Monthly Archive for August, 2010

UWE E. REINHARDT,  New York Times, August 13, 2010

Uwe E. Reinhardt is an economics professor at Princeton. He has some financial interests in the health care field.

In last week’s post I discussed Kenneth Arrow’s exploration of whether special characteristics set health care apart from other commodities — whether it had a “moral dimension.” The post generated a lively set of commentaries.

Professor Arrow, a Nobel laureate, explored in the early 1960s what the characteristics would be of a perfectly competitive market for an ordinary commodity, how the medical care industry deviated from those characteristics and what aspects of health care might explain these deviations.

He concluded that virtually all the special features of the medical care industry — the role of nonprofit institutions; the expectation that physicians, although vendors of medical services, would always put the interests of their patients above their own self-interest; professional licensing and many other forms of government regulation — could “be explained as social adaptations to the existence of uncertainty in the incidence of disease and in the efficacy of treatment.”

This uncertainty has several aspects.

First, physicians may not agree on the medical condition causing the symptoms the patient presents.

Second, even if physicians agree in their diagnoses,  they often do not agree on the efficacy of alternative responses — for example, surgery or medical management for lower-back pain.

Third, information on both the diagnosis of and the likely consequences of treatment are asymmetrically allocated between the sell-side (providers) and the buy-side (patients) of the health care market. The very reason that patients seek advice and treatment from physicians in the first place is that they expect physicians to have vastly superior knowledge about the proper diagnosis and efficacy of treatment. That makes the market for medical care deviate significantly from the benchmark of perfect competition, in which buyers and sellers would be equally well informed.

By VICTORIA McEVOY, M.D., August 9, 2010, NY Times

At dawn, an old woman in a bright but tattered dress picked her way along a muddy, trash-strewn path. She stopped at a pile of garbage and carefully removed the remains of a dirty onion. Then she sat and slowly began to eat it for breakfast.

I was in southern Sudan as part of a medical team fromMassachusetts General Hospital — my first foray into international medical work. The goal of this pilot project was to teach Sudanese hospital staffs the basics of newborn care and resuscitation.

Southern Sudan has barely emerged from more than two decades of civil war, in which at least two million people died. Since the war ended in 2005, many of the aid agencies that were sustaining education, nutrition and health care have pulled out, and despite the heroic efforts of those that remain, most citizens’ day-to-day existence is shocking. As a tent camp manager in the town of Wau observed, “The peace is killing us.”

Pictures of these war-torn regions do no justice to the physical and emotional realities. It was boiling hot each day as we trekked over dusty, crater-filled streets filled with noisy motorcycles and honking jitneys. After lugging our equipment to the hospital, we were sweaty and exhausted by the time we began rounds in the children’s ward with the sole pediatrician.

The hospital was beyond imagination. Beds were overflowing with infants and children, many of them desperately ill with malaria, malnutrition or viral diseases. Babies with diarrhea wore no diapers, but were wrapped in simple cloths that their mothers would rinse out periodically in the hospital yard.

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A few physicians are already practicing it, though many allergists object because it’s untested. Clinical trials are underway.

Amber Dance, Special to the Los Angeles Times, August 2, 2010

Caroline Cooper will pack her bags and head off for college this fall secure in the knowledge that she’ll be able to safely eat anything the cafeteria dishes up.

Her mother, Heather Cooper, meanwhile, will not have to worry that Caroline, 17, will go into anaphylactic shock while alone in the dorm.

This is notable because from the time she was 11 months old until this past spring, Caroline Cooper was severely allergic to milk — a bit of cheese or yogurt could have killed her. But early last year, the teenager began a type of immunotherapy, eating minute but gradually increasing amounts of milk protein. In March she tasted her first bite of ice cream, the same day she was accepted in the honors business program at the University of Texas at Austin.

Traditional immunotherapy, via allergy shots, is a century-old technique most commonly used to treat inhaled allergens — such as cat dander and pollen — and it’s also standard treatment for bee sting allergy.

Using immunotherapy to treat food allergies is rare and well outside mainstream practice. Cooper’s allergist, Dr. Richard L. Wasserman in Dallas, has treated fewer than 100 food allergy patients — and he knows of only two other physicians doing it in their practices.

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