I learned from Dr. Neumann that cost these high cost estimates are most strongly influenced by reduced productivity in adult workers with ADHD rather than direct costs of treating children with the disorder. Productivity costs include absenteeism, and reduced work output due to difficulty focusing. Dr. Neumann explained that ADHD has many “spill over effects” in that it impacts the educational system, the justice system, the healthcare system, and our work environments. Please check out our interview video for the full story.

Congressman Tim Murphy is a clinical psychologist with three decades of experience in treating people with ADHD. He is also Co-chair of the Mental Health Caucus and GOP Doctors Caucus where he regularly works to raise awareness of healthcare accessibility needs. I had the chance to interview him also at the event.

I learned from Rep. Murphy that the costs of ADHD multiply when patients are untreated.  Getting the correct diagnosis is critical, because impulsivity and problems with focusing are not always caused by ADHD. These symptoms can be caused by lead poisoning, damage to the limbic system of the brain, metabolic disorders, or even sleep apnea. Children who are inattentive should not be put on medications for ADHD without first confirming the diagnosis by ruling out other possible causes.

Rep. Murphy recommends a team approach to the management and treatment of ADHD and he believes that costs related to ADHD are escalating because some physicians are not managing children holistically, but resorting to prescribing medications without involving counselors and family directly. He sees lack of health insurance coverage for behavioral health services as a threat to comprehensive and effective ADHD treatment.

Please watch the video for the full interview with congressman Murphy.

This post originally ran on the Better Health blog on December 14th.

Realizing the seriousness and magnitude of the problem, SWHR began a multi-year program for women veterans in 2008 when we hosted a conference entitled, “PTSD in Women Returning from Combat Areas.”

SWHR’s president twice testified before the House Committee on Veterans’ Affairs on the important topic of enhancing healthcare services for women veterans and the need for research into sex differences that influence the unique health issues military women face.

In February 2011, SWHR launched Fatigues to Fabulous™ (F2F), an ongoing national campaign to honor and support female veterans as they transition home. Collaborating with veterans’ service organizations and the fashion industry, SWHR is raising awareness about the unique physical, emotional, and psychological challenges female veterans face, and is working to harness resources to support them.

A SWHR scientific conference in July 2011 “What a Difference an X Makes: The State of Women’s Health Research – A Focus on Female Veterans” brought together researchers and clinicians to discuss research gaps and clinician care options for military women.

SWHR believes sex differences must be researched in order to better understand the causes, prevention and treatment options needed to improve the health of the 1.8 million American women returning from combat zones.

Your donation will help us fund and advocate for vital research into sex-based differences in military health, educate the public on this critical issue, and support veterans’ organizations that provide important services to women veterans.

This Veteran’s Day, please show your support for women veterans by donating to SWHR at swhr.org or purchase an exclusive Fatigues to Fabulous^TM watch designed by DKNYC. The watch, featuring traditional military “dog tag” imagery in multiple colors, is available only through HSN.com.  For each watch sold, a donation will be made to SWHR to support F2F.

Thank you from all of us at SWHR.

In Is the Foreclosure Crisis Making Us Sick? published by the National Bureau of Economic Research in August 2011, Janet Currie and Erdal Tekin find that the number of foreclosures in a community is associated with increases in medical visits for mental health (anxiety and suicide attempts), preventable conditions such as hypertension, and a long list of stress-related diseases.

Furthermore, more foreclosures in an area are most harmful on people age 20 to 64, and disproportionately impact African-Americans and Hispanics compared to whites.

The map shows the “heat index” for areas with the most home foreclosures: the redder, the higher the foreclosure rates in the state. Currie and Tekin focused on four of the hardest-hit foreclosure states: Arizona, California, Florida and New Jersey. They combined foreclosure data from 2005 to 2009 with data on ER visits and hospital discharges at the zip code level.

Health Populi’s Hot Points: Previous research has looked at the link between health and the house mortgage crisis, finding that unhealthful behaviors are often used to cope with stressful life events. Such negative coping behaviors include tobacco use, alcohol consumption, sleep dysregulation, and weight gain perhaps via decreased physical activity. For more on these impacts, see the 2009 essay in PLOS Medicine by Gary Bennett et. al. called, Will the Public’s Health Fall Victim to the Home Foreclosure Epidemic?

The health of a nation’s macroeconomy clearly impacts the health of the household’s microeconomy – not just of a parent but on children’s health, as well, according to Currie and Tekin.

This study connects the dots between personal finances and health, which is a connection that people make for themselves. The first Edelman Health Engagement Barometer identified that people define their health and wellness across several dimensions: physical health, mental health, appearance, and financial health.

