PNHP

Can’t hold tongues on Obama’s health law

Can’t hold tongues on Obama’s health law

By David U. Himmelstein, M.D., and Steffie Woolhandler, M.D., M.P.H.
The Nation, March 26, 2012

PNHP note: In February The Nation magazine published an article titled “A spoonful of sugar” by Bernard Avishai. The article was a review of Paul Starr’s book “Remedy and Reaction,” and included the following comments: “Obamacare, in short, was health care reform’s best — and last — shot, and it would be unconscionable for liberals to remain cavalier about its defense, or Obama’s, for that matter. It’s past time to discard the misguided assumption that in a better economy, or with more of ‘a fighter’ in the White House, something like a Canadian-style single-payer system might have been (or might sometime fairly soon be) enacted.” On March 26, The Nation published four rejoinders to Avishai’s piece, three of them by physicians. The reply of PNHP’s co-founders appears below.

A bowlful of vinegar

Bernard Avishai (“A spoonful of sugar,” Feb. 13) portrays progressive critics of Obama’s health care bill as hopelessly naïve and out of touch with political reality. But intimate acquaintance with medical reality drove the criticism from us and our 18,000 colleagues in Physicians for a National Health Program who advocate single payer. As doctors, we’re too cognizant that the plan will leave 23 million uninsured and thousands dying each year from lack of coverage; do nothing for our insured patients with coverage so skimpy that serious illness would lead to bankruptcy; strip tens of billions from safety net hospitals; and let medical costs continue to skyrocket, leaving Medicare and public workers’ coverage open to savage cuts. Whatever its political merits, the bill is a failure in medical terms.

If anything’s naïve, it’s Avishai’s faith in cost savings from generalizing the Mayo Clinic model (Mayo shuns uninsured and Medicaid patients — and Medicare at some clinics — and was dropped from two big insurers’ networks because of its high costs) and from standardized and computerized billing. Computer firms have been promising paperwork savings for forty-six years (see the 1966 video at youtube.com/watch?v=t-aiKlIc6uk), but they haven’t materialized. He also seems unaware that hospital billing has been standardized and computerized for years (they all use the same ICD coding system, the UB82 billing form). As our studies in The New England Journal of Medicine have shown, single-payer reform could eliminate about $400 billion wasted annually on insurance overhead and billing paperwork; the reforms Avishai lauds will save bupkis.

Obama’s reform, closely patterned on a Heritage Foundation proposal, will deliver billions to insurance and drug firms and paltry benefit to Americans. Yet Avishai would have progressives hold their tongues. Should we also hold our tongues about the administration’s missteps on civil liberties, education “reform” and the environment?

David U. Himmelstein, M.D., and Steffie Woolhandler, M.D., M.P.H., reside in New York City.

Martha Livingston responds on CAM

The topic of yesterday’s Quote of the Day message: “Should a single payer system include complementary and alternative therapies?”

Martha Livingston, Ph.D., Professor of Health and Society, SUNY College at Old Westbury, responds:

Email
May 4, 2012

Dear Don,

I am deeply troubled both by the JAMA piece you cite here and by your comment.  The author – and you – have lumped together a world of different treatment modalities and individual treatments, and you have further characterized them all as “quackery.”  Not all CAM treatments are the equivalent of “drugs.”  And there is good science demonstrating the efficacy of many treatments referred to as CAM.  The JAMA author has chosen to cite only studies that did not show a therapeutic effect of a particular single treatment, and you have apparently decided that there are therefore no rigorous scientific studies showing the efficacy of any alternative treatment.

The term CAM itself is problematic, suggesting that all such treatments complement “regular” medicine.  Lumped under the heading of CAM are not only various herbal and other non-PhRMA-manufactured products, but “alternative,” that is, “non-M.D.” practitioners, and entire methods of treatment.  So the issues really must be distinguished and analyzed, e.g.,

1. Who gets to research various treatments? 
2. Who gets to practice medicine or, more broadly, healing? 
3. Who gets to decide who’s right?

Briefly, there is a long, convoluted history inextricably tied to issues of power, class and racism, e.g., the suppression of midwifery and continuing suppression of the superior woman-centered model of childbirth; the dismissal of traditional healing systems, e.g., the 4000 years of Traditional Chinese Medicine (TCM).

Further, proponents of (some) “alternative” modalities argue that a huge proportion of what is practiced in “regular” or “scientific” medicine has no scientific basis whatever, and only the weight of generations of apprenticeship behind it. 

I doubt that you are prepared to defend that all that is practiced in “regular” medicine is supported by good science, yet you aren’t dismissive of all regular doctors as quacks.  If you’d like to learn more about the science of other-than-standard medical practice, I refer you to the terrific body of work by Dr. Adriane Fugh-Berman of Georgetown, a longtime PNHP member.

Finally, I think it’s really important not to toss grenades into our coalition, Don.  Many PNHP members, both physicians and non-physicians, are supportive of some of the practices lumped together under the umbrella of CAM.  We need each other, and must agree to disagree about many issues, this one included.

Best,

Martha Livingston

qotd: Should a single payer system include complementary and alternative therapies?
https://pnhp.org/news/2012/may/should-a-single-payer-system-include-complementary-and-alternative-therapies

Comment: 

By Don McCanne, MD

Martha Livingston’s message reflects the tenor of many of the anticipated responses to my biased opinions expressed in yesterday’s Quote of the Day – views that I made clear were my own and did not represent the policy position of PNHP.

When the views are expressed as support or opposition to complementary and alternative medicine (CAM), passions run high and conflict is inevitable. That is the way I framed the message – quite deliberately to carry my point. But the real issue is not CAM. It is where do we draw the line on where our collective tax funds in a single payer national health program should be distributed?

There should be very little disagreement with a framing that all reasonable, beneficial, affordable, effective, preventive, diagnostic and therapeutic health care services should be covered under a single payer system. There should also be agreement that blatant quackery such as the Hoxsey cancer treatment should not be covered, though some still disagree with this.

