When was the last time you worried that your doctor doesn’t make enough money?

If you haven’t worried about this recently, maybe you should. I’m thinking about this today because of an article in The New York Times about cardiologists owning and operating 64-slice CT scanners. The gist of the article is that doctors are doing too many tests on these machines in order to make the payments on them. (Full disclosure: To the best of my knowledge no cardiologists in our area own these scanners; several LHN hospitals do.)

The article, by Alex Berenson and Reed Abelson, appears generally to be balanced and accurate, though the writers either found or created some goofy cardiologists to quote. One claims that he gave a free CT angiogram to a referring physician, a clear violation of Federal law if the report is accurate. Another is quoted as follows: “It’s incumbent on the community to dispense with the need for evidence-based medicine”. Gosh, most of the docs I know are going in the other direction. Evidence is, uh, usually a good thing.

The authors conclude that unnecessary scans are being done by doctors in order to turn a profit on their machines. They do quote a Georgetown University Economist, Jean M. Mitchell, who correctly observes that “this is not greed. This is normal economic behavior.” Why is it “normal” and “economic”?

The answer lies in circumstances that are not widely understood. Over the past two decades physician reimbursement has basically remained the same while inflation has more than doubled the cost of overhead (rent, staff, insurance, etc.), and of living, for U. S. physicians. That’s right, doctors have taken more than a 50 percent pay cut, as Medicare and insurance companies have held physician fees constant – or reduced them – while the consumer price index doubled!

Doctors are pieceworkers; they are paid by fee schedules tied to each service they perform. Physicians can compensate to some extent for stagnant or falling fee schedules by increasing the number of office visits or procedures they do, but this is clearly constrained by the number of hours in the day. And productivity increases are further limited by the rising documentation (paperwork and computerwork) requirements placed on our doctors.

Having tried cranking up their hours in an attempt to maintain their incomes and lifestyles, physicians are increasingly giving up and cutting back. Many are taking early retirement. Young doctors fresh out of training are choosing shorter hours and predictable lifestyles. And, unfortunately, they seem to be choosing cities other than Fort Wayne.

In years past, doctors came to our region to join a strong medical community but also because they could work hard and make above-average compensation. We are currently having more trouble attracting new doctors to northeast Indiana than at any time in my memory. With the compensation differential fading away, young doctors are selecting places with oceans, ski slopes, or balmier temperatures. We have growing shortages in several specialties, which we only grow worse as the national doctor shortage worsens.

Back to the Times article, it illustrates that doctors have sought to maintain their incomes by capturing a portion of the “technical” component of the healthcare revenue stream. That component, which historically went to hospitals, covers the facilities and equipment involved in procedures and tests, while the “professional” component is traditional physician fees. Venture capitalists and equipment manufacturers have exploited the falling professional fees by urging physicians to invest in CT scanners and the like in order diversify their revenue sources. Critics say this leads to the kind of overutilization alleged in the Times piece.

Physician attempts to capture technical revenue streams through imaging and surgery centers are under attack and are unlikely to succeed in the long run. Just this year, Medicare cut reimbursement for surgery and imaging centers, most of which are owned by physicians. Further efforts by the government and insurers to disincentivize “physician self-referral” are inevitable. There are stormclouds on the horizon for the CT-scanning doctors profiled in today’s article.

In the United States, we are punishing our physicians. The combination of declining reimbursement, deteriorating quality of life, and perverse incentives will ultimately take its toll. The crazy system of physician reimbursement is the biggest driver of the “healthcare crisis” in America, yet politicians rarely talk about it. Our doctors are behaving exactly as can be expected, responding appropriately to the incentives and disincentives offered to them by the government and the insurers.

What to do? The first step in health reform should be a bottom-up redesign of physician reimbursement to align doctor incentives with the health of the nation. An argument could be made that we should compensate doctors well for what they are trained to do and remove incentives for them to branch out into unfamiliar territory. And, if doctors are going to need to “participate in the technical revenue stream”, there are more sustainable models than “one-off” centers with narrow ranges of service that are susceptible to allegations of overutilization and cherry-picking.

