From Time.com:

On July 17, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, scrapped plans for a large clinical trial of the government’s most advanced HIV vaccine candidate to date. The vaccine, a two-shot injection, was designed to fight HIV infection a new way — by activating the body’s cell-based immune responses rather than by relying on antibodies to HIV.

It’s not a complete surprise, as a similar vaccine failed to live up to expectations last year. Very disappointing, and there’s not much else on the immediate horizon.

Early on in the AIDS epidemic, the experts were very confident that there would be a vaccine within a few years. Once the virus was identified, it was only a matter of putting the components together and coming out with the magic potion. But as the years passed, and vaccine attempt after vaccine attempt failed, the outlook was less rosy.

While I don’t think that efforts to find a vaccine should be abandoned, I do think that the emphasis should be on preventing and treating the disease. We know how its spread, we know how to stop it. Which is why it is so devastating to see the U.S. throwing away funding to meet political and idealogical goals, rather than the needs of the population being served. See my post from July 18.

Like, does it make sense to ignore sex workers? Are they going to disappear if they are ignored, go uneducated about AIDS, and untreated? Are they not going to infect anyone if we refuse to acknowledge that they exist? And do the wealthy politicians in the US have any inkling that sex work is the only job for many of these young girls (and boys)?

Or the idea that needle exchange is going to encourage people to be drug addicts. Please, that philosophy reeks of the “just say no” attitude. Drug addicts don’t live in a vacuum. If they share dirty needles, they spread infectious diseases. It’s as simple as that. And then not only will they become ill (and become a burden on society if you want to look at it monetarily), but they will spread it around.

Anyway, in lieu of the elusive vaccine, we need to work with the information and tools that we have right now.

Well, they didn’t exactly throw it away, but just missed a golden opportunity to make better use of funding. To channel funds where they are needed, and to use the money wisely, and get the most for the buck, so to speak.

The Center for Health and Gender Equity (CHANGE), in partnership with Advocates for Youth, the International Women’s Health Coalition, American Jewish World Service, the Sexuality Information and Education Council of the United States, and the National Council of Jewish Women is issuing the following press statement in response to the recently passed Senate bill (S. 2731) to reauthorize the President’s Emergency Plan for AIDS Relief (PEPFAR). The organizations emphasize the Senate’s politicization of public health and failure to rectify serious flaws regarding PEPFAR’s prevention policies that will have harmful implications for the health and rights of women and girls worldwide. Please contact CHANGE if you have any questions.

It’s Broke, But They Won’t Fix It:
The Senate Authorizes a Global AIDS Relief Package that Comes Up Short

Washington, D.C.–On Wednesday, the Senate voted 80 to 16 to reauthorize the President’s Emergency Plan for AIDS Relief (PEPFAR), a five-year, $48 billion global initiative to combat HIV/AIDS, tuberculosis and malaria.

The Senate missed a golden opportunity to epitomize the generosity of the American people by making U.S. global HIV/AIDS relief more effective, compassionate and fiscally responsible. As a result, millions of people are at greater risk of HIV infection.

Under pressure to act quickly, policymakers failed to address critical shortfalls in the bill that would have ensured effective use of scarce public funds and a sustainable response to the pandemic. Much has been learned since PEPFAR was enacted in 2003. However, rather than heeding to the evidence collected by our own government agencies, the bill passed by the Senate compromises sound public health practice for ideology and political expediency.

* One key change that should have been made in the PEPFAR bill was the abolishment of arbitrary funding guidelines that determine how money can be distributed on the ground. The Senate bill calls for spending at least fifty percent of prevention funds designed to halt the sexual transmission of HIV, in countries with generalized epidemics, only on abstinence and faithfulness programs. PEPFAR recipients that do not meet this requirement must justify their programmatic decisions through an onerous reporting requirement to Congress, potentially facing defunding.

This provision was left in the bill despite a 2007 report from The Institute of Medicine, which recommended the removal of PEPFAR’s then-requirement that one-third of prevention funds be spent on abstinence-only-until-marriage programs. The Senate’s decision to leave these de facto restrictions in the bill means that those fighting the HIV epidemic on the front lines will be deprived of the vital discretion they need in determining how funds are best spent.

* The PEPFAR bill passed by the Senate also failed to fully increase protection for women and young people, two groups increasingly vulnerable to new infections in nearly every region of the world. Women and young people are most likely to use family planning and other reproductive health services, and would benefit greatly from a strategy that integrated HIV prevention and treatment with family planning. Recent studies suggest that upwards of 90 percent of HIV-positive pregnant women in countries such as Uganda and South Africa have unmet need for integrated family planning and HIV services. However, the bill passed by the Senate fails to call for, or even acknowledge, the need to strengthen critical linkages between family planning and reproductive health services and HIV prevention efforts.

* The 2003 PEPFAR legislation contains a provision that enables organizations receiving U.S. funding to pick and choose the prevention and treatment services they wish to provide. Millions of dollars go to organizations to provide prevention services, even though they refuse to discuss the potential of condoms or other contraceptives in preventing the spread of HIV. As abstinence and partner reduction programs have outpaced programs that enable individuals to have all the information they need to prevent HIV, the law stands in the way of the effective use of resources.

The Senate has taken this bad policy and made it worse by extending the so-called “conscience clause”, or refusal clause, to organizations that provide care and support to people living with HIV/AIDS, their families and their communities. This provision paves the way for taxpayer-funded discrimination based on “moral” and religious grounds, allowing PEPFAR funding recipients to refuse to provide care for someone based on their religion, how they got infected or any other basis. The refusal clause is yet another damaging provision that flies in the face of good public health practice.

* Lastly, the Senate upheld the requirement that groups fighting HIV/AIDS overseas publicly pledge their opposition to prostitution and sex trafficking before receiving U.S. money. Prevention programs that have reached sex workers, a group that is marginalized and exceedingly vulnerable to HIV infection, have yielded dramatic reductions in HIV transmission. According to numerous reports, the pledge has led to further alienation and discrimination of already-stigmatized groups. This policy drives sex workers underground and away from the non-governmental organizations and health workers best poised to provide them with services they need to protect themselves from infection.

