U.S. health care’s dangerous profit fixation
July 11th, 2013
11:10 AM ET

U.S. health care’s dangerous profit fixation

By Russell J. Andrews, Special to CNN

Editor’s note: Russell J. Andrews is a neurosurgeon who has been a U.S. Army flight surgeon, a clinician and researcher in both academia and private practice and a medical device developer with NASA. He is the author of ‘Too Big to Succeed: Profiteering in American Medicine.’ The views expressed are his own.

Medicine is big business in America. Nearly one fifth of our GDP is spent on health care – 50 percent more than any other developed country. Yet by many measures we are not getting value for money. Even nearby Cuba, which spends less than one-tenth as much as the U.S. per capita on health care, has outcomes that are as good or better: life expectancy is just as long, and the infant mortality rate is actually lower. Health care in the U.S. is on an unsustainable course, and costs cannot continue to increase while outcomes continue to deteriorate.

This crisis has been blamed on greedy malpractice lawyers, drug companies, health care insurance companies and doctors who over treat patients by practicing defensive or wasteful medicine – unnecessary tests are ordered and unneeded operations are performed. And there is something to all of these. Doctors have failed to address this health care crisis, so other groups offer solutions – notably economists and political commentators. Not surprisingly these proposals represent the expected economic or political views, namely: “Which reform will rein in burgeoning health care costs?” and “Which reform will be politically acceptable?”

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How to fix America’s health care
July 2nd, 2013
09:39 AM ET

How to fix America’s health care

By William A. Haseltine, Special to CNN

Editor’s note: William A. Haseltine is president of ACCESS Health International, a non-profit that aims to improve access to health care worldwide, and the author of ‘Affordable Excellence: The Singapore Healthcare Story.

The American health care system is failing. Despite spiraling costs compared with other highly developed nations, the outcomes or results we are getting for all of our expenditures often don’t compare favorably. We spend almost 18 percent of our gross domestic product on health care – an astounding amount of money translating to $2.8 trillion dollars per year. In contrast, Japan spends just over nine percent of GDP; France is below 12 percent; and the United Kingdom spends 9.5 percent.

Some argue that we pay more but get the best health care in the world. Unfortunately, that just is not true – we are most definitely not getting what we are paying for. A recent survey by the National Institutes of Health looked at health care outcomes in high-income countries around the world, and we simply did not measure up. We had the highest rates of mortality for newborns and for children less than five years of age. We had the shortest overall longevity rates, and the highest rates of death from lung and heart disease. There are many other comparisons I could cite, but the unavoidable conclusion is that our system simply does not deliver.

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Topics: Health • United States
The battle for affordable drugs
June 3rd, 2013
09:19 AM ET

The battle for affordable drugs

By Thomas J. Bollyky, Special to CNN

Editor’s note: Thomas J. Bollyky is senior fellow for global health, economics, and development at the Council on Foreign Relations and author ofPreventing Pharmageddon.’ You can follow him @TomBollyky. The views expressed are his own.

“No intellectual property should stand in the way of you, the countries of the world, protecting your people. Do you agree or not?”

Margaret Chan, the director general of the World Health Organization (WHO), made international news when she departed from her prepared remarks to ask this question of the national health ministers gathered at last month’s World Health Assembly, the annual WHO meetings. Chan was referring to the contractual restrictions and patent application that some governments and scientists complain are undermining efforts to develop a vaccine against the Middle East respiratory syndrome coronavirus (MERS-CoV), a deadly new virus now emerging in Europe and the Middle East. Chan’s question, however, would apply with equal force to any number of the other controversies over intellectual property (IP) now raging in the global health community.

A long simmering fight over patented cancer medications in emerging markets is escalating. Last month, the Indian Supreme Court rattled the multinational drug industry by refusing to grant a patent application on Gleevec, a leukemia drug that costs $70,000 per year in the United States. Indonesia followed suit, issuing a compulsory license that enables local drug firms to produce low cost generic versions of a liver cancer-causing hepatitis B treatment. China and the Philippines amended their pharmaceutical patent laws, making it easier to issue such licenses. Brazil and South Africa are reportedly pursuing similar amendments.

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Moore must be ready for psychological aftermath
May 31st, 2013
09:11 AM ET

Moore must be ready for psychological aftermath

By Mahshid Abir, Special to CNN

Editor’s note: Mahshid Abir, M.D., is an adjunct behavioral and social scientist at the nonprofit, nonpartisan RAND Corporation. The views expressed are the author’s own.

Last Monday, a massive tornado devastated Moore, Oklahoma, leveling or largely destroying hundreds of homes, businesses and two elementary schools. Plaza Towers Elementary School, where 75 students and faculty had taken shelter, was in the direct path of the tornado. Moore Medical Center lost an entire floor of its facility, requiring many of the injured, including children, some with severe injuries, to be taken to other area hospitals. At least 24 people were killed and hundreds more injured.

