Later On

A blog written for those whose interests more or less match mine.

Archive for the ‘Healthcare’ Category

Anti-vax and anti-abortion movements are filled with misinformation

leave a comment »

Terry Gallagher, an assistant professor and family nurse practitioner at Rush University College of Nursing, a 2018-2019 fellow of the Duke-Johnson & Johnson Nurse Leadership Program, and a Rush Public Voices Fellow through The OpEd Project, writes in the Hill:

The World Health Organization recently issued an alarm about the resurgence of measles globally as a result of immunization refusals. Teens in the U.S. are seeking ways to get vaccinations on their own, in spite of their parents’ anti-vaxxing positions.

As a nurse practicing for the past 10 years, I’ve see the recent rise of the anti-vax movement as well as the anti-abortion movement as symptoms of a lack of understanding of safe, evidence-based medical practices.

Falsehoods based on flawed logic at times appear louder than the facts from medical providers. This is especially true when the president of the United States falsely accuses medical providers of executions, preferring to garner support with revulsion rather than facts.

Witnessing these emotional issues debated in the public forum is disheartening. My job is to prevent illness in my patients and to treat their diseases as they occur. I advise patients to receive vaccinations. I refer patients to another provider for an abortion if they request it and my decisions are based on medical facts, evidence and protocol.

Parents in my clinic refuse vaccines out of fear for the health of their child, but their fear is misplaced. They should fear the life-threatening illnesses which have largely been eradicated from the modern world, not the side effects of vaccines that are either rare or misstated.

The same is true for legal abortion. The fear that millions of women would choose abortion on a whim or because they “changed their mind” is unfounded. What people should fear is women not having access to this procedure which continues to save lives.

Some misconstrue the data regarding vaccines. I witnessed this firsthand as a piece I wrote on the HPV vaccine and its ability to eradicate cervical cancer around the world, was met with a swarm of anti-vaxxer, baseless denials on social media that are easily disproved with facts.

In the anti-abortion movement, a similar aversion to facts seems to dominate. The term pro-life assumes binary opinions and presumes anyone who does not prescribe is “anti-life.” In my experience, all health-care providers are pro-life as the mission is for people to live.

Prior to the recent abortion laws approved in New York state and the hotly contested proposed bill on third trimester abortions in Virginia, many in the anti-abortion movement incorrectly thought “on-demand” abortions were already available to women. The truth is most state laws restrict abortions after 20 weeks of gestation.

“On-demand” is a term coined by conservatives to further stoke an emotional response. The uniformed, incorrect belief was that any woman at any stage of her pregnancy, could walk into any Planned Parenthood in the United States and get an abortion.

As some misinterpret the Reproductive Health Act in New York, the term “on-demand abortion” resurfaces to cloud the facts.

Recently Sen. Marco Rubio (R-Fla.) and former Alaska governor Sarah Palin referred to abortion as “infanticide,” but infanticide is not a medical practice. The confusion apparently intended to further stoke an emotional response, however inaccurate.

Rubio and Palin were referring to comfort care, a common practice in health care where, should life-saving procedures prove fruitless, the decision is made to focus on reducing pain and suffering of the newborn. It is a peaceful time that allows the parents time to say goodbye to their newborn; it is nothing like the images the word “infanticide” conjures.

Certainly, proponents of the anti-vax movement are in the minority, and the anti-abortion movement does not represent the beliefs system and actions of all Americans. According to the Pew Research Forum, 58 percent of Americans believe abortion should be legal, while 37 percent believe it should be illegal.

Health-care professionals can also be misinformed. The most notable is Andrew Wakefield, the discredited physician who started the vaccines cause autism myth, with the recent 9th anniversary of that fraudulent study’s retraction.

Every day I need to reeducate my patients about misconceptions they saw on Facebook or read on a blog about medications I prescribe, ranging from contraceptives to anti-hypertensives (medicines to help manage blood pressure) to misinformation about risky pregnancies.

I’m pro-living, pro-humanity. The vaccines I give are life-saving, the abortions I refer patients to are life-saving.

Continue reading.

