The Attack On Doctors' Hippocratic Oath

By BETSY McCAUGHEY | Posted Wednesday, April 29, 2009 4:20 PM PT

Patients count on their doctor to do whatever is possible to treat their illness. That is the promise doctors make by taking the Hippocratic Oath.

But President Obama's advisers are looking to save money by interfering with that oath and controlling your doctor's decisions.

Ezekiel Emanuel sees the Hippocratic Oath as one factor driving "overuse" of medical care. He is a policy adviser in the Office of Management and Budget (OMB) and a brother of Rahm Emanuel, the president's chief of staff.

Dr. Emanuel argues that "peer recognition goes to the most thorough and aggressive physicians." He has lamented that doctors regard the "Hippocratic Oath's admonition to 'use my power to help the patient to the best of my ability and judgment' as an imperative to do everything for the patient regardless of the cost or effects on others."

Of course, that is what patients hope their doctor will do.

But President Barack Obama is pledging to rein in the nation's health care spending. The framework for influencing your doctor's decisions was included in the stimulus package, also known as the American Recovery and Reinvestment Act of 2009.

The legislation sets a goal that every individual's treatments will be recorded by computer, and your doctor will be guided by electronically delivered protocols on "appropriate" and "cost-effective" care.

Heading the new system is Dr. David Blumenthal, a Harvard Medical School professor, named national coordinator of health information technology. His writings show he favors limits on how much health care people can get.

"Government controls are a proven strategy for controlling health care expenditures," he argued in the New England Journal of Medicine (NEJM) in March 2001.

Blumenthal conceded there are disadvantages:

"Longer waits for elective procedures and reduced availability of new and expensive treatments and devices."

Yet he called it "debatable" whether the faster care Americans currently have is worth the higher cost.

Now that Blumenthal is in charge, he sees problems ahead.

"If electronic health records are to save money," he writes, doctors will have to take "advantage of embedded clinical decision support" (a euphemism for computers instructing doctors what to do).

"If requirements are set too high, many physicians and hospitals will rebel — petitioning Congress to change the law or just resigning themselves to . . . accepting penalties," he wrote in NEJM early this month.

The public applauded the new requirement for electronic records, not foreseeing that it would put faceless bureaucrats in charge of your care.

Having medical records instantly available is beneficial. Delivering current research to doctors electronically is also important. The often-cited 2003 study from the Rand Corp. found that about half of patients did not get optimal care.

But undertreating patients was the larger problem: 46% of patients failed to receive needed treatments, while only 11% got treatments they didn't need. That's why prompting doctors to do the right thing will not curb spending — a point that Dr. Blumenthal has also made in his writings.

To reduce spending, as President Obama promises, doctors will have to be pressured to deny care. Rand reported that Canada allows few cardiac procedures for patients age 65 and older.

In critiquing the Hippocratic Oath, Dr. Emanuel calls for training medical students "to move toward more socially sustainable, cost-effective care." He says the trend "from 'do everything' to palliative care shows that change in physician norms is possible."

What he fails to see is that government should not be interfering in decisions about when it's time to say enough is enough to medical care.

Dr. Emanuel also cites medical comforts for pushing up costs: "Hospital rooms in the United States offer more privacy, comfort and auxiliary services than do hospital rooms in most other countries," he noted in the Journal of the American Medical Association last June.

President Obama has appointed impressively educated advisers. But no matter how many degrees they have, it's still important to examine what they think.

The views articulated by Drs. Emanuel and Blumenthal are contrary to American values. Such views are common in Europe, where some governments create an environment of medical scarcity. Do Americans want to copy Europe?

McCaughey is a patient advocate and founder of the Committee to Reduce Infection Deaths. She is also a fellow at the Hudson Institute and a former lieutenant governor of New York State.

Uninsured Figures Overhype The Lack Of Health Coverage

By SEAN HIGGINS
INVESTOR'S BUSINESS DAILY | Posted Friday, June 26, 2009 4:30 PM PT

President Obama rarely misses a chance to stress that 46 million people in the U.S. lack health coverage. But the actual number of chronically uninsured Americans is far less, experts say.

Obama cited the figure in a recent speech to the American Medical Association to create a sense of urgency and moral necessity for his proposed health care reforms.

"We are not a nation that accepts nearly 46 million uninsured men, women, and children. We are not a nation that lets hardworking families go without the coverage they deserve; or turns its back on those in need. We are a nation that cares for its citizens," Obama said.

The media and lawmakers, especially those advocating for broader federal coverage, often cite the 46 million figure — 45.7 million in 2007 according to the latest Census survey. But several studies have found that paints a distorted picture of the problem.

"This situation is really misrepresented," said June O'Neill, professor of finance at Baruch College, part of the City University of New York. O'Neill is also the former director of the nonpartisan Congressional Budget Office. "It is contradicted by the studies that show the large amount of resources that the uninsured actually do get."

Many can afford coverage but, for various reasons, choose to go without it, O'Neill says. Others are eligible for coverage from the government but don't take it. Others choose alternative means, such as neighborhood clinics.

