Posts are a little scarce these days. I’m in Florida right now, and yes, it is hot and toasty. More like slushy. Humidity galore with thunderstorms. It’s not my favorite type of weather, but on the upside, I’ve been getting my butt out of bed and I’m out walking by about 6:15.

I’m at my mother’s house and there is only dial-up and one phone line, so I haven’ been on the computer all that much. And then I head for Orlando to ASCO.

It figures, just when the weather got nice at home–when it warmed up a little and the rain stopped, I had to leave town. This definitely is not my favorite time of year to be in Florida, but I guess they weren’t going to change the dates and the venue of the conference for me.

A local story now making the national news concerns a 13 year old boy with Hodgkin’s disease who has refused to undergo chemotherapy. He underwent one round, and then told his parents he didn’t want any further treatment. As the story goes.

His parents say they are supporting his decision to use alternative healing methods favored by a Missouri-based religious group, the Nemenhah Band, which bases its beliefs on natural healing methods advocated by some Native Americans.

Now here’s where it gets sticky. The doctors were concerned when he didn’t return to continue his treatment, and the final result was that a Minnesota trial court found that Daniel does not understand his medical situation and lacks the ability to give informed consent on medical procedures.

Daniel Hauser and his mother have now vanished, in defiance of a court order that he return for treatment. The story is all over the news, with a lot of opinions and debates being tossed around.

This is just one of those ever gray areas of medicine, when the parents, child, medical professionals, and legal system all clash with eachother. So many questions, so few answers. Who has the final say in a child’s treatment? The parents or physician? A judge? The child?

I would say that there is no one answer to this, and certainly, this is not a “one size fits all” situation. For example, there is a world of difference between a mature 17 year old and a 2 year old. Both are considered children, but in reality, the 17 year old could just as well be the 2 year old’s parent!

It also depends on the nature of the situation. Parents who stand over a 5 year old who has just been run over by a car, and refuse medical care, leaving it to God’s will vs. a 5 year old with an earache and parents who refuse antibiotics initially (most earaches are caused by viral infections).

What is interesting about this case, aside from all of the other factors, is the child’s age. I don’t know how mature he is, but 13 is the milestone into adolescence. No longer a tween but a teen.

Now, the argument is that a 13 year cannot possibly understand that he has a life threatening condition, or understand the choice that he has made. In other words, he is too immature to make decisions regarding his health, well being, and very life.

Suppose, however, that Daniel was just an average 13 year old without a serious illness, but one fine day just picked up a gun and calmly shot his parents. Would these same judges be saying that he didn’t understand the decision he made to murder? That he didn’t know what he was doing? Or instead, would the prosecutor be clamoring to try him as an adult and give him an adult sentence?

Also, it is conceivable that a 13 year old in the United States can marry. Yes, get married, even without the obligate pregnancy.

While the age of consent is 18 across the board, younger teens can marry in many states with parental permission. Here’s a few examples:

Texas–With parental and judicial consent, parties can marry but not below the age of fourteen for males and thirteen for females.

New Jersey–With parental consent, parties can marry at age sixteen or younger.

New Hampshire–With parental consent and the consent of the judge, males can marry at age fourteen and females can marry at age thirteen.

Massachusetts–With parental consent and/or the consent of a judge, males can marry at fourteen years of age and females can marry at the age of twelve.

If Daniel happened to be a girl, then he’d be old enough to get married in at least 3 states with a parent’s permission. So in the eyes of the law, a 13 year can marry if the parents agree, but not refuse medical treatment even if parents are in agreement.

Interesting.

I’m not offering any opinion on this case, just throwing out food for thought.

Today’s news is filled with sound bytes from a study out of Harvard and Boston Children’s Hospital about Down Syndrome and its relationship to cancer. It is important information, because the science behind the seeming lack of solid tumors seen in people with Down Syndrome is now being cracked open.

From the US News & World Report:

Scientists have long suspected that such genetic benefits might accrue from having an extra chromosome 21. A recent study found that people with Down syndrome are only about one-tenth as likely to get a solid-tumor cancer as are people without the syndrome.

A tumor needs veins and arteries to nourish its rapid growth. So tumors fashion a haphazard cluster of new vessels that mimic a legitimate body process called angiogenesis. The late Judah Folkman of Harvard Medical School in Boston saw angiogenesis as the Achilles’ heel of tumors and suspected that cancer suppression in people with Down syndrome could stem from extra copies of propitious genes on chromosome 21 that thwart angiogenesis.

In the new study, Folkman’s colleagues tested the antitumor effect of RCAN1, alsocalled DSCR1. The researchers compared two sets of mice, some with a third copy of the RCAN1 gene and some with the usual pair. When the mice were surgically implanted with melanoma or lung tumors, animals making the additional RCAN1 protein had less than half as much tumor growth and substantially fewer blood vessels around those tumors as did mice with a normal RCAN1 complement.

