"When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov
''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.'' -Robert Ehrlich, drug advertising executive.
"Opinions are like sphincters, everyone has one." - Chris Rangel
Crystal Ball Chemistry: Doctors at the Cleveland Clinic say they can predict who is destined to have a heart attack, according to this press release, I mean newspaper article:
Doctors believe the test would be used first in emergency rooms to distinguish people who are genuinely on the brink of a cardiac emergency from millions more who have chest pain from other causes. Eventually, it may be offered in doctors' offices as part of a battery of blood tests capable of identifying those who have heart disease but don't know it.
The test could save thousands of lives....
..."You can tell a patient he did great (on a conventional test), and a week later he drops dead," says Eric Topol of the Cleveland Clinic, an author of the study in today's New England Journal of Medicine. "There's always been something missing."
The new test measures blood levels of an enzyme called myeloperoxidase, which plays a key role in the body’s response to inflammation of various types.
The study of 604 consecutive emergency room patients complaining of chest pains showed that those with the highest levels of MPO face a fourfold increased risk of a cardiac crisis within two months.
The study does show a trend for greater risk of heart disease as levels of myeloperoxidase increase:
Myeloperoxidase levels were higher in patients who had a myocardial infarction within 16 hours after presentation than in those who did not (median, 320 vs. 178 pM; P<0.001). Among patients who had no biochemical evidence of clinically significant myocardial necrosis at presentation, base-line myeloperoxidase levels were significantly elevated in those who had elevated cardiac troponin T levels (0.1 ng per milliliter) within the ensuing 4 to 16 hours, but not in those who were consistently negative for troponin T (median, 353 vs. 309 pM; P<0.001).
The incidence of myocardial infarction increased with increasing quartiles of myeloperoxidase levels: it was 13.9 percent in quartile 1 (less than 119.4 pM), 16.6 percent in quartile 2 (119.4 to 197.9 pM), 25.2 percent in quartile 3 (198.0 to 393.9 pM), and 38.4 percent in quartile 4 (394.0 pM or more) (P<0.001 for trend). Patients who were initially negative for troponin T who subsequently had measurable levels at 4 to 16 hours were more likely to be in the third or fourth myeloperoxidase quartile than in the first or second quartile (proportion with 0.1 ng per milliliter troponin T levels, 5.3 percent of those in both quartile 1 and quartile 2, 8.0 percent of those in quartile 3, and 17.2 percent of those in quartile 4; P<0.001 for trend). Myeloperoxidase levels also correlated with the frequency of an adjudicated diagnosis of an acute coronary syndrome, increasing from 22.5 percent in quartile 1 to 58.0 percent in quartile 4 (P<0.001 for trend).
Base-line myeloperoxidase levels were higher among patients who subsequently required revascularization or had a major adverse cardiac event (myocardial infarction, reinfarction, need for revascularization, or death) in the ensuing 30-day and 6-month periods than in those who did not have such complications (P<0.001 for all comparisons). Myeloperoxidase levels were also higher among the 34 patients who died within six months after presentation than among the 570 patients who did not die (median, 270 vs. 194 pM; P=0.05).
The sensitivity, specificity, and predictive value of this measure, however, were only moderate.
So, don’t expect to go to your doctor and have this test ordered. It has yet to prove itself useful. posted by Sydney on
10/24/2003 08:54:00 AM
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Thursday, October 23, 2003
Emergency Popularity: Surprisingly, most of the non-emergent care in ER's is given to the insured:
Privately insured patients' use of the emergency room rose 24.3 percent to 43.3 million visits over that six-year period. People covered by Medicare, the government insurance for the elderly, visited the ER 16 million times, a 10 percent increase. Visits by uninsured patients rose 10.3 percent to 18 million, while those by patients covered by Medicaid, the government program for the poor, were flat at 18.4 million.
Only 46 percent of the ER visits by privately insured patients required care within an hour of arrival.
