According to womenshealth.gov, black American women have the highest rates of being overweight or obese compared to other groups in the U.S. About four out of five are overweight or obese.

Well, okay, you’ve probably seen these stats before. Maybe as a nurse or doc, you’ve spent a lot of time counseling patients on weight, or treating them for conditions that stem, at least in part, from excess weight.

Now, one in four black women, 55 years of age or older, has diabetes. That’s type II diabetes, which is directly related to lifestyle, primarily obesity.

The reason I am bringing this up is because of Obama’s pick for Surgeon General. You can read all about her qualifications, and she seems like a devoted family practice physician who would like healthcare for all.

However, at the risk of being exceedingly un-PC, the woman is overweight. Noticeably overweight. And yes, it was the first thing I noticed when I saw her photograph–sorry if I couldn’t look past it and be totally gender, color and weight blind–but what I saw was an overweight black woman.

Some people feel her credentials are weak, given that her career has been largely concentrated in a small rural area serving the poor. But the Surgeon General is less about credentials and more about image. I think her credentials are just fine, and even bordering on the heroic. However, the Surgeon General is a public figure who has little power but who is supposed to set an agenda.

Now I’m not the only one who’s noticed her extra weight, but many defenders of Dr. Benjamin have jumped on the bandwagon, calling detractors racist among other things, or that overweight people can be healthy, or that the woman is simply big boned, or that we place too much emphasis on appearance in our society, or that we should be looking at her qualifications and not her weight, and so on.

But we can blather all we want about it, but the fact remains that this woman will be in the public eye. She will mount the podium and speak on public health issues. Aside from access to healthcare and insurance coverage, the #1 health issue facing this country is overweight and obesity. And if the nation slimmed down, the need for many healthcare services would dramatically decrease. Preventive health will be the most life saving and cost effective proposition, but will people really take an overweight Surgeon General seriously?

Again, it is about image. Public eye. TV appearances. Public talks. Speaking to schoolchildren. No one is going to look at this overweight woman and think, “gee, maybe there’s a genetic reason why she’s fat. Or maybe she works out five days a week and runs 80 miles a day but just can’t shake the weight off.”

Or “she probably really eats healthy, never goes to MickeyD’s, eats broccoli every day, and shuns Frosted Flakes. It’s just a problem with her thyroid.”

And that’s what a lot of the people defending her have zeroed in on, as well as the fact that it’s somehow “normal” to be overweight “at her age.” Or that we should “consider her age, and the average weight of African American women of that age.”

Uh, that’s exactly what we don’t want to do. Black women should not be looking at her as a role model and thinking that “well if the Surgeon General herself is overweight, then nothing wrong with me carrying around all these extra pounds. Surely the doc wouldn’t be tilting the scales if it was such a bad thing.”

It is a big deal, considering the stakes at hand. The job of the Surgeon General is to get an agenda across, and one of our primary health agendas is to reduce preventable diseases. She says herself, that many of her family members died of preventable diseases like diabetes and lung cancer. I can’t imagine her discussing diabetes, and the need for lifestyle changes, if she seems incapable of managing her own weight. And even if she is the picture of health, with normal blood pressure, blood sugar, etc., the public is going to still see a fat woman. There, I said the “f” word, but that’s way it goes. That’s the reality. And I’m being kinder than many of the comments I’ve seen posted about her weight.

There are thousands of physicians out there that Obama could have tapped. It would have been nice for him to have selected a physician who is truly involved in preventive health. And one who looks the part, that can serve as a role model.

So again, I know that this is so un-PC, but the feeling that the pick must be a minority, or a woman, or both, should not supersede common sense.

That’s what Mr. Health Insurance exec says to the following questions–I don’t want a public plan to compete with me, I don’t want any type of insurance reform, and I don’t want to change my wicked ways.

The yes response? That we’ll continue to be unethical and rip off consumers as much as possible.

Now I’m not being unduly harsh towards insurers, but really, they are gritting their teeth at the mere mention of healthcare reform, except if a law is passed requiring people to purchase private insurance. But according to this article in the LA Times, they seem rather offended that anyone would even ask them to cease and desist highly unethical practices.

Executives of three of the nation’s largest health insurers told federal lawmakers in Washington on Tuesday that they would continue canceling medical coverage for some sick policyholders, despite withering criticism from Republican and Democratic members of Congress who decried the practice as unfair and abusive.

The hearing on the controversial action known as rescission, which has left thousands of Americans burdened with costly medical bills despite paying insurance premiums, began a day after President Obama outlined his proposals for revamping the nation’s healthcare system.

It is amazing to listen to their utter arrogance and defiance. Screwing the public is fair game to them. All they want is to collect premiums, but Lord help you if you actually get sick and need them to pay. Then they find all sorts of ways to get rid of you. Basically, they only want to insure healthy people who will send them a check every month and who will never utilize their services.

