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.
Law.com has an article discussing a disturbing trend among hospitals - filing for bankruptcy.
When Culver City, Calif.'s Brotman Medical Center filed for Chapter 11 bankruptcy in late October, attorneys paid attention. Its financial struggles are likely to be a harbinger of hospital woes to come as the number of uninsured patients grows and hospital revenues decrease. "All of those factors are forming a real storm for hospitals," said Stephen Warren, a partner in O'Melveny & Myers' L.A. office. "And this wave is going to involve sophisticated counsel."
Of course, law.com's take is that this is an interesting opportunity for attorneys, however, it sounds terrible for patients and hospitals. Law.com focuses on California but that state doesn't sound too different from many others. It reports:
Many California lawyers are especially interested in the hospital woes, since the state's high cost of compliance and higher costs of operating magnify the problems. The state's retrofitting requirements add an additional layer of expense to some already beleaguered hospitals. That's coupled with overarching stresses such as the proliferation of urgent-care centers as an alternative to hospital care. "I think there has to be a shakeout," Buchalter Nemer's Seigel said. "The hospital industry is going through a revolution." While more established hospitals like L.A.'s Cedars-Sinai will likely weather the storm, smaller community hospitals such as Brotman will be the hardest hit, he said.
The trend isn't going unnoticed. Just recently, members of Southern California's Turnaround Management Association, a group of professionals who work with distressed businesses, organized a presentation titled "Hospitals in Need of Care: The financial crisis looming in southern California's hospital system." "California's hospital system may be the 'canary in the mine' -- demonstrating weaknesses that are extant throughout the United States but have yet to become obvious elsewhere," the presentation stated. . . .
In January, Pfizer Inc. announced it was closing its storied research laboratories here, laying off 2,100 people. Among the casualties: Bob Sliskovic, a 23-year lab veteran who helped create the world's most successful drug.
The closure and Dr. Sliskovic's abrupt change of circumstances are emblematic of the pharmaceutical industry's declining fortunes. It was at the Ann Arbor facility in the late 1980s that Dr. Sliskovic first assembled the chemicals that make up Lipitor, the cholesterol-lowering drug that has generated about $80 billion in sales since its launch and ranks as the bestselling pharmaceutical product ever. Today, Lipitor is nearing the end of its patent life, and Pfizer hasn't been able to come up with enough promising new drugs to replace it.
Following that initial breakthrough some 20 years ago, Dr. Sliskovic worked on several other research projects, but none panned out. His losing streak mirrors the industry's. A byproduct of the late-19th-century chemical business, pharmaceutical research thrived for more than a century by finding chemical combinations to treat diseases. But after contributing substantially both to human health and drug-industry profits, it has failed to produce significant innovations in recent years. . . .
Ezra Klein also points to other issues facing the drug industry, including many problematic patent law issues.
Timely justice in these cases would require more staff to deal with appeals. Instead, continuing budget battles mean that SSA "will probably operate on the basis of continuing resolutions, which will keep agency spending at last year’s level and doom the plan to add judges."
The parsimonious and inaccurate bureaucracy excels at a few things, though. It generates lots of work for those who represent the claimants. And it displays a Kafkaesque willingness to help once it's too late:
In the past, said Walter Patterson, a disability lawyer in Charlotte, N.C., clients who received a foreclosure warning were pushed up the waiting list for quicker hearings. But as the hearing offices have become overwhelmed, he said, they now expedite cases only after seeing an actual eviction notice — usually too late to help.
Like the costly ER interventions that could be avoided if only we provided preventive medical care for the poor, the dilatory aid offered by a torpid SSA should provoke a rethink of bureaucratic justice here. Though the agency is under stress, it should no longer hide behind Mathews v. Eldridge to justify a deeply flawed and unfair system.
Last week, the Supreme Court granted cert. in the Huber v. Wal-Mart case concerning disabled employee rights to reassignment to vacant positions. Scotusblog provides a brief overview:
In the Huber case, the Court limited its grant of review to the first question raised, and Justice Stephen G. Breyer recused. The issue to be decided is whether an individual who is disabled and cannot perform her present job must be reassigned to a vacant, equivalent position without having to compete with other workers for that slot. The case involves Pat Huber, a Wal-Mart employee in Clarksville, Ark. After she became disabled by an injury, she sought an open job, but a non-disabled worker gained the position. Wal-Mart said the other worker was better qualified, and that it followed a policy of basing such assignments on qualifications. The appeal says that the U.S. Equal Employment Opportunity Commission has issued regulations providing that a disabled worker need not be the best qualified for an open position to obtain it in a reassignment. The Americans with Disabilities Act requires employers to make “reasonable accommodations” for their disabled employees. The Circuit Courts are split on the issue at stake.
Scotusblog also posts the following:
Case name: Huber v. Wal-Mart
Issue: Whether, under the Americans with Disabilities Act, disabled employees must be reassigned to a vacant position for which they are qualified or merely be permitted to apply for such a position.
The Laborprofblog has some thoughts on the case and is not optimistic about the plaintiff's chances.