After a six-year study, surgeons at the University of Maryland Medical Center in Baltimore have determined that they have found a better way to repair the mitral valve, which is key to proper blood flow.

The mitral valve is the "inflow valve" for the left ventricle, the heart’s main pumping chamber, Maryland officials explain. Blood flows from the lungs, where it picks up oxygen, across the open mitral valve and into the left ventricle. When the heart squeezes, the two leaflets of the mitral valve snap shut and prevent blood from backing up into the lungs. Blood is directed out of the heart to the rest of the body through another valve, the aortic valve.

Until now, surgical treatment meant repairing the diseased valve or replacing it with a metal one or one made from animal tissue. And the majority required open-heart surgery. Doctors concluded in their study -- which began in 2003 and ended in March -- that they could do a minimally invasive repair job by making a two-inch incision on the right side of the chest. The results of the study are published in the September issue of the Annals of Surgery.

The study of 187 patients showed the procedure is safe and effective and requires just a short hospital stay and rapid recovery, said lead author James S. Gammie, a cardiac surgeon at the University of Maryland Medical Center and associate professor of surgery at the University of Maryland School of Medicine. There were no strokes, kidney failures or infections, which are the most common complications from surgery. Almost all of the patients are still alive.

The doctors said repair is also better than replacement, which tends to cause blood clots. Animal tissue replacement valves also only last 10-15 years. Repairs can last a patient’s lifetime.

The procedure further advances the trend in minimally invasive techniques across most areas of surgery. Very few surgeons across the country perform the procedure now, according to E. Albert Reece, vice president for medical affairs at the University of Maryland and dean of the University of Maryland School of Medicine. Perhaps that now will change.

Read the abstract here.

Posted by Meredith Cohn at 1:22 PM | Permalink | Comments (0)
Categories: Medical studies
        

Recent data from the U.S. Census showed some stark geographic disparities in who has health insurance coverage and who doesn't.

An analysis by the Associated Press found that people who live in the Southwest are many times more likely to lack health coverage than residents in the Northeast and Midwest. The reason? Varying state laws, job industries and demographics.

The folks at NPR put together a very cool map about how congressional districts stack up. Take a look. (As a reporter who once covered demographics, I admit, I get really geeked about interactive maps!)

In addition, a piece explained how regions with the highest percentage of uninsured people also happen to be the places with the staunchest opposition to health care reform. Huh? you might ask...

Well, here's the crux of it, according to the piece: the voices of the uninsured appear to be drowned out by powerful interests.

It's a basic truth of political analysis that low-income residents — that is, those most likely to be uninsured — are less likely than middle-class people to attend town meetings and less likely to make campaign contributions.

How that shapes out in Maryland is an interesting question. Maryland's has one of the nation's lowest rates of the uninsured -- 12 percent, lower than the national average at 15 percent. Remember those loud protests at town hall meetings against health care reform? They took place in Western Maryland where the uninsured rate is among the highest in the state. Hmmmmmm.

image courtesy of USDA

Posted by Kelly Brewington at 7:23 AM | Permalink | Comments (0)
Categories: Health care reform
        

Boots are in style these days, but they aren’t always comfortable and healthy for your feet. So, the American Podiatric Medical Association  has come out with a handy-dandy chart that shows the kind of boots people favor and what to look for when shopping for them.

For example, if you like snow boots, look for ones with rubber bottoms and deep grooves for traction. If you like cowboy boots, don’t wear them too long because the toe space is too limiting.

Use arch insoles with your rain boots for support in such a rigid boot. And limit the height of fancy dress boots and look for a substantial heel so you don’t fall over.

Some tips for buying boots: Have your feet measured because your feet can change sizes; try boots on in the afternoon because your feet swell throughout the day; buy for your larger foot (people tend to have two different size feet); and carry an insole in case the boots don’t have arch support.

Also, make sure there is plenty of toe room, a good sturdy heel and traction; make sure they fit in the store because there shouldn’t be a "break in" period; and look for natural materials like leather that will keep your feet dry and comfortable in the winter.

And perhaps the most important advice: Take the boots off occasionally and wear some comfortable sneakers!

Associated Press file photo

Posted by Meredith Cohn at 6:25 AM | Permalink | Comments (0)
Categories: Healthy Living
        

A Baltimore communications company is offering a really cool incentive for its workers -- just in time for flu season.

Employees at Pinnacle Communications who get seasonal and swine flu shots will receive an hour with a personal trainer and an extra day OFF. (Um, hello Baltimore Sun powers that be -- are you listening?!)

It's a simple principle that makes good business sense. Sick employees can't come to work. Healthy employees keep the engines churning on the job.

"Our theory is that if we offer employees a healthy incentive to receive the seasonal and swine flu shots, they will miss less work because their chances of getting the flu will be lessened," said Tracey Haldeman, Pinnacle's president.

Exactly.

So, any other cool incentives being offered at your place of business? Has your job started vaccinating against seasonal flu yet?

Stock.xchng photo

Posted by Kelly Brewington at 11:11 AM | Permalink | Comments (0)
Categories: Swine flu/H1N1
        

Recently, we brought you some news on prostate cancer screening and how the blood test that detects the disease may in fact be leading to overtreatment of the illness. Some researchers think the screening test does more harm than good, exposing men to unnecessary treatment of cancers that will never harm them and never kill them. Others said the research was bogus and that the test saves lives.

Well, a new study raises more questions about the popular test known as prostate-specific antigen screening, or PSA, and is sure to intensify the debate. Men are not getting adequate counseling from their doctors on the risks of such testing, a new study published today in the Journal of the American Medical Association .

In a survey of 3,010 men 40 and older in 2006 and 2007, about 30 percent had not discussed the screening with their doctors before they had the blood test. About 45 percent said they weren't asked by their doctor about their preference for the test and 48 percent could correctly answer questions about prostate cancer risk and the accuracy of screening.

"Given the uncertain benefit for screening and known treatment risks, prostate cancer screening decisions should be guided by patient preferences," the reseachers write. "Indeed, most professional organizations recommend that the first step in screening should be a discussion between health care providers and patients about the risks and benefits of early detection and treatment so that patients can make informed decisions about whether to be screened."

When I wrote about this issue before, I received a ton of responses from all sides. I heard from men who said the test is vital and vehemently took issue with the initial research. They said PSA saved their lives and they would recommend it to all men 40 and over.

Others told me about unnecessary pain they had as a result of treatment and how they wish they had known more about prostate cancer before they agreed to the test.

What do you think? 

Posted by Kelly Brewington at 7:00 AM | Permalink | Comments (13)
Categories: Cancer
        

A rising number of women are choosing to remove a healthy breast after being diagnosed with breast cancer -- even though there is little evidence that doing so improves survival, a new study found.

The research, which appears in Cancer, the journal of the American Cancer Society, examined data from 6,275 New York state women, who had prophylactic mastectomies -- removal of a non-cancerous breast as a preventive measure.

Researchers looked at women who had a healthy breast removed after the discovery of cancer in the other breast as well as woman without cancer who had both breasts removed, but had a strong family history of the disease or a gene making them more susceptible to it.

From 1995 to 2005, the number of women who had cancer in one breast and choose to have the other breast removed more than doubled. Those with no personal history of breast cancer who had both breasts removed also increased, but slightly.  

While the number of these kinds of mastectomies remains small, they're rising and such surgery comes with risks. Other studies reveal increases in overal mastectomies, raising concerns that some women are being treated too aggressively and whether doctors are doing the right thing for patients.

Stephanie touched on the issue a while back in an interesting piece about the growing trend of mastectomies. For some women, though, the decision is clear: fear that the cancer will return supersedes all evidence about whether or not the surgery helps.

 "For some women, their quality of life is better with their breasts removed because you get rid of the concern, the anxiety" about recurrence, said Dr. Lisa Jacobs, a surgical oncologist with the Johns Hopkins Breast Center. "A lot of women come in and say, `I don't ever want to do this again.'"

Posted by Kelly Brewington at 7:08 AM | Permalink | Comments (2)
Categories: Cancer
        

Are you a runner -- or interested in becoming one? The Baltimore Marathon is coming (Oct. 10) and our friends at The Sun have launched a handy webpage to keep you posted on the latest marathon info.

Anyone planning to run in this year's marathon?

Posted by Kelly Brewington at 2:07 PM | Permalink | Comments (0)
Categories: Healthy Living
        

Surgeons try their best to repair torn cartilage and flesh in serious injuries. But what if they got a little help from the body itself? What if the body could generate its own repair mechanisms to replace vital tissues?

