WebMD News Watch

Retail Health Clinics: Should you treat your sore throat at the supermarket?

noreply@blogger.com (Michael Smith, MD) — Mon, 02 Nov 2009 23:01:00 +0000

By Denise Mann, MS
WebMD Guest Blogger

Nov. 2, 2009 – Buy groceries. Check. Pick up prescription. Check. Get blood sugar levels tested. Check. Get flu shot. Check.

Health care is increasingly becoming part of our one-stop shopping culture as retail health clinics pop up across the map. Retail health clinics are free-standing, walk-in medical kiosks in drugstores, shopping malls, and grocery chains that offer acute care for throat infections and earaches as well as diabetes and cholesterol screenings, routine checkups, and vaccinations. The fees are low, and care is often provided by a nurse practitioner rather than a physician.

The latest study shows that such care tends to be on par with that received in a doctor’s office or urgent care center and may even be better than the care received in emergency rooms for some conditions. The study appears in the Sept. 1 issue of the Annals of Internal Medicine.

In this study, retail clinics charged significantly less for services commonly offered for several hundreds of dollars by doctors in private settings. “The cost of care was much lower than compared to doctor’s offices and about 80% less than in the emergency room, and the uninsured save even more than insured,” explains lead author Ateev Mehrotra, MD, a professor of medicine at University of Pittsburgh School of Medicine and policy analyst at the Rand Corporation, a public policy think tank in Pittsburgh.

Not everyone is on board. The American Academy of Family Physicians does not endorse retail health clinics and believes that such health care delivery could interfere with the medical home, and other medical associations are concerned that the quality of care received care at these clinics may be sub-standard.

Acute care for simple issues is one thing, but some clinics may be branching out into treating more complicate health issues, and that is where things get dodgy. The jury is out on how well these clinics could treat more serious conditions, Mehrotra says.

If you build it, will they come?

The retail health clinic philosophy is ala Field of Dreams with a twist: If you build it they will come (as long as it is conveniently located and open late). “If we provide health care access where people live, work and play and they can go after work, on weekends, and when it is convenient, then people are more likely to avail themselves to it,” explains urgent care physician Matt Mesnick, MD, chief medical officer of Minute Clinic, a subsidiary of CVS pharmacy. “Tripping over a clinic is a nice solution to the health care access problem, and being open when it is convenient is a huge leveraging point,” he says.

As of now, there are more than 1,200 such clinics located throughout the U.S., according to the industry’s trade group, the Convenient Care Association.

“We are at the point where we are still trying to fine-tune the model and we will see a steady growth of these clinics,” Mesnick predicts. He discussed the growth and potential of retail health clinics at the General Electric Healthymagination conference in New York City, a two-week-long conference designed to introduce doctors, thought leaders, and patients to the next generation of medical care.

Mesnick sees these retail clinics as the ‘front porch’ of the medical home, a concept that refers to comprehensive primary care. In this scenario, the primary care doctor is on the first floor, and the retail health clinic ushers people into their lair.

Here’s how it works: Someone with diabetes goes to a drugstore or mall with a health clinic. He or she picks up their medication and gets a coupon for a blood sugar and diabetic foot ulcer check right next door. The results of these tests are input into an electronic medical record system and sent to their primary care doctor, so care is coordinated as well as convenient, Mesnick explains. Any issues are flagged and addressed by the primary care doctor.

Access still an issue

Such an approach could save lives, he says. As it stands, just 2% of people with diabetes are hitting their blood sugar targets. “Is it the fault of training, education, or is access an issue?” Mesnick asks. If access is part of the problem, getting more people with diabetes screened more frequently can help a greater number of people achieve their blood sugar goals and minimize the risk of diabetes complications and related hospitalizations.

For these clinics to really take off, coordination is needed, he says. Consider this: “If you bring Johnny in to pick up medication for an ear infection, then we can see when his last measles mump rubella (MMR) vaccine was or if he is due for any other vaccines,” Mesnick says. “If you have this access but don’t have the patient’s immunization records, it doesn’t work."

Access to health care is still an issue for the masses, Mehrotra says. Most of the clinics are in dense, urban areas. One-third of people in cities live within a 10-minute drive from a retail health clinic.

“We did find that people who go these clinics are young adults who don’t have a primary care doctor, so retail clinics are serving a population that aren’t that well plugged in to the health care system, but these clinics are located in wealthier neighborhoods,” he says. “Some had hoped that clinics would serve the underserved, and that’s not happening."

SOURCES:
General Electric Healthymagination conference. New York.
Matt Mesnick, MD, chief medical officer, Minute Clinic.
Ateev Mehrotra, MD, professor of medicine, University of Pittsburgh School of Medicine; policy analyst, Rand Corporation.
Mehrotra, A. Annals of Internal Medicine, Sept. 1, 2009; vol 151: pp 321-328.
Rudavsky, R. Annals of Internal Medicine, Sept. 1, 2009; vol 151: pp 315-320.

Is Your Doctor’s Office Fat-Free?

noreply@blogger.com (Sean_webmd) — Fri, 30 Oct 2009 20:55:00 +0000

By Denise Mann, MS
WebMD Guest Blogger

Oct. 27, 2009 -- You leave your house at 6:30 a.m. so you are sure to be the first person in line at the lab to have your blood work done. This way, you won’t be late for work, and with any luck, you will have the results of the tests by day’s end.

No such luck. You ended up sitting in the waiting room reading an outdated issue of People magazine and a few brochures on disease prevention for more than two hours before your name was even called, and didn’t get to the office until after lunch. Obviously, the results of your lab work were also delayed.

Sound familiar? Maybe not for long. Growing numbers of health care institutions are trimming the fat, and going lean. This doesn’t mean lay-offs, it means de-cluttering, reprioritizing, shifting resources, and striving to avoid bottlenecking in waiting rooms.

Lean can mean different things in different industries. For example, in the technology arena, lean means getting material through the factory, assembled, to the customer, installed, and ready to use faster than anybody else -- defect free, says Gary Reiner, senior vice president and chief information officer at General Electric.

Reiner spoke about the "leaning" of health care at the General Electric Healthymagination conference in New York City, a two-week-long exhibit designed to introduce doctors, thought leaders, and patients to the role that technology can play in improving health care.

Fat-free health care means less frustration

In health care, getting lean means improving patient satisfaction by cutting down length of stays or wait times without sacrificing care. It also means reducing costs. It’s about the bottom line -- but that doesn’t have to mean staff lay-offs or sub-standard care.

And many hospitals and health care systems are adopting this new mode of thinking by hiring consultants to put them on diets, so to speak. Brigham and Women’s Hospital in Boston, for example, got lean and cut average waiting time from 14-17 minutes to about 4-5 minutes. They also improved the lab turnaround time, and boosted patient satisfaction by 80%.

Lean is not mean

Tejas Gandhi, assistant vice president of management engineering and center for lean at Virtua Health, Marlton, N.J., is a believer. Going lean saved $14 million for the four health care systems that make up Virtua.

“Lean is about creating value from a customer prospective, and the customer is the patient who wants to know ‘how quick can I get home after a procedure or exam?’” he says.

In some cases, lean may involve some redesign. “Nurses and doctors walk miles and miles each day within their hospital hunting for equipment, looking for medication, charts, and supplies, but if they had the right tools in the right place at the right time, they would be able to spend more time by the bedside,” he says.

This strategy added 600 hours of doctor-patient face time -- and that is win-win.
“Patient satisfaction and employee satisfaction jumps the more time that the clinicians spend by the bed side because that is what they both want,” he says.
Lean is not mean, he says. “Many people may think lean is about job cuts, but we have not had a single layoff,” he says.

SOURCES:
Gary Reiner, senior vice president and chief information officer at General Electric.
Tejas Gandhi, assistant vice president of management engineering and center for lean at Virtua Health, Marlton, N.J.
General Electric Healthymagination conference in New York City.

Is the Health Care System Ready for Aging Baby Boomers?

noreply@blogger.com (Sean_webmd) — Thu, 29 Oct 2009 19:48:00 +0000

By Denise Mann, MS
WebMD Guest Blogger

Oct. 28, 2009 -- There’s a silver tsunami gaining strength, and the health care system may not be able to weather the storm.

“As the tidal wave comes, are we prepared?” asks Margaret Scott, chief investment officer of Belmont Village Senior Living in Houston. “Do we have health care providers, doctors, nurses’ aides, or systems in place to keep people at home.”

The answer is a resounding “no”, but many in the health care field are furiously working on developing innovative, multi-pronged solutions to these problems. Improved disease prevention efforts and technology are two important parts of any potential solution, but the clock is ticking.

“It’s very scary to all of us in terms of solving this,” says geriatrician Mark Leenay, MD, MS, senior vice president of medical management and physician services at UnitedHealth Group-Ovations, based in Minnetonka, Minn. Scott and Leenay took part in a sobering panel discussion on the challenges of providing quality care to the elderly and chronically ill at the General Electric Healthymagination conference in New York City.

Changing the rules of engagement

Fully 75% of today’s health care dollars are spent on treating chronic illness, Leenay says, and half of that is used to treat illnesses caused by poor diet, poor exercise, and tobacco use -- i.e. preventable causes of illness.

“The focus needs to be on preventing them from getting sick,” he says. That is easier said than done, but making risks very specific to the patient, rewarding them for positive behaviors, and motivating doctors to prevent diseases can help.

Technology and prevention can go hand in hand, he says. A diabetes pump can be programmed to monitor a person’s blood sugar and adjust insulin levels accordingly. This technology will lead to tighter control of diabetes, and a lower risk of complications and hospitalization down the road.

“Technology allows the caregiver or physician or registered nurse to do what they are there to do -- not fill out charts for four hours a day,” says John Cobb, CEO of Senior Lifestyles, a Chicago-based corporation that owns and manages 54 retirement communities across the map.

He is referring to things like electronic medical records that can put needed information at a doctor’s fingertips instead of having to sift through mounds of paper files located miles away from the patient.

This paves the way for more face time between doctors and patients and can help compensate for the shortfall of doctors by allowing them more time to practice medicine.

Telemedicine can also play a role in caring for baby boomers, says Lynn Townshend, executive aide to the Commissioner of the Connecticut Department of Public Health in Hartford. Video conferencing and other technologies can allow doctors to reach out to patients in their homes, and can allow specialists to have a presence in communities that they would not otherwise have access to.

All this works to improve care and keep people home longer, she says.
Preparing for the silver tsunami is an uphill battle, Scott says. “They will not come simply, but we will find solutions.”

SOURCES:
Margaret Scott, chief investment officer of Belmont Village Senior Living in Houston.
Mark Leenay, MD, MS, senior vice president of medical management and physician services at UnitedHealth Group-Ovations.
John Cobb, CEO of Senior Lifestyles, a Chicago-based corporation.
General Electric Healthymagination conference in New York City.

View From ASPS: Plastic Surgeons Like It Hot

noreply@blogger.com (Sean_webmd) — Thu, 29 Oct 2009 19:30:00 +0000

By Denise Mann
WebMD Guest Blogger

Oct. 29, 2009 (Seattle) -- Botox breast lifts, cleavage rejuvenation, fat injections in your butts, and breast and penis enlargement surgery.

