Monday, December 31, 2007
Writing at MSNBC.com, Arthur Caplan predicts a bleak year on the bioethics front for 2008. He writes,
One of the most exciting breakthroughs to occur last year was the simultaneous discovery of how to make a type of skin cell behave as if it were an embryonic stem cell. Teams in Japan and Wisconsin announced that they had induced pluripotency in skin fibroblasts, meaning the cells had the power to turn into virtually any kind of human tissue. Most of those in the United States involved in the national hair pull over the morality of using human embryos as a source of stem cells for medical research heaved a huge sigh of exhausted relief.
Who on either side could stand one more round of overly heated debate? Inducing pluripotency to turn skin cells in embryo-like cells is a compromise we can all support, right?
Well, kind of. While plenty of research will get done on this new source of stem cells in 2008 and beyond, it will quickly become evident that the techniques used to switch on the genes in adult skin cells are fraught with problems that make transplanting induced pluripotent cells into the human body a highly dangerous and highly unlikely thing to try. As a result, we'll be back to human embryos and cloned human embryos as the most promising sources of transplantable cells. It will be back to the new president and the new Congress to figure out whether they are going to spend money in this area or watch as the rest of the scientific world passes by the USA.
Easiest to predict disappointment
It is obvious that the American health care system is broke. It costs too much and for too many yet too often delivers poor quality of care. As the presidential campaign moves along, many are looking forward to an intelligent debate about how finally to fix it. Uh, not so fast.
The American health care system has been broken for the past three decades and nothing radical has been done to fix it yet. Moreover, the nation is running a huge debt from its overseas wars and profligate loan and credit habits. This is not a formula for fixing anything about health care anytime soon. . . . .
Biggest continuing frustration
In a recent column I noted with some sadness that the latest trial of an HIV vaccine by Merck had to be stopped prematurely due to a higher rate of deaths in the placebo arm of the study. I did not get this right. Instead there was a higher rate of HIV infection among those who got vaccinated than in the placebo group. Analysis of what actually happened is expected in 2008. It is still not likely to be good news. . . . .
And it continues . . . . well, I myself preferred listening to the Science Friday on NPR's Talk of the Nation about the biggest science stories of this past year - even if I am being naive (and I should note that it wasn't focused exclusively on bioethics issues so more positive stories were included) - it was a big more hopeful about the future.
Shakesville links to a recent associated press article discussing the use of Indian women as surrogates. The article raises many issues about the use of money to hire women from developing countries to bear children for other women. Shakesville states,
Commercial surrogacy is the latest job being outsourced to India, as dozens of women just in the western city of Anand are currently carrying babies for couples from around the globe.
Commercial surrogacy has been legal in India since 2002, as it is in many other countries, including the United States. But India is the leader in making it a viable industry rather than a rare fertility treatment. Experts say it could take off for the same reasons outsourcing in other industries has been successful: a wide labor pool working for relatively low rates.
…"It raises the factor of baby farms in developing countries," said Dr. John Lantos of the Center for Practical Bioethics in Kansas City, Mo.
Gee, ya think?
Dr. Nayna Patel, who runs a clinic matching willing surrogates with infertile couples in Anand, to which young women are lining up to serve as surrogates, naturally defends her dubious matchmaking service by pointing out what a pragmatic solution it is to both infertility and poverty: "There is this one woman who desperately needs a baby and cannot have her own child without the help of a surrogate. And at the other end there is this woman who badly wants to help her (own) family. If this female wants to help the other one ... why not allow that? ... It's not for any bad cause. They're helping one another to have a new life in this world."
Saturday, December 29, 2007
Reuters reports on President Bush's signing of temporary extension of SCHIP. It states,
President George W. Bush on Saturday signed into law a temporary extension of a popular health insurance program for children after months of deadlock with the Democratic-led Congress.
The legislation extends the program that covers about 6.6 million poor children through March 31, 2009, leaving decisions about renewal to the next president and Congress.
The legislation also provides a 0.5 percent increase for Medicare doctors for six months, delaying a scheduled 10 percent pay cut.
Bush twice vetoed more ambitious earlier bills that would have expanded the children's health program to cover about 10 million children in low and moderate income families, despite bipartisan support. . . .
Friday, December 28, 2007
A California Appellate Court made it harder for insurance companies in that state to rescind insurance policies when it had failed to check the accuracy of the applications first. The LA Times reports,
California health insurers have a duty to check the accuracy of applications for coverage before issuing policies -- and should not wait until patients run up big medical bills, a state appeals court ruled Monday.