This study raises many points for both health and economic policy which are inextricably linked. First is the rationale for universal health insurance coverage provides a health safety net for all health citizens, can help stem the negative impacts of unemployment in a community and the longer term downstream health costs that increase when conditions aren’t prevented and managed. Second is the importance of COBRA and unemployment insurance payments, the latter of which often can’t cover the former (see this post describing that financial disequilibrium).

Finally, the relationship between economic development and population health has been long documented. As the U.S. economy continues to lag — and the “recovery-less recovery” continues to continue — the public’s health will be in jeopardy, particularly in minority communities.

This scenario also reminds us of the connections between people that Christakis talks about…Health is Contagious, and vice versa.

Originally posted on Health Populi.

The following is a guest post from blogger and writer Amanda Kidd. She is a regular follower of healthy living her health guide includes all the health related topics. Amongst all she likes to write on sexual health a lot:

Sexual urge or the libido is a natural phenomenon in men and women alike. It is widely believed and understood that couples enjoy intimacy more in their young age rather than in matured stage of their lives. Though apparently this may be a well accepted notion and may also look very true, the research indicates otherwise.

Sexual urge in older women, or middle aged women, is a subject of immense interest and research amongst the scientists and researchers all over the world. What happens to the sexual drive of a woman when she crosses the threshold of 30 and enters into the middle age era? Does she feel bored? Does her desire begin to wane? Or is it that sexual urge in women has no age bar? And at any point in time they remain equally active, if not more than the man?

An article published in a health magazine in UK suggests that middle aged women show more urge for indulging in sex than their younger counterparts. Elaborating further on the sexual drives and sexual health of older women, the article claims that these women are also more willing than younger women to have sexual escapade!

As you age, definitely there are going to be hormonal, psychological and physical changes in your body. You may not find yourself as interested or inclined to have fun in the bed. On the other hand, you may be surprised to see yourself attracted towards your partner even more than ever. The sex drive may blossom the way flowers blossom in the season of spring.

A study conducted by a US University last year throws up some interesting facts about spring bringing with it a glance at older women’s sexual health. You may be surprised to know that contrary to the common conception, from amongst the 2000 women surveyed, 43 percent of women aged 45 to 80 reported moderate sexual desires and 60 percent had been sexually active in the previous three months.

Being sexually inactive is also a problem amongst many women – reasons varying from lack of interest in sex to lack of partner to physical problem of the partner to lack of interest by partner to having some personal physical problems.

You must not hesitate in consulting a doctor or a psychologist or a clinician if you fall under any one of the aforesaid categories. And doctors on their part should consider women’s overall health when addressing the concerns about sexual inactivity amongst elder women. They are supposed not only to focus on the women’s health and general well being, they should also take into consideration partner issues to solve the problem.

As a middle aged woman if you realize that you are confronting physical and emotional changes of aging and unable to maintain a satisfying sex life, you need to talk to your partner about it. Instead of trying to find ways to get back to the level of sexual activities you enjoyed as a youth, try to find ways to optimize your body’s response for sexual experience. Negotiate a way out which is mutually satisfying.

Love matures with age, they say, and so do your drive for sexual satisfaction. Maintaining sexual health is state of mind and you can remain in pink of your sexual health if you believe that you will be seventeen till your last breath.

Written with reporters in mind, “Covering Health Issues” is useful for anyone looking for concise information on health policy issues, and experts from across the political spectrum. Chapters contain fast facts, background, tips for reporters, story ideas and experts with contact information. The book also includes an extensive glossary, ideas and examples for TV and radio reporters, and links to polls on health issues. Supported by a grant from the Robert Wood Johnson Foundation.

To see a video demonstration of the book by Julie Rovner of NPR, click here. To see individual chapters, click on any of the chapter titles below. To download the entire sourcebook as a PDF, click here.

For all chapters, links are available to local news stories on the chapter topic. For many chapters, there is also a short video featuring one of the nation’s top health policy experts.

Table on contents:

• Introduction and Acknowledgments
• Health Reform
• Cost of Health Care
• Quality of Care
• Employer-Sponsored Health Coverage
• Individual Health Coverage
• Children’s Health Coverage
• Medicare
• Medicaid
• Long-Term Care
• Disparities
• Mental Health and Substance Abuse
• Public Health
• Polls on Health Care Issues
• Covering Health Issues for TV and Radio
• Acronyms and Glossary
• Experts
• Websites

The Alliance for Health Reform is a nonpartisan, not-for-profit health policy education group. We are committed to helping journalists, elected officials and other shapers of public opinion understand the roots of the nation’s health care problems and the trade-offs posed by various proposals for change. Our aim is quality, affordable health coverage for all in the U.S., although we do not lobby or take positions on legislation. Sen. Jay Rockefeller (D-W.Va.) is our founder and honorary chairman; Robert Graham, MD, of the University of Cincinnati is our board chairman.