No, this is not a rundown of hot topics discussed by the ladies of The View, it’s a mere snippet of the equally edgy -- and at times, bawdy -- subjects broached by leading plastic surgeons at the aptly titled topics “hot topics” session of the annual meeting of the American Society of Plastic Surgeons (ASPS) in Seattle.

And just like on The View, very little was off limits for this esteemed panel. Mark P. Solomon, MD, a Philadelphia-based plastic surgeon wowed the crowd by discussing a surgery that can add width and length to a man’s penis. Seeing is believing. And if before-and-after pictures can be believed, it really works. I kid you not.

And that was just the tip of the hot topics. Overall, there was less talk, and more action at this year’s ASPS meeting as new treatments moved to the breast and body. I’m talking about fat-melting injections with Lipodissolve -- a once controversial therapy that involves injecting a cocktail of chemicals into muffin tops, saddle bags, love handles, or other trouble spots to dissolve fat cells.

Several years back, V. Leroy Young, MD, a plastic surgeon in St. Louis known as a savvy clinical trialist and scion of surgical safety, began investigating this therapy. He was a skeptic at the time, but now Young is a believer. While the final results are not tallied, Lipodissolve may actually melt away fat.

What’s more, plastic surgeons have been talking about taking fat from thighs, butts, and other areas where it is plentiful and injecting it into the breast for cosmetic reasons for years. Some say it has merits, while detractors fear that it may mar mammograms, be mistaken for early breast cancer or even worse, cause cancer. But these fears are being dismissed by studies, and fat injections to the breast may be here to stay.

Plastic surgery is not all about nipping, tucking, and sucking or zapping away fat. There is another side to plastic surgery and plastic surgeons. The reconstructive side of the biz may not garner as many tabloid headlines as the sexy, celebrity-driven procedures like fat injections to the breast or cleavage rejuvenation, but reconstructive plastic surgery holds the power to save and changes lives every day.

This year’s meeting showed all of us how. An injured Iraqi citizen, a port wine stain patient, a breast reconstruction patient, and a patient who had skin cancer on her nose received the Patients of Courage: Triumph Over Adversity awards. Listening to these award winners tell their stories and talk about the doctors who treated them will forever change how you think about plastic surgery and plastic surgeons.

Design Thinking May Change Your Hospital Experience

noreply@blogger.com (Michael Smith, MD) — Wed, 28 Oct 2009 16:01:00 +0000

By Denise Mann, MS
WebMD Guest Blogger

Oct. 28, 2009 – Doctor. Nurse. Physican assistant. Lab technician. Interior designer?
Yes, you read that last one correctly. Designers are increasingly becoming important members of your health care team, and they are helping to change the way that you receive medical care in some very innovative and creative ways.

It’s called “design thinking,” and it is aimed at changing your health care experience by changing the environment where you receive care. It helps take the fear and anxiety out of the hospital environment by making things friendlier, brighter, and easier to navigate.

“The health care team of the future has to involve designers,” says Nicholas F. LaRusso, MD, director of the Center for Innovation & SPARC lab at the Mayo Clinic in Rochester, Minn. The SPARC lab is working to re-create and reshape the entire patient experience with the help of a cadre of designers. LaRusso discussed his experiences at a General Electric Healthymagination conference in New York City.

In Rochester, where the Mayo Clinic is based, designers are ingratiating themselves into the community to learn what members need in terms of their health care and how they feel about their own health. Armed with this type of information, the designers seek to break down barriers by changing and softening the environment, redesigning exam rooms, simplifying the appointment check-in process, and increasing patient education.

“Designers and design thinking are a critical component of our team,” LaRusso says. “The value of design and design thinking has been fully embraced by our institution and the demand for the designers services are exceeding capacity,” he says.
It’s a marriage made in heaven, LaRusso adds.

“Physicians are evidence-based and solution-driven thinkers and this has pluses and minuses,” he says. “We often move to solutions before considering all potential approaches, but designers slow us down and help us think more broadly about framing the question and exploring a wide array of potential approaches.”

The result of this union? Improved communication between doctors and their patients and better health care delivery, he says.

Gary Kalkut, MD, MPG, the senior vice president and chief medical officer at Montefiore Medical Center in the Bronx, agrees. The design thinking approach starts with seeing things through the patient’s eyes and going from there, he says. “At our hospital, I tell staff to physically walk patients to where they need to go as maps and directions can be confusing.” Such efforts humanize health care and help take fear and anxiety out of the hospital experience, he says.

SOURCES:
Gary Kalkut, MD, MPG, senior vice president and chief medical officer, Montefiore Medical Center, Bronx.
Nicholas F. LaRusso, MD, director, Center for Innovation & SPARC lab, Mayo Clinic, Rochester, Minn.
General Electric Healthymagination conference, New York.

Virtual Stethoscopes: Coming Soon to a Doctor’s Office Near You

noreply@blogger.com (Michael Smith, MD) — Tue, 27 Oct 2009 22:12:00 +0000

By Denise Mann, MS
WebMD Guest Blogger

Oct. 27, 2009 – It’s slim, it’s slick, it’s shiny, and it’s smart. It is also about the size of a cell phone, and the Vscan may help save lives in developing nations as well as rural parts of the United States.

The Vscan, developed by General Electric, is referred to as a virtual stethoscope and can be used to quickly and accurately make a diagnosis without relying on the more traditional and cumbersome ultrasound machinery. There is no pricing information available yet, but the product was unveiled at General Electric Healthymagination conference in New York City, a two-week-long exhibit designed to introduce doctors, thought leaders, and patients to the next generation of medical technology.

And that’s not the only high-tech product that may help save lives while cutting health care costs. Portable ECG machines that are about the size and weight of a laptop computer may allow doctors in small clinics and developing nations to quickly and efficiently assess the cause of heart problems. Electrocardiograms (ECGs) measure and record the electrical activity of the heart.

Former Sen. Bill Frist, R-Tenn., a former heart-lung transplant surgeon, is a fan of the Vscan. “If I had something like this, it would save what I had to do in the middle of the civil war in the Sudan when five patients showed up with abdominal masses that could have been caused by a number of things,’ says Frist, who is a member of a new advisory panel created by General Electric that aims to help use technology to provide access to affordable health care. With VScan, “instead of operating on all five, I might have only operated on one of them.”

A quick scan of the affected area with the lightweight device could have helped rule in or out causes of the pain that warrant surgery, he explains. And it’s not just the Sudan; this technology can also help doctors in rural areas of the U.S. such as Eastern Tennessee and Memphis, Frist says.

The smart ECG talks and gives feedback on the placement of the leads. While it has not received clearance from the FDA yet, some preliminary research shows that doctors dig its portability. The machine has a long-lasting battery life and allows users to transfer the information using a memory card.

Putting technology like the VScan or portable ECG into doctors’ hands will allow more people to be diagnosed sooner, says Michael J. Barber, a vice president of General Electric in Fairfield, Conn., who is head of Healthymagination.

“Health care reform is about providing access to more patients,” he says.

Sources:
Former Sen. Bill Frist, R-Tenn.
Michael J. Barber, a vice president of General Electric, Fairfield, Conn.
General Electric Healthymagination, New York.

GI Docs Talk Science, Find Time for Stress Relief

noreply@blogger.com (Sean_webmd) — Tue, 27 Oct 2009 20:24:00 +0000

By Kathleen Doheny
WebMD Guest Blogger

Oct. 27, 2009 (San Diego) -- Mention “gastroenterologist” and some people will ask, “Which doc is that, again?” Others will literally back away, wary of their upcoming (or recent) colonoscopy.

Suffice it to say, gastroenterologists -- charged with the health of our entire digestive tract and liver --don’t have the fun-and-games image of, say, pediatricians who wear clown noses to amuse their young patients.

But another side of GI docs emerged when about 5,000 of them gathered in San Diego this week for the annual meeting of the American College of Gastroenterologists. The fun side!

In between serious research sessions, some shot hoops in the exhibit hall at the booth of PLUS Diagnostics, a diagnostic laboratory. Spokesperson Char Schraibman admitted it was a shameless (and effective) attempt to attract docs.

Over at the booth of Shire Pharmaceuticals doctors tried their hands at a video game to deliver the medicine to the little man on the screen before the bugs got him.

And at a press briefing Monday, David A. Greenwald, MD, a gastroenterologist at Montefiore Medical Center in New York, excitedly unveiled what he calls “Facebook for GI docs.” It’s a secure social network, hosted by the American College of Gastroenterologists and called the GI Circle, designed to help gastroenterologists communicate and view breaking news on research.

Whatever your score at fun and games -- or your friend tally on Facebook -- the stress relief might be good for your GI tract, research presented at the meeting suggests. At a press briefing Tuesday, researchers warned that workplace stress can wreak havoc on your GI system.

Other research focused on improvements in colonoscopy, considered the gold standard for detecting colorectal cancer, which kills about 49,000 people annually in the U.S. High-definition colonoscopy is being phased in, with new machines replacing older ones.

A tiny camera device, called the Third Eye Retroscope or TER, gives doctors a better look at the colon as they withdraw the scope, helping them find growths hiding behind the many folds of the intestines.

There was news about old diseases, such as P. Patrick Basu, MD, of Columbia University College of Physicians and Surgeons’ report that a four-drug regimen, including antibiotics and a medicine to reduce stomach acid, works better to wipe out the ulcer-causing bacteria Helicobacter pylori than a three-drug regimen often prescribed.

It got a thumbs-up (over the phone) from Emmet Keeffe, MD, professor emeritus of medicine at Stanford University in Palo Alto, Calif., a gastroenterologist who reviewed the findings for WebMD. “This is a relatively convenient regimen and has a high success rate,” he says.

As for patients who suffer from inflammatory bowel disease or IBD, they should be extra wary of too much sun exposure, Millie Long, MD, of the University of North Carolina Chapel Hill cautioned.

In her research, she found that IBD patients were more likely to get nonmelanoma skin cancers, especially if they are on certain medications.

Her findings, she cautions, are no reason to abandon treatment, especially if IBD patients get relief. Rather, it’s a wakeup call, she says, to pay close attention to sun safety practices such as wearing sunscreen.

Despite the advances in technology, the GI doctors stressed that patients play a big role in their own GI health. Compliance with medications for IBD and other problems is always an issue, they say. And those about to undergo colonoscopy need to know preparation is crucial.

For those looking for a bowel prep alternative to that traditional pre-procedure cocktail, researchers from Wyckoff Heights Medical Center in New York reported that a pre-colonoscopy regimen of lukewarm salt water and exercise works as well as traditional measures.

Stay tuned, they’re studying the approach further before it is ready for prime time.

View from ACR: Luring Doctors With Tastykakes

noreply@blogger.com (Sean_webmd) — Tue, 27 Oct 2009 16:41:00 +0000

By Charlene Laino
WebMD Guest Blogger

Oct. 23, 2009 -- (Philadelphia) -- It’s been a busy couple of months since Labor Day. Medical meetings are in full swing, sending me chasing infectious disease specialists in San Francisco, tracking down cancer docs in Berlin, running after neurologists in Baltimore, and ending up this week, here in Philly, immersed in the latest news in arthritis, lupus and gout at the annual meeting of the American College of Rheumatology(ACR).

