Dr. Buttery's Public Health BLOG

A "toxic combination" of poverty and social injustice is killing people on a grand scale, a World Health Organization report said Thursday, urging states to fund healthcare to cut inequalities. The Commission on the Social Determinants of Health, a report commissioned by the WHO and chaired by Sir Michael Marmot of University College London, said these health inequalities were avoidable but only if concerted efforts were made by governments and civil society."Reducing health inequities is an ethical imperative. Social injustice is killing people on a grand scale," the report said.

Posted by at 11:42 AM | Permalink | Comments (0)

ScienceDaily — California's state tobacco control program saved $86 billion -- in 2004 dollars -- in personal healthcare costs in its first 15 years, according to a study by researchers at the University of California, San Francisco. California’s state tobacco control program saved $86 billion--in 2004 dollars--in personal healthcare costs in its first 15 years, according to a study by researchers at the University of California, San Francisco. During the same period, the state spent only a total of $1.8 billion on the program, a 50-to-1 return on investment, according to study findings. The study is the first that has been able to quantifiably connect tobacco control to healthcare savings, say its authors.

Posted by at 10:44 AM | Permalink | Comments (0)

The United States faces a serious shortage of family physicians, especially in rural and poorer communities," according to a report released on Monday by the National Association of Community Health Centers. The group noted that "[t]here are too few primary-care doctors and nurses to meet growing healthcare needs," and "availability depends on location." The data showed that "56 million Americans do not have a regular source of healthcare due to shortages of physicians in their communities," although many of these people have health insurance. In fact, some healthcare experts say that "even if universal healthcare comes into play tomorrow, not everyone would have access to a healthcare provider." The report's authors "estimate that in order to provide services to these medically disenfranchised Americans, as well as current patients, health centers will need up to 60,000 more primary-care professionals, and up to 44,500 additional nurses."

Posted by at 9:52 AM | Permalink | Comments (1)

60 years ago when in medical school I and my fellow students, along with the audience laughed ourselves sick at Roger Livsey (in the movie Dr. in The House) act as a swearing ,scalpel throwing surgeon at the 'Radcliffe' Infirmary in Oxford, particularly those of us training in London. Now, at last, according to the Boston Globe, the Joint Commission (JC), the national group that accredits healthcare organizations, "is requiring all hospitals, nursing homes, and other healthcare facilities to adopt 'zero-tolerance' policies by Jan. 1, including codes of conduct, ways to encourage staff to report bad behavior, and a process for helping and, if necessary, disciplining offenders." An increasing amount of "research suggest[s] that swearing, yelling, and throwing objects are not just rude and offensive to co-workers, but hurt patients by increasing the likelihood of medical errors."

Posted by at 9:44 AM | Permalink | Comments (0)

Now, after New York's lead. California has banned transfats in foods prepared in restaurants. This is not a clear cut health issue. There is research showing both hazards and benefits from using trans-fats. It is government intervention in an unproven area. Once more it gives the perception that government is protecting its citizens by intruding on commercial behavior.. The reason people are obese and have heart attacks is from too many calories and too little exercise. The ban is cosmetic. It would probably been more effective to require all food items to show caloric values. It will be interesting to review obesity, diabetes , heart attacks incidence in 5 years and see if there is any difference, and if so what evidence there is linking it to the ban. This is one more case of political emotion overiding data.

Posted by at 9:44 AM | Permalink | Comments (0)

The president is reported ready to veto the Tobacco Bill if passed as currently formulated. This bill, favored by Phillip-Morris is flawed in several ways. First the FDA already has too much on its plate. While Congress has increased its appropriations it is not nearly enough to manage its current responsibilities. That is a reason for the President to Veto it. Further Congress has refused to amend an exception for Menthol based cigarettes despite research from the Harvard School of Public Health showing that "Menthol cigarette brands have been rising in popularity with adolescents, and the highest use has been among younger, newer smokers."
The paper, "Tobacco Industry Control of Menthol in Cigarettes and Targeting of Adolescents and Young Adults," appears in the online "First Look" section of the American Journal of Public Health in advance of publication in the September 2008 issue. "For decades, the tobacco industry has carefully manipulated menthol content not only to lure youth but also to lock in lifelong adult customers," said Howard Koh, Professor and Associate Dean for Public Health Practice at HSPH and a co-author of the paper.
Further, an analysis by the American Association of Public Health Physicians raises concern that if the bill were enacted the tobacco companies would use the FDA oversight to declare that cigarettes had been found safe. There is nothing safe about cigarettes. They contain poisons. The FDA has no mandate to certify poisons safe for non-medical use.

