Map of life expectancy at birth from Global Education Project.

Monday, January 30, 2006

Medical Progress

With all the moaning and wailing that goes on here about drug companies pushing overpriced, useless or dangerous products; noscomial infections; trigger-happy doctors who overmedicate and over-operate; people spending their last days isolated in a nest of blinking machines and sucking, pumping tubes for no reason but to extend their dying; insurance companies, hospital and medical industry executives leeching on the public; far too little public investment in public health promotion and disease prevention; and corrupt greedy politicians just making the whole mess worse, it's easy to forget that the medical enterprise is actually finding new and better, and sometimes even cheaper ways of preventing and treating disease.

If that weren't true, I wouldn't be championing basic medical research (carried out in the public interest, by the non-profit and public sectors, not by drug companies looking only to make money), and universal health care insurance. But let's not forget that medical science and medical practice have given us all the expectation of longer and healthier lives. Here are a couple of positive findings from last week's journals. (Wish I could give you links, same old subscription only problem):

1) Ellen MacKenzie and a bunch of colleagues write in NEJM that hospitals with trauma centers save lives compared to hospitals without them. Adjusting for the severity of injuries, trauma centers have .8 relative risk of in-hospital mortality, and .75 risk of mortality after one year, compared with hospitals that don't have trauma centers. The difference is most pronounced, not surprisingly, in people with more severe injuries. It's not a huge difference in absolute terms -- 10.4% one-year mortality compared with 13.8%, in other words they're saving the lives of about 3.4% of the people who come in, but it's probably worth the investment -- even more so if we can make better decisions about making sure the most severely injured people get to the regional trauma center.

Bottom line -- I don't care how much you're into Reiki or Ayurveda, if you're hit by a bus you want to go to the hospital, and not just any hospital. Of course, trauma centers cost money, and if people come in without insurance, who's gonna pay for it?

2) I've known a few people with rheumatoid arthritis and it is a terrible disease -- painful, crippling, disfiguring. Well, it doesn't have to be any more. Paul Emery in the January 21 British Medical Journal tells us that there are new drugs that don't just control symptoms -- they can actually produce long-term remission, such that people don't even need to take medications any more. The biochemistry is complicated -- it has to do with a chemical called tumor necrosis factor alpha, which is blocked by the new drugs. What you need to know is that yes, there are side effects such as a reduced immune response and hence greater risk of infectious disease, but those aren't very severe and they sure as hell beat having progressive rheumatoid arthritis.

Caveat number two is you have to diagnose it, and treat it, early, before the bones start to erode. A good idea -- what if everybody had health insurance? Then you'd have a much better chance of getting it in time, and fewer people would suffer and become disabled. We'd even (get this!) save money because we wouldn't have to provide expensive, life-long treatment and surgery.

But we're heading in the opposite direction. This is from APHA:

On February 1, the House of Representatives will be voting on legislation-the Deficit Reduction Act of 2005-that contains cuts to entitlement programs, including Medicaid, student loan programs and child support enforcement efforts. It will allow states to charge high co-payments and premiums to Medicaid beneficiaries, scale back Medicaid benefits packages, and require native-born citizens to present citizenship documentation to be covered by Medicaid. If the bill passes, it will be sent to President Bush to be signed into law. Please contact your representative by January 31, especially if you live in a district of a target member (see below). With your help, we have a very good chance to have this legislation be voted down!

Please take action now by calling your representative toll-free at 1-800-426-8073 or sending him/her an e-mail or letter. Members of Congress always want to know how their constituents will be affected.


Connecticut-Johnson, Shays, Simmons


Florida-Brown-Waite, Lincoln Diaz Balart and Ros-Lehtinen



Michigan-Ehlers, Schwarz



New Jersey-Smith, LoBiondo, Saxton

New York-McHugh, Sweeney, Boehlert, Kelly, Kuhl

North Carolina-Jones

Ohio-LaTourette, Ney
Pennsylvania-Gerlach, Dent, Fitzpatrick, Weldon
Virginia-Tom Davis
West Virginia-Capito

And by the way, the non-partisan Congressional Budget office has figured out that the new premiums and co-pays will end up tossing 65,000 people off the Medicaid roles by 2015 -- most of them children. Then there's the compassionately conservative proposal we'll hear about in the State of the Union speech, to give everybody really crappy health insurance and let them pay for most of their needed care out of their own pockets, for which the rich will get tax deductions while the rest of us can just eat dog food. It's the ownership society, which means you own your broken skull, your internal injuries, and your auto-immune disorders. You should have prayed harder.

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