Nation's Hospital Bill

A handful of high-cost and high-volume conditions helped drive the national hospital bill up 7% in 2005, to $873 billion, a record high and nearly double 1997 spending adjusted for inflation, a federal agency reported. The report, from the federal Agency for Health Care Research and Quality, analyzed figures from the most recent year available and found in part that triple-digit percentage growth in the amount charged for blood infections, nonspecific chest pain, respiratory failure, back pain and arthritis over the past decade contributed to the increase.
The 20 costliest conditions accounted for 52% of hospital charges, and the five costliest accounted for a fifth of all charges. Medicare and Medicaid, the government health plans for the elderly, disabled and poor, accounted for nearly two-thirds of total charges. The five costliest categories were coronary-artery disease, pregnancy and delivery, newborn-infant care, heart attack and congestive heart failure, followed by pneumonia and arthritis.

Point Counterpoint Essays on HR 2640 (Gun Control Law)

About 3%-5% of all violence in the United States is perpetrated by individuals with mental illness. But the risk of violence is much higher with “rampage killers,” those who go into schools, malls, and other public places and shoot. About 50% have a history of mental illness and 8% have been committed. Legislation recently passed in the House of Representatives is a good idea if even one life is saved. The bill, H.R. 2640 (the National Instant Criminal Background Check System Improvement Amendments Act of 2007), would require the states to update the NICS with the names and other identifying information of people committed to mental institutions so that they could not buy firearms.

BUT

We still have no data to show that this approach would be effective. Guns are widely available from legal and illegal sources in the United States. Federal purchase restrictions only apply to purchases from a dealer. They do not affect those who already own guns, obtain a gun from another person, or buy one at a gun show. If even a single life could be saved by stopping gun purchase by mentally ill patients, why not do it? Because the costs would vastly outweigh a small likelihood of benefit. The financial impact will be enormous. The federal bill offers states $1 billion to participate in a national database. Think of what else we could do with that money to combat gun violence.

Health care challenges fire up U.S. students

One measure of the troubled state of U.S. health care is the hordes of idealistic young people lining up to fix it. . . . students are pouring into health policy classes in economics, political science, history, and public health departments. Many plan on making health policy their career.
"I tell some of my friends that are a few years younger then me, if they are interested in politics and what is going on -- take policy courses. Health policy is something that affects us and it's going to affect us in the long run," said Chang, who hopes to attend law school.

World 'must do more' for children

More must be done more quickly to make the world fit for children by 2015, the UN children's agency, UNICEF, has said. In a report it noted considerable strides had been made to meet pledges in education and areas of health care. But it stressed that "much more must be done" in order to meet the 2015 Millennium Development Goals deadline.

Marketing hype or a miracle cure?

A costly drug cocktail touted as the first pharmacological treatment for cocaine and methamphetamine addiction is at the center of a raging national debate.The treatment, called Prometa, is not approved by the Food and Drug Administration as an addiction therapy, nor has it undergone extensive scientific testing. But officials at Los Angeles-based Hythiam Inc., the company that sells the treatment protocol, say it can work miracles for people struggling to break their addiction.

Ranking America's Mental Health: An Analysis of Depression Across the States (Missouri Ranks #45)

Depression is a chronic illness that exacts a significant toll on America's health and productivity. It affects more than 21 million American children and adults annually and is the leading cause of disability in the United States for individuals ages 15 to 44.
Lost productive time among U.S. workers due to depression is estimated to be in excess of $31 billion per year. Depression frequently co-occurs with a variety of medical illnesses such as heart disease, cancer, and chronic pain and is associated with poorer health status and prognosis. It is also the principal cause of the 30,000 suicides in the U.S. each year. In 2004, suicide was the 11th leading cause of death in the United States, third among individuals 15-24.
Despite significant gains in the availability of effective depression treatment over the past decade, the level of unmet need for treatment remains high. On average, people living with depression go for nearly a decade before receiving treatment, and less than one-third of people who seek help receive minimally adequate care.
"Ranking the States: An Analysis of Depression Across the States" was researched and written by Mental Health America and Thomson Healthcare. It looks at data from 2002-2006 and was conducted from July to November 2007. The report compares depression levels and suicide rates in all 50 states and the District of Columbia and uses the information to highlight solutions to improve states' mental health status.

Doctors don't report colleagues, errors

Nearly half of doctors surveyed say they have failed to report an impaired or incompetent colleague or a serious medical error, and more than one-third say they would order an unneeded MRI scan for an insistent patient - though these actions conflict with what the physicians consider the heart of their professional obligations.

The survey is the first broad attempt to measure the success of a new movement called "medical professionalism." Arguing that government regulation, financial incentives, and public reporting alone will not improve the quality and efficiency of medical care, physicians groups in the past several years have been promoting a new code of professional values, meant to modernize the ancient Hippocratic Oath.

Exercise pill hope for depression?

Yale University experts say that experiments on mice could show why regular exercise can help people suffering from depression. Writing in the journal Nature Medicine, they say it could lead to more effective drugs. Mental Health charities in the UK already back exercise programmes as a way of lifting depression. While the link between exercise and improved mood is well known, the reasons behind it are not fully understood. The latest research focuses on an area of the brain called the hippocampus, which is already established as a target for antidepressant drugs.

Schizophrenia Risk May Start in Womb

Over the past several decades, a steady stream of studies has documented that people born in winter and spring have an increased risk for schizophrenia, a serious mental illness characterized by disordered thinking, hallucinations and other psychotic symptoms.
Explanations for the increased risk have ranged from the astrological -- different signs of the zodiac have been associated with various mental problems -- to accounts that suggested the risk came from seasonal variations in sunlight.
In recent months and years, scientists have developed a different explanation: Studies show the increased risk of schizophrenia appears linked to maternal infections during the first and second trimesters of pregnancy -- especially flu infections. Since the flu peaks in the fall, this might explain why babies born in the winter and spring have the higher risk.

A warning on safe sex at any age

KANSAS CITY, Mo. — Jane Fowler thinks it's about time college students had "the talk" with their grandparents.She doesn't mean grandmothers and grandfathers explaining the facts of life. She wants kids to explain safe sex to their elders.It's part of a broader message the 72-year-old has advocated for more than a decade. Ever since she contracted HIV when she was in her 50s, Fowler has made it her mission to help aging baby boomers and members of her generation avoid her mistakes."Once people get past their own embarrassment and understand grandparents today are still sexually active, they realize I'm right," said Fowler, who is scheduled to speak at a safe-sex event on the Kansas State University campus today. "Their grandparents face the same risks of sexually transmitted diseases as they do."

Costs of Hospice Care Rising

Hundreds of hospice providers across the country are facing the catastrophic financial consequence of what would otherwise seem a positive development: their patients are living longer than expected.
Over the last eight years, the refusal of patients to die according to actuarial schedules has led the federal government to demand that hospices exceeding reimbursement limits repay hundreds of millions of dollars to Medicare.

Older white women join Kenya's sex tourists

[T]he health risks are stark in a country with an AIDS prevalence of 6.9 percent. Although condom use can only be guessed at, Julia Davidson, an academic at Nottingham University who writes on sex tourism, said that in the course of her research she had met women who shunned condoms -- finding them too "businesslike" for their exotic fantasies.

Hard choices on healthcare (LA Times)

By most accounts, the SCHIP program has been a 10-year success story. The number of uninsured children dropped steadily from 11.1 million in 1998, the year after the program began, to its lowest level of 7.9 million in 2004, according to U.S. Census Bureau figures. But the number of kids without insurance grew by about 1 million from the beginning of 2004 through 2005, and according to the Kaiser Family Foundation, half of the newly uninsured children came from families earning from about $40,000 to about $80,000 a year (based on a family of four). "It increased in the last year, probably because both adults and kids are losing job-based coverage," says E. Richard Brown, director of the UCLA Center for Health Policy Research.Some of those newly uninsured children qualify for SCHIP but their families are unaware of the program. In some cases, states with budget shortfalls have stopped enrolling children. And when a family loses employer coverage, their children must go through a waiting period of a year, extended in August by the Department of Health and Human Services from three months, before being eligible.What's certain is that SCHIP-insured kids get their checkups. Children in the program are more likely to receive preventive healthcare, specialty care and dental care than uninsured children, and their parents report fewer financial burdens, unmet medical needs and less worry about their children, according to a report in the August 2007 journal Health Services Research. "It has provided access to kids who wouldn't have had coverage," says Brown. "It's cheap, and it'll help produce healthy and productive adults. I don't know what more we could ask for."

