Year in review: the top health stories of 2008

What were the top health news stories of 2008?

Everyone, it seems, has put together a list of the year’s best and most important stories: Health care reform. Statins. War wounds. Tainted peppers. Melamine.

Here’s a compilation of the top ones, as seen by various observers and experts.

From the Harvard Health Letter, the No. 1 news development of 2008 is "Blood sugar: How low should it go?":

The single-minded pursuit of low blood sugar levels is probably not the best approach to type 2 diabetes, particularly in people ages 60 and older. People with diabetes should not give up blood sugar control, but three clinical trials show it’s unwise to be overzealous about lowering high blood sugar, and certainly not without attending to high blood pressure and cholesterol.

Also on Harvard’s list, which was selected by the health letter’s editorial board, were news happenings ranging from Vytorin ("Nice name, nice numbers, but let’s see what you can do") to health care reform.

Over at WebMD, the editors’ top pick was salmonella-tainted tomatoes and their impact on U.S. confidence in food safety:

The Salmonella saintpaul outbreak, linked first to tomatoes and then to raw jalapeno and serrano peppers, was the nation’s largest food-borne outbreak of any kind in the past decade. It sickened more than 1,400 people, wreaking havoc on tomato farmers, shaking up grocery lists nationwide, and putting the FDA and CDC in the hot seat as the investigation dragged on for months.

Other picks in WebMD’s top 10: the death of newsman Tim Russert from heart disease, the dangers of belly fat, health care reform and the toll that America’s economic woes are taking on health.

The editors at MedPage Today made their choices from among medical news in 2008 that had an influence on clinical practice or triggered ongoing discussions among medical professionals. Their summary:

When it comes to LDLs and glycosylated hemoglobin, the philosophy of lower is better was dealt evidence-based blows this year with a series of surprising findings.

The list includes the study findings on Vytorin and on blood glucose control. MedPage Today also singled out the mounting toll of head injuries and post-traumatic stress among U.S. soldiers in Iraq as one of the year’s major medical stories.

Advances in stem-cell research and their implications for organ transplantation led the list at CNN. At FOXNews, the resurgence of measles in the United States and the world’s first double-arm transplant were among the top 10.

Statins, stem cells and transplants were some of the top medical happenings that ABC News selected for its review of 2008. And over at USAToday, stress, cancer and yes, Vytorin again, made the list.

Locally, the top health-related stories of 2008, in no particular order, are these:

- Affiliated Community Medical Centers opens a new clinic in New London to serve patients in the New London and Spicer areas. The $3 million facility, which replaces a clinic that had become outdated and crowded, will allow the medical staff to expand. It also has an optical department and a pharmacy, making these services more readily available in the New London-Spicer area.

- Lawrence Massa, chief executive officer at Rice Memorial Hospital since the beginning of 1994, resigns to take a new position as executive director of the Minnesota Hospital Association. A search committee is formed to start seeking his replacement.

- Rice Memorial Hospital eliminates two outpatient chronic disease management programs – one for diabetes and the other for congestive heart failure – and lays off 13 people as part of $3 million in budget cuts to help keep the city-owned hospital from slipping into a deficit. In response, Willmar Medical Services, a joint venture between the hospital and Affiliated Community Medical Centers, creates the Willmar Diabetes Center to ensure the local continuity of diabetes management and education. Family Practice Medical Center also announces it will add the management of congestive heart failure to its roster of primary care services.

- Willmar Medical Services completes its first year as a joint venture for same-day surgery services, integrated cancer care, medical imaging and diabetes management. Milestones include the addition of digital mammography and the consolidation of these services at the Affiliated campus, the launch of the Willmar Diabetes Center, and the completion of the design for a new cancer center, to be developed this coming year at Rice Memorial Hospital.

- Granite Falls Municipal Hospital becomes the second hospital in Minnesota to be designated a Comprehensive Advanced Life Support facility. The designation, which helps rural medical teams provide the best trauma and emergency care, required 39 people at the Granite Falls hospital to complete a specialized training program.

- Construction continued on a new $26 million addition at Meeker Memorial Hospital in Litchfield. The hospital also shortened its name from "Meeker County Memorial Hospital" to "Meeker Memorial Hospital."