However, what every news story that I’ve looked at so far has failed to mention is that Individuals with Down syndrome have a 15 to 20 times greater risk of developing leukemia. The majority of cases are categorized as acute megakaryoblastic leukemia, and often occurs within the first 3 years of life.

Leukemia is different from solid tumors, of course, but I would at least think that should be mentioned instead of making it seem that Down Syndrome seemingly makes a person cancer free. It’s called good reporting, and it doesn’t take much to include a few sentences about this, and if it in someway relates to this new revelation.

Also important to note that individuals with Down syndrome have a higher incidence of a number of medical problems, and that you just can’t sift out a resistance to solid malignant tumors from the whole picture. I’m sure the scientists who published this paper aren’t doing that, but the media reporting on it has omitted mention of that. In addition to a very high risk of leukemia, and developmental problems, up to 50% of individuals with Down syndrome are born with congenital heart defects. Alzheimer’s disease is another issue–while estimates do vary, about 25% of those with Down syndrome over the age of 35 will develop the clinical signs and symptoms of Alzheimer’s-type dementia.

So does any of this tie together? Maybe or maybe not, but it would be nice if at least one story mentioned the high rate of medical problems, and especially, while there may an inborn resistance to solid tumors, leukemia rates are much higher than the general population.

Apparently, some nurses were arrested at a Senate Finance Committee meeting on health care reform because they protested the meeting’s lack of representation for those who support a single-payer health care system.

I doubt that they got violent, but maybe they were disruptive enough to end up in the paddy wagon. Or perhaps the arrest was deliberate, in order to bring attention to the single-payer issue, which has been pretty much ignored in the hubris over healthcare reform.

Again, I think that single payer is not as cut and dry as some make it out to be, and certainly, a lot of issues would have to be addressed in order to make that a reality. But I think that single payer advocates should at the very least, be given a seat at the table along with everyone else, and that option should be discussed.

The AJN has a short report on the great nurse arrest of 2009.

….and hopefully not the same as the old boss. Enough with the ineptitude and corruption that is beginning to define the CDC  into a sinister joke (remember the small pox vaccine, and their continued muddling of real influenza stats–like how many people really die during an average flu year and not the exaggerated computer modelin). A new boss is taking over the agency, and hopefully, we will be leaving politics out of it and bringing in good solid science and common sense.

Physicians and Scientists Hail Choice of Thomas Frieden to Head the CDC

The Infectious Diseases Society of America (IDSA), HIV Medicine Association (HIVMA), and the IDSA/HIVMA Center for Global Health Policy applaud President Barack Obama for his appointment of Thomas Frieden, MD, as director of the Centers for Disease Control and Prevention. (CDC)

Dr. Frieden’s experience-as an epidemiologist, an administrator, a researcher and a clinician-make him an outstanding choice to lead the CDC at this critical moment in protecting America’s public health.

Dr. Frieden will bring to the CDC unwavering dedication, immense talents, and a strong track record of battling deadly epidemics, such as tuberculosis, HIV/AIDS, and most recently the 2009 Influenza A: H1N1 virus that threatens to spark the next influenza pandemic.

“Thomas Frieden demonstrated extraordinary vision, leadership and organizational ability in containing the multidrug resistant TB epidemic in New York in the early 1990s,” said Richard Chaisson, MD, a member of the Global Center’s advisory committee and director of the Johns Hopkins Center for Tuberculosis Research. “He then took that expertise to India, where he transformed that nation’s TB program, creating a model for the world and saving hundreds of thousands of lives as a consequence. His commitment to using scientific approaches to disease control will serve the nation well. He is an outstanding choice to lead the CDC.”

Roy Gulick, MD, chief of the infectious diseases division at Weill Medical College of Cornell University and a member of HIVMA, said Dr. Frieden will be a forceful advocate for putting evidenced-based science into practice in the battle against HIV/AIDS.

“As health commissioner of New York City, Tom Frieden increased community services for the infected community. He emphasized prevention by promoting needle exchange and condom use. He worked hard to promote routine HIV testing so that more New Yorkers would know their status.

He worked closely with HIV providers to monitor the HIV epidemic in New York and reached out to communities of color,” Dr. Gulick said. “With his training in infectious diseases and public health and his track record as New York City health commissioner, he is an outstanding choice for director of the CDC-he certainly will make a difference for those infected and affected by HIV in the U.S.”

“As an infectious disease physician and a New Yorker, I have been incredibly impressed with Dr. Freiden’s response to the recent Influenza A H1N1 outbreak and previous outbreaks of other diseases. Given the potential for an influenza pandemic, all of us should take comfort in having him at the helm at CDC,” said Anne Gershon, MD, president of IDSA and a pediatric infectious disease specialist at Columbia University College of Physicians in New York. “He will be a standout at CDC, but we will miss him in New York.”

