Health Wonk Review: Killer viruses and the undead public option

t camera oct09 064Killer viruses, computers that see all, and the undead public option. (Or, as Jon Stewart said last night –“It’s alive!“) Welcome to the haunted edition of the Health Wonk Review —  the  floating digest of posts from the health policy blogosphere. This week, we put the death back into death panels.

 The health care system is an out-of-control beast,  promising to heal us while sucking more and more out of our pockets. The shadowy Blob of the drug, device and insurance industries threatens to absorb a larger share of the GNP each year. (So do hospitals and some docs, but they have always worn their halos and angel costumes.) One time, a mob of angry Medicare recipients chased down a Congressman like a scene from Night of the Living Dead. But, the situation has become even more frightening. Until recently, people didn’t come to town meetings with guns to yell at at their reps and senators like crazed Jack Nicholson at the end of The Shining. There were no pictures of either Clinton with a Hitler mustache. t camera oct09 066And, who knows what other secrets lie behind closed White House doors beside deals with drug makers.

In honor of Halloween, BHN offers a costume theme. Add your own. Or go to the end and add a comment with your nominee for the scariest ever doctor, nurse, lawmaker, lobbyist  or other healthcare player — real or imagined. I vote for the twin gynecologists, both played by Jeremy Irons, in the movie “Dead Ringers.”  They made their own medical instruments.

 Cancer Screening: Two-Face from Batman

 Here at Boston Health News, we thought it was huge that The American Cancer Society finally admitted that cancer screening has been oversold. The push for screening is seen as model of a successful health campaign. So successful that people don’t want to believe that, in many cases, the value of early detection is a myth.  

Dr. Anthony Horan’s article on the Health Care Blog  Putting Profit before Patient ” contends that the current method of using PSA blood tests to screen for prostate cancer often causes more harm than good.

Then, there are some screening tests that work — like the pap smears and colonoscopies. But, most people don’t get colonscopies when they need them, says  National Committee for Quality Assurance (NCQA) president Margaret E. O’Kane. She blogs on the agency’s “The State of Health Care Quality 2009” report. The report includes good news -almost all of the 30 million Americans living with asthma are getting care. But, there are problems too. Only 42.5 percent of people are receiving colon cancer screening at the appropriate age. O’Kane recommends that Congress create insurance exchanges, tie payment systems to performance and standardize measures for public reporting.

H1N1: Virus shedding monster  

killer fluDespite new movement on health reform, the arrival of H1N1 and the shortage of vaccines is generating a lot of news. On the Disease Management Care Blog, Jaan Sidorov “points out that it may not be the fault of the Obama Administration’s but it is certainly responsible for the H1N1 vaccine shortages. This may have implications on how the Government will handle the rest of the nation’s health and could give another opening to opponents of health care reform.”

The Public option:  Devil or Superhero

 Here we get silly.

 Healthcare Technology News reports on a bit of harmonization in “Guerilla Music at the AHIP Conference.”

“On Friday October 23, America’s Health Insurance Plans (AHIP) met in the aftermath of a tumultuous month in which the health insurance companies’ lobbying operation released a study it commissioned which, according to the White House is “an attempt to confuse the debate around health reform…Just when the insurance industry must feel that it couldn’t get any worse, attendees at the AHIP conference were subjected to this guerilla music by “Public Option Annie.”

Health policy poet Madeleine Begun Kane offers this limerick urging the president to play a stronger role in bringing about the public option. (Too bad Obama vacationed in Martha’s Vineyard and not Nantucket.)

“Recent comments by Sen. Jay Rockefeller and others indicate
that a strong public option could become a reality, if only President Obama stopped being a Bystander President.”

postcardBystander President?

Public option’s at stake — tock, tick, tock.
Please step up to the plate, Dear Barack.
Though the sidelines were cool
For a while, you’re a fool
If you fail to ensure it’s a lock


Participatory medicine: Pirates

Jane Sarasohn-Kahn at Health Populi reports  on The Center for Connected Health and “the launch of the new Journal of Participatory Medicine. We can’t bend the cost curve without engaging people in their own health care.”

