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Rationed Care, Denied Treatment, And “Death Panels”

One of the canards slung at the Affordable Care Act is that it creates “death panels” that would allow the government to deny patients lifesaving treatments, even though two independent and non-partisan fact-checking organizations found it would do no such thing.

I don’t bring this up now to rehash the debate, but because the New York Times had a recent story on Arizona’s decision to deny certain transplants to Medicaid enrollees — “death by budget cuts” in the words of reporter Marc Lacey. His story profiles several patients who died when they were unable to raise money on their own to fund a transplant. Lacey quotes a physician expert on transplants who flatly states: “There’s no doubt that people aren’t going to make it because of this decision.”

Arizona Medicaid officials told the Times that they “recommended discontinuing some transplants only after assessing the success rates for previous patients. Among the discontinued procedures are lung transplants, liver transplants for hepatitis C patients and some bone marrow and pancreas transplants, which altogether would save the state about $4.5 million a year.” Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

New Food Allergy Guidelines

Walnuts and peanuts by viZZZual.com via FlickrThe National Institute of Allergy and Infectious Diseases (NIAID) issued comprehensive food allergy guidelines to help primary care physicians and subspecialists diagnose and manage patients.

The guidelines were published online at the NIAID food allergy guidelines portal, which also has a frequently asked questions section. The agency will release a patient synopsis early next year.

The guidelines establish consistent terminology and definitions, diagnostic criteria and patient management practices. Additional topics covered by the guidelines include the prevalence of food allergy and management of acute allergic reactions to food, including anaphylaxis. The report also identifies gaps about what is known about food allergy.

NIAID Director Anthony S. Fauci, MACP, said, “Because these guidelines provide standardized, concise recommendations on how to diagnose and manage food allergy and treat acute food allergy reactions across specialties, we expect both clinicians and food allergy patients to greatly benefit from these clear state-of-the-science clinical standards.” Read more »

*This blog post was originally published at ACP Internist*

Addressing Healthcare Spending: “Cowardice” Or Bravery?

In assessing the “best and worst” of the recommendations from the National Commission on Fiscal Responsibility, Washington Post blogger Ezra Klein accuses the Commission of “cowardice” in addressing healthcare spending:

“The plan’s healthcare savings largely consist of hoping the cost controls . . . and various demonstration projects in the new healthcare law work and expanding their power and reach. . . In the event that more savings are needed, they throw out a grab bag of liberal and conservative policies . . . but don’t really put their weight behind any. . .[their] decision to hide from the big questions here is quite disappointing . . . ”

Pretty harsh words, considering that in other respects Klein gives the Commission high marks. But I think there is a lot more to the Commission’s recommendations on healthcare spending than meet’s (Klein’s) eyes, even though I have my own doubts about the advisability and political acceptability of many of them. Read more »

*This blog post was originally published at The ACP Advocate Blog by Bob Doherty*

Bend The Healthcare Cost Curve By Preventing Diabetes

By 2020, an estimated 15 percent of adults will have diabetes and 37 percent will have prediabetes, a total of 39 million people, compared with rates of 12 percent and 28 percent today, respectively.

Today, more than 90 percent of people with prediabetes, and about a quarter of people with diabetes, are unaware of it, according to a report from UnitedHealth Group, the provider of insurance and other health care services.

The health savings alone of preventing diabetes would bend the cost curve of health care spending in the country. Health spending associated with diabetes and prediabetes is about $194 billion this year, or 7 percent of U.S. health spending, the report said. That cost is projected to rise to $500 billion by 2020, or a total of almost $3.4 trillion on diabetes-related care.

Engaging the at-risk population could save up to $250 billion, or 7.5 percent of estimated spending on diabetes and prediabetes, in the next decade. Of that money, $144 billion, or about 58 percent, would come from savings in Medicare, Medicaid and health care exchange subsidies. Read more »

*This blog post was originally published at ACP Internist*

Are Airport Security Pat-Downs Unhealthy?

Potential health effects of airport security are being questioned for their possible health consequences, from spreading germs to radiation exposure to the stress that being searched induces.

With cheaper flights available this year and the need for security in air travel, the Transportation Security Administration (TSA) is justifying its full body scans and its pat-downs that rise up travelers’ legs — all the way up.

The scanners use microwaves, leading some to question whether people may be receiving too much radiation. It’s also a concern to activists who may have already undergone a lot of radiation for existing condition, or who have other conditions for which TSA agents may not be trained. (Read one seasoned traveler’s personal experience here.) The TSA reports the scanners expose users less energy than a cell phone.

Some protesters refused the body scans in favor of a pat-down, in an effort to tie up air travel on the day before Thanksgiving and force a review on the issue. But a manual exam spreads germs, say others.

Amid all the speculation of potential health consequences, federal officials are reminding travelers that the security measures are there for passenger safety. However, retorts Jason Mustian‘s Twitter feed, “Body scans and genital fondlings would save more lives if our government was paying to have them done in hospitals rather than airports.”

*This blog post was originally published at ACP Internist*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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