Sunday, July 26, 2009

A Battle for the Soul of American Medicine

In the New Yorker, Atul Gawande told a story: It was the best of times. It was the worst of times. No truer Dickensian words were better inferred. Gawande told us the story of McAllen, Texas, a town whose doctor's got bit with the entrepreneurial bug.

"[A] medical community [who] came to treat patients the way subprime-mortgage lenders treated home buyers: as profit centers."


Gawande's article goes to the heart of the health care reform battle. He cites is as a tale of two cities: McAllen versus El Paso, Texas. Two towns with similar demographic make up and populations of about 700,000, yet significantly disparate Medicare per enrollee costs. Turns out McAllen on average charges Uncle Sam for about $15,000 per Medicare enrollee, twice their income per capita as well as twice the national average, and about half as much as what is spent in El Paso. (The data is from 2006, the best available for the analysis performed.)

Why? Because they doctor's can. The incentive pay structure is per exam performed, not for overall quality of care given. In McAllen, doctors stopped being doctor's and became business men. Are they providing better health care for all these tests? The data simply says it: no.

Providing health care is like building a house. The task requires experts, expensive equipment and materials, and a huge amount of coördination. Imagine that, instead of paying a contractor to pull a team together and keep them on track, you paid an electrician for every outlet he recommends, a plumber for every faucet, and a carpenter for every cabinet. Would you be surprised if you got a house with a thousand outlets, faucets, and cabinets, at three times the cost you expected, and the whole thing fell apart a couple of years later? Getting the country’s best electrician on the job (he trained at Harvard, somebody tells you) isn’t going to solve this problem. Nor will changing the person who writes him the check.


So what to do? Change the payer-playbook, charge for overall quality care, rather than quantity care. It goes back to a wise old saying, "patient care should always come first." So Doc, don't pay-a-hate, coordinate.

Thanks Gawande!

The Afterw@rd

Friday, July 24, 2009

Giving Meaning to Evidence-based

In this era of health "insurance" reform, everyone is looking for proof that reform is the better option than the status quo.

Social policies within the United States Armed Forces have served us well in race relations. Why not in health, particularly in suicide prevention?

The Suicide Prevention Action Network, a division of the American Foundation of Suicide Prevention, is seeking that states accurately track and evaluate health results. But what does that mean? What does that actually look like in the realm of suicide prevention?

Suicides in the armed forces are an all time high. The Defense Department is not only on notice, but finally has noticed. They are doing something about it. Proper evaluation of the prevention strategies they are executing on could potentially serve as a benchmark for other suicide prevention programs nationwide.

This is the insular, control case everyone has been waiting for.

The Afterw@rd

Monday, July 20, 2009

HEALTH REFORM NOW!!

Thank you for applying for a CareFirst BlueCross BlueShield or CareFirst BlueChoice plan. Unfortunately, your application has been denied.


Cherry-picking. That's what I call it.

I was just rejected for medical insurance. I just got out of an extremely toxic work environment. It took it's toll on me and my health. Here I am trying to love myself enough to take care of myself. But self-care comes at too high of a cost. It just sounds too much like right.

Pending recent economic factors, medical care was the number one cause of bankruptcy in America.

The route we are heading with health care in America is simply unsustainable. Here is a case for rationed health care.

I thank God and a strong grassroots movement for the passing of the Mental Health Parity Bill. But more still needs to be done to ensure that mental health checkups and proper holistic treatment is included in the health reform package.

Go to the Suicide Prevention Action Network (a subdivision of AFSP).

Scroll to the bottom of the page to Alerts and Updates.

Follow the instructions to fill in your zip code and identify your Congressional and Senate representatives to ensure the mental health care is properly included in the health reform package.

DO IT NOW!!!!

Lives hang in the balance.

What do we want? MENTAL HEALTH REFORM! When do we want it? NOW!

