Archive for the ‘Medical’ Category
Single-payer healthcare and non-profit hospitals look better and better. Lena Sun reports in the Washington Post:
A year ago, a study about U.S. hospitals marking up prices by 1,000 percent generated headlines and outrage around the country.
Twenty of those priciest hospitals are in Florida, and researchers at the University of Miami wanted to find out whether the negative publicity put pressure on the community hospitals to lower their charges. Hospitals are allowed to change their prices at any time, but many are growing more sensitive about their reputations.
What the researchers found, however, was that naming and shaming did not work. The researchers looked at the 20 hospitals’ total charges in the quarter of a year before the publicity and compared them to charges in the same quarter following the publicity. There was no evidence that the negative publicity resulted in any reduction in charges. Instead, the authors found that overall charges were significantly higher after the publicity than in previous quarters.
“We were thinking we would see a drop or lowering of some charges,” said Karoline Mortensen, one of the authors of the study published in the Journal of Health Care Finance earlier this year. “There’s nothing stopping them,” she said, referring to the hospitals. “They’re not being held accountable to anyone.”
Researchers say the main factors leading to overcharging are the lack of market competition, lack of hospital transparency and the fact that the federal government does not regulate prices that health-care providers can charge. Only two states, Maryland and West Virginia, set hospital rates.
When the original study was published, shares of Community Health Systems, which owns many of the 50 hospitals listed with the highest markups, traded with almost triple the volume of the preceding weekday, suggesting shareholders had concerns about the system’s pricing practices, the University of Miami researchers said. Share price fell by $1.39 that week, or more than 2.5 percent, but recovered by the end of that week.
Understanding hospital pricing and charges is one of the most frustrating experiences for consumers and health-care professionals. It is virtually impossible to find out ahead of time from the hospital how much a procedure or stay is going to cost. Once the bill arrives, many consumers have difficulty deciphering it.
After a Utah man posted a photo of his hospital bill on Reddit, showing a$39.35 charge for what he thought was for holding his newborn, his post triggered more than 11,000 comments. . .
A fascinating if somewhat ambivalent article by Melanie Thernstrom in the NY Times on the importance of allowing children to play without constant adult supervision.
t was a Friday afternoon at Mike Lanza’s house in Menlo Park, Calif., and the boys were going crazy. There were boys playing ball in the street, while in the backyard, boys were skittering along the top of the fence while others were wrestling on the trampoline. The house itself is nothing special — a boxy contemporary, haphazardly furnished — but even by the elevated standards of Silicon Valley, the Lanzas’ play space is extraordinary. It boasts a map of the neighborhood painted on the driveway, a fabulous 24-foot-long play river — an installation art piece, designed for children’s museums — and a two-story log-cabin playhouse with a sleeping loft, whiteboard walls inside for coloring and really good speakers, blasting Talking Heads.
Leo Lanza, who was 5 at the time, was taunting my kids, claiming they were too scared to climb 12 feet to the playhouse roof, using the toe holds, and then leap onto the trampoline, which has no surrounding netting. My daughter, Violet, the only girl there, continued to decorate the playhouse walls with a purple marker. “I don’t care if you get hurt,” she responded airily. Her twin brother, Kieran, scrunched up his round face, turning pink. “That’s not true!” he wailed. “I am not scared.”
My kids were in a prekindergarten program with Leo, the youngest of the three Lanza boys. I had heard a lot about Mike’s house, a few miles from our own, but that Friday-afternoon pizza party, a year and a half ago, was the first time I had gone there.
Through the glass doors of the kitchen, I could see Mike opening a bottle of wine for some guests. Mike is a well-known, if polarizing, figure in our community. An entrepreneur in his early 50s, he has a boyish grin, large hazel eyes and curly salt-and-pepper hair, and wears jeans and sneakers, like all the other middle-aged tech guys. After acquiring three Stanford degrees (a B.A., an M.B.A. and a master’s in education) and selling a handful of modestly successful start-ups, Mike decided to focus on his ideas about parenting. He began writing a blog and giving talks and eventually self-published a book entitled “Playborhood,” a phrase he coined to describe the environment he wanted for his kids. (He kept a hand in the tech world as well — an app he created, a map-based photo-sharing service called Streetography, is being released next week.)