Today was the big day, Florence Nightingale’s birthday. And the Daily News in New York has to remind us just how little nursing has advanced. Oh, I’m sure that they meant well, but the headline of the article says it all:

Happy International Nurses Day: Meet New York’s angels of medical mercy

How ObamaCare Will Affect Your Doctor

Is that really a word, Obamacare? I guess so. Anyway, this is the headline of an article in the Wall Street Journal, and it is interesting.  It is written by Scott Gottlieb, who used to work at the FDA, for Medicare and now is a fellow at the American Enterprise Institute and a practicing internist. He’s also partner to a firm that invests in health-care companies, so keep all this in mind as you read his take on healthcare.

That said, I do agree with what he is saying, about a need to fix the reimbursement for physicians and other practitioners, particularly at the primary care level.

From WSJ:

At the heart of President Barack Obama’s health-care plan is an insurance program funded by taxpayers, administered by Washington, and open to everyone. Modeled on Medicare, this “public option” will soon become the single dominant health plan, which is its political purpose. It will restructure the practice of medicine in the process.

Chad Crowe

Republicans and Democrats agree that the government’s Medicare scheme for compensating doctors is deeply flawed. Yet Mr. Obama’s plan for a centrally managed government insurance program exacerbates Medicare’s problems by redistributing even more income away from lower-paid primary care providers and misaligning doctors’ financial incentives.

Right now, Medicare pays docs 20-30% less than private plans, and the new public option will control spending by using its purchasing clout and political leverage to dictate low prices to doctors. The intention is to help the uninsured, but may lead to something more–and the result, like now with Medicare and Medicaid, is for doctors to refuse patients covered by these policies.

There are other ways to lower costs, than cutting into reimbursement. For starters, we should make it less expensive to become a physician–most graduate about $150,00 in debt. And then there’s the cost of malpractice, running an office, paying staff, and so on. Let’s start at the very beginning…

To mothers everywhere, hope you all had a good day. Got nice flowers (organically grown of course), a good meal, nice conversation, a little pampering, and did something fun.

This is a post from a blogger, who is clearly unhappy with the National Health System in the UK. I am neither agreeing or disagreeing with his post, but this is an ongoing discussion, or war as you have it. Clearly, the NHS is not an ideal system, and this may stem from poor management, poor use of the system, lack of real preventive care (British are the fattest in Europe, and just behind the US in obesity rates), economic problems in general, etc. Certainly, I’ve heard horror stories of the conditions of some of their hospitals and also about the absymal way some nurses are treated. Pay sucks, working conditions suck in general, and they are well known for poaching nurses from developing countries to staff their system.

That said, guaranteed health care paid for with taxes does have its advantages. Even if you may have to wait or certain drugs are unavailable.

This blogger writes:

Currently, waiting lists are common for most things on the NHS, especially hip and knee replacement surgeries, which are on the increase as people live longer. You can sometimes wait up to 18 weeks just for a referral. It can then take up to two years to actually receive the operation; that is if you meet all the NHS requirements, which include weight and age. One unlucky 61-year-old was refused life-saving heart surgery because she was deemed too old by a cash-strapped NHS Trust.

Well, that can happen here if you don’t have health insurance, or if you are underinsured. Both of our systems have problems with lack of access, anyway you look at it. People here who scorn socialized medical systems like this one never really look at the hierarchy that exists in the US. We have great healthcare if you can afford it. If you lose your health insurance, for whatever reason, and have a pre-existing condition, you may remain the uninsured until you reach Medicare age. Not a good situation if you are 30 years old when you turn into the leper that health insurance companies flee from.

Socialized medicine often means mediocre and late service. The patient does not get to choose the physician, the hospital, care plan, or timing of the operation or procedure. In Britain, that means relinquishing control and putting your health at the mercy of a system with a zip code lottery. Some Hospital Trusts have more money than others, but on the whole drugs are rationed, waiting lists are too long, and when things do go wrong you have to fight a bureaucratic machine that can take years and lots of your cash to prove medical negligence.

In many ways, our systems are not all that unalike. Especially when it comes to a bureaucratic machine or being at the mercy of a health system. Again, I’m not plugging this as the solution to our healthcare woes, but surely something else exists — in between our system and the NHS? In an alternate reality, maybe?

I’m really surprised that no one from the politically correct squad commented on my views about putting 19th caps on 21st century nursing heads.  Nothing about how it will benefit the patient if their nurses resembles Florence Nightingale, or how the cap closely resembles those worn by maids and afterall, that is how nurses should see themselves–selflessly serving the patient.

