Warning: file_get_contents(http://webbiscuits.net/images/blan.gif) [function.file-get-contents]: failed to open stream: HTTP request failed! HTTP/1.0 404 Not Found in /home/residenc/public_html/wp-content/themes/residencynotes/header.php on line 26

Archive for August, 2006

Thursday, August 31st 2006

It Just Keeps Coming

First from China, now from Sweden comes news carried by the mainstream press on success towards an HIV vaccine.

Researchers at the Karolinska Institute and the Swedish Institute for Infectious Diseases Control have completed a first round of tests of a new AIDS vaccine in healthy human volunteers and are thrilled with the results. The vaccine is made from selected bits of the genetic code of HIV, more than enough to make it unmistakably recognizable to the body, but far less than an entire killed or weakened virus, which could, in theory, cause the disease it’s supposed to prevent. A fourth dose, made of another bit of HIV DNA piggybacking on a cowpox virus, was added as a booster. This aggressive approach yielded impressive results: Fully 90% of the subjects developed an immune response to the virus, meaning antibodies were produced which, if they rose to the right levels, could protect the body from a live virus should it ever come along.

At the least, such diverse sources and seperate promising news on the possibility of a vaccine is incredibly good news.

Share/Bookmark
Thursday, August 31st 2006

It Begins!

13 minutes ago at 5 o’ clock CST, the college football season kicked off! Boston College v. Central Michigan is the first game of the season and is showing on ESPN 2.

Thursday, August 31st 2006

The Red Headed Step Child Shows Some Promise

Finally. Gene therapy has been used as part of a successful treatment for two patients with melanoma in a study. Here is the Los Angeles Times on it. Despite the promise it comes with caveats:

They added that there is still more failure than success with the technique. Fifteen other melanoma patients enrolled in the study failed to show sustained improvement from the modified immune cells.

The article quotes some outside oncologists with some encouraging words,

“The important thing is this approach worked,” said Dr. Margaret Kemeny, director of the Queens Cancer Center of the Queens Hospital in New York. “Can they make this approach work more often? That is the question.”

And then drops this bomb shell of scientific accuracy on us, so that we may all wonder at the credibility of the entire peice and just how much fluff went into it,

Rosenberg had previously discovered that some melanoma patients are able to generate a type of immune cell, called T cells, that recognize the tumor cells as unwanted intruders and respond by attacking them.

Yeah those melanoma patients are the only one’s making T Cells…Luckily here’s a link to the actual publication in Science and a WebMD article which might be slightly more in tune.

Thursday, August 31st 2006

Orion Gets A Contractor

The next manned space vehicle for NASA, the vehicle to take us back to the moon, has a contractor.

NASA on Thursday gave a multibillion dollar contract to build a manned lunar spaceship to Lockheed Martin Corp., the aerospace leader that usually builds unmanned rockets.

The last time NASA awarded a manned spaceship contract to Lockheed Martin of Bethesda, Marylad, was in 1996 for a spaceplane that was supposed to replace the space shuttle. NASA spent $912 million and the ship, called X-33, never got built because of technical problems.

The manned Orion module is part of Bush’s Vision for Space Exploration.

Thursday, August 31st 2006

An Effect Becomes A Cause

I’ve beaten this into the ground. We’re not paying for less necessarily in this country.

It just stirs me up, like a hornet in a cookie jar (yeah, I don’t know what that means either) when people spout in the same sentence that America spends more (and more per capita) on healthcare than any country in the world but our health is actually poorer! As if that is an approximation of the quality of healthcare in this country.

The situation wasn’t helped when those same people failed to read the conclusions of this study summarized in The Guardian.

Now I admit, I think the U.S. may be one of the most wasteful countries in the world in terms of healthcare spending. But, and I play the same old tune here, which one is the cause and which the effect in the relationship above?

But answers to why Americans are significantly less healthy than the British may lie in a different cultural divide. Many experts agree with Sir Michael that social differences, rather than healthcare systems, are responsible. They point particularly to the intense competition, economic insecurity and high levels of stress that run through American society.

Or from the Primary Investigator himself in The Guardian,

Professor Banks speculated that experiences earlier in life might be responsible. Perhaps childhood obesity left a health imprint that shows up later in life. “The obesity epidemic began later here, we are now catching up,” he said. “If that is the explanation then this health gap may potentially be closing in the future.”

