Triplix and the Real Problem with US Healthcare

Today I was watching TV when an ad for a drug named Triplix came on. You’ve probably seen it, or at least similar ads, too. Rugged-looking blue-collar Joes with serious faces gaze at the viewer and say something to the effect of “I thought I had my cholesterol under control…but diet, exercise, and a statin alone weren’t enough. That’s when my doctor told me about Triplix!”

I had seen this ad before, but for some reason it really bothered me this time, perhaps because I have been thinking about healthcare costs a lot lately. Triplix is a new drug recently approved for use in addition to statins to lower bad cholesterol and triglycerides. The catch, however, is that all research with the drug shows that while it fulfills its claim of lowering those blood markers, there is no decrease in heart attacks or heart disease compared to just taking a statin (Source 1, Source 2). It even tells you this nonchalantly in the ad, I’m assuming because of some FDA disclosure requirement. 

This one short ad encapsulates several deep-rooted problems with our health care system. First off, Triplix is hardly alone in being an FDA approved treatment that either works no better (or only marginally better) than existing, cheaper treatments. Take a look at cardiovascular stents, mesh implants that go in blood vessels to keep them open and maximize blood flow, which doctors in recent years have begun dispensing like candy. One inconvenient fact is that this expensive surgical procedure doesn’t have much long term benefit: many recent studies have shown no reduction in heart attacks or extended lifespan compared to those on drugs alone (Source). So basically, Triplix is a drug designed to be taken with another complementary drug (statins), but has no increased benefit over just the statin. Stents are very expensive surgical devices that are no more effective than routine drug intervention. 

Unfortunately in this country, we have gotten used to accepting that more is better, and more expensive is much better. Any talk of restricting insurance and/or Medicare reimbursement for drugs like Triplix or surgeries like stent implants is attacked as “rationing,” “socialized medicine,” or worse. Critics raise the specter of G-Men interfering with your personal doctor-patient relationship. I could not find a lot of specific information on Triplix online, but I assume as a new drug for a high-demand disease it is fairly expensive. If it is not preventing heart attacks, heart disease, or helping people live longer, it is sinking lots of money down the toilet. You might say, “But my insurance company pays for it, so who cares?” The increasing cost of our healthcare system is driven primarily by expensive new drugs, surgeries, and tests. When people waste money on non-effective drugs like Triplix, all of our premiums get raised, more people get declined, and the number of uninsured goes up.

Second, these treatments have risks. Stents require vascular surgery that carries anesthetic risk and the possibility of complications. Triplix can cause problems with muscle and kidneys. These are not insignificant, and if the benefit does not counter this risk, why are we using these treatments? They are not only expensive but possibly harmful.

Third, direct-to-consumer drug ads in general just piss me off. You are marketing complex drugs to lay people. They have no idea how the drug actually works, the impact of side effects and drug interactions, or how to assess indications and prognosis.  In my opinion, there is no reason for such ads besides profit for drug companies. Such ads have led to people storming into their doctors offices demanding drugs and treatments they may not need. How many times a day are we told to “Ask your doctors about the purple pill”? If you were a doctor and a patient was demanding a treatment he or she probably didn’t need, but might help and could make you some money, what would you do? It’s not that doctors are greedy assholes, they are human and if they can make money by a treatment that might be of some benefit, of course many relent and write the script.

Fourth, we need to ditch the idea that lawsuits and defensive medicine are the main reason for over-prescription of treatments. This revealing New Yorker article by a Harvard surgeon points out the fallacies in this argument by showing how health care spending in many areas of Texas that aggressively capped medical malpractice lawsuit rewards remained high with little benefit to patient health. The reasons for this are complex and beyond the scope of this article, but the take home point was that over-medicating and over-operating weren’t tied to medical lawsuits.

Finally, I wish the debate could change in such a way that people understand rationing is not only inevitable, but happeningright  now. Insurance companies routinely deny people coverage for experimental and non-beneficial treatments. But they still cover a lot of ineffective medicine and surgery. There are limited dollars in the economy, and we can’t afford to keep carting every person with a headache out for an MRI, or to put everyone with heart disease on 8+ drugs. Rationing can be done in different ways, but is necessary due to limited medical and financial resources. Just because we are a wealthy country does not change the limited resources principle–it only stretches the limits of what we can afford and what we can’t.