I can’t stress the importance of covering medical meetings enough. Whether it’s the premier cancer meeting in Europe or ACR here at home, conferences are considered the forums to unveil new research. They are where we first hear about breakthroughs that will transform practice and, more often, about new drugs and tests that show promise. And we hear about some unique studies along the way.

At ACR, for example, there was new research, spearheaded by an elementary school student, suggesting that video games may be causing finger and wrist pain in children, and the younger the player, the greater the risk. You can’t beat this advice from the study’s leader, 11-year-old Deniz Ince: “If you’re over 7, don’t play more than an hour a day. If you’re younger than 7, give it a break until you’re older.” Indeed.

Then there are studies suggesting that milk and water may help fight painful gout attacks. When I first saw the titles, I thought, how did they even come up with the idea of studying that? Turns out there’s a scientific rationale: Dehydration is a trigger for the disease.

Lupus Drug Takes Center Stage

Another reason to attend: The written abstracts that researchers submit months before their actual presentations are often out-of-date, and sometimes downright wrong. Further analysis in the weeks leading up to these disease marathons can dilute the strength of an association that seemed so powerful based on the preliminary data. You have to be here to hear the final results and talk with other specialists about their importance.

Meetings are also where I make contacts with leaders in the field, who help me sort through the hundreds of new drugs with names like ABC123 that hold so much promise, based on early studies. Which ones are going to live up to that promise and which will die in the lab, a blip on the screen, here today, gone tomorrow? If we told you about all of those, your head would burst.

At this year’s ACR meeting, the spotlight shined on Benlysta, the first in a new class of experimental drugs that dials down the abnormal immune response that wreaks havoc on lupus patients’ joints and organs. It outperformed standard treatment in a large clinical trial, and if the findings hold up, Benlysta will become the first new drug for lupus in half a century. Everyone I spoke to said to stay tuned.

There was also a great deal of enthusiasm for a large, head-to-head study showing that for many people with rheumatoid arthritis, the traditional, and much cheaper, disease-modifying antirheumatic drugs appear to work just as well as newer TNF blockers that target the underlying disease process. Importantly, the trial also suggested that for many patients, methotrexate alone may do the trick, at least for a while. A footnote echoed by all, however: The findings are based on symptoms. X-ray images, taken during the study but not available yet, may show one strategy is better at halting disease progression.

Speaking of TNF blockers, other new research links the immune-disease drugs to an increased risk of skin cancer. But please, do not read this and panic if you are on the drugs: For most, the benefits far outweigh the risks. Do, however, check your body regularly for any abnormal growths that can signal skin cancer.

While you’re in front of the bathroom mirror, checking your back for moles, why not multitask and brush and floss? A new study shows gum disease may raise your risk of developing rheumatoid arthritis (RA). Now, there’s a simple intervention to modify your risk of a disabling disease.

Actually, here’s another. Other research shows spraying your home and garden with insecticides may increase the risk of both RA and lupus. Maybe you’ll think twice next time you see a bug? They’re not that bad.

Attracting Doctors With … Tastykakes?

There was some disappointing news this year, too. Using a more sensitive measure of joint damage than in the past, researchers have found that the popular supplement glucosamine does not appear to slow the progression of knee osteoarthritis.

Maybe you’d be better off exercising and eating a healthy diet than spending money on supplements? That’s my personal view, one I must admit many of my friends take issue with. But this brings me to my latest concern: I’m a little worried we are going to end up with a nation of overweight doctors, at risk for everything from arthritis to heart disease.

Why? For years, in the enormous exhibits areas at every meeting, doctors stuffed their conference bags with “gifts” from pharmaceuticals companies -- everything from personalized ballpoint pens to the latest computer gadgets, all emblazoned with the company’s logo.

Rules that went into effect in the U.S. earlier this year frown upon inscribed giveaways. So how are the companies attracting doctors to their booths to hear about -- and hopefully then prescribe -- their drugs and diagnostics? With food, usually junk food no less. I kid you not. One booth had soft pretzels with mustard, another homemade chocolate cake. I’ve even had crepes, cooked to order. There are always cookies, candies, colas, and coffees. Philly’s hometown treat, Tastykakes, were a big hit at ACR. Talk about empty, but devilishly fun, calories.

More than one attendee admitted having to let his belt out a notch by the end of the week. I just hope they go home and work it off.

I know I have to.

New Image Mapping Takes the Guess Work Out of Cancer Treatment

noreply@blogger.com (Michael Smith, MD) — Tue, 27 Oct 2009 16:09:00 +0000

By Denise Mann, MS
WebMD Guest Blogger

Oct. 23, 2009 -- New image mapping technology that allows doctors to take a closer look inside cancer cells is helping usher in the era of personalized medicine.

Researchers can now map out more than 25 proteins in prostate and colon cancer cells and tell which signaling pathways are activated within these tumors -- a level of detail not possible with existing technologies. These findings will pave the way toward the development of more targeted therapies and allow doctors to more accurately match drugs with cancer patients, improving care and eliminating a lot of trial and error.

“We didn’t realize the heterogeneity within cancer cells,” says Richard J. Gaynor, MD, vice president of clinical investigation at Lilly Research Laboratories in Indianapolis. Calling the new technology a “huge coup,” Gaynor says that it “will potentially extend to all cancers and other disease where there is a molecular component, such as Alzheimer’s disease.” Eli Lilly developed the new technology with General Electric.

So far, the technology has been tested in colon and prostate cancer tissue, and preliminary studies on these and other cancers are slated to begin within a year, Gaynor tells WebMD. He envisions the technology being used in the diagnosis of disease and as a way to monitor treatment.

“If we can see what is going on at the cellular level, basically, our hope is that we can develop drugs that target specific proteins and signaling pathways and that can make a big difference,” says Mark Little, PhD, the senior vice present and director of GE Global Research in Fairfield, Conn. “So far, the results have exceeded our expectations.”

Personalized medicine is the wave of the future, says Marisa Weiss, MD, the president and founder of advocacy group Breastcancer.org and the author of several books, including Taking Care of Your Girls: A Breast Health Guide for Girls, Teens, and In-Betweens.

For example, “breast cancer is as unique as each woman who might one day receive a diagnosis [and] because no two cancers are identical, there is no one-size-fits-all treatment, says Weiss, who is also the director of breast radiation oncology and breast health outreach at Lankenau Hospital in Wynnewood, Pa.

The future of breast cancer diagnosis and treatment is to first conduct an intensive internal investigation into the unique extent and nature of the cancer, followed by a customized treatment plan that’s perfectly tailored to each woman’s individual situation,” she tells WebMD. “The promise of personalized medicine requires the development of a customized solution to precisely target the unique nature of each person’s cancer. Only then will the greatest benefits with the fewest side effects be achieved for each person facing a potentially life-threatening diagnosis of breast cancer.”

SOURCES:
Richard J. Gaynor, MD vice president of clinical investigation at Lilly Research Laboratories in Indianapolis.
Mark Little, PhD, senior vice present and director of GE Global Research in Fairfield, Conn.
General Electric Healthymagination conference in New York City.

It’s Not a CT Scan, It’s a Spaceship!

noreply@blogger.com (Michael Smith, MD) — Fri, 23 Oct 2009 20:50:00 +0000

By Denise Mann
WebMD Guest Blogger

Oct. 23, 2009 -- Your 3-year-old falls and hits his head so hard that he throws up. Does he have a concussion? Sometimes the only way to tell is with a CT scan.

Now just try to lure your son into one of those cold, metal – and frankly, terrifying machines. As many a parent or doctor can attest: it’s not easy. As a result, 70% to 80% of kids aged 3 to 8 who need diagnostic imaging such as a CT scan to rule out a concussion, for example, must be sedated, which increases the risks as well as parents’ fears about a diagnostic test that could save their lives.

But what if your son was dressed as a superhero replete with a cape and mask and asked to crawl through a tunnel to attempt a daring rescue? It might be an easier sell, and such medical play is becoming a reality in many hospitals across the United States where CT scanners are routinely being turned into space ships, jungle adventures, and more.

Preliminary data shows that there is 90% decrease in the need for sedation when children are presented such cleverly disguised scanners, says Bob Schwartz, general manger of global design for General Electric Healthcare, a company that is helping to spearhead such efforts. Schwartz made his comments at the General Electric Healthymagination conference in New York City, a two-week-long exhibit designed to introduce doctors, thought leaders, and patients to the next generation of medical technology. Clinical trials looking at the benefits of such disguised devices are slated to begin.

Such CT scanners are part of a new movement called “design thinking” that aims to take the cold, clinical, and scary out of medical equipment for kids, parents, and really patients of all ages.

The new CT scanners create illusions that change the environment. Instead of a diagnostic test, it’s an adventure that the child can be part of and this tale usually involves a scenario that calls for the child to lie very still, which allows the scanner to capture needed images.

“This softens the cold, metal traditional look of scanners, and makes it less intimidating because it is inherently fear-provoking,” says Gary Kalkut, MD, MPG, the senior vice president and chief medical officer at Montefiore Medical Center in the Bronx. Montefiore offers several such machines to pediatric patients.
Patients have a lot of anxiety about going to a hospital, and doctors and other health care professionals need to start seeing things through patient’s eyes, he says.

“Design thinking addresses the vulnerability and fear that are part of the hospital experience,” he tells WebMD.

“From the bedside to the hallways and all through the hospital environment, we need to address these issues with decorations on the wall, soft surface toys, sleeper sofas in kids rooms for parents, laptops, and/or flat screen TVs,” he says. “It’s important because you are no longer creating fear by walking into a sterile, harsh and unknown environment.”

It’s not just hospital equipment either. Some designers are working on child-friendly inhalers that work by inflating and deflating a balloon and medications that can be delivered by writing on your skin, says Paola Antonelli, the senior curator for architecture and design at the Museum of Modern Art in New York City.
Design thinking is the missing link, says Nicholas F. LaRusso, MD, director of the Center for Innovation & SPARC lab at the Mayo Clinic in Rochester, Minn. The SPARC lab is working to recreate and re-shape the entire patient experience with design thinking.

“We are diagnosing and treating disease more effectively than we ever have. There is no question about that,” he says. “What’s lacking is the delivery model, so the idea of bringing design thinking and innovation to the process of health care delivery is essential.”

Sources:
Gary Kalkut, MD, MPG, senior vice president and chief medical officer at Montefiore Medical Center in the Bronx, N.Y.
Nicholas F. LaRusso, MD, director of the Center for Innovation & SPARC lab at the Mayo Clinic in Rochester, Minn.
Paola Antonelli, senior curator for architecture and design at the Museum of Modern Art in New York City.
General Electric Healthymagination conference in New York City.

Virtual Care Eases Pressure on Sandwich Generation

noreply@blogger.com (Michael Smith, MD) — Thu, 22 Oct 2009 19:38:00 +0000

By Denise Mann
WebMD Guest Blogger

Oct. 22, 2009 -- Members of the so-called “sandwich generation” are often juggling their jobs and home responsibilities with those of caring for aging parents -- many of whom want to grow old at home. It’s not easy, but new technologies that allow caregivers to virtually monitor family members and doctors to conduct virtual visits may lighten the load of all involved.