By Jenni Sunde. The benefits of a sound mind and body can be traced all the way back to ancient Greco-Roman cultures.  Despite how long the concepts behind mind and body connection have been around, they are frequently overlooked in our modern society.  The connection between mind and body is particularly impactful for adolescents; studies have shown that happier youths are indeed, healthier youths.

Emily Shaffer Hudkins and her team of researchers at the University of South Florida conducted a study that focused on the impact that positive emotions, moods and overall satisfaction with life has on the health of teens.  Her research shows that these positive feelings, also known as subjective well-being are more significant than depression and anxiety when it comes to physical health.  Psychopathology has long been where the emphasis is placed when it comes to determining how the mind and body are connected. 

Hudkins conducted an experiment with 401 students, grades 6-8 from a suburban southeastern middle school in the US.  She monitored both their subjective well-being and psychopathological tendencies.  The study asked questions about the teens’ satisfaction with life; whether they were strong, proud and excited, and whether they felt lonely, guilty, or sad.  What Hudkins founds is that good mental health most often is linked to good physical health.  Mental health indicators explain roughly 30 percent of the difference in physical health ratings.  The findings show that subjective well-being has a significant, unique and primary affect on predicting important physical health outcomes in youth.  In other words, subjective well-being is more strongly associated with physical functioning than psychopathology.

What Emily proposes is that we change our wellness models to ones that are more holistic, so as to incorporate the entire spectrum.  With current standards, the subjective well-being is often overlooked in terms of its impact on physical health when it actually is more prominent than poor mental health in terms of how much it can affect the body.

But now we’ve learned that the woman playing Velma Kelly and other memorable roles is, in actuality, a very vulnerable individual facing significant challenges in her life.  Her publicist announced on Wednesday that Zeta-Jones had checked herself into a mental health clinic for treatment of a bipolar disorder.

Juxtaposed this week with the actress’s revelation was a study released by the U.S. Centers for Disease Control and Prevention pointing out that suicide rates among working-age Americans rise and fall based on economic cycles, the implicit warning being that incidences of suicide can be expected to increase during the difficult economic times currently affecting so many households.

With this disturbing report in mind, there is no question that Zeta-Jones performed a valuable public service this week.  She reminded us that there is and should be no stigma attached to admitting the need for behavioral health counseling.  By being frank about her illness and her need for professional health care, it can be hoped that she has made it a little bit easier for others to do the same.

The fact that she is currently involved in two movie productions also underscores the fact that a behavioral condition does not preclude a productive life and career.

In such stressful times, mental health support is an area that requires diligent monitoring by both policymakers and business leaders.  Good news was found in a survey released last fall by the Kaiser Family Foundation.  Kaiser found that, in response to implementation of Mental Health Parity Act passed by Congress in 2008, one-third of employers with 50 or more workers made changes to their mental health benefit packages.  Of those, 66 percent eliminated limits on coverage and only five percent dropped coverage altogether.

Not diminishing the financial difficulty of maintaining quality health coverage, but employers have a great deal at stake in maintaining behavioral health benefits.  Mental health has been cited as one of the leading causes of absenteeism and lost productivity in the workplace, making the case that behavioral health support is a sound investment.

And, as Catherine Zeta-Jones demonstrated this week, when that support is available, individuals in need of assistance shouldn’t hesitate to utilize it.

Yet, to some such concerns and crises seem insignificant or trite in comparison to recent headlines such as those about the Tsunami, earthquake and nuclear reactor explosions in Japan; Haitian elections; social unrest and justice in Egypt and elsewhere; and attacks in Libya. Or the ongoing headlines about the economic meltdowns on Wall Street; bank, savings and loans failures; or the continuing high unemployment statistics; and plummeting real estate values.  Or even NCAA March madness.

Although, there has been periodic news and media attention on teen and school bullying and some new efforts are in process to take a look at this growing challenge.  It  has been in the past several weeks, months and years, that I have learned about adolescent mental health services along with a bit about the legal/justice and educational systems.  Having worked in the health care “system” for almost 35 years, I thought that I was fairly well informed…I was wrong.