It is our moral obligation and fiscal responsibility to use PEPFAR funding to prevent as many infections as possible. However, large sums of money, spent unwisely, will not save lives and will require an ever growing need for increased resources in the future. The bill fell short exactly where more was needed: full and flexible funding of prevention programs that would enable us to make a difference in the lives of millions.

What is wrong with these people? The purpose of the funding is to prevent and treat infectious diseases, and not spread the moral viewpoints of a few wealthy Americans who can’t even begin to fathom what life must be life for people that the funding is supposed to help. I’m so glad that Brazil refused U.S., because it would compromise the great inroads that they made in treating HIV infection. But unfortunately, other countries don’t have that option–they need the money. So the most vulnerable people will continue to fall through the cracks, organizations that are given funding will have the option to pick and choose patients based on “morality,” and a full third of the funding will be tossed out on the abstinence until marriage programs which have failed miserably.

Sad, sad, sad. A great opportunity has been lost. And we can’t just blame Bush for this, because obviously, this was a bipartisan vote.

A lot of news about more babies getting hit with heparin overdoses. But as much of the news in the popular media, the information is incomplete and vague. I’m assuming that since it’s for a general audience, they assume that the public is too stupid to understand anything more detailed.

From the Wall Street Journal:

This time, it’s more infant overdoses: 17 babies at a Texas hospital got too much of the blood thinner; one has died, though hospital officials told CNN that it remains unclear whether the heparin contributed. Nurses keeping IV lines clear apparently used 10,000 units of heparin instead of 10, and the error wasn’t caught until two days later.

What kind of IV lines are they talking about? No one routinely flushes an IV line with heparin, unless it’s an arterial line. And even then, a tiny amount of heparin is mixed in with the IV solution, and that is normally done by the pharmacy. So what kind of lines are they flushing? Hep locks? That would only take a minute amount of fluid to flush through.

It would be nice if they actually explained what happened. Did the nurses add the heparin to the IV solution that was running through an arterial line and make an error–like use the wrong concentration? Was the vial mislabeled?

But of course, everyone has an answer for cutting down on medical errors, while ignoring the obvious.

The quality gurus at the Leapfrog Group, a consortium of employers aiming to improve health quality, said the problems underscored safety issues at hospitals across the country.

“Incidents like this are the reason why computerized systems for ordering medication in hospitals has been The Leapfrog Group’s number one safety measure that it urges all hospitals to take,” said Leapfrog CEO Leah Binder in a statement. Studies cited by Leapfrog suggest that computerized systems could cut drug error by 50% to 100%.

They’re not wrong of course, but I got into a “discussion” with a physician at a conference who also thought that computerized systems were the answer to all our prayers. Perhaps the WSJ article might also have told us about the staffing at these hospitals where the errors took place. How many patients did each nurse have? How sick were they? How many hours of mandatory overtime were they working?

Most medical errors are generally caused by a cascade of events that happen that lead up to the error–and since the nurse is at the end of the food chain, she often gets the full blame. Which isn’t to say that nurses shouldn’t pay attention to what they’re doing, but the current working conditions actually encourage errors of all kinds, and no amount of computerized systems is going to make up for lack of staff.

But again, nurses should not be working in unsafe conditions. ICU nurses should not be taking 3 patients (I hear complaining about it, but still the good nurse takes the assignment for the “sake of the patient”), and nurses should refuse mandatory overtime. They should take the time to read the labels of the meds they are giving, and if they get behind in their work, then they need to speak up. If they have to stay over to finish, then demand overtime. I met a nurse once who kept talking about how she could never finish her work on time, and generally had to stay over at least an hour every day to finish charting, but never asked for overtime. Even though her workload made it impossible to leave on time. What a dream nurse she was–every CEO’s dream.

Anyway, these hospital error stories, particularly the ones about heparin, are really getting tiring. How about we hear a story about a hospital that has actually done something about it? Like increased their staffing, makes sure pharmacy double checks what gets stocked on units (especially NICUs), gives nurses safe assignment and “stocks” the units with ancillary staff like clerks, respiratory therapists, aides, etc. Uses a computerized system that is user friendly and that actually makes the nurse’s life easier rather than more difficult? Are there any stories like that around?

Now how scary is this. Isn’t being a nurse hard enough without having to worry about being attacked by your wonderful patients or their loving family members?

The NY Times printed a wonderful story about dangers in the hospital. Finally, something other than the usual whining about the nursing shortage and how we have to step up recruitment and sanitize nursing so that students and potential students don’t know what they’re getting themselves in for. Just visit www.discovernursing.com if you want to see the greatest con job ever told.

But getting back to workplace violence–of course, hospitals say that its not their fault.

Richard Wade, a spokesman for the American Hospital Association, said health care facilities should not necessarily be blamed for patient violence. “These things don’t happen because of breaches of security,” he said, “but because something happens that you can’t predict, and nurses are on the front lines.”

But Mr. Wade added that hospitals were very much aware of the issue and were addressing safety concerns in a variety of ways, among them increasing camera surveillance, expanding the security staff and training employees to deal with potentially violent situations.

“You want to have good security, but you don’t want it to feel like going through an airport screening or like a place in lockdown,” he said. “Hospitals are by their very nature supposed to be open, caring places where patients and families feel safe and don’t feel imprisoned.”

Hmmm…does that sound like PR spintalk or what?

Maybe they can’t predict violent episodes, but they can certainly be better equipped to handle them. Like what about having an emergency button in every room, that a nurse can press if a patient or visiting even shows signs of hostility. And the response to the call button is 2 minutes or less. Is that possible? Of course it is, but most hospitals don’t really care if their nurses get beat up. They don’t want to invest money in their protection. In fact, many nurses say that they are discouraged from writing up incident reports. Nursing schools still fail to teach that nurses are not punching bags, and there should be zero tolerance of abuse from anyone. Hospitals are more interested in customer service, and in not antagonize the patient or family, even they push the nurse out the window.

There should be security in the emergency rooms at all times. Security should be patrolling round the clock. But despite Mr. Wade’s cheery spin, most facilities are woefully lacking in trained security, and response time is dismal. And yes, hospitals are places where patients and families should feel safe, but then, so should staff. And having extra security also protects patients.

