Saturday, July 9, 2011

Much Ado About Stem Cells (and Medicaid!)

Important things happened this week! Read on!

1. Lots going on in stem cell research. A patient in Sweden just received a trachea transplant -- made out of a synthetic Y-shaped polymer framework coated in his own stem cells! Two days later, the patient even had a cough reflex after accepting the transplant. This is a step-up for Dr. Paolo Macchiarini, professor of regenerative medicine at Karolinska University Hospital in Stockholm. Macchiarini previously performed a transplant of an artificial trachea created from donor tissue and combined with recipient stem cells in 2008.

In other news, a Phase II study out of Northwestern found that cardiac injections of hematopoietic stem cells (CD34 positive) can help relieve refractory angina. Angina occurred less often, and patients were better able to exercise, for about a year. Everyone involves cautions that these are preliminary results, and the invasive method of injection makes it impractical for routine use. There were adverse effects, to be sure: patients experienced bone pain and angina from the GCSF, and several patients showed cardiac enzyme levels consistent with non-STEMI.

2. The National Center for Health Statistics just released the findings of a survey on >4,000 private practice doctors regarding whether they would/do take on new patients with Medicare or Medicaid insurance. The survey is from 2005 to 2008 (it takes about two years to publish this info), and >90% would take new Medicare patients (most no's were for patients with fee-for-service plans here) but only about 2/3 of those surveyed would take new Medicaid patients. The article says that the Medicare numbers contrast with the popular idea that it's hard for older patients to get doctors -- but maybe it's an issue about certain regions?

3. Speaking of Medicaid, the first "valid" study was published proving that people with Medicaid are better off than people without any insurance. In 2008, Oregon had enough money to cover 10,000 people under Medicaid, but 90,000 applied. So the state sent up a lottery, and the National Bureau of Economic Research snatched up the opportunity for, essentially, a randomized trial comparing Medicaid vs. no insurance. The NBER found that those patients with Medicaid saw doctors more often, were more likely to be prescribed medication, were more likely to have preventive screening exams, had lower medical debt, had fewer bills sent to collection, and WERE MORE LIKELY TO SELF-REPORT BETTER PHYSICAL AND MENTAL HEALTH. Now please, stop cutting funding to this program.

4. I recently waited at the doctor's office 1.5 hours for a medical clearance visit (this consisted only of getting a TB test), which ended up costing me two hours in NYC traffic and being late to a meeting with a Dept. of Defense investigator (long story short, I needed to get up to Boston that day, and I was a personal reference for a friend). A few articles have been circulating lately about patients billing their doctors for wait times -- even I were so inclined, I have no idea how I'd do that for my aforementioned visit. But it is an interesting concept that doctors don't even seem that averse to. In fact, a few even preempt this by giving out giftcards for long waits or providing free wi-fi. How do you feel about this? Would free wi-fi make you more accepting of a long wait? What are your thoughts as future physicians?

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