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.

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.

I love old photos, especially the ones that depict daily life from another era. Well, since we are all being inundated with talk of the swine flu, the coming and long awaited pandemic, etc., I thought it was fitting to put in a link to these great old photos from the 1918-1919 Spanish flu epidemic. Courtesty of the National Archives.

In the photo below, a Seattle streetcare conductor is refusing to let passengers on board who do not have a mask. Like those flimsy masks were really going to keep the flu bugs away, but I suppose better than nothing.

I really wanted to take a break from the swine stuff, but here’s one more for you, and then its on to other things–unless this swine bug really picks up.

From the blog of Dr. Joseph Kim:

The World Health Organization (WHO) is raising the pandemic alert to phase 5 (and phase 6 is the highest level).

“Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short.”

Full fledged frenzy over the swine flu, reports the Chicagoist.

What started as a buzz late last week has grown into full-on shrieking as this year’s SARS has stepped up to the plate. With confirmed cases coming in from all over the country – including two in Kansas – the panic over the swine flu is rising. Which is fair enough: so far, 100 people are reported to have died in Mexico from the disease and it seems to be spreading fast. The threat of a pandemic even has the European Union urging cancellation of “nonessential travel” to North America.

It’s difficult to figure out exactly how many people in the continental US have actually come down with it, and more importantly, if it is really any more virulent than the ordinary winter time flu. Is it? I don’t know.

We also don’t know how serious and large the outbreak will get. Does it spread like normal flu? Is there more reason to worry? It’’s hard to say with so many mixed reports and so much misinformation.

It’s not to say that we’re overreacting this time, and certainly, one has to be prudent. But the hysteria that some tried to whip up about the avian flu has been unfounded. Every now and then, there’s still a case reported, but please, the projected pandemic remains just that–projected.

But in 1976, there was another bout of swine flu, which led to a decision to mass vaccinate the public. What happened was that in 1976, 2 recruits at Fort Dix, New Jersey, had an influenzalike illness. Isolates of virus taken from them included A/New Jersey/76 (Hsw1n1), a strain similar to the virus believed at the time to be the cause of the 1918 pandemic, commonly known as swine flu. Serologic studies at Fort Dix suggested that >200 soldiers had been infected and that person-to-person transmission had occurred. A 19 year old private died of the infection.

However, it seemed that the vaccine was more deadly than the flu. According to the LA Times, “More than 500 people are thought to have developed Guillain-Barre syndrome after receiving the vaccine; 25 died. No one completely understands the causes of Guillain-Barre, but the condition can develop after a bout with infection or following surgery or vaccination. The federal government paid millions in damages to people or their families.”

So it seems that another bout of swine flu is brewing. Time magazine has an interesting article on how to avoid the mistakes of 1976, when dealing with the current outbreak.

For ER nurses, are you seeing more patients coming in with symptoms of cold/flu, and panicking over having swine flu? Are they coming in with symptoms that they might normally just ignore or treat at home, but instead, showing up in the ER because they are afraid that they have contracted swine flu?

Not that I’m trying to deter tourism away from Florida, but there has been an outbreak of meningitis caused by a rare viral strain–W135.

So far, only 12 cases, primarily in Dade County (Miami area). But 4 of the 12 infected died, so it is a virulent bug and one not to mess around with. The W135, which accounts for about 3 percent of all meningitis strains, can kill within hours of symptoms–which include  severe headache, fever, nausea, vomiting and a stiff neck. If that applies to you, stop reading my blog and get to the ER pronto.

The troubling part is that it doesn’t seem to be confined to one geographic location. The people infected were all over the place. But since the W135 strain is so rare, health officials believe there is some connection by which it was passed on from Patient Zero to the other 11 victims.

In case you missed, bird flu has been upstaged by swine flu. And unlike the few, albeit highly lethal, cases of bird flu in humans, the swine flu has made a major jump from pigs to people.

From MSNBC:

A new swine flu strain that has killed as many as 68 people and sickened more than 1,000 across Mexico has “pandemic potential,” the World Health Organization chief said Saturday, and it may be too late to contain the sudden outbreak.