The tornado struck only days before the two-year anniversary of the deadly EF5 tornado that hit Joplin, Missouri, causing significant devastation and 155 fatalities. That twister lasted only minutes, but its toll on the mental health of Joplin’s residents lingered much longer. And the incident holds some important lessons for Moore and future disaster areas as they try to recover.

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Topics: Health • Natural Disaster
How big data helps fight flu
May 29th, 2013
12:22 PM ET

How big data helps fight flu

"Fareed Zakaria GPS," Sundays at 10 a.m. and 1 p.m. ET on CNN

Fareed speaks with Kenneth Cukier, data editor of The Economist, and Viktor Mayer-Schonberger, a professor at Oxford’s Internet Institute, about the applications of “big data.”

So, what’s the big story here?  I mean, we’ve always had data. Why is big data a quantum leap?

Cukier: Well, first we have vastly more data than we ever had before. That’s new. But secondly, we have more data on things that we never had rendered into a data format before. It was always informational, but not data. So you can take where you are, a location, as one example. Words in books that are now digitized and also datafied, is another. When you think about social media platforms like Facebook, it “datafies” our friendships. LinkedIn datafies our professional contacts. And we can do new things with that.

You have an example about the flu that’s fascinating, how Google and big data allowed people to figure out where flus were breaking.

Mayer-Schonberger: Yes, indeed. Think back at the H1N1 flu crisis that we had. And the Center for Disease Control in Atlanta wanted to find out where the flu was. And they asked doctors to report every flu case. But, by the time they had collected all the information and tabulated it, two weeks went by. And that’s an eternity if you have a pandemic at hand. And Google, at that time, thought that they could do better just by looking at what people searched for online.

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Topics: GPS Show • Health • Technology
Partners, not pledges, needed to fight HIV
May 23rd, 2013
09:16 AM ET

Partners, not pledges, needed to fight HIV

By Rebecca Schleifer and Darby Hickey, Special to CNN

Editor’s note: Rebecca Schleifer is the advocacy director for Human Rights Watch’s Health and Human Rights Program.  Darby Hickey is a policy analyst with the Best Practices Policy Project, which promotes the human rights of people doing sex work. The views expressed are their own.

The Supreme Court is expected to rule next month in a case about whether the U.S. government can require organizations to denounce prostitution as a condition of funding for their international HIV/AIDS work.

As those on the ground who work in programs trying to stop the spread of HIV have reported, this “anti-prostitution pledge” makes it harder to reach out to sex workers, the very people whose cooperation is needed to make these efforts work.

Since 2003, U.S. law has required organizations receiving U.S. anti-AIDS funds to have a specific organization-wide policy “explicitly opposing prostitution.” This requires organizations to censor their speech on prostitution, or sex work, even when using their own private funds in separate programs. The government contends the pledge is a way to identify the best organizations to carry out HIV/AIDS work and that the provision does not violate free speech because groups can set up parallel organizations  not bound by the pledge. The Alliance for Open Society International, which brought the Supreme Court case, says that the pledge not only violates its First Amendment rights but also undermines the very public health goals that the government is providing the money to achieve.

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Bangladesh’s other workplace catastrophes
May 20th, 2013
10:20 AM ET

Bangladesh’s other workplace catastrophes

By Richard Pearshouse, Special to CNN

Editor’s note: Richard Pearshouse is a senior health and human rights researcher at Human Rights Watch and author of Toxic Tanneries: The Health Repercussions of Bangladesh’s Hazaribagh Leather. The views expressed are his own.

Last year, I spoke with a 40-year-old woman working in a Bangladesh leather tannery in the Hazaribagh neighborhood of Dhaka. The Hazaribagh tanneries, which export hundreds of millions of dollars in leather for luxury clothes, shoes and boots around the world, spew noxious pollutants into surrounding communities. They can also make their workers very ill.

Much tannery work involves measuring and mixing chemicals, adding chemicals to hides in drums, or hauling hides saturated in chemicals out of pits. Fungal infections, scabies, hives, and contact dermatitis are common. Others suffer from respiratory illnesses and chest pains.

Asked what she thought of the possibility that Hazaribagh’s tanneries might eventually move out of the city, the woman told me, “It would be very good…They could start garment factories. This would be cleaner work with a better salary.”

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Topics: Asia • Economy • Health
April 29th, 2013
10:12 AM ET

Governors missing the point on Medicaid

By Carter C. Price, Special to CNN

Editor’s note: Carter C. Price is a mathematician at the nonprofit, nonpartisan RAND Corporation. The views expressed are the writer’s own.

Over the past several months, Governors Chris Christie of New Jersey, Rick Scott of Florida, and John Kasich of Ohio – all Republicans – have announced support for the Affordable Care Act’s (ACA) Medicaid expansion.  They join 22 other states and the District of Columbia in expanding the health insurance program for low-income Americans.

