To the Editor

I am constantly surprised at the anger surrounding efforts to reform America's broken health-care system. The recent Letter to the Editor from David F. Vazan, MD, (October 2009) decrying the current reform proposals is so filled with erroneous statistics and conclusions that it is understandable why a misinformed public would become so combative.

Many companies and individuals are benefiting monetarily from the health system as it exists today, so their supporters release health-policy editorials and unscientific "studies" designed specifically to make Americans doubt that a healthcare crisis even exists.

Much effort has been made specifically to diminish the importance of the number of uninsured. The uninsured has indeed "swelled" from 30 million in 1989 to nearly 50 million in 2008. Dr. Vazan feels that, because this represents only a 3 percent difference when considering the population increase, it is insignificant. Three percent is 20 million people. Nearly one-sixth of America's population has almost no access to healthcare providers. Much research links insurance status to health status. A recent, widely publicized study by Harvard researchers, for example, shows that 45,000 excess deaths yearly are associated with lack of health insurance.

Dr. Vazan goes on to give a breakdown of who supposedly make up the uninsured.
These are well-known talking points from conservative think tanks without any solid studies to support them. When the Census Bureau takes its yearly insurance survey, it does not ask demographic questions like immigration status or whether some choose not to buy insurance. Thus, conclusions about why people do not have health insurance are based only on conjecture. The most probable reason 50 million people do not have health insurance is that they cannot afford it. Whenever health costs exceed 10 percent of a family's income, people have severe difficulty in retaining health insurance.
Currently, it costs an American family about $17,000 per year for health-care costs. To be able to sustain that, a family would have to make $170,000 annually! No wonder millions of young, healthy men and women are forgoing purchasing health insurance. Dr. Vazan says that they "choose" not to buy insurance, but that's like saying I "choose" not to buy a Rolls Royce. He also claims that 9.3 million of the uninsured are non-citizens (as if non-citizens don't also deserve health care). As the Census Bureau's survey questions are posed solely in English and do not ask citizenship-status, that number remains a guess. The same goes for his listing 10.7 million who are eligible, but not yet signed up for, existing federal programs. Ironically, after painstakingly trying to minimize the number of uninsured, Dr. Vazan still asserts, "Everyone agrees we need reform …"

Dr. Vazan goes on to make numerous statements based more on emotion than fact:

"Rationing and price controls would un-doubtedly run rampant with the government the sole provider. The quality, efficiency and efficacy of our medical system would be fatally hobbled." American health care already has rationing, based mainly on ability to pay and the profit margins of insurance companies. European single-payer systems like those in France and Germany actually contain very little rationing; since companies want to be able to sell their products there, they negotiate prices downward accordingly. Nearly all analyses conclude that the quality, efficiency and efficacy of our medical system already rank poorly among industrialized nations. No proposal in Congress today (unfortunately) would create a single-payer system in the United States, so any complaints about a government takeover serve to scare rather than inform.

Dr. Vazan complains, "The government perpetually proves itself inefficient and wasteful." Actually Medicare, the much-loved government program, runs with 2 to 3 percent overhead, as compared to private health insurances which use 25 percent of funds for administrative costs and profits. That 25 percent  is put towards cherry-picking the healthiest customers and finding ways to deny or delay payments to doctors. The numerous insurance companies and their individual requirements force doctors and hospitals to apply 30 percent of their resources towards administration.

Dr. Vazan asks, "Would it not be prudent to examine all the options, the cost and the benefits before blindly plunging our nation down an irreparable course?" First, no legislation is irreparable. With 77 million baby boomers turning 65 within 20 years and making demands on Medicare, expect numerous future changes to health-care policy.
Second, all the options, in fact, have been developed and analyzed in public health circles for years. The current bills present a political compromise between the extremes of single-payer and private market. Third, a public debate of the various health-care options would be welcome, but the circus atmosphere at the August town hall meetings, with nonsensical cries of "Socialism" and "Nazism," shows that a very vocal minority will fight any proposals from progressives. Seeking political gain from the conflict, conservatives have not provided any viable alternatives. In fact, the 12 years of a Republican-led Congress resulted only in the Medicare Modernization Act which is projected to add $500 billion to $1 trillion to America's debt over 10 years by subsidizing expensive private Medicare Advantage Plans and incentivizing drug companies to increase prices with no fear of having to negotiate with Medicare.

The reason why Congressional health-care bills always seem so large and unwieldy is that problems only compound every decade that goes by without solutions. The federal government only steps in when the private market has failed to improve itself. Medicare was created (amid similar cries of "Communism" and "government takeover") in 1965 because private insurance failed to include seniors, all considered medically risky.
Today's "Public Option" results from the millions of uninsured and underinsured similarly ignored by private insurance.

