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30 April, 2005

KRUGMAN DISHONEST ABOUT HEALTH CARE TOO

"I'll give credit where credit is due: unlike on Social Security, Paul Krugman has followed through with his claim that he would back up his assertions about health care in future columns. Yet his recent effort is no more impressive. It is riddled with bogus comparisons, both explicit and implied.

He begins with an old lefty standby: "...we have lower life-expectancy and higher infant-mortality rates than countries that spend less than half as much per person." As I've explained previously, life expectancy and infant mortality are largely meaningless measures of the efficacy of a health-care system, as they are due largely to factors such as genetics lifestyle, with certain ethnic groups reducing America's averages. But let me add a few quick points here.

First, you can see the link of life expectancy to genetics and lifestyle by comparing ethnic groups across nations. If America's supposedly inferior health-care system were the cause of lower life expectancy, then you would expect to see that ethnic groups here have shorter life spans than their counterparts in other countries. But that is not the case. For example, John C. Goodman, Gerald L. Musgrave and Devon M. Herrick point out that Japanese Americans have life expectancy nearly identical to people in Japan.

The comparison of infant morality is doubly misleading because many countries do not report infant deaths the same way we do. Switzerland, to use one example, doesn't count babies measuring under 30 centimeters as a live birth. As a result, our infant mortality rate appears much higher when compared to that of other nations.

Next, Krugman relies on another old lefty standby:

According to the World Health Organization, in the United States administrative expenses eat up about 15 percent of the money paid in premiums to private health insurance companies, but only 4 percent of the budgets of public insurance programs, which consist mainly of Medicare and Medicaid. The numbers for both public and private insurance are similar in other countries -- but because we rely much more heavily than anyone else on private insurance, our total administrative costs are much higher.

Measuring administrative costs is a far trickier business than Krugman lets on. Reviewing the literature, Henry Aaron of the Brookings Institution was "struck by how hard it is to identify and estimate administrative costs accurately at a single point in time in a single nation, how doubly hard it is to compare costs at a single point in time among nations, and how triply hard it is to make meaningful international comparisons of trends in administrative costs over time." Indeed, the study Krugman refers to compares apples to oranges by measuring administrative costs in private insurance as a percentage of income while measuring administrative costs in public health care programs as a percentage of expenditures.

Comparisons of public and private health insurance are problematic for other reasons. Such comparisons may understate the administrative costs of Medicare and Medicaid because they do not factor in the cost of collecting the tax revenue necessary to fund such programs. Furthermore, private health insurance companies have a myriad of government regulations they must comply with that Medicare and Medicaid do not. And these regulations are expensive: According to a Cato Institute study, they come to about $99 billion annually. At this point Krugman begins beating up on the private sector in support of his implicit assumption that government can do better. First, he claims that private insurance imposes compliance costs on doctors:

And the costs directly incurred by insurers are only half the story. Doctors "must hire office personnel just to deal with the insurance companies," Dr. Atul Gawande, a practicing physician, wrote in The New Yorker. "A well-run office can get the insurer's rejection rate down from 30 percent to, say, 15 percent. That's how a doctor makes money.... It's a war with insurance, every step of the way."

Has he looked at how much hassle it is for doctors to comply with Medicare? There are thousands of pages of laws and regulations, not to mention over 7,000 Medicare billing codes that doctors have to contend with. Many doctors are no longer taking Medicare patients due to cuts in payment rates. Dr. Mark Krotowski, who stopped taking new Medicare patients in 2002, said, "I love my elderly patients. But they are very sick. They need a lot of attention, a lot of medications and a lot of time. Medicare reimbursement has not kept up with inflation or the cost of providing care to the elderly." Perhaps Krugman should be more familiar with such problems; that quote was taken from an article in the New York Times. Next, he notes how much private insurance hurts our economy:

First, in the U.S. system, medical costs act as a tax on employment. For example, General Motors is losing money on every car it makes because of the burden of health care costs. As a result, it may be forced to lay off thousands of workers, or may even go out of business. Yet the insurance premiums saved by firing workers are no saving at all to society as a whole: somebody still ends up paying the bills.

Government-run health care will impose a direct tax on employment -- a big one. We would do well to look at some economic indicators of countries with heavy government involvement in health care. America has a lower unemployment rate than most nations with more government involvement in health care, and a recent Labor Department report shows that none have a per-capita GDP near ours. Government-run health care will be a huge addition to our welfare state, and as other countries show, big welfare states impose high economic costs. And then there is the inevitable "private insurance is killing people" claim:

Second, Americans without insurance eventually receive medical care -- but the operative word is "eventually." According to Kaiser Family Foundation data, the uninsured are about three times as likely as the insured to postpone seeking care, fail to get needed care, leave prescriptions unfilled or skip recommended treatment. And many end up disabled -- or die -- because of these delays.

Government-run insurance kills people too, and at higher rates. For example, a recent news story from the United Kingdom exposed how that nation's chronic shortage of hospital beds likely led to a London man death from a blood clot. The evidence is not just anecdotal. Of women diagnosed with breast cancer in the United States, one-fourth die of the disease. About one-third die in France and Germany, and a little less than half do in the United Kingdom. Of men diagnosed with prostate cancer, less than one-fifth die in the U.S., while one-fourth do in Canada, nearly half in France, and more than half in the U.K.

By relying on misleading comparisons, Krugman's case for socialized medicine comes up way short. The answer to our health-care problems involves adopting more market-based reforms, the most important of which make health care consumer-oriented".

Source



INFORMATIVE DRUG LABELS NEEDED

"When Vioxx was pulled from the market, it was predictable that other drugs in its class of Cox-2 inhibitors might follow. The drug's manufacturer, Merck, stopped selling its top painkiller after studies showed that Vioxx doubled heart attack and stroke risk. Now the Food and Drug Administration has ordered Pfizer to remove the painkiller Bextra, leaving only one Cox-2 drug on the market, Celebrex [and] announced that 'black box' warnings must be added to many other painkillers, including household names like Motrin. This might increase consumer awareness of drug risks, but they are not enough. That's because risks must be interpreted in the context of benefits. ... You need balanced information about benefit and risk to decide whether drugs are worth taking. Instead ... [r]isk information is typically buried in fine print, and ... [t]he most basic information of how well drugs work is hardly ever provided.....

But drug ads don't have to be so uninformative. Imagine a prescription drug facts box, modeled after the nutrition facts box you see on packaged foods. Instead of calorie counts and daily requirements, the prescription drug facts box would convey crucial information about benefit and risk in a form people could understand.

The box would contain information on the experience of people who did or did not take the drug. How their experience was measured would depend on the drug's purpose. For medications treating symptoms, the measure would tell how many people felt better; for drugs preventing disease, how many got sick; for drugs that save lives, how many died. The box would present drug risks and prioritize them by presenting life-threatening ones plus the most common bothersome ones. Where would this information come from? It already exists -- buried in FDA approval documents.

Consider what a prescription drug facts box might have said about the benefit of Vioxx. A 60-year-old with knee or hip pain could expect a 9 percent chance of an ''excellent response" to Vioxx, a 50 percent chance of a ''good response," and a 41 percent chance of a ''fair, poor, or no response." Almost identical to people's response to good old Ibuprofen. Consumers knowing Vioxx provided no extra benefit over an older and presumably safer drug might not have accepted any added risk; including the risk inherent in all new drugs: that we simply don't know how its safety record will hold up over time.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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29 April, 2005

BRITISH PUBLIC MEDICINE JUST LURCHES FROM ONE UNPRODUCTIVE PANIC TO ANOTHER

'I can only see harm coming out of this. I can't believe that this is in women's interests whatsoever. It's another utterly absurd attempt to politicise clinical practice.'

Cancer specialist Michael Baum is unimpressed by Labour's election pledge to speed up the diagnosis of breast and cervical cancer. Baum, professor emeritus of surgery at University College London, has studied breast cancer for the best part of 30 years, and set up one of the first UK screening centres. He thinks Labour's latest targets could cause more harm than good.

As part of the bidding war for the attention of women voters, Labour has pledged that by 2008, all suspected breast cancer cases will be seen by a consultant within two weeks, and all women will receive cervical smear tests within seven days.

We're given an image of a gallant government running to save women from needless anxiety. Public health minister Melanie Johnson said: 'Today, we are saying to all women: "You will be treated as urgent cases - because when you find something wrong with your breast there is nothing more urgent in your life".'

Yet Baum says that clinics currently treat women as fast as they can - and that targets without more resources will change nothing. 'Almost all the specialist units in the country offer a one-stop shop. Women are seen, they have their X-ray or biopsy, and they get their results on the same day. If that is not provided, it is quite simply because we don't have the resources. If the government is not adding to the resources, targets just put pressure on another service, which means that another service implodes.'

And while it sounds good to say that women won't have to wait for their smear results, this could be of dubious value to their health. Indeed, the fact that tests pick up a broad range of abormalities, many of which have little health effect, could actually intensify women's anxieties. Baum says that cervical screening 'may have a detectable population effect, but for the individual woman it's a very, very small chance of benefit - about one in several thousand. And there are a lot of downsides, such as the over-diagnosis of borderline pathologies. This means that women think they have got cancer, but we are not sure what they've got. You get a lot of emotional cripples'.

Most of the improvement in mortality has come through better treatment for cancer, rather than speed of diagnosis. 'There is this idea that the answer to cancer is "catch it quick, catch it early"; and as long as politicians perpetuate that myth it will inhibit progress. That isn't the answer to cancer. The answer to cancer is better treatment. In the course of better treatment over the past 20 years there has been a 30 per cent reduction in breast cancer mortality. The government would claim that is due to screening, but we know that it's not due to screening because you see precisely the same reduction in mortality in the under-50s and the over-65s, who aren't invited for screening. We need more support for development of better treatment.'

According to Baum, cancer treatment should be a clinical matter for doctors, not the subject of election grandstanding. 'It's nothing to do with politics, and all to do with clinical medicine. By all means give us the resources to do our job, but let us decide what our job is. This is pure playing politics. It is an emotive issue; it's a common cancer, and everyone knows someone who has had breast cancer.'

Once political gestures drive clinical decisions, the result is likely to be a less efficient and less orderly service. Baum reflects on the effect of Labour's last set of cancer targets, made during the 2001 General Election, which promised that nobody suspected of breast cancer would wait more than two weeks before being seen. 'What happened following the last initiative was that women who had symptoms but were not expected to have cancer were forced to wait longer and longer, in acute anxiety. In order to get around this, some GPs started defining everyone as suspected of having cancer. And we also ended up with a paradox that some of people who waited longest actually did have cancer.'

But far from rectifying the results of the last set of targets, the latest set will make things worse. 'This will mean an intolerable pressure on already stretched resources. Clinics will be bursting at their seams. People will be waiting longer and longer in clinics, there will be more and more complaints, and doctors will make rushed decisions.'

Source



Defrauding Medicare: No end to flood of schemes: "Health care fraud has become a multibillion dollar business for a persistent breed of white-collar criminals. Yet, after years of investigations, congressional hearings and government crackdowns, fraud experts say little progress has been made in stemming the tide of federal losses. 'Health care fraud often gets overlooked and even trivialized, because it's seen as a victimless paper crime,' said Collin Wong, head of California's Medi-Cal fraud unit. 'But, in reality, the financial burden falls on all of us. We pay for it with heightened health care premiums, increased taxes to pay for social service programs or ... the reduction of services.' A Chronicle investigation published Sunday revealed that scam artists have been luring Bay Area seniors to give their Medicare numbers for wheelchairs and clinic visits they don't need -- at a cost to the federal government that could total millions of dollars.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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28 April, 2005

GOVERNMENT MEDI-BUNGLING HURTS AMERICAN COMPANIES

Which part of North America makes the most cars? If you answered Michigan, you would have been right for 100 years. But you would not be right anymore. Last year the Canadian province of Ontario surpassed Michigan in car production. Of course, most of the cars made in Ontario are manufactured by America's Big Three—General Motors, Ford and Daimler-Chrysler. These companies are shifting production out of the United States for one overwhelming reason: massive health-care costs. An American worker costs them more than $6,500 in health care per year. In Canada, which has a government-funded and -run health-care system, the cost to the employer per worker is just $800. While the Big Three are an unusual case, they highlight what might turn out to be the most significant threat to the competitiveness of American firms in an increasingly global economy: our out-of-control health system.

This year General Motors will pay about $5.2 billion in medical and insurance bills for its active and retired workers. That adds $1,500 to the cost of every GM car. For Toyota, whose products are manufactured in many countries abroad, these costs add just $186 per car. When China and India start making cars for sale in the United States and Europe, you can be sure that their health-care costs will be less than $50 per car.

It is often said that GM has been badly managed. This may be true, but the problems it is going through now are not primarily related to this issue. All large American companies to some degree have GM's health-care problem—accentuated greatly for the carmakers because of their older and highly unionized work force. For historical reasons, American companies pay the bulk of the medical costs of their workers (and often their retirees). And these costs have been rising across the United States at five times the rate of inflation for five years. It's GM's problem today. It will be GE's problem tomorrow.

One answer is for companies to stop paying for their workers' health care. But that doesn't really tackle rising medical costs, which someone has to pay. The trustees of Social Security and Medicare just reported that by 2030, one third of all wage increases would go to fund these two programs. And as Robert J. Samuelson points out, that doesn't even include the costs of Medicaid.

