News Cut Category Archive: Health

Mammogram panels?

Posted at 9:08 AM on November 17, 2009 by Bob Collins (11 Comments)
Filed under: Health

The timing couldn't possibly have been worse for the government to release new guidelines on when women should have mammograms to detect breast cancer early enough to save their lives -- right in the middle of the nation's health care debate over the role of government in health care decisions.

The guidelines, if you haven't heard, recommend women not have mammograms until age 50, instead of age 40, as most groups who research the issue suggest.

"There is no doubt that mammography screening in women in their 40s saves lives. To recommend that women abandon that is absolutely horrifying to me," Dr. David Dershaw, director of breast imaging at Memorial Sloan-Kettering Cancer Center said.

So why did they? Dr. Otis Brawley of the American Cancer Society suggests cost is behind this:

The USPSTF says that screening 1,339 women in their 50s to save one life makes screening worthwhile in that age group. Yet USPSTF also says screening 1,904 women ages 40 to 49 in order to save one life is not worthwhile. The American Cancer Society feels that in both cases, the lifesaving benefits of screening outweigh any potential harms. Surveys of women show that they are aware of these limitations, and also place high value on detecting breast cancer early.

"With its new recommendations, the USPSTF is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them.

And what Brawley didn't say, Dr. Sanjay Gupta did. Gupta, who was Barack Obama's initial choice for surgeon general before he decided to stay at CNN, speculated today that once the government recommends guidelines for medical care, private insurance companies will be quick to stop covering anything else.

Not death panels, mamography panels. It's worth pointing out, perhaps, that the government's guidelines now match Canada.

But Susan Pisano, spokeswoman for American Health Insurance Plans, appears to dismiss the concerns:

"Most of our member companies look at [the task force's guidelines] as the standard. But if you are in your 40s and have a discussion about risk and benefits and your doctor gives you a referral slip, then that generally is going to be covered."

Still, the story does highlight the extent to which cost factors into health care decisions, even after the possibility a life being saved is recognized.

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The story Wally couldn't tell

Posted at 4:30 PM on November 12, 2009 by Bob Collins (9 Comments)
Filed under: Health, War

If you've ever attended a Twins game and sat upstairs behind home plate at the Metrodome, the chances are pretty good that you know Wally Englund, 85, of Richfield. For 14 years he was an usher at the Dome and other sports facilities in the Twin Cities.

But only his wife, a few family members and some season ticket holders who've become his close friends over the years know the secret that, until recently, he couldn't talk about: He is still suffering from an incident in the South Pacific during World War II.

Eileen Smith (center below), one of the Twins' season ticket holders, contacted me about Wally. She only found out about his struggle during an enlistment ceremony at the Metrodome in the aftermath of September 11, 2001. "You walked back in the well and said 'they have no idea what they're getting into,'" she said today as we sat in his living room.

Wally told me his story because he doesn't want returning soldiers from Afghanistan and Iraq to live with the post traumatic stress disorder (PTSD) that began in August 1943, about a year after he graduated from high school in Alexandria and convinced his parents to allow him to enlist and go to war.

"Things were hot and heavy in the South Pacific, so they were sending everybody. I took a bus over the San Francisco bridge, and sailed under the San Francisco bridge in August 1943. About the beginning of August, I was down in the engine room with some motor machinist mates and some electricians, and a guy all of a sudden appeared -- I didn't know who he was -- I knew everybody by their faces but not everybody by their name. And he says, 'You don't belong here. Go upstairs.' So I obeyed his command and then just seconds later the ship went down real fast and heavy. A few of us jumped into the water and then the ship went down real fast and most of the guys were sucked down with the ship. I saw a piece of board or something and I swam to that and hung on for several hours until I was rescued." (Listen)

Englund knew everybody on the ship. But he'd never seen the person who saved his life. There were about 100 men on board the ship -- a floating dry-dock -- but only he and one other man survived.

"Everything happened so fast. It was early in the morning; I don't know if we hit a mine or what. It happened fast and all hell broke loose," he said.

When the war ended and he returned to Minnesota, he tried to tell his mother and father about the morning that was now haunting him at night. Every time he'd try, he'd start to cry. And men don't cry. Today, he fought tears each time he remembered. (Listen)

"I was having these nightmares and flashbacks in the middle of the night and when I first came back, I'd try to tell people my story and I'd start crying. So I thought, 'I'm a man now, I'm not supposed to cry,' so I quit sharing. And the longer I did that, the worse it got. I kept shoving it down and down, and I went through all these years with flashbacks and anger came in, and guilt and all kinds of things. I had a rough time for many, many years," he said.

"I lived and I was one of two survivors. All the rest of the guys that I talked to 'em the night before and the next morning they were gone. We were like family. We worked together; we slept together. Ate together. We were a pretty close outfit."

It wasn't until 1950, the year he and his wife, Katie, were married, that he was able to tell his story to someone. (Listen)

"One of the nights in bed , the next morning Katie says, 'Wally what's going on, the bed was just shaking all night. Are you holding something inside you're not sharing?' I told her the whole story and cried like a baby. What a release it was. I didn't care whether I cried or what happened."

And that was the last he spoke of it for more than 40 years. About 20 years ago he got a letter from the other survivor, who described a similar suffering to what he was going through. But he lost the letter and couldn't write back.

About 10 years ago, he tried to talk to his older brother, Bob, about it.

"His ship was sunk in the South Pacific, not too far from where I was about the same time," he said. "He was a few days in a life raft and he was rescued, and they took him to Hawaii and he spent one month in the hospital and all he did was cry every day.

"I asked Bob a few years ago about our experiences. I says, 'Bob, how are you doing with your experiences when that ship was sunk?' And he said, 'I'm fine.'

"I said, 'How do you do that, I'm still having problems?' and he says, 'I don't think about it.' I said, 'Well, I don't either but it's still there.'"

Sadness, depression, anger, guilt. Wally felt them all. But since he had no obvious wounds, he didn't know the Veterans Administration could've helped him. A few years ago, however, another stranger -- he thinks it was someone at a Twins game -- showed him the path out, telling him the VA could help him.

And it did.

"I love the VA; they helped me so much. I want to say to these guys coming home from Iraq or Afghanistan, I want to say if they've gone through an experience like I have, get help right away. Don't wait as long as I did," he said.

He now sees a psychologist every other month. He also found out he's not the only World War II veteran still suffering from the wounds of war.

"After 60 years I thought time would heal and it still hasn't," he said. "But it's much better."

His grandson is in the Marines. Wally says he's told him his story, but never tried to change his mind.

"I still don't tell many people," he said

(Click for larger image)

You probably know someone with an interesting life's journey. News Cut loves to tell their stories. Contact me.

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Health care: Better than nothing?

Posted at 11:40 AM on November 11, 2009 by Bob Collins (13 Comments)
Filed under: Health, Politics

The health care reform effort at the Capitol is raising an old dilemma for some politicians: Is a bill always "better than nothing"?

North Dakota Nebraska Democrat Sen. Ben Nelson is the latest facing the issue, and he's decided it's not.

"Faced with a decision about whether or not to move a bill that is bad, I won't vote to move it," Nelson told ABC News.

Nelson is opposed to a public option.

Minnesota politicians may be faced with the same dilemma, only this one is over a tax on the medical device industry that's in the House bill, according to MPR's Elizabeth Stawicki.

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Behind the health care vote

Posted at 8:46 AM on November 8, 2009 by Bob Collins (3 Comments)
Filed under: Health, Politics

The House last night voted 220-to-215 to pass the health care bill. The vote was not surprising. All but one Republican voted against it, joined by mostly conservative Democrats, including 7th District Rep. Colin Peterson of Minnesota.

The New York Times, however, has a fascinating graphic showing the "no" Democrats. Peterson had the 4th largest margin of victory in his last election of those who voted no (and weren't unopposed).

Not far behind was Stephanie Herseth Sandlin of South Dakota.

Eight of the Democrats represented districts carried by Barack Obama in the last election, an increasingly questionable yardstick for political punditry, since the presidential election is at least as much about the opponent who's running (and his vice presidential pick, occasionally) as it is about the candidate who carried the district.

The Times attempted to link the percentage of uninsured residents of each district (who weren't elderly) with the "no" vote. In Peterson's district, for example, only 11% of non-elderly residents don't have insurance.

The intent of the graphic appears to be to show the factors that went into the "no" vote besides the bill itself. But it actually suggests that most of the "no" votes among Democrats had more to do with their opinion that it's a bad bill.

The Washington Post, meanwhile, took a different approach to linking external factors to the votes. It provides a graphic showing campaign contributions from the health care industry. Curiously, however, it shows that most of the lawmakers with the biggest war chests from the health care industry voted "yes."

And with all of the votes displayed, rather than just the Democrat "no" votes, the Post does a better job of relating the percentage of uninsured in a district, with the representative's vote.

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Today in flu

Posted at 1:44 PM on November 6, 2009 by Bob Collins (2 Comments)
Filed under: Health, Media

It seems like only yesterday when the news media was being skewered for overblowing the H1N1 flu (which for some reason is increasingly being referred to as the "swine flu" again). Now, a survey by Pew Research Center suggests the news consumer can't get enough.

According to the survey of the Pew Research Center for People and the Press:

About three-in-ten (29%) name reports about the fast-spreading flu and its vaccine as the story they followed more closely than any other last week, according to the latest weekly News Interest Index survey, conducted Oct. 30-Nov. 2 among 1,001 adults by the Pew Research Center for the People & the Press. Somewhat fewer mention news about health care reform (22%) or the economy (17%) as their top story.

But a second survey, from the Pew Research Center's Project for Excellence in Journalism (PEJ), shows a disconnect between what the people want and what the people are getting:

The national news media devoted 5% of the newshole to swine flu, much less than the coverage given to the health care debate (16%), Afghanistan (13%) or the economy (12%).

Let's see if we can adjust that a little bit. Here's some H1N1 news:

Most people who are looking for the H1N1 vaccine can't find it, Harvard reports today.

Since the H1N1 flu vaccine became available in October, 17% of American adults, 41% of parents, and 21% of high-priority adults have tried to get it. Among adults who tried to get it for themselves, 30% were able to get the vaccine and 70% were unable to get it. Among parents who tried to get the H1N1 vaccine for their children, 34% were able to get it and 66% were unable to get it. Among high priority adults who tried to get the H1N1 vaccine, 34% were able to get it and 66% were unable to get it.

So far Minnesota has ordered more than 460,000 doses of vaccine from its share of the federal supply, MPR's Lorna Benson reported today. The state health department has been using a random lottery system to select sites from among thousands of clinics who'll get the vaccine.

Officials are worrying that people are getting frustrated in their search for the vaccine, and will just give up looking.

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Mythbusting H1N1: Hand sanitizer

Posted at 2:32 PM on November 5, 2009 by Bob Collins (1 Comments)
Filed under: Health

Today's H1N1 mythbuster is one that's been circulating around the News Cut Cubicle over the last day or so:

Hand sanitizer can make germs and bacteria more "super" and using it in the long run can hurt you.

True or False?

False, according to Dr. Mike Osterholm, who appeared on MPR's Midday and got a similar question from a caller. Osterholm, an expert on the flu, says he's not sure using hand sanitizer is reducing your risk of contracting H1N1, but it's helping with a lot of other things:

We often think about antibiotics that we take and because the viruses can mutate when they are exposed to these kinds of things, we get resistance; some of them that are growing in your body develop through mutation, a way to get around the antibiotic and they become the prevalent one.

What we're killing these bugs with is alcohol, which is like boiling. You don't get resistance. So we're not worried about breeding superbugs by using alcohol-based handrubs. That's a good thing. Don't worry about that.

Not only does that kill a great deal of the microbial life on your hands -- viruses and bacteria -- but in Minnesota we all know that in Minnesota, hands become more chapped. Hangnails become more common. It turns out that some of the bad bugs actually do much better on our hands and actually survive quite well when our hands are under challenge of the elements.

What happens with these alcohol-based handrubs, they not only have alcohol in them, they have emollients in it. And it turns out, we have shown in studies in health care studies, we can greatly reduce the burden of bad bugs on your hands by using these hand gels routinely. You can't use them too much.

One interesting point: Osterholm says that hands play a much less role in the transmission of the flu than previously thought.

Today, I would never tell someone to scrub down a workplace if someone had influenza there. Schools needlessly are scrubbing themselves down after cases of influenza there; that's not where the transmission is occurring.

So the key message is I'm not sure how much all this hand hygiene is really doing to reduce flu transmission, but it's sure good for a lot of other things.

Keep in mind, however, that some research a few years ago found that if the hand gel isn't at least 60-percent alcohol, it won't be very effective. Think about that before you give some to your kids:



Here's the entire show:

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Live-blogging: Flu vaccine update

Posted at 12:21 PM on November 4, 2009 by Bob Collins (1 Comments)
Filed under: Health

As Minnesota officials announce four more deaths from H1N1, Flu.gov is hosting a webcast with the latest information on the H1N1 flu vaccine. The experts are: Dr. Anne Schuchat, Director, National Center for Immunization and Respiratory Diseases, the Centers for Disease Control and Prevention; Dr. Gloria Addo Ayensu, MD, MPH, Director of the Fairfax County Department of Health, Fairfax, Virginia; Dr. Pierre Vigilance, Director, District of Columbia Department of Health, Washington, DC.

Here are the highlights.

Q: What do you need to do at vaccine clinics to prove you're in the "risk" groups.

A: It's an honor system. We publish the target groups but we don't check. We hope people will do the right thing and if they're not part of the high-risk category (currently children, health-care workers etc.), they'll wait their turn.

Q: How long do people have to wait once a clinic has been announced?

People have been lining up a couple of hours ahead of time (in DC). People who show up once a vaccine session starts don't have to wait so long.

Q Why has there been a delay?

A: Flu vaccines are made in a method that's tried and true, but not reliable. The viruses that are inoculated into eggs were growing too slowly -- more slowly than expected. So the initial amounts that we had aren't what we hoped. We don't know exactly when the amount of vaccine "out there" will be enough. It may be things get better sooner in one area than another. Demand can change all the time.

Q: When will communities see more vaccine?

A: More is hard to quantify (huh?). It could be "some time" before the amounts that are out in communities feel very ample.

Q: If my child has been diagnosed with the flu, should she still get the H1N1 and seasonal flu vaccine?

A: Even if you believe your child has had the H1N1 flu, getting vaccinated makes sense. If you know your child has had H1N1 -- through state labs -- then the child probably wouldn't need the vaccine.

This year the seasonal flu vaccine has been in short supply, too. But getting the H1N1 flu ivaccine is more important. For seniors, the seasonal flu vaccine is important.

Q: Are you worried about running out of anti-viral medicine?

A: The commercial supply for adults is good right now. The availability for children has been spotty but getting better. We've released the liquid form of Tamiflu. There's also capsules that can be turned into pediatric doses by pharmacists, mixing adult capsules into liquid that children can have.

Q: If my children and I have asthma but we can't get vaccine in our community, should we go to a neighboring state?

A: Yes. But check with private providers and state health departments first.

Q: Why was decision made to put out vaccine when you knew there would be shortages?

A: We had a choice to make between protecting people and having things be neat and orderly. We couldn't tolerate withholding a vaccine that could protect some people.

Q: If a young child misses the window for the second dose, should they start over?

A: No, if you miss the four-week mark, it's OK. What you don't want is to get the second dose too soon. Two doses are needed in children under 10.

Q: Are health care workers considered a priority at clinics if vaccine isn't available at work?

A: Yes.

Q: What can we be doing to protect ourselves while we wait for more vaccine to become available?

A: The ones we've been recommending: Cover your mouth, wash your hands, stay home if you're sick, get a seasonal flu shot.

Q: What's the difference between the mist and a shot?

A: The shot it is made from a killed virus. Mist is a virus that is diluted. Anyone over six months can get the shot. If you have an egg allergy , we recommend you not receive the vaccine.

Q: How can I be sure the vaccine is safe?

A: It's made the same way as seasonal flu vaccine. We're using the same processes and the same companies. 100 million people get the flu vaccine every year and we have an excellent safety record. We've increased safety monitoring. The risk from the flu is very real.

Q: How can you tell the difference between seasonal flu and H1N1?

A: The population affected by H1N1 is a younger than those affected by seasonal flu.

Q: Would someone with a suppressed immune system, would it be better to get two shots?

A: One dose should be fine. H1N1 vaccines in clinical trials have worked really well.

Q: Do children have some protection against H1N1 between the time they get the first dose and the second dose?

A: Yes, but only a little.

Q: Is vaccine linked to autism?

A: There's no scientific evidence of that. Some people have been concerned about primerisol -- a mercury-based preservative -- and we've asked manufacturers to make some that is primerisol free.

Q: Is H1N1 associated with more gastrointestinal symptoms than season flu?

A: We're seeing that.

Q: Are school nurses part of the priority group?

A: Yes.

(End)

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Can your pet get H1N1?

Posted at 11:09 AM on November 4, 2009 by Bob Collins (0 Comments)
Filed under: Health

A cat in Iowa has tested positive for the H1N1 influenza virus, according to the American Veterinary Medicine Association. It's the first time, apparently, that a cat has been diagnosed with the flu strain, raising a new concern: the health of your pet during flu season.

"Indoor pets that live in close proximity to someone who has been sick are at risk and it is wise to monitor their health to ensure they aren't showing signs of illness," said Dr. David Schmitt, State Veterinarian for Iowa.

Two of three family members had H1N1; both have recovered. It's believed the cat caught the flu from the people, not the other way around.

But the cat backlash has begun. In Beijing a university is rounding up homeless cats, according to one report. And a cat shelter was set on fire.

"There is not a single medical expert or research to suggest any connection between the H1N1 virus transmission and cats," a retired professor is said to have told the Web site.

Until now, that is.

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How much will health care cost you?

Posted at 3:29 PM on November 2, 2009 by Bob Collins (19 Comments)
Filed under: Health, Politics

How much will the middle class pay for health care under the House bill being considered in Washington?

The Congressional Budget Office today released its assessment of how much you and your family will pay for health insurance under the various plans being considered in Congress. You can read the entire letter to Rep. Charles Rangel, the chair of the House Ways and Means Committee here, but here are the major examples it gives under the House bill:

♦ A single person with income of $26,500 in 2016 (225 percent of the FPL) would pay a premium of about $1,900 (after getting a premium subsidy of 64 percent) and could expect to pay another $900 in cost sharing (net of federal subsidies); thus, the average payment by such a person for the premium and cost sharing combined is projected to be $2,800, or about 11 percent of income.

♦ A family of four with income of about $54,000 (also 225 percent of the FPL in 2016) could expect to pay about the same share of its income for premiums and cost sharing.

♦ The average premium for a family policy would be $15,000 -- $9,500 after subsidies.

♦ A family of four making $102,500 (four times the current federal poverty level) would pay $15,000 a year plus $5,500 in "cost sharing" (such as co-pays and percentages not covered by insurance) for a total of $20,500 per year.

Question: How many of you keep track of what your health care is costing you now? If so, would you care to share? I'll be happy to go first. It's about half of these numbers, but my plan is shared by my employer).

Meanwhile, a North Carolina congresswoman had an interesting take on this today. Rep. Virginia Foxx said health care reform is a greater threat to the country than any terrorist in any country.

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Today in the flu

Posted at 12:26 PM on October 28, 2009 by Bob Collins (2 Comments)
Filed under: Health

A quick trip around Planet Flu:

• Wisconsin announced today that four more people have died from H1N1. The state also said it will tell health care providers to stop conducting mass swine-flu vaccinations starting next week until vaccine supplies increase. Only target high-risk groups will get the vaccine.
(Minnesota reported two more deaths today.)

• "Swine flu police" told elderly California people to leave a vaccination clinic. "We're doing this for the children," a health official said. "Local government officials, hospital workers and doctors in private practice are being conscripted as ad hoc swine flu police," the New York Times reports. Some people appear to be sneaking into clinics to get the shots.

• In Texas, more than 45,000 at-risk prisoners will receive the swine flu vaccine, Texas prison officials said. They're at-risk, too.

• President Obama's daughters got vaccinated this week. There was no favoritism involved, the White House suggested. They received the vaccine "using the same process as every other vaccination site in the District," according to the first lady's Press Secretary Katie McCormick-Lelyveld. The president has not had the vaccine yet. Should he? When is someone supposed to be important and when is someone just one of the people?

• If enough people are afraid of H1N1, the Internet will get sick.

• What's the first thing people ask when someone says, "I don't feel good."? Usually it's "do you have a fever?" Now, MPR's Lorna Benson has revealed, you can have H1N1 and not have a fever.

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Predicting the flu

Posted at 1:37 PM on October 22, 2009 by Bob Collins (2 Comments)
Filed under: Health

Three more people in Minnesota have died as a result of complications from the flu, all had the mysterious "underlying medical conditions," MPR (AP) reports today.

Meanwhile, the latest government survey finds that 1 in 5 children in the U.S. "had a flu-like illness earlier this month, and most of those cases likely were swine flu," the Associated Press reported. Still planning on opening your front door to the kids on Halloween?

Try running the numbers on this and you'll see how impossible it is to put the flu into any sort of historical context.

According to the Centers for Disease Control, 38,000 people a year in the U.S. die as a result of flu or associated complications (like pneumonia). But the CDC doesn't really know this to be true since not all states have reported flu deaths and, if they do, they're not all reported the same way.

The CDC reset this year's count to zero in August after revamping the mechanism for reporting hospitalizations and deaths. According to its Web site, there've been 292 deaths since the end of August. Minnesota says there've been 10 deaths here.

The CDC does track pediatric deaths and through last week, there have been 43 reported -- about half the number of recent flu seasons and we're only at the beginning of the flu season now. Let's just say the CDC graphic-makers aren't producing the most intuitive graphs on the subject (click for larger image):

Nothing about the flu is predictable, it seems, including the arrival date of a flu vaccine. But that doesn't stop health officials and other experts from making predictions, the LA Times notes:

Statistician Sherry Towers and Zhilan Feng of Purdue University reported last week in the journal Eurosurveillance that a mathematical model of the swine flu pandemic predicts the disease will peak this week.

But officials from the Centers for Disease Control and Prevention have emphasized repeatedly that trying to predict what any form of flu will do in the future will most likely be an exercise in futility.