Maybe it was the early morning phone call stating that the teen was being taken to the county emergency crisis unit.  Or how about the parent who called 911 and was (thankfully) coached to “say the right thing” because the teen was standing in the house with two huge kitchen knives pointed at himself? Or the parents who got the phone call asking them to come down to the police station because of their teen’s arrests at an underage drinking party. Or the parents who came home one night and found their teen unconscious suffering from what turned out to be alcohol poisoning.   Or maybe it was the parents whose teen jumped out of the window at her therapeutic boarding school in spite of the promise of 24/7 supervision?   Or maybe it was the crisis center stating that given the history the teen needed to be evaluated at an emergency department because the teen posed a safety threat to self? Only the crisis center did not seem to know any local “teen-appropriate EDs”.

Or how about the crisis counselor/intake provider who was heard to say that could not complete the intake because she had to leave for the day?   Or the provider who stated that she had not paid much attention during the intake meeting because she did not think that the patient was going to be assigned to her?    Or the crises counselor who kept placing the family on hold during information gathering phone calls.  Or the discharge planner who claimed she could only find out information about one outpatient program at a time because she was too busy?  Or the physician who said he had indeed seen the patient the day before  even after the unit director clearly stated otherwise?  Or the physician who did not “see” the patient for two days in a row but was getting ready to discharge the patient to a yet to be determined out patient provider/setting?  And telling the family that the patient would be placed in county protective custody if the family did not agree to the discharge? 

• What is the likelihood that your school and its student guidance counselors would recognize a crisis when faced with one?  What school- and community-based interventions and resources are available in your area?
• Would you recognize alcohol or substance abuse? Depression? Rage?  Suicidal thoughts?   Or would you assume that “teens will be teens”? Faced with an emergency or crisis what would you be prepared to do?  What actions would you be comfortable taking?  Would you know if there are resources available in your community, such as mobile crisis teams who may be able to come to your home and assist you or your family member?  
• Which hospital or crisis center or ED would you go to?  Would you know if any nearby facilities have a “good” pediatric-adolescent mental health focus?   Which facilities have units to specifically care for adolescents?  Or are the teens “mixed in” with adults?  And are the staff specifically trained to work with adolescents?   
• Would you understand the differences between voluntary and involuntary mental health related treatment/care/admission? Would you know that there are   differences between partial hospitalization programs (PHP) and intensive outpatient programs (IOPS) and where such programs are located? And when you do find programs why do “the good ones” all seem to have dozens and dozens of people on their waiting lists while at the same time they all seem to have small program capacity?

Let’s face it in the middle of a crisis is not the time to compare “evidence based” practice or interventions. Nor is it the time to figure out which facility/provider offers the best chance for good outcomes.   In fact, finding resources and services is not easy under any circumstances and definitely not while you are in the middle of a crisis or emergency.

Resources:

• Association for Behavioral and Cognitive Therapies Society of Clinical Child and Adolescent Psychology Evidenced Based Mental Health Treatment for  Children and Adolescents   
• American Academy of Child and Adolescent Psychiatry  
• National Suicide Prevention Lifeline More than 150 crisis centers currently participate in the National Suicide Prevention Lifeline network. Each center receives calls from designated areas of the country, creating a nationwide coverage area. Calls to 1-800-273-TALK are routed to the closest available crisis center.
• National Alliance on Mental Illness (NAMI)  is dedicated to improving the lives of individuals and families affected by mental illness.
• National Institute on Drug Abuse
• National Institute of Mental Health 
• National Library of Medicine Medline Plus

Blogger Concetta Tomaino who participated in the December 1st Event is truly a disruptive woman as described in the post below. 

By Hope Ditto. We’re used to our Disruptive Women bloggers being on the cutting edge in their fields and doing amazing things every day. We’re used to them saving lives, fighting for those without a voice and revolutionizing the world around us. Still, it’s not every day that a major motion picture being featured at the world-famous Sundance Film Festival is directly connected to their work.

Not that we’re bragging, but we feel pretty fortunate to call Dr. Concetta Tomaino, D.A., MT-BC, LCAT, one of our own these days. Besides having her work featured in The Music Never Stopped (and having Julia Ormond, the actress playing the music therapist in the movie, consult her on the role), Tomaino is internationally known for her research in the clinical applications of music and neurologic rehabilitation. The Executive Director and co-founder of the Institute for Music and Neurologic Function and Senior Vice President for Music Therapy at Beth Abraham Family of Health Services, Tomaino works tirelessly to bring new understanding to the field of music therapy by working with neuroscientists to determine the effects of music on the brain.

Tomaino and her colleagues use music to treat a myriad of illnesses, injuries and conditions – from Alzheimer’s to Autism, brain injury to mental retardation. At the Institute for Music and Neurologic Function – which she co-founded – music therapists work to treat all of these things and more, using the power of music in different ways and to different effects.

