“Doctor, doctor, Mr. M.D.---can you tell me what’s ailin’ me?”---G. Stevenson
Is it just me? Or has an odd strain of Nitwit Flu attacked our primary care doctors’ offices, where the staffs are incompetent, the medicos aloof, the diagnoses often errant and the degree of concern for the patient somewhere in the low teens.
When we were kids, family doctors were the height of respectability, honored saints who watched over us like guardian angels. They knew everyone in the family, came into our homes, treated us with dignity, mourned with us when the time came. My mother, a sometimes LPN, thought they walked on water and my father was loathe to wake one in the middle of the night even while in the throes of a fatal heart attack. On the busy charts of positions one might rise to, doctoring was at the top of the list. “My son is a physician.” one mother might gloat. “Oh, you must introduce him to my daughter,” cooed another.
Granted, over the years doctors have been hamstrung and compromised by the likes of insurance companies, seedy lawyers, unending government regulations and copious paperwork, but somehow they still made it work. It seems only lately that the wheels fell off the wagon, at least for us. Covid started the ball rolling when our physician of thirty years recommended a horse wormer called Ivermectin for treatment. When we asked for evidence of efficacy, he steered us toward two radical right-wing rags that were straight off the turnip truck. Later, when we contracted Covid, he refused to prescribe Paxlovid, severing the relationship.
The next guy we got was a youngish buck also used by one of Siobhan’s employees. He was an adequate doctor but his office staff was Lucy & Ethel at the Chocolate Factory. Lucy simply couldn’t get anything done and Ethel was hopeless with phone messages. For three weeks they were unable to get a simple request for a procedure over to Shands. Eventually, I carried it over there myself. My next office appointment was running an hour over when I abandoned ship. They called me twenty-five minutes later and told me they were ready for me. By then, I was at my next appointment and gone forever.
After several years of fine professional management by my asthma & allergy doctor, he recently sold his bustling practice to a large consortium. The first thing my new physician did was change my Breo prescription to a generic for no apparent reason. My insurance company denied the new medication and after several contentious phone calls, the office has still not rectified the situation. Fortunately for me, I have a pharmacist willing to continue giving me the Breo, at least until the scrip runs out.
Siobhan has had similar problems. “The places I have looked are cookie cutter practices. They have a formula for new patients. If you’re a certain age, you get this shot, you take that test automatically. You probably don’t even get to see the doctor on your first visit. The kindly old country doc who actually gives a damn about his patients is largely a thing of the past.”
So now we’re both at UF Health on Main Street, which gets you in on time and has a roomy parking lot. Despite the competence of their doctors, however, Shands is famous for its difficulties with communication. Even with their prized “portal” for direct communication with doctors, I have occasionally been forced to carry letters over there to get a reply. And perish forbid you should ever actually ask to actually talk to your doctor other than at your appointment. Won’t happen. They live behind an impersonal wall and no intruders are permitted. Whatever happened to that friendly Marcus Welby, M.D. and Dr. Kildare? Where did Doogie Houser go when he grew up? Ben Casey? John Carter of E.R.? Where the hell is Trapper John when you really need him?
The Big O
“So excellent that it defies belief, as in She loves all her in-laws? That’s too good to be true.”---Thomas Lupton
Oh-oh-oh ZEMpic! It will dig a moat and float your boat, feed your goat, bring your coat and you’ll lose fifteen pounds by morning in the bargain. Like Chicken Man, Ozempic is everywhere, blasting the fat off tubby little television hosts, revolutionizing several fields of medicine, sparking trials with Alzheimer’s victims, saving billions in medical costs and leaping tall buildings at a single bound. Is there no end to the wonders this boon promises? If so, don’t tell us about it, we’re out buying monokinis.
The idea that a single drug might target so many different diseases might sound too good to be true. These drugs, called GLP-1s (glucagon-like peptide1 receptor agonists), mystify even the scientists who study them. When asked how it was possible that Ozempic might help with cognitive issues and nonalcoholic fatty liver disease and opioid addiction, the researchers skrunch up their shoulders and peep, “We haven’t a clue!”
