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by revere, cross-posted from Effect Measure

One of the most feared outcomes of infection with influenza is Acute Respiratory Distress Syndrome (ARDS; in less severe form it mahy be called Acute Lung Injury, ALI). For reasons we still do not understand, cells deep in the lung that are involved in gas exchange (oxygen and carbon dioxide) become so damaged that the basic work of supplying the body with enough oxygen for life and getting rid of the carbon dioxide generated by metabolism is too much for the patient and either some intervention to relieve the lungs of some of the work is made or the patient dies. ARDS is so severe that often no intervention works, and fatality ratios of 50% are quite typical. The most common intervention is a mechanical device called a ventilator to do some of the work of breathing for the patient. Critical care respiratory therapy is much more than pumping air in and out of the lungs, however. It is a very complex and tricky art, and it is now believed by many that conventional mechanical ventilation can make ARDS worse and decrease the odds of survival. The literature on ventilation in ARDS is highly technical, and advanced methods using sophisticated computer-controlled devices are often needed.

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A lot of the media coverage of the healthcare debate lately has focused on the politics, probably because journalists feel like they’ve already spent several months explaining the various aspects of proposed reform. But there are a few things that bear repeating, because not everyone seems to remember them.

The Washington Post’s Ezra Klein has one key reminder: In the US, we already ration healthcare:

We ration. We ration without discussion, remorse or concern. We ration health care the way we ration other goods: We make it too expensive for everyone to afford.

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CNN’s Elizabeth Landau reported yesterday on new research suggesting that online psychotherapy is an effective way to treat depression. The original study, published August 22 in the Lancet by Dr. David Kessler and colleagues in the UK, examined the effectiveness of cognitive-behavioral therapy (CBT) delivered by a therapist online in real time. When compared to usual care only, a combination of online CBT and usual care led to higher rates of recovery at follow-up eight months later.

Despite logistical and policy issues – health insurance coverage of online therapy, legal questions about offering treatment to people in other states, and privacy of transcripts, for example – online therapy has already been used in many forms. Read the rest of this entry »

As the nation mourns the loss of Senator Edward Kennedy, it’s worth reading a Newsweek piece he wrote just last month on why the struggle for universal healthcare has been the cause of his life. He writes about the many times in his life when he and his family members have needed healthcare, and have had no trouble getting top-quality procedures that saved their lives:

But quality care shouldn’t depend on your financial resources, or the type of job you have, or the medical condition you face. Every American should be able to get the same treatment that U.S. senators are entitled to.

This is the cause of my life. It is a key reason that I defied my illness last summer to speak at the Democratic convention in Denver—to support Barack Obama, but also to make sure, as I said, “that we will break the old gridlock and guarantee that every American…will have decent, quality health care as a fundamental right and not just a privilege.” For four decades I have carried this cause—from the floor of the United States Senate to every part of this country. It has never been merely a question of policy; it goes to the heart of my belief in a just society.

Jonathan Cohn at The Treatment mourns the loss of a Senator who was never afraid to make moral arguments for policies. He writes of Kennedy:

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Both the Washington Post and the New York Times report that the Obama administration is signaling a new willingness to jettison the public plan element of healthcare reform legislation. Jonathan Cohn at The Treatment questions whether anything’s really changed, though, because Obama has consistently praised the public option as a good idea without insisting that it be included in the final bill.

As the summer has worn on and Congressional committees have come out with specific proposals, healthcare reform supporters are getting a better sense of what we can reasonably hope to get out of this round of reform and what will have to wait. Coverage expansion will probably happen, and subsidies will help more people afford health insurance. On the down side, I have yet to see anything that makes me think we’ll make any substantive progress towards slowing the growth in healthcare costs.

