Reflex: September 27, 2011

Black/White racial disparities in health: A cross-country comparison of Canada and the United States, appeared in Archives of Internal Medicine. This study compared estimates of health indicators among native-born black Canadians as compared to native-born white Canadians, and then did the same in the US for comparison. “Native-born black Canadians generally reported comparable or better health outcomes than their white counterparts in contrast to the findings in the United States, where African Americans fared worse than white Americans on many health indicators.” Aaron’s comment: I’m still trying to come to grips with this one. Think about this the next time you try and dismiss some cross-country comparison because you think we have more diversity than other countries.

Some pediatricians are refusing to see kids who are not vaccinated, reports Michelle Andrews (KHN). “When repeated efforts to educate parents fail, some pediatricians are now taking action: They’re refusing to treat children unless their parents agree to have them vaccinated.” Some pediatricians worry “about other patients in the waiting room, some of them too young to be immunized or with health problems that compromise their immune systems. Unvaccinated children put those kids at risk.” Austin’s comment: I don’t fully understand the issues on this one. There are kids in the waiting room who are not vaccinated that pediatricians will see, like those with compromised immune systems. Don’t those children put others at risk too? Could the not-yet-immunized kids wait elsewhere, wear a mask, be seen at special designated times and places? Are there liability issues? Is refusing to treat children the best we can do for them even if their parents don’t agree to vaccination? (Paging Aaron.)

The cost of Cancer care is becoming unaffordable in developing nations, writes Meredith Melnick. She is writing about a group of papers in Lancet on the costs of cancer care and the need to decide how to prioritize treatments. Don’s comment: There is no purely technical way to make such decisions that would inevitably prioritize some treatments over others. Moving forward to develop practical policies to determine when we use cancer therapies will require both broad cultural discussion about values along side the technical production of information in an understandable format that can be used prospectively by providers and patients to guide decisions. It will be very hard. Focusing on three questions would help: does it extend life? Does it improve quality of life? How much does it cost?These questions are a first step; there will never be a last step as we will always struggle with how to spend limited resources.

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