Tom Faranda's Folly

Better to exercise in the morning, or later in the day?

Personal Best - To Exercise Early or Late, Now There’s a Question - NYTimes.com

Greg Atkinson, also at Liverpool John Moores University, said that some researchers, noticing that heart rates during exercise were lower in the morning, reasoned the way I did — that people must be more efficient in the morning. It would mean that exercise was easier in the morning. Of course, it seemed harder to me, but I could have been deluding myself. Not really, Dr. Atkinson said. It actually is harder to exercise in the morning.

“Most components (strength, power, speed) of athletic performance are worst in the early hours of the morning,” he wrote in an e-mail message. “Ratings of perceived exertion during exercise have generally been found to be highest in the early morning.”

I certainly  find this to be true.

“Is a heart rate of 140 in the morning indicative of the same level of workout cost as in the afternoon?” asked Dr. Smolensky, a visiting professor at the University of Texas Health Sciences Center in Houston.

“I would say no,” he added. “Exercise physiologists say you should be able to perform at the same level with a heart rate of 140 in the morning as in the afternoon or early evening. But chronobiologists say your capacity to generate and tolerate a higher heart rate is better later in the day.”

“In the afternoon and evening,” Dr. Smolensky said, “you are in a different biological state.”

But, he added, all this applies to people who are regular exercisers, who work out vigorously three or more times a week. People who are not regular exercisers, Dr. Smolensky said, put much more strain on their hearts in the morning, making their heart rates higher then.

The article goes on to say that if you are at risk of a heart attack, it's better to work out in the afternoon or early evening.

Former Hewlett Packard CEO Carly Fiorina, on her breast cancer

This is interesting. Fiorina is a pioneer woman in the business world - she got fired from HP, even as her business plan started to turn the company around.

I have her book, "Tough Choices", about her business career, but have not read it. I've always found her interesting Carly Fiorina - Wikipedia, the free encyclopedia and a little off-beat. For instance her college degree is in philosophy and medieval history, and she actually started working as a secretary.

Now she's eyeing a run for Senator from California.

Interview with Carly Fiorina: She Wants to Reboot California - WSJ.com

When Carly Fiorina sat down to speak with me recently, I was briefly taken aback. The former CEO of Hewlett Packard and current candidate for U.S. Senate from California was sporting a close-cropped, salt-and-pepper hairdo. Having completed six months of treatment for breast cancer, the 55-year-old Ms. Fiorina has dispensed with the auburn wig she'd been wearing as her hair grows back.

She says her health is now fine, and that "after chemotherapy Barbara Boxer isn't that scary anymore," referring to the three-term Democratic incumbent she wants to unseat in 2010. She laughs when I suggest her new 'do may get her a hearing in precincts like Berkeley and San Francisco. On a more serious note, she says that "in these hard times, a lot of people across the spectrum will listen to my message—that California can only recover if we encourage economic growth and restrain spending and job-killing regulation."

There are no "death panels" - but no need for a mammagram ...

UPDATE: Was thinking about this. I knew a woman who I met through business and who I got to know pretty well - after several years found out she was married to a classmate of mine in high school. When she turned 40 she had a baseline mammogram - and they found cancer. She lived for another six or seven years. How long would she have lived without the early diagnosis? Those were important years - she had three relatively young children.

AND, don't bother doing a self-exam!

New recommendation, OPPOSED by the National Cancer Society -

Note that it's a government panel - what a coincidence ...

Federal panel recommends reducing number of mammograms - washingtonpost.com

Several patient advocacy groups and many breast cancer experts welcomed the new guidelines, saying they represent a growing recognition that more testing, exams and treatment are not always beneficial and, in fact, can harm patients. Mammograms produce false-positive results in about 10 percent of cases, causing anxiety and often prompting women to undergo unnecessary follow-up tests, sometimes-disfiguring biopsies and unneeded treatment, including surgery, radiation and chemotherapy.

But the American Cancer Society, the American College of Radiology and other experts condemned the change, saying the benefits of routine mammography have been clearly demonstrated and play a key role in reducing the number of mastectomies and the death toll from one of the most common cancers.

"Tens of thousands of lives are being saved by mammography screening, and these idiots want to do away with it," said Daniel B. Kopans, a radiology professor at Harvard Medical School. "It's crazy -- unethical, really."

The new guidelines also recommend against teaching women to do regular self-exams and concluded that there is insufficient evidence to recommend that doctors do the exams or to continue routine mammograms beyond age 74.

Men over 40: one in eight chance of sudden cardiac death over the rest of their lives

Uh-oh.

For Men at 40, Risk of Cardiac Death 1 in 8 - WSJ.com

Researchers said men at age 40 in the U.S. have a one-in-eight chance of suffering sudden cardiac death over the rest of their lives, a stark indication of the toll cardiovascular disease exacts on society.

For women, researchers said, the risk is 1 in 24.

Hey, how fair is that?

And here's an, uhh, cheery chart -

Good feature on preventive medicines for cancer - what may work and what don't

There's more to this then the title suggests. But I do disagree with this quote from the fifth paragraph:

As the nation’s war on cancer continues, with little change in the overall cancer mortality rate ... 

As a matter of fact, the cancer death rate has dropped in the last several decades - from a cure rate of one in three to a cure rate of one in two. And many cancers that are not "curable" (like my lymphoma, supposedly) are "treatable", with dramatic increases in life expcetancy.

given that caveat, the article is very good -

Forty Years' War - Medicines to Deter Some Cancers Are Not Taken - Series - NYTimes.com

But prevention has proved more difficult than many imagined. It has been devilishly difficult to show conclusively that something simple like eating more fruits and vegetables or exercising regularly helps. And, as the response to the prostate drugs shows, people are not enthusiastic about taking anticancer pills, or are worried about side effects or not really convinced the drugs work. Others are just unaware of them.

And prostate cancer is not unique. Scientists have what they consider definitive evidence that two drugs can cut the risk of breast cancer in half. Women and doctors have pretty much ignored the findings.

Companies have taken note, saying that it makes little economic sense to spend decades developing drugs to prevent cancer. The better business plan seems to be looking for drugs to treat cancer. That is a sobering lesson, said Dr. Ian M. Thompson Jr., chairman of the urology department at the University of Texas Health Science Center in San Antonio.

“A scientific discovery that is very clear cut and that is not implemented by the public is a tragedy,” he said.

"Doctors on Health-Care Reform" A revealing Wall Street Journal op ed

Betsy McCaughey: Doctors on Health-Care Reform - WSJ.com

Straight talk. A couple of excerpts:

Dr. Cohen: "Let's talk about specialization for a moment. . . . We don't go to our general attorney when we have a patent problem, but they're telling us to do this now in medicine. We have different types of engineers, even journalists. There's a financial writer, there's a sportswriter . . . . Now in health care we're telling everybody, 'you just go to the guy who's your general doc. He's going to know everything and maybe we'll find a specialist for you if the panel decides maybe you're sick enough to need a specialist.' It really doesn't make sense at all."

and - regarding cost cutting -

Dr. Fields: "Government is in the process of duplicating everything that managed care did for the last 15 years that was reviled by everybody and which we fought very hard to overcome, The courts finally said 'You can't have withholds, you can't pay people to deny care. You can't have gag rules.' The government is in the process of doing all that. Massachusetts is about to establish capitation [a fixed payment remitted at regular intervals to a medical provider] as the rule of the state. Capitation was the wort thing that ever happened to medical care."