By and large, such virtual care and care giving are quickly becoming a reality.
One such virtual check-up system allows patients to chat with their doctor at scheduled times, as well as type in health information and vital statistics so that their condition can be remotely monitored. Some insurers even foot the bills for the technology.

A separate system in use at some nursing homes and assisted living facilities uses inconspicuous motion sensors to detect a person’s activity and establish patterns and trends. If there is a deviation in a pattern, the system picks it up. Say your loved one goes to the bathroom more frequently than usual at night? It could be a urinary tract infection. This high-tech system can also tell if a person slipped in the shower, took their pills, and ate three meals a day.

It may one day help family members keep a virtual eye on aging parents or loved ones -- from across the map or across the street -- easing their worry and allowing their loved ones to remain independent longer.

These new video monitoring systems were among many new technologies showcased at General Electric Healthymagination conference in New York City, a two-week-long exhibit designed to introduce doctors, thought leaders, and patients to the next generation of medical technology.

Research shows that patients and doctors like virtual visits. One such study in a recent issue of the Journal of Telemedicine and Telecare showed that evaluations done through videoconferencing were similar to face-to-face visits in terms of time spent with the doctor, ease of interaction, and personal aspects of the interaction. What’s more, diagnosis and treatments were the same whether a person was examined virtually or in the office.

“This is the wave of the future – no doubt about it,” says study researcher Ronald F. Dixon, MD, an internist at Massachusetts General Hospital in Boston. “You get to see and do a visual exam, which is helpful in diagnosing many conditions such as rashes and joint pain; you can gather the same data that you would in a ‘real’ visit, ask questions, and have all the information from the patient’s medical record in front of you,” he says. Dixon did not attend the conference.

There are other benefits too, he says. “Technologies that allow for continuous or regular monitoring of blood pressure and other vital signs such as pulse oxygenation are much better than the snapshot you would get in just one office visit,” he says.
Such technology will also one day help friends and family members keep track of their loved ones who are ill or homebound. “Anyone in your health social network could be alerted if there is an issue,” he says.

Dixon is not sure the technology is here yet, “but we are getting there.”

Such video monitoring and virtual doctor visits will also help reduce health care costs and improve care, says Former Republican Sen. Bill Frist of Tennessee, a former heart-lung transplant surgeon. Frist is a member of a new advisory panel created by General Electric that aims to help use technology to provide access to affordable health care. “Eighteen percent of people on Medicare are back in the hospital in 30 days,” he says. Why? The reasons are manifold. Maybe their doctors’ orders are a bit unclear or maybe they fail to pick up their medications, he says.

“Home monitoring can connect patients at home with nurses, with social workers, and with doctors so they don’t bounce back into the hospital,” he says. Keeping patients out of the hospitals and emergency rooms -- whenever possible -- can drastically reduce costs of care.

SOURCES:
Former Republican Sen. Bill Frist of Tennessee.
General Electric Healthymagination conference in New York City.
Ronald F. Dixon, MD, an internist at Massachusetts General Hospital in Boston.
Dixon R, et al. Journal of Telemedicine and Telecare. May 2009.

Health Reform Sparks Doubts About Cost of Coverage

noreply@blogger.com (Sean_webmd) — Tue, 13 Oct 2009 21:39:00 +0000

By Andy Miller
WebMD Guest Blogger

Affordability.

It’s the latest buzzword in the health care reform debate.

We're going to look at one angle -- the one for a family of four, making an annual income of $60,000 but lacking health insurance.

The new reform law would require the family to purchase coverage. If no employer coverage was available, the family would go to a new health insurance exchange and get federal subsidies to offset the cost of policy. Still, the price tag for the family, with a household head of age 50, would exceed $6,000 a year under the Finance Committee plan (using the Kaiser Family Foundation subsidy calculator at www.kff.org). And that cost doesn’t include the inevitable co-pays and deductibles.

The penalty for not getting insurance? It may be zero under the Baucus bill coming out of the Senate Finance Committee.

Will that family buy coverage or pay the (non) penalty and remain uninsured? Is the coverage truly affordable? “How many [families] have $6,000 of room in their budget?’’ says Bob Laszewski, who writes the blog Health Care Policy and Marketplace Review.

One major element in the debate involves the level of subsidies to help the uninsured buy coverage. The reform proposals give subsidies to people making up to four times the poverty level, or about $88,000 for a family of four.

The subsidies in the Baucus plan, at $461 billion over 10 years, is a large chunk of its price.

The subsidy carrot is accompanied by a stick – penalties for not getting coverage. And the recent weakening of penalties that has riled the insurance industry.

All along, insurers had been banking on a major tradeoff in supporting the drive for reform. The industry agreed to jettison their discriminatory practices against people with pre-existing conditions in exchange for a federal requirement that everyone obtain coverage. A mandate for people to buy insurance would bring millions of new customers to their health plans.

But the Finance Committee has reduced and delayed the penalties it originally proposed for people who don’t purchase coverage. Under an amendment, families would face no penalty the first year up to a maximum of $1,500 in 2017. And individuals and families would not face a penalty if coverage cost more than 8% of their income. In the previous version, the exemption started at 10%.

Those Finance Committee penalties and exemptions are not a big enough stick, according to America’s Health Insurance Plans, a major trade group. People will ignore the penalty or wait till they get a serious illness before they obtain coverage, the group said.

“Fewer people participating will lead to higher premiums for everyone else,’’ said Robert Zirkelbach, an AHIP spokesman. “Unless everybody participates in the system the market reforms aren’t sustainable.’’

Meanwhile, many experts insist the subsidies in the Baucus bill are not high enough, especially for the uninsured middle class.

And Laszewski says that under the plan, people “can wait till someone in their family has brain cancer to buy insurance.”

The subsidies for people under 250% of the poverty level are adequate, he says. But those at the upper end of the income range have trouble with affording a policy that could cost a family $6,000 to $10,000 a year, says Laszewski, who recommends raising both the subsidies and the penalties. “Where [the legislation] is now is political expediency that destroys the insurance market,’’ he says.

Finance Committee members are attuned to the affordability issue. Baucus last month said, “We want to make sure that if Americans have to buy insurance, it’s affordable.’’

Yet Ed Haislmaier, an insurance expert at the Heritage Foundation, says the insurance products under reform would attract a larger percentage of the sick but leave the young and healthy outside the system. “If someone is in reasonably good health, they’ll be more likely to pay the fine,” he says.

Congress is insisting on comprehensive coverage in the health insurance exchange, Haislmaier adds. “You’re selling something to people 25 and healthy that they don’t need and can’t afford. Young people are healthier and don’t earn as much.”

In 2006 Massachusetts reformed health care law to require individuals to buy insurance, but Boston-based consumer advocacy group Community Catalyst said the state’s subsidies for the uninsured were more generous.

“The reason people don’t have health insurance is that they can’t afford it.’’ says Michael Miller, the group’s director of strategic policy. “They have a mortgage to pay, kids with school expenses, a car payment.

“You have to make it affordable for individuals and families, not just the federal government,” Miller says.

The $900 billion cost barrier will have to be broken to make it more affordable for the middle class, says John Holahan, director of the Urban Institute’s Health Policy Center. “If we want health reform, you’ve got to put a little more money into it.”

Still, the current reform legislation would represent a vast improvement over the current individual insurance market, which is riddled with cost and coverage problems, says Families USA, another consumer group.

The price of insurance for those at the 400% poverty level “is a lot of money,” acknowledges Kathleen Stoll, director of health policy for the group. “But it’s a lot better than paying full freight. Is it absolutely a free ride? No way.”

Yet Stoll also notes that reform legislation would protect people against high out-of-pocket costs and annual and lifetime medical spending limits. “I would like to see subsidies higher, as an advocate for consumers. Do I think they’re a wonderful start? Yes.”

The affordability issue is difficult to project, both in the ultimate fate of legislation – if it’s passed – and in the marketplace. Dean Smith, a health care expert at the University of Michigan, says of the penalty vs. coverage dilemma: “It’s really hard to gauge the public sentiment on this.”

But if people remain uninsured, Smith notes, they will often get care in emergency rooms. “And someone is going to pay for it – that’s the taxpayers.”

SOURCES:

Associated Press.
Kaiser Health News.
New York Times.
Wall Street Journal.
John Holahan, director, Urban Institute Health Policy Center.
Bob Laszewski, Health Care Policy and Marketplace Review.
Dean Smith, professor, senior associate dean for administration, School of Public Health, University of Michigan.
Kathleen Stoll, health policy director, Families USA.
Michael Miller, director of strategic policy, Community Catalyst.
Kaiser Family Foundation Reform Subsidy Calculator.
America’s Health Insurance Plans.

WebMD & CDC Team Up to Focus on Flu

noreply@blogger.com (Sean_webmd) — Tue, 06 Oct 2009 22:28:00 +0000

As fall rolls around each year, you probably don't think much about the flu until the fever, muscle aches, and fatigue wipe you out for a week. But this year is different.

That's why WebMD is collaborating with the CDC to bring the latest flu developments right to you.

Nervous about the flu vaccine? Wondering if you should get the swine flu vaccine? Do you need antiviral drugs if you think you have the flu? How can you help prevent spread of pandemic H1N1 (swine) flu?

WebMD and CDC experts are here to ease your mind and answer your questions about swine flu and seasonal flu.

Along with WebMD Chief Medical Editor Dr. Michael Smith, WebMD experts Rod Moser and Dr. Matthew Hoffman and CDC expert Dr. Anthony Fiore will be answering questions and sharing the latest information.

We want to hear from you. No matter the question, we want to know what's on your mind. We'll do our best to help you and your family stay safe this unusual flu season.

Go to our new "Focus on Flu" page to join the conversation or get your questions answered.

Sean Swint
WebMD, Execuitve Editor

Swine Flu Q & A

noreply@blogger.com (Valarie_WebMD) — Tue, 15 Sep 2009 20:33:00 +0000

Note: Guest blogger Matthew Hoffman, MD, has written for WebMD since 2006. He is currently a fellow in pulmonary and critical care medicine at Emory University, where he also completed medical school and residency.

As swine flu cases increase around the country, we are seeing some excellent questions from our readers about this disease. Here are answers to the most recent ones:

Anonymous said...
Is there any information on how long the H1N1 virus may live on hard surfaces? I believe that with HBV and HIV the lives of those viruses were seconds and weeks.

Dr. Hoffman: Great question. The H1N1 influenza virus is mainly transmitted through airborne droplets. Someone with the flu sneezes, coughs, or just talks, and someone else inhales the virus before the infected droplets settle to the ground.

Experts suspect that people also can catch swine flu (and seasonal flu) by touching surfaces contaminated with infected secretions (like shaking hands or touching a doorknob). Far fewer people catch flu this way, compared to airborne transmission.

Influenza viruses have been shown to survive on surfaces for 2 to 8 hours. However, that doesn’t mean they’re lurking on every countertop and faucet handle. Frequent hand washing, avoiding contact with sick people, and avoiding touching your nose, mouth and eyes are the best ways to avoid swine flu.

