President Obama had this to say about health reform during his State of the Union address to Congress this past Wednesday:

“…if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know. (Applause.) Let me know. Let me know. (Applause.) I’m eager to see it. Here’s what I ask Congress, though: Don’t walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people. (Applause.)

Let’s get it done. Let’s get it done. (Applause.)”

What do you think will happen to health care reform after the State of the Union?

A: I am pumped. They’re totally going to get it done. Now!

B: This is going to be a nightmare. He asked for people to bring him better ideas — and that’s going to take another, like, eight years to get every idea organized and heard.

C: Fast track it!

D: I don’t know. I don’t really think anything is going to happen.

E: Other thoughts?? 

Do you have “a better approach” to health reform than we’ve seen so far?

I’ve grown weary of the public continuing to rate nurses as the most trusted profession (annual Gallup polls every year of this decade except 2001 when fire fighters understandably led the ratings), only to have leaders in health care agree but ignore us.

The Robert Wood Johnson Foundation released a Gallup poll that surveyed over 1500 opinion leaders in health care, including government officials, health care and insurance executives, and university faculty.

The survey found that:

• Doctors (54%) and nurses (42%) are the information sources about health and healthcare in whom opinion leaders have a great deal of confidence.
• Government (75%) and health insurance executives (56%) are viewed as most likely to exert a great deal of influence on health reform, compared to only 37% for doctors and 14% for nurses.
• 51% say nurses have a great deal of influence in reducing medical errors and improving patient safety
• 18% say nurses exert a great deal of influence on increasing access to care, including primary care.
• 39% say nurses will not have much influence on reforming health care over the next 5 to 10 years, compared with 10% of MDs.

Nothing new here to most nurses. We continue to have to be vigilant about whether nurses are included at decision-making and advisory tables, as speakers at national and regional conferences on quality and safety in health care, and on boards of health-related organizations. The next time you’re in a meeting on health care, look around the table and ask whether nurses are included — and not just a token RN. If they aren’t, ask why not and call for RNs to be appointed. Organizations and the nation are missing out if we don’t all change our expectations about who is at the table.

Every January, new billing rules and rates go into place for physicians’ services as part of the annual update to Medicare’s Physician Fee Schedule. Dominating DC health policy concerns in this arena are the medical community’s efforts with Congress to address Medicare’s cost-of-living adjuster, known as the “sustainable growth rate” (SGR), which would have lowered 2010 fees across-the-board by 21 percent, if not for a last-minute temporary stay through the end of February. Negotiations with Congress are on-going to provide a long term or multi-year solution—a costly “fix” that I believe is well worth the price to keep physicians in the Medicare program, and seems to have widespread support.

Getting much less attention is a unilateral policy pronouncement made by the Centers for Medicare and Medicaid (CMS) that Medicare will no longer pay specialists a higher rate for consultations—services often provided by specialists like cardiologists and neurologists. Instead, all physician visit services, whether defined as “evaluation and management” (E&M) services or consultations, will be reimbursed at the same E&M rates. (more…)

Disruptive Women blogger Tamar Abrams shared this glimmer of hope from Haiti. It’s an NPR profile of her sister-in-law, AK, who has been delivering babies in Haiti.

Amid Death And Destruction: New Life In Haiti

Despite the grim scene in Haiti, life, for some, goes on. NPR’s John Poole and Joanne Silberner have been embedded with the Massachusetts 1 Disaster Medical Assistance Team in a field hospital in Port-au-Prince.

Obstetrician Anne Kathryn Goodman oversees births at the Health and Human Services field hospital. As of Friday morning, Jan. 22, six babies had been delivered at the field hospital. Poole and Silberner were there to document the delivery of little Sampson Brazile.

Hear Silberner’s story:

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View photos on NPR’s Picture Show Blog

Although Sampson’s parents were relieved after 2 1/2 hours of labor, they look to the future with anxiety. The father, Tony Jean, used to work in a textile factory before the earthquake. But the factory has collapsed and he and his wife do not know what they will do after they leave the field hospital. The Haitian government plans to move 400,000 earthquake victims from the shattered capital to camps in outlying areas in the coming weeks. In the meantime, earthquake relief continues to trickle in slowly.

— Claire O’Neill

Source: NPR’s Picture Show Blog

The following guest post by Debra Gordon, an award-winning freelance medical writer, was recently featured on the Better Health blog. The original post can be found on Debra Gordon’s Musings on Medicine and Health Care blog.

