The good news is: the House passed health care reform. The work isn’t completely done yet, of course. The House had already passed a heath care bill, months ago, but this isn’t it; last night they passed the Senate’s version of the Bill, which had some glaring flaws. Under ordinary circumstances the House and Senate would get together and hammer out a compromise between their two bills. But in the meantime Republicans picked up an extra Senate seat in Massachusetts after Teddy Kennedy died, and they had promised to filibuster the compromise package. (Because, after all, what courageous moral stand could be worth invoking arcane parliamentary procedures more than the fight to prevent millions of people from getting health insurance, especially if that was the life’s goal of the Senator whose death allowed you to improve from having twenty fewer votes than the opposition to only having eighteen fewer votes?)

So Obama will sign the Senate bill that the House just approved, and then the Senate will consider a reconciliation bill also passed by the House last night. Under even-more-arcane procedures, the reconciliation measure can be passed without threat of filibuster. It requires only “majority vote,” a quaint notion in this highly baroque age.

It’s not an especially huge bill, whatever you may have heard, but it will have an impact. Here is a list of the major impacts, and an interactive graphic to figure out how you will be affected. The most important features seem to be:

• Establish health insurance exchanges, and provide subsidies for people below four times the poverty line.
• Guarantee insurance for people with pre-existing conditions, and eliminate “rescissions” that take away insurance from people who get sick.
• Push business to provide insurance for their employees, and self-employed individuals to buy insurance for themselves.
• Close the “donut hole” in the existing Medicare payout structure.
• Implement cost controls (mostly through slowing the growth of Medicare spending), thereby lowering the budget deficit by $130 billion over the first ten years, and by another $1 trillion over the next ten years.

Overall, it’s a relatively incremental bill, placing bandages over some of the more egregious wounds in the current system, while leaving in place the essential structure through which we funnel billions of dollars to middlemen while paying far more for medical care per person than any other country without getting better results. For 90% of Americans, coverage and insurance will continue as before. Basically, this brings us a little closer to where Western Europe was a century ago.

Still, a tremendous political accomplishment — maybe not from the perspective of what we were hoping for when Democrats took control of both houses of Congress and the Presidency in 2008, but certainly from the perspective of the last couple of months, when it often seemed like we weren’t going to get anything at all. More than anyone, credit for the accomplishment goes to Nancy Pelosi, who didn’t give up when things looked grim. From now on she won’t simply be known as the first female Speaker of the House, but one of the most effective leaders in its history. Here she is marching to the Capitol yesterday, arms linked with civil-rights pioneer Representative John Lewis from Georgia, carrying the gavel that was used when Medicare was passed in 1965. An historic moment.

Which brings us to the bad news. One of the reasons why Pelosi was marching with Lewis was to demonstrate support a day after this man who had marched at Selma was repeatedly called “nigger” by protesters outside the Capitol. Ugly by itself, but worse in context: it’s becoming harder and harder to have a meaningful debate in this country without participating in a race to the rhetorical bottom.

There exist reasonable arguments against health-care reform; not arguments I agree with, but ones that at least make superficial sense. It costs money to provide insurance for the uninsured, and someone will have to pay. Asking healthy people to buy insurance will be a burden to them. There will be less extra money floating around if we cut down on unnecessary costs, which might impede the pace of medical innovation. (I didn’t say they were great arguments, just that they made superficial sense.) But these aren’t the arguments that are actually made most frequently. Instead we hear that the Democrats are abandoning the principles of representative democracy by passing legislation while they control both legislative houses and the executive; or that liberals won’t stop until they have swept away the last vestiges of personal choice in American life; or that the government wants to decide when to kill granny. Right-wing bloggers nod with approval at the idea that people are stocking up on guns, preparing for fighting in the streets. The race to find the most scary and overheated characterization of a pretty benign state of affairs is a fierce one.

The most depressing aspect of the situation is not the existence of crazy fringe elements — those will always be with us, on both sides of any issue — but of the reinforcing dynamic between the fringe and the supposedly respectable parts of the Republican party. It’s been clear for a while to most people (outside the White House, anyway) that Republicans in Congress made a clear choice that their own self-interests are served by preventing Democrats from passing any meaningful legislation, whatever that might mean for the good of the country. Speeches during House “debate” last night consistently played to the worst aspects of the protesting mob. One Congressman shouted “baby killer!” at Democrat Bart Stupak, who is staunchly anti-abortion, as he spoke to support the bill. [Update: it was Randy Neugebauer (R-Tex.).] Two protesters inside the House chamber were arrested for being disruptive — and “several Republican lawmakers stood up and cheered during the interruption.”

Lest you think this is simply concern-trolling from a liberal telling conservatives to be less intrusive, note that conservative commentators like David Frum are making the same point: the rhetoric has gotten out of hand, and it’s not good for anybody, except maybe the “conservative entertainment industry.”

I’ve been on a soapbox for months now about the harm that our overheated talk is doing to us. Yes it mobilizes supporters – but by mobilizing them with hysterical accusations and pseudo-information, overheated talk has made it impossible for representatives to represent and elected leaders to lead. The real leaders are on TV and radio, and they have very different imperatives from people in government. Talk radio thrives on confrontation and recrimination. When Rush Limbaugh said that he wanted President Obama to fail, he was intelligently explaining his own interests. What he omitted to say – but what is equally true – is that he also wants Republicans to fail. If Republicans succeed – if they govern successfully in office and negotiate attractive compromises out of office – Rush’s listeners get less angry. And if they are less angry, they listen to the radio less, and hear fewer ads for Sleepnumber beds.

I’m not sure what the end game is — whether it’s possible to step back to a more reasonable dialogue. Disagreement is good, and it’s important to have an active and engaged opposition party, no matter who the majority party might be. But whipping up hysteria at the cost of working together constructively isn’t in anyone’s interests. Obama campaigned on a message of hope and change and bipartisan togetherness, and I think that was a sincere message on his part; but it certainly hasn’t come to pass, and there doesn’t seem to be any indication that it will.

The anti-vaccination movement is a little weird — they claim that vaccines, which are universally credited with wiping out smallpox and polio and other bad things, are responsible for causing autism and diabetes and other also-bad things, all just to make a buck for pharmaceutical companies. The underlying motivation seems to be a combination of the conviction that things must happen for a reason — if a child develops autism, there must be an enemy to blame — and a general distrust of science and technology. Certainly the pro-science point of view is fairly unequivocal; like any medicine, vaccines should be used properly, but they have done great good for the world and there are very real dangers of increased risk for epidemics if enough children stop receiving them. Good for WIRED for taking on the issue and publishing an uncompromisingly pro-science piece on it.

