Thursday, December 10, 2009

Life Lines Conference: Poetry for Our Patients, Our Communities, Our Selves

What are the challenges and benefits of offering poetry to patients? Can the sharing of poetry expand the vision of practitioners and students in healthcare professions?  What is the role of poetry in community treatment programs? In shelters? In prisons? What can caregivers gain from writing and reading poetry?

This conference is designed for those who have an interest in examining the place of poetry in caregiving.  Three panels of poets and health practitioners will present perspectives on the ways poetry can play a part in caring for our patients, our communities and our selves. Through discussion sessions, participants will have an opportunity to share experiences, to dialogue, to develop techniques, and to gain a deeper appreciation for poetry in the art of healing.

Medicine in Translation | Psychology Today

Danielle Ofri, M.D., Ph.D. is Associate Professor of Medicine at New York University School of Medicine and an internist at Bellevue Hospital, the oldest public hospital in the country. She is co-founder and Editor-in-Chief of the Bellevue Literary Review. Her newest book, Medicine in Translation: Journeys with my Patients--is about the experience of immigrants and Americans in the U.S. health care system.
She is the author of two collections of essays about life in medicine: Incidental Findings: Lessons from my Patients in the Art of Medicine and Singular Intimacies: Becoming a Doctor at Bellevue. She also edited the anthology The Best of the Bellevue Literary Review.

Trawling The Brain - Science News

The 18-inch-long Atlantic salmon lay perfectly still for its brain scan. Emotional pictures —a triumphant young girl just out of a somersault, a distressed waiter who had just dropped a plate — flashed in front of the fish as a scientist read the standard instruction script aloud. The hulking machine clunked and whirred, capturing minute changes in the salmon's brain as it assessed the images. Millions of data points capturing the fluctuations in brain activity streamed into a powerful computer, which performed herculean number crunching, sorting out which data to pay attention to and which to ignore.

By the end of the experiment, neuroscientist Craig Bennett and his colleagues at Dartmouth College could clearly discern in the scan of the salmon's brain a beautiful, red-hot area of activity that lit up during emotional scenes.

An Atlantic salmon that responded to human emotions would have been an astounding discovery, guaranteeing publication in a top-tier journal and a life of scientific glory for the researchers. Except for one thing. The fish was dead.

The scanning technique used on the salmon — called functional magnetic resonance imaging — allows scientists to view the innards of a working brain, presumably reading the ebbs and flows of activity that underlie almost everything the brain does. Over the last two decades, fMRI has transformed neuroscience, enabling experiments that researchers once could only dream of. With fMRI, scientists claim to have found the brain regions responsible for musical ability, schadenfreude, Coca-Cola or Pepsi preference, fairness and even tennis skill, among many other highly publicized conclusions.

But many scientists say that serious issues have been neglected during fMRI's meteoric rise in popularity. Drawing conclusions from an fMRI experiment requires complex analyses relying on chains of assumptions. When subjected to critical scrutiny, inferences from such analyses and many of the assumptions don't always hold true. Consequently, some experts allege, many results claimed from fMRI studies are simply dead wrong.

"It's a dirty little secret in our field that many of the published findings are unlikely to replicate," says neuro­scientist Nancy Kanwisher of MIT.

A reanalysis of the salmon's post­mortem brain, using a statistical check to prevent random results from accidentally seeming significant, showed no red-hot regions at all, Bennett, now at the University of California, Santa Barbara, and colleagues report in a paper submitted to Human Brain Mapping. In other words, the whole brain was as cold as a dead fish.

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Craig Bennett's blog:

A personal weblog of developmental cognitive neuroscience

Tuesday, December 8, 2009

Testing, Testing - The health-care bill has no master plan for curbing costs. Is that a bad thing? by Atul Gawande, New Yorker

Cost is the spectre haunting health reform. For many decades, the great flaw in the American health-care system was its unconscionable gaps in coverage. Those gaps have widened to become graves—resulting in an estimated forty-five thousand premature deaths each year—and have forced more than a million people into bankruptcy. The emerging health-reform package has a master plan for this problem. By establishing insurance exchanges, mandates, and tax credits, it would guarantee that at least ninety-four per cent of Americans had decent medical coverage. This is historic, and it is necessary. But the legislation has no master plan for dealing with the problem of soaring medical costs. And this is a source of deep unease.

