astounding increases in diabetes incidence in US

From a CDC report released today: "Among 33 participating states with data for both periods, the age-adjusted incidence of diabetes increased 90% from 4.8 per 1,000 in 1995--1997 to 9.1 in 2005--2007."

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5743a2.htm

What Baseball Can and Can't Teach Us About Healthcare Delivery

Greetings all,
I thought that I'd like to direct everyone's attention to an interesting opinion piece about what how healthcare systems can alter their best-practices through statistics-rich evidence-based medicine. The article notes how baseball management has changed its methods through sabermetrics (valuable baseball-y statistics), and how similar successful efforts have been attempted in the health field. If you're a tad skeptical, a nice rebuttal is provided here from one of my favorite health care blogs. At the least it is something for us HPMers to think about before we nod off at the 8 AM biostatistics class.

Enjoy!

Also, a little self-promotion for the site that I'm contributing to about public-private interventions in the developing world. For anyone who is at all interested in learning about new methods of health delivery in the developing world give it a read over. The chief dude behind the site, Dominic Montagu at UCSF, is co-teaching a class next semester on the topic. Check it out at www.ps4h.org.

UPDATE: Apropos of the article above, I forgot to mention that the lead writer is the one and only Billy Beane the A's awesome GM, and the co-writers are John Kerry and Newt Gingrich, so read it.

The FDA and Bisphenol A

Earlier this year, the Canadian government put Bisphenol A on its list of toxic substances and started drafting regulations to ban the sale of baby bottles containing the substance. BPA is a chemical that can mimic the hormone estrogen. Its harmful effects are more acute for infants, whose bodies cannot expel the chemical as fast as older children and adults. When the story first broke, the reaction was swift: I remember seeing several news stories about it, and it was next to impossible to find either plastic baby bottles or glass baby bottles in stores - the former because they had been pulled by manufacturers, and the latter because concerned parents had bought them all up because they were "safe."
In the United States, the FDA recently released a report stating that the low doses of BPA that humans get from eating out of plastic containers that contain the chemical are not harmful. This finding has seemingly been controversial, however, with many scientists questioning the initial report. In response, the FDA asked an independent panel to review the findings, and it has found that the margins of safety used by the FDA for BPA are inadequate. Further, the panel said that the FDA failed to consider all of the relevant scientific literature about BPA when it made its initial conclusion. It is not known yet whether or not (or when) the FDA will review its decision on BPA, but the findings of the panel will likely put pressure on the agency to do so. For more information, there is an article on the CBC's website: http://www.cbc.ca/health/story/2008/10/29/bpa-fda.html.

Lloyd Dean - Sunday Chron

I am still thinking about the amazing session with Lloyd Dean from last week....quite a visionary leader and someone we will have to watch to see what he does if the election tracks to the current polls and Obama is elected.

Coincidentally, this Sunday the Business section of the SF Chronicle had an interview with Mr Dean:

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/10/26/BUL613LU85.DTL&hw=lloyd+dean&sn=001&sc=1000

Kim

Canadian Election Results

The results of the Canadian election are in: the Conservatives are back in power with a strengthened minority of 143, while the Liberals took 76, the NDP 37, and the Bloq 50. Although the Conservatives strengthened their minority, they still do not have a majority, which means that they will need the cooperation of at least one of the other parties to pass legislation. When I last posted about the election, I mentioned that the Conservatives had no health care policies to speak of (and, in fact, no platform at the time). However, on October 9, Stephen Harper (the Canadian Prime Minister) announced plans to invest $10 million dollars between now and 2010 to support the development of a National Lung Health Framework, which is a strategic action plan to promote lung health, and to provide $15 million for a study of how Alzheimer's and Parkinson's disease affect Canadians. Over the past two years, the Conservatives have invested in important health care initiatives, such as the establishment of the Canadian Mental Health Commission and provincial wait times guarantees, so there is no reason to believe that they will not make good on these promises. At the same time, the more far-reaching health care platforms of the other parties will likely not be realized over the next four years unless the parties can work together to force the passage of new health care legislation.