Health Care: Solutions Without Borders

At a time when most Americans favor an overhaul of the health care system, it's important to look closely at what other countries are getting right. A growing number of health care stakeholders, including policymakers and insurance industry officials, are recommending that we look across the Atlantic to explore the health systems in countries that cover all of their citizens.
The Commonwealth Fund's 2007 International Health Policy Survey released in October—our 10th annual international survey—reveals that, while no one health system provides an ideal model, we have much to learn from the other countries.
Rather than caricature the health systems in other nations, we should evaluate their strengths and shortcomings—and use that knowledge to create a high-performing health system in the United States.

Study Debunks Theory On Teen Sex, Delinquency

Researchers at Ohio State University garnered little attention in February when they found that youngsters who lose their virginity earlier than their peers are more likely to become juvenile delinquents. So obvious and well established was the contribution of early sex to later delinquency that the idea was already part of the required curriculum for federal "abstinence only" programs.
There was just one problem: It is probably not true. Other things being equal, a more probing study has found, youngsters who have consensual sex in their early-teen or even preteen years are, if anything, less likely to engage in delinquent behavior later on.

Veterans Without Health Care

Although many Americans believe that the nation’s veterans have ready access to health care, that is far from the case. A new study by researchers at the Harvard Medical School has found that millions of veterans and their dependents have no access to care in veterans’ hospitals and clinics and no health insurance to pay for care elsewhere. Their plight represents yet another failure of our disjointed health care system to provide coverage for all Americans.

Advocates tout rising support for child health plan

Democrats and healthcare advocates are expressing increasing confidence that their emphasis on expanding children's health insurance - a measure already vetoed once by President Bush - has succeeded in putting healthcare on the national agenda. They point to a new round of polls that found wide public support for the child health program. Proponents say the difference between the Republican and Democratic positions is stark, giving voters a clear choice on what many call the most important domestic issue in next year's presidential election.

Autism epidemic may be all in the label

A few decades ago, people probably would have said kids like Ryan Massey and Eddie Scheuplein were just odd. Or difficult.
Both boys are bright. But Ryan, 11, is hyper and prone to angry outbursts, sometimes trying to strangle another kid in his class who annoys him. Eddie, 7, has a strange habit of sticking his shirt in his mouth and sucking on it.
Both were diagnosed with a form of autism. And it's partly because of children like them that autism appears to be skyrocketing: In the latest estimate, as many as one in 150 children have some form of this disorder. Groups advocating more research money call autism "the fastest-growing developmental disability in the United States."

Suicide Tourism

People are traveling to New York City with the aim of killing themselves in a phenomenon researchers call "suicide tourism," a Manhattan public health expert reported Monday. Research reported in Washington at the annual meeting of the American Public Health Assn. suggests that one in 10 suicides committed in Manhattan since 1990 have involved nonresidents.

Shy? Or Something More Serious?

Bashfulness, once prized as a virtue, became a sign for medical concern. According to the 1994 National Comorbidity Survey, as much as 12.1 percent of the U.S. population might have social anxiety disorder and a staggering 28.8 percent suffer from some kind of anxiety disorder.
As a result of statistics like these and the disease criteria listed in the updated Diagnostic and Statistical Manual of Mental Disorders, or DSM, large numbers of people swallow daily doses of Paxil, Prozac and Zoloft for conditions that many experts now consider medical problems stemming from a chemical imbalance. After examining prescription rates for these three antidepressants alone, David Healy and Graham Aldred of the North Wales Department of Psychological Medicine at Britain's Cardiff University reported in the International Review of Psychiatry that just over 67.5 million Americans had taken at least one of them in the 15-year period ended in 2002. More than 18.5 million of those had received a prescription for Paxil, the first antidepressant to receive FDA approval for social anxiety disorder.

WHO aims to balance drug companies, poor

GENEVA - The U.N. health chief urged countries on Monday to come up with new ways to make medicine for HIV/AIDS and other diseases more affordable in the world's poorest countries, without stifling innovation among pharmaceutical companies.
The World Health Organization's 193 member states are hoping to forge a global strategy on the highly divisive issues of drug development, patenting and pricing by the end of the week.
"People should not be denied access to lifesaving and health-promoting interventions for unfair reasons," said Dr. Margaret Chan, WHO's director-general, in opening the agency's first meeting devoted to the subject since May, when the United States walked out of a negotiating session and dissociated itself from a WHO resolution.
Under rules agreed by the World Trade Organization, countries can issue so-called "compulsory licenses" to disregard patent rights, but only after negotiating with the patent owners and paying them adequate compensation. If they declare a public health emergency, governments can skip the negotiating.
Brazil and Thailand have invoked the procedure to import cheap generic versions of American AIDS drugs, among other medicines, to treat patients who developed resistance to older anti-retrovirals and needed more expensive, second-line drugs.
The moves by Brazil and Thailand were praised by health campaigners but criticized by industry groups. The United States later placed Thailand on a copyright watch list of nations where American companies face problems protecting intellectual property rights. Countries on the list are under extra scrutiny and can face trade sanctions if alleged violations worsen.
The international aid group Oxfam says compulsory licensing almost never occurs because developing countries face pressure from rich governments acting on behalf of their drug companies. Its report last year on drug access cited WHO statistics that 74 percent of AIDS medicines are still under monopoly, and that 77 percent of Africans still lack any access to AIDS treatment.

Are we too quick to medicate children?

In 2005, the latest year for which statistics are available, at least 2.2 million American children over the age of 4 were being treated for serious difficulties with emotion, concentration, behavior or ability to get along with others. It's a figure mental-health professionals say has exploded in the last decade and a half, along with sales of a wide range of psychiatric medications for use by children.A welter of studies has shown that kids are being diagnosed at younger ages, with a wider range of disorders and with more severe disorders than ever before. And in growing numbers, they are being medicated with drugs whose safety, effectiveness and long-range effects on children have not been demonstrated by extensive research.

Depressed male veterans have highest suicide risk

Among depressed U.S. military veterans, young white men have the highest risk of suicide, the results of a large VA study suggest. Using government data for more than 800,000 veterans who were treated for depression between 1999 and 2004, the investigators found that the overall suicide risk was 7 to 8 times higher compared with that in the general population.
Male veterans had roughly three times the rate of suicide as female veterans did, while younger veterans -- those ages 18 to 44 -- had a higher suicide rate than their older counterparts. Men who were 65 years or older had the second highest risk, while the lowest risk was seen among men between the ages of 45 and 64 years old.

New Film Stirs Up ’Ex-Gay’ Debate

In spite of a near-unanimous consensus from the psychological community that homosexuality is a normal, natural, and fixed orientation, ex-gay ministries and reparative therapy groups have only grown larger over the years. Salzer decided to make the film after attending an annual American Psychological Association (APA) meeting, in which participants were becoming more and more concerned about the overwhelming efforts of ministries and organizations like Exodus and Love Won Out to target and conduct public outreach in the gay community.

1.8 Million Veterans Lack Health Coverage

Of the 47 million uninsured Americans, one in every eight (12.2 percent) is a veteran or member of a veteran’s household, according to a study by Harvard Medical School researchers published in the December, 2007 issue of the American Journal of Public Health (galley version available here). 1.8 million Veterans (12.7 percent of non-elderly veterans) were uninsured in 2004, up 290,000 since 2000, the study found. An addition 3.8 million members of their households were also uninsured and ineligible for VA care.

In China, Brain Surgery Is Pushed on the Mentally Ill

The irreversible brain surgeries performed at No. 454 Hospital, which are all but blacklisted for mental illness in the developed world, are being done across China. They are a symptom of the problems plaguing the nation's health-care system, which has left hospitals with scant public funding and hungry for profit.

Scientists Denounce Global Warming Report 'Edits'

Environmental and public health experts overwhelmingly denounced editing by the White House of a federal health agency head's testimony to Congress Tuesday. Significant deletions were made from the testimony, concerning global warming and the potential impact on human health. The original, unedited testimony presented to Congress by Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention (CDC) and obtained by ABC News was 14 pages long, but the White House Office of Management and Budget edited the final version down to a mere six pages.
Scientists and public health organizations called the move "frustrating," "terrible" and "appalling." The edits essentially deleted all sections that referred to climate change as a public health concern -- including the risks of increased food-borne and waterborne diseases, worsening extreme weather events, worsening air pollution and the effect of heat stress on humans. "Dr. Gerberding is the lead of the premiere public health agency in the U.S.," said Kim Knowlton, a science fellow on global warming and health at the National Resources Defense Council in New York. "It's shocking that she was not allowed to say in a public discussion some of these vital details.
"One has to wonder why was this is so threatening to the White House."

