HEALTH CARE/Joan Retsinas

‘At Last’ Awards

It is time for the “At Last” awards, presented to the organizations that at last step toward the future. The status quo acts like a spongy marsh: with every step forward, you sink deeper into the muck. It takes oomph to move. Not surprisingly, the powers-that-be generally embrace inertia with gusto.

First runner-up: The Department of Defense. This February, it agreed to dispense the emergency contraceptive pill to women in the military. Even the most conservative generals would concede: women in the military have sex, sometimes unprotected sex. And some of those 200,000 women don’t want to be pregnant. Outside the military, women who regret a tryst can go to a pharmacy for an emergency contraception pill. Women in the military – particularly stationed overseas - haven’t had that luxury until now, when “at last” the Department of Defense moved beyond Victorian-era notions of sexual morality.

Second runner-up: Abingdgon Memorial Hospital in Pennsylvania, for making hand-washing a job-requirement. For years think-tanks have tabulated the dire statistics on hospital-acquired infections, spread largely by staff. The current estimate is that 100,000 patients each year acquire an infection from their hospital stay. And for years think-tanks have urged staff to wash their hands, before and after entering a patient’s room. But in a fast-paced hospital environment, staff – especially physicians - have often neglected that recommendation. Two years ago Abingdon Hospital reported 31% compliance with hand-washing. An intense educational campaign, with omnipresent reminders and hand-sanitizers, boosted the rate to 60%. Tales of patients who contracted infections boosted the rate to what seemed an inevitable, if disappointing, plateau: 80%. Recently Abingdon upped the ante: “non-compliant” staff will receive an “infraction” notice. After three such notices, re-appointment will be “conditional.” “At last” Abingdon (and presumably other) hospitals got serious about protecting patients from those infections that thrive in hospitals.

Third runner-up: Federal court for pushing Pfizer’s transgressions into the scope of the Racketeer Influence and Corrupt Organization Act (RICO). The Food and Drug Administration approves drugs for specific conditions; physicians can prescribe those drugs for other conditions. (That off-label prescribing may lead to new discoveries.) But the company cannot promote its drug as effective for those off-label conditions. The FDA approved Neurontin for epilepsy, not migraines. Because the market for migraine-relief is far larger than the market for epilepsy-relief, the temptation to promote Neurontin for that use was strong. Kaiser Health System took Pfizer to court; the court ruled against Pfizer. Courts had fined Pfizer in the past; but this court “at last” got tough: it invoked RICO, which allows the court to triple the fine, to $141 million.

Grand Prize Winner: US Congress for pushing behemoth health reform legislation through a Byzantine political thicket. The law includes some little-noted benefits: a requirement that physicians disclose payments from pharmaceutical companies, an option for long-term health insurance, provisions for pilot programs to test cost-cutting measures, funds for community health centers. But the big reform is the extension of insurance to a major chunk of the population. “At last” the United States joins the rest of the industrialized world in guaranteeing basic health care to most citizens. The bill will ratchet down the disgracefully high percentage of people without insurance, and will eliminate those caveats that render “insurance” moot: pre-existing condition exclusions and caps. Over the past 50 years, Congress has faced similar legislation. This year “at last” our solons rose up from the comfortable inertia of the status quo.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email retsinas@verizon.net.

From The Progressive Populist, May 1, 2010