What we're learning about Obamacare

“We have to pass the bill so that you can find out what is in it.”

-- Nancy Pelosi

What we're finding out:

"Why don't you just bend over."

Take a rain check: Get ready for healthcare gridlock. Once the new healthcare law fully takes effect, all Americans will be entitled to a long list of preventive services with no out-of-pocket costs, but the healthcare system won’t have enough doctors to provide them. The shortage will create longer waiting periods that some patients will be able to cope with better than others. Lower income patients will be worse off, according to the Independent Institute.

Someone always gets rich. It turns out that Obamacare is going to be a very lucrative gig for a new crop of government bureaucrats. A subcommittee of the board charged with establishing a healthcare exchange is considering creating 24 positions and pay those employees a total of more than $3 million annually. The average annual salary of a health benefits exchange employee would exceed $125,000 under the plan. The highest salaries would be paid to the CEO ($200,400) and chiefs of finance, operations and communications would make $165,000 each.

Bad hospital, bad: A provision of ObamaCare is set to punish roughly two-thirds of U.S. hospitals evaluated by Medicare starting this fall over high readmission rates, according to an analysis by Kaiser Health News. Starting in October, Medicare will reduce reimbursements to hospitals with high 30-day readmission rates -- which refers to patients who return within a month -- by as much as 1 percent. The maximum penalty increases to 2 percent the following year and 3 percent in 2014.

This would be your death panel: Peter Orszag, the former White House budget director, derieds  the idea that better incentives can reduce costs. Mr. Orszag's alternative: the Independent Payment Advisory Board composed of 15 philosopher kings who will rule over U.S. health care. Who are these Orszag 15? Well, nobody knows. The board was supposed to be up and running by the end of September, but the White House is avoiding naming names for Senate confirmation until after the election. No one knows, either, what this group of geniuses will propose, but that too is part of the grand Orszag plan.

How it works in Canada: There are two tiers of men with advanced prostate cancer in Ontario: Those who get access to a remarkable drug through private insurance, and those who get a death sentence. The grim news is often delivered at the London Regional Cancer Program to men whose shoulders sag and jaws drop when told Ontario's Health Ministry has for 15 months refused to pay for a medication covered by every other Canadian province.

Alive but dumb: Parents and students facing sky-high state-run college tuitions aren't likely to be thinking about ObamaCare. But perhaps they should, since  ObamaCare will likely end up making college still more expensive. Why? Because ObamaCare relies heavily on Medicaid — the federal/state program that provides health insurance for the poor — to expand coverage. But Medicaid is already swallowing up state budgets, forcing states to cut back on everything else, especially support for public colleges.

Miracles and wonders: lab in a shoebox

Checking to see if she has a brain.

A scientific instrument featured on CSI and CSI: Miami for instant fingerprint analysis is forging another life in real-world medicine, helping during brain surgery and ensuring that cancer patients get effective doses of chemotherapy.

The instrument, called a "desorption electrospray ionization" mass spectrometer, or DESI, is about the size of a shoebox. Students have  carried it into a grocery store and held it close to fruits and vegetables to detect pesticides and microorganisms. 

It has also been used to identify biomarkers for prostate cancer and to detect melamine, a potentially toxic substance that showed up in infant formulas in China in 2008. In addition, DESI can detect explosives on luggage.

Now scientists want to  test the instrument in the operating room during brain cancer surgery, comparing it with traditional analysis of tissue samples by pathologists.

DESI can analyze tissue samples and help determine the type of brain cancer, the stage and the concentration of tumor cells. It also can help surgeons identify the margins of the tumor to assure that they remove as much of the tumor as possible.

 Innovations in medicine like this are happening all the time, and we are hardly aware of them.

If your'e a chicken, don't smoke

Smoked fish.

If you were annoyed to learn recently that eggs are once again bad for you, relax.

A study looked at patients with an average age of 62, some of whom really loved eggs and some of whom really loved cigarettes. Researcher David Spence then measured the amount of plaque in their arteries.

