An amazing story behind this year's Nobel Prize

Behind this year's Nobel Prize in Medicine is a remarkable story of Mario R. Capecchi, who was born in Italy, survived the fascist regime to immigrate to the US, studied political science before moving to MIT and Harvard, and worked with the man who discovered the double helical structure of the DNA, James Watson. For academics, perhaps the most interesting part of Capecchi's story is that he left his faculty position at Harvard for the University of Utah, reportedly because of disagreements and infighting at Harvard and the atmosphere in Utah that allowed for more long-term projects instead of demanding immediate results. The article about Capecchi and the other two Nobel Prize winners in Medicine for 2007 is available from The New York Times. Here is an excerpt:

When young Mario was not yet 4, the Gestapo came to their home in Tyrol, in the Italian Alps, to take his mother to the Dachau concentration camp — an event he said he remembered vividly.

Because she knew her time of freedom was limited, she had sold all her possessions and given the proceeds to an Italian farming family, with whom Mario lived for about a year. When the money ran out, the family sent him on his way. He said he wandered south, moving from town to town as his cover was exposed. He wandered, usually alone, but sometimes in small gangs, begging and stealing, sleeping in the streets, occasionally in an orphanage.

Aging Gay in the USA

While it is not surprizing that older gay and lesbian Americans face prejudice and discrimination, it is only recently that the issue has been brought nation-wide attention as a number of social justice organizations have tried to educate the public and fight discrimination. An article in The New York Times by Jane Gross reports on the issue:

Elderly gay people like Ms. Donadello, living in nursing homes or assisted-living centers or receiving home care, increasingly report that they have been disrespected, shunned or mistreated in ways that range from hurtful to deadly, even leading some to commit suicide.

Some have seen their partners and friends insulted or isolated. Others live in fear of the day when they are dependent on strangers for the most personal care. That dread alone can be damaging, physically and emotionally, say geriatric doctors, psychiatrists and social workers.

The Health and Happiness of Nations

David Blanchflower and Andrew Oswald, two researchers at NBER, found that happiness of nations, regardless of the number of physicians or a particular choice of survey used, is associated with lower levels of hypertension. The study adds yet another interesting, yet surely to be controversial, argument for continuing to expand the field of behavioral economics to better understand economic and consequently political individual behavior. Their article is available on the NBER site, and here is the abstract:

A modern statistical literature argues that countries such as Denmark are particularly happy while nations like East Germany are not. Are such claims credible? The paper explores this by building on two ideas. The first is that psychological well-being and high blood-pressure are thought by clinicians to be inversely correlated. The second is that blood-pressure problems can be reported more objectively than mental well-being. Using data on 16 countries, the paper finds that happier nations report lower levels of hypertension. The paper's results are consistent with, and seem to offer a step towards the validation of, cross-national estimates of well-being.

Clinton unveiled the highly-anticipated health care plan: $110 billion/year

Clinton unveiled her new health-care plan in Iowa. The New York Times reported the story here. As expected, the plan builds on the successful experience of Medicare, and in addition tries to help accommodate fears of those currently receiving high-quality private insurance. The plan will offer a wide degree of choice and offer a combination of subsidies for employer-provided insurance, private insurance, and government health insurance.

Two other Democratic candidates have different health care programs as a part of their campaign platform. Barack Obama's plan focuses on requiring employees to provide insurance and on expanding insurance for those worse off. John Edwards' program is similar to Clinton's in that it focuses on giving people the choice, but in addition promises to fund the new plan by increasing taxes on those at the top of the income distribution.

Epidemiology, trials and medical knowledge

While there is an increasing attention on monitoring drugs for safety after being approved by the FDA -- including large registries to study drug use and its effects in the 'real world setting' -- it is still remarkable how much confidence we put in the present-day state of medical knowledge. An analysis piece in the New York times points to the interesting dynamic of establishing then refuting, or revising scientific knowledge that affects the medical treatment of millions of Americans. Here is an excerpt from the article by Gary Taubes:
Many explanations have been offered to make sense of the here-today-gone-tomorrow nature of medical wisdom — what we are advised with confidence one year is reversed the next — but the simplest one is that it is the natural rhythm of science. An observation leads to a hypothesis. The hypothesis (last year’s advice) is tested, and it fails this year’s test, which is always the most likely outcome in any scientific endeavor. There are, after all, an infinite number of wrong hypotheses for every right one, and so the odds are always against any particular hypothesis being true, no matter how obvious or vitally important it might seem.
You can access the New York Times article here.

How expansion of state insurance can harm some children

Gruber and his colleagues at NBER found that for every 100 children who start receiving public health insurance about 60 lose their private insurance. They write about this new form of "crowding out" in their newest paper, published as an NBER working paper. The question then arises on how advocates of expanding state insurance can ensure that families affected are compensated for this welfare loss. Here is the abstract of their new paper:
he continued interest in public insurance expansions as a means of covering the uninsured highlights the importance of estimates of "crowd-out", or the extent to which such expansions reduce private insurance coverage. Ten years ago, Cutler and Gruber (1996) suggested that such crowd-out might be quite large, but much subsequent research has questioned this conclusion. We revisit this issue by using improved data and incorporating the research approaches that have led to varying estimates. We focus in particular on the public insurance expansions of the 1996-2002 period. Our results clearly show that crowd-out is significant; the central tendency in our results is a crowd-out rate of about 60%. This finding emerges most strongly when we consider family-level measures of public insurance eligibility. We also find that recent anti-crowd-out provisions in public expansions may have had the opposite effect, lowering take-up by the uninsured faster than they lower crowd-out of private insurance.

The paper can be accessed on the NBER website here.

