Category Archives: Prevention

On H1N1, Vaccines, and Differing Views

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I haven’t written too much about H1N1. Partially, this is because as an avid reader and headline scanner, I suffer a bit from H1N1 fatigue. From local news reports to national updates to reminders and policy talk at my job, H1N1 is everywhere.

But it’s also because everyone seems to have an opinion about the H1N1 vaccine. And lately it seems I can’t go anywhere without getting a hearty dose of other people’s strong opinions about it in my face.

It’s a controversial topic for many, and I get that. I respect other people’s right to make their own decisions about their health. The thing is, I don’t need to agree, or be convinced my own decision about my health is wrong. So when I’m getting my blood drawn and stressed about getting to work on time because the line is long and my veins are wily and unyielding, I don’t really need a lecture from a health care professional on how flu shots are full of toxins and poisons we shouldn’t put in our bodies. (While flanked by posters advocating flu shots, by the way.)

You might be drawing my blood, but that doesn’t mean you know anything about my health or my personal beliefs, or how I might interpret your unsolicited “advice.”

The same goes for the forwards and attachments that appear out of the ether in my inbox warning me against the evils of vaccinations.

Because you know what? I would do anything for an H1N1 shot right now. For months every single doctor and nurse on my medical team has repeated the same mantra: I am absolutely high risk and should get the shot. The problem is, they just aren’t available yet. I have reason to believe I can get one in the next month, so if I can avoid infection until then, I will be in good shape.

At the same time, it is not as possible for me to read the headlines but stay on the sidelines. Students in my classes now have the flu, and each time I get an e-mail about a 104-degree fever I worry about them, and about how many of us were exposed.

I am not a paranoid person, and considering I spend 7-8 months a year continually sick, I am pretty used to infections. Generally speaking, I take reasonable precautions and reasonable risks with my health.

After I read this NYT article on parental views about the H1N1 vaccine, I knew I couldn’t resist the pull of breaking the silence any longer. In discussing society’s willingness to be vaccinated during twentieth-century epidemics like polio and smallpox, historian David Oshinsky is quoted as saying, “People had a sense of risk versus reward and listened to public health officials.”

That line really resonated with me, because that’s how my doctors and I have approached the H1N1 shot. For me, the risks of contracting H1N1 are much, much more severe than any risks of getting the shot. (And yes, I get the seasonal flu shot every year without incident, and since they are made the same way, I personally do not have fears about the production of H1N1 vaccines.) Vaccination and communicable disease prevention are some of public health’s greatest triumphs, in my view, and I am incredibly grateful modern medicine gives me and my sub-par immune system some protection.

After all, otherwise healthy people face serious complications from H1N1, usually in the form of secondary bacterial infections (pneumonia) that linger because the flu virus damages cilia in the respiratory tract.

I don’t have working cilia. I also have bronchiectasis, which increases the likelihood of bacteria and mucus festering in my airways, causing severe exacerbations. That sounds like an awesome combination, doesn’t it? I can catch a cold in September and not recover until March, and I’m not exaggerating. I’ve almost died from infections on multiple occasions throughout my life, and have spent weeks in isolation units of hospitals. There are few antibiotics left that can squelch the secondary bacterial infections I am so good at growing. As much as my friends joke I need to live in a bubble, I can’t.

But if there is a way for me to prevent contracting H1N1, sign me up. This is the decision that makes absolute sense for my individual circumstances, and it is one every medical professional I know espouses.

I know every person’s situation is unique. For example, I know that for patients with certain autoimmune conditions, the risks of getting a flu shot are very real and very serious, and I would never presume to convince them otherwise.

But that’s just it—these are the kinds of conversations that should take place between doctors and patients, between the people who know the most about an individual’s medical history and constellation of risks. When people do ask me, I am always honest about how I feel about the shot for me, but emphasize I am not a medical professional.

I’m not saying I’m unwilling to engage in dialogue or debate about this, but there’s a difference between informed views on subjects and imposing personal views on other people. I know vaccination in general is a hotly contested topic right now, and there are so many voices on both sides. I don’t want to start shouting. Honestly, I just want to get my shot and get through this winter.

