November 29, 2008
Karl Rove on Obama's Health Reform
Thinkprogress provides an overview of Karl Rove's op-ed in the Wall Street Journal on President-elect Obama's new economic team and his plans for reforming health care. Fortunately ThinkProgress points out some problems with his analysis. Here is a brief excerpt:
. . . . But while issuing compliments of most of Obama’s nominees, Rove issued this back-handed swipe at Melody Barnes, who ThinkProgress first reported would be chosen to lead the White House Domestic Policy Council:
The only troubling personnel note was Melody Barnes as Domestic Policy Council director. Putting a former aide to Ted Kennedy in charge of health policy after tapping universal health-care advocate Tom Daschle to be Health and Human Services secretary sends a clear signal that Mr. Obama didn’t mean it when his campaign ads said he wouldn’t run to the “extremes” with government-run health care.
During the campaign, Barnes helped inform Obama’s health care approach — the same approach he is now promising to pursue in office. Obama pledged to bring together “doctors and patients, unions and businesses, Democrats and Republicans” together to build on the existing system and “reduce the cost of health care to ensure affordable, accessible coverage for all Americans.”
Taking a look at the health care stats in the Bush/Rove era, it’s clear that most Americans have seen a decline in their health care at the same time that health insurance companies have reaped tremendous gains:
– Since 2000, the ranks of the uninsured have grown by 7.2 million.
– Health care premiums have doubled under Bush. Employer-sponsored health insurance premiums have risen from $5,791 in 1999 to $12,680 in 2008.
– The fastest growing component of health care is health insurers’ administrative costs.
– Enrollment in Medicare private plans doubled. Through such plans, insurers “have increased the cost and complexity of the program without any evidence of improving care.”
–The combined profits of the nation’s largest insurance companies and their subsidiaries increased by over 170 percent between 2003 and 2007.
Obama is putting together a team, starting with Melody Barnes and Tom Daschle, who will be committed to ending the unfairness and inequity of the current health care system. Meanwhile, Karl Rove is committed to defending the health insurance industry and preventing any change to the status quo. Fortunately, the American people are proclaiming that they are ready for the change that Obama is promising.
November 28, 2008
Enjoying a day off work - perhaps you would like to experience the lovely law firm day even though you aren't there. Bitter Lawyer is a rather interesting look a law firm life (in some ways accurate) and quite funny. You can watch at your computer here.
Obama's Health Site
The Huffingtonpost reports on President-elect Obama's interactive health website. It is quite fun but unfortunately the interactivity will not help you work off your Thanksgiving meal.
November 27, 2008
Organ Distribution Changes
The Boston Globe reports on the Journal of American Medical Association's recent article concerning a change to the method of distributing organ donations - provide the donations to the sickest individuals. Turns out that this change in method helps eliminate some of the racial differences in survival rates.
Blacks waiting for a liver transplant used to be more likely to die compared to whites. Now they have the same chance of getting a life-saving organ under a nationwide system that puts the sickest patients first, a new study found. Racial differences disappeared when the old system was scrapped in 2002, according to the federally funded study, the first assessment of how blacks fared after the change.
"By design, we tried to make it race blind. It looks like we did," said Dr. Richard Freeman, a transplant surgeon at Tufts University School of Medicine in Boston, who helped create the new system and was not involved in the study. But the research, in Wednesday's Journal of the American Medical Association, suggests the system may favor men over women. Dr. Cynthia Moylan, the study's lead author and a transplant fellow at Duke University Medical Center in Durham, N.C., called for more research on gender differences. . . .
Under the old system, which relied heavily on how long a patient spent on an official waiting list, sicker patients were passed over in favor of those waiting longer. The system favored whites because blacks join waiting lists when they are sicker. Why isn't clear, but blacks may get treatment later or have poor access to liver specialists. . . .
The new system is based on three lab tests. Results are combined as a score that predicts a patient's risk of death within three months. Livers are allocated based on scores. The change was made after the government ordered the United Network for Organ Sharing, which runs the transplant network, to make liver allocation less arbitrary. Prior research has also found racial disparities in the allocation of kidneys. UNOS is currently evaluating its system for kidneys, which is now based on waiting time, blood type and tissue type. . . .