One of my readers has been whining that I haven’t posted in awhile (the other reader hasn’t noticed, yet).

I have my reasons, one of which can be found in this article in today’s New York Times. Apparently, bloggers are dropping dead at early ages (60? 50?) from the stresses and pressures of daily posting. Sorry, but the edification of neither of you is worth my suffering a premature M.I.

That said, I continue the slow but rewarding work of preparing the promised book review post, which has now been expanded to include movie reviews, too (I saw “Shine A Light” yesterday, a life-altering experience if there ever was one). Sometime this month, hopefully.

In the meantime, just a little followup from my post about Rob Jarvik’s career as a drug huckster. As both of you probably know by now, Pfizer has pulled the Jarvik Lipitor ads, mostly - in my view - because intrepid bloggers revealed that Rob had been replaced by a body double for the rowing shell scenes. This caused me to enter a period of reflection and introspection, because I have in fact been employing a body double in most of my roles and assignments for years. Watch this space because, if I can get the webmaster to remind me how to upload pictures, I plan to post a gif or jpeg of the real me sometime soon. This should help clear my conscience, and also prevent the scandal that plagued Rob-the-rower when his secret was disclosed by others.

I know I promised that my next post would be a book review of some biographies but, like Professor Harold Hill two generations ago, I’ve uncovered a nefarious plot that threatens the children, not just of River City, but America and possibly the world. It’s not pool, this time. It’s worse, and it must be exposed urgently.

Time magazine recently reported on a sinister new marketing ploy by record companies. In their never-ending quest to recoup revenues lost to downloading and sharing, they have identified a distribution vehicle that can’t be easily shared or copied and they’re hyping it to our innocent, unsuspecting kids. You’ll figure it out from the title of the article: “Vinyl Gets Its Groove Back“.

A lot of the article seems to be based on an interview with a 15-year-old high school sophomore who “owns more than 1,000 records”. He says “most things sound better on vinyl, even with the crackles and pops and hisses”. The writer opines that “LPs generally exhibit a warmer, more nuanced sound” than CDs and MP3s.

Balderdash!

The reason for this hype job is shown in a little graphic with the article. Digital downloads cost $8.99 on Amazon (free from Limewire or a friend), CDs average $10.50, but vinyl LPs sell for a whopping $14.00 a pop (pardon the pun). When your child declares an intention to purchase a vinyl record (or, heaven forbid, brings one home), you must be prepared with cogent arguments against this practice or soon he’ll be saying things like “Swell!”, and “So’s your old man”.

The Time article totally confuses three distinct issues: analog versus digital, digital compression, and the delivery/playback medium. You will need to educate your child on all three.

Analog vs. Digital

Music consists of sound waves, which are analog in nature. A pure musical note is a sine wave, which the picture nearby shows is continuously variable.

Up through the early ‘80s, music was recorded and processed in the analog realm. Microphones converted sound waves to analog electrical signals that were amplified, processed, and recorded on moving magnetic tape. Vacuum tubes in the signal chain added a “warmth” that was appealing to many but did not faithfully reproduce the original music. Noise (hiss) was introduced by the sliding of the tape across the recording and playback heads at, usually, 30 inches per second.

It became possible in the ‘70s to use computer chips to “convert” analog signals to digital ones. There are myriad reasons to do this, among them the elimination of tape hiss and pitch changes resulting from tape transports. The conversion involves chopping the sine wave into numerous vertical slices, then storing the amplitude of each slice in a digital file. It would take an infinite number of slices to reproduce an analog signal precisely, but we currently use “sampling frequencies” high enough (44.1 kHz or greater) that expert musicians cannot tell the difference after an analog-to-digital conversion. Today much music originates digitally (from an electronic keyboard, for example) and the rest is converted to digital at the micorphone preamplifier stage and exists in the digital realm from then on.

The earlier in the process the music is converted to the digital realm, the more faithful it will actually be to the original sound, but it will also be stripped of the “warmer, more nuanced” artifacts of vacuum tubes and analog tape.

During the era of transition from analog to digital recording, many musicians and producers resisted, claiming they could hear a brittleness in the converted signal; these concerns have faded as A-to-D converters have gotten better and sampling rates have risen.

