Booster Shots

Oddities, musings and news from the health world

Category: Politics & health

More women are refused healthcare due to hospital ideology, report says

May 27, 2010 | 12:27 pm

Contraceptives and abortion may be denied at Catholic hospitals; nun was excommunicated for approving an abortion in Phoenix A Phoenix-area nun was recently removed from her job as a senior administrator of a Catholic hospital and was excommunicated by the Catholic church because she was part of a hospital board that approved an emergency abortion last year for a woman -- a mother of four children -- whose life was in danger due to complications of the 11-week pregnancy.

That the nun, Sister Margaret McBride, should be punished for providing what is considered standard and appropriate medical care has led to a huge national outcry. But the issue goes further, according to a report released this week by the National Health Law Program, a national public-interest group that seeks to improve care for the working class, poor and minorities. The report claims that a growing number of patients are encountering hospital policies that deny some types of medical care -- such as abortion or contraceptive services -- due to ideological or religious beliefs. One in six Americans is seen in hospitals that have some restrictions, according to the report "Health Care Refusals: Undermining Quality Care for Women."

"When people go to the doctor, they should be able to expect that the care they receive meets prevailing medical standards," Susan Berke Fogel, the lead author of the report, said in a news release. "We reviewed policies at hospital systems representing more than 650 facilities across the U.S. and have documented the conditions and circumstances where that is not happening. We found a disturbing number of case studies where patients ended up far worse off either because their healthcare providers refused care or because their hospitals prohibited the care they needed for ideological or religious reasons."

This issue is typically framed as a moral contest between health providers' rights of conscience versus patient autonomy, Fogel writes in the report. But that narrow framework overlooks the most important factor in the debate: an evidence-based analysis of what constitutes the best medical practice.

-- Shari Roan

Photo: Daniel Hulshizer  /  Associated Press

Live right and Americans could all live an extra 4 to 5 years

March 23, 2010 |  2:03 pm

Sure, each of us would feel better if we would just put down that sugary midafternoon snack, lose the smokes, hit the gym and take those high blood pressure drugs the doctor prescribed.

But let's look at the impact of these health-improving measures as if we were, say, in one of those popular competitive reality shows. If we divided ourselves up into teams along ethnic and geographic lines--say, high-risk urban blacks, white middle Americans, Asians, Western Native Americans, low-income northern rural whites and low-income Southern rural blacks--who would win the great life-extension contest?

According to researchers from the Harvard School of Public Health, the low-income Southern black team has the most to gain by quitting smoking and bringing their weight, blood pressure and blood glucose levels into line with current recommendations. Men would gain an average of 6.7 years of life and women, 5.7 on average, with the greatest gains coming from controlling blood pressure and (for men, anyway) smoking cessation. African Americans from cities with high murder rates come in next with the most to gain by quitting smoking and lowering their blood pressure.

The article,which details the impact that smoking, high blood pressure, insulin resistance and excess weight have on different populations of Americans, appears in the journal Public Library of Science (PLoS) Medicine, released Monday. It finds that Asian American lifespans are the least affected by the big four health scourges. Average life expectancy in that community is currently 82 years for men and 87 for women, but with optimal health behavior, could reach 87 and 91, respectively.

(The PLoS study comes on the immediate heels of a set of studies in the American Journal of Public Health that finds within the ethnically diverse bloc of Asian Americans -- long considered the "model minority" in terms of health factors -- there are subgroups -- for instance, Laotian Hmong, Vietnamese, Cambodian -- that suffer unusually elevated risks of certain cancers, due generally to higher rates of smoking or lower rates of screening).

Have a look at the PLoS study's team tally here.

How did Middle America --- defined as all whites not living in the northern plains or the Dakotas, or in Appalachia or the Mississippi Valley -- do? Average life expectancies on that team now stand at 76 for men and about 81 for women. But if everyone on the team pitched in, Middle American men could be living, on average, to 81 and women to 85.

