Is the Road to National Health Care through Incompetence or Deviousness?

Posted by PITHOCRATES - December 19th, 2013

Politics 101

The American Left is always trying to Expand the Role of Government in our Lives

Hillary Clinton tried it.  When her husband was president.  Give us national health care.  But there was terrific blowback.  Because people didn’t want it.  For they were afraid it would take the best health care system in the world (it’s the United States the richest people in the world go to for their more serious health problems) and do, well, what Obamacare is doing to it now.

The American left is always trying to expand the role of government in our lives.  To make people more dependent on government.  Because once they are they will soon discover something very beneficial to the left.  They will learn that they need government.  And once they do they will keep voting for the party that promises to expand government ever more.

This is why the left so wants national health care.  For it makes people need government.  To stay alive.  And that pays big dividends at those annoying things that come around every 2 years that the left hates.  And thinks is beneath them.  Elections.

The Lesson the American Left learned from the Failure of Hillarycare was to Lie Better

Liberals are a bunch of elitists.  They think they are better and smarter than the rest of us.  Which is why they feel they have the right to tell us how to live our lives.  For in their eyes we’re just too stupid to know what’s best for us.  Much like the British nobles felt about their petulant North American colonists.  They’d have preferred we appreciated all that the Crown was doing for them.  Thank them.  And shut the hell up.  This is the mindset of the American left.

The British Crown did not like their American colonists questioning the established order of power.  Neither do liberals.  For they believe that they are a privileged class.  And should live under a different set of rules.  Like they continue to show us all the time as they implement Obamacare.  As they forced the majority of Americans to lose the health insurance, doctors and medicine they liked and wanted to keep waivers went out to those connected to the liberal ruling class.  And actual members of the ruling class.  Such as those Congressional staffers getting illegal subsidies for their gold-plated health care plans while ordinary Americans lost their bare-bones plans because the Affordable Care Act made them unaffordable.

Was this an unintended consequence of the Affordable Care Act?  Well, being that the promise that if you like your health insurance, doctors and medicine and wanted to keep them but now can’t as the year’s biggest lie, it makes one think.  If they lied why did they lie?  To do what was best for the American people?  Or was it because they learned a powerful lesson from the failure of Hillarycare?  That the people don’t want national health care.  So if that’s what you want you can’t tell the American people that.  No.  You lie to them.  Which is why President Obama and his fellow Democrats lied.  Because they knew the American people didn’t want the [deleted expletive] they were shoveling.

The American Left looks upon us with the same Contempt as the British Nobility looked upon the American Colonists

Originally the Affordable Care Act included a public option.  National health care for those who opted for national health care.  But this just didn’t pass the smell test.  For there were Democrats who had one of those nasty things they hated coming up.  An election.  And these Democrats knew that their constituents, though they voted Democrat, would not go for national health care in sheep’s clothing.  So they had to remove the public option from the bill.  For it was just too painfully obvious what their ultimate intentions were.  Which left them with Plan B.

People like their health insurance, doctors and medicine.  And you’re not going to usher in national health care when they have these things.  For they know that the VA and Medicaid (examples of national health care already in America) is second-class health care.  I mean, those rich people coming to the United States for their more serious health problems aren’t demanding to get into the VA or Medicaid programs.  So to get national health care you first have to destroy the private health insurance system.  And candidate Obama told the SEIU that it may take awhile (see The Fix Is In: From ObamaCare Set-Up To Single-Payer Solution by Larry Bell posted 11/26/2013 on Forbes).

“But I don’t think we’re going to be able to eliminate employer coverage immediately. There’s going to be potentially some transition process. I can envision a decade out or 15 years out or 20 years out…”

So is the disastrous rollout of the Affordable Care Act just incompetence?  Or is it part of a devious plan to get what they always wanted?  National health care?  By first destroying the private health insurance that gave people the health insurance, doctors and medicine they liked and wanted to keep?  If it’s incompetence that isn’t good for the American people.  For these same incompetent people will now be in charge of our health care.  With our lives literally hanging in the balance.  Or are they just devious?  Which also isn’t good for the American people.  For it means they look upon us with the same contempt as the British nobility looked upon the American colonists.  Who only cared about what was best for their privileged class.  And not the American people.

The problem the left has is one of timing.  Yes they hold the American people in contempt and believe they are privileged.  But because of elections they have to be careful about letting these truths out.  Because if they lose the Senate and don’t get the House back in the next election it could throw a wrench into their plans.  They need to destroy the private health insurance industry.  But doing so will make people hate them.  And vote against them.  So on the one hand they have to get people dependent on government as soon as possible.  To get them to need government.  But if they move too fast they may anger the people so much that they may lose in the upcoming thing a privileged class hates.  And thinks is beneath them.  An election.  Which may cause them to lose their power.  This is the dilemma the left faces in the rollout of Obamacare.  The degree to which they [deleted expletive] the American people.

