We are an exceptional nation. At least when it comes to healthcare spending.
We spend much more than any other rich country, but we certainly don’t get more for it. We get less. We get about the same health outcomes, but don’t cover everybody like other rich countries do. Now, there are a lot of statistics that show how singularly wasteful our healthcare system is, but the chart below, via Aaron Carroll, is maybe the most visually arresting. It compares life expectancies with healthcare spending per capita for rich and near-rich countries. There’s a pretty predictable relationship, with diminishing returns for more spending—and then there’s the U.S.
See that dot that’s almost off the chart? We spend more than four times as much as the Czech Republic does per persona, and live about just as long.The problem is everybody wants the system to change, but nobody wants their corner of it to change. Doctors don’t want their pay to change. And patients don’t want their coverage to change. Obamacare tries to change both at the margins, and even that is politically fraught.
But something has to change. We can’t afford our healthcare exceptionalism.
The public health message that “breast is best” has been received loud and clear. More mothers in the U.S. are breast-feeding, and they’re doing so longer than ever.
But those simple facts hide a complicated world where passions about breast milk run high, and demand has skyrocketed.
Women who have extra milk are intensively courted, by hospitals who need the breast milk for premature babies and by moms who can’t nurse their own babies and don’t want to use formula.
Courtney Helms, who works in fundraising for an educational nonprofit in Dallas, had no idea about the market for donated breast milk until her second son was born. Helms was a committed breast-feeder, but her supply dropped after recurrent bouts of strep throat. So she turned to a Facebook group to find moms who would give her extra frozen milk.
"Before I started to have kids I never would have thought of anything like this and maybe if I did, I would have thought it was weird," Helms said. "But being a wet nurse is not something we have just invented recently."
Helms wasn’t all that concerned about safety, though she met with donors in person and asked a few questions about diet, medications and caffeine intake. But mostly she just trusted them, because they were nursing their own babies.
That’s a mistake, according to people who work for breast milk banks. These banks, mostly nonprofits, carefully screen donors and also pasteurize the milk. Mothers are tested for infectious diseases like HIV and hepatitis, and the milk itself is tested for tested for bacteria, says Kim Updegrove, president of theHuman Milk Banking Association of North America.
"The practice of Internet sharing of human milk is not safe," Updegrove says. "Sharing a body fluid with all of its potential bacteria and viruses is dangerous, and it is playing Russian roulette with your child’s life."
A recent study in the journal Pediatrics now cast a light on the risks. The study compared breast milk purchased online from anonymous donors with milk donated to a milk bank by screened and trained donors. The milk sold on the Internet had higher bacteria levels, including contamination with fecal bacteria and salmonella.
In the photograph, Madison Fitzgerald, 20, holds her baby, Jake, in the neonatal intensive care unit at Texas Children’s Hospital in Houston. Jake, who was born 16 weeks too early, receives donor breast milk every three hours by mouth. (Carrie Feibel/KUHF)
Yes to Calories on Menus, No to Soda Limits
Most Americans (69%) see obesity as a very serious public health problem, substantially more than the percentages viewing alcohol abuse, cigarette smoking and AIDS in the same terms. In addition, a broad majority believes that obesity is not just a problem that affects individuals: 63% say obesity has consequences for society beyond the personal impact on individuals. Just 31% say it impacts the individuals who are obese but not society more broadly.
Yet, the public has mixed opinions about what, if anything, the government should do about the issue. A 54% majority does not want the government to play a significant role in reducing obesity, while 42% say the government should play a significant role. And while some proposals for reducing obesity draw broad support, others are decidedly unpopular.
The new national survey by the Pew Research Center, conducted Oct. 30-Nov. 6 among 2,003 adults, finds that two-thirds (67%) favor requiring chain restaurants to list calorie counts on menus. But just 31% support limits on the size of sugary soft drinks in restaurants and convenience stores – 67% oppose this idea. More than half (55%) favor banning TV ads of unhealthy foods during children’s programming, but barely a third (35%) supports raising taxes on sugary soft drinks and unhealthy foods. On each of these policies, Democrats and women are more supportive than Republicans, independents and men.
Major urban areas are magnets for the uninsured, and the state politicians who turned down the Affordable Care Act’s (“Obamacare”) Medicaid expansion are not the ones who will pay to treat them. Big cities, with their more extensive public health facilities, bear the burden of caring for a state’s uninsured. The resulting costs thus rest largely on urban hospitals and taxpayers. As reported in The Atlantic Cities:
Part of the issue here lies in a fundamental disparity between local governing and statewide politics. Governors and state legislatures have made many of these decisions to reject the Medicaid expansion on philosophical grounds rather than poverty rates or hospital budgets (often despite receiving detailed analyses on those fronts). County and municipal officials, on the other hand, can seldom afford ideology.
The Food and Drug Administration, or FDA, announced a proposal on Thursday to ban trans fat, which can be found in hugely popular snacks such crackers, cookies, baked goods and microwave popcorn, in a sweeping move that would force food manufacturers to reformulate processed foods that currently use this artery-clogging artificial unsaturated fat.
The FDA determined that partially hydrogenated oils, or PHOs, the primary dietary source of artificial trans fat in processed foods, are unsafe for consumption, and opened a 60-day review period to collect data on the time food companies would need to alter their products before the ban takes effect. Trans fat intake boosts the amount of low-density lipoprotein, or “bad” cholesterol, raising the risk of heart disease due to the buildup of plaque inside the arteries.
