Archive for the ‘Medical/Drugs’ Category
Many have described the Obama departure from the 70-year-old bipartisan postwar foreign policy of the
United States as reminiscent of Jimmy Carter’s failed 1977–81 tenure. There is certainly the same messianic sense of self, the same naïveté, and the same boasts of changing the nature of America, as each of these presidents was defining himself as against supposedly unpopular predecessors. But the proper Obama comparison is not Carter, but rather Warren G. Harding. By that I mean not that Obama’s scandals have matched Harding’s, but rather that by any fair standard they have now far exceeded them and done far more lasting damage — and without Obama’s offering achievements commensurate with those that occasionally characterized Harding’s brief, failed presidency.
The lasting legacy of Obama will be that he has largely discredited the idea of big government, of which he was so passionate an advocate. Almost every major agency of the federal government, many of them with a hallowed tradition of bipartisan competence, have now been rendered either dysfunctional or politicized — or both — largely because of politically driven appointments of unqualified people, or ideological agendas that were incompatible with the agency’s mission.
The list of scandals is quite staggering. In aggregate, it makes Harding’s Teapot Dome mess seem minor in comparison.
There is now no Border Patrol, at least as Americans have understood the agency whose job was enforcing federal immigration statutes. It died as an enforcement bureau sometime in 2013, not long after the reelection of Barack Obama, in a way that it could not have before the election. Instead, in Orwellian fashion, at a time of plague and terrorism abroad, it is now the Border-Crossing Enabling Service, whose chief task is facilitating the illegal entry of thousands from Latin America and Mexico, largely to further the political agenda of the Obama administration, contrary to the law, the will of Congress, and the wishes of the majority of the American people. Mention the phrase “immigration law” or “Border Patrol,” and Americans sigh that neither any longer exists. Yet such a perversion of the mission of a federal agency for political purposes has become thematic of this administration. Perhaps the end of border enforcement is emblemized best by Obama’s own uncle and late aunt, who in open defiance broke federal immigration law and did so with impunity, resided illegally in the United States, broke various state laws, and ended up either on public assistance or mired in the U.S. judicial system.
No one quite knows how to deal with the deadly threat of the Ebola virus. We can assume, however, that the Obama administration’s policy will be predicated foremost on some sort of predetermined ideological concern. Unlike many European countries, the United States still allows foreign nationals from countries with pandemics of Ebola to enter the country freely. What the administration has so far told us about Ebola — that a case here was unlikely, and then, after it happened, that probably only a handful of people had been exposed — was almost immediately proven false. (more…)
In the 1990s insurance companies developed managed-care plans that greatly increased their profits at the expense of the physician. With the Affordable Care Act, we are seeing new groups profiting from changes to the health-care system. Entrepreneurs and hospital executives are capitalizing on organizing physicians into groups called Accountable Care Organizations from which they will take a very substantial percentage of collected income. Now that physicians are being required to use electronic medical records, the companies that develop them are harvesting money from physicians’ practices and from hospitals.
The push to use electronic medical records has had more than financial costs. Although it is convenient to have patient records accessible on the Internet, the data processing involved has been extremely time consuming—a sentiment echoed by most of my colleagues. To save time, I was advised by a consultant to enter data into the electronic record during the office visit. When I tried this I found that typing in the data was disruptive to the patient visit. My eyes were focused on the keyboard and the lack of direct contact kept patients from opening up and discussing their medical and personal problems. I soon returned to my old method of dictating notes and pasting a print-out of the dictation into the electronic record.
Yet to avoid future financial penalties from Medicare, I must demonstrate “meaningful use” of the electronic record. This involves documenting that I covered a checklist of items during the office visit, so I spend 90 minutes each day entering mostly meaningless data. This is time better spent calling patients to answer questions or keeping updated with the medical literature.
If electronic records ever allow physicians to obtain data from previous laboratory and imaging testing, it will improve costs and patient care. So far, however, the data in electronic records—like paper charts—can’t be shared unless physicians work in the same health-care system.
My practice quickly adopted the new Medicare requirements for electronically prescribing medications. Yet patients often do not want their prescription sent electronically. They want a physical copy—either because they don’t trust the Internet or because they don’t need to fill the prescription immediately. If I don’t electronically prescribe for a certain number of Medicare patients, I am penalized with a decrease in reimbursement that can rise to a maximum of 5%. Patients should have a choice in how their prescriptions are delivered, and physicians shouldn’t be penalized for how the patients choose. (more…)
Lethal experimental infections of rhesus monkeys by
aerosolized Ebola virus.
- 1US Army Medical Research Institute of Infectious Diseases, Frederick, Maryland 21702-5011, USA.
