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Don't Be Fooled by Phoney Town Hall Unrest on Health Care Reform

David Mittleman — Wed, 05 Aug 2009 16:14:00 GMT

Yesterday I blogged about a new tactic that a plastic surgery firm was using to entice consumers to try their facelift procedure: by having their own employees post positive internet reviews of the plastic surgery procedure, Lifestyle Lift hoped to get more customers. That technique, aptly named “Astroturf marketing”, has now spread into the healthcare reform debate, too. “Grassroots” protestors, led by the conservative website FreedomWorks, have cropped up at town hall meetings on reforming the health care system. The only problem is, the “grassroots” protestors aren’t really homegrown at all—instead they are “Astroturf” protestors led by conservative lobbying groups.

The main orchestrator of these “grassroots” protests is FreedomWorks, which is run by former Republican Majority Leader, Dick Armey, who is known on The Hill as one of the top ranked ‘hired guns’. In other words, he is a corporate lobbyist with a history of directing FreedomWorks to support the goals of his lobbying clients. In fact, he has a long history of supporting the following industries (some of which have a vested interest in keeping health care reform off of the table):

Armey’s FreedomWork’s is actively organizing against health care reform because his lobbying firm represents pharmaceutical companies, such as Bristol-Myers Squibb, that oppose the comparative effectiveness research of the health reform plan because it may cut into their revenue for name-brand drugs.
Armey’s lobbying firm also represents the trade group for the life insurance industry: FreedomWorks mobilizes its members for deregulated life insurance reform.
FreedomWorks is currently lobbying for maintaining the U.S. reliance on fossil fuels on behalf of the domestic oil companies and on behalf of the Prime Minister of the United Arab Emirates, Sheik Mohammed Bin Rashid Al Maktoum.

Last year, the Wall Street Journal exposed FreedomWorks for building ‘amateur-looking’ websites to promote the lobbying interests of Armey. It appears as if Armey doesn’t really care, though. Indeed, other lobbyist-run groups such as Americans for Prosperity, run by a former associate of Jack Abramoff, are joining forces with Armey to orchestrate the tea party protests. In fact, these lobbying websites are instructing members to infiltrate town halls and harass Democratic members of Congress. Although some news coverage has depicted these “grassroots” movements as real, it is yet again, another familiar Republican attempt to look like a party who actually cares about the average American family. Don’t be fooled.

Originally posted at InjuryBoard by David Mittleman

"Watch and Wait" Approach to Low-Risk Prostate Cancer is as Effective as Aggressive Treatments

David Mittleman — Tue, 08 Sep 2009 12:03:36 GMT

When most doctors discover a cancerous lump of some sort, they usually suggest an aggressive treatment to rid the patient of the tumor as quickly as possible. Usually an “aggressive treatment” means a removal of the cancerous growth and sometimes radiation therapy if the tumor is especially dangerous. The theory behind the more proactive approaches of removal and radiation therapy is that cancerous tumors grow quickly and can eventually kill a person if left untreated. However, new research on prostate cancer seems to suggest otherwise—at least for lower-risk tumors.

According to a recent study by Dr. Martin Sanda, director of the Prostate Cancer Center at Beth Israel Deaconess Medical Center, in men with low-risk types of tumors there was no significant difference between those who sought immediate treatment versus those who opted for the “watchful waiting” approach. Specifically, Sanda and his colleagues looked at 51,000 men nationwide diagnosed with prostate cancer. Over a 15-20 year time period, the researchers found that about 10% of the men chose the “watchful wait” approach, or delaying any treatment for at least a year or more. At 10-15 years later, the men who chose this approach still required no treatment, revealing the fact that some tumors don’t require immediate treatment because they are of a slower-growing variety.