In fact, the Mayo Clinic, one of the world’s best hospitals, agrees. They think an independent panel of doctors need to frequently evaluate what we spend money on, and only reimburse the things that have value, and lead to improvements in patient length and quality of life. They disliked the initial health care reform bills coming out of Congress, but brightened up at the proposal of IMAC, a panel that would evaluate what Medicare and Medicaid reimbursed, which would also have the effect of influencing insurance companies. Unfortunately, this idea, one of the best parts of the proposed health care bills, is being attacked by both parties and will likely be killed. 

Until proponents of health-care reform are able to make the case for using available research to shape what gets funded and prescribed, and are also able to overcome the label of “rationing,” there will be no improvement in US healthcare. In a way it doesn’t even really matter who foots the bill, insurance companies or the government–if we keep spending on wasteful treatments our system will bankrupt itself without making us any healthier. Doctors also need to stop being afraid of research and “evidence-based medicine,” and use it as a way to inform their practice, not hinder. If a physician continues to use treatments shown to be of little benefit, he is harming his patient and costing all of us money.

Until then, I will continue to grimace every time I see that damn Triplix ad, which cheerfully informs us it doesn’t actually work.

The Newest Member of the Tinfoil Hat Club…

…Alan Keyes! Congratulations, come on down! 

(After watching the video make sure you rip out your fillings to keep the government radio waves from reading your mind.)

2001: A Tax Odyssey

Let’s take a leisurely stroll back in time. All the way back to 2001! The US economy was in the middle of a mild recession and we had a new president who wanted to stimulate the economy by cutting taxes.

His initial proposal was $1.6 trillion, which was popular with the majority but did not fly with the minority party at all (who argued it was not very stimulative and would add enormously to the debt). In the end it was argued down to a $1.35 trillion dollar tax cut, and 5 Senators in the minority broke with their party to vote for the plan.

That president was George W. Bush and the majority part was the Republicans. For more deja vu, consider that Bush even went on a cross-country townhall meeting campaign to drum up support for the tax plan.  

Epilogue: The White House and Republican majority pushed additional tax cuts through in 2003.

So I’m left wondering, why is the $787 billion stimulus an egregious waste when the opposition party (now lecturing us on the horrors of deficit spending) added about $1.8 trillion to the national debt during a milder recession? I’m confused, because the tax cuts arguably did little to stimulate the economy, worsened the income gap in our country, and–here’s the kicker–drastically cut federal revenue needed to pay off existing debt. 

Some will argue “that’s in the past, the Republicans today are different and we need to focus on solutions.” True, but don’t act as if the party that exploded the national debt can lecture us on deficits with a straight face. This isn’t even about Bush, it’s about the Republicans trying to save face and regain political power.

Questions That Need Answering

Let me start out by saying this: I’m all for bipartisanship. I think there is far too much party-over-the-people bickering in Washington, particularly in Congress. We need to see less ideology and more pragmatism from our lawmakers.

But this is just ridiculous.

Why are we listening to the Republicans on the stimulus bill? Why are we buying into the rants of an obstinate, obstructive party that is out of ideas and clinging to Reagan’s Greatest Hits of the Eighties?

Why are Republicans now suddenly concerned about the national debt when former Vice President Dick Cheney famously declared in 2004, “Reagan taught us that deficits don’t matter”? The party that took our country from a projected surplus in 2000 to the highest national debt ever (hint, it’s not the Democrats) is now chiding the other party for spending money during a legitimate crisis.

Why is $800 billion to stabilize our country in a deep recession so egregious to fiscal conservatives, when those same “fiscal conservatives” cheerfully passed a $1.3 TRILLION dollar tax cut in 2001? The Bush tax cuts benefited a small portion of Americans while simultaneously increasing our debt and decreasing the country’s income needed to pay off that very debt.

Why did 36 of 41 senate Republicans recently vote for scrapping the current stimulus bill and going with a $950 billion dollar tax cut? The big problem with tax cuts as catch-all solution is that when the money is spent it’s gone and you have nothing to show for it. At least with infrastructure and spending we have tangible buildings, roads, bridges, and investments to show for it.

Why are Republicans, who blocked a mortgage bailout for homeowners this past summer, now suddenly convinced that we absolutely need to have a mortgage bailout for homeowners?

Why are Republicans criticizing sending money to state governments who can’t pay their bills? It sounds nice to say, “Take responsibility and balance your budget,” but in reality it will just lead to massive layoffs across the country in an economy that already has the worst job losses in 30 years.