Dr. Joel Kassimir, dermatologist, Mt. Sinai Hospital, New York: "We're now being told by physicians advising the president that we take the Hippocratic Oath too seriously."

Dr. Tracy Pfeifer, plastic surgeon, president, New York Regional Society of Plastic Surgeons: "When physicians graduate from medical school we take an oath, the Hippocratic Oath, to do no harm to our patients. It's a very important philosophy to us and we uphold it and hold it very dear to our hearts. Plato, another philosopher, used to say things like 'Those with a poor physical constitution should be allowed to die. The weak and the ill-constituted shall perish.' These government programs that are being proposed I think are very scary in the sense that physicians could be induced to violate the Hippocratic Oath.

"There's a limit to how much of a financial penalty each individual practitioner is going to be able to bear. . . . If the patient is sitting in the examination room with us and they're wondering, 'Is the doctor not ordering a test for me because he's going to get penalized if he does it?' This is a major, major problem for patients and physicians alike."

Is the human body built for distance running?

Here's a fascinating article that says "yes."

Well - The Human Body Is Built for Distance - NYTimes.com

The scientific evidence supports the notion that humans evolved to be runners. In a 2007 paper in the journal Sports Medicine, Daniel E. Lieberman, a Harvard evolutionary biologist, and Dennis M. Bramble, a biologist at the University of Utah, wrote that several characteristics unique to humans suggested endurance running played an important role in our evolution.

Most mammals can sprint faster than humans — having four legs gives them the advantage. But when it comes to long distances, humans can outrun almost any animal. Because we cool by sweating rather than panting, we can stay cool at speeds and distances that would overheat other animals. On a hot day, the two scientists wrote, a human could even outrun a horse in a 26.2-mile marathon.

Why would evolution favor the distance runner? The prevailing theory is that endurance running allowed primitive humans to incorporate meat into their diet. They may have watched the sky for scavenging birds and then run long distances to reach a fresh kill and steal the meat from whatever animal was there first.

Other research suggests that before the development of slingshots or bows, early hunters engaged in persistence hunting, chasing an animal for hours until it overheated, making it easy to kill at close range. A 2006 report in the journal Current Anthropology documents persistence hunting among modern hunter-gatherers, including the Bushmen in Africa.

Why (and how) do some cancers vanish of their own accord?

From the always interesting health section of the NY Times.

Of course, if the mechanism (or my likley many different mechanisms) for spontaneous disappearance of cancers could be found, then we would be on our way to learning how to trigger the body itself to turn off cancer cells.

Cancers Can Vanish Without Treatment, but How? - NYTimes.com

“The old view is that cancer is a linear process,” said Dr. Barnett Kramer, associate director for disease prevention at the National Institutes of Health. “A cell acquired a mutation, and little by little it acquired more and more mutations. Mutations are not supposed to revert spontaneously.”

So, Dr. Kramer said, the image was “an arrow that moved in one direction.” But now, he added, it is becoming increasingly clear that cancers require more than mutations to progress. They need the cooperation of surrounding cells and even, he said, “the whole organism, the person,” whose immune system or hormone levels, for example, can squelch or fuel a tumor.

Cancer, Dr. Kramer said, is a dynamic process.

It was a view that was hard for some cancer doctors and researchers to accept. But some of the skeptics have changed their minds and decided that, contrary as it seems to everything they had thought, cancers can disappear on their own.

Great feature: M.D. Anderson Hospital "Where cancer is the norm"

The Houston cancer hospital, similar to my hospital, Memorial Sloan Kettering. Hit the link for the whole thing; I am excerpting only one short paragraph about a physician with cancer -

Forty Years' War - A Place Where Cancer Is the Norm - Series - NYTimes.com

By now he has gotten used to living with cancer.

“It just becomes your life,” Dr. Raber said. “You come in, you have tests, you go home, you do your thing, you come back again for treatment.

“I tell patients, ‘It used to be that you had cancer, you got treated, you died or you were cured,’ ” he said. “Now, for most of us, it’s a chronic illness. It’s not a question of being psyched up: I will have this surgery and then I will be cured. The disease comes back.”

He works part time, seeing patients on Tuesday and Thursday mornings and spending a day a week working at a clinic in the county hospital.

“A common question people would ask is ‘Are you a better doctor since you’ve been sick?’ ” Dr. Raber said. “My first answer is that I thought I was a good doctor before. I was worried about being a worse doctor. Having lived through these biopsies and all these tests, would I be hesitant to order all these things patients need because I had experienced them and knew they were not pleasant?

“Then I realized I am not better, but I am a different doctor,” he said. “I talk to patients differently. I understand more of what their situation might be.

“My life was very different than it was before that day in the CT scanner,” Dr. Raber said. “It’s not the life I thought I would have. But my life is still really good.

A reminder of just how fortunate I am.

Canadian healthcare and "poor access to healthcare"

Just yesterday, I was speaking to someone in my New Jersey office, ho has a Canadian friend who decided not to accept waiting 18 months for "another evaluation."

She drove to New York and paid cash ($65,000) for treatment.

Canada's lack of special care empowers brokers - Washington Times

Richard Baker is known as a critic of the Canadian health care system, but he's the first to acknowledge that it represents a real bargain for those with routine afflictions.

"In Canada, if your wife is pregnant, you have great prenatal care, great postnatal care, and the delivery is free. If you have the flu, your exam is free. If you break a leg, you can go to the emergency ward, and they'll set it immediately," Mr. Baker said.

The trouble starts when patients need treatment that isn't so routine. That's where Mr. Baker comes in. A British Columbia medical broker, he takes patients who find themselves on long waiting lists for procedures such as MRIs and surgeries, and connects them with specialists who can handle their cases immediately.

Most of the time, his clients wind up in the United States - and business is booming.

"That's what Americans need to know about the Canadian system," Mr. Baker said. "It's not that we have poor-quality health care - the quality is perfectly good. It's that we have poor access to health care."

Now, isn't the purpose of our healthcare reform to increase access? Doesn't seem to me that that's where we're headed.

Here's more -

For Mr. Caldara of the Independence Institute, the issue goes beyond policy. His 5-year-old son, Chance, has Down syndrome and has undergone eight operations, including open-heart surgery to repair a hole in his heart.

Under a Canadian-style system, Mr. Caldara said, Chance likely would have wound up on a waiting list and could still be waiting for life-changing or even life-saving procedures.

"This is not about some wonky public-policy issue; this is personal," he said. "This is about saving my son's life."

For more craziness on the so-called virtues of the healthcare systems we're modeling our reform on, go to my post yesterday - Hypocrisy watch: National Health Service in Great Britain buys private health insurance for 3,000 employees

After exercise, how important is a cool-down period?

Evidently, not important at all.

Personal Best - Is the Exercise Cool-Down Really Necessary? - NYTimes.com

...does it matter for the ordinary, average athlete? “Probably not a great deal,” Dr. Thompson said. And, anyway, most people don’t just stand there, stock still, when their workout is over. They walk to the locker room or to their house or car, getting the cool-down benefit without officially “cooling down.”

The idea of the cool-down seems to have originated with a popular theory — now known to be wrong — that muscles become sore after exercise because they accumulate lactic acid. In fact, lactic acid is a fuel. It’s good to generate lactic acid, it’s a normal part of exercise, and it has nothing to do with muscle soreness. But the lactic acid theory led to the notion that by slowly reducing the intensity of your workout you can give lactic acid a chance to dissipate.

