Monday, September 25, 2006
Cuz who wants to cure cancer anyway?
That, replicated over and over again, is the story of the modern NIH. Clinton had accelerated the agency's funding, but, in 2004, Bush and the Republican Congress shut off the spigot, and money has flat-lined since. That's left a significant gap between the number of promising proposals from reputable scientists that get submitted and the number of promising proposals from reputable scientists that get funded. Even worse, the NIH, like all big institutions, is a bit hidebound and loathe to gamble, so it's been the boldest and riskiest ideas that are getting shot down. Most of these would evaporate, but if a mere couple worked, the implications would be tremendous. These are the tradeoffs we make to fund tax cuts and hopeless wars -- and I wonder if the American people would really prefer another few years in Iraq to fully funding efforts to cure cancer.
Free market health care? Not so much.
Researchers from the Rand Corp. think tank, the University of California at Los Angeles and the federal Department of Veterans Affairs asked 236 elderly patients at two big managed-care plans, one in the Southwest and the other in the Northeast, to rate the medical care they were getting. The average score was high — about 8.9 on a scale from zero to 10.
In the second part of their study, the medical researchers systematically examined 13 months of medical records to gauge the quality of care the same elderly patients had received. The average score wasn't as impressive as those in the patient-satisfaction surveys: 5.5 on a 10-point scale. But here's the interesting part: Those patients who graded the quality of their care as 10 weren't any more likely to be getting high-quality care than those who gave it a grade of 5. The most-satisfied patients didn't get better medical care than the least-satisfied.
Surprise! Patients are poor judges of whether they're getting good care. And if consumer preferences don't map to high quality care, then a free market in health care won't necessarily produce better results or higher efficiency, as it does in most markets.
Back to the drawing board. Perhaps a national health care system would be a better bet to reduce costs, cover more people, provide patients with more flexibility, and produce superior outcomes. After all, why are we satisfied with allowing the French to have a better health care system than ours even though we're half again richer than them?
Social Security still under threat
Good news
Big Pharma thumbs nose at Project Bioshield
HMOs and Insurance Co's: Enemy #1
What can be done? It's not a query I'm particularly well-equipped to field, but I think a good start would be photocopying this article on retroactive cancellations by insurers and handing a copy out to each and every American. No other piece I'm aware of exposes the absurdities and cruelty of the system as clearly, and so irresistibly signals the need for reform.
The actual facts in the report are basic: California state regulators are investigating Blue Cross for unlawful cancellations of policies. When you buy individual coverage, unlike when you buy into group coverage, insurers can reject you based on your health history or conditions. In order to protect against fraud -- say, someone being diagnosed with heart disease, then applying for insurance the next morning without mentioning it -- the law allows for insurers to cancel policies if the applicant engaged in "willful misrepresentation."
What's clever is how the insurance industry has redefined the standard: If you had a condition you didn't know about, they'll seek to not only yank your policy, but dispatch debt collectors to recover what they've already paid out.
In practice, the scam works like this: Selah Shaeffer, age four, was found to have an aggressive, cancerous tumor in her jaw. The family had been with Blue Cross for about a year, and the bump was examined and biopsied after they'd bought their insurance. But because it was growing before, Blue Cross cut off reimbursement for surgeries it had already authorized, and is now trying to recover $20,000 from the Shaeffers.
Or take the Nazertyans, who had premature twins. They were covered by Blue Shield all throughout the pregnancy, and disclosed all facets of the birth and operations. Blue Shield not only dropped them, but was trying to get back $98,000 they'd already paid under the rationale that the Nazertyans hadn't disclosed an earlier miscarriage. After the Los Angeles Times reported the story, Blue Shield called off the debt collectors.
What's so remarkable about all this is what it exposes about the health insurance system in this country: We rely almost exclusively on private insurers whose primary business imperative is not to pay when we get sick. They do that by seeking to deny coverage before the fact, or reject claims afterwards. They pay for platoons of employees who have no job other than to scrutinize thousands of policies a week in the hopes of finding sufficient cause for cancellation. Say what you will about the inefficiencies of the public sector, but can it really match the ruthlessness and absurdity of insurers spending large amounts of money so they don't have to insure? Is that sort of profit motive really what you want underlying your health care coverage?