Posted by at 9:26 AM | Permalink | Comments (0)

In a story if today's Dallas Morning News is an article decrying increasing waiting time in doctor's offices. There are two problems with the story, if true. First, the comcern is about waiting times of more than an hour. There is no excuse for waiting times in either the waiting room or examining room of more than 5-10 minutes. Anything more is an example of poor management and should bring penalties from third party payers. Second, a reason given is a shortage of doctors. This is another misconception foisted on the public. There is no shortage of doctors, only a shortage of primary care doctors due to the training policies of medical schools, abetted by federal granters who favor specialty training programs, Medicare which pays for procedures rather than advice, and the medical school accreditors who are for the most part either PH.Ds. or medical specialists. This may well be one of the side efects of good intention which has recently focused on quality of care using procedures to measure quality, not outcomes desired by the public.

Posted by at 10:43 AM | Permalink | Comments (0)

Even though America spends more than $2 trillion annually on health care—more than any other nation in the world—tens of millions of Americans suffer every day from preventable diseases like type 2 diabetes, heart disease, and some forms of cancer that rob them of their health and quality of life.
Keeping people healthier is one of the most effective ways to reduce health care costs. This study, which was developed through a partnership of the Trust for America’s Health (TFAH), The Urban Institute, The New York Academy of Medicine (NYAM), the Robert Wood Johnson Foundation (RWJF), The California Endowment (TCE), and Prevention Institute, examines how much the country could save in health care costs if we invested more in disease prevention, specifically by funding proven community-based programs that result in increased levels of physical activity, improved nutrition (both quality and quantity of food), and a reduction in smoking and other tobacco use rates. After five years the return on investment will be $5.6 for each dollar invested.

Posted by at 3:53 PM | Permalink | Comments (0)

The main focus of the law was to prevent cuts to Dr's payments to prevent them from ditching Medicare patients. We are also told that it will pay for checkups. Unfortunately there is little data to show routine check-up make a difference to patients' health (although it improves Dr's income) once they have had an initial screening. It would have been better to pay for counselling about adverse behaviors such as failing to take prescribed medicines correctly.

Posted by at 9:40 AM | Permalink | Comments (0)

This month's Journal "Pediatrics" contains an excellent article on the safety of current vaccines and the need for further research, measurement and publicity about the safety and effectiveness of vaccines to enhance the public's trust. The authors note the amount of effort physicains have to spend to encourage parents to immunize theri children. in the short time available during routine visits. [Pediatrics 2008;122:149–153]

Posted by at 5:45 PM | Permalink | Comments (0)

Despite the media feeding frenzy on tomatoes the U.S. Food and Drug Administration’s Food Protection Plan Progress Report, released today in conjunction with the Interagency Working Group on Import Safety Action Plan Update, shows significant areas of activity to further improve the safety of America’s food supply since unveiling its Food Protection Plan in November 2007. The plan focuses on Prevention, Intervention and Response. The FDA is setting up standards agreements with major importers, devloping rapid detection methods for common biological contaminants, identifying best practices and increasing surveillance.

Posted by at 9:39 AM | Permalink | Comments (1)

The Boston Globe reports that "Sen. Edward Kennedy's (D-Mass.) office [began] convening a series of meetings involving a wide array of healthcare specialists to [start] laying the groundwork for a new attempt to provide universal healthcare, according to participants. Comment: We can only hope that he learns from the Massachusetts experience and is advised how complex the system is. Just trying to provide financial access will only make the system worse, unless it is restructured on a primary care/prevention base. One stumbling block is that too many interest groups will be focused on ensuring their specialty is not diminished.

