Health – Page 57 – artdiamondblog.com

“When Beds Are Available, Physicians Figure Out a Way to Fill Them”

Source of graphic: online version of the WSJ article cited below.

(p. D1) The Dartmouth investigators say there is no evidence that higher amounts and greater intensity of care lead to better outcomes for patients. They note past studies done at Dartmouth — looking at Medicare patients with heart attacks, hip fractures and colon cancer — that suggest centers with the most high-intensity care actually have slightly higher death rates than those with a lower intensity of care. As a result, the researchers say, the bills for patients with similar illness may be two or three times higher at some prestigious institutions, with no apparent additional benefit — and perhaps some risk of harm.

. . .

(p. D4) John E. Wennberg, principal investigator for the Atlas project, has pioneered research into variation of medical services. He says the differences among academic medical centers are particularly striking since the medical community depends on these institutions to develop effective treatment strategies. "If the academic medical centers don’t know how to do it, nobody will," Dr. Wennberg says.

He says his research suggests the primary reason for the differences is the capacity of services, such as hospital beds, intensive care units and specialist physicians, within communities. There isn’t any evidence that people are sicker in the markets of high-intensity services than in low ones, says Dr. Wennberg, but when beds are available, physicians figure out a way to fill them.

For the full story, see:

RON WINSLOW. "Care Varies Widely At Top Medical Centers; Utilization of ICU for Sickest Patients Is 5 Times Higher at Some Than Others; NYU Vs. Mayo." The Wall Street Journal (Tues. May 16, 2006): D1.

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

Entrepreneur Found Creative Way to Save Thousands of Babies

(p. 1) The babies were lined up under heaters and they breathed filtered air. Few of them weighed more than three pounds. They shared the Boardwalk there on Coney Island with Violetta the Armless Legless Wonder, Princess WeeWee, Ajax the Sword-Swallower and all the rest. From 1903 until the early 1940’s, premature infants in incubators were part of the carnival.

It cost a quarter to see the babies, and people came again and again, to coo and to gasp and say look how small, look how small. There were twins, even, George and Norma Johnson, born the day before Independence Day in 1937. They had four and a half pounds between them, appearing in the world a month too soon because Dorothy Johnson stepped off a curb wrong and went into labor.

All those quarters bought a big house at Sea Gate for Dr. Martin A. Couney, the man who put the Coney Island babies on display. He died broken and forgotten in 1950 at 80 years old. The doctor was shunned as an unseemly showman in his time, even as he was credited with popularizing incubators and saving thousands of babies. History did not know what to do; he was inspired and single-minded, distasteful and heroic, ultimately confounding.

. . .

(p. 31) He displayed incubators developed by his mentors at the Berlin Exposition of 1896, and though they caught on in Europe, acceptance was slower in the United States.

Using babies from New York hospitals that lacked the facilities to care for them, Dr. Couney mounted a display at Luna Park, a Coney Island amusement park, in 1903, soon adding another at a second Coney Island park, Dreamland.

. . .

At least 8,000 babies passed through the incubators, and the doctor was credited with saving at least 6,500, according to news reports of the time. The Johnson twins made it off the Boardwalk and grew up strong and tall. George Johnson found work, and a sense of freedom, driving trains up and down the coast for the Pennsylvania Railroad. Norma Johnson married a man named Coe. Between the twins there are nine children, 13 grandchildren and one great-grandchild. George and Norma attended Dr. Couney’s induction ceremony yesterday. "My father didn’t have any money, and this doctor says you can use our incubator for free, but you have to put them on display on Coney Island," Mr. Johnson said, sitting next to his sister on the porch at the Sheepshead Bay Yacht Club the other day. "It was us and a lot of other people, too."

The twins will turn 68 the day before Independence Day, old enough to enjoy the seaside air on an idle weekday morning.

Down the Boardwalk, the beach is open. Pretty girls and seagulls play their games. For a few dollars, you can watch a baseball game, shoot paint pellets at a hungry young dude or become a tattooed lady.

The likes of Martin A. Couney nobody has seen in 60 years.

For the full story, see:

MICHAEL BRICK. "And Next to the Bearded Lady, Premature Babies." The New York Times, Section 1 (Sun., June 12, 2005): 1 & 31.

(Note: ellipses added.)

The Johnson twins who were displayed, and whose lives were saved, by Dr. Couney. Source of photo: online version of NYT article cited above.

