Health Care Resources | Health care financing in America

The richest country in the world, the best health resources for citizens. Unfortunately, the United States, even in the Top 10 on Health Systems. The truth is that medical facilities in America, usually owned and operated by private firms. In addition, insurance is largely provided by the private sector are available. can not afford to inflation, a significant percentage of Americans are health resources, including primary care and prevention, safety of medicines and medical supplies and equipment, etc.

Currently, there are a lot of controversy on the issue of health care reform, President Barack Obama, who will address the lack of access to medical resources. It focuses on the restructuring of insurance to protect consumers. In general, these reforms are aimed at improving the general state of American health

So far, only low-cost resources, health services are as follows.

Health programs:

* Medicare - an insurance program for people age 65 and older, covers

* Medicaid - a health program of the federal government and state governments to individuals and families with low incomes and resources funding.

* Children's Insurance Program - Program U. S. Department of Health and Human Services, which finances medical services for eligible children under the age of 19 years

* veterans - a program to provide medical assistance from the U.S. Department of Veterans Affairs, where a variety of clinics, hospitals, medical centers and institutions work.

* military system - an integral part of the U. S. Department of Defense, provides health care for active duty and retired U.S. military personnel and their families.

Indian * services - responsible for providing medical assistance to persons recognized tribes and Alaska Natives. IHS is part of the Department of Health and Human Services.

Sanitary:

* State Hospital - a two-thirds of all urban hospitals in a row. It is used by the government (local, regional and federal level), support of poor, the uninsured patients of funding. Other Non-profit hospitals, usually with a religious community or a nonprofit organization linked.

Outpatient surgery centers * - aka surgicenters, ambulatory surgical centers, or centers of everyday surgery, medical facilities to perform this operation as outpatients. The value of transactions conducted in these centers do not require hospitalization, is expensive and less complicated for patients.

* provide social centers - sanitation in municipalities with low income or the uninsured patients, migrant and seasonal farm workers, homeless and people in social housing.

* Hill-Burton Services - consists of hospitals, nursing homes and other health facilities construction / renovation grants and loans in 1946, received in exchange for these structures are responsible for providing services to patients in poor areas. There are currently 200 homes on the national level to health care in patients' rights.

Health information:

* resources on health and management - the information center, which provides publications, resources and referrals for medical care, especially for low-income, uninsured patients and those associated with special health care needs.

* U. S. Public Health - includes all health care and social services and housing contract in order to ensure public health and to promote the prevention and the promotion of health sciences.

Health Care Resources | Medical care focused on health concerns

You can almost half of the dollar in almost 5000000000000 medicine and healthcare related includes the United States. It 'clear that our country is well educated professional, excellent technology and a wide range of medicines to address public health. But why so expensive medical care and problems of people think so much?

The growth of medical care

The more developed countries of the world in the medical field is one of the largest industries. If you count the money generated by sales of pharmaceuticals, diagnostics, nursing homes, hospitals, doctors and other supporting activities is relatively easy to understand why the medical sector accounts for 10-20% of gross area.

Only the U.S. has nearly 800,000 physicians, hospitals and more than 5,000 million health workers. One of every ten Americans now works in health care and this number is expected to grow. Yet there are not enough workers and facilities for 20 million patients currently receiving treatment every day. It is not shocking from outpatient visits average daily number of patients in hospital four -5000000.

The massive, complex health care in the United States, which attracts people from all over the world. Switzerland and Germany, both major medical industry, these countries run their health care differ from the U.S.. Would it be possible that the health of our nations to a radical form of a rapid phase of change?

The answers are hard to find

Is the answer to the dilemma of current health care as simple as the nationalization of health care for all? This possibility will only worsen the situation? How will the distribution of medical resources among the various segments of our society? These are just some of the questions awaiting an answer.

controversial issue

has become modern health problem of medical litigation for many groups of citizens. There is the restoration of the health system as we know it today. We also heard predictions that the government has tried to restructure the health system in the nation. Although much of this advertising reitric for several years, it seems that people are always polaraithe by changes that can now heads forever.

