Why Are American Health Care Costs So High?

Another brilliant video from John Green . . .



Green discusses the complicated reasons why the United States spends so much more on health care than any other country in the world. Who's at fault? Insurance companies? Drug companies? Malpractice lawyers? Hospitals? Or is it more complicated than a simple blame game?

Good stuff! Thought-provoking.

Why do Americans eat junk food?

I had heard this before, but Food, Inc. developed the theme with a brief look at the eating habits of one lower income family. "I can't afford good food," says the mother. It would be far better for her family--and especially her diabetic husband--if they were to eat vegetables, but a small helping of vegetables would cost more than a hamburger at a fast food restaurant. So fast food it is . . . as the family suffers the consequences of obesity and diabetes.

Reader's Digest featured a brief "Best of the Blogs" article in its October issue called Why That Salad Costs More than a Big Mac.

Look where federal food subsidies go--and then compare them to government dietary guidelines (which have problems themselves, but . . .)

Meanwhile, the government is proposing to take over our healthcare system. Who can afford healthcare nowadays, right?

But the largest factor in medical costs today? --The result of lousy nutrition.

So the federal government subsidizes not just poor nutrition, but actually debilitating nutrition . . . so that . . . what? It can subsidize the resulting necessary medical expenses?

Does this make sense?

Life Extension Magazine, October 2010 said,

Similar to the deferred effects of cigarette smoking, medical costs associated with obesity-related diseases are mostly postponed. This means that society has only begun to pay the enormous healthcare expenses that will accrue as overweight individuals succumb to cancer, vascular occlusion, kidney failure, diabetes, arthritis, early senility, and other illnesses.

The federal government’s meager steps to combat this calamity have failed. The evidence can be seen by the fact that nearly three times more Americans are obese today compared to 1960. A more startling statistic is that six times more Americans are morbidly obese (body mass index 40 and above) than in 1960.

Obese individuals (body mass index 30 and above) now comprise over one-third of the American population. Another one-third is overweight (body mass index of 25-29). The majority of Americans are thus destined to suffer higher incidences of degenerative diseases than this nation’s healthcare system can afford.

There's more, but I'll stop here.

Maybe those of us who can afford to eat properly ought to eat properly, despite government incentives to eat poorly. After all, it wasn't that long ago the average American family spent 30 percent or more of its income simply to eat. Few of us would need to approach anything close to that number to eat only healthy foods and all organic all the time.

But let us not "even" go that far. What if we "simply" modulate our intake of the truly awful "foods" (y'know, like soda pop, white-flour-and-sugar based sweets, French fries, potato chips and other similar deep-fried snacks), and what if we determined to eat at least half a pound a day, per person, of the cruciferous and deep green leafy vegetables? Those few changes might create a revolution in our personal health statistics.

Hey! Let's game the system!

As the rules become clear, the opportunities to push personal responsibility onto the foolish and gullible taxpayers also come to light.

If you don't have a major or chronic illness, forget buying insurance under the new national health care system. Save your money for when you really need it!

Brilliant, easy-to-understand, and mercifully short explanation of how to save thousands of dollars a year in medical expenses now that the government is here to save us all.

What's the word for this?

Oh, yes! "Moral hazard."

Reality begins to make itself known . . .

Since the passage of the new health care legislation, several major U.S. companies, including AT&T, Verizon, Caterpillar, Deere, Valero Energy, AK Steel and 3M, have announced that they expect the law will cost them billions of dollars in higher health care expenses and so they have announced they are taking one-time charges on their first-quarter balance sheets. Democrat leaders accuse them of politicking and have said they would hold hearings in late April to investigate "claims by Caterpillar, Verizon, and Deere that provisions in the new health care reform law could adversely affect their company's ability to provide health insurance to their employees."

I hope they do hold the hearings . . . and that the CEOs will be well-prepared with detailed answers--far more detailed, I expect, than any of their congressional inquisitors might be expected to have!

One corporate lobbyist said the CEO of the firm he represents had attempted to forewarn the president and lawmakers.

My CEO sat with the president over lunch with two other CEOs, and each of them tried to explain to the president what this bill would do to our companies and the economy in general. First the president didn't understand what they were talking about. Then he basically told my boss he was lying.

It will be interesting to see what comes from the hearings!

I expect they will be quite revealing.

