When I was in my twenties, I was diagnosed with glaucoma. At the time, I didn’t worry about it. I was twenty-something, busy teaching, having babies, writing a book—and, with glasses, my eyesight was 20/20.

It was only when I moved to Manhattan twenty-five years ago that I began to take the disease seriously. A friend recommended an ophthalmologist who, I was told, was one of the best in the city. He regularly turned up on lists of New York’s star specialists, had an office on Park Avenue, and didn’t take insurance of any kind. Twenty-five years ago, this was unusual. But, my employer’s insurance was generous and paid most of his very high fee.

At my first appointment, I mentioned the early diagnosis of glaucoma. After examining my eyes, Dr. X told me that that I must begin using eye drops immediately. I also should begin making appointments to see him every four months so that he could check the “pressure” on my optic nerve. Glaucoma is the second leading cause of blindness in the U.S. There is no cure, but usually it can be controlled with eye drops. “It must be watched carefully,” said Dr. X. 

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Gary Schwitzer writes on his blog “Health News Review” that he was “jolted” by a television commercial he saw recently for an artificial hip joint sold by medical device-maker Smith & Nephew.

The ad features athletic, fit, male body forms engaged in all sorts of strenuous pursuits; playing soccer, surfing, rock climbing up a craggy peak (!). The figures are rendered as stylized silhouettes but if I had to guess, I’d say they were designed with highly active men, age 40 to 50, in mind. Triatheletes and Ironmen wouldn’t be a stretch.

As Schwitzer notes, “it struck me that this younger demographic was the sole focus of the figures depicted in the commercial.”

Schwitzer would be right. The Smith & Nephew hip implant, called the Birmingham Hip Resurfacing System, is a newer kind of device that replaces just the damaged joint surfaces; not the complete joint. The femoral head is shaved down and covered by a metal cap and the hip socket is replaced with a metal cup. This procedure preserves some 3-4 inches more of the thigh bone than traditional total hip replacements. It’s being marketed as an alternative for active, younger patients (under 60) who are likely to outlive the implant and will need a total hip replacement 15 or 20 years down the road. By preserving more of the original joint, the theory is that the second surgery will be easier to perform and more successful. Two other companies now sell similar products; the Cormet Hip Resurfacing device (sold by Stryker) was approved by the FDA in 2007 and the Conserve Plus implant (sold by Wright Medical Group) got the nod in 2009.

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This fortnight’s Health Wonk Review is hosted by Louise Norris of the Colorado Long Term Care Insider who has done an excellent job of rounding up some of the most provocative health care posts published in the past two weeks.

Writing on the Incidental Economist, Austin Frakt explains that if we rein in health care spending, we have to go where the money is. And that is not in the health insurance industry. Insurance premiums are so high, in large part, because reimbursements to health care providers have been sky-rocketing, along with payments to drug-makers and device-makers.

“In each of the past 50 years payment to health care providers has accounted for more than 85 percent of health insurance premiums,” Frakt points out. “Thus, only a small fraction of spending on health insurance premiums is consumed as a cost of insurance. I have no doubt that there are ways to squeeze some efficiency out of the insurance system. But doing so is not likely to make a substantial, long-term impact on the inflation of health care costs.

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It’s open season in Congress on women’s reproductive rights. The Pence, Pitts and Smith trio of conservative Congressmen have been using gruesome depictions of abortion, charges of child-abuse (against fetuses), and other inflammatory tactics to help whip up support for their three separate pieces of anti-choice legislation.

Today, rhetoric grabbed the spotlight when the House voted 240-185 to pass Rep. Mike Pence’s (R-IN) amendment to specifically cut off all federal funding for Planned Parenthood, the 95-year-old women’s family-planning stalwart that he calls a “criminal enterprise.” The House vote is "a victory for taxpayers and a victory for life,” according to Pence who has had his sights on Planned Parenthood for years now. In fact, Pence’s amendment is a redundant, mean-spirited piece of legislation that is designed to not only block women’s access to a legal medical procedure, but is also aimed at preventing women from getting contraceptives, counseling, HIV testing and basic gynecological care.

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A vaccine or drug that can prevent healthy, yet high-risk people from developing the memory loss, confusion and other devastating cognitive problems that characterize Alzheimer’s disease is the Holy Grail for researchers, drug companies and patient advocates.

Interest in developing such a treatment is growing as it becomes increasingly clear that physiological changes occur in the brain years, even a decade, before patients experience the cognitive decline that we think of Alzheimer’s disease (AD). What was once deemed “early Alzheimer’s” is now recognized as a much later stage of the disease. And the truth is that dozens of drugs have failed to show efficacy in treating AD and the few available offer only modest benefits for alleviating symptoms. Frustration, paired with new research illuminating the molecular underpinnings and progression of Alzheimer’s is fueling a keen interest in devising drugs that can treat the “clinically silent” phase of the disease; years before cognitive symptoms become apparent. An oft-quoted analogy is heart disease, where preventing atherosclerosis is far more successful than treating heart failure.

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Over at Kevin M.D., Kevin Pho has raised the possibility that health care reformers who are calling for more “large integrated health systems like the Mayo Clinic or Kaiser Permanente” may wind up creating monopolies that have the market clout to charge more—raising the total cost of health care.

