Entries for the ‘Blame and Responsibility for Health’ Category

Bono and me…my orange lenses are not a fashion statement

Sunday, May 1st, 2016

May 1, 2016

117_1726A new identity. One with which I share something in common with Bono, tho it would take years before I would realize that. After more medical tests than I could keep track of, and literally pictures of my eyes that looked like perhaps all that testing was making them bleed, the ophthalmologists finally did the medical equivalent–figuratively speaking–of throwing up their hands and diagnosed the cause of my sudden loss of sight and my dead optic nerve as “idiopathic.” Then the head of the team that had been leading the poking and prodding said, “I am scheduling an appointment for you with our low vision specialist.” “What?” “Well, yes, there is kind of a whole industry–she can explain it to you.” And he was off with a trail of others in his wake. And I was left to wonder what more tests were coming my way. And to think, ‘like my experience over these past weeks hasn’t been part of…a whole industry…to use his phrase?’

117_1731My first appointment with the low vision specialist took hours. There truly are many devices and many many many questions and some, yes, eye exams that go along with figuring out what ‘aids’ might be offered to assist those of us with low vision. On that particular first day, the real life-changing event came when I was handed a large ‘key chain’ like collection of lenses of many colors. The specialist asked me to look through the one that I jokingly said, “Oh, you want me to look through rose-colored glasses?” Get it? At any rate, when I did and looked again at the laminated card she handed me, there was nothing. “Anything?” she asked. “Not really.” Silence. “Well, how about if you take the pile and go ahead and look through them.” So I did. And…what to my wondering eyes did appear but a sharper image when I held up the brightly colored hunter orange lens… Yeah. Auburn hair and bright orange…there is a color combination you want to recommend. Sigh.

All I can say when people ask me to describe it is to compare it to putting on the glasses you wear–if you do–to deal with bright sun glaring off the snow to go sledding or skiing. Those of you who use such glasses know what I mean. And that is really the closest thing I can think of to share what happens when I put on glasses that have been tinted that delightful orange color corrected to my prescription. No, It does nothing for the dead optic nerve. But somehow, for that central vision in the right eye, it makes the contrast sharper…

And so, when I read that Bono finally revealed–after 20 years [see, I am not taking that long to share…] that he wears orange specs due to his glaucoma [http://www.theguardian.com/music/2014/oct/17/bono-glaucoma-20-years-u2-dark-glasses], I felt some real kinship. And when he says, ” “You’re not going to get this out of your head now and you will be saying, ‘Ah, poor old blind Bono’”–I felt particularly connected to him and his experiences…

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A Book Review: “Deadly Outbreaks” by A.M. Levitt, PhD

Tuesday, January 21st, 2014

December 1, 2013

sam racoon hat dec 2013Phewww. It’s cold outside! This precious pic is my five-year-old grandson snuggled with a furry raccoon stuffed animal and wearing a soft and cuddly raccoon hat. For his nap. He knows how to stay warm!

I recently finished reading Levitt’s book, “Deadly Outbreaks: How Medical Detectives Save Lives Threatened by Killer Pandemics, Exotic Viruses, and Drug-Resistant Parasites.” [http://www.amazon.com/Deadly-Outbreaks-Detectives-Threatened-Drug-Resistant/product-reviews/1626360359/ref=dp_top_cm_cr_acr_txt?ie=UTF8&showViewpoints=1]

Published by Skyhorse Publishing in 2013, this book could provide the basis of a TV drama series and contribute to the audience’s understanding of how public health is organized and delivered in the US and why so many large nations want to model our approach.

The author hopes to introduce readers to field epidemiology, even getting them excited about it as a possible career choice. Because the book is carefully researched and provides a thorough narrative regarding the seven cases highlighted, she may achieve that aim. For these reasons, I will recommend it in future health communication seminars I teach and recommend it to you as well. Here’s more about why.

The CDC’s Epidemic Intelligence Service trains medical detectives, doctors who want to track down the source of population and health risks and guide the public health response. Dead birds, mosquitoes, New York City parks, and West Nile virus–collaboration with animal health officials brought a focus to disparate views about what was happening and what needed to be done in the book’s opening case.

Levitt then moves to a case giving us a historical context for modern policy related to refugees medical screening and movement into the US. This is a chapter that makes clear the need to be assertive in the public health sphere when faced with competing political agendas, to exercise skills that don’t traditionally come to mind when identifying the meaning of epidemiology. These skills include the ability to talk to [not ‘at’] members of local communities and to engage in participant observation, taking thorough notes to document both.

