August 6, 2005
Killer Flip Flops
Three in every four motorists have admitted they find it hard to drive in flip flops and road safety experts have warned that wearing the sandals in the car could be a lethal decision. . . .
And if that is not sufficiently scary . . .
The Sun also says that German researchers revealed last year that 14 out of 25 pairs of flip flops they studied contained toxic chemicals known to lower sperm count in men and attack the liver, kidneys and reproductive organs.
August 5, 2005
In response to the recent Slate article by Arthur Allen that I posted, I received this thoughtful reply and comment from Jay C. He also provides an article discussing the recent decline in autism rates in California, a decline that may relate to the removal of thimerosal from a variety of childhood vaccines. Jay writes,
I just read Arthur Allen's article in Slate after linking to it from your blog. I am the father of an eight-year-old autistic boy, and, like many parents of kids on the autism spectrum, I think it's premature to take one side or the other on the thimerosal debate. I certainly do not accept the thimerosal/autism connection hook, line and sinker. I also agree with others who believe RFK, Jr.'s recent article overstated the case. Mr. Allen's article, on the other hand, goes way, way too far in the other direction, IMHO. He glosses over some facts, conflates issues (e.g., citing research tending to invalidate the MMR vaccine/autism connection, which has nothing to do with the thimerosal debate) and, most tellingly, completely ignores at least one major development -- the recent DECLINE in the incidence in autism diagnoses as measured by the State of California, a decline which roughly coincides with the removal (or least reduction) of thimerosal from childhood vaccines. (See cut and pasted text below with heading California's Declining Rates of Autism") The data are far from conclusive, and the decline, at least from my lay perspective, seems modest, but how does Mr. Allen get away with ignoring this news?
California's Declining Rates of Autism
For those long convinced of a link between thimerosal in childhood vaccines and the rise in autism rates across the country, vindication may finally be at hand. New data compiled by the California Department of Developmental Services indicates that, while the number of children receiving state services for autism spectrum disorder (ASD) continues to grow, diagnoses of this condition are declining. The numbers peaked in 2002 with a record 3259 cases. In 2003, the number of new cases fell to 3,125. In 2004, the number was 3,074. For the first half of 2005, there were 1,470
new cases, compared to 1,518 in the same period in 2004. The ASD diagnostic and tracking system in California is considered to be the best in the nation.
Experts disagree about what has caused the decline. "Perhaps whatever caused [the autism rates] to go up ... is no longer present," said Dr. Robert Hendren, xecutive director of the University of California, Davis MIND Institute, which researches neurodevelopmental disorders. "It's all speculation. I wish we had good studies."
Others point to the fact that the decline in new cases roughly corresponds to the removal of thimerosal from childhood vaccines, a process which began earlier this decade following a federal recommendation made in 1999. Parent activist, Rick Rollens, who played a key role in the creation of the MIND Institute, says "we can argue till the cows come home about what caused the increase but before 2002, every quarterly report had shown an increase over the previous year. Now, that is no longer the case." According to the department, about 90% of all autistic children are entered into the system before age 6. The data do not include children under the age of 3. "This means," Rollens said, "that children born since the time that mercury was phased out of vaccines, are just now entering the system." He theorized that the slowdown could thus reflect the change in vaccination practices. The Department of Developmental Services does not compile information on vaccination rates among the children in their system.
Mark Blaxill, Executive Board Member of the non-profit organization Sensible Action For Ending Mercury-Induced Neurological Disorders (SAFE MINDS), cautions that, "... it is too early to draw conclusions from the California data. It is certainly encouraging that the rate of increase in autism has leveled off and even shown a bit of a decline, but we need to have more data, more time and more of a decrease in new cases before we can draw firm conclusions. We need to remember that thimerosal-containing vaccines (TCVs) were never recalled and remained in inventory long after the transition in vaccine production that started in 2001. Second, we have a new TCV problem, flu vaccine, which has been recommended to both infants and pregnant women." He further suggested that there is little serious risk of influenza to healthy women and children--that the CDC statistics on mortality from flu are exaggerated, including deaths from pneumonia--and that those who do wish to be inoculated against influenza should specifically request a mercury-free vaccine.
