Friday, February 26, 2010

Hope In New Jersey

The Center for Medicine in the Public Interest (CMPI) held its second annual Odyssey Award Gala Thursday night, and amidst all the discussion of health policy and medicine, here was one mega-topic on the program: Hope.

Sadly, hope is in short supply in Washington these days. On healthcare, which was supposed to be the signature agenda item of the Obama administration, as well as the Democratic majority in Congress, we now see that both the executive and legislative branches are thoroughly bogged down in unpopular bureaucratese. Leaders on both ends of Pennsylvania Avenue are still trying to pass healthcare "reform" that the American people manifestly do not want. What the American people do want health, but health is not what Washington is interested in advancing. Yes, that seems strange, but Washington is a strange town.

And so one had to go outside the Beltway, all the way to the Hyatt Regency in Morristown NJ, to see people--including prominent politicians--talking about health, and hope. Former New Jersey Congressman Mike Ferguson serving as the emcee, reminded the audience that New Jersey is “the medicine chest for the world" as he introduced Governor Chris Christie, who accepted the first of two the two Odyssey Awards that CMPI bestowed that night.

The bulk of Christie's speech concerned New Jersey issues; the freshman governor, elected on a reform agenda, is rightly determined to improve the Garden State's less than verdant business climate, not only for life-sciences companies, but for all other entrepreneurs and firms in the state. As Christie said, his goal "is to make New Jersey a magnet for people like you . . . people doing truly heroic work.”

The next speaker was John Crowley, whose story is worthy of Hollywood. When two of his three children were diagnosed with Pompe’s Disease--a neuromuscular wasting disease that usually kills its victims in adolescence--he quit his job and started a company to seek a cure. In fact, Hollywood did make a movie out of his story, “Extraordinary Measures,” released in January. I wrote about the film, for

As Crowley, now the CEO of Amicus Therapeutics, in Cranbury, NJ said, the cure for dread diseases will only arrive when the various players in the field “come together.” That is, the private sector, the regulators, such as the FDA, the grant-makers, such as the NIH, plus philanthropists, plus patient groups. Different players may have different agendas, even competing agendas, but there must be an overall sense of purpose--the sort of purpose that a great New Jerseyan, Alexander Hamilton, articulated more than two centuries ago.

In the same purposeful and inclusive spirit, Crowley started, at his various companies, sessions he called “lunch and learn,” where disease activists--including those ill with the disease--could come to his corporate campus and share their experiences. By putting human faces on the challenge, Crowley could remind himself and his coworkers what their work was all about.

And more than a quarter-century ago, in 1982, Crowley continued, a man named Maurice Klugman heard about the activist efforts of a Connecticut woman, Abbey Meyers, agitating on behalf of her son and all others who suffered from Tourette’s Syndrome. Maurice Klugman told his actor brother, Jack Klugman, then the star of a popular TV medical drama, “Quincy.” The issue of "orphan drugs"--drugs that might serve too small a market to be commercially viable without special incentives--was thus raised on an October 1982 episode of "Quincy." That TV show, Crowley recalled, stampeded both Congress and the White House to enact and sign the Orphan Drug Act into law in January 1983. And since then, he added, the number of “orphan drugs” has risen from just a dozen to more than 300.

Indeed, Crowley continued, some 30 million Americans suffer from one or more of some 7,000 obscure diseases; in fact, more Americans suffer from all those obscure diseases than from cancer. Seven thousand different diseases? That total sounds daunting, although, of course, many of these diseases are clustered into categories--digestive, neuromuscular, and so on--and past experience shows that if one if progress is made on one disease, progress is likely to be made on many similar diseases.

Finally, Crowley recalled one visit to a biotech conference where the speaker, a quadriplegic, said, "'Biotech' is a great big word that means ‘hope,’” and then he added, added, “You give me hope, you give everyone hope." The speaker was the late Christopher Reeve, who died in 2004, never having recovered from a 1995 spinal cord injury.

By dwelling on hope, Crowley underscored a huge bifurcation in American life today: In Washington, politicians speak in a dry and chilly language of technocracy, which only thinly disguises the real agenda, which is cost-cutting. Meanwhile, out in the rest of the country, ordinary people worry about their health, and about medicine and treatments. And in some places, such as Morristown NJ, they even talk about cures.

Indeed, the bifurcation was all the more glaring on Thursday, February 25, 2010. In Washington DC, on that same day, the White House convened a seven-hour talkathon on health insurance. The result? Most likely, nothing. And yet later that same Thursday, hundreds of miles to the north, a much different conversation took place.

As Robert Goldberg, co-founder of CMPI, along with Peter Pitts, observed at the Odyssey Awards Gala, when politicians in Washington "talk about healthcare as ‘controlling costs,’ they forget the transformative power of cures.” Exactly. Cures are not only popular for their lifesaving potential, they are not only good business in places such as New Jersey, but they are also money-savers for the government, because healthy people cost less, and produce more, than sick people.

Indeed, the economic potential in health was underscored by the second Odyssey Award winner of the evening, Dr. Frank Douglas, who has enjoyed a long and varied career in the medical and pharma world, and is now the President and CEO of the Austen BioInnovation Institute in Akron, OH.

The Austen BioInnovation Institute is a consortium—including Akron Children's Hospital, Akron General Health System, Northeastern Ohio Universities Colleges of Medicine and Pharmacy, Summa Health System and The University of Akron--focusing on orthopedic research, taking advantage of Akron's longstanding leadership in the field of polymers. Polymers are the molecular origin of Akron's legendary rubber industry, but polymers are also the building blocks of life itself. As Douglas observed, "We're all made of polymers."

In other words, there's hope, too, in Akron, and everywhere else where smart and well-meaning people are coming together to create better cures and treatments and therapies. A look back at more than two centuries of research and development in the US remind us of the Hamiltonian wisdom: If talented people come together, as Crowley says, good things are sure to happen.

And that's solid ground for hope, out beyond the Beltway, even as Washington sinks deeper in its self-made morass.

Would Sen. Lautenberg Be Alive Today If The Legislation He Supports Were In Force Today?

Fox News' Andrew Napolitano makes telling point, reminding us that the healthcare bill is full of provisions that now get little attention--but which could have huge consequences:

Last week, Sen. Frank Lautenberg (D-N.J.) collapsed in his apartment in Cliffside Park, N.J., a few miles south of the George Washington Bridge. When he called an ambulance and it arrived, he directed the driver to bring him to Mt. Sinai Hospital in New York City. That direction is today perfectly lawful. Under all three health care proposals (the Senate, House, and presidential versions), such a direction would be unlawful; as an ambulance would be forced to take a patient to the hospital closest to the patient; in Sen. Lautenberg’s case, a small community hospital a few blocks from his apartment. Sen. Lautenberg voted for the Senate proposal that would have denied him the free choice that probably saved his life.

Thursday, February 25, 2010

A Healthcare Summit With No Scientists

Politico provides a list of the attendees at the Blair House Summit. We see 38 names of Senators and Members of Congress, and yet only two of them are doctors: Sen. Tom Coburn of Oklahoma and Rep. Charles Boustany of Louisiana.