Suicide by Soldiers in Iraq

More service members killed themselves while serving in the Iraq war last year than in any year since the war began, and the suicide count for 2007 is on track to surpass that. The dead are generally junior enlisted soldiers who are single, white and male.

SCHIP Redux

Sensing a political advantage, Democrats rushed Wednesday to move a health care bill for children back to the House floor, having made minor changes to win over more Republicans.
Speaker Nancy Pelosi said the House would vote Thursday on the new bill. Like the original, which President Bush vetoed three weeks ago, it would cover 10 million children through the State Children’s Health Insurance Program and increase spending on the program by $35 billion, for a total of $60 billion, in the next five years.
But the new bill would tighten eligibility for the program, generally barring the use of federal money to cover illegal immigrants, childless adults and children of families with incomes exceeding three times the poverty level: $61,950 for a family of four. . . .
Under the new bill, as under the previous one, the federal excise tax on cigarettes would be increased by 61 cents a pack, to a total of $1, and Mr. Leavitt said the administration still opposed that provision.

Should Middle School Students Have Access to Birth Control?

Two days after the school committee voted 7 to 2 in favor of adding prescription contraceptives to the services offered at the health clinic, the issue continues to draw fervent support and ardent opposition in this city of 64,000, the largest in Maine.
“I think it’s a great idea,” said Cathleen Allen, whose son is enrolled at King. “Someone is finally advocating for these students to take care of themselves.”
Ms. Allen added, “It’s an eye-opener for all of us, but when you look at the facts, why not?”
Bishop Richard J. Malone of the Roman Catholic Diocese of Portland is calling on the school committee to rescind its decision, as have the state and city Republican Parties. The city party is also pushing a recall for members who voted in favor.
Nick McGee, the city’s Republican Party chairman, said of the policy, “It is an attack on the moral fabric of our community, and a black eye for our state.”
On Friday, John Coyne, chairman of the school committee and one of the two members who voted against the plan, said he wanted the panel to reconsider the program. Mr. Coyne said that parents should have the option to enroll their children in all aspects of the clinic except reproductive health treatment, and that parents should be made more aware of the state’s confidentiality laws.
“I still don’t feel comfortable with this,” Mr. Coyne said. “There’s no talk about the health issues and the possible long-term ill effects on these young ladies.”
The school’s clinic functions much like a physician’s office and has been offering condoms and testing for pregnancy and sexually transmitted diseases since 2000. It also offers dental, mental health and basic care.
The clinics at Portland high schools have offered oral contraceptives for years, said Douglas S. Gardner, the city’s director of health and human services. Health officials decided to extend the policy to middle school after learning that 17 middle school students had become pregnant in the last four years, seven of them in the 2006-7 school year.

Sexual misconduct plagues US schools

The young teacher hung his head, avoiding eye contact. Yes, he had touched a fifth-grader's breast during recess. "I guess it was just lust of the flesh," he told his boss.
That got Gary C. Lindsey fired from his first teaching job in Oelwein, Iowa. But it didn't end his career. He taught for decades in Illinois and Iowa, fending off at least a half-dozen more abuse accusations.
When he finally surrendered his teaching license in 2004 — 40 years after that first little girl came forward — it wasn't a principal or a state agency that ended his career. It was one persistent victim and her parents. . . .
One report mandated by Congress estimated that as many as 4.5 million students, out of roughly 50 million in American schools, are subject to sexual misconduct by an employee of a school sometime between kindergarten and 12th grade. That figure includes verbal harassment that's sexual in nature.

Biden unveils health care plan

Democratic presidential candidate Joe Biden on Tuesday released a plan that would expand access to health coverage for all children and adults, but stops short of mandating universal coverage. . . .
The plan would cost an estimated $110 billion each year. It would be paid for by rolling back tax cuts for the top 1 percent of Americans, eliminating tax breaks on capital gains and ending tax loopholes for hedge fund managers and private equity partners, the campaign said.
To provide health coverage for uninsured children, Biden proposes expanding the State Children's Health Insurance Program, or SCHIP, to at least 300 percent of the poverty level — or about $61,950 for a family of four, and raising the coverage age to at least 21. Families that don't meet the poverty criteria would be able to purchase coverage under the program.

Voters favor Democratic ideas to mend healthcare

Healthcare is widely seen as the top domestic issue in next year's presidential race. Two of the main proposals advanced by Democrats received majority support in the poll. Sixty-two percent said they supported requiring large employers to help pay for coverage whereas 31% opposed it. And 51% said they favored a mandate that individuals purchase health insurance, much as drivers are required to carry auto coverage; 39% disagreed. Tax breaks to make insurance more affordable -- a leading Republican idea -- more closely divided the public, with 44% backing that approach and 45% opposing it. In one of the most politically significant results, the poll finds that independents and moderates were generally lining up with Democrats in the healthcare debate.

Holiday-Suicide Link Newspapers Continue to Perpetuate the Myth

Despite no basis in fact, newspapers continue to report on the increased risk of suicide around the Thanksgiving, Christmas and New Year holidays. An analysis of newspaper reporting over the past seven years released today by the Annenberg Public Policy Center shows that this story represents about half of all holiday-relevant suicide reporting. . . .
As noted in previous studies, the rate of suicide in the U.S. is lowest in December, and peaks in the spring and fall. Data collected by the National Center for Health Statistics show that this pattern has not changed through 2003, the most recent year for which national data are available.

House Failure To Override Veto Good News For Tobacco

The U.S. House's failure Thursday to override President George W. Bush's veto of tobacco tax hike legislation is another break for the industry. The bill would have increased federal tobacco excise taxes the equivalent of 61 cents per pack of cigarettes. . . .
The $35 billion raised by the tobacco tax increase over five years would have offset the cost of expanding the State Children's Health Insurance Program. The bill's supporters said that by 2012, the expansion would have allowed the program to cover nearly 10 million children.
House Speaker Nancy Pelosi, D-Calif., already has promised to have the same bill back on Bush's desk within two weeks. Asked whether the bill might include an alternative funding source, Pelosi said simply, "no."
Bush vetoed the bill on Oct. 3, arguing that it would encourage families to drop private insurance. He has offered $5 billion that would temporarily increase the number of children enrolled in the program, but would reduce enrollment over the next five years.

Meth Stories

Some of these first-person accounts may be of interest.

Should Cities Offer Safe Sites for Injection Drug Users?

City health officials and addiction experts took the first steps Thursday toward opening the nation's only government-sponsored injection room that would give drug addicts a safe, clean place to shoot up. Hoping to reduce San Francisco's high rate of fatal drug overdoses, the local public health department co-sponsored a symposium on the only such facility in North America, a 4-year-old Vancouver site where an estimated 700 users a day self-administer narcotics under the supervision of nurses.

Optimal treatment for depression (LA Times article)

Nearly 20 million Americans suffer from some form of depression, according to the National Institute of Mental Health. About 14% of adults now take antidepressants -- triple the percentage during the late 1980s -- and most stay on them for at least six months. A study published in this month's issue of the Archives of General Psychiatry estimated that mental disorders, largely depression, cost Americans 1.3 billion days of normal activity each year. Many people with such illnesses say they feel hopeless, helpless, unable to face life, unable to find solutions to their problems, and at times think of killing themselves. Some of them do.

Medicare Audits Show Problems in Private Plans

Tens of thousands of Medicare recipients have been victims of deceptive sales tactics and had claims improperly denied by private insurers that run the system’s huge new drug benefit program and offer other private insurance options encouraged by the Bush administration, a review of scores of federal audits has found. . . . The audits show the growing pains that Medicare has experienced as it introduced the popular new drug benefit and shifted more responsibility to private health plans. For years, Democrats have complained about efforts to “privatize Medicare,” and they are likely to cite the findings as evidence that private insurers cannot be trusted to care for the sickest, most vulnerable Medicare recipients.

Kids get inadequate health care

As Washington debates children's health insurance, a startling study finds that kids who regularly see doctors get the right care less than half the time — whether it's preschool shots or chlamydia tests for teen girls. The findings, from the first comprehensive look at children's health care quality, are particularly troubling because nearly all the 1,536 children in the nationwide study had insurance. Eight-two percent were covered by private insurance. Three-quarters were white, and all lived in or near large or midsized cities. Two experts called the findings "shocking." Others said minority children, those with more-restrictive government insurance, and the millions with no insurance at all certainly fare even worse.

