In a recent report by one of the left wing Washington Health Care think tanks they state:
The U.S. ranked last on performance overall, and ranked last or near
last on the Access, Administrative Efficiency, Equity, and Health Care
Outcomes domains. The top-ranked countries overall were the U.K.,
Australia, and the Netherlands. Based on a broad range of indicators,
the U.S. health system is an outlier, spending far more but falling
short of the performance achieved by other high-income countries. The
results suggest the U.S. health care system should look at other
countries’ approaches if it wants to achieve an affordable
high-performing health care system that serves all Americans.
The New Scientist reports on this result:
A comparison of health systems in 11 wealthy nations has found the US
falling short by multiple measures, while the UK’s National Health
Service leads in several categories. “We measured performance quality across five domains, and the USA fell short in all five,” .... The domains were ease of access to
healthcare, how equal access is to people of different incomes,
administrative efficiency, how well the care process works for people
who use it, and how good the health outcomes are.
Now the CEO of this think tank was a prominent figure in the development and deployment of the ACA, Strange that his work has led to this disaster.
However if one looks more objectively we have the NHS in the UK depriving parents of their rights and also having the highest death rate from cancer in the developed world due to the rationing of care. Thus if you chose your criteria to meet your desired conclusion I guess the US can be considered the worst!
Ironically it was, in my opinion, the think tank CEO's role in the EHR space that led to the massive administrative inefficiencies! So who to blame?
Friday, July 14, 2017
The Vatican and Politics
Over the last two thousand years the Vatican, or the Papal forces wherever they may have been located (like Avignon), have ventured into politics. Each time they do so they seem to strike a multiplicity of hornet nests. Add to this mix the Jesuitical philosophy and sophistic speculations on various individuals and you have a rather messy mix. John Paul II was on the verge of banning the Jesuits with their extreme proponents of Liberation Theology (see Gutierrez, A Theology of Liberation, Orbis, 1996).
Now comes the current Bishop of Rome and his minions declaring that major portions of American Religious groups are Manichean. To be a Manichean one must believe in gods of good and gods of evil and they are at war with one another.
Along comes the Vatican noting as follows:
Religion has had a more incisive role in electoral processes and government decisions over recent decades, especially in some US governments. It offers a moral role for identifying what is good and what is bad. At times this mingling of politics, morals and religion has taken on a Manichaean language that divides reality between absolute Good and absolute Evil. In fact, after President George W. Bush spoke in his day about challenging the “axis of evil” and stated it was the USA’s duty to “free the world from evil” following the events of September 11, 2001. Today President Trump steers the fight against a wider, generic collective entity of the “bad” or even the “very bad.” Sometimes the tones used by his supporters in some campaigns take on meanings that we could define as “epic.” These stances are based on Christian-Evangelical fundamentalist principles dating from the beginning of the 20th Century that have been gradually radicalized. These have moved on from a rejection of all that is mundane – as politics was considered – to bringing a strong and determined religious-moral influence to bear on democratic processes and their results.
There is no basis for this set of conclusions. Frankly it is sophistic and polemical and lacking of the slightest scholastic insight. Then they state:
A third element, together with Manichaeism and the prosperity gospel, is a particular form of proclamation of the defense of “religious liberty.” The erosion of religious liberty is clearly a grave threat within a spreading secularism. But we must avoid its defense coming in the fundamentalist terms of a “religion in total freedom,” perceived as a direct virtual challenge to the secularity of the state.
The authors grossly misunderstand the concept of religious freedom in the United States. Unlike France, which proclaims itself to be totally secular, ironically a result of the extensive interference of the Jesuits against the Government and even the people of France, in the US we have an express right of religious freedom devoid of any interference of the state.
Then the authors make the following statement:
There is a shocking rhetoric used, for example, by the writers of Church Militant, a successful US-based digital platform that is openly in favor of a political ultraconservatism and uses Christian symbols to impose itself. This abuse is called “authentic Christianity.” And to show its own preferences, it has created a close analogy between Donald Trump and Emperor Constantine, and between Hilary Clinton and Diocletian. The American elections in this perspective were seen as a “spiritual war."
Humorous, yes, but reflective of all Americans, hardly! Now they also note:
Pastor Rousas John Rushdoony (1916-2001) is the father of so-called “Christian reconstructionism” (or “dominionist theology”) that had a great influence on the theopolitical vision of Christian fundamentalism. This is the doctrine that feeds political organizations and networks such as the Council for National Policy and the thoughts of their exponents such as Steve Bannon, currently chief strategist at the White House and supporter of an apocalyptic geopolitics.
