Tag: Health/Medical/Pharmaceuticals

Blaming Republicans Again

I know you thought that the current Ebola outbreak was the result of dysfunctional countries with horrendous health care systems. Or maybe you thought it was the fault of organizations like the WHO to respond quickly enough. Or maybe you think it’s no one’s fault and that disease outbreaks are going to happen.

But you’re wrong. The current Ebola outbreak is the fault of …. Republicans:

“Republican Cuts Kill” is the message coming from The Agenda Project, a 501(c)4 organization that is placing ads in various battleground states. According to an email signed by the group’s founder Erica Payne and titled “If you die, blame them,” the group is starting a

a multi-pronged blitzkrieg attack that lays blame for the Ebola crisis exactly where it belongs– at the feet of the Republican lawmakers. Like rabid dogs in a butcher shop, Republicans have indiscriminately shredded everything in their path, including critical programs that could have dealt with the Ebola crisis before it reached our country.

The supposed proximate cause is “deep draconian cuts” in the budgets of the NIH and the CDC which hindered their disease response. Never mind that the US still spends a total of $8 billion on global health. Never mind that the CDC and NIH have nearly $40 billion in funding between them. Never mind that cuts to CDC/NIH and specifically cuts for disease control were included in the budget proposal of Barack Obama who, last time I checked, was not a Republican. Never mind that according to Daily Kos’s own graph, the steep budget cuts in PHEP started in 2006, when the Democrats controlled Congress. Never mind that the Republican increased CDC funding over the President’s budget.

Conservatives, dammit!

This was partially stimulated by the head of the NIH saying that we would have an Ebola vaccine if not for budget cuts. Numerous people have responded by finding silliness in the NIH budget — such as $666,000 grant to find out why people like watching Seinfeld reruns — that they did have money for. I’m a bit loathe to play that game because often projects that sound stupid aren’t or are, at least, massively misrepresented.

But I will take issue with the NIH’s claim that we’d have an Ebola vaccine if it weren’t for budget cuts (a claim they are slowly backing away from). Vaccine research is hard. We’ve been spoiled because most of the vaccines we’re used to — like measles — are cheap, effective and have minimal side effects. Such vaccines have wiped out smallpox and brought polio to the brink of extinction. But not all vaccines are that easy. We’ve been working on an AIDS vaccine for thirty years. Enormous effort has gone into finding a vaccine for malaria — which kills hundreds of thousands of people a year — with no success. Even some of the vaccines we do have are hideously expensive, come with significant side effects or have limited effectiveness. NIH might have an Ebola vaccine if they had more money. They might also have nothing.

I’m a big fan of science funding, obviously. I like NIH to be well-funded. Public health is one of the few things we can all agree government should invest in. And I think basic science funding falls under Adam Smith’s description of something “which it can never be for the interest of any individual, or small number of individuals, to erect and maintain” but that benefits the public generally. But Ebola is not the reason to fund the NIH. They should be funded because of the outstanding research they do on everything else, especially the chronic common diseases that affect all of us. I especially want them to be working on antibiotic-resistant diseases, which, to my mind, pose the greatest healthcare menace for the 21st century. They should research Ebola as well. With a $30 billion budget, there’s plenty to go around. But Ebola research is only a tiny fraction of what they do. And I’d prefer they not try to pretend otherwise.

As for the CDC, a bit less money on public health issues and a bit more money on infectious disease would be a good idea. And that, my friends, is squarely on the President and the man he appointed to head that agency.

As a general rule, however, I would prefer that we keep Ebola and politics apart. This isn’t an excuse to grind your favorite political axe, be it immigration, budget cuts or single-payer healthcare. This is a time to calmly but decisively react to a potential health crisis. The main effort should be stomp this out in West Africa before it really does rage out of control. Because if this blows up to hundreds of thousands of people, if this spreads to South Africa or India or China, we will have a global epidemic on our hands.

First it was salt, now it is sunlight…

For some decades we were told to cut salt from our menu, only to find out that that was actually not a good idea. I never took that seriously, because I have always felt much better when I get a healthy dose of salt. And I knew several people that were chronically depressed and they avoided salt like vampires avoid garlic. Do some exercise, and salt is a great thing to eat. Of course in moderation, but for me that moderation number would freak out your average anti-salt zealot.