For most problems in Washington these days, there is an obvious answer but little political will to implement it. Take Social Security. The solution is simple—trim benefits by raising the retirement age, means testing, etc.—but somehow it is impossible to get this through a polarized political system. On health care, there is no simple answer. But there will have to be some broad bipartisan effort that involves compromise on both sides. There are only two major areas of the American economy where costs have risen for decades at three to four times the rate of inflation: health care and education. (Think of college-tuition bills.) In both cases the consumer does not pay the full cost, and government, the ultimate funder, has little power to negotiate costs or to ration benefits. (In education, government funding comes in the form of tax exemptions, grants and low-interest loans.)

If people paid for more of their health care themselves, they would use it more rationally, which disciplines costs. But it wouldn't really solve the problem because despite the mythology, American health care is not a free market. It is dominated by government funding, through Medicaid and Medicare. The big difference between our system and that of other countries is that in America the government cannot (often by law) exercise its clout as a buyer to drive down costs. So the individual doesn't have the incentive to control costs (why should he, someone else is paying?), and the government doesn't have the means to do so. This is a recipe for waste and overuse. In 2003, The New England Journal of Medicine published a study that showed that America's sprawling health-care system spends $209 billion more in administrative costs than does Canada's single-payer program.

Source



MISSOURI CUTS MEDICAID

Gov. Matt Blunt signed legislation Tuesday that will scale back Medicaid, the government's $5 billion health care program for the poor. The changes are expected to eliminate taxpayer-financed insurance coverage for about 100,000 parents, people with disabilities and elderly people. Thousands more will have to pay some of their medical bills. Many services, such as dental care and podiatry, will be discontinued for most adults in the program. Children, pregnant women and the blind are exempt from the cuts.

Blunt said Medicaid was growing faster than Missouri taxpayers' ability to finance it. "This is not Washington, D.C.," he told reporters. "We don't print money. We have to balance the budget." Even with his changes, he said the program is still "very generous" and will cover 15 percent of Missourians. The bill sets up a legislative commission to recommend a long-term overhaul of Medicaid by Jan. 1.

Another provision ends subsidies for parents who adopt foster children if parents earn more than twice the poverty rate -- $38,700 for a family of four. The bill takes effect Aug. 28.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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27 April, 2005

THE MEDICAID MELTDOWN

Reality is finally biting

Hundreds of thousands of poor people across the nation will lose their state-subsidized health insurance in the coming months as legislators scramble to hold down the enormous - and ever-escalating - cost of Medicaid. Here in impoverished southeast Missouri, nurses at a family health clinic stash drug samples for patients they know won't be able to afford their prescriptions after their coverage is eliminated this summer. Doctors try to comfort waitresses, sales clerks and others who will soon lose coverage for medical, dental and mental healthcare. "I don't know what cure to offer them," Dr. Hameed Khaja said.

Lawmakers say they feel for those who will lose coverage. But they say also that they have no alternative. Prenatal checkups, care in nursing homes and other health services for the poor and disabled account for more than 25% of total spending in many states. Medicaid is often a state's single biggest budget item, more expensive even than K-12 education. And the price of services, especially prescription drugs and skilled nursing for the elderly, continues to soar.

The federal government helps pay for Medicaid, but in the coming fiscal year, the federal contribution will drop by more than $1 billion because of changes in the cost-share formula. President Bush has warned of far deeper cuts to come; he aims to reduce federal spending on Medicaid by as much as $40 billion over the next decade. "It's frightening a lot of governors," said Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured.

Every state has frozen or is trying to cut the fees they pay doctors to care for Medicaid patients. More than a dozen states are looking for ways to cut the number of people covered - or reduce their benefits. Several are proposing restructuring the entire program.

In Tennessee, Gov. Phil Bredesen plans to end coverage for more than 320,000 adults, many of them elderly. In California, Gov. Arnold Schwarzenegger wants to shift more Medicaid recipients into managed care and require some to pay monthly premiums.

Minnesota may stop insuring 27,000 college students and adults without children. Washington state may require senior citizens to pay $3 for each prescription that Medicaid used to provide for free.

South Carolina Gov. Mark Sanford and Florida Gov. Jeb Bush have proposed privatizing Medicaid. Bush wants to give recipients vouchers so they can shop around for their own insurance plans. Sanford wants to set up Medicaid bank accounts; the state would deposit a fixed sum of money for each patient to spend on medical expenses.

In Missouri, where nearly one in five residents is enrolled in Medicaid, Gov. Matt Blunt is poised to sign the most drastic overhaul of all: a bill that would eliminate the program entirely in three years. Blunt expects that by then, the state will have established an alternative mechanism for helping the poorest of the poor. But the legislation on his desk does not insist on it. It only states that Missouri Medicaid will cease on June 30, 2008. In the meantime, the bill severely cuts the existing program, ending coverage for an estimated 65,000 to 100,000 people.

Legislators are still working out eligibility details. But under one leading proposal a single mother of two who earns $3,800 a year would be considered too wealthy to qualify for Missouri Medicaid. The woman's children would still be eligible for free healthcare. But if she gets a better job and starts earning $23,000 a year, they, too, would be bumped off Medicaid - unless she's willing to pay as much as 5% of her income in monthly premiums. The state expects many parents at that income level would be unable or unwilling to pay the premiums, forcing about 24,000 children off the Medicaid rolls.

Children who remain on Medicaid would continue to receive full benefits, but under legislation expected to take effect this summer, most adults would get a bare-bones package. The program would no longer pay for their dental care, hearing aids, eyeglasses, wheelchairs, hospital beds or even bedpans. State Rep. Trent Skaggs, a Democrat from Kansas City, considers the new rules cruel, especially at a time when more than 45 million Americans lack insurance. He worries parents will stop working so their income will drop low enough to qualify their family for free care. Rather than raise costs for minimum-wage clerks, Skaggs suggests increasing insurance premiums for lawmakers who get health coverage through the state. He recently introduced a measure that would have cost the average politician $115 a month - the measure failed on a close vote. "That made a complete mockery of the idea that leaders sacrifice first," Skaggs said. "Times are tough, but not so tough that we have to sacrifice?"

The Republican lawmakers who have been leading the Medicaid overhaul drive say such criticism distorts their goals. The cuts are not just about balancing this year's budget, they say. They're about steering Medicaid back to its original purpose: to serve as safety net for citizens who are too young, too old, or too ill to help themselves. Turning Medicaid into a welfare program for poor but able-bodied adults risks jacking up the costs so high, they say, that the entire system could go bust - stranding those who most desperately need the state's help. The cost of Missouri Medicaid has doubled in the last six years, to $5 billion. It eats up more than 30% of the state budget. More than 1 million people are enrolled. "Government is not here to do everything for everybody," said state Rep. Jodi Stefanick, a Republican representing suburban St. Louis. "We have to draw the line somewhere."

More here



REPORT-CARD FOR BRITISH NHS

Not good, Mr Blair

Dirty hospitals and a lack of information about medical treatments are among patients' top concerns about the NHS, according to an authoritative survey. They are also worried about a lack of involvement in decisions about medication and other NHS care. The service has improved, in some cases markedly, says the report from the Picker Institute Europe, but only in areas directly targeted by the Department of Health.

In other areas the service has languished or even become worse, according to the views of nearly a million patients who have contributed to surveys conducted since 1998. Angela Coulter, chief executive of the charity, said: "The most disappointing thing is that all the rhetoric about creating patient-centred care hasn't led to improvements across the board. "Only where specific targets have been set - in waiting times and in cancer and heart disease - are we seeing big improvements. Where there are no targets, in areas such as cleanliness and access to a GP, the service has not improved and in some cases has got worse. Many aspects of patients' experience still need urgent attention."

The charity has designed a series of national patient surveys for the NHS for the past seven years. Data collected by NHS trusts has been issued in reports from the Commission for Health Improvement and its successor body, the Healthcare Commission. Picker has now summarised the results in a new report - Is the NHS Getting Better or Worse? - in an effort, it says, to inject some facts "into the current poliical knockabout on the state of the NHS".

Areas in which things have become worse include family doctor services. In 1998, 87 per cent of GP patients said that they had sufficient time with the doctors, but by 2004 this had fallen to 74 per cent. Between 2002 and 2004 the proportion of patients complaining about inconvenient opening hours had increased from 20 per cent to 22 per cent. Professor Coulter said that she expected criticism to increase as the effect of the new GPs contract was felt. Reports from patients indicated increasing difficulties with getting an appointment at a convenient time. The disappearance of Saturday surgeries was a particular complaint, she said.

Hospital cleanliness is another problem. In 2004 only 54 per cent said that the ward they were in was very clean, 2 per cent less than in 2002. Only 48 per cent said that bathrooms and lavatories were very clean, 3 per cent less than in 2002. There is little evidence in the report that the NHS is becoming more patient-friendly. More than a fifth of inpatients and a quarter of A&E patients said in the 2004 survey that staff did not always listen to what they said - which represents no improvement since previous surveys.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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26 April, 2005

MORE HORROR STORIES FROM BRITAIN

Four times in seven days Premalatha Jeevagan needed urgent care as complication followed complication during the birth of her first child. The accountancy student might have thought that she was in the right place — the maternity ward of a leading London hospital — but four times she failed to get the help she needed and, after a few minutes with her baby daughter, she was dead.

Her husband was, he said, reduced to screaming at the doctors who broke the news to him: “What are you guys doing?” Selvaratanam Jeevagan is one of ten men whose children have been left without mothers after three years during which the maternal death rate at Northwick Park hospital soared to more than five times the national average. He lives in a quiet street within view of the new Wembley stadium. His daughter, Lathika, will be one next month. She sits on his knee in their front room, bewildered by The Times’s photographer’s flashbulb but too brave to cry. Not so her father, who is no longer taking anti-depressants but is unsure whether he can handle going back to work on the London Underground. “You never recover from this,” Mr Jeevagan, 34, said. “You cry every day, you cry inside, even if others can’t see it.”

The latest tragedy linked to the Northwick Park maternity unit was last month when Anna Marie Denso, a Filipina nurse, died after surgery during childbirth. Doctors are believed to have removed her liver as well as her uterus. One result is the legal case being prepared against the hospital by Mrs Denso’s husband, Andrew, with the help of the Philippines’ Ambassador to London. Another was the decision last week by John Reid, the Health Secretary, to put the unit on “special measures”. The hospital has been held responsible in only one of the nine deaths so far examined at coroners’ inquests — the case of Mrs Jeevagan.

Yet even the most complex and ambiguous case is deeply troubling. It ended in the death of Angela Shipperley, a Jehovah’s Witness, who told hospital staff in the 21st week of her pregnancy that she would not accept a blood transfusion because of her religious beliefs. Twelve days after giving birth prematurely to her son, Joel, Mrs Shipperley was suffering from dangerously low haemoglobin levels. Told that a transfusion could save her life, she refused one again. William Dolman, the coroner, noted at the inquest her “informed decision to refuse blood against medical advice”, but her widower, Alvin, is convinced that her death was avoidable. Another treatment was available, Mr Shipperley contends: it was prescribed but not administered because of confusion over which variant of the drug would match his wife’s blood, although her blood type had been known for three months. “The sad thing is it was only after my wife died that we started learning things about Northwick Park,” Mr Shipperley said. “I told people on my street that my wife had died after giving birth and they said — no prompting from me — ‘Northwick Park’.

“It’s too late for my wife, but we need answers and they need to get their act together so it doesn’t happen to others.” Mr Shipperley, 43, is now a full-time father in Pinner, “constantly tired” but grateful for the support of two brothers and his church. He lives on his wife’s pension and death benefits, and the child benefit and child tax credit to which Joel entitles him. “You learn to cut your cloth, don’t you?” he said. “I’ve never worked so hard, but it’s the best job I have ever had.”

From The Times



AMAZING INCOMPETENCE IN SCOTLAND

But I rejoice for that tough little baby. If I were religious, I know what I would say

A mother who underwent an abortion after learning that she was pregnant with twins is suing the NHS for £250,000 after one of the babies survived. Stacy Dow, who was 16 when she found out that she was pregnant, is seeking compensation and damages for the “financial burden” of raising her daughter. Miss Dow, whose father has had to take on a second job to help to pay for his granddaughter, is claiming for “loss, injury and damage” suffered at the hands of Tayside University Hospitals NHS Trust. The teenager, who hoped to train as a nurse, decided to have an abortion as soon as she discovered that she was six weeks pregnant. Days later the procedure was carried out at Perth Royal Infirmary, where doctors advised her that no live material was left in her uterus.

When Miss Dow started to put on weight and her periods stopped, she assumed that it was because of the contraception injection she had been given. The hospital had told her that possible side-effects included weight gain and an erratic menstrual cycle. Miss Dow said: “After 33 weeks I went to the GP and he told me I was pregnant. I thought he meant I had fallen pregnant again, and I couldn’t believe it when I was told that it was one of the original pregnancies.”

Miss Dow’s daughter, Jayde, who is now a healthy three-year-old, weighed 6lb 2oz when she was delivered by Caesarean section on August 30, 2001, at the same hospital in which her mother had had the abortion seven months previously...... Miss Dow lives with her parents, Douglas, 40, and Barbara, 41. The toddler’s father, who has not been named, had been Miss Dow’s boyfriend at school. He died two years ago.

Legal documents filed at Perth Sheriff Court accuse Perth Royal Infirmary of failing “to take reasonable care to establish that the termination had been successful”. Although the NHS, which is defending the action, admits that a baby survived, it says that a doctor “checked the cavity of the uterus and could feel no further products of conception. As far as could be clinically determined the pregnancy had been terminated.” It claims that the amount sought by Miss Dow is excessive.

From The Times

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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25 April, 2005

CANADIANS THROW IN THE TOWEL

They foolishly think that going private is a better option than living in pain or dying. How could they?

