Via a NYT article on teenagers with cancer:
Clinical trials for this age group have led to some breakthroughs — especially when it comes to acute lymphoblastic leukemia, the form of cancer Simone Weinstein had, said Dr. Crystal L. Mackall, chief of the pediatric oncology branch of the National Cancer Institute.
Teenagers with this type of leukemia, often called A.L.L., do not fare as well as younger children with what appears to be the exact same disease, a discrepancy that has baffled oncologists. But when researchers compared teenagers treated by pediatric oncologists with those treated by adult cancer doctors, they found that the first group did remarkably better.
“When we saw the differences, I was floored,” said Dr. Wendy Stock, director of the leukemia program at the University of Chicago Medical Center. “It wasn’t a subtle 5-percentage-point difference, but a 30-percentage-point difference in survival.”
Now the pediatric protocol is being offered to teenagers through clinical trial sites. Dr. Stock and others are trying to figure out what factors are responsible for the better outcomes, and whether the greater survival is because of the treatment protocol itself or other factors, like the more structured environment of a pediatric center or pediatric oncologists’ greater familiarity with A.L.L.
Filed under: Healthcare
A much-discussed topic in this house (with parentals working for / formerly working for insurance companies).
There’s lots of pros and cons with the current system and the new system proposed by Congress. I’m not going to get into it – that’s better left to Steph.
Finally, as a footnote, I’m not quite sure how accurate all of this is (although it’s from Wonk, so it should be). But, it’s a pretty cool representation.
Alex is dead on (btw, Steph and I had this same conversation yesterday morning…)
Via Steve Benen, here’s something from Paul Begala written last August that should be kept in mind as the debate over the Stupak Amendment unfolds over the next few weeks:
No self-respecting liberal today would support Franklin Roosevelt’s original Social Security Act. It excluded agricultural workers — a huge part of the economy in 1935, and one in which Latinos have traditionally worked. It excluded domestic workers, which included countless African Americans and immigrants. It did not cover the self-employed, or state and local government employees, or railroad employees, or federal employees or employees of nonprofits. It didn’t even cover the clergy. FDR’s Social Security Act did not have benefits for dependents or survivors. It did not have a cost-of-living increase. If you became disabled and couldn’t work, you got nothing from Social Security.If that version of Social Security were introduced today, progressives like me would call it cramped, parsimonious, mean-spirited and even racist. Perhaps it was all those things. But it was also a start. And for 74 years we have built on that start. We added more people to the winner’s circle: farmworkers and domestic workers and government workers. We extended benefits to the children of working men and women who died. We granted benefits to the disabled. We mandated annual cost-of-living adjustments. And today Social Security is the bedrock of our progressive vision of the common good.
Politics is the art of the possible, not the perfect. I understand this specific issue is a very, verybig deal to some people. But big enough to sink a once in a generation chance at meaningful heath care reform?
As with all legislation, these reforms can always be altered and improved later on, particularly because the major provisions don’t take effect for as many as 3 or 4 years. If it cannot be corrected now, it can always be corrected later. But if this bill fails to pass, we lose everything in it. There is no a la carte option here.
Lieberman is willing to let the whole thing die because of the public option, exhibiting a level of self-interested short-sightedness that drives his opponents on the left nuts. But now, some of his fiercest critics want to draw a similar line over abortion funding. And so I have to ask: would the women that so many are fighting to defend be better off with a reformed system that doesn’t provide insurance coverage for abortions, or with no reform at all? Because if this fight is pushed too far, those will be the choices.
I’m not saying that this isn’t a fight worth having. If you believe it is, then fight! But as you do, keep the biggest possible picture in mind.
Val’s coverage of Congressman Larson’s town hall yesterday in my hometown. Taking down the critics, one by one:
Yesterday, I attended the town hall health care forum with Congressman John Larson and an excellent panel of speakers. I happen to come across a blog post by Rick Green on his Courant.com blog, CTConfidential, entitled, “Paranoia runs deep: Read memo from CT Tea Party Central!.” Green’s commentary focuses on a memo that was sent to “Liberty Supporters” about yesterday’s event. The memo states that:
“[T]here were many of our people who showed up at the West Hartford town hall and although we were not allowed to go inside – because the room was packed with Obamacare supporters…we had plenty of people outside protesting and shouting down the other side.
