Summary: House Republican leaders unveiled a "Pledge to America" yesterday to repeal the health care overhaul law, along with other promises like canceling the unspent stimulus money. The New York Times asked me to write a short Op-ed for “Room for Debate.” The question at hand: “Can the Republicans gain traction on a promise to roll back benefits that are now in place? Conventional political wisdom says you can't sell a negative. But in what situations has such an approach won voter support?” You’ll find my piece, along with opinions from three other contributors, here.  

Below, the original version of my piece, restoring some information I cut to fit the Room for Debate format. You can Enter the Discussion on the Times site, and/or comment here.

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Summary: The National Physicians Alliance (NPA) http://npalliance.org/membership. is the American Medical Association (AMA) of the future. The AMA began as a guild, designed to protect the interests of its members. The NPA, by contrast, looks outward, and understands that it can save the profession only by focusing on the legitimate needs of patients.  Founded in 2005 by former leaders of the American Medical Student Association, the NPA represents a broad spectrum of some 20,000 forward-looking doctors committed to “service, integrity and advocacy.”  Its members take no money from the pharmaceutical industry.

Below, excerpts from a letter written Dr. Valerie Arkoosh, president of the NPA, to her membership, on the six-month Anniversary of the Patient Protection and Affordable Care Act. (ACA)

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Consumer Reports Health offers an excellent concise Guide to New Benefits—including the fine print. You’ll find it here.

You may have read that last year, Jack Welch fell victim to a medical error that could have killed him. While in the hospital, the retired General Electric Chairman and CEO contracted what was presumably a preventable spinal infection. It was so serious that some newspapers began polishing Welch’s obituary. 

The 73-year-old did recover—but only after spending 91 days in New York’s Columbia Presbyterian hospital battling “discitis.” Welch believes that the infection was caused by “a dirty needle from a cortisone shot he took to help him play golf.” The infection “not only spread through his spine, but also to his artificial right shoulder, which had to be surgically cleaned out.”

Enter GE Healthcare, a $16 billion unit of General Electric. Alarmed by Welch’s close call, GE researchers decided to take a close look at patient safety—and perhaps consider whether the company could develop a new line of business in the process.

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Summary: In the newest issue of The New England Journal of Medicine, famed health care economist Victor Fuchs argues that: “Current demographic, social, and economic forces will create new priorities for future biomedical innovations: more emphasis on improving quality of life and less on extending life, and more attention to value-enhancing innovations instead of pursuit of any medical advance regardless of its cost relative to its benefit.”

Sunday, Matthew Holt published a superb interview with Fuchs, (now the Henry J. Kaiser Professor Emeritus at Stanford University) on The Health Care Blog (THCB).  Below, excerpts from that interview. At the end, I offer extended commentary on this exceptional interview.  As always, Fuchs offers some eye-opening insights. You’ll find the complete September 19 THCB interview here.

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Summary: A report from the Congressional Budget Office (CBO) that came out last week spurred a flurry of headlines suggesting that fat people are responsible for the high cost of health care in America. “CBO– Obesity Will Decimate Future Health Costs and Care,” blared one headline. The story began: “While our nation’s obesity problem has trashed health care and insurance rates, the worst is yet to come.” In other words: forget about reform. Folks who eat too much will wipe out any savings.

It is true that obesity has become epidemic. As the CBO study points out, “From 1987 to 2007 the share of adult Americans who are obese has more than doubled –from 13 percent to 28 percent.” Over the same span, the amount that we spend on health problems associated with obesity has soared: “health care spending per adult grew substantially in all weight categories between 1987 and 2007,” the researchers write, but “the rate of growth was much more rapid among the obese. Spending per capita for obese adults exceeded spending for adults of normal weight by about 8 percent in 1987 and by about 38% in 2007.”

It is easy to assume this means that the rise in the percentage of Americans who sport a body-mass index (BMI) equal to or greater than 30, accounts for roughly one-third of the rise in health care spending. But that is not what the report says.

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Over at The HealthCare Blog (THCB), Michael Millenson, president of Health Quality Advisors and author of the critically acclaimed Demanding Medical Excellence: Doctors and Accountability in the Information Age, offers a fabulous account of the “Tonsillectomy Riots”  You will find it here: http://www.thehealthcareblog.com/the_health_care_blog/2010/09/remembering-the-tonsillectomy-riots.html

Millenson found the story on Tablet, an online magazine of Jewish news and culture, which, he writes, had rescued the tale “from historical obscurity. Piecing together old newspaper accounts in English and Yiddish, the magazine told what happened on New York’s heavily Jewish Lower East Side on a steamy day in June [1906] when 50,000 immigrant mothers descended on their local public schools demanding to see their children, having heard that there was a Board of Health-sanctioned child slaughter taking place.’”

In fact, the children in that particular school were in no danger. But the parents had reason to be worried. Tablet explains: “After tonsillitis reportedly kept scores of Jewish students out of school,  principal recommended the children have tonsillectomies.”  (“The idea of a contagious sore throat was apparently not part of folk wisdom at the time,” Millenson observes.)  

According to  the Tablet “When mothers complained they couldn’t afford either the doctor’s fee or taking time off to go see one, physicians were asked to perform tonsillectomies at the schools. Days before the riot, doctors had performed 83 tonsillectomies at one elementary school. That’s when the trouble began.

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Summary: Health care reformers have been promoting access to primary care as the answer to lifting the quality of care. If we had more primary care physicians, patients would be able to see them on a regular basis, and they would be less likely to wind up in the hospital–or so the theory goes.  But it’s not quite that simple.

A  report released today by Dartmouth’s Institute for Health Policy & Clinical Practice reveals that when it comes to managing chronic diseases Medicare beneficiaries  who live in regions of the country where patients typically receive more primary care, fare no better than patients in other regions.  This suggests that while primary care is important, it is effective only if it is part of a larger system of coordinated care. 

More primary care is not necessarily better care. That’s the first surprise. The second is that there is no simple relationship between the number of primary care physicians in a given area and the share of patients who see an internist on a regular basis. In fact, the study shows “no correlation” between the “supply” of primary care doctors and access” to primary care. In cities such as Boston, where the number of internists per capita is high, patients still have a hard time making an appointment. This may be because physicians are seeing their regular patients more often—leaving little room in their appointment books for new patients.

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Summary: Below, a story from Pulse—Voice from the Heart of Medicine, an online magazine that publishes true first-person stories and poems about the reality of illness and healing.

The story below raises some questions in my mind. Is this a case of humanity being trumped by the “technological imperative” –i..e, “if you have the technology you must use it”? Or was the trauma surgeon correct in reaching for the ventricular fibrillator, making a difficult, but necessary split-second decision to try to save the mother first?

On the other hand, he paid no attention to the chief resident. Was he too aggressive, too certain that he, alone, knew what to do?  Certainly, he wasn’t practicing medicine as a team sport. . .

Perhaps the answer is to look beyond the either/or. . . .See my comment at the end of the story.

I’d welcome responses from nurses, residents, doctors, medical students and patients.

To learn more about Pulse, click here : http://www.pulsemagazine.org/story.cfm?dropdown_us=1

 Broken

 Jordan Grumet

I was a third-year medical student in the first week of my obstetrics rotation. The obstetrics program was known to be high-pressure, its residents among the best. Mostly women, they were a hard-core group–smart, efficient, motivated–and they scared the heck out of us medical students.

I remember the day clearly: Not only was I on call, but I was assigned to the chief resident's team. I felt petrified.

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