Posted by at 10:51 AM | Permalink | Comments (0)

The Wall Street Journal reports that Daniel Carpenter, "[a] Harvard University professor, defended research suggesting the Food and Drug Administration (FDA) was making overly hasty approval decisions on medicines -- an analysis the agency has criticized as mistaken." The revised analysis indicates that "between 1993 and 2005, the 88 drugs approved near the FDA's deadline had a 15 percent chance of being flagged for severe safety problems," while the "rate was just five percent" for "226 other drugs." The FDA "has maintained that its own internal database showed only a modest increase in the rate of safety problems for such drugs." Comment: One more case of legislating in haste to regret the outcome at leisure. Several years ago activists complained the FDA took too long to make decisions., Congress leaned on the FDA to be quicker, without looking at the downside. No additional money was provided so the FDA had to cut corners. The results are a number of high profile drugs be let loose and then having to be withdrawn. The US syndrome of “want an answer immediately” does not work in science, but Congress will not learn. All of us who have managed large agencies have had to listen to legislators tell us what to do without the freedom to respond or discuss.

Posted by at 10:45 AM | Permalink | Comments (0)

Jack Colwill, professor emeritus of family and community medicine in the MU School of Medicine, and his research team found that the U.S. could face a shortage of up to 44,000 family physicians and general internists in less than 20 years, due to a skewed compensation system that rewards specialists increasingly more than primary care practitioners. The researchers are more optimistic about the future supply of general pediatricians. The wait to see a doctor could get a lot longer if the current number of students training to be primary care physicians doesn't increase soon, according to a new study. The U.S. could face a shortage of up to 44,000 family physicians and general internists in less than 20 years. Comment: Note that there is probably no shortage of specialists. To emphasize the problem the Wall St. Journal today reported that that medical professionals who "really want to do well, [should] become a nurse anesthetist." They "typically receive an undergraduate nursing degree, have experience working as registered nurses, and complete two to three years of post-graduate training." By one estimate, "nurse anesthetists recruited" over the past year "through the staffing firm Merritt Hawkins & Associates landed salaries that averaged $185,000." The nurses' salaries exceeded the salaries of "family-practice docs hired through the firm, who averaged $172,000, and internists, who averaged $176,000." If we want access to health care we need to change the rewards system to encourage primary care practice.

Posted by at 5:23 PM | Permalink | Comments (1)

In a wonderful article published in JAMA today, [Ezekiel J. Emanuel; Victor R. Fuchs:JAMA. 2008;299(23):2789-2791] Victor Fuchs describes the overselling of medical services to the public and excess desire for new technology by both health care professionals and the public. Also how rewards and punishment in the system has affected the Health Care system driving up its costs. This article should be read by everyone, both health care professionals, students and the public.

Posted by at 5:24 PM | Permalink | Comments (0)

Which is more important; rights or social responsiblity? Pennsylvania motorcyclists suffered large increases in head injury deaths and hospitalizations in the two years following the repeal of its motorcycle helmet law, according to a University of Pittsburgh study. Even after accounting for increases in motorcycle registrations that occurred during this period, study authors noted a 32 percent increase in head injury deaths and a 42 percent increase in head injury-related hospitalizations, raising concerns about motorcyclists' safety and the impact of this trend on health care costs. "Our study shows that since the repeal of Pennsylvania's motorcycle helmet law, helmet use has gone down, while head injuries from motorcycle crashes have gone up, even after increased motorcycle registration," said Kristen Mertz, M.D., M.P.H., study lead author and assistant professor, Department of Epidemiology, University of Pittsburgh Graduate School of Public Health.