So far, we have heard President Barack Obama, Senator Lamar Alexander of Tennessee, and Speaker Nancy Pelosi. Pelosi just quoted an American asking, "When is something going to happen on healthcare? We can't hold out much longer."

But again, we might ask: What does it mean, "something is going to happen on healthcare?" What is the essence of healthcare? Is it having health insurance, or is it getting treated and cured? As we have noted, you don't go to the doctor to show off your health insurance card, you go to get better.

Pelosi also just said, "Healthcare reform is entitlement reform." Oh, so it's not about health, it's about savings. No wonder the American people are turning off.

And then she added, "I want to talk about it what it means to the economy." But no mention of the jobs created by healthcare, to say nothing of medical research and medical technology.

And she cites the "job lock" because a child is sick. Well, "job lock" is a problem. But what if the child were not sick in the first place?

But of course, if we're going to think our way out of medical problems, we can't rely just on politicians. We need scientists, such as Dr. Jonas Salk, or Dr. Anthony Fauci, or Dr. Francis Collins. That's how to bend the curve: Just as Salk bent the curve on polio, and Fauci and many others bent the curve on AIDS. That's the way to reduce costs.

Update: Sen. Harry Reid told a moving story about a Nevada man whose child needed cleft palate surgery, and how the insurance company was giving the man a hard time over the cost of the surgery. Fair enough: But the real story of medicine is the fact that the surgery can be done in the first place. And the real key to pushing down costs for cleft-palate surgery, or any kind of surgery, is further technological advance. That's the story of laparascopic surgery, and it's a real cost-curve bender.

Wednesday, February 24, 2010

Jim Pinkerton and David Corn Talk About Healthcare is a terrific discussion and debate format.

Tuesday, February 23, 2010

Why Americans Hate Politics -- Even as They Love Their Own Health, and Medical Sagas

Veteran political analyst Bruce Drake, writing Poll Watch for Politics Daily, cites some interesting data: According to the Kaiser Family Foundation, just 25 percent of Americans think that the fight in Congress over Obamacare is over principle. Instead, 59 percent think that the fight is mostly just partisanship.

And while those poll findings are lopsided, the American people themselves are more closely divided on the merits of the bill: 45 percent are for it, and 45 percent are against it. (Although Drake further notes that within those dueling 45's, 32 percent of Americans say that they are "strongly" against the bill, while just 23 percent say that they are "strongly" for it--it's that differential in intensity that has on-the-fence Democrats staying, well, on the fence.)

Next, Drake produces a chart of health issues that the American people might unite around--that chart is reproduced above. It shows, for example, that 76 percent support reforming the way health insurance works, and that 72 percent of Americans support providing tax credits to small business to provide health insurance. Now of course, the devil is in the details--and in the deficit. If that second question, about tax credits, were reworked to say, "tax credits that would add to the deficit," the percentage of Americans supporting those credits would probably plummet.

What didn't get asked, though, were questions about cures. How many American would support the political class coming together to cure Alzheimer's? Or diabetes? Or spinal cord injuries? Or ALS? And yet the decision to proceed, or not to proceed, on such scientific quests is substantially political--influenced, of course, by the larger culture. So the real issue is one of agenda-setting. If the political class puts forward polling questions on healthcare policy, it will get back answers on healthcare policy. But if it puts forth polling questions on cures, it will get back answers on cures.

And yes, the decision to move forward on cures, or not, is intensely political. When big decisions get made, big things can happen--quick. A case in point is AIDS. The human immunodeficiency virus, HIV, was first discovered in 1981, and the first effective treatment, AZT, was used in 1987. That was a lag time of just six years. A long six years, to be sure, and AZT was no surefire cure, but it was a great beginning. A triumph of medical science, nurtured by a supportive political and cultural framework. And millions of lives have been saved as a result. The battle is far from over, but we can see now that HIV/AIDS can become a manageable condition, not a mass killer.

Yet as noted here at SMS many times, there's a curious mental bifurcation between "healthcare policy" and medicine. To the chattering class, healthcare policy is all about insurance, and exchanges, and "the public option." But to most American, healthcare policy is boring, even off-putting. And yet both parties, Democrats and Republicans, fall into the trap of arguing about "healthcare policy," to the exclusion of everything else. To the exclusion, therefore, of cures. To the exclusion, therefore, of public engagement.

And yet at the same time, discussions of cures, and the quest for cures, are a continuing subject of public fascination. For example, The New York Times' Amy Harmon has written a fascinating two-part series on melanoma treatment, the second of which is headlined, "After Long Fight, Drug Gives Sudden Reprieve." A pretty compelling story, no? To a country full of people watching "House," yes, it is compelling.

But not to the political class, and the politicized class. So today, on the second day of Harmon's skin-cancer series, the Times lead editorial today sings the praises of Obamacare. In other words, to highly politicized media editorialists, the Washington fight over healthcare finance is more important than the medical fight against skin cancer.

No wonder people hate politics.

Monday, February 22, 2010

My Mini-Op-Ed in The New York Times

My piece, below, was one of five contributions that the NYT solicited from a spectrum of Republicans:

When Americans think about health care, they think first of health, not finance. They go to the doctor to get well, not to show off their government-issued insurance card. So President Obama’s health care reform plan was doomed from the moment the American people figured out that his goal was to spend less on health care.

While the president’s idea of “bending the curve” on health care means cuts in Medicare, to the American people bending the curve means living better and longer. To the folks on Main Street, it means not appointing Kafkaesque committees to measure “quality-adjusted life years” but fostering a vibrant climate of scientific research and opening a wider pipeline for new medicines.

Sixty-seven percent of Americans say they are not getting enough medical treatment, according to Kaiser Family Foundation data. But we want not just more care; we want better health. Thanks to the public-private effort that decades ago brought us the polio vaccine, we no longer spend money on wheelchairs and iron lungs. We could do the same today for other diseases. Finding a cure is cheaper than paying for care.

Our medical industries can improve our economy as well as our health. As Robert Fogel, the Nobel-winning economic historian, wrote last year, health care is “the growth industry of the 21st century.” We won’t escape from the recession by provoking a recession within the health care sector. When people are healthier and more productive, they will need less chronic care, and tax revenues will rise out of the expanding economic pie.

A “more health” plan is a win for individual health, a win for economic growth and, yes, a win for the cause of long-term health savings.

Sunday, February 21, 2010

Do We Really Need CT Scans? (If You Thought That Question Was A Settled Question, Please Keep Reading.)

Did you know that CT scans, commonly called “CAT scans,” are a bad idea? Actually, only about half of them are bad--although, of course, we don’t know which half. But whichever half it is, CT scans are a bad idea: “a technology that just doesn’t compute.” So asserts writer Thomas Goetz, the executive editor of Wired magazine, in an article for If it seems strange that a Wired guy would be dumping on technology, well, keep reading. As we shall see, a paradox of Bay Area politics--Wired is based in San Francisco--is that folks out there take it as a given that technology is good for just about everything, except healthcare. On healthcare, folks living by Golden Gate seem to prefer holistic and empowering approaches, including, strangely enough, support for Obamacare-type rationing.

