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Welcome to the WebMD Health Exchange!

noreply@blogger.com (WebMD Blogs) — Mon, 01 Mar 2010 16:41:00 +0000

Our blogs have a new look – and an exciting new option for you! After reading a post, you’ll now be able to talk about it with others in our WebMD Health Exchange. Exchange provides a dynamic community experience that allows you to connect with others who have similar interests and concerns. So read what our expert bloggers have to say, then head over to the related Exchange community to comment and ask questions.

FDA to Restudy Avandia Safety

webmddan@gmail.com (Dan DeNoon) — Mon, 22 Feb 2010 22:12:00 +0000

Possibly in response to the recent Senate committee report questioning the safety of diabetes drug Avandia (see previous post) the FDA just announced a new action.

Now the federal agency says it will re-analyze the raw data from the RECORD trial. That's the trial that Avandia maker GlaxoSmithKline says proved Avandia carries no extra heart-attack risk.

(It's confusing, as Avandia does double the risk of heart failure. Actos, a similar drug, ups heart failure, too. But Actos doesn't increase heart-attack risk. Whether Avandia does up hear-attack risk is the point of contention).

The FDA also says it will include new observational data -- that is, reports on patients taking Avandia outside of a placebo-controlled study -- in its new analysis.

Meanwhile, the Endocrine Society now says it wants FDA to reconvene its Avandia advisory panel. In 2007 -- before the full RECORD results were available -- the panel voted overwhelmingly that while Avandia carried heart risk, it should not be taken off the market.

Avandia Safety

webmddan@gmail.com (Dan DeNoon) — Mon, 22 Feb 2010 18:24:00 +0000

Safety questions about the diabetes drug Avandia once again are in the news, thanks to "new" revelations from a Senate committee reported in the New York Times.

What's new? Nothing, really. The Senate committee's report rehashes FDA safety researchers' concerns over Avandia and asks whether clinical trials of the drug should continue given these concerns.

There's really been little or no new information since last June, when debate over the results of a study called RECORD showed that safety questions remain.

My colleagues and I have followed the question of Avandia safety for years. Lost in all the allegations that have gone back and forth between critics of Avandia (and it's maker, GlaxoSmithKline) and critics of these critics is the main question: Is Avandia safe or not?

Okay, nothing is completely without risk. Avandia has a number of known risks. The biggest one: It doubles the risk of heart failure. An alternative drug, Actos, also ups risk of heart failure.

The source of all the fuss is the question of whether Avandia ups risk of heart attack. Actos does not. Does Avandia? The RECORD trial was supposed to answer this question. GSK and the study authors say the study yields a clear answer: People who took Avandia were not more likely to die of heart attacks than were people who took older diabetes drugs.

But critics point out that many of the Avandia patients stopped taking the drug well before the study ended. The study authors told me this did not have a significant effect on the outcome; the critics told me it did. And the critics say the question of nonfatal heart attacks remains open.

At least two FDA researchers feel Avandia is too risky. Other FDA advisors feel differently. So here's the bottom line as I see it:

Don't take Avandia if you have heart failure.
Don't take Avandia if you have suffered heart damage from a heart attack.
Consider using older diabetes drugs before trying Avandia.
If older diabetes drugs don't work, talk with your doctor about starting insulin therapy.
If older diabetes drugs aren't working for you, and you want to try a non-insulin drug, talk with your doctor about other alternatives. Consider the pros and cons of Actos as well as of Avandia.
If monitored by their doctors, some patients will get safe, excellent results from Avandia.

An example here is Vioxx, which definitely increased the risk of heart death and finally was pulled from the market due to safety concerns. Were there patients out there who could have benefited from this drug? Yes. But the drug was sold to far more patients than the relative few who could use it safely.

So is Avandia safe? Not for everybody. Can Avandia's benefits outweigh its risks? Yes, but not for all patients. Should clinical trials continue? Certainly -- if study participants are given the full, straightforward story about Avandia safety concerns. That may be more easily said than done.

If the trial, called TIDE, continues, it could be interesting. For the first time, Avandia is being compared with ACTOS in a head-to-head battle.

President Bill Clinton, Stents, and Coronary Artery Disease

webmddan@gmail.com (Dan DeNoon) — Fri, 12 Feb 2010 16:03:00 +0000

Curuios about the procedure that President Bill Clinton underwent on Thursday?