As Connie explained, “For someone suffering from Parkinson’s or recovering from a brain injury, music can be a gateway to speech. They may not be able to speak words, but they often can sing lyrics to familiar songs. Whereas, for a child in the pre-language stage of development, who suffers from say autism or has a mental retardation, we can use music to help them gain an understanding of communication.”

The Music Never Stops is one such success story of music therapy. Based on the essay “The Last Hippie Standing” by neurologist and Beth Abraham colleague Dr. Oliver Sacks, the movie portrays a family coping with their estranged adult son’s grim prognosis following surgery to remove a large brain tumor. Without an ability to discern past from present from future and with little hope for improvement, the father discovers music therapy and seeks out a leading music therapist (a character inspired by Dr. Tomaino’s own work with the patient who inspired the film) known for her success with similar cases. Together, the father and son reconcile through music and memories, and with the help of music therapy. Set in the 1960s and 1970s, against the backdrop of the Vietnam War and the tumultuous protests, the film is culturally, intellectually and emotionally resonant. And apparently quite good, as it was purchased by Roadside Attractions almost a month before its Sundance premiere (full story here).

That’s not the only big news Tomaino and her colleagues are celebrating in 2011. Just recently, there was a major breakthrough in the field of music therapy, when neuroscientists at McGill University discovered that listening to “good” (definition forthcoming) music “changes the chemistry in the brain by boosting the pleasure chemical, dopamine,” (per ABC).

For Tomaino, this was the breakthrough she’d been waiting a lifetime to realize. Not only is her institute’s mission to do just this – pinpoint a medical reason why music heals by determining the effect that listening has on the brain – but it has been her primary focus since undergrad.  

Neuroscience helped to provide the scientific basis for what Tomaino and many others already knew — that music has a unique and awesome power to heal – but, as she is quick to remind you, “Neuroscientists are not the ones doing the treating!” It is music therapists who work to integrate music and other more traditional therapy techniques in order to treat patients young and old. Still, she is excited about this and about the future of the field, which she says is at a crossroads.

“Twenty-five years ago, neurologists couldn’t study music. But in the last five-six years, it has become the hot topic of neuroscience. People don’t believe that the things we say we do here [at the Institute] are possible, but by researching collaboratively [with neuroscientists and music therapists], we are able to prove ourselves, our work and our methodology once and for all.”

The Music Never Stops premieres today (Friday, January 21^st) at the Sundance Film Festival in Park City, Utah. For updates about the film and upcoming opportunities to see it in a theater near you, check out their Facebook page.

I have testified three times before Congressional house committees and the most recently on Military Sexual Trauma (MST). Approximately 22% of the women in the military have reported to the VA centers sexual assault or harassment, that is just the women who have left, no one  knows how many currently in the military have been affected and we know that many women who leave active service don’t seek help at the VA for various reasons, one of them being a predominately male culture. So the 22% is a low estimate, some feel it could be twice that number.

The ramifications of MST for women persist long after the initial assault. With most MST assaults being orchestrated by military personnel against military personnel, the environment of trust among those serving is broken, and a chain of command that fails to protect from and respond to MST further degrades unit cohesion.

So, every time I hear the “morale” issue as an excuse I think about the women in the military and  why is it that everyone is so concerned about gays able to serve openly  but not the morale of the women serving our country who are vulnerable to MST while risking their lives for us.

I find this an instructive analog to the first fatal flaw in health care for profit. If I am engaged in such an enterprise, I am obligated to make a profit. Each year I am expected to meet or exceed last year’s profits. That requires that I continuously decrease expenses and expand my yield. If I fail to do so, I will go out of business or at least lose my stockholders and my stock value. I can never let up on profit expansion. My first best option in decreasing expenses is to cut back on major categories, such as personnel, the big budget item.

I then demand greater productivity. We did this in health care in the 90s when our national average for cutting nursing personnel in hospitals was 9%, while concurrently shortening length of stay with concomitant dramatic increases in patient acuity. Greater productivity not only evokes employee dissatisfaction; it also leads to stress, fatigue, and ERRORS. These errors are expensive. We begin to self-destruct. (I would suggest that this is the maze of horrors much of corporate America finds itself in today; most interestingly, they also now have eliminated so many workers that there is no one to buy their products because unemployed people cannot make purchases…see, it is irrational!)

The second fatal flaw that no one acknowledges is of course that another great way to make a profit is to withhold services. Insurance companies understand this. Hence, finding ways to game the system makes sense. They need to make a profit and delivering services costs money. No matter how dedicated they may be to quality health care, it is in their self-interest to deny services whenever they can. It is easiest to do this with the poor, powerless, and disadvantaged. They are less likely to raise a ruckus, and if they do, we can count on dominant groups to ignore them. After all, this profit making is our driving value, we need to serve our stockholders, and there will be acceptable collateral damage in our push to succeed. Besides, poor people might now even know they have received fewer services.

