Surely medicine is above politics?
It seems like such a sensible question. What's the best way to determine if someone has a blocked artery in their heart? Figure out what test works best, then make sure Medicare covers THAT one, not others -- even if they are cooler. But the government is having a difficult time determining what high-tech scans are really better than cheaper methods. Read the article about CT scans vs. angiography, and be sure to read the comments as well. Then look up one of the following:
1. An effect of industry lobbying on another aspect of medicine
2. How CT scans or angiography or other cardiac diagnostic scans work
3. The rising cost of health care, and how the government (or presidential hopefuls) have sought to change it.
28 comments:
http://www.enterprisenews.com/lifestyle/health_and_beauty/x590555102
Health care costs are continuously rising, partly due to hospitals' pursuits for new technologies, which are expensive. Another reason has to do with the increasing popularity of brand-name prescription drugs thanks to the growth of pharmaceutical companies' direct-to-consumer advertising.
http://www.nytimes.com/2008/02/04/opinion/04krugman.html
One significant issue that the democratic candidates, Obama and Clinton, often bring up in their campaigns is universal health care. Both point out that many other advanced governments in the world have already provided their citizens with health care, and the two candidates hope to do the same if they become president. The biggest and most significant difference between Obama's and Clinton's proposals is that the Clinton plan requires that every person obtain insurance, while Obama's plan doesn't.
CT Scans (also known more commonly as CAT scans), is a "non-invasive, painless medical test that helps physicians diagnose and treat medical conditions. It uses special x-ray equipment to produce multiple images or pictures of the inside of the body and a computer to join them together. they provide greater clarity than conventional x-ray exams for internal organs, bone, and soft tissue.
Source: http://www.radiologyinfo.org/en/info.cfm?pg=bodyct
Some pictures of a CAT scan machine:
http://wdwbobbie.files.wordpress.com/2007/11/ctscan_mx8000.jpg
http://www.yalemedicalgroup.org/images/dxrad/coronal-ct_large.jpg
The angiography, or cardiac angiography, is a procedure in which a special dye is used and x-rays are taken in order to see the blood flow through the heart.
The process begins with an anesthetic to numb the pain. An IV tube will be inserted and a catheter is placed through the IV and carefully moved up into one of the heart's arteries. X-ray images help the doctor see where the catheter should be placed. The dye will be injected through the catheter and the X-rays will portray the blood flow with the dye.
This procedure is done mainly to find blockage in the coronary arteries, which can lead to a heart attack. Other possible reasons for the procedure are valve defects or unexplained heart failure, and chest pain. Possible side effects of the angiography are arrhythmia, low blood pressure, heart attack, and stroke.
http://www.nlm.nih.gov/medlineplus/ency/article/003876.htm
another choice of cardiac diagnostic scan is the Signal Averaged Electrocardiogram. It's basically the same thing as an EKG, which was discussed earlier, except it records more information, which means it also takes a longer period of time. Multiple ECG tracings are obtained over about 20 minutes and captures abnormal heartbeats which may occur only once in a while. A computer is used to record the info and then averages them to provide more information regarding the heart's condition. This is one of several procedures used to see if patients have irregular heartbeats (dysrhythmias/arrhythmias).
Other ways to test heart problems include resting electrocardiogram (ECG), Holter monitor, exercise electrocardiogram (ECG), cardiac catheterization, chest x-ray, computed tomography (CT scan) of the chest, echocardiography, electrophysiological studies, magnetic resonance imaging (MRI) of the heart, myocardial perfusion scans, radionuclide angiography, and ultrafast CT scan.
https://www.fhshealth.org/heart_proced/saekg/index.html
A small picture of the result can be found at http://www.cardiomyopathy.org/assets/images/ECGsmall.jpg
Presidential Candidates often bring up the prospects of Universal Health Care; however the reason many do not go along with this idea is because of increased taxes. When one looks at other nations that provide universal health care, like Sweden, taxation there is extremely high.
