Watch Out For Your Pets (And Yourself)

From the WSJ Health Blog:

We found an item in this week’s CDC Morbidity and Mortality Weekly Report inexplicably fascinating: A detailed accounting of the ways Americans trip over their pets.

This is not, as it turns out, a trivial issue: More than 86,000 Americans wind up in the emergency room every year because of falls related to cats or dogs. That’s about 1% of all fall-related ER visits. Nearly 90% of the injuries were dog-related, and females were twice as likely as males to be injured. Here’s more:

O Canada

From today's Economix:

If unemployment continues to rise over the next few months in the United States, as predicted, many families will lose their health insurance coverage or struggle to pay premiums they can ill afford. By contrast, increased unemployment won’t reduce Canadian access to health care.

As the economist (and fellow Economix blogger) Uwe Reinhardt explains, the single-payer Canadian health care system delivers very good results for about half the per-person cost of ours — with huge savings from reduced paperwork. Economic disparities in access to health care are significantly lower there.

and...

According to latest estimates from the Organization for Economic Cooperation and Development, a married worker earning the average wage, with two children, could expect 78 percent wage replacement in Canada, compared to 52 percent in the United States. The differences are even greater for those earning higher than average wages, because of low benefit ceilings.

The recently passed Economic Stimulus and Recovery Act offers incentives to states to expand unemployment provision to part-time workers and to those leaving jobs for “compelling family reasons.” The Canadian unemployment insurance system offers more comprehensive family benefits, including paid sick leave, paid compassionate care leave, and paid maternal and parental leaves of up to 50 weeks. Many American workers aren’t even eligible for the 12 weeks of unpaid family leave guaranteed by the Family and Medical Leave Act — although President Obama promises to change that.

Finally...

There’s no evidence that Canada’s public provision of health care and social benefits has reduced its economic growth, and the federal budget just presented is the first to show a deficit in 11 years.

What explains more support for public spending there? Slightly lower income inequality may encourage slightly more solidaristic policies. Such policies, in turn, reduce income inequality. The French social-democratic traditions of the province of Quebec exert a distinct influence. The Canadian political scientist Keith Banting argues that explicit efforts to develop a strong but multicultural national identity have strengthened norms of mutual support.

Good News! Cancer Risk Assessment Is Here...

...but only if you're white of course. It looks like the National Cancer Institute released a snazzy, fancy online protocol that helps people identify their approximate risk for colon cancer. The catch?

The catch is that it only works for whites.

That’s too bad, since blacks are at higher risk than whites for colorectal cancer, developing it and dying of it at higher rates, and recent reports suggest the racial gap is widening.

The new screening tool, developed by the National Cancer Institute and available at www.cancer.gov/colorectalcancerrisk, asks roughly 20 questions, the first two about race and ethnic background.

If the user answers “Hispanic” or “Black or African-American,” a box of red text pops up that says, “At this time the risk calculations and results provided by this tool are only accurate for non-Hispanic white men and women ages 50 to 85.” The text refers readers to another Web site for more information.

Financial Incentives for Smoking Cessation

A new study published in the New England Journal of Medicine observes that when given a financial incentive, smokers are more likely to quit for a given period of time. In particular, smokers were three times more likely to quit for six months when given approximately up to $750.

This raises several questions regarding study methodology and psychology. The question that sprung quickly into mind was how the payment structure worked. Were study participants paid after completion? Were they paid in advance? Was the payment in the form of a monthly stipend pending proof of smoking cessation? Each of these structures, of course, would have a vastly different effect on the outcome and provide different inferences about the human condition. Surely, for example, if a person were to be paid upon completion of a study, he or she would be more likely to quit smoking. I know that this is not exactly the point of the study -- rather it is more of an economics question to see generally how large the incentive would have to be for smokers to temporarily cease their bad habit. Yet, I am actually fascinated by the psychology underpinning this issue.