But the anti-vax movement is more than just committed; they’re pretty darn virulent. And since the article came out, author Amy Wallace has been subject to all sorts of attacks. She’s been documenting them on her Twitter feed, which I encourage you to check out. Some lowlights:

It’s pretty horrifying stuff. But there is good news: Wallace also reports that the large majority of emails she has received were actually in favor of the piece, and expressed gratitude that she had written it. There are strong forces arrayed against science, but the truth is on our side, and a lot of people recognize it. It gives one a bit of hope.

Listening to the current health care debate is unbelievably depressing. It isn’t really a debate about healthcare at all. Instead, it has devolved into a debate about all the conservative boogeymen: big government, high taxes, Obama personally telling your doctor what to do. The “debate” is fundamentally unmoored from the actual proposals being set forth. This is one of the most important public discussions this nation has had in recent memory. The results will directly impact each and every American. And yet, the entire debate is completely incoherent and misleading.

The possibility of a “single-payer” healthcare program has fallen off the table. I’m not sure exactly how or when this option became untenable, but it shows how quickly the efforts of pharmaceutical and insurance companies can reframe a discussion. After all, there are billions upon billions of dollars at stake, which is precisely why it is such a profound issue for our long-term fiscal health. It is not at all surprising that these companies are spending millions to defeat meaningful reform. The essential goal of this reform, after all, is to reduce the amount of money our nation spends on health care (while improving overall care). Which is not at all in the interest of these companies. What is astounding is that they are actually succeeding in derailing the discussion into lunacy.

Now it looks as if a “public option” will fall victim as well, and be eliminated from consideration. An (incredibly vocal) minority has become convinced that the public option will destroy capitalism, and that Obama is the second coming of Hitler. Really. These people live in an alternate Universe. Here is a two-minute summary of the public option by Robert Reich:

As Paul Krugman says, “the argument against the public option boils down to the fact that it’s bad because it is, horrors, a government program.” In addition, “the argument against it is sheer nonsense. It is nothing but the insurance lobby.”

In a few minutes Obama will give a much-anticipated speech on healthcare. We can only hope he is able to change the nature of the discourse. We are at a critical juncture. The whole nation is focused on fixing healthcare. The diagnosis is clear. The patient is in crisis. Prospects for recovery are increasingly slim. Heroic action is needed.

Update: Text of the speech can be read here. Obama made a range of proposals, including a public option. He tells us: “Well the time for bickering is over. The time for games has passed. Now is the season for action. Now is when we must bring the best ideas of both parties together, and show the American people that we can still do what we were sent here to do. Now is the time to deliver on health care.” I hope he can.

As if on queue, a Republican from South Carolina interrupted Obama in the middle of his speech, yelling “You lie!”. The irony, of course, is that at that very moment Obama was busy decrying the absurd claims being widely promulgated by those who aren’t interested in civil dialogue, but aim to “kill reform at any cost”. It gives a good sense of the current state of affairs: that a Congressman would actually interrupt the President, and accuse him of lying, to his face, on national TV. And, needless to say, the Congressman was absolutely, unequivocally wrong. And, “surprise”, he receives lots of money from healthcare industry lobbyists, and is basically a nutcase.

The video, also at New Scientist, takes data from studies by Dartmouth and the OECD, and uses Gapminder to make the graphs come alive. It helps explain one of the paradoxes behind health care in the U.S.: we spend more than most other developed countries, and we get less for it. The explanation — you’ll be unsurprised to hear — lies in our screwy incentive system. By making health care a matter of profit for various sets of people — doctors, hospitals, insurance companies, pharmaceutical companies — we push into the background the incentive that we’d really like the system to have, namely keeping people healthy. Changing those incentives doesn’t mean that Barack Obama decides what treatment you get from your doctor; it just means that we can focus human ingenuity on the task of making people healthier, rather than just making other people wealthier.

The health problem at the core is not my own, it’s my father’s. For some time, more than a year, he had had increasing trouble walking. I was convinced it was degeneration of his knees; at 77, after a physically demanding career as a locomotive mechanic in Chicago, that seemed to be the best explanation for his increasing difficulty.

In February we visited him in his house in Chicago and, unlike the previous visit in January, he came out to eat lunch. We had tremendous difficulty getting him down the stairs, to the car, into the restaurant, and back into his house. He took one stair at a time, very slowly, and we carried him up the last one. Clearly it would not be much more time until something had to happen. He had spent most of the winter inside; kind neighbors helped by buying him food at the store.

About a week later I got a call from him, on the cordless phone I had installed for him in the fall. He was on his way to the hospital, having fallen in the house. He had been unable to get up for hours, and finally the paramedics got the front door open and got him out of there. Being nearly 2000 miles away in California, with no family there in Chicago to help him, I was quite worried. He checked into the ER of a hospital near his house, and was admitted.

Over the next few weeks my dad received a full suite of tests to determine the underlying cause of his inability to walk, and got some physical therapy. The eventual diagnosis was scary: ALS, amyotrophic lateral sclerosis, or Lou Gehrig’s disease. ALS is the degeneartion of the voluntary motor neuron system. Any muscle that you can voluntarily control is affected. There is no known cause for ALS, and no known cure. The time from diagnosis to death, which is usually due to inability to breathe, is typically 3-5 years. There is no test for ALS; all you can do is rule out other conditions and it wasn’t joint degeneration, spinal cord damage, a toxin, brain tumor, or any of the numerous other things they checked. He was discharged to a skilled nursing facility for rehabilitation and physical therapy.

After several weeks, he decided to try to return home and live there, getting help from the neighbors. But it was short-lived; he fell again and decided to go back to the hospital. This time I urged him to go to a large university teaching hospital, which he did.

There they did a full suite of tests and concluded that indeed he most likely had ALS. He was discharged to a rehab institution and then back to the nursing home where he had been before attempting to return home. Through all of this he remained positive and upbeat, determined to defeat the ALS, and get back on his feet. His physical therapy, though, did not progress, and the nursing home threatened to discharge him.

But then, while in the nursing home, now mid June, he began to feel very ill, had flu-like symptoms, could not hold his head up or his eyes open, had trouble swallowing and talking, and controlling his hands. Terrified that the ALS was progressing rapidly, we got him back to the university hospital. There they tried to determine whether he had “bulbar ALS” (meaning that ALS was affecting the muscles controlled by the medulla: head/neck/throat/mouth) or something else. I flew out to Chicago, and found a totally changed man, head hanging and eyes drooping, laboring to breathe. It was very, very scary.