So please, please don’t assume to know the particulars of my situation and tell me I am crazy to pump my body of toxins. No matter how strongly I feel about opposing viewpoints on this, that is not a productive way to have a conversation.

And the way I see it, I’d be crazy to turn down the chance to protect my dodgy lungs.

Comparing Facts in Health Reform

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From the television ads and late night comedy sketches to the daily headlines about “death panels”and colorful town hall meetings, it’s obvious the dialogue surrounding health care reform is as contentious as ever.

But what about the substance of the actual proposals, which seems somewhat lost in all of the rhetoric? Chronic illness is a huge factor in reform, which is why I listened in with interest to a press call announcing Partnership to Fight Chronic Disease’s release of “Hitting the ‘Bulls-eye’ in Health Reform: Controlling Chronic Disease to Reduce Cost and Improve Quality.” The document is a side-by-side comparison of the bills and offers five recommendations for how Congress could control costs through chronic disease prevention.

You can access the publication by clicking here.

As the PFCD’s Dr. Kenneth Thorpe pointed out during the press call, looking at the big picture there are two major sets of issues involved in the health care debate: slowing down health care spending and improving quality, and providing insurance coverage to the millions of uninsured Americans. While the latter is hugely important, with the release of this document the PFCD is focusing on the first set of issues, which affect the chronic disease population in significant ways.

Thorpe characterized the current proposals a “good start” but said the idea would be that Congress would come back in the fall and build on this foundation and offer more aggressive solutions. As such, the report identifies five areas to target, many of which are familiar to us by now: prevention, better coordination of care, reduction of administrative costs, etc.

One thing I was really pleased to hear relates to disease prevention. Of course, we all know the best way to reduce disease expenditures is to prevent conditions from developing in the first place, and there are many specific ideas relating to that. As I’ve written before, when it comes to health care and existing chronic illness, prevention is often more a question of preventing progression than anything else. As such, I paid particular attention when Dr. Thorpe said we need to make sure we’re allowing patients to manage their own conditions and we need to remove barriers that stop them from doing that. His examples included getting hypertension re-checked or following up with blood sugar testing with doctors to prevent long-terms complications like amputations, but my mind went immediately to the types of long-term therapies (like chest PT) that keep patients like me out of the hospital.

The side-by-side comparison of proposals is really quite helpful, so make sure you click on over and go through the information yourself.

Is Soda the Next Big Tobacco?

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Prevention is always a big buzzword in health care reform, and lifestyle choices that decrease the risk of developing costly and debilitating chronic diseases are a huge part of this frequent conversation. A glance at the cover of this week’s Time magazine shows an issue devoted to prevention and wellness throughout the lifespan, and an article called “Food as Pharma” leaves no question about the impact of what we put into our mouths in terms of health and wellness.

With uncanny timing, the magazine arrived the day I had a scheduled interview with renowned nutrition/obesity expert Dr. Barry Popkin, author of The World is Fat as well as recent research linking the consumption of sugary beverages to negative health outcomes. He claims drinking one extra 12-ounce can of regular soda a day, at 140 calories, can cause you to gain 13 pounds in a year.

Dr. Popkin is a strong supporter of taxing beverages like soda and whole milk the way cigarettes are; in fact, he considers soda “the next big tobacco.”

When Massachusetts announced a plan to require chains to list the calories in their items staring next year, the gamut of reactions was predictably wide: some thought it was a great way to make consumers more conscious of their choices; others thought it was an egregious governmental interference into our lives. Against this backdrop, I was certainly excited to discuss Dr. Popkin’s research with him. Here is some of our conversation:

Why is soda the next big tobacco?

Like tobacco, soft drinks and sugary beverages have no health benefits beyond pleasing us, and they have many drawbacks.

According to Dr. Popkin, what makes sugary beverages unique in terms calorie intake is that drinking these calories does not reduce our food intake—normally when we eat food, even junk food, we cut other food intake down.

