Lead Plaintiff in Anti-Reform Case Declares Bankruptcy, Partly Due to Medical Bills

File under irony, along with genuine sympathy for this family’s plight.

Mary Brown, a 56-year-old Florida woman who owned a small auto repair shop but had no health insurance, became the lead plaintiff challenging President Obama‘s healthcare law because she was passionate about the issue.

Brown “doesn’t have insurance. She doesn’t want to pay for it. And she doesn’t want the government to tell her she has to have it,” said Karen Harned, a lawyer for the National Federation of Independent Business. Brown is a plaintiff in the federation’s case, which the Supreme Court plans to hear later this month.

But court records reveal that Brown and her husband filed for bankruptcy last fall with $4,500 in unpaid medical bills. Those bills could change Brown from a symbol of proud independence into an example of exactly the problem the healthcare law was intended to address.

The central issue before the Supreme Court is whether the government can require people to buy health insurance. Under the law, those who fail to buy insurance after 2014 could face a fine of up to $700.

The business federation, along with other critics of the law, calls the insurance mandate a “threat to individual liberty” that violates the Constitution.

Obama administration lawyers argue that the requirement is justified because everyone, sooner or later, needs healthcare. Those who fail to have insurance are at high risk of running up bills they cannot pay, sticking the rest of society with the cost, they argue. Brown’s situation, they say, is a perfect example of exactly that kind of “uncompensated care that will ultimately be paid by others.”

Decision to Include Pink Slime in School Lunches Shines Spotlight on Fundamental Conflicts at USDA

I wish could say that this is fiction, but it’s not.

Pink slime — that ammonia-treated meat in a bright Pepto-bismol shade — may have been rejected by fast food joints like McDonald’s, Taco Bell and Burger King, but is being brought in by the tons for the nation’s school lunch program.

The U.S. Department of Agriculture is purchasing 7 million pounds of the “slime” for school lunches, The Daily reports. Officially termed “Lean Beef Trimmings,” the product is a ground-up combination of beef scraps, cow connective tissues and other beef trimmings that are treated with ammonium hydroxide to kill pathogens like salmonella and E. coli. It’s then blended into traditional meat products like ground beef and hamburger patties.

We originally called it soylent pink,” microbiologist Carl Custer, who worked at the Food Safety Inspection Service for 35 years, told The Daily. “We looked at the product and we objected to it because it used connective tissues instead of muscle. It was simply not nutritionally equivalent [to ground beef]. My main objection was that it was not meat.”

Custer and microbiologist Gerald Zernstein concluded in a study that the trimmings are a “high risk product,” but Zernstein tells The Daily that “scientists in D.C. were pressured to approve this stuff with minimal safety approval” under President George H.W. Bush’s administration. The USDA asserts that its ground beef purchases “meet the highest standard for food safety.”

USDA school lunch policy is fundamentally conflicted, as is all USDA policy. In essence, the agency serves two masters whose agendas are frequently at odds with each other — (1) the physical health of the public and (2) the financial health of agribusiness.

This pink slime, aka “lean beef trimmings,” is just one example of a policy decision that benefits the corporation selling the product while harming kids from homes poor enough to qualify for the federally-funded school lunch program.

This pink slime story has made the rounds on the Internet the past few days, and we discussed it yesterday in the clinical nutrition class I teach for upper division chiropractic students. Everyone in class, needless to say, considered the slime a major gross-out.

A couple of students said they thought the solution might be to transfer school lunch programs to the states, which they believed were more likely to make better decisions.

My response was that the pink slime story made it a particularly difficult day for me to be defending the federal government. However, I added that in my experience, state governments are also fully capable of making terrible decisions. And that furthermore, agriculture and food industry lobbyists operating at the state level are often better able to achieve their goals (although they clearly do quite well for themselves at the federal level, too), because people and organizations supporting policies for enhanced health or environmental protection usually don’t have the capacity to lobby effectively in 50 separate states. Corporations, of course, do have the wherewithal to do this, and thus we often see an especially un-level playing field at the state level.

Regarding the school lunch program, one point I did not think to mention to my students is that if left to their own devices, I think it is likely that some states (perhaps many) would just drop the school lunch program altogether. I live in Kansas. I frankly do not know whether, given the choice, the state would decide to save money by dropping or substantially cutting back on school lunches. Recent budgetary decisions involving resdistribution of resources from those with less (via elimination of tax credits and decreased levels of social services) to those with more (via lower taxes) lead me to assume the worst.

