Medical Bleg

Asking for a friend: Anybody got advice on picking a competent hernia surgeon?

And/or tips on good elective surgical programs in the Boston area, or the Northeast generally?



GOP Congress: We Luv Babies, But Not As Much As We Love Our Treason Flag

Not The Onion/Andy Borowitz:

House Republican lawmakers sought to reverse previously passed legislation restricting the display of the Confederate flag in federal cemeteries by slipping a provision stripping the legislation into a larger appropriations bill that included Zika funding. The House bill passed last week on largely partisan lines, but was blocked in the Senate Tuesday by a Democratic filibuster.

The Confederate flag language was just one of a number controversial provisions included in the bill, which also included an amendment cutting Planned Parenthood funding and other swipes at the Obama administration’s public health initiatives.

Republican lawmakers are warning that the American public will now blame Democrats if Zika becomes a full-blown health crisis. But Democratic leaders suggested that filibustering Tuesday’s bill was an easy call — pointing to provisions like the Confederate flag reversal…

Mr. Pierce, “Did Republicans Really Just Bring the Confederate Flag into the Zika Debate?”:

The Democratic opposition to the bill in the Senate primarily dealt with the whack the bill took at Planned Parenthood, and the president was likely to veto this bill anyway, not least because it contains half of what he asked for to fight the disease, and because it does so by draining money from other urgent priorities. But, honestly now, babies are being born with severe birth defects, and this is seen as an opportunity to get back a fight you’ve already lost?

That’s not governing. That’s a talk show.

As of mid-June, per the Centers for Disease Control & Prevention, at least “Three women in the U.S. mainland infected with the Zika virus have delivered infants with birth defects and three others have lost or terminated pregnancies because their fetuses suffered brain damage from the virus”.

States have been scrambling to find funds for Zika prevention efforts, resorting to stealing it from other programs. At least one Republican, Rep. Ted Poe (Texas) complained that his district wasn’t getting enough Zika funding from the CDC — even as he personally voted to cut the agency’s funding.

And the women most likely to be affected are, of course, those least likely to be able to protect themselves.

Not for the first time, I find myself wishing that the GOP Talibangelicals and their enablers would actually be judged under the religious standards they profess, because it wouldn’t be the biblical Heaven to which the Jesus described in their holy book sent them.



Tuesday Morning Open Thread: Yes, It’s That Important

When SCOTUS struck down Texas’ HB2 regulations yesterday, Richard Mayhew predicted “A lot more from lawyers later.” Here’s a couple of respected legal analysts. Linda Greenhouse, in the NYTimes, “The Facts Win Out on Abortion“:

… There is no poetry in the 40-page opinion, which strikes down a Texas law that would have closed most abortion clinics in the state in the name of protecting women’s health. The dry, almost clinical tone could scarcely be more different from the meditative mood the Supreme Court struck the last time it stood up for abortion rights, in Planned Parenthood v. Casey, 24 years ago this week. “Liberty finds no refuge in a jurisprudence of doubt” was Justice Anthony M. Kennedy’s mysterious opening line in that opinion…

Although nearly one-third of American women will have an abortion in their lifetime, a goal of abortion opponents has been to carve out abortion practice from ordinary health care, to ghettoize and delegitimize it. Those days are now over, too. Singling out abortion for regulation that can’t be justified on medical grounds is unacceptable, as Justice Ruth Bader Ginsburg emphasized in a concurring opinion.

When I first read Justice Breyer’s opinion, my sense of relief struggled against a feeling that something nonetheless was missing: not necessarily the aspirational rhetoric of the Casey decision but some explicit acknowledgment of what it means to women’s equality and dignity not to be trapped in an unwanted pregnancy.

Then I realized that while the court in Casey called upon “the contending sides of a national controversy to end their national division by accepting a common mandate rooted in the Constitution,” it didn’t really work out. Maybe, after all, this is not a moment for poetry, but for facts. There’s not much in Justice Breyer’s opinion that’s quotable. But there’s not much that’s debatable either, and that’s what matters.

