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Tag: "Health"

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Stop Discriminating against Sick People!

Stop Discriminating against Sick People!

Jonathon Alter was a guest on “the Ed Show” tonight on MSNBC. In a noisy debate with Ed, he said that the goal of healthcare reform should be “to end discrimination against sick people”. He said that the path to reform was largely irrelevant. That whether or not there was a public option was largely irrelevant. That healthcare reform is a civil rights issue, and that reform had nothing to do with the mechanics of that reform.

To be clear, Mr Alter stated that he was personally very much for a public option. But he was also very clear that regardless of the public option, this reform needed to pass.

I agree with Jonathon. Discrimination against sick people must stop. Discrimination against people with ‘pre-conditions’ must stop. Discrimination against people, must stop.

It’s time to act. Call your congressman. Enact healthcare reform.

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Huffington quackery

Over at Salon.com, Rahul K. Parikh, M.D. makes a strong case that the Huffington Post is not strong on vetting their health and wellness contributors:

But when it comes to health and wellness, that diverse forum [Huffpo] seems defined mostly by bloggers who are friends of Huffington or those who mirror her own advocacy of alternative medicine, described in her books and in many magazine profiles of her. Among others, the site has given a forum to Oprah Winfrey’s women’s health guru, Christiane Northrup, who believes women develop thyroid disease due to an inability to assert themselves; Deepak Chopra, who mashes up medicine and religion into self-help books and PBS infomercials; and countless others pitching cures that range from herbs to blood electrification to ozonated water to energy scans.

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Health-less

Health-less

The boogeyman of Socialized Medicine is being dragged onto the field of rhetorical combat to block the move toward anything smacking of Single Payer Health Care in the United States. The argument is old and hoary by now, that adopting a system like that available in Canada or the United Kingdom would lead to a collapse of American health care. Somehow the fact that expenses might be shared and disbursed through the government will render the world’s best health care system somehow crippled inside a generation is not seriously questioned by most people. Because most people don’t know.

You can find case after case of anecdotal evidence to support the notion that British health care is worse than ours. Someone knows someone who, as the argument goes. And there is something to that. The waiting periods alone, the pigeonholing of treatment—horror stories abound which we glimpsed here when HMOs were instituted and accountants seemed to be in charge of medicine.

There is, in fact, too much information for the average American to digest much less make sense of.

Technologically, the United States has an extraordinary medical system. Unmatched in the world, despite some annoyingly negative statistics. That we achieve what we do in a country peopled by citizens who do the least for their own health than in any other country comparably empowered is amazing.

Americans eat too much. Medicine can only do so much against a rising tide of obesity related illnesses. The tradition of the doctor giving you a physical and then telling you to eat right and get some exiercise is not a quaint leftover from an age that didn’t know as much as we do—that is sound advice and more than half the battle in maintaining good health. The explosion of Type 2 diabetes in children has been alarming, and this can be tied directly to diet and exercise.

We also work longer hours under higher stress than almost anywhere else in the developed world. The need for vacations and long weekends is acute. This may sound sarcastic, but the link between stress and several major illnesses is no joke.

We are also a violent society. If one looks at emergency room statistics, it becomes quickly clear that we are a people who like to beat, stab, and shoot each other at higher levels than almost anywhere else.

What makes all these factors so overwhelming is that we have the means to do all this. Because a certain percentage, a significant percentage, of the population can afford to go to the doctor and have the consequences of all these lifestyle disasters “taken care of.”

I put all this out front because the one factor that is muted in the national debate over the rising cost of healthcare is the fact that we are, collectively, idiots. We do not do, statistically, the simplest things to avert the need for medical intervention.

The last detail in this litany has nothing to do with idiocy but with sentiment and perspective. It has been said for decades and it is true—80% of individual health expense in this country is spent in the last two years of life. We are, as a people, loathe to die and we will direct our health services to do absolutely everything to give us another day.

In Europe, such people are told to go home and die.

That sounds cold, I know, and I’m sure there are people in France and Germany and Italy with the resources to reject this advice.

But the nations as a whole are not expected to pay for it. Here we are.

Through health insurance.

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Statistical illiteracy afflicts health care professionals and their patients

Statistical illiteracy afflicts health care professionals and their patients

Over at Scientific American Mind Gerd Gigerenzer and his colleagues have published a terrific article documenting the statistical illiteracy that sometimes runs rampant in health care fields. The article, “Knowing Your Chances,” appears in the April/May/June 2009 edition.