"We may see in any particular community illness going down in the next several weeks, but we don't know whether it is going to go up again," Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Disease, said Tuesday.

If the statisticians are right, and the flu is peaking this week, then the number of pediatric deaths may be smaller than usual. If the current statistics from the CDC hold up for the entire flu season, the number of pediatric deaths will be substantially higher than usual.

Everyone's guessing, and there appears to be no reliable historical context for what's going on.

Some graphs from the Minnesota Department of Public Health try, like this one showing the number of doctor visits compared to previous years:

But is that because of a difference in severity of the flu, or the fact that every news organization is talking about it constantly?

Probably the former if the results of viral cultures are an indication:

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The cancer question

Posted at 11:07 AM on October 22, 2009 by Bob Collins (0 Comments)
Filed under: Health

This video of Sen. Al Franken "schooling" an opponent of health reform proposals has been making the Internet rounds over the last few days.

"The fearsome Harvard math major punished conservative economist Diana Furchtgott-Roth for claiming that Democrats' reforms would jack up bankruptcies for medical reasons," the Minnesota Independent reported.

Clearly, Franken was a senator prepared for combat, though conservative blogs have jumped on Franken's comeback for Furchtgott-Roth's attempt to point out that the U.S. has better cancer survival rates than European countries.

"That's because we find easily survivable cancers to count as ones that we survive," he said. If you're tallying cancer survival rates, shouldn't the "easily survivable" ones be counted?

Well, yes, except Franken's response claims the U.S. figures are cooked. He's referring to this "study" by Betsy McCaughey, the health care reform opponent who is, perhaps, best known as the person who started the "death panels" controversy.

There is a more recent -- perhaps more scholarly -- evaluation of cancer survival rates. A London researcher found the highest survival rates were found in the U.S. for breast and prostate cancer, in Japan for colon and rectal cancers in men, and in France for colon and rectal cancers in women.

The same study also found wide differences in survival rates among U.S. states, especially when race is considered.

Another study, this one from Canada, found that poor people in Canada had better survival rates for breast and prostate cancer than some U.S. states. Hawaii narrowed the gap, however. Hawaii mandates employer-provided health care.

While partisans are quick to jump on any factoids that prove their side is correct on the health care issue, FactCheck.org suggests there are too many variables to make the statistics meaningful one way or the other:

Dr. Marie Diener-West, a professor of biostatistics at Johns Hopkins University Bloomberg School of Public Health, told us that it would be a stretch to draw too many conclusions from comparing survival rates. "Part of the problem with the comparison is that it might not actually be comparable populations," she said. "It could be [one is] an older population, it could be they have more comorbidities [other conditions] that are affecting their survival in addition to cancer, there could be occupational differences. There are many different factors that could be playing a role." Diener-West pointed out that the uninsured, for instance, are generally poorer and may have different diets, different lifestyles and different exposure to tobacco and other drugs than the privately insured. And when you compare across countries, of course, you're also looking at two different gene pools.

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H1N1 threat overblown, report says

Posted at 1:31 PM on October 21, 2009 by Bob Collins (4 Comments)
Filed under: Health

We're six months into the outbreak of H1N1 flu and we still can't seem to get a clear picture of how serious the outbreak is.

True, some hospitals in the Twin Cities have turned away patients because they're overwhelmed with people who either have or think they have H1N1, but a CBS News investigation this afternoon claims the statistics are overblown.

It's impossible to know for sure because the Centers for Disease Control in July told states to stop testing patients for H1N1.

Had the states conducted the testing, CBS says, we would have found out that most people who have H1N1, really don't:

We asked all 50 states for their statistics on state lab-confirmed H1N1 prior to the halt of individual testing and counting in July. The results reveal a pattern that surprised a number of health care professionals we consulted. The vast majority of cases were negative for H1N1 as well as seasonal flu, despite the fact that many states were specifically testing patients deemed to be most likely to have H1N1 flu, based on symptoms and risk factors, such as travel to Mexico.

Meanwhile, Minnesota has set up a "flu hotline" for those people who think they've got the flu. The FluLine number is 1-866-259-4655.

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Patients or prisoners?

Posted at 3:08 PM on October 20, 2009 by Bob Collins (8 Comments)
Filed under: Health, Politics

Gov. Tim Pawlenty's reaction to a Star Tribune story on TVs for sex offenders confirms the reality of Minnesota's "treatment program" for sex offenders -- it's really just a jail for people who haven't been charged or convicted of crimes they might commit in the future.

"They don't need 50-inch, flat-screen plasma televisions for sex offenders," Pawlenty said today of the $1,576 TVs in the Moose Lake facility."Clearly, somebody just made a bonehead decision, and I'm going to reverse it."

The reversal comes over the objection of some of the staff at the facility who say there is a clinical benefit to the TVs. Indeed, the Associated Press refers to the people housed in the facility as "patients," not inmates.

"Patients" in Minnesota's sex offender "treatment" program have already served their jail time. They're housed under the guise of being in treatment, even though experts say there is no evidence that there's a treatment for sex offenders, and nobody who was committed under state law has ever come out of the program.

Dennis Linehan came closest. In 1965, Linehan kidnapped, raped, and killed a Minnesota teenager, was sentenced to 40 years in prison, escaped and was captured after sexually molesting a 12-year-old in Michigan. When he was scheduled for supervised release in 1994, then Gov. Arne Carlson ordered him held until he could get the Legislature to enact the Sexually Dangerous Persons Law, which allows Minnesota to lock up people who haven't been charged, under the theory -- upheld by the courts -- that the rights of the public outweigh the rights of the individual.

The Moose Lake "treatment" facility is, in fact, a wing of a prison. Whether the "patients" are pampered -- as suggested by the Star Tribune's TV story -- is a matter of some dispute, especially considering a complaint from the ACLU earlier this year:

* Detainees are subjected to strip searches and are handcuffed and shackled as part of standard operating procedure whenever detainees are transported (for example, to attend patient advisory committee meetings at the MSOP facility) and after contact visits in violation of their Fourth Amendment right to be free from unreasonable searches and seizures.

* Detainees' incoming legal mail has, on numerous occasions, been opened outside the presence of the detainee in violation of their Sixth Amendment right to counsel.

* Detainees allege that they are not allowed incoming calls and that their calls are monitored in violation of their First Amendment right to telephone access.

* Detainees are denied their right to Procedural Due Process by being deprived of their access to freely move around the Annex without escorts, and, consequently, access to the privileges afforded to all other civilly committed detainees including daily access to the gym, access to library services, the ability to communicate with other Annex detainees, and free access to outside activities. The conditions imposed on Detainees are similar to what the Minnesota Department of Corrections imposes on inmates who are in Administrative Segregation. Inmates in A-Seg are entitled to procedural due process before being housed in that restrictive setting.

* Detainees are subjected to potentially severe health risks due to inadequate sanitation in violation of their Eighth Amendment rights includinng:

1. Communal showers and bathrooms are only cleaned once a day;
2. Urine and fecal matter are frequently found on the bathroom floor or toilet seats;
3. No sanitizer is readily available to disinfect the floors and toilet seats;
4. Dining room tables are not adequately sanitized prior to serving each meal;
5. Mops and brooms used to clean the bathrooms and showers are also used to clean cells, thereby spreading germs to their cells;
6. Towels, blankets and cleaning rags are washed in one unit washer and the water does not reach a temperature needed to properly sanitize them.

* Detainees who had purchased 20 inch televisions at the Annex had their property seized and were forced to send them out of the facility at their own expense to comply with a MNDOC rule allowing only 13 inch clear televisions on the Moose Lake prison property.

* MSOP retaliated against two of the plaintiffs (Beaulieu and Yazzie) for their participation in litigation challenging their access to religious activities while civilly committed to the MSOP. The retaliation took the form of a reduction in their access to religious services, attorneys, the court and visitation by family; unreasonable restraint of Yazzie leading to injury; unreasonable searches of Beaulieu's property; and the seizure and copying of Beaulieu's legal papers.

"It has to be treated like a hospital -- it is not a prison," said Rep. Thomas Huntley, DFL-Duluth.

Wink.

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Got questions about the flu?

Posted at 12:00 PM on October 15, 2009 by Than Tibbetts (4 Comments)
Filed under: Health

The flu hasn't shown any signs of slowing down in Minnesota — 215 schools reported outbreaks last week — and this will be a great opportunity to clear up any lingering questions you might have about the flu.

We had a flu Q&A with MPR health reporter Lorna Benson here on Thursday at noon. You can replay the chat below; there were a lot of interesting questions and enlightening answers.

Also, check out MPR's H1N1 Flu Facts & Information portal. It's continually updated with the latest flu info.

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In the pink

Posted at 1:58 PM on October 6, 2009 by Bob Collins (3 Comments)
Filed under: Health, Marketing and advertising

How much pink is too much pink?

October is Breast Cancer Awareness Month and each year more and more consumer products "go pink." Is it about a good cause, selling products, or a little of both?

"If the AIDS organizations had backed off for one minute on red ribbons, think of where we'd be today," Nancy Brinker of Susan G. Komen for the Cure told MSNBC.

"Does it trivialize it?" countered Barbara Lippert, a writer. "I think it's done more good than harm but anything that becomes a big business has a danger of exploitation.

"My daughter-in-law died of breast cancer," Helga Russell told GoErie.com. "At the end, she told us she was tired of pink. We held a benefit and we wanted to wear pink T-shirts, and she said, 'No.' She said, 'Who knows whether the money is actually given to research?'"

The accompanying story points out, for example, that Diet Coke is festooned in pink, but nowhere on the packaging does it indicate any money is going to breast cancer research.

"I think that the pink ribbon, as a symbol, tends to pretty up what is a pretty crappy disease," a breast cancer survivor told the Boston Globe. "But a pink ribbon is easier to look at than the disease itself."

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Saving Pvt. Hafterson

Posted at 12:04 PM on September 30, 2009 by Bob Collins (12 Comments)
Filed under: Crime and Justice, Health

Ronald Bradley is seeing first-hand the difficulties American soldiers are having getting treatment for the post-traumatic stress syndrome (PTSD) they suffered as a result of their service in Iraq.

Bradley, an attorney and friend of the family, is trying to keep Marine Pvt. Travis Hafterson, 21, alive long enough to get him some treatment, but Hafterson has fallen into the hands of the military justice system, which he thinks may be more interested in punishing Hafterson than treating him.

By all accounts, Hafterson, a Circle Pines native with two tours of duty in Iraq, needs treatment in a hurry. A girlfriend says he slept with a gun under his pillow, and still has flashbacks of the cries of people he killed, and colleagues who died next to him.

He also has talked about committing suicide numerous times. Saying he doesn't want to live, doesn't deserve to live. He calls himself a murderer and speaks of countless innocent people he believes he killed, women and children included. He has talked about suicide countless times, but there are two times where I literally had to take his gun out of his hand because he felt it easier to shoot himself than to live with his conscience.

Hafterson's legal problems started during his second tour. "He was experiencing problems that are classically associated with PTSD, he was self-medicating with marijuana so he could sleep," according to Bradley. When he admitted marijuana use, he was court martialed and sent back to Camp LeJeune in North Carolina.

He was granted a leave in August but his orders changed at the last minute. "I think he had already started going away and instead of going back, he didn't go in right away," Bradley said. The Marines have a word for that: Desertion.

When Hafterson arrived in Minnesota last week, his mother called Bradley for help."We arranged to get him his psychiatric evaluation and he spent a good part of Saturday being interviewed. The doctor made his report and found and substantiated PTSD," Bradley said. Working through another lawyer, Hafterson contacted the combat stress officer -- a psychiatric nurse and highly regarded expert on PTSD -- at Fort Snelling and arranged for Hafterson to turn himself in on Monday.

He let the officer, Lt. Col. Cynthia Rasmussen, know they were coming in an e-mail:

I am the attorney for Private Travis Hafterson, USMC. My client has been evaluated and been diagnosed with PTSD by Dr. Peter E. Meyers. Private Hafterson is currently AWOL from the Corps, and is possibly classified as a deserter. His absence is just over 30 days from his Order to Report.

Private Travis Allyn Hafterson wishes to report and surrender to you at Ft. Snelling about 13:30-14:00 today at your office. He will be escorted by the following persons:

Ronald Robert Bradley, attorney
Dr. Peter E. Meyers, psychologist
Terri Lee Bradley, psychologist
Jamie Joyce Hafterson, mother

I understand that you will contact the front gate and let the guards know of our expected arrival. We will report to Bldg. 506, and I will call if there is any problem finding your office.

"The understanding was he was going to get the appropriate treatment, being referred to the VA (Veteran's Administration) or work with him for the Marines. We understood and he was told that he would suffer consequences for not returning to LeJeune right away," Bradley said. A military ombudsman was to meet him and escort him through the process, balancing treatment with the military justice system.

It didn't work out that way. A check at the gate revealed the federal warrant, Air Force security was called, and Hafterson was taken away. Bradley said the combat stress officer was apologetic and said it wasn't supposed to happen that way, but there was nothing she could do. The Marines had Hafterson and Bradley is worried they're more interested in punishing him than treating him first.

Hafterson is being held at the Ramsey County adult detention center.

"It seems like it's going to be exacerbating his problem because he doesn't have the therapy to work this through. I'm worried he's a danger to himself," he said.

He was on suicide watch on Monday, but was taken off it on Tuesday, against the wishes of the combat stress officer. The Marines are expected to return him to Camp Lejeune

"There seem to be kind of blinders on that they go forward with the criminal and ignore everything else," Bradley said. "The punishment will come at some point, but they have to recognize and triage and say, 'OK right now the most important thing is his well being, but first we gotta make sure the kid doesn't kill himself.'"

Bradley says he's been assured by some in the military that Hafterson will get treatment, but he's not convinced. "Because of the (marijuana) use, he was supposed to have chemical dependency treatment but when I talked to the chaplain's office at Camp Lejeune, he said, 'We do not have chemical dependency treatment for active-duty servicemen.' They recognize certain problems but they don't do anything about them."

Bradley has filed a petition in Ramsey County to get Hafterson immediate treatment. "The problem is at any given time the Corps could show up to take him away, and then we don't know what will happen," he said.

As of late Wedneday, Lt. Col. Rasmussen had not responded to a message for comment.

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Did money talk?

Posted at 2:04 PM on September 29, 2009 by Bob Collins (7 Comments)
Filed under: Health, Politics

The so-called "public option" component of health care reform died today when the Senate Finance Committee's Health Care Subdivision (essentially the entire committee) rejected an attempt to include it in legislation the panel is considering. Other bills circulating at the Capitol still have "public option," but Sen. Max Baucus removed it from his bill under pressure from Republicans, who considered it Socialist. The number of Democrats refusing to support the idea pretty much sinks it.

The vote was 15-to-8, with Democrats Baucus, Sen. Tom Carper, Sen. Kent Conrad, Sen. Blanche Lincoln, and Sen. Bill Nelson joining all of the committee's Republicans with "no" votes.

Most of the Democrats voting against the bill, were among the biggest Democratic recipients of health care cash in campaign fundraising. Coincidence? Who can say? The campaign finance system is such that one can only speculate what role it plays when legislation is considered that affects the campaign contributors. So you have to decide.

Here's the breakdown by committee members. The numbers in parentheses represents its rank for that senator in the grouping of contributions by industry. Keep in mind, these numbers are the amount raised through the end of June, well before the health care issue dominated the national dialogue.

DEMOCRATS

John D. Rockefeller, West Virginia (Chairman) - $255,950 from health professionals (2nd),

Jeff Bingaman, New Mexico - $210,563 from health professionals (3rd) and $92,000 from pharmaceutical industry (7th).

Sen. Kent Conrad, North Dakota - $239,533 from health professionals (3rd), $233,625 from the insurance industry (4th).

John Kerry, Massachusetts - $91,036 from insurance industry (7th). $64,948 from health professionals (13th)

Blanche Lincoln, Arkansas - $298,700 from health professionals (2nd), $153,304 from pharmaceutical industry (5th) and $131,850 from insurance industry (8th).

Ron Wyden, Oregon - $173,475 from health professionals (1st), $83,299 from insurance industry (7th).

Charles Schumer, New York - $155,300 from insurance industry (5th) , $108,650 from health professionals (9th).

Debbie Stabenow, Michigan - $338,455 from health professionals (4th). Second-biggest contributor was Blue Cross Blue Shield ($59,700)

Maria Cantwell, Washington - $206,001 from health professionals (11th).

Bill Nelson, Florida - $332,179 from health professionals (6th)

Robert Menendez, New Jersey - $256,950 from health professionals (7th)

Thomas Carper, Delaware - $238,680 from insurance industry (2nd), $139,520 from pharmaceutical industry (7th).

REPUBLICANS

Sen. Charles Grassley, Iowa - $241,856 from health professionals (1st), $201,148 from insurance industry (2nd), $152,650 from pharmaceutical industry (3rd), $139,137 from hospitals and nursing homes (4th). Blue Cross Blue Shield ($26,750) is second-largest contributor. Select Medical Group is third-largest contributor ($23,000).

Orrin G. Hatch, Utah. Ranking member - $481,081 from insurance industry (1st), $242,550 from health professionals. Blue Cross Blue Shield is second-largest contributor ($45,603)

Olympia Snowe, Maine - $174,074 from health professionals (2nd), $163,585 from insurance industry (3rd). Aetna Inc., is second-biggest contributor.

John Ensign, Nevada - $269,325 from health professionals (3rd), $211,462 from insurance industry (7th).

Michael Enzi, Wyoming - $218,700 from pharmaceutical industry (1st), $144,049 from health professionals (2nd), $124,250 from insurance industry (4th). Blue Cross Blue Shield is fifth-largest contributor ($15,000).

John Cornyn, Texas - $759,113 from health professionals (4th), $350,294 from insurance industry (9th).

John Kyl, Arizona - $649,383 from health professionals (4th).

Jim Bunning, Kentucky - $86,433 from insurance industry (1st), $63,650 from health care (3rd). Kindred Healthcare is fourth-largest contributor ( $12,100).

Pat Roberts, Kansas - $178,299 from pharmaceutical industry (9th).

(Source: OpenSecrets.org)

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Strung out on sanitizer?

Posted at 1:50 PM on September 21, 2009 by Bob Collins (9 Comments)
Filed under: Health

How desperate do you have to be for an alcohol fix to eat/drink hand sanitizer?

The Chicago Tribune says some people are raising concerns about the hand sanitizers school districts are providing to combat H1N1 flu.

"H1N1 has certainly created a different way of thinking about what we're doing in the way of influenza prevention," said Darlene Ruscitti, DuPage County's regional superintendent of schools. "But these are things we have to be aware of, and we need to make superintendents aware that people have brought up the issue of the alcohol content in these."

Hand sanitizer has to be 60-percent alcohol to work, and apparently some school districts have banned it because authorities suspect students would try to get drunk with it.

Has there been a big outbreak of drunken -- but sanitary -- schoolchildren? No.

The Duluth News Tribune reprinted the story today and some of the reader comments were actually worth reading.

I used to eat rock salt when I was in grade school. The janitor just left it sitting by the door, and I thought it was tasty. I lived to tell. A friend of mine was filling out the paperwork to purchase some cough medication at Wal Mart. She asked them to also shoot the information back to the automotive department because she needed to buy some windshield washer solvent, too. Still makes me laugh.

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What's so scary about H1N1?

Posted at 3:05 PM on September 14, 2009 by Bob Collins (3 Comments)
Filed under: Health

There was an odd moment on early morning TV today when an anchor for the CBS Early Show announced that the regular host wasn't in today because he's out sick. "It could be H1N1," she said.

Harry Smith, the regular host, then hauled himself off his deathbed and called into the show to reveal that he's feeling OK, but he's achey and feverish.

Runny nose? Temperature of 99.6? Why is this a big deal?

Meanwhile, in Minnesota today, it's reported that a vaccine against H1N1 "may get here too late?"

It's pretty clear by now that H1N1 isn't a death pandemic for most people. You get a runny nose. You get some fever. You feel lousy. And your best friends will make a bigger deal out of it than it needs to be.

Of course, if everyone comes down with H1N1 at the same time, companies will be hard-pressed to have enough workers to operate; every day will be like Fridays in the summer.

But the flu only last a few days and, so far, doesn't appear to present the threat to elderly people than the "regular flu" does, a fact that doesn't yield a very interesting headline..

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Can undocumented immigrants get government subsidized health care?

Posted at 9:34 AM on September 10, 2009 by Bob Collins (23 Comments)
Filed under: Health, Politics

There are also those who claim that our reform efforts would insure illegal immigrants. This, too, is false. The reforms -- the reforms I'm proposing would not apply to those who are here illegally.

That was the point at which Rep. Joe Wilson shouted, "you lie," and led to today's national dialog about whether people who are here illegally will have access to health care. Notice, however, that the president didn't say they would. He didn't say they wouldn't. He said "the reforms I'm proposing would not apply to those who are here illegally."

That's different than saying government won't pay for access to health care for people who are in the United States illegally. It already is. Technically.

Take Minnesota, for example.

Technically, "Nonimmigrants" and "undocumented persons" are not eligible for General Assistance, welfare, Minnesota Supplemental Aid, SSI, Food Support, Emergency General Assistance, and MinnesotaCare. But, again technically, they have access to government-subsidized health care even though they don't. How can both be true?

The 2003 Legislature eliminated GAMC coverage (General Assistance Medical Care) for nonimmigrants and undocumented persons who are under age 18, age 65 or older, blind, or disabled. It also eliminated GAMC coverage for all other nonimmigrants and undocumented persons.

But, according to the Minnesota House of Representatives Research Department, "Nonimmigrants and undocumented persons who meet MA eligibility criteria, such as children under age 21, parents of children under age 18, people who are age 65 or older, blind, or disabled, may be eligible for treatment of emergency medical conditions (including labor and delivery costs for pregnant women) under Emergency MA." That's federally funded.

In Minnesota and the U.S., SCHIP, the children's health insurance program, provides undocumented and nonimmigrants prenatal and delivery care through the end of the month in which the child is born.

Technically, that's government-subsidized health care.

So who's right? That's the problem. Technically both sides are. Especially when it's boiled down to sound bites and talk show rhetoric. That's why there needs to be more attention to the details of the various plans being discussed. The "immigrant issue" is a technicality being used to sway people who can't be bothered with such things.