It could happen. New stem cell research being done at Johns Hopkins is investigating the ability to use stem cells to help the body repair itself after injury.

Our colleague Frank Roylance gives us the scoop on how science is progressing on the stem cell front after he spent some time earlier this week at the 2009 World Stem Cell Summit, held here in Baltimore.

The Hopkins' lab, run by researcher Jennifer Elisseeff, is also working on technologies that will enable stem cells to reconstruct fat and muscle lost to surgery or trauma. Scientists are also testing a kind of contact lense that can help a patient's own stem cells rebuild a damaged  cornea. After years of promises from scientists that stem cells can transform modern medicine -- they are getting closer to such practical applications.

"People are working on the basic science of things and trying to understand how tissue develops but also at the same time developing practical technologies that can be used in the clinic today," Elisseeff said.

Fascinating stuff.

AP photo

Posted by Kelly Brewington at 12:11 PM | Permalink | Comments (0)
Categories: General Health
        

Pregnant women have access to more prenatal tests than ever before with numerous options available to determine the likelihood of genetic disorders. What if those tests slowly led to fewer babies being born with Down syndrome and if the disorder eventually disappeared?

Well, it's happening, according to new research.

Between 1989 and 2005 there was a 15 percent decrease in births of babies with Down syndrome, according to new study by Dr. Brian Skotko, a genetics fellow at Children's Hospital Boston.

It's a striking finding, considering that more women are waiting longer to have children -- a factor that increases the chance of Down syndrome. If there were no prenatal testing, researchers would have expected the opposite - a 34 percent increase, not a decrease, Skotko found. Instead, women are finding out the diagnosis of Down syndrome and choosing not to continue the pregnancy.

The research, appearing in the latest issue of the journal Archives of Disease in Childhood, raises some interesting questions about how doctors and patients should navigate such a diagnosis. As it is now, doctors do a poor job explaining Down syndrome and discussing the diagnosis with soon-to-be parents, Skotko says. This could only get tougher in the future.

New prenatal testing -- available within a year or so -- could allow doctors to detect genetic abnormalities earlier in a woman's pregnancy and with a simple blood test. That could lead to more women choosing not to continue with their pregnancies if their baby tests positive for Down syndrome, complicating matters for doctors and patients, the author states.

Unless improvements are made prior to the arrival of new prenatal tests, a true collision is on its way, Skotko says. More women will be going through the testing process, which could lead to a lot of difficult, uncomfortable conversations between physicians and expectant parents.

Doctors need better guidelines on how to deliver a Down syndrome diagnosis and should limit injecting their personal viewpoints into a patient's decision whether to carry on with the pregnancy, he says.

Skotko also asks a provocative question: does genetic testing go too far?

Where should our professional organizations draw the line? Should expectant parents be able to select out fetuses with an undesired sex? Should fetuses with genes that predispose them to adult breast cancer be prenatally identified? Should couples in the future be supported if they wish to terminate fetuses with genes correlated with sexual preferences? The age is swiftly coming where not all possible technologic advances may bring welcomed change.

photo courtesy of stock.xchng

Posted by Kelly Brewington at 7:00 AM | Permalink | Comments (1)
Categories: Pediatrics
        

Celebrities, they're just like us. Some of them even get the swine flu.

Take Dr. Sanjay Gupta, one of television's most recognizable faces who dispenses medical advice to the masses on CNN. He was on assignment in Afghanistan and came down with a terrible sore throat, body aches, a fever -- the whole shebang. Tests later confirmed that yes, this well-known health reporter had the swine flu. Way to throw yourself into one of the biggest medical stories of the year.

Marilyn Manson, the strange looking rocker, announced on his MySpace page that he has the swine flu. "Unfortunately, I am going to survive," he writes. Last spring, Harry Potter actor Rupert Grint -- he plays Ron Weasley, the boy wizard's best friend -- came down with the H1N1 virus.

And in a bit of irony, Laurie Garrett, a flu expert who wrote a book published in 1994 called The Coming Plague about emerging new diseases and author of a Newsweek cover story about the swine flu outbreak in May, has come down with it.

(OK, her celebrity isn't on the level of the others, but it's quite a coincidence, no?)

The bug is, in virology parlance, a "mild flu," but only somebody who hasn't been laid low by H1N1 would consider days of semi-delirium, muscle aches, fatigue, nausea, and stomach twisting to be "mild."

If the duration and depth of my personal illness are any indication of what's in store, and if scientists have correctly predicted that the bulk of infections in the U.S. will slam the entire nation long before vaccines are available, we are in trouble.

Watch this space. More celebs are bound to get the swine flu. Picture of Health will keep you up-to-date. More at 11.

Photo courtesy of Associated Press

Posted by Stephanie Desmon at 12:00 PM | Permalink | Comments (2)
Categories: Swine flu/H1N1
        

There are two ways to get the flu vaccine -- in a shot, or in a mist that sprays up the nose. While both have long been used to protect the public from seasonal flu strains, a new study found the shot was 50 percent more effective than the spray for healthy adults. 

The spray, made by Maryland manufacturer MedImmune and known as FluMist, uses a live -- but weakened -- form of the virus to make the vaccine. The traditional shot used in the study was manufactured by Sanofi Pasteur and is made from an inactivated virus grown in chicken eggs.

The mist has become an increasingly popular way to give the vaccine in children -- what child wants to sit still for a needle in the arm? It's also very effective in kids under 6. But people have questioned whether it is as effective in adults.

The study, published in the new issue of the New England Journal of Medicine, was carried out in 1,954 healthy adults 18 to 49 years old during the 2007-2008 flu season. Those who got the shot responded far better than those who used the mist.

The findings do NOT address the efficacy of the swine flu vaccine -- which will be offered in both shot and mist forms, the authors carefully point out. But this data may inform the decisions made in future flu season, no matter the strain, the authors said.

We are entering a new era of influenza control, one in which different types of vaccines may be appropriate for different age groups.

Baltimore Sun photo

Posted by Kelly Brewington at 7:00 AM | Permalink | Comments (0)
Categories: General Health
        

We're all paranoid about catching the swine flu. We're buying hand sanitizer by the bucketload, dousing our kids with the stuff in school and using it in church in the hope that we'll kill off the virus before we get sick. And messages to wash your hands are everywhere (Note to my employer: It would be helpful if the soap dispensers in the second-floor ladies' room actually contained some soap.)

The state health department is obviously big on getting the word out, too. They have created signs, brochures and even door hangers -- like the 'Do Not Disturb' signs in a hotel -- warning of the dangers of poor hand hygiene. If you go to the website of the Maryland Department of Health and Mental Hygiene, you can even print out copies of your own to display in your home or business.

My fave? The door hanger emblazoned with a hand pointing toward the knob you are about to grab and reading, "THIS is a great way to catch the FLU!" Ewww.

Posted by Stephanie Desmon at 1:26 PM | Permalink | Comments (0)
Categories: Swine flu/H1N1
        

My barefoot running story and blog entry garnered lots of attention yesterday. You guys had lots to say about this fledgling movement of runners who are out there jogging on the streets, sidewalks and grass without their Nikes. Many told tales of being inspired to try it after reading the best-selling book, "Born to Run." A well-thumbed chapter in there suggests that maybe all of those nagging running injuries could be caused by our fancy, well-cushioned shoes.

"I've been running barefoot regularly for three years and I feel great from head to toe," commented someone calling himself Happier Feet. "I couldn't say that when I ran in shoes - it was always one thing or another, from blisters to shin pains to aching arches."

Wrote someone named Peter: "It's a very free practice, mind-opening, mentally challenging more than physically, the calluses needed and generated are really minimal in my experience and I'm barefoot outdoors every day of the year, even in the snow (central Ohio)."

Picture of Health readers aren't the only ones who noticed. A producer for MSNBC's "Dr. Nancy" show read the story and contacted Dr. A. Ben Pearl, the Arlington podiatrist quoted in my story. Unless big news intercedes, he is scheduled to talk about barefoot running on the show today. Look for him between 12:30 p.m. and 1 p.m.
 

Photo courtesy KRT

Posted by Stephanie Desmon at 10:56 AM | Permalink | Comments (2)
Categories: Diet and exercise
        

The internet will get you into trouble. Everyone knows this, don't they? And yet, time and again we hear embarrassing tales of how someone posted a drunken photo or a dimwitted email on the web only to encounter the wrath of their employer.

Count medical students among the latest perpetrators. Sixty percent of medical schools reported incidents of students posting unprofessional content online, according to a new study in the Journal of the American Medical Association.  Nearly half reported use of discriminatory language, while 39 percent had depictions of intoxicated students and another 38 percent had reports of "sexually suggestive material." And perhaps most worrisome to medical schools, 13 percent reported incidents where doctors-in-training violated patient confidentiality online.

