Health care reform: comatose but breathing

Virginia Governor McDonnell, who proclaimed in his rebuttal to President Obama’s State of the Union address that we have “the best medical system in the world” has my qualified agreement on one point. My personal medical system is the best in the world. As a member of Kaiser Permanente, I consider my physicians among the best in the world and my care right up there. I can e-mail any of my physicians with any question; most of them reply in 24 hours or less. I can schedule appointments with specialists with ease; usually I see anyone I want within a few weeks. Medicare helps me pay for all this.

Problem is, not everyone in America enjoys such care at such cost. Millions of my fellow Americans – who might not agree with Governor McDonnell – would be happy for any kind of medical care at any remotely affordable cost. Millions of Americans are suffering and dying for lack of care. Maybe, to correct this, I’ll have to settle for just moderately excellent care rather than the best. So be it. Maybe my costs would go up. So be it. It is morally wrong for people in this country to be without health care.

(In a recent comment on this page written very late at night I attributed Governor McDonnell’s interesting phrase to former Virginia Governor Tim Kaine. Even before my astute True/Slant editors had caught the gaffe an astute reader had brought my attention to it. After I thanked him, Astute Reader replied, “Virginia might be better off if you did give it back to Tim Kaine.” We’ll see.)

But back to health care. Although it has faded slightly into the background, word is that House Speaker Nancy Pelosi and Senate Majority Leader Harry Reid are still hoping to salvage the sprawling bill. It could be done, if the Senate bill’s sprawl. As Noam Levey reported in Sunday’s Los Angeles Times,

(I)n the coming weeks, Pelosi and Reid hope to rally House Democrats behind the healthcare bill passed by the Senate while simultaneously trying persuade Senate Democrats to approve a series of changes to the legislation using budget procedures that bar filibusters.

At the same time, leading consumer groups, doctors and labor unions that have backed the healthcare legislative effort for more than a year are stepping up attempts to stiffen lawmakers’ resolve.

These included scaling back the Cadillac tax, boosting aid to help low- and moderate-income Americans buy insurance, closing the “doughnut hole” in the Medicare prescription drug plan, and giving all states the assistance that Nebraska secured to expand Medicaid.

But many House Democrats do not want to vote on the Senate bill until the Senate passes the fixes they want. And it is unclear whether the Senate could approve a package of changes to its bill before the House approves the underlying legislation, according to senior Democratic aides. Democratic leaders hope to agree on a procedural path forward by the end of this week.

Despite the hurdles, there is a growing consensus that a modified Senate bill may offer the best hope for enacting a healthcare overhaul.

“The more they think about it, the more they can appreciate that it may be a viable . . . vehicle for getting healthcare reform done,” said Rep. Gerald E. Connolly (D-Va.), president of the Democratic freshman class in the House.

Sen. Tom Harkin (D-Iowa), who chairs the Senate health committee, noted that even before the Massachusetts election, senior Democrats had substantially agreed on a series of compromises that addressed differences between the House and Senate healthcare bills.

This space still hopes that “the best medical system in the world” can be made available to a few of the millions in America who still so desperately need it.

Skip the cold meds – hit the gym

Just in case the cold weather and a few sniffles are luring you toward the couch in front of the TV, you may want to stop and read Wall Street Journal health writer Laura Landro’s article in today’s “Personal Journal” section first.

Regular workouts may help fight off colds and flu, reduce the risk of certain cancers and chronic diseases and slow the process of aging.

Who knew? Well, most of us knew, we just haven’t been convinced. But Landro’s piece is stuffed — no offense to couches or potatoes — with evidence from new research, including data on fitness v the common cold. The fit, it turns out, have fewer and less severe colds, of shorter duration than the afflictions of their less-fit fellow creatures.

No pill or nutritional supplement has the power of near-daily moderate activity in lowering the number of sick days people take,” says David Nieman, director of Appalachian State University’s Human Performance Lab in Kannapolis, N.C. Dr. Nieman has conducted several randomized controlled studies showing that people who walked briskly for 45 minutes, five days a week over 12 to 15 weeks had fewer and less severe upper respiratory tract infections, such as colds and flu. These subjects reduced their number of sick days 25% to 50% compared with sedentary control subjects, he says.

