Category Archives: Health & Diet

Rouhanicare: Iranian president’s unsung domestic success – Saeed Kamali Dehghan. 

When Ali’s father-in-law had a stroke in the Iranian city of Shiraz last year, the 67-year-old shopkeeper was rushed to Namazi hospital, where he received treatment for 20 days, including six days in intensive care.

While his father-in-law recovered, Ali turned his mind to how he would pay for the care. He borrowed money to build up a 100m rials (£2,000) reserve. But when he picked up the bill, it amounted to just 5.8m rials (£116).

“We thought they may have forgotten to add a zero,” he told the Guardian. “I looked at my brother-in-law, and we laughed. This was considerably less, it was almost nothing.”

Before he fell ill, Ali’s father-in-law had joined the healthcare programme brought in during President Hassan Rouhani’s first term, a scheme announced in 2014 and nicknamed Rouhanicare, in apparent homage to Obamacare, Barack Obama’s patient protection and affordable care act. It meant that Ali and his family were only expected to pay a fraction of the total 128m rials.

In the course of the past three years, Rouhani’s health ministry has insured nearly 11 million Iranians, meaning that those who were not previously covered, like the unemployed or the poor, are now protected.

The government’s bimeh salamat(healthcare) scheme pays 380,000 rials per person in monthly contributions, allowing most of those covered to pay a fraction of the cost of treatments.

Ali said he believed the healthcare plan was the president’s biggest unsung domestic achievement, and one that helped lead to a landslide election victory in May, which increased his mandate for his second term by 5m votes. Rouhanimeter, an independent website tracking Rouhani’s campaign promises, said it considers his pledges on healthcare to be a promise fulfilled.

“We have taken big steps to protect the social welfare of those with lower incomes and the nationwide healthcare plan’s implementation means all Iranians are now covered by medical insurance,” Rouhani said in his inauguration ceremony last month.

Initial estimates expected 5 million Iranians to apply for the scheme, but more than double that number have registered – many of whom did not dare to see a doctor previously for fear of the cost.

Shahram Shahbazi’s mother was an aerobics trainer in Tehran before developing a spine condition a couple of years ago that has left her housebound. “This healthcare really came to our rescue, otherwise we couldn’t afford the £5,000 needed for the surgeries,” Shahbazi, 27, said.

“It means that if she didn’t have the insurance, my mother would still be in pain and we would have to stop treatment after the first surgery. Under the insurance, you’re only supposed to have one big surgery a year, my mother had two and still they covered it.”

Despite the scheme’s success and popularity, it has not been without its problems. It is expensive – Rouhanicare costs about £770m a year, while other major health reforms, such as introducing a referral system and family physicians, means the annual healthcare bill is three times that figure. Rouhanicare’s funding comes from 1% of Iran’s 9% VAT rate and 10% of reserves saved through cut in subsidies.

Fars news, a semi-official news agency allied with the opponents of Rouhani, claimed last year that Rouhanicare was “on the brink of collapse” because it was not expertly thought-out and lacked funding.

“The nationwide healthcare plan is facing serious financial problems and state insurance agencies are saying that they are not able to pay back their debts to hospitals and it’s more than 10 months that they are facing those debts,” a Fars article said. Officials have admitted to the lack of funding in initial years.

Hossein Nafisimofrad is a graduate in business management at the University of Warwick who has done research about Iran’s health transformation plan. He also sounded an air of scepticism, saying his evaluation showed the “state-funded policy” was aimed at avoiding political unrest, but would be ineffective and unsustainable in the long run because of its costs.

Although Rouhani has taken the credit for the healthcare plan, it was envisioned in law more than two decades ago and was partially implemented during Mohammad Khatami’s reformist presidency.

Iraj Harirchi, a deputy health minister and spokesman, said Rouhani’s emphasis on the healthcare plan during his inauguration ceremony showed there was the necessary political will for its funding to continue.

“We’re proud to say that there is no Iranian without a medical insurance that we would refuse to cover,” Harirchi told the Guardian. “There may be some people who don’t want to apply, or there are issues with their IDs, otherwise anyone who registers can be covered.”

Nearly half of Iran’s population is insured through Rouhanicare or other means, with about 38 million having the government paying for their national insurance contribution. The rest are covered by medical insurance provided by their employers.

Most people using the government’s salamat insurance scheme contribute 6% of their overall treatment costs, and pay between 10% to 30% towards the costs of most drugs required for their care. Those assessed as unable to afford such payments are not charged.