From an evolutionary point of view, he pointed out that humans always drank water or breast milk. If we go without water for three days, we could die but if we don’t eat, it could take a month to two months to die. Over time, we developed mechanisms where the food and thirst mechanisms are separate, which adds to the unique caloric qualities of sugary beverages.

“Not only don’t they benefit us but they a 100 percent to our poor health by adding to our calories,” he says. What’s more, research suggests that the fructose in sucrose (natural sugar) or high fructose corn syrup adds directly to visceral fat, which is the fat around the heart and liver—and it is the only substance known to do this. It is the most toxic type of fat in terms of diabetes and metabolic syndrome as well as some cancers, so removing sugary beverages is a prime prevention method. (You knew I’d circle back to prevention, right?)

What about the tax and health reform?

Comparing this to the decrease in smokers (and by extension, the health consequences of smoking) as a result of the cigarette tax, Popkin maintains that taxing soda and sugary beverages will reduce the risk of overweight, obesity, type 2 diabetes, and cardiovascular disease. (He also has forthcoming research in this area). Massachusetts is one of a handful of states considering this kind of tax. Popkin also noted that on a larger scale, the United States lags behind many high-end nations in reducing the consumption of sugary beverages.

“We are good at causing disease but not good at fixing it,” Popkin says, a comment that goes beyond the idea of the soda tax and hits on the basic structure of our current medical system. Right now, we spend too much on band-aids for the problems rather than taking steps to correct them at the source. To that end, Popkin sees the beverage tax as a major way to help fund reform and improve health and quality of life.

What is the response to those who think such policies might go too far?

In response to this sentiment, Popkin pointed to previous public health initiatives that were initially met with resistance, like seatbelt use, measures to curb smoking, and putting fluoride in the water. “Clearly there isn’t a single public health initiative that hasn’t faced these arguments,” he says.

He also counters with the following facts: Right now, we’re ranked between 30-35th percent in life expectancy and health care costs are swamping us. Need more statistics on sugary beverages? Forty percent of soda drinkers consume a whopping 600-900 calories a day from their drinks. And, as many of us might now realize, he says natural sugar is just as bad as drinks sweetened with high fructose corn syrup—they both contain fructose, and both add to visceral fat and calorie count.

The way I see it, framing soda as the next big tobacco is also an extension of an even broader debate: if prevention is a fundamental component of health reform, what is the best way to accomplish it?

It’s your turn to weigh in: is soda the next big tobacco?

For more information, check out the video posted below, where Dr. Popkin and colleagues discuss the health impacts of sugary beverages at a recent International Chair on Cardiometabolic Risk (ICCR) conference:

Disease Prevention and the 4th Summit Conversation

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Since I spent yesterday talking about health insurance, it seems fitting to switch gears to another health reform discussion: the fourth America’s Agenda Health Care Summit Conversation, happening today at 11am PST at the University of California San Francisco.

I’ve mentioned these Summit Conversations before, and I do so again because I find the idea of consensus in health care reform both utterly essential and hard to envision. Yet it isn’t as hard to achieve as we used to believe, or perhaps as past attempts at health reform would have us believe. After all, the diverse group of speakers who come together for these talks, from labor, government, health policy, pharmaceutical, and other stakeholders, prove that there already is consensus: all sides agree we need to reform health care, and now is the time. Talks like these are a way to start hashing out how exactly that reform should happen.

As a patient with multiple chronic illnesses, I’m always particularly interested in how these stakeholders approach disease prevention. Considering that 75 percent of health care spending goes to treating patients with chronic disease, switching from a system that still favors treating acute health crises over prevention and wellness—a “sick” system, rather than a “health” system, as some Summit leaders have said—is critical.

And of course, as a rare disease patient, I’d like to see this notion of prevention now to control costs and improve quality of life later include covering the appropriate treatments we need to prevent disease progression, a distinction that matters to millions of people who live with conditions that are not as heavily influenced by lifestyle and behavioral changes.