Some scientists think The Big O and drugs like it may have a medical superpower---lowering inflammation in the body. Inflammation is a key part of the body’s defense system. When we sense a threat, such as that posed by a pathogen, our cells work to help us fight off the intruder. But chronic inflammation contributes to heart disease, lung disease, diabetes and a host of other major illnesses. If the new obesity drugs really do reduce inflammation, that could explain their effect across such a wide spectrum of diseases. Still, there are limits. Not everyone responds to GLP-1s. Even those who do dramatically slim down typically hit a floor after losing 15% of their body weight. Moreover, the drugs come with icky side effects like nausea, vomiting, diarrhea and constipation, all your very favorites. Some people develop gallstones and scary inflamed pancreases. They can eat so little they become malnourished and occasionally lose muscle mass. There’s usually a hefty price to pay for skinny.
Ozempic and critters like it are considered “forever drugs.” People are supposed to stay on them for the rest of their lives, same as statins and blood pressure medications. When you stop taking them, oops, they stop working. But this class of drugs has existed for less than 20 years. Ozempic itself has been on the market for only six. We don’t know what happens after lifetime use of these drugs. Researchers point to past examples of drugs we once thought miraculous, like fen-phen. It was astonishingly effective for weight loss, then doctors learned it damaged the heart, and the train screeched to an abrupt stop. And we all know what happened soon after those happy little tapeworm larva pills made the hit parade.
Anyway, the Great Experiment is on. Hundreds of thousands across the globe are taking the new wonder pills and the number will rise as they’re prescribed for more and more purposes. It may be years or generations before their full powers and limitations become manifest. Good luck to all you bold guinea pigs out there taking the plunge. If you wake up one morning and notice your eyebrows have burst into a nova and there’s an unearthly growth on the back of your neck, better tone it down just a bit and ring up the Lycantropes Anonymous help line. There are always a few piffling consequences for hellbent pioneers.
“Cleanup On Aisle 9, Please!”
“We warned you about those Quualudes, Joe.”
What if they held a debate and nobody came? That’s just what happened the other night when CNN locked the doors and tossed Joe Biden and Donald Trump into an Atlanta arena looking for action. If you were out back smoking a ham, you didn’t miss a thing, most of the audience passed out halfway through the proceedings.
Mostly, Donald concocted giant lies and Joe called him a prevaricator. We should have gotten the first hint of a slow night when Biden walked in wearing his bunny pajamas and asked the moderators when Gunsmoke was coming on. Trump told us (again) that he was the greatest president of all time, was highly esteemed in the homes of darkies everywhere and saved the planet from World War III. And he did not have sex with that woman and photos suggesting otherwise were illegally taken during a drunken night at the zoo.
Trump is a wizard at never answering the question asked. “What about the report of illicit sex with underage penguins on your secret visit to Antarctica?” “Yes, that’s a problem. Immigrant penguins are flooding our southern border, bringing in fentanyl, stealing strawberry-picking jobs from one-armed Texans and voting for Democrats. It’s a disgrace!”
“What do you have to say about that, Joe?”
“What the hell happened to Chester? He’s there for years doing a great job, then this Festus guy shows up and takes his place. Where did Chester go? Does he have his own show?”
It was that kind of night. We would rather watch American soccer or the WNBA without Caitlan Clark or the international ice fishing championships. When it was over, the network talking heads were all adither, speculating on a possible replacement for Slow-Walkin’, Slow-Talkin’ Joe. Several unlikely names were brought up, surprisingly not mine, and the ballyhoo ran long into the night, accomplishing nothing.
We’d like to make a suggestion since both men bore false witness to their physical abilities and prominence at the game of golf. Instead of another boring debate in a gloomy warehouse, take the TV cameras up to the Mayo Clinic in Minnesota and let the public watch expert physicians perform a two-hour medical exam on both of them, showing the voters their report cards when it’s all over.
“It seems you have Lesch-Nyhan Syndrome, former President Trump, while you, current president Biden merely have a case of yaws,” reports the medical panel.
“It figures,” cracks Donald, smiling. “I even have better diseases than this guy! I’m tellin’ ya---best president ever. Lincoln was okay, too.”
That’s all, folks….