The court also said insurers could not cancel a medical policy unless they showed that the policyholder willfully misrepresented his health or that the company had investigated the application before it issued coverage.
The unanimous decision by a panel of the 4th District Court of Appeal in Santa Ana is the latest blow to California insurance companies and the way they handle policy cancellations after patients get sick and amass major medical claims.
The insurers' practices are under scrutiny by the state Legislature, the Department of Insurance, the Department of Managed Health Care and the courts. In recent months, state agencies have fined, cited and sued the state's major health insurers for the way they have handled cancellations and treated policyholders.
The decision came in a closely watched case involving Steve Hailey, an Orange County small-business owner whose coverage was canceled by Blue Shield of California after he had a disabling car accident. The ruling in favor of Hailey sends the case back to the lower court for trial and requires Blue Shield to pay Hailey's appellate costs.
At issue for trial, the appeals court said, is whether the Hailey family intended to deceive Blue Shield and whether Blue Shield acted in bad faith by "blindly" accepting their application and taking their premiums until Steve's medical bills got too high.
Spokesman Tom Epstein said Blue Shield, one of the state's largest health plans, looked forward to the trial and would prove that "our underwriting was appropriate and that the Haileys misrepresented numerous important facts on their application."
The company said it was considering an appeal. . .
Until now, lower courts have typically dismissed cases in favor of insurers without trials, and insurers have settled confidentially out of court, insurers and policyholder lawyers say.
Bryan Liang, executive director of the Health Law Institute at California Western School of Law in San Diego, said the ruling was consistent with what the state Department of Managed Health Care has said -- that insurers "cannot cancel policies without willful misrepresentation."
The court "went further and stated quite clearly that the current policies of insurers simply do not serve as a basis for legal rescission," Liang said.
In the Haileys' case, Blue Shield rescinded Steve's policy after authorizing more than $450,000 worth of hospital and other medical care. The insurer also demanded that he repay more than $104,000 it spent on his behalf.
Blue Shield contended that Hailey lied on his application about preexisting conditions, failed to disclose a recent emergency room visit and shaved about 45 pounds off his weight.
But Cindy Hailey testified that she filled out the application for the family, including a teenage son, and mistakenly believed that it was asking for information about only her health. . . .
The New York Times reported yesterday on this EEOC ruling which declared,
. . . that employers could reduce or eliminate health benefits for retirees when they turn 65 and become eligible for Medicare. The policy, set forth in a new regulation, allows employers to establish two classes of retirees, with more comprehensive benefits for those under 65 and more limited benefits — or none at all — for those older.
More than 10 million retirees rely on employer-sponsored health plans as a primary source of coverage or as a supplement to Medicare, and Naomi C. Earp, the commission’s chairwoman, said, “This rule will help employers continue to voluntarily provide and maintain these critically important health benefits.”
Premiums for employer-sponsored health insurance rose an average of 6.1 percent this year and have increased 78 percent since 2001, according to surveys by the Kaiser Family Foundation. Because of the rising cost of health care and the increased life expectancy of workers, the commission said, many employers refuse to provide retiree health benefits or even to negotiate on the issue. In general, the commission observed, employers are not required by federal law to provide health benefits to either active or retired workers.
Dianna B. Johnston, a lawyer for the commission, said many employers and labor unions had told it that “if they had to provide identical benefits for retirees under 65 and over 65, they would just drop retiree health benefits altogether for both groups.” In a preamble to the new regulation, published Wednesday in the Federal Register, the commission said, “The final rule is not intended to encourage employers to eliminate any retiree health benefits they may currently provide.”
But AARP and other advocates for older Americans attacked the rule. “This rule gives employers free rein to use age as a basis for reducing or eliminating health care benefits for retirees 65 and older,” said Christopher G. Mackaronis, a lawyer for AARP, which represents millions of people age 50 or above and which had sued in an effort to block issuance of the final regulation. “Ten million people could be affected — adversely affected — by the rule.”
I am sure that this will turn out well . . . . it actually might force the enactment of some rather grand health care reform. Attaturk at Firedoglake expresses some of the sentiments that I felt when I read the article and responds to the EEOC's Ms. Earp by stating,
No, Ms. Earp, here is what it will do.
For younger retirees (generally prosperous to begin with) the same ol' same ol', i.e. "don't get sick". For those who retire at 65 or older; or the first group -- when they usually get the sickest...as far as their former employer is concerned, they can just go ahead and die.
It's all on the tax payers now, and they demand their tax cuts, or so we are always told. If ever there was a new policy interpretation that you know is going to work out badly, this is it.
