Slate had an interesting article last week on the overuse of prescription heartburn drugs like Prilosec. If you read through it, the author links the overuse of these drugs to doctors being too quick to write a prescription instead of getting a better understanding of the problem or doing lifestyle counseling instead. The author then takes the next step to say that paying for all these prescriptions is a major part of why our healthcare costs are skyrocketing.

Now, the fact that doctors are prescribing a new prescription medicine when a generic cousin is available is a problem that increases costs, especially in the light that the new medicine is not significantly better than the old one in any particular way. But the practice of dashing off a prescription and moving on cannot be blamed entirely on the doctors. It can be blamed to a certain extent on the way our healthcare system is structured.

Insurance companies do not have billing codes for 15-minute blocks of time. They have billing codes for office visits and patient assessments. Your doctor gets the same amount of money if they spend half an hour with you or 5 minutes with you. If they want to make enough to pay their mortgage, car payment, health insurance (you'd be surprised how expensive insurance is for doctors), they have to see a certain number of patients per day. Sometimes they work on salary for a clinic or HMO, but then they have to go through performance reviews which count how many patients they're seeing in a day.

Talk may be cheap, but not when you're talking to a lawyer, doctor, or other professional who expects a certain hourly rate far in excess of what you and I make. And insurers seem to have done the math and decided that they're paying less for prescriptions than they would for longer office visits.

But it's not just the insurance system that promotes overprescribing. We're Americans, goddamnit. If we go to the doctor and complain that hitting ourselves in the head with hammers is giving us headaches, we don't want our doctor to tell us to stop doing that. We want our doctor to prescribe the medicine we saw on TV that stops the headaches associated with hitting yourself in the head with a hammer. We don't feel better unless we walk out of there with a prescription in our hot little hands.

We already know "bed rest, fluids, Tylenol, and time" are what you do for a cold, and if we know that, we don't want to hear that from a doctor. We came to the doctor for expert advice, not common horse sense. And thus the doctor feels pressured to prescribe something. And that's likely a big contributor to the study showing nearly half of kids getting prescribed antibiotics for colds that won't even respond to antibiotics. I'm sure many doctors tried to put up a fight when they were young and idealistic, but got beat over the head so often by stupid parents who wanted a feel better pill, even if there wasn't one, they started handing out antibiotics just to avoid the argument.

High-priced prescriptions do add to the health care overhead. But so does procedure-based payment that encourages doctors to tag 'em and bag 'em. So do people who don't feel like they've been treated unless they get a prescription. So do people who would rather use pills to relieve the discomfort caused by bad lifestyle choices than suffer the self-denial of making good lifestyle choices. We're all to blame for our overmedication and the associated costs, and it won't get better until attitudes change in a number of camps.

Here are some more "not long enough to qualify for a blog post" facebook posts.

April 26:

I need those "Clockwork Orange" thingies to clamp my eyes open this morning.

April 28:

I won't blame Obama for everything Bush did. I'll just blame him for letting so much of it continue.

April 29:

Some signs I've created to spice up my office decor.

April 30:

Sieze the day, hold it hostage, and demand chocolate.

April 30:

Your job as a parent is not only to help your child learn to fly, but to terminate with extreme prejudice any motherfucker who would try to shoot that child down.

May 3:

One time, after my oldest son had chattered nonstop from the backseat for a while, I told him I "ran out of hearing." He'd talked so much, he used it all up. And if he wanted me to be able to hear him again, he was going to have to be quiet so I could build up a new reserve.

I just read a Seth Godin blog post, What's It Like (the sad story of the hot pepper), in which he summed up one of my greatest conflicts/challenges in talking about Hell on $5 a Day.

The point that Seth makes is that for most projects, you have to be able to be able to categorize it. People don't want to know what it is, but what it's like. That gives them a quick, experiential point of reference they can build on. "It's like King Kong, but with a giant bunny" lets the audience's memory/perception quickly fill in a whole bunch of blanks so you don't have to.

On a rare occasion, though, your project is so unique, it defies a simple categorization. You can't get that quick hit of familiarity. You either have to describe it in full, without the aid of familiar references, or you have to say "it's like nothing you've ever had. Just trust me and try it."

People would ask me to describe my novel in just a few words, and I couldn't. It wasn't a "vampire novel" per se. It just happened to have a vampire in it. Some of the story was driven by Alain's vampirism, but a lot of it wasn't. There was a lot of borrowing from Dante, some from Milton... Categorizing it was very difficult for me. I was too close to it to be able to boil it down to a few catchphrases and keywords.

I didn't know if it was that unique, or if I just didn't want to categorize it. To categorize it feels like you've not only limited it, but you've taken away a degree of its uniqueness. So, as the creator of an "artistic" work, it's quite possible I was merely resisting categorizing my story rather than the story itself resisting categorization. Every child is unique, right? Even if they aren't.

But when you're trying to sell a work, saying "just trust me and try it" is not a great approach if you haven't built trust with the person. Furthermore, when you say "this is unlike anything else," you have to be 100% sure it is unlike anything else. If someone gives you the benefit of the doubt, reads it, and says "this is just like...", you're screwed. You asked them to trust you about it's uniqueness and lost.

I'm still on the fence over whether my novel is resisting categorization or I'm resisting categorizing it, but Godin has given me some insight that is helping me look at it more honestly. If I want to sell it, I need the best answer for "what's it like" that I can find.

A friend of mine recently posted a Facebook status suggesting that people send Christmas cards to "A Recovering American Soldier" in care of the Walter Reed military hospital. Unfortunately, the hospital will not accept such cards. Here is a link to Walter Reed's official statement on the matter.

http://www.wramc.amedd.army.mil/WRResource/SupportRecoveringAmericanSoldier.pdf (requires a PDF reader)

For ideas on how to support our troops at Christmas, they recommend...

www.americasupportsyou.mil
http://www.usocares.org/
http://www4.army.mil/ocpa/tooursoldiers/

Additionally, the Red Cross is offering a program to deliver holiday cards to our troops and their families, but cards have to be received (not postmarked, but actually in their hands) by Monday, December 7th.

Red Cross Holiday Mail For Heroes

Please feel free to share this info.