Bill Scher's LiberalOasis

Home of the LiberalOasis Radio Show, Bill Scher columns and other liberal commentary

Month: November 2009

Okay, I’m just gonna have to go all Doctor on you now

No, it doesn’t mean that I’m going to charge you for reading this. 🙂
I’ve talked about healthcare reform over and over again (I don’t see how Joan does it every day without going insane). I’ve talked about healthcare from an emotional standpoint and from an American legislative standpoint. I’ve talked about all the benefits of healthcare reform. Well, I’d like to take a different tactic. I would like to review the medical literature. I’ve picked several studies which I will describe over the next several days. The one thing that all of these studies have in common is that they point out that health insurance is a predictor of outcome. On Wednesday or Thursday, I’m going to review an article from the Journal of the American Medical Association which clearly states that having a unified health program has survival benefits (we don’t have a coordinated, organized healthcare system in the United States).

As a trauma surgeon, I don’t like to talk “shop” with people who are not in the medical profession. As soon as you start mentioning cytokines and mitochondria DNA, most people’s eyes glaze over. But, with watered-down legislation creeping through the Senate at a glacial pace, I thought it was important for me to go over some of this literature. The literature makes approximately the same point that Keith Olbermann made approximate monthly go when he talked about having health insurance being life-and-death.

In trauma, we, trauma folks, would like to think that we treat patients all the same. Many states have trauma systems, in which an injured patient, is shunted away from small hospitals that probably cannot help that patient and toward trauma centers who have the expertise and the manpower to help. This move has been shown to save lives. Most, if not all trauma centers have protocols which are then individualized for a particular patient. We have found through numerous studies that these protocols help save lives. Therefore, you would figure that the outcome of a patient who was seriously injured in a car crash would be directly related to his or her injuries which is true for the most part. A recent study has thrown a wrench in this.
A study, which was published in The Archives of Surgery in 2008, investigated over 400,000 patients which had been entered into the National Trauma Databank. One thing that we have known for years is that socioeconomic status does influence your outcome. As expected, mortality rates for Black and Hispanic patients were higher than those of White patients. Patients with insurance had a mortality rate of approximate half of those without insurance. Now, for the shocker — both Blacks and Hispanics with insurance who were injured had a mortality rate less than Whites without insurance.

This was a very surprising result. Numerous studies in trauma patients over the years have shown differences in outcomes amongst the races. As more and more studies have been done, it is clear that race is a surrogate for multiple other factors including eating habits, living conditions, and other things that can affect outcome. It is also clear that insurance acts as a surrogate for those same kind of factors. People with insurance have jobs. People with jobs drink less than people without jobs. People with jobs tend to live in better conditions than people without jobs. What was surprising is how strong insurance is as an indicator of lifestyle.

So, if every American has health care coverage will they all have better outcomes from trauma? Well, this question is somewhat hard to answer. On one hand, just having insurance does not get you to live in a better house, in a better neighborhood with better indoor plumbing and a refrigerator that works all the time. On the other hand, one of the huge problems that we have in the trauma community is that we have to send many people home from the hospital, after their hospital stay is over, when they should go to a rehabilitation center for more therapy but they can’t qualify because they don’t have insurance. These patients will instantly do better. Getting adequate health care coverage to all Americans is a step towards better equality.
I would like all members of Congress to read this article. This is important. This is what we’re fighting for. We’re fighting for a more equitable society. I’m not trying to take away any healthcare from anybody but instead, I want to add healthcare to those who don’t have it.
Tomorrow, I’m going to review an article called health insurance and mortality in United States adults. This article expands on the concept that insurance is a marker for outcome.

What happened to the truth?

