healthcare

Among the regulations proposed by OSHA's staff but scuttled by political appointees was one meant to protect health workers from tuberculosis. Although OSHA concluded in 1997 that the regulation could avert as many as 32,700 infections and 190 deaths annually and save $115 million, it was blocked by opposition from large hospitals.

There's a simple reason why hospitals opposed this regulation: it would cost them money to implement these procedures, but the hospitals wouldn't realize any of the savings--insurance companies would. Arguably, this is why there are regulators: some things, such as not turning 190 hospital workers into dead people, are worth the financial hit. But as long as savings--and keep in mind the program would have lowered overall costs by $115 million annually--are parceled out among different special interest groups*, each armed with lobbyists that can corrupt oversight mechanisms, then we will continue to have health care inefficiencies that kill people.

That's why we need socialized insurance--not answerable to shareholders--because it's actually more efficient economically and in terms of public health.

PalMD was briefly positive but PZ is concerned that Gupta is merely a talking head or placeholder and an apologist for the US health care system. However, I see two main advantages...

The primary question is how Gupta would use this position in the Obama cabinet to promote health care reform and improved access to care for the indigent and the increasing number of un- or underinsured. But he is an expert in framing messages and complex medical issues to a diverse audience. This could be very good, if the position is used wisely to effect health care reform and improved public health.

The U.S. Environmental Protection Agency routinely allows companies to keep new information about their chemicals secret, including compounds that have been shown to cause cancer and respiratory problems, the Journal Sentinel has found.

The newspaper examined more than 2,000 filings in the EPA's registry of dangerous chemicals for the past three years. In more than half the cases, the EPA agreed to keep the chemical name a secret. In hundreds of other cases, it allowed the company filing the report to keep its name and address confidential.

This is despite a federal law calling for public notice of any new information through the EPA's program monitoring chemicals that pose substantial risk. The whole idea of the program is to warn the public of newfound dangers.

...

The newspaper's findings are just the latest example of how EPA administrators more often than not put company interests above the needs of consumers. Over the past 18 months, the Journal Sentinel has reported on numerous EPA programs that bow to corporate pressure, frustrating health and environmental advocates and disregarding the agency's own mission to inform the public of potentially dangerous chemicals.

To get at the story of health care in the United States, look past the individual sagas you've read about in newspapers. Don't think about patients losing their homes to medical bills, or of people watching a child or spouse or parent die because they can't afford care. While you're at it, put aside the medical attention you receive, which you're generally happy with, according to most surveys. Instead, immerse yourself in the harrowing statistics: The United States spends $2.1 trillion a year on health care. More than 30 percent of that -- about $700 billion -- has nothing to do with improving people's health. Instead, it goes to administrative costs and for tests and treatments that aren't necessary. About half of all patients don't receive proper treatment. Fifty-seven million Americans struggle to pay their medical bills, and around 46 million have no health care coverage at all. A study by the Institute of Medicine found that 18,000 Americans die each year because they don't have health insurance.

If the American health care system were a patient, such vital signs would suggest that it is very sick, and that the disease is spreading to the body politic. Indeed, despite spending nearly $7,000 per person a year on health care -- around twice as much as most other developed countries -- the United States ranks 42nd in the world in life expectancy. Try reading all those numbers without focusing on one word: crisis.

"The best of the best of our health system is the best in the world," says William R. Brody, president of Johns Hopkins University, who will retire from his post at the end of the year. "But the average is not so hot. We need to do better."

In one panel, a stick-figure Tevis greets a constituent by rattling off a stream of personal facts he's found online about her -- including her birthdate, voting pattern, divorce, paycheck, credit card balances and medical history -- to illustrate his interest in protecting individual privacy.

When she slams the door in his face, the cartoon Tevis muses, "Maybe I should rethink my approach."

"I figured I'd raise a few thousand dollars, at most," for his bid to become a state representative, said Tevis, a computer systems manager who works for an industrial manufacturing company.