Boom Times for Dentists, but Not for Teeth

Previously unreleased figures from the Centers for Disease Control and Prevention show that in 2003 and 2004, the most recent years with data available, 27 percent of children and 29 percent of adults had cavities going untreated. The level of untreated decay was the highest since the late 1980s and significantly higher than that found in a survey from 1999 to 2002.

Despite the rise in dental problems, state boards of dentists and the American Dental Association, the main lobbying group for dentists, have fought efforts to use dental hygienists and other non-dentists to provide basic care to people who do not have access to dentists.

Fifth Of State Prison Inmates Mentally Ill

A legislative report shows more than 20 percent of Connecticut's approximately 19,000 prison inmates have moderate to severe mental illness.That fact is prompting some state lawmakers to point out an apparent shortage of trained psychiatric nurses and a need for more training for correction officers. Also, there's talk of creating a separate facility for inmates with mental illness to ease the space crunch" . . . . "If you want to free up prison beds [to keep violent offenders behind bars longer], then get these mentally ill people out of there," Lawlor said.

Suicide prevention team: Victim's dad, former tormentor

After a 17-year-old fellow student took his own life, Kirk Zajac was devastated. Not because he and the other teen were friends; but because they so clearly were not.
Kirk didn't even know the name of the quiet boy whom he and others tormented regularly on the crowded bus to Notre Dame-Cathedral Latin School. They called him "Polar Bear" because of his size and refused to make room for him in a seat. They made fun of him behind his back and to his face.
Last September, when the principal somberly announced that Andy Lehman had died in a car crash, it took awhile for Kirk to even figure out who Andy was. Then he discovered that the crash was no accident.

Cost of the War in Iraq

The opportunity costs associated with this war are staggering.

The Need for Improved Payment Systems (Commonwealth Fund Report)

A growing number of health care professionals around the country are increasingly frustrated by health care payment systems that do not reward efforts to improve health care quality, and that often penalize them financially. There is fairly widespread agreement that one reason for high costs and quality gaps is that current health care payment systems impose significant financial penalties and offer disincentives to providers (hospitals, physicians, and others) who supply quality, efficient care (e.g., lower-cost services, higher-quality care, cognitive services, preventive care, etc.), while they offer significant incentives for providing expensive, inefficient care (e.g., invasive treatment, use of technology, etc.) irrespective of outcomes.

War Costing $720 Million Each Day

The money spent on one day of the Iraq war could buy homes for almost 6,500 families or health care for 423,529 children, or could outfit 1.27 million homes with renewable electricity, according to the American Friends Service Committee, which displayed those statistics on large banners in cities nationwide Thursday and Friday.
The war is costing $720 million a day or $500,000 a minute, according to the group's analysis of the work of Nobel Prize-winning economist Joseph E. Stiglitz and Harvard public finance lecturer Linda J. Bilmes.

Higher Costs, Worse Outcomes for Previously Uninsured Medicare Beneficiaries

Research published recently in the New England Journal of Medicine underscores the importance of having health insurance coverage—not only for ensuring access to needed care, but also for controlling overall health care costs and promoting good health outcomes.
The Commonwealth Fund-supported study, Use of Health Services by Previously Uninsured Medicare Beneficiaries, found that among U.S. adults ages 59 to 64 who had been diagnosed with hypertension, diabetes, heart disease, or stroke, those lacking insurance coverage had much higher medical costs—51 percent higher—after becoming eligible for Medicare at age 65, compared to those with insurance coverage.

Many Massachusetts hospitals will pay for errors

About half of Massachusetts hospitals say they have adopted policies to waive charges for serious medical errors such as wrong-site surgery and harmful medication mistakes, and others say they plan to, amid growing resistance from government and health insurers to paying for poor outcomes.

Bill makes drug-makers financial link to doctors known

Your doctor says you have high blood pressure. And he knows exactly which drug is perfect for you. You head home and hit a few keys on your computer. Instantly, you see the full picture: The medicine he wants you to take is going to help him a whole lot more than it's going to help you.

States Differ Widely in Spending on Health Care, Study Finds

A new federal study shows huge variations in personal health spending among states, ranging from an average of nearly $6,700 a person in Massachusetts to less than $4,000 in Utah.
The study, published on Monday in the Web edition of the journal Health Affairs, said that Massachusetts, Maine, New York, Alaska and Connecticut had the highest per capita spending on health care in 2004. The lowest-spending states were Utah, Arizona, Idaho, New Mexico and Nevada. Per capita spending in Utah was 59 percent of that in Massachusetts.

Senate Passes Mental Health Parity Bill

The Senate passed legislation Tuesday night that would require equal health insurance coverage for mental and physical illnesses when policies cover both. The bill, which passed by unanimous consent, moves advocates one step closer in their years-long quest for a concept known as mental health parity.
"The passage tonight of the Mental Health Parity bill underscores our commitment to treat all patients facing all diseases with the dignity and respect they deserve," said Sen. Edward Kennedy, D-Mass. "This new legislation will bring dramatic new help to millions of Americans who today are denied needed mental health care and treatment." Passage came on the same day that supporters inundated House Speaker Nancy Pelosi's office, urging a vote on mental health parity legislation in the House.

Medicare-for-all would keep everyone covered

The number of uninsured Americans has jumped by 2.2 million to 47 million. This rise in the number of people without health insurance is the biggest jump reported by the Census Bureau since 1992. There are now more uninsured people in the United States than at any time since the passage of Medicare and Medicaid in the mid-1960s.

Clinton unveils universal health care plan

Democrat Hillary Rodham Clinton called for universal health care on Monday, plunging back into the bruising political battle she famously waged and lost in her husband's administration on an issue that looms large in the 2008 presidential race. "This is not government-run," the party's front-runner said of her plan to extend coverage to an estimated 47 million Americans who now go without. Her declaration was a clear message to Republicans, the insurance industry, businesses and millions of voters who nervously recall what sank her effort at health care reform 13 years ago — fear of a big-government takeover.

How Are You Likely to Die?

This is a graphical way of displaying relative risk for dying from a variety of causes.

U. S. Critics Slam Canada's Health Care System

The birth of identical quadruplet girls to a Canadian woman in Montana last month has ignited debate in the United States with editorial writers and bloggers attacking the Canadian health-care system.
A shortage of neonatal beds in Calgary meant that Karen Jepp and her husband J.P. had to travel to Great Falls, Mont., for the birth of Autumn, Brooke, Calissa and Dahlia on Aug. 12.
The chance of giving birth to identical quadruplets is one in 13 million, so the event attracted widespread international attention and caused many Americans to focus on Canada's universal system of health care.

Abortion in the Philippines: a national secret

The backstreet abortions . . . may become more common as a United States government aid program plans to stop distributing contraceptives in the Philippines in 2008. This will leave birth control up to the government which under the influence of Catholic bishops advocates unreliable natural birth control methods rather than the pill and condoms.

Crisis on campus

Now, with the overall number of mentally ill college students rising, college administrators, mental-health professionals and students across the country are weighing that right to privacy against the need to assist those students who are deeply distressed or mentally ill. Several recent high-profile cases have pitted parents against colleges that refused to divulge details of students' mental-health status. A federal lawmaker has introduced legislation that could pave the way for colleges and universities to more easily share information with family members. And the April 16 massacre at Virginia Tech has provided a real-life worst-case scenario for what can happen when students don't get appropriate help and information is not shared among college officials and the student's family.

Bipolar disorder in youths may be over-diagnosed

The diagnosis of bipolar disorder in children and adolescents has risen fortyfold since 1994, according to a study released Monday. But researchers partly attributed the dramatic rise to doctors over-diagnosing the serious psychiatric disorder.The report in the journal Archives of General Psychiatry said bipolar disorder was found in 1,003 of every 100,000 office visits from children and adolescents in 2002-03, compared with 25 of 100,000 office visits in 1994-95.The diagnosis of bipolar disorder among adults increased twofold during the same period, researchers said.

Mentally ill 'suffering neglect'

Mentally ill people in the developing world are being badly neglected, according to a study published in the Lancet medical journal. The authors say mental illness makes up about 14% of global disease, more than cancer or heart disease.
Up to 800,000 people commit suicide each year, mostly in poorer countries. Despite this, the authors say, 90% of sufferers in developing countries receive no care - and in some cases are chained to trees or kept in cages.

