News Cut Category Archive: Health

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.

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."

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?

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?

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?

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.

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.

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.

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.

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.'"

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.

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.

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.

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.

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.

The Minnesota Department of Human Services is out with its drug trend report in the Twin Cities today. Here's the bottom line:

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.)

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.