Health-care costs are strangling our country. Medical care now absorbs eighteen per cent of every dollar we earn. Between 1999 and 2009, the average annual premium for employer-sponsored family insurance coverage rose from $5,800 to $13,400, and the average cost per Medicare beneficiary went from $5,500 to $11,900. The costs of our dysfunctional health-care system have already helped sink our auto industry, are draining state and federal coffers, and could ultimately imperil our ability to sustain universal coverage.

What have we gained by paying more than twice as much for medical care as we did a decade ago? The health-care sector certainly employs more people and more machines than it did. But there have been no great strides in service. In Western Europe, most primary-care practices now use electronic health records and offer after-hours care; in the United States, most don't. Improvement in demonstrated medical outcomes has been modest in most fields. The reason the system is a money drain is not that it's so successful but that it's fragmented, disorganized, and inconsistent; it's neglectful of low-profit services like mental-health care, geriatrics, and primary care, and almost giddy in its overuse of high-cost technologies such as radiology imaging, brand-name drugs, and many elective procedures.

At the current rate of increase, the cost of family insurance will reach twenty-seven thousand dollars or more in a decade, taking more than a fifth of every dollar that people earn. Businesses will see their health-coverage expenses rise from ten per cent of total labor costs to seventeen per cent. Health-care spending will essentially devour all our future wage increases and economic growth. State budget costs for health care will more than double, and Medicare will run out of money in just eight years. The cost problem, people have come to realize, threatens not just our prosperity but our solvency.

So what does the reform package do about it? Turn to page 621 of the Senate version, the section entitled "Transforming the Health Care Delivery System," and start reading. Does the bill end medicine's destructive piecemeal payment system? Does it replace paying for quantity with paying for quality? Does it institute nationwide structural changes that curb costs and raise quality? It does not. Instead, what it offers is . . . pilot programs.

This has provided a soft target for critics. "Two thousand seventy-four pages and trillions of dollars later," Mitch McConnell, the Senate Minority Leader, said recently, "this bill doesn't even meet the basic goal that the American people had in mind and what they thought this debate was all about: to lower costs." According to the Congressional Budget Office, the bill makes no significant long-term cost reductions. Even Democrats have become nervous. For many, the hope of reform was to re-form the health-care system. If nothing is done, the United States is on track to spend an unimaginable ten trillion dollars more on health care in the next decade than it currently spends, hobbling government, growth, and employment. Where we crave sweeping transformation, however, all the current bill offers is those pilot programs, a battery of small-scale experiments. The strategy seems hopelessly inadequate to solve a problem of this magnitude. And yet—here's the interesting thing—history suggests otherwise.

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Monday, December 7, 2009

Health-care nation - Robert J. Samuelson, Washington Post

President Obama's critics sometimes say that he is engineering a government takeover of health care or even introducing "socialized medicine" into America. These allegations are wildly overblown. Government already dominates health care, one-sixth of the economy. It pays directly or indirectly for roughly half of all health costs. Medicine is pervasively regulated, from drug approvals to nursing-home rules. There is no "free market" in health care.

What's happening is the reverse, which is more interesting and alarming: Health care is taking over government. Consider: In 1980, the federal government spent $65 billion on health care; that was 11 percent of all its spending. By 2008, health outlays had grown to $752 billion -- 25 percent of the total, one dollar in four.

Even without new legislation, the health share would grow, as an aging population uses more Medicare (insurance for the elderly) and Medicaid (the joint federal-state insurance for the poor, including the very poor elderly). Obama would magnify the trend by expanding Medicaid and providing new subsidies for private insurance. Thirty million or more Americans would receive coverage.

All this is transforming politics and society. The most obvious characteristic of health spending is that government can't control it. The reason is public opinion. We all want the best health care for ourselves and loved ones; that's natural and seems morally compelling. Unfortunately, what we all want as individuals may harm us as a nation. Our concern sanctions open-ended and ineffective health spending, because everyone believes that cost controls are heartless and illegitimate. The recent furor over proposals to reduce mammogram screenings captures the popular feeling.

