FEDS IGNORE MALPRACTICE LAW
Negligence by government doctors obviously has to be shielded where possible
Federal health agencies routinely flout a requirement to report any cases in which they pay medical malpractice claims against the government, federal investigators said Tuesday. Such reports are meant to protect the public against incompetent doctors. Hospitals and health plans check such information before hiring doctors or granting them privileges. Under a 1986 law, insurance companies, hospitals and others who pay malpractice claims on behalf of doctors must report the information to a federal clearinghouse known as the National Practitioner Data Bank. Under a 1990 policy directive, federal health agencies are supposed to report the same type of information within 30 days after a court judgment is awarded or a case is settled.
But the new inspector general of the Department of Health and Human Services, Daniel R. Levinson, found that the department itself had repeatedly ignored this requirement. From 1997 to 2004, Mr. Levinson said, 474 cases "should have been reported to the National Practitioner Data Bank," but were not. This failure, he said, deprives state licensing boards of information they need when they decide to grant, restrict or revoke doctors' licenses. Moreover, he said, "underreporting of the department's own medical malpractice cases lessens the usefulness of the National Practitioner Data Bank and undermines departmental efforts to regulate private and public sector compliance" with the reporting requirements.
Senator Ron Wyden, Democrat of Oregon, author of the law that created the databank, said: "It is imperative that the federal government fully comply with the reporting requirements. The National Practitioner Data Bank is only as good as the information it contains."
Federal health officials told the inspector general that they did not want to be bound by certain requirements that applied to insurers and hospitals in the private sector. Specifically, they said, they did not want to report payments if they believed that the care provided by a doctor measured up to an appropriate standard of care. But Mr. Levinson said, "The private sector is required to report all medical malpractice settlements and judgments" to the databank, regardless of whether they believed that the doctors had been negligent.
State medical boards use information in the databank to evaluate the performance of doctors. In at least 19 states, consumers can obtain information about malpractice payments made by or on behalf of doctors.
Mr. Levinson said the National Institutes of Health and the Indian Health Service did not want to report malpractice payments when, in their judgment, government doctors had provided acceptable care. Payment of claims does not prove that a doctor is bad, but it may prompt consumers and hospitals to examine a doctor's record more closely. In some cases, government lawyers, like insurance companies, settle claims to avoid the costs of litigation. Doctors often have little say over whether the Justice Department or an insurer decides to settle.
Senator Wyden said that "a pattern of six or seven malpractice payments on behalf of a doctor should set off bells," even if the doctor has not been formally found to be negligent. In choosing a doctor, he said, many consumers would want to know such information.
Federal agencies told the inspector general that they had failed to report some malpractice payments because they could not find the case files. Thus, for example, one agency in the department, the Health Resources and Services Administration, said that "in many instances, relevant data or records were misplaced or lost." The health services agency operates the databank and finances community health centers around the country. The federal government serves as the primary insurer for such health centers and pays malpractice claims on their behalf, as if their employees were working directly for the government. Such payments are supposed to be reported to the databank.
Betty James Duke, administrator of the health services agency, said she would soon recommend changes to "ensure greater compliance" with the reporting requirements. But in discussions with the inspector general's staff, federal agencies did not make any firm commitments. "It was not clear whether they would fully comply," Mr. Levinson wrote
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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Monday, October 31, 2005
Sunday, October 30, 2005
A LITTLE BIT OF STATE-FREE MEDICINE COMING UP?
Take a sample of saliva from inside your mouth. Put it into a vial of test fluid, and 20 minutes later you will learn whether you are infected with the virus that causes AIDS. The OraQuick Advance test is widely available in health clinics and doctors' offices, and the Food and Drug Administration (FDA) is considering permitting it to be sold over the counter. Supporters of home kits say they will spur more people to be tested and get treatment sooner if infected. However, concerns have been raised about whether a doctor or counselor should be nearby when people find out they are HIV-positive.
If approved, OraQuick Advance would become the first FDA-approved test that a person can take without the presence of a health care worker, or the requirement of mailing a sample to a lab.
The maker, OraSure Technologies of Bethlehem, Pa., has not decided how much it will charge consumers for the kit, said Ron Spair, the company's chief financial officer. The company sells the kits for between $12 and $17 to clinics and doctors, he said. The test is accurate more than 99 percent of the time, Mr. Spair said. Still, a positive result from the test should be confirmed through an additional test by doctors or public health officials, he said.
To take the test, a person swabs the inside of his mouth between the cheek and gum, and inserts the saliva into a vial of fluid that comes with the kit. Twenty minutes later, an indicator will light up if the test detects the presence of HIV-1 or HIV-2 antibodies. Those antibodies become present in the body several weeks after a person acquires HIV; the test will not detect the virus if it was acquired more recently.
Next Thursday, the FDA's Blood Products Advisory Committee will consider whether to recommend the product for over-the-counter sales. The FDA has the final say; it usually follows the advice of its advisory committees.
The kits are a good idea, said Terje Anderson, executive director of the National Association of People with AIDS. He said he doubts they will be as popular as at-home pregnancy-test kits, suggesting most people who want an HIV test would prefer to be with a doctor when they are tested. Use of the kits also may depend on their price. "Overall, I would say they are a step forward," he said. "Anything that helps more people learn their status is a good thing." ....
About 1 million people in the United States are thought to have HIV. The Centers for Disease Control and Prevention estimates nearly 300,000 people have the virus but do not know it.
More here
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Take a sample of saliva from inside your mouth. Put it into a vial of test fluid, and 20 minutes later you will learn whether you are infected with the virus that causes AIDS. The OraQuick Advance test is widely available in health clinics and doctors' offices, and the Food and Drug Administration (FDA) is considering permitting it to be sold over the counter. Supporters of home kits say they will spur more people to be tested and get treatment sooner if infected. However, concerns have been raised about whether a doctor or counselor should be nearby when people find out they are HIV-positive.
If approved, OraQuick Advance would become the first FDA-approved test that a person can take without the presence of a health care worker, or the requirement of mailing a sample to a lab.
The maker, OraSure Technologies of Bethlehem, Pa., has not decided how much it will charge consumers for the kit, said Ron Spair, the company's chief financial officer. The company sells the kits for between $12 and $17 to clinics and doctors, he said. The test is accurate more than 99 percent of the time, Mr. Spair said. Still, a positive result from the test should be confirmed through an additional test by doctors or public health officials, he said.
To take the test, a person swabs the inside of his mouth between the cheek and gum, and inserts the saliva into a vial of fluid that comes with the kit. Twenty minutes later, an indicator will light up if the test detects the presence of HIV-1 or HIV-2 antibodies. Those antibodies become present in the body several weeks after a person acquires HIV; the test will not detect the virus if it was acquired more recently.
Next Thursday, the FDA's Blood Products Advisory Committee will consider whether to recommend the product for over-the-counter sales. The FDA has the final say; it usually follows the advice of its advisory committees.
The kits are a good idea, said Terje Anderson, executive director of the National Association of People with AIDS. He said he doubts they will be as popular as at-home pregnancy-test kits, suggesting most people who want an HIV test would prefer to be with a doctor when they are tested. Use of the kits also may depend on their price. "Overall, I would say they are a step forward," he said. "Anything that helps more people learn their status is a good thing." ....
About 1 million people in the United States are thought to have HIV. The Centers for Disease Control and Prevention estimates nearly 300,000 people have the virus but do not know it.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Saturday, October 29, 2005
Fatal Flows - Doctors on the Move
The article below is from one of the world's most prestigious medical journals but displays a grade-school level of thinking. Their solution to the problem of third-world doctors migrating to richer countreies? More aid! Throw dollars at it! It shows how cretinous people can be when speaking outside their own narrow field of expertise. That the USA and other Western countries could improve their educational systems so that they themselves trained all the doctors they need is glided over. That aid will only buy golden bedsteads and Swiss bank accounts for the corrupt ruling elites of the poor countries concerned is CERTAINLY not mentioned
"The movement of physicians from poor to rich countries is a growing obstacle to global health. Ghana, with 0.09 physician per thousand population, sends doctors to the United Kingdom, which has 18 times as many physicians per capita. The United States, with 5 percent of the world's population, employs 11 percent of the globe's physicians, and its demand is growing. As underscored in the article by Mullan in this issue of the Journal, today, 25 percent of U.S. physicians are international medical graduates, and the number is even higher in the United Kingdom, Canada, and Australia. Many of these graduates come from poor countries with high disease burdens - precisely those nations that can least afford to lose their professionals.
The plain truth is that medical systems in the United States and other wealthy countries are heavily dependent on imported workers - for hospital staffing, coverage of underserved areas, and meeting gaps in skill levels. U.S. medical schools turn out a relatively stable 17,000 graduates annually, but the demand for residency staffing exceeds this number by 30 percent. This gap is filled by international medical graduates, most of whom will attain citizenship or permanent residence and remain in the United States to practice medicine. Medical coverage of disadvantaged Americans also depends on U.S. federal waivers for international medical graduates to enter primary care practice in underserved areas. The dependence is not confined to doctors, since nurses and other medically skilled workers are in equally high demand.
International professional mobility is inevitable when persons have skills they can sell in a global marketplace. The migration of medical professionals reflects a balance of supply and demand - but it has ethical implications, too. Demand in affluent countries pulls health care workers from poor countries as low salaries, limited career prospects, poor working environments, family aspirations, and political insecurity push them out. The beneficiaries are the importing countries and, of course, the migrants themselves. Countries that intentionally export skilled workers tolerate "brain drain" in exchange for financial remittances, relief from high unemployment rates, and the possibility of scientific connections. Markets for medical labor operate in and across all of the major world regions, with Asians moving into North America, Egyptians into countries with oil-exporting economies, and Eastern Europeans into an expanding European Union.4 South Africa exports health professionals to wealthier countries while simultaneously importing them from neighboring African nations.
Emigration from the poorest countries is unquestionably damaging. More than a dozen countries in sub-Saharan Africa have plummeting life expectancies mostly as a result of the epidemic of human immunodeficiency virus infection and AIDS.5 With just 600,000 doctors, nurses, and midwives for 600 million people, African countries need the equivalent of at least 1 million additional workers in order to offer basic services consistent with the United Nations Millennium Development Goals. Instead, these countries are moving backward, with the hemorrhaging of clinical and professional leaders crippling the already fragile health care systems. These failures have been characterized as "fatal flows," because poor people are left vulnerable to devastating diseases and avoidable death. The exodus also constitutes a silent theft from the poorest countries through the loss of public subsidies for medical education, estimated at $500 million annually for all emigrating skilled workers from Africa.
Moral outrage over the "poaching" behavior on the part of rich countries has reached a crescendo. Yet simply blocking migration is neither effective nor ethical, since freedom of movement is a basic human right. The challenge is to advance human health while protecting health workers' rights to seek gainful employment. The first responsibility for action belongs with each country to "train, retain, and sustain" its workforces through national plans that improve salaries and working conditions, revitalize education, and mobilize paraprofessional and community workers whose services are demonstrably more cost-effective and who are less likely to emigrate. Since such urgent actions must be pursued in the world's poorest nations, much will depend on the global community's provision of appropriate financial and technical aid".
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
The article below is from one of the world's most prestigious medical journals but displays a grade-school level of thinking. Their solution to the problem of third-world doctors migrating to richer countreies? More aid! Throw dollars at it! It shows how cretinous people can be when speaking outside their own narrow field of expertise. That the USA and other Western countries could improve their educational systems so that they themselves trained all the doctors they need is glided over. That aid will only buy golden bedsteads and Swiss bank accounts for the corrupt ruling elites of the poor countries concerned is CERTAINLY not mentioned
"The movement of physicians from poor to rich countries is a growing obstacle to global health. Ghana, with 0.09 physician per thousand population, sends doctors to the United Kingdom, which has 18 times as many physicians per capita. The United States, with 5 percent of the world's population, employs 11 percent of the globe's physicians, and its demand is growing. As underscored in the article by Mullan in this issue of the Journal, today, 25 percent of U.S. physicians are international medical graduates, and the number is even higher in the United Kingdom, Canada, and Australia. Many of these graduates come from poor countries with high disease burdens - precisely those nations that can least afford to lose their professionals.
The plain truth is that medical systems in the United States and other wealthy countries are heavily dependent on imported workers - for hospital staffing, coverage of underserved areas, and meeting gaps in skill levels. U.S. medical schools turn out a relatively stable 17,000 graduates annually, but the demand for residency staffing exceeds this number by 30 percent. This gap is filled by international medical graduates, most of whom will attain citizenship or permanent residence and remain in the United States to practice medicine. Medical coverage of disadvantaged Americans also depends on U.S. federal waivers for international medical graduates to enter primary care practice in underserved areas. The dependence is not confined to doctors, since nurses and other medically skilled workers are in equally high demand.
International professional mobility is inevitable when persons have skills they can sell in a global marketplace. The migration of medical professionals reflects a balance of supply and demand - but it has ethical implications, too. Demand in affluent countries pulls health care workers from poor countries as low salaries, limited career prospects, poor working environments, family aspirations, and political insecurity push them out. The beneficiaries are the importing countries and, of course, the migrants themselves. Countries that intentionally export skilled workers tolerate "brain drain" in exchange for financial remittances, relief from high unemployment rates, and the possibility of scientific connections. Markets for medical labor operate in and across all of the major world regions, with Asians moving into North America, Egyptians into countries with oil-exporting economies, and Eastern Europeans into an expanding European Union.4 South Africa exports health professionals to wealthier countries while simultaneously importing them from neighboring African nations.
Emigration from the poorest countries is unquestionably damaging. More than a dozen countries in sub-Saharan Africa have plummeting life expectancies mostly as a result of the epidemic of human immunodeficiency virus infection and AIDS.5 With just 600,000 doctors, nurses, and midwives for 600 million people, African countries need the equivalent of at least 1 million additional workers in order to offer basic services consistent with the United Nations Millennium Development Goals. Instead, these countries are moving backward, with the hemorrhaging of clinical and professional leaders crippling the already fragile health care systems. These failures have been characterized as "fatal flows," because poor people are left vulnerable to devastating diseases and avoidable death. The exodus also constitutes a silent theft from the poorest countries through the loss of public subsidies for medical education, estimated at $500 million annually for all emigrating skilled workers from Africa.
Moral outrage over the "poaching" behavior on the part of rich countries has reached a crescendo. Yet simply blocking migration is neither effective nor ethical, since freedom of movement is a basic human right. The challenge is to advance human health while protecting health workers' rights to seek gainful employment. The first responsibility for action belongs with each country to "train, retain, and sustain" its workforces through national plans that improve salaries and working conditions, revitalize education, and mobilize paraprofessional and community workers whose services are demonstrably more cost-effective and who are less likely to emigrate. Since such urgent actions must be pursued in the world's poorest nations, much will depend on the global community's provision of appropriate financial and technical aid".
