Florida judge rules against Obama’s health reform (Guardian)
Conservative judge in conservative part of conservative state ruled health care reform unconstitutional. He argued that, because the bill includes the requirement that everyone buy insurance, the whole bill is unconstitutional. “Congress could require that people buy and consume broccoli at regular intervals,” he wrote.
A conservative federal judge in a conservative area of the conservative state of Florida ruled today on the health care reform act. Not only did he rule that the individual mandate – the requirement that everyone have insurance – was unconstitutional, which was expected. He declared the entire bill unconstitutional.
This conclusion [that the entire bill is unconstitutional] is reached with full appreciation for the “normal rule” that reviewing courts should ordinarily refrain from invalidating more than the unconstitutional part of a statute, but non-severability is required based on the unique facts of this case and the particular aspects of the Act.
Why does the individual mandate raise a constitutional issue when other government health care programs – Medicare, Medicaid, health care for veterans – did not? An article in the The New England Journal of Medicine (NEJM) explains. (emphasis added) Read more
FDA regulation and non-approved use of drugs (KevinMD)
An intelligent argument from a doctor on why he prescribes off-label. The FDA’s policy is medicine’s equivalent of “don’t ask, don’t tell” and encourages doctors to be snitches.
The Anti-Social Network (Slate)
By helping other people look happy, Facebook is making us sad. Stanford researcher found that people feel “particularly crummy” about themselves after viewing “attractive photos, accomplished bios, and chipper status updates” on Facebook.
A Fine Balance (Inteligent Life)
On reading Yoga Journal: “I’m clearly far from the only person who finds it annoying that articles about accepting your body are always surrounded by photos of young, lithe, mostly-white women showing off skin-tight, expensive spandex.” Review of Poser: My Life in Twenty-three Yoga Poses by Claire Dederer. Read more
In yet another inspiring, beautifully written, and potentially influential New Yorkerarticle, Atul Gawande tells the story of pilot projects by rogue doctors who reduce medical costs by attending to the sickest and neediest patients.
Speaking of a health care service started by Dr. Jeffrey Brenner for the sickest and most expensive patients in Camden, NJ, Gawande writes: (emphasis added)
The Camden Coalition has been able to measure its long-term effect on its first thirty-six super-utilizers. They averaged sixty-two hospital and E.R. visits per month before joining the program and thirty-seven visits after—a forty-per-cent reduction. Their hospital bills averaged $1.2 million per month before and just over half a million after—a fifty-six-per-cent reduction.
These results don’t take into account Brenner’s personnel costs, or the costs of the medications the patients are now taking as prescribed, or the fact that some of the patients might have improved on their own (or died, reducing their costs permanently). The net savings are undoubtedly lower, but they remain, almost certainly, revolutionary. Brenner and his team are out there on the boulevards of Camden demonstrating the possibilities of a strange new approach to health care: to look for the most expensive patients in the system and then direct resources and brainpower toward helping them.
What does your body odour say about you? (Guardian)
Body odor is a growth area in science. Electronic sniffing devices locate victims of building collapse. Dogs have 91% success rate in distinguishing between the urine of prostate cancer patients and that of controls. Read more
Life expectancy rising slowly in the US (New Scientist)
US life expectancy rising slower than expected due to smoking, obesity, and lack of exercise. Japanese live 5 years longer. European advantage is small, but widening.
Create a disease to market a new drug (KevinMD)
Excerpt from Carl Elliott’s “White Coat, Black Hat.” Pharma’s recipe for creating a new disease: Promote the idea that doctors take the disease seriously; claim the disease is more common than previously realized; tell the public there’s nothing to be ashamed of.
Conscious During Cosmetic Surgery (Chronicle)
Latest cosmetic surgery trend: no general anesthesia. It’s cheaper. Patients are numbed, but pain is often excruciating and torturous. Surgeon on making choices during surgery: “It’s actually a lot of fun … like shopping for a new dress or a pair of shoes.”
Are Undergraduates Actually Learning Anything? (Chronicle)
More students are sent to college at increasingly higher costs, but for all too many the benefits — critical thinking, complex reasoning, written communication — are exceedingly small or nonexistent.
Social Animal (New Yorker)
According to David Brooks, recent developments in brain science tell us that perceptiveness is more important than I.Q. Emotion, social connections, and moral intuition are more important than reason, individual choice, and abstract logic. So maybe college students are doing OK after all.
Does Raising the Thermostat Increase Obesity? (WebMD)
The body burns energy when it’s cold. “When you look at what could be causing the obesity epidemic, there are many possible causes besides eating too much and not exercising enough, and this is clearly one of them.”
Does central heating make us fat? (NHS)
Scientific article suggests that as indoor temperatures have increased, we’ve reduced the calories we use to stay warm, leading us to store the excess energy as body fat. The study is “not conclusive and does not prove that simply turning down your thermostat will make you thinner. An alternative explanation could be that people put on winter weight because they stay indoors to keep warm and therefore do less exercise.”