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One Pharmaceutical Company spent on Average $12 Billion per new Drug they brought to Market

Posted by PITHOCRATES - July 28th, 2013

Week in Review

People hate pharmaceutical companies.  They think they’re gouging them on the price of their medication.  If the people only knew what it cost to bring a new drug to market (see The Truly Staggering Cost Of Inventing New Drugs by Matthew Herper posted 2/10/2012 on Forbes).

The average drug developed by a major pharmaceutical company costs at least $4 billion, and it can be as much as $11 billion…

Bernard Munos of the InnoThink Center for Research In Biomedical Innovation…divided each drug company’s R&D budget by the average number of drugs approved…

The range of money spent is stunning. AstraZeneca has spent $12 billion in research money for every new drug approved, as much as the top-selling medicine ever generated in annual sales; Amgen spent just $3.7 billion. At $12 billion per drug, inventing medicines is a pretty unsustainable business. At $3.7 billion, you might just be able to make money (a new medicine can probably keep generating revenue for ten years; invent one a year at that rate and you’ll do well).

…the main expense is failure.

Why include failure in the cost? Right now, fewer than 1 in 10 medicines that start being tested in human clinical trials succeed…

It really does cost billions of dollars to invent new medicines for heart disease, cancer, or diabetes. The reality is that the pharmaceutical business is in the grip of rising failure rates and rising costs. We can all only hope that new technologies and a better understanding of biology will turn things around.

This is why our medicines are so expensive.  And why we have to wait for patents to run out before cheap generics hit the market.  Because whoever will manufacture those cheap generics didn’t have to spend $12 billion to bring the drug to market.

If drug companies can’t recover these massive costs they may do something worse than charge us an arm and a leg for a drug that will save our life.  They may stop bringing drugs that can save our life to market.

People say the profit incentive shouldn’t guide something as important as health care and medicine.  But what is the alternative?  Have the government spend $12 billion to develop a life-saving drug?  Because they’re so smart and motivated by social responsibility?  Instead of profit?  Yeah, they sure can pick winners in the private sector.  Like Solyndra.  If you’re not familiar with the name it’s because Solyndra filed bankruptcy.  Because their solar panels were the wrong solar panels to bet on in the private sector.  But the federal government bet $535 million in loan guarantees because they were so sure that Solyndra was a winner.  And their bankruptcy shows why we don’t want the government spending $12 billion to develop a life-saving drug.  For the federal government is just not good at bringing things to market.

So if we want these life-saving drugs we have to let these drug companies recoup the $12 billion they spent to bring a new drug to market.  For the sad reality is that $12 billion is a bargain compared to what the government would spend.

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Canadian Doctors don’t want to Prescribe Medical Marijuana and Pharmacists don’t want to Dispense It

Posted by PITHOCRATES - June 15th, 2013

Week in Review

Americans love Canada when it comes to health care.  And drugs.  Because in Canada they have single-payer health care.  And medical marijuana.  However, while they do have medical marijuana the drug is still illegal unless you have a medical condition.  And a prescription.  Something simpler said than done (see Need medical marijuana? You’ll have to get it by mail by The Canadian Press posted 6/10/2013 on CBC News).

Pharmacists and physicians alike questioned the lack of research into medical marijuana.

In December, the president of the Canadian Medical Association, Dr. Anna Reid, described the proposed marijuana rules as “akin to asking doctors to write prescriptions while blindfolded.”

She said the government was dumping the responsibility for medical marijuana onto doctors.

“Not only does prescribing drugs that haven’t been clinically tested fly in the face of medical training and ethics, but marijuana’s potential benefits and adverse effects have not been rigorously tested…”

“There is little information available on safety, effectiveness, dosage, drug interactions or long-term health risks,” the association said in its letter to Health Canada.

“Pharmacists, physicians and nurse practitioners need evidence-based information to support safe and effective prescribing and dispensing of (medical marijuana).”

The association said it didn’t know how many pharmacies would be willing to participate a revamped system.

“While the distribution process would be regulated, there remains the concern with pharmacists dispensing a product that does not have adequate safety and effectiveness evidence. In addition, the potential security risks to pharmacies due to robberies would need to be considered.”

Apparently marijuana is not everything some would have you believe it is.  While it takes years of studies and clinical trials to bring a new drug onto the market this hasn’t happened with medical marijuana.  They say it has medicinal benefits but unlike EVERY OTHER DRUG brought to market there are no studies showing this.  Which is why doctors don’t want to write prescriptions for it.  For what will they write?  Smoke two-thirds of a joint twice daily?  Take three bong hits daily?  What will people do with the other third of that joint?  Or with the bong after three hits?  Snuff them out and through away the unused portion?  Yeah, like a pot smoker would do that.

