Category: Politics & Causes

California/Entertainment/General interest/Lifestyle/Politics & Causes/USA/Women
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Mr. & Mrs. Salahi vs Emily Post

by Fran Johns

Tired of the party crashers who won’t disappear? Aren’t we all. But since they are now accepting bids for TV appearances or something, they are clearly going to need a lot more high-priced agents and lawyers and publicists, and the least we can do in this space is offer a few more lines of coverage to help out.

One thing seems to be missing in all this. We are obsessing about security, and celebrity status or lack thereof, and too much or too little media coverage, and the excesses of reality TV which I have to admit to never having seen. But what about decorum? Could we sit the Salahis down with Letitia Baldrige? Preferably in a small, closed room? Lock them up in there (just Mr. and Mrs. Salahi, that is) until they finish Miss Manners’ Guide to Excrutiatingly Correct Behavior, every last word?

I grew up on Emily Post myself. Extend a hand contrary to the way Emily instructed (Ms. Salahi’s casual finger-work on Vice President Biden’s chest? Good grief) and one would suffer terrible, unrelenting embarrassment.

I think these people don’t know how to spell embarrassment. And as my Emily Post Book of Etiquette-bearing mother would say, “More’s the pity.”

Education/General interest/Health/Lifestyle/seniors/USA/Women
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Diet, exercise and Alzheimers

by Fran Johns

These paragraphs are a segue from talk of holiday festivities, over the past several days,  into the very un-festive subject of Alzheimer’s disease.

Part of the conversation at the very festive Thanksgiving dinner I was lucky to enjoy (without having cooked a single dish!) centered around food for the brain. One argument was that the good stuff for one’s neurotransmitters — egg yolks, broccoli, soy, starches — should be meticulously watched. I heard my mother’s voice in my head in response. “If you have three meals a day that look pretty on the plate,” she liked to advise, “you’re getting the proper diet.” When pressed she would explain that “pretty” equates to “color-coordinated,” i.e.: toast/bacon/scrambled eggs with parsley; or broccoli/carrots/potatoes/hamburger. I can’t remember whether our plates were 9-inch or otherwise.

Then there is the larger issue of exercise. Fitness, and occasionally brain exercise, have been contemplated several times in this space over the past few months (10/5: How’s your brain fitness today?; 9/7: The new best thing.) These theories hold that it is possible to strengthen, possibly even build anew, those neurotransmitters.

The definitive word on all this has not been written, and answers surely won’t originate with someone who barely passed Science I-II for the math/science requirement of her BA in Art. But some fascinating studies are being done, and new American Recovery and Reinvestment Funds will be going to projects that will be the focus of this space tomorrow.

Meanwhile, Alzheimer’s and various forms of dementia remain the ultimate tragedy in millions of lives, diet and brain exercise and clean living in general notwithstanding.

One of the most poignant insights into this disease you’ll be likely ever to see is currently offered by the PBS series Life (Part 2.) It follows a beautiful, articulate woman named Mary Ann Becklenberg as she confronts her own decline with incredible courage. What science may find answers for in the next few years, Mary Ann Becklenberg is exploring in real time. Schedules and clips are on the Life (Part 2) website.

Chances are, whether you’re over 50 or not, your life will be impacted by dementia. I, for one, am grateful for science and for Mary Ann Becklenberg.

California/General interest/Health/Lifestyle/Politics & Causes/USA
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The after-Thanksgiving 9-inch plate diet

by Fran Johns

At a very special holiday feast yesterday, one super-health-conscious guest chose a small plate for his buffet serving rather than the elegant-size plates of the rest of us. It was, he maintained, a matter of not having seen the table around the corner where the elegant-sizes were laid out, but he did manage to mention something about smaller portions being sufficient…

So. Now that you are, perhaps, stuffed with stuffed turkey, this space is pleased to pass along a novel idea passed along several days ago by Washington Post writer Jennifer LaRue Huget:

The holiday season brings with it an overabundance of advice on how to avoid gaining weight in the face of all those festive meals, cocktail parties and plates of cookies brought in by co-workers. Depending on whose advice you’re inclined to heed, you can cut back on carbs, mind the glycemic index of the foods before you, fill up on fat or count every calorie.

Or maybe you could just use smaller plates.