Now, lest you think that this is just “south of the border” and of no importance to those of us living in the northern regions, its important to note that microbes have no knowledge of national borders. Or state borders. And they can travel very quickly, especially when airborne.

The disease has already reached Texas and California, and with 24 new suspected cases reported Saturday in Mexico City alone, schools were closed and all public events suspended in the capital until further notice — including more than 500 concerts and other gatherings in the metropolis of 20 million.

So it’s here. Watch out.  KevinMD has a nice report about it on his blog.

Another Earth day. Have we made any progress since the first Earth Day way back when in those ancient times, circa 1970?

A few interesting tidbits. First, it seems that Earth Day had its humble beginnings in Seattle. Yes, Seattle of all places, during its pre-Microsoft days, when the waterfront was a bawdy spot for drunken sailors looking to get laid, and Starbucks just a mere twinkle in the eye of a caffeine lover. The city was green, because of all the rain, so perhaps that was the idea behind the green revolution.

Second, the person who first announced that there would be an Earth Day, in September 1969 at a conference in Seattle, was  U.S. Senator Gaylord Nelson of Wisconsin. Note, he has the same last name as me, so that must be some kind of omen that I was meant to be a radical veggie savior of the environment.  Anyway, at this meeting in rainy pre-Microsoft pre-Starbucks and pre-grunge Seattle, he  announced that in spring 1970 there would be a nationwide grassroots demonstration on the environment. This occurred during a time of great concern about overpopulation–that concern gets less press these days, but never fear, reproduction is alive and well and an out of control population still remains the greatest environmental threat.

Nelson viewed the stabilization of the nation’s population as an important aspect of environmentalism and later said:

“The bigger the population gets, the more serious the problems become … We have to address the population issue. The United Kingdom, with the U.S. supporting it, took the position in Cairo in 1994 that every country was responsible for stabilizing its own population. It can be done. But in this country, it’s phony to say ‘I’m for the environment but not for limiting immigration.’”

Senator Nelson first proposed the nationwide environmental protest to thrust the environment onto the national agenda.” “It was a gamble,” he recalls, “but it worked.”

Finally, the third most vital point is that the date chosen was April 22. No accident or coincidence, I assure you. That is today, and it is the day right before my birthday. So Earth Day is sort of the opening ceremony to my birthday, and then the real celebration is tomorrow.

Just two ordinary folks, working to improve healthcare. Its an interesting story on NPR, about people organizing and trying to organize the public, to improve healthcare. That’s how it starts, one step at a time. One person at a time..

Amazing as it may seem, there are actually people opposed to this bill. People in the medical community who think that education is dangerous. And that women are better off ignorant about their bodies.

Fight Pink aka HR 1740.

This is about an benign as it gets, so you really have to wonder who would be opposed to legislation they will introduce to highlight the breast cancer risks facing young women under the age of 40 to empower these women with the tools they need to prevent and fight this deadly disease.

Killer McCarthy

Now I’ve seen everything. Here is a website called the “Jenny McCarthy Body Count” and it blames her for all children in the US who have come down with an illness that is preventable by vaccine, and all deaths due to vaccine preventable illnesses. Now I realize that vaccination has been a hot button issue for many people, especially with the controversy over the HPV vaccine, but come on. Get a life.

The website was put up anonymously (come on, you feel so strongly about it then show your face), and puts up reproduced data from the CDC on morbidity and mortality. Note, and this is important, that the CDC data is just a table. It gives absolutely no information about the patients or their circumstances. While it might be quite true that the reason for the illness or death is due to the fact that the parent is opposed to vaccines, and as far-fetched as it may be, perhaps this parent was mesmerized by Jenny McCarthy and decided to ‘mimick her idol (including posing for Playboy), there is a good chance that its not the reason for most cases.

However, there are multiple reasons for the lack of vaccine protection, which the owner of this shadowy website doesn’t seem to have considered:

1) the vaccine may have been ineffective–yes, it does happen. Vaccines fail to “take.”