Is it medicine?  Well, if it is it is the first one ever that people really want to take.  And look forward to their medicine time.  Which kind of tells us it’s not medicine.  People want it to get high.  Yes, some may actually ameliorate their medical symptoms by using it but the vast majority of people just want to get high.  Which is why pharmacists don’t want to dispense it.  Because having a large quantity of it in their pharmacies will only attract the criminal element.  Who will want to break in and steal it.  So they can sell it to those who want to get high.

At best it’s like taking a shot of bourbon every night for medicinal purposes.  No doctor will want to prescribe that.  Because there are a whole lot of bad things that can follow by having a drink every night.   Especially if someone is on medication that shouldn’t be mixed with alcohol.  For which there is a lot of medical research available.  And if there was medical research available on medical marijuana it could very well be just as dangerous in the long run.  Even if people only consume it for medicinal purposes.

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Britain’s National Health Service works so well they Pass Laws Forbidding the Gagging of Whistleblowers

Posted by PITHOCRATES - March 16th, 2013

Week in Review

More and more people are finding out what life will be like under Obamacare.  And they’re not liking what they’re finding out.  Especially those pet owners who have just learned their vet bills are going up because the excise taxes on medical devices includes medical devices that can be used on people as well as animals.  Such as syringes.  Which is rather ironic that the most financially responsible health care in the United States will help subsidize the least financially responsible.  For people pay out of pocket at their vet.  Something they haven’t done at their people doctor since, well, forever.  Unless you lived before FDR’s time.  Before health care became a benefit.

While vets keep their bills to where people will pay them to save Fido and Whiskers no such restraint exists with people medicine.  Which probably explains why Fido and Whiskers are getting better health care than some get at people hospitals (see Ban on NHS gagging orders by Press Association posted 3/14/2013 on the guardian).

Gagging clauses that stop departing NHS staff from speaking out about patient safety or care have been banned by the government.

Hundreds of whistleblowers have in the past been silenced by the clauses in their severance packages.

The health secretary, Jeremy Hunt, said the practice would end with immediate effect to help create a culture of “openness and transparency” across the NHS.

Interesting.  Openness and transparency?  Like President Obama promised that his administration would be?  One thing we’ve learned from the president is that he has a problem with being open and transparent.  So you know this culture will carry over into Obamacare.  For they no doubt learned from the British that you have to shut your people up after they leave their jobs.  Or else they will talk about how horrible you’re running things.  Such as the abysmal job the Obama administration did protecting our diplomatic staff in Benghazi.  Despite all of the signs of a resurging al Qaeda.  The place was getting so dangerous that the British pulled their staff out before al Qaeda killed four Americans.  And what did we here from the dead ambassador’s boss when questioned in Congress about altered talking points used on the Sunday morning talk shows?  “What difference does it make?”  So much for all of that promised openness and transparency.

“The era of gagging NHS staff from raising their real worries about patient care must come to an end.”

Almost £15m was spent over three years on compromise agreements with staff leaving the NHS, the Mail said, of which 90% contained clauses to stop whistleblowers from speaking out.

Gary Walker, the former chief executive of United Lincolnshire Hospitals Trust, claimed he was sacked after raising concerns about patient safety.

He accepted a gagging clause as part of a settlement package but broke the terms to speak out last month about concerns over care, the Mail said…

The Health Secretary said that a “culture of covering up problems” led to the Mid Staffordshire scandal, and that NHS staff who identify problems should be encouraged to come forward and speak out…

“This can only be part of our response to Mid Staffs. If we have a culture where whistleblowing is necessary then obviously something has gone wrong.”

The National Health Service (NHS) has been doing national health care for a long time.  And, apparently, they still don’t have it right.  For if they did there would be no need for whistleblowers.  So here’s something to look forward to under Obamacare.  Gag orders and a culture of covering up problems.  And it has to happen here.  For the British are good people.  It’s just that national health care doesn’t work.  And we know the British are good people.  For they have been trying to make the unworkable national health care work.  Which must mean they care about their people.  So any failures of the system really can’t be blamed on the people.  It’s national health care that is at fault.  For it just doesn’t work.

So expect a lot of silence as more and more people suffer horrible health care.  And when a whistleblower does step forward and someone from the administration is called to testify before Congress we can already guess their answer to why more people are dying under Obamacare than they were before Obamacare.  “What difference does it make?”  Words you’ll never hear from your veterinarian.  Because there is no need for gag orders at your vet.  Why?  Because it’s cash out of pocket.  And vets have to meet a higher standard than some government policy.  They have to please Fido’s and Whisker’s owner.  The one with the pocket that has the cash that pays bill.  Which is why veterinarians work.  And Obamacare won’t.

