In today’s Dose:
Health care reform
(Health care reform won’t make us healthier)
The medical profession
(Does the AMA represent doctors?; Does the public trust doctors?)
Obesity politics
(The cost of healthy eating)
The doctor/patient relationship
(The effects of malpractice on doctors)
Graphic art
(Anatomically correct shoes)
Health care reform
- Ezra Klein has an article in The American Prospect called “Wealth-Care Reform: Fixing our health-care system will make us more economically secure. It won’t make us much healthier.”
Health-care reform is, in practice, health-care-system-spending reform. Politicians promise that their plans will “bend the curve” and pursue “universal coverage.” They do not promise the plans will make everyone healthier, reduce infant mortality, or set targets for life expectancy. The health of the nation, as opposed to its ability to pay hospital bills, is hardly under consideration. …
“The irony is that we use health as a rhetorical trope a lot in the health-reform debate. … There’s a big payoff to pointing to health as a beneficial outcome from health reform. There’s not a big political payoff to advocating for enacting specific measures that would improve health.”
“Our agricultural policy is actually counterproductive for health. We subsidize everything that gives you diabetes and nothing that keeps you healthy. Every grain you can think of is subsidized, particularly corn, but are carrots subsidized? No. Is the advertising of carrots subsidized? No.”
“College graduates … can expect to live at least five years longer than Americans who have not completed high school. Poor Americans are more than three times as likely as Americans with upper-middle-class incomes to suffer physical limitations from a chronic illness. Upper-middle-class Americans can expect to live more than six years longer than poor Americans. People with middle incomes are less healthy and can expect to live shorter lives than those with higher incomes — even when they are insured.” … Our health is not determined by what happens inside a hospital ward or a doctor’s office. It is determined … by “where people live, learn, work and play.”
The question should not be how much health care we can buy. It should be how much health we can buy. Whether that health comes through a doctor’s office or a preschool is immaterial.
Right on! A great article.
The medical profession
- Does the AMA represent doctors? Here’s a post from Lee Fang at The Wonk Room that traces the history of the AMA, including its relations with the pharmaceutical and tobacco industries.
[T]he AMA as an institution is not a neutral player simply representing doctors. Started in the mid 19th century as an accrediting organization, the AMA has morphed into a behemoth lobbying and member services entity that is deeply entwined with the for-profit health industry. …
AMA derives at least a fifth of its budget from drug companies through an arrangement known as “licensure.” The program consists of AMA selling drug companies its “Masterfile” of doctor profiles, spanning everything from detailed biographic information to an individual doctor’s prescription-writing history. The program is extremely controversial since drug companies in turn use the information to aggressively market their products to doctors. …
So while the AMA projects an image of representing doctors (a claim tarnished by the fact that the AMA inflates its numbers by giving reduced membership fees to medical school students and retirees, who make up about half of the dues payers), it is actually financially tethered to the drug industry.
- Does the public trust doctors? In his Washington Post column, Ezra Klein cites a recent Gallup Poll that asked: Are you confident doctors will recommend the right thing to do for health care reform? 73% said yes. He goes on to say, however:
[D]octor behavior, though generally admirable, is certainly not perfect. We’re still in a world, sadly, where study after study shows that the treatment we should get does not match the treatment we do get, where study after study shows that the treatments we do get are often not based on sufficient evidence. There are certain policies — things like comparative effectiveness review, or a reform of fee-for-service payment practices — that would improve the situation. But it’s hard for legislators to broach those subjects because doctors are a popular, and thus a powerful, constituency, and they reflexively oppose policies that could harm their salaries or limit their autonomy.
Obesity politics
- From the New York Times:
Source: The New York Times
And we wonder why the U.S. population has gained weight. Junk food consumption does result in increased weight, but more importantly, unhealthy food is bad for one’s health. There is no clinically proven evidence that increased weight is the *cause* of diabetes and other health problems. What makes more sense is that the increased consumption of unhealthy food — high in sugars, fats, and salt — has had a very negative impact on health. For the past few decades we’ve been eating quick, processed food that is cheap and low in nutritional value. This poor quality food produces weight gain and poor health. Concluding from this that weight gain causes disease is an interesting though unfortunate social phenomenon. I’ll have a lot more to say about this in many future posts.
- Here’s a more detailed graph of specific items.
Source: The New York Times
This is from a column by David Leonhardt in the New York Times. Since 1978 the cost of vegetables has gone up 41% and fruit has gone up 46%. The price of oranges has doubled.
The doctor/patient relationship
- A doctor blogs about the effects of a malpractice suit on his practice of medicine.
After the deposition, I got a better idea of what the plaintiff was going to allege that I did wrong. I waited too long. I didn’t focus on the right things. I didn’t call consultants as soon as the patient hit the door.
I started to question myself, wondering if maybe the plaintiff was right. My doubts sometimes affected my clinical practice. I noticed that especially with critically ill patients, I tended to worry as much about the potential liability I could incur as I did about the patient’s medical problems. For a while, I found myself practicing defensive medicine – almost as if I would be able to compensate for this lawsuit by being “extra careful” with future patients. Looking back on those times, I can’t think of one instance in which those hundreds of thousands of dollars in extra tests made any difference in the patient’s diagnosis or treatment. All they did was penalize the patients on whom I ordered them.
(Thanks to Kevin MD for this link.)
Graphic art
- Graphics from Street Anatomy: anatomically correct shoes.
The shoes, by SquarePeg, are supposed to be available from Etsy, a great art/fashion site that sells handmade items, but I couldn’t find them there. They may have run out. Here’s the link, in case they come back in stock.
Video
- When Sanjay Gupta turned down the position of Surgeon General, one of the reasons he gave was that he wouldn’t be able to practice medicine for at least four years, and he didn’t want to lose his skills as a surgeon. Here’s a video of Gupta the surgeon in action.
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