The third case takes us behind the scenes of a hospital in order to uncover the origin of unexplained deaths of children. A wide range of possible explanations were considered and found to be insufficient, including toxic fumes from repair work on the roof entering through air ducts. The point-by-point discourse guides us to both a conclusion and to new policy as accepted practice in most US hospitals today.

The fourth chapter guides the reader through the 1970s case of Legionnaires’ disease. Perhaps because I remember this one well, I was fascinated to read what was going on behind the scenes.

The last three cases introduce other contexts where the public’s health can either be supported or quickly go awry. I will never be on the interstate again passing a tanker-trailer truck labeled as carrying anything related to food without wondering about the conditions for keeping the food safe and bacteria free. Right now, most of the media images of the snowfall and road accidents involve those large semis. How many of them are carrying food-related products and what happens as they have to wait out the storm? What protocols kick-in? I feel comforted, but likely falsely so, that it is cold rather than blistering heat leading to breakdowns. I am thinking that keeping the chill on reduces bacteria’s chance to grow, thought it does not die, as discuss in the fifth case in the book. The case introduces us to FoodNet, a national surveillance system supported by the CDC to track foodborne pathogens.

The sixth chapter explicitly introduces the reader to the important principle of medical detectives sleuthing by asking ‘what if’. Asking that question and revealing the conversations that ensue really does remind me of one of the TV drama show that has been number one for years now and Abby’s character at work in the lab. Different context further broadened with the case in the last chapter. Not one we often have the privilege of looking behind the curtain at. But fascinating and filled with content to engage and inform. I highly recommend this book. Not one for light reading, but one that you will be glad you invested your time in.

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How do different metaphors to define genes relate to understanding?

Sunday, January 12th, 2014

November 14, 2013

rox and rose oct 2013.jpgphotoMany of the important messages about health include information about the role of genes for health. Genes matter. Behavior matters. Environments matter. The problem is how to communicate that genes do not absolutely determine health. This will be an important part of health communication for many decades to come.

Professor Celeste Condit wrote about how genes have been defined in her book, “The meanings of the gene” [http://www.amazon.com/The-Meanings-Gene-Heredity-Rhetoric/dp/0299163644].

Efforts to define genes often depend on the use of metaphor, explaining what a gene is in terms of something else that an audience is assumed to already understand. Many of these metaphors use “instruction” as a key component. Professor Rachel Smith and I decided to evaluate two of these instruction metaphors, one that defined genes as “a blueprint of our possibilities” and the other that defined genes in terms of “instructions” more generally. The abstract of the article to be published in February in the journal, Health Communication, appears at:  http://www.tandfonline.com/doi/abs/10.1080/10410236.2012.729181#.UtLxv1OFeSo. The online article is at: DOI: 10.1080/10410236.2012.729181

Participants received a message about the role of genes for health for which the introduction varied the definition of a gene, and all other content was the same. Participants who read a message with the blueprint metaphor were more likely to believe that genes absolutely determine health and that genetic therapies are the effective means to address the role of genes for health. The instruction metaphor related to participants having stronger beliefs that genes make one more susceptible to disease but do not absolutely determine the onset of disease, and beliefs that we have some personal control over the role that genes have for our health.

These results support the importance of the metaphors used to define health and scientific terms. Just one exposure to a message that defines genes in different ways can have powerful effects on our attitudes about genes and health.

 

 

 

 

 

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Public Health and Health Insurance as a Public Good: Part 3

Friday, January 10th, 2014

October 30, 2013

IMGP3157While the media has given a lot of coverage to citizens complaining about having to pay for health insurance for pregnancy when they are men or have wives past child-bearing age/interest, or for pediatric care, or birth control–the story being lost is the one about health insurance as a public good. If all citizens have access to a certain level of care, then all citizens should achieve a certain level of health, and that should be good for all of us, the public good associated with health insurance and the public’s health.

Of course, we hear these arguments in other contexts. There are people who don’t have children who don’t want to pay for public schools. People who don’t use the interstate system not wanting to pay for maintenance of the interstate system. So it seems to be a very old tune, but the words for the new verse haven’t been rehearsed very well. Without telling more about how sharing the cost of paying for a level of health care aims to benefit all of us, complaints get heard and the argument for the ACA gets lost.