For years, doctors have relied on a test called the PSA blood test that indicates whether a male patient has prostate cancer. Primarily, all men over 50 are instructed to have a prostate exam and the PSA blood test. However, Dr. Sanda believes that the test is a “double-edged sword”: while the test can catch serious tumors in a few, it can also cause needless worry and expense for the majority of men with tumors that grow too slowly to cause any real harm. Furthermore, according to Dr. H. Gilbert Welch of the VA Outcomes Group, an estimated 1.3 million additional men have been diagnosed with prostate cancer since the PSA test was first introduced in 1986. Of those 1.3 million, 1 million underwent surgery and other aggressive treatments. Granted, prostate cancer deaths have decreased since the introduction of PSA testing, however, Welch states that about 20 men had to be diagnosed and unnecessarily treated for every one man who actually benefited from an aggressive treatment approach.

Aggressive treatments include surgery, radiation, and/or hormone therapy and can result in impotence and incontinence in about a third of patients. Moreover, simply telling a patient that they have cancer can do harm—resulting in anxiety and feelings of vulnerability. Worst of all, having a cancer diagnosis can mean some men can’t get health insurance coverage. Currently, I have the “low-risk” cancer and have surgery scheduled in a month. But, after reading the results of this study, I am now seriously considering the “watchful waiting” approach.

Originally posted at InjuryBoard by David Mittleman

Women are second class citizens in Bart Stupak's America

Devon Glass — Sun, 08 Nov 2009 09:24:45 GMT

History was made last night as the House of Representatives passed a health care reform bill, and now it's up to the Senate to pass one as well. The bill passed does have a public option and will help control health care expenses in the coming decades. This bill was not passed without significant compromise, but one of the compromises made me really angry.

Representative Bart Stupak, who is from Michigan, decided his vote was contingent on being able to offer an amendment to the health care reform bill to prevent any federal money used in the new health care exchange from paying for abortion services. Nevermind that abortion is one of the most common surgical procedures performed in the United States. Nevermind that abortion is legal, and has been, for more than 30 years in the United States. Nevermind that access to abortion services is supported by the majority of Americans. To Bart Stupak, all of this is meaningless because he does not support abortion and since he gets to vote on this health care bill and you don't, his opinion matters more than yours. The price for Bart Stupak's support for health care reform is simple, sacrificing women's rights.

I find it interesting that, as a man, Bart Stupak gets to decide what medical services should be afforded to woman in this country. Rep. Stupak will never personally need to have an abortion, so I guess from his perspective it's okay to limit peoples access to abortion services. The effect of his amendment will not outlaw abortion, but it will make it tougher for people who need an abortion to pay for it. Since the new health care exchange won't be permitted to provide coverage for abortion services with federal money, anyone who gets insurance through the new health care exchange will need to pay out of pocket for an abortion or additional insurance to cover abortion services. I don't know about you, but my understanding is that most woman don't plan on having abortions so it's going to be difficult to convince them to pay extra for a service they don't believe they will need in the future.

To add insult to injury, the woman who are purchasing insurance on the new health care exchange are likely receiving assistance to pay for the insurance. This means it's unlikely they can afford to purchase additional insurance to cover abortion services. In effect, this will make abortion services something that only rich women can afford, creating a tiered health care system for women. Is that what we want when we are working to expand health care to cover most, if not all, of Americans?

I can only speculate what goes through Bart Stupak's mind when deciding to expand health care but limit health care options for women. This reminds me of the discussion between Sen. Debbie Stabenow and Sen. Jon Kyl about providing maternity care, which I've provided below. The thing is, there are lots of services that I don't use when I have health insurance, but we all pay because we don't know when we may need those services in the future. I may not need dialysis coverage now, but if I go into renal failure in the future I'm going to be glad I have it. The money I spend to pay for health insurance covers everyone who has health insurance and it should not be up to me or Bart Stupak or anyone else what services someone else gets to receive. It should be a decision made by the patient and their doctor. End of story.

