Have you seen a doctor recently? It’s very common to find yourself waiting in the doctor’s office for at least one to two hours. After filling out some basic information about yourself and about your previous health history, a nurse finally calls you in into a small, brightly lit room where you will sit and wait another minimum of thirty minutes. Once the doctor enters the room, you briefly chat and be examined under ten minutes, if even that. Then you’re out the door with a prescription in your hand.

  • Now imagine that scenario again but double the time you wait and shorten the actual examination period. With the new healthcare in full swing for 2014, you will slowly see changes in the new year of 2013. Even though we’re in our 20s and medicare does not apply to any of us, fortunately, as well as medicaid, it will somehow indirectly effect your next doctor’s visit. The purpose of President Obama’s Affordable Health Care Act is to provide health coverage to those who are uninsured. Those who are without a health insurance will soon be insured by 2014, unless they are willing to pay a fine. In a recent study in American Journal of Medical Quality,Characteristics of Primary Care Safety-Net Providers and Their Quality Improvement Attitudes and Activities: Results of a National Survey of Physician Professionalism,” researchers have found that doctors who willingly accepted uninsured and medicare patients, “safety-net” physicians, may have already reached their capacity of patients that they can see.

In a press release, Massachusetts General Hospital researchers have found that these so-called “safety net” physicians may no longer accept new patients or simply are unable to care for the increased number of patients.

“This study raises very serious concerns about the willingness and ability of primary care providers to cope with the increased demand for services that will result from the ACA. Even with insurance, it appears that many patients may find it challenging to find a physician to provide them with primary care services.” — Eric G. Campbell, PhD, of the Mongan Institute, senior author of published report in American Journal of Medical Quality.

You may think this does not apply to you just yet. However, what will you do if you need a doctor who is unable to see you because of the overwhelming number of patients flooding the office?

Whether you are self-employed or on a payroll, you will experience an increase in medicare taxes. Currently, employers deduct 7.65 percent of your wage to support the elderly and to those with permanent disabilities. And of that, 1.45 percent goes into Medicare’s hospital expenses. However, in the beginning of 2013, the Affordable Healthcare, Obamacare, will increase Medicare hospital tax by 0.9 percent for those who earn more than $200,000 (source: IRS). There is also a new 3.8 percent tax on investment income to the same provision as discussed earlier; for those who earn more than $200,000. Investment income is simply an unearned income; its what is left over after you have subtracted your investment expenses such as fees and commissions (source: financial dictionary).

Even though many of you still may be in college or are not worried about the future of healthcare, it is important to take note that it has the ability to effect the economy in which we are living in.

What are your thoughts?

An economic perspective for the benefits of universal coverage for the United States.

Class War In America

We are told that a serious shortage of doctors is coming, all over the world. But maybe that’s not quite true. What is coming may be a shortage of medical treatment. There are many medical services that do not require a physician, and there are far better ways of training physicians than we practice. And that’s not even our main medical problem.

In the US, we handicap ourselves because physician training is so expensive. Many people who might become physicians opt out for that reason, and we are left with a worsening shortage. In addition, a newly minted physician in the US begins practicing with $200,000 in debt, which requires high income from the first, which we have to pay for. We could do a lot better.

In the nations with the best national medical services, the government pays for physician training. In those nations there is no big debt…

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Costs of U.S. health care….

Women's Wellness Watch

Way back when I was a graduate student teaching Women’s Studies classes to undergraduates, one of my favorite texts to assign was Joni Seager’s Atlas of Women in the World. Seager uses maps and charts to illustrate persistent gender disparities around the globe. Her illustrations always made a big impression on students in a way that a journal article just couldn’t do.

Infographics are a great way of communicating complex information, allowing the viewer to  make comparisons and see details in a way that is, well, more graphic, than using text alone. So I was excited to learn about the Visualizing Health Policy series (see above), produced by the  Journal of American Medicine in partnership with the Kaiser Family Foundation.

The New York Times often presents information this way, and it’s one of my favorite features. Whether it’s  mapping happiness or reporting census data,  infographics are fun to…

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Last night was the first presidential debate between President Barack Obama and Governor Mitt Romney. One of the main topics that captured my attention, of course, was their individual opinions about the health care system.