Going back to vinyl records doesn’t reverse any of the changes of the digital revolution, since all new music is recorded digitally and most older stuff has been converted before the magnetic tape it resides on flakes and rots. So a vinyl record pressed today likely has digital music on it.

Digital Compression

The early portable music players had limited storage capacity, so digital songs were compressed for use on them. Common compression techniques are MP3 and Apple’s M4A (AAC). Encoders compress the original music into smaller files, while decoders in the playback devices reconstitute them. Quality is dependent on the design of the encoding and decoding software (sometimes called “codecs”), but also on the bitrate used by the encoder. Without getting any more technical, low bitrates result in playback of lower quality, because more information is lost in the compression process. Almost everybody can detect artifacts in music compressed at less than 128 kbit/s. Some audiophiles claim that they can detect any compression, but blind listening tests show that rates greater than 320 kbit/s (especially if variable bitrates are used) are very hard to distinguish from the lossless recordings that ship on CDs.

The “tinny” sound that the Time writer attributes to MP3 players and iPods is a function of compression and won’t be cured by going back to vinyl. Newer portable players have enough storage capacity that songs can be saved there as high bitrate or even lossless files.

The Medium

The worst thing about hyping vinyl is its extreme relative unsuitability as a distribution medium. The basic principles haven’t changed since Edison’s day (he patented the “phonograph” in 1878). The interface is electromechanical. Sounds are converted to mechanical energy to etch or engrave the grooves in the record. The stylus in the phonograph vibrates in the groove and generates electrical signals that are amplified and fed to loudspeakers.

The process of “mastering” a vinyl record is both interesting and instructive. In the ‘60s and ‘70s people made careers as mastering engineers. Their job was to take the master tape from the recording studio, predict the changes that the processes of vinyl record manufacture and playback would introduce, and pre-equalize the music to account for them. This was an art as much as a science, and mastering engineers had “good ears”. There are many arcana (masters, mothers, lacquers, stampers, etc.) of the record mastering and pressing world that we won’t explore here.

There are so many limitations in the electromechanical interface of a vinyl record that it is impractical to try to list them all. Frequency response is poor and nonlinear. Stereo separation is reduced and varies by frequency (pitch). Lots more.

The worst thing about vinyl, though, is its lack of durability. A brand new vinyl record begins to deteriorate with the very first playing. After all, we’re scratching a diamond stylus over the plastic. Even if we were able to avoid the extraneous physical damage introduced by scratches, dust, warping, etc., just the playing of a record destroys it. High-end frequency response is the first thing to go, but eventually the diamond stylus will simply wear the grooves smooth. Ten plays was pretty much my limit before a vinyl record started to annoy me. Audiophiles actually ration the playing of their favorite vinyl records.

CDs and computer files, on the other hand, do not deteriorate simply from use, and are more resistant to external destructive forces (physical damage in the case of CDs, hard drive crashes in the case of computer files).

In Conclusion

The most faithful reproduction of a musical performance is via a lossless, high-sampling-rate, digital file. The current ways to distribute these are downloads and CDs. I am sympathetic to the concerns of musicians and the record industry that digital files are easy to steal, and I actually have some ideas (for another time) about business models they could adopt that protect their interests. Those ideas don’t include copy protection (digital rights management or DRM), and they certainly don’t include VINYL.

If you let your kids buy vinyl records, I guarantee you that visits to the pool hall will not be far behind.

Uh, oh. I’ve been reading headlines again.

Today I saw the words “stirs passions” and “ouster” near a headshot of David Long. Even talking about “ousting” this guy is a really bad idea.

It seems as if proponents of an Indiana constitutional amendment to ban property taxes have set their sights on Dave, among others. I don’t know many folks who like property taxes, but Dave is not the enemy on this front. In fact, he’s one of the people best positioned to help bring the required parties together on a plan to address high property taxes as well as their cause.

I’ve been teasing Dave by calling him “Governor” for at least a decade now. I think it makes him uncomfortable, but in point of fact he’s well qualified for the job and I hope he gets it someday. For now, he’s been elected by his peers to a powerful position in the state Senate, and for good reason. Dave’s respected as knowledgeable about policy and as a great administrator and reconciler. We’ll need all of his skills to get appropriate property tax relief this year.

