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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La Crosse, Wisconsin: the town that is willing to talk about death

Excellent story by NPR. It's a long way from the Republican scare stories about "death panels":

People in La Crosse, Wisconsin are used to talking about death. In fact, 96 percent of people who die in this small, Midwestern city have specific directions laid out for when they pass. That number is astounding. Nationwide, it's more like 50 percent. In today's episode, we'll take you to a place where dying has become acceptable dinner conversation for teenagers and senior citizens alike. A place that also happens to have the lowest healthcare spending of any region in the country.
This piece reminds me that one of the main problems with the United States is that we cannot have meaningful conversations. This is refreshingly different. And important: One-quarter of health care spending occurs in the last year of life.

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The failure of AA (Alcoholics Anonymous)

What would it seem like if ONLY those who successfully completed a program were featured in the media? What would we think about a school where 85 out of 100 students flunked, but only the graduates showed up to say how good the program was? That is the starting point for Dr. Lance Dodes and Zachary Dodes' article in Salon: "The pseudo-science of Alcoholics Anonymous: There’s a better way to treat addiction."

Rehab owns a special place in the American imagination. Our nation invented the “Cadillac” rehab, manifested in such widely celebrated brand names as Hazelden, Sierra Tucson, and the Betty Ford Center. . . . The fact that they are all extraordinarily expensive is almost beside the point: these rehabs are fighting the good fight, and they deserve every penny we’ve got. Unfortunately, nearly all these programs use an adaptation of the same AA approach that has been shown repeatedly to be highly ineffective. Where they deviate from traditional AA dogma is actually more alarming: many top rehab programs include extra features such as horseback riding, Reiki massage, and “adventure therapy” to help their clients exorcise the demons of addiction. . . . Why do we tolerate this industry? One reason may sound familiar: in rehab, one feels that one is doing something, taking on a life-changing intervention whose exorbitant expense ironically reinforces the impression that epochal changes must be just around the corner.
Who is studying the effectiveness of these programs? Not the programs themselves or, at least, they are not making their data open. That makes these authors suspicious:
Efforts by journalists to solicit data from rehabs have also been met with resistance, making an independent audit of their results almost impossible and leading to the inevitable conclusion that the rest of the programs either don’t study their own outcomes or refuse to publish what they find.
What is the solution? Rather than preach to addicts about a "Higher Power," the authors suggest that they need something far more personally empowering: sophisticated self-awareness."

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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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