Posted by at 10:52 AM | Permalink | Comments (4)

California Public Health regulators have just taken to task 13 firms advertising genetic analysis to the public. The state Department of Public Health sent the cease-and-desist letters last week following an investigation spurred by consumer complaints about the tests' accuracy and cost, a department spokeswoman said Monday. The New York State Department of Health issued similar notices to nearly two dozen testing companies in April. The FDA has not issued notices at all. I have recommended avoiding any genetic testing offered outside teaching hospitals, because of the poor underlying science, and the likelihood of false positive tests; also the inability of the medical profession to know what to do with the results of such tests. They are innapropriate at best and dangerous otherwise.

Posted by at 9:53 AM | Permalink | Comments (2)

In this week's British Medical Journal, Professor Winkler of London Metropolitan Unversity complains about lack of enforcement of the EU laws prohibiting all forms of misselling, including false health claims on foods and other products. However, this impressive sounding legislation will have little effect on the real world unless it is enforced proactively and comprehensively. It would be welcome to have such legislation in this country with the deluge of false claims about so many products.

Posted by at 8:38 PM | Permalink | Comments (0)

A fascinating "Perspective" on autism,. the MMR vaccine, the National Advisory Committee on Immunization and the Vaccine Injury Compensation Program is presented in today's New England Journal of Medicine (N. engl j med 358;20 may 15, 2008), which discusses the origin of the compensation program, and the failure of the program to follow a science base in its awards, opening the door to great injury to the vaccine program and setting the stage for another rush of pharmaceutical companies to flee from tthe vaccine field. If the current case in court is decided on feelings, rather than science, millions of people may die in the near future from lack of vaccines.

Posted by at 6:37 PM | Permalink | Comments (0)

An interesting 'Perspective' has been published in the BMJ this week by Roger England asking the public health field to consider whether it took the wrong approach to AIDS. The 'Think' piece notes that AIDS is not more important than malaria, pneumonia, diabetes or heart disease in developing countries. It also notes that if it were not for the diatribes of the Gay Communities AIDS would have been treated like other sexually transmitted diseases such as syphilis or gonorrhea and that faster progress might have been made. Further the public health community should not have shelved action against other major killing diseases in favor of AIDS. Maybe now is the time to place AIDS into perspective and treat it both as a chronic disease, like TB, and as an acute infectious disease like syphilis.

Posted by at 10:51 AM | Permalink | Comments (0)

The American College of Medical Genetics has developed a 2008 Policy Statement on DTC Genetic Testing. The college is concerned with sudden influx of genetic tests offered to the to the public without requiring professional support and recommendation
The college discusses five principles in its public statement which should be read by everyone before planning to use any genetic test, however well intentioned:
A knowledgeable professional should be involved in the process of ordering and interpreting a genetic test.
The consumer should be fully informed regarding what the test can and cannot say about his or her health.
The scientific evidence on which a test is based should be clearly stated.
The clinical testing laboratory must be accredited by CLIA, the State and/or other applicable accrediting agencies.
Privacy concerns must be addressed.

Posted by at 10:21 AM | Permalink | Comments (1)

There will not be enough geriatricians when the 78 million baby boomers begin to turn 65 in 2011, according to a new Institute of Medicine report. By 2030, there will be an estimated 8,000 geriatricians, but the nation will need 36,000, according to the Assn. of Directors of Geriatric Academic Programs. IOM report recommends an increase in geriatric competency throughout the health care work force to offset a shortage in geriatric specialists. It also called for the adoption of interdisciplinary care models and a fundamental change in how health care is reimbursed. As noted in this blog previously, the primary care workforce is desperately underfinanced. The current reimbursment system militates against physicians choosing to work in primary care settings (of which geriatrics is part) after graduation. The current practice of training primary care physicians in hospitals where they are trained by specialists is also dysfunctional.

Posted by at 11:09 AM | Permalink | Comments (0)

In an interesting turn about, the Chicago Tribune has reversed its policy of fining employees who smoke on their own time. The original intent was to pressure employees into better health and reduce insurance premiums for all its employees. The president of the company has decided to try efforts ot entice employees to change behaviors with rewards rather than punishment. Changing adult behavior is very difficult. Peer pressure may work better than executive pressure. Should you be concerned about the health of your fellow workers if their behavior causes your insurance bill to increase? Few people today accept reponsibility for anything. We have become too lax with rewards and punishments. They need to be balanced. Is rewarding someone for changing behavior appropriate when those with desired behaviors get no reward?

