Category Archives: healthcare

Get the Shot!

Being a geek, I’m a big fan of the TV sitcom, “The Big Bang Theory”. It is well written and does a good job of reflecting real science. Several of the characters are scientists. Amy Farah Fowler is Sheldon’s sort of girlfriend. The character is portrayed by actress Mayim Bailik, a neuroscientist who holds a PhD from UCLA .

Here’s the problem; Amy the character, appears to be more scientifically literate than Mayim the real life scientist. Mayim is the spokesperson for a group with views that go far beyond main stream medicine, such as recommending homeopathic treatments and not following scientifically accepted vaccination schedules for infants. The former would substitute ineffective sham medicine (homeopathy) with scientifically proven, efficacious drugs. In the case of the latter, rejecting vaccinations or even delaying an appropriate vaccination schedule puts not only the person or their children at risk of unnecessary illness, but also society at large.

The effectiveness of vaccinations depends on so-called herd immunity. To stop communicable disease does not require absolutely everybody be vaccinated, just a high enough percentage to disrupt transmission. Some individuals can’t be vaccinated for certain diseases for example neonates and pertussis- whooping cough.

Fall and rise of Whooping cough

Fall and rise of Whooping cough

They are protected from this once common disease by virtue of the fact that those around them have been vaccinated and therefore don’t carry the disease. If an older unvaccinated child gets pertussis s/he can transmit the bacterium to an infant with fatal results.

A real problem with getting a vaccination is a misperception of risk. A person may known of someone who got a flu shot, and had a bad reaction or had the shot and still got the flu. This knowledge introduces a bias. It doesn’t however change the fact the the overwhelming odds are in favor of getting the shot. Depending on the vaccine, the strain of influenza, and several host factors,

“ …How well a flu vaccine works is challenging, in general, recent studies have supported the conclusion that flu vaccination benefits public health, especially when the flu vaccine is well matched to circulating flu viruses” – Centers for Disease Control statement. The odds of a severe negative outcome, usually to an allergic reaction to the vaccine are in the one to millions range.

Back to the bias of knowing someone for which a flu shot didn’t work, or had a reaction. Does knowing someone who won the lottery make you more likely to win the lottery? Most folks would say of course not. But this is the same kind of bias. You think of just one outcome among many, many. But that doesn’t change your odds.

We all know someone who doesn’t wear a seat belt. S/he frequently justifies the self-endangerment by claiming that they know of a case where someone died due to the seat belt. The same bias. Evidence from literally billions of passenger miles shows seat belts save lives.

Vaccinations are generally safe and are generally efficacious. Vaccinations protect not only those vaccinated but also others through the herd immunity. Participate in society, get the shot.

Global Warming and Disease Vectors

Mount Nebo, along with other mountaintop resorts in Arkansas, began as a place for the well-heeled to escape the summer miasma in the Arkansas River Valley below. By the middle of the nineteenth century steam boats brought folks seeking respite from the mosquitoes which bred in the swamps and transmitted deadly diseases such as malaria and yellow fever. Public health measures have eliminated these diseases in the United States but climate change raises concern for their return.

Malaria endemic countries

Malaria endemic countries

Recently the Intergovernmental Panel on Climate Change released the findings of their fifth report:Warming of the climate system is unequivocal, and since the 1950s, many of the observed changes are unprecedented over decades to millennia. The atmosphere and ocean have warmed, the amounts of snow and ice have diminished, sea level has risen, and the concentrations of greenhouse gases have increased. Each of the last three decades has been successively warmer at the Earth’s surface than any preceding decade since 1850. In the Northern Hemisphere, 1983–2012 was likely the warmest 30-year period of the last 1400 years.

A warming climate means a wider range for disease vectors such as mosquitoes, ticks and flies that carry viruses, bacteria, and protozoa. Examples of diseases born by these pests include malaria, yellow fever, dengue fever, and equine encephalitis to name a few.

current range of Chagas diease

current range of Chagas diease

Most worrisome is Malaria, a parasitic infection of red blood cells for which there is no real cure. Because of the complex life cycle of the parasite their has yet to be an effective vaccine developed. Malaria infects over two hundred million people world wide and kills about a million each year, mostly children.

The mosquito that carries yellow fever for which there is a vaccine also carries dengue fever for which there is no vaccine. The genus Aedes carries both these diseases, is endemic to northern Mexico, and as the climate warms is advancing northward.

These are some of the diseases we know about, but new diseases arise regularly. In the age of jet travel a new disease can move half the way around the world over night and a warmer climate can provide a more accommodating environment.

Every day as a result of burning fossil fuels for cheap energy the planet gets a little warmer, the weather a little more erratic and the oceans a little more acidic. Climate change has far-reaching consequences and touches on all life-support systems. It is a factor that should be placed high on a list of those things that affect human health and survival. The energy with the cheapest up front costs may be more expensive than imagined in the long run.



Quality health care in the United States has until recently been a luxury; that is, something only for those that can afford it. This should change over the next few years as the Patient Protection and Affordable Care Act – more colloquially known as Obamacare – rolls out.

healthcare costs

healthcare costs

Currently our system of “every man/woman/family for themselves” has resulted in total health care costs which are on the order of twice the rest of the industrialized world as measured as a fraction of the gross domestic product.