Neither Waxman or Stupak . . . had anything more than a cursory understanding of how the many sections of the bill would impact business or even individual citizens before they voted on the bill, says House Energy Democrat staff. "We had memos on these issues, but none of our people, we think, looked at them," says a staffer. "When they saw the stories last week about the charges some of the companies were taking, they were genuinely surprised and assumed that the companies were just doing this to embarrass them. They really believed this bill would immediately lower costs. They just didn't understand what they were voting on."

Do these guys really believe that they and their staff members are able--even in a 3,000-page document--to put together something in a couple of years that is more efficient and effective than what thousands of companies working independently for dozens of years have put together?

These stories are just now beginning to leak.

• Deere announcement;
  
• Caterpillar press release;
  
• Wall Street Journal article;
  
• Editorial in the Las Vegas Review-Journal;
  
• Article in The American Spectator.

A medical story . . . for a bit more than "fun" . . .

I've been using LDN (low-dose naltrexone) for several months as an alternative therapy in hopes of treating my rheumatoid arthritis.

(Report: I'm not sure it's really done all that much good. Actually, I'm not sure how much good anything I'm doing has done. . . . I am quite sure that wheat is bad for me. I'm getting the impression that heavy doses of sugar (as in soda pop) can trigger inflammation. By and large, my inflammation and pain has been kept down to a very dull roar. But is that because I would have experienced a very slow progression of the disease anyway? --I don't know.)

Anyway.

I am continuing on my various therapies, and I continue to read what I can and pursue potential remedies.

So this morning I came across a reference in my Yahoo RheumatoidArthritis-LowDoseNaltrexone group to an article by Dr. Joseph Mercola in The Huffington Post. The article was actually primarily about a Dr. Burt Berkson and Berkson's work with Alpha Lipoic Acid (ALA).

I imagine the reason this article was referenced in the LDN group, however, was this statement:

Dr. Berkson uses ALA along with low dose naltrexone (LDN) for the reversal of a number of more serious health conditions such as:

• Lupus
  
• Rheumatoid arthritis
  
• Dermatomyositis (an inflammatory muscle disease)
  
• Autoimmune diseases 

Most of his patients normalize in about one month on this combination of ALA and LDN.

Whoa! I've been taking both LDN and ALA for quite some time. --I wonder how much ALA Berkson recommends?

So I did a search on burt berkson alpha lipoic acid rheumatoid arthritis and eventually came to Burt Berkson, MD, PhD, Talks With Honest Medicine About His Work and Our Medical System.

Mercola had summarized a bit of Berkson's story when he said,

Early on in his career, while an internist, he was given several patients who were expected to die from hepatitis C. His job was more or less to simply baby sit them in the ICU and watch them die.

But Dr. Berkson was a rebel at heart and he simply couldn't do that. Instead he called an associate at the National Institutes of Health and found out how he could treat them. He learned that alpha lipoic acid had some impressive experimental support. Remarkably, although these patients were expected to die within a few weeks, they all completely recovered!

However not all went well for Dr. Berkson. As he made his superiors look foolish, they simply could not tolerate that so rather than embrace his findings, they actively suppressed the results and made his life miserable for showing them up.

This was a pivotal moment in Dr. Berkson's career and caused him to make choices that eventually led to where he is at now. Since then, Dr. Berkson has lectured all over the world on this topic, and published a study on the use of antioxidants for the treatment of hepatitis C.

His first book, The Alpha-Lipoic Acid Breakthrough was published in 1998.

Well, the article I discovered--actually, an interview--told the whole story, in Berkson's words. Very much more interesting!

DR. BERKSON: I was a resident in internal medicine in a teaching hospital in Cleveland Ohio, and one day the chief of medicine came by and said, "I am very upset with you." And I said, "Why?" (I thought he was kidding.) And he said, "You have no deaths on your service. Most people have seen several deaths by now and you haven't seen any." And I told him that I really try to keep people alive. He said, "It’s very unusual. I’m going to give you two people who will surely die. They have acute and fulminant liver disease. They ate poisonous mushrooms, and the expert on liver disease said we cannot get a transplant for them, and nothing can save them. So I want you to go upstairs, watch them die, take notes and present this to grand medical rounds."