Keith Hennessey, a top economic adviser to President Bush, breaks down the 45.7 million figure, based off of Census/Labor Department data. After excluding the well-off, young adults, noncitizens, those eligible for government programs and other factors, he finds there are just 10.6 million left.

Even that includes people who lacked coverage for a limited time.

The Census says people "were considered 'uninsured' if they were not covered by any type of health insurance at any time in that (past) year."

Thus, a person switching jobs who goes temporarily without coverage is deemed uninsured, even if he or she quickly gets coverage that same year.

"When you say 46 million Americans are uninsured that is a snapshot in time. It doesn't say anything about whether they were uninsured yesterday or whether they will be uninsured tomorrow," said Michael Tanner, health policy analyst at the free-market Cato Institute.

There are ways to address this issue, he says, such as making insurance more portable for workers.

Next, many people who can afford coverage on their own opt to go without to save money, other studies note. This is especially true of people in their 20s who as a group have the fewest health problems.

O'Neill did a recent study of people 18-64 who earn 250% of the poverty level — about $28,000 a year — or more. About 43% of those could afford coverage but went without it.

"Half of them are in the age group 18-34. These are people who are basically healthy. They may be in an accident but that's not enough for them to get coverage," O'Neill said. "The young are risk-takers."

A 2006 study by scholars at Johns Hopkins University and the Urban Institute argues that the number of people who have no insurance because they have no other option is closer to 24.9 million.

"We found that 24.7% of the uninsured are eligible for public health insurance programs. 55.7% are in the 'need assistance' category, and 19.6% are likely to be able to afford coverage on their own," the study's authors reported.

Even within the "need assistance" category, the authors didn't separate out people who lack coverage for a short time.

Many of those eligible for public programs may be unaware they are eligible. The authors called for more outreach.

Others may refuse to sign up, perhaps wanting to avoid the stigma of relying on a public program.

And some may be people who mistakenly tell researchers they are uninsured but actually are signed for Medicaid or SCHIP.

Co-author Lisa Dubay, an assistant professor at Johns Hopkins, who is working on an updated analysis, suspects the number of people who can't afford care has probably risen "because of what has happened with the economy and the job loss." She could not cite figures though, saying this was her "intuition."

Cato's Tanner also noted that the 45.7 million uninsured includes about 8 million to 10 million immigrants who may not be in the country legally and therefore are unlikely to be covered.

Ultimately, using the 45.7 million figure distorts the policy choices.

"It gives this implication that you have this huge pool of Americans who are never able to get insurance," Tanner said. "That inclines you towards much more government intervention than if you said we had a small pool of people who move in and out of the insurance market because they move in and out of the job market."

Congress this year expanded the COBRA health care program that lets people keep insurance after leaving their jobs, including subsidies for several months.

Lawmakers also have expanded the SCHIP health program for lower-income — and increasingly middle-income — children. That will boost the number of eligible Americans, though many already have private insurance.

Americans Want Health Reform But Not Government-Run Care

By RAGHAVAN MAYUR | Posted Friday, June 26, 2009 4:20 PM PT

Although sharply divided along party lines, most Americans favor an overhaul of the health care system, but they are concerned that the quality of care will decrease significantly if government is allowed to run it.

While 73% of respondents believe the health care system needs a "complete overhaul" or "major changes," nearly one-half (47%) say they fear a government-run program would lead to deterioration in quality.

The IBD/TIPP Poll of 922 Americans in the first week of June points to a sharp divide along party lines: Eight of 10 Democrats believe the government should guarantee health insurance for all, while almost as many Republicans (72%) believe health care is not government's responsibility.

If the government were to run health care, 33% of Democrats believe the quality of care would improve significantly and another 34% believe it would not be affected one way or the other. On the other hand, 77% of Republicans anticipate a decline in quality.

Eighty-one percent of Democrats express confidence in President Obama's ability to reform the health care system in a way that will satisfy most Americans, while only 26% of Republicans believe so.

(Independents are almost equally divided on the issue, with 56% expressing confidence in the president's ability to do so, compared with 43% who do not.)

View larger image

The near-consensus for overhaul appears to stem from soaring costs and estimates that as many as 47 million people in America are going without health coverage.

Perhaps most troubling to advocates of a "single payer" or "public option" to compete with traditional market-based private insurance is an emerging suspicion among Americans of government intervention in the private sector.

A majority (53%) of Americans do not support government control or ownership of key industries such as health care or energy. Thirty-four percent of Democrats, 79% of Republicans and 53% of independents say they want the government to stay out of key industries.

Americans see the recent aggressive government control of financial institutions and the automotive industry in a negative light. For example, 68% of Americans are skeptical of the government's recent decision to take a partial stake in the domestic automobile industry, with 49% of Democrats, 87% of Republicans and 74% of independents believing it will not solve the industry's problems.

Some pundits see President Obama's proposal to create a public plan as a way station to full-blown government-run health care in the future.

An increasing number of Americans see the country drifting toward socialism. Last August, only 25% of Americans surveyed in our IBD/TIPP Poll agreed with the statement, "The U.S. is evolving into a socialist state." When asked the same question this month, the number jumped to 35%.

