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Health Care in Crisis Part 3 of 5: Overmedicating America

Viewpoint July 28, 2009

In the U.S. today, doctors are too quick to prescribe drugs that their patients don’t really need and often can’t afford, writes Ed Wallace

By Ed Wallace

Editor’s Note: This is Part Three of a five-part series on the health-care crisis.

It started with creeping numbness across her upper right abdomen. When after months of concern the sensation would not go away, Judi, a news assignments manager for a Dallas TV news operation, decided it was time to have a complete physical. Her primary physician referred her to a neurologist, which led to a series of MRIs covering her spine, neck, and brain. The results were not reassuring: The scans showed a small spot of demyelination on her spinal cord, typically the first sign of multiple sclerosis.

In essence, Judi’s own immune system might be eating away at the protective sheath that covers the nerves running throughout her body, causing them to misfire. Her neurologist claimed that it was MS, but also ordered a lumbar puncture to test for MS markers in Judi’s spinal fluid—a compressed or damaged disc in her back would cause the same symptoms.

Judi sought a second opinion from Dr. Ralph Rashbaum at the Texas Back Institute in Plano, Tex., who was only slightly more encouraging. He told Judi that there was an 80% chance she had become a victim of multiple sclerosis. But he also shared that his own daughter Tracey was afflicted with MS, and she was receiving treatment from Dr. Elliot Frohman at Southwestern Medical in Dallas.

Risks of Treatment

Rashbaum’s praise for the groundbreaking work Frohman was doing was reassuring. He said his daughter was responding well and carrying on a full life as a wife and mother of two. For Judi, however, the shock of the diagnosis allowed little room for hope.

But there was a discrepancy in Judi’s spinal tap results: All the markers for MS came back negative. While there was one spot of demyelination on her spinal cord, the cause of that damage was not MS. Dr. Chen, Judi’s neurologist, delivered the good news—but at the same time said she wanted Judi to start the treatment as if her tests had come back positive.

This was a problem, because the proposed treatment’s side effects come with their own risks. As Dr. Rashbaum explained, one occasional hazard of treating MS with interferon-based medicines is death.

There was another major factor, and it too is a primary reason why health care costs so much in America. Treatment today for multiple sclerosis often exceeds $10,000 a year, and this disease is a lifetime commitment on the part of the insured’s health insurance plan. Moreover, treatment with the newest drug, Biogen’s (BIIB) Avonex, could cost upwards of $18,000 per year.

Pricey Medicine

The proposed treatment involved in this case could have amounted to a lifetime cost of more than $450,000—and this for a patient who in fact does not have the disease for which the treatment was prescribed.

Moreover, medical professionals disagree on how to proceed with treatment even if MS is the verified diagnosis. Some prefer to begin treatment immediately, while others suggest a waiting period; the disease has an extremely slow initial progression, and the symptoms with which MS can expand and ravage a person’s nervous system are not consistent.

However, there is total agreement among medical professionals that the advances in care for MS victims have been nothing short of phenomenal over the past 20 years. While current treatments do not stop MS, they can slow the progression of the disease to the point that its victims live much fuller lives for much longer.

Judi decided to wait one year, repeat the MRI scans, and see if the demyelination progressed. This decision saved her health-care provider more than $10,000 this year alone. Fifteen months later new scans showed no further areas of demyelination.

Too Many Pills?

Are we an overmedicated society? Certainly much has been written concerning doctors’ tendency over the past four decades to overprescribe antibiotics. Many physicians today worry that bacteria could build up immunities against these drugs, ruining antibiotics’ effectiveness in the future. But as they are relatively inexpensive, antibiotics are often favored by physicians.

But the expensive overmedication of America really began 12 years ago, when the Federal Drug Administration allowed drug companies to advertise their products on TV. Americans could now diagnose themselves during commercial breaks, and then “ask their doctor” to prescribe the most expensive, no-generic-available wonder drugs.

