Booster Shots

Oddities, musings and news from the health world

Category: healthcare

When the question about healthcare overhaul is simply: 'What about me?'

July 7, 2010 | 10:37 am

Pills "The most common question people have about health reform is 'How will I be affected?' The answer, of course, depends on the individual, as different demographic groups will be affected very differently." So begins a series of briefs from the Robert Wood Johnson Foundation.

The briefs, released Tuesday, analyze the expected impact of the healthcare overhaul on young adults, children, older people and (sort of) people who buy insurance on the individual or small-group market. The latter is a bit too complex to easily distill, it seems. 

The summaries are not what you would call light reading (and can we have a motion to ban the abbreviation PPACA?), but they are informative. And, of course, brief

(PPACA stands for Patient Protection and Affordable Care Act -- what most people call the health overhaul or health reform law -- and it's likely something of a deterrent to consumers looking for straightforward, easy-to-understand information.)

-- Tami Dennis

Photo: Overall, the nation's seniors will see prescription drug coverage improve, the analysis says. But some will also see the premiums increase. Credit: Mark Boster / Los Angeles Times

California program helps people record wishes at end of life

July 2, 2010 |  6:00 am

Oldage A program used in California to help nursing-home and terminally ill patients express their wishes regarding treatment at the end of life results in the type of care patients want and expect, maintains a new study.

The program is called Physician Orders for Life-Sustaining Treatment and has been adopted in many nursing homes, hospitals and long-term-care facilities in California beginning in January 2009. The program involves an innovative medical form, that is signed by a doctor, allowing patients to specify what kind of care they want at the end of life, such as feeding tubes and other medical interventions. The form was designed 20 years ago in Oregon because of concerns that traditional "do not resuscitate" orders and advanced directives did not fully communicate patients' wishes for many situations and types of treatments.

The multi-state study, published Friday in the Journal of the American Geriatrics Society, found that patients with the Physician Orders for Life-Sustaining Treatment forms had much less unwanted hospitalization and medical interventions. For example, 98% of people with the forms had orders about medical interventions in addition to resuscitation -- compared with 16% of residents without these forms.

The form "allows patients to tell their health care professionals exactly what they want, so providers know patients' wishes no matter what level of treatment they are seeking," Dr. Susan Tolle, a co-author of the study and director of the Center for Ethics in Health Care at the Oregon Health & Science University, said in a news release.

Efforts to increase awareness about the program are being led in California by the Coalition for Compassionate Care of California and the California HealthCare Foundation. Information and opportunities to learn about the program can also be found at this website.

-- Shari Roan

Photo: Justin Sullivan / Getty Images

Americans begin to overhaul -- just a bit -- their opinions of healthcare law

June 30, 2010 |  6:40 pm


Maybe the reassessment is triggered by a more relaxed summer mood, or the fact that Americans are inherently optimistic and figure they just as well hope for the best. In any case, the public appears to be looking slightly more favorably at the new healthcare overhaul law.

The Kaiser Family Foundation released a survey Wednesday showing that 48% of respondents expressed favorable views of the law (up 7 percentage points over last month); 41% were still less than impressed. And 10% had yet to choose sides.

Want to know what fellow Americans are thinking, why they're thinking it and more, especially now that they're less informed/swayed by the headlines of the day? The healthcare poll parses it neatly.

The report predicts a political effect come fall -- you know, election time.

If you're in the aforementioned 10%, keep this in mind: The site offers a wealth of information on health reform. It might be worth checking out before you show up at the voting booth.

-- Tami Dennis

Photo: To hear what Americans have to say, just ask. Credit: File

Black and Latino males twice as likely to have poor health

June 30, 2010 |  8:17 am

Black Latino Men health Given the inequality in healthcare in the United States, it's no surprise that some groups of people suffer far worse health outcomes than people with better resources. But if there is one group that has been especially overlooked in this equation, it's black and Latino boys. The major factor in their poor health, according to a new report by the California Endowment, is where they live. Growing up in poor and stressful neighborhoods with limited healthcare resources leads to poor health.

According to the findings in the report:

  • The odds of poor health outcomes for boys and men of color are more than two times higher than for white boys and men in California.
  • Latino boys are 4.1 times more likely than white boys to suffer from post-traumatic stress disorder.
  • African-American boys are 2.5 times more likely.
  • Latinos are 3.1 times more likely to have limited access to health care and 4.8 times more likely to lack health insurance.
  • Asthma disproportionately affects children who live in poorer neighborhoods.
    Black young men have a homicide rate 16 times greater than that of young white men.
  • African-American and Latino children are 3.5 times more likely to grow up in poverty compared to whites.

Poorer neighborhoods mean less access to stores selling health foods, fewer parks and safe places to run and play in and fewer social networks to promote health and safety.

The California Endowment has launched a 10-year initiative, called Building Healthy Communities, to improve the health of men and boys of color by making strategic improvements in the communities and neighborhoods in which they live. In the report, the group identifies a handful of successful programs to improve the lives of men of color already in place in the state that could be applied on a larger scale -- and why implementing these programs statewide cannot wait.
-- Shari Roan

Photo credit: Carlos Chavez  /  Los Angeles Times

U.S. is No. 1 in a key area of healthcare. Guess which one ...

June 23, 2010 | 10:19 am

Operation Australia, Canada, Germany, the Netherlands, New Zealand, Britain — all are outperforming the United States when it comes to most aspects of healthcare. Again. But we're still tops in one area: spending.

Take that, Netherlands.

The assessment is from a new Commonwealth Fund report, released Wednesday, ranking healthcare systems on quality, access, efficiency, equity and healthy lives.

After pointing out that the other countries have universal health coverage (perhaps you'd heard?) and that the access picture should change as the health overhaul is implemented, the summary of the report states:

"But even when access and equity measures are not considered, the U.S. ranks behind most of the other countries on most measures. ... It is apparent that the U.S. is lagging in adoption of national policies that promote primary care, quality improvement, and information technology."

The report notes that various legislative remedies (read: funds) are now being administered to mitigate these symptoms as well.

But money doesn't necessarily buy quality, as the assessment emphasizes, and it would appear we have a long way to go in improving key elements of our healthcare system.

Here's today's L.A. Times article on healthcare: Obama proposes interim health protections ... "The regulations, all outlined in the healthcare overhaul bill, include barring insurance plans from denying coverage to children with preexisting conditions. Republicans call the rules a sales job."

— Tami Dennis

Photo: A patient undergoes robotic surgery in Florida. Credit: Roberto Gonzalez / Orlando Sentinel


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Teenage girls may need two annual preventive health checkups

June 23, 2010 |  6:00 am

Teengirl Most kids have a well-child medical check-up once a year. That's what the experts recommend for school-age children and teenagers. But one medical group suggests that teenage girls should have two annual preventive health visits: one a general checkup with a primary care doctor and a second "dedicated" reproductive health visit.

The idea is proposed in the July issue of the journal Obstetrics & Gynecology by an American College of Obstetricians and Gynecologists committee. The group recommends a girl have her first visit with an ob-gyn between the ages of 13 and 15. The visit should be primarily educational and a chance to establish a relationship with the doctor, according to the paper. Topics of discussion could include puberty, menstruation, healthy eating habits, sexually transmitted disease and pregnancy prevention, sexual orientation and gender identity. A pelvic exam would be performed only if warranted. The visit should include a discussion involving the teenager, a parent and the doctor about patient confidentiality.

Such a visit would "assist an adolescent in negotiating entry into the health care system when she has a specific reproductive health care need," the authors wrote. In a news release, Dr. Diane F. Merritt, chairwoman of American College of Obstetricians and Gynecologists' committee on adolescent health care, added: "Given the high pregnancy and STD rates among adolescent girls in the U.S. compared with other developed countries, we continue to encourage parents to bring their daughters to an ob-gyn for their first visit earlier rather than later."

The American College of Obstetricians and Gynecologists has a resource for teens and their parents called Tool Kit for Teen Care.

-- Shari Roan

Photo credit: Mark Boster  /  Los Angeles Times

Best medical schools don't produce the most-needed doctors

June 14, 2010 |  2:00 pm

The nation has too few doctors, especially primary-care or family physicians and those who care for underprivileged populations, according to many studies. But don't look to the leading institutions for much help with this, say the authors of a new study. Researchers scored all U.S. medical schools on their ability to produce doctors who will work in primary care and in underserved communities.

Most of the schools with the finest reputations scored abysmally on the "social mission" criteria. That's not terribly surprising considering that the schools that rank as the best are often those that put a priority on research science. The survey, published Monday in the Annals of Internal Medicine, found that schools with substantial research funding from the National Institutes of Health did poorly in producing the most-needed type of doctors, as did private medical schools. Historically black schools, such as Morehouse College and Meharry Medical College, scored the highest in social mission rankings. The surveys were based on 60,000 doctors in active practice who graduated from medical school between 1999 and 2002.

Here are some details:

  • The highest-ranking schools in social-mission scores were: Morehouse, Meharry, Howard University, Wright State University, University of Kansas, Michigan State University, East Carolina University, University of South Alabama, University of Iowa and Oregon Health & Science University.
  • The top 10 lowest-scoring were: Johns Hopkins University, Stanford University, Duke University, Texas A&M University, Columbia University, Albany Medical College, Medical College of Wisconsin, University of Pennsylvania, Loyola University and Boston University.
  • Osteopathic schools placed more graduates into primary care.
  • Among California schools, UC Irvine ranked 138th among 141 schools in social mission. However, UC San Diego was among the few schools that received a large amount of government research funds while also producing a higher number of primary-care doctors.

Medical schools will be expanding enrollments for the first time in 30 years to meet the growing demand for health care. Perhaps the schools that turn out the most-needed types of doctors should receive the most financial support for expansion.

"Some schools may choose other priorities, but in this time of national reconsideration, it seems appropriate that all schools examine their educational commitment regarding the service needs of their states and the nation," the authors wrote.

-- Shari Roan

Photo: UCI Medical students at a student-run free clinic at the Orange County Rescue Mission's Village of Hope on Feb. 21, 2009. A survey found, however, that the school ranks low on promoting a "social mission" in medicine. Credit: Irfan Khan  /  Los Angeles Times.

Book Review: 'Passages in Caregiving' by Gail Sheehy

May 22, 2010 |  9:00 am

Book jacket of Passages in Caregiving-1 Caring for a loved one with a chronic illness -- a parent, partner, sibling or child -- is a role no one aspires to but many of us will take on.

In her superb new book, "Passages in Caregiving," Gail Sheehy writes that someone is serving as an unpaid family caregiver in almost one-third of American households. It's a job that lasts an average of five years.

"Nobody briefs us on all the services we are expected to perform when we take on this role," she writes.

That statement is no longer true, for "Passages in Caregiving" -- written from Sheehy's personal experience supplemented by a generous dose of reporting -- does it well. Her book outlines the road that awaits caregivers and gives practical advice to help them on the journey. It's an ambitious and readable blend of memoir, reportage, consumer advice, pep talk and love story.

Sheehy, author of the bestselling 1976 book "Passages" and many other books and articles, was married to Clay Felker, the legendary editor who founded New York magazine and cultivated such writing talents as Tom Wolfe, Jimmy Breslin and Gloria Steinem. They were a high-profile New York media couple with a life many would envy.

Then one day a phone call came that changed everything. It was a cancer diagnosis for Felker. As they absorbed the news and started making the rounds of doctors, Sheehy realized she had taken on a new role: family caretaker. She thought this would last six months to a year and then their life together would go back to normal. It didn't. 

Continue reading »

Just how many people have preexisting health conditions? About 1 in 5.

May 11, 2010 | 12:05 pm

Pills The unabashedly pro-healthcare-overhaul organization FamiliesUSA recently offered a look at the number of people in the U.S. with diagnosed preexisting health conditions. Those people will be among the Americans most dramatically affected by the upcoming changes in the health insurance market. On Tuesday, the organization offered a look at California's numbers.

The national report, Health Reform: Help for Americans with Pre-Existing Conditions, stated that 57.2 million non-elderly Americans have a condition that could jeopardize their ability to get insurance in the current insurance market. ("Current," of course, won't be "current" for long.) That amounts to more than 1 out of 5 people younger than 65.

California's numbers are similar, with almost 6.5 million non-elderly adults having a preexisting health condition. Again, that's about 1 in 5. The report offers age, ethnic and income breakdowns.

If the numbers neither shock nor compel you, head over to the organization's exploration of how the recent healthcare overhaul will affect the middle class, small businesses, the uninsured .... The information may not be overly reader friendly, but it is indeed thorough.

Here's recent Times coverage of impending healthcare changes.

— Tami Dennis

Photo credit: Associated Press

Events help launch muscular dystrophy clinic

May 3, 2010 |  7:38 am
Dylan Boys in the Los Angeles area with the genetic disorder muscular dystrophy will soon have a clinic to attend that does not require long-distance travel. The UCLA Muscular Dystrophy Clinic is slated to open later this year. The efforts to open the clinic, which began when two UCLA scientists learned their youngest son had the disease, are described in Monday's L.A. Times story, "A personal fight against a lethal childhood illness."
But several families have come together to make the clinic possible. Seven year ago, Paul and Debra Miller founded CureDuchenne, a national nonprofit advocacy group based in Newport Beach. The organization has focused much-needed attention on the plight of local MD families. CureDuchenne was aided by Chris and Amy Martin, a Los Angeles couple who have organized yearly fundraisers that have raised $200,000 for the clinic. The third-annual "Dealing for Duchenne Los Angeles Celebrity Poker Tournament" will be held June 12 at the Petersen Automotive Museum. Proceeds will benefit the clinic.
The efforts come at an opportune time, said Dr. Eric Hoffman, a leading researcher on the disorder at Children's National Medical Center in Washington.
"It's the best place the field has been in since I've been involved," he said. "There's a lot of progress in clinical trials."
-- Shari Roan
Photo: Photo of Stan Nelson and Carrie Miceli, both UCLA scientists, with their children, Calvin Miceli-Nelson, 16, and Dylan Miceli-Nelson, 9, at their Los Angeles home. Credit: Allen J. Schaben / Los Angeles Times


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