In memoriam: Dr. Michael Davidson, cardiac surgeon, killed while doing a job he loved. A reflection on bad outcomes versus mistakes and taking risks versus playing it safe.
It's easy to break a patient like Rogelio—Mexican and poor and chronically ill—down to his potassium level and to make medical decisions according to a number. But that's only part of the story of how the undocumented ill are cared for here in Houston. Within this city's history—a history that includes segregation during the 1960s, a large immigrant population, strong economic growth over the past half century, not to mention the world's largest medical center—is the story of how Houston sought local solutions to provide compassionate care to its indigent and undocumented, the latter of which, some might say, have helped the city grow.Dr. Ricardo Nuila reports from the emergency room at Houston's Ben Taub Hospital, where Harris County's undocumented ill can avail themselves of some of the country's best health care: Taking Care of Our Own. [more inside]
In the wake of increased compliance enforcement of the 1999 Olmstead Decision, which ruled that the unnecessary institutionalization of persons with mental illness was a civil rights violation, a man who suffers from schizophrenia and cerebral palsy struggles with the challenges of independent living after years of homelessness and psychiatric facilities.
"This world is not easy,” he said. “You can’t deal with it yourself. You gotta have somebody."
The majority of Nunavut’s children are born thousands of kilometres away from home. The territory is working to reverse that trend. Longform journalism by Katie May.
Governor Shumlin announced he would not pursue single-payer healthcare for his state. Reasons include high costs, high complexity, and Shumlin barely eking out reelection.
"When my partner Cheryl was dying from respiratory complications related to treatment for Hodgkin's lymphoma, she was in so much physical distress she couldn't bear to be touched. The only contact she could stand — one of the few ways I could share my love with her — was for me to rub her feet. As I stood at the foot of her hospital bed doing just that, a scrub-clad figure we had never seen before poked her head in the door, curled her lip and demanded: 'What is your relationship?' The question was clearly directed at me, but my girlfriend reached through her drug-induced, hypoxic haze to respond with her New Yorker tough-girl attitude: 'Really? Whose feet do you rub like this? What the hell are you, the relationship police?' " [more inside]
Aunt Bertha is a web-based platform that connects Americans in need to locally available government programs, non-profit organizations, and community-based resources that offer free or low-cost assistance with health and dental care, job placement, emergency and long-term shelter, clothing and household goods, child and elder care, legal aid, assistance with navigating the social safety net, and much more. All programs are searchable and sortable by ZIP code, city, or eligibility. Find food, health, housing, job training programs and more, anywhere. [more inside]
The Affordable Care Act was "put together by a bunch of elitists who don't really fundamentally understand the American people," said former DNC chair Howard Dean. A few years ago, Democratic Gov. Ted Strickland voiced concerns about Democrats' "intellectual elitism" and hesitancy to "talk using populist language." Republicans have long used accusations of elitism against Democrats as an electoral tactic. Did elitism lose the Democrats the 2014 midterms?
The Supreme Court has granted certiorari in King v. Burwell, invalidating subsidies through the federal healthcare exchanges, despite the lack of a Circuit split.
So I had no choice. At work, I spoke to my friend Shirley, who promised to call around her Bronx neighborhood that night. She knew someone who knew someone, and in a few days, it was arranged. I would stay with her and everything would be all right.What having an abortion was like in 1959.
'We Are Going For Change': A Conversation With 23andMe CEO Anne Wojcicki. 'After spending seven months in the Food & Drug Administration’s penalty box, the consumer genetics testing firm 23andMe recently submitted a new health-related test for FDA approval.' 'It was a significant step following last November’s FDA slapdown of 23andMe’s genetic tests, which included health reports outlining customers’ chances of getting a wide variety of diseases from celiac to melanoma. In a sharply worded warning letter, the FDA said the $99 tests, analyzed from a vial of customers’ saliva, constituted a medical device under its regulations, and the company needed to get explicit approval for providing risks of getting specific diseases.' [more inside]
"The possibility of withholding care represents a departure from the 'do everything' philosophy in most American hospitals and a return to a view that held sway a century ago, when doctors were at greater risk of becoming infected by treating dying patients. 'This is another example of how this 21st century viral threat has pulled us back into the 19th century,' said medical historian Dr. Howard Markel of the University of Michigan.
"Am I damning with faint praise? Not at all. This is what a successful presidency looks like. No president gets to do everything his supporters expected him to. FDR left behind a reformed nation, but one in which the wealthy retained a lot of power and privilege. On the other side, for all his anti-government rhetoric, Reagan left the core institutions of the New Deal and the Great Society in place. I don't care about the fact that Obama hasn't lived up to the golden dreams of 2008, and I care even less about his approval rating. I do care that he has, when all is said and done, achieved a lot. That is, as Joe Biden didn't quite say, a big deal." Paul Krugman (previously) writes "In Defense of Obama" for Rolling Stone.