Merriam-Webster defines “medicine” as “the science and art dealing with the maintenance of health and the prevention, alleviation, or cure of disease.” “Science” is defined as “the state of knowing; knowledge as distinguished from ignorance or misunderstanding.” “Art” is defined as “skill acquired by experience, study, or observation.”

Medicine is science combined with art, but it is not not art alone. If we are going to pay for the health care of other people, this is the standard that we should meet.

As you read the following quote from my comment yesterday, dismiss from your mind the arbitrary categories of “traditional medicine” and “complementary and alternative medicine.” Simply read carefully what I wrote:

“The application of science to medicine is a dynamic. Many older approaches prove to be ineffective or even harmful. As we gain new evidence, those approaches should be denied payment from our collective health funds, whether private or government. Beneficial new approaches should be added. These decisions should continue to be based on science.”

In medicine, we need to dump the bad and bring in the good – some of which may arise from CAM. CAM was chosen for discussion yesterday because it is a rich resource of unscientific and sometimes artless interventions of the type that we should not be asking our fellow countrymen to fund. If we want those services, we should pay for them ourselves.

For those who insist that the art of medicine is all we need and that we do not need the science, I can only say that our health care financing system cannot bear paying for extravagances such as the $120 million paid for “The Scream,” or $120 billion to be allocated for “scream therapy.”

Martha Livingston responds on CAM

The topic of yesterday’s Quote of the Day message: “Should a single payer system include complementary and alternative therapies?”
Martha Livingston, Ph.D., Professor of Health and Society, SUNY College at Old Westbury, responds:

Email
May 4, 2012
Dear Don,
I am deeply troubled both by the JAMA piece you cite here and by your comment.  The author – and you – have lumped together a world of different treatment modalities and individual treatments, and you have further characterized them all as “quackery.”  Not all CAM treatments are the equivalent of “drugs.”  And there is good science demonstrating the efficacy of many treatments referred to as CAM.  The JAMA author has chosen to cite only studies that did not show a therapeutic effect of a particular single treatment, and you have apparently decided that there are therefore no rigorous scientific studies showing the efficacy of any alternative treatment.
The term CAM itself is problematic, suggesting that all such treatments complement “regular” medicine.  Lumped under the heading of CAM are not only various herbal and other non-PhRMA-manufactured products, but “alternative,” that is, “non-M.D.” practitioners, and entire methods of treatment.  So the issues really must be distinguished and analyzed, e.g.,
1. Who gets to research various treatments?
2. Who gets to practice medicine or, more broadly, healing?
3. Who gets to decide who’s right?
Briefly, there is a long, convoluted history inextricably tied to issues of power, class and racism, e.g., the suppression of midwifery and continuing suppression of the superior woman-centered model of childbirth; the dismissal of traditional healing systems, e.g., the 4000 years of Traditional Chinese Medicine (TCM).
Further, proponents of (some) “alternative” modalities argue that a huge proportion of what is practiced in “regular” or “scientific” medicine has no scientific basis whatever, and only the weight of generations of apprenticeship behind it.
I doubt that you are prepared to defend that all that is practiced in “regular” medicine is supported by good science, yet you aren’t dismissive of all regular doctors as quacks.  If you’d like to learn more about the science of other-than-standard medical practice, I refer you to the terrific body of work by Dr. Adriane Fugh-Berman of Georgetown, a longtime PNHP member.
Finally, I think it’s really important not to toss grenades into our coalition, Don.  Many PNHP members, both physicians and non-physicians, are supportive of some of the practices lumped together under the umbrella of CAM.  We need each other, and must agree to disagree about many issues, this one included.
Best,
Martha Livingston
qotd: Should a single payer system include complementary and alternative therapies?
https://pnhp.org/news/2012/may/should-a-single-payer-system-include-complementary-and-alternative-therapies

Martha Livingston’s message reflects the tenor of many of the anticipated responses to my biased opinions expressed in yesterday’s Quote of the Day – views that I made clear were my own and did not represent the policy position of PNHP.
When the views are expressed as support or opposition to complementary and alternative medicine (CAM), passions run high and conflict is inevitable. That is the way I framed the message – quite deliberately to carry my point. But the real issue is not CAM. It is where do we draw the line on where our collective tax funds in a single payer national health program should be distributed?
There should be very little disagreement with a framing that all reasonable, beneficial, affordable, effective, preventive, diagnostic and therapeutic health care services should be covered under a single payer system. There should also be agreement that blatant quackery such as the Hoxsey cancer treatment should not be covered, though some still disagree with this.
Merriam-Webster defines “medicine” as “the science and art dealing with the maintenance of health and the prevention, alleviation, or cure of disease.” “Science” is defined as “the state of knowing; knowledge as distinguished from ignorance or misunderstanding.” “Art” is defined as “skill acquired by experience, study, or observation.”
Medicine is science combined with art, but it is not not art alone. If we are going to pay for the health care of other people, this is the standard that we should meet.
As you read the following quote from my comment yesterday, dismiss from your mind the arbitrary categories of “traditional medicine” and “complementary and alternative medicine.” Simply read carefully what I wrote:
“The application of science to medicine is a dynamic. Many older approaches prove to be ineffective or even harmful. As we gain new evidence, those approaches should be denied payment from our collective health funds, whether private or government. Beneficial new approaches should be added. These decisions should continue to be based on science.”
In medicine, we need to dump the bad and bring in the good – some of which may arise from CAM. CAM was chosen for discussion yesterday because it is a rich resource of unscientific and sometimes artless interventions of the type that we should not be asking our fellow countrymen to fund. If we want those services, we should pay for them ourselves.
For those who insist that the art of medicine is all we need and that we do not need the science, I can only say that our health care financing system cannot bear paying for extravagances such as the $120 million paid for “The Scream,” or $120 billion to be allocated for “scream therapy.”