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Regulators had Many Chances to prevent Meningitis Outbreak caused by Compounder NECC

Posted by PITHOCRATES - October 28th, 2012

Week in Review

Compounding is basically making small batches of custom medicines.  A pharmaceutical company may mass produce a pill that a few patients may be allergic to the hard pill coating or want it in a liquid form.  So the compounder makes these custom medicines.  So these are small labs producing small batches of medicine.  Where the small volume of medicine allow a very high level of attention to detail during the production process.  Including many safeguards and precautions.  The problems at NECC happened when they were no longer making small batches in a small lab.  Their problems started when they started acting like a large pharmaceutical company while still using production procedures of a small lab (see Insight: Red flags ignored for years at firm in meningitis crisis by Toni Clarke and Sharon Begley posted 10/26/2012 on Reuters).

A cracked vial here, a missing label there. The complaints coming into New England Compounding Center, the firm at the heart of the deadly U.S. meningitis outbreak, were piling up…

…More than 300 people who received a tainted steroid sold by NECC that was used to treat back pain have been infected with fungal meningitis and 25 have died.

Interviews with former NECC employees and its customers, and a review of internal documents and newly-released state records, paint a picture of a company whose rapid growth was marred almost since its inception by breaches of regulations governing compounding practices. They also show how regulators failed to punish the company despite repeated violations of the rules…

NECC was formed in 1998 by Cadden and his in-laws, the Conigliaro family, with a $5,000 investment, state records show.

So regulators knew about violations for a decade or so and yet never closed them down.  In fact, after numerous violations NECC asked for some leniency in the regulator’s final action.  Which they got.  Because it’s in the power of a state regulator to do that.  For that’s the power of a state bureaucrat.

It was not long before Cadden sought to expand into other states. He found a receptive audience among pain clinics that enjoyed the cost savings NECC offered – in one case, the company told a client it could save $4,500 a year if it purchased a particular steroid through NECC. It also sold to hospitals who were turning to compounders to fill the gaps caused by worsening shortages of prescription drugs from traditional manufacturers.

Nearly 1,200 drug shortages, from chemotherapies to painkillers, were reported between 2001 and mid-2011, with some of the biggest increases seen in the latter half of that decade, according to the Government Accountability Office. Many of the supply disruptions stemmed from manufacturers’ quality control problems and the waning profitability of certain medicines.

NECC thrived on the demand. By the time the company surrendered its license on October 3, NECC was supplying hundreds of hospitals across the country, according to a list of customers released by the FDA…

NECC has stopped operating and faces an array of federal and state investigations, not to mention the prospect of civil suits for liability. Its owners could face criminal charges.

The pharmaceutical industry is a highly regulated industry.  Which adds regulatory compliance costs.  Lawyers often sue pharmaceutical companies.  Because sometimes pills make it through the FDA approval process and yet still hurt people.  Which also adds further costs.  And despite the high cost of medicine pharmaceutical companies can have pressures on profits.  Causing them to drop certain medicines.  Leading to shortages.  And opening the door to compounders.  Who operated under lower overhead costs.  Allowing them to offer scarce medicines at low prices.

So that’s the background to this unfortunate crisis.  Regulators may have created the environment that encouraged the rapid growth of NECC.  And regulators failed to prevent this unfortunate crisis by going easy on NECC despite a record of violations.  What ultimately shut down NECC?  When their drugs started killing people.  For even if no one took any action against them and allowed them to stay in business no one would buy any of their drugs.  Because they were unsafe.  Which is a powerful incentive NOT to sell drugs that kill people.  Not to mention avoiding civil suits and criminal charges.

NECC probably meant no harm.  Nor did the regulators that let them do harm.  But they operated for about a decade until the market shut them down.  Civil and criminal action may follow.  But that is after the fact.  The government didn’t protect the people until after people started dying.  Something the market would have done anyway without the help of government.  So is more regulation going to help make our medicine safer?  Or will it only further increase the costs of the pharmaceutical companies.  Leading to more medicine shortages?  And perhaps setting the stage for another NECC?

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Greeks must now pay for their own Medications because the National Health Care System is Broke

Posted by PITHOCRATES - June 17th, 2012

Week in Review

As businesses wait with fear and trepidation for Obamacare to go into full effect we should consider what this will mean for the country at large.  More government benefits.  More government spending.  And higher taxation to pay for it.  Then we should look around the world for an example of large government spending and generous benefits.  To see if we can get an idea of how well something like a national health care system will work.  Let’s just pick a country at random.  Like this one (see Greek crisis hits hard at the pharmacy by Michael Birnbaum posted 6/13/2012 on The Washington Post).

From road-builders to priests to military suppliers, most walks of life have been affected by the government’s desperate bid to stanch the drain of euros from its coffers. Now health care is on the line, with pharmacists who are owed millions of euros by the government insurance system demanding in recent weeks that their clients pay the full sticker price for medicine. With unemployment at 22 percent and loans almost nonexistent, many people are doing without their drugs…

Under ordinary circumstances, the state health insurance system paid her pharmacist directly. Now pharmacists, fed up by delayed payments that they worry may never come, have told their customers that they need to pay cash and try their own luck at getting reimbursement from their health insurance.

