Category Archives: World Health

American Health Care Fail: Increased Death Rate Among Poor Whites Aged 45-54

The Proceedings of the National Academy of Sciences reported a disturbing study showing an unprecedented increase in the death rate among white citizens with the least education.  The details of the study were reviewed in the American Prospect.

The increased deaths were concentrated among those with the least education and resulted largely from drug and alcohol “poisonings,” suicide, and chronic liver diseases and cirrhosis. This midlife mortality reversal had no parallel in any other industrialized society or in other demographic groups in the United States.

Case and Deaton’s analysis, published today in the Proceedings of the National Academy of Sciences, also shows increased rates of illness, chronic pain, and disability among middle-aged whites. The findings have important implications for American politics and public policy, particularly for debates about economic inequality, public health, drug policy, disability insurance, and retirement income. The data also suggest why much of American politics may be taking on an increasingly harsh and desperate quality

The study points out that the U.S. is unique in that no other of the western industrialized nations is having a similar spike in mortality.  Read the entire American Prospect article for details.

Medicynical Note:  Hard to make a clever cynical comment about a study that focuses our attention on the failure of our culture to address it’s most basic needs.  We appear to have a problem not only with health care but with the very basis of our culture…..capitalism. 

US Healthcare vs the World: It Ain’t Pretty

The Commonwealth Fund compares the non-system of healthcare in the U.S. with 11 other industrialized nations.  How do we rank?

The United States health care system is the most expensive in the world, but this report and prior editions consistently show the U.S. under performs relative to other countries on most dimensions of performance. Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity. In this edition of Mirror, Mirror, the United Kingdom ranks first, followed closely by Switzerland

More here.

Medicynical Note:  Nothing new here, the weakness of money driven health care has been evident for years.  Our emphasis is on profits and revenue.  Healthcare?  Not the main concern of providers (the more you do the more you earn), suppliers, insurers and drug companies.  How else to explain our costs and problematic delivery of care.  Whether the Affordable Care Act will change this remains to be seen.  Sobering, but for the U.S. BUSINESS as usual.  Read the links for more information.

 

Malaria: Artemisinin, Antimalarial with a political agenda

Fascinating story of the development of artemisinin, a antimalarial developed in China during the Vietnam era. 

Artemisinin’s discovery is being talked about as a candidate for a Nobel Prize in Medicine. Millions of American taxpayer dollars are spent on it for Africa every year.

But few people realize that in one of the paradoxes of history, the drug was discovered thanks to Mao Zedong, who was acting to help the North Vietnamese in their jungle war against the Americans. Or that it languished for 30 years thanks to China’s isolation and the indifference of Western donors, health agencies and drug companies.

Medicynical Note:  Perversely, the delay in development and distribution prevented it’s wide use, and perhaps the development of resistance.  It remains an effective agent.

No New Polio Cases: India

This report of no new polio cases in India validates (no thinking person really needed further validation) the use of vaccines in serious life-threatening diseases. 

The world of polio as it appeared in 2011:  Countries in black still reporting cases, except perhaps India!

image

Source:  Kaiser Family Foundation

Medicynical Note:  In the early part of my medical career I observed the WHO’s vaccination strategy in Africa.  Small pox was eliminated as an active disease threat.  I didn’t expect another such advance in my lifetime. 

Millions of people have benefitted. 

Swine Flu–Walking and Chewing Gum

  • Thus far the swine flu epidemic has been manageable. 42 deaths in Mexico, two in the U.S., but mostly a reasonably mild disease for the great majority of those affected. Cases will continue but for now as the flu season winds down the epidemic seems manageable. From the WHO:

“23 countries have officially reported 2099 cases of influenza A(H1N1) infection.”

“Mexico has reported 1112 laboratory confirmed human cases of infection, including 42 deaths. The United States has reported 642 laboratory confirmed human cases, including two deaths.”

“The following countries have reported laboratory confirmed cases with no deaths – Austria (1), Canada (201), China, Hong Kong Special Administrative Region (1), Colombia (1), Costa Rica (1), Denmark (1), El Salvador (2), France (5), Germany (9), Guatemala (1), Ireland (1), Israel (4), Italy (5), Netherlands (1), New Zealand (5), Portugal (1), Republic of Korea (2), Spain (73), Sweden (1), Switzerland (1) and the United Kingdom (28).”

In the 1918 epidemic there were episodes of relatively minor disease that were later followed by periods of very virulent disease with explosive spread. The disease altered evolved or perhaps creationed itself (see this) into more dangerous forms which caused a rapidly progressing severe illness, killing millions. This could still happen.

We have some time to develop a vaccine and strategies for more severe disease should they occur. This from Science, May 1:

“Early on, CDC began to brew a “seed” strain for a possible vaccine against swine H1N1, and by 27 April the World Health Organization in Geneva, Switzerland, was already talking to vaccine manufacturers. One key problem is that the world’s influenza vaccine production capacity-which still relies on growing the vaccine virus in chicken eggs-is limited to some 400 million vaccine doses a year and is impossible to expand quickly. Manufacturing swine flu vaccine would thus come at the expense of seasonal vaccine production, says retired pharma executive and flu vaccine expert David Fedson, and might lead to higher mortality and morbidity from the three seasonal strains.For now, WHO says manufacturers should continue preparing vaccine for the 2009-10 flu season. But that could change if swineflu proves particularly severe. “We’re in a casino now, and we’re placing our bets,” says Fedson.”