And I went upstairs and I looked at these two very sick people. And as a medical doctor, especially in internal medicine, you're supposed to follow the orders of the chief, just like a private would follow the orders of a sergeant. But I had six years of education above my medical training, for a masters and a PhD in microbiology and cell biology, and I was always looking for new things. So I called Washington and spoke to the head of the National Institutes of Health in Internal Medicine, Dr. Fred Bartter, and I asked him, “Is there anything in the world that he knew of that might regenerate a liver?” And he said he was studying alpha lipoic acid because he knew it would reverse diabetic neuropathy and other complications of diabetes. But when he gave it to people, it seemed to regenerate their organs. It seemed to stimulate their stem cells and to start growing and regenerating new organ tissue.

He sent the lipoic acid to me. I picked it up at the Cleveland airport about three hours later. The commercial pilot handed it to me. I ran back to the hospital and injected it into these two people for a period of two weeks. And in two weeks, they regenerated their livers fully. And they’re still alive and well, in their 80s, thirty some years later.

( NOTE: One of the people whom Dr. Berkson saved by "not following orders," Eunice Goostree, wrote a very personal review of The Alpha Lipoic Acid Breakthrough on Amazon.com.)

I was all excited. Washington was all excited. But the chiefs were not happy with me.

JULIA SCHOPICK: They were actually angry at you?

DR. BERKSON: Well, they seemed to be angry. They said, “We told the families that these people were going to die, that there was no hope. And now they’re alive and well. You know, it makes us look bad. And you did something without asking us for permission.” And I said, “You told me that these people were my responsibility, so I did what I thought was correct.”

I said, “Do you want to know what I did?”

“No.”

JULIA SCHOPICK: They were not even curious?

DR. BERKSON: They said: “This is not an approved drug. And it’s not on our formulary. And you did not follow orders like a good internal medicine doctor.”

I was sort of depressed by this. You know, it was very different from what I had seen as a professor of biology. You know, when I discovered something new in biology, everybody would pat me on the back and give me awards. In medicine, it seemed to me that if you discovered something new, you were sort of thought of as an outlaw.

JULIA SCHOPICK: If I had not heard this story -- I heard you speak at NOHA so long ago, and of course, I read your book -– it’s too depressing.

DR. BERKSON: Well, anyway, more people came in, and I was told I should not do this again. They'd also eaten poisonous mushrooms, which really destroys the liver, and there’s not much you can do for these folks, except a transplant or, in this case, lipoic acid.

And the National Institutes of Health started supporting my work. I think because of that, the people at the hospital I was at had to go along with what I was doing, and eventually Dr. Bartter and I published a paper on 79 people with so-called terminal liver disease, and 75 of them regenerated their livers, with just intravenous lipoic acid.

There was no interest in the United States; almost nothing.

JULIA SCHOPICK: Where was your article published?

DR. BERKSON: My first short note was in the New England Journal of Medicine.

And they weren’t really interested in a big study. My own personal opinion was that it was because there was no large pharmaceutical company sponsoring the work. There was no one to take out ads in the magazines (i.e., the medical journals), or to buy reprints from them.

But, Dr. Bartter and I were invited to Europe to be visiting scientists at the Max Planck Institute and we published it in Europe.

I think you will find the rest of the article equally interesting.

Check it out!
*******
Short political commentary.

Since it is only just over a week since our "representatives" in the federal government agreed to take over medicine in our country, I would like to ask you: do you really want people like the uninquisitive (but, I'm sure, truly compassionate--he was very concerned, for Dr. Berkson's benefit, that Berkson would become familiar with death and dying) . . . --Would you want such a man--the chief of medicine at the teaching hospital in which Dr. Berkson was working-- . . . Would you want such a man to be in charge of your medical care?

It's looking more and more as if that is exactly what you and I are in for.

(I spent many hours a couple of months ago writing a lengthy post about the problems associated with acquiring natural thyroxin here in the United States, but never quite finished it, due to the time it was taking me. --That's just one story, perhaps, that I should yet tell about how our medical options are, even now, and even without nationalized health care, being severely curtailed "from the top." . . . And now, with greater and greater centralization, I'm afraid the squeeze is going to become ever tighter.)

Maybe we're still the land of the brave. Maybe. But we are rapidly becoming the land of the very un-free.

Follow-up to DCA post

You may recall my post on a potential semi-universal cure for cancer.

One of my readers contacted a professional cancer researcher, a friend-of-a-friend, who offered the following input:

• A quick literature search indicates that there have been promising in vitro studies (using cells grown on plates) which show cancer cells dying after treatment. However,
  
• In vivo there has only been one animal study using rats to show a decrease in tumor size (one lab did it with Michelakis as first author on the paper).
  
