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Not Even Discussed In Private Rooms: Childhood Sexual Abuse and Abuse Survivors


January 30th, 2013

There is a health crisis in this country (as well as worldwide) that adversely affects one-fifth of the US population. Consequences of this crisis manifest in a wide variety of serious disease conditions. Physically it can exhibit as cancer and/or as any number of equally severe mental illnesses. Socially the disease is, in a word, criminality. Costs are estimated at over $100 billion per year, or similar to the annual expense of the war in Afghanistan. Investment in its prevention is estimated at a nickel on every $100 in research, compared to $2 for cancer. (See Note 1)

Despite considerable attention drawn to this issue this past year — the Surgeon General termed it an “epidemic” well over a decade ago — the crisis was not discussed during the presidential campaign. It remains largely ignored by the Congress (though just prior to adjourning sine die an innocuous bill to evaluate child welfare systems was passed), was unaddressed by the Affordable Care Act, and has been ignored as well to date by the Center for Medicare and Medicaid Innovation. “The leading journal of health policy thought and research,” Health Affairs, has never published on the topic.

The health crisis is child sexual abuse, which adversely affects the health status of 50 million survivors.

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PCORI’s Problem: Reasons Are Not Causes


November 5th, 2012

Editor’s note: In another Health Affairs Blog post also published today, Joe Selby, the executive director of the Patient-Centered Outcomes Research Institute, responds to David Introcaso’s post below. For more on the concept of patient centeredness, comparative effectiveness research, and the Patient-Centered Outcomes Research Institute, see Health Affairs‘ October issue, “Current Challenges In Comparative Effectiveness Research.

This past May, the Patient-Centered Outcomes Research Institute (PCORI) approved five research priority areas: “assessment of prevention, diagnosis and treatment options”; “improving health care systems”; “communication and dissemination”; “disparities”; and, “patient-centered outcomes research and methodological research”. In June PCORI announced 50 pilot project research awards totaling $30 million. PCORI is anticipated to spend $3 billion between now and 2019.

What does it mean to be “patient centered” and what does this then mean about ways of “improving “health care systems” and “communication and dissemination”? PCORI belies its “patient centered” mandate since it has not put a primacy on understanding and improving the interaction between the patient and the provider — the only way the quality of health care delivery is ultimately improved. None of the fifty PCORI pilot projects examine the quality of these interactions. Understanding and improving patient-provider interactions also explains how clinical evidence is produced or becomes meaningful.

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