Larson’s folks bused people in – I hear that some came from Massachusetts. There were a bunch of kids – like 12 year olds … also SEIU people and Planned Parenthood people and union employees … plus some high school and college kids – who clearly did not know what they were asking for or what this issue is really about.” Full article.
I am a proud resident of West Hartford, Connecticut. I say proud because residents in my town, like many others, have a longtime reputation for being actively involved in our community. We regularly come out to town hall gatherings to hear from our elected officials and others on any given issue that is important to us. In fact, this is one of the reasons why we have one of the best K-12 public school systems in the country, and enjoy one of the highest voter turnout rates in our state. Moreover, when there is a town hall gathering on a critical issue close to us all, we all know to arrive early, or at the very least on time, to ensure that we get not just a seat, but a good seat.
There were no buses at yesterday’s event. There was a large representation from the community (and the first CD), i.e., elderly/retired citizens, small business owners, families, clergy, students, community activists, elected officials, as well as groups and organizations that are, in fact, a part of every community. In other words, do some of us belong to unions, to organizations, such as Planned Parenthood, AARP? Are some of us community activists, members of the Faith community, and more? Are some of us students? Do we come out as a family? Yes to all of these and more.
As for those who oppose some of the proposals of health insurance reform, I found that the majority of these individuals stayed clear of a relatively small group of loud hecklers. Once inside, one man who stated that he opposed health care reform called out for hecklers in the rear of the room to stop heckling so that we could hear what the speaker was saying. It was clear that the majority of participants, regardless of their personal viewpoint, wanted to hear from Congressman Larson and the excellent panel that was there.
Rallies are all about a call to action for a cause through signs, slogans, buttons, stickers, handouts etc. Prior to the forum, both sides rallied outside on the green in front of town hall.
Just prior to the forum, supporters of health insurance reform hosted a press conference outside on the front steps of town hall. Clergy and speakers did their best to be heard over those who shouted at them in opposition. The most heart-wrenching scene was the shouting at a person who shared their story of health insurance denial, sickness, loss and despair by those in opposition stating that they did not care about that person’s problems. This is heartless and shows a complete lack of humanity in every way.
To disagree on an issue or policy proposal on how we will accomplish health insurance reform provides for a healthy debate and allows for a diverse pool of thoughts and ideas, when done constructively. To deliberately stop the flow of dialog at all costs, to disparage those who, of no consequence of their own doing, become victims of our broken health insurance system, is despicable and unconscionable behavior that creates no value for anyone.
We must all call on our sense of humanity and engage in meaningful dialog. It matters not what our personal viewpoint on health insurance reform is. We are all in this boat together and there is a hole in the floor of the boat called health insurance costs. If we do not act constructively to close that hole, we will all sink.
Filed under: Healthcare
Wondering about some of the things you’ve heard about the new healthcare plan. The AP brings together the claims and the facts:
CLAIM: The Democrats’ plans will lead to rationing, or the government determining which medical procedures a patient can have.
“Expanding government health programs will hasten the day that government rations medical care to seniors,” conservative writer Michael Cannon said in the Washington Times.
THE FACTS: Millions of Americans already face rationing, as insurance companies rule on procedures they will cover.
Denying coverage for certain procedures might increase under proposals to have a government-appointed agency identify medicines and procedures best suited for various conditions.
Obama says the goal is to identify the most effective and efficient medical practices, and to steer patients and providers to them. He recently told a forum: “We don’t want to ration by dictating to somebody, ‘OK, you know what? We don’t think that this senior should get a hip replacement.’ What we do want to be able to do is to provide information to that senior and to her doctor about, you know, this is the thing that is going to be most helpful to you in dealing with your condition.”
How can the stress of poverty affect a child? How is this related to policy? What can be done?
The Economist sums it up (article in full):
I am just a poor boy though my story’s seldom told
Apr 2nd 2009
From The Economist print editionHow poverty passes from generation to generation is now becoming clearer. The answer lies in the effect of stress on two particular parts of the brain
PanosTHAT the children of the poor underachieve in later life, and thus remain poor themselves, is one of the enduring problems of society. Sociologists have studied and described it. Socialists have tried to abolish it by dictatorship and central planning. Liberals have preferred democracy and opportunity. But nobody has truly understood what causes it. Until, perhaps, now.