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Friday, October 28, 2005
DODGING A PROBLEM RATHER THAN SOLVING IT
But better than nothing, I suppose
The first state subsidies to help doctors worst hit by rising medical malpractice premiums are being distributed, the New Jersey Department of Banking and Insurance said Monday. Payments of nearly $11,000 each are being made to about 1,200 medical specialists: neurosurgeons, obstetricians and radiologists who read mammograms. The subsidy payments are being made under a 2004 law, the New Jersey Medical Care Access and Responsibility and Patients First Act, intended to ensure there are enough of certain specialists to treat patients in the state.
The three specialist groups are among those that took the worst hit when malpractice insurance premiums began spiking a few years ago. Doctors' groups say many specialists retired or moved to states with lower malpractice premiums to avoid high insurance costs in New Jersey.
Donald Bryan, acting commissioner of banking and insurance, said in a prepared statement that the subsidy is a key component of state legislation to address cost and availability of medical malpractice insurance. The payments are the first in a three-year program, he said. The subsidies come from the state's Medical Malpractice Liability Insurance Premium Assistance Fund. It is funded by $75-a-year fees paid by practicing doctors, dentists, chiropractors, podiatrists, optometrists and attorneys, as well as a $3-per-employee annual fee collected from most businesses.
According to the department, 65 percent of money in the fund goes for premium subsidies. The rest is split among the New Jersey FamilyCare health insurance program, hospital charity care reimbursements and reimbursement of student loans for obstetricians and gynecologists who agree to practice in New Jersey.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
But better than nothing, I suppose
The first state subsidies to help doctors worst hit by rising medical malpractice premiums are being distributed, the New Jersey Department of Banking and Insurance said Monday. Payments of nearly $11,000 each are being made to about 1,200 medical specialists: neurosurgeons, obstetricians and radiologists who read mammograms. The subsidy payments are being made under a 2004 law, the New Jersey Medical Care Access and Responsibility and Patients First Act, intended to ensure there are enough of certain specialists to treat patients in the state.
The three specialist groups are among those that took the worst hit when malpractice insurance premiums began spiking a few years ago. Doctors' groups say many specialists retired or moved to states with lower malpractice premiums to avoid high insurance costs in New Jersey.
Donald Bryan, acting commissioner of banking and insurance, said in a prepared statement that the subsidy is a key component of state legislation to address cost and availability of medical malpractice insurance. The payments are the first in a three-year program, he said. The subsidies come from the state's Medical Malpractice Liability Insurance Premium Assistance Fund. It is funded by $75-a-year fees paid by practicing doctors, dentists, chiropractors, podiatrists, optometrists and attorneys, as well as a $3-per-employee annual fee collected from most businesses.
According to the department, 65 percent of money in the fund goes for premium subsidies. The rest is split among the New Jersey FamilyCare health insurance program, hospital charity care reimbursements and reimbursement of student loans for obstetricians and gynecologists who agree to practice in New Jersey.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Thursday, October 27, 2005
YOUR REGULATORS WILL PROTECT YOU -- NOT
I think a $1,000 fine for killing a baby is a bit light. Don't you?
Because of the lack of information available to the public about our doctor's malpractice history, what my wife, Christine, and I didn't know could have saved our son Ian's life.
When our doctor gave Christine a small brown envelope of pills, with handwritten instructions to "take every four hours," it was impossible to know he had eight previous malpractice claims and restricted privileges at the local hospital. We later discovered this drug was not approved for this use. If we had been given the drugs at the pharmacy it would been boldly labeled explicitly stating it was not to be taken by a pregnant woman.
The drug caused violent, extreme contractions, smothering Ian. After hours of suffering, he was born blue and lifeless -- not breathing and without a hearbeat. Ian was revived and lived, but with severe injuries. He required around-the-clock care and ate through a feeding tube. His mind would never develop beyond that of a 6-month-old infant. Ian died at age 4, due to complications from his preventable injuries.
We filed a complaint with the state medical board. After a two-year wait, the board finally agreed with our accusation. But while the board found the doctor guilty of malpractice and misconduct, it simply issued a $1,000 fine. This obstetrician, who has injured at least two other babies after Ian, continues to practice.
Because of what happened to our son, I helped draft Initiative 336 -- a measure that will hold doctors, lawyers and the insurance industry accountable. It puts patients first by implementing measures that would allow them to know their doctors' complete malpractice history. Had this been in place when Ian was born, we certainly would have selected a different obstetrician.....
Less than half -- 44.7 percent -- of doctors with five or more malpractice payouts have been disciplined by Washington authorities or a state medical board, according to a recent Public Citizen study. Currently, the few bad doctors who cause the majority of medical malpractice incidents have no incentive to change their ways. I-336 will make this small population of bad doctors accountable for their actions.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
I think a $1,000 fine for killing a baby is a bit light. Don't you?
Because of the lack of information available to the public about our doctor's malpractice history, what my wife, Christine, and I didn't know could have saved our son Ian's life.
When our doctor gave Christine a small brown envelope of pills, with handwritten instructions to "take every four hours," it was impossible to know he had eight previous malpractice claims and restricted privileges at the local hospital. We later discovered this drug was not approved for this use. If we had been given the drugs at the pharmacy it would been boldly labeled explicitly stating it was not to be taken by a pregnant woman.
The drug caused violent, extreme contractions, smothering Ian. After hours of suffering, he was born blue and lifeless -- not breathing and without a hearbeat. Ian was revived and lived, but with severe injuries. He required around-the-clock care and ate through a feeding tube. His mind would never develop beyond that of a 6-month-old infant. Ian died at age 4, due to complications from his preventable injuries.
We filed a complaint with the state medical board. After a two-year wait, the board finally agreed with our accusation. But while the board found the doctor guilty of malpractice and misconduct, it simply issued a $1,000 fine. This obstetrician, who has injured at least two other babies after Ian, continues to practice.
Because of what happened to our son, I helped draft Initiative 336 -- a measure that will hold doctors, lawyers and the insurance industry accountable. It puts patients first by implementing measures that would allow them to know their doctors' complete malpractice history. Had this been in place when Ian was born, we certainly would have selected a different obstetrician.....
Less than half -- 44.7 percent -- of doctors with five or more malpractice payouts have been disciplined by Washington authorities or a state medical board, according to a recent Public Citizen study. Currently, the few bad doctors who cause the majority of medical malpractice incidents have no incentive to change their ways. I-336 will make this small population of bad doctors accountable for their actions.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Wednesday, October 26, 2005
A little perspective on the avian flu panic
Some reasons not to bow down before the government as our saviour. See also my post of 24th.
Okay, by now we have all about had our fill of hearing about the impending “bird flu pandemic” that is going to destroy half the population if we don’t jump into line for vaccinations and allow our civil liberties to be entirely ignored (instead of just mostly, as has been the case for years now) as “martial law” is imposed around us. I am in no sense of the word an expert on this subject, although I’ve been writing news blurbs on this and related matters for several weeks now. But in the process I’ve encountered enough ambiguity on the topic to make me at least skeptical about the warnings and the pending proscriptions.....
* Thus far, the evidence of human-to-human transmission of the “avian flu” virus is both sparse and anecdotal. The vast majority of reports can be traced to chicken-farmers, regularly inhaling the infected air around their diseased flocks, and/or contracting the virus directly from handling the chickens. The few exceptions may not even be the same ailment, as it turns out. Meanwhile, the continued reports of “bird flu sightings” in other countries besides Southeast Asia turn out to be BIRDS showing some sortr of disease, not HUMANS diagnosed with the specific H5N1 virus that has everyone so concerned. In short, as one story (Human bird flu: “science fiction”) puts it, the whole thing (like so many anxieties) may be just another “debt that may never come due.”
* Meanwhile, the reports that keep circulating in the news are doing very little to clarify the fact that the outbreaks being reported around the world are in birds, not humans. When you see a headlline like the one in today’s papers, “Bird Flu Arrives In England,” take note of the fact that it is about a parrot, which was quarantined alongside birds of other species that already had the H5N1 virus. We already know this thing is deadly to birds, of a variety of species; we still have no reported cases of a human being, taken completely away from the infected birds, passing the disease to another human being, who had not already been exposed to a diseased bird!
* There is as yet no “vaccine” developed for the human strain – and there cannot be, at least until a “human strain” is detected, extracted, experimented on and then diluted, so a vaccine can be prepared from allegedly weakened and/or denatured cultures. (Meanwhile, CDC labs around the country are doing experiments to recreate the KNOWN deadly virus of the 1918 Spanish Influenza, with some misguided idea that they might be able to create a vaccine from that pathogen that would combat this one, while pharmaceutical companies seek a shield against potential lawsuits. We should be far more concerned about that full-strength disease being released, accidentally or otherwise, in the wake of the present hysteria.)
* Meanwhile, the history of influenza epidemics may hold more warnings about “vaccination programs” than about successful cures. The very concept of vaccination still requires that the first step be a virulent killer virus, from with you then make a denatured or weakened version. And if that particular killer virus does not exist, you have to create it! Does that really make sense in this case?
* There is also at least one theory that the problem behind nearly all systemic illness is the indiscriminate taking of aspirin to hold down a fever. The fever is treated as part of the illness, when it is in fact the body’s defense mechanism to fight it; if you suppress the fever at the wrong stage of recovery, all you do is allow a virus to propagate in peace, and then it comes back in fuller force. There’s even a rather long webpage that outlines the effects of widespread use of aspirin (for fever reduction) explaining how and why the 1918 Flu was so devastating, and how we might avoid a repeat, simply by letting the fever perform its proper role in healing.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Some reasons not to bow down before the government as our saviour. See also my post of 24th.
Okay, by now we have all about had our fill of hearing about the impending “bird flu pandemic” that is going to destroy half the population if we don’t jump into line for vaccinations and allow our civil liberties to be entirely ignored (instead of just mostly, as has been the case for years now) as “martial law” is imposed around us. I am in no sense of the word an expert on this subject, although I’ve been writing news blurbs on this and related matters for several weeks now. But in the process I’ve encountered enough ambiguity on the topic to make me at least skeptical about the warnings and the pending proscriptions.....
* Thus far, the evidence of human-to-human transmission of the “avian flu” virus is both sparse and anecdotal. The vast majority of reports can be traced to chicken-farmers, regularly inhaling the infected air around their diseased flocks, and/or contracting the virus directly from handling the chickens. The few exceptions may not even be the same ailment, as it turns out. Meanwhile, the continued reports of “bird flu sightings” in other countries besides Southeast Asia turn out to be BIRDS showing some sortr of disease, not HUMANS diagnosed with the specific H5N1 virus that has everyone so concerned. In short, as one story (Human bird flu: “science fiction”) puts it, the whole thing (like so many anxieties) may be just another “debt that may never come due.”
* Meanwhile, the reports that keep circulating in the news are doing very little to clarify the fact that the outbreaks being reported around the world are in birds, not humans. When you see a headlline like the one in today’s papers, “Bird Flu Arrives In England,” take note of the fact that it is about a parrot, which was quarantined alongside birds of other species that already had the H5N1 virus. We already know this thing is deadly to birds, of a variety of species; we still have no reported cases of a human being, taken completely away from the infected birds, passing the disease to another human being, who had not already been exposed to a diseased bird!
* There is as yet no “vaccine” developed for the human strain – and there cannot be, at least until a “human strain” is detected, extracted, experimented on and then diluted, so a vaccine can be prepared from allegedly weakened and/or denatured cultures. (Meanwhile, CDC labs around the country are doing experiments to recreate the KNOWN deadly virus of the 1918 Spanish Influenza, with some misguided idea that they might be able to create a vaccine from that pathogen that would combat this one, while pharmaceutical companies seek a shield against potential lawsuits. We should be far more concerned about that full-strength disease being released, accidentally or otherwise, in the wake of the present hysteria.)
* Meanwhile, the history of influenza epidemics may hold more warnings about “vaccination programs” than about successful cures. The very concept of vaccination still requires that the first step be a virulent killer virus, from with you then make a denatured or weakened version. And if that particular killer virus does not exist, you have to create it! Does that really make sense in this case?
* There is also at least one theory that the problem behind nearly all systemic illness is the indiscriminate taking of aspirin to hold down a fever. The fever is treated as part of the illness, when it is in fact the body’s defense mechanism to fight it; if you suppress the fever at the wrong stage of recovery, all you do is allow a virus to propagate in peace, and then it comes back in fuller force. There’s even a rather long webpage that outlines the effects of widespread use of aspirin (for fever reduction) explaining how and why the 1918 Flu was so devastating, and how we might avoid a repeat, simply by letting the fever perform its proper role in healing.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Tuesday, October 25, 2005
MORE USELESS BUREAUCACY PUSHING U.S. HEALTHCARE COSTS UP EVEN FURTHER
Health care costs continue to skyrocket nationwide, driving up government spending at double digit rates and hurting American economic competitiveness. But, instead of addressing this crisis head on by passing medical malpractice tort reform and pro-competition policies like medical savings accounts, the federal health care bureaucracy is getting ready to add new mandates and regulations that will further drive up the cost of providing health care.
The latest onerous regulation is Hospital CAHPS (HCAPHS), which will pile unnecessary new burdens on our nation's hospitals with no discernable benefit. HCAHPS is a survey on hospital care dreamed up by Medicare and the Agency for Healthcare Research and Quality (AHRQ). Bureaucrats at these two departments have decided that all hospitals participating in Medicare—virtually every one in the nation—should "voluntarily" post patient responses to a new quality survey on the Medicare website. It is an exercise in regulatory overkill that expert after expert has indicated will actually hinder its supposed goal.
HCAPHS ignores that about 80 percent of our nation's hospitals already survey a percentage of patients upon discharge. Hospitals already spend a lot of money on surveys because they want to improve the quality of care they provide, and the results speak for themselves. For example, all four hospitals that have been awarded the federal government's prestigious Malcolm Baldrige National Quality Award are aggressive users of private sector survey products, and are outspoken advocates of quality initiatives. Hospitals as a group support public reporting of patient satisfaction data and have said they will voluntarily participate, but only if the government would not add a cost burden to their operations.
Unfortunately, HCAPHS does little or nothing to reinforce these ongoing quality programs. Despite a well-functioning private sector, Medicare and AHRQ bureaucrats have spent three-plus years developing a laundry list of ultra-specific questions for patients, including a pair about bed pan usage. The many incarnations of the HCAHPS questionnaire have ranged from 66 questions to 25; the present version is 27. During two separate comment periods, more than 1,900 hospital officials have recommended keeping the number of HCAHPS questions to between eight and ten, a range that would enable hospitals to include the government-sponsored questions in their own surveys and collect results at less of an added cost. Otherwise, existing data collection efforts will suffer and hospitals will have to engage in costly new practices—such as multiple mailings and telephone surveys—just to acquire enough feedback to keep federal regulators happy.