Nothing is free in life.  Not even free health care.  Because government doesn’t make life-saving drugs.  Pharmaceutical companies who specialize in making life-saving drugs make life-saving drugs.  But even for them they are not free.  For they have to pay employees to make these drugs.  And they have to buy the chemicals to make these drugs.  And their chemical suppliers have their own employees to pay.  All of these costs are passed down the purchasing pipeline.  Right to the pharmacists.  Who must buy these drugs before they can sell them.  And when the government stops paying their bills someone has to pay them.  Or these pharmacists will just go out of business.  Because they’re not independently wealthy.  They run a pharmacy for living.  And simply can’t afford to buy drugs and give them away for free.

But pharmacists say they have little choice. Their suppliers, wary of extending credit in euros only to be repaid in weaker drachmas if the country gets booted out of the currency union, are demanding cash before they make shipments. And, though the pharmacies are receiving some reimbursements from the government, they are owed $188 million by the main government health insurance program, said Konstantinos Lourantos, president of the Pharmaceutical Association of Athens.

Doing anything on credit in Greece is risky business.  Because it’s not that certain if anyone will be able to pay their bills.  What makes this worse in Greece is who is paying most of the bills.

In Greece, where much of the private sector was sustained on public-sector spending, many business owners have found themselves to be unwitting creditors of the government, as payments have languished for months while their own credit has dried up, forcing them to scale back their businesses. That has made Greece’s recession, now in its fifth year, even harder to escape.

Everything has a cost.  Nothing is truly free.  Even when government provides it.  And the more the government provides the higher the taxes it takes to fund this government spending.  Relying on government spending, though, is risky.  Because tax revenue goes up and down with the economy.  During a recession there are fewer people working to pay income and payroll taxes.  And fewer people buying things to pay sales and value-added taxes.  Business revenues are down so businesses pay fewer income taxes.  During a deep recession tax revenue can fall far below the level needed to meet all government spending obligations.  Like reimbursing pharmacies.  And what do governments do during budget short-falls?  They borrow.  And Greece has.

Greece has borrowed so much that they are now a very poor credit risk.  They just owe so much money that a lot of lenders have grown doubtful that they will ever get their money back.  Which drives up borrowing costs.  Increasing the amount of interest they pay on their outstanding debt.  And as the recession lingers on tax revenues keep falling.  While the interest on the debt keeps rising.  Leaving less and less of those borrowed funds available to pay their massive government spending obligations.  And this is where Greece is.  They can’t pay their obligations without borrowing.  But they have borrowed so much that when they take on massive amounts of new debt much of it just goes to paying the interest on the old debt.  Which means they have to borrow ever more.  Increasing their interest payments on the debt ever more.  And leaving less and less for that massive government spending.

This is where debt crises come from.  Governments spending too much.  In fact it is safe to say that no government ever had a debt crisis from spending too little.  We can learn a lot from the Greeks.  In fact, we already have.  Most of Western Civilization goes back to Athens.  But we can also learn what NOT to do from the Greeks.  And a good place to start would be to repeal Obamacare.  For it’s this kind of spending that got Greece into trouble in the first place.

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The Form-Based Efficiency of the NHS fails to Save a Baby from Chicken Pox

Posted by PITHOCRATES - May 5th, 2012

Week in Review

A baby dies despite the efficient use of forms in national health care (see Baby boy died from chicken pox after doctors sent him home THREE times – and all he needed was simple antibiotics by Paul Sims posted 5/3/2012 on the Daily Mail).

Hospital staff missed three vital opportunities to save a toddler with chicken pox and he would be alive today if they had acted, a coroner said yesterday.

Lewis Mullins was seen by doctors three times in three days after his mother became convinced his condition was deteriorating rapidly.

But on each occasion she was given painkillers to make her son more comfortable and sent home…

Rotherham coroner Nicola Munday said Lewis would have almost certainly have survived the infection had staff ‘heeded’ the warning signs, carried out routine tests and treated him…

She rushed her son to Rotherham’s NHS walk-in centre on Wednesday, March 30 last year and was told he had infected chickenpox.

But a questionnaire filled in by a nurse, which detailed Lewis’s pain, rash, high temperature, shaking episodes and breathing problems, was not passed to the GP who later saw him.

As a result the GP thought he was treating him for chickenpox and nothing more…

This is medicine on a grand scale.  National health care.  And what Obamacare will be like.  Where the focus will be on cost cutting and greater efficiencies.  Digitizing medical records.  Using forms and checklist discipline to process as many human inputs into the system as possible.  To make those limited health care resources stretch as far as possible.  Instead of old time medicine.  Where you have a family doctor.  And your family doctor knows you and your family.  Your family history.  A doctor that sees your children growing up.  A doctor that knows your child.  And his or her brothers and sisters.  Knowing them as children.  And not as checklists.  But we can’t have that with national health care.  And we won’t have that with Obamacare.  Because that will take too many doctors.  And too much time.  So our doctors will become strangers.  Strangers who peruse a checklist.  Then goes on and processes the next human input into the health care machine.