Disney Princesses and the Battle for Your Daughter’s Soul (Newsweek)
Review of Peggy Orenstein’s “Cinderella Ate My Daughter.” “[I]n today’s culture, it’s not just being the fairest of them all, it’s being the hottest of them all, the most Paris Hilton of them all, the most Kim Kardashian of them all.” Sharon Begley’s translation: Being shallow, narcissistic, slutty. Little girls learn — from mass marketing and media – “not that girls are strong, smart, or creative, but that each is a little princess of her own, judged by the beauty of her face (and gown).”
A Fighting Spirit Won’t Save Your Life (NYT)
Americans have a history of believing individuals can control their health through positive thinking. There’s no evidence that an upbeat attitude can prevent illness or speed recovery, yet we blame those who display an insufficient amount of self-empowering happy talk. Read more
Antioxidants Fall From Grace (Newsweek)
Old theory: Antioxidants (beta carotene, vitamins C and E) neutralize the free radicals that cause aging and disease. New theory: Free radicals are an important component of the immune system, fighting toxins and cancer.
New approach to weight loss debated (NHS)
Research article discusses merits of promoting “health at every size.” Focus on weight reduction leads to cycles of weight loss and gain, preoccupation with food and body image, lower self-esteem and eating disorders. Read more
“Common sense tells us that early detection of breast cancer is good, and most screening programs have been successful in reducing breast cancer deaths,” lead author Dr. Lideke van der Steeg, of the department of surgery at St. Elisabeth Hospital in Tilburg, said in a journal news release.
“However, while some women truly benefit from early detection, others experience harm and unnecessary anxiety. The women who received false-positives in our study experienced a significant reduction in their quality of life, especially if they were prone to anxiety, and the effects of this lasted at least a year.”
Following up on Dr. H. Gilbert Welch’s comments on the new blood test for cancer – that overdiagnosis may lead to an epidemic of individuals who mistakenly believe they have cancer – here’s a description of the climate that’s created when we try to scare people into believing they have cancer. It’s from a review of The Emperor of All Maladies, a new book on the history of cancer by Siddhartha Mukherjee.
Writing in The New Yorker, the author of the article, Steve Shapin, explains optimism surrounding the drug Gleevec, a new type of cancer drug that targets a known cancer gene. Gleevec has been quite successful in the treatment of leukemia. (emphasis added) Read more
Earlier this month scientists announced a test that can detect a single cancer cell in a blood sample. Although some news reports were realistic – BusinessWeekcommented that “researchers still aren’t sure what these circulating tumor cells (CTCs) actually mean” – most greeted the news as a revolution in the fight against cancer, promising early, non-invasive detection.
Dr. H Gilbert Welch offered a more sober opinion. Welch is the author of Should I Be Tested for Cancer?: Maybe Not and Here’s Why. While it’s commonly assumed that screening saves lives and that more screening is always better, Welch’s book helps patients (and the medical profession) understand that the implications of cancer screening are more complex.
More medical care leads to more screening
As Welch points out, medical care is a much more prominent part of our lives today than it was in the past. There are a number of reasons for this. Read more
A Short-Circuit to Distracted Driving (NYT)
Cell phone carriers to offer service that disables incoming calls while phone is in motion. “The lure of mobile devices has addictive properties, in that people feel an adrenaline burst when a call or text comes in and get a rush when they answer.”
The ominous rise of amateur ornithology (Slate)
Bird watching became popular in the nuclear era, a response to fear of an ecological apocalypse. “Birding is a steam valve for anxiety about nuclear-age strength and habits.” Its reemergence today is an indicator of quiet alarm.
Should obesity prevention be a personal matter? (KevinMD)
Why government policies focus on individual lifestyles as the source of obesity, rather than acknowledge the social, economic and political factors that create an obesogenic environment. Yes! This is exactly what we need to be talking about.
Gastric bands must stay a last resort (Guardian)
Gastric banding is being marketed as a legitimate alternative to dieting. “What was traditionally a last resort in the most extreme cases is not only being normalised, but also celebrated.” It’s “as accessible and accepted a practice as teeth whitening.”
Cancer breakthrough — or nightmare? (CNN)
A simple blood test that detects minute quantities of cancer cells in the blood “could just as easily start a cancer epidemic. … The conventional wisdom is people either have a disease or they do not. But, in fact, there are a lot of people somewhere in between.” H. Gilbert Welch on overdiagnosis.
Intelligence and physical attractiveness (Science Direct)
If women prefer intelligent men because they have higher incomes and status, and if men prefer physically attractive females, eventually the two traits merge. Study finds physically attractive people are more intelligent.