President Clinton's heart pain came from a clogged artery. The procedure to unclog the artery is called angioplasty, during which wire-mesh tubes called stents are installed to keep the artery open. Read about it here.

WebMD has a cool animation that makes the process clear. Go to this page, and under the headline "Illustrated Guide to Coronary Artery Disease," click the tab called "Treatment." That will bring up animations that illustrate angioplasty and stent installation.

The good news is that this procedure is a common one, with very high chances of an excellent outcome.

Haiti Heroes

webmddan@gmail.com (Dan DeNoon) — Mon, 25 Jan 2010 22:10:00 +0000

My heart is still with my friend in Haiti.

After more than a week of saving lives in Port-au-Prince, Haiti, our colleagues Dr. Flavia Mercado and Peter Anderson are on the way back to the U.S. I am very, very glad they are coming home now.

They failed to convince Dr. Michael Grady to return with them. I am very, very worried. But I think I understand.

We spoke yesterday by satellite phone. I asked him why he isn't coming home as scheduled, despite a physically and emotionally exhausting week treating hideous wounds in Port-au-Prince in an open-air, makeshift field hospital.

"You all have done so much," I said. "You're heroes."

"We're not heroic," Michael said. "Every day, I see Haitian people performing extraordinary acts of valor and endurance. They are the heroes."

That's so true. I guess that is why, when I see TV journalists saving lives, I feel two ways: Glad that they could help, and angry that they are making themselves the story.

Here's why Michael is finding it hard to leave. There is a line of people waiting patiently to see him. One will have an infected amputation. The next will be a little girl having trouble breathing. The next will have a dangling, broken limb.

There are fewer primary wounds now, but lots more infections and disease. Lots of people, especially kids, are having breathing problems, possibly due to all the dust they've inhaled. Today someone showed me a news story about doctors with nothing to do in Haiti, they clearly haven't found their way to the field at Matthew 25 guest house in Delmar 33, where Michael and a few other medical people are working.

A second team of volunteers from ServeHaiti, the charity he and I support, left today. Part of their mission is to bring Michael home. I hope they succeed. There will be a lot more to do as the remarkable people of Haiti heal.

Heart and Mind in Haiti

webmddan@gmail.com (Dan DeNoon) — Sun, 17 Jan 2010 20:50:00 +0000

My heart and my mind have been in Haiti, but my body is not yet there.

That's been a problem for so many of the people who want to be there - to search for, comfort, or bury loved ones; to offer a hand to those in need; and to bring in much needed supplies and expertise.

With mind and heart one place and body in another, I'd been fading in and out, neither here nor there. That wasn't doing anybody much good, so with the help of my wife and friends, I'm now back together again, and helping my colleagues pull it all together to face the challenges ahead.

Three of my colleagues - Dr. Michael Grady; Flavia, a pediatrician; and Peter, an experienced Haiti hand - tomorrow are flying to the Dominican Republic. Their mission is to reach Gran Bois, establish a supply line, and extend our perimeter toward the disaster area. Behind them, a small army of volunteers stands ready to carry in supplies.

I'm not on that trip, but plan to follow as close behind as I can. I'll keep you posted on their progress.

Meanwhile, here are excerpts from a note we at ServeHaiti received from Amber Lynn Munger, a volunteer with connections to AMURT, KONPAY, and other service groups. Munger is at Matthew 25, a guest house in the Delmar region of Port au Prince that normally houses service groups traveling in Haiti and which now headquarters for volunteers treating some 1500 injured people on the soccer field behind the guest house.

Munger writes:

"Here at Matthew 25, we have been doing amputations, and other painful surgeries, with no painkillers, no anesthesia, nothing to work with. There are no tools for our doctors. We have numerous Haitian doctors and nurses here but no supplies! We have run out of antibiotics twice but then found them by searching at nearby clinics run by missions and NGOs.

Haitians are helping each other in glorious acts of compassion and kindness every where you look. These people have endured so much unspeakable and unnecessary suffering. I am today, as always, blessed to be walking with them in their struggle to overcome their awful and unfair circumstances, and am even more blessed to be sharing in the strength of spirit that makes each one of them my hero."

While scenes of violence and selfishness make good television, those on the ground in Haiti report vastly more scenes of peaceful cooperation, sacrifice, and heroism as communities come together. This fits with my experience of Haiti, a land that is blessed with one huge resource: tremendous resilience.