Evidently searching for a clever hook for an article, author Goetz called his piece, “I Wanna CT Scan Your Hand: How the Beatles created our soaring health care costs.” Actually, the Beatles had noting to do with it; Goetz is teasing his readers because computed tomography, or CT, was invented in 1967 by a British engineer who happened to work at the Beatles’ then-record label. If all that seems a bit of a stretch, then welcome to the world of opportunistic book promotion. Goetz has a new book to promote, The Decision Tree: Taking Control of Your Health in the Era of Personalized Medicine, from which the CT article is an excerpt.

Goetz freely concedes, “CT technology has been a boon to medicine, aiding in the diagnosis of everything from broken bones to kidney disease to cancer.” Yet, he continues:

CT scans have also been a major factor in the explosion of health care costs in the United States. These days, these very expensive machines—along with their high-resolution brethren, MRIs [magnetic resonance imaging]and PET [positron emission tomography] scans—are sometimes used indiscriminately, often in an effort to generate a diagnosis rather than confirm one.

Note the planted assumption here: “explosion of health care costs”--which is another way of saying that “health care, consuming one-sixth of our economy, costs too much, and we all know that the cost of health is a more urgent problem than the lack of health.” One response to that planted assumption, of course, is that healthcare accounts for one-sixth of our wealth, and that both our wealth and our health are improved by the best possible diagnostic tools--tools for diagnosing “everything from broken bones to kidney disease to cancer.” But Goetz is on a different track:

Despite their high resolution, CT scans are still blunt instruments. They can actually introduce too much information into a situation. A high-resolution image of the inside of the body reveals so much that everything begins to look like an anomaly or a potential problem. As Shannon Brownlee wrote in her 2007 book Overtreated, “for every scan that helps a physician come to the right decision, another scan may cloud the picture, sending the doctor down the wrong path.” Which is exactly why, however useful they are in specific cases to ascertain specific diagnoses, they are particularly unsuited to being used as a screening tool—in other words, deployed broadly among asymptomatic pool of people. Which, unfortunately, is what many people are saying CT scans should be used for.

So there we have it: Goetz, citing Shannon Brownlee’s hugely influential book, Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer, says that we are overusing CT scans and we should use them less. And so, Goetz concludes:

The fact is that, like a lot of medical technology, a CT scan can do a lot of good in particular circumstances. But too often, the enthusiasm for CT scans outstrips its utility. And the result is a technology that just doesn’t compute.

It’s legitimate, to be sure, to argue over every aspect of medical science, based on new concerns and new information. But we might wonder what we should have done in other situations when we faced a 50 percent failure rate. At one time or another, half of all candlestick telephones, or vacuum-tube radios, or biplanes, were failing. In each case, the answer was to learn from mistakes, commit to the best practices, and push on through to the solution.

Indeed, it’s a strange kind of retro-thinking that leads one to say, “We have confronted a problem, and the answer is to turn backward.” That’s the same “limits to growth” thinking that we saw in the 70s, which, in turn, gave us the Jimmy Carter presidency, emphasizing rationing and “malaise.” And we can see the same thread of scarcity-think running through the Hillarycare healthcare plan of the early 90s, and the Obamacare plan of the last year or so. In each instance, the elite refrain has been, “We have too much, we use too much, it’s bad for us, and so we, the powerful, say, ‘Let’s cut back--and if you, the American people, don’t agree, we’ll try to force it on you!’” But of course, the elites don’t have that much power, at least not when they are pushing deeply unpopular programs. And so, in 1980, 1994, and 2010, the “limits to growth” agenda was defeated at the ballot box.

OK, that’s the politics of scarcity. As labor leader Samuel Gompers declared, the American people want “more,” not less.

But what about the substance of Goetz’s argument? He writes, for example:

Most technologies get cheaper as they get more popular. DVD players, digital cameras, flat-screen televisions, and pretty much every other technology you can think of has observed this pattern. But that’s not at all what’s happened with CT scans.

The resolution of a CT scan is measured in slices. Each rotation of the X-ray unit around an object generates a certain number of cross-sectional images; those cross-sections are called slices. The more slices per rotation, the higher the resolution of the image, just like a higher-resolution digital camera produces a sharper image. Since the 1990s, CT scans have leapt from four to eight to 16 to 32 to 64 slices, with a dramatic improvement in the quality of the machines. Yet the price of CT scanners has stayed consistently and breathtakingly high. From 1974 to 2004, the list price of a CT scanner increased from $385,000 to $2.2 million, a nearly sixfold increase (with inflation accounting for only about $1 million of that increase). Sure, that $2.2 million buys a better machine than $385,000 did 30 years ago. But the price arrow points in the opposite direction from that seen with other technologies, where the economics of scale and Moore’s law have consistently driven costs down, even as quality goes up.

Now we might begin by noting that in real terms, using Goetz’s figures, the price of a CT scanner rose about 55 percent in 30 years, from an inflation-adjusted $1.4 million to $2.2 million. That’s a big increase, but, as Goetz notes, the number of X-ray “slices” a machine can perform has risen from four to 64. That’s a 16-fold increase, or 1600 percent. Which is to say, the increase in the quality of CT machines has risen almost 30 times faster than the increase in the cost. If that’s not a Moore’s Law-level increase, it’s pretty close.

But Goetz prefers to label the evolution of CT scanners as an example of “market failure,” which is not surprising, he says, because “the health care industry is beset by market failure.” One putative failure is the just-cited price of the machines; another is personnel costs. He notes, for example, that diagnostic radiologists earn a median income of $361,000 a year. Is that really an outrageous amount for someone who learned and trained for a decade, and who is charged with diagnosing “everything from broken bones to kidney disease to cancer”?

But of course, if we really wanted to see the price of CT technology fall, we would use more of it--much more.

That’s the key point: more, not less. Going back to the beginning of the industrial revolution, more is the driver. As Goetz says, the price of electronic goods has fallen steadily--but only as the quantity of those goods has expanded dramatically. That is, 25 years ago, only a handful of people had portable phones--defined as bricklike things that worked only when they were in a good mood. But now, almost five billion people around the world have cell phone subscriptions. Yet as the quantity increased by an astronomical amount, the quality increased as well. The humblest cell phone made today is a better and more reliable instrument than the best cell phone of even a decade ago.

Thus the paradox of a certain strand of thinking: Technology is a good thing, and more technology is better--but not for healthcare. For scarcity-thinkers, healthcare as a separate category, separate from everything else, where “less is more.” Indeed, a chapter in Brownlee’s book is entitled, “When Less Is More.”

