For several years, Manhattan’s Swedish Institute (226 W 26th St.) was the place to go for low-cost acupuncture treatment in New York City. The Institute’s teaching clinics offer both acupuncture and Swedish massage. A 13 week course of acupuncture cost $360 ($150 for seniors).
Earlier this week we ran into a colleague, Dr. Ben Kligler, co-author of Integrative Medicine: Principles for Practice, who informed us that the Swedish Institute has been purchased by the Pacific College of Oriental Medicine. He recommended the PCOM teaching clinic where acupuncture is provided by interns at somewhat higher prices than the Swedish Institute; see the details on their website. The address of the PCOM is 915 Broadway, 3rd floor.
Both the Swedish Institute and PCOM have interesting websites. Here is the Swedish Institute’s explanation of what it’s like to experience an acupuncture session.
Advanced Directives
A recent article in The Teaching Physician (a publication of the Society of Teachers of Family Medicine) discussed a new (free) initiative to make it easier for people to both make – and retrieve – advanced directives. “Information Technology and Teaching in the Office: Advance Directives Online” by Richard P. Usatine, MD, and Craig M. Klugman, PhD, University of Texas Health Science Center at San Antonio was published in the October 2009 edition and discusses Caring Connections (http://www.caringinfo.org/).
Caring Connections was developed by the National Hospice and Palliative Care Organization (NHPCO) with support from the Robert Wood Johnson Foundation. The website offers a number of resources for people considering end-of-life care. The one highlighted in the article was the ability to create and store advanced directives on line.
As noted on the site: “Advance directives allow you to document your end-of-life wishes in the event that you are terminally ill and unable to talk or communicate. ” They generally take two forms. In a living will someone specifies what kind of care he or she would like in future. A health care proxy is someone who can make decisions for a patient if he or she is incapacitated.
As a practicing clinician I find that there are several problems with Advanced Directives. First, people don’t fill them out. No one likes to think about their own death. Second, people often turn to lawyers who charge money to complete these forms. This is really not necessary. The forms in New York State can easily be completed by a family. [The specifics of advanced directives, however, vary by state.] Finally, there’s no logical, single place to put Advanced Directives so that they are easily retrievable in an emergency.
The Caring Connections site deals with both problems. State specific forms are available for downloading. The forms come with very detailed instructions. Once they have been completed users are encouraged to scan them and upload them to a Google Health Profile. This profile can then be shared with the key people who need access to the advanced directives.
One is always a bit reluctant to further promote the Google monopoly on the web, but this is a useful free service. It is, however, only available in English, a true limitation in an ever more diverse United States.
Last Tuesday’s Social Medicine Rounds (9/8/2009) was prompted by the brutal murder of family physician George Tiller on Sunday May 31st 2009. While serving as an usher at the Reformation Lutheran Church in Wichita, Dr. Tiller was shot in the head and killed. We convened this Rounds to consider how we might respond to his death. Two issues dominated the discussion. The first was the failure of the American Academy of Family Physicians (AAFP) to condemn the murder. The second was an examination of the ongoing barriers to abortion care that exist even in a relatively progressive state such as New York. These problems were illustrated through 3 case vignettes.
The Death of Dr. Tiller
Dr. Tiller’s career as a family physician took a path he did not anticipate. Like many conscientious physicians, his clinical practice responded to the needs of his patients. Here is the story told in his own words (taken from the Physicians Voices section of the Physicians for Reproductive Choice and Health website):
In July of 1970, I planned to start a dermatology residency. On August 21, 1970, my father, mother, sister and brother-in-law were killed in an aircraft accident. My sister had a 12-month-old boy, Maurice. They had written out a will in longhand the evening before the airplane crash, that I was to raise Maurice. So we took charge of my sister’s boy and we moved back to Wichita. My game plan was to spend six months here, close out my father’s huge family medicine practice.
After I had been there for a little while, patients in the practice began to ask me if I was going to do abortions like my father did. I was outraged. Why would these nice people say that he was a scumbag kind of a physician?
