What were they thinking?

At a June 26  CDC press briefing, Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, took the agency's number of verified cases (over 27,000) of H1N1 ('swine flu') and extrapolated them into a much higher number. 

Having dealt with the press previously and on numerous occasions, Schuchat must have anticipated the resulting headlines, and the ensuing panic.

Here's what she said: 

"We're saying there have been at least a million cases of this new H1N1 virus in the United States so far this year. That's really not a perfectly accurate estimate.  It's just a number, a ballpark figure, that we think for sure there's been more than a million of these new infections."

As if that "not perfectly accurate," "we think for sure" statement wasn't enough to guarantee headlines, when asked for clarification Schuchat said she believed the number probably exceeded 1 million.

I think that was irresponsible, especially since Schuchat said most  hospitals and clinics don't have the means to test and classify virus samples.

"Fortunately, we have a new test that can be done in state and public health laboratories that can differentiate this new virus from other viruses but there's really not the sufficient number of those tests or the capacity in terms of the people to do those tests to test every single person who has an influenza-like illness," she said.

Doctors may have an extra busy day Monday morning dealing with the added people who come in clamoring for a flu shot that doesn't yet exist.

Oh well. At least a dozen or more companies (already paid billions by our government) in a half dozen countries are in a race to develop the first commercial swine flu vaccine. Some say they have created doses that are ready for testing on animals. May the best man win.

And may we not have a repeat of the 1976 debacle when public health officials vaccinated 40 million Americans to ward off a new flu strain, also called "swine flu" with a largely untested vaccine. The anticipated swine flu pandemic never occurred but at least 500 people who got the vaccine developed Guillain-Barre Syndrome, an often deadly neurological disorder for which there is no cure.

Maybe it was the way many seniors were burned by Medicare Part D, but AARP, the 40 million-member senior association that threw its power behind Part D, isn't coming out for any of the leading or trailing health care reform proposals this go-round.

AARP has joined other centrist groups* in the Divided We Fail campaign that calls for a bipartisan solution and states that "all Americans should have access to affordable, quality health care, including prescription drugs, and that these costs should not unfairly burden future generations."

Those sound like safe talking points. Just the kind that will ensure a repeat of the "reform" that gave us Medicare D.

As Rep. Louise Slaughter (D-NY) reflected in a 2006 editorial published in the New England Journal of Medicine: "The current problems with Medicare Part D are largely the direct result of the undemocratic way in which the plan was authored and passed. The final legislation, heavily influenced by drug-company and health insurance lobbyists, focused mainly on the needs of those industries instead of those of the seniors it should serve."

The absence of discussion on non-profit, single-payer health care came up recently on AARP's online member forum.

Some AARP members are cynical about AARP's non-advocacy stance during the current health care debate. There's a suggestion that they've been sold out. Wrote one, "AARP's income from royalties (amounts paid by insurers to allow them to use the AARP name in their advertising) is $498 million or twice the amount paid for membership fees.  Royalties represent 43% of the $1.168 billion total revenue."

Another suggested that AARP is attempting to kill President Obama's proposal for a public insurance option by requesting that Congress include long-term care in the health care bill, an expensive provision that would make it even less palatable to the hostages on Capitol Hill. "Then to have the gall to ask for donations when they get a half a billion in royalties from insurers," he or she added.

AARP's official "demands":

• Narrowing the Medicare Part D 'Donut Hole.' In 2007, 3.4 million Medicare beneficiaries fell into the donut hole, a coverage gap that left them responsible for their entire drug costs on top of their Medicare Part D premium. The donut hole is expanding as the rising costs of drugs outpace inflation.
• Approval of safe and affordable generic biologic drugs
• Give the Secretary of Health and Human Services authority to negotiate drug prices for Medicare
• Allow importation of lower cost drugs
  

In short, AARP leadership supports adding more band-aids to an already mummified health care system. Not much of a legacy to leave the children.

 * I am confused by SEIU's membership in Divided We Fail.

When people use tobacco insurance companies charge them higher premiums. So smoking and chewing must be unhealthy, right?

Right. More smokers means more lung cancer, heart disease and other illnesses. According to the CDC, about 443,000 Americans die from smoking-related illnesses each year.

Then why are seven of the largest life and health insurance companies in the United States, Canada and the UK invested to the tune of $4.4 billion in tobacco companies?

Having grown fat off individuals' health care premiums, particularly smokers', giant insurers like Prudential, Mass Mutual and Sun Life are investing some of those billions in tobacco companies.

J. Wesley Boyd, MD, PhD, and colleagues at the Cambridge Health Alliance at Harvard shared a list of the insurers and the size of their investments in tobacco companies as of March of this year. In a correspondence piece to the New England Journal of Medicine published June 4 they wrote:

"Although investing in tobacco while selling life or health insurance may seem self-defeating, insurance firms have figured out ways to profit from both. Insurers exclude smokers from coverage or, more commonly, charge them higher premiums. Insurers profit -- and smokers lose twice over.

"These facts should discomfit Canadian and British readers as their countries consider further privatization of health insurance," wrote Boyd. "For those of us in the United States, these data are a reminder of the true priority of the insurance industry, which is making money, not ensuring health and wellbeing."

A rational person might hope that this knowledge would cause some discomfiture in Washington, DC, where Congress is presumably wrestling over how to best reform the health care system so that it serves people, not profits, and wrests some control over health care delivery away from insurance companies. But so far, those in charge of crafting the plan are listening only to industry.

The strategically timed release of a poll showing a sudden 10-point flip in American views on abortion should raise a few eyebrows.

Gallup's press release claimed, "More Americans "Pro-Life" Than "Pro-Choice" for First Time."