Moreover, according to this techno-minimalist environment, there’s little room for the next breakthrough. And so, for example, what would these less-is-more types make of General Electric’s V-Scan, a portable ultrasound imaging tool? The V-Scan, which GE happily compares to the “tricorder” in the old “Star Trek” TV series, is potentially the beginning of something bigger than CT Scans, offering the prospect of constant, non-invasive health monitoring. And if the cell phone precedent is any guide, the V-Scan-like portable medical device technology will get better as it gets cheaper and more abundant. We must hope that America can keep its edge in such healthcare innovation, that such design and manufacture isn’t chased overseas by misguided policies aimed at “saving money,” or, as they say in Washington DC, “bending the curve.”

So let’s hear it for the CT scan, and all its spinoffs. Someday, if the price is allowed to fall, thanks to the engine of mass production, we will all have some sort of medical imaging/diagnosing device, just as we all have TV sets or microwave ovens. And thus we will be healthier. And if we remember to make them in the US, we will be richer, too, as we export those machines all over the world.

PS: For a better look at the value of CT scans, and subsequent life-saving innovations, we might look to this essay in Parade magazine, from a great doctor, NIH director Francis Collins.

Thursday, February 18, 2010

Dartmouth Debunked

Are the “data” behind Obamacare just as phony as the “data” behind global warming? And the “data” behind the stimulus package? Even the Mainstream Media is having its doubts.

The headline in today’s New York Times reads, “Report Cited by Obama on Hospitals Is Criticized.” The Times story concerns new criticism of the Dartmouth Atlas of Health Care, published by Dartmouth University’s Institute for Health Policy and Clinical Practice. The Atlas purports to show that there has been great variation in healthcare spending across the US, state by state, hospital by hospital, even though healthcare outcomes were not necessarily better at at the higher-spending states and hospitals.

For more than 20 years now, the Atlas has guided policy. It has been particularly popular among liberal policy wonks, because its findings suggested that all-seeing experts in Washington--guided, of course, by the big book--could do a better job of managing healthcare. It is from Dartmouth that the popular elite factoid, “30 percent of all healthcare spending is unnecessary” was derived. And from that 30-percent-is-wasted claim came came the further factoid, enshrined in the 2008 Democratic Party platform, which claimed that national health insurance would “save the typical family up to $2,500 per year.” Saving the average family $2500--sounds good!

But as Lt. Columbo, played by Peter Falk on the old 70s TV show, would say, “There’s just one more thing.” What if the Dartmouth Atlas is wrong? Way wrong?

That’s the argument made in a new analysis published in The New England Journal of Medicine, a mostly pro-Obamacare publication, bluntly headlined, “A Map to Bad Policy--Hospital Efficiency Measures in the Dartmouth Atlas.”

The author of the study, Dr. Peter B. Bach, a physician and epidemiologist at Memorial Sloan-Kettering Cancer Center in New York City, chops up the Dartmouth study in a crisply written 1400 words piece, zeroing on several glaring deficiencies in Atlas methodology. Bach notes, for example, that Dartmouth doesn’t measure the results of such treatment, only the cost of the treatment. Bach uses this example:

Say Hospital A and Hospital B each has a group of patients with a fatal disease. Hospital A gives each patient a $1 pill and cures half of them; Hospital B provides no treatment. An Atlas analysis would conclude that Hospital B was more efficient, since it spent less per decedent. But all the patients die at Hospital B, whereas only half of the patients do at Hospital A, where the cost per life saved is a bargain at $2. Although $1 cures are rare, changing the price or efficacy of the pill does not alter the fundamental problem with examining costs alone when cost differences are sometimes associated with outcome differences.

In other words, in the eyes of Dartmouth, a hospital where all the patients died cheaply is a better hospital than the one where half the patients survived, albeit at some cost. Ask yourself: Which hospital would you like to go to: the one offering a zero percent survival rate, or the one with a 50 percent survival rate? Sometimes, cheaper is not better!

It might seem hard to believe that Ivy Leaguers could make such elementary mistakes in methodology. But who says it’s a mistake? Having seen the deep corruption of “Climate-gate” and “Stimulus-gate,” we can put aside concerns about competence and go right to the question of whether or not these scientists and experts are worthy of our trust. As we have all learned, scientists can be politicized just like anyone else--some will bend their data to suit political objectives. Heck, they will even make it up.

Interviewed by the Times, Dr. Bach added: “We are about to embark on a huge transformation of our health care system. If we start with a bunch of flawed measures, it will be as devastating as putting in the wrong coordinates before a moon shot.” Well, yes, Dr. Bach is exactly right: If the Dartmouth folks had launched Apollo 11, our astronauts would have been lost in space.

But thanks to Dr. Bach’s scholarship, the likelihood that we are going to embark on a “huge transformation of our healthcare system” just got smaller.

New England Journal of Medicine Poll On Next Week's Healthcare Summit

This poll, appearing on the NEJM website, is non-scientific, but still revealing. It is still open, it will be interesting to see which way it trends in the next few days, although as we can see, with only 18 percent being optimistic that a breakthrough will occur, the percentage of optimists can't go too much lower.

Friday, February 12, 2010

GE Offers Hope--Does Anybody in DC Remember Hope?

As we have observed here at SMS many times, Washington DC seems determined to take all the drama and excitement out of medicine. Instead of the adventure of inquiry and the intensity of the life vs. death struggle, we get drab and dreary debates over "health insurance reform." And the American people, as we have seen, have reacted about as well as anyone might be expected to react to the drab and the dreary--they don't like it.

But happily, amidst all the grim news about rationing and restrictions, one company, General Electric, is going the other way--it is offering "hope." Does anybody remember "hope" in DC?

GE has launched a "Healtymagination" website, full of interesting ideas for healthcare, especially in the realm of Health IT. That's an area where GE hopes to make a lot of money in the years to come. To which we at SMS say, "Good!" We hope that GE, and lots of other companies, find healthcare to be a profitable area to work in. And if they do, all Americans will enjoy the benefits of greater invention and entrepreneurship.

We might hope, indeed, that GE's willingness to go "long" on healthcare and medicine. That's a point touched on by New York Times writer Stephanie Clifford in her report on the GE ad campaign. As Clifford's reporting indicates, this is a big push, even for a company as big as GE:

As the Olympics begin, the company is introducing its biggest campaign ever aimed at consumers. Called Healthymagination, it publicizes G.E.’s role in the world of doctors and hospitals. In the United States alone, G.E. expects to spend more than $80 million this year on the campaign.

Its role in health care is technical: G.E. makes and sells medical devices, like machines that measure bone density and perform M.R.I. scans. But the advertising focuses on the personal. “In the past, we have always shown the hardware, and that’s great — it works on one level — but we wanted to make a point here that this was about better health for more people,” said Don Schneider, executive creative director for BBDO New York, the Omnicom Group agency that created most of the ads.

Hippocrates and The New Cincinnati -- Doctors Rushing To The Aid of the Republic

A terrific piece in Fox Forum this morning from Dr. C.L. Gray, writing about the need to elect more doctors to Congress, and citing three physician-candidates in his home state of North Carolina: Dr. B.J. Lawson, Dr. James Taylor, and Dr. Dan Eichenbaum.

