Monday, June 30, 2008

Rethinking Health Insurance

Health insurers have certainly been beat up in the past few months by the political candidates. In some cases, I think it's right, when insurers are withholding payments for legitimate operations that might save a life. But in other cases, I don't think health insurers are the only ones to blame.

Here is an article written by Dr. Pam Popper, nutritionist, naturopath and President of the Wellness Forum in Columbus, Ohio.

I think she is right on with some views on how insurance companies could easily become the real innovators in our move to a better healthcare scenario.

There is so much wrong with health care that it is almost impossible to fix the existing system. And, in my opinion, we are focusing on the wrong things and blaming the wrong organizations for some of our problems.

For example, health care reform often involves criticizing insurance companies for not paying for certain types of treatments. For the record, I'll state that insurance companies are guilty of many things and do their part to contribute to the poor state of health care today. But forcing these companies to pay for any treatment offered by drug companies and desired by patients may be causing our problems to worsen, not get better.

For example, I have written before about Avastin, originally approved for colorectal and lung cancers, and recently granted "accelerated approval" by the FDA for metastatic breast cancer. It's actually almost worthless for all cancers. Avastin extends life by a few months for colorectal and lung cancer patients, and about 5.5 months for metastatic breast cancer patients. The side effects, according to an article in The New York Times, include death. Offered by Genentech, the drug costs $92,000 per year. Genentech acknowledged in an editorial that it "does not claim that the drug is cost-effective for advanced breast cancer but believes it will be clearly worth the cost if shown effective in earlier stages of breast cancer."

In spite of this, Avastin has already been prescribed off-label to over 11,000 cancer patients with advanced breast cancer, and the recent FDA approval would increase the number of patients who qualify for it to 43,000. Genentech acknowledges that the drug only extends life for only a few months. Using half of the $92,000 annual cost of the drug (since patients are almost always dead within a few months), the revenues to Genentech for this drug have grown to a potential of close to $2 billion dollars per year. Where does the money to pay for this drug come from? Insurance companies and Medicare/Medicaid. And if some of our political candidates get their way, we will add universal health care coverage, meaning more taxpayer-financed reimbursement, to the pool of available funds.

This is not the only example. Billions of dollars are spent annually on unnecessary back surgeries and other procedures, mammography and other useless diagnostics, as well as drug treatments that are completely ineffective, and often hurt people. Can you blame the insurance companies for refusing to pay for this?

Unfortunately, the insurance companies also deny reimbursement for treatments that do work, such as dietary intervention. They've thrown the baby out with the bath water, attempting to deny coverage for anything different or progressive.

Insurance companies are in a great position to be innovators in the health care field if they decide t do so. They could develop policies for people who choose to practice dietary excellence and optimal habits, and reimburse these people for the counseling and other support needed to learn how to do so. There is evidence that this will work, and can save enormous amounts of money. The average patient who gets bypass surgery spends $86,364 over a 5-year period; the average patient who has angioplasty spends $63,897 during a comparable period of time. A consultation with Dr. Esselstyn (who has an excellent track record reversing cardiovascular disease through dietary intervention) costs $500; a membership to The Wellness Forum, complete with books, CD's and DVD's costs only $221. Reimbursing for these types of services and refusing to pay for bypass surgery and angioplasty unless the need is clearly demonstrated (it rarely is) would result in huge savings for both private carriers and Medicare.

I'm not upset with the insurance companies for saying enough is enough as it pertains to reimbursement for medical services that do not work. And I do not think universal health care, which will result in all of us as taxpayers shouldering more of the burden for useless diagnostics and treatment is the answer either. The answer is to continue to educate people to make different choices, and to target the purveyors of misinformation as the real culprits - our government, national health organizations, medical schools, unenlightened doctors and others who continue to promote ineffective and harmful treatment.

Sunday, June 15, 2008

How To Get GIMP to Work on Mac OSX Leopard (And Get Focus Follows Mouse)

NOTE: This post is fairly old. One of my commenters below (Green) has given a solution that seems to be working for people more so than what I suggest here. I would say read my post briefly and then jump to his comment.