For women, MELD wasn't an improvement. The study found women had a 30 percent greater chance of dying or becoming too sick for transplant with the new scoring system. The gender difference wasn't significant before. One of the lab tests in the score may underestimate the severity of illness in women because of their smaller average size, said Dr. David Axelrod of Dartmouth-Hitchcock Medical Center in Lebanon, N.H., who was not involved in the study, but wrote an accompanying editorial. "With a relatively minimal change we can deal with that," Axelrod said, suggesting a different weight-adjusted measurement. . . .
Regional differences in waiting list times are still a big problem, said Dr. J. Michael Millis, head of transplantation at University of Chicago Medical Center. Donated organs are generally offered to local patients first. Some states with greater demand for organs have longer wait times. "In Wisconsin, waiting time is approximately half that in Chicago 90 miles away," Millis said. "There's no rational way to justify that."
Happy Thanksgiving - I hope it is happy and healthy for all of you! If you find that you have some extra food - now is the time that many people could use a little hand. Feeding America is a helpful place to start if you would like to express your thanks for all you have.
November 26, 2008
Step Away from the Computer and Call Me in the AM
The New York Times reports on a new ailment plaguing many Americans, Cyberchondria. Here are the symptoms:
On Monday, Microsoft researchers published the results of a study of health-related Web searches on popular search engines as well as a survey of the company’s employees.The study suggests that self-diagnosis by search engine frequently leads Web searchers to conclude the worst about what ails them. The researchers said they had undertaken the study as part of an effort to add features to Microsoft’s search service that could make it more of an adviser and less of a blind information retrieval tool.
Although the term “cyberchondria” emerged in 2000 to refer to the practice of leaping to dire conclusions while researching health matters online, the Microsoft study is the first systematic look at the anxieties of people doing searches related to health care, Eric Horvitz said. Mr. Horvitz, an artificial intelligence researcher at Microsoft Research, said many people treated search engines as if they could answer questions like a human expert. “People tend to look at just the first couple results,” Mr. Horvitz said. “If they find ‘brain tumor’ or ‘A.L.S.,’ that’s their launching point.” . . . .
They found that Web searches for things like headache and chest pain were just as likely or more likely to lead people to pages describing serious conditions as benign ones, even though the serious illnesses are much more rare. For example, there were just as many results that linked headaches with brain tumors as with caffeine withdrawal, although the chance of having a brain tumor is infinitesimally small.
The researchers said they had not intended their work to send the message that people should ignore symptoms. But their examination of search records indicated that researching particular symptoms often led quickly to anxiousness.They found that roughly 2 percent of all Web queries were health-related, and about 250,000 users, or about a quarter of the sample, engaged in a least one medical search during the study. About a third of the subjects “escalated” their follow-up searches to explore serious illnesses, the researchers said. . . . .
Cancer Deaths Decline
The LA Times reports on a recent cancer study demonstrating a decline in deaths from different cancers.
For the first time since the government began compiling records, the rate of cancer has begun to decline, marking a tipping point in the fight against the second-leading cause of death among Americans.
Researchers already knew that the number of cancer deaths was declining as the result of better treatment, but the drop in incidence indicates that major progress is also being made in prevention."The drop in incidence ... is something we have been waiting to see for a long time," said Dr. Otis W. Brawley, chief medical officer of the American Cancer Society. And "the continuing drop in mortality is evidence once again of real progress made against cancer, reflecting real gains in prevention, early detection and treatment." But the declines may be temporary, said Dr. Robert Figlin of the City of Hope Comprehensive Cancer Center in Duarte. "Baby boomers are reaching the age at which they develop cancer ... so we should not be surprised if it changes direction again." Researchers also fear that the economic meltdown may trigger a new increase in incidence as fewer people feel comfortable paying for screening tests and increased stress leads some people to resume smoking.