Back in the day when I was a newspaper reporter I completed a biomedical ethics fellowship at the University of Virginia Medical Center in Charlottesville, VA. In addition to sitting in on the hospital’s bioethics committee discussions, I spent much of the week shadowing a nurse in the ICU.

They called her the Death Nurse because her job was to intervene with doctors, nurses, patients and families when the time came for a patient to move from the ICU to hospice. While her title was Supportive Care, she flat out told her me her job was to help people die; not actively, but from behind the scenes by helping patients and those caring for them understand when the time had come to move from curative care to supportive care (email me if you’d like a copy of the article I wrote about her).

When I asked why her job was necessary, she told me it was because it was so hard for doctors, nurses, patients and even families to face the reality of death. Her thoughts were echoed by a doctor there who was completing a critical care fellowship: “A lot of us don’t know what to say because we’re so uncomfortable with death,” he told me. “When someone who is not part of the team says this is ridiculous, it’s time to stop, we listen.”

I bring this up because I completed that fellowship 13 years ago. One would hope that things had changed since then, that more openness and discussions about end-of-life care would have moved us towards a recognition that sometimes death is not a failure, but a success. Unfortunately, however, that doesn’t appear to be the case. Last week, a study published in the online edition of the journal Cancer on the results of a national survey of physicians caring for cancer patients found that most doctors aid they would “not discuss end-of-life options with terminally ill patients who are feeling well, and instead would wait for symptoms or until there are no more treatments to offer.”

Why? Why not talk to your patients about how they want to die, just as you talk to them about how they want to live, how they want to address their disease? Why not talk to them about how you will manage their pain and keep them comfortable as death approaches? How you hope this will give them and their families time to  reach closure in their personal and financial relationships. Give them time to come to terms with this next stage of their life.

These are not easy discussions to have. They take time and, for many doctors, additional training. Earlier versions of the healthcare reform bills now pending would have provided reimbursement under Medicare for doctors who had such discussions with their patients; but, of course, cries of “death panels” doomed that component.

So, I ask you, what is the answer? How do we learn to talk about death with one another, to stop fearing it, to understand that there is no way of avoiding it, and to accept that a death we have some control over will generally be a much better death than one that sneaks up on us?

Let me hear your comments.

On Tuesday, Republican Scott Brown won Ted Kennedy’s old U.S. Senate seat — which means the Democrats lost their majority vote in Washington.

There has been a lot of doom and gloom news reports saying that this one election could destroy the health care reform bill. As Fox News reported Democrat Martha Coackley said in her concession speech, “There will be plenty of Wednesday-morning quarterbacking.”

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My mother’s generation lived in fear of diseases we have the privilege to forget.  She graduated from nursing school 60 years ago, in an era when people died each day from diseases that today are physicians have never seen.

Like many from her generation, she is haunted by a sound she will never forget, the sound of an iron lung pushing life into patients crippled from polio who could not breathe on their own. It was a time when polio could not be prevented and the fear of paralysis and death haunted the country.

On April 12, 1955, church bells rang out, kids were let out of school, people danced in the streets. It was great news: Salk’s polio vaccine worked! Fifty years later, as my mother strolled through the National Museum of American History’s polio exhibit, she shared with me the stories of patients as we gazed together at artifacts from those harrowing days.

I was raised understanding the value of prevention and the gift of immunization. In the 70’s, you would find flu vaccine in our kitchen refrigerator, safely stored until the family lined-up for our fall ritual. Dad was always first, reminding the rest of us that needles were nothing to fear. It was a house with limited resources, yet there was always money for immunization. My mother never wanted to see her children suffer the fate she witnessed every day in the pediatric ward of her hospital.

I was reminded once again of these memories as I read the news of the H1N1 vaccine surplus. The good news is that we have enough; the scientists and companies did their part and now it’s our turn. The latest estimate from the Centers for Disease Control and Prevention is that 1 in 5 Americans are vaccinated against swine flu. We can do better than this. Immunization clinics are in abundance and the vaccine is available through pharmacies and in many grocery stores. In many cases, it’s literally just around the corner. Whether near or far, it’s worth the effort to find a clinic and get immunized.

I am lucky. I was raised in a home that understood prevention starts with each one of us. That prevention is a decision that must be prioritized against competing interests. Yes, my immunization card is up to date and I am grateful. Many are not as fortunate. But I have a nurse to thank for this, a nurse who witnessed the tide of history change in her lifetime and ensured her children were protected. This nurse, my mother, still hears in her mind the sounds of an era long forgotten, an era whose lessons are still relevant today. We will always face the challenge of communicable disease and if we are lucky, scientists will discover new vaccines. In the mean time, we should value the ones we have, knowing that prevention is gift not to be taken for granted.