2) the child may have been unable to receive proper vaccination due to allergies to vaccine components

3) the child may be immunocompromised and unable to receive some vaccines

4) child may be otherwise ill with any number of serious conditions, and unable to receive vaccines

5) child may have recently immigrated to the US, and may have already been infected upon arrival

6) child may be recent immigrant, and family doesn’t understand vaccine policy, know that they are available, or whatever. It’s not like there is a great primary care health system in place in this country, and many immigrants are isolated

7) family situation may not be very conducive to child’s welfare, and parent is neglectful. This type of situation has nothing to do with any opinion about vaccines or Jenny McCarthy. In fact, in some case, the kid is lucky if he gets something to eat, let alone vaccinated.

child may have had a severe reaction to a vaccine, and parent is fearful and distrustful that all vaccines may cause a reaction.

9) May have received vaccines but immunity has waned. This is particularly true for the pertussis vaccine, and it has now been firmly established that immunity from that vaccine may be gone by the early adulthood or even late teens.

These are reasons that some children go unvaccinated, or not fully vaccinated, and it has nothing to do with any particular ideology, or a particular person, including Jenny McCarthy. But the anonymous website master wrote:

In June 2007 Jenny McCarthy began promoting anti-vaccination rhetoric.  Because of her celebrity status she has appeared on several television shows and has published multiple books advising parents not to vaccinate their children.  This has led to a dramatic increase in the number of vaccine preventable illnesses as well as an increase in the number of vaccine preventable deaths.

Has Jenny McCarthy been responsible for a “dramatic increase” in in the number of vaccine preventable illnesses as well as an increase in the number of vaccine preventable deaths? If so, then why does this person’s list only go back 2 years, to June 2007? Can we have a look at the number of cases prior to 2007, so as to make an intelligent comparison?

Also, there is not a steady climb in the death rate from June 2007 until March 21, 2009 (those are the beginning and end dates as of today). There seems to be a cluster of cases from early Feb 2008 to early April 2008, and then the number drops down. Then it climbs a little for March 2009. So it is uneven.

Now, the poster contradicts him or herself:

Is Jenny McCarthy directly responsible for every vaccine preventable illness and every vaccine preventable death listed here?  No.  However, as the unofficial spokesperson for the United States anti-vaccination movement she may be indirectly responsible for at least some of these illnesses and deaths and even one vaccine preventable illness or vaccine preventable death is too many.

He/she admits that McCarthy isn’t directly responsible, and may only be indirectly responsible for some of them….but yet, still has assigned McCarthy the title of unofficial spokesperson for the anti-vaccination movement. Uh, I hate to be a party pooper, but having worked in maternal/child health since the 1980s, I can assure all of you, that questioning vaccine safety did not begin with McCarthy. There have been very vocal critics of vaccine policy for the past 2 decades, who were out there on center stage writing books, getting press coverage, putting together websites as the Internet became popular–way before McCarthy ever gave birth. So trying to pile the body count on her conscience is just silly. And as I said above, there are numerous reasons other than an anti-vaccine stance why kids may not be getting all their shots.

Finally, while it is sad that anyone should get sick or die if it could be prevented, the numbers are extremely low. In two years, there were 142 deaths, which is 71 a year. Considering the amount of children (and the ages aren’t given on the CDC report for most categories so some of these may be adults/teens whose immunity has worn off!), it is a tiny percentage of the population. Even the 720 who became ill and survived, over a 2 year period. Still exceedingly low.

I really don’t have time to go searching through data right now, but it would be nice if the poster would put up some numbers prior to 2007, so we can see if the numbers did increase. And even if it is true, there are many reasons for it, other than Jenny McCarthy. I think the poster is giving this woman more credit than is due–I have barely heard of her, I had no idea what she thinks about vaccines, and I tend to think that for the majority of people living in this country, her opinion is of no consequence.

Remember the day and time. March 28, 2009, at 8:30-9:30pm local time.

That’s when the lights go out.

I never heard of Earth Hour before, embarrassing to say. But its an uber world wide movement to cut off the lights, save energy and see the stars.

If you really want to go greener than green, turn off all of your electric power. No lights, no TV, no microwave, no oven (if electric), no computer except on battery…amazing how dependent we are on power. But I think for one hour, it can be managed for a lot of us.