If only real life could be more like a reality show!

-- Melissa Healy  

Why stop with simple recognition? Turn 'awareness' days into bona fide holidays

March 11, 2010 | 10:33 am

Mask "Recognizing National Public Health Week will serve as an important reminder for individuals, families and communities to focus on stopping preventable diseases before they start,” says Sen. Tom Udall (D-N.M.).

“National Public Health Week offers a reminder to all of our nation’s families that many of the choices we make in our daily lives directly determine how long we live and how well we live,” says Rep. Lucille Roybal-Allard (D-East Los Angeles).

Both are quoted in this release from the National Public Health Assn. Both have introduced resolutions calling attention to National Public Health Week. (It's April 5-11, should you want to mark it on your calendars.)

But is simply calling more attention to National Public Health Week enough? April is already a busy month as efforts to raise awareness go. 

April is also ...

* Alcohol Awareness Month

* Foot Health Awareness Month

* Irritable Bowel Syndrome Awareness Month

* National Autism Awareness Month

* National Cancer Control Month

* National Child Abuse Prevention Month

* National Donate Life Month

* National Facial Protection Month

* National Minority Health Awareness Month

* National Sarcoidosis Awareness Month

* National Youth Sports Safety Month

* Occupational Therapy Month

* Sexual Assault Awareness and Prevention Month

* Sports Eye Safety Month

* Women's Eye Health and Safety Month

And, let's not forget, April also has ...

* World Health Day

* National Alcohol Screening Day

* Sexual Assault Awareness Month's Day of Action

* National Infant Immunization Week

* and World Meningitis Day.

If we're serious about calling attention to the importance of public health, it's time to raise the stakes. Let's make April 5 an official holiday -- no mail delivery, no school, no banking services, the whole nine yards. We could use it for vaccinations, screenings, lectures on nutrition, group exercise classes in the park...

In fact, perhaps other awareness-raising efforts need their own holidays too -- but only the truly deserving ones. We'd hate to cheapen the impact of these noble health observances.

Here's the text of the resolutions. And here's the full observances calendar.

-- Tami Dennis

Photo: This traveler at LAX, arriving last spring during the swine flu outbreak, is a likely candidate for the "be aware of public health" message. Credit: Anne Cusack / Los Angeles Times

Well? 'Yes, very!' say four California cities in well-being survey [Updated]

February 16, 2010 | 11:31 am

Wellness While not quite a tradition yet, the Gallup-Healthways survey of well-being in the United States aims to provide a map of the United States' mental and physical health contours, updated annually. Its 2009 survey is the partnership's second annual effort, and it came out Monday.

As a whole, the country came in exactly where it did in 2008, at 65.9 points out of a possible 100. The nation slipped slightly in a number of specific areas scored; but respondents — led by African Americans — compensated for those losses by being more bullish than they were last year in evaluating the state of their well-being now and where they expect it to be in five years.

While much of the rest of the nation is contending with snow, ice and general adversity, four sun-drenched  communities in California are feeling very, very well, thank you: Of 185 U.S. cities, large and small, that were surveyed, Santa Rosa was found to be the nation's fifth most-well city;  Santa Barbara was sixth and San Jose seventh. Oxnard came in at No. 10. [Updated at 11:24 a.m. Feb. 16: An earlier version of this post, and the headline, incorrectly referred to the four cities as being near the coast. Santa Rosa is about 20 miles inland.)

Among the nation's big cities — those with 1 million or more residents — San Jose actually came in first (as they say there, "The fun never stops!"). 

Los Angeles landed in the top half of the class — it was declared the nation's 86th most-well city. Among the biggies — a field of 52 cities — Los Angeles came in smack in the middle of the pack, at 26th, well behind No. 5 San Francisco.

Well? What does that mean, you ask?

