Posted 10 July 2007 - 08:32 PM
Posted 11 July 2007 - 01:36 AM
Posted 11 July 2007 - 02:24 AM
Posted 11 July 2007 - 07:20 PM
News Source: Medical News Today
Studies Link Insurance Coverage To More Advanced Cancers
12 Jun 2007
Two new studies find the uninsured and people with certain types of public health insurance are more likely to be diagnosed with more advanced cancer compared to those with private insurance.
The studies, published in the July 15, 2007 issue of CANCER, a peer-reviewed journal of the American Cancer Society, find availability and type of health insurance predict disease severity in patients presenting with cancer of the oral cavity and breast in the United States.
More than 46 million Americans lack health insurance. Many more Americans are underinsured so do not have adequate access to health care. Studies have shown that uninsured adults are less likely than the insured to receive preventive care, to seek care in a timely manner, or to receive recommended treatments. The issue of health insurance and its relationship with disease severity is an important topic in the study of cancer because health insurance is a modifiable factor. The link between oropharyngeal cancer, disease severity and health insurance status has rarely if ever been studied. In breast cancer, this relationship has been reported only in local studies that are now dated. Amy Chen, M.D. and Michael Halpern, M.D., Ph.D. of the American Cancer Society analyzed data from a nationwide cancer database to investigate the relationship between insurance status and disease severity in oropharyngeal and breast cancers.
In what may be the first assessment of the association between insurance status and oropharyngeal cancer, Dr. Chen and co-investigators found that the strongest predictors of advanced disease were health insurance status and type. Compared to patients with private insurance, patients with no insurance were the most likely to be diagnosed with advanced disease, the largest tumors or invasive disease to regional lymph nodes. Patients with public health insurance, particularly Medicaid for low-income families, were also at higher risk for advanced disease, largest tumors, or lymph node involvement. Other factors were associated with more advanced disease at diagnosis, including gender (men were at higher risk), age (younger patients were at higher risk), and treatment facility type (patients who were treated at teaching or research facilities were at higher risk). However, type of health insurance remained the strongest predictor of stage at diagnosis and tumor size.
In their study of breast cancer and insurance status, Dr. Halpern and co-investigators found that uninsured and Medicaid insured patients were almost two and a half times more likely to be diagnosed with advanced disease than those with private insurance. In addition, they found African American and Hispanic patients were significantly more likely than white patients to be diagnosed at a more advanced stage. The authors say several factors probably contribute to the increased risk of disease among the uninsured and Medicaid populations, including fewer sources of regular medical care in general and less use of regular mammography in particular.
In both studies, health insurance strongly predicted disease severity. Authors from both studies recommend increasing access to healthcare and targeting screening programs specifically for the uninsured or underinsured to ameliorate this modifiable prognostic factor in these cancers. "[H]aving a usual primary care clinician, a trusted source of care, also known as a medical home, is a strong predictor of improved preventive care delivery," says an accompanying editorial by Richard C. Wender, M.D., president of the American Cancer Society and chair of the department of family medicine at Thomas Jefferson University. "A primary care medical home plays a vital role in reducing cancer mortality. Individuals who have a regular source of primary care are both more likely to be up to date with cancer screening and more likely to receive timely follow-up and evaluation for abnormal findings on an initial screen." Dr. Wender adds: "Clearly, the issues of adequacy, availability, and affordability of coverage are serious problems that must be addressed collectively as we work to fix what is wrong with our health care system."
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Articles:
"The Impact of Health Insurance Status on Stage at Diagnosis of Oropharyngeal Cancer," Amy Y. Chen, Nicole M. Schrag, Michael Halpern, Elizabeth M. Ward, CANCER; Published Online: June 11, 2007 (DOI: 10.1002/cncr. 22788); Print Issue Date: July 15, 2007.
"Insurance Status and Stage of Cancer at Diagnosis Among Women With Breast Cancer," Michael T. Halpern, John Bian, Elizabeth M. Ward, Nicole M. Schrag, Amy Y. Chen, CANCER; Published Online: June 11, 2007 (DOI: 10.1002/cncr. 22786); Print Issue Date: July 15, 2007.
Editorial: "The Adequacy of the Access-to-Care Debate: Looking Through the Cancer Lens," Richard C. Wender, CANCER; Published Online: June 11 2007 (DOI: 10.1002/cnc.22787); Print Issue Date: July 15, 2007.
Contact: Amy Molnar
John Wiley & Sons, Inc.
Article URL: http://www.medicalne...hp?newsid=73834
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American Cancer Society
The American Cancer Society (ACS) is a nationwide community-based health organization dedicated to eliminating cancer as a major health problem. Established in 1913 by a handful of physicians and business people in New York City, the ACS has grown into one of the world's largest voluntary health organizations. It has a staff of 6,000, over 2 million volunteers, and receives financial donations from over 10 million people annually. With assets of over $1 billion and an income of approximately $700 million per year, the society has established ambitious goals for controlling cancer incidence and mortality and improving the quality of life for survivors and their families.
While the ACS is recognized for its unique research programs, which have provided critical support for thirty Nobel laureates, it is also the major nonprofit sponsor of cancer control programs, advocacy efforts, and cancer information delivery systems. The American Cancer Society created a "cancer-conscious public," pioneering research and public programs that reduce mortality through prevention and early detection. ACS created the National Cancer Institute in the 1930s and lobbied for the renewal of the National Cancer Act in 1971. Currently, the ACS operates a 24-hour cancer information telephone line and publishes the widely used "Cancer Facts and Figures."