Thursday, December 27, 2007
DailyKos has a full discussion about the recent veto of SCHIP expansion means for the children in various states. DemFromCt reports,
. . . . I have been thinking about the state of play at the moment with SCHIP and where we go from here politically. This 12/20 summary is from kaisernetwork.org:
White House spokesperson Dana Perino in a statement said, "With this (SCHIP) bill, we can be assured that children will continue to have coverage, and Democrats won't be able to play election-year politics with children's health" (Neikirk, Chicago Tribune, 12/20).
The measure does not address an SCHIP policy directive announced in August by CMS that states must enroll 95% of children in families with incomes up to 250% of the federal poverty level before expanding eligibility, The Hill reports. Acting CMS Administrator Kerry Weems said that the Bush administration would not require states to disenroll children from the program despite the requirement. House Energy and Commerce Committee Chair John Dingell (D-Mich.) said that Weems' statement contradicts the policy, adding, "Perhaps CMS officials are reading their directive differently than the rest of us."
An analysis by the Georgetown University Health Policy Institute's Center for Children and Families found that 14 states provide SCHIP coverage to children in families with incomes greater than 250% of the poverty level and that they "will likely be forced to roll back their eligibility levels at some point before August 2008 or assume new coverage costs with state funds." Democratic Caucus Chair Rahm Emanuel (Ill.) on the House floor Wednesday said, "Because of the president's executive order, kids in those states will actually come off the rolls in August." The National Governors Association on Monday sent a letter to Congress asking it to "address the issue raised in the ... guidance issued by CMS" (Young, The Hill, 12/20).
[Rahm] Emanuel said SCHIP will be addressed this summer, when the new rules take effect. He said, "What we can't resolve, the American people will resolve in November," adding, "This will be the first thing a Democratic president will get done. We don't need March '09" (Johnson, CongressDaily, 12/19).
So, without defending (or piling on) the Democrats in Congress, who are having issues with caving on Iraq and perhaps a few other items, I would have been happier with more public votes. However, reality sometimes intrudes, and here are some realities:
Some states, at least, were running out of money. Georgia, for example: The latest plan would extend funding for PeachCare and other programs like it around the country through March 2009 - a timeline first proposed by Rep. Nathan Deal, a Duluth Republican who took a leading role in previous negotiations on SCHIP.
The Baucus-Grassley measure would keep PeachCare funding at its current levels. But it would add additional funds to prevent Georgia and about 20 other states from running out of money early - a problem that this year forced Georgia lawmakers to freeze and cap enrollment for the state’s eligible children...
"With appropriate funding," she said, "children already enrolled and eligible for PeachCare can continue without interruption of their health care."
Since Oct. 1, PeachCare has been operating under month-long - and, in the latest case, weeklong - extensions of its current funding, leaving Georgia officials worried about running out of money in early 2008.
While it made political sense to fight up to the edge, Georgia went over the edge 10/1 and could not enroll new children (who, despite government caps, have a habit of piling up when you are not paying attention). . . .
Tuesday, December 25, 2007
AMNews reports on the Santa's ability to make his yearly trip
Physicians suspect that Santa Claus is able to make his annual around-the-world gift-giving journey because he is vigilant about getting yearly influenza vaccinations, having regular checkups and staying physically active, according to a statement issued by the Pennsylvania Medical Society last month.
"Santa never misses an appearance or a delivery, and that makes me think he gets an annual flu shot. He knows how dangerous it would be for him to spread influenza to the children, elves or Mrs. Claus, and how disappointing it would be for him to come down with the virus," said William Lander, MD, a family physician in Bryn Mawr, Pa. and past president of the organization.
The society issued this statement during the holiday season to point out what could be learned about Santa's longevity that may be applicable to patients.
"What we tried to do with this was take something relevant to the time in the calendar as an opportunity to educate patients about what they should be considering for their health," said Daniel Glunk, MD, an internist in Williamsport, Pa. and president-elect of the medical society.
According to the statement, the man in red most likely takes precautions against skin damage by using gloves, lip balm and sunscreen. His fitness routine probably includes flexibility and balance exercises to allow him to shimmy down chimneys and walk along rooftops, although physicians do worry that the extra weight around his middle will eventually be to his detriment.
"Getting him into an obesity program would probably help Santa's longevity, and I have hope that he and Mrs. Claus will get their weight down in the next year or two," Dr. Lander said.
Physicians elsewhere concur with much of the statement, and many suspect Santa maintains his overall health by staying in an occupation he loves. He stays mentally agile by making lists of who is naughty and nice. Time spent with animals such as reindeer also could keep him going.
