McCain Obama Health Care Plans

August 21, 2008

Jonathan Oberlander, Ph.D. has written an excellent review of the candidates plans for healthcare reform in the recent New England Journal of Medicine. The article includes a succinct comprehensive summary of both candidates’ key elements for health care reform. His main criticism of the McCain plan is

” its reliance on the individual insurance market.”

“In contrast to John McCain’s emphasis on markets and deregulation, Barack Obama’s reform plan relies on an employer mandate, new public and private insurance programs, and insurance market regulation.”

Health care reform will be an important issue in the coming election and this article is a must read.


Childhood Injuries

July 20, 2008

My youngest son recently reminded me how difficult it was to grow up in the home of an emergency physician. All activities were ranked on a scale of 1-10 with 1 being almost no risk of injury, such as finger painting with non toxic paint to 10 being a good chance of injury, such as riding behind a neighbor’s car on a sled. There was always the reminder that high ranking injury activities would bring them into my ED on a stretcher. I was constantly telling them that the leading cause of death in children from 1-18 was unintentional injury and that injuries were not “accidents”.

Before the birth of my first child, I had childproofed the house with plugs in all outlets and no poisons in lower cabinets. I had posted the number for poison control on the refrigerator and removed all toxic houseplants. Bike riding was helmets only and when in a boat life preservers were mandatory. As they reached adolescence we had a driving contract which prohibited driving after dark for the first year. Since I had seen my share of underage drinking in patients, they were not allowed to stay with friends whose parents were not at home.

Did they have injuries…sure. Two anterior cruciate ligament injuries from team sports, a cut tendon from a knife, a smashed thumb caught in a car door ( A Volvo, of course) and an unavoidable auto crash ( in a 1990 Volvo).

So now that they are adults, I hope they remember the 1-10 injury grading scale when they are making their own decisions. We recently went swimming at a quarry with my oldest son and he was remarking how dangerous it was to dive off the rocks. I think he remembered.

The Ultimate Healthy Diet

July 4, 2008

I have finally found what I consider the ultimate healthy diet in Michael Pollan’s book “In Defense of Food”. He states it very simply:

Eat food, Not too much, Mostly plants

I have tried multiple diets including the “Diet for a Small Planet” approach by Fances Moore Lappe to eat complementary combinations of food. I have tried the low carbohydrate diet, the low fat diet, the no red meat diet and even the grapefruit diet. I scanned labels in the grocery store to learn the nutritional content of foods and to figure out the science of eating a healthy diet.

After reading this book, I buy mostly produce which comes with no packaging and no labels to confuse me with nutritional content. I am liberated by the statement “eat food, not too much, mostly plants.” It is so easy!

Presidential Candidates’ Health Care Reform Proposals

June 11, 2008

Health care will be a top priority in the next presidential campaign. As the candidates consider affordable heath care for every American, I hope they do not lose sight of public health and the huge achievements that have improved the health and extended the life expectancy of persons in the United States.

According to Senator McCain in response to an set of ten questions posed by the AMA to the candidates about their health care reform proposals.

“The most important players in health care; however, are the patient and their health care provider-as everyone else merely plays a support role”

I would like to remind Senator McCain of the Ten Great Public Health Achievements in the U. S. -1900 to 1999 which include:

  • Vaccination
  • Motor-vehicle safety
  • Safer workplaces
  • Control of infectious diseases
  • Decline in deaths from coronary heart disease and stroke
  • Safer and healthier foods
  • Healthier mothers and babies
  • Family planning
  • Fluoridation of drinking water
  • Recognition of tobacco use as a health hazard

Public health is a major contributor to the health of Americans and not “merely a support role”. Public health at the federal, state, and local level plays a critical role in disease prevention and health promotion.

Where does your food come from and how did it get to you?

May 24, 2008

I subscribe to Community Sponsored Agriculture (CSA) , Mattawoman Creek Farms, a local certified organic farm on the Eastern Shore of Virginia. CSA connects local farmers with local consumers. The subscriber purchases a share of the the harvest and in return receives a large bag of fresh local produce weekly during the growing season. In addition to supporting local farmers, CSA provides a direct link between the growing and the consumption of food. I now know how, where, and by whom my food was grown.