Abortion may be something that people feel icky about, but it's a legal medical procedure that more than 1 million women utilize every year. It should not be a political bargaining chip to convince someone to support health care reform. I think we should look at passing an amendment that erectile dysfunction treatment should not be covered by any insurance offered on the new health care exchange. The reasoning is simple, if old men didn't get boners they would not impregnant the women they are having sex with, therefore no abortion needed. However, I don't think you would get much support for such an amendment because it discriminates against men, but I don't see the difference between not providing coverage for abortion and not providing coverage for erectile dysfunction. Maybe Bart Stupak can explain the difference if you call his office and ask him really nice, he can be reached at (202) 225 4735.

http://www.youtube.com/watch?v=3Jj6pqajvB8

Originally posted at InjuryBoard by Devon Glass

Top Ten Secrets Your Dentist Doesn't Want You to Know

David Mittleman — Sat, 29 Aug 2009 11:43:16 GMT

Many of us fear going to the dentist—the drills and consequential pain that we may experience after the appointment can make any of us quake at the thought of a dental visit. However, it is important to have regular checkups and cleaning. In fact, according to the American Academy of Periodontology, a preventative checkup could save your life. For example, periodontal disease, a chronic inflammation of the gums, has been linked to other serious health risks such as diabetes, cardiovascular disease and even Alzheimer’s disease.

That being said, many people know very little about their dentist. Just as it is important to have regular dental checkups, it is just as important to have a well-qualified and well-equipped dentist to provide first-class dental care. Currently there are 165,000 dentists nationwide and according to the U.S. Bureau of Labor Statistics, the yearly earning of dentists averaged around $147,010 in 2007. Obviously, this country spends a great deal on dental care. But how much do you actually know about your dentist? Here are the top 10 secrets that your dentist doesn’t want you to know:

#1: Your dentist isn’t as educated as you think—dentistry has changed a lot since your dentist graduated from dental school. It is almost vital that a dentist have 100 hours or more of updated dental education EACH YEAR. Dental techniques and advances in materials used in fillings, bonding and root canals are just a few areas in the dental world that are said to change at an “almost daily” rate.

#2: Your dentist doesn’t have the latest technology—digital x-ray and ultrasonic cleaning are just two of the most important and advanced technological creations of today. It would cost your dentist about $2000 to update their equipment to provide you with the best possible care. There is not excuse not to have the latest technology.

#3: Your dentist may be using mercury—simply said, mercury is toxic. However, some dentist still put it in the mouths of their patients. In fact, the American Dental Association and the FDA have no problem with mercury fillings. Scary? Make sure to ask what’s being put in your mouth.

#4: The lab may be more important than your dentist—dental labs create crowns, bridges, orthodontic appliances and dentures. Unfortunately, to cut costs and increase profits, some dentists use foreign labs or cut-rate domestics labs that may use tin, aluminum or even lead to create your mouthpieces. Be particularly wary if your dentist uses a lab in China or Mexico, where the practice of using these cheap metals is very common.

#5: There’s more to good dentistry than just filling cavities—a good dentist checks for more than just tooth decay. A good dentist should also be concerned with sleep apnea, TMJ (jaw-related pain from grinding), periodontal disease, oral cancer, diabetes and hypertension.

#6: You are probably using the wrong specialist for dental implants—periodontists are usually the best option for replacement of your original tooth with an artificial implant. Many people assume an oral surgeon is best qualified to perform these types of procedures. This is usually an incorrect assumption.

#7 Bad dental advice about dentures can be fatal—dentures need to be replaced at least once every seven years. Poor fit or worn out dentures can cause sleep apnea, stroke, or even death.

#8: Your dentist may not know enough about sleep apnea—sleep apnea literally means that a person stops breathing during the night, sometimes several times. It is a blockage of the airway during sleep that can be treated with Continuous Positive Airway Pressure (CPAP). CPAP involves blowing pressurized room air through the airway at high enough pressure to keep the airway open. Your dentist should know about the latest techniques to treat sleep apnea.

#9: Not all cosmetic dentists have the skills to improve your smile—has your cosmetic dentist had post-graduate training? What kind of veneers do they use? Have them show you proof of their work! A cosmetic dentist should be able to show you at least 10 photographs of “before” and “after”.

#10: You may not need that root canal, even though your dentist suggests it—dentists receive kickbacks when they refer you to an endodontist, who will most likely perform a root canal. Why? Because it’s an expensive (and sometimes) unnecessary procedure! Sometimes an extraction and an implant is a better option.

Please keep up your bi-annual cleanings and check-ups. But be prepared with the right questions to ask your dentist to protect yourself and to receive the best possible dental care.

