Archive for medicine

Medicine and Healthcare

Posted in uncategorized with tags , , on November 3, 2013 by andelino

Medicine and Healthcare 00Interesting information for “those” who are “considering” signing up for “ObamaCare”

Medicine and Healthcare: What are the ways to contain medical costs in the US without a single payer system?

By: Jacob VanWagoner, Electrical Engineer and Physicist, working with semiconductor x-ray detectors.

Warning: Long answer that may be “devastating” to your “political” views, left or right.

In short, it ends up coming down to “repealing” any law that grants “anti-competitive” privileges to any “health care” providing organization, including “ObamaCare”.

But I’ll start by addressing the “myths” propagated by both the left and right and “exposing” them as negligible.

It can’t be “attributed” to any of the “factors” that are often touted as “root” causes.

First, as most often “promoted” by Republicans, medical “malpractice” suits:

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The dollars spent on medical “malpractice suits” are trending down.  Even at their peak, they were less than $20 billion dollars. One doctor’s personal perspective on it: Medical Malpractice: Myths and Realities.

To put those numbers in perspective, the net expenditure on health care in 2012 was pretty close to $2,700 billion.  (I left it in billions so it’s easier to put the numbers side by side).

If 100% of all medical malpractice dollars were to cease, that would put us down to . . . $2,680 billion.
Wait, what?  I thought all the costs were coming from ambulance chasing lawyers!
Funny how putting numbers on things makes you look at them differently.
(Note: I personally support some form of tort reform, but not because it will be a big cost saver).

Next on the list, cost as most favored by the left as the root cause, “uncompensated care” and shifting the “cost” to those who pay.

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Note the scale again: Billions. In 2010, the total uncompensated care added up to $41 billion.

Compare that again to the net spending:  $2,700 billion. It’s more significant than medical malpractice, but it’s still insignificant compared to the total spending.

Now for another lefty myth: “Uninsured people’s costs being shifted to insured people”:

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If we assume that all 15.4% of uninsured people are paying absolutely $0 on themselves and 100% of their costs are being shifted on to us, and that they don’t get any more or less in care than the rest of us do, how much would it reduce everyone else’s bills?

About 15%.  So . . . following the rate of health care inflation, that would put the insured person’s costs to about the 2011 or 2010 rate.  Gee, that sounds like where all the costs are coming from, doesn’t it!

But it doesn’t reduce total expenditures.  At all.  Just the insured person’s expenses.

By the way, those who choose not to pay with insurance can bargain with the billing office to set up payment plans to pay in cash significantly less than the bill — and in fact less than the insurance company is willing to pay out.

Another favorite thing to look at, occasionally mentioned by both left and right but not as often as it should be: “Allowing drug re-importation.”

It looks like they’re on to something at first glance, but wait until I get to the actual impact to see what I think.

Here’s the price of Plavix by country:

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Nexium:

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Here’s an average in 2005 and 2010, normalized to Canada:

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Now . . . what would happen if people could buy “genuine” pharmaceuticals in any country and “import” them to the U.S.A?

First, the price in the U.S.A. would drop dramatically.  After all, if you can buy 10,000 pills in Canada for $1/pill and sell them in the US for $1.20/pill, you make yourself 10,000 x $0.20 = $2,000.  And at $1.20/pill, that’s a lot cheaper than the $1.91/pill they’re being sold for here, so I can guarantee you’d have a great market of buyers.

Second (and there always is an unintended consequence), the prices everywhere else would have go up in order to compensate for the lost US revenue.

Countries with single payer systems are able to keep the cost of medicine down by saying “we will not pay more than $x for this drug,” and drug companies have been okay with it because they can just pass the cost of R&D on to US customers.

So either the other countries will end up having to pay more or they’ll just stop buying the drug. In either case, the US isn’t the sole source of R&D compensating revenue and is no longer shouldering the burden for the rest of the world.

The question is How much would it drop?”

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In 2007, the total spent on retail pharmaceuticals netted around $225 billion.  If I make the assumption that it hasn’t moved much since then, that the cost of pharmaceuticals will drop to become equal to everywhere else, and that big Pharma will be okay with getting the same margins in the US as everywhere else, then it will cut roughly in half, down to ~$120 billion.

That’s the “upper bound on cutting, assuming the average is average of all total sales.”

Compare $120 billion to $2,700 billion.  It’s certainly a lot more than any of the previous numbers, but still doesn’t add up.  Not to mention that $120B is an upper bound.

What if I assume that the revenues are coming from high-margin blockbusters with price differentials comparable to Plavix?