Can This Help Explain The Atlantic Health Disparities?

What we’re witnessing is that lifestyle choices, behavior lead to poorer health and poorer health leads to more spending. These are chronic conditions though. CV disease isn’t going away in a patient, diabetes isn’t going away.

Does this explain all, or even a good chunk, of the increased spending in the US? Of course not. But before patients go crying foul over their bills or pundits start citing the US healthcare system for failing, have you kids put down the Big Mac. Health and healthcare costs start with personal responsibility.

Thursday, August 31st 2006

Hometown Hero

Richard Lee apparently does more than make the final table of the world’s biggest poker tournemants and share a name with Robert E. Lee’s father. Mr. Lee, the newly annointed poker God of my hometown, is being investigated as a bookie!

Police are investigating local poker champion, Richard Lee. They believe he was working as a ‘bookie,’ placing big bets for other people online. Online gambling is illegal in the state of Texas.

The VICE unit has been investigating Lee for more than 8 months. On Tuesday, they obtained a search warrant to sieze his property, including his cars, computers, and hundreds of thousands of dollars in cash.



Yeah, Those Sunglasses Really Say, “Have My Money By Tomorrow Or It’s Your Knee Caps”

We now have Richard Lee’s response to the accusations.

Thursday, August 31st 2006

I Swear I Didn't Hear The Alarm Clock

It is well past August 31st in Tehran and Iran has failed to meet the deadline to accept the incentive/sanction deal put forth by the 5+1 group.

The U.N. nuclear agency declared Iran had failed to halt nuclear work by a Thursday deadline, and Tehran defied the threat of sanctions by vowing never to abandon a program the West fears could give it atom bombs.

A confidential report of the Vienna-based International Atomic Energy Agency (IAEA), leaked to Reuters, said Iran resumed enriching small amounts of uranium in recent days. The agency said its probes had been blocked by lack of Iranian cooperation.

“The Iranian nation will never abandon its obvious right to peaceful nuclear technology,” Iranian state radio quoted President Mahmoud Ahmadinejad as saying, hours before time ran out for Iran to stop enriching uranium.

The question of course, as I’ve brought up before, remains over what, if any, consequences Ahmadinejad has brought upon his country. This with Russia and China highly skeptical and France wavering.

Eventually, the punitive measures American and European officials say they will seek might expand to restrict travel by Iran’s leaders and limit the country’s access to global financial markets, according to diplomats involved in the talks who spoke only on condition of anonymity.

But even as an agreement shapes up among the United States, Britain, France and Germany, the push for sanctions faces a high hurdle in the Council, given Russia and China’s possession of veto power and their opposition to discussion of serious punishment for Iran.

In addition, the sanctions effort may also be hampered by a report to be issued Thursday by the International Atomic Energy Agency, in which inspectors will describe only slow progress by Iran in enriching uranium.

This in contrast of a Pentagon report, in which Iran will have nukes in 5 years. But of course the Pentagon report comes right off the heel’s of the House Intelligence Committee calling on US intelligence to publish more alarming threat assessments.

I think the U.S. is befuddled and has dropped the ball repeatedly. I also think Iran is a real threat. Mutually Assured Destruction is not a factor when playing chicken with a man like Ahmadinejad.

Thursday, August 31st 2006

Can I Repay You In Jury Verdicts?

According to Point of Law, the Wall Street Journal has a story on a Vioxx juror who owed money to a plantiff. I’m not sure how that slid by since I’m taking PoL at their word and cannot read the story itself.

If true of course that would endanger any verdict against Merck.

Thursday, August 31st 2006

We Don't Believe You

Self reported surveys show the perception (at least) of malpractice troubles are forcing students away from OB/GYN in Florida.

“Florida is already a state without enough obstetrician/gynecologists to meet the needs of patients. In some parts of the state, women must wait several months to see an obstetrician, and there are no perinatologists or maternal-fetal medicine specialists to take care of high-risk pregnancies,” Dr. Deutsch said. “Our findings suggest this shortage may get even worse.”

The USF researchers sent surveys to all fourth-year medical students in Florida in fall 2005. The senior year is when medical students find out where they will conduct their residencies – the period of specialized training for licensed medical graduates in their chosen medical field.

Florida mirrors a national trend of fewer medical students applying for ob/gyn residencies. The USF researchers hypothesized that student concerns about the rising cost of malpractice premiums and medical liability in Florida may contribute to the marked decline of students specializing in ob/gyn.

