Black Americans and Healthcare

The USA Today recently reported on the difficulties faced by African-Americans seeking healthcare in Alabama.  Death rates are higher for most categories of illness in black communities.  Oftentimes, physicians are unfamiliar with the obstacles encountered by residents in a particular neighborhood, such as the lack of fresh, healthy food in the grocery stores.  USA Today touts a new federal Health and Human Services program as a first step in identifying health disparities.  Churches provide support groups that assist in educating people about their health.  However, there is little time or money being spent by the Christian community to build clinics in communities such as this one in Alabama.  An overall infrastructure for providing charitable ministries is missing.

In Texas, it is common for people to say that if a person wants to have good healthcare they need to pull themselves up by their bootstraps.  An African-American friend of mine at Trinity once told me in response, “The problem is, some people don’t have any straps.”

Is a CT Scan an Ethical Issue?

All third-year students at Texas A&M are required to attend Saturday-morning radiology lectures, and I was surprised to hear my professor speak for the final 30 minutes yesterday on when not to order imaging.   Radiology is his life’s calling, but he recognizes that imaging studies like the CT scan can be harmful.  Of the $2.3 trillion spent on healthcare in the U.S., the largest share is spent on imaging, totaling $800 million.  CT scans have become a part of the American vernacular, but it is estimated that 1/3 of them are unnecessary.  What ethical issues concern the use of imaging in healthcare?

  • Patient Safety: Concerning chest scans, an X-Ray exposes the patient to 0.1-0.2 mSv of radiation, but the CT dose is 8.0 mSv.  At 50 mSv a person is at increased risk of cancer, so minimizing the number of exposures to a CT scan should be an important goal in healthcare.
  • Cost: Some of the ballooning in healthcare costs over the last decade is due to tests ordered by physicians.  Many doctors order tests not because they are indicated by the patient’s symptoms but because they serve as an extra layer of protection in the case of a lawsuit.  The irony of such defensive medicine is that one day a doctor may find himself in court for exposing the patient to too much radiation.  Patients never see the thousands of dollars of imaging charges, so they often authorize such studies and let the insurance companies handle the rest.
  • Physicians Lining Their Pockets: Research has shown that physicians increase the number of scans ordered when they are able to bill for the use of their own equipment.  One gastroenterologist related to me how his clinic moves a number of unnecessary endoscopies through his office for various reasons.  An endoscopy does entail some risk and is certainly not comfortable, but every CT scan is sure to expose the patient to radiation.  Physicians should refrain from allowing revenue strategies to trump good medical practice.

For more information on radiology, visit www.radiologyinfo.org.

Cancer, Hold the Chemo

Admittedly there are some things that I would never conceive could possibly “run out” or “dry up,” even in the worst economic times. As a non-doctor, drugs are one of those things.

But imagine, if you will for a moment, having to call your friends to see if they could get you the much needed drug that your hospital could not supply. If you do not get the drug, you will not be able to keep your disease under control…

This is exactly what happened to Thomas Kornberg, a professor with Hodgkin’s Lymphoma who was forced to contact doctor-friends to supply his need.

The American Hospital Association just issued a press release showing the results of their recent survey that exposed this apparent drug shortage:

  • Hospitals report that they have delayed treatment (82%) and more than half were not always able to provide the patient with the recommended treatment
  • Patients got a less effective drug (69%)
  • Hospitals experienced drug shortages across all treatment categories
  • Most hospitals rarely or never receive advance notification of drug shortages (77%) or are informed about the cause of the shortage (67%)
  • The vast majority of all hospitals reported increased drug costs as a result of drug shortages
    • Most hospitals are purchasing more expensive alternative drugs from other sources

The AHA has proposed some solutions: They want to establish early warning systems of shortages, remove regulatory obstacles, improve communication among stakeholders, and explore incentives to encourage drug manufacturers to stay in, re-enter or initially enter the market.

Clearly Kornberg is not the only case,

So what happened to the other people who don’t have the connections/resources that he does?

How are hospitals to deliberate on the dispersion of scarce resources?

Even more concerning, if this becomes a trend, will there be an even larger motive for inconspicuous sales?

 

Breaking News: Insurance Coverage Affects Access to Health Care!!

 

Okay, so maybe it’s not breaking news:  the type of insurance you have may affect whether or not you can get in to see a doctor.  In particular, if you have Medicaid-Chidren’s Health Insurance Program (CHIP) insurance (sometimes called “Public Aid”), you might have trouble finding a doctor who will see you.