It was something else, in fact: myasthenia gravis (MG). This autoimmune disease attacks the motor neuron/muscle interface in the bulbar region. There is a test for it: a very specific antibody in the bloodstream causes it. There is no real cure, but there is a drug therapy, intravenous immunoglobulin (IVIG) which somehow neutralizes the MG antibody. IVIG is tremendously expensive, as the drug is carefully extracted from thousands of donated human blood samples. Meanwhile, the production of the antibody can be suppressed with a less expensive drug called azathioprine, though this drug takes months to work.

My dad got IVIG therapy and was discharged to a different SNF since he did not particularly like the previous one. He rapidly improved, continued to receive IVIG every few weeks, and then we faced a problem: Medicare was about to run out.

Most of you readers not being over 65, you probably don’t really know how Medicare works. I didn’t, really, until all this happened. There are two parts: Medicare Part A and Part B. Part A covers hospitalization and other “inpatient” services, while Medicare part B covers outpatient services like doctors’ fees, prosthetics, etc. If you have been employed in the US for 10 years or more there is no premium for Medicare Part A, Part B costs $96.40 per month, with a relatively small annual deductible. (There are also Parts C and D but we won’t delve into that here.)

When I say “covers” I need to be clear. Medicare Part A has some hefty deductibles and daily hospital charges that could easily wipe someone out financially. And Medicare Part B typically covers 80% of doctors fees incurred during a hospital stay. And so, those who can afford to do so purchase supplemental Medicare insurance which covers the gaps in Part A and B. Fortunately, I had urged my dad some time ago to do this, and he did. Supplemental insurance costs about $200/month.

In the end his hospital bills were enormous, the equivalent of years of his retirement income, but completely paid by Medicare + supplemental except for a small deductible. The quality of the care he received was superb, particularly at the university hospital. His neurologist is one of the smartest, kindest, and dedicated physicians I have ever encountered, and in the face of this terrible illness showed true human compassion.

People who receive Medicare are generally very happy with it. Indeed, as we have seen this past August, a great deal of the outrage expressed at congressional town hall meetings has been to protest any possible changes or reduction of Medicare benefits. This has sent the Republicans into a logical tizzy, expressing their undying support for Medicare while at the same time railing against any sort of government run health care plan at all. Yet it is true Medicare is facing insolvency in the longer term if health care costs keep rising faster than inflation, and eating a larger and larger portion of the economy. Part of the challenge of health care reform is certainly stabilizing Medicare for the long term. With far lower administrative costs than private insurance, and no profit motive, a move away from fee-for-service and a cap on medical liability costs may be the answer.

I said that Medicare had “run out” for my dad in August. The reason is that Medicare is not long-term care insurance. After a hospitalization, Medicare plus supplemental insurance covers up to 100 days in a rehab or skilled nursing facility. After that you are on your own. If you have any money, you start paying for the level of care you need, and if you eventually run out of money, you go on public aid: Medicaid.

This is the classic scenario that people keep raising in the health care debate: should it be that if you have Medicare and supplemental insurance, then if you happen to get a disease that necessitates long term care, your life savings and (once you pass away) your home are taken from your estate? Should catastrophic illness be the huge cause of bankruptcy that it is?

Well, you can argue, there is long term care insurance. Anyone who is about 55 or over should think seriously about enrolling in LTCI. It costs $2500-4000 per year depending on your age. A skilled nursing facility costs $6000-7000 per month! My dad did not get LTCI; this would have raised his total insurance bill to about 30% of his total retirement income! It would have been the right move, though. I didn’t know about this Medicare 100-day limitation or I would have urged him to do this years ago. I assume all this was discussed in the AARP newsletters, etc. that he got as a senior for years.

And now, of course, he has a pre-existing condition, and is ineligible for long-term care insurance. He cannot return home and fend for himself – it’s simply unsafe. And assuming his ALS progresses, he will eventually lose his present ability to wheel himself around in the wheelchair, get in and out of bed, on/off the toilet, etc. because his arms will lose their strength. When this happens he’ll need full time skilled nursing.

When I tell this story to my European and Asian colleagues, they are appalled that this is how we treat senior citizens who are ill. They’ve grown up in a society where it is simply assumed that if you get seriously ill, or expect you might, you don’t need to wade through a mass of rules and regulations, limitations and deductibles and copayments to get the care you need.

Bankruptcy and state aid may be the inevitable final destination for my father, who is now in an assisted-living home very close to where I live in California. But we have one more hope, and that is due to the fact that my father served in the Air Force in the early 1950′s, during the Korean War. He was in Strategic Air Command, and helped keep our B-47s operational in Saudia Arabia and elsewhere. Last year, the VA made ALS a “presumptive service-related condition” because veterans get the disease at twice the rate of the general population. Here again, no one knows why, but it points to an environmental factor, obviously.

Having a service-related disability that requires aid and attendance triggers some pretty solid benefits from the VA, for which my dad has applied. We’ll know in the near future. I have found the VA people on the phone, in person in Chicago, and at our local county-funded veterans office to be incredibly helpful and very efficient. The VA is pretty far behind processing claims these days, but we are hopeful.

It’s hard to predict the future, and so I am focused on giving my dad some real quality of life in the time he has to enjoy it. He has taken quite a shine to his 14-month-old grandson, and seems to enjoy his new surroundings in California. He won’t have snow and ice to contend with all winter, and we’ll get him out and about when we can, including to one of the top neurologists in the world, yes, covered by Medicare. We need to start to get to the bottom of the question as to how he could have contracted two different neuromuscular diseases.

And yes, my dad has had some preliminary end-of-life counseling. ALS is a particularly gruesome way to die, and as there is no known cure, the questions about how to manage one’s care in the terminal stages are very important to address. I have found the crass politicization of end-of-life counseling by the anti-health-care-reform wingnuts to be disgusting in the extreme. Of course patients need to hear from their doctors what to expect, and of course patients need to discuss with their loved ones what they do and don’t want done if they are terminal, and of course this all should be an expense covered by health insurance! That this issue has been used to derail rational discussion on reforming health care is pure evil.

It was surprising to me that the wingnuts had not latched onto the hospice care provision in Medicare. But then, sure enough, just last night, listening to the right-wing talk radio show “The Hugh Hewitt Show” (I sometimes tune into these shows just to see how low they can stoop) there were blatant, unabashed lies being told about it, claiming that “if you don’t die within a certain time then Medicare says “too bad”. [Not so: Medicare covers an initial nine months of hospice care for terminal patients. Then, if you haven't died yet, and you can get a doctor to certify that you are indeed terminal, you get another six months, etc.] And people listen to these lies and just believe them.