AIDS is here to stay. At least for now…. It didn’t seem that way during the 1980s. As we learned more about HIV and its manifestations, the predominantly male and intervention-driven scientific world organized itself to find a solution within a decade or two. After all, the war against smallpox, polio and other infectious diseases had been won with medicines, vaccines and public health efforts. Well, here we are, way into the third decade, and despite the achievements, the pandemic continuous to grow. What lessons can we draw from the cumulative knowledge, organizational responses and manifestations of solidarity?

The first decade of AIDS was marked by fear, death and loss. AIDS was visible in the faces with Kaposi sarcoma and the wasting of the bodies. We feared the contagion, death, the loss of loved ones, the unknown. And among so much fear, we blamed others: the “4 Hs” (Haitians, hemophiliacs, homosexuals, heroin addicts), sex workers, … even monkeys. Conspiracy theories flourished to explain the origin of the virus: a biological weapon, a laboratory experiment gone wrong. But the first decade of AIDS gave birth to the very essence that made it a disease like no other. A powerful medical model was challenged by participation. A movement was created. Never again would patients be patient. AIDS forever changed the way health would be delivered.

The second decade of AIDS was marked by hope; hope for a treatment, a vaccine, a cure. Science took enormous strides. Antiretroviral therapies created miracles: the Lazarus effect, they called it. HIV became a chronic condition, not a death sentence. While a cure and a vaccine were still to be found, the benefits of the quest advanced all aspects of clinical care. The breath of fresh air that came with so many developments also fueled a stronger coalition. Communities began to take control and demand action. People living with HIV and AIDS showed their faces, let their voices be heard, and influenced program design and policy. Access to treatment became a unified call.

The ongoing third decade of AIDS has been marked by money. The unknown, stigmatized disease that nobody wanted to touch in the beginning of the pandemic came of age drawing the attention of global leaders. New public-private-partnerships such as the Global Fund to Fight AIDS, Tuberculosis and Malaria were created to unleash extraordinary levels of funding. The movement peaked with this expanded response but money did not buy a solution.

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Healthcare (insurance) reform has passed in the Senate and final negotiations are happening before it moves on to the President’s desk for signature. While the legislation is not perfect – in fact some would say far from perfect – it is a piece of legislation that is very much in keeping with our American philosophy, our constant pursuit of progress and change.

As the late Senator Kennedy’s career on Capitol Hill demonstrated, change is usually incremental, usually negotiated and usually compromised. But at the end of the day, change usually amounts to progress.

I see tremendous progress, too, as I look back on a decade’s worth of work to promote access to affordable quality health care using nurse practitioners in the role as primary care providers, thereby alleviating the burden on a strained primary care system.

We’ve come a long way regionally and nationally. The fact that we as a country are always striving to improve our path is what most invigorates me as a relatively new American. Our pursuit of progress is never ending, but it is what sets us apart from most countries in the world. We know our work is never done. As we enter a new year and decade, we always should remember that what makes us different from most people and countries in the world is that we have the freedom to purse progress and make change.

This health insurance reform bill is not the end all or be all, but it will help make affordable health insurance available to more than 30 million Americans who have been without it. Furthermore, the legislation contains many provisions for others who fall through the cracks and will need additional care and support.

That’s progress for individuals, families and America, as Walt Disney would have said. And not until you take a ride on the Magic Kingdom’s The Wheel of Progress will you truly appreciate how important it can be to take even a small step in the right direction.

Happy New Year! And a toast to a New Decade and our new Pursuits of Progress for individuals, families, and our country.

I am fairly confident that most women—certainly those post-menopausal or peri-menopausal—are aware of the extensive media coverage and dire warnings following the release of the results of the Women’s Health Initiative (WHI) study on hormone replacement therapy (HRT) in 2002.  At that time, it was stated that HRT is detrimental to a woman’s health, with risks outweighing the benefits.  It stated, pretty unequivocally, that HRT increased risk of breast cancer, cardiac events and stroke.

It would be overstating to say that all of the 2002 results were inaccurate, since, as we know, science is rarely definitive and more information is constantly emerging and being revised; however, women should know that many of the initial results have been found to have been distorted, misunderstood, over-generalized, and in some cases flat out wrong.  While the updated findings have been published in various scientific papers and journals, the mass media continues to refer almost exclusively to the 2002 WHI negative results.  Having received the attention they wanted, they have moved on.  But what if some of the findings turned out to be wrong…

A few recent examples highlight this continuing problem of misinformation:

-The New York Times recently published an article on what is currently known about what causes cancer and what prevents it.  The underlying thesis was that we know very little, but two things we do know:  first, that smoking causes cancer (okay, we can all agree on that); second, that HRT causes breast cancer.