"Patients fed up with long waiting lists in Canada are fuelling a fast-growing demand for brokerages that arrange speedy service in the United States as well as in Quebec's burgeoning for-profit medical industry. Brokers and other similar companies say business has as much as tripled over the past year as Canadians apparently become more comfortable with paying for diagnostic tests, second opinions and even surgery. They say their patients include not only the wealthy but also middle-class people willing to take out second mortgages or lines of credit to pay for faster care.

Driving the move are Canada's lengthy waiting lists for many medical procedures. A study last year found Canadians waited an average of 8.4 weeks from their general practitioner's referral to an appointment with a specialist in 12 different medical specialties, then waited another 9.5 weeks for their treatment. Those wait times are almost double what a similar study found in 1993.

An increasing number of patients looking to skirt the public system are being referred to physicians in Quebec's private health care sector, where operations such as hip replacements can be bought out of pocket -- and where the federal government has done little to intervene.

Patients approach the agencies in need of everything from joint replacements to diagnostic work and cancer treatment. The number that OneWorld Medicare of B.C. sends to the United States for at least a consultation has jumped three-fold over the past 12 months, while the company fielded twice as many inquiries between January and March as it did in all of 2004. "We have seen a very large growth in the last year," said Mike Starko of OneWorld. "We shouldn't have to be sending people down to the U.S., we really shouldn't. But that's the unfortunate reality at this point."

Some of the companies act simply as brokers, locating an appropriate private hospital or clinic to perform the needed procedure and negotiating what they call a discounted price. They take a portion of the savings as their fees. Another company, Medextra, provides a broader service, helping people navigate the system by getting them expert second opinions, a private-sector procedure or the right care within the public system in Canada. Its basic rate is $180 an hour. Business has doubled over the past year, with about 100 patients being served at any given time, said Dr. Jeff Brock, co-owner of the firm, which is also based in British Columbia. "There's been a really big shift in public sentiment," said Evan Savelson, another co-owner of Medextra. "There's been a shift from people having very negative feelings about alternatives to solving their medical problems to people welcoming it and being willing to pay for it."

Rick Baker, who started Timely Medical Alternatives in B.C. about 18 months ago without a client in his first month, says business is now thriving, with half a dozen e-mails and as many phone calls from patients waiting for him every morning. One of them was Velma Sutter, 68, of Edmonton. Two Alberta specialists had told her the excruciating pain she was feeling was a result of back trouble, but she'd have to wait a year to get into a pain clinic. Mrs. Sutter headed to the Mayo Clinic in Minnesota in January, where doctors said she had been wrongly diagnosed and really needed a hip replacement. She retained Timely Medical, which got her into surgery in Bellingham, Wash., within two weeks. She said she feels worlds better now. "It's the way to go," she said of the brokerage service."

Mr. Baker's clients -- such as an eight-year-old girl who went temporarily deaf from an ear infection in January, 2004 -- may continue to look elsewhere for help. The relatively straightforward surgery she needed to clear it up was not available until last July, then was postponed until September, then March. Mr. Baker's company stepped in last fall and arranged an appointment with an ear, nose and throat specialist in Washington. The doctor took one look and told the girl's father that if he waited for surgery any longer "your daughter will be dead." The infection had spread alarmingly during the long wait.

A client at OneWorld needed a double knee replacement but was told he could only get one knee done at a time in B.C., with a year-long queue just for the first one. The broker found a hospital in the United States to operate on both knees almost immediately, and within a couple of months he was walking without even much of a limp, Mr. Starko said.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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24 April, 2005

TWO MORE "DR. DEATHS" IN QUEENSLAND PUBLIC HOSPITALS

And the government is doing nothing about it!

"An inept foreign doctor working at a Queensland regional hospital botched two operations, leaving one patient dead and another fighting for his life. Details of Queensland's second "Dr Death" were revealed by Liberal health spokesman Bruce Flegg as the scandal over inadequately trained overseas doctors deepened. His claims came as Premier Peter Beattie announced former Liberal deputy premier and doctor Sir Llew Edwards would be part of a sweeping royal commission into the health system.

Dr Flegg said the latest case was remarkably similar to that of disgraced former Bundaberg surgeon Dr Jayant Patel. It involved an Asian doctor deemed to be a specialist surgeon by the Queensland Medical Board, who was operating well beyond his capabilities. Despite being unqualified, the doctor performed an operation to remove a large tumour from a patient's stomach. The patient had to be transferred to Brisbane for emergency treatment, but died.

Dr Flegg said he had been told that another patient was left seriously ill after major surgery beyond the scope of the doctor. "This was identical to the Dr Patel case – a doctor deemed a specialist trying his hand at whatever came along," he said. Dr Flegg received the information from a senior Brisbane medical specialist this week.

Queensland Health documents revealed the foreign doctor was still working at the regional hospital and was registered to do so until January 2006.

Contradicting a medical board announcement giving a clean bill of health to the 1670 foreign doctors working in the state, Dr Flegg also revealed allegations that another foreign doctor employed as an anaesthetist at a regional hospital "caused brain damage on a regular basis". He said the allegations about the anaesthetist were contained in documents he had received from a "senior medical source attached to a professional college". The documents, shown to The Sunday Mail, contained "terrifying" details about the East European doctor. "He has no anaesthetist training at all and yet is allowed to practise as a deemed specialist anaesthetist," the documents said. "He has had several adverse reports submitted re his lack of anaesthetic skills, to the medical superintendent – including mainly patients suffering mild brain damage on a regular basis because of his lack of skills. "Many nurses will not work with him and one of the specific anaesthetic assistants has now refused to work with him."

The documents said the doctor's case highlighted the problems with the medical board's assessment of overseas-trained doctors. "His primary qualifications are in (a language) and these were all given to the board in the form of translations into English – no one has any idea of the truth of the translations," the documents said.

The documents also identified an Asian doctor, acting as an anaesthetist in Brisbane, who was also under the spotlight this week. "Over the last five years, his surgeons have complained so much re his lack of skills that he was sent to several other hospitals for review, where he was found to be substandard," the documents said. "He was redirected to do retraining but found to be unsuitable for the complicated cases undertaken and was refused further work there."

The documents said the doctor had been returned to his original hospital in Brisbane to do "simple lists". "Even there most surgeons refuse to work with him because of the complication rate of his anaesthetics. "It has got to the stage that the district manager recently directed he not be placed on after-hours call because of the danger he presents to patients – nor to be in the operating theatre without a junior doctor to watch him."

Complaints had been made to the medical board but no action was taken. "They were simply not prepared to take any action against him or revoke his registration despite numerous examples given of patient injury," the documents said. "This highlights the fact that even when doctors are referred to the board and are clearly shown to be incompetent, no action is taken."

Dr Flegg condemned the board's clean bill of health for foreign doctors as a "meaningless publicity stunt" and urged Health Minister Gordon Nuttall to look into the latest allegations. "The board did not check the authenticity of files . . . all they did was a simple Google search," he said. "We know there were examples of fraudulent medical degrees." Dr Flegg said the claims made against the two doctors – who were still practising – were terrifying for patients and he demanded the board deregister them immediately.

A spokesman for Mr Nuttall said he would not comment on unsubstantiated allegations and directed complainants to go to the medical board. Medical board executive officer Jim O'Dempsey said yesterday that a "sweeping" internal audit and review of registration papers had found that no doctors had falsified their documents.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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23 April, 2005

THAT GOOD OLD BUREAUCRATIZED HEALTH CARE AGAIN: KILLING YOUNG BRITISH MOTHERS THIS TIME

Their only way out was to turn to the private sector

"The Government ordered a team of doctors into a failing hospital maternity unit where ten mothers have died in less than three years. John Reid, the Health Secretary, said yesterday that urgent action was being taken to address growing concerns about a high number of deaths at Northwick Park Hospital, in northwest London. The Healthcare Commission, which monitors hospital standards, wrote to Mr Reid demanding immediate action after an inquiry showed “serious system failures” at the hospital’s maternity unit caused by staff shortages. Ten women have died at the hospital, where about 5,000 births take place annually, in the past three years — five times the national average. An average of about one mother in 8,700 dies in childbirth in Britain.

An inquest was told in February that Premalatha Jeevagan died shortly after giving birth at the hospital when doctors failed to realise that she had suffered a womb haemorrhage. The hospital insisted that new procedures and protocols had been put into place after her death last May. But on learning this month of the death of another mother at the unit, the Healthcare Commission decided to carry out an unannounced spot check, which revealed that problems had still not been addressed. The commission said that while there was no evidence of a link between the ten deaths, it would now begin an investigation into each of them to be absolutely sure.

In his letter to Mr Reid, Sir Ian Kennedy, the commission’s chairman, asked for special measures to be taken immediately at the hospital, which is part of North West London Hospitals NHS Trust. It is only the second time that the commission has used such powers. The trust asked the commission to start an investigation into its maternity services in August last year. In December, the trust agreed to take urgent action to remedy any problems, but this month the commission found that that had not been carried out. “We found serious problems with these services and no longer had sufficient confidence that the trust could resolve them without external help,” Sir Ian said yesterday. “Under these circumstances, we must take immediate action to protect the safety of patients.”

The commission made a series of recommendations, including the introduction of extra clinicians and monitoring, which have been accepted by the Government. Mr Reid said yesterday that in order to relieve pressure on maternity services at the unit, elective Caesarean deliveries would be undertaken at the private Portland Hospital in Central London. Celebrities, including Victoria Beckham and Claudia Schiffer, have given birth at the Portland.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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22 April, 2005

THE "DR. DEATH" DISGRACE IN QUEENSLAND CONTINUES

Premier Peter Beattie is under mounting pressure to hold a wide-ranging inquiry into Queensland's health system. Mr Beattie was forced to act yesterday, announcing a royal commission would be held to investigate the damaging Dr Death scandal. Overseas-trained practitioner Dr Jayant Patel has been linked to more than 20 deaths after botched surgeries at the Bundaberg Base Hospital.

Mr Beattie is still to decide whether the royal commission will be limited to probing the Dr Patel allegations and Queensland's use of overseas doctors or to broaden its scope. He will spend the next week deciding who will head the royal commission before Cabinet meets to finalise terms of reference on Tuesday. But the Opposition, the Australian Medical Association and patients are calling on Mr Beattie to mount a full-scale investigation into all aspects of Queensland's ailing health system.

It comes as a public hospital doctor working as a specialist anaesthetist is being monitored closely by Queensland Health managers and doctors who are extremely concerned about his competency and high rate of complications. The case underscores concerns that problems are spread throughout the health system.

And it emerged that animals received better protection than people under a regulatory regime that is much tougher for overseas-trained veterinarians than doctors. The Australian Veterinary Boards Council confirmed comprehensive screening processes for veterinarians seeking work in Queensland includes rigorous scrutiny of qualifications by experts, written preliminary tests, English tests and a three-day clinical examination.

Dr Patel was recruited to a $200,000 role as director of surgery at Bundaberg. The Courier-Mail revealed that medical authorities had failed to properly screen the practitioner who had been found guilty of repeated gross negligence in the US. Dr Patel has fled Australia.

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ONLY ONE BRAVE NURSE SPOKE UP AS PATIENTS DIED

And the bureaucrats pressured other doctors to work unsafe hours

Another senior Queensland Health staffer from Bundaberg Base Hospital has stood aside amid anger from staff over her handling of the Dr Death scandal. It comes as new claims surfaced yesterday that patients of Dr Jayant Patel woke up to the shocking news that the overseas-trained doctor had performed different medical procedures to the ones they had consented to. The Health Rights Commission revealed the unconsented surgery was among the grievances that it had received since sending a complaints officer to Bundaberg on Monday.

Every day more former patients of Dr Patel are revealing horror stories, but most are describing him as the "ultimate conman" because his "bedside manner" was fantastic but his skills were Third World. And as the complaints continue, the commission has extended the stay of its complaints manager in Bundaberg by two days. They have received up to 75 complaints from patients about treatment.

Bundaberg Base Hospital's director of nursing Linda Mulligan, who was supposed to return from holidays this week, told staff yesterday she would be taking extended leave. Ms Mulligan has been criticised by nurses including the whistleblower nurse in charge of Bundaberg Hospital's Intensive Care Unit, Toni Hoffman, for failing to act on serious concerns over Dr Patel's conduct.

The Queensland Nurses Union has named Ms Mulligan along with the hospital's medical chief, Dr Darren Keating, and district manager, Peter Leck, in a formal written complaint to the Crime and Misconduct Commission. Both Dr Keating, who has apologised for his role, and Mr Leck, who has defended his actions, stood aside from their jobs last week. The complaint by the nurses' union to the CMC alleges they failed "to respond to the concerns raised by nursing staff".

A former Bundaberg Base Hospital anaesthetist also told yesterday of how overseas-trained doctors were threatened by Queensland Health, "an organisation that responds to criticism with savage efficiency". "Overseas trained specialists are particularly malleable as their visa depends on their job - hence management are able to manipulate and abuse them as they see fit," Dr Chris Jelliffe said. "They are paid 40 per cent less than Australian registered specialists so represent good value for money. "Over Easter 2002, I found myself the only anaesthetist available at Bundaberg Base Hospital, expected to be on call for the maternity suite, intensive care unit, wards, emergency department, as well as the operating theatres, for an eight-day stint, on call 24 hours per day. "My reasonable cancellation of some routine surgery for that period prompted a summons from the manager. "He opened the dialogue with words to the effect of 'Chris - just remind me of your visa status'. The reminder that I was happily married to an Australian changed the emphasis somewhat and the cancellations went ahead."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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21 April, 2005

SAN FRANCISCO: PUBLIC MEDICINE WIDE OPEN TO CORRUPTION

Brigido and Quintina Pullan, both 81, have no use for the pair of power wheelchairs and the two semielectric hospital beds sitting in unopened boxes at their tiny South of Market rental unit. Yet the federal government's Medicare program was billed more than $15,000 for them. Bagtolome Gorero, 80, and his wife Estelita, 79, each received a crisp $100 bill for taking a van ride to a sleep clinic in San Jose, where they were asked to lie on beds for four hours with wires attached to their bodies and watch movies. In turn, the clinic operators billed Medicare $7,950 for sleep studies on the two, who say they have no sleep problems whatsoever. These and two dozen other San Francisco seniors interviewed by The Chronicle say their Medicare accounts were purloined by medical con artists, who induced them -- and perhaps hundreds of others -- to give their Medicare numbers for health services and equipment they didn't need.

