Posted on | March 27, 2015 | No Comments
Meredith Magee Donnelly
There are a few moments in my life that I will cherish forever. The birth of my daughters was not a beautiful, calm experience. They were going to be born 6 weeks early, because of the anatomy of my spine the epidural wouldn’t go in, and after thirty horrific minutes of trying it was decided they were going to have to put me completely under to have the caesarean section. It was an awful moment. My husband was still in the waiting room and wasn’t going to be able to come in before they gave me the anesthesia.
It was lonely. It was sad. It was scary. But I’ll never forget the next moment. My doctor put her hands on my shoulders and came close to my face and quietly said “Meredith, I know not one thing has gone your way in this pregnancy and I am so sorry for that. I wish I could change it, but this is what we need to do for your girls.” It was 10 seconds, but those 10 seconds meant a lifetime to me.
There is always time to choose compassion. The choice is yours.
Posted on | March 25, 2015 | 1 Comment
Since the signing and implementation of the Affordable Care Act, with its successful provision of coverage for millions of uninsured and expansion of Medicaid in participating states, there has been a constant stream of warnings of impending disasters of various sorts.
It will break the bank! Early results show the opposite to be true.
Over utilization, fraud and waste will abound! There is no evidence of an uptick in any of these areas.
And finally, we’ll run out of doctors and their offices will be swamped by needy, super-sick patients!
On this final fear, Athena Health with the RWJ Foundation have just completed an analysis of the physician workforce demands secondary to the implementation of the Affordable Care Act. Some had warned that physician offices would be overrun by the new demand and chaos would reign. The results were far less dramatic.
“In the first year of the ACA’s health insurance expansion, some expected an influx of sick, newly insured patients to burden many practices across the nation. However, in 2014 there was only a very small increase in new patients while the percentage of patients with complex medical needs decreased.”
1. “New patient visits to primary care providers increased very slightly from 22.6% of all appointments in 2013 to 22.9% in 2014.”
2. “The percentage of visits with patients with complex medical needs decreased from 8.0% of appointments in 2013 to 7.5% in 2014.”
3. “The ACA has decreased the overall proportion of uninsured patients receiving care in physician offices, especially in Medicaid expansion states.”
4. “The number of diagnoses per patient visit also did not increase sharply compared to the previous year’s data.”
Passions aside, looks like we’re on the right track.
Posted on | March 22, 2015 | No Comments
So here’s my back yard with 9 days left in March. But I choose not to focus on the snow, but rather the sun – which is shinning today, and will soon lead to a short New England spring and a beautiful New England summer. But the sunny season for many has come to mean “sunfusion” – sunlight confusion. Is sun exposure good or bad? Let’s start here: Sun Beds (tanning salons) – bad.(1)
But what about everyday natural sun? On the positive side: boosts Vitamin D (may protect against diabetes, heart disease, osteoporosis and other diseases), elevates endorphins, and increases self esteem (in some). On the negative side: cancer, aging, cataracts and more. (2) Quite a divergent set of realities. No wonder we’re confused whether to seek sun or shade.
Let’s look at some basic sun facts. (3,4)
The Rays: UVA – penetrates clouds and glass, penetrates deep into skin layers (epidermis and dermis), creates wrinkles and causes skin aging, featured in tanning booths. UVB – stimulates melanin, varies with site and environment, penetrates upper layer of skin (epidermis), aids vitamin D production, can cause sun burns. (5,6)
A New Threat: Not really. But our focus has increased for good reasons. Sun worshiping and a “healthy” tan are now associated in our culture with health and wealth. We’re living longer (damage and risk are cumulative), beach wear exposes more skin surface, and today tanning parlors are big business. (2)
Reasonable Levels of Exposure: Some feel that over reaction to sun risk has caused an increase in Vitamin D deficiency. For most in the US, up to 30 minutes standard exposure 3 times a week takes care of Vitamin D, which is also available through supplements. (2,7)
The Cancers: 90% are directly linked to cumulative UV exposure. This includes basal cell and squamous cell cancers. Basal cell cancers occur mostly on the face and have a low risk of spreading. Squamous cell cancers often occur on ears, lips and temples and are more prone to spread. As for melanomas,experts say about 2/3 are directly related to UV induced genetic mutations. While only 3% of skin cancers are melanomas, they account for 75% of skin cancer deaths and are the most common cause of cancer for adults age 25 to 29. (3,4,6)
Tan Equals Protection: No. Tan equals skin damage. Melanin is sent to the upper layer of the skin to try to block UV rays. Tan does give some blocking equal to 3 SPF sun screen but skin cell DNA damage is the price you pay for this inadequate response. Tan also equals deep collagen damage which means wrinkles and visibly aging skin. (8,9)
Skin Tones: Six types ranging from freckle-faced fair to black skin face varying levels of risk according to the Skin Cancer Foundation. (2) If you are the former like me, SPF 30 should be your constant companion and you need to head for shade whenever possible. Others can get by with SPF 15. Site matters especially beaches and mountain slopes. Clearly lying on the beach all day fully exposed doesn’t make sense for anyone.
