Health – Page 43 – artdiamondblog.com

Government Actions Helped Spread 1918 Influenza

Source of book image: http://www.virology.ws/wp-content/uploads/2009/08/great-influenza.jpg

I like John Barry’s The Great Influenza very much, although not entirely for the reasons that I had expected to like it. I wanted to learn more of the details of the worst flu pandemic in history, and the book delivers those details.
But I had not expected that there would be substantial discussion of the epistemology of science and medicine, and of the political and global context that preceded and affected the 1918 H1N1 influenza pandemic.
As an added bonus, the book gives substantial coverage to the life and work of one of my heroes, Oswald Avery. As a result of his research related to the pandemic, he discovered that DNA was the genetic material—a huge milestone in the history of medicine. But he never received the Nobel Prize because the Nobel Committee didn’t want to be seen endorsing controversial work that had not stood the test of time.
On the other hand, the Nobel Committee had no such compunctions about giving the Nobel Peace Prize to President Woodrow Wilson. Barry’s book indicts Wilson for having major responsibility for the severity of the pandemic. His administration drafted huge numbers of young men to fight in WWI, bringing them into close contact in shoddy, incomplete training camps. Some of these young men already had the flu, and they quickly spread it to many of their fellow soldiers. The Wilson administration continued to move these soldiers around the country and to Europe, vastly speeding the spread of the disease.
Barry also documents that the Wilson administration, in the name of patriotism and morale, punished those who told the truth about the severity of the pandemic. The results extended far beyond the trampling of civil liberties. For example, there was a huge parade in Philadelphia to sell war bonds, a parade that could easily have been canceled, but was not—igniting the rapid spread of the disease in that hard-hit city. If the newspapers had been allowed to print the truth about the pandemic, then there probably would have been sufficient outcry to cancel the parade; or at the very least, many better-informed citizens would have avoided the parade, and saved their lives, and the lives of their family members.
There is also a lot in book about the biology of the disease that is of interest, and about the suffering of those who experienced it.
But what I found eye-opening was the extent to which the severity of the disease was due to avoidable actions by Woodrow Wilson and his administration.

Source of book discussed above:
Barry, John M. The Great Influenza: The Story of the Deadliest Pandemic in History. Revised ed: New York: Penguin Books, 2005.

For another eye-opening account about Woodrow Wilson and WWI, see:
Raico, Ralph. The Spanish-American War and World War I, Parts 1 & 2: Knowledge Products, 2006.

For a neat little paper on Oswald Avery, see:
Diamond, Arthur M., Jr. “Avery’s ‘Neurotic Reluctance’.” Perspectives in Biology and Medicine 26, no. 1 (Autumn 1982): 132-36.

Doctors Seek to Regulate Retail Health Clinic Competitors

“A nurse practitioner with a patient at a retail clinic in Wilmington, Del.” Source of caption and photo: online version of the WSJ article quoted and cited below.

Clayton Christensen, in a chapter of Seeing What’s Next, and at greater length in The Innovator’s Prescription, has persuasively advocated the evolution of nurse practitioners and retail health clinics as disruptive innovations that have the potential to improve the quality and reduce the costs of health care.
An obstacle to the realization of Christensen’s vision would be government regulation demanded by health care incumbents who would rather not have to compete with nurse practitioners and retail health clinics. See below for more:

(p. B1) Retail health clinics are adding treatments for chronic diseases such as asthma to their repertoire, hoping to find steadier revenue, but putting the clinics into greater competition with doctors’ groups and hospitals.

Walgreen Co.’s Take Care retail clinic recently started a pilot program in Tampa and Orlando offering injected and infused drugs for asthma and osteoporosis to Medicare patients. At some MinuteClinics run by CVS Caremark Corp., nurse practitioners now counsel teenagers about acne, recommend over-the-counter products and sometimes prescribe antibiotics.
. . .
As part of their efforts to halt losses at the clinics, the chains are lobbying for more insurance coverage, and angling for a place in pending health-care reform legislation, while trying to temper calls for regulations.
. . .
(p. B2) But such moves are raising the ire of physicians’ groups that see the in-store clinics as inappropriate venues for treating complex illnesses. In May, the Massachusetts Medical Society urged its members to press insurance companies on co-payments to eliminate any financial incentive to use retail clinics.
. . .
The clinics are helping alter the practice of medicine. Doctors are expanding office hours to evenings and weekends. Hospitals are opening more urgent-care centers to treat relatively minor health problems.