Life Has Improved; And Can Continue to Improve

Source of graphic: online version of the NYT article cited below.

(p. 1) New research from around the world has begun to reveal a picture of humans today that is so different from what it was in the past that scientists say they are startled. Over the past 100 years, says one researcher, Robert W. Fogel of the University of Chicago, humans in the industrialized world have undergone “a form of evolution that is unique not only to humankind, but unique among the 7,000 or so generations of humans who have ever inhabited the earth.”

. . .

(p. 19) . . . stressful occupations added to the burden on the body.

People would work until they died or were so disabled that they could not continue, Dr. Fogel said. “In 1890, nearly everyone died on the job, and if they lived long enough not to die on the job, the average age of retirement was 85,” he said. Now the average age is 62.

A century ago, most people were farmers, laborers or artisans who were exposed constantly to dust and fumes, Dr. Costa said. “I think there is just this long-term scarring.”

For the full story, see:

Kolata, Gina. "The New Age; Older and Better; So Big and Healthy Grandpa Wouldn’t Even Know You." The New York Times, Section 1 (Sunday, July 30, 2006): 1 & 18-19.

Source of graphic: online version of the NYT article cited above.

Source of graphic: online version of the NYT article cited above. Source of book image: http://www.cambridge.org/us/catalogue/catalogue.asp?isbn=0521808782

Fogel’s book is a primary academic source for much of what is interesting in the New York Times article. Fogel predicts that if we don’t screw things up, half of today’s college students will live to be 100. He shows that academics in the past have consistently and significantly underestimated the maximum lifespans that would be attainable in the future.

The full reference for the Fogel book is:

Fogel, Robert William. The Escape from Hunger and Premature Death, 1700-2100, Cambridge Studies in Population, Economy and Society in Past Time. Cambridge, UK: Cambridge University Press, 2004.

Medication Errors Harm 1.5 Million a Year

The report described below documents an incredibly high rate of errors in the administration of medications. Notice that one of the recommended practices is for patients to bring with them to each doctor’s visit, a complete listing of all of their medicines. It reminded me of accompanying my mother and father while my father was being treated for melanoma at one of the top cancer hospitals in the country. We were shuttled from doctor to doctor. And at each stop we were asked to give a full account of the medicines that Dad was taking. It gradually sunk in to me that the doctors at this prestigious hospital did not even know which drugs Dad had been prescribed, from within the hospital itself.

The Institute of Medicine has identified a problem, but has not identified a cure. If we really want to reduce medical errors, the key is not just to push isolated practices. The key is to change the system so that medical practitioners and institutions are rewarded when they do a better job of reducing errors. If the system provided the right incentives, then the practitioners themselves would be competing to invent and learn the practices that would be most efficient at improving patient health and well-being.

(p. A12) WASHINGTON, July 20 — Medication errors harm 1.5 million people and kill several thousand each year in the United States, costing the nation at least $3.5 billion annually, the Institute of Medicine concluded in a report released on Thursday.

Drug errors are so widespread that hospital patients should expect to suffer one every day they remain hospitalized, although error rates vary by hospital and most do not lead to injury, the report concluded.

The report, “Preventing Medication Errors,” cited the death of Betsy Lehman, a 39-year-old mother of two and a health reporter for The Boston Globe, as a classic fatal drug mix-up. Ms. Lehman died in 1993 after a doctor mistakenly gave her four times the appropriate dose of a toxic drug to treat her breast cancer.

Recommendations to correct these problems include systemic changes like electronic prescribing and tips for consumers like advising patients to carry complete listings of their prescriptions to every doctor’s visit, the report said.

. . .

Drug computer-entry systems, which are supposed to ensure that hospital patients get the right drugs at the right dose, are used in just 6 percent of the nation’s hospitals, said Charles B. Inlander, president of the People’s Medical Society, a consumer advocacy group, and an author of the report released Thursday.

Electronic medical records can help ensure that patients do not receive toxic drug combinations. The 1999 report urged widespread adoption of these systems. Thursday’s report called for all prescriptions to be written electronically by 2010.

Just 3 percent of hospitals have electronic patient records, said Henri Manasse, chief executive of the American Society of Health-System Pharmacists. Few doctors prescribe drugs electronically.

Even simple medication safety recommendations — block printing on hand-written prescription forms — are widely ignored.

. . .

Thursday’s report said that in any given week, four out of five adults in the United States took at least one medication. A third take at least five different medications. As the use of medications has soared, so, too have medication errors, Dr. Manasse said.

