Tag: Health care

General interest
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Doctors, neckwear & the male brain

by Fran Johns
Bob-baldric
Dr. Liner in his Baldric

This space is happy to offer up-to-the-minute insights, today’s concerning connections between neckties, germs, the male brain and other organs.

First, reporter Rebecca Smith writes in today’s Wall Street Journal that neckties may be helping spread flu germs, and many people inside and outside the health care industry think they should go.

“The list of things to avoid during flu season includes crowded buses, hospitals and handshakes. Consider adding this: your doctor’s necktie.

Neckties are rarely, if ever, cleaned. When a patient is seated on the examining table, doctors’ ties often dangle perilously close to sneeze level. In recent years, a debate has emerged in the medical community over whether they harbor dangerous germs.

Several hospitals have proposed banning them outright. Some veteran doctors suspect the anti-necktie campaign has more to do with younger physicians’ desire to dress casually than it does with modern medicine. At least one tie maker is pushing a compromise solution: neckwear with an antimicrobial coating.

BUT HOW ABOUT JUST SWITCHING TO THE BALDRIC?

My friend Robert Liner MD, a distinguished physician/piano player/tango dancer/fellow board member of Compassion & Choices of N.CA and general Renaissance man, made this switch some time ago. In rather characteristic Liner fashion, he then established a company which produces Baldrics in order that others may enjoy them.

Earlier Baldrics were worn by most respectable Scots so they would have something handy from which to hang their swords. But for the 21st century, as Liner writes on his company web site:

We are re-inventing the Baldric for present day men and women on the go. I originally conceived the idea of the Baldric as a new fashion statement for men. Instead of a constricting necktie, a man could dress up with a Baldric. Instead of carrying a sword, the modern man could employ his Baldric to carry his sword equivalent: a cell phone, I-Phone, Blackberry or other p.d.a.. Additionally, in place of a bulky wallet, he could keep credit cards, folding money and small personal items easily accessible in a secret pocket in his Baldric. The Baldric is a hybrid: it’s a necktie alternative that performs like a sleek, modified, minimalist messenger bag.

Contacted today about the germ issue, Liner reports he had indeed heard of such. “Of course, it’s seemed to me,” he muses further, “that the more significant problem with neckties from the point of view of health and world peace is the possibility that neckties reduce blood supply to the male brain. This may account for a good deal of what looks like irrational behavior on the part of my sub-species. This can especially be a problem during adolescence and at other times (ie. most of the time) when demand is placed upon the male circulatory system to divert blood to an organ that is not the brain but sometimes functions in place of the brain. Under these circumstances, the male blood stream can hardly afford to have any restriction placed upon the “choke point” by a necktie so that what little blood is left available to go north to the “main brain” is impeded, resulting  in chaos on a global scale.”

Considering the problems of H1N1 and other viruses, and the potential for advancing world peace as Dr. Liner suggests might happen with fewer neckties, this space hereby blatantly endorses the Baldric.

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.

California/General interest/Health/Politics & Causes/Women
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Doctors oppose abortion cuts in health bill

by Fran Johns

The San Francisco Medical Society has come out in opposition to removal of abortion coverage in the health reform bill, pointing out the potential danger to women’s lives if they are denied access to such care. Charles Wibbelsman, MD, President of SFMS, writes in today’s San Francisco Chronicle that the board of directors will urge congressional representatives to find a compromise.

It is a shame that such a complex issue as health care reform has been hijacked in the form of the Stupak amendment, which would ban all public funding for abortion (“Amendment to House bill reignites abortion debate,” Nov. 10).

Experience has shown that denying coverage of abortion does not stop or even curtail it, but rather shifts the costs elsewhere, and threatens to delay a woman in seeking and obtaining this medical procedure, thus potentially endangering her.

The San Francisco Medical Society’s board of directors has voted to urge our elected officials, particularly Sens. Dianne Feinstein and Barbara Boxer, to find a compromise that will not ban such funding and keep women with unwanted pregnancies safe.

Women’s lives should not be held hostage to politics.

At last, a ray of sanity from the medical community. I, for one, am proud of SFMS for standing up for the uncounted thousands of women, most of them poor and disadvantaged, who will suffer harm from denial of access to care should the conservatives and the U.S. Conference of Catholic Bishops win the day on this matter.

via Stupak amendment hijacks health care reform.

General interest
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Abortion foes winning health concessions

by Fran Johns

Anti-abortion forces, sensing victory in the health bill, are happily using their clout. They will undoubtedly win big. David M. Herszenhorn and David D. Kirkpatrick report in the New York Times that staunch anti-abortion Representative Brad Ellsworth (D-IN) is likely to get what he wants, which means other leading opponents of a woman’s right to choose, including a few elected representatives and the U.S. Congress of Catholic Bishops, will also get what they want.