Originally posted at InjuryBoard by David Mittleman

Malpractice Damage Caps: Adding Insult to Injury

David Mittleman — Mon, 18 Aug 2008 10:14:47 GMT

No matter how much education or training a doctor has, he or she is still a human being. As all of us know, humans make mistakes. Although some degree of error is essentially inevitable in any profession, the magnitude of harm that results from medical malpractice is perhaps unsurpassed. The victims’ betrayed trust and damaged bodily integrity are personal violations of the highest order. As a society, we expect that doctors who make mistakes should be held accountable for their conduct. Unbeknownst to most patients, however, is the fact that many states limit the amount of compensation they can receive if their doctor commits malpractice.

Medical malpractice damage caps, as they are called, are laws that protect insurance companies by ensuring that victims do not receive more than a certain amount of money for their pain and suffering, even if a jury awards them a larger sum. In Michigan malpractice cases, the limit on non-economic damages is $280,000 (adjusted yearly for inflation) in most instances and $500,000 (also adjusted for inflation) under certain, well-defined exceptions. This provision means that no matter how much pain a victim experiences or how drastically his or her life changes as a result of a doctor’s malpractice, he or she cannot receive more than the statutory limit. There can be no doubt that the Legislature adopted this measure to protect insurance companies at the expense of individual victims.

Proponents of malpractice damage caps argue that these laws keep the cost of health care down. This assertion has no basis in fact. Damage awards comprise such a small percentage of the overall cost of health care that imposing limits has a negligible effect on cost. One article in the New England Journal of Medicine attributes the bulk of rising health care costs to advances in, and overuse of, new medical technology. As the author notes, our current President favors a cap on non-economic damages. A more effective approach, according to the article, would be to ensure that a larger percentage of malpractice liability premiums are directed toward compensating injured patients.

Malpractice victims should be compensated in an amount proportional to their injuries. These patients deserve to have a jury decide what that amount is, not a decades-old law passed by a Legislature that put insurance companies before people.

Originally posted at InjuryBoard by David Mittleman

Don't take the bait on drug labeling preemption

David Mittleman — Wed, 04 Feb 2009 09:40:00 GMT

An editorial in last Thursday’s Detroit Free Press by Sally C. Pipes had me scratching my head over the ramifications of an upcoming United States Supreme Court decision in Wyatt v Levine. Ms. Pipes, who is president and CEO of the Pacific Research Institute (which is partially funded by the pharmaceutical industry) in San Francisco was concerned that a lack of federal preemption would cripple drug companies from an onslaught of frivolous lawsuits (Wyatt, in case you were wondering, was so frivolous the plaintiff only had her forearm amputated). What really doesn’t make sense in Ms. Pipes’s argument is this:

"Michigan state law, which currently limits such lawsuits against pharmaceutical firms whose products have FDA approval, would be invalidated if the court rules against preemption."

That’s just wrong. In fact, it is the total opposite of what would happen if the court rules against preemption. If a body of state law is NOT preempted, states are free to regulate as they see fit. Michigan could still easily use FDA approval as a standard to bar lawsuits. It is only when federal preemption DOES apply that you have to figure out the ramifications of preemption on state law. First, if state law directly conflicts with federal law that says it preempts state law, then federal law trumps. Second, if state law were to frustrate the purpose of federal law, be in conflict with the state law such that you could not follow both at the same time, or overtook a field of state law, then federal law would trump again. So assuming that there is federal preemption (and nobody would love this more than big business) a state law that basically says "you can’t sue this company if they followed the federal rules for getting their drug approved" does nothing to frustrate the purpose of the federal law. Either way, Michigan can continue to use the FDA approval process (and the federal law concerning how a drug is approved for sale in the marketplace) as its standard for when you can sue a drug company when its drug just happens to make you lose your arm (let’s hope Ms. Levine was a lefty).