In other words, we’re not going to get the full-scale overhaul of the healthcare system that our country needs, but we can make substantial improvements. President Obama seems to be trying to give us more realistic expectations for the pending legislation, and one of the most visible changes he’s making is to refer to the current effort as “health insurance reform” rather than “healthcare reform.” With his list of “Health Insurance Consumer Protections,” he’s trying to end some of the worst abuses of the insurance industry, like refusing people coverage based on past medical history, dropping coverage for those who become ill, and placing annual or lifetime caps on the healthcare expenses they’ll cover. These changes won’t solve the problem of rising healthcare expenditures overall, but they can prevent a lot of health-related bankruptcies. Here’s the complete list:

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In a national survey by the Emergency Nurses Association, more than half of emergency-department nurses reported that they’ve been physically assaulted on the job. For many nurses, being assaulted is a recurring problem: Approximately one-fourth of the 3,465 respondents reported experiencing physical violence more than 20 times in the past three years. While all hospital staff are at risk of both physical assault and verbal abuse, the problem is particularly severe in EDs, and against ED nurses in particular. 

In their article in the July/August Journal of Nursing Administration, the authors (Jessica Grack-Smith et al) explain who’s assaulting ED nurses and what the contributing factors are [references omitted]:

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by revere, cross-posted from Effect Measure

We’ve been rather kind to Senator Charles (Chuck) Grassley in the past. Yes, he’s a right wing Republican with some really odious ideas, ideas for which he deserves to be criticized. But he’s also been a champion of the Federal False Claims Act which has encouraged and protected whistleblowers to reveal how corporations have taken the taxpayer for a ride, something for which he deserves credit. Lately he has been on a tear about the ways Big Pharma has been buying influence with high profile medical professionals, with the direct implication that this has skewed their practice, their research and their publications (example here), if not resulted in outright falsification and fraud. He may be right in a number of these cases. His method is to publicize that academic researchers publishing on particular drugs or medical devices also receive undisclosed or unpublicized consultant fees or grants from the companies whose drugs or devices they publish favorable research about. We agree with him this is a conflict of interest. It’s not illegal but it does violate ethical principles. And for Chuck Grassley, the principle is the main issue.

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TIME’s Laura Blue notes that the U.S. has an appalling rate of preterm births (we were ranked 30th in the world in 2005, behind Cuba and Poland) and that prematurity costs us around $26 billion a year – but, she tells us, researchers don’t know why we have this problem. In many cases, there’s an apparent cause – like the mother’s age or health status, the babies being multiples, or a caesarean-section delivery – but doctors still can’t pinpoint a culprit in approximately 40% of preterm births.

Blue highlights the work of Emory University researcher Dr. Alfred Brann, who uses a different strategy than most other researchers studying this issue:

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Yesterday, President Obama announced his choice for the Surgeon General post: Regina Benjamin, a family doctor who built and repeatedly rebuilt a rural health clinic in Bayou La Batre, Alabama. She was the first African-American woman to be named to the American Medical Association’s Board of Trustees, became President of Alabama’s State Medical Association in 2002, and was named a MacArthur Fellow in 2008. In his remarks, though, Obama explained that it’s Benjamin’s experience delivering care in an underserved area that makes her such an appropriate choice at this particular moment:

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When discussing the costs of various healthcare reform proposals, it’s crucial to keep one thing in mind: doing nothing would be a financial disaster. If we don’t change the rate at which healthcare costs are growing, total health spending is projected to double over the next 11 years, from an expected $2.6 trillion this year to $5.2 trillion in 2020. Medicare and Medicaid will eat up a growing share of the federal budget; employers will stop offering insurance as premiums become harder to afford; and families will struggle to pay for needed healthcare. These problems all exist today, and they’ll only get worse if we don’t “bend the curve” – that is, do something to slow the rate of healthcare-cost growth.

President Obama doesn’t just want to control healthcare costs, though. He wants to make insurance coverage universal, and that will cost even more money. Expanding coverage can save some money over the long term – for instance, people can get health problems treated early, instead of putting off care until they end up in the emergency room. Such savings won’t come close to covering the cost of coverage expansion, though, and they certainly won’t show up in the 10-year horizon that Congress is considering. Really, the main reason to expand coverage is that it’s simply not right for 46 million people in the world’s richest nation to lack healthcare coverage.

Due to Congressional pay-as-you-go rules, new proposals must be either offset with savings or funded through increased revenues. (Although the amount to be saved and raised will vary depending on the specifics of each healthcare proposal, $1 trillion is a good ballpark figure to keep in mind.) Here are some of the ways to raise more money for health reform:

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