August 25, 2006
Health Care Proxy
Ezra Klein points to an interesting article on the KaiserNetwork.Org that reviews a recent study in the August edition of the Journal of General Internal Medicine. The study discusses the unexpected people who are selected to be health care proxies when individuals are asked by their doctors for emergency contacts and proxies. Some of the findings:
28% of participants selected someone other than their emergency contacts;
One-third of married participants did not select their spouses;
Participants selected their daughters three times more often than their sons and their sisters two times more often than their brothers; and
About one-fourth of participants said that physicians had never previously asked them to select a proxy.
Since I don't have any daughters, perhaps I need to start talking to my friends in more detail about my health care wishes . . . . On a more serious note, I did find the comments on Ezra's blog below the article to be very revealing and informative.
August 24, 2006
Plan B Compromise for Over-the-Counter Use
National Public Radio had a thorough report on the recent compromise to permit Plan B to be over-the-counter for those women who are age 18 and over. More information can be found in the New York Times. It reports:
The F.D.A.’s acting commissioner, Andrew C. von Eschenbach, wrote that he decided that 18 was the appropriate cutoff for sales because pharmacies already restrict nicotine and cold medicines sales at that age.
“This approach builds on well-established state and private-sector infrastructures to restrict certain products to consumers 18 and older,” Dr. von Eschenbach wrote in a memorandum.
Dr. von Eschenbach’s predecessor, Dr. Lester M. Crawford, said last year that science supported giving over-the-counter access of the drug to women as young as 17, but that he could not figure out how to ensure that such an age restriction was enforced.
The agency has now decided that it will depend upon Barr to enforce the rules. Barr’s chairman, Bruce L. Downey, said in an interview that the company would rely on pharmacists to abide by the restrictions. Barr will not sell the pills to convenience stores, and the company will conduct surveys to measure whether the restrictions are being followed, Mr. Downey said.
According to the Times article, both sides of the debate over Plan B's availability are not happy with this result. Those who wished for over-the-counter access believe that younger women may be injured by having to obtain a prescription for its use and those who opposed Plan B's over-the-counter availability believe that its increased availability will lead to an increase in sexually transmitted disease.
August 23, 2006
Universal Health Care by Mickey Kaus
Slate.com's Mickey Kaus has an interesting post concerning universal health care and receives some interesting replies to his proposal. Here is a brief excerpt:
Matthew Yglesias takes issue with my suggestion that a "decent" national health care system, added on top of our current Social Security system, will require a "larger tax burden than citizens are willing to bear." He argues:
The U.S. government currently spends a phenomenal sum of money on health care by world standards ... [W]hen you're talking about universal health care you're not really talking about increasing the aggregate resources poured into American health care. There's already tons of money being spent on it. You're talking about redistributing the spending somewhat from richer to less-rich people and altering the path through which the money flows.
I'm not a health care expert, but it seems to me:
1) If we want a system that reinforces social equality--everyone in the same waiting room-- that means we need basically the bottom 90% to use the same system. The hardest (i.e. impossible) way to do this is by forcing the affluent to get less care than they are willing to pay for ("redistributing the spending somewhat from richer to less-rich people," as Yglesias tactfully puts it.) The easiest way to do that is to offer subsidized universal care good enough so that the vast majority of the affluent will be content to use it. In other words, you can't just "insure" the poor with bare-bones HMO treatment. This will be expensive.
2) Medical technology will offer more and more complex and costly ways to treat illness. Some of these treatments will work. We want to offer them to everyone, with a minimum of rationing--again, in a system that most of the affluent will also sign up for. The alternative seems to be a system in which the upper middle class lives (because they can afford fancy treatments) and the working poor die. Avoiding this will be expensive.
3) We will still want to encourage future medical research and technological advance--or at least we want to retard it as little as possible. That's why I'm skeptical of some plans for realizing huge cost savings. For example, the government could undoubtedly use its monopsony power to lower the price it pays for drugs--maybe lower the price to something approaching the marginal cost of producing additional pills. It's not at all clear, however, that this is the price we should want to pay, because it does little to fund research and development costs of developing both the existing drug and new drugs. See Michael Kinsley's analysis here. Paying medical providers enough to fund future advances will be very expensive.
It is an interesting debate!