In making his argument, Gray cites the wisdom of Hippocrates, who reminds us why medicine is so highly revered--because doctors have earned that reverence, not only by saving lives, but by suffering with their patients:

In "Precepts" Hippocrates once wrote, “For if love of men is present, love of the art is also present.” In "On Breaths" he added, “The physician sees terrible things, touches what is loathsome, and from others’ misfortunes harvests troubles of his own.” For the Hippocratic physician, the well-being of the individual was of primary concern—not power, not money, not personal gain, and most assuredly, not the supremacy of the State. The Hippocratic physician was born to serve his fellow man.

Gray is 100% right--at its Hippocretean best, medicine is surely the noblest of professions. So is it a bit paradoxical to see doctors running for political office? Maybe. And most Americans would agree that politicking is a lower estate than doctoring.

But occasionally, the political situation becomes so egregiously bad that honorable citizens must put down their plows, as did Cincinnatus of Roman antiquity, rushing to the aid of the republic.

That duty to serve the commonwealth includes honorable doctors; they, too, should step forward into the public square, bringing their medical credibility to improve the political discourse and to reach better policy solutions. That's not to say that doctors are always right, about health and medical policy or anything else. But for reasons best put forth by Hippocrates, 2500 years, ago, doctors have credibility; as the legendary Greek physician said, “For if love of men is present, love of the art is also present.” Not many doctors, who love their art--and, in turn, are loved by their patients--would ever seek to demote medicine as the Obamans have, seeking to reduce the healing arts to just another bureaucratic subset of the federal government.

And so, most likely, we will be hearing more from Drs. Lawson, Taylor, and Eichenbaum.

Thursday, February 11, 2010

Bill Clinton Hospitalized--His Life Saved By Medicine, Not "Healthcare Reform"

Former President Bill Clinton, now in a New York City hospital room, under observation for chest pains, might be thinking to himself that it's a good thing that Clintoncare didn't pass in the early 90s. If it had, it's a safe bet that the sort of technological innovation that is keeping him alive tonight would never have advanced as far as it has. Clintoncare, after all, was about rationing; The explicit goal of that bureaucratic program was to reduce the cost of treatment, which is to say, reduce the amount of treatment. And Clinton needs more treatment, not less. As do many of us.

Moreover, Clinton, now 63, might also be hoping that Obamacare never passes, either, because, as he now realizes, he is going to be a major consumer of Serious Medicine in the years ahead.

By Serious Medicine, we mean such procedures and technologies as open heart surgery, stents, and angioplasties. Those technologies barely existed, a half century ago, but they are now routine. Indeed, on "NBC Nightly News," Robert Bazell said that a million Americans now have stents. That's a million lives saved, or at least dramatically improved.

How did all that happen? Where did this life-saving technology come from? A lot of it came from government-funded research. (Note to ardent free marketeers: Government is not the enemy.) But life-saving research came from that part of the government, i.e. the National Institutes of Health, that fosters research and even cures. It's great work that they do, and yet as we all know, the far greater government effort in recent years has been the effort for "health insurance reform." Indeed, the entire political class, on the right as well as left, seems transfixed by the issue of healthcare finance. Yet the real issue is health. And the real question, for heart disease and everything else, is "Can we cure it or not?"

By contrast, "health insurance" is simply much less important to Americans, if not to American politicos. If you have heart disease, you need treatment more than you need insurance. Both can be important, but treatment is more important. Treatment is the sine qua non--without which, nothing.

So heart patients can be grateful that others in the past cared enough to do heart research--and yet those heart patients would be even more grateful if they knew that someone was effectively researching not only treatments, but cures.

Happily, the liberal health insurance crusade keeps losing, in the 90s, and today. But we might worry that even the losing crusade might be enough to cast a shadow over medical research, not only in heart disease, but also in every other medical topic. That is, even the mere hint of government-driven rationing and price-controlling might be enough to chase venture capital into other fields, away from medicine. We can never know for sure how much "crowding out" of medical money has taken place, but it must be substantial. That"s another question for Bill Clinton to think about tonight.

And so, too, for all of us to think about. Because the bell that could be tolling for him will be tolling, as well, for every American. But better later rather sooner.

Tuesday, February 9, 2010

G-PACT vs. John McCain? Or McCain vs. Cures?

This is a guest edit from Michael Smith of G-PACT, the Gastroparesis Patient Association for Cures and Treatments, taking Sen. John McCain to task for opposing earmarked funding for gastroparesis, a paralysis of the digestive tract. Smith, a lawyer in New York City, describes himself as a longtime McCain supporter who is nonetheless angered by McCain's opposition to gastroparesis funding.

Note to Senator McCain: Not all earmarks are equal--equally bad. Some earmarks, in fact, are good. The challenge is to know the difference. But let Smith make his case:

Over the last two months, the digestive motility community has been in an uproar over a series of comments made by Senator John McCain with regard to a federal budget earmark of $665,000 for use in irritable bowel syndrome research taking place at Cedars Sinai Medical Center in Los Angeles. The research was actually to advance groundbreaking work being conducted by Dr. Mark Pimentel of Cedars, studying the interaction of the immune system with the human digestive tract, and how certain antibiotics could be marshaled to restart a failed digestive tract.

Unfortunately, Senator McCain’s comments lacked any forethought and insight and included the following:

December 12th-“$665,000 for, I'm not making this one up, for the Cedar Sinai Medical Center in Los Angeles California for equipment and supplies for the Institute for Irritable Bowel Syndrome Research. Now, I have a lot of comments on them . . . on that issue . . . but I'll just pass so not to violate the rules of the Senate."

December 13th-"Another (spending project) that I have been unable to describe adequately without violating the rules of the Senate. $665,000 for Cedar Sinai Medical Center in Los Angeles California for equipment and supplies for the Institute for Irritable Bowel Syndrome Research. The only thing I can say is that problem will not be reduced when people read this legislation, so there may be a need for it. The list goes on and on, it is crazy stuff."

Feb 3, 2010—On the Greta Van Susteren show, "On The Record," Senator McCain compared funding for motility research to funding for the US Census Bureau’s purchase of an ad during this past Sunday’s Super Bowl.

On a personal basis, these comments left me incredibly divided; as a lifelong supporter of the Senator’s, I was a supporter of his record and his dramatic recovery as a POW in Vietnam resulting the heights he has gained running for the presidency and as a tiger of the Senate. Being from Long Island, and having been President of the Republican Law Students Association in a law school where my Con Law professor sued Richard Nixon with regard to use of the Pentagon Papers, my respect for McCain was enormous.

However, after suffering from paralysis of the digestive tract for 22 years and working for a cure over this time, I can’t help to think that Senator McCain simply did not take the time to do his homework on this issue. Unfortunately, the need for government research funding for motility research for an amount that the Yankees would normally spend on a utility infielder has been caused by a complete market failure with regard to the US medical research industry’s ability to navigate the shoals of Washington towards a solution for digestive tract paralysis.