Mike is a deep believer in the idea that “kids have to find their own balance of power.” He wants his boys to create their own society governed by its own rules. He consciously transformed his family’s house into a kid hangout, spreading the word that local children were welcome to play in the yard anytime, even when the family wasn’t home. Discontented with the expensive, highly structured summer camps typical of the area, Mike started one of his own: Camp Yale, named after his street, where the kids make their own games and get to roam the neighborhood.
“Think about your own 10 best memories of childhood, and chances are most of them involve free play outdoors,” Mike is fond of saying. “How many of them took place with a grown-up around? I remember that when the grown-ups came over, we stopped playing and waited for them to go away. But moms nowadays never go away.”
In Mike’s worldview, boys today (his focus is on boys) are being deprived of masculine experiences by overprotective moms, who are allowed to dominate passive dads. Central to Mike’s philosophy is the importance of physical danger: of encouraging boys to take risks and play rough and tumble and get — or inflict — a scrape or two. Central to what he calls mom philosophy (which could just be described as contemporary parenting philosophy) is just the opposite: to play safe, play nice and not hurt other kids or yourself. Most moms are not inclined to leave their children’s safety up to chance. I certainly am not.
Mike had invited me to drop the kids off — not to hover. But I could see Leo brandishing a long rubber tube, as if he were about to whack my son, who looked worried. Beneath the pleasantries, it was clear that Mike thought I was putting my son at risk of turning into what used to be called a sissy — a concept whose demise he regrets. And I was of the opinion that Mike was putting his son at risk of being a bully, a label Mike thinks is now used to pathologize normal, healthy, boyish aggression.
Mike came out to the yard, his wineglass in one hand and a piece of cheese in another. His wife, Perla Ni, a lawyer who directs a nonprofit, was working late. Where Mike has a loud, large and boisterous presence (a neighbor once compared him to a Labrador retriever, happily trampling everyone’s shrubbery), Perla is quiet, petite, deliberate and self-contained. The only child of Chinese immigrants, she wants her sons to have considerably more fun than she had.
“Uh, can you keep an eye on them?” I asked Mike, reluctantly gathering my stuff to leave. “The society of 5-year-olds is fragile and may fall into savagery!”
“Yeah, yeah,” he replied affably. “I’m a believer in that Rousseau theory — what’s it called?”
“Something about a Noble Savage?” I said. “I’m more a believer in the truth of ‘Lord of the Flies.’ ” My smile was thin and conveyed, For the love of God, can you please put your drink down and watch the kids?
His smile told me he wanted me to leave already.
In 2006, when their oldest son, Marco, was 2, Mike and Perla began what proved to be a two-year house search in Menlo Park and neighboring Palo Alto. They were yearning for the kind of classic neighborhood that Mike recalled from his childhood on the East Coast in Scott Township, a suburb of Pittsburgh. They were living in San Francisco, but they wanted to move out of the city to a playborhood — a version of American kid life featured in shows like “The Little Rascals” and “Leave It to Beaver,” in which kids build forts and ride bikes outside, unsupervised — free, skirting danger, but ultimately always lucky. (The oddness of needing a neologism for what so recently would simply have been considered a “neighborhood” only reinforces his point.) Mike drove around deserted street after street: The kids were off at Lego robotics classes, Kumon learning centers or diving practice or squirreled away with their screens.
Despite having achieved a higher socioeconomic status for his family than he had as a kid, Mike felt his sons were at risk of having a worse childhood. Growing up in a middle-class Italian-American family in the 1960s and ’70s, Mike rated school as boring-to-O.K., whereas after-school play time with the gang was awesome.
Like many places, Silicon Valley is sports-crazy, with kids participating in year-round travel clubs and working with private coaches. But Mike feels that organized team sports fail to teach the critical life skills that he and his friends learned in pickup games they had to referee themselves. They were forced to resolve their own disputes, because if they didn’t, the game would end. Their focus was not on winning and losing, as when adults are in charge, he says, but simply on keeping the game going.
