June 23, 2006
Number of Uninsured Drops
The KaiserNetwork.Org reports on a study showing that the number of uninsured last year was 41.2 million. It reports that this is a small improvement over 2004. Thanks to Ezra Klein for the cite - he also has some further thoughts on the study. [bm]
South Dakota's Abortion Ban
This week's New Yorker runs a piece by Cynthia Gorney about South Dakota's abortion ban entitled, "Letter from South Dakota: Reversing Roe." The law bans abortion except where the life of the mother is threatened. Opponents to the law have run a successful petition drive to place the law on the ballot this fall for the citizens of that state to vote on whether they want to keep such a ban. The article provides an interesting overview of the current state of the abortion debate and demonstrates how the South Dakota law has divided some within the pro-life movement. The New Yorker article is not available on-line but an interesting interview between Ms. Gorney and Mr. Ben Greenman discussing abortion and the South Dakota law may be found here.
More Humane Lethal Injections
The New York Times reports today on how doctors have worked to make lethal injections for death penalty inmates more humane. The Times states,
. . . . medical experts say the current method of lethal injection could easily be changed to make suffering less likely. Even the doctor who devised the technique 30 years ago says that if he had it to do over again, he would recommend a different method.
Switching to an injection method with less potential to cause pain could undercut many of the lawsuits. But so far, in this chapter of the nation's long and tangled history with the death penalty, no state has moved to alter its lethal injection protocol.
At the core of the issue is a debate about which matters more, the comfort of prisoners or that of the people who watch them die. A major obstacle to change is that alternative methods of lethal injection, though they might be easier on inmates, would almost certainly be harder on witnesses and executioners.
With a different approach, death would take longer and might involve jerking movements that the prisoner would not feel but that would be unpleasant for others to watch.
The care and concern for the witnesses strikes me as a bit out-of-place. The article discusses the pending lawsuits in many states concerning the current method of lethal injection and whether it is an unconstitutional cruel and unusual punishment. In response to the lawsuits and these new techniques, the article says that some states may change their procedures to avoid future liabililty. Overall, it is a rather depressing subject and I understand why many doctors refuse to participate in executions. [bm]
June 22, 2006
Pediatric Cancer Stories
One of the reasons that I enjoy living in Cincinnati is the wonderful Children's Hospital Medical Center. Last night PBS had a wonderful program, entitled, "Lion in the House," concerning Children's Hospital and some of the pediatric cancer patients it has treated. It was a very moving program that addresses the issues facing the children and their families as well as the physicians, nurses and other caregivers who treat them. Here is a brief abstract of the program:
A LION IN THE HOUSE follows the stories of five exceptional children and their families as they battle pediatric cancer. From the trauma of diagnosis to the physical toll of treatment, this series documents the stresses that can tear a family apart as well as the courage of children facing the possibility of death with honesty, dignity and humor. As the film compresses six years into one narrative, it puts viewers in the shoes of parents, physicians, nurses, siblings, grandparents and social workers who struggle to defeat an indiscriminate and predatory disease.
These are some truly inspiring people. The PBS website has further information about the program and also provides some helpful biographies. [bm]
June 21, 2006
Update your favorites
Majikthise points out that Effect Measure (the terrific public health policy blog)has moved and joined a network of science blogs. You should check it out - there are many wonderful websites with terrific information there. [bm]
For Profit/Not-for-Profit Quality Issues
Erza Klein points out a new study published in the Health Affairs journal and summarized briefly here that shows that not-for-profit hospitals and nursing homes provide a higher quality of care. From the summary:
For-profit nursing homes and hospitals on average provide an inferior quality of care compared with their nonprofit peers, according to an extensive review of studies published on Tuesday.
Authors writing in the journal Health Affairs found that a systematic analysis of 162 studies of nonprofit versus for-profit health care providers supports the concept that a facility's ownership status makes a difference in outcomes and in the cost of health care.
"Their work should lay to rest claims that little distinguishes nonprofit versus for-profit health care," University of Michigan professor Jill Horwitz wrote in editorial also running in the policy journal.
The analysis found a pattern of differences between nonprofits and for-profits in cost, quality and accessibility, said Bradford Gray, a principal research associate at the Urban Institute -- a nonprofit research group -- and lead study author.
For-profit ownership is climbing in most sectors of health, from hospitals to hospice care. For example, for-profit hospitals accounted for 11 percent of all hospitals in the early 1990s and now account for 16 percent.