The ACS consists of a national organization, seventeen individually chartered and incorporated divisions, and local offices in 3,000 communities throughout the country. The national organization is governed by a 267-member volunteer assembly and a 43-member board of directors. The primary staff officer, the chief executive officer, works with the other officers and with volunteer and staff leaders to develop and implement methodologies designed to implement the society's mission.
(SEE ALSO: Cancer)
Bibliography
Ross, W. (1987). Crusade: The Official History of the American Cancer Society. New York: Arbor House.
Volume 110, Issue 2 , Pages 395 - 402
Published Online: 11 Jun 2007
Copyright © 2007 American Cancer Society
Original Article
The impact of health insurance status on stage at diagnosis of oropharyngeal cancer
Amy Y. Chen, MD, MPH 1 2 *, Nicole M. Schrag, MSPH 2, Michael T. Halpern, MD, PhD 2, Elizabeth M. Ward, PhD 2
1Department of Otolaryngology, Emory University, Atlanta, Georgia
2Department of Health Services Research, American Cancer Society, Atlanta, Georgia
email: Amy Y. Chen (amy.chen@emoryhealthcare.org)
*Correspondence to Amy Y. Chen, 1599 Clifton Road NE, Atlanta, GA 30329
See related editorial on pages 231-3 and related original article on pages 403-11, this issue.
Fax: (404) 327-6450
Keywords
Commission on Cancer • disease stage • National Cancer Database • oropharyngeal cancer • uninsured • health disparities • access to care
Abstract
BACKGROUND.
Although patients who have early-stage oropharyngeal cancer can be treated with little impairment of function, the treatment of advanced disease can result in decreased quality of life and mortality. Patients without insurance and with other barriers to access to care may delay seeking medical attention for early symptoms, resulting in more advanced disease at presentation. In this study, the authors examined whether patients who had no insurance or who were covered by Medicaid insurance were more likely to present with advanced oropharyngeal cancer.
METHODS.
In this retrospective cohort study from the National Cancer Database from 1996 to 2003, patients with known insurance status who were diagnosed with invasive oropharyngeal cancer at Commission on Cancer facilities (n = 40,487) were included. Adjusted and unadjusted logistic regression models were used to analyze the likelihood of presenting with more advanced stage disease.
RESULTS.
After controlling for other sociodemographic characteristics, patients with advanced oropharyngeal cancer at diagnosis were more likely to be uninsured (odds ratio [OR], 1.37; 95% confidence interval [95% CI], 1.21-1.25) or covered by Medicaid (OR, 1.31; 95% CI, 1.19-1.46) compared with patients who had private insurance. Similarly, patients were most likely to present with the largest tumors (T4 disease) if they were uninsured (OR, 2.82; 95% CI, 2.46-3.23) or covered by Medicaid (OR, 2.95; 95% CI, 2.63-3.31). They also were more likely to present with the greatest degree of lymph node involvement (N3) if they were uninsured (OR, 2.06; 95% CI, 1.76-2.40) or covered by Medicaid (OR, 1.66; 95% CI, 1.45-1.90).
CONCLUSIONS.
Individuals who lacked insurance or had Medicaid coverage were at the greatest risk for presenting with advanced oropharyngeal cancer. In the current study, the results for the Medicaid group may have been influenced by the postdiagnostic enrollment of uninsured patients. Insurance coverage appeared to be a highly modifiable predictor of cancer stage. The findings indicated that it is important to consider the impact of insurance coverage on disease stage at diagnosis and associated morbidity, mortality, and quality of life. Cancer 2007. © 2007 American Cancer Society.
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Received: 12 February 2007; Accepted: 13 April 2007
Digital Object Identifier (DOI)
10.1002/cncr.22788 About DOI
Cancer
Volume 110, Issue 2 , Pages 403 - 411
Published Online: 11 Jun 2007
Copyright © 2007 American Cancer Society
Original Article
Insurance status and stage of cancer at diagnosis among women with breast cancer
Michael T. Halpern, MD, PhD *, John Bian, PhD, Elizabeth M. Ward, PhD, Nicole M. Schrag, MSPH, Amy Y. Chen, MD, MPH
Epidemiology and Surveillance Research, American Cancer Society, Atlanta, Georgia
email: Michael T. Halpern (michael.halpern@cancer.org)
*Correspondence to Michael T. Halpern, Strategic Director, Health Services Research, American Cancer Society, 1599 Clifton Road NE, Atlanta, GA 30329-4251
See related editorial on pages 231-3 and related original article on pages 395-402, this issue.
Fax: (404) 327-6450
Keywords
breast neoplasms • outcome assessment • health insurance • health services accessibility • medically uninsured • Medicaid • neoplasm staging • data bases • retrospective studies
Abstract
BACKGROUND
Individuals without medical insurance or with limited insurance are less likely than those with broader insurance coverage to receive preventive services and to seek timely medical care. The authors examined the associations of insurance status with stage at diagnosis among women with breast cancer.
METHODS
This study included women age 40 years who were diagnosed with invasive breast cancer from 1998 to 2003 and who were reported to the National Cancer Data Base. Multivariable logistic regression analyses were used to examine the associations of insurance status with more advanced-stage breast cancer at diagnosis while controlling for other patient characteristics.
