All posts by Glenn Ellis

Glenn Ellis is a Health Advocacy Communications Specialist, with a focus on Ethics and Equity. He is the author of Which Doctor?, and is a health columnist and radio commentator who lectures, and is an active media contributor nationally and internationally on health related topics. His latest book, “Information is the Best Medicine”, was released in January 2012. He is currently working on his next book on the history of Blacks in Philadelphia medicine. Glenn is the Host of "Information is the Best Medicine", heard weekly at 9am (EDT) on 900amwurd.com. For more good health information, visit: www.glennellis.com

Fidel Castro, Poverty, and Race

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“a child is deemed to be living in relative poverty if he or she is growing up in a household where disposable income, when adjusted for family size and composition, is less than 50% of the median disposable household income for the country concerned”

 

Much is being said and written in recent days about Fidel Castro. Regrettably, much of the rhetoric is directed towards claims on human rights violations against the Cuban people. Admittedly, Fidel Castro was not a perfect man, but it seems there’s plenty of work that needs to be addressed here in the United States, before passing judgement.

Prior to the Revolution, led by Castro in 1959, there were profound inequalities in Cuban society — between city and countryside and between whites and blacks. Most Cubans lived in abysmal poverty; perpetually in debt and living on the margins of survival. Many were seriously malnourished and hungry. Neither health care nor education reached those Cubans at the bottom of society. Illiteracy was widespread, and those lucky enough to attend school seldom made it past the first or second grades.

Yet, today, over 50 years later, Cuba has one of the highest literacy rates (almost 100%), and best health outcomes in the western hemisphere, including the lowest infant mortality rate.  img_1901

Not claims that the U.S., the most powerful nation on the planet, can make.

According to the Office of Research at the United Nations Children’s Fund (UNICEF), the U.S. has one of the highest rates of child poverty in the developed world. Of the 35 wealthy countries studied by UNICEF, only Romania has a child poverty rate higher than the 23 percent rate in the U.S.

Black children are more likely to live in poverty than children of any other race. The poverty rate among black children is 38.2 percent, more than twice as high as the rate among whites. The poverty rate for Hispanic children is 32.3 percent.

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Twenty-four states and the District of Columbia have poverty rates higher than the national average of 15 percent, with the majority of the nation’s poor situated in the south. With a rate of 22.6 percent, Mississippi had the highest proportion of residents below the poverty line. At 8.8 percent, New Hampshire had the lowest.

In Pennsylvania, 37.6% of Black children, and 41.6% of Latino children live in poverty as of 2010. Fifty-three percent of Black children raised in the bottom fifth of the income distribution will remain there as adults compared to only 32 percent of White children raised in similar economic circumstances.

Compounding the poverty issue for children is the issue of homelessness. An estimated one in 45 children – or 1.6 million – was homeless in America each year between 2006 and 2010. Approximately 40 percent of those homeless children, or 640,000, were five or younger.

Living in a U.S. neighborhood with a high poverty rate is associated with a learning loss equivalent to a full year of school among Black children and high school graduation rates that are as much as 20 percentage points lower than those in more-advantaged communities.

In 2010, one in nine children – 16 million in total – lived in households struggling to afford the food they needed to ensure their children would not go to sleep or to school hungry. One out of 77 children went without enough food at least once.

Twenty-two percent of children who have lived in poverty do not graduate from high school, compared to six percent of those who have never been poor. Thirty-two percent of students who spent more than half of their childhoods in poverty do not graduate.

Compared to more affluent children, children on Medicaid may be less likely to live in neighborhoods where they can play and exercise safely outdoors, and their caretakers are less likely to have access to supermarkets selling fresh, healthy foods.

This is as much about poverty and race as it is about health.

The U.S. is the only country without paid maternity leave; a parent’s job isn’t protected if he or she takes a day off to care for a sick child; and the U.S. still lacks affordable, high-quality childcare. Our lack of quality childcare and after-school programs puts these kids at risk and endangers the nation’s future.

For me, one of Fidel Castro’s enduring legacies is this quote: There is often talk of human rights, but it is also necessary to talk of the rights of humanity. Why should some people walk barefoot, so that others can travel in luxurious cars? Why should some live for thirty-five years, so that others can live for seventy years? Why should some be miserably poor, so that others can be hugely rich? I speak on behalf of the children in the world who do not have a piece of bread. I speak on the behalf of the sick who have no medicine, of those whose rights to life and human dignity have been denied…”      cuba1-600x378

While we get ready to get in the “holiday” spirit, remember the children; the poor; the sick; and the underprivileged.

Sickle Cell Disease

 

Sickle Cell Disease

 

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September is National Sickle Cell Awareness Month. First officially recognized by the federal government in 1983, National Sickle Cell Awareness Month calls attention to sickle cell disease (SCD), a genetic disease.

      Most people who are diagnosed with Sickle Cell Anemia are African-Americans, and about 1 in every 365 African-  American children are born with it. Sickle cell disease is a blood disorder that’s inherited — meaning it’s passed down from parents to their children. Babies are born with sickle cell disease when they inherit two abnormal genes (one from each parent). These genes cause the body’s red blood cells to change shape.

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It’s a chronic disorder causing pain in the extremities and back, infections, organ failure and other tissue damage, skin infections, loss of eyesight, severe blood clots and strokes.

Normal red blood cells are shaped like discs or donuts with the centers partly scooped out. They are soft and flexible so they can easily move through very small blood vessels and deliver oxygen throughout a person’s body.

Sickle cells are stiffer. Instead of being disc shaped, they’re curved like crescent moons, or an old farm tool known as a sickle. That’s where the disease gets its name.

While sickle cell disease primarily affects persons of African descent, it is also present in Portuguese, Spanish, French Corsicans, Sardinians, Sicilians, mainland Italians, Greeks, Turks and Cypriots. Sickle cell disease also appears in Middle Eastern countries and Asia.

1910 is regarded as the date of the discovery of sickle cell disease, so 2010 was the 100th anniversary of that discovery, but just what does it mean to say the disease was “discovered”?

