Friday, September 29, 2006
The New York Times reported earlier this week that an advisory panel appointed by the Comptroller General concluded that "Congress should take immediate steps to guarantee that all Americans have access to affordable health care by 2012." The Times reports,
The panel, the Citizens’ Health Care Working Group, said Congress should create an independent “public-private entity” to define a basic set of health care benefits and services for all Americans.
While leaving many details to be worked out, the panel declared, “It should be public policy, written in law, that all Americans have affordable access to health care.”
The panel was created by the 2003 law that added a drug benefit to Medicare. Under the law, President Bush has 45 days to comment on the recommendations and offer a report to Congress. Five Congressional committees are then supposed to hold hearings on the proposals. . . .
The number of uninsured Americans keeps growing despite fluctuations in the economy, and the report from the working group increases the chances that health care will be a major issue as candidates gear up for the 2008 presidential race.
Census Bureau figures show that 39.7 million people lacked health insurance in 1993, when President Bill Clinton took office. The number rose, to 44.3 million in 1998, and then began to decline. Since 2001, when President Bush took office, the number of uninsured has increased by more than 5 million, to 46.6 million in 2005.
Thursday, September 28, 2006
During the awful events of Hurricane Katrina, four patients died of lethal doses of morphine while in the care of Dr. Pou and two nurses as they waited for help at the New Orleans' Memorial Medical Center during Hurricane Katrina. It is unclear whether the doctor engaged in a form of mercy killing or was attempting to relieve patient pain and suffering. The Louisiana Attorney General, Mr. Foti, apparently believes the former. Talkleft reports that the Louisiana State Medical Society has come out in defense of Dr. Pou. The Talkleft blog and the Kevin, MD Medical Blog provide some helpful background on this case. Dr. Pou appeared on 60 Minutes this past weekend to discuss her case and explain how she did not murder her patients.
Erza Klein has the latest information on Walmart's decision to stop offering what little traditional health care plans it did offer and move to high-deductible HSAs. After briefly describing the plan, he concludes,
This, of course, is only further evidence that it's time to stop making Wal-Mart offer decent health care -- which they will clearly not do -- and simply rip the responsibility away from them, ensuring all of their "associates" have generous, serious coverage they can fall back on.
More worryingly, Target has promised the same move. Which'll mean that the two largest retailers will both eschew traditional health care plans for low-cost (to the company), high-risk (to the employee), astonishingly stingy offerings. Now, of course, any retailers who seek to compete with them -- and that includes supermarkets, clothing outlets, and all the rest -- will be at a competitive disadvantage if they fund traditional health care plans for their employees.
Tuesday, September 26, 2006
The New York Times reported on Sunday interesting and good news about the recent rather dramatic decrease in waiting time for certain individuals for lung transplants. The Times reported some of the reasons, a new allocation method, more organ donors, and better technology:
Recent changes have revitalized lung transplantation. Starting in May 2005, new rules nationwide put patients who needed transplants most at the top of the list — people who would soon die without a transplant, but who had a good chance of surviving after one.
Previously, lungs went to whoever had been waiting longest, even if another patient needed them more. The waiting time was often two years or more, so there was little hope for people with lung diseases that came on suddenly or progressed rapidly.
Another major change is that more lungs from cadavers have become available, for two reasons: more people are becoming organ donors, and doctors have figured out ways to salvage lungs that previously would have been considered unusable. The new methods use drugs, respirator settings and other techniques to prevent damage to the lungs and keep their tiny air sacs open in brain-dead patients.
In the past, lungs could be retrieved from only about 15 percent of organ donors, but at some centers the rates have risen to 40 percent. Dr. Herrington said that in Minnesota, the number of lungs retrieved went to 97 from 25 in a single year.
Professor Paul Caron at TaxProfBlog posts the results of a Harvard Graduate School of Education survery that shows that faculty members care more about treatment than money. I am not sure that is correct for all members of the academy but it does ring somewhat true to me. Professor Caron states,
A press release issued today by the Harvard Graduate School of Education reports that New Study Indicates Faculty Treatment Matters More Than Compensation; Survey of 4,500 Tenure-Track Faculty Reveals Surprising Findings:
A new study by the Collaborative on Academic Careers in Higher Education (COACHE), a research project based at the Harvard Graduate School of Education, has revealed that climate, culture, and collegiality are more important to the satisfaction of early career faculty than compensation, tenure clarity, workload, and policy effectiveness.