In a study published in the June 16th New England Journal of Medicine, women posing as mothers of children with common health conditions called 273 pediatric specialist clinics throughout Cook County, Illinois.  They made two calls, one month apart, to each clinic, trying to get appointments for their purported children.  The calls were identical, except that one time the callers said they had Medicaid-CHIP insurance;  the other time, they said they had Blue Cross Blue Shield, a “good” private insurance.  The results are unsurprising but sobering:  66% of the callers reporting Medicaid-CHIP coverage were denied an appointment, compared with 11% of those reporting private insurance coverage.  For those Medicaid-CHIP patients who did get appointments, the average wait for the appointment was 42 days, compared to 20 days for the privately insured.

On the surface, one might attribute these inequalities to a bunch of bad, greedy doctors.  The reality, however, is more complex.  In Illinois, Medicaid-CHIP pays about 20 cents on the dollar (when it finally gets around to paying, which is sometimes six months after the fact).  Because of this, physicians may actually be spending more money than they take in for each Medicaid patient they see.  One can only  do that for so long and still keep the doors open and the lights on.  No, the inequalities do not merely stem from the behaviors of individual, money-hungry doctors;  the inequalities are built into a disastrously flawed system.

I am looking forward greatly to the upcoming CBHD conference examining the “Scandal” of Christian influence on bioethics.  Christians are perceived as being very concerned about issues like abortion, physician-assisted suicide, and embryonic stem cell research, which threaten human dignity by estimating a person’s worth based on their age, appearance, or utility to society.  But it seems that we are perceived as being less concerned about the structural, systemic factors built into our health care “system” which daily lead to insults to human dignity by estimating a person’s worth based on their pre-existing conditions, income, or occupation (i.e., their ability to get insurance).  I wonder, if we Christians really stood out in society because of our concern for the latter as well as for our concern for the former, whether we might not have a greater hearing and make a greater difference in all areas of bioethics.  (Remember Mother Theresa?)

Hope to see you at the Conference!

The Business of Drugs

I went to my first drug rep dinner the other night at Smith & Wollensky in Houston’s Highland Village.  The high-end steaks and 20+ bottles of wine left nothing to be desired by the nurses and physicians in attendance.   Research shows that being wowed with a nice meal influences later decision-making.  Yes, I could see how the memory of one of those juicy steaks could prompt a doctor to select a particular medication.

Special thanks to Joe Gibes for bringing to light how pharma business practices stymie important medical treatments.  I worked in business for over 7 years, and I saw two types of businesspeople.  One type focused on presenting the merits of the product and gave the buyer room to evaluate it and make a decision on a purchase.  This person would refrain from the pressure sales pitch and would frankly state what the product could and could not do.  Sometimes this went so far as recommending a competitor who sold a product that fit the customer’s needs better.  The other type of salesman I encountered had a different approach.   Marketing techniques were more about allurement rather than presenting one’s ware.  These folks were jovial types always given to conversation, but all the backslapping often left the customer with an uneasy feeling.

Business reform in general is needed in our country, but more is at stake when unethical business practices impact the field of medicine.  Since a person’s well-being is in the balance, extra care and protections must be employed.  I often hear medical students comment, “I can’t really do anything about the drug business.  It’s just the way things are.  I might as well enjoy the free meal.”  But don’t we owe it to our patients to remove any taint from medical care when their very lives are concerned?  Our Savior was a humble man, and there is no doubt his humility opened the door for His effective healing ministry.  Such a disposition sets an entirely different tone for healthcare, which our medical system desperately needs.

Thanks, GAVI!

In a world full of inequities in health care including a child mortality rate in some developing countries that continues to be alarming, it is good to recognize those who are making a difference.  The Global Alliance for Vaccines and Immunisation (GAVI) recently announced that they had entered into agreements with several vaccine manufacturers to obtain vaccines for developing countries at reduced costs.

GAVI is an international organization that attempts to unite donor nations, private donors, developing nations, international organizations, and immunization suppliers to meet the goal of saving children’s lives and protecting people’s health through better access to immunizations.  In the ten years from 2000 to 2010 more than 288 million children were immunized with GAVI-funded vaccines, and an estimated 5 million deaths prevented.

Organizations like GAVI deserve our thanks and support for making a positive impact on the lives of children around the world.