Their care for the elderly

The elderly population in the United States is closely what is being proposed as a result of drugs and health care concern issues important to them to look. And medical insurance for 65 years and many changes since 1980. Older people are very vocal about their disapproval of the way Medicare is addressing the problems and are worried about what the future holds. The cost of health care and medication needs fíorard for the elderly in their entirety. Every year there is a fear that the benefits of longer cut and now are new concerns for medical care.

Risk groups

Is just a few weeks galvanized many citizens, health governor Sarah Palin and her comments on the panel to predict death and nationalized care. Although many people are around her statements, the mere possibility that a radical concept, initiated by the shock wave country. This was particularly worrying many of the older population. The concern among advocates for the poor and disabled. Parents and carers of people with physical and mental health were still afraid and threatened.

Future health resource allocation?

Would it be possible to professionals, it would perhaps even a medical committee to allocate health resources deemed a more worthy? Here, both terrifying and thought "Orwellian" in perspective. careful review found that no written documentation that in fact these possibilities, but does not reduce anxiety and uncertainty for many citizens. Just the idea that access to hospital or medication restrictions, one day was enough to cause panic on a small scale in many communities across the nation.

Problems, problems, problems

medical concerns are healthcare and affordable medicines planning a major concern for everyone today. Insurance is very expensive. A growing trend among smaller companies to employees and family benefits for cost reduction. In some cases it is difficult for workers to participate in their insurance policies offered by employers. But a growing number of families are short of ATM only pay the premiums for health insurance. This is creating a "catch" type environment with 22 people to pay for the costs of illness and cost to insure.

Collaboration is the answer

It 'hard to know where are the biggest problems in health. Many people find fault with well-paid doctors and medical specialists and others point the finger at the hospital, which seemed to attract the billions of dollars annually, but always complain too small. malpractice lawyers, government regulators and the insurance companies involved have also participated in the health care of the current misery. The answer will not be easy to find, and any group associated with the medical industry must step up the plate and help.

Health Care Resources | Health Resources

Are you awake after a night of sleep, still tired? Do you prefer that your health and lack of energy to run the performance of daily tasks and activities you hold?

If so, tired.

Fatigue is a lack of energy a day, is not free from sleep. Someone feel exhausted at all times in body and spirit and can result from several factors are, in context. In most common causes are stress and lifestyle choices, as in the adoption of unhealthy diets lose weight. Conditions could only medical reasons for fatigue are diagnosed.

Fatigue strength, because

Someone keep pace with an emphasis on reason or feel like your body into overdrive. constant flood of adrenaline and fatigue in Body Kits released

Stress related to work environment - it's a lot of noise, boredom, or the concentration of repetitive tasks - personally to be tired. Burnout, the concerns about security have of the workplace.

How diet affects energy levels

Meet calories for basic needs

The estimated daily caloric intake big for a person below 55 kg weight of about 2100 calories to maintain weight and energy enough to carry out legitimate activities.

Get enough protein

Protein is important for our bodies to repair damaged and aging body and tissue repair. Humans need about 60 kg weight 63 kg protein per day.

Drink plenty of fluids

preventing About 8 glasses of water per day to increase dehydration another factor to reduce our energy. The classic symptoms of fatigue díhiodráitíodh light.

More About What We Don't Know About the Contaminated Heparin from China

We last blogged about the case of Baxter International's adulterated heparin here.  (For a more detailed summary of the case, look here.)

In summary, Baxter International imported the "active pharmaceutical ingredient" (API) of heparin, that is, in plainer language, the drug itself, from China. That API was then sold, with some minor processing, as a Baxter International product with a Baxter International label. The drug came from a sketchy supply chain that Baxter did not directly supervise, apparently originating in small "workshops" operating under primitive and unsanitary conditions without any meaningful inspection or supervision by the company, the Chinese government, or the FDA. The heparin proved to have been adulterated with over-sulfated chondroitin sulfate (OSCS), and many patients who received got seriously ill or died. While there have been investigations of how the adulteration adversely affected patients, to date, there have been no publicly reported investigations of how the OSCS got into the heparin, and who should have been responsible for overseeing the purity and safety of the product. Despite the facts that clearly patients died from receiving this adulterated drug, no individual has yet suffered any negative consequence for what amounted to poisoning of patients with a brand-name but adulterated pharmaceutical product.