I began to ask some of these women. And I found out that in 1945, ‘46, or ‘47, a young woman for whom Dad had already delivered two babies came to him pregnant again right away, and she said something to the effect that, “I can’t take it, can you help me?” That is apparently the way you asked for an abortion from your regular doctor before abortion was legal. Dad said, “No. Big families are in vogue, by the time the baby gets here, everything will be all right.” She had a non-healthcare provider abortion and came back and died.
I can understand how upset my father was. I do not know whether he did 100 abortions or 200 abortions or 300 abortions. I think it may have been something like 200 over a period of about 20 years, but I don’t know for sure. The women in my father’s practice for whom he did abortions educated me and taught me that abortion is about women’s hopes, dreams, potential, the rest of their lives. Abortion is a matter of survival for women.
When it became legal and my patients began to ask for it, I’d say, “Sure. It’s a legal process.” I was a service provider. I was a physician. The patients needed abortions, and I did them. It is my fundamental philosophy that patients are emotionally, mentally, morally, spiritually and physically competent to struggle with complex health issues and come to decisions that are appropriate for them.
We’ve been picketed since 1975. My office has been blown up. In 1993, I survived an assassination attempt. My kids were harassed in high school. I had to write letters of complaint to the City Council and the Board of Education. We had people who actually camped across the street from our house. I restrict where I go to eat, where I travel. You see a car following you, you think, “Ah-ha, let’s watch that.” You’re always on alert. You’re always looking around.
I was leaving the office. It was 7:00 in the evening. As I’m driving out, I have to slow down and I have to stop. Bang, bang, bang, bang, bang, bang, and I thought to myself, “That lady is shooting me with rubber bullets. I’m not afraid of rubber bullets.” Then I looked down and all this blood is all over the place. I thought, “She shot me. She can’t do that! I’ll get her.” I saw her running through some front yards. So I zipped down the street, turned in front of her to block her escape. She stops and reaches into this little fanny pack that she’s wearing in the front, and I thought, “She’s going for her gun again. She shot you once, George. She’ll shoot you again. You are in the wrong place at the wrong time.”
So then I drove off. Ended up back at the office, and I don’t remember anything for about 20 minutes. I remember trying to get into my car and drive myself to the hospital. I said, “Let’s not make this a big media event.” Well, I had lost 20 minutes and the TV trucks were there. I thought, “How’d they’d get here so soon?”
There was never any question in my mind that I was going back to work the next day. I belonged there and they were not going to separate me from my job and they were not going to separate me from my community. So I did go to work the next day, and we got everything done. People got taken care of, it took a long time. Arms hurt, bled a little bit, but so what? I am not going to be run over and I’m not going to run out. It’s just that simple.
I am a member of this community. Our DNA has been here since 1880. I belong here. The folks that come in from out of town, they are the intruders. Forty percent of all the people who were arrested here during the Operation Rescue in 1991 came from out of state. I intend to stay here. I am part of the fabric of Kansas and Kansas is part of the fabric of me.
I have more to be grateful for than I have to be resentful about. We have much more support in Wichita than we have rejection and castigation. If Wichita and our community did not want us to be here, I wouldn’t be here. But the vast majority of people in Wichita support, on a quiet level, what we do, which is help women and families.
Extensive coverage of the murder can be seen in this June 1, 2009 broadcast of Democracy Now. This program includes an excerpt from a 2008 speech Dr. Tiller gave to the Feminist Majority Foundation in which he explained his social vision: “We’ve given war, pestilence, hate, greed, judgment, ego, self-sufficiency a good try, and it failed. We need a new paradigm that consists of kindness, courtesy, justice, love and respect in all our relationships.”
Non-Response of the American Academy of Family Physicians
Tiller’s death was clearly not a random act of violence. As noted by Colorado physician Dr. Warren Hern:
I think it’s the inevitable consequence of more than 35 years of constant anti-abortion terrorism, harassment and violence. George is the fifth American doctor to be assassinated. I get messages from these people saying, ‘Don’t bother wearing a bulletproof vest, we’re going for a head shot.’