A shorter and simpler HCAHPS might be easier for patients, but the tremendous cost burden that will be placed on hospitals comes from simply having to send and collect data from two separate surveys. Studies by leading economists have concluded that the nationwide burden on hospitals of a lengthy HCAHPS could range from $100 million to over a half billion dollars over the next five years alone. Those millions of dollars are added to the bottom line of America’s health care bill.
Not surprisingly, the forces pushing for HCAHPS are the same forces that want to control and socialize private sector health care: the AARP and AFL-CIO. The union agenda is to force hospitals to adopt centralized systems of management that employ legions of (unionized) workers, and the AARP is a consistent supporter of the expansion of federal involvement in our health care system. HCAHPS questions can and will be designed to advance their specific left-wing policy goals. That is why, for example, we see two questions on labor-intensive bed pan performance, which is hardly an urgent measure of health care quality. The other group that loves a lengthy and invasive HCAHPS is the trial bar, a group already hard at work diminishing the quality and increasing the cost of American health care. The trial bar will surely distort the results of a complicated HCAHPS and use it to advance their organized fleecing of hospitals that are serving poorer and higher-risk patient populations.
The stakes, then, are huge. FreedomWorks expects the Department of Health and Human Services (HHS) to make a final decision on HCAHPS in the next few weeks. The Bush administration has a chance to stand up for common sense and limited government by ensuring the federal hospital survey known as HCAHPS does no harm to America’s health care providers.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Health care costs continue to skyrocket nationwide, driving up government spending at double digit rates and hurting American economic competitiveness. But, instead of addressing this crisis head on by passing medical malpractice tort reform and pro-competition policies like medical savings accounts, the federal health care bureaucracy is getting ready to add new mandates and regulations that will further drive up the cost of providing health care.
The latest onerous regulation is Hospital CAHPS (HCAPHS), which will pile unnecessary new burdens on our nation's hospitals with no discernable benefit. HCAHPS is a survey on hospital care dreamed up by Medicare and the Agency for Healthcare Research and Quality (AHRQ). Bureaucrats at these two departments have decided that all hospitals participating in Medicare—virtually every one in the nation—should "voluntarily" post patient responses to a new quality survey on the Medicare website. It is an exercise in regulatory overkill that expert after expert has indicated will actually hinder its supposed goal.
HCAPHS ignores that about 80 percent of our nation's hospitals already survey a percentage of patients upon discharge. Hospitals already spend a lot of money on surveys because they want to improve the quality of care they provide, and the results speak for themselves. For example, all four hospitals that have been awarded the federal government's prestigious Malcolm Baldrige National Quality Award are aggressive users of private sector survey products, and are outspoken advocates of quality initiatives. Hospitals as a group support public reporting of patient satisfaction data and have said they will voluntarily participate, but only if the government would not add a cost burden to their operations.
Unfortunately, HCAPHS does little or nothing to reinforce these ongoing quality programs. Despite a well-functioning private sector, Medicare and AHRQ bureaucrats have spent three-plus years developing a laundry list of ultra-specific questions for patients, including a pair about bed pan usage. The many incarnations of the HCAHPS questionnaire have ranged from 66 questions to 25; the present version is 27. During two separate comment periods, more than 1,900 hospital officials have recommended keeping the number of HCAHPS questions to between eight and ten, a range that would enable hospitals to include the government-sponsored questions in their own surveys and collect results at less of an added cost. Otherwise, existing data collection efforts will suffer and hospitals will have to engage in costly new practices—such as multiple mailings and telephone surveys—just to acquire enough feedback to keep federal regulators happy.
A shorter and simpler HCAHPS might be easier for patients, but the tremendous cost burden that will be placed on hospitals comes from simply having to send and collect data from two separate surveys. Studies by leading economists have concluded that the nationwide burden on hospitals of a lengthy HCAHPS could range from $100 million to over a half billion dollars over the next five years alone. Those millions of dollars are added to the bottom line of America’s health care bill.
Not surprisingly, the forces pushing for HCAHPS are the same forces that want to control and socialize private sector health care: the AARP and AFL-CIO. The union agenda is to force hospitals to adopt centralized systems of management that employ legions of (unionized) workers, and the AARP is a consistent supporter of the expansion of federal involvement in our health care system. HCAHPS questions can and will be designed to advance their specific left-wing policy goals. That is why, for example, we see two questions on labor-intensive bed pan performance, which is hardly an urgent measure of health care quality. The other group that loves a lengthy and invasive HCAHPS is the trial bar, a group already hard at work diminishing the quality and increasing the cost of American health care. The trial bar will surely distort the results of a complicated HCAHPS and use it to advance their organized fleecing of hospitals that are serving poorer and higher-risk patient populations.
The stakes, then, are huge. FreedomWorks expects the Department of Health and Human Services (HHS) to make a final decision on HCAHPS in the next few weeks. The Bush administration has a chance to stand up for common sense and limited government by ensuring the federal hospital survey known as HCAHPS does no harm to America’s health care providers.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Monday, October 24, 2005
Don't put your faith in a central Tamiflu stockpile
Countries around the world are stockpiling Tamiflu, in anticipation of a possible avian flu pandemic. This is better than doing nothing, but Tamiflu is unlikely to protect most of us, should a pandemic arrive. Here are a few reasons why:
1. Tamiflu must be taken within the first two days of symptoms. Your chance of getting some Tamiflu that quickly, in a pandemic, will not be great (of course you could buy some on your own).
2. Tamiflu, if taken preventively, can prevent you from getting sick in the first place. But you would need two tablets each day. Only essential medical personnel, and select politicians, are likely to receive such treatments.
3. You show up at the emergency room with avian flu, and then they have to decide where you stand on the priority list. Will the hospital fear a lawsuit? How long will this take? Will it require federal or regulatory clearance?
4. Given the crush of the infected, will you be afraid to show up at the emergency room in the first place? Maybe you just have the common cold. See point #1.
5. Many Tamiflu supplies will be exhausted on false alarms, such as colds and other flus.
6. A Tamiflu stockpile is only good for a few years. If avian flu does not come soon, do you expect the stockpile to be replenished? Or would avian flu become the new "swine flu", never to be uttered by politicians again? The avian flu threat will likely be with us for at least ten years, in the form of a bird "flu reservoir" for possible mutation.
7. There is some chance that the virus will develop Tamiflu immunity over time, especially if Tamiflu is applied indiscriminately at the early stages of a pandemic.
8. Let's say the virus arrives first in California. Will Tamiflu supplies all be sent that way at first? Will they ever later be shipped back to Kansas? How much of the stockpile -- an inevitable political football -- will be available at any point in time?
Did I mention that the U.S. won't be getting any more new Tamiflu for at least two years? Right now we only have 4.3 million courses.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Countries around the world are stockpiling Tamiflu, in anticipation of a possible avian flu pandemic. This is better than doing nothing, but Tamiflu is unlikely to protect most of us, should a pandemic arrive. Here are a few reasons why:
1. Tamiflu must be taken within the first two days of symptoms. Your chance of getting some Tamiflu that quickly, in a pandemic, will not be great (of course you could buy some on your own).
2. Tamiflu, if taken preventively, can prevent you from getting sick in the first place. But you would need two tablets each day. Only essential medical personnel, and select politicians, are likely to receive such treatments.
3. You show up at the emergency room with avian flu, and then they have to decide where you stand on the priority list. Will the hospital fear a lawsuit? How long will this take? Will it require federal or regulatory clearance?
4. Given the crush of the infected, will you be afraid to show up at the emergency room in the first place? Maybe you just have the common cold. See point #1.
5. Many Tamiflu supplies will be exhausted on false alarms, such as colds and other flus.
6. A Tamiflu stockpile is only good for a few years. If avian flu does not come soon, do you expect the stockpile to be replenished? Or would avian flu become the new "swine flu", never to be uttered by politicians again? The avian flu threat will likely be with us for at least ten years, in the form of a bird "flu reservoir" for possible mutation.
7. There is some chance that the virus will develop Tamiflu immunity over time, especially if Tamiflu is applied indiscriminately at the early stages of a pandemic.
8. Let's say the virus arrives first in California. Will Tamiflu supplies all be sent that way at first? Will they ever later be shipped back to Kansas? How much of the stockpile -- an inevitable political football -- will be available at any point in time?
Did I mention that the U.S. won't be getting any more new Tamiflu for at least two years? Right now we only have 4.3 million courses.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Sunday, October 23, 2005
DISGRACEFUL BRITISH HOSPITAL CLOSURES
At a time when there is a vast unmet demand for medical services in Britain. A private business would be EXPANDING facilities to cope with rising demand
If we had any proper democracy in this country, Patricia Hewitt would now be explaining to Parliament and the public why there is an undeclared war on local community hospitals, everywhere from Yorkshire to Suffolk to Wiltshire to Hampshire to, yes, Oxfordshire. Now that the election is over, and now that Gordon Brown is running out of money, we find that in towns across England, the Government is threatening to close local hospitals, in defiance of every promise they have made.
Did I say the Government? Forgive me: of course, the Government, when asked about this, denies all responsibility. Not me guv, say ministers, when you inquire why a loved and valued community hospital faces closure. It is, say ministers, entirely a decision for the local strategic health authority, or the primary care trust, and so the Labour people wash their hands of it.
It will not do. It is in the first place wrong that these hospitals are facing closure, when we all know that the biggest problem in the NHS is the waiting lists, made far worse by bed-blocking in the acute sector.
Why on earth are we proposing to close community hospitals, when they are not only relied upon for immediate treatment by local people, but when they also provide a place for recuperation, and so relieve the pressure on big general hospitals?
And then there is the second and more important point. Even if there were a case for closing these hospitals — which there is not — it should be made by Patricia Hewitt. It should not be the job of some worthy health service hierarch, some beleaguered quangocrat, to explain this baffling and outrageous decision. These hospitals were, by and large, built and funded by local people. They have been loved and used by local people for generations.
They were nationalised by the Labour Government in 1948; in other words they were taken away from the care and control of local people, to be run by national politicians. It is not good enough for those national politicians now to say that they have no responsibility for whether those hospitals stay open, especially since they have created the quangos.
It is not good enough for them to direct angry locals to write letters of protest to the strategic health authority, or to invite MPs to get in touch with the primary care trust. Apart from anything else, the Labour Government, having created the primary care trusts only three years ago, now proposes to abolish half of them. With whom are we supposed to be dealing, if we want to keep a hospital open?
No one seems to be in charge. No one is accountable. It is infamous. Instead of wasting everybody’s time and money with politically correct gerrymandering of public sector appointments, Patricia Hewitt should recognise that she is presiding over a massacre of local hospitals, and that it is her job — and her job alone — to justify the actions of her appointees
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
At a time when there is a vast unmet demand for medical services in Britain. A private business would be EXPANDING facilities to cope with rising demand
If we had any proper democracy in this country, Patricia Hewitt would now be explaining to Parliament and the public why there is an undeclared war on local community hospitals, everywhere from Yorkshire to Suffolk to Wiltshire to Hampshire to, yes, Oxfordshire. Now that the election is over, and now that Gordon Brown is running out of money, we find that in towns across England, the Government is threatening to close local hospitals, in defiance of every promise they have made.
Did I say the Government? Forgive me: of course, the Government, when asked about this, denies all responsibility. Not me guv, say ministers, when you inquire why a loved and valued community hospital faces closure. It is, say ministers, entirely a decision for the local strategic health authority, or the primary care trust, and so the Labour people wash their hands of it.
It will not do. It is in the first place wrong that these hospitals are facing closure, when we all know that the biggest problem in the NHS is the waiting lists, made far worse by bed-blocking in the acute sector.
Why on earth are we proposing to close community hospitals, when they are not only relied upon for immediate treatment by local people, but when they also provide a place for recuperation, and so relieve the pressure on big general hospitals?
And then there is the second and more important point. Even if there were a case for closing these hospitals — which there is not — it should be made by Patricia Hewitt. It should not be the job of some worthy health service hierarch, some beleaguered quangocrat, to explain this baffling and outrageous decision. These hospitals were, by and large, built and funded by local people. They have been loved and used by local people for generations.
They were nationalised by the Labour Government in 1948; in other words they were taken away from the care and control of local people, to be run by national politicians. It is not good enough for those national politicians now to say that they have no responsibility for whether those hospitals stay open, especially since they have created the quangos.
It is not good enough for them to direct angry locals to write letters of protest to the strategic health authority, or to invite MPs to get in touch with the primary care trust. Apart from anything else, the Labour Government, having created the primary care trusts only three years ago, now proposes to abolish half of them. With whom are we supposed to be dealing, if we want to keep a hospital open?
No one seems to be in charge. No one is accountable. It is infamous. Instead of wasting everybody’s time and money with politically correct gerrymandering of public sector appointments, Patricia Hewitt should recognise that she is presiding over a massacre of local hospitals, and that it is her job — and her job alone — to justify the actions of her appointees
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Saturday, October 22, 2005
THE ATTACK ON OUR GUARDIANS AGAINST DISEASE
In the wake of the management snafus of Katrina, President Bush was asked about the avian flu threat at his October 4 press conference; he offered a thoughtful answer which shows, at least, that no hapless Michael Browns will be in charge of a Viral Big One.
Yet once again, we don't know the future; we don't know whether the US government's response will be equal to the challenge. But some distant early warning indicators are not so promising; one of Uncle Sam's scenarios envisions shortages of food, medicine and electricity, followed by mass riots and the ultimate death of 1.9 million Americans. In other words, as we stare into the tiny grains of the flu virus, we could be looking at Katrina multiplied by a thousand. This is the best we can do? The richest country in the world? Clearly, what we have seen over the past few decades hasn't been management, but rather malpractice.
But even before we get to the management blame game, we should be looking toward the manufacture of a cure. Unfortunately a cure doesn't exist -- a future action item if there ever was one, which we will come back to later. For now, we do have an anti-viral medicine, called Tamiflu, but we don't have enough. Indeed, at present, so parlous is our condition that even if we wanted to start manufacturing more right away, it would still take years to build up an adequate stockpile.
What's more, as Waldemar Ingdahl has noted here at TCS, since 1970, the number of companies producing vaccines has fallen by 80 percent. Which is to say, while the need has been going north, the supply has been going south. What explains this wrong-way trend? One reason is that the government has practiced a kind of malign neglect toward vaccines and toward the innovative side of the pharmaceutical industry.
Consider the fate of Merck. The New Jersey-based company is currently being clobbered by costly Vioxx lawsuits, based on junk science, as the federal government watches passively. Yet even so, Merck has persevered on a vaccine for the human papilloma virus, which accounts for perhaps 70 percent of the world's cervical cancers. It would be a tragic shame if Merck were knocked out of the innovation box by big lawsuits, before its vaccine, Gardasil, ever reaches the women who need it. What national interest would that serve?