The article goes on to say that according to the federal Bureau of Labor Statistics, half of all nonfatal injuries resulting from workplace assaults occur in health care and social service settings. While some areas of healthcare are intrinsically more dangerous than the average office, ie, a psychiatric setting, that is still no excuse. There should be extra security. Nurses should never have to be in a vulnerable position in a ward or facility where violence occurs on a regular basis. Nursing homes have some of the poorest staffing, yet they are prime for violence because of the mental disturbances of many of the residents. Yes, that little old lady can pack a punch.

This is the most frightening of all:

The level of violence may well be higher, since the government figures include only the most serious incidents. A booklet published by the Occupational Safety and Health Administration in 2004 noted that violence in health facilities was “likely to be underreported, perhaps due in part to the persistent perception within the health care industry that assaults are part of the job.”

I rest my case. This perception didn’t come out of nowhere. The lack of protection for staff, the idea that nurses aren’t supposed to complain–even if a patient is crashing a chair over their heads, and the failure of hospitals to stand up for their staff. It’s the ER, these things happen. A gunshot isn’t so bad, you’ll get over it. so what if the patient bit your head off–there’s worse things in life…

But you know, this all goes back to nurses and other staff taking a stand. Nurses have to stand up for themselves, they need to file incident report and press charges (horror of horrors) and need to refuse to work if conditions are unsafe.

Is Pharma a dirty word? Do nurses who “defect” and go off to work for pharmaceutical companies sell out their souls and become defiled?

Or is working in the pharm industry simply another option for nurses, and should I add, one that pays well and doesn’t include wiping up puke in the job description?

The reason I bring this up is that I came across a posting by a nurse who seemed absolutely horrified that her coworker would leave the marvelous land of hospital nursing and go off to work at a pharm company. The nerve. And to think that her pay check would double, she would be off on weekends and holidays, and the company actually offered her a pension plan.

Granted, pharmaceutical companies do not have the best reputation, but some of it is media hype. And certainly, some of the problems within the pharm industry are reflections of the healthcare system as a whole.

But this posting reminded me of an essay I had read a number of years in a nursing magazine, one of those first person pieces penned by a nurse who had defected from the hospital but was now “seeing the light.” This particular nurse had worked in ICU, gotten fed up with the usual abuse, poor working hours, low pay, etc., and had left hospital nursing. Now working as a pharm rep, with a job that gave her a huge boost in pay, a company car, an opportunity for travel, and more regular hours, this nurse suddenly felt “dirty.” Like the job was stealing her soul and tainting her with pleasures of the flesh.

So what does the good nurse do? She returned to the hospital, and now felt that she had been “cleansed.” In fact, she now said that she felt “clean.” And here she was, back on night shift, running up and down hallways and would no doubt soon be complaining about her aching back and varicose veins, but at least she was clean.

The essay, as you might be able to tell, left me feeling ill. I think we can look at this from 2 different angles. The first goes back to the ancient concept that nurses are supposed to be poor, work out of love, and should expect to be manhandled and abused. Afterall, they are angels of mercy which is just a step above being a martyr. Any self-respecting nurse who gets to wear a suit to work, and not have a dinner tray thrown at her by an irate patient (with the hospital talking heads warning her to just “forget the incident or else”) should feel defiled. If you’re not suffering, then you’re not a real nurse.

The other take on this is that working for big Pharma is dirty. Period. You touch their brochures, bottles, and cash a check, and you’re dirty. It’s a big bad industry, and only the corrupted Satan worshipers go and work there.

So let’s see. Well, this particularly nurse, from what I can recall, didn’t really have any complaints about the company she was working for. She didn’t say that she was being forced to lie and cheat and adjust clinical trial data so that a big potential blockbuster could come on the market. Nothing of the kind. And for those nurses who think that working for a pharm company is bad just because, well, consider that the next time your patient needs a drug. Do you refuse to administer the prescribed drugs because you think pharma is bad? Do you tell the patient that–sorry, I refuse to give you this insulin because pharma is bad bad bad, and I am defiling myself by having anything to do with them.

Yes, have nurses who think that working for pharma is dirty ever considered that aspect? They develop the drugs but you’re the one who gives them. Touche.

However, I tend to think that my first rendition of this rings truer. It’s the guilt complex, the martyr complex, the idea that nursing is a calling and you shouldn’t even be paid for the privilege of getting stuck with a contaminated needle or berated by a pinhead wearing a manager’s cap.

Not much else to say about Jessie Helms, except the more I read about the details of his tenure in the Senate, the more, well, the more I can say that the world will be a better place without. At least, the world was a better place once he stepped down. Supported all the genocidal dictators in Central America during the 1980s–what a compassionate guy. Well, so as long as they weren’t communist, it didn’t really matter how many people were tortured and killed under their regimes.

But I wonder, as I mentioned in my previous post, if Jessie’s deeds really started to catch up with him. From AP:

As he aged, Helms was slowed by a variety of illnesses, including a bone disorder, prostate cancer and heart problems, and he made his way through the Capitol on a motorized scooter as his career neared an end. In April 2006, his family announced he had been moved into a convalescent center after being diagnosed with vascular dementia, in which repeated minor strokes damage the brain.

Did the horrors that he supported, including his war on funding for AIDS, really manifest as health problems? Did he have a conscience somewhere, buried in the midst of all that hatred and bigotry. Afterall, Helms and his wife adopted a 9 year old boy in 1962 with cerebral palsy–so surely, there had to be a thread of compassion somewhere in his soul.

But at any rate, Helms suffered from a host of physical problems that just kept mounting. I view it as the poison in his soul finally poisoned his body. Maybe it was only after he was suffering and in pain from his illnesses, that he was finally able to feel compassion for AIDS victims.

Who knows.

I suppose that this is a strange blog entry, in that I am commenting on the death of Jesse Helms. There are blog entries and newspaper articles and essays all over the print media and Internet, and I’m sure you can hear all about ol’ Jess on any TV news station.

To say the man was controversial was an understatement, and I can safely say that I didn’t shed any tears when he finally retired from the Senate. He was sickly, decrepit, and maybe his conscience was catching up with him. I remember seeing a photo of him riding around on a scooter, an indication that his mobility was waning and his health was becoming precarious.