This would probably not have happened in the United States.  For even though health care there is still not nationalized most children receive a chicken pox immunization.

Miss Conlay is now calling for a national immunisation programme for chicken pox. Vaccination is routinely available in the United States and Canada, but it is not offered to children in the UK…

Of course one can only assume the reason why the UK doesn’t is for the same reason that directs every decision in the NHS.  Cost.  Currently immunization clearly isn’t cost-effective.

It’s not the people in the NHS.  It’s the NHS.  The system.  Which is asking them to do the impossible.  For with their aging population and rising budget deficits they have little choice but to cut costs and pursue greater efficiencies.  And even though there is this great example of a large national health care system struggling to deal with an aging population and rising deficits the United States is heading down this same road.  Only with more human inputs to the health care machine.  That is struggling to deal with an aging population and rising deficits as well.  Who likes to hold up the model of Medicare as a success story.  Even though they project Medicare to go bankrupt in a decade or two.  So enjoy your health care in America while you can.  For if Obamacare isn’t repealed these are the kind of stories we’ll be reading about.  Only on a grander scale.

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Canadian Doctors adjust to Drug Rationing in Canada’s National Health Care System

Posted by PITHOCRATES - March 11th, 2012

Week in Review

Advocates of a national health care system in America point to Canada.  And say that’s what they want.  Free health care.  Not quality care at affordable prices.  But the utopia of having whatever you want or need for free.  Given to you by a caring and loving government.  Who puts people before profits.  And looks at health care from a cost basis.  Eliminating those nasty, smelly profits from the health care equation.  Because no one should profit on disease.  People should provide health care services out of love.  Not profits.  Making the world a better place in the process.  Isn’t that a better way to approach health care?  Sure, there are the naysayers.  But I ask them, what could possibly go wrong in this utopian system of health care?  Except, perhaps, this (see Hospitals depart from standard practices as injectable drugs become scarce by Kim Mackrael posted 3/9/2012 on The Globe and Mail).

Injectable drugs are so scarce in Canada that doctors across the country are being forced to restrict their use and depart from standard hospital practices.

Some hospitals are urging physicians to hold onto vials containing leftover medicine, instead of throwing them out after a single use. Cancer patients in Alberta have been switched from faster-acting injectable anti-nausea drugs to oral alternatives, and, in Ontario, at least one hospital has suggested staff consider low doses of more potent painkillers as supplies of commonly used drugs like morphine run low.

While doctors say these short-term solutions aren’t compromising patient safety, they point to the larger and more critical issue of getting a handle on a simmering drug-supply problem that has been years in the making.

Sandoz Canada, which manufactures most of the generic, injectable drugs used in the country, warned hospitals last month that it was cutting production following a citation by the U.S. Food and Drug Administration, which flagged the company for sterility concerns at its Boucherville, Que. factory. That shortage was exacerbated last week after a fire broke out at the facility, halting production entirely…

Doctors say they’ve faced drug shortages before, for a wide variety of medications. The problem, many say, is that manufacturers aren’t required to notify hospitals of pending shortages – as they are in other countries, including the United States and France.

It’s pretty sad when the United States government makes a Canadian factory throttle back production.  Even sadder is the Canadian government depending on one factory to provide ‘inexpensive generic injectable drugs’ for an entire country.  Which raises a few questions.  Like what was plan B should this facility catch on fire?  If there wasn’t a plan B wouldn’t you think they should have had one?  If there was only one factory providing these drugs how could they be sure they were getting the lowest price without any competition?  Why is the American government citing a Canadian factory for issues of sterility?  If this Canadian factory was deficient in areas of sterility why didn’t the Canadian government cite them?  And why is it that doctors face recurring shortages on a variety of medications in the Canadian health care system?

None of this would happen in a profit-driven system.  Where there would be another factory making that generic drug ready and willing to sweep in and pick up the business from that struggling factory.  And doctors facing drug shortages when ordering their drugs would simply order from another supplier.  Now I’m no expert in the medical drugs industry, but I do know this much.  I’ve never heard any doctor making substitutions like this in the American hospitals I’ve been in.  And I’ve been in a lot between my parents.  Who always seem to get the drugs they needed.  And the only complaint I’ve heard from their doctors was about the slow Medicare reimbursements.  The government part of their private health care system treatment.  Much like the Canadian government causes the problems in the Canadian health care system.  For when the doctors and nurses have the supplies they need they provide the highest of quality health care. 

The only problem in both the American and Canadian health care systems is their governments’ involvement in it.  The greater their involvement (as in Canada) the greater the problems.  The less involvement (as in the United States) the fewer the problems.  A trend that doesn’t bode well for Obamacare.

