Friday, June 26, 2009

Conflicts of Interest in Health Care For Long Life

Conflicts of Interest in Health Care
A conflict of interest in health care exists when a health care professional "with responsibility to others is influenced, consciously or unconsciously, by financial, personal, or other factors which involve self interest." In a profit-driven capitalistic system the typical motive for the existence of a conflict of interest is usually related to financial considerations. The Editor's experience in medicine has been that decision making not infrequently does not take into consideration the best interests of the patient as opposed to the best interest of the doctor, the hospital, the third party payor, or the government.

The "Expert"
Our society uses "experts" in many different capacities ranging from governmental advisors and consultants to "expert witnesses" in the courtroom or legislature, "expert" independent medical examiners, and "expert" specialists. It has been a healthy departure from "business as usual" to find that, more and more, an "experts'" credentials are being taken into consideration as well as any potential conflict of interest.

Advisors to Governmental or Institutional Organizations
It is a factual observation that those who are truly "expert consultants" (possessing the greatest knowledge and understanding regarding a specific subject) typically do have a bias or potential conflict of interest. Their "expertise" regarding a particular subject has usually resulted from their past activities related to incentivization involving personal gain. For example: knowledgeable experts who were members of United States Food and Drug Administration advisory panels in the past have been dismissed because they had potential conflicts of interest. They were replaced by others not having such conflicts but who were, unfortunately, selected only because they were representative of "politically correct" groups having little or no expertise in the issues under consideration. The intelligent utilization of expertise for the benefit of society requires more than political correctness. It involves using the expertise but also limiting the effect of bias. This can be effectively accomplished by the application of the "Sunshine Principal." This involves prior public disclosure of any and all potential biases or conflicts of interest.

The Expert Medical Specialist
When a patient turns to a specialist for advice and/or treatment it is fair to assume that the recommendations for treatment will reflect the patient’s best interests and that the individual being consulted is qualified to give an expert opinion. Unfortunately this is not always the case and it behooves the patient to be aware of potential risks in this regard. In surgical specialties it is not uncommon for surgeons to have developed treatments or medical devices or to have been involved in industry-academia connections for which a financial conflict-of-interest may exist. Minimally invasive heart surgery is considered very promising in medicine. A recent marketing blitz by a start-up company and its surgeon stockholders suggested that their enthusiasm for the procedure was premature and was apparently only a reflection of a significant conflict of interest on their parts and not on demonstrated efficacy of the procedure itself..

Another area of concern has to do with paying physicians to enlist patients to participate in drug company sponsored clinical trials without the patient’s being informed of the conflict of interest. There may be undisclosed financial benefits is to the physician based on the number of patients enrolled. Clinical drug development studies which used to be staid academic enterprises in the past in which researchers were motivated by desires for knowledge, fame or career advancement. In today's world drug and device development have become multi-billion dollar industries with hundreds of testing and drug companies working with thousands of private doctors (Research for Hire, N.Y. Times, May 16, 1999). In lieu of medical institutions requiring "Sunshine" disclosures it becomes prudent for patients to inquire if potential bias exist

Wednesday, May 6, 2009

Why Need Health Care

Governor's Council on Physical Fitness and Health

Physical Activity Recommendations

National recommendations for physical activity encourage all Americans to engage in regular physical activity and reduce sedentary activities to promote health, psychological well-being, and a healthy body weight.

Benefits of regular physical activity can include the

  • Reduced risk of premature death
  • Increased functional fitness
  • Reduced risk of coronary heart disease
  • Aid in weight control
  • Reduce risk of diabetes (type 2)
  • Decreases blood pressure
  • Reduce risk of colon cancer
  • Reduce risk of high blood pressure
  • Reduce risk of osteoporosis
  • Reduce effects of stress

Those who are just beginning to be physically active should start out slowly and gradually build to higher levels in order to prevent the risk of injury or feel bad from unrealistic goals. It is important to

  1. Consult with a medical provider before beginning any program of physical activity
  2. Encouragement from (family, co-workers, faith community, neighbors, etc..) to be physically active.
  3. Find physical activities that are of interest
  4. Establish realistic goals (concerning activity level and regularity)
  5. Gradually build on activities
  6. Make physical activity a part of your life

Physical Activity is any bodily movement produced by skeletal muscles that result in an expenditure of energy.

