Ophthalmologist Rand Paul's Message to ARDS Attendees

Attendees of the 43rd Annual Aspen Retinal Detachment Society (ARDS) Meeting earlier this year were thrilled to have a chance to hear Sen. Rand Paul, MD, deliver an exclusive speech at this year’s meeting. Not long after his speech at the ARDS meeting, Sen. Paul (R-Ky.) declared his candidacy for the Republican nomination for President of the United States.

It hardly needs to be said to readers of Retina Today that Sen. Rand Paul is also Dr. Rand Paul, who remains a practicing ophthalmologist even as he negotiates his duties in the Senate and a run for the White House. Through the valiant efforts of ARDS member Philip J. Ferrone, MD, who performed his residency at Duke University with Dr. Paul, meeting attendees had the opportunity to hear the soon-to-be candidate express his views on a number of important medical and political issues.

Hearing Dr. Paul’s insights was especially valuable not only because he is an ophthalmologist, but also because he sits on key Senate committees that have an impact on our everyday practices. He is a member of the Committee for Health, Education, Labor, and Pensions (HELP) and the committees for foreign relations, small business, and homeland security and government affairs.

Dr. Paul started his remarks by speaking about the sometimes unintended consequences of government actions.

“Does government ever do what we want it to do? Does government ever do something that does what we don’t want it to do?” he asked. He was referring to the 2013 Drug Quality and Security Act, which was passed in reaction to the 2012 nationwide outbreak of fungal meningitis linked to compounded steroid injections from the New England Compounding Center. In that outbreak, more than 750 people were sickened, and 64 died.

“Obviously, nobody wants anybody to die from an injection,” Dr. Paul said. “In fact, I was getting epidural injections that same year, so I’m glad I didn’t get a contaminant. So, should government do something? Yes. The problem is, once government gets going to do something, they catch up people in it who were not part of the problem. Frankly, retina surgeons were not part of the compounding problem. But now you get caught up in it.”

He noted that ophthalmic organizations helped to push for changes to the bill, including elimination of a requirement for patient-specific prescriptions for all compounded drugs. As a member of the HELP committee, Dr. Paul was instrumental in including those changes.

More broadly, he spoke about possible unintended consequences of the Patient Protection and Affordable Care Act, often referred to as Obamacare.

“Obamacare in general is going to have the intended result, helping people who don’t have insurance to have more access to medicine,” he said. “But we have to look at the unintended consequences also. We have to look at, where does the money come from? It’s easy to be for helping people, but if you’re not for where the money comes from, you really aren’t answering the ultimate question.”

Dr. Paul also spoke about the health of the Medicare program itself. As legislators, he said, he and his Senate colleagues are responsible for the entire program, not just one aspect or another. “I’m a physician. Like you, I don’t like the Medicare cuts. I’m sympathetic. But here’s the problem. For every dollar you pay in taxes throughout your working career, you’re going to take out $3.50 from Medicare. Not just you, but everybody, all the patients you treat. That’s an overall global problem, and it can’t be fixed by just saying, ‘We need to have a better fee for injecting anti-VEGF therapy.’ We have to understand and fix the overall problem.”

Numerous solutions to the problem have been proposed, including cutting fees and raising Medicare taxes. Dr. Paul’s preferred solution, he said, includes slowly raising the age of Medicare eligibility.

“I think you probably have to do a number of things,” he said. “I’ve been proposing letting the eligibility age go up gradually, and also means-testing the benefits. There are people who resist means-testing and say, oh no, we can’t differentiate rich from poor. But if we don’t, these programs, Social Security and Medicare, are done for.”

Dr. Paul concluded his remarks by speaking generally about careers in medicine. He said it frustrates him to hear physicians say they do not want their children to go into medicine.

“That does make me sad. I would still practice even if I didn’t get paid,” he said. “But I think we need to try to fix it and be constructive. I want to be part of the solution. I hope you will want to be part of the solution. Be part of something big. Be part of something where you can recommend to your son or daughter that you’d like to have them in medicine.”

A subsequent question-and-answer session touched on a number of topics. Dr. Paul said we are lucky to live in an age when we have many sources of news with varying slants so that we can compare sources and try to triangulate the truth on any particular issue. He said addressing tort reform on a national level is a challenge because malpractice cases are handled in state courts, not federal. He noted, however, that several states have instituted innovative approaches, such as tribunals that hear cases before they reach the court. In this way, he said, the 50 states serve as laboratories for good ideas that can be borrowed and traded back and forth.

All in all, the thoughts shared by Dr. Paul with the ARDS audience were insightful and timely. It is not often that we get a seat at the table with an ophthalmologist who is in such a position of power with regard to the governmental issues that affect us all. Attendees appreciated his generosity in sharing his time, ideas, and opinions. It was a great advantage to host a guest speaker who understands medicine and ophthalmology in the unique and intimate way that Dr. Paul does. n

Timothy G. Murray, MD, MBA, FACS, is the founder of Murray Ocular Oncology and Retina in Miami, Fla. He is a member of the Retina Today Editorial Board. Dr. Murray may be reached at +1-305-487-7470 or at tmurray@murraymd.com.