Category: Health

5 years of wrong predictions about Obamacare in 1 video

John Oliver’s Last Week Tonight created a supercut of premature declarations about the “end of Obamacare.” It’s a telling look at the manner in which political promises fuse with the news cycle to exaggerate reality.

After the US Supreme Court upheld healthcare subsidies for 6.9 million Americans in its decision on King v. Burwell, momentum to repeal the Affordable Care Act is waning, as Sarah Kliff wrote late week:

If the challengers had won, it would have thrown the health-care law into chaos. But the White House prevailing marks something equally momentous: President Obama’s signature legislative accomplishment is actually, really, definitely here to stay

For more on Obamacare, make sure to read and share the comprehensive card stack at the bottom of the VOX article.

My opinion has been stated here and elsewhere often enough:

Expansion of Medicare to all citizens within a single-payer system reduces costs by cutting out the insurance industry slice of the pie. Congress isn’t likely to have the courage for that. But, the experience of Social Security – with operating costs at least 80% cheaper than anything the insurance industry offers – proves the possibility.

The same holds true for Medicaid. And I may as well throw in my favorite criticism of the provisions as designed by Congress. There is no legitimate reason preventing taxpayers in general from enjoying the same fixed, government-negotiated rates for prescription drugs that are guaranteed to members of the military.

Don’t fear that killer Volkswagen robot

Headlines rang out across the internet…that a robot killed someone in Germany. Beneath the sensationalist surface, there was a tragic truth: an industrial robot at a Volkswagen plant in Germany had indeed killed a 22-year-old worker who was setting it up. Coverage notwithstanding, this didn’t seem like the start of a machine-led apocalypse–I wanted a second opinion before heading to my backyard bunker. Ryan Calo is a law professor at the University of Washington, and he’s published academic works on our coming robot future, and the interaction between robots and cyberlaw.

Here are some of the questions…paired with his responses:

Popular Science: Yesterday Twitter was all abuzz about an industrial robot killing someone. You said at the time “this is relatively common.” What did you mean by that?

Ryan Calo: In the United States alone, about one person per year is killed by an industrial robot. The Department of Labor keeps a log of such events with titles like “Employee Is Killed When Crushed By Robot” (2006) or “Employee Was Killed By Industrial Robots” (2004).

You’ve written before about the potential for unique errors from autonomous machines. In future “robot kills man” stories, what characteristics should we look out for that make something go from “industrial accident” to “error with autonomy”?

Right. Industrial robots tend to do the same thing again and again, like grabbing and moving, and cannot generally tell what it is they are working with. That’s why factories establish “danger” or “kill” zones that people have to stay out of while the robot is operating…

Initial reports attribute the death to human error. At what point do you think having a human “in the loop” for an autonomous system constitutes a liability, instead of a safety feature?

In industrial robotics, that ship has long sailed. You couldn’t have a person in the loop and maintain anything like today’s productivity. Rather, you have to try to make sure — through protocols, warnings, etc. — that people stay out of the robot’s way

RTFA for more of the same sensible discussion guaranteed never to make it into your local newspaper.

BTW, Professor Calo says he wouldn’t guarantee that Atherton’s questions weren’t being answered by a robot. :)

Myths and reality about Medicare and Medicaid

A pair of recent studies use evidence to challenge two widely held beliefs, namely that undocumented immigrants are draining the Medicare trust fund and Medicaid provides poor quality medical care.

In the first instance, a study conducted by investigators from Harvard Medical School and the City University of New York and published online in mid-June by the Journal of General Internal Medicine, found that undocumented immigrants pay more into the Medicare Hospital Insurance Trust Fund than they take out.

The second study, released June 25 and conducted by researchers at The Commonwealth Fund, found that in 2014, 95% of Medicaid patients who were covered all year had a regular doctor, and 55% said they received excellent or very good care.

“I think this underscores the need for evidence-based policymaking,” Sara Collins, PhD…a co-author of the organization’s study told MedPage Today. “It’s important that everyone look at the data that’s available.”