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The "M" word in health care

Posted at 4:55 PM on September 9, 2009 by Bob Collins (5 Comments)
Filed under: Health

You know by now, probably, that President Obama is coming here Saturday to turn up the heat for his health care plan. And, of course, he's speaking this evening to a joint session of Congress.

The White House has put together a well-crafted presentation about three people in need of health care, one of whom is from Wisconsin:

For many reasons, stories of people battling cancer or heart problems resonate with America. Most people accept that they could easily be in that situation. But few imagine a life of schizophrenia or other mental illness.

Access to mental health care has been mostly left out of the public debate., and
it's not because we've got the greatest mental health care system in the world. While there are defenders of the health care system in America, there are few who'll proudly defend the mental health care system here.

So, perhaps, it's a good time to revisit this MPR series, A Bad State of Mind, about Minnesota's mental health system, because things haven't changed much since 2004. Unlike people with heart attacks or people with cancer, even people with health insurance get turned away when searching for help because there aren't enough beds in mental health wards in hospitals, especially for kids in crisis. And mental health units were closed down earlier this decade because hospitals could make more money with pricier cardiac care facilities.

There are reasons this happened. Government regulations, for one, provided incentives for hospitals to close their mental health facilities.

Recent legislation provided for mental health "parity," but as WHYY in Philadelphia reported today, that doesn't mean people are getting it. It may be the one area where insurance companies are most dictating health care treatment. "In every hospital with every therapist office, somebody is recommending eight session, and the insurance company says, 'No, we think six is enough,'" according to Trevor Hadley at the center for Mental Health Policy at the University of Pennsylvania.

All of this is grist for the health care debate, far more, anyway, than death panels. But people would rather not talk substantively about the problem.

Count President Obama in that group. At least in initial drafts of the speech, there is no mention of mental health. Will Rep. Charles Boustany, a heart surgeon who's giving the GOP response, bring it up?

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H1N1's big numbers

Posted at 7:00 PM on August 25, 2009 by Bob Collins (2 Comments)
Filed under: Health

After the hype surrounding H1N1 flu last April, and the resulting less-than-disastrous result ("only" 522 people have died), the President's Council of Advisors on Science and Technology isn't backing off from the big numbers. A report says that up to 90,000 people may die.

It's not that the H1N1 flu will be more severe that a typical flu-season strain, it's that more people will get it and, thus, more people will die. Up to half the population of the U.S. will get H1N1. There also isn't the immunity to this strain of flu.

During an online "chat" with Amy Garcia of the National Association of School Nurses today, a questioner from Minneapolis on the Washington Post site asked if the "concern that we just don't know how it will react, as compared to the flu that we usually get every year? Or is it something more than that?"

This strain of H1N1 flu is novel, meaning new. So it spreads easily because people have not been exposed and do not have antibodies to it. This strain of H1N1 concerns me for several of reasons:

1. It disproportionately impacts children and pregnant women.

2. There seems to be a higher incidence of pneumonia, possibly because this virus replicates deep inside the lung.

3. It spreads very easily and quickly. My school nurse friends who have witnessed outbreaks describe large numbers of children getting very sick, very quickly.

4. The H1N1 virus may mutate to be more deadly, and still very contagious.

The experts issue the same recommendations to people they've been issuing since last April: Wash your hands regularly, don't cough in someone's face, and stay home when you're sick.

That last item is the big nut in all of this. People who don't have any sick time, tend not to take days off regardless of their medical woes and the threat to the rest of us. So the same experts are asking employers to "be flexible," another way of saying "don't penalize them for staying home."

After last spring's build-up and resulting backlash, who's left who's still listening to the warnings and advice?

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The health care debate: Marginal treatments

Posted at 2:00 PM on August 25, 2009 by Bob Collins (11 Comments)
Filed under: Health, Politics

Sen. John McCain is back on the stump with a "town meeting" style event for health care today.

"You know in England, the NICE (National Institute for Health and Clinical Excellence) has denied treatment for women with breast cancer, and people with Alzheimer's, and denied life-saving drugs for people with MS," the former presidential candidate said to a group of mostly senior citizens, the one demographic he won in last year's election.

True?

Apparently so. And it comes directly from a briefing paper prepared by the conservative Heritage Foundation, which said:

* NICE restricted access to two drugs for Age-Related Macular Degeneration, Britain's leading cause of blindness.[6] The first drug, Macugen, was completely blocked, while the second, Lucentis, was limited to the approximately one in five disease sufferers who have a specific type of the disorder.[7] Even then, Lucentis was restricted to patients with that type of the disorder in both eyes--and could only be used in the less-diseased eye. In the words of Tom Bremridge, chief executive of the Macular Disease Society, "allowing one eye to go blind before treating the second eye is cruel and totally unacceptable." Winfried Amoaku of the Royal College of Ophthalmologists explained, "There are differences in action between these two drugs, which may be important in individual cases, and so we do not wish to be limited in our treatment options in this way."

* NICE limited several Alzheimer's drugs to use in patients whose disease had advanced from early to middle-stage. Even though doctors argued that starting treatment at the onset of dementia would be most effective in slowing the progression of the disease,[8] NICE decided that patients would have to wait until they became sick enough for the treatments to meet the cost-effectiveness threshold. A charity has taken legal action, accusing NICE of "ignoring totally the proven benefits of the drugs for careers of those with mild symptoms, and grossly underestimating the savings they bring to the state by enabling suffers to remain in their own homes longer. [The charity] accused NICE of implying careers are far better off when the condition of their sick relative deteriorates so much that they are forced to move into a residential home."[9]

* NICE blocked access to Glivec, a leukemia treatment. Ann Tittley, a 55-year-old patient, was being treated for breast cancer when she was diagnosed with leukemia. After realizing she would be denied access to Glivec even though her physician had recommended she start it immediately, Ms. Tittley wrote a letter to then-Prime Minister Tony Blair. "Glivec was my lifeline, at least it would give me a chance of beating this disease," wrote Ms. Tittley. "Life is precious.... I appreciate that cost is important, but to deny patients this potentially life-saving treatment on this basis is totally unforgivable and criminal."[10]

In a June article, the Economist noted the concerns and suggested, however, there are provisions which could prevent them in a reformed health care system:

In America, the drugs and devices lobbies are violently opposed to a NICE-style agency that could issue mandatory rulings. They paint a scary picture of Americans being denied access to life-saving new drugs by faceless bureaucrats. In Britain NICE has come under fire for rulings that limited access to expensive drugs for Alzheimer's and cancer on the NHS. America could get around this problem by requiring and perhaps even funding studies, but leaving insurers and individuals to decide whether to pay for treatments.

As with many aspects of the health care debate, there's more to the story. Aricept is the drug NICE originally kept off its formulary, according to the New York Times. It costs about $2,200 a year and some Medicare drug plans pay for it; some don't, says The Times' Caring and Coping blog.

Daniel Callahan, a bioethicist at the Hastings Center, says the drug -- and several others that are linked to the anecdotes above, can slow the progression of a disease, but only for a short time and have only marginal benefits given their cost. It's a question, he says, Americans don't want to ask or discuss.

The most generic way this is done is to declare that life is priceless and even to pose such a question is immoral; and so also with the idea of rationing beneficial treatments. Considerations of cost should simply have no place in our reform calculus.

But there are more subtle ways that cost are sidelined in the reform debate. One of them is the powerful role of the pharmaceutical industry, also taken up in the New Old Age. By treating any consideration of cost as a threat to innovation, both the profit motive is protected (patents run out), and the American romance with endless medical progress is pandered to.

At the end of the debate where McCain traveled today, each side -- proponents and opponents -- can approach the same issue with two different questions.

(1) Why should the government tell me what drugs I can have when it should be my choice?

- or -

(2) Why should taxpayers -- or the other members of your insurance pool -- pay for a drug for you that has little value?

Pick your poison.

(AP Photo/Matt York)

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Who gets the flu vaccine first?

Posted at 4:14 PM on August 20, 2009 by Bob Collins (4 Comments)
Filed under: Health, Science

Some scientists are questioning whether the first people to get inoculated against the H1N1 flu should be the ones that are scheduled to.

The current formula calls for the people most likely to die to get the vaccine first. An article in Science Magazine, by way of Time.com, says it should, perhaps, be the people most likely to spread the illness.

"If you can stop transmission, you can protect the people who are vulnerable," says Jan Medlock, a mathematician at Clemson University and one of the authors of the Science paper.

That would be kids and the age group of their parents -- basically 20- and 30-somethings. Those are the people who, not coincidentally, have been the hardest-hit Minnesotans by the H1N1 outbreak so far.

The Minnesota plan for inoculation follows the federal guidelines: Health care workers, pregnant women, young children and people who care for infants under 6 months of age go first.

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Health care rationing?

Posted at 9:53 AM on August 19, 2009 by Bob Collins (13 Comments)
Filed under: Health, Politics

At the same time MPR's Kerri Miller was hosting a discussion today on where the money goes that's dumped into health care, and why health care costs so much, a Harvard professor was sounding an alarm that health care reform will lead to rationing, and getting significant pushback from an unlikely source.

"The best solution to this problem of private overconsumption of health services would be to eliminate the tax rule that is causing the excessive insurance and the resulting rise in health spending, Martin Feldstein wrote in a Wall St. Journal column today called ObamaCare is all About Rationing." Alternatively, Congress could strengthen the incentives in the existing law for health savings accounts with high insurance copayments. Either way, the result would be more cost-conscious behavior that would lower health-care spending."

Feldstein went on CNBC this morning, where anchor Mark Haines found his view objectionable.

Haines: Why would that lead to rationing?

Feldstein: Because that's what the administration strategy is. They've said they're going to cut the projected rate of growth on health care spending by 30 percent over the next two decades. That came from a White House study released in June. And the way they're going to do that is by setting rules for doctors and hospitals, what they call 'cost effective forms of treatment' that will limit the kinds of things that can be done.

Haines: And we don't have rationing now?

Feldstein: We have some of it, but this...

Haines: You bet your bippy we've got it. C'mon. You have profit-motivated bureaucrats making rationing decisions.

Feldstein: But I can talk to my doctor. I can talk to my hospital and say, 'should we do this or not do that?' And people with private insurance today have those kinds of options.

Haines: And then the insurance company has the final say on whether it actually happens, right? Rationing care.

Feldstein: They turn down very, very few things and, again, it is not the government that's doing it. So if my insurance company doesn't allow certain drugs, or doesn't allow certain kinds of treatment, I can choose a different kind of policy. And the idea as I see it in the Obama proposal is to force us all into a certain kind of spending pattern because the government is concerned -- the administration is concerned -- about how much the government is spending on health care, and Medicare, and Medicaid, but in order to control that, they want to change the kind of treatments that you and I -- outside the Medicare and Medicaid system -- can get on our own.

Haines. I'm sorry, but how are you being... how are we being forced into anything? You will be allowed to keep your private insurance.

Feldstein: Yes, but what the administration is talking about, what they describe in this White House report, is what they call 'comparative effectiveness research.' In other words: Their studies will say whether a particular kind of treatment is worth the money. And that's what concerns me.

Haines: Wait a minute! You want to be able to have anything regardless of its cost vs. its effectiveness?

Feldstein: No, I want to make that decision.

Haines: How are you qualified to make that decision?

Feldstein: I and my physician together will talk about whether something is worse spending the money to do. Whether the risks associated with not doing this test or that test are risks that we want to take. And I think that individuals who want to pay out of pocket, there ought to be higher co-payments. But I think individuals and their physicians rather than a bureaucratic process should be making the choice.

Haines: First of all, the private insurance companies are a bureaucracy, so this bureaucrat argument is nonsense. And, second, you'll pardon me sir, but your argument is a very easy one to make by someone who has money.

Feldstein: But 85 percent of Americans have insurance. So it's not that we're talking about a small handful of people who have insurance. And one of the nice things is there's choice. I can, here in Boston, I can join any of a number of plans and they're going to differ (Bob notes: He didn't mention that Massachusetts has universal health care) in the kinds of hospitals I would have access to and the kinds of limits on various things. So there's choice and it seems to me that's one of the things that's made the American health care system so good. That it has stimulated research. It has stimulated new technologies...

Haines: Well I'll say, again, sir, you have these choices because you can afford them. A lot of people can't afford them. And we're 29th in the industrial world in infant mortality. We spend two-and-a-half times what Britain spends for worse outcomes...I'm sorry.

Haines got so worked up, he turned the interview over to his co-anchor.

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Little evidence that sexual orientation change efforts work

Posted at 4:57 PM on August 5, 2009 by Bob Collins (1 Comments)
Filed under: Health

Case closed. There's no evidence that therapy can transform a homosexual into a straight person. So says the American Psychological Association, which approved two years of research on a 125-to-4 vote at its annual convention.

"There's no evidence to say that change therapies work, but these vulnerable people are tempted to try them, and when they don't work, they feel doubly terrified," said Judith Glassgold, who chaired a task force. "You should be honest with people and say, 'This is not likely to change your sexual orientation, but we can help explore what options you have.'"

At issue is how therapists should handle gay clients who are caught between their sexual identity and a religion that disapproves of them. One of the solutions, the report said, is suggesting they change churches.

Dr. Warren Throckmorton, who writes a blog at Crosswalk.com, sees elements of the report differently from its bottom line, and suggests there's a solution to gays in crisis with their faith:

There are different assumptions about what best constitutes the answer to the question: 'who am I?' This paper nicely addresses these assumptions and acknowledges that people who are deeply committed to a non-gay-affirming religious position may stay same-sex attracted but not identify as gay. As the paper notes, this is an acceptable alternative.

... which sounds somewhat like a "don't ask don't tell" policy to oneself. But the report makes clear that -- at least in terms of therapy -- the issue isn't necessarily only about how one lives out one's sexual orientation, but also about how one identifies his or her sexual orientation, suggesting the two are not always the same.

Here's the full report.

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Flying drunk

Posted at 10:23 AM on August 3, 2009 by Bob Collins (2 Comments)
Filed under: Crime and Justice, Health

"Tell those people up in Minnesota 'I'm really sorry,'" Joe Balzer said to me as I left our meeting at the EAA air show in Oshkosh a few days ago. "I had my worst day," he said of the day he committed what many, perhaps, believe to be an unforgiveable act. He and two others on the flight crew of a Northwest Airlines flight with 91 people aboard, were drunk when they flew from Fargo to Minneapolis.

He was arrested, convicted, and sent to prison.

Before the flight, he and his crew spent hours in a Moorhead bar, pounding down rum and Cokes and beer.

"That evening I was full of fear," he said. "I was on probation from Northwest Airlines, things weren't going well with the crew, we were a little dysfunctional. It was a terrifying event. It was the culmination of the ultimate struggle. A year before I had a blackout in Los Angeles as a pilot for Eastern Airlines. I tried to quit drinking on my own... I didn't have a support group, I didn't have a 12-step group, I wasn't seeking wise counsel from others. My chances of success were not very good."

Balzer, who's just released his book, "Flying Drunk", says he got drunk for the first time when he was three years old, drinking with his grandfather.

The low point of his life was hours after his flight landed in Minneapolis. "There we were in (Northwest Airline's) headquarters and the results came back and they said, 'All three of you guys tested positive for alcohol,' and I thought, 'This is bad, I'm going to lose my job and I'm going to lose my pilot's license.' That night I was stranded in a hotel in Minneapolis and I paced it off in the room. I walked back from the window and I thought, 'If I get going good I can get through that window and do a swan drive.' That's how ashamed I was about what I'd done. I let myself down and I knew that, but I looked at that window and I thought, 'This isn't the right thing to do; it'd be very selfish.' I had a good cry from deep inside and I just decided to accept responsibility and change my life."

Nineteen years after the incident, and years after prison in Georgia, Balzer rebuilt his aviation ratings. "One day I walked into American Airlines after they saw me speak. I'd been rejected by over a hundred different airlines." He was hired.

Not all airline pilots have forgiven Balzer. After the arrests and trial in Minneapolis, airline pilots were the target of jokes from late-night comedians. "What matters is I own my part and I've made amends to my professional brothers who made a living," he said. "At the time I thought I was OK to fly and I know today with the clarity of a recovering person... I had no business being near an airplane that morning. Had it happened before? Yes. Does it happen with pilots? Yes. It's a problem with brain surgeons, and pastors, and school teachers, and everyone. Ninety-eight percent of alcoholics show up and do a job. There will be pilots who will still hold it against me personally and all I can do is say 'I'm sorry.'"

He's still flying for the airline and still speaking to people, knowing that there's probably a drunk in the audience. "The pilot who knows he has a problem is really playing with fire. Alcoholism is a 100-percent fatal disease. It's very important for pilots who have scared themselves ... just like I did out in Los Angeles ... if people are having episodes like that and finding themselves with DWIs, they need to get some help," he said.

One of his messages to airline pilots is seeking help doesn't have to involve losing a career. He says the FAA, pilots unions, and the airlines have created programs for recovery.

"First they can save their lives. Then they can save their careers," he said.

Listen to the interview:

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The hidden issue of health care

Posted at 11:55 AM on July 23, 2009 by Bob Collins (5 Comments)
Filed under: Health, Politics

When I checked a few minutes ago, of the few dozen people who answered the question posed in this morning's Five at 8, 83% said they knew little to nothing about the specifics of the health care debate taking place in Washington.

How could that be? Because it's happening in Washington where process is most important.

Example. Read this article from the Associated Press. I'll wait right here.

Welcome back. Did you notice something about the article? There wasn't a single word about what's in the legislation or what the major points of contention are. Not one word. There is a reference to the Blue Dogs -- conservative Democrats -- being concerned about "tax increases and the impact on rural health care and small businesses." That's it. So what's in the House bill that specifically has them concerned?

It's no wonder that talk shows -- which boil legislation down to small talking points, some of which are occasionally in context and accurate -- steer the political debate.

But what if you want to be informed about the specific issues?

For the most part, it's piecemeal. Pick an editorial here or there, read a blog and piece it together.

Here are a few salient points.

Des Moines Register editorial

Democrats propose increasing taxes on the wealthiest Americans - about 2 million taxpayers - to help pay for reform. The surtax would be imposed on families earning more than $350,000 a year and individuals earning more than $280,000 a year. The tax rate would range from 1 percent to 5.4 percent.

The New York Times provided separate views of this proposal in a blog post here. "Should the Rich Pay for the Uninsured?" Included were these details.

Doctors' reimbursements:

The baseline budget calls for large cuts over the next decade in doctors' reimbursements under Medicare. Congress has always voted to waive these cuts. The health care reform bill will make this waiver permanent at a cost of more than $200 billion. It is disingenuous to get outraged over this expense, since we always knew that Congress would not allow the baseline cuts to go into effect.

Capping health insurance premiums:

Senator Max Baucus, chairman of the Senate Finance Committee, wants to cap the tax exclusion to put a lid on inflationary health insurance and restore fairness to the tax code. Workers could still keep their health insurance at work, but they would have a new incentive to stay under an annual cap of, say, $15,000 for a family policy.The company could still deduct any amount it spends on insurance, but employees would be motivated to stay under the cap.

Maggie Mahar, who writes the Health Beat blog for the Century Foundation, says misinformation is growing. She took apart a Wall Street Journal editorial which, she says, are full of falsehoods. She provides a few more details of what's actually in the bill.

The House bill actually protects and increases employer-sponsored insurance. According to official CBO numbers, 2 million more people would be covered under employer-sponsored insurance than is projected to be the case today - 164 million compared to 162 under current law.

But the best analysis of what's in the House bill -- which is H.R. 3200, by the way -- may be the Congressional Budget Office:

The legislation would establish a mandate to have health insurance, expand eligibility for Medicaid, and establish new health insurance exchanges through which some people could purchase subsidized coverage. The options available in the insurance exchange would include private health insurance plans as well as a public plan that would be administered by the Secretary of Health and Human Services. The specifications would also require payments of penalties by uninsured individuals, firms that did not provide qualified health insurance, and other firms whose employees would receive subsidized coverage through the exchanges. The plan would also provide tax credits to small employers that contribute toward the cost of health insurance for their workers.

... and ...

Changes to the Medicare Part D program... would establish a new prescription drug rebate program for some people who are eligible for both Medicaid and Medicare, while expanding drug coverage to beneficiaries that are currently subject to a gap in coverage (often referred to as the Part D "doughnut hole"), saving $30 billion over the 2010-2019 period.

A read of the actual bill shows a few other provisions: >> A grant to train more nurses, and to provide more diversity in the nursing profession.
>> Health clinics in schools
>> Low-interest student loans for primary care students.
>> Home visitation programs for families expecting children.
>> Optional Medicaid coverage for low-income HIV individuals.

It's not a perfect way to get up to speed on the actual issue of health care, but it's better than what we've had so far.

As for the politics of the debate, which are getting the lion's share of coverage, a guest on this morning's Midmorning program succinctly told us all we needed to know about that:

"Every dollar in the health care system is someone's income."

It was good listening.

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The health care debate

Posted at 1:01 PM on July 22, 2009 by Bob Collins (5 Comments)
Filed under: Health, Politics

Rochester's Mayo Clinic is getting plenty of attention as the health care debate has eclipsed the economy as the number one domestic issue.

President Obama holds a news conference tonight (7 p.m. CT with live-blogging here) to try to win support for his proposals, amid growing punditry that his entire presidency is on the line.

Mayo Clinic, and particularly its CEO Denis Cortese, doesn't like the president's proposals. In a story on National Public Radio on Tuesday's All Things Considered, it was described as "one of the health-care industry's great bargains, with costs 28 percent below the national average."

So when Mayo speaks, people in high places tend to listen. Here's the clinic's blog speaking:

"The proposed legislation misses the opportunity to help create higher-quality, more affordable health care for patients. In fact, it will do the opposite."

... and ...

"Unless legislators create payment systems that pay for good patient results at reasonable costs, the promise of transformation in American health care will wither. The real losers will be the citizens of the United States."

Dr. Cortese told NPR further that "by higher value, we mean better outcomes, better results, better safety, better service -- at lower cost over time."

How to do that isn't exactly spelled out. But in a response to a New York Times blog post on how much health care really costs ($15,000 a year per family), a Mayo physician, Randall Walker, offered his idea.

It's a lengthy comment that deserves a full reading (several times, in my case. Such is the nature of the health care debate).

The government simply needs to do what it has always done best: to obtain money from those who have more to help those who have less.