Why would that be? These people presumably have access to a doctor. One ER doc speculates:
Dr. Joseph Guarisco, chairman of the emergency medicine department at the Oscher Clinic Foundation in New Orleans, believes a big reason is convenience. Visiting the emergency room may not be prohibitively expensive for an insured patient -- a co-payment of $50 to $100 for a visit, rather than $10 to $20 for an office visit. But a patient can see a doctor, have some tests and consult with the physician again when the results come in all in one visit instead of three separate appointments.
SARS Update: The natural history of SARS is becoming better understood:
The finding that each patient infected on average three others is consistent with a disease spread by direct contact with virus-laden droplets rather than with airborne particles,' WHO said, noting that in airborne diseases such as influenza or measles, one person can infect an entire room by coughing.
...The report said health workers accounted for 21 percent of all cases. In some cases, transmission occurred even though they were wearing masks, eye protection, gowns and gloves.
The risk of a person transmitting the disease is greatest at around day 10 of the illness, when a maximum virus excretion from the respiratory tract occurs, then declines, the report said.
On the other hand, research found no evidence that patients transmit the infection 10 days after fever has subsided.
The report said children are rarely affected, with only two reported cases of transmission from children to adults and no reports of transmission from children to other children. No evidence has been found to show SARS transmission in schools, or in infants whose mothers were infected during pregnancy.
That's good news. Understanding its transmission will obviously help us to better control its spread.
Judging from the WHO report, it looks like the best prevention is careful handwashing. posted by Sydney on
10/23/2003 10:56:00 AM
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Art of Medicine: There's been a fevered discussion on one of my family medicine email listserves about evidence based medicine and the art of medicine. One of the members forwarded this very apt quote:
Clinical experience has been defined as "making the same mistake with increasing confidence for an impressive number of years," in contrast to "evidence-based medicine," which involves "perpetuating other people's mistakes instead of your own"
-(Anon.: Which humour for doctors? Lancet 351:1, 1998, quoting A Sceptic's Medical Dictionary, London, BMJ Publishing Company, 1997, cited in Sapira's Art and Science of Bedside Diagnosis by Jane M. Orient, Lippincott Williams & Wilkins, 2000). posted by Sydney on
10/23/2003 10:49:00 AM
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Hype? A reader writes to tell me I shouldn't fall for the hype surrounding the Terri Schiavo case:
MedicaidAdvocates.com,The Broward County based patient and Medicaid Client advocacy group that was formed to fight to save the Medicaid Medically Needy Share of Cost Program that Florida Governor Jeb Bush and the G.O.P. dominated Florida House and Senate had earmarked for elimination in the last Florida budget year, today is questioning the ethics and integrity of both Governor Bush and the leadership of the Florida House and Senate over their actions yesterday in Tallahassee.
"Although we sincerely empathize with the plight of Terri Schaivo, her husband, and her family, we find it highly suspect that Governor Bush, Speaker of the House Johnnie Byrd, and State Senator Daniel Webster could mobilize their forces so quickly to assist just this one patient whose case and plight has been working its way through the Florida Courts for over ten years. It is encouraging to see Speaker Byrd and Senator Webster publicly exhibit such moral concern and compassion for this one patient and her family, but the question must be raised; where was this same concern and compassion during our efforts to save the Medicaid Medically Needy Share of Cost Program and the 27,000 Medically Needy recipients whose medications, healthcare, and lives were in immediate jeopardy during the last budget year?
When this program came within literally hours of ending and Speaker Byrd was asked about action that was yet to be taken to save it and 27,000 Floridians lives, his response was that 'it wasn't an emergency'. Well, what exactly is the emergency now? Could it be perhaps that both Speaker Byrd and Senator Webster are running for the U.S. Senate seat now occupied by Senator Graham? It is such a travesty that this woman, who is now the subject of national news stories, is being used by these men as nothing more than 'political fodder' in a campaign for a National Senate seat" states MedicaidAdvocates.com Co-Founder Bill Rettinger. "Perhaps this same concern and compassion will be exhibited this week for the 1.9 Million Floridians on various Medicaid Programs whose lives were impacted earlier this year by the Florida Legislature's imposition of co-pay requirements for prescriptions and emergency room visits and these requirements can be eliminated during this special session utilizing the federal funds that were sent to Florida that were earmarked to enhance Medicaid and other health care programs as the U.S. Congress intended when this funding was created."
