Washington Post on alcohol

Go Easy on That Drink

If consumed in moderation. Should we repeat that? In moderation. Thirty years ago government health officials forbade the authors of the first study showing alcohol’s benefits to publish their results, fearing they would be misinterpreted. Now there are decades of studies on hundreds of thousands of subjects around the world that add up to a convincing link between a pattern of daily moderate drinking and health benefits, such as a decreased risk of heart attack. There is some conflicting evidence, and it’s difficult to control for overall lifestyle, but researchers are fairly certain about at least this much: If you are a man in your fifties who has already had a mild heart attack, abstinence could be harmful to your health.

So the Post understands the issue. But at the end they wimp out!

The benefits of alcohol are preventative, and thus vague. The downsides are obvious in drunk-driving death statistics and other violence. So public health officials probably should do what they’re already doing concerning alcohol, which is stay silent until the research holds steady for a decade or two more.

We just have a problem with the concept apparently. Most adults can drink moderately without few problems. I doubt that encouraging 1 drink 3 or 4 times each week will produce alcohol related problems. I am personally testing the hypothesis. Thus, far I am having no problem sticking with 1 drink. And I feel no urge for the second.

I cannot stay quiet on this issue. We have an enjoyable intervention which helps prevent disease. Maybe I should grow a beard and sell the stuff in a health food store!

Commentary on a plan for price controls on pharmaceuticals

Misguided drug plan

West Virginia Gov. Bob Wise wants a Canadian-style system to control pharmaceutical prices.
But if he gets his way, West Virginians will have fewer drug choices and longer, more costly illnesses.
Faced with a state budget crisis, deepened by rising Medicaid costs, Mr. Wise blames higher drug prices for West Virginia’s fiscal woes and wants drug-makers to charge the same prices set by the Canadian government, not by the marketplace.
But Canada’s rigid price-control system isn’t the answer. Because of its price-fixing, many of the newer and more effective pharmaceuticals for illnesses like cancer and hypertension are unavailable there.
The price of many medicines here is high, but they treat or prevent illnesses that would cost people hundreds of thousands of dollars more than the medicines themselves. Price controls that impose disincentives to develop new drug treatments, or prevent the best drugs from getting to ill patients, would make health care worse, not better.
A study by economist Frank Lichtenberg at Columbia University shows that every dollar spent on newer generations of drugs saved four times that amount in hospital costs.
Citizens for a Sound Economy (CSE), a Washington-based free market group that is lobbying against Gov. Wise’s plan, explains that “because prescription drugs are more often used for preventive care, they stave off more debilitating, more costly medical conditions requiring expensive and lengthy hospitalization. While a $600 annual prescription for two leading cholesterol-reducing drugs may seem expensive, it is the long-term effect of those drugs that helps avert an emergency bypass operation and lengthy hospital stay at an average cost of $300,000.”

As I have written recently, I believe that health care costs should rise (as a percentage of GNP). I still have major problems with the pharmaceutical industry – especially their advertising strategies and their physician bribes (purposely hyperbolic here). Nonetheless, we better not throw the baby out with the bath water (db using a trite phrase – if someone is grading me that probably takes 3 points off my grade). I believe that we can hold the industry to higher ethical standards, but free enterprise (and the attendant rewards) helps our patients.

Around the blogs

So what are the other medical blogs saying?

assumptions about her level of understanding – a nice piece about the importance of physicians gauging their patient’s understanding of their disease. That piece links to this important issue – Death Talk Two. Let me add that very early in my career I did some ER work and had to give this talk. My father (a clinical psychologist) taught me to lead the loved ones to be the first to use the word dead. Thus, I generally would sit down with them in a room. I would start the conversation by outlining why the patient had come to the ER. Then I would state clearly that I had bad news. I would lead them to use the word dead – and almost always succeeded. Then like Richard Winters I would continue my shift and finally go home and think. Giving bad news is very necessary and it never feels right.

As a ward attending, I often model giving bad news to students, interns and residents. After each session (for example, we told a patient on Friday that he had metastatic cancer), we do a debriefing. We criticize my style – both positive and negative comments are encouraged. I grade my performance! I share what I thought I did right and how I could have improved that performance. Those of us involved in medical education must teach these skills by both role modelling and explicit discussion of the process.

Medpundit has recently tackled lawyers. This link will get you started – and take you over to Jane Galt’s continuation of this topic – More Lawyer Letters. This dialogue should continue and I would hope gain national recognition. We need better understanding of their viewpoint. I believe that they need to better understand our angst (I assume they care). I also note the Rangel is weighing in on these issues. Start here – Reform the legal system! And also check out this – It’s Not Just ‘Sue the Docs’ Anymore

Yesterday’s Bloviator (see the links on the left column and then scroll to Sunday as he does not provide links to individual rants) provides more discussion of the vaccination issue I ranted about recently.

But as the OpEd points out (and as I pointed out a month ago, although I say it with far less shrill of a tone) the Thimerosal suits opened up the door to a new type of lawsuit concerning vaccines that, for whatever reason, the Vaccine Injury Compensation Program did not appear to cover. Failing to close that loophole means opening up the childhood immunization program (and, yes, the companies that make those vaccines) to a much greater risk of lawsuit, thereby jeopardizing the vaccine supply.

The vaccine ingredient bill should be refined to accommodate such things as extended statutes of limitations for injuries such as autism (should such a connection be definitively made), and to tie up the funding-related loose ends left out of the Homeland provisions. But it should not be revoked.

Will Congress fix their mess?

Congress weighs bill to stop Medicare 4.4% pay cut

A bill introduced by Rep. Bill Thomas (R, Calif.) on the first day of the 108th Congress would halt implementation of the physician fee schedule rule — including the pay reduction — released by the Bush administration in late December.

“One of the biggest problems is that physicians face significant and successive payment cuts that could harm patients’ access to care,” Thomas said. “Our newest legislation would block the 4.4% cut from taking effect.”

The measure would rely on an infrequently used mechanism that allows Congress to overturn regulations issued by federal agencies within 60 days of publication. The Congressional Review Act limits debate in the Senate to 10 hours and bans filibusters.

The House approved a bill last year that would have replaced the 2003 cut with a 1.9% increase. The Senate, however, was unable to pass the measure as key lawmakers, including Sen. Charles Grassley (R, Iowa), balked at offering a bailout for physicians without including funds for other health care groups.

Grassley, who is now chair of the Senate Finance Committee, has objected to the Thomas bill this year because it would set aside other provisions contained within the physician fee schedule rule. Grassley is trying to broker an alternative approach in the Senate that would maintain physician payments at 2002 levels and provide some limited relief for rural hospitals.

This demonstrates the problem with our political system. Take an issue with general agreement and Senators will always try to attach another provision. I agree with finding relief for rural hospitals. But that is a different issue and should be a different bill.

“Physicians have already taken a 5.4% cut in 2002,” Dr. Coble said. “If Congress doesn’t act by March 1, physicians will take cumulative payment cuts of 10% for treating our nation’s seniors and disabled, with more cuts to come.”

Dr. Coble said there was widespread agreement in Washington that the cuts resulted from a mistake in calculations and should have been fixed long ago.

Many physician practices already have decided to limit the number of new Medicare patients they will take, while others are contemplating a change to nonparticipating status this year. That would allow them to make up for the shortfall in government payments by billing their Medicare patients more.

And advocates cannot understand why physicians fear universal health plans. They would have to orginate with Congress. And we do not trust them to [1] pass the right bills or [2] correct their mistakes. Maybe we should just sue them for malpractice!