Suicide For those who may wonder at the Times Page 1 notice, “Suicide Rates In Middle Age Soared in U.S.” [May 3, 2013], you might make another try at reading my Article on this website Chad Varah & Suicide.  Give it another go.  I may go on and on, but the story is there somewhere toward the end.

An English parson, Chad Varah, developed an early successful suicide prevention program and the first idea of a telephone hotline “To befriend the suicidal and despairing.”  Learning from this Samaritan experience, successful programs were developed in Canada, in our Air Force, and in some additional countries.  Effective United Nations Model Guidelines for Prevention were developed.  In the U.S. the guidelines have not been closely followed. Read the rest of this entry »

I wonder if the New York Times will mind if I copy one of today’s editorials here. This may reach a few who may miss it.Novartis

“Another Alleged Drug Kickback Scheme “

Published: April 27, 2013

Two federal lawsuits charging a prominent drug company with making fraudulent kickbacks to promote sales of its drugs raise disturbing questions about how to control fraudulent behavior in the pharmaceutical industry, behavior that appears to be on the rise. The company is Novartis Pharmaceuticals, the American subsidiary of a Swiss-based multinational. Novartis denies any wrongdoing and vows to defend itself in court. Read the rest of this entry »

BogartSmoking We could benefit from having a few more with  the 19th century Victorian spirit of health reform among today’s masters of Public Health.  They would blame the villains not the victims. They would be more concerned with prevention than with treatment.

This Aside is the story of the struggle for population health against the tobacco industry, mainly as told in the just published National Research Council Workshop. The participants were drawn from the National Academy of Sciences, National Academy of Engineering, and the Institute of Medicine.  The blows struck or proposed for public health are modest.  There was no removing tobacco industry pump handles or arranging tours of dying emphysema and lung cancer victims; no shameless linking of cecession to virtue and even more shamelessly linking to revenge; no securing and leveraging a small congressional anti-industry coalition; no appealing to the Queen (or other celebrities) or funding industry enemies; no marching on shops or burning copies of Cigar Aficionado. And Nightingale would have written a much more vigorous Workshop report.  The Victorian reformers would have done all this and more.  The Workshop experts assume the industry’s right to harm people and the individual’s right to propagate ill health. The phrase “Tobacco Control” is widely used but sparingly practiced. Read the rest of this entry »

Lab Workers-1In an opinion piece in today’s Times, Ezekiel J. Emanuel, Obama’s point man for health policy, gathered 20 prominent oncologists to join him in a five-point policy letter addressed to the growing costs of cancer care.  The first point is “bundling” physician cost of care over the course of each patient’s treatment rather than the fee-for-individual-services payment system now in place.  Several “outsiders” expect that to be a horror show of unintended consequences if there is to be no fundamental change in the America’s profit-based health care system. The second point (insuring the above expected outcome) is to enable physicians to collude more perfectly on overall fees; the third (watch-dogging numbers one and two) is a loser monitoring of treatment utilization rates, the fourth is a greater use of nursing services, palliative care, and earlier on end-of-life talks [for which see the Nightingale at Large piece "Emanuel on ‘Better, If Not Cheaper, Care'”]; the fifth is tying interventions more closely to research results (a truly unexceptional recommendation). Read the rest of this entry »

Johns Hopkins Medicine-1 On March 11, 2013 the Washington Post published a short article (2,700 words) “Doubts about Johns Hopkins research have gone unanswered, scientist says” by Peter Whoriskey. The article had a tragic victim, a whistle blower, lab politics, clash of personalities, big money, obviousness and wonder. In a couple of days there were over 700 responses to the article, mostly quite thoughtful and professional. Read the rest of this entry »

B Starfield Although I have finished my article on the passionate statistician Barbara Starfield (1932-2011), it did not include her The Effectiveness of Medical Care; Validating Clinical Wisdom (1985).  I will soon rewrite that article, here titled Barbara Starfield’s Numbers. Since her research and reviews of research confirm many of my biases about American’s dysfunctional health care system, I will add this Aside with some of her conclusions in a more bullet-point format.  Please also see the article that I hope is a fair presentation of her career and the issues dear to her heart.

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Dutch-Boy The Milbank Memorial Fund (“bringing the best available evidence to health policy” with $21 million/year income from endowments) decided some time ago to fund two researchers, Gerald Markowitz and David Rosner, in producing a historical study titled Lead Wars: The Politics of Science and the Fate of America’s Children. The book will soon be published by the UC Press. Helen Epstein provided a pre-release review of the book in the current New York Review with some of the book’s detailing of the crimes of the American lead and lead paint industry as they knowingly poisoned American children.

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Diabetes Is an Epidemic

CargillFrutrose There have been clinical studies, books, blogs, articles and advice to the nation suggesting that we should do something about the intense advertising, marketing and distribution of high-sugar junk food and beverages. Yet there have not been enough warnings. Too seldom are controls demanded. Too often it’s a soft focus diversion on obesity. Hard to imagine how much publicity it takes to move 300 million people to get even the most necessary national health policy action. This is especially the case when there is no help forthcoming from the Food and Drug Administration or “America’s doctor,” the Surgeon General.

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Gun Violence Redux

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This Aside is not a replay of what you know very well: the many school shootings from Columbine High School on April 20, 1999 to Sandy Hook Elementary School–just the latest–on December 14, 2012 It is not a call for sociological studies of the obsession with handguns in Jefferson County, Colorado–certainly a factor in the massacre at Columbine—or in Newtown, CT where Sandy Hook Elementary is located, although I believe those are needed. Read the rest of this entry »

UnhealthySocieties For going on twenty years public health advocates have recognized that the toxicity of social circumstances and patterns of social organization are killing people: the extreme inequality, the fourfold difference in death rates recorded between people living in richer and poorer neighborhoods, policy benefits and media favors for corporate special interests, health-for-profit, capitalist-as-it-is, and all that. In this extremity some hope lies buried. As Richard G. Wilkinson puts it:

“There are grounds for thinking that during the next decade or so these issues may provide the impetus for a new era of social reform.” [p. 24]

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