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Latest Posts

Decreasing Jail Time, Treating Drug Abuse As A Public Health Issue

A couple of years ago, I served for several weeks on a grand jury for the Superior Court of the District of Columbia. Mine was designated a RIP (Rapid Indictment Protocol) jury, assigned to efficiently hand down indictments for small drug-related offenses. These cases usually involved undercover officers posing as customers making purchases from street dealers, or uniformed police stopping suspicious vehicles and searching them for drugs. Although rarely we heard testimony about defendants caught with thousands of dollars of contraband, the vast majority of offenses were possession of small amounts of marijuana, heroin, or cocaine for “personal use.” Many of the latter defendants had multiple such offenses, which had resulted in probation, “stay away” orders (court orders to avoid certain neighborhoods where drugs were highly trafficked), or brief stints in jail. Few, if any, had received medical treatment for their addictions.

After a few weeks of hearing these cases, my fellow jurors and I grew increasingly frustrated with this state of affairs. We felt like a cog in a bureaucratic machine, fulfilling a required service but making little difference in anyone’s lives. A young man or woman caught using drugs would inevitably return to the street, violate the terms of his or her probation or “stay away” order, and be dragged before our grand jury again for a new indictment. We openly challenged the assistant district’s attorneys about the futility of the process. They would just shrug their shoulders and tell us Read more »

*This blog post was originally published at Common Sense Family Doctor*

Even With Health Care Reform, Many Will Still Encounter Problems

Trudy LiebermanA couple weeks ago I walked the streets of Lincoln, Nebraska, talking to men and women about whether they thought Washington was listening to their economic concerns.  Jeff Melichar manages his family’s Phillips 66 gas station on the city’s main street, and one of his big financial problems happens to be health insurance.  The more we talked, the more I realized what a jam he could be in down the road because of a loophole in the health reform law, which has received almost no press coverage or public discussion: If you have health insurance from your employer, you may have to keep it whether or not it’s adequate or affordable.  Buying less expensive or better coverage from one of the state “exchanges” or shopping services will be off limits.  So despite all that talk about consumer choice, for many like the Melichars, there may be no choice.

Melichar’s wife is eligible for health insurance from the optical company where she works.   But the family waited until this fall to enroll when the firm offered coverage they finally could afford.  Their premium is Read more »

*This blog post was originally published at Prepared Patient Forum: What It Takes Blog*

Patient-Centered Outcomes Research Institute: Just Another AHRQ?

If you want to grow the expense of health care delivery in America very quickly, then create two government agencies to do the same job.

From the 28 September 2011 issue of the New England Journal of Medicine, we read about a small paragraph in our new health care law that created the Patient-Centered Outcomes Research Institute (PCORI). From that same article, here’s the PCORI’s mission:

PCORI responds to a widespread concern (eds note: emphasis mine. Really? What about the internet?) that, in many cases, patients and their health care providers, families, and caregivers do not have the information they need to make choices aligned with their desired health outcomes.

PCORI funding is set at a total of $210 million for the first 3 years and increases to approximately $350 million in 2013 and $500 million annually from 2014 through 2019. With more than $3 billion to spend between now and the end of the decade, PCORI will support many studies encompassing a broad range of study designs and outcomes that are relevant to patients, aiming to assist people in making choices that are consistent with their values, preferences, and goals.

We should recall that Read more »

*This blog post was originally published at Dr. Wes*

Asthma Patients Will Soon Be Required To Get Prescription Inhalers

This underestimates the increased cost by a huge factor…

Remember how Obama recently waived new ozone regulations at the EPA because they were too costly? Well, it seems that the Obama administration would rather make people with Asthma cough up money than let them make a surely inconsequential contribution to depleting the ozone layer:

Asthma patients who rely on over-the-counter inhalers will need to switch to prescription-only alternatives as part of the federal government’s latest attempt to protect the Earth’s atmosphere.

…But the switch to a greener inhaler will cost consumers more. Epinephrine inhalers are available via online retailers for Read more »

*This blog post was originally published at GruntDoc*

Physicians’ Donations To Political Parties: You Get What You Give

Why don’t docs get more of what they want in DC?  There’s a quite instructive graph in a blog post from NRO last week (talking about Union campaign donations), but I found this one to be very instructive, and have added labels so the point cannot be missed:

In politics, generally what you give is what you get. I’ve taken to giving more to the PACs that represent me.

As an aside, it’s political malpractice to give only to one party (Teachers). Eventually that one party will be on the outs, and then where are you?

*This blog post was originally published at GruntDoc*

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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