Health Wonk Review: Wearing the Green for the St. Patrick’s Day Edition

Here in Boston, researchers have looked into that most pressing of St. Patrick’s Day health questions: Is Guinness really good for you? Red wine gets all the press, but Tufts researchers found a positive association between beer and bone density.

For this edition of the Health Wonk Review, we take a a look at the Irish Times and find that even with a national health plan, Ireland has to deal with barriers to care. One story details slow progress in the establishment of promised primary care centers, and another story, asks “Is the EU good for your health?”

So, while we refight the battle over birth control, the Irish health ministry – of the largely Catholic country — is releasing a “sexual health” app.

Back here in the new world, the great grandchildren of Irish immigrants celebrate their heritage as Linda Leu at the Health Access Blog writes about a report that “highlights the need for cultural competency and language access, to welcome all ethnicities from California (and America’s) diverse communtiies….The Importance of Equity in the Bridge to Reform: As St. Patrick’s Day celebrates Irish ethnic pride, we need to take note of the full diversity of our states and nation. As we get ready for 2014, remember the communities that will be newly served may not look (or speak) the same as those that the current system serves.” 

For the once-a-year step dancers,Gary Schwitzer at Health News Review answers questions about outcomes data on knee replacement surgery. Also see posts on the JGIM paper on  data on  shared decision-making in prostate cancer surgery & coronary stents decisions   and an online “Daily Deal” coupon for preventive MRI scan – disease-mongering du jour

Boston’s own David Williams notes: “Profits are up at Massachusetts health plans –should you be upset? On his Health Business Blog, he writes: The Globe reports higher profits and CEO compensation at Massachusetts health plans. But profit margins are low and if anything the CEOs are underpaid.”

More of the best of recent health policy posts

At The Hospitalist Leader, Brad Flansbaum examines physician pay,“fairness, and how it relates to the reinvigoration of primary care. Specialty physicians take note.”

Another post on health care providers — and their support teams – notes: “There’s been much discussion of the potential impact of health reform, aka Obamacare, on employment”  Joseph Paduda at ManagedCareMatters.com writes: “Most has referenced employers cutting jobs to avoid the mandate or save dollars for premiums.  What hasn’t received much attention are the new jobs – mostly high-paying ones- that will be created as more Americans are insured and seek coverage and care.”

Julie Ferguson of Workers’ Comp Insider asks “If you had to guess what workplace experienced most assaults by customers/patrons what would you guess? If you guessed healthcare, you would be right.” She informs us that 61% of all workplace assaults are committed by healthcare patients, according to a recent report issued by NCCI.

Two posts came in on shady practices.

Colorado Health Insurance Insider offers: Colorado AG Files Lawsuit Against Discount and Mini-Med Health Plan:  ”It’s a pretty typical website for that sort of product, with lots of great-sounding claims and sample cases where members have supposedly saved thousands of dollars.  But they also have a link for people who want to “become a reseller”.  And their process of getting recruits enrolled to sell the product is what has come under the watchful eye of the Colorado AG.”

 Calling it “The latest example of misbehavior by a large health care corporation,”  Roy M. Poses at Health Care Renewal writes : Gentiva’s Odyssey Healthcare Settles Again, Signs Yet Another Corporate Integrity Agreement and gets “little more than a financial wrist slap.  The case was about allegations that a for-profit hospice enrolled patients who did not meet the regulations for federal reimbursement for hospice care.  In particular, they were alleged to be patients who really did not seem to have extremely limited life expectancies.  It is true that enrolling such patients lead the government to pay more for their care than might otherwise be the case.  But the real problem is that patients may have been denied treatments that could have improved, or even lengthened their lives. 

Two on workplace wellness:

“Wellness Program Implementation at WCS Looks a Lot Like Dating” says Kat Haselkorn Corporate Wellness Insights. This post details the similarities between customer satisfaction and romantic relationships. Although wellness program implementation and dating do not seem to have much in common, we have found that the process of making a client happy mirrors the act of keeping a romantic prospect satisfied. When it comes to setting up a wellness program, we do whatever it takes!

Henry Stern, LUTCF,  at the CBC InsureBlog writes about “Health vs Common $ense, challenging “the conventional wisdom that workplace health promotion programs work.”

And two on HIT:

“Competition today in healthcare encourages care providers to hoard patient data.”  says Vince Kuraitis of the  e-CareManagement blog in a post called “Stage 2 MU Rules : The proposed Stage 2 Meaningful Use rules support moving competition in healthcare to the right bases — sharing and adding value to patient health record data.