Eat dinner before or afterwards, or have a romantic dinner by candlelight, even if you live alone.

Invite friends over for an “Earth Hour” party. Make it a community thing.

Do some star gazing. If its a clear night, and enough lights are out, you may even see a star or two. In my neighborhood, it won’t make much of a difference since there aren’t any streetlights to begin with.

It is only an hour. Surely you can live without TV for an hour. And its a good experience if you have kids. Just explain it to them what’s going on, and how they personally, are helping the planet.

Earth Hour

I’ve written about the “service with a smile” previously, and about how hospital administrators (the ones who never got close enough to a patient to see the blood and poop) think that they are running a 5 star resort. Nurses are a combination concierge, housekeeper, cook, and slave, and administrators make sure that their customers (aka patients) are aware of that.

Even if it kills the patient.

And from what I’ve been reading, it seems that nurse managers and supervisors are also so busy brown nosing administration, that they too, forget that patient care and safety is the first priority. This is a story (which I have condensed and paraphrased) that a nurse posted on allnurses.com. It is really scary.

A child was admitted with a viral illness and febrile seizures, and the mother was a local physician’s secretary (uh-oh). The mother wrote a formal complaint to the hospital management about the nurse, because she committed the crime of checking the baby’s temperature every 4 hours. Now, if a baby is admitted with seizures due to fever, I would certainly hope that he was being monitored closely. In fact, I would expect temps to be taken every two hours. The baby also had an IV in, which does need to be checked–make sure it hasn’t infiltrated, flowing properly, sufficient fluid in the bag, etc.

But this parent said that the nurse “compromised the sleep of her baby and her” by coming into the room and checking the temp, and that the nurse’s actions were “insensitive to her needs” and that basically, the nurse should have just said “night, night,” and closed the door behind her, and left them alone for the shift. Unless, of course, mom wanted room service at 2am, or eggs benedict at 7am with a mocha latte (hold the foam).

I don’t know if the mother complained to the nurse or not, or if anything transpired between them–ie, mom telling the nurse not to disturb them, etc. If so, I would have told the mother that she is in the hospital for a reason (or did she think she was at Disneyworld?) and that her child needs to be closely monitored. This is the standard of care at this facility, these are the physician’s orders, and that we can’t care for her child if we are unable to look at him and assess him. If that speech failed, I would have phoned the physician and the nursing supervisor, and dumped it into their laps. Bottom line–you want a peaceful night of sleep without a pesky nurse trying to take your baby’s temp–then don’t come to a hospital. Or check out AMA.

Most shocking was the reaction of the nurse manager, in response to the complaint. It goes to show that a working brain is not required for the job. The manager told the nurse that in the future, she should check with families if it is “okay” to disturb them at night for vital signs and assessments. The nurse then asked her manager if she would be held responsible for a dead or seriously ill baby, should the family refuse to be disturbed during the night. The manager hesitated and said she wasn’t sure.

Double, triple and quadruple..DUH!

The poster doesn’t say how she responded to the manager, but again, her reaction to the complaint is so inappropriate–she should have her license revoked. The manager should have supported the nurse without question, and told the recipient of the complaint that this was unit policy, physician’s orders, and it was for the safety and well being of the patient. Throw in the word malpractice a few times, and lawsuit, and they start to get the message.

And her response that she wasn’t sure if the nurse would be held responsible? How about she take the responsibility instead? If a family again decides that they are at a poshy resort and don’t want their sick baby disturbed at night, the nurse calls the manager and lets her make the decision–and then charts it? For further back-up, the nurse should also call the physician and the nursing supervisor–and let everyone know that this family has come to the hospital to sleep, and not get their baby treated.

The customer service bandwagon is galloping out of control, but I’m sure that the weenies who came up with this bright idea never imagined the worst case scenario–that disgruntled customers, like the family whose baby dies from neglect because of their stupidity, are going to the sue the hospital and not the nurse. They are going to head for the big pockets.

Strong words, I know, but nurses and other employees scored a major victory in Alaska. Providence Alaska Medical Center rescinded its policy that every employee receive a flu shot as a condition of employment, right before the deadline to do so.

