The Health Care Blog – Page 935 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Commentology

Jan 25, 2009

Mitch came to the defense of Sanjay Gupta in the thread on Maggie Mahar’s post “Doubts About Gupta for Surgeon General.

“I guess I see this differently. One, Gupta is one of the most respected surgeons in the country in his field. Two, his work on TV makes him a natural communicator with the public, which we haven’t had for a very long time. Three, using his TV work to condemn him pretty much says that anyone who’s been in TV should be automatically disqualified for government work. Four, he talked about Anna Nicole Smith because that was his job; not everyone gets to pick and choose what they do or don’t want to do at work. Five, Moore did fudge some of the facts, and if you don’t believe me, ask people in Canada, England, and Australia that live in larger communities how long it takes them to get major procedures unless they pay for it themselves. And six, so he’s against medical marijuana; not every doctor agrees on every single thing. What’s happened to qualifications as guideposts for whether someone is qualified for a position or not? From where I sit, he’s imminently more qualified for the post of surgeon general than Leon Panetta is qualified to be the head of the CIA; true, it’s not a medical comparison, but it’s valid nonetheless. Sounds like a lot of jealousy to me from no-name, if possibly qualified, physicians, who wish it were them than Dr. Gupta.”

Richard Reece MD had this response to Roger Collier’s Sunday morning post “The Siren Song of Public Programs …”

In their frenzy for public programs to expand cover to all, wonk enthusiasts removed from reality conveniently forget the key to making expansion work: physicians. Coverage without physician access is meaningless. And the only federal progam doctors hate more than Medicare is Medicaid. Both are bureaucratic landmines, and both pay considerally less than private coverage.

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Jan 25, 2009

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Dr. George Lundberg for Surgeon General

Jan 25, 2009• 18

By Brian Klepper

The report that Mr. Obama’s Surgeon General choice might be neurosurgeon and CNN medical correspondent Dr. Sanjay Gupta produced an upwelling of strong opinion, particularly in the medical community. Some argued that Dr. Gupta has clearly demonstrated his abilities as an able communicator.

But others said that Gupta lacks the experience, seriousness and focus on public health. (I can’t help thinking that anyone who has achieved working neurosurgeon and national TV commentator status is pretty capable and serious, demeanor notwithstanding.)

And so it is that on Facebook, that Dr. Richard Lippin, a longtime Preventive Medicine physician based in Pennsylvania, has posted a letter he sent to President Obama and Secretary Daschle, urging the consideration of Dr. George Lundberg for Surgeon General.

The header reads: “We need a physician with the gravitas and the moral credentials and authority to use this bully pulpit position to speak for science and values based priority public health issues for all Americans. Dr. George Lundberg fits the bill.”

The letter provides a brief bio of Dr. Lundberg, the brilliantly eclectic, progressive, Alabama-born, down-to-earth physician who has been a visible mainstay of American medicine for decades. Dr. Lippin doesn’t mention Dr. Lundberg’s landmark 2002 book on American health care and reform, Severed Trust. (The title alone provides a lot of insight into Dr. Lundberg’s view of the world.)

But Dr. Lippin does believe the Surgeon General choice is about healing both America and American medicine, He writes, “we have a genuine crisis on many levels in US Medicine. Also we need desperately for the medical profession to regain its moral and ethical foundations and furthermore we also need medical leaders who must regain the trust of the American Public which has been dangerously eroded.

I agree with Dr. Lippin that those are the tasks, and I agree that Dr. Lundberg is a terrifically suitable candidate. Over many years, I have developed a warm friendship with him. It is impossible to not be bowled over by his range and grasp of issues, and by his unswerving willingness to stand clearly and openly for approaches that are tied to evidence and reason. The ultimate critical thinker, his judgments are founded most closely to merit, possibility and an unshakable belief in the correctness of the pursuit of excellence in health.

