A.
A National Experiment in Health Care
Narrator:
: This is Science Today. If you feel a little insecure
about your health care coverage, you have good reason.
Health economist James Robinson of the University
of California, Berkeley says that, due to their
high costs, hospitals are no longer at the center
of health care. And it's unclear what is.
Robinson: We are engaged in -- we, the United
States -- in a large uncontrolled experiment with
trying to find incentives to reduce the rate of
health care cost growth. It's not a matter of actually
reducing costs, but actually just slowing down the
rate of growth. And frankly, one way or another,
that's going to happen, because the trajectory that
we were on was -- especially with an aging population
-- was simply unsustainable.
Narrator: : More and more, HMOs
are forcing people to seek outpatient care. And
Robinson thinks that's not altogether a bad thing.
Robinson: Generally we would like to have
health care -- to the extent possible -- done in
the community, in doctor's offices, in patient homes,
in outpatient surgery facilities, keeping people
away from very expensive, very large, very bureaucratic
organizations.
Narrator: : For Science Today,
I'm Steve Tokar.
B.
Improving Doctors' Skin Cancer Scores
Narrator:
: Skin cancer is on the rise -- but your doctor
may not find it. This is Science Today. Barbara
Gerbert, a behavioral scientist at the University
of California, San Francisco, did a study to see
if primary care doctors could correctly diagnose
skin cancer as often as dermatologists. The primary
care doctors were right only half the time. Besides
not identifying lesions that were malignant, they
called lesions that weren't malignant cancerous.
Gerbert: And so they would do biopsies that
weren't necessary more frequently than the dermatologists.
Narrator: : But primary care doctors
who had had some experience in dermatology, usually
as medical students...
Gerbert: Were more likely to get higher scores,
better scores, and we do believe that experience
can help improve primary care physicians' abilities
with skin cancer.
Narrator: : Fortunately, Gerbert
found that with three to four hours' training, previously
untrained primary care doctors equaled the scores
of the dermatologists.
Gerbert: So in the area of dermatology, what
we would like is that every primary care physician
in training get three to four hours on skin cancer.
Narrator: : For Science Today,
I'm Steve Tokar.
C.
Artificial Swamps Will Have To Do
Horne:
Normally you wouldn't look to a sewage treatment
plant or a chemical treatment plant as a place where
you want to live if you're a bird.
Narrator: : This is Science Today.
Ecologist Alex Horne of the University of California,
Berkeley creates artificial wetlands -- swamps,
basically. He's discovered that they're an efficient
way to clean pollution from streams, rivers and
other sources of drinking water. Birds and animals
like them, too. Artificial wetlands often serve
as refuges for rare and endangered species. But
Horne makes an important distinction:
Horne: I'm not in the business of reconstructing
historical wetlands. That's a different scope and
a different field.
Narrator: : He points out that
in modern society, it's impossible to restore all
natural wetlands the way they were. Artificial ones
will have to do -- and he says they do pretty well.
Horne: And certainly for the next 50, 100
years that's going to have to be the way we go.
We can't get rid of everybody and recreate the wetlands
we used to have, but we can make some new wetlands
that do a lot of work, and if I was a bird or a
frog I'd say, okay, it's not perfect, but it'll
do for now.
Narrator: : For Science Today,
I'm Steve Tokar.
D.
On Earth, Those Inches Add Up
Narrator:
: On the surface of planet Earth, those inches add
up. This is Science Today. When you look at the
globe, you wouldn't think the continents are moving.
But they are, constantly, in a process called plate
tectonics. Geologist Mark Richards of the University
of California, Berkeley says continental movement
is slow but inexorable.
Richards: Average plate velocity is about
5 centimeters per year. So five centimeters is about
two inches.
Narrator: : You wouldn't think
that would add up to much, but over the course of
centuries it has big consequences -- on California's
San Andreas fault, for example.
Richards: Well, the San Andreas fault is
actually moving at like 2 to 3 centimeters per year
itself, and over a hundred years that's 2 to 3 meters.
So if you have a hundred years between two earthquakes,
you have 2 meters, 3 meters of slip all at once,
that has consequences -- that's what a big earthquake
is.
Narrator: : As recently as twenty
years ago, plate movement hadn't yet been accepted
as fact by all geologists. But Richards says it's
hard to argue with today.
Richards: We have very precise satellite-based
instruments called global positioning satellite
receivers that can actually measure these on a year
to year basis. And it works.
Narrator: : For Science Today,
I'm Steve Tokar.
E.
Closing Clinics Costs Money
Narrator:
: This is Science Today. Dr. Andrew Bindman of the
University of California, San Francisco found that
people with chronic medical conditions like asthma
were more likely to be hospitalized, rather than
treated and sent home, if they didn't have a regular
primary care doctor -- because emergency room doctors,
unfamiliar with their conditions, tended to hospitalize
them. Bindman found that during one year, unnecessary
hospitalizations cost one billion dollars in California
alone.
Bindman: And this is what's so worrisome
and strange about the decisions in places like Los
Angeles county to try to address their budget problems
in the health care area by shutting down their primary
care clinics. It just doesn't seem like a very wise
policy, because ultimately these patients will need
to go for care somewhere, they'll show up in emergency
rooms and ultimately end up in the hospital in many
cases where it will ultimately cost more money.
Narrator: : Although Bindman's
study was confined to California, he thinks the
results can be applied nationally.
Bindman: I don't think California is unique
in any way in terms of the types of problems we've
identified here.
Narrator: : For Science Today,
I'm Steve Tokar.
