The Great Economic Crisis of 2008 is taking a bite out of personal health spending, and we’re not talking about Botox and liposuction.

There’s the Texas woman for example, who showed up in an ER with back pain. Physician Doug Curran found cancer on her X-ray. “She’d had a lump in her breast for awhile, but things were tight and she said she couldn’t get it looked at,” Dr. Curran told the Washington Post. “We’re going to see more of that.”

Indeed. The number of Americans that skipped a doctor visit, didn’t fill a prescription and paid for health care using retirement savings all rose this year, according to a survey by Time Magazine and the Rockefeller Foundation. Ten percent of respondents said they had postponed their children’s check-ups during the year to save money.

These trends will worsen as the Crisis drags into 2009. “An economic downturn drives more people to be uninsured,” the New America Foundation’s Len Nichols told the Washington Post. “They lose their jobs, they lose their income and their insurance.”

“Many times in health care there’s a lag of three to six months before it really hits hard, added Donald Fisher, President of the American Medical Group Association who spoke with the Post about health seeking behavior during economic downturns. “If they have a problem, they get it fixed while they still have health insurance. Then we see a decline in elective procedures, and then we really see a drop-off.”

The good news coming out of a recent report on the state of maternity care in the US is that it’s easy to find areas where we can do better.

The report, Evidence Based Maternity Care, was produced by the Milbank Memorial Fund, Childbirth Connection and the Reforming States Group. Its underlying theme is that we rely too heavily on procedures and technology for what is essentially a natural process.

For example, we overutilize procedures like epidural anesthesia and cesarean section. We then deploy co-interventions to monitor, prevent and treat side effects caused by these procedures. And throughout, we overuse little-ticket items such as prenatal testing and continuous fetal monitoring.

As a consequence, per capita spending on childbirth in the US is the highest in the world.

Ironically, we tend to underutilize many low-tech, cost-reducing strategies. During pregnancy for example, we underprescribe prenatal vitamins and smoking cessation programs. We rarely use simple maneuvers to flip fetuses into a head-first position before delivery which can cut down unnecessary cesarean sections. At or near delivery, we underutilize continuous labor support and other measures that increase comfort and facilitate labor.

As a result we are no better than average among developed nations on key outcome statistics such as perinatal, neonatal and maternal mortality.

The report says we’ll have to overcome a familiar list of hurdles in order to implement more cost-effective maternity care. For example, we have no generally accepted quality measurement systems for childbirth. Our payment and tort systems create perverse incentives for providers. We rely excessively on specialists for low-risk populations, and so forth.

Depressing as this sounds, the report could have been written 25 years ago. Nothing has changed.

On October 8, previously sealed documents were released from a US District Court case in Boston, in which Neurontin users and insurers are suing Pfizer for unjust enrichment and consumer fraud. The documents purport to show that Pfizer executives suppressed negative results about Neurontin even as they launched a marketing campaign to increase utilization of the drug.

The Boston Globe, Wall Street Journal and other media outlets covered the development, as did Pizaazz.  

Yesterday, Dr. Joseph M. Feczko, Pfizer’s Chief Medical Officer wrote a letter to the Wall Street Journal, in which he responded to allegations made in the newly unsealed documents. Here is what he said:

“The suggestions made by plaintiffs lawyers in your article “Suit Alleges Pfizer Spun Unfavorable Drug Studies“ concerning Pfizer and its medication, Neurontin, paint an inaccurate and incomplete picture. The results of the studies named in your article were made public in professional journals or through presentations at medical conferences.

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Nowadays, consumers vent frustrations about companies using methods ranging from deviously clever to appalling. They post negative videos on YouTube, make critical comments on Twitter, or launch websites with domain names that leave no doubt what kinds of opinions will be found there. Gripe sites like starbucked.com and boycottwalmart.org see lots of volume, for example.

Companies targeted in this way can’t pull a video off YouTube or delete a Twitter post, but they can proactively purchase domain names that angry consumers might otherwise commandeer for the purposes of launching unseemly attacks.

FairWinds Partners, an Internet domain strategy firm recently studied the matter. They found that 20,000 sites ending with “…sucks.com” had been registered (that’s ten times more than the cohort ending in “…stinks.com” by the way).

And sure enough, among the Fortune 500 companies studied by FairWinds, 35% own their very own “…sucks.com” domain name. These include Wal-Mart, Target, Coca Cola, AMC Theaters and Southwest Airlines.

Surprisingly, Fairwinds recommends that companies choosing to scoop up their “…sucks.com” moniker should resist the temptation to bury it. Instead, Fairwinds implores companies to use these sites to elicit customer feedback.

Most of the above mentioned companies have not heeded FairWinds’ advice, although we’ve heard that AMC posts a satisfaction survey and Southwest directs visitors to its customer service page.