Speech Pathology Confidential

Bryan Castañeda told me the following:

I was talking to a good friend of mine who’s a speech pathologist. He works for a woman who runs a private practice in Connecticut. Says that a third of his patients require the amount of treatment his boss recommends, a third require treatment but less than she recommends, and a third require no treatment at all. But his boss is skilled at preying on parents’ insecurities (and their clientele has a lot of money), so she makes a killing. He agreed with your advice that people should be more skeptical of the claims of medical professionals and do their own research to evaluate to those claims.

The woman who runs the practice has a Master’s in speech pathology, same as Bryan’s friend. I asked about the treatments. Bryan’s friend replied:

It depends on the diagnosis. If it’s a speech disorder, we do articulation therapy. Articulation therapy usually consists of drills, correcting erred sounds by shaping the articulators appropriately and then having the client produce the sound in isolation, at the word, phrase, and sentence levels, and then in reading aloud and in conversation until they’ve reached 100% or close to 100% accuracy.

If it’s a language disorder, we do language therapy. Language therapy is a little more complicated. We target specific language areas based on the results of previous testing. It can vary a lot, but some of the more common things I do is read passages and have the client answer questions about it, teach grammar, work on formulating sentences appropriately, teach vocabulary, and word classification activities. A lot of worksheets and games too — materials that my boss writes off at tax time. We bill by the hour, so more hours certainly equals more pay for her,” he says. “We are all salaried, so the tighter she crams our schedules the more she gets to keep at the end of the day.

At least the unhelpful treatments are harmless, in contrast to a large fraction of mainstream medicine, where children have their tonsils removed, and so on.

Bitter Pill: Why Medical Costs Are Killing Us by Steven Brill

Steven Brill has a great article in Time called Bitter Pill: Why Medical Costs are Killing Us. I found it nauseating and terrifying — and I have health insurance. It is nauseating that helpless sick people are billed huge amounts of money that bear little relation to costs. It is terrifying that our government has failed to protect us from this.

Brill’s article is about the details of health care costs in America, especially hospital costs. Markups are huge. One example is a test strip for measuring blood sugar. The patient was charged $18 for each strip. On Amazon, the strips cost $0.50 each. The patient had no choice and was not told the wildly-inflated price. Brill gives many examples of similar markups. Hospitals, including nonprofit hospitals, are large prosperous businesses with very well paid CEO’s (e.g., $1 million/year). Yet Americans pay far more for health care than people in any other country and, judged by life expectancy, get worse results than people in about 40 countries. Brill’s article begins to explain the discrepancy.

Asked to explain their prices, many hospitals refused. One of them, MD Andersen in Houston, gave a statement that Brill quotes in part:

The issues related to health care finance are complex for patients, health care providers, payers and government entities alike . . . MD Anderson’s clinical billing and collection practices are similar to those of other major hospitals and academic medical centers.

Judging from the widespread refusals to explain and answers like this (“everyone does it”), the prices are indefensible.

The term stagnation — America is in the grip of profound stagnation — may be misleading because it makes it sound like things are staying the same. People point to a lack of increase in the median income over the last 30 years as indicating “stagnation”. Beneath stagnation is problems stacking up unsolved. (When they are solved, spread of the solutions produces an increase in income.) The problems aren’t staying the same: They’re getting worse. Health care costs are a good example. Health care costs have gone up faster than inflation for a long time, with plenty of signs that the American excess (the difference between what Americans pay and what everyone else pays) is completely wasted. (Or worse, given the many bad effects of drugs, surgery, and other high-tech medicine.) The American excess isn’t trivial, so median income, adjusted for it, has been going down for a long time, over the same period of time that median income in almost every other country has gone up. Quite a comment on the quality of our government.

As Brill says, the health care debate has been about who will pay? The question are prices too high? has been ignored. Jon Stewart said, “This should be a Silent Spring moment.”

Merck’s Vioxx and the American Death Rate

Ron Unz makes a very good point — that just one awful drug (Vioxx) sold by just one awful drug company (Merck) appear to have caused hundreds of thousands of deaths:

The headline of the short article that ran in the April 19, 2005 edition of USA Today was typical: “USA Records Largest Drop in Annual Deaths in at Least 60 Years.” During that one year, American deaths had fallen by 50,000 despite the growth in both the size and the age of the nation’s population. Government health experts were quoted as being greatly “surprised” and “scratching [their] heads” over this strange anomaly, which was led by a sharp drop in fatal heart attacks. . . .

