It is UNREASONABLE to assume that there won't be hospitals, doctors, ERs, antibiotics, insulin, surgeons (& staff, & the hi-tech support) who can perform coronary by-pass procedures, for starters. Just for argument's sake, because the unreasonable never happens in our comfortable modern American world, that all of that infrastructure disappears. What will be our fallback position?

Bill

-- William J. Schenker, M.D. (schenker@wir.com), December 27, 1997

Answers

Unfortunately, I'm still under the influence of my own left-brain thinking much of the time, so it's very difficult for me to deal with a statement that says, "Perhaps a Y2K problem means that we'll never have hospitals, doctors, ERs, etc forever and ever". My left-brain keeps saying, "Yes, but even if the entire medical infrastructure was totally destroyed, we would find a way to rebuild it" without really begin able to grasp the possibility that the infrastructure that SURROUNDS the medical/hospital community might also have collapsed (kinda hard to run a hospital if you don't have any electricity).

In any case, if it's hard for me and other Y2K-involved people to cope with this intellectually, it's not surprising that the average lay person would find it heretical. That's one of the reasons that we tried to present the Y2K problems in terms of "levels" of disruption that increase in tenfold levels -- e.g., a trivial disruption of 2-3 days, an annoying, moderate disruption of a month, a serious disruption of a year, and a cataclysmic disruption of a decade.

It's not too hard to convince people that there might be disruptions of a couple days ... and I've been able to get a lot of people to extrapolate to the level of a month-long disruption. The real difficulty seems to occur when you ask people to contemplate the possibility of a disruption lasting a year. Perhaps that's because a year-long disruption is beyond the point where you can simply "grin and bear it" and wait for the disruption to go away. I assume that a diabetic can stockpile insulin for a couple days without much trouble; a one-month supply might be more difficult, but perhaps not beyond the realm of possibility. But if insulin disappears for a year (e.g., because 50% of the world supply of insulin comes from one company in Amsterdam, as Martyn Emery discovered when he did his "Y2K hurricane model" for Amsterdam), it's a relatively unsolvable problem.

-- Ed Yourdon (ed@yourdon.com), December 27, 1997.

I don't agree that it is unreasonable to assume the above.

As an example, here in Bridgeton, NJ the State of NJ closed the ERs in both the Bridgeton and Millville hospitals for 72 hours. From news reports this is the first time such a thing has ever been done.

If ERs are closed now, prior to Y2K problems, I consider it reasonable to assume that some ERs will have problems post-Y2K.

Personally, I think we need a fallback plan for medical care at various levels: from family unit up to and including community hospitals. I see NO movement toward medical fallback plans.

bernie///

-- Bernie Sayers (sayers@cyberenet.net), December 27, 1997.

Bernie:

I hung out the bait and u BIT. Yes, I agree with you, our healthcare delivery system is fragile. It can break down; it has broken down, here & there. And we should have a fallback system (Come to , to the Discussion Forums, then to the General Discussion forum, then look for the threads on Alternative Medicine, Herbal Medicine, and soon, Colloidal Silver, for possible ways to go.)

But in addition to wanting to get something going on Ed's Q & A on the healthcare system, as important as it is, I am even more interested in looking at what's behind generalized Y2k Denial.

When most people come up against the possibilities inherent in a post-y2k world, they instinctively pull back to avoid the pain. They pull the blanket over their head, just like my friend's cat, who then is sure nobody can see him. I know the process. I was in & out of it for the 10 months, after reading about the problem a year ago.

And what is the tool most people use to prop up their blanket-tent? "Why, it's just not REASONABLE to assume all those possibilities that Ed talks about will really come to pass!"

And, neurologically speaking, where does "reasonableness" come from? It comes from left hemisphere thinking. That's the part of the brain that deals in linear, computational, rational thought processes. It's motto is: "Something that has continued, basically uninterrupted for this long, is going to continue uninterrupted in the future." It's a safe way to go. It works in so many of our everyday affairs.

It only stops working when Continuity abruptly is halted by a Discontinuous Event. Like The Titanic did on 4/14/12. Like 10/28/29. Like 12/7/41 (Pearl Harbor Day.) There are other similar events down thru history.

Is there any way to protect ourselves from left hemisphere boondoggles? Yep. But it involves risk. You have to switch over to right hemisphere processing. That's the side of the brain responsible for art, music, poetry, non-linear appraisals, "vision." It requires you to step out into the unknown & MAKE A PREDICTION.

It's sure comfortable to say, "Nobody knows what's coming, so don't make a fool of yourself; just leave tea leaves to Madame LaZonga. Be REASONABLE, man!"

Another version: "Hey, man, listen to what your neighbor on the right is saying; listen to what the one on the left is saying. They BOTH can't be wrong. Be REASONABLE, man!"

-- William J. Schenker, M.D. (schenker@wir.com), December 27, 1997.

