Growing up in suburban New Jersey,
my father was a hematologist; most of his patients suffered from leukemia. In
the 1960’s and early 70s, there were few effective treatment options for many
of them and my father spent a lot of time running to the hospital in the middle
of the night to provide blood transfusions for those who were in crisis;
offering support and personal attention to each of them.

These patients were mostly working-class or indigent men and
women who lived in Newark and the
gritty industrial towns that surrounded that tattered city. I don’t know what
kind of insurance my father’s patients had or whether they paid mostly out of
pocket for their care, but I was vaguely aware that an unofficial barter system
had developed over the years in lieu of some payment. That barter system, born
not only from need, but also gratitude toward a devoted doctor, served our
family well.

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In President Obama’s speech to the American Medical Association today he stood strong on all the elements of health care reform that he’s championed since the election. And in front of a tepid audience that has yet to drink the Obama Kool-Aid, the President sought to divide and conquer the larger population of physicians—reaching out to those who reject the long-term fear tactics that raise the twin specters of “socialized medicine” and “rationed care.” The AMA establishment has used these scary phrases to oppose past efforts to reform health care and recently, they’ve used them to warn against a public option for insurance.

Today, Obama reminded physicians that “you entered this profession to be healers,” not “bean counters.”

As has become increasingly clear since the AMA’s position became public, they do not speak for all doctors. First of all, the notion that the AMA represents all doctors, or even a majority, is just plain wrong. With 225,000 members, AMA membership represents just 25% of practicing U.S. physicians. They may have the loudest voice right now–and by spending $11 million on lobbying efforts last year, the dollars to make their voice heard by legislators—but others are quickly gaining ground in the fight over the heart and soul of reform.

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There’s a battle brewing over bisphenol A (BPA)—an ubiquitous chemical compound that is found in baby bottles, beverage containers, and in the lining of canned foods, as well as in hundreds of other consumer products. It’s a battle that might offer the first real test of the Food and Drug Administration’s new pledge to “put science first” when making decisions about potentially harmful substances. It’s also a battle that highlights serious deficiencies in the nation’s ability to control toxic substances in the environment.

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With a single bullet, the killing of Dr. George Tiller, an abortion provider in Wichita, Kansas, made the process of finding “common ground” in the abortion debate much more difficult.

As much as President Obama has been talking up conciliation, the rhetoric and ideology espoused by some abortion foes makes it almost impossible to work toward a national reconciliation on abortion and freedom of choice. So far, seven abortion clinic workers and doctors have been murdered by right-to-life extremists since 1994. More than a dozen clinics have been bombed over the last fifteen years and many others have suffered vandalism and near-constant threats of violence. These acts of violence are condemned by traditional right-to-life groups and conservatives, but the level of rancor coming from many of these groups serves to incite the acts nonetheless.

In my previous post I mention that there is a severe shortage of doctors who will provide abortions. This killing will make that shortage even direr—a goal that abortion foes have actively pursued.

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For the first time since 1995, it appears that Americans who describe themselves as “pro-life”  outnumber those who call themselves “pro-choice”  At least, that’s what a recent Gallup poll suggests. Gallup has been asking the question for fourteen years, and this time around 51% of those polled identified themselves as “pro-life” versus 42% who said they were “pro-choice.” These findings came out just days before President Obama delivered a controversial speech at the University of Notre Dame’s commencement where he reiterated his support for reproductive choice, while asking that both sides of the abortion issue establish common ground and “make sure that all of our health care policies are grounded in clear ethics and sound science, as well as respect for the equality of women."

How those stirring words will translate into policy remains to be seen.  As Sonia Sotomayor, Obama’s choice for the Supreme Court, faces confirmation hearings, the country is sure to be consumed once again by abortion politics as legislators scrutinize each and every one of her judicial decisions.

Meanwhile, the Gallup poll is not the only sign that Americans remain very conflicted about abortion and how it should be regulated.  A week after Gallup’s findings were announced, CNN and Opinion Research Corp. framed the issue a different way by focusing on Roe versus Wade:

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No surprise, these days more and more doctors are searching online for medical information. What is surprising, however, is that in a recent study, nearly 50% of physicians indicated that they use Wikipedia—the open-access encyclopedia that allows anyone to edit articles—as their source for medical information.