Between 2000 and 2011, unauthorized immigrants generated a substantial surplus for the Medicare Trust Fund — $35 billion, according to the Harvard study. That ranges to between $2.2 billion and $3.8 billion per year, or $316 per capita for that population, compared with $106 per capita for the rest of the American population…

On the Medicaid side of the equation, according to the Commonwealth Fund report…Medicaid patients ages 19-64 had similar experiences to people with private insurance and were in far better circumstances than those who lacked insurance altogether. Among the uninsured, the survey found, 77% of people reported having a regular doctor, with only 40% saying they received good care.

“There’s some conventional wisdom that Medicaid is not very good coverage, but this shows how well Medicaid does in enabling people to protect themselves,” Collins said. “It may be a surprise to many, but these figures do demonstrate that it’s certainly better to have Medicaid than to have no coverage at all.”…

Perhaps most telling, 19% of Medicaid beneficiaries reported having some kind of issue related to paying medical bills. About one-third of people with private insurance – and 47% of uninsured – reported the similar struggles.

Given the still-controversial Medicaid expansion called for by the Affordable Care Act, and the beating Medicaid coverage has taken in some quarters as a result, the survey findings call for a fresh look at what Medicaid really delivers, Collins said…

I hope you’re not surprised that evidence and data-driven analysis reveals a more positive outlook than conventional wisdom or conservative ideology. Now, let’s make it even better!

Expansion of Medicare to all citizens within a single-payer system reduces costs by cutting out the insurance industry slice of the pie. Congress isn’t likely to have the courage for that. But, the experience of Social Security – with operating costs about 80% cheaper than anything the insurance industry offers – proves the possibility.

The same holds true for Medicaid. And I may as well throw in my favorite criticism of the provisions as designed by Congress. There is no legitimate reason preventing taxpayers in general from enjoying the same fixed, government-negotiated rates for prescription drugs that are offered members of the armed services.

Scientist faked HIV breakthrough — sentenced to prison

A former Iowa State University scientist who altered blood samples to make it appear he had achieved a breakthrough toward a potential vaccine against HIV was sentenced on Wednesday to more than four and a half years in prison for making false statements in research reports.

Dong-Pyou Han, 58, also must pay $7.2m to a federal government agency that funded the research. He entered a plea agreement in February admitting guilt to two counts of making false statements.

Government prosecutors said Han’s misconduct dates to 2008 when he worked at Case Western Reserve University in Cleveland under Professor Michael Cho, who was leading a team testing an experimental HIV vaccine on rabbits. Cho’s team began receiving NIH funding, and he soon reported the vaccine was causing rabbits to develop antibodies to HIV, which was considered a major breakthrough. Han said he initially accidentally mixed human blood with rabbit blood, making the potential vaccine appear to increase an immune defense against HIV, the virus that can cause Aids. Han continued to spike the results to avoid disappointing Cho, his mentor, after the scientific community became excited that the team could be on the verge of a vaccine.

Iowa State recruited Cho in 2009, and his team – including Han – continued the research with NIH funding. A group of researchers at Harvard University found in January 2013 the promising results had been achieved with rabbit blood spiked with human antibodies…

Government prosecutors sought prison time to serve as a deterrent to Han and others who might consider research fraud.

Is this a positive sign – or window dressing? I’d like to believe it’s the former.

There are new science review publications rolled out by hustlers just to give the appearance of peer-review – for a fee. There is no shortage of quacks ripping off the current generation of Luddites every week with junk science to reinforce – and profit from – fears of modern medicine.

Powering desalination with the sun — in India and New Mexico


Natasha WrightPhoto/Bryce Vickmark

When graduate student Natasha Wright began her PhD program in mechanical engineering, she had no idea how to remove salt from groundwater to make it more palatable, nor had she ever been to India, where this is an ongoing need.

Now, three years and six trips to India later, this is the sole focus of her work.

Wright joined the lab of Amos Winter, an assistant professor of mechanical engineering, in 2012. The lab was just getting established, and the aim of Wright’s project was vague at first: Work on water treatment in India, with a possible focus on filtering biological contaminants from groundwater to make it safe to drink.