- The RC Hospital Foundation and Renville County Hospice received an unexpected windfall from a rural Olivia farmer, Gordon Ruebel, who left his entire estate, valued at approximately $2 million, to the two organizations.

‘The epitaph of profession’

What does it mean nowadays to be a doctor?

The last day of 2008 seems a fitting time to listen to Dr. Donald Berwick, one of the deans of the quality movement in American medicine, as he remembers his father, a general practitioner in rural Connecticut:

I loved my father, but I also loved what he did; who he was in our town. I loved the way people looked at him, trusted him, named children "Philip" after him… I loved that he knew secrets, and that he helped.

In a lecture delivered this past October to the Royal College of General Practitioners in Bournemouth, U.K., Berwick, the president and CEO of the Institute for Healthcare Improvement in Cambridge, Mass., reflects on how medicine has changed and how this has affected physicians and the doctor-patient relationship:

You – and your patients – have now become irrevocably part of something far larger than yourself, and the craft of care has transformed into the machinery of care. Science and system have swamped art and autonomy. In return for possibility – in return for miracles – you have paid a dear price. The price is that you have lost control.

Berwick asks the question: Is this the epitaph of the medical profession, or is it an opportunity to reinvent the practice of medicine? Read the essay and find out his answer, then share your thoughts in the comment section below.

New Year’s resolution countdown

If you’ve made a New Year’s resolution to improve your health, you have lots of company.

Losing weight is No. 1 on most people’s lists, according to separate polls by the Marist College Institute for Public Opinion and myGoals.com.

The Marist poll, a telephone survey conducted Dec. 9-10 among 1,000 adults, found that more than half of their respondents don’t plan to change anything about their lives. But of those who do, 20 percent want to lose weight and 16 percent want to stop smoking. This is the second year in a row these two resolutions have topped the list.

Third on Marist’s list: spending less money.

At myGoals.com, health and fitness resolutions have lost some ground to financial-related goals, but they’re still the leading category, reports spokesman Anthony Helmstetter.

Weight loss remains the most popular resolution, Helmstetter said. Other health and fitness resolutions – such as reducing stress and getting more sleep – are consistent with a growing interest in security, comfort and nesting, he said.

Helmstetter expects the second most popular New Year’s resolution for 2009 to be paying off debt. His predictions are based on goal-setting activity at myGoals.com during the third quarter of 2008.

Even the U.S. Centers for Disease Control and Prevention has gotten into the act with a series of free e-cards that can be e-mailed to yourself, your family or friends to help you (or them) stay on target with New Year’s goals.

There’s a one-page downloadable calendar containing health and safety tips, a mammogram reminder card and a card of helpful tips for quitting smoking. You can also send a card to your favorite insomniac or couch potato. And if you or someone in your life really needs it, you can send a virtual, guaranteed-to-work-every-time hug.

Health around the globe

A lack of organization and investment in primary care, in wealthy nations as well as poorer countries, is one of the key threats to global health, the World Health Organization reports in its year-end wrapup.

View the picture essay to see the WHO’s chronicle of the key public health issues faced by the world in 2008.

Among the challenges: the impact of climate change, the global economic downturn and its likely impact on health and social spending, and social and economic inequities that have dire consequences for people’s health.

Drug-resistant tuberculosis remains a threat. Tobacco use, especially among women and girls, is also on the rise.

Infectious disease, once a leading worldwide health issue, is slowly being supplanted by a growing incidence of stroke, heart disease and cancer as the global population ages.

Flu tracker, week 51

What’s happening with influenza during week 51, the week of Dec. 14-20:

The national report, from the U.S. Centers for Disease Control and Prevention:

- Influenza is occurring at a low level across the United States. Two states reported regional activity, six reported local outbreaks, and Puerto Rico and 36 states reported sporadic outbreaks. Five states had no confirmed cases of flu.

In Minnesota, influenza activity continues to be sporadic. One school outbreak was reported in Beltrami County. There have been no outbreaks of influenza yet in any of the state’s long-term care facilities.

At Minnesota’s 30 sentinel sites for flu surveillance, 0.94 percent of patients presented the week of Dec. 14-20 with influenza-like illnesses.