He is also bold and politically savvy. You don’t become the longest running Editor-in-Chief of the Journal of the American Medical Association (until he got politically at odds with them) and then build Medscape into the most widely read Web resource for clinicians worldwide unless you can continuously strike the delicate balances between science, sensibility and moral imperatives among your peers.

I can’t say whether Dr. Lundberg would be the best candidate for the job ahead. He has a huge following in the medical community, nationally and worldwide, the result of many, many years of consistently high performance infused with unassailable integrity. Whether he’s the right person for this moment is another issue, though, fraught with the complexities of political consideration, a vision consistent with the larger plan of the Obama team, fluency with the bewildering array of new technologies that are changing the face of medicine and the patient-physician relationship, and so on.

But Dr. Lippin makes an important point. American medicine is demoralized in the field. Overt, rampant financial conflict has caused many to believe that the profession has lost its compass. With that loss, the trust of patients and the authority that trust conveys have also diminished.

Restoring that trust and authority isn’t simply a matter of leadership or preaching, but will depend on fundamentally changing the business of medicine, a much larger task indeed that will require an orchestrated effort by all of us, not just physicians.

But the new Surgeon General, whoever he or she is, should be grounded first in science, evidence and best practice, in tirelessly advocating and maneuvering for a care delivery system that is as advanced and nuanced as the diagnostic and treatment approaches we’ve developed, and on advancing the health of ALL our people in ways that leverage rather than squander increasingly precious resources.

While there is no question that Dr. Lundberg is worthy, I’d be surprised if the call for his consideration is heard in the din of this transition. Even so, it is deeply gratifying to see an outpouring of support by his peers, the result of successfully dedicating his life to advancing medical knowledge and its best application.

A Shout Out to Our Sponsors

Jan 24, 2009

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Trackers – you can use Zume yourself at last (and others too)

Jan 24, 2009• 2

By Matthew Holt

In this piece I’m slightly pulling CEO Rajiv Metha’s chain (but he’s an Arsenal fan so he can take it). At any rate the Zume Life beta program is open and it works on the iPhone (as previewed at Health 2.0 in October. Zume has received the kind of publicity that tiny starts-up dream about (articles in the WSJ, NY Times et al) while only having a tiny number of people in pilots actually using the service. So it’'s good to know that the rest of us can actually use it and see what the fuss is about.

Meanwhile Zume is by no means alone in the market for lightweight trackers of health, diet and everyday activities. Health 2.0 “Launch” star thecarrot.com has a nifty interface to the iPhone designed in from the start, and has been adding different trackers to its platform at a ripping rate. For a pure platform approach that you can track basically anything at all on, it’s really neat.

It’s the platform, stupid

Jan 24, 2009• 6

By Scott Shreeve

I read with interest a recent article by my favorite health care reporter, Joe Conn, who has long time interest in the commercial success of the VistA Electronic Health Record system developed by the VA.

VistA has an incredible, well described impact on the clinical and
system peformance of the VA. Given its availability through the Freedom
of Information Act, it can and should seriously be considered as a
potential solution for government-based health care information
technology. I mean, why not? The several billion dollars already
invested, and the several billion dollars already wasted on
alternatives, would hopefully help the new administration come to their
senses to realize the development of a common platform for all
government related health IT would make good business sense.

The Truth About Health IT Standards – There’s No Good Reason to Delay Data Liquidity and Information Sharing

Jan 23, 2009• 9

By David C. Kibbe & Peter Neupert

Now that the Obama administration and Congress have committed to spending billions of tax payers’ money on health IT as part of the economic stimulus package, it’s important to be clear about what consumers and patients ought to expect in return—better decision-making by doctors and patients.

The thing is, nobody can make good decisions without good data. Unfortunately, too many in our industry use data “lock-in” as a tactic to keep their customers captive. Policy makers’ myopic focus on standards and certification does little but provide good air cover for this status quo. Our fundamental first step has to be to ensure data liquidity – making it easy for the data to move around and do some good for us all.

Nomination for U.S. Surgeon General

Jan 23, 2009• 1

By Richard A. Lippin, MD

This is a reprint of the letter originally posted to Facebook.