The disorder we call “Sickle Cell Disease” often abbreviated as SCD, had been present in Africa for at least five thousand years and has been known by many names in many tribal languages. What we call its “discovery” in 1910 occurred, not in Africa, but in the United States. A young man named Walter Clement Noel from the island of Grenada, a dental student studying in Chicago, went to Dr. James B. Herrick with complaints of pain episodes, and symptoms of anemia. Herrick was a cardiologist and not too interested in Noel’s case so he assigned a resident, Dr. Ernest Irons to the case. Irons examined Noel’s blood under the microscope and saw red blood cells he described as “having the shape of a sickle”. When Herrick saw this in the chart, he became interested because he saw that this might be a new, unknown, disease. He subsequently published a paper in one of the medical journals in which he used the term “sickle shaped cells”.

Microscopic view of sicke cells causing anemia disease.
Microscopic view of sicke cells causing anemia disease.

Originally from Africa and brought to the Americas by the forced immigration of slaves, it is more frequent where the proportion of African descendants is greater. Carriers of the sickle cell trait have some resistance to the often-fatal malaria. This is why it is found more frequently in persons of Middle Eastern, Indian, Mediterranean and African heritage because those geographic regions are most prone to malaria.

However, in areas such as the US, where malaria is not a problem, the trait no longer provides a survival advantage. Instead, it poses the threat of SCD, which occurs in children of carriers who inherit the sickle cell gene from both parents.

There are several types of sickle cell disease, and the most common one is sickle cell anemia. It makes you feel tired, because your blood cells don’t last as long as other people’s do.

Normally, red blood cells live about 120 days. New ones that replace them are made in the soft, spongy center of your bones called the marrow. If you have sickle cell anemia, your red blood cells start dying after only 10 to 20 days. Your bone marrow can’t replace them fast enough, which causes anemia. Red blood cells carry oxygen around your body, which gives you energy. If you don’t have enough of them, you’ll get tired and you might also feel short of breath.

SCD patients learn to function in a constant state of pain and when that pain becomes debilitating, they often end up in the emergency room. What brings people to the emergency room is called a crisis; in which the blood can’t deliver oxygen to the extremities. It is a sudden onset of severe, excruciating pain, which people describe as feeling as if all their bones are breaking. The pain is so bad and sudden that people require high doses of opioids.

Contrary to the belief of many in the medical profession, there is no data to support that sickle cell patients have any more likelihood of being addicted than anybody else. photo611475392035923911-660x346

Acute and unpredictable pain, severe enough to require large doses of narcotics, is a well-documented feature of sickle cell disease. When many sickle cell patients arrive at emergency rooms, they often have great difficulty getting the treatment they need.

Racism and the disease stigma itself are two barriers that you just can’t get away from. Clearly we can’t pretend that racism doesn’t play some part in this. If this were a white disease, people still wouldn’t be dying in their forties. That’s the bottom line. Sickle cell was “discovered” 106 years ago and there is only one drug, hydroxyurea, and blood transfusions to treat it.

There has been progress in Sickle cell disease. People didn’t used to live to be adults. Kids would die of stroke or of really bad infections before they were 20, and in some countries they still do.

#informationisthebestmedicine

To Vaccinate of Not to Vaccinate?


Your child spends more time at school than anywhere else except home. One of the many things that you now must  consider as back-to-school preparations begin: state laws that require students to be vaccinated in order to attend school.

Now that vaccines have virtually eliminated many once-feared diseases, the possibility of vaccine side effects or adverse reactions loom larger in some people’s minds than the diseases that vaccines prevent. Most parents have never seen a case of diphtheria or measles, and some wonder why their children must receive so many shots. Rumors and misinformation about vaccine safety abound. For example, many parents are concerned that multiple vaccines may weaken or overwhelm an infant’s immune system or that certain vaccines may cause autism, multiple sclerosis or diabetes.

Should you vaccinate your child and protect her from more than a handful of infectious diseases, or are the shots themselves more harmful than helpful?

As it stands, all 50 states require specific vaccines for school-aged children, although each grants exemptions for students unable to be vaccinated for medical reasons. The power struggle pitting parents against parents arises in the 19 states that allow families to opt out of vaccination requirements by claiming a “philosophical exemption,” whether based on personal, moral, or religious beliefs.

Every day, tens of thousands of parents across the United States make decisions that most medical experts believe could not only put their children at risk but other children as well. These parents refuse to have their children vaccinated against dangerous childhood diseases such as diphtheria, rubella, mumps, measles, influenza, whooping cough, and many more. The medical evidence is overwhelming that when an unvaccinated child who is ill comes in contact with vaccinated children, the vaccinated children can be infected. The doctor or nurse who gives the vaccination can tell you vaccines are effective 85-95 percent of the time.

Infectious disease was the leading cause of death in children 100 years ago, with diphtheria, measles, scarlet fever and pertussis accounting for most of them. Today, the leading causes of death in children under 5 years of age are accidents, genetic abnormalities, developmental disorders, sudden infant death syndrome and cancer.

In the U.S., vaccines have reduced or eliminated many infectious diseases that once routinely killed or harmed many infants, children, and adults. However, the viruses and bacteria that cause vaccine-preventable disease and death still exist and can be passed on to people who are not protected by vaccines.

Vaccines only work if enough people in a community are vaccinated. When enough people are vaccinated, viruses have trouble moving from host to host and cease to spread, sparing both the unvaccinated and those in whom the vaccination has not produced immunity. Researchers have found that for vaccines to work, 92 percent or more of a population must be immunized against the disease. For highly contagious viruses, it takes 95 percent to protect the entire community.

Childhood immunizations have a long, and interesting, history. By the mid-1980s, there were seven vaccines: diphtheria, tetanus, pertussis, measles, mumps, rubella and polio. Because six of these vaccines were combined into two shots (DTP and MMR), and one, the polio vaccine, was given by mouth, children still received five shots by the time they were 2 years old and not more than one shot at a single visit. Since the mid-1980s, many vaccines have been added to the schedule. Now, children could receive as many as 24 shots by 2 years of age and five shots in a single visit.