The Health Blawg’s David Harlow also  attended the Connected Health Symposium offering this: “Given the crushing cost of hospital-based health care services, the current and growing primary care physician shortage, and the expectation of high-quality health care services accessible to all, the Center for Connected Health is letting us all know that the road to the future is the information superhighway, paved with intelligent payment reforms — but that the nodes in the network will always be human beings.

Medicare: Uncle Fester

t camera oct09 065 The AMA argues that Medicare doesn’t pay doctors enough. The AMA threatens that, unless Congress passes a bill called “The Medicare Physicians Fairness Act ” physicians will be forced to stop seeing Medicare patients, who are already worried about the stability of the program.”

Granny killers!

Really, don’t they say that every time Congress tries to limit increases in Medicare Part B?  Joe Paduda at Managed Care Matters give a quick history of the program to control Medicare Part B costs that this bill would override and worries “Where are we going to come up with a quarter trillion dollars?”

Quality of Care: Angel  v. Dr. Sawbones

t camera oct09 051 Mike King  at Healthy Debate writes about how malpractice insurers recent years reduced the premiums they charge physicians. Some “at least scaled back annual premium increases that were common before reform. But there is no evidence to show that has led to a corresponding reduction in physician charges to patients.”

HIT  : Frankenstien (Lots of pieces. Can we put them together and make them work?)

David Williams at the Health Business blog says telemedicine has the potential to dramatically increase the level of competition among health care providers, resulting in reduced costs.

IMG_1868The e-CareManagement blog suggests Senator Chuck Grassley probe more deeply into electronic medical records and patient safety.: “You’re on Track about EMR Problems, But Here Are Some More Questions to Ask”

Health 2.0 and the Big Bang, from 10/13 : A review of the recent Health 2.0 conference in San Francisco “warns that conference organizers risk being seen as “all things to all people” if they don’t define what they want the term, “Health 2.0″ to stand for…and such a move, while financially lucrative in the short term (for the organizers), risks diluting any potential impact they wish to have on national policy…a mistake similar to the one made in the early 1990s by leaders (including myself) of the TQM movement.”

The Healthcare IT Guy— aka Shahid N. Shah  – gets a little acronymy on us. But ,we are self described wonks so here  it is:  “All healthcare organizations need to be aware of a problem that’s probably bigger than the Year 2000 (Y2k) migration – the ICD10 and HIPAA 5010 migration. A huge fiscal burden has been placed on payers and providers as they look to redesign business processes and systems to handle hundreds of thousands of new codes at an estimated cost of more than $14 billion

 Insurance: Dr. Jekyll and Mr. Hyde

t camera oct09 047

Roy Poses at HC Renewal wonders why we see nothing in health services research and medical literature about a potential solution to high health costs –“a repeal of a law around since 1945 that insulated health insurance from government anti-trust regulation, appear in the media.  As far as I can tell, the possibly causal role of this law, and whether it needed repeal never has been discussed in the above literature, a striking illustration of the anechoic effect (i.e., certain topics in health care rarely are discussed because doing so may offend powerful interests).

 The Health Access Blog analyzes objections to “employer responsibility” section of Senate Finance Committee. A section of the bill would require employers who don’t offer coverage to potentially pay $1,000s per employee. The fee applies to those who work at least 30 hours a week who receive subsidies to purchase coverage in a health insurance exchange. The fear — all the low-wage workers will get their hours cut to 29 a week. More here.

 The Health Affairs Blog reports on as paper entitled: Are Higher-Value Care Models Replicable? A Boeing Company pilot “shows that enhancing care via a ‘medical home’ designed explicitly for patients with severe chronic disease can improve quality of care and reduce per capita spending in well-led physician organizations without a long history of national clinical distinction.”

t camera oct09 063From Worker Comp Insider: Attorneys General in three states have put FedEx on alert for “widespread, long-term, and unlawful employment practices.” Jon Coppelman of Workers Comp Insider “looks at these new challenges to the company’s practice of classifying its drivers as independent contractors rather than employees, which leaves the drivers out in the cold when it comes to the safety net of workers comp coverage for work-related injuries – not to mention the protections of other basic labor laws.”

Obama Healthcare 2009 suggests that “Unions are supportive of the House health care reform bill , even though as a practical matter the bills discriminate against union workers.”

