Category: Health Care

Monday Wake-Up Call – October 20, 2014

Happy Monday! Here is your thought for the week:

“People react to fear, not love. They don’t teach that in Sunday school, but it’s true” − Richard M. Nixon

Not a complete surprise that Nixon was wrong. They DO teach fear in Sunday school:

COW Fear

 

 

 

 

 

 

 

 

 

 

 

 

 

In Liberia, only 43% of the adult population are literate, so radio, not the written word, is the best way to inform people about the disease. There are 16 local languages in Liberia, in addition to English. People rarely have access to the Internet or television.

Songs about Ebola are popular in West Africa. One of the most popular is “Ebola in Town” by Samuel “Shadow” Morgan and Edwin “D-12” Tweh, along with Kuzzy, of 2Kings. The song sounds like American hip-hop, but the style is called “Hip Co”, a form of colloquial English that appeals to young Liberians (about 50% of the population is under 18).

Here is an audio file of the song. There are YouTube videos out there, but they have extremely graphic depictions of Ebola victims, and may not be suitable for viewing at work or at home, if kids are in the room:

https://soundcloud.com/shadowmrgn/ebola-in-town-d-12-shadow-kuzzy-of-2kings

A sample of the lyrics:
Something happen
Something in town

Oh yeah the news

I said something in town
Ebola
Ebola in town

[Snip]

If you like the monkey

Don’t eat the meat
If you like the baboon
I said don’t eat the meat
If you like the bat-o
Don’t eat the meat
Ebola in town.

Songs can’t do all that much in a nation with the second-fewest doctors per person in the world.

Here are today’s hot links for your breakfast buffet:

Ebola got you stressed? Try textual healing. A new breed of online-therapy services offers flat-rate plans that allow you to text-chat with a licensed, accredited therapist as much as you like (need).

At least 30 states are still providing less funding per student for the 2014-15 school year than they did before the recession hit.

Researchers have created what they call Alzheimer’s in a Dish — a petri dish with human brain cells that develop the telltale structures of Alzheimer’s disease.

And we were doing so well in Pakistan: Six senior members of the Pakistani Taliban vowed allegiance to the Islamic State.

Go ahead, take your time getting to the party: Study shows that the median arrival time of 803 guests was 58 minutes after the party’s start time.

Of course we love our allies: Saudis to behead, then crucify a cleric who spoke out against the King. Did you know that Saudi Arabia doesn’t have a constitution?

We will never learn: John Allen, the general in charge of the US-led coalition’s response to ISIS says the US will create “a home-grown, moderate counterweight to the Islamic State”. Didn’t work in Vietnam, Afghanistan, or Iraq. Why would it work this time?

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Sunday Cartoon Blogging – October 19, 2014

Your thought for the weekend is from the movie, The Birdcage:

Senator Kevin Keeley: Louise, people in this country aren’t interested in details. They don’t even trust details. The only thing they trust is headlines.

Well, CNN headline writing is as bad as their broadcast. Is that Helvetica?

COW two Fonts

Since it is Nobel Prize time, here is an anecdote by Walter Gilbert (1980 winner in Chemistry) about what happens when you travel with your medal:

When I won this, my grandma, who lives in Fargo, North Dakota, wanted to see it. I…decided I’d bring my Nobel Prize. It was uneventful, until I tried to leave Fargo, and went through the X-ray machine. I could see they were puzzled. It was in my laptop bag. It’s made of gold, so it absorbs all the X-rays—it’s completely black. And they had never seen anything completely black.

“They’re like, ‘Sir, there’s something in your bag.’
I said, ‘Yes, I think it’s this box.’
They said, ‘What’s in the box?’
I said, ‘a large gold medal,’ as one does.
So they opened it up and they said, ‘What’s it made out of?’
I said, ‘gold.’
And they’re like, ‘Who gave this to you?’
‘The King of Sweden.’
‘Why did he give this to you?’
‘Because I helped discover the expansion rate that the universe was accelerating at.’
At which point, they were beginning to lose their sense of humor. I explained to them it was a Nobel Prize, and then their question was: ‘Why were you in Fargo?’”

How corporatists fight Ebola in Texas:

COW Ebola War

The truth is, everyone is infected by the headlines:

COW Ebola Fear

And the headlines gripped Wall Street:

COW Wall Street

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Ebola: Oh My God, We’re All Gonna Die!