There are already a number of filters on the market that can do this, and during her second trip to India, Wright interviewed a number of villagers, finding that many of them weren’t using these filters. She became skeptical of how useful it would be to develop yet another device like this.

Although the available filters made water safe to drink, they did nothing to mitigate its saltiness — so the villagers’ drinking water tasted bad and eroded pots and pans, providing little motivation to use these filters. In reviewing the list of questions she had prepared for her interviews with locals, Wright noticed that there were no questions about the water’s salty taste…

Almost 60 percent of India has groundwater that’s noticeably salty, so later, after returning to MIT, Wright began designing an electrodialysis desalination system, which uses a difference in electric potential to pull salt out of water.

This type of desalination system has been around since the 1950s, but is typically only used municipally, to justify its costs. Wright’s project aims to build a system that’s scaled for a village of 5,000 people and still cost-effective…

Wright’s solution offers an alternative to grid power: She’s designed a village-scale desalination system that runs on solar power. Since her system is powered by the sun, operational and maintenance costs are fairly minimal: The system requires an occasional cartridge filter change, and that’s it.

The system is also equipped to treat the biological contaminants that Wright initially thought she’d be treating, using ultraviolet light. The end result is safe drinking water that also tastes good

Although Wright’s work is currently focused on rural villages in India, she sees many uses for the technology in the United States as well. In isolated areas, such as the ranches in New Mexico where she tested her system at full scale, poor access to water pipelines often leads to a heavy reliance on well water. But some ranchers find that even their livestock won’t tolerate the saltiness of this water.

“It’s useful to install a small-scale desalination system where people are so spread out that it’s more costly to pump in water from a municipal plant,” she says. “That’s true in India and that’s also true in the U.S.”

It’s certainly true in downstate New Mexico. We have beaucoup brackish fossil water in great quantities. Not being used for much of anything, now.

Thanks, Om

A pool parasite — not carrying a beer

Cryptosporidium
Yes – highly magnified

A hardy parasite has led federal health officials to warn pool goers to be careful in the water this summer.

Outbreaks related to pools, hot tubs and other recreational uses of water can be dangerous and according to a new report the U.S. Centers for Disease Control and Prevention found that 90 outbreaks between 2011 to 2012 resulted in 1,788 illnesses, 95 hospitalizations and one death.

A major cause of the outbreaks in treated water, including hot tubs and pools, is a hardy parasite called Cryptosporidium, which is encased in a tough shell and causes acute gastrointestinal issues such as diarrhea.

Michele Hlavsa, chief of the CDC’s Healthy Swimming Program, said the parasite is particularity troubling due to how long it can live in treated water.

It can survive for 10 days,” Hlavasa told ABC News, noting that other bacteria including E. coli are killed in minutes to hours in a treated pool.

“With these outbreaks, we see they disproportionately affect young children,” Hlavasa said. “They’re the ones who can go to a pool and young children tend to carry lots of germs.”…

To stay safe, pool goers should look to see if their pool’s most recent inspection was posted through their local health department or even look into buying their own chlorine tests that can be used to test if the water is properly treated.

Eeoough! You’re often better off if you can avoid the young of your own species. :)

Anesthesiologist trash-talks sedated patient — $500K worth!

colonoscopy

Sitting in his surgical gown inside a large medical suite in Reston, Va., a Vienna man prepared for his colonoscopy by pressing record on his smartphone, to capture the instructions his doctor would give him after the procedure.

But as soon as he pressed play on his way home, he was shocked out of his anesthesia-induced stupor: He found that he had recorded the entire examination and that the surgical team had mocked and insulted him as soon as he drifted off to sleep.

