 1983.

I am extremely fortunate to have full motor function, though I do suffer from residual chronic pain and muscle spasticity. Cannabis works for me, and I work with it, ameliorating the effects of smoking through proper nutrition and exercise, which includes hemp seed, seed oil and cannabis essential oils.

I am circulating a formal complaint against the federal government, for taking a safe and effective herbal therapeutic away from people who are in pain, or suffer from other illnesses.

Do you think that this is a good idea?

Do you think physicians will support it considering the attack being made on doctors by the DEA?

I am intentionally phrasing my question out of concern for your freedom, considering the shifty laws that the DEA is sneaking in, violating physician's rights to speak about this subject.

PAUL VON HARTMANN
Mill Valley, CA

Dear Paul,

My answer may surprise you. I am not entirely in favor of many herbal treatments for only one reason: The contents of their active chemicals are difficult to monitor and are often unregulated. The medicinal value of which you speak is undeniable, but these are medicines, and are best dispensed by trained physicians in pill form. I do agree that the availability for prescription use ought to be vastly expanded beyond what is currently allowed.


I just discovered your column and I'm thrilled. I grew up in an illness-ridden family and long ago came to the same conclusions you have about the US healthcare reality.

My question concerns my ileostomy (and subsequent rectectomy, I like to call it) resulting from Crohn's disease. I read about fifteen years ago that the internal pouch created from the ileum is contraindicated for Crohn's patients, for obvious reasons. However, I've also read that internal-pouch surgery can be done on people with Crohn's as long as the disease has been in remission for at least ten years.

I have been to see a gastroenterologist about this, and he all but laughed at me, speaking of the healthcare reality here. (And I'm an educated white person, albeit the female variety.)

I'd certainly understand if this purported surgery turns out to be some kind of Internet urban legend and I'm chasing rainbows, but I wanted to ask a doctor for whom I have respect, if you know or are willing to look into it for me.

AMY TILLEM
Boston, MA

Dear Amy,

I too am concerned that such an elaborately made pouch could be affected by the pre-existing crohn's disease but the real issue here is that you feel ridiculed by this doctor. You must find a gastroenterologist, ideally in your area, with experience treating Crohn's disease to answer these questions.


My mother believed in diet, organic foods and natural treatments, and rarely went to a doctor except for injuries. She lived to 90, and my father lived to 96. She believed that pharmaceutical medicines did more harm than good and never took anything. Her thought was that they may help one aspect of ill health but generally at the cost of harmful side effects that become cumulative over the years.

I lived twenty years in Mexico, and the doctors overprescribe there. During a six-month strike of doctors, the death rate among the population declined dramatically. I am 68 years old, eat organically, take natural, nutritional supplements, never took birth control pills, HRT pills, nothing--I ride my bicycle regularly, work a stressful, full-time job and take NO pharmaceutical drugs. I plan to continue this regimen till death. I rarely see a doctor and usually for something minor. I feel great and can keep up with my younger co-workers. My theory is political, to work for a cleaner environment, to demand fresh organically grown food and be able to pay for it, and to stay away from drugs. What I save in drugs pays for incredibly delicious, locally grown organic food. This appears to be more of a statement than a question, but here it is for what you deem it may be worth.

SHIRLEY BOCCACCIO
San Francisco, CA

Dear Shirley,

I love your philosophy, and I certainly agree that many medicines are overprescribed. But there are many specific situations where modern medicine can clearly be lifesaving. Cholesterol-lowering drugs for one, and plain old aspirin for another, are two drugs with proven medicinal value of a high order. And I don't think an emphasis on organic foods and organic life has to be at odds with things like aspirin. I'm sure you can find a physician who reflects your philosophy and won't bombard you with modern medicine unnecessarily. Of course you have the right to refuse this advice, and I certainly wish you a long prosperous life. Sounds like you're off to a great start!


I have heard that approximately two-thirds of people receiving medical care at any given moment are in need of such care due to the effects of either smoking or drinking alcohol or both. If this is true would it not follow that reducing the number of smokers and drinkers would produce a corresponding reduction in the cost of everyone's healthcare?

If this is so why is it not used as a selling point for more aggressive actions to curb the use of tobacco and beverage alcohol?

RICHARD L. COTTINGHAM
West Point, VA

Dear Richard,

No question about it. And many groups do use this information in their campaigns. Mothers Against Drunk Driving (MADD) is a good example. Why the info isn't more widely known is a very good question and likely has something to do with the power of corporate lobbyists to influence politics.


With regard to nationalizing health care, I agree that competition-driven pricing results in quality being driven down and less money going to the providers.

There are two things that also concern me:

1) Indemnification. Health care providers won't be able to get out from under the HMO's until they are protected by law from unreasonable malpractice premiums. Government-backed insurance for medical practitioners is an alternative to nationalization, along with legislation doing a better job of limiting how deeply plaintiffs can dig in malpractice suits.

2) Government inertia. The bigger the change, the longer it takes the government to do something. A nationalized malpractice insurance will prove much easier to implement than a national healthcare system. I'm increasingly of the mind that citizens have more power than the government, if they will only stand up, gather together, and use it. I refer you to the response of MacDonald's Corporation to efforts to have antibiotics removed from their foods. Collectivization against the existing health care cabal may be our best bet.

RICHARD GAY
Dublin, CA

Dear Richard,

I agree with your second statement--the initial step towards treating the uninsured and the underinsured in this country is National Health Insurance. Once all citizens have adequate coverage, we can then begin to look at consolidating the system with an eye towards possibly creating a National Health Service.

I also agree with a crucial point made on the front page of a recent edition of the New York Times, that it's not just covering everyone, the crucial question is at what price. I used the European cohort as an example in the Washington Post back in June of how prices can be influenced by a large group only willing to pay a certain price. The Times used the VA system here to demonstrate the same principle.

In terms of your first statement, I have an alternative to what you suggest. Since the HMOs try to limit and regulate what tests are ordered and how their patient panel is treated, they simply need to be held responsible for this. It is not enough for doctors to document their suggestions and HMO refusal of coverage for a given procedure or test.

As you suggest, the end result now is more liability for the doctor, which costs more in terms of health care dollars and legal costs. The solution here is new legislation making the HMOs responsible legally for their decrees.

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