Some weeks ago I read your comments regarding the propagation of mad-cow disease into humans. I noted your statement that mad cow has so far been detected in a very small percentage of the human population, hence your opinion was that mad cow per se did not represent as large a threat to humans as some would believe, due to the protection offered by the species barrier. That is comforting but does not take into account the large numbers of people dying of various dementia disorders, of which a critical few cannot be differentiated until autopsy. Very few autopsies are actually performed on institutionalized dementia patients, who apparently die as a result of their primary dementia disorder. Therefore, it seems quite likely that the real scope of human infection and mortality from mad cow may be much larger than officially acknowledged.
Having had both of my parents die of compound dementias (multi-infarct, apparent Alzheimer’s, Parkinson’s….no autopsy or cerebral section post-mortem on either parent), I have spent a lot of time in nursing homes observing the ocean of very demented folks out there.
First, I’m very sorry to hear how you lost both of your parents. You raise a very interesting question. It is certainly conceivable that some of the various dementias reveal underlying causative agents that are either subclinical or are yet to be determined. A recent article in The New York Times Magazine looked at atypical presentation for mad-cow disease in humans, and it is possible that there are more prion infections than have been reported. However, prions do cause certain characteristic brain changes including vacuoles, and I do not believe that we can pin the vast majority of dementias on mad cow.
The politicians who have repeatedly failed to create a just and efficient universal health insurance system depend on the idea of greedy, uncaring doctors to help distract the public from their crimes. The public understands (in a general way) that physicians are required to care for anyone with a medical emergency without regard to the patient’s ability to pay. This gives them the erroneous idea that “everyone can get care.” They similarly are encouraged to accept the idea that physicians should rightly shoulder this burden of non-reimbursed care alone “because they are so rich anyway.” It is certainly “less unjust” for a physician to bear this than someone less well compensated. However, being “less unjust” doesn’t make something just. Moreover, it distracts from the real point. No individual, regardless of income, should have to pay for care individually that should be provided by society. Using the “greedy physician” scapegoat simply distracts from the real culprits: the insurance and pharmaceutical industry and the politicians they purchase.
While I deplore behavior I see sometimes as an ER physician who must piece together care for uninsured patients, I much more frequently deplore having to ask already overburdened physicians to provide care for a critically ill patient for which they will be completely uncompensated. While I hate the minority of my colleagues who have the wrong attitude toward the profession, I more frequently hate heaping huge mounds of work on colleagues who willingly do so for nothing more than knowing they’ve helped another person. This is especially the case when these patients never would have reached this stage of disease had they been able to access decent preventive care that should have been their right.
Blaming physicians for complaining about uncompensated care simply distracts from the far greater crime that places these physicians in this unfortunate position in the first place.