The Complete Patient

Curious developments on the tainted food front.

1. Just a day after my article about the shutdown of a California raw milk dairy appeared on BusinessWeek.com, California's Department of Food and Agriculture lifted its quarantine of Organic Pastures Dairy Co. I'd like to think my article played a role in the sudden turn-around by the state regulators. Only yesterday, the department's head of public affairs was telling me that it was in the midst of tests of Organic Pastures' raw milk that could take five to ten days. He kept using the term "until further notice" when I asked how long the farm would be shut down--a bureaucratic euphemism for a long time.

I suspect also that the decision by Mark McAfee, the farm's owner, to go public with his frustration over the state's shutdown of his dairy had something to do with the quick change of heart. There's nothing bureaucrats hate more than the bright light of public scrutiny. It tends to expose their tendency toward being arbitrary, especially with smaller businesses.

2. While a small raw milk dairy was shut down for a week by California authorities when four children who had drunk its milk became ill, none of the nine corporate spinach farms suspected of producing E.coli-tainted spinach that has poisoned nearly 200 people around the country has been shut down, or is even threatened with being shut down. When I inquired today with California public health officials as to the status of the nine California farms, Iwas referred to a phone press conference sponsored by the California Department of Health Services.

The public health official answering the questions kept referring to "systemic problems" at California vegetable farms that lead to periodic E.coli outbreaks. One California newspaper reporter asked the obvious question of public health officials: "Why not prevent (the nine farms suspected of triggering the current mess) from shipping till they get rid of the problems."

The California Department of Health Services official answering the questions basically refused to answer this question. "At the Department of Health Services, we are reviewing all of our options," he stated. "Good agriculturual processes must be in place." End of discussion.

Yes, it certainly seems a lot easier to pick on a small dairy farmer than on large corporate spinach growers.

It's difficult not to feel badly for Mark McAfee and his family. Together they run Organic Pastures Dairy Farm, a 300-cow farm near Fresno, CA, that has become California's largest provider of raw milk. As I detail in my latest BusinessWeek.com column, he's essentially been put out of business while the regulators search high and low for E.coli bacteria that might have made four children sick.

The problem is that, after a week, the 15 to 20 government inspectors who have been hanging around his farm have found only the good bacteria that are a part of raw milk (which isn't pasteurized or homogenized), and no sign of E.coli. They are frustrated, so they keep Organic Pastures shuttered tight and continue searching. Each day that goes by costs the McAfee family thousands, and tarnishes his carefully cultivated brand.

These are honest citizens who seem to have tried hard to do everything right in setting up their raw milk operation. But the spinach scare has spilled over into raw milk, and it seems as if the McAfees have been caught in the wrong place at the wrong time.

This is a developing situation, and as I say in the column, Mark McAfee seems determined to fight Big Brother. For more info, take a look at www.organicpastures.com.

There's lots of handwringing in the media about the fact that health care insurance coverage rose 7.7 per cent this year, which is more than double the overall inflation rate. And the situation can only get worse as the population ages, argue the pundits.

Well, I suspect that the situation is going to change, that costs will level out. The reason is that there's the scent of competition in the wind. The previous item, about the big retail chains providing health care services, is part of a newly emerging picture. Another part is emerging overseas competition in hospital services. American patients are heading to Thailand for heart bypass surgery that costs 80% less than in the U.S., and is of equal or better quality, reports NPR. Insurance companies are beginning to offer the overseas option to patients, letting them share in the savings.

Hey, if you can take your child to Wal-Mart when she has a strep throat on a Sunday, get service in ten minutes and walk out with your antibiotics for, say, $100, versus going to a hospital emergency room, waiting five hours, and paying $400 for the same outcome, which will you choose? Going to Thailand for a $10,000 heart bypass operation, versus $50,000 in the U.S., may take a bit more convincing, but as patients return with enthusiastic stories about the wonderful Thai nursing care and luxurious hospitals, attitudes will change.

As my mother said when I explained to her that the big retail chains are taking flu vaccine business from doctors, "It couldn't happen to nicer people."

The media have been full of stories about how there will be plenty of flu vaccine this year. What they didn't explain is  the proviso that there will be plenty if you want to go to Walgreens or Wal-Mart for your flu vaccine. Your physician may be rationing vaccinations. And therein lies a story, which is explained in my latest column at BusinessWeek.com. Suffice it to say that the Walgreens and Wal-Marts of the world want a share of your personal physician's profits.

At first, the idea of Wal-Mart, Walgreens, and Costco branching out from eye exams to perform other medical procedures like vaccinations and blood tests rubbed me the wrong way. I hate to see huge corporations honing in on small businesses of any sort. But when you really think about it, is it really so terrible? Everyone can use competition, and certainly the medical profession can, since it has enjoyed something akin to a monopoly for many decades, as you can tell from the arrogance of many practitioners.

A BusinessWeek article last summer provides a peek into this new world of mass merchandisers providing medical care, and it's not nearly as terrifying a view as one might imagine. It's a world in which it's possible to obtain basic medical care on short notice, and to seek out certain treatments on weekends without having to waste a day waiting in a hospital emergency room--all at reasonable cost.

Whomever thought our health care mess would begin to be solved by Wal-Mart and Walgreens? Stay tuned.

The cover of the current issue of BusinessWeek (Sept. 25) asks the question: "What's Really Propping Up the Economy?" Turns out it's the healthcare industry, which has added 1.7 million jobs since 2001, versus no job growth in the rest of the private sector. This article is worth a read to gain a sense of the dimensions of health care's influence on our economy. But it is also instructive in appreciating why the medical establishment, both in the U.S. and Europe,  approaches treatments the way it does.  Consider two random situations that just happened to come up in the media today:

--There's lots of excitement in Big-Pharma-land because of a drug being tested thathas shown evidence it can reduce the chances of developing Type 2 diabetes, according to a report in today's NYTimes. Big Pharma types see it as a new statin-type drug--the cholesterol-lowering drug class that is generating many millions in revenues because people take it forever, or otherwise till their livers give out. But a UK official of a diabetes advocacy group expresses concern: “We’re worried that people may think there’s a quick fix, when what is proved to work is lifestyle changes. For the moment, we don’t think we can solve this epidemic with a pill.” She doesn't get it, does she? If the drug generate big profits, who cares about silly matters like side effects or that patients remain susceptible to other lifestyle-related conditions, like arthritis? Oh, I forgot, there's Vioxx for arthritis.

--Kitty Dukakis, wife of the former Democratic presidential candidtate, Michael Dukakis, today in the Boston Globe Magazine describes her experiences using electric shock treatments to relieve her depression. She wonders why it's taken the medical establishment so long to re-accept shock, after it went out of vogue in the 1950s and 1960s. Well, one reason is that drugs for treating depression, taken on a daily basis, are much more profitable than some electric shock treatments administered every six months or a year.

The medical establishment hates it when you pursue treatments that don't require drugs or surgery. Those are where the money is. Everything else is chicken-feed.