photo credit: klaxtonphoto

I’m reading a letter to my friend (an internal medicine physician) from the Medical Outreach Coordinator of an organization called Hawkwing, a non-profit out of Glastonbury, CT. Hawkwing serves the people of the Cheyenne River Sioux Tribe (CRST) reservation, current home of the Cheyenne River Lakota Nation in South Dakota. The letter is a request for volunteers. More on that in a bit. 

The CRST sits on 4,000 square miles: approximately 3 million acres, about the size of Connecticut, and is made up of 15,000 people. The reservation has death rates higher than all other Americans: from tuberculosis (750% higher); alcoholism (550% higher); diabetes (190% higher); unintentional injuries (150% higher); homicide (100% higher); suicide (70% higher). 

Bleak numbers for a desperate situation. Talk about badlands. 

The CRST was originally created in 1889 after the defeat of the Lakota by the United States in a series of wars in the 1870s, and today it’s the fourth largest reservation in land area in the country -about the size of Connecticut. By treaty, the Lakota were originally granted a single large reservation covering North and South Dakota plus four other states, but after the wars, half of the reservation was confiscated by the US government, and in 1948, an additional 8%- 100,000 acres- was submerged by the damming of the Missouri River and the creation of the Oahe Dam for electrical generation and flood control. 

Today, the people of the reservation live in miserable conditions. With few jobs available, the unemployment rate is 88%, and over 90% of the community lives below the poverty line. Education is underfunded; dropout rates are 70%. Housing is critically appalling, with many living in ramshackle homes without running water, electricity or telephones. Water systems are lacking in general, and many of those in existence are polluted. Health care is deplorable. Services are under staffed and underfunded, and the nearest medical center is three hours distant. Life expectancy is 48 years, the lowest this side of Somalia. Infant mortality is three times US rates. Grim. And grimmer:

Per Capita Personal Health Care Expenditures Comparison:  

 Indian Health Service’s (IHS) user population: $2,690 

 Total U.S. population: $6,826 

Hawkwing’s website states that the organization is “a Native American Federal non-profit 501(c)3 organization created to offer cross-cultural education while assisting the people of the Lakota (Sioux) Cheyenne River Indian Reservation in South Dakota meet their basic human needs.” The letter from coordinator Elaine Reynolds, RN, BSN discusses gynecological needs on the reservation: “We would like to provide a gyn clinic… cervical cancer rates are the highest in the country…Elder Women cannot be seen by male gynecologists (and) there is only one male gynecologist available for the women of the reservation. He is only funded to provide 200 hours a year of gyn care and 200 hours a year for obstetrics to cover 2,500 women and …250 pregnancies annually.” That’s a 0.19 full-time equivalent- ten full days- to take care of the ob-gyn needs of 2,500 people. 

I’ve mentioned here and there about the dangers of believing everything you read regarding health care in the mass media. Now along comes this article from Science News which puts it bluntly: “if you believe what you read in the scientific literature, you shouldn’t believe what you read in the scientific literature.”

Great.

The author Tom Siegfried’s main emphasis is on statistics, as in “science fails to face the shortcomings of statistics”. And it gets better: “any single scientific study alone is quite likely to be incorrect, thanks largely to the fact that the standard statistical system for drawing conclusions is, in essence, illogical. “A lot of scientists don’t understand statistics,” says (biostatistician Steven) Goodman (of the Johns Hopkins University School of Public Health). “And they don’t understand statistics because the statistics don’t make sense.””

Siegfried goes on to look at the specifics of statistics, as in this regarding Fisher’s P: “there’s no logical basis for using a P value from a single study to draw any conclusion”.

Oh man. There’s more; lots more, too much to chew in one sitting. Read it.

Interesting take on the flu crisis that didn’t happen.

Check out this 35 second video.

I was catching up on my Facebook  news, and came across a lively give-and-take regarding health care reform. Basically, the points were: Republicans should be held libel for treason for holding up reform, vs, we don’t want big government.

So, I let loose:

Please take a few moments and get an objective view of what is happening with health care reform. Both parties are spinning the facts, but the bottom line is what the bill actually says.

Thing is, just about any bill would be better than what we have now. There are 50,000,000- 50 million- people uninsured, and that number goes up every day. Arizona has dropped its CHIPS program and put 47,000 low-income children at risk. 30% of Americans are having trouble paying their health care-related bills.

