Health – Page 72 – artdiamondblog.com

Chernobyl May Have Caused No Long-Term Increase in Cancer

Source of book image: http://luxuryreading.com/wp-content/uploads/2012/07/9781605294452.jpg

(p. C11) . . . Andrew Blackwell, a journalist and self-described “sensitive, eco-friendly liberal,” deserves praise for producing an environmentalist book that avoids the usual hyperventilation, upending stubborn myths with prosaic facts.
. . .
His Geiger counter convulses on a visit to the abandoned areas around Chernobyl, but Mr. Blackwell reacts soberly. While the initial disaster provoked a justifiable public panic, it also inspired scare-mongering from groups like Greenpeace, which claimed that the fallout would cause 270,000 cancer cases. He points to a study commissioned by the United Nations concluding that, after an initial spike in thyroid cancer, “no measurable increase has yet been demonstrated in the region’s cancer rates.” The author is also sure to irritate certain readers with the claim that “paradoxically, perversely, the accident may have actually been good” for the local environment, since the evacuation created an accidentally verdant nature reserve.

For the full review, see:
MICHAEL C. MOYNIHAN. “A Guided Tour of Catastrophe” The Wall Street Journal (Sat., May 26, 2012): C11.
(Note: ellipses added.)
(Note: the online version of the review has the date May 25, 2012.)

The book being reviewed, is:
Blackwell, Andrew. Visit Sunny Chernobyl: And Other Adventures in the World’s Most Polluted Places. New York: Rodale Books, 2012.

Why Health Care Costs So Much in McAllen

(p. 235) Atul Gawande lays out “The Cost Conundrum: What a Texas town can teach us about health care.” “It is spring in McAllen, Texas. The morning sun is warm. The streets are lined with palm trees and pickup trucks. McAllen is in Hidalgo County, which has the lowest household income in the country, but it’s a border town, and a thriving foreign-trade zone has kept the unemployment rate below ten per cent. McAllen calls itself the Square Dance Capital of the World. ‘Lonesome Dove’ was set around here. McAllen has another distinction, too: it is one of the most expensive health-care markets in the country. Only Miami–which has much higher labor and living costs–spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.”

Gawande as quoted in:
Taylor, Timothy. “Recommendations for Further Reading.” Journal of Economic Perspectives 24, no. 2 (Fall 2009): 231-38.

The full Gawande article can be viewed online at:
Gawande, Atul. “Annals of Medicine; the Cost Conundrum; What a Texas Town Can Teach Us About Health Care.” The New Yorker 85, no. 16 (June 2009): 36-44.

A later Gawande article, that asks why the health care system cannot be run as well as The Cheesecake Factory, can be viewed online at the link below. (Spoiler alert: I haven’t read this article yet, but I’m guessing it has something to do with the feedback and incentives provided by the free market.)
Gawande, Atul. “Annals of Health Care; Big Med; Restaurant Chains Have Managed to Combine Quality Control, Cost Control, and Innovation. Can Health Care?” The New Yorker 88, no. 24 (August 2012): 52-63.

Health Care Costs Can Be Lowered by Less Waste and More Cost-Reducing Innovation

(p. 234) Melinda Beeuwkes Buntin and David Cutler discuss “The Two Trillion Dollar Solution: Saving Money by Modernizing the Health Care System.” “Two sorts of savings are possible in health care. The first is eliminating waste and inefficiency. The most commonly cited estimate is that 30 percent of the money spent on medical care does not buy care worth its cost. Medicare costs per capita in Minneapolis, for example, are about half those in Miami, yet Miami does not have better health outcomes. International comparisons yield the same conclusion. . . . Second, reform might stimulate cost-reducing innovation instead of the continuous cost increases that accompany current innovation. For nearly 20 years, scholars have argued that generous reimbursement policies for medical care have led to innovations that almost always increase health care costs. Changing that dynamic by investing in research about what works and rewarding health care providers who choose efficient treatments could have a dramatic effect on cost growth. . . . Reducing costs by 30 percent will take time and effort, but it is not inconceivable over the long term. Experience in the health care sector and other industries suggests that cost reductions on the order of 1.5-to-2.0 percentage points per year are within reach.”

Buntin and Cutler as quoted in:
Taylor, Timothy. “Recommendations for Further Reading.” Journal of Economic Perspectives 24, no. 2 (Fall 2009): 231-38.
(Note: ellipses in original.)

The Buntin and Cutler report is:
Buntin, Melinda Beeuwkes, and David Cutler. “The Two Trillion Dollar Solution: Saving Money by Modernizing the Health Care System.” Washington, D.C.: Center for American Progress, 2009.