Struggling to finish their big health care legislation, House Democratic leaders signaled Tuesday that they were prepared to make several changes to the bill to satisfy abortion opponents, including many Democrats, who had threatened to block it.

The opponents are insisting that tax dollars not pay for health insurance that would cover abortion. That is a tricky proposition given that the health care bill would provide hundreds of billions in federal subsidies to help moderate-income Americans buy health insurance, mostly from private carriers.

But Democratic leaders have little choice but to make some concessions. As many as 40 Democrats have said they might oppose the health care bill without tighter restrictions on abortion – a potentially decisive number.

So okay. We desperately need health reform, and such concessions apparently have to be made.

I just wonder if any of these guys know anything about what it was like in the days before Roe v Wade, which is the scenario to which they wish to see us return.

And I find it interesting that they, who seek to exercise so much control over what a woman may do with her body, are mostly men.

Democrats Near Deal on Abortion Coverage – Prescriptions Blog – NYTimes.com.

General interest/Health/Politics & Causes
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End-of-life counseling stays in health care bill

by Fran Johns

Here’s a piece of very good news just in from Associated Press reporter Ricardo Alonzo-Zaldivar:

It’s alive. The Medicare end-of-life planning provision that 2008 Republican vice presidential nominee Sarah Palin said was tantamount to “death panels” for seniors is staying in the latest Democratic health care bill unveiled Thursday. The provision allows Medicare to pay for voluntary counseling to help beneficiaries deal with the complex and painful decisions families face when a loved one is approaching death.

The business of thinking ahead toward end-of-life decisions and making  one’s own wishes known through legal documents such as advance directives has long been encouraged by federal policies. But when coverage for talking things over with one’s doctor was incorporated into health reform it was quickly distorted by Republicans.  Sen.Charles Grassley led the successful campaign to strike it from the Senate bills. But saner heads have prevailed in the House.

“There is nothing more basic than giving someone the option of speaking with their doctor about how they want to be treated in the case of an emergency,” said Rep. Earl Blumenauer, D-OR. “I think the outrageous and vindictive attacks may have backfired to help raise awareness about this problem, which is why it’s been kept in the bill.” The legislation would allow Medicare to pay for a counseling session with a doctor or clinical professional once every five years. The bill calls for such sessions to be “completely” voluntary, and prohibits the encouragement or promotion of suicide or assisted suicide.

The counseling provision is supported by doctors’ groups and AARP, the seniors’ lobby. It was not included in health care bills passed by two Senate committees.

It’s alive! End-of-life counseling in health bill.

General interest/Health/Money
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Cancer, Viruses & Informed Consent

by Fran Johns

A commentary about cancer screenings and surrounding questions posted yesterday brought a thoughtful reader response: “Science, including public health,” wrote davidlosangeles, “is an evolving process.”  Unquestionably so.

What we the consuming public need to understand is not the science as much as the personal responsibility. Today’s New York Times features another story on the front page of the Business section (some of us still follow old-fashioned newsprint) by Duff Wilson about “Research Uproar at a Cancer Clinic”, namely the highly regarded Carle Foundation Cancer Center in Urbana, IL. It’s another instance of respected professionals questioning each others’ respectability — or protocols, or carefulness, to use gentler terms than are actually being used. One of the issues raised is that of informed consent, and here is where we the consuming public come in. Whether we are cancer patients, CFIDS sufferers or mostly healthy people susceptible to the usual ails, it is incumbent upon the individual to know what he or she is agreeing to, and to know as much as possible about the projected outcome. We’re all in a giant clinical trial here on the planet. Nobody really knows about the outcome, but participation in mini-trials along the way can be valuable and is certainly laudable. Just know what you’re doing.

I am a continuing participant in the Women’s Health Initiative study now well into its second decade, though the primary issues are over and done with. I didn’t try any new hormone replacement therapies or drastic lifestyle changes, mainly because I’m pretty wimpish, but I read every word of the small print in the reams of documents that came along and tried hard to appreciate what the pitfalls and premises were. It was a valuable study, and hopefully will continue to turn up usable data.

Other studies are underway, and more will undoubtedly begin, regarding the current hoopla over XRMV, and H1N1. And heaven only knows how many other viruses, techonological advances, genetic possibilities and scientific wonders are out there to create great harm or great benefit.

Since the benefits are to the buyers, it’s appropriate that the buyer beware.

General interest
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Helping Mom die

by Fran Johns

Flight #12 had not even left the gate in San Francisco yesterday before the conversation was underway. The man in seat #16F was talking to his new friend in #16E about his trip: another of many undertaken by himself and his siblings to their mother’s home in the long process of packing up, sorting through, tossing out, agonizing over. The scene is a familiar one to millions of Americans: aging, often isolated mom; far-flung, often cash-strapped, over-stressed children; a bewildering assortment of issues to be dealt with, ranging from health to housing to family dynamics.