Here’s the dirty secret, though. Ms. Pipes and her followers at the PRI probably don’t care about consumer safety, what they care about is getting large pharmaceutical companies to walk away free and clear from liability. Fortunately, it doesn’t look like that will happen. The conservatives on the Court are usually pretty tough on plaintiffs, but even Samuel Alito had this to say: "how could the FDA conclude that [this] was safe and effective when on the benefits side you don’t have a life-saving drug, you have a drug that relieves nausea, and on the risk side you have the risk of gangrene?" Good question, maybe it’s because the FDA has been horribly underfunded to the point that key FDA career officials have warned against preemption because, frankly, the FDA stopped being an effective protector of consumer safety under the Bush Administration. Moreover, another Republican appointed justice, Anthony Kennedy, put in his two cents: "You argue that it’s impossible for Wyeth to comply with the State law and at the same time with federal label. As a textual matter, as a logical matter, I just - I just don’t understand that."

Congressman Henry Waxman has committed to changing the federal law that governs the FDA if the Supreme Court rules in favor of preemption. While that would be good news for this issue, should the Court make that mistake, it would signal a long winter for consumer safety down the road.

The reason big business is waiting to hear the outcome on this is because unlike the federal law governing medical devices that expressly says it preempts state law, the federal law that governs the drug approval process has no express preemption language (especially not with respect to your ability to sue in state court for distributing what is later discovered to be an unsafe drug). There are hundreds of other situations where federal law regulates some aspect of consumer activity, but is silent as to federal preemption. If the Supreme Court finds preemption in Wyeth it sets a dangerous precedent for future defendants to say, "wait, your state law claim has been preempted by some totally irrelevant federal law on getting my product/service approved/licensed!" What next, you can’t go after accountants that embezzled your retirement savings because he passed a licensing exam? You can’t sue the drunk driver because he got a federal Real ID driver’s license? You can’t get your money back from a crooked home developer because it was through a federal first time homeowner program? Maybe it’s time big business check themselves into rehab, so the rest of us can breathe easy for a change.

Originally posted at InjuryBoard by David Mittleman

Why Speeders on the Highway Cause More Serious Accidents

Devon Glass — Fri, 28 Aug 2009 11:52:41 GMT

So it goes that we have a third party to add to our blog series. I think I speak for both Steve Lombardi at the Lombardi Law Firm, and myself at the Church Wyble, P.C. law firm, when I extend a hearty welcome to Wayne Parsons from the Wayne Parsons Law Offices in beautiful Honolulu, Hawaii.

Yesterday, both Wayne and Steve wrote about the dangers of speeding on interstate highways. No matter the state, whether that state is Michigan, Iowa or Hawaii, speeding drivers cause a huge danger to others. As Wayne so aptly stated, people love to speed on the Interstate Highway System, going as fast as they can and getting upset with those who choose to follow posted speed limits.

Steve mentioned that when he first learned how to drive, he was instructed that for every ten miles an hour, you need at least one car length to safely stop without rear ending the driver in front of you. Additionally, as Steve pointed out, drivers are more distracted than what they were even 10 to 15 years ago. With the advent of texting, drivers cannot possibly be as focused, and therefore as safe, as they were before texting existed. In fact, driving while texting increases the risk of collision by 23 times compared to when a driver is completely focused on the road. I cannot begin to imagine what the increased speeds of the interstate highway contribute to those omnipresent dangers.

Speed limits on the interstate vary to upper and lower extremes across the country. Michigan and Iowa represent the higher extremes of 70 mph, while Hawaii tends toward the lower at 60 mph. I’m not sure if these are still accurate for Iowa and Hawaii, so perhaps Wayne and Steve can correct me if I’m wrong. Nevertheless, the Insurance Institute for Highway Safety argues that some of these new, higher speed limits in the Midwest and elsewhere are costing lives. In fact, it estimates that deaths on highways and the interstate freeways have increased 15% due to the higher speed limits. Some researchers, such as those in the AOL article link I provided, will argue that speed actually decreases the number of accidents. However, these aren’t the pure facts. While higher speeds may keep some slower drivers off of the interstate, it boils down to the truth of the matter that higher speeds cause more serious injuries, including death. Indeed, speed influences the risk of crashes and crash injuries in three basic ways:

· It increases the distance a vehicle travels from the time a driver detects an emergency to the time a driver reacts.