Why is it that so many pundits feel the need to tweet/talk/bloviate in a way that sounds like they’re proven right when there is a new case of Ebola? Why did Bill O’Reilly feel the need to say that he knows better than the head of the Centers for Disease Control and Prevention about how to keep Americans safe from the Ebola virus? The greatest cost of our rampant corporatism may be the continued chipping away at our trust in public institutions.

Even though spreading panic is great politics, if we need to reevaluate our protocols for healthcare workers caring for patients with Ebola, fine, but if you live in another state from the person infected in Dallas, you’re gonna be ok.

Let’s remember that Thomas Duncan, the sole Ebola fatality in the US, spent 3 days at home with a fever of 103. He was infectious for the 3 days he was at home with the illness, and he could have infected someone else in the household, but he did not. Apparently, his family took great care not to be exposed, and they seem to be on the verge of succeeding, since the incubation period is up to 21 days. Duncan showed symptoms on Sept. 24th. If we count from then, the family still have a day or two before they are out of the woods. If we count from Sept. 28th, when he was vomiting and went to the hospital for the 2nd time, they would be safe on Saturday.

Most of the Americans flown to the US with Ebola were healthcare workers. The person who died from the disease in Spain was a healthcare worker. Many who get it in Africa are caregivers or healthcare workers. So, again, this indicates an ongoing risk for those who care for patients with Ebola, but the average American’s risk for catching the disease is still near zero.

That said, this report in Scientific American by Judy Stone, MD and infectious disease specialist, speaks to the problems with both process and culture in hospitals:

One hospital I am familiar with has Powered Air Purifying respirators (PAPRs), purchased with bioterrorism preparedness grants, but neither stethoscopes nor other dedicated equipment for isolation rooms. So nurses and docs gown up to go in the room of a patient with a “superbug” but take their stethoscopes into the room and then on to other patients, perhaps remembering to wipe it down first.

This New York Times blog post & graphic on the procedures for healthcare workers caring for people with Ebola echoes Dr. Stone’s discussion and shows how hard it is to be careful.

Here is a chart by Dr. Stone on of our expense for Public Health Preparedness spending since 2001:

Public Health Funding since 2001

This shows that funding for preparedness efforts have fallen by a cumulative total of $2.4 billion since the high point in 2006. The chart shows that the deepest cuts came in GW Bush’s second term. Since then, substantially more has been cut from the programs. Starve a program designed to educate and isolate a deadly outbreak among public health professionals and then blame the government when something goes wrong. Thanks Mr. O’Reilly.

Politics, as usual, is the fly in our soup. Unfortunately, next month Americans again go to the polls and at least half of them will vote for the very people who are doing everything in their power to eliminate public health care.

Isn’t it strange that public health policy is being decided based on economic beliefs about free trade and travel rather than mathematics and science? We in the West offered no assistance to immediately help control the initial Ebola outbreak in Africa. We said, let it burn itself out, like it has done before.

But, the New York Times reports that the new head of the World Bank, Dr. Jim Yong Kim, was among the first to see the need to move quickly against the Ebola threat. He committed $400 million to fight Ebola, and $105 million has already been disbursed. In September, he said to Dr. Margaret Chan, the head of the World Health Organization:

You have the authority to act in this emergency…so why aren’t you doing it?

Now, in October, she seems to be finally on the case.

Here at home, Republicans are vying with each other to shame the Obama administration into implementing a travel ban against Ebola-affected countries. That wouldn’t be an unreasonable suggestion if it could stop the spread of the disease. But it won’t. Here’s why:
• There is a de facto private ban already in place, since US-based airlines stopped flying to Ebola-afflicted countries two months ago (to protect their crew and passengers from exposure — and themselves from lawsuits).
• Delta and United offer direct, nonstop service between the US and West Africa—Delta to Lagos, Accra, and Dakar, and United only to Lagos.
• No travel ban or quarantine will seal a country completely. Models predict that even if travel could be reduced by 80%, new transmissions would be delayed only by a few weeks.

And health-care workers who become ill would not be able to get out for treatment, and the international health personnel needed to quell the outbreak would no longer be able to get in.