I, of course, am the mom. Well, not #16F’s mom, and currently in good health and of relatively sane mind. But 76, with children across the continent and a dizzying amount of Stuff to be dealt with if my husband should have the crass inconsideration to die first and leave me to deal with it. (Actually, he’s been very good about making arrangements for disposition of his Stuff, but still, there are those piles and boxes and shelves of miscellany and cupboards of chipped dishes. And closets full of clothes from the 1950s and still perfectly wearable… but I digress.)

My sisters and I were fortunate that our dad looked after our mom as she slowly died, swearing they had a fine conversation the night before although dementia had long stolen her ability to converse; my father created his own realities. Twenty years later, the town of Ashland, VA, with the assistance of Randolph-Macon College, looked after our dad, because indeed it takes a village. But fewer and fewer of us have the traditional village, and more and more of us have the complications: dementia, physical issues, personal problems, too little financial and emotional resources, too much Stuff.

There is help. There are community centers and assisted living arrangements, there is the new Villages concept (more about that one in the next week or so) and an array of other anti-isolationist possibilities; there are nonprofits of every sort, from the Family Caregiver Alliance to multiple physical/emotional-needs groups to my alltime favorite, in name at least, the National Study Group on Chronic Disorganization. God willing, we may even get health care, but thanks to those earlier, similar battles we at least now have Medicare and Medicaid.

But too many of us still put it all off, and it falls to the children. We cling to the past in the form of too many boxes of old photos and letters and opera programs; we drive too long and invite fender-benders or worse; we think that old chair is worth too much for a garage sale; we forget to take the pills.

The issue, of course, is not about dying; it’s about living. Living as well as possible for as long as possible, as closely as possible to what we would choose for ourselves. But here’s what happens eventually: mom dies. It’s tough, but it’s probably okay.

I gave my card with the True/Slant website on it to the nice people in #16E and #16F; maybe they’ll check in. When I get back home, though, I think I’ll clean out some files.

General interest/Health/Money/Politics & Causes/USA
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Will Anti-Abortionists Sink Health Reform?

by Fran Johns

Already the right wing, Catholic officialdom and Sarah Palin have won their battle to make sure that I, and countless other millions, will likely die only after expensive, prolonged, futile, aggressive, undesirable treatment rather than peacefully at home as I choose. Now they want the generations younger to be sure that any accidental, criminal or otherwise unplanned pregnancy results in another unwanted child coming into this overpopulated world. An assault on health reform is their latest battleground. I am careful to say Catholic officialdom, because all of the lay Catholics I know, many of them Good Catholics, support both reproductive and end-of-life choice. I am careful to mention Sarah Palin just to prove I have absolutely no resentment over the fact that whereas I can’t interest publishers in my several excellent book projects, she has a planned first run of 1.5 million on her dashed-off memoir.

But back to the problem at hand. Writing in Tuesday’s New York Times, David Kirkpatrick presents the new scary problem:

As if it were not complicated enough, the debate over health care in Congress is becoming a battlefield in the fight over abortion.

Abortion opponents in both the House and the Senate are seeking to block the millions of middle- and lower-income people who might receive federal insurance subsidies to help them buy health coverage from using the money on plans that cover abortion. And the abortion opponents are getting enough support from moderate Democrats that both sides say the outcome is too close to call. Opponents of abortion cite as precedent a 30-year-old ban on the use of taxpayer money to pay for elective abortions.

Abortion-rights supporters say such a restriction would all but eliminate from the marketplace private plans that cover the procedure, pushing women who have such coverage to give it up. Nearly half of those with employer-sponsored health plans now have policies that cover abortion, according to a study by the Kaiser Family Foundation.

Never mind that Obama has promised that no federal funds will go for elective abortions, and the current policies would remain unchanged, here is a handy opportunity to make points with conservatives and throw a monkey wrench into the works of reform.

Lawmakers pushing the abortion restrictions say they feel the momentum is on their side, especially because the restlessness of other Democratic moderates is making every vote count.At least 31 House Democrats have signed various recent letters to the House speaker, Nancy Pelosi, urging her to allow a vote on a measure to restrict use of the subsidies to pay for abortion, including 25 who joined more than 100 Republicans on a letter delivered Monday.

Representative Bart Stupak of Michigan, a leading Democratic abortion opponent, said he had commitments from 40 Democrats to block the health care bill unless they have a chance to include the restrictions.

So it’s all about halting abortion — maybe — or all about halting reform — maybe — but some of us who simply, desperately, wish better care and a few decent options for our less-advantaged citizens are left to wonder what it’s really all about.

Abortion Fight Complicates Debate on Health Care – Readers’ Comments – NYTimes.com.

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