Should a single payer system include complementary and alternative therapies?

Studying Complementary and Alternative Therapies

By Paul A. Offit, MD
JAMA, May 2, 2012

In 1992, with an initial budget of $2 million, Congress created the Office of Alternative Medicine (OAM). Based on legislation sponsored by Iowa politicians Tom Harkin and Berkeley Bedell, OAM’s mission was “to explore complementary and alternative healing practices in the context of rigorous science.”

In 1999, OAM became the National Center for Complementary and Alternative Medicine (NCCAM), a center within the National Institutes of Health (NIH). Funding has steadily increased; by 2012, NCCAM’s annual budget had reached $130 million. Since their inception, OAM and NCCAM have spent $1.6 billion. US taxpayers have a right to ask whether money appropriated for NCCAM—like money appropriated for all centers within NIH—has been well spent.

In support of NCCAM’s mission, proponents argue that one century’s folk medicine can be the next century’s mainstream medicine… Indeed, most drugs on today’s hospital formularies were originally derived from plants.

However, unlike studies of drugs derived from plants, many studies funded by NCCAM lack a sound biological underpinning, which should be an important requirement for funding. For example, NCCAM officials have spent $374 000 to find that inhaling lemon and lavender scents does not promote wound healing; $750 000 to find that prayer does not cure AIDS or hasten recovery from breast-reconstruction surgery; $390 000 to find that ancient Indian remedies do not control type 2 diabetes; $700 000 to find that magnets do not treat arthritis, carpal tunnel syndrome, or migraine headaches; and $406 000 to find that coffee enemas do not cure pancreatic cancer. Additionally, NCCAM has funded studies of acupuncture and therapeutic touch. Using rigorously controlled studies, none of these therapies have been shown to work better than placebo. Some complementary and alternative practitioners argue reasonably that although their therapies might not work better than placebos, placebos may still work for some conditions.

Although studies funded by NCCAM have failed to prove that complementary or alternative therapies are anything more than placebos, some proponents—pointing to studies of vaccine safety—argue that negative studies of biologically implausible hypotheses are worthwhile.

Does the same value of rigorously conducted negative studies hold for studies of complementary and alternative therapies? Have negative studies changed behavior? The answer is probably best found in NCCAM-funded studies of dietary supplements and megavitamins. Several studies have shown that garlic does not lower low-density lipoprotein cholesterol, St John’s wort does not treat depression, ginkgo does not improve memory, chondroitin sulfate and glucosamine do not treat arthritis, saw palmetto does not treat prostatic hypertrophy, milk thistle does not treat hepatitis, and echinacea and megavitamins do not treat colds.​ Moreover, some studies have found that megavitamins increase the risk of cancer and heart disease. Because the vitamin and supplement industry is not regulated by the US Food and Drug Administration (FDA), negative studies have not precipitated FDA warnings or FDA-mandated changes on labeling; as a consequence, few consumers are aware that many supplements have not delivered on their claims. In 2010, the vitamin and supplement industry grossed $28 billion, up 4.4% from the year before. “The thing to do with [these studies] is just ride them out,” said Joseph Fortunato, chief executive of GNC Corp. “We see no impact on our business.”

Although evaluating the research portfolio of any institute at the NIH is difficult, social and political pressures may influence area-of-interest funding, and decisions should be based on science. For complementary and alternative medicine, it seems that some people believe what they want to believe, arguing that it does not matter what the data show; they know what works for them. Because negative studies do not appear to change behavior and because studies performed without a sound biological basis have little to no chance of success, it would make sense for NCCAM to either refrain from funding studies of therapies that border on mysticism such as distance healing, purgings, and prayer; redefine its mission to include a better understanding of the physiology of the placebo response; or shift its resources to other NIH institutes.

http://jama.ama-assn.org/content/307/17/1803.full

And…

THINGS GET HOTTER FOR HOXSEY

U.S. Food and Drug Administration posts warning against man who makes millions from cancer victims

LIFE, April 16, 1956

Caption of a photograph of Harry Hoxsey:

HARRY HOXSEY holds the book he wrote which touts his cancer treatment. Beside him on a plaque is his motto: “The world is made up of two kinds of people – dem that takes and dem that gets took.”

http://books.google.com/books?id=Pk8EAAAAMBAJ&pg=PA125&dq=Harry+Hoxsey&hl=en#v=onepage&q=Harry%20Hoxsey&f=false

Comment:

By Don McCanne, MD

Complementary and alternative medicine (CAM) is a topic frequently brought up in discussions, forums, and in the medical and lay literature. When confronted on this topic, I usually respond by saying that anyone should be able to spend their own funds as they desire, but when the rest of us are paying the bills, whether through premiums for private insurance or through taxpayer-financed public programs such as Medicare, there is a responsibility for the administrator of the funds to prevent wasteful cost overruns by limiting spending to health care that is compliant to well accepted standards of mainstream medicine, which includes promising new diagnostic and therapeutic options that adhere to the rigors of science.

The application of science to medicine is a dynamic. Many older approaches prove to be ineffective or even harmful. As we gain new evidence, those approaches should be denied payment from our collective health funds, whether private or government. Beneficial new approaches should be added. These decisions should continue to be based on science.

What is different about the scientific evaluation of existing and innovative medical interventions and the evaluation of CAM? Why is CAM segregated, as, for example, in the National Center for Complementary and Alternative Medicine (NCCAM)? Quite simply, complementary and alternative therapies do not arise from inductive scientific reasoning. They are based on faith exclusively and have no basis in the scientific disciplines. If new discoveries suggest that there could be a scientific basis warranting further evaluation of a complementary or alternative therapy – an exceedingly rare event – then it is no longer classified as CAM but is moved into the arena of bone fide scientific research.

