September 2009 Archives

A study performed at  The University of Rochester Medical School   showed that when adolescents graduate to young adulthood, their preventive care tends to fall by the wayside. A recent study has found that young adults are much less likely to use ambulatory or preventive care, even though their mortality rate is more than twice that of adolescents. COMMENT: I have difficulty understanding why this should surprise anyone when the  various insurance programs, including Medicaid fail to pay for counseling by primary care practitioners. Further once the individual reaches 18 years of age eligibility for Medicaid vanishes.

In the New York Times (9/22) Economic Scene column, according to Harvard economist Amitabh Chandra, "$60 billion a year, or about three percent of overall medical spending, is a reasonable upper-end estimate" of what is spent on defensive medicine in the US. Leonhardt argues that the current "malpractice system does" indeed "affect the morale of doctors," leaving "them wondering when they will be publicly accused of doing the very thing they've sworn not to do: harm patients."

"The most important healthcare document released this week was not Sen. Max Baucus's Healthy Future Act. It was the Kaiser Family Foundation's 2009 Employer Benefits Survey." The survey, "which polls employers about health benefits to assemble a detailed look at the actual cost of healthcare, fits it squarely in our pocketbooks. The truth is we all pay, and much more than we recognize, for healthcare." According to Kaiser, "the average healthcare coverage for the average family now costs $13,375." Over the past decade, "premiums have increased by 138 percent.

ScienceDaily (Sep. 20, 2009) — A person, usually a child, dies of rabies every 20 minutes. However, only one inoculation may be all it takes for rabies vaccination, according to new research published in the Journal of Infectious Diseases by researchers at the Jefferson Vaccine Center.

Also in JAMA [JAMA. 2009;302(11):1223-1224] is a useful article suggesting how to reduce cost while trying to expand access the health care. Disease prevention initiatives aimed at improving nutrition, physical activity, tobacco use, and related lifestyle behaviors are likely to have the greatest effect on slowing the annual increase in health care costs. Evidence suggests that investment in physical activity, nutrition, and smoking cessation yields a 5-fold greater return in cost savings² than that documented for most clinical preventive services, owing to the inability of identifying the specific high-risk populations likely to benefit from such interventions as opposed to across-the-board screening and testing.^{1, 3} Current health reform proposals that would allocate $10 billion for a Prevention and Wellness Fund targeted to promoting healthier lifestyles and communities represents a major step toward slowing the annual increase in health care spending over time, given the current evidence on return on investment.

In the NEJM [V361,pp1131-1133. Sept 17] Is an article worth reading about the failure of current legislation to be serious about cost reduction, or even control. The article references three European countries with multiple payers that require annual collective bargaining with the government to control prices. Comment: The article is worth reading for the other serious options for controlling costs. The biggest barrier is the insurance industry

An excellent paper in JAMA [JAMA. 2009;302(11):1221-1222. ] this week shows how a country can respond to a new virus H1N1) and that all of us can learn how effective methods can be used to maximize participation by everyone in the country.

In this week’s NEJM a team of prominent doctors, scientists and policy makers says ”it could be a powerful weapon in efforts to reduce obesity, in the same way that cigarette taxes have helped curb smoking." Authors of the report include "the New York City health commissioner, Thomas Farley, and Joseph W. Thompson, Arkansas surgeon general."  Comment: There is too much of a rush by public health behaviorists to rush into punitive measures to change population behavior.  There seems to be no sense that this leads toward Huxley’s Brave New World.

The AP reports that researchers with the Institute of Public Health in Quebec are reporting that the end of a patient's coughing "is probably a better sign of when a swine flu patient is no longer contagious," noting that the CDC "has been telling people to stay home from work and school and avoid contact with others until a day after their fever breaks. The new research suggests they may need to be careful for longer -- especially at home where the risk of spreading the germ is highest. Swine flu also appears to be contagious longer than ordinary seasonal flu, several experts said."

According to a recent study by researchers from the University of Colorado at Boulder, dirty showerheads in homes may well be a potential breeding ground for infectious bacteria - Mycobacterium avium, which can cause lung infections when inhaled or swallowed.  The study, funded by the National Institute of Occupational Safety and Health and the Alfred P. Sloan Foundation, is part of a larger effort that is analyzing the microbiology of the indoor environment and its role in spreading to illness within the house. Comment: BUT, what evidence is there that people have been made ill by taking a shower? This seems to be an example of money looking for a spending source. In a depressed economy it is this kind of research that makes academics look bad,  It is certainly not a random sample of homes in the US. Ivan Illich would have loved this action.

• Advancing Technology, Demographics and Declining Health Status
• Lack of Productivity Growth
• Inappropriate Utilization
• Payment System Distortions
• Consumer Price Insensitivity
• Medical Errors and Inefficiency
• Medical Malpractice
• Defensive Medicine
• Higher Prices
• Administrative Costs

From the  Institute of Medicine: Local governments play a crucial role in the fight against childhood obesity by creating environments that make it either easy or hard for children to eat healthier diets and move more. A new report from the Institute of Medicine and National Research Council provides local officials with action steps that hold the greatest potential to reduce obesity rates among children, such as zoning restrictions on fast-food restaurants near schools, community policing to improve safety around public recreational sites, and publicly run after-school programs that limit video game and TV time.

USA Today reports, "Uninsured patients aren't the only ones using the [emergency department (ED)] for non-urgent care. With too few primary-care doctors to go around, many patients turn to the [ED] when they can't get an appointment with their regular physician, says Sandra Schneider, president of the American College of Emergency Physicians." Ted Epperly, president of the American Academy of Family Physicians, pointed out that "in some ways, insurance payments contribute to the shortage...by discouraging physicians from going into primary care." Medicare "pays doctors far more to perform procedures than to monitor a patient's overall health, Epperly says. In the past decade, only 10 percent of new doctors -- who graduate from medical school with an average of $140,000 in student loans -- have gone into primary care," according to Epperly.

Everyone who has an interest on the Congressional approaches to health care reform should read the current issue of ‘Health Affairs’ and note the monetary costs of the various approaches.  In the papers we find the expectation that the reforms would consume more than 50% of GDP, while others show that in 75 years the reforms would cost more than the entire GDP.  It is clear that the various activists have never taken economics 101.  The financial projections indicate totally unrealistic expectations for reform,.  There have to be limits to new expenditures. Anyway you wish to make changes there has to be some form of rationing.  There also has to be some reduction in money devoted to research.  Too much research money funneled to medical schools results in too little immediate benefit to the public but solves much of the fiscal problems of the teaching hospitals.

The New York Times (9/2, Rabin) reported in Vital Signs, "Women can cut their risk of breast cancer by almost half if they watch their weight, exercise daily, breast-feed their babies and limit alcoholic beverages, according to a new report by the American Institute for Cancer Research." For the study, researchers updated "a 2007 review of more than 800 studies, adding information from 81 new studies." The researchers "estimated that nearly 40 percent of new breast cancer cases in the United States...could be prevented if every woman followed the recommendations."  Comment: This sounds fine but how often have we been able to change behavior?

“The number of men diagnosed with prostate cancer began rising in 1987, the year after the publication of a widely publicized study on the use of the" prostate-specific antigen (PSA) test," Dartmouth Medical School researchers found. "For the next five years, the rate increased an average of 12 percent annually, peaking in 1992." However, the "majority of 1.3 million men whose prostate cancer was found because of increased screening between 1986 and 2005 didn't benefit from the treatment they received." Comment; Beware of recommendations made by specialists rather than epidemiologists.