Their stories are evidence of a series of scams that may have cost the government health plan millions of dollars in the Bay Area. The schemes -- which have resulted in FBI raids that shut down two clinics -- shed light on how fraud, abuse and error cost Medicare tens of billions of dollars a year. The Chronicle's investigation shows how senior citizens and immigrants are used to defraud the giant health care system for the elderly. In San Francisco, the Medicare scammers targeted Filipino seniors -- many of them veterans who served with U.S. forces in World War II. Hundreds of people have reportedly received investigative letters from the FBI, questioning their Medicare usage. No charges have been filed in the investigation. The U.S. attorney's office in San Francisco refused to confirm or deny the existence of any investigation. FBI spokeswoman LaRae Quy said only: "We have not yet arrested anyone in this matter."

Records obtained from the seniors by The Chronicle show Medicare billings coming from a half-dozen doctors, four medical clinics in San Francisco and San Jose, and 11 medical distribution firms from the Los Angeles region. For example:

Apolonio Ladia, 81, is physically fit and has no major medical complaints. Yet recruiters paid him to go to three Bay Area clinics where he underwent 46 medical and laboratory tests -- for which clinic operators billed Medicare more than $8,500. Gonzalo Esnero, 80, is not diabetic nor does he require tube feeding. Yet his Medicare records show the insurance program for the elderly was billed $4,806 for diabetes and tube feeding supplies that he says he never ordered.

The federal government is struggling to find money to pay for such basics as prescription drugs for the elderly. At the same time, government reports estimate that $1 in every $10 spent by the $300 billion Medicare system goes to erroneous, abusive or fraudulent payments. In California, an incomplete accounting identified $553 million in improper payments last year, according to a December Medicare report. "We're seeing California as a hotspot of fraudulent activity," said Ted Doyle, who heads a new Centers for Medicare and Medicaid Services unit designed to root out fraud in the Los Angeles area.

The network of scams targeting Bay Area seniors appears to mirror medical fraud rings that have been investigated and prosecuted in Los Angeles and dozens of other cities. Many of the schemes have involved organized crime. "In the past six years, we've seen increasing amounts of criminal activity from several well-established organized crime groups, including the Russian mafia and Southeast Asian gangs," said Collin Wong, who heads California's Medi-Cal fraud unit. The Bay Area schemes now under federal investigation involved a network of clinics that employed recruiters to round up patients from immigrant communities. One recruiter, Lolita Ramos, 77, of San Francisco, told The Chronicle she was paid $50 for every Medicare beneficiary she brought to three clinics in San Jose and San Francisco.

Three doctors employed by these clinics said they accepted jobs in the facilities only to find out later that their names, medical certificates and bank accounts were being used in scams they knew nothing about. In San Francisco, the fraud involved a clinic that rented space at the West Bay Pilipino Multi-Service Center, a 30-year-old South of Market nonprofit. This clinic, which West Bay Director Edwin Jocson said has been closed since a December search by FBI agents, was housed in a space at the Seventh Street center rented by a mysterious man named Harut (Harry) Kirakossian. Jocson said the center was exploited by the clinic operators. Dozens of seniors said they were recruited to go to that clinic, where they lined up to apply for wheelchairs or to take van rides to San Jose clinics. Many said they were paid $100 each to join vanloads of other Medicare recipients who were driven to clinics in San Jose and San Francisco to undergo long batteries of unnecessary medical tests on Medicare's tab.

More here



ANYBODY CAN BE A SPECIALIST IN AT LEAST ONE AUSTRALIAN PUBLIC HEALTH SYSTEM

Your government will see that you get the best worst.

Queensland's health scandal has snowballed, with claims that hundreds of Government-sanctioned overseas-trained doctors are risking lives by working well above their qualifications. Opposition health spokesman Bruce Flegg said leaked Queensland Health documents proved doctors, often from developing countries, were working as specialists with the blessing of the state, but without accreditation. His comments come as Premier Peter Beattie said the Government would pursue the Indian-trained doctor Jayant Patel if an investigation proved he was criminally negligent, and the Government braced itself for a wave of legal action.

Dr Patel, dubbed Dr Death by colleagues at Bundaberg Base Hospital, has been linked with the serious injury or death of at least 14 patients. The 55-year-old doctor, who had also faced accusations of negligence in the US state of Oregon, is believed to have gone to India after leaving Australia at Easter. Because of his Bundaberg stint, the Oregon Board of Medical Examiners cancelled his licence for not telling it he was moving his practice.

Mr Beattie, who returned yesterday from a trade visit to Japan, said the Government would pursue Dr Patel if an investigation into his treatment of patients proved he was negligent. Although Queensland had no extradition treaty with India, there was an existing arrangement that might hold sway. Mr Beattie said: "If the legal case justifies that, which it would seem on the surface to me that it does, and that's the determination by [the police] then yes, absolutely [we will seek extradition]. "I think the people of Bundaberg, who have gone to hell and back and have suffered this pain, would expect nothing less of the Government than to pursue this if the legal case stands up to scrutiny in a court."

Mr Beattie conceded the Government had braced itself for a wave of legal action, as law firm Shine Roche McGowan said it would pursue personal injury compensation claims for Dr Patel's victims. Lawyers Simon Morrison said his firm had been approached by at least 11 people so far.

Dr Flegg said yesterday leaked Queensland Health documents proved it had been State Government policy since 2002 to employ inadequately trained overseas doctors, a policy which had led to the "Dr Death" tragedy. "What these documents show for the first time is the Queensland Government, as a matter of policy over the past 2 years, has been using overseas-trained doctors as specialists despite the fact that they do not have the qualifications to be registered in this state," Dr Flegg said. "The exact number is unknown . . . but, anecdotally, we're probably dealing with hundreds of doctors." He said the documents went a long way towards explaining the havoc wreaked by Dr Patel during his two-year stint as director of surgical services at Bundaberg Base Hospital.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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20 April, 2005

THE FRENCH SYSTEM

Tim Worstall thinks that Krugman misrepresents it. Excerpts:

Funding via taxation means precisely that, that general revenue is raised and then fed through the normal political process to pay for the health system. This has, certainly from the UK experience, two effects: constituencies of Ministers do seem to get bright shiny new hospitals and the minutiae of treatments become national political events. Three weeks ago the UK was convulsed over whether one particular woman who had had her operation for a broken shoulder delayed eight times, including visits to her from a Cabinet Minister and the Leader of the Opposition. Perhaps not all that sensible a system.

Compulsory insurance is how, for example, the French system works. Deductions are made from wages and sent to a specific fund which then runs the health system, in large part by-passing the grandstanding and pork barrels of the elected politicians.....

Now as we all know, prediction is very difficult, especially about the future, so I offer this only tentatively, but I think that Krugman will come up with a system that is a single provider, single payer one. Note that the VA (which is both) is regarded as lean and efficient, that competition is regarded as bad (I'm willing to believe that at times and in places this can be so but not in the provision of a service like health care), and that personal choice leads to higher costs. To put it crudely, that he will propose a system whereby we pay taxes and then get back the treatment that the bureaucracy thinks we should have. Essentially the UK's National Health System. That is, one of the very few rich world ones that is truly awful. The current target (amongst the 1600 that govern this centrally managed system) is that no one will wait more than 6 months for an operation, and Tony Blair recently boasted about how few there are waiting longer than this. (Note that even Ted at CT doesn't think this is a good idea.)

This is where I think the bait and switch will come in, for he has, as above, rightly praised the French system. Yet the French system is not a single payer system at all. The compulsory insurance element collected through pay packets pays for only a portion of treatment costs (35-65% on prescriptions, 70% in general, except in some exceptional circumstances like cancer treatment). There are myriad private insurers who offer a variety of plans to cover the un-reimbursed costs and sometimes the extra costs that can be charged over the prixe fixe. One could with a straight face actually state that this is less generous than the current Medicare and Medicaid systems in the US. Anyone want to try and get the AARP behind the idea that the old geezers should be paying 65% of their Viagra prescriptions and 30% of the cost of their GP visit?

The second thing is that it is not a single provider system. There are indeed publicly owned hospitals, as there are non-profit or charitable ones, as well as profit seeking private providers. All patients have complete freedom to seek treatment from whomever they wish, so certainly an amount of personal choice there.

What worries me is that the Professor will point to a decent system, that of France, and use it to propose a terrible system, that of the UK.



AUSTRALIAN PUBLIC SYSTEM FAILS THE MENTALLY ILL

Australia's health system is still failing the mentally ill, a leading mental health specialist says. After 12 years of national mental health reform, gaps remained in the system, said Professor Ian Hickie of the Mental Health Council of Australia. Writing in the latest Medical Journal of Australia (MJA), Prof Hickie, who is also executive director of the Brain and Mind Institute at the University of Sydney, said governments were not providing enough funding for acute care and suicidal patients. "The mental health community reports little progress in implementing its key priorities, such as expanded early intervention programs, co-management of people with mental health problems and related alcohol or substance misuse, and widening of the spectrum of acute care settings," Prof Hickie said in the MJA report. "We propose new national targets for reducing the social and economic costs of poor mental health."

He said the targets included increased access to effective care and reduced suicide rates. Prof Hickie said in 2003, people aged between 25 and 49 accounted for 56 per cent of all suicides in Australia, while the rate was 31.1 per cent for men aged 25 to 29. He said any new funding for mental health care was welcome, but $110 million over four years represented only 10 per cent of the federal government investment that was needed with a similar level from the states.

Australian Medical Association (AMA) federal president Bill Glasson said federal and state governments were uncoordinated in providing sufficient care, especially for acute patients. "It's an area of medical care that has been totally neglected, the acute sector particularly," Dr Glasson told AAP. "What they have to make sure they do is set up appropriate care facilities for treating the mentally ill. "We are lacking beds, we are lacking facilities."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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19 April, 2005

EVEN THOSE WHO RUN IT ARE GIVING UP ON AUSTRALIA'S PUBLIC MEDICINE SYSTEM

Their only solution is to pass the buck to the Feds

The nation's health system is "stuffed" and "a disaster waiting to happen", South Australian Health Minister Lea Stevens has warned. "To put it quite bluntly, the current health system is stuffed," she said. She says the State Government cannot afford to keep pouring funds into the health budget and that a lack of hospital beds, shortages of doctors and nurses, and funding cuts have put the system under severe stress. "It is not just in Australia. It is also the situation in countries comparable to us," she said.....

"Nothing is being done to reform the basic parameters of the way health services are being delivered," she said."If we don't do something like this (reform the system), we are going to be run over by health."

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PUBLIC MEDICINE GIVES UP (IN AUSTRALIA'S MOST POPULOUS STATE)

Private hospitals would be paid to operate on public patients who have waited more than 12 months for elective surgery, under a State Government plan. More than 4,500 patients in NSW who are waiting for low-complexity procedures including cataract and ear, nose and throat surgery would benefit from the plan, designed to cut hospital waiting lists. The Premier, Bob Carr, said about 2,000 of the patients would be operated on in public hospitals, but 2,591 patients would go to private hospitals. "This is a further part of our extensive plans to increase access to surgical procedures for all patients, from emergency cases to less urgent procedures," Mr Carr told reporters. "Our priority is to ensure that people who have been waiting more than 12 months have their elective procedures completed as soon as possible. "That is why we are thinking outside the square to engage the private hospital sector where they indicate they have additional capacity to perform a range of procedures." All private hospital and day centre operators in NSW have been asked to express their ability to perform the 2,591 low-complexity procedures.

Source



HOW PUBLIC MEDICINE IS ADMINISTERED IN A THIRD AUSTRALIAN STATE

A culture of bullying in Queensland Health starts at the top, one of the state's leading heart surgeons says. Professor Con Aroney, former director of the coronary care unit at Prince Charles Hospital, has slammed departmental bosses for using threats and intimidation to hide the truth about our health care crisis. He also attacked Premier Peter Beattie and Health Minister Gordon Nuttall for failing to stop the bullying by senior Health Department officials. "Their method has been to shoot the messenger, to cover things up and to deny there's been a problem," said Prof Aroney, who told the Government a crisis in cardiac care was killing patients. "People are unwilling to speak out because of this bullying ethos."

Warnings of a crisis by Prof Aroney - who quit the public system last month because of bullying - were vindicated this week by a damning report into two deaths at Prince Charles Hospital. The report revealed thousands of Queenslanders could die waiting for heart operations because of a lack of funding, hospital infighting and a bed shortage. Liberal Party deputy leader Bruce Flegg said Mr Nuttall's failure to stop bullying in his own department was proof he condoned it. "He's the one man in a position to do something and he tolerates it," Dr Flegg said. "Bullying is across the board in Queensland Health and it's their way of sitting on an issue. It shuts people up and anyone who complains is threatened and intimidated."