RESULTS
Among the 533,715 women with breast cancer who were included in the current analysis, the proportions with advanced-stage (III/IV) cancer at diagnosis ranged from 8% among privately insured patients to 18% among uninsured patients and 19% among Medicaid patients; differences in the proportions of women with advanced-stage cancer were statistically significant (P < .0001). Regression analyses indicated that, compared with privately insured patients, uninsured patients and Medicaid patients had a greater likelihood of diagnosis at stage II (odds ratio [OR], 1.5) or at stages III/IV (OR, 2.4) versus stage I (P < .001). Black and Hispanic patients also were significantly more likely than white patients to be diagnosed at a more advanced stage (P < .001).
CONCLUSIONS
The results from this study provided strong evidence that patients without health insurance or with Medicaid coverage, as well as black and Hispanic patients, were more likely to present with advanced-stage breast cancer. These results are consistent with other reports that have documented less use of preventive services, including mammography, among uninsured women and delays in diagnosis and treatment for black and Hispanic women. Cancer 2007. © 2007 American Cancer Society.
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Received: 9 March 2007; Revised: 22 March 2007; Accepted: 13 April 2007
Digital Object Identifier (DOI)
10.1002/cncr.22786 About DOI
Published Online: 11 Jun 2007
Copyright © 2007 American Cancer Society
Editorial
The adequacy of the access-to-care debate
Looking through the cancer lens
Richard C. Wender, MD 1 2 *§
1American Cancer Society, Atlanta, Georgia
2Department of Family Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
email: Richard C. Wender (stephen.finan@cancer.org)
*Correspondence to Richard C. Wender, Department of Family Medicine, Thomas Jefferson University, 833 Chestnut Street, Suite 301, Philadelphia, PA 19107
See referenced original articles on pages 395-402 and 403-11, this issue.
Richard C. Wender is President of the American Cancer Society and Chair of the Department of Family Medicine at Thomas Jefferson University.
§Fax: (215) 955-9158.
Received: 4 April 2007; Accepted: 9 April 2007
Digital Object Identifier (DOI)
10.1002/cncr.22787 About DOI
Article Text
With more than 46 million uninsured Americans,[1] it is not surprising that much of the focus in the current health care reform debate is on increasing the number of individuals with health insurance coverage. Although this is a commendable objective, it is not about numbers alone. The nation's policymakers also must consider the affordability, availability, and especially the adequacy of that coverage.
The American Cancer Society has formally adopted guiding principles to use in evaluating any health insurance reform proposal. Meaningful reform must include available, affordable, and adequate health insurance coverage without further segmenting the insurance market...In their study, Halpern et al observed that women who were diagnosed with breast cancer and were uninsured or enrolled in Medicaid at the time they initiated therapy were from 2.4 to 2.5 times more likely to be diagnosed at stage III or IV disease than women who were enrolled in private health insurance. Women who were diagnosed with more advanced-stage disease experienced lower survival rates, more debilitating treatment outcomes, and greater long-term treatment-related morbidity...Another study presented in this edition of Cancer by Chen et al provides further evidence of this need, demonstrating that individuals with oropharyngeal cancer who are uninsured or who are enrolled in Medicaid are significantly more likely to be diagnosed with advanced disease than patients who have private insurance.[3]..Breast cancer is the second leading cause of cancer mortality among women. ...The studies by Halpern et al. and Chen et al. help to illustrate that an exclusive focus on the uninsured, although it may be fundamental, is not sufficient.[2][3] Adequacy of coverage and availability of appropriate health care services are equally vital.
...
The American Cancer Society, along with our sister advocacy organization, the American Cancer Society Cancer Action Network, is dedicated to ensuring that primary care, prevention, early detection, and quality care are available to all. Achieving these goals demands health care reform. Framing the health care debate in a way that makes sense for cancer patients, survivors, their caregivers, and the general public will provide a standard by which proposals for reform can be judged. It is time to get this right. Effective solutions to our current crisis must address adequacy and affordability in addition to availability of health care insurance for all.
2 Halpern MT, Bian J, Ward EM, Schrag NM, Chen AY. Insurance status and stage of cancer at diagnosis among women with breast cancer. Cancer. 2007; 110: 403-411. Links
3 Chen AY, Schrag NM, Halpern M, Ward EM. The impact of health insurance status on stage at diagnosis of oropharyngeal cancer. Cancer. 2007; 110: 395-402. Links
...
Edited by adam_kamil, 11 July 2007 - 09:05 PM.
Posted 12 July 2007 - 03:17 AM
Posted 12 July 2007 - 03:18 AM
Posted 04 September 2007 - 04:19 AM
'
Here's a review of SIKCO by one of my all time favorite movie reviewers: A.O. Scott. I have a tendency to bold parts of articles that I really like, but in this case the whole article would be bold; so I won't do that here.
The New York Times: News Source
June 22, 2007
MOVIE REVIEW | 'SICKO'
Open Wide and Say ‘Shame’
Michael Moore heads to Paris to explore universal health care in the documentary "Sicko."
By A. O. SCOTT
It has become a journalistic cliché and therefore an inevitable part of the prerelease discussion of “Sicko” to refer to Michael Moore as a controversial, polarizing figure. While that description is not necessarily wrong, it strikes me as self-fulfilling (since the controversy usually originates in media reports on how controversial Mr. Moore is) and trivial. Any filmmaker, politically outspoken or not, whose work is worth discussing will be argued about. But in Mr. Moore’s case the arguments are more often about him than about the subjects of his movies.
Some of this is undoubtedly his fault, or at least a byproduct of his style. His regular-guy, happy-warrior personality plays a large part in the movies and in their publicity campaigns, and he has no use for neutrality, balance or objectivity. More than that, his polemical, left-populist manner seems calculated to drive guardians of conventional wisdom bananas. That is because conventional wisdom seems to hold, against much available evidence, that liberalism is an elite ideology, and that the authentic vox populi always comes from the right. Mr. Moore, therefore, must be an oxymoron or a hypocrite of some kind.