Out with the old

Since the new year is supposed to be a time of new beginnings, the American Pharmacists Association suggests starting the year with a clean medicine cabinet.

Pharmacists recommend doing this once a year to clear out unused or expired prescription and over-the-counter medications. Hanging onto old or unused medications can increase the chances of taking the wrong one. Old drugs also can lose their potency, making them less effective at treating the condition for which they were prescribed.

Tips from the Pharmacists Association:

- Check the date on everything in your medicine cabinet and dispose of anything that has passed the expiration date.

- Properly dispose of anything you haven’t used in the past 12 months.

- Properly dispose of any prescription medications you no longer need. Do not share prescription medications with others.

- Properly dispose of medicines no longer in their original container or ones that can no longer be identified.

- Properly dispose of medicines that have changed color, odor or taste.

What’s the proper way to get rid of prescription and over-the-counter medications? Here’s how:

Don’t flush medication or pour it down the drain unless otherwise indicated. Pour medication into a sealable plastic bag. If the medication is a solid, such as a pill or liquid capsule, crush it or add water to dissolve it. Add cat litter, sawdust, coffee grounds or some other material that mixes with the medications and makes it less appealing to children or pets. Seal the plastic bag and place it in the trash.

Be sure to remove and destroy all prescription labels and any other identifying information from all medication containers before recycling them or throwing them away.

More information about the safe disposal of medication can be found at SmarxtDisposal, including a list of medications that should be flushed.

A final tip from the Pharmacists Association: The best way to store prescription and over-the-counter medication is in a secured area that has low humidity, stable and non-extreme temperature, and adequate but intense lighting.

The top health scares of 2008

Many of the headlines in 2008 had Americans scared for their health.

We read that chemicals used in manufacturing plastic are hazardous to human health. We read that cell phones can cause brain tumors. We read about granite countertops that emit radiation and Victoria’s Secret lingerie that contains formaldehyde.

But none of these scary-sounding risks, according to the American Council on Science and Health, have any basis in scientific fact.

The council lists these and others among its top 10 in a rogue’s gallery of unfounded health scares during 2008.

Elizabeth Whelan, the council’s president, said many of this year’s claims – for instance, that bisphenol-A, a component of the plastic used in manufacturing baby bottles, has been linked to cancer and reproductive problems – "stem from high dose studies on laboratory rodents and ignore the basic toxicological principle that ‘only the dose makes the poison.’"

She said that according to the Food and Drug Administration and other scientific groups, there’s no evidence that bisphenol-A is hazardous at the low levels to which humans are exposed.

The council notes that many of this year’s unfounded health scares are recycled from previous years but are no more scientifically sound than they were last year or the year before. Said the group in its annual news release:

Each scare (and there are more on the ACSH website) only distracts people from the real, proven health risks that they should attend to – such as not smoking, maintaining appropriate body weight, and getting necessary vaccinations.

The American Council on Science and Health is a nonprofit consortium for promoting the use of scientifically sound evidence in the regulatory, public policy and legal arenas, and helping consumers distinguish between real and hypothetical or overhyped health threats. It focuses particularly on food, nutrition, chemicals, lifestyle and the environment.

The hospital pricing maze

A reader left some comments this past weekend on the West Central Tribune news site, expressing shock at how much more it costs to have an uncomplicated delivery at Rice Memorial Hospital than at other hospitals in Minnesota.

Why such a difference in prices? It’s a valid question but one that’s not so easy to answer.

We started with the Medica Web site, because it’s the one that prompted this reader to comment and post the link. And here it is: $2,048 to $2,920 for a normal, uncomplicated delivery at the lowest-priced facilities, which include St. Cloud Hospital, Regions and Hennepin County Medical Center. At the highest-tier hospitals, which included Rice Memorial Hospital in Willmar, the Buffalo Hospital and Avera-McKennan in Sioux Falls, S.D., the same uncomplicated delivery costs between $4,009 and $5,875.

But if you click on the tab for "How were these costs calculated?", you find the money quote, so to speak:

Keep in mind that cost estimates are based on contract rates for Medica’s Choice network and may not reflect the costs for health benefit plans that utilize a different network.