Medical experts say inactivity poses as great a health risk as smoking, contributing to heart disease, diabetes, hypertension, cancer, depression, arthritis and osteoporosis. The Centers for Disease Control and Prevention says 36% of U.S. adults didn’t engage in any leisure-time physical activity in 2008.

Even lean men and women who are inactive are at higher risk of death and disease. So while reducing obesity is an important goal, “the better message would be to get everyone to walk 30 minutes a day” says Robert Sallis, co-director of sports medicine at Fontana Medical Center, a Southern California facility owned by managed-care giant Kaiser Permanente. “We need to refocus the national message on physical activity, which can have a bigger impact on health than losing weight.”

[INFORMED]

Researchers are also investigating whether exercise can influence aging in the body. In particular, they are looking at whether exercise lengthens telomeres, the strands of DNA at the tips of chromosomes. When telomeres get too short, cells no longer can divide and they become inactive, a process associated with aging, cancer and a higher risk of death.

A companion article goes further, suggesting that “spurring more exercise out of the half of Americans who are already active is just as important as coaxing the sedentary off the sofa.” The jury on this, however, is still out. For the time being, you could focus on warding off the January chest cold and stretching out the telomeres.

The Hidden Benefits of Exercise – WSJ.com.

Taking on MoveOn

I am a certified MoveOn supporter. Though I had to opt out of the e-feeds because my Inbox overfloweth, I have sent money, forwarded news, heeded their messages.

But enough is enough. They are pushing for measures we should have, but won’t get today. I am coming down on the side of those who say just get us a bill. In the words of Washington Post editorial writer E. J. Dionne — in a column today aptly titled Don’t scream: organize:

Instead of trying to derail the process – exactly what conservative opponents want to do – those on the left dissatisfied with the Senate bill should focus their efforts over the next few weeks on getting as many fixes into it as they can.

What we have in the Senate bill is a mishmash of stuff we didn’t want, along with the absence of stuff we did. Ridiculous obstacles to a woman’s right to choose to have an abortion — write two checks every month just so Ben Nelson can get benefits in perpetuity for Nebraska and maybe we’ll satisfy the U.S. Conference of Catholic Bishops in the bargain? — piled on top of other obstacles for the poor and benefits for the rich (read: Big Pharma.) But come on, folks, it’s a bill. If we get a bill, it can be improved. If we fail, it’ll be another generation of a punitive, non-working “system” of health care before we get this far again. By then there will be other Joe Liebermans eager to grab the spotlight and claim the power to derail every other beneficial detail. I’ll be dead, but I plan to haunt you.

Dionne points out that the House bill is superior, the two bills will now have to be reconciled, and there will be future opportunities to build on this beginning.

Enactment of a single bill will not mark the end of the struggle. It will open a series of new opportunities. It’s a lot easier to improve a system premised on the idea that everyone should have health coverage than to create such a system in the first place. Better to take a victory and build on it than to label victory as defeat.

Successful political movements prosper on the confidence that they can sustain themselves over time so they can finish tomorrow what they start today. At this moment, rage is understandable, but hope is what’s necessary.

Progressives – don’t scream: organize.

Can you beef up your brain?

Not multi-tasking fast enough? Trouble concentrating? Worried about memory loss?

Maybe those neurotransmitters in your poor, information-overloaded brain can be expanded to improve these functions… and maybe not.  A panel of experts on the PBS series Life (Part 2) is tackling the topic of brain exercise — a topic which has been tackled in this space several times in the past (How’s your brain fitness today, 10/5; Diet, exercise and Alzheimer’s, 11/28.)

We talked with panelist Denise Park, PhD, founder of the Center for Vital Longevity at the University of Texas, who starts right out by debunking any notion that those crossword puzzles will keep you sharp: [youtubevid id=”xZBzZZJHic0″]

But all is not lost. Jigsaw puzzles could indeed help. “With jigsaw puzzles you’re manipulating materials,” Park comments, “and actively puzzle-solving; what we call executive function.” This may explain — though only in part — the brilliance of British novelist Margaret Drabble, whose new memoir, The Pattern in the Carpet is subtitled A Personal History with Jigsaws; although my own personal history with jigsaws unfortunately hasn’t enabled me to write like Margaret Drabble.

It is the combination of functions that stimulates, and perhaps enhances, those brain cells, Park explains. She recommends doing something both stimulating and fun: dancing (“I believe the social component is important”), learning to play a musical instrument, etc. — in which motor, auditory and other systems all come into play. Or taking up something like photography, with which one masters one step and then moves on to the next.