Yet, Dr. Foster said, even though scientists know the lactic acid theory is wrong, it remains entrenched in the public’s mind.

“It’s an idea we can’t get rid of,” he said.

Hypocrisy watch: National Health Service in Great Britain buys private health insurance for 3,000 employees

From the "You can't make this stuff up" department.

Information was gotten by a member of the Liberal Democratic party under Britain's Freedom of Information act. The LB's are the third party in Britain, not to be confused with the Labor Party or the Conservative (Tory) party.

3,000 NHS staff get private care - Times Online

THE National Health Service has spent £1.5m paying for hundreds of its staff to have private health treatment so they can leapfrog their own waiting lists.

More than 3,000 staff, including doctors and nurses, have gone private at the taxpayers’ expense in the past three years because the queues at the clinics and hospitals where they work are too long.

Figures released under the Freedom of Information act show that NHS administrative staff, paramedics and ambulance drivers have also been given free private healthcare. This has covered physiotherapy, osteopathy, psychiatric care and counselling — all widely available on the NHS.

“If the NHS has to circumvent their own waiting lists the system isn’t working well enough. It’s an admission by the NHS that their own system isn’t able to respond to the mass of people desperate to get back to work.”

Dementia - a physical as well as mental illness

There was a very fine feature in the excellent health section of the NY Times yesterday.

My mother is suffering from dementia. A month ago she had to move out of the independent living facility into an assisted living residence. She has real memory problems, trouble remembering to take her meds, as well as some mobility issues. She is doing much better now that she is getting the additional assistance she needs.

hitthe link for the whole article.

Well - Physical Toll of Dementia Often Overlooked in Treatment - NYTimes.com

Dementia is often viewed as a disease of the mind, an illness that erases treasured memories but leaves the body intact.

But dementia is a physical illness, too — a progressive, terminal disease that shuts down the body as it attacks the brain. Although the early stages can last for years, the life expectancy of a patient with advanced dementia is similar to that of a patient with advanced cancer.

The lack of understanding about the physical toll of dementia means that many patients near the end of life are subjected to aggressive treatments that would never be considered with another terminal illness. People with advanced dementia are often given dialysis and put on ventilators; they may even get preventive care that cannot possibly help them, like colonoscopies and drugs for osteoporosis or high cholesterol.

Does exercise hurt or help the immune system?

An important question (and certainly very important to me!).

This is a not-very-long but comprehensive posting on the NY Times Health blog, looking at both experimental animal studies and human studies.

The tentative conclusion is that intensive exercise can indeed suppress the body's immune response. On the other hand, experiments with mice indicate that mild exercise can help the immune system.

Phys Ed: Does Exercise Boost Immunity? - Well Blog - NYTimes.com

Why exercise should affect either your susceptibility to catching an illness or how badly a particular bug affects you is still unclear. But it does appear that intense workouts and racing suppress the body’s immune response for a period of time immediately after you’ve finished exercising and that “the longer the duration and the more intense” the exercise, “the longer the temporary period of immunosuppression lasts — anything from a few hours to a few days has been suggested,” ...

Wall Street Journal guide to Obamacare

"A comprehensive collection of our editorials and op-eds"

WSJ's Guide to ObamaCare - WSJ.com

Does it matter if you use hot or cold water when washing your hands?

An interesting question and here's the answer -

Really? - The Claim - Always Wash Your Hands With Hot Water, Not Cold. - Question - NYTimes.com

They found no evidence that hot water had any benefit, and noted that it might increase the “irritant capacity” of some soaps, causing contact dermatitis. “Temperature of water used for hand washing should not be guided by antibacterial effects but comfort,” they wrote, “which is in the tepid to warm temperature range. The usage of tepid water instead of hot water also has economic benefits.”

Free speech and civil rights advocate Nat Hentoff on the Senate health plan penalties for Dr's treating the elderly.

Nat Hentoff is a dedicated leftist; except he's against things like euthanasia and abortion. Here's his recent column on penalties for Dr's who overtreat their patients who are on Medicare. Excerpts bleow, but hit the link and read the whole 16 paragraph column. 

Health bill's deadly fine print

I am postponing my second column on the direct complicity of doctors and psychologists during the CIA's torturing of terrorism suspects because of the sudden disclosure that, in the influential Senate Finance Committee's health-care bill, there is a dangerous provision that could deny crucial health treatments for Medicare patients.

>>>>>>

During the continuous, extensive coverage of this proposed legislation, there has been only very limited mention – and none I've seen in the mainstream press – of a section that penalizes doctors for Medicare patients who, for at least five years (from 2015 to 2020), authorize total treatments that wind up in the top 10 percent of national annual Medicare costs per patient.

The 1 in 10 Medicare doctors who spend beyond this limit will themselves lose 5 percent of their own total Medicare reimbursements. Considering the already low rates Medicare doctors get – and the president pledges they will get lower – this could be a heavy penalty.

As Burke Balch, director of the National Right to Life's Center for Medical Ethics, says: "This (part of the Baucus bill) means that all doctors treating older people will constantly be driven to try to order the least-expensive tests and treatments for fear they will be caught in that top 10 percent. Note that this feature operates independently of any considerations of quality, efficiency or waste. If you authorize enough treatment for your patients, however necessary and appropriate it may be, you are in danger of being one of the 1 in 10 doctors who will be penalized each year."

Healthcare in Switzerland

Somehow, the Swiss provide high quality healthcare without a government option, and in fact without any kind of Medicare-type program for senior citizens.

Their approach is to mandate coverage, with government subsidies for those who cannot afford to pay. Very similar to the Massachusetts model.

Swiss Model for Health Care Is Gaining Admirers - NYTimes.com

... as a potential model for the United States, the Swiss health care system involves some important trade-offs that American consumers, insurers and health care providers might find hard to swallow.

The Swiss government does not “ration care” — that populist bogeyman in the American debate — but it does keep down overall spending by regulating drug prices and fees for lab tests and medical devices. It also requires patients to share some costs — at a higher level than in the United States — so they have an incentive to avoid unnecessary treatments. And some doctors grumble that cost controls are making it harder these days for a physician to make a franc.

The Swiss government also provides direct cash subsidies to people if health insurance equals more than 8 percent of personal income, and about 35 to 40 percent of households get some form of subsidy. In some cases, employers contribute part of the insurance premium, but, unlike in the United States, they do not receive a tax break for it. (All the health care proposals in Congress would provide a subsidy to moderate-income Americans.)

Unlike the United States, where the Medicare program for the elderly costs taxpayers about $500 billion a year, Switzerland has no special break for older Swiss people beyond the general subsidy.

A new study of dementia among former NFL football players indicates much higher rates

As the article states, more studies are needed (how accurate is a telephone survey?) but it is troubling. I wonder how it relates to former rugby players? I had three concussions (or was it two? I still remember waking up on the sideline in New Orleans ...) in my thirties while playing.

And - how it relates to younger, college and high school players who never become professionals?

Study Indicates Higher Rate of Dementia in Former N.F.L. Players - NYTimes.com

The Michigan researchers found that 6.1 percent of players age 50 and above reported that they had received a dementia-related diagnosis, five times higher than the cited national average, 1.2 percent. Players ages 30 through 49 showed a rate of 1.9 percent, or 19 times that of the national average, 0.1 percent.

