Tuesday, September 01, 2009

Prisoners have a better diet than British public hospital patients

Patients in Health Service hospitals are far more likely to go hungry than criminals in jail, scientists warned yesterday. They say frail and elderly patients do not get the help they need with meals, and nobody checks whether they get enough to eat. Despite years of Government promises to tackle poor hospital nutrition, food still arrives cold, and patients often miss out because meal times clash with tests and operations.

Meanwhile, prisoners are enjoying carbohydrate-rich, low-fat foods which in many cases are better than they would have been eating on the outside.

The Daily Mail has been highlighting the scandal of old people not being fed properly in hospital as part of its Dignity for the Elderly campaign. Hospital meals are often taken away untouched, because they are either unappetising or are placed out of patients' reach. The latest figures show 242 patients died of malnutrition in NHS hospitals in 2007 - the highest toll in a decade. More than 8,000 left hospital under-nourished - double the figure when Labour came to power. The NHS throws away 11million meals every year, and many nurses say they are too busy to help the frail eat.

Earlier this year the Mail revealed that some hospitals spend less on meals than the average prison. Ten hospitals spent less on breakfast, lunch and an evening meal than the £2.12 a day allocated for food by the prison service. One spent just £1. Although most hospitals do spend more than £2.12, prisoners end up better nourished than patients, say experts from Bournemouth University. After studying the food offered to inmates and across the NHS, they found patients face more barriers in getting good nutrition.

Professor John Edwards said around 40 per cent of patients were already malnourished when they were admitted to hospital, but their condition did not tend to improve while they were there. 'If you are in prison then the diet you get is extremely good in terms of nutritional content,' he said. 'The food that is provided is actually better than most civilians have. 'There's a focus on carbohydrates, then there's the way they prepare the food, it's very healthy. They don't add salt and there's relatively little frying of food - if you have a burger then it goes in the oven. Hospital patients don't consume enough. 'And from the work we've done we know that people who sit round a table eat a lot more, but this doesn't happen in hospitals.'

His colleague, Dr Heather Hartwell, said fruit and vegetables were given out in hospitals 'but this doesn't mean it's eaten'.

While patients suffer due to a loss of appetite as a result of their illness, they often go hungry because there is no one to help them eat. Dr Hartwell said once food was prepared, it generally hangs around waiting for porters to transport it to patients. Then it may be left on wards until it goes cold. 'Ward staff also don't actually know how much patients are eating because it is domestics who clear the trays away,' she said. 'This is an example of fragmentation in hospitals that does not necessarily happen in prisons.'

The research found temperature and texture are among the most important factors in patients' satisfaction with food. It concluded lack of appetite due to a medical problem is probably the main reason for under-nutrition, but said hospitals can make improvements.

Liberal Democrat health spokesman Norman Lamb said: 'It's incredible that so many hospitals are failing to serve healthy meals. If prisons can serve good food then so can hospitals.'

The Department of Health said: 'The majority of patients are satisfied with the food they receive in hospitals, and we are working to improve services further. 'The Nutrition Action Plan, Improving Nutritional Care, outlines how nutritional care and hydration can be improved and highlights five key priority areas for NHS and social care staff to work with. 'We have also introduced the concept of "protected mealtimes" where all non-urgent activity on the ward stops, so that patients can enjoy their meals.'


Australia: The moronic Queensland government ambulance service again

Young mother angry at 'stupid' grilling during emergency call -- but the QAS are not backing down or apologizing -- even though they cannot provide details to refute her claims. Sounds like she got a Pakistani callcentre operator. I am pretty sure the QAS record all calls so they must know exactly what happened and are just "hanging tough" -- in the light of the big spray of complaints that have recently been made against them. They think a policy of "no admissions" is going to help them ride out the storm caused by their own bureaucratic incompetence

A REDBANK Plains mother said she had to answer a list of "stupid" questions before she could get an ambulance for her newborn baby who was vomiting and shaking uncontrollably. Suzanne Lang said her son, Zavier, only 30 hours old, had his eyes rolling up as she struggled with a 000 dispatcher she could barely understand.

