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October 22, 2004

BehindTheMedspeak: 'If you can wait for two years for bypass surgery, either you don't need it or you're dead' - Dr. Naresh Trehan


He's a cardiovascular surgeon in India who's among the pioneers of that awakening world power-to-be's burgeoning "medical-tourist" complex.

Up to now, so-called "medical tourism" - traveling to another country to get surgery performed inexpensively - was pretty much confined to plastic and cosmetic procedures, mainly in Thailand.

Now the ante's being raised, big-time, by the ability of superbly trained (most often in the U.S. or Great Britain) Indian cardiac surgeons to perform open-heart surgery for $10,000.

That includes roundtrip airfare and a trip to to the Taj Mahal afterward.

The same procedure - heart valve replacement - would've cost about $200,000 at Durham Regional Hospital in North Carolina, the home of Howard Staab, a 53-year-old carpenter without medical insurance.

Oh, I almost forgot: the hospital wanted a $50,000 deposit up front before they'd schedule Staab for his surgery.

I recall my introduction to foreign cardiac surgeons, many years ago during my anesthesiology residency at UCLA.

We routinely rotated out to the Wadsworth Veteran's Administration Hospital for a couple months.

They had a Filipino cardiac surgeon, whose first name was Ray and whose last name escapes me.

He couldn't pass his oral surgery boards, so the only place he could work was at a VA hospital.

I was used to big-time problems post-op after open-heart surgery at UCLA Hospital, one of the country's leading centers, with all manner of famous cardiac surgeons on the staff.

When I got to the VA, the cardiac anesthesia attending told me they routinely woke up the heart cases in the OR, immediately after surgery, same as if they'd had a hernia repair.


What about keeping them intubated, on a ventilator, and then a day or two in the ICU on the blower until they were stable enough to be taken off the vent?

Don't need to do that, said the attending.

Ray's patients never have problems. You'll see.

Seeing was believing.

That guy was the slickest thing I'd ever seen once he got into the chest; his pump times were unbelievably short, and his patients never bled and had to come back in the middle of the night to have their chests cracked open again.

So I never sell short surgeons who aren't in the classic mold.

Here's John Lancaster's front page story on the new tourism, from yesterday's Washington Post.

Surgeries, Side Trips for 'Medical Tourists'

Affordable Care at India's Private Hospitals Draws Growing Number of Foreigners

Three months ago, Howard Staab learned that he suffered from a life-threatening heart condition and would have to undergo surgery at a cost of up to $200,000 - an impossible sum for the 53-year-old carpenter from Durham, N.C., who has no health insurance.

So he outsourced the job to India.

Taking his cue from cost-cutting U.S. businesses, Staab last month flew about 7,500 miles to the Indian capital, where doctors at the Escorts Heart Institute & Research Centre - a sleek aluminum-colored building across the street from a bicycle-rickshaw stand - replaced his balky heart valve with one harvested from a pig.

Total bill: about $10,000, including round-trip airfare and a planned side trip to the Taj Mahal.

"The Indian doctors, they did such a fine job here, and took care of us so well," said Staab, a gentle, ponytailed bicycling enthusiast who was accompanied to India by his partner, Maggi Grace.

"I would do it again."

Staab is one of a growing number of people known as "medical tourists" who are traveling to India in search of First World health care at Third World prices.

Last year, an estimated 150,000 foreigners visited India for medical procedures, and the number is increasing at the rate of about 15% a year, according to Zakariah Ahmed, a health care specialist at the Confederation of Indian Industries.

Eager to cash in on the trend, posh private hospitals are beginning to offer services tailored for foreign patients, such as airport pickups, Internet-equipped private rooms and package deals that combine, for example, tummy-tuck surgery with several nights in a maharajah's palace.

Some hospitals are pushing treatment regimens that augment standard medicine with yoga and other forms of traditional Indian healing.

The phenomenon is another example of how India is profiting from globalization - the growing integration of world economies - just as it has already done in such other service industries as insurance and banking, which are outsourcing an ever-widening assortment of office tasks to the country.

A recent study by the McKinsey consulting firm estimated that India's medical tourist industry could yield as much as $2.2 billion in annual revenue by 2012.

