Author Archives: mpowers

More technology brings more cancer

This article from the New York Times discusses the possible threat of thyroid cancer.  The topic gained a lot of concern after being addressed on the Dr. Oz show.  Dr. Oz said that thyroid cancer was “the fastest-growing cancer in women,” due to radiation from tooth x-rays and mammograms.  You can imagine how many women would become concerned about this health threat.

This is an example of how our technology and media contributes to how we view health.  Thyroid cancer has always been a health concern, but once it was discussed on national TV, people’s worries increases exponentially.  When a doctor on TV tells you that you are at an increased risk for cancer, you can’t help but get worried.  Especially since the increased health risk seems to be a direct cause of x-rays and mammograms–actions that can be very beneficial to a person’s health. Concern over radiation from Japan only contributes to these concerns.

When people’s health is threatened they panic.  However, the article also talks about how developments in technology might play a role in the number of people who are being diagnosed with thyroid cancer.  Though Dr. Oz called it “the fastest-growing cancer in women,” the increased prevalence is found in women of all ages.  If mammograms were a significant contributor to this issue, there would be an increase in women over 50 years old who were developing thyroid cancer.  The increase in the number of thyroid cancer cases has been attributed to the development of technology.  Nowadays, we are able to diagnose cancers that would not have been a significant health problem.

It is important to be informed about health, but it is also important to understand the true health threats.  Though radiation from a mammogram or tooth x-ray might increase the level of radiation in your body, that mammogram could save you from a worse health outcome.

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Dying from Drug Overdoses

In Portsmouth, Ohio the number of people dying from prescription drug overdoses is rising.  Many of those dying are adolescents and young adults.  This article describes the increasing problem in the town.  According to the article nearly 1 in 10 babies had tested positive for drugs last year. Seventh graders have been caught with prescription drugs and many rehab facilities are filling with young patients.  As of 2007, deaths from drug overdose were greater than deaths from car crashes.

This situation has been compared to the 1980s, when grandparents had to raise the children of drug addicts who grew up to become addicts, too.  An Ohio policeman talks of how children today are third or fourth generation addicts.  One fact that shocked me:  more people died in Ohio within two years due to overdoses than the number of people who died in 9/11.

A lot of people would consider drug overdoses to be a fairly private issue.  Families might be ashamed or embarrassed that their young relatives died because of prescription drug misuse.  However, in order for the issue to be addressed, the problem needs to be made public.  Local and national government officials have made this issue a priority within the past few years, designating funds to combat adolescent drug abuse.

In the Ohio town, the problem is so prevalent that business owners are having trouble finding job candidates who can pass a drug test.  The drugs are coming from a number of places:  doctors, parents, and neighbors with access to prescription drugs.

When I first read this article, I was shocked by many of the statistics, including the number of babies who test positive for drugs and the number of young drug users.  Then I thought, why is drug abuse so prevalent in this state and in this town?  Is there a reason that adolescents are turning to prescription drugs?  Shouldn’t there be help in place to prevent drug abuse from becoming a family trait?  The article noted that Portsmouth was once an industrial town.  In many towns such as this, industry has declined and there are not enough jobs.  Even those with jobs are not receiving wages with which they can live reasonably.  Perhaps this decline in productivity has led to a decline in social structure and support.  However, can the problem be solved/lessened by targeting social support systems?  Should rehab or prevention be a priority?

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A new source of donor organs?

On the front page of today’s New York Time (also found online here) is an article regarding organ donations.  As we already know, the US faces a huge shortage of organs available for transplant.  The waiting lists for organs are not getting any shorter, and donors are not really all that plentiful.  This article discusses a push to allow HIV infected organs available for transplantation to HIV positive recipients.

People who are HIV positive often suffer from kidney failure, meaning they will eventually require a new kidney.  They could possibly even require more than one transplant.  We have talked in class about personal choice, social lottery, and natural lottery in regards to burdens of disease and who should receive health resources.  Some people think that former alcoholics or patients with HIV shouldn’t receive new organs because there are people on the waiting lists who haven’t “made poor choices” about their health.  We know this isn’t always the case–sometimes there are social circumstances that lead to poor health.  Nevertheless, there is still a shortage of organs.  And yes, there is a systematic process by which UNOS determines a person’s placement on the waiting list, but that list is still really long. Allowing HIV infected patients to receive HIV infected organs would be a way to make 500-600 livers and kidneys available to those who need them.  “Every HIV infected one we use is a new organ that takes on more person off the list.” In order for this to be possible, a 23 year old amendment to the National Organ Transplant Act would have to be repealed.  This ban was passed during the height of the AIDS scare in the 1980s.