Incidence rates for all cancers combined and for men and women combined dropped by 0.8% per year from 1999 through 2005, with the rates for men dropping at about three times the rate for women. The only ethnic groups for which rates did not decline were American Indians and Alaskan natives. The overall death rate declined by an average of 1.8% per year over the same period.
November 25, 2008
Newshour on Health Care Reform
The Newshour had an excellent discussion last week on the road to health care reform for President-elect Obama and some of the new obstacles that may exist because of the weak economy. Here is a link to the transcript.
On a related topic of health news generally, the Wall Street Journal's health blog reports today on the Kaiser Family Foundation's study with the Pew Research Center's Project for Excellence in Journalism concerning the reporting on health news - health news made up only 3.6% of all the news content. The WSJ breaks out the study results and reports,
Here’s how the study broke down the type of health coverage that was out there:
42% of stories were about specific diseases or conditions. Cancer got the most attention, at 10% of all health coverage.
31% focused on public health issues, including potential epidemics and contamination of food and drugs.
27% focused on health policy or the health-care system. . . .
Kaiser is taking direct action to improve coverage of health policy. The New York Times reports on the group’s plan to start publishing health stories early next year. Our former colleague Laurie McGinley and ex-Congressional Quarterly editor Peggy Girshman are running the service, called Kaiser Health News.
Flu Vaccine for All
Sydney Spiesel at Slate.com writes about the wonders of the flu vaccine and argues that a new study from Canada demonstrates that everyone should receive the wonderful shot each year. He writes,
If we're going to give annual flu shots to children from 6 months to 19 years old, the parents of babies, pregnant women, people 50 years and older, and everyone else with a chronic disease, maybe everybody should just get it. Starting in 2000, the Canadian province of Ontario offered free flu shots to everyone older than 6 months. Fortunately for science, though perhaps not for public health, the other Canadian provinces continued to offer the flu vaccine just as we do in the United States—targeted to specific populations, like the very old, the young, and people with chronic disease. This "experiment in nature" gave Canadian public-health researchers a unique opportunity to compare the benefits of universal influenza immunization with targeted policies.
Results: It's slightly dicey business to compare data from Ontario with those of the provinces that didn't enact a universal-immunization policy. Researchers can't be sure that the differences in the rate of immunization actually caused the differences in influenza diagnoses, hospitalization rates, or excess deaths. In fact, during the seven-year period under study, there was improvement in flu-vaccination rates in all the provinces. As a result, influenza statistics everywhere in Canada improved—but they improved a lot more in Ontario than in the rest of Canada. Influenza-associated deaths dropped by 57 percent in the rest of Canada, but they fell by 74 percent in Ontario. Every other statistic about influenza in Canada—flu-related cases seen in emergency rooms, doctors' offices, or hospital admissions—showed exactly the same pattern: Things are significantly better in Ontario. We do need to be a bit skeptical—that difference might, indeed, be due to some other environmental, economic, or educational difference between Ontario and the rest of Canada. But this evidence is the best we have today, and it's probably good enough to serve as a basis for changes in public-health policy. The only Ontario patients who didn't get significant benefit from flu shots were the elderly. As other studies have also shown, it seems as if it's simply harder to give the elderly good protection against flu using our standard methods of immunization, and there is active ongoing research to develop new, more potent vaccines. Meanwhile, we keep giving older people the present vaccine, hoping that at least some will benefit.
Conclusion: The next question is, Can it be done? Judging by the results in Ontario, the answer seems to be "yes" but only by providing newer sites for immunization, more easily available to the public—for instance, schools, stores, airports, train stations, even election polling sites. Should we do it? People afraid of needles are going to hate me for saying this, but yes, I think so. Extrapolating from the Canadian results, I think it is very likely that a policy of universal influenza immunization will lower hospitalization and death rates and even be economically advantageous. But, of course, it's easy for me to say: As a health care provider, I've already gotten my shot this year.