Likely, over time, debates will unfold as data collects to support or fail to support ACA’s benefits for society. Will we improve on some of the major health indicators, such as infant mortality rate–with the U.S. ranking 30th on a recent list [http://www.cbsnews.com/news/us-has-highest-first-day-infant-mortality-out-of-industrialized-world-group-reports/]. That is the hope. It will likely take some discussion and some effort to work toward achieving such aims. And some revision of the ACA. A foundation of understanding related to its purpose is a good place to start.

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Social Justice, Workers and Congress, and the Affordable Care Act: Part 4

Sunday, November 17th, 2013

IMGP3160September 30, 2013

It didn’t take long for efforts associated with covering costs associated with worker’s health care to become burdensome. In 1927, the Congressional Committee on Costs of Medical Care proposed Health Maintenance Organizations [HMOs] as a strategy aimed at providing affordable health care to all citizens. A minority report written by doctors and adopted by the American Medical Association, however, took the position that HMOs would hurt the quality of health care. As a result, the Committee’s recommendation was not seriously considered.

Congress initiated a program for its own health care in 1928. In response to a number of elected lawmakers collapsing and even dying while on duty that year, Congress asked the Navy to provide a physician for the Capitol. The Office of the Attending Physician provides some basic care to members at a cost of about $500 a year, the same rate that has been in place since 1992.  The budget for the Office of the Attending Physician is more than $3 million [http://thomas.loc.gov/cgi-bin/cpquery/?&sid=cp113l8f0T&r_n=hr173.113&dbname=cp113&&sel=TOC_22349]. There are several Navy doctors providing the care, together with more than a dozen registered nurses. The budget also includes a pharmacist, an ambulance available at the steps of the Capitol building, plus first-aid stations that staff members may use, and the x-ray and lab equipment available for care. In addition, care for families of Congress comprises choices much like all of us must make [http://jeffduncan.house.gov/legislative-work/fact-or-fiction/fact-or-fiction-do-members-congress-get-free-health-care].    

 

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Social Justice, Workers, and the Affordable Care Act: Part 3

Tuesday, October 29th, 2013

IMGP3152September 25, 2013

In the first two decades of the 20th century, middle class progressives realized that the American industrial society’s working-class citizens suffered ill health and injury through no fault of their own. Work places were often unsafe, causing injury to workers and their ability to work. In recognition of these facts, a number of economists formed the American Association for Labor Legislation (AALL) in 1905 for the purpose of studying labor conditions and labor legislation [see http://www.proquest.com/en-US/catalogs/collections/detail/American-Association-for-Labor-Legislation-38.shtml].

The AALL group advocated for health reforms in industry and sought compulsory health insurance. Initial efforts to argue the merits of such legislation focused on workmen’s compensation. This strategy aimed to provide access to care for workers injured on the job.

Woodrow Wilson joined the AALL [http://www.ssa.gov/history/corningchap1.html]. He included their social insurance plank in the 1912 Progressive party’s platform. In 1915, the AALL published a model health insurance bill in legislative language to be considered by State legislatures, with California, Massachusetts, and New Jersey supporting the proposal out of the 12 States that discussed it. As debate continued within the States, so did opposition to a proposal for government health insurance. AALL leaders assumed that such reform would be viewed as beneficial to all. The stage was set for health insurance to dominate conversations about health care.

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Social Justice, Military, and Affordable Care Act: Part 2

Sunday, October 27th, 2013

IMGP3125September 20, 2013

Other early federal debates led to the provision of health care to the armed forces, naming the public good and satisfaction of economic aims to support the government’s role. It was argued that a healthy army and navy were necessary for national defense. The patchwork of care for the U.S. military covers decisions relating to those who serve, have served, and their families [see http://usmilitary.about.com/cs/healthcare/a/medicalcare_4.htm for a summary]. Lost in the conversation about the uninsured and the Affordable Care Act is the data about our nation’s veterans. They comprise a very large group of the uninsured. Here is the estimate from the Robert Wood Johnson Foundation: http://www.rwjf.org/en/research-publications/find-rwjf-research/2013/03/uninsured-veterans-and-family-members.html — 1.3 million veterans plus their families [about another 1 million] have no access to health care.

