Emergency workers are sometimes lowering the chances that heart attack victims will survive by improperly administering CPR.

On virtually every visit to a private doctor’s office, I am amazed at the amount of clerical staff that even relatively small offices employ. Having run a law office for many years, I understand that the amount — and productivity — of clerical staff is an important component in the overall profitibility of the office. There is no discernible reason why that principle should be any different in most doctors’ offices.
This NY Times article may explain a part of this phenomenom. Despite pressure from an array of interest groups, only a few dozen medical centers across the country are making full use of the latest computerized patient safety systems. Hospitals and doctors contend that they have good reason to be cautious about the new technology because they believe that the computerized systems will never repay their multimillion-dollar cost, or will be outmoded or cost much less in a few years. Moreover, many doctors complain that using the systems to write prescriptions and order tests diverts them from patient care and running their offices on already stressful workdays.
The coordination of technology with patient care and medical practice business operations is one of the most challenging problems in the complicated field of health care finance at this time. This is an issue that we all need to follow closely.

It’s springtime in Houston. You need to know the difference.

This NY Times article reports on new studies that increasingly indicate that coronary bypass opearations and angioplasty procedures are not as effective in preventing heart attacks in high risk patients than non-invasive treatments such as giving up smoking and taking drugs to control blood pressure, reduce cholesterol levels, and prevent blood clotting. The research reflects that that just one of those treatments — lowering cholesterol to what guidelines suggest — can reduce the risk of heart attack by a third. However, only 20% of heart patients follow that approach. As the Times article notes:

But, researchers say, most heart attacks do not occur because an artery is narrowed by plaque. Instead, they say, heart attacks occur when an area of plaque bursts, a clot forms over the area and blood flow is abruptly blocked. In 75 to 80 percent of cases, the plaque that erupts was not obstructing an artery and would not be stented or bypassed. The dangerous plaque is soft and fragile, produces no symptoms and would not be seen as an obstruction to blood flow.
That is why, heart experts say, so many heart attacks are unexpected ? a person will be out jogging one day, feeling fine, and struck with a heart attack the next. If a narrowed artery were the culprit, exercise would have caused severe chest pain.
Heart patients may have hundreds of vulnerable plaques, so preventing heart attacks means going after all their arteries, not one narrowed section, by attacking the disease itself. That is what happens when patients take drugs to aggressively lower their cholesterol levels, to get their blood pressure under control and to prevent blood clots.
Yet, researchers say, old notions persist.
“There is just this embedded belief that fixing an artery is a good thing,” said Dr. Eric Topol, an interventional cardiologist at the Cleveland Clinic in Ohio.

Arnold Kling at EconoLog carries on an interesting discussion of health care finance with Steve Verdon in which Arnold makes the following common sense observation:

A free-market but compassionate health care system would provide vouchers for catastrophic insurance coverage, but eliminate all other subsidies, including the tax-advantages for employer-provided health insurance.

Tyler Cowan over at Marginal Revolutions has this interesting post about the Russian health care system, which has been in the news because of recent reports regarding the decreasing life expectancy of Russian men. Tyler’s post contains several good links and solid analysis of the reasons for this crisis in Russian health care.

This NY Times article delves into the confusion among doctors regarding HDL — the so-called “good” cholesterol. Doctors have been saying that patients should pay attention to both the so-called bad cholesterol (LDL), and the good cholesterol (HDL) to prevent cardiovascular disease. As a general proposition, the doctors believed that the good cholesterol counteracted the bad. But now, some scientists say, new and continuing studies have called into question whether high levels of the good HDL cholesterol are always good and, when they are beneficial, how much. As the Times article relates:

In the meantime, doctors are calling researchers and asking what to do about patients with high H.D.L. levels, or what to do when their own H.D.L. levels are high, and patients are left with conflicting advice.
“There is so much confusion about this that it is unbelievable,” said Dr. Steven Nissen, a cardiologist at the Cleveland Clinic.

In the meantime, as noted in this earlier post, the pharmaceutical companies are watching this development closely.

This Rand Corporation study concludes that many of the improvements in health that medical advances have bestowed upon middle-aged and older Americans will likely be effectively erased over the next 20 years if Americans’ weight continues to increase.
The proportion of health care expenditures associated with treating the consequences of obesity would increase from 14 percent in 2000 to 21 percent in 2020 for 50-69 year-old men, and from 13 percent to 20 percent for women in the same age group, according to the study to be published in the March/April edition of Health Affairs ($).
Absent changes in health behavior or medical technology and assuming obesity trends continue through 2020, the study predicts that the proportion of people 50-69 with disabilities (those who are limited in their ability to care for themselves or perform other routine tasks) will increase by 18 percent for men and by 22 percent for women between 2000 and 2020.
These statistics — coupled with America’s broken health care finance system and accelerating Medicare costs — indicate that health care in America is headed for a day of reckoning soon. In my view, one of the Bush Administration’s biggest political problems in the upcoming election is the perception of many Americans that the administration ignores major domestic issues such as these.

Both the NY Times and the Wall Street Journal ($) have extensive articles about the results of a Bristol-Myers Squibb sponsored study that compared high doses of Pfizer‘s most powerful cholesterol-lowering drugs, Lipitor, with Bristol-Myers Squibb’s less potent drug, Pravachol. Both drugs are statins, a class of medications that block a cholesterol-synthesizing enzyme and are often prescribed for patients with heart problems.
Much to Bristol-Myers’ dismay, the study concluded that the patients taking Lipitor were significantly less likely to have heart attacks or to require bypass surgery or angioplasty than those taking Pravachol. The study is spurring discussion among cardiologists and the medical community that lowering cholesterol far beyond the levels that most doctors currently recommend can substantially reduce heart patients’ risk of suffering or dying of a heart attack. This could greatly change how doctors treat patients with heart disease and will likely result in re-evaluation of how low cholesterol levels should be even for people without heart problems.

This NY Times article discusses a doctor-owned Texas company that has been operating a Web site, DoctorsKnow Us.com, that compiles and posts the names of plaintiffs, their lawyers and expert witnesses in malpractice lawsuits in Texas and beyond. The Times article attempts to place a political spin on the service indicating that the website provides information on cases regardless of the merit of the underlying claim. However, plaintiffs’ lawyers in medical malpractice cases have used the Internet for years in coordinating cases and expert witnesses, and there is nothing wrong with the defense teams in such litigation attempting to use the Web for similar information sharing.