The U.S. is the only industrialized country in the world that allows this practice, and it’s not without controversy here. The pro argument is that some individuals who have been quietly suffering from one malady or another can be motivated to find a doctor and obtain medical help. The con argument is that many individuals with only one symptom—which might not necessarily indicate the problem the drug in the TV ad is for—may demand that medication from a physician, who in turn may see no harm in prescribing it.

Today, TV ads encourage consumers to self-diagnose and treat potentially serious medical problems as easily as they rid themselves of dandruff with the right shampoo. Sleepless nights, diabetes, seizures, allergies, depression, chronic bronchitis, high cholesterol, dry eyes, overactive bladders, tingling in your legs, baldness, and the list goes on and on. In some cases, the commercial even suggests that the drug’s manufacturer will help you find a physician to gladly write the prescription for you.

Selling Sick

Two years ago a UCLA study published in the Annals of Family Medicine came down hard on these advertisements. It found that pharma ads are so suggestive that they’re influencing Americans to believe that we are sicker than we really are—and, as a result, we’re taking medicine we don’t need.

UCLA’s Dr. Dominick Frosch summed up this modern movement toward selling drugs for potentially nonexistent conditions in Medical News Today: “We’re seeing a dramatization of health problems that many people used to manage without prescription drugs. And the ads send the message that you need drugs to manage these problems, and without medication your life will be less enjoyable, more painful, and maybe even out of control.”

No one knows the real cost to our health-care system for those unnecessary drugs, but it is possibly in the tens of millions or even billions.

Another drug-related issue, especially for families with elders, is the sizable number of different medications their loved ones are taking. One of the problems with pharmaceuticals, particularly where multiple doctors are prescribing for the same patient, is the potential for serious issues arising from bad drug interactions. There is also the potential for one life-saving drug to cancel out the effect of another.

Tricky Treatment

Take the case of a heart attack victim who also suffers severe allergic reactions. The beta-blocker prescribed by the cardiologist for your heart can also block an EpiPen’s epinephrine, stopping it from reversing the effects of severe allergic shock. If your heart doesn’t kill you, the bee sting might.

Medicine is a complex science, and some doctors suggest that at times it’s more of an art. However, there is little difference (besides the cost) between suggesting treatment for a case of MS that didn’t exist and suggesting drugs on TV to treat possibly nonexistent problems.

The drug ad debate continues because some people are saved or have their health restored because medical cures are advertised directly to the public. But the practice also puts the nation’s physicians in a position where they can lose good patients by refusing to prescribe new drugs that may not be needed. Many physicians are asked every day for these medicines; they likely do a risk-benefit analysis, but if in the end they assess that it could do no real harm, they generally write the scrip.

And so the overall cost of health care in America continues to skyrocket, fueled in part by advertising designed to convince us we are sicker than we really are. And at least one neurologist who suggests incredibly expensive, even potentially life-threatening treatments for a condition that the patient doesn’t have.

Ed Wallace hosts the talk show Wheels from 8:00 to 1:00 Saturdays on 570 KLIF in Dallas. Visit his Web site, www.insideautomotive.com, to read his work.

Complete article at:

Health Care

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New Primer Examines Medicare’s Financing and Long-Term Fiscal Outlook

Wednesday, July 29, 2009

New Primer Examines Medicare’s Financing and Long-Term Fiscal Outlook

The Kaiser Family Foundation issued a new primer that provides an overview of Medicare’s financing and the fiscal challenges the program faces in the coming decades. As the nation’s provider of health coverage for the elderly and people with disabilities, Medicare now covers 46 million American with total expenditures of $455 billion in fiscal year 2008, accounting for 15 percent of the federal budget, exceeded only by defense spending and Social Security.