The skepticism about government control may be rooted in the performance of other government-run programs.

Medicare is in dire straits, spending so much more than it takes in that, at the present rate, the system will operate in the red as early as 2017, according to the Medicare trustees' report. The Social Security trustees recently announced that the Social Security trust fund will run out of money by 2037, four years earlier than previous estimates.

Lack of success in government-run health care systems overseas may also contribute to Americans' quality concerns.

In Sweden, where the government pays almost all health care costs, budgetary concerns are forcing rationing, leading to waiting lists for medical appointments and surgery. Health care systems in Great Britain and Canada have also been beset with problems, with the waiting time to see a specialist in Canada running as long as 18 weeks.

In summary, Americans want an overhaul but do not see their government as the locus of control.

Mayur is president of TechnoMetrica Market Intelligence, which directs the IBD/TIPP Poll that was the most accurate in the 2004 and 2008 presidential elections.

Heeeere's Barack!

By INVESTOR'S BUSINESS DAILY | Posted Friday, June 26, 2009 4:20 PM PT

Media Bias: ABC's prime-time special starring President Obama was shameless journalistic favoritism. But as a promotional event, it backfired; the broadcast revealed no public demand for his vision of health reform.

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After announcing that it would carve out a valuable evening slot for what might best be called "The Health Care Show Starring Barack Obama," ABC assured the public it would be no glorified White House infomercial. But an analysis of the broadcast's content indicates otherwise.

The program's real name was "Questions for the President: Prescription for America." But it was more like "Long Answers from the President." Obama had plenty of time for monologues. An analysis by the Business and Media Institute found that some 60% of the 75 minutes of airtime was eaten up by the president talking.

Questions and comments from the pre-picked audience were a total of just 12% of the programming, well under 10 minutes — this on a show advertised as dialogue about the future of U.S. health care.

There were no real health care experts present to ask the president any tough, informed questions from a divergent viewpoint, no John Goodman of the National Center for Policy Analysis or Dr. David Gratzer of the Manhattan Institute. Unless, of course, you count ABC's latest incarnation of Marcus Welby, M.D., the network's "medical editor," Dr. Tim Johnson.

John Sheils of the Lewin Group, which did a devastating analysis on the effects of establishing a government health care option, was nearly apologetic in his one brief chance to ask a question. He had no opportunity for a follow-up.

As for Republican members of Congress, who could have presented the TV-watching public with alternative reform plans, or made the case for keeping the status quo rather than embracing the path to socialized medicine, there were none to be seen.

With no chance to rebut, the Republican National Committee was justified in demanding through a letter to ABC that "the Republican Party should be included in this primetime event, or the DNC should pay for your airtime."

ABC's response to the RNC was: Don't worry, "ABC News will have complete editorial control. To suggest otherwise is quite unfair to both our journalists and our audience."

But America, after all, is a republic. We elect representatives who analyze policies and decide on our behalf. How can we have a televised "conversation" about a major issue featuring the president, but not elected officials from the opposing party who fundamentally disagree with his position? That's just the president having a conversation with himself in the presence of a TV audience.

And speaking of those watching at home, if Americans are so anxious to change our health system, why is it that the Obama Show came in third among the top three networks in the ratings? How is it that even a rerun of CBS' "CSI:NY" beat out this oh-so-important debate on the future of medicine?

The meager ratings should be particularly satisfying for those who wanted to buy ad time during the show to make the case against ObamaCare but were not allowed to by ABC. With so few watching, they wouldn't have gotten their money's worth anyway.

In the context of moderate congressional Democrats refusing to support the establishment of a government-run alternative health care plan, and the airwaves already filled with warnings of the consequences of ObamaCare, the president's ABC infomercial can only be viewed as having backfired.

Viewer interest was poor as Obama tried to rally the public behind a program designed to make him the 21st-century FDR, and no one should wonder why. After spending hundreds of billions already — purportedly to "save" the world economy — the president's insistence that we also have to transform a health care system, that though flawed remains the envy of the world, simply rings false.

We continue, however, to be in great danger of being subjected to "reform" that will yield socialized medicine. The only prescription that will protect the public from it: a large dose of information.

Dozens of National Guard Soldiers Sick After Iraq 2003 Deploy, Toxic Chemical Eyed

Saturday, June 27, 2009

Larry Roberta's every breath is a painful reminder of his time in Iraq. He can't walk a block without gasping for air. His chest hurts, his migraines sometimes persist for days and he needs pills to help him sleep.

James Gentry came home with rashes, ear troubles and a shortness of breath. Later, things got much worse: He developed lung cancer, which spread to his spine, ribs and one of his thighs; he must often use a cane, and no longer rides his beloved Harley.

David Moore's postwar life turned into a harrowing medical mystery: nosebleeds and labored breathing that made it impossible to work, much less speak. His desperate search for answers ended last year when he died of lung disease at age 42.

