And now…drum roll…the part we’ve all been waiting for. Michael Levitt’s plan to eliminate teenage pregnancy and all non-procreative sexual activity–mandatory chastity belts for all!

Okay, just kidding. But now we are closing in to the grand finale of my three part series on “What’s Wrong With Michael Leavitt as Secretary of HHS?”

As we might expect, Leavitt is an absintence-until-marriage kind of guy, and a staunch opponent of legalized abortion. The worst case scenario is that Leavitt is going to flush even more millions down the toilet ( $170 million currently being flushed as I write this) for the ineffective abstinence programs that are dooming young people to ignorance and a higher probability of getting pregnant or picking up a nasty little critter when they do start screwing around. And surprise, stats show that most of them will succumb to carnal lust, in the absence of marriage.

But according to the Sexuality Information and Education Council of the United States (SIECUS), Leavitt’s past performance on these issues has been somewhat mixed–despite his personal views.

Though Leavitt is an advocate of abstinence-only-until-marriage programs and is opposed to abortion rights, his decisions have not always reflected those beliefs. In 2000 he vetoed a state abstinence-only-until-marriage bill that would have limited sex education in schools to the teaching of abstinence before marriage and fidelity afterwards. The legislation also would have prohibited any discussion of birth control and would have required teachers to tell students that extramarital sex is illegal in Utah.

At the time he explained, “the system as it is currently practiced serves the vast majority of the people of our state to their satisfaction.” He also stated that, “We cannot take this matter lightly…Parents must be involved. Abstinence and fidelity are the essential core of instruction for our students.”

But before we get our hopes up, after vetoing the bill, he did go to instruct the state education board to implement many of the same proposals that were contained in the bill, including a requirement that school districts establish a committee made up of parents and educators to approve outside materials and guest speakers.

His flip-flopping seems to have also upset members of the abstinence camp as well. According to the Abstinence Clearinghouse Update from December 13, 2004, “Leavitt appears to have a mixed record on abortion and abstinence education. He claims to be pro-life (and has signed some pro-life bills), but has repeatedly upset pro-life activists for some of his decisions. Likewise, he claims to be pro-abstinence education but has upset abstinence advocates for vetoing an abstinence education bill and his administration appears to have misspent federal abstinence funding on basketball games.”

Medicaid Slash and Burn

Leavitt’s restructuring of Medicaid in Utah garnered accolades from some, while it was resoundedly condemned by others. I guess it all depends whose outlook you decide to go with. The official government bio shows a man who did great things for the poor of his state. But then, government bios always shine up their officials, and leave the dirt out of sight.

Sec. Leavitt is widely recognized as a health care innovator and welfare reformer, and his record of achievement in Utah bears this out. In 1994, the Utah legislature passed Gov. Leavitt’s “Healthprint,” a comprehensive, incremental approach to health care improvement in the state. A decade later, Utah has more than 400,000 additional people with health insurance, marked increases in the number of children with health care coverage, dramatically improved immunization rates and per capita cost of healthcare 25% below the national average.

Others look at it quite differently. As governor of Utah, you cut health care for the poorest Medicaid beneficiaries to pay for inadequate health benefits for others. Robbing Peter to pay Paul it seems. Leavitt cut benefits from those already receiving Medicaid, in order to “add more to the roster.” But does it really help if everyone just gets a tiny piece of the pie, and no one has real coverage?

Leavitt’s plan was known as the Utah waiver. It was part of the Bush administration initiative that enabled states to re-structure the Medicaid program without legislative approval. The end result would be cutbacks in health coverage and increased “cost-sharing” for current Medicaid beneficiaries. Cost-sharing, a nice term for saying that they will have to pay more out of pocket. According to the Bush administration, this would enable states to increase health coverage for others who are currently uninsured.

Ron Pollack, executive director of Families USA, (and someone I trust more than anyone in the Bush administration including Mike Leavitt, released the following statement about the new Utah waiver in 2002:

“The Utah waiver approved by the Bush Administration will do considerably more harm than good for low-income families that need help to get health coverage. This proposal is like robbing Peter and Paul to pay Phil.

“Since the Utah waiver is a forerunner for other state waiver requests, low-income families across the country have reason to worry that Medicaid will soon become unaffordable and will provide diminishing coverage. We believe that the Administration would be better advised if it made a commitment to expand health coverage to the uninsured without cutting the existing Medicaid program.”

Child Welfare

Finally, the last major blight stuck to Leavitt is his horrendous failure to improve Utah’s child welfare system. During his tenure, a federal court ruled that Utah “had violated the constitutional rights of every child in custody.” However, it took the state a decade to comply with the ruling. Now is this a man who cares about the welfare of America’s children?

From the Center for American Progress: There is only one way to describe the condition of Utah’s Division of Child and Family Services during Leavitt’s tenure as governor: reprehensible. From 1993-1996, ten children who were under DCFS care died. Ultimately, the case came to head when the National Center for Youth Law in Oakland, Calif., filed a class-action lawsuit “on behalf of 17 children who had been horribly abused and neglected in Utah’s foster care system.” The court eventually ruled that “the state had violated the constitutional rights of every child in custody.” Though Leavitt’s supporters defend him by saying that he had simply been unfortunate enough to inherit the quagmire, the near decade-long period that it took for the state to fall in line with the court settlement – which demanded an overhaul of foster care and an increase in training and case oversight – fell squarely during Leavitt’s time as governor. The state’s child protection service continues to be monitored to this day.