Then that puts a cutting boundary down a lot further. Without actually using a calculator, let’s say it cuts it to ~$30B total spent, so just to be generous let’s say it saves us $200B.  (Not using calculated numbers, just really rough estimates on the proper scale).

Now compare that $200B cut to the $2,700B total. That number is still good, but it’s still not enough to call it a root cause.

This is getting really fun now, isn’t it?  “Arithmetic is a harsh mistress and she doesn’t care about your political opinions.”

Now on to some real good stuff:  “Lack of price transparency and lack of level billing.”

Andy Grove, former CEO of Intel, had a really interesting “insight” into this problem.  Here’s an article he wrote that was published by Wired magazine: Peeling Away Health Care’s Sticker Shock

He brings up, as one example, the cost of an appendectomy.  First, it’s impossible to find out up front.  Then when you get the bill, it could be orders of magnitude different than somewhere else.  “This is without complications — just the routine procedure!”

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Some of his sources:

The Pricing Of U.S. Hospital Services: Chaos Behind A Veil Of Secrecy
How much does an appendectomy cost? Somewhere between $1,529 and $186,955

What would happen if we were to enforce level billing in health care — that is, the hospital must charge the same amount for the same procedure under reasonably similar conditions, and must publish their price or be subject to lawsuits for racketeering and/or billing fraud — how would it change the total costs?

Fortunately we have an example of a health care entity that has done just that — The Surgery Center of Oklahoma.

The prices for most of their services are under $10,000, including the anesthesiologist, pre-and post-surgery consultation and follow-up care (see:  http://www.surgerycenterok.com/p…)

I don’t know about you, but that looks pretty close to the minimum there.

The “catch?”  The prices they post are the “cash” prices.

If we use the median price and assume all the prices are at the median (not a good assumption as the total money spent is skewed toward the higher side), but makes the math easier), then assume that level billing would fix prices closer to the Surgery Center of Oklahoma (a decent assumption, as the provider wants to attract patients to their facilities), then that brings the total cost of procedures down to about 1/3rd of what they are now.

1/3rd. That brings $2.7 trillion down to $0.9 trillion.

Now we’re getting somewhere, aren’t we?

Now for another fun fact:  “Unreasonable markup by providers.”

Here’s a background story for that claim: $80K Bill Stings Worse Than Scorpion

A woman was stung by an Arizona Bark Scorpion, which sting can be lethal if untreated.  She rushed to the hospital and received the treatment.  Her treatment was simply to be injected with two doses of Anascorp, a relatively new scorpion anti-venom.  Each dose of Anascorp is distributed to hospitals for $3,800 — expensive, but just wait.  The hospital billed her $80,000 — that is, about $40,000 per dose.  That’s a 40x markup!  No, it’s not a 400% markup, it’s a 4,000% markup.

What’s worse is that the drug is available in Mexico, where it is made, for about $100 per dose. The 40x markup to the hospital could be understandable given drug re-importation laws, but to add an additional 40x markup is insane!

And no, this is not an “isolated” incident.

Hospitals mark up cancer drugs by 10 times their value
Cost Spotlight: A 443% Markup on Prescription Drugs

There are hundreds, if not thousands more articles on different ubiquitous instances. If you have ever been to the hospital and have been given Tylenol, Aspirin or Ibuprofen, you should have looked at your bill.  $10 for a single dose?  Are you kidding?  At that price, I would have called my wife to drive over and buy me a whole bottle from the corner store instead of accepting it from the hospital!

The cost “differentials” and massive “markups” point to only one possibility: “The medical system is a monopoly or cartel.”

Only a monopoly or cartel can get away with that kind of crap.

A real market, with the rule of law properly enforced such as the http://en.wikipedia.org/wiki/She… and http://en.wikipedia.org/wiki/Cla… would introduce competitors who still make large profits — “large enough to make them filthy rich” — by undercutting the competition by doing the same thing but with greatly reduced markups and perhaps slightly reduced margins on services.

And there is clear legislation that establishes medical providers as effective monopolies: http://en.wikipedia.org/wiki/Cer… laws.

There are plenty of other supplements that protect the monopoly status of providers, but “CON” laws are a large part of the root of how the monopoly/cartel is maintained.

“Certificate of Need” laws require any prospective provider of any medical service (such as running an MRI clinic) to obtain a certificate of need from the local hospital or largest care provider, where that largest provider indicates that the new prospective provider will be providing a service that the largest provider cannot supply enough of.

For a fair comparison, it would be as if you invented a new microprocessor for computers, all entirely with your own architecture and intellectual property, but you had to go to Intel and ask for their permission before you would be allowed to sell it.