Written by LeisureGuy

18 February 2019 at 4:57 pm

When Teens Threaten Violence, A Community Responds With Compassion

leave a comment »

Rhitu Chatterjee reports at NPR:

Psychologist John Van Dreal has spent almost 30 years working with troubled kids. Still, it’s always unsettling to get the kind of phone call he received one morning eight years ago as he was on his way to a meeting.

“I got a call from the assistant principal at North [Salem] High, reporting that a student had made some threats on the Internet,” remembers Van Dreal, the director of safety and risk management for Salem-Keizer Public Schools in Salem, Ore.

Threats of violence in a Facebook post

“There were a number of statements about hitting people with pipes, breaking knees, bashing heads with pipes and looking for help in doing so,” Van Dreal says.

And there was more.

“F*** North Salem High School,” the student had written. “Seriously, it’s asking for a f***ing shooting or something.”

Van Dreal says students who saw the post were frightened. They told their parents, who called the school administration. Faculty and staff were worried, too, he notes. This particular student had been in trouble before, but this time it felt different.

“They were definitely concerned and afraid,” Van Dreal says.

The signs were serious enough, Van Dreal knew, that he needed to convene his entire threat assessment team — including representatives of the school administration, mental health professionals and police.

He turned his car around and immediately headed to the high school.

After the shooting at Marjory Stoneman Douglas High School in Parkland, Fla., last year, many schools received federal funding through the Stop School Violence Act to establish a threat assessment program to help prevent school shootings and other kinds of violence.

Van Dreal’s school district has been using its own version of the approach since 2000 with good success in identifying kids in crisis and getting them off the path to violence.

How to assess the risk

Threat assessment is essentially how the Secret Service responds to threats made to government officials and property, and it is increasingly being used by schools around the U.S.

In the first hours, the multidisciplinary team gathers information from interviews with the student, the student’s friends, parents and teachers to evaluate the risk: Does the student have a plan to attack? Does the student have weapons? Is there a specific target?

If an action or statement of intended harm is deemed serious, a school must act quickly to prevent violence and keep everyone safe. If the student making the threat has firearms, then the team works with law enforcement officials and the student’s parents to try to limit gun access.

Once the concern about immediate danger has eased, the team digs deeper into the student’s background and psychological history: What is driving the student? What is the anger about? What is the situation at home and at school? Are there any underlying mental health issues?

Studies have shown that students contemplating violence are often in some kind of crisis, and the best way to move them off that path is to provide support and supervision to solve the problem.

Just blowing off steam?

When he was called in to investigate the case in 2011, Van Dreal and his team got to work immediately.

The student was a 17-year-old named Mishka, who “was known to be pretty aggressive and combative,” says Van Dreal. (NPR is not using Mishka’s full name to protect his privacy.)

Clem Spenner was the police officer on Van Dreal’s team that day. “My biggest concern at that point [was] safety,” says Spenner. “Is there any indication that this person is going to act before we can do some intervention?”

The Facebook post did contain some key elements the team looks for when assessing a threat’s likelihood of being carried out. “We look into weapons acquisition, scheduling, soliciting help, plans [and] ongoing vendettas,” explains Van Dreal. “Some of that fit for Mishka.”

Meanwhile, Mishka had been pulled from class, handcuffed, searched and interrogated by the police. “The police asked me, ‘OK, what’s going on?’ ” the now-25-year-old Mishka recalls. “Was I actually intending to do something? And I’m like, ‘Nope, just blowing off steam.’ ”

Mishka says he had been furious that day because two of his friends had been beaten up by jocks not long before, in the boys locker room.

“And my buddies got suspended for that,” he says.

He thought this was unjust because his buddies didn’t start the fight, he says. And that’s what he told the police officers. “I was just mad, and that’s where the Facebook post came from.”

The threat assessment team concluded there was no risk of a school shooting in this case. The 17-year-old had no specific plan for an attack, had never used a gun and didn’t have access to one. The police confirmed that with his parents.

But they also realized this was more than just a kid ticked off about one fight. Mishka was still enraged and had a history of battling others. “He had made threats of bringing a pipe to school and hurting people with that,” says Spenner. “That’s a far easier thing to accomplish. I mean you can find a piece of pipe anywhere.”

The school was worried about Mishka’s rage, he says. “And he really was an angry young man.”