And really, to tear apart such a heroic effort at improving nursing during National Nurses Week. Well, glad the nurse police aren’t out and about, or at least, maybe attending to real matters, like workplace abuse.

Cam anything be sadder than this story? After nurses have tried heroically to update the profession, to be treated with respect and to maybe look like they belong to the 21st century, a hospital in England is bringing back “Nightingale style caps.” I feel like I’m going to throw up.

The reasoning? Patients like them. Um, I think patients would be happier if you forgot the caps and instead, paid your nurses better, treated them better, so you might be able to attract more people to the profession and thus have decent staffing. Which translates into better care.

Now isn’t that cap cute? Wouldn’t you love to be taken care of by a nurse who looks like she just stepped out of the 19th century with a doily on her head? Doesn’t that just reek of professionalism?

From the Telegraph:

The nurses’ cap has made a come back at Broomfield Hospital in Chelmsford, Essex, to help patients and visitors distinguish between nurses and therapists.

Nurses on Stock Ward are wearing the distinctive white hats for a three-month trial to gauge patients’ reactions before it is decided whether to roll them out across the hospital.

The caps were originally introduced to keep the nurse’s hair neatly in place and it was used by Florence Nightingale in the 1820s.

Not only is the cap a ludicrous idea, but it would certainly help if the journalist who penned this took 3 seconds to look up Florence Nightingale on the Internet.  There is no name on the article, and understandably so. Sorry to shove this into your face, but Nightingale didn’t wear this cap in the 1820s. She was first born in 1820, so maybe she wore some kind of baby cap as an infant and toddler. Her nursing school wasn’t established until 1861.

Now, rather than ask any of the nurses what they think of the caps, or tell the readers if indeed, the nurses are actually going along with this charade, this brilliant journalist just stuffs the story with silly quotes and more inaccuracies over the history of caps. But this quote is priceless.

Mrs Wilson continued: “The nurses with the armed forces still wear hats and look exceedingly smart and professional.

“I have decided that there was a possibility that nurses wearing hats would remind patients of the value and professionalism that nurses bring to their care.”The Mrs. Wilson is this quote is Gwyneth Wilson, director of nursing at Mid Essex Hospitals Trust.

Now, perhaps Mrs. Wilson has not realized that hats are part of all military uniforms, that they match the military uniforms, and are not simply something that a military nurse sticks on her head. The reason that military nurses wear hats is because it is standard part of a military uniform. Notice, military nurses are not being asked to wear 19th century bonnets.

And that last quote–that’s one of the reasons for the sorry state of nursing. Mrs. Wilson thinks that wearing caps is going to remind patients of how valuable and professional nurses are. Maybe she should also dress them in floor length skirts and aprons, so that they can look just like Florence.

If Mrs. Wilson wants professionalism, perhaps she might fight to get nurses paid as professionals and for them to be treated respectfully. And as director of the trust, to improve working conditions, so that they can provide care for their patients. And the journalist who wrote this ridiculous article should have asked her these very questions.

What a combination.

Journalism at its worst, and a nursing director who is infatuated with 19th century head gear.

We are in the midst of National Nurses Week, and I don’t even want to get into that farce. You know, where employers put up plaques of the “best” nurses (no raise, of course), and give up vouchers for free stale cookies, although you can only get those if you work day shift. You know the drill if you’re a nurse. Maybe they might even give you free parking for a day, or a plastic keychain from China that destined for landfill.

Anyway, National Nurses Week coincides with the birthday of none other than Florence Nightingale. Now, this was the woman who thought nursing should be a calling and not a profession–and I guess really believed that the ranks of the world’s nurses would be filled with wealthy women such as herself who had never so much as brushed their own hair, let alone figure out how to write a check.  She was horrified at the thought of nurses organizing, and bitterly opposed it in the UK. To stoop so low as ….trade unions. My goodness, imagine trying to get paid enough to buy food and pay rent.

But this is her family home, at Embly Park (today its a school). It’s easy to understand now why she was so out of touch with the real world, and with the women who eventually became the trained nurses she dreamed about.

And how do we explain this one, this little glitch which somehow allowed hackers to break in and kidnap a significant wad of data and hold it hostage until ransom is paid?

Kidnapping is getting exotic these days. It used to be people snatched and held for ransom, and now its data. Changing times.

This is from Bruce Schneier’s blog:

On Thursday, April 30, the secure site for the Virginia Prescription Monitoring Program (PMP) was replaced with a $US10M ransom demand:

“I have your shit! In *my* possession, right now, are 8,257,378 patient records and a total of 35,548,087 prescriptions. Also, I made an encrypted backup and deleted the original. Unfortunately for Virginia, their backups seem to have gone missing, too. Uhoh For $10 million, I will gladly send along the password.”