The potential of aerogenic infection by Ebola virus was established by using a head-only exposure aerosol system. Virus-containing droplets of 0.8-1.2 microns were generated and administered into the respiratory tract of rhesus monkeys via inhalation. Inhalation of viral doses as low as 400 plaque-forming units of virus caused a rapidly fatal disease in 4-5 days. The illness was clinically identical to that reported for parenteral virus inoculation, except for the occurrence of subcutaneous and venipuncture site bleeding and serosanguineous nasal discharge. Immunocytochemistry revealed cell-associated Ebola virus antigens present in airway epithelium, alveolar pneumocytes, and macrophages in the lung and pulmonary lymph nodes; extracellular antigen was present on mucosal surfaces of the nose, oropharynx and airways. Aggregates of characteristic filamentous virus were present within type I pneumocytes, macrophages, and air spaces of the lung by electron microscopy. Demonstration of fatal aerosol transmission of this virus in monkeys reinforces the importance of taking appropriate precautions to prevent its potential aerosol transmission to humans.
- [PubMed – indexed for MEDLINE]
Airborn Transmission of Ebola?
Ronald R. Cherry, MD
Many people have been mis-informed regarding human to human transmission of Ebola. The Canadian Health Dept. States that airborne transmission of Ebola is strongly suspected and the CDC admits that Ebola can be transmitted in situations where there is no physical contact between people, I.e.: via airborne inhalation into the lungs or into the eyes where individuals are separated by 3 feet. That explains why 81 doctors, nurses and other healthcare workers have died in West Africa to date. These courageous health care providers use careful CDC level barrier precautions such as gowns, gloves and head cover, but it appears they have inadequate respiratory and eye protection.
Currently the CDC advises health care workers to use goggles and simple face masks for respiratory and eye protection, and a fitted N-95 mask during aerosol-generating medical procedures. Since so many doctors and nurses are dying in West Africa, it is clear that this level of protection is inadequate. Full face respirators with P-100 replacement filters would provide greater airway and eye protection, and I believe this would save the lives of many doctors, nurses and others who come into close contact with, or proximity to, Ebola victims.
Since CDC level respiratory/eye precautions for Ebola are inadequate for healthcare workers in West Africa, I assume they will also be inadequate in the United States.
Ronald R. Cherry, MD
Page Printed from: www.americanthinker.com/blog/2014/08/airborn_transmission_of_ebola.html at August 15, 2014 – 08:25:54 AM CDT
With the recent revelations about the disgraceful treatment of patients by the Veterans Affairs hospitals, the public is discovering what the majority of doctors in this country have long known: The VA health-care system is a disaster. Throwing more money at the system, or demanding the scalps of top bureaucrats—Washington’s reflexive response to any problem of this sort—won’t repair the mess. What’s needed is a fundamental rethinking of how to provide medical care for America’s veterans.
The federal government runs two giant health-care programs—Medicare and the VA system. Medicare is provided by private physicians and other providers. Its finances are a mess, but the care that seniors receive is by and large outstanding. The VA health-care system is run by a centrally controlled federal bureaucracy. Ultimately, that is the source of the poor care veterans receive.
U.S. doctors are well aware of the problems with VA hospitals because many of us trained at them. There are 153 VA hospitals. Most of them are affiliated with the country’s 155 medical schools, and they play an integral role in the education of young physicians. These physicians have borne witness to the abuses and mismanagement, and when they attempt to fight against the entrenched bureaucracy on behalf of their patients, they meet fierce resistance. (more…)
As a group, the nearly 880,000 licensed physicians in the U.S. are, for the most part, well-intentioned. We strive to do our best even while we sometimes contend with unrealistic expectations. The demands are great, and many of our families pay a huge price for our not being around. We do the things we do because it is right and our patients expect us to.
So when do we say damn the mandates and requirements from bureaucrats who are not in the healing profession? When do we stand up and say we are not going to take it any more?
The Centers for Medicare and Medicaid Services dictates that we must use an electronic health record (EHR) or be penalized with lower reimbursements in the future. There are “meaningful use” criteria whereby the Centers for Medicare and Medicaid Services tells us as physicians what we need to include in the electronic health record or we will not be subsidized the cost of converting to the electronic system and we will be penalized by lower reimbursements. Across the country, doctors waste precious time filling in unnecessary electronic-record fields just to satisfy a regulatory measure. I personally spend two hours a day dictating and documenting electronic health records just so I can be paid and not face a government audit. Is that the best use of time for a highly trained surgical specialist? (more…)
EXCERPT FROM THIS ARTICLE: The benefits of the digital revolution are large. But we’ll also have to deal with problems and unanticipated consequences, mostly related to privacy, the possibility of misuse, and the concern that patients might be overwhelmed with so much information. The government via the FDA will need to play a role to ameliorate all three of these potential issues. Regardless, digital medicine is coming over the next few years with the force of a hurricane whether we doctors—and we patients—are ready or not.