>>>>>>

Dr. Daniel P. Perl, the director of neuropathology at the Mount Sinai School of Medicine in New York, agreed with Dr. Borenstein but described the Michigan work as significant. “I think this complements what others have found — there appears to be a problem with cognition in a group of N.F.L. football players at a relatively young age,” he said.

Healthcare reform or personal ego trip?

the Washington Post editorial and op ed pages have been (rightly) skeptical of the claims for the necessity of radical, and dramatic healthcare changes.

Here's a good column - only 11 paragraphs long, looking at some of the unproable claims about reform.

The Health-Care Ego Trip - washingtonpost.com

What's driving the great health debate of 2009 is not a popular clamor for universal insurance. "Many Americans are balking again at the prospect of health care reform," writes pollster Andrew Kohut of the Pew Research Center. A new Wall Street Journal poll found 41 percent of respondents opposed to President Obama's proposals and 39 percent in favor (the rest were undecided). The underlying driver is politicians' psychological quest for glory.

"My colleagues, this is our opportunity to make history," Chairman Max Baucus implored last week as the Senate Finance Committee opened consideration of his bill. Politicians, in their most self-important moments, see themselves as instruments of national destiny. They yearn to be remembered as the architects and agents of great social and economic transformations. They want to be at the signing ceremony; they want a pen.

Ordinary Americans are rightly suspicious of this exercise in collective ego gratification, which has gripped Obama and many of his congressional allies. Even when the goals are worthy -- as they are here -- the temptation to exaggerate, simplify and sugarcoat often proves irresistible. ...

Hand-washing and the flu

UPDATE: While at open School Night at Fordham prep yesterday, I noticed that all the rooms have Purell dispensers.

Everyone knows washing your hands is important. So why read this NY Times article?

Well, there's quite a few scientific studies of hand-washing.

18 short paragraphs.

Well - Hand-Washing Helps Fight Flu - NYTimes.com

A host of recent studies have highlighted the importance and the scientific underpinning of this most basic hygiene measure. One of the most graphic was done at the University of California, Berkeley, where researchers focused video cameras on 10 college students as they read and typed on their laptops.

The scientists counted the times the students touched their faces, documenting every lip scratch, eye rub and nose pick. On average, the students touched their eyes, noses and lips 47 times during a three-hour period, once every four minutes.

Hand-to-face contact has a surprising impact on health. Germs can enter the body through breaks in the skin or through the membranes of the eyes, mouth and nose.

The eyes appear to be a particularly vulnerable port of entry for viral infections, said Mark Nicas, a professor of environmental health sciences at Berkeley. Using mathematical models, Dr. Nicas and colleagues estimated that in homes, schools and dorms, hand-to-face contact appears to account for about one-third of the risk of flu infection, according to a report this month in the journal Risk Analysis.

In one study of four residence halls at the University of Colorado, two of the dorms had hand sanitizer dispensers installed in every dorm room, bathroom and dining area, and students were given educational materials about the importance of hand hygiene. The remaining two dorms were used as controls, and researchers simply monitored illness rates.

During the eight-week study period, students in the dorms with ready access to hand sanitizers had a third fewer complaints of coughs, chest congestion and fever. Over all, the risk of getting sick was 20 percent lower in the dorms where hand hygiene was emphasized, and those students missed 43 percent fewer days of school.

Healthcare reform should not limit medical innovation and improvements, or place a limit on society's healthcare spending

The Administration's position is that spending 17% of our gross domestic product (GDP) on healthcare is too much.

I disagree. Of course I am biased. When I was diagnosed with mantle cell lymphoma, the online data (which was outdated!) said the average life expectancy for someone with mantle cell was three years.

Well, I'm still here, in remission and no sign of cancer, six years later. And that's due to advances in diagnosing types of lymphoma, and better treatments, in the last 15 years.

And this is the experience of any number of people who I know. Recent medical innovation and advances have extended lives and increased quality of life.

Of course, as a society we have skewed priorities. Last night I watched a bit of the Giants vs. Cowboys football game, as Dallas unveiled their new 100,000 seat stadium, with the world's largest high definition TV screen hanging over the field (The Giants won! Yah!!). The Stadium cost almost $1.2 billion. And I'll bet the Cowboys got big State tax breaks to make their "investment". Oh, in the state with the highest percentage of uninsured citizens. 

Here's an excellent op ed in the Wall Street Journal - excerpts below, but hit the link for all 12 paragraphs.

Newt Gingrich: A Growth Vision for Health Reform - WSJ.com

A 3-year-old boy was recently diagnosed with a rare, aggressive, soft-tissue cancer in his bladder. Radiation treatment would have stunted the growth of his pelvic bones, hips and bladder and left him disabled. Radical surgery could remove his bladder, prostate and portions of his rectum. That would have left him impotent, using a colostomy bag, and urinating through another bag in his abdomen.

His parents chose a third option—a new "unproven" therapy where a proton beam precisely targeted the radiation dose so that it didn't cripple their son for life. The boy is now cancer-free and his body functions normally.

This story would seem to be an example of our health-care system at its best. But it is incompatible with the left's vision for overhauling the health-care industry.

>>>>>>

Standing in opposition to this world of hope is the vision of reform advanced by President Barack Obama and congressional Democrats. That vision would destroy the economic incentives that drive health-care innovation because it starts with a fundamental conceit: that government planners can spend health-care dollars better than patients and doctors in the marketplace. This planning is the foundation for the arbitrary insistence that spending 17% of our GDP on health care is "too much."

>>>>>>

No American should suffer pain, disease or worse because of a lack of health care. We already spend huge sums to help those of modest means through Medicaid and other programs. Reform those programs to create a true health-care safety net. Back it up with state high-risk pools to ensure health coverage for everyone.

Excellent. The answer is not a government takeover. I really don't care if as a society we spend 20 or 22% of our GDP on healthcare. Where is money better spent? And here's another quote from the above article -

...the plan released by Sen. Max Baucus (D., Mont.) last week would impose new taxes on medical device manufacturers of $40 billion over 10 years. That's more than industry venture capital investment.

An absurdity. All in the name of expanding the power of the federal government.

Senate Finance Committee unveils it's Health Reform package

This just in. I have friends who will support this, no matter what it says, and others who will oppose it, no matter what it says.  

Baucus Introduces $856 Billion Health-Care Bill - washingtonpost.com

Senate Finance Committee Chairman Max Baucus unveiled an $856 billion health-care reform plan Wednesday that would require nearly all Americans to carry health insurance while barring insurance companies from discriminating against people based on their health status or denying coverage because of preexisting conditions.

The plan does not call for a government-run insurance option, as advocated by President Obama and most Democrats, but would set up a system of nonprofit consumer-owned cooperatives to compete with private insurers -- a provision intended to appeal to Republicans who have railed against the "public option" in recent weeks.

>>>>>>

Under the Baucus plan, new Web-based insurance exchanges would be established to allow consumers to shop for and compare insurance plans. The package would also expand Medicaid and place caps on patients' annual health-care costs. It would be paid for with $349 billion in new taxes and fees and $507 billion in cuts to government health programs.

