So educated - so dumb

Low vaccination rates in Silicon Valley. [Link]

The scientists, technologists, and engineers who populate Silicon Valley and the California Bay Area deserve their reputation as innovators, building entire new economies on the strength of brains and imagination. But some of these people don’t seem to be vaccinating their children.

A WIRED investigation shows that some children attending day care facilities affiliated with prominent Silicon Valley companies have not been completely vaccinated against preventable infectious diseases. At least, that’s according to a giant database from the California Department of Public Health, which tracks the vaccination rates at day care facilities and preschools in the state. We selected more than 20 large technology and health companies in the Bay Area and researched their day care offerings. Of 12 day care facilities affiliated with tech companies, six—that’s half—have below-average vaccination rates, according to the state’s data.

Drink up!

It is good for you, even if they don't want to admit it. [Link]

So the more you drink—up to two drinks a day for woman, and four for men—the less likely you are to die. You may have heard that before, and you may have heard it doubted. But the consensus of the science is overwhelming: It is true.

Although I dispute many of the caveats offered against the life-saving benefits of alcohol, I will endorse two. First, these outcome data do not apply to women with the “breast-cancer gene” mutations (BRCA 1 or 2) or a first-degree (mother, sister) relation who has had breast cancer, for whom alcohol consumption is far riskier. Second, drinking 10 drinks Friday and Saturday nights does not convey the benefits of two or three drinks daily, even though your weekly totals would be the same: Frequent, heavy binge drinking is unhealthy. But then you knew that already, didn’t you? If you don’t distinguish binge drinking from daily moderate drinking, that would be due to Americans’ addiction-phobia, which causes them to interpret any daily drinking as addictive.

The global summary of alcohol’s benefits raises a key question: How much do you have to drink regularly before you become as likely to die as an abstainer? We’ll see below.

First, let’s address some typical objections to these findings. Of course, abstainers may not drink because they are already ill. Thus the meta-analysis relied on studies that eliminated subjects who are abstaining due to illness, or else contrast drinkers with lifetime abstainers. Additionally, objectors note, drinkers showing such longevity may be wine-sniffling, upper-middle-class professionals (virtually no study has ever found that the type of alcohol consumed impacts these results), people who exercise, eat right, and don’t smoke. To counter this argument, researchers from the prestigious Harvard Health Professionals Study published a paper which found that even men with four healthy life factors (diet, weight, non-smoking, exercise) had one-third to one-half the risk of suffering a heart attack if they had one to two drinks daily, relative to comparable men in each category who abstained.

Now let’s turn quickly to four special topics—biological mechanisms; cognitive benefits of drinking; the resveratrol myth; and the answer to our key question: If you drink just a little too much alcohol, doesn’t your death rate shoot up way over that of abstainers? (This is the so-called “J–shaped curve.”)

Obamacare not reaching the uninsured

Wasn't that the entire point of this slow motion train wreck? [Link]

ObamaCare isn’t achieving its primary goal of extending coverage to the uninsured, according to a new study.

The survey released Thursday by the McKinsey & Co. consulting firm found that only 27 percent of people who have selected a plan on the new exchanges didn’t previously have coverage.

The Obama administration says 4 million people have selected a plan since the exchanges launched on Oct. 1, but has not said how many of them already had an insurance plan.

At a healthcare industry conference on Thursday, Gary Cohen, a top official at the Centers for Medicare and Medicaid Services (CMS), said it’s not something the administration has the ability to track.

“That's not a data point that we are really collecting in any sort of systematic way," Cohen said, according to The National Journal.

A CMS official told The Hill that it’s an important measurement that the agency hopes to be able to report on in the future.

“We are a looking at a range of data sources to determine how many marketplace enrollees previously had coverage,” the official said. “The marketplace application asks applicants only if they are looking to apply for coverage, not whether the consumer currently has coverage. Previous insurance coverage is an important metric, and we hope to have additional information in the future.”

Still, the 4 million ObamaCare enrollees are a small fraction of those who may have obtained coverage for the first time. 

The administration said earlier this month that almost 9 million people had signed up for Medicaid since Oct. 1, but it's also unclear there how many of them are newly insured.

A recent analysis by Avalere Health, a Washington-based healthcare consulting firm, estimated that 2.4 million to 3.5 million of the enrollees may be receiving Medicaid.

Figures released by the administration have often painted incomplete picture of the healthcare law's progress. It reported enrollment figures that included people who have selected a plan but not completed the process by making their first premium payment.

