Cuba vs. the US on the health front: what do we know?

Today's New York Times has a thought-provoking little piece on health care in Cuba, where life expectancy is longer than in the U.S. apropos of Michael Moore's forthcoming movie "Sicko."

After presenting possible reasons for lower infant mortality (more abortions) and longer life-expectancy (failing to take account of the death of refugees), the article muses as to whether Cubans' relative privations (fewer cars=more walking, less [but adequate] food=less obesity) might actually improve their health. A Cuban doctor who defected and now works in Miami points out that there are actually two health care systems in Cuba, one for public officials and visitors, which has everything, and one for everyone else. The second-tier system is pretty bare-bones, but begs the question - not asked by the article - of what are the essential elements of a functioning health care system that actually improves health?

As always, it's hard to separate the impacts on longevity of lifestyle (and socioeconomic) factors from that of health care itself. However, there's certainly lots more to be learned about the Cuban system(s), which we may not be able to learn, given restrictions on access.

Clinton gets it

In today's New York Times: Finally, a democratic presidential candidate who's not just touting universal health care as the be-all and end-all, but recognizes that such approaches as broader preventive care and Medicare drug payment negotiation are part and parcel of lowering health care costs. I trust there's more detail forthcoming; she has been leading in this area in Congress from the beginning.

Moore's "Sicko": I can't wait.

Michael Moore's documentary on health care in the U.S., which is getting good reviews at the Cannes film festival, is due out the end of next month. As pointed out today by the New York Times (who interviewed a number of health care experts who'd seen a preview), it could promote the national dialogue on health care. Why not? We're overdue for a fight, not just among policy wonks and presidential candidates (though a real argument would be nice there, too). I'm still waiting for mass protests on the Mall.

A friend of mine argues that Moore is such a polarizing personality that he'll be a distraction. I'll take his point, but counter that (1) we're getting used to him, and (2) raising the issues in a popular/populist format such as this is exactly the kind of exposure the topic needs to set the ball rolling. I'm more worried that the argument will devolve into anecdotes. But that in itself could be a useful opportunity for analysis (e.g., Moore says X, data says Y).

And yes, I will probably take the cost of my ticket as a tax deduction.

News coverage of screening tests

My colleague Gary Schwitzer has a new article on the Poynter Institute website in which he discusses how much news coverage on screening tests contradicts evidence-based recommendations from the U.S. Preventive Services Task Force and the American College of Physicians. He also includes some useful insight from health journalists on why screening gets the kind of coverage it does.

Important step for anti-smoking efforts

The Motion Picture Association of America, which makes recommendations on the suitability of movies for young viewers, has now decided to include smoking alongside violence and sex in its ratings. (Here's a NYTimes article.) Even though the prevalence of smoking portrayed in movies has come down a bit in the past few years (under lots of pressure from anti-smoking advocates, as was this ruling, for sure), there are still lots of films in which smoking is portrayed as glamorous, sexy, or appealing in some ways.

I don't want to be too cynical here, but I do question whether giving a movie an R rating actually keeps (younger) teens from seeing it, or whether it actually increases its allure, and hence the exposure. Particularly now, in the DVD era, I imagine it's a lot easier for teens to have access to forbidden stuff. But that's just a guess, and a different question.

On the whole, I think the new rules are a good thing, particularly as they increase awareness of the issue.

Storefront clinics: good or bad?

You'll want to have a look at a great discussion - be sure to read the comments - on the convenient clinics that CVS and similar stores are developing, to be staffed largely by nurses and physicians' assistants.

News-critique feature at Ben Goldacre's blog

Ben Goldacre, wickedly smart - and funny - health writer for the Guardian and blogger at bad science, has added a new mini-blog feature (which you can access via rss feed). In it, he simply responds to tenuous health stories with sassy one-liners (or in many cases less than one-liners).

For example:

Headline: Researchers uncover genetic link to obesity
Ben: Is it the gene for the muscle that opens the mouth?

Science for the OCD in all of us

Harold McGee has moved his column on food safety to the New York Times, and in this week's column he examines the five-second rule, which has now been addressed by a real study that involved pouring Salmonella broth on different flooring surfaces and then dropping bologna slices on them for varying lengths of time.

Yep, it's for real, and it's great stuff.

Genetics blog has moved

Hsien Hsien Lei's genetics blog, formerly Genetics and Health, is now Eye on DNA. Looks great!

This week's primary health care roundup from Australia

Here's another edition of PHC RIS, from the Australian Primary Health Care Research and Information System...

International comparisons of health care systems

Ezra Klein has an article in the May issue of The American Prospect comparing efficiency - what you get for what you pay - in Germany, France, Canada, Great Britain, and the Veterans' Health Administration, with reference to what we get in the US. Thoughtful and well worth reading.