There's good news and . . .

well, kind of bad news. KWC suggested I discuss this report in the new NEJM, which you aren't allowed to read because you're commoners, but it is discussed for the benefit of the rabble here.

It turns out that people in northern California who have excellent health insurance -- specifically Kaiser Permanent members -- had a sharp decrease in the rate of heart attacks from 2000 to 2009, and were also more likely to survive if they did have one. It's partly -- at least a little bit -- due to lower rates of smoking, but it's mostly due to more people taking pills to control cholesterol and blood pressure and reduce the risk of blood clots. As we are all too well aware, diet, activity patterns, and fatness have been getting worse, not better.

Fortunately, the pills are available as inexpensive generics and for the most part have few and mild side effects. A scare story came out just yesterday about a weak association between angiotensin receptor blockers and cancer, but only a minority of people take ARBs and they are more expensive than the alternatives anyway. Some docs, unfortunately, will prescribe them as first line treatment for hypertension because a few patients get a dry cough and itching from angiotensin converting enzyme inhibitors, but really -- try the ACE inhibitors first and only worry about it if you do have a problem, which you probably won't. If you do, you can just stop.

But, this is only good news as long as people can afford medical care, the industry keeps making billions of pills, and people keep taking them. It's kind of unappealing esthetically -- wouldn't you rather have everybody be fit and eating their veggies? And people in poor countries or people here who can't get health insurance don't benefit. And you can be sure we'll still have the latter for the foreseeable future, even with the recent legislation.

Ironically, uninsured people who do have heart attacks can still go to the ER and get the emergency treatment that benefits them, although they aren't likely to get the follow up care. But we don't bother to give them the cheap pills that would have prevented the problem in the first place.