As watching the debate, I was amazed at how both candidates pulled exact numbers and percentages in order to support their arguments. The followings are few of the fact checks that I have read from FactCheck.org and POLITICO that I thought was necessary to point out especially in regards to the future health systems. The FactCheck.org is a project of Annenberg Public Policy Center of University of Pennsylvania. This organization is a nonpartisan and a nonprofit organization in which their goals are to “reduce the level of deception and confusion in U.S. politics.” POLITICO is an American political journalism located in Arlington, VA. They have sponsored both Republican and Democratic Presidential candidate debates.

  • Health care premiums – President Barack Obama over-exaggerated the success of his health care law. “…. health care premiums have “gone up slower than any time in the last 50 years.” That’s true of health care spending, but not premiums. And the health care law had little to do with the slowdown in overall spending.” –Factcheck.org
  1. One of the main concerns about the Affordable Health Care law is the price. Factcheck.org agrees with the President that it is true that health care spending has been steady but not health care premiums. The premiums have increased 1 to 3 percent last year due to “more generous coverage requirements.” The President did acknowledge that the premiums have increased steadily however, the employer-sponsored family premiums have fluctuated from 4 percent in 2011 and 2012, and increased 9 percent the year before –Kaiser Family Foundation. Therefore, it was incorrect to suggest that Obamacare slowed health care premiums “any time in the last 50 years.” As factcheck.org states, the growth rate “…was sitting around 5 percent from 2007 to 2009.”
  • Obama: The Republican Medicare plan “would cost the average senior about $6,000 a year.” – POLITICO
  1. The estimated cost the President suggest comes from the Center on Budget and Policy Priorities which is a liberal think thank. They had estimated that “the plan would shift nearly $6,400 in costs to seniors. But that plan had a hard limit on how much could be spent on Medicare each year — and Romney’s campaign says his plan has no such limit.” Governor Mitt Romney argues that he plans to bring the cost down by bringing competition among the private plans. – POLITICO
  • Romney claimed a new board established by the Affordable Care Act is “going to tell people ultimately what kind of treatments they can have.” Not true. The board only recommends cost-saving measures for Medicare, and is legally forbidden to ration care or reduce benefits. –Factcheck.org
  1. An analysis of Governor Mitt Romney’s claim that the new board established by ACA will essentially tell the people which treatments a patient can receive. However, factcheck.org concluded that this statement can not be true. According to the law, board members are not allow to restrict the care that a patient can receive. Also, the new government board can not dictate nor ration certain medical treatments. However, “It could make some binding recommendations about such things as what drugs or medical devices would be paid for by Medicare, but it has no legal power to dictate treatment or ration care.”

What’s officially called the Independent Payment Advisory Board, made up of appointed health care experts, medical professionals, and consumer representatives, would make binding recommendations to reduce the growth of spending. Congress could override them with a three-fifths majority in each house. – FactCheck.org

  • Romney: “Pre-existing conditions are covered under my [health care] plan.” – POLITICO
  1.  Mitt Romney’s health plan covers individual with pre-existing conditions who have already maintained a continuous coverage. Romney’s advisers states that Mitt Romney will expand those protections to individuals and “go beyond the current law.” However, as POLITICO points out, “Coverage can be expensive for people with pre-existing conditions, and he hasn’t said how he would make sure they don’t get charged premiums they can’t afford.” –POLITICO

More information and analysis on Medicare spending can be read here.

Also, check out the “Implementation Timeline” created by the Kaiser Family Foundation. It is an interactive timeline which gives you an idea of the past, present, and the future implementation of the health care law.

A Guide to the Supreme Court’s Affordable Care Act Decision” by the Kaiser Family Foundation.

An article from The Heritage Foundation, “Medicaid Expansion Will Become More Costly to States,” explains that the Medicaid program should be reformed. Since the passing of the Affordable Health Care Law, the states “may choose to expand their Medicaid populations to include individuals below 138 percent of the federal poverty level….” The Heritage Foundation suggests that this is attractive to the states but it is only a temporary relief. Using the Heritage Health Insurance Microsimulation Model, they created similar scenarios to estimate costs and expenses in result to the ACA. There are several graphs and data interpretations in this article.

