Tag: San Francisco Chronicle

California/Education/Money/USA
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Greeting the new GRE revisions

by Fran Johns

It should be said up front that I never took the Graduate Record Exam. MFA programs are not, I think, noted for their insistence on past academic rigor; and in any event I was grateful for the University of San Francisco graduate school’s willingness to consider 45 years’ writing experience in lieu of my less than stellar undergraduate record. In the interest of higher education in general, though, I try to keep up with such things as this, just reported in the San Francisco Chronicle:

After two false starts, the Graduate Record Exam, the graduate school entrance test, will be revamped and slightly lengthened in 2011 and graded on a new scale of 130 to 170.

On the quantitative section, the biggest change will be the addition of an online calculator. The writing section will still have two parts, one asking for a logical analysis and the other seeking an expression of the student’s own views.

One has to worry about that online calculator. I did indeed study math about the time of the abacus, but what’s the matter with adding and subtracting in the head? Maybe they just mean that some mysterious online genie will immediately calculate results.  Still, I am heartened that expressions of students’ own views will be sought.

The Educational Testing Service, which administers the GRE, described its plans Friday at the annual meeting of the Council of Graduate Schools in San Francisco, calling the changes ‘the largest revisions’ in the history of the test.

Although the exam will still include sections on verbal reasoning, quantitative reasoning and analytical writing, each section is being revised. The new verbal section, for example, will eliminate questions on antonyms and analogies. The section will focus more on reasoning than on individual words, all of which will be used in context.

Personally, I think I could shine on antonyms and analogies, not to mention individual words, and hate to see them go. But reasoning is good.

‘The biggest difference is that the prompts the students will receive will be more focused, meaning that our human raters will know unambiguously that the answer was written in response to the question, not memorized,’ said David Payne, who heads the GRE program for the testing service.

If one worries about online calculators, one can only rejoice over the presence of human raters. Best, however, that one who is possessed of a perfectly respectable BA in Art and a fairly impressive MFA in short fiction, stay away from the GRE altogether.

GRE undergoes major revisions, gets new scale.

California/General interest/Health/Lifestyle/Politics & Causes/seniors/USA/Women
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Gay Rights, Abortion Lose – – Meanness Wins. Is this the 50s?

by Fran Johns

The New York State Senate‘s rejection of a bill that would have allowed marriage between two people who love each other — but happen to be gay — is just the most recent in a string of set-backs in the area of gay rights. Other set-backs have been occurring, or are currently looming, in women’s rights, specifically reproductive rights. One wonders about the mood of this country.

This particular one wonders if anyone else is harking back, with more than a little sadness, to the 1950s. If you weren’t around then, I can tell you it was a strange decade. Great optimism for the future — well, there’s not much of that today — while simultaneously there was terrible meanness behind the McCarthy witch hunts and the denial of women’s rights, plus a certain amount of smugness embedded into a bland, national complacency.

At ladies’ bridge parties there were small china ashtrays on each corner of the table and the conversation usually drifted toward those lovely wonder drugs emerging to give instant relief for any problem. The conversation never drifted toward back-alley abortions, unless someone had recently died and the others knew how it had happened. Those of us who had jobs — running a house, entertaining for the husband’s business, raising children; those were not considered jobs — usually had male counterparts doing the exact same thing for twice the salary. One did not complain. If one were middle class white, and involved in any sort of civil rights work, one never brought that up at the bridge table.  It was a strange decade.

Today’s New York Times story quotes senators who voted against the same-sex marriage bill as saying “the public is gripped by economic anxiety and remain(s) uneasy about changing the state’s definition of marriage.” The San Francisco Chronicle article includes a comment from sponsoring Senator Thomas Duane, “I wasn’t expecting betrayal.” I’m sure those are both accurate reports. Whatever its underlying economic, political or social fears, the public seems also to harbor a degree of meanness in discounting the rights of others.

If you substitute a measure of cynicism or hopelessness about the future for the complacency of a half-century ago, and throw in the self-righteousness of those who for religious or political reasons justify the denial of rights to their fellow citizens, it’s easy to draw parallels between this decade and that one long ago.

In the fifties the groundwork was being laid for civil rights, for women’s liberation, for Roe v Wade and the upheavals that eventually led to progress, by courageous and energetic people of all sorts. I wish I could list myself in that number; I was at the bridge table trying to pretend normalcy in a life gone amok.  Today there are others working just as hard for the rights of their fellow men and women.

I hope they can keep the faith.

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.

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.

Education/General interest/Politics & Causes/USA
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Thinking about the Bush think tank

by Fran Johns

Why am I not encouraged by reports of the official launch of the George W. Bush Institute on the campus of Southern Methodist University? According to Dallas Morning News reporter Lori Stahl,

Former President George W. Bush will make his first scheduled Dallas appearance at SMU today when he and wife Laura unveil plans for the Bush Institute before an audience of 1,500 people at McFarlin Auditorium.

The Institute has been described by foundation officials as a scholarly forum that will conduct research and promote dialogue on four core principles identified by the Bushes.

These core principles, reports the San Francisco Chronicle, include education, global health, human freedom and economic growth. Hmm.

My father Earl Moreland, who grew up to be, among other things, president of Randolph-Macon College in Ashland, VA for 28 years, died in 1987 without voting for either of his fellow Texans. He was in the first class ever to enter what would become SMU, and one of my fond memories is of accompanying him to Dallas for his 60th reunion.  I believe it is safe to say he would not be proud to have a Bush think tank on the campus of his alma mater.