For that matter, let’s toss some kudos at the entire northeast Indiana delegation in the legislature. Time was when only about 80 percent of the taxes we sent to Indy came back home in the form of state services; I think the rest stayed in Marion County. Increasingly, our area legislative delegation has worked in a bipartisan manner to make sure our voices are heard in Indy. And many of them have achieved positions of power and respect within the legislature. All have left their marks on important legislation.

As this short session gears up, I’m going to remind myself and others that every member of our delegation is making sacrifices and adjustments in careers and family life to serve in the legislature. I hope both of my readers will do the same, and I know that each and every one of these folks would be happy to hear your ideas and receive your encouragement.

This is the title I’m gonna (listen to TV and radio announcers, they use “gonna” all the time) use for posts that wander around among topics.

As I head into my third month of blogging, I want to thank both of my readers for your support. I look back at my first post and read that I wasn’t sure how often I would be able to post here. One thing I’ve learned: daily doesn’t work for me. I can’t imagine anyone wanting to read about what I did every day, although some days there will be cool things that happen at Dupont Hospital that I’ll want to write about. I will try to keep that to a minimum, though, because this is not intended to be a promotional blog, but rather one to draw people to the great interactive Dupont website.

The model that feels best to me is that of a weekly columnist. This gives me time to select a topic and run it through a few drafts in Word before uploading. And it seems as if the columnists in the Sunday papers inspire me. Everyone in Knightstown in the ’50s and ’60s went to the basketball games on Friday night to watch our Falcons (later the Panthers) play. In grade school, I would get so fired up watching the varsity on Friday night that I could hardly wait to get back into that gymnasium for church league ball on Saturday morning. There were four team: Presbyterians, Quakers (we called them Friends), Disciples of Christ (we called them Christians), and Methodists. We shot our free throws underhanded, and used two hands for jump shots. The good players selected their Sunday School based upon its team’s prospects for the year. Alas, the Presbyterians were stuck with me based upon my mother’s unwavering theology. So, I was a Presbyterian Tiger, and my career total (fifth and six grades combined) was three points. We did make the championship game in my sixth grade year, and were drubbed by the Quakers. I was second high scorer with one point.

Speaking of points, the one here is that I get inspired by the “varsity” columns on Sunday, and that generates my weekly urge to blog. It appears as if I’m good for (or bad with) about 600 words a week. I think one of my readers checks here daily (not sure about the other one) and I’m just trying to lower both of your expectations for frequency of posting right here. The rest of the Dupont Hospital site is worth visiting several times a day. Only if you promise to check it at least once a week will you be permitted to subscribe to the RSS feed.

P.S. I think the next post will be about biography. Think Eric Clapton, Hillary Clinton, and Douglas MacArthur.

Congratulations to Sylvia Smith on her election as president of the National Press Club. Sylvia has been the eyes and ears of our region in Washington for years as the Washington Editor for the Journal-Gazette. She’s done a great job, and her recognition is well-deserved.

My wife looked up at me from the breakfast table this morning to comment on Sylvia’s report on Susan Bayh’s corporate directorships. She said something like, “Sylvia really worked hard on this, but I’m not sure there’s a story here”. I saw the Bayh family picture over her shoulder, and opined that if you look up “integrity” in the dictionary you’ll find a picture of Evan Bayh.

As an aside, I am very proud of both Indiana senators. I’ve known Dick Lugar since he was mayor of Indianapolis, and Evan since family friend Frank O’Bannon served as his lieutenant governor. Neither gets much national attention (when Dick does get on TV, folks like Charlie Gibson mispronounce his name), but both represent our state in an exemplary fashion. The reader could probably discover that Liz and I have supported the campaigns of both for years.

Anyway, Liz always starts with the Journal-Gazette while I work on the New York Times. Then we switch.