The study was based on a survey of medical schools nationwide to gauge how the proliferation of Facebook, Twitter and YouTube had affected professionalism for soon-to-be physicians. The survey also gathered information on policies regarding online conduct. Few schools, it turns out, (less than 10 percent) had any formal policies on internet use.

"The social contract between medicine and society expects physicians to embody altruism, integrity and trustworthiness. Furthermore, ethical and legal obligations to maintain patient confidentiality have unique repercussions," the study says.

But just what does "professionalism" mean when it comes to medical students and the wild wild west of the interwebs? Medical schools aren't quite sure.

While certain behavior such as violating patient confidentiality are clearly unprofessional, others such as making negative comments about the school or its professors may not be, the authors write.

Schools should add a digital media component to their professionalism curriculum with instruction on managing one's "digital footprint." "This is important, given that residency program directors, future employers and patients may access this information."

This article got me wondering, what are the true boundaries of professionalism online? A colleague once advised me: don't put anything on the internet that you wouldn't want a potential employer to see. Sounds reasonable. But when everyone seems to be sharing their every thought on the web, do things that used to be taboo become more acceptable? When have we gone too far?

Photo: AFP/Getty Images

Posted by Kelly Brewington at 7:00 AM | Permalink | Comments (0)
Categories: Medical studies
        

The shorthand these days for categorizing your healthy weight is BMI, or body mass index. This inexpensive and relatively simple calculation, which uses height and weight, hands everyone a number and puts us into broad categories of underweight, normal weight, overweight and obese.

But the numbers don't mean a lot to most people, says a University of Nevada, Reno professor, who has developed his own shorthand for calculating a healthy weight. His doesn't involve online calculators or charts. And it doesn't use weight ranges, which he thinks confuse more than help people.

Dr. George Fernandez, who teaches applied statistics, has devised the maximum weight limit, "one number that we know we can't go over, just like a speed limit," according to a press release from the University of Nevada, Reno. It's just a simpler way of knowing if we are in a danger zone, he said.

"It's a very simple calculation that most of us can do in our heads," he said. For men and women, there is a baseline height and weight. For men, it is 5-foot-9 with a maximum weight limit of 175 pounds, meaning someone that height shouldn't go over 175 pounds. For women, it is 5-feet tall, with a maxium weight limit of 125 pounds.

Then you just figure out how much taller or shorter you are than the baseline. If you are a man, just add or subtract 5 pounds for every inch taller or shorter than 5-foot-9 you are. A 6-foot-tall man's maximum weight limit would then be 190 pounds (175 plus 15 pounds). Women should add or subtract 4.5 pounds for each inch they differ from 5-feet.

This is something people can remember, Fernandez said.

Meanwhile, researchers at the University of North Carolina at Chapel Hill's medical school have also been thinking about BMI. In a small study published in the September/October issue of the journal American Pediatrics, researchers found that parents are more likely to understand a BMI chart if it is color-coded like a traffic light.

Parents don't always know when their children are overweight or are gaining weight too fast. And when study participants were given a standard BMI chart, with percentiles and ranges, they had a much more difficult time figuring that out than a color-coded chart, the researchers said. The color-coded charts made more sense -- with green indicating healthy BMI, yellow showing more risk wand red putting the child is in an unhealthy zone.

Is simplifying BMI going to aid us in the war on obesity?

Baltimore Sun photo

Posted by Stephanie Desmon at 12:15 PM | Permalink | Comments (3)
Categories: Diet and exercise
        

So, if you've ever been interested in barefoot running, then let me know because I'm looking to start a barefoot running club. I know it sounds crazy at first, but if you haven't tried it, then I suggest you liberate your feet and give it a chance.

I'm the only one who answered Engwall's ad. But I didn't want to run with him (my tootsies are too delicate for that). I wanted to hear about how he got into barefoot running.

It's building up something of a cult following in some circles. Barefoot runners swear that it's their fancy running shoes, with their arch support and thick cushioning and more, that are the root of jogging injuries. And a movement has sprung up in recent years of people who hit the asphalt, the sidewalk, the grass for long runs -- and leave their high-tech Nikes at home. Some use minimalist footwear. But others just go in the buff (their feet, that is).

It used to hurt when Engwall, 26, ran. He all but gave it up. Then he heard about the skimpy shoes and tried them out. They felt good, but one day he ditched them altogether. Now, he runs three and four miles at a time, pain-free, unless you count the berries and pebbles he occassionally steps on. His fiancee won't run with him if he is barefoot. She worries too much that he'll step on somthing and get hurt.

I spoke to several who have recently given up their running gear and gone barefoot. Many of its adherents were inspired to give up their shoes after reading Born to Run, the New York Times bestseller by Christopher McDougall that tells the story of the Tarahumara Indians in Mexico who run long distances with ease. What resonates with the barefoot runners is the chapter about how running injuries became more prevalent with the rise of newfangled running shoes and his well-researched suggestion that we might all be better off without them.

Several doctors I spoke to tell me there is no conclusive evidence either way. "Is it good? It's as good or as bad as running with shoes," said Dr. Benno Nigg, a kinesiologist at the University of Calgary. But, I must say, that is one convincing chapter.

It was almost enough to get me out there on the road with nothing on my feet but hot pink polish. Almost.

Baltimore Sun photo

Check out the Sun's website for the upcoming Baltimore marathon.

Posted by Stephanie Desmon at 7:32 AM | Permalink | Comments (13)
Categories: Diet and exercise
        

The swine flu vaccine works in one dose for older children, but children younger than 10 will likely need two doses, according to early results of clinical trials, federal health officials said this morning.

The vaccine produced an immune response in children 10 to 17 years old in just 10 days, but younger children had weaker responses. They will likely need two shots 21 days apart, officials said.

The findings are something of a surprise to infectious disease experts who initially assumed that children of all ages would likely need two doses of the vaccine, since their immune systems are less mature than adults.

But so far, the immune response to the H1N1 inoculation is "acting strikingly similar" to seasonal flu shots, said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. Typically, younger children who have never received a seasonal flu shot before must have two shots to spark an adequate immune response.

The findings mean that younger children could need four shots this fall, to protect against the seasonal flu and the swine flu.

The preliminary results come from data gleaned at NIH-sponsored trials of a vaccine made by French manufacturer Sanofi Pasteur. The trials are being conducted at the University of Maryland's Center for Vaccine Development and a handful of other sites. The studies tested two doses of the vaccine (15 micrograms and 30 micrograms) on 600 children of three age groups: 10 to 17 years old, 3 to 9 years old, and 6 months to 36 months.

In children 10 to 17 years old, 76 percent had a strong immune response to one 15-microgram dose. But for kids 3 to 9 years old, only 36 percent had a strong immune response with the same dose. In the youngest group, a single 15-microgram dose of vaccine produced a strong immune response in just 25 percent of recipients.

photo: AFP/Getty Images

Posted by Kelly Brewington at 12:22 PM | Permalink | Comments (2)
Categories: Swine flu/H1N1
        

It's a wrenching story. In 2001, 18-month-old Josie King was burned over 60 percent of her body after being scalded in the bathtub of her family's home.

Her parents took her to one of the most renowned medical institutions in the world -- Johns Hopkins. She died there three weeks later, not becuase she wasn't getting better, but because doctors made fatal errors in her care.

Sun readers might remember the heartbreaking tale told about Josie by former reporter Erika Niedowski in 2003. In the new book, Josie's Story, Josie's mother Sorrel King tells the story in her own words, describing how she turned grief into a crusade to eliminate medical mistakes.

The book describes how Sorrel and her husband took the money from their settlement with the hospital to set up a foundation to prevent similar tragedies from happening and what they learned and how they grieved along the way.

I spoke with Sorrel King for a Q&A that ran in today's newspaper. Here are a few highlights:

Why did you decide to write this book?

I wrote it for the health care industry, to inspire them. I wrote it for a parent who lost a child. I wrote the book for my children. I wrote the book for the general public so it can be another tool in my toolbox to raise awareness on this issue that I don’t think people quite get.
The most important thread to me that I hope to get out to all these categories is the book is about loss. We are all going to suffer some kind of loss at some time in our lives — loss of a job, death, cancer, divorce. What do you do when something bad happens? I hope people learn to take it and learn how to make something good come out of it. ...
 

What is the most important issue concerning medical errors that you helped bring to the forefront?

The thing I will continue to talk about until people don’t want to hear about it anymore is the importance of communication. To me, communication is not like cancer, or AIDS or diabetes. We don’t have to wait until a scientific breakthrough. We — doctors and patients together — we can fix it now.