As a result, I am glad that there is a federal program to feed students from poor families. I just wish they would keep the pink slime off the menu.

My Full Interview with Harriet Washington Now Available in PDF

A PDF version of my Harriet Washington Interview with Harriet Washington is now available. This was previously posted in four parts. Her book, Deadly Monopolies, is a powerful and thorough indictment of corporate greed and overreach, particularly as this affects our health, well-being and personal autonomy.

Thanks to my wife Beth Lily Redwood for the graphic design.


Serving Size Scams Exploit Loophole in FDA Nutrition Labeling Rules

The Food and Drug Administration has helpful policies in place to help consumers understand the nutrient and calorie content of various packaged foods. Sure enough, the companies selling the packaged foods find ways to fool the public.

This Men’s Health article has numerous examples, including these two:

Serving Size Rip-Off: Kellogg’s Pop-Tarts

Listed calories: 200
Servings per box: 2
Total calories: 400

What’s worse than eating 200 calories of enriched flour stuffed with sugary fruit goo? Eating twice that many calories without even realizing it. The nutritional information on a box of Pop-Tarts lists one tart as a serving, but these iconic morning pastries come wrapped in twos, forcing you to decide between eating two Pop-Tarts now or one stale Pop-Tart tomorrow. Here’s a smarter option: Drop a piece of whole-wheat bread into your toaster, and then spread it with strawberry jam and be on your way. You’ll take in fewer calories with more fiber and real fruit.

20 Habits That Make You Fat

Serving Size Rip-Off: Campbell’s Chunky Microwaveable Soup

Listed calories: 200
Servings per container: 2
Total calories: 400


Okay, clearly this is a single-serve cup. As if you’d ever microwave the cup, eat half, and then put the rest in the fridge to microwave another day. C’mon Campbell’s, you’re better than that.

Blunt-Rubio “Contraception” Amendment: A Stealth Attack on Essential Health Services?

Press coverage this week on the Blunt-Rubio amendment to a Senate highway spending bill focused to a large extent on its sponsors’ stated goal of allowing employers to deny contraceptive coverage in health plans offered to their employees, based on religious or moral objections. Republicans sought to frame the issue as freedom of religion while for Democrats, it was primarily an attack on contraception and, more broadly, on women’s rights.

It is important to realize that impact of Blunt-Rubio, were it to be enacted into law, extends far beyond contraceptives, sex, and religion, taking aim squarely (if quietly) at the entire idea of requiring insurance plans to cover what are deemed “essential services.” It is no exaggeration to say that this proposal has the potential to thoroughly undermine the long-established process of requiring insurers to cover a defined set of health services.

This amendment, which only failed by a 51-48 vote, would allow all employers to determine whether or not to deny coverage for contraceptive services, regardless of whether the Institute of Medicine, Department of Health and Human Services, or state insurance regulators judged these to provide substantial health benefits. But more signifcantly, what it would also do is to allow any employer to eliminate coverage for any health care service, based on the religious or moral beliefs of the CEO or other decision makers.

How do we define moral beliefs? Our morals may be based on religious teachings (Catholic, Protestant, Jewish, Hindu, Buddhist, Muslim, Scientologist, Wiccan, etc.). Or, they may be based on anything else we choose to believe. Morals are quite personal and American society is exceptionally diverse in the range of moral beliefs professed by its citizens. Your moral beliefs may be based on deep philosophical inquiry and meditation, or they may be based on the last thing you heard on your favorite talk radio station.

If you are a CEO who strongly believes that vaccination is immoral because it violates the sanctity of the body as a temple, or any other reason), should you be able to eliminate that coverage from your employees’ list of covered services? How about a CEO who has joined the Church of Scientology and decides as a result to eliminate psychiatric benefits from his employees’ coverage? Should a corporate leader who considers sex outside of marriage to be immoral be permitted to eliminate not only coverage for abortion or contraception but also prenatal care for those who transgress his moral code?

Where does this stop? Blunt-Rubio is silent on that question, with its advocates preferring to limit the discussion to contraception. Did they not think it through? Or is this a stealth attack on government’s ability to define essential services and require insurance policies to cover them?

The implications are truly breathtaking in their comprehensiveness. Any employer can deny any health service for any reason, as long as he or she states that their objection is “moral.”  This is philosophically consistent with the conservative philosophy of governance that judges democratically elected officials to be the worst imaginable source to depend on for health care policy, choosing instead to vest that power in the hands of the private sector, specifically corporate CEOs or those to whom they delegate their power.

Is that the kind of health policy you favor?