For the full story, see:
AMY MERRICK. “Retail Health Clinics Move to Treat Complex Illnesses, Rankling Doctors.” The Wall Street Journal (Thurs., SEPTEMBER 10, 2009): B1-B2.
(Note: ellipses added.)

A brief commentary by Christensen (and Hwang) on these issues, can be found at:

CLAYTON CHRISTENSEN and JASON HWANG. “How CEOs Can Help Fix Health Care.” The Wall Street Journal (Tues., July 28, 2009).

For the full account, see:
Christensen, Clayton M., Jerome H. Grossman, and Jason Hwang. The Innovator’s Prescription: A Disruptive Solution for Health Care. New York: NY: McGraw-Hill, 2008.

Source of graph: online version of the WSJ article quoted and cited above.

Increase Health Insurance Competition by Ending Cross-State Ban

(p. A13) How do we get to a competitive market? The tax deduction for employer-provided group insurance, which has nearly destroyed the individual insurance market, is a central culprit. If we don’t have the will to remove it, the deduction could be structured to enhance competition and the right to future insurance. We could restrict the tax deduction to individual, portable, long-term insurance and to the high-deductible plans that people choose with their own money.

More importantly, health care and insurance are overly protected and regulated businesses. We need to allow the same innovation, entry, and competition that has slashed costs elsewhere in our economy. For example, we need to remove regulations such as the ban on cross-state insurance. Think about it. What else aren’t we allowed to purchase in another state?

For the full commentary, see:
JOHN H. COCHRANE . “What to Do About Pre-existing Conditions; Most Americans worry about health coverage if they lose their job and get sick. There is a market solution.” The Wall Street Journal (Fri., AUGUST 14, 2009): A13.

In Economic Policy, as in Medicine: “First, Do No Harm”

(p. A13) Consider someone rushed into an emergency room in severe cardiac distress. After starting acute life-support measures, doctors still apply the rule stated by Galen of Pergamum more than 1,800 years ago: primum non nocere, or “First, do no harm.” Treatment interventions are selected carefully from a battery of technologies and potent drugs while recognizing that any one of them, or a combination, could hurt the patient if misapplied or given in the wrong dosage. Economic interventions require no less care.
. . .
Our economic doctors should permit America’s uniquely effective immune system to take over as companies and financial institutions deleverage their balance sheets. With people and with capitalism, the tincture of time is often the best medicine.

For the full commentary, see:
MICHAEL MILKEN and JONATHAN SIMONS. “Illness as Economic Metaphor; The first rule, as always, is do no harm..” The Wall Street Journal (Sat., June 20, 2009): A13.
(Note: italics in original; ellipsis added.)

Four Month Wait for Blood Test in Brits’ Government Health Care

(p. 6) Founded in 1948 during the grim postwar era, the National Health Service is essential to Britain’s identity. But Britons grouse about it, almost as a national sport. Among their complaints: it rations treatment; it forces people to wait for care; it favors the young over the old; its dental service is rudimentary at best; its hospitals are crawling with drug-resistant superbugs.

All these things are true, sometimes, up to a point.
. . .
Told my husband needed a sophisticated blood test from a particular doctor, I telephoned her office, only to be told there was a four-month wait.
“But I’m a private patient,” I said.
“Then we can see you tomorrow,” the secretary said.
And so it went. When it came time for my husband to undergo physical rehabilitation, I went to look at the facility offered by the N.H.S. The treatment was first rate, I was told, but the building was dismal: grim, dusty, hot, understaffed, housing 8 to 10 elderly men per ward. The food was inedible. The place reeked of desperation and despair.
Then I toured the other option, a private rehabilitation hospital with air-conditioned rooms, private bathrooms and cable televisions, a state-of-the-art gym, passably tasty food and cheery nurses who made a cup of cocoa for my husband every night before bed.

For the full commentary, see:
SARAH LYALL. “An Expat Goes for a Checkup.” The New York Times, Week in Review Section (Sun., August 8, 2009): 1 & 6.
(Note: the online title is “Health Care in Britain: Expat Goes for a Checkup.”)
(Note: ellipsis added.)

