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Be Not Afraid

Thu, 11 Mar 2010 00:00:00 -0800

The New England Journal of Medicine - By Len M. Nichols, Ph.D. - Mar. 11 (Opinion) - Aside from the stunningly effective misinformation campaign, the substantive issue that has stalled health care reform is economic: Can we afford this new promise to ourselves, now?

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Communicating Medical News -- Pitfalls of Health Care Journalism

Wed, 31 Dec 2008 00:00:00 -0800

The New England Journal of Medicine - By Susan Dentzer - Dec. 31 (Opinion) - In my view, we in the news media have a responsibility to hold ourselves to higher standards if there is any chance that doctors and patients will act on the basis of our reporting. We are not clinicians, but we must be more than carnival barkers; we must be credible health communicators more interested in conveying clear, actionable health information to the public than carrying out our other agendas. There is strong evidence that many journalists agree — and in particular, consider themselves poorly trained to understand medical studies and statistics.5 But not only should our profession demand better training of health journalists, it should also require that health stories, rather than being rendered in black and white, use all the grays on the palette to paint a comprehensive picture of inevitably complex realties. Journalists could start by imposing on their work a "prudent reader or viewer" test: On the basis of my news account, what would a prudent person do or assume about a given medical intervention, and did I therefore succeed in delivering the best public health message possible?

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Screening for Prostate Cancer among Men 75 Years of Age or Older

Thu, 11 Dec 2008 00:00:00 -0800

The New England Journal of Medicine - By Michael J. Barry, M.D. - Dec. 11 (Special Report) - Prostate-cancer screening with the prostate-specific antigen (PSA) test remains one of the most controversial issues in modern medicine. The U.S. Preventive Services Task Force (USPSTF), an independent group of experts supported by the Agency for Healthcare Research and Quality under a mandate from Congress, recently revised its recommendations regarding prostate-cancer screening. The USPSTF concluded that "the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years," but it now "recommends against screening for prostate cancer in men age 75 years or older."1 In its 2002 statement, the task force did not recommend for or against screening in either age group. The implication of the new recommendation for medical practice is that clinicians should discuss the potential benefits and known harms of screening with men between 50 and 74 years of age, but not necessarily with older men.

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Voters and Health Reform in the 2008 Presidential Election

Wed, 05 Nov 2008 00:00:00 -0800

The New England Journal of Medicine - By Robert J. Blendon, Sc.D., Drew E. Altman, Ph.D., John M. Benson, M.A., Mollyann Brodie, Ph.D., Tami Buhr, A.M., Claudia Deane, M.A., Sasha Buscho, B.A. - Nov. 05 (News Report) - First, we examine the public's perceptions of the state of health care. Second, we look at the role of health care in this election and compare its relative importance with that in previous elections. Third, we report and contrast the health policy views of registered voters who say they intend to vote for Senator John McCain with those of supporters of Senator Barack Obama. In analyzing these views, we will focus on the issues that have been raised by the presidential candidates during the campaign. Finally, we will discuss our view of the implications of our findings for the prospects of health reform in the next administration.

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Learning from Failure in Health Care Reform

Thu, 25 Oct 2007 06:34:01 -0700

The New England Journal of Medicine - By Jonathan Oberlander, Ph.D. - Oct. 25 (Opinion) - Since 1994, inaction and incrementalism have governed U.S. health policy, with the predictable result that both health care spending and the number of uninsured Americans have reached record levels. Indeed, worsening conditions in the health care system have triggered renewed interest in comprehensive health care reform. Signs of change in the health care debate are everywhere -- in the formation of coalitions by business and labor groups to pursue reform, the launching of advertising campaigns by the American Cancer Society and the American Medical Association to highlight the plight of the uninsured, the pursuit of ambitious plans by states such as Massachusetts to expand insurance coverage, and the unveiling of an array of health care reform plans by candidates in the Democratic and Republican presidential primaries. Health care reform is even the subject of an attention-grabbing movie, Michael Moore's Sicko. It is thus tempting to believe that the moment for reform has finally arrived and that we stand on the verge of historic change. Yet before reform advocates get too exuberant, they would do well to remember what happened the last time health care reform topped the national agenda. In the early 1990s, reformers also believed that the conditions were ripe for change1; then, as now, soaring health care costs and growth of the uninsured population fueled public dissatisfaction (see table). When President Bill Clinton took office in 1993 with Democratic majorities in the Senate and House of Representatives, the country appeared inexorably headed toward health care reform. But just a year after its introduction in September 1993, the Clinton Health Security Act (see box) was dead in Congress. What happened to the Clinton plan, and what lessons can today's reformers learn from its failure?

