Monday, 25 October 2004
Health care and the market
Recently, The New York Times
carried an article by Donald L. Barlett and James B. Steele on health care in the United States. In the article, the authors assert that Americans do not have adequate health insurance coverage because of "the inability of market-based, for-profit medicine to deliver on the political promises".
We spend more per capita on health care than any other developed country. Yet on the important yardsticks, like life expectancy measured in healthy years, we don't even rank among the top 20 nations. In fact, according to the World Health Organisation, we come in an embarrassing 29th.
The authors claim that the market fails in the following:The money in health care is in disease treatment whereas good health care requires disease prevention.The market focuses on demand rather than on need, and carries out marketing to create that demand.The United States government does not exert influence over prescription drug prices, so Americans pay more for these drugs.
The authors recommends the following:
What's needed to control the costs and to provide basic health and hospitalisation coverage for all Americans is an independent agency that would set national health care policy, collect medical fees, pay claims, reimburse doctors fairly and restrain runaway drug prices -- a single-payer system that would eliminate the costly, inefficient bureaucracy generated by thousands of different plans.
However, the authors' recommendation must be treated with a high degree of skepticism. In my opinion, the problem lies not in the fact that the market cannot deliver proper health care to Americans but that the United States has failed to provide an efficient, competitive market.
The health care market is always likely to be controlled by health care professionals because of the concentration of knowledge in the latter. An efficient market requires a free flow of information. When information between service providers and consumers is as unbalanced as it usually is in health care, the resultant market is also unlikely to be very free.
Therefore, health care regulation must focus on redressing this imbalance. Instead, health care regulation in the United States has often further distorted the free market.
Many economists have already pointed out that onerous safety requirements in drug regulation raises the cost of bringing new drugs to the market, which are then passed on to consumers with the help of patent laws that restrict competition. Contrary to what the authors assert, the United States already influences drug prices through safety and patent regulation. But because the influence is by way of reducing effective competition, prices go up.
Which makes it ironic that the authors want a single agency to control the entire health care system. The single agency will be devoid of competition and be one huge bureaucracy, with all its attendant inefficiency and disregard of market needs typical of such bureaucracies. It is hardly likely to result in an affordable and accessible health care system for the United States.
Friday, 8 October 2004
US lifestyle worsens children's health
A recent New York Times report stated what many people already think: A US life-style is not healthy.
Foreign-born children are healthier when they arrive in the United States than those of the same age who were born in the country, a study shows. But the longer immigrant children stay in the US, adopting the diet and lifestyle of their peers, the unhealthier they are likely to become, according to the report released this week.
The study is a synthesis of several national studies by the David and Lucile Packard Foundation, a California philanthropy that studies the well-being of children.
The report suggests that a language barrier may ironically help immigrants.
"It's a bit of a twist," said Ms Kathleen Harris, director of the National Longitudinal Study of Adolescent Health...cited in the report. "Linguistic isolation is a protective thing because it slows assimilation, and most people think assimilation is good." But, she added, "in this case, assimilation means adopting unhealthy behaviour and risk factors from which they are protected in their own culture".
The report stated that among first generation of immigrant adolescents, there was less asthma, less obesity and fewer school days missed than was the case among the second generation, that is, those born in the US to immigrant parents. The foreign-born children were also less involved in substance use, sex, delinquency and violence.
Apparently, an American life-style is not what it's cracked up to be. Then again, I am sure there are many who never thought it was.
Monday, 20 September 2004
Eating habits and age
A study by nutritionists at the University of Newcastle has found that adults eat twice as much fruits and vegetables as they did when they were children and take in less fat and sugar.
The study, which is published in the academic journal Appetite
, looked at the eating habits of 200 children aged 11 and 12 and then revisited the same people in their early 30s.
The finding should not come as too much of a surprise. For one thing, adults are more aware of the health consequences of a poor diet. And the fact that the consequences are more imminent for them should provide them with greater motivation to improve their eating habits.
Of course, knowing that adults eat more fruits and vegetables and less fat and sugar than children is one thing. The other question is whether they should actually start younger.
Animal studies have shown that extremely low-calorie diets produce considerably extended life spans. Significantly greater life-span extensions are achieved when the low-calorie diets are started young than when started in adulthood.
It is likely that a similar difference should apply to the high fruit/vegetable and low fat/sugar diet.
However, animal studies also show that undernutrition in young animals also cause stunted growth. That is obviously not ideal for our children.
It is not necessarily true that what is healthy for adults is also healthy for children.
Thursday, 26 August 2004
Gene helps to burn fat
Researchers have discovered how to alter a gene in mice that increased their stamina and enabled them to eat huge amounts of food without getting fat.
Howard Hughes Medical Institute investigator Ronald Evans, leader of the study, said that it could lead to a pill that gives many of the benefits of exercise without the need to exercise.
"It is a pill that, in part, mimics exercise. It mimics the metabolic activity associated with exercise," he told Reuters recently.
The gene involved is called PPAR-delta, a master regulator of different genes. Activating this gene had been shown to help raise metabolism and fat-burning.
Dr Evans and his colleagues wrote in the journal Public Library of Science Biology
that they altered the PPAR-delta gene to stay in a permanently "on" position and then genetically engineered mice with it.
The genetically engineered mice were able to run an hour longer than normal mice were, and when fed a high-fat diet, the normal mice became fat, while the genetically altered mice gained no weight.
The mice grew more slow-twitch muscle fibres, which are used for endurance activity, as opposed to the fast-twitch muscles used for sprinting.
Dr Evans said he is still studying the mice to determine the impact on longevity. With obesity linked to several age-related diseases like heart disease, diabetes and cancer, there is potential beneficial impact.
The researchers used genetic manipulation in the study, but they also gave an experimental drug called GW501516 that also activates PPAR-delta. Normal mice given the drug could also eat a high-fat diet without gaining weight.
In the fight against obesity and its associated diseases, these findings should be welcome indeed.
Wednesday, 7 July 2004
Bird flu is back
It looks like the bird flu is back.
Thailand has confirmed that 7,000 of 44,000 chickens in Ayutthaya had died in the last fortnight from the H5N1 strain of the bird flu. The surviving chickens have been culled.
On Tuesday, China had announced a new outbreak of bird flu after tests at a farm in the southeastern province of Anhui confirmed that chickens had died of bird flu. In March, China had declared it had defeated the disease after killing 9 million chickens and other poultry.
Bird flu has also appeared in Vietnam over the last three months.
In the earlier outbreak early this year, the disease ravaged flocks throughout Asia. It also spread from birds to humans, killing 16 people in Vietnam and eight in Thailand. About 100 million chickens across the region were slaughtered to halt its spread.
"It's not surprising that it has come back," said Roy Wadia of the World Health Organization in Beijing. "It stays in the environment a long time."
In April, Severe Acute Respiratory Syndrome -- or more commonly known as SARS -- threatened a similar comeback, making a re-appearance in China and causing one death. Fortunately, it was quickly contained again.
No doubt, health authorities in Asia have become better at controlling such outbreaks. Hopefully the latest bird flu outbreak is also quickly brought under control.
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