To see what some Summit speakers have to say about disease prevention, check out the video below, and browse other YouTube videos on topics covered in these talks.

Health Care Reform and Existing Chronic Illness

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On the cusp of Obama’s inauguration, it’s hard not to get excited about the potential for health care reform in America. After all, some promising issues were touted during the campaign: affordable health insurance for all Americans, investment in electronic medical records and biomedical research, and increased focus on disease prevention and disease management, to name a few.

As a resident of Massachusetts, whose universal health insurance law has made us the state with the lowest uninsured rate in the country, it’s been especially interesting to see the successes and the inevitable complications of implementing this type of reform.

Obviously I think the most important thing we need to do is make sure people have access to health insurance. There are many, many reasons to support this notion, but I can’t help going to the most personal: As you know if you’re familiar with this blog, I am a patient with multiple chronic diseases—lifelong, progressive diseases that require constant care and maintenance. Even with reasonably good insurance a significant portion of our budget goes to health care expenses, and most of our major life decisions are made around issues of health outcomes and health insurance.

Ask me to try and live without the insurance that makes this possible, and everything else I’ve worked for in my life crumbles. That’s no way to ensure a sound economy, let alone a positive health status or a reasonable quality of life.

It’s not surprising, then, that beyond increasing access to health insurance what matters most to me is how we approach chronic disease in this country. Preventive medicine and wellness initiatives are hugely important, especially in terms of preventing and treating costly diseases like type 2 diabetes, obesity, and related health problems. From a health perspective and a financial perspective, this makes so much sense, and I hope the measures proposed during the campaign come to fruition.

But there’s more to this notion of preventing and managing chronic disease that demands attention. Consider that one in 12 Americans live with autoimmune disease, or that 25 million Americans live with more than 600,000 rare diseases and you begin to understand the scope of existing chronic illness in this country.

What matters to me are policies that make it affordable to maintain existing chronic illnesses and help prevent disease progression. For example, in terms of my ability to work, contribute to society, and minimize cost and use of resources, I am much a much cheaper patient when I can get the medications and routine physical therapy I need to try and prevent serious lung infections than I am when I am an inpatient.

For patients like me, health care that covers our nebulizer medications, certain IV therapies, or chest physiotherapy not only keep us out of costly hospitalizations in the short term, but they lessen the damage to our lungs that can mean massively expensive problems down the road.

Like so much about chronic illness, the universals here are much more significant than the personal details—whether it’s degenerative arthritis, multiple sclerosis, etc, being able to take the appropriate medications and access the treatments we need to stay healthier and remain productive contributors to society is so important.

Above all, it just makes so much sense…which is though I have a healthy dose of skepticism, I am cautiously optimistic about where we’re going in terms of health care reform.

Women, Health Care, and the Presidential Election: Why Our Vote Matters

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In an election where economic woes dominate the conversation and health care platforms are discussed in terms of polarity rather than specifics, it is easy to see how the importance of the female vote when it comes to matters of health is undervalued.

But it shouldn’t be. After all, women make two-thirds of health care decisions and are consistently health care voters. They also constitute a key swing vote—60 percent of undecided voters are women.

In advance of the upcoming election and on the eve of the next presidential debate, the Partnership to Fight Chronic Disease and two leading political pollsters, Brenda Wigger of Voter/Consumer Research and Celinda Lake of Lake Research Partners, released these and other results of a large poll exploring the attitudes of female and male votes regarding health care and the presidential election.

The survey of 1500 likely voters found that while the economy was the number one major issue men and women care about, health care was the second issue in line, especially for women. As the discussion moved from macro global issues to personal and family issues, health care was the top personal concern, beating out terrorism, energy, Iraq, and so many other issues.

Candidates, are you listening?

What’s more, the target voter, the independent female voter (I count myself in this population), is especially focused on health care—65 percent of female voters say it is the major or one of the major issues in the presidential election.