The key is to structure this within a frame-work that nonetheless gives everyone, across all levels of income and employment conditions, more first-dollar responsibility for health care expenses, with the opportunity that comes with it to directly retain the savings of their wiser health care choices.

Dr. Walker says later in life, health savings accounts could be tax-free gifts to heirs...

In this way, many consumers would forgo a lot of the futile, expensive medical interventions toward the end of life that do not significantly improve the quality or duration of one's life -- knowing they and their heirs can directly enjoy the financial benefits of these choices.

It all starts, quite simply, with comprehensive means-adjustment -- for both the below-deductible payments to providers and the premiums to insurers that consumers would pay in relatively high-deductible / low-premium insurance policies.

At the heart of much of the health care debate, it seems to me, is the notion that people are simply wasting the health industry's time by seeking treatment without regard for its true cost. Perhaps, but is that what you"re seeing at the end of the health care food chain?

I don't dismiss the logic, but I also don't see how it meets the intent to raise the quality of care. There are plenty of stories about people who die of heart attacks because they didn't choose to go to the ER when the chest got tight.

The other day, a family member told me the story about getting hit in the head during an athletic contest. His head hurt and his vision was blurry and common sense dictated a trip to the doctor was in order. But he didn't go because he knew a CT-scan would be prescribed and those cost too much.

I fell off a roof last year and didn't go to the doctor for exactly the same reason. That might make financial sense, but it doesn't make medical sense.

And that's the issue that's making everyone's head hurt in the health care debate. How can a system do both?

Writing on the Health Care Blog, Matthew Holt suggests the question doesn't matter, because the legislation being considered doesn't do either.

Of course we'll be back here in a few years because the fundamental problems of the health care system--employment-based insurance & fee-for-service medicine--will remain whatever happens this summer. And they continue to be a recipe for disaster. Although of course it's a disaster that has lots of supporters.

It's almost enough to make you tune out and turn on Fox. Almost.

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Is West Nile Virus hype too?

Posted at 2:33 PM on July 16, 2009 by Bob Collins (0 Comments)
Filed under: Health

West Nile virus is getting its moment in the sun today with news that the first case of the illness has been reported in Minnesota. Fourteen people have died since the virus was first discovered in the state in 2002, state health officials say.

But this would most likely fit the conventional definition of "overhyped." Since H1N1 (swine flu) was "hyped," as many say it was, anything less severe is also "hype".

From April through early July, Minnesota has had 634 cases of H1N1. The state has had about 450 cases of West Nile since 2002. It had only 10 last year.

211 people nationwide have died from H1N1 since April. 44 died from West Nile in 2008.

Hyped? Maybe. But maybe the reason only 44 people died last year is because someone hyped the disease in 2002, when 284 people died from West Nile. The number has been steadily dropping since people became more aware of how to avoid it.

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One person's health care

Posted at 11:02 AM on July 14, 2009 by Bob Collins (1 Comments)
Filed under: Health

The story of health care in America is loaded with lives that changed in a split second.

One year ago next week, Alan Henley, a popular airshow performer, was doing some chin-ups on a bar when it collapsed. He was playing with his kids at the time. He hasn't walked -- or done much else -- since.

His wife has been relentless in posting updates to his Caring Bridge site. But today, there's the desperation in her words that serve as a reminder that for millions of Americans, there's more to the health care debate than politics.

You all know how hard it is for me to update when things are not going well, but I so believe in the power of prayer that I'm just going to say, things are not going well at all. I'm assuming it has to be because we are almost upon the year anniversary of that night...the night that has forever changed our lives irreversibly. We had so hoped for more return but it's just not coming back, so now instead of hope we have to face reality.

Yes I believe that Alan will be able to do so much more in time but he needs help and equipment that BCBS just won't pay for. His therapy visits will be up in the beginning of August and then we are on our own. He said, "I guess they just give up on you when they no you have no hope of getting better." To say that this has impacted his frame of mind and determination is an understatement. I can't blame him and I find it hard to help him and relate from my able bodied state. I would be a fool to think I get it. But what breaks my heart is how do I get him back? He feels like he has nothing to live for and is just a burden. How did it get to this?

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Doc in the house

Posted at 12:36 PM on July 13, 2009 by Bob Collins (0 Comments)
Filed under: Health, Politics

Say whatever you want about President Obama's selections to the cabinet and courts, but you can't deny they often have fascinating personal journeys.

Sonia Sotomayor? No. Regina Benjamin. She has been selected to be the next surgeon general.

She founded the Bayou La Batre Rural Health Clinic, then rebuilt it when Hurricane Katrina destroyed it. Then had to rebuild it again, according to President Barack Obama.

When Hurricane George destroyed the clinic in 1998, she made house calls to all her patients while it was rebuilt. When Hurricane Katrina destroyed it again and left most of her town homeless, she mortgaged her house and maxed out her credit cards to rebuild that clinic for a second time. She tended to those who had been wounded in the storm, and when folks needed medicine, she asked the pharmacist to send the bill her way.

And when Regina's clinic was about to open for the third time, and a fire burned it to the ground before it could serve the first patient, well, you can guess what Dr. Benjamin did. With help from her community, she is rebuilding it again. One disabled patient brought her an envelope with $20 inside. Another elderly man said simply, "Maybe I can help. I got a hammer."

She's not it in for the money. There are only 2,500 residents in the town where it's located.

She was named a MacArthur Foundation Fellow in 2008:

She has established a family practice that allows her to treat all incoming patients, many of whom are uninsured, and frequently travels by pickup truck to care for the most isolated and immobile in her region. Benjamin is skilled, as well, in translating research on preventive health measures into accessible, community-based interventions to decrease the disease burdens of her diverse patient base, which includes immigrants from Vietnam, Cambodia, and Laos, who comprise a third of Bayou La Batre's population. A committed local physician, she also plays key roles statewide and nationally, helping others establish clinics in remote areas of the country and serving in leadership positions in such health-related organizations as the American Medical Association and the American Academy of Family Physicians. With a deep, firsthand knowledge of the pressing needs and health disparities afflicting rural, high-poverty communities, Benjamin is ensuring that the most vulnerable among us have access to high-quality care.

She had big plans for the money: Expanding the clinic:

She's also the first African American woman to serve on the American Medical Association's board of trustees.

Back in 1995, she was named Person of the Week on the late Peter Jennings' nightly news program.

It's not clear now, however, what happens to the clinic when she leaves town.

(h/t: Chris Worthington)

Here are her remarks today:

Continue reading "Doc in the house"

Inclusion

Posted at 10:30 AM on July 13, 2009 by Bob Collins (4 Comments)
Filed under: Health, Schools

There's a documentary coming to Public Television in October that has the ability to change and amplify the debate over special needs in public schools, a debate that is now mostly faceless.

Photojournalist Dan Habib produced the film after his son, Samuel, was born with cerebral palsy. Now he's considering how his son is going to grow up and keep up in public schools.

"What makes inclusion successful? What makes it fail?" he asks.

"Everybody else in life is going to limit him; I can't do it," Samuel's mother says.

Here's a preview:

Related: In its story today about the difficulty young teachers in Minnesota are having getting and keeping jobs in a time of school cutbacks, this lone sentence jumped out:

What's more, with the exception of math, science and special education areas, Minnesota already is overloaded with teachers.

If you have a story to share on the subject, please drop me an e-mail.

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The health care bills

Posted at 12:02 PM on July 2, 2009 by Bob Collins (0 Comments)
Filed under: Health, Politics

As the economy continues to collapse, it appears health care has overtaken it as the most important issue facing Washington politicians.

The Senate's giant health care bill has been posted here. It's 615 pages long. The chairman's amendments are another 175 pages.

How many people who boil the characterization of the bill down to talk-show-sized bites will actually read it? How politicians will actually read it? And this is just the Senate version.

Most people won't. But that won't stop them from having an opinion.

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The amazing shrinking and expanding Minnesota

Posted at 11:44 AM on July 1, 2009 by Bob Collins (2 Comments)
Filed under: Health, Surveys and trivia

Oh for the love of the sweet, sweet paradox.

Two stories in the news today could be related. But they're not.

First:
We're shrinking.

Second:
No, we're not.

As long as we're on the subject, let's talk about obesity and the half-full/half-empty coverage.

Twenty-five percent -- one in 5 3 4 of us -- in Minnesota aren't just fat We're obese. Twenty-three percent of Minnesota kids are overweight, according to a survey out today from The Trust for America's Health.

"Obviously, Minnesota is doing something right," said Serena Vinter, one of the authors, told the Star Tribune.

We are?

Here's a line from her press release:

Adult obesity rates increased in 23 states and did not decrease in a single state in the past year, according to the F as in Fat: How Obesity Policies Are Failing in America 2009.

Maybe we're not as fat as, say, Wisconsin, but how is it possible to categorize this as a success story?

The situation remains a disaster waiting to happen -- except it's happening now. Since the data shows Minnesota is not improving, this 2003 MPR series -- The Fight Against Fat -- remains timely.

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Mapping HIV

Posted at 11:11 AM on June 22, 2009 by Bob Collins (1 Comments)
Filed under: Health

The National Quality Minority Forum today unveiled its National HIV/AIDS atlas, showing county-level prevalence data of the illness throughout the United States. The licensing agreement is pretty restrictive -- you need to register and, technically, you're barred from linking to the site -- which would seem to defeat the purpose of providing more information.

It's not exactly ready for prime time. The data loads slowly -- if at all. And, at least in the case of Minnesota, it's not something we couldn't have gotten from the state.

For example:

Through the end of 2008, 8,819 people in Minnesota have been diagnosed with HIV; 2,976 have died.

Hennepin County has the most AIDS cases, not surprisingly. Several cases were diagnosed in greater Minnesota in 2008, however.

White people had the largest share of HIV diagnosis in 2008. The infection rate increased for white men in 2008, but dropped for African American and Hispanic men.
The rate increased for white and African American women.

The primary mode of exposure for males continues to be male-to-male sex (MSM) while for females the predominant mode of exposure is heterosexual sex.

Nationwide, New York and California have the highest concentrations of HIV/AIDS, which isn't new. However, parts of the South appear especially hard-hit by the virus, the Associated Press reported today. More than half the 48 counties with the highest rates of the AIDS-causing infection were in Georgia.

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Wisconsin's safety net

Posted at 1:18 PM on June 16, 2009 by Bob Collins (0 Comments)
Filed under: Health

Gov. Tim Pawlenty is fond of comparing Minnesota's social service programs with neighboring states -- usually Wisconsin -- to show that the state is overly generous.

Today, he is expected to announce further cuts in health care coverage for the poor. Ironically, it comes at the same time Wisconsin is expanding its state subsidized health care plan to cover adults with no children.

Starting yesterday, the state began enrolling adults with family income at or below 200% of the federal poverty level guidelines ($1,805 for a single person and $2,428.33 for a married couple) into its Badgercare program.

Under the plan, residents must not have any access to insurance from an employer, and must not be gettingMedicaid or Medicare.

In Minnesota, adults without children can enroll in MinnesotaCare under the General Assistance Medical Care program (GAMC).

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Live-blogging: Single-payer health

Posted at 9:02 AM on June 16, 2009 by Bob Collins (19 Comments)
Filed under: Health

I generally find discussions about health care to be endless and unenlightening. So why am I live-blogging today's Midmorning discussion about the future of a single-payer health plan proposals? Because today the game changes for health care when thousands of Minnesotans are thrown under the bus through Gov. Pawlenty's unallotment plan for balancing the state budget. And thousands more will lose their health care as they continue to lose their jobs. Health care in tough times is a different beast than health care when times are good.

You can listen to today's show here. I hope you'll share your stories.

Guests: David Himmelstein, primary care doctor and co-founder of Physicians for a National Health Program. He's also associate professor of medicine at Harvard University.

Thomas Miller, resident fellow at the American Enterprise Institute. He was former senior health economist for Congress' Joint Economic Committee.

9:09 a.m. - Kerri just promoted a July 9 event in the UBS Forum on health care. However her instructions won't work. It's not listed on the MPR page. I'll try to get that fixed.

9:11 a.m. - Hillmelstein says the Canadian system has only a few people in a hospital for sending out bills. Back in Boston, a local hospital had 350 people doing the same task. "Each doctors office has to have the clinical staff to fight with the insurance companies," he said. He says $400 billion could be saved with single-payer.

9:13 a.m. - Miller says "going down a different trail doesn't deliver all those things that are promised." He says it'll just create a different bureaucracy. "Most of the problem is in how health care is delivered.... choices we make." We hear the choice thing all the time. What does that mean? Getting you to understand the cost more. If you had chest pains and the ambulance costs $900, would you be less likely to pay attention to the chest pains?

9:16 a.m. - Thirty-one cents of every health care dollar goes to bureaucracy, Himmelstein claims. Miller disagrees and cites this data. There, by the way, you'll find a list of how fast health care costs are growing (thru 2004). In Minnesota -- 7.6%.

"He's absolutely lying" Himmelstein counters. Oh dear. This has potential to be YouTube comments section.

9:21 a.m. -- Caller: Sheila in St. Croix Falls. Would there be an option so that insurance are run as non-profits?

Miller: There've been different ways to propose that. Sen. Conrad of North Dakota reflected uneasiness among moderate Democrats who want to have a cooperative insurance plan through the government w/o heavy hands. Howard Dean rejected this idea.

Miller says we're not going to take profit out of the health-care system in this country. Himmelstein says the idea would help, but not that much.

9:25 a.m. - "Why is single payer a non-starter on Capitol Hill," Kerri Miller asks.

"Most doctors aren't going to be activists," Himmelstein says. "The majority of doctors are with us, but I think the reason it's not on the agenda in Washington is clear. There's an industry here that does nothing useful and is taking money from the American people -- the health insurance industry." The industry is a big campaign contributor, he says.

9:27 a.m. - OpenSecrets.org: Health Insurers Owe Policyholders, But Pay Congress Instead

9:29 a.m. - Obama referred to a 'public plan option' yesterday. Is that single-payer? "Same railroad track, different speeds, reflecting political realities," Miller says. "We've already overloaded the government with massive amounts of debt; You just can't absorb that much."

9:30 a.m. - Caller Tim from Duluth says Canadians come to the U.S. for their health care needs. "The Canadian insurance industry wants to portray that as true," Himmelstein says, "but it's not true." He says surveys of hospitals along the border -- including the Mayo Clinic -- and they found a few Canadians come across the border for care, but not many. The Mayo Clinic, by the way, actively recruits Canadian patients.

9:33 a.m. -- Here are the details of the July 9 event in the UBS Forum on health care. (h/t: Michael Wells)

9:35 a.m. - Recommended reading during the news break:

Kathleen Sibelius "This is not a trick"
Red State Single Women: Support Single Payer Healthcare, or Stay Virgins

9:38 a.m. - Caller John from Minneapolis. "The paperwork has gotten out of hand. We do less paperwork than the nursing staff but it increases all the time. I've yet to take care of a disgruntled Canadian patient." (He works for HealthEast)

Tom Miller says "I don't want to make up numbers." He gives his email address: tmiller@aei.org and says he'll email information comparing the two systems. "There's not a gigantic pile of money (through cutting waste) that's going to solve all of our problems."

9:41 a.m. - An online commenter says he/she worries that a single-payer plan would operate "like the DMV," slow and inefficient with poor service. "That's what we have now," Himmelstein counters.

9:42 a.m. - Doctors weigh in on health care plan as outlined by President Obama.

9:47 a.m. Caller Henry in Owatonna: "I lived and practiced in Canada and I now practice in the U.S. When it (Canadian system) first started, I thought I'd gone to heaven. 100% were insured and it made no difference to how I related to patients. After about 15 years, the government found the plan was too expensive for them and the government started budgeting hospitals the way you do school districts... They would give a hospital administrator $100 million to run the hospital for a year. To get the cost down, the administrator finds things that don't cost much -- my mother had a stroke and spent 9 months in the hospital. Here in Owatonna, they'd have spent a week."

9:48 a.m. - "We spend $8,000 per person, they spend $4,000 per person and they deliver better care," Himmelstein says. He says for whatever money is spent, a Canadian-style plan gets you better care.

9:52 a.m. - Would it make sense to try it on a state level? No, says Miller. There are three barriers: "Politics, economics, compulsion," he says.

Himmelstein says there should be an option to buy supplemental coverage over a state or federal single-payer plan. "You can't make the system run with private insurers in the middle of it," he says.

9:55 a.m. - Online comment from Eagan:

I keep excellent health and pay $600 a month premium and my employer pays atleast that much towards my health care. Literally I dread the occassions to visit a doctor. As much as I can, I keep fit by good eating habits and exercise routine.

I feel sorry for those people who donot have health insurance and my heart goes out to those who file for bankruptcy because of health care costs.

Medicine in USA is treated as money making machine for business and not as keeping healthy citizens and treating deceases. Now the entities who fear loss of their profits are fighting tooth and nail to protect, all the in the name of free choice. Only people waking upto this reality and actively participating in the debate will make a difference.

9:56 a.m. - Miller and Himmelstein debate whether one of them is lying. Welcome to TV cable talk show.

9:58 a.m. - I'm not sure anything much has been accomplished. This remains a hot-button issue, of course. BTW, here's an interesting blog post on NPR Check on how the issue was covered recently.

// end of live blog

==> An additional blog post with more information can be found here.

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What's the health care solution?

Posted at 8:09 PM on June 15, 2009 by Bob Collins (4 Comments)
Filed under: Health

President Obama heard the boos from doctors on Monday when he said he wouldn't support limits on jury awards in malpractice cases. The president spoke to the American Medical Association in Chicago (See transcript), warning doctors that if something isn't done about health care, the country might go the way of GM.

But at the same time, he seemed to allay fears of a big upheaval.

"If you like your health care plan, you will be able to keep your health care plan. Period. No one will take it away. No matter what," he said.

"What's the 'reform' about simply allowing you to keep your present plan as is?" ABC's medical editor, Dr. Tim Johnson, wrote in an online column.

"Obama wants single payer, government controlled and operated. He is a facist (sic) who will stop at nothing but total control," a commenter wrote.

About that single-payer stuff. We heard from Doug Miron, of Solway, Minn., in advance of a show Kerri Miller is doing Tuesday on the subject.

We, as a young family, lived in Canada from 1970-1979. Before then, I grew up in Conn. from '41. After that, we lived in Brookings, SD until '99, and have lived here near Bemidji since 2000. I have 60 years experience with American medicine and 9 years with the Canadian system.

Right off, let me say that we much prefer the Canadian system. It is simpler for everybody involved. The medical service is as good as anything we found in the U.S. The main cost control is that the provincial governments negotiate the prices with the physicians. In neither Clinton's effort nor the present effort aimed at real cost control through negotiation of prices charged by the providers.

I have heard on NPR that some rich opponent of single-payer coverage is going around the world collecting horror stories for commercials against it. On the one hand, I think somebody should check the facts if these commercials hit the air. On the other hand, I think supporters ought to make horror-story commercials about our system. The other day we heard stories about farmers and rural workers who either couldn't afford medical insurance or were one serious illness away from bankruptcy. My wife, Molly, remarked that this would be a strange conversation to a Canadian. In the past, we've heard stories about indigent patients who show up at places that don't want to give free medical treatment and are trucked off and dumped at a county hospital or a free clinic.

Of my own experiences, I think the most damning was one in the mid '70s. We were visiting Molly's sister on her dairy farm in upstate New York. Our middle son, then a crawling baby, sustained a head injury. I held him to me while we all piled into cars and drove to the Ogdensburg Hospital. I walked in with blood all over my shirt holding the baby and the first thing said to me was something to the effect that we need to do the financial paperwork. I growled "Fix the baby first, then we'll talk about paperwork." They stabilized him and we were sent to a hospital near Watertown, where they could really deal with the injury. Luckily, while his skull was penetrated, his brain sheath was not.

Opponents of the plan now in Congress say that the public insurance component is a step toward socialized medicine. I hope it passes and they are right.

Midmorning will, indeed, tackle the subject at 9 a.m. on Tuesday. I'll live-blog it here.

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Inside the world of mental health

Posted at 7:14 AM on June 13, 2009 by Bob Collins (1 Comments)
Filed under: Health

The Mental Health America media awards were announced last night. The pieces that won are worth looking at.

PBS won for Depression: Out of the Shadows, which was produced for WGBH in Boston and Twin Cities Public Television in Minnesota. Particularly compelling is the Faces of Depression section of the Web site.

National Public Radio won for a two-part series -- Two Families Grapple with Sons' Gender Preferences -- which shows how two psychologists can have two entirely different views of the same symptoms.

And Newsweek magazine won for Growing Up Bipolar: Max's World.

Max Blake was 7 the first time he tried to kill himself. He wrote a four-page will bequeathing his toys to his friends and jumped out his ground-floor bedroom window, falling six feet into his backyard, bruised but in one piece. Children don't really know what death is, as the last page of Max's will made clear: "If I'm still alive when I have grandchildren," it began. But they know what unhappiness is and what it means to suffer.

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Honor amid the gathering gloom

Posted at 2:10 PM on May 19, 2009 by Bob Collins (1 Comments)
Filed under: Health, Politics

A ceremony to honor emergency medical services personnel couldn't escape the long shadows cast by the nearby Capitol and the looming gubernatorial race today.

On the former helipad of Regions Hospital in St. Paul, Mayor Chris Coleman, a possible gubernatorial candidate, said, "We all need to stand up... to protect people who don't have the ability to provide for themselves," referring to Gov. Pawlenty's promise to cut medical care for the poor and mentally ill. "Let's not lose what we have here," he said outside a new wing of the trauma hospital.

Hospitals have started -- or are expected to start -- laying off people in anticipation of the cuts. "I'm humbled in light of what all of you are facing in the next few months," Rep. Paul Thissen, DFL-Minneapolis, (on the right in the photo below) told the crowd of mostly hospital employees. He has announced plans to run for governor.

Sen. Tom Bakk, DFL-Cook, (on the left in the photo above) who is also a candidate for governor, claimed some victory in the tax bill sent to Gov. Pawlenty; a provision that extends the ability of communities to increase the property tax for emergency medical services. "It was one line in a 300 page tax bill," he said.

By the time the ceremony got around to the people who provide those services, however, most of the politicians had disappeared.

While the Capitol's eight-month summer vacation is underway, the EMS people have gone back to work, stopping long enough for a rare moment in the spotlight.