Surveying a random and representative sample of residents from each state and city, Gallup surveyors measured "well-being" by asking respondents to evaluate (1) their life situation, now and five years from now; (2) their emotional health, including whether they smile and laugh frequently, have stimulating hobbies or interests, feel they are treated with respect, and how much anger, sadness or stress they feel; (3) their work environment and whether it is open and trusting, allows them to use their talents, whether their supervisor is reasonable; (4) their physical health, including obesity, chronic illnesses or disabilities, whether they get enough rest or have daily pains; and (5) their health behaviors, such as smoking, eating healthfully, getting exercise; (6) their level of access to basic health needs, such as clean water, medicine, health insurance and healthcare, a safe place to exercise, money for and access to healthful food, and shelter.

From those answers, Gallup tallies a 100-point index for each state and city. Hawaii came in first, with 70.2 points — they don't call it paradise for nothing. The No. 2 slot was shared by Utah and Montana (clearly, the Mormon tradition confers certain health benefits, and the Marlboro Man no longer lives in Montana — in fact, he no longer lives at all).

California ranked 20th, with 66.5 points. Way down at the bottom are West Virginia, Kentucky, Arkansas, Ohio and Nevada.

Healthways, which helps underwrite the well-being project, is a provider of health and benefit information and solutions to health insurers and employers.

— Melissa Healy

Photo: A child plays in Montecito, just south of Santa Barbara. Credit: David McNew / Getty Images

Freeze? What freeze? FDA in line for another budget boost

February 2, 2010 |  2:54 pm

The Food and Drug Administration is a screaming exception to the Obama administration’s freeze on discretionary spending in the 2011 budget. 

Overall, the FDA budget could grow by as much as 23% to just over $4 billion from the current $3.3 billion. But getting all of what the agency wants will require Congress to authorize more than a quarter-billion dollars of new fees on food facilities and generic drug makers.

The healthy increase in the face of the sagging economy and a debt-ridden federal government is a testament to 1) the FDA’s increasingly complex responsibilities monitoring a global supply chain in both food and drugs, 2) to a perception that the agency has been underfunded for many years, and 3) to its new duties as a regulator of tobacco. The FDA’s budget has swelled by 78% since 2008 and no agency programs are on an Office of Management and Budget hit list of line items slated for extinction or downsizing. 

The increased spending would allow the FDA to add 1,200 jobs, expanding its workforce by 10%. Key boosts in spending for 2011 include $318 million to improve food safety, $215 million for anti-smoking programs and $100 million to improve the safety of drugs and medical devices.

More than one-third of the 2011 budget -- about $1.5 billion -- would come from user fees paid by businesses that make payments for FDA services such as evaluating new applications for drugs and medical devices. The FDA is collecting about $920 million in user fees this year, so the new figure represents a whopping 63% increase.

The increase in the "budget authority," or tax-funded component of the budget, is relatively modest by comparison, rising 6% to $2.5 billion from $2.36 billion.

More than half of the uptick in user fees would come from increases in existing fee-based programs, and in statutorily-mandated payments by tobacco companies. But the FDA needs lawmakers to sign off on $220 million in fees on food facilities and $38 million for fees on generic drug applications.

The food fees are a critical component of the FDA’s food safety initiative -- a combination of increased inspections and improved data collection and food tracking technology -- which the agency lists in budget documents as its top priority.

But it’s not clear that the food industry or key members of Congress are on board with the fees.

A House-passed version of food safety legislation includes the charges, but a version passed in November by the Senate Health, Education, Labor and Pensions Committee does not.

Both the chairman of the Senate panel, Iowa Democrat Tom Harkin, and ranking member Mike Enzi of Wyoming, spoke against imposing user fees. “If this is something for public protection, it’s something we should all pay for,” Harkin said at the time.

A key industry lobbyist, Scott Faber of the Grocery Manufacturers Assn., said that his organization wasn’t necessarily opposed to fees but wanted the money spent on improving food safety science as opposed to facility inspections.   