Dear President Obama and Former Senator Tom Daschle:

As a physician leader in the medical specialty Preventive Medicine for 30 plus years, I am writing this open e-letter to you to strongly urge you to consider George D. Lundberg, MD as our nations next U.S. Surgeon General.

My letter relates to the distinctly unique qualifications that Dr Lundberg would bring to this important position and to express my views about the position itself since various previous administrations have held variable views on how to define the activities of the position itself. And the “power of personality” of some of our best US Surgeon Generals has influenced the perception of the role.

Rationing — how will it be spun?

Jan 23, 2009• 11

By Sarah Arnquist

The House of Representatives’ $825-billion stimulus package proposed last week included $1.1 billion to fund comparative effectiveness research — research that evaluates two or more medical technologies or treatments to see which is most effective.

This is welcome news to those who say the need for such efforts to ensure the U.S. gets more value from its abundant health care spending is long overdue.

But not everyone thinks comparative effectiveness research is a good idea. Some say it is a front for rationing health services — for allowing the government to make health care decisions instead of doctors.

Inciting fears of rationing will be an easy card to play in the forthcoming health reform debate. If the national goals are to provide universal coverage and control costs, it seems setting some limits on health care would be necessary.

The use of comparative-effectiveness analysis and separately cost-effectiveness analysis fall squarely within this anticipated debate.

Fans of comparative effectiveness research include key players in the Obama Administration: Tom Daschle, Secretary of Health and Human Services; Peter Orszag, Office of Management and Budget director; and Carolyn Clancy, acting director of the Agency for Healthcare Research and Quality (AHRQ).

Many developed countries, including Germany, England, Canada and Australia, already invest in this research and use it to decide what health services to pay for. Many health policy experts, health economists and health plan leaders — both public and private — say the U.S. is behind the times.

Nearly everyone agrees that having more evidence to support clinical decisions is a good thing, but there’s strong disagreement on whether it should be mandatory to guide coverage decisions and whether the analysis should factor in the relative costs of treatments.

Scott Gottlieb, a fellow at the conservative American Enterprise Institute and former FDA official, warned Americans this week in the Wall Street Journal about this “mirage” Democrats are calling comparative effectiveness.

“In Britain, a government agency evaluates new medical products for their “cost effectiveness” before citizens can get access to them. The agency has concluded that $45,000 is the most worth paying for products that extend a person’s life by one “quality-adjusted” year. … Here in the U.S., President-elect Barack Obama and House Democrats embrace the creation of a similar ‘comparative effectiveness’ entity … They claim that they don’t want this to morph into a British-style agency that restricts access to medical products based on narrow cost criteria, but provisions tucked into the fiscal stimulus bill betray their real intentions.”

Gottlieb makes comparative clinical effectiveness analysis and cost-effectiveness analysis seem as though they are the same. They aren’t. It’s true that England uses both in its determination, but supporters of the creating a centralized center to do comparative effectiveness research in the U.S. split on whether or not costs should be included.

Comparative effectiveness research and how it could be used to shape health policy is complex with no singular definition, method or form. Proponents may overstate its ability to save money (it actually doesn’t in most countries where it’s used). Opponents may write it off as an underhanded attempt at rationing. THCB will tease apart those arguments over the coming months. Stay tuned.

When You’re a Wonk, You’re a Wonk All the Way

Jan 23, 2009• 1

Folks at the Health Affairs blog are proudly highlighting a Business Week snippet about incoming health
reform czar and HHS Secretary Tom Daschle. The magazine quotes a friend talking about Daschle’s intensity this way: “He really does unwind by reading [policy journal] Health Affairs.”

As long-time Health Affairs readers, we applaud this seriousness of purpose. However, we cannot help but be reminded of the story of the man who went to see a psychiatrist and complained that all he dreamed about was baseball, baseball, baseball. “Don’t you ever dream about travel, or adventures or women?” asked the shrink. “What,” replied the man, “and miss my turn at bat?!”