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Second Opinion

Proto readers share their thoughts on veterinary medicine, medical journals and hospital mergers.

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YOU, ANIMAL

As a veterinarian, my first thought after reading “What Veterinarians Can Teach Us” (Winter 2013), Barbara Natterson-Horowitz’s interview on a cross-species approach to medicine, was: “Welcome to my world!”

Though I was gratified to see the human medical profession look to ours as a source of inspiration on issues as diverse as education, mental health and end-of-life care, the degree to which these obvious insights have been overlooked for decades comes as a shock. After all, veterinarians experience this light-bulb moment on the first day of anatomy class, where horse, dog, pig, chicken and cow cadavers are routinely studied ... all at once!

Patty Khuly // Veterinarian, Miami

FINDING THE RIGHT CONNECTION

Hospital mergers (“The Merger Push,” Winter 2013) are clearly sustainable and create unambiguous command-and-control structures, but they are not a panacea. Mergers take an extended period to produce results, and they presume that system leadership will take all of the right strategic steps.

Independent organizations today need two fundamental things: a connection to a structure that will give them economies of scale equivalent to those with whom they compete and a connection to a structure that will give them a place at the table in managing population risk in markets broader than their own.

I use the word connection because there are many methods by which these two things can happen without a merger. Alternative structures may be the best means to build relationships between independent hospitals and systems, ultimately leading to more successful mergers.

Howard Peterson // Founder and Managing Partner, TRG Healthcare, Philadelphia

PROBING DEEPER

Probing Journals” (Winter 2013) touches only briefly upon the most concerning topic: the distortional effects of financial conflicts of interest.

Tremendous monetary forces are at work. In 2008, Reed Elsevier, publishers of Cell and The Lancet, derived more than $3.1 billion in revenue from biomedical publishing. The nonprofit Massachusetts Medical Society, publishers of the New England Journal of Medicine, reported $97.2 million in revenue. Much of this revenue is derived not from clinician subscribers, but from pharmaceutical companies.

It will require a continued concerted effort of outspoken vigilance to ensure that biomedical publishing remains committed to the education of clinicians and the health of patients, rather than a tarnished conduit for pharmaceutical self-promotion.

Ryan Patrick Radecki // Assistant Professor of Emergency Medicine, The University of Texas Health Science Center, Houston

THE PRICE OF COMFORT

A very good article about the looming shortfall of home health aides (“Stuck, At Home,” Winter 2013). In the last two months before my wife died in 2011, we had home hospice. Medicare paid $225 for a 30-minute visit from a nurse, and paid an average of $75 for a one-hour home aide visit. Home aides should receive much more money and the overhead must be drastically reduced—and this will not be easy.

William Zettler // Winchester, Ma.

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