Socio-economic Background Affects Brain Function

Hey all.

Here's an interesting article from BBC, talking about a study performed at Berkeley that tested the brain function of kids from both low and high socio-economic backgrounds. Turns out that kids from low SE families did not process information in their brains as well as those from higher SE backgrounds.


"This is a wake-up call - it's not just that these kids are poor and more likely to have health problems, but they might actually not be getting full brain development from the stressful and relatively impoverished environment associated with low socioeconomic status."

http://news.bbc.co.uk/2/hi/health/7762492.stm

Researchers think this lower performance may be because these children were not spoken to as much by adults as they developed.

NY Time Article

Yes, this is a bit late....

I came across this article in the Times: Finding a Voice to Match the Pressing Medical Needs of Hispanics.

It is an interesting story about a Latino community that rallied together and compelled their governor to give fully fund a program which institutes interpreters in medical facilities.

Certainly a step in the right direction--Yay :)

Impoverished HIV Patients in California

Hey Everyone,

This just came out today in the LA Times about California's health care system for poor patients with HIV:

http://www.latimes.com/features/health/la-me-hiv5-2008dec05,0,6358115.story

In 2002, Governor Gray Davis signed a bill into law that would make Medi-cal more accessible to low-income HIV patients.

Unfortunately, California's Department of Health Care Services failed to take the mandated steps to put the law into action.

Now, a LA County Superior Judge has decreed that Governor Schwarzenegger's administration has not fulfilled it's obligation to enact the law.

The intent of the law was to cut the costs of AIDS care by switching patients from expensive fee-for-service systems into managed care. The savings would then be used to extend Medi-cal coverage to more poor HIV patients.

A spokesperson for the Department claims that the increased cost of care could not be resolved by the proposed changes. However, instead of looking at other strategies for making the changes successful, it seems that the program was just abandoned.

It is disappointing to see our Department of Health Care Services giving up so easily on a project that could pave the way for more universal coverage. It's hard to say how much analysis or effort they put into the situation from reading just one article, but it would be nice to see some inspiring dedication and creative efforts put into something that is this important. If anyone has any insight on what went on behind the scenes, I'd love to know!

Nicole

Quick update: Obama & changes to U.S. healthcare!

Quick summary of Obama's recently announced plan here: I can't get the URL to work, so just go to news.google.com and type in "FACTBOX: Obama's ambitious healthcare plan"

My favorite points of the plan are:

-- Stop insurers from denying coverage based on pre-existing conditions.

-- Obama says he can reduce healthcare spending by 8 percent and save each taxpayer $2,500.

-- The Lewin Group, a consulting firm, forecasts the Obama proposal would raise federal spending by $1.17 trillion from 2010 through 2019. (From wikipedia: "In 2007 the U.S. spent $2.26 trillion on health care")

(Quick side note: The Lewin Group conducted a study on the single payer CA Bill SB840 showing that a single payer system would SAVE (versus increasing spending) $8 billion in the first year. Savings are because you decrease the insurance companies' 25% administrative overhead to the 4% Medicare admin overhead. Check it out here: http://www.healthcareforall.org/studies.html)

-- A National Health Insurance Exchange to help people buy private insurance, act as a watchdog and create standards

-- Tax employers who do not provide coverage.

-- Small business tax credit to help pay for employee health insurance

-- Require healthcare for all children, expanding Medicaid & SCHIP to cover poor children

If the U.S. really can get insurance companies to take everyone, regardless of pre-existing conditions, that would make a big difference and would make us more like Germany, which you can watch a 10 minute Frontline video about here: http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

Health Care Reform Reveals Doctor Shortage

Hi everyone,

It seems that every time time I read the news I encounter a new article about the need for universal health care. Just today, I was reading about former Senator Tom Daschle, Obama's nominee for Secretary of Health and Human Services, who has plans to hold holiday-season house parties to brainstorm over how best to overhaul the U.S. health-care system.

One subtle aspect that is not being openly discussed is the fact that health insurance does not necessarily guarantee health care access. To prove this point, I just saw an article in the New York Times that relates a new crisis facing Massachusetts universal health care reform: the lack of primary care physicians to provide care for all the newly insured. The article stresses that what has happened in Massachusetts has put " a spotlight on the workforce shortages that don't get meaningfully talked about in just about any other other state." The main point is that Massachusetts is the first to encounter a problem that will confront other states as more people are able to afford/receive health insurance. People will have insurance, but who will accept them as patients? Unfortunately, this is a problem that promises to particularly affect poor and underserved communities.

