Stupidism, the other S word

I am having difficulty with the current presidential campaign understanding how our political system reveres the stupid.

It’s simply stupid to believe that Palin is the “best” candidate the republican party could find for Vice President. She’s clueless, and unqualified. Her lack of qualification is manifest in her intellectual achievements (see her academic record, also review McCain’s); lack of national experience and basic knowledge of the world; skepticism regarding science and scientific method; performance in interviews after her selection; and in her loudly stated view that a African American son of a single mother who through the strength of his intellect became a highly respected lawyer and community organizer is one of the “elite.” It’s as if being smart is a problem. She simply makes no sense. Yet she is the best the republican party can do. Her choice and views are prime manifestations of stupidism in this campaign.

The presidential candidate for that party has proposed an elaborate shell game that is his health care policy. It will eliminate health insurance as we know it and move most of us to the expensive individual health insurance market. Many will not be accepted for insurance or charged outrageous premiums because of all things they are sick and need their health insurance. Nothing like a policy that works to eliminate coverage for those who need it most.

In regard to healthcare the question is who is more stupid. Those who propose a flawed bizarre policy or those who will seek temporary personal advantage in such a policy–by not having coverage or by buying cheap policies that don’t provide comprehensive coverage. I say temporary because we all will have illness at some point. When that happens these guys will have inadequate or no coverage and be unable to afford their treatment. At that point they may try and upgrade their health insurance policy and as noted above will be flushed out of the private insurance system. Not understanding the implications of segregating risk in health insurance and voting for a candidate who proposes such a policy is also a manifestation of stupidism.

With the economy tanking, the repubicans sell the notion that up is down and down is up. McCain a long term and recent proponent of deregulation now claims he has always been for regulation of financial markets; Palin wonders how a Democrat can propose cutting the military budget in a time or war, while McCain has stated he knows of waste and mismanagement at the Pentagon and can easily cut their budget. For these people, support of a stupid war is patriotic but paying for it with taxes isn’t. What isn’t stupid about this campaign?

Consider this election a ballot initiative on stupidism.

Selenium and Vitamin E don’t prevent Prostate Cancer

Another of the vitamin/mineral delusions seems to have been put to rest.

The notion that selenium did something against cancer goes back to a study published in 1996. It showed that selenium was not associated with decreases in skin cancer but noted incidentally that all factor mortality was less in the group supplemented with the mineral. This has led to a decade long love affair with selenium as a “anti-oxidant” disease preventative.

In fact it appears that selenium increases the risk of some types of skin cancer and now along with vitamin E has been proven ineffective in preventing prostate cancer.

Among other observations the study is reported to have noted:

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“The $119 million study, involving more than 35,000 men, also found hints that the nutrients might increase the risk for prostate cancer and diabetes”

“The announcement marks the latest in a series of disappointing findings about the potential health benefits of vitamins and other nutritional supplements, which earlier studies had indicated could have a host of advantages. One theory was that antioxidants could mop up damaging free radicals, which are a natural byproduct of cellular processes in the body.”

“But subsequent studies testing antioxidants and other nutritional supplements have not confirmed the benefits, and several have even been alarming. For example, beta carotene increased, rather than decreased, the risk of lung cancer among smokers, and Vitamin E — also touted as helping to prevent heart disease — appeared to boost the overall risk.”

Rather than alternative medicine, the anti-oxidant theory appears to be alternative reality. All those selenium containing products are worthless and should be discarded.

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What are these pathetic people thinking?

Eight year old shoots himself with an Uzi at a gun show.  You could not imagine a scenario where this could possibly happen.  Yet in our good ole US of A…………

Placebos, Much ado about nothing, literally

For years we’ve been hearing of the “benefits” of such interventions as homeopathy, mega-vitamin therapy, coffee enemas, detoxification, cranial sacral therapy, weekly chiropractic therapy and a multitude of other alternative remedies.  People swear they help and spend billions.   Yet there is precious little evidence that show’s benefit such as decreased chronic illnesses or improved longevity.