Daniel DeNoon
Senior Medical Writer, WebMD

Haiti After the Earthquakes

noreply@blogger.com (Sean_webmd) — Thu, 14 Jan 2010 22:07:00 +0000

By Daniel J. DeNoon
WebMD Senior Medical Writer

My travel kit is packed with a big bottle of cipro, and I'll be starting anti-malaria prophylaxis soon. I'm scheduled to fly to Port au Prince on Feb. 3 with Dr. Michael Grady. We may go sooner, if we can be part of the relief effort.

Like everyone who knows anyone in Haiti, I keep checking my email inbox. Too many friends and loved ones are missing.

Unlike many, the news for me has been mostly good. As good as news can be when yet another horrible disaster has struck an undeserving people.

Nearly a year ago, I made my first eye-opening trip to Haiti after being invited to serve on the board of the service organization ServeHaiti.

The clinic we built in the mountainous region called Gran Bois is not far from Port au Prince -- but only as the crow flies. Human travel, up a tortuous "road," takes at least four hours, often much more.

The earthquakes are still shaking the ground, but so far the clinic stands unharmed. Our staff that was in Gran Bois, including Dr. Leo, are unharmed. But many of our Haitian friends and colleagues were in the city.

A few minutes ago I got one of those emails I've been looking for. The title: Boule is safe. I cried.

Earlier today, one of our volunteers sent a very different message. The title: Pray for me. Two of her loved ones are dead. I wept.

Watch this space for more news and stories. Please tell us about your Haiti connections, and what you know and don't yet know.

Keep on hoping. Keep on praying.

Alzheimer's Disease: A Special Segment

noreply@blogger.com (Sean_webmd) — Tue, 12 Jan 2010 17:41:00 +0000

There is obviously a very large concern out there about Alzheimer's, especially since we are all living longer, and also may have to care for our parents as they get older. There's good reason for this: Currently, Alzheimer's affects over 5 million Americans, and that number is expected to grow to as many as 16 million by 2050.

We think information is one of the most important health tools you can have, and with that in mind I wanted to bring to your attention what I think will be a very important piece tonight on CBS Evening News, WebMD's partner-in-health.

Their senior medical correspondent, Dr. Jon LaPook, has for the last several months been preparing the most extensive segment he's ever been involved with since becoming a medical correspondent for the CBS Evening News with Katie Couric in 2006.

The network will devote six minutes (yes, that's six minutes, incredible for an evening news broadcast) of the 22-minute broadcast to present Dr. LaPook's look at the latest research in Alzheimer's in a segment called "CBS Reports: Where America Stands."

It will air on CBS this evening, January 12th, between 6:30 and 7 pm EST.

If you have concerns about Alzheimer's, or someone in your life is affected by it, I would urge you to tune in. I've worked with Dr. LaPook for the last few years, vouch for his dedication and skill, and I'm sure it will have terrific reporting and be full of important information.

As a warm-up, here are two links from Dr. LaPook premiering the event:

Senior Moment or Alzheimer's? The story

or

Senior Moment or Alzheimer's? The video.

I hope you get a chance to tune in for more this evening.

Sean Swint
Executive Editor, WebMD

To join the conversation, enter WebMD's Alzheimer's disease community board.

Massive Crib Recall

noreply@blogger.com (Sean_webmd) — Mon, 23 Nov 2009 16:06:00 +0000

The Consumer Product Safety Commission has announced a recall of nearly 2.2 million Stork Craft drop-side cribs, including about 147,000 Stork Craft drop-side cribs with the Fisher-Price logo. These cribs were sold in the USA and Canada.

WebMD has the full details here including where the cribs were sold, model numbers, and what to do if you have this crib.
http://www.webmd.com/parenting/news/20091124/2point2-million-cribs-recalled

The recall involves cribs with dropdown sides because children may suffocate by getting their heads stuck between the side rail and the headboard. There have been deaths and several injuries associated with these cribs that we detail in our story.

Photo: CSPC

For additional information, contact Stork Craft toll-free at (877) 274-0277 anytime or visit storkcraft.com to order the free repair kit. CPSC urges parents and caregivers to immediately stop using the recalled cribs, wait for the free repair kit, and do not attempt to fix the cribs without the kit. They should find an alternative, safe sleeping environment for their baby. Consumers should contact Stork Craft to receive a free repair kit that converts the drop-side on these cribs to a fixed side.

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.