Now, an article in the Wall Street Journal by Alicia Mundy tells us more about what we don't know,

The Chinese government didn't pursue an investigation into contaminated heparin sent to the U.S. in 2007 and 2008, despite repeated requests from the U.S. for help, according to a congressional probe.

Two House Republicans said Food and Drug Administration officials recently told them that the agency has been "severely hampered" by the lack of cooperation from China in finding those responsible.

Furthermore,

'It is shocking to find out two years after Chinese-made heparin was killing Americans, the Chinese government still has done no investigating to find out why,' said Mr. Barton, the top Republican on the House Energy and Commerce Committee. He called on ... [FDA Commissioner Margaret] Hamburg to air the issue with Chinese officials.

Chinese officials denied there is a problem,

Yan Jiangying, spokeswoman for China's State Food and Drug Administration, said the congressmen's accusations are 'not true.'

Ms. Yan said her agency 'did a very thorough investigation, including very detailed inspection and testing, and surveys of enterprises as well. We signed an agreement with the FDA on drug safety in the end of 2007, and strengthened the monitoring of heparin.'

Note that their investigation, such as it was, did not appear to identify any misconduct or wrong-doing by anyone.

So now we know more about what we do not know about the deadly adulterated heparin from China.

But remember this is a case about heparin sold in the USA by Baxter International, an American company as an American product, resulting in the death of Americans.  Also, remember that the American company obtained the heparin from another American company, Scientific Protein Laboratories LLC, which in turn obtained it from a factory in China operated by Changzhou SPL, which in turn was owned by Scientific Protein Laboratories and by Changzhou Techpool Pharmaceutical Co. 

Since Baxter International sold the heparin under its own label, should not its leaders be responsible for the safety and purity of the product?  Since Scientific Protein Laboratories LLC furnished the active pharmaceutical agreement to Baxter, and obtained it from a factory it partially owned in China, should not its leaders also be responsible for the safety and purity of the product?

It would be important to find out ultimately where in China the adulterated heparin entered the supply chain, but the current uncertainty about the initial origin of the contamination does not absolve those in the US who sold the active pharmaceutical ingredient, and then sold that ingredient in bottles with a US company label of responsibility for the safety and purity of the drug.

Why have we heard nothing more from Baxter International's and Scientific Protein Laboratories' leaders about the deadly heparin which they had sold?  Why have we heard nothing more about any investigation of these US based participants in this case? 

Both US companies doubtless saved money by buying the heparin from the cheapest Chinese sources they could find, by not directly inspecting and supervising its production, and by at best ignoring the lack of regulation of producers of active pharmaceutical ingredients in China.  They and their leaders benefited from this out-sourced, off-shore production.  (Note that Baxter CEO Robert L Parkinson Jr received total compensation of $14,361,305 according to the company's proxy statement, and six named officers all received more than $2,200,000.) Why aren't they being held accountable for its bad results?

As we have said until being blue in the face, as long as the leaders of health care organizations are not held accountable for the results of their decisions on health care quality, cost, and access (even in such extreme quality violations as those resulting in multiple patient deaths), we can expect continuing decisions that sacrifice quality, increase costs, and worsen access, but that are in the self-interest of the people making them.

To really reform health care, we must hold health care organizations and their leaders accountable (and not blame all the problems on doctors, other health care professionals, patients, and society at large).

Hat tip to Ed Silverman on the PharmaLot blog.

Open Letter to Dr. Josephine Briggs

Josephine P. Briggs, M.D.
Director, National Center for Complementary and Alternative Medicine

Dear Dr. Briggs,

As you know, we've met twice. The first time was at the Yale "Integrative Medicine" Symposium in March. The second was in April, when Drs. Novella, Gorski and I met with you for an hour at the NCCAM in Bethesda. At the time I concluded that you favor science-based medicine, although you are in the awkward position of having to appear 'open-minded' about nonsense.