Large Pharma companies, most specifically Novartis and Johnson & Johnson, failed in attempts to manufacture medications that resulted in saving thousands of motility patients lives, as a result of FDA and class action lawsuit intransigence resulted in such drugs being banned from the US market. Small Pharma’s attempts at developing the next generation of such medications requires a liferaft to navigate the dangerous waters of being able to satisfy federal regulators and grow, through the worst economy in 80 years. Attempts to develop stem cell research that would regenerate GI nerve and muscle tissue are bracketed by Republican fear of violating the sanctity of human life (which is an issue that can be worked around through new developments in the use of adult or autologous stem cells) and Democratic fears that not even a microscopic risk of a side effect is insufficient to prevent a treatment from being able to see the light of day.

Despite these difficulties, advocates for the motility diseases have worked over the past year to build productive working relationships with agencies of the Federal government where we can educate them about our need for effective treatments while they guide and educate us with regard to the justifiable concerns of the risks of medical research. However, after working for nearly two decades for such developments, the recent statements of Senator McCain have presented a crushing blow to the hopes and dreams of patients suffering from digestive tract paralysis throughout the United States.

If I had a chance to speak with the Senator, I would say, "Senator, while appreciating your fervor against endless earmarks which could threaten to being down the US economy, what about the loss to the US economy of five million individuals who cannot hold down jobs, who cannot support families and who require public assistance to function because of digestive tract paralysis. Why do you value the contribution of these individuals in much the same way that you value $819,000 in catfish genome research in Alabama?" (See link here.)

If you can help us navigate the shoals of federal regulation which has served not to permit a valid new treatment for digestive tract paralysis on the US market for nearly 40 years, we would be more than happy to work with you to ensure that all research funding for these conditions occurs privately in a manner that will not cause you to believe that patients suffering from digestive tract paralysis are bringing down the US economy.

While we appreciate your continued fervor to make sure that Iran does not have a better credit rating than the United States within 10 years, the way to do that is not by harming whatever little research is currently being done to prevent the failure of an entire organ system.

It is my sincere hope that the maverick in you does not seek to follow the ways of old Washington; to block the hopes of Americans simply seeking a better life; if Federal government funding of research to treat and cure digestive tract paralysis is not a way you intend for this nation to go, then instead of following the ways old Washington obstructionism, show us a third way, convene a conference of doctors, patients and other stakeholders so that we can say that John McCain was the hero who helped to lead patients suffering from digestive tract paralysis to a brighter day, for we have tired of the endless dark nights.

And of course, the Republicans, as a party, should know better than to get themselves crosswise of the cures constituency. We know that the Democrats have done so in the last year, thank to their scarcity agenda.

But now that Republicans are again gaining strength, we will see if the GOP has figured out what sells, and what doesn't sell in healthcare politics.

The Red Cross--A Great Brand For Healthcare, Not Just For Emergencies

Here at Serious Medicine Strategy, we read with great interest this article on the front page of The Washington Post "Style" section this morning. The piece is about the efforts of Red Cross chief Gail McGovern to revive the agency and, of course, to provide aid to Haiti.

But we couldn't help but gaze at those three oil paintings of Red Cross nurses in the article--shown above. Obviously they are part of a gallery within the Red Cross HQ in Washington. Now that's powerful branding. Those Red Cross women--the paintings all appear to be from the World War Two era--look both pretty and angelic, like nurses, mothers, sisters. Maybe even girlfriends.

And they have faces. If you want to build your brand, it helps to personify. We realize that advertising styles change, and that those sort of idealized images--think Betty Crocker, Uncle Ben, Aunt Jemima--have gone out of fashion. But the new fashion, showing celebrities, or logos of some kind, is not necessarily for the better, even from the point of view of the advertisers.

And oh yes, the Red Cross nurses wear uniforms. Uniforms convey a sense of ordered esprit and structured dignity and purpse--what Edmund Burke, recalling the chivalry of old Europe, called "proud submission." But the mobilizing idea can be just as easily applied to small "r" republican politics. Almost everyone is eager to serve the nation in some way, if he or she can find a good way to do so. And, no doubt, a way to look good doing so.

In other words, shifting to the current political argument, those Red Cross posters possess just about everything that Obamacare does NOT possess. In the past, we have noted that Obamacare lacks the "cool" of Apple and Silicon Valley. Well, it also lacks the class and elegance and solidarity of uniforms. Discussions of looks, and the look of things might seem like a small point to make, but it's actually a big point--there's a reason why, when nations want to get something done, they put men and women in uniform. And of course, the Obamans right now need all the help they can get; rethinking the failures of the last year, they should rethink every aspect of their program. And maybe learn from more successful Democratic presidents, including Franklin D. Roosevelt, who knew how to mobilize the country. Back in those days, uniforms were part of the package.

Suppose, for instance, someone had the task of visualizing Obamacare as it is today. What would be shown? Since we are talking about proponents for the moment, there would be no gag images of intensive care units. We know that Obamacare opponents would show people waiting in line, or grim-faced "death panels." But what would proponents show? One imagines that proponents would seek to present smiling children, grateful parents, and contented seniors. But what the Obamacare proponents would probably notshow would be the insurers--because it would be too easy to parody them in Kafka-esque terms. In other words, the central point of Obamacare--the people administering the program--cannot be shown, because they are too scary. That should tell us something about the way that Obamacare is pitched in the public mind.

Of course, our purpose here at SMS is not to argue for any one program. Instead, our goal is a better healthcare system and, more to the point, more cures. That's our only goal.

And so, in that spirit, some free advice for Republicans. Let's suppose that the Republicans had to illustrate their healthcare plan. What would they show? The big Republican healthcare themes--beyond opposition to Obamacare--are "freedom" and "choice." The word "freedom" is explicit in Sen. Jim DeMint's Health Care Freedom Act, and it is also loud and clear in the Patients' Choice Act, put forth by Sen. Tom Coburn,Rep. Devin Nunes and others.

But how does one visualize "freedom"? The word is hard to picture, which is why the word "freedom" is usually coupled, visually, with the flag, or Uncle Sam, or troops, or a monument, to give people something to visualize. But that's the point: If you want to rally people around healthcare give them a healthcare image--say, a Red Cross nurse. It requires something of a bank shot to say, "We will give you more freedom, and that will, in turn, give you better healthcare." If you want to drive home a healthcare message, make the message about health and medicine, not something abstract.

But in the meantime, the greatest icon of health ever created in America, the Red Cross, sits relatively fallow. It is, as they on Madison Avenue, an underleveraged grand. And yet it's possible to imagine, say, 50 or 75 years ago, that the Red Cross could have expanded into healthcare--both health insurance and medical research. There it would have sat as a sort of middle point, between bureaucrats on the one side, and health insurers on the other side. The road not taken. But that road is still there, waiting for someone to take it.

A Google search of "red cross posters" shows something interesting: most of the posters are old. They are beautiful and evocative. And so it's telling that the Red Cross seems to have peaked in its art half a century ago. It's not too late, Red Cross. You can go home again.