 Critics have warned that the administration’s numbers are inflated because not everyone who selects a plan will complete the final step to obtain coverage.

I'm pretty sure that they aren't capturing that information because they don't want to know how bad the enrollments are.

3-D Printed Prosthetic Hand

Now that is a good use for a 3-D printer. [Link]

3-D printers are one of the coolest pieces of technology available. Part of what makes them so cool is how easily they can improve someone's life. Paul McCarthy was looking for an inexpensive but functional prosthetic hand for his son Leon. Leon was born without fingers on his left hand. Paul found a video online about a prosthetic hand that anyone could make with a 3-D printer, based on a design by Washington state inventor Ivan Owen. Now Leon proudly calls himself a cyborg as he shows off his functioning robotic hand. The coolest part: It didn't even cost that much. After spending around $2000 on the printer, materials only cost about $10 — much less than the tens of thousands a prosthesis would cost.

Artificial womb

Welcome to the future. This is a common feature of many sci-fi stories, particularly those of Lois McMaster Bujold. Her stories quite often involve reproductive technology as major plot elements. [Link]

The artificial womb exists. In Tokyo, researchers have developed a technique called EUFI — extrauterine fetal incubation. They have taken goat fetuses, threaded catheters through the large vessels in the umbilical cord and supplied the fetuses with oxygenated blood while suspending them in incubators that contain artificial amniotic fluid heated to body temperature.

Yoshinori Kuwabara, chairman of the Department of Obstetrics and Gynecology at Juntendo University in Tokyo, has been working on artificial placentas for a decade. His interest grew out of his clinical experience with premature infants, and as he writes in a recent abstract, ”It goes without saying that the ideal situation for the immature fetus is growth within the normal environment of the maternal organism.”

Kuwabara and his associates have kept the goat fetuses in this environment for as long as three weeks. But the doctor’s team ran into problems with circulatory failure, along with many other technical difficulties. Pressed to speculate on the future, Kuwabara cautiously predicts that ”it should be possible to extend the length” and, ultimately, ”this can be applied to human beings.”

For a moment, as you contemplate those fetal goats, it may seem a short hop to the Central Hatchery of Aldous Huxley’s imagination. In fact, in recent decades, as medicine has focused on the beginning and end stages of pregnancy, the essential time inside the woman’s body has been reduced. We are, however, still a long way from connecting those two points, from creating a completely artificial gestation. But we are at a moment when the fetus, during its obligatory time in the womb, is no longer inaccessible, no longer locked away from medical interventions.

The future of human reproductive medicine lies along the speeding trajectories of several different technologies. There is neonatology, accomplishing its miracles at the too-abrupt end of gestation. There is fetal surgery, intervening dramatically during pregnancy to avert the anomalies that kill and cripple newborns. There is the technology of assisted reproduction, the in-vitro fertilization and gamete retrieval-and-transfer fireworks of the last 20 years. And then, inevitably, there is genetics. All these technologies are essentially new, and with them come ethical questions so potent that the very inventors of these miracles seem half-afraid of where we may be heading.

Let's keep people poor

Don't make too much money or your mandatory health insurance will be too expensive. [Link]

People whose 2014 income will be a little too high to get subsidized health insurance from Covered California next year should start thinking now about ways to lower it to increase their odds of getting the valuable tax subsidy.

"If they can adjust (their income), they should," says Karen Pollitz, a senior fellow with the Kaiser Family Foundation. "It's not cheating, it's allowed."

Under the Affordable Care Act, if your 2014 income is between 138 and 400 percent of poverty level for your household size, you can purchase health insurance on a state-run exchange (such as Covered California) and receive a federal tax subsidy to offset all or part of your premium.

If your income falls below 138 percent of poverty, you qualify for Medicaid, which provides no-cost health care to low-income people. In California, it's called Medi-Cal.

If your income is higher than 400 percent of poverty, you can purchase a policy on or off the exchange, but in either case, you won't get a subsidy and the policy must provide certain essential benefits that many low-cost individual policies lack today, such as maternity care.

For older people, getting below the 400 percent poverty limit could save many thousands of dollars per year.

Take, for example, Jacqueline Proctor of San Francisco. She and her husband are in their early 60s. They have been paying $7,200 a year for a bare-bones Kaiser Permanentehealth plan with a $5,000 per person annual deductible. "Kaiser told us the plan does not comply with Obamacare and the substitute will cost more than twice as much," about $15,000 per year, she says.

