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It's mosquito and tick season once again -- and with the rains we got in April, that actually means something. The Guilford County Department of Public Health has posted some helpful suggestions to deal with those problems, ranging from reducing their breeding areas to reducing your own chances of being bitten. Bug bites, in addition to hurting and/or itching, can spread disease, notably (from ticks) Rocky Mountain spotted fever, so this is something to take seriously.

The Henry J. Kaiser Family Foundation, which does research and communications related to health care, has a new poll up that, unsurprisingly, ranks health-care costs among Americans' top economic concerns.

Currently, the economy is Americans' No. 1 concern, but that issue takes in such disparate factors as gas prices, the jobless rate and stagnant/falling wages as well as health care.

You can read more here.

"Strap yourself in; this isn't pretty."

So warns Brian Klepper by way of introducing a new report from the Economics Policy Institute called "A Decade of Decline: The Erosion of Employer-Provided Health Care in the United States and California, 1995-2006."

Among Klepper's observations from the report:

• The drop in the percentage of American workers with employer-sponsored health insurance between 2000 and 2006 was bigger than the gain between 1995 and 2000, even though both stretches encompassed times of relative economic prosperity.
• The drop may be fueled by growth in health care costs that, between 2000 and 2006, were four times the increase in workers' earnings and five times the general rate of inflation.
• The drop is hitting all workers: "The burden of these employer cuts is not carried by part-time or marginal workers. Rather, the most dramatic loss is among workers with the strongest connection to the labor force."
• The actual number of American uninsured is probably substantially larger than the commonly cited 48 million.
• The drop has economic implications because of the relationship between health, productivity and competitiveness.
• Even those with insurance have higher costs and lower benefits than in the recent past.

"The market can make care and coverage less expensive and more available," Klepper writes. "But getting to a system that assures appropriate care to everyone within our borders must be facilitated through policy. It will require political will, backed by a national understanding, already firmly in place within our largest corporations, that without secure access to health care, our people cannot be highly productive or continue to lead on the global stage" (emphasis added)

I don't often say, "Go read the whole thing," but: Go read the whole thing.

Via Health Beat, here's a compendium of articles in The American Prospect discussing health-care reform. (Intro here; follow "related articles" links to the right for the others.)

One key takeaway: The problem of the uninsured, big as it is, isn't the biggest problem with our health-care system. The biggest problem is cost, and until costs are contained, the problem of the uninsured may well not be addressed. Health Beat blogger Maggie Mahar quotes Dr. Marcia Angell, former editor-in-chief of The New England Journal of Medicine: "Costs are the central problem; universal health care would be easy if money were no object."

Almost as big as the issue of cost is the issue of what's politically possible: Out of all of the many ways in which health-care costs could be cut, what way, or combination of ways, can make it through the House and the Senate, particularly the latter, where not just 51 but 60 votes are needed (to prevent a filibuster)?

2009-10 may not be 1994 all over again, but the obstacles to any meaningful effort to control costs (and make other changes, such as expanding coverage) are many. Backers of significant change, of whatever type, shouldn't be confident that that change, or any change, will happen.

It's not online, but I had an article in Wednesday's paper about a talk given Tuesday night by Dr. Ed Weisbart at a forum sponsored by the League of Women Voters and the Moses Cone-Wesley Long Community Health Foundation.

Dr. Weisbart talked about the need to use more generic drugs, instead of brand-name prescriptions, primarily because doing so would save between $20 billion and $40 billion a year. He also said generics are safer because any safety issue with a drug tends to surface while it is still in the brand-name phase, before its generic equivalent can come on the market.

The article prompted an e-mail from Dr. John Lusk, a retired local physician active in the Greater Greensboro Society of Medicine. He writes:

A caveat for patients seeking less costly drugs is that they should realize that generics and brand name drugs are not all equal.

One should be certain that the generic being offered has been made by a reputable manufacturer. The major chains and the locally owned pharmacies most probably vet the source of their non-brand named drugs.

Your readers should be careful if drugs are ordered via the internet. This is especially true if the order is place with an off-shore supplier. Some of these medications have the potential to be counterfeit, and contain none of the active ingredient.

As you are more than likely aware, the FDA requires that tablets and capsules carry some type of identification, printed or embossed. I've seen some "ineffective" pills without these markings.

Another potential difference is the use of different excipients and binders. Occasionally one of these compounds will react with the active ingredient to render it inactive. I have sometimes seen evidence that pills pass thru an intestinal tract intact and almost unchanged in appearance.

I suppose the old advice is the best advice: Talk to your doctor and your pharmacist.

The Minnesota-based UnitedHealthcare Children's Foundation, a charitable nonprofit, is making grants of up to $5,000 for children who need critical health treatment and are not covered or not fully covered by their parents' health-insurance plans.

