Map of life expectancy at birth from Global Education Project.

Thursday, June 16, 2011

A busy day in the medical journals

First, another open door crashed through, but sometimes you need to prove the obvious to get people to pay attention. (Props to NEJM for making this open access, BTW.) Joanna Bisgaier, M.S.W., and Karin V. Rhodes, M.D., had women call pediatric specialty clinics pretending (yeah yeah, deception) to be parents of sick kids and trying to get an appointment. In 54% of cases, the first question asked was what kind of insurance the kid had. If it was Medicaid or CHIP, the child was refused an appointment 66% of the time. If it was private insurance, only 11% of kids didn't get an appointment. Waiting times for kids purportedly on Medicaid, if they did get an appointment, were also much longer. This is because Medicaid doesn't pay as well as private insurance.

If you're worried about the safety of nuclear power, a review article on the health consequences of nuclear power accidents (also open access) will help inform your thinking. If you ask me, you really ought to compare this to the health risks from fossil fuel burning, which don't just happen occasionally when there's a catastrophic accident, but all the time.

After a period of considerable pessimism, we may be getting close once more to eradicating polio from the planet. It's going to be tricky, however, because once we're confident we've cleaned out an area, we have to stop giving live attenuated virus vaccine, which can occasionally escape and cause an outbreak. So it has to be played juuuuussssst right.

Over in JAMA, where more of the good stuff is behind the prescription wall, there are a few mildly interesting items but the one I'm going to highlight is the TV Kills epidemiological meta-analysis by Grøntved and Hu. "The estimated absolute risk differences per every 2 hours of TV viewing per day were 176 cases of type 2 diabetes per 100 000 individuals per year, 38 cases of fatal cardiovascular disease per 100 000 individuals per year, and 104 deaths for all-cause mortality per 100 000 individuals per year." As with all epidemiological studies, there are reasons for doubt. Maybe people who have other risk factors are more likely to watch more TV. Investigators try to control for that but they can't do it completely. And maybe these don't seem like huge numbers but they add up over time and re-runs of Jersey Shore. Watch 4 hours a day for 15 years and you've got maybe a 3 or 4 percent chance of dying prematurely. If we're talking about kids getting zombified in front of the TV from age 4, they've got the potential for 50 years of exposure time and by then we're saving on not having to pay out Social Security and Medicare.

I'm less worried about that than I am about brain rot, however.

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