Opposition Leader Lawrence Springborg said systematic bullying had been rife within the department for years. "Queensland Health uses its heavy-handed code of conduct to effectively gag staff from speaking out," he said. "Under Labor, bullying became entrenched with former minister Wendy Edmond turning abuse and criticism of staff who complained into an art form. "Minister Nuttall has continued the system of bullying and undermining staff who speak out."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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18 April, 2005

THREE MYTHS OF SOCIALIZED MEDICINE

How it ACTUALLY works:

Our national flirtation with the illusory benefits of "free" national health insurance corrodes our debate about improving the quality of health care in the United States. Partly because of the allure of this delusion of free or single-payer national health insurance, we are slowly ceding our medical service system to government mismanagement at patient and taxpayer expense.

The most dangerous delusion of all is that government-paid universal medical services are compassionate because they are supposedly "free" for everyone. This egalitarian theme sounds benevolent in theory, but is callous in practice. When government gains a monopoly on payment for medical services, health care personnel must give priority to bureaucratic over patient needs if they want to get paid. This makes government, rather than the doctor, patient or his family, responsible for health care - and the ultimate arbiter of who lives and who dies. The outcome is fundamentally heartless.

The reasoning behind these delusions is explained and exposed in detail in a new book, Lives at Risk: Single-Payer National Health Insurance Around the World by John C. Goodman of the Dallas-based National Center for Policy Analysis (NCPA) and co-authors Gerald L. Musgrave, and Devon M. Herrick. Although the book discusses twenty "myths" that underlie the push for single-payer national health insurance, the first three form its philosophical base.

The first myth is well expressed in this quote from the U.S. Physicians' Working Group for Single-Payer National Health Insurance: "Access to comprehensive health care is a human right. It is the responsibility of society, through its government, to ensure this right." The authors point out that the so-called basic human right to health care in countries with national health insurance is "nothing more than the opportunity to get services for free (or at very little cost) as the government decides to make those services available. But government is under no obligation to provide any particular service." Government controls costs by imposing global budgets on hospitals and health authorities and limiting supply. As a result, demand exceeds supply for virtually every service and patients are forced to wait months and even years for treatment. They are sometimes apologetic, however. An electrocardiogram appointment letter from the Moncton Hospital to a New Brunswick, Canada,heart patient said the examination would be in three months. It added: "If the person named on this computer-generated letter is deceased, please accept our sincere apologies."

Rationing of health care occurs in the U.S. too, especially in public hospitals that provide care for the uninsured, and for those on Medicare and Medicaid. In spite of this, average wait times in the U.S. are far shorter than in countries with national health care systems. For example, 27% of Canadian patients and 36% of British patients must wait more than four months for elective, non-emergency surgery. By contrast, only about 5% of American patients wait that long.

Aneurin Bevan, father of the National Health Service (NHS) established in Britain in 1948, articulated the second myth - equal access to health care for all people. He declared, "the essence of a satisfactory health service is that rich and poor are treated alike, that poverty is not a disability and wealth is not advantaged." In spite of this high-minded goal, studies in both Britain and Canada indicate that their socialized systems are far from fulfilling this goal. In an article on the problems of unequal access in Britain, Patrick Butler observed: "Generally speaking, the poorer you are and the more socially deprived your area, the worse your care and access is likely to be."

Very significant disparities were also found in British Columbia, Canada, between services provided in rural areas compared with major cities. For example, the amount spent on physician specialist services per patient, per year, was $610 in the Vancouver area and $232 in the rural Peace River area. As a result of these inequities, many people travel hundreds of miles for adequate treatment. Disparities by region and wealth also exist in the U.S. But because emergency rooms cannot turn away any patient and the private medical sector is relatively robust, people in the U.S. have more actual access to health care services than is available in nationalized systems. We don't want to lose this access.

The third myth is related to the above two: that care should be based on medical need rather than ability to pay. But people in countries with a socialized system are increasingly willing to pay outside the system for better and faster treatment. "Free" surgery isn't worth much if you have to wait until you're near death to receive it.

Somewhere lurking in all these myths is the delusion that cost is the only limiting factor in obtaining health care. If government provides the medical services to everyone for "free", then, as the British Medical Journal predicted so hopefully in 1942, a national health system will provide "a 100 percent service for 100 percent of the population." After sixty years of trying, they haven't even come close.

Rationing, inefficiencies, and lack of quality are the real fruits of this socialist experiment. And we need less, not more of it. On the other hand, when patients decide and speak with their own resources, including private insurance and cash, hospitals and doctors pay attention to them - and meet their needs.

Source



What should "healthcare" mean? "Allowing a single trade-union, no matter how high-priced that union's members may be waged, to dictate all forms of policy in that realm ... is not only wrongheaded, but counterproductive to the goal of good health for a society of individuals. Given that the physicians' trade-union has both monopoly powers and the backing of pretty much every government agency to enforce its will, it is surprising more libertarians are not just as outraged by this condition as they are about the IRS, the DEA or the other laundry-list of interventionist agencies around."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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17 April, 2005

THIS IS WHERE AMERICA DOES HAVE SOCIALIZED MEDICINE

Look forward to similar immovable indifference towards everybody if the Dems get their way

Despite a court order to improve medical care for inmates, San Quentin State Prison's health facilities and treatment practices are so harrowingly bad that many sick prisoners should not be taken there at all, independent examiners have concluded. The court-appointed experts inspected the medical records of 10 inmates who died over the last few years in California's oldest and best known prison and concluded that in each case, the treatment "showed serious problems" and "most deaths were preventable."

Doctors and nurses misdiagnosed illnesses, gave patients the wrong medications, neglected them for months and even years or delayed sending them to emergency rooms until they were fatally ill, the experts discovered.

The examiners watched a dentist examine inmate after inmate while wearing the same pair of gloves. Records were in such disarray that doctors reported that they could not find medical files for at least 30% of the inmates they examined.

Based on visits to the prison earlier this year, the experts' April 8 report documented filthy clinics and patient housing. Dental examinations are done in a place without light or water; inmates are initially evaluated in a room without a sink for washing hands; nurses until recently used a broom closet as an examination room; and wheelchair-bound patients cannot roll into the hospital cells on their own because the doors are too narrow.

"We found a facility so old, antiquated, dirty, poorly staffed, poorly maintained, with inadequate medical space and equipment and overcrowded that it is our opinion that it is dangerous to house people there with certain medical conditions and also dangerous to use this facility as an intake facility," the experts wrote.

The examiners found less dreadful but nonetheless extensive shortcomings with the medical care at Salinas Valley State Prison and the California State Prison at Sacramento, in Folsom. Although they found improvements, the visits uncovered some of the same management problems that plague San Quentin, including a lack of basic medical equipment, dirty facilities and a culture of indifference among some senior medical staff.......

Romero said the reports make her question whether the prison system is capable of reforming itself. She noted that while $1 billion of the $7-billion annual prison budget is spent on healthcare, the reports suggest that much of this money is squandered. "What these reports reflect is there has been a culture of negligence by the bureaucracies across the various administrations in terms of addressing the most basic healthcare needs of inmates," Romero said....

The experts also noted that the prison only emerged within the last decade from a previous federal order to improve medical care. "The system of organizational structure within the [California Department of Corrections] that permitted this facility to deteriorate over the past 10 years to the state described in this report must be addressed as well," they wrote. "These problems have not occurred overnight."

Among the problems at San Quentin identified by the examiners:

* Three patients who later died had been seen by the same doctor, who the experts said failed to properly treat patients with clear signs of extreme illness and did not refer them for emergency care "until their conditions had deteriorated to the point where their deaths were inevitable." The doctor, who was not named in the report, was placed on administrative leave after the third death.

* One patient identified as having "extremely high blood pressure" was "basically neglected for over a year and a half" until he died.

* Another patient who died from renal failure was not correctly diagnosed for "an extended period" and then was not given dialysis. He was, however, given medicines that were not safe for him.

More here



AUSTRALIANS GO FAR TO AVOID WAITING LISTS

Pity if you are too sick to travel

Patients needing elective surgery are turning to country hospitals, where waiting times are shorter than in metropolitan hospitals. New State Government figures show patients are waiting up to a year or more for elective surgery at Melbourne hospitals. But smaller waiting lists at country hospitals allow patients to have most types of elective surgery within 10 weeks.

Waiting lists for every Victorian hospital were released yesterday on a government internet site. The Your Hospitals list is designed as a guide for patients, allowing them to choose which hospital offers the shortest wait for elective surgery. But it has revealed some embarrassing figures for some major Melbourne hospitals. Patients at Frankston and Monash hospitals wait 55 weeks for surgery on feet and toes. Hip replacements take up to 44 weeks at Williamstown Hospital.

But at hospitals in Shepparton, Traralgon and Ballarat, the wait for the same surgery is no longer than 20 weeks. Knee reconstruction patient Ross Fernando, 23, bypassed lengthy waiting lists at Maroondah and Box Hill hospitals. He chose instead to see a surgeon at the West Gippsland Healthcare Group in Warragul, 90km from his Montrose home, and waited just two months before surgery. "It was an hour-and-a-half drive, but it saved me a 10-month wait," Mr Fernando said.

Health Minister Bronwyn Pike said waiting lists at some hospitals were not up to scratch. "Some of these figures are still too high and other governments may have baulked at providing them to the community, but giving choice and information to make the system better over-rides any other concerns," she said.

However, Opposition health spokesman David Davis said the Government's statistics did not reveal the full story about hospital waiting times. He said some elective patients waited years. Marina De Vizcay, 62, from Wantirna, said she had been waiting nearly seven years for breast reduction surgery to ease neck and back pain. And Maroondah Hospital staff had told her she could be waiting a further two years, she said. "I feel like I have been forgotten," she said.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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16 April, 2005

THE MORE THE GOVERNMENT SPENDS ON HEALTH CARE THE MORE IT COSTS YOU

As you raise a pen to sign your tax return this year, you will undoubtedly regret that the U.S. Treasury is taking so much of your income. You should also ask why so much of the income you have left is spent on health care and health insurance. The two questions are related. The plain fact is that the U.S. government spends more of your tax dollars "providing" health care every year. The expense is increasing rapidly, and the rate of increase for Medicare and other programs will escalate further as the years pass. At the same time, what you have to pay for health care or health insurance will increase even faster. This may seem illogical. It is not. It is the ruthless logic of cause and effect. Your health care costs will continue to escalate not in spite of government involvement with health care, but because of it.

Does anyone really believe that, if the cost of something is a problem, the federal government is the solution? As P.J. O'Rourke remarked, "If you think health care is expensive now, just wait until it is free." Contemporary medicine, from the development of new prescription drugs to revolutionary diagnostic tools to innovative new treatments and breakthrough surgical procedures, is a highly technological field. It is changing at breathtaking speed, based on dynamic science that the government cannot begin to understand, let alone micromanage. A few hundred thousand civil servants will not add clarity to the process. If they try hard, they can probably destroy a lot of this progress through rationing, controls, bureaucracy and political favoritism. But the traditional government approach - pumping in billions of dollars of government money - has not heretofore demonstrated an ability to decrease costs. The government cannot even control the cost of something as straightforward as postage stamps!

Health care can be expensive. Innovation, breakthrough technologies and new drugs all require brains, hard work and freedom. Private investors require one other thing that government programs do not: results. Government spending and controls will chase away the investments that get results and attract those who want to build administrative empires with your taxes.

A near-government monopoly on anything becomes an enormous magnet that draws in special interests, political cronies and anyone with an agenda. What has long since happened to education in this country is now happening to medicine. Will powerful national health care unions focus on better health care for individuals or on higher wages and shorter hours for their members? Will politicians put the interest of patients first or the interests of workers whose paychecks are automatically tapped every month to make political contributions? Will the quality of health care improve for everyone or only for those with "politically correct" diseases - if even them? Will affirmative action mean that the best health care will be reserved for those who used to get the worst? The possibilities that politicians can exploit are endless.

The best way to reduce both taxes and the cost of health care is to keep control of your own health care. That means that you have to take responsibility to insure that it is paid for. Recent tax code provisions for Health Savings Accounts can helpyou do this. In conjunction with low-premium, high-deductible health insurance policies, this puts health care within the financial reach of most Americans. While President Bush has unfortunately done much to expand government involvement in your health care, he has now made one decent proposal: tax exemption for the cost of those insurance premiums.

If you would like to have a healthier experience on April 15 in future years, look into tax-free Health Savings Accounts. Fight to liberate your health insurance premiums from the burden of tax, and to keep the heavy hand of government-managed health care from threatening your life.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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15 April, 2005

ROGUE TENNESSEE JUDGE REINED IN

The Tenncare saga is coming to an end

A federal appeals court ruled Tuesday that state officials do not need a judge's approval to drop 323,000 adults from Tennessee's expanded Medicaid program. A three-judge panel of the 6th U.S. Circuit Court of Appeals said in a ruling issued from Cincinnati that a federal judge overstepped his authority in January when he blocked the state from making the cuts.

Gov. Phil Bredesen wanted to cut the rolls to save money on the $8 billion TennCare program, and he got approval last month from the federal government, which pays two-thirds of the bill. TennCare recipients went to court to protect their benefits, and U.S. District Judge William J. Haynes blocked the cutbacks pending a hearing.

The appeals court said Haynes improperly restricted "the state's substantive policy choices in altering the TennCare program."