How ironic that he died on Independence Day. I suppose that he would think that confirmed him as a true patriot, and indeed, the news is full of people call him one. I kind of think a little differently; a man who excelled in marginalizing large segments of the population cannot be a patriot, any more than one who breathes hate and intolerance can be considered a Christian (think Jesus=love). He even called the University of North Carolina, the outstanding school from his own home state, a “university of Negroes and communists.” Believe me, he didn’t mean it in a complimentary way.

But I’ve gotten off track. I want to focus on one aspect of his career, and that is AIDS (my blog, afterall, is health related). It’s an interesting story about Jesse and AIDS, because he went from being “damn those gays, they brought it on themselves” and trying to block funding for the disease, to publicly repenting and working to help AIDS patients in Africa. Remarkable.

First, here’s a little rundown about Jesse Helms and AIDS from Tom’s Civil Liberties Blog at About.com:

Until his very last year in the Senate (when he finally agreed to support an Africa AIDS funding bill), Helms did everything he could to block federal AIDS funding (declaring AIDS to be a fair punishment for homosexuality) and led that charge throughout the Senate in the 1980s. Because of his partially successful efforts to delay AIDS research and prevention efforts, he is indirectly responsible for the early deaths of millions.

So what can I say positive about Jesse Helms? Well, he became less of a visible segregationist when it became politically unpopular to be a segregationist, and he grew less opposed to AIDS funding when it became politically unpopular to oppose AIDS funding. I guess that demonstrates some kind of moral progress, either on his part or on the part of his constituents. But most of all, he retired in 2002–and the life he has led since then was almost certainly much more noble, much more admirable, than the life he led in the Senate. Could he have become a good man over the past six years? Maybe so. Probably so. Let’s run with that.

Perhaps he realized that he was getting close to the end of his life, and maybe having so much blood on your hands is not the best way to enter the hereafter. Maybe he realized that his behavior was profoundly un-Christian, and he was having visions of hell and a smiling Devil beckoning to him. Because if he really believed in heaven and hell, then his actions on earth directed him to only one path (hint: he wasn’t going to be meeting up with St. Peter any time soon).

However, this is another interesting story about his conversion to compassion. An interesting essay about Helms by David Waters at the Washington Post, entitled “Under God.”

Helms, who had spent many years slashing foreign aid budgets, had rendered his judgment on AIDS loudly and clearly. In 1995, for example, he told The New York Times that the government should spend less money on people with AIDS because they got sick as a result of “deliberate, disgusting, revolting conduct.”

But after talking to Bono, Helms apologized and said he was ashamed. “I have been too lax too long in doing something really significant about AIDS,” Helms said.

What did Bono tell him?

“Christ only speaks about judgment once and it’s not about sex but about how we deal with the poor, and I quoted Matthew, ‘I was naked and you clothed me, I was hungry and you fed me.’ Jesse got very emotional, and the next day he brought in the reporters and publicly repented about Aids. I explained to him that AIDS was like the leprosy of the New Testament.”

If a rock star can have that sort of impact on Jesse Helms, there’s no telling what Jesus can do.

What strange bedfellows, Bono and Jesse Helms, but maybe it did actually happen this way. Although I suspect that Helms was already feeling some degree of remorse, that maybe he needed to embrace the 21st century and perhaps try to amend for some of the devastation that he was responsible for.

I hope that his change of heart helped generate funding for AIDS in Africa. I hope that at least one human being has been helped by his change of attitude.

I came across this website while just doing a little browsing for any new insights into the nursing shortage–you know, hoping to find an article about how a facility has discontinued canceling nursing shifts when patient census is down, or how they are stocking their place with state of the art technology that will make the lives of nurses easier, or have adopted realistic nurse-patient ratios –you know, stuff that will help keep nurses on the job.

Instead, I found this odd website devoted to the nursing shortage. The title of the website is “Nursing Shortage” and then it has a nice little set of buttons down the side which are supposed to tell you all that you ever wanted to know about the nurse scarcity gripping the nation.

There is no mention of who owns this site, who runs it, or anything–just a half-baked generic email address. And if you actually click on the buttons and read the content…well, with each click, it looks suspiciously more and more like PR double talk.

“Reasons behind the nursing shortage” makes no mention of burn-out or experienced nurses leaving the profession. It only gives the usual, tired, let’s get out the violins excuse of how schools can’t mass produce enough little nurses on the assembly line. And yes, it also squeezes in about the boomers getting old, decrepit, and sickly, and how they will need nurses to change their catheters and bedpans…

And yet, the usual schtick about nurses retiring…

Are we in Kansas yet?

The other sections are no more enlightening. This is from their section on “addressing the shortage:”

When the factors behind the nursing shortage are thoroughly analyzed, it becomes apparent that in order to begin to fix the problem, one of the factors in this cycle needs to be stopped. The cycle is such that there are fewer nurses because many older nurses are retiring. However, there are fewer nursing graduates entering the field because of a lack of funding to nursing schools and programs. How can these younger nurses be expected to enter the field if their educational needs cannot be met? The most important way in which the nursing shortage can be addressed is through this avenue. In order for the shortage to begin to be alleviated, the lack of funding and space in these nursing programs needs to be evaluated. Because of these constraining factors, not enough applicants can be accepted and therefore graduate ready to enter the field –and the shortage continues to grow.

The rest of the section is just as silly. Nothing about improving working conditions, retention of nurses, and so on. The section called “World of Nursing” does mention burn-out, but its entire focus is on long hours–12 hours shifts which many nurses actually prefer working–and on unsafe patient loads. But the way they put it:

Nursing shortages and turnover rates have been reported to be the highest in critical care facilities, in which nurses are worked for long hours and have to care for more patients then they feel they can safely care for.

Uh, what about other areas of the hospital? Unsafe patient loads are not mentioned, like the med/surg nurse assigned 10 patients–6 with IV meds, 4 who can’t get out of bed, 5 with colostomies, 3 with NG tubes, 2 on oxygen…you get the idea.

They also make no mention of mandatory overtime, which is one of the reasons why nurses are working such long hours. Or of the general disrespect that nurses get on the job, or verbal/physical abuse, or hospital PR weenies screaming that the “customer is always right” even if the patient slugs the nurse in the face….and so on.