It isn't just insulin - I take three medications each day for high blood pressure. Currently I buy enough for 3 months, and there are times the drug store can only supply part of my refill. I am suggesting to those in my age-bracket (55-60) who are on maintenance dosages of any drug to make sure they fill their prescriptions in December, 1999. My local pharmacy is aware of the Y2K problem, but they are using software from the national chain (which doesn't work very well - one pharmacist is not very adept at using it.) If the local hospitals don't stock up, there could be major shortages of supplies.

-- George Ball (gball@servtech.com), December 29, 1997.

Assuming that Bill's assertion was bait to start the discussion. In addition to known prescription requirements, shouldn't we be thinking as a fallback position, some substantial first aid kits, not the half used dinky ones I have in my medicine kit. And how about some substantial training, retraining in something more compre- hensive than the first aid courses I see offered. Perhaps some of the MD's could help us here. Does their ethos allow them to give such advice?

-- Art Scott (Art.Scott@marist.edu), December 30, 1997.

Here's a good place to get a start on a real first aide kit. http://www.equipped.com/medical.htm Some good discussion of training and other stuff as well. I'm not affiliated

Paul

-- Paul Cordes (pcordes@igateway.net), December 30, 1997.

I am an herbalist and writer, and have been very concerned about the potential lack of medical care for families during an unknown period of time after Jan. 1, 2000. For this reason, I have written a book, titled "Herbal Remedies for the Year 2000: A Comprehensive Guide." My intention is to offer the book, herbs, and seeds, for those who, like me, want to hope for the best and prepare for the worst. If you would like to investigate this further, you can visit my web site at: http://angelfire.com/co/SurviveY2K/index.html

Thank you, Lua Sage

-- Lua Sage (shaeliya2@yahoo.com), January 10, 1998.

For more info on medical uses of herbs contact your local Pagan bookstore if you have one. Try looking for a "metaphysical" or "new age" type of place. Most of us have been using herbal remedies for decades!

-- Annie O'Dea (annie@mbay.net), March 02, 1998.

Everyone keeps talking about medicine and never mentions dentistry. It would be very difficult for a layperson to treat a serious dental problem with any degree of success. Herbs are great, but an abscess requires antibiotics and the removal of the tooth or nerve (root canal). Fractured teeth... cavities..., etc. are big problems many are facing. Don't forget that we dentists have to survive too. The barter system will work as well for services as it does for goods. Maybe I'll take out your tooth for some food or other service which I am unable to do myself.

-- Christy Esmond, D.D.S. (ealting@prodigy.net), March 07, 1998.

Perhaps a little perspective may help here: In a number of places the prevailing standard of medical care is pre-digital. For example, victims of radiation poisoning from Chernobyl are being treated in wards reminiscent of 1940s America, operated on using "recycled" (hopefully autoclaved) syringes, scalpels, etc., and given life support using iron lungs last seen here prior to the polio vaccine. In the third and fourth worlds local clinics are substantially more primitive. There exists a body of medical practice and pharmacology which can be applied to the Y2K scenario in the absence of malpractice suits. It can achieve results at least as good as those which satisfied the expectations of the WW II generation in their prime. This does not require turning to herbals and accupuncture. It requires remembering what was in the country doctor's traveling bag in 1954 (the year of my birth) and what passed for diagnosis and treatment before CT Scans. With a little forethought, some stockpiling and adaptation of recent knowledge to older technology we could get by reasonably well. Others are doing it around the world today.

-- Steve Pettit (s._j._pettit@oxy.com), March 18, 1998.

Besides the "Just in time" supply issues, individuals will want to make sure they are considered "eligible" to receive healthcare after the end of 1999.

Date arithmetic is involved. Besides ID cards, providers use computers, IVR's, etc to get authorization for procedures and prescriptions.

-- Mary Mack (telemack@msn.com), March 19, 1998.

Mr. Pettit, Where will the supplies and equipment to practice 1950's style medicine come from? Also, considering that two or three generations of physicians have become licensed and begun to practice since the 50's and those who were practicing are retired, or nearly so, is it safe to assume that they have the knowledge? Most of the docs I work with wouldn't have a clue without all of the computerized diagnostics (including lab, xray, ct, etc). Sure, they have some physical assessment skills, but they don't practice in a 50's style environment. The healthcare problem, IMHO, is not unlike the railraod problem, all of the older technology has been replaced. Even if it could be retrofitted to earlier technology, the skilled operators don't exist. I'd like for all of this not to be true. Perhaps you can convince me.

-- P. Larson (ptrades@earthlink.net), March 19, 1998.

Mr. Larson, perhaps unintentionally, is asking just the right question : "where will we find them?"