The American College of Obstetricians and Gynecologists (ACOG) finds the murder of George Tiller, MD, deplorable and tragic. There is no excuse, no explanation, and no justification for this brutal slaying of a courageous and honorable physician who provided safe and legal reproductive health care to women who otherwise might not have received it. It is especially chilling and deeply disturbing that this violence has occurred at a time when the leaders of this country are committed to finding a common ground in the abortion debate.
ACOG extends its sympathy to the family of this dedicated physician who treated his patients with dignity and compassion.
As ACOG expressed in response to the 1998 murder of Dr. Barnett A. Slepian, “With each new incident of anti-abortion violence, the previously unthinkable becomes commonplace—that vandalism could turn to murder, that slayings could move from the clinic to inside the home.” The murder of Dr. George Tiller is even more horrific in that he was killed in a house of worship as he and his family attended church services.
There is no common ground when it comes to violence of this nature. All groups in the abortion debate, whatever their personal opinion on abortion, must condemn such brutality in the strongest possible terms. Failure to make such condemnation is acquiescence to violence and intimidation. Only by standing together can we ensure that acts of brutality end.
In fact, even some anti-abortion groups condemned the killing. Here are the words of Troy Newman of Operation Rescue from a June 3, 2009 editorial in USA Today:
The fundamental tenet of the pro-life movement is that human life has intrinsic value and is deserving of protection from the moment the seed and egg unite, until natural death. To take a life without due process devalues all life.
We at Operation Rescue were shocked to hear of the killing of late-term abortionist George Tiller and were among the first groups to denounce the cowardly act that took Tiller’s life. It was not justice, but vigilantism, which must be abhorred by a society that embraces the rule of law over anarchy.
With even the anti-abortion movement condemning the murder, how odd it seems that the American Academy of Family Physicians (Working for Family Medicine, Working for You), of which Tiller was a member, refused to issue a statement. A strongly critical commentary by Dr. Joshua Freeman (The Murder of George Tiller – Where is Family Medicine’s Response) in this month’s Family Medicine explored the reasons cited by the Academy for this refusal. The AAFP pointed to a policy that it “does not comment publicly on a member’s death (regardless of how it occurred) but expresses condolences privately to the family.” Of course George Tiller did not merely die. He was murdered. He was not simply murdered. He was assassinatedfor carrying out his duties as a physician. One cannot help but remember the comments of ACOG:
All groups in the abortion debate, whatever their personal opinion on abortion, must condemn such brutality in the strongest possible terms. Failure to make such condemnation is acquiescence to violence and intimidation.
Barriers to Abortion Access in New York: 3 case studies
We then considered three case scenarios illustrating the barriers to abortion access in New York State. Each case came with a series of discussion points. One point, considered in each of the cases, was the role of abortion in current health care reform proposals. (All identifying information has been removed or altered in these cases).
Case 1: Teresa is a 22 year old woman, G1P1, who comes to your office for a refill of her Nuva-Ring. She reports that she had actually run out 4 weeks ago, but couldn’t afford the time off from work at the Post Office to get in any sooner. She had unprotected sex 2 weeks ago. Her pregnancy test is now positive. Teresa is sure she cannot afford to have another baby right now. She decides with you to have an abortion. You give her the number to call Planned Parenthood to schedule it, and she calls you back later to tell you her insurance does not cover the procedure because she is a federal employee.
Discussion Points:
The Hyde Amendment bans the use of federal funds for abortions except in cases of life endangerment, rape or incest.
In addition, 32 states and the District of Columbia have prohibited the use of their state Medicaid funds for abortions except in limited cases allowed under the Amendment.
What is your role as her primary care doctor in facilitating her timely access to abortion care?
What are the implications for a universal federal health plan?
Case 2: Angela is a 31 year old woman G6P4, who works as a babysitter “off the books,” and comes to your office because she is pregnant and wants an abortion. You know that she has Medicaid so you refer her to the local abortion clinic for care. She calls you the next day to tell you she was denied care because her insurance does not cover abortion. You are confused because in New York Medicaid does cover abortion, so you call the clinic. They tell you that your patient has Fidelis (a Catholic HMO) and Fidelis does not cover abortion care.
