Regulating Genetic Testing: It was while I was reading about this issue that I first thought: gosh, Barack Obama seems to turn up whenever I am reading about some insanely wonky yet important issue. And this one is not just off the radar; it and the radar are in different universes. Anyways:
You might be surprised to learn that there is very little quality control over genetic testing. I was. If I offer some genetic test, I can basically say what I like about what it will reveal, so long as I avoid violating the laws against fraud. And if you think about how easy it would be to avoid those laws just by talking about, say, a test for some gene that has been found to be slightly associated with increased IQ, you can see how many deceptive (but not legally fraudulent) claims this allows.
Moreover -- and more seriously -- there is very little oversight of the quality of labs that do tests -- that is, whether or not they tend to get the right answers when they do those tests. There is a law (passed in response to evidence that significant numbers of people were getting incorrect results on pap smears) that requires what's called proficiency testing for labs. But though the law requires that the government develop special proficiency tests for labs that do work requiring special kinds of knowledge, and though genetic testing plainly fits that bill, the government has not developed any proficiency tests for genetic testing labs.
This is serious, and bad. Suppose you are mistakenly informed that you are a carrier for some horrible disease: you might decide never to have kids. Suppose you have a fetus tested and you are told that it has, say, Downs' syndrome: you might abort. To do these things as the result of a lab error would be horrible.
Not nearly as horrible as the results of some false negatives, though. Consider this case (from a
very good report on the topic):
Tay-Sachs is an unbelievably horrible disease:
So imagine this: you know that you and your spouse are at risk for carrying this disease. You both get tested; neither is a carrier. You give birth to an apparently healthy child. But after a few months, the child you love stops developing normally, and it turns out that both your test and your spouses were misinterpreted, or screwed up, or whatever, and as a result your child is going to die a horrible death by the age of four. Oops!
In your copious free time, you can think of more cases in which screwing up a genetic test would be disastrous. After you get through with the cases involving children and inherited diseases, consider the effects of misreading a genetic test and informing a man that he is not the father of his child when in fact he is. The possibilities are endless.
You can probably guess who has
introduced legislation that addresses this problem. The people who wrote the initial report (note: I know them; they're very good)
think it's good. So do I.
Reducing medical malpractice suits the right way: Contrary to popular belief, medical malpractice claims
do not do much to drive up
health care costs. Still, medical malpractice litigation is a problem. Tort reform would address this problem at the expense of people who have been the victims of real, serious medical malpractice, who would lose their right to sue, or have it curtailed. If you read the medical literature, however, it turns out that there's a much better way to minimize malpractice suits, namely: apologizing. Strange to say, it turns out that people are a lot less likely to sue when doctors and hospitals admit their mistakes up front, compensate the patients involved fairly, and generally treat people with respect. It certainly would have helped in
this case:
I'd want to know what happened too, if someone cut off all my arms and legs. And in a case like this, if it was malpractice, limiting the damages a person can collect doesn't seem like the right answer, somehow.
Barack Obama and Hillary Clinton teamed up to introduce legislation aimed at helping hospitals to develop programs for disclosure of medical errors. (They describe it in this
NEJM article.) Again, I think it's good policy: this really is what the evidence suggests is the best way to reduce malpractice claims, and it does it without curtailing the rights of people who have already been injured through no fault of their own. Moreover, when people feel free to discuss their errors, they are much more likely to figure out ways to avoid repeating them. (The legislation provides support for this.) And that's the best way of all to deal with malpractice claims: by addressing the causes of medical malpractice itself.
***
Those are some of the wonkier things he's done. (There are others: introducing
legislation to make it illegal for tax preparers to sell personal information, for instance, and legislation on
chemical plant security and
lead paint.) He has done other things that are more high-profile, including:
* His
"health care for hybrids" bill
* An
Energy Security Bill* Various
bills on relief for Hurricane Katrina, including
aid for kids and a
ban on no-bid contracts by FEMA* A
public database of all federal spending and contracts* Trying to
raise CAFE standards*
Veterans' health care* Making certain kinds of
voter intimidation illegal* A
lobbying reform bill (with Tom Coburn), which would do all sorts of good things, notably including one of my perennial favorites, requiring that bills be made available to members of Congress at least 72 hours before they have to vote on them.
* And a
proposal to revamp ethics oversight, replacing the present ethics Committee with a bipartisan commission of retired judges and members of Congress, and allowing any citizen to report ethics violations. This would have fixed one of the huge problems with the present system, namely: that the members have to police themselves.
More... and hat tip to Katherine Regina for putting this together.