From Anchorage Daily News:

Providence Alaska Medical Center on Thursday rescinded its policy that every employee receive a flu shot as a condition of employment.

The flu shot requirement “was the right decision for the safety of our patients and community,” said hospital administrator Bruce Lamoureux in a press release. “We do acknowledge, however, the strong feelings that the requirement and its swift implementation elicited in some employees.”
The move brings to a close a controversial month for the state’s largest hospital, which employs 3,100 people. Some employees supported the preventative measure while others balked, calling it a violation of their rights.

Interestingly enough, healthcare workers are some of the people least likely to get flu shots. Surely, if flu shots were so effective, and if hospital patients were really dropping like flies–due to catching the flu from their nurse or respiratory therapist–health care workers would be more compliant, n’est-ce pas?

In reality, about 60% of doctors and nurses refuse to get flu shots. I think this policy that Providence Hospital tried to enforce merely has to do with trying to cut down absenteeism in its workforce and has nothing to do with patient health and safety. I’ve yet to see any real data that large numbers of hospitalized patients are contracting the flu during their stay, and that the transmission is coming from healthcare workers.

Research anyone? Stats? Any real information and numbers, other than the CDC’s dreary “36,000 people die of the flu every year and 200,000 are hospitalized with it?” The CDC has not released any real numbers on death rates and certainly, nothing on the supposed connection between unvaccinated healthcare workers and passing the flu to unsuspecting patients. As any nurse knows, you are more likely to contract something from the patient, than the other way around.

I thought I had already blogged on the Alaska situation, when they first passed the mandate, but I guess not. FYI, physicians were not included in this ruling. I guess its okay for them to carry the germs, but not nurses. My guess is that the hospital rescinded because of the grievance filed by the Alaska Nurses Association, and also fear of lawsuits. They would have no way of defending their ruling, in the absence of any real data or the fact that it didn’t extend to doctors. And if patients are really contracting the flu when hospitalized, then the most likely source of transmission are visitors.

This is from Newsminer.com, about the original ruling.

is tomorrow. It is almost 30 years since the first published document about AIDS appeared in MMWR in 1981, a short little article about 5 gay men with strange problems afflicting their immune system. Of course, it was not the first time this strange syndrome had appeared, but the first time it appeared in the scientific literature. Thus, June 1981 has been marked as the beginning of the AIDS epidemic.

According to UNAIDS estimates, there are now 33.2 million people living with HIV, including 2.5 million children. During 2007 some 2.5 million people became newly infected with the virus. Around half of all people who become infected with HIV do so before they are 25 and are killed by AIDS before they are 35.

But as we get ready to mark World AIDS day, some experts are saying that the epidemic is overblown

Interesting article and some points to consider. The different viewpoints are all valid, but it all adds up to the same thing--money. How should we best be using scarce resources?

One good use of money would be to increase salaries of nurses and physicians in developing nations so that these people have some incentive to stay and work in their homelands. While brain drain is talked about, nothing seems to be done about it.

While neither candidate is offering a universal system of health care, it does seem that Obama is closer to the mark. McCain’s plan sounds like Bush’s idea of privatizing Social Security–give people tax credits and let them choose. Sounds all well and good, that people should have a choice, but in reality, how much of a choice does one actually have?

Regulation of the health insurance industry is pathetic, and I fear that a McCain led government would make it even more “free market.” In other words, continuing to pander to the wealthiest corporations.

A regular nurse, maybe even a hokey mom or a pitt bull with lipstick (but one who sounds a lot more coherent that Caribou Barbie, who is in dire need of lessons in English language syntax) penned a nice opinion piece about the healthcare positions of the two candidates.

The gap between the rich and the poor is widening. This gap and current structure of our health care system has affected the health of all Americans. If we do have insurance, we are paying higher deductibles and in some cases, have to get permission from our insurance company to access the care we need. Our employers are unable to provide raises and invest in expansions due to the rising cost of insurance premiums.

