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From the AMA's American Medical News today, we find that the cost of immunizing a child less than 18 years old was $11.68 in 1975, while in 2006 it was $668.81. The cost has risen as more shots are recommended, as the cost of making new vaccines increases, as safety concerns arise, and as protection from adverse events is included in the cost.
USA Today carries a headline story on lead poisoning in children, noting that replacing paint on wndow sills, on which teething children chew might prevent this. Why should any family with children have to rent a domicile which contains lead paint. A few cities have required prerental inspection of homes, for more thn 30 years, to ensure safety from lead and other hazards before thay can be rented. It should,be a national standard.
How many potential parents think twice before unprotected sex? A report found that for women with private insurance, the average delivery cost was $6,520 and the average cost for prenatal care was $1,962, compared with $4,577 and $2,142, respectively, for women enrolled in Medicaid, the Washington Times reports. Private health insurers covered 87% of the expenses of insured women, who paid 8% of the remaining costs out of pocket and 5% from "other sources," the report said. Medicaid paid 92% of expenses for beneficiaries, who paid less than 1% out of pocket and 8% from other sources. According to the Times, costs associated with childbirth have increased significantly during the past 10 years. And, this is only the start. How many potential parents even consider the cost, effort and responsibility of raising a child, let alone producing one?
Read the lead editorial and contents of this week's BMJ, which focuses on the relationship between income and health, or the reverse. WhIle many of us have been teaching about these issues, this week many major medical journals are focusing on the topic.
Despite news media excesses and actions of tort lawyers, women who receive silicone gel-filled breast implants do not have a higher risk of breast cancer or other cancers and do not experience lower survival rates after breast cancer diagnosis, according to a new report published in the November issue of Annals of Plastic Surgery. This is the first exhaustive review in almost a decade of the health effects of cosmetic breast implants. This is one more study that should caution the public and the courts about a rush to judgement based on mass media hysteria and activist statements. The courts are not the place to test scientific data.
The following extract from today's lead editorial in the NEJM should entice all of you to read the whole editorial.
"The Clinton administration's misadventure carries several broader lessons about the politics of health care reform. First, no matter how much momentum it seems to have, no matter how many signs point to change, there is nothing inevitable about health care reform in the United States. In U.S. health policy, the status quo is deeply entrenched and, despite all its failings, the system is remarkably resistant to change, in part because many constituencies profit from it. Thus, although everyone decries the amount of money spent on health care, the political reality is that national health care expenditures represent income to health industry stakeholders, whose interests lie in ensuring even greater spending. "
The quantity of alcohol consumed, and not the type consumed, is an indicator of increased breast cancer risk in women, according to Kaiser Permanente researchers who presented their findings Sept. 27 at the European CanCer Organization’s annual conference. In addition, the increased breast cancer risk from drinking three or more alcoholic drinks a day is similar to the increased breast cancer risk from smoking a pack of cigarettes or more a day, according to Kaiser Permanente researchers Yan Li, MD, PhD and Arthur Klatsky, MD.
In an article published in 'Pediatrics' lead author, Julie A. Mennella, PhD, a psychobiologist at Monell states “Infants spent less time sleeping overall and woke up from naps sooner when their mothers smoked prior to breastfeeding,” While many women quit or cut down on smoking while pregnant, they often relapse following the birth of the baby. Mennella omments, “Because nicotine is not contraindicated during lactation, mothers may believe that smoking while breastfeeding will not harm their child as long as the child is not exposed to passive smoke. However, there has been very little research on either short- or long-term effects of nicotine delivered through breast milk.”
“In Sub-Saharan Africa, Malaria kills at least 800,000 children under the age of five each year,” said UNICEF Executive Director Ann M. Veneman. “Controlling malaria is vital to improving child health and economic development in affected countries. Studies show that malaria disproportionately affects the poorest people in these countries, and so contributes to their further impoverishment.” There has been a rapid increase in the supply of insecticide-treated nets, with annual production of nets more than doubling from 30 to 63 million. Another large increase in production is expected by the end of 2007.