One question was whether her baby was talking or not, she said. After the ambulance arrived, she said she had a harrowing unsecured ride to Ipswich Hospital on a stretcher. Lacking a seat belt, "I literally fell across the ambulance with my baby in my arms", she said.

The emergency occurred about 10pm on August 19, the night after her baby's birth. Mrs Lang said she feared her child's convulsions were a seizure because one of her other children suffers from seizures. Doctors actually determined the cause was an allergic reaction to sterilisation chemicals.

The Queensland Ambulance Service said the ambulance arrived at the home in 10 minutes and dispatchers spent only two minutes on the phone before it was sent. "The QAS will investigate claims relating to restraints used in this case," a spokeswoman said.

The family said it was the second negative experience with the Queensland Ambulance Service in a year. Mrs Lang said she had to drive her partner, Marcus, to the hospital after he injured his back and she gave up waiting on an ambulance after 40 minutes. The hospital reprimanded the couple for driving him because of the potential for greater damage to his vertebrae.

Mrs Lang said some of the dispatcher's questions about her baby's condition were appropriate but others seemed a waste of critical time. She said the dispatcher seemed to become irritated when she couldn't answer whether the baby had a heart condition. "I said, not that I know of. I mean, he's only 30 hours old," she said.

Queensland Ambulance Service defended the way its dispatchers answered 000 calls. It could not provide a list of specific questions asked because more than 30 scripts were used depending on the emergency. However, it said of the 400-600 calls received a day from 000, audits showed 95 per cent were well handled. [And the 5%? Anybody disciplined?]


Vive Le French Care?

Health care in France is often held up as a model the U.S. might follow. Yet the French have their own problems that show there's no such thing as a free lunch — or a free doctor's visit

Call it the grass-is-greener syndrome. Advocates of national health care, acknowledging the flaws in ObamaCare yet despising the current U.S. system that has the best medicines, the best medical equipment and the shortest waiting lists, have turned their eyes lovingly to places like France. As City Journal contributing editor Guy Sorman notes, the French would also love to have the low-cost, high-service system some Americans gush about. Unfortunately, they don't. France's system isn't that cheap and is financed by high taxes on labor that have heavy economic consequences.

Sorman notes that a Frenchman making a monthly salary of 3,000 euros has 350 of them deducted for health insurance. Then the employer throws in an additional 1,200 euros. This raises the cost of labor to prohibitive levels and puts a brake on economic growth. This helps explain why French unemployment hovers around 10%.

France imposes an additional tax levy to cover the constant deficits that national health insurance runs. The French Parliament raises this levy, which applies to all forms of income, every year. Altogether, Sorman writes, "25% of French national income goes toward what's called Social Security, which includes health care and basic retirement pensions for all."

Drugs developed in America at enormous expense do cost less in France, which decides what drugs are to be used and at what prices. American patients in effect subsidize the French, who take the same pills at half the price because American pharmaceutical companies don't want to lose the French market.

French taxpayers fund a state health insurer, Assurance Maladie. Assurance Maladie has run in the red since 1989, and this year's shortfall is expected to be 9.4 billion euros ($13.5 billion) and 15 billion euros in 2010, about 10% of its budget.

Regardless of the cost, does the French system produce better outcomes? Not always. Infant mortality rates are often cited as a reason socialized medicine and single-payer systems are better than what we have here. But according to Dr. Linda Halderman, a policy adviser in the California State Senate, these comparisons are bogus.

Official World Health Organization statistics show the U.S. lagging behind France in infant mortality rates — 6.7 per 1,000 live births vs. 3.8 for France. Halderman notes that in the U.S., any infant born that shows any sign of life for any length of time is considered a live birth. In France — in fact, in most of the European Union — any baby born before 26 weeks' gestation is not considered alive and therefore doesn't "count" in reported infant mortality rates.