November 24, 2008
Medical Students and Abortion
Yesterday, the Washington Post ran a lengthy article entitled, "A Hard Choice," discussing a pro-choice medical student and her struggle with decisions concerning her future medical practice and abortion particularly. The article provides a look into the decision of a young female medical student as she considers whether she will perform abortions as part of her medical practice. It reviews the danger that some of the doctors who do provide these services experience as well as some of the conflicting viewpoints individuals hold about the abortion procedure. The article spotlights some of the ethical dilemmas that doctors face in their practice,
You think you are pro-choice, Carole Meyers was saying. But, really, "how pro-choice are you? What does it mean for you? What's your limit? Will you do an abortion on a woman who is 12 weeks pregnant? Twenty-four weeks pregnant?" What's your limit with birth defects? she asked. "Would you do an abortion at 28 weeks if the baby had a club foot? How about hemophilia?"
Meyers, a 51-year-old obstetrician and genetics expert, has performed hundreds of abortions over the course of her career and, until earlier this year, served as the medical director of Planned Parenthood of Maryland. She loves her work -- it's very rewarding, she said, and women always thank her -- but she doesn't shrink from examining abortion's ethical dilemmas or from setting her own limits. The truth, she told Lesley and the other medical students, is that abortion is not a black-and-white issue, not for patients and not for doctors.
"If you are going to perform abortions, how is your family going to think about it?" she asked. "How will you tell your kids? What are you going to do if your church doesn't want you to come anymore?" . . .
How medical students choose to become abortion providers is in some ways no different from how they choose to become cardiac surgeons or pediatric neurologists. They explore the specialty and test themselves in it, finding some connection to a patient or a mentor that ignites their passion. Except for one difference: Medical students must explore abortion largely on their own.
Today, the Washington Post has a forum for those who wish to discuss the article with the featured medical student Lesley Wojcik and the article's author freelance writer Patricia Meisol. They will be online Monday, November 24 at 12 noon ET.
Malcolm Gladwell's Outliers
Well, with the holiday season approaching, many new books appear that might be worth a read. The Washington Post provides a quick review of Malcolm Gladwell's lastest work, Outliers. I have enjoyed his earlier works, Tipping Point and Blink because of his interesting use of social science research to describe various aspects of our society. The Post is not as enthusiastic about this work but it does have some appeal for those who are interested in the nature/nurture debates and what makes some people more successful than others. Here is an excerpt from the Post's review,
With his knack for spotting curious findings in the social sciences, his vivid writing about phenomena that he has named (The Tipping Point, Blink), his signature Afro and his star quality in public appearances, Malcolm Gladwell stands out among contemporary writers: In his own terms, he is one of the outliers -- "men and women who do things that are out of the ordinary."
As an outlier, Gladwell turns conventional wisdom on its head. In much of the world, particularly in the United States today, we attribute success to the attributes of the individual. In other regions, and in other eras, great achievements are attributed to luck or fate. But the pendulum of explanation swings. Following a period in which it was politically incorrect to invoke nature, we now find ourselves in an era in which biological causes are all too readily cited.
By reconceptualizing the relationship between nature and nurture, Gladwell performs a valuable service. He assembles a powerful brief in favor of the argument that the time, place and resources available to individuals and groups are decisive factors in their eventual success or failure. In vintage Gladwellian fashion, he applies this lens to a fascinating array of cases, many of them unfamiliar, and culminates with an account of one outlier to whom he has special access: himself. . . .
November 23, 2008
Five Health Law Myths Exposed
The New America Foundation's Shannon Brownlee and Ezekiel Emanuel have a terrific article in the Washington Post concerning the myths surrounding our health care system and discussing the need for reform. They write,
With Congress ready to spend $700 billion to prop up the U.S. economy, enacting health-care reform may seem about as likely as the Dow hitting 10,000 again before the end of the year. But it may be more doable than you think, provided we dispel a few myths about how health care works and how much reform Americans are willing to stomach.
1. America has the best health care in the world. . . . .
2. Somebody else is paying for your health insurance. . . .
3. We would save a lot if we could cut the administrative waste of private insurance. . . .
4. Health-care reform is going to cost a bundle. . . . .
5. Americans aren't ready for a major overhaul of the health-care system. . . . .
The article makes many interesting points and is well worth a quick read. Thanks to Ezra Klein's blog for the link.