Posted by at 1:42 PM | Permalink | Comments (1)

The New England Journal of Medicine today published two "Perspective' articles on the responsibilities of the FDA and the total lack of responsibility of both the legislative and executive branches of government to support the FDA. Then the politicians turn around and criticize the FDA for their own failings. The FDA is given oversight responsibility by Congress to evaluate all drugs and medical devices. No-one in Congress has put a price tag on these legislated mandates. It is easier to criticise the FDA when they cannot carry out their assigned role. The Congressional Budget office reccomends $multimillion increases to the FDA budget. It is clear that the politicians have no idea about the complexity of scientific accountability, or the time it takes ot hire, train and disperse staff. Even if they provide the funding required there is little evidence that the Executive Branch would pass the appropriation to the FDA., The FDA Commissioner is put in an untenable position and cannot criticize either the President or Congress. All of us who vote should remove every congressman who has failed to support the FDA and who criticizes the agency without providing the necessary resources. Yet, there are some who think Congress can fix our failed health system!!

Posted by at 6:59 PM | Permalink | Comments (1)

WhIle everyone talks about it, and this latest report from The Center for Health System Change adds to the data, few in Congress take notice. The media continues to publish stories about the need for more attention to prevention, yet as this paper shows less than 3% of the annual $2.2 Trillion health care dollars is spent on public health and disease prevention, particulalry to enhance the staff needed to carry out the services. Insurance companies only give lip service to the idea but do not reimburse primary care physicians for preventive interventions , except in those instances where intrusive technology is used. There needs to be a close liaison between public health agencies and primary care practitioners, who together will be a more effective force for prevention than either by themselves.

Posted by at 10:35 AM | Permalink | Comments (2)

The News Media today publish two stories about the inability of Congress to come to grips with changes needed to the health care system. First, Senator Baucom fails to understand that Medicare is rapidly going broke but he is trying tu repeal cuts in the Medicare payment system. He should be concentrating on the cause for Medicare's forthcoming insolvency, the excess of preventable chronic disease in a growing aging population with a payment system that focuses on the wrong interventions. Secondly, Congress is concerned about a "Dr. Shortage". For the most part this is a myth. The 'shortage'' is in primary care. The third party payment programs short change primary care and focus om specialty care. Thus, young doctors $100,000 or more of debt choose a spocialty that will reduce their debt most rapidly, As usual politicians focus on perception rather than reality.

Posted by at 9:45 AM | Permalink | Comments (0)

Senator Kennedy has it absolutely right in commenting on policy changes to rein in the health care system. He is quoted in 'The Hill' as saying " reducing the cost and improving the quality of healthcare in the United States cannot be accomplished without changing the way patients with chronic diseases are treated and the way medical providers are paid. He is joined by Dr. Carmona, former Surgeon General who says “We are obviously not doing enough to reward real value in healthcare,” pointing out that treatments for the chronically ill with conditions such as diabetes and high blood pressure consume a grossly disproportionate share of the nation’s spending on healthcare. Seventy-five cents of every dollar you’re spending on healthcare is on chronic disease, much of which is preventable.” With healthcare costs continuing to mount, rates of chronic illnesses like diabetes rising and the Baby Boom generation advancing in age, the situation will deteriorate without change, he cautioned. “The bank is breaking now and it’s only going to get worse.”

Posted by at 10:50 AM | Permalink | Comments (0)

While many people of all ages take dietary supplements, the prevalence increases as people age, amd could well be labelled substance abuse. A wonderful piece in today’s NYT by Jane Brody is essential reading. Ms. Brody discusses abuse of legally sold dietary supplements — vitamins, minerals, herbals and homeopathic remedies — all of which can be sold over the counter without prior approval for safety and effectiveness. A new federal law requires supplement manufacturers to report serious adverse effects to the Food and Drug Administration, but it depends on consumers to call in reactions. This form of passive reporting is unlikely to describe the depth, distribution and dangers of this form of supplement abuse. The ‘complementary medicine’ advocates make the problem worse while Congress shows no will to intervene. This form of abuse may be just as bad as addiction to narcotics, but is silent because of research priorities which focus on highly visible and often relatively rare medical problems, than on a common and dangerous habit. We might well ponder how many of these supplemetary producers are underwritten by drug companies.