So the table has been set for a big brouhaha over “Sicko,” which contends that the American system of private medical insurance is a disaster, and that a state-run system, such as exists nearly everywhere else in the industrialized world, would be better. This argument is illustrated with anecdotes and statistics — terrible stories about Americans denied medical care or forced into bankruptcy to pay for it; grim actuarial data about life expectancy and infant mortality; damning tallies of dollars donated to political campaigns — but it is grounded in a basic philosophical assumption about the proper relationship between a government and its citizens.
Mr. Moore has hardly been shy about sharing his political beliefs, but he has never before made a film that stated his bedrock ideological principles so clearly and accessibly. His earlier films have been morality tales, populated by victims and villains, with himself as the dogged go-between, nodding in sympathy with the downtrodden and then marching off to beard the bad guys in their dens of power and privilege. This method can pay off in prankish comedy or emotional intensity — like any showman, Mr. Moore wants you to laugh and cry — but it can also feel manipulative and simplistic.
In “Sicko,” however, he refrains from hunting down the C.E.O.’s of insurance companies, or from hinting at dark conspiracies against the sick. Concentrating on Americans who have insurance (after a witty, troubling acknowledgment of the millions who don’t), Mr. Moore talks to people who have been ensnared, sometimes fatally, in a for-profit bureaucracy and also to people who have made their livings within the system. The testimony is poignant and also infuriating, and none of it is likely to be surprising to anyone, Republican or Democrat, who has tried to see an out-of-plan specialist or dispute a payment.
If you listen to what the leaders of both political parties are saying, it seems unlikely that the diagnosis offered by “Sicko” will be contested. I haven’t heard many speeches lately boasting about how well our health care system works. In this sense “Sicko” is the least controversial and most broadly appealing of Mr. Moore’s movies. (It is also, perhaps improbably, the funniest and the most tightly edited.) The argument it inspires will mainly be about the nature of the cure, and it is here that Mr. Moore’s contribution will be most provocative and also, therefore, most useful.
“Sicko” is not a fine-grained analysis of policy alternatives. (You can find some of those in a recently published book called “Sick,” by Jonathan Cohn, and also in the wonkier precincts of the political blogosphere.) This film presents, instead, a simple compare-and-contrast exercise. Here is our way, and here is another way, variously applied in Canada, France, Britain and yes, Cuba. The salient difference is that, in those countries, where much of the second half of “Sicko” takes place, the state provides free medical care.
With evident glee (and a bit of theatrical faux-naïveté) Mr. Moore sets out to challenge some widely held American notions about socialized medicine. He finds that British doctors are happy and well paid, that Canadians don’t have to wait very long in emergency rooms, and that the French are not taxed into penury. “What’s your biggest expense after the house and the car?” he asks an upper-middle-class French couple. “Ze feesh,” replies the wife. “Also vegetables.”
Yes, the utopian picture of France in “Sicko” may be overstated, but show me the filmmaker — especially a two-time Cannes prizewinner — who isn’t a Francophile of one kind or another. Mr. Moore’s funny valentine to a country where the government will send someone to a new mother’s house to do laundry and make carrot soup turns out to be as central to his purpose as his chat with Tony Benn, an old lion of Old Labor in Britain. Mr. Benn reads from a pamphlet announcing the creation of the British National Health Service in 1948, and explains it not as an instance of state paternalism but as a triumph of democracy.
More precisely, of social democracy, a phrase that has long seemed foreign to the American political lexicon. Why this has been so is the subject of much scholarship and speculation, but Mr. Moore is less interested in tracing the history of American exceptionalism than in opposing it. He wants us to be more like everybody else. When he plaintively asks, “Who are we?,” he is not really wondering why our traditions of neighborliness and generosity have not found political expression in an expansive system of social welfare. He is insisting that such a system should exist, and also, rather ingeniously, daring his critics to explain why it shouldn’t.
SICKO
Opens today in Manhattan.
Written and directed by Michael Moore; edited by Christopher Seward, Dan Sweitlik and Geoffrey Richman; produced by Mr. Moore and Meghan O’Hara; released by Lionsgate and the Weinstein Company. At the Lincoln Square, 1998 Broadway, at 68th Street. Running time: 123 minutes.
Click here to view video on NYtimes site
Published on The Cornell Daily Sun (http://cornellsun.com)
Michael Moore's Half Truth
By Ben Birnbaum
Created Aug 21 2007 - 12:00am
Last week, against my better judgment, I went to see Michael Moore’s new movie Sicko, about the evils of the American health care system. And to my surprise, I enjoyed it ... I really enjoyed it. Though I make no secret of my dislike for Moore as a human being and as a political commentator, I cannot deny his talent as a filmmaker. And politics aside, Sicko is one hell of a movie — alternately hilarious and heartbreaking — though misleading at times and one-sided throughout.
Sicko introduces us to several Americans whose lives have been shattered by the American health care system. We meet one uninsured man who accidentally sawed off two of his fingers and was told that it would cost him $60,000 to reattach his middle finger and $12,000 to reattach his ring finger (ever the romantic, he chose the latter). We meet a middle-aged middle-class couple who have been forced to move into their daughter’s basement after their respective medical conditions cost them their house and most everything else they had. And, most disturbing of all, we meet several 9/11 volunteers now suffering a variety of worksite-related injuries that they can’t afford to address (Moore takes them on a boat trip to Cuba — with a priceless stop at Guantanamo Bay — and they receive superb free care from the communist country’s national health service.)