Sunscreen Confusion: FDA in 2011 published new standards for protection and terminology need upgrading. No more use of the terms “sunblock” or “waterproof”. And SPF ratings over 50 will disappear as the SPF up-coding between competitors abates. The new system will be a simple 1 to 4 rating and include UVB and UVA rays. (8,9,10)
So those are the basic facts. Hopefully that solves some of the “sunfusion”. Bottom line – moderation, common sense exposure, increased care for the very fair.
For Health Commentary, I’m Mike Magee.
1. Magee M. Dangers of Tanning. Health Politics. 2006.http://www.youtube.com/watch?v=qaMv3xyIvR0&feature=channel_page
2. Beck M. Sun-Kissed or Sunburned? The Wall Street Journal. D1. April 27, 2010.http://online.wsj.com/article/SB10001424052748703465204575208011470022100.html
3. Skin Cancer Foundation. Basic Facts. http://www.skincancer.org/Skin-Cancer-Facts/
4. Skin Cancer Fact Sheet. American Academy of Dermatology. https://www.aad.org/search/?k=skin+cancer+facts
5. Skin Cancer Foundation. UV Information. http://www.skincancer.org/UV-Information/
6. Landro L. A Shade Seeker Finds New Ways To Block UV Rays. The Wall Street Journal, D1. April 27, 2010. http://www.wsj.com/articles/SB10001424052748704388304575202110726832690
7. Vitamin D Fact Sheet. American Academy of Dermatology. http://www.aad.org/media/background/factsheets/fact_vitamind.htm
8. Skin Cancer Foundation. Sunscreen. http://www.skincancer.org/Sunscreen/
9. Facts About Sunscreens. American Academy of Dermatology. http://www.aad.org/media/background/factsheets/fact_sunscreen.htm
10. FDA Announces New Requirements for OTC Sunscreens. 2012. http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/ucm258468.htm
Posted on | March 13, 2015 | No Comments
December 14, 2012 seems a long time ago – 27 months ago tomorrow. That is when 20 young souls, age 6 and 7, were shot down in Newton, CT. Two days after the tragedy, I wrote:
“Did we as a nation do all that was possible to avoid the disaster in Newtown, CT? Clearly no. Do the issues of what we didn’t do – manage our guns, manage our mentally ill, manage our violent culture – require elaborate study? Not really. What we require is thoughtful and deliberate action. Policy defines action. Actions seek to alter or curtail human behavior – move us forward toward our finer selves in the interest of the collective good.”
Was our nation able to overcome the destructive impulses of the NRA and pass meaningful laws to help ensure that these youngsters have not died in vain? No.
And yet, in the actions of our citizens, there is cause for hope. Since the tragedy, a group of Moms, Mayors, and Gun Survivors have coalesced. They are now 2 1/2 million strong and growing. They are asking each of us to “Join the campaign to expose the NRA’s state-by-state effort to gut our public safety laws.”
Since Newtown, “Everytown For Gun Safety” has been tracking the shootings of youngsters in schools across America, and analyzing and mapping the events. They have just released the findings for December 15, 2012 – December 9, 2014. To see their maps, and the entire report, go HERE .
In the meantime, here’s their quick summary:
“In the two years since the mass shooting in Newtown, Connecticut, there have been at least 94 school shootings including fatal and nonfatal assaults, suicides, and unintentional shootings — an average of nearly one a week. During the last three months alone, there were 16 school shootings including a single week in which there were five incidents in five separate states. These school shootings resulted in 45 deaths and 78 non-fatal gunshot injuries. In 32 percent of these incidents at least one person died.”