CSA gives me the opportunity to try many new local foods such as mizuna, bok choi, and tatsoi. I eagerly look forward to my weekly supply of fresh produce delivered directly from the farm. The iceberg lettuce wrapped in cellophane at the supermarket will have to wait until winter.

Flu Vaccine – Who gives the shot?

May 17, 2008

According to CIDRAP, the recent National Influenza Vaccine Summit led to some heated discussion over where patients receive their flu vaccine – public health clinics, personal physician, or alternative vaccination sites such as grocery stores, workplaces, pharmacies. Some physicians argue that alternative sites leads to fragmentation of health care and steers patients away from their “medical home”

One of the basic problems is who gets vaccine early and who has vaccine left when flu peaks late in the season. Primary care physicians argue that the alternative sites get vaccine first and their patients are tempted to go elsewhere for vaccination. In 15 of the past 25 flu seasons in the U.S. flu peaked in February or March and it is hard to locate providers with vaccine late in the season.

The summit was attended by many participants in the vaccination process such as manufacturers, clinicians, and public health. Hopefully this type of discussion can lead to innovative methods to improve vaccination rates.

Drugs – Country of Origin and Safety

April 26, 2008

Are the pills you take as safe as the food you eat? I can peel my imported fruit but I must swallow my pills without washing or peeling.

There was an interesting article in the Wall Street Journal about the country of origin of pharmaceutical ingredients.

“Indeed, the FDA requires drug companies to disclose only the name and place of business of the manufacturer, packer or distributor of prescription medications. Active and inactive ingredients must be listed on the label, but not the raw materials or their origins, which are considered “commercial confidential.”

Since the FDA does not have the resources to inspect all overseas facilities that manufacture ingredients, it is up to the pharmaceutical companies to ensure good manufacturing practices. The recent contamination found in the blood thinner heparin supplied by China shows that this system does not always work.

According to a recent article in the New England Journal of Medicine (NEJM) Trying Times at the FDA – The Challenge of Ensuring the Safety of Imported Pharmaceuticals by Stuart O Schweitezer, Ph.D

“This sort of problem should theoretically have been prevented by the FDA, which inspects foreign factories producing drugs and chemical components that are intended for export to the United States. Investigations are continuing, but preliminary information shows that the FDA did not inspect the plant, though it had intended to do so. The FDA’s program for inspecting foreign drug manufacturers has been swamped by a rapid increase in overseas manufacturing of both finished drugs and chemical components. The FDA has a mandate to inspect producers of both drugs and chemicals used to manufacture drugs (active pharmaceutical ingredients, or APIs) in order to certify that plants meet the current Good Manufacturing Practice (GMP) standards. Data on the number of foreign drug and API manufacturers are difficult to obtain. The FDA uses two databases listing foreign plants that are subject to inspection. According to a 2007 report by the Government Accountability Office (GAO), one database lists approximately 3200 establishments, whereas the other lists 6800.3 Even if the smaller number is accurate, the agency inspects only approximately 7% of foreign establishments in a given year, meaning that it could take at least 13 years to inspect them all — once. The FDA cannot say how many foreign plants have never been inspected.”

The pharmaceutical industry is increasingly using foreign plants and ingredients. The burden on the FDA to ensure that the drugs we take are are safe and pure is daunting. So what is the solution to this problem?

In a recent NEJM article Allastair J.J.Wood M.D. has a very reasonable suggestion.

“We need to acknowledge that ensuring the safety and integrity of our food, drugs, cosmetics, and medical devices is primarily the responsibility of manufacturers, with the FDA providing a regulatory framework and oversight. It is also critical that legislators recognize their responsibility to provide the agency with funding that is adequate for it to perform its important functions.”

“No longer should manufacturers be able to imply that inadequate FDA inspection is an excuse for adulteration of their product during manufacture. We must stop allowing the game of “kick the FDA” to be risk-free to participants. The public’s health is at stake, and the time for adequate federal funding of the FDA is now.”