If you have been following the progress of President Obama’s proposed healthcare reforms, you would have noticed the numerous obstacles and protracted course it has taken. When he first mooted it during the presidential campaign, Obama the Democrat stood for government to provide healthcare for everybody by expanding the role of the existing Medicare into a compulsory public insurance scheme. This has now metaphosised currently into two Bills to be considered in Congress: the House Bill and the Senate Bill, both with differences. But whatever the Bill, Obama had to backtrack by accommodating private insurance companies; with the proviso that they would operate in a single insurance exchange incorporating public insurance schemes.
Why is this important to all of us outside the US? Quite simply, healthcare is a massive trillion dollar industry in the US and whatever happens here is bound to affect the rest of the world. Meanwhile, as the bureaucrats and politicians mull over what’s next, healthcare delivery seems to be spluttering along. Take for instance, the plan to close the only acute care hospital in Greenwich,NY (St Vincents) because of insurmountable debts (see here). This has understandably created a strong protest from the local community.
Elsewhere, I wrote in a recent posting about the plan to close the Royal National Orthopaedic Hospital in London for very much the same reason – soaring expenditure well over budget.
If we look at the healthcare reforms in the US or Great Britain, the question regulators need to ask is not who’s going to pay for the costs. The bigger question should be : how to reduce costs?
There’s a growing feeling that not enough attention is being given to look at ways and means to bring expenditure down. Rather, more attention seems to be devoted in identifying the payors. Should not more focus be given to minimising duplication of services for a particular geographical region to enhance efficiency? Or capping the litigation costs and awards for medicolegal suits? Or enhancing the usage of generic drugs that have proven efficacy?
Many of these measures will generate strong opposition from vested parties, but since the health reforms are about fundamental rights to healthcare, it would seem logical that the wellbeing of the public should override the interests of those with vested interests, like big pharmas and private insurance companies, for instance.
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Let me state upfront a disclaimer that I am not a soothsayer or fengshui expert, but some healthcare trends which I can forsee this year were already ‘works in progress’ and therefore have a high chance of seeing the light of day in 2010.
1.Cutting Down The Salt – nothing new, you might say; but recent evidence in the New England Journal of Medicine shows that reducing salt intake to 1 rounded teaspoon daily would “prevent up to 120,000 heart disease cases, 66,000 strokes, and save 92,000 lives in the USA alone every single year.” So, there is a renewed push by health authorities to push for a reduction in the amount of salt in packaged and restaurant foods by 25 percent over the next five years.
2.A Renewed Anti-Smoking Campaign- while the dangers of smoking are widely accepted and smoke-prone countries like India and Turkey have banned smoking in public in 2009, the frontiers where smoking is banned in bars and restaurants will be pushed even further. Such a ban has been imposed this year, for instance, in North Carolina, the leading tobacco-producing state in the US and home of R J Reynolds. Pretty unthinkable a decade ago! Other countries have begun to raise the prices of smokes (quite ineffective, I must say) and even put vivid diseased organ pics on the packs.
3.A Ban on TransFats – eating foods containing transfats, such as french fries, doughnuts, pastries and cookies, causes the bad LDL cholesterol to go up and the good HDL cholesterol to go down, leading to an increased risk of stroke, heart attacks and diabetes. I think we can see a consumerist movement towards banning transfat coming up. In fact, in California, restaurants are banned from using transfats beginning this year.
4.Stem Cells Galore- the progress in using undifferentiated cells to morph into tissues and organs seemed to have spluttered the last decade. But this year should see the explosive use of this technique to repair damaged tissues and organs. Ranging from damaged joints to breast enlargement, the demand is set to rise with improved techniques, such as using one’s own cells (autologous method).
5.Surge in Rejuvenative Medicine- whereas people were content initially to just look good and resorted to cosmetic surgery to achieve this, now there is awareness to also feel good – hence the popularity of antiaging medicine with physical and mental enhancement techniques.
6.Ban on Texting while Driving – using mobile phones have been blamed for many traffic accidents, but the increasing popularity of sending texts may account for more accidents than talking on the mobile( well, at least your eyes are still on the road!). More states in the US (19 to date) have now started to ban texting while driving. This is likely to be the trend in many other countries as well.