On April 24, 2005, the New York Times ran another of its long stories about the continuing Vioxx controversy, disclosing that Merck officials had knowingly concealed evidence that their drug greatly increased the risk of heart-related fatalities. . . .

A cursory examination of the most recent 15 years worth of national mortality data provided on the Centers for Disease Control and Prevention website offers some intriguing clues to this mystery. We find the largest rise in American mortality rates occurred in 1999, the year Vioxx was introduced, while the largest drop occurred in 2004, the year it was withdrawn. Vioxx was almost entirely marketed to the elderly, and these substantial changes in national death-rate were completely concentrated within the 65-plus population. The FDA studies had proven that use of Vioxx led to deaths from cardiovascular diseases such as heart attacks and strokes, and these were exactly the factors driving the changes in national mortality rates.

The impact of these shifts was not small. After a decade of remaining roughly constant, the overall American death rate began a substantial decline in 2004, soon falling by approximately 5 percent, despite the continued aging of the population. This drop corresponds to roughly 100,000 fewer deaths per year. The age-adjusted decline in death rates was considerably greater.

This illustrates how Merck company executives got away with mass murder on a scale that the Khmer Rouge would be proud of. It also illustrates why I find “evidence-based medicine” as currently practiced so awful. Evidence-based medicine tells doctors to be evidence snobs. As I showed in my Boing Boing article about tonsillectomies, it causes them to ignore evidence of harm — such as heart attacks and strokes caused by Vioxx — because the first evidence of harm does not come from randomized controlled studies, the only evidence they accept. It delays the detection of monumental tragedies like this one.

Assorted Links

  • Where are they now? J. S. Boggs, profiled by Lawrence Wechsler in The New Yorker. Boggs made small paintings closely resembling money (e.g., a $100 bill) that he offered in place of real money. He sold surrounding details (e.g., the receipt) to a collector who would try to get the bill Boggs had drawn from the merchant in order to “complete” the work of art.
  • A SLDer (Shangri-La Dieter) loses 80 pounds in 18 months. That’s 1.0 pounds/week.
  • More medicine does not equal better medicine. I agree with every word of this critique by a Glasgow general practitioner named Des Spence. For example, “The prescribing of powerful antipsychotic and potentially addictive stimulant drugs to children is a societal norm. . . . A quarter of US women are taking mental health drugs.” As Spence says, these are signs of a healthcare system biased toward those who make money from it and against everyone else (including children). One way to sum up why this is a mistake: Your health is too important to be left to those who only make money if you are sick.
  • Japan: from rice to wheat to rice.

Thanks to Bryan Castañeda.

Assorted Links

  • All about kefir
  • Fraud and waste at a New York hospital. From the comments you can see that the problems have lasted decades. If someone is always sick, year after year, it means there is something about their sickness (about health in general, actually) we do not understand. Likewise, the decades-long persistence of huge problems at this hospital suggests there is something fundamental about regulation (and perhaps health care) we do not understand.
  • This paper about how well blood uric acid level predicts mortality, which appeared in 2004, did not get nearly the attention it deserves. I was shocked by its existence — American medical school professors are almost incapable of good research. Well, it’s from Finland.
  • David Healy’s new blog.

Thanks to Bruce Charlton, Jazi Zilber, Melissa McEwen and Alex Chernavsky.

Assorted Links

Thanks to Tom George and Mark Griffith.

Assorted Links

How Accurate are the QuackWatchers? Mercury Amalgam Fillings

From Amalgam Myths and Facts (amalgam here means mercury-containing amalgams used by dentists):

Myth 10: Amalgam has been banned in Germany and Sweden and therefore should be banned in the United States.

Fact 10: Dental amalgam has not been banned in any country in the European Union.

From a 2009 press release:

The [Swedish] Government today decided to introduce a blanket ban on mercury. The ban means that the use of dental amalgam in fillings will cease.

In response to the Swedish ban, the American Dental Association put out a press release that said such a ban was “not necessary” in America because dentists do such a good job recycling the amalgam that doesn’t go into your mouth. Moreover, “a recent economic impact study published in the journal Public Health Reports indicates dental care costs in the U.S. would increase up to $8.2 billion in the first year alone if amalgam use was discontinued.” I don’t know what “up to” means. Perhaps it means that dental care costs would increase by a trivial amount “up to” $8.2 billion. Mercury-containing amalgam fillings are about half mercury.

Soon after I had two mercury fillings removed, I slowly became faster at arithmetic.

Assorted Links

Thanks to Hal Pashler and Anne Weiss.

Assorted Links

Thanks to Tim Beneke.