That’s the premise of “The 9-Inch ‘Diet’ ” (PowerHouse), a book published last November by a pair of advertising executives that makes a strong visual and verbal argument that much of America’s weight problem stems not from eating the wrong foods but from eating too much.

Alex Bogusky, who wrote the book with Chuck Porter, is best known for his work on the “Truth” anti-tobacco ad campaign. He starts the book with a simple tale. Having just bought a lakeside cottage built in the 1940s, he and his wife went out to stock up on dinnerware. But the plates they bought (regular ones from somewhere like Target) didn’t fit, no matter which way he tried to jam them in the cupboards. Slowly it dawned on him that those cupboards had been built with much smaller plates in mind. Further research revealed that while most dinner plates today measure 12 inches, in the middle of the past century the standard was nine inches.

And so a “diet” was born. (Bogusky notes that it’s not a diet at all — and thank goodness, as most diets don’t work in the long run, he observes.) Bogusky replaced his plates with vintage nine-inchers, and he and his family adjusted their serving sizes accordingly. “Research has proven,” Bogusky told me in an e-mail, “the mind is a much bigger trigger for how and when we feel satisfied and full than anybody had formerly realized. More so than the stomach.” As a result, he says, he’s eating considerably less food at every meal.

And you can, too.

“The 9-Inch ‘Diet’ ” is a fun read, chock-full of images that show how the continual super-sizing of American food-serving vessels has led to our consuming ever-increasing portions. Obviously, the diet is just a way of exercising portion control. But it’s an elegant and adaptable way.

Huget explains the subtleties of this system: you take smaller portions, which means you select and cook foods that will work (forget the 12-oz steaks and indivisible barbecued ribs…), and explains why, as the book in question has been around for a year, she is now bringing it up:

…I know it works, and I knew so even before reading the book. Last Thanksgiving, feeling sentimental, I dug out of my attic my Grandma LaRue’s 1950s-era dinnerware, including her nine-inch plates, in a pattern my husband and I have long referred to as “Hideousware.” They looked kind of Thanksgiving-y, so we used them at our celebration. The plates were indeed tiny. And we all ate less than usual — without really noticing.

I have to admit, I noticed what my very fit and healthy friend was consuming on his 9-inch plate.  Maybe a little bit less than I had on my elegant one. But if one were also to pass on the offering of seconds, and then not sneak extra bites when helping clean up, or pick friends whose dinners aren’t as delicious as my friend Liz’ …  There may be another diet book here.

Meanwhile, you might want to stimulate the economy by getting a new set of 9-inch plates before the next holiday season.

Jennifer LaRue Huget – Eat, Drink and Be Healthy: 9-inch plates are key to diet success – washingtonpost.com.

California/General interest/Lifestyle/Politics & Causes/seniors/USA/Women
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Pilgrims? Turkeys? None of the above. Today was just Honest Abe's good idea

by Fran Johns

Perhaps the pilgrims and the Indians did indeed sit down to a great feast and a peace pipe; there were probably plenty of wild turkeys around in the early days of the pre-U.S. But all of those things had nothing to do with the beginnings of Thanksgiving Day — you knew that, of course.

Nope. It was Abraham Lincoln’s effort to bring a little peace into the fractured country he found himself trying to lead, at a time about as fractured here as the world is, today, everywhere. Abe thought a little reverence and repentance would be a good thing. Here, in part, is what he had to say:

“But we have forgotten the gracious hand which preserved us in peace and multiplied and enriched and strengthened us, and we have vainly imagined, in the deceitfulness of our hearts, that all these blessings were produced by some superior wisdom and virtue of our own. Intoxicated with unbroken success, we have become too self sufficient to feel the necessity of redeeming and preserving grace…”

Poor Abe. If he thought he knew deceitfulness and intoxication, he should have seen what’s going on in health reform. And if he looked beyond our shores he might have sensed wider “punishment and chastisements in this world” and called for a global pause.

Whatever its origin — Lincoln’s formal establishment of the day was in 1863, but what would preschool be without pilgrims and cornucopias? — Thanksgiving Day still offers a nice time to pause.

