Robert Maguire's Library tagged chinese OR medicine →  View Popular

Taiwan’s adoption of a national health insurance (NHI) system in 1995

Health spending as a share of GDP was 4.79% in 1993 (prior to NHI) and 6.1% in 2007 (after NHI).

I never quite processed the fact until I read this article,
on the AMA recommending renewed study of the medical utility of
cannabis, that the federal government actually restricts marijuana more
severely than cocaine or morphine. Marijuana is a Schedule I drug,
meaning it's illegal and has no medical uses. Cocaine and morphine are
controlled substances that do have some medical uses and can be
prescribed. So even though coke is physically addictive while marijuana
isn't, and morphine can kill you while marijuana can't, they're
Schedule II. That's kind of nuts, and it puts into perspective the
reason why people want to get it scientifically established that
marijuana really does have some medical applications, particularly in
fighting pain and nausea for cancer patients; the medical-marijuana
movement is not purely a stalking horse for people who want to legalise
and tax it like alcohol.

The American Medical Assn. on Tuesday urged the federal government to
reconsider its classification of marijuana as a dangerous drug with no
accepted medical use, a significant shift that puts the prestigious
group behind calls for more research.

"Despite more than 30 years of clinical research, only a small number
of randomized, controlled trials have been conducted on smoked
cannabis," said Dr. Edward Langston, an AMA board member, noting that
the limited number of studies was "insufficient to satisfy the current
standards for a prescription drug product."

First, there is absolutely no reason that plant medicines can’t be standardized and controlled for purity and potency. Indeed, the Netherlands has been doing just that for years, with medical marijuana distributed in Dutch pharmacies that is “of pharmaceutical quality and complies with the strictest requirements,” according to the Dutch government.

Second, the FDA has never said that a natural plant product can’t be a medicine. Indeed the agency has a lengthy “Guidance for Industry: Botanical Drug Products,” specifically designed to aid developers of plant medicines. The document not only doesn’t rule out plants as medicines, it even states, “In the initial stage of clinical studies of a botanical drug, it is generally not necessary to identify the active constituents or other biological markers or to have a chemical identification and assay for a particular constituent or marker.”

We ran Kronick's paper by a number of health care policy experts to see whether they thought it undercut the Institute of Medicine's death estimate. Everyone agreed that both Kronick personally and the journal that published him are credible. Because the significance of his finding could also have political consequences — on June 24, for instance, John Goodman, president of the conservative National Center for Policy Analysis, testified to the House Energy and Commerce Subcommittee on Health that we "do not know how much morbidity and mortality is attributable to lack of health insurance" — we also wanted to determine whether there may be any ideological bias at work. But we found no evidence of it.

In fact, far from having ties to the conservative movement, Kronick served as a senior health care policy adviser in the Clinton administration, where, according to his biography, he contributed to the development of the Clinton health care reform proposal. Kronick's articles have appeared in the New England Journal of Medicine and the Journal of the American Medical Association , and his work has at times been funded by the Commonwealth Fund, whose mission is "to promote a high-performing health care system" that aids "society's most vulnerable," including "the uninsured."

Kronick even told PolitiFact that his finding was "not the answer I wanted" and, as a result, he agonized over whether to publish it or not. He said he's "grateful" that it has so far been unnoticed in the increasingly hostile debate over health care. "I don't have a whole lot of friends, and will probably lose a few over this," he told us. "And I might make some friends I didn't want."

On one key point, the Institute of Medicine and Kronick actually aren't that far apart. Kronick said he doesn't doubt that individuals' health suffers when they're uninsured — he just hasn't found evidence that they die sooner. "No one would choose not to have insurance if they could afford it," Kronick said. "There's no benefit to having 47 million Americans uninsured."