Many Immigrants Face Cultural Barriers, Other Obstacles to Psychiatric Treatment

The parents had tried with little success to cope with their son's accelerating deterioration. Unable to concentrate, he had dropped out of college and moved back home. When he could no longer function at the job he had held briefly, his parents kept him sequestered in their house, his condition a closely guarded secret. By the time the trio arrived in the emergency room, the youth was hallucinating and had assaulted his parents.
When psychiatrist Amir Afkhami asked why the couple had waited two years to seek treatment for their son's schizophrenia, the answer was simple: "We thought he was just spoiled."

Youth Suicides Increased As Antidepressant Use Fell

From 2003 to 2004, the suicide rate among Americans younger than 19 rose 14 percent, the most dramatic one-year change since the government started collecting suicide statistics in 1979, the study found. The rise followed a sharp decrease in the prescribing of antidepressants such as Prozac, Zoloft and Paxil after parents and physicians were confronted by a barrage of warnings from the Food and Drug Administration and international agencies.

Suicide Trends Among Youths and Young Adults Aged 10--24 Years --- United States, 1990--2004

In 2004, suicide was the third leading cause of death among youths and young adults aged 10--24 years in the United States, accounting for 4,599 deaths. (MMWR Report)

Lancet Series (for those of you interested in international mental health)

The Lancet Series on Global Mental Health: Article Collection
Launching a new movement for mental health
“Despite the great attention western countries pay to the mind and human consciousness in philosophy and the arts, disturbances of mental health remain not only neglected but also deeply stigmatised across our societies.”
These are the introductory words of The Lancet's editor Dr Richard Horton, in a comment to introduce the series. He says: “For the most part, these organisations have done far too little, if anything at all?

Bill Bradley on Politics (New York Times Editorial)

A party based on charisma has no long-term impact. Think of our last charismatic leader, Bill Clinton. He was president for eight years. He was the first Democrat to be re-elected since Franklin Roosevelt. He was smart, skilled and possessed great energy. But what happened? At the end of his tenure in the most powerful office in the world, there were fewer Democratic governors, fewer Democratic senators, members of Congress and state legislators and a national party that was deep in debt. The president did well. The party did not. Charisma didn’t translate into structure.

Middle-Class Americans Join Ranks of Uninsured in 2006 as Private Coverage Shrinks

The U.S. Census Bureau released data today showing that the number of uninsured Americans jumped by 2.2 million in 2006 to 47.0 million people, with nearly all the increase (2.03 million) concentrated among middle-class Americans earning over $50,000 per year, according to an analysis by Physicians for a National Health Program (PNHP). Strikingly, 1.4 million of the newly uninsured were in families making over $75,000 per year. An additional 600,000 were in families earning $50,000 to $75,000 per year. (The median household income in 2006 was $48,200).
"Middle income Americans are now experiencing the human suffering that comes with being uninsured. It makes any illness a potential economic and social catastrophe," said Dr. Steffie Woolhandler, co-founder of Physicians for a National Health Program and Associate Professor of Medicine at Harvard Medical School.

Medical Homes Promote Equity in Health Care

The Commonwealth Fund 2006 Health Care Quality Survey finds that when adults have health insurance coverage and a medical home—defined as a health care setting that provides patients with timely, well-organized care, and enhanced access to providers—racial and ethnic disparities in access and quality are reduced or even eliminated. When adults have a medical home, their access to needed care, receipt of routine preventive screenings, and management of chronic conditions improve substantially.

Why can't Americans give up their guns?

According to the U.S. government's Center for Disease Control and Prevention, in 2004 — the latest year for which such figures are available — a total of 11,624 people were shot dead or murdered. That averages out to 32 a day. In the same year an additional total of 16,750 people shot themselves to death with firearms, 649 people died in gun accidents, and 311 in "legal intervention," that is, shot dead by police. Also, 235 people died for unknown reasons though it was clear that they did so of gun wounds. A grand total of 29,569, or an average of 81 people a day, were killed or died by use of guns.

Romney's rhetoric glosses Massachusetts years

On the presidential campaign trail, Mitt Romney points to healthcare reform as his major achievement as Massachusetts governor, presenting the plan as an example of how he used conservative principles to provide affordable health insurance for all state residents without a government takeover. But he does not mention aspects of the plan that may hold less appeal for his Republican audiences. For example, he decries "socialized medicine" and says the Massachusetts plan is "all a private initiative, a private-based, market-based healthcare" -- omitting the fact that the state and federal governments subsidize much of the overall cost and that a public board negotiated the benefits and prices that private insurers now offer. . . .

Science vs. politics gets down and dirty

Malicious, vindictive and mean-spirited. These are words that might surface in divorce court.
But they have been lobbed in the course of a different estrangement: the standoff between the Bush administration and the nation's scientific community.
The relationship, which has been troubled since the dawn of the Bush presidency, hit a new low last month when Richard Carmona, surgeon general from 2002 to 2006, lashed out at his former colleagues in testimony before a House committee.

Lawmaker Calls for Registry of Drug Firms Paying Doctors

WASHINGTON, Aug. 3 — An influential Republican senator says he will propose legislation requiring drug makers to disclose the payments they make to doctors for services like consulting, lectures and attendance at seminars.
The lawmaker, Charles E. Grassley of Iowa, the senior Republican on the Senate Finance Committee, cited as an example the case of a prominent child psychiatrist, who he said made $180,000 over just two years from the maker of an antipsychotic drug now widely prescribed for children.

Under the influence

For many Americans, a doctor's decision to prescribe medication is something of a sacred transaction. A physician considers the patient and symptoms and chooses the best drug for the job, drawing upon years of training and clinical experience. It is an exchange conducted in a hushed sanctuary, far from the heat and noise of the marketplace -- a place where cool judgment reigns. That sanctuary has been breached. Today, drug manufacturers do everything in their considerable power to ensure that their brand-name prescription medications are on the lips of patients and in the minds of physicians every time the two meet across an exam table. A growing chorus of critics says their efforts have begun to rewrite the dialogue between patient and doctor, influence physicians' judgments and open the act of prescribing to forces more profit-minded than sacred.

Children’s Health Plan Focus of New Struggle

The Children’s Health Insurance Program has suddenly become a vehicle for an ideological struggle between President Bush and Congress over the future of the health care system.
But in the short term, members of both parties say, the broader outline of that struggle is likely to be reduced to a simple question: “Are you for or against children?” . . . . Representative John Shadegg, an influential conservative from Arizona, said, “This debate is the opening salvo in a battle over the future of health care in America.” . . . . Republicans say Mr. Bush’s opposition to the House and Senate bills stems from conviction and principle, not a political calculus. But, they say, he is not running for re-election and appears oblivious to the political risks for Republicans.

Child abuse claims raise queries about Maori culture

The case of a three-year-old girl who was allegedly hung from a washing line and spun in a tumble-dryer has reignited debate in New Zealand about the touchy subject of child abuse within Maori communities. . . . In many such cases, it has emerged that the victim's extended family knew the child was being mistreated. But it is Maori custom that people sort out their problems themselves, rather than report them to the police.

Bill Would Let States Force Drug Discounts

U.S. Rep. Chris Van Hollen is preparing legislation that would allow states to make prescription drugs more affordable for low- and moderate-income Americans, a challenge to Bush administration policies that have thwarted such efforts in Maryland and elsewhere.
Van Hollen (D-Md.) said he will introduce a bill early this week allowing states to use their purchasing power to require drug companies to provide discounts on medications for low-wage workers. Under the proposal, states could negotiate the same breaks they get for people on Medicaid, the state-federal health-care program for the poor.

Skipping doses could be deadly

Consider it the other drug problem: Millions of people don't take their medicine correctly — or quit taking it altogether — and the consequences can be deadly. On average, half of patients with chronic illnesses like heart disease or asthma skip doses or otherwise mess up their medication, says a report being issued later this week that calls the problem a national crisis costing billions of dollars.

The Right Rx for Sadness

. . . [T]here's a growing concern that medicine often goes to people who shouldn't be taking it. And a consensus has formed that the estimate of how many people will develop depression at some point—1 in 6—might be greatly inflated. "There's no question that the availability of these drugs has increased the diagnosis of depression," says Jerome Wakefield, a professor of social work at New York University. Wakefield is coauthor of the new book The Loss of Sadness, which argues that selective serotonin reuptake inhibitors—Prozac, Paxil, Zoloft—are commonly overused to treat sadness, a normal and healthy response to divorce, sudden unemployment, the end of a friendship, a house foreclosure.

Bush Aide Blocked Report

A surgeon general's report in 2006 that called on Americans to help tackle global health problems has been kept from the public by a Bush political appointee without any background or expertise in medicine or public health, chiefly because the report did not promote the administration's policy accomplishments, according to current and former public health officials.