Health Affairs offers a post by Danny McCormick, of Harvard Medical School and the Cambridge Heath Alliance, and coauthors David Bor, Stephanie Woolhandler, and David Himmelstein. The title of the post is  “The Effect Of Physicians’ Electronic Access To Tests: A Response To Farzad Mostashari”

The four authors of the post are also the authors of an article in the March issue of Health Affairs. The article reported that electronic access to computerized imaging results (either the report or the actual image) by physicians was associated with a 40% -70% increase in imaging tests, including sharp increases in expensive tests like MRIs and CT scans; the findings for blood tests were similar. The article prompted a critical blog post by national health IT coordinator Farzad Mostashari.

Jason Shafrin writes: “Americans are a litigious culture.  The malpractice claims that make it to court, however, are not many as you may think.The Healthcare Economist explains why.

Finally, how does health care In the U.S. compare to other countries?  On the Disease Management Care Blog  Dr. Jaan Sidorov tests our knowledge of and finds: We’re not so bad after all!

So, our days of drinking black — or green  — beer are over. But, on Saturday I’ll boil up some cabbage and — sorry Walter Willett – and a hunk of  corned beef in honor of my Irish nanny and the Readys and Gradys  and Murphys who left their green shores and made their way across the sea to settle in Boston and New York.  Happy St. Patrick’s Day from BHN.

 

Did news reports miss the message on IOM breast cancer/environment study?

Earlier this week, we cast this IOM study as offering little new news.  But, as Julia Brody of  The Silent Spring Institute points out, that’s not quite true.  From the environmental Health News website:

…(M)ost of the news media missed the significance of the assessment on environmental chemicals. The real news is that the report is an authoritative statement that a cascade of scientific evidence plausibly links consumer product chemicals and pollutants with biological activity suggesting breast cancer risk.

Instead of saying what is in the report, glass-empty stories said that the IOM “failed” to “definitely” link any chemicals to breast cancer or find “clear” environmental links. Some incorrectly said the report tells women to stop worrying about consumer product risks. These stories ignore the report’s important explanation that definitive evidence is not attainable and lack of human evidence of harm doesn’t mean something is safe.

From original NYTimes story on the report:

The report, 364 pages long and two years in the making, was issued on Wednesday by the Institute of Medicine, an independent group that is part of the National Academy of Sciences and advises the government and public. The work was done by a committee of 15 outside experts, mostly from universities, and nine institute staff members. The sole sponsor was a breast cancer advocacy group, Susan G. Komen for the Cure, which requested the report and spent $1 million on it.

For women who were hoping for definitive safety information about the huge number of chemicals to which people are exposed — from air pollution and cosmetics to cleaning products, food and drinking water — the report may come as a disappointment. It is based largely on a review of existing research, and its limited advice reflects the lack of solid scientific information in many areas of concern to the public.

Women should take note on Cape Cod, where the breast cancer rate is higher than average.  The Silent Spring Institute, one of the few groups doing research on environmental links to breast cancer, recently reporting finding 27 chemicals in well water on the Cape.

The 27 contaminants detected included 12 pharmaceuticals (the most common being one antibiotic and one epilepsy drug); five perfluorinated chemicals (found in non-stick and stain-resistant household products); four flame retardants; two hormones; one skin care product; one artificial sweetener; one insect repellent; and one plastics additive. Health-based guideline values were available for only four detected chemicals (PFOS, PFBS, DEET, carbamazepine), and no samples approached or exceeded these values. The most frequently detected chemical was acesulfame, an artificial sweetener, which was found in 85 percent of wells, and perfluorinated chemicals were detected in 70 percent of wells.

“While the levels of pharmaceuticals, flame retardants, and other emerging contaminants in drinking water are not currently regulated, we still think that it is prudent to find ways to prevent discharges from septic systems and wastewater treatment plants from impacting drinking water supplies, as we don’t fully understand the potential health impacts,” lead investigator Laurel Schaider said.

For more on health and the Massachusetts environment see  SSI or the Massachusetts Environmental Public Health Tracking (MA EPHT) Program Website

This website is designed to provide you with access to current and accurate health and environmental information available for Massachusetts. You can use Massachusetts Environmental Public Health Tracking (MA EPHT) information to learn about the health of your community and access information about your environment.

 

 

 

 

Are we prepared for a Japanese-style nuclear disaster?

Two items on nuclear power today. Juliette Kayyem,  a former homeland security adviser for both Massachusetts and the US Department of Homeland Security, asks on today’s Globe Op/Ed page: Can the US handle a nuclear disaster?