In Conclusion…

Now that I have discussed all of those little incidentals about Leavitt–his history, which shows such strong regard for the public’s health and well being, his ability to act and protect vulnerable children, his ingenious re-structuring of Medicaid, and his wonderful concern for preserving our land for future generations. And then of course, this is a man who will come to office without any bias as far as reproductive rights go, and who will ensure that our students receive a comprehensive education that will guide them in making right decisions when it comes to sexuality, and wouldn’t dream of using tactics like fear, shame, medical inaccuracy or a policy of ignorance.

Wouldn’t it be nice if this really was the man who had just been appointed? Well, we can dream, can’t we.

So let’s see, aside from any clear education or experience in healthcare, what else do we need to concern ourselves about when it comes to our new Secretary of HHS, Michael Leavitt?

Environmental Blahs

Well, let us begin with his environmental record, during his tenure as governor of Utah. It is enough to give you a headache, and environmental health is intricately entwined with public health. If you don’t give a damn about one, the other is going to fall flat on its face as well.

Leavitt’s appointment to head the Environmental Protection Agency was opposed by virtually every environmental organization on the planet, including several in Utah, who had borne witness to his devastating policies.

“Based on his Utah record, Governor Leavitt will bend over backwards at EPA to make sweetheart deals with American industries that jeopardize the American public’s health. We’re asking Senators to safeguard our environment and public health by opposing his appointment.” said Zach Frankel, executive director of Utah Rivers Council.

“Governor Leavitt will likely gut the EPA by putting industry interests far above public health concerns thereby making the agency a toothless watchdog” said Jason Groenewald, Executive Director of Families Against Incinerator Risk.

So what did he do as governor? In a press release, the Sierra Club, who vehementally opposed Leavitt’s appointment to the EPA, had this to say:

Governor Mike Leavitt’s environmental track record, which includes working behind closed doors with Interior Secretary Gale Norton to open up Utah ’s wildlands to polluting industries, suggests that he will be a good fit for the Bush administration but a disappointing choice for Americans concerned with environmental protection.

Governor Leavitt also championed the notorious Legacy Highway, which would have destroyed Utah ’s world renowned wetlands and fertile farmlands along the Great Salt Lake. His appointment does not inspire confidence in a Bush Administration that removed federal oversight for 20 percent of America ’s waterways.

An article which appeared in the Salt Lake Tribune on September 28, 2003, pointed out the obvious–why Mike Leavitt was a dangerous choice for the EPA–dangerous to the environment and the American people, that is.

The governor suggested at the hearing that “collaboration” and “balance” are his trademark when dealing with environmental issues. But if that’s true, why are Utah’s environmental groups so dead set against his nomination, while lobbyists for the mining and power industries can hardly conceal their delight?

Just whose scientists is Gov. Leavitt listening to?

So What Have We Here…

So here we have a man, without training in science or health. A man with deeply ingrained special interests, as mentioned in my previous article. And now, for part 3, a history of complete and blatant disregard for the public health of the people of Utah. Doesn’t give a hoot about dangerous pollutants in the air, or contaminants in the water. In other words, couldn’t care less how many people get sick and drop dead because he’s too busy pandering to the favored industries. And who cares if he destroys the land that belongs to the people of Utah?

So now this is the man that is going to head up the HHS. Are you getting queasy yet? Stay tuned, there’s more coming.

However, there is one bright light shining through all of this stinking manure. At least, Leavitt will no longer be in the EPA. Fortunately, he was there too short a time to do any real damage to the nation as a whole.

Michael Leavitt has been confirmed as secretary of Health and Human Services (HHS), a rather powerful position which puts him largely in control of public health policy for the nation. A brief background on Leavitt–he is the current EPA director (only since 2003), former Governor of Utah and former director of an insurance brokerage.

A press release from the American Medical Association commended Bush on his appointment of Leavitt, saying that “We applaud President Bush for his choice of a well-seasoned leader to head this vital department.”

Well seasoned? Well seasoned in what? Aside from this man’s track record as either governor of Utah or head of the EPA, and ignoring his personal convictions, Leavitt seems a most peculiar choice for the job. And certainly, odd that an organization of physicans would be thrilled about it.

I would expect that someone to head up HHS would have some medical training, some expertise in healthcare, or at minimum, scientific training. Leavitt has none. He earned a bachelor’s degree in economics and business from Southern Utah University, and before he ran for governor, he rose to president and chief executive officer of a regional insurance company. His tenure at the EPA is scarcely a year old, so we can hardly consider that to have given him a solid scientific background. Basically, Bush has appointed a man without any health or science credentials or experience, to be responsible for the nation’s public health.

And as far as the AMA supporting this, well, it could be that John C. Nelson, MD, MPH, current president of the AMA, served as the Utah Deputy Director of Health during Leavitt’s tenure as governor of Utah. So this is a more a subjective opinion, and really doesn’t say anything about Leavitt’s ability to take on the public health of a nation.