Setting aside the ungraciousness of whining about your own needs in the face of someone else's tragedy, it would appear that it's the Medicaid advocacy group that has fallen for the hype. As this NRO reader and right-to-die supporter put it (permalink didn't work, so I'll quote it all):
"I've been listening to the BBC and NPR today -- I confess, I'm basically a liberal but mostly I'm a political junkie and enjoy reading opinion from all over the spectrum.
In any case, what has struck me with the BBC and NPR is that there has been no mention, zilch, about the actual disputes in this case: the fact that there are some clear conflicts of interest surrounding Shaivo's husband, that the only evidence of her wishes regarding life support come from him, and that there is medical disagreement about Terri's condition and prospects, with her husband having virtually prevented examination by any but his own doctors and from attempting any rehabilitation. I've heard a bit of discussion about the debate about her status, but quite literally zero mention of the conflict of interest situation -- the 'fiancee', the money at stake, multiple affidavits attesting to Shciavo talking about what he'll buy with the money, etc.
Overall, I'm in the 'right to die' camp; I've voted for Oregon's assisted suicide law twice.
But in this case it seems that debate isn't over rights, but facts: what were Terri's wishes and what is her condition? It seems to me extremely dangerous to establish a precedent that the next of kin alone can not only make all decisions, supposedly based on a patient's wishes and their medical status, but, then also giving the next of kin sole right to announce what those wishes were and to determine how the patient's condition will be determined. Given the obvious conflicts of interest that can arise over inheritance, etc., such a system invites abuse.
While I usually think you conservatives are whining about 'liberal bias', given how important the context is to understanding this case and given how easy that information is to find, I can't help suspecting that the fact that this case came to national attention due to lobbying by the religious right means that the 'elite media' have automatically come down against it (even though the 'money grubbing husband wants to kill wife' theme would normally have appeal). "
As further proof of the slant, the Schiavo story got mention today in an AP story about the partial birth abortion ban:
The latest victories came almost simultaneously -- congressional approval of a bill banning a disputed late-term abortion procedure and Florida lawmakers' vote empowering Gov. Jeb Bush to order resumed feeding of a woman who has been in a vegetative state since 1990.
``A monumental day for the sanctity of human life,'' declared the conservative Family Research Council after Tuesday's votes in Washington and Tallahassee, Fla.
However, Dr. David Grimes, a North Carolina physician who formerly headed the abortion surveillance division of the federal Centers for Disease Control and Prevention, called it ``a very sad day.''
``Here we have a governor of Florida interfering with a family's choice, and Congress interfering with a woman's right to choose,'' Grimes said Wednesday. ``I thought this administration's role was to get government off people's backs.''
The role of government is also to protect, something that this administration knows all too well. posted by Sydney on
10/23/2003 08:54:00 AM
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Case in Point: This local coverage of the rising costs of Medicare HMO premiums is a case study in how little people are willing to give up. The overall tone of the article is that premiums are increasing beyond people's means. It's accompanied by a photo of a worried looking elderly couple with their insurance company paperwork spread out before them (that American flag on the table cloth is a nice touch, no?) Their premium is going up by a startling.....$40 a month! Less than the cost of cable television.
In truth, none of the news is all that bad. Seniors in our area will actually have more Medicare HMO's to choose from this year, and at costs that are far below the premiums for secondary insurance (usually in the triple digit range rather than the double digit range that these people are complaining about.) The couple in the picture even have the option of taking a less expensive version of their HMO at $35 per month. (When's the last time you found insurance for that little?)
And this sentence made me look twice:
The rates jump from $85 to $95 for Summit County residents and from $95 to $99 for enrollees in Medina, Portage, Stark and Wayne counties.
When I first read "rates jump," I just breezed past the actual dollar amounts. Then it sunk in - one was only a $10 increase and the other was $4.