Native Americans Suffer from Government Health Care

(p. A11) Native Americans have received federally funded health care for decades. A series of treaties, court cases and acts passed by Congress requires that the government provide low-cost and, in many cases, free care to American Indians. The Indian Health Service (IHS) is charged with delivering that care.

The IHS attempts to provide health care to American Indians and Alaska Natives in one of two ways. It runs 48 hospitals and 230 clinics for which it hires doctors, nurses, and staff and decides what services will be provided. Or it contracts with tribes under the Indian Self-Determination and Education Assistance Act passed in 1975. In this case, the IHS provides funding for the tribe, which delivers health care to tribal members and makes its own decisions about what services to provide.
. . .
Unfortunately, Indians are not getting healthier under the federal system. In 2007, rates of infant mortality among Native Americans across the country were 1.4 times higher than non-Hispanic whites and rates of heart disease were 1.2 times higher. HIV/AIDS rates were 30% higher, and rates of liver cancer and inflammatory bowel disease were two times higher. Diabetes-related death rates were four times higher. On average, life expectancy is four years shorter for Native Americans than the population as a whole.
. . .
Personal stories from people within the system reveal the human side of these statistics. In 2005, Ta’Shon Rain Little Light, a 5-year-old member of the Crow tribe who loved to dress in traditional clothes, stopped eating and complained that her stomach hurt. When her mother took her to the IHS clinic in south central Montana, doctors dismissed her pain as depression. They didn’t perform the tests that might have revealed the terminal cancer that was discovered several months later when Ta’Shon was flown to a children’s hospital in Denver. “Maybe it would have been treatable” had the cancer been discovered sooner, her great-aunt Ada White told the Associated Press.
. . .
The Chippewa Cree Band runs its own hospital and has hired a registered dietician who has gotten the local grocery store to implement a shelf-labeling system to improve consumer nutritional information. They’ve also built a Wellness Center with a gym, track, basketball court, and pool. These are small steps that won’t immediately eliminate heart disease or diabetes. But they move in the direction of local control and better health.
At a time when Americans are debating whether to give the government in Washington more control over their health care, some of the nation’s first inhabitants are moving in the opposite direction.

For the full commentary, see:
TERRY ANDERSON. “OPINION: CROSS COUNTRY; Native Americans and the Public Option; After decades of government-run care, some Indians are finally saying enough.” Wall Street Journal (Sat., August 29, 2009): A11.
(Note: ellipses added.)
(Note: the online version is dated Fri., Aug.28, 2009)

Small Business Sceptical of Big Government Health Plan

“No, I mean it,” said Ms. Brigugulio, “I expect you to keep your word on this.” Source of the photo and caption: http://boss.blogs.nytimes.com/2009/07/30/mr-prez-meets-ms-biz-the-story-behind-the-photo/

(p. A11) Patty Briguglio thinks President Obama may have a public relations problem selling his health care plan to small-business owners.
And Ms. Briguglio, who was photographed exchanging a wagging finger with the president at his health care forum Wednesday in Raleigh, N.C., should know: she runs her own small business, MMI Associates, a public relations firm in Raleigh.
Ms. Briguglio pays much of the cost of health insurance for her firm’s 19 employees, though she does not offer a group plan. Because the members of her staff are so young, it is cheaper simply to provide an allowance for them to buy individual policies.
When Mr. Obama called on Ms. Briguglio at Wednesday’s forum, she asked, ”What current long-term social program created and run by the government should we look to as a model of success and one that we as taxpayers should be confident that a new government-run health care system would be better than the current system in place?”
The president suggested Veterans Affairs hospitals and Medicare, both of which, he said, ”have very high satisfaction rates.”
And, he added, ”Medicare costs have gone up more slowly than private-sector health care costs.”
Ms. Briguglio was not completely satisfied. ”I’ve never associated any government program with ‘cost effective’ or ‘efficient,’ ” she said in a telephone interview on Thursday. ”I don’t believe that the government will be a better steward of the money that I set aside for health care for my employees than I will be.”