You really have to wonder about the reasons for this appointment. Judging from the man’s history and personal views, he is definitely well esconced in the Bush ideology. But surely Bush could have found a loyal follower who had at least some experience with health? Some education in science?

Also problematic is Leavitt’s personal views on reproductive issue, which some fear may cloud his judgement. And his background on enviornmental issues is absymal, which is probably the reason the Bush initially plunked him into the spot at the EPA. As for his actions regarding public health, while governor of Utah, there are mixed views on those.

Finally, there’s a little matter of a conflict of interest. According to a financial disclosure report filed in 2003, Michael Leavitt revealed his holdings of various investments in pharmaceutical companies – including Johnson & Johnson and Merck & Co. Leavitt also maintains an investment worth $5 million to $25 million in Leavitt Group Enterprises, which is the 27th largest insurance broker in the U.S. He used to serve as chief operating officer as well.

When his predecessor, Tommy Thompson, was confirmed as secretary of the HHS, he was forced to sell all of his pharmaceutical stock, and it is expected that Leavitt will do likewise. However, Leavitt’s potential conflicts of interests run far deeper than Thompson’s, as this is a family business. Federal law prohibits personal and substantial participation in decisions that could directly affect not only the executive branch employee’s finances but his family’s financial interests as well, and Leavitt’s brother Dane is the president and CEO of Leavitt Group Enterprises, which underwrites personal and property liability lines of insurance including but not limited to Medicare supplemental plans (Medigap policies) and medical malpractice insurance plans. These are two areas of health that Leavitt will have direct jurisdication over in his new job.

More to come on Mr. Leavitt…

Governor Arnold’s dream of ruling California without opposition isn’t coming as easy as he planned. For one thing, I think that it may finally getting through to him that he is no longer the terminator, and in fact, if he continues to piss off the public, he, himself, will be the victim of termination.

His latest plan is to eliminate 88 state boards and commissions, and place them under his control. This, he contends, will be for the good of the consumer. But to his surprise, he is facing rather strong confrontation and protest. Poor Arnold, it’s not easy to become ruler of California just because you want to.

This is from the California Nurses Association

Plan to reduce boards bashed
Little Hoover Commission hearing gets an earful from legislators, others about risks in consolidation.

Gov. Arnold Schwarzenegger’s plan to eliminate 88 state boards and commissions faced strong resistance Wednesday from an independent oversight panel, an early indication that the Republican governor’s reorganization effort may have problems moving forward.

“That sounds like a concept that exists in Syria or Russia, but I don’t know of an appeals process that works in the free world with an at-will appointment,” Zax said.

Michigan is really attacking the smokers. I just saw another link to a “no smoking anytime” workplace requirement. In this case, it’s not that you’ll be fired; you just won’t be hired for a full time job. And if you’re a part-timer, forget about ever getting a promotion.

If you smoke and want a full-time job at Kalamazoo Valley Community College, you can forget it. A new hiring policy that took effect on Jan. 1 tells job seekers that tobacco users will not be considered for full-time employment at KVCC.

Part-timers looking to move up a rung to a full-time position can’t if they smoke or use other tobacco products. Officials say the new policy is an effort to contain health-care costs, based on national research suggesting that tobacco use increases medical claims.

This is getting ridiculous. About 10% of the people working at KVCC smoke. If they want to ban workplace smoke, fine. But to deny employment to someone who smokes in their own home, well, that is discrimination. Unless they deny employment to everyone else who engages in habits that increase health risks, you just can’t single out smokers. For starters, how about refusing to hire people who eat at fast food joints? Or maybe a diabetic who is lax about keeping their blood sugar under control. Now that would be a sticky one. Go for it, guys.

In writing up this tidbit about the Weyco company, I was reminded of an incident that occurred while I was still working as a nurse in Los Angeles. One fine day, some ignorant bimbo in adminstration decided that we should have a dress code for nurses. Many of us (me included) wore scrub clothes issued by the hospitals. We wore street clothes into work, changed into scrubs before going onto the unit, and then changed back before leaving for the day.

The bimbo decided that nurses should be banned from wearing jeans and sweats, and other “casual” clothing into the hospital. Instead, we were supposed to wear business clothing. Now again, this was during a nursing shortage, and the hospital was lucky that they had anyone working there at all. But to tell me what I could wear when they weren’t paying me? And to think I was going to go out and buy a “dress for success” wardrobe, just so I could change out of it when I got to work?

This was one of those rare occasions when the nurses banded together and said, “Screw you.” I sent a memo to the administrator and told her that I would be happy to buy a new wardrobe if the hospital planned on giving me a clothing allowance, and that since they would now be paying me from the moment I stepped out of my house in the morning, I would also be adding an hour of overtime to every paycheck. I mean, if you’re mandating what I wear to work, then I assume you’re paying me my regular wage for the time that I wear these clothes? And if she had a problem with this, then I would be happy to relay it over to the California Labor Board.

She never responded, but when the day arrived for the big changeover, most of the nurses wore their sloppiest clothes. Even our head nurse, a major ass-kisser, wore a sweatshirt and jeans both. The issue died a silent death, and never reared its ugly head again. Not as long as I was working there, at least.