Moses Alejado, Scott Swenson, Tony Vanneli, and Michael McGaene - St. Paul's Medic 23 C Shift unit -- responded when Mike Popovich felt his chest tighten during a post-bike-ride shower. They treated him, and took him to Regions, where the cardiac team performed an angioplasty. It took all of 31 minutes.

"There was a time, there, that I thought I might, perhaps, die," Popovich told them today, shortly before asking them to sign a picture he took of them.

A helicopter medical team was also honored for rescuing a young girl in Baldwin, Wisconsin.

And representatives of Hennepin County Medical Center EMS, Allina Transportration, North Memorial Hospital, Lakes Region EMS and Kannebec County EMS were acknowledged for their works at the I-35W bridge collapse.

"In one hour and 35 minutes, they had cleared all four sections of the bridge and treated and transferred over 50 patients," Minneapolis Fire Chief Alex Jackson said. "By the time the national media flew in to see the rescue, it was over."

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Taking women's heart attacks seriously

Posted at 1:56 PM on May 18, 2009 by Bob Collins (1 Comments)
Filed under: Health

Emergency medical personnel don't take women seriously. That's the takeaway from a University of Pennsylvania study released today that found no differences in the time of EMS care given to African Americans and white patients, but found women don't get the same medical care when exhibiting signs of heart attacks.

The researchers looked at whether patients got aspirin and nitroglycerin -- two immediate treatments for chest pain, and whether they were put on heart monitors and had IV lines put in while enroute to the hospital.

"Results showed that women were significantly less likely than men to receive aspirin while in the care of EMS - 24 percent of them were given the drug, compared to 32 percent of men," according to a report.

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Is it time to end the war on drugs?

Posted at 10:56 AM on May 14, 2009 by Bob Collins (4 Comments)
Filed under: Crime and Justice, Health

The White House's "czar" on drugs has proposed an end to the "war on drugs."

Gil Kerlikowske, a former police chief in Seattle, suggests the Obama administration will pursue a policy of treatment rather than incarceration. He doesn't have the power to enact such a change; he'll have to work with a Congress that doesn't much cotton to running against a barrage of "soft on crime" opposition ads.

It's a gamble, obviously. Appearing on Daily Show last night, Pakistan's ambassador to the United States, Husain Haqqani, noted that the evils perpetrated by the Taliban, come from the fruit of the poppy -- heroin.

The Daily Show With Jon Stewart	M - Th 11p / 10c
Husain Haqqani
thedailyshow.com
Daily Show Full Episodes Economic Crisis Political Humor

There is a cost to this, documented by the War on Drugs Clock Web site. Nearly two million are arrested on drug violations a year. But many people argue the war has been lost. Is it possible to eliminate a demand only through treatment? Discuss.

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Live chat: What's right, what's wrong when biking?

Posted at 1:06 PM on May 14, 2009 by Bob Collins (6 Comments)
Filed under: Bridges and roads, Health, Life, Sports

Today, of course, is Bike to Work Day. If you have any pictures to share, I'd love to pass them along during the chat. Send them to me at bcollins@mpr.org.

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The legacy of Chad Green

Posted at 1:12 PM on May 8, 2009 by Bob Collins (4 Comments)
Filed under: Crime and Justice, Health

I won't wade too deeply into the story of the Sleepy Eye couple who want the right to have their son's cancer treated as they see fit, other than to point out that the story mirrors one of the landmark cases pitting a family with religious convictions, a child with cancer, and a government that sees things differently.

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Are journalists class clowns on swine flu coverage?

Posted at 3:27 PM on May 6, 2009 by Bob Collins (10 Comments)
Filed under: Health, Media

One of the harshest criticisms about coverage of the swine flu comes today from a journalist. Stacey Woelfel, the chair of the Radio Television News Directors Association, calls journalists "class clowns" for their coverage.

Now, let me get it on the record here that I think there is some news value to this story. Any time there is a communicable disease on the loose that can make the sufferer uncomfortable for a time, it's worth a report or two. Since death is rare (there's only been one in the entire United States so far), it's not like this is as serious as a major foodborne illness like Hepatitis A. Remember the outbreak in Pennsylvania in 2003 when a Chi Chi's served some bad green onions. Six hundred fifty people got sick and four people died--all from one bad batch of green onions in one city. Compare that to the 226 cases and 1 death we have as I write this. The green onion/hepatitis story was a big one about a threat than anyone could face in the grocery store or restaurant. The swine flu story just isn't. Note this sentence from the CDC website on the swine flu: "It is expected that most people will recover without needing medical care." That's right. If you get swine flu, you probably don't even have to go to the doctor to get it looked at. It's a virus. It has to run its course. Only those in special at-risk categories even need to worry about it. So why all the coverage?

Why all the coverage? It could be, perhaps, because the characteristics of the flu that Woelfel describes as fact, have only appeared to be fact in the last day or so, and that quite often coverage of the flu involved relaying the comments of the experts who were trying to figure out what was going on.

While Woelfel says "the swine flu story just isn't," no responsible journalist could make that declaration a week ago when the nature of the strain hadn't even been determined yet. It was only Tuesday that officials announced, for example, the flu is not as bad as first thought. So saying the story was worth only one or two mentions stretches credibility somewhat.

Woelfel says death is rare. Last week, the people who were telling us the flu story is not a story because 36,000 people die from the flu each year, this week are saying it's not a story because death is rare. You can't have it both ways.

To be clear, there's been some really terrible coverage. But critics are being sweeping in their condemnation by not naming specific journalists or news organizations they allege are being unethical in their coverage, painting all journalists with a broad brush. Most ethical journalists -- and that's the majority -- have done nothing more than what good journalists do: tell you what is known and what isn't.

On National Public Radio's Morning Edition on Tuesday, Gary Schwitzer, the University of Minnesota School of Journalism and Mass Communications professor who writes the Health News Blog (and who called my attention to the RTNDA article via his blog), said "When you start fear mongering in all of your messages on air and on your Web site, I don't think we're serving the public in the best way." No argument there.

The story on NPR also criticized CNN reporter John Roberts, for asking the question:

"Is this the killer virus that we've all been hearing about. Is it just a threat? Is it like 1986 when we had a small outbreak, or is it like 1918 when 20 million people died worldwide?"

With the benefit of a week since the story broke, that might be low-hanging fruit for media critics, but it ignores an important point: There's nothing wrong with asking a question if the answer to it is something we want -- if not, need -- to know. What offended sensibilities was any following speculation that pretended to have an answer different than the one the experts were offering.

While I give CNN a pass on the question, it's hard to argue with criticism of the network. When I asked him about what TV outlets he considered "class clowns" Schwitzer cited CNN's "Bracing For the Worst" and "Outbreak of Fear" graphics. Good examples.

But when you ask critics who level allegations on an entire industry for specifics -- in this case the media -- they almost always cite CNN or Fox or a major TV network. The problem with that, as I mentioned yesterday, is that there's much more to journalism than CNN or Fox or a major TV network, a fact that usually surprises people who work at CNN, Fox, or a major TV network.

"If only RTNDA and its chairman and its website and its terrific code of ethics seemed to make any difference with its members!" Schwitzer wrote on his blog post today. He comes by his expertise honestly, he once headed CNN's medical unit.

But he hasn't watched any of the coverage with which he disagrees, he confirmed for me in an e-mail this afternoon. "I still haven't watched one minute of TV coverage. All the examples I gave you were things I read about from newspaper TV columnists across the country like Howard Kurtz, James Rainey, David Zurawik, Al Tompkins and others. I have no reason to question the accuracy of their accounts of the specific instances they've written about."

It's a pity all of them have chosen to ignore some of the solid reporting on the story.

(Photo: Getty Images)

update 9:13 p.m. - The RTNDA chair who said TV reporters are "class clowns" and who said the flu story is a story that isn't, is news director of KOMU TV in Columbia, Missouri. Let's check and see what the top story on the station's Web site is this evening:

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The other side of the story

Posted at 10:49 AM on May 5, 2009 by Bob Collins (1 Comments)
Filed under: Health

Testifying on the flu-that-must-not-be-named at the Capitol today In a Morning Edition interview today, former state epidemiologist Mike Osterholm, also one of the premier experts in the country on the subject of pandemics, provided a real glimpse into the workings of the major American news media:

"I actually had a reporter from a major media venue on Thursday of last week interview me about was the government doing enough, quickly enough, you know had they failed to act in this very important public health problem? And yesterday called me and now is doing a story on did the government hype it. The story line went that quickly from 'they didn't act fast enough' to 'now they hyped it.'"

Some things can mutate faster than the flu.

Unfortunately, that one reporter -- probably from CNN or Fox -- becomes "the poster child" for "the media," and paints an unfortunate picture that ignores the work of hundreds of well-informed, calm, and ethical journalists who have worked tirelessly on the subject. And, yeah, I'm talking about MPR's Lorna Benson, for one. Her appearance with Tom Crann a week ago, was nothing short of magnificent.

Media anecdotes provide great sound bites, but they do as much damage as the approach the journalist in question is taking and undermines legitimate efforts to inform you. Why should you trust any journalist?

Somewhat related to this, Mark Henderson, the science editor of The Times (London), wrote today that there's still plenty of reason to take the outbreak seriously:

Most health scares are indeed groundless, and some, such as MMR, have caused grave damage to public health. Swine flu, however, is not one of them. It is a threat that must be taken extremely seriously, even if the death toll does not rise sharply in the next few weeks.

While scientists are describing swine flu as a mild strain, this terminology is relative. There is no such thing as mild flu -- it is always a serious infection that can be life-threatening. The danger from this particular virus is especially acute because it is new: our immune systems are naive to it, and this raises the likelihood that it will infect a very large number of people.

There is also no guarantee that this virus will continue to be comparatively benign. It is a fact of life that flu mutates fast, and there is every possibility that H1N1 will become more virulent, or resistant to antiviral drugs. The 1918-19 Spanish flu began as a mild virus in the northern hemisphere spring. It returned with a vengeance in the winter, bearing a mutation that enabled it to kill 50 million. If swine flu disappears over the summer, we can expect it back when the weather gets colder and wetter. It might well have turned nastier by then.

But, overall, this remains a no-win situation for health authorities. There are too many agendas in play to expect otherwise.

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The myth of the health care access fund

Posted at 5:14 PM on May 4, 2009 by Bob Collins (5 Comments)
Filed under: Health, Politics

At the Capitol today, some health care advocates pushed for a higher "provider tax" to avoid health care cuts proposed by Gov. Tim Pawlenty.

The 2 percent tax -- known as a "sick tax" in health care provider circles -- is part of the funding mechanism for the Health Care Access Fund, which also uses premiums paid by enrollees of MinnesotaCare, the state-subsidized health care plan for low-income Minnesotans. The tax is levied on doctors, dentists, and other health care providers.

"MinnesotaCare is an excellent program providing coverage for the working poor in Minnesota and if it requires some additional tax on health care providers to keep those services in place, our members as a whole are willing to step forward and do that," said Lawrence Massa with the Minnesota Hospitals Association.

If you didn't know any better, you'd think the HCAF had run out of money, so the governor is imposing the cuts. You'd be wrong.

The Health Care Access Fund is one of the few dedicated taxes in Minnesota that actually works for the limited goal that spawned it. It works so well, in fact, that it often runs a surplus, which is why the governor and Legislature have regularly used it as a "slush fund" to balance shortfalls in the state budget, over the objection of the health care providers.

Last year, for example, the governor proposed pulling $149 million from the fund. Over his term, he's diverted more than $400 million from the fund.

Writing in the Spokesman Recorder last month, Rep. Bobby Joe Champion criticized the governor for proposing the HCAF money go directly into the General Fund.

The governor wants to keep collecting the Provider Tax while diverting it away from the people it was created to help. That's on top of the hundreds of millions of dollars that his administration has already shifted out of the fund to balance previous deficits. Those shifts have resulted in fewer people able to access MinnesotaCare and other programs.

Such a move would have allowed Pawlenty to spend the health care tax on anything but health care, and avoid the annual attention of raiding the fund. Tax bills emerging in the House and Senate, however, did not include Pawlenty's plan.

The people Massa represents -- hospitals -- have a serious problem, to be sure. The Bemidji Pioneer's Brad Swenson admirably describes the health care mess (registration required), partially created by years of shifting money from areas for which it was intended.

The situation is the underpinning of the coming showdown between the governor and Legislature. But its core is simple.

1. Health care providers pay a tax to provide health insurance for low-income Minnesotans.
2. The fund that provides the insurance often runs a surplus.
3. The governor diverts the surplus -- and more -- to other uses and notes the spiraling cost of health care, while cutting reimbursements to hospitals who end up providing care to those who can't afford to pay for it.
4. Pressure builds to remove more people from health insurance coverage.
5. Proposals surface to increase the tax to provide health insurance for low-income Minnesotans, even though it ends up being used for something else.

The problem, of course, is exacerbated by the reality of the economy and the state budget which -- even if the health care fund were used for other things -- is still going to lead to major cuts in Minnesota health care.

Does anybody see a solution here?

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The flu picture

Posted at 2:31 PM on May 4, 2009 by Bob Collins (3 Comments)
Filed under: Health

Whether the fill-in-the-name-you-wish-to-use-here flu outbreak is overstated is a matter of some conjecture, but perhaps we can agree that attempts to graphically represent the outbreak generally fail miserably.

Take the government's PandemicFlu.gov Web site's map above. We're a red state now and it looks bad -- real bad. Severe, even. An epidemic, perhaps.

Reality: Minnesota has had but one confirmed case of the flu-that-must-not-be-named as of 11 this morning. In the great flu pandemic of 1918, it took only a week for the state to go from one confirmed case of the flu, to 1,000.

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The flu formerly known as swine

Posted at 3:02 PM on April 30, 2009 by Than Tibbetts (6 Comments)
Filed under: Health, Media, Politics

What's in a name?

We've moved beyond the "panic" stories to the politically tinged debates over what to call that nasty virus traversing the globe.

World Health Organization officials today begin referring to the virus formerly known as swine flu as "influenza A (H1N1)." (Though the WHO has shown it isn't above industry meddling.)

The Center for Disease Control and Prevention has this note posted on one of its flu pages:

This is a rapidly evolving situation and current guidance and other web content may contain variations in how this new H1N1 virus of swine origin is referred to.

Over the coming days and weeks, these inconsistencies will be addressed, but in the interests of meeting the agency's response goals, all guidance will remain posted and new guidance will continue to be issued.

But they might have trouble switching things up as they've been giving out cdc.gov/swineflu as the site for information.

The City of St. Paul just sent out a press release titled "Information available on H1N1 (swine) flu threat."

Then there's the World Organization for Animal Health which, so far, has the most novel approach:

No current information in influenza like animal disease in Mexico or the USA could support a link between human cases and possible animal cases including swine. The virus has not been isolated in animals to date. Therefore, it is not justified to name this disease swine influenza. In the past, many human influenza epidemics with animal origin have been named using geographic name, eg Spanish influenza or Asiatic influenza, thus it would be logical to call this disease "North-American influenza".

MPR received a letter from a pork producer representative that laid bare the industry's objections to calling it swine flu:

[Please] reference the present flu virus by its appropriate name, the 2009 N1H1 flu.

Referring to the present flu virus as "swine flu" is not only damaging to MN pork producers, but demonstrates an uneducated, reckless approach, which is undoubtedly uncharacteristic of MN Public Radio.

The negative connotations to swine, unfairly made and scientifically unsupported, affect consumer confidence and therefore have a significant negative impact on pork production.

There is scientific evidence that the virus is genetically connected to pigs, but you cannot get the flu by eating pork products. It's not like we're not calling it bacon flu, though. To be fair, when your industry is under sudden and near total onslaught, you have a right to be defensive.

When it comes down to it, the media, at least for now, will likely stick with swine flu.

Today on Talk of the Nation, host Neal Conan was asked by a caller why he was not using the term "correct" term of H1N1. Said Conan, "We call it swine flu because that's what people call it."

So... what do you call it?

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The changing flu landscape

Posted at 10:05 AM on April 29, 2009 by Than Tibbetts (0 Comments)
Filed under: Health, Media

What you knew yesterday about the swine flu might not be true today. Are you keeping up with the information fast enough? Have you passed on information that's incorrect?

Mexico's death toll appeared to be rapidly accelerating, some reports yesterday had put the total at more than 150. But...

Only 26 cases, including seven deaths, have been definitively confirmed to be swine flu, [Mexico Health Secretary Jose] Cordova said.

The virus is suspected in 159 deaths, and other reports suggest that some of these might be caused by unrelated respiratory ailments.

And then there's the big number, you know, of people who die from the flu every year.

U.S. officials stressed there is no need for panic, noting that flu outbreaks are quite common every year. The CDC estimates about 36,000 people in the U.S. alone died of flu-related causes each year, on average, in the 1990s.

Do the math, that's just shy of 100 a day.

We were also told yesterday to call it "H1N1" and not "swine flu," because "this really isn't swine flu," as Agriculture Secretary (and former Iowa governor) Tom Vilsack said. The name change was ostensibly because the virus had genetic components from humans, birds and swine, and not to assure the weary consumer that pork is safe. But...

The deadly H1N1 influenza virus that's fueling fears of a global pandemic is a hybrid of two common pig flu strains, scientists who have studied the disease told Wired.com Tuesday. Earlier reports called it a combination of pig, human and avian influenza strains.

"This is what we call a reassortment between two currently circulating pig flu viruses," said Andrew Rambaut, a University of Edinburgh viral geneticist. "Why it's emerged in humans is anyone's guess. It hasn't been seen before in pigs as far as I know."

Sorry, pork producers, you're probably just going to have to tough this one out. "Swine flu" is easier to say and understand than "H1N1."

So, to some it all up: Take caution, but don't panic. But you haven't been watching 24-hour news channels, right?

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Grilled

Posted at 1:40 PM on April 21, 2009 by Than Tibbetts (4 Comments)
Filed under: Health, Science

MPR's Lorna Benson reports on a new University of Minnesota study that shows eating charred or burned meat may increase your risk of pancreatic cancer by 60 percent.

Nearly four years ago (recognize the byline?) the same team showed an association between people who ate burned meats and a higher rate of pancreatic cancer, which is among the hardest cancers to detect and diagnose early and, as a result, treat successfully.

Now before we haul the Weber off to the dumpster and bang down the doors of the Food and Drug Administration with demands to start regulating barbecues, there's a simple solution for all you carnivorous News Cut readers.

As U of M researcher Kristin Anderson told me in 2005, "Just use common sense; slow down."

Which, by the way, are the two cardinal rules of barbecuing to begin with.

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Bedbugs

Posted at 11:29 AM on April 14, 2009 by Bob Collins (0 Comments)
Filed under: Health

The EPA is holding a two-day summit on bedbugs at a suburban Washington hotel that apparently didn't mind being associated with a talk about the critters. Bedbug infestations are on the rise across America.

If you don't mind the "ick factor", try out the Bedbug Registry, an online record of bedbug complaints. Enjoy reading the complaint against the Disneyworld Contemporary Resort.

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Weapons of mass mosquito destruction.

Posted at 5:54 PM on March 18, 2009 by Bob Collins (3 Comments)
Filed under: Health, Tech

Here's another bonus, courtesy of my fill-in work this week on Future Tense:

Picture this: Malaria-carrying mosquitoes are heading toward a village. A drone aircraft, armed with a laser weapon, blankets the village, killing the mosquitoes, sparing everything -- and everyone -- else.

Astrophysicist Jordin Kare has spent his career doing things many people consider far fetched. He hunted for supernova explosions with an automated telescope, and designed interstellar propulsion systems. Now, he and astrophysicist Lowell Wood -- they also worked on President Reagan's Star Wars initiative -- are working on building the laser weapon the mosquitoes.

Life imitates art. It was just a few years ago when this spoof went viral:

But this is no joke. It's serious business with serious Bill Gates-like money behind it.

I know what you're thinking. "Give me one of those babies and a warm summer night." And while it's true that Jordin Kare says he wouldn't mind seeing his project be used for that, it's not the priority.

Here's an extended interview with Jordin Kare. Listen

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You're 22? It's all downhill from here, kid

Posted at 11:09 AM on March 16, 2009 by Bob Collins (3 Comments)
Filed under: Health

When does old age begin? Around 27, according to some new research out of the University of Virginia. Professor Timothy Salthouse has published the results of a seven-year study into aging, asking the study's participants to remember words and do puzzles etc. He found the age of optimum performance is 22. And the age at which things begin to fall apart is 27.

This might explain why my 23-year-old son received an AARP membership solicitation last week. Welcome to the club, old timer!

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Vets: Who pays for their treatment?

Posted at 3:21 PM on March 11, 2009 by Bob Collins (6 Comments)
Filed under: Health, Politics

Veterans who are injured in battle would be required to pay for treatment of their injuries with private insurance under a plan being considered by the Obama administration, CNN reports. It says the idea has been confirmed by Veterans Affairs Secretary Eric Shinseki. Currently, vets' insurance companies are billed when they're treated for non-service-related injuries and illnesses.

It's also a plan that's dead on arrival if the president decides to propose it, according to some influential lawmakers and , as you might expect, veterans groups are vehemently opposed to the plan (See a letter sent to the president).

Even the usually Obama-friendly Talking Points Memo criticizes the plan, saying it would put Obama further to the right of John McCain.

The idea, not surprisingly, never came up during the campaign, particularly at a stop in Fargo last year when Obama outlined his veterans' policy. "Caring for our veterans," he said, "is one thing that we can still get right," and promised to "fully fund VA health care."

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Should marijuana be legalized in Minnesota?

Posted at 9:39 AM on March 11, 2009 by Bob Collins (25 Comments)
Filed under: Crime and Justice, Health

Should Minnesota legalize marijuana for medicinal uses? The issue is steaming along at the Capitol. On Tuesday, it passed through a Senate committee. Today, the bill got an OK from a House committee.

"I spent the last eight years in the nursing home with my aunt and my mother, also at the end of my fathers life, I watched them in a lot of pain and taking a lot of pills," Rep. Tom Rukavina, DFL-Virginia, said. He's sponsoring the proposed legislation. "I just think there's a better way for some folks to address their pain and medical marijuana is legal in 13 other states and there's overwhelming public support."

Like many bills that make annual appearances at the Capitol, the arguments on both sides were predictable, but no less emotional with every story.

