Failing health of the United States
BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k496 (Published 07 February 2018) Cite this as: BMJ 2018;360:k496
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Is it an accident that the decline in aggregate health followed the "Reagan Revolution?"
Competing interests: No competing interests
Woolf and Aron are alarmed at the fall in life expectancy for USA citizens, for the second successive year. Their comments, and references to health risks and risk behaviour, are particularly relevant to adults and adolescents.
The situation concerning child health in the USA is no less alarming, maybe more so.
USA childhood mortality is the worst out of twenty OECD countries. (1)
“The US has poorer child health outcomes than other wealthy nations despite greater per capita spending on health for children. “ (2)
USA infant mortality rates (deaths under one year of age per 100 live births) are 71% higher than the comparable country average. (3)
The USA has mandatory childhood vaccination, with a more extensive vaccine schedule than any other country. It mandates Hepatitis B vaccine within 24 hours of birth. (4)
Will this expanded schedule prevent child health in the US from becoming even worse than it is already?
The incidence of developmental disabilities is increasing.
The CDC recently revealed that one in thirty six US children were on the autistic spectrum in 2016. (5)
Therein may lie reasons to continually reassess the role of vaccines, and vaccine adjuvants like aluminium, in influencing child health. (6,7)
The suggestion that increased clinical awareness has caused the large documented increase in ASD and developmental disabilities, rather than environmental factors, has been exhaustively explored, and appears disproven. (8)
The difficulties that face anyone wishing to debate these concerns in an open and informed manner were recently emphasised by Professor Christopher Exley, whose paper on aluminium levels in the brains of ASD youngsters (6) has been met with near silence, and abuse. (9)
1 https://edition.cnn.com/2018/01/08/health/child-mortality-rates-by-count...
2 https://www.healthaffairs.org/doi/10.1377/hlthaff.2017.0767
3 https://www.healthsystemtracker.org/chart-collection/infant-mortality-u-...
4 https://www.cdc.gov/vaccines/schedules/downloads/child/0-18yrs-child-com...
5 https://www.cdc.gov/nchs/data/databriefs/db291.pdf
6 https://www.sciencedirect.com/science/article/pii/S0946672X17308763
7 http://www.ageofautism.com/2017/12/autism-1-in-36-asd-rate-set-a-new-rec...?
8 Omsted and Blaxill. Denial. Skyhorse Publishing, 2017.
9 https://www.hippocraticpost.com/ageing/autism-aluminium-din-silence/
Competing interests: No competing interests
As a native-born, semi-retired American physician (MD, Ophthalmology) of more than 40 years, it has been dismaying to watch the general health of my fellow citizens deteriorate. In my humble opinion, there are many reasons for this and the blame can be assigned in many directions. To quote Walt Kelly's character, Pogo: "We have met the enemy and he is us."
Since WWII, our once-thriving Republic has evolved into the present Corporatist State that exists today - a nation where soul-less corporate entities run by 21st century pirate capitalists have merged with Big Government and placed profit above Humanity. The American people have been systematically looted of their wealth and health even as the State continues to export its militaristic empire building abroad. Many trillions of dollars have been given to banks, trans-national corporations, our medical- and military-industrial complexes just in the past decade. In recent years, the political scene has devolved into one of never-ending identity politics centered on race- and gender-baiting with a dose of xenophobia. Our "oh-so-concerned" politicians believe that their power can better be maintained by keeping the people in a constant state of anxiety and fear. So far this has worked beautifully for our ruling elite.
In addition to this, we have been worn down by climate engineering centered on spraying vast amounts of toxins over the nation (aluminum, fly ash, etc.), GMO'd crops, increasingly contaminated water and food, deteriorating socio-economic conditions, a failing health care system that is more about disease creation and maintenance than healing. It is no accident that public debate about healthcare revolves around vaccinations and abortions - and, lately, euthanasia for the handicapped and infirm.
Many thanks to the Editor at The BMJ for posting your commentary on the failing health of the US. Perhaps it will make a difference for us here in the benighted colonies. Peace and hope...
Competing interests: No competing interests
The authors fail to examine the role of the rise of managed care in the US over the past 50 years. These large insurance entities have become wealthy while claiming that they actually coordinate and manage care. They have reaped $billions in profits while exerting enormous political influence at both state and federal levels to get laws passed which enhance their profits with virtually no oversight of actual patient outcomes while effectively blocking the ability of victims of their bad care to sue them in the courts.
Congress passed ERISA laws and the US Supreme Court interpreted them to defend business interests' ability to ration care to those they regally provide health insurance for. US courts have gutted the protection of EMTALA laws. In my state, Texas, harsh tort reform by now Energy Secretary, Rick Perry, then Governor, in 2003 effectively ended all lawsuits for bad emergency room care and lowered the standard of care for emergency patients. Now Texas has the highest maternal mortality rate in the developed world and experts are scratching their heads and blaming it on bad data.
But if you want to blame it on opioid deaths, look to the Veterans Administration. Go to the testimony of veterans, widows of veterans and whistleblower physicians at a US House Subcommittee on Health of the Committee on Veterans Affairs on October 10, 2013 (one of the last times our government was "shut down") and see how the VA itself addicted veterans with opioids as the fastest way to deal with chronic pain. And see how the VA has failed to follow its written guidelines for managing chronic pain.
Finally "ObamaCare" (the ACA) itself, which on one hand expanded access to care on paper, also brought with it narrow networks of doctors and promotion of large hospital systems buying up doctors' practices which led to as much as 5-fold increases in the prices of already high priced procedures.
Competing interests: No competing interests
Re: Failing health of the United States
As an academic epidemiologist I have ties to a patient community with Familial Mediterranean Fever (FMF); a condition, although rare, that presents an apt metaphor for the failing healthcare system in the U.S. Until 2009, patients had access to the gold-standard treatment for FMF, colchicine, which was proven safe, health restoring, and life-saving. It cost about $12 per month and was covered by insurance. Since then the pharmaceutical industry, enabled by FDA regulators, has worked hard to establish proprietary positions covering the range of medications now used for the treatment of FMF. (1) Today the annual cost of treatment for an FMF patient ranges from $7,000 for colchicine to more than $100,000 for newer biologics. As of 2017 the largest U.S. healthcare insurers dropped coverage for the bloated cost of colchicine and placed high hurdles, in many cases insurmountable, for coverage of the highest priced drugs.(2) The result is a crisis affecting FMF patients only in the U.S., for whom treatment, once readily accessible, is now out of reach. By contrast, any FMF patient in Mexico can step into his local pharmacy and purchase a year’s supply of colchicine – still the gold standard treatment - for $88. The continuing deterioration in the U.S. healthcare system has no defensible explanation and from the perspective of our rare disease community, the decline in health indicators may be related to a critical decline in access to vital treatments and healthcare services.
1 Kesselheim AS, Solomon DH. Incentives for Drug Development — The Curious Case of Colchicine. N Engl J Med 2010; 362:2045-2047.
2 https://www.goodrx.com/blog/40-drugs-to-be-dropped-by-insurance/
jcj@virginia.edu
Competing interests: No competing interests