Maybe I’m wrong but it sure seems like times have changed. At the risk of sounding like one of those old-timers in the movie Barbershop, it seems that words like integrity, honesty and truth have lost their meaning. As the two major parties clash over everything from healthcare to Afghanistan to global warming, it seems that they can’t even agree on the basic facts. We see this not just our leaders but everywhere around us. The other day when I was in my own barbershop, there was this older gentleman who had conspiracy theories involving the government, our preachers and, well, everybody. He had a lot to say. Unfortunately, a lot of what he had to say was devoid of facts. I don’t blame him. This is the way our society has been going for the last 30 years. Although “truthiness” (a term coined by Stephen Colbert which he defined as “truth that comes from the gut, not books.” In other words, stuff that we wish were true.) did not start with President Ronald Reagan, he brought it to the forefront. Former Speaker of the House Newt Gingrich, conservative columnist Ann Coulter and others have perfected this means of communication in which you start with something that is the truth and then segue into something that is almost true and end up with something that is completely false. To the unsuspecting observer, you made sense.

To say that the problems in the black community have been caused by the US government is laughable. Sure, maybe government programs like welfare did not help the black community, but it sure did not cause the problems with joblessness and lack of education and our youth growing up without fathers. It did not start with welfare or the Great Society. In The Philadelphia Negro, written back in 1897, W.E.B DuBois describes joblessness, black men fathering multiple kids and a lack of education in the black community. What we see now has been going on for over 100 years!

Do you remember August? The right wing was pushing several items that simply weren’t true. They told us that health-care legislation included death panels. There was no such thing in the legislation. They also told the elderly that, in order to save money, Democrats were trying to kill them off. This is simply a lie. I’m not saying that either the right or the left has a monopoly on truth. Neither side does but give me a break.
One of the common themes that heard over the last several years is that gay marriage will destroy the institution of marriage. I simply don’t understand this logic. I don’t know how somebody else who gets married – a man and a woman, a woman and a woman or a man and a man – I don’t know how they’re going to affect my marriage. Maybe it’s just me, but it seems that my marriage is mostly affected by me and my wife. I have a high likelihood of divorce if I forget my wife’s birthday or I buy her something ill-advised like a vacuum cleaner for our anniversary. I simply don’t see how gay marriage is going to affect it.
Finally, the new economic numbers came out for October. The economy still is not making jobs. Republicans have stood up and asked where are the jobs? This is a little gamesmanship being played by the Republicans. 190,000 jobs were lost last month, which is the lowest figure since the recession started. Any economist will tell you that business will need to start making money and feel good about their economic prospects before they begin hiring workers again. If people would like to criticize Obama’s economic plan, they should ask where are the jobs are going to come from? The lackluster Bush recovery was driven by the housing market. The housing market is currently problematic. New jobs are going to have to come from Obama’s green energy initiative.
I guess my point is that many people think that they know the answers to the ills of America. Most of our problems are complex and require a thoughtful solution. Anyone who gives you a knee-jerk answer to a complex question is probably leading you astray. There are definitive truths in our society. We just have to be willing to find them.

The LiberalOasis Radio Show: Copenhagen Preview Edition

The LiberalOasis Radio Show was broadcast Saturday at 12 noon on WHMP in Western MA. This week’s show features David Roberts from Grist.org previewing the upcoming international climate summit in Copenhagen and the prospects for clean energy jobs and climate protection legislation in the U.S. Senate. Plus, host Bill Scher on what to expect for today’s kickoff of the Senate health care debate.
You can download the podcast at these links: (iTunes / XML feed / MP3).

The Week In Blog: Way Too Much Palin Edition

The latest edition of The Week In Blog is up at Bloggingheads.tv featuring Matt Lewis and myself discussing blog reaction to the Palin book tour, Obama Asia trip and the Senate health care bill. Watch it below.
http://static.bloggingheads.tv/maulik/offsite/offsite_flvplayer.swf

The LiberalOasis Radio Show: Moderate Fail Edition

The LiberalOasis Radio Show was broadcast Saturday at 12 noon on WHMP in Western MA. This week’s show features Bill Scher on the failure of Senate moderates to take responsibility for watering down the impact of the stimulus, Valley Advocate’s Sarah Buttenwieser on the real-world impact of the anti-abortion Stupak amendment and “Momtroversies” essayist Traci Olsen on the day in the life of a wannbe Supermom.
You can download the podcast at these links: (iTunes / XML feed / MP3).