How does the Affordable Care Act affect military families? An analysis that includes comparisons between Tricare and ACA requirements appears at: http://www.militarytimes.com/article/20130926/BENEFITS06/309260025/Affordable-Care-Act-No-impact-Tricare-some-coverage-isn-t-equal. It appears that the ACA will require more coverage than Tricare offers in various instances.

As for veterans and their families, if their income levels fall within Medicaid guidelines, they may receive care through an ACA Medicaid-expansion option. That depends upon their State’s buy-in, however, so it remains unclear whether this group of hundreds of thousands will find a path to care or not.   

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Social Justice and the U.S. Affordable Care Act: Part 1

Saturday, October 26th, 2013

IMGP3158September 15, 2013

As President Obama took on the health care issue, his overall aim appeared to be to address access to health care for those who do not have it. This includes some of our most vulnerable citizens, ranging from children living in poverty to the elderly who lack the resources for care. This President, as others before him, sought to promote the dignity of citizens through the provision of health care and to exercise social justice in ways that represent ideals expressed in the Declaration of Independence—promoting “life, liberty, and the pursuit of happiness.”

The U.S. Constitution, which was adopted in 1787 as the supreme law of the newly formed national government for the thirteen states, does not endow Americans with a protected right to health care. This was a conclusion reached by the U.S. Supreme Court but one that finds itself at odds with other republics where a level of health and health care are explicitly guaranteed [see Poland, for example—p. 3 of http://www.ehma.org/files/Benefit_Report_Poland.pdf].

The reasons for an absence of reference to health and health care in the U.S. Constitution likely reflect both the desire to avoid government intervention—related to the very foundation leading to the formation of this nation–and the practical reality that medicine was in its infancy at that time. Thus, there was not much anyone, let alone government, could do to promote the health of individuals. Family comprised the primary unit of both social and economic life, and family assumed the role of caring for sick and injured members.

Very early on, these realities conflicted with the fact that merchant seamen, who acted on behalf of the welfare of all U.S. citizens, became ill and/or disabled in the performance of their duties. Thus, it was only “just” to pay for their health care. In accord with this premise, Congress passed an act to provide for merchant seamen’s medical care in 1798. Congress used the authority of Article I, Section 8 of the U.S. Constitution to support this policy. It empowers the federal government to regulate commerce with foreign nations and to tax for the general welfare as a means to that end. The health and well-being of individual seamen was not the argument used to support a role for government in providing health care. The need for a government role in health and health care resided in a focus on promoting commerce. Government efforts to provide health care, however, were squarely on the table, beginning a path toward where we are today.

 

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“Your potassium level is low”–what fruits can do about this message from my doctor

Saturday, August 24th, 2013

August 23, 2013

IMGP0012Well, the annual check-up was mostly good news. My numbers were mostly good. 64 resting pulse. 120 over 78 for blood pressure. But then my doctor said, “Don’t you like fruit?” Huh?

“Your potassium is low. Don’t you like fruit?” I eat an apple almost every day, I say. He nods and says, “Eat more fruit.” OK. What kind? How much?

First, potassium–why is it important? I guess I could’ve asked but it seemed as if I was expected to know. And I knew I could find out online. Which I did.  Let’s just say that potassium is very important. It is crucial for heart function and for muscle contraction.

There are lots of food sources of potassium but I did find a ‘top 10’ list of fruits at  http://www.healthaliciousness.com/articles/high-potassium-fruits.php. Dried apricots are number 1 and bananas are on the list but much closer to the bottom. Prunes,  raisins, dates, and figs are on the list as well. I guess I will try a little harder to get some more of these in my daily routine.

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What is an ‘improvement standard?’

Thursday, August 22nd, 2013

August 21, 2013

YoungGirlOldWoman-03

A familiar image. What do you see when you first glance at it? An older woman? A younger woman? Can you see both?

Much of the language being used to define standards for care reminds me of this image. There has been a lot of discussion about an ‘improvement standard’ in the health care arena. The notion is that providers may not cover care if a patient is not expected to have long-term improvement in  their medical condition. Some law suits have tackled this issue, especially in relation to paying Medicare.

In one such case, skilled nursing care for a patient was argued to have been denied because the patient was not expected to improve in the long term. In the case of Jimmo vs. Sebelius, the improvement standard was considered and never directly addressed. The decision instead was that skilled care would not be covered when less skilled care would suffice. The Center for Medicare Services declared that they would do an educational campaign to address the issue of the improvement standard. Read more here: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/Jimmo-FactSheet.pdf

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