Should the government have any role in oversight of CAM? Yes, for two reasons. Most important, some CAM therapy is harmful, and the government has an legitimate role in protecting us from harm by removing from the market truly dangerous products with no redeeming value. The other role of government is to ensure that the producers and sellers of these ineffective products are providing honest disclosure to the consumers. Such disclosure is not required today. If the product is crap, the producers should be required to tell us that it is crap.

What the government should not be doing is wasting our tax dollars on this phony research strictly for the purpose of pleasing the eccentrics who have political influence.

My concerns go back to my teenage years when I had several discussions with my father – a physi
cian – over these topics now classified as CAM though more appropriately referred to then as quackery. I remember very clearly reading a LIFE magazine article on the cancer quack Harry Hoxsey. I have repeated to myself over an over again throughout the years Hoxsey’s motto that appeared in the photograph of him in that article (which I was amazed that I could find today with a Google search – link above):

“The world is made up of two kinds of people – dem that takes and dem that gets took.”

Until now, I have been reserved in my comments on CAM, partly because so many sincere, dedicated individuals in our single payer coalitions are supportive of CAM – including some members of PNHP who should know better. But dammit! Quackery is quackery! The smug CAM producers who retreat to their mansions are “dem that takes,” and the uninformed patient/victims lacking an adequate scientific background are “dem that gets took.”

When I was a teenager, I wanted to become a physician like my father and help clean house of these unscrupulous thieves. Alas, they are still with us, and now they have been joined by their brethren in the insurance industry who don’t have a tangible product to sell us but rather simply expropriate our money directly out of our collective health funds in exchange for taking away our choices in health care. That’s worse than quackery!

(This is not a PNHP policy statement, but is a cathartic release of pent up emotions of the author.)

Poll Shows Kentuckians Support Universal Healthcare, But Not Federal Healthcare Law

By Kenny Colston
WFLP Radio (Louisville, Ky.), May 1, 2012

A new poll shows Kentuckians are becoming increasingly aware of the commonwealth’s health issues and willing to act on them.

The Kentucky Health Issues Poll is conducted annually by the Foundation for a Healthy Kentucky. The latest poll for last year was just released this week and found many Kentuckians worry about childhood obesity and depression.

The poll also found mixed results when it comes to universal health insurance. Every region found 80 percent or more of citizens favored health care for everyone. But less than 50 percent in every region said they were favorable to the health care reform law Congress passed a few years ago.

Foundation CEO Susan Zepeda says the polling shows people approve the concept, but has issues with certain parts of the law.

“I think what they’re telling us is either that they are uncomfortable with the Affordable Care Act, they’re not aware of what it contains, or they think it may have approaches that aren’t consistent with their preferable approaches to solving those access and cost problems,” she says.

The poll did show low overall knowledge about the health care law and favorable response to inpidual aspects of the law.

Zepeda says one thing that is certain is a new awareness about obesity in Kentucky kids. After years of low awareness about the issue, the poll found increased awareness in all five regions of the state.

The poll surveyed 1,621 Kentuckians last Fall, including 308 by cell phone. The poll is typical conducted in the Fall of each year before being released the following spring.

To see the poll results for inpidual regions, click below.

Greater Louisville
Greater Lexington
Eastern Kentucky
Northern Kentucky
Western Kentucky

http://www.wfpl.org/2012/05/01/poll-shows-kentuckians-support-universal-healthcare-but-not-federal-healthcare-law/ 

Why this pediatrician quit medicine

By Lumi St. Claire, MD
KevinMD blog, April 4, 2012

There are an awful lot of reasons that led up to my eventual resignation from a career in primary care medicine.  I don’t know that any one of them is more important than the other (it really just depends on which day you ask me).  One that stands out for me though as a universal problem shared by millions is Managed Health Care, and the imposition it has posed on physicians and patients alike is enormous.

A (mercifully) brief history of managed care: The origins of the first managed care efforts in this country date back to the early 1900′s, when prepaid physician services started showing up in a few select industries and health care organizations.  In 1947, the American Medical Association was walloped with an anti-trust violation for their efforts to limit physician involvement with group health plans.  The movement gained momentum and really got some teeth when President Nixon signed the HMO Act of 1973 into law (way to go, Dick).  This provided a legal avenue for using federal funds to promote the growth of Health Maintenance Organizations.  The backlash really caught up in the late 90′s, when US per capita spending started to rise again, despite the mission of managed care to reduce heath care costs.  US healthcare expenses continue to eclipse the national income, and have been increasing approximately 2.4 percentage points faster than the annual GDP for the past forty years.

Ironically, while the whole point of managed care was to reduce healthcare expenses in this country, insurance company executives have continued to earn grossly exorbitant salaries.  The top executives working at the country’s five biggest for-profit health insurance companies earned compensation of almost $200 million in 2009.  Cigna insurance company paid its outgoing and incoming chief executives a combined $136.3 million that year.  And for all this, we still have the worst health care outcomes compared with six other leading industrialized nations.

Now you have to layer on top of this healthcare cost crisis the fact that doctors have really had to change the way they practice medicine.  Managed care means less time spent directly with patients, and more time spent on non-clinical activities (i.e. paperwork).  The  2011 Medscape Physicians Compensation Report generated survey results from almost 16,000 physicians across 22 specialty areas regarding income and practice parameters.  Primary care physicians have the shortest access time per patient, with a median visit time of 13-16 minutes per patient.  (For the record, pediatricians averaged more patient visits per week than any other specialty.)  17% of primary care docs spent more than 20 hours a week on paperwork and other non-patient activities, and less than half of primary care physicians would choose to go into primary care again if they had the chance to do it all over again.

Quite honestly, this turns my stomach.  And I already got out of clinical practice.