"Certainly, the Grinch has a very short life expectancy because he does not have a positive mental attitude," said James Applegate, MD, a family physician in Grand Rapids, Mich. "And caring for animals has been shown to improve your longevity."
Although the lead health concern for Santa seems to be his girth, some also worry about the potential harm he faces from occupational hazards.
"My first concern is whether he could be developing the metabolic syndrome because of his truncal obesity, but he's had a good long life. He might be one of these people who are fit and fat," Dr. Applegate said. "But I wonder whether he might have lung disease like emphysema or COPD.I would want to check his lung function to make sure that coal dust and coming down chimneys is not a problem for him."
Serious holiday health concerns
Contemplating Santa's health and well-being is a lighthearted way to discuss with patients the importance of preventive care. But the holiday season also tends to bring with it some very serious developments that can have a grave impact -- on both people and the health care system. Specifically, this time is marked by increases in heart attack deaths.
"In many ways, the holidays constitute 'the perfect storm' for heart attacks, and emergency departments typically experience an influx of cardiac patients," said Linda Lawrence, MD, president of the American College of Emergency Physicians.
The circumstance has been documented by several studies. Notably, a paper in the Dec. 21/28, 2004, Circulation highlighted the occurrence of spikes around Christmas and also New Year's Day. The article estimated that 42,039 deaths from 1973 to 2001 could be attributed to the holiday season. The magnitude of the effect also increased from year to year.
"Hospitals need to be aware that there's an increase, and need to be adequately staffed," said Robert A. Kloner, MD, PhD, director of research at the Heart Institute of Good Samaritan Hospital in Los Angeles. He has authored several papers on this subject, including an editorial accompanying the Circulation study. "Physicians need to be aware of the phenomenon so they can advise their patients."
The exact cause of what are being called "Merry Christmas coronaries" and "Happy New Year heart attacks" is unknown; colder temperatures do not appear to explain them. Experts suspect they are caused by a combination of overindulgence and waiting until the holiday season is over to get medical attention. Regular medications may be forgotten. Emotions can run high. Patients tend to drink more alcohol, eat more and exercise less, but the holidays also might require them to be more physically active in ways that are not good for them.
"Patients with cardiac disease need to find someone else to shovel their snow," Dr. Kloner said.
Sunday, December 23, 2007
Many of you may be aware of the recent actions by CIGNA health insurance to deny payment for a liver transplant to Nataline Sarkisyan. I am linking to one recent discussion of the incident. I still have not figured out all the facts but it is surely a terrible case if the media's accounts are accurate. Christy Hardin Smith at Firedoglake writes,
Insurance companies make money by finding ways to not pay claims. That's the truth of it. This past week, we sadly saw the result of this in the death of Nataline Sarkisyan. From the CA Nurses Association:
On Dec. 11, four leading physicians, including the surgical director of the Pediatric Liver Transplant Program at UCLA, wrote to CIGNA urging the company to reverse its denial. The physicians said that Nataline “currently meets criteria to be listed as Status 1A” for a transplant. They also challenged CIGNA’s denial which the company said occurred because their benefit plan “does not cover experimental, investigational and unproven services,” to which the doctors replied, “Nataline’s case is in fact none of the above.”
The CA Nurses Assoc. organized a massive protest against Cigna's spreadsheet-based decision, but the turnaround from Cigna came too late for Nataline, who passed away without ever receiving her transplant. C&L has news video on the story, and it is absolutely heartbreaking.
I keep thinking about this poor girl's parents, having already gone through so much with their child who battled and survived cancer only to face this latest hurdle, to be told by doctors -- including the head of pediatric transplant surgery at UCLA -- that she had at least a 65% chance of surviving six months or more with a liver transplant...and then be told by their for-profit insurers that they wouldn't pay to save their child's life. Death by spreadsheet and profit margin, indeed. All Spin Zone lays it out (via RawStory):
AP/AR is is business shorthand for “accounts payable / accounts receiveable”. In theory, as long as AR > AP on the corporate ledger, a company is profitable and satisfies the needs of its stakeholders (business partners, customers, vendors, employees, and stockholders). So, most large companies employ teams of individuals who manage corporate risk. Guidelines and protocols are established to enable these teams to make decisions on when it makes economic sense to spend money, approve projects, and invest in research and development.
It’s all about risk management. Keep this in mind as you read further — because you are a risk, not a client — to your healthcare, life, auto, and homeowners insurance providers....
The conflict between medical treatment needs and the corporate bottom line happens in a whole lot of medical cases. In the abstract, you can see why this happens. . . .