The LiberalOasis Radio Show: Post-Election 2009 Edition

The LiberalOasis Radio Show was broadcast Saturday at 12 noon on WHMP in Western MA. This week’s show features post-election analysis and the impact on health care and climate legislation, “Momtroversies” essayist Traci Olsen on the politics of vaccination, “The Optimist” Tom Pappalardo on his shoddy memory and “Poetry on the Radio” with Sarah Lariviere feels the loss of summer.
You can download the podcast at these links: (iTunes / XML feed / MP3).

The Week In Blog: Election 2009 Edition

The latest edition of The Week In Blog is up at Bloggingheads.tv featuring Conn Carroll of The Heritage’s Foundation and myself discussing blog reaction to the 2009 elections and the rise of economic populism. Watch it below.
http://static.bloggingheads.tv/maulik/offsite/offsite_flvplayer.swf

Immunity

There are two things I know very little about: medicine, cars, and the Law. (I am also not great at math.) So, like many people, I am sort of at the mercy of my doctor when I have medical decisions to make. She could tell me ANYTHING and I would just have to believe her.
‘Well, Traci, you have hematomiosis with recurring acne. Also your lug nuts are loose.” She seems like a nice enough person, very bright and un-evil, so I believe her, because I have to trust in someone. Similarly, my mechanic can tell me I need 4 liters of blinker fluid and that a new headlight costs $400– how am I to know?
As I wrote this yesterday, I got an email telling me that a person who has contact with my daughter is being treated for H1N1. So again, I have to make decisions on whether or not to immunize myself and especially my kid and I am again at the mercy of the medical profession.
Like most of you in the listening area, I did research before she was born, and made the informed decision – THAT WAS RIGHT FOR ME AND MY FAMILY AND IS IN NO WAY A JUDGMENT ON HOW YOU RUN YOUR LIFE FOR GOD’S SAKE DON’T BE Such A big baby- to stick mostly with the routine scheduled vaccinations. I almost didn’t do the chicken pox vaccine because I thought, really? I had the chicken pox it was no big deal I stayed home from kindergarten for a while and watched General Hospital with my mom every day. But then I was taking a stroller walk with other parents of tiny babies, and one of them happened to be a doctor, and he sort of turned white and got this 1000 yard stare and began to talk about his ER days, and dear lord woman, when chicken pox goes wrong it goes REALLY REALLY WRONG and I started to cry and tried to stroller my baby to the nearest walk in clinic and handcuff myself to the reception desk until they shot The Girl up with dead chickens or whatever it is they have to do. It was pretty traumatic.
And so here we are again, and we, as an informed, news watching public, are being pulled in a million different directions. If we vaccinate, Will she get the flu from the vaccine? Will she grow up to rob banks because she got the vaccine? Will she suffer horribly if she doesn’t get the vaccine? Will there even be enough vaccine to go around?
I am sympathetic to the alternative medicine way of thinking; I used to work for an acupuncturist, who prescribed me teaspoons full of some horrible tasting concoction; We use ginger for bellyaches, and Calms Forte for sleepless nights. I am not in the pocket of Big Pharma – I am unfortunately not in the pocket of anyone. I get the fear: having to count on someone else, essentially a stranger, to have the expertise to make decisions that affect your kids makes you feel powerless. Nobody loves your kid more that you do; how can they possibly make the best decision for them? Truth be told, and as attached as I am to other people’s children, if it means saving Audrey’s life, all those other kids can just fend for themselves, and I know other parents feel the same way. Having said that, I am firmly in favor of vaccinations, and I am a bit dismayed by the rise of non-vaccinations in the US.
(cue the angry mob coming to burn my house down)
I think it is disingenuous to call parents who choose not to vaccinate victims of pseudo-science or hippie morons who believe unicorns cure cancer. Like I said, it is scary to have to trust in experts, and the stakes are so high. Scientists are not always the best spokespeople for their cause, either; ask any nerdy person you know about the thing they are nerdy about, and your eyes will glaze over almost immediately. But, to quote a famous scientist, I recently read something Carl Sagan said about pseudo-science satisfying a human need and offering more comfort than cold, hard science:
“A great many of these belief systems address real human needs that are not being met by our society,” Sagan wrote this about the embrace of reincarnation, channeling, and extraterrestrials. “There are unsatisfied medical needs, spiritual needs, and needs for communion with the rest of the human community.” Simply put, science may be the truth, but our brains are hard wired to want more than that. So, I get it, I truly do. I am not inclined to just believe anything the government or big corporations tell me. I read 1984. But I do believe in science.
In a recent Wired magazine article, which I link to at my blog, it says:
“nonprofit health care provider Kaiser Permanente reported that unvaccinated children were 23 times more likely to get pertussis” which is whooping cough, and potentially deadly to infants. “Kaiser’s Institute for Health Research, revealed that the number of reported pertussis cases jumped from 1,000 in 1976 to 26,000 in 2004. A disease that vaccines made rare, in other words, is making a comeback.”
Choosing to not vaccinate your children is simply choosing a different risk- you are betting your kid won’t get the flu, or whooping cough, or polio. You are basing a lot of this bet on the fact that most kids do get vaccinated, so you are piggybacking on their continued good health. Statistically,however, the better bet is with getting the vaccinations. Especially in an area where a lot of parents are not vaccinating, there have been outbreaks of disease; most recently there was a measles outbreak in San Diego and one of mumps in Brooklyn. It would be heartbreaking to have your kid, or anyone else’s kid, get sick or even die because of the choice you make. Remember that babies don’t get a lot of these vaccines til later, so these outbreaks affect other people’s children as well as your own. So the stakes are high. No vaccination is risk-free, but we are also taking a greater risk by not vaccinating.
There is a huge debate over whether vaccines are terrible and bad and more specifically cause autism, it can be summed up by the following: science says it doesn’t, Jenny McCarthy, actor/playboy model/mother of an autistic child, says it does.
The controversy stems mainly from a preservative called thimerosal, which contains ethylmercury. Pregnant women are told not to eat fish because of the mercury content, so naturally freak out a bit when they hear about this preservative, and, somehow- the origins of this theory are unclear to me- it became linked with autism. Possibly because symptoms of autism show up around 18 to 24 months of age, around the time when kids typically get certain vaccines. Thimerisol has largely been removed from vaccines since 2001, yet the incidences of autism continue to rise, probably because of better diagnostics and clearly not because of mercury. There is also talk of the aluminum salts in vaccines used to increase antibody response, which also sounds really bad, right? However, one dose of antacid has about 1,000 times as much aluminum as a vaccine does. But, it’s too late. Many people have “vaccines = bad” already stuck in their heads. It doesn’t help that nobody knows exactly what causes autism, and autism has been in the news a lot in the past decade. We want to protect our kids, and we will do so in any way we can, right?
My cousin is autistic, and my aunt always laughs and says, “He’s not my problem child. His sister, on the other hand…” I in no way want to minimize the effort, the worry, the heartache of having a child with autism. However, i speak for my entire family when I say that we would very much rather have my cousin in our lives, rather than risk his life by exposing him to infectious and potentially deadly disease. Autism has never killed anyone. And, again, for the record, there are no reputable, peer reviewed studies that make the link between vaccines and autism. I have links to the CDC and FDA websites on my blog if you would like their take on it, as well as other sources.
I expect a lot of mail about this, a lot of name calling and rending of garments. Don’t disappoint me, people.
Links to articles on this subject can be found here.