MN’s health industry reacts to proposed cuts

Proposed cutbacks in Minnesota’s publicly funded health care programs have providers deeply worried about the potential fallout – to patients as well as to the health care infrastructure in Minnesota.

Lawrence Massa, president of the Minnesota Hospital Association, said it will undermine the stability of hospitals and unravel the health care safety net for the poor. And the Minnesota Medical Association has criticized the plan for "balancing the budget on the backs of the needy."

The cutbacks, proposed this week by Gov. Tim Pawlenty, go deep: $365 million, including matching federal dollars, could be slashed from hospitals. Some 84,000 people are at risk of being dropped from the rolls of Medical Assistance, General Assistance Medical Care and MinnesotaCare. Reductions also have been proposed in medical education funding.

The eligibility reductions alone for the publicly funded health care programs would result in more than a 20 percent increase in the number of Minnesotans who are uninsured, Massa said in a statement this week.

As more and more Minnesotans become unemployed, the need for these programs is increasing. Without insurance, these people are likely to rely on hospitals’ emergency rooms as their sole source of health care, thereby increasing hospitals’ growing uncompensated care costs and further straining our fragile health care system’s ability to deliver quality, timely care.

Dr. Noel Peterson, president of the Minnesota Medical Association, calls it "short sighted and damaging."

"Ignoring the immediate need for health care won’t save money in the long run," Peterson warned. "The costs of providing care to people without insurance are shifted onto private payers, which means higher premiums, especially for small employers."

Massa said Minnesota’s physician shortage is likely to worsen if medical education funding is cut.

"We’ve already seen caregivers and other staff lose their jobs because of the economic downturn and the state’s previous cuts to hospitals," he said. "The governor’s proposed budget will lead to more layoffs, fewer physicians in our work force and elimination of vital hospital community services."

TV-watching among teens influences future eating habits

The more TV that high school-aged teens watched, the lower the quality of their diets five years later, according to a new University of Minnesota study that appears today in the International Journal of Behavioral Nutrition and Physical Activity.

It’s believed to be one of the first studies to investigate the relationship between TV and eating habits across the transition from adolescence to young adulthood.

The study was conducted as part of the university School of Public Health’s Project EAT (Eating Among Teens). It followed almost 2,000 high-school and middle-school children from the Twin Cities area over a five-year period.

Among the findings: Teens who reported watching five or more hours of TV a day ate fewer fruits, vegetables, whole grains and calcium-rich foods, and more snack foods, fast food and sugar-sweetened beverages five years later.

Daheia Barr-Anderson, a kinesiology professor at the university and the lead researcher, said there may be a number of factors that influence this connection.

"Adolescents who watch too much television become adults who watch too much television, and thus continue to be exposed to advertisements for unhealthy foods," said Barr-Anderson. "Repeated exposure to these [unhealthy] foods may lead adolescents to consume more of them."

People’s tendency towards "mindless eating" while watching TV may also contribute to the problem.

"Studies have shown that adolescents consume a lot of their caloric intake while watching TV," said Barr-Anderson. "We think that’s also playing a part, but there is a need for more investigation."

Parents can guide their children towards healthier habits by limiting their hours in front of the TV and monitoring what foods they’re eating, she said.

Light therapy for winter blahs

If you’re one of the estimated 15 million Americans with Seasonal Affective Disorder, you might want to think twice before heading for a tanning salon to help cure the winter blahs.

Many tanning salons advertise their services as a treatment for SAD – but the ultraviolet radiation they produce is not a component of light therapy, said Michael Terman, director of the Center for Light Treatment and Biological Rhythms at Columbia University Medical Center in New York City.

Seasonal Affective Disorder is a form of depression triggered by the shortened hours of daylight during the autumn and winter. (Less commonly, it also can occur with the onset of summer.) People who have SAD may find themselves depressed and lethargic during the winter months. They might withdraw socially, spend more time sleeping, and have difficulty concentrating. Some cases can be severe enough to require treatment with light therapy or drugs.

Light therapy mimics outdoor light and is thought to affect the brain’s biochemistry by creating a more positive mood – although clinical trials haven’t yet established this for a certainty.

The therapy is often suggested as a treatment for SAD. People should be aware, however, that tanning beds are not a substitute, Terman said. Light therapy acts through the eyes and requires visible light, not the ultraviolet light used in tanning beds, he said.

Moreover, people who visit a tanning salon in search of a fix for SAD are putting themselves at higher risk for skin cancer, the Skin Cancer Foundation warns. Many newer high-pressure sunlamps produce as much as 12 times the annual UVA dose compared to normal sun exposure, the foundation said.

Light boxes used in light therapy provide up to 10,000 lux of visible light, equivalent to outdoor light about 40 minutes after sunrise. They’re typically used in the morning for 15 minutes to an hour.

If you’re shopping for a light box, choose one with 10,000 lux of illumination; fewer lux are believed to be less effective. Make sure the box includes an ultraviolet filter or diffusing screen to protect your skin and eyes. Also, opt for soft white lights; full-spectrum lights produce more blue light, which can harm the eyes, and more UV radiation.