In other words, what the consumer pays is not unilaterally determined by the hospitals. It’s determined at least partially by the contracts that the individual health plans – in this case, Medica Choice, although it applies to virtually all other health plans as well - negotiate with their participating hospitals.

So how can you meaningfully compare the cost of one hospital versus another? For that, we turned to Minnesota Hospital Price Check, a database maintained by the Minnesota Hospital Association that provides raw costs for 75 of the most common inpatient and outpatient procedures at Minnesota hospitals.

The price for a normal, uncomplicated delivery at Rice Hospital: $5,675.

At St. Cloud Hospital, one of the lowest-tier hospitals in the Medica Choice network, the undiscounted price for a delivery is $5,713. But at Regions – also one of Medica Choice’s lowest-tier hospitals – the price is $7,398, and at Hennepin County Medical Center it’s $9,246. Meanwhile, according to the Hospital Price Check database, the median cost of an uncomplicated delivery at all Minnesota hospitals is $7,187.

So what happened to the $2,000-$3,000 delivery?

Here’s how Minnesota Hospital Price Check explains it:

In the hospital billing process, hospitals charge all patients who receive the same services the same price. Patients’ final out-of-pocket costs, though, can be higher or lower than their neighbors’ – even when they’ve undergone the same procedure. That’s because health insurance plan discounts, which vary widely, are applied to the price, and insurance plan benefit levels are unique to each plan.

If it sounds confusing, it’s because it is confusing.

What can be learned from this? Two things: 1) the health plans and insurance companies wield considerable influence over what we pay for health care and, by extension, what the providers are paid; and 2) despite all the information that’s available and despite all the empowerment consumers are being asked to embrace, it’s still very challenging to interpret and fully understand a health care pricing system that contains so many layers of complexity.

Deadline looms for Medicare drug plan signup

The open enrollment period for Medicare’s prescription drug benefit will come to a close on Wednesday. That gives seniors just two more days to evaluate their coverage and decide if it’s more advantageous for them to switch plans.

Open enrollment for Medicare Part D takes place each year between Nov. 15 and Dec. 31. Seniors who don’t opt to switch plans will be automatically re-enrolled in their current plan on Jan. 1.

As the Medicare prescription drug benefit heads into its fourth year, it appears to be living up to expectations. Not only do enrollees report high levels of satisfaction, but the costs of the program have been less than projected when the Medicare Modernization Act was signed into law in 2003.

Although the average premium for basic coverage will be about $3 higher in 2009 than in 2008, this is still 37 percent lower than the original estimates.

In Minnesota, 85 percent of people with Medicare have prescription drug coverage, half of them through Part D. Thirty-six percent of those enrolled in Part D are receiving the low-income subsidy.

In 2009, there’ll be 48 Medicare prescription drug plans available in Minnesota. Two of the plans offer premiums for less than $25 a month, 27 of the plans have $0 deductibles and 26 of them offer enhanced benefits or services.

A new yardstick for America’s health

Twenty specific health indicators – from life expectancy and infant mortality to health-related behaviors such as smoking and physical activity – could provide the best and most comprehensive picture yet of America’s overall health and wellbeing, according to a new report from the national Institute of Medicine.

The 20 indicators have been recommended by the IOM for a new Web site being developed by the nonprofit State of the USA Inc. as a tool for measuring and tracking national trends.

Hundreds of health-related measures are collected each year in the United States. But which of these markers matter the most? Which of them help provide the broadest picture of Americans’ health and the nation’s health system?

The IOM’s task was to select no more than 20 indicators, each of them backed by a substantial amount of high-quality data.

Among those they settled on: life expectancy, infant mortality, injury-related mortality, chronic disease prevalence, smoking, physical activity and obesity. Indicators also were selected to help measure the performance of the American health care system. These markers include per capita spending on health care, the percentage of children with up-to-date immunizations, the percentage of adults without health insurance coverage, and the rate of unmet needs for dental and medical care and prescription drugs.

Those that made the final cut are seen as the most comprehensive reflection of how health care is faring in the United States. Each of the markers can be tracked and compared from one year to the next. The data also can be sorted by subgroups, such as population or geographic region, for more detailed analysis.