The National Law Journal has an interesting article about the most recent use of civil rights laws to challenge reimbursement rates. It reports,
Rural health care providers who serve the poor have the right to sue state officials using civil rights law to challenge limited reimbursement of certain costs, the 4th U.S. Circuit Court of Appeals has held.
This is the first time that private right of action has been recognized by any circuit in this particular section of the law. The 1st Circuit, however, in 2005 presumed such a right without finding it specifically in the same Medicaid Act section, in Rio Grande Cmty. Health Ctr. Inc, v. Rullan, 397 F.3d 56 (1st Cir.).
The recent 4th Circuit opinion by Judge Allyson K. Duncan did provide an out for the states. The ruling held that health care providers can waive their right to sue in contract terms with the state, without violating federal law.
'All over the place'
"This is exactly the kind of case where the circuits go all over the place," said Ken Woodington of Davidson, Morrison & Lindemann in Columbia, S.C. He represented South Carolina in the 4th Circuit case, Pee Dee Health Care v. Sanford, No. 06-2108.
"It's the first of its kind, but there are 65 subsection provisions of the Medicaid Act and circuits will look at each one and decide individually if they create a right of action — and circuits split," he said.
The dispute began in 2005 when a coalition of rural health care providers sued over plans by South Carolina Governor Mark Sanford to curtail the state's Medicaid program by reducing some coverage in a way that the providers argued violated federal Medicaid regulations. . . .
The case was removed to federal court by the state. At that point, claims expanded to include a challenge to amounts paid to reimburse the health care providers for Medicaid expenses dating back to 2001. The reimbursement issue was appealed to the 4th Circuit by Pee Dee Health. The 4th Circuit also held that Pee Dee had waived its right to challenge the state-court forum in its contract with South Carolina. If there is no appeal, it would go back to the state court for resolution, Woodington said.
Law.com reports on the latest in pre-emption lawsuits in the drug products liability arena. It states,
In two appeals that could have a huge impact on the litigation of drug product liability cases, the 3rd U.S. Circuit Court of Appeals heard arguments this week on the issue of whether plaintiffs should be pre-empted from suing over allegedly inadequate warnings on prescription drugs because the warning labels were approved by the Food & Drug Administration.
Lower court judges have reached opposite conclusions, with U.S. District Judge Michael M. Baylson in the Eastern District of Pennsylvania holding that such claims are pre-empted, and U.S. District Judge Jerome B. Simandle in the District of New Jersey holding that they are not.
Both cases stem from suicides in which the plaintiffs claim that manufacturers of antidepressant drugs failed to warn of the increased risk of suicide.
In Colacicco v. Apotex Inc., Baylson found that the plaintiffs' state law tort claims are pre-empted because Congress granted control to the FDA to regulate the prescription drug industry, including the authority to regulate "the specifics of drug labeling."
But in McNellis v. Pfizer Inc., Simandle concluded that a state tort claim was not pre-empted because the FDA's regulations "empower drug manufacturers to enhance the labeling warnings beyond the approved text when new risks emerge." . . .
According to the Associated Press, popcorn manufacturers are removing the chemical diacetyl, which has been linked
to cases of bronchiolitis obliterans, a rare life-threatening disease
also known as popcorn lung.
The AP reports,
The nation's four biggest makers of microwave popcorn have removed a flavoring chemical linked to a lung ailment in popcorn plant workers from nearly all their products. The companies say all their microwave popcorn recipes should be changed by January. But it might take several months for the reformulated popcorn to replace all the older varieties on store shelves.
In August, the Weaver Popcorn Co. of Indianapolis said it had removed the butter flavor diacetyl from all its microwave popcorn varieties. ConAgra Foods Inc. of Omaha; General Mills Inc. of Golden Valley, Minn.; and the American Pop Corn Co. of Sioux City, Iowa, all promised in September to change their microwave popcorn recipes. Those three companies sell Orville Redenbacher, Act II, Pop Secret, and Jolly Time microwave popcorn.
"We want to assure our consumers they can continue to enjoy their favorite popcorn with complete confidence," said ConAgra's Stan Jacot, who oversees popcorn marketing for the company. The chemical diacetyl has been linked to cases of bronchiolitis obliterans, a rare life-threatening disease often called popcorn lung. Diacetyl occurs naturally in foods such as butter, cheese, and fruits, and the FDA has approved its use as a flavor ingredient.
Wednesday, December 19, 2007
Ezra Klein blogs about California's recent health reform measure. He states,
Potentially big news out of California . . . . where the Assembly has passed the first piece of a massive health care expansion. Passage in the Senate will be a bit trickier, and the funding component isn't even in the legislation, and is instead being offered as a ballot measure a few months down the road. So there are many hurdles left to leap.