This new plan, Kaiser's cheapest offering for 2014, would consume about 25 percent of their after-tax income. The new plan still has a $5,000 deductible but provides coverage for things her current policy does not, such as maternity care, healthy child visits and coverage for dependents up to age 26. Proctor has no use for such coverage, since her son is 30.

Was this the outcome intended?

Making food safer with viruses

Fighting fire with fire. [Link]

Over the years, Satzow has adopted a variety of antimicrobial products and processes to try and close that window. In 2011, he added a new weapon to his bacteria-fighting arsenal, a spray that contains billions of virus particles called bacteriophages—“phages” for short—which target and destroy bacteria, but not human or animal cells. “We try to be on the cutting edge of everything,” Satzow says. So now each package of chorizo or smoky maple links that rolls down the smokehouse’s spotless conveyor belt gets a squirt of a bacteriophage product called Listex before being sealed.

Inside that liquid are billions of phages that bind to bacteria and inject their genetic material. These molecular instructions direct the cells to make more phages that produce an enzyme that “breaks open the cell wall from the inside out,” says Olivia McAuliffe, a senior researcher at the Teagasc Food Research Centre in Ireland. The bacterium bursts and dies, and the phages escape and infect other bacteria.

Doctors began using phages to treat bacterial infections nearly a century ago, but the idea that phages could protect against food-borne pathogens came about in the past decade. “The food industry isn’t known for its quick adaptation for new innovations,” says Dirk DeMeester, director of business development for Micreos Food Safety, the Dutch company that developed Listex. Yet the idea seems to be slowly gaining traction. DeMeester declined to provide sales figures, but he hinted that business is booming. “Our growth is exponential,” he says. “People are starting to understand that it’s more than just a good idea. It’s going to be an industry standard.”

Medical Newspeak

Redefining the word 'cancer'. [Link]

The federal government wants to reduce the number of Americans diagnosed each year with cancer. But not by better preventive care or healthier living. Instead, the government wants to redefinethe term “cancer” so that fewer conditions qualify as a true cancer. What does this mean for ordinary Americans — and should we be concerned?

On July 29, 2013, a working group for the National Cancer Institute (the main government agency for cancer research)published a paper proposing that the term “cancer” be reserved for lesions with a reasonable likelihood of killing the patient if left untreated. Slower growing tumors would be called a different name such as “indolent lesions of epithelial origin” (IDLE). Their justification was that modern medical technology now allows doctors to detect small, slow-growing tumors that likely wouldn’t be fatal. Yet once patients are told they have a cancer, many become frightened and seek unnecessary further tests, chemotherapy, radiation, and/or surgery. By redefining the term “cancer,” the National Cancer Institute hopes to reduce patient anxiety and reduce the risks and expenses associated with supposedly unnecessary medical procedures. In technical terms, the government hopes to reduce “overdiagnosis” and “overtreatment” of cancer.

Here is an existing redefinition, that of live birth:

For example, the definition of a “live birth” has become important in discussions over health care policy. Many on the political Left cite the supposedly high infant mortality rate in the US relative to Europe as one of the failures of the US health system.

But Dr. Bernadine Healy (former director of the National Institutes of Health and of the American Red Cross) has noted:

The United States counts all births as live if they show any sign of life, regardless of prematurity or size. This includes what many other countries report as stillbirths. In Austria and Germany, fetal weight must be at least 500 grams (1 pound) to count as a live birth; in other parts of Europe, such as Switzerland, the fetus must be at least 30 centimeters (12 inches) long. In Belgium and France, births at less than 26 weeks of pregnancy are registered as lifeless. And some countries don’t reliably register babies who die within the first 24 hours of birth.

Thus, the United States is sure to report higher infant mortality rates. For this very reason, the Organization for  Cooperation and Development, which collects the European numbers, warns of head-to-head comparisons by country.

Auto-Brewery Syndrome

Making beer in your gut. [Link]

Other medical professionals chalked up the man's problem to "closet drinking." But Cordell and Dr. Justin McCarthy, a gastroenterologist in Lubbock, wanted to figure out what was really going on.

So the team searched the man's belongings for liquor and then isolated him in a hospital room for 24 hours. Throughout the day, he ate carbohydrate-rich foods, and the doctors periodically checked his blood for alcohol. At one point, it rose 0.12 percent.

Eventually, McCarthy and Cordell pinpointed the culprit: an overabundance of brewer's yeast in his gut.

That's right, folks. According to Cordell and McCarthy, the man's intestinal tract was acting like his own internal brewery.