It’s hard to figure out who put together this brilliant little piece of information. There’s a lot in it about agency nursing and travel nursing, so I’m assuming that a temp agency put it together. If anyone thinks that putting out nonsense like this is “helping” the nursing shortage, they are sadly mistaken. It merely just helps to fuel the myth that hospitals are desperate and willing to do anything to hire and keep their nurses, that workplace abuse just doesn’t exist, and that the primary reason for the shortage is a lack of new nurses.

This is like, getting so old…

It seems that our neighbors north of the border are also having a little crisis in healthcare. Canada’s healthcare system is remarkably different from ours, but it seems that they are plagued with the same problems when it comes to staffing shortages. And according to this article from the National Post, it seems that they are taking the same dumb-assed approach to solving a physician shortage (which was artificially created in the first place) that we are taking to solve the nursing shortage here (also artificially created).

The country [Canada] has approximately 15,000 too few doctors, a figure roughly double the total number of students in all years of study at our 17 medical schools combined. At a doctor-patient ratio of just 2.3 per 1,000 population, we are 24th on the list of 28 industrialized countries. Approximately 1.5 million Canadians cannot find a family physician as a result.

No, it isn’t the climate that is causing the shortage in Canada. The problem is multifaceted and complex, just like the nursing shortage here. It was created artificially, and the brilliant idea to solve it is to shorten medical training.

Yep, you heard right. Shave off a year of medical school, from 4 years to 3. And voila, all the issues that caused the shortage in the first place will disappear. Surely, whoever dreamed up this idiocy must have been receiving intel from the same idiot who decided that shortening nursing education in the US was the key to solving the shortage. Some brilliant minds at work no doubt. Just mass produce them puppies, and all troubles will melt like lemon drops.

The writer of this editorial agrees with me, and thinks that the idea is insane. Just like putting a bandaid on a head injury where your brains are oozing out of the skull.

If this scarcity can be alleviated, even in part, by shortening the duration of doctor training, it might be worth a look, provided Canadians can also be reassured the change will not dull the skill of the country’s new doctors. However, it doesn’t go to the twin hearts of the problem: socialized medicine and centralized planning of health care. Graduating more doctors sooner won’t cure the underlying condition. Rather, it is more like treating a wound on the left hand by suturing the right one.

The doctor shortage began in the mid-1980s — not coincidentally, at the same time the last Trudeau government passed the Canada Health Act, which forbade user fees, balanced billing by doctors and private clinics and hospitals. Immediately, doctors began moving to the United States by the hundreds every year. The effects of this exodus were compounded in the early 1990s when provincial health ministers consciously decided to limit enrolments in their medical schools. Doctors, they reasoned, were the enemies of health budgets; limit the number of doctors and there would be fewer tests ordered, fewer hospital beds filled, fewer surgeries performed and lower costs to their department’s budget. (By this thinking, eliminating doctors altogether would really bring provincial cost into line.)

And here I thought that the Canadians had more sense when it came to healthcare. Guess I was wrong.

They’re on the move, the nurses that is. Going on strike it seems.

From SF Gate:

As many as 4,000 registered nurses are expected to begin a 10-day strike this morning at eight Bay Area hospitals operated by the Sutter Health network.

This is the third action in six months against Sutter Health hospitals by nurses represented by the California Nurses Association, and today’s walkout is scheduled to be the longest. The union held two-day strikes in October and December, but nurses at some facilities were kept off their jobs longer because hospital managers said they needed to hire replacement workers for longer than two days.

It seems that the CDC, while certainly concerned about human health, is also concerned about phama industry financial health and profits. Most of you have probably seen the new recommendation that all children get a flu shot, every year! Like kids aren’t already getting enough shots, now the CDC wants to add a yearly flu shot to the repertoire. I certainly hope that this will not become a mandatory requirement for school, as a lot of people just do not want flu shots for either themselves or their family (I am one of them).

This was an interesting opinion piece on the subject, and also points out the rather disturbing factors that figure into this equation, namely to “buy” flu shots so that the manufacturers continue to make them.

From foodconsumer.org:

The panel’s advice came roughly two weeks after the U.S. health officials at the CDC showed concerns about the efficacy of the flu vaccine that does not well-match the strains that are circulating currently in all the 50 states.

As estimated, large percentages of flu strains are not covered by the flu vaccine, meaning that vaccine’s efficacy is in doubt. And indeed, it has been observed that some people who got flu shots still came down with the illness that often causes only inconvenience.

However, Dr. Joe Bresee of the CDC’s influenza division said early “While a less-than-ideal virus match between the viruses in the vaccine and those circulating viruses can reduce vaccine effectiveness, we know from past influenza studies that the vaccine can still protect enough to make illness milder or prevent flu-related complications.”

Early this month, the CDC released news saying that 6 children died from flu complications, but the agency did not elaborate any case. Sensitive health observers took a note of this and predicted earlier that the CDC’s vaccine panel in the regular meeting this year would make their recommendations for flu vaccine in a way to cover all people.

So even though the vaccine is often less than effective, they still want to push this yet on more of the population. A lot of people do not want this vaccine, and while it would be difficult to mandate it for adults, I suppose that the CDC/pharm lobby figure that they can push up usage (and profit) by forcing it on children instead.

One very hazy area is the actual death rate from the flu. The CDC touts the magic number “36,000″ as the number of Americans who die from the flu each year, and if you ever notice, that number does not change. It remains the same whether its a bad year or a good year, and I imagine that if everyone on earth got a flu vaccine, they would still be touting that same number.

You know why? It’s not an actual number and amazing how the media never questions it. It’s a computer guesstimate. Notice that the CDC never actually posts the real number of people who die due to flu complications. That’s because the number is incredibly low, and doesn’t fit into the scare tactics of “needing” a vaccine.

If you ever take a look at their actual statistics, the CDC lumps influenza and pneumonia together. That makes the number higher. When divided up, the real casualty from flu is probably about 1 to 1.5% of these 36,000, and the rest was due to pneumonia.

