Buyer Beware: Car Salesmen, Doctors.

Everyone knows to beware of a good salesman, especially when making major purchases like a car or house. The reason for concern stems from the perceived level of objectivity of the information being considered. Presented with a perfect stranger seeking to make a one time commission, the buyer is concerned that the salesman’s vested interest is making the most profitable sale rather than best value and match for the buyer. The bias of the sales person toward his own interests creates a situation characterized by misinformation and can result in erroneous and harmful decisions being made. The same phenomena can occur within the field of health care research if the selected methods and population samples of a study have not neutralized the possible bias of those administering it.

If providers and payers continue the trend of the last 30 years and merge into fewer but larger group organizations and as such inherit more market power, should health care consumers be concerned about possible bias, when confronted with formularies, best practices and clinical guidelines developed by these organizations? In order to determine whether or not the characteristics of the individuals making up a group influence the outcomes and conclusions of formal consensus amongst health policy makers, Hutchings and Raine conducted a large meta-analysis of 52 different studies. The data was collected by executing designed searches of various medical databases such as MedLine or PsychInfo. For inclusion into the meta-analysis, studies had to use one of three formal consensus methods (NGT, Delphi, or RAND/UCLA) and differentiate the two groups or individuals based on their characteristics and perceived level of appropriateness for whatever treatment being considered. After the data was aggregated, Hutchings and Raine calculated the overall percentage agreement, kappa coefficient, and odds ratios were calculated. Based on this information, they were able to…

Americans The Ugly Racists, a Song.

Normally I would never re-publish anything racially/gender offensive or irrationally critical, but in order to understand how significant the underlying problem behind any person, let alone a lawmaker, finding it appropriate to disseminate this material in public, it is necessary to see / hear it. The thought that the guy who passed this song around the GOP wants to become its leader isn’t nearly as scary as the blind ignorance of the people making most of the comments on the YouTube comment thread. However, a wise man once said, if life hands you lemons make lemonade, so with that in mind, let’s learn a lesson about the justification bigots use for being racist.

Apples to Oranges Argument: Making fun of Sarah Palin for being an idiot is perfectly acceptable as long as your standard of judgement is universal to men, women, blacks, and whites. It’s crazy that people actually justify racism under the assertion that making fun of Sarah Palin’s gaffs is somehow as egregious.

LOL! The Democrats are spitting chips over this video being put on cd and sent to GOP members to laugh at! I guess it was OK to have a crush on Obama and make fun of everyone else, or call Palin a dummy…but it’s not OK to laugh at Obama! LOL! I like you black guys.you took some hits for the team thats for sure…You guys do know that there’s a whole bunch of white people who don’t believe BamBam was naturally born American right? I figure you might want to talk to them ya? - http://www.youtube.com/user/badnetprac

Two Wrongs Make a Right Argument: This guy acknowledges that the song is racist, but he thinks that because someone (a comedian in this case) else made a racist joke once, it’s OK for a congressman to publicly acknowledge and condone the existence of…

If the ER Can’t Handle Today, What About Tomorrow?

The American College of Emergency Physicians recently reported that there is definite reason for concern about the country’s ability to supply emergency medical services for the current status quo day to day demand. While it would be irrational to think that in a time of crisis or disaster all emergency medical services would be provided inside an ‘emergency room,’ the apparent inability to provide necessary care in the traditional setting should shake public confidence as to the readiness of emergency medicine providers to work outside of their comfort zone in a school gymnasium or baseball stadium. However unlikely the statistical probability of such a disaster occurring, events such as Hurricane Katrina, show that things do happen and prove that having anything less than a complete plan for response is wholly irresponsible.

As the College of Emergency Physicians points out, the current state of emergency medical service delivery is unable to be wholly relied upon in the event of disaster. Integrating community, state, and national organizations roles in disaster preparedness will be key to any effective health care reform plan. Administrators at all levels will need to be able to rapidly and effectively direct services to needed areas on a micro and macro level without having to worry about breaks in the supply or communication chain. Establishing a national protocol for disaster response and preemptively disseminating it throughout community and local organizations will reduce confusion as to what role each organization will provide in a high stress dynamic environment.

In a privatized system of health care delivery in which various health services are provided and paid for by a diverse group of organizations, cohesion in a time of crisis becomes harder to plan and less likely to succeed. As a health care delivery system becomes more universal, inherent to that change comes solidarity…

Senate Auto Bailout Fail for Dummies.

Fourth Grade Social Studies paints a beautiful picture of legislative process. It teaches us that the federal government is a simple, law making machine.  Is it safe to assume that everyone remembers the cartoon video about how a bill becomes a law, you know, from the same people who brought you “Three, The Magic Number?” You remember that?  The bill is born, vote in the House, vote in the Senate, President signs it, and BAM, law!  Forget it.

It probably took less than an hour after waking up this morning to find out that “The Auto Bailout Bill” failed in the Senate, but actually it was never even officially discussed on the floor. Instead, a vote to limit the amount of time for debate, to no more than 30 hours, on “HR7005 - To amend the Internal Revenue Code of 1986 to provide alternative minimum tax relief for individuals for 2008″ failed, 52-35, to achieve the necessary 60 votes. That was the end of the “Auto Bailout Bill.”

Confused yet? The actual “Auto Bailout Bill”, created by Barney Frank in the House of Representatives, is HR7321. It was passed in the House and received in the Senate on December 11, 2008. Senate rules require that in order for a Bill to be brought onto the floor for consideration it must be read aloud on two separate occasions. This bill was never even read once. Instead, through a complex labyrinth of procedure, the Senators were able to tank it without ever considering it.

Here’s how it went down:

HR7005 has absolutely nothing to do with cars. It was designed to provide relief from the alternative minimum tax and subsequently passed in the House and received in the Senate during September 2008. It just so happens, however, that having already been read twice, this bill was…

Tom Daschle, America’s Healthcare Jesus?

Today CNN reports that President-Elect Obama has chosen former Senator Tom Daschle to head the Department of Health and Human Services. His primary objective will be to write the much anticipated, highly publicized, “Obama Healthcare Overhaul” which will be presented to Congress next year. As a key component of this plan, Daschle intends to create an independent oversight committee similar in structure and autonomy to the Federal Reserve. The goal of this board will be to evaluate the cost vs. efficacy ratio of current and future therapies in order to determine a specific formulary of clinical and therapeutic best practices. These best practices will represent the finite standard of care the government will be willing to provide for recipients of its health delivery systems, namely Medicare and Medicaid. Compare that mission statement with the mission statement of an already existing government agency, taken directly from its website:

The FDA is responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, our nation’s food supply, cosmetics, and products that emit radiation. The FDA is also responsible for advancing the public health by helping to speed innovations that make medicines and foods more effective, safer, and more affordable; and helping the public get the accurate, science-based information they need to use medicines and foods to improve their health.

Sounds similar. In fact, the establishment of the FDA by the Food, Drug, and Cosmetic Act of 1938 came during a time of similar economic and political pressure. According to the FDA website, the Food, Drug, and Cosmetic Act of 1938 was a response to the death of 100 people who had essentially eaten antifreeze, the main component in a “sulfa wonderdrug” of the time, and so the FDA was established to protect citizens from…