Still: It would be a big deal to have the Golden State pass universal health reform. Schwarzenegger's bill is, in many ways, similar to Clinton and Edwards' plans -- and in certain ways it goes further. It forces insurers to offer insurance at standard rates rather than discriminating based on preexisting conditions; imposes an individual mandate to ensure broad buy-in; and offers heavy subsidies up to 250 percent of the poverty line and limits health spending to 5.5% of income for those making between 250 percent and 400 percent of the poverty line. It puts a sliding scale tax on businesses, a small tax on hospitals, and a $1.50 on cigarettes. It allows the state to purchase pharmaceuticals as a whole in order to negotiate better prices. . . .
Tuesday, December 18, 2007
The Massachusetts Supreme Judicial Court ruled December 10th that a "doctor who failed to warn his patient about the effects of his treatment can be held liable for injuries to a third party." Coombes v. Florio, Mass., No. SJC-09869, 12/10/07. The BNA Health Law Reporter summarizes the case and states,
The divided court ruled in favor of the mother of a 10-year-old boy killed in an automobile accident by an elderly driver who had been taking several strong medications. The decision overturned a finding of summary judgment by a lower court in favor of Dr. Roland J. Florio and allowed Lyn-Ann Coombes to proceed with a lawsuit charging Florio with negligence.
Florio "owes a duty of care to all those foreseeably put at risk by his failure to warn about the effects of treatment he provides to his patients," Justice Roderick L. Ireland said. Although there was no conclusive evidence that the effect of the medication was the cause of the accident, there is a genuine issue of material fact, making summary judgment inappropriate, he found.
In a strongly worded dissent, Chief Justice Margaret H. Marshall said that "the inevitable result" of the ruling will be "a significant increase in third-party litigation against doctors and an attendant increase in expenses at a time when our health care system is already overwhelmed with collateral costs."
More is available at the BNA website and the full opinion is available here.
Americans could save $1.5 trillion in healthcare costs over the next decade while covering the uninsured and improving overall quality, according to a report to be released today. But it would take widespread reforms to root out inefficiency, not to mention higher tobacco taxes and other levies.
"We are not getting good value for our dollar," said Karen Davis, president of the Commonwealth Fund, a New York-based research group that prepared the report. "Will we continue to head down a path of less access to care [and] higher costs . . . or will we start now to make the changes needed to transform our healthcare system?"
Intended to provide a menu of options for the next president, the report blends ideas put forward by leading political candidates with other proposals. Many of the ideas are likely to stir controversy.
For example, the report calls for boosting the federal tobacco tax by $2 from the current 39 cents a pack. It also proposes a penny tax on 12-ounce, sugar-sweetened soft drinks to fund a campaign against obesity. And it proposes a 1% levy on insurance premiums to finance rapid computerization of records kept by doctors and hospitals. . . . .
Such a combination of different approaches -- there are a total of 15 major proposals in the report -- could work together to produce hundreds of billions in savings, the authors say. . . . .
The United States will spend about $2.3 trillion on healthcare this year, twice as much on a per-capita basis as any other country. But the health of Americans is not appreciably better than that of people in other industrialized countries, most of which offer government-run care systems.
And U.S. healthcare costs, which are growing faster than wages and faster than the economy, are projected to double in the next 10 years. Economic experts who advise both government and the business community say the current rate of growth is unsustainable. Demanding greater efficiency has become a popular refrain among Democrats and Republicans. . . .
Hopefully with a new President - we might see some changes. Currently, President Bush does not seem to think that there is much wrong with our health care system. He announced yesterday in Virginia,
I’m going to tell you something — we have fabulous health care in America, just so you know. I think it’s very important — before people start griping about the health care system here — and of course there’s always grounds for complaint — just to compare it with other systems around the world.
ThinkProgress provides more discussion about how our health care system compares to other countries, noting in particular,
In 2002, the U.S. spent more on health care per person than other industrial countries like Britain, Canada, France, and Germany. But unlike those countries, which have universal health care systems, there are roughly 47 million Americans who lack health coverage.
In 2000, the World Health Organization (WHO) did a comparative assessment of the health systems of 191 countries. The WHO found that in terms of the five measured performance indicators, the U.S. ranked 37th:
The U. S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The United Kingdom, which spends just six percent of gross domestic product (GDP) on health services, ranks 18th . Several small countries — San Marino, Andorra, Malta and Singapore are rated close behind second- placed Italy.
Monday, December 17, 2007
Five members of a family in Pakistan are among eight people who may be the country's first human cases of bird flu, the World Health Organization said. At least one brother died.