Why are Republicans ridiculing things like purchasing a new fleet of fuel-efficient cars? The government would save money in the long run by using efficient vehicles and this would provide a large work order for troubled American car companies.

Why are Republicans insisting on cutting funding for food stamps, the most effective per-dollar stimulus on record? Not to mention it helps out families hit hard by the recession.

Why are we taking advice from a party that had an economic summit with Joe the Plumber? (Seriously, they are asking an unlicensed plumber/campaign prop for economic policy advice).  

Why are Republicans and pundits pushing the myth that FDR prolonged the Great Depression? Looking up the numbers shows that FDR cut unemployment from mid 20s to 10% by 1937, in addition to seeing good economic growth. When in 1937 politicians demanded that FDR balance the budget and he cut programs and raised taxes, the economy relapsed.

What exactly are Republicans up in arms about? Democrats have capitulated to them on numerous fronts. Tax cuts have crept up as a larger and larger percentage of the bill, and many things the Republicans wanted cut were taken out (and replaced with tax cuts). 

Yet the Republicans are still not happy. The recent 36/41 vote showed what is really going on here: The Republicans don’t want any stimulus to pass, and if one absolutely has to, they want it to be 100% tax cuts.

Republicans found a great strategy here: Crucify the man who ran on bipartisanship. Because Obama espoused a platform of compromise and working together, the Republicans realized they could whine their way to getting whatever they wanted or Obama and the Democrats were being “partisan.” Sorry, but bipartisanship means compromise, not getting everything you want or you walk away with your toys.

My question to Obama is: Why are you letting the Republicans push you around? Why are you bending over backwards for a party that has clearly rejected all compromise?

That’s a question I want answered.

Why I do not support the Lockport High School Capital Improvement Project – A Local Issue

(Via one of my Lockport High School friends who writes at In One Ear Out the Other, original article here)

December 13, 2008 · No Comments

This discussion pertains to an upcoming vote in my hometown of Lockport, New York. Though the specifics are quite local, I am sure that the issues at hand can be applied to any number of towns across the country.

On December 16th, Lockport residents will vote on Propositions 1 and 2,  which pertain to capital improvement projects for Lockport High School. The Union Sun and Journal lists the proposed improvements as follows:

Proposition 1 includes improvements to the high school, such as a state-of-the-art performing arts center, art gallery and a fitness center for gym classes. Smaller items such as new windows and new bleachers and padding in the gymnasium are also part of the proposition. An elevator would also be added, and bathrooms would be made handicap-accessible. The technology wing would also be updated, the library would be renovated to make room for a computer lab and bathrooms would be added nearby. Other improvements include relocating the Locust Street bus loop, a parent drop-off site on Lincoln Avenue, and improvements to ventilators and mechanical systems.

The proposition also includes a six-classroom addition, which covers the classrooms lost by adding the fitness center, and a new entrance to alleviate some of the congestion in the hallway. This proposition makes up about $23.5 million of the total project.

Proposition 2 is a varsity sports complex, which includes a parking expansion, resurfacing of tennis courts and a varsity softball field. The stadium includes bleachers that seat 2,500, locker room, concession stand and an artificial turf field, which can be used by a number of school sports teams. It makes up about $6 million of the project.

First of all, I do agree that each of the listed improvements are, taken out of context, positive. However, it is precisely the context that makes these two propositions good ideas proposed at the wrong time.

No matter which way anyone spins it, the nation is facing a serious recession and that is going to result not only in job loss, bankruptcy and general belt tightening, but it will also create serious spending problems for Federal, State and Local governments. Add to this the disaster that has been the New York State budget, and you get a picture of what our circumstances are.

The issue at hand is one of want versus need. While each of the improvements listed in the propositions would indeed be beneficial to students at LHS and I am glad to say I want to see my old high school have them, there are very few elements of those lists that I would contend the school needs.

First for the needs. I am all for improving the ventilator systems, updating wheelchair accessibility and updating our tech wing and library facilities. These things are all sorely outdated and directly impact the education and health of LHS students. These are the sort of maintanance projects that any school district should engage in on a year to year basis. They are not the stuff of large, one-off spending projects.