The other thing I try to get as much as I can is sunlight. For some decades now they have been telling us sunlight is terrible because it causes cancer. I spent, or misspent, if you want to label it that – my youth in many countries where sunlight was basically unavoidable. Heck, I have people that told me that they thought I might be black back in the day because of how tan I was. I love the ocean, and nothing beats the ocean in the tropics. It is one of the things I miss the most about living in Connecticut, and I will have to rectify that someday. Anyway, I never understood the sun phobia of the last few decades. Sure, some people have sensitive skin and complexions, and they should definitely avoid the sun Same applies to people with history of skin cancer in the family. It means you are genetically predisposed to it, and while you can still get it while avoiding the sun, it’s never a good idea to throw more gasoline on the bonfire. But the truth is that most of us are genetically protected due to natural selection. And just as I have observed that lack of salt results in many people developing depression, I believe lack of sunlight does the same. But you were looking for a court martial if you said these things amongst the intelligentsia.

Queue more recent studies, and now some are pointing out that lack of sunlight affects blood pressure:

Here’s why sunbathing feels so good: It may lower your blood pressure, British researchers reported Friday. Just 20 minutes of ultraviolet A (UVA) sunlight lowered blood pressure by a small but significant amount in 24 volunteers, they report in the Journal of Investigative Dermatology. Further checks suggest the sun does this by increasing levels of nitric oxide, a chemical linked to blood flow.

The effects are so strong they may help explain why people who live in the darker north, like the Scots, have higher rates of death from heart disease, Richard Weller of the University of Edinburgh and Martin Feelisch of the University of Southampton say.

And I would not be surprised we discover a connection between blood pressure and depression one of these days. Eat that salt and get yourself some nice war m sunlight. I bet it will do wonders for you. Now if we could only discover this stuff could cure mental disorders like being a progressive. Then we would be getting somewhere!

David Goldhill, Part II

Four years ago, on the eve of Obamacare, David Goldhill wrote one of the best pieces about healthcare reform. If you didn’t read it then, you should read it now because it is still one of the best things written about healthcare.

(Second place would go to Steven Brill’s expose of hospital billing. Brill’s piece, which is now behind a firewall, has some issues (see here and here) but is a must-read if you can. I caught it before it went behind the wall.)

Given that Obamacare is now resulting in millions of cancelled policies and increased premiums, it’s worth asking what Goldhill thinks now. Reason did a half-hour interview with him. Again, it is very worth your time:

Goldhill hits a number of great points, pointing out how preventative care doesn’t really save money, how “first dollar” coverage will drive costs up, how the incentives in healthcare are all aligned toward more spending and less efficiency, how, in the words of P.J. O’Rourke, when buying and selling are controlled by legislation, the first things to be bought and sold are legislators. This is all basic economics. But something surprised me: Goldhill is a Democrat who believes in universal healthcare. He’s just honest enough and smart enough to see that the way we’re going about healthcare reform is about 180 degrees from how we should be. There are points on which I disagree with him (the Medicaid expansion in particular). But what he’s saying is correct: we could have a better healthcare system at a fraction of the cost by understanding how markets work instead of pushing us closer and close to monopsony.

The Healthcare Market

Reason has a great video about a free market healthcare system in Oklahoma. It is definitely worth six minutes of your time. By going outside the traditional insurance model, they have cut healthcare prices to a fraction of what they usually are.

A few things to clarify. This obviously wouldn’t work for people without jobs or cash to pay for these services (although it would be cheaper than Medicaid). And some of the most expensive parts of our healthcare system — long-term and end-of-life care — would not fit under this model. But, if this were applied universally, we would be talking about massive and major cuts in our healthcare bill and imminently more affordable care for hundreds of millions.

I can testify to a couple of aspects of this first-hand. I left the healthcare industry 17 years ago, but it was getting top-heavy with administrators then. I am assured by friends and relatives it has only gotten worse. It is not unusual at all for the highest paid people in a healthcare system to be, not doctors, but administrators like — oh, let’s take a random example — Michelle Obama before her husband became President.

I have also had two encounters with our healthcare system this year. The first was with the traditional system when I had my gallbladder popped out. Even that comparatively simple procedure was ridiculously expensive. But my surgeon’s fees were a comparatively small fraction of that; most was the hospital. The second was with a completely private system in our (so far unsuccessful) attempts to have a second child. Fertility isn’t cheap, but we got rigid quotes, outstanding service and doctors determined to go the last mile. At one point, we had to switch fertility medication at the last minute when the clinic was closed. The head nurse had us pick it up from her house. How often does that happen in the traditional system?

