There is No Free Lunch and There is No Free Contraception

Robert Laszewski

Posted 2/10/12 on Health Policy and Marketplace Review

The otherworldy Obama Administration solution to the contraception firestorm might work politically but it makes no sense in the real world. The President, hoping to quell a growing political firestorm, today announced a new policy that no longer requires religiously affiliated organizations to provide employees with contraception coverage in health-insurance plans. Under the new policy, insurance companies will be required to offer free contraception for their employees and dependents. The administration’s idea is to shift the onus for the coverage from the employer to the insurer. Catholic leaders, and lots of other people, had objected to the requirement, which exempted churches but not hospitals, charities and universities with religious affiliations. So, let’s just play a game here. The religious organization just pretends that it has nothing to do with it but the insurance company pays for it anyway. Hey, the insurance companies are rich. Continue reading “There is No Free Lunch and There is No Free Contraception”

Racing To Nowhere

Merrill Goozner

Posted 2/7/12 on Gooz News

I had dinner over the weekend with a close friend who is a breast cancer survivor (her word) and a former avid participant in the annual marathons sponsored by the Susan B. Komen Foundation. Her status as a former activist was new. “Is this what we were racing for?” she said. She is skeptical by nature, and the brouhaha over Komen’s back-and-forth over funding Planned Parenthood last week didn’t make her angry. It merely flipped the switch that changes skepticism into cynicism. To paraphrase the old Phil Ochs song, she ain’t a marchin’ anymore.

Continue reading “Racing To Nowhere”

Graham Center: Integrate Mental Health Into Primary Care

Kenneth Lin

Posted 11/14/11 on Common Sense Family Doctor

Based in part on a positive recommendation from the U.S. Preventive Services Task Force, the Centers for Medicare and Medicaid Services recently announced that it will cover annual depression screenings for Medicare patients in primary care settings “that have staff-assisted depression care supports in place to assure accurate diagnosis, effective treatment and follow-up.” However, as the below Figure illustrates, translating the USPSTF guideline into practice has been challenging for many primary care physicians.

Policy One-Pager from researchers at the Robert Graham Center, published in the November 1st issue of American Family Physician, details the obstacles that clinicians face in identifying and treating depression and other mental health problems. As Dr. Robert Phillips and colleagues observe, “Current health care policy makes it difficult for most primary care practices to integrate mental health staff because of insufficient reimbursement, mental health insurance carve-outs, and difficulty of supporting colocated mental health professionals, to name a few.”

On a related note, an editorial in the same issue discusses strategies for improving adult immunization rates, which have historically lagged far behind rates of immunizations in children. According to Dr. Alicia Appel, immunization registries and electronic clinical decision-support systems can complement low-tech interventions such as patient reminders and standing orders. Clinicians, what has been your experience with incorporating depression screening and immunizations into routine health care for adults?

Kenny Lin is a family physician practicing in the DC area. He writes at Common Sense Family Doctor.

The Great Prostate Debate: “We” Versus “Me”

Richard Reece

Posted 10/12/11 on MedInnovation Blog

The public demands certainties but there are no certainties.

H.L. Mencken (1880-1956)

The government, representing “We, The People,” is responsible for spending the public’s money intelligently based fact. The individual citizen, “Me, The Person,” is responsible for preserving his/her health based on what he/she perceives to be in his best interest.

With PSA screening for prostate cancer, these responsibilities conflict because the screening may do more harm than good. Prostate cancer is a common, slow moving cancer. Five times more men with it than from it, and the side effects of biopsy and treatment can be devastating.

Hence, the great prostate debate – whether to screen routinely for prostate cancer with PSA testing, and whether to biopsy and treat patients with marginally elevated levels.

Continue reading “The Great Prostate Debate: “We” Versus “Me””

The Meeting That Wasn’t, Revisited

Kenneth Lin

First posted 10/05/11 on Common Sense Family Doctor

New York Times Magazine story published on the newspaper’s website this morning details the complicated history of screening for prostate cancer in the U.S. and revisits the related story of the U.S. Preventive Services Task Force meeting that was abruptly cancelled for political reasons on November 1, 2010, the day before the midterm Congressional elections. I was interviewed several times for this story, starting shortly after my resignation from my position at the Agency for Healthcare Research and Quality, where for 4 years I had supported the USPSTF’s scientific activities on a wide range of topics.

Continue reading “The Meeting That Wasn’t, Revisited”

Mammograms and Death Panels: Why the Preventive Services Task Force Keeps Pulling Its Punches

Kenneth Lin

First posted 8/18/11 on Common Sense Family Doctor

Health reform was supposed to have been good news for the U.S. Preventive Services Task Force. Until 2009, this independent panel of federally-appointed experts in primary care and preventive health was not particularly well known, and its evaluations of the effectiveness of clinical preventive services had no binding authority on public or private insurance plans. Within the small circle of physicians and policymakers who were aware of the their work, however, the USPSTF won accolades and respect for “calling it as they saw it,” sticking strictly to the evidence and writing screening recommendations that frequently conflicted with more expansive guidelines promulgated by other professional organizations.

Continue reading “Mammograms and Death Panels: Why the Preventive Services Task Force Keeps Pulling Its Punches”

Politics in Service of Public Health

Kenneth Lin

First published 8/1/11 on Common Sense Family Doctor

Below is the text of a proposed resolution that will be submitted by the District of Columbia Academy of Family Physicians to next month’s Congress of Delegates of the American Academy of Family Physicians in Orlando, Florida.

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WHEREAS family physicians rely on current, unbiased sources of evidence-based guidelines to select appropriate screening tests and counseling services for their patients;

WHEREAS the primary source of evidence-based prevention guidelines for family physicians is the federally-sponsored U.S. Preventive Services Task Force (USPSTF), whose recommendation statements commonly serve as the basis for AAFP clinical policies on preventive services;

Continue reading “Politics in Service of Public Health”