While I found all of the results interesting, as a young woman, an independent voter, and a patient with multiple chronic diseases, some of the ones highlighted in today’s press conference call were especially resonant. Not only did 83 percent of voters express familiarity with chronic disease, indicating a marked increase in awareness of chronic disease, but when given a long list of items on a health care agenda, treating and preventing chronic disease is at the top of this list. That means chronic disease factors more prominently than such hot button issues as electronic medical records or medical malpractice.

Policy makers, are you listening?

As I know all too well, managing health is a costly endeavor. These days I flirt with postponing appointments and tests to save money, and spend more time paying and filing medical bills than I do any other kind. The fear of losing existing health insurance and the rising cost of health care that is the number one issue for me in this election—indeed the number one issue in most of my personal and household decisions—is also an especially intense concern among younger female voters polled(defined as women under 50).

So I can claim solidarity with these likely voters on so many levels: chronic disease is the dominant issue in health care (remember, 130 million Americans have at least one chronic condition and it costs us $1.1 trillion annually in lost productivity); like most likely voters I am insured but not confident in my coverage; and like 92 percent of voters, I believe that early diagnosis, education, and prevention of chronic disease will make a difference.

Despite the recent crisis on Wall Street, increasing energy prices, and so many other strains, many voters polled supported increasing access to health insurance to all Americans even if it meant raising taxes, even if those dreaded words “federal government” were involved. Since access to insurance means access to education and prevention, that says a lot about our priorities.

Health care reformers, are you listening?

Most voters surveyed didn’t think health care is enough of an issue in the presidential campaign. I agree, and like so many of them, I see this election as a real opportunity to address it.

For what it’s worth, being a younger chronically ill patient who cannot afford to lose my health insurance, someone who is in no way a desirable candidate for insurers, means Barack Obama’s health care platform is more appealing to me. In short, the mix of existing private insurance and expanded government programs for those without access is a much better position for me than the free market would be. Check out their platforms and make your own informed personal decision.

More than anything else, timing is critical here. The female voter matters so much in this election, and chronic disease is what matters most to this important demographic when it comes to health care. It’s time to make our vote count, and it’s time for our leaders to demonstrate that when it comes to chronic disease and prevention, they are listening.

Chronic Pain: Class and Cost Distinctions

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As I sat icing my hips today—I knew my beloved elliptical machine was bad for the hips, but wasn’t expecting the stationary bike to be so tortuous—I recalled an interesting Time article about chronic pain I read last week.

That chronic pain is both exhaustive in reach and hugely expensive certainly isn’t news. Still, some of the statistics the article highlights are sobering:

–More than one quarter of Americans suffer from chronic pain
–Each year, chronic pain costs us $60 billion in lost productivity
–In 2004, Americans spent a whopping $2.6 billion on OTC pain medications

Even more compelling are the recent finding from the Lancet that explore chronic pain and its class implications. The Time article goes on to report that:

“Americans in households making less than $30,000 a year spend nearly 20% of their lives in moderate to severe pain, compared with less than 8% of people in households earning above $100,000.”

Other points of interest? The difference extends to the nature of pain itself. People on the affluent side of the economic split often experienced pain from activities like exercising; people on the other end of the spectrum experienced pain as a result of the physical labor and repetitive movements intrinsic to blue-collar jobs.

What’s positive here is that with better preventative policies in the workplace some of this pain can be managed. But coupled with another study’s finding that those who live in poorer ZIP codes have less access to pain medication because their local drug stores don’t stock enough of it, the picture isn’t as clean.

Anyway, be sure to click on over and read the whole article–I’ve highlighted what was most interesting to me, but there’s more to it, especially information on gender that isn’t what we usually hear.

Obviously the scope of pain goes far beyond exercise and physically demanding jobs—from migraines to arthritis to a whole host of conditions, there are plenty of reasons people are in pain, miss work, socialize less. I know for me, the tendonitis in my hips is a source of pain less frequently than pain in my lungs or joints from other conditions. Often these sources cut across class and economic boundaries, but until the gap in access to resources closes, a divide remains.