Despite what some of Moore’s conservative enemies will have you believe, (almost) everything in Sicko is true. Nearly 50 million Americans are uninsured; millions more are underinsured. Not surprisingly, the most common causes of personal bankruptcy in America are medical. Among industrialized nations, America has nearly the lowest average life expectancy and nearly the highest infant mortality rate. Overall, according to the World Health Organization, American health care ranks 37th in the world (right below Dominica and Costa Rica, right above Slovenia and Cuba.) And for that health care, the U.S. spends far more per capita than any other country. Other developed nations, it seems, spend less on health care yet provide their citizens with more. If it were all up to President Moore — shiver — America would join them by junking our for-profit private system for a universal national health service.
But there are other facts, ones Moore leaves out of Sicko, that reveal a more complex picture.
As CNN reported in its review of the movie, American patients, despite their complaints, are the most satisfied in the world. American doctors, though (in my opinion) undercompensated relative to American lawyers, are still the best paid in the world. And perhaps most notably, the American pharmaceutical industry, much maligned in Sicko, has produced more lifesaving drugs per capita than any other countries’.
Canada, Britain and France — the socialized models that Moore praises — aren’t perfect, either. For one, citizens of those countries endure longer waiting times for most procedures than do Americans. And the “free health care” they get isn’t free at all. It’s paid for out of their taxes, which for that reason, are far more burdensome than Americans’. One might miss that watching Sicko because it’s mentioned only once, in passing, and not by Moore. But it bears repeating because Sicko is an argument not just for free health care, but free everything (free college, free vacation, free day care, etc.) What begins as an indictment of the American health care system devolves into one long ode to socialism and the welfare state.
Socialism, it’s true, has become a dirty word in American politics. Whereas many mainstream left-wing parties in Europe proudly call themselves “Socialist,” Democrats in this country run away from the label (even faster than they do from the word “liberal”) But there’s a reason for that: Capitalism has served America well, and Americans know it. Despite the undeniable inequality in this country, the average American is still better off financially than the average Canadian, the average Brit or the average Frenchman. And we’ve gotten to that point because the profit motive, relatively unhindered in America, has encouraged companies like Pfizer to make the best drugs, companies like Apple to make the best new gadgets and people like Michael Moore to make the best documentaries. The desire for money may be the root of all evil, but it’s also the root of all prosperity.
None of this changes the fact that American health care is in need of serious reform — we need some form of universal health insurance — but it casts doubt on Moore’s big-government solution. There are other ways. Lawmakers in my home state of Massachusetts, under the unlikely leadership of Republican Governor (and now presidential candidate) Mitt Romney, recently passed a market-friendly universal health care plan that makes private health insurance mandatory (like car insurance) for those who can afford it and subsidizes it for those who can’t. Most employers are required to cover their workers or pay into a fund that helps cover the state’s uninsured. Democratic candidates for president, most notably John Edwards, are proposing similar plans on a national scale.
We must help the 1 in 6 Americans who don’t have health insurance, but we can do it without screwing over the 5 out of 6 who do.
Ben Birnbaum is a senior in the College of Arts and Sciences. He can be contacted at bhb9@cornell.edu. Infomaniacs Anonymous will appear Tuesdays this semester.
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Source URL:
http://cornellsun.co.....;s-half-truth
August 17, 2007
Helpful Hints for Saving the Planet
By MANOHLA DARGIS
Published: August 17, 2007
Yeah, yeah, yeah, the environment, blah, blah, blah, melting ice caps. To judge from all the gas-guzzlers still fouling the air and the plastic bottles clogging the dumps, it appears that the news that we are killing ourselves and the world with our greed and garbage hasn’t sunk in. That’s one reason “The 11th Hour,” an unnerving, surprisingly affecting documentary about our environmental calamity, is such essential viewing. It may not change your life, but it may inspire you to recycle that old slogan-button your folks pinned on their dashikis back in the day: If you’re not part of the solution, you’re part of the problem.
The problem looks overwhelming, literally, as demonstrated by the images of overflowing landfills and sickeningly polluted bodies of water that flicker through the movie like damning evidence. Structured in mainstream fiction-film fashion (in other words, like a term paper), it opens with an introduction that presents the case, builds momentum with an absorbing analytical middle section and wraps up with just enough optimism that I didn’t want to run home and stick my head in an energy-efficient oven. No matter how well intentioned, political documentaries that present problems without real-life, real-time, real-people solutions — an 800 number, an address, something — just add to the noise (pollution), becoming another title on some filmmaker’s résumé as well as a temporary salve for the audience’s guilt.
Written and directed by the sisters Leila Conners Petersen and Nadia Conners, and narrated on- and off-camera by Leonardo DiCaprio, who served as one of the producers, “The 11th Hour” attempts to stave off helplessness, and the nihilism that often follows it, mostly by appealing to our reason.
In one interview snippet after another, dozens of scientists, activists, gurus, policy types and even a magical-mushroom guy go through the arguments, present the data and criticize the anti-green faction, putting words to the images that are liberally interspersed between these talking heads like mortar. Every so often, Mr. DiCaprio pops up on screen to interrupt this show and tell, squinting into the camera and pushing the narrative to the next topic.
If your head isn’t lodged in the sand, much of what’s said in the movie will be agonizing and familiar. Gasping children, disappearing animals, gushing oil, billowing smoke, dying lakes, emptying forests, warming weather — the list of ills is numbingly familiar. In the movie’s eye-catching opener, the directors riffle through a veritable catalog of timely snapshots, some obvious (a smoggy skyline), others less so (a human fetus).