Everything else clearly falls under the wants category, some of them truly excessive. A state-of-the-art performing arts center? An art gallery? A entirely new sports stadium? No, these requests are ridiculous considering the state of the economy, and, more importantly, the state of Lockport High School. I absolutely support the arts and the importance expanding students’ education beyond math, science and history. However, there is no need for Lockport to splurge on a new, much less state-of-the-art performing arts center so long as we have access to Artpark and the gem that is the Palace Theatre (which, in my opinion, is a much better use of funding to support the arts). Also, and please correct me if I am wrong here, I do not believe that the auditorium that LHS currently has is inadequate or falling apart. If there are improvements that could be made, they would fall under the category of things that should be done on a year to year basis.

Proposal 2 is reprehensible in its entirety. Please explain to me why we need a brand new, multi-million dollar facility to house our sports teams when we have been spending the last few years upgrading our current sports fields and have spent so much time and money creating a state-of-the-art, multi-purpose sports field behind Emmit Belknap Middle School? What in the world would be purpose of that massive structure after creating this new stadium? Certainly not to support modified and Middle School sports, as they are being cut from the budget already.

If we are interested in supporting our sports teams, let us talk about addressing the debacle that is the LHS swimming pool. The repairs to the collapsing roof have been delayed time and again while much needed improvements to the pool itself are being ignored. I have not been following this situation as closely, but it is a great example of how our district handles improvements and repairs to the building.

Expanded parking lots? Where? Instead of spending millions of dollars to tear up the limited space around the school to move the entire bus loop and expand parking opportunities, why don’t we make the rules for students driving to school more strict? I cannot point to any sources, but there are a huge number of students whole obtain parking permits when they do not even own a vehicle to park there. Further, if it is necessary to allow fewer students to drive themselves to school, then so be it. We have a school bus system for a reason. There is a late bus to accommodate those involved in extra curricular activities. I am not sympathetic to students who want to leave school early their senior year. To them I say, stop wasting my tax money and make the most out of your public education.

Ninety percent of the projects described by Propositions 1 and 2 would allegedly be funded by State-level grants, while the remaining ten percent would be covered by reserve funds held by the school district. First of all, as I stated before, I am of the opinion that in the current economic climate, these funds are not to be taken for granted. Second of all, just because these funds are available from the state does not mean that Lockport is automatically entitled to them. I am just as sick of hearing about pork-barrel politics as anyone else, but again, just because we want it does not mean we need it. These funds could be better spent in a district that has the tax base to accommodate these sorts of luxury improvements and can afford to reap the benefits from state-of-the-art sports and performing arts centers. Just because these facilities exist in Lockport does not mean that they will be utilized in a profitable fashion. I direct you to the renovations to the Downtown area, the plaza behind Eckerd off of Transit and the renovations done to the original Harrison Radiator building and other historical sites along the canal, just to name a few examples. I am sorry, but just because you build it does not mean they will come. And please, stop telling me that because this is state money we can achieve all of these improvements at no cost to the taxpayer. Where do you think the State of New York gets its money?

Now, on to what I think money should be spent on at LHS; education. Instead of pandering to a sports program that bends the rules to accommodate students who are failing or are convicted of sexual harassment or counterfeiting money, let us augment the primary function of a high school and update our curriculum, purchase updated text books, hire more qualified faculty and improve the classrooms themselves. I understand that the money the district claims will cover 90% of the proposed improvements can only be spent on capital improvements. We can look elsewhere for funding. We could start, for example, with the $9.4 million of tax-payer funds that the district has been hoarding for the past five years instead of allowing for significantly lower property taxes in the area. The Buffalo News reports that the New York State comptroller criticized the Lockport school district for inappropriately holding the funds in reserve.

School Superintendent Terry Ann Carbone defended the move, explaining:

“I applaud the previous board and administration that set up these reserves in 2002 and saved for a rainy day because right now it’s pouring out,” Carbone said.

“.‚.‚. We can use some of these funds to help offset an anticipated reduction in state aid next year,” she said. “We could be facing up to a 10 percent reduction. What would this district do if it didn’t have these reserves?”

Well, for one, we could hold off on building state-of-the-art sports and performing arts centers.

Many supporters of the Propositions argue that LHS does not afford its students the same opportunities as other schools in Western New York such as Williamsville or Orchard Park. They claim LHS students deserve the best we can offer. I agree. But where LHS really lags behind is in academics. If we really want our students to have the same valuable experiences as other schools in the region, let us offer more Advanced Placement courses. Let’s improve our classrooms and offer a wider variety of course material. Let’s actually prepare our students for college rather than artificially glorifying the four years they spend inside the building itself. High School is about preparing students for the future, not making sure they have all the latest, greatest stuff.