Food : The Headless Horseman

t camera oct09 062 Of Carrot Cake and Oreos : The New America Foundation’s Joanne Kenen spent an afternoon with Dr. David Kessler, “talking about carrot cake, Oreos  , policy, parenting and why the American diet is the biggest public health care challenge of our times. ”

Healthcare Hacks ask — Should we tax soda?

 Financing — Banker from Monopoly or Hobo

Drug offers an analysis of the CBO review of Baucus bill and its implications for Pharmacy Benefit Managers (PBMs) and pharmacies: “Retail pharmacies would benefit from increased prescription volume but will likely see gross margins drop as the uninsured get the advantage of third-party bargaining power,” says Adam J. Fein, Ph.D.

t camera oct09 067Free-market supporter and health policy grad student John J. Leppard  says Obama’s approach is flawed and should be dumped. On his Healthcare Manumission blog, he asks: “With all the talk about reforming health care going on, I’m a little surprised that no one is actually talking about health care reform.”

Uninsured: Circus performer, no net

College students who want to take a break from school to cope with a serious illness get more bad news when they file their claims. Many insurers won’t cover dependents over 18 unless they are in school full time.

Henry Stern of InsureBlog comments on Michelle’s Law, which aims to change that.  “A college student has to choose between life-saving treatment and losing her insurance to pay for it. InsureBlog reports on a new law forbidding carriers from dropping students in this frightening position.”

Finally to bring to all back home to the land of Lizzie Borden and the Salem witch trials,  the Health Reform Galaxy Blog tells us: The secrets of Massachusetts’ success (including bigger carrots and smaller sticks)

Thanks to my East Cambridge neighbors for allowing me to showcase their annual haunted house.

Oct. 31, 2004

“The short red line gets long — Flu symptoms jump in Mass

BHN has been regularly updating an earlier post. But, it looks like it is time to put H1N1 back on the top of the queue.  

11/5 New state weekly report:

As illustrated in this week’s report, we continue to see dramatic increases in the number of cases of Influenza-like illness (ILI) across the state. This means that it is more important than ever for everyone to follow our flu prevention and control measures.

Not surprisingly, many schools are seeing an increase of H1N1 flu circulating and parents are, understandably, concerned about their children getting sick. We would like to share with you some information on how the Department of Public Health is working with administrators and school nurses across the state to help them prevent the spread of the flu.

 11/5  Sacha Pfeiffer at WBUR has a nice piece on kids with flu symptoms flooding the Childrens Hospital ER and why that’s a bad idea.  Here’s a sidebar on what to do when your kids get sick. (BHN heard the audio on this earlier but there is no link to it on the story’s web page.)

11/4 Boston Business Journal on the randomness of getting an H1N1 shot.

11/4 According to a report from a worker’s rights group “Wal-Mart’s stingy sick-leave policy may contribute to swine flu’s spread.” Workers there are punished for taking too many sick days. Via the fine folks at the Institute for Southern Studies.

The report found that the only time the company is removing sick workers from the food section is when they are coughing too loudly or violently — and then the person is merely transferred to another department rather than being sent home.

11/3 General CDC information for parents of children K-12.  

11/2 — NECN story on H1N1 vaccines clinics in RI and VT. Still reporting no public clinics in Mass. until December.  

11/1 From the AP: Govt says swine flu vaccine catching up to demand.

 10/30  Today’s weekly update of Mass residents with flu like symptoms shows ” a continuous, dramatic increase in ILI (influenza-like illness) activity over the past few weeks in excess of what was seen at the same time the last two years.”

It also includes an update on vaccine availability for n women.

(N)ot all obstetrical practices in Massachusetts are registered to receive the vaccine. This poses a problem for women who go to these providers and who wish to be vaccinated. 

If your doctor is not currently registered to administer H1N1 vaccine, you might recommend that they do so through the DPH website at the DPH vaccine provider registry . Registration is fast and easy, and continues to be open for new registrants. You may also ask your provider to refer you to a medical associate who is enrolled to administer the vaccine.