Friday, September 15, 2006
Bionic woman
The process doctors used to create a responsive prosthetic arm for her is nothing less than a medical wonder:
In preparation for the bionic arm, Kuiken and his surgical colleagues first re-create a biological control panel for a hand on the amputee's chest. They use muscle and skin that can be sacrificed -- or, more precisely, hijacked -- for that purpose.
They cut the nerves to two chest muscles, the pectoralis and serratus, at a point where those nerves have branched to go to different parts of the muscles, but far "upstream" from the point where the nerves divide into tiny fibers that attach to individual bundles of muscle fiber.
They then sew the stumps of the large nerves that once went to the arm and hand to the cut ends of the chest-muscle nerves. In the same operation, the nerves carrying sensation from the skin over the pectoral muscle are also sewn into the arm nerves.
Over several months, the arm nerves grow down the sheaths of the motor fibers and attach to the muscles. (Interestingly, the amputee assists this process by mentally "exercising" the missing hand, which helps promote a firm nerve-muscle connection.) Simultaneously, the sensory nerves grow down the sensory sheaths and into the skin.
If all goes well, a person is left with chest muscles that twitch in different places in response to such thoughts as "bend the wrist back," "move the thumb" and "clench the fingers." The person also ends up with a patch of skin about the width of a baseball that, when stroked, warmed or pricked, feels like a hand rather than part of the chest.
The bionic arm makes use of this feat of anatomical alchemy.
The prosthesis is strapped onto the shoulder stump and torso in a way that positions electrodes over the regions of the chest muscles that are responding to different "hand instructions." Those electrodes, in turn, are wired to a computer and then on to motors in the forearm and hand of the device.
When the amputee tells the fingers to close, the designated part of the pectoral or serratus muscle twitches and the electrode over it detects the signal, activating the appropriate motor.
Wow. That's all, just wow. Do read the whole thing.
Monday, September 11, 2006
$11 million per hour
Uninsured numbers still rising
President Bush says “the foundation of our economy is solid, and it’s strong.” That’s true, for some: corporate profits have now climbed to their highest share of GDP since the 1960’s.
But new Census Bureau data show the real state of the current economy. The Bush record on combating poverty and insuring more Americans is an undisputed failure.
At left are the number of our uninsured measured in millions.
More on the new census data HERE.
Playing shell games with Medicare payments
This way, the Medicare mouskateers happily say, the Medicare bill for 2006 will look like its $5.2 billion less than it really is. This will help those folks who are in office pick up a few more votes to stay in office. That $5.2 billion will get tacked onto next year's budget, so we're saving anything, but there's no election next year.
I swear, every time I think these guys can't get any more childishly foolish they do. It's like having a bunch of scheming high school freshmen running the country.
Consumer directed care: another empty promise?
Researchers from the Rand Corporation's think tank, the University of California at Los Angeles and the federal Department of Veterans Affairs asked 236 elderly patients at two big managed-care plans to rate the medical care they were getting. The average score was high — about 8.9 on a scale from zero to 10.
Then they poured through 13 months of medical records to gauge the quality of care the same elderly patients had received and found an average score wasn't as high as those in the patient-satisfaction surveys: 5.5 on a 10-point scale.
But here's the kicker: Those patients who graded the quality of their care as 10 weren't any more likely to be getting high-quality care than those who gave it a grade of 5. The most-satisfied patients weren't getting any better medical care than the least-satisfied.
Patients, it seems, are rather poor judges of whether they're getting good care. And if consumer preferences don't map to high quality care, then a free market in health care won't necessarily produce better results or higher efficiency. Don't expect mere facts from mere scientific studies, however, to slow down the political rush to consumer-directed care. The politicians know that: 1) this stuff buys votes, and 2) by the time we all figure out it was another false promise, they'll all be safely out of office.
We're still unprepared for disaster
Social Security still threatened
