Kim’s public health blog

I attended one of the several thousand commnty gatherings to discuss the infrastriucture of a new approach to health care last week, conducted by Obama supoprters.. It was one of the larger ones with at least 100 peopel attending. Several things became very clear, The public as a group feel they have been ripped off by the private insurance industry and thinks it needs replacing. They are dissatisfied with the  excess of specialists and want access to primary care physicians, and better reimbursement for these physicians to practice preventive medicine.  There is a general feeling that there is too much technology used, and that mental health and dental care have been neglected. There was a general agreement that health care was a right.  There was agreement that we should be able to provide access to care for the everyone in the country without increasing the cost of health services. Having a single insurer would reduce costs, as would better access to primary care.  The medical schools will have to change from an emphasis on specialty care to primary care and reimbursement will have to favor primary care over specialty care. There was a  belief that the insurers, hospitals and drug companies would be the biggest hurdles to overcome, unless it was made clear that the pubilc was unwilling to grant them further special status, Reading reports of other similar meetings the same points are being made at all meetings.

Who really thought that a scanner that looked like a cell phone, used in Star Trek the Next Generation could be for real? Now In the lab of UCLA electrical engineering professor Aydogan Ozcan, a prototype cell phone has been constructed that is capable of monitoring the condition of HIV and malaria patients, as well as testing water quality in undeveloped areas or disaster sites. The imaging platform, known as LUCAS (Lensless Ultra-wide-field Cell monitoring Array platform based on. Now that Ozcan has successfully created prototypes with a cell phone and webcam, his next step is to build from scratch a handheld device incorporating the LUCAS imaging system. Using this device, people in remote areas of the world would be able to monitor the spread of disease, allowing doctors to focus limited resources in the areas of greatest need.

A report to be published on line in the Journal; Health Affairs comparing the US and 7 other developed countries, focusing on chronic diseases notes that outcome in the US was worse than in any of the other countries studied.  Karen Davis, PhD, president of the Commonwealth Fund, said the data were collected before the US economy went into a tailspin last fall. “In a downturn, more people will be unemployed and more will lose their medical insurance,” she said. “With the election of the new president and Congress, we have a window of opportunity to change directions and move on a path to a high-performance health system.”

An article published in JAMA today identifies the dangers posed among many people, especially older ones, who use multiple medicines, mixed with over the counter (OTC) drugs and dietary supplements which often interact.  Most physicians do not ask about the use of OTC drugs or supplements. If they discourage them there is no assurance patients will follow  their advice.

Have you puzzled over the “helpful” advice printed out with each prescription? If so you are not alone. A recent study by the FDA found that the printed consumer medication information (CMI) voluntarily provided with new prescriptions by retail pharmacies does not consistently provide easy-to-read, understandable information about the use and risks of medications. Only about 75 percent of this information met the minimum criteria for usefulness as defined by a panel of stakeholders. In 1996, Congress called for 95 percent of all new prescriptions to be accompanied by useful CMI by 2006. Shouldn’t 10 years have been ;long enough? In 2009 the FDA will hold a public meeting to discuss the study’s findings. In addition, the FDA has created a Web site to receive public comment on the study and solicit feedback on the best ways to provide useful prescription information to consumers.

ScienceDaily (Dec. 16, 2008) — More than half a million babies are born preterm in the United States each year, and preterm births are on the rise. Late preterm births, or births that occur between 34 and 36 weeks (approximately 4 to 6 weeks before the mother’s due date), account for more than 70% of preterm births. A new study and an accompanying editorial in The Journal of Pediatrics investigate the serious neurological problems associated with late preterm births. Much of the preterm birth increase maybe due to elective caesarian intervention and twin births due to use of fertility drugs.[ Petrini et al. Increased Risk of Adverse Neurological Development for Late Preterm Infants. The Journal of Pediatrics,]

ScienceDaily (Dec. 17, 2008) — Clinicians using an electronic prescribing system appear more likely to prescribe lower-cost medications, reducing drug spending, according to a new report.  “Patients who received care from a geriatrician tend to have better prescribing and they tend not to receive drugs that are inappropriate for older patients,” said Mary Jo Pugh, Ph.D., the study’s lead author. That is because geriatricians are trained to “take a much closer look at the medications than the average physician does, and their assessment is focused on how medications may affect patients differently as they age.”Comment: The newer electronic systems take into account both the appropriateness of the drug and the reimbursement requirements of the different payment plans. [Medical Care 46(2), 2008]

The latest ruling from the Supreme Court, allowing tobacco users to sue in state courts for false labeling of products may do far more to reduce tobacco consumption than giving the FDA oversight. A Washington Post (12/16, pA18) editorial says that “although it often makes sense to avoid a hodgepodge of state and local rules governing big business in favor of uniform federal strictures, in this case the tobacco companies tried to stretch the federal Labeling Act to cover much more than Congress intended.”

A three-year study involving more than 3,400 chronically ill seniors led by Oregon Health & Science University underscores the enormous societal costs of a health care infrastructure that does not adequately support the interdisciplinary services and care coordination needed to prevent adverse outcomes for older adults with multiple chronic illnesses. The study author, Dr.. David A Door says ”it is clear “that to provide the kind of high quality and efficient coordination of care tracked in this study across the nation’s health care system will require the redesign of primary care as well as reform of the payment system and reinforcement from policymakers. Comment: I wonder how often we have to keep repeating this same type of study before policy makers pay any attention?

A peanut on the floor of a school bus leading to evacuation and decontamination for fear that it might be eaten by the 10 year old passengers, and schools declaring themselves “nut free” by banning nuts, peanut butter, homebaked goods and any foods without ingredient labels, are just some examples cited in this article. According to Professor Nicolas Christakis from Harvard Medical School, there is no evidence that any of these extreme restrictions work better than more circumscribed policies or that they are worth the money and disruptions they create. In comparison: In the US, 150 people die each year from food allergies. This is compared to the 50 who die from bee stings, the 100 who die from lightening strikes, the 45,000 who die in motor vehicle accidents, and the 10,000 who are hospitalized for traumatic brain injury from playing sport. But these issues do not incur such extreme reactions, such as calling for an end to sport. Christakis says that the “gross over-reaction to the magnitude of the threat” is very similar to mass psychogenic illness (MPI), previously known as epidemic hysteria. Comment:Maybe the fear is for lawsuits engendered by tort lawyers for whom there is nothing that does not lead to a law suit. WE are focusing on the wrong nuts!