I remember my own horror stories perfectly.  Like the day I spent six hours on the phone with an insurance company trying to get one of my patients a badly needed MRI.  I also had one insurance company deny authorizing my patient an EpiPen.  As medical professionals know, EpiPens are automatically-injecting syringes pre-filled with epinephrine that patients carry with them who have life-threatening allergies to things like bee stings, peanuts, etc.  They keep people from dying.  I could not imagine on what planet and in what solar system an insurance company would have a sane reason for denying a severely allergic patient one of these.  And the worst part was they absolutely had to talk directly to me about it. They couldn’t discuss it with one of our residents, our nurses, or our nurse practitioners.  I had to take time out of my excruciating schedule to have a lively chat on the phone about why it was important for my patient not to croak.

This is a crime.  I did not pay a small fortune and spend four years in medical school to be trained on how to deal with the insanity of managed care.  And I don’t think my patients would have wanted me spending precious time learning how to appropriately fill out an authorization form, when I could be learning about medical disease processes.  Yes, people are specifically trained to deal with managed care, but often enough the insurance companies demand explanations from us that they simply won’t accept from other staff.  And if we don’t comply, our patients are the ones that pay the price.  If I put my foot down and say it’s inappropriate for an insurance company to require I give a pharmacy my DEA number just for tracking purposes, my patients simply won’t get the medication they need.

Having recently retired myself from clinical practice, I will be the first to admit I miss my colleagues.  I desperately miss my patients (well, most of them anyway).  But I don’t miss this.  Not for one solitary moment.  My heart goes out to my colleagues who are still trying to practice actual medicine in the face of mounting adversity.  Keep fighting the good fight.

Lumi St. Claire is a pediatrician who blogs at My White Coat Is On Fire.

http://www.kevinmd.com/blog/2012/03/pediatrician-quit-medicine.html

NHS reforms will 'betray generations to come'

By Dr. Kailash Chand
publicservice.co.uk, May 2, 2012

The NHS will now become ‘just a logo’ – a US style insurance scheme that is divorced from care delivery and dishes out public money to private companies, now that the government’s NHS reforms have passed into law, writes one leading clinician

The NHS bill is now an act. It was a bad bill and now is a bad act. It is a mess. That is my straight forward view of it. I think it is confused and confusing and I think it is unfortunately setting the NHS back.

The implications will betray not only the people who rely on today’s NHS but also generations to come. It will strike at the heart of Britain’s proudest institution. Nobody is opposed to NHS reforms, but the question is what kind of reforms are these and whether it makes our NHS better or worse.

The government has won the parliamentary battle, but no one is quite sure what kind of a victory it has achieved, or at what price. A lot of staff on the ground lack confidence in the bill, or say they don’t like it, at a time when we need massive energy and commitment from the NHS staff. Go to any hospital or GP surgery just now and you will hear the continual opposition from doctors and nurses about this act, their worry about how much harder it will make their jobs. I think they’re right.

Remember, the NHS has to save £20bn by 2015. What it means is managing the NHS with less money and dealing with the consequences on priorities and quality of patient care. The entire NHS workforce could become preoccupied with the changes rather than concentrating on efficiency and innovation the NHS so desperately needs. The reforms would be demoralising, not just for professionals but for patients too, who would begin to see fewer treatments available to fewer people as the NHS cuts start to bite – with wealthier people able to “top up” treatments. The rich really will be able to have much more. It’s not just a postcode lottery, it’s a taxcode lottery.

The NHS is clearly under huge threat, it will be a completely different healthcare system in five-10 years time. A system, which I believe will signal the end of the National Health Service, and a system that will be much worse in terms of access, equity, health outcomes, and cost. The NHS will just be a logo, most cherished institution reduced from being the main provider of heath services in England with one of the biggest workforces in the world, to a US style insurance scheme, divorced from the actual delivery of any care. It will become a bureaucratic governing body dishing out public money to private companies.

My response to the discredited NHS reforms hasn’t just been writing letters and articles about why it is seriously flawed. I also started my own e-petition because I was concerned about the lack of democratic accountability of the coalition government and I wanted the bill to have its ‘day in court’.

The e-petition broadened the debate amongst all sections of society securing around 180,000 signatures. It has inspired other activists and spread knowledge about the reforms. It has stimulated Liberal Democrat factions within the coalition to question their own beliefs and forced the Labour Party to raise its game.

Opposition to the bill has come from a wide spectrum including organisations such as the BMA, most royal colleges, as well as trade unions and patient groups. The e-petition did have its day in court despite attempts by some MPs on the Business Backbench Committee to block it, salvaging a few strands for the democratic rights of those who use e-petitions to force parliamentary debate over an issue that evokes public outrage.

Now that I have been elected to the BMA national council, I’ll do my best to ensure the main priority of BMA is to minimise damage to NHS caused by Health and Social Care Act. I’ll continue my efforts to defend NHS, medical professionalism, and the doctor -patient relationship. And I hope to safeguard patients’ interests in these difficult times.

For me the entire campaign against the Health and Social Care Bill is about saving a service to which I have devoted all my life. I came to this country over 30 years ago to work in what I believe to be the best healthcare system in the world. During those thirty years I have worked in many aspects of the health service and have also campaigned to ensure that the key principles of the NHS, including free universal healthcare for all, are maintained. I work in Tameside which is a deprived borough where the threat of privatisation raises the risks to those who need the NHS the most; elderly people, those with chronic disease, and the mentally ill are the most vulnerable from the coalition reforms under the bill.

The bill may have become law, but those like me who cherish the NHS will continue to fight for the right to universal healthcare as a basic human right regardless of whether they live in flourishing suburbs or inner city deprived areas.

Dr. Kailash Chand OBE is a GP, chairman of Tameside and Glossop NHS and was recently elected to the British Medical Association national council.