But getting back to kids…this year, 22 children had died of the flu, but last year, which was a milder season, 68 children died. While it is sad that these children died, it is not a reason to force the vaccine on 59 million children, in order to avoid 22 deaths. That’s like saying that school age children shouldn’t be allowed in cars, because so many die in traffic accidents (a helluva lot more who died of the flu). Or backyard pools should be banned, because children have drowned in them ( a lot more than die of the flu)

This is perhaps the most insidious comment:

Even in the group aged 6 months to 2 years, the inoculation rate was only 20% during the 2006-2007 period, according to Reuters reporting today, a rate that has made CDC officials to show their worry last year that the pharmaceutical companies may cease producing the flu vaccine because of the low usage rate. One top official at the CDC indicated last year that even for the sake of the vaccine makers, people should go get flu shots.

So in other words, we should all get the flu vaccine just to keep the manufacturer happy? Are these people daft or what?

If someone wants to get a flu vaccine, or wants to get a child vaccinated, then fine. But making flu vaccines mandatory for anyone is way out of line, simply because of the fear that the manufacturer isn’t making a huge profit. First, how about the CDC publishing real numbers as far as death rates from the flu. That would be a start. It is amazing how the mainstream media just spits out that 36,000 number like its a mantra. Haven’t any reporters noticed that its a little weird how the number never changes?

Second, vaccine production needs an overhaul. There must be some way that the government and manufacturers can come to an agreement about the vaccine.

Just as an addendum to the late, great study on STDs in teens. I notice that none of the mainstream media outlets mentioned the timing of this, given how Merck’s aggressive and ethically challenged lobbying for HPV vaccine mandates was exposed and largely failed last year. Why now? Is it because enough time has passed that people don’t remember, so it’s time to make another push for the vaccine by going through the back door, via a “scientific study.”

Also of concern is the study population itself. The survey contacted 838 women ages 14 to 19 who agreed to be tested for a sexually transmitted infection. Now, these are girls who are probably sexually active if they agreed to be tested. Do they represent the general population? Maybe, maybe not. It depends on where you’re looking, and also the age group. There are going to be a lot more 18 and 19 year old girls screwing around, as opposed to 14 year olds.

But from the very select population, the researchers estimated that 3.2 million teenagers are infected with at least one STD.

It doesn’t seem like any reporters questioned this data, or asked the CDC what else can be done aside from promoting the Merck vaccine.

Well, yeah, we already know that the United States leads the developed world in sexually transmitted infections, and also in HIV infection (as opposed to just your run of the mill twat and weenie diseases). And we also lead the developed world in rates of teenage pregnancy, abortion, and unwanted/unintended pregnancy in general, despite the fact that rates for pregnant teens have declined somewhat.

But this new CDC report is a little sketchy, and of course, the mainstream media has to present it in the most alarmist way possible. Nothing like stirring the pot in the fight for ratings, is there.

From Reuters:

WASHINGTON (Reuters) - More than one in four U.S. teen girls is infected with at least one sexually transmitted disease, and the rate is highest among blacks, the U.S. Centers for Disease Control and Prevention said on Tuesday.

An estimated 3.2 million U.S. girls ages 14 and 19 — about 26 percent of that age group — have a sexually transmitted infection such as the human papillomavirus or HPV, chlamydia, genital herpes or trichomoniasis, the CDC said.

This really isn’t at all surprising, considering that decent and informative sex ed isn’t available in schools (just say no until marriage doesn’t cut it). And after we get through the hype and canned quotes, it isn’t until much further down that we learn that HPV, which can cause genital warts and cervical cancer, was the most common infection, seen in 18% of the girls. HPV, for the vast majority of both girls and boys, is transient. You catch it, and your own body’s immune system takes care of it. There is no treatment for it and most people wouldn’t need treatment anyway. Most people in fact, never even know that they have an HPV infection. So girls who were counted at the time of the survey as having HPV may have been “cured” of it by the time theses results were published.

It says that the second most common infection was chlamydia, seen in 4% of the girls. Trichomoniasis was seen in about 3% of the girls, and 2% had Herpes simplex virus type 2–which seems kind of low. They didn’t ask about syphilis, gonorrhea or HIV infection, but the prevalence of those diseases are quite low in this age group. But without HPV in the picture, the rate of STDs that actually cause symptoms and have a treatment protocol, is only 9%.

This isn’t to downgrade the importance of HPV as having the potential to wreck havoc, but as I said, for most people who come in contact with it, HPV is benign. Some studies estimate that up to 75% of the sexually active population are exposed to at least 1 strain of HPV (there are about 100), and because HPV is so firmly entrenched in the general population, a person can have very few sexual partners and still come into contact with this virus.

But I think the main message here is the differences among ethnic/racial groups.

Forty-eight percent of black teen-age girls were infected, compared to 20 percent of whites and 20 percent of Mexican American girls. The report did not give data on the broader U.S. Hispanic population.

So why are black girls so much more likely to be infected? Well, I guess that can be the subject of a thesis, as racial disparities in healthcare are seen in all areas, whether it be breast cancer, heart disease or STDs.

What does this survey tell us? Absolutely nothing that we didn’t already know. Instead of wasting time and funds coming up with new numbers to crunch, how about doing something about the high rates of STDs in the U.S., as well as racial disparities. But I guess it’s easier to keep doing studies that conclude that we “need to do something,” rather than actually doing it.

Doing something about it means getting the new HPV vaccine, according to the CDC. And these articles read like an advertisement for it. I wouldn’t be surprised if this survey was just a scare tactic to show how many girls are infected with it, and why we are in dire need of this vaccine. Never mind that evidence is slowly creeping out that there are safety issues connected with the vaccine (deaths have been reported), and that perhaps the benefit does not equal the risk.

I would recommend the vaccine to women in developing nations, where cervical cancer is a major cause of cancer death. But in the U.S. and other industrialized nations, closer attention needs to be paid to the adverse events.

And as I said, touting a vaccine doesn’t to address the health problems that I described above. The CDC should be on the forefront advocating universal primary health care, reproductive services for both men and women, and getting some real sex ed into schools–and having it taught by someone who is trained to teach it, not the algebra teacher who isn’t quite sure what sperm is.