• Keep in mind that nothing is really believable until it can be replicated in other labs.
  
• Many other papers indicate that ingestion of DCA in mice caused liver cancer and another showed damage to peripheral nerves.
  
• Basically, there are no human or even monkey studies to support the claims of DCA being a safe and effective drug for cancer treatment.

The same researcher then forwarded original versions of two articles:

1. A popular article from Nature magazine, written in March 2007 (almost three years ago, and just a month after the DCA story first came out in the scientific press: Cancer patients opt for unapproved drug

and,

2. An academic (but relatively readable) article by Dr. Michelakis, the researcher who first brought DCA to the attention of cancer researchers: Dichloroacetate (DCA) as a potential metabolic-targeting therapy for cancer. (This article was published in September 2008, but was first received for publication in December 2007.)

The first article takes a generally antagonistic stance toward patients who would ingest "unapproved" drugs:

Jim Tassano, who owns a pest-control and marketing company in Sonora, California, came across DCA when researching alternative cancer therapies to help his dying ballroom-dance instructor. He wanted something that was effective, safe and that he could lay his hands on: DCA fit the bill. He ordered some from chemical supply companies, teamed up with a chemist friend and they worked out a way to synthesize the compound themselves. “I couldn’t walk away from it,” Tassano says. “It could do so much good for so many people.”

Tassano set up two websites. The first of these (thedcasite.com) hosts information on DCA and a patient chatroom. On the second (buydca.com) Tassano is selling his homemade DCA. . . . Many patients taking DCA — acquired from Tassano, chemical companies or other sources — are reporting their progress on thedcasite.com.

And the problem with this, according to Dr. Michelakis and others?

Although DCA seems safe overall, they point to a clinical trial that was stopped early because those taking the drug developed damage to their peripheral nerves (P. Kaufmann et al. Neurology 66, 324–330; 2006). Without a control group, they point out, it will be impossible to tell whether any improvement in the patients’ condition is caused by the drug. Patients could also be taking DCA that is not of pharmaceutical grade and might contain harmful impurities.

Michelakis says the patients could end up undermining efforts to do a controlled clinical trial if, for example, some develop harmful side effects and the drug earns a bad reputation. “It’s destroying efforts to do this right,” he says. “Any way you look at this, it’s a negative development.”

"Any way you look at it," it's a negative development? From the perspective of the patients who have, otherwise, been given no hope?

The article's author continues:

The battle between dying patients who want immediate access to unapproved drugs and doctors who urge trials and caution is a perennial one. Some patients argue that they cannot wait for trials and should have the right to take unapproved drugs, regardless of the risks.

But there are arguments against this. An estimated 95% of cancer drugs that enter clinical trials do not get approval, many because they are ineffective or unsafe, so patients risk shortening their life or making their last days more uncomfortable.

Okay. But shouldn't it be up to the patients themselves to determine whether they are willing to take the risks? On what grounds should that decision be left to the government or the "powers that be" who get to "approve" drugs for trial?

Oh. And then there's another argument "against" permitting patients to make their own decisions about whether to use "unapproved" drugs:

[I]f patients can access DCA — or other unapproved drugs — there is no incentive for them to enter a clinical trial. So in terms of public health, ethicists argue, more people will be helped if access to unapproved drugs is restricted and proper trials performed.

So, apparently, selflessness is to be mandated by law. You must, by law, sacrifice yourself for the potential of helping others--"one day, maybe, long after you're dead, if we can just get the funding."

Peter Jacobsen, an expert in ethics, health and law at the University of Michigan in Ann Arbor, doubts whether any good can come of the patients’ efforts. They are so desperate to see results, he says, that there is no way they can report unbiased results and no mechanism to ensure the reports are accurate. “I don’t trust the data,” he says. “It’s hard enough to rely on them in clinical trials, let alone this.”

Okay. I'll buy that. I'll buy the need for caution and the need for skepticism. But . . .

Then I read Michelakis' article.

Remember that clinical trial that was "stopped early because those taking the drug developed damage to their peripheral nerves"? Michelakis notes,

[T]he first two randomised control trials of chronic oral therapy with DCA in congenital mitochondrial diseases were reported in 2006. In the first, a blinded placebo-controlled study was performed with oral DCA administered at 25 mg kg^-1 day^-1 in 30 patients with MELAS syndrome (mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes) (Kaufmann et al, 2006). Most patients enrolled in the DCA arm developed symptomatic peripheral neuropathy, compared with 4 out of 15 in the placebo arm, leading to the termination of the study.