In addition to their vicious commentary, the doctors discussed avoiding the man after the colonoscopy, instructing an assistant to lie to him, and then placed a false diagnosis on his chart…

There was much more. So the man sued the two doctors and their practices for defamation and medical malpractice and, last week, after a three-day trial, a Fairfax County jury ordered the anesthesiologist and her practice to pay him $500,000…

The jury awarded the man $100,000 for defamation — $50,000 each for the comments about the man having syphilis and tuberculosis — and $200,000 for medical malpractice, as well as the $200,000 in punitive damages. Though the remarks by Ingham and Shah perhaps did not leave the operating room in Reston, experts in libel and slander said defamation does not have to be widely published, merely said by one party to another and understood by the second party to be fact, when it is not…

Because he was going to be fully anesthetized, the man decided to turn on his cellphone’s audio recorder before the procedure so it would capture the doctor’s post-operation instructions, the suit states. But the man’s phone, in his pants, was placed beneath him under the operating table and inadvertently recorded the audio of the entire procedure, court records show. The doctors’ attorneys argued that the recording was illegal, but the man’s attorneys noted that Virginia is a “one-party consent” state, meaning that only one person involved in a conversation need agree to the recording.

The recording captured Ingham mocking the amount of anesthetic needed to sedate the man, the lawsuit states…”…The discussion soon turned to the rash on the man’s penis, followed by…comments implying that the man had syphilis or tuberculosis. The doctors then discussed “misleading and avoiding” the man after he awoke

Ingham then mocked the man for attending Mary Washington College, once an all-women’s school, and wondered aloud whether her patient was gay, the suit states. Then the anesthesiologist said, “I’m going to mark ‘hemorrhoids’ even though we don’t see them and probably won’t,” and did write a diagnosis of hemorrhoids on the man’s chart, which the lawsuit said was a falsification of medical records.

After declaring the patient a “big wimp,” Ingham reportedly said: “People are into their medical problems. They need to have medical problems.”

Stupid 101. Testimony included expert opinion that anesthesiologists should be aware that any patient might not be in a deep sleep and might recall hearing silly, irrelevant remarks. Catching the whole procedure as an audio recording was a plus that locked everything up for the lawsuit.

If you feel like RTFA, some of the recordings are available. :)

Thanks, Honeyman

Antihypertensive drug may remove major component of drug and alcohol addiction

image

Researchers at The University of Texas at Austin have successfully stopped cocaine and alcohol addiction in experiments using a drug already approved by the U.S. Food and Drug Administration to treat high blood pressure. If the treatment is proven effective in humans, it would be the first of its kind — one that could help prevent relapses by erasing the unconscious memories that underlie addiction…

Scientists once believed that drug addiction was simply a physical craving: Drug addicts who became sober and then later relapsed merely lacked willpower. But that view has gradually shifted since the 1970s.

Today, most experts acknowledge that environmental cues — the people, places, sights and sounds an addict experiences leading up to drug use — are among the primary triggers of relapses. It was an environmental cue (a ringing bell) that caused the dogs in Ivan Pavlov’s famous experiments to salivate, even when they couldn’t see or smell food.

Led by Hitoshi Morikawa…a team of researchers trained rats to associate either a black or white room with the use of a drug. Subsequently, when the addicted rats were offered the choice of going into either room, they nearly always chose the room they associated with their addiction.

Then one day, the researchers gave the addicted rats a high dose of an antihypertensive drug called isradipine before the rats made their choices. Although rats still preferred the room they associated with their addiction on that day, they no longer showed a preference for it on subsequent days. In fact, the lack of preference persisted in the isradipine-treated group in ways that couldn’t be found in a control group — suggesting the addiction memories were not just suppressed but had gone away entirely…

Addictive drugs are thought to rewire brain circuits involved in reward learning, forming powerful memories of drug-related cues. Antihypertensive drugs all block a particular type of ion channel, which is expressed not only in heart and blood vessels but also in certain brain cells. The researchers found that blocking these ion channels in brain cells, using isradipine, appears to reverse the rewiring that underlies memories of addiction-associated places…

“Addicts show up to the rehab center already addicted,” Hitoshi Morikawa said. “Many addicts want to quit, but their brains are already conditioned. This drug might help the addicted brain become de-addicted.”

Morikawa noted that because isradipine is already labeled as safe for human use by the FDA, clinical trials could potentially be carried out much more quickly than with nonapproved drugs.

Regular readers of my personal blog know I’m not especially positive about dealing with junkies. It’s just the streets where I grew up don’t ever seem to lose that population. I don’t spend much time on the range of reasons why – or why not. There hasn’t been any diminishing of my cynicism over a long, long time.

