The Insulin Wars and other health news

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How insurance companies farm out their dirty work to doctors and patients.

“Doctor, could you please redo my insulin prescription? The one you gave me is wrong.” My patient’s frustration was obvious over the phone. She was standing at the pharmacy, unable to get her diabetes medication.

We had gone through this just the week before. I’d prescribed her the insulin she’d been on, at the correct dosage, but when she showed up at her pharmacy she learned that her insurance company no longer covered that brand. After a series of phone messages back and forth, I’d redone the prescription with what I’d thought was the correct insulin, but I was apparently wrong. Again.

Between 2002 and 2013, prices tripled for some insulins. Many cost around $300 a vial, without any viable generic alternative. Most patients use two or three vials a month, but others need the equivalent of four. Self-rationing has become common as patients struggle to keep up. In the short term, fluctuating blood sugar levels can lead to confusion, dehydration, coma, even death. In the long term, poorly controlled diabetes is associated with heart attacks, strokes, blindness, amputation and the need for dialysis.

The exorbitant prices confound patients and doctors alike since insulin is nearly a century old now. The pricing is all the more infuriating when one considers that the discoverers of insulin sold the patent for $1 each to ensure that the medication would be affordable. Today the three main manufacturers of insulin are facing a lawsuit accusing them of deceptive pricing schemes, but it could be years before this yields any changes... (continues)
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Scientist Who Edited Babies’ Genes Is Likely to Face Charges in China

HONG KONG — A Chinese scientist who claimed to have created the world’s first genetically edited babies “seriously violated” state regulations, according to the results of an initial government investigation reported on Monday by Chinese state media.

The investigators’ findings indicate that the scientist, He Jiankui, and his collaborators are likely to face criminal charges.

Dr. He shocked the world in November when he announced that he had used Crispr, a powerful gene-editing technique, to alter the genes of human embryos. He produced some data but no definitive proof during his presentation at an international conference in Hong Kong.

The investigation found that Dr. He and his team had edited the genes of human embryos and then implanted the embryos in female volunteers, as he claimed last year. One volunteer gave birth to twin girls in November, and another volunteer is now pregnant, according to Xinhua, the Chinese state news agency... (continues)
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Why Infants May Be More Likely to Die in America Than Cuba

Many Americans would welcome some traits of the island’s free, universal health care system.

HAVANA — Claudia Fernández, 29, is an accountant whose stomach bulges with her first child, a girl, who is due in April.

Fernández lives in a cramped apartment on a potholed street and can’t afford a car. She also gets by without a meaningful vote or the right to speak freely about politics. Yet the paradox of Cuba is this: Her baby appears more likely to survive than if she were born in the United States.

Cuba is poor and repressive with a dysfunctional economy, but in health care it does an impressive job that the United States could learn from. According to official statistics (about which, as we’ll see, there is some debate), the infant mortality rate in Cuba is only 4.0 deaths per 1,000 live births. In the United States, it’s 5.9.

In other words, an American infant is, by official statistics, almost 50 percent more likely to die than a Cuban infant. By my calculations, that means that 7,500 American kids die each year because we don’t have as good an infant mortality rate as Cuba reports... (continues)
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Study Links Drug Maker Gifts for Doctors to More Overdose Deaths https://nyti.ms/2HiWfEP
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How to Inoculate Against Anti-Vaxxers https://nyti.ms/2RRZ83y
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Stuck and Stressed: The Health Costs of Traffic
The physical and psychological toll of brutal commutes can be considerable.

Sometimes the seemingly small things in life can be major stressors.

Nobody likes sitting in traffic, for example. According to one study, commuting is one of the least pleasant things we do. But it’s not just an annoying time waster — there’s a case that it’s a public health issue.

According to analysis by the Texas A&M Transportation Institute, the average American commuter spends 42 hours per year stuck in rush-hour traffic. In the Los Angeles area, the figure is nearly twice that, equivalent to more than three days. A 2015 Los Angeles Times pollfound that among residents of that city, traffic concerns exceed those pertaining to personal safety, finances or housing costs.

The total cost of traffic associated with lost time and wasted fuel exceeds $100 billion per year. As time slips away, idling vehicles add pollution, which has environmental and health consequences, including contributions to climate change. Long-term exposure to vehicle exhaust is associated with respiratory problems, especially in children.

Another toll is to psychological well-being, stemming from the sense of helplessness we experience in traffic, and its unpredictability. This, too, can be quantified. One study found that to save a minute of time spent in traffic, people would trade away five minutes of any other leisure activity. Another study found that we deal better with the commuting delays that we can anticipate... (continues)==
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