Wednesday, March 31, 2004

Learning From Prozac: Will New Caution Shift Old Views?
An essay in the New York Times by Tanya Luhrmann,professor at the University of Chicago and the author of Of Two Minds: An Anthropologist Looks at Modern Psychiatry on last week's FDA public health advisory on antidepressants - ".... Yet even if it turns out that the antidepressants do increase suicidal thoughts or actions in some people, that pales as a public health problem beside the challenge of treating depression in the general population. Most people with serious depression — an illness that affects one of 10 Americans at some point — never seek treatment. Antidepressants, whatever their side effects, work for many people and have undoubtedly prevented countless suicides. Still, most experts agree that the drugs do not work well enough. Many people improve but do not recover completely. About a third of depressed patients do not respond to any medication at all. In this sense, the drug agency's action may have salutary consequences. Studies have made it increasingly clear that the best treatment for most psychiatric difficulties is a combination of medication and psychotherapy, or at least continuing contact with a mental health professional..." [Viewing New York Times resources requires registration, which is free].  
  

Health care bill plays down race
Story in the Times-Picayune (New Orleans) - "There is little dispute that when it comes to health, race matters. A bookshelf full of studies has shown that African-Americans, Hispanics and American Indians get sicker and die sooner than white people. A landmark scientific report in 2002 found that they also receive worse health care, sometimes because of doctors' prejudices. But legislation that the Republican Senate leadership says is a top priority diverges from the notion that race is the most important factor separating the sick from the healthy. The bill, sponsored by Majority Leader Sen. Bill Frist, R-Tenn., with Sen. Mary Landrieu, D-La., as the only Democratic co-sponsor thus far, would make poverty a bigger part of the equation. That could make more poor white people eligible for government assistance..."  
  

Covering The Uninsured: What Is It Worth?
A "web exclusive" in the latest Health Affairs in both HTML and Acrobat format - "One out of six Americans under age sixty-five lacks health insurance, a situation that imposes sizable hidden costs upon society. The poorer health and shorter lives of those without coverage account for most of these costs. Other impacts are manifested by Medicare and disability support payments, demands on the public health infrastructure, and losses of local health service capacity. We conclude that the estimated value of health forgone each year because of uninsurance ($65-$130 billion) constitutes a lower-bound estimate of economic losses resulting from the present level of uninsurance nationally." See also related papers and two other related articles, How Federalism Could Spur Bipartisan Action On The Uninsured and The Institute Of Medicine Committee’s Clarion Call For Universal Coverage.  
  

Painful cuts loom for Medicaid (Florida)
March 29 story in the St. Petersburg Times on proposals by Gov. Jeb Bush of "a far more radical idea" than tightening eligibility and the scope of optional services - "...a spending cap that would mean some poor people could be left without medical care. The governor has dispatched state health officials to Washington, D.C., to talk to federal Medicaid administrators about making Florida a pilot program for reengineering Medicaid, which is straining state budgets across the nation. The plan would allow Florida to keep Medicaid programs while serving fewer people...."