For the full story, see:

ROBB MANDELBAUM. “To Challenges For Obama, Add Another.” The New York Times (Fri., July 31, 2009): A11.
(Note: the online version of the article does not have the photo of Briguglio wagging her finger, that was published in my print version of the paper. The photo above is from later in the exchange, and appeared on the NYT blog.)

“The Voluntary Slaves of a ‘Compassionate’ Government”

Thomas Szaz has been defending liberty for many decades. It is good to see him still eloquently at it:

(p. A13) If we persevere in our quixotic quest for a fetishized medical equality we will sacrifice personal freedom as its price. We will become the voluntary slaves of a “compassionate” government that will provide the same low quality health care to everyone.

For the full commentary, see:
THOMAS SZASZ. “Universal Health Care Isn’t Worth Our Freedom.” Wall Street Journal (Weds., JULY 15, 2009): A13.

Experiments Suggest We Can Live Longer

“Rhesus monkeys, 27-year-old Canto, left, and Owen, 29, are among the oldest surviving subjects in a study of the links between diet and aging.” Source of photo and caption: online version of the WSJ article quoted and cited below.

(p. A3) A study published Wednesday found that rapamycin, a drug used in organ transplants, increased the life span of mice by 9% to 14%, the first definitive case in which a chemical has been shown to extend the life span of normal mammals.

Anti-aging researchers also expect a second study, to be released this week, will show that sharply cutting the calorie intake of monkeys extends their lives substantially. The experiment is said to be the first technique shown to retard aging in primates.
The prospect of a reliable human longevity pill is still distant. A commentary released with the rapamycin study strongly cautioned against taking the drug to prolong life because of potentially deadly side effects. Rapamycin suppresses the immune system and carries strong warnings about the resulting risk of infections and death.
But the mouse and monkey findings appear to mark the most substantial scientific progress yet in the search for ways to extend human life spans — once viewed as a fringe area of study.
“It’s time to break out of our denial about aging,” said Aubrey de Grey, a British gerontologist who has drawn controversy for his suggestions on how to forestall death. “Aging is, unequivocally, the major cause of death in the industrialized world and a perfectly legitimate target of medical intervention.”

For the full story, see:
KEITH J. WINSTEIN. “”Two Mammals’ Longevity Boosted; Transplant Drug Lengthens Lives of Mice, and Fewer Calories Benefit Monkeys.” The Wall Street Journal (Thurs., JULY 10, 2009): A3.

Source of graphic: online version of the WSJ article quoted and cited above.

Free-Range Pork Carries More Disease

(p. A19) Is free-range pork better and safer to eat than conventional pork? Many consumers think so. The well-publicized horrors of intensive pig farming have fostered the widespread assumption that, as one purveyor of free-range meats put it, “the health benefits are indisputable.” However, as yet another reminder that culinary wisdom is never conventional, scientists have found that free-range pork can be more likely than caged pork to carry dangerous bacteria and parasites. It’s not only pistachios and 50-pound tubs of peanut paste that have been infected with salmonella but also 500-pound pigs allowed to root and to roam pastures happily before butting heads with a bolt gun.

The study published in the journal Foodborne Pathogens and Disease that brought these findings to light last year sampled more than 600 pigs in North Carolina, Ohio and Wisconsin. The study, financed by the National Pork Board, discovered not only higher rates of salmonella in free-range pigs (54 percent versus 39 percent) but also greater levels of the pathogen toxoplasma (6.8 percent versus 1.1 percent) and, most alarming, two free-range pigs that carried the parasite trichina (as opposed to zero for confined pigs). For many years, the pork industry has been assuring cooks that a little pink in the pork is fine. Trichinosis, which can be deadly, was assumed to be history.
. . .
Let’s not forget that animal domestication has not been only about profit. It’s also been about making meat more reliably available, safer to eat and consistently flavored. The critique of conventional animal farming that pervades food discussions today is right on the mark. But it should acknowledge that raising animals indoors, fighting their diseases with medicine and feeding them a carefully monitored diet have long been basic tenets of animal husbandry that allowed a lot more people to eat a lot more pork without getting sick.

For the full commentary, see:
JAMES E. McWILLIAMS. “Free-Range Trichinosis.” The New York Times (Fri., April 10, 2009): A19.
(Note: ellipsis added.)