No vaccine is perfectly safe or effective. Each person’s immune system works differently, so occasionally a person will not respond to a vaccine. Very rarely, a person may have a serious adverse reaction to a vaccine, such as an allergic reaction that causes hives or difficulty breathing. But serious reactions are reported so infrequently (on the order of 1 in 100,000 vaccinations) that they can be difficult to detect and confirm. More commonly, people will experience temporary side effects, such as fever, soreness, or redness at the injection site. These side effects are, of course, preferable to getting the illness.

The decision to vaccinate your child is a personal one. Whatever you decide, it’s important that you have enough information to make a good, sensible decision.

Remember, I’m not a doctor. I just sound like one.

Glenn Ellis, is a regular media contributor on Health Equity and Medical Ethics. He is the author of Which Doctor?, and Information is the Best Medicine. Listen to him every Saturday at 9 a.m. (EST) on www.900amwurd.com, and Sundays at 8:30 a.m. (EST) onwww.wdasfm.com. For more good health information, visit: glennellis.com

The Final Battle: Muhammad Ali and Parkinson’s Disease


In light of the recent news on the passing of Muhammad Ali, I thought it would be appropriate to take the opportunity to focus on the realities of Parkinson’s disease and what you need to know about the illness. While you’re probably familiar that The Champ had been living with the disease since 1984, chances are there’s a lot you still don’t know about Parkinson’s disease (PD).
Appropriately, the news media was filled with his exploits, both in and outside of the ring.
Yet, two of the most significant contributions that Ali made had been either glossed over, or underreported: His defiant stand in opposition of the Vietnam war, and putting a face to Parkinson’s Disease that resonated around the world.
With such an incredibly high profile and public persona, the courage and moral grounding required for a man of African descent to vehemently refused to be inducted into the military was not only unprecedented, but was historic in a most profound way. Much more needs to done to insure that this part of Ali’s legacy remains in the annals of history.
But, equally as significant was the fact that this man spent the last 30-plis years of his life imprisoned by the ravages of Parkinson’s Disease. It was interesting to hear Hall of Fame Footballer, Jim Brown proclaim, “he wasn’t considered a hero until he could no longer talk”.

So let’s take a look at Parkinson’s Disease.
Parkinson’s disease (PD) is a chronic and progressive movement disorder, meaning that symptoms continue and worsen over time. Muhammad Ali was just one of the more than one million people in the US that are living with Parkinson’s disease. The cause of Parkinson’s is unknown, and there is presently no cure. For certain people, there are treatment options such as medication and surgery to manage its symptoms.
While Parkinson’s itself isn’t considered fatal, people can die from complications of the disease.
Complications of the disease were the cause of Ali’s death, not Parkinson’s itself. He died of septic shock after spending five days at an Arizona hospital for what started out as respiratory problems and gradually worsened. We only know that Ali was hospitalized for a “respiratory infection”. Sepsis is the body’s reaction to fight infection that becomes essentially failed effort. The body’s trying so hard to fight infection and basically just gives out. Septic shock is what happens as a complication of an infection where toxins can initiate a full-blown inflammatory response from the immune system. The CDC reports that more than 1 million cases of sepsis are recorded in the United States each year, and between 28 and 50 percent of people who suffer from sepsis die.
Parkinson’s, itself, involves the malfunction and death of vital nerve cells in the brain, called neurons. It is a very slowly progressive neurodegenerative condition affecting multiple circuits in the brain. The Mayo Clinic describes Parkinson’s as, “a progressive disorder of the nervous system that affects movement. It develops gradually, sometimes starting with a barely noticeable tremor in just one hand. But while a tremor may be the most well-known sign of Parkinson’s disease, the disorder also commonly causes stiffness or slowing of movement”. During the early stages, the person’s face begins to show little, or no, expression, and the arms no longer swing when the person walks. As the disease progresses, tremors and shaking becomes more and more pronounced, and what speech remains is slurred or very soft (almost mumbling). Parkinson’s patients also experience non-motor symptoms; which studies have shown may be even more disabling. These symptoms may include depression, anxiety, and sexual dysfunction.
The general consensus from the scientific and the medical community (and many of his fans and detractors) is that Ali’s condition was the result of the continued pounding to his head during his career as a boxer. They believe that repeated hits to the head might contribute to Parkinson’s.
Comparing the brain to a squishy ball, when it’s hit extremely hard, the ball bounces against the skull. About three to 12 days later, massive inflammation follows and the brain is flooded with proteins that are associated with Alzheimer’s or Parkinson’s.
Parkinson’s results from a loss of brain cells that produce the chemical dopamine. After inflammation, these dopamine neurons are much more fragile, and more likely to become injured by other things, such as regular aging. But, the scientific evidence points to a genetic predisposition. According to several neurological experts familiar with Ali’s symptoms and the course of his disease, they conclude that they were also consistent with a genetic form of Parkinson’s.
His trainer Angelo Dundee and daughter Rasheda indicates that Ali may have boxed with symptoms of Parkinson’s. In some patients, events like head trauma or medications can “unmask” disease that’s still in its earliest stage. So, in Ali’s case, boxing may have contributed to his illness, but genetics was likely a bigger factor.
Like any other disease or medical condition, should we become affected, we must always remember that life can, and must, go on. Parkinson’s disease is a progressive disorder, and although it is not considered to be a fatal disease, symptoms do worsen over time and make life difficult. There are many medications available to treat the symptoms of Parkinson’s, although none yet that actually reverse the effects of the disease. It is common for people with Parkinson’s to take a variety of these medications in order to manage the symptoms of the disease. Life expectancy for people with Parkinson’s who receive proper treatment is often about the same as for the general population. The average life expectancy of a black man in America is 75.5 years, Muhammad Ali died 6 months’ shy of his 75th birthday. Not bad; all things considered.

Early detection is the key to reducing complications that can shorten your life. Another good reason for regular checkups with your doctor.

Remember, I’m not a doctor. I just sound like one.
Take good care of yourself and live the best life possible!

Glenn Ellis, is a Health Advocacy Communications Specialist. He is the author of Which Doctor?, and Information is the Best Medicine. A health columnist and radio commentator who lectures, nationally and internationally on health related topics, Ellis is an active media contributor on Health Equity and Medical Ethics.