Disability Rights Update:Good news for Terri Schiavo and her family, bad news for her husband. If she can regain her strength and survive her dehydration, perhaps she'll get the rehab she needs. Although, it would have been much better to get it earlier in the course of her illness. posted by Sydney on
10/22/2003 08:30:00 AM
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Healthcare Solutions:The Health Care Blog (an excellent health policy blog, by the way) has some thoughts on the recent ABC News poll that showed support for a single-payer system among Americans. He wonders if I’m an advocate of MSA’s and explains in this earlier post, why MSA’s aren’t such a good idea:
If you allow people to withdraw money from an insurance pool it eventually only insures the sick and therefore collapses under its own weight. That's more or less what's happened to the individual insurance system in this country over the last 20 years and is what the Democrats are afraid will happen to Medicare if the "healthy" seniors are allowed to leave. (I'm not sure they are right to be that concerned about that happening given the record of Medicare Risk HMOs, but that's another discussion.)
I’m not necessarily a supporter of MSA’s (although my family has one now that I’m self-employed.) What I do think we need is a paring down of our current insurance benefits rather than the politically popular expansion of them. In the 1990’s, when managed care was all the rage, we went from insurance that covered illnesses to insurance that covered everything. This, coupled with the aging population, is one of the main drivers of the increase in healthcare costs over the past several years. The idea behind managed care was that if insurers paid for things like mammograms and pap smears and immunizations they’d save money in the long run by preventing disease. But that’s not necessarily so. If one disease doesn’t get you, another one will - eventually. So, the healthcare dollar saved by preventing cervical cancer may be consumed by heart disease further on down the road. The insurance companies don’t necessarily gain any dollar savings. (Although the patient certainly gains in years of life.)
That may seem like a cold calculus, but the sad truth is that preventive care ends up making overall healthcare more expensive. Having a third party pay for preventive measures may make them more utilized, and it probably saves lives in the short term, but it isn’t clear that it make us an overall healthier population, and it does come at a significant cost. (Note: I’m not against prevention. On an individual basis it’s good to screen for preventable diseases like cervical and colon cancer. The question is whether it’s a cost that society should bear for everyone regardless of their ability to pay.)
To make matters worse, the number of things that we offer and promote for preventive health are growing more numerous every day. We now recommend bone density screening at $200 a pop, followed by a drug if it’s abnormal, at $70 a month. It isn’t at all clear if the treatment improves the quality of life for the majority of people. We just assume it does. And we don't even ask if it's worth the cost. We give Hepatitis B shots to every infant to prevent a disease that's transmitted through sex and contaminated blood. Is it worth the cost? We give chickenpox vaccines to avoid the possibilty that a small percentage of immunocompromised children won't get chickenpox. Again, is it worth the cost? Cholesterol screening can cost up to $200, depending on the lab, and the drugs to treat high cholesterol cost up to $120 a month. The kicker is that the expensive cholesterol medication needs to be monitored every two to six months with the expensive lab tests. The costs add up quickly, but no one ever questions whether that money is worth the small percentage decrease in incidence of heart attacks, because no one involved in the treatment decisions has to pay the price of the therapy.
The first step to reigning in medical costs - and insurance costs - would be to scale back the coverage so that well-care and routine visits are paid for by the patient. It would lead to a wiser use of resources by both physician and patient, and to tell you the truth, it would be cheaper than the several hundred dollars a month that most people pay now in insurance premiums. Even the elderly with chronic, stable diseases seldom see the doctor more than two to four times a year.
Where insurance is needed is to cover the very big expenses - like hospitalizations and surgeries. Those don’t happen all that often in most people’s lives, but when they do, they can be financially devastating. But, spreading out the risk over the entire population should mean that this sort of coverage could be offered at cheaper rates than our “everything -but- the- kitchen -sink -spread -over -small- risk -pools -of -employers” system.