We need to rethink our approach to manufacturing, because at present, US government mismanagement -- tolerance for predatory lawsuits -- is undercutting the productive and lifesaving fundaments of the pharmaceutical industry. Indeed, motivated by a strange mix of desperation and calculation, many governments around the world are considering compounding past mismanagement with still more mismanagement. Here's how: Hans Hogerzeil, acting director of the department of essential drugs and medicines policy at the World Health Organization, demanded recently that Roche, the maker of Tamiflu, cut its price and waive its patent rights, so that anybody, anywhere, could make the drug.
Hogerzeil's comments stand in sharp contrast to those of his boss, Lee Jong-wook, who, mindful of the enormous investment needed to make medicines, has said that it is bad policy to weaken drug patents, since they are the cornerstone of production. But of course, it's Hogerzeil's flamboyantly anti-corporate populism that grabs the attention of the controversy-crazed world media.
If any of this legal-medical jousting sounds familiar, it should. Because the same Hogerzeil and the same WHO had the same bright idea about AIDS drugs. Working closely with NGO activists, the world's public health-ocracy cooked up a scheme to "pre-qualify" copycat AIDS drugs, manufactured in India, onto the market. But "pre-qualification" proved to be a synonym of "non-quality." So great was the danger of these pseudo-drugs that they had to be withdrawn from the marketplace. It was a humiliating for the neo-Naderite "H Team" of genericists, but evidently not so humiliating that the H-ers aren't up to the same trick again.....
If it costs close to a billion dollars to make a drug, and if future profits are non-existent -- well, it doesn't take much management expertise to see that future discovering and manufacturing will be non-existent, too.
More here
Bravo! Less money for drug research and more money for lawyers: Just what the world needs: "Swiss drugmaker Serono SA has agreed to pay $704 million to settle criminal and civil charges that it illegally promoted its AIDS drug, prosecutors said yesterday, in one of the biggest sums collected in the government's growing scrutiny of pharmaceutical firms. The company's Serono Labs unit of Rockland agreed to plead guilty to charges it conspired to market Serostim by supplying doctors diagnostic software that was not fully approved by the Food and Drug Administration. The software, prosecutors said, led to an increase in demand for the drug prescribed to treat wasting in AIDS patients. The company also agreed to plead guilty to offering doctors all-expense-paid trips to a medical conference in Cannes, France, in return for writing prescriptions of Serostim, an arrangement that US Attorney General Alberto R. Gonzales blasted as 'The 'Cannes Kickback' campaign.'"
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
In the wake of the management snafus of Katrina, President Bush was asked about the avian flu threat at his October 4 press conference; he offered a thoughtful answer which shows, at least, that no hapless Michael Browns will be in charge of a Viral Big One.
Yet once again, we don't know the future; we don't know whether the US government's response will be equal to the challenge. But some distant early warning indicators are not so promising; one of Uncle Sam's scenarios envisions shortages of food, medicine and electricity, followed by mass riots and the ultimate death of 1.9 million Americans. In other words, as we stare into the tiny grains of the flu virus, we could be looking at Katrina multiplied by a thousand. This is the best we can do? The richest country in the world? Clearly, what we have seen over the past few decades hasn't been management, but rather malpractice.
But even before we get to the management blame game, we should be looking toward the manufacture of a cure. Unfortunately a cure doesn't exist -- a future action item if there ever was one, which we will come back to later. For now, we do have an anti-viral medicine, called Tamiflu, but we don't have enough. Indeed, at present, so parlous is our condition that even if we wanted to start manufacturing more right away, it would still take years to build up an adequate stockpile.
What's more, as Waldemar Ingdahl has noted here at TCS, since 1970, the number of companies producing vaccines has fallen by 80 percent. Which is to say, while the need has been going north, the supply has been going south. What explains this wrong-way trend? One reason is that the government has practiced a kind of malign neglect toward vaccines and toward the innovative side of the pharmaceutical industry.
Consider the fate of Merck. The New Jersey-based company is currently being clobbered by costly Vioxx lawsuits, based on junk science, as the federal government watches passively. Yet even so, Merck has persevered on a vaccine for the human papilloma virus, which accounts for perhaps 70 percent of the world's cervical cancers. It would be a tragic shame if Merck were knocked out of the innovation box by big lawsuits, before its vaccine, Gardasil, ever reaches the women who need it. What national interest would that serve?
We need to rethink our approach to manufacturing, because at present, US government mismanagement -- tolerance for predatory lawsuits -- is undercutting the productive and lifesaving fundaments of the pharmaceutical industry. Indeed, motivated by a strange mix of desperation and calculation, many governments around the world are considering compounding past mismanagement with still more mismanagement. Here's how: Hans Hogerzeil, acting director of the department of essential drugs and medicines policy at the World Health Organization, demanded recently that Roche, the maker of Tamiflu, cut its price and waive its patent rights, so that anybody, anywhere, could make the drug.
Hogerzeil's comments stand in sharp contrast to those of his boss, Lee Jong-wook, who, mindful of the enormous investment needed to make medicines, has said that it is bad policy to weaken drug patents, since they are the cornerstone of production. But of course, it's Hogerzeil's flamboyantly anti-corporate populism that grabs the attention of the controversy-crazed world media.
If any of this legal-medical jousting sounds familiar, it should. Because the same Hogerzeil and the same WHO had the same bright idea about AIDS drugs. Working closely with NGO activists, the world's public health-ocracy cooked up a scheme to "pre-qualify" copycat AIDS drugs, manufactured in India, onto the market. But "pre-qualification" proved to be a synonym of "non-quality." So great was the danger of these pseudo-drugs that they had to be withdrawn from the marketplace. It was a humiliating for the neo-Naderite "H Team" of genericists, but evidently not so humiliating that the H-ers aren't up to the same trick again.....
If it costs close to a billion dollars to make a drug, and if future profits are non-existent -- well, it doesn't take much management expertise to see that future discovering and manufacturing will be non-existent, too.
More here
Bravo! Less money for drug research and more money for lawyers: Just what the world needs: "Swiss drugmaker Serono SA has agreed to pay $704 million to settle criminal and civil charges that it illegally promoted its AIDS drug, prosecutors said yesterday, in one of the biggest sums collected in the government's growing scrutiny of pharmaceutical firms. The company's Serono Labs unit of Rockland agreed to plead guilty to charges it conspired to market Serostim by supplying doctors diagnostic software that was not fully approved by the Food and Drug Administration. The software, prosecutors said, led to an increase in demand for the drug prescribed to treat wasting in AIDS patients. The company also agreed to plead guilty to offering doctors all-expense-paid trips to a medical conference in Cannes, France, in return for writing prescriptions of Serostim, an arrangement that US Attorney General Alberto R. Gonzales blasted as 'The 'Cannes Kickback' campaign.'"
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Friday, October 21, 2005
HERCEPTIN SHAKES UP THE BRITISH HEALTH BUREAUCRACY
The drug Herceptin was yesterday hailed as a potential cure for breast cancer that will revolutionise the way the disease is treated and save up to 1,500 lives a year in Britain and many tens of thousands across the world. As an editorial in the world's most authoritative medical journal spoke of the drug's "stunning" results in trials, the Prime Minister insisted that it had to be made available in Britain more quickly.
A health authority in the West Country has become the first in the NHS to say that it will make the drug available to all suitable women with early breast cancer, even before it is cleared by regulatory authorities. The cost for a year's treatment is 21,800 pounds per patient.
The publication of trial data on Herceptin in the New England Journal of Medicine was accompanied by an editorial by a top US specialist proclaiming the results as revolutionary. The most striking finding is that the peak in recurrence of the disease in the first two to three years after surgery has been eliminated in women taking Herceptin, said Dr Gabriel Hortobagyi in the editorial. "This observation suggests a dramatic and perhaps permanent perturbation of the natural history of the disease, maybe even a cure," he wrote. "Longer follow-up will determine whether this is correct." .....
Forced on to the back foot by growing clamour from patients and cancer charities, the Prime Minister yesterday conceded in the Commons that Herceptin had shown the need to speed up drug approvals. "At present, I think we all accept the procedures are too slow," Mr Blair said. "We are looking at how we can speed that process up in cases where it particularly matters to people who may be desperately ill and think there is a drug on the market that can help them."
Currently, the drug is licensed for use only in advanced breast cancer, though doctors can use their discretion to prescribe it in other exceptional cases.
More here
British woman sells her house to pay for Herceptin in India
A breast cancer sufferer is spending more than 25,000 pounds to be treated with Herceptin by a private clinic in India. Linda Vijeh, 50, of Ilminster, Somerset, is selling her 125,000 pound house to pay for the drug. She is believed to be the first British patient to travel abroad for Herceptin. Speaking from India yesterday, she said: "Herceptin is only licensed in the UK for use where cancer has spread to other parts of the body. Well it's a bit bloody late then. "It takes some leap of faith to fly to a Third World country to be treated by a doctor you've never met in a hospital you've never heard of. That is how desperate I was."
Ms Vijeh, a former chef to the British Ambassador to the UN in New York and a Tory member of South Somerset District Council, had cancer diagnosed after finding a lump in her right breast in August last year. She was tested and found to have HER-2 positive breast cancer, the form of the disease that can be treated by Herceptin. She had the tumour removed a year ago before beginning chemotherapy in March at Treliske Hospital, Cornwall. It was there that she met an Indian doctor who referred her to a consultant in India.
After flying out on September 27 she had a mastectomy and reconstruction surgery. She is receiving one course of Herceptin in India; it will be administered intravenously during two-hour sessions every two weeks. That course is costing her 1,000 pounds and she is also paying the doctors about 17,000 pounds for a year's worth of the drug to bring back to Britain. Once home, she plans to find a private clinic to administer it
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
The drug Herceptin was yesterday hailed as a potential cure for breast cancer that will revolutionise the way the disease is treated and save up to 1,500 lives a year in Britain and many tens of thousands across the world. As an editorial in the world's most authoritative medical journal spoke of the drug's "stunning" results in trials, the Prime Minister insisted that it had to be made available in Britain more quickly.
A health authority in the West Country has become the first in the NHS to say that it will make the drug available to all suitable women with early breast cancer, even before it is cleared by regulatory authorities. The cost for a year's treatment is 21,800 pounds per patient.
The publication of trial data on Herceptin in the New England Journal of Medicine was accompanied by an editorial by a top US specialist proclaiming the results as revolutionary. The most striking finding is that the peak in recurrence of the disease in the first two to three years after surgery has been eliminated in women taking Herceptin, said Dr Gabriel Hortobagyi in the editorial. "This observation suggests a dramatic and perhaps permanent perturbation of the natural history of the disease, maybe even a cure," he wrote. "Longer follow-up will determine whether this is correct." .....
Forced on to the back foot by growing clamour from patients and cancer charities, the Prime Minister yesterday conceded in the Commons that Herceptin had shown the need to speed up drug approvals. "At present, I think we all accept the procedures are too slow," Mr Blair said. "We are looking at how we can speed that process up in cases where it particularly matters to people who may be desperately ill and think there is a drug on the market that can help them."
Currently, the drug is licensed for use only in advanced breast cancer, though doctors can use their discretion to prescribe it in other exceptional cases.
More here
British woman sells her house to pay for Herceptin in India
A breast cancer sufferer is spending more than 25,000 pounds to be treated with Herceptin by a private clinic in India. Linda Vijeh, 50, of Ilminster, Somerset, is selling her 125,000 pound house to pay for the drug. She is believed to be the first British patient to travel abroad for Herceptin. Speaking from India yesterday, she said: "Herceptin is only licensed in the UK for use where cancer has spread to other parts of the body. Well it's a bit bloody late then. "It takes some leap of faith to fly to a Third World country to be treated by a doctor you've never met in a hospital you've never heard of. That is how desperate I was."
Ms Vijeh, a former chef to the British Ambassador to the UN in New York and a Tory member of South Somerset District Council, had cancer diagnosed after finding a lump in her right breast in August last year. She was tested and found to have HER-2 positive breast cancer, the form of the disease that can be treated by Herceptin. She had the tumour removed a year ago before beginning chemotherapy in March at Treliske Hospital, Cornwall. It was there that she met an Indian doctor who referred her to a consultant in India.
After flying out on September 27 she had a mastectomy and reconstruction surgery. She is receiving one course of Herceptin in India; it will be administered intravenously during two-hour sessions every two weeks. That course is costing her 1,000 pounds and she is also paying the doctors about 17,000 pounds for a year's worth of the drug to bring back to Britain. Once home, she plans to find a private clinic to administer it
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Thursday, October 20, 2005
NEW YORK: GOVERNMENT MEDDLING KILLS OFF THE VERY ILL
In 1989, New York became the first state in the nation to make public the mortality rates of its heart surgeons. Report cards for two different procedures, coronary bypass and angioplasty, were chosen as the standards by which the entire profession would be judged—a sort of litmus test for the skill of a given surgeon or hospital. The mortality numbers, risk-adjusted by age and other factors, are released every year or so on the Internet and reprinted in newspapers for all to see, hospital by hospital and doctor by doctor. Ending years of private, clubby surgeon culture, the public report cards were intended to shine a light on poor surgeons and encourage a kind of best-practices ethic across the state. If the system worked, mortality rates would fall everywhere from Oswego to NYU.
At first glance, the system seems to have made an enormous difference. Although there’s no satisfying way to compare our risk-adjusted death rates with those of other states (most of which only have data from Medicare patients, who tend to be sicker and therefore skew the sample), the most recent data suggest that in the past fifteen years, New York’s coronary-bypass surgeons have improved their mortality rates to the point that they are, on average, just one-third of what they were. Sharma’s risk-adjusted mortality rate in the latest angioplasty report is an astonishing 0.1 percent, the state’s lowest. In eleven years, he has been the only doctor to have consistently earned the state’s coveted double asterisk, which designates a surgeon with numbers far below the norm. These days, plenty of his colleagues have low numbers, too; everyone has drifted downward together. Like the children of Lake Wobegon, the surgeons of New York are all, apparently, above average.
But the statisticians who devised the report cards have been tormented by a persistent, intractable glitch in the system: It involves human beings. From the start, it was clear that surgeons’ careers were on the line as well as patients’ lives, and even before the first set of data was released, leaders in the heart-surgery community warned with an air of eerie certainty that the threat of public exposure would create a chilling effect—influencing surgeons to turn their backs on the sickest patients in order to prop up their personal success records.
Today, it seems clear that this prophecy has come true. Many surgeons, simply put, began gaming the system immediately and continue to do so today. “We still have people at this hospital who will not treat a high-risk patient,” says David Brown, an angioplasty cardiologist at SUNY–Stony Brook, with evident frustration. “I see a case on Monday morning with an acute myocardial infarction”—a heart attack—“that wasn’t treated. They come in and assess the patient, they think the patient’s at risk of dying no matter what they do, so they do nothing. And people admit to it.”