Anonymous said...
once diagnosed with swine flu and you have recovered can you contract the virus again?

Dr. Hoffman: No. Once you have had H1N1 influenza, your body develops antibodies against multiple parts of the virus. If you were then re-exposed to swine flu, your body would quickly destroy the virus and you would not become ill. (This assumes you have a normal immune system.)

Remember, though, that influenza viruses are constantly changing and combining with each other into new forms. (That’s why you need a new flu shot every year.) New seasonal flu viruses, and possibly swine flu viruses, will eventually develop. Immunity against the current H1N1 doesn’t necessarily provide immunity against any other form of influenza.

Anonymous said...
I want to know the answer to the second question. We think our college-age daughter had H1N1 this summer (all the symptoms--every one) but the initial rapid flu test had come back negative. Should she be getting vaccinated, since we're only 99% positive it was H1N1?

Dr. Hoffman: If your daughter is younger than 24, she should probably get vaccinated despite her previous illness. The Centers for Disease Control recommend vaccination against H1N1 influenza for anyone in these groups:

• Aged 6 months through 24 years old
• Pregnant women
• Regular close contacts of children younger than 6 months old
• Health care workers
• Anyone aged 25 to 64 with chronic illnesses

Rapid flu tests are only about 40-70% accurate at diagnosing influenza. In other words, a normal result still leaves about a 50-50 chance of having swine flu. Although your daughter may well have had swine flu earlier this year, you can’t be sure without a positive culture result.

Griph said...
I have been Diagnosed by my doctor with the Swine Flue, will I die?

Dr. Hoffman: It’s very unlikely that you will die from swine flu. In this country, the H1N1 influenza virus seems to be only slightly more dangerous than the regular seasonal flu.

People at higher risk of serious illness from swine flu include pregnant women and people with chronic illnesses. However, it’s true that unlike seasonal flu, swine flu has caused the deaths of a small number of otherwise healthy young people. I’m glad you were feeling well enough to write—most likely, that means you’re doing OK.

Our Family of 7 Got the Swine Flu

noreply@blogger.com (Valarie_WebMD) — Fri, 11 Sep 2009 10:00:00 +0000

Note: WebMD employees are sharing stories about their experiences with swine flu as part of an occasional series: "WebMD Has Swine Flu."

By Donna Seigfried
Senior Editor

We have a full house: my husband, Keith (44), me (43), our four kids ranging from 2 to 15, and my mom (67). All of us got the flu, and we think we know how.

Friday night, August 21, was a big night in our community. The brand new high school had just opened for the first day of school on August 10, and on the 21st, the new football stadium was being dedicated. Athletes from all sports were being introduced, dads were making predictions about the new football team, little kids were running around playing ball, and moms were socializing.

There was plenty of hugging, hand shaking, and high-fiving going on that night between neighbors, teammates, and friends. Within 48 hours, many people in our neighborhood were suddenly sick, my 15-year-old son, Steven, and I included. Everyone else in our house followed within a few days.

While home sick from school, Steven’s friends were trading text messages about their symptoms. We all had the same thing: vomiting and/or diarrhea, sore throat, headache, fever of 101 to 103 for several days, body aches, and overwhelming fatigue.

Then the confirmations from other moms in our neighborhood started: “Patrick tested positive for flu.” “Michael was confirmed with H1N1.” “Marria has joined the club.” “Braedon has the swine flu and an ear infection.” Two people we knew had pneumonia. My friend Gail, a nurse, said her pediatrician’s office became so overwhelmed with patients that they stopped testing for flu type. If you tested positive for flu, the doctor was 98% sure it was swine flu.

So there we had it. With many around us being confirmed as swine flu cases and having the same symptoms we had, why go for a test and risk exposing others? We felt too horrible to leave the house anyway. We just stayed home and dealt with the flu in the usual way: sleeping and drinking fluids.

When I woke up on the Friday before Labor Day, my temperature was finally down around 99 and stayed slightly above normal all weekend. I had lost 10 pounds from the severe diarrhea and sweating. The Tuesday after Labor Day, I was diagnosed with bronchitis. I think we caught it just before it fully blossomed into pneumonia.

The directive from work was to stay out of the office until the symptoms were gone for 24 hours. Even though it felt strange to be home for so many days in a row, considering how fast this flu spread in our community, that was wise advice. Everyone in our house got over the flu, but altogether, it disrupted our lives for a little over two weeks.

Dr. Louise Chang, WebMD medical editor, comments on Donna's experience:
Donna's experience highlights how easy it really is for flu to spread. Experts estimate that spread of H1N1 swine flu will be greatest among school kids and households. In a recent news story, researchers estimate that an infected student will infect an average of 2.4 other students from school and the probability of an infected household member will infect someone else at home is 27%. If you are ill, following the CDC's recommendation to stay at home and infection control practices like covering coughs and hand-washing can prevent more people from getting sick.

My Son Had Swine Flu -- Maybe

noreply@blogger.com (Valarie_WebMD) — Wed, 09 Sep 2009 20:24:00 +0000

Note: WebMD employees are sharing stories about their experiences with swine flu as part of an occasional series: "WebMD Has Swine Flu."

By Sean Swint
Executive Editor, WebMD

It was the Saturday morning after my 16-year-old son had three friends spend the night.

Two of them woke up that morning feeling bad, and one of them was my son.

At first, my wife and I took it in stride. Put four teenagers together in a downstairs man-cave with a gaming computer, guitars, a bass, two amps, a big TV and video game systems galore, and they generally get about two hours of sleep. At best, my son was usually groggy and grouchy the morning after such an event.

After a few hours though we realized this was a bit different.

Dylan could hardly get off the couch. He felt stuffed up, foggy-headed, and very, very tired. Then we found out he had a fever. So, we figured it was either a bad cold, or … well, I work for WebMD. Swine flu is with me every day as a concept, but now I had to face the possibility that it was about to hit home.

To be honest, I wasn't scared, but I was concerned. I knew from all our stories on WebMD, that despite the fact that swine flu is a "pandemic" and people are dying, in most cases, it's just another form of flu. But as a father, I hated to see my son feeling sick – and I knew swine flu wasn't an illness (if in fact that was what it was) to be trifled with.

My wife and I didn't see the need to take him to an emergency room, so she took him to a local clinic where he was examined by a nurse. The nurse hardly asked any medical questions, and she didn't ask Dylan anything at all, except, "what do you think you have?"

Then, she quickly looked in both ears and said he had a double-ear infection. Dylan hasn't had an ear infection since he was a baby, and then rarely. My wife asked the nurse, is there any way it could be the flu or swine flu?

The nurse said, "No, swine flu is abdominal." Then she prescribed antibiotics. We ignored the diagnosis, and didn't give Dylan the antibiotics.

We tended to Dylan over the weekend as best we could, and it wasn't until Monday afternoon that I could finally get Dylan into his pediatrician, during walk-in hours.

When we got there, we walked into pandemonium. The place was standing room only. This was not your average visit – something was up. I knew that the part of the U.S. that swine flu was hitting was the Southeast, and we live right outside Atlanta. I didn't need to be a scientist to know I was witnessing visual confirmation.

After more than an hour, our name was called, and we were escorted into a doctor's room. When the nurse came in the room about 10 minutes later, she asked all the requisite questions, then tested Dylan for strep (negative). She said since he didn't have a fever this day, she wouldn't test for flu. I knew swine flu doesn't always show up with fever, but I didn't speak up. I knew she'd been dealing with these cases for days now.

When our doctor came in, he did a thorough check-up and talked to us for about 10 minutes. He said it was definitely viral, maybe a bad cold, maybe a sinus infection. He eventually said, let's swab him for flu to see if it might be an "atypical seasonal virus." I thought that was an appropriately diplomatic way to avoid "swine flu." No need to scare people.

When the nurse came back in she said, the test was negative. Still, rapid flu tests are not always accurate. (By the way, the doc checked Dylan's ears. No infection.)

So, we went home with a prescription of rest and fluids, but no solid answer. Still, I was satisfied. I knew my son would be fine.

The bottom line: Even if the flu test came back positive, we would still never know what kind of flu it was, and that will be the case with many people this fall.

So, what did I learn? Three things. One, don't panic. Swine flu is a virus that most people will easily defeat with their own immune systems.

Two: Educate yourself! Know your, or your child's symptoms accurately, know the symptoms of flu or swine flu, and come armed with questions.

And finally, trust your instincts, especially after you've read up on the topics.

As for my son, he was back at his favorite climbing gym scaling a 30-degree incline wall like a teenage gecko several days later. He did say though that illness has hammered his high school, with multiple sick-outs.

And me? So far, I've been granted immunity.

Dr. Michael Smith comments on Sean's experience:
Even swine flu can be a learning experience. I work next to Sean every day and he has the benefit of being knee deep in swine flu and other health information. He probably knows more about swine flu that many doctors. That’s why he knew what to expect, the proper steps to take, and that there was no need to panic. Sean’s experience has probably brought up other questions for you about swine flu. Sean was prepared and you should be too. WebMD’s Swine Flu Center has what you need to know, from swine flu symptoms and the latest developments to whether it’s time to buy a mask. Stay tuned for more swine flu stories from other WebMD employees.

WebMD Has Swine Flu

noreply@blogger.com (Michael Smith, MD) — Fri, 04 Sep 2009 18:47:00 +0000

Since the swine flu outbreak began, the writers, editors, and doctors at WebMD have made sure that you are on top of the latest swine flu developments.

But now swine flu has hit us in a different way. Like many other Americans, WebMD employees are coming down with swine flu symptoms.

Just in the past week, there have been several employees who have been home sick with swine flu symptoms, or home with sick kids.

Their experiences, which they will share over the next few days, will answer questions you have probably been wondering about.

What will the doctor do if you have swine flu symptoms? What should you do? Read their stories and learn all you can about swine flu in WebMD's Swine Flu Center.

Learn what to expect from others who have already gone through it. It might not be what you'd guess.

For example, if you had swine flu symptoms, you'd want to be tested to know for sure if you actually had swine flu, right? Well, you probably won't be. Unless you're very sick or have complications, which, thankfully, most people don't, your doctor won't likely test you for swine flu. And the truth is there is really no reason for the test in most of us. The test won't change treatment, it takes a long time (and by that time you're better anyway), and it's not very accurate.

It might be trite, but knowledge really is power when it comes to swine flu. You need to be prepared before you get sick.

Know when you should stay home, when you should go see the doctor, and what to expect if you do go see the doctor.

Even though some of us are home sick (which is where you should be if you think you may have swine flu!), WebMD is on top of the latest swine flu developments and recommendations, including "New Details on Swine Flu Deaths in Kids" and the latest CDC swine flu recommendations on day care advice.

What's Your Best Defense Against Swine Flu?

noreply@blogger.com (Michael Smith, MD) — Mon, 31 Aug 2009 18:15:00 +0000

Tamiflu? Swine flu vaccine? A mask?

If only it were that easy ...

Unfortunately, popping a pill or rolling up your sleeve isn't the key. In this case, you are your own best bet for preventing yourself -- and others -- from getting swine flu.