More details:

Hackers last week broke into a Virginia state Web site used by pharmacists to track prescription drug abuse. They deleted records on more than 8 million patients and replaced the site’s homepage with a ransom note demanding $10 million for the return of the records, according to a posting on Wikileaks.org, an online clearinghouse for leaked documents.[...]

Whitley Ryals said the state discovered the intrusion on April 30, after which time it shut down Web site site access to dozens of pages serving the Department of Health Professions. The state also has temporarily discontinued e-mail to and from the department pending the outcome of a security audit, Whitley Ryals said.

Photo courtesy of Stock.xchng

Yeah, being a medical writer and avid networker, I do get on a lot of mailing lists. For a while, my name somehow got on PR phone lists, but I politely curtailed that immediately. No, I do not want to be called to hear about Dr. DooDoo’s latest talk on do-it-yourself face transplants.

I don’t mind getting press releases. Some are quite applicable to my work, some are just very interesting, while others are mediocre/trash and can be remedied by the delete key. Into the bucket with other spam.

But every so often, along comes an offering that I can’t resist. This is a classic spam, a push for the milk industry, disguised as public health/mother’s day article on preventing osteoporosis. To their credit, at least they admit its a shill for the milk industry.
TOPIC: Mom’s Important Role When it Comes to Bone Health
May is National Osteoporosis Awareness and Prevention Month

(notice, the attempt at putting mom together with bone health, to make it all nice and cozy, warm and fuzzy–yes, a glass of milk does all that)

GUEST: Registered Dietitian and Best-Selling Author Carolyn O’Neil

Osteoporosis affects 44 million Americans; and while women are much more likely to develop osteoporosis, men and children can also be at risk. However, osteoporosis is treatable and beatable, but it is important to take care of your bones by eating calcium and vitamin D-rich foods from an early age. In fact, a person’s genetically determined peak bone mass is reached sometime between late adolescence and the early 20s.

(What they fail to mention up here is that osteoporosis is entirely preventable, and in fact, seems to be a disease of industrialized countries.  And the most important source of Vitamin D is sunlight, not vitamin D rich foods, which are quite scarce. Unless of course, we are talking about vitamin D enriched milk! Yay, another plug.)

May is National Osteoporosis Awareness and Prevention Month and a great time to talk about ways we can all build strong bones. A Gift from Mothers to Daughters is the theme of this year’s Osteoporosis Awareness and Prevention Month, which is attempting to break the cycle of generations of women suffering from this debilitating bone disease that affects 1 in 2 women over age 50. (Again, note, it makes it sound like osteoporosis is an inevitable disease and according to these stats, half of all women above the age of 50, who reside on Planet Earth, are suffering from it. They carefully neglect that it is nearly non-existent in many parts of the world, and I find the stats of 1 in 2 women a little bit high even for industrialized nations. I think that they keep extending the parameters of bone density, so that women who have a normal but on the low side bone density are now considered to have osteoporosis or pre-osteoporosis. Better to sell more drugs that way. And milk!)

Registered dietitian, best-selling author and mom Carolyn O’Neil is available for interviews to discuss five steps to optimize bone health and help prevent osteoporosis: (do you think I would ever use this woman as an “expert” to quote from in any story that I wrote?)

-Role-model good nutrition for your children – Several studies have found that mothers who drink milk are more likely to have daughters who drink milk, and research suggests that milk-drinking teens have stronger bones compared to their peers who drink little or no milk. (Now this is very carefully worded. What peers are they comparing them to–girls who drink a lot of soda instead? Soda has been linked to the development of decreased bone mass, so yeah, someone who drinks more milk than soda will probably have stronger bones.  Ditto for eating a diet high in sugar. And what do they actually mean by “stronger bones?” Its such an ambiguous term. But do these stronger bones seen in milk drinkers translate into lower rates of osteoporosis? What about the milk pushing moms? How are their bones doing? I realize that this is just a press release, but the wording and lack of info really grates on the intellect.)

-Engage in regular weight-bearing exercise – Get the entire family moving together with weight training, walking, hiking, jogging, climbing stairs, tennis or dancing. (yes, very good. Exercise is needed, but notice, no mention of making sure to get outdoors to get some sunshine)

-Drink your milk – (the second plug for milk. Can we be more obvious that this is just an infomercial for moo juice and nothing more?) Decades of research have shown that milk helps improve bone density. Milk drinkers are more likely to have strong bones and less likely to break a bone – and that’s particularly true for life-long milk drinkers, as you need a steady supply of calcium early in life to reach peak bone density. (I would love to see the references for their “decades of research” since there hasn’t been one study that showed that drinking milk helped prevent osteoporosis. Not one, and not even studies sponsored by the milk industry. Being less likely to break a bone is not the same thing as avoiding osteoporosis, and I love how they try to mingle the two together. Gotta love PR dweebs flush with industry money)

-Avoid smoking and excessive alcohol – Smoking and alcohol abuse are risk factors for the diseases.

