Dr Paul Farmer on Fixing Haiti

1/27/2010 Paul Farmer of Partners in Health telling Congress what Haiti needs:

The relief efforts, focused now on addressing the initial wave of devastation from the earthquake, will soon turn to a new set of concerns. Hastily cobbled together camps are at risk of outbreaks of cholera and other waterborne disease. The Haitian government has wisely proposed avoiding huge camps, which will be difficult to manage, but we must hasten our efforts to get tents, tarpaulins, and latrines or composting toilets to Haiti. It is humbling to see the relief efforts be so slow—in large part because delivery of services was so weak before the quake. Now we must do more to get food and water to people every day for some time to come. Creating safe schools and safe hospitals, even makeshift ones, is a known need in rebuilding a society, and storm resistant housing must also be a carefully considered priority since there is little time before the rainy season. Students need to be back in school; the planting season cannot be missed and requires fertilizer, seeds, and tools.

No names in AG hospital cost report?

The Globe reports:

Massachusetts insurance companies pay some hospitals and doctors twice as much money as others for essentially the same patient care, according to a preliminary report by Attorney General Martha Coakley. It points to the market clout of the best-paid providers as a main driver of the state’s spiraling health care costs.

Which hospitals?

The report did not identify insurers and providers by name, and Coakley declined to release the names of the highest-paid, saying she wanted to lay out systemwide problems, not blame individual organizations

A good time to revisit the Globe series on Partners hospital system and its impact on costs.

And wasn’t that a former insurance executive who ad-walked across this story while I was reading it?

How to check out a nursing home

The reform debate has shrouded the other healthcare crisis – How to pay for and deliver long- term care. In the meantime, buyer beware. Here’s some help.

Medicare has a new searchable database on Nursing Home Quality.

USA Today has a story on it and their own version of the database.

One in five of the nation’s 15,700 nursing homes have consistently received poor ratings for overall quality, a USA TODAY analysis of new government data finds.

Massachusetts already has a database but the two above are easier to read.

Scleroderma mystery remains unresolved in Boston

The Globe reports on a new state study that failed to find an environmental link between a cluster of scleroderma cases in Southie. Not that the sample of women was too small to come up with any solid confusion In other words, not enough women signed up for the study for researcher to come to a solid conclusion, except genetics might be a factor. From The Globe :

Elizabeth Lombard’s right hand is stiff and wooden, unable to flex or move.

“It won’t bend,’’ she said, displaying the tightened skin that is pulling back her fingers into a crooked and clawlike form.

Lombard has scleroderma, a rare, life-threatening autoimmune disease that hardens muscles and internal organs, and causes the body’s immune system to attack itself.

The disease, which has no cure, has long confounded South Boston, where a cluster of longtime residents from the City Point section – most of them middle-aged women – were falling ill with it. The residents, who lived near a power plant and hazardous waste sites, believed they were victims of their environment.

Their case gained national media attention and sparked an 11-year investigation by the Massachusetts Department of Public Health. In their findings, released earlier this month, state researchers acknowledged “higher than expected cases’’ of scleroderma in South Boston, a neighborhood of roughly 30,000 people.

But it determined that genetics, not the environment, played a significant role.

“It’s not necessarily that the community they were living in was producing this disease,’’ said Robert Simms, the chief of rheumatology at Boston Medical Center and a researcher in the study. “When you look at the data, it does not support that.’’

Also, see The Silent Spring Institute on on how hard it can be to trace a long-brewing disease back to an original, environmental cause. The group has been looking at the breast cancer cluster on Cape Cod.

When life-saving radiation turns deadly

Walt Bogdanich of the NY Times followed up on reports of radiation overdoses for cancer patients in Florida and Philadelphia. He found horrific medical errors and little oversight. His story ran on Sunday, 1/26.

Americans today receive far more medical radiation than ever before. The average lifetime dose of diagnostic radiation has increased sevenfold since 1980, and more than half of all cancer patients receive radiation therapy. Without a doubt, radiation saves countless lives, and serious accidents are rare.

But patients often know little about the harm that can result when safety rules are violated and ever more powerful and technologically complex machines go awry. To better understand those risks, The New York Times examined thousands of pages of public and private records and interviewed physicians, medical physicists, researchers and government regulators.

The Times found that while this new technology allows doctors to more accurately attack tumors and reduce certain mistakes, its complexity has created new avenues for error — through software flaws, faulty programming, poor safety procedures or inadequate staffing and training. When those errors occur, they can be crippling.

While the Times stories are about radiation therapy, Neuroradiologist Michael Lev of Massachusetts General Hospital argues for quality assurance to CT scans in the current American Journal of Neuroradiology

Because of incorrect settings on the CT scanner console, more than 200 patients over a period of 18 months received radiation doses that were approximately 8 times the expected level. While this event involved a single kind of diagnostic test at 1 facility, the magnitude of these overdoses and their impact on the affected patients were significant. About 40% of the patients lost patches of hair as a result of the overdoses.

This episode highlights the importance of CT quality assurance programs

Snowe: Will History Call Back?

Brown’s win has emboldened the GOP to call on Dems to hit the restart button on health reform. Kaiser Health News aggregates it for you, including news that Maine Republican Olympia Snowe is waiting for a call from Dems.

From AP via the Globe.

PORTLAND, Maine –U.S. Sen. Olympia Snowe, smarting over the way Democrats moved health care negotiations behind closed doors and left her and other Republicans shut out of the process, is waiting for them to make the first move toward salvaging portions of the health care overhaul bill.