——-

As presidential election nears, it is important to understand and to consider both views. It is also valuable to be open minded and to research the facts instead of believing everything that is said.

In addition to my previous post – New York City to Ban Sugary Drinks

Huffington Post article “Big Apple Bans Big Soda: Big Deal?” written by David Katz, M.D. Director, Yale Prevention Research Center, gives the readers an update of Mayor Bloomberg’s plan which is to ban sugary drinks as large as 16 ounces.

“Now that the ban is policy, the only meaningful verdict can come from data. We need to pass judgment on the effects it has.”

According to the Consumer Reports, they may have found some level of arsenic in rice and rice products. In their study, 223 samples of various rice products were tested for arsenic. The samples were localized; store bought items from New York metropolitan area and even online retails. The test results showed that brown rice yielded more arsenic than the white rice. Even though brown rice has a higher nutritious value than white rice, its finding of having higher arsenic levels in brown rice is no surprise. Manufacturing white rice is by removing the outer layer, which may be highly concentrated with arsenic, then the rice is polished to produce the white, pearl-like color which may aid in reducing the arsenic levels. The brown rice retains the outer layer which may be concentrated with arsenic therefore finding that brown rice resulted significantly higher in arsenic levels than white rice. – Consumer Reports 

You can read more about their complete results and findings at their website via PDF file.

The purpose of Consumer Reports finding is to reduce the levels of arsenic in rice and other rice products. Also, the scientists are asking for the following:

  • The EPA should phase out use of pesticides containing arsenic.
  • The USDA and the EPA should end the use of arsenic-laden manure as fertilizer.
  • The FDA should ban the feeding of arsenic-containing drugs and animal byproducts to animals.

DNJ (A Gannett Company) – Reported by Pettus Read titles the article “READ: No need to panic about arsenic in rice supply.” The writer starts the report by reminiscing his childhood eating habits where he was frequently told to finish everything off his plate. He notes that the media is often frenzy “over carcinogens and other chemicals in the foods we consume, without real cause for alarm….  In fact, there are large numbers of carcinogens in every meal we eat, all perfectly natural and traditional, making no human diet completely free of these elements.” The writer also briefly explains the Consumer Reports findings of arsenic in rice. He then refers to 1958 when Congress passed a law to eliminate carcinogens in food products. He further explains that carcinogen tests have been studied with laboratory animals to parallel to the human body. As he finishes the report, leaves the readers to think about how “It is important that we all become educated consumers and dismiss the “carcinogen of the week” scare that is media-hyped. Rather we should study our lessons and recognize the fact that many times all the facts are not reported.”

Huffington Post – Reported by Maria Rodale and written by Sonya Lunder and Dawn Undurraga, of Environmental Working Group. A picture of bowl of rice is at the beginning of the report. The writers state that there are reports from “… U.S. Food and Drug Administration (FDA) and the highly regarded Consumer Reports magazine, and both focused on the worrisome amounts of arsenic in rice and popular rice-based processed foods.” The report is titled “10 Ways to Get Arsenic Out of Your (and Your Kids’) Diet.” Just as the title suggests, the writers list 10 directional ways to reduce and to eliminate arsenic levels. The very first is to limit rice intakes, and suggest other grain items. The remaining nine other items can be found at the website.

Metro – New York – Interview with the registered dietitian Rachel Begun, M.S., R.D.; The report is an interview with the news reporter and the registered dietitian. Rachel Begun briefly summarizes that the Consumer Reporters found arsenic levels in rice. When asked if consumers should stop consuming rice and if there are safer ways to incorporate rice into our diets, she answered “…Eat a balanced diet that includes a wide variety of foods, including a variety of whole grains. This ensures adequate intake of nutrients while minimizing the risk of potential harm from any one food….”

Associated Press – The news report states its findings from the Consumer Reports and also quotes the FDA Commissioner Margaret Hamburg in which she suggests that “…consumers shouldn’t stop eating rice, though she does encourage a diverse diet just in case.” It ends the report with a statement from Professor Jaymie R. Meliker of Stony Brook University that “it’s [arsenic] all a matter of moderation. …In general, in life, you shouldn’t stand out in the sun eight hours a day,” he said. “You shouldn’t eat rice exclusively every meal. You should introduce variety in your diet because there are contaminants in everything. Nothing is completely safe.”