Moderate intensity physical activity refers to a level of effort in which a person should experience:

  • Some increase in breathing or heart rate
  • A “perceived exertion” of 11-14 on the Borg Scale
  • 3-6 metabolic equivalents (METs); or
  • Any activity that burns 3.5 to 7 calories per minute (kcal/min)

Vigorous intensity physical activity refers to a level of effort in which a person should experience:

  • Large increase in breathing or heart rate
  • A “perceived exertion of 15 or greater on the Borg Scale
  • Greater than 6 metabolic equivalents (METs); or
  • Any activity that burns more than 7 calories per minute (kcal/min)

Sunday, March 22, 2009

Universal Health Care a Necessity

The stimulus package currently undergoing Senate debate, a combination of tax reductions and domestic spending designed to create jobs, is a step in the right direction to fixing the economy.

In the long run, however, another glaring problem faces our economy. That "elephant in the room" is the condition of the American health care system.

Approximately 46 million Americans are uninsured at the moment. Millions more, while they have insurance, could lose it at any point if they encounter significant medical conditions. The health insurance situation in this country is a patchwork one; individuals and families find health care through employer-based insurance, individual, and government-assisted plans. Some choose simply to forgo insurance altogether, considering its costs.

In the United States, costs of the uninsured treated in emergency rooms are passed on to hospitals and eventually to consumers. Furthermore, patients with good insurance often receive more treatment than necessary. Ultimately, care is not distributed efficiently and as a result, the system costs much more than it should.

Businesses are severely limited due to health insurance costs. If they choose to cut back on benefits, however, they are less able to attract talent. For graduating seniors, this is a real concern. As many of us leave and are no longer eligible to be covered by the insurance of our parents, our job search is limited by the benefits offered. Individuals take jobs not based on what their talents best suit them for, but based on what they can get out of it in terms of health insurance. This discourages the free movement of labor and hinders the progress of the American worker and employer.

Most industrialized countries have realized that health care costs are unnecessarily restrictive on the economic movement of society and have chosen to decrease these costs by providing universal health care. It is high time that the United States followed suit. Universal health care would encourage economic growth, revitalize the middle class, and cost society less.

The economy will grow with a universal health care plan because the plan will decrease costs for businesses, allowing for greater job creation. Consider the plight of the automakers. According to, General Motors estimates that health care costs add $1,525 to each car it produced. In 2004, the company spent more on health care than on steel. These types of costs are simply prohibitive on good business at this point. Universal health care would ease these costs and allow struggling businesses to stay afloat.

Universal health care is necessary to revitalize the middle class in America. Stimulus checks are helpful, but the risk of serious illness or injury often prevents families from injecting money back into the economy, preferring instead to save it for an emergency that they fear will not be covered (if, indeed, they are fortunate enough to have health insurance). Middle class spending is key to driving the economy out of a recession, but the burdensome costs of health care restrict this spending and choke economic growth.

Then there is the question of affordability. It may seem hard to believe, but U.S. health care spending currently dwarfs that of countries with universal systems. According to a study done by the Commonwealth Fund (a health policy group), the United States spends 53 percent more per capita on health care costs than any other industrialized country. The reasons are numerous, but significant ones include administrative overhead across numerous insurers and the fact that the costs of emergency room care for those who cannot afford it are passed on to hospitals, insurers, and ultimately, consumers.

While there are many proposed models for universality, in the short run, a system where the government offers a program to compete with private insurers would help insure more people while driving costs down.

Medicare, for example, boasts significantly lower administrative costs (the most conservative estimates still regard them to be at least three times cheaper) than the private sector, but is only available to a certain set of Americans (seniors). Making a similar program available to all, regardless of their location or pre-existing condition, would serve as greatly needed competition in an industry where quasi-monopolies already exist on the state and local level. This would reduce costs for everyone.

There are different paths to achieving this objective, ranging from affordable government plans to compete with insurers, to coverage mandates, to a single-payer system. There should be vigorous study and discussion of proposed plans and the government should aim to find one that works.