Discussion Points:
What is your role as her primary care doctor in facilitating her timely access to abortion care?
What happens with Medicaid HMO’s that are “owned” by the Catholic Church?
What does this mean about how our tax dollars are being spent?
Can Angela use her Medicaid to pay for her abortion?
Would she be covered by a federal health plan?
Case 3: Monica is a 16 year old woman, G0P0, currently attending Roosevelt High School. She was sent to you by her school-based health center because she had a positive pregnancy test. Monica’s parents have insurance, but she does not want them to know that she is pregnant. After talking to you, she decides she would like an abortion. But she stresses the importance of not letting her parents find out. She tells you that last year her 18 year old sister got pregnant and they kicked her out of the house.
Discussion points:
What are the rules in New York State regarding confidentiality for teens around pregnancy care?
Can she get other insurance to pay for her abortion?
What are the systems issues around eligibility for Medicaid?
What is your role as her primary care doctor in facilitating her access to abortion care?
Among the most popular posts on the portal have been those in our series on Free and Low Cost Health Care. In this post I would like to emphasize the importance of comparison shopping for medications. Prices for the same medication can vary dramatically from pharmacy to pharmacy. I would like to illustrate this by sharing the story of one of my patients.
An unpleasant experience at CVS
The patient was an 80 year old woman who had just undergone her first round of chemotherapy for cancer. Her physician prescribed Ondansetron, the generic version of Zofran, an anti-nausea drug used primarily in cancer treatment. Ondansetron is generally taken twice a day and the physician prescribed sixty 8 milligram pills in anticipation that the patient would undergo multiple rounds of chemotherapy.
When the patient went to pick up the prescription at her local CVS she was asked to pay $900. When she demurred from what seemed like an excessive price, the pharmacist offered to supply a lesser quantity of pills – 10 for $150. This was still the same price, but a lesser quantity of pills. The patient was informed that all pricing of drugs was done centrally by CVS and that nothing could be done at the store about the price. She left the pharmacy and asked me for assistance.
I checked my Epocrates software and learned that thirty 4mg Ondansetron tablets were available on drugstore.com for about $39.99. The equivalent price for this patient’s prescription (120 4mg tablets) would be $160, not $900. To verify that this was a fair price I called a local pharmacy I use frequently in the Bronx and asked them how much they charged for sixty 8 milligram tablets. I was told that they could sell this for $135, perhaps less if my patient did not have much money. When I mentioned the CVS price of $900 the pharmacist remarked, with a touch of irony, “that’s quite a mark-up.”
The “mark up” in this case meant that CVS charges roughly six times what other pharmacies are charging. I would consider this to be price-gouging (“pricing much higher than is considered reasonable or fair“). It is particularly concerning that the victim of this was a vulnerable elderly patient undergoing her first round of chemotherapy. Fortunately, she was able to get her medicine for considerably less at a pharmacy I recommended.
CVS responds
I wrote to CVS about this case and here is the gist of their reply:
1. CVS’s two primary drug chain competitors charge more for Ondansetron.
Learning that three of the major pharmacy chains all charge six times the going rate for Ondansetron is hardly reassuring. And, as I never tire of repeating to my sons, “the fact that someone else gets away with doing something wrong, doesn’t mean you should do it.”
2. CVS also sells other anti-nausea medicines (notably Prochlorperazine and Promethazine) at considerably less, about $10 for a ninety day prescription.
This may well be true, but what exactly does it mean for my patient? Certainly, CVS cannot suggest that she should have exercised some type of medical judgment that Promethazine (a drug she undoubtedly never heard of) was equivalent to the medicine prescribed by her oncologist. Should she have had the oncologist paged at 6PM to request a cheaper medicine? And what if the oncologist had stated that drugs like Ondansetron are considered among the drugs of choice for chemotherapy related vomiting? (See, for example, The Medical Letter, 12/15-29/2008)
3. Finally, CVS noted that it provided a variety of other services, such as expanded hours and online prescription ordering, that were not offered by its competitors.