The White House planning document for a nuclear event essentially admits that the public would be foolish to rely too heavily on the government. Sheltering in place (for any contingency) requires a few minutes to prepare your home with basic essentials, including water and food, and to ensure that your loved ones know where to go in the event that all communications are disrupted. It is that simple; no drama, no duct tape…

There is no doubt that nuclear safety will be the subject of a heated debate in the months to come. And that debate may serve as an important opportunity to challenge not only the nuclear industry’s assumptions about plant safety, but also our own assumptions about empowering ourselves to protect our well-being.”

Also, the investigative group ProPublica asks how well plant operators are prepared.As this story notes,  Mass Democratic Rep. Ed Markey has been pushing for safer rules and is not pushing harder.  

Can the US handle a nuclear disaster?

by John Sullivan, Special to ProPublica March 13, 2011

Published with permission.

As engineers in Japan struggle to bring quake-damaged reactors under control [1], attention is turning to U.S. nuclear plants and their ability to withstand natural disasters.

Rep. Ed Markey, a Massachusetts Democrat who has spent years pushing the Nuclear Regulatory Commission toward stricter enforcement of its safety rules, has called for a reassessment. Several U.S. reactors lie on or near fault lines, and Markey wants to beef up standards for new and existing plants.

“This disaster serves to highlight both the fragility of nuclear power plants and the potential consequences associated with a radiological release caused by earthquake related damage,” Markey wrote NRC Chairman Gregory Jaczko in a March 11 letter [2].

Specifically, Markey raised questions about a reactor design the NRC is reviewing for new plants that has been criticized for seismic vulnerability. The NRC has yet to make a call on the AP1000 reactor [3], which is manufactured by Westinghouse. But according to Markey, a senior NRC engineer has said the reactor’s concrete shield building could shatter “like a glass cup” under heavy stress.

The New York Times reported last week [4] that the NRC has reviewed the concerns raised by the engineer, John Ma, and concluded that the design is sufficient without the upgrades Ma recommended. Westinghouse maintains that the reactor is safe [5].

Boiling water reactors [6], like the ones hit by the Japanese earthquake, are built like nested matroyshka [7] dolls.

The inner doll, which looks like a gigantic cocktail shaker and holds the radioactive uranium, is the heavy steel reactor vessel. It sits inside a concrete and steel dome called the containment. The reactor vessel is the primary defense against disaster — as long as the radiation stays inside everything is fine.

The worry is that a disaster could either damage the vessel itself or, more likely, damage equipment that used to control the uranium. If operators cannot circulate water through the vessel to cool the uranium it could overheat and burn into radioactive slag — a meltdown.

Reports say a partial meltdown is suspected [1] in two of three reactors at the Fukushima Daiichi Nuclear Power Station in Japan, which was hit by the 8.9 magnitude quake and ensuing tsunami.

Reactors have multiple layers of equipment to make sure this never happens. But last year, Markey asked Congress’s investigative agency [8], the Government Accountability Office, to look into a long list of nuclear safety issues, including earthquake and flood protection.

Markey cited the 2007 Chuetsu earthquake [9] (6.6 magnitude) that hit the Kashiwazaki-Kariwa nuclear plant. The quake started a fire, spilled some low-level radioactive waste and damaged equipment that was not critical to the reactor. It led Japanese regulators to reassess earthquake danger near the plant, and Markey wanted GAO to see whether NRC had been on top of earthquake risk in the U.S.

As seen here, Hurricane Gustave damaged the River Bend Nuclear Generation Station in St. Francisville, La. (NRC photo provided by Union of Concerned Scientists)

He also listed a few cases in which other natural disasters had damaged nuclear plants, like a 1998 tornado that knocked out power to the Davis-Besse [10] plant outside Toledo, Ohio, or Hurricane Andrew, which knocked out power to the Turkey Point [11] plant south of Miami site for five days in 1992. In 2008, Hurricane Gustav damaged the River Bend Nuclear Generation Station in St. Francisville, La. [12]

At both Davis-Besse and Turkey Point, the plants’ emergency diesel generators kept the equipment running until crews fixed the power lines.

News reports have said the Fukushima Daiichi Nuclear Power Station went to backup diesel power after the quake but lost it, along with the ability to keep cooling water flowing.

Edwin Lyman, a senior scientist with the Union of Concerned Scientists, told Reuters [13] that U.S. reactors don’t have adequate backup power. “We do not believe the safety standards for U.S. nuclear reactors are enough to protect the public today,” he told the news agency.