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The Battle over SCHIP

Thu, 06 Sep 2007 09:05:59 -0700

The New England Journal of Medicine - By John K. Iglehart - Sep. 06 (Special Report) - Reauthorization of the State Children's Health Insurance Program (SCHIP), which was considered a routine matter until recently because of the program's success in expanding coverage to children of the working poor, has become embroiled in a larger struggle over ideologies that divide the political parties. The immediate battle to reauthorize SCHIP, for which the legal mandate expires on September 30, will resume this fall as Democrats, who command the House and Senate by slender margins, seek to stand up to President Bush, who has said he would veto the SCHIP bills approved by the two chambers because they authorize too much spending and go "too far in federalizing health care." In the last days before Congress broke for its summer respite, the Senate defied Bush's threatened veto and underscored the bipartisan popularity of SCHIP by reauthorizing the program for 5 years on a vote of 68 to 31. House Democrats approved a more expansive version by a vote of 225 to 204, but only 5 Republicans supported it. Because the House-approved bill would also repeal an impending reduction in Medicare payments to physicians, broaden prevention benefits to Medicare beneficiaries, and increase support for selected hospitals (as well as eliminate the higher Medicare payments to private plans, as compared with fee for service), it attracted the support of the American Medical Association and allied physician organizations, as well as the formidable elderly lobby (AARP). This support adds muscle to the efforts of Democrats to overcome the administration's opposition but also complicates the process.

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Safer Drugs for the American People

Wed, 18 Jul 2007 15:38:59 -0700

The New England Journal of Medicine - By Gregory D. Curfman, M.D., Stephen Morrissey, Ph.D., Jeffrey M. Drazen, M.D. - Jul. 18 (Editorial) - By wide margins, both the House and the Senate have now passed bills that aim to ensure the safety of the drug supply in the United States.1,2 Given the serious safety problems that have arisen with drugs taken by millions of Americans, this legislation is long overdue. It is now up to both houses of Congress to resolve the differences between the two versions and agree on a strong final bill to send to the President. This year, Congress had to consider reauthorization of the Prescription Drug User Fee Act (PDUFA), which it must do every 5 years. Under PDUFA, the major funding for the review of new drugs by the Food and Drug Administration (FDA) comes from user fees paid by pharmaceutical companies. This mechanism has been controversial because, although it was designed to accelerate the drug-approval process and can make new drugs available to patients without delay, it has directed no money to the postmarketing assessment of drug safety. In addition, some believe that user fees pose a conflict of interest for the FDA. Nonetheless, to ensure that the FDA has adequate financial resources, both the House and the Senate versions of the bill not only maintain these user fees but increase them (with some of the money now directed to safety assessment).

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Use of Health Services by Previously Uninsured Medicare Beneficiaries

Thu, 12 Jul 2007 19:20:39 -0700

The New England Journal of Medicine - By J. Michael McWilliams, M.D., Ellen Meara, Ph.D., Alan M. Zaslavsky, Ph.D., John Z. Ayanian, M.D., M.P.P. - Jul. 12 (Special Report) - Previously uninsured adults who enroll in the Medicare program at the age of 65 years may have greater morbidity, requiring more intensive and costlier care over subsequent years, than they would if they had been previously insured.

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