France reimburses its doctors at a far lower rate than U.S. physicians would accept. As David Gratzer, a physician and senior fellow at the Manhattan Institute, wrote in the summer 2007 issue of City Journal: "In France, the supply of doctors is so limited that during an August 2003 heat wave — when many doctors were on vacation and hospitals were stretched beyond capacity — 15,000 elderly citizens died."

After the tragedy, the French parliament released a harshly worded report blaming the deaths on a complex health system, widespread failure among agencies and health services to coordinate efforts, and chronically insufficient care for the elderly. It's hard to imagine that happening here, where hospitals have enough air-conditioned beds and doctors that aren't on vacation.

Fact is, most Americans like their health care. There are ways to provide expanded coverage at lower cost, such as pushing individually owned health savings accounts, malpractice reform and allowing insurance to be bought across state lines. We needn't be forced to sacrifice quality for cost. Nor do we need to look to the French for a better solution. They don't have one.


Another Attack On Big Drugmakers

Powerful California Rep. Henry Waxman wants to save Medicare billions by going after drug industry "windfalls." As usual, his "savings" will very quickly turn into higher costs for you-know-who. So many industries, so little time — that might be the Democrats' motto. By demonizing the drugmakers, Waxman and his allies in Congress hope to convince you they're doing something about rampant cost increases in Medicare.

They're right that Medicare costs have risen rapidly. Indeed, since 1970 Medicare's costs have risen 34% faster per patient than overall medical costs. To us, that's just another reason for not trusting our medical system to the government in the first place. But that hasn't stopped Waxman, who heads the House Energy and Commerce Committee and is widely seen as the most influential player in health care overhaul in the House.

Waxman's proposal to go after drugmakers to trim Medicare costs is wrong on many levels. For one, it'll shift costs onto those with private insurance. For another, it'll make all of us less healthy by forcing drugmakers to abandon or delay development of new drugs.

Recall that just a few months ago, drugmakers were forced to swallow a "deal" with the White House to cut $80 billion from the cost of drugs over 10 years. They did so reluctantly, knowing full well they'd be politically demonized and attacked if they didn't. Despite that good-faith effort, Waxman says it's not enough. He claims the industry is the recipient of a $3.7 billion "windfall" — or $30 billion over 10 years — due to new drug benefits that were added to Medicare in 2006. Those changes added 6.4 million people to Medicare's rolls who were previously on Medicaid. And since the Medicare Part D program — the drug program — doesn't let the government negotiate lower prices with drugmakers, while Medicaid does, these new enrollees cost the government more. Waxman thinks America's drugmakers should make up the difference.

This is par for the course for members of Congress. They think they can impose whatever costs they want on an industry, with no real-world impact.

For the record, drugmakers are largely responsible for the lengthening of lives worldwide. From 1986 to 2000, according to a recent study of 56 countries, life spans grew by nearly two years. That study by a Columbia University researcher found that 40% of the gain was due to new drugs. In the U.S., average life spans for women jumped from 74.7 years in 1970 to 80.4 in 2005. For men, it leapt from 67.1 years to 75.2. Drug company research creates blockbuster medicines for dreaded diseases such as cancer, stroke, HIV, heart disease, Alzheimer's and lupus. In other words, the drugs help us live longer and better lives.

Yet few Americans realize what goes into making a successful drug. Of every 5,000 to 10,000 new compounds investigated, only about five make it through the lengthy process and will be sold to the public. This process takes 10 to 15 years on average, data from the Pharmaceutical Manufacturers' Association show. The cost, according to research from Tufts University, is $1.3 billion per drug. And only two of every 10 drugs that make it to the market recoup even their R&D costs.

The point is, it's very costly to make people well. In 2007, spending on drugs reached $286.5 billion. As Sally Pipes, president of the Pacific Research Institute, notes in her book "The Top Ten Myths of American Health Care," that's bigger than Ireland's entire GDP.

To keep up the innovation and research, drugmakers need big profits. That's how they attract more investment, and how you benefit. Those who applaud as Congress goes after a successful industry that improves all our lives should be ashamed of themselves.