More debate urged on nonsmoker hiring practices

The list of places where people can smoke is steadily shrinking. But a growing number of employers aren’t content to draw the line at tobacco-free workplaces; they’re adopting policies to not even hire anyone who smokes.

Among them are the World Health Organization, which stopped hiring smokers in 2005, and the National Cancer Institute, which encourages the hiring of nonsmokers.

There’s some evidence that these kinds of policies can help boost productivity and reduce absenteeism. But are they a good idea for society at large?

A recent essay in Tobacco Control raises this question, pointing to a dearth of studies on the effectiveness of smoker-free workplace policies on people’s health. Moreover, there can be unintended consequences for smokers, their families and the community, argue the authors, who are affiliated with the University of Washington in Seattle and Boston University School of Public Health.

Such policies single out smokers for discrimination and put them at risk for unemployment, the authors said. They can also be a slippery slope towards wider hiring bans on people who are obese or whose blood pressure or cholesterol are too high.

The authors call for "increased discussion about the use of smoker-free employment policies as a public health intervention and for increased engagement of employers by the public health community in worksite health promotion."

Hospital under fire for using pigs in trauma training

Ethicists are colliding in Fargo, N.D., this week over the use of live pigs in training for trauma personnel at MeritCare Medical Center.

The Fargo Forum reports that a written complaint is being filed with the U.S. Department of Agriculture by the Physicians Committee for Responsible Medicine, a Washington, D.C., group that promotes compassion and ethics in medical treatment and research.

MeritCare uses the pigs in its Advanced Trauma Life Support training program to help doctors sharpen their skills in trauma care.

The Physicians Committee for Responsible Medicine is asking the USDA’s Animal and Plant Health Inspection Service to investigate MeritCare’s use of pigs in its trauma trainings, the complaint states. 

“We believe that this animal use is a violation of the Animal Welfare Act because there are equivalent alternative nonanimal technologies available,” Dr. John Pippin, a PCRM senior medical and research adviser, wrote in the complaint. 

Dr. Neal Barnard, president of the PCRM and a Fargo native, argues that MeritCare should also be using nonanimal teaching methods not just because “you’re killing animals unnecessarily,” but because pigs are not the same anatomically as a human being.

“If a trauma surgeon or emergency physician is going to give the best care, they ought to train on something that’s as close to human as possible,” Barnard said Tuesday. He suggested theuse of human cadavers and the human simulator called the TraumaMan System instead.

MeritCare’s response is that its trauma training program meets all the requirements of the American College of Surgeons.

The use of live animals in medical education and training remains highly controversial. Pressure from animal rights groups has resulted in a significant decline in the number of medical schools in the U.S. that use animals for training medical students. Yet many continue to support the practice, saying it’s necessary for developing medical skills.

What do you think? Do the benefits of using live animals for surgical and trauma training outweigh the harm? Share your thoughts in the comment section below.

Study sheds light on men’s vs. women’s response to food

Maybe it really is a guy thing.

Men appear to be better than women at controlling their brain’s response to their favorite foods, a unique brain-imaging study has found. The results were published online this month in the Proceedings of the National Academy of Sciences journal.

The researchers who led the study believe the findings might help explain why women have higher rates of obesity and eating disorders than men do, and why women often have a harder time losing weight.

The study was conducted at the U.S. Department of Energy’s Brookhaven National Laboratory and involved 23 volunteer subjects – 13 women and 10 men who underwent positron emission tomography scanning of the brain.

During one set of scans, they were presented with their favorite foods, such as pizza, warm cinnamon rolls or barbecued ribs, and asked to smell, taste, observe and react to the food but not eat it. During another set of scans on a separate day, they were told to inhibit their desire for food before being tempted with the same foods. Control scans also were conducted with no food.

The volunteers were also asked to rate the food and describe their feelings of hunger and desire to eat during the scans when food was present.

Among both men and women, several brain areas associated with emotional regulation, conditioning and motivation lit up in response to tempting foods, indicating increased brain activity. When asked to inhibit their response to food, both men and women described themselves as less hungry – but only the men showed a corresponding decrease in food-activated brain activity. Among the women, activity could still be seen in regions of the brain that control the drive to eat.

The study did not explore possible reasons for this gender difference, although the researchers speculated that differences in sex hormones, such as estrogen, might play a role.

The authors said their findings are consistent with behavioral studies showing women are more likely than men to overeat when they’re presented with tempting food or are under emotional stress.

Weighing in on the Hib vaccine

Last week’s news story about a resurgence of Haemophilus influenzae B in Minnesota is reverberating around the medical blogosphere.

Should parents be held accountable for not vaccinating their children against Hib (or other vaccine-preventable diseases, for that matter)?

Dr. Rob Lamberts, a pediatrician who blogs at Musings of a Distractible Mind, thinks so:

These parents probably thought “what’s the harm? Why can’t we just wait to do the immunizations until the risk is less?” A 7-month-old infant died from this logic.

WhiteCoat, an emergency room physician who blogs, puts the question to his readers, who respond with some choice comments about parents who refuse to vaccinate. "This issue is one that makes me almost homicidal with rage," one person writes.

