Archive for the ‘Politics’ Category
Sarah Palin — One heartbeat away from ‘Four More Years’?
Well, unless you have been living underneath a rock, you might have noticed that Mccain has announced his running-mate, Sarah Palin.
All you need to do is hit google, or keep up with the wikipedia link above to get all that is known (or, rather, not known) about Sarah Palin. There are a lot of faults that are being pointed out, but what I find most troubling has to do with the most important job of the vice-presidency.
I like McCain. Not enough to vote for him necessarily, but certainly I think our country would have been better off if he was the President the last eight years rather than Bush, Gore, or Kerry. I also think he is experienced enough and strong enough to follow what he thinks is right rather than that of his party.
I have always felt that John McCain was a principled man who did things right rather than BS around, but I seriously wonder if this presidential run as changed him. He himself said was the most important criteria for Vice-Presidency : “”person most prepared to take my place.” Sarah Palin may be a wonderful person (I don’t know), but by that standard she seems to be woefully lacking. It appears that John McCain is more interested in winning the election than finding someone fit for the job.
Sarah Palin’s lack foreign policy, and Washington political experience is really concerning. If she ends up president, it won’t be long until the Republican machine (i.e. Dick Cheney) takes over everything that happens inside the White House.
Let’s face it, John McCain’s health isn’t the best to begin with, and even if it was good, things happen to people, and people die suddenly without warning. Is this country ready for even the possibility of “Four More Years” ?
NYT: China and Pollution
Law of Unintended Consequences
One of the hardest things to try to explain to people when discussing various kinds of institutional or governmental policy is the law of unintended consequences. It basically says the policy can have effects that are very different than what one expects. History is full of examples, yet people continue to believe that the idea/policy is smart enough to prevent thousands or millions of people from figuring out a way to mess it up while imaginatively trying to better their lives. It shouldn’t scare someone from trying to change things, but steps need to be taken to measure the change in order to ensure that what was intended to happen is indeed happening.
Glen Whitman, an associate professor of economics at California State University, Northridge, wrote a very nice article on this topic, linked here. It is worth a read, as it explains an idea which can be difficult to explain in a nice, accessible way.
The article is also saved after the break for archival purposes.
NEJM: Kellermann: Crisis in the Emergency Department
Arthur L Kellermann is a role-model to many of us who have earned or aspire to MD-MPH degrees. Having met him, he speaks with uncommon insight and wisdom. He has written a valuable editorial in the New England Journal of Medicine this week regarding the rising problem of crowding in the Emergency Department, particularly regarding disaster capacity. The Journal has been good enough to offer the editorial for free on their website.
When crowding reaches dangerous levels, hospitals often divert inbound ambulances to other facilities. In 2003, diversions occurred more than half a million times — an average of once per minute.3 Diversion may provide a brief respite for a beleaguered staff, but it prolongs ambulance transport times and disrupts established patterns of care. It also creates ripple effects that can compromise access to care throughout a city. Because crowding is rarely limited to a single hospital, one facility’s decision to divert ambulances can prompt others to follow suit. When that happens, a city may experience the health care equivalent of a “rolling blackout.” Everyone’s access to care is affected — the insured and uninsured alike.4
The complete article can be found here.
Timothy Keller transcript: the problem of suffering
Some of you may be familiar with Tim Keller, the head pastor at Redeemer Presbytarian Church here in New York.
Linked below is the transcript of a speech made by Tim Keller in an anniversary service to the families of victims of 9/11, made on September 10th, 2006. The transcript is originally found on the blog of his son here.
For those of you who haven’t heard Tim Keller speak, I have to also recommend listening to his words shortly after the event, available at the Redeemer Sermon Store (I get no proceeds… ) You can download many free samples there as well.