Digging deeper

For the team evaluating Mishka’s threat potential, it didn’t matter whether the injustices he described were real or not, explains Van Dreal. To calm him down, Van Dreal knew he had to get to the root cause of Mishka’s anger and understand how the teenager saw the situation. “He’s the one justifying the violence and I have to get behind that and see why,” says Van Dreal.

As the team interviewed Mishka, his friends, family and teachers over the next couple of days, a fuller picture emerged.

Clues in past traumas

Mishka’s struggles had begun years earlier, the team learned. A boy had come up to him in middle school and tried to pick a fight, Mishka says.

“As I was turning around and saying, ‘Dude, I don’t want to fight,’ he takes a swing and hits me directly in my eye,” Mishka says. “Everything went black for a moment. And I got mad. That was the first time I actually punched a person.”

The physical damage done to his eye that day is undisputed. Mishka’s vision began failing, and it affected his schoolwork.

“It literally felt like I was swimming in dirty water, a dirty pool,” he says. . .

Continue reading. There’s much more and it’s interesting.

Written by LeisureGuy

17 February 2019 at 8:57 am

Utah gov defies voters, signs limited Medicaid expansion

leave a comment »

Nathaniel Weixel reports in the Hill:

Utah’s governor on Monday signed legislation into law a limited Medicaid expansion plan, defying voters who approved a full expansion in November.

The bill signed by Gov. Gary Herbert (R) would cover far fewer people, and cost taxpayers more money, than the plan voters approved in November.

The new law calls for the state to ask the Trump administration for permission to launch a partial expansion of Medicaid for people earning up to 100 percent of the poverty level, rather than the 138 percent under ObamaCare.

In a statement, Herbert said the measure “balances Utah’s sense of compassion and frugality. It is now time to set aside differences and move forward to get those in greatest need enrolled on Medicaid and on the federal health care exchanges.”

The new plan is set to be implemented beginning April 1.

In November, voters narrowly approved Proposition 3, which called for full expansion. The new plan signed Monday effectively replaces the voter-approved measure with one that’s much more narrowly focused.

Anyone earning between 100 and 138 percent of the federal poverty level will have to purchase coverage on the federal exchange.

Proposition 3 would have covered 150,000 people, and would have been paid for by an increase in the sales tax.

The new law will cover about 48,000 fewer people, and will cost $50 million more than full expansion, according to a state analysis. It includes a cap on enrollment if costs are greater than expected, as well as a requirement that would remove coverage from people that don’t meet a work requirement.

The law relies on the Trump administration giving Utah billions of dollars to expand coverage to only a fraction of the people called for under the law, a request the Centers for Medicare and Medicaid Services has denied in the past.

Still, state legislators have told reporters they are confident the waiver will be approved. If it’s not, the legislation calls for the program to revert to the full expansion approved in November, with certain restrictions. . .

Continue reading.

Republicans are willing to spend public money to be mean-spirited. What a disgusting political party and outlook.

Written by LeisureGuy

15 February 2019 at 8:37 am

My experience with socialized healthcare in Canada

with one comment

I’ve read the usual stories—terrible wait times, can’t see anyone, etc.—but it’s actually so far been much the same as US healthcare. In the US I had pretty significant wait times at the doctor’s office and also at the ER when I went. In addition, of course, in the US there are the co-pays, and the arguments with the insurance company which tries to talk you out of getting a doctor-ordered test, and the hassle with pre-authorization, and (months later) a substantial bill for what the insurance company did not cover.

I have had a couple of chest pains, and given that I’m getting on to elderly and a diabetic, a heart attack is the most likely exit strategy, so I thought I should not just ignore it. (I had friend who ignored heart pain—”It’ll go away”—and died, far from home, on a business trip.) The chest pain—a twinge, really, but rather sharp—seems to happen when I’m just sitting in my chair, and no often at that. But still…

So I went to the walk-in clinic nearby. Wait time: 15 minutes. I explained why I was there, and the doctor said I should just go over to the ER since there they could run tests that the doctor didn’t have equipment for in the office.