What these three men — one sick, one dying, one dead — had in common is they were National Guard soldiers on the same stretch of wind-swept desert in Iraq during the early months of the war in 2003.

These soldiers and hundreds of other Guard members from Indiana, Oregon and West Virginia were protecting workers hired by a subsidiary of the giant contractor, KBR Inc., to rebuild an Iraqi water treatment plant. The area, as it turned out, was contaminated with hexavalent chromium, a potent, sometimes deadly chemical linked to cancer and other devastating diseases.

No one disputes that. But that's where agreement ends.

Among the issues now rippling from the courthouse to Capitol Hill are whether the chemical made people sick, when KBR knew it was there and how the company responded. But the debate is more than about this one case; it has raised broader questions about private contractors and health risks in war zones.

Questions, says Sen. Evan Bayh, who plans to>>>

Why He Was Booed

By INVESTOR'S BUSINESS DAILY | Posted Wednesday, June 17, 2009 4:20 PM PT

Health Care: President Obama talked a lot about cutting medical costs during his 7,300-word speech to doctors Monday. But he rejected the only item he brought up that would actually cut medical costs.

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IBD Exclusive Series: Government-Run Healthcare: A Prescription For Failure

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Though he acknowledged that part of the high cost of health care is due to defensive medicine — doctors ordering more tests and treatments than necessary in an effort to avoid being sued — he told the American Medical Association that he is "not advocating caps on malpractice awards."

"I personally believe (they) can be unfair to people who've been wrongfully harmed," he said.

Obama, who took some boos from a few American Medical Association members who don't agree with him, is free to hold that opinion. But the facts show generous awards that juries hand out to plaintiffs in medical malpractice lawsuits have raised costs.

• In 2004, Towers Perrin Tillinghast looked at the trial lawyer industry and found that "At nearly $27 billion in 2003, medical malpractice costs translated to $91 per person.

"This compares to $5 per person in 1975 (not adjusted for inflation). This significant escalation in medical malpractice costs has contributed to the increase in health care costs in the U.S. over the past 30 years."

• The Department of Health and Human Services said in its 2002 report "Confronting the New Health Care Crisis": "If reasonable limits were placed on noneconomic damages to reduce defensive medicine, it would reduce the amount of taxpayers' money to the federal government by $25.3 billion to $44.3 billion per year."

• The increase in medical malpractice lawsuits and the associated costs that keep going up have forced insurance companies to raise premiums for malpractice coverage. Doctors, in turn, pass the added costs on to patients.

"The litigation and malpractice insurance problem raids the wallet of every American," the Department of Health and Human Services said in the same report.

"Doctors alone spent $6.3 billion last year to obtain coverage. Hospitals and nursing homes spent additional billions of dollars."

• HHS has further said that reasonable limits placed on noneconomic damages in malpractice cases would save $60 billion to $108 billion a year.

"These savings would lower the cost of health insurance and permit an additional 2.4 million to 4.3 million Americans to obtain insurance," the department said.

Nearly 10% of the cost of health care services, figures PricewaterhouseCoopers, is attributable to medical malpractice lawsuits. Roughly 2% is caused by direct costs of the lawsuits while an additional 5% to 9% is due to expenses run up by defensive medicine.

PricewaterhouseCoopers also>>>

The Phantom Uninsured

By INVESTOR'S BUSINESS DAILY | Posted Tuesday, June 16, 2009 4:20 PM PT

Health Care: The administration uses the "46 million uninsured" as a reason to nationalize health care. But the Census Bureau says about a fifth of those aren't U.S. citizens. In fact, a goodly number are illegal aliens.

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At a town hall meeting in Green Bay, Wis., last week, President Obama spoke of the need to cover the "46 million people who don't have health insurance." At another point he simply referred to the "46 million uninsured." At neither point did he refer to them as "Americans."

That was wise, because not all them are, the Census Bureau says.

According to "Income, Poverty, and Health Insurance Coverage in the United States," a Census Bureau report published last August, of the 45.6 million persons in the U.S. that did not have health insurance at some point in 2007, 9.7 million, or about 21%, were not U.S. citizens.

The Census Bureau does not ask if anyone is here legally or illegally, so we can't tell how many are actually illegal aliens. We do know that throughout the Southwest and elsewhere, emergency rooms have been overburdened by a continuous flood of illegal aliens.

Also among the uninsured are 17 million Americans who live in households where the annual income exceeds $50,000; 7 million of those without coverage have incomes of $75,000 a year or more.

The notion that the uninsured are without health care is bogus, as well. They consumed an estimated $116 billion worth of health care in 2008, according to the advocacy group Families USA. Many of the uninsured are young and healthy (40% are between ages 18 and 34) and at this point in their lives, particularly in this economy, choose to put their dollars elsewhere.

Subtract noncitizens and those who can>>>

Truth-Mongering

By INVESTOR'S BUSINESS DAILY | Posted Tuesday, June 16, 2009 4:20 PM PT

Health Reform: The president predicts "scare tactics and fear-mongering that (have) worked in the past," warnings of "socialized medicine," "rationed care" and bureaucratic control. Real fears deserve mongering.