Here are a few examples of the annual compension packages paid to CEOs of some of the major insurers: United Healthcare $8.3 million, WellPoint, Inc. $5.2 million, Cigna $4.7 million (Atlantic Information Services, April 24, 2006). Can you see where I am going with this?

So the next time you get an insurance raise, and they give you the usual corporate “bleeding heart” whine about growing medical costs, ask them about their CEO’s compensation package.  Should $8.3 million of your insurance premiums really be going to line this guy’s pocket, especially when after paying your exhorbitant premiums, they still demand a copay of 25%?

Do either of our candidates have a plan to streamline insurers and force them to be accountable? Or to force them to insure everyone who wants it, even if they had their tonsils removed 25 years ago? Or were treated for acne in 1962?

Despite the shortcomings of both candidates, this nurse feels that Obama has more of grip on reality, and on a plan that is more workable.

Studies by the Tax Policy Center say the Obama plan would reduce the number of uninsured Americans by 18 million in 2009 and McCain’s plan would only reduce the number of uninsured by 1 million in 2009. In my opinion, the McCain plan falls short of most Americans’ expectations. The United States is the only industrialized nation that does not have a universal healthcare system.

Healthcare has fallen a bit by the wayside, in lieu of the more urgent financial crisis.  But it is still important, and it is a chronic issue that is going to be waiting for us after the dust clears.

I was going to blog about something entirely different, until I looked at Google news and saw that today ushers in a month of pink.

Pinky this and pinky that, all in the same of curing breast cancer.To be quite honest, this whole campaign makes me a little queasy. One, because the “pinkettes” have somehow turned a dreadful disease such as breast cancer into a trendy and feminine and celebrity ridden “event.” We run for the cure, do dances for the cure, buy pink colored nonsense because a company is going to give some undefined proceeds to curing the world of breast cancer…while the real issues remain silent.

Real issues like why has the rate of breast cancer–that is, the number of women who get the disease, showed such a dramatic increase over the past few decades? The pink brigade tends to be silent on that, and instead, the whole movement is focused on the elusive cure. A world without breast cancer, they say. Well, that world isn’t going to happen until we take a serious look at the causes (and many are known but its safer just to ignore them) and address it.

The safe causes, which are often cited by rote, are the increased used of mammography, more women delaying childbearing, rising obesity rates and perhaps the popularity of hormones to treat symptoms of menopause. I will agree, these factors could have added to it, but do not show the whole picture. Take for example, this chart, from 2004.

Note: numbers are per 100,000.Source: J. Ferlay, F. Bray, P. Pisani and D.M. Parkin. GLOBOCAN 2002. Cancer Incidence, Mortality and Prevalence Worldwide. IARC CancerBase No. 5, version 2.0. IARCPress, Lyon, 2004.

Note the position of the U.S. on the chart. The highest incidence of breast cancer. Not the highest death rate, but certainly, these numbers should give one pause. Why is the incidence of breast cancer so high in this country? Certainly other industrialized nations are grappling with the usual suspects, ie, delayed childbearing, increased use of mammography, rising obesity rates, and hormone use. So what is it about the U.S. that gives us the distinction of almost being the breast cancer capitol of the world?

But hey, we’ve got pink ribbons and bon bons. And women with breast cancer can even get pink teddy bears and all sorts of cutesy items.

There is a really good commentary in the Guardian about pink month, and her disappointment in the lack of real discussion about breast cancer.

October is breast cancer awareness month, and the breast cancer industry is in overdrive. You can buy a plastic duck with swirling eyelashes from Cancer Research UK, exclusively designed by Twiggy. Or you might purchase a pink product from Next, which will donate 10% of proceeds to Breast Cancer Care. Breast cancer is indeed the darling disease of the corporate world. And it has lodged itself in the national consciousness in a way that HIV/Aids once did, but this time without the icky wrong-sort-of-sex connotations.

Imagine that, a duck with swirling eyelashes, all in the name of breast cancer. I have a better idea–instead of wasting money on pink objects you don’t want, have no use for, or paying 10 times the amount of what they’re worth–why not just donate money to the breast cancer charity of your choice? It’s a better bet for your buck.