Snowe, once viewed as President Barack Obama’s best hope of crossing party lines to support his health care legislation, said she remains committed to playing a constructive role. But she was left frustrated by the partisanship she saw after Senate Democrats mustered 60 votes, enough to move forward without the threat of delaying tactics by Republicans.

Here’s what she said on October 12 when she cast the sole Republican vote for health reform.

“Is this bill all that I would want? Far from it. Is it all that it can be? No. But when history calls, history calls…”

Barney Frank has second thoughts on health reform bill

First, check out the latest edition of Health Wonk Review, which this week comes with an Avatar theme and plenty of pontificating on the outcome of Mass Senate race.

So, it was hard to find and you have to scroll down on this page to read it, but the Globe’s Susan Milligan reports that Rep. Barney Frank — who said the health bill is dead — has had second thoughts.

WASHINGTON – In the land of spin and message management, Representative Barney Frank offered a startlingly blunt mea culpa yesterday, saying he was just wrong when he called health care overhaul “dead’’ in Congress.

Frank, a Newton Democrat unabashed about letting colleagues and reporters know when he believes they are wrong, issued a lengthy statement saying he had been overly “pessimistic’’ in decreeing the legislation moribund. Frank had earlier given a radio interview in which he said the election of Republican Scott Brown to the Massachusetts Senate seat meant health care was “dead.’’

More from The Hill

Did Massachusetts Sink Health Reform?

Barney Frank thinks so. Jonathan Cohn says go for it.

Much more in the national press about large role health reform played in Tuesday’s Senate race.

Kaiser Health News offer a good round-up, including this from Politco.

“Scott Brown’s opposition to congressional health care legislation was the most important issue that fueled his U.S. Senate victory in Massachusetts, according to exit poll data collected following the Tuesday special election,” Politico reports. The poll was conducted by a Republican firm; no news organizations conducted independent exit polls for this election (Catanese, 1/20).

(See my unscientific poll of ten voters in Cambridge, where Coakley won with 85 percent of the vote.)

If you ignore the snarky comments about Massachusetts*, The Health Care Blog offers a whole page of pontificating on health reform and the defeat of Martha Coakley.

Mike Millenson says that the White House did not do enough to sell reform to the public.

Throughout this process, Obama and his Chicago-bred advisers have been intent on avoiding the mistakes that sunk reform during the Clinton administration. But their diagnosis was flawed. Yes, Bill and Hillary stiff-armed both the special interests and their Republican opponents, falsely believing that public opinion polls showing widespread support immunized them from the insidious need for compromise. But while the Obama administration cut early deals with doctors, hospitals, insurers and the pharmaceutical companies, attempts to bring moderate Republicans into the fold conspicuously failed.

When the inevitable counter-attack on reform emerged, it made the infamous “Harry and Louise” ads of the early 1990s look like a C-SPAN broadcast of a CPA convention.

Writers at Kaiser Health News made the same point:

As a candidate, Barack Obama promised to pass a health plan with important benefits for the average American. For the typical family, costs would go down by as much as $2,500 a year. Adults wouldn’t be required to buy insurance. No one but the wealthy would face higher taxes.

But a year later, the health care proposals in Congress lack many of those easy-to-sell benefits, which became victims of the lengthy process of trying to win over wavering lawmakers, appeasing powerful special-interest groups and addressing concerns about the heavily burdened Treasury.

“There’s nothing in it the average person could understand about why your costs would be lower,” says Robert Blendon, professor of health policy at Harvard’s School of Public Health. “They don’t even have good illustrations about how it would be cheaper. They did not find a way to save money for people with job-based insurance.”

Finally, bad day for Democrats, good day for people who profit from the health care system the way it is now. AP via the Globe.

Among health stocks, insurers Aetna Inc. rose $1.30, or 4.2 percent, to $32.66 and UnitedHealth Group Inc. rose $1.38, or 4.1 percent, to $35.13. Pharmaceutical company Merck & Co. advanced $1.15, or 2.9 percent, to $40.62 and was the biggest advancer among the 30 stocks that make up the Dow industrials.

*From Health Care Blog, re Massachusetts

I’ve always thought that, given the absence of passport controls, if you lived there and could move to California and didn’t, you were probably crazy. And yesterday the residents of that fair state proved me right.

At least we’re fair.

BHN Exclusive: Voter Voices from the Polls: Health Reform and the Mass. Senate Race

No campaign staff worked the polling station at the William Cardinal O’Connell Library in East Cambridge today. It was cold, slushy and raining in a city where voters tend to lean to the left of liberal.

A sample of the locals leaving the polls found that almost all of them considered the future of health care reform when they cast their votes. Some were for it, some against. Here’s what the Globe has heard. Here ‘s what voters in Cambridge told BHN:

Election day in Cambridge, Mass. Heatlh Reform and the Senate

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WBUR reports here. Also, find a roundup of news on  health and the senate race on Kaiser Health News.

Worried about health reform? Vote on Tuesday

Whether you are for it or against it, you can have your say on Tuesday.

From the NY Times:

WASHINGTON — With the Massachusetts special election for United States Senate increasingly unpredictable, Democrats in Washington are contemplating a fall-back plan to advance far-reaching health care legislation, even if a Republican victory on Tuesday deprives Senate Democrats of the crucial 60th vote they need to overcome filibusters.

More from Kaiser Health News