Source



Medicare mess: "As President Bush and Congress try to fix Social Security, the other huge federal program for seniors faces insolvency even sooner. But when it comes to Medicare, the politicians have no prescription. The national health program for Americans 65 and older faces all the demographic difficulties that have made Social Security the president's No. 1 domestic priority: aging baby boomers, fewer workers paying taxes in the future, and a system that will soon be unable to deliver on its promises. Social Security's fiscal problems escalate in about 2018, when it is projected to begin paying out more in benefits than it receives in taxes; Medicare reached that milestone last year."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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14 April, 2005

ONE GUESS THAT THIS IS A PUBLIC HOSPITAL

More than 270 patients died from the alleged misuse of sedatives at a Madrid hospital over two years, it was reported yesterday, prompting calls for a judicial inquiry. The patients died after being admitted to the accident and emergency department of the Severo Ochoa hospital in Leganes, a Madrid suburb. Most died within 24 hours of being admitted to A&E after being treated with the sedatives morphine, midazolam and tranxilium.

Luis Montes, 56, has been suspended as head of the department, where the death rate was three times higher than in similar clinics in Madrid, according to El Mundo, a daily newspaper. The hospital's own investigations found that in at least 42 cases the amount of sedative administered was either not indicated, was excessive, or doubtful, according to El Mundo. Two senior medical officers have also been suspended.

Despite the public disquiet over events at the hospital, colleagues of Dr Montes have called for his reinstatement. Dr Montes, who was known by hospital staff as Shining Path after the Peruvian Maoist guerrilla movement, has denied that he acted improperly.

The hospital had drawn up its own protocol in the case of terminally ill patients, which held that sedatives could be administered if sufferers were expected to live for only six more months or less. But last week the daughter of a man who went in for a routine examination for respiratory difficulty and died after being sedated, began legal proceedings, according to El Mundo, which has, because of what it called grave irregularities, demanded an urgent judicial inquiry into the affair... There had been no fatalities from misuse of sedatives since the suspension of Dr Montes, the newspaper said.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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13 April, 2005

WHEN YOUR CUSTOMERS DON'T PAY AND ARE BORING TOO, YOU HAVE EVERY MOTIVE TO GET RID OF THEM

In Britain, of course

A coroner is demanding a public inquiry into claims that 11 hospital patients were deliberately starved to death. He believes that it could be Britain's first case of forced "mass euthanasia". Peter Ashworth, the coroner for Derby, will open an inquest later this year into the suspicious deaths at the city's Kingsway hospital. He considers the matter so serious that he has written to the Department of Health asking for the inquest to be superseded by a judicial inquiry with powers to investigate practices at the hospital.

There is now increasing concern across Britain about the way hospitals appear to be hastening the deaths of elderly patients. Police in Leeds and Hampshire are also looking into similar cases.

The 11 patients, all men aged between 65 and 93, died in the Rowsley ward for the elderly at Kingsway. A review of the cases, ordered by the coroner, found evidence that their deaths may have been speeded up by withholding sufficient food. The allegations first surfaced after Jayne Drew, a healthcare assistant, alerted the hospital managers after the deaths of Simon Smith, 74, and Arthur Boddice, 81, in the summer of 1997.

Families of fellow patients at the hospital claimed that some staff had become so upset at seeing elderly people being starved that they had taken it upon themselves to feed them secretly. One relative has described how it was distressing to see his father go without food. Andrew Hughson said his 75- year-old father, also called Andrew, would vainly stretch his hand towards meals being delivered to other patients. "We kept being told that feeding him would be bad for his general health, and he was too frail to tell us otherwise," he said.

The inquest has been delayed by two investigations: one by the hospital, which found no evidence of wrongdoing, and the other by Derbyshire police, which sent a file to the Crown Prosecution Service (CPS). The CPS ruled that there was insufficient evidence to prosecute and now the police are awaiting the results of Ashworth's inquest, which is expected to take three months.

After taking over the case, he sent 23 patients' medical notes to Clare Royston, the clinical director of elderly people's services at the Bedfordshire and Luton Community NHS trust. She concluded that 11 of the deaths may have been deliberately speeded up.

Yesterday Ashworth released a statement saying: "I am aware there is a possibility that issues might arise in the inquest which are not within my jurisdiction to consider."

The health department has offered to hold a confidential internal inquiry [Coverup! coverup!] into practices on the ward after the inquests. This has been rejected by the victims' families because it would not have the same powers as a judicial inquiry. "As a group we have rejected that offer," said Simon Smith's son Michael, a zoologist. "They have been arguing, but we and the coroner want a full public inquiry.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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12 April, 2005

THE HAND THAT GIVETH CAN ALSO TAKE AWAY

Patients who refuse to change their unhealthy lifestyles could be refused medical treatment, under proposals from the [U.K.] Government's NHS watchdog. The controversial suggestion from the National Institute of Healthcare and Clinical Excellence would mean that a smoker in need of heart surgery might be denied the operation unless he or she promised to give up the habit.

The proposal is contained in a document which sets out for the first time the social values that should underpin decisions by the institute on which treatments to provide on the NHS.

It says all patients should be treated equally regardless of their age or social responsibilities and rules out discrimination on the grounds of gender, race or socio-economic status.

The only exception should be where a patient's age might affect the chances of success of the treatment. "Health should not be valued more highly in some age groups rather than others," it says. On self inflicted illness - that caused by "unhealthy lifestyles", such as casual sex, smoking, drinking or dangerous sports - it rejects the idea of "deservedness" in deciding who should receive treatment and says it would be impossible in many cases to determine which illnesses were self-inflicted.

It adds: "If the self-inflicted causes of the condition influence the likely outcome ... of an intervention, it may be appropriate to take this into account." A spokesman admitted there was a "grey area" between denying treatment on clinical grounds, because a patient might not benefit from it, and "blackmailing" them to change their behaviour in line with medically accepted health norms.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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11 April, 2005

A REAL MEDICAL DISASTER

Dangerous drug-resistant staph infections are showing up at an alarming rate outside hospitals and nursing homes in the United States. New research found that in one part of the country, as many as one in five infections were picked up out in the community. Until recently, these hard-to-treat cases were seen only in hospitals and other health-care settings where they can spread to patients with open wounds or tubes and cause serious complications. Now doctors are seeing resistant strains among inmates, children and athletes. Researchers at the Centers for Disease Control and Prevention suspected that those outside infections might just be leaking out of hospitals rather than emerging from the general population. But their study in Baltimore, the Atlanta area and Minnesota proved that theory wrong.

Overall, they found 17 percent of drug-resistant staph infections were caught in the community and did not have any apparent links to health-care settings. "Close to one-fifth of what used to be a hospital-specific problem is now a community problem. And that's a large number," said the CDC's Dr. Scott K. Fridkin. "We didn't think it would be anywhere near that high when we started the study." Their findings are published in Thursday's New England Journal of Medicine.

In a second study in the journal, researchers reported that drug-resistant staph has acquired "flesh-eating" capabilities and caused 14 cases of rare necrotizing fasciitis in the Los Angeles area. All needed surgery and 10 were in intensive care. The condition is usually caused by strep bacteria, and there has been only one other confirmed case caused by staph. "The bugs are winning, unfortunately, and we need to catch up," said Dr. Loren G. Miller, one of the researchers at Harbor-UCLA Medical Center. "We really need to rapidly develop antibiotics to catch up with the bugs and start using antibiotics more appropriately."

Source

My American medical contacts tell me that public hospital cleaning in America is in many hospitals done exclusively by minorities -- who because of their minority status are virtually unsackable. Any attempt to sack one would be "racism". As a result, their cleaning efforts are very desultory. And it is mainly poor cleaning that allows the buildup and spread of MRSA. So America as a whole now looks set to pay a huge price for affirmative action

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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10 April, 2005

SERVICE CUTBACKS: THE FUTURE OF GOVERNMENT MEDICINE

Some patients would be forced to catch a school bus to get hospital care under government plans to close beds and reduce services at a New South Wales north coast rural hospital, a doctors' group said today. The Rural Doctors' Association of NSW said it had become aware the state Government planned to close all 14 inpatient beds and end 24-hour emergency services at Campbell Hospital at Coraki, near Lismore. The Government wanted to have the emergency department open only during business hours, the group said.

The association's president Peter McInerney today urged NSW Health Minister Morris Iemma to guarantee existing services would continue at the hospital, 740km north of Sydney. "Closing Coraki Hospital is bad policy and bad politics," Dr McInerney said. "Those living in and around Coraki will be left without local access to ongoing hospital treatment, immediate assistance with emergency births and 24-hour accident and emergency care. "If the hospital closes, some patients who need inpatient services or minor procedures and have no transport of their own may have to travel by school bus to access services in other centres."

Dr McInerney questioned why government funding was available for mothers to have home births in Sydney, but there was no money for 24-hour emergency care in a rural community.

Source



PAINKILLER HYSTERIA

The blockbuster painkiller Bextra was yanked off the market Thursday, and the government ordered that 19 other popular prescription competitors - from Celebrex to Mobic to high-dose naproxen - carry tough new warnings that they, too, may increase the risk of heart attacks and strokes.

The warnings encompass an entire class of anti-inflammatory medicines called NSAIDs that are the backbone of U.S. pain treatment, not just newer versions of the painkillers initially suspected when the heart concerns made headlines last fall.

The warnings - in black boxes, the strongest the Food and Drug Administration can order - are likely to cause confusion because they won't tell patients and doctors which of these prescription drugs is a safer choice. In addition, the FDA will make over-the-counter NSAIDs, or nonsteroidal anti-inflammatory drugs, such as ibuprofen, naproxen and ketoprofen bear stronger reminders to take only low doses for a few days at a time to avoid the same risks of high-dose, long-term use.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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9 April, 2005

YOUR GOVERNMENT WILL LOOK AFTER YOU

They are so desperate to get staff for their public hospitals that they will be hiring Rover the dog as a doctor next. No wonder they are running a big coverup

Nurses at Bundaberg Base Hospital were asked to "hide" patients so they would not be treated by a Pakistan-trained doctor dubbed "Dr Death" by colleagues. The doctor, who has fled the country since the beginning of an investigation into his work at the public hospital, has been accused of gross incompetence linked to the deaths of at least 14 patients.

But Health Minister Gordon Nuttall will keep secret a report detailing evidence about the deaths and a trail of serious injuries suffered by patients at Bundaberg Base Hospital. The report, by Chief Health Officer Gerry Fitzgerald, includes evidence gained from interviews with doctors and nurses at the hospital.

Queensland Health medical sources described the doctor, hired more than two years ago under the controversial overseas-trained doctors scheme, as "dangerous and incompetent". They said his actions had been extremely harmful, and in some cases lethal, to more than 14 patients and were an indictment of the health system for its failure to respond to complaints two years ago. Patients who have been harmed, and the relatives of those who have died, are demanding an explanation from Queensland Health about the doctor's proficiency and conduct.

The Courier-Mail has been told of how at least one specialist at the hospital was so concerned he pleaded with nurses to "hide" his patients in various wards to prevent them being seen by the doctor.

But Mr Nuttall and director-general Dr Steve Buckland yesterday went to Bundaberg Base Hospital to tell a confidential staff meeting that the evidence gathered by Queensland Health in relation to the doctor's conduct would not be made available. They admonished staff for leaking some of the evidence, which embarrassed Mr Nuttall because it was revealed in State Parliament last month before he was aware that an investigation by his own Chief Health Officer was under way.

The doctor, whose Queensland Medical Board registration lapsed last week, quit his job and left Australia at Easter, days after the concerns were made public. Mr Nuttall told staff that as the doctor had left Australia, the report on his conduct could not be fully completed and that any issues raised would be dealt with at a district level. But a senior medical source described this as "an outrageous cop-out and an insult to everyone who ever underwent surgery by (the doctor)". He said it was "a shocking attempt to play down the seriousness" of evidence gathered by Dr FitzGerald, who interviewed a number of doctors and nurses and scrutinised patient notes and previous written complaints.

Mr Nuttall refused to be interviewed by The Courier-Mail, but his spokesman David Potter said the minister had "not seen any report and he would not expect to get it because the doctor has left the service. He has probably been updated on it". "It can't be completed without going back to the doctor and, obviously, we can't go back to him because he has packed up and gone," Mr Potter said.

Bundaberg Base Hospital executives were accused in Parliament of failing to properly and urgently address a number of serious complaints two years ago by staff who were alarmed at the rate of complications, deaths and injuries after the doctor's surgery. State Parliament was told one of the hospital staff had been traumatised "because I've watched patients die, and I feel that every time I see him walk into the unit, I feel sick because I think, who's he going to kill now".

A Queensland Health report leaked to The Courier-Mail in late 2003 warned that a growing number of overseas doctors rushed into Queensland public hospitals lacked "medical competence and capability" and were putting patients and the community at risk. Senior doctors in the public and private sector have repeatedly warned that Queensland Health, the Federal Government and the Medical Board of Queensland were compromising public safety by failing to check the clinical skills of imported doctors. Registration boards and the state and federal governments have relaxed standards for checking the competence of imported doctors, some of whom have highly questionable clinical skills and difficulty in communicating in English.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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8 April, 2005

SCIENCE MCCARTHYISM

Blackballing sections of the science community: The new US protocol that says scientists with corporate connections are unfit to judge drug safety smacks of modern-day McCarthyism

In March 2005, the US National Institutes of Health (NIH) announced new rules purporting to eliminate 'conflict of interest' among its employees - including banning all consulting (paid or volunteer) for biomedical companies, and prohibiting employees or their families from owning stock in any biotechnology or pharmaceutical company.

The new rules were the latest result of a campaign championed by so-called public interest consumer groups to rid scientific institutions and review boards of 'pro-industry' bias. They demand full disclosure of funding sources and other industry ties among all scientists researching, writing and publishing on topics related to medicine and public health.

This debate goes back to the 1990s. On the editorial boards of prestigious medical journals, charges and countercharges about pharmaceutical company funding biasing data on drug safety and efficacy abounded - and new, strict guidelines were established to require disclosure of funding prior to publication. In 2001, the Center for Science in the Public Interest (CSPI), inspired by consumer activist Ralph Nader, launched its 'Integrity in Science' project, which provided information on the financial links between scientists, organisations and industry. As CSPI put it at the time, it was 'concerned about the link between industry and science, and how the demands of the former can undermine the public interest mission of the latter'.