We need a return, as a nation, to an informed and rational debate about the choices facing us in reforming health care. We have a chance to do this right, but it’s obviously a very complex and emotional subject. I do hope Obama’s address to Congress on Wednesday will remind us that we are, after all, in this together as a nation, and to remain respectful and compassionate for each other.

Anyway dear readers, now you know why I have not been blogging lately…more to come about my summer in future posts.

…the greatest threat to America’s fiscal health is not Social Security, though that’s a significant challenge; it’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.

Without a doubt, medical care in the United States is in crisis. It is unsustainable as currently conceived, and it is failing its population in important ways. For “heroic” procedures our hospitals remain among the best in the world, but for day-to-day care our system is lackluster at best. Our life expectancy is considerably below most other industrialized nations: the average American lives five (5!) years less than their Japanese counterpart (Table 1 of the latest WHO report). This should shock and appall all Americans. Five extra years of life is a big deal. I’d be into that.

A couple of months ago the New Yorker had a nice article by Atul Gawande on the problems with medical care in the US. Gawande is a surgeon at Harvard, and I find him to be one of the more interesting and thoughtful commentators on medicine. In this article he explores the community in the US with the highest per capita medical costs. Care to guess which town? McAllen, Texas, in Hidalgo County. Gawande explores how this has come to pass, and highlights many of the fundamental problems facing our health care system along the way. For example, one of the defining characteristics of medical care in McAllen is that patients on average get more care than usual. They are not healthier than average. They just pay more, for more tests, more visits, more procedures:

Americans like to believe that, with most things, more is better. But research suggests that where medicine is concerned it may actually be worse. For example, Rochester, Minnesota, where the Mayo Clinic dominates the scene, has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen. Two economists working at Dartmouth, Katherine Baicker and Amitabh Chandra, found that the more money Medicare spent per person in a given state the lower that state’s quality ranking tended to be. In fact, the four states with the highest levels of spending—Louisiana, Texas, California, and Florida—were near the bottom of the national rankings on the quality of patient care.

The condensed version of what is wrong: The incentives in medical care are structured to maximize profit, and not to maximize health. Or even more condensed: Health care is a for-profit business. There are notable exceptions, with the Mayo Clinic, based in Rochester, MN, providing an extreme example. As Gawande touches upon, there is some hope that Mayo could be used as a model for a different sort of health care. But at present Mayo is certainly the exception which proves the rule:

But decades ago Mayo recognized that the first thing it needed to do was eliminate the financial barriers. It pooled all the money the doctors and the hospital system received and began paying everyone a salary, so that the doctors’ goal in patient care couldn’t be increasing their income. Mayo promoted leaders who focussed first on what was best for patients, and then on how to make this financially possible. No one there actually intends to do fewer expensive scans and procedures than is done elsewhere in the country. The aim is to raise quality and to help doctors and other staff members work as a team. But, almost by happenstance, the result has been lower costs. “When doctors put their heads together in a room, when they share expertise, you get more thinking and less testing”

There is no quick fix. And I’m not sure I find Gawande’s suggestions for progress all that compelling. But he does an admirable job of exploring some of the complexity of the problem. The vast majority of us living in this country will interact with the medical establishment at some point in our lives, for better or worse. And there are many reasons to be concerned. I want my five extra years of life.

So here are some facts. In 2007, according to HHS, total health care expenditures in the US were $2.2 trillion, and expected to grow at a steady 6.1% to $2.33 trillion in 2008. Others, like the National Coalition for Health Care, estimate that in 2008 it was $2.4 trillion, fairly close. Now, 1/700 of that is $3.4 billion, which is actually a thousand times larger than Stephen Hemsley, the CEO of UnitedHealth Group, makes.

So was Elizabeth Edwards wrong? Turns out, she might have been referring to UnitedHealth’s former CEO, Willim McGuire, who was ousted in late 2006 after an options backdating scandal. McGuire made $125 million in 2005. That’s a mere 1 in every $20,000 spent on health care I guess. Taking into account the stock options he sat on, it might bring the ratio down…but I must conclude that there was some hyperbole on Edwards’ part.

I forgive her, mainly because this isn’t the point. What I find truly impossible to accept is that we have a for-profit healthcare insurance system at all. As I have pointed out in the past in CV, this seems to me to be one of the clearest conflicts of interest that you could devise: reward health insurance companies and their shareholders for giving as little actual health care as possible for every dollar received. What other way is there to maximize profits? Oh, right, I almost forgot: keep the costs of health care rising so that this industry grows out of control as a fraction of GDP.

The system where we rely on our employers to provide health care coverage is broken. The rising costs have driven some employers, like the big automakers (who spend more on healthcare than steel) to the brink of bankruptcy, and have driven others to continually pare back the level of coverage for their workers. Underinsurance is as serious a problem as the nearly 50 million not covered at all. Should the particular disease you get wipe you out financially just because it’s too rare a situation to be covered by your plan? Should companies and their shareholders be making profits while our loved ones are being denied treatment? Or even denied coverage at all due to a “pre-existing condition”?

The health care companies have realized that change is coming, quite possibly in the form of a government-run alternative plan with much smaller administrative costs and no profit motive. A report appeared recently in The Washington Post that Blue Cross Blue Shield is launching a large PR campaign against the possible government-sponsored public insurance option. In addition, the health cartel has put forth a plan a couple weeks ago promised to reduce the rate of growth of costs by 1.5%, to about 4.5% presumably. Whoopie.

The right wing is fearful of rationing, long waiting times, or being unable to choose a doctor. The problem is that they simply don’t seem to give a hoot about the 50 million un(der)insured, who wait until they are terribly ill and then show up in ER’s. Guess who pays for that.

Another huge factor in the exorbitant cost of health care in the US is a topic that seems to be very seldomly discussed in the media: the end of life. Something like 27% of Medicare costs go to the last year of a patient’s life. How much of this is simply due to the fact that the patient, and their family, wants to try anything possible to achieve a cure, when in fact the doctors and the nurses know full well that the patient is terminal? Greater emphasis on counseling patients and families, plus a change in our culture that would make us more accepting of death, and an increased focus on preventative and palliative care rather than heroic but clearly futile and expensive late-stage treatments could save our society hundreds of billions of dollars per year.

