Recently in Politics & health Category

The American College of Physicians - the largest medical specialty organization and the second-largest physician group in the United States - has issued this statement:

The U.S. Preventive Services Task Force (USPSTF) recommendations on mammography, which were published in ACP's flagship journal, the Annals of Internal Medicine, have regrettably been used by some critics of the health reform bills being considered by Congress to make baseless charges that the bills would lead to rationing of care. Other critics have made unfair and unsubstantiated attacks on the expertise, motivations, and independence of the scientists and clinician experts on the USPSTF.

ACP believes that it is essential that clinicians and patients be able to make their own decisions on diagnosis and treatment informed by the best available scientific evidence on the effectiveness of different treatments and diagnostic interventions. The USPSTF is a highly regarded, credible and independent group of experts that performs this role, on a purely advisory basis, to the Department of Health and Human Services, as it relates to interventions to prevent or detect diseases. As is often the case with evidence-based reviews, the USPTF's recommendations will not always be consistent with the guidelines established by other experts in the field, by professional medical societies, and by patient advocacy groups. Such differences of opinion, expressed in a constructive and transparent manner so that patients and their clinicians can make their own best judgment, are important and welcome. It is not constructive to make ill-founded attacks on the integrity, credibility, motivations, and expertise of the clinicians and scientists on the USPSTF.

Some critics have erroneously charged that the USPSTF's recommendations were motivated by a desire to control costs. According to the Agency for Health Care Research and Quality, "the USPSTF does not consider economic costs in making recommendations." The Agency continues, "it realizes that these costs are important in the decision to implement preventive services. Thus, in situations where there is likely to be some effectiveness of the service, the Task Force searches for evidence of the costs and cost-effectiveness of implementation, presenting this information separately from its recommendation" and the "recommendations are not modified to accommodate concerns about insurance coverage of preventive services, medicolegal liability, or legislation, but users of the recommendations may need to do so." [emphasis added in bold]

Under the bills being considered by Congress, the USPSTF will have an important role in making evidence-based recommendations on preventive services that insurers will be required to cover, but the bills do not give the Task Force -- or the federal government itself -- any authority to put limitations on coverage, ration care, or require that insurers deny coverage. Specifically, the House and Senate bills would require health plans to cover preventive services based in large part on the evidence-based reviews by the USPSTF, but no limits are placed on health plans' ability to offer additional preventive benefits, or in considering advice from sources other than the USPSTF in making such coverage determinations. Accordingly, patients will benefit by having a floor - not a limit - on essential preventive services that would be covered by all health insurers, usually with no out-of-pocket cost to them. Patients will also benefit from having independent research on the comparative effectiveness of different treatments, as proposed in the bills before Congress. The bills specifically prohibit use of comparative effectiveness research to limit coverage or deny care based on cost.

The controversy over the mammography guidelines illustrates the importance of communicating information on evidence-based reviews to the public in a way that facilitates an understanding of how such reviews are conducted and how they are intended to support, not supplant, individual decision-making by patients and their clinicians.

ACP urges Congress, the administration, and patient and physician advocacy groups to respect and support the importance of protecting evidence-based research by respected scientists and clinicians from being used to score political points that do not serve the public's interest.

Questions about the booming medical imaging business in Texas

Great piece of local health policy journalism by the Dallas Morning News. Excerpts:

"There's a lot of money to be made in owning imaging machines," said Dr. Richard Strax, president of the Texas Radiological Society. "You can buy a relatively inexpensive second- or third-hand MRI machine for a few hundred thousand dollars and make millions on it."


"Today we can't even tell you how many MRI machines are in Texas, who owns them, what condition they're in and what quality of scans they're turning out," Ron Luke, health policy chairman of the Texas Association of Business, told state lawmakers this year. "That doesn't sound like we're very bright, does it?"

For three sessions, radiologists and doctors have fought in the Texas Legislature over the issue of self-referral. This year's legislation, backed by radiologists and business lobbyists, would have required licensing and accreditation of imaging machines, along with a year-long state study of the extent of self-referral by physicians. But it failed.

Proponents of the legislation say opponents are driven by financial motives. Imaging has become a "lifeline" for many doctors, said Dr. Cynthia Sherry, past president of the Texas Radiological Society.

"It's all about the money, OK? Those very doctors opposed to this are the ones participating in it," Sherry said.

An 1,800-word story on a vital health policy topic. Wow, do we need more like this. Ten gallon hats off to the Dallas Morning News.

Not enough talk about evidence-based medicine in current "debate"

In an editorial in the Sacramento Bee today, Shannon Brownlee and Michael Wilkes write:

"Why isn't the issue of medical evidence front and center in the health care debate? Maybe because doctors have not always been truthful in telling people what they know and don't know. Many physicians are either unwilling or unable to take the time needed to fully explain where uncertainty exists. As a result, 65 percent of California voters are under the mistaken impression that most or nearly all of the health care they receive is backed up by scientific studies."

This is a masterful example of how to face a crowd - a crowd you don't control - and have a rational, meaningful discussion on health care reform.

Maybe it's "Minnesota Nice" at play.

However, calling this setting "an angry mob" is like calling lutefisk a national treasure.

Read how a pioneering, caring, important health care initiative - in a town often called one of "the best places to live" - was converted into a monstrous myth. Nice job by the Washington Post.

U.S. Rep. Michele Bachmann (R-Minn.) thinks U.S. health-care system is best in the world, but the statistics say otherwise, reports Casey Selix of Minnpost.com.