The New York Times reports on a new way medical professionals are gaming the system (to the tune of $2.8T a year) - by making end runs around cost controls through out of network consultation calls.
The Atlantic pulls back the partition on Hollywood, Health, and Society, a CDC-funded clearinghouse for popular media to better understand modern medicine - and modern medical legislation like the Affordable Care Act.
"Why do so many poor people eat junk food, fail to budget properly, show no ambition? Linda Tirado knew exactly why… because she was one of them. [more inside]
Republican legislators in Missouri are pushing to expand abortion restrictions in the state. A bill mandating a 72-hour waiting period, vetoed by Governor Jay Nixon in July, is likely to become law on Wednesday in a special legislative session. [more inside]
Since 2006, Alice Proujansky has photographed childbirths around the world for a project entitled 'Birth Culture.' Her intent is to highlight 'the universal aspects of childbirth, elements that are culturally-specific and the struggle to provide women with safe, respectful maternity care.' Images: Photographer's site. NYTimes Gallery. Agnostica. Slate. Some photos may be NSFW.
I haven't been blogging for a while. Now I'm ready to tell you the story. Just so you're prepared, the story ends with "in two weeks I'm having brain surgery." Or maybe that's how the story should begin.
"... now, my sight and my world and my life have all returned." Vision: Healing the Blind in Ethiopia [vimeo, 10m] [more inside]
A timeline of diseases and vaccines [warning: graphic photo of cutaneous diphtheria at year 1975]. Categories are: diphtheria, measles, polio, smallpox, yellow fever, and 'others'. You can select one keyword to view only that subject's timeline. From the History of Vaccines website (about page | FAQ). Similar timelines at the same site for pioneers, science and society, and there's an En Español timeline, too. [more inside]
For the past several months, Allergan has been fighting a take over by its competitor Valeant. While mergers and acquisitions are far from unusual in the pharma world, this may be the first time that a public corporation has combined efforts with an activist investor (Bill Ackman of Herbalife fame) in a bid to buy another company. Last week, Allergan sued both Valeant and Ackman, claiming their actions go beyond regulatory arbitrage and enter the realm of insider trading. At risk is Allergan's R&D operation- while Allergan spends roughly 17% or revenues on research (in line with the industry), Valeant, run by McKinsey alum Mike Pearson, spends under 3%. [more inside]
A Republican panel of the D.C. Circuit has ruled [.pdf opinion] in the case of Halbig v. Burwell that a drafting error in the Affordable Care Act provides subsidies exclusively to state-based exchanges and not to federally-facilitated ones, even while subjectively intending to provide subsidies in both cases. The ruling threatens to take away federal subsidies for insurance sold on Obamacare exchanges in 36 states.
V91.07xD Burn due to water-skis on fire, subsequent encounter I did not know water skis can catch on fire. Presumably, somebody's water skis did catch on fire, resulting in a trip to the hospital. [more inside]
"When our donors met the actual people they were helping they often didn’t like them. During our Secret Santa drive, volunteers sometimes refused to drop gifts at houses with TVs inside. They got angry when clients had cell phones or in some other way didn’t match their expectations. Other times, the donations we got were too disgusting to pass along—soup cans that bulged with botulism and diapers so dry rotted they crumbled in our hands. One Thanksgiving, a board member called from the parking lot, requesting help carrying a frozen turkey from her trunk to our office. “Can you find a deserving family?” she asked. I lugged the bird up three flights of stairs. Somewhere near the top, I noticed the expiration date. It was seventeen years old." Anya Groner talks about working for Hudson Outreach in up-state New York and the sobering, chilling effect it had on her idealism.
How the U.S. Health Care System Compares Internationally - "The United States health care system is the most expensive in the world, but this report and prior editions consistently show the U.S. underperforms relative to other countries on most dimensions of performance. Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity." [full report (pdf)] [more inside]
The entire first episode of John Oliver's new current-events comedy show on HBO, Last Week Tonight, is viewable on its official YouTube Channel. [more inside]
"If an NHS trust proposed today that it was going to introduce Viagra sales reps into men's genitourinary wards, or reps for walking aids to orthopaedic wards, the very least you'd expect would be some stout resistance. It is a measure of the strength of the association between "motherhood" and "buying stuff" that the presence of commercial representatives on maternity wards has been tolerated for so long."[more inside]
About half of countries who attempt to build single-payer systems fail. That’s Hsiao’s estimate after working with about 10 governments in the past two decades. Whether he’s in Taiwan, Cyprus, or Vermont, the process is roughly the same: meet with legislators, draw up a plan, write legislation. Only half of those bills actually become law. The part where it collapses is, inevitably, when the country has to pay for it.Ezra Klein's Vox Media looks at the financial and administrative mechanics of Governor Peter Shumlin's quest to bring single-payer health care to Vermont. Bonus: 12 questions about single-payer.