"If we do this right, we can heal the world," said Prathap C. Reddy, a physician who founded Apollo Hospitals, a 6,400-bed chain that is headquartered in the coastal city of Chennai and is one of the biggest private health care providers in Asia.

The trend is still in its early stages.

Most of the foreigners treated in India come from other developing countries in Asia, Africa or the Middle East, where top-quality hospitals and health professionals are often hard to find.

Patients from the United States and Europe still are relatively rare - not only because of the distance they must travel but also, hospital executives acknowledge, because India continues to suffer from an image of poverty and poor hygiene that discourages many patients.

Taken as a whole, India's health care system is hardly a model, with barely four doctors for every 10,000 people, compared with 27 in the United States, according to the World Bank.

Health care accounts for just 5.1% of India's gross domestic product, against 14% in the United States.

On the other hand, India offers a growing number of private "centers of excellence" where the quality of care is as good or better than that of big-city hospitals in the United States or Europe, asserted Naresh Trehan, a self-assured cardiovascular surgeon who runs Escorts and performed the operation on Staab.

Trehan said, for example, that the death rate for coronary bypass patients at Escorts is 0.8%.

By contrast, the 1999 death rate for the same procedure at New York-Presbyterian Hospital, where former president Bill Clinton recently underwent bypass surgery, was 2.35%, according to a 2002 study by the New York State Health Department.

Escorts is one of only a handful of treatment facilities worldwide that specialize in robotic surgery, which is less invasive than conventional surgery because it relies on tiny, remote-controlled instruments that are inserted through a small incision.

"Our surgeons are much better," boasted Trehan, 58, a former assistant professor at New York University Medical School, who said he earned nearly $2 million a year from his Manhattan practice before returning to India to found Escorts in 1988.

Although they are equipped with state-of-the-art technology, hospitals such as Escorts typically are able to charge far less than their U.S. and European counterparts because pay scales are much lower and patient volumes higher, according to Trehan and other doctors.

For example, a magnetic resonance imaging (MRI) scan costs $60 at Escorts, compared with roughly $700 in New York, according to Trehan.

Moreover, he added, a New York heart surgeon "has to pay $100,000 a year in malpractice insurance. Here it's $4,000."

In addition to patients from other developing countries, top Indian hospitals derive a significant share of foreign business from people of Indian origin who live in developed countries but maintain close ties to their homeland.

But the same hospitals now are starting to attract non-Indian patients from industrialized countries, and especially from Britain and Canada, where patients are becoming fed up with long waits for elective surgery under overstretched government health plans.

"If you can wait for two years for a bypass surgery, then you don't need it or you're dead - one of the two," Trehan said.

"Similarly, if you're wobbling on your frozen joints for two years because of a waiting list, it's a human tragedy."

One such patient is Tom Raudaschl, an Austrian who lives in Canada and earns his living as a mountain guide.

Suffering from osteoarthritis in his hip, Raudaschl last year decided to undergo "hip resurfacing," a relatively new procedure that involves scraping away damaged bone and replacing it with chrome alloy.

He learned he would have to wait as long as three years if he wanted to have the operation under Canada's national health plan, a delay that would have cost him his job, Raudaschl said.

In the United States, the procedure would have cost $21,000, he said.

So this month, Raudaschl flew from Calgary to Chennai, on India's east coast, where a surgeon at Apollo Hospital performed the operation Wednesday for $5,000, including all hospital costs, Raudaschl said by telephone from his hospital bed.

"As soon as you tell people that you're going to India, they frown," Raudaschl said.

But he said he could not be more pleased with the service.

"They picked me up at the airport, did all the hotel bookings, and the food is great, too," said Raudaschl, whose private room was equipped with Internet service, a microwave and a refrigerator.

Most important, Raudaschl said the surgeon told him he would be "skiing again in a month."

To cope with its backlog of cases, Britain's National Health Service has begun referring patients for treatment to Spain and France, although for now, the health service limits referrals to hospitals within three hours' flying time, according to Anupam Sibal, a British-trained pediatrician and Apollo's director of medical services.