The authors point out numerous medical care fallacies caused by statistical illiteracy , including Rudy Giuliani’s 2007claim that because 82% of Americans survived prostate cancer, compared to only 44% in England, that he was lucky to be living in the United States and not in England. This sort of claim is based on Giuliani’s failure to understand statistics. Yes, in the United States, men will be more quickly diagnosed as having prostate cancer (because many more of them are given PSA tests), and then many more of them will be treated. Despite the stark differences in survival rates (the percentage of patients who survive the cancer for a least five years, “mortality rates in the two countries are close to the same: about 26 prostate cancer deaths per 100,000 American men versus 27 per 100,000 in Britain. That fact suggests the PSA test

has needlessly flagged prostate cancer in many American men, resulting in a lot of unnecessary surgery and radiation treatment, which often leads to impotence or incontinence. Because of overdiagnosis and lead-time bias, changes in five-year survival rates have no reliable relation to changes in mortality when patterns of diagnoses differ. And yet many official agencies continue to talk about five-year survival rates.

Gigerenzer and his colleagues give a highly disturbing as example regarding mammogram results. Assume that a woman just received a positive test result (suggesting breast cancer) and asks her doctor “What are the chances that I have breast cancer?” In a dramatic study researchers asked 160 gynecologists taking a continuing education course to give their best estimate based upon the following facts:

A.) the probability that a woman has breast cancer (prevalence) is 1%
B.) if a woman has breast cancer the probability that she tests positive (sensitivity) is 90%
C) if a woman does not have breast cancer, the probability that she nonetheless tests positive (false-positive rate) is 9%

The best answer can be quickly derived from the above three statements. Only about one out of 10 women who test positive actually has breast cancer. The other 9/10 have been falsely diagnosed. Only 21% of physicians picked the right answer. 60% of the gynecologists believed that there was either an 81% or 90% chance that a woman with a positive test result actually had cancer, suggesting that they routinely cause horrific and needless fear in their patients.

What I found amazing is that you can quickly and easily determine that 10% is a correct answer based upon the above three statements–simply assume that there are 100 patients, that one of them (1%) actually has breast cancer and that nine of them (9%) test false positive. This is grade school mathematics: only about 10% of the women testing positive actually have breast cancer.

As the article describes, false diagnosis and bad interpretations often combine (e.g., in the case of HIV tests) to result in suicides, needless treatment and immense disruption in the lives of the patients.

The authors also discuss the (tiny) increased risk of blood clots caused by taking third-generation oral contraceptives. Because the news media and consumers so often exhibit innumeracy, this news about the risk was communicated in a way that caused great anxiety. People learned that the third-generation pill increased the risk of blood clots by “100%.” The media should have pack is aged the risk in a more meaningful way: whereas one out of 7000 women who took the second-generation pill had a blood clot, this increased to two in 7000 women who took the new bill. The “absolute risk increase” should have been more clearly communicated.

Check out the full article for additional reasons to be concerned about statistical illiteracy.

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Not Ready to Meet their Maker?

Not Ready to Meet their Maker?

Reading through my back issues of the Economist, I came across this article from March. According to a study published in the Journal of the American Medical Association religious people seem curiously unwilling and unready to die.

According to the study, by Andrea Phelps and her colleagues at the Dana-Farber Cancer Institute in Boston, religious people seem to use their faith simply to cope with the pain and degradation involved in treatment, and that they are more willing to experiment with more aggressive treatments, even though such treatment rarely makes much difference to the outcome or their life expectancy.

Dr Phelps and her team followed the last months of 345 cancer patients. The participants were not asked directly how religious they were but, rather, about how they used any religious belief they had to cope with difficult situations by, for example, “seeking God’s love and care”. The score from this questionnaire was compared with their requests for such things as the use of mechanical ventilation to keep them alive and resuscitation to bring them back from the dead.

According to the study, three times as many ‘religious’ people requested aggressive life extension measures (mechanical ventilation and resuscitation) versus the least religious.

I would expect that the religious would be happy to eventually ‘meet their maker’ - but I suppose this is yet another aspect of the cognitive dissonance we find among religion and it’s adherents.

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Ballpark food lighting up our Pleistocene taste buds.

Ballpark food lighting up our Pleistocene taste buds.

What is it about ballpark food that makes it so delicious? I think that these new truth-in-marketing signs at the ballpark pretty well sum it up.

Photo (etc) by Erich Vieth

These stadium food vendors truly excel in offering superstimuli for our not-ready-for-modern-times stomachs and eyes. What should we do about this mismatch between our pleistocene cravings and our modern abilities to pump out this life-shortening quality-of-life-diminishing fare? That’s the question raised by Dr. David Kessler, former Commissioner of the FDA:

Fifty years ago, the tobacco industry, confronted with the evidence that smoking causes cancer, decided to deny the science and deceive the American public. Now, we know that highly palatable foods—sugar, fat, salt—are highly reinforcing and can activate the reward center of the brain. For many people, that activation is sustained when they’re cued. They have such a hard time controlling their eating because they’re constantly being bombarded—their brain is constantly being activated.