Supporters of these 'full disclosure' policies (and the more draconian NIH rules, which prohibit even perceived ties to corporations) argue that these rules are in the interest of consumers and have no negative effects for individual scientists or for free and open scientific debate. But this is misguided. Indeed, such policies: a) create a dichotomy between credible scientists (those who have no industry ties), and non-credible scientists; b) discourage what would otherwise be successful interactions between America's top scientists and corporations; and c) chill the scientific debate by removing scientists with 'industry ties' from advisory and decision-making roles, leaving only those seen as pure and untainted.

These negative effects were evident in the recent CSPI attack on the integrity of scientists evaluating the safety of the painkillers Vioxx, Bextra and Celebrex, from a group known as Cox-2 inhibiting drugs.

Relying on data from its Integrity Project, the CSPI in essence argued that the only reason that the Food and Drug Administration (FDA) scientific advisory panel voted in February 2005 to return Vioxx to the market and leave its pharmaceutical cousins Bextra and Celebrex on drugstore shelves, was that the panel was packed with pro-drug industry surrogates who cast their votes not based on their professional interpretations of the available data but to please their corporate sponsors. (This claim was the subject of a front page New York Times story, '10 voters on panel backing pain pills had industry ties', on 25 February 2005.)

The implication was that biased scientists (defined as scientists with 'ties to industry') put their own financial interests above the health of American consumers and voted, despite the available evidence, to approve the sale of dangerous drugs.

Those who campaign against scientists' industry ties make several questionable assumptions:

-- scientists who had at some time worked for or consulted for a pharmaceutical industry by definition could not be trusted to make an unbiased decision based on their interpretation of the available science;

-- panelists who boasted of not having industry ties were by definition credible, honest and independent - and thus in a better position to do what was right for the American consumer;

-- in the case of Vioxx and its cousin drugs, the FDA had not acted in the public interest, and in the future should be prevailed upon to exclude from scientific panels any scientist who has any tie with companies whose product was under review - whether that tie be previous employment, one or more consulting positions or stock ownership in the company;

-- the only truly pro-consumer decision of this FDA panel would have been a ban on the pain-relieving drugs, and only scientists without ties could make this worthy decision.

All scientists have personal ideologies

The result is a protocol separating credible from non-credible scientists by applying a formula for modern-day McCarthyism, asking scientists who want to qualify for FDA committee membership: 'Are you now or have you ever been the recipient of financial compensation or other revenues from drug companies?' Indeed, the Integrity Project is actually a list - much like the list of known or suspected communists in the 1950s - of scientists who have been identified as having at some point in their careers worked with 'industry'. A scientist on the list is apparently lacking in integrity. A scientist not on this list has his or her integrity intact. The implications of such blackballing are grave.

First, self-appointed consumer advocates - especially the Nader groups such as the Center for Science in the Public Interest and the Health Research Group - have a long history of opposing any products of technology, not just pharmaceuticals but food additives, pesticides and tools of modern agriculture and food production. These groups have a clear agenda: they oppose technology and any profits that technology generates, no matter what the benefits to consumers may be. In debating the issues, however, these groups often lack scientific evidence. So to succeed in public debates, they often rely upon ad hominem attacks on those who consider any technology (food, drugs, consumer products) to have benefits that outweigh the risks.

Second, in dismissing any scientist who has consulted with industry as tainted and non-credible, self-appointed consumer advocates overlook the reality that corporations turn to the best and brightest scientists for expert advice. If one wanted to play the ad hominem attack game, one could just as easily argue that those who are not consulted may be less knowledgeable than their consultant counterparts. Populating the FDA advisory committees (and similar committees in other federal agencies) only with people who haven't worked with corporations, would introduce some real sources of bias into such panels.

Third, in the case of the painkilling drugs, it was a legitimate scientific position to decide that Cox-2 inhibitors offered options to those who suffer greatly from arthritis - and offered enormous potential for reducing risks of cancer. But in the view of consumer advocates, that conclusion should only be allowed to reach the public if uttered by the most unlikely source, those scientists who have a track record of contempt for the pharmaceutical industry.

Campaigning groups are really saying that there is no legitimate position other than their own - all others are bought and paid for by industry, and they will find the ties that delegitimise them. There is, apparently, no such thing as an alternative independent, credible position.

But what matters in science is not funding, but the accuracy and legitimacy of the data generated and the conclusions drawn. The now-defunct Tobacco Institute, funded by the industry, used to claim that it had never been proven that cigarette smoking causes human disease and death. Was this outfit credible? No, but not because it got its money from tobacco companies. If the Tobacco Institute had been funded by the Easter Bunny, its pronouncements would still have been scientifically outrageous, because the controversy had long since ended over whether cigarettes are the primary cause of premature, preventable death.

If scientists who have consulted industry are viewed with suspicion, what about potential biases associated with other forms of funding - for example, funding from government, private foundations and even consumer contributions? Government regulatory agencies need a steady stream of reasons to justify their existence. If the US Environmental Protection Agency gives a group a grant to evaluate the environmental toxin du jour, might there be a bias towards finding data to justify the regulation of this chemical, thus pleasing the regulatory agency? Government agencies are not neutral; they are their own special interest groups.

Private foundations may not be neutral either. The Tides Foundation, a generous funder of most major US environmental advocacy groups, has a commitment to ridding the environment of 'toxic' chemicals - whether they are in farmed salmon, household dust, cosmetics or children's toys. Why is an ideologically fueled foundation any less suspect as a funding source and a source of bias than a corporation?

Then there is potential bias that is outside the financial arena. If a researcher reports on AIDS data and policy, should we require that his sexual orientation be identified? If a scientist is evaluating policies related to affirmative action programs, should her race be identified? If a physician is reporting on the promising results of a new heart drug, should consumers be made aware that he has spent decades of his career trying to prove this drug safe and effective, and has a professional and emotional commitment to having the results come up positive so that his years of work have not been in vain?

The reality is that all scientists have personal ideologies, motivations and goals - all of which can potentially introduce bias into research. Scientific work should be evaluated on its merits (that is what peer review and replication of results are all about), not on 'conflicts of interest' that may or may not exist.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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7 April, 2005

AN EVIL U.S. GOVERNMENT AGENCY

Since the late 1990s, the U.S. Drug Enforcement Administration has allied with state and local law enforcement agencies to stamp out abuse of the painkiller OxyContin. Citing rises in emergency room episodes and overdoses associated with the drug (both of which have been roundly disparaged by critics), the DEA insists its "Operation OxyContin" is a necessary reaction to the diversion of the prescription narcotic for street use.

Unfortunately, despite frequent robberies and burglaries of pharmacies, doctors' offices, and warehouses where prescription medications are stored and sold, the DEA has focused a troubling amount of time and resources on the prescriptions issued by practicing physicians. It's easy to see why. Doctors keep records. They pay taxes. They take notes. They're an easier target than common drug dealers. Doctors also often aren't aware of asset forfeiture laws. A physician's considerable assets can be divided up among the various law enforcement agencies investigating him before he's ever brought to trial.

Over the last several years, hundreds of physicians have been put on trial for charges ranging from health insurance fraud to drug distribution, even to manslaughter and murder for over-prescribing prescription narcotics. Many times, investigators seize a doctor's house, office, and bank account, leaving him no resources with which to defend himself. A few doctors have been convicted. Many have been acquitted. Others were left with no choice but to settle.

All of this has been happening just as the field of chronic pain management has made some remarkable progress. The development of opium-based narcotics like OxyContin (also known as "opioids") has been a Godsend to the estimated 30 million Americans who suffer from chronic pain. Opioids are safe, effective, and, contrary to conventional wisdom, very rarely lead to accidental addiction when taken properly. Most of the medical literature puts the rate of such addiction at less than one percent.

The DEA's campaign puts law enforcement officials in the troubling position of determining what is acceptable medical practice in a field that's dynamic, still emerging, and relatively experimental. The very fact that any course of treatment "beyond the normal practice of medicine" can be cause for cops to launch a career-ending investigation is enough in itself to stifle innovation in palliative therapy.

The high-profile arrests and prosecutions of physicians (up to 200 per year, by one estimate) have caused many doctors to under-prescribe or refuse to see new patients. It corrupts the candor necessary for an effective doctor-patient relationship. Many physicians have left palliative therapy for less controversial practice. The Village Voice reports that medical schools are now advising students to avoid pain management practice altogether.

To calm its critics, the DEA commissioned several pain specialists to work with federal officials to put together a set of guidelines for physicians who treat pain with opioids. These guidelines were posted on the agency's website, and most doctors were led to believe that following the recommendations would keep them safe from prosecution. For a short time, experts, doctors, and drug warriors had reached a compromise.

But it didn't last long. Late last year the guidelines mysteriously disappeared from the DEA's website. Their removal coincided with the trial of Virginia pain specialist, Dr. William Hurwitz, whose attorneys had attempted -- and failed -- to admit the guidelines as evidence on the belief that Hurwitz's practice conformed to their parameters. Hurwitz was eventually convicted, and faces a life sentence later this month.

A few weeks after Hurwitz's judge refused to admit the guidelines as evidence, the DEA renounced the contents of the brochure, and in a brief explanatory note made clear that the agency wasn't bound by any standards or practices when it came to determining what physicians it would investigate.

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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6 April, 2005

DRUG SAFETY: SANITY PREVAILS FOR ONCE

Celebrate. Celebrate.No, that's not the return of the Celebrex TV ad with its aerobic arthritics. That's the euphoria of physicians delighted with a Food and Drug Administration advisory panel's recommendation earlier this year that Vioxx and its cousins Bextra and Celebrex (all medicines known as Cox-2 inhibitors) should remain on the market, despite evidence they increase heart disease risk in some people. The panelists reached their decision after weighing all the data and concluding the benefits of these pain-relieving drugs outweighed the risks

Specifically, these scientists acknowledged that, for some patients, these prescription drugs were uniquely effective in reducing pain from arthritis and other causes. For others — concerned about ulcers associated with aspirin and other OTC analgesics — the Cox-2 inhibitors offered the advantage of minimizing potentially serious effects of stomach irritation.

Vioxx is back in the news this week as pretrial hearings in hundreds of federal liability cases against Merck begin in New Orleans (Merck asked that the cases be placed under one judge for pretrial motions so it isn't dealing with hundreds of similar cases in different courts). Now is an appropriate time for everyone to take a fresh look at the benefit-risk equation for Vioxx and the other Cox-2 inhibitors.

The risks — increased risk of heart disease in some who use the drugs — have been well publicized. Much less publicity has been given to a spectrum of real and potential benefits that go way beyond reduced risk of stomach irritation. These little-discussed benefits would have been lost, perhaps permanently — had Vioxx, Bextra and Celebrex been driven from shelves in pursuit of perfect safety, an unattainable goal.

For example, there is substantial evidence Cox-2 inhibitors can reduce development of colon polyps, precursors of colon cancer. Indeed, Celebrex is FDA-approved for those genetically prone to colon cancer. Ironically, the 2004 study that revealed the elevated heart attack risk of Vioxx was primarily designed to further establish the drug's efficacy in protecting against colon cancer. And while the results of that interrupted trial have not yet been published, there is good reason to believe they will confirm the protective effects against colon cancer established in research over the last 10 years.

At the time of its withdrawal from the market last fall, studies of Vioxx as well as the other Cox-2 drugs suggested they had other anticancer properties as well, possibly reducing the risk of malignancies of a number of sites, including the prostate, lung, bladder and esophagus. Preliminary studies of Celebrex offered hope it might protect women from breast cancer risk by lowering levels of estrogen receptors.

This relatively new class of drugs also showed promise for forestalling the devastating effects of dementia, such as Alzheimer's disease.

Had these drugs been banished — as many pharmaceutical foes advocated — their untapped promise for prevention would have evaporated well before it was evaluated and applied to save lives. Fortunately, cooler and wiser heads prevailed.

Bravo to the FDA advisory panel for insisting benefits and risks be considered in decisions about any drug, even ones sold over the counter. Even aspirin can cause gastrointestinal bleeding, severe allergies and, in kids, potentially lethal Reye's syndrome.

The cautionary tale is that real or purported risks of pharmaceuticals must not be considered apart from the benefits. Patients in consultation with their physicians — not bureaucrats and strident self-appointed consumer advocates — should decide whether to take a drug.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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5 April, 2005

BRITISH NHS IS NOWHERE NEAR COPING WITH SEXUAL DISEASES

A survey has suggested the majority of sexual health clinics have turned patients away in the last year. The snapshot picture from 69 doctors from across England found two-thirds said their clinics could not cope with demand. The sexual health charities who carried out the survey said £300m of government investment last year had had an impact. But they warned the money was not getting through to frontline services in some areas.

The survey is the third yearly analysis of services to be carried out by the Terrence Higgins Trust, the British HIV Association BHIVA) and Providers of Aids Care and Treatment (PACT). It found that 34% of clinicians reported they had "often" turned people away without being able to offer them any help. Another 30% said they had "occasionally" had to do so. The charities warn most of these patients would have been unlikely to have been able to access sexual health services elsewhere. They said this meant those who did have a sexually transmitted infection would have continued to experience symptoms themselves, and potentially pass their STI on to new partners. One specialist who responded to the survey said: "We have a single centre covering 500,000 people - currently turning away 600 patients a week."