This isn’t just about high-risk patients. It’s about doctors playing games with practically any patient to get better scores. Some surgeons look for ways to make their easy cases seem harder. Others make their hard cases appear so difficult that they place out of the state reporting system. When it comes to the sickest patients, some surgeons simply turn them away, asserting that they’re better off getting drug treatments, or waiting in the ICU. “The cardiac surgeons refer their patients to the cardiologists, and the cardiologists refer them to the intensive-care unit,” says Joshua Burack, a SUNY–Downstate surgeon in Brooklyn who in 1999 released a study revealing that nearly two-thirds of all heart-bypass surgeons in the state anonymously admitted to refusing at least one patient for fear of tainting their mortality rates. “Everyone’s going to pass along the hot potato to the person who’s not vulnerable to reporting.”
In the past five years, no fewer than five studies have been published in reputable journals raising the possibility that New York heart surgeons are not operating on certain cases for fear of spoiling their mortality rates. The clincher came in January, when, in an anonymous survey sent out to every doctor who does angioplasty in the state, an astonishing 79 percent of the responders agreed that the public mortality statistics have discouraged them from taking on a risky patient. If you’re a hard case, in other words, four out of five doctors would think twice before operating on you.
And consider this: Research shows that New Yorkers are more prone to dying from heart attacks than people in any other state, and the death rate from heart disease in the New York metropolitan area remains disproportionately high. There could be something wrong with our diets. It could be the stress of living here. But it’s also possible that another factor plays a part: Just as more people than ever are dying of heart disease in New York, the very system designed to make heart surgery safer here may be convincing surgeons to turn patients away.
Much more here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
In 1989, New York became the first state in the nation to make public the mortality rates of its heart surgeons. Report cards for two different procedures, coronary bypass and angioplasty, were chosen as the standards by which the entire profession would be judged—a sort of litmus test for the skill of a given surgeon or hospital. The mortality numbers, risk-adjusted by age and other factors, are released every year or so on the Internet and reprinted in newspapers for all to see, hospital by hospital and doctor by doctor. Ending years of private, clubby surgeon culture, the public report cards were intended to shine a light on poor surgeons and encourage a kind of best-practices ethic across the state. If the system worked, mortality rates would fall everywhere from Oswego to NYU.
At first glance, the system seems to have made an enormous difference. Although there’s no satisfying way to compare our risk-adjusted death rates with those of other states (most of which only have data from Medicare patients, who tend to be sicker and therefore skew the sample), the most recent data suggest that in the past fifteen years, New York’s coronary-bypass surgeons have improved their mortality rates to the point that they are, on average, just one-third of what they were. Sharma’s risk-adjusted mortality rate in the latest angioplasty report is an astonishing 0.1 percent, the state’s lowest. In eleven years, he has been the only doctor to have consistently earned the state’s coveted double asterisk, which designates a surgeon with numbers far below the norm. These days, plenty of his colleagues have low numbers, too; everyone has drifted downward together. Like the children of Lake Wobegon, the surgeons of New York are all, apparently, above average.
But the statisticians who devised the report cards have been tormented by a persistent, intractable glitch in the system: It involves human beings. From the start, it was clear that surgeons’ careers were on the line as well as patients’ lives, and even before the first set of data was released, leaders in the heart-surgery community warned with an air of eerie certainty that the threat of public exposure would create a chilling effect—influencing surgeons to turn their backs on the sickest patients in order to prop up their personal success records.
Today, it seems clear that this prophecy has come true. Many surgeons, simply put, began gaming the system immediately and continue to do so today. “We still have people at this hospital who will not treat a high-risk patient,” says David Brown, an angioplasty cardiologist at SUNY–Stony Brook, with evident frustration. “I see a case on Monday morning with an acute myocardial infarction”—a heart attack—“that wasn’t treated. They come in and assess the patient, they think the patient’s at risk of dying no matter what they do, so they do nothing. And people admit to it.”
This isn’t just about high-risk patients. It’s about doctors playing games with practically any patient to get better scores. Some surgeons look for ways to make their easy cases seem harder. Others make their hard cases appear so difficult that they place out of the state reporting system. When it comes to the sickest patients, some surgeons simply turn them away, asserting that they’re better off getting drug treatments, or waiting in the ICU. “The cardiac surgeons refer their patients to the cardiologists, and the cardiologists refer them to the intensive-care unit,” says Joshua Burack, a SUNY–Downstate surgeon in Brooklyn who in 1999 released a study revealing that nearly two-thirds of all heart-bypass surgeons in the state anonymously admitted to refusing at least one patient for fear of tainting their mortality rates. “Everyone’s going to pass along the hot potato to the person who’s not vulnerable to reporting.”
In the past five years, no fewer than five studies have been published in reputable journals raising the possibility that New York heart surgeons are not operating on certain cases for fear of spoiling their mortality rates. The clincher came in January, when, in an anonymous survey sent out to every doctor who does angioplasty in the state, an astonishing 79 percent of the responders agreed that the public mortality statistics have discouraged them from taking on a risky patient. If you’re a hard case, in other words, four out of five doctors would think twice before operating on you.
And consider this: Research shows that New Yorkers are more prone to dying from heart attacks than people in any other state, and the death rate from heart disease in the New York metropolitan area remains disproportionately high. There could be something wrong with our diets. It could be the stress of living here. But it’s also possible that another factor plays a part: Just as more people than ever are dying of heart disease in New York, the very system designed to make heart surgery safer here may be convincing surgeons to turn patients away.
Much more here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Wednesday, October 19, 2005
GOOD OLD BUREAUCRATIC BUCK-PASSING
Even when people are dying, nobody's to blame in a bureaucracy
BUNDABERG Hospital's top bureaucrat Peter Leck has used his return to the stand at the health inquiry to deflect some of the blame for the Jayant Patel scandal, criticising his offsider Darren Keating, Queensland Health and even hospital medical staff.
Mr Leck, who initially asked to be exempt from giving evidence on the grounds of mental illness, testified from a closed court with only audio of his testimony beamed into an adjacent room at the Brisbane Magistrate's Court.
He gave evidence to the first inquiry in May. He told commissioner Geoff Davies that because he had no medical training, he relied on his director of medical services, Dr Keating, to bring any clinical issues to his attention. He said Dr Keating had repeatedly reassured him that concerns being raised about chief surgeon Dr Patel were nothing to worry about.
Mr Leck -- suspended from his general manager's position pending the inquiry's outcome – said he was under constant pressure from Queensland Health to bring the hospital in under budget and to avoid bad publicity.
But Mr Leck, who was warned last week by Mr Davies, QC, to expect rigorous cross-examination, had his own conduct spotlighted by senior counsel assisting David Andrews, SC – particularly the failure to subject Dr Patel to credentialling and privileging checks during his two-year tenure. It is a district manager's sole responsibility to ensure such checks take place.
Mr Leck said he had delegated the credentialling process to Dr Keating and had pressed him several times about the need to get it up and running. "I kept on pressing and he became a little short with me and basically said that he had a lot on his plate and that he couldn't work the hours that I worked because he had family," Mr Leck said.
Mr Leck was also questioned about why he failed to report to his superiors the death of Gerry Kemps - one of Dr Patel's patients who died after surgery in late 2004 - which was required in the event of an unexpected death.
Late yesterday senior counsel assisting, David Andrews, SC, showed the inquiry an e-mail from Mr Leck to his director of nursing, Linda Mulligan, on January 13 this year in which he said they needed to "quieten down" any potential rumours circulating about Dr Patel. Mr Leck said he wrote the e-mail in response to a group e-mail from a staffer. Mr Leck said he assumed the first e-mail referred to Dr Patel because he had told other staff about the allegations that had been made about him.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Even when people are dying, nobody's to blame in a bureaucracy
BUNDABERG Hospital's top bureaucrat Peter Leck has used his return to the stand at the health inquiry to deflect some of the blame for the Jayant Patel scandal, criticising his offsider Darren Keating, Queensland Health and even hospital medical staff.
Mr Leck, who initially asked to be exempt from giving evidence on the grounds of mental illness, testified from a closed court with only audio of his testimony beamed into an adjacent room at the Brisbane Magistrate's Court.
He gave evidence to the first inquiry in May. He told commissioner Geoff Davies that because he had no medical training, he relied on his director of medical services, Dr Keating, to bring any clinical issues to his attention. He said Dr Keating had repeatedly reassured him that concerns being raised about chief surgeon Dr Patel were nothing to worry about.
Mr Leck -- suspended from his general manager's position pending the inquiry's outcome – said he was under constant pressure from Queensland Health to bring the hospital in under budget and to avoid bad publicity.
But Mr Leck, who was warned last week by Mr Davies, QC, to expect rigorous cross-examination, had his own conduct spotlighted by senior counsel assisting David Andrews, SC – particularly the failure to subject Dr Patel to credentialling and privileging checks during his two-year tenure. It is a district manager's sole responsibility to ensure such checks take place.
Mr Leck said he had delegated the credentialling process to Dr Keating and had pressed him several times about the need to get it up and running. "I kept on pressing and he became a little short with me and basically said that he had a lot on his plate and that he couldn't work the hours that I worked because he had family," Mr Leck said.
Mr Leck was also questioned about why he failed to report to his superiors the death of Gerry Kemps - one of Dr Patel's patients who died after surgery in late 2004 - which was required in the event of an unexpected death.
Late yesterday senior counsel assisting, David Andrews, SC, showed the inquiry an e-mail from Mr Leck to his director of nursing, Linda Mulligan, on January 13 this year in which he said they needed to "quieten down" any potential rumours circulating about Dr Patel. Mr Leck said he wrote the e-mail in response to a group e-mail from a staffer. Mr Leck said he assumed the first e-mail referred to Dr Patel because he had told other staff about the allegations that had been made about him.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Tuesday, October 18, 2005
BRITAIN: ONLY 24 YEARS TO DIAGNOSE A COMMON ILLNESS
For years Nicola Howells was told her illness was "in her head". She was just 11 months old when she had her first seizure, but it was another 24 years before doctors finally diagnosed her with epilepsy. She was sent for psychiatric treatment, told she was suffering from vertigo and panic attacks, and put on anti-depressants.
But it was not until her father died from a hereditary tumour that doctors finally scanned her and diagnosed epilepsy. And it was nearly two months before she saw a specialist.
"It got to the point that they told me it was all in my head. "My teenage years and my childhood were stolen from me. If I had been diagnosed younger, I would have come to terms with it more easily and would have learnt to take my medication, but as an adult I felt that my whole world had been rocked. "They sent me to a child psychiatrist and I was told that it was all in my head. I know so many people who have gone through so many similar scenarios.
"My mum tried to fight my corner and she is riddled with guilt because when they said it was all in my mind she began to think it was."
Epilepsy experts say Nicola's story is not uncommon. They are calling for more money and expertise to be ploughed into the UK's services. National Institute for Health and Clinical Excellence (NICE) guidance states that misdiagnosis rates for epilepsy in the UK are between 20-31%.
Patients currently have to wait between eight to 10 weeks from diagnosis until their first hospital appointment. They wait about five weeks for an EEG (to monitor electrical activity in the brain) and 24 weeks for a magnetic resonance imaging scan (MRI), which can reveal structural abnormalities in the brain. NICE standards call for waiting times of no more than a month. Neurologists, nurses and epilepsy charities say the specialty needs an investment of 150 million pounds to overcome serious gaps in the service.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
For years Nicola Howells was told her illness was "in her head". She was just 11 months old when she had her first seizure, but it was another 24 years before doctors finally diagnosed her with epilepsy. She was sent for psychiatric treatment, told she was suffering from vertigo and panic attacks, and put on anti-depressants.
But it was not until her father died from a hereditary tumour that doctors finally scanned her and diagnosed epilepsy. And it was nearly two months before she saw a specialist.
"It got to the point that they told me it was all in my head. "My teenage years and my childhood were stolen from me. If I had been diagnosed younger, I would have come to terms with it more easily and would have learnt to take my medication, but as an adult I felt that my whole world had been rocked. "They sent me to a child psychiatrist and I was told that it was all in my head. I know so many people who have gone through so many similar scenarios.
"My mum tried to fight my corner and she is riddled with guilt because when they said it was all in my mind she began to think it was."
Epilepsy experts say Nicola's story is not uncommon. They are calling for more money and expertise to be ploughed into the UK's services. National Institute for Health and Clinical Excellence (NICE) guidance states that misdiagnosis rates for epilepsy in the UK are between 20-31%.
Patients currently have to wait between eight to 10 weeks from diagnosis until their first hospital appointment. They wait about five weeks for an EEG (to monitor electrical activity in the brain) and 24 weeks for a magnetic resonance imaging scan (MRI), which can reveal structural abnormalities in the brain. NICE standards call for waiting times of no more than a month. Neurologists, nurses and epilepsy charities say the specialty needs an investment of 150 million pounds to overcome serious gaps in the service.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Monday, October 17, 2005
British babies fall sick as doctors ignore superbug hygiene
Newborn babies at 90% of hospitals are carrying the superbug MRSA, according to a study which found that doctors and nurses are ignoring basic hygiene measures to combat the spread of infection. Fewer than half of doctors and 63% of nurses always wash their hands with antiseptic gels between patients, says the report. In some parts of the country only a third of hospitals have cleaners at night.
The findings by the Patients Association, which cover England's 28 strategic health authorities, will be a blow to Patricia Hewitt, the health secretary, who has made tackling MRSA and other hospital acquired infections a top priority. In May Hewitt announced a code of practice for hospitals to ensure that hygiene standards are met. Katherine Murphy, director of communications at the association, said: "Washing your hands properly is not complicated. We now have alcohol foams and gels that are very easy to use. "Another basic step is ensuring that wards are clean, but our report showed that in some hospitals there is no access to cleaners in the evening. This is not acceptable. What happens if there is a blood spillage after 7pm?"
MRSA is now so rife in hospitals that in 22 of the 28 health authorities questioned babies less than one week old have been found with the bug. The infants could have contracted MRSA from their mothers, from other patients or from doctors and nurses. While most of these babies would have been carrying the bug in their noses or on their skin without it causing harm, they are at risk of it developing into an infection.
Hewitt's warning to hospital managers followed the Patients Association's Clean Hospitals Summit in April at which the actress Leslie Ash, star of Men Behaving Badly, criticised the government for failing to keep hospitals clean. Ash fell victim to MSSA, a variant of MRSA. At the two-day event the association set hospital trusts a "100-day challenge" to improve standards. At the end of August, when the 100 days were up, it carried out an investigation to find out if improvements had been made. The full results will be published at a follow-up conference in London next month.
The study also showed that hospitals are overcrowded. In 58% of hospitals bed occupancy was in excess of 95% and in 90% of hospitals the rate was above 85%. Government guidelines advise managers that it should be no more than 82%.
MRSA is now so prevalent in wards that babies of less than one week old have been found with the bug in 90% of hospitals. Last week two newborn babies had to be put in isolation at St James's University Hospital, Leeds after they were found to be carrying the MRSA bug. In February a two-day-old baby became the youngest victim to die in hospital from MRSA. Luke Day had been born healthy, weighing 7lb 7oz. But he died just 36 hours later at Ipswich hospital in Suffolk. Microbiologists said that a doctor or nurse was the most likely source of the infection.