Do you think Intel would give you the okay if it had the potential to take any market share from them?

Enforce “Sherman and Clayton”, and “repeal” any laws that “grant” exceptions to them.

I forgot to mention that “Single Payer” systems control costs by “price” arbitrage – “we will pay this much for it and no more.”

I welcome any comments and criticism.  I will answer them to the best of my ability.

Jacob VanWagoner

Jacob VanWagoner

Science Of Pregnancy

Posted in uncategorized with tags , , , , , , on August 24, 2012 by andelino

When a viable sperm penetrates a viable egg inside a woman’s reproductive tract, the result is a fertilized egg that can then implant in the uterus. That fact of life is consistent regardless of how that sperm and egg met up, including whether or not the sperm was ejaculated during rape.

That may be news to Rep. Todd Akin from Missouri who told a local television station, in explaining his stance that abortion should not be allowed even in the case of rape: “If it’s a legitimate rape, the female body has ways to try to shut that whole thing down.”

“Physiologically, if the sperm is in the vagina, a pregnancy can occur, regardless of the circumstances of how that sperm got there,” said Dr. Melisa Holmes, an ob-gyn and founder of Girlology, an organization that promotes healthy sexuality and communication in families.

And though the anti-abortion Republican says he “misspoke,” Holmes says that Akin’s remark also suggests that some rapes are not “legitimate,” and this continues a harmful misconception about violence against women.

“A rape is a rape, and a woman has the same physical and emotional consequences whether she’s raped by a stranger in a dark alley or someone she’s known for five years,” Holmes told LiveScience. “That’s one of those misconceptions that gets perpetuated and unfortunately affects women in a bad way — ‘Were you really raped, or were you at fault for part of it?'”

Perhaps Akin is correct in thinking it’s not the easiest of tasks to get pregnant; that’s why men don’t ejaculate just one sperm and instead release nearly 100 million sperm. (Men who have fewer than 20 million sperm per milliliter of semen may have difficulty conceiving, according to a WebMD article.) That’s because few sperm survive the grueling journey from the vagina to the fallopian tubes where they can meet up with an egg. Even for those that make it, only the healthiest will penetrate, and fertilize, the egg. [11 Odd Facts About the Pregnant Body]

Still, of the 6.7 million pregnancies in the United States every year, about half are unintended, according to the Guttmacher Institute. The chance of getting pregnant from one event of unprotected sexual intercourse is 5 percent on average, according to the Rape, Abuse & Incest National Network (RAINN).

And according to research by Holmes and her colleagues published in 1996 in the American Journal of Obstetrics & Gynecology, that same rate applies to rape victims, though it’s tricky to compare these different populations.

Rape-related pregnancy occurs with significant frequency,” the study researchers wrote in their journal article. “It is a cause of many unwanted pregnancies, and is closely linked with family and domestic violence.”

In the study, Holmes and her colleagues, followed more than 4,000 American adults over a three-year period. Nationally, they found rape-related pregnancy rate was 5 percent among women of reproductive age, 12 to 45, meaning about 32,000 pregnancies result from rape each year, they concluded. Among 34 cases of rape-related pregnancy that they looked at closely, 32 percent of women maintained the pregnancy and kept the infant, 50 percent underwent an abortion, nearly 6 percent placed the baby up for adoption and nearly 12 percent had a miscarriage.

At the end of the day, Holmes said of Akin’s comments, “It’s just simple lack of education into the human body,” adding that “the reproductive system is going to respond in the same way whether it’s rape, or you’re madly in love with someone. It’s tubes and pipes and sperm and eggs, and there’s nothing that will stop that process.”

Gonorrhea

Posted in uncategorized with tags , , , on June 2, 2012 by andelino

Gonorrhea is a very widespread disease. So it is quite normal that people are curious about it. The Gonorrhea Symptom are found in women are secretion in the vagina, pelvic pain, while urinating itching or burning sensation, conjunctivitis or red, itchy eyes, bleeding between periods, burning in the throat for oral sex , vulva getting swollen, swollen glands in the throat. These symptoms are generally seen 2-10 days after getting infected. And men’s Gonorrhea Symptom is seen within 2-14 after infection. Their symptoms are penis secretion, in the time of urinating burning sensation, burning in the throat, painful testicles and swollen glands in the throat.

A potentially dangerous sexually transmitted disease that infects millions of people each year is growing resistant to drugs and could soon become untreatable, the World Health Organization said Wednesday.