Here in San Francisco a few hundred or so of us will be doing that at the 5th Annual Interfaith Thanksgiving Service, where we’ll have a group Ommmm, a Muslim call to prayer, a bunch of other prayers to Whomever has not given up on us all,  “with one heart and one voice” as Mr. Lincoln suggested we do. Then we’ll go home and eat stuffed turkey and watch ball games.

And a Happy Thanksgiving to all.

California/General interest/Lifestyle/Politics & Causes/seniors/USA
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God, Thanksgiving & Mother Theresa

by Fran Johns

Former San Francisco Mayor Art Agnos spoke briefly, and with holiday hilarity, this morning to several hundred Christians, Muslims, Jews, Buddhists and assorted other believers at the annual San Francisco Interfaith Thanksgiving Breakfast — “the biggest crowd I ever addressed at seven in the morning.” The event highlighted some of the work the SFIC does in the city: an annual winter shelter for homeless men, a citywide disaster preparedness program, a variety of ongoing efforts to promote understanding, cooperation and general interfaith goodwill. Agnos told a tale of encountering Mother Theresa which is condensed and paraphrased below as a Thanksgiving present from this space.

Coming home one Sunday night during his tenure, the mayor got a message (this was in the late 1980s, pre-cellphones) from his wife saying Mother Theresa was at their door. (“What should I do?” “Let her in.”)  When he walked into the living room, sure enough, there was the diminutive nun in her blue and white habit, seated on the Agnos’ sofa with another nun on each side. She wanted the mayor, she explained, to secure a particular piece of property for her good works. It was after 9 PM.

“I’ll get right on it, first thing in the morning,” Mayor Agnos said.

“No,” said the tiny nun in her quiet voice. “God’s work does not wait until morning.”

The property in question was in an area of town into which few ventured after dark. When that factor was mentioned as cause for caution, however, Mother Theresa would have none of it. “God,” she said in her still-quiet voice, “will protect us.”

So the mayor, the three nuns, the mayor’s wife (who wasn’t about to miss this experience) and a police bodyguard Mayor Agnos invited along just in case God wasn’t paying attention, climbed into a police car and drove to the building in question. Working their way through a fence which had long before been erected around the property, they walked around the back to find a small group of homeless men gathered around a fire. It was not only getting later all the time, it was mid-winter.

“Oh,” the men said in unison, “it’s Mother Theresa.” She blessed them. Then the mayor asked if the building did indeed belong to the city. “Well, yes,” they said, “but we’ve been living here for several years and nobody’s bothered us.” So the mayor assured the nun that he would get to work on her request first thing in the morning.

She was not finished. Next, she wanted to see about another piece of property, this one necessitating a trip to San Francisco General, the City/County hospital of last resort for citizens in need. By now it was getting on towards midnight.

At that hour at San Francisco General, Mayor Agnos explained, most of the people on site are the cleaning crews and base-level helpers — all of whom immediately recognized Mother Theresa. “When we got ready to leave,” said Agnos, “it was like a football huddle. Everybody in the area gathered around this tiny nun you couldn’t even see in the middle of the crowd.”

“When you die and go to heaven,” said Mother Theresa to her fellow laborers, “you will meet God. And God will bless you for your good work.”

“So,” concluded the Mayor as he opened his arms to indicate those around the room, “when you die and go to heaven, you will meet God. And he or she, whomever, will bless you for your good work.”

Makes you thankful to be in the presence of so many people doing good work.

California/General interest/Health/Politics & Causes/seniors/USA/Women
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Doctors making house calls? An old idea whose new time has come

by Fran Johns

Could house calls make a comeback? It’s already happening. The University of California at San Francisco, for one success-story example, started the UCSF-Mt. Zion Housecalls Program in 1999 with a philanthropic gift. Its original goal was to teach medical students about home care, but with the exploding need for primary care for homebound elders it has evolved into filling that need throughout San Francisco — while still teaching the new generation about house calls.

In an article in the San Francisco Chronicle, staff writer Victoria Colliver details some of the many advantages that such programs have.

June Hagosian’s brain tumor has made it difficult for the 77-year-old San Francisco woman to leave her house in recent years, keeping her mostly confined to her bed.

For someone like Hagosian whose medical needs require frequent doctor visits, that would usually pose a problem. But because of a program run by UCSF, the doctor comes to her. She has had to leave her bright yellow home in the Richmond District to go to the hospital just three times in the past seven years.

