KOLAHUN

An anticipated step

The Senate passes SCHIP by a veto-proof margin.  Bush will likely veto it next week - and then...will the House Democrats pressure the 25 Republicans to switch to a 'yea' vote and override his veto?

When do the men come?

Dr. C pointed me to this New York Times article about Walmart's addition to the generic drug program.  The main new drugs are oral contraceptive pills (for $9/month), generic lamisil, and carvedilol, a beta-blocker (with beta and alpha properties without intrinsic sympathetic properties and excellent heart failure results).  Walmart, of course, isn't providing this as a public health service:

"The company said it would also sell a month’s supply of two popular birth control medications and a fertility drug for $9 each, a move meant to lure young women shoppers to the store. The company said it decided to offer those drugs at $9 because they would not have been profitable at $4."

Which begs the question...when will Viagra be available for $4?  Won't that wildly increase the number of men that go to Walmart?

(and yes...the title is a supremely clever pun!)

SCHIP (volume 2)

For a recap on its history, see this earlier SCHIP post.  Briefly, though, the federal government enacted SCHIP in 1997 to cover the gaps between children in poverty (who Medicaid covers) and those whose parents can afford private insurance.  The issue is coming to a head now because SCHIP will expire on September 30, 2007, ten years after enactment.  Covering this story entails looking at it from both political and an ideological angles. 

(Fiscally, on the other hand, we can easily afford this program - $60 billion over 5 years...the US budget for 2007 alone will be $2.8 trillion dollars.  The question really isn't whether we'll pay for this program, but rather will we pay the states or insurance companies.)

On a political level, the fight comes down to a steadfast/obstinate President at the end of his political career, with no future elections in sight, hoping to salvage history's favor against Representatives and Senators from states where the SCHIP has been wildly popular and are up for re-election within then next year.  Tuesday, the House passed the legislation, but not by a veto-proof majority.  The Senate will take up the compromise bill today and for the next few days.  President Bush has vowed to veto the bill in its current format. 

Rather than speculating on the various possible outcomes, I'll throw a dart at the board and predict what will happen: 

• The Senate will pass the bill and Congress will send it to the President
• Bush will veto it (he's never backed down before)
• The country will come to the the September 30th deadline
• Congress will over-ride the veto

On an ideological level, the argument comes down to this: should the government or insurance control health care.  It goes to a fundamental question of whether one trusts bureaucrats or capitalists to do the right thing.  This is going to take a bit longer to get into and I'll save it for the next installment.

For a primer, here are some good links:

• Kaiser Family Foundation basic summary of SCHIP
• White House myths/facts
• Heritage Foundation criticism of SCHIP
• Cato Institute criticism of SCHIP

Then why are they called 'politicians'?

Politicians, those wonderful people who dissemble, obfuscate and (in many cases) outright cheat to win elections, then profess to deny that they're actually doing their jobs.  Take this wonderful statement by the White House on the SCHIP legislation:

"MYTH #4: Democrats are not seeking a political victory by passing a bill they know will be vetoed."

Remove the double-speak and one finds that the White House is arguing that Democrats are playing politics....

...but that's what they do.  THEY'RE POLITICIANS.  War, taxes, health-care - it's all politics.  Our particular brand of politics involves majority-rule, checks-and-balances, and that dirty word, "compromise".  But, in the end, Congress passes legislation and the President chooses to sign them or not.  If the President chooses not to, then Congress can go to the electorate in the next election cycle and say, 'that guy sucked...vote for us and we'll pass similar legislation in the future." 

 

Bangin for bhangra

Listen - i've been trying to write a post for a bit regarding race for at least an hour, tying in Jena 6 and this Paul Krugman article on racism regarding Southern whites and I just can't.  It's too large a subject and I don't understand it well enough. 

But whatever we've got negatively, here's what's going on...

• Barack Obama is a viable presidential candidate
• Hillary Clinton (who rocked the Sunday morning shows yesterday) will probably become president
• Condi Rice followed Colin Powell as Secretary of State
• ...and in Louisiana Bobby Jindal will likely become Governor in October this year. 

My hero (and I just bought his book!)

Dr. Anthony Fauci just won some big award called the Lasker Award.  I have no idea what the award celebrates, nor how prestigious it may be.  But here's what they wrote:

"Anthony Fauci, the director of the, NIAID will receive the award for his work orchestrating the $15 billion President's Emergency Plan for AIDS Relief (PEPFAR) program, which supports 114 countries in creating prevention, treatment and care plans for the disease. Fauci recognized HIV as major public health crises when it first emerged in the 1980s. He re-focused his laboratory's efforts to study the molecular mechanism of HIV infection, and was the 10th most-cited HIV/AIDS researcher between 1996 and 2006.