Obviously, thre's got to be some caveats to barring insurance companies from denying coverage because of preexisting conditions. Otherwise everyone would wait until they were sick before buying insurance. Although - somewhere in the package I think there's a requirement that everyone buy insurance, or face penalties administered through the tax code.

Want to read the whole Bill? Here it is - all 233 pages. How many of the Senators will read it?

http://www.washingtonpost.com/wp-srv/politics/documents/americas_healthy_future_act_of_2009_091609.pdf?sid=ST2009091601167

Patrick Swayze

Pancreatic cancer, diagnosed in March, 2008.

57 years old. What a pity.

Publicist: Patrick Swayze dies at 57 - Yahoo! News

Healthcare reform ideas, from the Brooking Institute

An analysis written up in a Washington Post editorial -

Required Reading - washingtonpost.com

... the group endorses changes such as raising the tax on sweetened beverages to target obesity and offering premium rebates to customers who improve their health or eliminate risk factors. It argues for capping the amount of health insurance that employers can provide tax-free, "to encourage carriers to design and workers to choose more cost-effective coverage." It proposes overhauling Medicare payment practices to reward performance and promote preventive care, and it endorses an entity that could propose fast-track policy changes for Medicare and Medicaid.

Some of its suggestions are part of the pending legislative proposals, but too much has been left out or watered down. Among the more intriguing ideas is a thoughtful approach to malpractice reform: The group suggests creating "health courts with specialized expertise in medical liability"; shielding providers from lawsuits if they adhere to "evidence-based guidelines"; and establishing "a legal pathway for early communication, apology and compensation."

Good news for Faranda household: Moderate drinking reduces risk of dementia

Vital Signs - Moderate Drinking Over 60 May Lower Dementia Risk - NYTimes.com

The American Journal of Geriatric Psychiatry, reviewed 15 studies that together followed more than 28,000 subjects for at least two years. ...

Compared with abstainers, male drinkers reduced their risk for dementia by 45 percent, and women by 27 percent.

... there is ample evidence from other studies that moderate alcohol consumption can increase HDL, or “good cholesterol,” improve blood flow to the brain and decrease blood coagulation. All three factors may reduce the risk for dementia.

Do over the counter pain meds taken before exercise help or hurt?

This is interesting. It deals with ibuprofen (advil) but can probably be applied to other meds. I have deen known to take ibuprofen or acetominaphen (tylenol) before exercising occasionally.

Phys Ed: Does Ibuprofen Help or Hurt During Exercise? - Well Blog - NYTimes.com

After looking at racers’ blood work, he determined that some of the ultramarathoners were supplying their own physiological stress, in tablet form. Those runners who’d popped over-the-counter ibuprofen pills before and during the race displayed significantly more inflammation and other markers of high immune system response afterward than the runners who hadn’t taken anti-inflammatories. The ibuprofen users also showed signs of mild kidney impairment and, both before and after the race, of low-level endotoxemia, a condition in which bacteria leak from the colon into the bloodstream.

These findings were “disturbing,” Nieman says, especially since “this wasn’t a minority of the racers.” Seven out of ten of the runners were using ibuprofen before and, in most cases, at regular intervals throughout the race, he says. “There was widespread use and very little understanding of the consequences.”

>>>>>>

When, then, are ibuprofen and other anti-inflammatory painkillers justified? “When you have inflammation and pain from an acute injury,” Warden says. “In that situation, NSAIDs are very effective.” But to take them “before every workout or match is a mistake.”

It would be interesting to see other studies.

Healthcare in France

Here's a pretty good look at the French system. Iknow quite abit about the British system, but nothing about the French.

Click here: Is French health system a model for U.S.? | News for Dallas, Texas | Dallas Morning News | Latest News

As America seeks a better way to provide medical care, France offers an example of a system where everyone has government-provided, basic health insurance – citizens and immigrants alike. Expenses for such chronic illnesses as cancer, diabetes and multiple sclerosis are covered entirely by the state so patients can focus on treatment rather than financial ruin.

But if France is instructive on health security, it also shows how high, vexing medical bills push government into a constant reform struggle. Lately, the French are taking a page or two from the U.S. playbook to try to cope by exploring managed-care practices.

Rice University alum Elizabeth Dutertre, who's lived in France since 1968, has had good and bad experiences with French health care.

"Many liberal Americans are convinced that the French system is the be-all and end-all solution to health care costs in the United States," she said. "But the system is costly to both the workers and the state. In fact, it is going bankrupt."

Bankruptcy looms for America as well. Health care absorbs more than 17 percent of the U.S. economy, or $2.4 trillion. The French fork over 11 percent.

After the biopsy - an implantable device to monitor cancer

It's in the works.

Novelties - A Tiny Monitor With a Huge Task - Tracking Cancer - NYTimes.com

Researchers at the Massachusetts Institute of Technology have created prototypes for cancer monitors the size of a grain of rice, small enough to fit easily into the bore of a biopsy needle. Tiny coated particles inside the devices can bind with molecules linked to cancer at the site, creating minuscule clumps that can be detected by a non-invasive scan like an M.R.I., said Michael J. Cima, a professor of materials science and engineering at M.I.T. and leader of the team that created the devices.

>>>>>>

Dr. Cima is planning a variety of devices, each set up to monitor a different metabolic activity of tissue near a tumor.

“Things as simple as pH and dissolved oxygen are known to be very good indicators of responses to therapy,” he said. “If the therapy is having an impact on the survival of that tumor, you’ll see it in the local metabolites.”

But testing on human patients is years away. “The next step is to implant these devices in larger animals with tumors that look more like human tumors,” he said.

He hopes that the devices will eventually lead to a stream of diagnostic information, he said, “to help physicians treat cancer as a chronic disease as opposed to an acute one.”

Time Magazine:"Exercise Won't Make You Thin"

This is written in the usual glossy weekly know-it-all style. I read the whole article (while in the gym on the stationery bike).

Here's the gist of the article:

"The basic problem is that while it's true that exercise burns calories and that you must burn calories to lose weight, exercise has another effect: it can stimulate hunger. That causes us to eat more, which in turn can negate the weight-loss benefits we just accrued. Exercise, in other words, isn't necessarily helping us lose weight. It may even be making it harder."

So don't eat more! The basics still apply - if you use more calories than you take in, you'll lose weight.

Go here for the whole essay -

Why Exercise Won't Make You Thin - TIME

Advances in knee repair

From the NYT health section a week ago.

Having had my knee 'scoped about five years ago (deteriorated meniscus), I am interested -

Novelties - Mimicking Human Cartilage to Repair a Knee - NYTimes.com

... companies are developing potentially simpler knee patches: small, off-the-shelf plugs engineered to mimic the composition of human bone and cartilage.

These ready-made cylinders can be inserted in an arthroscopic procedure; they are often used after a sports injury. They are known as osteochondral scaffolds, because they support new bone and cartilage as it grows.

The Real Deal on Health reform: an M.D.'s take

Specifically an anesthesiologist -

Ronald Dworkin: An Anesthesiologist’s Take on Health-Care Reform - WSJ.com

Incredibly, Congress's proposed health-care reform plan risks skimping on anesthesia. According to one of the health-care bills in Congress, H.R. 3200, the public option would reduce reimbursement for anesthesia by over 50%.

More broadly, the bill reflects the incorrect assumptions progressive politicians have made about the mindset of today's doctors and how the health-care system operates.

Hey? Who needs anesthesia anyway? Americans have grown soft - we need to toughen up!

