Friday, June 30, 2006
Although not technically a health law decision, Ramdan v. Rumfeld is a decision that improves the public health of the United States is you read "public health" broadly to include the protection of our constitutional values and the rule of law. SCOTUSblog has a great discussion and examination of Hamdan and Firedoglake has a wonderful write-up as well wilth links to many other discussions around the web concerning the decision. [bm]
You were thinking that encouraging more exercise and fast food might be the only answer. Well, apparently there are more creative minds at work than mine and they have developed new heavier toys to help with the childhood obesity problem. CNN reports on this development:
Researchers at Indiana State University in Terre Haute tried a small experiment to test the effects of having kids play with heavier toys. They found that 10 children ages 6 to 8 burned more calories and had higher heart and breathing rates when they moved 3-pound toy blocks instead of unweighted blocks.
So could adding a small weight to stuffed animals and other toys help kids get fit?
"This is not going to solve the obesity problem," said John Ozmun, a professor who did the study with graduate student Lee Robbins. "But it has a potential to make a positive contribution."
Some experts caution that children could hurt themselves trying to lift too much too soon and said more activity is preferable to heavier toys. But all agree childhood obesity is a big problem. . . .
Kara Tucker, youth development coordinator for the National Institute for Fitness and Sport in Indianapolis, said active playing helps youngsters work out without realizing it.
Weighted toys might be another way to sneak in exercise, but not everyone thinks a 3-pound stuffed animal sounds like fun.
Rambunctious kids could throw heavy toys at playmates, said Celia Kibler, president of Funfit, a family fitness club in Maryland. Kibler also fears children could hurt themselves if they lift too much weight before their bodies are fully developed.
"I think that can be more dangerous than beneficial," she said. "There's so much activity that a child can do that can keep them in shape without the use of weights. That's what they should be concentrating on."
The study's authors stressed that their report is a starting point, and involved only a few children under very controlled circumstances.
Weighted toys in the real world would have to be designed to be safe while holding a child's interest, said Ozmun, acting associate dean of Indiana State's College of Health and Human Performance. . . .
"Having a 3-pound teddy bear may not only help with strength, but with balance and coordination," he said.
The U.S. Surgeon GeneralRichard H. Carmona issued a report earlier this week that concludes that there exists no safe level of second-hand smoke. The report is entitled, The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. In sum, it states that nonsmokers exposed to scondahnd smoke at home or work increase their risk of developing heart disease and lung cancer by as much as 30 percent. The report further finds that even brief exposure to secondhand smoke can cause immediate harm and that the only way to protect nonsmokers is to eliminate smoking indoors.
A news release from the Department of Health and Human Services states,
“The health effects of secondhand smoke exposure are more pervasive than we previously thought,” said Surgeon General Carmona, vice admiral of the U.S. Public Health Service. “The scientific evidence is now indisputable: secondhand smoke is not a mere annoyance. It is a serious health hazard that can lead to disease and premature death in children and nonsmoking adults.” Secondhand smoke contains more than 50 cancer-causing chemicals, and is itself a known human carcinogen. Nonsmokers who are exposed to secondhand smoke inhale many of the same toxins as smokers. Even brief exposure to secondhand smoke has immediate adverse effects on the cardiovascular system and increases risk for heart disease and lung cancer, the report says. In addition, the report notes that because the bodies of infants and children are still developing, they are especially vulnerable to the poisons in secondhand smoke.
“The good news is that, unlike some public health hazards, secondhand smoke exposure is easily prevented,” Surgeon General Carmona said. “Smoke-free indoor environments are proven, simple approaches that prevent exposure and harm.” The report finds that even the most sophisticated ventilation systems cannot completely eliminate secondhand smoke exposure and that only smoke-free environments afford full protection. . . . .
“Our progress over the past 20 years in clearing the air of tobacco smoke is a major public health success story,” Surgeon General Carmona said. “We have averted many thousands of cases of disease and early death and saved millions of dollars in health care costs.” He emphasized, however, that sustained efforts are required to protect the more than 126 million Americans who continue to be regularly exposed to secondhand smoke in the home, at work, and in enclosed public spaces.
Wednesday, June 28, 2006
As you are now probably more aware than you ever wanted to be, Rush Limbaugh, the conservative radio host who recently had made headlines for his legal problems surrounding his addiction to oxycontin, was detained at U.S. customs and found to have a bottle of Viagra in his physician's name. Setting aside Rush's potential legal problem, I did find it interesting that his attorney, Roy Black, stated that the prescription was written in his doctor's name "for privacy purposes." I have never been offered such a service by my physician (and really haven't we all had some medications prescribed that we didn't want our names on) . . . and doesn't HIPAA already provide some privacy protection in this arena. . . .
