Cleaning out the inbox

I've gotten a couple of press releases lately, which I usually ignore because I don't like to be told what to write about, if you know what I mean, but these I do commend to your attention.

This Time Magazine article by Steven Brill has gotten some coverage in the blogosphere, but it won't hurt to link it here as well. The general idea is that hospitals and other health care provider institutions don't tell you ahead of time what prices they will charge, and a lot of those prices end up looking totally outrageous. They also vary enormously, and seemingly arbitrarily. Insurance companies, which you would think would have a lot of leverage, really don't when it comes to the prestigious hospitals, which the insurers' customers demand access to and which are usually regional monopolies. Medicare and Medicaid pay less, but their prices are set through the political process and you know how that works -- powerful interests prevail over consumers and taxpayers. Medicare isn't even allowed by law to negotiate over drug prices.

It is a fact that one of the main reasons health care costs so much more in the U.S. than in  civilized nations is simply that we pay more for the same goods and services. Single payer national health care would mean the payer has real bargaining power and can get those prices down. It does not, however, guarantee that it would happen given the political process in this country.

Meanwhile, Choosing Wisely has released a new list of procedures that usually aren't indicated but are often done anyway. This also has gotten some press coverage. They sent me the release on Monday but embargoed the info until today. Since I don't usually blog at 12:01 am, I was behind the curve on it. Anyway, that's another reason why we pay more here for health care -- we don't have an equivalent of the UK's National Institute on Clinical and Health Excellence that issues guidelines on what the National Health Service will pay for because it's worth it, and won't pay for because it isn't. Congress won't allow that either.

Here are a few examples:

   Don’t use feeding tubes in patients with advanced dementia. Studies show that percutaneous feeding tubes do not result in better outcomes for these patients. The recommendation states that assistance with oral feeding is a better, evidence-based approach. (American Academy of Hospice and Palliative Medicine; American Geriatrics Society)

Don’t perform routine annual Pap tests in women 30 – 65 years of age. In average-risk women, routine annual Pap tests (cervical cytology screenings) offer no advantage over screenings performed at three-year intervals. (American College of Obstetricians and Gynecologists)

·   Don’t automatically use CT scans to evaluate children’s minor head injuries. Approximately 50 percent of children who visit hospital emergency departments with head injuries are given a CT scan. CT scanning is associated with radiation exposure that may escalate future cancer risk. The recommendation calls for clinical observation prior to making a decision about needing a CT. (American Academy of Pediatrics)

But insurance, whether public or private, will pay for all of the above, no questions asked. (BTW CT to diagnose appendicitis is also questionable in many cases, but there's no systematic review or guidance on that as yet. Maybe some day . . .)

Here's something you definitely should not pay for. (No link!)

As with any computer, it is imperative to occasionally reboot, refresh or restart your body. Unbeknownst to most, your body has its own CTRL ALT DEL function that can be set into motion by a trained physician practicing a lesser-known form of therapy called Cranial Osteopathy. This technique is capable of literally resetting, restoring and recharging our bodies and minds, to operate at optimal levels by improving the health of the cervical spine . . . .

Cranial osteopathy encourages the release of stressors and sources of tension throughout the body – especially within the head and neck region. Osteopaths utilize their finely honed sense of touch to detect and restore the Cranial Rhythm and elicit a therapeutic response.

This is probably the most ridiculous, manifest bullshit I have ever seen. There is no such thing as "cranial rhythm" and there is no such thing as "rebooting" your body, and anybody who falls for this crap is an idiot who deserves to be relieved of his or her money. That is all.