-Talk to your healthcare provider about bone health – Osteoporosis is a major health threat for 44 million Americans and can strike at any age. People cannot feel their bones getting weaker and may not know they have osteoporosis until they break a bone. Have a bone density test.

What this pathetic diatribe also fails to mention is that the highest rates of osteoporosis are found in countries with the highest intake of dairy products.  Now isn’t that a strange finding, one which they also fail to mention. The US drinks more cow’s milk than almost any other country, and we have one of the highest–if not the highest–rates of osteoporosis in the world. But according to this article, drinking milk is necessary to prevent osteoporosis, so therefore, we should have one of the lowest rates in the world.

What is wrong with this picture?

They also fail to mention that about 75-80% of the world’s adults are lactose intolerant. Which means that they lack an enzyme to digest milk sugar.This is not a disorder, but on the contrary, a normal state of being. The enzyme begins to disappear by about age 8 because guess what–milk is baby food and adults were not meant to be drinking it. The body stops producing lactase because it is no longer needed.

Drinking milk if you’re lactose intolerant can cause substantial digestive woes, but hey, diarrhea is a-okay with these guys.

At least they added this in, although how much more obvious can it get that this is just advertising for the dairy industry and not information based on face:

Interview Source: Milk Processor Education Program

Hey Barack, pay attention. Nurses can help with healthcare reform in a lot of ways. Tell the doctors not to get their knickers in a twist, we’re not trying to compete with them, but nurse practitioners may well be the people who dare to go “where no doctor has been before.” I’m not talking about outer space, but into rural areas, inner cities, etc, the places that are suffering the most from shortages of primary care clinicians.

Anyway, if you’re interested, tune in on May 8 to the news conference. Details below:

Whether Dealing with Pandemic or Acute Shortage of Physicians, Nurse-Managed Health Centers Seen As A Key Solution to Health Care Crisis

WASHINGTON, D.C. May 8, 2009–Health care reform is going to mean that nurse practitioners will play a more front-and-center role in treating patients, especially the more than 46 million Americans who currently lack health care insurance and are underserved by today’s health care system. Whether treating patients with the H1N1 swine flu virus or other illnesses, nurse-managed health centers – an innovative delivery model for primary and preventive care, especially for low-income and vulnerable populations – should expand significantly to increase the capacity of the nation’s over-strained health care delivery system.

That will be the message of speakers at the phone-based news conference to be held Friday (May 8, 2009) at 10:30 a.m. EDT by the American Academy of Nursing (AAN) and its “Raise the Voice” (RTV) campaign.

Involving more than 1,500 professionals and organizations, the nationwide RTV campaign is designed to harness the power of nurses, nurse practitioners and other professionals to provide needed primary health care, health promotion and disease prevention through “disruptive solutions” such as community-based care. That is, care delivered by advanced nurse practitioners and related professionals in a holistic, patient-centered way. The goal of a national network of 200 Nurse-Managed Health Centers (NMHCs) nationwide, many of them associated with schools of nursing, is consistent with the call from President Obama to double the number of community health care centers. The American Academy of Nursing’s “Raise the Voice” campaign receives support from the Robert Wood Johnson Foundation; the news conference is supported in part by the Independence Foundation.

News event speakers will be:

* University of Miami President Donna E. Shalala, former Secretary of the U.S. Department of Health and Human Services (HHS) and Chair of the Advisory Committee of the “Raise the Voice” campaign of the American Academy of Nursing;

* Pennsylvania Governor Edward G. Rendell;

* National Nursing Centers Consortium Executive Director Tine Hansen-Turton; and

* Independence Foundation President Susan E. Sherman.

TO PARTICIPATE: You can join this live, phone-based news conference (with full, two-way Q&A) at 10:30 a.m. ET on May 8, 2009 by dialing 1 (800) 860-2442. Ask for the “nurses/health care reform” news event. Copies of speaker slides are available on http://www.aannet.org.

CAN’T PARTICIPATE?: A streaming audio recording of the news event will be available on the Web as of 3 p.m. EDT on May 8, 2009 at http://wwww.aannet.org.

CONTACT: Robin Strongin, (202) 263-2917 or rstrongin@amplifypublicaffairs.net.

I guess that they expected more from Barack, when it comes to insidious microbes and battling them. But in all fairness, he’s got a lot on his plate, even when it just comes to health.  He may be looking more realistically at the costs of overhauling healthcare in the US, as well as other issues, and global health drops down a peg.

I personally don’t think he has broken his promise. Even though I haven’t had a private audience with Barack about this, I tend to think that he has to put some things on hold, and all the hysteria with the swine flu hasn’t helped matters.