The survey of 4,500 tenure-track faculty at 51 colleges and universities discovered that there are key climate variables for junior faculty, such as: interest senior faculty take in their work, fairness with which they are evaluated, opportunities to collaborate with senior faculty, how well they seem to fit in their departments, sufficient professional and personal interaction with colleagues, and a sense of community in the department. The survey revealed that collegiality matters much to the success and satisfaction of new scholars, in stark relief to studies of an earlier generation that showed autonomy was one of the most important attractions to academic life.
Quite frankly, part of the attraction of teaching is working in an environment that is different from the typical law firm or in-house corporate position and,while autonomy is an important part of that, so is the opportunity to share ideas and thoughts with other individuals who also enjoy studying the law.
Monday, September 25, 2006
Professor Seth Chandler, Foundation Professor of Law and Co-Director Health Law & Policy Institute, sends the following excerpt from a London ambulance driver's blog. It is very moving.(http://randomreality.blogware.com/blog/_archives/2005/9/5/1194694.html)
More and more seniors are suddenly discovering the Medicare Part D Donut Hole, according to Ezra Klein, writing at Tapped, and the discovery is not pretty (and that is putting it very mildly). He writes,
Millions of seniors are about to tumble into the donut hole, a coverage gap that extends (usually) from $2,250 to $3,600, at which point federal insurance kicks back in. Most seniors, as we already knew, were unaware of the gap. And this is what it looks like when they fall in it:
Frances Acanfora, 65, had been paying $58 for a three-month supply of her five medications. But this month the retired school lunchroom aide learned that her next bill would be $1,294. She had entered the doughnut hole.[...]
After talking to her doctor, Acanfora decided to temporarily stop taking a drug as part of her treatment for breast cancer. She hopes to obtain some free samples of eye drops for her glaucoma. Three other medicines -- for high cholesterol, diabetes and osteoporosis -- cost $506.62, which Acanfora put on her credit card.
"I pay a little bit at a time," she said. "What am I going to do? I need it. . . . Sometimes, just to think about it, I cry."
In case anyone's wondering about the staggeringly strange structure of it all -- don't. It makes no sense. The concept behind donut holes is that they ensure coverage for basic care, so folks don't skimp on preventive and diagnostic services, then impose a certain level of cost-sharing in order to incentivize all those magical things price-conscious consumers apparently do, then pick up the coverage again for those who are simply ill. It makes a certain amount of sense -- unless you're dealing with prescription medications for seniors.
Ezra has more to say about the subject and its impact on seniors who need their medication. He further notes that this donut hole could be a big problem for politicians this Fall.
Saturday, September 23, 2006
The New York Times reports that Walmart "will begin selling generic versions of widely prescribed drugs to its workers and customers at sharply reduced prices, a move that could force rival pharmacies to do the same." Interesting move. The Times states,
The giant discount chain, which has used its size to knock down the costs of toys, clothing and groceries, will sell 300 generic drugs for as low as $4 for a one-month supply. On average, generic drugs cost between $10 and $30 for a 30-day prescription.
Wal-Mart will test the lower prices at 65 stores in the Tampa, Fla., area and, depending on consumer response, is likely to expand the program next year.
The drugs covered by the program treat common conditions like allergies, cholesterol, high blood pressure and diabetes. In some cases, the company said, customers could save more than 60 percent over typical generic drug costs. The lower prices will be available to the insured and the uninsured.
The Florida experiment with lower generic drug prices appears to mark the first time that Wal-Mart has used its unrivaled influence in the American economy to lower the cost of health care for its customers. . . .
In the past year, Wal-Mart has introduced several programs to improve health benefits for its workers, like extending insurance coverage to the children of part-time workers and starting a benefit plan with monthly premiums as low as $11.
Still, critics complain that health insurance is out of reach for many of Wal-mart’s 1.3 million employees in the United States, forcing thousands of them to turn to state-sponsored programs or forgo health coverage altogether.
Several states even considered legislation that would force the chain to increase its spending on health care, but only one such bill, in Maryland, became law. The law has since been struck down by a judge, and its future is in doubt.
For Wal-Mart, the lower generic drug prices could blunt criticism of its health care coverage and prove a boon to business. Wal-Mart’s chief executive, H. Lee Scott Jr., has identified the chain’s pharmacy business as an area that needs improvement, and $4 generic drugs could turn the chain into a destination for those seeking the best prices on prescriptions.
Wal-Mart said it obtained the lower generic drug prices by squeezing costs out of its already efficient supply chain, rather than pressuring drug manufacturers to lower costs.
Ezra Klein has some further thoughts on Walmart's decision.
Friday, September 22, 2006
Some rather alarming news, AOL News reports on a recent study that will be published in journal Fertility and Sterility showing that fertility clinics are receiving more requests to screen for sex selection.