The third fatal flaw for me focuses on the most daunting of patient populations, the indigent mentally ill. No matter how many people sing the praises of Ronald Regan, for me he will always be the man that dismantled care for indigent mentally ill persons, normalized homelessness as an acceptable alternative for these sick persons, and adapted prisons as the “other” alternative to homelessness when necessary.

By definition, indigent mentally ill persons without treatment cannot function. One can make righteous comments about “boot straps” forever and that does not change this fact. As neuroscience, among other great endeavors, unveils how often mentally ill persons cannot “will” themselves into a healthy state, one then has to ask how they can get treatment. Certainly their care will not generate a profit.

The final fatal flaw is the one that I fervently wish would save us from ourselves. Making a profit on the suffering of others is simply obscene. It is inhumane to withhold care from people because they are not likely to generate a profit or their care is too costly. Yes, this is a moral argument, and I am increasingly struck by our collective willingness as a nation to insist that moral conduct is a luxury, perhaps naïve or childish. To take a stance on moral principle is increasingly viewed as negligent of the bottom line. There is something downright creepy about this drift.

This month Reuters published the results of a study comparing “Catholic, other church, investor-owned, and not-for-profit hospitals”. Their results validate my observations to some degree. “Overall, Catholic and other church-owned systems were listed first and second respectively in terms of being significantly more likely to provide higher quality performance and efficiencies to communities than investor-owned systems. Investor-owned systems demonstrated lower quality performance than all other groups.” This report did not make the front page of the Wall Street Journal.

Lest you think I am making the case for government run health care, I would observe that the private sector could control all of health care. In particular, we might want to find ways to preserve our Catholic and church owned hospitals. Perhaps they have value positions that influence their choices…hmmmm.

My argument is that health care should not be a for-profit enterprise. If you have read thus far, I congratulate you. In our current befuddled state as a nation, we are not even having this discussion. It is assumed that health care for profit is the wave of the future. Heaven help our grandchildren!

Our panel this morning discussed the issues surrounding how the WHI results were interpreted and communicated to women and their health care providers. We recognize that hormones are not appropriate for all women, and look forward to hosting a future panel that highlights alternatives.

The speakers have a variety of backgrounds and experiences (and genders), and we aim to promote diversity of voices.

This was not normal breakfast conversation.

Today was a jolting – and disruptive – talk about what happens to women’s bodies when they age. (Who knew that if you’re menopausal and you don’t take your hormones, your vagina can literally dry up and shrink?)

The second in Disruptive Women’s 2010 breakfast series, today’s talk was titled, “News (Hot) Flash: Sex, Drugs & Menopause.” The breakfast at Johnny’s Half Shell, was sponsored by Medco – and we’re happy to say there were two men in the audience this month – double last time.

The breakfast started with a screening of trailer for the upcoming movie Hot Flash Havoc. (Think: Michael Moore tackles menopause.)

“It’s not available in theaters yet – but it will be,” said Disruptive Women’s Robin Strongin, introducing the film.

I’m genuinely sad that the documentary isn’t being released until October-ish. Normally, I don’t want to watch anything at 7:30 in the morning, but the little bit that was shown was so funny I can’t wait to see the whole thing. (Seriously, put it on your Netflix queue now.)

Introducing the speakers, Strongin briefly summed up a woman’s life cycle. “You start out life in this estrogen gel – like a gefilte fish,” she said. “Then you hit puberty, you’re either fertile or you’re not, then you’re pre-menopausal, then menopausal, then post-menopausal. Then you die.”

The talk today focused on the menopausal portion of the life cycle. Phyllis Greenberger, President and CEO of the Society for Women’s Health Research, started off speaking about the Women’s Health Initiative. “There was a lot of misinterpretation, some of the results reported were incorrect,” she said.

She quickly explained what they did, what was wrong, and what’s true today. The Women’s Health Initiative was a giant study of postmenopausal women, testing whether hormone replacement therapy could help prevent cardiovascular disease, cancer, and osteoporosis. The results were different for different age groups – women starting hormone therapy in their 70s had generally bad outcomes (increased risk of heart attack, breast cancer, stroke, etc.), while women starting in their 50s had generally good outcomes. But the results widely reported were the negative ones from older participants – so many women never heard about the rest of the research, or anything we’ve learned since!

The next speaker was Dr. James Simon, a clinical professor of obstetrics and gynecology at the George Washington School of Medicine – and a menopause researcher. (But he will forever be remembered to me as the man who scared the crap out of me about the future health and wellness of my vagina. I may not sleep tonight.)