Every dollar Waxman takes from a drug company today will cost lives tomorrow. As for those who blame drug costs for soaring Medicare costs, it just isn't true. Prescription drugs account for just 10% of U.S. medical spending. Yet, dollar for dollar, they arguably have the greatest impact on our health.

Waxman and the other health care control freaks in Congress would like nothing more than to dictate the prices you pay for drugs. Ultimately, that will lead to rationing and higher drug costs — not to mention fewer life-saving drugs on the market. Waxman claims he'll "save" you money. But can he save your life? America's drug companies, the best in the world, can. Quit going after them.


An ounce of prevention is no cost-saving cure

In the debate over health care reform, preventive medicine has become almost everyone's panacea. During recent campaign-style town hall meetings in New Hampshire, Colorado and Montana, President Barack Obama never missed an opportunity to claim that preventive care and wellness programs would save money and lives.

Yet there are some inconvenient truths facing would-be reformers who tout prevention as if it were a bottle of "Dr. Feel-Good's Incredible Health-Promoting, Cost-Saving Elixir." The facts suggest that Americans have plenty of reason to be reluctant to swallow what politicians are trying to sell.

The most recent warning came from the Congressional Budget Office. The nonpartisan agency has issued a study that debunks the claim that preventive care for all Americans would translate into substantial savings for the federal government.

To the contrary, the CBO noted, "Researchers who have examined the effects of preventive care generally find that the added costs of widespread use of preventive services tend to exceed the savings from averted illness."

How could this be true? Can't just about everyone recite Benjamin Franklin's adage that "an ounce of prevention is worth a pound of cure?" Wouldn't it make sense to increase cancer and cholesterol screenings, vaccinations, anti-smoking programs, food content labeling and the like so that we focus on health care instead of disease care?

Obama made this case during his recent town hall meeting in Montana: "Are we better off waiting until somebody gets diabetes and then paying a surgeon for a foot amputation, or are we better off having somebody explain to a person who's obese and at risk of diabetes to change their diet, and if they contract diabetes to stay on their medications?"

Democratic congressional leaders echo the same refrain. "Reform will mean higher-quality care by promoting preventive care so health problems can be addressed before they become crises. This, too, will save money," argued House Speaker Nancy Pelosi, D-Calif., and Majority Leader Steny Hoyer, D-Md., in USA Today. "We'll be a much healthier country if all patients can receive regular checkups and tests, such as mammograms and diabetes exams, without paying a dime out-of-pocket," they said.

Republicans have also been eager to embrace preventive medicine. Sen. John McCain, R-Ariz., regularly insists that "the best care is preventive care." Former Republican presidential contender Mike Huckabee of Arkansas has claimed that wellness campaigns to reduce smoking and encourage diet and exercise could save "billions of dollars."

The number crunchers at the CBO aren't buying it. As the agency explained in an August letter, "for most preventive services, expanded utilization leads to higher, not lower, medical spending overall."

The CBO isn't alone in its assessment. According to Alan Garber, the director of the Center for Health Policy at Stanford University, "the few studies that have compared preventive care to treatment have shown that either form of care can be cost-effective -- or not -- depending on how it's used. There's no magic to the idea of prevention, except that it sounds good."

In a report published last year in the New England Journal of Medicine, researchers analyzed some 600 studies done since 2000 assessing the value of preventive care. They concluded that although about 20 percent of preventive measures -- including flu shots and colorectal cancer screenings -- did save money, "the vast majority reviewed in the health economics literature do not."

One reason why? Prevention programs spend a lot of money targeting people who are perfectly healthy. Say, for example, that in screening 500,000 people, health workers find one person whose ailment can be pre-empted before it develops into a costly, life-threatening condition.

They might save, say, $50,000 on late-stage treatment for that patient. But they will have spent much more than that to test the other 499,999 people who were just fine.

Here's another example from a study published last year in the journal Circulation. Suppose we enact several highly recommended measures to control cardiovascular disease and diabetes. Among other ends, the programs would improve blood pressure monitoring, increase access to medication and reduce cholesterol levels in high-risk patients.