Pakistan's national laboratory found the lethal H5N1 avian flu strain caused the infections in three brothers and two cousins from the same family, according to information from a Dec. 15 WHO statement and Gregory Hartl, a WHO spokesman in Geneva. Another brother from the U.S., who attended a funeral for one of the victims, and his son tested negative for the virus at a hospital in Nassau County, New York, Hartl said.
Medical teams have been sent to Pakistan to assist local authorities in investigating the cases, in which two people had only mild symptoms, Hartl said. Doctors are monitoring for signs avian flu may be adapting to humans by killing fewer people, fostering its spread.
Daily Kos goes on to note the importance of keeping informed. They state,
So what do we take away from all of this? H5N1 is endemic in bird populations and will not simply go away. New outbreaks in new countries are likely part of the 'new normal', and we should expect a steady diet of news like this, particularly this time of year. In addition, the idea that "this will never be seen in North America" needs to be seriously rethought by anyone still holding on to that concept. We had a near miss last week, and modern travel conditions make the possibility of a human case in NYC more than just science fiction. . . .
Preparations to mitigate a pandemic need to be carried out beforehand, and are currently being done in many places throughout the United States and the world (for example, by groups as diverse as the American Red Cross, law enforcement, State Departments of Health, and many others). The ubiquity of the preparations, which may include your local school system, tells you something about the threat.
The next pandemic may not be H5N1, but H5N1 remains a candidate virus, and the planning to handle an event such as a pandemic will help with whatever comes (there's nothing wrong with an all-hazards approach to disaster preparation, as long as the all-hazards approach includes things as extensive as pandemics). Do yourself a favor and review your own family plans for natural disasters such as hurricanes, tornadoes and ice storms. Stock up on two weeks of food and water, and plan for power outages, if relevant to your community (it's very relevant in New England). You can rotate your stock and keep it fresh. It's time well spent and the effort will not go to waste.
The Wall Street Journal's Health Blog has an interesting discussion concerning the recent treatment of pharmaceutical companies. It reports,
Former FDA big shot and perennial defender of the free market Scott Gottlieb makes the case in the WSJ that drug makers are being persecuted by Washington.
Exhibit A: Eli Lilly’s guilty plea to a criminal indictment from the Bush Justice Department in 2005 over the off-label promotion of the company’s osteoporosis pill Evista to reduce the risk of breast cancer in post-menopausal women. Lilly paid $36 million in fines and disgorged its ill-gotten gains, he notes. But, Gottlieb asks, what was the crime? Lilly’s campaign to get the word out relied on findings “from a series of landmark national studies, some eventually touted by government research,” he writes. He goes on to cite another example involving the government’s investigation of Genentech for alleged promotion of Rituxan for unapproved uses in cancer.
There was the problem that Lilly only got FDA approval of Evista’s cancer indication this September.
But in Gottlieb’s view, ” ‘Off label’ are now dirty words in (the) conventional lexicon, made synonymous with lawbreaking as a result of these prosecutions, even though these words describe the way more than half of cancer medicine is practiced. It is true that some off-label drug use is based on very unsettled science and has more risks. But medicine — and not just cancer care — involves lots of hard choices.”
On this very same day, Paul Krugman, writing in the New York Times, notes how hard it will be to reform health care partially because of the influence of --- pharmaceutical companies. He writes,
Broadly speaking, the serious contenders for the Democratic nomination are offering similar policy proposals — the dispute over health care mandates notwithstanding. But there are large differences among the candidates in their beliefs about what it will take to turn a progressive agenda into reality.At one extreme, Barack Obama insists that the problem with America is that our politics are so “bitter and partisan,” and insists that he can get things done by ushering in a “different kind of politics.” At the opposite extreme, John Edwards blames the power of the wealthy and corporate interests for our problems, and says, in effect, that America needs another F.D.R. — a polarizing figure, the object of much hatred from the right, who nonetheless succeeded in making big changes. . . . .
The argument began during the Democratic debate, when the moderator — Carolyn Washburn, the editor of The Des Moines Register — suggested that Mr. Edwards shouldn’t be so harsh on the wealthy and special interests, because “the same groups are often responsible for getting things done in Washington.”
Mr. Edwards replied, “Some people argue that we’re going to sit at a table with these people and they’re going to voluntarily give their power away. I think it is a complete fantasy; it will never happen.” This was pretty clearly a swipe at Mr. Obama, who has repeatedly said that health reform should be negotiated at a “big table” that would include insurance companies and drug companies.
On Saturday Mr. Obama responded, this time criticizing Mr. Edwards by name. He declared that “We want to reduce the power of drug companies and insurance companies and so forth, but the notion that they will have no say-so at all in anything is just not realistic.”