When we upgraded my wife's Mac Mini (PowerPC) to Apple's Leopard, we needed to reinstall X11 so she could run her favorite graphics program GIMP.

This turned out to be quite a hassle. Let me tell you how we should have done it.

  1. Upgrade to Leopard using Apple's DVD.
  2. Apple will immediately ask you to upgrade to 10.5.3 (or the latest version of Mac OSX), so do that through Software Update. Trigger it yourself if you have to.
  3. DO NOT use the X11 in the Optional Installs folder on the Leopard DVD! This is old and GIMP will not work.
  4. Instead, go here and get XQuartz (use the link that says X11-2.2.2.pkg), which is a newer version of X11 that works much better.
  5. Now download the latest version of GIMP from here. As of this writing it is Gimp v2.4.
  6. Ah, but now you've lost your additional brushes, haven't you? Well, you can re-download those, our favorites are here and here. (Remember, GIMP can now use Photoshop brushes seamlessly). You just copy them into the right directory of the GIMP application.
  7. Now GIMP should work pretty well in X11. will find that you need to click on each GIMP window twice because you need to bring focus to the window first before you can do anything.
  8. Ha! This is a fun one. I could not actually find the right command to fix this, but eventually we figured it out. Open up the Mac OSX Terminal (in the Applications folder) and then type this command on the command line:
defaults write org.x.x11 FocusFollowsMouse -string YES

If you find that this was a mistake, you can go back to Terminal and type the same command with the word NO instead of YES. That should reverse it so that focus does not follow the mouse in X11.

I think that's it! I'll continue this post if we find any other problems, but for now, it looks like GIMP is working pretty well in Leopard. This is all running on an old Mac Mini with a PowerPC chip. You just have to make sure to download the right executable of GIMP for the PowerPC vs Intel.

Good luck. Please post a comment if this works (or doesn't work) for you.

Saturday, June 14, 2008

Quote from Barack Obama's Book "The Audacity of Hope"

Here's why I'm voting for Barack Obama. I see him introducing Politics 2.0, in word and in deed, an end to the partisan bickering and gridlock.

Just wait until he introduces Government 2.0.

A quote from his second book "The Audacity of Hope:"

Maybe the critics are right. Maybe there's no escaping our great political divide, an endless clash of armies, where any attempt to alter the rules of engagement is futile.

Or maybe the trivialization of politics has reached a point of no return, so that most people see it as just one more diversion, a sport, with politicians as our paunch-bellied gladiators, and those who bother to pay attention, just fans on the sidelines. We paint our faces red or blue and cheer our side and boo their side, and if it takes a late hit or cheap shot to beat the other team -- so be it. For winning is all that matters.

But I don't think so.

They are out there, I think to myself, those ordinary citizens who've grown up in the midst of all the political and cultural battles but who've found a way, in their own lives at least, to make peace with their neighbors. And themselves.

I imagine the white southerner, who, growing up, heard his dad talk about niggers this and niggers that, but has struck up a friendship with the black guys at the office and is trying to teach his own son different; who thinks that discrimination is wrong, but doesn't see how the son of a black doctor should get admitted into law school ahead of his own son.

Or the former Black Panther, who decided to go into real estate, bought a few buildings in the neighborhood, and is just as tired of the drug dealers in front of those buildings as he is of the bankers who won't give him a loan to expand his business.

There's the middle-age feminist who still mourns her abortion, and the Christian woman who paid for her teenager's abortion, and the millions of waitresses, and temp secretaries and nurses' assistants and Wal-Mart associates who hold their breath every single month in the hope that they'll have enough money to support the children that they did bring into the world.

I imagine that they are waiting for a politics with the maturity to balance idealism and realism, to distinguish between what can and what cannot be compromised, to admit the possibility that the other side might sometimes have a point. They don't always understand the arguments between right and left, conservative and liberal, but they recognize the difference between dogma and common sense, responsibility and irresponsibility. Between those things that last, and those that are fleeting.

They are out there, I think, waiting for Republicans and Democrats to catch up with them.

Saturday, June 07, 2008

The Benefits of Train Travel

EcoGeek points out the unexpected benefits of train travel.  Watch this mode of transportation (for shipping and people transport) come back in a big way.