Health Care

How do you solve a problem like the ethical erosion of doctors who treat patients like walking diseases rather than people? Harvard and N.Y.U think that making incoming med-students face patients on their first day of training could help give students a little more humanity, reports the New York Times.

The students are given a more of a hands-on education in order to improve idealism and morality, the alternative is to have them spend two years in lecture halls and libraries, buried deep in textbooks.

Tens of thousands of pre-schoolers are among the half a million kids in the U.S. being given antipsychosis drugs. Most of the pre-schoolers given drugs fail to receive a full and adequete mental health assessment to determine whether such radical treatment is neccessary.

We are giving very young children drugs without fully exploring the risks and alternatives, or questioning whether the drugs are necessary at all. Factor in aggressive marketing by drug companies (Johnson & Johnson went as far as handing out Legos stamped with name of anti-psychotic drug Risperdal) and we've got even more reason for caution in dealing with an industry that has seen antipsychosis drugs become a $14.6 million market, by revenue no class of drug sells more.

But with children as young as two or three years-old being diagnosed as clinical depressed, perhaps traditional and common sense thinking on young children's mental health is off the mark and in need of updating to reflect new advances and possibilities.

One researcher says that despite common wisdom, babies need fish in their diet. So she's been working on creating a baby food made from salmon that even kids will eat.

Susan Brewer, a University of Illinois food science professor and a registered dietitian, says that feeding salmon puree to babies has two advantages: first, it pumps them full of crucial omega-3 fatty acids needed for brain, nerve, and eye development. When babies switch from nursing to solid food, they don't get nearly enough omega-3s.

Second, starting them early could give Junior a taste for fish his whole life, which, mercury issues notwithstanding, is a healthy taste to have. Fish-based baby foods already sell well in Asia, the UK, and Italy, places where fish are more often eaten (and not in stick form).

Contrary to expectations, the new state-based, high-risk health insurance pools have gotten off to a crawling start. A Kaiser Health News/NPR news report finds that only about 3,600 people have applied and about 1,200 have been approved since the federal government launched the Pre-Existing Condition Insurance Plan back on July 1.

Under the new health care law, all states are required to run insurance pools for people with pre-existing conditions judged too expensive to insure by health insurance companies. State governments could either take federal funding and administer their own pools or have the federal government run the programs directly. The high-risk insurance pools are a temporary solution until 2014 when insurers are forbidden to reject applicants based on their medical history.

States and the federal government initially had anticipated a greater demand for this type of coverage. Fearing they would not meet the demand, 22 states decided to let the Department of Health and Human Services (HHS) run their high-risk pools. Washington DC and 28 other states decided to run their own. The 22 HHS administered pools have garnered a total of 2,400 applicants since August 13. The numbers for the states that are running their own pools vary widely from as little as one applicant in Connecticut to 400 in Oregon.

As a medical educator, I try to encourage my residents to see beyond the next step in a patient’s care.  For example, before simply ordering a test, I challenge them to think of what they would do with the results.  If the test is negative, are we really reassured that there is no disease?  On the other hand, if it’s positive, will it help us in the treatment of this patient?  You’d be surprised at how often performing a test is not always the best thing to do.

So it’s with that mindset that I read about a new test for Alzheimer’s disease.  Via a spinal tap, we can now determine with a startling degree of accuracy whether Alzheimer’s is indeed present or not.

I wonder about the utility of this test, however, and also about how such a definitive diagnosis might make practitioners less vigilant in their workup of patients. At present, Alzheimer’s disease is virtually untreatable.  Would detecting the disease early make a significant difference in a patient’s health?  Additionally, Alzheimer’s is one of those illnesses to which it’s far too easy to attribute symptoms that may actually be harbingers of something more serious, not to mention treatable.  Worsening confusion?  It would be very easy to chalk it up to Alzheimer’s and not look for other conditions that could do the same thing.

This may come as no surprise, especially for those who’re currently being walloped by the economic crisis: a new study reported in the New York Times finds Americans have cut back spending on routine medical care far deeper than people in five other countries with universal health care.

The study was published by the National Bureau of Economic Research and based on surveys conducted in the U.S., Canada, France, Germany, and Great Britain. Researchers found the global economic slump has caused loss of wealth and income in all six countries. But  the U.S. came out highest in the number of survey respondents who reported reducing their use of routine medical care since the recession’s start in 2007—26.5 percent versus 5.3 percent in Canada, 7.6 percent in Britain, 10.3 percent in Germany, and 12 percent in France.

People in countries with universal health coverage also have some out-of-pocket medical costs. The study found that the larger the out-of-pocket costs, the more people cut back their usage of healthcare services. The U.S. once again came out on top with more of its citizens paying greater out-of-pocket costs than any of the other countries surveyed. The huge number of uninsured people--about 15 percent of the population—is also a chief reason why the U.S. outstrips the other five countries in the number of people forgoing routine medical care.

Do you have your organ donor card signed yet? Do  you? I’m asking because I’d like to think that if more organs were available, stories like this wouldn’t happen, in which a very nice young man gets stricken with one of those awful, can’t-do-anything-to-prevent-it kind of diseases that is slowly destroying his liver.

His brother, also a very nice young man with a very nice young family, watches as his sibling wastes away for want of an organ. He has some testing done and discovers that he is a perfect match, and the two brothers travel to a well-respected transplant center to have a living-related liver transplantation.

The first brother, the recipient of 60% of his brother’s liver, is slowly recovering. The other brother, the donor, died, leaving behind a wife and three young children. The cause of death is still unknown, but given that it occurred in an otherwise healthy man 4 days post-operatively it stands to reason that the surgery may have had something to do with it.