Last December 14-week-old Connor Bull became one of the youngest known MRSA victims when he caught the infection at Leeds General Infirmary. Claire Wilkinson, his mother, had to scrub down before she could touch him. He fought off the infection after 19 weeks in intensive care.
Mark Enright, an MRSA expert at Imperial College London, expressed his disappointment at the failure of hospitals to take basic measures to improve hygiene. "If we are not even delivering on improved hand washing and cleaning of hospitals then we are not really doing very much in the fight against MRSA," he said.
Professor Hugh Pennington, a microbiologist and expert in hospital acquired infection, added: "This confirms that MRSA is a problem that affects babies and young children and not just older people and patients who have had a lot of surgery." The Department of Health said: "We expect hospitals to enforce strict standards of hygiene and cleanliness. All National Health Service trusts now have directors of infection control and teams to ensure good practice is followed. [And black is white too]
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Newborn babies at 90% of hospitals are carrying the superbug MRSA, according to a study which found that doctors and nurses are ignoring basic hygiene measures to combat the spread of infection. Fewer than half of doctors and 63% of nurses always wash their hands with antiseptic gels between patients, says the report. In some parts of the country only a third of hospitals have cleaners at night.
The findings by the Patients Association, which cover England's 28 strategic health authorities, will be a blow to Patricia Hewitt, the health secretary, who has made tackling MRSA and other hospital acquired infections a top priority. In May Hewitt announced a code of practice for hospitals to ensure that hygiene standards are met. Katherine Murphy, director of communications at the association, said: "Washing your hands properly is not complicated. We now have alcohol foams and gels that are very easy to use. "Another basic step is ensuring that wards are clean, but our report showed that in some hospitals there is no access to cleaners in the evening. This is not acceptable. What happens if there is a blood spillage after 7pm?"
MRSA is now so rife in hospitals that in 22 of the 28 health authorities questioned babies less than one week old have been found with the bug. The infants could have contracted MRSA from their mothers, from other patients or from doctors and nurses. While most of these babies would have been carrying the bug in their noses or on their skin without it causing harm, they are at risk of it developing into an infection.
Hewitt's warning to hospital managers followed the Patients Association's Clean Hospitals Summit in April at which the actress Leslie Ash, star of Men Behaving Badly, criticised the government for failing to keep hospitals clean. Ash fell victim to MSSA, a variant of MRSA. At the two-day event the association set hospital trusts a "100-day challenge" to improve standards. At the end of August, when the 100 days were up, it carried out an investigation to find out if improvements had been made. The full results will be published at a follow-up conference in London next month.
The study also showed that hospitals are overcrowded. In 58% of hospitals bed occupancy was in excess of 95% and in 90% of hospitals the rate was above 85%. Government guidelines advise managers that it should be no more than 82%.
MRSA is now so prevalent in wards that babies of less than one week old have been found with the bug in 90% of hospitals. Last week two newborn babies had to be put in isolation at St James's University Hospital, Leeds after they were found to be carrying the MRSA bug. In February a two-day-old baby became the youngest victim to die in hospital from MRSA. Luke Day had been born healthy, weighing 7lb 7oz. But he died just 36 hours later at Ipswich hospital in Suffolk. Microbiologists said that a doctor or nurse was the most likely source of the infection.
Last December 14-week-old Connor Bull became one of the youngest known MRSA victims when he caught the infection at Leeds General Infirmary. Claire Wilkinson, his mother, had to scrub down before she could touch him. He fought off the infection after 19 weeks in intensive care.
Mark Enright, an MRSA expert at Imperial College London, expressed his disappointment at the failure of hospitals to take basic measures to improve hygiene. "If we are not even delivering on improved hand washing and cleaning of hospitals then we are not really doing very much in the fight against MRSA," he said.
Professor Hugh Pennington, a microbiologist and expert in hospital acquired infection, added: "This confirms that MRSA is a problem that affects babies and young children and not just older people and patients who have had a lot of surgery." The Department of Health said: "We expect hospitals to enforce strict standards of hygiene and cleanliness. All National Health Service trusts now have directors of infection control and teams to ensure good practice is followed. [And black is white too]
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Sunday, October 16, 2005
IMPENETRABLY BUREAUCRATIZED AMERICAN MEDICINE
When Bracha Klausner returned home after an extended hospital stay for a ruptured intestine three years ago, she found stacks of mail from doctors and hospitals waiting for her. There were so many envelopes - some of them very thick - that at first, Mrs. Klausner, 77, could not bring herself to open them, and she stored them in large shopping bags in her Manhattan apartment. When she finally did open some of the envelopes, there were pages filled with dozens of carefully detailed items, each accompanied by a service code: "Partial thrombo 2300214 102.00," "KUB Flat 2651040 466.00." On the 15th page or so of each bill, a "balance forward" line listed amounts in the tens of thousands of dollars. One totaled $77,858.04.
Another mailing, from her insurance company, clearly said, in large type, "This is not a bill." But she could make no sense of the remark codes: "G7 - Your benefit is based on the difference between Medicare's allowable expense and the amount Medicare paid" or "QN - Your claim may have been separated for processing purposes."
Mrs. Klausner's experience is shared by millions of Americans who, frustrated and confused, find themselves devoting enormous amounts of time and energy to sorting out their medical bills. Walk into any drugstore, and the next few minutes of your life are fairly predictable. After considering the choices, you make your purchases and head for the cashier. Seconds after the transaction, you are handed a receipt that reports to the penny what you paid for each product, along with its brand, its size, and the date, time and location of the purchase. But become a patient, and you enter a world of paperwork so surreal that it belongs in one of Kafka's tales of the triumph of faceless bureaucracies. And although some insurers and hospitals are trying to streamline and simplify bills, the efforts have been piecemeal.
Medical paperwork is a world of co-payments and co-insurers, deductibles, exclusions and contracted fees. Nothing is as it seems: patients receive statements that often do not reflect what is actually owed; telephone calls to customer service agents are at best time-consuming and at worst fruitless. The explanations of benefits that insurers send out - known as E.O.B.'s - are filled with unintelligible codes. The system is so impenetrable that it mystifies even the most knowledgeable. "I'm the president's senior adviser on health information technology, and when I get an E.O.B. for my 4-year-old's care, I can't figure out what happened, or what I'm supposed to do," said Dr. David Brailer, National Coordinator for Health Information Technology, whose office is in the Department of Health and Human Services. "I can't figure out what care it was related to or who did what."
Dr. Blackford Middleton, a professor at Harvard Medical School with special training in health services research, said he did not fare much better than Dr. Brailer. "I understand the words of diagnoses and procedures," he said. "But codes? No. Or how things are paid or not paid? I don't understand that." Dr. Brailer said he often used an analogy to describe the current state of medical billing. "Suppose you walk into a restaurant," he said, "and you don't get a menu, you don't get any choice of what food you'll eat, they don't tell you what it is when they're serving it to you, they don't tell you what it's going to cost." "Then, weeks or months later, you get a bill that tells you all the food you ate and the drinks you had, some of which you remember and some you don't, and although you get the bill, you still can't figure out what you really owe," Dr. Brailer said.
Some people make valiant efforts to sort through bills and claims, but end up throwing up their hands; others ignore them, until they are pursued by collection agencies; still others, basically healthy but weary at the prospect of a paperwork fusillade, stop going to the doctor altogether.
In the days before managed care, most insurance plans operated on a fee-for-service basis. Patients paid 20 percent of medical fees; insurers paid 80 percent. But as health care costs have continued to rise, many patients are being required to pay an ever-larger part of their medical bills, and deductibles continue to increase. And to keep the system churning, close to 30 cents of every dollar spent on health care goes for administration, much of it spent generating bills and explanations of benefits.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
When Bracha Klausner returned home after an extended hospital stay for a ruptured intestine three years ago, she found stacks of mail from doctors and hospitals waiting for her. There were so many envelopes - some of them very thick - that at first, Mrs. Klausner, 77, could not bring herself to open them, and she stored them in large shopping bags in her Manhattan apartment. When she finally did open some of the envelopes, there were pages filled with dozens of carefully detailed items, each accompanied by a service code: "Partial thrombo 2300214 102.00," "KUB Flat 2651040 466.00." On the 15th page or so of each bill, a "balance forward" line listed amounts in the tens of thousands of dollars. One totaled $77,858.04.
Another mailing, from her insurance company, clearly said, in large type, "This is not a bill." But she could make no sense of the remark codes: "G7 - Your benefit is based on the difference between Medicare's allowable expense and the amount Medicare paid" or "QN - Your claim may have been separated for processing purposes."
Mrs. Klausner's experience is shared by millions of Americans who, frustrated and confused, find themselves devoting enormous amounts of time and energy to sorting out their medical bills. Walk into any drugstore, and the next few minutes of your life are fairly predictable. After considering the choices, you make your purchases and head for the cashier. Seconds after the transaction, you are handed a receipt that reports to the penny what you paid for each product, along with its brand, its size, and the date, time and location of the purchase. But become a patient, and you enter a world of paperwork so surreal that it belongs in one of Kafka's tales of the triumph of faceless bureaucracies. And although some insurers and hospitals are trying to streamline and simplify bills, the efforts have been piecemeal.
Medical paperwork is a world of co-payments and co-insurers, deductibles, exclusions and contracted fees. Nothing is as it seems: patients receive statements that often do not reflect what is actually owed; telephone calls to customer service agents are at best time-consuming and at worst fruitless. The explanations of benefits that insurers send out - known as E.O.B.'s - are filled with unintelligible codes. The system is so impenetrable that it mystifies even the most knowledgeable. "I'm the president's senior adviser on health information technology, and when I get an E.O.B. for my 4-year-old's care, I can't figure out what happened, or what I'm supposed to do," said Dr. David Brailer, National Coordinator for Health Information Technology, whose office is in the Department of Health and Human Services. "I can't figure out what care it was related to or who did what."
Dr. Blackford Middleton, a professor at Harvard Medical School with special training in health services research, said he did not fare much better than Dr. Brailer. "I understand the words of diagnoses and procedures," he said. "But codes? No. Or how things are paid or not paid? I don't understand that." Dr. Brailer said he often used an analogy to describe the current state of medical billing. "Suppose you walk into a restaurant," he said, "and you don't get a menu, you don't get any choice of what food you'll eat, they don't tell you what it is when they're serving it to you, they don't tell you what it's going to cost." "Then, weeks or months later, you get a bill that tells you all the food you ate and the drinks you had, some of which you remember and some you don't, and although you get the bill, you still can't figure out what you really owe," Dr. Brailer said.
Some people make valiant efforts to sort through bills and claims, but end up throwing up their hands; others ignore them, until they are pursued by collection agencies; still others, basically healthy but weary at the prospect of a paperwork fusillade, stop going to the doctor altogether.
In the days before managed care, most insurance plans operated on a fee-for-service basis. Patients paid 20 percent of medical fees; insurers paid 80 percent. But as health care costs have continued to rise, many patients are being required to pay an ever-larger part of their medical bills, and deductibles continue to increase. And to keep the system churning, close to 30 cents of every dollar spent on health care goes for administration, much of it spent generating bills and explanations of benefits.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Saturday, October 15, 2005
THE ARROGANCE OF SOCIALIZED MEDICINE
Give the people choice
The [British] nurse who this week won her legal battle to be prescribed the breast cancer drug Herceptin has struck something of a blow for patient rights. Health authorities may claim, as they have been doing, that Barbara Clark’s win does not set a legal precedent for the 10,000 other women each year who might benefit from Herceptin but are currently denied it. In practice, however, it will be difficult for health officials around the country to deny the drug to other patients which, at a cost of about £20,000 a year, could dent a few budgets.
Never mind that. What is alarming about this case was health officials’ decision to give Ms Clark the drug owing to exceptional circumstances: she has a terminally ill 11-year-old foster son. The day the NHS officially decides to treat people according to their personal “worth”, or society’s need for them, rather than their medical need, will be the day the health service dies.
I say “officially” because in practice, of course, hospital consultants faced with long waiting lists make such judgments all the time. A child will be operated on before an 80-year-old and a smoker will be told to quit before being given a heart bypass. But those decisions are based on a calculation of future quality (and quantity) of life. In the end they are, as far as is possible, medical computations, not moral judgments about who “deserves” treatment. Is a childless person to be worth less than a mother? Which of them is more likely to be paying for the NHS? You cannot pick and choose without losing the consensus that supports the health service in the first place.
So let all have Herceptin if it would help them, even at a cost of £200 million a year. The only reason local health trusts are not able to offer the drug routinely (apart from its cost) is that it is caught up in the Government’s lengthy regulatory procedures. The manufacturer, Roche, says it has not yet collected the safety data needed to apply for a licence for its use to treat early breast cancer. Once a licence is granted, the drug has still to go through the National Institute for Health and Clinical Excellence system, which will decide whether it is sufficiently effective and cost effective to be made available nationally. In other words, okaying it will take years. Yet the data available is so persuasive that good private health insurers already pay for it.
The way we, as patients, allow the Government to dictate which medicines should and should not be available to us is overdue a rethink. The current system of regulating all medicines as prescription only, available over the counter from a pharmacist, or general sales dates back to the 1960s, when far less information was available to patients about the benefits and potential side-effects of treatments.
But patients today have acccess, via the internet, to a barrage of information inconceivable in 1968. Anyone who has a serious condition diagnosed can quickly become a patient-expert, and many do. I have one friend who discovered the expert’s expert in her disease, a doctor in the US, and rang his office. She was astonished when he actually came to the phone to speak to her, and was extremely helpful, even genuinely interested in her symptoms.
To continue to suggest that patients should be passive recipients of whatever is doled out to them by the NHS, or would become pill-popping morons without the toughest state control, is offensive. Nobody wants to take a breast cancer drug that doesn’t have a good chance of doing them some good. Few would risk the unwanted side-effects of most medicines without good evidence that it might help them. Publish all the data (and I mean all of it) and let people decide. Then let them go to a doctor if they wish to seek further advice on their decision.
The licensing system anyway ignores the fact that the full side-effects of a drug are not known until hundreds of thousands of people have taken it; look at what happened with Vioxx, a painkiller given to arthritis sufferers and withdrawn last year after it was linked to an increased risk of heart attacks and stroke. Why not set up a website for patients to record their experiences with different drugs?
I remember, years ago, being advised to take Larium, a malaria prophylactic, by a doctor. Doesn’t Larium have nasty side-effects, I asked him. Oh, it makes one in a few thousand go mad, he replied airily. One of those affected happened to be my friend, who suffered some kind of nervous system collapse and all but lost the ability to speak; and of the others I knew who had been prescribed it, all experienced frightening side-effects. I don’t care what it says on the packet. No thanks.
