The promise of fecal transplants

Some patients are having astounding success with fecal transplants, and a DIY community is growing. BBC reports:

There is growing recognition that faecal transplant is the best way to treat [some] patients. In the first randomised trial of the technique published in the New England Journal of Medicine last year, 94% of patients were cured by the treatment, whereas a course of antibiotics cured just 27%. The disparity was so huge that the researchers stopped the trial early, on the grounds that it was unethical to deny the better cure to the cohort assigned antibiotics.

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A personal perspective on Obamacare

My family just signed up for an extremely expensive "Bronze" policy with Obamacare. It is shameful that there are only two companies "competing" for our dollars in St. Louis (it's worse than shopping for a phone company). It's shameful that none of the policies in the bronze or silver range include Barnes Hospital (St. Louis' premium teaching hospital) in their network. It shameful that even though we are paying $1,000/month for a family of four, that the annual deductible is in the range of $4,300 for indiv and $8,600 for family, with annual out-of-pocket deductible for our family being $12,700. There is no real competition here, and I have yet to see the any reason to believe that the ACA will pressure providers to lower their costs. In America, we pay many times the amount for basic services (e.g., MRI scan) than people in other countries. Our economic side of our hospitals, including "non-profit" hospitals, are a joke, with their executives getting exorbitant salaries while they are on a shopping spree to buy up the local medical practices so that there is no meaningful competition, even your local doctors. I recognize that the ACA forces insurance companies to provide certain minimum coverages and that they can no longer cherry-pick patients based on pre-existing conditions, which was rampant and immoral. The ACA is certainly better than nothing. The most shameful thing of all, however, is that even with the faults of Obamacare, the Republicans want to destroy the modest protection it offers many of us, and the substantial protection it offers low-income families. They propose to replace it with nothing at all. The Republican proposals I have seen would send all of us back to ravages of the dog-eat-dog for-profit health market where cherry-picked customers pay unregulated prices, where premiums have been skyrocketing for decades, where many folks are offered paltry coverage that they have no way of paying for, and where many people are deemed "uninsurable." If politicians can only convince us to keep watching lots of sports events and movies, maybe we will never force them to enact meaningful reform. We need single-payor coverage, like most other civilized countries. For more on the dreadful situation we currently have, check out Stephen Brill's excellent article. I'll end with this somber reality from Brill's article:

The health care industry seems to have the will and means to keep it that way. According to the Center for Responsive Politics, the pharmaceutical and healthcare product industries, combined with the organizations representing doctors, hospitals, nursing homes, health services and HMO’s, have spent $5.36 billion since 1998 on lobbying in Washington. That dwarfs the $1.53 billion spent by the defense and aerospace industries and the $1.3 billion spent by oil and gas interests over the same period. That’s right: the health-care-industrial complex spends more than three times what the military-industrial complex spends in Washington.

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Physicians’ gag order regarding fracking to be re-evaluated

Amazing that such a law could be passed in the first place. From Alternet.

Challenges by Pennsylvania citizens and townships on provisions in the law that prohibit doctors from telling patients about health impacts related to fracking chemicals were sent back to Commonwealth Court for reevaluation. The “physician gag order” (or “ frack gag“) was recently challenged by a doctor who claimed it infringed on his First Amendment rights and his duties as a doctor, but his challenge was thrown out by a Pennsylvania court in October. The Supreme Court’s decision to send the Commonwealth Court’s decision back down for re-evaluation spells trouble for the gag order. Doctors have expressed concern over this rule in Pennsylvania and what it means for their patients — a report from Pennsylvania documented a range of health problems affecting residents living near natural gas operations, including skin rashes, headaches and chronic pain.

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Ralph Nader discusses a better approach to hernia repair surgery

This article at Common Dreams is ostensibly a discussion about hernia repair surgery, namely, an option to be treated more humanely and cheaply in Canada than in the U.S. The discussion turns to deeper criticisms of the American way of providing healthcare, however.

Too many general surgeons and hospitals have on average over 10 times the rate of recurrence, four times the rate of infection, and often use expensive mesh both to replace lack of surgical skill and to speed up the operation. Plus they charge much more before they quickly say “sayonara.” The Shouldice [Hospital, outside of Toronto] procedure is described by hospital officials as a “natural tissue repair that combines the surgical technique with the body’s natural ability to heal,” and takes, on average, forty-five minutes to complete. Except in rare circumstances, “the technique does not use artificial prosthetic material such as mesh because mesh can introduce unnecessary complications such as infections or migration, dramatically increasing the cost of the operation. Shouldice does not use laparoscopic technology because of the potential intestinal punctures and bladder and blood vessel injuries, which may lead to infection and peritonitis.” Shouldice staff note that laparoscopic surgery also requires general anesthesia and hugely higher costs for disposable items per surgery than is the case at their hospital. There are about one million abdominal wall hernia operations yearly in the U.S. Hospitals and general surgeons for the most part do not use the Shouldice Procedure. Still the deplorable “quick and dirty” that invites overuse of mesh – about 80 percent of the patients – has become a perverse incentive for higher billings in the United States. Superior talent is needed for the more natural procedure used by Shouldice.

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