A few possible concerns about this proposal:

Allowing HIV infected organs to be transplanted would increase concern about healthy patients receiving the wrong organ or contracting HIV in some other way.  Also, some people still feel that HIV infected patients do not “deserve” a new organ or do not have strong enough systems to accept new organs.

I think this is an interesting solution to a shortage of organs.    Would it be better to have presumed consent, where people must opt out if they do not wish to be organ donors, instead of having organ donation be voluntary?  This can be a very sensitive and controversial issue, so I will be curious to see how it all plays out.

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Anti-choice: Limiting Abortion Insurance Coverage

There is a lot of disagreement over new developments regarding coverage for a state health care exchange.  Two articles from the NY Times discuss the issue: 1) Restrictions in Private Insurance and 2) Virginia Lawmakers Limit Coverage.

Abortion is already a controversial topic.  So is health care insurance.  So, it is only to be expected that the two together would spark a lot of disagreement.  The number of bills limiting abortion rights have been passing more often within the past few years due to Republican controlled legislatures.  In the 1990s, only a dozen or so were passed, compared to the 35 bills that were passed last year.

There are already restrictions on low income women receiving abortion aid due to federal spending laws, but part of the issue now is worry about future restrictions.  Many people are worried that if these abortion restrictions pass (currently five states have bans on abortion coverage), these policies will be the norm not the exception.  In fact, this is exactly what happened with contraception coverage.  After many states mandated contraception coverage, it is now the norm.  Right now,  many employers and employees do not know that most employer based health insurance provides abortion coverage.   The health care reform debates brought this issue to light, and now abortion opponents are trying to use the opportunity to restrict abortion coverage in private plans.

I wonder how this will affect other areas of coverage, especially since most of the people who will be covered through the exchanges will be low and middle income groups.  People may argue that these groups are already limited in their health insurance, so why not officially limit certain coverage.  But what happens when that doesn’t stop at abortion coverage?  Will other services be cut, especially if people’s perception of what is “normal/typical” coverage is dictated by the number of states that has laws regarding them  (ex: contraception)?

 

 

 

 

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Another look at the health care market

In class, we have discussed the pros and cons of the market system in health care.  This article presents another issue: competition among companies and their tactics to improve sales.  The article talks mostly about a company–Biotronik– that produces heart devices.  Biotronik is a little known company whose national share of the heart-device market is about 5 percent.  Still, last year 95% of the heart devices implanted at the University Medical Center of Southern Nevada were Biotronik devices.  Even more remarkable, the company’s devices were not even used before 2008. So, why are the devices that were not used at all 2-3 years ago dominating at one hospital?  Well, lets not forget that the health system is a market. In 2008, Biotronik hired cardiologists at the hospital to be ‘consultants’ for the company.  These surgeons receive payments as high as $5000/month for this role. In addition, the physicians are “courted” with fancy dinners and other ways of flattery.  Regarding this subject, one report claimed that “He loves his white wine and being entertained.”

The practice of using consultants is not unique to Biotronik.  Medtronic, St. Jude Medical, and Boston Scientific (who are the leaders in the heart device industry) also use these tactics.  So, what do we think about them?  Are the merely a result of the health system market?

There is competition among companies to provide their device to hospitals, yes, but does that mean anything to the patient?  Doctors can influence the hospitals at which they work to buy the device that they ‘consult’ for.  That doctor then chooses to implant the device into his patient.  The patient does not receive savings on the device (which can cost up to $35000) simply because his doctor is getting a good deal.  Thus, there is not really consumer choice or competitive pricing.  On the other hand, there is plenty of company self interest.  We also have to wonder if this competition is unhealthy.  If doctors can be persuaded to use a certain company’s device, how can we be certain that the device is best for a certain patient.  Does the competition to snatch doctors up as consultants lead to compromised quality?

