Tuesday, August 11, 2009

THE GREAT HEALTH DEBATE NEEDS COOLING

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THE GREAT HEALTH DEBATE

The White House has the best communications professionals and modern campaign consultants ever assembled. However they didn’t watch the details of Congressional health care policy-making.

The initial financial stimulus was only two pages long. The details came out as the plan progressed. Unfortunately, the reverse is true with this healthcare program. With all the details on the table, it will be very hard to please anyone.

TOWN HALL MEETINGS

Town hall meetings are set up by politicians to orchestrate their events as much as protesters do to disrupt them. It may not be right, but that is democracy.

Everyone has a right to go to a town hall meeting and express their views on issues that affects them. All of us should have the same right to talk, argue, or even shout about issues. It's too bad we are doing it in an unruly way.

THE GREAT DEBATE

There is a vicious debate over how to change health care in America. The debate is hurting Obama’s high approval rating as this debate drags on. The intensity is seeing in congressional town hall meetings throughout the country. This debate is quickly consuming the country. There are various interpretations of the proposed legislative plan, and there is certainly is much to debate: the cost to taxpayers, how private insurance companies will be affected, the cost to businesses, how seniors will be effecting etc.

A lot of the debate is not helping anyone on both sides of the arguments. There is some hysteria among opponents and some exaggerations among proponents. In America, people always question what the government proposes, rather than swallowing it blindly. That is democracy in action. All this shouting and viscious confrontations are not pretty, and better manners should exist. However silence would be much worse.

CONCERNS MAGNIFIED

Pres. Obama has yet to convince skeptics that reform will lower healthcare spending. There is also concern that people will not be able to keep their same health coverage. People worry about the government dictating the levels of minimum coverage, cost containment, end of life dictates, reduced Medicare coverage, and the government’s intent to create its own public plan that might remove people from private insurance coverage.

There is a fear that government will decide what level of treatment you may get at the end of life. Advanced care planning consultations are planned where doctors would talk to their elderly people about end-of-life care, living wills, and wishes for terminating care in some circumstances--this is not resonating well with seniors. There are numerous interpretations, some are extreme, and everyone is trying to educate everyone else.

CAN’T SIMPLIFY THE ISSUES

The real issues of health care coverage cannot be overly simplified and generalized. Yet both sides rely on bitter slogans and exaggeration to create shock value. It is not been a good debate, not even a serious one. Complex health care answers cannot be conveyed in a nine second commercial.

The healthcare issue is bigger than anyone ever thought. It has resulted in falling congressional personal polls and angry town hall meetings. This great recession has changed the mood of our nation. All of Congress seems to be shell- shocked. They had not really known how people feel about their health care.

IS THE PASSION AUTHENTIC?

The public is passionate and is scared. Both sides claim the passion isn't authentic, was set up by insurance companies, lobbyists, and especially the Republican national committee. Accusations are made that people are carrying swastikas, are two well dressed in jackets and ties, and must represent an organized planned protest engineered to hurt the president.

The Republicans, on the other hand, criticize the White House about creating a new White Hous e-mail address to encourage citizens to report any “fishy’ information they may see on an e-mail or anything on the web that looks suspicious and then send it to flag@Whitehouse.gov. This is an attempt to “fight intentionally misleading information” says the white house.

The Republicans accuse the White House of compiling an enemy list with this website, creating a dissident database. If this were so, why would the White House make it so public?

COMMENTARY

With a government health care plan so complex, confusing, and undercooked, can anyone really say what it will or will not allow, what it will or will not pay for? What is being sold, is not accepted by the public. No matter how good the communications may be now, bad policy must be changed.

It seems concerned citizens are being mocked, called stupid, extremists, right-wing, and can not see light, but in reality they are merely concerned citizens that deserve respect.

Americans question our government whose members take our tax money while taking bribes, shout for morality, and then get caught with their pants down, or lecture business people about private planes, and then turn around and order a bunch of them for themselves.

This health care plan should be argued on its merits. The bill submitted is over 1000 pages long, and many different bills are being submitted with the same length. What the final bill will be, is unknown.

Congress needs to act responsibly, deliberate, and with wisdom. Every day the town meetings seem to be a little angrier, and people are more afraid. With President Obama himself having three town meetings this week, the rhetoric may change.

Since, we have a peace initiative in the Middle East, why not have a peace initiative on health care reform? Perhaps the timing is wrong, and it should take a little longer for Americans, to have the health care details clairified.

As we face uncharted territory, with all the details of the plan on the table, it certainly will be hard to please anyone.

What do you think? Visit www.drneedles.com for more information on medical controversial subjects.

Monday, August 3, 2009

KIDNEY DONOR BLACK MARKET

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KIDNEY DONOR BLACK MARKET TRADE

More than 80,000 Americans now wait for a kidney, thirteen die daily--the rest are on dialysis. The number of donors decreases each year.

A Brooklyn broker, Rosenbaum, conspired the sale of a human kidney for a transplant. The cost to the recipient was $160,000 and the donor got only $10,000. Rosenbaum brokered such sales many times over the past 10 years.