“I’m reluctant to prescribe anything to improve cognition,” Park says, “because we don’t know yet. We need to know a lot more.” Still, current findings — Park’s Center is doing fascinating work with aging citizens who are learning to quilt — are heartening, and anecdotal evidence about those of us reciting lists of numbers to each other and then trying to do them backwards, as suggested by the SharpBrains people, suggests that hilarity is good.

And the best news may be that computers aren’t the be-all and end-all here. Park suspects that sitting in front of a computer playing games, even games advertised to stimulate the brain, may have no great brain-building value at all.

So this space advises getting out the dancing shoes or the mandolin, inviting friends in to play numbers games — and maybe buying a giant jigsaw puzzle (for two.)

New cancer insights from man's — and woman's — best friend

Lessons on love and fidelity have long been learned from the canine kingdom; now add cancer and aging.

The Gerald P. Murphy Cancer Foundation, a not-for-profit research foundation headquartered in West Lafayette, Indiana, has a mission “to accelerate medical progress in the fields of cancer treatment, cancer prevention, and aging,” and is coming up with useful data through studies of pet dogs. (The center was named posthumously, after his untimely death, for founder Gerald Murphy, developer of the Prostate Specific Antigen (PSA) test that remains the gold standard for early detection of prostate cancer.) Most recently comes news of discoveries made with the help of Kona, a Rottweiler who is getting along in years herself. It was reported last week on MSNBC by by Anne Marie Tiernon of WTHR-TV.

There are new clues about why some of us live longer than others. A new study of dogs has revealed a new role for the ovaries. Ovaries produce eggs and hormones and also have a primary role in bearing children. But the study in West Lafayette points to a larger ovarian ecology, meaning the ovaries have a role in how long we live.

Kona, a 13-year-old Rottweiler from Cleveland, has achieved exceptional longevity for her breed. Most live about nine years. Data about Kona and 304 other Rottweilers was collected and analyzed at the Gerald P. Murphy Cancer Foundation.’We are trying to find ways to promote exceptional longevity in pets and people,’ said Dr. David Waters, DVM PhD. director of the Exceptional Living Studies Center.

In combing through the dog data, the Center’s researchers found links between ovaries and a long life.

‘To reach exceptional longevity is to live about 30 percent longer, similar to the difference between a 100-year-old person and a person that would only live, let’s say, 72 years,’ Dr. Waters said. So we are talking about a big difference and that keeping ovaries longer was associated with an increased likelihood of reaching exceptional longevity.’

Being a female, Kona was born with a 2-to-1 advantage over male dogs to reach her 13th birthday.

‘But the interesting part was when we take a look at the dogs who lose their ovaries, the females who lose their ovaries in the first four years, now the female survival advantage disappears,’ Dr. Waters said.

Dr. Waters, whose research work has extended to a variety of complex issues relating to cancer and aging, sums up the bottom line for women:

The takeaway from these studies, including the one with Kona? That doctors and women will pause and question the routine removal of ovaries during a hysterectomy. In the United States, the standard practice for decades has been to remove the ovaries during a hysterectomy to prevent ovarian cancer and maybe some breast cancers that are estrogen-fed.

The findings are something new to add to your plus and minus columns when making a decision with your doctor.

Moving Mom & Dad — into a Village

What about moms and dads who really don’t want to move?

The problem of where to go and what to do about housing in the sometimes not-so-golden years has an assortment of solutions for those who prefer (and can afford) the retirement community or any of the multitude of assisted living communities around. But for those who are bound and determined to stay put in the old house or the long-familiar apartment? A collection of obstacles begins to accumulate.

Enter the village.

Swiftly catching on around the country, aging-in-place “villages” are designed to help  members overcome those obstacles by providing a variety of programs and services – while the members stay put. The prototype was Boston’s Beacon Hill Village, founded in 2001, which offers “groceries to Tai Chi to cultural and social activities to home care.” Others have popped up in states ranging from Colorado to New York, Florida to Nebraska, Massachussetts to Hawaii.

San Francisco Village was the second, after Avenidas in Palo Alto, to get off the drawing boards and into action in California. Although each Village differs from others, SFV illustrates many of the attractions that are drawing in the stay-put crowd. The organization began with some local grants and individual donations, and is sustained now by annual membership fees.