Again, none of these suggested improvements are inherently negative. It is just that they come to the wrong place at the wrong time. We have more important things to worry about right now. I do believe that we should maintain up-to-date facilities in the public education system, and that our students deserve the best that we can provide. I do not mind paying higher taxes to improve education, not in the least. But when our Federal government is spending billions of dollars to prevent our nation’s financial system from collapsing and will in all likelihood spend billions more to prop up the Big Three automakers, we at the state and local level have to be prudent with the limited resources we have. Let’s improve and repair our schools gradually and over time with money we can guarantee, and save the big magnificent projects for times of prosperity. We are, after all, part of a larger economy and a larger budget; we can’t think about only ourselves.

This issue was recently discussed in a poignant editorial released by the US&J editorial board. I will copy the article here, but I first I want to close by saying that the intent of this post was to induce you to think a little bit about what you really think about these two Propositions before you go to vote on Dec. 16. The recession is causing a lot of partisans and political ideologues to do some soul searching to see what it is they really believe in. I believe this is a good opportunity for us all to do just that. Think before you vote, and please, do vote. I encourage you to reply to this post to start a discussion on the matter. I want to hear the thoughts of others.

Now, the US&J editorial:

EDITORIAL: A revised Prop. 1 for LHS could be endorsed

Lockport Union-Sun & Journal
Over the past few weeks our Editorial Board has opposed the $29.5 million Lockport High School capital construction proposal. Our stance has been met with agreement by many and, for obvious reasons, disagreement by district officials.

Superintendent Terry Ann Carbone and members of her administrative team met with the US&J Editorial Board this week to explain the project in great detail, hoping to change our opinion.

For the most part, they did not.

As it stands today, the project is split into two separate spending propositions, both to be voted on Dec. 16 either in person or through absentee ballot. The absentee ballot option was news to us, so be sure to spread the word on that portion of it to your snowbird friends.

Administrators have said the project will have no impact on local school tax rates because most of it will be paid for by state aid and the portion that’s not is to be covered by existing district savings.

Our opinion remains that there are no guarantees from the state and, considering the financial crisis afflicting both the nation and the state, there’s no better time than now for the school district to protect its reserve funds.

Proposition 2, which would pour $6 million into a Lockport Lions athletic complex including a varsity stadium with artificial turf, should be thrown out the window. It’s the perfect symbol of increasingly widespread public sentiment about this project generally: great idea, bad timing.

Proposition 1, tabbed at $23.5 million, should be rejected as well.

Elements within it are worth preserving, however. What we would recommend, after a double “no” vote, is that the Lockport School Board come back with a revised Proposition 1.

Projects within that warrant support are:

n All renovations except the cafeteria/kitchen re-do. Bringing the technology education wing up to date, adding handicap-accessible bathrooms and an elevator in the classroom wing and cleaning up the crowded entry corridor are projects that meet legitimate student needs. Rearranging the cafeteria into multiple dining stations, so Suzy can go for Chinese while Sam visits the Mexican stand, is not.

n All building condition survey work, including window replacement and mechanical upgrades, to increase energy efficiency.

n Addition of a computer lab and special education/life skills classroom. Carbone made a convincing case for both enhancing students’ day-to-day education.

n Site improvements: Increased parking, relocation of the Locust Street bus loop and creation of a parent drop-off and visitor area on Lincoln Avenue.

Other parts of Proposition 1 — addition of four “general” classrooms, a new chorus room, a new fitness room, an art gallery (?!) and band room expansion — are luxury items and should be scrapped.

We urge residents to listen carefully to district officials’ choices of words to defend Props 1 and 2. You’re being told that the state aid and district reserves can only be spent on capital improvements, not books, staff or other resources that affect children more directly. OK, that’s fine; a slimmed-down Prop 1 still fits the bill.

You might also be told, by Carbone, that your children “deserve” the best facilities, as good as any found in a district like Williamsville or Orchard Park, and these propositions are all about helping your children aim higher.

Listen: We all want the best for Lockport’s students, but this is not Williamsville, where the tax base is thriving and population is growing.

Lockport is a small-city school district, with big city struggles, which Carbone knew when she took the job. As superintendent of such a district, she ought to realize the difference between needs and wants.

Once again, this proposal seems like a great academic case study in fiscal responsibility and priority setting. We all deserve great things; that doesn’t mean we’ll get them all.

You might also be warned, “if we don’t use it (state aid) someone else will.”

We say “Let them.”