"Nobody even questions the capability of an Indian doctor, because there isn't a big hospital in the United States where there isn't an Indian doctor working," he said.

Before they would admit him for surgery, Staab, the heart patient, said hospital officials at Durham Regional Hospital asked for a $50,000 deposit and warned that the entire cost of treatment could run as high as $200,000.

Katie Galbraith, a hospital spokeswoman, confirmed in an e-mail that hospital costs in such cases typically are in the neighborhood of $100,000; the surgeon's bill, which is charged separately, would have added tens of thousands more.

Patients such as Staab who do not qualify for charity care often are offered a payment plan, she said.

Staab was discharged from the Indian hospital Monday and was recuperating at a nearby hotel. He planned to return to Durham after visiting the Taj Mahal.

October 22, 2004 at 05:31 PM | Permalink | Comments (1) | TrackBack

'Surfing for Jimmy Choo' - the web goes upmarket


Earlier this year, I noted my amusement with the ultra-upscale purveyors of things luxurious and their disdain for the web as a sales avenue.

Only a matter of time until they weaken and crumble, said I.

It's happening as you read this.

Yesterday's Wall Street Journal story by Cheryl Lu-Lien Tan and Sally Beatty reports on how Burberry, Prada, and their ilk are suddenly getting that ol' online religion.

I say again: get on the internet train, or be left behind at the station.

I took a look at some of the high-end brand websites just now, and was appalled at what I found.

They are clueless about what the internet buyer wants.

They uniformly employ Flash, and start you off on the wrong foot right from the get-go.

Ah, well.

They'll catch on eventually, after they flush enough money in lost sales down their Flash toilets.

Here's the article.

Surfing for Jimmy Choo: Luxury Hits the Web

High-End Retailers Move Online After Early Reluctance; How Barneys Stacks Up

With the lucrative Christmas shopping season just around the corner, a number of luxury retailers are belatedly launching sites in order to sell their $1,000 handbags and $500 shoes on the Web.

To date, the fashion flock has been slow to go online, either shunning the Web altogether or letting people look but not buy.

But this fall, a number of stores and designers are reversing course.

Bergdorf Goodman ventured into online shopping in August with an extensive site featuring items like $630 Manolo Blahnik chain-mesh stilettos and a $2,575 Narciso Rodriguez satin cocktail dress.

On Nov. 15, Salvatore Ferragamo SpA will begin allowing visitors to its Web site to buy clothing, shoes, handbags and other accessories by clicking on a shopping icon.

Burberry Ltd. added shopping to its site October 1.

And Barneys New York Inc. last month revamped its site (www.barneys.com) to add user-friendly features such as a designer-brand search option, though their selection remains limited.

Even high-end boutiques are jumping in.

Intermix, the New York-based chain that carries names from Givenchy to Stella McCartney, officially launches online shopping next month at www.intermixonline.com.

And Scoop, a New York purveyor of Jimmy Choo shoes and Marc Jacobs apparel, is retooling its site (www.scoopnyc.com) in time for the holiday-season.


It will include a designer search and index and expanded shipping options.

A few retailers, including Neiman Marcus Group Inc., which had an extensive catalog operation, have been building strong Web presences for several years.

But many other luxury retailers initially held back from selling online, on the grounds that their high-end customers weren't ready to make pricey purchases sight unseen.

Some stores also saw online sales as "putting yourself in the same playing field as Wal-Mart," said Marshal Cohen, chief analyst for the NPD Group.

Other high-end stores and designers resisted doing online sales until they felt ready to handle the increased volume and pull off logistical tasks such as filling customer orders in a timely fashion and responding to e-mail and phone requests for help in ordering online, among other things.

Ferragamo opted to team up with Neiman, rather than go it alone, in order to speed its entry online.

Now, however, luxury retailers have decided they must establish a presence on the Web.

According to a study by Shop.org and Forrester Research, online apparel sales are expected to grow 42% this year to $11.7 billion.

In jewelry and luxury goods, the study predicts a 39% increase in sales this year to $2.8 billion.

Despite the luxurious offerings, shoppers accustomed to the ease and broad selection of an Amazon.com will find that the new sites have some significant drawbacks: limited selection in some cases, packaging and mailing problems in others.