Parents and legal guardians can get more information or apply online at www.uhccf.org. The children must be 16 or younger. Families must meet certain economic guidelines, live in the U.S. and be covered by a commercial health benefit plan.

The New England Journal of Medicine has posted an article online about the travails of the Food and Drug Administration. The agency has been criticized for its role in the withdrawal of Vioxx from the marketplace and recent problems with contaminated Heparin from China.

But we ask the FDA to do a lot with not very much:

The fundamental problem is that legislators have heaped more and more responsibility on the FDA without appropriately increasing its budget. Between 1988 and 2007, additional FDA responsibilities were imposed by 137 specific statutes, 18 statutes of general applicability, and 14 executive orders. At the same time, the FDA received a 2007 federal appropriation of only $1.57 billion -- less than 75% of the budget for the school district in its home county in Maryland, and about the same as the projected cost of the infamous Alaskan "bridge to nowhere." The number of federally appropriated personnel authorized for the FDA has decreased from 9167 in 1994 to 7856 in 2007. And the remaining personnel must work with inadequate information technology: 80% of the FDA's computer servers are more than 5 years old; critical clinical trial records are stored on paper in warehouses, largely inaccessible for analysis; and the information technology budget is about 40% of that for the Centers for Disease Control and Prevention.

More money may not be the answer; the answer may be redefining and limiting the FDA's role. I don't know. But it is clear that to do its job as currently defined, the FDA lacks adequate resources. In particular, it doesn't have enough staff to inspect the foreign facilities from which 80% -- yes, you read that right -- of our drugs and drug ingredients now come. Under the current circumstances, additional problems similar to that of the Heparin from China might be not just likely but inevitable.

UPDATE: Americans' confidence in the FDA "has hit rock bottom."

Maybe the cure isn't worse than the disease, but it sure ain't good:

Two years ago, scientists had high hopes for new pills that would help people quit smoking, lose weight and maybe kick other tough addictions like alcohol and cocaine.

The pills worked in a novel way, by blocking pleasure centers in the brain that provide the feel-good response from smoking or eating. Now it seems the drugs may block pleasure too well, possibly raising the risk of depression and suicide.

Some pills that work in this way, the article points out, may not overact. But the pills may put some people at special risk, it says, given that a lot of people are both addicted to something and depressed.

A side-effect-free super anti-addiction pill would be a godsend, saving us no end of costs in public health (including wrecks), lost jobs and homes and destroyed relationships. But we aren't there, we can't see there from here and we have barely the beginnings of a map, it looks like.

This is a tad late for Earth Day, but here's a short piece on why we really need to take care of the species we've got.

The Health Beat Blog says it bluntly: Medical practitioners are often slow to adopt well-researched, proven mental health interventions -- because they're rarely profitable.

... you'd think that health care practitioners would make it a priority to provide effective mental health treatment. But a 2005 study from the National Institutes of Mental Health (NIMH) and Harvard found that only one-third of mental health therapies received by patients meet minimal standards for adequacy as established in national guidelines. That means that when we know what works -- and even draw up guidelines to define best practices -- relatively few providers follow the rules. Why is it so hard to translate knowledge into practice?

Three academics -- Robert Drake, M.D. and Jonathan Skinner, Ph.D from Dartmouth Medical School, along with Goldman -- wrote an issue brief for the conference that looked at his very question. Their conclusion? It's all about the money.

According to the authors, most effective mental health treatment regimes are not purely medication-based but also involve psychosocial intervention -- that is, a program of cognitive and behavioral measures such as patient education, psychotherapy, and peer support. ...

Given [cognitive behavioral therapy]'s focus on self-esteem, perspective, and encouragement, it might come off as somewhat touchy-feely to the outside observer -- but in fact it's proven to be quite effective. ...

Why can't psychosocial treatments seem to catch a break? "Unlike new medications, where the marketing of new practices is supported and encouraged by patents," notes Drake et al. in their issue brief, "psychosocial treatments are not patented and therefore lack the economic incentives to promote them widely. Because it is difficult to market, doctors are less exposed to best practice strategies and consumers are often unaware of other strategies for treatment."

Speaking about this issue in person during a panel at the conference, Drake didn't mince words, noting that "no one makes a profit off psychosocial interventions, so they are used less often." Moreover, a treatment like CBT is not quick and easy: it's sequential, collaborative, and personalized. In short, it's messy, labor intensive -- and thus hard to sell.

Is there a way these "best practices" can be applied more widely when market forces appear to be arrayed in opposition? Or is this a problem the market cannot fix? I'm not much of an economist, so anyone who has some insights, please speak up.