Finally, physicians who fear governmental involvement in health-care financing may not realize that reimbursements remain artificially high because Medicare is paying the bill. If America were to change to a completely market-based system, including individual patients negotiating fees with doctors, most analysts project a precipitous drop in payments. Why would a patient pay you $1,000 for a cataract operation when the super-surgeon ophthalmologist down the street is charging $500?

A health-care revolution is inevitable in America. The high number of uninsured, combined with the rising cost of private insurance, baby boomers becoming older, medically related bankruptcies, poor health-care outcomes, increasing malpractice premiums, duplication of medical testing, unrelenting administrative pressures on doctors, etc., have led us to this moment. Instead of repeating statistics created to mislead and just complaining about legislation, doctors must play an active, informed, constructive role in sculpting this change.

Sincerely yours,

Chandak Ghosh, MD, MPH

New York, N.Y.

 

To the Editor:

The first report of a new device or procedure is typically cited in subsequent publications dealing with the same subject. Unfortunately and for quite some time, there has been a revisionist history concerning the detection of precataractous lens changes using Dynamic Light Scattering (DLS).

In the October 2009 article, "Cracking the Cataract Code: New Technology, New Hope, Dr. Datiles again reports his development of the DLS device to study cataract formation. The one reference that is cited1 also reports their invention of a "new DLS device" that "was shown to detect lens protein changes much earlier than conventional optical methods" in animals and "following these findings, a clinical device was developed."
This second paper provided 52 references which dated from 1971 to 2007 with a noticeable absence of references from 1980 to 1987.

We developed an instrument at M.I.T. in 1980 and were the first to report precataractous lens changes using DLS in normal and irradiated animals.2,3 In 1981, at the Joslin Diabetes Center, I developed a biomicroscopic-based clinical instrument and we were the first to report DLS measurements in diabetic and nondiabetic patients.4,5 This clinical device also allowed us to make reproducible measurements from different areas within the patient's lens. None of our seven publications in peer-reviewed journals nor any of the 10 abstracts presented at national meetings from 1982 through 1986, which also included an analysis of the size distribution of the lens-scattering elements,6,7 were referenced by Dr. Datiles. I filed the seminal patent for the clinical DLS instrument in 1982, which subsequently resulted in three issued patents.

My work was supported by four grants from the National Eye Institute and consulting agreements and financial support from CooperVision, Alcon Laboratories and Allergan. I constructed and sold two DLS instruments to Allergan which were utilized to develop a drug to prevent or at least delay cataract formation. Unfortunately, I also demonstrated my equipment to Kowa, which resulted in the "Laser Flare Meter," and to Cambridge Instruments, which copied my patent and manufactured the "Early Cataract Detector." I was forced to seek legal help to protect my intellectual property from these companies.

While advancements in electronics over the last 30 years have understandably resulted in technical improvements, the current work should be placed in historical perspective and evaluated in the context of the contributions made by others a long time ago. Adding bricks to someone else's wall does not confer ownership of the wall.

Jeffrey N. Weiss, MD

Retina Associates of South Florida

Margate, Fla.

 

1. Datiles MB, Ansari, RR, Suh KI, Vitale S, Reed GF, Zigler JS, Ferris FL. Clinical detection of precataractous lens protein changes using dynamic light scattering. Arch Ophthalmol 2008;126:1687-1693.

2. Weiss JN, Nishio I, Clark JI, Tanaka T, Benedek GB, Giblin FJ, Reddy VN. Early detection of in-vivo cataractogenesis using laser light scattering. Invest Ophthalmol Vis Sci (Supp). 1982; March:153.

3. Nishio I, Weiss JN, Tanaka T, Clark JI, Giblin FJ, Reddy VN, Benedek GB.  In-vivo observation of lens protein diffusivity in normal and X-irradiated rabbit lenses. Exp Eye Res 1984;39;61-68.

4. Weiss JN. Laser light scattering of in-vivo human lenses. Am J. Ophthalmol 1982; 94:683.

5. Weiss JN, Rand LI, Gleason RE, Soeldner JS. Laser light scattering spectroscopy of in-vivo human lenses. Invest Ophthalmol Vis Sci 1984; 25:594-598.

6. Weiss JN, Bursell SE, Karalekas DP, Craig MS. Evaluation of size distribution of lens scattering elements.  Invest Ophthalmol Vis Sci (Supp). 1985; 26:212.

7. Bursell SE, Weiss JN, Craig MS, Karalekas DP. Investigation of lens scattering element changes in diabetes.  Invest Ophthalmol Vis Sci (Supp). 1985; 26:298.