Kathy Rippentrop, whose mother was diagnosed with colon cancer, described her mother's slow death. "Mom tolerated the first round of chemo, but the pills to control vomiting cost $100 each. Mom was withering away to nothing with no appetite."

Her father, a recovering alcoholic and drug user, got some marijuana from a friend. "The only miracle drug for cancer is marijuana," she said. "My father will tell you how ironic it is that the government is concerned about the pain of a murderer, but makes the only cancer drug that reduces pain against the law."

Joni Whiting told the story of her 26-year-old-daughter, Stephanie, who was diagnosed with skin cancer and died six years ago. "They cut her face off one inch at a time until there was nothing left," she said. Despite being told by a doctor that smoking marijuana would ease her pain, neither Whiting or her daughter could break the law. By the time she died, Whiting said, her daughter was taking 50-60 Oxycontin pills a day.

"The fear of being caught was significant," she said of her and her daughter's initial decision. That changed when someone left a bag of marijuana on the front step. By the end, Whiting said through tears, her daughter couldn't "stand the pain of us touching her."

"To threaten the sick and dying with jail is unconscionable," she told the House Civil Justice Committee. "What would you have done if you were in my shoes. What price would you be willing to pay to relieve the pain of a loved one. I was the one who listened to her scream in pain."

But Michael Campion, the state's commissioner of public safety defended the state's position on legalization of marijuana. "There is an absence of any empirical data that this legislation is going to do what it intends to do; there's a lot of anecdotal stories but the AMA and the FDA have not endorsed the smoking of marijuana," he said. "It's against federal law and it puts the federal justice system in conflict with our state partners."

An ex-drug dealer testified briefly that if the law is enacted, "people will kick the door in to get those plants in." Under the bill, people would be allowed to grow 12 plants of marijuana.

Another man, Jim Fahiz, testified he blew a hockey scholarship at the University of Minnesota because he smoked marijuana. "I've known thousands of drug addicts," he said, "and every one of them started with marijuana."

The bill passed the committee on a voice vote without opposition.

A similar bill passed through committees in the House last year but never came up for a vote on the House floor.

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An HIV blocker discovered?

Posted at 12:00 PM on March 4, 2009 by Bob Collins (2 Comments)
Filed under: Health

Was the cure for the virus that causes AIDS really under our noses all this time?

The University of Minnesota researchers found that the cheap ingredient, used in ice cream, cosmetics and breast milk appears to protect female monkeys against the primate form of HIV.

According to MPR's Lorna Benson, "U researchers say that GML temporarily shuts down the cells that tell the body's immune system to ramp up. That's good when dealing with HIV because the virus uses the immune system to spread itself throughout the body."

According to the latest report from the Minnesota Department of Health, over 8,000 people in Minnesota have been diagnosed with HIV infection. Nearly 3,000 have died.

It's important to point out that the researchers are not saying that glycerol monolaurate (GML) prevents the transmission of HIV in humans, but the possibility that it does has got the science world buzzing this afternoon.

The findings are published in this week's edition of the journal Nature. The magazine's podcast has more on the findings:



Hopes for an anti-HIV vaccine have been rising -- and falling -- for a few decades now.

One of the big problems with HIV is it mutates quickly. In Houston, doctors have found a section of HIV's structure that doesn't change. They're racing to see if they can develop a vaccine for HIV, although when their work was publicized last August, it was thought a vaccine is still at least five years away.

Last month, it was revealed that doctors in Germany gave a bone marrow transplant to an American who had taken "antiretroviral" drugs, and hasn't had to take them since. But the treatment costs tens of thousands of dollars.

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Step away from the screen

Posted at 4:20 PM on February 25, 2009 by Bob Collins (3 Comments)
Filed under: Health

It doesn't take much to get the social networking sites going but they're abuzz today over the comments of Lady Greenfield, a neuroscientist in the UK who is theorizing that relationships online -- via Twitter and Facebook, for example -- are doing things to our brains that we probably don't want done.

On Tuesday she said social networking sites remind her of the way that "small babies need constant reassurance that they exist, according to the NY Times.

Asked to explain further, she suggested it may even have something to do with ADHD and autism.

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Why insured people aren't paying their medical bills

Posted at 2:32 PM on February 20, 2009 by Bob Collins (2 Comments)
Filed under: Health

Last week I blogged about an increase in the number of people with insurance who aren't paying medical bills. At North Memorial, for example, $1 million in unpaid bills by people with insurance in 2007 swelled to $8 million in 2008.

So MPR's Michael Caputo, of the Public Insight Network, solicited your stories about this factoid.

One of the things he found is that a lot of unpaid bills are the result of battles that consumers are waging with insurance companies, health care providers, or the go-betweens that are supposed to prevent bureaucratic nightmares with insurance companies and health care providers.

Liz Shatek of Cambridge tells the story of not having nearly enough money to pay for health costs, including those around the birth of a child. So she was counseled by her insurance provider to use a financial services provider - MedCredit - that gives loans to patients who can't afford the bill.

"Anyway, once we started questioning whether insurance had covered the appropriate amounts, we started getting caught in between the MedCredit company and the insurance company. Both would tell us we needed to talk to the other first, no one seemed able to get at the information we were asking for and I wanted to pull my hair out! I was trying to take care of a new baby in between insurance phone calls and waiting on hold for hours (our phone bill was astronomical for a few months). Eventually we just used tax money to pay off the last of the balance with MedCredit and stopped worrying about whether the insurance company had paid for what they said they would."

Find some of Michael's stories here. He's still looking for yours.

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Hospitals in a squeeze

Posted at 5:03 PM on February 12, 2009 by Bob Collins (2 Comments)
Filed under: Economy, Health

It's no secret that hospitals in the area are hurting. During the economic downturn, people are putting off elective surgery. The state has cut $73 million in funding for health care and human services. And with people losing their jobs and health care coverage, they're showing up in emergency rooms for free care, which the hospitals have to absorb.

Even people with health insurance are costing the hospitals money, however. I was checking out a rumor that North Memorial had eliminated more nursing positions (they hadn't) today, when Robert Prevost, a spokesman for the hospital, told me about the rapidly rising rate of delinquent accounts by people with health insurance.

In 2007, he said, the hospital had over $1 million in unpaid bills by people who had health insurance coverage. In 2008, that number has risen to $8 million.

No interest is added to medical bills, Prevost said, so people who have insurance but may be having financial difficulty, are putting medical bills last in line to be paid. And quite often they're not paid at all.

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Peanut butter widget

Posted at 10:18 AM on February 2, 2009 by Bob Collins (1 Comments)
Filed under: Health

I'm not sure how many Web sites are out there that would be interested in posting a widget about the peanut butter salmonella recall, but you have to give the Food and Drug Administration credit for trying new ways to get information out.



Today, however, President Obama put the FDA in his crosshairs. "I think that the FDA has not been able to catch some of these things as quickly as I expect them to catch," Obama said in an interview. "And so we're gonna be doing a complete review of FDA operations."

(h/t: Ross Holtan)

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Hope for MS patients

Posted at 3:18 PM on January 30, 2009 by Bob Collins (1 Comments)
Filed under: Health, Science

Over the last few months, I've neglected the science beat a bit, but a story out today cannot be ignored.

Scientists have reversed the effects of Multiple Sclerosis... they think.

The research comes from Northwestern, according to the Chicago Sun-Times:

The successful use of stem cells to reboot MS patients' immune systems could be a big step forward in the treatment of the disease, in which the immune system attacks the protective covering of nerve fibers in the brain and spinal cord -- the myelin sheath.

Still, Burt cautioned that his results -- being published online today by the British medical journal the Lancet Neurology -- need to be duplicated in a broader study. "It's encouraging, but, honestly, it's unproven until you have a randomized trial that proves it," he said.

One of the people in the study was Barry Goudy, 51, of Michigan who now says, "Life is very good. I have no restraints anymore because of MS."

It's only coincidental that the news came on the same day that a company in Toronto announced that its drug to treat MS doesn't work.

Meanwhile, Wendy Booker isn't waiting around. She plans to climb Mt. Everest this spring, becoming the first person with MS to climb the tallest peak on each continent.

"I wanted to show what life with MS is like," she says. "It's a struggle. You can't always get to the top."

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Pandemic plans

Posted at 10:45 AM on January 30, 2009 by Bob Collins (3 Comments)
Filed under: Health

The state's Web site that outlines the ethical considerations of a pandemic flu has now gone live.

The report, called For the Good of Us All: Ethically Rationing Health Resources in Minnesota in a Severe Influenza Pandemic, is available here.

Among the items in it:

Thirty percent of Minnesotans will get the flu during the pandemic.

Minnesota will have enough antivirals to treat 21 percent of Minnesotans. It the duration or dosage is doubled, it'll be 10 percent.

The state has stockpiled 2.4 million respirators.

The notion of age-based rationing as the most controversial for the panel that devised the framework.

172,000 people will be hospitalized.

The pandemic will last two years.

Morgues and mortuary services will be overwhelmed.

The U.S. GDP will drop by around 5 percent.

The first goal is to make sure that no group suffers more deaths than another.

The panel rejected social value (race, gender, education, religion or citizenship),quality of life, duration of benefit (with the exception of persons who are imminently and irreversibly dying) and first-come, first-served as methods for rationing health care.

Suggested considerations for who gets resources in the event of rationing are: exposure to one of the earliest cases of influenza or to a contained outbreak;risk of exposure; risk of influenza-related mortality and serious morbidity; key role in supporting basic health care, public health, public safety or other critical functions; risk of transmitting influenza to persons at high risk of flu-related mortality; and possibly age.

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Who's the most important in a flu pandemic?

Posted at 3:32 PM on January 29, 2009 by Bob Collins (8 Comments)
Filed under: Health

Around 10 a.m. on Friday, you can go online and see the draft framework the Minnesota Department of Public Health is going to use to determine who gets "critical health care resources" in the event of a flu pandemic. It's more a matter of when, not if, a pandemic hits us, the Minnesota Department of Health says.

When it does, up to 30,000 Minnesotans may die.

Who should get first crack at life-saving vaccines, drugs, or equipment such as antiviral masks? That's what the guidelines will reveal. For example, health care workers would seem to be first in line for vaccine, but there won't be enough vaccine, so which health care workers should get it first?

One of the things the federal government has advised states is to be prepared for strong suspicions and distrust. Guidelines also said "social worth" should be considered.

In ordinary circumstances, the distribution criterion, 'to each according to his or her social worth,' is not morally acceptable. However, in planning for a pandemic where the primary objective is to preserve the function of society, it is necessary to identify certain individuals and groups of persons as 'key' to the preservation of society and to accord to them a high priority for the distribution of certain goods such as vaccines and antiviral drugs. Identification of key individuals for this purpose must be recognized for what it is: it is a social worth criterion and its use is justified in these limited circumstances. Care must be taken to avoid extension of the evaluation of social worth to other attributes that are not morally relevant.

Here's the Web site that will be active at 10 a.m. You'll be able to comment on the draft framework.

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On Campus: Facing roadblocks

Posted at 11:01 AM on January 29, 2009 by Bob Collins (2 Comments)
Filed under: Health, News Cut on Campus, Politics

MPR's Midday program continues the examination of Gov. Pawlenty's proposed budget cuts during its first hour today. University of Minnesota president Robert Bruininks and James McCormick, chancellor of the Minnesota State Colleges and Universities System are the guests.

Their view is how it looks from their offices. But the human face of the budget proposals can best be found at the micro-level.

Take Joe Neumayer, who I met yesterday during my visit to Minneapolis Community and Technical College. He says he "feels God's calling" to be a certified nursing assistant. He's also on General Assistance, and stands a chance of being caught up in the proposed cuts. The eligibility for General Assistance may be pared to the federal poverty level.

"You almost can't be working (to get help)," he said, which is a problem for him since the entire point of his going back to school and getting help is that he can work.

"I'm trying to get off it, but I have a problem where I start jobs and have to quit due to my depression, but I'm trying to overcome that," he said. "I'm trying to see doctors and psychiatrists. But I'm trying real hard out there; I'm pressing forward."

He's also concerned about whether higher education cuts will make it too difficult to get the training he needs to become a nurse assistant.

"You've got people who have mental illnesses that need this type of program. They have no choice," he said. "They can't go to work. They're also seeing psychiatrists and doctors. Then you have people taking advantage of the system. Those people need to be addressed. We can't have that go on. If they're going to do any cuts, they need to cut the people just coming into the program and look at what their mental illness is."

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The governor's budget

Posted at 2:10 PM on January 27, 2009 by Bob Collins (34 Comments)
Filed under: Economy, Health

The governor has unveiled his budget proposals to close the large state deficit. A couple of things stand out.

The governor is using money from the Health Care Access Fund, again. This is the tax on health care providers that funds the MinnesotaCare system. It usually runs a surplus. Doctors and providers hate the tax as it is, but they really hate it when the governor takes the money and uses it for things it wasn't intended to be used for.

The governor is reducing eligibility for Medical Assistance to 100% of the federal poverty level. Right now, that's $10,400 for a single person. $21,200 for a family of four.

He's providing less state reimbursement to hospitals and long-term care providers.

Adults without children will no longer be covered under MinnesotaCare. Who are these people? As has been mentioned elsewhere, they're quite often people with mental illnesses who need meds.

The repeals on MinnesotaCare are most interesting (at least to me). Said the governor:

Several enhancements to health care programs have been enacted in the last three years and are simply unaffordable in today's financial climate. The Governor's package repeals recent coverage expansions and premium reductions, some of which have yet to be implemented, in Medical Assistance (MA) and MinnesotaCare.

As indicated before, MinnesotaCare is funded by the Health Care Access Fund (the tax on providers). In recent years, however, the fund's surplus has been used to offset other areas.

The governor proposes merging the Health Care Access Fund with the General Fund. This is why so much budgeting is now being done through Constitutional Amendments. Taxes are raised for a specific purpose, and eventually, the money gets siphoned off for something entirely different, recreating the original need for the tax.

The governor replaces the 87 counties handling human services program with 15 regional entities.

The governor eliminates state funding of the Combative Sports Commission, and Target Center.

He cuts funding to the Arts Board by almost $3.5 million in FY2010 and almost twice that next year. This will be an interesting debate. Arts groups are included in the constitutional amendment voters approved last November that raised the sales tax to provide additional funding for outdoors and cultural programs. That funding was not originally meant to replace current state support.

He calls for an additional $90,000 in fees via the Barber/Cosmetology Examiners Board. (I nailed that one! See post earlier today). He also increases fees for dairy and food-handling inspections. Currently, it costs a farmer $45 for an inspection. Now, it will cost $100.

He doubles the fee for people who dispense hearing aids from $350 to $700 a year. Also included is a two-year $550 surcharge and a $1,000 exam fee (from $500).

He increases fees for hospitals and ambulatory care facilities to participate in the mandated program to report to the state whenever one of 28 serious health incidents occur. He proposes a $100 increase plus a $3 increase per bed.

He calls for a $45 increase in the fee to inspect swimming pools, citing the new law on drain covers at swimming pools.

He requires local governments to begin paying Well Program fees, including a fee of $50 for each annual monitoring well maintenance permit.

He proposes a 20% fee increase for beverage, food, and lodging licenses.

He does not reduce or delay payments to ethanol producers, something that state did during the last budget crisis.

He eliminates funding for restorative justice programs in the state. Here's an old MPR story on one such effort.

He proposes a 5% reduction in the governor's office budget and 5% in the Legislature's operating budget, and 5% for the Supreme Court, and Secretary of State, and several other agencies and offices.

He doubles fees for trailer parks and recreational camping areas.

He proposes a new $70 fee for background checks for adoptions.

He proposes delaying services to children with severe mental health issues for a year.

There are about a half-dozen MPR reporters working on the story. You can examine some of the budget documents here.

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The peanut butter chronicles

Posted at 8:15 AM on January 19, 2009 by Bob Collins (3 Comments)
Filed under: Health

Any minute now, perhaps, the peanut butter industry will file its request for some bailout money. It has to be reeling as health investigators from Minnesota and across the country continue to track the salmonella outbreak

We should emphasize Minnesota more than across the country there.

A Seattle Post Intelligencer blog writer takes note of that.

Seattle lawyer Bill Marler, the guru of the nation's food safety investigators, is spitting mad about the way the Food and Drug Administration failed to take any definitive action when the first case of peanut-butter spawned salmonella surfaced in Minnesota in September.

"What in the hell are they thinking?" Marler told me today. "The FDA knew there was a problem on Labor Day and they wait for inaugural day to do anything."

Marler says he just returned from Minnesota where the nationwide outbreak of 500 or so cases of illness and at least six deaths were first reported by Minnesota's top notch health detectives.

The peanut butter contamination has been traced to a plant in Georgia, and companies that don't use the plant's peanut butter are issuing claims of innocence. No matter, consumers mostly can't tell what peanut butter in what cookie or other snack came from one plant. Better to avoid it altogether, said the Food and Drug Administration on Sunday.

Because identification of products subject to recall is continuing, the FDA urges consumers to postpone eating commercially-prepared or manufactured peanut butter-containing products and institutionally-served peanut butter until further information becomes available about which products may be affected. Efforts to specifically identify those products are ongoing.

If you'd like to check your current stocks against the list of products that have been traced to the salmonella-contaminated plant, here's a list.

update - Via comments, the above list are product that contain peanut butter, not necessarily the bad peanut butter. A link to recalls is in comments.

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Bed bugs

Posted at 4:49 PM on January 15, 2009 by Bob Collins (4 Comments)
Filed under: Health

We don't have a shortage of things to worry about these days but just in case, here's a little number from Worthington: a bed bug infestation. A local motel had an infestation and the Daily Globe newspaper reported a private residence also had to be fumigated. Back in the day, our parents' greatest nightmare (other than that we wouldn't duck under our desks quickly enough when the nuclear bomb exploded over our town), was that we would be sent home with head lice. But at least the local newspaper didn't tell the rest of the town.

The description of a day in the life of a bed bug reads like a cheap sci-fi thriller:

Bedbugs are nocturnal feeders, meaning they come out at night and feed on human an animal hosts. They are similar to a mosquito in that they bite their host, suck blood, detach and then go back into hiding.

Bedbugs leave behind a bite mark on the host that may itch and cause skin irritations or lesions.

"Some will have bites that really itch," said Kloss.

The next night or a couple of nights later, the bedbugs return for another blood meal. The population grows as adults lay eggs that hatch into nymphs.

"The opportunities for bedbugs will only increase if they have human hosts," Kloss said.

Bedbugs can live dormant for up to six months without a human host.

Now comes the really worrisome news: Bed bugs are making a comeback because they've developed a resistance to poisons. Some experts say regular vacuuming take care of the problem, but many of us have developed a resistance to that.

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The peanut butter mystery

Posted at 11:29 AM on January 12, 2009 by Bob Collins (1 Comments)
Filed under: Health, Schools

On Friday night, the Minnesota Department of Public Health traced a salmonella outbreak to a peanut butter sold primarily to institutions such as nursing homes and schools.

Today, a press release from the the Minnesota Pubic Schools trumpets:

Minneapolis Public Schools not affected by King Nut peanut butter recall

And it takes the honor also for world's shortest press release:

MINNEAPOLIS - MPS Nutrition Services does not serve peanut butter. We are not affected by the King Nut peanut butter recall.

A sign of my age, however, is that I think the big news here is that Minneapolis public schools don't serve peanut butter. I'll bet they don't even have "mystery meat" anymore. The times have changed, you whippersnappers.

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Minnesota health agency cracks salmonella mystery

Posted at 6:55 PM on January 9, 2009 by Bob Collins (9 Comments)
Filed under: Health

When he was on MPR's Midday on Friday, former state epidemiologist Michael Osterholm said this about the Minnesota Department of Public Health investigation into a nationwide salmonella outbreak:

The first cases occurred in early October. This has been gaining a head of steam with most cases occurring in the last six weeks. This is a common strain of salmonella. We have the ability to fingerprint the organisms. It took time for the "fingerprints" to be obtained. It has increased in the number of states which tells us a lot about the product involved. It's probably a store-shelf product.

The cases in Minnesota are more recent nature. It's likely that the Minnesota Department of Public Health will be the one to crack it.

He got all but the store-shelf product part right. Late Thursday afternoon the department determined it was from peanut butter, that's delivered to hospitals, nursing homes, schools and other locations. But it's not available on the store shelf.

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Questions and answers about the salmonella outbreak and flu

Posted at 10:59 AM on January 9, 2009 by Bob Collins (6 Comments)
Filed under: Health, Science

Michael Osterholm, the former Minnesota state epidemiologist and now director of the , the University of Minnesota Center for Infectious Disease Research and Policy is on MPR's Midday (Listen here), discussion the nationwide salmonella outbreak.

I'm live-blogging the pertinent questions and answers. He's also talking about other issues facing health investigators. The other big health story today is the word that Tamiflu may not be effective on this year's strain.

Osterholm says there's actually three strains of flu that float around the world, one of which was an "escapee" from a Russian lab years ago.

Q: Why isn't Tamiflu working?
A: The strain changed in a way that makes it resistant to the flu. The good news is (a) the change may not stay. Next year's strain may lose the resistance, and (b) this year "we have a great match on the vaccine with the strain that's in Minnesota.

Q: Has the possibility of a pandemic or bird flu changed?
A: We're closer to a pandemic today than we were yesterday. When people say "if it were to happen it would've happened by now, H3N8 strain jumped from birds to horses in the 1960s and we have no idea why. The same strain then jumped to dogs and we're seeing problems with dogs. We know little about influenza.

Q: Why are we just hearing about the salmonella outbreak now?
A: The first cases occurred in early October. This has been gaining a head of steam with most cases occurring in the last six weeks. This is a common strain of salmonella. We have the ability to fingerprint the organisms. It took time for the "fingerprints" to be obtained. It has increased in the number of states which tells us a lot about the product involved. It's probably a store-shelf product.

The cases in Minnesota are more recent nature. It's likely that the Minnesota Department of Public Health will be the one to crack it.

Q: Has something changed in the food environment?
A: Even a loaf of Sara Lee bread, the ingredients are likely from 10 different countries. It's remarkably how safe food really is, given how much food we eat. The average person has two food-borne illnesses a year. But we have so many more processes than we had before.