Effectively blunt, this sequence provoked a colleague to invoke the name of the avant-garde giant Stan Brakhage, but the truer visual and structural model here is a film like “Koyaanisqatsi,” with its streaming global landscapes. The difference is that the images in “The 11th Hour” are pointedly horrifying, not reassuring, pacific or aestheticized.
That can make it tough to watch, which the directors clearly know. They whip through the pictures and the interviews fast — at times a little too fast — and keep the information flowing as quickly as the visuals. This swift, steady pace means that you receive a lot of bad news from a lot of different sources. The ecologist Brock Dolman explains, “When we started feeding off the fossil fuel cycle, we began living with a death-based cycle.” From there the topic nimbly jumps to climate change, national security (courtesy the former director of the C.I.A., R. James Woolsey), Katrina, asthma and the stunning news from the oceanographer and author Sylvia Earle that “we’ve lost 90 percent of most of the big fish in the sea.”
Yes, it’s bad, but it’s not over yet. Many of those same sober talking heads also argue with equal passion that we can save ourselves, along with the sky above us and the earth below. The capacity for human beings to fight, to rise to the occasion, as Mr. Woolsey notes, invoking America’s rapid, albeit delayed jump into World War II, gives hope where none might seem possible.
It is our astonishing capacity for hope that distinguishes “The 11th Hour” and that speaks so powerfully, in part because it is this all-too-human quality that may finally force us to fight the good fight against the damage we have done and continue to do. As the saying goes, keep hope alive — and if you’re holding this review in your hands, don’t forget to recycle the paper.
“The 11th Hour” is rated PG (Parental guidance suggested). It has freakily scary environmental images.
THE 11TH HOUR
Opens today in New York and Los Angeles.
Written and directed by Leila Conners Petersen and Nadia Conners; narrated by Leonardo DiCaprio; directors of photography, Peter Youngblood Hills and Andrew Rowlands; edited by Pietro Scalia and Luis Alvarez y Alvarez; music by Jean-Pascal Beintus and Eric Avery; production designer, Ms. Conners; produced by Mr. DiCaprio, Ms. Petersen, Chuck Castleberry and Brian Gerber; released by Warner Independent Pictures. Running time: 91 minutes.
Copyright 2007 The New York Times Company
Posted 04 September 2007 - 05:37 PM
Posted 04 September 2007 - 05:45 PM
because Moore makes a fairly compelling argument that the system is broken, but not on how to fix it.
Posted 04 September 2007 - 06:09 PM
Posted 04 September 2007 - 11:55 PM
The WHO judged a country's quality of health on life expectancy. But that's a lousy measure of a health-care system. Many things that cause premature death have nothing do with medical care. We have far more fatal transportation accidents than other countries. That's not a health-care problem.
Similarly, our homicide rate is 10 times higher than in the U.K., eight times higher than in France, and five times greater than in Canada.
When you adjust for these "fatal injury" rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation.
Diet and lack of exercise also bring down average life expectancy.
Another reason the U.S. didn't score high in the WHO rankings is that we are less socialistic than other nations. What has that got to do with the quality of health care? For the authors of the study, it's crucial. The WHO judged countries not on the absolute quality of health care, but on how "fairly" health care of any quality is "distributed." The problem here is obvious. By that criterion, a country with high-quality care overall but "unequal distribution" would rank below a country with lower quality care but equal distribution.
It's when this so-called "fairness," a highly subjective standard, is factored in that the U.S. scores go south.
Anyway, insurance is a terrible way to pay for things. It burdens us with paperwork, invites cheating and, worst of all, creates a moral hazard that distorts incentives. It raises costs by insulating consumers from medicine's real prices. Suppose you had grocery insurance. With your employer paying 80 percent of the bill, you would fill the cart with lobster and filet mignon. Everything would cost more because supermarkets would stop running sales. Why should they, when their customers barely care about the price? Suppose everyone had transportation insurance. The roads would be crowded with Mercedes. Why buy a Chevy if your employer pays? People have gotten so used to having "other" people pay for most of our health care that we routinely ask for insurance with low or no deductibles. This is another bad idea. Suppose car insurance worked that way. Every time you got a little dent or the paint faded, or every time you buy gas or change the oil, you'd fill out endless forms and wait for reimbursement from your insurance company. Gas prices would quickly rise because service stations would know that you no longer care about the price. You'd become more wasteful: jackrabbit starts, speeding, wasting gas. Who cares? You are only paying 20 percent or less of the bill.
Insurance invites waste. That's a reason health care costs so much, and is often so consumer-unfriendly. In the few areas where there are free markets in health care -- such as cosmetic medicine and Lasik eye surgery -- customer service is great, and prices continue to drop.
Posted 05 September 2007 - 03:56 AM
Sure, but health care is not like buying groceries. Occasionally catastrophic events come along; that is really what you should have insurance for. My recent 6 week hospital stay came to $587,000.00, according to the bill they sent me. That's what it would have cost me if I didn't have insurance. However, the insurance company paid them a negotiated rate of $120,000.00, and that was that. One might consider having only catastrophic coverage, i.e. a really huge deductible, but unless everyone did this, the advantages of competition would not occur, and you would pay absurd rates for all the small things. The negotiated rates also apply at the low end of the scale, and without benefit of those, you just get killed. I'll note that competition IS occurring now, in the form of the negotiated rates. Rising copays are probably starting to suppress some needless healthcare, though certainly not all of it. Does Stossel have a plan that improves upon the present situation? Maybe what we need is a healthcare buying cooperative; sort of a Costco for healthcare, along with catastrophic insurance coverage.Anyway, insurance is a terrible way to pay for things.