Programmed for Love (Chronicle)
New Sherry Turkle book “Alone Together.” The growing trend in robotics to create machines that act as if they’re alive could lead us to place machines in roles that only humans should fill. Plus effects of social media on young people. “Although always connected, they feel deprived of attention.”
Andrew Wakefield has received a great deal of negative publicity over the past few weeks, ever since journalist Brian Deer, writing in the British Medical Journal, presented evidence that Wakefield faked the data in his study linking the MMR vaccine to autism. Deer also made the case that Wakefield’s motive was financial gain: Wakefield was employed by a lawyer who planned a highly lucrative lawsuit against vaccine manufacturers and investors were promised millions.
Wakefield has publically responded to the charges. In a story from Bloomberg he asserts that his study was “not a hoax.” He also says: “I have lost my job, my career and my country.”
Given the stressful nature of Wakefield’s situation – some accuse him of a moral crime, others feel he should be prosecuted – it’s both eerie and fascinating to watch him defend himself. He appeared on “Good Morning America,” where he was interviewed by George Stephanopolous. In that interview, Wakefield claims his accuser committing a fraud by selectively omitting data.
The War on Logic (NYT)
Krugman on health care repeal: “The modern G.O.P. has been taken over by an ideology in which the suffering of the unfortunate isn’t a proper concern of government, and alleviating that suffering at taxpayer expense is immoral, never mind how little it costs.”
GAO takes on health claims. Yes! (Food Politics)
Government Accountability Office recommends FDA action. “Imagine: health claims on food packages that actually have some science behind them. What a concept!” (1/18)
GOP wants repeal, but fervor slips in poll (Seattle Times)
Strong opposition to health care now at 30%, lowest level since September 2009. Only 25% want repeal. Opposition among Republicans drops below 50%. Republican lawmakers have not united around an alternative plan.
The New York Times ran an article in December about the declining mental health of college students. The focus of the article was actually on how difficult it is for understaffed counseling centers to cope, but the problem was framed with some disturbing statistics: “44 percent [of students] in counseling have severe psychological disorders, up from 16 percent in 2000, and 24 percent are on psychiatric medication, up from 17 percent a decade ago.”
The article offered two possible explanations for these statistics: More students are able to attend college because effective psychiatric medicine is available and/or counselors are now better at recognizing a serious illness than they used to be.
Experts say the trend is partly linked to effective psychotropic drugs (Wellbutrin for depression, Adderall for attention disorder, Abilify for bipolar disorder) that have allowed students to attend college who otherwise might not have functioned in a campus setting.
There is also greater awareness of traumas scarcely recognized a generation ago and a willingness to seek help for those problems, including bulimia, self-cutting and childhood sexual abuse.
Furor about new breastfeeding study (Food Politics)
BMJ commentary and Guardian reporting (“Six months of breastmilk alone is too long and could harm babies, scientists now say”) creates uproar. Several BMJ authors consult for formula companies.
Many US doctors – especially primary care physicians – are unhappy with their working conditions and financial compensation. Things could be worse.
In Czechoslovakia, one fifth of hospital doctors are expected to resign by March 1 (4,000 doctors out of 20,014). Their grievances include low salaries and poor working conditions.
Jana Vedralova, an official of the trade union that organized the doctors’ protests, toldThe Lancet: (emphasis added)
We don’t want to destroy the health system. We want to treat patients. But this is a final, desperate attempt to change the situation for doctors in our country. For the last 20 years we have very politely listened to politicians saying that there will be reform and things will improve when there is enough money and that things will get better soon. But it has been 20 years of empty promises and we have had enough. Our patience has run out and we cannot wait any longer.
Should doctors earn more than fast-food employees?
The Age-Old Struggle against the Antivaccinationists (NEJM)
“[A]ntivaccinationists have done significant harm to the public health. … [S]ociety must recognize that science is not a democracy in which the side with the most votes or the loudest voices gets to decide what is right.”
There’ll be many products we’ll be allowed to buy but not see advertised – the things the government will decide we shouldn’t be consuming because of their impact on healthcare costs or the environment but that they can’t muster the political will to ban outright.Read more
Why Chinese Mothers Are Superior (WSJ)
“What Chinese parents understand is that nothing is fun until you’re good at it. To get good at anything you have to work, and children on their own never want to work, which is why it is crucial to override their preferences.”
Is Extreme Parenting Effective (NYT)
Response to WSJ article on superiority of strict Chinese mother parenting style. Does strict control of a child’s life lead to greater success or can it be counterproductive? Read more
What’s not widely known, however, is that this is not the first time the physical exam has gone into decline. We know from surviving medical treatises that the exam was an integral part of a physician’s practice in ancient Greece and Rome. This continued to be true until the late Middle Ages (1300-1500). The hands-on exam then disappeared for hundreds of years, reemerging gradually in the late 18th century. Read more