While partisan mainstream editorial writers openly gloated about the "stunning" and "shocking" poll released in May, few traditional media looked critically and honestly at what the poll actually revealed, and reported the findings with the same slant as the news release. Rather than spending a minute exploring why it was stunning or shocking, the media simply reported it as fact.

First off, polls should be suspect. While they may have been reliable in a more innocent age, Gallup, like many other polling companies, is a for-profit corporation. They are commissioned to conduct polls. Unfortunately, polling companies are not required to disclose the name of the commissioning organization, even though it's the ethically responsible thing to do.

The Gallup poll was released on the day anti-abortion groups planned protests against President Obama's commencement address at Notre Dame and just as there's a new seat to fill on the U.S. Supreme Court. It certainly smells of partisan efforts to create a buzz and revitalize controversy.

Here's what the watchdogs said about the Gallup poll as well as a Pew poll that also re-interpreted long-standing findings about America's stand on abortion choice:

Newshounds: "The truth is that while the Gallup poll showed that a greater number of those polled identified themselves as "pro-life" (51%) than "pro-choice" (42%), the majority (76%) responded that abortion should be legal in either all or limited circumstances. Only 23% responded that abortion should be illegal in all circumstances."  

Media Matters: "...Gallup hypes a poll that finds a majority of Americans self-identify as "pro-life" for the first time ever, even though that finding is based on the implausible premise that the two parties are tied in Party ID -- a premise that Gallup itself contradicts elsewhere. And, get this, Gallup didn't mention the tie in Party ID in its release touting the abortion findings. Had it done so, the findings would have (appropriately) been greeted with much more skepticism.

"That's pretty dishonest -- Gallup withheld information about its own poll that undermined the sensational claim it was making about that poll's findings.  And it's a useful reminder that broad announcements like "More Americans 'Pro-Life' Than 'Pro-Choice' for First Time" shouldn't be taken particularly seriously unless they are accompanied by the complete poll."

The Monkey Cage:  "Simply put, the Pew and Gallup findings obscure far more than they reveal. They purport to show shifts in opinion that are not evident in other data. There is no consistent evidence for a "conservative turn," as Pew puts it.

"Moreover, both Pew and Gallup employ vague questions that do not easily map onto actual policy debates. Once more precise data are employed, it becomes clear that opinion strongly depends on the circumstances under which the abortion would occur. While people who are favor a legal abortion under any of the circumstances mentioned outnumber those who unequivocally oppose abortion by a factor of abut 3, most people are in the middle. In the GSS data, 58% favor a legal abortion under some circumstances, but not others."

Finally, here's a comment from a participant in an abortion poll published in a letter-to-the-editor of the Seattle Times:

Biased method could impact results

"I was polled during the time frame that Gallup did its polling on the "pro-life" issue, although I do not know definitively if it was the Gallup poll who called me because the polling organization did not identify itself.

 

The poll was recorded. I was first asked if I was a registered voter. When I responded "yes," I was asked if I was "pro-life" (not "pro-life" or "pro-choice," which is the more appropriate question). I was a bit disconcerted at the question because it was not framed in terms of abortion -- just "are you pro-life?" I gave my answer and the recording thanked me and hung up.

 

I hung up feeling angry because there was no nuance allowed in the answers and I was not given the option of declaring myself pro-choice. I had to answer no to being "pro-life" because I assumed, correctly, that the opposite answer would register me as being anti-abortion.

However, believing that abortion should be legal does not make someone "anti-life" or "pro-death." I would like to know who polled me in this very biased manner. If this poll was not conducted by Pew or Gallup, it would be nice to know who is trying to confuse the issue.

 

I suggest the press delve a little more deeply into this issue." -- Deanna Nelson, Seattle

 

Much of the problem can be boiled down to what Ms. Nelson says in her letter.

Doesn't a complex issue like abortion deserve more than black and white thinking and a narrowly interpreted poll?

Budget cuts to state dental care programs proposed by Minnesota Gov. Tim Pawlenty will be a costly shift that will end up costing state taxpayers more, say inflamed Minnesota dentists.

The governor has proposed eliminating dental care for adults receiving General Assistance, Medical Assistance, MinnesotaCare, and the Critical Access Provider Payment Program, and replacing it with an ER care program on Jan. 1, 2010.

(That's right. Take your toothache or broken tooth to the emergency room. They have to take you.)

"Non-pregnant adults would continue to receive emergency dental care through hospital emergency departments for emergencies such as severe pain, trauma or infections," states the governor's budget proposal on page 102.

There's just one problem.

Hospital emergency rooms aren't set up as dentist's offices. They can supply patients with pain medications for tooth aches and antibiotics for dental infections but they don't extract teeth. "They can't actually perform dental procedures so there will be repeated visits," says Tom Day, director of legislative affairs for the Minnesota Dental Association (MDA).

"It's a short-term cut to make the budget work but it will significantly increase visits to the ER," Day said. "We are absolutely opposed to the cuts."

About 20,000 uninsured people visited emergency rooms for dental care in 2008, according to the MDA. About 7,400 of those dental-related ER visits were to Hennepin County Medical Center and at $450 to $550 per visit, cost the state millions of dollars in medical billings, according to Dr. Anthony DiAngelis, chief of dentistry at HCMC and a professor at the University of Minnesota School of Dentistry.

More on the national trends in dental care and ER visits:

A Healthy Blog: http://blog.hcfama.org/?p=2742 
theagle.com: http://tinyurl.com/dj4wzn
University of Mich. Health System: http://www.newswise.com/articles/view/548867/
Oregnlive.om http://tinyurl.com/dkqxd5

I'm sure this is welcome news to ER staff around the country.  Maybe they need to organize and say "enough."