The paragraphs in bold letters are the way they were written for the press release, and not my handiwork.

Global HIV/AIDS & TB Experts Disappointed With Obama Budget Call on Congress to Overturn Short-Changing of PEPFAR, Other Health Programs

Leading disease experts said President Barack Obama’s 2010 budget proposal for global health falls far short of what is needed to combat the deadly twin epidemics of HIV/AIDS and tuberculosis.

Details on global health spending were released by the White House today, and a preliminary analysis indicates the President is proposing only $165 million in additional funding for bilateral AIDS as well as the US contribution to the Global Fund.

“This proposal is even worse than we had feared. With this spending request, Obama has broken his campaign promise to provide $1 billion a year in new money for global AIDS, and he has overlooked the growing threat of tuberculosis,” said the Center for Global Health Policy’s Director, Christine Lubinski.

While malaria receives a significant boost, Obama’s call for a meager increase in the President’s Emergency Plan for AIDS Relief (PEPFAR) budget is no match for the scope of the AIDS crisis, which killed 2 million people in 2007, nearly 5,500 a day.

Obama’s detailed budget blueprint comes as developing countries are struggling to preserve their fragile health systems. In several countries, drug shortages and treatment program cutbacks now threaten the lives of millions of HIV/AIDS and TB patients.

This unfolding health crisis could quickly spread, as people who stop treatment become far more infectious. Treatment disruption can also lead to drug-resistance, an extremely expensive and potentially deadly development.

“Increases in the PEPFAR budget are needed to continue progress in expanding treatment access and to invest in prevention interventions, like male circumcision, that will save money in the long run,” said Ken Mayer, MD, co-chair of the Center’s Scientific Advisory Committee. “Sadly, this budget is bound to stall the fragile progress made in saving lives with antiretroviral drugs and could force a self-defeating choice between providing treatment or greater prevention.”

The President’s proposed budget includes only a very small, $10 million increase for bilateral TB programs, which is woefully inadequate for a disease that killed more than 1.7 million people in 2007. With drug-resistant TB on the rise across the globe, a much more aggressive commitment is needed to battling this deadly, debilitating ailment.

Investments in preventing and treating HIV and TB are urgent because they strengthen underlying health systems in the developing world, bolstering their ability to respond to other disease outbreaks such as influenza.

“Short-changing the response to TB is extremely shortsighted, since last month the World Health Organization called drug resistant TB a ‘time bomb,’” noted Carol Dukes Hamilton, MD, co-chair of the Center’s Scientific Advisory Committee. “Today’s Obama proposal contradicts the bill that the President co-sponsored last year when he was a U.S. Senator, which promised $4 billion over 2009-2013 for TB programs,” she said.

AIDS and TB experts were also disappointed by Obama’s proposed US contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has saved an estimated 3.5 million lives from these three deadly diseases since its 2002 inception. The Fund also provides significant resources for health system strengthening.

Increased support for the Fund is vital to increasing capacity in poor countries to develop and support large-scale health programs. The Fund is facing for this year and next a $5 billion donation gap, jeopardizing a program that provides a quarter of all international financing for AIDS globally and two-thirds for tuberculosis. Leaders at the Center for Global Health Policy vowed to press Congress for an emergency infusion of resources into the Fund through the 2009 supplemental budget and a $2.7 billion commitment to the Fund in fiscal year 2010.

I don’t know this person, but I just saw this article about her. She’s in medical school and has leukemia, and is in desperate need of a bone marrow transplant. I know, there are a lot of sad stories, but I guess I am highlighting this one because she is a future healthcare professional, and who knows, may decide to become an oncologist–a specialty that is shrinking in numbers but increasing in need.

So if you are mixed black/white, and willing to up some cells to a good cause, check this out.

Natasha Collins needs a hero.

Collins, 26, was diagnosed with leukemia in 2006 and needs a bone marrow transplant, which could save her life. She is waiting on the right donor, but that is proving difficult because she is half black and half Caucasian.

Because of that, her chances of finding a matching donor are less likely.

“It’s scary,” Collins said. “I try not to think about all the consequences all the time. I try to keep it day by day.”

Of those listed in the donor registry of the National Marrow Donor Program, mixed race people representing a mere 2 percent of the total, according to the Mavin Foundation.

Because of this, the odds of a patient of any minority heritage, or combination of heritages, being able to find a BMT donor when needed are extremely small.

Originally from upstate New York, Collins takes classes at Yale Medical School and lives in New Haven while undergoing chemotherapy treatments.

The chemotherapy and an umbilical cord blood transplant prevailed for a year and a half, but she relapsed in February of this year.