I’m extremely proud to be an American, and the democratic system, although flawed, works, and it will only keep working if Americans respond to the social need: we help our neighbors so we can all move together to keep our country great. It’s the ethical thing to do. It is the moral thing to do. It is the only reason we inhabit this planet: to move the next generation into the future and maintain our fragile relationship with life.

Social Security, Medicare, Medicaid, Unemployment Insurance, COBRA: all social government programs and institutions, without which how many millions of Americans would be left destitute, ill, and forgotten.

Yes, I will pay extra taxes to help the poor, the sick and needy. That’s the way I was raised.

Treason? “Outside legal spheres, the word “traitor” may also be used to describe a person who betrays (or is accused of betraying) their own political party, nation, family, friends, ethnic group, team, religion, social class, or other group to which they may belong.” (http://en.wikipedia.org/wiki/Treason). Maybe in the aforementioned sense. Republicans are the party of the corporate, the rich, and the beholden. We all know that.

The biggest problem that I see is that people are not looking at the facts. They are getting their news from the right-leaning loudmouths, FOX TV, and self-centered internet sites. Or from the left hand liberals, who do not have a corner on what is right. Facts, data: read it and then make an opinion.

I’ve been in the health care industry for 30 years and I’ve seen it all. Nothing, absolutely nothing has ever been this bad, this screwed up. If we don’t change things now, the future of our country, of our children, and of our children’s children, will never be the same.

The American College for Physicians:
“Why ACP supports a “yes” vote … the facts: I expected spirited commentary on ACP’s position on the final health reform bill, including taking our fair share of lumps. Particularly at a time when emotions are running high, I think the debate needs to be informed by the factual and substantive reasons for ACP’s posture.
ACP’s website has a new two page summary, a more detailed section by section analysis of how the legislation compares with ACP policies, and responses to Frequently Asked Questions about the legislation.”

“Most Americans have self-rationed health care due to cost in the past year: The health care cost crisis has hit at least 1 in 2 American families, based on the latest Kaiser Family Foundation Health Tracking Poll.
KFF found that 30% of Americans have had trouble paying medical bills in the past 12 months. Challenges paying for health care increase if you’re black, Hispanic, earning under $40,000 a year, or….in poor health.”

“Arizona Drops Children’s Health Program”

“CBO Figures Show Health Care Bill Would Cut Deficit”

“How Does the Reconciliation HCR Bill Compare on the Numbers?”

“Number of uninsured Americans could grow by 10M in five years”
A RWJF report projects that by 2015, there could be as many as 59.7 million people uninsured, and that number could swell to 67.6 million by 2020. An estimated 49.4 million individuals were without health coverage in 2010.
The report also shows that spending on government healthcare programs for the poor could more than double by 2020.
Analysts at the Urban Institute used a Health Insurance Policy Simulation Model to assess the changes in coverage patterns and healthcare costs that will occur nationally from 2010 to 2020 if major reforms aren’t enacted.

How Does the Reconciliation HCR Bill Compare on the Numbers?

Radial Artery Matches Saphenous Vein for CABG

“The radial artery is easiest to harvest and taking it doesn’t impair blood supply to the arm, Goldman noted.”

…leaving only the ulnar artery to  supply blood to the hand (?).

from MediaWatch:

“I think I admitted last week that I was getting a bit wrinkly. Well, apparently lots of Australians, much younger than me, think that about themselves, and it causes them all sorts of angst – at any rate, that’s what the media breathlessly told us last Wednesday.”

It all starts here.

photo credit: quinn.anya

The Age, a large 155 year old newspaper in Melbourne, Victoria, AU, printed a story by Nick Miller on September 9, 2009, entitled “New leukemia treatment doubles remissions”. The article describes the medication Magthera, a ten tear old drug used for non-Hodgkins lymphoma (cancer of the lymphoid tissue, i.e. lymph nodes, spleen, and other organs of the immune system; according to the American Cancer Society, a person has a 1 in 50 chance of developing non-Hodgkin’s lymphoma) as a new treatment for adult leukemia (cancer of the white blood cells; estimated new cases and deaths from leukemia in the US in 2009: new cases, 44,790; deaths, 21,870). In the article, Professor John Seymour of Melbourne’s Peter MaCallum Cancer Centre is quoted as saying that “This is the largest single advance in the treatment of this disease in the last 30 years. In most medicines we are used to small steps – this is an improvement of substantial magnitude.” But get this: 1) there are no peer-reviewed published studies, only a presentation at a conference in 2008; 2) Professor Seymour disclosed that he has acted as an adviser for Roche, the manufacturer of the drug; and 3) a minor $24,000 per treatment cycle.

