The changing healthcare landscape

. . . . While doctor nurses are still a rare breed nationally, that's about to change dramatically. The first class of 24 doctor nurses graduated in December from the University of Minnesota's School of Nursing, one of a handful of schools at the forefront of this trend. All have returned to their jobs or new positions, some with expanded roles and pay. Now more than 90 nursing schools have introduced DNP programs and 200 more are about to start. Beginning next year, the University of Minnesota is converting its entire master's of nursing practice program into a doctoral course, meaning any nurse practitioner who passes board exams will be a doctor nurse. . . . . Experts are forecasting a shortage of physicians in the country by 2020 because the population has grown even as enrollments in medical schools have remained flat. What's more, 36 percent of active physicians are older than 55 and most will retire by 2020 . . . . The shortage is already showing up in primary care, which includes family medicine, pediatrics and internal medicine. This year, U.S. medical graduates filled just 1,156 of 2,387 residency positions nationally in family medicine; the rest were filled by foreign medical graduates. Primary care doctors are paid far less than specialists. . . . According to Delaney, there is already an 80 percent overlap between what nurse practitioners do and what primary care physicians do.

Curbing guns, but not too much

ON APRIL 16th last year a deranged student, Cho Seung-hui, killed 32 people before shooting himself at Virginia Tech university. He had legally acquired the two handguns he used that morning. Before his rampage on the campus, which spreads over the rolling hills of Blacksburg, teachers and university police were already worried about his volatile behaviour and violent writings. He was recommended for psychiatric treatment but, because of cracks in the state mental-health system, never received it.
Virginia's rush to reform has been dramatic but incomplete. At the urging of the state's governor, Timothy Kaine, the legislature has funnelled an extra $42m into mental-health treatment and staff. Virginia has also rewritten its laws for identifying and monitoring the mentally ill. One new law requires colleges to alert the parents of students who may be a danger to themselves or to others. And the state now requires mental-health questions on the instant-background checks for gun-buyers. These might have kept firearms out of Cho's hands.

The oldest Americans are also the happiest

It turns out the golden years really are golden. Eye-opening new research finds the happiest Americans are the oldest, and older adults are more socially active than the stereotype of the lonely senior suggests. The two go hand-in-hand: Being social can help keep away the blues."The good news is that with age comes happiness," said study author Yang Yang, a University of Chicago sociologist. "Life gets better in one's perception as one ages." A certain amount of distress in old age is inevitable, including aches and pains and the deaths of loved ones and friends. But older people generally have learned to be more content with what they have than younger adults, Yang said. This is partly because older people have learned to lower their expectations and accept their achievements, said Duke University aging expert Linda George. An older person may realize "it's fine that I was a schoolteacher and not a Nobel prize winner."

President Is Rebuffed on Program for Children

The Bush administration violated federal law last year when it restricted states’ ability to provide health insurance to children of middle-income families, and its new policy is therefore unenforceable, lawyers from the Government Accountability Office said Friday.The ruling strengthens the hand of at least 22 states, including New York and New Jersey, that already provide such coverage or want to do so. And it significantly reduces the chance that the new policy can be put into effect before President Bush leaves office in nine months.At issue is the future of the State Children’s Health Insurance Program, financed jointly by the federal government and the states. Congress last year twice passed bills to expand the popular program, and Mr. Bush vetoed both.

Before Medicare, Sticker Shock and Rejection

IF you want to retire before you are 65 and eligible for Medicare, health insurance is vital to your plans. Without it, you risk losing everything. Less than a third of employers offer retiree health benefits, down from almost half in 1993, according to a survey by the Mercer Health and Benefits consulting firm. Those without retiree health benefits who are eligible can use a patchwork of federal and state laws to build an insurance bridge — although an expensive one — to Medicare.Usually, however, the best, least-expensive option is to buy an individual policy, but that can be problematic if you have pre- existing health conditions.

Few US doctors answer e-mails from patients

Doctors have their reasons for not hitting the reply button more often. Some worry it will increase their workload, and most physicians don't get reimbursed for it by insurance companies. Others fear hackers could compromise patient privacy — even though doctors who do e-mail generally do it through password-protected Web sites.
There are also concerns that patients will send urgent messages that don't get answered promptly. And any snafu raises the specter of legal liability.
Many patients would like to use e-mail for routine matters such as asking for a prescription refill, getting lab results or scheduling a visit. Doing so, they say, would help avoid phone tag or taking time off work to come in for a minor problem.
Still, a survey conducted early last year by Manhattan Research found that only 31 percent of doctors e-mailed their patients in the first quarter of 2007. . . Dr. Daniel Z. Sands, an assistant clinical professor at Harvard Medical School, is among the early adopters who doesn't get paid for e-visits. He sees communicating with patients online as no different from phoning them, a practice that also is not billable.