Linda Hirshman, in the Washington Post, “How Ruth Bader Ginsburg just won the next abortion fight”:

She has written into law the factual finding that abortion is safe.
… The strategy of purporting to help women, which has, until today, been stunningly successful, started with the attack on so-called “partial birth abortion” in 1995. It reached its high water mark with Justice Anthony Kennedy’s hotly contested 5-to-4 decision upholding the restrictions on such procedures in Gonzales v. Carhart in 2007. Kennedy found medical disagreement about the safety advantages of the procedure. Importantly, he then deferred to the findings of the legislature that women would be safer and better off without partial birth abortion…

… When the news broke that RBG was concurring, the initial reaction was puzzlement. Why would Ginsburg need to write separately from a pro-choice opinion by her liberal colleague Breyer? Looking at her concurrence, however, the explanation is clear.
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Open Thread: John Oliver Is AWESOME

As explained at Slate:

On Sunday night John Oliver staged what he described as “the largest one-time giveaway in television show history,” giving $14,922,261.76 to nearly 9,000 lucky Texans. Or maybe not-so-lucky Texans, at least until Sunday: The money came in the form of forgiveness for out-of-statute medical debts, debts so old they could no longer be recovered in court. It was part of a lengthy investigation into the shady ethics and questionable practices of debt buyers, companies that buy up debts for pennies on the dollar and go to great, sometimes illegal lengths to collect them…

The broader case Oliver is making is that the entire debt buying industry is corrupt and underregulated, not just the most laughably incompetent collectors. It’s difficult to argue after seeing his footage of the Debt Buyers Association’s annual conference, in which trade group members scoff at the idea of their debtor’s legal rights. But the strongest argument Oliver makes that the industry needs work is that they let him become a part of it. Without too much hassle, he was able to set up his own debt collection company and purchased a portfolio of nearly $15 million in Texas medical debts. (Total cost: less than $60,000.) Then, with the press of a giant red button, he forgave all $15 million. As best as the staff of Last Week Tonight could figure, this gives Oliver the record for largest giveaway (previously held by Oprah Winfrey for giving her audience cars). Given the misery debt buyers and collection agencies cause, it’s hard to imagine any late-night host doing more concrete good for such a small cash outlay—but here’s hoping they make a competition of it.

Oliver’s deft at turning jokes about what’s actually a horrific situation: America’s self-proclaimed Masters of the Universe have birthed an entire industry based on screwing every last penny out of the victims of medical catastrophes. I cannot believe this is the best and highest purpose for the richest, most advanced society on the planet.



Late Night Horrorshow: Zika Is Coming, Ready or Not

I’m probably gonna get dinged for chicken-littling, because hey, no Ebola outbreak happened in America, right? And yet… “White House Ebola response coordinator from 2014 to 2015” Klain’s Washington Post article:

The good news is that both the House and Senate have finally passed bills that would provide some funding to combat the Zika virus. The bad news is that this action comes more than three months after President Obama requested the aid. Moreover, the House bill provides only one-third of the response needed; pays for this limited, ineffective response by diverting money allocated to fight other infectious diseases; and necessitates a conference committee to resolve differences with the Senate bill, meaning we still do not know when any money will finally get through Congress to fund the response…

As befuddling as Congress’ refusal to approve funds for the Zika response is, perhaps even more of a mystery is why such approval is needed in the first place. If nature was threatening us with serious injury and evacuations via fire, flood or hurricane, the president could use his authority under the Stafford Disaster Relief and Emergency Assistance Act to provide immediate aid without waiting for Congress to act. The fact that epidemic “natural disasters” are the result of disease and not an earthquake or tornado should not constrain the federal government’s ability to provide a timely, comprehensive response…

Speaking of those damaged babies? Once the Zika virus gets established in “our” mosquitos, microcephaly is going to become yet another standard prenatal test for women in the afflicted areas. Or who’ve visited those areas. Or whose male partners were exposed to Zika, even months before the pregnancy. And by the time microcephaly can be diagnosed, it’s too late for a quiet ‘medical abortion‘ — women will need full surgical services, and most will have been visibly pregnant. It’s not going to be easy for ‘fundamentalist’ anti-choicers to find reasons to blame good married Christian white ladies in the Sunbelt for having been bitten by the wrong mosquito… but I’m sure they’re gonna try their damndest.
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Monday Morning Open Thread: Positive Thoughts

I’m sure Richard Mayhew will be along to tell us about this in much more detail, but this is good news. Per the NYTimes, “Immigrants, the Poor and Minorities Gain Sharply Under Health Act”

LOS ANGELES — The first full year of the Affordable Care Act brought historic increases in coverage for low-wage workers and others who have long been left out of the health care system, a New York Times analysis has found. Immigrants of all backgrounds — including more than a million legal residents who are not citizens — had the sharpest rise in coverage rates.