10/29 From the DPH, More Details About the H1N1 Vaccine Distribution Program

As of today, more than 480,000 doses of H1N1 vaccine have been distributed to providers in Massachusetts –- just the tip of the iceberg of the total 3.5 million doses of vaccine that we expect to receive this flu season. This is not where we expected to be at this point based on what we were initially told by the federal government, and it creates a difficult and frustrating situation for everyone, especially those people at greatest risk of complications from the H1N1 flu… 

10/29 Sacha Pfeiffer at WBUR tries to sort out who is getting the vaccine and who isn’t:With the H1N1 swine flu vaccine in high demand and short supply in Massachusetts and nationwide, people considered “high-risk” are supposed to be vaccinated first. But some high-risk patients can’t find the vaccine even though some seemingly healthier patients can. That has many people wondering if there’s any rhyme or reason to how the vaccine is being divvied up.

10/28: I’m lapsed but go to Mass now and then. I was wondering what it would take to get the Catholic Church to see the risks involved in shaking hands with seven or eight strangers. The Globe reports that it was H1N1 .

10/27 — The latest from the state on access  to the vaccine, or lack of it. Now looking at late November for most people. Their “limited supply is reserved for people at especially high risk for flu, which includes pregnant women, children, caregivers of infants and healthcare workers with direct patient contact. As supplies grow, this will expand to include the additional priority groups of young adults up to the age of 24, and people between the ages of 25 and 64 with underlying health conditions like asthma and diabetes. 

We expect the number of doses of H1N1 vaccine in the state to exceed 1 million by the end of November. As it arrives, we will continue to work to ensure that the vaccine that is available goes to these high priority groups. We thank you for your patience and understanding10/26 H1N1 Mist v. Shot, from the Mass DPH

The H1N1 flu shot in an inactivated vaccine, which means that it contains killed virus. The shot is given with a needle, usually in the arm. The flu shot is approved for use in people 6 months of age and older, including healthy people, people with chronic medical conditions and pregnant women. You can find more information on the H1N1 flu shot in this CDC .pdf file.

 The H1N1 nasal spray flu vaccine is made with live, weakened viruses that do not cause the flu. The spray is sometimes called LAIV for “live attenuated influenza vaccine.” The spray is approved for use in healthy people 2 years to 49 years of age who are not pregnant. More info here.

 On Saturday, Obama just declared H1N1 a “national emergency,” a move that is less alarming than it sounds.

The state DPH posted this  response on Sunday:

The Patrick Administration has conferred with the Massachusetts Hospital Association regarding the President’s declaration and joint efforts are being made to inform hospitals of its content.  The declaration does not increase the pace at which the H1N1 vaccine will become available to the public.  Production delays have decreased the shipments of vaccine to Massachusetts and all other states.  So far in Massachusetts, 300,000 doses of the vaccine have been distributed to clinical sites.  Hundreds of thousands more are expected in the coming weeks.  Public health officials reaffirmed that residents of the state can play an active role in decreasing the spread of the flu by staying home when sick and by carefully practicing health hygiene.

 Also:  The red line on a chart showing the  incidence of flu like symptoms in the state has finally appeared for this year. It is short, as they say, but it is much higher than the line for the two previous years.

Or as the state DPH put it, the line shows a “continuous, dramatic incidence in ILI (influenza type illness ) activity over the past few week.”  

On the national emergency:  From the AP, via the Globe:

The declaration, which the White House announced Saturday, allows HHS in some cases to let hospitals relocate emergency rooms offsite to reduce flu-related burdens and to protect noninfected patients.

Administration officials said the declaration was a pre-emptive move designed to make decisions easier when they need to be made. Officials said this was not in response to any single development on an outbreak that has lasted months and has killed more than 1,000 people in the United States.

You’ll need to be in a high-risk group to get a H1N1 vaccine before November. See the CDC for that list. Check with your doctor or to find out when the vaccine will be available.  More on vaccine supply here, also from the CDC.

This from the state:

Our top priority is and will remain those members of the public who are at greatest risk.  Initially that category includes children, pregnant women and health care workers.  As supplies allow, we will also target young adults below the age of 25, and 25-64 year olds with certain underlying health conditions.  Public clinics will only be held at the point that there is sufficient volume to shift beyond the focus on these target groups.  The CDC states that eventually there will be enough H1N1 vaccine to protect anyone in the population who wishes to be immunized.