Congress Near Deal on Genetic Test Bias Bill

Congress reached an agreement clearing the way for a bill to prohibit discrimination by employers and health insurers on the basis of genetic tests. . . . Some of the tests already exist, like one for breast cancer risk, and new ones are being introduced almost every month. But backers of the legislation say many people are afraid of taking such tests because they fear the results would be used to deny them employment or health insurance.

The silent tsunami (Economist article)

A wave of food-price inflation is moving through the world, leaving riots and shaken governments in its wake. For the first time in 30 years, food protests are erupting in many places at once. Bangladesh is in turmoil; even China is worried. Elsewhere, the food crisis of 2008 will test the assertion of Amartya Sen, an Indian economist, that famines do not happen in democracies.
Famine traditionally means mass starvation. The measures of today's crisis are misery and malnutrition. The middle classes in poor countries are giving up health care and cutting out meat so they can eat three meals a day. The middling poor, those on $2 a day, are pulling children from school and cutting back on vegetables so they can still afford rice. Those on $1 a day are cutting back on meat, vegetables and one or two meals, so they can afford one bowl. The desperate—those on 50 cents a day—face disaster.

Every year, between 300 and 400 doctors take their own lives—roughly one a day

The unsettling truth is that doctors have the highest rate of suicide of any profession. Every year, between 300 and 400 physicians take their own lives—roughly one a day. And, in sharp contrast to the general population, where male suicides outnumber female suicides four to one, the suicide rate among male and female doctors is the same. . . . One way to address physician suicide, says Reynolds, is to focus on medical students and residents, since depression often starts in young adulthood. Medical schools across the country have launched programs that, among other things, guarantee students who seek help that it will not appear on their records.

Should Pro-suicide Internet Websites be Banned?

Researchers used four search engines to look for suicide-related sites, the British Medical Journal said. The three most frequently occurring sites were all pro-suicide, prompting researchers to call for anti-suicide web pages to be prioritised. Mental health campaigners said such sites preyed on vulnerable people. Unlike in some countries, pro-suicides sites are not banned in the UK.

Is This Good Policy?

France's lower house of parliament today adopted a groundbreaking bill that would make it illegal for anyone to publicly incite extreme thinness. Fashion industry experts said that the law, which would apply to magazines, advertisers and websites, would be the strongest of its kind anywhere. Valerie Boyer, from the ruling UMP party, proposed the new legislation which she said would give judges the power to imprison offenders and fine them up to 30,000 euros (£24,125) if convicted of "inciting others to deprive themselves of food" to an "excessive" degree.

Study: Boomers to flood medical system

"We face an impending crisis as the growing number of older patients, who are living longer with more complex health needs, increasingly outpaces the number of health care providers with the knowledge and skills to care for them capably," said John W. Rowe, professor of health policy and management at Columbia University. Rowe headed an Institute of Medicine committee that released a report Monday on the health care outlook for the 78 million baby boomers about to begin turning 65. The report from the institute, an arm of the National Academy of Sciences, said:
_There aren't enough specialists in geriatric medicine.
_Insufficient training is available.
_The specialists that do exist are underpaid.
_Medicare fails to provide for team care that many elderly patients need. . . .
The federally required minimum number of hours of training for direct-care workers should be raised from 75 to at least 120, the report said, noting that more training is required for dog groomers and manicurists than direct-care workers in many parts of the country.
And it said pay for geriatric specialists, doctors, nurses and care workers needs to be increased.
A doctor specializing in elderly care earned $163,000 on average in 2005 compared with $175,000 for a general internist, even though the geriatric specialist required more training.

Clinton, Obama differ slightly on health plans

Sens. Obama and Clinton both say they make reducing the number of people without health insurance - 47 million - a cornerstone of their health plans. Their approaches are so similar that some health experts say this is not the issue that will help most voters decide between the two Democrats. The real fireworks will come in the fall when one of them faces Sen. John McCain, the presumptive Republican nominee, whose proposal is starkly different and represents a greater departure from the status quo. . . . Both Clinton and Obama say they want to build on the current mix of public and private health insurance to make coverage universal and affordable. Both say they would offer tax subsidies to help people buy insurance, require most employers to help pay for insurance, and limit insurance company profits. Individuals and small businesses could join big groups to buy private insurance or a Medicare-like public plan.
The big difference between the two is that Clinton would require everyone to have health insurance and Obama would mandate it only for children.