The patient had an infection with Saccharomyces cerevisiae, Cordell says. So when he ate or drank a bunch of starch — a bagel, pasta or even a soda — the yeast fermented the sugars into ethanol, and he would get drunk. Essentially, he was brewing beer in his own gut. Cordell and McCarthy reported the case of "auto-brewery syndrome" a few months ago in the International Journal of Clinical Medicine.

When we first read the case study, we were more than a little skeptical. It sounded crazy, a phenomenon akin to spontaneous combustion. I mean, come on: Could a person's gut really generate that much ethanol?

Brewer's yeast is in a whole host of foods, including breads, wine and, of course, beer (hence, the name). The critters usually don't do any harm. They just flow right through us. Some people even takeSaccharomyces as a probiotic supplement.

But it turns out that in rare cases, the yeasty beasts can indeed take up long-term residency in the gut and possibly cause problems, says Dr. Joseph Heitman, a microbiologist at Duke University.

"Researchers have shown unequivocally that Saccharomyces can grow in the intestinal tract," Heitman tells The Salt. "But it's still unclear whether it's associated with any disease" — or whether it could make someone drunk from the gut up.

$546 for Six Liters of Saltwater

Tracing the path of saline from manufacture, where it is around a dollar, to where it is charged to a patient with a minimum of a hundred fold markup. [Link]

Luckily for anyone who has ever needed an IV bag to replenish lost fluids or to receive medication, it is also one of the least expensive. The average manufacturer’s price, according to government data, has fluctuated in recent years from 44 cents to $1.

Yet there is nothing either cheap or simple about its ultimate cost, as I learned when I tried to trace the commercial path of IV bags from the factory to the veins of more than 100 patients struck by a May 2012 outbreak of food poisoning in upstate New York.

Some of the patients’ bills would later include markups of 100 to 200 times the manufacturer’s price, not counting separate charges for “IV administration.” And on other bills, a bundled charge for “IV therapy” was almost 1,000 times the official cost of the solution.

It is no secret that medical care in the United States is overpriced. But as the tale of the humble IV bag shows all too clearly, it is secrecy that helps keep prices high: hidden in the underbrush of transactions among multiple buyers and sellers, and in the hieroglyphics of hospital bills.

At every step from manufacturer to patient, there are confidential deals among the major players, including drug companies, purchasing organizations and distributors, and insurers. These deals so obscure prices and profits that even participants cannot say what the simplest component of care actually costs, let alone what it should cost.

And that leaves taxpayers and patients alike with an inflated bottom line and little or no way to challenge it.

How can we reduce costs if we can't know what anything costs?

Bears in Space!

Hibernation for astronauts. [Link]

Bradford's team is trying to leverage and extend medical advances in therapeutic hypothermia, which seeks to prevent tissue damage during periods of low blood flow by lowering core body temperature.

For every drop of 1 degree Fahrenheit in body temperature, metabolic rate decreases by 5 to 7 percent, Bradford said. The researchers are aiming for a 10-degree drop during manned Mars missions, or a 50 to 70 percent reduction in metabolic rate.

That's a big drop, but it's still a far cry from the suspended animation featured in sci-fi films such as the 1979 classic "Alien," which takes body processes all the way down to zero. [6 New Sci-Fi Movies to Watch in 2013]

"We're not freezing anybody. It's not cryopreservation; it's closer tohibernation," Bradford said. "So they're still breathing, and they still need sustenance." (Food and water would be delivered intravenously, he added.)

Ideally, the body-temperature drop would induce an unconscious state by itself, he added, so sedatives would not have to be administered to voyaging astronauts.

The team is investigating the best ways to cool an astronaut's core. The front-runner idea at the moment may be the gel pads that doctors use during hypothermia therapy, Bradford said. Injecting fluids into the bloodstream could also get the job done, but the researchers are hoping to avoid such invasive methods.

It's also possible to take another tack, Bradford said: Let the Mars-bound spacecraft cool down in the frigid depths of space, but work to warm the astronauts up to the desired temperature.

The longest anyone has remained in a medically induced hypothermic torpor to date is about 10 days, Bradford said. But that's likely not an upper limit, he stressed; rather, it's a reflection of the low medical need to keep people in such states for prolonged periods of time.

"We're trying to give [the medical community] a need, or a rationale" to push the 10-day record out to 30 days and beyond, and to look for any possible attendant complications, Bradford said.