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IBD Exclusive Series: Government-Run Healthcare: A Prescription For Failure

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His teleprompter locked and loaded, President Obama has set off on a full-bore health care offensive that will lead to socialized medicine if the American people acquiesce. One of his chief tactics in what is no less than a war is to claim that those who say this are liars.

In his first big volley of the conflict, the president's lengthy address to the American Medical Association warned of "fear tactics to paint any effort to achieve reform as an attempt to, yes, socialize medicine." Scaremongers will "give warnings about socialized medicine and government takeovers, long lines and rationed care, decisions made by bureaucrats and not doctors."

In describing the nightmares himself, he has launched a pre-emptive strike against the 2009 versions of the anti-HillaryCare Harry and Louise commercials of 15 years ago.

The president twice promised upheaval in U.S. health care — a system Americans know, for all its flaws, to be the finest in the world. "If you like your doctor," he assured, "you will be able to keep your doctor, period." Same with your current health plan.

This is like telling a Dutchman living>>>

Built To Waste

By INVESTOR'S BUSINESS DAILY | Posted Friday, June 05, 2009 4:20 PM PT

Health Care: All the players talk cost cutting now, and many of their ideas could have been enacted long ago. The real question is why that didn't happen, and why we should expect the future to be different.

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Laugh at them if you want, but six big health organizations have been working hard to show they really mean it this time about cutting waste in American health care. Last Monday, they produced a 28-page report for President Obama outlining proposals that, they say, could save up to $1.7 trillion the next 10 years.

Their report, according to a cover letter, is the fruit of four weeks of activity that included "seven all-day meetings and multiple conferences." Doctors, drug companies, hospitals, makers of medical technology, insurers and unionized health care workers all had a say. Only the lawyers and (as is usual in such exercises) consumer-patients were left out.

That $1.7 trillion is a big number. So why is this report not a big story (and to judge from the quiet reaction it got, it's definitely not)? Why do we and so many others have trouble taking it seriously?

Three reasons, at least.

One is that the predicted savings are probably overblown because the organizations making them want to look like part of the solution, not part of the problem. After all, they were volunteered for this task by the Obama administration, which is implicitly asking all of them why they should be trusted to maintain their power in the system and not just take orders from the government.

Two is the well-founded skepticism>>>

The GOP Can Stop ObamaCare

• JUNE 18, 2009

By KARL ROVE

It's extremely unlikely that Republicans will be able to pass their own health-care plan in this Congress. But in politics you can't beat something with nothing, so it is critical that the GOP offers an alternative to President Barack Obama's government-run monstrosity.

Americans will listen more closely to Republicans if they make empirical and specific arguments against Mr. Obama's attempted government takeover of the nation's health system. But they must also offer proposals that families, small-businesspeople and health-care providers will applaud.

Fortunately, Sens. Tom Coburn of Oklahoma and Richard Burr of North Carolina, and Reps. Paul Ryan of Wisconsin and Devin Nunes of California have devised a plan that will likely appeal to anyone interested in making health insurance more affordable and portable.

Their proposal -- called the Patients' Choice Act -- is to leave in place the tax deduction companies receive for providing employees with health insurance and to create a "Medi-Choice" tax rebate that will give individuals $2,200 and families $5,700 to spend on health insurance.

The rebate will make health insurance more affordable>>>

FDA Warns Against Use of Zicam

• JUNE 16, 2009

By JENNIFER CORBETT DOOREN

The Food and Drug Administration told consumers to stop using certain Zicam cold and allergy products because they can cause permanent loss of smell, the latest crackdown under new FDA leaders.

The frequently advertised over-the-counter products contain zinc and have been the target of hundreds of lawsuits by consumers alleging that their sense of smell was damaged or destroyed.

FDA Warns About Homeopathic Remedy Zicam

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Health blogger Jacob Goldstein talks about the FDA's warning to consumers that Zicam can cause loss of smell.

More

• Health Blog: Zicam, the FDA and Homeopathy
• FDA warning letter
• Video: FDA Warns About Homeopathic Remedy Zicam

Zicam's maker, Matrixx Initiatives Inc., said it believes the products are safe and don't cause loss of smell. It called the FDA's move "unwarranted." William Hemelt, Matrixx's acting president and chief operating officer, said in an interview: "This isn't a new issue for us. We've certainly studied it for many years, and we think our products are safe." He declined to comment further.

In a separate notice on Zicam's Web site, the company said it would stop shipping the nasal sprays and swabs and reimburse customers seeking a refund.

The action on Zicam is one of several high-profile moves under new FDA Commissioner Margaret "Peggy" Hamburg and her principal deputy, Joshua Sharfstein.

In an interview Tuesday before the Zicam announcement, Dr. Hamburg said public health is her top focus. "We've been more aggressive in enforcement actions, where people's health is at risk," Dr. Hamburg said.

Under Dr. Sharfstein, who came to the agency in March while Dr. Hamburg was awaiting confirmation, the FDA issued strong warning letters to some of the largest drug makers regarding Web-based marketing and announced recalls on California pistachios.