Obamacare has many flaws but the biggest is that it completely turns its back on the idea of a free market in healthcare. There is no provision for high-deductible major medical plans (again, if you’ve never read it, read David Goldhill on this). There is no incentive for innovation. Its cost controls are the kind of top-down bureaucratic bullshit that fails (if we’re lucky) or creates bad unintended consequences (if we’re not).

Oklahoma is showing the way forward. Does anyone want to follow?

Surprise Study Finds Rappers Use Brains

Yeah, I’m a music critic now.  What about it?

During the freestyle rapping, there was increased activity in an area of the brain that is responsible for motivation of thought and action (called the medial prefrontal cortex). At the same time, there was decreased activity in brain regions that normally play a supervisory or monitoring role (dorsolateral prefrontal regions).

The study went on to note that the wave patterns of rappers’ brains during nightclub shootings, assaults on record label producers, domestic violence situations, and appearances on VH-1 reality shows registered slightly between those seen in the brains of small mammals and the center of potatoes.  Jay-Z’s brain activity during Obama’s fundraisers were consistent with an adolescent either driving drunk or having an orgasm.  It was kind of inconclusive. 

Thank God nobody’s done this study yet on bloggers.

The HPV Question

The big fireworks in Monday’s debate were about Rick Perry mandating the HPV vaccine for girls in Texas. Bachmann basically accused him of taking a bribe, Perry admitted the policy was mistaken, lots of applause lines were had.

Did Perry make a mistake? There’s a lot to untangle on the HPV question, so I’ll break it down.

On a personal level, I’m very much in favor of the HPV vaccine. I intend to have Sal 11000 Beta inoculated when she gets to the right age as well as any other Betas that come along. This includes any boys, since I don’t want them catching or spreading the illness. The things mows down 4,000 women a year and that’s just the tip of the iceberg. There is growing evidence that HPV can be spread through saliva and cause throat cancer.

It’s critical to remember that: abstinence and being right with Jesus does not insulate you from HPV. It can be spread by skin-to-skin contact and possibly by saliva. Half of Americans have it. Both partners could be virgins on their wedding night and still be exposed. This is not a disease that is confined to slutty women (as if that would matter anyway).

The vaccine itself is very effective and very safe, despite Bachmann’s claim that it left a girl “retarded”. With millions of doses given, it is showing few, if any, side effects. I’m unwilling to declare the vaccine perfectly safe until the first generation of girls start having children and show no ill effects. But … so far, so good.

Nothing I’ve said above is particularly controversial. One of the refreshing things about this issues is how quickly the entire Right Wing blogosphere sided against Bachmann, at least on the retardation issue. For the party that is supposed to hate science, I have seen very few entertaining the idea that this vaccine is unnecessary, unsafe or ineffective. A surprising fraction are familiar with Andrew Wakefield and his fraudulent research on the vaccine-autism link. It actually made me smile.

(One of the points debated — not in the actual debate, but on the blogs — is whether the HPV vaccine will make girls sleep around more. Count me in the “maybe a little, but not much” category. Try this thought experiment: what if all venereal diseases were eliminated? Would women suddenly sleep with everyone? I don’t think so. But I do think the lack of VD threat would make people in general less cautious. I’ll take that tradeoff — assuming it is a tradeoff.)

Where the debate really breaks down in on the mandate. And here — and I can’t believe I’m going to say this — I’m with Bachmann and … Richard … John … Santorum. No, really. Here’s what Santorum said in the debate.

Why — ladies and gentlemen, why do we inoculate people with vaccines in public schools? Because we’re afraid of those diseases being communicable between people at school. And therefore, to protect the rest of the people at school, we have vaccinations to protect those children.

Exactly. Measles, mumps, rubella, polio — these can be spread by casual contact. HPV requires more intimate contact. Not necessarily sex, but skin-to-skin contact or kissing. To me, that’s enough to take a pass on the mandate. I might be willing to mandate it for sports that involve skin-to-skin contact — wrestling or football, for example. And I would be fine with the state strongly recommending it, giving information to parents and paying for poor people to get it if they are on Medicaid. The possibility of dramatically cutting the incidence of HPV and saving thousands of women’s lives is simply too beautiful to ignore.

But on the mandate, I’m with … those guys.

Now, did Rick Perry mandate this because of a $5,000 donation to his campaign and the job it later gave to his Chief of Staff? While I thought as much at the time, I’m beginning to side more with Perry. That’s way too low a price for this kind of bribe. Merck has much better reasons to support Perry, such as the tort reform that limited Vioxx judgements and made Texas one of the least dangerous tort states.