Monday, February 8, 2010

Obama's Comeback

I wrote a piece for Fox News this morning listing some reasons why Barack Obama is making something of a comeback. Here's one of the reasons--dueling visions of healthcare policy, specifically, the statism of Obama vs. the libertarianism of Rep. Paul Ryan (R-Wisc.).

We know that the American people don't like Obamacare, but will they will like Ryancare any better? Or will it seem even worse to them? We'll know a lot more on the 25th, when this debate goes live on national TV:

. . . The fourth factor is something that Obama had nothing to do with. It was the decision of a leading House Republican, Rep. Paul Ryan of Wisconsin, to release a strongly conservative budget plan, calling for deep cuts in spending, including the partial privatization of Social Security and the voucherization of Medicare. Maybe we need those deep cuts in spending, but for sure, those cuts are not popular with middle-of-the-road voters.

Congressional Democrats, seeing their own chance to get back on offense, immediately pounced on the Ryan plan, even thought it was not an official product of the House Republican leadership. As of Friday, the Democratic leadership, smelling political blood, was scheming to force a House vote on Ryan’s proposal. That would be a tough vote for most Republicans: Do they side with Ryan and the limited-government tea-partiers? Or with senior citizens and centrists?

Republicans with long memories will recall that the GOP has been down this particular road before. Back in 1995, another bunch of Republican insurgents had much the same idea: Cut Medicare. And another Democratic president, Bill Clinton, picked a fight with the GOP--and won. So now, with Ryan, are Republicans repeating that unhappy history? Most Republicans on Capitol Hill are looking forward to whacking Democrats this year; they are not looking forward to whacking popular programs for the elderly.

So now, in two-and-a-half weeks, comes Obama’s health care meeting with Congress. Obamacare has cratered, in the wake of the Scott Brown special election, and thus the White House must figure out what to do next. There’s no way to know what will happen at that session, of course, but it’s a safe bet that there won’t be much actual negotiating on February 25. Yes, we are finally getting those C-SPAN negotiating sessions that the candidate promised during the 2008 campaign--and we will soon discover why the proposal was half-baked when Obama first cooked it up.

But here’s another bet: Obama will do just fine later this month. As he did during the State of the Union, he will remind Republicans that since they won that 41st vote in the Senate, they, too, share the power. So, Obama will surely say, Republicans have a duty to step up and contribute to the solution.

The Republicans are free to say “no,” of course. They can even say “hell, no” if they want to--although if they come across as too partisan and belligerent, they will look bad to “purple” voters. And if the Loyal Opposition is really lucky, it will get a chance to put forth a few of its own health are ideas. But make no mistake: Obama will have the home-field advantage. He will set the agenda, and he will get the last word. After all, it’s his bully pulpit.

Democrats are piling on Ryan, and even Republicans are a bit nervous.

Friday, February 5, 2010

The Obama Administration is Violating the Hippocratic Oath of Policy: First, Fund No Harm

What's in a name? Good question. Sometimes, as we all know, government agencies have names that run counter to their true function. The most extreme examples come from George Orwell, of course, Uncle Sam, our federal government, can run a close second. And so it is, for example, that an agency dedicated to advancing science is actually spending its money to diminish science.

Robert M. Goldberg, vice president of the Center for Medicine in the Public Interest, goes digging into the Obama budget proposal, and finds some astounding skeletons rattling around in there. Skeletons that, of course, we are paying for.

Specifically, he observes that the Agency for Healthcare Research and Quality (AHRQ), whose motto reads, "Advancing Excellence in Health Care," is actually funding groups that are making healthcare worse. The big issue right now is vaccines; everyone knows that some fringe groups have come out against vaccines, and had influence. But not everyone knows that AHRQ, for which Obama wants $640 million next year, is funding some of those groups. Take a look:

AHRQ's involvement with anti-vaccine groups is also longstanding. It has given millions a year to Consumers United for Evidence Based Care (CUE) an organization that "advocates for local and federal legislative changes," in favor of CER. CUE includes groups like the Center for Science in the Public Interest and the National Center for Trangender Health. The anti-vaccine groups SAFEMINDS and the National Vaccine Information Center are also active parts of CUE.

Goldberg makes the further point that AHRQ is funding the worst and sloppiest sort of Comparative Effectiveness Research, the kind that reaches broad conclusions about "efficacy," without noticing that people are different, and that some treatments work better for some people than for others. That is, bad CER is a formula for the worst kind of "one size fits all" government policymaking. As Goldberg explains:

So, for instance, in reviewing the "science" of mammography, AHRQ ignored "differences in outcomes among certain risk subgroups, such as women with BRCA1 or BRCA2 genetic susceptibility mutations, women who are healthier or sicker than average, or black women who seem to have more disease at younger ages than white women." As a result, the study only provided "estimates of the average benefits and harms."

That's why Nobel Prize winner and NIH Director Francis Collins who helped map the human genome worries that CER studies are a step backwards because they consider "everybody equivalent, which we know they are not." Collins says that CER -- and AHRQ by extension -- fails to use "all that we have gained in understanding how individuals differ and how that could be factored into better diagnostics and preventive strategies."

From here, it's just a hop, skip, and a jump to Lysenkoism. It's bad enough that this is bad science--but remember: these are your tax dollars at work!

So when someone from the government comes up to you and says, "I'm from the Agency for Health Care Research and Quality, and we are here to help your healthcare"--please understand that, at best, the picture is more complicated than that.

Goldberg concludes:

Given the deficit, AHRQ's budget should be cut, starting with is funding of outdated science, transgender advocacy and anti-vaccine movements. That would insure CER actually improved the public health.

Here's the text of the Goldberg article, which appears in The American Spectator this morning:

This week the British medical journal Lancet officially retracted an already discredited article it published by Andrew Wakefield which falsely claimed vaccines caused autism. (See how the journal was shamed into doing the right thing here.)

At the same time, President Obama increased the budget of the Agency for Healthcare Research and Quality (AHRQ) -- charged with developing information about what are the best and most cost-effective medical treatments -- by $640 million, including money for anti-vaccine groups who regard Wakefield as a hero and push studies examining the effectiveness of treatments and diets based on Wakefield's study for reversing or curing autism.

AHRQ is the same agency that provided the United States Preventive Services Task Force (USPSTF) the data for recommending women under the age of 50 not get a regular mammogram. Before every major health group rejected the decision, the administration said the guideline was based on the "best available science."

Mentioned twelve times in the health bill, AHRQ states its goal is "translating research into improved health care practice and policy. " In fact, AHRQ was and is the administration's go-to agency for "bending the healthcare cost curve." Hence, in 2009 AHRQ's budget increased from $300 million to $1 billion for "comparative effectiveness research" (CER): studies looking at two or more treatments or a diagnostic for the same disease to see if one delivers equal or better results for the same amount of money. The studies would be used to create government guidelines for hundreds of medical treatments like the mammogram decision.

Proponents claim that CER helps doctors make better "patient-centered" decisions instead of one-size fits all recommendations. But AHRQ spends all its money making comparisons based on research -- as it did in producing the study recommending against routine mammography for women under 50 -- that ignores individual differences in patients.