The agency also said it is reconsidering its approval last December of a knee-surgery device that has been under attack by agency scientists, an unusual retreat for the FDA.

Such moves have caused concern among some industry officials, who say that if the FDA gets too tough it may prevent patients from speedy access to life-saving treatments.

and much more here>>>

Health Reform and Competitiveness

• JUNE 17, 2009

Democrats have spent years arguing that corporate tax rates don't matter to U.S. competitiveness. But all of a sudden one of their favorite arguments for government-run health care has become . . . U.S. corporate competitiveness. Political conversions on this scale could use a little scrutiny.

"Businesses now recognize that if we don't get a handle on this stuff then they are going to continue to be operating at a competitive disadvantage with other countries," President Obama recently remarked. "And so they anxiously seek serious reform."

Sure enough, many business leaders who should know better have picked up the White House theme. "You won't fundamentally solve the problems in business until you solve the problem of spiraling health-care costs, which is driving everybody crazy," said Google CEO Eric Schmidt the other day.

Messrs. Obama and Schmidt need to brush up on their economics. Employers may write the checks to the insurance companies, but workers still pay for the coverage they get from those employers. The total cost of an employee is what matters to businesses, and fringe benefits are as much a part of compensation as cash wages. When health costs rise, firms don't become less competitive, as if insurance were lopped out of profits. Instead, nonhealth compensation drops. Or wages rise more slowly than they otherwise would.

A recent study from none other than the White House Council of Economic Advisers notes exactly this point: If medical spending continues to accelerate, it expects take-home pay to stagnate. According to the New York Times, White House economic aide Larry Summers pressured CEA chairman Christine Romer to make the competitiveness argument, "adding that it was among the political advisers' favorite 'talking points.'" Ms. Romer pointedly retorted, "I'm not going to put schlocky arguments in there." How the schlock gets into Mr. Obama's speeches is a different question.

It's certainly true that the U.S. employer-based>>>

Smart Balance Keeps Tight Focus on Creativity

• JUNE 8, 2009

By JOANN S. LUBLIN

PARAMUS, N.J. -- The product-development laboratory at Smart Balance Inc., a food marketer keen to grow through innovation, contains chemical analyzers, lab benches and refrigerated cases. But there are rarely people.

"We don't have legions of white coats," explains Robert S. Gluck, Smart Balance's chief operating officer. Six of its staffers are charged with developing products, but they often work in suppliers' facilities nowhere near its headquarters here.

Smart Balance helps people stay lean with "heart healthy" merchandise, including low-cholesterol spreads, peanut butter, popcorn, cooking oil and milk. The company itself is lean as well, with just 67 employees and scant fixed assets. Its "virtual" business model outsources almost everything else, including manufacturing, product distribution and sales. The unusual approach is attracting attention, especially as recession-battered businesses slow new-product introductions.

More Management News

• Full Coverage: WSJ.com/Management
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"We are a pretty aggressive innovator despite>>>

Diabetes Study Questions Expensive Treatments

• JUNE 8, 2009

By KEITH J. WINSTEIN

Aggressive use of expensive diabetes drugs and medical devices called stents did no better than cheaper treatments at preventing deaths, heart attacks or strokes in a large study of diabetics with heart disease.

The study, sponsored by the National Institutes of Health and several drugmakers, is the latest to humble fancy new treatments by finding them no better than older medicines at preventing the deadly consequences of major diseases. The results add to a debate about alleged overuse of stents, made by companies including Abbott Laboratories, Boston Scientific Corp. and Johnson & Johnson, and controversial diabetes drugs from GlaxoSmithKline PLC and Takeda Pharmaceutical Co.

Funding for similar "comparative effective" studies have just been given a big boost. These bake-offs between competing therapies for the same condition have been hailed as a possible answer to wasteful health-care spending in the U.S. Washington allocated $1.1 billion for such research in the economic-stimulus bill passed in February.

The findings could make it more difficult for stents to sustain a recent sales rebound that followed a drop-off caused by a 2007 study that questioned their effectiveness.

The results also pose new questions for GlaxoSmithKline's Avandia, a diabetes drug already hurting because of worries about serious side effects; and for Takeda's Actos, an Avandia rival that has picked up market share in the wake of Avandia's problems.

Diabetes, in which the body can't control the amount of sugar>>>

Male Circumcision Reduces Risk Of Genital Herpes And HPV Infection, But Not Syphilis

ScienceDaily (Mar. 30, 2009) — Heterosexual men who undergo medical circumcision can significantly reduce their risk of acquiring two common sexually transmitted infections--herpes simplex virus type 2 (HSV-2), the cause of genital herpes, and human papillomavirus (HPV), which can cause cancer and genital warts, according to a report in the March 26 issue of the New England Journal of Medicine (NEJM). In the study, circumcision had no effect on their risk of becoming infected with the bacterium that causes syphilis, however.

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See also:

Health & Medicine

• STD
• Sexual Health
• Infectious Diseases
• HIV and AIDS
• Men's Health
• Viruses

Reference

• Trichomoniasis
• Transmission (medicine)
• Sexually transmitted disease
• HPV vaccine

that causes syphilis, however.