“Of the K-12 school shootings in which the shooter’s age was known, 70 percent (28 of 40 incidents) were perpetrated by minors. Among these K-12 school shootings where it was possible to determine the source of the firearm, nearly two-thirds of the shooters (10 of 16) obtained their guns from home.”
“In 35 shootings— more than a third of all incidents — at least one person was shot after an argument or confrontation escalated and a gun was on hand. Regardless of the individuals involved in a shooting or the circumstances that gave rise to it, gunfire in our schools shatters the sense of security that these institutions are meant to foster. Everyone should agree that even one school shooting is one too many.”
I don’t believe that our legislators will have the courage to face off the NRA, and do what is right, without a countervailing political force. So I encourage you to have a look at Everytown, and to make your town part of the movement. Join Moms Demand Action For Gun Sense In America.
Don’t Give Up! Don’t Give In!
For Health Commentary, I’m Mike Magee
Posted on | March 6, 2015 | No Comments
Hillary Clinton’s use of a private email server to avoid the transparency that was assured by the Freedom of Information Act should be of concern to all Americans, Democrats and Republicans alike. If this is true for the general public, it goes doubly for anyone concerned with improving the health of our nation.
This is because health is fundamentally political. The battles between science and religion, industry and environmentalists, protectionists and profiteers, is hard-wired into our democratic process. Debate, compromise, and hopefully wise course corrections, require consensus and agreement on the facts. Debates can go on for years before consensus is reached, as is so well illustrated with global warming. It’s messy for sure, but impossible in the absence of transparency and disclosure.
In every Administration, there are significant battles, only partially visible, being waged in and among the differing wings of government. There is no reason to believe it would be any different with a Hilliary Clinton Administration. To illustrate how contentious things can become, and how we Americans rely on the free flow of information and an active Press Corps, let’s go back to 1988, and an investigative piece by Peter Schmeisser in the New York Times on July 10, 1988 called “Pushing Cigarettes Overseas”. Here’s a paraphrased summation:
A quarter of a century ago, C. Everett Koop shocked the Tobacco Institute, the lobbying arm of Big Tobacco, with the release of a 618-page report that had reviewed 2,000 research papers, and come up with one overlying conclusion: “Tobacco is as addictive as heroin”.
”Smoking is responsible for well over 300,000 deaths annually in the United States,” Koop said on July 10, 1988. Using charts to reinforce the data, he called for a , ”a smoke-free society.”
He faced some stiff opponents, and I’m not talking about R.J.Reynolds or Jesse Helms. I’m talking about members of the federal government, most specifically, the Office of the United States Trade Representative, who were anxious to open lucrative foreign markets to American tobacco.
The Departments of Commerce and State, as well as Southern congressmen, loved the $2.5 billion annually in export revenue and especially the 76% rise in tobacco export revenue in 1987 over the prior year.
There was trouble in the air. Canada had just pulled the plug on all tobacco advertising and established the principle of using warning labels. Additionally activists in Japan (where 63% of the adult population smoked) and China (where 90% of the adult population smoked) were beginning to use wartime language to describe the American advertising assaults, saying for example that “the current clash that pits America against Asia over tobacco and trade is nothing less than a new Opium War.”
There was no question where Koop stood on the issue of exportation. During the press conference that day he said, ”I don’t think that we as citizens can continue to tolerate exporting disease, disability and death.”
With trade officials like Catherine R. Field, associate general council at the trade office, it was business as usual. ”Personally, I have no love of cigarette smoke. But we are not telling people to smoke, we are simply gaining access to an existing market,” is what she said at the time.
Over the recent years, Europe had closed their doors to advertising. But companies like Philip Morris snuck through the back door by linking name and logo to Formula 1 Grand Prix cars. That had been going on since 1972.
Public Health experts like Judith L. Mackay, then executive director of the Hong Kong Council on Smoking and Health, warned about “the cost in mortality, hospital care, or lost productivity.” Ronald M. Davis, then director of the Centers for Disease Control’s office on smoking and health, agreed with her. He went on record to say, ”My life’s work has been devoted to reducing global morbidity figures, yet in this case we are exporting an obviously hazardous agent. This kind of thing perplexes me as a Government official and frustrates me as a doctor.”