According to the latest report from the WHO Recent scientific advances and increased vaccine manufacturing capacity have prompted experts to increase their projections of how many pandemic influenza vaccine courses can be made available in the coming years. Dr Marie-Paule Kieny, Director of the Initiative for Vaccine Research at WHO, said today. "However, although this is significant progress, it is still far from the 6.7 billion immunization courses that would be needed in a six month period to protect the whole world."
If we have to wait until six months after a pandemic is declared the majority of susceptible people will have had the flu.
An editorial in the November issue of the AJPH [November 2007, Vol 97, No. 11; AJPH, 1936-1938] states that "The United States spends $2 trillion per year on health care, 2 to 3 times per capita than that of other developed nations. Despite this staggering financial investment, our citizens have a lower life expectancy than those in many other countries, and it has been reported that patients receive only about half the evidence-based care that they should." Source documents suggest that the vast majority of NIH dollars will be steered toward technological interventions, especially pharmacogenetics. The NIH curiously ignores "P" for prevention. This is the continuing policy base pushed by Congress and by cause based advocates. Public Health has little voice in Congress, I believe this is because it has chosen the wrong causes and the wrong champions in the past.
A new study finds that survival for elderly patients with lung cancer has changed little despite large increases in healthcare expenditures for lung cancer treatment. The study from Harvard University, published in the December 1, 2007 issue of CANCER, finds that average life-expectancy rose by less than one month between 1983 and 1997, while costs rose by over $20,000 per patient. Lung cancer remains the top cause of cancer death in the United States, with an estimated 160,390 deaths expected to occur in 2007.
Published in the December 1, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study found that emotional well-being was not an independent factor affecting the prognosis of head and neck cancers. The question of whether or not the mind, through psychological state and emotional status, has the ability to heal organic disease in the body continues to be reviewed and tested in human health research. A large body of evidence strongly suggests that, for life-threatening diseases such as advanced cancer, it does not. However, this debate continues in popular and scientific circles.
In today's newsmedia much ado is being made about a study published in the Journal of Clinical Oncology about the increasing but small number of women who are opting for double mastectomy to prevent recurrence in the second, intially unaffected, .breast. The author states "Some choose the procedure because they "believe having their opposite breast removed is somehow going to improve their breast cancer survival. In fact, it probably will not affect their survival," A co-investigator states ""Some would argue that the need for aggressive surgery should be going down, not up." In addition, cancer experts estimate "that women who get cancer in one breast each year have [a] 0.5 to 0.75 percent chance of the cancer reappearing in the second breast." But removing the second breast "does not improve their chances overall."
The two studies in this week's's NEJM are complex. Their analysis is well covered in the editorial, which should be required reading for everyone with an interest in how to move from research to policy. The issues of sensitivity vs. specificity and cost effectiveness vs possible harmful interventions are found in Volume 357:1650-1653 October 18, 2007 Number 16
After this week's JAMA article on MRSA it is worth reading the CDC fact sheets, rather than relying on news media reports. The facts sheet cover both health facilty acquired MRSA and community acquired MRSA.
From the American College of Gastroenterology we find that obesity is the strongest risk factor for Colorectal Cancer among women; greater than smoking. Although smoking posed a significant increased risk for colorectal neoplasia, researchers found that for women, obesity was the highest attributable risk factor for developing the disease.
A study from Columbia University Mailman School of Public Health and the Virginia Commonwealth University shows that a student graduating from high school after attending smaller-sized classes gains an average of 1.7 quality-adjusted life-years and generates a net $168,431 in lifetime revenue. “Higher earnings and better job quality enhance access to health. Peter A. Muennig, MD, MPH, assistant professor of Health Policy and Management at the Mailman School says,. “Regardless of class size, the net effect of graduating from high school is roughly equivalent to taking 20 years of bad health off of your life." More cost effective than direct health care
"The evidence is unmistakable: We are truly turning the tide in the cancer battle," said John R. Seffrin, PhD, chief executive officer of the American Cancer Society. "The gains could be even greater if everyone in the US had access to essential health care, including primary care and prevention services." Looking at the population as a whole, the report shows that cancer death rates have decreased for the majority of the 15 most commonly diagnosed cancers in men and women.