A Commons Health Select Committee report this year found the relationship between pharmaceutical companies and the medical profession to be too close for comfort (www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf). The Department of Health spends £4.5 million a year providing independent medicines information to prescribers; the drugs industry spends £1.65 billion, often cushioned with free trips abroad or other goodies for your doctor. Are you sure that he knows best?
Liberalising the market in medicines raises questions about cost as well as safety. But this is a debate the country is going to have to have. The cost of medicines to the NHS has risen by 46 per cent since 2000 to £8 billion a year, or 11 per cent of its budget. Keeping drugs as prescription only can work in the interests of the pharmaceutical companies, allowing manufacturers to set prices that the NHS can bear, rather than what individuals will pay. If a drug was too expensive for you or I to buy over the counter, then we would ask for something else. When the antihistamine Claritin was changed to an over-the-counter drug in the US three years ago, the price for a year’s supply fell from $1,066 to $365.
The Government has accepted the case for reclassifying more drugs “down” from prescription to over the counter, but has set an entirely arbitrary figure, up from five to ten annually. Why ten? Why not eleven? Or 111? Deregulate more of the most common drugs and give people the option of buying them rather than queueing at the doctor’s for a prescription. Giving patients more control could turn out to be healthier all round
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Give the people choice
The [British] nurse who this week won her legal battle to be prescribed the breast cancer drug Herceptin has struck something of a blow for patient rights. Health authorities may claim, as they have been doing, that Barbara Clark’s win does not set a legal precedent for the 10,000 other women each year who might benefit from Herceptin but are currently denied it. In practice, however, it will be difficult for health officials around the country to deny the drug to other patients which, at a cost of about £20,000 a year, could dent a few budgets.
Never mind that. What is alarming about this case was health officials’ decision to give Ms Clark the drug owing to exceptional circumstances: she has a terminally ill 11-year-old foster son. The day the NHS officially decides to treat people according to their personal “worth”, or society’s need for them, rather than their medical need, will be the day the health service dies.
I say “officially” because in practice, of course, hospital consultants faced with long waiting lists make such judgments all the time. A child will be operated on before an 80-year-old and a smoker will be told to quit before being given a heart bypass. But those decisions are based on a calculation of future quality (and quantity) of life. In the end they are, as far as is possible, medical computations, not moral judgments about who “deserves” treatment. Is a childless person to be worth less than a mother? Which of them is more likely to be paying for the NHS? You cannot pick and choose without losing the consensus that supports the health service in the first place.
So let all have Herceptin if it would help them, even at a cost of £200 million a year. The only reason local health trusts are not able to offer the drug routinely (apart from its cost) is that it is caught up in the Government’s lengthy regulatory procedures. The manufacturer, Roche, says it has not yet collected the safety data needed to apply for a licence for its use to treat early breast cancer. Once a licence is granted, the drug has still to go through the National Institute for Health and Clinical Excellence system, which will decide whether it is sufficiently effective and cost effective to be made available nationally. In other words, okaying it will take years. Yet the data available is so persuasive that good private health insurers already pay for it.
The way we, as patients, allow the Government to dictate which medicines should and should not be available to us is overdue a rethink. The current system of regulating all medicines as prescription only, available over the counter from a pharmacist, or general sales dates back to the 1960s, when far less information was available to patients about the benefits and potential side-effects of treatments.
But patients today have acccess, via the internet, to a barrage of information inconceivable in 1968. Anyone who has a serious condition diagnosed can quickly become a patient-expert, and many do. I have one friend who discovered the expert’s expert in her disease, a doctor in the US, and rang his office. She was astonished when he actually came to the phone to speak to her, and was extremely helpful, even genuinely interested in her symptoms.
To continue to suggest that patients should be passive recipients of whatever is doled out to them by the NHS, or would become pill-popping morons without the toughest state control, is offensive. Nobody wants to take a breast cancer drug that doesn’t have a good chance of doing them some good. Few would risk the unwanted side-effects of most medicines without good evidence that it might help them. Publish all the data (and I mean all of it) and let people decide. Then let them go to a doctor if they wish to seek further advice on their decision.
The licensing system anyway ignores the fact that the full side-effects of a drug are not known until hundreds of thousands of people have taken it; look at what happened with Vioxx, a painkiller given to arthritis sufferers and withdrawn last year after it was linked to an increased risk of heart attacks and stroke. Why not set up a website for patients to record their experiences with different drugs?
I remember, years ago, being advised to take Larium, a malaria prophylactic, by a doctor. Doesn’t Larium have nasty side-effects, I asked him. Oh, it makes one in a few thousand go mad, he replied airily. One of those affected happened to be my friend, who suffered some kind of nervous system collapse and all but lost the ability to speak; and of the others I knew who had been prescribed it, all experienced frightening side-effects. I don’t care what it says on the packet. No thanks.
A Commons Health Select Committee report this year found the relationship between pharmaceutical companies and the medical profession to be too close for comfort (www.publications.parliament.uk/pa/cm200405/cmselect/cmhealth/42/42.pdf). The Department of Health spends £4.5 million a year providing independent medicines information to prescribers; the drugs industry spends £1.65 billion, often cushioned with free trips abroad or other goodies for your doctor. Are you sure that he knows best?
Liberalising the market in medicines raises questions about cost as well as safety. But this is a debate the country is going to have to have. The cost of medicines to the NHS has risen by 46 per cent since 2000 to £8 billion a year, or 11 per cent of its budget. Keeping drugs as prescription only can work in the interests of the pharmaceutical companies, allowing manufacturers to set prices that the NHS can bear, rather than what individuals will pay. If a drug was too expensive for you or I to buy over the counter, then we would ask for something else. When the antihistamine Claritin was changed to an over-the-counter drug in the US three years ago, the price for a year’s supply fell from $1,066 to $365.
The Government has accepted the case for reclassifying more drugs “down” from prescription to over the counter, but has set an entirely arbitrary figure, up from five to ten annually. Why ten? Why not eleven? Or 111? Deregulate more of the most common drugs and give people the option of buying them rather than queueing at the doctor’s for a prescription. Giving patients more control could turn out to be healthier all round
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Friday, October 14, 2005
CRAZY HEALTHCARE COSTS
I don't know what to make of the news item below at all. $15,897 for two X-rays sure sounds amazing. I have just phoned my local private Catholic hospital here in Brisbane and they quoted me $100 for such a service. An X-ray machine is just a big old-fashioned camera after all. Perhaps the story following the news item explains the American way. The story was in fact sent to me by an American medical specialist
A group of former patients of the California Hospital Medical Center on Tuesday filed a class-action lawsuit against Catholic Healthcare West alleging that the hospital chain overcharged uninsured patients and engaged in unfair business practices that violate California's consumer protection laws, the Los Angeles Times reports. Activist K.B. Forbes, head of the advocacy group Consejo de Latinos Unidos, organized the suit on behalf of three Latino plaintiffs. One patient stayed in the hospital for two days with gastritis and was charged $20,296.50, compared with $5,600 for the same medical care from an average private insurer and $3,994 for a Medicare beneficiary. Another patient was billed $15,897 for two X-rays of his shoulders, compared with $4,451 from a private insurer and $3,839 from Medicare (Lin, Los Angeles Times, 10/12). The suit aims to make CHW consider reforming its billing practices in California, Nevada and Arizona and reimburse the three patients, the AP/Contra Costa Times reports (Prengaman, AP/Contra Costa Times, 10/12).
Comments:
"It's price gouging," Forbes said, adding that CHW should have informed the patients of available charity care and government assistance programs. Forbes said he wants CHW to implement standards similar to those of Tenet Healthcare, which was sued in 2003 by Consejo de Latinos Unidos. Tenet subsequently started offering uninsured patients discounted rates after the suit. Forbes said, "None of these people are looking for a free ride. They are looking for a fair rate." CHW officials did not comment on the suit, but they said the company already offers free and discounted rates to the uninsured and has helped many such patients obtain state and federal coverage (Los Angeles Times, 10/12). Jan Emerson, spokesperson for the California Hospital Association, called the lawsuit "unfounded," adding, "The allegation of price gouging is absurd" (AP/Contra Costa Times, 10/12).
Source
THE CREW RACE - THE AMERICAN WAY
A Japanese company and an American company decided to have a crew race on the Missouri River. Both teams practiced long and hard to reach their peak performance before the race. On the big day the Japanese won by a mile. Afterward, the American team became very discouraged and morally depressed. The American management decided the reason for the crushing defeat had to be found. A Management Team made up of senior management was formed to investigate and recommend appropriate action. Their conclusion was the Japanese had 8 people rowing and 1 person steering, while the American team had 8 people steering and one person rowing.
So American management hired a consulting company and paid them an incredible amount of money. They advised that too many people were steering the boat, while not enough people were rowing. To prevent losing to the Japanese again next year, the American rowing team's management structure was totally reorganized to 4 steering supervisors, 3 area steering superintendents, and 1 assistant superintendent steering manager. They also implemented a new performance and productivity system that would give the 1 person rowing the boat greater incentive to work harder. It was called the Rowing Team Quality First Program, with meetings, dinners, PowerPoint presentations, and free pens for the rower. Even new paddles and medical benefit incentives were promised for a winner. We must give the rower the empowerment and enrichments through this quality program. The next year the rower rowed as hard as he could, but the Japanese won by two miles. Humiliated, the American management laid off the rower for poor performance, hired a Mexican rower replacement, halted development of a new canoe, sold the paddles, and canceled all rower medical benefits. The money saved was distributed to the senior executives as a bonus.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
I don't know what to make of the news item below at all. $15,897 for two X-rays sure sounds amazing. I have just phoned my local private Catholic hospital here in Brisbane and they quoted me $100 for such a service. An X-ray machine is just a big old-fashioned camera after all. Perhaps the story following the news item explains the American way. The story was in fact sent to me by an American medical specialist
A group of former patients of the California Hospital Medical Center on Tuesday filed a class-action lawsuit against Catholic Healthcare West alleging that the hospital chain overcharged uninsured patients and engaged in unfair business practices that violate California's consumer protection laws, the Los Angeles Times reports. Activist K.B. Forbes, head of the advocacy group Consejo de Latinos Unidos, organized the suit on behalf of three Latino plaintiffs. One patient stayed in the hospital for two days with gastritis and was charged $20,296.50, compared with $5,600 for the same medical care from an average private insurer and $3,994 for a Medicare beneficiary. Another patient was billed $15,897 for two X-rays of his shoulders, compared with $4,451 from a private insurer and $3,839 from Medicare (Lin, Los Angeles Times, 10/12). The suit aims to make CHW consider reforming its billing practices in California, Nevada and Arizona and reimburse the three patients, the AP/Contra Costa Times reports (Prengaman, AP/Contra Costa Times, 10/12).
Comments:
"It's price gouging," Forbes said, adding that CHW should have informed the patients of available charity care and government assistance programs. Forbes said he wants CHW to implement standards similar to those of Tenet Healthcare, which was sued in 2003 by Consejo de Latinos Unidos. Tenet subsequently started offering uninsured patients discounted rates after the suit. Forbes said, "None of these people are looking for a free ride. They are looking for a fair rate." CHW officials did not comment on the suit, but they said the company already offers free and discounted rates to the uninsured and has helped many such patients obtain state and federal coverage (Los Angeles Times, 10/12). Jan Emerson, spokesperson for the California Hospital Association, called the lawsuit "unfounded," adding, "The allegation of price gouging is absurd" (AP/Contra Costa Times, 10/12).
Source
THE CREW RACE - THE AMERICAN WAY
A Japanese company and an American company decided to have a crew race on the Missouri River. Both teams practiced long and hard to reach their peak performance before the race. On the big day the Japanese won by a mile. Afterward, the American team became very discouraged and morally depressed. The American management decided the reason for the crushing defeat had to be found. A Management Team made up of senior management was formed to investigate and recommend appropriate action. Their conclusion was the Japanese had 8 people rowing and 1 person steering, while the American team had 8 people steering and one person rowing.
So American management hired a consulting company and paid them an incredible amount of money. They advised that too many people were steering the boat, while not enough people were rowing. To prevent losing to the Japanese again next year, the American rowing team's management structure was totally reorganized to 4 steering supervisors, 3 area steering superintendents, and 1 assistant superintendent steering manager. They also implemented a new performance and productivity system that would give the 1 person rowing the boat greater incentive to work harder. It was called the Rowing Team Quality First Program, with meetings, dinners, PowerPoint presentations, and free pens for the rower. Even new paddles and medical benefit incentives were promised for a winner. We must give the rower the empowerment and enrichments through this quality program. The next year the rower rowed as hard as he could, but the Japanese won by two miles. Humiliated, the American management laid off the rower for poor performance, hired a Mexican rower replacement, halted development of a new canoe, sold the paddles, and canceled all rower medical benefits. The money saved was distributed to the senior executives as a bonus.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Thursday, October 13, 2005
SHRIEK! PATIENT CHOICE: HOW AWFUL!
Bureaucracies endangered!
NHS wards, departments and even entire hospitals may be forced to close under the latest health reforms designed to extend patient choice, the Government is warned today. In a damning report, the Audit Commission says the new funding method, where money follows the patient, is destabilising the NHS and fuelling the current financial crisis. Instead of increasing choice it could have the opposite effect, with services going to the wall unless the payment system is radically reformed, says the commission. It also cautions that critical services essential to support emergency admissions could close down in some hospitals because of the failure to attract patient referrals.
The system of “payment by results” was brought in by the Government for foundation trusts in 2004-05 to improve choice and efficiency in the NHS and is now being extended to all trusts. Commission insiders gave warning that if foundation trusts, the top- performing hospitals, were finding the system difficult to operate it would create turbulence when extended nationwide. Under the system hospitals charge a fixed price for an operation, which is agreed nationally, and claim the money back according to the number of patients treated.
Efficient, well-managed hospitals are expected to make a profit from the set price, which includes the costs of equipment and staff overheads. But weaker, inefficient hospitals risk exceeding the “tariff” and falling further into debt. NHS reforms are already causing disputes. An extraordinary battle has developed in Dorset between the primary care trust and the local hospital. GPs received a letter from the Bournemouth Teaching Primary Care Trust (PCT) giving warning that the local hospital, Bournemouth and Christchurch, was working too hard. Payment by results will mean that hospitals are paid by the numbers they treat so, paradoxically, hospitals doing well could be in trouble. “The hospital is undertaking a lot more work than we have agreed to purchase, and this is causing us a great deal of concern” wrote Debbie Fleming, the PCT’s chief executive, and Paul French, chairman of the executive committee, in a letter that has been seen by The Times. “If action is not taken now, the PCT will face a bill of around £2 million.”
The Audit Commission says that, so far, the system has proved chaotic because of poor budgeting, inadequate IT services and difficulties in predicting patient admissions. It also claims that hospitals already strapped for cash are having to invest £100,000 each in the new systems, equivalent to £50 million across England. The NHS is already facing a £254 million deficit, despite record levels of cash over the past few years. One in four NHS trusts is now in financial difficulties.
