(Roughly) Daily

Posts Tagged ‘medicine

“America’s health care system is neither healthy, caring, nor a system”*…

Care is deteriorating even as prices rise. There are a number of reasons; Fred Shulte explores a new and growing category of culprit…

Private equity is rapidly moving to reshape health care in America, coming off a banner year in 2021, when the deep-pocketed firms plowed $206 billion into more than 1,400 health care acquisitions, according to industry tracker PitchBook.

Seeking quick returns, these investors are buying into eye care clinics, dental management chains, physician practices, hospices, pet care providers, and thousands of other companies that render medical care nearly from cradle to grave. Private equity-backed groups have even set up special “obstetric emergency departments” at some hospitals, which can charge expectant mothers hundreds of dollars extra for routine perinatal care.

As private equity extends its reach into health care, evidence is mounting that the penetration has led to higher prices and diminished quality of care, a KHN investigation has found. KHN found that companies owned or managed by private equity firms have agreed to pay fines of more than $500 million since 2014 to settle at least 34 lawsuits filed under the False Claims Act, a federal law that punishes false billing submissions to the federal government with fines. Most of the time, the private equity owners have avoided liability…

The terrifying details: “Sick Profit: Investigating Private Equity’s Stealthy Takeover of Health Care Across Cities and Specialties,” from @FredSchulte at @KHNews.

See also: “Private equity, health care, and profits: It’s time to protect patients,” “Private equity health-care monopolies are on a profitable killing spree,” and “Private equity deals drive up healthcare use, costs among physician practices, JAMA study finds” (this last, source of the image above).

* Walter Cronkite

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As we muse on mercenary medicine, we might send healing birthday greetings to James Collip; he was born on this date in 1892. A biochemist, he partnered with Frederick Banting and Charles Best to discover insulin in 1921. The co-inventors sold the insulin patent to the University of Toronto for a mere $1. They wanted everyone who needed their medication to be able to afford it.

Today, Banting and his colleagues would be spinning in their graves: Their drug, on many of the 30 million Americans with diabetes rely, has become the poster child for pharmaceutical price gouging.

The cost of the four most popular types of insulin has tripled over the past decade, and the out-of-pocket prescription costs patients now face have doubled. By 2016, the average price per month rose to $450 — and costs continue to rise, so much so that as many as one in four people with diabetes are now skimping on or skipping lifesaving doses

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Written by (Roughly) Daily

November 20, 2022 at 1:00 am

“Infant mortality and life expectancy are reasonable indicators of general well-being in a society”*…

… and in the U.S., as Adam Tooze explains, we’re doing not so well of late…

In August America’s Center for Disease Control (CDC) published a set of data that ought to have brought political, economic and social debate to a standstill. If there is one question that should surely dominate public policy debate, it is the question of life and death. What did the Declaration of Independence promise, after all, if not “life, liberty and the pursuit of happiness”. But on that score the CDC in 2022 delivered alarming news. In the last three years, life expectancy in the United States has plunged in a way not seen at any point in recent history.

America is inured to bad news about its health. Life expectancy in the United States has stagnated since 2011, a trend which separates the United States not just from rich peer countries but from most other countries in the world, rich or poor.

Given economic growth and advances in medicine for life expectancy to stagnate requires serious headwinds. In the United States those headwinds include, homicides and suicides, the opioid epidemic (so-called deaths of despair) car accidents and obesity. As John Burn-Murdoch shows in the FT, without those factors the US would have tracked its peer societies much more closely…

But stagnation is one thing, the collapse since 2019 is a phenomenon of a different quality. It is a full measure of the disaster that was the COVID pandemic in the United States. Over a million Americans died of COVID, one of the worst outcomes on the planet.

…it is not only China that has overtaken the United States based on this metric. In 2021 Cuba has a higher life expectancy than the US. So does Albania.

In a society marked by inequality as deep as modern America’s, to speak in terms of national averages is not very meaningful. The circumstances of life and health outcomes are vastly different…

Source: BMJ

…One might think that faced with these stark facts all other subjects of political debate would pale into insignificance. Whatever else a society should do, whatever else a political system promises, it should ensure that its citizens have a healthy life expectancy commensurate with their nation’s overall level of economic development. An ambitious society should aim to do more, as Japan does for instance. Judged by this basic metric, the contemporary United States fails and for a substantial minority of its population, it fails spectacularly. And yet that extraordinary and shameful fact barely registers in political debate, a silence that is both symptom and cause.

Life, liberty and the pursuit of happiness? How China, Cuba and Albania came to have higher life expectancy than the USA,” from @adam_tooze. Eminently worth reading in full.