NRC spokesman David McIntyre said the agency was not granting interviews about the Japan quake. He pointed to the agency’s website, which does have a lot of information on the seismic issues.

For instance, NRC regulations require that every plant is built to survive an earthquake larger than the strongest ever recorded in the area. The agency says it periodically updates earthquake estimations as more detailed information becomes available.

Most recently, the NRC spent five years reassessing earthquake risk for nuclear plants in the Midwest and eastern United States. The results of the study [14], which were released last September, confirmed that the plants were built to withstand the heaviest quake likely for their area.

However, the NRC found that the risk of earthquake was greater than expected in some areas, so the agency plans further research [15].

In an NRC meeting on earthquake safety last September, Torrey Yee, an engineer for the San Onofre nuclear plant near San Diego, said designers evaluate two levels of earthquakes: the maximum possible quake for a site; and an “operating basis” quake, usually about half of the maximum strength.

The critical structures and equipment at the plant are built to withstand the maximum quake, and the plant has to shut down for inspection if it sustains a quake higher than the operating basis.

The 104 commercial reactors [16] in the United States produce 20 percent of the nation’s power.

Hormone disrupters: Is Triclosan the next BPA?

 From the Globe

 Some scientists and environmentalists say triclosan may do more harm than good because — while industry insists it is safe in everyday applications — there is evidence it can disrupt animal hormones.

 Representative Edward J. Markey, following several months of correspondence with federal agencies about potential health effects, is calling on the federal government to ban its use in a broad range of consumer products that are used to wash hands and prepare food, or are marketed to children. He is also filing legislation that would accelerate the government’s evaluation and regulation of potentially harmful products. 

Markey Press Release.

 From this office

A copy of the FDA response can be found here: http://markey.house.gov/docs/fdatriclosanresponsereduced.pdf
A copy of the EPA response can be found here:  http://markey.house.gov/docs/epatriclosanresponse.pdf

A fact sheet on triclosan prepared by Chairman Markey’s office can be found here: http://markey.house.gov/docs/triclosan_information_final.pdf

Home health and healthy homes

For the latest on the Senate health reform bill, see Kaiser Health News or The Washington Post.  

This on home health from David Abel in today’s Globe.

A $332 million state program that oversees home health care services for about 18,000 elderly and disabled residents is vulnerable to fraud and has employed personal care attendants who have committed felonies, including manslaughter, assault, and threatening to commit murder, according to a report released yesterday by the Office of the State Auditor.

Click here for the actual audit report. People are constantly trying to rip off the home health system, something that is so needed and so expensive. They are not just stealing from frail elderly, but from the rest of us. Fraud leads to more paperwork and auditing, making it doubly evil. 

Also, it might be fair to say you’re only as healthy as your hometown. I just discovered the CDC’s Healthy Places program.  

CDC recognizes several significant health issues that are related to land use, including–

       Accessibility

       Children’s Health & the Built Environment

       Healthy Aging & the Built Environment

       Gentrification

       Healthy Community Design

       Healthy Homes

       Health Impact Assessment

       Injury

       Mental Health

       Physical Activity

       Respiratory Health & Air Pollution

       Social Capital

       Water Quality

 

The EPA has a similar program.

 EPA helps communities grow in ways that expand economic opportunity, protect public health and the environment, and create and enhance the places that people love. Through research, tools, partnerships, case studies, grants, and technical assistance, EPA is helping America’s communities turn their visions of the future into reality.

 I found a link on their website to a new Institute of Medicine reporting on “Local Government Actions to Prevent Childhood Obesity” that cites a health promotion program in Somerville called Shape Up Somerville.

Shape Up Somerville is a city wide campaign to increase daily physical activity and healthy eating through programming, physical infrastructure improvements, and policy work.  The campaign targets all segments of our community, including schools, city government, civic organizations, community groups, businesses, and other people who live, work, and play in Somerville. 

This effort began as a community based research study at Tufts University targeting 1^st through 3^rd graders in the Somerville Public Schools.  Today there is Coordinator working on active and healthy living programs supported by the Health Department and a Taskforce that is a collaboration of over 11 initiatives and 25 stakeholders involved in working on various interventions across the city, such as:

• School Food Service
• Teachers teaching an-School Curriculum
• After School programs using a new curriculum
• Parent, City Employee and Community Outreach
• Restaurants
• Walkability and Safe Routes to School
• Extension of the Community Path
• School Nurses and Pediatricians
• Policy Initiatives
• Farmers markets and community/school gardens