Of Socio-Economic Matters

Sometimes I sit in sociology class and silently fume, wondering how the instructor and my classmates could ever arrive at the conclusions that they do.
Last week, we discussed lobbying. Lobbyists are firms hired by special interest groups to take their cases before the the legislators. Lobbyists shmooze and booze the legislators with gifts until the the legislators cave and push those bills through. Lobbyists are often former legislators and know Joe Senator(s) + play the insider card for all its worth.
Lobbyists aren't the scum of the earth, the legislators are. Taking gifts/bribes should be illegal and you should be kicked out of Congress for doing it. I realize that this would eliminate 99.9% of the Congress but if you don't make strict consequences for something it isn't going to stop. And then we got on the topic of drug reps doing the same thing and I think that's a little differant, the doc still has an obligation to his patient.If the doc wants to be bribed, I don't see a problem with it, as long as the patient is getting good care. Obviously, I don't know much about drug reps and someone else can educate me on why thats a horrible idea. We don't elect doctors- we do elect Congressmen and they need to be pandering to the overall good of the people, not to the will of Corporation X. Lobbying can be good(more research for diseases) but the system is all wrong. Legislators are only thinking about making the special interest groups happy. Everyone says they shouldn't be doing it, no one wants to suggest radical methods to STOP the corruption.
Then, we got to discussing the rich, evil CEOs and I'm thinking, get a life, people. Yes, by and large they are not the phelanthropic sort but we pay our sport gods millions a year without batting an eyelid and then complain bitterly about shelling out for a CEO(whose jobs encompass much more personal responsibility and extreme stress) I believe CEO's should be well paid, they have important decisions to make. I don't believe their severance packages should be so well padded, they should get the same as the next dude.(have some concern for the company going under) And as it relates to the automabile crises...I think that its partially due to the recession, partially the fact that everything made in this country is slapped with such high taxes its just cheaper to buy foreign. If Congress can't see the importance of getting a fairer tax system, they'll have to continue to bail out the big dudes on a regular basis.

(1 day of finals done...2 to go!)

The Line Between the Two

I've been thinking about the concept of using CGM's in the hospital and have come to the conclusion that that there is just no way it could EVER work.

Patient "M" is extremely sick, in the ICU. Patient M's blood sugar is going up and down like a pregnant women on steroids. Patient M could really benefit from stabler bgs and fewer hypos. Patient M, however, is being pumped full of acetaminophen/narcotics and that pretty much voids out the usefulness of a CGM.(acetaminophen makes the moniter read HI) Throw in the occasional (or not so much,if they are in the ICU they might have a few of those) MRI and the staff had better remember to remove the sensor or the patient will be dead. (due to the metal in the sensor) You think about the lawsuits waiting to happen, it's rare for staff to be acquainted with pumps, let alone CGM's. (I have a question for anyone who has ever been
in the hospital, with a pump...assuming they even permitted you to continue using it, did they even ask if you were changing the site every 2-3 days? I don't, so it doesn't disturb me,but many people are prone to infection + that needs to be addressed. Breeding ground to further issues, is the pump site infection.)
And for infection prone patients, it is something else for the staff to forget. (changing it occasionally) In its current form, CGM's would be a headache for use in the hospital setting. I'd far rather have frequent bg checks then rely entirely on the CGM it is a good thing that there are many more type 2's then type 1's in the hospital or even more staff would be required.(so I think) There are so many D's in the hospital, they make up like 2/3 of the patient population.(according to Diabetes Forecast) The CGM is a very valuable tool, but someone has to be following it, tweaking, looking at patterns and another characteristic of non-endocrinologists is they are REACTIVE,(aka the "sliding scale") rather then proactive. I realize I'm lumping all of them into one generic group but its a case of guilty until proven innocent. Until someone demonstrates their D-savvyness, I do not assume that they've got it. And I would not use a CGM without meter confirmation. A CGM, does not replace the need for meter monitoring.

I think the answer lies in being more proactive with management, rather then the highly unpractical, time-consuming, expensive CGM. How about an insulin pump or IV insulin drip rather then then NPH/Regular shots?(for starters) Or how about not serving juice, jello, and various other high glycemic foods to skyrocket the patient's blood glucose even more? The goal is to prevent complications, not encourage them. I'm not sure things will ever improve, to where they should be, even in the enlightened hospitals. I wish I could tell this to a few hospital CEO's, better blood sugars translate into money(and lives) saved.