Listen to Glenn, every Saturday at 9:00am (EST) on www.900amwurd.com, and Sundays at 8:30am (EST) on www.wdasfm.com. For more good health information, visit: www.glennellis.com

Children, Poverty, and Race

According to the Office of Research at the United Nations Children’s Fund (UNICEF), the U.S. has one of the highest rates of child poverty in the developed world. Of the 35 wealthy countries studied by UNICEF, only Romania has a child poverty rate higher than the 23 percent rate in the U.S.  
The rate is based on the definition of relative poverty used by the Organization for Economic Co-operation and Development (OECD).
Under this definition, a child is deemed to be living in relative poverty if he or she is growing up in a household where disposable income, when adjusted for family size and composition, is less than 50% of the median disposable household income for the country concerned.
Black children are more likely to live in poverty than children of any other race. The poverty rate among black children is 38.2 percent, more than twice as high as the rate among whites. The poverty rate for Hispanic children is 32.3 percent.
The longer a child lives in poverty, the tougher it can be for them to climb out later in life. According to an analysis by Columbia University’s National Center for Children in Poverty, 45 percent of people who spent at least half of their childhood in poverty were poor at age 35. Among those who spent less than half of their childhood in poverty, just 8 percent were poor at age 35.
In Pennsylvania, 37.6% of Black children, and 41.6% of Latino children live in poverty as of 2010. Fifty-three percent of Black children raised in the bottom fifth of the income distribution will remain there as adults compared to only 32 percent of White children raised in similar economic circumstances.
Compounding the poverty issue for children is the issue of homelessness.
An estimated one in 45 children – or 1.6 million – was homeless in America each year between 2006 and 2010. Approximately 40 percent of those homeless children, or 640,000, were five or younger.

Homeless children: Experience food insecurity, with one-third reporting that they skip meals; are more than twice as likely as middle-class children to have moderate to severe acute and chronic health problems; and are twice as likely as other children to repeat a grade in school, to be expelled or suspended, or
to drop out of high school.

Living in a neighborhood with a high poverty rate is associated with a learning loss equivalent to a full year of school among Black children and high school graduation rates that are as much as
20 percentage points lower than those in more-advantaged communities.
In 2010, one in nine children – 16 million in total – lived in households struggling to afford the food they needed to ensure their children would not go to sleep or to school hungry. One out of 77 children went without enough food at least once.
Twenty-two percent of children who have lived in poverty do not graduate from high school, compared to six percent of those who have never been poor. Thirty-two percent of students who spent more than half of their childhoods in poverty do not graduate.
Compared to more affluent children, children on Medicaid may be less likely to live in neighborhoods where they can play and exercise safely outdoors, and their caretakers are less likely to have access to supermarkets selling fresh, healthy foods.
This is as much about poverty and race as it is about health.
A 2012 Annie E. Casey Foundation study examined the relationship among family income, high school completion and third-grade reading on a national level:
• About 16% of children who could not read proficiently by the end of the third grade do not graduate from high school on time—this is four times greater than the rate for proficient readers.
• This percentage rises to 26% for children who have been poor for at least a year of their lives and who could not read proficiently by the end of the third grade.
• This statistic climbs to 35% for children who are poor, who live in neighborhoods of concentrated poverty and who could not read proficiently by the end of the third grade.
Inadequate school attendance is another problem for poor children. Research indicates that poor children tend to miss four times more school than their more affluent peers. Studies have found a number of reasons to explain this problem, including hunger, asthma, anxiety, fear, insufficient funds for school supplies or books, and a lack of quiet places to read or study.

Without high-quality early childhood intervention, an at-risk child is: 25 percent more likely to drop out of school; 40 percent more likely to become a teen parent; 50 percent more likely to be placed in special education; 60 percent more likely never to attend college; 70 percent more likely to be arrested for a violent crime; and thirty percent of poor children score very low on early reading skills, compared to only seven percent of children from moderate- or high-income families.

Our lack of quality childcare and after-school programs puts these kids at risk and endangers the nation’s future in a knowledge economy. Our lack of support for flexible work arrangements and Social Security credits for caregivers puts these parents at risk.
Some of us have the luxury of getting in our cars and going to our local grocery store where there is a plethora of opportunities to buy vegetables, fruits and other food that is healthy for our bodies. Sure, the grocery stores are all stocked with food and snacks that are really bad for most of us as well, but with a little strength we can ignore those aisles.
What if those opportunities were not as available to us as they are now? What if we lived in what’s called a food desert, where we are surrounded by fast food and cheap grocery stores that offer fatty snacks, drinks with pounds of sugar and cheap highly processed foods? People who live below the poverty line in large cities have more opportunities to eat unhealthy and it has hit epidemic proportions.
While we get ready to get in the “holiday” spirit…remember the children.
When it comes to educating children, and them growing into healthy and productive adults, poverty matters…

Lack of Access to Life-Saving Medicines: Drug Patents and Prices

The problem of access to life-saving medicines is proving more deadly than many of the most deadly diseases themselves. Millions of people in developing countries will die within 3 years without immediate access to affordable antiretroviral medicines, according to the World Health Organization. As dismal as availability of essential medicines is, access to newer medicines, including those for chronic diseases, is even worse, because these patent-protected medicines are also too expensive. 

Admittedly, there are many factors that contribute to a lack of access to existing medicines in developing countries: tattered health systems, insufficient numbers of health workers, weak regulatory regimes, and poor procurement and distribution systems. Yet, the most troubling problem is the price of medicines, and the corresponding protection of patents that pharmaceutical companies enjoy. But what may come as a surprise to many readers of this column is that there is a similar, and equally as deadly, “Drug War” in the United States.

In the United States and other rich industrialized nations, “Big Pharma” is already the gatekeeper for life-saving medicines.  The FDA is on track to approve a record number of high-priced specialty drugs in 2015, according to a new report from Express Scripts.

But blockbuster growth comes with blockbuster spending. The 25 new treatments to gain FDA approval this year could drastically increase the country’s spending on specialty drugs, which already is a primary driver of health care costs.