Many nurses served in Vietnam, and it is important to note that Vietnam was the first war in which MEN were allowed to nurse. Ironic, isn’t it, to think of how reverse discrimination resulted in hundreds of male nurses (I’m assuming hundreds rather than thousands, since not that many men were nurses during WWII and Korea) could not work as nurses. Even though the need was dire for trained healers, and even though there was an abundant supply of men who could serve as soldiers, male nurses were not permitted to work as such until Vietnam. Talk about stupidity and idiocy.

In fact, there was an episode on the popular TV show MASH, where the subject came up. It wasn’t the main storyline, but there was a male soldier who said he was a nurse, but couldn’t work as one in the army. The military instead, forced him to pick up a gun and learn to kill, rather than allowing him to be at the bedside of the injured and sick, and save lives.

So this little background scenario brings me to the subject at hand. The American Journal of Nursing has a nice story in this month’s issue about Vietnam Women’s Memorial. It’s been a long time in coming, but is finally here.

According to the Vietnam Women’s Memorial Foundation (www.vietnamwomensmemorial.org), more than 265,000 women-almost 90% of them nurses-volunteered for service in the U.S. military during the Vietnam War era. About 11,000 of these women were stationed in Vietnam. The average army nurse serving in Vietnam was under the age of 24, and 65% had less than two years of nursing experience. They found that their own fear of being in a war zone was quickly replaced by the need and desire to care for others.

Kettlewell, like many nurses who served in Vietnam, faced overwhelming trauma and danger and witnessed a great deal of death. Most nurses were young and inexperienced-unprepared for seemingly endless pain and tragedy. And unknown numbers returned with PTSD and painful memories of caregiving situations. This past year, the 15-year anniversary of the Vietnam Women’s Memorial recognized the heroism and sacrifices of these women with a candlelight ceremony, storytelling, a reading of the names of those who died in Vietnam, and other events.

If you go to the article, you can also click on icons for images and podcasts. Nice story, AJN!

I can’t believe that it is May, and the 3rd day of the month no less. What happened to March? Or even April? This seems to be the fastest year on record–going by the fastest and I’m getting the least amount of my goals done.

Well, I shouldn’t say that. I have decided to make it a point to write shorter posts, with some exceptions, and blog every day. Which I’ve managed to do for about two weeks? I also signed up at Twitter and am tweeting away, and building up followers. I signed up at Linkedin, although I do need to complete my profile. Facebook is the final frontier, at least for this round of social networking.

But I just had a nice day out, instead of sitting by my computer. Went to see a good friend and meet two new kitties (exceedingly cute). Made an effort to go to Seattle on Thursday to meet with work colleagues who were in town. So yes, I am getting less lazy and am going to sign up for a cooking class next week.

Well, time for dinner, but I just wanted to check in. And now, back to regularly scheduled programming–swine flu, nursing shortage, the sky is falling…

The CDC has a list of swine flu cases, as of today, in the US. But what is missing from this chart and the webpage, is any information about the acuity of the illness. So far, it seems one person has died–a toddler visiting from Mexico, where the cases seemed to be more severe, at least initially. But there is no information on how many of these people required hospitalization or even treatment, as compared to regular flu.

Even though some people receive anti-viral treatment for the flu, most do not need it and recover on their own–or would recover on their on without any drugs. So without any comparative information, there is really little to go on here. Just the number of actually proven cases, which is quite low. There may be more cases, but if so, then they must be fairly mild if the patient did not seek medical care or testing.

It is unfortunate that there have already been blatant false alarms which leads people to lose faith in our infectious disease experts, and the media for fanning the flames of hysteria. The 1976 panic over swine flu was a fiasco, and the dire warnings of the bird flu–that we were in imminent danger of a massive pandemic that would kill millions upon millions–never happened. And lest we forget the small pox vaccine initiative, when we faced imminent danger of a bioterrorist attack, and the call was out to vaccinate the so-called first responders. When the vast majority flatly refused, and started asking questions about risk, side effects, paid time off, manufacturer liability, etc, and when less than 10% of the number projects were actually vaccinated, the plan was quietly shelved. Amazing how the threat of a bioterrorist attack also vanished, and nothing has been said since.

So in lieu of these past events, it is not unusual that many are quite skeptical. I think we should remain guarded and watchful, but that’s it. Considering the despicable environment of factory farming, it is not surprising that pigs get ill and when you have thousands crowded together in unsanitary conditions, not unusual that viruses will mutate. Add that to the overload of antibiotics that are fed to commercially raised farm animals to fatten them up, and to keep them from getting sick (an attempt to make up for the unsanitary and cruel environment), and we’ve got a perfect mix for breeding new and resistant diseases. The virus jumped species and seems to have quickly adapted itself to a human to human transmission, which is something that did not happen with the avian flu.

Instead of panic, wringing hands, and trying to find the ultimate vaccine, we should be devoting some energy to eliminating the cause and cleaning up farming.