Half of the Florida students surveyed – 42 percent men and 58 percent women – responded. The respondents were divided into three groups – students who selected ob/gyn as a career (had applied to ob/gyn residencies); those who considered ob/gyn as a career but ultimately decided against it; and those who never considered ob/gyn. Of the students selecting a career in ob/gyn, 86 percent reported they are considering leaving Florida to practice because of the medical liability concerns.

I’m sure someone will find fault with the conclusions.

Thursday, August 31st 2006

Take That! And That!

Let’s not pretend I know more than the blogs I link to. Or for that matter, anything on this topic. But I do know faulty logic and vindictive rhetoric when I see it sometimes.

An NEJM publication (read a summary on Med Page Today) claims that healthcare is a bargain. Indeed, Dr. Cutler, the PI in the NEJM published study, is a key figure in the New York Times piece cited in “We Have To Spend It On Something…

From Med Page Today,

The authors calculated that the increase in life expectancy over the 40 years studied, from 69.90 years in 1960 to 76.87 years in 2000, cost an average of $19,900 per life-year gained.

Considering that insurance companies and medical decision-makers consider a year of life (known as the value of a “statistical life”) to range between $50,000 and $200,000, medical expenses give a pretty good return.

“According to virtually any commonly cited value of a year of life, we found that if medical care accounts for about half the gains in life expectancy, then the increased spending has, on average, been worth it,” they wrote.

This seems to have been ignored over at The Health Care Blog,

How anybody without the benefit of a tenured Harvard professorship can possibly describe spending $145,000 to gain one extra year of life expectancy from somebody who is over 65 as “reasonable value” boggles the mind.

Wow.

But, let’s move on. I really don’t understand where Mathew Holt, the author, is getting off on some of these assumptions which he goes on to make.

[T]he average American working income is just above $40,000 a year. That would suggest that the average working American’s life is worth somewhere below $50,000 a year. According to Cutler’s calculations, it has cost some $36,000 to gain an extra year of life. But of course all those years of life that are being gained are at the end of life, when incomes are considerably lower, so it’s hard to tell why that $36,000 number is a reasonable value, when it exceeds the total value that the economy as a whole places on an average retired individual

Of course Holt uses only one means of valuing life, and I’m not stirring up the public cry that “life is invaluable,” I mean in actual economic terms.

Dr. Cutler probably does a very good job representing the range of values attributed to a statistical life. The Health Care Blog does nothing to place his ‘estimate’ above other figures.

As well, it doesn’t appear Holt can have it both ways. If he’s going to concede the basic premise so he can crticize it for overvaluing the life of a retiree then the argument is implicit that the care for a neonate is vastly undervalued.

I certainly think Holt’s trashing of Cutler as some looney tool of the healthcare industry is uncalled for. Cutler does enough to raise his own concerns

for the current trend toward expensive care for older adults. For those 65 and older, the incremental cost of an additional year of life jumped from $46,800 in the ’70s to $145,000 in the ’90s, the authors noted.

“The foremost cause of concern posed by rising medical costs is the tremendous strain coming from increased costs for the elderly,” Dr. Cutler said. “The cost per year of life for seniors is three times higher today than it was in the 1970s.”

Over at Forbes we even get this gem on healthcare waste and quality, which seems to imply a larger understanding of the situation than The Health Care Blog gives Cutler credit for,

Experiments have started in several parts of the country to measure the quality of care provided by doctors, Cutler said. Estimates of the cost of ineffective care run as high as 20 percent to 30 percent of medical funding, he said, but “we hope we can get doctors to do the effective stuff without the ineffective stuff.”

Holt has a previous post criticizing the NY Times piece that I picked up from DB in the post below. You hear many of the same arguments.

This is from the NY Times piece,

By 2030, predicts Robert W. Fogel, a Nobel laureate at the University of Chicago Graduate School of Business, about 25 percent of the G.D.P. will be spent on health care, making it “the driving force in the economy,” just as railroads drove the economy at the start of the 20th century. Unless the current system is changed, most health care costs will continue to be paid by insurance, especially Medicare, which means that the taxpayers will foot the bill. But Dr. Fogel says he is not alarmed. Americans can afford it, he says, because the nation is so rich.