Sarah Goldman agreed, after a good bit of arm-twisting, to be a poster girl for SFV in upcoming stories for the neighborhood’s New Fillmore newspaper. Sarah was among the first to join the organization, and in many ways typifies the village member-enthusiast: fit, active and fiercely independent at 80, she plans to stay that way as long as humanly possible. Her first move, as a Village member, was in support of someone older still and desperately in need of help: her landlady. Goldman could see that the landlady, who also lived alone, was becoming forgetful and increasingly unkempt – the distress signals that often propel seniors into care facilities. So she began by talking the landlady into joining also. This paved the way for calling in, with the landlady’s approval, a wide-ranging group of service providers: house cleaners, organizers, financial assistance people, personal care helpers. All had been vetted by SFV. Their help has now enabled both landlady and tenant to keep right on aging in place.

Goldman also quickly started a program patterned after one she had organized when working with an assisted living community. SFV’s play-reading group was an immediate hit among those seeking socialization and intellectual stimulation. Three necessities of life — social, physical and mental fitness — added to issues such as those dealt with by the landlady, add up to the heart of the Village. Members hope that by accessing things like this while staying on familiar turf their golden years may indeed stay shiny.

This one hopes that SFV membership will help keep the contributions of this space emanating from this laptop on this Sacramento Street kitchen counter for a very long time to come.

Health Bill Should not Pit Women against Seniors

The health care issue is, one would think, too important for partisan games pitting one group against another. Especially when huge portions of each group are one and the same. But as Robert Pear and David M. Herszenhorn report in today’s New York Times, that seems to be happening.

In a day of desultory debate on sweeping health care legislation, senators appealed to two potent political constituencies on Tuesday, with Democrats seeking additional medical benefits for women and Republicans vowing to preserve and protect Medicare for older Americans.

The Democrats’ first amendment, offered by Senator Barbara A. Mikulski of Maryland, would require insurers to cover more screenings and preventive care for women, with no co-payments.

‘Women often forgo those critical preventive screenings because they simply cannot afford it, or their insurance company won’t pay for it unless it is mandated by state law,’ Ms. Mikulski said.

I met with my oncologist two days ago and decided to have a mammogram. It’s been two years since the last one. She and I agree that, having had breast cancer in 2006 and breezed through a mastectomy, and being fit and healthy overall, my particular situation suggests the potential benefits — catch another cancer early, gain another good decade or so of life — outweigh the risks.  This is what the whole thing is about: every woman is different, every woman should be allowed to decide, with her doctor, on screening and preventive care. The Mikulski amendment will insure that can happen, whatever one’s age and circumstances.

The first Republican proposal, offered by Senator John McCain of Arizona, would strip the bill of more than $450 billion of proposed savings in Medicare. The savings would curb the growth of Medicare payments to hospitals, nursing homes, health maintenance organizations and other providers of care.

‘The cuts are not attainable,’ Mr. McCain said. ‘And if they were, it would mean a direct curtailment and reduction in the benefits we have promised to senior citizens.’

Senators said that debate on the bill, which embodies President Obama’s top domestic priority, would last for several weeks and perhaps continue into January. A vote on Ms. Mikulski’s amendment has not been scheduled but could come Wednesday.

The health care bill would require most Americans to carry insurance. It would subsidize coverage for people with moderate incomes, expand Medicaid and create a government insurance plan, which would compete with private insurers. The House passed a similar bill last month.

Ms. Mikulski’s proposal was prompted, in part, by the recent furor over new recommendations from a federal task force that breast cancer screenings begin later for many women.

The Senate majority leader, Harry Reid, Democrat of Nevada, hailed Ms. Mikulski’s proposal, saying: ‘The decision whether or when to get a mammogram should be left up to the patient and the doctor. That decision should not be made by some bureaucrat, a member of Congress or someone they’ve never met.’

As health costs and insurance premiums rise, Mr. Reid said, ‘more women are skipping screenings for cervical and breast cancer, and doctor visits that can catch problems like postpartum depression and domestic violence.’

Votes on the Mikulski amendment will show whether Republicans “truly want to improve this bill or just want to play games, stall,” Mr. Reid said.