San Francisco attorney Tiffany Schauer continues to be frustrated that her favorite high-end store, Barneys New York, offers only some of its merchandise on its Web site.

Just yesterday, she went searching for baby gifts on Barneys.com and Burberry.com but was disappointed with the few items she found on both sites.

"When you go to the store, they have racks and racks of it," she says.

"But they're not giving you what's available in the store online."

She increasingly turns to sites such as eBay, saying she doesn't have a lot of time to shop.

"Very few people have time to spend in a store looking and touching and feeling - we have to work," she says.

Next month, Burberry plans to add a broader array of apparel and accessories, plus more men's offerings.

Barneys New York executive vice president of marketing Karl Hermanns says the store's current emphasis is on opening more bricks-and-mortar stores.

The desire to focus on improving the store experience has been a factor for other retailers as well.

Prada, Marc Jacobs and Dolce & Gabbana still don't allow shoppers to buy from their Web sites.

A spokesman for Prada says the company is working on a "cutting edge" Web site to be launched "in the near future."

But a recent experiment by Vogue magazine showed the Web's potential to reach big-spending customers.

In September, the magazine launched a site - www.shopseptembervogue.com - that allowed people to click on and purchase items in ads.

During the first two weeks, according to Vogue Vice President and Publisher Tom Florio, 24 people bought a $1,570 leopard-print Dior bag, 22 readers purchased a $3,135 Chloe silk chiffon gown and 26 bought a $3,950, 18-kt gold Tiffany bangle.

An additional reason retailers and designers are ramping up their Web endeavors is that they are hoping to win younger customers before their Internet buying habits are established.

At Bergdorf Goodman, Michael Crotty, senior vice president of marketing, says the store wanted to make sure its Web site wouldn't be disappointing to customers familiar with its brand: "I remember a couple of years ago when stores would launch sites and there would be very little there."

Now, he adds, the store has to be online. "We have a very traditional customer, but we also have her daughter shopping with us."

While Bergdorf is new to the Web, parent company Neiman Marcus, which is handling its online sales, is well-versed in the arena.

Sales at all three of its Web sites, including Neimanmarcus.com, Chefscatalog.com and Horchow.com, topped $240 million for the twelve months ending in July, an increase of more than 50% over the same period a year ago, said Brendan Hoffmann, chief executive of Neiman Marcus Direct.

"Over half our business on Neimanmarcus.com comes from places we don't have a store in," said Mr. Hoffmann.

He says Bergdorf Goodman logged purchases from 46 states in the first month after Bergdorf began selling online.

For shoppers, the improved sites mean they can buy a larger variety of fashionable merchandise without having to visit major cities.

Also, by going online, luxury retailers are opening the door to shoppers who are younger or not as affluent, and who may feel intimidated about setting foot in their stores.

"It gives you an opportunity to browse around without feeling like, 'People are looking at me, they think I can't afford anything. They don't think I should be here,'" says Scott Silverman, executive director of Shop.org, the National Retail Federation's online division.

In order to reach shoppers who may not be familiar with their New York-based brands, Bergdorf and Intermix are advertising their new Web sites in shopping magazines like Lucky or newspapers in cities such as Los Angeles and Chicago.

The new e-tailers also are banking on selling points such as a reputation as arbiters of New York fashion.

Bergdorf, for example, is emphasizing its carefully edited selections of clothing displayed in head-to-toe ensembles, said Robert Burke, senior fashion director for Bergdorf Goodman.

And some retailers are carefully watching their Internet sales for indications on where to open new stores.


Khajak Keledjian, chief executive officer of Intermix, says he plans to open four new stores nationally next year and will be monitoring Web-site sales to figure out where the next ones will go.

October 22, 2004 at 03:01 PM | Permalink | Comments (2) | TrackBack

BehindTheMedspeak: Flu Shot Follies


I wasn't even gonna bother with this whole subject, the flu and the surrounding uproar over the vaccine shortage, but I've gotten kind of annoyed reading the big headlines every morning about how getting a flu shot has become, for many people, the focus of their existence.

I mean, the Charlottesville Daily Progress reports that one man arrived just after 4 a.m. at our local Kroger to get in line for a shot that wouldn't be given until 1 p.m. that afternoon.