Well, it turns out the physicians may be in a little trouble for their help in protecting Rush's privacy in this manner. Talkleft reports on a recent article in the Florida Sun-Sentinel and quotes that paper stating:
Florida civil rules governing doctors and pharmacists require that the true patient's name and address are on the label, according to two attorneys and a Florida Medical Association spokeswoman.
Doing otherwise "is technically a violation of dispensing and prescribing by the doctor," said Allen R. Grossman, a Tallahassee attorney who defends physicians in disciplinary cases. Grossman formerly was general counsel to the Florida Board of Medicine, which licenses and oversees doctors.
TalkLeft continues by discussing the issue.
Other Florida experts, including those involved with professional and medical boards weigh in:
"The department is aware of it and we'll have more information on that later," board spokeswoman Thometta Cozart said. However, the three professionals said state civil rules forbid doctors from prescribing drugs without a name or under a third person's name, as a way to prevent people from passing medicine to others.
"That would be considered a fraudulent prescription," said Lisette Gonzalez Mariner, a spokeswoman for the Florida Medical Association, the trade group for doctors. "You cannot do that. It's not commonly done and that's illegal." Likewise, pharmacists cannot dispense drugs to someone other than the name on the prescription label or their representative, said attorney Edwin Bayo, a former general counsel of the Florida Board of Pharmacy licensing board.
On another issue, I haven't heard much about any potential insurance fraud concerns but there may be some problems with having someone else's name on your prescription with regard to insurance as well. [bm]
Tuesday, June 27, 2006
According to a story in the New York Times, a new study reveals that the Food and Drug Administration has cut back its enforcement efforts rather dramatically in recent years. The Times states,
A 15-month inquiry by a top House Democrat has found that enforcement of the nation's food and drug laws declined sharply during the first five years of the Bush administration.
For instance, the investigation found, the number of warning letters that the Food and Drug Administration issued to drug companies, medical device makers and others dropped 54 percent, to 535 in 2005 from 1,154 in 2000.
The seizure of mislabeled, defective or dangerous products dipped 44 percent, according to the inquiry, pursued by Representative Henry A. Waxman of California, the senior Democrat on the House Government Reform Committee.
The research found no evidence that such declines could be attributed to increased compliance with regulations. Investigators at the F.D.A. continued to uncover about the same number of problems at drug and device companies as before, Mr. Waxman's inquiry found, but top officials of the agency increasingly overruled the investigators' enforcement recommendations.
The biggest decline in enforcement actions was found at the agency's device center, where they decreased 65 percent in the five-year period despite a wave of problems with devices including implantable defibrillators and pacemakers. . . . .
Aside: You would think that Vice President Cheney would be concerned by this news. The article continues,
David K. Elder, the director of the agency's Office of Enforcement, explained that the F.D.A. had increasingly focused on the most serious violations.
"As a result of F.D.A.'s focus on those firms and those violations that present the highest risk to consumers and public health," Mr. Elder said in a statement, "the agency has taken prompt, targeted and aggressive action against firms that are in violation of law."
Jack Calfee, a resident scholar at the conservative American Enterprise Institute, said the decline in the statistics was meaningless because most of the violations involved paperwork problems. "I doubt that it makes a significant difference in the safety of drugs or other products," Mr. Calfee said.
Mr. Waxman began his inquiry after Congressional hearings in 2004 suggested that the agency was partly to blame for a shortage of flu vaccines. His staff requested thousands of documents from the F.D.A. The investigation found that by almost every measure, enforcement actions had significantly declined from 2000 to 2005. The lone exception was in the number of products that had to be recalled from the market: that increased 44 percent. "Since one of the goals of an enforcement system is to deter violations and keep dangerous products off of the market," the report said, "the increase in recalls is not a hallmark of effective enforcement."
Hope everyone stays healthy because this doesn't look like good news in the long run. [bm]
With all the rather depressing news in the world, the Buffett billions and all the good that the Gates' Foundation will be able to do with the money were some welcome cheer. The New York Times reports,
The foundation hopes to use the enormous gift, among other things, to find a vaccine for AIDS, Mrs. Gates said. And Mr. Gates went further, saying that while he might be "overly optimistic," he believed there was a real shot at finding cures for the 20 leading fatal diseases, as well as ensuring that every American has a chance at a decent education.