Boy or girl? Almost half of U.S. fertility clinics that offer embryo screening say they allow couples to choose the sex of their child, the most extensive survey of the practice suggests.Sex selection without any medical reason to warrant it was performed in about 9 percent of all embryo screenings last year, the survey found.
Another controversial procedure - helping parents conceive a child who could supply compatible cord blood to treat an older sibling with a grave illness - was offered by 23 percent of clinics, although only 1 percent of screenings were for that purpose in 2005.
For the most part, couples are screening embryos for the right reasons - to avoid passing on dreadful diseases, said Dr. William Gibbons, who runs a fertility clinic in Baton Rouge, La., and is president of the Society for Assisted Reproductive Technology, which assisted with the survey. "There are thousands of babies born now that we know are going to be free of lethal and/or devastating genetic diseases. That's a good thing," he said.
However, the survey findings also confirm many ethicists' fears that Americans increasingly are seeking "designer babies" not just free of medical defects but also possessing certain desirable traits.
Professor George Annas weighs in on the recent findings,
"That's a big problem if that's true," Boston University ethicist George Annas said of the sex selection finding. "This is not a risk-free technique," he said referring to in vitro fertilization, which can over-stimulate a woman's ovaries and bring the risk of multiple births.
"I don't think a physician can justify doing that to a patient" for sex selection alone, Annas said.
Survey results were published on the Internet Wednesday by the medical journal Fertility and Sterility and will appear in print later.
The survey was led by Susanna Baruch, a lawyer at Johns Hopkins University's Genetics and Public Policy Center in Washington, D.C., with the cooperation of the reproductive medicine society. It involved an online survey of 415 fertility clinics, of which 190 responded.
Yesterday, the Centers for Disease Control and Prevention recommended that HIV testing become a routine part of medical life for Americans from ages 13 to 64. The CDC hopes that such testing will help prevent the spread of the disease and through early diagnosis increase the needed care for those who are unaware that they have the disease. The AP reports,
"By identifying people earlier through a screening program, we'll allow them to access life-extending therapy, and also through prevention services, learn how to avoid transmitting HIV infection to others," said Dr. Timothy Mastro, acting director of the CDC's division of HIV/AIDS prevention.
Although some groups raised concerns, the announcement was mostly embraced by health policy experts, doctors and patient advocates. "I think it's an incredible advance. I think it's courageous on the part of the CDC," said A. David Paltiel, a health policy expert at the Yale University School of Medicine. The recommendations aren't legally binding, but they influence what doctors do and what health insurance programs cover.
However, some doctors' groups predict the recommendations will be challenging to implement, requiring more money and time for testing, counseling and revising consent procedures. Some physicians also question whether there is enough evidence to expand testing beyond high-risk groups, said Dr. Larry Fields, the president of the American Academy of Family Physicians. "Are doctors going to do it? Probably not," Fields said. But the recommendations were endorsed by the American Medical Association, which urged doctors to comply. . . . .
Under the new guidelines, patients would be tested for the AIDS virus as part of the standard tests they get when they go for urgent or emergency care, or even during a routine physical. The CDC recommends everyone get tested at least once, but annual testing is urged only for people at high risk.
Consent for the test would be covered in a clinic or hospital's standard care consent form. Patients would be allowed to decline the testing. The CDC's guidelines say no one should be tested without their knowledge.
An American Civil Liberties Union official protested the CDC's idea of dealing with HIV on standard consent forms, and the agency's de-emphasis of pre-test counseling. "By eliminating these safeguards, what they're calling 'routine testing' will in practice be mandatory testing," said Rose Saxe, a staff attorney with the ACLU AIDS Project. Doctors should tell patients anonymous testing is also available, if they'd rather choose where they want to get HIV testing, Saxe said.
The cost of the new policy is not clear. A standard HIV test can cost between $2.50 and $8, public health experts say.
Thursday, September 21, 2006
The New York Times reports that the Senate Health, Education, Labor and Pensions Committee approved Andrew von Eschenbach to head the Food and Drug Administration. His approval had been delayed due to the politics surrounding the delayed approval for Plan B. The Times reports that there are new issues that may further stall his confirmation vote before the full Senate. The new delay comes from the Republican side this time. The newspaper reports,
Senator David Vitter, Republican of Louisiana, has promised to hold up Dr. von Eschenbach’s nomination until the Bush administration agrees to legalize imports of cheaper drugs from abroad. And Senator Jim DeMint, Republican of South Carolina, said he would not allow the nomination to proceed until Dr. von Eschenbach took action to suspend sales of RU-486, the abortion drug. The F.D.A is not expected to take any such action soon.
