Wednesday, April 29, 2009
Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the supply of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.
The officials said they were particularly concerned about shortages of primary care providers who are the main source of health care for most Americans.
One proposal — to increase Medicare payments to general practitioners, at the expense of high-paid specialists — has touched off a lobbying fight.
Family doctors and internists are pressing Congress for an increase in their Medicare payments. But medical specialists are lobbying against any change that would cut their reimbursements. Congress, the specialists say, should find additional money to pay for primary care and should not redistribute dollars among doctors — a difficult argument at a time of huge budget deficits.
Sunday, April 26, 2009
unit for patients with dementia, he would give her a perfunctory kiss,
then wander off through the rooms and stare out the window. Elsie tried
to walk with him and hold hands, but he would shake her off, leaving her
A music therapist at the facility, Alicia Clair, was searching for ways
to help couples like Elsie and Tom connect. Ms. Clair asked Elsie if
she'd like to try dancing with Tom, then put on some music from the '40s
— Frank Sinatra singing "Time after Time." Ms. Clair said recently, "I
knew Tom was a World War II vet, and vets did a lot of ballroom dancing."
As Sinatra began singing, Elsie opened her arms, beckoning. Tom stared a
moment, then walked over and began leading her in the foxtrot. "They
danced for thirty minutes!" Ms. Clair said. When they were finished,
Elsie broke down and sobbed. "I haven't been held by my husband in three
years," she told Ms. Clair. "Thank you for bringing him back."
Ms. Clair, a professor of music therapy at the University of Kansas,
tells this story to show how music can reach people with Alzheimer's
disease. Music has the power to bypass the mind and wash through us,
triggering strong feelings and cueing the body to synchronize with its
Researchers and clinicians are finding that when all other means of
communication have shut down, people remember and respond to music.
Familiar songs can help people with dementia relate to others, move more
easily and experience joy. Tom had forgotten his name and couldn't utter
one word, but hearing Sinatra prompted him to dance.
Music memory is preserved better than verbal memory, according to Ms.
Clair, because music, unlike language, is not seated in a specific area
of the brain but processed across many parts. "You can't rub out music
unless the brain is completely gone."
Ms. Clair noted, too, that Alzheimer's is retrograde: "Things fall off
in the opposite order from the way they were acquired." So if someone
sang to you as a baby, before you even knew words, you'll respond to
music after words are gone.
The discipline of music therapy (MT) was established in 1950, and last
year close to a million people received MT services in hospitals, care
facilities, hospices and schools. MT is not merely playing music for
people, although that's beneficial. Practitioners are skilled musicians
who play instruments and sing, then are trained and certified to use
music for therapeutic purposes.
Patients with a wide range of ailments — from children with disabilities
to burn victims to people with Parkinson's disease and stroke — have
experienced the ability of MT to speed healing, improve mood and
increase mobility. In a study published by the American Society of
Neurorehabilitation, music therapy and conventional physical therapy
were given to two groups of stroke victims who could barely walk. The
group who received music therapy showed greater improvement in walking
in a shorter period of time than those getting physical therapy.
My daughter, Rachel Strauss, who's studying for a master's degree in MT,
said, "It works faster to relax people than any drug. It's cost
effective and has no side effects."
There's been a burst of interest in MT for people with Alzheimer's. Kate
Gfeller, who directs the graduate MT program at the University of Iowa,
published a study in the Journal of Music Therapy finding that
activities like moving to music, playing rhythm instruments and singing
led to more group involvement and less wandering and disruptive behavior
among 51 patients with dementia in five nursing facilities.
Other studies demonstrate that MT can slow the progress of Alzheimer's,
relieve pain and create emotional intimacy. The goal, Ms. Gfeller said,
is to keep people functioning at their present level as long as
possible: "We can't reverse the disease, but we can make the quality of
each day as good as it can be."
Not just any music will do, though. The trick is finding out what music
was popular when the patient was a teen and young adult. Ms. Gfeller
said those years are such a powerful time in developing autonomy — a
time of first love, learning to drive, getting the first home of one's
own — that people will play the music they heard during those years all
their lives, and recall it the longest.
I remember visiting my grandfather, Louie Wass, when he was hospitalized
with dementia, lying in bed, unable to talk. I started singing a
Hungarian song he'd learned as a youth and later taught to me,
"Territch-ka." I sang the verse and when I stopped, he opened his mouth
and sang the chorus: "Yoy, Territch-ka!" Right on key.
My daughter has asked me to send her books of music from the '60s
because, she said, "Boomers will be the next generation in the nursing
facilities." That was cheering. With the generation currently in these
facilities, she uses songs like "A Bicycle Built for Two." She likes
those songs but said, "Your generation will be awesome — we'll get to
play the Beatles."