Remember the expression "Bite the bullet"? It's about to stage a comeback.  

Does exercise reduce the risk of cancer?

Yes - more and more evidence that it can substantially lower the risk of cancer.

Phys Ed: Does Exercise Reduce Your Cancer Risk? - Well Blog - NYTimes.com

What these recent studies, including the one from Finland, share is the suggestion that, in order to use exercise to reduce the risk of cancer, you must make yourself sweat. In the Finnish study, the most beneficial exercise was both frequent and demanding. The researchers used METs (an acronym for metabolic equivalent of task, a numerical comparison of the oxygen or energy used during an activity versus the amount used at rest) to characterize their subjects’ exercise habits. A MET of 1 is the equivalent of lolling inertly on the couch. In his study, jogging steadily for 30 minutes or so represented a MET of about 10. The men whose METs reached at least 5 almost every day were the least likely to die of cancer, especially of the lung or the gastrointestinal tract. Similarly, in one of the studies included in the colon cancer review, women who walked briskly for five to six hours a week were much less likely to develop colon cancer than those who strolled for 30 minutes per week.

>>>>>>

But it remains difficult to tease out the specific molecular effects of regular, brisk exercise from the generally healthy habits of exercisers. Although the Finnish study controlled for diet, the scientists write that other, unspecified “lifestyle factors” and the luck (good and bad) of genetics may well have affected their results. Still, their findings offer a prescription for potentially reducing your risk of certain cancers that has few obvious, undesirable side effects, except among the intractably lazy. “At least moderately intense physical activity is more beneficial than low intensity physical activity in the prevention of cancer,” the authors conclude. The takeaway, in other words, is that jogging trumps berry picking.

U.S. life expectancy at all time high

Latest stats (2007): Life expectancy now 77.9 years. Women - 80.4, men 75.3

U.S. Life Expectancy at All Time High - Well Blog - NYTimes.com

Doctors say that not only is lifespan increasing, but more important, the “active” lifespan is increasing as well.

“The most noteworthy aspect about all this is not just that people are living longer but living better,” said Dr. Gary Kennedy, director of geriatric psychiatry at Montefiore Medical Center in the Bronx, N.Y. “At the same time, people are living a longer active lifespan. Seniors are healthier, more active and economically better off than they ever have been.”

Yeah, bring on government healthcare...

Working out to prevent lymphedema

Lymphedema, a problem especially for breast cancer patients.

Well - Weight Lifting May Help to Avert Lymph Problem - NYTimes.com

After a woman has surgery for breast cancer, she is typically given a long list of don’ts. Don’t lift anything heavier than 15 pounds, including your child. Don’t carry a heavy purse or grocery bags. Don’t scrub, push, pull or hammer.

The goal is to prevent lymphedema, a painful and unsightly swelling of an arm or leg that can occur near the site where lymph nodes have been removed or damaged by radiation. But new research suggests that much of that advice may be too restrictive. To prevent lymphedema after breast cancer, the best strategy may be more exercise, not less.

Krauthammer on preventive care and healthcare financing

Not the panacea,unfortunately.

Charles Krauthammer - Preventive Care Isn't the Magic Bullet for Health Care Costs - washingtonpost.com

Reform proponents repeat this like a mantra. Because it seems so intuitive, it has become conventional wisdom. But like most conventional wisdom, it is wrong. Overall, preventive care increases medical costs.

This inconvenient truth comes, once again, from the CBO. In an Aug. 7 letter to Rep. Nathan Deal, CBO Director Doug Elmendorf writes: "Researchers who have examined the effects of preventive care generally find that the added costs of widespread use of preventive services tend to exceed the savings from averted illness."

How can that be? If you prevent somebody from getting a heart attack, aren't you necessarily saving money? The fallacy here is confusing the individual with society. For the individual, catching something early generally reduces later spending for that condition. But, explains Elmendorf, we don't know in advance which patients are going to develop costly illnesses. To avert one case, "it is usually necessary to provide preventive care to many patients, most of whom would not have suffered that illness anyway." And this costs society money that would not have been spent otherwise.

Think of it this way. Assume that a screening test for disease X costs $500 and finding it early averts $10,000 of costly treatment at a later stage. Are you saving money? Well, if one in 10 of those who are screened tests positive, society is saving $5,000. But if only one in 100 would get that disease, society is shelling out $40,000 more than it would without the preventive care.

That's a hypothetical case. What's the real-life actuality? In Obamaworld, as explained by the president in his Tuesday town hall, if we pour money into primary care for diabetics instead of giving surgeons "$30,000, $40,000, $50,000" for a later amputation -- a whopper that misrepresents the surgeon's fee by a factor of at least 30 -- "that will save us money." Back on Earth, a rigorous study in the journal Circulation found that for cardiovascular diseases and diabetes, "if all the recommended prevention activities were applied with 100 percent success," the prevention would cost almost 10 times as much as the savings, increasing the country's total medical bill by 162 percent. That's because prevention applied to large populations is very expensive, as shown by another report Elmendorf cites, a definitive review in the New England Journal of Medicine of hundreds of studies that found that more than 80 percent of preventive measures added to medical costs.

This doesn't mean we shouldn't be preventing illness. Of course we should. But in medicine, as in life, there is no free lunch.

Sarah Palin comments on "death panels"; Senate to exclude that "counseling" from Senate healthcare bill.

Palin Facebook entry - a comprehensive look at the "voluntary" (my quotes) counseling. Good quotes from several sources, including Washington Post editorial writer Charles Lane, Washington Post columnist Eugene Robinson (uber Obama supporter) and NY State Senator Democrat Ruben Diaz.

I met Diaz a couple of years ago - great man - and in fact took this picture. I don't remember who the young girl is ...

 

Sarah Palin: Concerning the "Death Panels" | Facebook

So are these usually friendly pundits wrong? Is this all just a “rumor” to be “disposed of”, as President Obama says? Not according to Democratic New York State Senator Ruben Diaz, Chairman of the New York State Senate Aging Committee, who writes:

Section 1233 of House Resolution 3200 puts our senior citizens on a slippery slope and may diminish respect for the inherent dignity of each of their lives.... It is egregious to consider that any senior citizen ... should be placed in a situation where he or she would feel pressured to save the government money by dying a little sooner than he or she otherwise would, be required to be counseled about the supposed benefits of killing oneself, or be encouraged to sign any end of life directives that they would not otherwise sign. [9]

But the "death panels" won't be in the Senate version of reform

Senators exclude end-of-life provision from bill - Yahoo! News

Ann Althouse (moderate Dem., voted for Obama) posted it this way:

Althouse: Senators decide not to kill your grandma...

Sarah "Death Panels" Palin vindicated.

Of course in Oregon there's already end-of-life counseling and rationing. Remember this situation from about a year ago?

American Thinker Blog: 'Death Panels' in Oregon?

Could sexual practices be causing the racial gap in cancer survival rates?

Here's a study that makes that suggestion - details in the article.

Findings May Explain Gap in Cancer Survival - NYTimes.com

The racial gap has often been explained as a result of late diagnosis among African-Americans, lack of access to care and less aggressive treatment, but experts said that in the case of oropharyngeal cancer, there appeared to be distinct biological differences between the tumors.

This suggests that the racial gap in survival for this particular cancer may trace back to social and cultural differences between blacks and whites, including different sexual practices, experts said.

