Health and Medical News and Resources

General interest items edited by Janice Flahiff

[News release] Medical expansion has led people worldwide to feel less healthy

From the 19 March 2015 Ohio State University news release

In 28 countries, more medicine has unexpected effects

COLUMBUS, Ohio – Across much of the Western world, 25 years of expansion of the medical system has actually led to people feeling less healthy over time, a new study has found.

A researcher at The Ohio State University used several large multinational datasets to examine changes in how people rated their health between 1981 and 2007 and compared that to medical expansion in 28 countries that are members of the Organization for Economic Co-operation and Development.

During that time, the medical industry expanded dramatically in many of those countries, which you might expect would lead to people who felt healthier.

But that’s not what Hui Zheng, assistant professor of sociology at Ohio State, found.

“Access to more medicine and medical care doesn’t really improve our subjective health. For example, in the United States, the percentage of Americans reporting very good health decreased from 39 percent to 28 percent from 1982 to 2006,” Zheng said.

Hui Zheng

In fact, Zheng conducted what is called a “counterfactual analysis” using the data to see what would have happened if the medical industry hadn’t expanded at all in these countries since 1982. In this analysis, other factors that are generally linked to improved health, such as economic development, were left unchanged.

Under this scenario, the analysis predicted that self-rated health would have increased in these 28 countries. For example, the percentage of Americans reporting very good health could have increased by about 10 percent.

“It seems counterintuitive, but that’s what the evidence shows. More medicine doesn’t lead to citizens feeling better about their health – it actually hurts,” Zheng said.

The study appears in the July 2015 issue of the journal Social Science Research.

The OECD is an organization of countries, including the United States and many countries in Europe, that accept the principles of representative democracy and free-market economy. This study included information from OECD Health DataWorld Development Indicators, the World Values Survey and theEuropean Values Study.

Zheng measured three kinds of medical expansion. One was medical investment, which includes health care spending per capita and total health employment; medical professionalization and specialization, which includes the number of practicing physicians and specialists; and expanded pharmaceutical industry, which includes pharmaceutical sales per capita.

 

Zheng said there are several reasons why medical expansion may actually lead people to feel less healthy. For one, more diseases are discovered or “created,” which increases the risk of being diagnosed with “new” diseases. Three examples, he said, include the rise in diagnoses of attention deficit hyperactivity disorder (ADHD), depression and autism.

In addition, there is more aggressive screening, which turns up more diseases in people. Overdiagnosis can potentially cause harm to perfectly healthy people, he said.

As more medical care becomes more widely available, people may expect better health, perhaps to an unrealistic degree, Zheng said.

“Consumers begin demanding more medical treatment because of the declines in subjective health and the increasing expectations of good health, and medical expansion continues. It is a cycle,” Zheng said.

In a separate but related study published online in Social Science Research, Zheng found that Americans’ confidence in medicine has declined over the last three decades, again at the same time as medical expansion.

“The decline in confidence has occurred at the same rate, regardless of gender, age, income or any other factor,” Zheng said.

March 21, 2015 Posted by | Medical and Health Research News | , , , , | Leave a comment

[Press release] Carnegie Mellon, Pitt Ethicists Question Impact of Hospital Advertisi

About 20 years ago I started thinking along similar lines. Now I am at a point questioning if it is ethical to profit from health care. Two years as a Peace Corps volunteer (back in 1980/81 in Liberia, West Africa) changed my views on many topics considerably. Also I think it was the wonderful humanistic/social justice  tone of grade school religious textbooks, notably 8th grade back in 1969.

Summary (from EurkAlert!)
Ethicists question the impact of health information that is available online, specifically hospital advertisements, and argue that while the Internet offers patients valuable data and tools — including hospital quality ratings and professional treatment guidelines – that may help them when facing decisions about where to seek care or whether to undergo a medical procedure, reliable and unbiased information may be hard to identify among the growing number of medical care advertisements online.

From the 30 January 2015 Carnegie Mellon press release

In a commentary piece published in JAMA Internal Medicine, Carnegie Mellon University’s Alex John London and the University of Pittsburgh’s Yael Schenkerquestion the impact of health information that is available online, specifically hospital advertisements. London and Schenker argue that while the Internet offers patients valuable data and tools — including hospital quality ratings and professional treatment guidelines — that may help them when facing decisions about where to seek care or whether to undergo a medical procedure, reliable and unbiased information may be hard to identify among the growing number of medical care advertisements online.