Why the decreased interest in primary care? Why are so many existing primary care physicians disenchanted? Among the issues highlighted in the articles are high student-loan debt and poor compensation/reimbursements by insurance companies, Medicaid and Medicare for primary care visits--no one pays for the time it takes to fill out enormous amounts of paperwork, take on the insurance companies on behalf of patients or to write sick notes to employers.

What to do to change this situation? As one article states, "the solution is ultimately political, since it requires making sure that our enormous public investment in medical care goes where it will do the most good."

You can take a look at the following articles I just referenced at:
http://www.nytimes.com/2008/04/05/us/05doctors.html?pagewanted=1&sq=primary%20care%20physician%20shortage

http://seattletimes.nwsource.com/html/opinion/2002895859_rosenblatt29.html

http://www.npr.org/templates/story/story.php?storyId=97620520

All the best,
Rosa

Interesting article on health care access by undocumented immigrants

Hey everyone,

As I was preparing for our presentation a couple of weeks ago, I came across this comprehensive yet concise article on health care access/use by undocumented immigrants. In the heated immigration debates in California, it's often stated that undocumented immigrants use a disproportionate amount of public services, especially health care. The data presented in the article demonstrates that this population has low rates of health care utilization and that immigrant authorization status remains a significant barrier to health care access.
You can take a look at the article at: http://archinte.ama-assn.org/cgi/content/full/167/21/2354

Many regards,
Rosa

Homless Hospital Release Solutions

Here's an article that I found from National Coaltion for the Homeless that describes some of the changes that have to occur with physicians when homeless patients are released from hospital, in order to imporove patient outcomes.

http://www.nhchc.org/Network/HealingHands/2008/Oct2008HealingHands.pdf

I found most interesting the program at OHSU with their hospital, which seemed to mirror/alleviate many of the same problems that we have with patients at the Hillcrest hospital. I was also aghast at the crazy practices going on in LA.

A breathtaking aspiration for AIDS

An interesting opinion piece in the IHT about a Lancet research paper that suggests testing and treating everyone who tests positive in Africa. The idea is quite simple: test everyone, suppress viral loads in everyone who is positive, and transmission rates with be dramatically reduced. Whatta ya think?

Today is World AIDS Day, Please Take Action

Hey Everyone,

Today is World AIDS Day and it would be great if you could take a minute to help increase the availability of antiretrovirals and other life saving medicines in the developing world. I started a chapter of Universities Allied for Essential Medicines here at UCSD - it is a national advocacy organization that works to ensure Global Access Licencsing for university-based biotechnologies and drugs. You can ask me more about it if you are interested. Anyways, we are stepping up our campaign to encourage the President of the University of California system (Mark Yudof) to adopt global access licensing for all UC-developed health technologies. Please go to http://www.essentialmedicine.org/uc and sign the letter that will then be emailed to Yudof, and please send it to other friends and professors. Over 100 physical letters were already collected at UCSD alone, and nearly 1,000 at all the UC schools combined, and have been hand delivered to the UC President's office. We need to continue to remind him how important it is that the fruits of university research should be available to all, not just those who are fortunate enough to afford it.

Thanks,
Chris

Hey all! So, I'm finally sharing some thoughts on the blog. About time . . . Below is a link to a relevant article that was buried deep in the NYTimes over the weekend. It discusses a new report from the European Union which accuses Big Pharma in Europe of intentionally delaying generic production of certain medications, which cost the EU almost $4billion over the last seven years. Drug policy is an interest of mine and I would encourage us all to ask questions about not only access to care but also the cost of helathcare. Lets all encourage the Obama administration to ensure access to low cost medications!

http://www.nytimes.com/2008/11/29/business/worldbusiness/29drugs.html?_r=1&pagewanted=print

Along the same lines, I recently became aware that many corporate pharmacies have a $4 generic drug list. Any drug on the list only cotst $4 to fill a prescription, with or without insurance. So, let's try to make sure our attendings are writing Rx for generics whenever possible, particularly if we know our patient doesn't have insurance!