Despite the fear-mongering, we know what needs to be done. We have organized the deployment of 3,000 troops and have begun marshaling a wider international response that is tragically slow. With the announcement of the Dallas case, hospitals across the country are now scrambling to get their procedures up to snuff.

We need to have the boots in Africa to help manage the probable local panic as well. It is a linear investment by the US that could have an exponential payback.

 

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Meds Are Too Damn High

On Sunday, 60 Minutes ran a segment about the high cost of drug therapies. They exposed the rip-off prices Big Pharma charges for certain Cancer drugs. Moreover, the clear message was that if you have a life-threatening disease, it is likely that some drug company has come up with a treatment that may extend your life, at a price. How much would you pay for another year of life? In 2012, of the 12 cancer drugs approved by the FDA, 11 cost over $100,000 per year.

Who wouldn’t pay that (if they could) in order to stay alive? 60 Minutes quoted Dr. Leonard Saltz, chief of gastrointestinal oncology at Memorial Sloan Kettering:

And remember that many of these drugs, most of them, don’t replace everything else. They get added to it. And if you figure one drug costs $120,000 and the next drug’s not going to cost less, you’re at a quarter-million dollars in drug costs just to get started.

The big lie told to the American people is that these high prices are necessary for innovation. 60 Minutes asked John Castellani, the CEO of the industry’s lobbying group, PhRMA, to explain why drug prices have to be so high:

The drug companies have to put a price on a medicine that reflects the cost of developing them, which is very expensive and takes a long period of time, and the value that it can provide.

This is, of course, BS. You never buy anything because it costs more to develop. You wouldn’t pay more for a car because GM wasted extra money in R&D without results. You buy the car because the car is safer in a collision.

The same with drugs: we should pay what they’re worth, not what it cost to develop them, particularly if you knew about your options, or were able to negotiate, like you can at the car dealership. The neoliberal meme at work is that profits motivate someone to invent. Perhaps Big Pharma just forgets about Dr. Jonas Salk, who gave his polio vaccine to the public free of charge, demonstrating the big lie spoken by the Big Pharma lobbyist.

Of course sociopathic entities, (that would be our beloved Corporations, who are people now) do not grasp altruism and empathy.

The Food and Drug Administration (FDA) approves drugs if they are shown to be “safe and effective”, but does not consider what the relative costs might be once the new medicine is marketed. From Bloomberg:

By law, Medicare must cover every cancer drug the FDA approves. (A 2003 law, moreover, mandates payment at the price the manufacturers charge, plus a 6% cushion) In most states private insurers are held to this same standard. Physician guideline-setting organizations likewise focus on whether or not a treatment is effective, and rarely factor in cost in their determinations.

The reality is that the drug companies are taking advantage of the current US law (that they lobbied for) to price their Cancer drugs.

Are these prices a rip-off? Prices for some of these drugs have increased the longer they are available, even though there is no increased research, no additional expenses in order to produce the drug. For example, Bloomberg notes that Gleevec, from Novartis, possibly the greatest cancer drug ever invented, cost $24,000 a year when it was introduced in 2001; now it costs $90,000 per year, nearly quadrupling in price. The typical new Cancer drug coming on the market a decade ago cost about $4,500 per month (in 2012 dollars); since 2010, the median price has been around $10,000. Two of the newest Cancer drugs cost more than $35,000 each per month of treatment.

A final quote from Bloomberg: (Emphasis by the Wrongologist)

While generic drugs… now make up 86% of all medicines used in the US, that hasn’t reduced total spending on prescription drugs. In 2012, Americans spent $263 billion, or 11% more than the $236 billion in 2007, according to government data.

Fifty million people went without needed prescriptions in 2012 because they couldn’t afford them. It’s high time something is done about this.

A possible solution is to change the law so that Medicare negotiates volume discounts with the pharmaceutical companies, adding a fixed markup over costs, including R&D, plus the cost to produce and market the drug, and then adding a “fair profit” say, 20%.

By multiplying the number of probable drug users, the dose frequency, term of the prescription and the length of an exclusivity period, we could determine the cost/dose required to achieve that return. Parenthetically, the government should directly fund antibiotic research and also control the price of those drugs to give the company a fair fixed profit (at a lower return than if the R&D had been paid by the companies).

The drug industry needs to think about how it can limit Cancer and other drug costs, and how to price affordably — before someone decides to do the thinking for them.

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