Patients who die in the hospital in the United States are almost five times as likely to have spent part of their last hospital stay in the ICU than patients in England. What’s more, over the age of 85, ICU usage among terminal patients is eight times higher in the US than in England, according to new research that compared the two countries’ use of intensive care services during final hospitalizations.
In an op-ed in The Hill (10/8), former FDA commissioner Andrew C. von Eschenbach, now a senior adviser at the Center for Health Transformation, and Wayne W. Oliver, a CHT vice president, write that despite A plan to spend $5 billion of stimulus funds on government grants to increase medical research, “not one dollar of stimulus money will be used to enhance the capacity and capability of the FDA.” Despite “decades of neglect” the agency continues to have “a diminished capacity to embrace new scientific technologies and meet the demands needed to protect the public health.” Von Eschenbach and Oliver call for new resources and “the design and implementation of a 21st century regulatory framework” that will help the FDA “drive innovation, dramatically shorten the time between discovery and delivery, and allow Americans everywhere to have access to safe, effective and miraculous discoveries” Comment: In previous Blogs I have said the FDA was severely restricted by funds yet Congress keeps adding duties, including the most recent tobacco responsibilities.
Everyone who has an interest on the Congressional approaches to health care reform should read the current issue of ‘Health Affairs’ and note the monetary costs of the various approaches. In the papers we find the expectation that the reforms would consume more than 50% of GDP, while others show that in 75 years the reforms would cost more than the entire GDP. It is clear that the various activists have never taken economics 101. The financial projections indicate totally unrealistic expectations for reform. There have to be limits to new expenditures. Anyway you wish to make changes there has to be some form of rationing. There also has to be some reduction in money devoted to research. Too much research money funneled to medical schools results in too little immediate benefit to the public but solves much of the fiscal problems of the teaching hospitals.
ABC World News reports, “Protection against the swine flu is going to be delayed for millions of Americans. Federal officials now say that only about a third of the swine flu vaccine the country is counting on will be available by mid-October. That’s when the mass vaccination campaign is scheduled to begin.” Comment: It is not surprising that politically dominated decisions about medial subjects rarely pan out as intended. The usual rush to judgment was made without adequate scientific input, or else such input was ignored, the most likely event. At the same time we must not let ourselves be diverted from ensuring that children get all the recommended current immunizations.
The IOM has just published a monograph on “Comparative Effectiveness Research”. There are many competing treatments for the major conditions that affect us. There are few studies showing which if any are more effective, other than personal opinions, which doctors and patients can use to choose between them. This monograph speaks to the need to evaluate the various options to improve the rate of recovery and control for various disease. It is worth reading by everyone in public health.
New research shows that physicians failed to report clinically significant abnormal test results to patients — or to document that they had informed them — in one out of every 14 cases of abnormal results. In some medical groups, the failure rate is close to zero; in others it is as high as one in four abnormal results.
The study suggests that five simple, common-sense processes are useful for dealing with test results:
1. All test results are routed to the responsible physician
2. The physician signs off on all results;
3. The practice informs patients of all results, normal and abnormal, at least in general terms;
4. The practice documents that the patient has been informed; and
5. Patients are told to call after a certain time interval if they have not been notified.
A new article “American Healthy Homes Survey: A National Study of Residential Pesticides Measured from Floor Wipes.” Environmental Science & Technology, 2009; 43 (12): 4294 tell us that technology can ,measure past use/abuse of pesticides in homes. Comment: However being able to measure a compound at parts per billion or less tell us nothing about possible causes/effects. It become one more tool for the EPA to use to get more funds because of potential peril.
The Los Angeles Times reports that “the cesarean is now routine. The most common operation in the US, it is performed in 31 percent of births, up from 4.5 percent in 1965.” But, “with that surge has come an explosion in medical bills, an increase in complications — and a reconsideration of the cesarean as a sometimes unnecessary risk.” According to the Times, “It is a big reason childbirth often is held up in healthcare reform debates as an example of how the intensive and expensive US brand of medicine has failed to deliver better results and may, in fact, be doing more harm than good.” Comment: Many physicians have been concered abou the rising rate of cesarian deliveries for at least 20 years.
The nay-sayers are girding up for battle with misinformation about the need to change the US Health Care System. The first two sentances of an editorial in this week’s Lancet shoud be buirned into all our memories and the full editorial read. “The USA has the highest health care expenditure of any industrialized nation (currently US$2•5 trillion or roughly 20% of GDP), yet it ranks 29th in infant mortality and 45th in life expectancy; a third of every health-care dollar is spent on bureaucracy. 46 million US citizens do not have health insurance (costing $123 billion annually in acute emergency care). For those who are insured, health resources are controlled by third parties (employers and insurance companies). Most personal bankruptcies are caused by health-care debts.”
Dentists have used amalgam, an alloy of mercury with at least one other metal, in fillings for over 200 years. Amalgam fillings don’t contain enough mercury to cause potential health problems associated with larger doses, says Dr. Rod Mackert, professor of dental materials in the MCG School of Dentistry Department of Oral Rehabilitation. “The dose makes the poison,” he says, quoting 16th century Swiss physician Paracelsus. A person would need between 265 and 310 amalgam fillings before even slight symptoms of mercury toxicity could be felt. A person with seven fillings, which is average, absorbs only about one microgram of mercury daily. About six micrograms are absorbed daily from food, water and air, according to the Environmental Protection Agency. Comment, Yet, because of media space given to activists we continue to throw money away trying to prove nothing happens.