Powered by Zoundry Raven

Mark Dybul’s Removal–inevitable

Mark Dybul by all indications was as effective as an HIV/AIDS coordinator could be working for a narrow minded, religious right agenda driven administration. That being said it appears he compromised too often to be held over in the new administration.

This from Michelle Goldberg in the American Prospect:

“A gay man who had, in the past, donated to Democrats, Dybul seemed to pride himself on his ability to make common cause with conservatives. As global AIDS coordinator in the Bush White House, he often sided with allies like Rick Warren rather than with women’s-health advocates on issues ranging from abstinence to sex-worker outreach to family-planning funding.”

“Thus, while PEPFAR did miraculous things to treat and care for people with HIV — an expensive but relatively uncontroversial undertaking — it missed many opportunities to prevent new infections. Initially, at the administration’s behest, the legislation authorizing PEPFAR earmarked a third of the money dedicated to HIV prevention for abstinence and faithfulness programs, often run by religious groups. With other PEPFAR prevention funds directed toward things like mother-to-child transmission, very little was left over for comprehensive sex education and condom distribution. In fact, in order to fulfill the abstinence earmark, Dybul’s office told those in the field to devote a full two-thirds of the money available for the prevention of sexual transmission of HIV to programs encouraging chastity and fidelity.”

Medicynical note: An effective proponent of ineffective prevention policy is not an automatic reappointment candidate. As noted the abstinence mandate in the Bush/Dybul program corroded the effectiveness of the interventions. Dybul appears to have compromised what might work with the ineffective and scientifically flawed.

I’ve always felt that selling out the AIDS program to the religious right, who previously couldn’t even say the AIDS word, was a travesty. In that Dybul facilitated this sell out he didn’t deserve reappointment.

Powered by Zoundry Raven

Abstinence education, Virginity Pledges –Failed concepts both here and in Africa

In of all places, Bloomberg, there is an article on the failure of abstinence education and “virginity pledges, more here. These faith based approaches to teen pregnancy and controlling the HIV/AIDS epidemic rely on “reason” to control lust. Unfortunately several studies have now shown that this approach doesn’t work. In the U.S. young people taking virginity pledges were as likely to have sex as those not doing so. Imagine how effective this approach is in Africa controlling HIV/AIDS.

The article reported:

“Teenagers who pledged to avoid sex until marriage were as likely to have intercourse as other U.S. adolescents, according to a survey of conduct mostly in 1990s.”

“Teens who took the pledge also were less likely to use birth control pills or condoms”

“Today’s study relied on surveys of students in 1996, when Congress authorized increased funding for abstinence-only education as part of an overhaul of welfare, and 2001. A Congressionally authorized report in 2007 on the program in that bill, Title V, also found students were no more likely to abstain. That program gets about $50 million a year.”

The article notes a study showing some effectiveness in one program but the overall results indicates that the strategy is not a success.

And from Freakonomics:

“Studies have repeatedly shown that abstinence-only students have almost the same number of sexual partners, and have sex almost as early, as students who receive traditional sex ed. In fact, abstinence-only programs may actually increase the risk of STDs and unintentional teen pregnancies. That’s because those abstinence-only students who do have sex tend to be less likely to use protection.”

What’s fascinating about the discussion in the article is the all or none philosophy of the abstinence types. They simply won’t countenance a program that has both abstinence and safe sex components. It’s another example of pre-existing bias affecting the implementation of public policy.

Young people need all the information and advice available. We need to encourage abstinence but also equip them to protect themselves when and if they decide to be sexually active. People are not machines with on off switches, they need options and alternatives.

Meanwhile in Africa the AIDS epidemic continues and the U.S. policy to deemphasize safe sex and emphasize abstinence , more here, does not appear to promoting abstinence. Those counseled were more likely to use condoms, abstinence doesn’t appear to be likely in those situation. The study in Nigeria “did not see a reduction in the number of partners.”

So in Africa we have a program forced to devote 1/3 of it’s spending on an ineffective strategy. Inefficiency in our health care programs is not limited to our domestic health care system.

Medicynical comment: What’s fascinating is that when one does a google search on abstinence education Africa, you find many sites associated with church causes promoting the concept but relatively few facts. We need more studies on this and need to merge the two approaches–abstinence and safe sex.

For the record most of these Christian groups, including Rick Warren’s, had nothing to do with HIV for the first twenty years of the epidemic. That neocon icon, Ronald Reagan, couldn’t even bring himself to say the word AIDS during his presidency. Twenty million people died and another twenty or so million became infected in this period.

These groups opposed funding of any anti-HIV intervention in the 80’s and 90’s. Their philosophy, as voiced to me by a missionary in Uganda in 1988, was that those with HIV got what they deserved. When Bush, to his credit, decided to put money into HIV in Africa. These churches, so to speak got religion, and followed the money. The only problem is that they wish to dominate the program with an ineffective HIV education message. Hopefully this will change.

Powered by Zoundry Raven