Carmona told lawmakers that, as he fought to release the document, he was "called in and again admonished . . . via a senior official who said, 'You don't get it.' " He said a senior official told him that "this will be a political document, or it will not be released."

Paul Krugman: The Waiting Game

Being without health insurance is no big deal. Just ask President Bush. “I mean, people have access to health care in America,” he said last week. “After all, you just go to an emergency room.”
This is what you might call callousness with consequences. The White House has announced that Mr. Bush will veto a bipartisan plan that would extend health insurance ... to an estimated 4.1 million currently uninsured children. After all, it’s not as if those kids really need insurance — they can just go to emergency rooms, right?...

Yes, We Can All Be Insured

[T]he public knows the American health-care system is breaking up, no matter how much its backers cheer. For starters, there's the 46 million uninsured (projected to rise to 56 million in five years). There's the shock of the underinsured when they learn that their policies exclude a costly procedure they need—forcing them to run up an unpayable bill, beg for charity care or go without. And think of the millions who plan their lives around health insurance—where to work, whether to start a business, when to retire, even whom to marry (there are "benefits" marriages, just as there are "green card" marriages). It shocks the conscience that those who profit from this mess tell us to suck it up.
. . . .
Right now, Congress is trying to bring 3.3 million uninsured children into the State Children's Health Insurance Program. President George W. Bush says he'll veto the expansion as "the wrong path for our nation." He objects to "government-run health care" (like Medicare?) and says that SCHIP "deprives Americans of ... choice" (like the choice to go uninsured?). Buzzwords like "government run" are supposed to summon up monsters like "socialized medicine" that apparently still lurk under our beds. If these terror tactics work, prepare for another 46 million uninsured.

Children’s health must be nation’s priority (John Kerry on SCHIP)

We have been modest where we should have been bold. If we, as senators, don’t stand for insuring every child in America, then what do we stand for? If America can spend $10 billion each month in Iraq, surely we can also spend $10 billion each year on children’s health.
Even more troubling, the president has launched a disinformation campaign to denounce this bill as a larger Democratic strategy or plot to massively expand federalized medicine. He has stubbornly pledged to veto a bill he hasn’t even read. Apparently, confronted with a bipartisan compromise to extend health care coverage to half of the 9 million American children without insurance today, the president sees only a vast, left-wing conspiracy.

Shortage of doctors affects rural U.S.

A national shortage of doctors is hitting poor places the hardest, and efforts to bring in foreign physicians to fill the gap are running into a knot of restrictions from the war on terror and the immigration debate. Doctors recruited from places such as India, the Philippines and sub-Saharan Africa to work in underserved areas like the Mississippi Delta and the lonesome West already face an arduous and expensive gauntlet of agencies, professional tests and background checks to secure work papers and permanent residency. . . .The government estimates that more than 35 million Americans live in underserved areas, and it would take 16,000 doctors to immediately fill that need, according to the American Medical Association. And the gap is expected to widen dramatically over the next several years, reaching 24,000 in 2020 by one government estimate. A 2005 study in the journal Health Affairs said it could hit an astonishing 200,000 by then, based on a rising population and an aging work force.

Express-Lane Medicine (Newsweek)

[By] offering patients quicker, cheaper alternatives to doctors, so-called convenience-care clinics—staffed by nurse practitioners who offer low-cost treatment for easy-to-diagnose conditions—are spreading faster than a cold in a kindergarten.

The Politics of Sex

Despite years of evidence clearly showing that these [abstinence] programs are ineffective and harmful, federal funding continues at over $200 million a year and growing. Under the Bush administration, abstinence-only subsidies have gushed forth -- creating a deluge of funding for far-right religious groups, amidst a dearth of federal oversight. . . . In reality 95 percent of Americans do have sex before marriage, most before they reach age 19. We must stop funding harmful and ineffective abstinence-only programs and instead support a more comprehensive approach to sexuality education and reproductive health.

Healing Healthcare (LA Times)

VOTERS IN THE United States rank healthcare second only to Iraq as an issue of concern in the presidential campaign. Close to 45 million people in this country lack healthcare coverage, including 6.5 million in California — roughly 17% of the state's population. Increasingly, Americans realize that our healthcare system, which at $2 trillion a year represents 18% of GDP, with spending expected to double by 2016, is probably unsustainable. That adds up to an economic crisis that must command the attention of the 18 candidates with serious aspirations to become the next president. . . .
The cost question is a painful one because it inevitably leads to the question of sacrifice. If everyone is going to be covered, every treatment probably won't be. Clear conversation on this, however, begins with the recognition that this country already rations healthcare — those without insurance routinely go without care.The complexity of the country's healthcare crisis makes it difficult to debate in the rapid-fire exchanges that too often characterize our modern political campaigns. So it is all the more important that candidates present substantive proposals. America has a chance to grapple with this fundamental issue now. If we succumb instead to slogans, we will long regret it.

Sicko Review (The New Yorker)

Just this year, in my own surgical practice, I have seen a college student who couldn’t afford the radiation treatment she needed for her thyroid cancer, because her insurance coverage maxed out after the surgery; a breast-cancer patient who didn’t have the cash for the hormone therapy she needed; and a man denied Medicare coverage for an ambulance ride, because the chest pain he thought was caused by a heart attack wasn’t—it was caused by a tumor. The universal human experience of falling ill and seeking treatment—frightening and difficult enough—has been warped by our dysfunctional insurance system.

Senate Panel Adds Billions for Health

Defying a veto threat from President Bush, the Senate Finance Committee approved a major expansion of the Children’s Health Insurance Program on Thursday, with a majority of Republicans joining all Democrats on the panel in supporting the legislation.
The vote, 17 to 4, sends the measure to the full Senate, which is expected to take it up within two weeks. Mr. Bush has repeatedly denounced the bill as a step toward “government-run health care for every American,” describing it as a “massive expansion of the federal role” in health care, financed by “a huge tax increase.”

Start from ground up to fix health care

Earlier in the week, PricewaterhouseCoopers' Health Research Institute reported that the United States will be short 1 million nurses and 24,000 doctors by 2020. It said that while applications to nursing program had risen, the number of students denied admission had grown six fold since 2002, mostly because of a shortage of instructors. . . . "People in the United States spend $532 billion (a year) on health. That $532 billion is not spent very wisely."

Critics Accuse Bush Administration of Trumping Science With Politics

Health experts said Wednesday they agreed with former Surgeon General Richard H. Carmona's claim that the Bush administration has continually silenced medical and scientific opinions in favor of politics and religious dogma.

During his testimony before a Congressional panel on Tuesday, Carmona said that "top Bush administration officials repeatedly tried to weaken or suppress important public health reports because of political considerations,"The New York Timesreported.

It doesn't surprise us to hear that the administration was ignoring science and attempting to silence scientists. That's how they have operated about stem cells for years. . . ."

Psychiatrists Top List in Drug Maker Gifts

As states begin to require that drug companies disclose their payments to doctors for lectures and other services, a pattern has emerged: psychiatrists earn more money from drug makers than doctors in any other specialty. How this money may be influencing psychiatrists and other doctors has become one of the most contentious issues in health care. For instance, the more psychiatrists have earned from drug makers, the more they have prescribed a new class of powerful medicines known as atypical antipsychotics to children, for whom the drugs are especially risky and mostly unapproved.

Bush calls a Democratic effort to expand a popular program a move toward government takeover of healthcare.

Laying down a marker on healthcare, President Bush on Wednesday strongly criticized a push by Democrats and some moderate Republicans to broaden a popular children's insurance program. Bush called the plan a step toward a government takeover of medicine.After months of watching from the sidelines as Congress ignored his healthcare ideas, Bush forcefully reinserted himself into the debate. His bottom line: Government healthcare programs should focus on the poor and near-poor, not on middle-class families.

Closing the Divide: How Medical Homes Promote Equity in Health Care

The Commonwealth Fund 2006 Health Care Quality Survey finds that when adults have health insurance coverage and a medical home—defined as a health care setting that provides patients with timely, well-organized care, and enhanced access to providers—racial and ethnic disparities in access and quality are reduced or even eliminated. When adults have a medical home, their access to needed care, receipt of routine preventive screenings, and management of chronic conditions improve substantially. The survey found that rates of cholesterol, breast cancer, and prostate screening are higher among adults who receive patient reminders, and that when minority patients have medical homes, they are just as likely as whites to receive these reminders.

