Health Business Blog

Giant sucking sound (III)

New Orleans has fewer than a quarter of the number of staffed hospital beds it had before Katrina, according to the Associated Press. Lots of people left town after the Hurricane. Doctors and nurses –with plenty of professional opportunities elsewhere– have less reason to come back than most people. Expect health care staffing shortages to be a drag on New Orleans rebuilding indefinitely.

See Giant sucking sound and Giant sucking sound (II) for earlier thoughts on the topic.

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Drink if you like, but not for your health

For a society like ours where alcohol is accepted but illegal drugs are demonized, it’s comforting to have solid evidence that moderate drinking is actually good for you. (Back in college we took it a step further, figuring if 2 drinks a day were good then you could have 14 drinks in a day if you drank once a week.)

I’ve mentioned before that the connection between good health and alcohol consumption actually isn’t so clear. Now a study by UCSF researchers has noted a common flaw in the “alcohol is good for you studies.”

The studies tend to include as abstainers people who used to drink but have stopped. The problem is that a good number of the quitters stopped drinking due to poor health. Therefore they make the abstainer category look sicker than it would otherwise.

The San Francisco Chronicle has more.

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Doesn’t look like prayer will be a covered benefit

From the New York Times (Long-Awaited Medical Study Questions the Power of Prayer)

Prayers offered by strangers had no effect on the recovery of people who were undergoing heart surgery, a large and long-awaited study has found.

And patients who knew they were being prayed for had a higher rate of post-operative complications like abnormal heart rhythms, perhaps because of the expectations the prayers created, the researchers suggested.

This doesn’t mean prayer is a bad thing or that it doesn’t offer benefits, but it probably does mean you won’t be able to use your HSA to pay for someone to pray for you. And it looks like your religious institution won’t have to change the wording on its tax deduction letters that say, “Only intangible religious benefits were received in exchange for this donation.”

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Health Wonk Review –Call for submissions

Health Wonk Review is a new biweekly compendium of the best of the health policy blogs. Health policy, infrastructure, insurance, technology, and managed care bloggers participate by contributing their best recent blog postings to a roving digest, with each issue hosted at a different participant’s blog. For participants, it’s a way to network and share ideas, and for those readers who don’t live in this space every day, it’s a way to sample some of the latest thinking and the “best of the best.”

I’m hosting the Health Wonk Review next week. Please get your submissions in by April 5 at 9 am. You can send your submissions to dwilliams@mppllc.com or use the online submission form. The submission should include:

• Blogger’s name or pseudonym
• Title of and URL for the submitted post
• Title and URL of the blog itself
• A synopsis of the post itself

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AMA shames itself with spring break “poll”

They took a deceptive approach to disclosure that is becoming more common, inaccurately describing a non-random Internet panel survey as a “random sample” complete with a “margin of error.”

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Pay for performance doesn’t erode doctor/patient relationship

Patients who are told that their primary care physicians participate in a pay-for-performance scheme are not bothered by it, according to a study in the Archives of Internal Medicine (A Trial of Disclosing Physicians’ Financial Incentives to Patients). That’s not surprising, because the things the physicians are doing to earn the incentives are typically in the patient’s interest any way. (One potentially significant exception is generic prescribing, which could cause physicians to shy away from more expensive but possibly better medications that do not have generic equivalents. Increased generic prescribing is in many cases the main way that health plans generate a return on investment for their pay for performance programs.)

The study didn’t examine how patients would feel about capitation. Chances are most patients wouldn’t like to hear that their doctor has an incentive not to see or treat them.

See MedPage Today for more.

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Not so simple

A story in today’s Boston Globe (Care bill may be a hospital bonanza) contends that health care legislation in Massachusetts, framed under the guise of improving coverage for underserved patients, has turned out to have somewhat different beneficiaries than expected.

With heavy lobbying from powerful healthcare providers and insurers, a bill designed to expand healthcare coverage to the uninsured has turned into what many critics say is a financial bonanza for some of Boston’s major hospitals…

”Powerful hospitals and insurers did a better lobbying job than access advocates,” said Alan Sager, one of two directors of the Health Reform Program at Boston University’s School of Public Health…

It’s tempting to swallow the Globe’s logic and blame lobbyists for a bad outcome, but the main problem is that any legislation that injects more money into the payment system will naturally tend to benefit strong providers and payers who are already supplying or subsidizing services to those who are uninsured or underinsured.

I’d rather see money spent on re-engineering and restructuring care delivery and empowering patients with information. Simply adding dollars to the existing reimbursement scheme will have the predictable effects outlined by the Globe.

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Clinical trial victims doing a little better

Two of the six “healthy volunteers” who ended up in critical condition as the result of a Phase I trial gone wrong a couple weeks ago have been discharged from the hospital. One patient is still in critical condition, and another three are out of critical care but still in the hospital.

See more in the hospital’s press statement.

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Biased treatment advice on prostate cancer
From MedPage Today:

Men trying to decide how to have their localized prostate cancer treated may get incomplete or biased advice from both physicians and patient-education materials, a review of the literature suggested.

For example, urologists nearly universally indicate that surgery is the optimal treatment strategy, and radiation oncologists similarly indicate that radiation therapy is optimal, said Scott D. Ramsey, M.D., Ph.D., of the Fred Hutchinson Cancer Research Center here, and colleagues.

“Given the bias in treatment preference by specialty, it is likely there is discordance in which treatment options are provided to patients and the strength of individual recommendations associated with each option,” Dr. Ramsey and colleagues wrote in a study published online today by the journal Cancer.

There’s a real shortage of unbiased advice. Even if patients turn to their health plan for information there may be bias toward less expensive options.

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The value of doing nothing

“Watchful waiting,” “expectant management,” and “active surveillance” are all terms for not treating a condition when it appears. It turns out this path is a good one for many men with prostate cancer. After all, treatment can cause incontinence and/or impotence while doing nothing in many cases does no harm.

According to the Wall Street Journal (Doctors Seek to Identify Which Patients Can Avoid Prostate-Cancer Treatments):

Watchful-waiting patients who end up needing treatment anyway haven’t compromised their care, the Journal of the National Cancer Institute reported this month. Researchers at Johns Hopkins Medical School studied 38 patients who needed surgery after about two years of watchful waiting, compared with 150 similar patients who opted for surgery right away. There was no difference in noncurable cancer between the two groups.

“Most individuals are not comfortable with monitoring because the physicians and the patients are worried about losing the window of opportunity for a cure,” says Ballantine Carter, professor of urology and oncology at Johns Hopkins. But if a careful selection process is used, “there is no reason for a man to rush into any treatment.”

Prostate cancer is the first big example of watchful waiting, because the cancer can be detected well before it causes serious harm. As diagnostic tests improve patients will be “diagnosed” with all sorts of maladies –including other forms of cancer– at such an early stage that they may never do any harm. If we treat everything aggressively, not only will the cure be worse than the disease but the cost will be higher, too.

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