Posted 05 September 2007 - 04:40 AM
Posted 05 September 2007 - 03:14 PM
WHO's assessment system was based on five indicators: overall level of population health; health inequalities (or disparities) within the population; overall level of health system responsiveness (a combination of patient satisfaction and how well the system acts); distribution of responsiveness within the population (how well people of varying economic status find that they are served by the health system); and the distribution of the health system's financial burden within the population (who pays the costs).
Responsiveness: The nations with the most responsive health systems are the United States, Switzerland, Luxembourg, Denmark, Germany, Japan, Canada, Norway, Netherlands and Sweden. The reason these are all advanced industrial nations is that a number of the elements of responsiveness depend strongly on the availability of resources. In addition, many of these countries were the first to begin addressing the responsiveness of their health systems to people's needs.
Fairness of financial contribution: When WHO measured the fairness of financial contribution to health systems, countries lined up differently. The measurement is based on the fraction of a household's capacity to spend (income minus food expenditure) that goes on health care (including tax payments, social insurance, private insurance and out of pocket payments). Colombia was the top-rated country in this category, followed by Luxembourg, Belgium, Djibouti, Denmark, Ireland, Germany, Norway, Japan and Finland.
Colombia achieved top rank because someone with a low income might pay the equivalent of one dollar per year for health care, while a high- income individual pays 7.6 dollars.
Overall Level of Health: A good health system, above all, contributes to good health. To assess overall population health and thus to judge how well the objective of good health is being achieved, WHO has chosen to use the measure of disability- adjusted life expectancy (DALE). This has the advantage of being directly comparable to life expectancy and is readily compared across populations. The report provides estimates for all countries of disability- adjusted life expectancy. DALE is estimated to equal or exceed 70 years in 24 countries, and 60 years in over half the Member States of WHO. At the other extreme are 32 countries where disability- adjusted life expectancy is estimated to be less than 40 years. Many of these are countries characterised by major epidemics of HIV/ AIDS, among other causes.
Distribution of Health in the Populations: It is not sufficient to protect or improve the average health of the population, if - at the same time - inequality worsens or remains high because the gain accrues disproportionately to those already enjoying better health. The health system also has the responsibility to try to reduce inequalities by prioritizing actions to improve the health of the worse-off, wherever these inequalities are caused by conditions amenable to intervention. The objective of good health is really twofold: the best attainable average level – goodness – and the smallest feasible differences among individuals and groups – fairness. A gain in either one of these, with no change in the other, constitutes an improvement.
Distribution of Financing: There are good and bad ways to raise the resources for a health system, but they are more or less good primarily as they affect how fairly the financial burden is shared.
A fair distribution of healthcare financing health care (whether the burden of health costs is fairly distributed based on ability to pay, so that everyone is equally protected from the financial risks of illness)
Edited by hrc579, 06 September 2007 - 01:00 AM.
Posted 05 September 2007 - 04:34 PM
Posted 05 September 2007 - 05:10 PM
Asian men in California lived to an average age of 80, and Asian women lived to an average age of 85, with common causes of death that included heart disease, cancer, strokes and aneurysms;
Hispanic men in California lived to an average age of 77, and Hispanic women lived to an average age of 83, with common causes of death that included heart disease, cancer and diabetes;
White men in California lived to an average age of 75, and white women lived to an average age of 80, with common causes of death that included heart disease and cancer; and
Black men in California lived to an average age of 68, and black women lived to an average age of 75, with common causes of death that included heart disease and cancer.
Racial disparity in IMRs has not been explained fully by differences in socioeconomic status. Black infants born to college-educated parents have higher IMRs than white infants born to parents of similar educational background; this difference is attributed to a higher rate of very low birthweight.
Despite higher poverty and lower education rates, Hispanic infants have higher birthweights and their IMRs approximate those of white infants. This finding is consistent with previous studies [9] and contradicts common assumptions about poor, underserved minority groups. Cultural practices, family support, selective migration, diet, and genetic heritage are possible contributing factors [9]. Furthermore, U.S. Hispanics are a heterogeneous group, and IMRs are higher among Puerto Rican infants [10]. In Philadelphia, 79% of Hispanic births were born to Puerto Rican mothers, possibly explaining the higher IMR in that city.
Edited by hrc579, 06 September 2007 - 09:12 PM.
Posted 06 September 2007 - 01:49 AM
Posted 06 September 2007 - 02:21 AM
Posted 06 September 2007 - 03:27 AM
Again, show me something better. The WHO might not be great, but if you think that their rankings of death rates and things are bad, then find a better ranking system. (or create one yourself I guess)
Edited by hrc579, 06 September 2007 - 03:48 AM.
Posted 06 September 2007 - 04:33 AM
Posted 06 September 2007 - 02:45 PM
For patients diagnosed with solid tumours in 2000 to 2002, the survival rate was lower in Europe than the USA. 5 year survival for all cancers in the USA was 66.3 per cent for men and 62.9 per cent for women. These figures are significantly better than the European cancer survival rates for the same period: 47.3 per cent for men and 55.8 per cent for women.
The evidence is unmistakable: Europe's pharmaceutical industry is in the midst of a long and steady decline, and Europe's bio–tech industry is lagging significantly behind its American counterpart. What is also clear—but far more controversial—is that by adopting certain aspects of the American R&D system, Europeans could regain their innovative and competitive edge.