For an example of the ways in which these wounds are self-inflicted: “The Human Psyche Was Not Built for This.”

* P. J. O’Rourke

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As we ponder priorities, we might recall that it was on this date in 1892 that the first diagnostic public heath laboratory in the U.S. was founded by New York City (as its “Division of Pathology, Bacteriology and Disinfection”). Spurred by the cholera epidemic of the time, it soon took on the diagnosis and tracing of diphtheria and tuberculosis; in 1895, it began production of a smallpox vaccine.

The New York City public health laboratory became a model for other cities’ public health departments. Within a few years, similar labs had become essential components of an effective health departments across the nation.

“The Cholera Invasion,” from Frank Leslie’s Illustrated Weekly, by West B. Clinedinst, 1892. National Library of Medicine.

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Written by (Roughly) Daily

September 9, 2022 at 1:00 am

“Can’t have dirty garbage!”*…

Rebecca Alter, with a paean to an unexpected TikTok delight…

At some point earlier this year, my For You Page changed for the better. Between cute boys making sandwiches, Brian Jordan Alvarez videos, and American Girl Doll memes, I started getting the occasional video from @nycsanitation. I don’t think I’ve ever watched through a full video on TikTok from any government department, local or federal, but @nycsanitation has clawed its way through algorithms and attention spans to be that rarest of finds: an official organization or company account that’s actually good. The Department comes across in its TikToks as a bunch of genuine, hardworking salt-of-the-earth folks. I mean that literally; @nycsanitation TikTok reminds us that they’re the ones in charge of salting the streets in winter…

Read on for wondrous examples featuring googly-eyed snowplow trucks and earnest charm: “The Department of Sanitation Has an Oddly Excellent TikTok,” from @ralter in @Curbed.

* Spongebob

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As we keep it clean, we might might recall that it was on this date in 1865 that Joseph Lister, a student of Pasteur’s germ theory, performed the first successful antiseptic surgery (using carbolic acid to disinfect a compound fracture suffered by an 11-year-old boy). After four days, he discovered that no infection had developed, and after a total of six weeks he was amazed to discover that the boy’s bones had fused back together, without suppuration. He subsequently published his results in The Lancet in a series of six articles, running from March through July 1867.

Lister developed his approach to extend to Lister instructing surgeons under his responsibility to wear clean gloves and wash their hands before and after operations with five per cent carbolic acid solutions. Instruments were also washed in the same solution, and assistants sprayed the solution in the operating room.

At first, his suggestions were criticized: germ theory was in its infancy and his techniques were deemed too taxing. But his results– sharp reduction in post-op infection and death– ultimately carried the day. Indeed, he so revolutionized his field that he is known as “father of modern surgery.”

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“The welfare and the future of our societies depend on our capacity to remain mobilized so as to improve the health of every mother and child”*…

Preparing for a world post Roe v Wade…

The red states poised to ban or severely limit abortion already tend to have limited access to health care, poor health outcomes and fewer safety net programs in place for mothers and children.

If the U.S. Supreme Court overturns Roe v. Wade, as it’s expected to, the ensuing increase in births will likely leave families in tough circumstances and strain systems that are already hanging by a thread.

“What we’re facing as a country is hundreds of thousands of births, probably disproportionately located in the states that have been most limited in what they do for pregnant women, infants and children. So this is the great paradox that we are dealing with,” said Sara Rosenbaum, a health law and policy professor at George Washington University. “We have not ever designed these programs for a world without Roe,” she added. “You need a child welfare system, the likes of which we’ve never seen.”…

A growing shortage of obstetricians, higher maternal mortality rates and worse health care outcomes generally, increased pressure on U.S. foster and adoption systems— it all bodes ill…

We know from focus on health outcomes that kids born into poverty, kids born into unstable social circumstances, tend to have higher incidence of early onset chronic diseases,” Shannon said. “We also know that when those children are raised in unstable circumstances and have to be cared for in foster care, the outcomes there are really sobering.

Richard Shannon, chief quality officer for Duke Health

Red states aren’t prepared for a post-Roe baby boom,” from Caitlin Owens (@caitlinnowens) in @axios.

* Jean Ping

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As we contemplate care, we might sending healing birthday greetings to Thomas Huckle Weller; he was born on this date in 1915. A virologist, he developed a technique for cultivating poliomyelitis viruses in a test tube, using a combination of human embryonic skin and muscle tissue– which enabled the study of the virus “in the test tube,” a procedure that led to the development of polio vaccines. He was awarded the Nobel Prize in Physiology or Medicine in 1954.

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“The real alchemy consists in being able to turn gold back again into something else; and that’s the secret that most of your friends have lost.”*…

16th century alchemical equipment, and 21st century reconception of Luria’s 16th century Sephirotic array by Naomi Teplow.

