Longer looks: Doctors advocating less care; addiction as a 'disease'

Aug 19 2011

Every week, Kaiser Health News reporter Jessica Marcy selects interesting reading from around the Web.

The Daily Beast: One Word Can Save Your Life: No!
These physicians are not anti-medicine. They are not trying to save money on their copayments or deductibles. And they are not trying to rein in the nation's soaring health-care costs, which at $2.7 trillion account for fully one sixth of every dollar spent in the U.S. They are applying to their personal lives a message they have become increasingly vocal about in their roles as biomedical researchers and doctors: more health care often means worse health. … That less health care can lead to better health and, conversely, that more health care can harm health, runs counter to most patients' conviction that screenings and treatments are inherently beneficial. … Most of us wouldn't think twice if our doctor offered a test that has the power to expose a lurking tumor, or a clogged artery, or a heart arrhythmia. Better to know—and get treated—than to take any risks, the reasoning goes. … In fact, for many otherwise healthy people, tests often lead to more tests, which can lead to interventions based on a possible problem that may have gone away on its own or ultimately proved harmless (Sharon Begley, 8/14).

The New York Times: The Two Minus-One Pregnancy
As Jenny lay on the obstetrician's examination table, she was grateful that the ultrasound tech had turned off the overhead screen. She didn't want to see the two shadows floating inside her. Since making her decision, she had tried hard not to think about them, though she could often think of little else. She was 45 and pregnant after six years of fertility bills, ovulation injections, donor eggs and disappointment — and yet here she was, 14 weeks into her pregnancy, choosing to extinguish one of two healthy fetuses, almost as if having half an abortion. … For all its successes, reproductive medicine has produced a paradox: in creating life where none seemed possible, doctors often generate more fetuses than they intend. … With that, pregnancy reduction shifted from a medical decision to an ethical dilemma. As science allows us to intervene more than ever at the beginning and the end of life, it outruns our ability to reach a new moral equilibrium. We still have to work out just how far we're willing to go to construct the lives we want (Ruth Padawer, 8/10).

TIME: Why the New Definition of Addiction, As "Brain Disease," Falls Short
In 1956, the American Medical Association declared alcoholism a "disease." More than half a century later, the American Society of Addiction Medicine (ASAM) has proclaimed addiction, including alcoholism and "process" addictions like gambling, to be the same. According to the ASAM's definition, published on the group's website on Monday, addiction is a "primary, chronic disease of brain reward, motivation, memory and related circuitry." This clarification, which was based on consultations with more than 80 experts, is aimed in part at de-stigmatizing addictive disorders. That's an admirable goal. The scientific evidence shows that addiction is rooted in distinct brain changes, just like other mental illnesses such as depression (though in both instances, the same changes are not found in all people with the conditions). … But if you want to reduce stigma, calling something a brain disease may not be the best way to go. Studies that have looked at this question have found that labeling a disorder as "neurobiological" tends to have either no effect on stigma or actually increases it (Maia Szalavitz, 8/16).

Economist: Unexpected Consequences: Stem-Cell Research May Be Coming Back Onto The Political Agenda
Mr Perry, a young-looking 61, is a fitness fiend. Last year he made headlines when he shot a coyote while running in the hills west of Austin, Texas's state capital. But time takes its toll. Last month Mr Perry had an operation to fix a recurring back problem. While the surgeon was at it, he injected the governor with stem cells, in an experimental procedure meant to speed recovery. Pro-life conservatives oppose embryonic stem-cell research on the grounds that it destroys life. They are keen, however, on adult stem cells, which they hope may obviate the use of the embryonic kind. The stem cells used in Mr Perry's procedure were his own. And the governor has been a proponent of adult stem-cell research, for economic reasons as well as ethical ones. If such treatments gain federal approval, and become more popular, Texas could be a centre of that industry. Mr Perry's experiment may draw new attention to the issue. Opposition to embryonic stem-cell research has been somewhat subdued since the last presidential election; but it has never gone away (8/13).

The Atlantic: Why Hospitals In Portland Are Banning Early Births
More than one in three American babies is born by cesarean section. Use of the procedure increased more than 50 percent between 1996 and 2007, a HealthGrades study found, and in the Golden State, a recent California Watch investigation found that "women are at least 17 percent more likely to have a cesarean section at a for-profit hospital than at one that operates as a non-profit. A surgical birth can bring in twice the revenue of a vaginal delivery." ... "All 17 Portland-area hospitals have agreed to put what they call a 'hard stop' on elective induction and caesarian section births before 39 weeks, unless those inductions are medically necessary." The story goes on to note that "induced births even one day before 39 weeks will now require patients to present their case to a designated arbiter at the hospital and prove that there is a medical reason why the early birth should take place" (Conor Friedersdorf, 8/12).

National Review: Rick Perry's Bad Medicine
Texas, we have a problem. Your GOP governor is running for president against Barack Obama. Yet one of his most notable acts as executive of the nation's second-largest state smacks of every worst habit of the Obama administration. And his newly crafted rationalizations for the atrocious decision are positively Clintonesque. In February 2007, Gov. Rick Perry signed a shocking executive order forcing every sixth-grade girl to submit to a three-jab regimen of the Gardasil vaccine. He also forced state health officials to make the vaccine available "free" to girls aged nine to 18. The drug, promoted by manufacturer Merck as an effective shield against the sexually transmitted human papillomavirus (HPV) and genital warts, as well as cervical cancer, had been approved by the Food and Drug Administration just eight months before Perry's edict (Michelle Malkin, 8/17).

American Medical News: Reform, Pay Cuts Likely To Widen Gap Between Rich And Poor Hospitals
When it comes to hospitals and their financial health, they are either thriving or wheezing -- with no in-between. … analysts say anyone who has seen news reports about hospitals alternately adding jobs or subtracting them is right in thinking that hospitals are either growing or struggling. Larger, more well-capitalized hospitals always have had advantages over their smaller, less financially stable competitors. But analysts say health system reform, and declining or changing government payments, are making those differences more acute. With quality-based payments and accountable care organizations a big part of health reform, analysts say the advantage goes to hospital systems that can assemble a network of primary care, specialty care and acute care services, and manage patient information electronically. Those systems that can't accomplish this either will die or be acquired by those that can (Bob Cook, 8/15).

Columbia Journalism Review: The Back Story On Medicare's Wild Spending
It's no secret Medicare spending is on a wild ride northward. The politicians—Dems and Republicans alike—tell us that every day. What has not been brought into the conversation is why. Now every reporter was taught at some point that "why" is a significant question to ask. But as my Campaign Desk colleague Greg Marx and I have been noting for some time, the "why" is missing in the current Medicare discussion. For some inexplicable reason, journos or their bosses aren't keen on reporting much about the overuse of medical technology and the sales ingenuity of the medical marketplace. …Hey, guys, there's a nexus between this kind of marketing, the high-tech effect on corporate profits and physicians' bottom lines, the drive to shift more of the cost of care to Medicare beneficiaries as a way to solve the government's spending problem, and the deficit. This connection has been missing from both political discourse and media speak. It's easier for the press to quote ad nauseam the political line that Medicare cuts may be necessary to bring down the deficit than to investigate the reasons why. Perhaps the CT study will prompt more journos—and members of the public—to ask the "why" question (Trudy Lieberman, 8/17).