"Can that happen in our lifetime?" Mr. Gates said, sitting next to Mr. Buffett at the New York Public Library, where the gift was formally announced after news of it broke on Sunday. "I'll be optimistic and say, Absolutely."
But Mr. Gates acknowledged that spending the money effectively would be difficult. The scientific tasks the foundation has set for itself in fields like malaria and tuberculosis take time as well as money, because they require years of laboratory work followed by years of clinical trials, sometimes ending fruitlessly. Improving American education — once better ideas have been found — can take just as long. . . .
Mr. Buffett, for his part, said he saw no need to tinker with the foundation's essential goal: improving the lot of poor people elsewhere in the world without regard to their color, religion or other differences.
Monday, June 26, 2006
Ezra Klein has an interesting post on the pay for performance medicine (P4P) idea. He states,
. . . . Our surgeons may be on the cutting edge (thanks folks, I'll be here all week), but stepping back a bit from the frontier, the vast majority of care is either inefficiently delivered, or simply forgotten. Studies show that we receive only about 55 percent of the recommended treatments for most serious complaints -- and we're not talking CAT scans here, but easy lifesavers, like aspirin and beta blockers after a heart attack. America offers the world's best care for its most exotic and complicated problems, but if you're unlucky enough to suffer something more mundane, you're better off in a host of other hamlets.
The policy response here is something called pay For Performance medicine, or P4P. At base, the incentives in our system are to offer treatments, particularly intensive ones. It's called fee-for-service, and it offers no incentives for quality care or low intensity (aspirin) treatments. P4P, by contrast, pays based on outcomes, on percentage of suggested care delivered (for a fuller explanation, see this reviewended. Utilizing more than 200 hospitals and 38 states, Medicare instituted P4P systems, paying based on treatment quality and comprehensivity and offering bonuses for outcome improvement. The results? Not only did care get better, but it got cheaper. "2004 hospital costs for pneumonia patients were $10,298 for patients who received a low number of the care measures and $8,412 for those who received a high amount. Hospital costs for heart bypass surgery patients also varied widely, with those receiving a low number of measures costing $41,539 while those who had the highest amount cost $30,061."
Sunday, June 25, 2006
Stephen Miles, a medical ethicist has written a' new book, "Oath Betrayed," discussing how some in the medical profession participated in torture during this War on Terror and its coverup. Andrew Sullivan of Time magazine has a brief review and the excellent editors at TalkLeft have some further discussion. Here is a brief excerpt from the Time magazine article by Mr. Sullivan:
One of Defense Secretary Donald Rumsfeld's first instructions for military interrogations outside the Geneva Conventions was that military doctors should be involved in monitoring torture. It was a fateful decision — and we learn much more about its consequences in a new book based on 35,000 pages of government documents obtained under the Freedom of Information Act. The book is called Oath Betrayed (to be published June 27) by medical ethicist Dr. Stephen Miles, and it is a harrowing documentation of how the military medical profession has been corrupted by the Bush-Rumsfeld interrogation rules.
One of those rules was that a prisoner's medical information could be provided to interrogators to help guide them to the prisoner's "emotional and physical strengths and weaknesses" (in Rumsfeld's own words) in the torture process. At an interrogation center called Camp Na'ma, where the unofficial motto was "No blood, no foul," one intelligence officer testified that "every harsh interrogation was approved by the [commander] and the Medical prior to its execution." Doctors, in other words, essentially signed off on torture in advance. And they often didn't inspect the victims afterward. At Abu Ghraib, according to the Army's surgeon general, only 15% of inmates were examined for injuries after interrogation.
Some of the medical involvement in torture defies belief. In one of the few actual logs we have of a high-level interrogation, that of Mohammed al-Qhatani (first reported in TIME), doctors were present during the long process of constant sleep deprivation over 55 days, and they induced hypothermia and the use of threatening dogs, among other techniques. According to Miles, Medics had to administer three bags of medical saline to Qhatani — while he was strapped to a chair — and aggressively treat him for hypothermia in the hospital. They then returned him to his interrogators. Elsewhere in Guantánamo, one prisoner had a gunshot wound that was left to fester during three days of interrogation before treatment, and two others were denied antibiotics for wounds. In Iraq, according to the Army surgeon general as reported by Miles, "an anesthesiologist repeatedly dropped a 2-lb. bag of intravenous fluid on a patient; a nurse deliberately delayed giving pain medication, and medical staff fed pork to Muslim patients." Doctors were also tasked at Abu Ghraib with "Dietary Manip (monitored by med)," in other words, using someone's food intake to weaken or manipulate them.