Vitamins Don't

Studies continue to prove that vitamin supplements do no good, and in many cases do harm. But that will not stop anyone who is already convinced taking them is good for you. [Link]

In 1994, the National Cancer Institute, in collaboration with Finland's National Public Health Institute, studied 29,000 Finnish men, all long-term smokers more than fifty years old. This group was chosen because they were at high risk for cancer and heart disease. Subjects were given vitamin E, beta-carotene, both, or neither. The results were clear: those taking vitamins and supplements weremore likely to die from lung cancer or heart disease than those who didn't take them -- the opposite of what researchers had anticipated.

In 1996, investigators from the Fred Hutchinson Cancer Research Center, in Seattle, studied 18,000 people who, because they had been exposed to asbestos, were at increased risk of lung cancer. Again, subjects received vitamin A, beta-carotene, both, or neither. Investigators ended the study abruptly when they realized that those who took vitamins and supplements were dying from cancer and heart disease at rates 28 and 17 percent higher, respectively, than those who didn't.

In 2004, researchers from the University of Copenhagen reviewed fourteen randomized trials involving more than 170,000 people who took vitamins A, C, E, and beta-carotene to see whether antioxidants could prevent intestinal cancers. Again, antioxidants didn't live up to the hype. The authors concluded, "We could not find evidence that antioxidant supplements can prevent gastrointestinal cancers; on the contrary, they seem to increase overall mortality." When these same researchers evaluated the seven best studies, they found that death rates were 6 percent higher in those taking vitamins.

In 2005, researchers from Johns Hopkins School of Medicine evaluated nineteen studies involving more than 136,000people and found an increased risk of death associated with supplemental vitamin E. Dr. Benjamin Caballero, director of the Center for Human Nutrition at the Johns Hopkins Bloomberg School of Public Health, said, "This reaffirms what others have said. The evidence for supplementing with any vitamin, particularly vitamin E, is just not there. This idea that people have that [vitamins] will not hurt them may not be that simple." That same year, a study published in the Journal of theAmerican Medical Association evaluated more than 9,000 people who took high-dose vitamin E to prevent cancer; those who took vitamin E were more likely to develop heart failure than those who didn't.

In 2007, researchers from the National Cancer Institute examined 11,000 men who did or didn't take multivitamins. Those who took multivitamins were twice as likely to die from advanced prostate cancer.

In 2008, a review of all existing studies involving more than 230,000 people who did or did not receive supplemental antioxidants found that vitamins increased the risk of cancer and heart disease.

On October 10, 2011, researchers from the University of Minnesota evaluated 39,000 older women and found that those who took supplemental multivitamins, magnesium, zinc, copper, and iron died at rates higher than those who didn't. They concluded, "Based on existing evidence, we see little justification for the general and widespread use of dietary supplements."

Two days later, on October 12, researchers from the Cleveland Clinic published the results of a study of 36,000 men who took vitamin E, selenium, both, or neither. They found that those receiving vitamin E had a 17 percent greater risk of prostate cancer. In response to the study, Steven Nissen, chairman of cardiology at the Cleveland Clinic, said, "The concept of multivitamins was sold to Americans by an eager nutraceutical industry to generate profits. There was never any scientific data supporting their usage." On October 25, a headline in the Wall Street Journal asked, "Is This the End of Popping Vitamins?" Studies haven't hurt sales. In 2010, the vitamin industry grossed $28 billion, up 4.4 percent from the year before. "The thing to do with [these reports] is just ride them out," said Joseph Fortunato, chief executive of General Nutrition Centers."We see no impact on our business."

How could this be? Given that free radicals clearly damage cells -- and given that people who eat diets rich in substances that neutralize free radicals are healthier -- why did studies of supplemental antioxidants show they were harmful? The most likely explanation is that free radicals aren't as evil as advertised. Although it's clear that free radicals can damage DNA and disrupt cell membranes, that's not always a bad thing. People need free radicals to kill bacteria and eliminate new cancer cells. But when people take large doses of antioxidants, the balance between free radical production and destruction might tip too much in one direction, causing an unnatural state in which the immune system is less able to kill harmful invaders. Researchers have called this "the antioxidant paradox." Whatever the reason, the data are clear: high doses of vitamins and supplements increase the risk of heart disease and cancer; for this reason, not a single national or international organization responsible for the public's health recommends them.

Who could have seen this coming?

A: Everyone. [Link]

My first response to this was “Cry me a river”…

Dozens of lawmakers and aides are so afraid that their health insurance premiums will skyrocket next year thanks to Obamacare that they are thinking about retiring early or just quitting.

The fear: Government-subsidized premiums will disappear at the end of the year under a provision in the health care law that nudges aides and lawmakers onto the government health care exchanges, which could make their benefits exorbitantly expensive.