While government health officials are preparing for the rise in swine flu cases that's likely to come, their most effective strategy -- the swine flu vaccine -- won't help much until late November.

We can't wait until then because swine flu cases are already on the rise with school starting and the cooler weather on the way.

So how far away do you need to stay away from sick people? Do you need a face mask? What should you do if you suspect you or something else has swine flu?

Here's your two-step plan.

The first part of the plan is to avoid infection:

Wash your hands frequently and thoroughly. Use soap and warm water when available; use hand sanitizer between hand washings.
Avoid close contact with sick people. Close contact means getting within 6 feet of a sick person. If you must care for someone who is ill, minimize close contact.
It's not known whether face masks protect against infection. If you use one, don't slack off on hand washing or avoiding close contact with sick people. Use the face mask properly and throw it away after use.
Get your seasonal flu vaccine as soon as possible. It's safe, and it protects against the three seasonal flu bugs expected to circulate this fall and winter -- even though it won't protect against H1N1 swine flu.

The second part of the plan is to keep from spreading the swine flu virus:

Stay home if you are sick.
Observe flu etiquette. Don't cough or sneeze into your hands. Cough/sneeze into a tissue -- or, failing that, your elbow.
If you can do so comfortably, wear a face mask if you come into contact with others.
If you are an employer, do not penalize workers for staying home if sick or for caring for sick children.
Make plans -- now -- for what you'd do if you or your children get sick this fall.

Spread the word. The key to this working is all of us jumping on board. While it may not feel like you have the power to make much of a difference in combating the swine flu pandemic, you do!

So, tell the truth. Are you doing anything different to help prevent spread of swine flu or do you think it's a bunch of hogwash?

Health Care Reform: Myths vs. Facts

noreply@blogger.com (Sean_webmd) — Thu, 20 Aug 2009 15:07:00 +0000

By Andy Miller
WebMD Guest Blogger

August has turned into a month of myth-making on health reform.

Half-truths, distortions, and downright falsehoods have mixed freely with the facts in the incendiary debate, stoked by town hall meetings, talk radio, and the Internet.

Misinformation can travel as fast as email. Some unfounded rumors have received mainstream attention, such as former vice-presidential candidate Sarah Palin's claim that ''death panels'' would encourage euthanasia. Another widely circulated myth: Bureaucrats would deny care to a person going blind in one eye if the other eye functions normally.

Neither side in the battle appears to have a perfect truth-telling score. Here's a look at the facts behind several claims about reform:

CLAIM: The health care reform bill does this and that…

THE FACTS: There isn't just one bill. The Senate has produced one, and the House has created another version. Yet another bill is expected to emerge soon from the Senate Finance Committee, and it may look very different from the others. The legislative process has many miles to go before each chamber enacts a final version of reform -- if it gets that far. Reform opponents, meanwhile, may have an advantage in that it's easier to make charges about a moving target -- or targets.

CLAIM: The Democrats' health reform will require counseling sessions that will encourage seniors on how to end their life sooner.

THE FACTS: The noisiest fact-defying issue of all. The House legislation would let Medicare reimburse doctors for their time if seniors choose to consult them on end-of-life issues, such as making a living will or hospice care. There's no requirement for Medicare members to do this; it's voluntary. The reform legislation has nothing regarding euthanasia. AARP's John Rother says rumors that suggest the provision calls for government to encourage euthanasia 'is a gross, and even cruel, distortion -- especially for any family that has been forced to make the difficult decisions on care for loved ones approaching the end of their lives.''

CLAIM: Health care reform will lead to rationing of medical services, and the government will decide what care people get.

THE FACTS: Plenty of rationing already exists in the health care system. Insurance companies and employer benefit plans often limit a person's choices of medical services. For the uninsured, elective procedures are difficult to get, if not impossible. But reform would specifically bar some forms of rationing: Insurers would no longer discriminate against an individual with a pre-existing medical condition.

The rationing argument ignited when former New York Lt. Gov. Betsy McCaughey wrote in an opinion piece that government research comparing the effectiveness of medical treatments would eventually limit seniors' access to services.

But FactCheck.org says the council overseeing the research is barred from issuing requirements on insurance coverage. President Obama says the research goal is to provide information to doctors and patients about what treatments may work best for a medical condition. And Julius Hobson, a health policy adviser for the law firm Bryan Cave in Washington, says private insurers would be more likely than Medicare to use that treatment information to make rationing-style decisions.

CLAIM: If you like your health plan, you can keep your health plan; if you like your doctor, you can keep your doctor under reform.

THE FACTS: President Obama has used this line often to tamp down fears about change. But keeping a health plan or a doctor isn't a guarantee even under the current insurance system. Employers now switch insurance plans frequently to get the best possible deal. Doctors, if dissatisfied, can drop out of health plans. So it's difficult to see how reform could ensure that individuals can keep their health plan or doctor.

Obama's plan builds on the current job-based coverage system, and insurance provided by large employers may stay the same. But reform may mean some employers may choose to drop their current coverage and pay a penalty instead. The Congressional Budget Office (CBO) says millions would gain job-based coverage under the House Democrats' legislation, and that millions would lose it.

CLAIM: The House bill is entirely paid for by a combination of Medicare cuts and taxes, and won't add to the deficit.

THE FACTS: The CBO says the House bill would add $239 billion to the deficit over 10 years, with that extra money reversing a scheduled Medicare pay cut to doctors. Democrats don't count that increase as part of the cost of reform, saying it's a separate issue.

Obama has estimated that about $500 billion to $600 billion in Medicare and Medicaid savings can be achieved by restructuring the delivery system, establishing new ways of paying doctors, reducing waste, decreasing medical errors, increasing efficiency, and other changes.

Long-term savings from such ''game-changers'' could be substantial, but would accrue over a 20- to 30-year timetable, says Josh Gordon, policy director for the Concord Coalition, a grassroots organization advocating fiscal responsibility.

The reform bills aren't yet paid for fully, FactCheck.org concludes.

CLAIM: Health reform will cover illegal immigrants.

THE FACTS: Not true. Both the House legislation and the Senate health committee bill rule out subsidizing insurance coverage for anyone who is not a citizen or legal resident. Illegal immigrants get care now -- often in emergency rooms, with the cost frequently borne by hospitals, those who have private insurance coverage, and even taxpayers.

CLAIM: Reform will lead to socialized medicine, like the British system.

THE FACTS: Some Republicans and other opponents of the plan have repeated phrases such as 'government takeover of health care' to rouse opposition. But the Democratic legislation doesn't create a ''single-payer'' system in which government controls health care. The bills would preserve the private insurance system.

Reform would increase government regulation over health insurers. And an option for a public insurance plan, run like Medicare, would inject more federal funding into health care and could alter the market while competing with insurers in an exchange. A public plan would add to government's role, ''but it's not a takeover of health care,'' Hobson says. Recently the White House has backed off somewhat in its insistence on a public plan as part of reform.

CLAIM: Reform will raise your taxes.

THE FACTS: True for the richest Americans, under the House legislation. House leaders have proposed a surcharge or tax on the wealthiest individuals to help pay the cost of reform.

Obama has talked about limiting tax deductions for the wealthiest, and has insisted that the middle class not receive higher taxes. 'It's clear that some taxes will be raised to pay for reform,'' says Gordon. Other tax ideas include a levy on lush, Cadillac-style benefits plans.

CLAIM: Health care overhaul will contain health care costs.

THE FACTS: Health care costs for years have risen faster than inflation, and as a result, insurance premiums have more than doubled over the past decade. But while containing these costs is a goal of reform, many experts believe the current House legislation doesn't do enough. Gordon says greater cost control could be accomplished by capping the tax exclusion on employer health benefits, creating an independent commission to evaluate Medicare payments, and moving Medicare to a system that rewards quality of care, not quantity of services.

CLAIM: The U.S. has the best health care system in the world.

THE FACTS: Statistics suggest we're not getting enough bang for the buck. The U.S. spends 20% more per capita on health care than the next highest-spending country, and 50% more than the third. Countries in the Organization for Economic Co-operation and Development with the highest life expectancy spend half as much per capita as the U.S., notes FactCheck.org, which also cites a 2000 report from the World Health Organization that ranked the U.S. 37th in overall health system performance and 72nd on level of health. 'If you're concerned about primary care, you may be better off in another developed country,'' says Hobson.' If you need to see a specialist, you can't beat the U.S.''

CLAIM: Reform will cut benefits to people on Medicare.

THE FACTS: Obama calls this a myth, and he's right, according to AARP. None of the proposals would reduce seniors' benefits, the organization says. And Obama says reform will narrow the infamous 'doughnut hole' in Medicare prescription drug coverage. Health reform supporters do plan to eliminate subsidies to private insurance companies who offer Medicare Advantage coverage; the effects of the cuts on those plans are unknown.

CLAIM: Reform will lead to government subsidizing abortion.

THE FACTS: PolitiFact.com, a fact-checking web site, says the legislation contains nothing that would require the use of taxpayer money for subsidizing abortion. An amendment in House legislation aims to ensure that federal funds are not used for this coverage.

Obama noted recently that 'we also have a tradition of, in this town, historically, of not financing abortions as part of government-funded health care.'' PolitiFact also says people could have a choice of a health plan that has payment for abortion coverage, and one without it. It's possible that women with subsidized coverage could buy a plan that has abortion coverage. The final wording on this issue, though, won't be clear till later in the process.

SOURCES:

Politico; CNN; Medical News Today; PBS.org; The Wall Street Journal; AARP Bulletin; FactCheck.org; Dow Jones Newswires; The Los Angeles Times; Kaiser Family Foundation; The Washington Post; The Associated Press; PolitiFact.com; NPR; Julius Hobson, health policy adviser, Bryan Cave LLP; Josh Gordon, policy director, the Concord Coalition

Health Reform: A Government Takeover?

noreply@blogger.com (Sean_webmd) — Tue, 11 Aug 2009 21:25:00 +0000

By Andy Miller
WebMD Guest Blogger

A Democratic president calls for a national health insurance program. Opponents denounce it as socialized medicine – too much government.

2009, meet 1945.

Long before Barack Obama was born, Harry Truman proposed a health care plan for the country. But the American Medical Association raised fears about government control of medicine and eventually helped sidetrack Truman's idea.

The players have changed, yet the playbook for health reform opponents looks remarkably the same. Often heard on television and talk radio these days are warnings of an impending invasion of the health care system. The buzzwords: Government intrusion. Government control. Government takeover.

Frequently mentioned concerns include government rationing of medical care and potential euthanasia of the elderly (a distortion of a provision in Democrats' plan, according to factcheck.org). Sarah Palin joined the fray, labeling Obama's plan "evil."

Obama addressed the takeover notion at a recent appearance in North Carolina: "Nobody is talking about some government takeover of health care. I'm tired of hearing that. I have been as clear as I can be.

"Under the reform I've proposed, if you like your doctor, you keep your doctor; if you like your health care plan, you keep your health care plan. These folks need to stop scaring everybody, you know?"

Yet opponents have turned up the heat. Last week, anti-reform demonstrators disrupted town hall meetings on health care.