Effective strategies to prevent such errors have, however, been known for years, Mr. Inlander said.

“This is not rocket science,” Mr. Inlander said. “It’s simple. The key is having the will to make these changes in an organized and uniform way. And it’s not that expensive.”

For the full story, see:

GARDINER HARRIS. "Report Finds a Heavy Toll From Medication Errors." The New York Times (Fri., July 21, 2006): A12.

For a link to the full "Preventing Medication Errors" report from the Institute of Medicine, see: http://www.nap.edu/catalog/11623.html#toc

Exercising to Win, Hurts Lifetime Fitness

Source of image: online version of the NYT article cited below.

(p. E1) The dirty secret among former high school and college jocks is that many don’t remain active as adults. In their glory days they were the fittest among their peers. But as adults many are overtaken by nonjocks who embrace fitness as a commitment to health, forget the varsity letter.

Onetime elite athletes often languish once organized competition is over and a coach isn’t hounding them, sports scientists and exercise physiologists say. Many are burned out. Others become discouraged when their lackluster fitness can’t compare to their highlight reels. Running on a treadmill in a sea of anonymous gym-goers doesn’t compare to the thrill of being an m.v.p. on campus.

"Basically, they’ve been to the mountaintop and now they’re on these little hills, and that is difficult to deal with," said Dan Gould, the director of the Institute for the Study of Youth Sports at Michigan State University in Lansing.

Extrinsic motivation is tricky business, said Dr. Gould, a professor of kinesiology. He said he has found that athletes who played for trophies (p. E8) or attention are more at risk of becoming sedentary as adults than people who have taught themselves to get off the sofa and exercise, those with "intrinsic motivation."

For the full story, see:

JILL AGOSTINO. "Once an Athletic Star, Now an Unheavenly Body." The New York Times (Thurs., July 6, 2006): E1 & E8.

Global Warming Ranked at Bottom of World Priorities by Economists and Ambassadors

Bjorn Lomborg. Source of image: online version of WSJ article cited below.

(p. A10) Bjorn Lomborg busted — and that is the only word for it — onto the world scene in 2001 with the publication of his book "The Skeptical Environmentalist." A one-time Greenpeace enthusiast, he’d originally planned to disprove those who said the environment was getting better. He failed. And to his credit, his book said so, supplying a damning critique of today’s environmental pessimism. Carefully researched, it offered endless statistics — from official sources such as the U.N. — showing that from biodiversity to global warming, there simply were no apocalypses in the offing. "Our history shows that we solve more problems than we create," he tells me. For his efforts, Mr. Lomborg was labeled a heretic by environmental groups — whose fundraising depends on scaring the jeepers out of the public — and became more hated by these alarmists than even (if possible) President Bush.

Yet the experience left Mr. Lomborg with a taste for challenging conventional wisdom. In 2004, he invited eight of the world’s top economists — including four Nobel Laureates — to Copenhagen, where they were asked to evaluate the world’s problems, think of the costs and efficiencies attached to solving each, and then produce a prioritized list of those most deserving of money. The well-publicized results (and let it be said here that Mr. Lomborg is no slouch when it comes to promoting himself and his work) were stunning. While the economists were from varying political stripes, they largely agreed. The numbers were just so compelling: $1 spent preventing HIV/AIDS would result in about $40 of social benefits, so the economists put it at the top of the list (followed by malnutrition, free trade and malaria). In contrast, $1 spent to abate global warming would result in only about two cents to 25 cents worth of good; so that project dropped to the bottom.

"Most people, average people, when faced with these clear choices, would pick the $40-of-good project over others — that’s rational," says Mr. Lomborg. "The problem is that most people are simply presented with a menu of projects, with no prices and no quantities. What the Copenhagen Consensus was trying to do was put the slices and prices on a menu. And then require people to make choices."

Easier said than done. As Mr. Lomborg explains, "It’s fine to ask economists to prioritize, but economists don’t run the world." . . .

So all the more credit to Mr. Lomborg, who several weeks ago got his first big shot at reprogramming world leaders. His organization, the Copenhagen Consensus Center, held a new version of the exercise in Georgetown. In attendance were eight U.N. ambassadors, including John Bolton. (China and India signed on, though no Europeans.) They were presented with global projects, the merits of each of which were passionately argued by experts in those fields. Then they were asked: If you had an extra $50 billion, how would you prioritize your spending?

