They Used To Use Tar for Psoriasis Treatment

The TV report was very low key. There was an assistant head of a shrimper's group who said he was really concerned about the his health, his wife's health, his kids' health, his brothers' health and the health of the people working, not in the normal trades, but in the massive oil spill cleanup breathing that air that smelled so bad. In his direct honest way, he plaintively asked why there was so little information from the government or anyone else about the health effects on people of the oil and its fumes. He said that the people in the area had poor insurance, if any, little access to health care facilities, and felt adrift.

Then another TV scene, this of a lot of doctors at a Louisiana meeting, not of a government agency but of an important-sounding institute group. Lots of uniforms, very somber people. Their words were as guarded as a lawyer's  before the U.S. Supreme Court. Nothing to cause panic or to even raise alarm.  The big issue was skin rashes from irritation from the petroleum floating in the water and filming the marshes.  If you listened carefully, there was only the slightest hint of concern expressed about long-term effects.  What was most significant was the silence about serious health issues. What was most significant was that there was no responsible response to the shrimper's pleas for information about the health effects of the oil and its benzene-containing fumes and what they could expect in the short term and out eight to ten years.

When I was in medical school, various tars (often from coal derivatives) were used to treat conditions such as psoriasis. I was surprised that no one, recorded by the TV cameras,  said "consider the "up" side: smear some tar on your psoriasis and your skin might improve.

Link to CDC site for professionals added 7/1/2010:

Judge For Yourself: Health Risk Information About BP's Crude Oil Disaster

 From the CDC, published today: "Occupational health and safety experts have questioned the Offshore Air Monitoring Plan for Source Control, BP’s plan to protect the health of the more than 24,400 workers cleaning up the oil spill in the Gulf of Mexico, because they say it exposes workers to higher levels of toxic chemicals than is generally acceptable. The clean-up effort exposes workers to volatile organic compounds (VOCs), which are subject to federal regulations that do not specify safety thresholds. Because of this, BP is not currently required to supply respirators, evacuate workers, or take other precautions. Critics say the plan allows workers to remain in an area where vapors are four times higher than accepted practice. “This protocol seems to be written in a way that allows them to continue to work when conditions are such that, in any other setting, you’d pull your workers or you’d put them in better protection,” said Mark Catlin, a worker safety advocate and expert who worked on the 1989 Exxon Valdez tanker spill. BP spokesman Ray Viator, however, said that the plan is aggressively monitoring toxins and protecting workers. “It’s being managed by professionals who have reviewed the plan and who are making sure it’s been implemented correctly. It involves graduated responses and we’re prepared to accelerate it if the situation arises,” he said. The Coast Guard approved the plan on May 25, and although the Occupational Safety and Health Administration (OSHA) reviewed the plan, the agency’s jurisdiction only extends three miles off-shore."

To form your own judgment on whether Americans in the affected area are receiving appropriate information from the federal government read and analyze the  CDC's evaluation of the BP Gulf  oil spill and consider applicable federal law pertinent to emergencies.

See Taylor's Miami Herald expert's analysis of the protection offered to works and residents of the affect area (referenced above).

And finally, if you can stomach it, take a look at Louisiana's May 5, 2010 information to its coastal citizens.

Another Example of Severe Disease From Toxic Exposures

Not only did the 9/11/2001 terrorist attack on New York have an immediate destructive effect on lives and structures, as  Aldrich and others' New England Journal of Medicine 4/8/2010 article concluded, carefull follow-up studies have shown a substantial number of rescue workers to have serious permanent abnormalities in lung function from their massive acute exposure to dust at the World Trade Center site both at the time of the attack and afterwards. The workers' health will never be the same.

Unlike today's  BP downwind exposure victims, politicians rushed to New York and the Pentagon to laud firefighters and Emergency Service Workers for their heroism and self sacrifice as they worked to save lives and property. The news media featured pictures of the rescue workers and highlighted their service above self-interest in the face of an horrific American tragedy. America recognized the sacrifices those people had made.