… but that’s not fair. More accurate to say “Cry me a river, Democrats.” I really do feel bad for any Republican staffer or legislator in a cleft stick over this, and do you know why? It’s because NO REPUBLICAN VOTED FOR OBAMACARE. It’s not their fault. But Democrats either voted for this mess, or endorsed it after the fact – and ‘caucusing with the Democrats’ does, in fact, count as ‘endorsing’ in this context. So does ‘working for a Democrat.’ This is Obamacare. This is what they voted for; if it turns out that it’s actually a hot, steaming mess of pure stupidity and failure, well, we in the Republican party weren’t shy about saying that at the time.

Guess it should be repealed, huh?

Injury by Turtle, Lamppost and Macaw

New Obamacare required injury codes. [Link]

Obamacare will require doctors to use roughly 122,000 new medical diagnostic codes to inform the federal government of injuries sustained by Americans, so says Kentucky Senator Rand Paul.

The new codes, Sen. Paul explained, include classifications for "injuries sustained from a turtle," "walking into a lamppost" and "injuries sustained from burning water skis."

"Your government just wants to take care of you," he added, criticizing the new law's 9,000-plus pages of new regulations. "They don't think you're smart enough to make these decisions."

Physicians currently have about 18,000 medical diagnostic codesto choose from to help them inform insurers of their patients' ailments. However, as Paul (himself a physician) notes, Obamacare includes a mandate for 140,000 of those codes -- and some of them sound downright ridiculous.

"Included among these codes," the senator continued, "will be 312 new codes for injuries from animals; 72 new codes for injuries just from birds; 9 new codes for 'injuries from the macaw."'

"The macaw?" he asked. "I've asked physicians all over the country, 'Have you ever seen an injury from a macaw?"'

He continued, adding that he had found "two new injury codes under Obamacare for 'injuries sustained from a turtle."'

"Now, you might say, 'Well, turtles are dangerous' -- but why do you have to have two codes?" he asked.  "Your doctor has to inform the government whether you've been struck by a turtle or bitten by a turtle."

He added:  "There is a new code for ... walking into a lamppost. There's also a code for 'walking into a lamppost, subsequent encounter.'"

"I guess that's if you don't learn," he added. "[T]here is [also] a code ... for 'injuries sustained from burning water skis."'

Unexpected Results in Oregon study on Medicaid expansion

I don't think anyone expected this. [Link]

On Wednesday, a team of researchers released a new study on Oregon's Medicaid expansion, showing that people who gained access to treatment had no statistically significant improvement on physical health measures like blood pressure or cholesterol.  I wrote:  "Given this result, what is the likelihood that Obamacare will have a positive impact on the average health of Americans? Every one of us, for or against, should be revising that probability downwards. I'm not saying that you have to revise it to zero; I certainly haven't. But however high it was yesterday, it should be somewhat lower today."

But how should we update our beliefs?  Does this mean there's a chance that health care doesn't work?    

That's one possible interpretation. Let's look at the strongest case.  Assume for a moment that if we could somehow study the entire population of the United States, we'd find that gaining access to health insurance doesn't improve blood pressure, blood sugar, or cholesterol control.  What would that tell us?  That health care doesn't work?

That's not actually as crazy as it sounds.  Lots of treatments are bad for you, and gaining access to the health system may just give you opportunities to get sicker.  Say you're an 88 year old with bad hips.  Now, maybe sitting still and not exercising is making you sick.  But going to get a hip replacement gives you all sorts of ways to die: blood clot, hospital acquired infection, adverse reaction to anaesthesia.  If it's not covered by insurance, maybe you'll stay home, take aspirin, and live longer.  

But I don't think that's the most likely read of the Oregon results.  No, I think that this would tell us something different: not that health care is bad, but that health insurance doesn't actually improve access to necessary treatment that much.  If someone else covers the cost, it can help with the financial burden of health care.  But uninsured people will mostly find a way for the most important treatments, the ones we know improve health, from stitches to control bleeding, to antibiotics, to blood pressure medication.  It's the expensive stuff on the frontier--the stuff that's as likely to be useless, or harmful, as it is to help--that the uninsured mostly forego.  