About a decade ago, the formidable Lawrence Weschler was a visiting scholar at the Getty Research Institute in Los Angeles, where he conceived a concept for an exhibit that, sadly, never materialized. Happily, he has shared the design in his wonderful newsletter, Wondercabinet

Lead into Gold:

Proposal for a little jewel-box exhibit

surveying the Age-Old Quest

To Wrest Something from Nothing,

from the Philosopher’s Stone

through Subprime Loans

The boutique-sized (four-room) show would be called “Lead into Gold” and would track the alchemical passion—from its prehistory in the memory palaces of late antiquity through the Middle Ages

(those elaborate mnemonic techniques whereby monks and clerks stored astonishing amounts of details in their minds by placing them in ever-expanding imaginary structures, forebears, as it were, to the physical wondercabinets of the later medieval period—a sampling of manuscripts depicting the technique would grace a sort of foyer to the exhibition),

into its high classic phase (the show’s first long room) with alchemy as pre-chemistry (with maguses actually trying, that is, to turn physical lead into physical gold, all the beakers and flasks and retorts, etc.) to one side, and astrology as pre-astronomy (the whole deliriously marvelous sixteenth-into-seventeenth centuries) to the other, and Isaac Newton serving as a key leitmotif figure through the entire show (though starting out here), recast no longer in his role as the first of the moderns so much as “the Last of the Sumerians” (as an astonished John Maynard Keynes dubbed him, upon stumbling on a cache of thousands of pages of his Cambridge forebear’s detailed alchemical notes, not just from his early years before the Principia, but from throughout his entire life!).

The show would then branch off in two directions, in a sort of Y configuration. To one side:

1) The Golden Path, which is to say the growing conviction among maguses and their progeny during the later early-modern period that the point was allegorical, an inducement to soul-work, in which one was called upon to try to refine the leaden parts of oneself into ever more perfect golden forms, hence Faustus and Prospero through Jung, with those magi Leibniz and Newton riffing off Kabbalistic meditations on Infinity and stumbling instead onto the infinitesimal as they invent the Calculus, in turn eventually opening out (by way of Blake) onto all those Sixties versions, the dawning of the Age of Aquarius, etc., which set the stage for the Whole Earth Catalog and all those kid-maguses working in their garages (developing both hardware and software: fashioning the Calculus into material reality) and presently the Web itself (latter day version of those original memory palaces from back in the show’s foyer, writ large);

while, branching off to the other side, we would have:

2) The Leaden Path, in which moneychangers and presently bankers decided to cut to the chase, for, after all, who needed lead and who needed gold and for god’s sake who needed a more perfect soul when you could simply turn any old crap into money (!)—thus, for example, the South Sea Bubble, in which Newton lost the equivalent of a million dollars (whereupon he declared that he could understand the transit of stars but not the madness of men), tulipomania, etc., and thence onward to Freud (rather than Jung) and his conception of “filthy lucre” and George Soros (with his book, The Alchemy of Finance), with the Calculus showing up again across ever more elaborate permutations, leading on through Ponzi and Gecko (by way of Ayn Rand and Alan “The Wizard” Greenspan) to the whole derivatives bubble/tumor, as adumbrated in part by my own main man, the money artist JSG Boggs, and then on past that to the purest mechanism ever conceived for generating fast money out of crap: meth labs (which deploy exactly but exactly the same equipment as the original alchemists, beakers and flasks and retorts, to accomplish the literal-leaden version of what they were after, the turning of filth into lucre).

And I appended a xerox of that napkin sketch:

Eminently worth reading– and enjoying–in full. “The age-old human quest to turn nothing into something.”

* Edith Wharton

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As we appreciate the abiding attraction of alchemy, we might recall that it was on this date in 1933 that President Franklin D. Roosevelt signed the act creating the Tennessee Valley Authority. A feature of the New Deal, the TVA was created to provide navigation, flood control, electricity generation, fertilizer manufacturing, regional planning, and economic development to the Tennessee Valley, a region (all of Tennessee, portions of Alabama, Mississippi, and Kentucky, and small areas of Georgia, North Carolina, and Virginia) which was particularly hard hit by the Great Depression relative to the rest of the nation. While owned by the federal government, TVA receives no taxpayer funding and operates similar to a private for-profit company.

The TVA has been criticized for its use of eminent domain, which resulted in the displacement of over 125,000 Tennessee Valley residents for the agency’s infrastructure projects. But on balance the TVA has been documented as a success in its efforts to modernize the Tennessee Valley and helping to recruit new employment opportunities to the region.

FDR signing the TVA Act [source]
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