I am not saying that no one should make a profit performing or delivering health care. Doctors, nurses, hospitals, medical suppliers do what they do to make a living. (Let’s leave Big Pharma out of it for a moment – that deserves a whole post by itself.) What I *am* saying is that no one should turn a profit by adding an unnecessary and bloated layer of bureaucracy. As Donald Cohen pointed out in March at the Huffington Post, the for-profit players are crying foul at Obama’s plan, essentially for a government-run Medicare-like option, because they don’t want the competition. As Cohen points out:

Private insurance overhead and profits eat up 20% and more of health care premiums while Medicare overhead (and no profit) is closer to 3%. There is big money to be made in health insurance. The top 7 “for profit” health insurers made a combined $12.6 billion in 2007– an increase of 170.2% from 2003. The same year, the average CEO compensation package for these health insurance companies was $14.3 million. Pay packages ranged from $3.7 million to $25.8 million.

Government-sponsored single-payer healthcare, which succeeds admirably in many other countries around the world, is probably not a realistic possibility in the US. I think that the next best thing in the long run is that an array of private, not-for-profit companies like Kaiser Permanente could run the for-profits into the ground. The government can encourage the non-profits in any number of ways, with little cost to taxpayers. One way or another I hope that Congress and the Obama administration can create a viable option for the 50 million uninsured, soon.

Access to quality health care should be a basic human right in a civilized, technologically advanced society like the US. It has become our greatest shame in the world that we cannot provide that for one in six of our people.

Imagine the sensation it would cause in the news media: a new disease appears in the US, killing hundreds, then thousands, then tens of thousands per year. The death rate closes in on 100,000 people per year. People are terrified, the medical community launches a massive campaign to control and eradicate the new pestilence, the federal government creates a new bureaucracy, a special arm of the CDC to deal with this growing death toll.

Here’s the weird thing. It’s here, and we may well top 100,000 dead per year soon in the US. There is no media outrage, no massive federal programs, and precious little available public information at all about it.

The disease? MRSA: methicillin-resistant staphlyococcus aureus. This “superbug”, a virulent strain of staph, has a chilling death rate: about 20-30% of the people who get it die from it. This is a highly variable statistic, because most of these infections are occurring in hospitals, and the people who are there are already very ill, and often immune-compromised. This so-called health-care-associated MRSA (HA-MRSA) is to be distinguished from the growing number of cases of community-associated MRSA (CA-MRSA) which account for around 15% of the incidence.

In fact, getting the total US death toll number is rather difficult to do, because hospitals don’t want to report these deaths and have actively lobbied against state laws requiring them to do so. In California, I am happy to say, The Governator signed into law in September a bill requiring such reporting (though he killed such a bill a year ago!) As of October, only half the states in the country had such laws. (Interesting aside: in 2003, then-Illinois state senator Barack Obama championed such legislation and got it passed.)

Maybe the media is finally getting the story. The Seattle Times recently had an editorial on the subject, lashing out at the hospital industry for bring this pestilence upon us, after an investigative report.

Okay, so what about that 100,000 number? Okay, I made that up. But in 2005, it is documented all over that there were about 19,000 deaths in the US, and infection rates were climbing very, very rapidly. In California the Department of Health Services estimated about 9,600 deaths from hospital related infections, which extrapolates to around 80,000 deaths nationwide. Not all of these are MRSA, clearly. But I am going to take a wild guess that the 9,600 number was low-balled. It is striking that we don’t know how many people are dying from MRSA, but it could become the fifth or sixth leading cause of death soon.

There are a lot of things that need to change, not least of which:

- There need to be more media stories; people need their awareness raised.

- The government, and the CDC in particular needs to get very serious about getting accurate statistics out and available openly.

- Hospitals need to put in place whatever measures they can, from copper door knobs to better MRSA screening on intake, to better staff education (no pun intended) on infection control.

- There should be a major research effort launched to understand the new-gen superbugs like MRSA, C. difficile, and the lovely new one from the Iraq battlefield, A. baumanni.

I guess what I find most chilling here is the almost unbelievable cynicism of the hospital/health insurance companies who actively fight against having to report statistics on MRSA infection rates. To me, it just underscores a general conclusion that I have formed in the past several years: our health care system should not be managed by organizations that have a profit motive. Think about it: the free market has not produced an efficient, responsive health care system. The profit-based health insurance industry has only created an enormously expensive bureaucratic layer whose main effect has been to drive up health care costs at quadruple the inflation rate while continually restricting actual health care services, and has left 50 million Americans with no health care coverage at all.

I blame them.

A retinal detachment involves the retina (which lines the back of your eye like wallpaper) sagging away from the back of the eye (as your wallpaper might do in a damp bathroom). Now, if you’ve ever tried to wallpaper a curved surface, you know it’s not easy to get some intrinsically flat thing to stick smoothly to the inside of the curve, especially when that bitch Gravity is pulling it down all the time. The clever way that retinal surgery deals with this (squeamish people stop reading now, please) is to suck some of the goo out of your eye and replace it with a gas bubble. You then tilt your head into the right position to have the gas bubble float up into the correct portion of the eye while the retina re-attaches. For a month. If you’re lucky, you get to sit up, but if you’re unlucky, you spend a month looking at the floor. In addition, you cannot go up or down in altitude by more than a thousand feet or so, because when you have an air bubble in your eye pressure changes are not a great idea.

My husband has been lucky enough to have a sitting-up kind of detachment so far (though I’m writing this while waiting for him to get out of surgery a second time, since it seems to have detached again, and based on where he lost vision and knowing the inversion of the image that takes place in the eye’s reimaging system, I’m worried he’s going to be a floor-looking guy when he comes out). The cool bit about getting to look at him face-on is that you can actually see the bubble! He looks like a human level, as the bubble readjusts as he tips his head.

The other physicsy bit is that when you have a gas bubble in your eye, your index of refraction is all wrong, and in spite of having a working retina attached in the right place, you still can’t see, because the air-lens interface steers the light to the wrong place. This gets better as the air is absorbed by the body and replaced with fluid. It’s also better when you tip your head down so the bubble floats away from the lens.

The upshot of all this is that I think that modern medicine is pretty darn clever, though I wish I didn’t have to know about it.

——————————————————————

Burrowing into tragedy: a story behind the story of the Iraq War Suicides.

My thanks to all here who gave me such a warm welcome on Monday (and, again, to Sean for asking me here in the first place).

This post emerges out of this sad story of a week or so ago.

Over Memorial Day weekend this year there was a flurry of media coverage about the devastating psychological toll of the Iraq and Afghanistan wars. The single most awful paragraph in the round-up:

“According to the Army, more than 2,000 active-duty soldiers attempted suicide or suffered serious self-inflicted injuries in 2007, compared to fewer than 500 such cases in 2002, the year before the United States invaded Iraq. A recent study by the nonprofit Rand Corp. found that 300,000 of the nearly 1.7 million soldiers who’ve served in Iraq or Afghanistan suffer from PTSD or a major mental illness, conditions that are worsened by lengthy deployments and, if left untreated, can lead to suicide.”