Much attention has recently been focused on the skyrocketing prices of hepatitis C drugs. They’ve become a cover story-sized problem that is putting critically important medications out of reach for millions of consumers. The problem will get bigger, given that future hep C drug approvals may cost more than Sovaldi’s enormous $84,000 price.

Specialists in infectious disease are protesting a gigantic overnight increase in the price of a 62-year-old drug that is the standard of care for treating a life-threatening parasitic infection.

Turing Pharmaceuticals, a start-up run by a former hedge fund manager, acquired a drug, called Daraprim, in August. Turing immediately raised the price to $750 a tablet from $13.50, bringing the annual cost of treatment for some patients to hundreds of thousands of dollars. A rival company has since made the drug available for $1.00, in what may yet turn out to be a strategic marketing effort to bring more visibility to the competing company. (forgive me for being a skeptic) 

But what’s even more disconcerting about the specialty drug pipeline is the flood of new cancer treatments that will carry astronomical price tags. There are more than 1,000 cancer drugs under development, most of which will cost an average $10,000 per patient per month. In 2012, 12 of the 13 new drugs approved for cancer were priced above $100,000 per year.

 

The other “weapon” in this battle against equitable access to life-saving medicines is drug patents.

When a pharmaceutical company first develops a new drug to be used for a disease condition, it is initially sold under a brand name by which the clinicians can prescribe the drug for use by patients. The drug is covered under patent protection, which means that only the pharmaceutical company that holds the patent is allowed to manufacture, market the drug and eventually make profit from it.

In most cases, the drug patent is awarded for around twenty years in the United States. The lifetime of the patent varies between countries and also between drugs. Since the company applies for a patent long before the clinical trial to assess a drug’s safety and efficacy has commenced, the effective patent period after the drug has finally received approval is often around seven to twelve years.

Once the patent has expired, the drug can be manufactured and sold by other companies. At this point, the drug is referred to as a generic drug. According to guidelines in most countries, including those from the US FDA, generic drugs have to be identical to the branded drug. The company holding the initial patent may, however, renew the patent by forming a new version of the drug that is significantly changed compared to the original compound.

The power and influence of pricing and patents wielded by the global pharmaceutical industry should be underestimated. In the U.S., the industry contributes heavily to the annual budget of the U.S. Food and Drug Administration (FDA), which is charged with regulating drugs and devices made by those same companies. The global market for pharmaceuticals topped $1 trillion in sales in 2014. The world’s 10 largest drug companies generated $429.4 billion of that revenue. Five of the top 10 companies are headquartered in the U.S.: Johnson & Johnson, Pfizer, Abbot Laboratories, Merck and Eli Lilly; all located, ironically, in political swing states of New York, New Jersey, Pennsylvania; Illinois, and Indiana.

President Barack Obama ran for office under a pledge to allow the same kind of bargaining that keeps medicine prices lower in other nations. But the idea was abandoned on the path toward the Affordable Care Act. In 2009 Big Pharma agreed to contribute $80 billion towards ObamaCare. In return the White House agreed to spare the drug companies from central planning such as allowing the Health and Human Services Department to “negotiate” lower drug prices.

This is vital information that can inform your health decisions and your political decisions.

Remember, I’m not a doctor. I just sound like one.

Take good care of yourself, and live the best life possible!

Aging and Healthcare in Cuba

“Many men can draft many laws. But few have the piercing and humane eye, which can see beyond the words to the people that they touch. Few can see past the speeches and the political battles to the doctor over there that is tending the infirm, and to the hospital that is receiving those in anguish, or feel in their heart painful wrath at the injustice which denies the miracle of health to the old and to the poor. And fewer still have the courage to stake reputation and position, and the effort of a lifetime upon such a cause ….”
– President Lyndon B. Johnson on the signing of Medicaid Bill, 1964 –


President Obama culminated 6 months of intensive efforts to normalize relations with Cuba last week with the announcement of the reopening of Embassies in the respective countries. Among other things, I believe we will now begin to hear more about the intricacies of the Cuban Healthcare System.
Over the past 10 years, I have made dozens of trips (legally) to Cuba. In my visits there, I have lectured, done collaborative research, and in a variety of ways, studied their health and medical system. It is an understatement to say that I emerged from these experiences with deep fascination.
Put simply, my fascination with the Cuban Health System stems from the similarities of their system, and our system of Medicaid and Medicare, and how Cuba has succeeded at making sure that Health care is a human right rather than a product for economic profit. Therefore, all Cubans have equal access to health services, and all services are free.
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As we know, Medicaid was introduced for two reasons: 1) providing medical insurance to people with incomes low enough to qualify for cash assistance, and 2) to complement Medicare by paying for long-term care for people with the means to do so for themselves.
I have always envied how Cuba is able to provide high quality care to a poor population, with limited financial resources. Yet, the Cuban people enjoy better health outcomes in every category of measure: low infant mortality; low rate of depression and sickness in the elderly; and almost everything in between.
Cuba has the lowest infant mortality and the lowest HIV/AIDS rates in the western hemisphere; they have a life-expectancy equal to that of the United States; and in addition to notable advances in vision and diabetes treatments, have numerous approved vaccines developed and approved for global use.
Medicaid is at the foundation of our nation’s commitment to insure equal opportunity for all people, regardless of income, disability, age, or race.
Medicaid is a critically important source of health coverage for a significant share of blacks and Latinos, in this country, who would otherwise have no access to the health care they need.
One particular visit was devoted to looking at how the elderly receive healthcare in Cuba.
Like the rest of the world, the US is an aging society. This will place substantial additional pressure on publicly funded health, long-term and income support programs for older people. The older U.S. population (persons 65 years or older) numbered 39.6 million in 2009 (the latest year for which data is available). They represented 12.9% of the U.S. population, about one in every eight Americans. By 2030, there will be about 72.1 million older persons, more than twice their number in 2000. People 65+ represented 12.4% of the population in the year 2000 but are expected to grow to be 19% of the population by 2030.
In the last 25 years, aging on the island increased by 6.5 percent, and in 2010 the elderly population was greater that the number of Cubans between 0 and 14 years of age, representing 17.8 percent of the total 11.2 million inhabitants. An estimated 54 percent of Cubans over 60 are retired.
As I visited many different parts of the healthcare system devoted to care of the elderly in their society, I paid close attention to the “take-aways”, that I felt were of particular interest to the challenges we face here in the US.
One of the biggest problems found in elderly Americans is depression.
Depressive disorder is not a normal part of aging. Emotional experiences of sadness, grief, response to loss, and temporary “blue” moods are normal. Persistent depression that interferes significantly with ability to function is not.
Many health professionals in this country seem to mistakenly think that persistent depression is an acceptable response to other serious illnesses, and the social and financial hardships that often accompany aging – an attitude, unfortunately, often shared by older people themselves. This contributes to low rates of diagnosis and treatment in older adults.
In Havana, I saw hundreds of elderly people full of life, and looking forward to a meaningful, productive years in their family, their neighborhoods, and their general communities.
I visited clinics; “senior centers’; a Rehab Center; and a Family Medicine Office (primary care). I was even able to join a doctor for her regular visit to the home of one of her patients.
After my of interviews with professionals and elderly Cubans in the community, I found a vibrant, healthy, and active elderly population, with healthcare providers organized, and structured, in a way to allow healthcare to be delivered to met the needs of the elderly.
I also conducted interviews in Spanish (with the help of a translator) with officials and community leaders of the Cuban National School of Public Health.
The Cuban health care model is a public health/holistic one. In other words, health care includes the whole person; the physiological, psychological, emotional, social (including family relationships), and environmental aspects of the person. The services are distributed in a public health triage model. If ten people are waiting to be served, rather than be seen on a first-come-first-serve basis, they are taken in the order of need.

