Too much of the debate on Health Care reform this past year has been in the realm of propaganda- where gesture is substance and words are deeds- but last night (Feb.8) PBS Newshour had a stunning segment on the use of simple checklists in surgery to save lives and millions of dollars.
Similar results with checklists have been achieved in I.C.U.; Dartmouth College's Institute for Health Policy and Clinical Practice has been studying "unwarranted" variations in medical spending for years as has Oregon's Health & Science University*. Institute of Medicine's conservative estimate makes preventable hospital error the eighth leading cause of death annually, ahead of motor vehicle accidents (43,458), breast cancer (42,297) and AIDS (16,516).[1999]
InfoPOEMS, Patient Orientated Evidence that Matters, sorts through more than two thousand articles published each month in a hundred medical journals, looking for the few articles that could make a real difference in patient care. The research team, all of whom are experts in dissecting clinical trials, pick apart each article to make sure the results are credible. Only about one in forty studies makes the cut.
Although Dr.Arnold S. Relman (' Rescuing America's Health Care') says " the notion of an orderly and scientific rationing process, explicitly identified as such, and managed by experts who would be free of political and commercial influence and could persuade doctors and patients to accept their judgments, is unrealistic." all efforts in this direction should not be abandoned. They would be crucial to the success of any universal system.
Although statements like this do not make the sort of stirring, purple-tainted political stump speeches to which we have grown accustomed or focus much on the personal attraction and eloquence of those that make them, if Obama's "change" must go down in defeat (which is now virtually assured), this would be the best way to go about it.
Congratulations to PBSNewshour for their effort.
*IN 2005 researchers at Oregon Health & Science University set out to evaluate the scientific evidence that had been published on the medicines prescribed for attention deficit disorders. The oregon group included some of the few academic drug experts in the country who had refused to take money from the pharmaceutical industry. The Oregon researchers combed through the medical literature dating back to the 1970's, looking for studies involving Ritalin the other ADHD meds. They found 2,433 articles, an amazing amount of research on one type of drug. Yet the numbers were decieving. Many of the trials were far too brief to provide reliable information. More troubling, some of the clinical studies had been designed in ways that biased their results so that the medicines appeared to be safer and more effective than they actually were (removing people who responded well to placebos, or had adverse reactions from preliminary studies, only publishing results from the second trials.)
ReplyDelete"I spent the first several years of my career doing full-time research on brain serotonin metabolism, but I never saw any convincing evidence that any psychiatric disorder, including depression (and ADD), results from a deficiency of brain serotonin," said David Burns, an adjunct clinical professor of psychiatry and behavioral sciences at Stanford University.."In fact we cannot measure brain serotonin levels in living human beings there is no way to test this theory" Some neuro-scientists would question whether the theory(mental illness is caused by a chemical imbalance in the brain) is even viable, since the brain does not function in this way, as a hydrological system."
ReplyDelete"It was not until academic researchers at Emory University reported that Detrol and Ditropan could harm the memories of the patients taking them, a study by British researchers in 2003 that found the cognition of patient's Alzheimer's grew worse when using these drugs, became widely known, that Pfizer's sales began to decline."
By the year 2005 Americans were spending $250 billion on prescription drugs, more in 2004 than they did on gasoline and fast food, twice as much in that year as they spent on either higher education or automobiles. They spend more on medicines than do all the people of Japan, Germany, France, Spain, the U.K., Australia, New Zealand, Canada, Mexico, Brazil and Argentina combined.
The vast majority of drugs-more than 90%- only work in 30 to 50 percent of the people talking them....across all drug categories. Today an average of 50 percent of the people treated with individual drugs are receiving treatments that are not efficacious for them."
"Expensive blood-testing done in West Virginia suggests that prescription drugs were contributing factors in highway accidents with a frequency equal to that of alcohol."
"Hampering efforts to understand how many people die from their medicines is the fact that hospitals no longer perform autopsies on most patients..the autopsy rate in the nation's hospitals has plummeted, from 50% after WWII to less than 8% today. Some perform no autopsies...That decline in the rate of autopsies, which are considered one of the most powerful tools in the history of medicine, has had tragic consequences. Without an autopsy to verify what a doctor writes on the death certificate, diagnosis like "cardiac disease" or "Alzheimer's disease" have become death causes of convenience."
from'Our Daily Meds" by Melody Peterson
"For-profit insurance businesses extract their profits and their overhead and management costs from the premium before paying doctors and hospitals for services provided. This amounts to a diversion of approximately 10 to 25 percent of the premium. By comparison, the overhead costs of private, not-for-profit plans are about half that amount.( The overhead costs of public insurance are about 3%).Investor-owned hospitals usually spend considerable money on high executive salaries and bonuses, consultants, legal advice, brokers, marketing and advertising, back-office operations, public relations, and many other expenses that are common in business but until the arrival of the "medical-industrial complex" were absent in not-for-profit hospitals These overhead expenses apply as well to investor-owned insurance plans, which spend more money than public insurers and not-for-profit plans on underwriting ( risk management) and avoiding customers who may need more than average care.
ReplyDeleteI can find no evidence that the for-profit plans add anything that is worth this all this extra cost.
Quality deficiencies in patient care identified by state inspection were 56 more common in private, for-profit facilities and 43 more prevalent than in public facilities. When only deficiencies considered by inspectors to be serious were tallied, for-profits had 40 percent more citations than non-profits and 36 percent more than public nursing homes. In dialysis centers: the mortality rate was 20 percent higher and the likelihood of being placed on a waiting list for transplantation 26 percent lower, in the for-profit facilities".
Arnold S. Relman
"We still labor under the myth that somehow we're each on our own and as individuals we can make these choices to prevent heart disease",epidemiologist Ichiro Kawachi says, "If society or government really wanted to drive down the rates of heart cardiovascular disease, they would be tackling it at macro levels. Policies that appear to have little to do with health, like macroeconomic policies to reduce the level of income inequality, can have a major impact on driving down rates of illness in society"
ReplyDeleteHis research shows that death and sickness rates from cancer, heart disease, and other major illnesses in the U.S are higher in states where participation in civic life is low, racial prejudice is high, or a large gap exists between the incomes of the rich and poor and of women and men.
Animal studies support their conclusions. In experiments where rabbits and monkeys are placed in isolation or in subordinate positions, or they are put under stress, their blood pressures and levels of "bad" cholesteral tend to increase.") in "Social Epidemiology" ( Oxford Univ. Press, 200, Ichiro Kawachi and Lisa Berkman).
The blurring together of food and medicine in American culture renders us susceptible to dubious reasoning about food."
"The Gospel Of Food; Everything You Think You Know About Food Is Wrong" by Barry Glassner; HarperCollins 2007
Talk to the chief executives of America's preeminent health-care institutions, and you might be surprised by what you hear: When it comes to medical care, the United States isn't getting its money's worth. Not even close.
ReplyDelete"We're not getting what we pay for," says Denis Cortese, president and chief executive of the Mayo Clinic. "It's just that simple."
"Our health-care system is fraught with waste," says Gary Kaplan, chairman of Seattle's cutting-edge Virginia Mason Medical Center. As much as half of the $2.3 trillion spent today does nothing to improve health, he says.
Not only is American health care inefficient and wasteful, says Kaiser Permanente chief executive George Halvorson, much of it is dangerous.
U.S. 'Not Getting What We Pay For'
Many Experts Say Health-Care System Inefficient, Wasteful
By Ceci Connolly
Washington Post Staff Writer
Sunday, November 30, 2008