Sadly, because of our past approach, we’ve end up with poorer health care outcomes such as higher infant mortality rates and shorter life expectancies. There are several reasons why we pay more but get less compared to the rest of the world. First and foremost is the lack of preventive care for the poor or those that think it is unnecessary.

infant mortality

infant mortality

When it comes to health care, the old saw “an ounce of prevention is worth a pound of cure” rules. An example or two should suffice: The absolutely most effective health care dollar spent is the dollar spent on vaccinations. Horrible diseases such as small pox and polio have been eradicated. Other diseases that caused high infant mortality rates such as diphtheria and pertussis in the past have been drastically reduced.

Yet much preventive care is unachieved. Consider heart attacks and stokes as a cost factor. Either of these conditions can cost hundreds of thousands of dollars to treat after the fact, but literally pennies a day to prevent with blood pressure medication.

Over a million families file for bankruptcy every year. Medical bills are the principle cause or contribute to these filings over sixty per cent of the time. Obamacare will reduce bankruptcies by abolishing lifetime benefit limits and price discrimination for pre-existing conditions, thus lowering out of pocket costs for families.

What is cheaper to you personally? Assisting the poor (and mandating those who can but refuse to) obtain health care? Or picking up their tab through higher premiums for your health care? The rest of the world has the answer and it is the former. That is why Obamacare will lower costs overall by adopting policies which favor preventive care and full participation in our common care.

Considerably more savings in health care can be had if we control costs via even more collective action. A Titanium alloy hip joint costs about 350 bucks to produce yet insurers are charged close to ten thousand dollars, a markup of three thousand per cent! Why? Because they can, and we pay unnecessarily. In Belgium, on the other hand, the national health system takes a bid for the same joint. The resultant cost is less than a thousand dollars, a tenth of the cost we pay for the exact same item.

There are many things that benefit us collectively such as education, police and fire protection, national defense, infrastructure for commerce, scientific research, and the list goes on and on. It is time we recognize that our health care should fall into the same category. The Patient Protection and Affordable Care Act is a step in the right direction but there is still more that can be done to lower costs further and improve care.

My Fifteen Minutes of Blame

My fifteen minutes of blame

Blame the Republican house, blame the Republican party, Blame the Republicans. Yesterday evening Steve Womack – Republican representative for the third congressional district came to Russellville, Arkansas for a townhall meeting. A small crowd of about thirty folks listened quietly for about a half an hour as he politic-ed. From the nature of his presentation it was obvious that he worried more about his right flank.

He explained how shutting down the government over Obamacare was a bad idea. Not because it would harm the public welfare, but rather because it was politically unwise – it would turn the public away from the party. He staked out the traditional republican position, railing against spending, the Affordable Care Act, and the senate position on immigration. This kind of republican is actually more dangerous than the buffoons of the tea party.

A couple challenges from his right, shutting down the government and deporting all 12 million undocumented people were deflected. The real fun came from his left. A local pastor who happened to be sitting next to me made an eloquent and sensible argument for passage of the senate immigration bill. She spoke of how two of her parishioners, brothers, risked their lives (and their mothers life savings) by riding on the tops of trains for three weeks to get to the United States for a job. She was taunted somewhat by the crowd about lazy Mexicans, even though she had previously said that they had traveled for three weeks and risked life and limb FOR A JOB. I suspect those brothers have a stronger work ethic than most of the people in the room.

Then I got a few bites at the apple. On one of his slides (there’s an anachronism) he included a bullet on health savings accounts. [ME] OK, consider a guy with a health savings account who gets really, really sick; cancer, heart attack, or stroke with extended hospital care. He runs up a tab that is twice his savings. Who picks up the remainder of his costs? Somebody needs to pay for the drugs and reimburse the nurses and aides and janitors who cared for him. Bankruptcy is about his only alternative. I’ll tell you who pays, we do through our insurance premiums! [HE] ummm. He gave no real answer, he just went off on how if you have this savings and you don’t use it for healthcare, then you have this nice little savings account to use for other purposes. The long and short of it: he wouldn’t or couldn’t answer the question.

Probably my favorite encounter of the evening is when I asked another simple question: [ME] I understand why we all have an obligation to our common national defense, why not a similar obligation to our common national health? [HE] uhhh. Then he gestured by holding his hands in the air as if he were trying to measure the relative weight of a couple of objects. [HE] The two aren’t the same, providing for the national defense is in the constitution! [ME] So is providing for the general welfare! Then he said something about having skin in the game, but provided no real answer. He tap danced around the subject for a while, only to make his case worse.

He said something which I still don’t understand about do I pay to get my teeth cleaned. Maybe he was leading to a discussion of preventive care. [HE] I’m proud that while mayor of Rogers, AR we built a taxpayer-funded Adult Wellness Center. A lot of people benefit because of the center, why one gentleman I talked to said that he paid over 2000 dollars a month for some medication but since he started coming regularly to the center, his costs for the medication have been cut in half!

My jaw-droppingly obvious answer: [ME] My point exactly. If we taxpayers act together we can save ourselves some money. If we provide preventive care for the poor we will save money overall. Ten cents a day spent on the front end for a generic blood pressure drug can save us hundreds of thousands dollars in the prevention of just one hear attack or stroke. And that is a big part of the Affordable Care Act! [HE] We’ll just have to agree to disagree! He made my point, what else could he say?

One final egotistical riff. Another participant there who knows me commented on something about caps on payments for physical rehab. He said “as Dr Allen said…” while gesturing towards me. Womack swung his gaze at me and his eyes got just a little bit bigger. I guess titles still impress some people. It was just a funny moment.