There’s bipartisan support for a reform of the nation’s food safety laws, the admittedly big issue of funding notwithstanding. But a full Senate vote on its version of the food bill has so far been hostage to healthcare overhaul negotiations. 

Though it doesn’t have the huge line item of ongoing food, drug and tobacco programs, a $25-million allocation for “advancing regulatory science for public health” is listed among the agency’s top four priorities in its budget document. That’s because, according to the FDA, regulatory science has not kept up with advances in the rest of science:

"During the past two decades, extraordinary investments have led to revolutionary advances in the biomedical sciences. However, FDA’s scientific expertise and infrastructure have not kept pace with these advances. Today, FDA is relying on 20th century regulatory science to evaluate 21st medical products,” the budget document states.

The goal is to keep up with development in genomics, nanotechnology, wireless medical devices and other cutting-edge science so that the agency can prudently regulate the products developed from it.

-- Andrew Zajac

U.S. health workers recall their time in Haiti

January 15, 2010 | 11:07 am

Haiti The many healthcare professionals and humanitarian workers who spend time in Haiti have been hit hard, emotionally, by the earthquake. Ulrick Gaillard, executive director of the Batey Relief Alliance, a nonprofit group that provides assistance in Haiti, had left the country Monday, 24 hours before the quake, after a productive meeting with the country's minister of health. The Batey Relief Alliance received grant money recently from the U.S. Agency for International Development to build a medical clinic and provide services to Haitians who lived on the border between Haiti and the Dominican Republic and who often try to cross the border to seek healthcare. Ulrick and Haiti's minister of health signed an agreement to move the project forward.

Now Haiti faces new demands, Ulrick said.

"The country was living under sub-basic conditions before the earthquake," he said. "There will be no access to clean water, no sanitation, no public morgues, no healthcare, no medicine. It will be a catastrophic situation."

The dire health status of Haitians was detailed today in a story in the Los Angeles Times.

The earthquake brought Dr. Christina Catlett, a doctor at Johns Hopkins, to tears. Catlett, associate director for health preparedness at the Johns Hopkins Office of Critical Event Preparedness and Response, had been to Haiti several times on medical relief missions.

After her first trip to Haiti, Catlett said, she felt an urgent need to return as soon as possible -- so great were the needs of the people.

"After the first mission I did there I think I was in shock," she recalled Thursday. "I've been carrying a piece of Haiti around in my heart since I went there in 2005. The people are amazing. Big hearts. Very resilient. Even though they are so suppressed, they still welcome you in and would give you the shirts off their backs."

-- Shari Roan

Photo credit: Ramon Espinosa / Associated Press

Demise of Botox tax brings applause from AMA leader

December 21, 2009 |  8:47 pm
As Senate Democrats look to close debate on the healthcare bill, an epic battle that has drawn in pharmaceutical companies, the insurance industry and ordinary Americans bearing personal horror stories, American Medical Assn. President-elect Cecil B. Wilson applauded a concession on the left's part: to drop the "Botax" from the bill. 

It almost sounds too Jerry Springeresque to be part of this months-long political saga, but it's true. Plastic surgeons and Botox manufacturer Allergan beat back a 5% levy on breast implants, face-lifts and other types of cosmetic surgery. Tanning salons, hit with a 10% tax, were not so lucky: indoor salons made for easy pickings, reports said, because of the link between ultraviolet radiation and cancer.

Forget Medicare, insurance premiums or the ill-fated public option. Clearly our representatives and medical professionals have their priorities straight, and our best interests at heart.

-- Amina Khan

Opinion from Atul Gawande; news on health reform

December 7, 2009 |  3:27 pm

Gawande The author and surgeon weighs in, via the New Yorker, on the Senate bill's cost-control measures, or lack thereof:

He writes:

"Where we crave sweeping transformation, however, all the current bill offers is those pilot programs, a battery of small-scale experiments. The strategy seems hopelessly inadequate to solve a problem of this magnitude. And yet -- here’s the interesting thing -- history suggests otherwise."