 10/23  Here it comes. This from the Globe:

Flu activity is widespread in Massachusetts for the first time this fall, public health officials said today, leading a Central Massachusetts high school to close its doors until Wednesday and almost certainly reflecting cases caused by the swine flu virus, whose return has been expected since it first emerged in the spring.


Screening for Cancer Questioned

BHN thinks this it is huge that the American Cancer Society finally admitted that cancer screening sometimes leads to overdiagnosis.

Or did they? This blog item from the Associations of Health Care Journalists notes that ACS backpedaled a day after the NYTimes reported on the society’s change of heart. Check out their links too.  

(Times writer Gina) Kolata’s story was published on Tuesday. On Wednesday, the ACS released a statement from Brawley in which he says the organization stands by its screening recommendations.

Here’s why the mantra  of early detection is a problem. We’ve gotten better at finding cancer but we are not very good at sorting the nasty ones out from the tumors that will never grow. If you have a raging tumor, it doesn’t seem to matter when you find it. And, yes, some malignant tumors –possibly quite a few — never grow.  The concept of early detection was a very successful health campaign. Too bad, in many cases, it was wrong.

Gary Schwitzer of  University of Minnesota School of Journalism believes in evidence-based reporting.  He’s been following the follow-ups on this story and isn’t happy.

New media writer Jeff Jarvis, recently diagnosed and treated for prostate cancer, is writing about screening again: “I say, thank god science for screening.”

 He’s entitled to his opinion. He is not entitled to his own personal version of the facts. He writes: “There is a growing rumble about curtailing screening.”

 No. That is simply wrong. There is no move for “curtailing” screening. There are many, however, who are calling for better and more balanced presentation of the potential harms – not just the potential benefits – of such screening.

The debate over mammography and prostate cancer screening has been around for a while. According to the National Women’s Health Networkfifteen years after the debate about the value of screening mammography first flared up, too many women (and clinicians) still don’t know it’s more complicated than the “early detection is your best prevention” slogan.

The stories of note from the NYTimes. 

 Benefits and Risks of Cancer Screening Are Not Always Clear, Experts Say

Most people believe that finding cancer early is a certain way to save lives. But the reality of cancer screening is far more complicated.

Studies suggest that some patients are enduring aggressive treatments for cancers that could have gone undetected for a lifetime without hurting them. At the same time, some cancers found through screening and treated in the earliest stages still end up being deadly.

As a result, the chief medical officer for the American Cancer Society now says that the benefits of early detection are often overstated. The cancer society says it will continue to revise its public messages about cancer screening as new information becomes available.

And, Gina Kolata’s 10/21 story

The American Cancer Society, which has long been a staunch defender of most cancer screening, is now saying that the benefits of detecting many cancers, especially breast and prostate, have been overstated.

It is quietly working on a message, to put on its Web site early next year, to emphasize that screening for breast and prostate cancer and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.

“We don’t want people to panic,” said Dr. Otis Brawley, chief medical officer of the cancer society. “But I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”

As far as mammography goes, Breast Cancer Action has been all over this. In honor of Breast Cancer Awareness month, check out their “Think Before You Pink” campaign while you’re at it.

Health reform, wired and unwired

There was a State House hearing scheduled today on bill to establish  a single payer health care system in the state. BHN missed it and can’t find any reports. We’ll keep looking. Here’s the background from Mass Care.

We are going to try to hit this wired health care meeting,  which takes place tomorrow and Friday at the Park Plaza.    

Up from Crisis: Overhauling Healthcare Information, Payment and Delivery in Extraordinary Times

Healthcare will have its renaissance when it moves beyond the hospital and clinic and into the day-to-day lives of patients and consumers. The Connected Health Symposium asks how information technology — cell phones, computers, the Internet and other tools — can help people manage chronic conditions, maintain health and wellness, and age with independence. Please come to Boston in the fall, as all of us join the issues of real change in 2009

We’ll try to get the low down on this early morning speech.

Healthcare Reform, Payment Reform, and the Implications for Connected Health by Stuart Altman, of the Heller School at Brandeis University. He’s been up close for health reform efforts through at least five presidents.



