Summary: An exceptional essay in the April issue of Lancet explores why even healthy, asymptomatic people are terrified when they hear the word “cancer.”  Robert Aronowitz, an internist and professor of the history and sociology of science at the University of Pennsylvania, describes “cancerphobia,” a term coined in the 1950s by a Cleveland Clinic surgeon who suggested that our “fear of cancer can cause even more suffering than cancer itself . . . public health campaigns with their constant calls for surveillance and aggressive treatments combine to increase cancer fears, which in turn has led to demands for increasingly aggressive intervention and more surveillance.”  Over-testing leads to over-diagnosis and over-treatment. A study just published in the Journal of the National Cancer Institute offers disturbing numbers on the magnitude of “over-diagnoses,”  defined as “the diagnosis of a ‘cancer’ that would otherwise not go on to cause symptoms or death.”

Even when we are told that tests are ineffective or of little benefit, testing gives many patients a false sense of control over their fears. Meanwhile, cancerphobia has spawned an enormous, lucrative industry.

                                   ~~~~~~~~~~~~~~~~~~~~~~~~

The very word “cancer” inspires a degree of fear that “heart attack,” “stroke” or even “kidney failure” do not. Any of these conditions can kill. Even worse, in rare cases, a stroke can leave a patient “locked in” — conscious and able to think, but unable to speak or move.

Yet, somehow, to many of us, the idea of cancer seems more horrifying.  Perhaps it is because the word calls up an image of something evil invading the body, and then spreading. It is a growing, living thing, crawling inside one’s own body, preying on the tissue.

Continue reading →

Note: The “summary” below is a HealthBeat pilot project. Some readers have noted that HealthBeat posts are, well . . . a tad long. At the same time, many seem to appreciate comprehensive, in-depth coverage of a topic. HealthBeat has a niche, and I wouldn’t want to desert those readers.   So I’ve decided to experiment with offering what a medical journal would call an “abstract” at the beginning of each post. Since HealthBeat isn’t a medical journal, I’m just calling it a “summary”. Many thanks to friend and fellow blogger Joanne Kenen  for this suggestion. Please let me know what you think about the change. mm.

Summary: Short-term, at least, hospitals are winners. When it came to negotiating with reformers, they “got into the tent early,” and the reductions in Medicare increases that they accepted will be offset by an influx of paying patients. Granted, government payments to hospitals that take a disproportionate number of uninsured low-income patients will be slashed, but because there will be many fewer uninsured patients, most hospitals will come out ahead. Those that continue to care for larger share of those who can’t pay will receive additional payments.

Fear-mongers fret that cuts in Medicare spending will threaten the financial health of the nation’s hospitals: they argue that hospitals already lose money on Medicare patients. The truth is that, today, more efficient hospitals make money or break even on Medicare beneficiaries. Hospitals that run a tight ship save money and offer better care. Unfortunately, waste remains an enormous problem in many U.S. hospitals, and waste and poor quality care go hand in hand.

Medicaid’s expansion also will help hospitals. True, Medicaid payments to hospital are low, but in the past, hospitals were treating many patients who didn’t qualify for Medicaid, but were too poor to pay their bills. Low payment beats no payment.

Continue reading →

Since 1992, the federal government has spent close to $1 billion on abstinence-only sex education, despite growing evidence that these ideology-based programs are ineffective in delaying the onset of sexual activity, preventing teen pregnancy and the spread of sexually-transmitted disease among teens. Meanwhile, comprehensive sex education—the kind where teens are given information about both abstinence and contraceptives—has received virtually no federal funding.

That’s why it was so encouraging when President Obama released his budget earlier this year and the $50 million per year since 1996 that’s been devoted to abstinence-only programs was missing. It looked like this ill-conceived emphasis on “Just Say No” sex education had finally ended.

Except it hasn’t. It turns out that Senator Orrin Hatch attached $50 million a year for 5 years into the health care bill; it made the cut to the final version, and funding for abstinence-only sex education has been reborn. It’s not clear why the funding stayed in the final legislation—reports are that it was used as a sweetener to score the votes of socially-conservative Democrats—but now $250 million is once again available for states that agree to offer only the most restrictive no-sex-before-marriage curriculum.

Continue reading →

In his latest post on GoozNews,  Merrill Goozner asks; “Why Is Tom Friedman Championing Higher Health Care Costs?” Goozner is referring to a recent op-ed piece in the New York Times in which Friedman gushes about a medical device start-up called EndoStim that he says “is the epitome of the new kind of start-ups we need to propel our economy: a mix of new immigrants, using old money to innovate in a flat world.”

This new-style start-up has no headquarters and keeps expenses low by depending on “teleconferencing, e-mail, the Internet and faxes — to access the best expertise and low-cost, high-quality manufacturing anywhere,” according to Friedman. EndoStim also plans on conducting clinical trials for its experimental implantable device in India and Chile where expenses are low. “[O]nly by spawning thousands of EndoStims — thousands — will we generate the kind of good new jobs to keep raising our standard of living.”

Continue reading →

 Twenty-eight states are now engaged in a heated debate over the difference between a doctor and a nurse: Legislators in these states are considering whether they should let a nurse practitioner (NP) with an advanced degree provide primary care, without having an M.D. looking over her shoulder.  To say that the proposal has upset some physicians would be an understatement. Consider this comment on “Fierce HealthCare”:

 “An NP has mostly on the job training…they NEVER went to a formal hard-to-get into school like medical school,” wrote one doctor. “I have worked with NPs before, and their basic knowledge of medical science is extremely weak. They only have experiential knowledge and very little of the underpinning principles. It would be like allowing flight attendants to land an airplane because pilots are too expensive. HEY NURSIE, IF YOU WANT TO WORK LIKE A DOCTOR…THEN GET YOUR BUTT INTO MEDICAL SCHOOL AND THEN DO RESIDENCY FOR ANOTHER 3-4 YEARS. NO ONE IS PREVENTING YOU IF YOU COULD HACK IT!” [his emphasis]

Continue reading →

Lobbyists representing the many who profit from our $2.6 trillion health care industry spent millions in the war over healthcare reform. Yet National Journal Contributing Editor Eliza Newlin Carney suggests that “it's unclear whether all that lobbying, advertising and check-writing yielded much.”