My point was that rather than panicking or looking exclusively to the New Age, herbalist, or accupunture, we should remember pre-digital medicine. It is still practiced in America by a few more traditional physicians, as well as those whose access to ultrmodern medical technology is limited by distance or cost. It is still used in many parts of the world as the best available practice. Manufacturers are still making nondigital thermometers, mechanical blood pressure cuffs (I don't know how to spell sphygnometer...), self winding watches, non-electronic IV drip controls and any manner of other more simple medical equipment, both to supply foreign demand and for the veterinary market (I have read that the USDA regulates veterinary medicine purity at the same level as human, although some procedures and medications are not approved for humans...). The knowledge exists in some older practitioners, those who train for or do offshore "missionary" service (including church groups, Physicians Without Borders, WHO, Peace Corps,etc.)

Mr. Larsen is also right in noting that most younger physicians, nurses and med techs in the US were never taught or cannot remember how to do it without the electronics. I would rather see us (as private groups or with the possible sponsorship of somebody like FEMA in the name of whatever preparedness crisis will sell: disaster prep for floods and hurricanes; disaster prep for Saddam's biologicals; disaster prep for domestic terrorism) gather the gear and redistribute the knowledge. If transportation and technology returns to the level of the rural West of the 1930's for a while (a realistic scenario) we will at least have the benefits of the medicine of the day, without having to fall back on the practices of sixteenth century Europe and Asia.

-- steve pettit (s._j._pettit@oxy.com), March 20, 1998.

Mr. Pettit, Are you a healthcare professional? I don't believe there is a single non-computerized serum chemistry analyzer, xray machine (incl processing), ct scan in the entire US that is actually in daily use. In fact, the CLIA regulations governing clinical laboratories would forbide it. The practitioners you describe who still have the knowledge, I submit, are very few and far between. They certainly don't exist in sufficient numbers to train people even regionally. How many nurses have you seen manually set IV infusion rates recently? Most wouldn't remember how. This is not to say they couldn't re-learn. Unfortunately, all of this could be mitigated somewhat if the industry was willing to step up and do some fast and furious contigency planning. However, they don't seem currently willing to do so. Most are still in the awareness and assessment phases. Then we consider Medicare. How will the industry be paid when Medicare cannot function post y2k? I'm afraid the picture is dim for healthcare as we have come to know and rely on it over the last 20 years.

-- P. Larson (ptrades@earthlink.net), March 23, 1998.

Once again, Mr. Larson and I are largely in agreement. The prospects of continuing health care as we have known it for the last 20 years are GRIM.

The regulation and economics of modern health care (read: fedral and state regs, Medicare payment regs, competition, HMOs, malpractice lawyers, etc.) have changed the way medicine is practiced. The people driving the system are presently uninterested in Y2K and are unlikely to change in time.

A whole generation of health care providers have been raised on high tech tools, agreed. They are smart enough to learn, but have to be taught, agreed. There are few people who focus on pre-digital medicine in the U.S.: the Peace Corps, the Red Cross, religious missionary societies, international health charities, providers of "bush medicine" in remote and impoverished areas. The knowledge is available but rare. And nothing is apparently being done to spread it around.

There are low tech tools and treatments in use elsewhere in the world, where they constitute the best available practice. For the reasons discussed above, they cannot be generally employed in the absence of economic crisis - war, natural disaster, Y2K. But they should be stockpiled. If a serious Y2K medical crisis fails to materialize, the stockpiles can thereafter be distributed in the developing world, where they will undoubtedly increase the level of medical care from Calcutta to the Cape.

I am frustrated that neither my children nor I will soon be able to rely on the best which medical research is able to provide. But I would rather trust my health to what was in the office, traveling bag and head of my late father in law (a general surgeon in the 1950s, 1960s, and 1970s) than a New Age faith healer with potions and chants.

-- steve pettit (s._j._pettit@oxy.com), March 23, 1998.

Mr. Pettit, I again ask, are you a healthcare provider/professional or an outside observer? I don't believe we are largely in agreement. I do not believe the type of 1950's, currently bush employed "best practices" you refer to could be widely implemented in the US in the time remaining prior to y2k--even if the industry were willing to step up to the plate. Interesting rhetoric at the end of your post. I wonder if "potions" and "chants" are why approximately 40% of healthplans currently have coverage for "alternative" providers (incl. acupuncture, herbalists, guided visual imagery). I suspect not. It is because a growing number of consumers have re-discovered the efficacy of many of these "treatments" and are asking for coverage. It is also because a growing body of scientific literature supports the use of the "alternative" therapies. It is hardly accurate to call them "potions" and "chants"--unless that is your only argument against employing them. My point is that people should consider, as part of their contigency plan, alternatives to the current system. This includes, in may case, having a HUGE first aid kit (of course I'm in the business and have access to more stuff), getting a supply of antibiotics, AND learning to grow and use herbs as well as learning about other "alternative" therapies to employee to provide healthcare as effectively as possible. Perhaps you, or a member of your family, will require the services of someone like me post y2k. Hopefully, someone in your region will have taken the time, and made the committment, to prepare in a manner similar to that I have just described--and provide relief.

-- P. Larson (ptrades@earthlink.net), March 24, 1998.