“The marketing objective of selling services by making them seem attractive to consumers can create tensions or outright conflict with the ethical imperative of respect for persons, since the latter requires that patients make medical decisions in light of balanced information about the full range of risks and benefits associated with their care,” said London, professor of philosophy in CMU’s Dietrich College of Humanities and Social Sciences and director of the Center for Ethics and Policy.

Referencing a research article in the same journal issue that found hospital websites failed to disclose risk information for transaortic valve replacement (TAVR), a recently approved procedure to treat patients whose aortic valve does not open fully, London and Schenker pinpoint four risk concerns for patients seeking medical information online:

1. Identifying Advertising — Hospital websites often have the appearance of an education portal, leaving patients to assume that the information presented is informational, not persuasive.

2. Finding Unbiased Information — Unlike FDA-regulated direct-to-consumer advertising for prescription drugs, hospital advertising is overseen by the Federal Trade Commission and subject to the same “reasonable” standards applied to advertisements for common consumer goods such as cars and cereal. While hospital advertisements may describe specific medical interventions that entail significant
risks, there is no legal requirement that these risks be disclosed.

3. Recognizing Incomplete or Imbalanced Information — Poor-quality medical information is hard to recognize unless the person reading it is a trained clinician.

4. Influence on Health Care Decisions — As patients seek out information online, the quality of their decision-making and care choices will be influenced by the accuracy or inaccuracy of the information they are likely to encounter.

To begin to fix the risk to patients seeking medical information online, London and Schenker recommend to clearly label hospital websites as advertisements; allocate resources to created balanced online informational tools; and focus future attention on not only the content of health care advertising but its impact.

For more information, visit http://www.hss.cmu.edu/philosophy/faculty-london.php.

 

Related Resource

  • Evaluating Health Information (Health Resources for All, Edited by JaniceFlahiff)
    • The Penn State Medical Center Library has a great guide to evaluate health information on the Internet.

      The tips include

      • Remember, anyone can publish information on the internet!
      • If something sounds too good to be true, it probably is.
        If the Web site is primarily about selling a product, the information may be worth checking from another source.
      • Look for who is publishing the information and their education, credentials, and if they are connected with a trusted coporation, university or agency.
      • Check to see how current the information is.
      • Check for accuracy. Does the Web site refer to specific studies or organizations?
    • How to Evaluate Health Information on the Internet (US National Cancer Institute)

January 31, 2015 Posted by | Medical and Health Research News | , , , , , , , , , , | Leave a comment

[Reblog] Keeping Elders Out of Hospitals as Much as Possible

From the December 4, 2013 post  by Marti Weston at As Our Parents Age

 

H 4 hospAnyone who has spent time with an elder parent in the hospital knows just how easy it is for one problem to be solved only to have the person discharged with different problems. This is not necessarily the fault of the medical caregivers or the hospital itself — it’s a result of a system that puts older people into beds and keeps them there. Add in bed alarms, the inability to move much, and that hospitals isolate elder patients from their routines and support communities, and you have a recipe for unsuccessful care, a result of age associated hospital complications.

So I recommend reading The Hospital is No Place for the Elderly, a November 20, 2013 article that appeared in the The Atlantic. This piece aptly illustrates the conundrum of frail elderly patients with chronic health issues admitted to hospitals where medical care focuses primarily on fixing acute health problems. The difficulty is that most of frail elders’ medical issues cannot be fixed — but the quality of their lives can improve. Author Jonathan Rauch also describes several programs in the United States — teams of physicians, nurses, and other health professionals — that collaborate to keep patients as healthy as possible and out of the hospital. The teams even save money.

Many team-based support programs for frail elders run deficits, despite that they are so successful, but Rauch reports that the climate is changing, as Medicare and some insurance companies develop a more welcoming attitude toward innovative health care programs. The Affordable Care Acthas designated money to support innovative and new models of care delivery. (To learn more about other innovative programs you might also want to read Atul Gwande’s 2011 New Yorker article about changing models of medical care.)

One of the most interesting parts of The Atlantic article was the description of the team meetings where participants collaborate and coordinate patients’ medical care in order to help elders stay as healthy as possible.

Best Atlantic Article Quotes

    • The idea is simple: rather than wait until people get sick and need hospitalization, you build a multidisciplinary team that visits them at home, coordinates health-related services, and tries to nip problems in the bud.
    • These people aren’t on death’s doorstep, but neither will they recover. Physically (and sometimes cognitively), they are frail
    • Patients were presented not as bundles of syndromes—as medical charts—but as having personal goals, such as making a trip or getting back on their feet. The team tries to think about meeting patients’ goals rather than performing procedures.

 

 

December 5, 2013 Posted by | health care | , , , , , , | Leave a comment

   

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