The results? Both smoking and eating eggs were independently associated with plaque increases, and eggs were almost as bad as cigarettes. “The effect size of egg yolks appears to be approximately 2/3 that of smoking,” Spence wrote. “Probably egg yolks should be avoided by persons at risk of vascular disease.” 

The problem is that the conclusion is based on self-reported lifetime history of smoking and egg-eating  -- and only smoking and egg-eating.

While it’s entirely possible that people who ate a bunch of eggs filled the rest of their diets with kale and dust and steel-cut oats, it’s just as possible they were eating those eggs alongside bacon and sausage and Hollandaise sauce. In other words: Maybe eggs aren’t solely to blame here.

In fact, we have no way of telling, based on this study, what role eggs specifically played in the development of these arterial plaques.

Antonis Zampelos, a nutrition professor, told Canada’s CBC News that these results lack validity. “The results are not as strong as the statement that came out … I’m not saying that this is not an interesting study. I’m saying that you can’t really make such a strong statement about smoking.”

“This is very poor quality research that should not influence patient’s dietary choices,” Steven Nissen, chair of the department of Cardiovascular Medicine at the Cleveland Clinic Foundation, told ABC News. “It is extremely important to understand the differences between ‘association’ and ‘causation’.”

So maybe you can take care of me

I've been doing some retirement planning this week, and I'm not too far away from signing up for Medicare. I sure hope they have some good-looking nurses.

It is discomforting to absorb the impressions in the media -- President Obama has cut $716 billion from the program; Republican Veep nominee wants to "end Medicare as we know it."

I'm less concerned with how my retirement portfolio is doing than where I'll get healthcare. (Note to financial advisor: ignore this.)

So which is which? You should care, too, because you don't want me knocking on your door in a few years and asking for help with a catheter.

(That is just disgusting. I can't believe you said that.)

It looks as though it's correct that Obama is cutting funds to Medicare to fund Obamacare. The Washington Post, which no one will accuse of having a Republican bias, confirms it. The article's headline: "Romney’s right: Obamacare cuts Medicare by $716 billion. Here’s how."

And it shows where the cuts will come from in this chart.

That's not encouraging. Moreover, a bureaucratic panel of 15 men and women will enforce a spending cap by decreeing how medicine should be practiced and how doctors and hospitals are organized. Did anybody say "Death Panel?" How about "Catheter Committee?"

So what do Romney and Ryan have in mind? I use as sources FactCheck.org and the Kaiser Family Foundation for this:

• For seniors who are now in Medicare, nothing changes. They can stay with the traditional program as it is.
• Beginning in 2023, 65-year-olds would have their choice of insurance plans — private and traditional — on a new Medicare exchange. A premium-support payment, like a subsidy, would be sent to the plan of their choice.
• If the chosen plan costs more than the premium-support, the senior would pay the difference.
• The Medicare eligibility age would be slowly raised to 67 by 2034.
• All plans on the Medicare exchange would offer a base level of benefits, and they would be regulated by the Centers for Medicare and Medicaid Services.
• The premium-support payments would be tied to the second-cheapest plan, which can’t grow more than gross domestic product plus 0.5 percentage points. If the cost does grow faster, Congress would be required to step in and take some action to keep costs down.

I know that if Medicare "as we know it" isn't changed, it's going to collapse on top of my head, pretty nurses and all.

I'll take my chances with Romney and Ryan.

Miracles and wonders: swallow this, touch that

Take two and call me in the morning.

I don't think we fully appreciate that we're in the midst of a revolution in medicine.

According to the mortality tables, there’s a two-thirds chance that a male who’s age 55 today will live to age 80. If you  plan on being among those who die before age 80, but don’t. Some saying that you should plan on living to age 105, or at least 30 years in retirement. One expert: a 65-year-old husband with a 60-year-old wife would require a 40-year planning horizon to be 90% confident of covering the last to die.

The US Food and Drug Administration has approved a grain-sized ingestible digital sensor that can be swallowed in a pill to track health data from inside the body. The idea is that the data can be used not only by patients themselves, but also by caregivers and doctors to individualize their care. The signal that it sends from the stomach travels through the patient's body to a patch worn on the skin. The patch contains technology that senses the signal and records the exact time the ingestible sensor was swallowed.