Health care costs have risen, in part, because of the amount of those that are uninsured. When those who can't pay for their own medical care, tax payers must foot the bill to cover their costs. In addition costs have also risen because of new technologies that are at the same time, extremely expensive.
Presidential hopeful Obama has recently stated that he will make Health Care mandatory for children but not for adults, while Clinton has stated she will make it universal and cheap at the same time.
http://obama.senate.gov/issues/health_care/index.html
http://www.nchc.org/facts/cost.shtml
http://www.hillaryclinton.com/issues/healthcare/
"Coronary angiography is done to find a blockage in the coronary arteries, which can lead to heart attack. It may be done if you have unstable angina, atypical chest pain, aortic stenosis, or unexplained heart failure.
Coronary angiography is a procedure that uses a special dye (contrast material) and x-rays to see how blood flows through your heart.
Coronary angiography is usually done in conjunction with cardiac catheterization.
Before the test starts, you will be given a mild sedative to help you relax.
An area of your body, usually the arm or groin, is cleaned and numbed with a local anesthetic. An IV (intravenous) line will be inserted into the area. A thin hollow tube called a catheter is placed through the IV and carefully moved up into one of the heart's arteries. X-ray images help the doctor see where the catheter should be placed.
Once the catheter is in place, the dye (contrast material) is injected into the IV. X-ray images are taken to see how the dye moves through the artery. The dye helps highlight any blockages in blood flow."
On this page there were also two good pictures showing the catheterization and the angiography.
http://www.nlm.nih.gov/medlineplus/ency/article/003876.htm
Healthcare is a delicate topic as it already is. The healthcare in the United States is an even more delicate and controversial topic. To emphasize my point, I have to share a story regarding my or in this case, my siblings' encounters with this dilemma. Both of my brothers are attending medical schools right now, and both of them had to tirelessly interview with different medical universities. They told me that one of the perhaps hardest questions the universities ask is regarding healthcare. One of the interviewer asked my brother about what the United States should do about its healthcare policies and personal questions such as whether my brother would examine a person who needed medical attention but had no money or papers justifying his/her presence in the United States.
The state of healthcare in the United States of America is of uncertainty. U.S. healthcare spending is approximately 16 percent of its GDP and in 2007, the United States spent somewhere around 2.6 TRILLION dollars on healthcare. Even though the United States does not have Universal Healthcare, it spends the most on healthcare on a per-capita basis. Healthcare costs are rising faster than wages, and therefore, medical bills are the most common reason for personal bankruptcy.
As for our presidential nominess, all three of them take different stands on healthcare policies. McCain focuses on importance of healthcare for veterans and military retirees. His healthcare policies revolve around that major premise. Hillary Clinton supports Universal Healthcare, meaning that healthcare be extended to all citizens, by the end of her second term. Clinton's plan makes it mandatory for everyone to have healthcare or purchase coverage and face a penalty if a person does not comply. On the other hand, Obama does not have an individual mandate in his plan but he would require all children to be covered. Hillary states that Obama's plan would leave 15 million people uncovered and without any healthcare. As one can see, the policies are a puzzle that a common person can rarely fully understand. Surely medicine is not above politics. In morals and theory, it SHOULD be, but in reality politics makes policies and policies allow medicine.
http://www.thehealthcareblog.com/the_health_care_blog/2008/02/hillary-clinton.html
This website should be of great help to anyone who is searching for different opinions and ideas on healthcare. While reading, do remember that blogs are not peer reviewed and may contain bias.
Although CT scans are less invasive and more appealing to a patient, they may not be the best option to detect a problem.
Angiograms are more invasive and have a better chance to directly see all potential problems and an other plus to angiograms is that when the scope is inserted into the artery the doctor can immediately fix a blockage if they come upon one. Many times the doctor can clear the blockage without an invasive surgery when the angiogram is performed.
