Healthcare

Levy Izhak Rosenbaum gets 30 months (though he may end up being deported to Israel) for brokering kidney sales in New York, something which I don’t think has happened before in the United States:

He pleaded guilty in October to three counts of organ trafficking and one of conspiracy. … Three ailing people in New Jersey paid Rosenbaum a total of $410,000 to arrange the sale of kidneys from healthy donors, and an undercover FBI agent paid him $10,000. … Rosenbaum told a federal agent that he began brokering kidney sales around 1999, recruited Israelis to sell their organs and charged Americans as much as $160,000 a kidney. He told the agent that he had arranged “quite a lot” of transplants, according to a criminal complaint. … Before the judge imposed sentence, prosecutors presented testimony from a doctor and administrator from Albert Einstein Medical Center in Philadelphia. Rosenbaum organized about a dozen kidney transplants there from 1999 to 2002 and the hospital didn’t know the surgeries involved black-market kidneys, they said. … A New York man born in Israel, Elahn Quick, told the judge that he sold his kidney for about $25,000 in 2008 in a transplant organized by Rosenbaum. Becky Cohen, the daughter of the man who bought the kidney, testified that the family paid Rosenbaum $150,000 for the organ. The transplant surgery itself was financed by Cohen’s family insurance. A locksmith, Quick, 31, said he sold his kidney because he needed the cash and thought doing so was a good deed.

The role of the transplant center in Philly is an interesting one—I wonder where they thought the kidneys were coming from. Perhaps some story about relatives?

Both the legal and illegal sides of the transplant industry are embedded in the wider world of health care provision. As Bryan O’Sullivan remarks, the third paragraph of the article, setting up the story, inadvertently does quite a good job of describing US healthcare as a whole:

“It’s a kind of trading in human misery,” Thompson said of black-market kidney sales. Rosenbaum “charged a fee” for kidneys and “used a complicated web of transactions” to finance his business. “He corrupted himself,” the judge said.

“So as you can imagine it was quite difficult for us to build a case against him”, Thompson did not add.

A recent study by the Washington University School of Medicine in St. Louis found that women using IUDs and other methods like under the skin implants or Depro-Provera injections were much less likely to have an accidental pregnancy than women using ordinary birth control pills, the trans-dermal patch, or the vaginal ring. (CT readers who are not up-to-the-minute on ladyissues may be interested to learn that the ring is a polymer, well, ring, which is inserted into the vagina, and then releases hormones over the course of three weeks. The birth control type is replaced after four weeks. Another version is used to treat the effects of menopause and has a different schedule.)

The women using the pill etc. were, in fact twenty times as likely to have an accidental pregnancy as the other group. “We know that IUDs and implants have very low failure rates — less than 1 percent,” says Brooke Winner, MD, a fourth-year resident at Barnes-Jewish Hospital and the study’s lead author. “But although IUDs are very effective and have been proven safe in women and adolescents, they only are chosen by 5.5 percent of women in the United States who use contraception.” In this case the study provided the various types of birth control at no cost. Worth noting, when the cost barrier was removed, the percentage of women choosing long-acting contraceptives went way up, to 75%.
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Having gotten music all over the blog, I am now going to cover it with human blood. Intrauterine devices, whether copper only or with a progestogen-releasing cylinder, are actually the most common form of reversible birth control in the world. Most of the users are in China, however (2/3 according to Wikipedia). In the U.S., IUDs suffered a fatal blow to their reputation when the defective Dalkon Shield was released, causing at least 7 deaths and many septic abortions. It was pulled from the market in 1974, but the damage was done; as a girl I was never even informed about IUDs as a method of birth control.

That wasn’t totally unreasonable because they are less effective for women who have never given birth vaginally, being more likely to be expelled. I think there was also a misguided consensus that you couldn’t dilate a woman’s cervix enough to insert the device unless she had previously given birth. Today, as I understand it, manufacturers produce a smaller size to solve this problem.

I was on the pill for about 10 years. I always had trouble with it, experiencing breakthrough bleeding (basically you get your period twice a month, no thank you) and other various side effects including, in my opinion, exacerbation of depression. I got switched around to more types than I can remember in an attempt to find one that was acceptable.

Here’s what’s great about the copper IUD: no hormones! The copper makes your womb inhospitable to a fertilized egg, for reasons that I think are still somewhat unknown. So, maybe an egg is fertilized, but it can’t attach itself and begin appropriating resources to build a placenta. I’m not sure whether this counts as baby-killing to the anti-abortion crowd; probably yes, even though the definition of getting pregnant involves a fertilized egg implanting itself in your uterus. Not just, you know, hanging around briefly. (Do these people really think when they go to heaven they will be vastly outnumbered by the souls of fertilized eggs who failed to implant and were washed away during menses? That’s going to be some boring conversation right there. Will those little dudes be casting down their teeny, tiny golden crowns around the glassy sea? I call bullshit; I don’t think anti-abortion people believe that at all.)