Women's interest in health vs. pop culture

http://news.bbc.co.uk/2/hi/health/7662942.stm

I read this article from BBC News that tries to compare women's interest in popular culture vs. their interest in breast cancer. The statistics from the 1000 women surveyed show that 4 out of 5 women can name celebrities but only half check themselves for breast lumps once a month. It is true that over 40, 000 women in the UK are diagnosed with breast cancer each year, however I do not believe it is true that women are more interested in the gossip page than their risks at contracting this disease.

Pretty much everyone in this class has our 200C Core class, and we all listened to Lori Dorfman speak about media advocacy. I believe that this article is a perfect example of framing. This article does mention the seriousness of breast cancer and the concern women should have about their own health. It also illustrates the lack of care some women take in their own regular examination. Yet, the article frames the issue in such a way that it blames the victim. Women are the victims of breast cancer, and often are uninformed about their risks unless they have someone in their life who has been a victim of the disease. It may be true that more women read tabloid magazines and know who is dating whom, than their risks of developing cancer. However, this does not indicate to me the apathy surrounding breast cancer health the article suggests.

A more productive framework for this article would be to inform about the problem and then give suggestions on what women can do to get more information. The article mentions the Breast Cancer Campaign, (whatever that is) but there is no suggestion on where the public can even get a breast exam. There is no mention of how to be proactive about one's breast health and no guidance on what women should do should they find a breast lump at all.

I believe that part of the problem of lack of information is articles like this one. By blaming women for being more interested in celebrity drama than their health, we ignore the fundamental problem with the system. Information about popular culture is just easier to acquire. People absorb what is put in front of them and with articles like this, we miss the point: breast exams should be done regularly by all women and a conversation about breast cancer should be had with one's doctor. When reading this the majority of people would ignore the institutional shortcomings of lack of information about this topic, and blame the personal choices of women to not give themselves monthly exams.

Emma's Field Trip to the Alameda County Public Health Department

This afternoon, I was invited by Pam Willow, a legislative analyst at the Alameda County Public Health Department, to sit in on one of the Department's Legislative Council meetings. For all of you public health policy wonks, this was heavenly. The goal of this Council is to raise awareness of public health issues throughout the County, and to ensure that public health policies and programs are appropriately targeted to community needs. The Council is an engine within the department for legislative advocacy and the development of effective health policy. It is the only council of its kind within any of Alameda County's departments, and Ms. Willow was not sure if a similar council exists anywhere else in the country. On the agenda today was the Council's 2009 legislative platform, which is to include issues such as fighting health inequities and chronic disease, reducing inequities in HIV/AIDS, and promoting a healthier built environment. If you want more information about the Legislative Council, you can access their website here: http://www.acphd.org/user/services/AtoZ_PrgDtls.asp?PrgId=55.

WHO Membership Questions from Last Week

So, apparently, the only countries that aren’t members of the WHO are: Kosovo and Taiwan, and, weirdly enough, Lichtenstein. With regard to Kosovo, it hasn’t stopped the WHO from doing interventions there, but on the other hand, China has strong-armed the WHO into denying Taiwan’s doctors and hospitals access to information. Non-UN members (Niue and the Cook Islands) have been admitted, and non-governing areas like Puerto Rico and Tokelau have been allowed membership under an associate status. Furthermore, other members can be admitted as observers, like the Palestinian Liberation Organization and Vatican City.

Apparently though, the WHO does have problems when involved with countries that are disputed, such as Western Sahara. No clue on how they’d respond to health threats on the Principality of Sealand, the Gay and Lesbian Kingdom of the Coral Sea Islands, or other micronations.

This has IMPLICATIONS for health care...

Yesterday, I attended a part-talk and part-press conference given by CA Senator Barbara Boxer. Boxer toured the UC Berkeley Institute for Quantitative Biosciences to “learn more about green technology programs being researched by the interdisciplinary department,” according to the Daily Californian.

Boxer, who has not made visits to UCB a priority during her 16 years of service, was a welcome presence and an insight into national politics for those who are unabashed policy wonks (like me). However, I think her visit signified something greater.

Politicians (especially those of the Democratic variety) are often between a rock and a hard place when it comes to university constituencies. There is no guarantee that students will be registered to vote (or registered to vote in a specific district) and too many visits to a campus can often be seen as pandering to the “liberal elite.” Boxer’s record of visits to UCB shows this and for what it’s worth, I can offer some compelling anecdotal evidence to support this as well :).