Guilt by association? Possibly.
One wonders why the Vatican has taken up a battle against the U.S. Not really if one truly understand South American Jesuits!
Now comes the current Bishop of Rome and his minions declaring that major portions of American Religious groups are Manichean. To be a Manichean one must believe in gods of good and gods of evil and they are at war with one another.
Along comes the Vatican noting as follows:
Religion has had a more incisive role in electoral processes and government decisions over recent decades, especially in some US governments. It offers a moral role for identifying what is good and what is bad. At times this mingling of politics, morals and religion has taken on a Manichaean language that divides reality between absolute Good and absolute Evil. In fact, after President George W. Bush spoke in his day about challenging the “axis of evil” and stated it was the USA’s duty to “free the world from evil” following the events of September 11, 2001. Today President Trump steers the fight against a wider, generic collective entity of the “bad” or even the “very bad.” Sometimes the tones used by his supporters in some campaigns take on meanings that we could define as “epic.” These stances are based on Christian-Evangelical fundamentalist principles dating from the beginning of the 20th Century that have been gradually radicalized. These have moved on from a rejection of all that is mundane – as politics was considered – to bringing a strong and determined religious-moral influence to bear on democratic processes and their results.
There is no basis for this set of conclusions. Frankly it is sophistic and polemical and lacking of the slightest scholastic insight. Then they state:
A third element, together with Manichaeism and the prosperity gospel, is a particular form of proclamation of the defense of “religious liberty.” The erosion of religious liberty is clearly a grave threat within a spreading secularism. But we must avoid its defense coming in the fundamentalist terms of a “religion in total freedom,” perceived as a direct virtual challenge to the secularity of the state.
The authors grossly misunderstand the concept of religious freedom in the United States. Unlike France, which proclaims itself to be totally secular, ironically a result of the extensive interference of the Jesuits against the Government and even the people of France, in the US we have an express right of religious freedom devoid of any interference of the state.
Then the authors make the following statement:
There is a shocking rhetoric used, for example, by the writers of Church Militant, a successful US-based digital platform that is openly in favor of a political ultraconservatism and uses Christian symbols to impose itself. This abuse is called “authentic Christianity.” And to show its own preferences, it has created a close analogy between Donald Trump and Emperor Constantine, and between Hilary Clinton and Diocletian. The American elections in this perspective were seen as a “spiritual war."
Humorous, yes, but reflective of all Americans, hardly! Now they also note:
Pastor Rousas John Rushdoony (1916-2001) is the father of so-called “Christian reconstructionism” (or “dominionist theology”) that had a great influence on the theopolitical vision of Christian fundamentalism. This is the doctrine that feeds political organizations and networks such as the Council for National Policy and the thoughts of their exponents such as Steve Bannon, currently chief strategist at the White House and supporter of an apocalyptic geopolitics.
Guilt by association? Possibly.
One wonders why the Vatican has taken up a battle against the U.S. Not really if one truly understand South American Jesuits!
Thursday, July 13, 2017
CAR-T Cells
Last year we wrote an extensive analysis of CAR-T cells. In Nature this week there is a piece on the FDA progress on approving them. They note:
External advisers to the US Food and Drug Administration (FDA) have thrown their support behind a therapy that genetically engineers a patient’s own immune cells to target and destroy cancers. In a unanimous vote on 12 July, the panel determined that the benefits of CAR-T therapy outweigh its risks. The vote comes as the agency considers whether to issue its first approval of a CAR-T therapy, for a drug called tisagenlecleucel, manufactured by Novartis of Basel, Switzerland. The FDA is not obligated to follow the recommendations of its advisers, but it often does...Studies have shown that CAR-T therapies can produce lasting remissions in such cases. In one key trial of tisagenlecleucel, which started in 2015, 52 out of 63 participants — 82.5% — experienced overall remissions. The unpublished trial had no control group, so investigators cannot yet say with certainty how much effect the treatment had. But many participants of such trials have remained cancer-free for months or years.
These are most likely the first of many therapeutics that are customized to attack specific individual cancer cells of an individual patient. Simply stated:
1. Immune System is Used to Attack
2. Targets on the cancer cells are identified
3. Chimeric cells are created to use the patients immune system but modified to attack the specific cancer cell
4. The cells are individually customized and then reinserted into the patient.
5. This is a very powerful approach! It may actually be akin to carpet bombing, turning the immune system against itself. There seems to be no way to turn it off.