California's data are considered particularly reliable because the state guarantees access to special education for all hildren diagnosed with autism and other developmental problems.
> Sources: www.safeminds.org, www.sacunion.com, www.latimes.com
For those who are interested in a further discussion of this topic, Jay notes that this coming Sunday, August 7, 2005, Meet the Press will provide a forum to hear both sides of the issue. Tim Russert, the host will moderate, and one of the guests will be David Kirby (the author of Evidence of Harm) and one of the leading physician/scientists from the IOM. [bm]
JAMA Law and Mental Health Articles
In "Criminal Records of Homicide Offenders" (JAMA 2005;294:598-601), Philip J. Cook and colleagues set out to answer two questions: (1) Do adults with a criminal record have a higher likelihood of committing a homicide? (2) If so, by how much would a hypothetical intervention program directed toward this group lower society’s overall rate of homicide, if the program could reduce the group’s homicide commission rate to the risk level of adults without criminal records? Using a case-control analysis and data from Illinois arrests and felony convictions, the authors concluded that persons arrested for homicide were 10 times more likely to have a prior felony conviction than the general population. The authors calculated that the hypothetical intervention might reduce the homicide rate by 31 percent. Here is a link to the article’s abstract:
A second article (JAMA 2005;294:563-570) compares a specific type of psychotherapy with "usual care" in preventing future suicide attempts. This form of treatment, called "cognitive therapy," was developed by psychiatrist Aaron T. Beck, M.D. (one of the article’s coauthors), and has proven effective for treating many psychiatric conditions, including depression. In this study of persons who had recently attempted suicide, patients in the experimental group underwent ten sessions of cognitive therapy. In these sessions, therapists and patients tried to identify thoughts, images, and beliefs that occurred just before the suicide attempt; then, therapists helped patients develop thinking and behavior strategies to cope more effectively with stressors. Patients who received cognitive therapy had lower likelihoods of subsequent suicide attempts and less depression than patients in the usual-care group. Here’ a link to the article’s abstract:
Finally, in an editorial (JAMA 2005;294:623-624), Drs. Thomas Cole and Richard Glass point out that in the U.S., "suicide and homicide are the fourth and fifth leading causes of death for persons" 10-60 years old. Studies show that most persons who attempt or succeed in committing suicide have a diagnosable mental disorder. Although most people who have mental illness are not violent, scientific investigations over the last 15 years confirm that having certain types of psychiatric disorders and mental symptoms increase a person’s statistical risk of acting violently. On the basis of the issue’s two other articles and several other published studies, Drs. Cole and Glass believe that "[i]Identifying persons at risk of violence to themselves or others and offering or compelling them to receive mental health treatment services is warranted." They acknowledge, however, that this would raise concerns about confidentiality and discrimination, and that many pe! ople who n eed psychiatric care
August 4, 2005
Morning After Pill
There has been quite a bit in the news recently about the morning-after pill as two Governors, who are also potential future presidential candidates, have taken strong stands against making the pill more easily available. This morning, National Public Radio ran a thorough and interesting piece on some of the debates involved over whether the morning-after pill is a contraceptive device or an abortifacient. You can listen here.
I earlier in the week provided the link for the new NARAL blog. To provide some balance, here is a link to the American Association of Pro-Life Obstetrician and Gynecologists website that provides some helpful overview on their point of view. [bm]
New Autism Article
Autistic Disorder, or (as it is more commonly called) autism, is one type of "pervasive developmental disorder" usually diagnosed in childhood. Individuals with autism display marked impairments in social interaction, often evidenced by abnormal or repetitive behavior, lack of peer relationships, highly restricted preoccupations, and communication abnormalities. (In the movie "Rain Man," Dustin Hoffman played an adult with autism.) Many websites list the American Psychiatric Association’s diagnostic criteria for autistic disorder, including this one: http://locus.umdnj.edu/autism/dsmiv.html
Most children with autism unquestionably suffer from disabilities that interfere with their ability to learn, but they may encounter difficulties in receiving needed educational support from public school systems. A valuable article — with many useful links to additional information — appears on the current Medscape website, at this URL:http://www.medscape.com/viewarticle/508088?src=hp12.infocus (free with registration)
The article is an interview with Jill G. Escher, an attorney who has a child with autism and who works in the field of autism law. In the interview, Ms. Escher describes statutes, policies, rights, and procedures available to gain appropriate services for children with autism. She also discusses what parents might do to get their children evaluated by experts, information sources for parents concerning books and websites about the law and autism, and the pros and cons of attorney representation. Although the article is directed toward physicians who treat patients with autism and the parents/guardians of these children, the article provides a useful introduction to attorneys and others interested in this topic.