Cuba possesses specialized geriatrics services throughout the country, as part of the actions to prolong, with quality, the life of its inhabitants.
Cuban health authorities give large credit for the country’s impressive health indicators to the preventive, primary-care emphasis pursued for the last four decades. These indicators – which are close or equal to those in developed countries – speak for themselves.

Cuba’s physician per population ratio is 1 per 255, as compared to 1 to 430 in the United States. With a life expectancy of 76.9 years, Cuba ranks 28th in the world, just behind the US. However, its spending per person on health care is one of the lowest in the world, at $186, or about 1/25 the spending of the United States. Health care spending increased tenfold between 1980 and 2011, when it reached $2.6 trillion and accounted for 17.6 percent of the U.S. economy. All that spending isn’t bringing Americans the best care in the world, either.
Yes, it’s possible to take care of the poor and underprivileged with bankrupting America. I left Cuba with a new sense of optimism about what is possible…if only we have the “Political will”.

“The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those in the shadows of life, the sick, the needy and the handicapped.”

Remember, I’m not a doctor. I just sound like one.
Take good care of yourself and live the best life possible!

This column is for informational purposes only. If you have a medical condition or concern, please seek professional care from your doctor or other health professional.

Homeless Children and Adults in America

The United States’ economy, recently on the brink of collapse, appears to be making a recovery. The poorest families haven’t yet seen the benefits of the recovery. The result is an increase of homeless children and adults.
According to federal law, homeless children include those who lack a fixed, regular, and adequate nighttime residence. Although some students will volunteer their personal information, many homeless students will make oblique references to where they are staying.
Estimates show that nearly 1.4 million children are homeless in this country every year. In the 2011-2012 school year, 1,166,339 homeless children and youth were enrolled in public schools. This is a 71 percent increase since the 2006-2007 school year. The number of homeless children increased in 31 states between 2012 and 2013, with leaps of 10 percent or more in 13 states and Washington, D.C.. It is important to note that this number is not an estimate of the prevalence of child and youth homelessness; in fact, it is an underestimate, because not all school districts reported data to the U.S. Department of Education, and because the data collected represents only those children identified and enrolled in school. Finally, the number does not include all preschool-age children, or any infants and toddlers. Students may also indirectly indicate that they are homeless through changes in their habits and appearance, such as increased sleepiness; wearing the same clothes frequently or other personal care issues; a decreasing quality of school work; and most often, and absences from school. Homeless students are of every race and cultural background. Ninety percent of homeless families are single-parent families that are typically headed by the mother. The characteristics of homeless students are similar to other students living in poverty, the difference being that they do not have consistent housing.
Homeless students are often on their own by the time they reach secondary school age. Administrators frequently refer to these older homeless students as unaccompanied youth or, more informally, as “couch surfers” or “couch hoppers.” Homeless students sometimes do not get enough to eat and therefore come to school hungry. Homeless students may not get enough sleep at night or are afraid to sleep. Many homeless students do not receive adequate medical or dental care and are more likely to have health problems. Homeless students have higher rates of upper respiratory and ear infections, skin diseases, and common cold symptoms than their peers.
About 12% of homeless children are not enrolled in school and up to 45% do not attend school regularly.
The relationships that homeless students have with school staff members may be the only associations they have with people who are living in a productive and positive manner and who can serve as guides for how to live constructive lives.
The number of Americans who are homeless at some point during a year changes constantly as people move in and out of homelessness, sometimes for days at a time, sometimes weeks or months.