More about that below, but first let me address the principal reason for this letter: it is disturbing that you will shortly appear at the 25th Anniversary Convention of the American Association of Naturopathic Physicians (AANP). It is disturbing for two reasons: first, it suggests that you know little about the tenets and methods of the group that you'll be addressing; second, your presence will be interpreted as an endorsement of those methods and of that group---whether or not that is your intention. If you read nothing more of this letter or its links, please read the following articles (they're "part of your education," as my 91 y.o. mother used to say to me):

Naturopathy: A Critical Appraisal

Naturopathy, Pseudoscience, and Medicine: Myths and Fallacies vs Truth

The first article is an introduction to the group to which you will be speaking; the second is my response to complaints, from that group and a few of its apologists, about the first article. It was a surprise to me that the editor, George Lundberg, preferred that I make my response a comprehensive one.

Thus the second article inevitably became the crash course---call it CAM for Smarties---that your predecessors never offered you, replete with examples of useless and dangerous pseudoscientific methods, real science being brought to bear in evaluating such methods, proponents' inaccurate or cherry-picked citations of biomedical literature, bits of pertinent but little-known history, the standard logical fallacies, embarrassing socio-political machinations, wasteful and dangerous 'research' (funded---unwittingly, I'm sure---by the NCCAM), bait-and-switch labeling of rational methods as "CAM," vacuous assertions about 'toxins' and "curing the underlying cause, not just suppressing the symptoms," anti-vaccination hysteria, misleading language, the obligatory recycling of psychokinesis claims, and more.

Please excuse me if this sounds preachy; I admit that it does, but understand that I'm writing in good faith. My own views of "CAM" did not dawn on me overnight, but were the result of years of research. My 'internship,' as it were, consisted of sitting on a state commission from the fall of 2000 until the spring of 2002, listening to AANP members (including at least one with whom you will share the podium), reading about 'naturopathic medicine,' and attempting (unsuccessfully) to engage its advocates in rational discussion. I began that task open to forming opinions based on whatever information became available; by its end it had become abundantly clear that the group is best characterized as a pseudoscientific cult, and nothing since has altered that opinion.

Regarding your presence at the convention being tantamount to an endorsement of 'naturopathic medicine,' this is so obviously true that it ought not be necessary to mention it. Previous experience, however, has taught me to expect an air of---please don't take this personally---utter cluelessness whenever I've raised such an issue. If you've read the second naturopathy article linked above, you already know that according to proponents,

The validity of naturopathic medicine is demonstrated by its support in government (including accreditation of its schools and NIH-funded research), on medical school Web sites, and in other parts of the public domain.

An appearance at their annual convention by the most important "CAM" administrator at the NIH surely has the political arm of the AANP licking its chops. NDs, as they call themselves, are currently licensed in 14 or 15 states and a couple of provinces, and aggressively seek licensure throughout the U.S. and Canada. They appear to wield political clout well out of proportion to their numbers, no doubt thanks in part to the legislative language that created the NCCAM's National Advisory Council for Complementary and Alternative Medicine (NACCAM):

Of the 18 appointed members...Nine...shall be practitioners licensed in one or more of the major systems with which the Center is involved. Six of the members shall be appointed by the Secretary from the general public and shall include leaders in the fields of public policy, law, health policy, economics, and management. Three of the six shall represent the interests of individual consumers of complementary and alternative medicine.

Thus there have been 1-3 NDs on the NACCAM since its inception in 1999, although their numbers in general are, by any measure, miniscule: I reckoned there were about 2500 in the U.S. in 2003; the AANP now places that number at 6000. By comparison, there are about 800,000 MDs and 50,000 DOs in the U.S.

NDs claim to be well trained to practice what most people think of as family medicine or primary care medicine, although their version of training is chock full of pseudoscientific nonsense and lacks a true residency program. They began by purporting to use only "natural medicines," but in regions where they've become politically connected they've sought, and been granted, the license to prescribe numerous drugs. Predictably, they've recently begun to bump people off with such exotic choices as intravenous colchicine and disodium ethylenediaminetetraacetic acid (that pesky TACT drug), in addition to more folksy nostrums such as acupuncture, vitamin B12, and an "herbal tincture" for a teenage girl who would shortly die of asthma.