Six years ago, PBS's feature documentary program, Frontline, aired Sick Around the World, a documentary examining health care systems around the world -- and specifically how all those featured were generally superior to the American system. (2008 MeFi post) Today, the American Senate subcommittee on primary health and aging brought the debate over single-payer care to Washington. C-SPAN has a fine video of the hearing, which features seven witness representing health care systems and think tanks from around the US and the world. [more inside]
Inside the Nightmare Launch of HealthCare.Gov - "Unknown to a nation following the fiasco, McDonough's assignment from the President had boiled down to something more dire than how to fix the site. As the chief of staff remembers his mission, it was 'Can it be patched and improved to work, or does it need to be scrapped to start over? He wanted to know if this thing is salvageable.' Yes, on Oct. 17, the President was thinking of scrapping the whole thing and starting over." (previously) [more inside]
Estonia, with a population of 1.3 million, might just have the most technologically forward-thinking government around.
The Ultimate End of Life Plan. "...Torn, I called my mother's internist. 'I know your mother well enough, and I respect her,' he said. 'She doesn't want to risk a surgery that could leave her debilitated or bound for a nursing home. I think I would advise the same decision if it was my Mom.' I called my mother and said, 'Are you sure? The surgeon said you could live to be 90.' 'I don't want to live to be 90,' she said. 'I'm going to miss you,' I said, weeping. 'You are not only my mother. You are my friend.' That day I stopped pressuring my mother to live forever and began urging her doctors to do less rather than more. A generation of middle-aged sons and daughters are facing this dilemma, in an era when advanced medical technologies hold out the illusion that death can be perfectly controlled and timed."
As a result of new coverage under the ACA, many previously uninsured people in eastern Kentucky are giving the nation a glimpse of life under the new health care law.
On Breaking One's Neck. Dr. Arnold Relman, former Editor in Chief of the New England Journal of Medicine, gives a first-hand account of a catastrophic accident, intensive care, and rehabilitation--as a patient. I am a senior physician with over six decades of experience who has observed his share of critical illness--but only from the doctor's perspective. That changed suddenly and disastrously on the morning of June 27, 2013, ten days after my ninetieth birthday, when I fell down the stairs in my home, broke my neck, and very nearly died. Since then, I have made an astonishing recovery, in the course of which I learned how it feels to be a helpless patient close to death. I also learned some things about the US medical care system that I had never fully appreciated, even though this is a subject that I have studied and written about for many years.
"Obamacare horror stories" where innocent citizens are losing their insurance and being forced to pay astronomical costs for new plans on the exchanges are being reported by some media outlets. The problem is that most of these stories don't survive further scrutiny. [more inside]
The conventional wisdom about the origins of the Affordable Care Act is that it is a reformulated plan from the Clinton era, one that right-wingers like Newt Gingrich and the Heritage Foundation created. How true is it? [more inside]
It's time for Americans to gather around the dinner table, eat too much, and argue about politics! A new genre of Thanksgiving-themed web pages seems to be taking off this year, that being the "How to argue with your [opposite political party] family members at Thanksgiving" genre. From the left side of the political spectrum, the Democratic National Committee has launched "The Democrat's Guide to Talking Politics with Your Republican Uncle", and The Huffington Post chimed in with "Here's Every Argument You'll Need To Win Your Obamacare Debate This Thanksgiving". Not to be outdone, conservatives have responded with cheat sheets of their own, including RedState.com's "Thanksgiving dinner with your liberal relatives" and The Washington Examiner's "The Thanksgiving guide to making conservative arguments liberals can understand". [more inside]
The O+ Festival in San Francisco offers artists an opportunity to barter their services for dental and health treatment. "The O+ Festival in San Francisco this weekend would seem a typical indie arts event, with performances by local musicians and displays of funky art. But in a twist that highlights a longstanding problem in the creative economy, the artists involved will be paid not in cash but rather in something they may need just as badly: health care." [more inside]
Native Americans were promised health care by the government, but what are they really getting? Stanford Medicine on the Rosebud Indian Reservation in South Dakota, where health services are underfunded, suicide rates are high, and the life expectancy is just 46 years:
In the Shadows. The healthcare and human rights challenges of the LGBT populations of Malawi -- where homosexuality is outlawed. Via
The Rising Cost of Cancer Drugs: "New drugs could extend cancer patients’ lives—by days. At a cost of thousands and thousands of dollars. Prompting some doctors to refuse to use them."