In today’s Dose:
Health care reform
(Robert Reich on the public option)
(Migraines, Nipple piercing and breast feeding)
(TB and the thrifty gene)
Health care reform
- Be sure to see today’s two posts on Wendell Potter, the former health insurance executive who testified today before the Commerce Committee. Potter left the industry after witnessing the plight of the uninsured. Health insurance insider speaks out and A health insurance executive changes sides
- As you may have noticed by now, I’m a fan of Robert Reich. He has an opinion column in the Wall Street Journal that pulls together much of what he’s been saying in his blog posts on health care, such as his insistence on the importance of a public health insurance option.
[W]ithout a public option, the other parties that comprise America’s non-system of health care — private insurers, doctors, hospitals, drug companies, and medical suppliers — have little or no incentive to supply high-quality care at a lower cost than they do now.
Which is precisely why the public option has become such a lightening rod. The American Medical Association is dead-set against it, Big Pharma rejects it out of hand, and the biggest insurance companies won’t consider it. No other issue in the current health-care debate is as fiercely opposed by the medical establishment and their lobbies now swarming over Capitol Hill. Of course, they don’t want it. A public option would squeeze their profits and force them to undertake major reforms. That’s the whole point.
Critics say the public option is really a Trojan horse for a government takeover of all of health insurance. But nothing could be further from the truth. …
Private insurers say a public option would have an unfair advantage in achieving this goal [better health care for less]. Being the one public plan, it will have large economies of scale that will enable it to negotiate more favorable terms with pharmaceutical companies and other providers. But why, exactly, is this unfair? Isn’t the whole point of cost containment to provide the public with health care on more favorable terms? …
But, say the critics, the public plan starts off with an unfair advantage because it’s likely to have lower administrative costs. That may be true — Medicare’s administrative costs per enrollee are a small fraction of typical private insurance costs — but here again, why exactly is this unfair? Isn’t one of the goals of health-care cost containment to lower administrative costs? …
Critics charge that the public plan will be subsidized by the government. Here they have their facts wrong. …
[C]ritics say that because of its breadth and national reach, the public plan will be able to collect and analyze patient information on a large scale to discover the best ways to improve care. The public plan might even allow clinicians who form accountable-care organizations to keep a portion of the savings they generate. Those opposed to a public option ask how private plans can ever compete with all this. The answer is they can and should. It’s the only way we have a prayer of taming health-care costs. But here’s some good news for the private plans. The information gleaned by the public plan about best practices will be made available to the private plans as they try to achieve the same or better outputs.
- I had migraines in mid-life, so I was interested in the article in the latest Journal of the American Medical Association (JAMA) that found mid-life migraines were associated with the blockage of blood supply in the brain (infarcts) later in life. The study found that this association was statistically significant only for women. Okay. And, only for migraines with aura. “Migraine without aura and nonmigraine headache were not associated with an increased risk.” Whew. No auras for me. Migraines in women during mid-life can be the result of fluctuating hormones during peri-menopause, BTW.
The complete text is available only with a subscription, but here’s the abstract.
- Does nipple piercing – an increasingly frequent practice, according to JAMA — interfere with milk production and breast-feeding?
Current information states that nipple piercing is generally not deemed to be detrimental to maternal milk supply. However, irritation or trauma may predispose a nipple-pierced breast to infant attachment problems or blocked ducts.
This from the current issue of JAMA (subscription only). Here’s the first 150 words.
When obesity researchers speculate about the “thrifty gene” as an explanation for the recent increase in obesity, the counter-argument is: The obesity “epidemic” has happened too quickly — there hasn’t been enough time for such a significant genetic change.
An article in the current issue of JAMA has an interesting take on this question. It speculates that obesity may be related to the prevalence of tuberculosis in the 19th and early 20th centuries.
This Commentary explores the possibility that the tuberculosis epidemic during previous centuries generated selective pressures that intensified the metabolic syndrome and the inflammatory processes now associated with obesity. These proinflammatory defenses (with immune systems that are especially robust and more easily triggered) in partnership with the metabolic syndrome (insulin resistance, dyslipidemias, and hypertension), may have provided an advantage during the tuberculosis pandemic when food availability was limited and average life span was short. Currently, in developed countries, tuberculosis is relatively uncommon, food is abundant, and life expectancy beyond the reproductive years is substantial; the evolutionarily enhanced immune and metabolic elements now act possibly to intensify the pathological consequences of obesity. (emphasis added)
Again, the complete text is available only with a subscription, but here’s the first 150 words, including those quoted above.
- Gary Schwitzer is a health care journalist who works tirelessly for responsible coverage of medical issues. He has a regular service called Health News Review where he analyzes current health news reporting. He assigns grades based on various criteria: disease mongering, availability of the featured product/treatment/test/procedure, discussion of cost, discussion of risks and benefits, and so on. Health News Review is modeled after similar sites called Media Doctor in Canada and Australia.
He also writes a blog and occasionally, when he finds an issue sufficiently distressing, sends an email.
Yesterday he sent an email on drug companies financing the training of medical journalists. The Society of Professional Journalists (SPJ) ran an ad in its newsletter about Pfizer fellowships for journalists who want to write about cancer issues. Here’s the ad:
Interested in covering the health industry, science and medical research? Even more interested in using journalism to inform the public about the leading cause of illness and death worldwide? The National Press Foundation offers an all-expenses-paid four-day fellowship for journalists on “Cancer Issues.” … Fifteen fellowships will be awarded and they all include lodging, airfare and most meals.
Schwitzer takes issue with The National Press Foundation for accepting drug money and with SPJ for accepting their advertising.
Why don’t journalists see any problem with these arrangements? Actually journalists did see problems with such activities — at one time. The ones who wrote the SPJ code of ethics. Something about “Refuse gifts, favors, fees, free travel and special treatment….avoid conflicts real or perceived…etc.”
You can read his letter and readers’ comments on it in his blog post “Journalism organizations too cozy with drug industry.”