August 3, 2005
Dorf's 5-minute Guide to the First Year of Law School
If our students get hold of Prof. Dorf's 5-minute intro to the first year of law school, a lot of us are going to be looking for a new line of work! And if he makes good on his threat to cover the entire upper-level curriculum next year, we will be shutting all these schools down.
For those unfamiliar with Dorf's inspiration for this column, click here for Fr. Guido Sarducci's 4-minute sketch, "The Five-Minute University."
Dead Woman Gives Birth, Dies Again
From today's AP/Yahoo:
Brain-Dead Woman Dies After Giving Birth
By MATTHEW BARAKAT, Associated Press Writer
ARLINGTON, Va. - A brain-dead woman who was kept alive for three months so she could deliver the child she was carrying was removed from life support Wednesday and died, a day after giving birth. . . .
Susan Torres, a cancer-stricken, 26-year-old researcher at the National Institutes of Health, suffered a stroke in May after the melanoma spread to her brain.
Her family decided to keep her alive to give her fetus a chance. It became a race between the fetus' development and the cancer that was ravaging the woman's body.
Doctors said that Torres' health was deteriorating and that the risk of harm to the fetus finally outweighed the benefits of extending the pregnancy.
Torres gave birth to a daughter, Susan Anne Catherine Torres, by Caesarean section on Tuesday at Virginia Hospital Center. The baby was about two months premature and weighed 1 pound, 13 ounces. She was in the neonatal intensive care unit. . . .
It's a tragic story, but for our purposes, there are at least a couple of points worth noting:
- Keeping a brain-dead patient's organs and metabolic processes tooling along at a level that provided a healthy, supportive environment for the fetus must be close to the record for such things. The last time I remember doing research on this in PubMed (in 2003), the longest period of support for somatic function of a pregnant woman's brain was 107 days, from 15 to 32 weeks' gestation age. As the authors of that meta-analysis stated, "Preservation of uterine/placental blood flow is the most important priority during somatic support. Imprecise autoregulation of the uterine vasculature during maternal hypoxemia or hypotension makes this goal a significant challenge." Crit Care Med. 2003 Apr;31(4):1241-9. A year later, it appeared that the 107-day mark was still the longest period of successful support. Intensive Care Med. 2004 Jul;30(7):1484-6. The 2003 article goes on to discuss "special considerations for nutrition; medication use; cardiovascular, respiratory, or endocrine therapy; fetal monitoring; hormone replacement; and ethical concerns."
- Ah, yes: the "ethical concerns." For almost a generation, ethicists have written about the tendency of the law in at least some jurisdictions to regard women as "fetal containers," usually in the context of treatment disputes involving unwanted C-sections or other recommended interventions. As the technical ability of intensivists and obstetricians to support somatic brain function until 32 weeks improves, will there need to be a similar debate over the development of a new standard of care for brain-dead pregnant women?
- Ah, yes: "brain-dead pregnant women." In Virginia, as in all other states, "brain dead" means "dead." See Virginia Code § 54.1-2972. (Actually, to be "medically and legally dead" in Virginia, a patient must lack "brain stem reflexes, spontaneous brain functions and spontaneous respiratory functions." I'm not sure, but I don't think the third diagnostic criterion adds anything to the first two.) Once dead, a patient can't die again. But, amazingly, 37 years after the Ad Hoc Harvard Medical School report on "irreversible coma," the public's resistance to the notion of neurological criteria for death is curiously persistent.