· It increases the distance needed to stop a vehicle once an emergency is perceived.

· It increases the “crash energy” by the square of speeds—when an impact speed increases from 40 to 60 mph, the energy that needs to be managed increases by 125%. In other words, the crash impact is going to be astronomically greater than if you were going at a slower speed.

Anyway, enough about physics. The point is speed does kill. It may be faster (and more fun) to speed, but it just isn’t safe. Slow down and follow the posted speed limits.

Here's a video on the impact of speed. Albeit a video created in the UK, but speed doesn't discriminate who it will kill by country of origin.

http://www.youtube.com/watch?v=77MoOl5o5aM

If you just joined our series, here’s a recap of what you’ve missed:

Are Double-Bottomed Semis More or Less Dangerous to You?

Who wins and loses when a Ford Focus and a fully-loaded semi-truck crash?

Hawaii Freeway Chronicles #1: What Are The Danger Points On H-1, H-2 and H-3?

The Interstate Highway Graveyard, “Speed Kills”

Originally posted at InjuryBoard by Devon Glass

CDC Considering Mandatory Circumcision for Baby Boys to Stop Spread of HIV

David Mittleman — Sun, 30 Aug 2009 11:42:38 GMT

The Centers for Disease Control are currently considering making routine circumcision mandatory for baby boys born in the United States. Circumcision is considered a method of reducing the spread of the HIV virus.

The recommendations are extremely controversial, however, recent research shows that circumcised men in African countries that are severely affected by AIDS, had half the rate of infection when compared to uncircumcised men. Critics of mandatory circumcision argue that mandatory circumcision places infants in a position where they are forced to undergo a medically unnecessary surgery without being able to give their consent. Nevertheless, CDC experts continue to argue for all infants to receive the procedure. Specifically, they maintain that any method to prevent the spread of HIV is a step in the right direction.

It is difficult to say how much mandatory circumcision would affect the rate of HIV infections, as many men in the U.S. are already circumcised. In fact, 79% of adult males are circumcised in this country. Additionally, little evidence exists to suggest that mandatory circumcision would dramatically reduce the number of homosexual men affected by HIV.

Originally posted at InjuryBoard by David Mittleman

Negligent Circumcision and Failure to Respond lead to $2.3 Million Dollar Jury Verdict

David Mittleman — Fri, 03 Apr 2009 08:54:41 GMT

A jury in Georgia awarded $1.8 million in damages to a boy (and $500,000 to his mother) who will live the rest of his life with a severed penis. At the time of his birth, the attending physician removed too much tissue while performing a circumcision. A nurse attempted to contact the child’s pediatrician, but the pediatrician failed to respond and go to the hospital.

The boy’s penis could have been re-attached, had a urologist attended to the boy within 8 hours of the medical malpractice. However, the severed tip of the penis remained in a biohazard bag even after the nurse detected the excessive bleeding.

The jury did not award any punitive damages in favor of the boy and his mother, but rather compensated them for the cost of medical treatments and psychiatric counseling that the boy and family will require throughout his life.

Originally posted at InjuryBoard by David Mittleman

Red, Red Wine Or Resveratrol

David Mittleman — Tue, 27 Jan 2009 09:32:00 GMT

According to a recent CBS, 60 Minutes episode, a red wine resveratrol pill is coming to the market as an anti-aging pill. Resveratrol is a component found in red wine and is said to be a molecular mimic of a calorie restricted diet; a plan that has been shown to almost double the life span of all forms of life when caloric intake is cut in half. Giant Pharmaceutical Company, GlaxoSmithKline is wagering almost a billion dollars that a small start-up company developing a potent synthetic version of resveratrol will work.

In the mean-time Newsweek recently reported 4 more reasons to drink red wine (in moderation):

It can keep you fit;
It may help fight Alzheimer’s;
It boosts heart healthy Omega 3 levels;
It may lower lung cancer risk.

Please remember when it comes to any alcoholic intake–you must act responsibly. Too much of a good thing can be bad.

Originally posted at InjuryBoard by David Mittleman