June 20, 2006
Supreme Court Grants Cert. to Partial-Birth Abortion Ban Act
From Willamette Law Online – Willamette University College of Law comes the news that the Supreme Court has granted certiorari in the Gonzales v. Planned Parenthood case. The Ninth Circuit opinion can be found here: 435 F.3d 1163 (9th Cir. 2006); http://caselaw.lp.findlaw.com/data2/circs/9th/0416621p.pdf
Here is the Williamette Law Online summary of the case:
The United States Court of Appeals for the Ninth Circuit held that the Partial-Birth Abortion Ban Act is unconstitutional on three grounds,invalidated the law, and permanently enjoined enforcement of the law in its entirety.
Immediately after President George W. Bush signed the Partial-Birth Abortion Ban Act (Act), 18 U.S.C. Sec 1531(b)(1), into law in 2003, thePlanned Parenthood Federation of America, Inc. (Planned Parenthood) filed suit, claiming that the Act violates constitutionally guaranteed rights.
The City and County of San Francisco successfully intervened as a plaintiff. In 2004, the United States District Court for the Northern District of California (District Court) found the Act unconstitutional on three grounds and entered a permanent injunction against its enforcement. First, the Act was held to impose an undue burden on a woman’s right to choose to terminate pregnancy before viability because it creates a substantial risk of criminality for virtually all abortions performed after the first trimester. Second, the District Court found the Act unconstitutionally vague. The District Court reasoned that the Act’s use of unrecognized medical terms inhibits fair notice to physicians and encourages arbitrary enforcement. Finally, the District Court held that the Act’s failure to include a health exception is unconstitutional. The United States Court of Appeals for the Ninth Circuit (Court of Appeals) affirmed the District Court’s decision, stating the Act unconstitutional on all three grounds and also affirmed enjoinment of the Act’s enforcement in its entirety as the proper remedy. The United States Supreme Court granted Certiorari. [Summarized by Viva Foley.]
Probabilities in Health Care
Erza Klein has a great post entitled, "The Problem with Probabilities," discussing the medical dilemma faced by one individual to demonstrate the probabilities issue. He writes:
"Nice illustration of a constant medical dilemma by Ogged, who happily appears to be stomach-cancer free:
the debate hadn't been between those recommending a gastrectomy and those favoring a follow-up endoscopy, but between those favoring a follow-up endoscopy and those who wanted to send me home and tell me to forget the whole thing. The latter group was convinced that the original finding were just a strange anomaly--not a mistake, exactly, but not worth worrying about. Older, more cautious doctors eventually brought everyone around to the consensus that they couldn't take even the small chance that I do have cancer lightly, so a follow-up is warranted. But even the doctor I talked to "officially" said "we don't expect to find anything."
So much of medicine is probabilistic. If you wanted to
really cut costs, you'd take a coldly statistical view of the whole
thing, with those who ended up on the wrong side of the numbers
regrettable sacrifices. As a society, we're not ready or willing to do
that -- and rightly so. But this is the essential conflict: politicians
and hospital administrators look at the global budget, while doctors
and patients look at the individual's health. The latter militates for
constantly seeking the lowest possible error, the former for going with
the statistics and saving money where you can.. . . ." [bm]
June 19, 2006
National Public Radio's Diane Rehm show had a terrific discussion about the causes and potential solutions to the childhood obesity issues facing this nation. It is entitled, "Fighting Childhood Obesity. Click here for an interesting listen. [bm]
June 18, 2006
La. Governor Signs S.D.-Style Abortion Ban
From Jurist comes this news:
Governor Kathleen Blanco [official website] of Louisiana signed a bill [PDF text; SB 33 summary] Saturday that could ban most abortions in the state. The bill, which would apply to all abortions except when the life of the mother is threatened, will take effect only if the US Supreme Court [official website] overturns the 1973 Roe v. Wade [text] decision or if the US Constitution is amended to allow states to prohibit abortions. The Louisiana Senate [official website] unanimously approved the bill [JURIST report] earlier this month.
Blanco said in a statement [text] that while she had hoped the bill would include additional exceptions for victims of rape and incest which did not pass, "the central provision of the bill supports and reflects my personal beliefs." The law is similar to South Dakota legislation [JURIST report] approved in March. Reuters has more.