As a minister, of course, I’ve spent countless hours with people who are struggling and wrestling with the biggest question – the WHY question in the face of relentless tragedies and injustices. And like all ministers or any spiritual guides of any sort, I scramble to try to say something to respond and I always come away feeling inadequate and that’s not going to be any different today. But we can’t shrink from the task of responding to that question. Because the very best way to honor the memories of the ones we’ve lost and love is to live confident, productive lives. And the only way to do that is to actually be able to face that question. We have to have the strength to face a world filled with constant devastation and loss. So where do we get that strength? How do we deal with that question? I would like to propose that, though we won’t get all of what we need, we may get some of what we need 3 ways: by recognizing the problem for what it is, and then by grasping both an empowering hint from the past and an empowering hope from the future.
NYT: Scaling Back Changes to Medicare Payments
The New York Times is reporting today about how Medicare changes that were planned are being reversed. I guess it’s a fancy way of saying that nothing has changed.
The “scale back” (lack of change) was argued as being a good thing. In particular, the new payment system would have made heavy cuts into the payments for cardiac coronary artery drug-eluting stents, defibrillators, and other “newest technology.” The New York Times cites a number of analysts:
“The final rule significantly moderates proposed cuts for cardiac procedures,’’ Citigroup said in a note to investors. Lehman Brothers described the final rule as “a win for cardiac and orthopedic device companies, specialty hospitals and general acute care hospitals.’’ The Prudential Equity Group said the final rule, which takes effect on Oct. 1, was “favorable for device manufacturers’’ like Boston Scientific, Medtronic and St. Jude Medical.
The part that concerns me, however, is what follows:
“Under the final rule, hospitals will receive much smaller increases than originally proposed for treating some conditions, like pneumonia and chronic obstructive pulmonary disease.”
The issue I have is with the assumption that the newest technology represent the best of medicine. As a self-proclaimed gadget geek, this might surprise you, but it is not entirely clear that the latest findings are the best and most accurate. In particular regarding devices, very few of these have good long term studies showing safety and efficacy. In fact, by their very nature, because they are new technologies, nobody truly knows what is going to happen 20 years down the road.
Medical devices, unlike other technologies, don’t automatically improve. Windows XP (no matter how bad) is better than Windows 95, is better than Windows 3.1, but it’s not clear if the new hip device is worth 50% more than the old hip device. This goes hand-in-hand with the fact that a major reason for rising health care costs in this country for the past 20 years is due to medical technology such as these.
I’m not down on medical devices in general. The innovation of these companies is commendable. I just worry that the “new technology” is taking precedence over tried and true technology such as antibiotics. I worry that innovation is being steered away from less profitable fields like pulmonology and into fields flush with money such as cardiology and orthopedics. In my hospital, I can already see that the patients who have “high-paying” problems generally get preference, and these payment structures only exaggerate the multiple-tier system.
I suppose these payment systems are examined by people smarter and better informed than me. I am happy that the health care field is getting money, I just wonder if it is going to the right place, and whether we are creating the proper incentives for innovators within our field.
The complete article, as usual, is below:
NYT: Disowning Conservative Politics, Evangelical Pastor Rattles Flock
“Those are the two buttons to push if you want to get Christians to act,” he said. “And those are the two buttons Jesus never pushed.”
The article is reproduced below:
NYT: Johnson & Johnson Told to Pay Damages in Pain-Patch Death
Another article from the New York Times. Many physician joke that the health section is the only medical journal they read. Most of the time, it’s only a joke.
The article discusses a case of a family winning a case against Johnson and Johnson for the tune of $772,500 after the patient had an unexpected death thought to be due to overdose/defect of a duragesic (fentanyl) patch. I’m not sure if the patches were actually defected, and I certainly agree that the death of a such a young woman is indeed tragic. It’s not clear if the jury knew if the defect existed or not as well. It is also not clear if the patient died due to intentional (but misguided) overuse.