So it’s not surprising that a study of routine medical practices reveals that doctors candidly believe some of the practices no better than placebo.  I used to tell patients with colds that without treatment it would take seven long days for the problem to resolve.  With antibiotics it would take just one week–yet that is what they wanted.  I was told that if I didn’t treat them they’d find someone else to do so and a number of patients did so.

It’s as simple as that, people believe an intervention anyone, even lacking in evidence, is better for them than none.  How else to explain the “efficacy” of homeopathic remedies which contain no active ingredient and is diluted to the the point of having no medicinal value.  Yet patients swear by it because they think they are being treated and they do get better.  It should be pointed out that the great majority of what a family doc sees each day would also better, just as quickly and completely, without any intervention.  Patients seek  reassurance but also in many cases insist on something being “done.”

That’s the essence of placebos and as long as patients want to believe it works it will in most instances–just a week rather than 7 long days.

But it is a costly game.

Taxing Benefits vs a Salary Cut–McCain’s Hobson’s Choice

If McCain is elected and implements his health program you can say good bye to employer based health coverage and expect a salary cut.

The McCain health plan proposes to tax health benefits provided by employers as ordinary income.  If the employer stops providing health benefits (worth up to $12,000 or more) then there will be a tax credit offered of $5000/couple ($2500/person) to buy insurance in the open market.

You have to watch your wallet here.  By slight of hand the plan takes an up to $12,000 insurance benefit that comes with employment and throws you into a treacherous individual insurance market with $5000.  If you or a family member have a serious illness under McCain’s “plan” you will be charged more or even denied coverage.  If you are healthy you may be offered a variety of products many of which provide inadequate coverage that you only discover is inadequate after you become sick.  You will be rated each year and there is no guarantee of continued insurance coverage at any price if you are in great need.  Quite a program for insurers.

Adding insult to injury, you remember your health benefit that was being taxed as your ordinary income?  It was worth up to $12,000.  Guess whose money that is?  It was to be taxed as your income but as soon as the employer dropped coverage, your income became the employer’s revenue.  In other settings that’s what’s known as a salary cut.  It’s almost as obtuse and ingenious as leveraging mortgages or credit default swaps.

I should disclose that while I don’t particularly care for employer provided coverage, the McCain program would be an abomination.

The Four topics rarely discussed at medical meetings

1. Cost/Efficacy–Is the response to treatment worth the cost.  At most meetings cost is never mentioned when discussing results.  This in  an era of $100,000 medications and health cost inflation.

2.  Value–Presentations at meetings are geared to show off new medications.  At time the educational programs will objectively review the field and make unbiased suggestions but for the most part the programs are funded by the industry and the speakers are on the payroll.  As a result evaluations of alternative treatment and of course considerations of cost/efficacy are rarely heard.

2. Patent reform–Meetings are for the most part sponsored by drug companies (patent holders), enough said.

3. Conflicts of interest–It’s not unusual to have speakers touting results of studies who are on the payroll of the drug company that makes the product being tested.  Disclosure is not enough!

What Tony Snow’s death tells us about Cancer therapy today

Snow presumably had access to the latest and best treatments for colon cancer.  Yet he died just three years from diagnosis.  His disease was apparently localized disease at diagnosis.  He received adjuvent therapy to prevent recurrence.  It failed as it does in about 1/3 of patients so treated,  and his cancer recurred with metastatic disease just over a year ago.

You may hear all manner of propaganda about new advances from big Pharma, new drug regimens,  miracle biologic agents that cost thousands of dollars a month, and improvements of survival.   You need to remember however that the advances improve survival minimally (in advanced disease about two months) at great financial cost.

The lesson if there is one is that the best approach is prevention (for those cancers so amenable) and early diagnosis.  Colonoscopy should be a part of health maintenance for everyone, particularly if there is a family history of colon cancer.

Our poorly rated health care non-system

This article from Reuters puts out system in perspective:

“Americans are the least satisfied with their health care system, while the Dutch system is rated the best, according to new research.