The idea that an employer thought that they had a right to dictate what I wore off-duty was more than distasteful; it was an attack on my privacy. I was not “theirs” as soon as I set foot in the hospital. Indeed, I had to arrive at least 15 minutes early in order to find scrubs and change, and then my departure was also delayed by having to change back. I wasn’t paid for that extra time, I wasn’t responsible for patients, and I wasn’t working.

This story neatly fits into the Annals of Hospital Stupidity when it comes to trying to hire and retain nurses. But in the larger picture, it was an attempt for them to extend their power beyond the workplace.

How far do the rights of employers go? What can they dictate at work, and can they tell you how to live your life once you are “off the clock” so to speak?

Weyco, an Okemos, MI, based insurance benefits administrator has made smoking off-limits to all of their 200 employees, be it at the office or in the privacy of their own homes.

“You can do whatever you want, but if you’re going to work here, you can’t be a smoker, like you can’t be a drug user,” owner Howard Weyers said, in an article which appeared in the Lansing State Journal.

But the problem is, Mr. Weyers, is that smoking is perfectly legal in this country. It’s one thing to forbid your employees to engage in illegal drug use, bank robbery, or embezzlement because those things are against the law of the land. Smoking is not.

There’s no law in place at the moment to prevent Weyco from taking such action. Under their policy, employees can be tested to determine if they smoke and the test is presumed to be sensitive enough to distinguish people exposed to secondhand smoke from those who are smokers. If you fail the test, out you go.

Several employees have quit, and the issue is ripe for a legal challenge. The question is how far can an employer go in dictating your lifestyle?

Weyers says the reason for the policy is his concern about health care costs associated with smoking. Studies show smokers are more prone to lung problems, including emphysema and cancer.

Well, I have news for Weyers; smoking is not the only lifestyle habit that causes health problems. And indeed, there are many many smokers who live long lives without any sort of health-related problems. So then, do we stop at smoking? It’s really minor, in the grand scheme of unhealthy habits.

What about alcohol? It’s legal and I view it as a far worse problem than smoking. Can employers start forbidding worker to drink during their off hours, and subject them to random testing?

What about skiing? A lot of people have accidents and break bones, thus necessitating them being out of work and driving up healthcare costs. Okay, no skiiers. If we find out you spent the weekend in Tahoe, you’re fired.

Are employees soon going to have to pass periodic fitness tests, like they do in the military? Run two miles, do 50 push-ups, otherwise, you’re fired.

Will they command what kind of car you drive? If you refuse to trade in your roadster for a boxy 4 door sedan, will you be fired? Can an employer mandate that you wear boots when it snows, to prevent you from getting a cold or the flu? Can they demand that you don’t use your fireplace, because breathing in the fumes may not be healthy? Can they force you to give up sky-diving, bungee jumping, or even demand that you move to a “safer” neighborhood?

In a related article it does seem like this Mr. Weyers is now set to launch an offensive against the overweight. Which I think is great, if he really helps overweight people reduce down to a healthy weight. However, they should not be forced to do so, they should not feel coerced, and their job should not be laid on the line.

Since it is now acceptable to attack smoking and smokers, some people may read this and say, “Oh, well smoking is a dirty and unhealthy habit and the company is right to do this. Ordering employees to stop smoking will ostensibly lower health insurance rates and thus keep costs down.”

But the real issue is the invasion of the employer into the private life of the employee, and the ability to exert control. Just because they pay you doesn’t mean they own you–not yet, anyway.

Okay, insurance costs. Well, that can be easily remedied without the employer sticking his nose into a person’s private life. One solution might be to have the company a certain percentage of the bill, and then the employee can pay for the whatever the cost is over that–their smoker’s premium, so to speak. This way, employees are free to do as they wish, and the company meets its goal of managing costs.

I view this as more of a desire for control, rather than concern about employee health. And how does the company treat its employees on average? Does it give them a hard time if they call in sick? Does it give them ample vacation time? Does it force them to work overtime without compensation? Is the work environment healthy, ie, natural light, vents cleaned at frequent intervals, employees allowed to personalise their workspace, etc? Does the cafeteria (if there is one) serve healthy food? Is their a work-out room on the premises? Does management listen to their employees and try to work together? All of these things go a lot farther in keeping employees healthy, than trying to dictate their life outside the workplace.

How does Weyco score on any of the things I mentioned? I don’t know. It would be interesting to find out, as well as hope that the employees who quit file a legal challenge and win.

I got busy with other stuff today and horror of horrors, realized that I had not posted on my blog. I am sort of tired of typing, so when in doubt, there’s nothing like cute fluff pictures. And here they are, two together on the tree.

Most of the “solutions” to the nursing shortage are ploys that overwhelmingly ignore the heart of the problem. Every time I search the media, to see what nuggets are being presented as cures for the shortage–well, it does get frustrating. About a year or two ago, I even came across an article where one multiple PhD nurse said something to the effect that nurse-patient ratios were a “nice” idea, but we needed “real solutions.” In her mind, people didn’t want to be nurses anymore because of the way they were portrayed in the media, so all we needed to do was buff up the celluloid image. And voila, crisis abated.