No question, the reform legislation that finally passed falls short of many reformers’ hopes. The public option is gone. Private sector insurers will scoop up all of the new business.  Meanwhile, by agreeing to support reform—and make some financial concessions—Pharma bought protection from generic competition, plus  a promise that it can continue to set prices, without worrying about Medicare trying to bargain for discounts.

Continue reading →

No doubt you have seen some of the numbers about the assault that corporate lobbyists mounted to try to block health care reform: In 2009 spending on health-care-related lobbying and TV advertising topped $700 million. The Center for Public Integrity reports that much of that money funded the 4,525 healthcare lobbyists who swarmed the capitol– eight for every member of Congress. You couldn’t beat them off with a stick. Of course, many legislators didn’t want to.

Yet despite that extravagant effort, National Journal Contributing Editor Eliza Newlin Carney questions whether the health care industry’s lobbyists got good value for their dollars.

 “For health industry players . . .  it's unclear whether all that lobbying, advertising and check-writing yielded much,” Carney writes. “At bottom, partisan rifts and fickle political winds have done more to derail proposed health care changes than any lobbying campaign. That stands in contrast to President Clinton’s failed health reform plan 16 years ago, which ran aground in part because of deft insurance industry lobbying.”
That last sentence made me pause. I remember 1994, and it’s true. Lobbyists played a much, much larger role in maiming, and then killing reform.

Continue reading →

Abortion was such a hot-button issue in the battle over health reform that it threatened to derail the process on multiple occasions—including the final push to get the legislation through Congress.

Supporters of comprehensive reproductive health benefits stood by and watched in frustration as the Hyde Amendment’s draconian ban on federal funding for abortion was extended even to private insurance plans available through the new exchanges. Their only solace was that the restrictions in the legislation would at least temporarily tamp down the furor over “taxpayer-funded abortions.” And with the legislation mandating increased funding for family planning and sex education, the nation could instead focus on the other strategies Obama—and seemingly many Americans—support to reduce unwanted pregnancy.

Now it’s became clear that the abortion fight is far from over; anti-choice activists are far from mollified and are eager to push their agenda far beyond health care reform. Today, Nebraska’s governor signed into law legislation banning abortions that occur in that state at or after 20 weeks gestation, using a new standard that assumes fetuses feel pain after this point. Gov. Dave Heineman also signed a law requiring women who seek abortions to receive screening and counseling for vague “risk factors” both before and after the procedure. Failure to identify such a “risk factor” could result in a doctor facing a penalty of $10,000.

Continue reading →

MYTH #1:  Reform legislation calls for a 21% cut in Medicare payments to physicians.

FACT:  First, the 21% cut has nothing to do with reform legislation. Secondly, it is never going to happen.

Back in 1997 Congress passed legislation which said that if Medicare spending on physicians exceeds a complicated “Sustainable Growth Rate” (SGR) formula in a given year, Medicare fees to all doctors would be trimmed the next year. Since then, Congress actually followed the SGR formula only once. Every other year, it postponed the cuts until the following year—which is why the accumulated postponed cuts now exceed 22%.

The SGR rule was, from the beginning, a crude solution to health-care inflation. We don’t want to whack all doctors’ fees across the board. Any adjustments should be made with a scalpel, not an axe. We know that Medicare pays some doctors (primary care docs, gerontologists, palliative care specialists and general surgeons) too little while overpaying some specialists for certain services.

Continue reading →

    Pulse: An Invitation to HealthBeat Readers

From time to time, I have quoted stories from Pulse: Voices from the Heart of Medicine, on HeathBeat. This free, online magazine publishes both narratives and poetry. Most are written by patients or health care providers. All are based on true events.

I believe that medical narrative is becoming an important part of health care reform.  Too often, when talking about healthcare, we focus only on the numbers, and ignore the stories.  As Dr. Donald Berwick, President Obama’s candidate to head the Centers for Medicare and Medicaid points out, “our measurements will mislead us if we forget the stories.” Indeed, "measurement can pluck the heart from a story.”

Pulse aims to capture the experience of receiving or giving care, and it does this very well. The authenticity of the writing is striking and the editing is excellent. Full disclosure: Paul Gross the magazine’s editor and founder,  is a friend.

But I am not alone in noticing this small magazine. Just last week, the Washington Post called attention to Pulse: “Subscribers to the free online magazine Pulse (http://www.pulsemagazine.org) receive a weekly essay or poem about health care . . . . Paul Gross, a physician and assistant professor at the Albert Einstein College of Medicine at Yeshiva University in New York, launched Pulse nearly two years ago, frustrated with the chasm between the scientific studies in medical journals and what it's like to practice medicine on a daily basis. The missing link turned out to be the voices of patients, providers and educators.” http://www.washingtonpost.com/wp-dyn/content/article/2010/03/29/AR2010032902931.html 

Pulse has now asked subscribers to invite friends to sign up for this free on-line magazine. So I am extending the invitation to all HealthBeat readers. To subscribe, please click here http://www.pulsemagazine.org/signup.cfm

Continue reading →