Backlash on bipolar diagnoses in children

No one has done more to convince Americans that even small children can suffer the dangerous mood swings of bipolar disorder than Dr. Joseph Biederman of Massachusetts General Hospital.
From his perch as one of the world's most influential child psychiatrists, Biederman has spread far and wide his conviction that the emotional roller coaster of bipolar disorder can start "from the moment the child opened his eyes" at birth. Psychiatrists used to regard bipolar disorder as a disease that begins in young adulthood, but now some diagnose it in children scarcely out of diapers, treating them with powerful antipsychotic medications based on Biederman's work.

States Face Decisions on Who Is Mentally Fit to Vote

Rhode Island is among a growing number of states grappling with the question of who is too mentally impaired to vote. The issue is drawing attention for two major reasons: increasing efforts by the mentally ill and their advocates to secure voting rights, and mounting concern by psychiatrists and others who work with the elderly about the rights and risks of voting by people with conditions like Alzheimer’s disease and dementia.

Bush Again Vetoes Bill on Stem Cell Research

President Bush today issued his second veto of a measure lifting his restrictions on human embryonic stem cell experiments, a move that effectively pushed the contentious scientific and ethical debate surrounding the research into the 2008 presidential campaign.
At the same time, Mr. Bush issued an executive order intended to encourage scientists to pursue other forms of stem cell research that he does not deem unethical. But that research is already going on and the plan provides no new money.
Advocates for embryonic stem cell research called the new plan a ploy to distract from Mr. Bush’s opposition to the studies. “I think the president has issued a political fig leaf,” said Sean Tipton, spokesman for the Coalition for the Advancement of Medical Research, an advocacy group. “He knows he’s on the wrong side of the American public.”

Study Finds 1.8 Million Veterans Are Uninsured

As the nation struggles to improve medical and mental health care for military personnel returning from Afghanistan and Iraq, about 1.8 million U.S. veterans under age 65 lack even basic health insurance or access to care at Veterans Affairs hospitals, a new study has found.

. . . . Rep. Bob Filner (D-Calif.), the committee's chairman, said taking care of veterans is a continuing cost of war. "All veterans should have access to 'their' health-care system," he said. "This is rationing health care to veterans, those who have served our nation. And I think it's unacceptable for a nation of our wealth and our ability."

http://www.nytimes.com/2007/06/09/washington/09surgeon.html

President Bush’s nomination of Dr. James W. Holsinger Jr., a Kentucky cardiologist, to be surgeon general is drawing criticism from gay rights groups, physicians and lawmakers who say they are troubled by opinions critical of homosexuality that Dr. Holsinger has voiced in nearly 20 years as a high-ranking layman in the United Methodist Church.

A National Survey of Physician–Industry Relationships

A new national survey finds nearly all physicians (94%) have some type of relationship with the pharmaceutical industry—from receiving drug samples or food in the workplace, to being reimbursed for professional meetings, to receiving consulting fees.
The authors of "A National Survey of Physician–Industry Relationships" (New England Journal of Medicine, Apr. 26, 2007) document widespread relationships between physicians and the pharmaceutical, medical device, and other medically related industries, and also find that such relationships vary according to type of specialty, practice setting, and other factors.

Doctors, Legislators Resist Drugmakers' Prying Eyes

Many doctors object to drugmakers' common practice of contracting with data-mining companies to track exactly which medicines physicians prescribe and in what quantities -- information marketers and salespeople use to fine-tune their efforts. The industry defends the practice as a way of better educating physicians about new drugs. . . . The American Medical Association . . . makes millions of dollars each year by helping data-mining companies link prescribing data to individual physicians. It does so by licensing access to the AMA Physician Masterfile, a database containing names, birth dates, educational background, specialties and addresses for more than 800,000 doctors.

An International Update on the Comparative Performance of American Health Care

Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. . . . Compared with five other nations—Australia, Canada, Germany, New Zealand, the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. The U.S. is the only country in the study without universal health insurance coverage, partly accounting for its poor performance on access, equity, and health outcomes. The inclusion of physician survey data also shows the U.S. lagging in adoption of information technology and use of nurses to improve care coordination for the chronically ill.

The Millions Left Out

By BOB HERBERT
The New York Times
May 12, 2007

The United States may be the richest country in the world, but there are many millions — tens of millions — who are not sharing in that prosperity.

According to the most recent government figures, 37 million Americans are living below the official poverty threshold, which is $19,971 a year for a family of four. That’s one out of every eight Americans, and many of them are children.

Psychiatrists, Children and Drug Industry’s Role

[T]he intersection of money and medicine, and its effect on the well-being of patients, has become one of the most contentious issues in health care. Nowhere is that more true than in psychiatry, where increasing payments to doctors have coincided with the growing use in children of a relatively new class of drugs known as atypical antipsychotics.

These best-selling drugs, including Risperdal, Seroquel, Zyprexa, Abilify and Geodon, are now being prescribed to more than half a million children in the United States to help parents deal with behavior problems despite profound risks and almost no approved uses for minors.

Suicidal Acts Using Firearms Highly Lethal Compared to Other Means

Boston, MA -- In the first nationally representative study to examine the relationship between survey measures of household firearm ownership and state level rates of suicide in the U.S., researchers at the Harvard School of Public Health (HSPH) found that suicide rates among children, women and men of all ages are higher in states where more households have guns. The study appears in the April 2007 issue of The Journal of Trauma.
"We found that where there are more guns, there are more suicides," said Matthew Miller, Assistant Professor of Health Policy and Management at HSPH and lead author of the study.
Suicide ranks as one of the 15 leading causes of death in the U.S.; among persons less than 30 years old, it is one of the top three causes of death. In 2004, more than half of the 32,439 Americans who committed suicide used a firearm.

Lawmakers urge closing gaps in federal-state gun laws

WASHINGTON -- Grappling with the deadliest shooting spree in U.S. history, lawmakers said Sunday they want to eliminate a gap between state and federal laws that can allow someone with a history of mental illness to buy guns.

Members of Congress have shown little political appetite, however, for attempting to expand federal gun control in response to the massacre at Virginia Tech.

Seung-Hui Cho, who gunned down 32 people on campus and killed himself Monday, was evaluated at a psychiatric hospital in late 2005 and deemed by a judge to present "an imminent danger to himself as a result of mental illness." That should have disqualified him from purchasing a gun under federal law, experts say.

But Virginia court officials insist that because the judge ordered only outpatient treatment -- and did not commit Cho to a psychiatric hospital -- they were not required to submit the information to be entered in the federal databases for background checks.

Lawmakers pushed Sunday to eliminate such breakdowns. They called for uniformity between state and federal reporting to make background checks more dependable.

How Should Universities Respond to Potentially Violent Students?

For the most part, universities cannot tell parents about their children’s problems without the student’s consent. They cannot release any information in a student’s medical record without consent. And they cannot put students on involuntary medical leave, just because they develop a serious mental illness.

Nor is knowing when to worry about student behavior, and what action to take, always so clear.

“They can’t really kick someone out because they’re writing papers about weird topics, even if they seem withdrawn and hostile,” said Dr. Richard Kadison, chief of mental health services at Harvard University. “Most state laws are pretty clear: you can only bring students to hospitals if there is imminent risk to themselves or someone else, so universities are in a bit of a bind that way.”

Phil Zimbardo on the Daily Show

Stanford social psychologist Philip Zimbardo discusses his book The Lucifer Effect and similarities between the Stanford Prison Experiment and Abu Ghraib.

Resisting the Drums of War

Social psychologist Roy Eideslon discusses the ways in which the Iraq war was sold to the American public by exploiting five core concerns: Vulnerability, injustice, distrust, superiority, and helplessness.

A Shock Wave of Brain Injuries

About 1,800 U.S. troops, according to the Department of Veterans Affairs, are now suffering from traumatic brain injuries (TBIs) caused by penetrating wounds. But neurologists worry that hundreds of thousands more -- at least 30 percent of the troops who've engaged in active combat for four months or longer in Iraq and Afghanistan -- are at risk of potentially disabling neurological disorders from the blast waves of IEDs and mortars, all without suffering a scratch.

How do young people manage without health insurance?

They offer insurance at Home Depot, but you’re only allowed to sign up during a two-week period and I missed it. If it’s a cut or bruise or whatever, I try to patch it up myself. I usually know what to do. I bruised a rib last winter. I just wrapped it in rags to keep it tight, and it got better after a few weeks. Also, I cut my head on a wineglass back at Halloween. I was very drunk, and there was blood all over the place. My friend wanted to call the ambulance, but I told her not to. I just cleaned it out myself. Now I’ve got a scar, but at least I’m not broke.

