HCR -- Recent Links

By John Ballard

Following health care reform is like watching trees grow. You know it's happening but you can't see any motion. As much as I want this subject to be exciting, the best I can come up with is interesting, and hopefully intelligent. Think chess by mail instead of racquetball.

?Guess Who Has Been Over-Treated For More Than Twenty Five Years?
Maggie Mahar, of all people, has come to the conclusion that she was misdiagnosed with glaucoma years ago and has been living in the shadow of that diagnosis ever since. If anyone has stood in the eye of the health care reform storm it is she. And her candid first-person story is a lesson for everyone, healthy or sick.

Ultimately a friend who is an M.D. recommended a new ophthalmologist, a young man from India who I actually liked very much. Dr. Z was funny, somewhat iconoclastic, and very candid. He could write me a new prescription for eye-glasses, he said, but the difference would be very slight. I would be wasting my money. The second or third time I saw him, Dr.Z asked me a question point-blank: �What makes you think you have glaucoma?�

I was stunned. Because over a period of twenty-five years five or six different physicians had been treating me for the disease??

�Look,� he said, �Glaucoma is not my specialty. But it is a progressive disease. What I can�t figure out is how you�ve had it for so many years with so little progression.�

�Because the eye drops worked?� I asked.

�Maybe,� he said. �But I�d urge you to see someone who does specialize in the disease, and have the doctor you saw for two or three years send her the records of your visual field tests over time. He gave me a card, and urged me to call for a second opinion. It turned out this doctor wasn�t available. And Dr. Y. had retired, so I never got the records.

Still, I thought about what Dr. Z had said and some months later did visit a glaucoma specialist. I asked her: �Is it possible I don�t have glaucoma?� I explained that I was no longer using the eye drops as regularly as I probably should.

After examining my optic nerve and checking the pressure (which was surprisingly low), she said: �It is possible that you don�t have glaucoma. Sometimes it�s over-diagnosed. But I�d like to put you on different eye drops, and run some tests.�

Go to the link for the full story. No breaking news here. Just a good read that anyone can appreciate. (Hypochondriacs should skip this, however. It may ruin your day.)

?Dr. John Halamka's Regression to the Mean also uses a personal story to illustrate a principle. 
In this case I find the content of his biography far more impressive than the principle being explained.
(For anyone interested here's a link to the common-sense regression to the mean idea, also called the Sports Illustrated effect,  that strikes me as common sense. I came across it lately, was totally underwhelmed and kept moving. But hey, maybe that's just me; it might be a great insight for others.)

The best part of this link is Dr. Halamka's personal story.

When I was 18 and started at Stanford, I realized that my scholarships would only cover the first year of tuition. I visited the Stanford Law library, read the US tax code and wrote software for the Kaypro, Osborne 1, and CP/M computers that calculated taxes. The software shipping from my dorm room generated enough income to start a small company. When the PC was introduced, we were the first to provide such software to small businesses seeking to compute their tax obligations. By the time I was 19, I moved into the home of Frederick Terman, former Provost of Stanford, and the professor who first encouraged William Hewlett and David Packard to build audio oscillators and form a new company called HP. The story of a 19 year old running a software company and living in the basement of founder of HP was newsworthy at the time. I did interviews with Dan Rather, Larry King, and NHK TV Japan.

Believe it or not, it gets better. I have linked Dr. Halamka before and have followed his blog for some time. This guy is CIO for one of the best health care systems in the world and he really knows his stuff.

?House Family Planning Cuts: Bad Medicine And Bad Economics
Everyone knows by now about the House of Representatives defunding Planned Parenthood in the "budget" being sent to the Senate.
I put the word budget in scare quotes deliberately. Using the word budget to describe what was passed is like referring to a canoe as a nuclear submarine. Surely the Senate will not let that part stand. But who knows?  Elected representatives are looking collectively like a bunch of pussies.
Emily Steward at Health Affairs Blog summarizes the madness.

House Republicans claim that the total elimination of the family planning program is part of a broad plan to reduce the federal deficit. But, even at face value, these claims don�t ring true. According to the Guttmacher Institute, every $1 invested in family planning services saves Medicaid $3.74 � savings for both the federal and state governments. Every year, the Title X family planning program stretches $317 million dollars to provide cancer screenings, HIV screening, sexually transmitted infection (STI) testing and treatment, and family planning to more than five million Americans � helping them to stay healthy, support their families, and plan their lives.

Likewise, the effort to de-fund Planned Parenthood is a transparent political attack on health centers that work every day to provide lifesaving health care to Americans, prevent unplanned pregnancies, and improve the health of communities. It�s clear that the amendment to cut federal funding for Planned Parenthood (spearheaded by Rep. Mike Pence of Indiana) does nothing to reduce the deficit, does nothing to improve the economy, and would actually result in Americans losing their jobs. Most importantly, millions of Americans would lose access to affordable health care.

More information at the link. Take along your barf bag.

?The Other Scarlet Letter by Dr. J.D. Kleinke at The Health Care Blog is a fairly long read for a blogpost. And the comments thread makes it an even longer visit, thanks in part to a couple of wordy contributions from me.
This can be seen as a continuation of the previous link. The subject is abortion and Dr. Kleinke, a very accomplished writer as well as a physician, has a way with language that makes for easy to like, understandable reading.

If the crusaders for the �unborn� actually wanted to eliminate abortions, they would be doing everything in their power to expand Planned Parenthood�s funding and full range of services. They would seek to fund this and every other avenue for the provision of basic health services for vulnerable girls and women. They would, of course, also hold their noses and support the health care reform bill � any health care reform bill � that increases access to basic health care services for poor women. They would work to create massive new systems to enable the adoption of unwanted babies of girls and women who choose not to abort. And they would be doing everything in their fiscal power to increase sex education in our schools.

Give girls and women access to all of that, and then you can run your mouth about what they should do with their bodies. By contrast, if you are against providing girls and women with access to services that will reduce the number of unwanted pregnancies in this country, then you are either na�, or stupid, or a shameless hypocrite who obviously cares more about punishing girls and women for their sexuality than you do about preventing abortion, and you should shut up for a minute and take a hard and honest look at your own attitudes about sex.

Now That I Have Your Attention

Among the tactics of the �pro-life� zealots who masquerade as �pregnancy counselors� and entrap terrified girls and women struggling with unwanted pregnancies is this brutal condemnation: �if you abort your baby, you will regret it for the rest of the life.� While this is tantamount to emotional terrorism, it also happens to be � for some unknown number of women who do terminate a pregnancy � sadly and painfully true. And while it would be a coup de grace if these same zealots and their clinic-bombing militia wing diverted their considerable free time and energy from the harassment of girls and women to the adoption of their unwanted children, the burden of course would be too great for them alone.

Luckily, there is a more scalable solution to the nation�s abortion conundrum, lurking not that far from the picket line in front of the women�s health clinic. In many cities, it is actually housed in a different wing in the very same clinic, the one where otherwise infertile women spend tens of thousands of dollars a year flooding their bodies with hormones and technology, in the hope that they might establish and carry to term a pregnancy their body obviously does not really want. In wildly disproportionate numbers, of course, these pregnancies do not go to term; many fetuses conceived through in vitro fertilization and intrauterine insemination come in twos, threes and fours, are born prematurely, and end up in the NICU, costing all of us hundreds of thousands of dollars more.

?Ending on a lighter note, NPR brings us a story from the UK.  Not exactly in the category of Health Care Reform (yet) but one over the top story deserves another.  (H/T Abbas)
Breast Milk Ice Cream A Hit At London Store
The title is all you need. I won't spoil your discovery with a precis, but here is a picture.