The Wall Street Journal recently provided news about a multimillion ($34 million) award against Wyeth for a breast cancer supposedly caused by a menopausal treatment drug. There are over 5000 similar cases awaiting trial. This award should cause great concern. All drugs have side effects, many cannot be observed until there is widespread use. Just as vaccines almost disappeared until Congress developed a national program to cover any ill effects, we may see all development of new drugs come to a screeching halt, or available only in countries with a less litigous climate. I wonder how much litigation would be prevented if we had universal heltsh care coverage?
A study from the RAND corporation published in this week's NEJM finds that children in the United States fail to get recommended health care more than half of the time, according to a new study that is the largest and most comprehensive examination of health care quality for America’s children. They are not receiving recommended preventive care and screening services, such as regular weight and measurement checks to ensure that they are growing properly and not at risk for obesity; nor are they receiving standard care for conditions such as asthma and diarrhea. While the study lays the fault at pediatrician's doors there is liuttle said about the failure of families toi seek care, or follow the advice given.
The American Medical Informatics Association is launching a 5-year cooperative agreement with the Centers for Disease Control and Prevention to strengthen the breadth and depth of the public health workforce by providing training in public health informatics and encourage new explorations of innovations at the intersection of public health and health informatics. The AMIA 10x10 will utilize curricular content from existing informatics training programs and other AMIA educational initiatives with a special emphasis toward programs with a proven track record in distance learning. The content will provide a framework but also cover plenty of detail, especially in areas such as electronic and personal health records, health information exchange, standards and terminology, and health care quality and error prevention.
While many newsmedia are publiciziing this report from yesterday's MMWR about the work limitations associated with 'arthritis' this survey is based on individual response, but is not validated by evidence from examination, or reports from place sof employment. This survey needs more extensive evaluation before drawing too many conclusions, particularly before developing public policies.
Editorials in several journals today: Global health is too important to be left to global health experts. That is why a new initiative announced by the Bill & Melinda Gates Foundation in Cape Town on Oct 9 is welcome. The initiative, a 5-year US$100 million grant programme called Grand Challenges Explorations, will provide hundreds of small start-up grants to researchers who come forward with promising new ideas to tackle key problems in global health. The initiative is modelled on the investment strategies favoured by venture capitalists. Initial grants will be about $100 000 but more funds will become available if projects show progress.
A fascinating summary of testimony from three former Surgeons General to Congrerss about political interference with the scientific part of their work, to be found in the journal Science, today..
Insulin, it turns out, may be as important for the mind as it is for the body. Research in the last few years has raised the possibility that Alzheimer's memory loss could be due to a novel third form of diabetes. Now scientists at Northwestern University have discovered why brain insulin signaling -- crucial for memory formation -- would stop working in Alzheimer's disease. They have shown that a toxic protein found in the brains of individuals with Alzheimer's removes insulin receptors from nerve cells, rendering those neurons insulin resistant.
Drawing upon a series of observations and experiments, Duke University Medical Center investigators postulate that the beneficial bacteria in the appendix that aid digestion can ride out a bout of diarrhea that completely evacuates the intestines and emerge afterwards to repopulate the gut. Their theory appears online in the Journal of Theoretical Biology. Drawing upon a series of observations and experiments, Duke University Medical Center investigators postulate that the beneficial bacteria in the appendix that aid digestion can ride out a bout of diarrhea that completely evacuates the intestines and emerge afterwards to repopulate the gut. Their theory appears online in the Journal of Theoretical Biology. "While there is no smoking gun, the abundance of circumstantial evidence makes a strong case for the role of the appendix as a place where the good bacteria can live safe and undisturbed until they are needed," said William Parker, Ph.D., assistant professor of experimental surgery, who conducted the analysis in collaboration with R. Randal Bollinger, M.D., Ph.D., Duke professor emeritus in general surgery.