“This program has been so wonderful,” Hagosian said during a recent home visit with her physician, Rebecca Conant, director of UCSF’s Housecalls Program. “I wish everyone could have it.”

Conant, who had just 15 patients when she took over the program in 2001, is one of five part-time UCSF physicians who spend all their clinical time outside the office, traveling from home to home visiting frail and elderly patients. Housecalls currently serves nearly 100 San Francisco residents and has an eight-month waiting list.The Housecalls physicians visit patients whose conditions make it so hard for them to go to the doctor’s office that they might otherwise put off seeking medical care. By then, they would be so sick they would need an ambulance and end up in a hospital emergency room. The program takes patients regardless of whether they have insurance or an ability to pay, which separates it from private practices that offer home visits as a convenience but at an added cost.

UCSF’s 10-year-old Housecalls Program is an old idea that has gained new traction. Both the House and Senate versions of the health reform bills contain proposals to examine whether home-based care improves the health of chronically ill patients and saves the government money by reducing hospitalizations and ER visits.”There’s no question there is both a medical need and substantial cost savings to the Medicare program,” said Constance Row, executive director of the American Academy of Home Care Physicians.

The Department of Veterans Affairs’ Home-Based Primary Care program, which has been operating for more than two decades, has showed a 24 percent reduction in costs for those patients, and some studies suggest savings as high as 40 percent, Row said.

UCSF’s Housecalls Programs operates on an annual budget of $300,000, almost all of which is devoted to physician salaries. That’s an average cost of $3,000 per patient, which does not include the cost of hospital care when needed. Medicare spends a national average of $46,412 per patient over the last two years of life, when patients typically have several chronic illnesses, according to researchers from the Dartmouth Institute for Health Policy and Clinical Practice.

But new technology – the ability to X-ray patients using portable machines, conduct blood tests and provide other services using mobile devices – allows doctors to offer a much higher level of care in the comfort of the patient’s home.

Conant, an associate clinical professor at UCSF, said she uses mobile devices to aid in her patient care, but she finds home visits offer other advantages like allowing her to see patients’ physical environments, meet their caregivers and better understand what kind of care they need.

“Not only does that improve medical care, but it’s based in reality,” she said.

The UCSF program is not the only home-based primary care program in the Bay Area. Kaiser Permanente, for example, serves some 370 members in San Francisco as part of its 13-year-old Community Care Program, which is handled by physicians, nurse practitioners and social workers.

Reinstituting and reinforcing in-home care, considering the significantly improved care for patients and the reduced cost to the taxpayer, would seem a no-brainer. But brains are losing out to politics a lot these days.

via UCSF program shows house calls’ time returning.

General interest/Health/seniors/USA/Women
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New Cancer Guidelines: One Good Message

by Fran Johns

News about changing guidelines for cervical and breast cancer screening have some women cheering, a lot of women fuming, and most women feeling confused. Or betrayed, or mistreated or worse.

There is one universal message in it all: every woman has to be her own advocate.

For most of us, that is no big deal. We’ve known for a long time that no two of us (and surely no four collections of breast tissue or no two histories of sexual activity) are alike, and most of us have gotten used to asking a lot of questions. It’s unfortunate that so many changes have been announced at almost the same time, and especially that the issue has become politicized.

New York Times health writer Denise Grady summed up the latest developments, and the issues that have caused confusion and anger in a November 20 article:

New guidelines for cervical cancer screening say women should delay their first Pap test until age 21, and be screened less often than recommended in the past.

The advice, from the American College of Obstetricians and Gynecologists, is meant to decrease unnecessary testing and potentially harmful treatment, particularly in teenagers and young women. The group’s previous guidelines had recommended yearly testing for young women, starting within three years of their first sexual intercourse, but no later than age 21.

Arriving on the heels of hotly disputed guidelines calling for less use of mammography, the new recommendations might seem like part of a larger plan to slash cancer screening for women. But the timing was coincidental, said Dr. Cheryl B. Iglesia, the chairwoman of a panel in the obstetricians’ group that developed the Pap smear guidelines. The group updates its advice regularly based on new medical information, and Dr. Iglesia said the latest recommendations had been in the works for several years, “long before the Obama health plan came into existence.”