This sounds positive. This sounds potentially useful. My basics haven’t changed. I still think we can take the crime out of drugs by completely decriminalizing drug use. That removes most costs from addiction and from society. But, this is an addition to treatment worth following up on in serious research.

Obamacare upheld by SCOTUS


Click to enlargeJim Lo Scalzo/EPA

Chief justice John Roberts has come to the rescue of Barack Obama’s healthcare reforms for a second time as the US supreme court struck down a Republican-led challenge to Obamacare that could have gutted the legislation and stripped millions of Americans of their health insurance.

Rescue? No. Roberts may be a conservative dork; but, his style of judgement rests on the intent of Congress and law. Passed by a Congress lightyears ahead of what we’ve had to bear since Year 3 of Obama, the intent of the ACA was clear and Roberts supported the law – as far as Congress went.

The decision in the high-stakes case of King v Burwell all but guarantees that Obamacare will survive intact until at least the 2016 election, giving its supporters hope that it will become impossible to reverse even if a Republican is elected to the White House.

The case, which turned on the meaning of four words – “established by the state” – was brought by Virginia limousine driver David King, who sued the then health secretary, Sylvia Burwell, on the grounds that insurance subsidies erroneously paid to those on low to middle incomes forced him to take out cover against his will by pushing him above an affordability threshold…

In most respects, the same as laws establishing minimum levels of automobile insurance. Opposed just as vehemently in its day by cheapskate conservatives who hate paying for anything.

But six of the nine justices, including Roberts, sided with the government in agreeing that other parts of the legislation made the broader meaning clear and allowed subsidies to be paid to exchanges run by states or the federal government.

“Given that the text is ambiguous, we must turn to the broader structure of the act to determine the meaning,” wrote Roberts in a passage that represents a huge victory for the Obama administration…

Democratic frontrunner Hillary Clinton…praised the court’s decision, tweeting: “SCOTUS affirms what we know is true in our hearts & under the law: Health insurance should be affordable & available to all.”

Fellow presidential candidate and leftwing Vermont senator Bernie Sanders praised the court for recognizing “the common-sense reading of the Affordable Care Act” but went on to call for replacing Obamacare with a “Medicare-for-all, single-payer system”.

If and when we get a Congress that not only fights for the needs of average Americans; but, has the courage to provide a bit of leadership – we’ll get round to Bernie’s proposal. Only a bit over a half-century after the rest of the industrial West did so.

Which prompts me to note why I – as someone who has nothing more than contempt for the 2-party/electoral college bordello our politics are chained to – still suggest voting for Democrats when there isn’t a progressive 3rd-Party alternative. If we leave a mediocrity to fall into the hands of truly corrupt class-worshippers, we’re really in line to be screwed. And we will be getting what we deserve for our inaction.

Doctors/Public Health prescription for healthier planet

Some top international doctors and public health experts have issued an urgent prescription for a feverish planet Earth: Get off coal as soon as possible.

Substituting cleaner energy worldwide for coal will reduce air pollution and give Earth a better chance at avoiding dangerous climate change, recommended a global health commission organized by the prestigious British medical journal Lancet. The panel said hundreds of thousands of lives each year are at stake and global warming “threatens to undermine the last half century of gains in development and global health.”

It’s like a cigarette smoker with lung problems: Doctors can treat the disease, but the first thing that has to be done is to get the patient to stop smoking, or in this case get off coal in the next five years, commission officials said in interviews…

Dr. Anthony Costello…called it a “medical emergency” that could eventually dwarf the deadly toll of HIV in the 1980s. He and others said burning coal does more than warm the Earth, but causes even more deaths from other types of air pollution that hurt people’s breathing and hearts…

Virtually everything that you want to do to tackle climate change has health benefits,” Costello said. “We’re going to cut heart attacks, strokes, diabetes.”…

In a companion posting in Lancet, World Health Organization director general Margaret Chan also compares fighting climate change to fighting smoking and saving lives. Both Chan and the Lancet commission quote WHO studies that say by 2030 climate change would “be likely to cause about 250,000 additional deaths per year” around the world.

Overdue.