Mike recalls how his gang was often short of a quorum for games. There were two other boys their age, but one was deaf and the other, he says, was “whatever the P.C. way to describe what used to be called ‘mentally retarded.’ ” Since they didn’t want to “stoop all the way to girls,” he says, giving me a smile, they found ways to change the rules to accommodate the two boys with special needs in their game — “not because a grown-up forced” them to be inclusive, Mike says, but because they were motivated to be. . .
‘There is no such thing as “free” vaccines: Why we rejected Pfizer’s donation offer of pneumonia vaccines.’
Jason Cone, Executive Director of Doctors Without Borders in the United States explains why a contribution of a million doses of a pneumonia vaccine was declined:
I recently had the difficult task of telling Ian Read, Pfizer’s CEO, that Doctors Without Borders/ Médecins Sans Frontières (MSF) is rejecting the company’s offer to donate a significant number of pneumonia vaccine (PCV) doses for the children we serve. This is not a decision that we took lightly, since our medical teams working in the field witness the impact of pneumonia every day.
Pneumonia claims the lives of nearly one million kids each year, making it the world’s deadliest disease among children. Although there’s a vaccine to prevent this disease, it’s too expensive for many developing countries and humanitarian organizations, such as ours, to afford. As the only producers of the pneumonia vaccine, Pfizer and GlaxoSmithKline (GSK) are able to keep the price of the vaccine artificially high; since 2009, the two companies have earned $36 billion on this vaccine alone. For years, we have been trying to negotiate with the companies to lower the price of the vaccine, but they offered us donations instead.
You might be wondering, then, why we’d rather pay for the vaccine than get it for free. Isn’t free better?
No. Free is not always better. Donations often involve numerous conditions and strings attached, including restrictions on which patient populations and what geographic areas are allowed to receive the benefits. This process can delay starting vaccination campaigns, which would be an untenable situation in emergency settings, or grossly limit who you’re able to reach with the vaccine.
Donations can also undermine long-term efforts to increase access to affordable vaccines and medicines. They remove incentives for new manufacturers to enter a market when it’s absorbed through a donation arrangement. We need competition from new companies to bring down prices overall — something we don’t have currently for the pneumonia vaccine.
Donations are often used as a way to make others ‘pay up.’ By giving the pneumonia vaccine away for free, pharmaceutical corporations can use this as justification for why prices remain high for others, including other humanitarian organizations and developing countries that also can’t afford the vaccine. Countries, which continue to voice their frustration at being unable to afford new and costly vaccines such as PCV, need lower prices as well to protect children’s health.
Critically, donation offers can disappear as quickly as they come. The donor has ultimate control over when and how they choose to give their products away, risking interruption of programs should the company decide it’s no longer to their advantage. For example, Uganda is now facing a nationwide shortage of Diflucan, an essential crytpococcal meningitis drug, in spite of Pfizer’s commitment to donate the drugs to the government. There are other similar examples of companies’ donation programs leaving governments and health organizations in a lurch without the medical tools they need to treat patients.
To avoid these risks and to limit the use of in-kind medical products donations, the World Health Organization (WHO), and other leading global health organizations such as UNICEF and Gavi, the Vaccine Alliance, have clear recommendations against donation offers from pharmaceutical corporations.
Donations of medical products, such as vaccines and drugs, may appear to be good ‘quick fixes,’ but they are not the answer to increasingly high vaccine prices charged by pharmaceutical giants like Pfizer and GSK.
There are times, however, when overwhelming pragmatic needs demand a short-term solution. Such was the case in 2014, when, after five years of unsuccessful price negotiations, MSF agreed to accept a one-time donation from Pfizer and GSK of their pneumonia vaccines. This was a notable exception to our prohibition on in-kind corporate donation policy that was made with great consideration, so that children would not go unvaccinated while issues of affordability and sustainability were under discussion. But in agreeing to the donation, both Pfizer and GSK assured us that they would work on a longer-term solution for children caught in crisis and developing countries.