You really have to wonder whose side of the equation someone like that is on. Yep, after spending a frustrating day of hearing the CEO announce a freeze on salary, having to care for 10 patients, missing all breaks and lunch, staying an hour over and the supervisor then refusing to approve overtime, and having an irate physician chew you out because the unit clerk was laid off and no one answered the phone….this nurse is going to come home, put on the television set and watch ER. And after watching the poor portrayal of nurses on the show, she will throw up her hands and say, “I can’t work as a nurse anymore because of the way television shows portray nurses. I quit.”

Sigh sigh sigh. What planet is Dr. Triple PhD living on? She probably hasn’t seen a real live working nurse in 30 years, as she sits in the protective world of academia. Another brilliant idea came from yet another “high level” nurse, who mused that she looked forward to the day when all bedside nurses would be trained at the master’s degree level. I didn’t know whether to laugh or cry, it was so pathetic.

A Real Move

Anyway, strewn in amidst the usual pleas for scholarships and more federal money to “battle” the shortage, I saw an article about a positive move in the state of Vermont. At the Vermont Technical College, they are beginning a registered nurse re-entry program, which allows registered nurses whose licenses have lapsed to re-enter their field through a combination of 240 hours of classroom and clinical experience.

This program allows the nurse to work with a faculty adviser at seven of the college’s nine nursing sites around the state to complete 120 hours of academic work, which they do at home on their own schedule. Then they have to complete 120 hours of clinical time.

While only about 70 nurses with lapsed licenses have shown an interest in the program, it is a start. And 70 nurses is well, 70 additional nurses who can be added to the workforce.

More disturbing news, especially for people with asthma and other respiratory illnesses. Say the word “environment” and many people immediately think that it has to do with saving spotted owls or a rainforest in a far off land. But environmental policy has much to do with contamination of the very air we need to survive and the water we need to stay alive.

The Bush administration, anxious to please all big corporations, is willing to sacrifice the nation’s health. This includes their own children and grandchildren, but maybe they’re planning on keeping them in a plastic bubble, and away from ever increasing toxic air quality?

Anyway, a news brief from the Organic Consumers Association:

New EPA Deal Lets Factory Farms Pollute Air without Restriction

The day after the inauguration, January 21, the Bush Administration signed an agreement that allows factory farms to freely violate any and all clean air standards for the next two years, and forgives these same companies from paying fines for past air pollution violations. In exchange for the freedom to pollute without any restrictions, the deal “requests” that factory farms agree to monitor their air pollution and provide that data to the government.

Fortunately there is a 30 day public comment period, and the OCA is collecting petition signatures for submission to the EPA. Please sign the petition or make comments directly to the EPA.

Mike Leavitt
EPA Administrator
U.S. EPA, 1300 Pennsylvania Ave., N.W.,
Washington, D.C. 20460
leavitt.michael@epa.gov
Fax: 202-501-1450

If you want to sign their petition, it can be found on their website.

George Bush was in Cleveland, OH, the other day, talking about how health care needs to “computerize.” I would agree, that technology can greatly help in preventing medical errors, streamlining care, and allowing workers to spend less time playing with paper and more time with patients. Of course, issues such as privacy need to be addressed, but all in all, we do need to move forward in modernizing our healthcare system.

That said, Bush now seems to be focusing in on this issue, as though it will be a panacea for all of the other problems in healthcare that he chooses to either ignore or minimize.

A press release from the Association of Trial Lawyers of America (they are on Bush’s hit list!), gave a response to Bush’s comments regarding health care technology, that he made during his trip to Cleveland.

Todd A. Smith, President of the Association of Trial Lawyers of America, released the following statement:

Bush’s computerized prescription plan misses the point—
His malpractice “reforms” will protect drug makers who kill Americans.

It is ironic that President Bush is proposing to computerize prescriptions to make sure patients get the drugs they are prescribed, when his medical malpractice proposals protect companies whose drugs kill when used as prescribed.

While the president’s health care technology proposals may be small steps worth taking, they miss the point. What does it matter how high-tech the prescription system is if the drug still gives you a stroke when you take it?

Just this week the FDA reported that Vioxx may have caused 140,000 excess cases of coronary disease. But President Bush unashamedly advocates legislation that would protect insurance industry profits and prohibit any punishment for the makers of dangerous drugs like Vioxx.

His proposals would make drug companies the new untouchables. They will ensure that drug companies like Merck – which cover up the risks of their products, deceive the FDA and the public, and injure patients in the process – will never be held accountable.

All the computers in the world won’t make bad drugs safer, and all the press conferences Bush can hold won’t change the fact that his agenda will allow the insurance industry, the HMOs, and the drug companies to enhance their profits at the expense of the people they hurt and defraud.

No, it’s not really an update about Ivan Noble, just about what I wrote earlier. I had actually gone back to read some of the entries in his online diary which I had never read, and he does mention that he has a “brain tumour called a high grade glioma.” In another place, he calls it a glioblastoma. So unfortunately, I was correct in my diagnosis. They are almost always lethal, as Ivan, despite his determination and optimism, is now experiencing.