Posted by at 9:49 AM | Permalink | Comments (6)

The opening paragraph of the executive summary of the 2008 report from the Dartmouth Atlas of Health Care focuses on chronic disease and raises important issues:
"More than 90 million Americans live with at least one chronic illness, and seven out of ten Americans die from chronic disease. The quality of care for Americans with chronic disease is remarkably uneven.Most patients receive episodic care from multiple different physicians who rarely coordinate the care they deliver. And the growing costs of chronic disease care present a threat not only to patients and their families but also to the nation."
Considering that the care of chronic disease is rapidly raising the cost of medical treatment beyond the capability of the nation to sustain it, this publication should be read by everyone. It is clear our training and organizational methods of care need radical revision. We do not provide equitable, appropriate, effective, efficient, affordable care across the couintry. We need to move away from organ based specialty training to developing teams of professionals who can intervene on our behalf before we get to the stage in life described in this report. We need much more focus on primary care.

Posted by at 9:44 AM | Permalink | Comments (0)

Massachussetts as the first state to develop a universal medical access plan "has reached a crisis point" because the "crushing costs of the program endanger its long-term viability," Says Christopher Anderson in the Boston Globe, The lesson to learn from Massachussetts is that money cannot buy universal access without reforming the medical care system, All Massachussetts has done is provide relatively low cost insurance to enable access to an unchanged system, overwhelmed by chronic disease and lawsuits. We have to move from a system dominated by specialists and drug companies to a primary care, prevention oriented system. We have to stop tinkering around the edges.

Posted by at 11:10 AM | Permalink | Comments (0)

Indiana University Study Finds Majority of U.S. Physicians Favor National Health Insurance Support Has Grown 10 Percent Over Past 5 Years. The largest survey ever of American physicians' opinions on health-care financing has found that 59 percent of doctors support government legislation to establish national health insurance while only 32 percent oppose it. A similar survey conducted by the IU researchers in 2002 found 49 percent of physicians supporting national health insurance and 40 percent opposing it. The 2007 survey results demonstrate a significant change in the level of support for national health insurance. While some of the presidentiaol candidates support such a move the details are mssing, as are major policy recommednations to develop such a system.

Posted by at 10:15 AM | Permalink | Comments (3)

Congress and the media are again hounding the FDA. All drugs (medicines) are dangerous. This statement is one that the media and politicians need to learn. One cannot test a medicine in more than a few thousand people at a time, before it is released to the practicing physicains. Once it is released for use and millions are exposed to the medication rare events, a number of the including death, may occur. Some of these are coincidental but the activists want cause and do not undestand the issue of coincidence.. How many adverse events are acceptable? Should millions of people be denied use of a useful drug because one in a million has a serious adverse eevnt. How many sheets of advice must a scienitifically untrained person read before a prescription is written? How many of you read the small print of every document you sign? Not many I bet! Perhaps we need to stop advertising prescription drugs as this pressures physicians to use drugs that might not otherwise be recommended. Then when patients have adverse effects they run to a lawyer rather than accept blame for their own behavior. One more reason for the rapidly increasing cost of the health care system.

Posted by at 10:38 AM | Permalink | Comments (1)

Although advances in genomic medicine for common adult chronic diseases such as heart disease, diabetes, and cancer hold promise for improved prevention, diagnosis and treatment, health professionals and the public are not prepared to effectively integrate these new tools into practice, according to a study released today by researchers from the Department of Veterans Affairs and the RAND Corporation.
Researchers say the findings demonstrate a need for a large-scale effort to educate both health professionals and the public about genomic medicine, and to develop and evaluate new ways to deliver genetic services.