I drove to the ER, and parked there at 11:25a.m. (You do have to pay for parking: CDN$2.75 for two hours, until 1:25p.m.) I had my BC Health Services Card. I was admitted (total wait time about 5 minutes), then went through some tests, waiting 10 or so minutes before each test: blood draw, EKG, chest X-ray. Then I saw the doctor.

Everything looks very good. Chest X-ray (haven’t had one for years) was (the doctor said) excellent. EKG was fine. I told him that my last EKG had commented that I had bradycardia, and I asked. The doctor said that was a slow heart rate, and it looked very good—possibly the result of the training effect of my walking (to which he suggested I return as soon as weather permits).

The pains sounded to him like a nerve pain. These can happen anywhere, and that they were high on my chest was just random. My heart looks very good. I left the parking lot at 1:10p.m., not owing a cent, not having had to talk to any insurance company, and knowing that no bill will arrive some weeks from now.

I think that’s pretty good. A lot of the friction one encounters in US healthcare simply doesn’t exist here.

Oh: I also picked up three prescriptions at the local pharmacy. Total cost $1.80 (60¢ each). That’s for a 3-month supply of each.

Written by LeisureGuy

13 February 2019 at 1:57 pm

Kevin McCarthy: McCarthy: Yeah, We Tried to Kill Protections for Preexisting Conditions

leave a comment »

Kevin Drum points out an admission by Majority Leader Rep. Kevin McCarthy:

I would like to hear this recording:

Speaking privately to his donors, House Minority Leader Kevin McCarthy squarely blamed Republican losses in last year’s midterm elections on the GOP push to roll back health insurance protections for people with preexisting conditions — and in turn blamed his party’s right flank. McCarthy’s comments, made in a Feb. 6 conference call from which The Washington Post obtained partial recordings, represent a vindication of Democratic efforts to elevate health care as an issue in last year’s campaign.

….“When we couldn’t pass the repeal of Obamacare the first way through, an amendment came because the Freedom Caucus wouldn’t vote for” the original House bill, McCarthy said. “That amendment put [the] preexisting condition campaign against us, and so even people who are running for the very first time got attacked on that. And that was the defining issue and the most important issue in the race.”

To McCarthy, this is about a feud between the Freedom Caucus and the rest of the Republican Party. But it’s more than that: it’s an admission that Republicans did, in fact, try to repeal protections for preexisting conditions. This is something they have routinely denied ever since they did it.

But they did it. And now McCarthy has admitted that they did it. I sure wish this could get as much attention as a minor tweet from a newly elected member of the House.

Written by LeisureGuy

13 February 2019 at 11:03 am

Stopping the World’s Biggest Infectious Killer

leave a comment »

Madhukar Pai writes in Scientific American:

Diseases that have plagued humanity since ancient times continue to hold billions of people back, and tuberculosis is one of the most significant among them. Today, there are an estimated 10-million-plus new TB cases each year, and the disease causes more than 1.6 million deaths, earning it the dubious honor of being the world’s number one infectious killer.

While training as a doctor in India, where TB is more prevalent than in any other country, I saw first-hand its devastating impact on individuals, families and entire communities.

Since my time as a medical trainee, I have been encouraged to see modest progress. Globally, the mortality rate dropped 42 percent from 2000 to 2017. New diagnostics and medicines are now available, including bedaquiline, which is proving to be a potential game-changer for drug-resistant TB—and countries like South Africa have successfully rolled it out. Political commitment is also on the rise, with heads of state agreeing to mobilize $13 billion for TB care and prevention by 2022 at a high-level meeting in September, 2018.

Yet one of the most frustrating challenges in the TB epidemic perseveres: the lack of adequate 21st-century tools to fight what’s now a 21st-century epidemic. Despite recent scientific advancements for many diseases, patients and care providers continue to rely on antiquated, inefficient diagnostics, vaccines and drug regimens.

This is unacceptable.

Take vaccination. The BCG vaccine we use for TB today was developed in the 1920s, and has limited efficacy. What about diagnostics? The most widely used test for TB dates back to German scientist Robert Koch, who identified the tuberculosis bacterium under a microscope in 1882, and it is barely 50 percent sensitive. How can we defeat TB if we have no good vaccine and can only detect it half of the time?

For those who do get an accurate diagnosis, the complexity of treatment is another major problem. Existing medications require . . .