University of Florida researchers have moved a step closer to treating diseases on a cellular level by creating a tiny particle that can be programmed to shut down the genetic production line that cranks out disease-related proteins. By combining a protein enzyme and a DNA molecule on gold nanoparticles to mimic the gene regulatory mechanism called RNA interference, a “nanozyme” was able to destroy hepatitis C virus in human liver cells and in the livers of mice.

It is clear that all kinds of products and services  would be available online if we had the bandwidth. Programs that involve massive transfers of data or frequent two-way video communications would be two obvious examples. What’s interesting is how many of these new products and services involve healthcare: Jeff Pfaff of Overland Park, Kan., says he hopes to use the service to “push the limits” of a health-monitoring system he’s building. It would enable at-home patients to teleconference with doctors and family members via a camera hooked up to a TV set and a remote control.

European researchers say they have developed the world's first real-sized, five-fingered robotic hand able to grasp and manipulate objects with human-like dexterity. The team  built a hand using strings that are twisted by small, high-speed motors in five fingers, each with three segments. The device was able to handle a delicate Easter egg and lift a five kilogram load. Light sensors were attached to the hand, making it possible to calculate the force required for the fingers to grasp an object without squashing it or losing its grip.

The story of your health in a black box

Yikes! That hurts!

For years I thought that one answer to our broken healthcare system was electronic health records. I still think so, but with a lot of caveats.

The federal government is pushing hard for their adoption. Physicians, driven by the promise of better care, cost savings and nearly $23 billion in new federal incentive payments, are racing to turn their scribbled medical records into digital files, Smart Money reports.

Thirty-five percent of hospitals now use such systems, more than double the share two years ago, according to U.S. government figures. But for all the hype about electronic records, little attention has been paid to what some say is a serious weak spot: When those sensitive bits and bytes fall into the wrong hands, it's often patients who feel the pain.

Here's the trouble.

Since 2009, there have been more than 420 security breaches involving the records of some 19 million patients, according to the U.S. Department of Health and Human Services' Office for Civil Rights. And such breaches are on the rise. A December 2011 report by the Ponemon Institute, a security-research firm, found that the frequency of data losses and thefts among health care organizations increased 32 percent over the previous year.

This is one reason I'm a skeptic about a national healthcare system. Already too many computer systems are familiar with my body.

A doctor in your hand

Is there a doctor in the House?

Health-related apps for smart phones are coming of age. Here are some of the latest.

• One of the latest device-and-app creations to pass muster with the federal Food and Drug Administration is iBGStar, a blood glucose meter that attaches to iPhones or iPads for diabetes monitoring. It's a product of Bridgewater, N.J.-based Sanofi, and sells at Apple retail stores and Walgreens drugstores for about $100 and $75, respectively.

• Heart-EKG uses the iPhone's microphone or camera flash to calculate users' average number of heartbeats per minute or to take their pulse, after placing the phone over an artery, and activating the app. Dallas-based Surich Technologies says the app is handy for aerobic workouts, but isn't intended as a lifesaving monitoring device. It's downloadable from iTunes, for $2.99.

• The iHealth Wireless Blood Pressure Wrist Monitor, expected on the market in September, measures users' blood pressure directly from their iPhone, iPad or iPod Touch. Its app records systolic/diastolic numbers, heart rate and pulse wave, and can chart blood pressure readings, says Karyn Anderson, spokeswoman for Mountain View, Calif.-based iHealth Lab.

• AliveCor Heart Monitor has developed an electrode-studded cellphone case that turns the iPhone 4 into an electrocardiogram device that users hold in their hands or place on their chests to detect irregular heart rhythms. Combined with the app, the monitor can analyze, transmit and store an ECG reading for diagnosis. The heart monitor has been through several clinical trials, said physician David Albert, the device's inventor and co-founder of San Francisco-based AliveCor. He hopes to introduce it for veterinarians' use for dogs, cats and horses later this summer. The device doesn't yet have FDA approval.