Maine’s Top Court Backs State Authority To Limit Health Plan’s Profits

Among the most important issues facing the American body politic is the extent to which insurance companies and other corporate entitites are allowed to use their financial and political muscle to dominate the delivery of health care. For those who do not believe that corporations should have unlimited powers, yesterday’s Maine Supreme Court decision limiting the premium increases by Anthem Health Plans marks a step in the right direction.

One of the many moving parts of the Patient Protection and Affordable Care Act (aka Obamacare) is the power it grants the Secretary of Health and Human Services to limit unreasonable premium increases by insurers. This Maine decision is based on state rather than federal law, but it tracks well with the issues in play at the federal level:

In a case closely watched by the insurance industry, Maine’s top court Tuesday upheld state regulators’ authority to hold down rate increases sought by Anthem Health Plans of Maine.

In its ruling, the Supreme Judicial Court said that Maine’s insurance superintendent had “properly balanced the competing interests” in arriving at an approved rate increase of 5.2 percent. The insurer, a unit of Wellpoint, the nation’s largest insurer, had sought a 3 percent profit margin as part of an overall 9.2 percent increase in health insurance rates for policies sold to individuals in 2011. It argued that state regulators’ decision to grant a 1 percent profit margin violated state law and the U.S. Constitution by depriving the company of a “fair and reasonable return.”

The Maine Supreme Court is essentially affirming that “reasonable return” is not an area where corporations have the final say. This case, or one like it, may well reach the U.S. Supreme Court. Perhaps one day we will have a Supreme Court that does not consider corporations to be people and remembers that corporations are permitted to exist under law in order to serve a public purpose.

It is not widely appreciated in this country that while many nations allow private companies to provide insurance services, all but the United States limit these to the nonprofit sector. Allowing life-and-death health matters to be influenced by the constant urge to maximize shareholder profits is only permitted here.

That is unlikely to change anytime soon. For now, passing and enforcing laws limiting the more rapacious instincts of corporate CEOs is a necessary step in defense of the public.

FDA Requires Diabetes and Memory Loss Warning Labels for Statin Medications

Pharmaceuticals are a double-edged sword. With help can come harm, as the FDA recognized yesterday in its announcement requiring an addition to the labels of all statin medications of new warnings about increased risk of diabetes and memory loss , which are used to lower cholesterol levels.

Whenever considering use of a medication, there are two key questions. Are the benefits likely to outweigh the risks for a particular individual? And, is there a different method that is safer, more effective or less costly?

The prevention and treatment of heart disease is the main rationale for statins, which are the best selling drugs in history. Is there an alternative approach that is safer, or more effective, or less costly? It happens that there is a method that meets all of these goals — Dean Ornish’s program for reversing heart disease.

Ornish’s methods have been extensively researched over decades, with the results published in journals including The Lancet and the Journal of the American Medical Association, consists of a very low-fat vegetarian diet, exercise (walkign and yoga), and stress management methods including meditation and emotional support groups. In his 1990 landmark article in The Lancet, Ornish and colleagues demonstrated something previusly believed to be impossible — a decrease in plaqueing of the coronary arteries, as measured by quantitative coronary angiography and other scanning methods.

The Ornish program has been covered by insurance policies for many years and was recently approved for coverage by Medicare.

If I am less than enthusiastic about the highly-touted statins, it is because heart disease, with rare exceptions, is both treatable and preventable via the Ornish approach. (I provide a list of references on page 2 of this post.)

Most people are never told by their physicians that heart disease can be prevented through these natural methods, even though the scientific literature shows this to be beyond dispute. Why? First and foremost, I think it’s that contemporary medical practice, so skilled in diagnosis, still has a major blind spot when it comes to non-pharmacologic methods. In other words, the drug option is almost always the first option. And sadly, too often patients are not even told that there is an effective non-drug option.

Part of the problem is that there exists no equivalent of the multi-billion dollar drug company infrastructure to push the lifestyle-based, diet/exercise/stress reduction approach. That is one of the great tragedies of our time.

References after the jump for those wanting to explore the science more deeply …

Walking Back the Decision to Curtail Hormone Replacement Therapy

After waiting several years until the furor died down, it appears that the drug companies and those they fund have decided that the time is ripe to walk back the decision to sharply curtail use of hormone replacement therapy. That decision was based on the landmark 2002 Women’s Health Initiative findings that showed an increased risk of heart disease from HRT, in contrast to previous claims that these medications would decrease heart disease.