The primer describes how Medicare is financed and examines several methods of assessing the program’s long-term financial outlook. It also discusses the factors that drive the growth in Medicare spending, which is primarily due to rising health care costs that affect all public and private payers nationwide. The primer also examines geographic variation in health care spending and its impact on the Medicare program, and how rising Medicare costs affect beneficiaries’ out-of-pocket spending burden.

Lastly, the primer discusses the outlook for the future of Medicare financing and the potential for various policy proposals under discussion to change the current upward trajectory of costs, both for Medicare and for the health care system overall.

A Primer on Medicare Financing is available online at Primer.

For more information, please contact Craig Palosky at (202) 347-5270 or cpalosky@kff.org.

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New Resource Provides Data on State Variation and Health Reform

Thursday, July 30, 2009

New Resource Provides Data On State Variation and Health Reform

Health reform is a national undertaking, but any comprehensive overhaul of the health care system would have different effects across states due to their varying economies, demographics and health care profiles. A new online resource (Health reform) from the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured presents an array of state-level data that can help policymakers and others understand the disparate impacts of potential health reform on the 50 states and the District of Columbia.

The resource, which draws on data from the Foundation’s Statehealthfacts.org Web site, includes interactive tables and maps that present key information for each state. Taken collectively, the data illustrate widespread regional and state variation, including:

- A general economic profile, with data on poverty rates, major industries, unemployment rates and fiscal conditions;
- Data on health care costs, including overall health spending, average family premium costs and Medicare expenditures;
- A profile of the uninsured;
- A snapshot of the distribution of health coverage;
- A summary of Medicaid eligibility, enrollment and spending;
- Data on access to health care services, primary care workforce shortages, unmet health care needs and Medicaid provider fees;
- A synopsis of private coverage, individual and small group market regulation, and enrollment in high risk pools.

The new resource is available on the Foundation’s new health reform gateway page at http://healthreform.kff.org/, which serves as a clearinghouse of key information, news and analysis about national health reform efforts. Among the resources found there are an interactive online tool allowing users to compare major health reform bills, briefs on key reform concepts and the Foundation’s research and analysis on key issues in health reform, webcasts of reporters-only briefings with key congressional leaders, Kaiser’s polling data, analysis from Kaiser president Drew Altman, and news summaries compiled by Kaiser Health News, an editorially independent health policy news service established by the Foundation.

For more information, please contact Chris Lee at (202) 347-5270 or clee@kff.org.

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Defending Canada’s Health Care: Truths and Lies

Jack Layton NDP Leader
Posted: July 30, 2009

Last week a new study showed that 92% of Canadians would recommend their doctor to friends and family. Two-thirds have had their doctor for over five years and 85% of Canadians have a regular doctor.

Does that sound like the health care system depicted in the right-wing Republican-backed smear campaign against Canada?

No care for life-threatening conditions, no choice, exorbitant costs, bureaucrat control, poor outcomes — these are the bogeymen of the right-wing smear campaign. And like all bogeymen, once you look under the bed they don’t exist.

Our system does have flaws. We need better prescription drug coverage, better remote access to care and better practices in hospitals and clinics. No honest advocate for our health care system would dismiss these things. But Canadian health care works — and works well.

If you face a medical emergency — you get the help you need. An admitting nurse doesn’t check your credit card — she checks your pulse. Across Canada innovative best practices in hospitals and clinics are cutting wait times for emergency treatment and elective surgery alike.

Costs are under control in Canada. We spend similar amounts on public care – around 7% of GDP. For that price, Canada covers everyone, the U.S. just one third of the population. In case you’re worried Canada wastes money on bureaucracy, know that just 2.4% of our total costs go to administration compared to 7% of what your government spends. In end, Canadian care costs $2,500 less per capita – and covers everyone.

Our outcomes are excellent too: infant mortality is lower, people live longer and we are less at risk of cardiovascular disease than Americans.

Does all this mean that the United States should adopt Canada’s health care system?

No. America can no more adopt our health care system than we can swap hockey for baseball as our national pastime. A good health care system reflects a country’s values, and each country’s values are different.