Let someone else risk Albany changing the aid game mid-stream. Let someone else spend down the reserves on luxuries. Let someone else gamble on the long-term outlook turning rosy again.

Deborah Coder, Carbone’s assistant superintendent for finance and management, asserts project critics are confused when they think the stock market’s troubles mean borrowing to cover costs upfront is bad; the municipal bond market is doing well, she said, and by the time the district actually takes out a loan, in 2010, conditions likely will be even better.

Less than 24 hours after Coder insisted that’s so, we received an alert about municipal borrowing from the office of state Comptroller Thomas P. DiNapoli. It read, in part: “The credit crunch is squeezing local governments. The disruption in the markets could have serious implications for school districts and local governments, which need access to short-term credit to manage cash flow and finance infrastructure projects. Higher borrowing costs are making an already volatile fiscal situation more challenging for school districts and local governments.”

Boiled down, DiNapoli said, municipal capital projects that invoke borrowing may have to be postponed until the market situation improves; and since one cost of delay is price hikes, municipal planners will have to rethink their priorities even when the markets do improve.

And there we have it: Do we “need” Props 1 and 2 or do we simply “want” them?

Whether the public approves or rejects one or both propositions on Dec. 16, Lockport City School District needs to adopt a long-term capital improvement plan, one that spans 10 to 15 years, so taxpayers aren’t hit with one giant, catch-all spending proposal every decade or so.

Chipping away at the needs is what any good homeowner does with an aging house. The district ought to treat the high school, and the rest of its aging buildings, the same. Better planning is necessary.

-Mike

Myth Busters: Economic Meltdown Edition

Myth: Fannie Mae and Freddie Mac caused the financial crisis by giving mortgages to poor people. (Bonus points for highlighting Democratic support of Fannie and Freddie or insinuating minorities caused the calamity).

Truth: The vast majority of subprime loans were made by private companies and repackaged by investment banks. Fannie and Freddie were minor players in the subprime loan market that entered very late, after most damage had begun.

Federal Reserve Board data show that:

• More than 84 percent of the subprime mortgages in 2006 were issued by private lending institutions.
• Private firms made nearly 83 percent of the subprime loans to low- and moderate-income borrowers that year.

(Fun fact: Subprime actually originally meant a loan not up to the strict regulations of Fannie or Freddie) Source: Federal Reserve data in a McClatchy news article

Myth: We need to cut corporate tax rates in bad economic times to create jobs because our corporations pay the highest tax rates in the industrialized world.

Truth: Over 2/3 of all US corporations paid ZERO income taxes between 1998 and 2005. Source is an Associated Press story citing the Government Accountability Office

 

(more editions of economic Myth Busters to come as I get time)

The Big Question: What kind of vet will you be?

So, what kind of vet do you want to be, large or small animal? That’s the question that inevitably comes up whenever people find out that I’m going to vet school. It might seem like an easy question to answer, but there’s more to it than whether I prefer cows and horses or dogs and cats. The question brings up issues beneath the surface, like potential salary, educational loans, opportunity for advancement, typical schedule and benefits like health insurance.

Young, idealistic students don’t like to discuss these sticky financial matters. I find that the notion of entering a career for money is more upsetting to my vet student peers than those in other graduate fields. We cling to the idea that the one and only reason anyone goes into veterinary medicine is “Because I love animals!” No one wants to be labeled a “sell-out.”

And indeed, any focus on money seemed troubling to me until the last six months or so when I had to get my financial house in order by completing exit interviews for loans from Cornell and signing off new loans to pay for vet school at Western University. After graduating with a bachelor’s degree in animal science, I owe $33,000 to the federal government and Cornell. I was one of the lucky ones to get grants, scholarships and subsidized direct loans because of financial need. But as I’m now finding out, any financial assistance in professional school beyond loans is rare.

Western calculated the first-year student’s budget at $61,609. To borrow less than that, I scaled way back on my personal expenses, travel costs and food budget. I still had to take out a $55,000 unsubsidized loan for my first year. For the sake of this article, let’s assume I take out the same amount for each of four years at Western University and add my Cornell debt. I would owe $253,000 upon receiving my doctorate in veterinary medicine (DVM). That’s an awfully scary number for a young person, especially in today’s economy.

But this isn’t an article just about my loans. It’s about vet students all across the country and their career choices in graduate school. It’s about the plummeting number of large animal vets in every sector of agriculture from beef and dairy to equine and poultry. As older farm vets retire, new DVM graduates simply aren’t going into production medicine to fill their shoes.