New Antitrust Cases
- Nilavar v. Mercy Health System-Western Ohio, No. 3:99cv612 (W.D. Ohio, July 5, 2005), pdf: "The U.S. District Court for the Southern District of Ohio has granted summary judgment to the defendants in a case involving a hospital system's exclusive contract with a radiology group. The court, applying geographic market analysis used in hospital merger cases, held that the plaintiff failed to present evidence of a proper geographic market."
- Jackson, Tennessee Hospital Co., LLC v. West Tennessee Healthcare, Inc., o. 04-5387 (6th Cir., July 11, 2005), pdf:
"The 6th Circuit, in Jackson, Tennessee Hospital Co. v. West Tennessee Healthcare, Inc., held that the state action doctrine immunizes from antitrust liability government hospital authorities and the private entities with which they contract. The defendants in this case were Jackson-Madison County General Hospital District (the Hospital District) an entity created by the State of Tennessee to own, manage, and operate hospital facilities and Blue Cross Blue Shield of Tennessee, a private payor with whom the Hospital District contracted. The plaintiff, a private hospital, filed suit alleging various anticompetitive acts, including exclusive contracting with doctors and insurance companies, acquiring real estate around the plaintiff's site to block its expansion, and bundling its services. The defendants claimed that the state action doctrine barred antitrust liability, an argument accepted by both the district court and the 6th Circuit."
I've quoted brief excerpts from the e-alert - there's more where that came from, but access is limited to members of the practice group. [twm]
New NARAL Blog
If you have an interest in reproductive rights, you may want to check out NARAL Pro-Choice blog here. It contains many posts from a variety of people who provide overviews of the law in this area as well as opinon pieces. It has a clear viewpoint and provides interesting and informative updates. [bm]
In Defense of Thimerosal
Today's on-line magazine Slate has a story by Arthur Allen concerning the continuing debate over Thimerosal. He cannot believe that a debate continues about the drug given all the studies proving it safety. He writes.
Parents who are convinced thimerosal damaged their babies attack the big epidemiological studies as a whitewash by vaccine makers. They're especially concerned about the U.S. study, which in its early drafts showed a link between thimerosal and neurodevelopmental problems—though not autism, despite Kennedy's claims to the contrary. He extols the studies by David and Mark Geier, a father-and-son team who work out of their basement in Silver Spring, Md. The Geiers have done a series of studies published in obscure journals that purport to show a link between autism and mercury, and they spend a lot of their time testifying on behalf of allegedly vaccine-injured kids. In the polite language of the Institute of Medicine report that dismissed the vaccine-autism link, the Geier studies are "uninterpretable." The main Geier approach is to mine data from a CDC reporting system that contains a mishmash of real and garbage vaccine-injury allegations, according to the vast majority of the scientists who work in this area. The Geiers have found a sixfold increase in autism in children who got thimerosal-containing vaccines. But nearly all the reports of autism they tallied came after allegations of the vaccine link had been publicized in the newspapers. In other words, the Geiers report the public's response to a scare as if it were meaningful data.
Probably the most damning epidemiological evidence against the vaccines-cause-autism theory, and another point that Kennedy gets wrong, is contained in the document that got critics started on their claim of a vaccine-provoked epidemic—a 1999 Department of Developmental Services report from California. Like reports from other states in the country, it shows a dramatic increase in autistic children seeking state services, from 2,778 autistics on the rolls in 1987 to 10,360 in 1998. An impressive diagram of this increase was projected on a screen at a Committee for Government Reform hearing chaired by Indiana Republican Dan Burton, who believes that vaccines gave his grandson autism. "Look at that graph," Burton said. "They are having an epidemic out there." But the graph actually vindicated vaccines. MMR vaccination began in children born in 1970, but there was no increase in autism reports in the state until 1980, which also happened to be the first year the psychiatric definition of autism spectrum disorders changed. A 2001 study showed that while MMR vaccination rates increased 14 percent from 1980 to 1994, autism intakes in California's state programs increased 373 percent. The increase also showed no apparent connection to the addition of thimerosal-containing vaccines to state pediatric immunization schedules.
August 2, 2005
Book Review: Don't Read Kevin Trudeau
Just in case you were thinking of purchasing the new bestselling advice book by Kevin Trudeau, "Natural Cures 'They' Don't Want You to Know About" Salon.com has a review that will save you some money (as well as your sanity - the book sounds truly terrible).