Yes, but do such services justify these prices? And will my patient be making an informed choice when she spends the extra $700 plus dollars for the CVS extras?
Let the buyer beware
The most important lesson of this story is that drug prices vary dramatically from store to store. The chain stores are not always the cheapest. And, as many patients learn, you might have better luck bargaining with a local pharmacist.
What are the larger implications of this case?
As the debate over health care reform rages in Washington, it is important to keep in mind the fundamental question we face: Is health care just another commodity (like bricks or toothpaste) or is it a human right?
The social argument for making health care a commodity is based on the idea that market rationality will create an efficient health care system. Individual consumers guided by rational self-interest will make wise choices, rewarding efficient health care suppliers with their patronage and punishing inefficient health care suppliers. Of course, no actually existing health care system is run this way. And there are many ways in which health is not like a commodity. Nonetheless, the belief that rational markets will create efficiency in health care is behind many recent reforms internationally and the current proposals to have insurance companies administer the US health care system.
But a case like that of this patient shows several of the weaknesses of this argument. Having just received her first session of chemotherapy and without any medical expertise, this patient was particularly vulnerable and clearly in no position to make the presumably rational choice of – for example – calling up a variety of pharmacies to ask for alternate prices. Or of calling up her oncologist and querying her oncologist’s medical judgment. Or of deciding that she would prefer more nausea to less money.
Indeed, can there be an economically rational choice with respect to nausea versus money?
It might be argued that the responsibility for economic rationality lies with the physician, not the patient. But in this case the physician had prescribed a generic medication, an economically rational choice. Is one really to expect physicians to know the prices of all the medications they prescribe at all the potential pharmacies their patients visit?
This is a dramatic case, but the issues are similar in less dramatic ones.
Wouldn’t the rational thing be for the government to assure that people get the drugs they need and negotiate real prices with the drug companies? This solution is not without its own set of problems, but surely they are better than what happened to my patient.
A suggestion for action on this issue:
This story is old news. In August of 2004, the (then) New York State Attorney General Elliot Spitzer released a survey of drug prices in the state and documented “Sharp Price Differences … in Common Prescription Medications.” To remediate this situation the Attorney General’s office set up a website that would allow consumers to comparison shop the 150 most common drugs: http://rx.nyhealth.gov/pdpw/. Other States have undertaken similar initiatives.
And yet the price disparities continue to exist. Perhaps this should be one of Project Censored’s top censored stories. They take nominations at this link.
Disclaimers
The patient in this case graciously provided me with permission to share her story. I have no financial interests in any pharmaceutical company or drug store chain. I would not want readers of this column to construe this story as a specific endorsement of drugstore.com. Buyers should beware, always.
This website has a very extensive list of resources. For example, it lists 170 dental providers and 687 clinics. Each listing provides detailed information about the provider, including address, phone, services provided and even links to provider web pages. It is also possible to search for providers by zip code and distance you are willing to travel. The site also has a help phone number: (866) 370-HITE.
Here is a description of the site taken from their FAQ page:
The Health Information Tool for Empowerment (HITE) is the first online directory of health and social services specifically for uninsured and under-insured New Yorkers. With the click of a mouse, HITE allows professionals to link their underserved clients with a broad array of health and support services.
HITE has two components:
Resource Directory. A comprehensive directory containing thousands of national, state, and local organizations and programs available to low-income, under-insured, and uninsured people, as well as links to dozens of Web sites that provide information on everything from how to apply for public health insurance to where you can get free or low-cost medications.
Eligibility Calculator. Eligibility screening tool for public health insurance, private health insurance, and other public benefits programs. HITE links to two screening tools. The NYC Human Resources Administration pre-screening tool helps determine whether their clients meet the basic eligibility requirements for one of New York’s publicly funded health insurance programs: Medicaid, Child Health Plus (CHP), and Family Health Plus (FHP); or for a low-cost private insurance program. ACCESS NYC, sponsored by the City of New York Mayor’s Office screens for eligibility for public health insurance and other public benefits/government entitlements.