However, ALL was a deadly disease. One of the first cases I saw was in 1967 when a classmate was sent home from Marine Corps training with a high and uncontrolled fever. It was ALL and he was dead in a couple of weeks. If this approach works it may very well stop this disease and more.
External advisers to the US Food and Drug Administration (FDA) have thrown their support behind a therapy that genetically engineers a patient’s own immune cells to target and destroy cancers. In a unanimous vote on 12 July, the panel determined that the benefits of CAR-T therapy outweigh its risks. The vote comes as the agency considers whether to issue its first approval of a CAR-T therapy, for a drug called tisagenlecleucel, manufactured by Novartis of Basel, Switzerland. The FDA is not obligated to follow the recommendations of its advisers, but it often does...Studies have shown that CAR-T therapies can produce lasting remissions in such cases. In one key trial of tisagenlecleucel, which started in 2015, 52 out of 63 participants — 82.5% — experienced overall remissions. The unpublished trial had no control group, so investigators cannot yet say with certainty how much effect the treatment had. But many participants of such trials have remained cancer-free for months or years.
These are most likely the first of many therapeutics that are customized to attack specific individual cancer cells of an individual patient. Simply stated:
1. Immune System is Used to Attack
2. Targets on the cancer cells are identified
3. Chimeric cells are created to use the patients immune system but modified to attack the specific cancer cell
4. The cells are individually customized and then reinserted into the patient.
5. This is a very powerful approach! It may actually be akin to carpet bombing, turning the immune system against itself. There seems to be no way to turn it off.
However, ALL was a deadly disease. One of the first cases I saw was in 1967 when a classmate was sent home from Marine Corps training with a high and uncontrolled fever. It was ALL and he was dead in a couple of weeks. If this approach works it may very well stop this disease and more.
Obesity vs Sugar
There has been an ongoing war, more than just a battle, over what causes obesity and then the issue regarding its sequellae. Namely such things as Type 2 Diabetes, then heart disease, kidney failure, and a significant number of inflammatory disease including cancers. Obesity leads to inflammation and inflammation leads to cancer. That is well established.
But people seem to focus on the wrong things. Some call it a disease, namely obesity. Thus one could call anything a disease, it is a way to hide the fact that it is done by choice. Some seek a single cause, carbohydrates, and even down to sucrose, plain white sugar.
Now white sugar is known to be a major cause of tooth decay. Yes it can add to obesity and is rather dangerous when one has diabetes.
Now there is an article in the Guardian that states:
I am now a member of the zipper club. I know, I thought it sounded rude too. But apparently it’s the club name for those of us who have a scar right down the middle of our chest. I have one down my leg too, from groin to ankle. And as I spend time recovering from a heart bypass operation – mostly doing very little, watching the cricket, reading the paper – I have started to reflect on my condition. How did it come to this? How did the arteries of my heart become so clogged with gunk that I may have been just weeks from meeting my maker? “Diabetic,” they said. “Pah,” I thought. I don’t feel any different. I just get up to pee a bit more at night. Some biochemical medical problem just seemed a bit too elusive, abstract, distant. I mean, .... who really took that seriously? Earlier this year, I was sent on a diabetes awareness day and spent the time looking out of the window, bored. They tried to explain it to me but I wasn’t concentrating. Well, now that someone has sliced through my breastbone as they might a Christmas turkey, the whole thing doesn’t seem quite so distant. And suddenly – and unsurprisingly – I am concentrating. All ears to, and pretty evangelical about, the evils of sugar.
This person knew or should have known that he was potentially a walking time bomb. The chest crack is perhaps just the beginning. He appears to have been obese for quite a while. How does one stop this? Good question. I have tried to tell folks what the problem is. When a teenager has a BMI in excess of 30 the mother says he is just a bit chubby and will out grow it. Doubtful.
The long term costs are explosive. Any new health care plan must somehow include a set of incentives regarding this issue. Otherwise the ongoing 3.75% Medicare tax on us older folks will go towards these chronic diseases, not to what it is supposed to go towards.
But people seem to focus on the wrong things. Some call it a disease, namely obesity. Thus one could call anything a disease, it is a way to hide the fact that it is done by choice. Some seek a single cause, carbohydrates, and even down to sucrose, plain white sugar.
Now white sugar is known to be a major cause of tooth decay. Yes it can add to obesity and is rather dangerous when one has diabetes.