If you don’t read the BBC online, chances are, you’ve never heard of Ivan Noble. But if you do, then you are probably just as sad as I am today, as his long running diary has come to an end.

Ivan is a science and technology writer, but ironically and tragically, that is not what has brought him the most fame. Rather, it is the journal that he has been posting at fairly regular intervals, detailing his life since his diagnosis with a brain tumor.

In August 2002, at age 35, Ivan was found to have an aggressive and malignant tumor growing in his brain. While he has never actually said what kind of tumor it is, from his descriptions, I am guessing that he has a glioblastoma. They are highly aggressive and virulent tumors, with a high rate of return, no matter how many times they are surgically removed. They also have a very poor prognosis. No significant advancements in the treatment of glioblastoma have occurred in the past 25 years, and current therapies are generally palliative, as they improve the quality of life.

Without treatment, lifespan after diagnosis is about three months. With therapy, and that includes throwing the book at it, average survival is about one year. Some live longer, some less. At any rate, I could be wrong, but Ivan’s descriptions seem to point to this type of tumor.

I first discovered his diary about a year ago, and have been following it since. That he survived two and a half years is quite an accomplishment, and his diary is filled with optimism and hope that he will be the one to beat this cancer. He celebrates his birthday, the birth of his son, his remissions, a vacation, and focuses on the little miracles of life.

However, his last few entries have foreshadowed this final one. His last remission gave him only a reprieve of a few weeks before the cancer returned. He is cautiously optimistic that he still will be around to celebrate his son’s first birthday. The entry after that one, while still trying to be optimistic, is decidedly more retrospective, quieter, reflective. We are not sure what the doctor’s have said because Ivan does not reveal that; however, we sense that it is not good news, and perhaps, there is nothing more that can be done for him.

And this am, I was stunned by his entry.

This is my last diary.

That time has now come.

Ivan is dying, and even though I have never met him, I feel like a friend is leaving me. I was teary eyed this morning as I read this final post, where he thanks his doctors and nurses for his care, while he is still “able” to, and then goes on to try to make some sense of it all.

What I wanted to do with this column was try to prove that it was possible to survive and beat cancer and not to be crushed by it.

I have not been defeated.

Ivan will probably not be here six months from now, when his son celebrates his first birthday, and his son will have no memory of him. Even his three year old daughter, while she will feel the loss, is still too young to understand fully what is happening. As she grows older, she will only have the faintest memory of her father.

But they will have his diary, and they can read about the journey that he was set upon against his will, and how he persevered. Perhaps it will give them courage as they face their own problems and issues, and help them deal with whatever life gives them.

What will politicians think of next? Here in Seattle, they close libraries periodically to save money. I have written to the mayor’s office and suggested that they close down for several weeks instead, as no one in the city would know or care. Libraries are an essential part of life in this city and closures are sorely felt, whereas closing the mayor’s office to save some money would go entirely unnoticed.

So here is another brainstorm. To raise money for poor children’s health insurance, a Washington state senator came up with the idea of taxing plastic surgery. The assumption is that only rich people have these procedures done, and they won’t notice having to pay a “vanity tax.” Thus far, New Jersey is the and only state to tax plastic surgery, at 6%.

I have a better idea. Why not put a whopping tax on junk food? The tax would include all fast food, all junk food sold in supermarkets, and all foods containing deadly ingredients, like known or suspected carcinogens (yes, the FDA allows them) or trans-fats, and over a certain percentage of sugar. Now not only will that raise money for the poor children, but it may help curtail junk food appetites. And that will result in improved health in the general population, and a subsequent lowering of health care costs.

But I can tell you why that scenario isn’t likely to happen. The processed food lobby will throw a fit, and probably run a zillion dollar campaign condemning such a drastic notion. On the other hand, taxing plastic surgery isn’t likely to cause much of an uproar. The American Society of Plastic Surgeons has called New Jersey’s law a “dangerous precedent,” but they don’t have nearly the clout of the food and dairy industry. Now if all doctors got together to protest a tax on medical procedures, that might make some headway.

Basically, politicians pick on those who are unlikely to fight back in any significant way. The idiot who proposed this new tax is Washington state senator Karen Keiser, who, according to an article today in the Seattle Times, thinks that “we could do Botox-for-babies parties. It might be the new thing.”

Botox for babies. Maybe she’d like to hold the first one at her house. And how about “veins-for-vaccines,” where parties can be held to remove spider veins from faces and legs? Or “Kollagen-for-kids?” Yes, the stupidity is endless.

“Anyone who can afford the money for cosmetic procedures, I don’t think they would be deterred by a little sales tax. You pay it on your lipstick.”

Gee thanks, Karen, for that brainstorm. But paying 6.5% tax on a $10 lipstick is slightly less than having to add an additional 6.5% on a procedure that may cost several thousand dollars. Some people spend years saving up to have a cosmetic procedure done. It helps their self-esteem, helps them feel better about themselves, and may even help them keep their jobs if maintaining a youthful appearance is essential.

How about putting a tax on a big Mac with cheese, or on those products which kind of pass for food, but you’d need an organic chemistry textbook to decipher the ingredients? Then we can hold “junk-food-for-junior” parties!