"The United States has two parties now--the Obama Party and the Fox Party," writes
Jonathan Alter in Newsweek. He continues:

The Obama Party is larger, but it is unfocused and its troops are whiny. The Fox Party, which shows up en masse to harass politicians, is noisy and practiced in the art of simplistic obstruction. As the health-care debate rages, it's the Party of Sort-of-Maybe-Yes versus the Party of Hell No! The Yessers are more lackadaisical because they've forgotten the stakes--they've forgotten that this is the most important civil-rights bill in a generation, though it is rarely framed that way.

"Smoking Memo - or Bad Journalism" - that's the title of Maggie Mahar's blog post on the alleged Obama-PhRMA deal. Excerpt:

Yesterday, it seemed that the Huffington Post's Ryan Grim had a scoop. He reported that Huffington has obtained a memo that "confirms" that the White House and the pharmaceutical lobby secretly made a deal--the deal that I wrote about a few days ago in a post titled "What Was Billy Tauzin Thinking?" According to the memo, the White House supposedly pledged to oppose any Congressional efforts to let Medicare negotiate for discounts on drugs, or to import drugs from Canada.


The memo in question turns out to be typed--and unsigned. How does the reporter know that it is authentic? "A knowledgeable health care lobbyist" told him so. According to the lobbyist the memo "was prepared by a person directly involved in the negotiations [and it] lists exactly what the White House gave up, and what it got in return.

Wait a minute. As PhRMA senior vice president Ken Johnson points out later in the story: "Anyone could have written it. Unless it comes from our board of directors, it's not worth the paper it's written on. . . ."

And who is the "knowledgeable lobbyist" who gave the memo to Huffington? His name is not disclosed.

What we have then, is a story based on what one unnamed source says--and a typed memo that probably is untraceable.

She goes on to quote me about whether this is acceptable journalism.

Killing Grandma and Stephen Hawking

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Roundup from the Kaiser Health News Service: "Brits Fight Back Against 'Ridiculous Claims' About Their Health System."

Senator Charles Grassley's bulldog pursuit of medical conflict of interest issues may accomplish some good in health care reform. But his repeated talk about euthanasia in health care reform makes one question his sanity.

In an Iowa meeting with citizens he said, "you get the idea that someone is going to decide grandma's lived too long."

Watch what you say on tape, Chuck: your idiocy ends up on YouTube for everyone to see.

Here's a news account of Grassley's folly.

Brazen Billy Tauzin & Pharma's Lock on US Health Care Spending

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Former US Senator David Durenberger writes in his weekly e-mail newsletter:

Former Democratic and Republican Congressman and PhaRMA exec Billy Tauzin brazenly told the White House that they'd made a deal to contribute $80 billion over 10 years to reducing the cost of health care and it was the White House's job to make sure the Democratic Congress stuck to the deal. Said brazen Billy: "Who is ever going into a deal with the White House again if they don't keep their word? You are just going to duke it out instead."


Within a few short hours, the Democratic leadership in the House told Mr. Tauzin where he could shove his "deal" and they were more than prepared to duke it out with him. Cheers from everyone for the quick put-down - which should have come from the White House, but didn't. Breathes there a man (or woman) with soul so dead that never to him/herself has said, "the drug industry has had health care financing policy to itself forever?" If a Democratic majority in Congress and the White House can't break PhaRMA's lock on America's health and health care spending, then health policy reform is impossible.

Poor Billy Tauzin

"You're known as a brazen politician, with few scruples," writes Maggie Mahar.

But, as head of the Big Pharma trade group, you now make friends with the White House to protect your industry interests as best you can. But Mahar writes:

Then out of the blue, you're blindsided by House liberals who mange, at the 11th hour, to tack on an amendment to the House bill giving Medicare the authority to negotiate discounts on drugs. How can this be? This is America. The governments of other countries may try to regulate prices, but we believe in free markets. Drug manufacturers should be able to charge whatever the market will bear--and when people are in pain, and afraid, let me tell you, the market will bear quite a bit. What right does government have to interfere in the Pharma-patient relationship?


"We had a deal!" you squeal. Furious, you spill your guts to the New York Times, explaining that when Pharma "volunteered" to contribute $80 billion to the cause over ten years, the White House agreed to limit the industry's concessions to that amount.

Poor Billy.


Read Mahar's entire blog posting on this.

Canadian legislator Bob Rae writes:

Watching the debate in the U.S. about health care has been a fascinating, if depressing, experience. In particular, the fact that a Canadian woman has played into the hands of the Republican lobby because of her understandable anxiety about her medical condition doesn't make me mad; it just makes me sad.


Shona Holmes is a Canadian insured by the Ontario Health Insurance Plan. She says she was made to wait months to get a diagnosis for her benign tumour. Once she was diagnosed, she wanted an operation right away, so went to the States for the procedure. Now she wants OHIP to pay for the cost of her U.S. treatment, which she paid for out of her own pocket. She has a public insurer, and wants a refund on her private treatment, which she decided had to happen right away.

But the trouble is that the people on whose behalf she's made the ad don't want to have a public insurer; they want to maintain a system where over 40 million people don't have coverage at all.

How many millions of Americans go untreated, undiagnosed because of their current system? How many are turned down by their insurance companies? How many Americans have gone bankrupt because of uninsured medical costs?

The ad Ms. Holmes appears in says Canadians are denied care because "the government says patients aren't worth it." So private insurance companies that routinely deny treatment and coverage in the U.S. are Good Samaritans? I think not.



Read his entire column.

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