“Before the [Rouhani’s] health transformation plan, people on average paid for 37% of their treatments costs, now they pay 6% and if it’s through referral only 3%,” Harirchi said, adding the reforms have also significantly reduced corruption and bribery in the health sector.

About 90% of the 11 million people covered by salamat insurance live in the suburbs. The government has recently decided that those who can afford should pay between 15% and 100% of their contribution based on an income assessment, but it was not clear when the new requirement would come into force.

Haririchi acknowledged that funding remains a challenge, but he was confident the government would find the money. “Iran’s population pyramid points towards an ageing population and this would increase the health and treatment costs so we would need more money.”

Vahid Rosoukhi, a contractor specialising in software working in the healthcare sector in Tabriz, north-west Iran, said recent reforms had benefited those on low incomes, but added that more money was needed to meet demand.

“A big challenge facing the healthcare is the bigger picture. From the beginning, we’ve heard criticism from doctors citing its huge financial burden and the government access to limited funds. That’s why from the beginning of this year, the government has relaxed some of its duties under the healthcare and limited its use to state-run health centres,” Rosoukhi said, referring to a cabinet decision this summer which restricted patients covered by Rouhanicare to only use state hospitals and doctors.

Hundreds of nurses have protested in front of the Iranian parliament, Majlis. In February, they complained that Rouhanicare has increased pressure on them, while their salaries have stagnated.

Outside the medical profession, others view Rouhanicare as a success, even those who did not vote for the president, including Roshanak, 39, a computer engineer based in Tehran.

“I don’t know why he kept focusing on the nuclear deal during his election campaign while it was the healthcare that had the most tangible effect on those with lower incomes,” she said.

“Before this plan, many people didn’t even dare to go for a checkup or treatment because they were afraid of the costs but you look at people now and everyone has got a daftarche (insurance notebook).”

The Guardian 

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Are Children Getting Too Many Vaccines? – Paul A. Offit, MD. 

One hundred years ago, children received a vaccine to prevent one disease—smallpox. This meant that children received only one inoculation in the first few years of life. Today children receive vaccines to prevent 14 different diseases; now they can receive as many as 26 inoculations early in life and 5 at one time. And while it is difficult to watch children receive so many injections, most parents would probably be surprised to learn that the immunological challenges from today’s 14 vaccines are less than the challenge from that one vaccine given a hundred years ago.

Smallpox is the largest of the mammalian viruses. As a consequence, the smallpox vaccine contained about 200 viral proteins. The number of viral proteins, bacterial proteins, and bacterial polysaccharides (complex sugars on the surface of bacteria) contained in the 14 vaccines given today adds up to about 150. Total. In other words, with advances in protein chemistry, protein purification, and recombinant DNA technology, vaccines contain fewer immunological components today than a century ago.

In the womb, babies live in a sterile environment. When they enter the birth canal and the world, however, they are bombarded with bacteria. People have about 100 trillion bacteria living on their skin as well as on the lining of their nose, throat, and intestines. Each of these bacteria contain between 2,000 and 6,000 immunological components—to which children make an immune response. If they didn’t, these bacteria could enter their bloodstream and cause harm. Indeed, children born without an immune system (called Severe Combined Immunodeficiency) often suffer sepsis caused by these bacteria. The food we eat isn’t sterile. The water we drink isn’t sterile. The dust we inhale isn’t sterile. In response, we make large quantities of immunoglobulins every day to prevent these colonizing bacteria from causing harm. Vaccines are a drop in the ocean of what children encounter and manage every day.

The reason that children are immunized early in life is to protect them against diseases that occur early in life. Fortunately, babies mount an excellent immune response from the moment they are born—given the challenges that they face, they would have to. The proof that young children can respond to these vaccines is evidenced by the fact that many of the diseases that commonly crippled or killed young children have been virtually eliminated.

Viruses and bacteria like measles, mumps, pneumococcus, chickenpox, hepatitis A, hepatitis B, influenza, rotavirus, tetanus, and whooping cough are still common enough that a choice not to get a vaccine is a choice to risk getting those diseases. Some vaccine-preventable diseases, however, are extremely rare. Rubella, diphtheria, Haemophilus influenzae type b (Hib), and polio have either been completely or virtually eliminated from the United States. So why are we still giving vaccines to prevent them?