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To the casual observer, it would seem surprising that marijuana would be legalised under the Obama administration. Law-enforcers will apparently not arrest users and sellers of marijuana (aka weed,grass,cannabis,hashish,ganja) – provided they conform to US state laws on its use for strictly medical purposes.
New Jersey became the latest USA state to allow its medical use, adding to the 14 which had done so earlier. Unlike California, where doctors are authorizing patients to take marijuana to relieve such minor ailments as anxiety, headache, premenstrual syndrome, and trouble sleeping, New Jersey has tightened regulations to allow its medical use only for people who have less than a year to live, or those with specific symptoms resulting from certain chronic diseases like AIDS, cancer and Crohn’s.
Marijuana has been used medicinally as an intoxicant for thousands of years in Eastern culture. In Western medicine, several well-known pharmaceutical companies, including Eli Lilly , sold cannabis in powdered or tincture forms in the early 20th century as a painkiller, antispasmodic, sedative, and “exhilarant.” Since then, its use declined because more effective drugs for these purposes became available.
Now, researchers have shown its usefulness in the treatment of neuropathic pain (intense pain due to nerve damage), improving nausea and poor appetite in patients on chemotherapy as well as releasing muscle spasms in patients with multiple sclerosis. While medical research has been slow, (researchers are finding it difficult to get the plant legally and to get permission to undertake such research), its medical use remains controversial in many areas other than the few indications above.
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The news of the enormity of the earthquake that hit Haiti on 12 January has been rather muted up till now, maybe because of the difficulty in establishing proper communication channels. There is even a page on Facebook called Earthquake Haiti for people to look for the missing. But consider the following:
-estimates of deaths may reach 200,000.(the 2004 Indian Ocean tsunami caused about the same number of deaths)
-a large number of foreigners are missing, including 1,415 Canadians.
-75% of the capital Port-au-Prince has been destroyed.
Added to the misery is the fact that only 2 hospitals are operational, the rest destroyed, including the 3 clinics run by Doctors Without Borders. This is on top of the fact that there’s no running water, no sanitation, no food, and no electricity.
While the immediate health problems are obvious to the 3 million Haitians that need urgent medical help, the real challenge will come in the weeks ahead when diarrhoea, lung infections and complications of chronic disease set in because of the poor sanitation, nutrition and inferior medical facilities.This is when international agencies like the WHO and Red Cross can lead by example, just like when they did it for the H1N1 pandemic. Perhaps they can do it with the same resolve,urgency and resource?
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Even if you have never heard of the Royal National Orthopaedic Hospital (RNOH) located in north London, it doesn’t take too much to gather that it is a national healthcare institution revered by the British. The RNOH is one of the world’s leading orthopaedic hospitals and treats 60,000 patients a year. The big problem is this ageing hospital is in a chronic state of disrepair and costs millions of pounds to maintain every year.
The hospital is the single biggest employer in the constituency, but nearly two-thirds of the buildings are pre-fabricated pre-war structures. Water leaks through the ceilings while surgeons operate on patients (I know a few recently-constructed hospitals which are doing the same!), and the maintenance backlog is running at an estimated £54m. The NHS trust, which owns and operates the RNOH figures it would be in the best interest (whose?) to decentralise the hospital services and shut down the current one, so that it would be more economically viable.
Well, not if Professor Tim Briggs, medical director of the RNOH, can help it. He intends to challenge the former health minister Tony McNulty as an independent candidate for Harrow East with the aim of securing the future of the renowned institution. Despite intense lobbying the last 15 years , he has not got the required £60m from the NHS despite the support of the Prime Minister and successive health ministers.
Now, Professor Briggs is applying to the electoral commission to register his new political party, the Central Party for Reform, before he takes on the incumbent Labour MP.
And his chances of winning? Going by precedence (In 2001, Dr Richard Taylor unseated the incumbent Labour MP when he fought to save Kidderminster hospital), he does appear to have the upper hand..
Read more about it here.
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