The findings build upon earlier clinical research funded by the National Institute of Allergy and Infectious Disease (NIAID), part of the NIH, which found that circumcision decreases a man's risk of acquiring HIV infection through heterosexual intercourse by more than 50 percent.

"Medically supervised adult male circumcision is a scientifically proven method for reducing a man's risk of acquiring HIV infection through heterosexual intercourse," says NIAID Director Anthony S. Fauci, M.D. "This new research provides compelling evidence that circumcision can provide some protection against genital herpes and human papillomavirus infections as well."

The study was conducted by scientists at the Rakai Health Sciences Program in Uganda in collaboration with researchers at the Johns Hopkins University Bloomberg School of Public Health in Baltimore, Makerere University in Kampala, Uganda, and NIAID's Division of Intramural Research. The collaborators examined samples from two parallel clinical trials in Rakai that successfully proved male circumcision as an HIV prevention method and also assessed the surgical procedure's ability to prevent other sexually transmitted infections, including syphilis and HSV-2. These infections cause genital ulcers and are associated with an increased risk of HIV acquisition. The research team also assessed circumcision's effect on HPV infections, which can cause anal, cervical and penile cancers and genital warts.

The two trials, one funded by NIAID>>>

Losing Control

• MAY 15, 2009

By DANIEL AKST

With all the talk of swine flu, universal health insurance and computerizing medical records, you'd think epidemics and inadequate medical care were the major threats to public health in this country. But an important new study on preventable deaths will quickly disabuse you of that notion. Read the report and you'll likely conclude that the biggest premature killer of Americans is . . . Americans.

Too many of us appear to be bent on slow-motion suicide. Consider smoking; if we could get every American to stop, we'd save 467,000 lives annually. Solving high blood pressure (much of it arising from unhealthy lifestyles) would save 395,000. And if we could get everyone to slim down to an appropriate body weight, we'd save 216,000 lives.

You can't aggregate all the lives that would be saved from the 12 lifestyle factors covered by the study because of some serious overlap; obesity, for instance, causes a lot of hypertension. But Dr. Majid Ezzati, a Harvard School of Public Health professor who co-authored the report, estimates that if you net out the double-counting, somewhat more than a million people die annually from the 12 behavioral risk factors, which include the obvious (immoderate alcohol consumption) and the less so (eating too little fish, which provides omega-3 fatty acids).

Put more starkly: Of the 2.5 million deaths that occur annually in America, something approaching half could be prevented if people simply led healthier lives.

The study, "The Preventable Causes of Death in>>>

Health Costs Are the Real Deficit Threat

• MAY 15, 2009

By PETER R. ORSZAG

This week confirmed two important facts -- that health-care costs are the key to our fiscal future, and that even doctors and hospitals agree that substantial efficiency improvements are possible in how medicine is practiced.

David Gothard

The numbers speak for themselves. The Medicare and Social Security trustees' reports released this week show that health-care costs drive our long-term entitlement problem. An example illustrates the point: If costs per enrollee in Medicare and Medicaid grow at the same rate over the next four decades as they have over the past four, those two programs will increase from 5% of GDP today to 20% by 2050. Despite the attention often paid to Social Security, spending on that program rises much more modestly -- from 5% to 6% of GDP -- over the same time period. Over the long run, the deficit impact of every other fiscal policy variable is swamped by the impact of health-care costs.

Spiraling health-care costs are not just some future abstraction, however. Right now, families across America who have health insurance are seeing their take-home pay reduced and their household budgets strained by high costs and spiraling premiums. State and local governments also are feeling this pinch. And the growing weight of health costs on state budgets translates into an inability to make investments in areas such as education, hindering our overall economic growth.

The good news is that there appear to be significant opportunities to reduce health-care costs over time without impairing the quality of care or outcomes. In health care, unlike in other sectors, higher quality currently seems to be associated with lower cost -- not the opposite.

For example, health-care costs vary substantially>>>

A Celebrity Patient's Backing Turns Sour for Drug Company

• MAY 14, 2009

By SHIRLEY S. WANG

Bristol-Myers Squibb Co. has worked with hundreds of patients in its promotional efforts. The drug maker says every collaboration, except for one, has been positive for both Bristol-Myers and the patients who tell their stories.

Andy Behrman is the one.

In 2004, Bristol-Myers held a retreat for 1,250 sales representatives, to prepare them to market a powerful psychiatric drug for a new use -- bipolar disorder.

Pharmaceutical companies have taken to paying patients to help promote their products. In the case of Andy Behrman and Bristol-Myers, the relationship has backfired.

A video of Mr. Behrman, a 42-year-old bipolar patient, filled a gigantic screen. He recounted how a Bristol-Myers drug, called Abilify, had changed his life. Unlike other medicines he had tried, Abilify had no side effects, he said. The testimonial drew a standing ovation.