In her excoriating essay Cancerland, the American writer Barbara Ehrenreich describes induction into the pink and perky world of breast cancer, following her own diagnosis in 2001. “In the mainstream breast cancer culture, one finds very little anger, no mention of possible environmental causes, few complaints about the fact that, in all but the more advanced, metastasised cases, it is the treatments, not the disease, that cause illness and pain.” She begs: “Let me die of anything but suffocation by the pink sticky sentiment embodied in that [ribbon-branded] teddy bear.”

Infantilising merchandise aside, Ehrenreich correctly identifies the unspoken in the breast cancer discourse. Disease rates have increased by more than 50% over the past 20 years in industrialised countries. From the preservatives in our lipsticks to the flame retardants on our sofas, little is said about the possible link between everyday chemicals and breast cancer. The majority of money raised goes to treatment rather than prevention. And, meanwhile, car and cosmetics manufacturers continue to appropriate the (untrademarked) pink ribbon to boost their image with consumers as they boost their bottom line.

I couldn’t say it better myself. So while finding effective treatments for breast cancer is certainly a priority, and we have done a very good job in prolonging life and curing the disease, the unspoken needs to become the spoken.

Pink somehow washes the disease, making it seem less ominous. Pink is a sweet color. So should we all be good girls and not question the powers that be, and just dutifully wear our pastel bracelets and run for the cure? And tiptoe around the unspoken causes, because someone’s feelings (and profits) might get hurt?

Photo courtesy of Stock.xchng.com

Salary. The faux pas of nursing. The purists believe that nurses are angels of mercy and shouldn’t be concerned with anything so mundane as money. Those with an iota of common sense believe that nursing is a stressful job, one that requires a great deal of skill and responsibility, and that you should be making more money than the 17 year old checking your groceries at Whole Foods.

But what do nurses really earn? It is so hard to tell, since every survey comes up with remarkably different results, and the results often differ from the “real world” experiences reported anecdotally by nurses.

This came into my in-box today, courtesy of Nursing Spectrum/Nurseweek. Now, this particular publication tends to skew a bit, meaning that it always tries to present the rosy side of nursing, and never the dismal realities.  Even when they’re discussing a serious and morbid subject, such as workplace violence, they somehow manage to spin sunshine into it.

There’s nothing wrong with optimism, but I find that their articles don’t do much to present a balanced portrayal of nursing. For example, I’ve never seen them tackle the subject of nurses being cancelled due to low census. Or being forcibly floated to work on units where they have no skills or just don’t want to work there. Why not?

Anyway, it doesn’t mean that their survey is inaccurate, but I just have to wonder who exactly, they surveyed. And there is no real explanation of the results. Are these staff nurses, or per diems (who generally earn more per hour)? How many years experience do the nurses have, do these figures include overtime, shift and weekend differentials, etc. What kind of facility are these nurses working in–makes a big difference much of the time.

Also, note that they combined nurses in all different types of jobs to come out with their “average” salary of $$62,618. Managers, administrators and APNs can earn a great deal more than a staff nurse, and thus give this average quite a boost, even though they are in the minority. All in all, I think this survey would be more useful if they would break it down more carefully, and tell us exactly what a staff RN with XX years of experience makes per hour in any one of these locations. For example, RNs working at an academic medical center in Southern California, with 5 years experience, average $XX/per hour as their base pay. That kind of information is useful, not this hodgepodge mixed together. But then, as I said, this publication strives for the rosy picture, and its nice to make nursing salaries look as high and attractive as possible.

So here they are:

A reader profile study of Nursing Spectrum/NurseWeek nurse readers released in 2007 provides a mixture of results, influenced by specialty, setting, and experience. Of the 2,598 total respondents, 1,910 answered a study question about their approximate annual incomes and 1,720 answered a question about their hourly wages for a regularly scheduled shift.
How does your salary rate compare with the Nursing Spectrum/NurseWeek readers who responded to this Harvey Research Inc. questionnaire? Do you rank with the more than 14% of RNs who earn between $60,000 and $69,000 per year?