Great examination of aspects of the House healthcare Bill, HR 3200.

UPDATE: The Fortune Magazine (owned by Time, Inc - not part of the great right wing conspiracy [GRWC]) article from the end of July makes many of the same assertions of Professor Lewis.

I posted it here on july 28th - Tom Faranda's Folly: Fortune Magazine: Five Freedoms You'll Lose Under Obama healthcare

Here's the text of the study by Duke Professor John David Lewis, who is neither a doctor or a lawyer, but rather states "I am citizen, concerned about this bill’s effects on my freedom as an American. I would rather have used my time in other ways—but this is too important to ignore."

This is really an excellent evaluation of some elements of the Bill, but not an exhaustive study.

Prints out at five and a half pages, takes about ten minutes to read.

The Health Care Bill

And here is the author's own website - Home  My Courses

NY Times weekend editorial on the Massachusetts mandated insurance coverage plan

I have been following the Massachusetts legislation. In fact, I've posted eight times about the program. I thought it was a promising initiative. Here are two of the postings, including the original one in April, 2006. Massachusetts mandates health coverage . And here's a second one - Update on Massachusetts universal health plan .

The problem has been - no surprise - paying for it.

But the NYT says it's not a real problem.

Editorial - The Massachusetts Model - NYTimes.com

The Massachusetts Taxpayers Foundation, a non-partisan research group, recently concluded that the cost of achieving near universal coverage “has been relatively modest and well within early projections of how much the state would have to spend to implement reform.” That is heartening news given that the major features of the Massachusetts reforms are similar to those under consideration in Washington.

Then they say this -

There have been growing pains and glitches. The initially generous insurance benefits had to be scaled back to keep costs manageable. Cigarette taxes had to be raised to help pay for the reform. The number of people reporting problems paying medical bills and gaining access to care, after falling sharply, has begun to rise again. Tens of thousands of people who make too much to qualify for subsidies have to be exempted from the mandate each year on the grounds that they cannot afford to buy insurance. People just above the exemption level who lack employer coverage often face what they consider very high premiums.

Such problems are a warning perhaps that subsidies need to be extended higher up the income range. Massachusetts gives subsidies to families of four earning $66,000 a year, while pending Congressional bills would provide subsidies for those earning up to $88,000. That could mean added strain on government budgets.

So we are supposed to subsidize families making $88,000/yr? Where will this end? Who is going to pay?

I expect the Wall Street Journal, which has been critical of the Massachusetts Plan because off the expense, will have an editorial about the NYT editorial, and I will post it.

You can't get 21st century medical care at 1970's prices

click on the link for 4 paragraphs of common sense (from a hedge fund manager's blog)

Cliff Asness on Health Care - WSJ.com

You cannot judge the “cost” of something by simply what you spend. You must also judge what you get. I’m reasonably certain the cost of 1950s level health care has dropped in real terms over the last 60 years (and you can probably have a barber from the year 1500 bleed you for almost nothing nowadays). Of course, with 1950s health care, lots of things will kill you that 2009 health care would prevent.

>>>>>>

Health care today is a combination of stuff that has existed for a while and a set of entirely new things that look like (and really are) miracles from the lens of even a few years ago. We spend more on health care because it’s better. Say it with me again, slowly—this is a good thing, not a bad thing. . . .

Text of the House Health Bill, HR 3200, with a little analysis

Go here for all 1,017 pages.

http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.pdf

No I didn't read it. Here's a partial analysis which I can't vouch for, EXCEPT for the "Pg. 58" analysis, which I looked up. Yup, it's there, couched in careful verbiage.  The era of "Big Brother" could be starting...

Some examples, from a quick inventory by Family Security Matters:

Pg 22 of the HC Bill mandates the Government will audit books of all employers that self insure.

Pg 30 Sec 123 of HC bill — a Government committee (good luck with that!) will decide what treatments/benefits a person may receive.

Pg 29 lines 4-16 in the HC bill — YOUR HEALTHCARE WILL BE RATIONED!

Pg 42 of HC Bill — The Health Choices Commissioner will choose your HC Benefits for you.

PG 50 Section 152 in HC bill 0 HC will be provided to ALL non US citizens, illegal or otherwise.

Pg 58 HC Bill — Government will have real-time access to individual's finances and a National ID Healthcard will be issued!

Pg 59 HC Bill lines 21-24 Government will have direct access to your bank accts for election funds transfer.

PG 65 Sec 164 is a payoff subsidized plan for retirees and their families in Unions & community organizations (read: ACORN).

Pg 72 Lines 8-14 Government will create an HC Exchange to bring private HC plans under Government control.

PG 91 Lines 4-7 HC Bill — Government mandates linguistic appropriate services. Example — Translation for illegal aliens.

Pg 95 HC Bill Lines 8-18 The Government will use groups, i.e. ACORN & Americorps, to sign up individuals for Government HC plan.

PG 85 Line 7 HC Bill — Specifics of Benefit Levels for Plans. AARP members — your Health care WILL be rationed.

PG 102 Lines 12-18 HC Bill — Medicaid Eligible Individuals will be automatically enrolled in Medicaid. No choice.

pg 124 lines 24-25 HC No company can sue Government on price fixing. No "judicial review" against Government Monopoly.

pg 127 Lines 1-16 HC Bill — Doctors/ AMA — The Government will tell YOU what you can earn.

Pg 145 Line 15-17 An Emp loyer MUST auto enroll employees into public option plan. NO CHOICE.

Pg 126 Lines 22-25 Employers MUST pay for HC for part time employees AND their families.

Pg 170 Lines 1-3 HC Bill Any NONRESIDENT Alien is exempt from individual taxes. (Americans will pay.)

Pg 195 HC Bill -officers & employees of HC Admin (the GOVERNMENT) will have access to ALL Americans' finances and personal records.

PG 203 Line 14-15 HC — "The tax imposed under this section shall not be treated as tax" Yes, it says that.

Pg 239 Line 14-24 HC Bill Government will reduce physician services for Medicaid. Seniors, low income, poor affected.

Pg 241 Line 6-8 HC Bill — Doctors — doesn't matter what specialty — will all be paid the same.

PG 253 Line 10-18 Government sets value of Doctor's time, professional judgment, etc. Literally, value of humans.

PG 265 Sec 1131 Government mandates & controls productivity for private HC industries.

Pg 317 L 13-20 OMG!! PROHIBITION on ownership/investment. Government tells Doctors what/how much they can own.

Pg 317-318 lines 21-25,1-3 PROHIBITION on expansion — Government will mandate hospitals cannot expand.

Pg 354 Sec 1177 — Government will RESTRICT enrollment of Special needs people!

0A

PG 425 Lines 4-12 Government mandates Advance Care Planning Consultations. Think Senior Citizens end of life prodding.

PG 425 Lines 22-25, 426 Lines 1-3 Government provides approved list of end of life resources, guiding you in how to die.

PG 427 Lines 15-24 Government mandates program for orders for end of life. The Government has a say in how your life ends.

PG 429 Lines 10-12 "advanced care consultation" may include an ORDER for end of life plans. AN ORDER from the Government to end a life!

Page 472 Lines 14-17 PAYMENT TO COMMUNITY-BASED ORGANIZATION. 1 monthly payment to a community-based organization. (Like ACORN?)

More on cancer screening; only limited benefits?

