health

As you consider whether or not to get a flu shot for either the regular seasonal flu or for H1N1, you might want to read this analysis of the evidence for seasonal flu vaccination from the BMJ:

In children under 2 years inactivated vaccines had the same field efficacy as placebo, and in healthy people under 65 vaccination did not affect hospital stay, time off work, or death from influenza and its complications. Reviews found no evidence of an effect in patients with asthma or cystic fibrosis, but inactivated vaccines reduced the incidence of exacerbations after three to four weeks by 39% in those with chronic obstructive pulmonary disease. All reviewers reported small data sets (such as 180 people with chronic obstructive pulmonary disease), which may explain the lack of demonstrable effect.

The same author in a different article makes the interesting point that only about 7% of what seems, casually, to be flu -- "ILI", or influenza-like illness -- is actually influenza. Obviously an influenza vaccination is not protective against other, more common causes of ILI.

A study of the benefits of exercise for octogenarians, published in the Archives of Internal Medicine, found that active 85-year-olds had a three-year survival rate three times higher than those who were inactive.

Even those who started exercise late saw benefit -- previously sedentary 85-year-olds who got a move on had three-year survival rates double that of elder couch potatoes.

Nor did it take intense training to qualify as active. It seems that walking four hours a week had as much benefit (in terms of survival, at least) as more vigorous activity.

So keep moving! Me, I intend to still be continuing my karate training into my 80s. And 90s. And 100s.

A few weeks ago I argued that one reason for intervention in the health care marketplace is that health is contagious. So I was fascinated to see this New York Times story about how data from the famous Framingham Heart Study backs up this idea:

...When they ran the animation, they could see that obesity broke out in clusters. People weren’t just getting fatter randomly. Groups of people would become obese together, while other groupings would remain slender or even lose weight.

And the social effect appeared to be quite powerful. When a Framingham resident became obese, his or her friends were 57 percent more likely to become obese, too. Even more astonishing to Christakis and Fowler was the fact that the effect didn’t stop there. In fact, it appeared to skip links. A Framingham resident was roughly 20 percent more likely to become obese if the friend of a friend became obese — even if the connecting friend didn’t put on a single pound. Indeed, a person’s risk of obesity went up about 10 percent even if a friend of a friend of a friend gained weight.

“People are connected, and so their health is connected,” Christakis and Fowler concluded when they summarized their findings in a July 2007 article in The New England Journal of Medicine, the first time the prestigious journal published a study of how social networks affect health. Or as Christakis and Fowler put it in “Connected,” their coming book on their findings: “You may not know him personally, but your friend’s husband’s co-worker can make you fat. And your sister’s friend’s boyfriend can make you thin.”

...Smoking, they discovered, also appeared to spread socially — in fact, a friend taking up smoking increased your chance of lighting up by 36 percent, and if you had a three-degrees-removed friend who started smoking, you were 11 percent more likely to do the same. Drinking spread socially, as did happiness and even loneliness. And in each case one’s individual influence stretched out three degrees before it faded out. They termed this the “three degrees of influence” rule about human behavior: We are tied not just to those around us, but to others in a web that stretches farther than we know.

A reminder of the stakes involved in health care reform, from MoveOn.org:

Dawn Smith is an aspiring playwright in Atlanta. Four years ago, she was diagnosed with a rare, but treatable brain tumor. Her doctors are ready to remove it, but they can't because CIGNA refuses to pay for the surgery.

Dawn has been fighting CIGNA on her own, but now she's asking for our help. CIGNA may be able to ignore her, but they won't be able to ignore millions of us standing together.

Can you sign this statement of support to shine a light on Big Insurance's abusive tactics, get Dawn the care she needs and make sure they don't do this to anyone again?

A compiled statement with your individual comment will be presented to H. Edward Hanway, CEO of CIGNA.

Some more info at MoveOn's Facebook page: "CIGNA, her insurer, refuses to pay for the care she needs because the only hospitals qualified to treat her are out-of-network. And after years of fighting, Dawn just received her final denial letter."

The publicity may make CIGNA do the right thing (though this is the same company whose death panel of accountants delayed and delayed treatment until Nataline Sarkyian died); but we can't rely on every case of abuse by health insurance companies to become a cause celebre. There must be real reform, now.

A 47-year-old British man with only five weeks of previous athletic training has just completed running 43 marathons in 51 days. For seven weeks he's done at least 27 miles a day for six days a week, over 1,110 miles total.

No joke -- it's comedian Eddie Izzard, running for charity.

He did have the help of Olympic experts, and he's got blisters on top of blisters, but still -- it is truly amazing what potential lies within each and every "ordinary" human being.

A recent New England Journal of Medicine poll found that 62.9 percent of physicians favor a public option as part of health care reform. An additional 9.6 percent favored a completely government-run single payer option.

The alternative to the public option being put forth by industry shills is some sort of co-op. Now normally, I'm all in favor of co-ops and other non-profits: they're a great illustration of how a non-capitalist organization can function in a free market. But the idea of for-profit competing with non-profit organizations doesn't work for insurance, because of the nature of pooled risk.