And another thing, although the people in the polls are enamored of their employer-sponsored health insurance, they’d think differently if they ever lost their job or got a divorce. That’s one of the most common laments I hear in my practice. Women who have relied for years on their husbands’ health insurance benefits suddenly find themselves cut off without insurance in middle age. Divorced, unemployed, and unemployable after spending the prime of their lives raising a family, they have very little recourse when it comes to health insurance. Even if they get a good divorce settlement. And laid off middle-aged workers fair no better. It wouldn’t be an issue if health insurance plans were designed for individuals, not corporations. (How many people do you suppose are staying in lousy marriages and jobs they hate just for the insurance coverage? I get the sense that there are plenty, unless I just have a lot of complainers in my practice.) That’s why proposals like this are so appealing:
Under the Breaux plan everyone in the United States would be required to have health insurance, similar to current state laws that require drivers to carry auto insurance. Breaux’s proposal would encourage businesses currently offering employee health benefits to continue doing so, but it would not require all businesses to offer coverage. The proposal also calls for states to establish purchasing pools to ensure that people without employer-sponsored coverage could buy insurance at group rates. In addition, the government would offer tax credits to help people with low to moderate incomes purchase insurance. Under the plan, the government would fully subsidize health plan premiums for people with annual incomes lower than 150% of the federal poverty level, or about $27,000 for a family of four, and would partially subsidize premiums for those with incomes up to 250% of the poverty level, or about $45,000 for a family of four. Breaux said he will attempt to convene a bipartisan group in Congress to draft a specific proposal.
And that’s the direction we need to move. Unfortunately, it’s also a politically unpalatable one. No one wants to give up something they’re already getting for free. (Or think they’re getting for free.)
UPDATE: Health Care Blog responds here. I'm not so sure that end-of-life care is what's driving most of our high healthcare costs, even though conventional wisdom has it that it is. When I look at my practice, very few of my dying patients end up in the hospital in the ICU before dying. Some die suddenly at home, some are diagnosed with terminal cancer and go straight to hospice, some die at nursing homes. A very small minority die in the hospital after days of expensive care. On the other hand, a lot of my patients request CT scans and MRI's for headaches and sciatica, excercise stress tests for indigestion. They want bone densitometries, cholesterol screenings, and any other new test they read about in the paper that might predict a predeliction to disease. They want expensive drugs to prevent those diseases that they don't yet have. And I'm sure that my practice isn't an anomaly. posted by Sydney on
10/22/2003 07:25:00 AM
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Doctors have been groomed in very competitive environments, ... so when you put them together, it's at least twice as hard to get around the p_ssing contest to their true reactions and motivations.
Quite true. Just go to a hospital staff meeting and see how much time is wasted as each physician tries to upstage the next with ideas. Also, ask a group of them how many patients they see a day and they'll all exaggerate by about five or ten.
They also suggest trying to understand the reasons people become doctors:
- To be good from parent's wish perspective - "My son the doctor"
- Wanting to help people or other altruistic motives
- Intellectual Curiosity
- Love of science and scientific inquiry
- Hero/superman wish
- To have more relationships with people (especially FPs & nephrologists) [Nephrologists? They're about as opposite as family physicians in personality as you can get. -ed.] - God like image/Priest
- To look smart
- To be a rescuer
- Immediate gratification of solving a problem - (especially for surgeons)
- Money
- Power
- Prestige
And there's this summation of the doctor personality:
Docs are very career-focused, and fit into the corporate/medical/academic world quite naturally. They are constantly scanning their environment for potential problems which they can turn into solutions. They generally see things from a long-range perspective, and are usually successful at identifying plans to turn problems around - especially problems of a strategic nature. Docs are usually successful, because they are so driven to leadership. They're tireless in their efforts on the job, and driven to visualize where an organization is headed. For these reasons, they are natural leaders.
There is not much room for error in the world of Doc. They dislike to see mistakes repeated, and have no patience with inefficiency. They may become quite harsh when their patience is tried in these respects, because they are not naturally tuned in to people's feelings, and more than likely don't believe that they should tailor their judgments in consideration for people's feelings. Docs have difficulty seeing things from outside their own perspective. Docs naturally have little patience with people who do not see things the same way as they do. Doc needs to consciously work on recognizing the value of other people's opinions, as well as the value of being sensitive towards people's feelings. In the absence of this awareness, Doc can be a forceful, intimidating and overbearing individual. Doc has a tremendous amount of personal power and presence which will work for him as a force towards achieving their goals. However, this personal power is also an agent of alienation and self-aggrandizement.
