From the category archives:
Who is to blame for America’s obesity epidemic?
“Feminists and liberals have transformed a legitimate medical issue of the poor into identity politics for the affluent,” [author and friend Greg Christer] told me, “which I find the worst kind of narcissistic behavior.”
How about global biological war?
Late last week, Newt Gingrich testified before the House Government Reform Technology Subcommittee on the public health system’s use of information technology to defend against and respond to terror. Yesterday, Tom Ridge engaged in a tabletop exercise with the nation’s Governors, simulating a biological attack on the United States. This morning, President Bush signed into law S.15, the Project Bioshield Act of 2004, which sets aside billions of dollars for the development and stockpiling of vaccines for bioterrorism agents, such as anthrax and smallpox (a/k/a lots of money to Bush’s Big Pharma Buddies).
All this, and anonymous rumors of sock stuffing just hours before the 9/11 commission report comes out! How about that.
Tabletop exercises and Rose Garden signing ceremonies make for pretty decent special effects, but in the case of bioterrorism preparedness, when you look behind the curtain, it becomes clear that the Administration’s committment has very little brains, heart or courage.
Reformation of the medical malpractice system has been an issue of great contention in recent years. And then, John Edwards got the nod as the Democratic Vice Presidential Candidate. I’m not sure if you’ve heard this, but there are a few people who would like you to know that, before becoming a Senator, Edwards used to spend his days before neutral triers of fact representing those who may have been injured by others. And he was pretty good at it. Edwards’ presence on the ticket has whipped the pro-“tort reform” crowd into a frenzy, and over the past few weeks the drum beat for change has grown even louder (and the band would appreciate it if you pay no mind to whether the drummer has any rhythm).
The problems within the medical malpractice system are myriad. The legislative solutions proposed, however, have generally been myopic. This is because the proponents of change — the Republicans and physicians — have successfully boiled down the debate to One Big Thing: a cap on damages. And that’s precisely the One Big Thing the Democrats and trial lawyers do not want to see put in place. It’s been largely like this for thirty years, and so long as the discussion remains on this single axis, there is little hope for making significant progress toward improving the quality of care delivered in our health system.
Fortunately, there are a few people who are trying to reframe the debate, and in this month’s issue of Health Affairs, William M. Sage offers some exciting and innovative solutions to the medical malpractice quagmire. He does it by noting how different the health care system is from when the debate began three decades ago, and by focusing his attention on the aging hippopotamus that has been standing quietly in the corner, hoping no one would notice him.
Brayden King notes that the Wall Street Journal is concerned about ever-rising health care costs in the United States. I’ve been looking at data on national health systems for a paper I’m trying to write. It turns out that there’s a lot less theoretical work done on comparative health systems than you might think, certainly in comparison to the huge literature on welfare state regimes. Here’s a figure showing the relationship between the “Publicness” of the health system and the amount spent on health care per person per year. Data points are each country’s mean score on these measures for the years 1990 to 2001.
*Update*: I’ve relabeled the x-axis to remove a misleading reference to ratios.
The Food and Drug Administration has rejected over-the-counter availability of the morning-after pill. As I have mentioned here before, easier access to such emergency contraception could reduce significantly the millions of unwanted pregnancies in the US. In case anyone is wondering whether the decision was political, consider the following:
The decision was an unusual repudiation of the lopsided recommendation of the agency’s own expert advisory panel, which voted 23 to 4 late last year that the drug should be sold over the counter and then, that same day, 27 to 0 that the drug could be safely sold as an over-the-counter medication.
[..]
The “not approvable” letter was signed by acting director of the FDA’s Center for Drug Evaluation and Research, Steven K. Galson, not by members of the FDA review team, as is usual. Former officials of the FDA said that generally means that the review team had made a different recommendation.
Those interested in reproductive health and rights probably already know that back in December an advisory panel of the Food and Drug Administration recommended that the “morning after” pill[1] be sold over the counter (OTC). The easy availability of such emergency contraception (EC) could reduce unwanted pregnancies significantly. Unfortunately, the issue is now running up against political hurdles.
Kevin Drum picks up on something Matthew Yglesias noted a while ago: the American government spends more per person on health than some governments that run quite good comprehensive public health systems. The data almost suggest that public health care is more efficient than private health care. Of course, if America gets better quality health care for all the extra $$$$$ it is spending, this conclusion wouldn’t follow. There’s remarkably little actual data to bear that out, but if you trawl through Kevin’s comments board you’ll find lots of people reporting fourth- or fifth-hand anecdotes to that effect. So I thought I’d add my own little anecdotes, comparing the only two countries I’ve ever spent significant time in. My non-expert observations suggest
1. A person with private health insurance in Australia gets higher quality health servives than a person with private health insurance in the US.
2. A person without private health insurance in Australia gets much higher quality health servives than a person without private health insurance in the US.
3. In some cases (e.g. mine) a person without private health insurance in Australia gets slightly better health servives than a person with private health insurance in the US.