Hmm. Do Obama supporters who celebrate his hoped-for ability to bring us together realize that “us” includes the insurance and drug lobbies? O.K., more seriously, it’s actually Mr. Obama who’s being unrealistic here, believing that the insurance and drug industries — which are, in large part, the cause of our health care problems — will be willing to play a constructive role in health reform. The fact is that there’s no way to reduce the gross wastefulness of our health system without also reducing the profits of the industries that generate the waste.
Thursday, December 13, 2007
Today, Talk of the Nation on National Public Radio had an interesting segment discussing patient use of the internet to help with diagnosis and to research their physicians. It contains some interesting discussion of how doctors are responding to patients who come into their offices with information obtained from the internet. The show's summary states,
A new report from the Pew Internet & American Life Project gives a glimpse of some of that change. It studies people with disabilities and chronic conditions, who are some of the most avid users of Internet health sites. Fewer of them go online than the overall population, probably because many are elderly, a group that is still less likely to use the Internet. But when people with disabilities and chronic conditions do use the Internet, they are more likely than other users to look up health information and use that knowledge to question a doctor, manage pain or change the way they cope with a chronic condition.
Wednesday, December 12, 2007
This week's Journal of the American Medical Association contains a book review of Leonard Sax's Boys Adrift. The book examines the reasons for the lack of motivation and apathy allegedly found among current young men. JAMA reviewer,Maureen E. Lyon, PhD, states,
Concern about ne’er do well sons is ancient. In a quote attributed to Socrates by Plato, Socrates laments, "The children now live in luxury . . . and love chatter instead of exercise." Leonard Sax, a family physician and research psychologist, continues this tradition in Boys Adrift, arguing that there is a growing epidemic of unmotivated boys and underachieving young men. Five factors are identified to account for this proposed decline: (1) feminization of education; (2) video games; (3) increased prescription of psychotropic medications that affect the motivational systems of the brain; (4) exposure to endocrine disrupters; and (5) lack of heroic role models. . . . .
The impact of educational changes on boys is powerfully and persuasively presented. Late cognitive maturation in most boys compared with girls puts boys at risk for failure: first, because girls, on average, may perform better than boys on the same task; and second, because the revised curricula of kindergarten and first grade have become more academic and less experiential. Furthermore, there are excellent references demonstrating that boys learn better in competitive environments, in contrast to the philosophy of some new curricula in which everyone is a winner. Zero tolerance for violence in schools may be further inhibiting the competitive spirit that can help boys succeed.
Most provocative is the author's speculation on the long-term effects among boys taking amphetamine-based medication for attention deficit-hyperactivity disorder. Animal studies demonstrate an association between amphetamines and changes in the nucleus accumbens, related to increased apathy and decreased motivation to act. Although Sax provides a disclaimer about cause and effect with humans, this distinction may be lost on parents. . . .
Is there support for this thesis that boys and young men are less motivated to succeed than 30 to 40 years ago? The evidence of the increased proportion of young women, relative to young men, in college is cited. Yet Census Bureau statistics on women and men graduating from college with a bachelor's degree show that the percentage of men graduating increased from the 1950s through the 1970s, where it then hovered between 25% and 30% until 2006. In 2006, 25.3% of men between the ages of 25 and 29 graduated from college, not a significant decrease over time. Yes, there is a higher proportion of women than men in college. But is this change detrimental to males? This is a different question not addressed in Boys Adrift.
Boys Adrift is at its strongest in providing practical advice to parents about how to increase their sons' academic motivation; how to set appropriate limits on video game use; and how to protect their sons from the potential harm of psychotropic medications and environmental estrogens. Boys Adrift is at its weakest in supporting the thesis that there is an epidemic of unmotivated and underachieving young men.
On a humorous note, perhaps I should institute a no computer game playing in class policy for my male students (I know some of them must be playing - there is way too much typing going on at times). It will be for their own good . . .
Forget the Iraq War and Social Security, the Wall Street Journal's Peter Orszag notes that the true budget buster is our health care system. He writes:
The nation's economic outlook may look troubling in the short run, but these difficulties pale beside the economic consequences that will follow if we don't address the nation's long-term fiscal gap -- or the prospective mismatch between projected spending and revenues.
The fiscal gap does not arise, as many believe, primarily from the coming retirement of the baby boomers. Rather, the rate at which health-care costs grow will be the primary determinant of the nation's long-term budget picture.
The entire article is rather alarming - unfortunately I cannot link to the full article because you need to subscribe to the Wall Street Journal. These is a free preview period.