Docs are very forceful, decisive individuals. They make decisions quickly, and are quick to verbalize their opinions and decisions to the rest of the world. A Doc who has developed in a generally less than ideal way may become dictatorial and abrasive - intrusively giving orders and direction without a sound reason for doing so, and without consideration for the people involved.
Although Docs are not naturally tuned into other people's feelings, these individuals frequently have very strong sentimental streaks. Often these sentiments are very powerful to the Doc, although they will likely hide it from general knowledge, believing the feelings to be a weakness. Because the world of feelings and values is not where Doc naturally functions, they may sometimes make value judgments and hold onto submerged emotions which are ill-founded and inappropriate, and will cause them problems - sometimes rather serious problems.
Well, that's a little oversimplified, but it does seem to describe Howard Dean rather well, doesn't it? posted by Sydney on
10/20/2003 09:14:00 AM
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Unintended Consequences: Everytime Congress passes an well-intentioned law that sounds reasonable on the surface, there's a series of ripples of unforeseen consequences:
Craig is 200 miles west of Denver on what is still called Colorado's frontier. It is a community small enough that many people use family names or landmarks — the Smith place — rather than street addresses to describe where their neighbors live.
That seemed to be merely a rural custom in the town of 9,189 — until the U.S. government's new law designed to keep medical records private took effect in April. To protect the privacy of those needing medical help, 911 dispatchers stopped mentioning residents' names in radio calls to emergency response teams. That made it more difficult for the teams to find addresses.
Craig resident Joanne Lighthizer says that on June 9, she watched helplessly as emergency crews stopped nearby to ask for directions while her neighbor, Francis Moore, lay dying from a heart attack in his backyard. He was 54. "We could see them going to the other houses," Lighthizer says. "One of my neighbors told me they went to her house and asked where the address was. She said, 'If you tell me the name, I can tell you where it is.' And they said they couldn't. We waited and waited. I've never been so frustrated."
Part of the problem is that the penalties are so stiff (they include time in prison) that no one wants to risk any breach, no matter how nonsensical and impractical complying with it may seem. I've heard colleagues say that they've had requests for old medical records from other practices or hospitals rejected because their request form was deemed "non-HIPAA compliant," and I've heard nurses ask one another if they're allowed to tell another nurse in another department - say dialysis - details about the patient they're sending over for care.
Most see the law as punitive - one that will be used by the disgruntled and unhappy as one more weapon in their attack arsenal. (along with laws on disability, sexual harassment, equal opportunity, etc.) That makes people - especially those who manage large organizations - very nervous. And that's another reason they abandon common sense so readily.
posted by Sydney on
10/20/2003 08:36:00 AM
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Babies and Bath Water: Baby bath seats won't be banned after all, but instead urged to carry prominent warning signs - such as "Don't leave your baby unattended in the bathtub," "Don't use when baby is able to stand on own," etc. This is the type of seat that's under fire, not this, but either one always seemed safer to me than trying to hold a squirmy, slippery, soapy, wet baby upright in a tub or sink of water. posted by Sydney on
10/20/2003 08:02:00 AM
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Careful What You Ask For: The majority of Americans answering an ABC news poll say that they would like a single payer system:
Americans express broad, and in some cases growing, discontent with the U.S. health care system, based on its costs, structure and direction alike — fueling cautious support for a government-run, taxpayer-funded universal health system modeled on Medicare.
In an extensive ABCNEWS/Washington Post poll, Americans by a 2-1 margin, 62-32 percent, prefer a universal health insurance program over the current employer-based system. That support, however, is conditional: It falls to fewer than four in 10 if it means a limited choice of doctors, or waiting lists for non-emergency treatments.
Support for change is based largely on unease with the current system's costs. Seventy-eight percent are dissatisfied with the cost of the nation's health care system, including 54 percent "very" dissatisfied.