FDA has Q & A layout in their analysis of arsenic in rice and rice products. One of the important things to focus is that they do not agree or disagree with Consumer Reports finding. However, the FDA does state that their preliminary testing is consistent with the Consumer Reports study.

Recently there has been lots of talk of increased obesity within children. Progressively, the diets in children have shifted to instant or take-out foods. Poor choices in food leads to bad eating habits which invariably could cause obesity and other health problems. Now, the news media is claiming that chemical BPA is also linked to children’s obesity. Chemical BPA is often found in plastics. The study that was conducted which led to this speculation was from the National Health and Nutrition Examination Survey between 2003 and 2008. The editor-in-chief Dr. Howard Bauchner has said that “this paper is speculative.” Not necessarily that BPA causes obesity in children but the “speculation” is that the fatty tissues may store more BPA and release harmful chemicals more often than normal.

The Chart

The chemical bisphenol-A, or BPA, has a long and controversial history.

Used to manufacture some plastics – like the kinds in soda or water bottles – and as an anti-corrosive in aluminum cans, BPA has been under fire for some time from consumer advocacy groups.

The FDA recently banned BPA in baby bottles and sippy cups after concerns were raised about potential side effects on the “brain, behavior, and prostate gland in fetuses, infants, and young children,” according to the FDA website.

Still, the organization has stood by the overall safety of the chemical; in March the FDA denied the Natural Resources Defense Council’s petition to ban BPA outright.

Now a new study published this week in the Journal of the American Medical Association is adding more fuel to the flames.  The paper shows an association between BPA levels in children’s urine and obesity prevalence.

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…researchers encoded an entire book into the genetic molecules of DNA…

Public Health--Research & Library News

From the Wall Street Journal:

In the latest effort to contend with exploding quantities of digital data, researchers encoded an entire book into the genetic molecules of DNA, the basic building block of life, and then accurately read back the text.

Read the article here.  Read the article in Sciencehere.

Church GM, Gao Y, Kosuri S. Next-Generation Digital Information Storage in DNA.  Science. 2012 Aug 16. [Epub ahead of print] PMID: 22903519

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There has been a study conducted from a Canadian Researcher, David Spence  of Western University in Ontario. His medical interests are atherosclerosis, cholesterol, homocysteine, hyperlipidemia, hypertension, and stroke prevention. Further background information can be found in the provided link above.

The purpose of his recent research was to determine if there was a correlation between the effects of consuming egg yolks and cigarettes. In the abstract of “Egg yolk consumption and carotid plaque,” it explains that the “potential harm from high cholesterol intake” from egg yolks are “…considered insignificant.” Therefore, the study continues to explain that the researchers were set to determine if there were any “atherosclerosis burden” from eating eggs. The cigarettes are related in the research to show the similarity of possible arterial damage it can create from smoking and consuming egg yolks.

The conclusion and their interpretation of research “suggest[s] that regular consumption of egg yolk should be avoided by persons at risk of cardiovascular disease. This hypothesis should be tested in a prospective study with more detailed information about diet, and other possible confounders such as exercise and waist circumference.”

With that said, the mass media has been very adamant of relying the information that egg yolk consumption is simliar to smoking cigarettes.

The Washington Post – Starts the article with a hypothetical question by asking what eggs and cigarettes have in common. The article shows that the new study was conducted by researcher David Spence in Canada and providing a link to the limited access of the actual peer-reviewed paper. They also provide an additional link directing the readers to the USDA Dietary Guidelines for Americans (2010). It ends the article with a direct quote from the study stating that “We conclude that the prevailing tendency to ignore dietary cholesterol as a risk factor for coronary heart disease requires reassessment, including the consumption of cholesterol from eggs.”