Let's say you've got a bunch of people, half of whom -- call them group A -- are going to get significantly sick this year, and half -- group B -- that aren't. Pulling numbers out of the air for illustrative purposes, let's say that a group A person consumes $1,500 worth of health care over some period of time (including the necessary administrative costs), and a B consumes $500.

In an efficient non-profit insurance system, one that does the best job of spreading the risk, we set everyone's cost at the average, at $1,000.

But now, let's introduce a for-profit provider into the model. If you can tell ahead of time who's an A and who's a B -- based on things like medical history and age -- you can offer Bs a plan priced at $900. That's cheaper than the $1000 they're paying now, and since Bs only consume $500, you make $400 on the deal. Wow! What's not to love?

The problem is that this cherry picking takes Bs out of the risk pool. Say that, with that $100 incentive, half of the Bs leave the non-profit and buy into the for-profit plan. Then the non-profit's risk pool now has twice as many As as Bs. The average cost to provide care to the non-profit group jumps from $1,000 to $1,167, so that's the new cost of the non-profit plan. (Either that, or the non-profit plan has to start kicking As off its rolls.)

And so more Bs leave the non-profit pool to join the for-profit plan. And -- here's the fun part -- with that increased demand, and the costs of the general pool rising, the for-profit plan can raise its price! At, say, $1,050, it might be more expensive than what a B was paying before the for-profit plan came along, but it's cheaper than the non-profit's new prices.

Betsy McCaughey is widely regarded as the person responsible for starting the "death panel" rumors. In this press release, she disputes a recent profile piece the New York Times did about her.

Here's what's interesting: her objection to doctors being rated on whether they help patients articulate their own wishes, and whether those wishes are adhered to:

Doctors' quality ratings will be determined in part by the percentage of the doctor's patients who create a living will and the percentage who adhere to it. (And quality ratings affect a doctor's Medicare reimbursement)

The "adhere to" part is especially dangerous. Some people say "they'd rather die than be on a ventilator, but when the time comes, they choose to live. Doctors will incur penalties when families do not adhere to end of life written plans. - a horrible conflict of interest. As a patient advocate, I see these difficult situations and know that government should not be
involved.

Let's be clear: if you can decide for yourself whether to die or to remain on a ventilator, your living will is not in effect.

But putting that nonsensical part aside, if you're in a condition where you can't decide, and you've left a living will or advance directive, presumably you want that to be followed! (Else, why did you make it?) Whether it says "pull the plug" or "hook me up to every machine you've got," you want your doctor to follow your directions.

It's not your family's choice, it's your choice. If a doctor disregards a patient's wishes, of course they ought to be down-rated!

It seems what McCaughey and her ilk object to is you being able to make your own decisions about end-of-life care. That's what this is about: these folks want to give you the same treatment they gave Terri Schiavo.

I do so love a medical mystery. From The Daily Telegraph:

Retired architect Mr Darby, from Leicestershire, had worn spectacles since the age of two but was stunned when he came round after surgery to clear the blood clot causing his stroke, that he could see clearly without his glasses.

...

Malcolm suffered a major stroke on May 13 last year when he was working in his office at home in Oakham and managed to tell his wife Sylvia, 68, to dial 999 before he collapsed.

He was rushed to Kettering General Hospital for surgery where a two-hour operation was carried out to remove a blood clot that was blocking 80 per cent of his right carotid artery in his neck.

...

It is unclear why the stroke or the operation appears to have caused such a dramatic improvement in Mr Darby's sight but doctors believe there may have been pressure on the optic nerve at the back of the eye which was relieved as the clot was cleared

HealthDay News reports on a Canadian study of the safety of home births attended by a registered midwife:

The mortality rate per 1,000 births was 0.35 in the home birth group, 0.57 in hospital births attended by midwives, and 0.64 among those attended by physicians, according to the study.

Women who gave birth at home were less likely to need interventions or to have problems such as vaginal tearing or hemorrhaging. These babies were also less likely to need oxygen therapy or resuscitation, the study found.

The authors acknowledge that "self-selection" could have skewed the study results, in that women who prefer home deliveries tend to be healthier and otherwise more fit to have a home birth.

Even with possible self selection, though, it's hard to ignore that difference in mortality rate.

And I suspect that midwives attending home births are much less likely to push women into unnecessary C-sections.

Speaking of which -- see this recent story where a district court held that a woman's refusal of an unnecessary C-section was “negligent”, and upheld taking her baby away. Because, you know, we might not be able to control who women marry anymore, and we can't stop them from using birth control, and we haven't been able to outlaw abortion yet, but by god we can still put them in their place by controlling how they give birth! Fortunately this part of the finding was overturned by the appellate court, but the fact that it was ever an issue ought to make you feel a bit queasy.

HealthDay (at U.S. News & World report) reports on research on the link between obesity and the loss of brain tissue:

For every excess pound piled on the body, the brain gets a little bit smaller.

That's the message from new research that found that elderly individuals who were obese or overweight had significantly less brain tissue than individuals of normal weight.

"The brains of obese people looked 16 years older than their healthy counterparts while [those of] overweight people looked 8 years older," said UCLA neuroscientist Paul Thompson, senior author of a study published online in Human Brain Mapping.

Much of the lost tissue was in the frontal and temporal lobe regions of the brain, the seat of decision-making and memory, among other things.