For decades the food industry was able to argue, “We’re just giving consumers what they want.” Now we know that giving them highly salient stimuli is activating their brains. The question becomes what do they do now?

When I say “superstimulus, I mean it. I can’t believe how many obese people I recently saw at the stadium. Half of them wore Albert Pujols jerseys, but none of them looked like Albert Pujols.

Now, while we’re still discussing stadium food, here’s an untouched photo clearly demonstrating that the world is almost out of fresh water. After all, there’s no other explanation for why anyone would pay twice as much for 20 ounces of drinking water than for a gallon of refined gasoline.

image by Erich Vieth

I can just imagine the conversation:

Child: Daddy, can I have a few sips of water?

Father: Billy, how many times have I told you that we can’t afford to drink water!

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Avoid Swine Flu, the Science-Guy way!

Swine flu has captured the attention of the nation, including calls from European health officials to restrict travel to the US.

It’s all rather overblown, because almost everyone* has the ability to avoid the flu and it’s symptoms. Just follow the directions in the video, courtesy of Bill Nye, the Science Guy!

* the exception is immune-compromised individuals.

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Socialism is Good for your Health

Socialism is Good for your Health

A new study from the Cato Institute finds that Portugal’s policy on drug decriminalization is paying health dividends. Portugal decriminalized possession of all drugs on July 1, 2001, including heroin and cocaine. Trafficking in drugs is still a criminal offense.

The study clearly indicates rehab is a major component of the success of the decriminalization policy, and that such rehab needs to be available to all. Successful rehab is thus only possible when health is a public service. Without a public health program, most users (who are poor) would be unable to afford rehab (which tends to be relatively expensive), thus removing any possibility of improved public health outcomes - users will remain as users with increasing incidence of STD & death.

Unfortunately, the US would rather spend untold sums on the War on Drugs, and on the incarceration of users. Apparently it is still un-American (to some) to invest those sums in public health.

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Patients sharing symptoms and treatment results: Patients Like Me

I just learned that there is a site called Patients Like Me, where people fighting diseases can share symptoms and treatment experiences. This is another wonderful benefit of being able to network using the Internet. It might even be a life-saver. Here’s how the site describes itself:

Whether you’re depressed, bipolar, anxious, obsessive-compulsive, or simply want to monitor your mood fluctuations, this is the online community for you. By sharing your symptoms, treatments and mood charts, you can gain insight into what affects your mood while helping others learn from your experiences. Create a profile today to begin taking control of your health. Imagine knowing every medication, supplement, or device used to treat your disease. Imagine knowing what treatments work for people just like you — and having the ability to easily connect with those people. That’s what makes PatientsLikeMe different. Patients share their treatments and outcomes not just to help themselves, but to help others. Become part of making a difference for everyone with mood conditions today.

The site has special categories for neurological disorders, mood disorders and immune conditions. It’s wonderful that patients can have information above and beyond their own health care providers–the opportunity to be a member of a larger community of like-minded people sharing ideas and encouragement.

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Billboards for your body, your mind and your planet

Billboards for your body, your mind and your planet

Consider the types of billboards that we most often see along the highway. They encourage us to pollute our bodies with unhealthy food, to pollute our minds with shallow amusements and to pollute our Earth by wasting resources and indulging in luxuries. The two billboards I photographed below are all-too-representative of what I’ve read along highways.

Yes, there are also billboards for public services as well as billboards for useful and reasonable products. What concerns me, though, is that most billboards carry unhealthy messages. There are so many unhealthy billboards out there that unhealthy activities seem to be norm. It’s booze, gambling and conspicuous consumption all the way down the highway. What effect might this have on us? It reminds me of James Q. Wilson’s broken window theory of crime:

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Why practicing Catholics should vote for Barack Obama, not for John McCain

I am a practicing Roman Catholic, and will vote for Barack Obama for President of the United States. Not only will I vote for Senator Obama, I will do so gladly and with a clear conscience.  The reasons are many.  This lengthy post enumerate many of those reasons, providing ample links in support.
I accept the [...]

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Sniffing out skin cancer

I thought the bloggers of DI might be interested in a short video I recently had a hand in creating and during which I got to see behind the scenes at a sensory laboratory.

Chemist Michelle Gallagher, while doing her post-doctoral research at the Monell Chemical Senses Center, became fascinated when she learned of a study [...]

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Michael Moore’s dream country

Michael Moore didn’t mention this country in Sicko, but it offers health benefits that exceed those of most other countries, even France. It is a “model of sustainable ecology.” And check out the prison. This country has the world’s lowest murder rate, yet the longest prison sentence available is 21 years. [...]