NHS reforms will ‘betray generations to come’

By Dr. Kailash Chand
publicservice.co.uk, May 2, 2012

The NHS will now become ‘just a logo’ – a US style insurance scheme that is divorced from care delivery and dishes out public money to private companies, now that the government’s NHS reforms have passed into law, writes one leading clinician

The NHS bill is now an act. It was a bad bill and now is a bad act. It is a mess. That is my straight forward view of it. I think it is confused and confusing and I think it is unfortunately setting the NHS back.

The implications will betray not only the people who rely on today’s NHS but also generations to come. It will strike at the heart of Britain’s proudest institution. Nobody is opposed to NHS reforms, but the question is what kind of reforms are these and whether it makes our NHS better or worse.

The government has won the parliamentary battle, but no one is quite sure what kind of a victory it has achieved, or at what price. A lot of staff on the ground lack confidence in the bill, or say they don’t like it, at a time when we need massive energy and commitment from the NHS staff. Go to any hospital or GP surgery just now and you will hear the continual opposition from doctors and nurses about this act, their worry about how much harder it will make their jobs. I think they’re right.

Remember, the NHS has to save £20bn by 2015. What it means is managing the NHS with less money and dealing with the consequences on priorities and quality of patient care. The entire NHS workforce could become preoccupied with the changes rather than concentrating on efficiency and innovation the NHS so desperately needs. The reforms would be demoralising, not just for professionals but for patients too, who would begin to see fewer treatments available to fewer people as the NHS cuts start to bite – with wealthier people able to “top up” treatments. The rich really will be able to have much more. It’s not just a postcode lottery, it’s a taxcode lottery.

The NHS is clearly under huge threat, it will be a completely different healthcare system in five-10 years time. A system, which I believe will signal the end of the National Health Service, and a system that will be much worse in terms of access, equity, health outcomes, and cost. The NHS will just be a logo, most cherished institution reduced from being the main provider of heath services in England with one of the biggest workforces in the world, to a US style insurance scheme, divorced from the actual delivery of any care. It will become a bureaucratic governing body dishing out public money to private companies.

My response to the discredited NHS reforms hasn’t just been writing letters and articles about why it is seriously flawed. I also started my own e-petition because I was concerned about the lack of democratic accountability of the coalition government and I wanted the bill to have its ‘day in court’.

The e-petition broadened the debate amongst all sections of society securing around 180,000 signatures. It has inspired other activists and spread knowledge about the reforms. It has stimulated Liberal Democrat factions within the coalition to question their own beliefs and forced the Labour Party to raise its game.

Opposition to the bill has come from a wide spectrum including organisations such as the BMA, most royal colleges, as well as trade unions and patient groups. The e-petition did have its day in court despite attempts by some MPs on the Business Backbench Committee to block it, salvaging a few strands for the democratic rights of those who use e-petitions to force parliamentary debate over an issue that evokes public outrage.

Now that I have been elected to the BMA national council, I’ll do my best to ensure the main priority of BMA is to minimise damage to NHS caused by Health and Social Care Act. I’ll continue my efforts to defend NHS, medical professionalism, and the doctor -patient relationship. And I hope to safeguard patients’ interests in these difficult times.

For me the entire campaign against the Health and Social Care Bill is about saving a service to which I have devoted all my life. I came to this country over 30 years ago to work in what I believe to be the best healthcare system in the world. During those thirty years I have worked in many aspects of the health service and have also campaigned to ensure that the key principles of the NHS, including free universal healthcare for all, are maintained. I work in Tameside which is a deprived borough where the threat of privatisation raises the risks to those who need the NHS the most; elderly people, those with chronic disease, and the mentally ill are the most vulnerable from the coalition reforms under the bill.

The bill may have become law, but those like me who cherish the NHS will continue to fight for the right to universal healthcare as a basic human right regardless of whether they live in flourishing suburbs or inner city deprived areas.

Dr. Kailash Chand OBE is a GP, chairman of Tameside and Glossop NHS and was recently elected to the British Medical Association national council.

Should a single payer system include complementary and alternative therapies?

Studying Complementary and Alternative Therapies

By Paul A. Offit, MD
JAMA, May 2, 2012
In 1992, with an initial budget of $2 million, Congress created the Office of Alternative Medicine (OAM). Based on legislation sponsored by Iowa politicians Tom Harkin and Berkeley Bedell, OAM’s mission was “to explore complementary and alternative healing practices in the context of rigorous science.”
In 1999, OAM became the National Center for Complementary and Alternative Medicine (NCCAM), a center within the National Institutes of Health (NIH). Funding has steadily increased; by 2012, NCCAM’s annual budget had reached $130 million. Since their inception, OAM and NCCAM have spent $1.6 billion. US taxpayers have a right to ask whether money appropriated for NCCAM—like money appropriated for all centers within NIH—has been well spent.
In support of NCCAM’s mission, proponents argue that one century’s folk medicine can be the next century’s mainstream medicine… Indeed, most drugs on today’s hospital formularies were originally derived from plants.
However, unlike studies of drugs derived from plants, many studies funded by NCCAM lack a sound biological underpinning, which should be an important requirement for funding. For example, NCCAM officials have spent $374 000 to find that inhaling lemon and lavender scents does not promote wound healing; $750 000 to find that prayer does not cure AIDS or hasten recovery from breast-reconstruction surgery; $390 000 to find that ancient Indian remedies do not control type 2 diabetes; $700 000 to find that magnets do not treat arthritis, carpal tunnel syndrome, or migraine headaches; and $406 000 to find that coffee enemas do not cure pancreatic cancer. Additionally, NCCAM has funded studies of acupuncture and therapeutic touch. Using rigorously controlled studies, none of these therapies have been shown to work better than placebo. Some complementary and alternative practitioners argue reasonably that although their therapies might not work better than placebos, placebos may still work for some conditions.
Although studies funded by NCCAM have failed to prove that complementary or alternative therapies are anything more than placebos, some proponents—pointing to studies of vaccine safety—argue that negative studies of biologically implausible hypotheses are worthwhile.
Does the same value of rigorously conducted negative studies hold for studies of complementary and alternative therapies? Have negative studies changed behavior? The answer is probably best found in NCCAM-funded studies of dietary supplements and megavitamins. Several studies have shown that garlic does not lower low-density lipoprotein cholesterol, St John’s wort does not treat depression, ginkgo does not improve memory, chondroitin sulfate and glucosamine do not treat arthritis, saw palmetto does not treat prostatic hypertrophy, milk thistle does not treat hepatitis, and echinacea and megavitamins do not treat colds.​ Moreover, some studies have found that megavitamins increase the risk of cancer and heart disease. Because the vitamin and supplement industry is not regulated by the US Food and Drug Administration (FDA), negative studies have not precipitated FDA warnings or FDA-mandated changes on labeling; as a consequence, few consumers are aware that many supplements have not delivered on their claims. In 2010, the vitamin and supplement industry grossed $28 billion, up 4.4% from the year before. “The thing to do with [these studies] is just ride them out,” said Joseph Fortunato, chief executive of GNC Corp. “We see no impact on our business.”
Although evaluating the research portfolio of any institute at the NIH is difficult, social and political pressures may influence area-of-interest funding, and decisions should be based on science. For complementary and alternative medicine, it seems that some people believe what they want to believe, arguing that it does not matter what the data show; they know what works for them. Because negative studies do not appear to change behavior and because studies performed without a sound biological basis have little to no chance of success, it would make sense for NCCAM to either refrain from funding studies of therapies that border on mysticism such as distance healing, purgings, and prayer; redefine its mission to include a better understanding of the physiology of the placebo response; or shift its resources to other NIH institutes.
http://jama.ama-assn.org/content/307/17/1803.full