My concerns regard the reverberations of this case. According to the article:
“Johnson & Johnson, based in New Brunswick, N.J., added warnings to the patch’s label last July, saying doctors should not prescribe them for patients who cannot tolerate similar drugs or who might be prone to abusing them.The patches, introduced in 1990, release the opiate fentanyl through the skin. Researchers say fentanyl can cause addiction or death in some users.”
Vague terminology like “some” and “might” are entirely unhelpful guidelines.
The medical field tends to undertreat pain, and duragesic patches have done wonders toward relieving pain to thousands if not millions of patients in the US suffering from intractable pain. However, the “guidelines” put out by Johnson and Johnson are just broad statements designed to protect themselves from lawsuits and push the liability onto the physicians that prescribe them. If JNJ seriously thought that fentanyl patches are dangerous to an undefinable segment of the pain-suffering population, perhaps they should pull the product entirely. Of course, they don’t do anything such as that.
This practice is all too common, and physicians have found themselves in a bind as pharmaceuticals create unhelpful guidelines without the best interest of the patient in mind. Many medications are used routinely as “off-label,” and are considered standard of care and best practice. The problem is that a drug only can become FDA approved for that indication if the company applies for it. At times one will find a disconnect where the medical research clearly shows the benefit of the drug and the company simply does not apply to get the medication “officially approved” for that reason.
In the end, it is because of these kinds of lawsuits that JNJ has to charge so much money for their drugs to cover their costs. It is because of these lawsuits that they make statements to push away liability. It is because of these lawsuits that doctors pay high malpractice premiums and eventually leave practice. It is because of these lawsuits that the United States is spending 16% of it’s GDP on healthcare, even as over 40 million people don’t have health insurance.
Time to get off the Saturday morning soapbox….
Medicaid: Proof of Citizenship Required
The article from the New York Times today reports on how there will be an exemption on the new law that requires documented proof of citizenship on application for Medicaid. The part that really struck me was a section in the middle:
“The new documentation requirement is part of the Deficit Reduction Act, signed by President Bush on Feb. 8. It is meant to stop the “theft of Medicaid benefits by illegal aliens,” in the words of Representative Charlie Norwood, Republican of Georgia, a principal author of the provision.”
The attempt to withhold care to certain populations is rather mind-boggling. The truth is that society pays for the care of these patients, one way or another. Furthermore, study after study shows that paying for whatever outpatient care they need is cost-effective…. you can give a patient 20 expensive medications for months and the cost still would not equal a single night of stay in an intensive care unit (ICU).
If these patients don’t get outpatient care, they clog up the ER. Yes, yes, I know the studies that show that ERs are clogged by non-underserved people as well. Sick people is bad for productivity, bad for the economy, and is a public health hazard. What happens if the government refuses to pay? The hospitals will take the hit at first, and they’ll have to bill those who can pay in order to make ends meet. If they can’t, they will close down, and not provide care to anyone. Eventually, the government will have to bail them out, thus costing more taxpayer money.
The evidence is there. Also see another article regarding a homeless drunk housing project in Seattle. It’s simply cheaper to take care of these people. It is a social good. We don’t have to like them, but we have to realize that by ignoring them and pretending that they don’t exist, we’re costing ourselves a whole lot of money.
Alternative Energy
This article has recently popped up on digg.com, and i think it’s worth looking at the comments as well, because there are a few well-informed gems there. Of particular note, is the list of relevant wikipedia articles on alternatives such as solar, hydroelectrical, and geothermal. Of further note,there was an article on the realities of alternative energy from popular mechanic a while back that was dugg as well.
And if that wasn’t enough, here’s some info regarding nuclear power.
I’m not sure where to go in terms of a personal opinion on this matter. The global shortage of oil is real, and probably understated as a whole…. Gas and energy prices are not going down anytime soon. We may have to use more coal, and deal with the subsequent pollution. Nuclear power has a lot of promise to be sure, and has the negative popular sentiment that stinks of being a panicked over-reaction. But I don’t know. In the meantime, I’m buying oil exploration stocks and the like to help fund my ever increasing energy bill. 