This post sort of continues the previous one, about violent attacks against nurses. There is an interesting new thread about on allnurses.com, about the Tao of being hit by a patient.

What I find astonishing, that in this day and age, the nurse is asking what to do about it. As though assault is still a fuzzy area, and the wonderful professional called nurse should still be wondering if it is okay for a patient (who is completely coherent and not suffering from dementia) to slap her across the face. And wondering what she should do about it.

Fortunately, most of the responses are positive, in that they are telling her to file charges against the person who hit her. Afterall, if someone slaps you in the supermarket, would you just smile and say that it’s okay? That the person who hit you is a little stressed and need to get out their aggression. What if you were working as a supermarket checker and a customer slapped you across the face, because she said you were moving too slow? Would it be okay?

Is it okay for a child/teen to smack his teacher? Does the teacher just say, “Oh, that’s okay. I know this is a rough class.”

What would your doctor do if you smacked him/her? Would the CEO of the hospital take kindly to be being whacked across the face? Or some middle-management weenie who crunches numbers all day? Would they just say that the customer is always right, even though that’s often still the message given to nurses?

If You Get Hit…

If you are working as a nurse in a clinical area, or any area, it is NEVER okay for anyone to abuse you. I don’t care about the idiocy that instructors are still dishing out, or the “customer training” that is becoming rampant in hospitals today (they think its a solution to the nursing shortage). It is not okay.

If the patient has dementia, or is otherwise not in the right mind, then it would be difficult to press charges. However, you should never again be alone with that patient and if the patient is prone to violence, the facility needs to take appropriate precautions. Do not place yourself in danger. Tell the CEO to go in and give the patient his medication, if he doesn’t think there is a need to hire on extra security.

But if anyone in their right state of mind (arguable, of course, as to who really is right in the mind) ever hits you, immediately react. I don’t care if its the Chief of Staff. Call the police and press charges. File an incident report. Don’t let anyone talk you out of it. If you don’t do it, then not only are you telling the world that nurses are somehow “different” from everyone else, and not entitled to the same protection, but it will happen again. The same person that hit you may again strike you, only next time harder. He/she may also feel free to attack someone else, since they know there are no consequences. And your hospital won’t do anything to protect its nurses.

As a human being, you have a right to a safe and stable work environment. Don’t let anyone tell you otherwise.

FYI, the person who posted this says she is a new nurse and still on orientation. That means that her schooling was insufficient, and that her instructors managed to skim over that huge white elephant sitting in the classroom–that nurses are vulnerable to physical and mental abuse. Or they delivered the old school line of thought about how the nurse should rise above that, she should report it to her charge nurse, etc. In other words, suck it up baby.

This is part of what this nurse wrote:

So, my question is this….at what point does a nurse actually look at a situation as being assaulted. If this lady slapped me across the face in the middle of the grocery store, I would have called the police.

What is that fine line? What if she bruised my face? Is that different?

I think she answered her own question, but isn’t it sad, that she thinks that because she’s a nurse, there is somehow another standard for assault. Or that a certain amount of damage needs to be done before a nurse can consider a physical attack “assault.”

It seems that’s what needed in addition to education and getting a license in the UK. A startling news release from Unison, a British nursing union, reported that one in three nurses in the UK have been attacked. Where is Rambo when you need him most?

Nurses are vulnerable to both physical and verbal attack in the U.S., but these stats are ludicrous. Why are nurses in so much danger? Do hospitals just consider violent attacks on nurses akin to vandalism–you know, that nurses are things not people, and attacking a nurse is similar to painting graffiti on the hospital wall? Do the words “increase security” ring a bell?

And then hospitals around the world wonder why no one wants to be a sweet nursey anymore.

From Unison:

04/03/08) Almost a third of UK nurses suffer frequent violence at work, according to new research.

UNISON has condemned the findings, which reveal one of the highest rates in Europe. Only in France are more nurses attacked.

The study, published in the journal Occupational Medicine, found that 29% of UK nurses had suffered frequent violent incidents at the hands of patients or their relatives.

“These statistics should make people in the UK ashamed,” said UNISON head of nursing Gail Adams.

“It is totally unacceptable for nurses to face rising levels of violence, when all they are trying to do is help and care for their patients.”

More needs to be done to protect staff, Ms Adams said.

She stressed that prevention is the key, coupled with better training and tough penalties for anyone found guilty of assault.

And she urged hospitals to review the support they offer staff, to ensure they offer good occupational health services.

“The survey shows many feel abandoned and depressed following an assault, which should not be allowed to happen.”

The researchers surveyed 39,894 nurses in 10 countries.

They found that violence had wide-reaching effects including recruitment and retention problems, increased amounts of sick leave and burnout.

Whatever happened to those dear beloved nurse angels? Hospitals would like to know, especially when faced with angels who have been unionized.

Sutter facilities in the San Francisco Bay Area may soon be faced with a strike, but it seems a little unclear what the strike is about, or how serious the infractions are.

From the MercuryNews.com:

A strike could come as soon as the middle of the month for the nurses, who are represented by the California Nurses Association. The union and management have failed to reach an agreement in contract negotiations that began in May. The dispute has already resulted in two strikes, each lasting two days, in October and December.

The nurses say the stalemate is not about salaries, but the issues of patient care, under-staffing and their health and retirement benefits. The nurses described a “hostile” bargaining attitude by Sutter Health, and expect to approve the strike vote.

In general, hospitals are not known for being benevolent employers and their attitude towards nurses is usually deplorable. Nurses are a service, not people, and its something that’s thrown in with the laundry, dietary service, and housekeeping. In fact, a nurse can double for all of those.

But in this case, I’ve seen a few differing reports about the strike, so I don’t have an opinion on it at the moment. Perhaps as the story unfolds…

If you are not weary yet of press releases, here is another one from the Center for Health and Gender Equity. Apparently, our government officials, or at least the ones who hold the purse strings to PEPFAR (no names mentioned) think that family planning is anti-life.

I’m not really sure whose life they are talking about. The potential fetus who may be conceived if the HIV infected woman has unprotected sex and doesn’t use any time of contraceptive? Are we now going from embryos to “possible embryos.”