After our earlier posts on free and low-cost health care in New York, we were approached by someone seeking care for a broken tooth.
Our earlier post had suggested the NYU College of Dentistry Clinic and similar clinics at other dental schools. We also mentioned New York City Department of Health dental clinics for people up to age 21. (Our patient was 23).
If you have no insurance, this is a useful site to visit. It provides a screening tool (it shows up as a sidebar on each page) to help you determine if you might be eligible for any public or private insurance plans.
Finally, – in terms of free non-dental services – this week we learned the NYC DOH offers free condoms and lubricants to organizations that will distribute them for free. Click on this link.
Brush your teeth and floss after each meal, stay away from sweetened drinks and have fun (safely).
As part of our series on free and low cost health care in New York I wanted to share a few resources on free and low cost medicines.
Dr. Brian Alper (a family physician who foundedDYNAMED) has put together a very useful set of clinical links for physicians at: www.myhq.com/public/a/l/alper. Among the many categories in this list are six links to “indigent drug programs.” To test these sites out, I decided to look up Herceptin, an anti-cancer agent made by Genentech. [I was recently asked to find this drug for a medically indigent patient.]
Needy Meds: is a not-for profit “with the mission of helping people who cannot afford medicine or health care costs.” The information at NeedyMeds is available anonymously and free of charge. The most useful part of this website is the listing of drugs – both generics and brand – that are available from patient assistance programs (PAP’s). If you find a drug and a PAP, many of the applications can be downloaded from the website. Most of the links seem to be from 2008. The site also has a link to free clinics. I easily found Herceptin on the Needy Meds site with links to application form in English and Spanish as well as the Genentech website.
Rx Assist is managed by Astra Zeneca and claims to be the “Web’s most current and comprehensive directory of Patient Assistance Programs.” The Rx Assist site has a searchable database so you don’t have to scroll down lists. Herceptin was also easy to find on RxAssist, but the site linked only to the English application and the Genentech site.
Benefits CheckUp is run by the National Council on Aging and is a very different type of site. It provides information on a wide variety of benefits – housing, food, medication, medical care, utilities, “and more.” It works a little bit like an online social worker. To find information on Herceptin (for a fictious patient), I needed to input zip code, age, information about work, income, and assets; this process generally takes 10-15 minutes according to the website. I could easily imagine that it would take much longer if you had to find all the documentation. When this was through, Benefits CheckUp suggested I apply for New York State’s EPIC program (which helps elderly people with prescription costs), New York State Medicaid and also offered the Genentech program. There were links to the Genentech site, application forms, and even a list of documents I would need. Very complete, but a bit daunting in terms of the information I needed to supply.
All three of the above sites linked to a variety of health care resources, not just medications.
Partnership for Prescription Assistance also links to PAP programs. This site required me to enter information (age, location, income, insurance coverage, etc) before leading me to the Genentech site. It did not link directly to the Herceptin application. Unlike the sites listed above PPARx did not provide links to other types of social programs (such as free clinics).
The Medicine Program seemed like a commercial site. Herceptin brought up no hits on the site’s search engine.
Finally, Dr. Alper’s site links to an August 2004 article in the American Family Physician “Curbside Consultation: When Patients Cannot Afford Their Medications” This is a very thorough review of the topic with – in typical AFP style – lots of useful information. According to the AFP article 5.5 million people were enrolled in PAP programs in 2002.
I would note that – based on my personal experience – the typical patient who needs the PAP’s often times does not have access to the internet nor facility with completing forms. So having someone to be their advocate is crucial. This is a weakness of these websites.
A couple of additional suggestions:
Patients should always check to see if they are overpaying. Do this by looking up the prices of medicines on Drugstore.com. Oftentimes pharmacies charge unreasonable prices (people go, after all, to the local store) and lots of money can be saved by shopping around.
A recent blog from Suite 101.com entitled “How to Find Free, Cheap Drugs” offered (among other information) a list of retailers offering low cost or free medications. These include WalMart, Target, K-Mart, and various food chains. For example, “Publix supermarkets offer free antibiotics if you have a valid prescription, regardless of whether you have health insurance. A 14-day supply is offered.”