So, for instance, in reviewing the "science" of mammography, AHRQ ignored "differences in outcomes among certain risk subgroups, such as women with BRCA1 or BRCA2 genetic susceptibility mutations, women who are healthier or sicker than average, or black women who seem to have more disease at younger ages than white women." As a result, the study only provided "estimates of the average benefits and harms."

That's why Nobel Prize winner and NIH Director Francis Collins who helped map the human genome worries that CER studies are a step backwards because they consider "everybody equivalent, which we know they are not." Collins says that CER -- and AHRQ by extension -- fails to use "all that we have gained in understanding how individuals differ and how that could be factored into better diagnostics and preventive strategies."

Meanwhile AHRQ allows CER researchers to hand out money to each other.

For instance, Dr. Alan M. Garber of Stanford University has received millions of dollars of AHRQ grants over the years and is a member of member of AHRQ's panel for determining what evidence should be packaged into guidelines. Garber also advises Congress on what AHRQ should spend money on. HMO's also happen to operate CER research centers that get much of AHRQ's funding.

Dr. Mark Helfand -- who contributed research to the mammogram decision -- runs the Oregon Health & Science University Drug Effectiveness Review Project that receives millions from AHRQ each year. Helfand also directs AHRQ's "science" board for its CER program.

Sean Tunis, another AHRQ consultant also advised Congress on the AHRQ agenda. Tunis once said he never saw adequate evidence to justify paying for new medical technology.

AHRQ's involvement with anti-vaccine groups is also longstanding. It has given millions a year to Consumers United for Evidence Based Care (CUE) an organization that "advocates for local and federal legislative changes," in favor of CER. CUE includes groups like the Center for Science in the Public Interest and the National Center for Trangender Health. The anti-vaccine groups SAFEMINDS and the National Vaccine Information Center are also active parts of CUE.

CUE participants use CER to push their own political agenda with AHRQ help. In 2005 CUE coordinator Dr. Kay Dickersin (another AHRQ grant recipient) and transgender advocacy groups challenged Washington State's Medicaid program decision not to cover sex change operations. SAFEMinds used CER to claim that you couldn't rule out vaccines "causing" autism.

And now AHRQ is funding the NVIC/SAFEMINDS pet project that looks at the effectiveness of controversial and dangerous autism treatments such as chelation therapy, which have killed several children.

Given the deficit, AHRQ's budget should be cut, starting with is funding of outdated science, transgender advocacy and anti-vaccine movements. That would insure CER actually improved the public health.

There should, indeed, be some sort of oath that government health officials should have to take: First do no harm. And second, don't fund it!

Tuesday, February 2, 2010

Another Vote (With His Feet) Against Single Payer

Danny Williams, the premier of the Canadian provinces of Newfoundland and Labrador, is coming to the US for major surgery.

The site Associated Content describes him as "A stout defender of the government-run health care system in Canada [so] opting out of that same system is rather too glaring not to notice."


The Democrats Discover Their Inner Herbert Hoover

So the Obama administration has kinda sorta given up on healthcare reform. As the President said in his State of the Union address, “By now it should be fairly obvious that I didn’t take on health care because it was good politics.” Nobody’s going to argue with that assessment--certainly not Senate Majority Leader Harry Reid, who volunteered last week, “We’re not on health care now. We’ve talked a lot about it in the past. . . . There is no rush.”

Thus Obamacare exists as a political zombie--not alive, but not dead yet. In the words of The Washington Post this morning:

And while Obama's budget assumes that health-care legislation eventually will pass, reducing deficits over the next decade by about $150 billion, neither the White House nor congressional Democrats have outlined a plan to push the measure through a reluctant Congress.

But in avoiding a real decision on healthcare policy, the Obamans are giving themselves the worst of both worlds. They are still, theoretically, pushing a 70s-style healthcare plan that nobody except a few Beltway wonks really wants, and yet they are now moving down a path toward cutting healthcare expenditures, because they think they need the money elsewhere. In other words, they are ditching their own vision of “reform,” however cockeyed it was, and are picking up the more familiar refrain of budgetary bean-counting.

Indeed, the Obamans, and the Democrats, are getting themselves on the wrong side of what anthropologists call a “taboo trade-off”--that is, the idea that healthcare, possessed as it is with all sorts of mythic and primal resonances, can be reduced to a Gradgrindian exercise in shaving and paring costs. The American people, as we have seen, recoil at this sort of blood-for-money calculus. If the Obamans think they need to make spending cuts, they should stop talking about healthcare altogether, focusing only on deficits and debt. Yet by using “healthcare reform” as just another label for spending cuts, they are increasing public cynicism--cue up “death panels”--and poisoning the well of future medical progress.

The Obamans think they need to do this--a “pivot,” they call it, from healthcare to jobs--in order to win re-election. But what they don’t seem to realize is that healthcare could be a positive for them--if they could bring themselves to see healthcare as a source of growth and jobs. And oh yes, better health. Think about it: Is there any lack of enthusiasm for better health and medicine? Are fewer people worried about their aches and pains--or the illness that killed their grandparents? Are fewer people watching Sally Field’s Boniva commercials?

The demand for healthcare--defined as what actually makes your health better, as opposed to healthcare financing schemes of one kind or another--is as strong as ever.

Just yesterday, in the middle of a deep recession, St. Jude’s Children’s Research Hospital and Washington University School of Medicine announced a joint $65 million project, privately financed, to help develop new treatments for pediatric cancer. The effort, which will create jobs and growth in both St. Louis and Memphis, builds upon the efforts of the Cancer Genome Atlas, a project of the National Institutes of Health. In the words of NIH director Francis Collins, “The long term dream is that this will uncover a list of powerful new drug strategies that we don’t know about.” In highlighting new treatments and drugs, Dr. Collins was thus offering hope to the 10,000 children a year who are stricken with pediatric cancer. Does anyone remember “hope”?

Such announcements of new medical efforts, as well as new medical breakthroughs, are routine, of course--along with a permanent buzz of news reports and advertisements about medical matters, proof of steady public interest--but for the most part, our politicians have lost interest in medical topics. And so on the same day as the St. Jude’s announcement, President Obama was announcing his retrenchment budget, and Republicans, for their part, were denouncing it as not retrenching enough. None of them, that I could see, paused from their partisan spitballing to take note of the good work that St. Jude’s and Wash U. are undertaking. That’s good work that will not only make children healthier, but that also holds out the promise of a better economy--as people grow up to be productive, as new industries sprout to make popular new medicines.

Yet as noted, national politicians are ignoring such news, because the Zeitgeistial story line is that we are spending too much, and that healthcare, too, needs to take a haircut. In other words, we must provoke a recession in healthcare, as part of an overall austerity package.

A recession within the biggest sector of the economy--in the name of promoting economic recovery? Does that sound like a good plan? It’s not a good plan for health, to be sure. And it’s not a good plan for the economy, either. The only person who might think of it as a good plan is Herbert Hoover, wherever he is. And he, of course, did not win re-election. In fact, he got beat in a landslide.