In the 1970s, pharmaceutical companies developed drugs that could prevent organ rejection. Kidney transplants became common about 13 years ago when the anti- rejection drug ,cyclosporine, became available. With a lack of medical regulation, the organ black-market developed.

The dramatic success rates of operations also fueled kidney transplant growth. Lack of regulations and loose medical ethics followed . Desperate people depend on dialysis machines and the demand for kidneys has not kept up with the demand. The poor sell their kidneys to pay for a daughter’s dowry, to build a small house, or feed their families.

THE PROBLEM

Every year, more than 1 million people worldwide develop end-stage kidney failure. Because of the long waiting list, patients who have enough money resort to other options. It may be unethical and immoral, but it exists.

Since one kidney is sufficient for a good quality of life, people are willing to trade the other one for cash. When there is a shortage of deceased kidney donors, and donations are restricted, and one desperately needs an organ, people are willing to buy organs.

Thanks to the Internet, anyone on the globe can sell one of his or her kidneys without any difficulties. Potential recipients might get lucky and find a transplant that matches. There are literally hundreds of offers to sell a kidney, like shopping on eBay. Donors are desperate, but the poor and vulnerable people suffer.

THE KIDNEY ORGAN TRADE

There are many trafficking networks in India, Turkey, Ukraine, China, and Israel. If you have approximately $70,000 you can travel abroad and get yourself a kidney in these countries.

Out of desperation young people in parts of Eastern Europe sell one of their kidneys for sums up $3000, while the recipients pay between 100,000 and US$200,000 for each transplant. The donor's health generally worsens due to absence of any medical follow-up, their hard physical work, and their unhealthy lifestyle, complicated by inadequate nutrition and high alcohol consumption. In time, most of these illegal donors may themselves need dialysis treatments.

WHO ARE THE DONORS?

90% of organs from China come from deceased prisoners. They sign agreements before execution. A leprosy colony near Madras, India, freely donated kidneys for money offered by agents. Prominent doctors removed the kidneys of nearly 1000 people in a leading city hospital. The donors were offered jobs: they were told blood was being removed, rather than kidneys. The kidneys went to patients from the Middle and Far East.

SOLUTIONS

The strategy to crack down on trafficking in organs and body parts is doomed, since it ignores the fact that efforts to stamp out the underground markets either drive corruption further underground, or causes it to erupt elsewhere. The critical shortage of organs for transplants can only disappear by giving legitimate incentives (like money) to people who might be willing to donate their organs.

IRAN MAY HAVE THE ANSWER

Iran has no waiting list for kidney transplants, since the practice of selling one's kidney for profit is legal and regulated. The government supports such programs. Organizations match donors to recipients, setting up tests to ensure compatibility. The donor gets approximately $6000 for kidney donation. There is a strict regulation of the allocation of organs only to local citizens (no foreigners allowed), restricting international trade.

LEGISLATIVE LOOPHOLES

Most countries still have legislative loopholes since criminal responsibility in organ trade is rarely established in international criminal codes. Congress will probably raise the penalties for underground organ sales, as in Mr. Rosenbuam’s case. Al Gore tried to push a voucher system or a tax credit to a donor's estate to improve voluntary donation. Democratic Senators aren't talking about governmental entities offering donor benefits but they are raising penalties for brokering. The proposed bill allows states to offer health and life insurance to living donors, or funeral benefits to families of posthumous donors. Donors could be offered a tax credit, or perhaps a very generous contribution to a charity of their choice (not to themselves). Organs would be distributed according to formulas already in place, and not be available just to the wealthy. The rewards would go to approved charities or state governments, but not to individuals. Congress might allow donors to accept third-party benefits for saving the life of a stranger. Otherwise, desperate patients and donors will continue to be reluctant co-conspirators in crime, as they seek organs.

COMMENTARY

The illegal organ trade is booming across the globe. It will only disappear when the critical shortage of organs for transplants disappears. If legal incentives, (like dollars), could be given to people who might be willing to donate, the shortage might disappear.

Most countries require living donors to be either family members, or organs removed from cadavers, usually accident victims. It is illegal and unethical to remove kidneys from live donor especially for money. Donating a kidney isn't particularly risky, and does not impair one's health. They are easily available. With any illegal kidney black market that caters to buyers around the world, many countries have benefited from the kidney trade.

Must a person who sells one of his kidneys, be treated as a felon? This has encouraged the black market with middlemen who can benefit, like Mr. Rosenbaum, from Brooklyn. We could lower the cost of medical dialysis treatment by finding a solution to kidney donations. But does the government really want a solution? You might live too long.

What do you think? Your comments are always appreciated. Visit www.drneedles.com for more commentaries on controversial medical subjects.

SOURCES Cherry MJ. Kidney for sale by owner: human organs, transplantation, and the market. Washington: Georgetown University Press; 2005./ Doctors banned from brokering transplants. China Post. 2006 Aug 17. /The Guardian. 2005 Feb 10. /McLaughlin A, What is a kidney worth? Christian Science Monitor. 2004 Jun 9 /Hogg C. Why not allow organ trading? BBC News. 2002 Aug 30