And…

THINGS GET HOTTER FOR HOXSEY

U.S. Food and Drug Administration posts warning against man who makes millions from cancer victims

LIFE, April 16, 1956
Caption of a photograph of Harry Hoxsey:
HARRY HOXSEY holds the book he wrote which touts his cancer treatment. Beside him on a plaque is his motto: “The world is made up of two kinds of people – dem that takes and dem that gets took.”
http://books.google.com/books?id=Pk8EAAAAMBAJ&pg=PA125&dq=Harry+Hoxsey&hl=en#v=onepage&q=Harry%20Hoxsey&f=false

Complementary and alternative medicine (CAM) is a topic frequently brought up in discussions, forums, and in the medical and lay literature. When confronted on this topic, I usually respond by saying that anyone should be able to spend their own funds as they desire, but when the rest of us are paying the bills, whether through premiums for private insurance or through taxpayer-financed public programs such as Medicare, there is a responsibility for the administrator of the funds to prevent wasteful cost overruns by limiting spending to health care that is compliant to well accepted standards of mainstream medicine, which includes promising new diagnostic and therapeutic options that adhere to the rigors of science.
The application of science to medicine is a dynamic. Many older approaches prove to be ineffective or even harmful. As we gain new evidence, those approaches should be denied payment from our collective health funds, whether private or government. Beneficial new approaches should be added. These decisions should continue to be based on science.
What is different about the scientific evaluation of existing and innovative medical interventions and the evaluation of CAM? Why is CAM segregated, as, for example, in the National Center for Complementary and Alternative Medicine (NCCAM)? Quite simply, complementary and alternative therapies do not arise from inductive scientific reasoning. They are based on faith exclusively and have no basis in the scientific disciplines. If new discoveries suggest that there could be a scientific basis warranting further evaluation of a complementary or alternative therapy – an exceedingly rare event – then it is no longer classified as CAM but is moved into the arena of bone fide scientific research.
Should the government have any role in oversight of CAM? Yes, for two reasons. Most important, some CAM therapy is harmful, and the government has an legitimate role in protecting us from harm by removing from the market truly dangerous products with no redeeming value. The other role of government is to ensure that the producers and sellers of these ineffective products are providing honest disclosure to the consumers. Such disclosure is not required today. If the product is crap, the producers should be required to tell us that it is crap.
What the government should not be doing is wasting our tax dollars on this phony research strictly for the purpose of pleasing the eccentrics who have political influence.
My concerns go back to my teenage years when I had several discussions with my father – a physician – over these topics now classified as CAM though more appropriately referred to then as quackery. I remember very clearly reading a LIFE magazine article on the cancer quack Harry Hoxsey. I have repeated to myself over an over again throughout the years Hoxsey’s motto that appeared in the photograph of him in that article (which I was amazed that I could find today with a Google search – link above):
“The world is made up of two kinds of people – dem that takes and dem that gets took.”
Until now, I have been reserved in my comments on CAM, partly because so many sincere, dedicated individuals in our single payer coalitions are supportive of CAM – including some members of PNHP who should know better. But dammit! Quackery is quackery! The smug CAM producers who retreat to their mansions are “dem that takes,” and the uninformed patient/victims lacking an adequate scientific background are “dem that gets took.”
When I was a teenager, I wanted to become a physician like my father and help clean house of these unscrupulous thieves. Alas, they are still with us, and now they have been joined by their brethren in the insurance industry who don’t have a tangible product to sell us but rather simply expropriate our money directly out of our collective health funds in exchange for taking away our choices in health care. That’s worse than quackery!
(This is not a PNHP policy statement, but is a cathartic release of pent up emotions of the author.)

Where they take care of their sick — and ours

By Greg Dobbs
The Denver Post, April 23, 2012

BELFAST, NORTHERN IRELAND — When I’m sick, I want the world’s best health care as much as anybody.

That’s why I’m happy to report that 36 hours after launching on a fantastic journey through the length and depths of my digestive tract — after I collapsed and almost died more than a week ago from massive internal bleeding — an expensive and innovative tool called the PillCam, collecting almost 60,000 diagnostic images inside me to pinpoint the problem, has just completed its mission.