Step right up folks, and tune in to the paranoid world of master huckster Kevin Trudeau, whose book "Natural Cures 'They' Don't Want You to Know About" climbed to the top spot on the New York Times bestseller list for advice titles last weekend. The Federal Trade Commission virtually banned Trudeau from the airwaves last year in an attempt to "shut down an infomercial empire that has misled American consumers for years." But by shifting his business model from selling supposed cure-all products to peddling books, which are protected by the First Amendment, Trudeau has been able to slip past federal regulators and continue to sell snake oil to the masses -- first through his infomercial and now via mainstream book retailers like Amazon.com and Barnes & Noble. . . . .
The book, which Trudeau self-published, is a paranoid mixture of self-evident and widely known health facts with very few, if any, natural cures. It is almost amusingly campy -- except that the information is so odd, and alarmist. "Natural Cures" is poorly sourced and peppered with jaw-dropping absurdities, such as "The sun does not cause cancer. Sun block has been shown to cause cancer" or "All over-the-counter nonprescription drugs and prescription drugs CAUSE illness and disease." Or, this tribute to logic and language: "If you read the labels of everything you put in your mouth, you would see the name [sic] of various chemicals. All the chemicals listed are dangerous man-made chemicals. They are poisons. If you were to take any of those chemicals and ingest a large amount at one time, you would probably die. Therefore they are in fact poisons."
New Study on Immigrants' Use of Healthcare
According to the Washington Post, a new study in the American Journal of Public Health reports that immigrants receive an average of $1,139 worth of care per year, compared with $2,564 for non-immigrants. The study was launched to combat the belief that immigrants take advantage of the American health-care system. Co-author Sarita Mohanty, an assistant professor of medicine at the University of Southern California says that "Our study lays to rest the myth that expensive care for immigrants is responsible for our nation's high health cost... The truth is immigrants get far less care than other Americans." The study found that immigrants, both legal and illegal, consumed eight percent of total health services even though they account for 10 percent of the population, with the largest gap among immigrant children. The researchers say health-care costs for the poorest immigrant children are 84 percent below those of native-born kids. Immigrants, on average, receive about half the health care services provided to native-born Americans, on average several hundred dollars less a year in health costs.
Other immigration experts counter that tracking per capita spending ignores the larger societal costs of a growing immigrant population, which is far less likely to have health insurance. Steven Camarota, research director at the Center for Immigration Studies responds to the study by saying that "The fact that immigrants, when uninsured, might use 27 percent less medical care doesn't change the fact that they're 200 percent more likely to be uninsured in the first place...Why have a system that allows in so many people aren't self-sufficient?" He says that immigrants account for 18 percent of the costs associated with the uninsured--expenses likely to be borne by taxpayers and charities. However, both sides recognize the many barriers, including cultural and language differences, lack of high school education, land ow-income neighborhoods with fewer hospitals, clinics, and physicians and pharmacies for immigrants in obtaining affordable health care.
The authors, who are members in the liberal Physicians for a National Health Program, offer the solution of providing every person with basic healthcare coverage, as well as lifting restrictions on government health programs and easing entry into employer- provided health plans. For more information on Medicaid and SCHIP eligibility for immigrants, see CMS.
Lindley Bain provided assistance with this post. [twm]
Palliative Care and Income
Today's New York TImes reports on a new study published in the Journal of Palliative Medicine about the availability of palliative care in the United States. According to the New York Times review of the study,
People whose net worth is over $70,000, the median in the United States, are 30 percent less likely than poorer people to feel pain at the end of their lives, a difference that persists even when controlling for age and severity of illness, a new study shows.
The findings, which appear in the August issue of The Journal of Palliative Medicine, used information on more than 2,600 adults over 70 who died from 1993 to 1998. The researchers interviewed proxies, usually surviving spouses, to gather information about pain, depression, delirium and difficulties in breathing or eating at life's end.
Wealth was a strong predictor of how many different types of discomfort an older adult suffered, with those whose net worth was over $70,000 having a 9 percent lower risk of experiencing multiple symptoms. . . . .