A sweeping transformation of medicine has begun that will rival in importance the introduction of anesthesia or the discovery of the germ basis of infectious disease. It will change how patients and physicians interact. It will change medical research and therapy. “Sick care”—the current model of waiting for you to get sick and then trying to alleviate symptoms and make you well—will become true “health care,” where prevention is the mantra and driving force. Welcome to the world of digital medicine.
First and foremost, the digitalization of medicine will personalize health care: Treatment will be tailored to each person as a unique individual suffering a unique illness according to his or her genetic makeup. Currently, therapy is based on population statistics. Patients are separated into groups defined in various ways but usually by similar symptoms or by the results of basic lab tests (like cholesterol levels). These groups are then treated with drugs that may help many people, but not all of them, and often only a fraction of them. By incorporating information from an individual’s DNA, the data made available through digitalization will enable clinicians to match individuals with treatments. Only patients who will benefit will get a particular drug.
This is huge. Giving drugs to patients who are not helped has been enormously expensive and often perverse. Particularly with anticancer drugs, it often condemns such patients to horrendous side effects for no benefit.
Second, digitalization will democratize medicine: You will own or control the data about your own medical condition, and you will be able to analyze it instantly by your connectivity to the Web. In many ways, the profession of medicine today is where Christianity was when the Gutenberg Bible put scriptures into the hands of the laity. But the profession is going to change, subtly and not so subtly shifting power away from the medical-industrial complex: doctors, health insurers, hospitals, medical labs and Big Pharma. (more…)
An Obamacare Report Card
The grades are bad so far—and likely to get worse
Christopher J. Conover
Perhaps the most unpleasant aspect of my otherwise quite enjoyable job as a college professor has been the requirement to assign grades to students. Given that we’re now about halfway through implementation of the Affordable Care Act—which even President Obama is happy to call “Obamacare”—it seems appropriate to assign midterm grades. These are not intended as a forecast of the final grade; moreover, implementation of Obamacare is the responsibility of many thousands of individuals, not just one. Nevertheless, as President Truman’s legendary Oval Office desk sign reminds us, “The buck stops here” when it comes to presidential leadership. So whether President Obama likes it or not, the public and historians are likely to base their assessment of his performance on how well his “signature piece of domestic legislation” is implemented.
First Grading Standard:
Promises vs. Performance
Both as a candidate and as president, Barack Obama has made at least 80 promises related to health care. For purposes of grading, I have focused on the 8 most consequential.
Promise #1: Universal Coverage. Candidate Obama promised on June 23, 2007: “I will sign a universal health care bill into law by the end of my first term as president that will cover every American.” The latest CBO projections last May show that as of the end of 2013, Obamacare will have reduced the number of nonelderly uninsured by less than 4 percent. This figure excludes 11 million unauthorized immigrants (51 percent of whom are uninsured). Even when Obamacare is fully implemented in 2017, it will cover only 92 percent of the nonelderly population who are not unauthorized immigrants (nearly everyone age 65 and above is already covered by Medicare), and 84.7 percent of that group already had coverage in March 2009, a full year before Obamacare was signed into law. Even if we concede that other countries relying on an individual mandate have failed to drive their uninsured rates below 1 percent (Switzerland) or 1.5 percent (Netherlands), Obamacare will close only 53 percent of the gap that existed when President Obama was sworn into office. Grade: F.
Promise #2: No New Taxes on the Middle Class. Candidate Obama promised on September 12, 2008: “I can make a firm pledge under my plan, no family making less than $250,000 a year will see any form of tax increase. Not your income tax, not your payroll tax, not your capital gains taxes, not any of your taxes.” Using official estimates from the Congressional Budget Office and the Joint Committee on Taxation, the House Ways and Means Committee projects that Obamacare will increase federal revenues by $1.058 trillion between 2013 and 2022. Only 30 percent of this total will be raised from taxes that exclusively target taxpayers earning over $200,000 (singles) or $250,000 (married). The remaining 70 percent will be borne by households at all other income levels. Tax Policy Center figures show that such households do not account for more than half of all federal taxes. So even if we generously assume such households will bear a similar share of the myriad levies to be imposed on health insurers, medical device manufacturers, and drug manufacturers—levies which will be passed onto consumers—that still leaves at least 35 percent to be borne by families at or below middle-class incomes.
And these figures do not include the hundreds of billions of dollars in new revenue that will have to be collected by states to pay for their share of Obamacare-induced growth in Medicaid. Nor do they include the impact of “taxation by regulation”—i.e., the tens of billions of dollars in higher premiums that young Americans are being forced to pay under Obamacare’s modified community rating rules in order to subsidize predominantly higher-income people who happen to be older. In short, President Obama’s promise at best was 65 percent true and more likely 50 percent or less true. Grade: F. (more…)