So, in the end, I find myself agreeing with both sides. The vaccine should be used by everyone, should not be mandated, but Perry wasn’t bribed. That’s kind of rare for me to not be bashing someone over the head.

Measles in Mass

Ulp:

Measles continues to spread in Massachusetts, with two new cases confirmed this week, including one involving a 23-month-old boy from Boston who had received his first measles vaccination last year, according to the Boston Public Health Commission. The other was a teenage boy from outside the city who was treated at a Boston health care facility.

That brings the state total to 17 this year — and counting. In each of the previous four years, Massachusetts has had one to three cases. The surge has been occurring nationwide as well, with federal health officials announcing Tuesday that measles cases have been on their fastest pace since 1996. So far this year, 118 infections have been reported in 23 states, compared with 50 in a typical year.

And we’re lucky that most parents have not bought into the whole anti-vax nonsense:

France reported 10,000 cases — and six deaths — during the first four months of the year, most likely due to low vaccination rates. The US Centers for Disease Control and Prevention attributes the rise in measles cases in this country to the surge in cases globally, most notably in France, India, and the Philippines.

Vaccinations are one of the greatest scientific breakthroughs in human history. Measles alone used to strike about half a million Americans per year. At that rate today, we’d be seeing a few billion dollars and a couple of thousand lives gobbled by the virus every year. And that’s just measles. I won’t say anything about whooping cough, the resurgence of which has killed children too young to be vaccinated. Even if vaccines caused autism — which they don’t — they would still be worth the risk.

The efficacy of any vaccine is dependent on having herd immunity: having enough people vaccinated to deny the virus the reservoirs it needs to break out. For that, you need to vaccinate almost everyone who isn’t immuno-compromised. You can maybe make some religious exemptions. But you simply don’t have room for people who refuse to vaccinate because they believe the tissue of lies that was Andrew Wakefield’s discredited study.

For people to turn their backs on this miracle is maddening. It’s like they’re going back to living in caves. Only they’ll take a few innocent people with them.

More Healthcare Lies

Sullivan has posted this infographic on why our healthcare cost so much. I have rarely seen such a huge a stack of healthcare lies collected in one place.

  • They claim that America’s obesity rate is not driving our healthcare costs, only accounting for $25 billion in spending. If that’s the case, someone needs to tell the CDC, which has estimated obesity to be responsible or at least 10% of our healthcare spending and projects it to eventually cause 20% of our spending. Obesity is a primary risk factor for heart disease, something we spend a lot of money on. Lipitor alone is a $7 billion expense.
  • They claim malpractice isn’t driving healthcare costs, only being responsible for 2% of spending. This ignores defensive medicine. Now I’m aware that Haav-vud has estimated defensive medicine to be a tiny expense. But their lawyer-friendly study is far far too conservative. The Kessler study estimates 10% and I would even say that’s conservative. A huge amount of our healthcare spending is for end of life care and a huge driver of that is the fear of lawsuits. Many procedures and tests that are considered “routine” would not be without lawsuit threats. Additionally, the effect of malpractice is not linear. For hospitals, it’s a small part of the budget. For practicing physicians — especially OB/Gyn’s — it can cost more than the rent on their office.
  • They then say that providers charge more because they can — true enough — because the US government is not involved in price regulation. So Americans have “less power” over healthcare costs. I’m not going to re-open the price control debate again. It’s too complicated for a group this stupid. But I will note that there are other ways for consumers — not “the people” to have power over healthcare costs.
  • They complain that admin costs are 21% of our healthcare bill — twice what other countries spend and that 85% of this is due to private insurance. This tells me that they are buying the lie — and it is a lie — that Medicare’s costs are only a tiny fraction of the private sector. Keep in mind, this is the Medicare that is currently spending 20 cents on the dollar on fraud — a problem that they perversely try to blame on the private sector.
  • They complain that 41% of healthcare costs are for outpatient procedures. But outpatient procedure usually save money. They specifically site the example that 60% of UK hernias are treated inpatient, but only 11% of US hernias are treated inpatient. What?! Treating a hernia — usually not really an optional procedure — is MUCH cheaper done as an outpatient. Outpatient procedures save money. And lots of it.
  • Finally, they say are doctors are overpaid. I’ll leave that talking point for the class.

Sullivan should embarrassed to have posted this on his site. It’s quite clear that the people who put this together have an agenda and have resorted to distortions of fact that would make Michael Moore blush. This isn’t adding to the debate. It’s setting it back twenty years.