The thing is, this wasn’t at the internationally famous Mayo Clinic, or the vaunted Cedars-Sinai in Los Angeles, or our own world-class University of Colorado Medical Center.

It was at the big, battle-tested, National Health Service trauma center in Belfast, Northern Ireland, called Royal Victoria Hospital — known to locals as well as reporters like me who covered the warfare here in the 1970s and ’80s as the Royal Vic.

It hasn’t been a perfect experience. I’ve felt lost in the chaos of the emergency room. I’ve had bloodlines spring leaks where they’re inserted in my arms. I’ve heard fellow patients screaming all night. And I’ve been presented with a couple of plates of food I wouldn’t pay for at a restaurant. But you know what? It’s a hospital! As a veteran of life-threatening traumas, I’ve suffered the same at institutions in the United States.

More important, just as I have in American hospitals, I’ve had the high-tech procedures I needed when I needed them. Two angiograms, two endoscopies, CT scans, X-rays, a colonoscopy, and that tiny alien capsule that I swallowed, the PillCam.

Some argue that in a universal health care system like this one, you’ll get urgent care only if you have urgent needs.

Well, about 10 years ago when my back collapsed and I was reduced to crawling around with screaming pain until I could have some vertebrae fused, I’d say the need was pretty urgent. But it took a week and a half to get me into surgery. That was in suburban Denver.

The bottom line is, maybe it’s socialized medicine, but the doctors and nurses and procedures and protocols here are first-rate; they saved my life.

By the way, I have pre-existing conditions, which disqualify me for most insurance at home. Except for personal medical history to help treat me, no one here even asked. In fact, the bureaucracy is so minimal and the priorities so different, no one has even asked to see an identification card to prove who I am, let alone a credit card to prove my ability to pay.

And the cost? The “emergency” parts — the ambulance, the ER, the transfusions — came with no charge. The rest? Oh, since I only came to Belfast to shoot a television news segment and don’t pay taxes and thus am not insured, I’ll pay all right, but since the model for hospital revenue isn’t based on market-driven, sometimes-price-gouging profit centers, I won’t pay through the nose.

If you think it’s no different in the U.S., you’re not paying attention.

But here’s the biggest difference between the two health care systems: This one is open for everybody. Residents don’t have to assess and agonize over the cost because they don’t have insurance. If they need medical care at any level, they just go. As I did. And get fixed. As I am.

And guess what: Anyone here who doesn’t like their universal health care system and wants something more can have it, through private insurance, if they’re willing and able to pay for it. Gee. That’s just like us.

Greg Dobbs is a Denver-based correspondent for “World Report” on HDNet television.

http://www.denverpost.com/opinion/ci_20446181/where-they-take-care-their-sick-mdash-and#ixzz1tjnIRKgW

Khati Hendry on Canada's solution to insurance job lock

Email

From: Khati Hendry
To: Don McCanne
Date: Tue, May 1, 2012 at 10:56 PM
Subject: Re: qotd: Lack of retiree plans can cause job lock

Hi Don,

This article reinforces one of the things that really impressed me when I first moved from the US to practice in Canada 7 years ago–I started seeing all these patients who were retiring way before age 65.  What was up?  They didn’t all seem independently wealthy.  Some were taking up other avocations, running B&Bs, but others were, well, just retired.  Of course the big difference is that they don’t have to take into account health insurance.  They are covered working, retired, laid-off, in transition, in school, married, single, rich, poor–you understand completely.  What a difference it makes to a life when you don’t have the angst of health financial disaster looming, and you can make your decisions on all the other things important to you.

Cheers,
Khati

MiniProfile: Khati Hendry
http://futurehealth.ucsf.edu/Public/Leadership-Programs/MiniProfile.aspx?asuid=4863

qotd May 1, 2012: “Lack of retiree plans can cause job lock”
https://pnhp.org/news/2012/may/lack-of-retiree-plans-can-cause-job-lock

Comment: 

By Don McCanne, MD

If you read Khati Hendry’s MiniProfile (link above) you will see that she is indeed an expert, but her credibility stems not just from what she has done in her career. Much more, it is her dedication to making the health care system work for her patients and for all patients that most qualifies her when she speaks out on health care justice.

For more on her views, this link provides access to a transcript of a radio broadcast featuring Dr. Hendry on “Demystifying the Canadian Health System”

Khati Hendry on Canada’s solution to insurance job lock

Email

From: Khati Hendry
To: Don McCanne
Date: Tue, May 1, 2012 at 10:56 PM
Subject: Re: qotd: Lack of retiree plans can cause job lock

Hi Don,

This article reinforces one of the things that really impressed me when I first moved from the US to practice in Canada 7 years ago–I started seeing all these patients who were retiring way before age 65.  What was up?  They didn’t all seem independently wealthy.  Some were taking up other avocations, running B&Bs, but others were, well, just retired.  Of course the big difference is that they don’t have to take into account health insurance.  They are covered working, retired, laid-off, in transition, in school, married, single, rich, poor–you understand completely.  What a difference it makes to a life when you don’t have the angst of health financial disaster looming, and you can make your decisions on all the other things important to you.

Cheers,
Khati

MiniProfile: Khati Hendry
http://futurehealth.ucsf.edu/Public/Leadership-Programs/MiniProfile.aspx?asuid=4863

qotd May 1, 2012: “Lack of retiree plans can cause job lock”
https://www.pnhp.org/news/2012/may/lack-of-retiree-plans-can-cause-job-lock

Comment: 

By Don McCanne, MD

If you read Khati Hendry’s MiniProfile (link above) you will see that she is indeed an expert, but her credibility stems not just from what she has done in her career. Much more, it is her dedication to making the health care system work for her patients and for all patients that most qualifies her when she speaks out on health care justice.

For more on her views, this link provides access to a transcript of a radio broadcast featuring Dr. Hendry on “Demystifying the Canadian Health System”