We should be careful what we ask for, we just might get it, and then make no mistake, there would be limited access to doctors and waiting lists for treatments. That's the way monopolized payers ration care.
The most frustrating aspect about this debate is that it's always presented as only two options - our current system or a single-payer system. There's never any mention of revamping the current system so that it's no longer linked to employment, or of taking the third payer out of basic care and limiting insurance to catastrophic coverage. Quite truthfully it's in basic care that our spending, especially on drugs, spirals out of control.
I've often sat with patients who complain that they're taking too many drugs and try to weed out those that aren't truly necessary. "That Aricept that you take to help your memory? It's giving you a few percentage points in memory retention. Probably not enough to notice the difference if you stop."
"Oh, no. I need that. I don't want my early Alzheimer's to accelerate."
"Well, that Lipitor is only improving your chances of avoiding a heart attack by a few percentage points."
"Oh, no. Can't risk not taking that."
"OK. You could do without this Zoloft. You started taking it when your husband died last year, and you seem to have adjusted well."
"Oh, no. Since I started it, I don't snap at my family nearly as much. Can't stop that."
The bottom line is that few people have to pocket the expense of these drugs that are either marginally beneficial or that they're taking for marginal reasons, so they have no incentive to consider their shortcomings or limited benefits. And even those who do pay for them have trouble understanding their marginal usefulness. They've heard so many good things about them in the media and in the direct to consumer advertisements, that it's extremely difficult to overcome the mindset that they're more effective than they are.
The medical profession deserves the largest share of blame for this. We too eagerly embrace the latest research findings and media hype without questioning its validity or clinical usefulness. We've shamelessly promoted drugs as the solution to everything. And now it looks like we'll soon reap the bitter fruits of our thoughtless enthusiasm. posted by Sydney on
10/20/2003 07:58:00 AM
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Miracle Diagnostics: Interesting aside in the story of Mother Teresa's beatification:
Miracles almost always involve medical cures in part because most of Jesus Christ's miracles were related to healing. At the midpoint of the last century, the Vatican established a medical board, the Consulta Medica, about 100 prestigious Italian doctors who examine the cures.
To be considered miraculous, a cure must be instantaneous or sudden, complete and permanent, and without scientific explanation.
On average, five Consulta Medica doctors examine a case, and three of the five must agree that the criteria are met. They judge whether the cure is complete and without scientific explanation.
And here's an interview with a member of the Consulta Medica.
There's some controversy over the nature of Mother Teresa's miracle. The story in the Seattle Times says that a woman was cured of ovarian cancer while lying in a hospice thanks to prayers to the nun. But this report from India makes it sound less dramatic:
The reported miracle took place on September 5, 1998, the first anniversary of Mother Teresa's death, when Besra was lying seriously ill in one of the late nun's Missionaries of Charity shelters.
During the afternoon, nuns of the order placed a medal on Besra's stomach and prayed with her for several hours. The same medal of the Virgin Mary had been placed on Mother Teresa's body after she died.
Besra says that when she woke up early next morning, the tumour had disappeared. She was immediately certain she had experienced a miracle.
But a number of respected figures in the Indian medical establishment are certain of the opposite. 'Monika Besra was rid of her tumour with the help of very strong medicines and treatment for several days at Balurghat Hospital,' former West Bengal health minister Partho De said in interviews last October.
'I mean no disrespect to Mother Teresa but it is stretching the truth to say that it was a miracle worked by her,' he added.
Doctors at the Balurghat hospital have also been quoted as saying Besra was cured by the strong medicines she was given for a bout of tuberculosis she suffered before the tumour was discovered.
It would indeed be miraculous for a woman with ovarian cancer to still be alive five years later without ongoing treatment. Especially if her tumor was never removed surgically. The tumor may not have been caused by cancer, but by tuberculosis:
The reports of Besra's illness vary, and she herself claims not to really understand what ailed her. Some doctors say she had a large malignant tumor in her abdomen; others diagnosed tubercular meningitis.