This is The Health Care Blog,

Now there is a huge difference between “we can afford it” and saying that it’s the driving force in the economy like “railways”.

Wait a minute. Dr. Fogel doesn’t even say that, it isn’t in quotes. Taking a reporter at her word is always a fine thing, Mr. Holt. In anycase, Dr. Fogel’s major work discredited the commonly held belief of the driving force the railway system provided to a growing America.

Robert Fogel believed that much of the praise heaped on the economic contributions of the railroad were little more than overblown rhetoric, and he set out to prove it. In his 1964 book, Railroads and American Economic Growth, Fogel examined the American economy for the year 1890

Holt sets out to teach us, that healthcare cannot be a driving force of the economy. But, it looks like Dr. Fogel’s work was centered on challenging the very assumptions The Health Care Blog goes on to make,

Thinking back to your high school economics class, you were taught that there were two types of economic activity—those that assisted in making stuff (usually called “manufacturing”) and those that didn’t directly assist in making stuff (“services”). Railways (and telecommunications and power and all the other utilities) are infrastructure that directly assist in the support of making stuff, usually by allowing producers to access new markets, and those markets to access new producers. That’s basically the logic whether it was railways opening Kansas wheat fields to East Coast markets, or the Internet allowing American software companies to access Indian programmers.

Health care, though, is a consumption good.

Now I am completely sure that Mathew Holt has accurately represented a widely held economic tenet, concerning what drives the economy. But, at the very least The Health Care Blog has misrepresented Dr. Fogel’s position. Clearly the noble laureate understands the difference between infrastructure supporting manufacturing and a service, his most famous works were on the ability of any one piece of the infrastructure to drive the economy! A simple Google search would’ve shown that. Mathew Holt implying he’s informing us of something that Dr. Fogel must have missed in making his claim, that healthcare could be a driving force, is arrogant.


=
Is This Really What Fogel Said?

Beyond what I believe are fallicies, The Health Care Blog engages in some rhetorhic that is questionable at best.

He questions the credibility of the NEJM (*rolls eyes*), the journal which published Dr. Cutler’s work,

Which of course makes me very suspicious about why the not exactly purer than pure New England Journal is one publishing this somewhat obscure economic analysis in its limited policy section, as opposed to some real debate about how to fix the healthcare system’s problems. Is it possible that they too are bending before their advertisers? Perhaps Roy Poses will find out for me!

Yes, his antecedal evidence for the claim that the NEJM is less “purer than pure,” probably runs along like this. In actuality beyond the APPROVe study, I have no idea where he gets the criticism for the NEJM. Not that he needs to back it up with anything, it is not a “logic” technique he’s using.

Holt does it more absurdly when he discredits Folger, in the post on the NY Times piece, by comparing him to HIV denier and Noble Laureate Kerry Mullis (!)

I guess in some ways it shows the fallibilty of Noble prize winners. Still.

Off the choice of words and vindictive attacks and back to The Health Care Blog’s reasoning. Read this with the sarcasm Holt intended,

There’s clearly no chance that the actors in the system have somehow captured the body politic to ensure that ever growing health care spending is the result. No, no chance of that at all. After all health care is a pure free market Adam Smith would love–yes it is!

I raise an eyebrow. Healthcare is overprized because he thinks the manufacturers and providers have their hands too deep in the cookie jar? Really? Please reader, let’s go in this hypothetical world where restrictions on physician compensation are removed – no protections on collections of debts, no insurance contracts that don’t allow them to bill for the remainder, no fee schedules set by a cabal of payees – and you’re in a car crash or your child is deathly ill. What’s the healthcare worth then? No better example of subjective theory of value exists than the healthcare market, something Holt ignores throughout his pieces.

Holt’s right, this isn’t a free market, but not because providers and manufacturers are ringing every last dime out of politicians with lobbying efforts and campaign contributions. Its because a single payee controls more than 40% of reimbursements. Its because better than probably 80 or 90% are controlled by a cabal. I don’t see the overvalue. Talk about price fixing.

I have some humor about throwing my opinion out there. I’m sitting over here with a film degree and a half read Economics for Dummies. That is true. So you take my last comment with a grain of salt. My criticisms of The Health Care Blog’s criticisms though? Those I stand by.

In any case, I think there’s more of a debate here than apparently others. Dr. Cutler makes some fine points. You should read both the NY Times piece and the summary of the NEJM published study.