Confronting Confinement

On any given day, 2.2 million people are incarcerated in the United States, and over the course of a year, many millions spend time in prison or jail. 750,000 men and women work in correctional facilities. The annual cost: more than 60 billion dollars. Yet within three years, 67 percent of former prisoners will be rearrested and 52 percent will be re-incarcerated. At this moment, the effectiveness of America's approach to corrections has the attention of policy makers at all levels of government and in both political parties. The Commission and its report, Confronting Confinement, make a unique contribution to this timely national discussion by connecting the most serious problems and abuses inside jails and prisons with the health and safety of our communities.

ACLU Free Speech Victory

In one of the most important student free speech cases in decades, the ACLU joined attorneys for former student Joseph Frederick before the U.S. Supreme Court this week and urged the high court not to abandon its famous 1969 ruling that students do not “shed their constitutional rights to freedom of speech or expression at the schoolhouse gate.”

Families USA Publications

A Pound of Flesh: Hospital Billing, Debt Collection, and Patients' Rights provides an overview of some of the progressive reform measures that state policymakers have implemented to help families struggling with medical debt. [Recommend you read this document, along with any of the other publications that may interest you.]

Families USA Global Health Initiative

"With globalization, the same sea washes all of humankind. We are all in the same boat. There are no safe islands. There is no dividing line between "foreign" and "domestic" infections...There is no them: only us.” –UN Secretary General Kofi Annan

Is Genuine Health Care Reform Finally Feasible?

It has been nearly a decade and a half since the last effort to overhaul the nation's health care system. But the issue is back, driven by recent state initiatives seeking ways to provide universal health care and by the 2008 presidential campaign. . . . The phrase "universal health care" has been widely used among the Democratic presidential candidates.
Sen. Barack Obama, the Democrat from Illinois, recently told the International Association of Fire Fighters that he will make sure that everybody in the country has universal health care by the end of his first term as president.
Not to be outdone, Democrat John Edwards, the former North Carolina senator and presidential candidate, has already laid out a fully detailed plan for universal health coverage. On NPR's Talk of the Nation, Edwards pledged that he would implement his plan even faster than Clinton and Obama would: before the end of his first presidential term.

Can the Best be the Enemy of the Good?

It’s Kennedy versus Kennedy as two members of Congress from the same family face off over competing versions of legislation that would require many health insurance companies and employers to provide more generous benefits to people with mental illness.
Representative Patrick J. Kennedy, Democrat of Rhode Island and chief sponsor of the House bill, has criticized as inadequate the Senate bill introduced by his father, Senator Edward M. Kennedy, Democrat of Massachusetts. Representative Kennedy is trying to mobilize mental health advocates to lobby for what he describes as “the stronger of the two bills, the House bill.”

Do You Support Prescriptive Authority for Appropriately Trained Psychologists?

Community health centers across the state and the Hawaii Primary Care Association strongly endorse Senate Bill 1004 and House Bill 1456, which address prescriptive authority for certain psychologists. We believe that the requirements outlined in these bills regarding psychopharmacological training, supervised practice, standardized testing, board review and authorization, restrictions on what drugs can be prescribed, and practice only within community health center settings will ensure that patients will be well served rather than jeopardized.

The Best Health System in the World?

With some of the best-equipped hospitals and most highly specialized physicians in the world, it is no wonder that many people believe the U.S. health system is the best on earth. The evidence, however, suggests this confidence is misplaced.
According to the National Scorecard on U.S. Health System Performance, the United States scored just 66 out of 100 when comparing the nation's average performance on three dozen indicators against benchmarks set either within the U.S. or abroad. Given America's high standards—and high spending on health care—that is simply unacceptable.

Social Isolation Is Hazardous to Men's Health

Researchers at the Harvard School of Public Health who looked at more than 28,000 men over a period of 10 years found that those who were socially isolated were more likely than others to have died of all manner of illness, accidents and suicide. This study and others show that men who lack strong social networks are at far greater risk of developing heart disease and that those who already have heart disease are more likely to die from it. And men who are not connected with other people run a higher risk of depression and other mental health problems.

Harvard economist proposes team approach on healthcare

WASHINGTON -- A renowned Harvard economist unveiled a plan yesterday to revamp the US healthcare system by focusing on the value of care to patients, arguing that improving the quality of medical services can by itself save money and provide a road map to a national health plan. . . . The nation's healthcare system is using "21st-century technology delivered with a 19th-century system," Porter said. Medical care, he added, is "the only sector in our economy that has not undergone reconfiguration seen everywhere else."

Paying for Care Episodes and Care Coordination (Karen Davis, NEJM)

The fee-for-service system of provider payment is increasingly viewed as an obstacle to achieving effective, coordinated, and efficient care. It rewards the overuse of services, duplication of services, use of costly specialized services, and involvement of multiple physicians in the treatment of individual patients. It does not reward the prevention of hospitalization or rehospitalization, effective control of chronic conditions, or care coordination.

Price Variations for Generic Drugs

Wolf began snooping around and found that two chains, Costco and Sam’s Club, sold generics at prices far, far below the other chains. Even once you factor in the cost of buying a membership at Costco and Sam’s Club, the price differences were astounding.

[Note to Class: Will you refer your clients to Sam's Club? Do you have any ethical concerns about supporting companies like Walmart? Poke around this website and explore some of the interesting stories, and, if you have the time, read this book.]

Does Treatment Work for Sex Offenders?

Similar to aspects of Alcoholics Anonymous, relapse prevention has sex offenders own up to wrongdoing and resign themselves to a lifelong day-to-day struggle with temptation. But one of the few authoritative studies of the method, conducted in California from 1985 to 2001, found that those who entered relapse prevention treatment were slightly more likely to offend again than those who got no therapy at all.
Clinicians who work with sex offenders cling to relapse prevention nonetheless, and its durability speaks volumes about the troubled, politically fraught science of treating sex offenders. Not only is relapse prevention of questionable value, but so are the tests to gauge whether sex offenders in treatment still get inappropriately aroused, the drugs used for so-called chemical castration and the methods of predicting risk of reoffending.
Treatment methods have become particularly topical as thousands of sex offenders are confined or restricted beyond their prison terms under civil commitment laws on the books in 19 states.

Should sex offenders be released after they have finished their prison terms?

The decision by New York to confine sex offenders beyond their prison terms places the state at the forefront of a growing national movement that is popular with politicians and voters. But such programs have almost never met a stated purpose of treating the worst criminals until they no longer pose a threat.
About 2,700 pedophiles, rapists and other sexual offenders are already being held indefinitely, mostly in special treatment centers, under so-called civil commitment programs in 19 states, which on average cost taxpayers four times more than keeping the offenders in prison.

Health-care debate revives

After sorry 14-year hiatus, health-care debate revives - USATODAY.com: "Hopes were high 14 years ago when Bill and Hillary Clinton proposed an ambitious plan to provide health insurance for all Americans. Democrats and Republicans alike cheered when the president threatened to veto anything less than universal coverage.
That promising moment didn't last long. After initially winning support from medical, business and labor groups, the Clintons' top-down plan collapsed under the weight of its own complexity. Attacks on 'Hillary Care' helped Republicans win control ofCongress in 1994. Ever since, health care reform has been considered too costly, in dollars and political capital, for most politicians to touch. But the beleaguered system's problems — one in seven people without insurance, rising premiums and lower reimbursements for those who have insurance, endless payment hassles — haven't gone away. Attempts at fixing them have been incremental and timid at best. That could be about to change. Several groups that usually are at odds on health care now agree on the need for broad reform. These strange bedfellows are still a long way from agreeing on a plan, but the fact that they now see a common need signals a shift in the political dynamic. "

Drug Company Detailers

Independent lens - The Boston Globe: "Drug companies flood doctors' offices with attractive salespeople whose mission is to boost the number of prescriptions written for their products. But some say that the tactics used by the representatives, known as detailers, wrongly hype expensive new drugs when older, cheaper treatments work just as well. To combat the sales pitches, critics are now employing the same marketing methods that drug companies use to sell doctors on new products."

Child Health Care Splits White House and States - New York Times

Child Health Care Splits White House and States - New York Times: "Governors clashed with the White House on Monday over the future of the popular Children’s Health Insurance Program, an issue that some members of both parties said was as important as money for the Iraq war. Michael O. Leavitt, the secretary of health and human services, held a hearing with governors Monday at their winter conference. In the session at the White House, when President Bush reported on progress of the war, governors pressed him to provide more money so they could guarantee health insurance for children. In response, administration officials said states should make better use of the money they already had."