Hey, gang, these aren't World Series tickets they're selling, they're flu shots.

I never understood why people got flu shots, anyhow.

I mean, the shot hurts, your arm feels sore and aches, you get a little sick, and for what?

So that maybe - maybe - you don't get the flu?


Here's a dirty little secret about flu shots: you can still get the flu even after you've had a shot.

Between 10% and 30% of those vaccinated get it anyway.

And there's one thing you can get from a flu shot you won't get from the flu.

It's called Guillain-Barré syndrome.

It's devastating.

And it's associated with flu shots.

True, it's rare.

But it'll destroy your life.

Victims often are on respirators for months.

No one knows how many, really.

Because no one really can keep track of the scattered, infrequent cases.

Me, I take the Warren Buffett approach to flu shots, just like I do with anything medical or, for that matter, life-related.

If the downside is enough to wreak havoc with me, no matter how unlikely it is to happen, then no matter how good the upside is, I'll pass.

So I'll pass on the flu shot once again this year, just like I have every year.

Even though I'm a doctor with patient contact, and so eligible to go to the head of the queue.

You can have mine.

Anyway, for most people the flu is like a cold.

You get it, you live with it a few days, you get over it.

I mean, the fact people actually go to the doctor or ER because they have flu symptoms is, to me, beyond bizarre.

Then there are the various companies out making big bucks on various useless things.

For example, Quidel Corporation took out a full-page ad in Monday's USA Today touting their QuickVue flu test.

You go in and get a test to prove you have the flu.

Wonder what that costs.

Hey, gang - if it walks like a duck, talks like a duck, and quacks like a duck - it's probably a duck.

You don't need a weatherman to see which way the duck flies.

Wait a minute.

That's not how it goes.

Is it?

Wind blows, yeah, that's right. Where was I?

Oh, yeah, flu-associated medical rip-offs.

I believe doctors who prescribe the currently available anti-viral drugs for the flu are just this side of practicing bad medicine.

These drugs won't do much good, and they may have side-effects far worse than any flu.

Besides, they're expensive as heck; just a complete Big Pharma scam on the hapless consumer/patient.

You sit home, you drink tea, you take some Tylenol, you rest.

Trust me.

I'm a doctor.

October 22, 2004 at 02:01 PM | Permalink | Comments (1) | TrackBack

Page Four - The China Daily offers true stories of daily life in China


I guess this will have to do until I join thedoll on a future Chinese hejira.

Every day, The China Daily - the government owned-and-run English language newspaper - publishes about two dozen tales, gathered from newspapers all over China.

To read it regularly,

1) go to the paper's website [www.chinadaily.com.cn]

2) click E-Paper (top right)

3) click on "Home News" (on the left)

4) scroll down to "Home Scene" on the lower left

5) click on one of the five geographic areas (North, South, East, West, and Central)

Hey - it's not as hard as it sounds.

If I can do it, you can do it.

Trust me.

I'm a doctor.

Aren't I? But I digress.

Here's today's news from the South.

Wasp sting woman burns down garden

A woman seeking revenge after being stung by a wasp tracked down its nest and set it alight.

Unfortunately a strong wind whipped up the flames which spread out of control and engulfed her entire garden, reports the Bagui Metropolis News.

The woman had been gardening when the errant insect stung her on the bottom.

Firemen eventually brought the blaze in Hepu, of the Guangxi Zhuang Autonomous Region, under control.

Rubbish clearance reaps valuable reward

A valuable fungus has been found growing on a pile of rubbish by an abandoned pond.

It was discovered by a security guard in the Haizhu District of Guangzhou as he cleared away the rubbish, reports the Southern Metropolis News.

The plant has powerful medicinal qualities and in bygone times was credited with miraculous powers and considered a potent symbol of good luck.

The size of a large fan, the fungus is rarely found in the hot, wet climate of Guangzhou.

Devoted husband of sleeping beauty

A 90-year-old man whose wife falls into a coma-like slumber each year reads poetry to his "sleeping beauty" every day until she wakes.

Romantic works written by ancient poets are his favourites, reports the Southern Metropolis News.