USA Today reports "Laws aimed at breaking legal hurdles that prevented hundreds of doctors and nurses from volunteering to help Hurricane Katrina victims in 2005 are gaining momentum in states from Oregon to Pennsylvania." The Uniform Emergency Volunteer Health Practitioners Act (pdf) "would allow doctors, nurses, pharmacists, coroners, emergency medical technicians and veterinarians who aren't licensed in states struck by disaster to get quick authorization to offer medical help."
The new study, led by Scripps Research scientists was recently published in PLoS Pathogens*. "The new anti-anthrax agent that we developed is an important and potentially critical development for anyone who works with the bacterium or those who might be exposed to it in a bioterrorism attack," Schneemann said. "While other strategies are being pursued to develop improved anthrax vaccines, none of these offer the distinct advantage of combining the function of a vaccine with a potent antitoxin."
One more reason to use Folic Acid. The more we study it the more value we find. A new study by researchers at Columbia University Mailman School of Public Health finds that folic acid supplements can dramatically lower blood arsenic levels in individuals exposed to arsenic through contaminated drinking water.
The number of medical graduates entering residency for the first time rose 11% over the past five years. The increased subspecialization occurs at a time when most health policy experts recommend increases in primary care practice.
Many telephone surveillance systems -- including the world's largest, the Behavioral Risk Factor Surveillance System, which was established in 1984 by the Centers for Disease Control and Prevention and state health departments -- traditionally have collected data by landline phones. Now, sizeable chunks of the population have chosen to become entirely wireless, making it much more difficult -- and expensive -- to reach them. The National Health Interview Survey found that half of cell-phone-only users are younger than 30 and 22% are low-income adults, or those earning less than 200% of the poverty level. In addition, the cell-phone-only users were: The major issue is how representative cell phone users are of the entire population, and how to maintain accurate surveys.
In Postgradiuate Medicine On-Line, a study from Peninsula Medical School, Universities of Exeter & Plymouth, Exeter, UK, shows that systematic searches of electronic databases and contacting experts and professional bodies in the field resulted in the location of only three randomised clinical trials of individualised herbal medicine. It should be stressed that professional bodies representing the interests of different practitioner factions from around the world were unable to contribute any more studies than this. The paucity of data supporting the effectiveness of individualised herbal medicine, and the important safety concerns associated with this particular form of phytomedicine, should be taken into account by policymakers concerned with the regulation of practitioners using this modality.
It is not surprising that a study from the University of Michigan showed patterns of educational success or failure are well established for most adolescents by the time they reach the end of eighth grade, while drug use has only begun to emerge. The researchers found that the strongest and most long-lasting effects of early educational success or failure are not on drinking or illicit drug use, but on cigarette use. Unfortunately the research focuses on behavior in school and not on the chidren's families. I would be willing to bet that the children with the best outcomes have the strongest family structures. There is really nothing new or surprising about this 'research.'
In the U.S. the pharmaceutical industry has pulled the wool over legislators' eyes with their advertising. In today's BMJ editorial "a stark warning this week from New Zealand, explains that, in the absence of legislation to prevent it, direct to consumer advertising has taken hold. Having opened Pandora's box, New Zealand's government now seems unable to close it." The editor further states "It's obvious why industry wants direct to consumer advertising: it's particularly effective at driving up prescription of expensive new drugs." Perhaps the coming elections should focus on removing pharmaceutical advertsing as part of the packge to hold costs of health care down.
A week ago there was an article in a major medical journal questioning the value of giving flu vaccine to the elderly, a group to whom I belong. Now, in the NEJM today, we have an article extolling the value of giving flu vaccine to the elderly [N Engl J Med 2007;357:1373-81.] The conclusions of the latest study are that during 10 seasons, influenza vaccination was associated with significant reductions in the risk of hospitalization for pneumonia or influenza and in the risk of death among community-dwelling elderly persons. Vaccine delivery to this high-priority group should be improved..