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Reforms in the National Health Service opposed by the BMA, Royal College of Nurses and the Royal College of Midwives

Posted by PITHOCRATES - January 28th, 2012

Week in Review

There is a struggle in Britain about power and money in the National Health Service (NHS).  Health care costs are rising.  Services are being rationed.  And the current government is trying to fix these problems by decentralizing the NHS.  By transferring budgets and decision making to the general practitioners (GPs) at the local level.  The front-line doctors.  Making the GPs responsible for their budgets.  And their patients’ care.  At the local level where doctors treat patients.  Making the practice of medicine once again an intimate relationship between doctor and patient.  But others see this as a heinous plot to introduce market forces into health care (see NHS ‘in peril’ if health reforms fail, warn GPs by Stephen Adams posted 1/27/2012 on The Telegraph).

In a letter to The Daily Telegraph, the heads of more than 50 new doctors’ groups argue that the British Medical Association’s policy of “blanket opposition” to the Health and Social Care Bill fails to represent GPs’ views.

They warn that previous reforms have not gone far enough and have consequently “paid the price of disengaging the frontline staff most needed to modernise the NHS”…

The letter has been signed by 56 GPs who are helping set up clinical commissioning groups (CCGs) across England. Under the Bill these will effectively replace primary care trusts (PCTs) and be handed their budgets.

Andrew Lansley, the Health Secretary, has consistently argued that the central thrust of the Bill is to give doctors a greater say, and key to this is giving them more responsibility for commissioning health services…

However, many believe the real motive is to open up the NHS for greater private sector involvement.

Last November the BMA moved to a position of total opposition to the Bill, and since the New Year the Royal College of Nurses and the Royal College of Midwives have followed suit. The Royal College of GPs is deeply sceptical, although not yet publicly in total opposition.

The inefficiencies of national health care have resulted in medical rationing.  Which has lowered the quality of health care for the patient.  So why would anyone oppose reforms to improve the quality of health care for the patient?  Because it will introduce market forces into health care.  Which will reduce costs and improve efficiency.  Which could also impact pay, benefits and pensions of health care providers.  The most expensive part of national health care.

This is the danger of national health care.  It destroys the quality of health care.  But it also creates a very vocal and powerful health care bureaucracy.  That takes on a life of its own.  And makes reform nearly impossible.  It’s happening in Britain.  And will happen in the U.S. if Obamacare is not repealed.

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LESSONS LEARNED #70: ” There is no such thing as ‘consensus’ in science.” -Old Pithy

Posted by PITHOCRATES - June 16th, 2011

State of the Art Medicine – Balancing the Four Humors

Early science was sometimes by consensus.  Arrived at by some guesses that were almost educated.  Early medical science, for example.  The human body was and is a complex thing.  Most of our knowledge was based on the excretions we observed coming from the body.  Someone with a cold had a runny nose.  Someone with a fever sweated.  Someone with an upset tummy vomited.  And, of course, there’s poop and pee.  If you didn’t excrete enough of either there’s probably something wrong with you.  Even today we look at our poop and pee.  For things like blood.  Or other abnormal secretions.  Because that can be a problem.  So the human body is a plethora of excretions.  Or fluids.  Each telling a story.

Early medicine broke these fluids down into 4 basic fluids.  The four humors.  Black bile, yellow bile, phlegm and blood.  A healthy body had the four humors in balance.  A sick body had an imbalance.  Too little of one.  Or too much of another.  So early medicine looked at putting the four humors back into balance.  Either through putting humors into the body.  As in herbs or food.  Or taking humors out of the body.  As in bloodletting or inducing vomiting.  Or applying a poultice.  Out with the bad.  In with the good.

This was state of the art medicine at its time.  They even used it on George Washington in 1799.  The most important man in America.  He was making his rounds on horseback, inspecting his plantation one day in the rain and snow.  Got a bit of a sore throat.  Came in that evening for dinner.  Didn’t change out of his wet clothes so as not to inconvenience his guests.  The next day his throat was worse.  And he had a fever.  He also had trouble swallowing.  Today we’d see our doctor and ask for some antibiotics.  Before antibiotics, though, you tried to balance the four humors.  So they bled Washington.  State of the art medicine back then.  Washington died 6 days later.  Having never recovered from his sore throat.  Despite using what was then the consensus for the finest medical care.  Bleeding.

The Fight against both Smallpox and the Medical Consensus

Interestingly, George Washington was a healthy man.  He lived longer than most Washington men.  Even survived a run in with Smallpox in his youth.  Which makes his death from something starting out as a sore throat sadder still.  Because Smallpox was a killer.  People feared it like the plague.  In time, though, people found a way to make themselves immune to the disease.  By infecting themselves with a little of it.