The commission advises the Government not to go ahead with plans to extend “payment by results” to emergency admissions next year without reform. Last night Howard Stoate, a Labour MP who is the only praticising GP in the House of Commons, said: “Payment by results does unfortunately have negative side-effects. There is the risk it could put pressure on some (hospital) departments where they are effectively competing against a neighbouring trust and could lose busines “There is also a risk it could destabilise and put pressure on primary care trusts because they pick up the bill at the end of the day.”
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Bureaucracies endangered!
NHS wards, departments and even entire hospitals may be forced to close under the latest health reforms designed to extend patient choice, the Government is warned today. In a damning report, the Audit Commission says the new funding method, where money follows the patient, is destabilising the NHS and fuelling the current financial crisis. Instead of increasing choice it could have the opposite effect, with services going to the wall unless the payment system is radically reformed, says the commission. It also cautions that critical services essential to support emergency admissions could close down in some hospitals because of the failure to attract patient referrals.
The system of “payment by results” was brought in by the Government for foundation trusts in 2004-05 to improve choice and efficiency in the NHS and is now being extended to all trusts. Commission insiders gave warning that if foundation trusts, the top- performing hospitals, were finding the system difficult to operate it would create turbulence when extended nationwide. Under the system hospitals charge a fixed price for an operation, which is agreed nationally, and claim the money back according to the number of patients treated.
Efficient, well-managed hospitals are expected to make a profit from the set price, which includes the costs of equipment and staff overheads. But weaker, inefficient hospitals risk exceeding the “tariff” and falling further into debt. NHS reforms are already causing disputes. An extraordinary battle has developed in Dorset between the primary care trust and the local hospital. GPs received a letter from the Bournemouth Teaching Primary Care Trust (PCT) giving warning that the local hospital, Bournemouth and Christchurch, was working too hard. Payment by results will mean that hospitals are paid by the numbers they treat so, paradoxically, hospitals doing well could be in trouble. “The hospital is undertaking a lot more work than we have agreed to purchase, and this is causing us a great deal of concern” wrote Debbie Fleming, the PCT’s chief executive, and Paul French, chairman of the executive committee, in a letter that has been seen by The Times. “If action is not taken now, the PCT will face a bill of around £2 million.”
The Audit Commission says that, so far, the system has proved chaotic because of poor budgeting, inadequate IT services and difficulties in predicting patient admissions. It also claims that hospitals already strapped for cash are having to invest £100,000 each in the new systems, equivalent to £50 million across England. The NHS is already facing a £254 million deficit, despite record levels of cash over the past few years. One in four NHS trusts is now in financial difficulties.
The commission advises the Government not to go ahead with plans to extend “payment by results” to emergency admissions next year without reform. Last night Howard Stoate, a Labour MP who is the only praticising GP in the House of Commons, said: “Payment by results does unfortunately have negative side-effects. There is the risk it could put pressure on some (hospital) departments where they are effectively competing against a neighbouring trust and could lose busines “There is also a risk it could destabilise and put pressure on primary care trusts because they pick up the bill at the end of the day.”
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Wednesday, October 12, 2005
AND THIS IS WHAT THE LEFTIST BA****DS WISH ON US!
I recently came face to face with a level of Western ignorance that I hadn't encountered since the 1980s, when Russian immigrants were still a novelty to Americans. A British-American asked my father a question that could only come from someone who has known freedom his whole life: "Why did you leave Russia? Your family was there, you had a job, you had free health care. Why did you leave?" The questioner, a former editor with the New York Times, then proceeded to assert that today's Britain and U.S. are no longer free.
The exchange reminded me just how out of touch many who live in the free world are with the reality of life under tyranny--and why, therefore, so many Americans and Brits think nothing is scarier than war. On the subject even of that oft-cited "perk" of Soviet life, universal health care, a picture of the system in practice on its happiest occasion would shock Americans and Western Europeans alike.
Since ordinary people in Russia didn't have cars, Dad called a taxi to take Mom to the hospital when her contractions started on Feb. 25, 1970. Some procedural questions were asked, then Mom was sent to a room called the rodilka, or "birther," where there were 10 or so women at various stages of dilation. For the night there were one doctor, one nurse, a female orderly and a lot of screaming. (Epidurals for painless labor were unheard of.) At this stage of pregnancy a woman loses control of some bodily functions even after taking preventive measures, so that one woman would be defecating into a pot by her bed while another would be eating dinner in the next bed. Medical students passed by casually observing.
After my elder sister was born and the nurses took her away, Mom began the two-day fluid-expulsion process, which in civilized countries is managed by a changing of the sheets as often as every two hours. Back in the USSR, the new mother would soak in her puddles on a small linen sheet and oil cloth, since patients weren't entitled to more than one or two changes per day. If she wanted an extra change, she'd have to beg and brown-nose the nannychka, as the orderly was addressed by the screaming women. Someone would always yell back: "I just gave you new sheets, and you soiled yourself again!"
Those who were able to bribe the nurse or orderly would get better service, but Mom didn't know and hadn't brought anything. One woman kept giving the nurse fruit so that she'd yell at her less and give her what she needed. Mom could only beg, the whole time feeling as if she'd done something wrong. Granted, the nurse was under an inordinate amount of stress. She was alone responsible for so many, and was running nonstop throughout the night.
For her second delivery, Mom never went into labor. She was two weeks overdue and the baby had stopped moving. Fearing the worst, she took the metro to the hospital.
"Are you in labor?"
"No."
Again Mom thought she'd done something wrong because people were yelling at her as soon as she walked in: "Then why did you come? You like hanging around hospitals, do you?"
"I don't feel anything moving."
"Oh. OK, wait for the doctor."
Fortunately, a younger nurse overheard the conversation. "What--it's not moving? How long? Since last night? OK, go over there and get undressed."
People stopped yelling at my mother then, and she got more attention.
"I don't hear the baby," said the old doctor who was on duty. "Is this your first child?"
"No."
"Did the first one live?"
"Yes."
"Good. Because the prognosis here isn't good."
Since there was no labor activity, labor was induced. In Russia this was called "stimulating labor," and it required one to drink castor oil. My mother has its taste on her tongue to this day, she told me. Her body contorted inexplicably, and she became catatonic, unable to move her arms or legs.
She could hear the yelling at the others as it continued in the background: "Stop screaming!" "You're not the first to give birth; you won't be the last!" "Shut your mouth!" After some time, Mom's catatonia relaxed and the contractions started. A few hours later the baby was born, and my mother heard the doctor call to an orderly: "Quick! You with the water--the baby is in asphyxia!" My mother lay emotionless, able only to hear spanking for what she believes to be nearly half an hour as the doctor tried to revive me. Finally, she heard crying.
Had my mother been a party boss's relative, her birthing experiences would have looked a lot more like the common woman's in America. But such was delivery for 99% of the Russian female population.
In America, women often remember abortion as traumatic. My mother barely remembers her two abortions (Russian birth control), but she can't forget a single traumatic detail of her children's births.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
I recently came face to face with a level of Western ignorance that I hadn't encountered since the 1980s, when Russian immigrants were still a novelty to Americans. A British-American asked my father a question that could only come from someone who has known freedom his whole life: "Why did you leave Russia? Your family was there, you had a job, you had free health care. Why did you leave?" The questioner, a former editor with the New York Times, then proceeded to assert that today's Britain and U.S. are no longer free.
The exchange reminded me just how out of touch many who live in the free world are with the reality of life under tyranny--and why, therefore, so many Americans and Brits think nothing is scarier than war. On the subject even of that oft-cited "perk" of Soviet life, universal health care, a picture of the system in practice on its happiest occasion would shock Americans and Western Europeans alike.
Since ordinary people in Russia didn't have cars, Dad called a taxi to take Mom to the hospital when her contractions started on Feb. 25, 1970. Some procedural questions were asked, then Mom was sent to a room called the rodilka, or "birther," where there were 10 or so women at various stages of dilation. For the night there were one doctor, one nurse, a female orderly and a lot of screaming. (Epidurals for painless labor were unheard of.) At this stage of pregnancy a woman loses control of some bodily functions even after taking preventive measures, so that one woman would be defecating into a pot by her bed while another would be eating dinner in the next bed. Medical students passed by casually observing.
After my elder sister was born and the nurses took her away, Mom began the two-day fluid-expulsion process, which in civilized countries is managed by a changing of the sheets as often as every two hours. Back in the USSR, the new mother would soak in her puddles on a small linen sheet and oil cloth, since patients weren't entitled to more than one or two changes per day. If she wanted an extra change, she'd have to beg and brown-nose the nannychka, as the orderly was addressed by the screaming women. Someone would always yell back: "I just gave you new sheets, and you soiled yourself again!"
Those who were able to bribe the nurse or orderly would get better service, but Mom didn't know and hadn't brought anything. One woman kept giving the nurse fruit so that she'd yell at her less and give her what she needed. Mom could only beg, the whole time feeling as if she'd done something wrong. Granted, the nurse was under an inordinate amount of stress. She was alone responsible for so many, and was running nonstop throughout the night.
For her second delivery, Mom never went into labor. She was two weeks overdue and the baby had stopped moving. Fearing the worst, she took the metro to the hospital.
"Are you in labor?"
"No."
Again Mom thought she'd done something wrong because people were yelling at her as soon as she walked in: "Then why did you come? You like hanging around hospitals, do you?"
"I don't feel anything moving."
"Oh. OK, wait for the doctor."
Fortunately, a younger nurse overheard the conversation. "What--it's not moving? How long? Since last night? OK, go over there and get undressed."
People stopped yelling at my mother then, and she got more attention.
"I don't hear the baby," said the old doctor who was on duty. "Is this your first child?"
"No."
"Did the first one live?"
"Yes."
"Good. Because the prognosis here isn't good."
Since there was no labor activity, labor was induced. In Russia this was called "stimulating labor," and it required one to drink castor oil. My mother has its taste on her tongue to this day, she told me. Her body contorted inexplicably, and she became catatonic, unable to move her arms or legs.
She could hear the yelling at the others as it continued in the background: "Stop screaming!" "You're not the first to give birth; you won't be the last!" "Shut your mouth!" After some time, Mom's catatonia relaxed and the contractions started. A few hours later the baby was born, and my mother heard the doctor call to an orderly: "Quick! You with the water--the baby is in asphyxia!" My mother lay emotionless, able only to hear spanking for what she believes to be nearly half an hour as the doctor tried to revive me. Finally, she heard crying.
Had my mother been a party boss's relative, her birthing experiences would have looked a lot more like the common woman's in America. But such was delivery for 99% of the Russian female population.
In America, women often remember abortion as traumatic. My mother barely remembers her two abortions (Russian birth control), but she can't forget a single traumatic detail of her children's births.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Tuesday, October 11, 2005
BRITAIN'S GOVERNMENT-RUN HEALTH INSURANCE LEAVES CANCER SUFFERERS IN THE LURCH
Maintaining their vast bureaucracy matters more to them than curing the sick
Joanne Lees, a pay-roll clerk, relies on the National Health Service. But, as she has discovered, deep pockets can be required here, too - particularly if the worst does occur. When she received a telephone call at work in August last year asking her to go to hospital immediately, she expected to receive bad news. But she did not expect it to be quite so awful. Lees, 31, learnt that she had a fast-growing tumour in her right breast. She had a mastectomy a couple of weeks later; but there were two complicating factors.
First, she was six months' pregnant. Her baby son Nathan had to be delivered by caesarean section 10 weeks early so that she could undergo chemotherapy and radiotherapy. Additionally, it was her second bout of cancer. She had lost her left breast when she was 26. Lees had a quiet Christmas with Nathan and her husband Sean, but thought that she might not be around to enjoy another one. She was told that the likelihood of the disease returning was 81%.
Her breast cancer nurse offered a glimmer of hope, however. Early results from clinical trials showed that a new drug, Herceptin, could reduce the chances of cancer coming back in some patients. A test showed that Lees was positive for the HER-2 gene, which put her among the 25% of breast cancer patients who could benefit from this new wonder drug. Her oncologist at the University hospital of North Staffordshire was prepared to prescribe the medicine. There was just one problem: the NHS would not pay for it.
Lees and her husband had no idea where they would find the 40,000 pounds asked for a two-year course of treatment. "We are just a normal family," she said. "Very few people would be able to pay for this medicine from savings." They were not alone, however. Family, friends, colleagues and even their local pub in Alsager, Staffordshire, have rallied round. With their help, Lees is paying for her Herceptin on a three-weekly basis. If necessary, the couple will remortgage their home to meet the next instalment.
The potential burden is enormous. If the optimistic predictions of experts are correct, Lees could be taking Herceptin, at a cost of 20,000 pounds annually, for years to come. "I don't dare think about the future. I want to be here for my little boy. All I am asking for is the chance to be there for Nathan, to see him grow up," she said.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Maintaining their vast bureaucracy matters more to them than curing the sick
Joanne Lees, a pay-roll clerk, relies on the National Health Service. But, as she has discovered, deep pockets can be required here, too - particularly if the worst does occur. When she received a telephone call at work in August last year asking her to go to hospital immediately, she expected to receive bad news. But she did not expect it to be quite so awful. Lees, 31, learnt that she had a fast-growing tumour in her right breast. She had a mastectomy a couple of weeks later; but there were two complicating factors.
First, she was six months' pregnant. Her baby son Nathan had to be delivered by caesarean section 10 weeks early so that she could undergo chemotherapy and radiotherapy. Additionally, it was her second bout of cancer. She had lost her left breast when she was 26. Lees had a quiet Christmas with Nathan and her husband Sean, but thought that she might not be around to enjoy another one. She was told that the likelihood of the disease returning was 81%.
Her breast cancer nurse offered a glimmer of hope, however. Early results from clinical trials showed that a new drug, Herceptin, could reduce the chances of cancer coming back in some patients. A test showed that Lees was positive for the HER-2 gene, which put her among the 25% of breast cancer patients who could benefit from this new wonder drug. Her oncologist at the University hospital of North Staffordshire was prepared to prescribe the medicine. There was just one problem: the NHS would not pay for it.
Lees and her husband had no idea where they would find the 40,000 pounds asked for a two-year course of treatment. "We are just a normal family," she said. "Very few people would be able to pay for this medicine from savings." They were not alone, however. Family, friends, colleagues and even their local pub in Alsager, Staffordshire, have rallied round. With their help, Lees is paying for her Herceptin on a three-weekly basis. If necessary, the couple will remortgage their home to meet the next instalment.
The potential burden is enormous. If the optimistic predictions of experts are correct, Lees could be taking Herceptin, at a cost of 20,000 pounds annually, for years to come. "I don't dare think about the future. I want to be here for my little boy. All I am asking for is the chance to be there for Nathan, to see him grow up," she said.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
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