Angiography is not necessarily less or more expensive then CT scans they both just appeal to different patients. Patients with known health problems probably would want a more accurate test , being the angiogram, where other patients would prefer the CT scan. Either one could give an accurate diagnoses and both could also miss a block or leak.
http://www.sirweb.org/patPub/angiography.shtml
Among many cardiac diagnostic tests, there are non-invasive and invasive tests. One of the invasive tests used by the cardiologist and physicians is Cardiac Catheterization. When physicians are performing this type of test, they insert a small catheter or a small hollow tube into an artery or vein in the leg or an arm. This tube is guided to the heart.
After physicians insert this tube, they insert dye through the tube. From then on, physicians observe how the dye travels through the heart by using moving x-ray pictures.
Through this test, doctors can discover the narrowing of arteries, the outside size of the heart, pumping ability of the heart, and the pressures of the heart chambers. Also, this test shows how much oxygen is in the blood.
http://www.americanheart.org/presenter.jhtml?identifier=4491
http://www.stanfordhospital.com/healthlib/greystone/heartcenter/heartprocedures/diagnostictests
There is a method for cardiac diagnostic test which is called Electrocardiogram (ECG or EKG. This test measures the electrical activity of the heart. The test is administered by placing positioning leads (electrical sensing devices)on specific parts of the body and reading the electrical activity that is present in the heart. This can tell someone mainly about the heart muscle and whether it is damaged and how so.
This test is not normally given at "life threatening" times but simply at Physicals and routine doctor check-ups. The test then determines heart rhythm, possible heart attack symptoms, and heart muscle tissue.
Finally, the ECG is not used for identifying severe heart problems at the given time. It is simply used as a routinely test to make sure the heart is performing normally.
http://www.medicinenet.com/electrocardiogram_ecg_or_ekg/article.htm
Sam White
#82182565
There is a method for cardiac diagnostic test which is called Electrocardiogram (ECG or EKG. This test measures the electrical activity of the heart. The test is administered by placing positioning leads (electrical sensing devices)on specific parts of the body and reading the electrical activity that is present in the heart. This can tell someone mainly about the heart muscle and whether it is damaged and how so.
This test is not normally given at "life threatening" times but simply at Physicals and routine doctor check-ups. The test then determines heart rhythm, possible heart attack symptoms, and heart muscle tissue.
Finally, the ECG is not used for identifying severe heart problems at the given time. It is simply used as a routinely test to make sure the heart is performing normally.
http://www.medicinenet.com/electrocardiogram_ecg_or_ekg/article.htm
Americans are spending far more on health care than residents of any other industrialized country. Only 60% of Americans receive health insurance through their employers today, and this trend is mostly affecting lower-wage workers. The Bush administration is encouraging consumers to switch to consumer-directed health plans, whose high copayments would force them to shop for more cost-effective care. However, this course of action is said to only be beneficial to the wealthy.
http://library.cqpress.com/cqresearcher/document.php?id=cqresrre2006040700&type=hitlist&num=0
CT(Computerized Tomograph)Scan is also known as CAT Scan. It is a special procedure that takes image of certain body part of people. Through the procedure, doctor can diagnose the disease. CT scan is often used to sense the condition of the brain, neck, spine, chest, abdomen,pelvis, and sinuses. This is very fast and harmless procedure to patients, so it is very popularized.
Source:
http://www.emedicinehealth.com/ct_scan/article_em.htm
CAT scans take the idea of conventional X-ray imaging to a new level. Instead of finding the outline of bones and organs, a CAT scan machine forms a full three-dimensional computer model of a patient's insides. Doctors can even examine the body one narrow slice at a time to pinpoint specific areas.
