Fewer Pap Smears Recommended

I offer this up as part of an emerging trend in the prevention world. It seems that there is a dawning realization that more treatment, more intervention, does not always lead to better outcomes. It might shock many patients to realize that, for example, HPV (human papilloma virus) is eliminated in most cases by the patient's own immune system and won't cause any problems. Just as some breast cancers are small and will go away and the treatment might be worse than any outcome of letting the cancers be. This is a "hard sell" after so many years of admonishing people to get screened for all sorts of conditions. More on my practice, here.

March 14, 2012, 5:58 pm
New Guidelines Advise Less Frequent Pap Smears
By TARA PARKER-POPE

The annual Pap smear, a cornerstone of women’s health for at least 60 years, is now officially a thing of the past, as new national guidelines recommend cervical cancer screening no more often than every three years.

In recent years, some doctors and medical groups, including the American College of Obstetricians and Gynecologists in 2009, began urging less frequent screening for cervical cancer. Even so, annual Pap smear testing is still common because many women are reluctant to give up frequent screening for cervical cancer...

“We achieve essentially the same effectiveness in the reduction of cancer deaths, but we reduce potential harm of false positive tests,” said Dr. Wanda Nicholson, a task force member and an associate professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill. “It’s a win-win for women.”

Cost is not a factor in the task force recommendations. Instead, its members focus on the effectiveness of a screening test to reduce cancer deaths, balanced against the potential harms that accompany the screening. The worry about frequent Pap smear screening is that tests can result in a large number of false positives that lead to sometimes painful biopsies and put women at risk for pregnancy complications in the future, like preterm labor and low-birth-weight infants...

Finally, the group also recommends against regular HPV screening for anyone under 30. In 2003, the task force said it did not have enough evidence to make a recommendation about HPV testing. It now says the test is unnecessary because many women exposed to the virus will eventually eliminate the virus without any intervention.

“HPV in women under 30 is highly prevalent but also highly transient,” Dr. Nicholson said. “Women under 30 may get infected with HPV, but they have a high likelihood of clearing that infection on their own, and it not causing any long-term change to their cervical tissue.”

Getting Rid of Mercury, Good News for Once

Tremendous health news. EPA will regulate mercury from coal plants. This is to be filed in the "First Do No Harm" file, but is a tremendous victory for regulation and standing up to moneyed interests. I will link you to Paul Krugmans' blog post on the subject. But I especially like that he says "This is actually a much bigger issue, when it comes to saving American lives, than terrorism." I always look at the numbers and there are a lot preventable causes of death and disability that are more dangerous than terrorism, yet it is terrorism that gets all the attention, and, of course, money. No money in prevention, lets face it. I've cut down the post, so feel free to link to the full one.

The Meaning of Mercury

Let me repeat part of that: it will save tens of thousands of lives every year and prevent birth defects, learning disabilities, and respiratory diseases. This is actually a much bigger issue, when it comes to saving American lives, than terrorism.

As Roberts explains, we’ve known about these costs of mercury pollution for decades, yet it took until now to get something done. The reason is, of course, obvious: special interests, hiding behind claims of immense economic damage if anything was done, were able to block action.

It’s worth noting that these claims of economic harm from pollution regulation have always been proved wrong when the regulation finally came. Ozone regulation was supposed to cripple the economy; so was acid rain regulation; neither did.

Oh, and if we’re going to have to scrap some power plants and replace them, it’s hard to think of a better time to do it than now, when the workers and resources needed to do the replacing would largely have been unemployed otherwise...

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Private Hospitals Encourage ER use, Medicaids seeks to decrease usage

In a bygone era in China, a physician was only paid if he kept his patients healthy. If they fell sick, he would not be paid. This is still the ethos in Chinese Medicine, and, of course, we don't live in anything resembling that world anymore, nor should we. But I bring up that framing of "health care" as a gentle reminder of how far from ideal our for profit system has become. If a fraction of the money spent on procedures, hospitalizations, and ER visits were spent on clinic visits, home visits or even providing decent food our outcomes would be so much better. This story just underlines the difference in the two systems, where Medicaid tries to keep costs at a minimum, yet can barely pay for clinic visits due to the reimbursement structures, where for profit hospitals see huge mark ups on ER visits. You have to wait for an advertisement to read the story. Excerpts below.

Hospitals seek more ER patients even as Medicaid tries to lessen demand
By Phil Galewitz, Published: August 22

Complaining of abdominal discomfort and chronic bronchitis, 22-year-old Toshia Johnson, an unemployed mother on Medicaid, went to a hospital emergency room in Bend, Ore., more than two dozen times in the year that ended in June 2010. She was never admitted to the hospital and used the ER for routine care because, she says, it’s near her home and the care was free.

But in the first six months of this year, after entering a state-funded program designed to reduce unnecessary ER use by Medicaid patients in central Oregon, Johnson has gone to the ER just once, after breaking her tailbone. In the first half of this this year, ER visits by the 400 patients in this program have declined by more than half from the same period last year, saving Medicaid $1 million, officials say.

Efforts to reduce unnecessary ER visits by patients in Medicaid, the joint state-federal health program for the poor and disabled, are proliferating as states search for ways to control the soaring costs of the program. But state officials complain that their efforts are sometimes hampered by hospitals’ aggressive marketing of ERs to increase admissions and profits.

“Many hospitals are actively recruiting people to come to the ER for non-emergency reasons,” said Anthony Keck, South Carolina’s Medicaid director, citing facilities that tout their speedy ER service on highway billboards. “When you are advertising on billboards that your ER wait time is three minutes, you are not advertising to stroke and heart attack victims,” he said.

ER visits totaled 124 million in 2008, an increase of about 31 percent since 1997, according to the Centers for Disease Control and Prevention. The average wait time for treatment is 33 minutes, up from 22 minutes.

...
Dallas-based Tenet Healthcare Corp., a large hospital chain some of whose facilities have seen a surge of patients using the ER for primary care, recently began accepting online appointments to make it easier for patients to use the ER. It’s also promoting average waiting times on the Internet and on billboards. Spokeswoman Carol Britton says that there hasn’t been a “significant increase” in ER visits by Medicaid patients as a result of the promotion.

Medicaid officials in Washington state were so concerned by hospitals’ ER marketing that they issued new rules making it harder for hospitals to qualify for Medicaid bonus payments if they promote their ER for primary care. “They sure don’t help us when we are trying to get word out that the ER is not the place you go for primary-care diseases like treating asthma or diabetes,” said Jeffrey Thompson, chief medical officer for the state Medicaid program.

Sicker than most

States are focusing on Medicaid recipients in part because these patients use ERs three times as much as people with private insurance and twice as much as people with no health insurance, according to federal researchers...

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