An investigation by the House Subcommittee on Oversight and Investigations showed that health insurers WellPoint Inc., UnitedHealth Group and Assurant Inc. canceled the coverage of more than 20,000 people, allowing the companies to avoid paying more than $300 million in medical claims over a five-year period.

It also found that policyholders with breast cancer, lymphoma and more than 1,000 other conditions were targeted for rescission and that employees were praised in performance reviews for terminating the policies of customers with expensive illnesses.

Ya just gotta love ‘em.

If anyone has any hope of health reform that really reforms the system, then you need to contact your state and national reps and tell them what you want. Also let them know that they can easily be replaced by representatives who are more in tune to what constituents really want.

Here’s a comforting thought from the LATimes:

Sen. Lindsey Graham calls a cost analysis report a ‘death blow’ to ‘a government-run health plan.’ Sen. Dianne Feinstein says there might not be enough votes among fellow Democrats to pass a plan.

They are arguing against a government run public health plan as an alternative, yet not making any demands on the insurance industry. I haven’t seen anyone calling for laws to reform health insurance, like not allowing them to dump people as soon as you send in a claim, or charging exorbitant rates for pre-existing conditions–like if you had strep throat when you were 6 years old and now you’re 60.

Or demanding the insurers offer better coverage, and cut their own internal costs (like zillion dollar bonuses to executives), to avoid raising rates.

So Senators and Congresspeople who oppose the public plan because it will offer “unfair” competition to private insurance–what are you plans to amend the system? Can you offer an alternative other than tearing apart what’s been put on the table?

Granted, this press release does come from industry, but it does make some very good points about a recent proposal about reimbursements for Medicare. Healthcare proposals have to be reasonable and deal with the real world, not the planet bean counters live on. The bottom line is that if physicians are underpaid, they will cease practice in an area and move, which will leave patients without local care. If physicians move and service is cut, that affects the whole healthcare system of an area.

This is an abbreviated press release from the Access to Medical Imaging Coalition:

This data demonstrates that imaging centers in rural areas operate equipment on average 48% of the time their offices are open. This is inconsistent with President Obama’s recent proposal to adopt a 95% imaging equipment use assumption across the board when calculating Medicare reimbursements. Under this proposal, physicians who operate at rates below 95% of the time their offices are open will be underpaid for their services.

The Radiology Business Management Association (RBMA) data, which studied 261 imaging machines in 46 centers, show that imaging equipment in rural regions of the country operates only 48% of the time an office is open, while equipment in non-rural areas operates 56% of the time a center is open for business. Neither rural nor urban non-hospital diagnostic imaging providers operate equipment at rates anywhere near the levels the President or MedPAC recommend the Centers for Medicare and Medicaid Services (CMS) use to base reimbursements.

These cuts would adversely impact patients in rural areas in particular − where fewer providers serve larger geographic areas and more disparate patient populations − causing congestion/delays at the point of care, forcing physicians to scale back services, further reducing care options and making patients travel further to receive care.

President Barack Obama’s imminent approval of the $787 billion economic-stimulus bill will clear the way for the government to compare the cost-effectiveness of drugs, surgery, medical devices and other methods used in treating particular diseases. The legislation, which calls for the creation of an advisory council of up to 15 members, allocates $1.1 billion to fund the systematic analysis of published research as well as head-to-head clinical studies.

However, in the “name of the public interest” 2 Republican senators are furiously working to defeat this aspect of the bill. Sens. Jon Kyl, R-Ariz., and Mitch McConnell, R-Ky., introduced a bill that would block the proposal to conduct comparative-effectiveness research on drugs, medical devices and other treatments. Kyl argued that the research would lead to rationed health care, eventually delaying treatment and weakening the quality of care.

How conducting comparative effectivness research on drugs will weaken the quality of care certainly is a brain twister.  The bottom line is that they are jumping to oppose anything that will interfere with the bottom line of industry, and they immediately throw the fear mongering catch words–ration care! Government interference! Socialized medicine! Apocalypse now!

A few tidbit quotes from Politico:

Senate Minority Leader Mitch McConnell, in a floor speech scheduled for this afternoon warned that what Americans “don’t want is a Washington takeover of health care along the lines of what we’ve already seen with banks, insurance companies

, and the auto industry. Americans don’t want a government-run system that puts bureaucrats between patients and doctors.”

The catchword on this one is that Americans don’t want a system that “puts bureaucrats between patients and doctors.” Uh, perhaps McConnell is living on Cloud 9, but we already have that–its called insurance companies, who continually interfere with patient care.  Our whole system is designed to give bureaucrats the final word. But I suppose that govt bureaucrats will be different from the ones working for a profit-making insurer, whose only interest in their financial health?

Senate GOP Conference Chairman Lamar Alexander (R-Tenn.) predicted that Americans would begin to sour on President Barack Obama’s call for a public option.