Readers of this publication are no doubt aware that dairymen across the country are having a hard time finding vets to treat their cows. Due to constant traveling between isolated farms and a shrinking overall supply of vets, many dairies are unable to reach a vet for emergencies until it’s too late. Often a cow that could have easily been saved gets euthanized, instead.

According to a 2006 press release by the American Veterinary Medical Association (AVMA), food animal veterinary trends predict a 12 to 13 percent rise in demand for dairy, poultry and beef vets between now and 2016. Unfortunately, that press release also forecasts a 4 to 5 percent annual drop in practicing food vets. As older large animal veterinarians retire, fewer new graduates are replacing them.

What’s driving my peers away from food animal medicine? The 2006 AVMA report concludes that the primary reason new graduates opt out of production animal medicine is financial concerns – particularly the debt-to-salary ratio. More than half of graduating veterinary students owe over $109,000 in educational debt, according to the DVM Newsmagazine’s March 2008 story, “Economic Emergency.” That same article lists some other interesting facts, such as veterinary school tuition nationwide increasing 100 percent since 1997, while vet salaries only rose 46.5 percent during the same time period.

Such economic problems affect all branches of veterinary medicine, but are particularly felt among dairy, beef and poultry vets. For one thing, large animal vets usually see less clients a day than their small animal counterparts because production vets must drive to each farm, while small animal vets have a centralized clinic that can crank out office calls. Another issue, from my personal experience, is that large dairies are increasingly having farmhands do jobs previously performed by vets, such as vaccinating herds, delivering calves, dehorning heifers and administering intravenous antibiotics. Certainly, such displacement of labor is an economic necessity for farms, but it still chips away at a large animal veterinarian’s salary.

Finances alone, however, don’t keep students away from farm medicine. A myriad of other factors contributed to this shortage, from less focus on large animal medicine in vet school, to a lack of role models in food production, to an increasingly suburban and urban population. These three issues are linked by the common need to draw students from non-rural/farm backgrounds into food animal medicine.

In the past, when the U.S. had a large base of young people from rural and agricultural backgrounds, vet schools were able to tap into those students to fill the ranks of large animal veterinary medicine. Now that demographics are changing, vet schools, farmers and youth groups, like the 4-H program, are going to have to aggressively recruit from cities and suburbs.

When I went to get dairy experience for vet school, I had difficulty finding a farm that would hire a college student with minimal farm experience, even with help from Cornell Cooperative Extension. Some of the farmers I called on the phone were downright rude. Others never returned my calls. Luckily, I found a wonderful dairy farm in western New York on Lake Ontario that would give me a chance. I spent the summer as a calf-feeder who also took care of the dry cows and did odd jobs. I loved the experience, and it made me go back for more dairy work the following year. But I would have never been exposed to a large dairy operation if some farmers didn’t take me on, train me and allow me to learn.

One worker at a dairy I spent time on joked, “Our goal this summer is to get you to stay away from large animal medicine!” It was all in good fun. I laughed along with them, but there was an underlying truth to the joke: “Suburban kids can’t handle, and won’t like, farm life.” To be the judge of that you have to let them try it, first.

I encourage more dairymen to offer jobs to any qualified students who seek employment. I also encourage farmers to get involved with organizations like 4-H and their university cooperative extension program because these groups provide agricultural networking.

I wrote this article to relate my experiences to the growing shortage of dairy vets. I hope I’ve highlighted the financial worries young vet students have in a way that is neither preachy nor whiny. The debt issue isn’t hopeless, but young students need encouragement and support. Most of all, I hope that the dairymen and veterinarians who read this are inspired to foster a pride and joy in dairy farming among teenagers and college students, so that some of them may decide they like agriculture enough to become a food production veterinarian.

So what kind of vet do I want to be? Small or large animal? I never answered that initial question. The truth is, I honestly don’t know. I’ve spent more time working on dairy farms than in small animal clinics, and I enjoy rural living away from the noise of the suburbs. My coursework at Cornell focused on ruminant nutrition and reproduction. I feel very much at home with large animal agriculture. On the other hand, I’ve been a lifelong pet owner who adores cats and dogs. And small animal practice always has the lure of a “normal” work week.

It’s going to be an interesting four years as I study in vet school and ponder my options.