She called the timing crazy, uncanny and “an unfortunate perfect storm,” adding, “There’s no political agenda with regard to these recommendations.”

Dr. Iglesia said the argument for changing Pap screening was more compelling than that for cutting back on mammography — which the obstetricians’ group has staunchly opposed — because there is more potential for harm from the overuse of Pap tests. The reason is that young women are especially prone to develop abnormalities in the cervix that appear to be precancerous, but that will go away if left alone. But when Pap tests find the growths, doctors often remove them, with procedures that can injure the cervix and lead to problems later when a woman becomes pregnant, including premature birth and an increased risk of needing a Caesarean.

Still, the new recommendations for Pap tests are likely to feed a political debate in Washington over health care overhaul proposals. The mammogram advice led some Republicans to predict that such recommendations would lead to rationing.

It boils down to this: every woman will need to pay close attention to her own health care. That is bad news for the less educated, the less aggressive, and those with less access to care, and not particularly good news for many older women who grew up with “The doctor knows best” excuse for not paying attention.But it’s good news for those of us, particularly older women, who have questioned what sometimes seemed too-frequent testing and screening.

Asking questions just got more respectable.

Guidelines Push Back Age for Cervical Cancer Tests – NYTimes.com.

Health/Women
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Skip mammograms, quit breast self-exams, and maybe lighten up on 'defensive medicine' while we're at it

by Fran Johns

All those mammograms, self-exams and dutiful attention to catching breast cancer at the very first sign? Forget it. Might even do more harm than good.

As summarized by Associated Press writers Stephanie Nano and Marilynn Machione late Monday,
Most women don’t need a mammogram in their 40s and should get one every two years starting at 50, a government task forcesaid Monday. It’s a major reversal that conflicts with the American Cancer Society‘s long-standing position.

Also, the task force said breast self-exams do no good and women shouldn’t be taught to do them.

For most of the past two decades, the cancer society has been recommending annual mammograms beginning at 40.

But the government panel of doctors and scientists concluded that getting screened for breast cancer so early and so often leads to too many false alarms and unneeded biopsies without substantially improving women’s odds of survival.

“The benefits are less and the harms are greater when screening starts in the 40s,” said Dr. Diana Petitti, vice chair of the panel.

The new guidelines were issued by the U.S. Preventive Services Task Force, whose stance influences coverage of screening tests by Medicare and many insurance companies.

But Susan Pisano, a spokeswoman for America’s Health Insurance Plans, an industry group, said insurance coverage isn’t likely to change because of the new guidelines. No changes are planned in Medicare coverage either, said Dori Salcido, spokeswoman for the Health and Human Services department.

Maybe, just maybe, a clearer look at breast cancer screening could be accompanied by a good look at a little of the other possibly unnecessary and extraordinarily pricey “defensive medicine” going on around the country. What a fine way that would be to hold down costs and save a lot of time and angst. In another recent article (November 5) published in the San Francisco Chronicle, Associated Press reporter Steve LeBlanc wrote of how the costs of “defensive medicine,” along with malpractice insurance and lawsuit awards, are adding significantly to the soaring costs of health care.

LeBlanc illustrates the issue with a story that rings sadly true:

Dr. James Wang says he tries to tell his patients when medical procedures aren’t necessary. If they insist, though, he will do it – not so much to protect their health as his own practice.

After being sued for allegedly failing to diagnose a case of appendicitis, Wang says he turned to what’s known as “defensive medicine,” ordering extra tests, scans, consultations and even hospitalization to protect against malpractice suits.

“You are thinking about what can I do to prevent this from happening again,” he said, adding that he did nothing wrong but agreed to a minor settlement to avoid a trial.

We have, LeBlanc explains, doctors battling malpractice premiums and lawyers saying malpractice suits discourage bad medicine — meanwhile, the costs of it all add up to some ten percent of health care expenditures.

We the public, healthy and sickly alike, are caught in the middle. Could we not somehow declare a truce? We’ll quit rushing to sue, lawyers back off from chasing ambulances, doctors go about the business of practicing medicine according to patient need rather than fear of consequences. Seems like a good idea to me, but I’m not holding my breath.

I’m also not having any more mammograms any time soon.

New advice: Skip mammograms in 40s, start at 50 – Yahoo! News.

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