Following up a link from Iain Murray on mad cow disease and the threat it does or doesn’t pose to humans I came across a column on the subject by Steven Milloy “an adjunct scholar at the Cato Institute” and proprietor of JunkScience.Com in the LA Times. Molloy is sceptical of the prion theory and reports of the British experience that:
bq. Though laboratory testing seemed to indicate that BSE and variant CJD were similar, no one could determine with certainty whether and how the BSE epidemic was related to the “human mad cow” cases. There were no geographic areas in Britain with a significantly higher incidence of variant CJD cases, and there were no cases of variant CJD among apparently high-risk groups such as farmers, slaughterhouse workers and butchers.
Two minutes of googling found the report of the British government’s report into BSE and vCJD.
The image of Hogarth's Gin Lane comes to mind after reading three pieces on Open Democracy on the booze culture in England , Ireland and Scotland . Central Bristol on a Friday and Saturday night is very much as Ken Worpole describes the centre of many British cities: full of inebriated teenagers, casual violence and, eventually, vomit. Dublin — a destination of choice for young Brits seeking to get smashed out of their brains — also has a big problem:
bq. The results of this behaviour are alarming –- doctors, from a variety of hospitals, estimate that from 15-25% of admissions to accident and emergency units in 2002 were alcohol-related. In March 2003, representatives of the medical profession highlighted some of the horrendous consequences of excessive drinking. Mary Holohan, director of the sexual assault treatment unit at the Rotunda Hospital in central Dublin, said the pattern of alcohol consumption had changed greatly. One shuddering statistic that emerged was that in the past five years there had been a four-fold increase in the number of women who had been so drunk they could not remember if they had been sexually assaulted.
That last could be a dodgy statistic (if the number rose from one to four for example) but it sounds like there’s a serious issue.
I’ve been reading Amartya Sen’s magnificent Development as Freedom this week. A more bloggable books would be hard to find: startling facts and insights jostle one another on every page. Even when you already know something, Sen is pretty good at reminding, underlining and making you think further about it. So this, for example on the life prospects of African Americans:
bq. Even though the per capita income of African Americans in the United States is considerably lower than that of the white population, African Americans are very much richer in income terms than the people of China or Kerala (even after correcting for cost-of-living differences). In this context, the comparison of survival prospects of African Americans vis-a-vis those of the very much poorer Chinese or Indians in Kerala, is of particular interest. African Americans tend to do better in terms of survival at low age groups (especially in terms of infant mortality), but the picture changes over the years.
bq. In fact, it turns out that men in China and in Kerala decisively outlive African American men in terms of surviving to older age groups. Even African American women end up having a survival pattern for the higher ages similar to that of the much poorer Chinese, and decidedly lower survival rates than then even poorer Indians in Kerala. So it is not only the case that American blacks suffer from _relative_ deprivation in terms of income per head vis-a-vis American whites, they are also _absolutely_ more deprived than low-income Indians in Kerala (for both women and men), and the Chinese (in the case of men), in terms of living to ripe old ages.
Shocking, for the strongest economy on earth to create these outcomes (which, as Sen reminds us, are even worse for the black male populations of particular US cities).
UPDATE: Thanks to Noumenon for a link to this item . I closed the comments thread because I didn’t want to spend my weekend fighting trolls. But email suggests that there are some people who have worthwhile things to say so I’m opening it again (though I won’t be participating myself).
Play safely this holiday season. (Heck, play safely even if it’s not a holiday season.) Brought to you by the UK National Health Service. [Warning: content – including audio – may not be appropriate in some work environments.]
There’s an interesting piece in yesterday's Guardian about a BMA debate on the sale of organs for transplant. Leading the charge for this is, predictably enough, John Harris:
bq. With the backing of some of Britain’s leading transplant surgeons, he will say thousands of lives could be saved by establishing “an ethical market” in live organs. Under current law the only organs used are those donated free of charge, usually by a relative, or taken from a cadaver.
Live donors running the risks of surgery to provide the organ or tissue should receive payment tax free and without consequent loss of state benefits, Prof Harris will say. They and their families should also have high priority for a subsequent transplant, should the need arise. (…..)
Prof Harris will argue that the NHS should be the monopoly buyer of donated organs….
Today the Guardian has a couple of interesting letters responding to the proposal and worrying about its social effects.
As it’s Medicare week, the NYT seems to be focusing on how US trade policies can hinder healthcare abroad. Earlier this week, Nicholas Kristof marked the FTAA discussions by reporting from Guatemala, where the government hopes to win US favour by buying brand name Aids drugs instead of generics, even though it costs three times as much and means the Guatemalans can only, presumably, treat a third as many people.
Yesterday’s front page story was about the US pharma industry’s drive, through the USTR, to stop other governments from imposing price controls on drugs bought to treat citizens. The Medicare bill was quite a victory for the drugs companies, as it prevents the US government from imposing price controls, and also mandates progress reports to Congress on efforts to open Australia’s drug pricing system.
On a first read of the story, I was transported back to my happy days in Public Policy and Public Choice I. I could almost hear the pharmas arguing; ‘In the US, we’ve just managed to ‘tie the king’s hands’, and stop the government from naming the price it pays for drugs (otherwise the government would pay such low prices that developing new drugs wouldn’t be worthwhile and soon we wouldn’t have any.). But abroad, we’re forced by governments to sell our drugs at lower prices. Which means the durn furners are free-riding on all that American R&D.’