And here’s Sandy Szwarc at Junkfood Science:

Today, most younger doctors and nurses have never even seen a case of Hib and few parents have watched babies get sick or die from Hib. So, Hib might not seem a big deal. We can only hope that we can reach young parents and help them understand why it is a big deal and why it is important to get their babies vaccinated.


To be sure, the underlying shortage of Hib vaccine remains an issue. Even when parents are willing to have their child vaccinated, they can be stymied by a lack of vaccine.

And it’s somewhat alarming to note that because of the cost associated with buying and administering vaccines, some primary care doctors are giving serious thought to not offering children’s vaccines anymore. The study, reported last month in the Pediatrics journal, notes, "Although large-scale withdrawal of immunization providers does not seem to be imminent, efforts to address root causes of financial pressures should be undertaken."

Has prevention been oversold?

Have prevention and screening been oversold to the public? A small but increasingly vocal number of doctors is starting to ask this question, according to an article in the latest edition of American Medical News, the weekly publication of the American Medical Association.

It’s not that prevention has no value. But expectations for what screening and prevention can deliver are often unrealistic – among doctors as well as the public, the article says.

Why expectations for prevention have become so great is not clear, although experts have several theories. Various preventive modalities are heavily promoted by patient organizations, medical societies and public health agencies. The limits of a preventive strategy may get lost as the benefits are emphasized and complex messages get oversimplified in awareness campaigns.

A zeitgeist also emerged in the last century that early detection and lifestyle changes always make a difference. "It just seems like it’s the right thing to do," said Russell Harris, MD, MPH, a former (U.S. Preventive Services Task Force) member and professor of medicine at the University of North Carolina.

Some experts are calling for a better balance in how screening and prevention are viewed. Among women ages 50-69, for instance, mammography can help reduce the risk of dying from breast cancer by 15 percent – but it reduces the absolute risk of breast cancer by only 0.05 percent. For every 2,000 women who are screened over a decade, one will have her life prolonged and 10 healthy women will be treated unnecessarily, according to the American Medical News article.

At the same time, it’s important to avoid deterring patients from doing something that can genuinely benefit their health, experts said.

Some physicians say the process for deciding what preventive strategies to pursue is a good fit for shared decision-making to engage patients in understanding various strategies’ potential harms and benefits.  No one working in this area believes that any of these interventions are inherently bad or dangerous, but many hope to see them applied appropriately.

Indeed, some preventive measures, most notably vaccinations and smoking cessation, might actually be undersold – and the sheer volume of prevention messages might be drawing people’s attention away from the strategies that are most effective, the article notes.

Flu tracker, week 2

Influenza activity slowly increased during week 2, the week of Jan. 11-17.

From the U.S. Centers for Disease Control and Prevention: One state reported widespread flu activity, six states reported regional activity and 11 states reported local activity. In 30 states, plus the District of Columbia and Puerto Rico, influenza activity was sporadic. Two states reported no flu activity.

Nationally, there were two flu-associated deaths among children.

In Minnesota, flu activity remains sporadic, according to the Minnesota Department of Health. Three school outbreaks of influenza were reported during the week of Jan. 11-17. At the state’s 30 sentinel sites for flu surveillance, 0.08 percent of patients showed up with influenza-like illnesses.

Working-age adults struggle with drug costs

It’s not just senior citizens who have trouble paying for prescription drugs. A new report from the Center for Studying Health System Change has found that increasing numbers of working-age American adults are going without prescription medication because they can’t afford the cost.

In 2003, one in 10 children and working-age adults skipped a medication because of the cost. In 2007, this jumped to one in seven, the survey found. The data were collected from the center’s 2007 Health Tracking Household Survey.

The rising cost of prescription drugs, coupled with shrinking drug coverage by health plans, were the main reasons why younger people are having increasing difficulty affording their medications, the report’s authors said.

The authors called it a "troublesome" trend, noting that prescription drugs are often an important component in health, especially in managing chronic conditions.

Moreover, patients who go without needed prescription drugs may experience worsening health and expensive complications. The most vulnerable people – those with low incomes, chronic conditions and the uninsured – continue to face the greatest unmet prescription drug needs. Yet, between 2003 and 2007, higher-income adults and those without chronic conditions experienced percentage point increases in unmet needs nearly as large as those with lower incomes and chronic conditions, respectively. This signals that prescription drugs are becoming more expensive for everyone and that insurance coverage provides less financial protection against out-of-pocket drug spending than it did in the past.

The report’s authors noted that the situation is likely to get worse as the economy deteriorates.

Among the survey’s specific findings:

– Although the largest increase in unmet prescription drug needs occurred among uninsured working-age Americans, working-age adults with employer-sponsored insurance also were feeling the pinch. The study found that 10.7 percent of working adults with employer-sponsored insurance reported going without a prescription drug in 2007, compared to 8.7 percent just four years earlier.

– Uninsured working-age adults (ages 19-64) with one or more chronic conditions were the worst off; two-thirds reported going without a prescription drug because they couldn’t afford it.

– Children are less likely than adults to need prescription medication. Nevertheless, in 2007 an estimated 3.9 million American children didn’t receive medication they needed because of the cost.