Insertion of the device does hurt. It only takes a few seconds, though, and then you don’t have to do anything about it for several years. The main reason women have the device removed it that it causes heavier bleeding during their period. My experience was that this was (dramatically!) true at first, but that my body then adjusted.

Obviously the IUD does nothing to protect you from STDs. But it’s not competing with condoms in this area, it’s competing with the pill. Pregnancy rates are lower when using IUDs than when being on the pill, probably because it’s very difficult to be a perfect pill user. Guys may think it sounds easy: you take one a day, end of story. But sometimes you forget if you’ve taken it or not; actions repeated so frequently have a tendency to blur together. Or you end up staying out super-late and crashing at your friend’s place. In theory you’re meant to add condoms to the mix at that point until you start taking a new set, but in real life people often don’t bother. Part of the appeal of the IUD is that you don’t have to do anything.

My only jealousy now is of the new pills where you only get your period 4 times a year. That would be great! Let’s face it: getting your period is a pain. There’s blood everywhere! Who needs it? It’s true that it can be the most welcome sight in all the world, when you have been sitting there thinking you might be pregnant, and wondering what the hell to do about it. And suddenly these is a cadmium red solution to all your problems. Otherwise: lame. So, ladies, IUDs are great and you should consider them.

UPDATES: One commenter notes that although we don’t know how the IUD works, it seems to work primarily by inhibiting fertilization, and only secondarily by preventing implantation. So we all win, including the little dudes with the tiny crowns. Another commenter who survived a pregnancy while his/her mother was using an IUD wants me to point out that this is a possibility, and that grave birth defects can result. This is true, and something my doctor mentioned to me. The failure rate is incredibly low, but if the IUD does fail the consequences can be very serious for the developing fetus (if not fatal before the fetus is viable outside the womb, which is more likely).

<a href=”http://www.someecards.com/usercards/viewcard/MjAxMi01ZjE3NWFjODAxZmQ1Yjg0″><img src=”http://static.someecards.com/someecards/usercards/1328094881684_8768313.png” alt=”someecards.com – Thank you for cutting off funding to cancer screening programs in order to prove that you are pro-life.” /></a>
In case you hadn’t heard, the latest you-must-be-shitting-me news in re. lady parts is that the massive fund-raising organization responsible for all those pink mixers and spatulas at Target, the Susan G. Komen Foundation, has decided that preventing breast cancer is <a href=”http://www.latimes.com/health/la-he-planned-parenthood-komen-20120201,0,4104682.story”>less important than Taking a Stand for The Babies</a>. [click to continue…]

Last week’s nef event on shorter working week, which I blogged about a few days ago, is now available to watch via the LSE channel. Enjoy.

For the first time, India has gone a full year without a new polio case, the World Health Organization announced last week.

The last case, the only one in 2011, was of an 18-month-old girl in West Bengal State whose sudden paralysis was confirmed as polio on Jan. 13. There were 42 known cases in 2010.

Polio eradication officials described a year without new cases as a “game-changer” and a “milestone” because India was for decades one of the biggest centers of the disease.

All from the NYT article. I…can’t think of anything bad about this at all! Don’t help me.

<a href=”http://colorlines.com/archives/2011/12/in-home_care_workers_finally_get_federal_minimum_wage_and_overtime_protections.html”>This is huge</a>: medical homecare workers will start to be treated as actual workers, with overtime and minimum wage requirements, rather than volunteers. At some point perhaps other groups of workers excluded from that kind of basic protection–waiters, other domestic workers, farm laborers–will also overcome the racist legacy of not counting Certain Classes of People as “real” workers.

In the meantime, for god’s sake tip well and if you’re not paying the person who cleans your house or mows your lawn or delivers your newspaper or nannies your kids two weeks bonus wages at some point during the year (it doesn’t have to be during the Big Spending Season, but everyone is entitled to a vacation, and don’t give me this crap about how they’re “self-employed” and it’s “their responsibility” to budget for their own vacation), you suck.*

*Possibly not if you live in a country in which people who do this kind of work actually get the same benefits and protections as so-called “professionals.”

I can’t believe the Obama administration caved on this.

For the first time ever, the Health and Human Services secretary publicly overruled the Food and Drug Administration, refusing Wednesday to allow emergency contraceptives to be sold over the counter, including to young teenagers. The decision avoided what could have been a bruising political battle over parental control and contraception during a presidential election season.

Thanks a lot, Kathleen Sebelius. God knows we wouldn’t want one of the groups least likely to use contraceptives properly to be able to easily get their hands on some Plan B. Up next: banning over-the-counter sales of paracetemol. Ha.

Belated Update: Reading below I do see that excerpt is misleading if you haven’t read the whole article; they didn’t take Plan B away from existing over-the-counter-sales, they just refused to extend it to full OTC status which would extend to those 17 and younger.