Some of the key ingredients of America's thriving biopharmaceutical sector: a system of free pricing of drugs (almost inconceivable in Europe); great dynamism in the bio–tech sector due to a pool of active venture capital; direct–to–consumer advertising of prescription drugs; flexible labor laws and an entrepreneurial spirit; an active and often symbiotic connection between academic scientists and private industry; and a limited role of the state in the R&D process, with private R&D preferred over the large–scale sponsoring of research by the state
Ultimately, lost or constrained innovation impacts public health. Access to new drugs, for instance, is far superior for American consumers than European ones. For cancer patients, access to new drugs is crucial: a report by the Swedish Karolinska Institute, published in the Annals of Oncology, found that "The United States has been the country of first launch for close to half of the oncology drugs brought to the market in the past 11 years." The authors of the report observe that "Nearly half of the observed improvement in the 2–year cancer survival rate between 1992 and 2000 at 50 US cancer centers could be attributed to the use of new cancer drugs," evidence that America's embrace of new medicines translates into saved human lives.
Edited by hrc579, 06 September 2007 - 09:09 PM.
Posted 06 September 2007 - 10:12 PM
But the American health care system may be performing better than it seems at first glance. When it comes to medical innovation, the United States is the world leader. In the last 10 years, for instance, 12 Nobel Prizes in medicine have gone to American-born scientists working in the United States, 3 have gone to foreign-born scientists working in the United States, and just 7 have gone to researchers outside the country.
The six most important medical innovations of the last 25 years, according to a 2001 poll of physicians, were magnetic resonance imaging and computed tomography (CT scan); ACE inhibitors, used in the treatment of hypertension and congestive heart failure; balloon angioplasty; statins to lower cholesterol levels; mammography; and coronary artery bypass grafts. Balloon angioplasty came from Europe, four innovations on the list were developed in American hospitals or by American companies (although statins were based on earlier Japanese research), and mammography was first developed in Germany and then improved in the United States. Even when the initial research is done overseas, the American system leads in converting new ideas into workable commercial technologies.
In real terms, spending on American biomedical research has doubled since 1994. By 2003, spending was up to $94.3 billion (there is no comparable number for Europe), with 57 percent of that coming from private industry. The National Institutes of Health’s current annual research budget is $28 billion, All European Union governments, in contrast, spent $3.7 billion in 2000, and since that time, Europe has not narrowed the research and development gap. America spends more on research and development over all and on drugs in particular, even though the United States has a smaller population than the core European Union countries.
From 1989 to 2002, four times as much money was invested in private biotechnology companies in America than in Europe. Dr. Boehm argues that the research environment in the United States, compared with Europe, is wealthier, more competitive, more meritocratic and more tolerant of waste and chaos. He argues that these features lead to more medical discoveries. About 400,000 European researchers are living in the United States, usually for superior financial compensation and research facilities. Medical innovations improve health and life expectancy in all wealthy countries, not just in the United States.
The gains from medical innovations are high. For instance, increases in life expectancy resulting from better treatment of cardiovascular disease from 1970 to 1990 have been conservatively estimated as bringing benefits worth more than $500 billion a year. And that is just for the United States
The American health care system, high expenditures and all, is driving innovation for the entire world.
Posted 06 September 2007 - 10:42 PM
More robust statistical analysis confirms that health care spending is not related to life expectancy. Studies of multiple countries using regression analysis found no significant relationship between life expectancy and the number of physicians and hospital beds per 100,000 population or health care expenditures as a percentage of GDP. Rather, life expectancy was associated with factors such as sanitation, clean water, income, and literacy rate.8 A recent study examined cross-national data from 1980 to 1998. Although the regression model used initially found an association between health care expenditure and life expectancy, that association was no longer significant when gross domestic product (GDP) per capita was added to the model.9 Indeed, GDP per capita is one of the more consistent predictors of life expectancy.
et the United States has the highest GDP per capita in the world, so why does it have a life expectancy lower than most of the industrialized world? The primary reason is that the U.S. is ethnically a far more diverse nation than most other industrialized nations. Factors associated with different ethnic backgrounds - culture, diet, etc. - can have a substantial impact on life expectancy. Comparisons of distinct ethnic populations in the U.S. with their country of origin find similar rates of life expectancy. For example, Japanese-Americans have an average life expectancy similar to that of Japanese.10
A good deal of the lower life expectancy rate in the U.S. is accounted for by the difference in life expectancy of African-Americans versus other populations in the United States. Life expectancy for African-Americans is about 72.3 years, while for whites it is about 77.7 years.11 What accounts for the difference? Numerous scholars have investigated this question.12 The most prevalent explanations are differences in income and personal risk factors. One study found that about one-third of the difference between white and African-American life expectancies in the United States was accounted for by income; another third was accounted for by personal risk factors such as obesity, blood pressure, alcohol intake, diabetes, cholesterol concentration, and smoking and the final third was due to unexplained factors.13 Another study found that much of the disparity was due to higher rates of HIV, diabetes and hypertension among African Americans.14 Even studies that suggest the health care system may have some effect on the disparity still emphasize the importance of factors such as income, education, and social environment.15
Hopefully such difficulties can be resolved as the project progresses. In the meantime, policymakers, pundits and reporters should stop referring to life expectancy and infant mortality as meaningful comparative measures of health care systems.
Posted 06 September 2007 - 11:25 PM
Posted 08 September 2007 - 02:58 AM
Posted 16 October 2007 - 07:30 PM
Posted 12 November 2008 - 07:18 PM
Edited by abilash81, 12 November 2008 - 07:19 PM.
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