But a system with 47 million uninsured, coverage denied due to pre-existing conditions and people thrown off plans when they become ill? That doesn’t reflect American values.

Fixing the health care system won’t be easy — from Truman to Nixon to Clinton presidents have tried and failed. But it wasn’t easy in Canada either.

Sixty years ago Canadians families shouldered their own medical bills. Those with the money got the care they needed, but those without struggled — they sold their farms, mortgaged their homes, or went without care, suffered, and even died.

Tommy Douglas, one of my predecessors as leader of the New Democrats, believed everyone should get the health care they needed, regardless of income. So in 1947 Tommy and his supporters launched a decades-long battle for Canadian Medicare.

The forces of the status quo — like those in America today — fought back. Small and big business, patients and doctors groups — at different times they all fought reform. Doctors even went on strike, leaving sick women, men and children without care. But by 1984 the Canada Health Act had secured a national public health care system that has become part of our identity. It’s not a perfect system, but it works.

With health care reform in the U.S. closer to success than at any time in my life, our hopes are with you. Don’t let right-wing lies about Canada help derail health care reform in America.

Complete article at:

Canadian health care

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Obama’s Doctor, Others: Not Doing Single Payer a “Terrible Mistake”

Thursday, July 30, 2009

DAVID SCHEINER, MD, SIDNEY WOLFE, MD, via Barbara Holzer, bholzer@citizen.org, http://www.citizen.org

MARGARET FLOWERS, MD, nose1@aol.com, http://www.md.pnhp.org, http://www.pnhp.org

At a news conference at the National Press Club today, David Scheiner, who was Obama’s personal physician for 22 years, said he would not support a proposal currently working its way through Congress: “If we don’t go the route of single payer, we’re making a terrible mistake.”

Asked if he has spoken to the president, Scheiner indicated he was disinvited from a recent forum that featured Obama. “I would give up my eyeteeth to speak to him. Perhaps he can invite his old doctor to the White House for a drink of water.”

Speaking on the anniversary of Medicare’s enactment 44 years ago, Scheiner stated that there is a great deal of disinformation about healthcare reform. He particularly focused on “this myth that the government would get between a doctor and patient. Medicare never gets between me and my patients. What does get in the way is the private insurance companies.”

Read Scheiner’s full statement:

pressroom

Joining Scheiner was Sidney Wolfe, MD, acting president of Public Citizen and director of Public Citizen’s Health Research Group. Wolfe indicated that Obama’s stated goals of universal coverage and budget neutrality can only be achieved with a single-payer model: “The private insurance industry can’t exist in a program that is universal and cost neutral.” Wolfe called the current proposal a “false promise” that “is no longer a bill for national health insurance,” adding that “we are against Obamacare because it is a disaster for the millions left out.”

Said Wolfe: “We should be celebrating the 44th anniversary of Medicare by finally passing legislation that would truly result in everybody in, nobody out, instead of seriously considering legislation that guarantees that millions still will be left out just so the private health insurance industry can stay in. A single-payer system, eliminating the private health insurance industry, with the resultant $400 billion annual savings — that’s $4 trillion over ten years — is the only realistic way for everybody to be in.”

Also speaking at the news conference was Dr. Margaret Flowers, a pediatrician who is congressional fellow with Physicians for a National Health Program, which just released a letter signed by over 3,500 doctors, including Scheiner. The letter states: “Mr. President, you once embraced a single-payer reform that would threaten private insurers, and foresaw its passage if Democrats regained control of the House, the Senate and the White House. These conditions have been met. Yet now Democrats propose diverting additional billions to private insurers by requiring middle class Americans to purchase defective policies from these firms — policies with so many gaps and loopholes that they currently leave millions of our insured patients vulnerable to financial ruin.