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On a somewhat related note, I was quoted in a USA Today column on spirit-boosting tips when you’re dealing with illness or pain. Check it out–hopefully, some of the patient experience collected there cuts across class and economic boundaries,too.

Universal Health Care and Primary Care Problems

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So we’ve already established that patients like me are pretty much a primary care physician’s nightmare—complicated histories, hordes of specialists, all sorts of medications and symptoms to monitor. As I wrote a few months ago, though, some of those factors are the very reasons people like me need a good PCP, someone who can help coordinate the moving parts of disease management.

(As an aside, I have yet to find a group that is accepting new patients, but I’m going to renew my search now that a tough winter is over.)

Yet effective preventative medicine is the key to minimizing or even eliminating chronic disease, one of the most expensive and pervasive issues in health care. This is a given, and the logical extension of this is the idea that the more access people have to health care coverage, the better the outcome.

But theory and practice aren’t always as close together as we’d like. For example, here in Massachusetts a universal coverage plan was implemented several months ago. While costs have been significantly greater than previously estimated, a more compelling result is the one referred to in this New York Times article. In looking at the growing gap between urban and rural care, the article went on to posit this:

“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.”

Of course, the fact that 340,000 patients are now covered is an encouraging one. But if one of the main goals of health insurance is to promote preventative medicine, how effective can it be if the patients who have lacked primary care medicine are unable to use their new insurance to see a physician? Or must wait months for an appointment?

Factors behind the primary care drought—lower salaries, educational debt, an aging population that demands more care—were already there. Add to that an influx of patients who all need the same resources, and it’s all too easy to see why doctors and patients alike are feeling the crunch:

“It is a fundamental truth — which we are learning the hard way in Massachusetts — that comprehensive health care reform cannot work without appropriate access to primary care physicians and providers,” Dr. Bruce Auerbach, the president-elect of the Massachusetts Medical Society, told Congress in February.”

Trends and Prevention

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“Trends” is a big buzzword in healthcare. As such, I can’t help but notice a trend of my own. Yes, it is Easter, and yes, instead of Easter brunch with the family, I am hunkered down on the couch, nursing a fever and infection.

Sound familiar?

Let’s review: Thanksgiving (freak infection spread to my jaw; dinner was consumed via straw); Christmas (nursed a cold but unlike many Christmases, wasn’t in the hospital); New Year’s (very serious infection that felled me for weeks). On the bright side, at least I haven’t had to worry about the traditional holiday food hangover the past several holidays.

There really isn’t more to rehash about this trend of mine except that it broke my 11-day streak of being infection-free, a personal record since early October. So instead, I’ll turn this idea of chronic disease trends outwards.

The Partnership to Fight Chronic Disease and the Milken Institute released a new study that puts the annual cost of seven common chronic diseases (cancer, diabetes, hypertension, stroke, heart disease, pulmonary conditions and mental illness) at $1.3 trillion.

Of that amount, a staggering $1.1 trillion is the result of lost productivity. Since I spend an inordinate amount of time trying to meet deadlines when I am sick, I can’t help but focus on this particular statistic about work, productivity, and illness. Since we live in an age where economics, healthcare, and quality of life are increasingly linked together and increasingly strained, I can’t help but focus on this study as a whole.

Sobering information? Definitely. But there’s a bigger message in these results, a positive one: most of this economic impact is avoidable through effective disease prevention.

In fact, according to an article on the PFCD’s site, “The study is the first of its kind to estimate the avoidable costs if a serious effort were made to improve Americans’ health. Assuming modest improvements in preventing and treating disease, Milken Institute researchers determined that by 2023 the nation could avoid 40 million cases of chronic disease and reduce the economic impact of chronic disease by 27 percent, or $1.1 trillion annually. They report that the most important factor is obesity, which if rates declined could lead to $60 billion less in treatment costs and $254 billion in increased productivity.”

There’s reason to hope this trend doesn’t have to continue.

(And with winter almost behind us, there’s reason to hope my own trend won’t continue, either. After all, my track record for July 4 is practically spotless!)