But the toxic exposure of children and adults in Louisiana downwind from BP's mess seems to merit no such interest although Obama has made cursory trips to the area and today's New York Times shows a sympathetic  picture of an oiled bird and an antiseptic picture of oil decontamination in Alabama. What about toxic exposure of the the adults and children  (who could not afford to run self-serving costly full-page newspaper ads, as BP did) to the fumes from  BP's flood of oil and the possible health consequences of that exposure. What is the extent of their exposure, what consequences can be predicted and why is our government and news media not talking about this issue?

Is there a conspiracy of silence?  Or is it just an election year? Or is BP advertising revenue a factor?

The Past, Remembered

Today's Saratoga California Rotary Art show, at a nearby public community college was wonderful. All of the usual arts were represented and my wife and I enjoyed our walk through the displays on a warm sunny Spring day. Until we smelled a really foul cigar smoked by a chubby late-middle aged man in a straw hat. We checked with the art show staff, where others were making the same complaint about the same person, and were told that there were many signs indicating that smoking was prohibited anywhere on the public campus. When we later ran into this smoker again and told him what we had learned he waved at us, indicating that we were the ones who should leave.

As one who formerly smoked, I understood the cigar smoker's addiction (and the rudeness which he used to ward off any threats to his denial of addiction). I also remembered seeing acutely sick patients of all ages in hospital emergency rooms, brought there by the toxic effects of alcohol and tobacco. Tobacco and alcohol are major factors in the cost of United States health care and we will not succeed in "health care reform" until we reign-in the use of these dangerous drugs.

A number of years ago  my wife and I attended a conference on the USSR presented by a noted Harvard professor who told us that the USSR was dependent on its revenue from taxing alcohol (primarily Vodka) for many of its national expenditures, including defense.  He should have gone further to indicate that America and its individual states also have an ambivalent approach to smoking and drinking because the nation and its political subdivisions derive substantial revenues from alcohol and tobacco.

If we want health reform, and individual health improvement, we need to resolve our national ambivalence and convince Americans to stop smoking, stop using "chewing" or  "mouth" tobacco, and stop drinking to excess.  If we divert money from our unsuccessful narcotics interdiction programs to high-power campaigns to deglamorize tobacco , alcohol and other controlled substances, maybe we could really cut health care costs and improve results.

That cigar, today, smelled awful.

Energy Inflation and Health Care

What does energy cost inflation have to do with health care? As it turns out - a lot!

Health care is thoroughly enmeshed in the economy (consider - the cost of commodity supplies in the health care cost of living index has recently outstripped many other elements; malpractice insurers factor inflation into their premium structures because claims and settlements look forward for years; and hospitals and health care providers use large quantities of increasingly expensive energy). Not only will we have the usual increases in health care costs resulting from an aging population, increased requirements for innovative technology and treatment, intensivity of care, cartel-like market behavior, and other factors, inflation in energy costs will ultimately feed general inflation and have an additive impact on health care inflation.

Dollars spent for energy will not be available to employers or families to pay for increasing insurance or health care costs. Business closures or dislocations caused by inflating energy costs will mean that currently employed persons whose insurance is company sponsored, may lose their insurance or their ability to pay for insurance.

When the cost of energy is high, business and individuals seek dollar-cheaper energy sources. While the focus of the public is on low impact green energy sources (wind, water, solar), the big-money push is on to burn coal to replace or supplement petroleum-based energy sources. The coal industry has an extensive advertising program touting coal's low cost, plentiful resources, and ready availability. The advertisements do not discuss the track record of black lung disease in coal miners, black lungs in city dwellers exposed to coal smoke, nor the risks of acid rain, the release of strontium and other radioactive materials associated with the burning of coal, and the coal industry's troubling history of environmental degradation. The ads do not discuss the power-generating industry's sidestepping of clean air regulations through the use of grandfathering "add-ons" rather than the application of current standards to all current construction. Coal's immediate focus on dollar cost will seem like a bargain until we understand that the industry's cost-shifting will shift increased health care costs caused by diseases and environmental consequences of coal burning to the public.