Now, perhaps Boxer came to UCB because she is not running for election this year and has a safe seat if she does choose to run again in 2010. And, of course, it is also likely that she values UCB’s research achievements and contributions. But UCB has been making research breakthroughs at least since 1992 (when Boxer was elected), so why was this seen as an opportune time to come for a visit? (And no, she did not really try to soothe any fears about the impending end of the world from the Wall Street melt down.)

This optimist thinks that her visit was symbolic of the greater access being afforded to youth through the Obama campaign. I know that politicians visited universities and engaged youth before Obama (and some might call this an optimistic view of the world), but never before have young people made up such a potentially large portion of the electorate. Obama is changing the framework through which we participate in and learn about the political process, and if in doing so his actions encourage others to do so as well, then all the better!

Raw Food & Natural Healing - Buy it or not?

After looking around on CNN.com at some of the recent health news, I stumbled across an article: Woman goes raw, loses more than half herself.  I was reminded of the Hippocrates Health Institute, where my sister was employed for a while after graduating college.  I went to visit her in the earlier part of the decade, and was witness to alternative healing methods (including the promotion of the raw diet -- when you checked into the resort, you only received one cooked meal a week).  The combination of organic, enzyme-enriched foods as well as magnetic therapy, exercise, juice-fasting & cleansing, detox (...and the list goes on), has saved the lives of those who have been told by medical professionals, that there is nothing left that medicine can do for their health.  While these methods may currently be more expensive than the everyday individual can afford, this type of sustainable lifestyle appear to prove to be more beneficial than some expensive medical processes that you can get under insurance coverage.

I'm wondering if health insurance will every broaden its horizons into this type of healing that promotes health through alternative formats  (which in turn could prevent a lot of common health issues that we see related to poor nutrition).  I would hope that the observations of these alternative forms of healing, would be proof that they are effective; and in return, give consumers the option of being able to undertake these forms with some type of insurance that makes them affordable.  Programs, like the one at the Hippocrates Health Institute, educate individuals about how to make this lifestyle sustainable.  This sustainability seems like it would be less costly in the long-run, in preventing many health issues that cause frequent visits to the hospitals (that we recently discussed have been cutting down their max capacities) and hike up insurance costs.  Thoughts anyone???

My Shameless Plug: For those of you who are interested in the raw and vegan lifestyle, my sister co-authored a book that is both educational in this type of living as well as provides some tasty recipes. You can buy it on Amazon at the following URL: 

Newest Edition -- Healthful Cuisine: Accessing the Lifeforce Within You Through Raw and Living Foods

It comes HIGHLY RECOMMENDED!!! 

Public Health Law and Childhood Obesity

On Friday afternoon, I had an interview with Manel Kappagoda of Public Health Law and Policy, which is part of the Public Health Institute in Oakland. She is currently the Deputy Director of the National Policy and Legal Analysis Network to Prevent Childhood Obesity (NPLAN). The Network is working on developing model ordinances to tackle the specter of childhood obesity in America with funding from the Robert Wood Johnson Foundation. Childhood obesity is one of RWJF’s program areas, and the Foundation is committed to reversing the epidemic by the year 2015.

The ordinances that NPLAN is developing are essentially legal tools designed to create social norm changes that will lead to a healthier population. One of these was recently released for communities interested in requiring restaurants to include nutrition information on their menus. It is based on a law that was passed by the Californian Senate but later vetoed by Governor Schwarzenegger. NPLAN will continue working to develop similar regulations that will help communities keep their children healthy at least through 2010, when their current funding will end. Ms. Kappagoda was incredibly enthusiastic about the work she is doing, but spoke of some of the challenges in preventing childhood obesity; she talked about laws that exist in Quebec that prevent the advertising of children’s products directly to children and the fact that the 1st Amendment would prevent similar laws from being adopted in the US, even though these have had a strong positive effect on the health of children in Quebec.
Ms. Kappagoda stressed that she and her colleagues are not advocates, but that they are just developing products based on the best research available and distributing these to advocate groups and interested governments across the country. If you want more information on this program, or anything else that PHLP is doing, their website is here: http://www.phlaw.org/. They also have a very interesting program on public health and urban planning called "Planning for Healthy Places." This is definitely an organization to keep in mind if you are interested in public health policy and public health law!