DaVita Threw Out Medicine and Billed Taxpayer: Huge Medicare Fraud

I saw this clip broadcast on Wolf Blitzer’s “Situation Room” broadcast on 11/29/12 (if memory serves–it might have been the day before).
The clip shows the magnitude of the fraud, but also emphasizes that there were significant incentives for those who knew about the fraud to keep their mouths shut.
This is one huge case of over-billing, but over-billing happens all the time. Taxpayers could have used that money for other purposes. The opportunity cost is huge.

A link to the clip posted on CNN, is:
http://ac360.blogs.cnn.com/2012/11/29/company-accused-of-giant-medicare-fraud/?iref=allsearch
(Note: I believe the November 29, 2012 date in the image above is the date that Drew Griffin posted the clip to the CNN blog, not necessarily the date of the broadcast.)

Personal DNA Data, Smart Phones, and the Social Network Can Democratize Medicine

(p. 236) With the personal montage of your DNA, your cell phone, your social network—aggregated with your lifelong health information and physiological and anatomic data—you are positioned to reboot the future of medicine. Who could possibly be more interested and more vested in your data? For the first time, the medical world is getting democratized. Think of the priests before the Gutenberg printing press. Now, nearly six hundred years later, think of physicians and the creative destruction of medicine.

Source:
Topol, Eric. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books, 2012.

Progress Will Slow If Consumers Wait for Doctors to Creatively Destroy Medicine

(p. 195) . . . it remains unclear whether there is adequate plasticity of a plurality of physicians to embrace the digital world and acknowledge that the era of paternalism is passé. My sense is that young physicians who are digital natives will be likely to assimilate but that it will be quite difficult for the vast majority who are in practice and inculcated with an older idea of how medical care should be rendered. Eventually there will be enough digital native physicians to take charge, but that will take decades to be accomplished. In the meantime, consumers are fully capable of leading the movement and contributing to medicine’s creative destruction. And so they must.

Source:
Topol, Eric. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books, 2012.
(Note: ellipsis added.)

Sclerotic Doctors Resist Change

(p. 177) Atherosclerosis, referring to a progressive and degenerative process of artery walls, is typically translated for a lay audience as “hardening of the arteries.” We’ve never needed a similar word to describe the medical community. It came with sclerosis built in. Of all the professions represented on the planet, perhaps none is more resistant to change than physicians. If there were ever a group defined by lacking plasticity, it would first apply to doctors.
(p. 178) The inherent “hardness” of physicians and the medical community suggests they will have a difficult time adapting to the digital world. Before the emergence of the Internet, physicians were high priests, holding all the knowledge and expertise, not to be challenged or questioned by the lowly consumer patient. “Doctor knows best” was the pervasive sentiment, shared by patients and especially physicians.

Source:
Topol, Eric. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books, 2012.

AMA Resists the Democratization of DNA

The “Walgreens flap” mentioned below was the episode in 2010 when Walgreens announced that it would cell a genome testing saliva kit, but was pressured by government regulatory agencies, and withdrew the kit from the market within two days of the announcement.

(p. 119) . . . there will likely never be a “right time”—after we have passed some imaginary tipping point giving us critical, highly actionable, and perfectly accurate information—for it to be available to the public. The logical conclusion is that the tests should be made available. What’s more, the fact that they have been available has meant that democratization of DNA is real. Consumers now realize that they have the right to obtain data on their DNA. As a blogger wrote in response to the Walgreens flap, “To say that this information has to be routed through your doctor is a little like the Middle Ages, when only priests were allowed (or able) to read the Bible. Gutenberg came along with the printing press even though few people were able to read. This triggered a literacy/literature spiral that had incredible benefits for civilization, even if it reduced the power of the priestly class.”

The American Medical Association (AMA) sees things differently. In a pointed letter to the FDA in 2011, the AMA wrote: “We urge the Panel … that genetic testing, except under the most limited circumstances, should carried out under the personal supervision of a qualified health professional.” The FDA has indicated it is likely to accept the AMA recommendations, which will clearly limit consumer direct access to their DNA information. But this arrangement ultimately appears untenable, and eventually there will need to be full democratization of DNA for medicine to (p. 120) be transformed. Of course, health professionals can be consulted as needed, but it is the individual who should have the decision authority and capacity to drive the process.
The physician and entrepreneur Hugh Rienhoff, who has spent years attempting to decipher his daughter’s unexplained cardiovascular genetic defect and formed the online community MyDaughtersDNA.org, had this to say: “Doctors are not going to drive genetics into clinical practice. It’s going to be consumers …. The user interface, whether software or whatever will be embraced first by consumers, so it has to be pitched at that level, and that’s about the level doctors are at. Cardiologists do not know dog shit about genetics.”