Bush White House vs. Children Insurance

It seems that President Bush is determined to make it more difficult for uninsured children in California and New York to get their state's help in obtaining health insurance. The New York Times reports on the story:
The Bush administration, continuing its fight to stop states from expanding the popular Children’s Health Insurance Program, has adopted new standards that would make it much more difficult for New York, California and others to extend coverage to children in middle-income families.

The politics of Medicaid funding allocation

The new expansion of health insurance for children in the US provides an excellent example of how Congressional politics influences the distribution of government funding across the US, and down to the regional and even city-wide level. Through political negotiation and bargaining, the legislators are able to funnel directed funding to specific hospitals, under the auspices of a universal legislation such as the Children's Health Insurance Program. Here is an excerpt a recent article by the New York Times describing the process in more detail:

One hospital, Bay Area Medical Center, sits on Green Bay, straddling the border between Wisconsin and the Upper Peninsula of Michigan, more than 200 miles north of Chicago. The bill would increase Medicare payments to the hospital by instructing federal officials to assume that it was in Chicago, where Medicare rates are set to cover substantially higher wages for hospital workers.
Lawmakers did not identify the hospital by name. For the purpose of Medicare, the bill said, “any hospital that is co-located in Marinette, Wis., and Menominee, Mich., is deemed to be located in Chicago.” Bay Area Medical Center is the only hospital fitting that description.

Guiliani's health plan

Yesterday, the NYT had a good feature about Guiliani's helath care plan. While it is difficult to compare the GOP and Democratic plans at this stage of the campaign, it is refreshing to see health care discussed in detail on the GOP side as well.

Obesity research discussed on NPR

The recent finding that social networks can transmit obesity risk between friends (see previous post) has also been featured in a more in-depth interview with Nicholas Christakis on the National Public Radio. Here is the beginning of the article:
Are Your Friends Making You Fat?
A new study suggests that your best friend's weight may be very influential in determining whether you'll gain or lose weight over the years. The research documents the spread of obesity from person to person in a study of more than 12,000 people.

Friends do(not) make friends get obese?!

While there is much attention on the epidemic of obesity in the US, new research on the mechanism by which this occurs is just starting to come out. New research by Nicholas Christakis and James Fowler at the Harvard Medical School and UCSD published in the New England Journal of Medicine found that social networks in the Framingham Heart Study transmit the risk of obesity. In an extensive dataset of social networks formed by thousands of residents of Framingham over several decades, the authors found that people gain weight when their friends gain weight, and that this relationship also works in the opposite direction: those with friends who lost weight lost weight themselves. See The New York Times article that discusses the research and some of the controversies that it causes in how we think about obesity and its social implications.

Health inequalities now include eating disorders

Eating disorders, particularly binge-eating has been added to a growing list of poor health outcomes that Latinos in the US are experiencing. Researchers at Harvard Medical School used a national survey to analyze patterns and correlates of over-eating. The PI on the project was Margarita Alegría, who runs a center for the study of mental health: www.multiculatralmentalhealth.org. This finding adds to previous evidence that other minorities in the US are more likely to suffer from obesity, diabetes, and a have an increased risk of a range of chronic diseases associated with these two. See more about the report at the Cambridge Health Alliance website.

Can Democrats expand healthcare coverage during the Bush White House?

The Democrats in Congress today pushed for significant changes in Medicare funding that would complement the bipartisan agreement on expanding government-funded health care coverage for low-income children across the US. According to a report by the New York Times, Democrats Press House to Expand Health Care Bill, President Bush is likely to veto a bill that would cut Medicare funding for privately-run health plans. How credible, really, is President Bush's announcement that expanding coverage for low-income American children is a step down the path of big, government-run health care? In any case, it does seem unlikely that the Bush White House will allow the passage of a significant expansion of any health care reform that does not fit into Bush's vision of a highly-privatized, competitive market with significantly less government intervention than today. Whatever the outcome, it is likely that this will become a campaign issue, and a particularly difficult one for GOP candidates to deal with.

US Congress and Drug Safety

The NEJM editors published a response to the recent changes in FDA's funding and a shift to more focus on drug safety once the drugs are on the market (Safer Drugs for the American People). The editors endorsed the existing proposals by Congressmen Henry Waxman and Edward Markey and by Senators Edward Kennedy and Michael Enzi to pass new legislation on drug safety, introducing significant changes in how the FDA operates and how the drug manufacturers are held responsible for ensuring the safety of drugs in the US.

Children's Health Insurance

A new paper published by NBER reports that health insurance take-up by low-income immigrant children is equally high as by native-born children, suggesting that the state programs are successful in reaching traditionally under-served and under-covered immigrant populations. The article is by Thomas Buchmueller, Anthony Lo Sasso and Kathleen Wong, titled "How Did SCHIP Affect the Insurance Coverage of Immigrant Children?" Here is the abstract:

The State Children's Health Insurance Program (SCHIP) significantly expanded public insurance eligibility and coverage for children in "working poor" families. Despite this success, it is estimated that over 6 million children who are eligible for public insurance remain uninsured. An important first step for designing strategies to increase enrollment of eligible but uninsured children is to determine how the take-up of public coverage varies within the population. Because of their low rates of insurance coverage and unique enrollment barriers, children of immigrants are an especially important group to consider. We compare the effect of SCHIP eligibility on the insurance coverage of children of foreign-born and native-born parents. In contrast to research on the earlier Medicaid expansions, we find similar take-up rates for the two groups. This suggests that state outreach strategies were not only effective at increasing take-up overall, but were successful in reducing disparities in access to coverage.

Welcome

I created this blog as a place for posting and discussion of new research in politics and health. Let me know if you know of any recent research in government -- from political science, economics or sociological perspective -- that engages problems in health and medicine...both in the US and overseas.