This site has some interesting information about how CT Scans work.
http://science.howstuffworks.com/cat-scan.htm
There is no doubt that the cost of health care is on the rise, so what are our presidential hopefuls planning on doing to solve this issue? Hilary Clinton stated that her health plan was better than Obama's because it has an "original mandate." This means that everyone would be required to purchase her plan. Obama's plan would only require children and employees to purchase it. Either way, these plans do nothing to solve the issue that it is difficult to have enough money to purchase the plan in the first place. That is why both candidates have included in their plans ways in which to lower the costs of various health practices. In conclusion, the health care plans of the two candidates are quite similar in terms of lowering costs, but will that be enough to help us out?
http://www.thehealthcareblog.com/the_health_care_blog/2008/02/hillary-clinton.html
The advantage of early diagnosis of coronary artery disease is to prevent need for coronary bypass surgery and prevents sudden cardiac deaths. The major issue to CT heart scans is cost and radiation exposure. Hopefully with low dose radiation exposure and reduced costs to the patients these tests would be very helpful. The future in diagnosis would appear to be in magnetic resonance imaging. Good reference article included:
http://heartdisease.about.com/cs/otherhearttests/a/cardiacMRI_3.htm
The use of CT scanning of the heart in the emergency room to diagnose early acute coronary syndrome has shown benefit in 4 different studies.
http://www.medscape.com/viewarticle/550185_7
Another cardiac diagnostic scan is Echocardiogram (Echo). It is a noninvasive test (which means that it is a medical procedure which does not penetrate or break the skin or a body cavity) that uses ultrasound to examine the motion of the heart’s chambers and valves. The echo sound waves create an 2-dimensional image on a monitor.
The way this procedure is performed is sticky patches or electrodes are attached to a patient’s chest and shoulders and connected to other electrodes or wires. These help to record the electrocardiogram (EKG or ECG) during the echocardiography test. The EKG helps in the timing of various cardiac events (filling and emptying of chambers). A colorless gel is then applied to the chest and the echo transducer is placed on top of it. The echo technologist then makes recordings from different parts of the chest to obtain several views of the heart. The images are constantly viewed on the monitor and are recorded to be examined and reviewed by the physician prior to completion of the final report.
Echocardiography is important because it provides the doctor with important information about the size of the chambers of the heart including the dimension or volume of the cavity and the thickness of the walls. The appearance of the walls may help identify certain types of heart disease. It also provides important information about the pumping function of the heart.
Source of information:
http://www.heartsite.com/html/echocardiogram.html
With the rising cost of health care due to the amount of people who are uninsured, presidential hopeful Hillary Rodham Clinton promises to provide affordable and accessible health care for the American people. She wants to make sure that there are choices out there for people who do not have health care or are not satisfied with their current plan. The method of making health care affordable would be having a plan that uses tax credits to help working families cover the cost. There will only me a low percentage that families will have to take out of their income to pay for health care unlike before where some families could face bankruptcy. By making it available to all Americans with equality, no one will be limited from coverage based upon their past and pre-existing condition. Perhaps one of the best benefits would be for people who lose their jobs because they will still be able to keep their health care to insure that they are taken care of if anything were to happen in the duration that they are unemployed.
http://www.hillaryclinton.com/issues/healthcare/
New and advanced technology lead to diagnose complex and abnormal diseases and injuries. It makes convenience to doctor to focus on specific body parts.
ECG(Electrocardiogram) shows the record of heartbeat that detect the damage of heart.
PET(Positron Emission Tomography) Scan procedes nuclear scan to see the abnormailities of arteries to heart muscles.
There are more cardiac diagnositc tests: http://www.ohsu.edu/health/health-topics/topic.cfm?id=8282&parent=11971
A CT or Computerized Tomography scanner is a special kind of x-ray machine. It sends several beams through your body rather than just one, which a typical x-ray machine does. The x-rays from the beams are measured in terms of strength once after they have been sent through the body. "The relative density of the tissues" can be examined by the use of a computer, which then illustrates the results as a 2D picture. This is very helpful in examining internal wounds such as a torn kidney. I think the CT scan is by far one of the most advanced medical tools we have in the world today. It makes it easier for doctors to monitor the inside of the body without having to perform troublesome examinations.