Some sites I have seen offer to help patients find low-cost drugs from a small fee. Clearly this is not reasonable since this information is available for free.
As I have noted in previous blogs these various efforts do not solve the root cause of the problem: lack of universal access to healthcare (including medications) in the United States. But for patients in need these resources can be helpful.
La Casita de la Salud, the free clinic of New York Medical College
Since our last posting (on 10/8/2008) about free and low-cost health care, we have learned of the following additional resources:
A 2003 article in the Village Voice entitled Free and Low Cost Health Care describes various options available in the City. One of the key issues for many people is dental care and the Voice article suggests the NYU College of Dentistry Clinic. Similar clinics exist at other dental schools and generally charge less than private practice. The New York City Department of Health also has dental clinics for people up to age 21.
There are several additional free medical student clinics which we did not mention in our prior posting. The following list (hopefully complete) is taken from the Cornell site:
The NYU site has a rather extensive list of free and low cost services in New York. The Cornell Site has a shorter list, but it is still worth looking at.
Finally, New Yorkers may want to look at the website of the Mayor’s Office of Citywide Health Insurance Access to learn if they might be qualify for either public or private insurance.
Free and low cost services are vitally important to the many people who are denied coverage by the current US healthcare system. But it is equally important that our society provide care to all who need it, obviating the need for free clinics.
For addtional posts about this topic, click here. We would be happy to post additional resources.
As a follow up to our October 8, 2008 posting on free and low-cost health care in New York City, our friends at Columbia Medical School sent us an announcement about Columbia Student Medical Outreach (CoSMO), a free clinic in operation since 2004. Their website is http://www.cosmoprimarycare.org.
The clinic operates on Saturday mornings in the UrgiCare Center, located on the corner of 166th Street and Audubon Ave in the northern tip of Manhattan. Patients who are interested in more information can obtain details on their website.
Junot Diaz, the Pulitzer Prize-winning author of The Brief Wondrous Life of Oscar Wao, will be joining CoSMO for a book reading and conversation on Friday, November 7th at 7:30pm. All proceeds from the reading will go toward prescription medications for CoSMO’s uninsured patients.
The night will also include free appetizers provided by Mamajuana restaurant, old school hip-hop sounds by DJ Strike (former tour DJ of De La Soul), and visual arts by the Sound of Art collective.
The fine print:
Junot Diaz: A Reading, A Conversation
Friday, November 7th at 7:30pm
Alumni Auditorium
William Black Research Building
650 W. 168th Street
New York, NY 10032
Tickets sold online: https://www.ovationtix.com/trs/pe/769922
$15 general, $10 with student ID
Some of The Brief Wondrous Life of Oscar Wao was originally published as a short story in the New Yorker Magazine. You can also hear Junot Diaz read excerpts from the book online.
[Correction: The day of action on 11/7/1008 has been canceled. See the comment section for another upcoming Rock Dove event.]
The Rock Dove Collective, a “radical community health exchange” is organizing a day of action on 11/7/2008 to find free and low cost health clinics in New York City. The development of a comprehensive list of such clinics – available on the web – would be a great resource.
The NYC Department of Health has free clinics available for STD screening and treatment, dental care, as well as for the treatment of tuberculosis. [In our opinion the City's chest clinics provide the best TB care in New York.] Unfortunately the link to the list of all DOH clinics is down. Calling 311 might be a good place to start to see if a clinic is available for a specific problem.
There are at least three student run free clinics in the city. The Institute for Urban Family Health runs two. The ECHO clinic in the Bronx was the first medical student free clinic, set up by students at AECOM. The New York City Free Clinic in Manhattan is a project of NYU medical students In addtition, students at SUNY/Downstate have organized the Brooklyn Free Clinic.
New York City also has an extensive network of Community Health Centers which provide low cost care to people without insurance.
Free clinics are not the solution to our healthcare problems, indeed they are a symptom of the problem. And yet they also point to what might be the ethos of a national health system devoted not to profit, but to health. I would be happy for interested readers to post additional resources.