"Anything to demonize health reform is something opponents have been doing for decades,'' says Ken Thorpe, an Emory University health policy expert. "Most people don't understand what's in the legislation. There's a lot of misinformation."

First, some basics about U.S. health care: Government already has a massive imprint in health care, with its programs such as Medicare and Medicaid accounting for almost half of U.S. health care spending.

And government-run Medicare is exceedingly popular among seniors. A recent survey by the Commonwealth Fund found that elderly Medicare beneficiaries reported greater overall satisfaction with their health coverage, better access to care, and fewer problems paying medical bills than people covered by employer-sponsored plans.

"Medicare has always polled as highly popular among seniors,'' Thorpe says.

Many people don't realize that Medicare gives physicians more autonomy than private insurance and has launched innovations such as Hospice, says Donald Taylor, a Duke University health policy professor.

Still, reform advocates face a $2 trillion-a-year challenge: changing a system that is one-sixth of the U.S. economy. Obama and the Democrats have taken on a gigantic task. People don't like change -- and this change affects them personally, Taylor notes.

America will hear much more about reform and government during the August congressional recess. Already, more than $52 million has been spent this year on health care reform-related ads, according to the Campaign Media Analysis Group.

The government takeover talk, Taylor adds, "has been shockingly effective."

Critics have focused on one House reform provision, a "public plan." That's a government-run Medicare-like option that would compete with private insurers in a national marketplace, or exchange.

This public option could ruin private insurance, opponents charge. They cite a Lewin Group study that said under one scenario, more than 100 million Americans could end up on a public plan.

The Congressional Budget Office put the number at 10 million to 11 million.

Still, Robert Moffit, director of the Heritage Foundation's Center for Health Policy Studies, says a government takeover is not an exaggeration. The House bill, he says, will allow the federal government to determine an acceptable benefits plan, set up an insurance exchange, and run a public health plan. "I don't think there's any intention to preserve private insurance," Moffit says. "It's a huge concentration of power into the hands of federal officials."

Reform advocates, though, may abandon the public option in favor of nonprofit health insurance co-ops, run locally or regionally, which would compete with private insurers. The White House last week signaled that Obama may accept the co-op idea if consumers are guaranteed more choice and competition in buying insurance.

One way to reverse the momentum, Emory's Thorpe says, is for reform supporters to address the public's question: What's in it for me?

Obama will emphasize the insurance prohibitions in the legislation, which bars discrimination against people with medical conditions, as part of the upcoming outreach for middle class support, says Ron Pollack, executive director of consumer group Families USA.

Thorpe says reform also must contain real measures to contain health care costs, which have been rising for businesses and employees at rates higher than inflation, causing many to drop or sharply limit insurance coverage.

The Senate Finance Committee apparently is pushing toward a strong, independent commission to oversee Medicare spending. Taylor says it should work like the military base-closing panel, which curbs the influence of politics and lobbying in decision making.

Worrying about health costs is the one area of agreement for everyone, even foes of the Democrats' plan, Taylor notes. That's one advantage that Obama has over the Clinton's administration's stab at reform in the 1990s, he says.

Back then, various stakeholders defended the status quo. "Not many folks are saying that now," Taylor says.

SOURCES:

Ken Thorpe, Robert W. Woodruff Professor, Rollins School of Public Health,
Emory University; Donald Taylor, assistant professor of public policy, Duke University; Robert Moffit, Director, Center for Health Policy Studies, the Heritage Foundation; Ron Pollack, executive director, Families USA ; The Associated Press.; Cleveland.com: "Obama declares that health care reform isn't a government takeover."; The Truman Library; Geselbracht, R. The Civil Rights Legacy of Harry S. Truman, Truman State University Press, July 1, 2007; Kaiser Family Foundation; The Commonwealth Fund; The Wall Street Journal: "Ten Questions on the Health-Care Overhaul."; The Lewin Group; The Washington Post: "Groups Take Health-Reform Debate to Airwaves."; Factcheck.org.

Health Reform Roadblocks

noreply@blogger.com (Sean_webmd) — Thu, 30 Jul 2009 20:25:00 +0000

By Andy Miller
WebMD Guest Blogger

Eighty percent done.

That's what White House spokesman Robert Gibbs said last weekend about progress on legislation to revamp the nation's health care system. "We've got about 80% agreement," Gibbs said on Fox News Sunday. "We're still working on that last 20%."

That last 20% will be a hard slog. It's where the horse trading will be done and details sweated out. Where a deal may crumble -- or be watered down enough to be meaningless. Meanwhile, the political conflicts will percolate when Congress enters its August recess.

The broad agreement on reform includes requiring individuals to purchase health insurance and providing subsidies for lower-income people so they can afford it. And there's agreement on barring insurers from rejecting people with pre-existing medical conditions and not allowing them to charge higher premiums due to a person's health status.

Changing those insurance practices alone is a very important step, says Stuart Altman, a health policy expert at Brandeis University.

Show Me the Money
The hard part -- the final 20% -- breaks down this way:

Extending insurance coverage for up to 45 million uninsured won't come cheap – or easy.

Lawmakers have proposed a mix of ideas on how to pay the $1 trillion reform cost, and each, in turn, has drawn opposition. The House legislation introduced a surtax on the wealthiest Americans. Another proposal aims to end or cap the tax exemption on workers' health benefits paid by employers. More recently, a tax on insurers for more expensive -- sometimes referred to as "Cadillac'' or "gold-plated" -- benefit plans has surfaced.

A levy on sugary beverages, meanwhile, has gone nowhere. "That affects everybody – it ticks off too many people,'' says Dean Smith, a health care expert at the University of Michigan.

Much of the money is needed to subsidize coverage for the uninsured. But the more people who get subsidies, the greater the price tag. Will subsidies be available to people up to 300% of the poverty level ($66,150 for a family of four), or 400% ($88,200 for a family of four)? The influential, fiscally conservative Blue Dog Democrats have worked to lower the subsidy ceiling.

And a requirement that large employers provide insurance or pay a penalty -- fiercely opposed by business groups -- may not make the final cut. The Senate Finance Committee is working on an alternative to that mandate.

"It's impossible to do health reform without taxing someone,'' says Bill Custer, a health insurance expert at Georgia State University. A sunset provision on a new tax, he adds, could provide some political cover.

Overall, the money problem is the biggest potential deal-breaker for reform, Michigan's Smith says.

Get a Grip on Health Costs
U.S. health care spending rose 6.1% in 2007, a rate much higher than general inflation. And that increase was actually less than previous years.

There's consensus on trying to "bend the cost curve,'' but not how to accomplish it, says Stan Dorn, a senior research associate with the Urban Institute.

President Obama has pushed for an independent Medicare commission that would set payment policies for the huge government program. The panel could make politically unpopular decisions to control spending. "Medicare is going to go broke,'' says Altman. "What's bugging Obama is this Medicare problem.''

One line of attack is to transform the way that doctors are paid. Physicians typically get fees for each service they give to patients. That can lead to unnecessary tests and procedures – and higher costs. Reformers have pushed "bundled payments'' to doctors and hospitals, where, in Obama's words, ''you aren't paid for every single treatment ... but instead are paid for how you treat the overall disease."

Already, Dorn says, "there are islands of success, like the Mayo Clinic,'' where doctors are paid by salary. Reform legislation could test these ideas in pilot projects, then extend them more broadly, he says.

There's also a push to compare the effectiveness of medical treatments, medications, and devices to save money and improve quality of care.

None of these ideas, though, will deliver substantial savings in the short term.

How Does Government Fit In?
Much of the partisan wrangling centers on having a Medicare-like public insurance option to compete with health insurance companies. Obama himself has pushed a public plan to ''keep insurance companies honest.''

Republicans see it as a red-meat issue. They have argued a public option would run private insurance companies out of business and lead to a government-run health system. "The health insurance industry is one of the most regulated industries in America," said Sen. Jon Kyl (R-Ariz.) this week. "They don't need to be 'kept honest' by the government."

Some liberal Democrats say they would rebel at legislation that didn't include a public option. "Our votes won't be there if there isn't a public option," said Rep. Jerrold Nadler (D-N.Y.)

Altman of Brandeis says the public plan issue "has been a lightning rod,'' but also a distraction.

Meanwhile, a bipartisan group on the Senate Finance Committee is leaning toward a compromise: creating nonprofit health cooperatives that could compete locally with insurers for business.

Politics and Compromise
Obama and Democrats want a bipartisan bill, but Mitch McConnell (R-Ky.), the Senate minority leader, so far is skeptical. "The only thing bipartisan about the measure so far is the opposition to it," said McConnell.

The Senate Finance Committee is likely to produce a bill with the best hope for some GOP support.

A final bill -- if it gets that far -- may be a compendium of compromises to achieve support from some Republicans and the Blue Dog Democrats, though the result may fall quite short of universal health insurance coverage, Michigan's Smith says.

Still, there is widespread recognition that the health care system needs change, says Marilyn Moon, director of the health program at the American Institutes for Research. "There is an understanding that this problem will not fix itself.''

Sources: Fox News, "Transcript: Robert Gibbs on 'FNS'"; The New York Times, "Reach of Subsidies Is Critical Issue for Health Plan", "Hospital Savings: Salaries for Doctors, Not Fees"; The Associated Press, "Deal With 'Blue Dogs' Sets Up Health Care Vote", "Democrat Says Health Overhaul Needs GOP to Pass"; The Wall Street Journal, "Liberals Fear Losing Public-Plan Option"; Kaiser Health News, "Big Employers Could End Up Paying 'Cadillac' Tax", "Senate Committee's Reform Bill Could Cover 95% of Uninsured"; Health Affairs, "National Health Spending in 2007: Slower Drug Spending Contributes to Lowest Rate of Overall Growth Since 1998"; Stuart Altman, Sol C. Chaikin professor of national health policy, Brandeis University; Marilyn Moon, vice president and director of the health program at the American Institutes for Research; Dean Smith, professor and senior associate dean for administration of the University of Michigan School of Public Health; Stan Dorn, senior research associate, the Urban Institute; Bill Custer, associate professor, Institute of Health Administration, Georgia State University.

Health Care Reform: Now or Never?

noreply@blogger.com (Sean_webmd) — Thu, 23 Jul 2009 21:44:00 +0000

By Andy Miller
WebMD Guest Blogger

Midnight, New Year's Eve, 2009.

Conventional wisdom says that if major health care reform hasn't passed Congress by then, it may not be revived for years, if at all.

Why is it now or (maybe) never?

This year offers an unusual alignment of stars that makes health reform's chances better than at any time since 1993, when Bill and Hillary Clinton launched an overhaul plan that later fizzled in Congress.

The confluence of favorable 2009 factors starts with political realities.

President Obama, a popular leader in his first year in office, has robust Democratic majorities in both houses of Congress. He clearly upped the stakes in recent days, and again in a televised news conference Wednesday night, on the importance of getting health reform done now.

But if major legislation isn't approved this year, Congress enters an election year in 2010, when it typically avoids the big-idea bills. The next year begins a presidential election cycle, notes Julius Hobson, senior adviser on health care for Bryan Cave, a law firm. "It's now or never -- that's why the president is pressing Congress,'' Hobson says.