The U.S. Trade Representative and allied Big Tobacco executives had the support of the Reagan Administration, and largely shut down public HHS activities on the issue. Peter S. Allgeier, Assistant U.S. Trade Representative at the time, easily slipped the noose saying that the U.S. loosing out on China’s annual 1.3 trillion cigarette addiction was foolish because “they’re going to smoke whether the U.S. is exporting cigarettes or not.”
David Yen, then chairman of the John Tung Foundation, a Taipei public health organization, had already sent a pleading letter to Reagan asking that the U.S. not use “tobacco as a tool to solve the trade imbalance…We are happy to buy any other American products, but please, don’t push your cigarettes on us.” He was especially worked up about R.J.Reynold’s latest stealth campaign which had sponsored a famous rock band for a concert, and offered tickets which could not be bought for any amount of cash. One could only get a ticket in exchange for 5 empty Winston cigarette packs – if you threw in 5 more, you received a ticket and a souvenir sweatshirt.
Who were the Tobacco Institute’s lobbyists at the time? Former Reagan Administration heavy weights, Michael Deaver and Richard Allen, now prominent Pro-Tobacco players. In the meantime, Jesse Helms was busy sending nasty letters to various country’s Prime Ministers threatening trade tariffs. Of course, he didn’t mention that the U.S. based, Southern companies were not even using North Carolina tobacco leaves at the time. In 1984, R.J. Reynolds had inked a deal with Beijing to harvest leaves and manufacture their product in China for Chinese consumption. Same thing for the Philippines, and on and on.
This caused U.S. Congressman Charles Rose (D, NC) to complain ”The farmers lose income, as the big tobacco corporations break into the Fortune 500.” Helm’s response? ”Our tobacco farmers are experiencing the best of times, with increased quotas…” Rep. Chet Alkins (D, MA) didn’t like the tone of that. He said, that the Reagan Administration was ”sending Asians a message that their lungs are somehow more expendable than American lungs.” Striking a Senior Statesman pose, Strom Thurmond, without cracking a smile said, ”I don’t think that we should dictate to other nations what their health policy should be. . . . That would be interfering with the internal policies of a sovereign nation.”
The president of the Tobacco Institute, added patriotically, ”Tobacco is one of the very few American industries that has the ability to produce a world-class export product.”
In America, we’ve come to expect that our Press will expose characters like these and their unhealthy activities to the light of day. But this is by no means assured. It requires that all of us – including Hillary Clinton – properly balance individual privacy concerns with pressing societal needs for transparency.
For Health Commentary, I’m Mike Magee.
Posted on | February 25, 2015 | 2 Comments
Bill Maher prides himself on logic and clarity, and of course, in-your-face, biting humor. This is on full display during his “New Rules” segment, with which he closes each show. He is especially well known for his personal and professional advocacy for the legalization of marijuana. His major points are that the substance is relatively harmless and that the criminalization of the substance has done far more harm than good, especially for minorities.
As he said last week, (while excoriating Ted Cruz and Jeb Bush, both of whom have admitted using the substance in the past, but are opposed to legalizing it), “Obama should acknowledge that putting people in jail for nonviolent drug offenses was a giant mistake in the first place, and then he should use the power of the presidential pardon and free them all.” And, with special reference to the youthful indiscretions of the Bush brothers, “We should at least be honest with our kids and tell them the truth about drug laws in this country. Kids, if you’re gonna experiment, make absolutely certain that beforehand your parents are white and well-connected.”
And, of course, Maher is right. The “Drug War” has been a disaster, and it is patently racist. Just consider the record in the largest cities on the East and West coast. In New York, during Mayor Bloomberg’s tenure, from 2002 to 2012, 1 million police hours were expended making 400,000 marijuana possession arrests. And who gets arrested? That’s well-documented – it’s primarily blacks and hispanics, caught up in “stop and frisk”.
New York Times columnist Charles Blow went after the city’s Democratic politicians on the “how it happens” piece. As he said, “The war on drugs in this country has become a war focused on marijuana, one being waged primarily against minorities and promoted, fueled, and financed primarily by Democratic politicians. Young police officers are funneled into low income black and Spanish neighborhoods where they are encouraged to aggressively stop and frisk young men. And if you look for something you’ll find it. So they find some of these young people with small amounts of drugs. Then these young people are arrested. The officers will get experience processing arrests and will likely get to file overtime… And the police chiefs will get a measure of productivity from their officers. The young men who were arrested are simply pawns.… No one knows all the repercussions of legalizing marijuana but it is clear that criminalizing it has made it a life ruining racial weapon.”