August 21, 2006
Mummified Bodies from China
This article appeared last week in the New York Times and discusses China's growing mummified body business:
Inside a series of unmarked buildings, hundreds of Chinese workers, some seated in assembly line formations, are cleaning, cutting, dissecting, preserving and re-engineering human corpses, preparing them for the international museum exhibition market.
“Pull the cover off; pull it off,” one Chinese manager says as a team of workers begin to lift a blanket from the head of a cadaver stored in a stainless steel container filled with formalin, a chemical preservative. “Let’s see the face; show the face.”
The mastermind behind this operation is Gunther von Hagens, a 61-year-old German scientist whose show, “Body Worlds,” has attracted 20 million people worldwide over the past decade and has taken in over $200 million by displaying preserved, skinless human corpses with their well-defined muscles and sinewy tissues.
But now with millions of people flocking to see “Body Worlds” and similar exhibitions, a ghastly new underground mini-industry has emerged in China.
With little government oversight, an abundance of cheap medical school labor and easy access to cadavers and organs — which appear to come mostly from China and Europe — at least 10 other Chinese body factories have opened in the last few years. These companies are regularly filling exhibition orders, shipping preserved cadavers to Japan, South Korea and the United States.
Fierce competition among body show producers has led to accusations of copyright theft, unfair competition and trafficking in human bodies in a country with a reputation for allowing a flourishing underground trade in organs and other body parts.
Here in China, determining who is in the body business and where the bodies come from is not easy. Museums that hold body exhibitions in China say they have suddenly “forgotten” who supplied their bodies, police officials have regularly changed their stories about what they have done with bodies, and even universities have confirmed and then denied the existence of body preservation operations on their campuses. . . .
Worried about a growing trade in illegal bodies, the Chinese government issued new regulations in July that outlawed the purchase or sale of human bodies and restricted the import and export of human specimens, unless used for research. But it is unclear how the regulations will affect the factories. . . .
Experts say exhibitions featuring preserved bodies are now among the most popular attractions at American science and natural history museums. While the shows have not appeared at two of the most respected museums — the Smithsonian and the American Museum of Natural History in New York — they have appeared at major museums in Chicago, Houston and Los Angeles. . . .
The industry is dogged by questions about the origins of the corpses. Premier says its exhibition uses unclaimed Chinese bodies that the police have given to medical schools. None of the bodies, it says, are those of executed prisoners or people who died of unnatural causes. . . .
Officials at the Customs Bureau here in Dalian and the Dalian Medical University, however, said they had no records showing the supplier of Premier having acquired bodies and then transporting them to exhibitions abroad.
“I don’t know where the bodies came from,” said Meng Xianzhi, a spokesman for the university.
Dr. von Hagens, who opened the first large-scale body preservation factory here in Dalian in 1999, said he abided by the regulations.
The fierce rivalry between Premier and Dr. von Hagens’s company, the Institute of Plastination, has moved to the courts, over everything from copyright claims to rights to the name “Body World.” They have each publicly hinted that their rival is engaging in unethical behavior in acquiring bodies in China.
Although the exhibitions appear to have some educational value, I am not sure they are worth it when the bodies apparently could have been donated involutarily.
Cuban Health Care
Ezra Klein has an interesting post on the Cuban health care system. Apparently some individuals seem to think it is a system to be copied. However, he provides an educational counterpoint to this view:
I'm always skeptical when I hear good liberals waxing rhapsodic about the wonders of the Cuban health care system. Not only is there a total dearth of decent data on the country's care, but what does exist tends to be agenda-driven and ideologically colored. But it is interesting to read why Hilda Molina, one of the countries most honored and highly placed surgeons, resigned her position and became a hated enemy of Fidel's:
In 1989, Dr. Molina realized a longtime dream by getting the government to establish the International Center for Neurological Restoration. The center conducted research and treated Cubans from all walks of life for maladies such as strokes and epilepsy. Fidel Castro would come for visits, often with foreign dignitaries in tow. "It was a point of pride that Cuba could have such an advanced facility," says Dr. Molina, who was rewarded with a seat in the Cuban Parliament. . . .
But in the 1990s, the collapse of the Soviet Union, which had bankrolled the Castro regime, began undermining the project to which Dr. Molina had dedicated her life. Dr. Molina says authorities ordered her to begin setting aside more beds for paying foreign patients, rather than ailing Cubans. "It was all about earning hard currency for the government," she says.
The entire piece is well worth a read as we wait to see how well Fidel Castro recovers.