When I read the Smith pieces, I have to confess that a couple of alarm bells did tinkle. As I finished reading, George Stephanopoulos was on the tube interviewing Presidential candidate John Edwards. Edwards, of course, has accused Republicans and even other Democrats of timidity in “standing up” to drug and insurance companies in the quest for healthcare reform. These companies were in the thick of it when Hillary tried last time, and certainly will be looking out for their own interests as this comes up again.

When we look at Susan’s directorships . . .

This is a tough one. No one would suggest that Susan Bayh lacks the qualifications for the boards on which she serves. Many of us are members of two-career couples, and it would be hypocritical to deny either Bayh a career. Evan noted that Susan has even modified the areas of her legal practice over the years to avoid perceptions of conflict with his work. My wife doesn’t dictate policy to me, but she is my best friend and we do talk about lots of things, including each other’s lives and careers.

To dissect: Emmis Communications makes sense. It’s an Indianapolis company, and Susan’s been on the board since it went public in 1994. And, in 2007, it’s practically impossible to create a government-sanctioned communications monopoly, even if the Bayhs and Jeff Smulyan were determined to try.

Drugs and health insurance are different. Susan’s drug companies are relatively small, but it’s hard to forget that Big Pharma has pretty much had its way with the Federal government over the years. Medicare Part D (the drug benefit) was a recent boon for them. I don’t recall how Evan voted.

The potentially troublesome board is the one that pays Susan the most, WellPoint. This massive healthcare company, known to most Hoosiers by its former name Anthem, is moving upward through a 30 percent market share toward monopoly in our state. It has been a contractor for virtually every state healthcare delivery program, under both Democratic and Republican governors. It will certainly lobby vigrously in the coming national debate over universal healthcare. And if Sylvia got her facts right (who could doubt?), Susan Bayh made over $700,000 on her WellPoint options last year. Those options were part of her compensation for being a director.

I do not believe that anyone has acted improperly, here. But a revered investment banker mentor of mine told me in my college days, “You must not only be right, but be apparently right”. I trust Susan and Evan Bayh. I wonder, though, if everyone will.

The lead story in today’s Wall Street Journal is headlined “Big Pharma Faces Grim Prognosis”. You couldn’t figure that out from watching TV or reading a magazine. My old friend Rob Jarvik is showing up everywhere, hawking a drug that the Journal calls “a blockbuster” and “the most successful drug ever”. That drug would be Lipitor, which lowers cholesterol, and I sorta lied when I called Rob a “friend”. Actually, my then-partner Al Peterson, Lutheran Hospital’s artificial heart guru, introduced me to Rob back in 1986. Al and I went to Utah with a team from Lutheran to learn how to implant the devices Rob had helped Don Olsen develop. Later, in 1988, we brought Rob to Fort Wayne to give a speech and receive an award at a symposium downtown.

So, I haven’t seen Rob in almost 20 years. Or, rather, I hadn’t until he showed up all over the tube. His forehead appears to have gotten taller, though I could be wrong about this because back when I knew him he combed his hair in the manner of a young Paul McCartney. Also, back then he was married to the “world’s smartest person” as certified by the Guinness Book of Records, who today writes a weekly column in the academic journal Parade. They may still be married, but you don’t see her in the commercials; a son does make a brief appearance to say, “Ready, Dad?”.

This may be petty, but I’m not sure I’d take drug advice from Rob. His artificial heart was way cool, but the company he founded to make and sell it went belly up. Additionally, if memory serves, Rob went straight into research after medical school. I don’t believe he ever served an internship or residency, held a license to practice medicine, or wrote a prescription.

So much for my resentment and envy over all the money Pfizer is paying Rob to look good for the camera. Let’s talk, though, about drug advertising for a minute. The gist of the WSJ story is that the drug companies are tanking because there are few new products in the pipeline to replace those whose patents are expiring. This is true despite costly legal maneuvers and payments to generic manufacturers to keep their factories idle. The story notes that one of Big Pharma’s solutions to this “grim prognosis” is to increase their advertising.