http://www.netdoctor.co.uk/health_advice/examinations/ctgeneral.htm
http://video.google.com/videoplay?docid=-423571372660219856&q=&hl=en
We would all like to think that the health of US citizens come first to members of the US Senate, sadly that does not appear to be the case. This 60 minute investigation reveals some of the dirty details that surrounded the passing of the Medicare Prescription drug bill in 2007. The US pharmaceutical industry spends $100 million a year for lobbying in Washington DC, with the ultimate goal being to maximize profit. Basically, what was at stake in this bill was the governments ability to negotiate drug prices with the drug companies. As if the fact that the voting took place at 3am was not suspicious enough, they kept the voting machines (which are supposed to be open for 15 minutes) open for 3 hours as drug company lobbyist pressured and arm twisted members of congress to change their vote. As far as the effect goes, now people covered under medicare are having to pay more for their prescription drugs as the drug companies are free to raise their prices. Another disturbing fact brought up in the investigation is the tendency of politicians who vote in favor of the pharmaceutical companies often tend to wind up with high paying jobs at the same company once their political careers are over.
http://www.truthout.org/issues_06/022207HA.shtml
So when I began my search for "medicinal lobbying" I found an overwhelming number of websites promoting medical marijuana, but I finally came across the website listed above, which provides insight to Mereck & Co.'s lobbying involving their slightly new human papilloma virus vaccine. Mereck and Co's HPV vaccine, called Gardasil, is the first of its kind, and serves the purpose of preventing two virus strains that cause 70% of cervical cancer. The controversial and political issue here is Mereck & Co's role in trying to make this three shot system a requirement for any 11 or 12 year old female to attend school. Legislatures in 20 states had mandates that would require young girls to get the vaccine but none have been approved yet. The vaccine is also controversial in the sense that this $360.00 shot series has "inadequate reimbursement" by insurance companies. The governor of Texas did issue an executive order on Feb 2. 2007 that young girls were required to get the shot unless parents opted out for religious reasons.
There are two types of angiograms, the catheter angiograms and the CT angiograms. There are many differences of these two angiograms. The catheter angiograms is considered more invasive to the patients. A special dye is used to enhance the linings of the artery. Then x-ray images are taken in high quality. With catheter angiograms, the doctor can even inflate the heart and use a stent to improve blood flow to the artery. The disadvantages of catheter angiography can cause infection and the patient has to be put to sleep.
The other type of angiogram is the CT angiogram. This angiogram is used by inserting small needle in the patient and adding a contrast agent. There is no risk of infection like the catheter, but there is a risk of radiation exposure which stands as a debate from the article assigned (wallstreet journal) Even though this is a less riskier process, the catheter angio is more detailed and high quality than the CT angio and more can be done with catheter angio. So the best way to determin if someone has a blocked artery in the heart would be to use the catheter.
http://www.ct-angiogram.com/Angiogram_vs._CT_Catscan_Angiogram_2273.htm
There are two types of angiograms, the catheter angiograms and the CT angiograms. There are many differences of these two angiograms. The catheter angiograms is considered more invasive to the patients. A special dye is used to enhance the linings of the artery. Then x-ray images are taken in high quality. With catheter angiograms, the doctor can even inflate the heart and use a stent to improve blood flow to the artery. The disadvantages of catheter angiography can cause infection and the patient has to be put to sleep.
The other type of angiogram is the CT angiogram. This angiogram is used by inserting small needle in the patient and adding a contrast agent. There is no risk of infection like the catheter, but there is a risk of radiation exposure which stands as a debate from the article assigned (wallstreet journal) Even though this is a less riskier process, the catheter angio is more detailed and high quality than the CT angio and more can be done with catheter angio. So the best way to determin if someone has a blocked artery in the heart would be to use the catheter.
http://www.ct-angiogram.com/Angiogram_vs._CT_Catscan_Angiogram_2273.htm
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