An article [Arch Pediatr Adolesc Med. 2007;161:978-985. ] in the Pediatric Archives today analyses current NHANES data and concludes that dietary supplement use has increased among adults in recent years, yet it appears to have remained relatively constant or to have declined in children. The prevalence of supplement use increases from low levels in infants and young children to about 49% for 5-year-old children, followed by a steady decline to 20% among 15-year-old adolescents, with an increase among older teenagers (28%) and into young adulthood. Most interestingly children in higher-income families, children with less recreational screen time, and children in smoke-free households are most likely to use supplements. In contrast, children in families with lower income, non-Hispanic black children, children in families without heath insurance, children in households where people smoke, and children who spend more time engaged in recreational screen time are the least likely to take supplements.
From the Unversity of Utah in a study to be published in the October 2007 issue of the Journal of Medical Ethics, researchers found that legalizing physician-assisted suicide in Oregon and the Netherlands did not result in a disproportionate number of deaths among the elderly, poor, women, minorities, uninsured, minors, chronically ill, less educated or psychiatric patients.
Of 10 "vulnerable groups" examined in the study, only AIDS patients used doctor-assisted suicide at elevated rates.
At a recent meeting of ACOG "The issue has been whether thyroid screening should be a routine test during prenatal care," ACOG says there is no evidence that identifying and treating pregnant women with subclinical hypothyroidism improves either maternal or infant outcomes. The US Preventive Services Task Force says there must be demonstrated improvement in important health outcomes of those individuals identified through screening before recommending routine screening of asymptomatic people. "There just isn't any data that supports the routine screening of millions of pregnant women for subclinical hypothyroidism every year because the long-term effects are not certain and there is no evidence that any treatment would make a difference in the long run,"
Hospitality workers' exposure to harmful second hand smoke has fallen by 95 per cent since smokefree workplaces were introduced in England on 1 July 2007, according to new research revealed today (Monday) at the National Cancer Research Institute Conference in Birmingham on the three month anniversary of smokefree England. Researchers calculated that on average, employees' exposure was the equivalent to smoking 190 cigarettes a year before the legislation, and this dropped to the equivalent of around 44 cigarettes after.
While parents may think this is the case they need to curb the time their children watch tv, according to a new study from the Johns Hopkins Bloomberg School of Public Health. The Hopkins researchers found that the impact of TV viewing on a child’s behavior and social skills varied by the age at which the viewing occurred. More importantly, heavy television viewing that decreased over time was not associated with behavior or social problems. The American Academy of Pediatrics recommends that children under age 2 watch no television while children age 2 and older are limited to no more than two hours of daily viewing. The study is published in the October 2007 issue of Pediatrics.
In a new book just released by the Institute of Medicine a number of policies are recommended for ending Tobacco Use to prevent chronic heart, lung and other diseases, caused by both direct use and from second hand smoke. Tobacco use is a a major cause of death and disability among people of the world, yet is preventable. The U.S. is late coming to the table but can learn from actions taken in many other countries.
The $110 billion health system reform proposal from the Clinton campaign would:
Require individuals to have health insurance, just as states require car insurance.
Allow people to keep their existing private insurance; choose a new plan based on those available to federal employees; or choose a public, Medicare-like plan.
Require insurance companies to offer coverage to everyone willing to pay for it and to renew policies automatically.
Limit insurer profits and the ability to charge different premiums based on age, gender or occupation. The plan would use refundable tax credits to limit the cost of premiums to a percentage of income.
Provide tax credits to individuals and small businesses to help purchase health insurance and require large employers to offer health coverage or contribute to the cost of coverage.
Make taxable part of employer contributions for above-average benefits for employees earning more than $250,000 a year.
Weblink:Sen. Hillary Rodham Clinton's American Health Choices Plan (www.hillaryclinton.com/feature/healthcareplan)
My Comment: Much of this extra cost could be prevented by better use of primary care & preventive interventions..