The precise reasons that more affluent people suffer less are not known, but the authors speculate that richer people may be more demanding of better care, have access to care beyond what insurance provides, have more social supports and end their lives in settings with high-quality care.
Perhaps extra wealth should allow you to buy designer shoes, a nicer car, or a larger house with a pool, but pain relief at the end of life?? We need to disconnect patient income level from quality of health care and soon! [bm]
August 1, 2005
New from the GAO
Here are some summer pubs from the Government Accountability Office (f/k/a General Accounting Office):
- Medicare: Concerns Regarding Plans to Transfer the Appeals Workload from SSA to HHS Remain, GAO-05-703R, June 30, 2005
- Influenza Pandemic: Challenges in Preparedness and Response, GAO-05-863T, June 30, 2005
- Medicaid Fraud and Abuse: CMS's Commitment to Helping States Safeguard Program Dollars Is Limited, GAO-05-855T, June 28, 2005
- Medicaid: States' Efforts to Maximize Federal Reimbursements Highlight Need for Improved Federal Oversight, GAO-05-836T, June 28, 2005
- Ryan White CARE Act: Factors that Impact HIV and AIDS Funding and Client Coverage, GAO-05-841T, June 23, 2005
- Mail Order Pharmacies: DOD's Use of VA's Mail Pharmacy Could Produce Savings and Other Benefits, GAO-05-555, June 22, 2005
- Medicaid Drug Rebate Program: Inadequate Oversight Raises Concerns about Rebates Paid to States, GAO-05-850T, June 22, 2005
- Health Centers And Rural Clinics: State and Federal Implementation Issues for Medicaid's New Payment System, GAO-05-452, June 17, 2005
- Medicare: More Specific Criteria Needed to Classify Inpatient Rehabilitation Facilities, GAO-05-825T, June 16, 2005
- Global Health: The Global Fund to Fight AIDS, TB and Malaria Is Responding to Challenges but Needs Better Information and Documentation for Performance-Based Funding, GAO-05-639, June 10, 2005
Uwe Reinhardt on the War and Sacrifice
Professor Uwe Reinhardt has a piece in today's Washington Post entitled, "Who's Paying for Our Patriotrism?" He draws a comparison between moral hazard in health insurance and the current lack of sacrifice that we are being asked to make in defense of our country at this time of war.
The strategic shielding of most voters from any emotional or financial sacrifice for these wars cannot but trigger the analogue of what is called "moral hazard" in the context of health insurance, a field in which I've done a lot of scholarly work. There, moral hazard refers to the tendency of well-insured patients to use health care with complete indifference to the cost they visit on others. It has prompted President Bush to advocate health insurance with very high deductibles. But if all but a handful of Americans are completely insulated against the emotional -- and financial -- cost of war, is it not natural to suspect moral hazard will be at work in that context as well?
A policymaking elite whose families and purses are shielded from the sacrifices war entails may rush into it hastily and ill prepared, as surely was the case of the Iraq war. Moral hazard in this context can explain why a nation that once built a Liberty Ship every two weeks and thousands of newly designed airplanes in the span of a few years now takes years merely to properly arm and armor its troops with conventional equipment. Moral hazard can explain why, in wartime, the TV anchors on the morning and evening shows barely make time to report on the wars, lest the reports displace the silly banter with which they seek to humor their viewers. Do they ever wonder how military families with loved ones in the fray might feel after hearing ever so briefly of mayhem in Iraq or Afghanistan?
Moral hazard also can explain why the general public is so noticeably indifferent to the plight of our troops and their families. To be sure, we paste cheap magnetic ribbons on our cars to proclaim our support for the troops. But at the same time, we allow families of reservists and National Guard members to slide into deep financial distress as their loved ones stand tall for us on lethal battlefields and the family is deprived of these troops' typically higher civilian salaries. We offer a pittance in disability pay to seriously wounded soldiers who have not served the full 20 years that entitles them to a regular pension. And our legislative representatives make a disgraceful spectacle of themselves bickering over a mere $1 billion or so in added health care spending by the Department of Veterans Affairs -- in a nation with a $13 trillion economy!