Ms. Mikulski said her proposal would ‘shrink or eliminate the high cost of co-payments and deductibles’ for women who receive screenings for cancer, heart disease, diabetes and other conditions.

Senator Kay Bailey Hutchison, Republican of Texas, criticized the proposal, saying it would ‘allow yet another government agency to interfere in the relationship between a woman and her doctor.’

No, Senator Hutchison, the government isn’t interfering in my relationship with my doctor, nor will it do so by insuring other women’s choices and coverage.

Republicans argued that the bill would be paid for on the backs of older Americans.

‘We are receiving incredible and overwhelming response from seniors all over America,’ Mr. McCain said. ‘They paid all their working lives into the Medicare trust fund, and now they’re in danger of having $483 billion cut out of it.’

Mr. McCain’s proposal would effectively cripple the bill, because Democrats are relying on savings in Medicare to help offset the cost of providing coverage to more than 30 million people who are now uninsured.

This senior would like to add a word to that “overwhelming response” Mr. McCain reports. I paid all my working life into Medicare (which, by the way, was not exactly a gift to America from the Republican party) and I want a decent health bill more than I want every penny of my Medicare coverage protected.

A lot of us have come to terms with the fact that the health bill we may get is a long way from the health bill we so fervently wanted. We are still hoping that something survives the attempts to sink it at any cost.

Senators Pitch to Women and Elderly on Health Bill – NYTimes.com.

Recovery Act funds boost Alzheimer's research

Spotting brain changes before symptoms appear… identifying risk-factor genes… finding drugs that improve memory… these are a few goals of newly-funded Alzheimer’s research. And for millions of us, tomorrow won’t be too soon. The National Institute on Aging (NIA), part of the National Institutes of Health, is boosting these and other research areas in grants made with American Recovery and Reinvestment Funds.

Dementia is the looming fear of most of us over 50, an age group that recently inducted my son. My own mother died at 70, after a decade of strokes and the gradual fuzzing-out of a once sharp mind. My father-in-law, and his father, both suffered from “Alzheimer’s-related” illness. We are now light years beyond what we knew then, but probably another few light years away from prevention or cure. When you have witnessed close-on the devastation that dementia wreaks, any step toward those goals is very good news.

A few of the new or ongoing projects getting a boost from Recovery Act dollars were summarized several days ago by Medical News Today:

“We are delighted to announce the award of Recovery Act funds to many dedicated, hardworking scientists committed to advancing scientific discovery into Alzheimer’s disease and cognitive impairment,” said NIA Director Richard J. Hodes, M.D. “Over the next two years, the recipients will use this unprecedented boost in research funds to help reach our ultimate goal of understanding age-related cognitive decline and reducing the individual and societal burden of this devastating disease.”

More than 100 Alzheimer’s or Alzheimer’s-related research grants were awarded under the Recovery Act.

The complete list, a daunting read for the scientifically challenged, is available online at the ARRA (Recovery Act) site. Snippets of the list, paraphrased from the Medical News Today, summary, include:

$24 million to the Alzheimer’s Disease Neuroimaging Initiative to track changes in the living brain as older people transition from normal cognitive aging to amnestic mild cognitive impairment (MCI), in which individuals have a memory deficit but generally retain other cognitive abilities, and from MCI to Alzheimer’s disease.

A grant of more than $5.4 million to add 3,800 Alzheimer’s patients and an equal number of people free of the disease to a previously funded study by the Alzheimer’ Disease Genetics Consortium (ADGC), which aims to identify the additional risk factor genes for late-onset Alzheimer’s disease. These huge datasets will allow scientists also to search for genes associated with a number of traits associated with Alzheimer’s, as well as for genes related to cognitive decline.

Another study, examining cognitive decline in older African-Americans will collect and analyze the DNA of 4,140 elderly African-Americans enrolled in NIA-funded aging studies already taking place in Chicago and Indianapolis. The study will assess the associations of over 900,000 genetic markers for such issues as stroke and high blood pressure.

Another $820,000 in Recovery Act funds will advance Alzheimer’s genetics research by developing methods for identifying combinations of genes that might influence age-related risk of AD.

There are more — some looking at drugs and exercise, some studying specific populations, many (including the above) examining a multiplicity of factors in the search for answers to the puzzles of the brain.

This space will be following the progress of them all — if I don’t forget.

Recovery Funds Advance Alzheimer’s Disease Research.

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