Q: Is food illness more insidious?
A: Think of all the food that you don't cook. Even the things you do cook, there are things you don't cook adequately. Part of the problem is some contamination occurs in plants (such as deli meats) after the cooking process.

Q: When the CDC investigated the "tomato outbreak" (which turned out to be wrong), does the CDC get gunshy about publicizing an investigation?
A: You're right, but having been at the Minnesota Department of Public Health as long as I was, Minnesota doesn't get it wrong and they get it quickly often. When the first outbreak of Salmonella St. Paul was identified in Minnesota, they identified it quickly that it wasn't tomatoes, it was peppers. Had the other states been half as competent as Minnesota, it could've been picked up much earlier.

Osterholm says he's worried the Health Department will "take a hit" in the coming budget cuts.

Q: Is there a fear that publicizing these things too early will hurt industry?
A: Yes, but I don't think that's the case here. Once the number of cases grew here quickly, they (the MDH) jumped on it. I wouldn't be surprised to see this solved in just a couple of days.

Listener questions

Q: What advice would you give to Obama?
A: Osterholm says he's working with the Obama transition team on who to bring in. "I'm excited about the interest in solid science," he said. As a world, we are going to have to take major cuts in programs. What I worry about is public health, which is only 1% of the budget and much of that funding is in jeopardy right now. If you cut out some basic public health programs, you'll pay more down the road. If the pandemic flu hits tomorrow, it'll make everything else seem like child's play.

Q: Should people have faith in federal health agencies?
A: I was critical of the CDC in the tomato vs. peppers outbreak, but I also saw the CDC do a great job overall. Is some of it a problem? Absolutely. But it's unfortunate that people label everything dark or light or right or wrong.

Q: What do you think of Sanjay Gupta as surgeon general?
A: He's a friend and his knowledge is exceptional. He'd make a great surgeon general. Having known past surgeon generals, the office has been "dumbed down." The Obama administration wants to restore that to a very strong voice to the world. There's very few health communicators out there than Sanjay Gupta. He's an actively practicing physician. Every Monday morning he scrubs in and does some amazing brain surgery.

Q: What is the health impact of people coming across the border from the south?
A: At Hennpin County Medical Center, they needed to have 65 interpreters to provide health care. Of 65 6.2 billion on the face of the earth, 2 billion have TB. We want to make sure we deal with the populations from their health perspective. We don't want it to spread to others and that's where I get people's concern about people coming in from other countries... there's been very limited transmission of disease to other groups. We see it within their own family. We shouldn't use it as a wedge issue to say "they shouldn't be here."

Q: Why is Minnesota better than other states at finding the answers to food-borne illnesses?
A: In 1965, we had three people who worked in infectious diseases. Over the years we built the group up through outside resources -- research money, grant money -- and since the early '80s, the MDPH has had an ethic of excellence where some of the top people in the country have been trained and have stayed. We have people at the U who are on call all of the time. We can do some testing in three days that takes the state of Texas 6 weeks. Our laboratory is one of the best -- if not the best -- in the country. There's been a sense of excellence that has stayed and we're lucky to live in a state that values that.

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Salmonella outbreak

Posted at 12:08 PM on January 8, 2009 by Bob Collins (8 Comments)
Filed under: Health

There's a salmonella outbreak in Minnesota.

The factoid was contained in a nationwide Associated Press article, quoting the Centers for Disease Control in Atlanta.

The Minnesota Department of Public Health has made no announcement of the outbreak. The University of Minnesota's Center for Infectious Disease Research, however, quotes the DPH spokesman:

Doug Schultz, a spokesman for the Minnesota Department of Health (MDH), told CIDRAP News that Minnesota has confirmed 30 cases that are linked to the national outbreak and that the department expects to detect additional cases. Experts from the MDH, including Team Diarrhea, a group that conducts case-control studies in foodborne disease outbreaks, are continuing their investigation into the source of the Salmonella, he said.

With no leads, it's difficult to say what to avoid, so health officials advise only to cook meat thoroughly and wash your hands often.

However, the CDC is theorizing that it may have something to do with chicken. If that's true, and if 34 states are involved, doesn't that suggest one of the big chicken processing companies as a source?

Stay tuned for more today.

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Bottoms up

Posted at 8:02 AM on December 29, 2008 by Bob Collins (10 Comments)
Filed under: Health

Many of the budget-cutting antics of state government in recent years have shifted costs to Minnesota's counties, allowing state politicians to cluck about local governments and counties not doing more to cut their budgets.

The Park Rapids Enterprise (registration possibly required) is carrying the story today about the cost of sobering up drunks. The economy being what it is, people are drinking more and requiring more time in detox, the paper says.

The cost of one day in detox, usually at Pine Manors, has risen from $260 per day to $275. There is a sliding fee schedule depending on the patient's financial status, but most patients are without the means to pay.

And that bothers (Hubbard County social services director Daryl) Bessler. "The state sells the stuff, they allow the license for booze to be sold, they put a tax on it and then they don't assist in the payment of the costs," he said.

The state requires detox services to be provided and the counties have to pay for them. The county official says the declining amount of money should be spent elsewhere. "I have to deny day training services to a mentally retarded person who was born that way versus somebody I had to provide services for because the law said I had to," Bessler told the paper.

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Alzheimer's

Posted at 11:02 AM on December 26, 2008 by Bob Collins (1 Comments)
Filed under: Health, Science

Ten million of us baby boomers are going to develop Alzheimer's. Expect coverage of research to increase. Let's begin with this one that's out today.

At Northeastern University in Boston, researchers say the disease may get its start by an insufficient blood flow carrying sugar to the brain. They suggest that exercise -- now -- may be the answer.

Meanwhile, a researcher at McGill University is out with a study today that says patients who frequently kick or cry out in their sleep may be at an increased risk of developing a neurodegenerative disease, such as Alzheimer's or Parkinson's.

There's no simple test for Alzheimer's. The Alzheimer's Foundation of America is suggesting a five-minute test, which others say is hugely controversial. Why? Take it and see if you can figure it out:

Tell someone three random words: car, pencil, banana. Then have the person draw a clock with the correct time, as a distraction. A little later, can he or she recall the words?

As a Chicago Tribune article pointed out, "Failing such a test doesn't mean someone has dementia. But it signals there might be a problem with short-term memory that should be checked by a doctor. Maybe it's something fixable, such as depression or thyroid disease. Maybe it is an Alzheimer's warning sign. Or maybe the person just isn't a good test taker."

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The first face transplant

Posted at 11:41 AM on December 16, 2008 by Bob Collins (3 Comments)
Filed under: Health

This one takes some thinking. In Cleveland, it was announced today, doctors have performed the country's first near total face transplant

Reconstructive surgeon Dr. Maria Siemionow replaced nearly all of the woman's face - 80 percent - with that of a dead female donor in an operation a couple weeks ago.

The patient's name and age were not released. The hospital plans a news conference Wednesday and would not give details until then.

My question if I get to ask it on Wednesday: Does the recipient look exactly like the donor? If so, isn't that kind of strange for the donor family?

The Discovery Health Web site has a slideshow of some face transplants (partial, I presume). Some may consider these graphic.

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Ray's story

Posted at 2:43 PM on December 15, 2008 by Bob Collins (7 Comments)
Filed under: Health

Lorna Benson's story today about Ray Sandford is one of the most compelling -- and sad -- stories about mental illness we've heard in a long time.

He wants to stop the court-ordered electroshock treatments for his psychotic episodes, but it's not his choice. Lutheran Social Services is his guardian.

His mother thought the sessions would help, but she thought they'd stop after a few treatments. They didn't.

"I don't care if he forgets the birthday of his nieces and nephews, although it's very important to him to remember that and probably more important to him that it is to anybody else in the family. But I do care that he can remember the names and know that they're born and remember what he did last Christmas if it was a happy memory, remember the good times. It's too bad to take away that."

Ray will be in court tomorrow for a hearing on this.

Be sure to read Lorna's story. What do you think is the proper course of action here?

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Why Angie died

Posted at 11:07 PM on December 7, 2008 by Bob Collins (14 Comments)
Filed under: Health

A couple of years ago on my personal blog, I wrote a scathing (even for me) piece against news editors who ignored the story of a seven-year-old girl who died a day after being physically restrained by employees at a Rice Lake, Wisconsin counseling center. News editors like me; I had ignored the story, too.

In late May 2006, Angellika Arndt was placed in a "control hold" after several infractions, such as gargling her milk, an initial state investigation showed. She died the next day at Children's Hospital in Minneapolis and, for the most part, her case was -- and continues to be -- ignored.

Last week, the Wisconsin Protection & Advocacy Agency (Disability Rights Wisconsin), an independent agency, released its investigation and I won't make the same mistake twice.

In its 75-page report to the state, called "A Tragic Result of a Failure to Act," investigators chronicled the very definition of tragedy in such a short life. Angellika was only three when she was taken from her biological parents for physical and sexual abuse. She roamed the foster care system and by age five, she'd been diagnosed with a host of psychological problems. But she'd made progress with a new foster family and was sent to the Rice Lake facility to "help prepare her for first grade."

Subsequent investigations showed the girl was placed in restraints for hitting her chin with her hand and in some cases -- said to be routine -- staff members held her face-down on the floor for an hour and a half. This was how children looking for help transitioning to first grade were treated in 2006. They still may be.

Here is the account of her final hours:

Angie arrived at RLDTC around lunch time, and a short time later found herself in a "cool down" precipitated by staff's determination that she had not followed directions for talking and was gurgling her milk with her straw. When Angie couldn't sit still in the chair for her time out, staff took her to the special cool down room. This was the special seclusion room that had no window or furniture besides the single "cool down" chair. The hard floor was covered with a thin carpet glued down to the concrete below. Staff reminded Angie that her cool down time didn't begin until she sat still and in the proper position. Instead of obeying, Angie curled up in the chair, began to cry and soon appeared to fall asleep.

After about five minutes Angie awoke and began to swing her legs back and forth in the chair. Staff warned her that if she didn't stop, they would have to place her in a control hold for safety. Undeterred, Angie continued to swing her legs and cry. Eventually, staff reported that Angie made an aggressive move as she sat in the cool down chair, so they took her down with a prone restraint. More staff were called to assist with the restraint.

One staff person placed his body across Angie's small back and held her head face down on the floor. Three others held her arms and legs immobile. Angie was restrained in this position for over an hour until they felt she was calming down. In the RLDTC report written after her death, staff reported that Angie stayed on the floor making cooing noises after they freed her. Staff left her there for about five minutes, thinking she had fallen asleep. Only then, when Angie failed to respond to questions, did staff roll her over and discover that her lips were turning blue.

One staff member was sent to jail for 60 days. The facility was closed and just when you think this tragedy couldn't be any more senseless comes the revelation that nowhere near enough has been done as a result of Angie's death to prevent it from being repeated with another child.

The Wisconsin Department of Health Services formed a committee to create a plan for training and technical assistance. It still hasn't finished its work. A memo on prohibited restraint practices has never been issued. And worst of all, "nothing has been done to review or revise the children's day treatment regulations," the report said.

After Angie's death DHFS did cite the facility for numerous violations, leading to the facility's closure. However, the Department has been slow to take action to decrease the use of seclusion and restraints in children's programs and goals dealing with care planning, training, quality assurance, and monitoring have not been met. In November 2007 a number of mental health advocacy groups wrote the DHFS Secretary requesting an official DHFS memo to providers that would identify prohibited practices in the use of restraint with children, so that additional deaths such as Angie's would not occur. That memo has not been issued.

Well more than a year later, nobody has provided a fit answer for why children are treated as Angie Arndt was.

Here's a full copy of the report.

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The sandwich generation

Posted at 12:48 PM on November 10, 2008 by Bob Collins (1 Comments)
Filed under: Health, Life

A national law firm is providing a benefit unique to a generation. A support line for members of the "sandwich generation," the baby-boomers who are trying to raise their own kids, while also taking care of their parents, according to the Boston Globe. Goodwin Proctor is setting up a hotline specifically for care-givers in its employ:

Staffed by registered nurses and geriatric social workers, it will help employees navigate the complex maze of medical and social services for the elderly and disabled, including housing, transportation, insurance, nutrition, and nursing care.

It will also offer assessments and referrals, and will field questions such as how to persuade aging parents to move into assisted living or give up their driver's licenses.

In turn, the firm hopes the service will improve productivity and reduce turnover, since the time demands and emotional toll of caregiving can have a deleterious effect on workplace performance.

About 20 million people are in the "sandwich generation." Joan Brunwasser, who heads a national group for election reform, described the challenges last week when her mother got sick near Election Day:

My mother was most considerate about when she get sick. Timing really is everything. Had she been ill on Monday night, I would have been hard pressed to be downtown with her and at my polling place by 5:00 the next morning. (I was a volunteer poll watcher on November 4th.) Likewise, if she had gotten sick on Election Day itself, I would have been physically incapable of responding that evening. After that long, long day, I felt like I had been hit by a Mack truck. At least I was able to rack up one good night's sleep before the flu struck. Way to go, Mom!

Companies have good reason to consider adding the benefit. Members of the "sandwich generation" are more likely to get sick themselves, or lead an unhealthy life, according to a study this month from Indiana University.

Compared with people caring for a single generation, people in the sandwich generation were less likely to check food labels, wear seat belts or choose foods based on health values. They also smoke more.

Are you a member of the sandwich generation? Tell me about your life. You can either post in the comments below, or write to me using this form and we can talk about it.

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Cindy Lander

Posted at 11:51 AM on November 9, 2008 by Bob Collins (0 Comments)
Filed under: Health

We received a sad update today to a story MPR's Lorna Benson did in August 2007 about the pioneering open-heart surgery by doctors at the University of Minnesota

It focuses on Cindy Lander, who had a hole in her heart and wasn't expected to live past 20 without help. She was just 11 when she had her surgery.

In August 2007, she returned to the U of M to celebrate 50 years of life thanks to the surgeons at the U.

Her cousin wrote today to tell us that Cindy has died.

I am sorry to report that the subject of this article, my cousin Cindy Lander, passed away on November 6, 2008. She will be buried on November 11, 2008. You can view the obit .

She was a wonderful, kind, joyful person who will be greatly missed by her family.

The family is requesting donations to the Lillehei Heart Institute.

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When people do great things

Posted at 6:51 PM on November 7, 2008 by Bob Collins (1 Comments)
Filed under: Health

Let's leave this week behind on an uplifting note.

Lost among all of the political stories this week was a charming story from MPR's Lorna Benson on the 40th anniversary of the Bone and Marrow Transplant Program at the University of Minnesota.

The story started with this passage:

Dr. John Kersey was a U of M medical student when his mentor Dr. Robert Good used bone marrow stem cells to successfully treat a 4-month old boy. The baby suffered from a genetic immune system disease that had killed 11 male children in his extended family.

Dr. Good and his team were determined to figure out a way to save the infant, Kersey says.

"Back in those days it was very common for people to say if a child has a very severe disease there's nothing that can be done about it. And the attitude amongst my colleagues here was, 'No. We should be trying new things. We should be doing things we can to cure these diseases.'"

It took two transplants, but eventually the baby recovered.

U of M doctors succeeded where others had failed because they focused on getting the best bone marrow match possible for their young patient, Kersey says.

This afternoon, we received this e-mail from Cynthia Olson of Minneapolis:

As I listened to your story about the first bone marrow transplant on a baby at the U of M hospital in 1968, I went flying back in time, to a rocking chair in the nursery with that baby in my arms. I was a nursing student working nights that summer. One night I was charged with caring for that little guy. As I rocked the baby in the quiet darkness a doctor entered the nursery. He told me (playfully) not to drop the baby because this baby was making history. It was so thrilling to hear a forty year old man talking about his life saving procedure. Thanks for the update.

And thanks for the reminder that people can do great things.

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A win for MinnesotaCare

Posted at 3:59 PM on November 5, 2008 by Bob Collins (1 Comments)
Filed under: Health

Gov. Pawlenty's office announced this afternoon that it's received an extension of a waiver to allow MinnesotaCare to cover 18,000 parents to remain eligible for the state subsidized health care plan. The feds had previously decided against renewing the waiver, which would've cost thousands of people their health care coverage.

"Our administration has been negotiating with the federal government to ensure that funding was preserved for this program," Governor Pawlenty said. "I appreciate the help of our state Congressional delegation to obtain this waiver," he said in his press release which was headlined slightly less modestly:

Governor Pawlenty secures Federal Waiver to Allow MinnesotaCare Funding to Continue

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Turn back the risk of a heart attack

Posted at 4:00 PM on October 29, 2008 by Bob Collins (0 Comments)
Filed under: Health

Research from Sweden today says there may be a connection between turning your clock back an hour (which we are to do on Sunday morning) and a lower risk you'll have a heart attack on Monday, according to the Journal of the American Medical Association. Likewise, there are more heart attacks on the first three days after clocks are set forward.

"The finding that the possibility of additional sleep seems to be protective on the first workday after the autumn shift is intriguing," the authors wrote.

Monday is the most common day of the week for heart attacks anyway, but other researchers have suggested it may just be the stress of a new work week.

This isn't the first link between heart attacks and sleep. Last summer, the Mayo Clinic researchers found that the risk of heart attacks is higher among people with sleep apnea.

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The cold facts

Posted at 1:48 PM on October 28, 2008 by Bob Collins (1 Comments)
Filed under: Health, Science

File this in the "news you'd hear if it weren't for politics" file.

At a conference on infectious diseases today, University of Virginia researchers released a study of the common places where people pick up colds.

The researchers started with 30 adults with early symptoms of colds and retraced the things they touched in the previous 18 hours, using DNA tests to hunt for rhinovirus, which causes about half of all colds.

"We found that commonly touched areas like refrigerator doors and handles were positive about 40 percent of the time" for cold germs, said Dr. Birgit Winther, an ear, nose and throat specialist who helped conduct the study.

The culprits:

Salt and pepper shakers

Refrigerator door handles

Light switches

Remote controls

Telephones

Dishwasher handles

The researchers also figured out that a person touching these items could catch the cold virus even if it had been 48 hours since the person transmitting the cold had touched them. This, apparently, is not true for the flu virus.

Why can't we cure the common cold? The Buffalo News has a sensational article analyzing that today. The short answer? There's too many viruses. Another answer: Viruses are smarter than we are. For example, the reason a cold isn't more severe than it is is because the virus needs you to walk around infecting other people

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Science: What if?

Posted at 7:33 AM on October 16, 2008 by Bob Collins (1 Comments)
Filed under: Health, Science

It's always a bad idea to get too far ahead where medical research is concerned, but it's hard not to play "what if" with a science story being reported now.

Researchers have found monkeys, taught to play a computer game, can regain use of paralyzed muscles and even learned to use muscles that previously had nothing to do with wrist movement.

The significance? According to the Associated Press:

Remarkably, the monkeys regained use of paralyzed muscles by learning to control the activity of just a single brain cell.

The result is "an important step forward," said Dawn Taylor of Case Western Reserve University in Cleveland, who studies the concept of using brain signals to overcome paralysis. She wasn't involved in the new work.

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Study shows low rate of cervical cancer vaccination

Posted at 2:01 PM on October 9, 2008 by Bob Collins (4 Comments)
Filed under: Health

I've detected another round of TV ads touting the benefit of cervical cancer vaccinations. "We chose to help protect ourselves against cervical cancer and other HPV diseases. Now the choice is yours," women in the ad say. Major guilt trip.

The Minnesota Legislature dabbled with the idea nearly two years ago before the sponsor withdrew the bill. There was already some pushback from some parents who said vaccinating girls against a sexually-transmitted disease was tantamount to saying "it's OK to have sex."

There was also some discomfort with some of the cash supporting the pro-vaccination campaigns around the country was coming from Merck, the company that made the drug, Gardasil.

Today, federal researchers report that only 1 in 4 girls have gotten the vaccine. About 4,000 people are dying from cervical cancer every year.

"The overall trends are good news," said Dr. Lance Rodewald, director of the Division of Immunization Services at the CDC′s National Center for Immunization and Respiratory Diseases. His study measured progress on four area of immunizations, including the virus that causes cervical cancer.

Part of the reason for the low immunization rate -- aside from moral objections -- is the cost : about $360. Three doses are required before a girl is sexually active. But a recent study suggests another reason: the vaccine may not be cost effective.

Still, the issue is one where the feds and the state of Minnesota disagree. Federal health authorities recommend the vaccination. The Minnesota Department of Public Health does not recommend it because after five years, the effectiveness is in question.

Some people may not have a choice. A federal rule added Gardasil to the list of vaccinations that female immigrants ages 11 to 26 must get before they can obtain "green cards."

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Whatever happened to the flu pandemic?

Posted at 5:01 PM on October 6, 2008 by Bob Collins (8 Comments)
Filed under: Health

It wasn't that long ago -- within the last two years, actually -- that a flu pandemic was our biggest worry. Here at the world headquarters of News Cut, we even had a meeting or two about how we would function if we were all sick or half of us dead.

Those were the days.

A new report from Johns Hopkins Berman Institute of Bioethics, however, has reminded us -- in the event we weren't depressed enough already today -- that a pandemic is still a real possibility.

Says the report's outline:

This article provides ethics guidance for pandemic planning, response, and resource allocation--that is, what ethical considerations determine which public health responses are implemented, who will be restricted and who will be helped, what will be communicated to the public, and how will the public be included in decisions and responses?

In other words: Who's going to get first crack at vaccine and other treatment? Their suggestions are surprising. First responders? Sure. The sickest? Not so fast.

While some have suggested that scarce medical countermeasures be allocated primarily to first responders and then to the sickest, we suggest that an ethical public health response should set priorities based on essential functions. An ethical response also will engage the public, will coordinate interdependent sectors as a core preparedness priority, and will address how plans affect and can be understood by the least well off.

Public health "experts" and "government officials to whom the public will turn for information and direction" are on the priority list. So are utility workers, truck drivers, and people who work in grocery stores.

"Alongside healthcare workers and first responders, priority should be given to the people who provide the public with basic essentials for good health and well-being, ranging from grocery store employees and communications personnel to truck drivers and utility workers," said Nancy Kass, deputy director of public health at the Berman Institute.

Nothing about bloggers.

Minnesota, however, is way ahead of Johns Hopkins. In 2006, a task force outlined a strategy for who's the most important and who should be "saved" first.