Poor health can contribute to being homeless, and being homeless can lead to poor health. Limited access to health care can make it worse. That’s why the health of homeless people in the United States is worse than that of the general population. Common health problems include
• Mental health problems
• Substance abuse problems
• Bronchitis and pneumonia
• Problems caused by being outdoors
• Wound and skin infections
Many homeless women are victims of domestic or sexual abuse. Homeless children have high rates of emotional and behavioral problems, often from having witnessed abuse. One study found that 28 percent of homeless people with previous psychiatric hospitalizations obtained some food from garbage cans and 8 percent used garbage cans as a primary food source.
More than 124,000 – or one-fifth – of the 610,000 homeless people across the USA suffer from a severe mental illness, according to the U.S. Department of Housing and Urban Development. They’re gripped by schizophrenia, bipolar disorder or severe depression — all manageable with the right medication and counseling but debilitating if left untreated. The number of mentally ill homeless surged in the 1970s and ’80s as the second half of the Baby Boom generation reached the age of onset for schizophrenia, which typically begins when a person reaches their 20s, and psychiatric hospitals and group homes struggled to keep up with demand.
In many cities such as New York, homeless people with severe mental illnesses are now an accepted part of the urban landscape and make up a significant percentage of the homeless who ride subways all night, sleep on sidewalks, or hang out in the parks. These ill individuals drift into the train and bus stations, and even the airports.
Many other homeless people hide from the eyes of most citizens. They shuffle quietly through the streets by day, talking to their voices only when they think nobody is looking, and they live in shelters or abandoned buildings at night. Some shelters become known as havens for these ill wanderers and take on the appearance of a hospital psychiatric ward. Others who are psychiatrically ill live in the woods on the outskirts of cities, under bridges, and even in the tunnels that carry subway trains beneath cities.
There is evidence that those who are homeless and suffering from a psychiatric illness have a markedly elevated death rate from a variety of causes. This is not surprising since the homeless in general have a three times higher risk of death than the general population and severely ill individuals have a 2.4 times higher risk of death during any year.
One approach to understanding mental illness and homelessness in this country is go back to the JFK-era.
In 1963, President John F. Kennedy delivered an historic speech on mental illness and retardation. He described sweeping new programs to replace “the shabby treatment of the many millions of the mentally disabled in custodial institutions” with treatment in community mental health centers. This movement, later referred to as “deinstitutionalization,” continues to impact mental health care. Though he never publicly acknowledged it, the program was a tribute to Kennedy’s sister Rosemary, who was born mildly retarded and developed a schizophrenia-like illness. Terrified she’d become pregnant, Joseph Kennedy arranged for his daughter to receive a lobotomy, which was a disaster and left her severely retarded.
While 6 percent of the general population is severely mentally ill, one-third of homeless people have untreated mental illnesses.
Between 2009 and 2012, states cut a total of $4.35 billion in public mental-health spending from their budgets. By cutting their budgets for mental health services, states are not saving themselves money. It costs less to treat people appropriately, including providing housing, than it does to pay for the emergency room services, shelters and prisons they wind up in instead.
Even if homeless individuals with mental illnesses are provided with housing, they are unlikely to achieve residential stability and remain off the streets unless they have access to continued treatment and services. Research has shown that supported housing is effective for people with mental illnesses. In addition to housing, supported housing programs offer services such as mental health treatment, physical health care, education and employment opportunities, peer support, and daily living and money management skills training. Successful supported housing programs include outreach and engagement workers, a variety of flexible treatment options to choose from, and services to help people reintegrate into their communities. Homeless people with mental illnesses are more likely to recover and achieve residential stability if they have access to supported housing programs.

Helping homeless people with mental health problems isn’t a question of finding and spending more money. We already are spending that money, to fund prisons, shelters, emergency rooms, and other safety-net institutions. The question is directing the money to the right place: supported housing programs, where people get both housing and help with their mental illness and with day-to-day life. All it takes is the political will at the state level. Sadly, political will is in very short supply these days.

Know Who’s Providing your Care in the Hospital

When you become a patient at a hospital you and your family enter a partnership with your healthcare team.

Chances are, you’ll be in what is known as a “Teaching Hospital”.                                      

The U.S. health care system relies on teaching hospitals for the clinical education of medical students and residents. They are generally affiliated with medical schools or universities, and may be owned by a university or may form part of a wider regional or national health system. Currently, there are only about 400 Teaching Hospitals out of a total of almost 6,000 hospitals in the U.S. Teaching hospitals are essential “classrooms” for physicians, nurses, and other health professionals and other health providers. The term, Teaching Hospital is used to describe hospitals that have missions beyond just patient care.

Teaching hospitals are providers of primary care and routine patient services, as well centers for experimental, innovative and technically sophisticated services. A teaching hospital is committed to teaching and training future physicians. Medical students are provided with the opportunity both to observe and directly participate in patient care under the direct supervision of residents and fellows at all times, as well as by attending physicians. Most teaching hospitals pursue three related enterprises:

  • Teaching: Training medical students and resident physicians
  • Research: Conducting both basic science and clinical investigation
  • Patient care: Delivering health care services through a network that may include one or more hospitals, satellite clinics, and physician office practices.

For many people, this concept of “teaching” is the notion that leads one to think, “They aren’t real doctors, they are practicing on me”.

A teaching hospital is a hospital which provides medical training to medical students and residents. Residents are physicians who have recently completed medical school and are in training.

After graduating from medical school, doctors must complete a training program. This is called a “residency.” During the first year of residency, a doctor is called an “intern.” After the first year, interns become “residents.” Both interns and residents are members of the hospital house staff. They are employed by the teaching hospital and are supervised by a hospital staff doctor.

Also called a hospital doctor or “staff” doctor, an attending physician is the doctor in charge of the patient’s care. The attending is a senior doctor in general medicine or in a medical or surgical area. An attending in a teaching hospital supervises interns and residents.

Your Primary Care Doctor (also, known as your PCP) is who you see at your regular office visit. He/She sees patients in the office setting and on “rounds”, the examinations of patients in the hospital. Many teaching hospitals have strong links with a nearby medical school.

Residency is a 3-year or more training program in a medical specialty. The first year of training after medical school is called internship, or more commonly it is called first year of residency. Much of what your doctor will learn in a chosen specialty will be learned in their residency.

After 12 years of school, 4 years of college and 4 years of medical school, there is still so much to learn. The first 20 years of school are the foundation and the tools your doctor will need to learn his/her specialty. During residency they will learn medicine by caring for patients with a variety of diseases. The more patients they care for, and the more disease and variations of disease that they see and treat, the more proficient they will become.