The Women’s Health Initiative’s results scared a lot of menopausal women into quitting their hormones cold turkey. That, is a very bad idea, he said. Going off hormones makes women unhappy and unpleasant, but more disturbing, he said, “when women go off their hormones their vaginas dry up and get smaller.”

(!)

Which makes sex painful – so women stop having it. And, he says, marriages today have enough problems without eliminating sex (or arguing about it).

“No one wants to have sex when it hurts…. You can’t have good sex with a dried-up vagina. That’s a fact,” he said. “I can give you a two-hour lecture on why the parts don’t work.”

Uhm, great. Go on.

Instead, he told a horrifying story about one of his 55-year-old patients – a prominent writer for the Washington Post, who came to his office for her annual healthy woman exam. He asked her how she was feeling, how were things with her husband, how’s their sex life? Good, good, good, she said. Everything was fine.

Then she put her feet in the stirrups.

“I couldn’t even put the speculum in because it’s too shrunk and dry and small,” he said. “I could barely fit a pencil.”

(I have heard stories about women “drying up” and that if you don’t use it you lose it – but I thought that was just, well, talk. I didn’t think it was true.)

He asked her if she was having sex.

She was silent.

Then she started crying. “She cried and cried,” he said.

Painful dried up vaginas aren’t something a lot of women talk about. “It’s grin and bear it, tough it out, or give it up,” he says.

But, being an honorary Disruptive Woman – he laid it on the table.

And Susan Wysocki, president and CEO of the National Association of Nurse Practitioners in Women’s Health pointed out more menopause-related things a lot of young women don’t know – or talk about. Like, who knew some menopausal women off their hormones are in so much pain they can’t ride an exercise bike, or even comfortably sit down.

“Here we are,” she said, “saving at least one vagina at a time.”

She also discussed the fact that some women worry about taking hormones because they don’t want to get breast cancer. She says that sometimes a woman may have a teeny tiny potential tumor that could go un-noticed for years. But, sometimes the hormones can make it grow big enough to show up on a mammogram. And that way a woman can get treatment faster.

“That can be a good thing,” she said.

For more about menopause, hormone replacement, and the WHI study, you can read:

• Women’s Health Initiative site, National Institutes of Health
• “A Fresh Look at Post-Menopausal Hormone Therapy: Benefits and Risks,” Society for Women’s Health Research, January 2010 (updated April 28, 2010)
• “The Estrogen Dilemma,” New York Times Magazine, April 12, 2010
• Hot Flash Havoc movie site

Don’t miss the next Disruptive Women in Healthcare breakfast, “Childhood Obesity: A Big Fat National Challenge.” May 27 at Johnny’s Half Shell. Reserve your spot now!

Dr. Binagwaho is a pediatrician specializing in emergency pediatrics, neonatology, and the treatment of HIV/AIDS in children and adults. She has served 4 years as Chair of the Rwandan Steering Committee for the United States President’s Emergency Plan for AIDS Relief (PEPFAR), and was responsible for the management of the World Bank MAP Project in Rwanda, while also serving on the country’s High Commission on Aid Policy.

Unfortunately, in the majority of the developing world, mental health is not an issue that is given adequate attention. However, if we take the definition of WHO, mental health plays as important part in overall health as the physical aspects do. To improve mental health, governments have to create a well-trained and well-equipped workforce to care for mental health and ensure that the funding and human and physical infrastructures are available. This will help to increase access to mental health care, but should be completed by making drugs available, like psychotropic drugs. Many of these medications are not so expensive and can be part of public essential drugs available at public health facilities. It is a matter of paying attention to the problem.

Also, the general population should be educated via mass media campaigns so that they will have less fear and a better understanding of mental health diseases and those who suffer from them, causing mental health patients to suffer from less isolation, stigma and discrimination. This can be done by partnering the government with civil society organizations to improve the public education on this issue through TV, radio, speeches, billboards and community events.

Both of these points are vital and necessary if we wish to improve the care of people who suffer from mental illness, because they will encourage the community to send people for care when mentally ill, and when the patient arrives, the health care providers will be ready to give proper care.

This is the system that the Government of Rwanda is creating by having one psychiatric nurse in each district hospital working in an integrated manner with hospital personnel, and by training general practitioners in the diagnosis and treatment of simple mental diseases and in the identification of severe ones so that such patients can be transferred to the national referral hospital for mental health. We also have some psychotropic drugs available as essential drugs, but we still have a long way to go to ensure that every Rwandan in need of mental health receives it.