A bunch of people sarcastically asked whether I was planning to drop my health insurance.  The answer is no, because my employer pays for it.  But if the question is "Has this caused you to revise downward your estimate of the value of health insurance?" the answer has to obviously be yes.  Anyone who answers differently is looking deep into their intestinal loops, not the Oregon study.  You don't have to revise the estimate to zero, or even a low number.  But if you'd asked folks before the results dropped what we'd expect to see if insurance made people a lot healthier, they'd have said "statistically significant improvement on basic markers for the most common chronic diseases.  The fact that we didn't see that means that we should now say that health insurance, or at least Medicaid, probably doesn't make as big a difference in health as we thought.

Certainly, this bolsters my belief that health insurance should provide financial protection from catastrophic events, not wrap-around first-dollar coverage.  Those who used to read me on The Atlantic may recall that the McArdle Plan for Healthcare involved the government picking up the tab for any medical expenses above 15-20% of income: simple, progressive, and aimed at the actual problem we know health insurance can fix.  Unfortunaely, Obamacare made that sort of coverage functionally illegal.  

Bipartisan anti-science from Congress

Vaccines save lives and DO NOT cause Autism. Science has proven this, but we still had to have hearings on it. [Link]

Let me be clear right off the bat: Vaccines don’t cause autism.

It’s really that simple. We know they don’t. There have been extensive studies comparing groups of children who have been vaccinated with, say, the measles, mumps, and rublella (MMR) vaccine versus those who have not, and it’s very clear that there is no elevated rate of autism in the vaccinated children.

This simple truth is denied vigorously and vociferously by antivaxxers (those who oppose, usually rabidly, the use of vaccinations that prevent diseases), but they may as well deny the Earth is round and the sky is blue. It’s rock solid fact. They try to blame mercury in vaccines, but we knowthat mercury has nothing to do with autism; whenthimerosal (a mercury compound) was removed from  vaccines there was absolutely no change in the increase in autism rates.

I could go on and on. Virtually every claim made by antivaxxers is wrong. And this is a critically important issue; vaccines have literally saved hundreds of millions of lives. They save infants from potentially fatal but preventable diseases like pertussis and the flu.

So why did Congress hold hearings this week promoting crackpot antivax views?

Medical Tricorders. When?

Soon there will be an app or apps for that. [Link]

Among the organisations pushing for the development of a medical tricorder is the X Prize Foundation, an organisation that aims to spur innovation by offering cash prizes. Earlier this year it announced the Qualcomm Tricorder X Prize, financed by the Qualcomm Foundation, the charitable arm of Qualcomm, a maker of wireless communications technologies. It has put up $10m in prize money and another $10m to pay for the administration of the competition. So far more than 230 teams from over 30 countries have applied to enter the contest, the guidelines for which will be finalised this month. The goal is to create a mobile platform that will enable people to diagnose a set of 15 conditions, including diseases as varied as pneumonia, diabetes and sleep apnoea, without having to rely on a doctor or nurse. “Ultimately this is about democratising access to health care around the world,” says Peter Diamandis, the head of the X Prize Foundation.

But the obstacles to building a medical tricorder are not merely technological. Regulatory agencies such as America’s Food and Drug Administration (FDA) may delay or restrict consumers from getting their hands on such devices, and the medical establishment, infamous for its inertia, may be wary of granting patients a more active role in diagnosis. Many doctors do not believe that patients can be trusted with their own medical data and are reluctant to give them access to it, explains Eric Topol, a cardiologist and the author of “The Creative Destruction of Medicine”. He believes the push to adopt new digital technologies in health care will have to come not from doctors but from the public.

Making self-service diagnostic technology cheaper and more widely available would, however, have enormous benefits in both rich and poor parts of the world. The Association of American Medical Colleges projects that America could have 90,000 doctors fewer than it needs by 2020, as doctors retire, the population ages and chronic illnesses become more prevalent. All this will place huge demands on America’s sprawling health-care system, and threatens to increase health-related spending still further. Other rich countries are also looking for ways to keep a lid on rising health-care expenditure.

The 'granny pod'

A portable hospital room as an alternative to a nursing home. [Link]

As the first private inhabitant of a MedCottage, Viola is a reluctant pioneer in the search for alternatives to nursing homes for aging Americans. Her relatives agonized over the best way to care for Viola only after her ability to care for herself became questionable. Their decision exposed intergenerational friction that worsened after the new dwelling arrived.

The MedCottage, designed by a Blacksburg company with help from Virginia Tech, is essentially a portable hospital room. Virginia state law, which recognized the dwellings a few years ago, classifies them as “temporary family health-care structures.” But many simply know them as “granny pods,” and they have arrived on the market as the nation prepares for a wave of graying baby boomers to retire.