The practice is mirrored exactly on the West coast. Even though young whites have been shown to use marijuana at higher rates than blacks, LA police officers in the past 20 years have arrested blacks for marijuana possession at a population adjusted rate six times that of whites. How about other cities? San Diego – 6X disparity; Pasadena – 12.5 X disparity. In the state capital of Sacramento, the black population (14% of the total) accounts for over half of all marijuana arrests.
Now when you combine the targeting of minorities with the lack of legal resources to fight these arrests, you begin to understand how a minority that accounts for 13% of the population can be the source of more than 40% of all imprisoned Americans. Compare that with whites, who represent 64% of our population, but contribute only 39% of our prison population.
So Bill Maher is right about marijuana, but he’s also terribly wrong. Where he loses me is in glibly suggesting that weed is harmless, at least in comparison to other substances. On the surface, I’ve always known this to be untrue. After all, you’re breathing chemical-laden smoke deep into the bronchial tree. That can’t be good. Young active minds dulled and confused? That can’t be good. Operating motor equipment while impaired? That can’t be good.
Now a major study, published last month in Addiction magazine, under the auspices of the WHO, supports my biases with facts. The author, Wayne Hall, an addiction specialist at the University of Queensland in Australia, compared populations in 1993 and 2013. He focused on “two New Zealand birth cohort studies whose members lived through a historical period during which a large proportion used cannabis during adolescence and young adulthood; sufficient numbers of these had used cannabis often enough, and for long enough, to provide information about the adverse effects of regular and sustained cannabis use.” His results were in line with other recent cohort studies in Australia, Germany and the Netherlands .
Adverse effects of chronic use:
Regular cannabis users can develop a dependence syndrome, the risks of which are around 1 in 10 of all cannabis users and 1 in 6 among those who start in adolescence.
Regular cannabis users double their risks of experiencing psychotic symptoms and disorders, especially if they have a personal or family history of psychotic disorders, and if they initiate cannabis use in their mid-teens.
Regular adolescent cannabis users have lower educational attainment than non-using peers.
Regular adolescent cannabis users are more likely to use other illicit drugs.
Regular cannabis use that begins in adolescence and continues throughout young adulthood appears to produce cognitive impairment but the mechanism and reversibility of the impairment is unclear.
Regular cannabis use in adolescence approximately doubles the risk of being diagnosed with schizophrenia or reporting psychotic symptoms in adulthood.
All these relationships have persisted after controlling for plausible confounders in well-designed studies, but some researchers still question whether adverse effects are related causally to regular cannabis use or explained by shared risk factors.
Physical health outcomes:
Regular cannabis smokers have higher risks of developing chronic bronchitis, but it is unclear if it impairs respiratory function.
Cannabis smoking by middle-aged adults probably increases the risks of myocardial infarction.”
That’s quite a list. Now Bill Maher is right on two counts: First, alcohol is worse. For example, as we’ve seen on multiple college campuses, you can die from alcohol intoxication. You can’t from marijuana. Second, marijuana possession has become the ultimate “Scarlet Letter” on the records of countless young black and hispanic males in the US. That’s why I’m for legalization.
But at the same time, Maher owes it to his faithful viewers, in his next “New Rules”, to point out that wide open use of marijuana by adolescents and young people is not without risk, and in fact, in Bill’s own words, “Is pretty f—ing stupid!”
For Health Commentary, I’m Mike Magee
Posted on | February 25, 2015 | 1 Comment
“President Obama’s new initiative to fund genetic sequencing could be a powerful tool for good in improving U.S. health care—but only if the medical establishment welcomes it.”
That’s the view of Duke Chancellor Emeritus, Ralph Snyderman, MD in a recent article in The American Interest.
In the article, he explains, “On January 30, 2015, President Obama announced a bold funding initiative to support the sequencing of the genomes of a million volunteers and correlate the data with clinical information to allow a better understanding of the roles genes play in health and disease. This information will boost precision or personalized medicine and allow appropriate therapeutics to be targeted to those who need them — that is, getting the right drug to the right person. This is in contrast to our current “one-size-fits-all” approach to care, where more than half of major drugs are ineffective or cause unwanted side effects, and drug expenditures are currently about $320 billion a year and rising. Replacing that approach with one designed to meet the precise needs of the patient would not only be better medicine, but also more cost-effective.” Read on…
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