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TECH: Brailer takes weekend off in SF

The S.F. Chron has an article about local boy made good David Brailer and his attempt to persuade American health care to inter-operate, or whatever it’s supposed to be doing in the absence of a mandate or any money! Brailer lives in San Francisco and truies hard to be in California on the weekends. It’s a good article complete with actual photos of actual doctors in a real life-hospital trying to use an EMR. And there were people who scoffed that it would never happen!

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Meanwhile, the profile tells us something I never knew, not that it’s relevant to his gig or his career or in the least unusual in our fair city; Brailer is gay. He frequently mentions his kid in his speeches, and I just assumed and assumed wrongly. So given that my immediately previous article in THCB was about another Bush appointee who thinks that Brailer and his ilk will rot in hell, it’s good to see that the Adminstration for once ignored its maniac Christian right in a relatively non-political appointment. Or given that a quick google search shows up nothing on the topic, perhaps Rove at al were as political as usual but their background searches were as competent as their war-planning and hurricane relief efforts.

OFF-TOPIC: The ultimate theocratic fascist cashes in

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And in my end of week rant….. Arianna Huffington nails John Ashcroft, now lobbyist.

There’s no question that bible-thumping fascist John Ashcroft was my least favorite Republican of recent years. His Justice department converted the war on drugs into the war on patients and doctors. The former AG was determined that everyone using marijuana or opiates for their treatment be banned from doing so, and face incredible draconian penalties. Everyone that is apart from his nephew, who got probation despite running a sizable marijuana grow-op for profit (not for medical use) while he was Missouri governor. Funny that, eh.

He also was responsible for the FBI. You know the same FBI that was so good at tracking down the terrorists and managed to avert a catastrophic hijacking plot with some well-timed arrests in late August 2001. Then he signed off on the illegal wiretaps from his hospital bed.

In a just world where would he end up? In prison for constitutional crimes? On skid row due to a Bill Bennett like gambling problem? As a Rush Limbaugh-like pill popper unable to legally find the OxyContin he needs to control his pain from that surgery? Arrested at a raided cannabis club unable to deal with the nausea from his chemo?

No, of course he’s ended up on K street. He’s back in DC working for Israeli defense contractors and nebulous corporations like ChoicePoint (the goons behind the Florida “felons voter” list in 2000 that got Bush the election) to which his department awarded a huge contract while he was AG. And he’s becoming a very very rich man as a consequence.

Ashcroft is being handsomely rewarded for his helpful ways. “I’ve been stunned at how good people have been to me,” says Ashcroft, revealing a remarkably low stun threshold. “It’s been gratifying, and I’m earning significant multiples of what I’ve ever earned before.”

So what’s he doing for all that cash? Well apart from the after the fact bribes ChoicePoint is paying him direct now? Surprise, surprise greasing the wheels in the Dept of Homeland security as the booty capitalists swoop in to get the spoils of war on the home front. Well at least he understands well the corruption necessary to get around whatever we have left in the way of laws about that stuff. After all he didn’t care about the FISA law in the wiretapping cases, and he didn’t care about following a Missouri State law that mandated drug forfeiture seizures went to education when he preferred it to go to corrupt cops instead. It’s just now that the kick-backs are getting bigger and bigger. And of course Ashcroft is the AG who wanted all government departments to automatically not comply with freedom of information act requests, so we’ll never really find out what he gets up to in his new job any way.

Its a triumphant American success story. And his God is no doubt very pleased.

 

HOSPITALS: The transparency debate

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Here’s my editorial from today’s issue of Fiercehealthcare:

We’ve been hearing a great deal about price transparency in health care. California has a new law mandating that hospitals release their chargemaster billing data. The Administration’s advisors are demanding that hospitals and doctors reveal pricing, and one health plan (Aetna) has revealed its negotiated rates with physicians in one market (Cincinnati, OH). The theory is that pricing transparency will increase competition and make it easier for consumers to shop around. Proponents point to the reduction in the advertised price of LASIK surgery as an example of what might happen.

Speaking before Congress, Paul Ginsburg sounded several warnings about this trend. First, health care is in no way prepared to deliver pricing information. Several studies have shown that hospitals and physician groups do not know their costs or prices per service, and hence there is wide variation in what, if anything, they can tell consumers. Secondly, most health care is purchased not by consumers directly but by insurers. Ginsburg gave evidence that where contracted rates of insurers are exposed by regulation, prices tend to rise. Thirdly, there’s still little agreement on what we should be pricing. Each service? Each episode? Care per month? All care per year? Finally, apparently in the LASIK market, there’s less transparency than meets the eye, so to speak, and advertised low prices are in some respects come-ons like those cheap air-fares that aren’t really available. Transparency in health care is needed, but we need to think carefully what that really means in practice.

BLOGS: Health Wonk Review up at Kate’s

Damn. Health Wonk Review is up at Healthy Policy and I didn’t even notice till late PST. But young punkette Kate Steadman did a great job.

By the way, the punkette is still in Kansas City but is intending to move to DC to get a policy job. Having run many research projects with equally keen but, shall we say, less intuitive, young talent, I’d reccomend that any research shop looking for fresh meat snap her up PDQ.