See if you can read this article without spotting the not-so-hidden hand of Big Pharma lurking in the shadows. If you arrive at the end of the article without finding it, be sure to read the conflict-of-interest disclosure at the end of the piece.

Menopausal hormone therapy doesn’t have to follow “the lowest dose for the shortest time” strategy for all women anymore, the North American Menopause Society said today.

The group endorsed a flexible approach to duration that takes into account the type and timing of therapy and individual patient characteristics in a statement in its journal, Menopause.

For women in their 50s, the absolute risks are low; younger women without a history of breast cancer can use replacement hormones at least until the normal menopause age around 51, and longer if needed for symptom management, according to the guidelines.

“No ‘one size fits all’ approach is acceptable anymore,” JoAnn E. Manson, MD, DrPH, NCMP, of Harvard, and president of the society, said in answer to a query from ABC News and MedPage Today.

Manson’s position is somewhat surprising since she was a principal investigator for the Women’s Health Initiative, the landmark randomized trial that derailed the hormone therapy movement when it reported a link between Premarin (estrogen/progestin) and increased risk of breast cancer and thromboembolic conditions.

As an organization, “NAMS has close ties with industry, which provides grant support for the organization, advertises in its journal, pays annual dues, etc.,” noted Diana Zuckerman, PhD, president of the D.C.-based National Research Center for Women & Families Cancer Prevention and Treatment Fund.

The new guidelines loosen up on timing, agreed Michelle P. Warren, MD, NCMP, of Columbia Presbyterian Medical Center in New York City, who was also involved with the guidelines.

Women who need hormone therapy can use it for as long as needed, she said in an interview.

That shift should be reassuring for many women, Manson suggested.

After reading the conflict-of-interest disclosures about drug company funding, are you feeling reassured?

Annual Sleeping Pill Death Toll May Top 500,000 in U.S.

All health practitioners have seen patients who develop a dependence on prescription anti-insomnia medications. This apparent increase in mortality risk, however, comes as a surprise.

The usual caveats apply, in that this study does not prove a cause-and-effect relationship. However, the researchers quoted in this MedPage article seem quite concerned.

The use of hypnotic sleep aids was associated with a three- to five-fold higher mortality risk compared with the risk for nonusers, even when the prescription was for a small number of pills, investigators reported.

A prescription for 0.4 to 18 doses per year was associated with a mortality hazard ratio of 3.60 compared with patients who had no prescriptions for hypnotics.

The hazard jumped to 5.32 for patients prescribed more than 132 doses a year, investigators reported online in BMJ Open.

“Rough order-of-magnitude estimates … suggest that in 2010, hypnotics may have been associated with 320,000 to 507,000 excess deaths in the U.S. alone,” Daniel F. Kripke, MD, of the Scripps Clinic in La Jolla, Calif., and co-authors wrote. “From this nonrandomized study, we cannot be certain what portion of the mortality associated with hypnotics may have been attributable to these drugs, but the consistency of our estimates across a spectrum of health and disease suggests that the mortality effect of hypnotics was substantial.”

Patients who used hypnotics most often also had an increased risk of cancer, with an overall cancer increase of 35% among those prescribed high doses.


Scandal Erupts Over Drug Company Relationships with State Medical Boards

Which conflict-of-interest is worse? You be the judge.

1. Drug company money setting the agenda for university drug research, with publication controlled by the corporations, or;

2. Drug company funding the Federation of State Medical Boards to publish a report on the opioid drugs these companies manufacture.

Here’s a powerful piece of investigative journalism on the medical board scandal:

The Federation of State Medical Boards, often develops guidelines that serve as the basis for model policies with the stated goal of improving medical practice — but after its guideline for the use of opioids to treat chronic pain patients was adopted as a model policy, it asked Purdue Pharmaceuticals for $100,000 to help pay for printing and distribution that policy to 700,000 practicing doctors.

That $100,000 was just a small downpayment on the $3.1 million that the Federation’s foundation estimated it would cost for its campaign to get out the word about “safe” use of opioid analgesics in treatment of chronic pain.

The federation, which functions as a trade group representing some 70 allopathic and osteopathic medical boards, won’t say how much money it received from industry, but the $100,000 request was detailed in a document obtained by the Milwaukee Journal Sentinel/MedPage Today from University of Wisconsin School of Medicine and Public Health.

There’s much moreI recommend reading the entire article. And I would expect more to follow.

They say that sunlight is the best disinfectant, but some infections are so toxic that sunlight alone won’t do the job. Legal and/or legislative action seem appropriate here.