 NY Daily News – The first thing a reader may see is a bolded statement with some hypothetical questions, “Like Hollandaise sauce? Too bad — for your heart and blood vessels. Yolks are packed with cholesterol, causing blood-vessel-clogging plaque buildup, just like smoking does.” This article from the NY Daily News is listed number two under the Most Popular/Most Read list. There is a picture of a breakfast plate that greets the readers. The caption for the picture reads, “The Canadian study found that people who consume egg yolks regularly had 2/3 the plaque buildup of smokers.” Even though it may be leading the readers to believe that egg yolks is correlated to cigarettes, the article ends with a contradicting statement from a Cleveland Clinic Foundation cardiologists Dr David Frid. The cardiologists explains that there could be other factors influencing the plaque build up and also states that “…people who consume a lot of eggs also consume a lot of other fatty foods.”

The Huffington Post UK – The article presents that the study was conducted from Canada and it was investigated in London Health Sciences Centre (in Canada). “The study was carried out by Canadian researchers and examined 1,231 patients with an average age of 61.” The article also included the methods of determining the plaque build up which was through an ultrasound. It ends the report quoting Dr. Spence stating “What we have shown is that with aging, plaque builds up gradually in the arteries of Canadians, and egg yolks make it build up faster – about two-thirds as much as smoking.”

With the mass media tying the relationship between egg yolks and cigarettes, it can be easily confused and misled that consuming eggs may be equivalent as to smoking a cigarette. From the U.S. National Library of Medicine, PubMed Health, has provided some information and insights to what the media may have missed.

The followings are the factors that the media and/or the researchers have limited in their report:

  • the study has lack of “detailed information on how the eggs were cooked”
  • additional factors could have contributed “to artery clogging” such as “lack of exercise or alcohol consumption”
  • the study has limited recollections of the participant’s egg yolk consumption
  • assumes fatty build ups are the cause and effect of the increased heart disease
  • the study consisted of “small, selective sample of adults”
  • the consumption of egg yolk was determined by a questionnaire responses which could have errors
  • “The researchers specifically say that they did not assess: alcohol intake, exercise taken, liquorice consumption”
  • “The association was not affected by adjustment for age.”
  • the study does not specifically state how the egg yolk/eggs were prepared (could have been fried, boiled, seared with butter, etc.)
  • none of the participants in the study reported to suffer from heart problems
  • the researchers acknowledged that they did not take into the participant’s dietary factors when conducting the research

“This study perhaps best supports the notion of all things in moderation. Eggs are a good source of protein in addition to other vitamins and minerals and most experts advise that they can form part of a healthy, balanced diet.”  – PubMed Health

According to The New England Journal of Medicine, an oral immunotherapy is an effective way to treat egg allergies in children. The experiment was conducted by increasing the dosage of egg white powder at 10 months and at 22 months. In result, after 10 months of therapy, those under oral immunotherapy had passed the food challenge and were considered to have been desensitized; after 22 months, 75% of the children treated with oral immunotherapy had passed the food challenge. A food challenge was to test the children’s unresponsiveness to egg-white powder and a cooked egg.

“At 30 months and 36 months, all children who had passed the oral food challenge at 24 months were consuming egg.” – NEJM

Fox News – Introducing the readers with a picture of white, fresh looking eggs, the article is informative and full of factual information you can also read for yourself in the NEJM. They also note that this is an on-going experiment and caution the readers not to try this in a non-clinical setting. There are credible resources cited throughout the article such as the following: researcher from University of North Carolina – Chapel Hill, Mayo Clinic, and the New England Journal of Medicine.

Journal of American Academy of Physician Assistants – A print via HealthDay News; a document similarly written to the actual study from NEJM.

ABC News – A picture of a child peeling the hard shell of a boiled egg is shown. The article aligns similarly to the NEJM and cites credible sources such as the researcher from UNC-Chapel Hill. An allergist at Winthrop University Hospital in New York states that if this experiment proves to be safe, it will be the “Holy Grail for food allergic patients.”

CNN blog – Along with the previous news media, CNN also reports similarly as NEJM study. CNN provides additional information of the importance of the development of oral immunotherapy. Egg products can be found in numerous food items which can be solved if oral immunotherapy can treat certain allergies. Closing the article, CNN presents a personal story of a 6 year old girl who is allergic to peanuts and nuts.

USA TodayWeb MD, International Business Times – All very similar report. They all derived their report from the actual study from NEJM. It informs the readers and also notes the results of the experiment conducted. They all warn the readers not to try this “experiment” in a non-clinical setting. This is an on-going experiment which should be monitored and supervised by medical researchers.

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