We’ll get to the advertising in a minute, but first let’s consider what drugs these folks have mostly been “developing” over the past couple of decades. Since Lipitor is a certified “blockbuster”, let’s start with that. (Full disclosure: I take Lipitor, not so much for my cholesterol but for its mystical life-prolonging and mood-enhancing effects.) Lipitor is one of about a dozen available drugs in a class called “statins”. Statins, also known as “HMG-CoA reductase inhibitors”, arose out of good solid basic research by Japanese scientists in the 1970s. They isolated the drug that Merck ultimately marketed (beginning in 1987) as Lovastatin, from a fungus similar to the one that led Fleming to the discovery of penicillin more than half a century ago.

Once the cholesterol-lowering effects of statins were known and Merck had figured out how to manufacture the molecule, the race was on among the pharmaceutical companies to engineer “copycat” drugs. There’s nothing inherently wrong in taking an existing molecule with known characteristics and making minor modifications to see if efficacy can be improved, safety increased, or side effects reduced. However, over the past two decades at least, the billions of dollars Big Pharma has invested in research have largely gone toward this endeavor. A major goal: a drug that works as well as or better than the original but is different enough to patent.

So, today we have these classes of similar drugs, pretty much copies of each other within a class, that are marketing against each other under their respective patent protections. A great example is those purple reflux meds, Prilosec, Prevacid, and Nexium. Two of them are so similar that their molecules are mirror images of each other, but they compete on TV for your attention. Other classes of drugs that come to mind are those for erectile dysfunction, the newer sleep meds, pain medications like Vioxx (oops), and of course the statins.

Doctors can and do take advantage of the subtle differences within a class of drugs on occasion to address specific therapeutic needs. My problem is with the drug companies going to you and me with the same kinds of advertising messages used to sell cars in an attempt, apparently, to get us to talk our doctors into prescribing the one the manufacturer wants us to want.

With few exceptions, the drugs now marketed on television and in magazines are patented, prescription drugs. You can’t get them without visiting your doctor. And, since your doctor (not you) is in the best position to select a drug from within one of these categories (more often than not it’s a less expensive generic) why is Big Pharma spending all this money on consumer advertising? The Journal says it’s because the patents are running out, and they just might be right.

Healthcare costs too much, and too little of what we do spend finds its way to the doctors and hospitals who are providing the care. There is absolutely no reason for consumer marketing of prescription medications. I propose a ban. After that, we can take on medical device and implant manufacturers. Does anybody really plan to submit to major surgery just so they can have a knee that’s just like Mary Lou Retton’s?

I’ve been a fan of Steve Penhollow for a long time, but he outdid himself in the movie rundown in today’s paper. I actually laughed out loud. If you read this post after your paper is on the bottom of your birdcage, hit this link now.

The long weekend afforded an opportunity to read a number of books and newspapers, and of course to watch the Colts on the tube. Some random observations:

I was pleasantly surprised by the job Bryant Gumbel and Chris Collingsworth did in the booth for the Colts-Falcons game. Nothing flashy, but no silliness either. The analysis kept me interested even after the Colts had the game put away. I was surprised when I googled these guys and found out that a fair amount of vitriol has been tossed at them. They sure beat Madden in my book. The directing was crisp, too, on the “NFL Nework”, and the graphics were good.

Michael Schroeder did a fine job this week in The Journal-Gazette of localizing the international story that human skin cells could be made to act like embryonic stem cells without destroying embryos. He interviewed Drs. Bader and Crawford, and the head of Allen County Right to Life, all of whom had reason to be knowledgeable on the subject. Far too often, local reporters just grab stories off the wire or the feed complete with the commentary of “experts” from wherever the story originated, when there are folks in town who would be just as authoritative and lend a local perspective. Again, kudos to Mr. Schroeder; a lesser reporter might have done an embarrassing “man on the street” snore job if attempting to localize this matter at all.

Shame on Peggy Noonan for wasting 50 column-inches in the weekend edition of The Wall Street Journal on a pathetically trivial piece on politics and religion. She obviously wrote this puppy in a real hurry, and even poked fun at her old boss Ronald Reagan for being “unused to the normal ways of Christian service” because he “happily dipped the bread in the wine as communion was passed”. Uh, it’s called intinction, Peggy. As with Reagan, apparently, it makes millions of Christians from a wide range of denominations just as “happy” as other recognized forms of receiving the Eucharist.