When 1976 came and went, the date for a cure, or at least substantial progress, kept being put off. It was going to happen by 2000, then by 2015.
Now, President Barack Obama, discussing his plans for health care, has vowed to find “a cure” for cancer in our time and said that, as part of the economic stimulus package, he would increase federal money for cancer research by a third for the next two years.
Cancer has always been an expensive priority. Since the war on cancer began, the National Cancer Institute, the federal government’s main cancer research entity, with 4,000 employees, has alone spent $105 billion. And other government agencies, universities, drug companies and philanthropies have chipped in uncounted billions more.
Yet the death rate for cancer, adjusted for the size and age of the population, dropped only 5 percent from 1950 to 2005. In contrast, the death rate for heart disease dropped 64 percent in that time, and for flu and pneumonia, it fell 58 percent.
Still, the perception, fed by the medical profession and its marketers, and by popular sentiment, is that cancer can almost always be prevented. If that fails, it can usually be treated, even beaten.
The good news is that many whose cancer has not spread do well, as they have in the past. In some cases, like early breast cancer, drugs introduced in the past decade have made an already good prognosis even better. And a few rare cancers, like chronic myeloid leukemia, can be controlled for years with new drugs. Cancer treatments today tend to be less harsh. Surgery is less disfiguring, chemotherapy less disabling.
But difficulties arise when cancer spreads, and, often, it has by the time of diagnosis. That is true for the most common cancers as well as rarer ones.
With breast cancer, for example, only 20 percent with metastatic disease — cancer that has spread outside the breast, like to bones, brain, lungs or liver — live five years or more, barely changed since the war on cancer began.
With colorectal cancer, only 10 percent with metastatic disease survive five years. That number, too, has hardly changed over the past four decades. The number has long been about 30 percent for metastatic prostate cancer, and in the single digits for lung cancer.
As for prevention, progress has been agonizingly slow. Only a very few things — stopping smoking, for example — make a difference. And despite marketing claims to the contrary, rigorous studies of prevention methods like high-fiber or low-fat diets, or vitamins or selenium, have failed to find an effect.
What has happened? Is cancer just an impossibly hard problem? Or is the United States, the only country to invest so much in cancer research, making fundamental mistakes in the way it fights the cancer war?
Researchers say the answer is yes on both counts. Cancer is hard — it is not one diseaseMore ...
They have been dubbed "The Sandwich Generation" — caring for young children on the one side and elderly parents on the other, but the phrase doesn't really capture the many ways in which one person can be simultaneously pushed and pulled.
Yesterday, scores of you wrote in to describe your everyday scrambles as a parent. In a guest blog today, Emeliana McEvoy walks us through a single morning — one where she juggles far more than just the needs of her 3-year-old daughter, her 9-year-old son and her at-home business in a small town in Massachusetts.
The ingredients of Emeliana's overloaded sandwich also include her husband's mother, who was recently diagnosed with Alzheimer's; her husband's father, who recently broke his ankle, which led to surgery, which led to a infection, which led to months confined to the house; Emeliana's own mother, who recently lost her job; and her father, who recently suffered a minor stroke, and whose own business is shaky, leading him to pay his employees, but no longer take a salary himself.
Emeliana is not her real name. She asked to use a pseudonym because these setbacks and diagnoses are new and raw, and she doesn't want to shine a spotlight on anyone she loves, or make them think they are a burden.
MEDICAL bills have a way of piling up — especially when you're sick or underinsured. Just ask Kirk Kupka, 48, and his wife, Susie, 53.
Mr. Kupka has multiple sclerosis. The Kupkas, who live in Lindstrom, Minn., have an annual income of $45,000 — a combination of her salary as an office manager and his disability payments.
More than 20 percent of that income goes toward health care. Their annual insurance premiums total $5,400, and then there's the $4,000 Mr. Kupka spends on drugs, doctor's visits and lab fees before he fulfills his policy's deductible.
In the three years since Mr. Kupka's disability forced him to stop working as a mental health therapist, he has accumulated $12,000 in debt.
"It's frustrating," he says. "We earn too much to qualify for state and county assistance, but not enough to stay ahead of the bills. I've thought maybe my wife and I should get divorced. But not only is it against our faith, it turns out it wouldn't help."
Medical debt can lead to drastic measures, forcing people to raid their 401(k)s, tap into home equity lines and, in some cases, declare bankruptcy. Surveys by the Commonwealth Fund, a nonprofit health care research foundation, found that 41 percent of adults said they were struggling to pay their health care bills in 2007, up from 34 percent in 2005. That percentage is almost surely growing.
In the quest for better health, many people turn to doctors, self-help books or herbal supplements. But they overlook a powerful weapon that could help them fight illness and depression, speed recovery, slow aging and prolong life: their friends.