-A November 29 article on sex and menopausal issues, also in The Times, stated that many women stopped taking hormone therapies because of their link to small increases in breast cancer, heart attacks and strokes.

-A November 12 article in HealthDay News posited that the “declining use of HRT” may be driving down rates of a condition called atypical ductal hyperplasia—a known risk factor for breast cancer.  Other articles have gone even further, to say that the incidence of breast cancer is down for the same reason.

Seemingly no one in the mainstream media is quoting the analyses and research that questions all of the 2002 results.  For example, in an article published in The Cancer Journal in 2009, Dr. Avrum Bluming, Clinical Professor of Medicine at the University of Southern California and Master of the American College of Physicians, along with Dr. Carol Travis, debunk many of the previous 2002 research findings.  Their work joins a growing list of reports on the WHI results and newly published research studies, chipping away at the theory that HRT is bad for all women, all of the time.

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As we all know, children can’t speak for themselves, but if they could, they’d probably point out the obvious: they need more attention.    There have been some great strides over the years and some compelling examples such as those shown in Bill and Melinda Gates’ Living Proof project and the Measles Initiative.  In the recent installment of Raj Shah, the new USAID Administrator, he touts the progress that his new agency has already made in preventing unnecessary deaths.  He is pragmatic and encouraging as he also says that much more should be done.  To save more lives, we need to make sure the US investments are there. Look at the numbers: More is needed to ensure two leading childhood killers are addressed.  More global funding is needed for new vaccines such as pneumococcal and rotavirus vaccines offered through the GAVI Alliance to prevent much of the disease in these at risk children.  Vaccines can’t do the whole job, so inexpensive treatments such as antibiotics or oral rehydration therapy are also needed along with training of health workers to prescribe or education of parents to seek care – certainly not impossible, but requiring some effort and focus.

Sources: US Global Health and Child Survival Budget, 2009 and UNICEF, State of the World’s Children, 2008

Now is the time to speak up and insure that the right investments will be made.  Please Call to USAID to take action on pneumonia and diarrhea.  You can submit a letter to Dr. Shah both welcoming him and asking for him to speak up for children.  Visit: http://www.change.org/actions/view/call_to_usaid_to_take_action_on_pneumonia_and_diarrhea.

The following guest post on the subject of cervical cancer screening guidelines is written by Susan Wysocki, WHNP-BC, FAANP, president and CEO of the National Association of Nurse Practitioners in Women’s Health and Susan Scanlan, chair of the National Council of Women’s Organizations. The article below initially appeared on America Media Forum’s website.

It’s not surprising that women are confused about the recently changed recommendations for cancer screening and prevention. New guidelines from the American College of Obstetricians and Gynecologists (ACOG) – the leading medical group that provides health care for women – say women should wait longer to begin cervical-cancer screening and that they should be screened less frequently. On the heels of similar changes to breast-cancer screening guidelines, it’s understandable that many women might see this as a step backward.

On the contrary, the new cervical-cancer screening recommendations reflect advances in our understanding of this disease and in tools now available to prevent it. More importantly, they present an opportunity to educate women about the significant opportunity we have to further prevent – if not eliminate – cervical cancer.

New ACOG screening guidelines recommend women should begin getting Pap tests at age 21 (as opposed to within three years of becoming sexually active) and that, from ages 21 to 29, most women should have Pap tests every two years instead of annually. Additionally, screening for women 30 and older with a history of normal Pap test results now moves to every three years.

To understand the rationale for these changes, it’s important to first know how the disease develops. Cervical cancer is caused by “high-risk” types of the human papillomavirus (HPV), a common sexually transmitted infection. Most women will have HPV at some point in their lives, but their immune systems will typically clear the virus without symptoms or treatment. HPV infections that persist over time – typically many years – can cause cell changes that can potentially lead to cervical cancer. Because cervical cancer is slow-growing, it generally allows ample time for screening to detect problems that can be treated before the cancer can develop. The majority who die of cervical cancer in the U.S. have either never been screened or have not been screened in many years.

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It is with tremendous excitement and a great deal of pride that I introduce our newest Disruptive Women in Health Care bloggers.