(For details and a link to a PDF of the Army report – go here.)

This report, obviously, is the simply the quantitative background to a surfeit of individual tragedy – but my point here is not that war produces terrible consequences.

Rather, the accounts of the Iraq War suicides — 115 current or former servicemen and women in 2007 – struck me for what was implied, but as far as I could find, not discussed in the mass media: the subtle and almost surreptitious way in which the brain-mind dichotomy is breaking down, both as science and as popular culture.

How so? It is, thankfully, becoming much more broadly understood within the military and beyond that “shell shock” is not malingering, or evidence of an essential weakness of moral fiber. PTSD is now understood as a disease, and as one that involves physical changes in the brain.

The cause and effect chain between the sight of horror and feelings of despair cannot, given this knowledge, omit the crucial link of the material substrate in which the altered and destructive emotions can emerge. PTSD becomes thus a medical, and not a spiritual pathology.

(This idea still faces some resistance, certainly. I launched my blog with a discussion of the attempt to court martial a soldier for the circumstances surrounding her suicide attempt. But even so, the Army is vastly further along in this area that it was in the Vietnam era and before.)

Similarly, depression is clearly understood as a disease with a physical pathology that underlies the malign sadness of the condition. (H/t the biologist Louis Wolpert for the term and his somewhat oddly detached but fascinating memoir of depression.)

This notion of the material basis of things we experience as our mental selves is not just confined to pathology. So-called smart drugs let us know how chemically malleable our selves can be.

More broadly, the study of neuroplasticity provides a physiological basis for the common sense notion that experience changes who we perceive ourselves to be.

All this seems to me to be a good thing, in the sense that (a) the study of the brain is yielding significant results that now or will soon greatly advance human well being; and (b) that the public seems to be taking on board some of the essential messages. The abuses (overmedication, anyone?) are certainly there. But to me, it is an unalloyed good thing that we have left the age of shell shock mostly behind us.

At the same time, I’m a bit surprised that the implications of this increasingly public expression of an essentially materialist view of mind haven’t flared up as a major battle in the science culture wars.

Just to rehearse the obvious: the problem with cosmology for the other side in the culture war is that it conflicts with the idea of the omnipresent omnipotence of God. The embarrassment of evolutionary biology is that it denies humankind a special place in that God’s creation, destroying the unique status of the human species as distinct from all the rest of the living world.

Now along comes neuroscience to make the powerful case that our most intimate sense of participating in the numinous is an illusion.

Instead, the trend of current neuroscience seems to argue that the enormously powerful sense each of us has of a self as distinct from the matter of which we are made is false. Our minds, our selves may be real—but they are the outcome of a purely material process taking place in the liter or so of grey stuff between our ears.

(There are dissenters to be sure, those that argue against the imperial materialism they see in contemporary neuroscience. See this essay for a forceful expression of that view.)

I do know that this line of thought leads down a very convoluted rabbit hole, and that’s not where I am trying to go just now.

Instead, the reports of the Iraq suicides demonstrated for me that the way the news of the materiality of mind is is slipping into our public culture without actually daring (or needing) to speaking its name.

That the problem of consciousness is still truly unsolved matters less in this arena than the fact of fMRI experiments that demonstrate the alterations in brain structure and metabolism associated with the stresses of war or the easing of the blank, black hole of depression. The very piecemeal state of the field helps mask its potentially inflammatory cultural implications.

To me this suggests two possibilities. One is that it is conceivable that when the penny finally drops, we might see backlash against technological interventions into the self like that which has impeded stem cell research in the U.S.

On the other hand, I don’t think that the public can be motivated or even bamboozled into blocking the basic science in this field. Too much rests on the work; any family that has experienced Alzheimers knows just how urgent the field may be — not to mention anyone with a loved one in harms way.

This actually gives me hope for a shift in the culture war. For all the time and energy wasted over the last several years defending the idea of science against attacks on evolution, with the cosmologists taking their lumps too – the science of mind could force a shift in the terms of engagement decisively in the right direction.

Or I could be guilty of another bout of wishful thinking. Thoughts?

Image: Brain in a Vat, article illustration. Offered in homage to my friend and source of wisdom, Hilary Putnam, who introduced the brain-in-a-vat thought experiment in this book. Source: Wikimedia Commons.

Here is the basic econo-physics of the situation:

As a rule, processed foods are more “energy dense” than fresh foods: they contain less water and fiber but more added fat and sugar, which makes them both less filling and more fattening. These particular calories also happen to be the least healthful ones in the marketplace, which is why we call the foods that contain them “junk.” Drewnowski concluded that the rules of the food game in America are organized in such a way that if you are eating on a budget, the most rational economic strategy is to eat badly — and get fat.

This perverse state of affairs is not, as you might think, the inevitable result of the free market. Compared with a bunch of carrots, a package of Twinkies, to take one iconic processed foodlike substance as an example, is a highly complicated, high-tech piece of manufacture, involving no fewer than 39 ingredients, many themselves elaborately manufactured, as well as the packaging and a hefty marketing budget. So how can the supermarket possibly sell a pair of these synthetic cream-filled pseudocakes for less than a bunch of roots?

For the answer, you need look no farther than the farm bill. This resolutely unglamorous and head-hurtingly complicated piece of legislation, which comes around roughly every five years and is about to do so again, sets the rules for the American food system — indeed, to a considerable extent, for the world’s food system. Among other things, it determines which crops will be subsidized and which will not, and in the case of the carrot and the Twinkie, the farm bill as currently written offers a lot more support to the cake than to the root. Like most processed foods, the Twinkie is basically a clever arrangement of carbohydrates and fats teased out of corn, soybeans and wheat — three of the five commodity crops that the farm bill supports, to the tune of some $25 billion a year. (Rice and cotton are the others.) For the last several decades — indeed, for about as long as the American waistline has been ballooning — U.S. agricultural policy has been designed in such a way as to promote the overproduction of these five commodities, especially corn and soy.

I remember the moment it first dawned on me that Coke was significantly less expensive than orange juice. But making soda is a complicated chemical process, while oranges literally grow on trees! Of course, once you master that process, mass-producing the chemicals is fairly straightforward, while growing oranges requires a certain amount of patience. At the time I didn’t really appreciate the other aspect of the puzzle: we pay people to grow corn, which is turned into high-fructose corn syrup, which sweetens all of the processed food we find on our supermarket shelves.