One consequence is a slow, steady and largely invisible degradation of other public and private goals. Historian Niall Ferguson, writing recently in Newsweek, argued that the huge federal debt threatens America's global power by an "inexorable reduction in the resources" for the military. Ferguson got it half right. The real threat is not the debt but burgeoning health spending that, even if the budget were balanced, would press on everything else.

"Everything else" includes universities, roads, research, parks, courts, border protection and -- because similar pressures operate on states through Medicaid -- schools, police, trash collection and libraries. Higher health spending similarly weakens families' ability to raise children, because it reduces households' discretionary income either through steeper taxes or lower take-home pay, as higher employer-paid premiums squeeze salaries.

A society that passively accepts constant increases in health spending endorses some explicit, if poorly understood, forms of income redistribution. The young transfer to the elderly, because about half of all health spending goes for those 55 and over. Unless taxes are increased disproportionately for older Americans (and just the opposite is true), they are subsidized by the young. More and more resources also go to a small sliver of the population: In 2006, the sickest 5 percent of Americans accounted for 48 percent of health spending.

Political power in this system shifts. It flows to groups that promote and defend more health spending -- AARP, the lobby for Americans 50 and over, and also provider organizations such as the American Medical Association (AMA), which represents doctors. Predictably, AARP has been active in the present debate. It claims to have participated in 649 town-hall and other meetings and to have reached more than 50 million people through ads this year. Not surprisingly, AARP and the AMA recently conducted a joint TV ad campaign.

The rise of health-care nation has confounded America's political and intellectual leaders, of both left and right. No one wants to appear unfeeling by denying anyone treatment that seems needed; no one wants to endorse openly meddling with doctors' independence. It's easier to perpetuate and enlarge the status quo than to undertake the difficult job of restructuring the health-care system to provide better and less costly care.

Obama's health-care proposals may be undesirable (they are), but it's mindless to oppose them -- as many Republicans do -- by screaming that they'll lead to "rationing." Almost everything in society is "rationed," either by price (if you can't afford it, you can't buy it) or explicit political decisions (school boards have budgets). Health care is an exception; it enjoys an open tab. The central political problem of health-care nation is to find effective and acceptable ways to limit medical spending.

Democrats are no better. Obama talks hypocritically about restraining deficits and controlling health costs while his program would increase spending and worsen the budget outlook. Democrats congratulate themselves on caring for the uninsured -- who already receive much care -- while avoiding any major overhaul of the delivery system. The resulting society discriminates against the young and increasingly assigns economic resources and political choice to an unrestrained medical-industrial complex.

Diabetes called a brewing 'economic tsunami' - The Globe and Mail

The number of Canadians living with diabetes will rise dramatically over the next decade, spurring an "economic tsunami" that will be felt well beyond the health system, new research predicts.

By 2020, there will be 3.7 million Canadians with diabetes, up from 2.5 million today, and from 1.3 million a decade ago, according to projections prepared by Robin Somerville of the Centre for Spatial Economics in Milton, Ont.

Stated simply, more than 20 people will be diagnosed with diabetes every hour for the foreseeable future.

The numbers are soaring because of Canada's changing ethnic makeup (diabetes rates vary by ethnicity), the population is aging (the risk of diabetes increases with age) and due to poor health habits of Canadians (obesity and inactivity raise the risk).

The report stresses that while some of those factors cannot be altered, the key is catching diabetes early so it can be controlled and so that harmful, expensive complications can be averted.

If current trends continue, the economic burden of the disease will climb to $16.9-billion in the next decade, up from $12.2-billion today, the analysis shows. (The cost data are all in 2005 dollars to allow for direct comparisons.)

"Diabetes is a financial crisis for the health-care system. It is consuming an ever-larger share of provincial and territorial health-care budgets and will force an increase in those expenditures," the report states. "Diabetes is a personal crisis for people living with the disease and for their [families]," it adds.

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