The old lady was stricken a decade ago by the strange illness which causes her to fall asleep for one or two months each year at home in Liwan District of Guangzhou, capital of Guangdong Province.

Doctors say it is a symptom of a brain disorder or psychological problem, which could be cured with appropriate treatment.

Immigrant city woes spell unhappiness

A survey has revealed that 90,000 youngsters in the booming economic hub of Shenzhen are unhappy, reports the Guangzhou Daily.

Pressure to perform well academically, coupled with the difficulties of being an only child, invariably of migrant parents, are all combining to make life a misery for many.

The survey was conducted by Shenzhen Kangning Hospital, a former psychiatric hospital.

With a history of only two decades, the young city has the largest migrant population in the province.

Doctors warned that moving home, changing schools and a general indifference among residents have contributed to a sense of solitude and melancholy among young people.

How do you say "Boing Boing" in Chinese?

October 22, 2004 at 01:01 PM | Permalink | Comments (0) | TrackBack

America's greatest collection of Himalyan art - it's located in a former Barneys


Yes, it's a fact: the Rubin Museum of Art, at 150 West 17th Street in the heart of Chelsea in New York City, offers more than 1,000 sculptures, tapestries, paintings, and photographs.

The museum opened earlier this month to rave reviews after years of construction.

The collection is displayed throughout the 70,000 square feet of the six-floor museum, wrapped around a grand spiral staircase under a 25-foot-wide skylight.


On the sixth floor, for example, you find "Methods of Transcendence," a collection of Himalayan mandalas and thankgas and Buddhist statuary.


Worth a trip.

October 22, 2004 at 12:01 PM | Permalink | Comments (0) | TrackBack

Brett Herbst of the Maize - world's greatest creator of corn mazes


Oh, so you didn't think you could make a living doing this?

You'd be dead wrong, 'cause Brett Herbst, 33, and his company, the Maize, has quietly become the world's most prolific corn maze maker, with over 150 mazes constructed to date.

He's based in Utah but travels an awful lot, as you might imagine.

He grew up on a farm in Salmon, Idaho, and agriculture is his passion.

He learned how to design corn mazes through trial and error.

His first, in 1996, took him three weeks to create.

Now he can knock one out in a day.

The work is seasonal, with the off-season devoted mostly to brainstorming design ideas and scouting for sites.

He continues to run his own flagship maze in Utah, even as his consulting and design business grows.

Thousands of visitors a year come to wander through his Utah creation, many with wonderment on their faces as they exit.

[via Mary Ellen Slayter and the Washington Post]

October 22, 2004 at 11:01 AM | Permalink | Comments (0) | TrackBack

Watch the Disney trial online


Yes, it's true: there are people who simply can't get enough of the fireworks surrounding Michael Ovitz's $140 million golden parachute for 14 months of acting as a useless, space-occupying lesion in the CEO's office at Disney back in 1995-96.

The trial's taking place as we speak in Delaware Chancery Court, and CourtroomConnect brings it to you wherever in the world you might be.

If you live in Delaware, it's free.

If you don't, and you're one of the first 50 people to log on each day, it's free.

If you don't, and you're #51 or after, you pay $10 a day.

So after I'm done for the day (last post, remember, is 4:01 p.m.), you can mosey over there and watch the proceedings.

It's broadcast continuously through the night until the next day's session begins.

October 22, 2004 at 10:01 AM | Permalink | Comments (0) | TrackBack

BehindTheMedspeak: Glucoboy


It's a glucose meter for diabetics that can be connected to a Nintendo GameBoy.

Coming out next spring, it's the new new thing in interactive blood sugar control.

Paul Wessell, whose son Luke was diagnosed with diabetes at age 3, is the creator of Glucoboy.

Wessell noticed that Luke, when he was 7, clung to his GameBoy and hid his blood glucose meter.

So Wessell, whose background is in automation technology, founded Guidance Interactive Healthcare four years ago and invented Glucoboy for his son.

The device creates an incentive for kids to play with their hand-helds after scoring well on their blood tests.


October 22, 2004 at 09:01 AM | Permalink | Comments (2) | TrackBack

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