There are alternatives. This is an incredible era of genetic exploration. The laboratory techniques which bring us a sophisticated understanding of the human genome could also be devoted to bringing genetic solutions to lower energy cost and availability. For instance, since nitrogen-fixing bacteria free legumes from the need for added commercial fertilizers, can we develop a gene-based nitrogen fixing technology which will substantially reduce the need for petroleum-based fertilizers on other crops? Can we use such a technology to produce biofuels, using marginal otherwise unfarmable land, while high-quality land, unencumbered by high doses of industrial grade petroleum fertilizers, is used to grow food essential for a healthy population. Can we move towards energy independence?

We have a choice: continue to destroy the environment, our health and our economy or use informed innovative science to help us deal with tough issues, such as energy and health.

Polls About Pols and Health Care

Click on Kaiser Family Foundation's health08.org site for interesting information about politicians and their health care proposals as well as "non-partisan" polling which sheds light on public opinion/perception. The url is: http://www.health08.org/.

Words Do Count - As Lawyers Should Know

Senator Clinton is a Yale Law School graduate; Senator Obama is a Harvard Law School graduate. (I must acknowledge a bias towards HLS - my class was 1959.) Both of these respected institutions teach their students that words do count and lawyers must be experts at using words.

Clinton's web site (Obama will be discussed in a separate blog( has a summary of her health plan proposal: http://www.hillaryclinton.com/issues/healthcare/summary.aspx. As I read through it (fully recognizing that it is a "summary"), I noted the use of vague terms, weasel words, and few concrete definitions. The summary calls for ". . . affordable, quality health insurance" and reigning "in costs and to insist on value and quality." Clinton calls for a plan which "will secure, simplify and ensure choice in health coverage for all Americans. . . finally addressing the needs of the 47 million uninsured and the tens of millions of workers with coverage who fear they could be one pink slip away from losing their health coverage - with no overall increase in health spending or taxes." Magically, "For those with health insurance, the plan builds on the current system to give businesses and their employees greater choice of health plans - including keeping the one they have - while lowering cost and improving quality".

When I turn to Clinton's "americanhealthchoices.pdf" site, where the resources (savings related to existing spending) to pay for this utopian health care system are described, I find projected savings related to "Reducing Overpayments and New Efficiencies": $10 billion from Phase-outs of Excessive Medicare Overpayments to HMOs and Other Managed Care Plans; $7 billion in savings related to Unnecessary Medicare and Medicaid Spending; $4 billion in savings related to Constraints on Prescription Drug Costs; $35 billion in savings from Modernizing the Health System. I also find a projected $54 billion savings through "Limits on High-Income Tax Breaks". Add these together to get $110 billion which is a relatively small percentage of our $2 trillion plus current expenditure.

The words do not adequately describe the means for accomplishing the needed savings and new revenue sources Clinton's plan requires, nor do they address the practical means of accomplishing her proposed enormous task. Clinton has not just left herself wiggle room, her use of words belies her own belief in her ability to accomplish the health reform which America needs.

Health Insurers, HMOs and Automotive History

After World War II, a Democratic presidential economic advisor observed that mergers and acquisitions in the auto industry left concentrated power in fewer companies (GM, Ford and Chrysler) which made them much easier for the government to control. Government controlled and regulated them, competitors have appeared, and the big three are struggling to survive.

We have seen merger and acquisition after merger and acquisition in the health insurance industry with relatively few major players still standing. Well-paid industry executives and advisors forgot to study industrial history, and their own vulnerability, when they reduced the number of viable insurers and HMOs. As they hungrily gobbled each other up, they did not recognize they were committing industrial suicide. If the election in November of 2008 results in a Democratic victory, the health insurance industry is ripe, as never before, for much tougher government control and regulation. And who is going to speak in behalf of the health insurance industry? Certainly not employers and unions who have seen unfilled promises of cost control and more appropriate provision of health care to their employees. Certainly not religious organizations and small governmental entities which are struggling to provide care to the uninsured and poor. Certainly not the public which readily expresses its anger and skepticism (go to a movie and hear the audience snicker when the "HMO" is used disparagingly). Not the physicians and other health care providers who have seen the quality of the service that they are paid to provide slide under the financial pressure of health insurers which cost-shift their way out paying for reasonably expected and necessary health services.