The article quotes the Senator Senate Committee chairman as noting that the FDA commissioner's confirmation is as difficult as that of a Supreme Court justice. It does appear to be that way.
The New England Journal of Medicine has a great article (available free) on the politics of stem cell research. It provides a good overview of some of the potential benefits of stem cell research and some of the unknowns about that research that still exist. The article concludes,
On July 19, Bush missed an opportunity to show support for research on cells that do have the potential to differentiate into many different kinds of tissues. His veto thwarted new prospects for advancing embryonic stem-cell research and will result in a terrible waste: tens of thousands of fertilized eggs will be destroyed without a single one being permitted to contribute to our knowledge of cell differentiation. Fortunately, research on embryonic stem cells will proceed in a number of excellent scientific centers in this country, without federal funding and, one might argue, at a pace unfettered by the federal bureaucracy. But the lack of federal support and the political climate do hinder stem-cell research in the United States. A new center in Singapore, for example, has recently attracted gifted American investigators who are fed up with political restrictions on their research. Other countries — such as China, Sweden, and the United Kingdom — are also entering the field.
We really don't know what will ultimately come out of research on embryonic stem cells. It is important to play down promises to the public that the work will produce anything of clinical value in the foreseeable future. We simply don't know how an embryonic stem cell will behave in a human, and we don't know whether human marrow contains a pluripotent stem cell that can transdifferentiate. Equally important, we don't yet know whether research on embryonic stem cells will teach us how to revise the differentiation program of a tissue-specific stem cell, thereby circumventing the need for embryonic cells. Research on stem cells will encounter many twists and turns, but it is an endeavor that is eminently worth pursuing. The delay of medical advances by theological disputes is not in the best interests of the sick and disabled.
Thanks to Jim Tomaszewski for the heads-up on this article!
Wednesday, September 20, 2006
Yesterday's New York Times Science section had an interesting article on a new book by Paul C. Rosenblatt that discusses sleeping together. The book is entitled,“Two in a Bed: The Social System of Couple Bed Sharing,” Dr. Rosenblatt interviewed 42 couples for his book, married and unmarried, homosexual and heterosexual couples. One of the interesting "health" findings is that some couples claim that sharing a bed may have saved their lives. The Times states,
“It surprised me how many people thought they were alive today because they shared a bed,” Dr. Rosenblatt said.
For example, he said a woman’s seizure was noticed immediately by her husband with whom she spooned every night. Similar stories came from couples where one partner had a heart attack, stroke or went into diabetic shock.
The article is fairly amusing and the book sounds quite interesting. I wonder if it will help me with my petit problem of stealing the covers . . . .
Hyman is an adjunct scholar at the Cato Institute, and so his book, as you may have considered but not believed, literally takes as its conceit that Medicare is a demonic program sent to encourage all manner of deadly sins and, eventually, bring down the American republic. Spending so much time in the blogosphere, which vastly over-represents libertarians, it's occasionally easy to forget that libertarianism is a distinctly fringe ideology. Seeing them (jokingly) suggest Satanic origins for the massively popular and successful (if deeply in need of reform) system of health insurance for the elderly helpfully reminds.
That said, the book is actually quite good. I'd happily recommend it to anyone with a basic grasp on health care and a desire to learn a bit more about Medicare. Hyman is a felicitous and fun writer, and he conveys an impressive amount of history and data in as accessible and absorbable a manner as one could hope. I know how tricky it is to make health care a quick and gripping read, and I'm all for anyone able to enrich the debate and educate readers by doing so.
The rest of the review and the comments are also quite good.
Tuesday, September 19, 2006
The very real problems with the health-care system mask a simple fact: Without it the nation's labor market would be in a deep coma. Since 2001, 1.7 million new jobs have been added in the health-care sector, which includes related industries such as pharmaceuticals and health insurance. Meanwhile, the number of private-sector jobs outside of health care is no higher than it was five years ago.
....Both sides can agree that more spending on information technology could reduce the need for so many health-care workers. It's a truism in economics that investment boosts productivity, and the U.S. lags behind other countries in this area. One reason: "Every other country has the payers paying for IT," says Johns Hopkins' Gerard Anderson, an expert on the economics of health care. "In the U.S. we're asking the providers to pay for IT" — and they're not the ones who benefit.
He then provides some interesting insight into the reasons for this inefficiency and some of the problems it causes:
The fact that this inefficiency means we employs a lot more people than we would if we had a rationally run system is hardly a great rallying cry for the status quo. A national healthcare system, besides being tremendously beneficial for the actual consumers of healthcare, would also align the market incentives more reasonably and reduce costs considerably. I'm willing to take the risk that we'll somehow figure out what to do with all the jobs and money we save along the way.