Via Trudy Lieberman at _Columbia Journalism Review,_ an excellent story on the dubious linkages between medical academia and drug companies.

bq. Richard Page thinks Multaq is an excellent new drug for treating atrial fibrillation, a type of irregular heartbeat that affects more than 2 million Americans. And Page, chairman of the department of medicine at the University of Wisconsin School of Medicine and Public Health, should know. He co-authored a large, international study that led to the drug’s approval by the Food and Drug Administration last year, a move that could mean hundreds of millions in sales for Sanofi-Aventis, the company that makes the drug. But in putting his name on the influential paper, Page allowed Sanofi-Aventis to dictate the terms. He vouched for the accuracy and completeness of the study despite not seeing the raw data. The company, which paid for the study, collected that information and performed the analysis without an external audit for accuracy or completeness. Page says it comes down to trusting the drug company. “These companies, if they were falsifying data, wouldn’t be kept in business if that were found out,” he said. “I was satisfied and remain satisfied that the study was conducted in an appropriate way.” … In the Multaq case, Page and all six co-authors had financial ties to Sanofi-Aventis at the time of the study. Two authors worked for the company and owned its stock. Page and the four other authors moonlighted as consultants or speakers.

Genteelly corrupt relationships are a really big problem for medical research. The Boston Review has an excellent forum on this broad topic up on their website, including a quite preposterous defense by Thomas P. Stossel of medical-industry research ties against _any_ suggestion that formal standards, requirements of transparency etc might be helpful.

7854 posts in CT’s history, and virtually none written on autism. I think we are missing an opportunity here, to talk about something most people have no clue about, while chances are real that they have non-diagnosed people with autism in their families, neighbourhoods or professional circles. April 2nd was International Autism Awareness day, but since I was leaving that day for a family holiday, the post that I wanted to write arrives only now.
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Good job, House Dems!

K. Lo’s reaction. “Congratulations, Democrats. Beginning now, you own the health-care system in America. Every hiccup. Every complaint. Every long line. All yours.”

I think this does serve as a nice expression of the Republican case against health care reform. Hic! Damn you, Nancy Pelosi! Hic! Damn you, Nancy Pelosi!

In other health care reform news, I have been enjoying Awesome Hospital rather muchly. “Back off, Dr. Space Baby!” On the other hand, our girls have been getting sick at a rate of 1.2 medical emergencies a day, for a week. And Belle is traveling, so I’m a bit worn to a frazzle of a nubbin of myself. I think we should have a Frequent Faller card from our local hospital. Get 2 tests and the 3rd is free! Get 20 stitches and the next 5 are free! Baffle the diagnostician 3 times and the 4th bafflement comes at no extra charge! (Thankfully, we haven’t had to get stitches this week.)

Reading the current US debate on health care from the outside is pretty dispiriting. It is an example of what happens to rational debate in circumstances of inequality where vested interests and partisan pundits can distort discussion by throwing loads of noise, fear and disinformation into the conversation. Still, that’s no reason not to try to have a conversation about which principles ought to obtain, and I think for that it is hard to beat Ronald Dworkin’s paper “Justice in the Distribution of Heath Care”, _McGill Law Journal_, 38 (1993), pp. 883-98 (though I’m looking at the reprint in Clayton and Williams eds _The Ideal of Equality_ ).

Dworkin’s “central idea”:

bq. … we should aim to make collective, social decisions about the quantity and distribution of health care so as to match, as closely as possible, the decisions that people in the community would make for themselves, one by one, in the appropriate circumstances, if they were looking from youth down the course of their lives and trying to decide what risks were worth running in return for not running other kinds of risks. (C&W, 209)

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Megan McArdle replies to my post:

So I’m not sure that this conversation is likely to be productive, since at least one side of it has decided to substitute sarcasm for engagement. But let’s see if we can’t tone down the nastiness a little, and try to have a reasonable discussion.

I agree with the first sentence. And I agree with the second sentence. Moving right along. [click to continue…]

Three weeks ago Megan McArdle was annoyed. Have you ever noticed how health care reform proponents act as though there’s deep wisdom in reminding us that there is going to be rationing one way or another? “This is one of the things that most puzzles me about the health care debate: statements that would strike almost anyone as stupid in the context of any other good suddenly become dazzling insights when they’re applied to hip replacements and otitis media.” I – and others – pointed out that there were problems with McArdle’s use of the word ‘ration’. Without missing a beat, McArdle has moved on to being impressed by the deep wisdom of the thought that (envelope please): there is going to be rationing one way or another. She muses about the ironic circumstance that no one wants to utter the r-word and – long story short – ends by suggesting that reformers are particularly remiss in this regard. They want the fact that there is going to be rationing, one way or another, to be invisible. Have you ever noticed this about health care reform proponents?

Silly reformers. [click to continue…]