Diet and Nutrition. Natural Health, and Healthy Living

Are we finally ready to close the door on the much-disputed link between the MMR vaccine and autism?

On January 30, Britain’s General Medical Council ruled that Andrew Wakefield, a gastroenterologist, had acted “dishonestly and irresponsibly” in conducting his research that established a link between autism and the MMR vaccine. And yesterday, the British medical journal Lancet finally retracted the resulting 1998 study authored by Wakefield that helped drive MMR vaccination rates in the U.K. down to the point where in 2008, measles was officially declared “endemic” in the country.
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The tempest that greeted the United States Preventive Services Task Force guidelines on mammography screening for women in their 40s prompted the Senate to insert a mandate in its health care reform bill that every insurer cover every mammography screening test at no cost to beneficiaries. If it passes, it will spark an upsurge in mammography screening, especially among women under 50, and raise the nation's health care tab.

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For a Broadway stage, the set is simple and spare – a long, white leather couch, a handful of wooden tables and chairs. No ornamentation is needed; the stories being told on the stage are what command the audience’s attention. Let Me Down Easy is health reform as poignant, funny and gripping theater.

A supermodel compares the high-powered physicians a cosmetics company gets her after she signs a lucrative contract to the doctors she had access to during her working-class childhood. A middle-aged woman emotionally refuses dialysis because of the terrible injuries her daughter sustained while undergoing dialysis when a hospital’s mistake left her covered in blood. And a cancer patient hospitalized with a post-chemotherapy fever describes being told not to take it personally that her chart has been lost: “that happens here quite a bit.”

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As many involved in the worlds of Health 2.0 and Information Therapy know, some of the most interesting experiments in the world of patient-physician engagement have been happening in the somewhat unlikely environs ofsmall townOklahoma. There the City of Duncan has put its employees (and their providers) into a system that incents (but doesn’t mandate)physicians to practice according to accepted guidelines, and incents (but doesn’t mandate) patients to read information prescribed by their physicians about their treatments (and tests them about it). The system then asks each party to rate the other.

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America’s hospitals are a triumph of modernity, stocked as they are with PET scanners, ECMO machines, and ICUs bedecked in eye-popping gadgetry.

They are also the most complex organizations ever created by man. The seemingly simple process of delivering a drug from the pharmacy to the bedside for example, typically involves a 30-step process executed by a half-dozen people on 3 floors. There are hundreds of ways it can fail.

It often does, and that’s just half the story. Each hospitalized patient requires a unique combination of services including lab tests, physical therapy, a discharge plan and so forth. Since a complex process must be executed to produce each service, the hospital becomes a job shop.

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In this Wall Street Journal op-ed, Norbert Gleicher suggests that expert panels won't improve health care because the the quality of the research on which they would base their physician practice guidelines is not reliable. Instead, he suggests that our system can self-correct when experts lead us astray. He asserts that we have a "well working free market of ideas in health care, where effective therapies can rise to the surface and win out."

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Here’s a dirty little secret: Cutting health care costs is not that difficult, nor will it harm patients. That’s because it only involves giving up unnecessary medical care—tests and treatments patients may want but really don’t need because they don’t benefit their health.

How is this supposed to happen? In Minnesota we call it “unallotment.” When the state had to reconcile a projected multibillion dollar budget deficit this year, and the Republican governor and Democratic lawmakers couldn’t agree on how to do it, the governor simply “unalloted” billions of dollars of planned expenditures.

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With scant public input, state and federal officials are pushing ahead with plans that -- during a severe flu outbreak -- would deny use of scarce ventilators by some patients to assure they would be available for patients judged to benefit the most from them. 

The plans have been drawn up to give doctors specific guidelines for extreme circumstances, and they include procedures under which patients who weren’t improving would be removed from life support with or without permission of the families. 

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The problem in the current political climate with the health care policy debate is that the real issues all too often get subverted. The travesty that momentarily turned end of life issues, quality of life, and palliative care, into ‘death panels’ is Exhibit A. It has been well characterized on The Health Care Blog by Bob Wachter with references to excellent articles in The New York Times and Joe Klein’s piece in Time. Like so many issues in health care reform the hysteria that ‘government’ was posed to step in and dictate our options as to how we would die and what final options we might have is sadly misplaced. Reality holds its own sadness because too few of us get to die the death we would choose and when we do choose our death it’s the current health care system and our trusted friends and family who inadvertently subvert our best intentions.

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After generations in denial, doctors and lawmakers are paying attention to the importance of allowing sick people a dignified death, and to the value of helping patients and their families let go and say good-bye. Aggressive medical intervention in terminal cases is increasingly considered an avoidable cruelty, inflicted on a suffering patient by someone -- occasionally a doctor, but more often a family member -- unable to acknowledge the inevitable.

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