Nurses’ salaries, of course, depend on level of education, years of experience, type of work, and specialty area. They also vary from from location to location. The majority of survey respondents from across the U.S. are BSN grads (39.3%) with 21 to 30 years of experience (33.2%), who work full time in hospitals (49.7%) in a med/surg primary specialty (13.9%). About 60% are not certified in their nursing specialty or subspecialty area.

Of the almost 75% who responded to the question on salary, the average salary was $62,618. This group included nurses who provide direct patient care (46.3%); managers (9%); educators/staff developers (5.5%); APNs/CNSs (5.4%); and administrators (2.6%).

Notable Findings in Nurses’ Earnings by Region

Southeast
Average Annual Salary: $57,261
Average Hourly Wage: $29.60

Florida
Average Annual Salary: $59,204
Average Hourly Wage: $30.00

IL/Chicago
Average Annual Salary: $58,810
Average Hourly Wage: $32.00

Midwest
Average Annual Salary: $53,759
Average Hourly Wage: $29.10

New England
Average Annual Salary: $61,707
Average Hourly Wage: $36.10

NY/NJ
Average Annual Salary: $73,630
Average Hourly Wage: $37.30

Philadelphia
Average Annual Salary: $61,719
Average Hourly Wage: $33.40

DC/MD/VA
Average Annual Salary: $63,920
Average Hourly Wage: $34.50

South Central
Average Annual Salary: $59,288
Average Hourly Wage: $28.80

Northwest
Average Annual Salary: $59,562
Average Hourly Wage: $32.90

California
Average Annual Salary: $74,950
Average Hourly Wage: $41.60

Heartland
Average Annual Salary: $52,771
Average Hourly Wage: $28.80

Southwest
Average Annual Salary: $59,562
Average Hourly Wage: $32.90

Other Data

Now, keeping the limitations of ths survey in mind, I found data from 2005. Unfortunately, the link to the whole article is no longer valid. But still, there was quite a difference from 2005 to 2008. It’s barely 3 years, and things have not changed all that much.

If you live in a metro area of California or New York, for example, you stand to have a higher paycheck than your cousin in rural North Carolina. Our results show 70 percent of California RNs and 72 percent of New York RNs making $55,000 or more. These figures are comparable to BLS statistics, which say the top five highest annual mean wages for nurses are in California ($65,100), Maryland ($63,070), Massachusetts ($59,890), New York ($59,370) and Hawaii ($59,570).

On the other hand, only 31-34 percent of RNs in rural New England, Indiana, North Carolina, Tennessee and Alabama make that much.

Florida

I am especially leery of their salary rates for Florida, which is generally cited by nurses as being very low paying, considering the cost of living. In 2007, a nurse wrote that “A nurse with 10 yrs experience can make $27.00/hr full time with benefits. Cert pay for ACLS and PALS add another $1.50 and speciality certs like CEN, CCRN etc adds another $1.50. ” This was for Brevard County.

That comes to about $56,000 a year. However, some report that new grads start out at $18/hour or lower, which certainly pulls the salary down quite a bit. Brevard County is also on the mid-Atlantic coast, and the location of the Space Center. Salaries in less affluent parts of Florida are lower, and higher in areas like Miami and Ft. Lauderdale. A nurse just reported that starting pay in Tampa/St. Pete area is about $20/hour.

The website from the Florida Nurses Association states even more dismal stats:

Salaries vary depending on locale. However, the average starting salary for a new nurse in Florida in acute care ranges from an average of about $15.00/hr or $31,200/year. Salaries increase with experience. The salary range of an ARNP can range from $45,000 to over $90,000 generally. Salaries of nurse administrators are comparable to the ARNP salaries.

Wow, $15 an hour.  That’s about what I made working per diem/registry in Florida 25 years ago.  But look at the ranges they’re giving. No wonder the Nurseweek survey is so vague.  If you just take the poor nurse making $31,000 a year, and combine her with the ARNP making $90,000 a year, you get an average of $60,000. Hardly an accurate figure to throw out and say, “This is what the average nurse makes in Florida.”

Beware surveys. Do your own homework. Ask employers upfront, ask other nurses what they really make. Don’t get sideswiped by “feel good” surveys.