Secondly, unlike during the Clintons' flameout, major medical stakeholders have stepped up to support reform efforts.

That includes the health insurance industry. Insurers have agreed to not reject applicants due to pre-existing medical conditions, as long as everyone is required to have coverage. The industry behind the potent anti-reform "Harry and Louise'' ads in the '90s is now on board, albeit with an asterisk: Health insurers fiercely oppose a public insurance option run by the government.

The American Medical Association has thrown its support to the House Democrats' plan, though not all physicians would agree. Hospitals have agreed to some concessions to help pay for health reform, as has the pharmaceutical industry.

And retail giant Wal-Mart, whose health benefits plans have drawn strong criticism in the past, has endorsed a requirement that employers provide insurance to workers.

"There is tremendous momentum,'' says Ken Thorpe, an Emory University health policy expert. "The stage is set.''

While this coalition has given reform a big boost, the interest groups also have objected to certain proposals. "Everybody wants reform,'' Hobson says. "Everybody has something they like, but everybody has something they dislike, too.''

Reform opponents, meanwhile, appear to be gathering strength. Bradley Blakeman, a Republican strategist, said in response to Obama's news conference, "The president is selling a product that no one wants. He is desperate and refuses to pull the plug on health care legislation that even Democrats concede is DOA.''

Conservative "Blue Dog" Democrats are balking at proposed new taxes and inadequate health cost containment in various reform plans.

And polls show that public confidence on health reform is slipping. CNN released a poll of polls Wednesday that found less than half the country approves of how Obama is handling the issue.

Obama targeted those public perceptions Wednesday night -- and the issue of how it affects the average taxpayer: the ''What's in this for me?'' question.

"This is not just about the 47 million Americans who don't have any health insurance at all,'' he said. "Reform is about every American who has ever feared that they may lose their coverage if they become too sick, or lose their job, or change their job. It's about every small business that has been forced to lay off employees or cut back on their coverage because it became too expensive … If we do not control these costs, we will not be able to control our deficit. If we do not reform health care, your premiums and out-of-pocket costs will continue to skyrocket. If we don't act, 14,000 Americans will continue to lose their health insurance every single day.''

He returned later to that pocketbook problem. "Premiums for families that have health insurance have doubled over the last 10 years,'' he said. "They've gone up three times faster than wages … Employers are going to put more and more costs on employees or they're just going to stop providing health care altogether."

Other health care statistics are worsening, too. A Gallup poll released Wednesday found 16% of American adults -- one in six -- are uninsured. That's up from an average of 14.8% among those interviewed in 2008.

The U.S. spends much more on health care than other countries, yet the medical results are worse than many nations, Obama also noted.

His push on health reform undoubtedly will continue through the summer and into the fall, to get a bill this year. "Everyone recognizes that inaction will make all the problems infinitely worse,'' Hobson says.

Still, E. Richard Brown, director of the UCLA Center for Health Policy Research and an expert on health reform, says 2009 is not the last chance for reform.

It could come together again in 2011, if defeated this year, Brown says. "If we don't get it done now, the same pressures will be there in two years.''

Yet Brown also sees 2009 as a prime opportunity. "It's an opportunity we cannot afford to pass up. I do think this moment is a rare moment, an alignment of different interest groups. ''

SOURCES: Julius Hobson, senior policy adviser, Bryan Cave LLP; Ken Thorpe, professor, Rollins School of Public Health, Emory University; E. Richard Brown, director, UCLA Center for Health Policy Research; New York Times web site; CNN web site; Politico, The Arena; American Medical Association; California Healthline web site; Gallup Poll.

Growing Girth: Obesity in America

noreply@blogger.com (Miranda) — Wed, 08 Jul 2009 19:33:00 +0000

There's no sign of a slowdown in obesity, with about 26% of U.S. adults being obese in 2008, according to the CDC's latest obesity statistics, which were released today.

But if you take a close look at that figure, you might see a little wiggle room.

The CDC calculated adult obesity rates based on phone interviews with more than 400,000 U.S. adults who gave their height and weight as part of a national health survey in 2008.

Be honest -- if you were called for that survey, how accurate would you be in reporting your stats? Would you fudge it a smidge -- and when was the last time you got on a scale to check?

Even if you know your numbers to the ounce and inch, there's a chance that BMI (body mass index), which relates height to weight, doesn't do you justice.

For instance, BMI doesn't show how much of your weight is muscle, how much is fat, and where that fat is distributed. Having a large waist (over 40 inches for men; over 35 inches for women) may put you at higher risk of type 2 diabetes, high blood pressure, high cholesterol, and heart disease. That's why some health experts like checking waist measurement or waist-to-hip ratio, instead of relying on BMI.

Plus, there is debate about whether weight is really what matters, or whether fitness -- regardless of size -- is more important.

In August 2008, researchers reported that nearly a third of obese people aren't at high risk of diabetes or heart disease. That same study showed that being skinny doesn't mean you're a low risk of those conditions. And in 2007, Italian researchers coined the term "normal-weight obese" to describe people who weren't overweight but had a high percentage of body fat.

But in April 2008, other researchers reported that being physically active doesn't totally make up for being overweight.

Stigma about obesity is also important. Too often, weight gets cast in "good" or "bad" terms, though it's a lot more complex than just personal choices, as experts from Mississippi -- the nation's fattest state -- recently told WebMD.

The CDC's new report isn't about all that. It's a statistical snapshot, the latest in a long line of similar reports.

What do you think it will take for the U.S. to start to curb obesity? How does the term "obesity" make you feel -- especially if you're one of the millions of Americans in that category -- and are your biggest weight challenges about your personal choices, your environment (like whether you can afford healthy food), or how people treat you?

Diprivan in Michael Jackson's Medicine Cabinet?

noreply@blogger.com (Michael Smith, MD) — Mon, 06 Jul 2009 16:56:00 +0000

While it may be of no surprise to find out that another fallen star has a wide array of drugs in his medicine cabinet, I was still quite shocked about the reports of Diprivan found in Michael Jackson's home.

If true, I can't think of one reason to have Diprivan -- also called propofol -- in your home.

Diprivan is an injectable drug used to either put someone to sleep before surgery or sedate and keep someone calm on a breathing machine in the hospital.

It's an extremely strong sedative and one that causes unconsciousness and often stops breathing -- that's why it's only given to people on a ventilator breathing machine.

Reports have suggested that Jackson suffered from insomnia but Diprivan is not used (or at least certainly shouldn't be used) to treat insomnia -- or any other medical condition.

Diprivan acts very quickly in the body and also leaves the body very quickly. Someone would lose consciousness within seconds and wake up within 10 to 15 minutes after receiving a shot of Diprivan. In the hospital, a continuous infusion is usually given in the vein and it may take the person an hour or so to awaken.

There have been reports of other drugs in the Jackson home as well, including Demerol and Oxycontin. Both of these are narcotic painkillers and are used to treat severe forms of pain.

Oxycontin has received quite a bit of attention in recent years due to the high rate of reported abuse. More than 12% of 18- to 25- year olds reported using the drug for nonmedical reasons in 2006, according to federal figures.

The particularly troubling thing about all of these drugs in the Michael Jackson case is that they all can slow -- and even stop -- breathing if too much is taken.

It's not known at this point if Diprivan -- or any other drug -- contributed to Jackson's death. However, reports were that he was found not breathing but had a slight pulse. All these drugs could have slowed and potentially stopped breathing, which would have eventually -- within a few minutes -- stopped the heart.

And then if you combine 2 or more of these drugs, the risk of an overdose and death goes exponentially higher. The much awaited toxicology results should be ready in a few weeks and hopefully that will solve the mystery of Jackson's death.

Acetaminophen and Liver Injury

noreply@blogger.com (Miranda) — Tue, 30 Jun 2009 15:06:00 +0000

Three FDA advisory committees are meeting today to discuss possible ways to try to cut the risk of liver injury from acetaminophen in over-the-counter and prescription products.

You might not know "acetaminophen," because that's the drug's generic name. It's found in many over-the-counter products -- including Tylenol, aspirin-free Anacin, Excedrin, and numerous cold medicines. It's also found in many prescription drugs.

The FDA says acetaminophen is generally considered safe when taken according to the directions on product labels. But taking too much acetaminophen -- even a little too much taken by accident -- can lead to liver injury.

Products containing acetaminophen already note that risk. But today's FDA meeting is happening because some people still take too much acetaminophen.

Today, the three FDA advisory committees will vote on various options, ranging from additional warnings to limiting doses to banning over-the-counter acetaminophen products. The FDA isn't required to follow the advice of its advisory committees.

Makers of acetaminophen products and the Consumer Healthcare Products Association (CHPA), a trade group for the over-the-counter drug industry, have stressed the safety of acetaminophen when used properly and argued for keeping the products on the market, according to media reports.

As the FDA advisory committees weigh their options, here are steps the FDA wants people to take when using acetaminophen to reduce the chance of liver injury:

• Follow dosing directions and never take more than the recommended dose of acetaminophen.
• Do not mix acetaminophen-containing products. For instance, acetaminophen could be in a headache medicine and in a cold medicine; if you take both, you may wind up getting too much acetaminophen.
• Talk to your doctor about acetaminophen if you drink alcohol or have liver disease.
• Be aware that acetaminophen comes in many forms, including drops, syrups, capsules, and pills.
• Check drug labels to see if it contains acetaminophen. If you're taking a nonprescription (over-the-counter) product, check the "Active Ingredients" section of the "Drug Facts" label.
• Know that acetaminophen may be abbreviated as "APAP" on prescription drug labels.
• Don't take acetaminophen for more days than directed.

The FDA notes that acetaminophen can be given to infants, children, and teens, but the FDA reminds parents and caregivers to take these steps, posted on the FDA's web site, for safety's sake:

• Check the active ingredients list on drug labels. Your child should never take more than one medicine containing acetaminophen, whether it's an over-the-counter drug or a prescription drug.
• Read and follow all the directions given by your child's doctor and on product labels.
• Choose the right medicine based on the child's weight and age. Check the "Directions" section of the "Drug Facts" label on over-the-counter products to see if the medicine is right for your child, how much medicine to give, how many hours to wait before giving another dose, and when to stop giving acetaminophen and ask a doctor for help.
• Use measuring tools that come with the medicine. Don't use a spoon that's meant to be used for cooking or eating. If you don't have the measuring tool that came with the medicine, ask your pharmacist for one.
• Keep a record of what doses you gave the child and when.
• Keep all medicines where they can't be seen or reached by children -- a locked box, cabinet, or closet is best.

If you or someone else takes too much acetaminophen, the FDA recommends calling 911 or Poison Control (800-222-1222) right away to find out what to do. Liver injury symptoms may not appear for hours or even days -- and by then, the damage may be severe and could lead to death.

Of course, any medication should be taken as directed. That includes other types of pain relievers besides acetaminophen. For more FDA tips on pain medicines, read A Guide to Safe Use of Pain Medicine.

And tell us, how careful are you when you take acetaminophen? How strictly do you follow the directions on the label -- even when you're, say, hung over or feeling sick?