Posted by at 10:11 AM | Permalink | Comments (0)

With all the newest information about the prevalance of STDs among teen girls, nothing new to the public health community although we had to discuss it "sotto-voce", we not only need to be sure that children are taught about problems of sexiual intimacy early, but that they undestand the value of condoms. Certain parents think it irresponsible to teach children about sexual behavior, so they let them get misinformation from their peers, while failing to educate their children themselves. Then they wonder about how the teens became infected with an STD. While condoms may occassionly fail (much rarer than activists would have you believe) they are still the next best thing to abstinence which is rare in today's environment. I can remember back to my youth just after the end of WW2 when girls would not go out with a boy if they did not see the outline of a condom in his back pants pocket. Maybe we need to resurrect this habit Since the advent of "birth control pills' all the onus for sexual outcomes has been placed on the girl instead of the boy.

Posted by at 9:38 AM | Permalink | Comments (8)

The remaining candidates have it all wrong. The Republican candidate make no pretense of caring for the uninsured and has no idea that the health care system is imploding. The Democratic contenders, while aware there are problems seem to think all they have to do is provide insurance coverage! The Massachussetts program is in deep financial trouble. The California program died in committee. The New Jersey plan is unlikely to go anywhere as it only focuses on insurance, mainly for children. Until the plans stop looking at hospital costs and freedom of choice for anything one wants, and focuses on a primary care home for everyone, and sets limits to interventions there will be nothing except sets of new unfulfilled promises. It is time we learn from every other nation in the world that access to health services has to start in the primary care arena, with a single practice responsible for comprehensive care, acting as a gate keeper. Further. such care has to place an emphasis on preventing disease, not just intervening after symptoms occur. There is no way any system can pay for everything. There must be be evidence that interventions work, particularly in the realm of all the "me-too" prescriptions, many of which are overpriced and undereffective. Prescription advertising has to stop.. Any program that ensures population wide access must include a system that precludes some interventions as too expensive and inneffective. This is even more important with all the new research in genetics that will translate into useful inteventions within the next decade, and the associated population boom..

Posted by at 10:58 AM | Permalink | Comments (6)

Those few who might be swayed by recent stories about linkages between vaccines and autism should look at the report that Hib meningitis has been virtually eliminated in young children in Uganda just five years after the country introduced Haemophilus influenzae type b (Hib) vaccine nationwide, according to an independent study. Each year, Hib kills approximately 400,000 children under five years of age, most of them in the developing world. It is also responsible for approximately three million cases of serious illnesses resulting in long-term consequences such as deafness, paralysis, mental retardation and learning disabilities. One should be suspect of claims by the 'ME' generation, and their attorneys, that an individual is more important than the population as a whole.

Posted by at 9:55 AM | Permalink | Comments (0)

As we age many of us may need nursing support (up to one in three of those turning 65 in 2010.) The proportion of the "aged" population is increasing dramatically due to our ability to extend lives and modify chronic diseases.

Posted by at 11:52 AM | Permalink | Comments (0)

Duke Hospital is limiting access by visitors with Upper Respiratory Infections (URI). Many of these will be Influenza and can harm those in the hospital already. Similarly businesses should tell employees with URIs to stay home. counsel all employees to wash hands frequently, and stop shaking hands when greeting visitors.

Posted by at 11:13 AM | Permalink | Comments (0)

Data from projections on the cost of medical care show that within the next 40-50 years, if unrestrained, medical care will use up 50% of the GNP! Within the next 10 years, according to reports in major news papers today, the Centers for Medicaid & Medicare Services (CMS). While we are living longer, and many living without significant disease or deterioration, those who do not observe good health habits early will break the the US fiscal system. We cannot keep puttering along tinkering with the fringes of medical care organisation. Neither can we continue to focus on institutional care, but need to commit to a system that ensure access for all to good quality primary care, with a focus on health instead of disease. There are many who think that whatever the cvost we must treat all disease with a high tech approach. Every additional dollar we spend on treating disease, instead of preventing it is a dollar less for food, housing, education, transportation and productivity.