I have mixed feelings about this milestone in health history, I have to admit. I know, I know, primitive dentistry was cruel and unusual punishment. As the story goes, my great-grandmother died from overwhelming sepsis after having a tooth extracted, but it still doesn’t make me feel anymore sympathetic to the discovery of that device which belongs in horror movies–the dentist’s drill.

Primitive drills have been around since the 18th and early 19th century, although most people really didn’t make regular trips to the dentist. Power drills began to appear after the second half of the 19th century, and todays tidbit of history celebrates (?) the electric dental drill, which was patented on this date in 1875, by Kalamazoo, MI, dentist James B. Morrison. It was a revolutionary step in dental technology, and hopefully, technology will continue to march on and someday, dental drills will be obsolete!

After writing all of these depressing health stories, I thought my blog needed a bit of cheer. So what better way to lighten the mood that with a picture of Cosette.

The sad case of Terri Schiavo has been in the media, on and off, for the past decade. I’m not going to go into all of the details, as there is ample information about her all over the Internet (I’ll add some links at the end of this entry) but it is one of the most contested cases of a person’s right to die.

Terri is in what some doctors call a “persistent vegetative state” (’PVS’). Her heart is still beating, she breathes all on her own, and her other vital organs are working, without any assistance. However, she is unable to eat on her own and life is being sustained with an indwelling feeding tube.

The question is; should she be “allowed” to die?

The problem in allowing Terri to die is that she is not dying at the moment. Other cases are far more clear; a terminally ill patient wishes futile treatment to end, the family of a patient on life support with irreversible brain damage agrees to pull the plug, and so on. With Terri, however, the question of her PVS has been disputed and there is not unanimous agreement on it. And in order to “allow” her to die, she will have to be killed.

We Walk the Fine Line

The Schiavo case is riddled with disagreement between the family and Terri’s husband Michael, and as a result, a bitter battle has erupted over what is best for Terri. Her husband has succeeded in getting the courts to rule that Terri’s feeding tube, the one obstacle keeping her alive, can be removed. Jeb Bush, governor of Florida, stepped in and put a halt to that ruling, and gave Terri a temporary reprieve. But now it seems that the courts have once again ruled that Terri’s tube should be removed.

Not to get into the specifics of the case, which includes many factors that question the motives of Michael Schiavo, but instead, let’s talk about what this really means. Is death by deliberately starving a woman to death “natural?” Or is this passive form of allowing her to die just another form of euthanasia? Yes, that terrible “e” word. Why can’t they just come out and say that Terri will be euthanized, because that is what is about to happen? Better yet, why make this poor woman starve to death? If you want her dead, then just kill her and get it over with. Give her a powerful overdose of a narcotic and let her die quickly and quietly.

In October 2003, Diane Alden, writing in Newsmax.com,had some very interesting thoughts about starving Terri to death:

Termination by starvation and dehydration has been used many times before. Reports on elder abuse and news accounts from around the U.S. reveal that it is one of the most notorious ways to kill feeble elderly. It has also been used on disabled and brain-damaged younger people and babies.

It was also used in Auschwitz, Bergen-Belsen, Treblinka and the Soviet gulags. Stalin used starvation as a means of control. Nazi doctors experimenting on unwilling “patients” adopted all kinds of cruel techniques. One of those techniques was starvation and dehydration. It is recorded in the records of the Nuremberg Trials.

Joseph Stalin starved between 6 and 12 million Ukranians to death in about a year’s time. Pol Pot starved and tortured one third of the population of Cambodia. We refer to these actions as genocide. So why do we think it is okay to starve Terri?

I am not opposed to removing life support when it is clearly futile. I don’t believe that allowing a patient to die is a failure. But this is far different. I am horrified that our legal system thinks it is okay to starve a person to death, and think that this isn’t euthanasia. It is, sorry. It is a deliberate move to kill this woman, and it is cruel and unusual punishment. We don’t even starve death row prisoners–they at least get the benefit of a quick and relatively painless demise.

In case you want to know more about Terri:

Terri’s Fight. This is the website set up by her parents. It has extensive information about Terri, her condition, and the latest updates on the case.

Timeline of Terry Schiavo case

From the viewpoint of her husband, here is a transcript of an interview with Michael Schiavo, when he appeared on Larry King Live

By now I’m sure that the FDA would prefer that it never heard that nasty work “Vioxx.” But they were negligent in approving the drug in the first place, and for not following it more carefully during its initial years on the market. Sorry, but that’s how it goes. If the FDA can’t be held responsible, then who is?

“The FDA has become a little bit too beholden to the drug companies and is either unwilling, afraid or unable to get them to do the safety studies that need to get done once there’s a signal that there may be a problem,” said Dr. Jerry Avorn of Harvard, who co-authored an editorial in Tuesday’s issue of Archives of Internal Medicine.

The Chicago Tribune reports that a study just published in the British medical journal Lancet, suggests that Vioxx may be connected to tens of thousands of deaths. Adding further fuel, an editorial appeared a day later in the American journal Archives of Internal Medicine, calling for a major overhaul of the way the FDA approves and monitors new drugs.