VP debate

What did everyone think of the VP debate? There were a few healthcare remarks... I was very excited, lol

AP: Obama attacks McCain on health care

Apparently the Obama campaign is going to talk a lot about health care in the next few days. It will be interesting to see how this all plays with voters...

Obama attacks McCain on health care

By NEDRA PICKLER

CHICAGO (AP) — Barack Obama launched a multifaceted attack on presidential rival John McCain's health care proposal Saturday, elevating an issue that has been on the back burner in the White House race but remains a top concern for voters.

Obama planned to criticize McCain's plan to tax health care benefits as "radical" during an event in Newport News, Va., while his campaign echoed the message in four new television ads, four separate mailers targeted to swing state voters, radio commercials and events in every battleground state.

The McCain plan would be a dramatic change to the way Americans get health insurance. The Republican presidential nominee, who makes opposition to tax hikes a centerpiece of his campaign, has proposed to tax the health benefits that 156 million people get through the workplace as income. In exchange, McCain would give tax credits to help pay for insurance — $2,500 for individuals and $5,000 for families, paid directly to the insurer they choose.

"On health care, John McCain promises a tax credit," an announcer says in one of Obama's new ads, over images of families examining their bills. "But here's what he won't tell you: McCain would make you pay taxes on your health benefits, taxing your health care for the first time ever, raising costs for employers who offer health care so your coverage could be reduced or dropped completely. You won't find one word about it on his Web site, but the McCain tax could cost you thousands or even your health care. Can you afford it?"

It's true that McCain doesn't mention that he would tax health benefits on the section of his Web site where he describes his plan. But the Obama ad also leaves out some important context — the tax credit McCain plans to offer would be more generous than the current tax break, at least for most families for the first several years, according to an analysis by the Tax Policy Center.

The Obama campaign's mailings repeat the same message, with pictures of families receiving medical treatment and Obama consulting with doctors, and one piece centered around a doctor saying they fear patients will lose the coverage they have through their employers under McCain's plan. The campaign found a local doctor in each swing state to be featured in the mailing delivered to voters in that state.

In remarks prepared for his Saturday rally, Obama tells voters that under his opponent's plan, younger, healthier workers would purchase cheaper insurance outside the workplace, leaving an older, sicker pool to drive up the cost of the employer-based system.

"As a result, many employers will drop their health care plans altogether," Obama said. "And study after study has shown, that under the McCain plan, at least 20 million Americans will lose the insurance they rely on from their workplace."

An assessment by health care economists published last month in the journal Health Affairs projected McCain's plan would lead 20 million people to lose their employer-sponsored insurance. But it also found that 21 million people would gain coverage through the individual market.

Republican National Committee spokesman Alex Conant responded, "Barack Obama is lying about John McCain's plan to provide more Americans with more health care choices. Obama's plan only offers more government, while McCain's plan offers more choices."

Polls show Obama has taken a lead in the race recently, fueled by voters' increasing confidence that he would be better equipped to handle the struggling economy. The campaign said they long planned to focus on economic issues in these final weeks of the campaign, but the debate over the government's $700 billion Wall Street bailout focused voters on financial concerns more than they could have imagined.

The push on health care is an opportunity to raise the debate on a pocketbook issue that voters rank near the top of their concerns as the campaign enters its final month. According to an AP-Yahoo News poll taken last month, 78 percent of voters rate health care as at least a very important issue, which puts it behind the economy in a group of second-tier issues along with Iraq and terrorism.

The candidates have sharp differences on how to address increasing health care costs and help cover more than 47 uninsured Americans.

Obama wants the government to subsidize the cost of health coverage for millions who otherwise would have trouble affording it on their own. He also would also require all but small businesses to make a "meaningful" payment for health coverage of their workers or contribute a percentage of payroll toward the cost.

McCain wants patients to have more control over their care and how their health care dollars are spent. His tax credit could help people buy insurance through their employer or directly from insurers in the individual market, licensed in any state.

The assessment published in Health Affairs found McCain's plan could lead to employers declining to offer coverage if they know workers can get it elsewhere. The authors also said Obama's requirement for employers to contribute would lead to job losses or pay cuts.