More data; I've posted about this before, like here  Controversy about the value of mammograms for women in their 40's and here Prostate cancer screening saves lives, right? Well, maybe not.

Forty Years' War - In Push for Cancer Screening, Limited Benefits - Series - NYTimes.com

An upshot of the decades-long war on cancer is the popular belief that healthy people should regularly examine their bodies or undergo screening because early detection saves lives. But in fact, except for a few types of cancer, routine screening has not been proven to reduce the death toll from cancer for people without specific symptoms or risk factors — like a breast lump or a family history of cancer — and could even lead to harm, many experts on health say.

That is why the continued rollout of screening campaigns, and even the introduction of a Congressional bill, worries some health experts. And these experts say such efforts add to the large number of expensive and unnecessary treatments each year that help drive up the nation’s health care bill. Rather than heed mass-market calls for screening, these experts urge people without symptoms or special risks to talk to their own doctors about what cancer tests, if any, might be appropriate for them.

Blanket screenings do come with medical risks. A recent European study on prostate cancer screening indicated that saving one man’s life from the disease would require screening about 1,400 men. But among those 1,400, 48 others would undergo treatments like surgery or radiation procedures that would not improve their health because the cancer was not life-threatening to begin with or because it was too far along. And those treatments could lead to complications including impotence, urinary incontinence and bowel problems.

This is an excellent article; hit the link above and read the entire feature.

Poll: By a two to one margin, people think abortion does a woman more harm than good.

53 to 26%.

Abortion - more harm than good (OneNewsNow.com)

Georgette Forney of Silent No More says that is because more hurting women are opening up to loved ones about their abortion experiences.
 
"We're the norm. We are women who have had abortions and then come to a place -- sometimes the day after, sometimes 20 years later, sometimes 30 years later -- when we realize that we didn't just have an abortion like you have your tonsils out, but that the abortion took the life of our child," she contends.

Washington Post's Robert Samuelsen op ed: "Obama's Misleading Medicine"

Robert Samuelsen has been a columnist for the Washington Post and Newsweek since 1977. So not exactly a right winger.

He is reality-based, not pie in the sky. This is an excellent commentary.

Robert J. Samuelson - Obama Reform Sidesteps Health Costs - washingtonpost.com

... If you listen to President Obama, his "reform" will satisfy almost everyone. It will insure the uninsured, control runaway health spending, subdue future budget deficits, preserve choice for patients and improve quality of care. These claims are self-serving exaggerations and political fantasies. They have destroyed what should be a serious national discussion of health care.

>>>>>>

changing the way medical care is delivered and paid for would take years and involve disruptive and unpopular measures. Patient co-payments might increase; networks of doctors and hospitals might displace individual practices; the tax exclusion for employer-paid health insurance might be curbed. Obama downplays the obstacles. His "reform" isn't likely to compel needed changes, partly because it's not clear what will work.

>>>>>>

...Obama sees all blue sky. "Here's what reform will mean for you," he said at a recent rally. "It will mean lower costs and more choices and coverage you can count on. Health insurance reform will save you and your family money," he said. (Note: Except for subsidies, it's doubtful families will experience savings anytime soon.) And later: "We'll also change incentives so that our doctors and our nurses can finally start providing patients with the best care and not just the most expensive care. And if we do that, then reform . . . will lower our deficits in the long run."

>>>>>>

Judged objectively, "reform" may do exactly the opposite of what Obama says. But because the president is so well-spoken, he has the ability to make misleading statements sound reasonable or sophisticated. Still, they're misleading.

Fortune Magazine: Five Freedoms You'll Lose Under Obama healthcare

Hard to believe a magazine published by Time, Inc. would be this critical of Obama reform. And it's posted on the CNN website!

The freedoms you'll lose are:

1. Freedom to choose what's in your plan

2. Freedom to be rewarded for healthy living, or pay your real costs

3. Freedom to choose high deductible coverage

4. Freedom to keep your existing plan

5. Freedom to choose your doctors

You'll lose 5 key freedoms under Obama's health care plan - Jul. 24, 2009

Your brain and physical fatigue

An interesting NY Times blog posting.

Can Your Brain Fight Fatigue? - Well Blog - NYTimes.com

The role of the brain in determining how far and hard we can exercise — its role, in other words, in fatigue — is contentious. Until recently, most researchers would have said that the brain played little role in determining how hard we can exercise. Muscles failed, physiologists thought, because of biochemical reactions within the muscles themselves. They began getting too little oxygen or were doused with too much lactic acid or calcium. They stiffened and seized.

But there are problems with the idea that fatigue involves only the muscles. ...

The real word on embryonic stem cell research is finally getting out

Leaving aside the immorality of dissecting living human embryos for their stem cells, they have been passed by adult stem cells and induced pluripotent stem cells.

We know there are good adult stem cell therapies, or I wouldn't be here!

Here's a good article.

The Dirty Secret of Embryonic Stem Cell Research - Forbes.com

That's especially so given that ES cells are hardly the end-all and be-all of regenerative medicine, with stiff competition from adult stem cells (AS cells) and what are called "induced pluripotent stem cells." These iPS cells, engineered from mature human skin cells, are considered to be just as flexible as embryonic ones. But as with AS variety, they have neither the health concerns nor moral baggage of the embryonic ones

>>>>>>

AS (adult stem) cells have now treated scores of illnesses including many cancers, autoimmune disease, cardiovascular disease, immunodeficiency disorders, neural degenerative diseases, anemias and other blood conditions. They've been used in over 2,000 human clinical trials. There has never been an ES cell clinical trial. Former National Institutes of Health director Dr. Bernadine Healy, once an ES cell research enthusiast," now calls them "obsolete."

That's why it hardly makes sense to vastly increase federal research funding for ES cells. Medical research spending is always a zero-sum game. However big the overall budget, every dollar approved for one grant is a dollar lost to others.

A major study on African Americans and cancer; even with equal care they are more likely to die of some cancers than whites

Blacks Getting Equal Health Care Are Still More Likely to Die From Some Cancers - washingtonpost.com

In the new study, Albain and her colleagues used data collected from about 19,457 patients between 1974 and 2001 by the Southwest Oncology Group, a National Cancer Institute-funded national cooperative of clinical trials. Because all patients in the studies received the same treatment, if poverty and other socioeconomic factors were to blame, then differences in survival should remain constant across all cancers, the researchers reasoned.

A detailed analysis of the data found no statistically significant association between race and survival for lung and colon cancer -- two of the most common forms of cancer -- or for leukemia, lymphoma and myeloma.

But African Americans were still 49 percent more likely than whites to die from early-stage postmenopausal breast cancer, 41 percent more likely to die from early-stage premenopausal breast cancer, 61 percent more likely to die from advanced ovarian cancer and 21 percent more likely to die from advanced prostate cancer.

Because all the cancers for which the disparity persisted were related to gender, the findings suggest that the survival gap may be the result of a complex interaction of differences in the biology of the tumors and inherited variations in genes that control metabolism of drugs and hormones, Albain said.

An inadvertently amusing feature on how a restricted calorie diet may extend life expectancy

Here's an interesting and speculative feature in the science section of this morning's NY Times, about a long term study of rhesus monkeys.

Dieting Monkeys Offer Hope for Living Longer - NYTimes.com

It's filled with amusing lines like "Although people are similar to mice in many ways, they differ in other ways..."

There's an insight.