The industry insurance/ppo industry has set itself up for control by government on government's terms (regulators do not make fancy salaries and are not particularly sympathetic to those who do) and has, through its expression of greed, has made itself as vulnerable - as GM, Ford and Chrysler were in post-war America. Oh, if they had only paid attention to history!

Not A Collaborative Articulation of Shared Purposes

As I sat through the second day of a continuing medical education course, I was confronted by a hypothetical in which a 59 year old Mexican-American man presented with high blood pressure, obesity, diabetes, and abnormal blood fats. The instructor emphasized that this man was at very high risk of a heart attack or stroke. The instructor and audience carefuly considered the diagnostic and treatment program needed to reduce this man's very high risks of death and disability related to diabetes, arteriosclerosis, heart and blood vessel disease and high blood pressure.

As I listened to the expert instructor's exquisite analysis, it struck me that the wrong questions were being asked. This man was approaching the end of his disease shortened lifespan because when he was 19 years old, no one was interested in intervening and preventing or ameliorating the diseases he was genetically programmed to develop. Why not?

Our health care system's insurers, PPOs and HMOs, had no incentive to spend a significant amount of money on a man who would likely be the customer of a competitor when he finally developed expensive serious sickness. In previous blogs, I have described the practice of employers to frequently shift insurers, PPOs and HMOs to save money. Perhaps Kaiser, which works hard to retain members, might have a long-term interest in its members' health. But most of the country's health care is not provided through Kaiser. For the working population it is provided through relatively few insurers, PPOs and HMOs which focus on short term profits and yearly executive bonuses rather than long term health of clients. And it is left to Medicare to pick up the costs of caring for the disabled and elderly who may have been victims of systemic neglect early in their lives, when intervention might have made a big difference.

We have a dysfunctional expensive and wasteful health care system in which the principal players have disparate goals and in which the intention is not to further the health of our nation but to game the system, maximize profits and leave it to others to pick up the shattered lives of unhealthy Americans when they are - for example - 59. Let's all agree that we must take care of our young people, when that intervention can make a major difference in their lives, their health, their contribution to our nation and its economy, and our common good.

Dealing With Medically Underserved Areas

Medical education is already heavily subsidized (tuition does not cover the educational institutions' costs). Some young physicians choose their career paths primarily based on their assessments of how quickly their earnings will pay off their debts. There could be an alternative: provide financial incentives to medical students, interns, residents and fellow to choose the specialties which America needs, where the needs exist, and commit to providing them with free educations if they serve in designated medically underserved areas for a defined period following completion of their training. If the young physician's career objective is to be a Beverly Hills cosmetic plastic surgeon, he or she should receive no subsidy or income guarantee; if he or she will contract to practice plastic surgery in an inner city hospital for seven years, provide a generous subsidy which makes the medical training free and provide a reasonable and adequate income so that the physician can support his or her family. The decisions on need and location cannot be left to the medical profession alone, nor to hospitals, because the medical profession and health institutions will game the system for their advantage.

Who Is Kidding Whom?

In the mid 1980s, I suggested that in twenty years we would have six major health care systems in the United States, in addition to government systems. We are pretty close to that number now, and the insurance/HMO/health care industry has opted to consolidate which makes their operations virtually indistinguishable in principle from Medicare. There is one major difference: with the exception of Medicare and the Permanente health care system, the others soak up a lot of dollars that should be used to purchase health care and divert those dollars to administrative overhead. One research study demonstrated that about twenty five percent of the premium dollar wasn't buying physician services, hospital services, ancillary services, preventive health services or the other items we recognize as health care - the twenty five percent of the premium dollar was buying clerks and offices and administrative salaries and generous payments to top executives, while business and the individual purchaser of insurance products were struggling to manage their own health care costs. If Medicare and Permanente can provide the range of health services that their beneficiaries/members need for near 3 percent of the health care dollar, and since the insurers and their subsidiaries have become large impersonal, inefficient, unfriendly and difficult to deal with, why don't we exercise some common sense and move to a single or near-single payer system - so that we can use health care dollars for health care and maybe even have some money left over to provide for the 47 million uninsured in America?