A number of companies including Biotronik are undergoing or have undergone investigations regarding marketing and sales practices.  Also, under the new federal health care law, by 2013 these companies will have to disclose any payments to doctors for consulting and other services.   Will this limit these practices or will companies simply find a new way to promote their devices?  Is this simply a part of the health system market or should something be done to stop it?

 

 

 

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The changing market of health insurance

I recently found this article about health insurance and thought it was relevant to the assigned reading for this week.  The article briefly describes the story of Jerry Garner, a man who underwent a kidney transplant and who ended up uninsured.  After mistakenly ignoring a survey sent by his previous insurer, Garner lost his insurance.  Without health insurance, the $2000/month costs of his immunosuppressant drugs had to be paid out of pocket.  As could be expected, this steep bill was a huge burden for the Garner family.   Even though the family was often forced to choose between the mortgage and the drugs, they didn’t completely forgo the medications needed to keep Mr. Garner alive.  This emphasizes the idea that there is not a limit on price when it comes to life and death decisions.  Garner did not have insurance, but he was willing to pay $2000 that he did not have in order to receive the medication.

Fortunately, Garner was eventually able to find and qualify for a pre-existing condition insurance plan.

We have always known that insurance companies do not want to insure people with pre-existing conditions because of the risk they pose to the companies profits.  People suffering from conditions such as diabetes or people who have had organ transplants cannot shop around for insurance companies because no one will take them on.  Instead, they are forced to pay out of pocket for their medical expenses, or forgo the treatments altogether (and as we have learned, people are usually willing to pay anything for their medical care even if they cannot afford it).

Until recently, health insurance has been virtually impossible for those with pre-existing conditions (unless they entered a state high risk pool).  The new health care law has now required pre-existing insurance plans, which have much lower premiums than the state high risk pools.  The new plans offer standard coverage, extended coverage, or a plan with a high deductible and health savings account.  Though there are eligibility restrictions (you must be uninsured for at least 6 months, cannot be on Cobra, must have proof you are uninsured, etc), this is a good temporary option for people who would otherwise not have access to health insurance and is evidence that the health market is changing.

 

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The 125 year old billionaire?

Okay, I wrote another entry on a different article I had picked out, but when I read this article, I decided I really wanted to share it with you guys.  I know there was a post about longevity on this blog a week or two ago, but I thought this article presented another side to the issue.

This article does not focus on the disparities between groups of people in terms of longevity, but focuses on one man who is determined to live to see his 125th birthday.  David Murdock is a spry 87 year old billionaire who has put his time, effort, and money into research that will aid him in his goal.  He has nearly unlimited resources to visit the Mayo Clinic, to build buildings to house the California Health and Longevity Institute across the street from his company’s headquarters, and do whatever else he pleases (include import rocks from Taiwan).  The article describes his efforts to extend his life for an unheard amount of time.   (For reference, the oldest person to date was a 122 year old woman;the oldest man was 115).

One might think why should one person be able to do everything imaginable in order to better his health and extend his life when people all across the US (and across the globe) do not have access to the resources that will enable them to live to half his age?  Is this just?  The distribution of wealth and access certainly appears to be unfair.  Those with less money/access do not seem to be getting any additional benefits.  Still, he is not hurting anyone by attempting to achieve his goal.  In fact, he provides gym access and healthy foods for his employees and gave a bonus to a contractor who lost 30 pounds.  Another thing to consider:  Murdock came from a family that struggled to make ends meet.  He dropped out of high school when he was 14, and since then has had only informal education by reading books and doing his own research.  Does it matter that he is a self-made billionaire?   The outcome is still the same, even though the path to get there may have been different than we originally believed.  This is a bit like the question we asked in class: can something be unjust if the outcome was unintentional?  Murdock began his life with a limited access to education and healthcare.  He was even homeless for a period of time.  Can it be unjust that he made the most of his situation and uses his wealth to better his health?

On another note, I thought it was interesting how determined Murdock is to live to 125.  In fact, his determination seems more like an obsession.  He even criticizes people who do not eat/live as healthy as he does.  What do you think about this?  Is it unnatural to go to such lengths to live to be 125 or is Murdock merely living the ideal healthy life?

 

 

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