“Moreover, a ‘public plan option’ would do little to mitigate the damage of a reform that perpetuates private insurers’ dominant role. Even a robust public option would forego 90 percent of the bureaucratic savings achievable under single payer. And a kinder, gentler public option would quickly fail in a health care marketplace where competition involves a race to the bottom, not the top, where insurers compete by NOT paying for care. But HHS Secretary Sebelius has made clear that any public option will be far worse than that, specifically crafted to prevent it from evolving to a single payer. This kind of public option would amount to a government-run clone of private insurance, reproducing the worst features of private plans.”

Video of the news conference will be posted at: http://www.singlepayeraction.org

From: Institute for Public Accuracy

Bob Englehart
(www.cagle.com)

Mike Luckovich
(www.cagle.com)

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Rove’s latest distortion: Dems plan $1T “price tag” for health reform

Karl Rove advanced the falsehood that the House health care reform bill would add $1 trillion to the federal deficit. In fact, the Congressional Budget Office (CBO) has found that the House tri-committee bill “would result in a net increase in the federal budget deficit of $239 billion over the 2010-2019 period,” not $1 trillion.

Read More

Rove’s latest distortion

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THE RETURN OF GREED

Banks Reopen Global Casino
07/28/2009

Investment banks, of all things, are making serious money again, thanks in part to government aid. Ironically, they are benefiting from the crisis they helped to create. As profits go up, so do salaries — only this time, it’s the taxpayers who are shouldering the risks.

…

Complete article at:

Global Casino

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[Dallas Fed] Latest Dallas Beige Book Released

Wednesday, July 29, 2009
Latest Dallas Beige Book Released

Dallas Beige Book
July 29, 2009
Federal Reserve Bank of Dallas

The Federal Reserve System’s latest Beige Book survey has been released. The Dallas Beige Book, along with a link to the national summary and reports from other Federal Reserve Districts, is available at

Dallas Beige Book

This summary of current economic conditions is based on information ollected on or before July 20, 2009. This report summarizes comments received from businesses and other contacts outside the Federal Reserve and does not reflect the views of Federal Reserve officials.

The national Beige Book summary can be found at

National Beige Book

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Petroleum Supply Monthly

Thursday, July 30, 2009

Petroleum Supply Monthly

The July Petroleum Supply Monthly with May data has been updated to the EIA website on Thursday, July 30, 2009.

Petroleum Supply Monthly website:

Petroleum Supply Monthly

Petroleum Navigator:

Navigator

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Drunk-Ass Biden Crashes White House Beer Party

Andy Borowitz
BorowitzReport.com
July 30, 2009

President Obama’s plans for a conciliatory beer party between Harvard professor Henry Louis Gates and James Crowley, the Cambridge policeman who arrested him, went off the rails this evening when Vice President Joe Biden unceremoniously crashed the event.

Mr. Biden, whom onlookers said was clearly inebriated, burst into the Oval Office just as the three men were getting the party underway.

Furious that the party had started without him, Mr. Biden reached into a tub of cold beers and smashed a bottle over the edge of Mr. Obama’s desk.

Brandishing the broken bottle menacingly at the three men, Mr. Biden shouted, “All right you fuckers, who wants a piece of me?”

Officer Crowley, who said he felt pressure to show that he treats all citizens equally regardless of race, told Mr. Biden that he was “disturbing the peace” and asked to see his I.D.

“I’ve got my I.D. right here,” Mr. Biden said, unzipping his trousers. “Say hello to Little Joe!”

After Mr. Biden was subdued by White House security and removed from the Oval Office, Mr. Obama said he felt that, despite the disruption, the event had been a success.

“It was full of teachable moments,” the President said.

Follow Andy Borowitz on Twitter: Borowitz Report

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three thousand words

(click here to view)

Pat Bagley Salt Lake Tribune Jul 31, 2009 EditorialCartoonists.com

Matt Davies: … should be available to everyone
(davies.lohudblogs.com)

R.J. Matson: a liberal is a conservative who …
(www.cagle.com)

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