Among other things, I’m a connoisseur of headlines. No, seriously. It’s hard enough to get the five “w”s and an “h” into the first paragraph, and then some other guy has to get the essence of the entire story (most of which he didn’t read) into the head, hopefully in a way that draws reader interest and sells newspapers. This challenging task does lead to some wonderful puns and alliterations, as well as the occasional blooper.

My first job (this would have been about 1964) was at a small publishing company in my home town. The owner was a neat guy and a neighbor (his kids were some of my childhood friends). He was one of my first mentors, and it was a privilege to work for him (because of the next sentence, I think I’ll just omit his name, though). Mr. Hearst (we’ll call him) once showed me a headline he had written while sports editor of his college newspaper. It told the story but I gather it got him into some trouble: “Illini To Face Wisconsin With Peters Out”. Uh, Peters was one of the running backs, and he couldn’t play because of an injury . . . well, you get the point. This seemed scandalous to a 14-year-old, and it stuck with me as evidence of how dangerous a headline could be. The cautionary tale helped me avoid writing memorable headlines for over 40 years.

A headline in one of the papers last week inadvertantly generated some confusion about the roles some of us have assumed within the Lutheran Health Network. For good or ill, lots of things are named after Martin Luther (considerably more than are named for, say, Johan Tetzel). One thinks of the Evangelical Lutheran Church in America, the Lutheran Church Missouri Synod, Lutheran Social Services, the Lutheran Foundation, a number of churches and seminaries . . . the list goes on.

The pithy headline helped people confuse the Lutheran Health Network with Lutheran Hospital of Indiana (both names, after all, start with - and are sometimes truncated to - “Lutheran”). The Board at Lutheran Hospital (LHI) in July named Joe Dorko as it’s CEO, replacing Tom Miller in one of his former roles. Since it took more than one person to replace Tom, your humble correspondent was named CEO of Lutheran Health Network (LHN) earlier this week. The headline in question apparently led some to conclude, wrongly, that Joe’s tenure at LHI had been rather short, when it was actually Tom’s other job that I got. To nip further erroneous speculation in the bud, none of us holds, or has been deposed from, office at either Lutheran Cemetery in Jewell County, Kansas.

The Lutheran Health Network is a - follow me, here - “network” of hospitals and other health providers in northeastern Indiana. It is called the Lutheran Health Network (LHN) because the first hospital in it was Lutheran Hospital (LHI). Others who joined later include St. Joseph Hospital, Kosciusko Community Hospital, Wells Community Hospital and Caylor-Nickel Medical Center (now merged as Bluffton Regional Medical Center), Dupont Hospital, Dukes Memorial Hospital in Peru, etc. The Boards of Trustees of these facilities wanted to be part of the Network but keep their own local names and identities, so they did. We try to tie them all together in the public mind with a cute little butterfly logo (depicted nearby) that is supposed also to remind you of the “H” sign for hospitals.

Each of our hospitals has an administrator (CEO) reporting to a Board of Trustees, but some of us hospital people do double duty and serve at the Network level, too. So, when Tom was the CEO of both LHN and LHI, I was the CEO first of St. Joseph and then of Dupont, while also serving as Tom’s sidekick and briefcase-carrier as COO of the Network. For some time, now, Kirk Ray’s primary job has been CEO of St. Joseph Hospital (Tom Miller and I have each done that in the past, too!), but I have recently assigned him a secondary task of responding to reporters’ calls for comments about me in as sycophantic a manner as possible. Joe was COO of LHI while all of this was going on, and . . .

If you’re not already confused, I am. To clear all this up, let me dump some movie metaphors into the proverbial Cuisinart. Joe is Captain Kirk, ensconced on the bridge of the flagship Enterprise (LHI). I am Han Solo, captain of the Millenium Falcon (Dupont Hospital), but I also get to be the post-mortem Obi Wan, advising and coordinating the leaders of the rebel forces (LHN). Our various hospital Boards of Trustees are the Jedi Council, and Tom is Starfleet Command. Though our roles have shifted some over the past decade, most of this team has been working together in this region for longer than that. Bodes ill for any Romulans who try to build a Deathstar.