States 'recycle' meds to battle costs

The struggle to keep soaring medical costs in check is feeding an increase in state programs that collect unused prescription drugs to give away to the uninsured and poor. Some states allow donations of sealed drugs from individuals, while others only accept pharmaceuticals from institutions, such as doctor's offices or assisted-living homes. Drugs are typically vetted by pharmacists to cross-check safety, then distributed by hospitals, pharmacies or charitable clinics. The type of drugs donated run the gamut and include antibiotics, antipsychotics, blood thinners and antidepressants. At least 33 states have laws to allow or study drug recycling programs, according to the National Conference of State Legislatures. Most state programs are just a few years old or still in the test stages, but officials envision huge gains.

Antidepressants and suicide

A health warning meant to alert doctors about the potential risks of prescribing antidepressants to youth may have actually triggered a significant rise in suicides among Canadians under age 18, a new study has found. The findings, published today in the Canadian Medical Association Journal, are adding new fuel to an already heated controversy about whether certain antidepressants may pose a risk to Canadians, particularly teens and children, or if the drugs help reduce suicide rates.

In Massachusetts, Universal Coverage Strains Care

In pockets of the United States, rural and urban, a confluence of market and medical forces has been widening the gap between the supply of primary care physicians and the demand for their services. Modest pay, medical school debt, an aging population and the prevalence of chronic disease have each played a role. Now in Massachusetts, in an unintended consequence of universal coverage, the imbalance is being exacerbated by the state’s new law requiring residents to have health insurance. Since last year, when the landmark law took effect, about 340,000 of Massachusetts’ estimated 600,000 uninsured have gained coverage. Many are now searching for doctors and scheduling appointments for long-deferred care.

Researchers Find Huge Variations in End-of-Life Treatment

New research shows huge, unexplained variations in the amount, intensity and cost of care provided to Medicare patients with chronic illnesses at the nation’s top academic medical centers, raising the possibility that the government could save large amounts of money.

In a report being issued on Monday, Dartmouth researchers say that total Medicare spending in the last two years of life ranges from an average of $93,842 for patients who receive most of their care at U.C.L.A. Medical Center to $53,432 at the Mayo Clinic’s main teaching hospital in Rochester, Minnesota.

Is Prevention Always Cost Effective?

In 1986, a health economist named Louise B. Russell published "Is Prevention Better Than Cure?," in which she concluded that prevention activities tend to cost more than they save. Since the book's appearance, her observation has been borne out by studies of hundreds of interventions -- everything from offering mammograms to all women and prescribing drugs to people with high cholesterol to requiring passenger-side air bags in cars and shortening the response time of ambulances.

Should CEO Salaries at Not-for-Profits be Capped?

The Boston Herald on Wednesday featured an article about hospital CEO salaries in the Bay State. According to the article, 14 top executives at nonprofit Massachusetts hospitals have "million-dollar-plus pay packages". A
state legislator is proposing to cap compensation at nonprofits in the state.

Abortion Restored in Reproductive Health Database

Dean of the Johns Hopkins University Public Health School, Dr. Michael J. Klag, ordered the school’s federally-funded online database of reproductive health literature reprogrammed to restore the word 'abortion' as a search term. Administrators had set POPLINE, the world’s largest database on reproductive health, with more than 360,000 records and articles on family planning, fertility and sexually transmitted diseases, to ignore abortion as a search term.
The move to censor abortion-related materials was met with harsh criticism from libraries trying to access the articles and women’s health advocates, according to UPI. POPLINE representatives said that the decision to do so was tied to their funding from the US Agency for International Development (USAID).

One in 4 Teen Girls Has a Sexually Transmitted Disease

More than 3 million teenaged girls have at least one sexually transmitted disease (STD), a new government study suggests. The most severely affected are African-American teens. In fact, 48 percent of African-American teenaged girls have an STD, compared with 20 percent of white teenaged girls. "What we found is alarming," Dr. Sara Forhan, from the U.S. Centers for Disease Control and Prevention, said during a teleconference Tuesday. "One in four female adolescents in the U.S. has at least one of the four most common STDs that affects women." "These numbers translate into 3.2 million young women nationwide who are infected with an STD," Forhan said. "This means that far too many young women are at risk of the serious health effects of untreated STDs, including infertility and cervical cancer."