Good Entropy

Just-as-good Medicine » American Scientist

That decrementally cost-effective innovations are so rarely described in the health-care literature suggests that medicine is distinct from most other markets, in which cost-decreasing, quality-reducing products are continuously being introduced—think IKEA, Walmart and the Tata car. Several reasons may explain this “medical exceptionalism.” First, there is fundamentally a lack of incentives both for physicians to control costs, especially under a fee-for-service regime, and for patients to demand less expensive treatment when insurance shields them from the direct costs of care. Second, medical “bargains” frequently come with health risks, and trading health for money strikes some as vulgar, regardless of ratio. The inherent ethical unease that decrementally cost-effective innovations can elicit poses a serious public relations and marketing challenge.

From Mounting evidence links language pathway to autism

FOXP2 codes for a protein that regulates the expression of other genes. Last year, an international group of scientists identified one of its targets, contactin-associated protein-like 2 (CNTNAP2). They also found that certain common variants of CNTNAP2 tend to crop up in people with specific language impairment, a developmental disorder.

CNTNAP2 was an exciting find because three independent teams had recently published that common variants of the gene up the risk of developing autism.

“I think the evidence now that CNTNAP2 is involved [in autism] is quite good,” says leader of one of the teams, Aravinda Chakravarti, professor at the McKusick Nathans Institute of Genetic Medicine at Johns Hopkins University. “We’re now interested in finding the molecular basis of this.”

In unpublished data, Chakravarti says he’s found that CNTNAP2 is over-expressed in a small number of postmortem autistic brains.

Geneticists have discovered many different autism-related variants of CNTNAP2, a massive gene spanning 2.3 million base pairs. “Disruptions in the front end of the gene [usually] mean you’ll get a more severe disorder, like full-blown autism or severe expressive language delay,” notes Martin Poot, research associate professor of medical genetics at the University Medical Center Utrecht, in the Netherlands.

Great site:

http://www.ischool.drexel.edu/faculty/ssilverstein/failurecases/

In the comments to
The Data Model That Nearly Killed Me

Alexander Scarlat MD
April 18, 2009

“Data modeling is not optional” (Data Modeling Essentials by Simsion & Witt)

Great article and a correct diagnosis of one of the main problems of the Healthcare Informatics industry.
I am a physician with a degree in computer sciences currently employed as Chief Medical Informatics Officer with a medium sized hospital in the USA. We are now in the process of setting up a clinical data repository to store and present the users with laboratory results, imaging links and pharmacy orders on top of the diagnosis and procedures. I found out repeatedly that vendors are not willing to share the database schema of their products with the excuse it is a proprietary document. Unfortunately, many times this is just an excuse for a complete lack of such a schema. Even worse -the conceptual diagram, logical and physical data model is either non existent, poorly defined or kept in someone’s vault. The analogy that comes to mind is trying to build a house without a blueprint or with one that is kept in the builder’s vault.
I strongly recommend anyone in the HIT industry to read the book I have quoted above. I have no doubt it will save millions of $, mountains of users ‘ frustrations and most probably a couple of lives.

Mark A. Hall, JD, and Robert A. Berenson, MD
Annals of Internal Medicine
1 March 1998 | Volume 128 Issue 5 | Pages 395-402

It is untenable for the medical profession to continue asserting an idealistic ethic that is contradicted so openly in daily practice. However, a satisfactory ethic appropriate to the managed care era has not yet been developed to replace the traditional ethic. Many in the profession have not come to terms with the conflicting expectations they now face and so feel caught in a moral crisis.

Over at The Covert Rationing Blog

He quotes a journal piece:

It is untenable for the medical profession to coninue asserting an idealistic ethic that is contradicted so openly in clinical practice. . .We propose that devotion to the best medical interests of each individual patient be replaced with an ethic of devotion to the best medical interests of the group [of patients] for which the physician is personally responsible.

from:Hall MA, Berenson RA. Ethical practice in managed care: a dose of realism. Ann Intern Med. 1998; 128:395-402.

This is a good example of how not having the patient paying for care allows ne forces the doctor to serve two masters in terms of ‘best medical interests’. Individuals are treated by physicians not groups.

The whole post is very worthwhile. He goes onto cite pioneering work by progressives to extend medical ethics to include

…a third ethcial precept: The Principle of Social Justice.

A high tech form of the same old ‘detoxification’ woo

Whenever I hear that term, I’m at least 90% certain that I’m dealing with seriously unscientific woo. The reason should be obvious to longtime readers of this blog or to anyone who has followed “alternative medicine” for a while, because “detoxification” is a mainstay of “alternative” treatments and quackery for such a wide variety of diseases and conditions. Of course, toxins are indeed a bad thing, and we close-minded reductionist “allopathic” physicians do indeed use detoxification when appropriate. What differentiates us from “alternative” medicine practitioners is that we have this extremely annoying tendency (annoying to alties, that is) to want to know exactly what toxins we are dealing with, to verify that they are present in concentrations that can cause problems or damage before instituting any sort of treatment for them, and then to tailor our therapies to remove the specific toxins causing symptoms and to verify that we are successful. Not so for the “detoxification” as practiced by so-called “complementary and alternative medicine” (CAM) practitioners. CAM “detoxification” most often does not specify which “toxins” are being “detoxified,” or when it does it is intentionally vague about them. Occasionally, they will get specific (mercury as a cause for autism), but the problem with specifying a “toxin” as a cause for a disease is that doing so allows for falsification; it also allows scientists who know something about the disease to assess the specific toxin as a cause for a disease for biological plausibility. Not surprisingly, rarely is the mechanism biologically plausible.

It occurs to me that just because someone is uninsured does not mean they are not getting adequate health care.