Now, there does seem to be an obvious point missing in the article: the popularity of Twinkies over carrots cannot be put down solely to the greater density of calories per dollar. A lot of people like how Twinkies taste, deep-fried or not. But that doesn’t mean we should be actively subsidizing their production.

Pollan strikes an optimistic note at the end of his piece, suggesting that the importance of the Farm Bill may finally be percolating up to the national consciousness. (At least until the next time that a celebrity with fake boobs dies of a drug overdose.) It’s long been considered political suicide to even suggest messing with farm subsidies, especially with the Iowa caucuses playing such a large role in Presidential primaries. We’ll see if next year is any different.

You click on one of the websites of a participating local transport organisation and cleverly remark to yourself how amusing it is that the prize you could win for bringing your bike onto their subway, train, or bus system that special day is…. a bike. So if you don’t have a bike, you can’t participate, and so can’t win a bike….which would allow you to participate. Well, maybe you could borrow one and give it a try…..? Anyway…..

You’ll agree that it is in principle a good thing that those cyclists do (and you noted before that you’ve seen many more of them in the last few weeks due to the rising gas prices), and that it is a pity that your own special situation makes it impossible for you to join them, or perhaps use the bus or train, or some combination of them. Or does it? You make a mental note to try it next year. Or perhaps the year after…..

Happy Bike to Work Day!

-cvj

Again, apologies to Girls Are Pretty.

Europe, led by the UK, last night signalled a major split with the United States over curbing the Aids pandemic in a statement that tacitly urged African governments not to heed the abstinence-focused agenda of the Bush administration.

The statement with which the article is concerned makes clear that rejection of science is the problem here

We are profoundly concerned about the resurgence of partial or incomplete messages on HIV prevention which are not grounded in evidence and have limited effectiveness,” it says.

The current US stance on tackling AIDS in Africa is hopelessly hamstrung, requiring, among other absurd demands, that no funds be distributed to any organization that even counsels a pregnant woman that abortion is an option, and that two-thirds of funds go to programs that stress abstinence (a third goes to abstinence only programs). If you want to understand how experts in the US see this, see what Planned Parenthood has to say.

A specific example is provided by Uganda, which used to be the poster child for AIDS programs in Africa, and which has suffered a recent setback that is at least partially linked to a decrease in the availability of condoms due to US policies.

The issues here are entirely obvious to anyone who is not blinkered by ideology and/or repression. As the British international Development secretary, Hilary Benn, put it

“Abstinence works if people can abstain, but I don’t think people should die because they have sex. We need to make sure people have all the means [of prevention] at their disposal – condoms and clean needles. It includes education and access to sexual and reproductive health services.”

This is an example of what people mean when they say that the Bush administration is ignoring science in favor of ideology. It is an established scientific fact that abstinence only programs do not work. Yet these are the ones we are using to fight a disease that is ravaging parts of Africa. This shouldn’t be a partisan issue. It is one of common sense, and of common decency. Is there any chance that sensible, reason-based people, Democrats and Republicans, could agree on this?

They should be out-of-this-world experiences. But US experts have warned that sex in space will bring problems not pleasure for men and women heading to the moon and Mars.

A panel of scientists has told Nasa interplanetary passion could cause chaos to its latest plans to send humans on long missions.

Cramped in spaceships for years, surrounded by the starry void, astronauts thoughts are bound to turn to romance, states the report, ‘Bioastronautics Roadmap: a risk reduction strategy for human exploration of space’.

The resulting close encounters could have profound consequences, it adds. Without supplies of the necessary precautions, zero-gravity romps could lead to zero-gravity pregnancies.

Snickering aside, I’m sure it’s a real problem — send a bunch of people into isolation in close quarters for a period of years, and something will happen.

Now, I know that certain of my co-bloggers are reliable readers of the Guardian science section, but apparently they were going to keep this story to themselves. The extra value-added you get from Cosmic Variance, of course, is that we will actually link directly to the NASA Bioastronautics Roadmap from which the story derives. Although, as it turns out, a cursory inspection didn’t turn up anything nearly as off-color as you’d find in a novel by a recently indicted former high-ranking White House staffer. But this bit was interesting:

Serious interpersonal conflicts have occurred in space flight. The failure of flight crews to cooperate and work effectively with each other or with flight controllers has been a periodic problem in both US and Russian space flight programs. Interpersonal distrust, dislike, misunderstanding and poor communication have led to potentially dangerous situations, such as crewmembers refusing to speak to one another during critical operations, or withdrawing from voice communications with ground controllers. Such problems of group cohesiveness have a high likelihood of occurrence in prolonged space flight and if not mitigated through prevention or intervention, they will pose grave risks to the mission. Lack of adequate personnel selection, team assembly, or training has been found to have deleterious effects on work performance in organizational research studies. The duration and distance of a Mars mission significantly increases this risk. The distance also reduces countermeasure options and increases the need for autonomous behavioral health support systems.

Oh, great. I see a Stranger in a Strange Land scenario on our horizon.

From: Target.Response Target.Response@target.com
Date: Oct 20, 2005 7:18 AM
Subject: Filling Prescriptions at Target

Dear Target Guest,

Target places a high priority on our role as a community pharmacy and our obligation to meet the needs of the patients we serve. We expect all our team members, including our pharmacists, to provide respectful service to our guests, particularly when it comes to their health care needs.

Like many other retailers, Target has a policy that ensures a guest’s prescription for emergency contraception is filled, whether at Target or at a different pharmacy, in a timely and respectful manner. This policy meets the health care needs of our guests while respecting the diversity of our team members.

Your thoughts help us learn more about what our guests expect, so I’ll be sure to share your feedback with our pharmacy executives.

Thanks for taking the time to share your questions, thoughts and comments. I hope we’ll see you again soon at Target.

Sincerely,

Jennifer Hanson
Target Executive Offices

I’ve written before about this kind of nonsense. My Orange Quark post began

A pharmacist in California refuses to fill the prescriptions of AIDS sufferers, because that would be interfering with God’s plans for gays. Another pharmacist, in Michigan, won’t provide arthritis medication, because gnarled hands are God’s way of stopping masturbation. A third pharmacist, in Florida, refuses to fill Viagra prescriptions, because, after their child-bearing years are over, God does not intend women to have to put up with the advances of their wrinkly old husbands.

whereas AMERICAblog has their own examples of equally ridiculous possibilities that would seem to be consistent with paying pharmacists not to do their jobs.