Hispanics, a coveted group of voters this election year, accounted for nearly a third of the increase in adults with insurance. That was the single largest share of any racial or ethnic group, far greater than their 17 percent share of the population. Low-wage workers, who did not have enough clout in the labor market to demand insurance, saw sharp increases. Coverage rates jumped for cooks, dishwashers, waiters, as well as for hairdressers and cashiers. Minorities, who disproportionately worked in low-wage jobs, had large gains…

Until now, the impact of the law has been measured mostly in broad numbers of newly insured people — about 20 million by the administration’s most recent account. But the Times’s analysis of census data from 2014, the first year the heart of the law was in full effect, provides a finely detailed look at who the newly insured actually are — by race, education, occupation, immigration status, and family structure…

“From the vantage point of the poor and working poor, Obamacare has been profound,” said Jim Mangia, president of the St. John’s Well Child and Family Center, a federally funded health clinic in South Los Angeles that has enrolled 18,000 new patients under the law, nearly all of them Hispanic or black and the vast majority in Medicaid. The clinic reported a 44 percent increase in cervical cancer screenings, a 25 percent increase in tobacco cessation therapy, and a 22 percent increase in the share of patients with controlled hypertension since 2014, the result, he said, of more patients having insurance.

Having insurance does not necessarily mean better health, but experts hope it could start to ease some of the worst disparities that have kept the United States close to the bottom of health rankings of rich countries…

***********
Apart from cheering improvement, what’s on the agenda as we start another week?



Horror Movie Open Thread: Teach Screen the Controversy!

Zombie lies, they’re not just for economics any more! Per the NYTimes:

In a decision that has dredged up the widely debunked link between vaccines and autism, the Tribeca Film Festival plans to screen a film by a discredited former doctor whose research caused widespread alarm about the issue.

The film, “Vaxxed: From Cover-Up to Catastrophe,” is directed and co-written by Andrew Wakefield, an anti-vaccination activist and an author of a study — published in the British medical journal The Lancet, in 1998 — that was retracted in 2010. In addition to the retraction of the study, which involved 12 children, Britain’s General Medical Council, citing ethical violations and a failure to disclose financial conflicts of interest, revoked Mr. Wakefield’s medical license…

On Friday, Robert De Niro, one of the festival’s founders, said in a statement issued through the festival’s publicists that he supported the plan to show the movie next month, although he said he was “not personally endorsing the film,” nor was he against vaccination.

Mr. De Niro’s statement seemed to suggest that this was the first time he has expressed a preference that a particular film be shown at the festival.

“Grace and I have a child with autism,” he wrote, referring to his wife, Grace Hightower De Niro, “and we believe it is critical that all of the issues surrounding the causes of autism be openly discussed and examined. In the 15 years since the Tribeca Film Festival was founded, I have never asked for a film to be screened or gotten involved in the programming. However this is very personal to me and my family and I want there to be a discussion, which is why we will be screening VAXXED.”…

The plan to show the film has unnerved and angered doctors, infectious disease experts and even other filmmakers…

According to the festival’s website, “Vaxxed” will be screened only once, on April 24, the festival’s closing day. A talk with the director and the film’s subjects will follow.

An earlier version of this article suggested that perhaps Mr. de Niro intended to rebut the film during his talk, but that doesn’t seem to be what he’s planning, per Deadline:

[T]he TFF promotional material could easily be taken to endorse Wakefield’s cause. “Digging into the long-debated link between autism and vaccines, Vaxxed: From Cover-Up to Catastrophe features revealing and emotional interviews with pharmaceutical insiders, doctors, politicians, parents, and one whistleblower to understand what’s behind the skyrocketing increase of autism diagnoses today.” Also this: “The most vitriolic debate in medical history takes a dramatic turn when senior-scientist-turned-whistleblower Dr. William Thompson of the Centers for Disease Control turns over secret documents, data and internal emails confirming what millions of devastated parents and ‘discredited’ doctors have long-suspected.”…

One happy effect of De Niro’s statement, according to the LA Times: “The De Niro news does quell reports that actor Leonardo DiCaprio was involved in backing the film — as Wakefield apparently told reporters on a promotional cruise — and even may have been orchestrating its Tribeca screening.”