Over the past decade, the population of Americans who are 65 or older has grown faster than the total population, the Census Bureau says. In less than 20 years, the number of Americans who are 65 or older will top 72 million, or more than twice the population of older Americans in 2000, and many will need to find living arrangements that balance their need for independence and special care.

Viola’s family understood this. Her daughter, Socorrito Baez-Page, 56, who goes by Soc, and her son-in-law, David Page, 59 — both of whom are doctors — began planning her care well before Viola’s husband died of cancer last February. They explored many options and had firsthand experience with several. Soc and David had taken care of or arranged various types of care, including assisted living and hospice, for other parents.

Their decision to buy the first MedCottage in private use, along with Viola’s bumpy adjustment to life inside it, offers a look at an unusual solution to an increasingly common situation and the emotional trade-offs that arise from it.

Pre-existing Ignorance

I did not know this. [Link]

That line involves, first of all, the notion that Obamacare is simply the definition of health-care reform, and that to oppose it means to not want to solve the problems with our system. Reporters are therefore surprised anytime a Republican expresses the desire to solve those problems, and they assume that means he must want to keep Obamacare. They have no idea, for instance, that numerous Republicans in recent years have backed proposals (like this one) that would be likely to get us much closer to universal coverage than Obamacare (which after all CBO says will leave 30 million people uninsured) at far lower cost.

And this line involves, secondly, the notion that the little things Obamacare has started to do (including constraining the exclusion of pre-existing conditions by insurance companies) are the essence of Obamacare, so that to oppose Obamacare is just to oppose these.

The fact is that all of the rules and requirements that have gone into effect before Obamacare really gets going in 2014 are just little bones thrown to the public to distract voters from what Obamacare is all about. The pre-existing condition question, which is so prominent in the rhetoric of Obamacare’s champions, is a perfect example of this. Pre-existing condition exclusions have been illegal in the employer-based insurance market (where the vast majority of privately insured people get their coverage) since the mid-1990s, so they only affect people who are in the individual market or who have gone without insurance for a time. Even in those situations, such exclusions are prohibited in many instances, and are not practiced by insurers in most others, though not all. About 2 to 4 million people are estimated to be vulnerable to such exclusions (though not all of them are in circumstances that mean they actually experience them). That’s roughly 1% of the population. That doesn’t mean their problem is unimportant (or that other people shouldn’t be worried about finding themselves in that group in the future), but rather it means that it can be solved without spending $2 trillion, raising taxes by nearly a trillion, taking $716 billion out of Medicare to fund a new unsustainable entitlement, imposing layers upon layers of new bureaucracies and regulations between people and their medical care, causing millions of families to lose the coverage they have now, and undermining employment, investment, and medical research. The idea that Obamacare is about dealing with pre-existing condition exclusions or keeping 26-year-olds on their parents’ insurance is just plain nonsense.  

Living With Voices

Fascinating article about a novel way to treat schizophrenia: negotiate with the voices. [Link]

So Hans found himself in an inpatient psychiatric hospital, where he stayed for more than a year. He was diagnosed with schizophrenia and given Clozaril, one of the new “miracle” drugs for schizophrenia—miracle for a small handful of patients, a desperate stopgap for the rest. Nothing really changed for Hans on Clozaril, neither his voices nor his delusions, but he became calm. He became so calm that he slept all day. His panicked mother argued with the doctors, telling them this was no kind of life. They told her sleeping was normal “at this stage.” Hans’s skin itched. He gained 90 pounds, and now he could not think clearly or move comfortably, a Michelin man with tubby limbs. Over the course of the year, little changed.

Then Hans joined a group of people like him who met once a week. They talked about their voices, and they were encouraged to talk back to them. They were even encouraged to negotiate with their voices. One of Hans’s voices thought he would be better off if he devoted his life to Buddhist prayer. Hans is not a Buddhist—like many Dutch, he grew up as a secular Protestant—and he did not want to follow the voice’s command. The group persuaded him to cut a deal with his voices. He told his voices that he would read a book on Buddhism every day for one hour—but no more. He would say one Buddhist prayer every day—but no more. And if he did this, he told them, they had to leave him alone.

They did, more or less. He began to feel better. His psychiatrists began to lower his Clozaril from its high of 500 mg per day down eventually to a dose of 50 mg. He lost weight. He became more alert. He moved out of the hospital. The voices didn’t disappear immediately, but they got nicer. When he was moving into an apartment by himself—and petrified by the prospect—he heard a voice say, “Buck up, we know you can do it.” By the time I met him in 2009, he hadn’t heard a voice in more than a year.