Finally, just last month, in a significant shift — and after years of negotiations and months of public campaigning — GSK announced that it would offer its pneumonia vaccine to humanitarian organizations at the lowest global price (currently $3.05 per dose or $9.15 per child for all three doses needed for full vaccination). This is an important step towards a sustainable solution for humanitarian organizations that wish to extend the benefits of pneumonia vaccination to children caught in crisis. In contrast, Pfizer has not made any pricing concessions, and has yet to announce any meaningful solutions. . .
I’m sure the data are available, and it would be interesting to see such things as whether a team’s win rate and concussion count are positively correlated. Or not. And which team leads each league in concussion counts. All-time record number of concussions—player, team (all seasons), team (one season), by salary level, and so on.
Ariana Eunjung Cha has an interesting albeit infuriating article in the Washington Post:
Cancer patients taking high doses of opioid painkillers are often afflicted by a new discomfort: constipation. Researcher Jonathan Moss thought he could help, but no drug company was interested in his ideas for relieving suffering among the dying.
So Moss and his colleagues pieced together small grants and, in 1997, received permission to test their treatment. But not on cancer patients. Federal regulators urged them to use a less frail — and by then, rapidly expanding — group: addicts caught in the throes of a nationwide opioid epidemic.
Suddenly, Moss said, investors were knocking at his door.
“As clinicians, we wanted to help palliative patients,” said Moss, a professor and physician at University of Chicago Medicine. “The company that bought our work saw a broader market.”
Today, Moss’s side project is hailed as the next billion-dollar drug. And the once-disinterested pharmaceutical industry is bombarding doctors and the public with information about a serious, if previously unrecognized, condition common among the millions of Americans who take prescription painkillers. They call it “opioid-induced constipation,” or “OIC.”
The story of OIC illuminates the opportunism of pharmaceutical innovators and the consequences of a heavily drug-dependent society. Six in 10 American adults take prescription drugs, creating a vast market for new meds to treat the side effects of the old ones.
Opioid prescriptions alone have skyrocketed from 112 million in 1992 to nearly 249 million in 2015, the latest year for which numbers are available, and America’s dependence on the drugs has reached crisis levels. Millions are addicted to or abusing prescription painkillers such as OxyContin, Vicodin and Percocet. Statistics from the Centers for Disease Control and Prevention show that, from 1999 to 2014, more than 165,000 people died in the United States from prescription-opioid overdoses, which have contributed to a startling increase in early mortality among whites, particularly women — a devastating toll that has hit hardest insmall towns and rural areas.
The pharmaceutical industry’s response has been more drugs. The opioid market — now worth nearly $10 billion a year in sales in the United States — has expanded to include a growing universe of medications aimed at treating secondary effects rather than controlling pain.
There’s Suboxone, financed and promoted by the U.S. government as a safer alternative to methadone for those trying to break their dependence on opioids. There’s naloxone, the emergency injection and nasal spray carried by first responders to treat overdoses. And now there’s Relistor, the drug based on Moss’s work, and a competitor, Movantik, for constipation.
In colorful charts designed to entice investors, numerous pharmaceutical makers tout the “expansion opportunity” that exists in the “opioid use disorders population.”
Indivior, a specialty pharmaceutical company listed on the London Stock Exchange, sees “around 2.5m potential patients, the majority of whom are addicted to prescription painkillers,” as opposed to illicit drugs such as heroin. Another company, New Jersey-based Braeburn Pharmaceuticals,highlights “growth drivers” for the market, noting that millions of additional Americans not yet identified are also likely to be dependent on opioid painkillers.
Analysts estimate that each of these submarkets — addiction, overdose and side effects — is worth at least $1 billion a year in sales. These economics, experts say, work against efforts to end the epidemic.
If opioid addiction disappeared tomorrow, it would wipe billions of dollars from the drug companies’ bottom lines.A potent product
From a profit-making standpoint, opioids are a potent product. Chronic use can cause myriad side effects that usually are mild enough to keep people taking painkillers but sufficiently uncomfortable to send them back to the doctor.
Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing, said this domino effect can turn a patient worth a few hundred dollars a month into one worth several thousand dollars a month.
“Many patients wind up very sedated from opioids, and it’s not uncommon to give them amphetamines to make them more alert. But now they can’t sleep, so they get Ambien or Lunesta. The amphetamines also make them anxious, paranoid and sweaty, and that means even more drugs,” said Kolodny, who also serves as chief medical officer to Phoenix House, a nonprofit organization that offers drug and alcohol treatment in 10 states and the District.
Women, in particular, are ideal customers [probably should say “victims” – LG] . . .
The video is in this post at MediaMatters.org. When you watch the video you will see that finding a compromise that meets the interests of various factions is going to be challenging. It also makes one question the efficacy (and perhaps also the goals) of American education. It’s true that Texas specifically prohibits the teaching of critical thinking skills. Without such skills, … well, watch the video. And reflect that those without critical thinking skills don’t have the tools to deal with what you see: they are defenseless and unprepared.
In Gulliver’s Travels, Jonathan Swift has a wicked political satire in the voyage to Lilliput, but the satire is also thoughtful as well as pointed. There were two great disagreements. One was whether heels should be high, or low. Both sides, the Low and the High, defended their positions fiercely, but compromise was possible: heels come in all heights, and you find a height that’s low enough to placate the Lows and high enough to shut up the Highs, a height between the extremes.
Unfortunately, the other great disagreement was not so adapted to compromise. This was the disagreement between the Big-Endians, who thought you cracked a hard-boiled egg on the large end, and the Small-Endians, who maintained that the egg is cracked on the small end. (I’m a Big-Endian myself.)
That disagreement, like the actual disagreement in the US on abortion, doesn’t lend itself to compromise. Some say issues that do not lend themselves to compromise have no place in politics because politics consists of working to find the most satisfying (or least unsatisfying) compromise. (In this connection, I highly recommend Getting to Yes, by Roger Fisher and William Ury. Inexpensive secondhand copies abound.)
The DEA, of course, maintains that marijuana has no medical use and so will not allow research into possible medical applications, but other countries apparently are more enlightened. A researcher at UCLA discovered that marijuana smokers do not get lung cancer the way that cigarette smokers do. And now Madison Margolin reports in Motherboard on how cannabis could treat cervical cancer:
A new study suggests that cannabis might be useful in treating cervical cancer.
Through in vitro, or test tube/petri dish, analysis, researchers from the biochemistry department at North-West University in Potchefstroom, South Africa found that the non-psychotropic cannabinoid, or chemical compound, CBD (cannabidiol), taken from a Cannabis sativa extract, could hold anticarcinogenic properties. They pointed out that cannabis acted on the cancerous cells through apoptosis, or a process of cell death, causing only the cancerous cells to kill themselves, and inhibiting their growth.
Cervical cancer is no longer a leading cause of death as much as it used to be in the United States, thanks in large part to the widespread use of pap smears, but it’s still a widespread threat. And in Sub-Saharan Africa, it kills 250,000 women every year. “This makes it the most lethal cancer amongst black women and calls for urgent therapeutic strategies,” the study’s authors wrote in the BMC Complementary and Alternative Medicine journal. “In this study we compare the anti-proliferative effects of crude extract of Cannabis sativa and its main compound cannabidiol on different cervical cancer cell lines.”
It will take much more research before cannabis can be integrated into official cervical cancer treatments in sub-Saharan Africa. But earlier studies also shows that cannabis has been useful in treating not only the symptoms of cancer and chemotherapy, but also the cancer itself.
One study from the journal of Current Clinical Pharmacology found that cannabis served as a preventative agent, reducing inflammation, which researchers also said was useful in reducing the likelihood of cancer. Another study from Oncology Hematology also noted cannabis’ anti-cancer effects, explaining how the plant’s cannabinoids inhibited tumor growth in vitro, such as in a petri dish or test tube, and in vivo, or a living organism.
A handful of other studies have also looked into cannabis as a treatment specifically for cervical cancer. Another from the University Hospital in Geneva, Switzerland, found that . . .