Mr. Lomborg grins and says that before the event he briefed the ambassadors: "Several of them looked down the list and said ‘Wait, I want to put a No. 1 by each of these projects, they are all so important.’ And I had to say, ‘Yeah, uh, that’s exactly the point of this exercise — to make you not do that.’" So rank they did. And perhaps no surprise, their final list looked very similar to that of the wise economists. At the top were better health care, cleaner water, more schools and improved nutrition. At the bottom was . . . global warming.

For the full interview, see:

KIMBERLEY A. STRASSEL. "The Weekend Interview with Bjorn Lomborg; Get Your Priorities Right." The Wall Street Journal (Sat., July 8, 2006): A10.

(Note: first ellipsis is added; the second ellipsis is in the original.)

Source of book image: http://www.amazon.com/gp/product/customer-reviews/0521010683/ref=cm_cr_dp_2_1/104-0101568-2686373?ie=UTF8&customer-reviews.sort%5Fby=-SubmissionDate&n=283155

“My Merit Is My Caste; What Is Yours?”

NEW DELHI, May 22 — The problem of caste prejudice here is as ancient as the Hindu texts. The efforts to redress it date from the formation of modern India nearly 59 years ago. Today — as India enjoys awesome rates of economic progress and confronts the challenge of spreading the benefits to its needy majority — the nation faces a polarizing totem of public policy: a government plan to extend college admission quotas to certain "backward" castes.

Affirmative action is in some ways an even more emotional issue in India than in the United States. In recent weeks, a proposal to extend quotas for admission to some of the country’s flagship, federally financed universities has caused fresh turmoil.

Protests — particularly by medical students who say merit should be the only basis for admission to India’s intensely competitive medical schools — have spread across the country and, here in the capital, hobbled public health services. Advocates and opponents of the measure have exchanged often ugly rants.

. . .

Medical students have been particularly outraged because the plan would further restrict the limited number of seats. Medical education in India begins with a five-year undergraduate program, and the proposal could affect students’ chances of completing their training.

The central lawn of the All India Institute of Medical Sciences, the pre-eminent public hospital, was occupied Friday by medical students on the fifth day of a strike that began last week and continued on Monday. "My merit is my caste. What is yours?" read one T-shirt.

. . .

The opponents say set-asides would diminish the quality of India’s best universities and divide students along caste lines.

"Why after 55 years are we still thinking in terms of caste-based reservation?" demanded Poojan Aggarwal, a third-year student at Safdarjung Medical College here. "We should talk now of total meritocracy. We know on this issue none of the political parties will support us."

For the full story, see:

SOMINI SENGUPTA. "Quotas to Aid India’s Poor vs. Push for Meritocracy." The New York Times (Tues., May 23, 2006): A3.

(Note: ellipses added.)

Doctor Overhead Increased 15 – 20% Due to Insurance Delays in Paying Claims

Source of the graphic: the online version of the NYT article cited below.

What is noteworthy in the table above is not the differences in delays in paying. What is noteworthy is that the fastest payer still takes a month to pay.

(p. C1) Few things rankle a doctor more than an insurance company’s saying it cannot find a claim for medical services. Particularly when there is even a signed return receipt to document delivery of the bill.

"We actually had the little green card to show who signed for the dang thing," said Elizabeth Wertz, chief executive of the Pediatric Alliance, a large group of Pittsburgh doctors. "We sent it by certified mail. The insurance company said they didn’t have it."

The claim was for several thousand dollars, according to Ms. Wertz, who declined to identify the company, a large regional insurer, for fear of making it more difficult to wrangle payments. It is a problem known to many doctors as they struggle to balance the rising cost of providing patient care with what they see as a reluctance by some powerful insurers to pay promptly.

Pediatric Alliance’s 37 doctors are among the 7,000 physicians, nurse practitioners and other health care providers around the country who are clients of the claims-processing company Athenahealth, which plans today to present a rare warts-and-all look at how well — or not — the nation’s seven biggest health insurers pay their bills.

Not well enough, in many cases, according to the data and to experts who say the survey provides the most comprehensive look yet at the state of accounts payable vs. accounts receivable in the nation’s health care system.

Tardiness or refusal to pay what doctors consider legitimate medical claims may add as much as 15 to 20 percent in overhead costs for physicians, forcing them to pursue those claims or pass along the costs to other patients, according to Jack Lewin, a family doctor who is chief executive of the California Medical Association, a professional group of 35,000 physicians.

. . .