Treatment of HIV-infected Individuals to Prevent Transmission

The interim results of the HPTN 052 study released last week indicate that treating HIV-infected individuals dramatically reduces the likelihood that they will transmit the virus to their sexual partners.  This study of HIV-positive patients whose heterosexual partners were HIV-negative and whose disease was at a stage at which treatment would be considered optional showed a dramatic decrease in transmission to their sexual partners for those treated immediately and was stopped early due to the results.

This study raises some interesting ethical questions.

Are HIV-positive persons who have an unaffected partner now obligated to undergo treatment even if there is not evidence that the benefit of the treatment outweighs the adverse effects for the individual?

If treatment of infected persons is an effective means of preventing the spread of HIV, how aggressive should those responsible for public health be in seeking to identify and treat those with HIV?

What should be done in countries with a high level of HIV that already cannot afford antiretroviral treatment for the more severely affected?  If treatment of all infected people would dramatically reduce the incidence of new cases in those countries where do we get the resources to provide that treatment?

The Philanthropic Principle

And he called the twelve together and gave them power and authority over all demons and to cure diseases, and he sent them out to proclaim the kingdom of God and to heal. – Luke 9:1-2

The Methodist Hospital, Houston, Texas

As I sit writing this article on the 21st floor of M.D. Anderson’s Pickens Tower, I survey the names that dot the skyline of the Texas Medical Center: St. Luke’s Episcopal Hospital, the Methodist Hospital, Baylor (Baptist) College of Medicine—all philanthropic ventures founded by Christians.  Today, their respective denominations are only nominally involved, providing some guidance for chaplaincy programs, some of which include Muslim services.  Granted, these medical institutions are now massive, multi-million dollar operations, yet many of their congregations have significant wealth that could be used to provide funding.  Obviously, they are plagued by the theological waywardness of their respective churches, but other more traditional churches lack involvement in health care in a similar fashion.  In speaking with a pastor of a large Baptist megachurch, I learned that they had stopped investigating opportunities to build a charitable medical clinic because of the fear of lawsuits.  Financial and physician resources were at their disposal, but such a ministry was a risk they were not willing to take.

During my year at Trinity in 2008-2009, I made several trips to Lawndale Community Church in downtown Chicago.  As many of you know, Lawndale has built an extensive medical clinic for the people of that neighborhood.  Though drawing its membership from some of the poorest of people, Lawndale has made it a priority to spread the Gospel through practical programs ranging from sponsoring a pizza parlor to providing medical care.  In Christian circles some mention that poorer patients look for opportunities to win cash through lawsuits, but Lawndale views medical outreach as a necessary risk in their pursuit of Christian goals.

 

Baptist Medical Centre, Nalerigu, Ghana

Today, unfortunately, we face the trend of Christian groups pulling out of medical care.  American Christianity now boasts some of the largest churches ever, with extensive programs and services that include multi-site ventures and online attractions.  Few, however, see medical care as a main function of the church.  Take the Baptist Medical Centre (BMC) in northern Ghana, for example.  BMC, like other Christian hospitals founded by Americans in Africa, is facing the withdrawal of American financial support for its mission.  Part of the reasoning behind the separation is to allow Ghanaians to mature in their leadership of such projects.  This is certainly a proper goal.  However, much of the termination in sponsorship is based on the idea that hospitals siphon off funding that could be better used in programs that are specifically evangelistic.  The fact of the matter is that chaplaincies in hospitals provide excellent ways to present the Gospel to people who would avoid any other Christian ministry.  The Muslim population is one of the major groups BMC serves, and these people would never enter a Christian building otherwise.  The fact of the matter is that pastors (not to mention Christian doctors and nurses) stationed at the hospital have a constant opportunity to communicate the hope and healing of Jesus.  No pastor hidden behind church doors here.

Conflict between two philosophies of health care in America has reached a fever pitch.  The medical field is marked by a battle between health care based on government oversight versus medical services maintained by profit found in the marketplace.  I recommend we reconsider medical care based on philanthropy as a third option.  There is great wealth to draw from, and health care is tailor-made to work hand and hand with the Gospel of Jesus.

For more information about Christian philanthropy and medical care, visit these websites:

The Faile Foundation of the Baptist Medical Centre, Nalerigu, Ghana

Lawndale Christian Health Center, Chicago, IL

Baptist Medical Dental Fellowship

Christian Community Health Fellowship