Polls about health care in 10 developed countries by Harris Interactive revealed a range of opinions about what works and what doesn’t.

In the United States a third of Americans believe their system needs to be completely overhauled, while a further 50 percent feel that fundamental changes need to be made.

“Given that all countries other than the U.S. have universal health care systems in place, this may invite questions on why the U.S. remains the only wealthy, industrialized country without such a system,” Harris president George Terhanian told Reuters.”

“The U.S. model, widely criticized on its combination of private insurance and publicly-funded programs, spends more on health care than any other nation worldwide but ranks low on overall quality of care, according to the World Health Organization (WHO).”

The health plans offered by Obama and McCain do not answer the questions raised by this polling.  Neither mandate universal health coverage nor attack the lack of value in health care in the U.S.  Our costs are double those elsewhere and our outcomes worse.  Is this the American way?

McCain’s so called plan actually does away with the employer mandate so fewer people will likely be insured.  His tax rebate scheme will not cover insurance costs and further his plan allow insurers to deny insurance to the sick and other high risk groups.  He would, hard as it is to believe, make things worse than they are.

Obama’s plan is better but still allows the waste and duplication of multiple insurers administrative costs–which amount to about 30% of health care spending.  Medicare spend under 10% on administration.

A Case for National Health and Rational Use of Expensive Drugs–Tarceva for example

Nice feature on NPR regarding the United Kingdom’s approach to expensive medications. There are trade-offs–toxicity, expenses, limited efficacy.

You don’t find such openness in the U.S. where unrealistic expectations, incomplete information, irrational use of funds and conflicts of interest drive utilization.

Conflicts of Interest–nothing new. You could make a movie about this!!

I came across a letter in the June 26th N.Y. Review of Books from Gayle Greene regarding a dispute in the 50’s and 60’s about the safety of x-raying pregnant mothers. Today a defense of this practice would be viewed as ludicrous but read the letter, and also the book The Woman Who Knew Too Much: Alice Stewart and the Secrets of Radiation to learn more.

From the NY Review of Books:

“I interviewed Doll while writing about Stewart, the physician and epidemiologist who discovered that the practice of X-raying pregnant women, which was common in the Forties and Fifties, doubled the chance of a childhood cancer. Doll and Stewart moved in the same Oxbridge circles, sat on the same committees and editorial boards. Both started out as physicians, then moved into epidemiology after the war, each making major discoveries in the Fifties that helped shape epidemiology so it came to include cancer as well as infectious diseases. But after Stewart went public with the dangers of radiation, she plummeted to obscurity, while Doll, credited with discovering the link between lung cancer and smoking, rocketed to fame and a knighthood.”

“Immediately after Stewart published her findings, Doll launched a study to prove her wrong. For nearly two decades, he succeeded in keeping her findings from being accepted, thereby allowing fetal X-raying to continue”

“After his death it came out that Doll was receiving payment from Monsanto (quite a lot) all the while he was doing the studies that cleared vinyl chloride of an association with liver cancer. I’d have thought that would have laid to rest this overblown veneration. But no, Horton defends him, suggesting that he may simply have been “naive.” I can tell you, whatever else he was, he was not naive.”

Not much has changed as indicated in today’s (June 8,2008) NY Times report on professors of pediatrics receiving unreported income from drug companies.

“In 2000, for instance, Dr. Biederman received a grant from the National Institutes of Health to study in children Strattera, an Eli Lilly drug for attention deficit disorder. Dr. Biederman reported to Harvard that he received less than $10,000 from Lilly that year, but the company told Mr. Grassley that it paid Dr. Biederman more than $14,000 in 2000, Mr. Grassley’s letter stated.”

“At the time, Harvard forbade professors from conducting clinical trials if they received payments over $10,000 from the company whose product was being studied, and federal rules required such conflicts to be managed.”

This is the tip of the iceberg of unreported relationships between physicians, researchers, and institutions and the medical industrial complex.

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