As far as I know, HIV is spread by having unprotected sex, among other routes. HIV is also transmitted from mother to baby. Being ill with a disease like AIDS, to say nothing of the socioeconomic impact, isn’t really the best time for most women to think of starting a family, adding to their current family, or getting pregnant accidentally. To say nothing of how many women die of pregnancy/childbirth related causes in developing countries, or die from botched illegal abortions.

But somehow, providing reproductive services is “contrary to PEPFAR’s life saving principles.” Hmm, let’s see how many little chickadees the Bush girls produce once they get married. And how odd that George himself only had 2 children, and twins no less, that were the product of a single pregnancy. Why is it okay for people living in wealthy nations like the U.S. to have access to family planning, but it’s not okay for women in poor nations (and arguably the ones who need it most) to have the same benefit?

However, I know we’ve heard a lot of this gibberish before, but twisting together family planning with HIV infection, and calling it “anti-life” goes beyond absurdity.

U.S. Health, Rights Leaders Decry Department of State Position that Family Planning is Anti-Life, Demand Response

(Washington, D.C.)-As the U.S. House Committee on Foreign Affairs deliberated over legislation to reauthorize the President’s Emergency Plan for AIDS Relief (PEPFAR) this week, U.S. health and rights organizations objected to the State Department’s opposition to a draft version of the bill regarding a provision that would have allowed PEPFAR funds to be used for family planning to prevent HIV transmission.

How difficult is it to get this right? They try to do something helpful, but in the end, put up hoops and inundate everything with this abstinence only nonsense. How many times do they have to be told, that abstinence-until-marriage programs do not address the needs of the populations who are currently most at risk for getting infected with HIV (hint: women who are ALREADY married, but have husbands with wandering organs and/or who are at risk for sexual abuse).

Another thing is the obsession with sex workers. If you ignore sex workers, or try to muscle them out of HIV programs, you may as well pack up shop and leave. Sex workers exist, like it or not, and if you don’t treat them and make sure they protect themselves, they are one group that is capable of spreading the virus like there is no tomorrow.

And just to add–perhaps Mr. Bush and his prudish friends, who can’t bear the sound of the word “prostitute,” might like to come up with an alternative means of making a living for these people. What does he plan to do, right now, right at this second, to help several thousand poor illiterate women who have no means of supporting themselves? Or the girls out there who are making money to feed their families with the only thing they have–their body?

Well, I’m waiting. Come on guys, let’s hear it. Are you packing your bags and heading overseas to give these women (and men) jobs? Are you setting them up in school or in a place to learn skills? Are you going to give them money to live on so that they don’t have to peddle their bodies for cash (or dinner, or medicine for their infant, etc)?

It sounds so noble to come out against prostitution, and to have recipients of PEPFAR funding pledge their opposition to prostitution, but in reality, the vast majority of people working as prostitutes in developing nations probably aren’t doing it as a lifestyle choice. It’s a lifestyle necessity, so maybe instead of trying to pretend they don’t exist or moralize them away, it may be more useful to do something constructive about it.

And as far as abstinence, you know, you never hear Bush talk about his daughters’ virginity. Are they abstinent until marriage? Are both of them pure and pristine? Was GW Bush or Laura before marriage? How about all the other holy rollers? How about their kids?

Anyway, this diatribe is leading up to a press release about the latest from PEPFAR.

U.S. Congress Introduces New PEPFAR Bill: Two Steps Forward, Three Steps Back

Center for Health and Gender Equity praises removal of abstinence earmark and support for female condoms; criticizes ambiguous abstinence language, compromise over family planning language, and re-insertion of the anti-prostitution pledge

The Center for Health and Gender Equity (CHANGE) is a US-based non-governmental organization that seeks to ensure that U.S. international policies and programs promote sexual and reproductive health and rights through effective, evidence-based approaches to prevention and treatment of critical reproductive and sexual health concerns, and through increased funding for critical international programs and institutions.

Just when you thought that you couldn’t hear anything worse about the insurance industry, along comes the clincher that wins the pie in the sky. If there is actually pie in the sky, that is.

Blue Cross would like to enlist healthcare practitioners in a witch hunt, to seek out those infidels who dared to lie on their insurance applications. Those lowlifes who did not claim all, who failed to mention that they had their tonsils removed 50 years ago, or that they were treated for leukemia in 1965 and it has never returned so they kind of thought themselves cured and not worth mentioning the disease.

From ABCNews:

“Any condition not listed on the application that is discovered to be pre-existing should be reported to Blue Cross immediately,” according to the letter obtained by the newspaper

Other than the fact that Blue Cross wants doctors to break patient confidentiality, there are 3 amazing things to note in this story.

1) Blue Cross was recently fined $1 million for unfairly revoking coverage to scores of its policy holders. You’d think that they’d lay low and keep a low profile until the fuss blows over.

2) The reason that people may be withholding this information is that they fear that they will be denied insurance. Blue Cross, did that ever cross your mind?

3) They must be truly living in an alternate reality if they think practitioners are going to supply them with that information. Aside from breaking confidentiality (and a patient may have grounds for a lawsuit), the physician will lose money from the deal. If patients lose their insurance, they are less likely to visit their physician, or to even have a primary physician. Thus, everyone loses out except Blue Cross.

I found this article on a website, which is not available unless you subscribe, so I can’t supply a link. But anyway, it was about the growing and proliferating pasttime of heading overseas for medical care. Many of the people who travel overseas have been denied insurance here, or who have insurance but their out of pocket expenses far exceed the cost of getting care in another country.

Anyway, the last paragraph of the article would have been hysterical, if it wasn’t so pathetic:

The medical tourism industry has caught the eye of congress. Last year, the Senate held a hearing on the globalization of health care to determine what is at the root of the growing trend. It found the ease of international travel and the growth of quality care facilities in developing countries plays a role, as well as soaring costs of medical care in the United States.

Uh, did they really need to hold a hearing to figure out what an intelligent 12 year old might have told them? Isn’t it obvious why people are seeking alternatives? Are they just dense, or do they have to put on a hearing for show, so they can come up with some “solutions” and “proposals?” Hint–do something to make healthcare more affordable here, and make sure everyone has decent coverage, and guaranteed, medical tourism will take a nosedive.