Whoa! Sounds bad!

But he continues:

Seventeen out of 19 patients had at least partial resolution of peripheral neurological symptoms by 9 months after discontinuation of DCA. . . . No other toxicities were reported.

Beyond this,

It is important to note that peripheral neuropathy often complicates MELAS because of primary or secondary effects on peripheral nerves; for example these patients also have diabetes and diabetes-related peripheral neuropathy.

And then,

In contrast [to the negative results of this one study that was terminated], another randomised placebo-controlled double-blinded study failed to show any significant toxicity of DCA, including peripheral neuropathy. In this study only one of 21 children with congenital lactic acidosis treated with DCA orally at 25 mg kg^-1 day^-1 for 6 months demonstrated mild peripheral neuropathy. Serial nerve conduction studies failed to demonstrate any difference in incidence of neuropathy in the 2 arms (placebo vs DCA). Sleepiness and lethargy, muscular rigidity of the upper extremity and hand tremor were reported in one patient in each group (Stacpoole et al, 2006).

So what is Michelakis' view of the divergent results with respect to neuropathy?

The higher incidence of peripheral neuropathy in adult MELAS patients may represent an intrinsic predisposition to this complication in MELAS or its associated conditions, that is, diabetes mellitus; this toxicity might also be age-dependent. . . . [Moreover, a]s peripheral neuropathy is a frequent complication of taxane, platinum and vinca-alkaloid chemotherapies, the risk for DCA-associated peripheral neuropathy may depend on whether cancer patients have prior or concurrent neurotoxic therapy. . . . [But i]n summary, peripheral neuropathy is a potential side effect of DCA that appears to be largely reversible.

I want to quote one more section from Michelakis' article. Before I do, however, I would like to add some weight to what he said in the section I have just quoted. One of the moderators on thedcasite.com, Jay C, comments,

Researchers at the University of Alberta have reported that DCA is relatively non-toxic, since it has already been used as a medicine on adults and children to treat metabolic disease, and for hypertension. It has been known to have some mild side effects in a minority of patients and they include a change in gait [and] some nerve problems, but both of these symptoms appear to be reversible upon cessation of DCA. This is certainly in positive contract to most of the poisons being administered today as "chemo", including IL-2 (requires on[e] week in ICU), Interferon, and DTIC.

So why the apparently special concern over possible complications from DCA? Is it really scientific objectivity at work here? Or, possibly, something else? [Fear of losing power on the part of gatekeepers like the FDA? Fear of lost profits on the part of major pharmaceutical companies? "The preclinical work on DCA (showing effectiveness in a variety of tumours and relatively low toxicity) (Bonnet et al, 2007), its structure (a very small molecule), [and] the low price (it is a generic drug) . . ., provide a strong rationale for rapid clinical translation," Michelakis says early in his article. Oh. I should probably include the last comment that I elided from the immediately preceding quote. One other factor that ought to provide a rationale for rapid clinical translatioin? " . . . and the fact that DCA has already been used in humans for more than 30 years" (presumably without notable safety concerns).]

The concluding paragraph in Michelakis' article adds another note of interest to this reader:

[E]ven if DCA does not prove to be the ‘dawn of a new era’ (Pan and Mak, 2007), initiation and completion of clinical trials with a generic compound will be a task of tremendous symbolic and practical significance. At this point the ‘dogma’ that trials of systemic anticancer therapy cannot happen without industry support, suppresses the potential of many promising drugs that might not be financially attractive for pharmaceutical manufacturers. In that sense, the clinical evaluation of DCA . . . will be . . . [a] paradigm shift.

While I'm at it, I ought to include one last note. A "Note to Proof" appended by the editors of the British Journal of Cancer at the end of Michelakis' article:

Since the acceptance of this review two important papers have confirmed the novel anticancer effects of DCA in prostate and endometrial cancers: Wong JY et al, Dichloroacetate induces apoptosis in endometrial cancer cells. Gynecol Oncol June 2008; 109(3): 394–402 and Gao et al, Dichloroacetate (DCA) sensitizes both wild-type and over expressing Bcl-2 prostate cancer cells in vitro to radiation. Prostate 1 August 2008; 68 (11):1223–1231.