The Afterw@rd

Thursday, July 9, 2009

If You're in New York City July 19, 2009


This seems like a awesome play to go see, "Call me Crazy: Diary of a Mad Social Worker." As a native New Yorker, the fact that the play is at the legendary Nuyorican Poet's Cafe says it all. They always drop knowledge.

236 E. 3rd St. (btnw Ave B & C), NY, NY 10009

It's only $15 bucks. Interested? Buy tickets at www.theatremania.com or call 212.352.3101. Have more questions? Email callmecrazy@HDLPoet.com

'Nuf Said.

Makes me want to go home.

The Afterw@rd

Drink Your Milk And Get Your Sun

This is something deep and worthy of consideration...

Therese Borchard writes:

I've been wondering how vitamin D and mental illness are related, so I did a search and found that vitamin D does, indeed, play a role in mental illness based on these reasons from the Vitamin D Council's website:

1. Epidemiological evidence shows an association between reduced sun exposure and mental illness.
2. Mental illness is associated with low 25-hydroxyvitamin D [25(OH)D] levels.
3. Mental illness shows a significant comorbidity with illnesses thought to be associated with vitamin D deficiency.
4. Theoretical models (in vitro or animal evidence) exist to explain how vitamin D deficiency may play a causative role in mental illness.
5. Studies indicate vitamin D improves mental illness.

Here's even more details, according to the Vitamin D Council:

* Mental illness has increased as humans have migrated out of the sun.
* There is epidemiological evidence that associates vitamin D deficiency with mental illness. Two small reports studied the association of low 25(OH)D levels with mental illness and both were positive.
* Depression has significant co-morbidity with illnesses associated with hypovitaminosis D such as osteoporosis, diabetes, heart disease, hypertension, multiple sclerosis, and rheumatoid arthritis.
* Vitamin D has a significant biochemistry in the brain. Nuclear receptors for vitamin D exist in the brain and vitamin D is involved in the biosynthesis of neurotrophic factors, synthesis of nitric oxide synthase, and increased glutathione levels -- all suggesting an important role for vitamin D in brain function. Rats born to severely vitamin D deficient dams have profound brain abnormalities.


Yikes.
***

Originally published on Beyond Blue at Beliefnet.com. Linked through Huffington Post.

Sunday, July 5, 2009

Happy 4th of July: Daddy's Girl

I was daddy's little girl. As an only child, our relationship was beyond father daughter, it was more like a man and his shadow. Our morning breakfast routine started when I was very young, during the early school years. My dad would drive me to the bus stop, I would kiss him on the cheek and off I would go. He was the kind of father who was constantly teaching me and at the same time, he was constantly learning himself. I shared his love for college basketball; he taught me how to use my first laptop and took me kayaking for my very first time. He let me shine as he stood behind the camera at every show or recital, and would listen as he knelt by my bedside to say our prayers each night. My dad and I shared everything including our blue eyes.

It was not until I became older that I could see what a successful man my dad had become and the goals he had reached. Traveling overseas in the army during his early adult years, he worked his way through college eventually earning his masters degree, and then making a successful career in system technologies at well known university around where we lived.

My dad loved his family and his co-workers alike, having a general curiosity about life. It was his ambition which I admired most about him, how he would never let anything stand in his way. He instilled in me that I could achieve anything, as long as I was not afraid of the challenge.

It was as I grew older, my dad first started to show signs of clinical depression. The symptoms characteristically are irritability, fatigue, and lack of interest in activities which are normally fulfilling. Maybe I was so wrapped up in the mini dramas that make up a girl's teen years, or maybe he was just good at hiding it, but it took me a while to notice it. He would miss a few morning breakfast routines, stopped attending church with my mother and I, and stayed home from work more often; but it did little to the relationship I had with my dad.

Above all, my dad was patient and understanding even when it came to the subject of Math, my least favorite subject. The night before a giant pre-algebra test in Eighth grade, my dad and I were going over problems, me getting more nervous as my frustration built. I still remember crying in my dad’s arms that night, like a small child. The next day my dad dropped me off in the morning and I gave him a kiss on cheek and was on my way just like a typical morning. That afternoon I received a 94 on the test and was so excited to return home that night and tell him. My anxious waiting was answered by something no one can be prepared for. A knock on my door changed my world forever. My dad never came home from work that night.