Kevin notes that “according to the Dartmouth Atlas” these large integrated health systems “lead to better patient care and improved cost control. . .  To that end, [the idea of ]Accountable Care Organizations has become a major part of health reform . . . But,” he warns, “the creation of these large, integrated physician-hospital entities that progressive policy experts espouse comes with repercussions.

“Monopoly power.

“To prepare for the new model of health care delivery, physician practices have been consolidating. In many cases, they’re being bought by hospitals. Last year, I wrote how this is leading to the death of the private practice physician.

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Today, close to one-third of all babies born in the U.S. enter the world through a slit in their mother’s abdomen, usually just above her pubic bone. Since 1975, the share of mother who undergo a Cesarean has more than tripled, rising from roughly 10.5 percent to nearly 32 percent according the Public Citizen Research Group, a health care watchdog based in Washington D.C.

These numbers have been widely reported, most recently by Leap Frog, the employer-driven hospital quality watchdog. But a central question remains unanswered: Why are so many more women choosing C-sections? Do they have enough information to make informed decisions? What role do physicians and perhaps, most importantly, hospitals play in C-section rates?

The Link between C-Sections and Induced Labor

Today, more and more expectant mothers are scheduling their babies’ births. Rather than leaving the timing to the whims of Mother Nature, they arrange to have their physicians induce labor; using drugs or mechanical devices to ripen the cervix two or three weeks before their due-date. Over the past two decades, the odds that a doctor will jump-start labor have doubled, rising to 22.5 percent of all births, reports the National Center for Health Statistics (NCHS).

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Below, a guest post from the Center for Public Integrity, one of the country’s oldest and largest nonprofit news organizations. The Center’s mission is to produce “original investigative journalism about significant public issues to make institutional power more transparent and accountable.”  Recently the Center has begun partnering with other news outlets, including the Wall Street Journal, Newsweek and the Daily Beast, to provide the in-depth investigative reporting that the vast majority of newspapers and magazines in our downsized news industry can no longer afford.

Here I am cross-posting a large chunk from a piece which focuses on how “Digital Mammography Saps Medicare Dollars.”  The subtitle reads: “How GE, Others Used Political Muscle, Advertising to Lure Medicare into the New Procedure.” 

For regular Health Beat readers, the second half of the story will be eye-opening. (Scroll down to “A Promising New Technology”).  Most of you know that our health care system  is suffering from what some call “an epidemic” of testing, but few journalists have written about the role that lobbyists for corporate giants such as GE have played in making hospitals feel that they have no choice but to buy exorbitantly expensive, and not always fully tested, medical equipment.

Click on the link to read the full story.

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Last month I wrote about the Mental Health Parity law that requires insurers to provide equal coverage for both medical and mental health services. When health reform rolls out fully in 2013, many Americans with expanded access to private health insurance will have more equitable coverage for treatment of depression, attention disorders, addiction problems and other serious mental health ills. But parity laws that apply to private insurance will do little to advance the plight of the growing portion of our population that is seriously—and chronically—mentally ill, often homeless and increasingly showing up in the criminal justice system.

According to the Department of Justice, 14.5% of men and 31% of women recently admitted to jail have a serious mental illness. Applied to the 13 million jail admissions reported in 2007 (the most recent figure), the findings suggest that more than 2 million individuals with a serious mental illness may be locked-up annually. In many cases they cycle in and out of the criminal justice system; with a stop on the way to the emergency room or for hospitalization. It’s an expensive and futile exercise.

With all the emphasis on health reform and discussion centering on a vast overhaul of how we deliver, pay for and mandate medical care, the plight of the seriously mentally ill gets short-shrift. But that doesn’t mean there isn’t a real crisis in funding (especially at the state level) and treatment–or that there isn’t a wave of reform coursing through the mental health field. It’s just that without the loud voices of lobbyists from doctor, pharmaceutical and hospital organizations and powerful patient advocates, the mental health field is reform’s poor step-sister—beyond insurance parity, very few provisions in the Patient Protection and Affordability Act address chronic, serious, mental illness.

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We all have heard that “spending more” on health care does not necessarily lead to better care. In fact, in regions of the country where care is more intensive and more expensive, sometimes outcomes are worse. This is the basic thrust of what has become known as the “Dartmouth research,” and most medical researchers agree.

But a paper just published in the Annals of Internal Medicine suggests that specific types of higher hospital spending may lead to better outcomes. After examining the records of some 2.5 million patients admitted to 208 California hospitals from 1999 to 2008 a group of researchers from the University of Southern California and Harvard Medical School report that patients who received more costly and aggressive care were less likely to die while in the hospital.

Let me be clear: this study is not trying to prove that the Dartmouth research is “wrong." The investigators, led by John Romley of the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California, begin by acknowledging that “a convincing set of studies demonstrates that U.S. regions that spend more on medical care–using more specialists, diagnostic tests, imaging, and inpatient hospital care–have similar or poorer patient outcomes than areas that spend less. (Here they footnote the Dartmouth Atlas and this article by Dartmouth’s Elliott Fisher, et.al. 

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