Posted by Kelly Brewington at 7:10 AM | Permalink | Comments (21)
Categories: General Health
        

Our friends over at the Consuming Interest blog will hold a live chat at noon Monday on health care reform. Got questions you'd like to ask a health care expert? Columnist Eileen Ambrose will bring you two policy experts from Johns Hopkins Bloomberg School of Public Health.

Feel free to ask questions in advance by emailing Eileen: eileen.ambrose@baltsun.com.

Posted by Kelly Brewington at 4:09 PM | Permalink | Comments (0)
Categories: Health care reform
        

Sun columnist Laura Vozzella turns us on to the new swine flu lingo taking hold at Johns Hopkins. It's pretty hilarious. See some examples of the glossary below. And you thought those Hopkins kids were a bunch of dorky scientists in without a sense of humor. Whatevs.

"Pig: A student ill with suspected or presumed H1N1 flu. (Variation: Piglet: a sick freshman.)

"Pig in a blanket: A sick student complying with doctor's advice to stay home, drink fluids and get plenty of rest.

Bacon: What a pig experiencing an H1N1 fever feels like, i.e., fried. (Usage: Doctor: “Pig, how are you feeling today?” Pig: “Like bacon, doc.”)

Check out the full list here.

AP photo

Posted by Kelly Brewington at 2:19 PM | Permalink | Comments (0)
Categories: Swine flu/H1N1
        

Congratulations to Alan C. Reese. His question has been chosen by a panel of distinguished judges (OK, Kelly and me) to be answered as part of Picture of Health's inaugural "Ask the Expert" feature. And as the first, he wins our special prize, a one-year membership at Brick Bodies. (Cue the confetti).

Dr. Richard A. Desi, a gastroenterologist at the Institute for Digestive Health and Liver Disease at Baltimore's Mercy Medical Center is our expert today.

Q: How do you distinguish between heartburn and a heart attack?

A: "That's actually not a very easy question," says Dr. Desi. "It's a difficult question for patients and for doctors."

One key, he said, is to look for what are considered the classic symptoms of each. With heartburn, burning sensations are likely to radiate from the center of the stomach and into the chest. Typically those symptoms will improve when you take an antacid and worsen when you lie down. It can be set off by a meal.

With a heart attack, the common sensation is left-sided chest pain, radiating down the left arm with numbness or tingling. It can be accompanied by shortness of breath and can be set off by physical exertion.

But sometimes, Desi says, the typical symptoms don't appear and sometimes, they will overlap, making it hard to know the difference. His advice: If you've never had the pain before, have it checked out by a doctor. "It's probably something that you shouldn't be gambling with," he says, considering that heart disease is the No. 1 killer in the United States.

He says some people are sent to his office from the emergency room, where they raced after thinking they were having a heart attack only to be told it was acid reflux instead. "It's better to err on the side of being a little bit embarrassed," he says.

To read more, try this explanation from the Mayo Clinic.

Photo of Dr. Desi/Mercy Medical Center

Posted by Stephanie Desmon at 12:01 PM | Permalink | Comments (2)
Categories: Cardiovascular Health
        

And you thought Death Panels was so last month. The debate over end of life costs is back at the fore this month in an interesting article in Newsweek, called "The Case for Killing Granny." 

"My mother wanted to die, but the doctors wouldn't let her," the story begins.

Beyond the provocative headline (it doesn't really advocate for offing anyone's grandma) it gets at the heart of what it calls a crucial issue facing lawmakers as they try to overhaul the health care system. "The need to spend less money on the elderly at the end of life is the elephant in the room in the health-reform debate."

It's time, the author says, to finally have a discussion about dying, something American's are terrified of.

The article makes the case that the root of uncontrolled soaring health care costs is the money spent to keep very sick, very old people alive. Doctors are encouraged to order more tests and keep treating people because of how they are paid -- by each procedure, test and doctors visit. And this fee-for-service model does not result in better quality care, the article concludes. This argument is nothing new -- articles on health care are talking about it every day. 

But what I found most interesting was the discussion near the article's end about the philosophical aspect of health care. People go to the doctor "to try to make themselves feel better, even if the doctor is not doing much physically to heal what ails them" the article states.

The story discusses a program in Massachusetts is trying to change that reliance on health care, by assigning nurses to the sickest and costliest patients, giving them basic care before deciding if a doctors visit is really necessary. The program cut costs by 5 percent.

Talking to the elderly about end-of-life issues is critical and could actually reduce costs, the article  says. Most of all, the article argues, that sometimes, after a long battle with illness, a patient wants to die -- quietly and with dignity.

Our medical system does everything it can to encourage hope. And American health care has been near miraculous—the envy of the world—in its capacity to develop new lifesaving and life-enhancing treatments. But death can be delayed only so long, and sometimes the wait is grim and degrading. The hospice ideal recognized that for many people, quiet and dignity—and loving care and good painkillers—are really what's called for.

The article reminds me of another really well-done piece by the NYT last month about the challenges facing palliative care doctors -- a growing specialty in which physicians are trained to deal solely with end of life issues.

Beyond health care reform and dollars and cents, these pieces beg many moral, legal and philosphical question of how our society deals with death and dying.

Posted by Kelly Brewington at 7:12 AM | Permalink | Comments (5)
Categories: Health care reform
        

Racial health disparities cost the United States $229 billion between 2003 and 2006, money that could help pay for an overhaul of the nation's health care system, according to a new report by Johns Hopkins researchers.

"The statistics are just stunning and shocking," said HHS Secretary Kathleen Sebelius, during an announcement of the findings this morning. "There is no question that reducing the health disparities can save incredible amounts of money. But more importantly it saves lives and it makes us a healthier and more prosperous nation."

Up until now, those fighting to close racial health gaps have made their pleas on moral grounds. Confronting why black men are twice as likely to have prostate cancer than white men, is simply the right thing to do, they say. But the new figures aim to break the issue down into dollars and cents at a time when everyone is concerned about soaring health care costs.

"What we are arguing in this report is if you want to get a handle on health care costs and quality and ensuring that the U.S. has a healthcare system that is worthy of this nation, you need to account for disparities," said Thomas A. LaVeist, director of the Hopkins Center for Health Disparities Solutions and the report's author. "And the economic effect of the disparities alone could likely pay for the care for those who don’t have access now."

LaVeist gleaned the figures from data from the government's Medical Expenditure Panel Survey, which keeps tabs on how much individuals pay for health care and how healthy they are. He broke down the figures by race and age group to compare how minorities fare to whites in different categories.

It's long been known that blacks, Latinos and Asians are more likely to suffer bad health outcomes that whites in a host of diseases. But what's less clear is how to fix it. While the study puts a dollar figure on what's lost, it doesn't explain specifically how to address the problem besides the general concept of overhauling the health care system.

Presumably, more access to doctors, better preventive care can help. But health disparities are a deeply complex issue that touch on access to quality care, adequate insurance coverage and even genetics, some experts believe.

LaVeist thinks this report is a launching off point to have more of those conversations. And most importantly, he hopes they add fodder for advocates who want to reform the current health care system.

Posted by Kelly Brewington at 12:26 PM | Permalink | Comments (1)
Categories: Health care reform
        

The way a group of leading nutritionists and economists sees it, taxing sugar-sweetened beverages could lead to smaller waistlines, expanded government coffers and big savings on health care costs.

In a report published in today's New England Journal of Medicine, the group, led by Yale's Kelly D. Brownell, tries to make the case for a 1 percent per ounce excise tax on caloric sodas, fruit drinks and other beverages containing high-fructose corn syrup. They say that these drinks are a major culprit in the nation's obesity epidemic and costs associated with overweight and obesity issues are estimated to be 9 percent of all health care expenditures in the U.S.

"The science base linking the consumption of sugar-sweetened beverages to the risk of chronic disease is clear," they write.

They say the tax would increase the cost of a 20-ounce soft drink by 15 to 20 percent. And based on the economic principle of price elasticity, when the price of soda has risen by 10 percent, consumption has dropped by an average of 8 percent. People who cut out those calories are likely not to replace many of them, the researchers said, and could lose a significant amount of weight.

A national tax of the sort they recommend could raise $14.9 BILLION in the first year, money that could go toward nutrition or obesity prevention programs. They estimate such a tax would generate $284.5 million in Maryland in the first year.

Some have argued a tax on sugar-sweetened beverages would be regressive. The beverage industry has objected when individual jurisdictions have proposed such taxes.

"PepsiCo threatened to move its corporate headquarters out of New York when the state considered implementing an 18% sales tax on sugar-sweetened beverages," they write.

While the idea shocks some, they figure people will get used to the idea, just as they warmed to tobacco taxes: "Much as taxes on tobacco products are routine at both state and federal levels because they generate revenue and they confer a public health benefit with respect to smoking rates, we believe the taxes on beverages that help drive the obesity epidemic should and will become routine."

Photo/flikr

Posted by Stephanie Desmon at 7:00 AM | Permalink | Comments (12)
Categories: Healthy Living
        

I spent yesterday interviewing students at the University of Maryland College Park about how swine flu is changing their lives -- or not. So far, the university has at least 557 suspected cases of the virus and cases at campuses nationwide are rising fast. 

So I asked: are you, invincible college students, changing your hygiene habits to protect against the virus? The answer: Yes and no. Some students said they were pretty scared of "the swine," and have seriously stepped up their hand-sanitizing cough-in-their-sleeve ways. Others think the scare is overblown. "It's just the flu," they scoff, and carry on with their business.

And still others assume it's inevitable that they'll get sick but they have no fears of it being too bad. So, they crack jokes. Stop swhining, already! (That means stop whining to squares like you and me) Ah, to be young and carefree.

As for how swine flu is affecting the dating scene, as one young man told me, he checks to see if a woman is coughing before he makes a move "I don't want to be swapping swine," he said. Nice.

As these students approach the swine flu with a mix of apprehension, fear and invincibility, administrators are urging them to wash their hands and stay home if they're sick.

The university also appears to be dealing with some mixed messages about who has the swine flu and who doesn't. Some students told me their friends were diagnosed with seasonal flu, not swine flu. And a woman I interviewed as she was leaving the health center said she was told she probably has the seasonal flu, not the H1N1 variety. But the truth is, doctors typically aren't testing to determine the difference. In addition, studies point to swine flu being the predominant strain this fall. And surveillance from the CDC has shown most of the virus tested in the last month has turned out to be swine flu. 

Baltimore Sun photo

Posted by Kelly Brewington at 11:45 AM | Permalink | Comments (0)
Categories: Swine flu/H1N1
        

The Food and Drug Administration approved four swine flu vaccines and some 45 million doses of it should be available by mid-October, federal officials said yesterday afternoon.

Preliminary trials of the vaccines showed a "robust immune response in most healthy adults eight to 10 days after a single dose," said the FDA in a statement.

The news comes on the heels of Friday's announcement that the vaccine works in just one dose rather than two, defying scientists' expectations and fears that there might not be enough vaccine to go around.

Officials spent $1 billion to secure 195 million doses of the vaccine and Health and Human Services Secretary Kathleen Sebelius says "we will have enough vaccine for everybody." Priority groups such as pregnant women and health care workers will be at the front of the line.

The FDA's stamp comes as the vaccine is still being tested in children and pregnant women, who are thought to be at greatest risk of complications from the H1N1 virus.

Results from the trials on children could be ready in a few weeks, said Dr. Wilbur Chen, a flu expert who is overseeing the clinical trials of the vaccine at the University of Maryland's Center for Vaccine Development. But trials in pregnant women will take longer, since they just began last week.

For now, Chen thinks that the results will find this vaccine is as safe and effective as the seasonal flu shot -- and for all groups of people.

Perhaps a bigger question is will everyone want one?

Results from our less-than scientific poll here at Picture of Health found that 44 percent of you say you will get the shot, while 35 percent of you would not. Another 20 percent are not sure.

An interesting story in the LA Times takes a look at the growing issue of vaccine skepticism. 

I wonder if the latest FDA news might alter anyone's decision. 

AP photo

Posted by Kelly Brewington at 7:00 AM | Permalink | Comments (1)
Categories: Swine flu/H1N1
        

Admit it: the health care debate is confusing. Your eyes gloss over at terms like "bending the cost curve" and "health insurance exchange." You're not sure how a public option might be different from a non-profit co-op and why you should even care.

You want to know what this plan might mean for you and you want it in simple language that makes sense.

You have plenty of company. Nearly all Americans -- 93 percent -- think the reform debate is important and yet more than two thirds -- 67 percent -- say the issue is difficult to understand, according to a new poll by the Pew Research Center for People and the Press. 

Here at Picture of Health, we don't blame you for your confusion. We, too, are sifting through the massive bills, the endless spin to help boil down the issue to important and interesting nuggets for our readers. And it's not always easy.

With that in mind, we want to help. We want to hear from you. What do you want to know about health care reform? What do you worry about most when it comes to health insurance? And if you could ask any question to a member of Congress or a health care expert what might that be?

Share here in this space, and we'll work on getting you the answers.  

AP photo

Posted by Kelly Brewington at 12:00 PM | Permalink | Comments (10)
Categories: Health care reform
        

Antibiotics are easily available online and without a prescription, a new study finds, a potentially unexplored source of overuse of this kind of medication.

Researchers at the Medical University of South Carolina did simple Google and Yahoo! searches to find more than 130 vendors selling pencillin, erythromycin, even Cipro online. One-third sold antibiotics without a prescription, while the others just required someone to fill out a medical history to get the drugs. It is illegal to sell antibiotics without a prescription in the United States.

Antibiotic resistance is a big worry in the medical and research communities. Many are concerned that antibiotics are over-prescribed. So-called "superbugs" have been popping up, dangerous bacteria that are resistant to many forms of antibiotics, something that comes with their overuse. Educational campaigns have been directed, according to the study, to doctors who prescribe antibiotics, cautioning them to use the drugs more judiciously.

The paper, which appears in the September/October issue of the Annals of Family Medicine, suggests that these sales mean there is "a potentially large pool of antibiotics in the United States that ... may be contributing to antibiotic resistance." The paper found that most of the antibiotics sold over the Internet didn't arrive for more than a week (after the window of their usefulness in many cases) and often orders are larger than would be needed by a single individual.

"This reservoir of antibiotics is likely to be used inappropriately -- the Web sites promote self-diagnosis and self-medication, and antibiotics are likely to be used in inappropriate dosages," the researchers write.

"The general structure of the transactions," they conclude, "encourages self-medication and low quality of care."

Photo courtesy of stock.xchng.

Posted by Kelly Brewington at 7:00 AM | Permalink | Comments (0)
Categories: General Health
        

Dr. Ari Silver-Isenstadt is a pediatrician. Most of his young patients have health insurance, either private or through Maryland's Children's Health Insurance Program. But, as he writes in a letter to the editor published in the Baltimore Sun today, their parents -- many times -- go uncovered. The activist Laurel doc is a major proponent for the public option as a way to ensure universal health care. Regardless of where you stand on this, listen to what he sees in his practice:

My patients' parents are less well covered. It is not unusual for a parent to ask me about his or her own health issues during a visit for the child. These parents do not have their own physicians and often they look ill; they do not have health insurance to help cover the cost of medical care. ...

Adults should not be forced out of desperation to ask their child's doctor, a specialist in pediatrics, not adult medicine, for advice and for medication.

Despite the passions of those like Silver-Isenstadt, the public option -- which would be a public, less expensive insurance plan along the lines of private insurance -- appears to be losing momentum on Capitol Hill, after taking hits from the right and some in the center. Conservatives say such a plan would mean unfair competition to private insurance companies. Some doctors and hospitals don't like it either because they fear it will mean they are reimbursed at lower rates, similar to Medicare.

Photo from flickr/ACP Internist

Posted by Stephanie Desmon at 11:27 AM | Permalink | Comments (0)
Categories: Health care reform
        

Federal health officials were elated last week after preliminary results from swine flu vaccine tests defied their expectations. Scientists found just one dose instead of two would offer effective protection against the H1N1 virus, meaning there would likely be more vaccine supply to go around.

Yet, the folks at the National Institutes of Health are still planning to go through with a study starting today on an immune-boosting substance known as adjuvant that could be added to the vaccine. Using an adjuvant would mean giving the shot in smaller doses, further stretching supply.

It's unlikely it will be needed this fall, especially if further tests show that one standard shot is good enough to protect people from the virus. But using adjuvant could prove helpful in future years, or if the flu took a turn for the worst, said Dr. Wilbur Chen, a vaccinologist at the University of Maryland's Center for Vaccine Development, who is leading the NIH-sponsored tests.

The trials are start here in Baltimore on adults and elderly with an experimental adjuvant manufactured by GlaxoSmithKline. Chen thinks the adjuvant, essentially an oil-and-water mixture added to the vaccine -- could be particularly helpful in strengtheninng the response in the elderly, since flu vaccines work less well in older people.

Thing is, adjuvant is added to seasonal flu shots in Europe, but it's never been licensed here in the states. Using it here would require emergency declaration by the Food and Drug Administration. That's enough to make some people worried.

The web is crawling with people who think adjuvants are unsafe and others who worry that the government is moving just a little too quickly on swine flu vaccine development.

Chen thinks that some of the reluctance comes from conspiracy theorists who simply distrust vaccines, no matter what science says.

"Flu vaccines are among the most well-studied vaccines in human history," he said. "I don't think I can come up with an argument that will change the opinions of these people, no matter how much data is out there."

AP photo

Posted by Kelly Brewington at 7:00 AM | Permalink | Comments (0)
Categories: Swine flu/H1N1
        

A first round of swine flu vaccine trials from Australia reveal the vaccine to protect against the H1N1 virus works in just one dose.

The news comes as a surprise and a relief to scientists and public health officials who feared that two doses or more might be required to protect people from the virus, and that would leave not enough vaccine supply to reach everyone who would need it.

The preliminary results, just published in the New England Journal of Medicine, found that 97 percent of adults who got one 15 microgram dose developed antibodies to protect from the virus after 21 days, and in some cases within 10 days. The trials were done in Australia by vaccine maker CSL, Ltd., which is licensed to provide millions of doses of the vaccine here in the United States.

This trial is separate from the National Institutes of Health-ordered tests on adults and children being done here at the University of Maryland's Center for Vaccine Development and a handful of other academic centers nationwide. The preliminary results of those tests, however, are expected this afternoon and reveal that the vaccine tested here could also work in just one dose, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told the Associated Press.

photo courtesy of stock.xchng

Posted by Kelly Brewington at 10:16 AM | Permalink | Comments (1)
Categories: Swine flu/H1N1
        

In France, everyone kisses. The light cheek-to-cheek kiss is a social ritual as French as haute couture and people-watching sidewalk cafes. But the tradition, known as la bise, could be the latest victim of -- what else? -- the global swine flu pandemic. 

Schools, workplaces and a Health Ministry hotline are telling people to avoid the ritual hello and goodbye pecks, out of fear of spreading the H1N1 virus. 

The country has recorded just three deaths from swine flu -- Maryland alone has had seven --but officials are taking no precautions. In addition to public health officials' endless pleas that everyone wash their hands, officials are saying no hand shaking, face caressing and one website even suggests folks keep a three-foot buffer zone around them and wear masks.

Some people are not happy about the clampdown on the kissing custom. So they've devised some subsitutes. Here's my favorite part of the AP story on restrictions of la bise:

As a playful alternative, some teachers in the town have set have set up "bise boxes": Pupils slip heart-shaped greetings inside before they're exchanged in class ...

Awwww! 

photo courtesy of Reuters

Posted by Kelly Brewington at 7:07 AM | Permalink | Comments (0)
Categories: Swine flu/H1N1
        

The swine flu vaccine won't be available for at least a month, but already people who are at the highest risk for complications from the new virus are wary of getting themselves or their children inoculated.

Pregnant women notoriously avoid seasonal flu shots and young children also have very low vaccination rates. Expectant moms worry about everything they put in their bodies. And this H1N1 vaccine is something new. Some new and current mothers alike are concerned that the new vaccine hasn't been thoroughly tested.

Health officials are confident that the vaccine will be safe and effective by the time it hits the market and they note that pregnant women and infants and toddlers are likely to be severely impacted why what has in most cases been a mild disease so far.

Still, just over one month out from when the vaccine is expected to be ready, the vaccines are still being tested. Just this week, the National Institutes of Health began testing it in pregnant women.

Posted by Stephanie Desmon at 1:30 PM | Permalink | Comments (5)
Categories: Swine flu/H1N1
        

The U.S. Census just released some surprising figures on the number of Americans without health insurance. The agency says the percentage of the uninsured did not grow between 2007 and 2008 -- holding steady at 15.4 percent. Meanwhile, the number of uninsured people rose slightly 45.7 million to 46.3 million.   

During a monster recession, with rising unemployment and so many employers cutting health insurance to their workers -- can those figures be right? 

Just how many Americans lack insurance has been a tough figure to pin down. In his pitch to reform the health care system and expand coverage to every American, President Obama often says there are 47 million people among the ranks of the uninsured. But other estimates from government agencies and interest groups vary widely from tens of millions of people -- in one way or another.

A closer look at the Census figures, however, sheds some light on what might be going on. For one, the number of adults without health insurance increased from 19.6 percent to 20.3 percent between 2007 and 2008, while the number of uninsured children decreased substantially, perhaps offsetting the adult numbers.

Drill down a bit more and it's clear that more Americans appear to be losing their employer-sponsored insurance while at the same time more people are getting coverage from the government -- from Medicaid, Medicare and the Children's Health Insurance Program.

The percentage of people covered by their employers decreased to 58.5 percent in 2008, from 59.3 percent in 2007. Menwhile, 29 percent of Americans were covered by government programs, up from 27.8 percent in 2007.

It's important to point out that number of uninsured people is clearly an estimate and the census figures are a snapshot in time. They don't capture the many people who lost their jobs later in the year and were missed by counters who compiled the data early in 2008.

Reform advocates are already seizing on the figures as further evidence that lawmakers should pass legislation in a hurry. 

 “Disturbingly, the uninsured numbers from the U.S. Census Bureau represent the tip of the problem," said the American Public Health Association in a press release. "There are another 25 million underinsured people who also receive inadequate access to care and are at risk of many of the same outcomes as those with no coverage at all."

“The new Census Bureau report should give Congress an even greater sense of urgency to enact high-quality, affordable health coverage and care for all Americans this year,” said the advocacy group Families USA in a statement.

Baltimore Sun photo

Posted by Kelly Brewington at 11:35 AM | Permalink | Comments (4)
Categories: Health care reform
        

Up until now, food manufacturers determined if and when they would tell government officials about products they believed could seriously sicken humans or animals.

This week, the Food and Drug Administration changed that, instead requiring companies to alert them within 24 hours if  contamination is suspected. The FDA rolled out its Reportable Food Registry, an electronic system designed to head off potential cases of foodborne illness.

According to the FDA, the reasons why a company might have to report a problem include if there has been bacterial contamination, allergen mislabeling or elevated levels of certain chemicals.

Companies that fail to report could face fines or other sanctions. Companies are not required to report a problem if they have solved it and taken steps to correct it before an item is shipped.

"We learn about problems after people get sick," Michael Taylor, senior adviser to the FDA's commissioner, told reporters. "This is intended to inform us of contamination problems before people get sick."

The registry was mandated by Congress in 2007 and is supposed to be an answer to complaints that FDA doesn't react quickly enough to food safety issues. There have been a series of high-profile cases of foodborne illness recently, where many have gotten sick and some have died from consuming contaminated peanut butter, spinach, cookie dough and more.

Posted by Stephanie Desmon at 7:08 AM | Permalink | Comments (1)
Categories: General Health
        

There's still time left to take part in Picture of Health's inaugural "ask an expert" extravaganza. Got a pressing medical concern? Step right up and submit one here. We'll pick the best question, find you the right expert to answer it and post the response here. (The original deadline for submissions was supposed to be today, but because of the holiday week, we're extending it until next Wednesday)  

And wait, there's more. (Cue the infomercial voiceover) Our fist winner will receive a year's gym membership to Brick Bodies. (Fine print alert: Must be a local resident 25 and older. Good at any location. First-time visitors qualify and the membership is not valid with a current membership.)

Watch this space. On Friday, Sept. 18, we'll publish the winning question (complete with a response from a doc).

photo: stock.xchng

Posted by Kelly Brewington at 2:00 PM | Permalink | Comments (3)
Categories: General Health
        

Sarah Palin is talking death panels again. This time, instead of using Facebook, she is recycling this bugaboo in the pages of The Wall Street Journal this morning.

Hoping to grab attention on the morning of the president's health care address to Congress, she criticizes Obama's desire to create an Independent Medicare Advisory Council, what she calls "an unelected, largely unaccountable group of experts charged with containing medical costs." Using Obama's words, the failed 2008 vice presidential candidate says this group "should guide decisions regarding that 'huge driver of cost ... the chronically ill and those toward the end of their lives ...'"

Given such statements, Palin writes: "[I]s it any wonder that many of the sick and elderly are concerned that the Democrats' proposals will ultimately lead to rationing of their health care by -- dare I say it -- death panels. Establishment voices dismissed that phrase, but it rang true for many Americans."

The concept of death panels has been debunked time and time again, but the former Alaska governor keeps trotting it out,  because she wants the spotlight. It's working. Television this morning was all over the gambit, discussing her latest attempt to get into a policy discussion in which she has no role.

The Atlantic's Marc Ambinder wrttes in a piece called "Media Challenge: Will They Take The Palin Bait?" -- soon after the op-ed became available online last night -- that Palin should not be taken as an authority on health care issues.

So here's a challenge to the media: if you want to do justice to conservative ideas and find some balance in your coverage tomorrow, book serious Republicans with original ideas on your programs.  If you don't, Palin is giving herself a voice at your expense and through little effort of her own.

AP Photo

Posted by Stephanie Desmon at 10:39 AM | Permalink | Comments (9)
Categories: Health care reform
        

President Barack Obama seems to be talking health care reform everywhere these days. Tonight, he'll address a joint session of Congress. He's even on the cover of the October issue of Men's Health magazine, which hits newsstands next week, where he does discuss health care reform, but also takes on a range of health issues. (Sorry, ladies, unlike this mag's more typical cover models, his abs are hidden under a dignified suit and tie.)

Among the tidbits in the mag:

* Obama thinks a "sin tax" on soda and other sugary products "is an idea that we should be exploring." Still, he acknowledges that could spark a fight on Capitol Hill where "legislators from certain states that produce sugar or corn syrup are sensitive to anything that might reduce demand for those products." He adds that some people, understandably, don't want "Big Brother telling them what to eat or drink." Kids, he said, "drink way too much soda."

* Obama talks about his six-day-a-week workout schedule. "My blood pressure is pretty low, and I tend to be a healthy eater. So I probably could get away with cutting [my workouts] back a bit," he tells the mag. "The main reason I do it is to clear my head and relieve me of stress."

October's issue of Women's Health has an even more popular Obama in its pages: First Lady Michelle. She tells the mag how some of her healthy eating habits have their roots in her childhood, where money was always tight. Going to McDonald's was a reward, she said, but only on rare occasions. They got pizza on report card day and tiny scoops of ice cream, whenever they had it at all. The First Lady says: "Those values -- even though they were the result of economic circumstances -- were really good, and they created some pretty healthy boundaries about food."

And my favorite is when she talks about having dinner together as a family as often as possible (my own mother was a stickler for this growing up). "No matter what's going on, he sets aside that time," Mrs. Obama says. "Dinner is at 6:30 p.m., and he comes in, we sit down." She makes it sound just like dinner at your house. The Obamas say a blessing and "we have the tradition of just going around and talking about our days, the good and the bad aspects," she said.

Photo courtesy of Men's Health.

Posted by Stephanie Desmon at 7:15 AM | Permalink | Comments (4)
Categories: General Health
        

Apparently, Americans are in denial.

So suggets a new survey from the market research firm Mintel which finds that we think we're a whole lot healthier than we actually are. In our heads, we're a nation of skinny people who eat proper quantities of healthy food. In reality, we're a bunch of overweight folks who eat whatever we want and lots of it.

In the survey, 25 percent of respondents told Mintel they were obese or overweight. According to  the Centers for Disease Control and Prevention, 67 percent of Americans fall into one of these categories.

"Right now we say one thing, but then our actions contradict those perceptions and best intentions," senior analyst Krista Faron said in the press release.

More stuff from the survey:

Sixty-five percent of adults said they "try to eat healthier food these days," but nearly as many (59 percent) say they eat the foods they like "regardless of calories."

Seventy percent of respondents said they think they should exercise more. Just 37 percent say they exercise regularly and half of them only do it twice a week or less.

Photo/AFP

Posted by Stephanie Desmon at 12:37 PM | Permalink | Comments (4)
Categories: Diet and exercise
        

Lawmakers are back in Washington today to wrangle over health care reform -- particularly the cost of overhauling the system.

But what about the cost to individuals? Lawmakers want to expand insurance to some 47 million Americans. But what if the premiums are still too high for folks to afford them?

I take a look at the affordability question in a story today that draws on an example from Howard County. There, an innovative program offering access to doctors for as little as $50 a month -- far cheaper than any of the Congressional proposals would offer. Yet, it's still too expensive for some people.

Key to making insurance affordable would be providing subsidies large enough for low and moderate income people.  But for now, Congress hasn't decided how many people would qualify for subsidies and for how much.

Dr. Peter Beilenson, Howard County's health officer, told me that the subsidies should be vastly increased to make insurance affordable to more Americans. But just where would that money come from? For now, I guess we'll just have to stay tuned to the debate ...

photo courtesy of stock.xchng

Posted by Kelly Brewington at 7:02 AM | Permalink | Comments (5)
Categories: Health care reform
        

And we wonder why two-thirds of Americans are overweight.

Add this one to the horrifying, artery-clogging trend of deep frying everything -- and clearly we mean everything: Deep-fried butter (you read that correctly). It is among the new offerings that will be available at the Texas State Fair this year, where fried food is as outsized as everything there.

Your cardiologist is cringing right now.

I don't think I need to tell you that a stick of butter is 810 calories and that is before anyone coats it and tosses it into the deep fryer.

Contributor Laura T. Coffey tells us how it's done on the website for NBC's Today Show.

“I mean, butter by itself does not taste good,” the dish's creator, 39-year-old Dallas resident Abel Gonzales Jr., told her. “Nobody just grabs a stick of butter and eats it. That would be gross.”

Yes, it would.

"So here’s what Gonzales does: He takes 100 percent pure butter, whips it until it is light and fluffy, freezes it, then surrounds it with dough," Coffey writes. "The butter-laden dough balls are then dropped into the deep fryer."

When it's done, deep-fried butter apparently tastes like a buttered roll, though when it comes to your health, a buttered roll would be so much better for you.

Gonzales could be the poster child for unhealthy cooking. His past creations apparently include Texas Fried Cookie Dough, Fried Peanut Butter, Jelly and Banana Sandwich and Fried Coke recipes.

Photo/stock.xchng

Posted by Stephanie Desmon at 12:10 PM | Permalink | Comments (7)
Categories: Diet and exercise
        

Checked your Facebook account lately? Are you seeing what we are? Status updates that go something like this:

No one should die because they cannot afford health care, and no one should go broke because they get sick. If you agree, please post this as your status for the rest of the day

Or this:

No one should die, go blind, or be crippled because they can't afford health care. No one should go broke because they get sick. No one should be unable to change jobs because of a "pre-existing condition." If you agree, please post this as your status for the rest of the day.

The beginning of a health care reform movement? Or just idle chit chat on a social networking site where folks are constantly trying to impress their "friends?" And will an anti-reform response be next?

AP photo

Posted by Kelly Brewington at 7:00 AM | Permalink | Comments (1)
Categories: Health care reform
        

One person's little pink pill looks like a little blue pill to someone who is colorblind. With color blindness found in 8 percent of men and .4 percent of women, color-coding of medication may not prevent mistakes as it is intended. Instead, it can create confusion, write Australian optometrists in the only journal The Lancet last week.

They cite an earlier study of 100 colorblind people where 2 percent reported taking the wrong drug because they couldn't tell what color the pill was. People with red-green colorblindness have difficulty with colors on both of those spectra and are better able to pick out yellow, blue, grey and white.

At the right, pictures A and C are how most people see colors. Pictures B and D are similar to what a colorblind person might see.

Manufacturers often color-code pills to make it easier for people, the researchers from the University of Melbourne report. "Colour is a good way to differentiate tablets and their containers because it enables more immediate recognition than do words printed on labels or embossed onto tablets," they write. "Moreover, patients with poor vision or those not wearing their reading glasses can have difficulty reading print on labels or tiny low-contrast embossed text on tablets."

They caution doctors and pharmacists to use color to instruct patients on how to identify tablets only if they know the patient has normal color vision.

Photo courtesy of The Lancet

Posted by Stephanie Desmon at 2:02 PM | Permalink | Comments (0)
Categories: General Health
        

We here at Picture of Health know you worry about your health. We do, too. And we know you probably have pressing questions you would love to ask your doctor, if only she had time to sit and chat. So next Friday, we will inaugurate our Ask a Medical Expert feature.

Here's how it works: You submit your questions. We will pick the best one and the winning question will be answered here next Friday, Sept. 11. It's that easy

We hope you will submit questions. We hope you will tell your friends and family to submit questions. And since we are feeling generous today -- and not above bribery -- our first winner will receive a year's membership at Brick Bodies. (Offer good for local residents 25 and older. First-time visitors qualify and the membershop is not valid with a current membership. Good at any location. I love writing the fine print.)

So ask away and watch this space for answers.

Posted by Stephanie Desmon at 11:00 AM | Permalink | Comments (1)
Categories: General Health
        

Whether spending now to prevent chronic illnesses actually reins in costs is a huge issue  lawmakers will confront when they return to Washington next week to battle out health care reform.

Many lawmakers and the Obama administration assert there will be huge savings down the road from preventing chronic diseases now -- enough to pay for a health care overhaul. But a new study from the journal Health Affairs, pokes holes in those claims. Researchers found that while costs will likely decrease over time, prevention efforts will not result in enough savings to pay for reforming the entire health care system. 

Still, the authors say, if the government took a longer view on costs, it would see greater savings. The Congressional Budget Office projects the cost of prevention efforts over 10 years, and finds that most preventive services, result in greater spending, not savings. But the study's authors think the government would find a rosier picture if it projected out 25 years. The bottom line:

 "There's no free lunch here. Prevention will not pay for everything. But it's not as expensive as it looks at first blush," said Michael J. O'Grady, a senior fellow at the National Opinion Research Center at the University of Chicago, told the Washington Post.

The study is just the latest to weigh in on the question of whether prevention saves money and the opinions vary widely.

For instance, the New England Journal of Medicine found last year that expensive preventive measures don't save money in the long run. It doesn't call into question eating right and exercising, but rather questions specific interventions, such as screening tests and costly monitoring of people with chronic diseases.

Meanwhile, a recent CDC study said better prevention efforts are desperately needed to bring down costs of such chronic illnesses as obesity. Others, however, caution that money must be spent only on interventions that are proven to be effective.

Then of course, there are others who argue that preventing diabetes and teaching our kids to eat healthier are simply the right thing to do, cost savings or no.

Baltimore Sun photo

Posted by Kelly Brewington at 7:00 AM | Permalink | Comments (1)
Categories: Health care reform
        

Attention health geeks: obsessed with your iPhone AND the swine flu? Well here's a new application that claims to help you track disease outbreaks from your favorite handheld device.

The app, called Outbreaks Near Me, was designed by researchers at the Children's Hospital of Boston. You can find it via HealthMap, which aggregates disease outbreaks worldwide using everything from Google news alerts to updates from the World Health Organization and the Centers for Disease Control and Prevention.

The folks behind it acknowledge it's not an exact science, but they say it can help people pinpoint where disease outbreaks occur -- and not just swine flu, but all sorts of illnesses. And for serious nerds, the app enlists your help as an outbreak "detective," to report your findings to the network using your iPhone.

"You will get credit as a disease detective and your find will be featured on the website," according to the site.

True geeks know this isn't the only way Apple is going after folks interested in health. Forget the useless applications that allow you to pop virtual bubble wrap or drink a virtual bear, there are a ton for doctors and patients ...

For docs, there are medical manuals, drug guides and access to medical journal articles.

For patients, Apple offers everything from Quitter, an application to help smokers kick the habit, and Lose it, a free one that tries to help you shed pounds, to various applications that allow diabetics to keep track of their glucose levels. There's even an app for would-be guinea pigs to search tens of thousands of clinical trials. 

Do you guys use these or others? Do they help? We're intrigued.

image courtesy of HealthMap

Posted by Kelly Brewington at 11:49 AM | Permalink | Comments (1)
Categories: Swine flu/H1N1
        

Swine flu, the World Health Organization is telling us, is now the dominant strain of influenza across most parts of the globe. And new research, led by University of Maryland researchers, suggests that the new H1N1 virus spreads more quickly than the seasonal strains and caused more serious disease.

The upside: While researchers conclude the swine flu will likely outcompete the seasonal flu in humans this fall, it doesn't appear likely to combine with other viruses to create a sort of more virulent "superbug." The National Institutes of Health-sponsored study was done in animals -- ferrets, to be precise.

"I'm not surprised to find that the pandemic virus is more infectious" than seasonal flu, virologist Daniel Perez said in the university's press release, "simply because it's so new, so hosts haven't had the chance to build immunity yet."

But if swine flu is going to dominate this fall, why the push to get the seasonal flu vaccine, which protects against several strains of influenza -- but not the new virus? Couldn't people just skip the seasonal flu shot and hold out for the H1N1 vaccine under development?

I put these questions to Dr. Karen L. Kotloff, who is leading clinical trials of an experimental H1N1 flu vaccine at the University of Maryland's Center for Vaccine Development. Kotloff says that influenza is a wily virus, one that is difficult to predict. Just because the H1N1 is the dominant virus now doesn't mean things won't change as fall turns into winter, she says.

"Your safest bet if you don't want to get the flu" -- any flu -- "is to get both," she said.

Posted by Stephanie Desmon at 7:14 AM | Permalink | Comments (5)
Categories: Swine flu/H1N1
        

The government unveiled its latest weapon in the fight against the swine flu pandemic: Elmo. That's right boys and girls, because when the furry Sesame Street star says wash your hands you go right ahead and do so.

It's all a part of a public service campaign designed to spread the word about good hygiene in the battle against the H1N1 virus. And since children are more susceptible to this new flu -- not to mention their germy ways are known to spread viruses fast -- the Department of Health and Human Services is aiming its message squarely at them. HHS Secretary Kathleen Sebelius, at right, explains the strategy.

 And really, who can resist Elmo's utter cuteness? Check out how he and Gordon espouse the benefits of hand washing and coughing in one's sleeve:

Posted by Kelly Brewington at 2:40 PM | Permalink | Comments (1)
Categories: Swine flu/H1N1
        

Here's a new piece of research that we here at the Picture of Health share with you cautiously: The more alcohol people drink, the more likely they are to exercise. And the more heavily people drink, the study says, the harder they exercise -- though not, we're pretty sure, at the same time.

These tidbits come via the Sepetember/October issue of the American Journal of Health Promotion. The authors of the study, led by a health economist at the University of Miami, say their findings don't suggest that drinking actually causes people to work out more. It's just that when they analyzed data from an annual telephone survey of 230,000 Americans, they found the two were linked.

They found that women who drank alcohol exercised 7.2 minutes more per week than teetotalers. Heavy drinkers exercised nearly 20 minutes more per week than those who abstained. And drinking was associated with a 10 percent increase in the probability of engaging in vigorous physical activity. The results were similar for men.

For real? Researchers analyzed data from an annual telephone survey of more than 230,000 Americans. But previous studies have seen things differently. They have instead suggested that people who drink heavily tend to do other unhealthy things like smoke, eat an unhealthy diet --and shun exercise.

What could explain the latest findings? The authors suggest that maybe "heavy drinking is part of a sensation-seeking lifestyle," which may include skiing, mountaineering, kayaking or deep-sea diving. The link could be "the result of people socializing and drinking after participating in organized group sports," they venture. Or, they write, perhaps people exercise "to compensate for the extra calories gained through drinking or to counterbalance the negative health effects of drinking."

What's the moral here? I'm not really sure. The authors suggest that doctors may overlook problem drinking in patients who eat well and exercise, because they appear to have a healthy lifestyle. They suggest doctors consider the possibility that some of those seemingly healthy patients could have "alcohol use problems that could be detected and treated."

We don't make this stuff up.

Photo by AFP/Getty Images

Posted by Stephanie Desmon at 11:40 AM | Permalink | Comments (13)
Categories: Diet and exercise
        

My story today about overdiagnosis and overtreatment of prostate cancer reignites a controversial debate about whether men should be screened for the disease. 

In the two decades since a blood test became the prevailing screening tool for prostate cancer, more than 1 million men nationwide have been diagnosed with and treated for the disease—most of them unnecessarily, a new study finds 

The research, published in today's Journal of the National Cancer Institute, raises questions about whether the screening test -- known as prostate-specific antigen screening, or PSA -- does more harm than good. That may sound odd, since screening, on its face, seems beneficial. Catch cancer early and you'll live longer, right?

Well, not always. It's possible for people to have cancers that may never harm or kill them. When it comes to prostate cancer, many men are being diagnosed and referred to treatment that they don't need and that can actually cause harms such as incontinence and impotence, the study says.

Some urologists are pretty upset at the findings and think the study is misguided. They say it dismisses that PSA testing has helped doctors catch some cancers early and save lives.

With all the back and forth, men reading this are likely wondering: should I get a PSA test or not?

Well, that's a tough question to answer. The American Cancer Society and the U.S. Preventive Services Task Force don't recommend the screening but the American Urological Association does. The study's authors aren't advising for or against the PSA test, but they do stress that patients become informed and have conversations with their doctors about the risks of screening and possible treatment. Knowledge is power.

Posted by Kelly Brewington at 7:30 AM | Permalink | Comments (5)
Categories: Cancer