No one expected a man of such grace and dignity, so ambitious and passionate about life to turn around and take his own. It turned out that the only thing that was standing in his way was himself. I thought back to the night before when I was crying because of my frustration, little did I know or truly understand the tremendous frustration that was going on inside my dad, the pain he still was trying to hide from me.

How could he not see the brilliant man I saw in him?

As the years have gone by since his death, I have asked myself many questions and have learned that brilliant men like my father are not the only ones that suffer from this disease.

When it was time for me to go to college, I decided to go to school at the same University that my dad spent 27 years of his life as a student and an employee. The institution he loved so very much was the same place he ended it all. Some thought it was strange that I returned to place where my father literally ended it all, but after all he was the one that taught me that you should not let things stand in your way and that almost anything can be achieved as long as you are not afraid of a challenge. I decided to go to a place my father was so much apart of, to be among his colleagues, and a place to keep his memory alive.

Though the days that I passed the building where he ended it all were challenging, it gave me the chance to tell people about the brilliant man that my dad was.

I am not ashamed of my dad because of his disease, I only feel sorry for those who do not realize or understand its devastating effects. The disease can affect anyone. Depression is hard to detect, it is a disease that affects people even though they do their best to hide it.

There is not a day that goes by that I don not wish for ordinary things, like a simple phone conversation or rooting for our college basketball team together. I think about the moments in my life I wish he had been apart of and the sixty-year-old man he would be today. I am sharing my story today because people should not turn their backs on depression because they think it is a challenge to understand, it is a disease that needs to be brought into the light. The light in my dad burned out long before it should. It is my mission in life to help keep that flame of knowledge and awareness burning for others.

By J. Suwalski
Tweet @J9007

Thursday, July 2, 2009

Death by MySpace, Revisited

On November 26, 2008, I wrote about the landmark court ruling against Lori Drew who created a bogus MySpace account to cyberbully 13 year old Megan Meier, leading to the young girl's suicide.

According to the New York Times, today, "Judge George H. Wu said that he was tentatively acquitting the woman, Lori Drew, of misdemeanor counts of accessing computers without authorization and that the ruling will be final when he issues his written decision...Judge Wu said that were Ms. Drew’s conviction to stand, anyone who has ever violated MySpace’s terms of service would be guilty of a misdemeanor." Thus, he posits that such a verdict would be a violation of our constitutional rights.

Is Judge Wu smoking crack? While I can see where he is going, not all misdemeanors end in the death of a 13 year old. A suicide no less. This woman aided and abetted in cyberbullying. Megan was of a generation that has never lived without internet. The impact this has on a young psyche is still not well known. This is why new rules regarding internet communication are so important.

We are entering new territory. Nevertheless, to paraphrase Martin Luther King, Jr., just because we don't see the whole staircase doesn't mean we don't take the first step.

This is one of the reasons why Suzy's Law is so important.

The Afterw@rd

Wednesday, July 1, 2009

Coping With Bipolar Disorder

Yesterday, on the Diane Rehm show, she had three fantastic guests that faced the trials and tribulations of diagnosing/treating Bipolar Disorder and having a child with Bipolar Disorder. However, with an estimated 2.5 million people in the US facing this disease, it is imperative that we act proactively.

I recognize that it is difficult to treat something we don't fully understand but we know what works. Some of the challenges and good advice is provided in this show.

It is imperative that health reform includes proper treatment for mental psychiatric disorders.

The Afterw@rd

AFSP Overnight Walk

We raised $1.2 million and so much more is needed.
I just got to feel my feet today. :)
You can still donate through August 31, 2009.
Do what you can to help support vital suicide prevention research.
For more information visit www.afsp.org.

Be Blessed,
The Afterw@rd