It is interesting to note that The Lancet study was done by David Graham, associate director for science in the FDA’s Office of Drug Safety, the same man who said his supervisors tried to suppress his findings in back in November, right before he was scheduled to appear before a congressional committee and spill out the truth on Vioxx.

“The FDA had responsibility for regulating this drug, and they didn’t do what they should have,” Graham said Monday in a telephone interview. “I believe the FDA … views industry as its client and not the public, and that what happened with Vioxx is an example of that.”

With the exception of a labeling change in 2002 that referred to potential heart risk, Graham said, “the FDA allowed Vioxx to be marketed extensively without effectively dealing with the risk or informing consumers.”

Vioxx was the most heavily advertised drug in the year 2000, with the manufacturer, Merck, spending $161 million to peddle it to the public. A second study, also from the Archives of Internal Medicine, found that mass marketing often led doctors to switch patients over from cheaper (and safer) drugs, when it wasn’t necessary at all. Plain old over the counter Aleve and Advil work just as well as Vioxx, except that they can increase the risk of gastrointestinal bleeding. But not everyone needs to worry about that and in fact, the study showed that in 2001 7.6 million patients, or 40% of those at a very low risk of bleeding, were prescribed Vioxx.

Should the FDA withdraw the other Cox-2 inhibitors? Are they as dangerous? Some experts and consumer groups say yes, act now, before we have another “revelation” like the one with Vioxx. The consumer watchdog group Public Citizen has already filed a petition to the FDA to immediately remove Celebrex and Bextra off the market.

And so the sad story continues. Needless deaths caused by, in many cases, a drug that they didn’t need. How’s that for medical progress?

Congratulations to Respironics! They have been voted the the 2004 Troublemaker of the Year by 10News.com in San Diego. The Troublemaker of the Year nominees are “standouts in the field of rascals and scoundrels profiled this past year by 10News.”

Back in September, I posted a few articles about Respironics and how it will no longer maintain and service the iron lungs currently in use by about 40 polio survivors (1, 2 )

Respironics beat out three other competitors for this dubious honor, which was voted upon by the public. Since I wrote the story in September, Respironics has not budged on its position. But there has been growing support for this tiny population. According to 10News.com Rep. Susan Davis is going to bat for the polio survivors and the FDA is also opening a door to other independent parts makers and service companies to step in.

Nursing shortage. It almost sounds like a mantra. Just a few minutes ago I did a Google search of the news, and 11 stories popped up about the nursing shortage. And while they came from newspaper across the nation, they all sounds remarkably the same.

Now here’s a really good one from today, from NBCSandiego.com. Local hospitals in the San Diego area say that they have 1,000 vacancies. As a solution to this monumental problem, someone has come up with the brainstorm of shortening nursing education. Yes, you got it. Train ‘em quick and toss ‘em into the world, and God help the patient.

The plan is this; National University (which I’ve never heard of) is going to squash a two year nursing program into 18 months. In other words, removed a full six months of training. As it is, nurses barely get enough clinical time, and now this school wants to make it even shorter. Amazing that this is seen as a “solution” to the problem.

Statewide, the shortage is estimated at 14,000 nurses. But how interesting that Kaiser Permanente, who employs 10% of nurses in California, isn’t really affected by the shortage. On average, Kaiser has a vacancy rate less than half of the statewide average. Just a few weeks ago, I was speaking with a nurse at one of the Kaiser facilities about a pilot program that they are involved in, and I asked her if it was helping with retention and hiring of nurses. She reiterated what I had already read about, that her hospital, along with the other Kaisers, have taken steps to fill vacancies and retain their nurses. And it’s working.

So what’s their secret? Well, the things that I’ve been preaching about all along. Good pay, good staffing, treating nurses like professionals, creating a supportive environment, good benefits…you know, the little things. Plus, most of the Kaiser facilities are unionized.

So again, if hospitals were truly interested in solving their staffing problems, they’d take a good and hard look at how they treat their nurses. Does housekeeping leave at 3pm and then nurses are expected to pull trash and mop up spills? Are nurses supposed to “pitch in” for the unit clerks on a regular basis, or do they even still have a unit clerk? Are nurse spending most of their time doing paperwork or patient care? Is there a zero tolerance for abuse policy in place or do abusive physicians get a tap on the wrist and do the nurses get blamed when an abusive patient complains about them?

But so it goes. Churn out more nurses, and the faster the better. Of course, pouring nurses into a broken system is just like trying to fill a pail that lacks a bottom.

I’m just waiting to see how this “shortening” of education pans out. Let’s see, an associate degree nurse gets two years of training before she can become an RN. To become a licensed vocational/practical nurse (LVN/LPN), the schooling is generally one year to 18 months. So if they’re clipping an RN’s education, maybe they can clip the LVN’s as well, to around 9 months. And after that, who knows? If the patient death count isn’t too high, they can keep on cutting. The sky’s the limit. Maybe the next step is then to have RNs train in one year, while the LVN education is clipped to 3 months. Cut, cut, cut, and before you know it, we’ll have school down to 15 minutes!

Will that solve the nursing shortage?

Image courtesy of Geekphilosopher.com