I took a look at the source study in the NEJM (a note to readers: you may be able to only view the abstract of the study, as I have a subscrition to the Journal). As suspected, the study participants were periodically interviewed and paid part of the total reward during each interview if they had successfully stopped smoking (proved with a cotinine test) and the rest upon completion. This suggests that individuals would accept some form of reward (not necessarily financial) to temporarily relinquish a bad habit, but I wonder what would happen if the study were expanded for a significantly lengthier period. Suppose the investigators tracked participants for a decade, two decades, etc and offered a substantially larger reward for completion. What if these participants were paid a monthly stipend rather than a lump sum? Would smokers permanantly give it up?

My guess is not. In general, I think, individuals are willing to accept small probabilities of harm or death for small rewards (i.e. jaywalkers accept a small chance of getting killed by a car in order to save a few seconds of time). Conversely, individuals might be willing to accept small monetary rewards to spare some temporary pleasures (cigarette smoke), but are probably not as likely once the magnitude of the risks and rewards are increased.

More Gyro Please!

From the NYTimes:

After nearly five years of follow up, about 275 people in the healthy group developed mild cognitive impairment. People who closely adhered to a Mediterranean diet had a 28 percent lower risk of developing mild cognitive impairment, compared to those whose eating habits were the least like a Mediterranean diet. Moderate followers of a Mediterranean diet also benefited, showing a 17 percent lower risk than the lowest-scoring group.

A Mediterranean diet also appeared to slow decline in those already diagnosed with mild cognitive impairment. Among the 482 men and women with mild cognitive impairment at the beginning of the study, 106 developed Alzheimer’s disease about four years later. But among those who strictly adhered to the Mediterranean diet, risk of Alzheimer’s was 48 percent lower, while risk was 45 percent lower among those who ate a moderate version of the diet.

Let's Get Digital

What are the main issues at play blocking the digitalization of patient records in the United States? High cost to hospitals and private practices? Patient privacy? Insistence on maintaining a tradition of incomprehensible doctor handwriting?

Is this an issue that the government (federal or state) has jurisdiction to act on by insisting on the use of digital records? Or is it to be left to the discretion of private practice, or perhaps benevolent third parties.

Some News..

Here's something fun:

Sen. John McCain promises that, as president, he would “cut taxes and balance the budget.” But his current economic plan would create deficits as deep as 5.7% of GDP by the end of a two term presidency — the highest federal budget deficit in 25 years — and would accumulate the biggest debt since the second World War, according to a new analysis by the Center for American Progress Action Fund. McCain’s current fiscal plan would recklessly exacerbate the fiscal irresponsibility of the Bush Administration further by gutting revenues far below the average level of the past 25 years.

Oh, and how about this?

The Bush administration improperly issued a policy directive last year that restricts states' abilities to expand their SCHIP programs, the Government Accountability Office and the Congressional Research Service said on Thursday during a House Energy and Commerce Health Subcommittee hearing, CQ Today reports. The Aug. 17, 2007, policy directive requires states to enroll 95% of children in families with incomes up to 200% of the federal poverty level before expanding coverage to children in families with incomes greater than 250% of the poverty level.

Informed Decisions

Freakonomics linked to this article today:

Doctors are adjusting their bedside manner as better informed patients make ever-increasing demands and expect to be listened to, and fully involved, in clinical decisions that directly affect their care. In a study just published in Clinical Orthopaedics and Related Research, Dr. J. Bohannon Mason of the Orthocarolina Hip and Knee Center in Charlotte, NC, USA, looks at the changes in society, the population and technology that are influencing the way patients view their orthopaedic surgeons. As patients gain knowledge, their attitude to medicine changes: They no longer show their doctors absolute and unquestionable respect.

Is this a blessing or a curse? On the one hand, developments in technology have produced more informed patients that do not blindly succumb to the will of their seemingly omnipotent physicians, and can use efficient internet tools in order to research information on signs, symptoms, diagnoses and procedures, statistics, risks, etc. On the other hand, these same factors have resulted in patients becoming more arrogant, disrespectful to doctors, and impetuous in selecting medical treatments. After all, looking up information on the internet is certainly no substitute for the experience and training that a typical physician would have acquired. It is also common that such a savvy patient would be more susceptible to medical marketing and influenced by factors other than evidence-based medicine.

Thoughts?