“While consumption of potentially harmful artificial trans fat has declined over the last two decades in the United States … further reduction in the amount of trans fat in the American diet could prevent an additional 20,000 heart attacks and 7,000 deaths from heart disease each year,” FDA Commissioner Margaret Hamburg said, in a statement.
Over the past decade the consumption of trans fat in the U.S. has significantly fallen, due to health concerns following the FDA’s proposal in 1999 requiring food manufacturers to clearly mention the amount of trans fat on food labels listing nutrition facts. However, the proposal came to force only in 2006, and according to the FDA, trans fat intake of people in the U.S. dropped from 4.6 grams a day in 2003 to about 1 gram a day in 2012.
Among the products the FDA singled out are cakes, frozen pies, snack foods, frozen pizza, vegetable shortenings and stick margarines, coffee creamers, refrigerated dough products, such as biscuits and cinnamon rolls, and ready-to-use frostings, meaning a ban would affect manufacturers across the board.
However, trans fat would not be completely eliminated from foods even after the ban, because it also occurs naturally in small amounts in meat, dairy products, and in fully hydrogenated oils, where it is produced during manufacturing.
The FDA urged consumers to check detailed nutrition facts on food labels even if they claim “0 grams trans fat,” because under current regulations, manufacturers are allowed to print such a claim if the food limits trans fat to 0.5 grams or less of trans fat per serving.
Washington, D.C.-based Grocery Manufacturers Association said, in response to the FDA’s proposal, that food processing companies in the U.S. have “voluntarily lowered” the amounts of trans fat in their food products by more than 73 percent.
(From International Business Times)
The percentage of babies born prematurely in the United States fell for the sixth straight year, but the problem remains more common than in most other industrialized nations, says an annual report card out Friday.
The nation’s preterm birth rate in 2012 was 11.5%, which is a 15-year low, according to the report from the March of Dimes. But the non-profit organization says it could be as low as 9.6% if known prevention efforts were fully embraced.
The group gave “A” grades to six states that achieved that — including the state with the most births, California – but it gave a “C” to the nation overall. An earlier global report on preterm births found the United States ranked 131st out of 184 countries, on par with Somalia, Turkey and Thailand and far behind nations ranging from Finland to China.
"We need to do better," says Edward McCabe, medical director of the March of Dimes, based in White Plains, N.Y.
That’s particularly true, he says, when it comes to reducing preterm births among black and Native American women, who had rates of 16.8% and 13.6% of births. For white women, it was 10.5% of births.
The reasons for those racial gaps are poorly understood and not explained by socioeconomic and educational differences, says Craig Rubens, executive director of the Global Alliance to Prevent Prematurity and Stillbirth, based at Seattle Children’s Hospital. One theory, he says, is that stress — including stress associated with racism — can play a role.
What is known is that premature birth — before the 37th week of pregnancy — is the leading cause of newborn deaths in the United States and can contribute to life-long problems in health and development among survivors. Prevention strategies include reducing smoking and increasing health insurance coverage among pregnant women, McCabe says. If the new health care law results in more women getting insurance and prenatal care, that could help, he says.
Meanwhile, efforts to eliminate elective early births, by cesarean section and induction before 39 weeks of pregnancy, already are helping, he says. That’s because doctors and women sometimes get due dates wrong when they schedule deliveries for 37 or 38 weeks and end up with premature babies. That practice is now strongly discouraged by the American College of Obstetricians and Gynecologists and many hospital systems. Efforts to reduce multiple births, by more prudent use of fertility treatments, also are helping, McCabe says.
But making more progress, in the USA and around the world, will mean learning more about why so many babies are born too soon, Rubens says.
"It’s really embarrassing to say that we don’t even know why women go into labor at full term, much less why some go into labor early," he says.
Rubens says it’s important to note that one reason the USA fares so poorly on international rankings is that many babies born very early — between 23 and 28 weeks — survive long enough to be counted in the United States but are listed as stillbirths in countries with less medical technology or less stringent record-keeping. Even so, he says, that does not explain why the USA has so many more preterm births than countries with similar resources.
In addition to California, states that got an “A” on the report card were Alaska, Maine, New Hampshire, Oregon and Vermont.
Puerto Rico and three states, Alabama, Louisiana and Mississippi, each scored an “F,” for preterm birth rates at or above 14.6%.
(From USA Today)
In 2011, the U.S. recorded 1,925 malaria cases, the Centers for Disease Control and Prevention, said Friday. This is the highest number of cases reported since 1971 and represents a 48 percent increase from 2008.
All but five of the malaria cases were imported from other countries. Most of them came from Africa, specifically West Africa. One person caught the disease in the laboratory.
Both travel and inadequate prevention measures might have contributed to the rise in malaria, the scientists write in the Morbidity and Mortality Weekly Report. “These increases appear to be similar to those being reported in other parts of the world … Despite progress in reducing the number of malaria cases in regions where malaria is endemic, international travel appears to be growing steadily, and use of appropriate prevention measures by travelers is still inadequate.”
Interestingly, airline crews make up only a very small number of malaria cases in the states. But they might increase, as well, given a bump in the number of direct flights from the U.S. to West Africa, the scientists said.
Top: Number of malaria cases diagnosed in each state during 2011 (Centers for Disease Control and Prevention)
Bottom: The malaria parasite Plasmodium gallinaceum (purple) are caught in the scanning electron microscope invading a mosquito’s gut (yellow). (NIAID/Flickr.com)
Plasmodium gallinaceum produces malaria in poultry.
P. ovale, P. falciparum, P. vivax and P. malariae produce malaria in humans
Insurance coverage among immigrants vs US-born population.