Tuesday, May 31, 2011

Being a (public health) expert means never having to say you are sorry

One of the continuing pleasures of following and sometimes participating in the world of medical blogging is the enjoyment of watching some bloggers who regularly hit things out of the park. I am thinking particularly about DrRich (aka Dr Richard Fogoros of the blog " the covert rationing blog") and his recent commentary about public health efforts that go wrong,sometimes badly so,and how the experts cram their previous advice down the memory hole and go on with their latest recommendations . See here for his latest and then here for an earlier spot-on critique of our public health brothers and their follies .

Public health experts enjoy a decision making advantage over the medical doctor who has to often take aggregate data-such as randomized clinical trials but often less reliable data) and then attempt to apply that to the individual patients sitting in his office.All the public health expert has to do is to look at the aggregate data and base recommendations on that while the practicing physician realizes that lying under the summary statistics are individual patients some of whom may will benefit from the proposed treatment while others are unaffected and still others are harmed. Life in the dealing with real patient trenches is more complicated ,nuanced and reality based than in the offices of the academic public health experts who can base their conclusions and recommendation on the utilitarian imperative .

DrRich talks about public health experts " displaying every ounce of the overblown self-confidence traditionally enjoyed by the expert class operating within our Progressive
institutions "

The public health experts share the following view with " leaders with ideas " who vie for the position of architect in the redoing of American health care :

The basic tenet of what I call the medical progressive is that:

health care is too important (and too complicated) to be left to the individual physician and her patient.

"..to demonstrate to men how little they really know about what they imagine they can design.

This F.A.Hayek's quote was directed to the central planners who believed they could control an economy from a governmental perch and did not need the knowledge derived from competition of a price driven market.The problem of knowing what and how much everyone should and should not eat is of a different sort but Hayek's words can function as a much needed counterpoint to their hubris .

Wednesday, May 25, 2011

Is WHO's "World Health report 2000" the worst study ever?

After reading the commentary (see here )by Dr. Scott W. Atlas I would give that publication my vote as the worst or darn close to it. Dr. Atlas is a Senior Fellow at the Hoover Institution and is chief of neuroradiology at the Stanford University Medical Center and has a long list of scientific publications to his credit.

It is amazing how often sound bites from that study are quoted not only by the main stream media but also recited as gospel by medical researchers often in the boiler plate introductions to what otherwise would legitimately pass for a scientific publication.

How many times have we been told that something must be done about the U.S. health care system because although the U.S. spends 16 % of its GDP on health care it ranks 37th (out 191 countries) in something the WHO staffers called "overall performance".

Dr. Atlas said the the WHO publication " ranked countries according to their alignment with a specific political and economic ideal-socialized medicine-and then claimed it was an objective measure of "quality" ".

Quality,which is always a usefully ambiguous concept, was in the view of the report's authors the degree to which a country had distributed wealth and centralized administration of health care.

Atlas explains that 62.5 % of the overall performance index created by the report to rank countries was an assessment of one particular concept of equality and not about health care outcomes at all.

Quoting Dr. Atlas :

In fact,
World Health Report 2000 was an intellectual fraud of historic consequence—a profoundly deceptive document that is only marginally a measure of health-care performance at all.

Read Dr. Atlas's commentary for more details of the methods used by the WHO staffers to achieve this propaganda masterpiece. I expect politicians and policy wonks with a particular agenda to quote the WHO's factoids but it is embarrassing to see medical researchers use the bogus material from the report as fillers and appropriately politically correct genuflexions to the notion of social justice in their publications.

Sunday, May 22, 2011

Can this really happen in the U.S.?

This commentary is fairly far afield from the areas of my usual writing but the facts are so egregious and frightening that I had to say something. The topic is civil forfeiture. I defer to the excellent commentary on this subject by one of my favorite writers,Dr. Donald Boudreaux who is trained in economics and the law having a PhD in the former and is teaching at George Mason University.See here.

The case he discusses and the subsequent decision of the Supreme Court can fairly be described as mind-boggling , the dictionary definition of which is "intellectually or emotionally overwhelming".

In regard to the case,Bennis versus Michigan,Boudreaux and his co-author, A.C. Pritchard, said in part the following:

[the Supreme Court's decision] allows government to impose huge costs on people never charged with criminal wrongdoing"

Those of us who,probably against all reason,still think that the Supreme Court will overturn Obamacare find little hope that the supremes will do the right thing after one reads their decision in this case.

A slightly positive note is this was a five to four decision by the court and one of the dissents was penned by Justice Kennedy who is generally thought to be the possible swing vote when the health care bill gets to the court. Maybe he will do the right thing again.

Monday, May 16, 2011

Will the over crowded ERs generated by Obama care reflect social justice

As the facts continue to flow out of various analyses of Obamacare and we learn that it will not keep the nation from "going bankrupt"and (shockingly) it will actually cost money and that various elements of it have to be postponed or exemptions for certain provisions have to manufactured to avoid voter push back in 20122, advocates are running out of justifications and may have to fall back on their claim of furtherance of social justice.

Some Democratic Senators and several spokesmen for medical organizations risked shoulder injury so exuberant were their efforts at self congratulation when the bill was signed into law.To be able to discern what the results would be in a bill so long, dense and ambiguous regarding details would require analytic ability not yet achieved by any creature who evolved on this earth.In fact, the details of the bill had not yet been written as the particulars were in numerous instances delegated to government entities for rule making some of which were yet to be formed.

Down the road there will be a situation in which this justice will be quite visible.That will play out in the emergency rooms across the country. The rich and the poor alike, those with insurance cards and those without will wait together as increasingly overworked and overstressed ER docs ( and their physician extenders) try and cope with the infusion of 30 plus million more insurance card holders into the health care system. Everyone waiting together to be screened by the NP or PA or as things evoke a NP assistant will give a lovely portrait of the wisdom of the central plan for [almost] everyone having nominal access to medical care but operationally finding little of it.

Social justice typically means redistribution and accordingly to CMS czar Dr. Donald Berwick good medicine must mean redistribution . Easier access to health care will be redistributed and diluted so that everyone gets to wait and wait and everyone's quality of care goes south.

For those of us who hope that having a retainer doc will help, and I think it will, here is a sobering thought and something else to worry about. With more vertical integration of medical care and the latest acclaimed saviors of medicine (the ACOs) becoming prevalent and perhaps dominant, will independent retainer docs even be allowed to admit and treat patients in a hospital or will her patients also end up in the increasingly long lines in the ERAs and the retainer physician unable do anything about it.Is there really anyway to escape from the clutches of Obamacare? Will it all be up to Justice Kennedy? Will it even be possible (i.e. legal) for someone to purchase health care outside of the centrally planned system? If you have not worried about that issue before I suggest you visit this and other commentaries by DrRich.

Here is a commentary from NPR on what ER docs think will happen when millions ( about 34 million) of new folks get an insurance card to show the clerk in the ER. Let us see-increased demand and no significant increase in supply combined with the already in place price controls in Medicare just might mean shortages , long lines, and decreased quality of care.You think.