Suppose that these prevention measures were 100 percent successful. The estimated cost of treating at-risk patients over the next 30 years would drop by about a trillion dollars. The preventive measures themselves, though, would cost $8.5 trillion -- offsetting the savings by a factor of almost 10.

As for the net value of wellness programs, the CBO has determined that there's not enough evidence to demonstrate that government efforts to discourage certain bad health habits would actually result in cost savings.

Fifteen years ago, the federal government began requiring food manufacturers to post nutrition and calorie information on food labels. Since then, Americans have had access to a barrage of data on every Snickers bar and bag of Cheez Doodles. But the labeling hasn't made us healthier. In fact, we're actually fatter -- since the advent of nutrition labels, the percentage of obese Americans has increased by two-thirds. With smoking cessation programs, the story is similar.

The reason is simple. Extending longevity tends to increase overall health spending. Illnesses like Alzheimer's, osteoarthritis, osteoporosis and prostate cancer make the final years of life incredibly expensive. The average nonsmoker who lives to age 84 will require about $100,000 more in medical expenses than the average smoker who dies seven years sooner because of his bad habit.

A few preventive measures do indeed save money. Others may impose a net cost but nonetheless are worth it because they improve our well-being. Preventive and wellness efforts may reduce pain and suffering and increase quality of life -- which may be justification enough.

But that's not the justification Washington is offering. Instead, lawmakers are trying to sell us on the seductive -- but ultimately false -- idea that taxpayer dollars spent on prevention can yield long-term savings.

We face a staggering federal deficit and increased taxes for all Americans if Obama's health care reform ideas are enacted. We need honest information about what proposed reforms will cost. And so it's time for politicians to swear off "Dr. Feel-Good's Incredible Health-Promoting, Cost-Saving Elixir."


Leading Republican blasts health care plan

A leading Republican negotiator on health care struck a further blow to fading chances of a bipartisan compromise Saturday by saying Democratic proposals would restrict medical choices and make the country's "finances sicker without saving you money." The criticism from Sen. Michael B. Enzi, Wyoming Republican, echoed that of many opponents of the Democratic plans under consideration in Congress. But Mr. Enzi's judgment was especially noteworthy because he is one of three Republicans trying to negotiate a bipartisan bill in the Senate's so-called "Gang of Six."

In the Republicans' weekly radio and Internet address on Saturday, Mr. Enzi said any health care legislation must lower medical costs for Americans without increasing deficits and the national debt. "The bills introduced by congressional Democrats fail to meet these standards," he said.

Mr. Enzi, together with Republican Sens. Charles E. Grassley of Iowa and Olympia J. Snowe of Maine, has held talks with Senate Finance Committee Chairman Max Baucus, Montana Democrat. But the chance of a bipartisan breakthrough has diminished in the face of an effective public mobilization by opponents of Democratic proposals. "I heard a lot of frustration and anger as I traveled across my home state this last few weeks," said Mr. Enzi, who has been targeted by critics for seeking to negotiate on legislation. "People in Wyoming and across the country are anxious about what Washington has in mind. This is big. This is personal."

Hours after the address aired, about 1,000 people rallied in New York City in support of an overhaul. Rep. Carolyn B. Maloney, New York Democrat, told the crowd near Times Square about legislation that she said would lower costs for almost everyone.

The debate over health care will resume in Washington after Labor Day, just two weeks after White House budget officials projected that deficits would total $9 trillion over the next 10 years. Though President Obama has said he wants the total health care bill paid for without adding to the deficit, congressional budget specialists have estimated that House health care proposals would cost the government more. "The Democrats are trying to rush a bill through the process that will actually make our nation's finances sicker without saving you money," Mr. Enzi said.

Democrats also are calling for cuts in Medicare spending, using some of the savings to help uninsured workers. A House bill would result in a net reduction in Medicare of about $200 billion, though Mr. Obama has insisted the reductions would not cut benefits in the health program for the elderly.

But Mr. Enzi said, "This will result in cutting hundreds of billions of dollars from the elderly to create new government programs."


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