As we welcome in 2010, we also welcome our newest colleagues–women with unique experiences, vast knowledge, and extra-ordinary accomplishments:

	Agnes Binagwaho, MD, the Permanent Secretary of the Ministry of Health of Rwanda, is a pediatrician specializing in emergency pediatrics, neonatology, and the treatment of HIV/AIDS in children and adults.
	Psychiatrist Arletty Pinel, MD, an expert with decades of global experience in sexual and reproductive health, is the Director of SurGlobal, a special new program on health and development at the International Center for Sustainable Development in Panama.
	Beatriz de Faria Leão, MD, PhD, who has been in health informatics since 1980, is a founder of the Brazilian Health Informatics Association with expertise in the areas of standards and electronic health records.
	Karen H. Nielsen, MBA, MPA, is President of Nielsen & Associates, LLC, has worked in the health care field for over 20 years, and is predominately focused on collaborative efforts between private and public organizations.
	Lois Privor-Dumm, IMBA, is the Director, Alliances and Information for the International Vaccine Access Center at Johns Hopkins Bloomberg School of Public Health.
	Michele Barry, MD, FACP is the Senior Associate Dean for Global Health and Director of Global Health Programs in Medicine at Stanford and serves as the health consultant for the Ford Foundation overseas programs.
	A national leader in patient safety, Rosemary Gibson is a writer, strategist, and thought leader in U.S. health care with a new book, The Treatment Trap, which puts a human face on overuse of unnecessary medical treatment.
	Sally Stansfield, MD is the Executive Secretary of the Health Metrics Network (HMN), responsible for managing the technical and financial contributions of HMN partners to accelerate reform of health information systems for improved health outcomes on behalf of the Network and its host, the World Health Organization (WHO).
	Co-founder and Executive Director of the Convenient Care Association, Tine Hansen-Turton, MGA, JD, is also Vice President at the Public Health Management Corporation (PHMC), and has earned a reputation as an effective change agent, systems-thinker, social innovator and policy advocate.

Learn more about our new bloggers, as well as all the Disruptive Women.

Healthy New Year everyone!

Like many people I’m starting the year with healthy – and preventive care – intentions. How about you?

That put a few items on my holiday ‘to do’ list:

• Get a pap smear,
• Find H1N1 vaccine,
• Wrestle the results of a recent bone density scan (Dexa) out of the hands of the medical center and into the hands of my physician, and
• Confirm with Morris White, my trainer, that I’d continue workouts.

The pap smear was easy – this time. I’d not been able to get one during my late-summer vacation visit to the doctor because the appointment was two weeks prior to the annual date of the prior test. That required another trip. Holiday downtime was a good time to do that. Check that off the list.

In doing so, I finally found an H1N1 vaccine dose! Getting a seasonal flu shot was easy at www.phillyflushots.com, but even after calling several immunization providers and both of my physicians at least twice monthly since H1N1 became available, checking websites and following news reports of shots at pharmacies – well, no success. Luckily, my doctor had just received a few doses of H1N1 that day of the pap smear. Check that off the list.

Results of a bone density scan months ago had still not shown up at my doctor’s office. Holiday time was a good time to badger for the ‘results,’ though it was hardly worth the trouble. Turns out  my physician is not part of that medical center’s ‘network’ and can’t get detailed results. Only a note: ‘normal.’ Sorry, that’s not good enough. Neither my physician nor I know whether there has been any change in bone mass since prior tests. Sure, the test results might be ‘normal,’ but the measures might also be trending in a direction that means I’m losing bone mass, something we both should know about. No check there, still on my list.

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Disruptive Women is thrilled to announce our January Man-of-the- Month, Greg Simon, Senior VP of Worldwide Policy at Pfizer.

Greg has served as a senior congressional staff member in both the House and the Senate, was the chief domestic policy advisor to Al Gore, and is past president of Faster Cures.

And now, Greg is Senior Vice President, Worldwide Policy, Pfizer Inc. As such, he leads a global team of professionals in a number of areas including (1) worldwide government policy (2) science policy (3) economic policy and research and (4) international policy.

At the moment, Disruptive Women was interested in his role advising Pfizer’s CEO about the company’s involvement in health care reform.

Greg shared a DVD of a recent speech he presented at a Pfizer legislative conference. In a 25-minute talk we saw why he’s so good at enacting legislative change — he exudes energy and enthusiasm—and he cares about patients. As a motivated, savvy policy and legislative expert, when he talks, you just feel like the right changes are going to be made. Soon.

“Healthcare reform should be about patients,” he told the audience.

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