November 19th, 2009 by Dr. Val Jones in Announcements, Health Policy, Quackery Exposed
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For those of you following the surprising healthcare reform bill mandate of Christian Science prayer as a medical treatment to be payed for by your taxes… I have good news. That was stricken from the merged legislation.
The bad news is that there is currently even more worrisome language in the S.3950 bill. Senator Tom Harkin has introduced language that would essentially require ineffective medical treatment systems like homeopathy to be paid for by government programs, and give people without legitimate medical training the right to become primary care physicians who would establish a “medical home” for patients. Read more »
November 19th, 2009 by Dr. Val Jones in Health Policy, Opinion
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I was having an interesting Twitter chat with online friends (Liz Cohen @, Dr. Chuk Onyeije @; Dr. David Gorski @gorskon; Dr. Marya Zilberberg @murzee; Sherry Reynolds @cascadia; and @speakhealth) about the mammogram debate. They asked me “where I drew the line” on paying for expensive screening tests that may save lives but require unnecessary surgery for countless others. My opinion takes into account human nature and political savvy rather than pure science and statistics on this one.
To me, the bottom line is that the mammogram is a sloppy screening test. It’s expensive, there are lots of false positives and unnecessary surgeries, yet it saves occasional lives (which is dramatic and meaningful). We have to appreciate that women have come to accept the risks/benefits of this test, and have been told for a long time that they should begin screening at age 40.
It’s not emotionally or politically possible to reverse course on this recommendation until a better choice is available. You can trade the mammogram for a better test, but you can’t trade it for doing nothing. The amount of drama associated with the perception of having something potentially life-saving taken away is just not worth the cost savings. It may be a reasonable value judgment based on the data, but it’s not politically feasible so we should mentally take it off the table. Read more »
November 18th, 2009 by Dr. Val Jones in Audio, Expert Interviews, News, Research
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Dr. Avrum Bluming is a medical oncologist and clinical professor of medicine at the University of Southern California. He is also a dear friend, scientist, and careful analyzer of data. I asked him to help me understand the current mammogram guidelines debate, and what women (now faced with conflicting recommendations) should do about breast cancer screening. Please listen to his fascinating discussion captured here:
[audio:https://getbetterhealth.com/wp-content/uploads/2009/11/mammogrambluming.mp3]
What I learned is that the guidelines must be tailored to each woman’s unique situation. The variables that must be considered are incredibly complex, as breast cancer risk factors include everything from when and if one has given birth, to a history of smoking, drinking, overweight, breast cancer in the family and even the age of your parents when you were born. Beyond risk factors, new research suggests that some breast cancers spontaneously resolve without treatment, but our technology is not advanced enough to distinguish those from others that will go on to become life-threatening tumors – so we treat all cancers the same. Read more »
November 16th, 2009 by Dr. Val Jones in Health Policy
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Someone I know works at a non-profit organization (supported by health insurers) that is trying to simplify the administrative processes in healthcare. He’s tasked with finding ways to make data transfer between doctors’ offices and health insurance companies more uniform and straightforward. His work is such a success that it was promoted to President Obama as a clear example of health insurers’ efforts to reduce waste and simplify healthcare. There is even talk of his project becoming mandated.
So why is this simplification strategy now in jeopardy of being tabled rather than legislated? Vendors and clearinghouses who exist to transfer data from one disparate health insurance bureaucracy and medical practice to another are fighting to block this progress because their business model is at risk. If health insurers and physicians can safely and efficiently exchange data – then they become less reliant on middle men.
One person’s waste (non-uniform, inefficient data exchange) is another’s (clearing houses and vendors) job security.
And we wonder why it’s so difficult to reform healthcare?
Sigh.
November 12th, 2009 by Dr. Val Jones in Health Policy, Opinion
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There hasn’t been much discussion about serious tort reform in the current healthcare reform debate. That’s probably because most policy experts don’t believe it will make a significant dent in healthcare costs. I happen to believe that tort reform would be a huge boon for healthcare (just ask Ob/Gyns in Texas) and save a lot in defensive medicine practices and unnecessary testing, but even if I’m wrong and it wouldn’t result in cost-savings, there’s another issue at play: access to primary care physicians.
We all agree that we’re in the midst of a major shortage in primary care physicians. Many different solutions have been proposed – everything from “let the nurses do it” to forgiving medical school loans to physicians who choose primary care as a career. However, solving the PCP shortage isn’t just about recruitment, it’s about retention. And with up to a half of PCPs saying that practice conditions are so unbearable they’re planning to quit in the next 2 years – Houston, we have a problem. Read more »