BU prof raises questions about anti-tobacco efforts

05-1215-060BHN noted the name of Boston University’s Dr. Michael Seigel in a recent NYTimes story on the link between smoking bans and heart disease. The study concluded that bans trigger a quick and robust drop in heart disease

Seigel called the study “sensationalist.” Scientists rarely call anything sensationalist. They tend to use terms like “overstated” or “not carefully controlled.” So, I checked him out.

He has interesting things to say about the downside of FDA regulation of tobacco.  

He also thinks the “tobacco control movement is overstating the risk of second hand smoke.” He’s no tobacco industry apologist. He appears to makes his case based on a clear analysis of the evidence.

Here’s an abstract of “Is the tobacco control movement misrepresenting the acute cardiovascular health effects of secondhand smoke exposure?

…(I)t appears that a large number of anti-smoking organizations are making inaccurate claims that a single, acute, transient exposure to secondhand smoke can cause severe and even fatal cardiovascular events in healthy nonsmokers. The dissemination of inaccurate information by anti-smoking groups to the public in support of smoking bans is unfortunate because it may harm the tobacco control movement by undermining its credibility, reputation, and effectiveness. Disseminating inaccurate information also represents a violation of basic ethical principles that are a core value of public health practice that cannot and should not be sacrificed, even for a noble end such as protecting nonsmokers from secondhand smoke exposure. How the tobacco control movement responds to this crisis of credibility will go a long way towards determining the future effectiveness of the movement and its ability to continue to save lives and protect the public’s health.

Here’s a BU profile of him.

Health care protesters arrested at Newton insurance office

Both the Globe and a Newton paper had stories.

This from the single-payer supporters at MassCare:

Four Mass-Care activists were arrested at Cigna’s offices in Newton yesterday, as part of a delegation of eleven health care advocates who were asking Cigna to sign a pledge that they will: 1) not use patients’ premium dollars to lobby against universal health reform, 2) not to stand in between a doctor and their patient, and 3) not discriminate against enrollees based on pre-existing conditions, age, ethnicity, gender, immigration status, or any other social status. Instead of meeting with the delegation – which consisted of concerned residents ranging in age from 23 to 80, including a doctor, a teacher, a nursing student, a patient who has not been able to receive needed care from the insurance system, a veteran, a student, and representatives from Mass-Care, Health Care NOW, Northeast Action/Health Care for America Now, and – Cigna instructed police to arrest the group if they attempted to enter the property. Many of the delegation carried Mass-Care posters and wore signs on their backs reading “Cigna Profit$, Patients Suffer.”

The arrestees joined eight other cities where acts of civil disobedience targeted insurance companies for their crimes against patients: New York, Washington DC, Palm Beach, Portland, Los Angeles, Reno, and Phoenix. Among the eleven arrested were Mass-Care’s Eastern Massachusetts Co-Chair, Dr. Patricia Downs Berger, Mass-Care’s Executive Director, Benjamin Day, and Mass-Care activists Walter Ducharme, a veteran and retiree, and Lorie Miller, a nursing student. They will be arraigned in Newton District Court on October 30th.

Noticias sobre la vacuna contra la gripe H1N1, Massachusetts


Massachusetts Department of Health: Grupos prioritarios para la vacuna H1N1



Ayude a reducir el dolor de las vacunas contra la gripe de sus hijos

Según los expertos, los ejercicios de relajación y las burbujas pueden ayudar a reducir el dolor


La gripe en televisión y radio

Hace un par de semanas le dije que continuaríamos trayéndole información sobre la gripe. También hace algunas semanas estuvimos con nuestra amiga, Verónica Robles, hablando sobre el tema. Por favor, véalo:

From 10/16:

English translation below, or see the previous link.  

Las personas clasificadas dentro de los grupos de prioridad deberían comunicarse con sus médicos para programar una fecha para recibir la vacuna H1N1. Se espera que puestos de vacunación públicos y en planteles escolares abran sus puertas a partir de noviembre y diciembre. Sus horarios estarán disponibles en

In English:   

People who are in a high-priority group to get vaccinated should contact their health care provider to find out when they can schedule an appointment to get the H1N1 vaccine. Public health and school-based H1N1 vaccination clinics are expected in November and December, and will be posted at as they are scheduled.