What follows is the Rock Dove announcement:
Rock Dove Day of Action!!
Health Clinics for Community Healing
Friday November 7th
10:30am – 4:00pm
Your friendly neighborhood Rock Dove Collective is calling our second Day of Action! On Friday, November 7th, volunteers will fan out across the city, visiting free and low cost health clinics and gathering information about their services from both the staff and the clients who are there receiving services. Our goal is to use this information to create comprehensive profiles of health clinics in NYC, as part of our ongoing effort to make free and low cost health services accessible to those in need.
We will meet up in downtown Manhattan at 10:30am, at a location TBA. Over breakfast and icebreakers, volunteers will receive their travel plans for the day as well as a quick training on how to gather information when visiting a clinic. Volunteers will go out in pairs and hit up 1-2 clinics before we all meet up at 4pm to decompress, share information, eat, drink, and be merry!
How to Contribute:
-Volunteer! Bring your friends! Join us as we hoof it through NYC in search of comprehensive information about free and low cost health services. If you plan on volunteering, RSVP to Freya at freyapowell@gmail.com.
-Donate! If you can’t join us the day of, please donate food and/or cash so that we can feed our volunteers breakfast and snacks, and help them
Tuesday, March 9th: NO SOCIAL MEDICINE ROUNDS ON THIS DATE. POSTPONED UNTIL SUNDAY 3/14.
Wednesday, March 10, 5:30-6:30 PM: AECOM Student-run Social Medicine Course: "Separate and Unequal: Medical Apartheid" Neil Calman, MD and Nisha Agarwal, JD, Forcheimer Auditorium
Sunday, March 14, Social Medicine Rounds in the Community: Noon to 2PM: Visit to the Chua Kien Buddhist Temple, 2011 Clinton Avenue, Bronx, NY. Noon: Discussion, 1PM: Lunch
Tuesday, March 16, 5PM-6PM: Global Health Center: Nicholas Kristoff, co-author Half the Sky: Turning Oppression into Opportunity for Women Worldwide. Robbins Auditorium.
Tuesday, March 16, 7:15 PM: AECOM Student-run Social Medicine Course: "Liberation Medicine" Lanny Smith, MD, MPH Forcheimer Auditorium. NOTE THIS EVENT WILL BE HELD ON A TUESDAY AND AT 7:15PM
Wednesday, March 17, 5:30-6:30 PM: AECOM Student-run Social Medicine Course: "Rentry: Old Fears, New Hopes" Meekaelle Joseph, Forcheimer Auditorium
Tuesday, March 23, 4:30-6:00 PM: Social Medicine Rounds: "Street Medicine" Jim Withers MD, 3rd Floor Conference Room, 3544 Jerome Avenue.
Wednesday, March 24, 5:30-6:30 PM: AECOM Student-run Social Medicine Course: "Street Medicine" Jim Withers MD, Forcheimer Auditorium
Wednesday, April 7, 5:30-6:30 PM: AECOM Student-run Social Medicine Course: "The History & Practice of Community Psychiatry" Thomas Betzler, Forcheimer Auditorium
Wednesday, April 14, 5:30-6:30 PM: AECOM Student-run Social Medicine Course: "Nyaya Health: A Case Study in Developing a Healthcare NGO" Ryan Schwarz and Bijay Acharya, MD, Forcheimer Auditorium
Wednesday, April 21, 5:30-6:30 PM: AECOM Student-run Social Medicine Course: "Refugee and Asylee care: Human Rights for Torture Survivors" Nicole Sirotin, MD, Forcheimer Auditorium
Wednesday, April 28, 5:30-6:30 PM: AECOM Student-run Social Medicine Course: "Ayurvedic Medicine" ∙Bhaswati Bhattacharya, MD, PhD, Forcheimer Auditorium
The views and opinions expressed on this site do not necessarily reflect the views of Montefiore Medical Center, Albert Einstein College of Medicine, Yeshiva University or the Social Medicine Publishing Group.
Health Information Tool for Empowerment
After our earlier posts on 