England learned of this procedure from the Turks.  Lady Mary Wortley Montagu brought the practice (variolation) back from Turkey.  The king volunteered subjects for experimentation in England.  Which proved to be a success.  Even though there was a risk of death (about 1 in 1,000).  And during the procedure people were highly contagious.  Still, it was a whole lot better than dying from the pox.  So the Royal physician inoculated the Royal family.  And the practice slowly spread.  African slaves were doing it, too, and brought the practice to the New World and taught the procedure to the Reverend Cotton MatherEdward Jenner conducted further experiments.  Found a safer way to inoculate using cowpox.  Without the higher death rate.  Or with people being highly contagious during the process.  And the Smallpox vaccination was born.

But the acceptance of inoculation wasn’t easy.  The accepted medical practice did not include such a radical procedure.  Those in medicine belittled the procedure and anyone practicing it.  The medical consensus was that these were just some misguided people playing God who were going to turn people into cows after injecting them with cowpox.  But fear of dying can change minds.  Especially when there is a Smallpox epidemic in your country.  Which there was during the American Revolutionary War.  More soldiers died from Smallpox than were killed in battle.  A lot more.  More than half of the army.  Soldiers inoculated themselves using the puss from the pustules on infected soldiers.  John Adams’ wife, Abigail, inoculated her own children.  The inoculations saved the army.  And many of the cities.  And it was the successful fight against Smallpox that allowed the fight for independence to proceed.  Thanks to those who went against the consensus.

Contagions, not Bad Air, make you Sick

Part of the reason the disease was so contagious was because of poor sanitary conditions.  Soldiers cramped together in barracks.  Or in hospitals.  Crowded cities.  A lot of sick people in contact with a lot of healthy people got a lot of healthy people sick.  Some understood this and tried to stay away from sick people.  But they didn’t really understand germs.  They tried to stay away from sick people so they wouldn’t catch what they had.  By breathing the same air.  Not necessarily the breath they were exhaling.  But the air they were breathing in that made them sick in the first place.

A common medical opinion was that ‘bad’ air caused illness.  Thomas Jefferson believed this.  That’s why he hated leaving Monticello during the summer.  When the tidewater air was ‘bad’.  The coastal towns.  Where the government met.  He hated going to New York, Philadelphia and Washington.  Because they all had ‘bad’ air during the summer.  And that ‘bad’ air could give you malaria.  Of course, it wasn’t the air.  It was the mosquitoes who liked the marshy tidewater areas.  And understanding this was the first step in (almost) eradicating malaria.

Benjamin Franklin didn’t believe in ‘bad’ air.  Well, not the kind other people worried about.  He didn’t believe cold air gave anyone a cold.  Or the flu.  No one knew anything about germs or viruses yet, but he had an open mind.  And constantly questioned things.  He was, after all, America’s greatest scientist.  Why did he not get sick when traveling in the coldest of winters?  Yet he could catch cold in a warm and comfortable room when someone with a cold was in that same room?  The answer was obvious.  Bad air.  Created by the sick person exhaling their sickness into a room with no fresh air.  Whereby he had no choice but to breathe in this same air.  A contagion spread the sickness.  Not cold air.  Sure of this he would forever sleep with the window open.  Even during winter.  Even when sharing a bed with a sick John Adams during a diplomatic mission to discuss possible terms with the British on Staten Island to stop the rebellion.   There was no room at the inn.  So they had to share.  And they discussed Franklin’s theory.  Adams had a cold and wanted to close the window.  Franklin didn’t want to catch Adams’s cold and insisted on leaving the window open.  Adams returned to bed while listening to Franklin opine.  And fell asleep.  With the window open.  He was no sicker in the morning.  And Franklin did not catch his cold.

Before Modern Science there was Consensus and Bad Medicine

Poor sanitary conditions and a lack of understanding of germs killed a lot of people.  During the American Civil War, doctors would go from patient to patient without washing their hands.  After an amputation, they just wiped their saw on their apron before moving on to the next patient.  These were approved medical procedures.  The consensus was that it wasn’t necessary to wash your hands.  Or your saw.  And the result was an epidemic of gangrene.  And high mortality rates in Civil War hospitals.  Louis Pasteur‘s work on the germ theory of disease began to change things.  And Joseph Lister introduced the modern sterile and antiseptic operating room.

We were making progress.  Modern medicine was coming into being.  But we were still doing a lot of questionable things.  Even though it was accepted by the medical community.  Sometimes we just didn’t know any better.  Like giving people heavy doses of toxic mercury.  Then there were things where we should have known better.  Like sticking an ice pick through someone’s eye socket into the brain to sever the connections to and from the prefrontal cortex during the popular lobotomy craze of the early 20th century.  We don’t do these once accepted medical practices anymore. 

Before modern science and modern surgical tools and equipment there was little more than consensus in medicine.  No one knew anything.  So they started by guessing.  And if a guess won a popular vote, it became an accepted medical procedure.  For it was the consensus of the medical community.  Which until real science came along was the best they could do.  Thankfully, today, we have real science.  We no longer have to guess.  Or win popularity contests.  Which has greatly reduced the amount of bad medicine in our lives.  Thanks to those lone voices in the crowd.  The few who dared to go against the consensus.

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