Monday, September 18, 2006
With everything going so well on the health front, i.e., the increased number of uninsured, the e-coli outbreak, the re-defining of torture, and more, who would have thought that our efforts to improve our stockpiles of bioterror drugs would be problematic. . . . The New York Times reports today that there are been some difficulties, political ones, which have caused delays and well, things aren't progressing like people had hoped. The Times states,
The last of the anthrax-laced letters was still making its way through the mail in late 2001 when top Bush administration officials reached an obvious conclusion: the nation desperately needed to expand its medical stockpile to prepare for another biological attack.
The result was Project BioShield, a $5.6 billion effort to exploit the country’s top medical and scientific brains and fill an emergency medical cabinet with new drugs and vaccines for a host of threats. “We will rally the great promise of American science and innovation to confront the greatest danger of our time,” President Bush said in starting the program.
But the project, critics say, has largely failed to deliver.
So far, only a small fraction of the anticipated remedies are available. Drug companies have waited months, if not years, for government agencies to decide which treatments they want and in what quantities. Unable to attract large pharmaceutical corporations to join the endeavor, the government is instead relying on small start-up companies that often have no proven track record.
The troubles have been most acute with the highest priority of all: a $900 million push to add a new anthrax vaccine to the stockpile. What had begun as an effort to test and manufacture a safer, faster-acting vaccine has turned into an ugly battle between two biotech businesses.
Each has hired Washington lobbyists to attack its rival’s product and try to win over lawmakers and administration officials. Delivery of the new vaccine is far behind schedule, and a dispute between the Department of Health and Human Services and VaxGen, the company chosen to make the vaccine, could even end the deal. The only doses that have been added to the stockpile are of a decades-old vaccine that has generated complaints of serious side effects. . . .
“The inept implementation of the program has led the best brains and the best scientists to give up, to look elsewhere or devote their resources to medical initiatives that are not focused on biodefense,” said Michael Greenberger, director of the Center for Health and Homeland Security at the University of Maryland. . . .
From the start, officials in Washington knew that Project BioShield would be a risky venture — for the government, the companies involved and even ordinary Americans, who might be asked to take relatively untested treatments in an emergency.
Officials hoped $5.6 billion in federal money would entice companies to develop new drugs and vaccines for anthrax, smallpox, botulism, Ebola and other deadly diseases.
Because of the perceived urgency of the threat, the project suspends some traditional standards. It allows new vaccines or drugs to be used in emergencies before completing the lengthy Food and Drug Administration approval process. Full testing on humans is also not required because it is too dangerous, even though that means no one will know with certainty whether the vaccines will work until used in a crisis.
For their part, the companies have to take all the risks of developing and manufacturing new products; they get paid only upon delivery.
The article ends on a slightly upbeat note - people have recognized that there is a problem and will be meeting to solve some of the issues raised in the article so there may be some hope for the future.
Professor Tung Yin at Prawfsblawg has an excellent post for students on how to receive a great letter of recommendation for a judicial clerkship. I must admit that my hand is still a bit sore after all the letter signing that occurred earlier this semester. I find it helpful when the student will spend some brief time filling me in on some of their life history before I write the letter. Even getting to know a student in a seminar doesn't always let you see the full person - why did they go to law school, what are their goals, do they have children that they are taking care of while attending law school, what outside activities or community events do they enjoy etc.
Sunday, September 17, 2006
Friday, September 15, 2006
Toss out that bagged spinach (which is usually quite tasty and a terrific timesaver)! According to CNN.Com, the e-coli outbreak has spread to twenty states. The site reports,
Federal health officials say an outbreak of E. coli has spread to 20 states and sickened 94 people.
The news prompted health officials to warn the public that even if you wash the spinach, you still could be at risk.
Sober warnings for salad lovers came from federal health officials Friday as they struggled to pinpoint a multistate E. coli outbreak that killed one person and sickened dozens more.
Bagged spinach -- the triple-washed, cello-packed kind sold by the hundreds of millions of pounds each year -- is the suspected source of the bacterial outbreak, Food and Drug Administration officials said.
The FDA warned people nationwide not to eat the spinach. Washing won't get rid of the tenacious bug, though thorough cooking can kill it. Supermarkets across the country pulled spinach from shelves, and consumers tossed out the leafy green. (Watch CNN's Dr. Sanjay Gupta explain why this advisory is significant -- 2:07) . . . .
FDA officials said they issued the nationwide consumer alert without waiting to identify the still-unknown source of the tainted spinach.
I always thought that the triple-washing made the bagged salad greens, including the spinach rather safe. I have more to learn obviously.