In fact, before he created the comic strip, Tevis spent weeks asking cash-strapped friends and family for help and walking door-to-door in the district. He raised $1,525.

The comic strip -- at www.seantevis.com/3000 -- was first posted online July 16. Today, when he files his campaign finance forms with the Kansas secretary of state's office, Tevis will report that he has raised $95,162.76 in donations through PayPal, the online service that allows payments and money transfers via the Internet.

My name is Sean Tevis. I'm an Information Architect in Kansas running for State Representative. I've decided to "retire" my current State Representative. I'm going to win. This is my story (XKCD homage style) so far.

In 1992, three surgeons at a major hospital here that specializes in organ transplants met in the hospital's cafeteria to informally discuss the California Legislature's effort to enact a mandatory motorcycle helmet law.

"This looks like it might pass," one doctor said. The others nodded. "This could have serious consequences for the hospital."

"How so?" asked the doctor sitting closest to him.

"Motorcycle fatalities are not only our No. 1 source of organs, they are also the highest quality source of organs because donors are usually young, healthy people with no other traumatic injuries to the body, except to the head," the first doctor answered. "Studies have shown that when helmet laws are enacted, motorcycle deaths significantly decrease. The hospital already has serious financial issues to deal with. This could put us out of business -- or at least the business of organ transplants."

...

Just then the third doctor stood up and said: "I'm a member of the hospital's ethics committee, and I can tell you, as physicians, we can't even have this conversation." With that, she left the room.

On June 18, Esmin Green, 49, was involuntarily admitted to the psychiatric emergency department of Kings County Hospital Center on June 18 for what the hospital describes as "agitation and psychosis."

Upon her admission, Green waited nearly 24 hours for treatment, said the New York Civil Liberties Union, which on Tuesday released surveillance camera video of the incident.

The surveillance camera video shows the woman rolling off a waiting room chair, landing face-down on the floor and convulsing. Her collapse came at 5:32 a.m. June 19, the NYCLU said, and she stopped moving at 6:07 a.m. During that time, the organization said, workers at the hospital ignored her.

At 6:35 a.m., the tape shows a hospital employee approaching and nudging Green with her foot, the group said. Help was summoned three minutes later.

In addition, the organization said, hospital staff falsified Green's records to cover up the time she had lain there without assistance.

Avastin is a drug approved to treat colon cancer. It works by choking off blood vessels to the tumor. It turns out, however, that a tiny dose of the same drug, when injected into the eye can also stop the uncontrolled growth of blood vessels behind the retina that produces a leading cause of blindness in the elderly, macular degeneration. The good news is a compounding pharmacy can take the large dose in the Avastin package and split it into sterile eyeball-appropriate doses. The cost is somewhere between $20 and $100. That's good news for consumers, anyway. It wasn't such good news for Genentech, the maker of Avastin. So they went about making a small modification of the drug, renamed it Lucentis, and got FDA approval for its use in macular degeneration -- at $2000 per monthly injection. Avastin is not approved for the same purpose because Genentech has not applied for approval. It's still legal to use it off label, however, and numerous ophthalmologists have been doing so to save their patients and the taxpayers' money.

Genentech was not amused. So they announced in October they would no longer sell Avastin to compounding pharmacists.

One of the most ridiculous ideas to come down the pike is the notion that most people, who are woefully ignorant of medicine and biology (e.g., the massive misunderstandings a out antibiotics and infectious disease), will actually make intelligent decisions regarding their own healthcare. In fact, I bet most people would do worse than flipping a coin in many situations. That's before you get to the roughly twenty percent who are functionally illiterate.

This probably sounds elitist. And you're right, it is elitist. Because, as Atrios notes, medical doctors are part of an elite group of people who have extensive experience and training in medicine, which most people lack. While trying to 'puzzle out' your healthcare treatment options isn't quite as stupid as trying to puzzle out how to build a nuclear reactor, it's still pretty stupid.