Read more.

His points are well-taken. But feel free to disagree.

On the news front, from today's Los Angeles Times, there's:

Senate healthcare talks picks up pace

The fight's back in John McCain

And now appearing on the blog D.C. Now, there's:

Abortion debate begins as part of Senate healthcare bill

-- Tami Dennis

Nutrition ad mentioning Obama daughters is criticized *

August 12, 2009 |  5:45 pm

ObamaAD Nutrition experts, child health advocates and politics have been colliding in recent days on the Internet as people debate an advertisement on the importance of healthy school lunches that mentions President Obama's daughters.

The ad, distributed by the pro-vegetarian-diet group Physicians Committee for Responsible Medicine, has a photo of a young girl and states "President Obama's daughters get healthy school lunches. Why don't I?"

The advertisement, posted around Washington, D.C., is designed to grab the attention of Congress regarding the re-authorization of the Child Nutrition Act. The Physicians Committee for Responsible Medicine wants to see more fruits, vegetables and low-fat foods on school lunch menus, as well as more vegetarian meals.

But, according to a Washington Post story Tuesday, the White House objects to the mention of Obama's daughters and asked the group to take the posters down. The group refused.

Reaction is mixed. Many people say it's not fair to bring the president's daughters into the argument. "The children of the president are always off-limits," Frank Luntz, Republican political consultant, told the Post.

A blog post on Moms Fighting Fat says: "As a mother, and considering President Barack and Michelle Obama's daughters are so young, I think the ad could do without using their names. Children often feel the weight of the world on their shoulders and I can only imagine the guilt they'd feel knowing they are eating better than most of their peers. Not that they aren't aware of such a fact already, but having it publicized in such a manner may do more harm than good to them ... However, at the same time, maybe the ad will get the attention of not just President Obama but other officials in Washington which would force them to take action."

A post on argues: "The ads were specifically designed to get the attention of the White House, and perhaps more nutritious veg meals for children will be a result."

Congress will take up work on the act after the August recess.

* An earlier version suggested that a blogger on Moms Fighting Fat thinks it's OK to fight dirty. She, in fact, doesn't.

-- Shari Roan

Photo credit: Physicians Committee for Responsible Medicine

Boosting health and the economy

March 10, 2009 | 10:10 am

Public health advocates are praising the $1 billion for disease prevention and wellness programs included in President Obama's economic stimulus package but say that it is only a fraction of the billions needed to keep the country  healthy.

The United States spent about $35 billion a year on disease prevention in 2008, or about $17 per person, according to Jeffrey Levi, executive director of Trust for America's Health, a Washington-based advocacy group. That compares with $2.4 trillion spent on treatment.

According to the ounce-of-prevention argument, spending on the former would help whittle down the latter.

Public health spending covers a wide variety of programs, including inspecting restaurants, tracking tuberculosis cases, providing vaccines, preparing for disasters and promoting exercise and nutrition.  Such services are intended to counter, among other things, food poisoning outbreaks, the spread of infectious diseases and the surge in chronic conditions such as obesity and diabetes.

But faced with a financial crisis, local and state governments are cutting public health spending. More than 11,000 public health jobs were eliminated in 2008, Robert M. Pestronk, executive director of the National Assn. of County and City Health Officials, said during a teleconference this morning. That, he said, is the equivalent of two states completely shutting down their public health departments.

The teleconference was called to publicize the release of a report called "Shortchanging America's Health: A State-By-State Look at How Federal Public Health Dollars Are Spent," produced by Trust for America's Health and the Robert Wood Johnson Foundation.

"It's essential that as the country considers ways to reform its health system, we not only think about providing quality healthcare to everyone but that a strong public health program has to be the cornerstone," Pestronk said.

-- Mary Engel


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