(p. C10) Athenahealth, which says it collected $1.8 billion on behalf of its physician clients last year, is among the biggest of several thousand companies that help doctors and hospitals get paid by editing their claims and helping them to deal with difficult cases. Health care providers who can afford such services say they have become a necessary part of doing business.

In the case of Pediatric Alliance, with 37 pediatricians in a dozen offices in and around Pittsburgh, the doctors’ group spends at least $250,000 a year on salaries for eight billing clerks who handle claims and pursue money owed by insurers and patients. That is on top of salaries in Pediatric Alliance’s offices for staff members to verify the patient’s coverage and collect co-payments, plus paying an outside company to check for errors before the bills go out.

Ms. Wertz, the alliance’s chief executive, says some insurers’ telephone call centers limit claims-related issues to 10 per call. "That’s incredibly inefficient," she said. "We see thousands of patients. Our people have to sit on phone 30 minutes to get a live person."

. . .

"I would much rather have my staff talking to patients than talking to insurance companies," Dr. Katz said.

For the full story, see:

MILT FREUDENHEIM. "The Check Is Not in the Mail." The New York Times (Thurs., May 25, 2006): C1 & C6.

(Note: The "Dr. Katz" mentioned is "Dr. Molly Katz, a Cincinnati gynecologist and former president of the Ohio Medical Association.")

Paperwork is 31% of U.S. Health Care Costs

. . . , a large part of America’s health care spending goes into paperwork. A 2003 study in The New England Journal of Medicine estimated that administrative costs took 31 cents out of every dollar the United States spent on health care, compared with only 17 cents in Canada.

For the full commentary, see:

PAUL KRUGMAN. "The Medical Money Pit." The New York Times (Friday, April 15, 2005): A19.

Canada may beat the U.S. in this dimension of health care, but they lose in many other important dimensions–for example the wait time to receive ‘elective’ surgeries. And anyway, isn’t 17 percent still too high?

British Pull Own Teeth Under Public Dental Care

"William Kelly, 43, extracted part of his own tooth, leaving a black stump. He plans to pull one more." Source of caption and image: online version of NYT article cited below.

ROCHDALE, England, May 2 — "I snapped it out myself," said William Kelly, 43, describing his most recent dental procedure, the autoextraction of one of his upper teeth.

Now it is a jagged black stump, and the pain gnawing at Mr. Kelly’s mouth has transferred itself to a different tooth, mottled and rickety, on the other side of his mouth. "I’m in the middle of pulling that one out, too," he said.

. . .

But the problem is serious. Mr. Kelly’s predicament is not just a result of cigarettes and possibly indifferent oral hygiene; he is careful to brush once a day, he said. Instead, it is due in large part to the deficiencies in Britain’s state-financed dental service, which, stretched beyond its limit, no longer serves everyone and no longer even pretends to try.

Every time he has tried to sign up, lining up with hundreds of others from the ranks of the desperate and the hurting — "I’ve seen people with bleeding gums where they’ve ripped their teeth out," he said grimly — he has arrived too late and missed the cutoff.

"You could argue that Britain has not seen lines like this since World War II," said Mark Pritchard, a member of Parliament who represents part of Shropshire, where the situation is just as grim. "Churchill once said that the British are great queuers, but I don’t think he meant that in connection to dental care."

Britain has too few public dentists for too many people. At the beginning of the year, just 49 percent of the adults and 63 percent of the children in England and Wales were registered with public dentists.

And now, discouraged by what they say is the assembly-line nature of the job and by a new contract that pays them to perform a set number of "units of dental activity" per year, even more dentists are abandoning the health service and going into private practice — some 2,000 in April alone, the British Dental Association says.

. . .

The system, critics say, encourages state dentists to see too many patients in too short a time and to cut corners by, for instance, extracting teeth rather than performing root canals.

Claire Dacey, a nurse for a private dentist, said that when she worked in the National Health Service one dentist in the practice performed cleanings in five minutes flat.

Moreover, she said, by the time patients got in to see a dentist, many were in terrible shape.

"I had a lady who was in so much pain and had to wait so long that she got herself drunk and had her friend take out her tooth with a pair of pliers," Ms. Dacey said.

Some people simply seek treatment abroad.

For the full story, see:

SARAH LYALL. "In a Dentist Shortage, British (Ouch) Do It Themselves." The New York Times, Section 1 (Sun., May 7, 2006): 3.

(Note: ellipsis added.)