But more than a dozen of their counterparts in other states have decided against implementing the expansion, and the fight goes on in several states including Florida and Ohio where Scott and Kasich face hurdles in getting expansion through their state legislatures.  Many have said these decisions are based on fears that expansion will cost states money in the longer-term. Yet, recent RAND research suggests that the economic arguments against state implementation may be questionable, especially for some lower-income states.

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China's bird flu mystery
April 6th, 2013
01:03 PM ET

China's bird flu mystery

By Laurie Garrett, Special to CNN

Editor's note: Laurie Garrett is a Pulitzer prize-winning journalist and senior fellow for global health and the Council on Foreign Relations. The views expressed are her own.

This week, millions of Chinese visited family cemetery plots for the annual Tomb Sweeping Festival. They left or burned objects they thought their deceased ancestors could use in the afterlife, including chickens, pigeons and other food delicacies. Mao Zedong banned tomb sweeping because he thought it a decadent symbol of China’s Confucian past. But this year, China’s Communist Party had a different concern for tomb sweepers: Don’t handle live birds for your ancestors, or you just might be joining them in the afterlife.

It’s bird flu.

The emergence of the H7N9 avian influenza, mutated into a humanly infectious form, would be cause for concern even if it were a one-off event in a remote Chinese farm village. After all, this class of flu virus has never before infected, sickened or killed human beings – it’s a bona fide bird flu. But the disease drama now is unfolding in five large eastern China cities with a combined population of 48 million. This is a decidedly urban flu, its human victims identified to date span from ages 4 years to 87, and for most of the cases there is no obvious explanation for how they contracted their infections, or why their loved ones, co-workers and neighbors apparently did not.

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Topics: Health
March 29th, 2013
01:29 PM ET

Why we need to fix our health care

By Fareed Zakaria

I have long argued that cutting government spending in the midst of a weak recovery is not a path toward growth.  But I have also argued that America does have a debt and deficit problem and we need to take it very seriously.

The fact is the vast majority of our debt problems relate to the costs of health care in America. Now that the debate over Obamacare is over, we should start thinking seriously about how to get America's health care costs under control. As it turns out, two new works – a book and a magazine cover story – provide some very useful ways to think about this.

The central debate between Democrats and Republicans is over whether the free market works well in health care. In a new book, Catastrophic Care, David Goldhill makes the case for the market, arguing that people need to become consumers of health care so that they, not insurance companies, not the government, actually see, feel and pay the bills. That will force producers of health care – doctors and hospitals – to push down prices and drive up quality. That's what happens with groceries or television sets or computers.

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Topics: Health • United States
March 14th, 2013
10:37 AM ET

The danger of our sedentary society

"Fareed Zakaria GPS," Sundays at 10 a.m. and 1 p.m. ET on CNN

Fareed speaks with David Agus, author of "The End of Illness" and one of the world's leading oncologists, about health in America. To see all of this or other interviews, download the show at iTunes.

You also point out something really interesting, which is that we all think that the path to being fit is to go to the gym. And you say if you go to the gym for 45 minutes, an hour a day – that actually doesn't make much of a difference if...

Well, listen, if you sit the rest of the day, sitting for five hours is equivalent to smoking a pack or a pack and a quarter of cigarettes. It's an amazing thing that we design buildings based on LEED certifications, right? It's going to help the environment and everything is recycled, etc. But we're not doing anything on health. The more important you are, the closer your parking space is to your desk. The more resources you have, the more bathrooms in your house. You don't have to walk place to place.

Well, 1953, they looked at the British Transit Authority. There were 26,000 workers. Half were the bus drivers and half were the ticket takers that walked up and down those double decker buses. Well, it was more than half the death rate of heart disease in the ticket takers and significantly less cancer. And they weighed the same...

Because they're the ones walking around?

They smoked the same, everything the same, it's just moving. Your body was designed to move. That's how your lymphatics work. Yet we've engineered our society to sit. We need to change that.

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Topics: Health
March 13th, 2013
11:08 AM ET

The pill that everyone should be taking?

"Fareed Zakaria GPS," Sundays at 10 a.m. and 1 p.m. ET on CNN

Fareed speaks with David Agus, author of "The End of Illness" and one of the world's leading oncologists, about health in America. To see all of this or other interviews, download the show at iTunes.

The one thing you do say we should take is a drug that is 3,000 years old.

Yes. You know, Hippocrates described, over 2,400 years ago, taking the bark of the willow tree, chewing it and getting rid of pain and fever. That pill, if you take it every day, will reduce not the incidence, but the death rate of cancer, by over 30 percent, and heart disease by over 20 percent. It's called a baby aspirin. So we all have a right to smoke, to drink, to do whatever we want. But the question is, what is the right thing to do? And when scientific data hit a certain point, probably it shouldn't be optional.

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