"Because of his scientific credibility, and his unflappable confident manner," said Goldstein, "he has been able to convince members of the legislature and the government, who are not that enthusiastic about science," to devote resources to public health issues."

Regardless of what the Lasker is all about, a few words need to be said about Dr. Fauci.  His accomplishments in immune-related diseases, even before his HIV, remarkably advanced medical understanding and therapy of those diseases - from Wegener's to Polyarteritis Nodosa. 

He further dedicated a significant portion of his work in the 80s and 90s and eventually as the director of the National Institute of Allergy and Immunologic Diseases (a branch of the NIH) to HIV care.  He pushed President Bush to expand funding to HIV care in Africa through the PEPFAR - a program most international health workers empirically appreciate, some more than the Global Fund process.

And anyone who's ever heard him give a speech or be interviewed on NPR or PBS can sense both the intelligence and humanity in his work.  He seems like the kind of physician-scientist-humanitarian we could use more of.  Here are a couple of excerpts from a Frontline interview:

"... What was the significance of [the 2000 International AIDS Conference in] Durban, [South Africa]?

…To challenge the assumption that just because … drugs cost a lot of money and require daily administration, that you would rule out the possibility that people in developing nations, particularly in sub-Saharan Africa, would ever have access to those drugs.

This was challenged in Durban. The main phrase that you heard was "Why not?" Tell me why we can't do this, because the easy excuse was that the drugs are just too expensive. It's $18,000, $20,000 a year for a regimen. Forget it. The health care per capita costs that are designated to people there was $60, $70, $80 at the most, sometimes $1 or $2, sometimes measured in cents, as opposed to in our country, where it's thousands of dollars. So there was no way that anybody was going to get drugs.

Then all of a sudden the prices of the drugs dropped. Then there were generics. Then there were companies that were giving it away. So the next thing was, well, you don't have an infrastructure. How are you going to get the drugs to them? So then when we started to look and went to Africa several times, [we] said, … why can't we get out into the bush, get to the people, get them tested, and get them on medications? ...

...When I went to Uganda in the '90s and went into a hospital in Kampala and immediately related to my medical colleagues -- these were African physicians and nurses who were well trained, who understood the disease, and I made rounds with them on patients. ... What we saw was something that you don't almost ever experience in the United States: making rounds with someone who you know what's wrong with them, absolutely, and you have nothing to do for them. ...Harrison's. 

You know sometimes you go and make rounds on a patient, they have a very advanced cancer and you've tried all the chemotherapies and there's nothing left, but here's something where a simple drug could have a major impact either on their opportunistic infection -- cryptococcus, tuberculosis or what have you -- or HIV/AIDS with an antiretroviral drug and you just have nothing to offer then but just general care. And you go bed after bed after bed. That was really for me the defining and crystallising event that what I had known from a broad conceptual and philosophical standpoint from what we had been doing in Zaire and in Haiti and in other places, to actually be there and make rounds on patients in which you can't do anything.

That triggered in me this absolute resolve that this is just something that as human beings we can't accept. You're looking at it straight in the eye and you say, "What am I going to do?" So we went back home, and that's when we started agitating for overcoming these artificial barriers and reasons that you can't even try to do anything in a developing nation because of the lack of infrastructure, the lack of ability to get drugs there, the lack of people to understand the complexity of the situation.

In fact, all of those proved to be difficulties, but not insurmountable obstacles. That was really crystallized by the expression of the activist movement that we saw in the global meeting in South Africa, ... and it was that impetus that led to the resolve to get treatment, care and prevention into the trenches in developing nations in whatever manner or form we can.

…Is it right to characterize this as your life's work?

Oh, totally. Totally. This is what consumes me.

Do you ever get the feeling, when you go to developing countries and see the kind of horror of the disease that we once saw here in the West, that you're reliving your youth, when you first saw the disease?

Oh, yeah. There are memories that are embedded in me. I used to treat diseases before HIV, some of which we have fortunately developed cures for, where everybody would walk out of the hospital healthy. When the AIDS epidemic hit and we first started admitting patients in 1981, nobody left the hospital. They essentially all died. That was a tremendous cultural shock for a physician like myself and my colleagues to see almost everybody die. If they don't die on this admission, they'll go out and come back, and they die in the next admission. It was really terrible.

That is totally magnified when you go to a sub-Saharan African country, because not only is the situation in the hospitals in the sub-Saharan African countries similar to the way the things were in the hospital when we first started taking care of patients, the mortality was so strikingly high, but the spillover into society is so obvious when you are in a country like Botswana, South Africa, Uganda, Kenya and places like that, where a measurable, significant proportion of the population is infected, and when you walk around, there isn't a village or a home or a community that hasn't been severely impacted by HIV. It is kind of like back in the '80s when you went to the Castro district of San Francisco or the Village in New York City; it was palpable how the community had been so disrupted and wrecked by this terrible disease. You go to sub-Saharan Africa, it's like everything is a Castro district, everything is a Greenwich Village when you look at the proportion of the people that are infected. That is quite compelling and depressing.