Take polio, for example. Polio was eliminated from the United States in 1979 and from the Western hemisphere in 1991. But polio still exists in the world; the virus continues to circulate in Pakistan, Afghanistan, and Nigeria. And, because international travel is common, cases of polio still occasionally pop up in other countries. It is likely that people who have been exposed to poliovirus travel to the United States. And because only 1 of every 200 people infected with polio has symptoms, it’s hard to know who is infected and potentially contagious. Poliovirus hasn’t spread in our country because immunization rates are high. If immunization rates drop, however, polio will be back. Which is exactly what happened in an undervaccinated Amish community in Minnesota in 2005 when five children came down with polio.5 Or in an Amish community in Pennsylvania in 2001 when six children suffered meningitis caused by Hib.6 Or in states newly independent of the Soviet Union between 1990 and 1994 when 50,000 people, mostly children, were infected with diphtheria.7 Let your guard down, and these diseases will come back. So until these diseases have, like smallpox, been wiped off the face of the earth, it’s still important to shield against them.

Despite claims by Carson, Christie, and Paul, every one of these vaccine-preventable diseases can cause permanent harm or death. So, choosing one vaccine over another wouldn’t be a reasonable choice; it would be an untenable choice—a Sophie’s Choice.

Paul A. Offit, MD is a professor of pediatrics and director of the Vaccine Education Center at the Children’s Hospital of Philadelphia.

The Daily Beast

It’s not just the Pharmaceuticals screwing you Americans! Your doctors are in on the scam too. – Robert Reich. 

The real threat to the public’s health is drugs priced so high that an estimated fifty million Americans—more than a quarter of them with chronic health conditions—did not fill their prescriptions in 2012, according to the National Consumers League. The law allows pharmaceutical companies to pay doctors for prescribing their drugs. Over a five-month period in 2013, doctors received some $380 million in speaking and consulting fees from drug companies and device makers. Some doctors pocketed over half a million dollars each, and others received millions of dollars in royalties from products they had a hand in developing. Doctors claim these payments have no effect on what they prescribe. But why would pharmaceutical companies shell out all this money if it did not provide them a healthy return on their investment?

Drug companies pay the makers of generic drugs to delay their cheaper versions. These so-called pay-for-delay agreements, perfectly legal, generate huge profits both for the original manufacturers and for the generics—profits that come from consumers, from health insurers, and from government agencies paying higher prices than would otherwise be the case. The tactic costs Americans an estimated $3.5 billion a year. Europe doesn’t allow these sorts of payoffs. The major American drugmakers and generics have fought off any attempts to stop them. The drug companies claim they need these additional profits to pay for researching and developing new drugs. Perhaps this is so. But that argument neglects the billions of dollars drug companies spend annually for advertising and marketing—often tens of millions of dollars to promote a single drug. They also spend hundreds of millions every year lobbying. In 2013, their lobbying tab came to $225 million, which was more than the lobbying expenditures of America’s military contractors. In addition, Big Pharma spends heavily on political campaigns. In 2012 it shelled out more than $36 million, making it one of the biggest political contributors of all American industries.

The average American is unaware of this system—the patenting of drugs from nature, the renewal of patents based on insignificant changes, the aggressive marketing of prescription drugs, bans on purchases from foreign pharmacies, payments to doctors to prescribe specific drugs, and pay-for-delay—as well as the laws and administrative decisions that undergird all of it. Yet, as I said, because of this system, Americans pay more for drugs, per person, than citizens of any other nation on earth. The critical question is not whether government should play a role. Without government, patents would not exist, and pharmaceutical companies would have no incentive to produce new drugs. The issue is how government organizes the market. So long as big drugmakers have a disproportionate say in those decisions, the rest of us pay through the nose.
Robert Reich , from his book ‘Saving Capitalism’ 

The link between your gut and your brain, mental health, and sleep. How does your gut talk to your brain?

The gut microbiota is the community of bugs, including bacteria, that live in our intestine. It has been called the body’s “forgotten organ” because of the important role it plays beyond digestion and metabolism.

You might have read about the importance of a healthy gut microbiota for a healthy brain. Links have been made between the microbiota and depression, anxiety and stress. Your gut bacteria may even affect how well you sleep. World Economic Forum

Experts May Have Found The Cause Of Crohn’s Disease. 

People with Crohn’s disease know the uncomfortable symptoms of the chronic condition all too well: diarrhea, abdominal pain, weight loss and fatigue, among others. But what doctors have not been able to tell the approximately 565,000 people in the U.S. with Crohn’s is why they’ve developed the inflammatory bowel condition in the first place. Huffington Post