The crucial breakthrough was made three years ago, when Martha Farah of the University of Pennsylvania showed that the working memories of children who have been raised in poverty have smaller capacities than those of middle-class children. Working memory is the ability to hold bits of information in the brain for current use—the digits of a phone number, for example. It is crucial for comprehending languages, for reading and for solving problems. Entry into the working memory is also a prerequisite for something to be learnt permanently as part of declarative memory—the stuff a person knows explicitly, like the dates of famous battles, rather than what he knows implicitly, like how to ride a bicycle.
Dr Evans’s and Dr Schamberg’s volunteers were 195 participants in a long-term sociological and medical study that Dr Evans is carrying out in New York state. At the time, the participants were 17 years old. All are white, and the numbers of men and women are about equal.
Stress in the city
To measure the amount of stress an individual had suffered over the course of his life, the two researchers used an index known as allostatic load. This is a combination of the values of six variables: diastolic and systolic blood pressure; the concentrations of three stress-related hormones; and the body-mass index, a measure of obesity. For all six, a higher value indicates a more stressful life; and for all six, the values were higher, on average, in poor children than in those who were middle class. Moreover, because Dr Evans’s wider study had followed the participants from birth, the two researchers were able to estimate what proportion of each child’s life had been spent in poverty. That more precise figure, too, was correlated with the allostatic load.
The capacity of a 17-year-old’s working memory was also correlated with allostatic load. Those who had spent their whole lives in poverty could hold an average of 8.5 items in their memory at any time. Those brought up in a middle-class family could manage 9.4, and those whose economic and social experiences had been mixed were in the middle.
These two correlations do not by themselves prove that chronic stress damages the memory, but Dr Evans and Dr Schamberg then applied a statistical technique called hierarchical regression to the results. They were able to use this to remove the effect of allostatic load on the relationship between poverty and memory discovered originally by Dr Farah. When they did so, that relationship disappeared. In other words, the diminution of memory in the poorer members of their study was entirely explained by stress, rather than by any more general aspect of poverty.
To confirm this result, the researchers also looked at characteristics such as each participant’s birthweight, his mother’s age when she gave birth, the mother’s level of education and her marital status, all of which differ, on average, between the poor and the middle classes. None of these characteristics had any effect. Nor did a mother’s own stress levels.
That stress, and stress alone, is responsible for damaging the working memories of poor children thus looks like a strong hypothesis. It is also backed up by work done on both people and laboratory animals, which shows that stress changes the activity of neurotransmitters, the chemicals that carry signals from one nerve cell to another in the brain. Stress also suppresses the generation of new nerve cells in the brain, and causes the “remodelling” of existing ones. Most significantly of all, it shrinks the volume of the prefrontal cortex and the hippocampus. These are the parts of the brain most closely associated with working memory.
Children with stressed lives, then, find it harder to learn. Put pejoratively, they are stupider. It is not surprising that they do less well at school, end up poor as adults and often visit the same circumstances on their own children.
Dr Evans’s and Dr Schamberg’s study does not examine the nature of the stress that the children of the poor are exposed to, but it is now well established that poor adults live stressful lives, and not just for the obvious reason that poverty brings uncertainty about the future. The main reason poor people are stressed is that they are at the bottom of the social heap as well as the financial one.
Sir Michael Marmot, of University College London, and his intellectual successors have shown repeatedly that people at the bottom of social hierarchies experience much more stress in their daily lives than those at the top—and suffer the consequences in their health. Even quite young children are socially sensitive beings and aware of such things.
So, it may not be necessary to look any further than their place in the pecking order to explain what Dr Evans and Dr Schamberg have discovered in their research into the children of the poor. The Bible says, “the poor you will always have with you.” Dr Evans and Dr Schamberg may have provided an important part of the explanation why.
Passed in the House 303-115. It had passed in the Senate earlier last week.
Here’s what Pelosi had to say.
Congrats Andrew!