Now on to Crikey, an independent news source also in Melbourne, who on March 17, 2010 published the article: Spinning the Media: PR 101 for drug companies. The item discusses the original The Age article, and states that on September 10, 2009, Dr Ian Haines, an oncologist at Melbourne’s Cabrini Hospital, wrote a letter to The Age raising his concern that the article was misleading. “It was an exaggeration of the benefits of the treatment with no presentation of the downsides … which is that it’s incredibly expensive, it’s not without risk,” he told the Australian Centre for Independent Journalism.

The same day, Miller explains in his blog how the story came about, stating that the abject boosterism was his fault for “not asking the right questions and not seeking comment from a second oncologist”. He goes on to explain: “I got an email from Peter Mac — a cancer hospital in Melbourne — saying ”Please find attached today’s press release detailing a breakthrough in adult leukaemia treatment — following international trials in which associate professor John Seymour, from the Peter MacCallum Cancer Centre, led the Australian involvement.’”

Here are some additional facts:

• Missing from Miller’s article and blog was the fact that the PR promotion around Mabthera was being driven by Roche itself.
• The media around the drug was managed by Roche’s PR company, Cube.
• The MacCallum Cancer Centre receives considerable funding – $400,000 in 2008- from Roche to run joint research projects.
• Miller said that he didn’t receive the Cube press release.
• According to a Cube account manager, Miller received the press release on the day the article was written.
• Of note, Cube is a health PR company that claims that journalists can shop there for “all the elements needed to write your story.”
• Cube was exposed in 2009 for illegally promoting a prescription medication (under the TGA- the AU Therapeutic Goods Act), and subsequently Eli Lilly AU was fined $60,000 for breach of conduct rules.
• Sections of the Cube and MacCallum press release are identical, including Professor Seymour’s comments.

This might be all a big to-do about nada, but Crikey’s article also states that warnings from the TGA and the USFDA detailed connections of Mabthera with three deaths from PML, which is a reactivation of a virus in the central nervous system of the immune-compromised. But the bad news had been overridden by PR hype in a way that has become a routine in the world of Big Pharma and the medical elite. Health journalism is also sometimes guilty of promoting the novel to the detriment of the consumer, misinforming in its way to a quick and easy PR-supplied story. Consider this from the Crikey story:

“One example is the media treatment of Bayer’s contraceptive pill Yaz, which was widely praised before its release in September last year.

Under the headline “Miracle cure all”, The Daily Telegraph wrote “Not only does a new pill, Yaz, act as a contraceptive, it promises to relieve pain, acne, weight gain and mood swings in what will be a godsend.”

One journalist told us: “The Tele ran it in such a way that it looked like it was the most amazing breakthrough since the discovery of the pill in the 1960s. But when you look at it closely it’s clear there isn’t a great difference to existing contraceptives in terms of what it does. Experts working in this space would have looked at that with shock.”

If they did look at it with shock, this certainly wasn’t reported by the media.

Nor has it been reported that a study in the British Medical Journal found Yaz to produce a fivefold increase in the likelihood of women developing dangerous blood clots. German public broadcaster Deutsche Welle reported that seven women have died in Germany while taking drugs from the Yaz family since 2001, while in the US Bayer is reportedly facing 129 law suits due to safety concerns surrounding the drug.  None of this has made the news in Australia.

Because drug companies (and even the Therapeutic Goods Administration) rarely put out media releases publicising this kind of news, journalists who rely on PR to generate their stories are much less likely to report these types of medical concerns.”

(This story originally discovered at Covering Health.)

photo credit: Lone Primate

Weary men, what reap ye? Golden corn for the stranger.
What sow ye? Human corpses that wait for the avenger.
Fainting forms, Hunger—stricken, what see you in the offing
Stately ships to bear our food away, amid the stranger’s scoffing.
There’s a proud array of soldiers—what do they round your door?
They guard our master’s granaries from the thin hands of the poor.
Pale mothers, wherefore weeping? ‘Would to God that we were dead—
Our children swoon before us, and we cannot give them bread.

Jane Francesca Elgee