Source:
Topol, Eric. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books, 2012.
(Note: first ellipsis added; other ellipses in original.)

Personal Genomics Startups Struggle Under a “Circus” of Government Regulation

(p. 118) Government regulation of consumer genomics companies has been centerpiece (and the semblance of a circus) in their short history. Back in 2008, the states of California and New York sent “cease and desist” letters to the genome scan companies. State officials were concerned that the laboratories that generated the results were not certified as CLIA (Clinical Laboratory Improvement Amendments) and that the tests were being performed without a physician’s order. All three companies developed work-around plans in California and remained operational but were unable to market the tests in New York.
In 2010, the regulation issues escalated to the federal level. In May it was announced that 7,500 Walgreens drugstores throughout the United States would soon sell Pathway Genomics’s saliva kit for disease susceptibility and pharmacogenomics. While the tests produced by all four companies had been widely available via the Internet for three years, the announcement of wide-scale availability in drugstores (which was cancelled by Walgreens within two days) appeared to “cross the line” and set off a cascade of investigations and hearings by the FDA, the Government Accountability Office (GAO), and the Congressional House Committee on Energy and Commerce. The FDA’s Alberto Gutierrez said, “We don’t think physi-(p. 119)cians are going to be able to interpret the results,” and “genetic tests are medical devices and must be regulated.” The GAO undertook a “sting” operation with its staff posing as consumers who bought genetic tests and detailed significant inconsistencies, misleading test results, and deceptive marketing practices in its report.
All four personal genomics companies are struggling.

Source:
Topol, Eric. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books, 2012.

“The Resistance from the Priesthood of Medicine Is at Its Height”

(p. 77) In December 2010 in Milwaukee, Wisconsin, Nicholas Volker, a five-year-old boy with a gastrointestinal condition that had not previously been seen, who had undergone over a hundred surgical operations and was almost constantly hospitalized and intermittently septic, was virtually on death’s door. But when his DNA sequence was determined, his doctors found the culprit mutation. That discovery led to the proper treatment, and now Nicholas is healthy and thriving. Even though this was only the first clearly documented case of the life-saving power of human genomics in medicine, (p. 78) few could now deny that the field was going to have a vital role in the future of medicine. Some would argue that the treatment led to an even bigger breakthrough: health insurance coverage of sequencing costs for select cases.
It took the better part of a decade from the completion of the first draft of the Human Genome Project for genomics to reach the clinic in such a dramatic way. To make treatment like Volker’s common will likely take more time still. Even if that’s the ultimate prize, the creative destruction of medicine still has various other, less comprehensive, genomic tools for us to use, based on investigations of things like single-nucleotide polymorphisms, the exome, and more. The material can be a bit heady, but it’s worth pushing through: these tools could effect not just dramatic corrections of faulty genes but a better, more scientific understanding of disease susceptibility and what drugs to take. Moreover, as they empower patients and democratize medicine, they make medical knowledge available to all and deep knowledge of ourselves available to each of us. Nevertheless, at this level, perhaps more than anywhere else in this ongoing medical revolution, the resistance from the priesthood of medicine is at its height. The fight might be tougher than the material, but in neither case can we afford to give up.

Source:
Topol, Eric. The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books, 2012.

Health Inefficiencies Free-Ride on “Home Run Innovations”

The article quoted below is a useful antidote to those economists who sometimes seem to argue that health gains fully justify the rise in health costs.

(p. 645) In the United States, health care technology has contributed to rising survival rates, yet health care spending relative to GDP has also grown more rapidly than in any other country. We develop a model of patient demand and supplier behavior to explain these parallel trends in technology growth and cost growth. We show that health care productivity depends on the heterogeneity of treatment effects across patients, the shape of the health production function, and the cost structure of procedures such as MRIs with high fixed costs and low marginal costs. The model implies a typology of medical technology productivity: (I) highly cost-effective “home run” innovations with little chance of overuse, such as anti-retroviral therapy for HIV, (II) treatments highly effective for some but not for all (e.g., stents), and (III) “gray area” treatments with uncertain clinical value such as ICU days among chronically ill patients. Not surprisingly, countries adopting Category I and effective Category II treatments gain the greatest health improvements, while countries adopting ineffective Category II and Category III treatments experience the most rapid cost growth. Ultimately, economic and political resistance in the United States to ever-rising tax rates will likely slow cost growth, with uncertain effects on technology growth.

Source of abstract:
Chandra, Amitabh, and Jonathan Skinner. “Technology Growth and Expenditure Growth in Health Care.” Journal of Economic Literature 50, no. 3 (Sept. 2012): 645-80.