Posted by at 10:02 AM | Permalink | Comments (0)

A fascinating article in the current American Journal of Public Health examines the value of dietary guidelines and the evidence supporting them. In particular the critique is concerned about the potential ill effects of dietary changes when the public may believe they are fully informed. We should be particularly careful about emulating the public health intervention on eliminating trans fats that has been enacted in New York City. While data may be fair on the value of reducing fats to prevent cardiovascular disease, there is almost no data on ill effects from the elimination of trans fats. Many of the dietary guidelines are based in flimsy evidence with politics playing a major role. We need to be very careful about trying to change behavior by legislation, without much better data than that currently available. The accompanying article about the critique, by Woolf & Nestle should also be read, as well as the author's response to Woolf & Marantz.

Posted by at 11:51 AM | Permalink | Comments (0)

On today's Richmond Times Dispatch editorial pages are discussions about the efforts of public health activists to mandate "health" policies that are becoming policing actions.. While educational efforts to reduce smoking have had some success, particularly among men, constant new legislative efforts are turning public health agencies into police departments. Now with foci on how we can cook what we are allowed to eat, when we are allowed to eat (laws to ban restaurants from serving food to over weight people), in addition to suggested laws on how much we must exercise and suggestions to tax our weight, Aldous Huxley must be spinning in his grave. The Brave New World is here. Walter WIllaims is correct about the camel's nose under the tent. We are moving from education, the strength of past public health efforts, to policing behavior. We are part of the way there with behavioral agencies that have expanded from improving mental health into social tinkering. All these efforts, while well intentioned are dangerous to the public's well being..

Posted by at 9:41 AM | Permalink | Comments (1)

Based on a report sponsored by a foundation established by New York City mayor Michael R Bloomberg the WHO recommends a public policy that would increase one particular form of taxation even further—a move that would effectively tax citizens everywhere to life instead. Increasing taxes on tobacco products is a proven method of reducing their consumption and is one of the six core interventions in the WHO Report on the Global Tobacco Epidemic 2008. The six-point plan is a clear roadmap, supported by country-specific data and includes:
Monitor tobacco use and prevention policies
Protect people from tobacco smoke
Offer help to quit tobacco use
Warn about the dangers of tobacco
Enforce bans on tobacco advertising, promotion and sponsorship
Raise taxes on tobacco

Posted by at 10:37 AM | Permalink | Comments (1)

An analysis by AHRQ has identified the most expensive medical conditions that keep driving up the cost of medical care. Public health programs need to focus their skills on reducing these conditions, in addition to their traditional programs. The ten conditions are:
Heart conditions—$76 billion.
Trauma disorders—$72 billion.
Cancer—$70 billion.
Mental disorders, including depression—$56.0 billion.
Asthma and chronic obstructive pulmonary disease—$54 billion.
High blood pressure—$42 billion.
Type 2 diabetes—$34 billion.
Osteoarthritis and other joint diseases—$34 billion.
Back problems—$32 billion.
Normal childbirth—$32 billion.

Posted by at 9:22 AM | Permalink | Comments (0)

A study just released by the Urban Institute finds that insurance reforms will not work unless they include mandates that individuals must obtain health insurance. Without the mandate many people will not purchase insurance. Those that are likely to purchase may be the sickest who will use more resources and prevent savings to allow enrollemnt of the poorest members of the population.

Posted by at 10:21 AM | Permalink | Comments (1)

According to an article in this month's American Journal of Public Health investments in state tobacco control programs are independently and significantly associated with larger and more rapid declines in adult smoking prevalence, according to a study by researchers at the Centers for Disease Control and Prevention. The study covers the period from 1985 to 2003. However it depends what you mean by tobacco control programs. Much of the credit is probably due to increasing taxes on cigarettes and public programs to reduce public smoking, particularly in restaurants, offices and stores. I believe the behavioral programs that occurrred concurrently had minimal effect.

Posted by at 10:10 AM | Permalink | Comments (1)