It’s just a gut feeling, but I would guess that there are many more readers of this blog who might occasionally shop at Target than at, say, Walmart (Don’t ask me why – maybe it’s the Michael Graves collection – I don’t know). If so, then this is a real opportunity to make a difference. If you get a chance, follow the advice at AMERICAblog, and call Target‘s press office at one of these numbers

Susan Kahn, 1-612-761-6735
Cathy Wright, 1-612-761-6627 or 1-847-615-1538
Paula Thornton-Greear, 612-696-3400
Carolyn Brookter, 1-612-696-6557

Instead, or in addition, you could call or write to your local Target and tell them how you feel about this. We really need to stand up against this insanity. I’m going to make my calls tomorrow. Perhaps I’ll do it instead of teaching. After all, just because I’m paid to teach doesn’t mean I should be forced to do it!

It certainly seems that most people are burning the candle at both ends these days, partly because of work and family responsibilities, and partly because of the increasing availability and variety of communication and entertainment options, such as the Internet and cable television.

I’ve always been one of those people who wholly embrace such new freedoms and, since I’ve never really needed a lot of sleep, have often found myself taking advantage of them late at night and early in the morning. I frequently read or deal with email and refereeing requests after midnight, and spend part of the early morning, around 6am, reading news sites and blogs before (when things are going ideally) exercising and heading off to work. This means that I can devote most of the day-time hours, plus large chunks of many evenings, to working, plus going out with my wife or with friends on occasion. I like living this way, although I must say that, now and then (every couple of months or so), it all catches up with me and I spend a Saturday essentially curled up in bed reading a novel while watching baseball.

Many of my friends and colleagues have schedules of a similar tempo, although with different weightings of activities (often including getting up to get kids to school, which seems to be an immensely time-consuming process all on its own). We all seem pretty happy; but then again, we all also seem pretty exhausted from time to time.

But maybe we shouldn’t be so complacent. Sunday’s Washington Post has an interesting article about recent scientific studies concerning the health implications of living with a long term sleep deficit. Although, as I’ll mention briefly below, I don’t think this is a stellar science article, it nevertheless made me sit up and think.

Starting from the observation that most people need between seven and nine hours of sleep per night, the health complications that some researchers claim correlate with getting less than, say, six hours, comprise a scary list: heart disease, obesity, colon cancer, breast cancer, prostate cancer, diabetes and stroke. And I most definitely got the impression that they were just getting warmed up.

This is a timely article because the results of several new studies, with rather large sample sizes, have recently been released. I found it a little difficult to ferret out serious details of these studies from the article, but one involves 10,000 subjects, and another is out of Harvard Medical School and involved 82,000 nurses.

One thing I didn’t like was that there was an attempt to provide balance with the usual glib “but others think differently” comment:

“There are Chicken Little people running around saying that the sky is falling because people are not sleeping enough,” said Daniel F. Kripke of the University of California at San Diego. “But everyone knows that people are getting healthier. Life expectancy has been increasing, and people are healthier today than they were generations ago.”

Other researchers acknowledge that much more research is needed to prove that the apparent associations are real, and to fully understand how sleep disturbances may affect health. But …

This seems like it is an interesting and potentially important comment from a credible researcher. However, the details behind Dr. Kripke’s objections are not followed up, and one is left thinking either that his comment is unimportant or that something crucial is being ignored.

This criticism aside, I did learn some interesting nuggets about the kind of research that’s going on and what it might tell us about the potential hazards of our changing sleep habits. The connection with obesity leads to some particularly cute evolutionary speculation

The newest study on obesity, from Columbia University, is just the latest to find that adults who sleep the least appear to be the most likely to gain weight and to become obese.

Other researchers have found that even mild sleep deprivation quickly disrupts normal levels of the recently discovered hormones ghrelin and leptin, which regulate appetite. That fits with the theory that humans may be genetically wired to be awake at night only when they need to be searching for food or fending off danger — circumstances when they would need to eat to have enough energy.

“The modern equivalence to that situation today may unfortunately be often just a few steps to the refrigerator next door,” [Emmanuel] Mignot [of Stanford] wrote in his editorial [in the journal Sleep].

Despite all this, I can’t imagine dramatically changing my lifestyle any time soon – I just like it too much. However, I think I will try to be a little more alert for those signs that I’m becoming over-tired, and maybe take that lazy Saturday or the occasional lie-in a bit more frequently than I do at present. It’s for my health you understand. The fact that those sleepy mornings usually lead to deliciously decadent afternoons of baseball and contemporary literature is just a side effect of the medication.

For more than a year, federal drug officials have insisted that their repeated delays in deciding whether to approve over-the-counter sales of a morning-after contraceptive have nothing to do with abortion politics. Among veterans of the battles over drug approvals here, it is hard to find anyone who believes them.

The most recent study on EC (which, for those who are unaware, is just a high dose of normal birth control pills: sometimes with estrogen and progestin, sometimes just progestin) suggests that in the majority of cases, it prevents pregnancy by inhibiting ovulation or fertilization (ie, just like normal birth control pills) — and not by preventing implantation. There is no evidence that EC can effect an implanted fertilized egg in any way; it cannot abort it and it does not seem to harm it. Much of the hubbub is also about whether girls under the age of 18 can understand how to use the drug properly; there is also no evidence that 16 and 17 year olds can’t understand how to take a few pills, or any evidence of stronger adverse effects on girls under 18 — except, of course, for the fact that then they might not be sufficiently punished for having sex.

These facts make it pretty clear that at least for the bulk of the anti-abortion movement, it’s not about saving babies, it’s about controling women. If you want to prevent abortions, over the counter emergency contreception is a proven, excellent way to do it. If you want to prevent women from controlling their own lives, not so good. (Note: Amanda at Pandagon makes this same point better and snarkier…)

More info on emergency contreception here, with details about how to use normal birth control pills. Planned parenthood has an action alert here.

At least someone who (was) still left in the Adminstration had some balls (so to speak): the women’s health chief at the Food and Drug Administration resigned today over the decision. Here’s what she had to say:

”I have spent the last 15 years working to ensure that science informs good health-policy decisions,” Wood, director of FDA’s Office of Women’s Health, wrote in an e-mail about her departure to agency colleagues. ”I can no longer serve as staff when scientific and clinical evidence, fully evaluated and recommended by the professional staff here, has been overruled.”

Wood said the final decision was made not in FDA’s usual manner but ”at the commissioner level … where most if not all of the professional staff were excluded.” Nor has FDA ever raised questions about teen use of other drugs, she said.

This should have been a medical and scientific decision, not a political one. Bravo for her.

Although, my new antioxident love is Brazilian açai…