• A cellphone-based E. coli sensor for water and other fluids is under development by a University of California-Los Angeles research team. Commercial manufacture of the system, which uses a lightweight attachment to the phone's camera, could be only two years away, said team leader Aydogan Ozcan, a UCLA associate professor for electrical engineering.

• San Francisco-based CellScope's otoscope attaches to the phone's camera lens and will enable parents to photograph their child's eardrum, and e-mail the images to medical professionals checking for an ear infection. CEO Erik Douglas says he hopes to get this to market in about a year.

You'll wanna stay awake for this

Good advice.

"If I told you that I had a neurological disease which meant that for eight or more hours a day I lost control of my faculties, bade farewell to the outside world, and was subject to complex hallucinations and delusions – such as being chased by a grizzly bear at Stockport Railway Station – you would think I was in a pretty bad way. If I also claimed that the condition was infectious, you would wish me luck in coping with such a terrible disease, and bid me a hasty farewell.

"The fact that we accept without surprise the need for a prolonged black-out as part of our daily life highlights our tendency to take for granted anything about our condition that is universal. We don’t see how strange sleep is because (nearly) everyone sleeps.

"Since all animals sleep, we assume it has a biological purpose. The trouble is, we don’t know what that purpose is. There are many theories – energy conservation, growth promotion, immobilisation during hours of darkness when it might be dangerous to be out and about, consolidation of memories – but they are all open to serious objections. William Dement, one of the leading researchers of the last century and co-discoverer of Rapid Eye Movement sleep, concluded from his fifty years in the forefront of the field that 'the only reason we need to sleep that is really, really solid, is that we get sleepy.'"

-- Raymond Tallis

Miracles and wonders: a new hand, zapping cancer

Tickling the ivories, digitally.

The real news in healthcare is coming out of the laboratories, not bureaucracies in Washington.

A research team from Georgia Tech has been working on a rehab glove that is already showing effectiveness for people with limited hand motor skills and proprioception due to spinal injury. The electronic Mobile Music Touch (MMT) glove works with a piano and vibrates individual fingers to point to which keys should be pressed. Using the MMT, people in the study practiced playing the piano for thirty minutes three times a week, and followed up with the glove but without the piano (air piano?), and saw considerable improvement at a time when traditional therapy is usually no longer effective.

Damaged and aged heart tissue of older heart failure patients was rejuvenated by stem cells modified by scientists. "Since patients with heart failure are normally elderly, their cardiac stem cells aren't very healthy," said Sadia Mohsin, Ph.D., one of the study authors and a post-doctoral research scholar at San Diego State University's Heart Institute in San Diego, Cal. "We modified these biopsied stem cells and made them healthier. It is like turning back the clock so these cells can thrive again."

Devising effective drugs is only half the battle faced by pharmaceutical companies. The other half is delivering them to the place in the body they are needed. Some researchers, therefore, are exploring an alternative: building tiny factories that make and release a drug precisely where it is needed. Among these investigators is Daniel Anderson, a chemical engineer at the Massachusetts Institute of Technology. And as he reports in Nano Letters, he and his colleagues have built a device which might do just that. Dr Anderson’s drugmaking machine is a simplified, artificial version of a living cell.

A new method of mapping people's DNA promises to make the procedure more accessible to patients and to help doctors zero in on gene mutations that may cause disease, according to a report Wednesday in the journal Nature. The latest advance in whole-genome sequencing requires only a small amount of DNA to produce a more complete picture of someone's genome, and to immediately determine whether a faulty gene is inherited from the mother, the father or both. That finding could be critical to interpreting results.

In a significant step forward for the development of a potential new cancer treatment, scientists have found how a common cold virus can kill tumors and trigger an immune response, like a vaccine, when injected into the blood stream. Researchers said that by hitching a ride on blood cells, the virus was protected from antibodies in the blood stream that might otherwise neutralize its cancer-fighting abilities. The findings suggest viral therapies like this, called reovirus, could be injected into the blood stream at routine outpatient appointments -- like standard chemotherapy -- making them potentially suitable for treating a range of cancers.