PHYSICIANS: Docs believing in God, not as many as you’d think

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I’m the ultimate American outcast in that I’m an atheist (or as we’re known now secular humanist), who thinks that (as one old friend put it) "all religions from the Bhagwan Rajneesh to the Unitarians are only interested in putting their hand in your pocket".

But I accept that makes me pretty unusual in America where roughly 90% of the population reliably polls as believing in God  (although I’d fit in OK in Sweden and most of Europe).

God

What I fund pretty interesting was a survey that came out last summer but was just featured in Forbes. The authors seem to be all excited that they found that American physicians were likely to believe in God and have it influence their daily lives. That’s because they were comparing physicians to scientists, who have very low rates of religious belief.

But what I found interesting was that only 76% of physicians said that they believed in God. If we take that to include a wide meaning of "God", that means that in their beliefs about religion, physicians look more like Europeans than Americans.

But I have no idea what conclusions to draw from that for the health system.

POLICY: Pat Salber says we should change policy on food availability

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Pretty scary stuff from Pat Salber over at Peertrainer: The Doctor Weighs in on The epidemic of childhood obesity.

It is estimated that boys born in the US in the year 2000 have a 30% chance of developing Type 2 diabetes during their lifetime; girls have a 40 percent chance. Think of that: 1 in 3 boys and close to half of girls who are now in kindergarten will become diabetic at some point in their lives. 

Pat is right. If you’ve seen SuperSize Me or read Fast Food Nation you just know that we are with food where we were with smoking in the early 1960s. It’s going to be a 30–50 year battle, but in the end the forces that will have to pay the costs of obesity will gang up on the big food vendors and producers. It will remain a private choice, but one that is increasingly difficult to get to due to limits on access and social opprobrium. And the obvious place to start, as Arnie knows, is in the school cafeteria and with commercials. After all we know the commercials work, or they wouldn’t be on TV!

I did see this most amusing article a while back that showed that watching violence on TV didn’t make anyone violent, but watching food made 36% of the viewers want to eat.  I know it’s true! I personally am in the middle of one of my violent diets. I have taken a month off-booze, off-cards, off-sugar and off-meat three times since January 2005, and gone seriously onto working out at the gym. The good news is that I’m back snowboarding with no problems and have lost around 30 pounds. The bad news is that any restaurant or food commercial is making me ravenous! And boy do I miss my chocolate milk!

INTERNATIONAL: Exactly what care does a pregnant woman need? with UPDATE

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Lynn Payer wrote a great book a while back called Medicine and Culture. I remember that Americans were put on medication if their blood pressure was too high, and Germans were put on medication if their blood pressure was too low. Here’s an amazing example of differences in medical treatment between the UK and Germany for the same “condition” — normal pregnancy. Be sure to read the comments!

NHS Blog Doctor: Vaginal examinations in pregnancy

 I asked a leading UK ObGyn with whom I’ve had a life long relationship what he thought. Here are my dad’s comments:

I agree entirely with Dr Crippen, vaginal examinations in pregnancy require a proper indication. apart from that there is no indication for performing vaginal ultrasound after about 13 weeks as abdominal u/s gives more information. About the only indications for v/e in pregnancy are to give an assessment of pelvic size in late pregnancy if the head does not engage in a primigravida (prior to xray pelvimetry if elective c/s for disproportion is contemplated) or to assess the state of the cervix if labour (in your language, labor!) is to be induced. In early pregnancy the only indication I would accept is in the investigation of vaginal infection (discharge). If there is any doubt as to the progress of early pregnancy, either diagnosis or possible missed abortion then vaginal u/s is indicated.

POLICY: I think Borowitz has got it

From the always good but sometimes brilliant The Borowitz Report. This one finally explains the point of Medicare Part D.

U.S. CONFUSES INSURGENTS WITH PRESCRIPTION DRUG PLANMilitary Launches ‘Operation Incomprehensible Program’ Across IraqIn an effort to confuse Iraqi insurgents, the Pentagon announced today that the U.S. had begun bombarding insurgent positions with copies of President Bush’s Medicare prescription drug plan.At a press briefing at the Pentagon, Secretary of Defense Donald Rumsfeld said that the idea of confusing the insurgents with the President’s Medicare plan was hatched last week, after Mr. Bush appeared at a series of town hall meetings at which seniors in his audience seemed thoroughly bewildered by the intricate new program.“We realized, if this prescription drug plan is that confusing in English, imagine how incoherent it would seem once it was translated into Arabic,” Secretary Rumsfeld said.As soon as Pentagon planners seized upon the idea of using the
President’s plan to confuse the insurgents, Operation Incomprehensible
Program was launched.

According to Secretary Rumsfeld, U.S. warplanes pounded insurgent
positions in the citiers of Tikrit and Najaf with copies of the
prescription drug plan in the early morning hours of Monday.
Mr. Rumsfeld said that satellite photos of those positions have
been encouraging thus far, showing dozens of Iraqi insurgents reading
the prescription drug plan and scratching their heads.
The Defense Secretary said he was hopeful that Operation
Incomprehensible Program would leave the Iraqi insurgents totally
baffled, but he hinted that the Pentagon had other tactics up its
sleeve: “We are fully prepared to bombard them with copies of my press
briefings.”