Last week I wrote about the situation of the Grady dialysis clinic which the Grady Board voted to close last week. This means certain death for patients treated there without insurance as the private dialysis clinics won’t treat the patients, and emergency rooms will only treat them if they are within two days of death (see “I Need the Dialysis. I Think I will Die.”) This struck some of us in the healing professions as particularly cruel and inhumane, and some of our readers from other countries said we didn’t have the right to call ourselves a civilization if we treated people like that. The 90 or so patients represent a mix of undocumented aliens, people waiting for their green cards, and those who haven’t lived in Georgia for five years and don’t qualify for Medicaid. So far efforts to get private clinics and local teaching hospitals to provide compasionate care have been to no avail.

Last Wednesday local attorney Lindsay Jones, working pro bono, was able to get a court injunction to keep the clinic open. Last Friday the local AJC did some slam dash journalism by picking up the phone and getting someone from the New Jersey Medicaid department who said that they did not provide care for undocumented aliens, in spite of what a spokesman for Grady said. His response was “Nah-ah”.

Tomorrow there is a court date at Fulton County court on Central Ave between Prior and Martin Luther King Blvd in downtown Atlanta. There will be a protest at 8:15 am on the courthouse steps.

This afternoon we met with the lawyer and the dialysis patients.

Neil Shulman MD discusses situation with dialysis patients

I spoke with a woman from Nigeria named Ade Abner. She is 43 years old and has been on dialysis for 10 years. She is married to an American who was born in Georgia who is also on dialysis. She works as a registered nurse and is waiting for a green card. She is therefore not an undocumented alien.

Ade Abner
Some of the patients from Mexico said that some people had already gone back to Mexico. The Mexican Consulate, who Grady has been working with, told one woman that she had to leave now or she wouldn’t be able to return later. Feeling pressured to leave she went back. One woman went to Birmingham AL and is currently getting dialyzed in an ER. Others had been offered $2,000 to go back to Mexico, where they would be dialyzed for only three months.

Our friend Senator Max Baucus (D-Mont.) came out with the bill that we had long been anticipating that Judas traitor and bed partner of healthcare industry “stakeholders” would come out with, namely dumping public option healthcare insurance and eliminating the chance that the government could negotiate prices of prescription medications. His plan calls for an expansion of Medicaid and financial penalties to induce individuals and their employers to sign up for healthcare insurance. This will be paid for by cutting Medicare spending to hospitals, taxing family healthcare insurance plans that cost over $21,000 a year, and getting some concessions from industry. This continues his pattern of serving up the grub for his industry partners who contributed so handsomely to his campaign. Too bad for us little guys.

Max Baucus is keeping the industry guys well fed.

This development caused the stock in insurance companies to rise and led to the comment that the insurance companies had “ducked a bullet”. I thought that was an interesting choice of, well, animals, since we had previously noticed that a congressman had observed that introducing a public health insurance option into the health insurance mix would be like having an “alligator compete with a duck.”

Karen Ignagni (AHIP). If it walks like a duck...

And Billy Tauzin of PhRMA negotiated supposedly negotiated an 80 billion “payment” from drug companies which is essentially the “doughnut hole” between when Medicare stops paying for prescription drugs and when it kicks in again for super high bills. In concession the government gives up the right to negotiate prices, so it really isn’t much of a concession to give up the doughnut hole for drugs that are way overpriced anyway.

Those healthcare industry guys must all be high fiving each other right now. Without a public option and without the government retaining the right to negotiate prices the costs of healthcare will only continue to rise and there will continue to be individuals who are not covered, perpetuating an inhumane and immoral system, that will eventually lead to an implosion of the economy.

This week President Barack Obama named Thomas Frieden MD as Director of the Centers for Disease Control and Prevention (CDC) in Atlanta, GA, and Dr. Margaret Hamburg as Director of the Food and Drug Administration (FDA) with Joshua Sharfstein MD as Deputy Director.  

NYC Mayor Michael Bloomberg and Thomas Frieden MD

Frieden is the former Public Health Commissioner for New York City, where he became famous for banning trans fat and smoking from restaurants and bars, and pushed aggressive screening for HIV. NYC has been described as a city state and likened to Florence in the Middle Ages, where you would have much more power than at the head of a federal agency like CDC. Well, anything would be better than Julie Gerberding, whose main goal in life seemed to be pleasing the father figures that were above her in the federal bureacracy.

Julie rides off into the sunset. Bye the bye, Julie...

Hamburg is a bioterrorism expert who also used to run public health in NYC. Sharfstein was director of public health in Baltimore an developed a reputation for an aggressive approach to public health.

All have a reputation for idealism and taking an active role toward public health, which will be a welcome improvement over the lame pandering to anti-science creationists and corporate interests which characterized the last eight years of the CDC , and the lack oversight and whining deference to drug companies at the FDA, all of which led to the total collapse of public trust in these agencies.

CDC SAYS DON'T DO THIS!!!

Last week Mrs. Bremner was communicating to us from the American Heart Association Meeting about the importance of salt on blood pressure and health which led to a post about the topic which led to a lively discussion. David Colquhoun started out by pointing out that the graph showing a correlation between salt load and hypertension from the paper by Professor MacGregor could be accounted for by four data points. Mrs. Bremner countered by pointing out that they had re-analyzed the results without the four lowest data points and it was still significant. She subsequently pointed to another paper which summarizes clinical trials on the effects of salt reduction in the diet on health.

In this paper the authors point out that many studies that are used to argue that salt reduction has no effect on hypertension or health are studies in which the salt reduction only occurred of the course of one week, or involved acute salt depletion. The authors point out that one week is not long enough to evaluate the effects of salt reduction, and that acute salt reduction leads to an activation of the sympathetic nervous system, which leads to an artificial increase in blood pressure. Sounds good to me so far, guys.

They listed 17 trials of people with hypertension and 11 trials of people with normal blood pressure that were conducted for four weeks or more and had adequate salt reduction (4.6 g per day) as measured by excretion in the urine. People with hypertension had a 5 mm Hg point drop in systolic and 3 point drop in diastolic. People with normal blood pressure also showed a drop to a lesser extent. The authors note that this amount of salt reduction would result in a 14% drop in strokes and a 9% drop in heart deaths.

Clinical trials of dietary salt reduction and high blood pressure

Unfortunately noone has done a randomized trial of low salt versus high salt diet and it is unlikely to happen now due to ethical issues. Mrs. Bremner points out that increases in salt in the diet lead to a craving for salty food that causes a vicious cycle, which is one way people may become addicted to salty junk foods and snack foods.

Dr B.’s comment: It looks like cutting down on salt does lower blood pressure although a 14% relative reduction in cardiac events may not be that big of a deal in terms of absolute reduction of risk for a single individual. Salt may be just part of the problem with junk food. There was a study showing that people who eat in fast food restaurants three times a week have a greater than 90% risk of getting diabetes or heart disease and I need to find that reference again.