I see that your talk is titled "Complementary and Alternative Medicine: Promising Ideas from Outside the Mainstream." I imagine that it will cover some of the material that you covered at the Yale Symposium, where you used the similar phrase, “Quirky Ideas from Outside the Mainstream.” Without reading more into that word substitution than is warranted, let me assure you that there are no promising ideas emanating from naturopathy, even if there are plenty of quirky ones, e.g., inflating balloons in the nasopharynx to effect a “controlled release of the connective tissue tension to unwind the body and return it toward to its original design."

Regarding the implicit requirement of your office that you appear open-minded even to medical absurdities, you made that clear in your own account of our NCCAM meeting and of another that you'd had a few weeks earlier, involving a group of homeopaths and associated crackpots who called themselves "the leading scientists in the field":

Recently, I hosted two meetings with groups that represent disparate views of CAM research. These meetings have given me a renewed appreciation for the value of listening to differing voices and perspectives about the work we do.

My NCCAM colleagues and I know there are differing views of the value of doing CAM research. On one side, we have stakeholders who are staunch CAM advocates, and on the other side, we have CAM skeptics.

Each group has its own beliefs and opinions on the direction, importance, and value of the work that NCCAM funds. The advocates would like to see more research dollars
supporting various CAM approaches while the skeptics see our research investment as giving undue credibility to unfeasible CAM modalities and want less research funding.

As I've stated before, our position is that science must remain neutral, and we should be strictly objective. There are compelling reasons to explore many CAM modalities, and the science should speak for itself. (emphasis yours)

Certainly science must remain neutral in the face of not-yet-seen data from rigorous studies, but that is different from what you, in your dual roles as "CAM" Explicator-in-Chief and Steward of Public Funds, must remain. You typically face questions that are, for all purposes relevant to the NIH, to modern medicine, and to the American citizenry, already settled---whether by basic science, clinical studies, rational thinking, or all three. I've offered several examples in the two naturopathy articles linked above.

Consider homeopathy, a core claim of "naturopathic medicine" and the subject of your meeting with the "staunch CAM advocates." It makes no more sense for you to remain neutral on that topic than it would for the NIMH Director to remain neutral on exorcisms, or for the NCI Director to remain neutral on Krebiozen. Edzard Ernst, a one-time homeopath whose own portfolio of "CAM" investigations dwarfs the entire output of the NCCAM, puts it this way:

Should we keep an open mind about astrology, perpetual motion, alchemy, alien abduction, and sightings of Elvis Presley? No, and we are happy to confess that our minds have closed down on homeopathy in the same way.

Science and skepticism, moreover, are not distinct. Good science involves, first and foremost, skepticism. This is true for the design of any experiment, in which the primary goal is to attempt to falsify the hypothesis, and also for scientific thinking in general. Bruce Alberts, the editor of Science, discussed this in a 2008 editorial titled "Considering Science Education":

...society may less appreciate the advantage of having everyone acquire, as part of their formal education, the ways of thinking and behaving that are central to the practice of successful science: scientific habits of mind. These habits include a skeptical attitude toward dogmatic claims and a strong desire for logic and evidence. As famed astronomer Carl Sagan put it, science is our best "bunk" detector. Individuals and societies clearly need a means to logically test the onslaught of constant clever attempts to manipulate our purchasing and political decisions. (emphasis added)

I believe that you know all this at some level, but that your current job demands that you bend over backward to frame skeptics as extreme---distinguishing them from "neutral" scientists. Thus you, like many reporters, have placed skeptics of homeopathy or naturopathy at one end of a contrived belief spectrum, and "staunch CAM advocates" at the other. Please indulge me while I compare this version of 'neutrality' with others that exist in the popular domain:

• Some people feel strongly that the moon landings were a collective hoax. Others feel just as strongly that they really happened.
• Some people believe that the Holocaust didn't happen. Others believe that it did.
• Some people believe that the variety of species on earth is a product of Intelligent Design (ID). Others believe in the theory of evolution by variation and natural selection.
  