The study, conducted by Manhattan Research, and reported on here found that although physicians were visiting Wikipedia for medical conditions and other health information, only about 10% of the 1,900 physicians surveyed created new posts or edited existing posts on the encyclopedia.

“The number of physicians turning to Wikipedia for medical information has doubled in the past year alone,’ said Meredith Abreu Ressi, vice president of research at Manhattan Research. ‘Physicians, just like consumers, are heavily search engine reliant, and often Wikipedia results are what come up in the top of the organic results.’

Abreu Ressi noted the concern about accuracy regarding Wikipedia, which allows its users to create content for the site essentially without restriction. Articles are subject to perpetual editing by Wikipedia's readers. Inevitably, false information sometimes slips through the cracks.”

Wikipedia is not a reliable source of medical information for doctors.

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There was real excitement two weeks ago among some FDA officials and drug and medical device lobbyists when reports came out that Senator Charles Grassley (R-IA) might leave his position as leader of the Senate Finance Committee to take over Arlen Specter’s spot as ranking member of the Judiciary Committee. Grassley has been a tenacious critic the Food and Drug Administration’s oversight of food, drug and medical device safety. He’s also fought to curtail industry payments to physicians and researchers who conduct trials on new drugs and devices.

 As it turns out, the cheering was premature. The FDA—and its new leadership—will still have to answer to Chuck Grassley, at least for the near future: The Judiciary position was given to Senator Jeff Sessions (R-Ala), although Grassley is likely take over leadership at the end of next year.

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Fifteen years ago, insurers were trying to put a brake on healthcare costs by “managing care”—which often meant saying “no” to patients. Too often, insurers denied coverage for care that patients needed. Then came the backlash against managed care, and insurers relented.  They began to say “yes” to more treatments, and passed the cost along to customers in the form of higher premiums, co-pays and deductibles. 

More recently, insurers have begun trying to save money by shifting their focus from patients to doctors. Increasingly, insurers have been delaying payments to physicians, and, doctors say, insurers are underpaying for many services. Physicians are now fighting back, bringing lawsuits against insurers. Doctors often complain that we live in a terribly litigious society. Now, they are hiring the lawyers. Are the suits justified?

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Earlier this month the House passed a landmark bill allowing the Food and Drug Administration to regulate tobacco products, granting the agency broad authority in controlling the manufacture, marketing and sale of cigarettes and other tobacco-based goods. This legislation, called the Family Smoking Prevention and Tobacco Control Act (H.R. 1256) , is now awaiting a vote in the Senate where it is expected to be approved “expeditiously” according to Senator Edward Kennedy, one of the bill’s sponsors.  Senator Harry Reid, the majority leader, recently told Congressional Quarterly that he thought the bill will be taken up before the current session ends at the end of May.

A year ago, with the Bush Administration opposing similar legislation, sponsors of the Senate bill worried that they would not be able to muster the 60 votes needed to override the expected Presidential veto and never voted on the measure. This year, with a strengthened Senate Democratic majority and implicit support from President Obama and Kathleen Sebelius, his Health and Human Services secretary-designate, there appears to be much more optimism that the bill will pass with the two-thirds majority needed to overcome a possible filibuster from Senator Richard M. Burr, Republican of North Carolina, the nation’s leading tobacco producing state, and home to R.J. Reynolds.

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Below, a post by Naomi Freundlich, who has joined The Century Foundation.  Welcome Naomi! — MM

I still remember the sound of her voice on the phone: scared, frustrated and looking for answers. That summer I was working as a patient representative at a New York City hospital when I got a call from a middle-aged woman who had undergone a routine mammogram two weeks earlier. She still hadn’t received the results. When the woman called the imaging center, she was told that the radiologist had not yet provided his report because he wanted to see films from her last mammogram in order to make a comparison. This simple request created great anxiety for my client:

Why was it taking so long to get results? Had the radiologist seen something suspicious? Was this a sign that something was really wrong? The woman then told me that several years before, a doctor had seen an anomaly on her mammogram and that had led to more invasive testing, including further imaging and a surgical biopsy. The lesion ultimately turned out to be benign, but the experience had been extremely stressful and made her yearly mammograms a dreaded procedure.

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