(Originally published in Progressive Dairyman magazine, September 30, 2008)

My bank failed today

Today my bank, Washington Mutual, failed. It was seized by the FDIC, and the company with over $300 billion in assets was bought by JP Morgan Chase for the fire-sale price of $1.9 billion. This was the largest bank failure in history (the previous record was a $40 billion dollar bank that failed in 1984).

My bank assures me the transition will be seamless and I won’t experience interruption of service. Plus the FDIC insures up to $100,000 per account, and as a graduate student living on loans, I promise you I have much, much, much less in my WaMu account.

What concerns me is not just WaMu or my few thousand dollars but where the bank closures will stop. How far will this go? How many more banks are going to fail? How deep are we going to fall before hitting bottom?

CNN Living: 15 Jobs that Pay Over $70,000 and “don’t require a Ph.D. or 10 years experience”

Check out this cute little weekend story from CNN, “15 jobs that pay $70,000 per year”: http://www.cnn.com/2008/LIVING/worklife/08/27/cb.jobs.that.pay.70k/index.html

High salaries have a nasty stigma attached them. One that reeks of years of school, advanced qualifications, extensive training and many years of experience, which some people just don’t have.

While these are in fact requirements of some high-figure salaries, they aren’t a prerequisite for all of them.

What many workers don’t know is that there are numerous jobs that pay well above the average full-time worker’s salary of $33,634* — that don’t require a Ph.D. or at least 10 years experience.

Wow, I was intrigued. Tell me more! Let’s see what careers are on the list…

Radiation therapist, Nuclear power reactor operator, Management analyst, Industrial-organizational psychologist, Environmental engineer, First-line supervisor/manager of police and detectives, Computer systems analyst, Advertising and promotions manager, Administrative law judges, adjudicators, and hearing officer, Administrative services manager, Education administrator, post-secondary, Marine engineers and naval architect, Physician assistant, Agricultural sciences teacher, post-secondary, and Veterinarian

Wait, hold up. VETERINARIAN? On a list of jobs that doesn’t “reek of years of school, advanced qualifications, extensive training and many years of experience.” Are you kidding me?! I was aghast when I saw my career on a list of relatively “easy to get jobs.”

To the author’s minimal credit, she does say:

That’s not to say that the following positions are easy to come by — like any position, no matter what the salary, you do have some qualifications to score the job. (emphasis mine)

You’re right, we do have to have some minimal credentials. Like earning a DVM, which stands for DOCTORATE OF VETERINARY MEDICINE. That’s right, it’s a medical degree. And it takes 4 years after regular college, just like your family physician. Oh, and you have to pass a separate licensing exam to even practice, and keep it up to date.  Just like a “real” doctor.

To get into vet school you have to attend at least three years of an undergraduate study and take more required courses than a pre-medical student. You have to keep your grades up, get great test scores, and have over a thousand hours of hands-on animal experience. 

If a veterinarian does not continue on to advanced study in a residency or internship (which is becoming increasingly common), it generally takes 8 years (rarely does a student get accepted before earning a bachelor’s degree).

This is just the latest example of how veterinarians are viewed. To the public at large, we are not professionals but pill poppers who couldn’t get into med school (News-flash: it’s usually tougher to get into vet school than med school). We have as much training as doctors and dentists and more than lawyers and many PhD holders. Would it even cross anyone’s mind to have included dentists on a list like this? Of course not. So why should a profession whose practitioners spent as many years training and had to learn more information (think its fun to learn the anatomy, physiology, and pathology of at least 6 different species?) be treated like second class citizens?

And to add insult to injury, our salaries aren’t even as high as the article insinuates ($79,368)! The university studies I’ve seen put the current average salaries for the profession more around $65,000, and starting salaries for small animal associates are around $50,000 in many parts of the country. Even if you ballpark the wrong figure of $80,000, keep in mind the average indebtedness of vet students is over $110,000 and many break $250,000.

On average, most veterinarians work more than 40 hours a week, including large animal vets who often work over 65 hours per week. So if you compare our salaries to someone with a 40 hour work week (as this article attempts to do), the salary actually drops even more!

I may seem bitter, but don’t let that fool you. I am glad to be a vet student and enjoy my line of work. I didn’t get in it for the money, I wanted a satisfying career. I just wish ignorant articles like this didn’t slap hard-working vets in the face by insinuating our profession is a great paying, easy to achieve career that only requires a few years experience.

Ok media and politicians, I’ll agree to ban the word “Change” if you stop calling people “Mavericks”

Seriously. It needs to stop.