* * * *
When our son, then a recent Princeton graduate, decided to join the Marine Corps in 2001, I advised him thus: "Do what you must, but be advised that, flourishing rhetoric notwithstanding, this nation will never truly honor your service, and it will condemn you to the bottom of the economic scrap heap should you ever get seriously wounded." The intervening years have not changed my views; they have reaffirmed them.
Privatization of Prison Health Care
The New York Times continues a series examining the work of Prison Health Services, the biggest commercial provider of medical care to inmates. It seems quite clear that privatization is not the answer to better care for prisoners at least not when involves corruption and failure to keep promises, the firing of whistleblowers and more. Somehow shareholder value and prisoner health don't work in that type of environment - at least not for the prisoners. The Times reports,
Even within the troubled Alabama penal system, this state compound near Huntsville was notorious for cruel punishment and medical neglect. In one drafty, rat-infested warehouse once reserved for chain gangs, the state quarantined its male prisoners with H.I.V. and AIDS, until the extraordinary death toll - 36 inmates from 1999 to 2002 - moved inmates to sue and the government to promise change.
Alabama's solution was to fire the local company in charge of medical care and hire Prison Health Services, the nation's largest commercial provider of health care behind bars. Prison Health's solution was to recruit Dr. Valda M. Chijide, an infectious-disease specialist who arrived last November with a lofty title: statewide coordinator of inmate H.I.V. care.
She was an unlikely candidate for the job in one sense, having never stepped inside a prison. But it did not take her long to conclude that the chaos was continuing, and that much of the problem was Prison Health itself.
Though the company had promised the help of other doctors, she said, she was left alone to care for not only the 230 men in the H.I.V. unit, but the 1,800 other prisoners, too. Nurses were so poorly trained, Dr. Chijide said, that they neglected to hand out life-sustaining drugs or gave the wrong ones. Medical charts were a mess, she said, and often it was impossible to find such basic items as a thermometer, or even soap.
Dr. Chijide lasted barely three months. After she complained in writing, Prison Health suspended her for reasons it would not disclose, and she quit.
Her short, frantic stint - battling for drugs, hospitalizations and extra food for skeletal inmates, she said - was not unusual in the world of Prison Health Services, which has had a turbulent record in many of the 33 states where it has provided jail or prison medicine. But her story, a rare firsthand account of a doctor in charge of a prison's health care, offers an intimate glimpse of the company's work at a moment when the need for change could not have been more pressing, and the spotlight on Prison Health could hardly have been more intense.
Related articles from the New York Times series:
Harsh Medicine: As Health Care in Jails Goes Private, 10 Days Can Be a Death Sentence (February 27, 2005)
In City's Jails, Missed Signals Open Way to Season of Suicides (February 28, 2005)
A Spotty Record of Health Care at Juvenile Sites in New York (March 1, 2005)
State Board Calls Rikers Suicide a Glaring Case of Poor Care (April 4, 2005)
Medical Group for City Jails Is Investigated (May 11, 2005) .
Questions for John Roberts
Several women senators want more input from the American people on the selection of Judge John Roberts. They have a website that encourages you to submit questions that you want answered about him during his Senate Judiciary Committee hearing. Here is link - ask away.
In the meantime, the Washington Post has a new article on Judge Roberts and some of his conservative views here and as usual, the SCOTUSblog and its sister blog, Supreme Court Nomination blog have excellent updated information on his nomination.
July 31, 2005
The New York Times reports on a recent trend in health care - the conciege doctor. It seems a far cry from universal health care and doesn't seem to be the medical profession at its best. According to the Times,
Last October, Barbara L. Allan, 57, received a letter from her family physician, Dr. David Rosenberg, asking her for $1,500 annually to remain a patient. He would be offering longer appointments, with no waiting, and giving out his cellphone number for after-hours calls. Ms. Allan would be one of just 400 patients, the letter said, and she would have his help navigating the local health care system. Dr. Rosenberg said he was switching to a concierge practice to maintain the highest quality of patient care.
To her, it was an attractive pitch. "I was tired of going in for routine things and waiting an hour and a half," said Ms. Allan, who is president and chief executive of SRA Research Group Inc. in Jupiter, Fla. She recalled walking out of the doctor's office two or three times when he made her late for a meeting.