Oh...and in case that isn't enough, he's also one of the lead editors of the most important medical textbook: Harrison's. 

Sometimes the system cares

So at the clinic today, Dr. K saw an 82yo female.  She's got some issues going on and he needed to get an ultrasound, some pulmonary function tests and some bloodwork. 

Fortunately for her, she lives right next to a hospital across the river.  Unfortunately for her, no doctor at this clinic has privileges at that hospital - West Jefferson Hospital.  But not to worry...they went ahead and scheduled her for all those tests next Monday (in 5 days!).  And because she has Medicare, she'll not have to pay much (if anything at all). 

And she'll follow up with Dr. K back in this clinic in a few weeks. 

Pretty sweet deal for everyone involved - the patient, West Jefferson Hospital and for this clinic. 

Jena 6

I suppose bloggers aren't supposed to cut-and-paste heavily.  But on this issue, I have little to say and if I just link to the story, I fear the (three) readers of this blog might not actually read the whole article. 

So here's a good chunk of the editorial in the Gambit Weekly....(please go to the link and read the whole thing):

"For years, an oak tree in the Jena High School yard -- planted 20 years ago as "the tree of knowledge" -- was regarded as a "whites only" spot of shade at the school. Last year, Kenneth Purvis, a black student then in his junior year, asked school officials if he could sit beneath the tree. He was told that he could sit anywhere he liked. Not long afterward, Purvis and several black friends went to the tree to hang out with white classmates. The next day, three nooses hung from the tree.

That should have been signal enough to school officials, but the symbolism of that ugly gauntlet apparently was lost on them: they suspended the three white boys who admitted hanging the nooses for a few days, but that was it. The incident and school officials' obtuse handling of it touched off a cycle of racial discord at the school and around the small town of 3,500, which is more than 85 percent white. An arsonist burned down a wing of the school during last year's Thanksgiving break. Soon afterward, Robert Bailey Jr., a black student, was punched and beaten with beer bottles when he tried to attend a mostly white party. The white youth who reportedly threw the first punch was charged with simple battery and given probation. The next day, a young white man who was at the party allegedly pulled a gun on Bailey, who wrestled it away. Bailey was later charged with stealing the gun.

The following week at school, Justin Barker, a white student who is a friend of the boys who hung the nooses, allegedly taunted Bailey during lunch. Later, a black student hit Barker from behind and knocked him unconscious. White witnesses say a group of black students -- including Bailey -- then beat up Barker, kicking and stomping him. Black witnesses dispute that account. Barker was treated at a local hospital and released that same day. He attended a ring ceremony that evening and returned to school the next morning.

The six black students who allegedly beat him were immediately arrested and charged with attempted second-degree murder. District Attorney Reed Walters sees no injustice in the disparate charges thrown at white and black youths. Bear in mind, a white kid beat up Bailey with a beer bottle but got off with a misdemeanor charge and probation. Black students who beat up a white kid with only their tennis shoes as "weapons" were initially charged with attempted second-degree murder, which carries a sentence of up to 80 years in prison. A judge reduced the charges to attempted second-degree battery, but they still face 22 years in jail each. An all-white jury has already convicted one of the "Jena Six," 17-year-old Mychal Bell. He is scheduled to be sentenced on Thursday (Sept. 20), and the town could boil over if he gets a long jail term. Some 20,000 protesters are expected to descend upon Jena this week."

The White Tree and Jena 6

The Jena 6 story has been percolating in the local and national news and will get bigger this week.  I don't know a lot about the facts, nor do I understand the race politics in the South (and no, New Orleans doesn't really count as the 'South' - it's kinda a weird little pocket).

The best editorial/summary I've read is in this week's Gambit Weekly, which is the local free weekly newspaper.  It's not on-line yet but when it is, i'll post it.  In the meanwhile, feel free to read this wikipedia outline (noting all of wikipedia's shortcomings). 

What about the Algerians?

On a related note to the post below, on Thursday, I received Longman's book on the VA health care (which expounds on this article).  I'll try to review it when I finish A Savage War of Peace, a book detailing the Algerian fight for independence against the French in the 1950s. 

I've only finished half of it, but it seems like the French keep winning battles (e.g the Battle of Algeria) and keep taking out the heads of the FLN (National Liberation Front)...and yet, we know that the Algerians eventually won.  What does this say about our victories in battles in Iraq?  How come no senators ask the counter-insurgency expert, General Petraeus on the historical record of insurgents versus the counter-insurgents?  Did the British or the Russians win in Afghanistan?  The French or Americans in Indo-Chin?  The French in North Africa?