The U.N. health agency is urging governments and doctors to step up surveillance of antibiotic-resistant gonorrhea, a bacterial infection that can cause inflammation, infertility, pregnancy complications and, in extreme cases, lead to maternal death. Babies born to mothers with gonorrhea have a 50 percent chance of developing eye infections that can result in blindness.

“This organism has basically been developing resistance against every medication we’ve thrown at it,” said Dr. Manjula Lusti-Narasimhan, a scientist in the agency’s department of sexually transmitted diseases. This includes a group of antibiotics called cephalosporin’s currently considered the last line of treatment.

“In a couple of years it will have become resistant to every treatment option we have available now,” she told The Associated Press in an interview ahead of WHO’s public announcement on its ‘global action plan’ to combat the disease. Lusti-Narasimhan said the new guidance is aimed at ending complacency about gonorrhea and encouraging researchers to speed up their hunt for a new cure.

Once considered a scourge of sailors and soldiers, gonorrhea — known colloquially as the clap — became easily treatable with the discovery of penicillin. Now, it is again the second most common sexually transmitted infection after Chlamydia. The global health body estimates that of the 498 million new cases of curable sexually transmitted infections worldwide, gonorrhea is responsible for some 106 million infections annually. It also increases the chances of infection with other diseases, such as HIV.

“It’s not a European problem or an African problem, it’s really a worldwide problem,” said Lusti-Narasimhan.

Scientists believe overuse of antibiotics, coupled with the gonorrhea bacteria’s astonishing ability to adapt, means the disease is now close to becoming a super bug.

Resistance to cephalosporin’s was first reported in Japan, but more recently has also been detected in Britain, Hong Kong and Norway. As these are all countries with well-developed health systems, it is likely that cephalosporin-resistant strains are also circulating undetected elsewhere.

Therefore the Geneva-based agency wants countries not just to tighten their rules for antibiotic use, but also to improve their surveillance systems so that the full extent of the problem can be determined.

Better sex education is also needed, as proper condom use is an effective means of stopping transmission, said Lusti-Narasimhan.”We’re not going to be able to get rid of it completely,” she said. “But we can limit the spread.”

Penile Tattooing

Posted in uncategorized with tags , , , , , , , , on January 6, 2012 by andelino

Ever thought of jazzing up your “weenie” with a little ink work at the tattoo parlor?

The old-fashioned expression to “pull a boner” usually refers to someone making a silly mistake.

In an act of love and devotion, it seems as though one 21-year-old Iranian dude may have taken that expression a little too literally.

Perhaps with a view of impressing his girlfriend he thought it would be a great idea to have his “little gentleman” penis tattooed with the Persian script phrase borow be salaamat” (meaning “good luck on your journeys”) and the first initial of her last name “M.”

Unfortunately for the young Don Juan, his sense of bravado turned tragic leaving him with a permanent 24/7 semi-erected boner. Needling ink into his schlong he soon found out that his half mast “phallus member” priapic erection wouldn’t go away.

Apparently, the artist was doing the inking by hand without an electric gun and went a little too deep. The resulting puncture wounds left the man with what’s called a “blood vessel fistula”, resulting in a “pseudo aneurysm” that has caused the semi-permanent arousal.  In non-medical terms, he now has a “chronic chubby”.

The Iranian doctors then advised the Iranian guy to see a specialist to have the blood removed. However, he rejecting the idea and had another doctor perform a shunt procedure on him that didn’t work. Since the victim was still able to have normal sexual intercourse and achieve a more-or-less normal erection he shied away from any more treatments, even the one his urologists suggested in the first place.

Shunning doctors’ advice, and possibly the advances of every woman in the future, he kept the tattoo and the unintended side effects. Very aptly and probably as a cautionary advice to other future brash males out there, the Iranian doctors wrote in the Journal of Sexual Science “based on this unique case, we discourage penile tattooing”.

I commend him on the bon voyage” message to his sperm but I shake my head at the initial engraving? Everyone knows that getting a tattoo dedicated to a girlfriend or boyfriend is pretty much a “kiss of death” for future romantic intercourse engagements. The more important question, however, is whatever he got tattooed on his cock was worth the hoopla, embarrassment and possible permanent injury to his “most precious body part?”

That’s the lesson to be learned from this guy’s dumb ass decision to get a tattoo on his penis to last for all eternity. While that might sound kind of kinky, especially for someone who has no problem getting needles jabbed into his winky, “think before you ink, especially if it involves your downstairs renovation.” Oh, yeah, and good luck with that “halfie prick” journey. At least he doesn’t have to worry about shrinkage.

All this guy wanted was a “Yin and Yang symbol with some dragons”

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