She was put on four anti-TB drugs, said Dr. Ranjan Mustafi, the chief gynecologist who treated Besra at Balurghat District Hospital.
Unable to care for herself, and too poor to remain at the state hospital, Besra says her family took her to the Missionaries of Charity hospice in Patiram, a town on the outskirts of Balurghat.
As it turns out, pelvic tuberculosis mimics ovarian cancer. And it's not so uncommon in the developing world. The miracle looks dubious, but Mother Teresa did do a lot of good work at great personal sacrifice. You can't take that away from her. posted by Sydney on
10/19/2003 08:41:00 PM
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Money for Reconstruction:The Weekly Standard looked into where we might get the $87 billion needed for Iraq and came up with this:
The tort system costs about $200 billion a year, according to the Manhattan Institute, and the president's Council of Economic Advisors says at least $87 billion of that is pure waste. (Note to the truly conspiracy-minded: The council came up with its figure before the appropriations request was final.)
On second thought, that last item might not be too appealing to most of the folks opposing the Iraq supplemental. After all, THE SCRAPBOOK assumes that the massive donations to Democratic candidates that trial lawyers are in the habit of making were counted in the 'pure waste' category.
Bioterrorism Preparedness: A Canadian reader comments:
It is worrying that the smallpox program is slipping away. At the same time an article in the current American Journal of Epidemiology presents evidence that immunity from smallpox vaccination may last a lot longer than people think. The paper examines data from the 1950-1970 recurrence of smallpox in England and finds that individuals who had been vaccinated around the turn of the century and without intervening re-immunization were significantly less likely to have a severe case and were very significantly less likely to die.
I also have to say that, as an outsider, this seems all to common a problem with the Bush administration (and maybe with previous presidencies) in that its attention span for issues seems even shorter than that of a classic ADD case. Port security seems to have vanished as an issue without being solved, Afghanistan seems no longer of much concern (except to us Canadians now who seem to be carrying the ball there, at least in Kabul), the failure to locate bin Laden dead or alive appears to no longer be noticed, etc. Not that I think Canadian politicians are very good at keeping thoughts active for very long either, but I think the Bush administration is probably an outlier in the bad direction on this.
The study of Brits who were immunized at the turn of the century is reassuring, but you have to remember that they were also constantly exposed to community cases of smallpox which essentially gave them constant little boosters.
Our politicians do seem to have short attention spans, but the smallpox program was deluged from the beginning by political opponents - much as the war on terror has been in general. Healthcare worker unions opposed it and the public health establishment opposed it. These opponents came across as neutral critics in the media, but in reality they're both political opponents of the current adminstration. The unions are affiliates of the AFLCIO, and many of the comments by members of the public health establishment betrayed their true motivations in opposing the program.
The Bush Adminstration may simply have felt that of all the political battles they have to fight in the war against terror, this was the least important. After all, they offered us the chance to protect ourselves. It was we the people -or at least the medical profession - who declined to take advantage of it.
Diet Review: Michael Fumento looks at the latest trend in diets - The South Beach Diet and finds it wanting. Money quote:
... although the subtitle of Agatston's book modestly calls it 'foolproof,' a whole chapter is devoted to why people fail on it. posted by Sydney on
10/19/2003 05:55:00 PM
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Healthcare Platforms: Healthcare proposals of the presidential candidates at-a-glance. The full report, available here, goes into more detail, but here's the price tag:
The estimated costs of the proposals to the federal budget over a 10-year period range from $89 billion (Bush) to $6 trillion (Kucinich). The costs of the Kucinich plan have not been estimated formally, but the campaign has placed its cost at this level. Gephardt’s plan is the second most expensive, primarily because of its dual role as an economic stimulus package—it infuses a substantial amount of money into businesses and
state and local governments that already provide coverage. The Bush plan has the lowest cost due to its limited scope.
The costs in billions of dollars over ten years are:
Bush: $89
Dean: $932
Edwards: $590
Gephardt: $2,500
Kerry: $895
Kucinich: $6,117
Leiberman: $747
posted by Sydney on
10/19/2003 08:36:00 AM
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