An extremely important area of mental health care for women is trauma due to conflict situations, where many women are devastated because of rape and other sexual violence, as these health issues are often neglected. Mass rape has been used as a tool for war for centuries, and can be found in modern history as well: from the rape by German and Japanese armies during World War II, to the use of systematic rape and deliberately infect women with HIV during the Rwandan 94 genocide against Tutsis; this: from the rape of women during the Kosovo conflict, to the current use of rape to intimidate and humiliate women in the eastern regions of the Democratic Republic of Congo and through the devastation of their genital organs. For these women, international organizations should play a bigger role, since most of the conflicts are predictable and usual time for rape, sexual abuse and violence and psychological traumas.

In post conflict situations such psychological destruction needs specific attention to rebuild mental health and care for psychological reconstruction as a priority. Instead, the thousands of individual women suffering from this type of trauma are totally neglected and suffer in silence. Furthermore, in some countries these women additionally face stigma because of forced sex and pregnancy out of marriage, and are sometimes even forced to leave their households and villages because of that – doubling their trauma. In this manner, the communities who should be helping these women instead end up being on the same side of the perpetrators of this violence. For the prevention of mental health illness in women post wartime sexual violence, we must do massive behavior change campaigns for tolerance in countries recovering from wars.  That was we did and still do in Rwanda. If not, these women will be denied their basic human rights to gender non-discrimination, to live without violence, and to access care for mental illness and other health issues like STIs, HIV, and genital organ damage.

Over the next two weeks, Disruptive Women and guest bloggers, all experts in their respective field–each representing a different perspective — patient, physician, nurse, pharmacist, researcher, behaviorist, policy analyst, distributor, to name a few–will share their analyses, opinions, and solutions.

At the completion of this series, we will compile an e-book as we did when we tackled the issue of Comparative Effectiveness Research.

THE SCOPE OF THE PROBLEM

A new report, Thinking Outside the Pillbox: A System-wide Approach to Improving Patient Medication Adherence for Chronic Disease, issued by the New England Healthcare Institute (NEHI) found that patients who do not take their medications as prescribed pay a price in poorer health, more frequent hospitalizations and a higher risk of death.

Collectively, noncompliant patients incur up to $290 billion annually in increased medical costs–that’s $290 billion in avoidable medical spending every year, according to the NEHI report.

This is not a new problem, nor is it unique to the US.  In 2003, the World Health Organization (WHO) issued a landmark report entitled Adherence to Long-Term Therapies in which it noted:

Adherence to therapies is a primary determinant of treatment success. Poor adherence attenuates optimum clinical benefits and therefore reduces the overall effectiveness of health systems.

“Medicines will not work if you do not take them.”  Medicines will not be effective if patients do not follow prescribed treatment, yet in developed countries only 50% of patients who suffer from chronic diseases adhere to treatment recommendations. In developing countries, when taken together with poor access to health care, lack of appropriate diagnosis and limited access to medicines, poor adherence is threatening to render futile any effort to tackle chronic conditions, such as diabetes, depression and HIV/AIDS.
This report is based on an exhaustive review of the published literature on the definitions, measurements, epidemiology, economics and interventions applied to nine chronic conditions and their risk factors. These are asthma, cancer (palliative care), depression, diabetes, epilepsy, HIV/AIDS, hypertension, tobacco smoking and tuberculosis.

In the intervening years since the WHO issued its report, adherence has become more problematic.  Numerous reports highlight the ongoing challenges, which are especially critical in the mental health arena.

A study in the American Journal of Psychiatry found that close to 60% of schizophrenics who were prescribed anti-psychotic drugs did not take the medication as prescribed by their physicians.  “We looked at adherence to anti-psychotic medication because they form the backbone of treatment for schizophrenics,” said Dr. Dilip Jesete, co-author of the study.  “These medications are good, but only work when taken properly.”

The study found that psychiatric hospitalizations were higher for people who did not take their medication as prescribed.

When schizophrenics, a disease which affects over 2 million Americans, do not take their medication, they are at risk for dying by suicide.  Four out of ten people who suffer from schizophrenia attempt suicide and one in ten die by suicide.

SOLUTIONS

Despite the complexity of adherence related challenges, a number of promising solutions, innovative responses and well-researched efforts are underway.  Many of these will be described in greater detail in our Drug Adherence series.

Some of these include:

• Text message alerts to remind patients
• Greater use of health care teams
• Integration of health information technology
• Creation of online and offline medication management systems, reminders
• Health e-games
• Insurance reforms
• Public awareness campaigns
• Patient education
• Mobile phone applications
• Research in gender-based barriers

We look forward to your comments and input as we shed light on this critical policy issue.