However, this is not an issue on which we can afford to continue our present course of action. The country needs to address its health care crisis, and soon. The long-term strength of the economy depends on it.

Tuesday, February 24, 2009

Health Care For Long Life

When considering the history of Universal Health Care and the giants of Canadian politics, T.C. Douglas surely stands at the forefront. Tommy Douglas was a remarkable Canadian whose contributions have helped to shape the great nation. Although he is most famous as the founding father of Medicare, the most advanced health-care system in the world, Douglas’ contributions to Saskatchewan and Canada were tremendous.

Tommy Clement Douglas was born on October 20, 1904 in Falkirk, Scotland. In 1911, Tommy, his mother and his sister moved to Winnipeg to join his father who had moved there the previous year. Shortly after settling in Winnipeg, Tommy was diagnosed with osteoarthritis in his right leg. Tommy’s family was not wealthy and subsequently his family could not pay for the best or most immediate treatment. The delay nearly cost Tommy his leg. This experience marked the beginning of Tommy’s quest for universal, public health care.

In 1961, In Saskatchewan, Canada, The North American Medical Establishment tried to defy Medicare, Douglas’s top priority project, and Saskatchewan politics became an intense battleground. This turbulent time was marked by the Doctor’s Strike as the physicians of the province protested socialized healthcare. However, the striking doctors were no match for Douglas. When the dust settled with the resolution of the strike, Medicare in Saskatchewan was born. Douglas showed Canada two things: that it was possible to develop and finance a universal Medicare system and that the medical profession could be confronted. Had Douglas not have made these first ground breaking steps, national Medicare would never have happened. This movement and political struggle helped pave the way for universal health care on a global scale. Since then, Canada's system of health care has been imitated and implemented in various countries around the world.

Wednesday, June 4, 2008

Health Care

The health care industry consists of the following nine segments:
Hospitals. Hospitals provide complete medical care, ranging from diagnostic services, to surgery, to continuous nursing care. Some hospitals specialize in treatment of the mentally ill, cancer patients, or children. Hospital-based care may be on an inpatient (overnight) or outpatient basis. The mix of workers needed varies, depending on the size, geographic location, goals, philosophy, funding, organization, and management style of the institution. As hospitals work to improve efficiency, care continues to shift from an inpatient to outpatient basis whenever possible. Many hospitals have expanded into long-term and home health care services, providing a wide range of care for the communities they serve.

Barack Obama's Plan

Obama's Plan to Cover Uninsured Americans: Obama will make available a new national health plan to all Americans, including the self-employed and small businesses, to buy affordable health coverage that is similar to the plan available to members of Congress. The Obama plan will have the following features:
Guaranteed eligibility. No American will be turned away from any insurance plan because of illness or pre-existing conditions.
Comprehensive benefits. The benefit package will be similar to that offered through Federal Employees Health Benefits Program (FEHBP), the plan members of Congress have. The plan will cover all essential medical services, including preventive, maternity and mental health care.
Affordable premiums, co-pays and deductibles.
Subsidies. Individuals and families who do not qualify for Medicaid or SCHIP but still need financial assistance will receive an income-related federal subsidy to buy into the new public plan or purchase a private health care plan.
Simplified paperwork and reined in health costs.
Easy enrollment. The new public plan will be simple to enroll in and provide ready access to coverage.
Portability and choice. Participants in the new public plan and the National Health Insurance Exchange (see below) will be able to move from job to job without changing or jeopardizing their health care coverage.
Quality and efficiency. Participating insurance companies in the new public program will be required to report data to ensure that standards for quality, health information technology and administration are being met.

why Health Care is Necessary?

Millions of Americans are uninsured or underinsured because of rising medical costs: 47 million Americans — including nearly 9 million children — lack health insurance with no signs of this trend slowing down.

Health care costs are skyrocketing: Health insurance premiums have risen 4 times faster than wages over the past 6 years.

Too little is spent on prevention and public health: The nation faces epidemics of obesity and chronic diseases as well as new threats of pandemic flu and bioterrorism. Yet despite all of this less than 4 cents of every health care dollar is spent on prevention and public health.