But Mr. Behrman says he had only taken the drug for four days before the video was filmed. He says he later experienced side effects -- including dazed spells and agitation in his legs -- unpleasant enough that he stopped taking the drug within a year. He says he eventually told several company employees privately about the difficulties he was having with the drug.

Yet, he continued to talk glowingly about Abilify throughout 2004 and 2005, to sales representatives and other company employees, as well as psychiatrists hired by the company as consultants. In all, Bristol-Myers paid him $400,000.

Bristol-Myers says it has no record of Mr. Behrman telling any of its employees he was experiencing side effects, nor did it ever instruct him to misrepresent his experience with the drug. The company says it doesn't have records of when Mr. Behrman started or stopped taking Abilify. It says he was part of the company's "disease awareness" efforts, and his contract didn't require him to take Abilify.

Drug makers spend nearly $60 billion a year marketing their products, twice what they spend on research and development, according to a study published in PLoS, a journal of the Public Library of Science. Patient testimonials -- in TV ads, on Web sites and at company meetings -- have become an important part of that, alerting the public to illnesses ranging from heart disease to cancer and connecting medicines with real-world stories of problems solved.

Clearly, working with psychiatric patients can present>>>

Cigarette Design May Boost Risks

• MAY 19, 2009

| ASSOCIATED PRESS

WASHINGTON -- It may be riskier to smoke cigarettes today than it was a few decades ago -- at least in the U.S. -- says new research that blames changes in cigarette design for fueling a certain type of lung cancer.

Up to half of the nation's lung-cancer cases may be due to those changes, David Burns of the University of California, San Diego, told a recent meeting of tobacco researchers.

It's not the first time that scientists have concluded the 1960s movement for lower-tar cigarettes brought some unexpected consequences. But this study, while preliminary, is among the most in-depth looks. And, intriguingly, it found the increase in a kind of lung tumor called adenocarcinoma was higher in the U.S. than in Australia, even though both countries switched to so-called milder cigarettes at the same time.

"The most likely explanation for it is a change in the cigarette," Dr. Burns said in an interview, and he cited a difference: Cigarettes sold in Australia contain lower levels of nitrosamines, a known carcinogen, than those sold in the U.S.

That's circumstantial evidence that requires more research, he acknowledged.

But antismoking advocates are citing the study as Congress considers whether the Food and Drug Administration should regulate tobacco, legislation that would give the agency power to decide such things as whether to set caps on certain chemicals in tobacco smoke.

Smokers once tended to get lung cancer in larger air tubes, particularly a type named "squamous cell carcinoma." Then doctors noticed a jump in adenocarcinoma, which grows in small air sacs far deeper in the lung. Initial studies blamed the introduction of filtered, lower-tar cigarettes. When smokers switched, they began inhaling more deeply to get their nicotine jolt, pushing cancer-causing smoke deeper than before.

Dr. Burns's study, presented at a meeting of the>>>

Hidden Risk: Millions of People Don't Know They Are Diabetic

• MAY 19, 2009

By MELINDA BECK

One of the most troubling statistics in health care is this: Twenty-three million Americans have diabetes, and one-quarter of them don't realize it.

Experts know these people exist -- even if they don't know themselves -- by extrapolating from big government health surveys that include blood tests. A surprising number of adults have elevated blood-sugar levels that meet the criteria for diabetes but have never had symptoms or ignored them. The numbers would no doubt be higher if they included children, since Type 2 diabetes is being found at ages as young as 4.

Are You Vulnerable

The American Diabetes Association recommends:

Age 45 and older, you should be screened every 3 years and more often if you have any of the following:

• Family history of diabetes
• BMI of 25 or more
• Inactive lifestyle
• High blood pressure
• High cholesterol and/or high triglycerides
• Gestational diabetes
• African-American, Hispanic, Asian, Native American or Pacific Island heritage
• Polycystic ovary syndrome

Under 45, you should be screened regularly if you have a BMI of 25 or more and any one of the other risk factors.

For more information on your individual risk, see the ADA's online quiz .

Source: American Diabetes Association

Discuss

• Do you have diabetes? If so, how did you find out and how are you managing it? Join the discussion, at Journal Community.

The danger of undiagnosed diabetes is that, left untreated, it raises the risk of heart disease and stroke and can escalate into blindness, kidney failure, loss of limbs and death.

Yet fear of such complications is a key reason it often goes undiagnosed. "Many people know of elderly relatives who died or had these complications, and they don't get it checked out because they're terrified," says Robin Goland, co-director of the Naomi Berrie Diabetes Center at Columbia University Medical Center in New York. "But it doesn't have to be that way. We know how to manage it."

Some people fail to get tested because Type 2 diabetes is often associated with being overweight and sedentary. "People think it's their fault, but that's not true," Dr. Goland says. Roughly 20% of the people with Type 2 diabetes are thin, and 75% of obese people never get it.

The biggest risk factor is a family history. The more relatives you have with the disease, the higher your own risk is. Being overweight seems to activate the genetic predisposition in many cases, but not always. "People with a lot of genetic loading can get it at a younger age and a lower body weight," Dr. Goland says.

Diabetes is technically an imbalance between sugar,>>>