“Washington takeover are two words we’ve been hearing a lot from the Obama Administration these days,” said Alexander. “That’s a different direction that Republicans want to go.”

Let’s cut to the chase. The only reason for the opposition to the public plan is that the health insurance industry fears that it will offer competition. But isn’t that what free market is all about? And I guess that Lamar Alexander has been living on Cloud 9 with his pal, and isn’t aware of the millions of Americans who would chance at the chance for a public option, because at long last, they will have insurance. At long last, they may have insurance that they can afford and that actually provides decent coverage.

Talk about fear mongering. It isn’t a Washington takeover, but just offering up another choice for people. So what is wrong with that? But since the Republicans haven’t come up with any alternatives, all they can do is try to stir up fear in the hearts of the uninsured and minimally insured Americans, and those who are overpaying for piddly insurance. It really is sad, I have to say.

But then, these two senators aren’t worried about their own healthcare.  They’ve got coverage for life.

Here’s an interesting tidbit. Well, it’s not really a tidbit but rather a very disturbing announcement from our own Chamber of Commerce–the boys and girls there apparently want to spend hundreds of millions to wage war against Obama’s recovery program. They seem to be orbiting another galaxy and oblivious to all that has occurred because their position is to defend the free market system at all cost.  Government regulation and assistance is for sissies.  Or worse yet, commies.

From Politico:

As the Obama administration encroaches deeper into the private sector and Congress contemplates more regulations, the U.S. Chamber of Commerce is launching a multimillion-dollar campaign to defend the free market system.

Donahue is Chamber President Tom Donohue, and while this particular article doesn’t address it, I’m sure that they will be battling against any form of healthcare reform.  What Mr. Donahue has failed to mention, in his praise to the glory of the free market, is that un-regulated greed got us into our current mess in the first place (and the great Depression as well), and the only thing that will stand between America and another equally bad mess is strong government regulation. It is quite apparent that the free market system cannot be trusted to sselfregulate. As soon as regulations were weakened (remeber the S&L crisis in the 1980s?), as what happened with banking, it was a free for all.  Why does Donahue think that the free market system is suddenly going to magically regulate itself?

Most important, what solutions does he have? How does he propose getting this situation under control without government assistance? And what about healthcare? The free market has failed miserably in that sense.

Then again, people like Donahue and his friends in the Chamber aren’t really affected by all this. They haven’t lost thier jobs, their retirement accounts, their savings, their homes, or their health insurance.  Perhaps he and his pals should go out in the streets and talks to some of the millions who have had a less than enjoyable experience with an unregulated, free market system. Like the guy who can’t get health insurance because of a pre-existing condition, or Mrs. Smith who was set to retire this year but oops–pension and retirement account are gone with the wind.

Is the American Medical Association hemorrhaging members? Could it be that they are out of step with the majority of physicians practicing in the US? An interesting article discusses how the AMA has opposed any sort of national healthcare program, and that their current president may still have loyalties to managed care.

In August, the AMA launched a $15 million advertising campaign that focused on the problems of the uninsured, hoping to persuade voters to cast their ballots in 2008 with the issue in mind. But this project has frustrated reformers, who contend that the organization’s approach to achieving universal care—providing tax breaks and vouchers for those lacking coverage so they can purchase affordable plans—is too timid.

“At best … the AMA is advocating a completely unproven method of achieving their ends and ignoring things that we know will work,” says Dr. Stephanie Woolhandler, co-founder of Physicians for a National Health Program.

Given these realities, many doctors are turning their backs on the AMA. The medical news service MedPage Today estimated that the AMA represented only 15 percent of practicing U.S. physicians in 2005, down from 70 percent during the 1961 Medicare fight.

Tax breaks and vouchers.  Yep, that’s really going to solve the problem. Their opposition is interesting because if people don’t have insurance, or if they have insurance with enormous copays/coinsurance or huge deductibles, people are not going to see their doctors. They are going to put off surgeries or other treatments. In short, the docs will lose revenue. So how does their opposition help the average physician trying to stay in practice?

The stats are also quite telling. Only 15% of physicians in the US are members of the AMA, a drop from 70% in 47 years. Is the AMA paying attention to this, I wonder?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Interesting.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How ObamaCare Will Affect Your Doctor

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

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

From WSJ:

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

Chad Crowe

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

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

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

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

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

This blogger writes:

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

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

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

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

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

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

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

From the Telegraph:

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

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

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

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

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

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

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

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

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

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

What a combination.

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

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

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

This is from Bruce Schneier’s blog:

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

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

More details:

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

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

Photo courtesy of Stock.xchng

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What is wrong with this picture?

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

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

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

Interview Source: Milk Processor Education Program

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

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

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

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

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

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

News event speakers will be:

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

* Pennsylvania Governor Edward G. Rendell;

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

* Independence Foundation President Susan E. Sherman.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.