Continue reading.

Written by LeisureGuy

11 February 2019 at 2:33 pm

Americans have healthier hearts. We have a healthier budget, too.

leave a comment »

Catherine Rampell has an interesting column in the Washington Post:

Thanks to preventive medicine, older Americans have healthier hearts. Which also means, incidentally, that federal budgets are healthier, too.

At the turn of the millennium, health spending growth was spiraling out of control. Economists projected that the already ginormous health-care sector would soon gobble up monster portions of the federal budget and the entire economy. But something strange happened over the past decade and a half.

Rather than rocketing upward at ludicrous speed, health spending growth slowed — dramatically so.

That’s true whether we’re talking about public- or private-sector health spending; for Medicare, Medicaid, private insurance and out-of-pocket spending, annual outlays have been way lower than the doomsday forecasters anticipated. Curiously, too, the sharpest slowdown has occurred with Medicare.

In fact, about three-quarters of the health spending slowdown nationwide was due to slow-as-an-(almost)-trickle growth in spending on the elderly. From 1992 to 2004, per-capita spending among Medicare beneficiaries grew by 3.8 percent each year, adjusted for economy-wide inflation; since 2005, the rate has been a mere 1.1 percent, according to a new Health Affairs study.

In plain English, that means total spending per elderly person hasn’t fallen, per se, but we’re spending thousands of dollars less today than was projected to be the case back in the early 2000s.

So who gets credit?

Some have attributed the spending slowdown to lousy economic conditions, although in retrospect the timing isn’t exactly right. The deceleration appears to have begun before the Great Recession, and it continued long after it ended. What’s more, Medicare spending should be relatively shielded from the business cycle, at least relative to the private sector.

Some have credited structural changes to the health-care system, including some of Obamacare’s cost-control measures. Maybe bundled payments and accountable care organizations are responsible — though studies so far suggest their effects have been modest compared with the magnitude of the overall changes in health spending trends. What’s more, the slowdown pre-dates Obamacare.

That new study suggests a different cause: Americans taking better care of their hearts.

The study, from a team of researchers led by Harvard economics professor David M. Cutler, focuses specifically on medical spending for the elderly. The authors began by disaggregating spending into categories, based on the condition a patient was being treated for — cancer, dementia and so on.

They noticed something striking. The categories with far and away the biggest slowdown in spending were related to heart health. Spending on cardiovascular and cerebrovascular diseases (heart attack, cardiac arrest, stroke, etc.) declined by $827 per person, relative to earlier trends. Spending on a related category called cardiovascular risk factors (high blood pressure, high cholesterol, diabetes) also fell $802 per person below the trend line.

Altogether, the researchers calculated that more than half of the elderly spending slowdown was because of slower spending on cardiovascular diseases and conditions. In dollar terms, this means the slowdown in cardiovascular spending growth effectively saved the Medicare program about $34 billion in 2012 (the most recent year of data available).

You can see similar results in other health stats. Elderly death rates for cardiovascular diseases, for instance, have plummeted, according to data from the Centers for Disease Control and Prevention.

These are significant findings, with major policy implications.

The conventional wisdom among health policy experts has long been that preventive medicine does not save money. It has other virtues — including, well, making people healthier. That’s quite a good thing! But study after study has found that in dollar terms, at least, investing more in preventive care doesn’t pay off.

This new paper suggests that at least when it comes to heart health, that’s not the case.

Lower-than-expected cardiovascular spending appears to be primarily due to successful use of preventive measures, the authors find. Greater use of statins, anti-hypertensives, diabetes medications and aspirin has helped prevent lots of expensive health events and contributed to outright declines in hospital admissions for heart disease and stroke.

“We think that half of the reduction in cardiovascular cost growth is a result of more people taking medications and taking them more regularly,” Cutler said.

Why are people taking their meds more regularly? The authors don’t know for sure, but there are a few possibilities. There’s more awareness of the need for treatment, for one. But also, a bunch of existing drugs went off patent and got cheaper. And in 2006, we got Medicare Part D, which reduced out-of-pocket prescription costs for many older people and probably led to more compliance. . .

Continue reading.

Written by LeisureGuy

10 February 2019 at 6:31 am

%d bloggers like this: