HHS Secretary Kathleen Sebelius wades into the mammogram fray

The reaction to this week's U.S. Preventive Services Task Force recommendation against regular mammograms for women under 50 was swift, emotional and highly public. Today, Health and Human Services Secretary Kathleen Sebelius weighed in, pointing out that, well, the task force is actually just an independent panel offering advice, not setting policy, so ... just do what you've been doing.

Seriously. "My message to women is simple. Mammograms have always been an important lifesaving tool in the fight against breast cancer, and they still are today. Keep doing what you have been doing for years — talk to your doctor about your individual history, ask questions and make the decision that is right for you."

Here's her full statement.

(Enjoy the fallout, task force folks! You're on your own!)

If you want to know more about that panel, check it out here.

By the way, it's sponsored by the Agency for Healthcare Research and Quality, an agency that — we'll say it if few others will — is known for producing excellent work based on science, not emotion. That agency is within, yep, the Department of Health and Human Services.

Here's the original story: Mammogram guidelines spark heated debate

Plus a blog post on the reaction: Don't like those new mammogram recommendations? You're not alone

And here's today's story: Mammography outcry points to trouble for healthcare reform: Some Republicans say the new recommendations are an example of "rationing" that would take place under President Obama's plan to save money by basing treatment on experts' advice.

— Tami Dennis

Photo: HHS Secretary Kathleen Sebelius said she wanted to address recent confusion head on. Address it, she did. Clear it up? Perhaps not.

Credit: Mandel Ngan / AFP / Getty Images

 

The future for older Americans: More disabilities

One of the resounding hopes expressed by the baby boom generation is to change the perception of aging by remaining active, vital and healthy deep into their golden years.

The prospect of achieving that goal isn't promising. A study published today by researchers at UCLA is the first to show that disability trends among older Americans are getting worse. Disabilities were assessed through measures that recorded a person's ability to perform various tasks, such as being able to walk up a flight of stairs, manage personal finances and perform household chores.

In the 1980s and 1990s, studies showed disability rates among older Americans were improving. But the new study compared data from two time periods, 1988 through 1994 and 1999 through 2004, and found that disability rates rose among people ages 60 to 69. The greatest increases were seen among non-whites and people who were overweight or obese.

The study, funded by the National Institute on Aging, found no changes in disability rates among people ages 70 to 79. Among people ages 80 and older, improvements in disability were seen, especially among women.

The study doesn't pinpoint why more people are becoming disabled in their later years, although the obesity epidemic appears to be the major factor, said the lead author of the study, Teresa E. Seeman, a professor of medicine and epidemiology at UCLA's David Geffen School of Medicine.

"Normal-weight individuals do not show a trend of increasing disabilities," she said. "It does seem to be that the increase is restricted to the groups that are overweight and obese. But part of the problem is that more and more people are overweight and obese."
 
The people in their 60s who show increasing rates of disability are likely "harbingers" for the baby boom generation, Seeman said, an observation that should be considered in Washington during the debate over health care reform.

"I think this kind of data highlights the importance of this [health care] debate," she said. "How do we provide health care people need and services that will prevent disability?"

The study is published today in the American Journal of Public Health.

-- Shari Roan

Photo credit: Francine Orr  /  Los Angeles Times

Those medical bills won't just go away; now's the time to get a handle on them

Medical debt doesn't take care of itself. As with a serious illness, ignoring the symptoms will simply ensure more problems down the road.

So today, Families USA offers up tips on what to do about it. The advice from the organization, whose ultimate mission is affordable healthcare for all Americans, is practical and straightforward. It begins with, "Make sure the charges are correct," and ends with links to organizations that can provide additional services.

Here's the complete guide: Your Medical Bills: A Consumer’s Guide to Coping With Medical Debt.

For a general look at medical debt, from the Washington Post and Kaiser Health News, there's this: Americans ensnared by medical debt.

And here's a recent look specifically at California. This report, from the UCLA Center for Health Policy Research, finds that almost 1 in 7 nonelderly Californians has medical debt of one kind or another. It includes breakdowns by region and county.

And here's some more advice, from an article that first appeared in the L.A. Times' Health section: Negotiating Your Medical Bills.

It begins: "Unless you've been rushed to the hospital in an emergency, the time to start thinking about paying the bill for hospital care comes as soon as your doctor says you need to have a test, procedure or surgery."

-- Tami Dennis

Photo: When it comes to costs, and debt, those medical tests can add up.

Credit: John Moore / Getty Images

When making public statements, shouldn't those statements actually state?

When news breaks out, organizations frequently offer up their two cents on the topic at hand. Sometimes these statements clarify the issue or a group's stance -- but only sometimes.

Today, we received this official statement from the American Psychiatric Assn. on the Fort Hood, Texas, shootings:

“The American Psychiatric Association is saddened and shocked by the events at Fort Hood on Thursday, November 5. Our hearts are with the soldiers, the families, and all the members of the Fort Hood and military community affected by this tragedy.”

Couldn't the same be said of most people's reactions -- and the location of their hearts? Here's what the position looked like in its entirety.

And last week, there was this from the National Women's Law Center on the gang rape of a 15-year-old California girl who'd attended a dance:

“The circumstances reported about this brutal assault, as well as the shocking inaction of those who stood by and watched it happen, are shocking – and should be widely condemned."

Again, society didn't seem to need much urging.

If you're going to make a statement, then do so. Here's one this week from the National Right to Life Committee on a legislative move in the House:

"The Ellsworth language is a political fig leaf made out of cellophane -- it directs the federal Secretary of Health to hire a contractor to deliver to abortion providers the payments for elective abortions, payments that are explicitly authorized by the bill [on page 110].  This is a money-laundering scheme -- a federally funded 'bag man' will deliver government funds to abortionists.  This is federal funding of elective abortion."

Here is that statement in its entirety.

Whether you think the statement is an accurate reflection or a grotesque parody of the current political debate, at least there's a point in saying it.

-- Tami Dennis

Photo: Sometimes the point isn't what is said, just that something is said.

Credit: Los Angeles Times

Study questions the value of family medical history

It's the first thing you do at a doctor's visit after producing your proof of insurance -- fill out a family medical history. Many doctors ask detailed questions or require patients to complete long forms, and patients sometimes worry about not knowing or forgetting something important.

But does a medical history collection actually do any good? A new study casts some doubt about its value. Researchers funded by the Agency for Healthcare Research and Quality reviewed 137 studies on various aspects of family history-taking. The studies were performed between 1995 and March of this year. Researchers set out to examine three aspects of the issue: the pros and cons of collecting a family medical history; how well the history predicts an individual's risk of disease and how accurate patients report it.

They found that there were few studies that actually examined these questions thoroughly. Overall, there was not enough evidence to say how history collection affects patients' outcomes. The analysis found that patients tend to report the absence of disease in relatives better than the presence of disease.

"We understand the absolute importance of family history in assessing the risk of genetic conditions," said the lead author of the study, Dr. Brenda J. Wilson, an associate professor of epidemiology at the University of Ottawa. "But when you are looking at complex diseases, such as heart attacks, strokes, diabetes and so forth, we wouldn't expect the family history to tell us everything we need to know. Family history plays into it, but it's one of many factors."

Family history has been thought to serve two purposes. One is to assist doctors in assessing a patient's risk. The other is to motivate the patient to make changes that might lower risk. But the authors concluded that more research should be done to pinpoint what is helpful about a family history and how much it matters along with other risk factors. For example, Wilson says, a doctor looking at the risk of heart disease will take a patient's blood pressure, weight and will perform cholesterol and perhaps other tests.

"What we don't know is how useful family history is along with this other risk information," Wilson said. "For complex disorders, we need to develop the evidence for how to use it -- so physicians know how it factors in."

Methods for collecting family medical history should be simpler, she added. Electronic medical records and other information-gathering tools should be helpful.

"I think we are going to have to take family history more seriously," Wilson said. "We may want to put this in the hands of family members and have them gather it and be the custodians of it."

The study was published Monday in the Annals of Internal Medicine.

-- Shari Roan

Photo credit: Christopher Nielsen  /  For The Times

Lack of health insurance played a role in thousands of child deaths, researchers say

An analysis of 23 million hospital records from 37 states shows that a lack of health insurance likely played a role in the deaths of nearly 17,000 U.S. children over a 17-year period.

Researchers at Johns Hopkins Children's Center examined records from 1988 to 2005. They compared the risk of death in hospitalized children who were covered by health insurance with those who did not, and found that uninsured kids were 60% more likely to die, regardless of their medical condition. This does not mean that the children received less aggressive care at the hospital but that they were probably in poorer health before the arrived, researchers said. Insurance status did not affect how long a child spent in the hospital, according to the study.

The study did not count children who died outside the hospital or after leaving the hospital, which means that deaths among uninsured children are probably even higher. The report will be published Friday in the Journal of Public Health.

"Can we say with absolute certainty that 17,000 children would have been saved if they had health insurance? Of course not," a co-author of the study report, David Chang, said in a news release. "The point here is that a substantial number of children may be saved by health coverage. From a scientific perspective, we are confident in our findings that thousands of children likely did die because they lacked insurance or because of factors directly related to lack of insurance."

As the healthcare reform debate reaches a critical stage in Washington, the study is a reminder of the human cost of healthcare inequality. About 7 million American children are uninsured.

"In a country as wealthy as ours, the need to provide health insurance to the millions of children who lack it is a moral, not an economic issue," Dr. Peter Pronovost, a co-author of the study, said in a news release.

-- Shari Roan

Photo: Healthcare reform advocates protest outside the offices of Cigna Insurance in Los Angeles. Credit: Mark Ralston / AFP/Getty Images

Recommendations for new school meal nutrition standards

The nutrition standards behind the National School Lunch Program and the School Breakfast Program have not been updated since 1995. Today, the federal Institute of Medicine is issuing a report recommending new standards, calling for more produce, more whole grains. And for the first time, a limit to calories.

Thirty million children eat school lunch, and 10 million eat school breakfast -- and the IOM panel says it hopes new standards will help those children develop good habits that they carry into adulthood. That, the panel says, should help curb obesity and other health problems associated with diet.

The panel's recommendations go to the U.S. Department of Agriculture for possible implementation. It was the USDA which requested the report.

The panel says new standards would cost money -- for food as well as for training and capital improvements. But it says food costs would go up by less than 10% for breakfast and 25% or less for lunches. The government now spends $8.7 billion a year in reimbursements for school meals to school districts.

The recommendations are meant to bring school food in line with the dietary guidelines the government issues for Americans. It seeks to have the amount of sodium in school meals reduced by more than half over the next decade.

Among its recommendations: that calories be limited, based on age level, for breakfast and lunch, and that the sodium level for a typical lunch be eventually reduced to 740 milligrams. It also sets out targets for weekly servings of fruits and vegetables, and it calls for more whole grains.

"It's about time," says Matthew Sharp of the California Food Policy Advocates and one of the people who testified before the panel. Meals, he says, should be nutritious and affordable and they also should "teach kids healthy habits" and expose them to a variety of foods.

-- Mary MacVean

But surely people providing healthcare have health insurance

As the nation's leaders discuss who should get health insurance and in what fashion and how much it should cost, many people who provide healthcare are watching from the sidelines.

First, the Kaiser Family Foundation offered up an analysis this week of the nation's much-discussed 46 million uninsured people.

That report notes: "More than eight in ten of the uninsured are in working families -- about two thirds are from families with one or more full-time workers and 14% are from families with part-time workers. Only 19% of the uninsured are from families that have no connection to the workforce. Even at lower
income levels, the majority of the uninsured are in working families. Among the uninsured with
incomes below the poverty level ($22,025 for a family of four in 2008), 55% have at least one worker in
the family.

Then came a closer look at healthcare workers specifically, many of whom would fall into this category. (And by healthcare workers, think beyond doctors and nurses to include the people doing the most basic tasks.)

Using National Health Interview Survey data, researchers at the University of Minnesota found that 11% of healthcare workers are uninsured. Residential care workers are especially likely to lack coverage. 

Here's the abstract of that study, published online Thursday in the American Journal of Public Health.

-- Tami Dennis

And now a word from a connoiseur of world healthcare systems...

T.R. Reid's a busy guy. First the journalist and author schleps from one country to another in his quest to assess the world's healthcare systems -- and their treatment options for his aching shoulder. Then he schleps from one interview and appearance to the next in his quest to discuss his findings -- and the book that resulted.

That book, "The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care," explains in highly readable fashion how other countries manage to offer healthcare to their citizens -- and what those citizens can expect.

Reid wrote last month in a Newsweek article that synopsized his book quite efficiently:

"The design of any country's health-care system involves political, medical, and economic decisions. But the primary issue for any health-care system is, as President Obama made clear last week, a moral question: should a rich society provide health care to everyone who needs it? If a nation answers yes to that moral question, it will build a health-care system like the ones in Britain, Germany, Canada, France, and Japan, where everybody is covered. If a nation doesn't decide to provide universal coverage, then you're likely to end up with a system where some people get the finest medical care on earth in the finest hospitals, and tens of thousands of others are left to die for lack of care. Without the moral commitment, in other words, you end up with a system like America's."

The book lays out the precise differences among other nations' systems, not just the ones mentioned above. (His recount of the Ayurvedic approach in India is especially riveting.) And those differences are considerable even among countries that try very hard to get it right, with "universal healthcare" being markedly different than a universal approach. 

Whether you're primed to agree with Reid's bleak assessment of the U.S. healthcare system or not, his perspective -- both global and intimate -- makes for worthwhile reading as the nation tries to come to terms with its current and future approach to healthcare.

(Today's news story: Healthcare triumph gives way to heightened battle)

If you're looking for Reid giving a quick primer on the topic, here he is recently on NPR's "Fresh Air", in a question-and-answer article on Oprah.com, and in a podcast from Stanford School of Medicine. As noted, he's been busy.

Then there's the "Frontline" documentary that spawned it all: "Sick Around the World." And of course, the book itself.

-- Tami Dennis  

Photo: T.R. Reid.Credit: "Frontline" / PBS

MRIs plus low-back pain equals more dubious surgeries

Areas of the country with the highest number of MRIs have the highest incidence of surgery for lower-back pain, despite the lack of evidence showing that the surgeries are beneficial, Stanford researchers reported today in the journal Health Affairs. Previous studies have shown that increased surgery rates for back pain don't improve patient outcomes, "so heading in this direction is concerning," said senior author Laurence C. Baker, a professor of health research and policy at the Stanford University School of Medicine.

Between 2000 and 2005, the availability of MRI scanners in the United States more than tripled, from 7.6 machines per 1 million persons to 26.6 per million. State-of-the-art scanners cost more than $2 million apiece, so scans are expensive--about $1,500 for one low-back scan. The increased use of the scanners and the growing number of surgeries that result from such scans are one component in the increase in healthcare costs, Baker said.

Baker and Jacqueline D. Baras, a medical student, obtained Medicare claim data from 1998 to 2005 for about 20% of patients with non-specific low-back pain and compared it with data on the availability of MRI scanners, as determined by IMV Ltd., a healthcare consulting firm that provides such data to the medical industry. They found that the number of scans for low-back pain and the number of resulting surgeries in each of the 318 Metropolitan Statistical Areas were directly proportional to the availability of scanners. About two-thirds of the scans, moreover, occurred in the first month after the onset of pain, despite clinical guidelines that recommend at least a one-month delay because of the large number of patients who spontaneously recover.

"The net result is increased risks of unnecessary surgery for patients and increased costs for everybody else," said Dr. John Birkmeyer, a professor of surgery at the University of Michigan who was not involved in the study.

-- Thomas H. Maugh II

A state-of-the-art MRI can cost $2 million.

Credit: Jim Cole / AP