It recommends young, healthy people get the vaccine first. The report also says that giving priority to health care workers won't work because there won't even be enough vaccine to go around.

And you? How critical do you think you would be during a pandemic?

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Bad timing

Posted at 10:20 AM on September 26, 2008 by Bob Collins (7 Comments)
Filed under: Crime and Justice, Health

There's never a good time to have a scandal in a gubernatorial administration, but the one that's apparently hitting Gov. Tim Pawlenty is especially ill-timed.

The St. Paul Pioneer Press, citing sources, says an employee of the Department of Human Services allegedly stole $1 million from the Medical Assistance program for the employee's personal use.

How does one person in an agency of 7,200 people steal a million dollars by him or herself without anyone noticing until now?

According to the paper, that question -- and any others -- will go unanswered:

Terry Gunderson, a spokeswoman at the Minnesota Department of Human Services, said no information about any ongoing investigation would be made public.

Now, about that timing thing. The state just went hat in hand to the federal government (most of the money that funds the state's Medical Assistance program is federal money), asking for more time to explain why Minnesota shouldn't lose $130 million in federal assistance to provide health insurance to low income adults.

Federal Medicaid money is normally targeted for kids, but Minnesota already insures low-income kids through the state-funded (with a tax on health care providers) MinnesotaCare program, so Minnesota uses the money to insure their parents, by virtue of a waiver from the federal government allowing it to do so. The feds are threatening to eliminate the waiver.

Minnesota isn't the onliy one fighting this kind of battle. The feds are also threatening to strip the cash from Massachusetts, which also has a state-subsidized health care program. That state is trotting out a heavy hitter in the battle, Sen. Ted Kennedy, who is Kennedy, who is the chairman of the Senate Committee on Health, Education, Labor, and Pensions,

It's been that kind of political year; Ted Kennedy may turn out to be Tim Pawlenty's best friend on the issue.

Update 1:48 p.m. By way of MPR's Tim Pugmire at the Capitol we have an update from Sen. Linda Berglin:

Berglin, who heads the committee that oversees state health care funding, said the embezzlement stretches back more than six years and began before current anti-fraud measures were put in place.

Berglin said she suspected that the employee invented a fictional health care provider to skim payments.

"If this would have happened today it would have been discovered right away," said Berglin, who heads the Senate Health and Human Services Budget Division. "The systems that are in place today were not in place when this began."

Berglin said she didn't know how the fraud was detected, but called it a huge breach of trust.

So now the question isn't when did it begin, but when did it end?

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The smoking ban -- One year later

Posted at 12:34 PM on September 25, 2008 by Bob Collins (3 Comments)
Filed under: Health

I'm generally suspicious of polls that are put out by groups with a special interest in the results, but a poll out today from ClearWay Minnesota provides the basis for an ongoing discussion on the smoking ban in Minnesota.

The poll says that one year after the beginning of the Minnesota smoking ban, 77 percent support it.

From the looks of things, a year of living under the smoking ban hasn't changed many minds. Those who were against it, may still be against it. Those who were for it, are still for it. The 2006 State Fair survey, for example, found about the same level of support for the ban (71%). Another poll in 2007 found 77% favoring some form of smoking ban.

This latest poll didn't ask how people think the law is working and only 17% of the people surveyed were smokers. (Download poll questions in Word format). One wonders what percentage of the 23% who don't favor the ban, are the 17% who smoke?

Is that number going down as a result of the smoking ban? It's too early to know officially. According to the Minnesota Medical Association, 17% is the percentage of Minnesotans who smoke, citing the Minnesota Adult Tobacco Survey.

The survey found that Minnesota's adult smoking rate has declined to a new low of 17 percent. That figure is down approximately 5 percentage points since 1999 and represents 164,000 fewer smokers. Minnesota's declines are impressive compared to national trends, where smoking rates appear to have stalled at about 20 percent since 2004.

However, the reduction in smoking cited in the survey had nothing to do with the smoking ban (and so far there's no indication the ban has led people to quit smoking) because it used statistics through 2007.

Has the smoking ban had any effect on you or your business?

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Treating depression

Posted at 1:51 PM on September 22, 2008 by Bob Collins (2 Comments)
Filed under: Health

Two interesting -- and unrelated -- stories about treating depression are in the news today.

A new analysis of phone therapy research by Northwestern University shows that when patients receive psychotherapy for depression over the phone, more than 90 percent continue with it, according to the New York Times.

Perhaps it's a sign of our non-face-to-face generation but the number of people who dropped therapy after getting it by phone was only 7.6 percent, compared to 50-percent for the in-person kind, which few people apparently want anyway. Among patients who say they want psychotherapy, the story says, only 20 percent actually show up for it,and half of those drop out.

Therapy, massage, and other techniques not spelled "drugs" was the message behind a Star Tribune piece today on a movement to treat depression in children with "mind-body therapies."

At Children's Hospitals and Clinics of Minnesota, kids are being taught how to manage depression and anxiety with everything from scented oils to deep-breathing, exercise, prayer and "quiet reflection."

"I think people are fed up with having their kids medicated as the only option," said Dr. Timothy Culbert, head of integrative medicine at Children's, and Henry's doctor.

The reaction to the article mirrored the national debate that's been going on for years in the area of mental health and children. Some alleged mental health treatment is a "legalized drug addiction," another -- like this one -- said chemical imbalances cannot be ignored in an organ that communicates with itself via chemicals.

Would we tell a diabetic to use vitamins or stress-relief techniques to help with their insulin? This is just another article perpetuating the idea that mental illness is not a real, medical condition needing treatment, that we can "think" our way out of it.

But there is a developing concern about the side effects of a new class of antipsychotic drugs. Prescription rates for the newer drugs have increased more than fivefold for children over the past decades and a half, and doctors now use them to settle outbursts and aggression in children with a wide variety of diagnoses, despite serious side effects, the New York Times said.

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MinnesotaCare cuts loom

Posted at 1:14 PM on September 17, 2008 by Bob Collins (1 Comments)
Filed under: Health

Gov. Pawlenty and state officials are trying to talk the Bush administration out of cutting $135 million over three years to the state's MinnesotaCare program.

This afternoon the governor released a statement on a meeting with the Department of Health and Human Service's secretary, Michael Leavitt.

"In our meeting today with Secretary Leavitt, we expressed our goal to maintain federal funding for the 18,000 Minnesotans who would be put at risk by the federal government's proposal. The meeting was constructive and HHS has agreed to consider our request to maintain this critical federal funding and address numerous other outstanding issues between Minnesota and HHS. The Secretary and I will be speaking again regarding these matters in the coming days.

An estimated 18,000 low-income adults would lose their health insurance coverage. Most of them are parents of children who are covered.

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Safe or not?

Posted at 4:26 PM on September 16, 2008 by Bob Collins (4 Comments)
Filed under: Health

What we have here... is a failure to communicate.

Today, the first major study of the effect on humans of BPA -- a common ingredient in plasticware and baby bottles -- showed that among 1,455 U.S. adults, those with the highest levels of BPA were more likely to have heart disease, diabetes and liver-enzyme abnormalities than those with the lowest levels.

Says The Washington Post...

Dr. David O. Carpenter, director of the Institute for Health and the Environment at the University at Albany in New York, noted that he has shown that these very same diseases are associated with PCBs, dioxins and chlorinated pesticides.

"I have a strong suspicion that BPA is doing exactly the same thing," he said. "I have been arguing that BPA should be banned for a long time just on the basis of its effect on endocrine systems. The industry reports that argue that it has no adverse effects are simply wrong," he said.

So what are we supposed to do now? The Food and Drug Administration is sticking with its position that the plastics are safe, according to FDA official Laura Tarantino...

"We have confidence in the data that we've looked at and the data that we're relying on to say that the margin of safety is adequate..."

On the other hand...

"There are things you can do if you choose to reduce your level of bisphenol A..."

Alright, then.

"... but we have not recommended that anyone change their habits or change their use of any of these products because right now we don't have the evidence in front of us to suggest that people need to."

I see.

Canadian health authorities have announced plans to ban some products. The U.S. National Toxicology Program has "some concern" it may harm development of the prostate and brain.

Studies have shown that BPA is in the urine of more than 90 percent of people in the United States.

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Drugs in drinking water

Posted at 8:39 PM on September 11, 2008 by Bob Collins (3 Comments)
Filed under: Health

Last March, I wrote in this space about the abundance of pharmaceuticals found in the source water for drinking supplies. A study out today updates the situation: It's worse than we thought.

The AP reports:

Chicago, for example, found a cholesterol medication and a nicotine derivative. Many cities found the anti-convulsant carbamazepine. Officials in one of those communities, Colorado Springs, say they detected five pharmaceuticals in all, including a tranquilizer and a hormone.

"This is obviously an emerging issue and after the AP stories came out we felt it was the responsible thing for us to do, as a utility, to find out where we stand. We believe that at these levels, based on current science, that the water is completely safe for our customers," said Colorado Springs spokesman Steve Berry. "We don't want to create unnecessary alarm, but at the same time we have a responsibility as a municipal utility to communicate with our customers and let them know."

Fargo found small amounts but they were so small the water director sent them to the health director to figure out how to interpret the results.

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Why are fewer young people smoking?

Posted at 7:59 PM on September 11, 2008 by Bob Collins (7 Comments)
Filed under: Health

Do they still sell candy cigarettes? When I was a kid, we'd ride our bikes down to the co-op store and plunk down a nickel and we'd get horrible tasting candy cigarettes, with a little swipe of red on the end (I guess that was the ash). Then we'd stand out on steps and pretend we were smoking because it's what made us look cool. It was only when we didn't get dates for the prom years later that we realized that it'd take more than candy cigarettes. And, by then too, we learned more about what smoking can do to you.

Still, even fairly recently, kids started smoking, partly because they thought it made them look cool.

But what's happened here?

A new Blue Cross and Blue Shield of Minnesota survey finds a big drop in the number of young adults smoking in Minnesota. And it's not just this state; other states are reporting similar findings over the last few years. The research shows the state's 75 cent a pack "health impact fee" introduced in 2005 played a role in curbing smoking as did smoke-free policies on campuses and other public places.

MPR's Paul Tosto wants to hear from you if you've tried to quit.

"We've heard already from several folks in our Public Insight Network," Paul says. "One young woman told us she quit when she got pregnant and the 'increasing lack of social tolerance for smoking,' together with the memory of how hard it was to quit, kept her from going back. Smoking 'was an almost instant passport into a social group anywhere you went' when she started in 1997 but by 2007 when she quit for good most people looked down on it.

"A 24-year-old tells us that smoking was not even an option for her growing up. 'No one did it at home and I was too involved in activities like sports to get involved in smoking.'"

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Leroy Sievers, 1955-2008

Posted at 7:31 AM on August 18, 2008 by Bob Collins (2 Comments)
Filed under: Health, Icons

Leroy Sievers died Friday of the cancer about which he's blogged for the last few years.

He made several appearance on MPR's Midmorning. This one in 2006, this one last November, and this one just last month, when he acknowledged his disease was gaining on him.

The last post on his blog came from his wife, Laurie Singer, last Thursday:

On any normal day, this would just be a really bad thunderstorm rumbling its way across the summer sky.

But it's not a normal day and the rumbling is more like the growl of a predator stalking its prey.

Leroy's cancer is making its move.

I guess we all knew this day would come. The day when his doctor would say the medicine needs to be stronger.

The day when I would need to be stronger still.

The thunderstorm has passed, but I can still hear the growl.

-- Laurie

Have you ever seen 954 (at last count) comments to a blog post before? Me neither.

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To be old, frail, and evicted

Posted at 8:30 AM on August 11, 2008 by Bob Collins (5 Comments)
Filed under: Health

A peek at the National Public Radio story board this morning shows All Things Considered is planning on a story this evening on "assisted living evictions." No details are provided, but that's what Google is for.

As near as I can tell, this subject starts in New Jersey where the most vulnerable among us are, as usual, the victims of apparent greed, according to thepressofAtlanticCity.com.

The investigation by the state Department of the Public Advocate comes after complaints from residents who spent tens of thousands of dollars paying for assisted living. When the residents prepared to switch to Medicare after draining their life savings, the company involuntarily discharged them.

From there it became obvious this is something of a nationwide problem, the Wall Street Journal reported. Long-term residents of facilities are being replaced by short-term residents. There's more money in it.

Those on Medicaid bring facilities as little as half what they can get from residents who pay out of pocket, with private health insurance or through Medicare, the federal-state health program for the elderly.

No one counts evictions nationwide. But formal complaints about nursing-home discharge practices have doubled over a decade, to 8,500 nationally in 2006, making it the second-biggest category tracked by the federal Administration on Aging, trailing only complaints about unanswered calls for assistance.

Part of the problem is that assisted-living facilities are often below the radar of regulation. And old people's needs change over time, often to the point where a facility almost can't afford to care for them, anymore. That's something that often doesn't get mentioned in the glossy brochures. Here's a view of things from a couple of consultants for the long-term health care industry.

A typical disclosure provides details on services included in the base rate and a listing of additional services available for purchase. More importantly, the form "should" include critical information regarding staffing patterns, staff licensing and staff training. Equally important, the form should disclose what changes in health status will result in a discharge or transfer. While the resident, the family and the facility may all agree that aging in place is the optimal goal, full disclosure assists everyone in the decision-making process and eliminates future surprises regarding the facility's capacity for delivering increased services.

For nursing homes, Minnesota has been a battleground for a few years now. The Tower Timberjay, for example, pointed out the situation in an article just last Friday.

The decisions to reduce beds and increase the levy are both driven by economics. State payments to nursing homes have not kept pace with rising costs. In three of the past six years, nursing homes saw no increases by the state.

Although the state approved a modest cost-of-living increase for fiscal year 2009 and agreed to re-evaluate the rate cap for the first time since the 1990s, the gap between revenues and expenditures remains daunting. More than 50 percent of nursing homes in northeastern Minnesota are posting losses of minus five percent per year or greater, according to a 2007 study of the industry.

The situation is critical, and it's not getting much attention. I'm guessing there are News Cut readers who are living this situation. If so, I'd like to hear from you.

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Slugs in training

Posted at 4:03 PM on July 15, 2008 by Bob Collins (0 Comments)
Filed under: Health

Our stop-the-presses scientific study of the day comes from the University of California San Diego. When kids hit the teen years, they become sluggish, and don't get much exercise.

It's reported by the Associated Press:

The latest study, appearing in Wednesday's Journal of the American Medical Association, tracked about 1,000 U.S. children at various ages, from 2000 until 2006.

Special gadgets were used to record their activity. Average levels of moderate-to-vigorous activity fell from three hours a day at age 9 to less than an hour at age 15.

(Dr. Phillip) Nader said he was "surprised by how dramatic the decline was,"and cited schools dropping recess and gym classes and kids' increasing use of video games and computers as possible reasons.

As usual, video games, DVDs and Internet use get the blame.

Boys were more active than girls at every age. But by age 15, even boys' average activity levels fell short of recommendations, particularly on weekends, the study said.

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Talking cancer

Posted at 9:25 AM on July 3, 2008 by Bob Collins (1 Comments)
Filed under: Health

What do you say to someone who has cancer? That was one of the questions a caller asked earlier this week when MPR's Midmorning talked with Leroy Sievers, a journalist who has been writing about his battle with cancer on an NPR blog.

Yesterday, Sievers wrote about the question on his blog:

Cancer patients know how difficult it is to talk about our disease. It's hard for us. I have broken down into tears any number of times recently.

But what's more important, more important than the words you might say, is the effort to simply say anything. And if that "anything" isn't about cancer, that's even better.

The best conversations I have these days are about something, anything else. Politics, sports, books, whatever.

If cancer is not in the room for even an hour or two, that's a gift.

The difficulty, of course, is sometimes "How 'bout those Twins?" sounds a lot like "this is me not talking about cancer." The comments section of the blog post provided a good example: a mix of highly sensitive thoughts mixed in with questions about politics and the Red Sox.

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A patient's view of bipolar

Posted at 11:34 AM on June 25, 2008 by Bob Collins (14 Comments)
Filed under: Health

A passage of her book that Marya Hornbacher read on MPR's Midmorning this morning, described pretty well why I tend to think people who battle depression and bipolar disorder are some of the most courageous people among us.

Here's the hell of it: Madness doesn't announce itself. There isn't time to prepare for its coming. It shows up without calling and sits in your kitchen, ashing in your plant. You ask how long it plans to stay, it shrugs its shoulders, gets up, and starts digging through the fridge. But even that implies some sort of lag time between the arrival of madness and the actual experience of it.

In the early years, it's like a switch flips on and though only a moment before you were totally sane, suddenly you've gone mad. But as you learn to manage madness, you begin to notice sooner that it's on its way. I lick my finger and hold it up to detect the direction of the wind. Madness is in the air. I can smell it like I can smell snow. It's in the vicinity though I don't know where or long it will be until it comes.

The trick is to shut the gate, throw sheets over the roses, go inside, lock all of the windows and doors and go to the basement and sit on a chair and wait. Sometimes these preparations are enough. The locks on the windows and doors are tight, you've taken the medication faithfully, you've exercised to induce a sense of Dopamine calm, you've put every lamp in the house in your office and flipped on the light box (it mimics sunlight for people who get depressed in winter.),and the room is lit up as if by floodlights and you're so hot you're working in your bra.

You've stayed off the coffee, you've taken the supplements, you've worked starting at the same time for the same length everyday. You've interacted with human beings at least a few times this week. You've gotten yourself to the point where you can sleep in the normal timeframe from night until morning, and your mornings are not a horrible struggle to stay out of bed, and you make the bed so you aren't tempted to get back in it. You check off the entires on the list that runs your life.

But sometimes the system fails. Maybe it's a chemical shift in the brain that the medications don't block. Maybe it's a stressor in your life that you didn't expect. Maybe there is no reason and you're just going mad for the hell of it, but you try not to think about that because that would imply that no matter what you do, no matter how tightly you batten the hatches, madness can get in.

You wake up one morning and there it is, sitting in an old plaid bathrobe in your kitchen, unpleasant and unshaved. You look at it, heart sinking. Madness is a rotten guest. You can tell it to leave 'til you're blue in the face, you follow it around the house, explaining that it's come at a bad time and could it come another day?

Eventually you give up and go back to bed, shutting the door. But, of course, it barges in and demands to be entertained. Before you know it, it has strewn its stuff all over the house, and there are sticky plates in its bed and it has refused to change its sheets. Madness lounges all day in front of the TV, watching Oprah, and munching on a bag of chips, and drinking milk from the carton and getting crumbs between the cushions of the couch.

Soon, your life revolves around it. You do everything you can to keep it comfortable because you don't want to upset it. You tiptoe around the house and wait for it to leave. In most cases you wake up one morning and it's gone. There's minimal damage. You pick up its mess and get on with your day. But sometimes it settles in to stay. Immediately it is all demands: it starts bossing you around, interrupting your conversations, refusing to let you out of the house. The phone stops ringing. Soon it's just you and madness. You circle each other like boxers, throwing punches to the jaw, but sometimes it takes round after round and you lie on the living room floor, unable to get up.

It refuses to let you sleep. You run out of food. It draws all the blinds and stands peering through the slats. It convinces you you're in danger. It says that people are coming and they will hurt you if you let them in.

Soon, madness has worn you down. It's easier to do what it says than to argue. In this way it takes over your mind. You no longer know where it ends and you begin. You believe anything it says. You do what it tells you no matter how extreme or absurd. If it says "you're worthless," you agree. You plead for it to stop, you promise to behave. You are on your knees before it, and it laughs.

A rather frightening account.

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Drug abuse snapshot

Posted at 3:32 PM on June 16, 2008 by Bob Collins (33 Comments)
Filed under: Health

The Minnesota Department of Human Services is out with its drug trend report in the Twin Cities today. Here's the bottom line:

Heroin use and prescription drug abuse rising

Marijuana use increased to 33 percent of high school seniors in 2007, compared with 29.2 percent in 2004, although declines were seen for grades nine and six.

Cocaine treatment admissions are gradually declining.

Marijuana continued to account for more admissions to addiction treatment programs than any other illicit drug, with 3,067 admissions that represent 16.1 percent of total admissions in 2000.

Cocaine treatment admissions are gradually declining.

Ecstasy use rose from 4.3 percent in 2004 to 5.7 percent in 2007.

LSD use rose from 4.9 percent in 2004 to 6.2 percent in 2007 among Twin Cities metropolitan area high school seniors.

Here's the entire report.

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Drunks on the road

Posted at 12:03 AM on April 23, 2008 by Bob Collins (11 Comments)
Filed under: Health

It's established fact that the upper Midwest can -- and does -- outdrink the rest of the nation. And one out of three high school students binge drinks, so it's not a problem that's going to disappear anytime soon.

What happens to all these people? They get in their cars. A government report out today says the upper Midwest has the worst drunk driving rates in the country. Nationally, nearly one out of 6 drivers on the road has driven drunk in the last year.

Wisconsin -- and this will knock you over with a feather -- is the worst with more than a quarter of the adult drivers reporting they've driven drunk. North Dakota is #2, Minnesota 3, Nebraska 4 and South Dakota rounds out the top five.

"It's not surprising, but it means that these jurisdictions should take this data and think about how they approach public education campaigns and enforcement campaigns," said Dr. H. Westley Clark of the Substance Abuse and Mental Health Services Administration.

Another expert, Eric Goplerud, research professor at George Washington
University Medical Center, cites cultural and demographic issues for the high rates of drunk driving in these parts. He said strong religion in the southeast discourages drinking, which perhaps is a slap at the heathens in this neck of the woods.

This area, the experts say, is also suspect because of its predominantly white racial makeup. Blacks, they say, drink at substantially lower rates than whites.

(Posting will be light this morning; I'm speaking to a journalism class at the U and then will hunker down on stuff later.)

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What we've learned

Posted at 8:05 AM on April 16, 2008 by Bob Collins (0 Comments)
Filed under: Health

Today is the one-year anniversary of the shootings at Virginia Tech that left 32 people dead. What have we learned? Perhaps quite a bit, a story in the Fargo Forum newspaper (reg. possibly required) suggests. It details how colleges and universities in that region are responding to the mental health needs of the students.

In some cases the efforts were underway even before last year's killings, but a subsequent study of Minnesota college students showed a significant number have been diagnosed with a mental health condition at some point in their lives.

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