More than half of the specialists said their ability to provide services has got worse over the past year. The survey also revealed long waits for tests. It suggested one in five patients wait a month for an STI test and more than a third wait more than two weeks for an HIV test. The charities also surveyed 47 primary care trusts. Almost half said they had not increased their spending on sexual health in the last year. But they said government investment had improved services - where funding had reached clinics.



Lisa Power, head of policy at Terrence Higgins Trust said: "Despite the government's commitment to improving sexual health, many PCTs and clinicians are still struggling to improve access to diagnostic and treatment services, and sexual ill-health continues to worsen in England. "Where government money is getting through to sexual health services, matters are improving. But too often, PCT managers are failing to take sexual health seriously." She said last year's White Paper on Public Health had committed the NHS to cutting waiting times in sexual health clinics and a national campaign to improve public awareness about safer sex. But she added: "This needs to be matched by commitment at local level if we are to see better sexual health across the country."

More here. (Via Astute Blogger)

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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4 April, 2005

GOOD IDEA FROM THE U.K.

Huge numbers of U.K. hospital employees are bureaucrats ("administrative staff"). What motivation do the hospital managers need to fire some bureaucrats and hire some more cleaners? Maybe even make the bureaucrats into cleaners? That would be good to see.

John Reid is planning to charge hospital bosses with corporate manslaughter if poor hygiene standards result in patient deaths from MRSA. The health secretary wants to close a loophole which means that nobody is legally responsible for deaths from preventable hospital-acquired infections. He has told the Healthcare Commission that if Labour wins the next election a bill will be introduced immediately. Chief executives and boards who fail to maintain the highest standards would face fines or possibly imprisonment if it can be proved that their negligence led to a patient's death.

The change will be controversial. Chief executives say the causes of MRSA are so varied that no one person can be blamed. They say attempts to bring corporate manslaughter charges in other industries have failed. However, Reid has been riled by coverage suggesting that the government has failed to stem the spread of the superbug. He wants the measures to cover care homes and nursing homes as well. "We have looked at legislative rules and at the moment we are considering them in detail," he said.

The move is expected to be trailed in Labour's manifesto. A source close to Reid said: "You can give matrons the power to close wards like the Tories are suggesting, or change cleaning companies like we do, but the buck stops with the hospital manager. The act would be another way of shutting all the loopholes which hospital managers use to get round spending money on cleaning."

Chief executives said that they have a statutory duty to ensure quality. Miles Scott, chief executive of Harrogate General Hospital NHS Trust, said: "There's a myth that managers are only interested in the financial balance. We take our statutory duties very seriously. After all, failure to fulfil them means we lose our jobs."

Andrew Lansley, shadow health secretary, said that Reid would do better to implement what was already in place. Tory research suggests only 50% of hospitals have adopted new model cleaning contracts. The MRSA controversy revived last week when Luke Day became Britain's youngest victim. He died within 36 hours of being born at Ipswich hospital. This weekend it emerged that a doctor or nurse carrying the bug was the most likely source.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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3 April, 2005

The FDA Can't Be Reformed

The past year or so has been tough on the Food and Drug Administration (FDA). In that time, the agency has taken heat over the discovery of a statistical correlation between antidepressants and "suicidal thinking and behavior." It has also been accused of sitting on information regarding another statistical correlation, this time between pain drugs such as Vioxx and an increased risk of heart attack or stroke. And it was accused of failing to foresee (and do something about) last fall's influenza vaccine shortage. All of this has led to negative publicity, congressional hearings, and (of course) calls for a bigger budget and more authority for the FDA.

But giving the FDA new powers and more money will only make things worse. The agency is beyond being "reformed." Here is why.

First, the FDA is a legally protected monopoly. It has the sole authority to ascertain the safety and effectiveness of all new drugs and medical devices for the U.S. market. Like all such monopolies, the FDA faces no competition and therefore offers a lower standard of service at a higher cost than would otherwise be the case.

In Europe, for example, makers of low-risk medical devices, such as tongue depressors, are free to certify that their products meet European Union standards, while private "notified bodies" compete with each other for the business of certifying new, higher risk devices. This competition gives each notified body an incentive to be both thorough and expeditious. "As a result," Henry Miller, formerly with the FDA, writes, "approval of new medical devices in Europe takes only half as long as in the United States, shortening the development process by roughly two years without compromising safety."1

Furthermore, bringing a new drug to market in the U.S. is "more lengthy and expensive than anywhere in the world," according to Dr. Miller. It now typically takes between ten and 15 years to bring a new drug to the U.S. market at a cost of over $800 million.2

All this means the overall supply of new drugs and medical devices in the United States is kept artificially low, driving up the price of existing products. (In this way, large, established pharmaceutical companies with expertise in dealing with the FDA benefit from the agency's regulatory regime.) It also impedes the development of marginally profitable health-care products designed to help people with more unusual conditions.

Another reason the FDA cannot be "reformed" is its lopsided incentive system. With the exception of politically sensitive drugs, such as new treatments for AIDS, the agency's employees have little incentive to speed new drug approvals and strong incentives for sometimes needless delay. There is often little cost to delaying the introduction of a drug or medical device, while there is a potentially enormous cost-in negative publicity, career damage, and so on-to FDA approval of a drug that is found to have a potentially dangerous side-effect. As a result, FDA officials have an institutional tendency to err on the side of caution-even if this keeps a potentially helpful drug or medical device off the market for months or even years. As political scientist Daniel Carpenter has written, "because learning more about [a] drug requires additional studies and additional time to review them, there is always a value to waiting."(3 This cautious posture-whether it takes the shape of delayed approvals, advertising restrictions, or other types of obstructions-can result in needless suffering and death.

For instance, the FDA for many years prohibited aspirin makers from advertising the potential cardiovascular benefits of their product since the agency had not originally approved aspirin for that purpose and despite widespread knowledge that aspirin therapy could significantly reduce the risk of heart attack in males over 50. In the words of economist Paul H. Rubin, "The FDA surely killed tens, and quite possibly hundreds, of thousands of Americans by this restriction alone."4

In another example, the FDA approved the gastric ulcer drug Misoprostol in 1988-three years after it had been available in other countries. Analyst Sam Kazman estimated-using the FDA's own figures-that this delay may have led to between 20,000 and 50,000 unnecessary deaths.5

And in another instance, the FDA prohibited vitamin and food manufacturers from advertising the potential health benefits of folic acid in preventing birth defects, although the Centers for Disease Control (CDC) recommended that women of child-bearing age take folic acid supplements for this very reason. Widespread knowledge of this benefit was therefore delayed by the FDA for another two years until Congress "loosened the FDA's vice on the advertising of vitamins and other dietary supplements" in 1994.6

These are just a few examples and obviously do not include the needless suffering resulting from the drugs and medical devices that were never developed in the first place because of the FDA. At least two studies have led researchers to believe that the agency dramatically reduced the number of new drugs introduced each year in the U.S. market after its powers were significantly expanded in 1962.7 (One study, by Sam Pelzman, showed that before 1962 an average of 40 new drugs were introduced each year. After 1962 that figure fell to just 16.)

A final reason the FDA cannot be reformed is that it has an impossible task. The agency is charged with weighing the risks and benefits of new drugs and devices for everyone. This is preposterous. All drugs have potential side-effects. Yet no person, committee, or bureaucratic agency can know what level of risk is appropriate for all people. Only individuals themselves can possibly make this choice because only they know their own circumstances. By attempting to set an acceptable level of risk for everyone else, the FDA merely prevents some people from exercising an option they might otherwise be willing to take. The FDA's one-size-fits-all standard cannot possibly "fit-all" since everyone has a different level of risk tolerance.

Fortunately, some Americans are able to get around FDA restrictions. For instance, when agency guidelines prohibited Mexican or Canadian influenza vaccines from coming into the United States during the 2004-2005 flu season (when supplies were unusually low), many elderly Americans rode buses for hours across the Canadian or Mexican borders to receive non-FDA approved vaccines.8 And many of us know from our own experience someone who has flown to Japan, Europe, or some other location to receive medical treatments not available in the United States.

Private companies could replace the FDA in cases in which consumers demanded product safety and efficacy assurance or whenever manufacturers believed their products would benefit from a private certifier's "seal of approval." Private quality-assurance certifiers already exist in the markets for many consumer products and even-informally-many health-care products.9 Private providers of assurance for medical products would have market-incentives to protect their reputations for accuracy and fairness while having a further incentive-something the FDA lacks-to act expeditiously.

Americans like to believe they live in a free country. But how free is a land in which bureaucrats and politicians decide which health-care options are legal and which are not? No one is made better off by having peaceful options in life denied him. The FDA is beyond being "reformed." It is fundamentally flawed. It should be abolished.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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2 April, 2005

WHAT BRILLIANT PROOF THAT HEALTH CARE SHOULD NOT BE BUREAUCRATIZED

With 1.4 million employees in a nation of 60 million the British NHS still cannot provide good health care -- some people wait years for treatment

It's official: the National Health Service is the fifth largest organisation in the world. The fact has emerged in an email from the Department of Health, disputing a Telegraph report that it is the third largest after the Chinese Army and the Indian Railways. Jon Hibbs, the NHS head of news, said: "Still peddling that old chestnut about the NHS being the third largest organisation in the world? You may be interested to know that our best intelligence suggests our world ranking is as follows: Chinese People's Liberation Army, 2.3m; US Dept of Defence, 2m; Indian Railways, 1.5m; Walmart, 1.5m. "So that makes the NHS, despite continual growth to more than 1.3m, at least fifth largest in the world - if you don't count McDonald's, where estimates are as many as 12m, although most of their operations are franchised."......

Yesterday, the Department of Health also released its annual workforce census which showed that less than half the new employees it hired last year were frontline health professionals. Of the 44,200 whole time equivalent new employees, 7,200 are doctors, 10,500 are nurses and 2,600 allied health professionals. The balance of 23,900 are back office staff, administrators, receptionists, lab technicians and cleaners.

However, alternative figures compiled by the Office for National Statistics two weeks ago included some other support staff. These show the NHS hired 69,000 people last year, taking the total to over 1.4m. On that basis less than a third of new NHS employees are engaged in frontline health care.. John Reid, Health Secretary, said: "We now have more doctors, nurses, scientists and therapists than ever before. The NHS is the world's biggest army for good."

More here



GOVERNMENT DRUG MANIACS TARGET DOCTORS INSTEAD OF CRIMINALS

Doctors are SO much easier to find

"A website dedicated to tracking this issue lists EIGHTY-SEVEN physicians currently under indictment and/or conviction for 'drug trafficking' -- in most cases, without a single charge having been brought by ANY private citizen or legitimate pain patient. As the site declares, the Department of Justice (and specifically the DEA) consider all of these physicians 'drug dealers' and is prosecuting or has already prosecuted them for 'running pill mills.' ...

In virtually every instance, these physicians have been entrapped by undercover agents posing as patients 'needing pain relief' or making similarly nebulous declarations; in some cases, the doctors were hauled in on 'conspiracy to traffick' charges, simply because one or more patients they prescribed for subsequently went out and sold their Oxycontin, Percoset or other prescribed medication on the street."

More here

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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1 April, 2005

FIVE HOUR DRIVE FOR BIRTH

Public hospitals in Australia's largest city all full

An expectant mother was forced to make a five-hour, 280km ambulance relay from Windsor to Canberra yesterday because there were no beds to care for a premature baby in NSW. She was loaded into an ambulance at 5.25am, beginning a trip that lasted into the morning. Stops were made at Narellan, Bowral and Goulburn before the ambulance arrived at Canberra Hospital at 10.20am.

Mr Goodier said that during the trip he feared for Natalie's life and thought his son would end up being born on the side of the Hume Highway. He said he thought Ms Brown would be taken to any one of Penrith, Liverpool or Westmead hospitals to give birth. "When the nurse said that Canberra was where we were going, I thought she was joking," he said. "I just did not believe it, I did not think it was for real." Mr Goodier said the NSW health system had let his family down. "It needs a lot of looking at, and a lot of work," he said. "It's upside down."

While the couple were transferred from one ambulance to the other, a casual nurse who accompanied them had to find her own way back to Sydney. "It's pretty hard to smile," Ms Brown said, struggling with pain, after settling in her Canberra hospital bed.

Mr Goodier, had just finished a shift at a restaurant in the bowling club at Baulkham Hills when Ms Brown told him she was in pain. He will stay in Canberra until Ms Brown has the baby - another boy. The boy will be the couple's third premature child. Mr Goodier will return to Sydney after the birth to retrieve his children, before returning to Canberra.

Hospitals whose neonatal intensive care units were on code red and unable to take more patients included John Hunter in Newcastle, Nepean in Penrith, Royal Hospital for Women in Randwick and Royal North Shore Hospital. Those on amber included the Children's Hospital at Westmead, Sydney Children's at Randwick, Liverpool hospital, Royal Prince Alfred, Westmead and Canberra.

Professor Henderson-Smart, director of the NSW pregnancy and newborn services network said yesterday: "The best place for the mother and the baby to be was Canberra because they had facility to look after the baby. The NSW Ambulance Service said only three ambulances were used in a relay from Windsor to Canberra.

Ms Brown's father Tony, who contracted Mike Carlton's 2UE radio program yesterday morning, said he went "ballistic" after hearing there was no hospital in NSW to care for his daughter. "We are the biggest city in Australia and yet we can't find facilities to deliver a baby," he said.

Dr John Gullotta, president of AMA NSW said there should be more neonatal intensive care beds in the Sydney metropolitan area. Mr Goodier said Health Minister Morris Iemma had apologised for what the young couple had been through. Mr Iemma yesterday commissioned an expert review into the case and flagged an increase in funding in the next state budget for more neonatal intensive care beds.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.

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