For my part, I am just stumbling over those “core principles,” and their connection to our former president. Education? Global health? Embodied by someone who condemned millions throughout Africa and beyond to sickness and death through his ill-advised policies? Economic growth? Hello? Times are surely tough today, ten months into Barack Obama’s presidency, but did he create this mess or inherit it?

Some of my favorite people voted for George W. Bush. All of them are, in my humble opinion, smarter than he is. One of them did graduate work at SMU years ago, but does not support placement of the Institute on campus.

During our trip to Dallas for his reunion (the school opened in 1915, you can do the math) my father remarked that he would come back for his 65th if there were anyone around to reune with. Turned out he never made that return visit. If he were here today I’m not sure he would be making plans for his 100th.

My father had a favorite response to all things he considered outrageous (often applied to his daughters) which sounded like “Poosharisha!” It was from his second language (which I sadly never learned), adopted during a 12-year period in Brazil at the Instituto Porto Alegre. Long after he died I learned it was a Portugese expression that  translates, roughly, “That is beyond anything within the natural order of the universe.”

Somewhere in the ethernet I hear my father contemplating the coming of the George W. Bush think tank, and clearly also hear his voice. Poosharisha.


George W. Bush to unveil Bush Institute programs today at SMU | News for Dallas, Texas | Dallas Morning News | Latest News.

Health/Politics & Causes/USA
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Public option still alive: believe it…or not

by Fran Johns

The fact that there are still believers in the public option, and its inclusion in whatever health bill eventually survives, may say more about the believers than the belief. But Nancy Pelosi hasn’t yet caved, and a few among the many who see this as the only way real reform will happen are still betting on it. Two of those are strategic technology consultant Robert Weiner and his research chief Rebecca Vander Linde who penned an op ed in the San Francisco Chronicle Friday. I’m not a gambler, but I cheer their position.

Opponents’ caricatures have become commonplace – the Republican National Committee video puts House Speaker Nancy Pelosi side by side with James Bond’s villainess, Miss Galore. The Iowa Republican, a party newsletter, on Sept. 18 called Pelosi “inept at her job.” Actor and former Sen. Fred Thompson labeled her “naive.” On Sept. 10, master Republican strategist Karl Rove asked, “How much capital will Speaker Nancy Pelosi have” to pass health care?

Pelosi answered that in a conversation Sept. 29 at House Judiciary Committee Chairman John Conyers‘ 80th birthday party, after the Senate Finance Committee had just rejected the Medicare-like public option for all by a 10-13 vote: “We will not be deterred. We will pass the bill.”

The public option is still viable. The House is set to pass it. It is neither “fading” nor “waning” (New York Times) nor on “life support” (ABC News).

Citing a recent CBS News poll that showed public support for the public option rose from 57 to 68 percent after President Obama’s speech to Congress in September, Weiner and Vander Linde argue that keeping it is the only way to “counter the insurance stranglehold” that makes our current system so dysfunctional — and that Pelosi will keep it in the blended version of the three House bills and eventually see it through.

For those who doubt Pelosi’s ability to pass the bill, know that she has passed every bill she has brought forward, usually with 60-plus margins, since the Democrats recaptured the House in 2006. These include the Recovery Act, Credit Card Bill of Rights, Homeowner Affordability, Lilly Ledbetter Fair Pay, Troubled Assets Relief Program (TARP) and State Children’s Health Program expansion to 11 million youths.

About the Senate…

Senate Finance Chair Max Baucus, D-Mont., said he could not vote for the public option because “I can’t see how we get to 60 votes.” The Constitution and the law require only a majority 51. The Senate amended its rules to require a “supermajority” to end debate. This procedure, called cloture, is a pander to allow special-interest contributors (Baucus has a million dollars from insurance companies) to block bills. Pelosi is right to support Senate “reconciliation,” which would allow a simple majority to pass health reform Americans want.

We believers may turn out just to be dreamers, but we’re still sending e-mails to Speaker Pelosi.

via Public option still alive – believe it.

General interest/Health/Lifestyle/Politics & Causes/USA
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Safeway carrot-stick plan a boon to reform

by Fran Johns

There was a little local pride in a key segment of the Senate Finance Committee’s health care bill reported today by Andrew S. Ross of the San Francisco Chronicle:

It’s not every day a local grocery has a congressional amendment named after it. Such an honor has been bestowed on Pleasanton’s Safeway Inc., whose stick-and-carrot health insurance program is the model for a “wellness provision” in a health care reform bill that passed the Senate Finance Committee last week by an unusually bipartisan 18-4 vote.

“Yes, it’s quite fair to call it the ‘Safeway amendment,’ ” said a spokesman for Sen. John Ensign, R-Nev., who co-sponsored the amendment with Sen. Tom Carper, D-Del. “He’s a big advocate of the Safeway program.”The provision, designed to “incentivize Americans to lead healthy lifestyles in order to lower their overall health care costs,” would allow companies with self-insurance programs to reward employees with bonuses and/or premium reductions of up to 50 percent if they follow health guidelines, like undergoing regular screenings, quitting smoking, losing weight, taking cholesterol-reducing medications and so on.

While some question the accuracy of reported cost savings, the measure has strong support among key politicians up to and including President Obama.

As a beneficiary of Kaiser‘s “wellness” program — a constant push toward healthy lifestyles and preventive medicine — I hope this piece of the legislation stays. As long as he’s not going to resign, Senator Ensign might as well be doing something useful over there.

via Safeway plan part of Senate health care debate.

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