Now there is an article in the Guardian that states:
I am now a member of the zipper club. I know, I thought it sounded rude too. But apparently it’s the club name for those of us who have a scar right down the middle of our chest. I have one down my leg too, from groin to ankle. And as I spend time recovering from a heart bypass operation – mostly doing very little, watching the cricket, reading the paper – I have started to reflect on my condition. How did it come to this? How did the arteries of my heart become so clogged with gunk that I may have been just weeks from meeting my maker? “Diabetic,” they said. “Pah,” I thought. I don’t feel any different. I just get up to pee a bit more at night. Some biochemical medical problem just seemed a bit too elusive, abstract, distant. I mean, .... who really took that seriously? Earlier this year, I was sent on a diabetes awareness day and spent the time looking out of the window, bored. They tried to explain it to me but I wasn’t concentrating. Well, now that someone has sliced through my breastbone as they might a Christmas turkey, the whole thing doesn’t seem quite so distant. And suddenly – and unsurprisingly – I am concentrating. All ears to, and pretty evangelical about, the evils of sugar.
This person knew or should have known that he was potentially a walking time bomb. The chest crack is perhaps just the beginning. He appears to have been obese for quite a while. How does one stop this? Good question. I have tried to tell folks what the problem is. When a teenager has a BMI in excess of 30 the mother says he is just a bit chubby and will out grow it. Doubtful.
The long term costs are explosive. Any new health care plan must somehow include a set of incentives regarding this issue. Otherwise the ongoing 3.75% Medicare tax on us older folks will go towards these chronic diseases, not to what it is supposed to go towards.
Thursday, July 6, 2017
Government Does Not Seem to Be Able to Do Anything
Jul 06, 2017 09:48:41 PM Train service is suspended in and out of Penn Station New York due to a minor NJ Transit train derailment. All mid-town direct trains will be diverted To HOB
Yes indeed, another train fell off the track. Our outgoing Gov spends time on closed public beaches, only God knows what the Secretary of Transportation does for a living, and the trains keep falling off the tracks. Metaphor anyone?
Next Monday they close Penn Station. That's 600,000 people per day. Go where? We need a new Dante!
And yes, there is zero chance that the work will be done on time or correctly. It is after all the Government folks are doing it. The only thing it will do is pad Pensions for these folks, Sad!
Sunday, July 2, 2017
Health Care Strategy
Eight years ago as the former Administration and Congress pushed the existing ACA, the media and the "think tanks" aligned with the Administration extolled the advantages and disadvantages of the collection of plans and how they finally morphed into what became the ACA.
In reality it was a massive Potemkin Village attack. While the focus was on trivial issues, the hidden agenda of control and taxation received no coverage. For example Medicare on all capital gains was never discussed, EHR mandates never discussed, and such flawed entities such as the USPSTF and PCORI were never discussed.
Bottom line, we all focused on the Potemkin Village while not seeing the armed vehicles come down the back road and add $400 billion to our annual deficit! Only half of that is excess Medicaid.
Now what have the Republicans done. Nothing. They have no voices out there with tables and charts, not specifics on anything, and they never even built a Potemkin Village! In fact they do not even have fuel for their tanks! The Senate head seems as lost as his spouse who seems to be fiddling while Penn Station, well euphemistically at least, "Burns".
Eight years ago I could read the Bill, make my nasty comments and bemoan our fate. Now we can read nothing and in fact our fate is now being cast in concrete.
It is a shame that we cannot reach some agreement. But alas, it is Washington!
In reality it was a massive Potemkin Village attack. While the focus was on trivial issues, the hidden agenda of control and taxation received no coverage. For example Medicare on all capital gains was never discussed, EHR mandates never discussed, and such flawed entities such as the USPSTF and PCORI were never discussed.
Bottom line, we all focused on the Potemkin Village while not seeing the armed vehicles come down the back road and add $400 billion to our annual deficit! Only half of that is excess Medicaid.
Now what have the Republicans done. Nothing. They have no voices out there with tables and charts, not specifics on anything, and they never even built a Potemkin Village! In fact they do not even have fuel for their tanks! The Senate head seems as lost as his spouse who seems to be fiddling while Penn Station, well euphemistically at least, "Burns".
Eight years ago I could read the Bill, make my nasty comments and bemoan our fate. Now we can read nothing and in fact our fate is now being cast in concrete.
It is a shame that we cannot reach some agreement. But alas, it is Washington!
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