This could go on and on, but you probably get the point. The last bullet is more pertinent to your tacit endorsement of the AANP than you might imagine. What follows is a representative view of herbalism offered by Thomas Kruzel, with whom you will also share the podium at the convention (he will discuss "Emunctorology"; don't ask). Kruzel is Past President of the AANP and the former Vice President of Clinical Affairs and Chief Medical Officer at the Southwest College of Naturopathic Medicine. He was selected Physician of the Year by the AANP in 2000, and Physician of the Year by the Arizona Naturopathic Medical Association in 2003:

Herbal Medicine: Naturopathic physicians have been trained in the art and science of prescribing medications derived from plant sources. The majority of prescription drugs are derived as well from plants but are often altered and used as single constituents. What makes herbal medicine unique is that plants have evolved along with human beings and have been used as non-toxic medications for centuries.

If there is any problem with herbal medicines it is that unless one knows how to prescribe them, they may not be effective. Herbal medications should be prescribed based on the symptoms that the person presents rather than for the name of the disease. Herbal medications are much more effective at relieving the patients symptoms when prescribed in this manner. When prescribed the medicines act with the body’s own innate healing mechanism to restore balance and ultimately allows healing to occur.

What’s nice about plant or herbal medicines is that because they are derived from the whole plant they are considerably less toxic to the body. The plant medicine has evolved to work in harmony with the normal body processes rather than taking over its function as many drug therapies do. Because of this herbal medicines may be taken for longer periods of time without the side effects so often experienced with drugs.

You are particularly impressed, I hope, by the magical, ID-like claim that "plant medicine has evolved to work in harmony with the normal body processes." Other curious assertions include the conflation of herbal medicine with the core claims of either homeopathy or the non-existent 'allopathy' (we can't tell which)---"...should be prescribed based on the symptoms..."---demonstrating that the author doesn't know much about even the fanciful methods for which he claims expertise; and the dangerously false statement that medicines "derived from the whole plant are considerably less toxic" (than are well-researched and precisely dosed "prescription drugs").

Dr. Briggs, please consider the possibility that you no longer must hide your considerable scientific prowess in order to be a good NCCAM Director. Your 'stakeholders' include not only very small numbers of naturopaths, homeopaths, and other fringe practitioners, but also far larger numbers of citizens who wonder about the validity of what those practitioners are peddling. It is to those citizens that you should be directing your efforts, which ought to begin with sober, objective, skeptical, scientific considerations of the various claims, the vast majority of which can, like balloons in the nasopharynx, be deflated in milliseconds by anyone with even a modest understanding of nature. They don't require clinical trials.

Things are changing elsewhere. My colleague Steve Novella has just written about substantial efforts to deny insurance coverage for homeopathy in the land of its birth, Germany. In the UK, homeopathy has been far more popular than it is here, even to the point of its being funded by the National Health Service. One of the "staunch CAM advocates" who reportedly attended your meeting by teleconference was Peter Fisher, Homeopath to the Queen. Yet both the British Medical Association and the House of Commons Science and Technology Committee have seen through the ruse of pseudoscience that is homeopathy, the former declaring it "witchcraft" and latter making this statement:

The Committee concurred with the Government that the evidence base shows that homeopathy is not efficacious (that is, it does not work beyond the placebo effect) and that explanations for why homeopathy would work are scientifically implausible.

American citizens want and deserve, for their tax money, exactly that sort of definitive evaluation of such claims. Your first responsibility, Dr. Briggs, is to them---it is not to the AANP, other "CAM stakeholders," Tom Harkin, Orrin Hatch, or Dan Burton, and certainly not to the members of the NACCAM. Yes, we "skeptics see [the NCCAM] research investment as giving undue credibility to unfeasible CAM modalities," because the evidence is overwhelming that this is the case. We also see your appearing at conventions of pseudomedical pseudoprofessional organizations as giving undue credibility to unfeasible and dangerous claims.

Sincerely yours,

Kimball C. Atwood, M.D.
Skeptic

This letter has been cross-posted on Science-Based Medicine.