Here is a synopsis of different medical specialties and subspecialties and the length of their training programs (internship and residency) after medical school:

  • Anesthesiology – 4 years
  • Dermatology – 4 years
  • Emergency Medicine – 3-4 years
  • General Surgery – 5 years; Subspecialties of Surgery require an additional 1 to 4 years after the 5 year residency, they include: Vascular Surgery, Cardio-Thoracic Surgery, Pediatric Surgery, Colon and Rectal Surgery. Some surgical specialties require 1-2 years of General Surgery, then an additional 3-5 years of specialty training, they include: Neurosurgery, Orthopedic Surgery, Ophthalmology, Otolaryngology, Plastic Surgery, and Urology.
  • Internal Medicine – 3 years; subspecialties of Internal medicine require an additional 2-3 years after the 3 year residency, they include: Cardiology, Endocrinology, Gastroenterology, Geriatrics, Hematology, Oncology, Infectious Diseases, Nephrology, Pulmonary, Rheumatology
  • Neurology – 4 years
  • Obstetrics and Gynecology – 4 years
  • Pathology – 4 years
  • Pediatrics – 3 years; subspecialties of Pediatrics require and additional 2-3 years after the 3 year residency, they include: Pediatric Cardiology, Pediatric Endocrinology, Pediatric Gastroenterology, Pediatric Infectious Diseases, Pediatric Critical Care, Neonatology, Pediatric Nephrology, Pediatric Pulmonology, Pediatric Rheumatology
  • Psychiatry – 4 years
  • Radiology – 4-5 years; subspecialties of Radiology require and additional 1-2 years after residency, they include: Neuroradiology, Vascular and Interventional Radiology, Pediatric Radiology.

Most doctors are doctors of medicine (M.D.). They treat all kinds of diseases and injuries. Some doctors are doctors of osteopathic medicine (D.O.). They focus on muscles and bones. Both are able to do a residency at a teaching hospital.

Healthcare blogger Kris Hickman complied an excellent tool to understand some basics about the terms to describe the condition of a patient. “According to Medline Plus, “vital signs” include heart beat, breathing rate, temperature and blood pressure. “Normal” vital signs change with age, physical fitness, gender, weight and overall health, but for the average healthy adult at rest, “normal” means:

  • Blood pressure: 90/60 mm/Hg to 120/80 mm/Hg
  • Breathing: 12 – 18 breaths per minute
  • Pulse: 60 – 100 beats per minute
  • Temperature: 97.8 – 99.1 degrees Fahrenheit / average 98.6 degrees Fahrenheit

Those standards provide the basis of understanding what kind of condition a patient is in. In this brief on privacy regulations, the American HospitalAssociation (AHA) recommends that all providers use the following definitions when describing a patient’s condition:

Undetermined: The patient has not yet been assessed, diagnosed or treated.

Good: The patient’s vital signs are stable and within normal limits. He or she is conscious and comfortable, with excellent indicators for recovery.

Fair: The patient’s vital signs are stable and normal, and the patient is conscious, but he or she might be uncomfortable. Indicators for recovery are favorable.

Serious: The patient is very ill, and might have unstable vital signs outside the normal limits. Indicators are questionable.

Critical: The patient has unstable vitals that are not normal, and could be unconscious. Indicators for recovery are unfavorable.

Treated and released: The patient was treated but not admitted to the hospital.

Treated and transferred: The patient received treatment at one facility and was then transferred to another facility.”

Be prepared to be an active participant in your care during a hospital stay. Know who’s who in the hospital…

Ebola? You’re worrying about the wrong disease!

A deadly disease is set to hit the shores of the US, UK and much of the rest of the northern hemisphere in the coming months. It will swamp our hospitals, lay millions low and by this time next year between 250,000 and 500,000 worldwide will be dead, thousands of them in the US.

Despite the best efforts of the medical profession, there’s no reliable cure, and no available vaccine offers effective protection for longer than a few months at a time.

If you’ve been paying attention to recent, terrifying headlines, you may assume the illness is the Ebola virus. Instead, the above description refers to seasonal flu – not swine or bird flu, but just your regular garden variety influenza. Flu activity is increasing in the United States with most states reporting widespread influenza activity.

 

As we stare with horror at the ravages of Ebola, it is easy to overlook an old familiar foe: the flu. Ebola has claimed fewer than 4,000 lives globally to date, none in the United States. Flu claims between 250,000 and 500,000 lives every year, including over 20,000 in the United States – far more American lives than Ebola will ever claim.

Influenza viruses cause respiratory illness that can be mild or very severe. Common symptoms are fever/chills, muscle aches, cough, sore throat, headache and runny or stuffy nose. “Stomach flu” which is caused by bacteria, parasites and viruses, is often confused with influenza. Common stomach flu symptoms, nausea, vomiting, diarrhea are not the primary symptoms seen in influenza.

Influenza virus types A and B are making their ways to the United States from Asia. Flu season officially began this month and will go through May. In its wake it will leave millions sick and from 10,000 to 40,000 dead, 90% of whom will be 65 or older.

Influenza is transmitted by air. Airborne diseases are much easier to contract than fluid-borne illnesses such as Ebola. Heavy breathing, coughing or sneezing is all that is needed to spread influenza virus and infect others (or become infected.)

Ebola symptoms that mirror flu include fever, muscle aches, nausea and general weakness. But most flu sufferers also have cough, runny nose, scratchy throat, very congested, which can help differentiate the two illnesses early on.

The current Ebola 2014 virus is mutating at a similar rate to seasonal flu (Influenza A).  This means the current Ebola outbreak has a very high underlying rate of viral mutation.  The bottom line is that the Ebola virus is changing rapidly, and in the intermediate to long term (3 months to 24 months), Ebola has the potential to evolve. Science cannot predict exactly what the Ebola virus will look like in 24 months. It could evolve into the flu virus.

Since Ebola’s first symptoms resemble that of the flu, fears about Ebola could drive an influx of patients to doctors and emergency rooms with flu symptoms, who might otherwise have stayed home.

You know from whom we have more to fear than some person returning from Liberia?

The person who doesn’t wash his or her hands before handling the serving ladles at the  buffet establishment!

You want to protect yourself? Cover up your mouth.  

In their song “Express Yourself,” the Staple Singers said, “You keep talking ’bout the president won’t stop air pollution: put your hand on your mouth when you cough – that’ll help the solution”?

Same thing goes in this instance. If you want to increase your chances of staving off or not spreading illnesses, put your hands on your mouth when you cough, wash your hands frequently.

You know from whom we have more to fear than some person returning from Liberia?

The person who doesn’t wash his or her hands before handling the serving ladles at the Golden Corral and other fine-dining buffet establishments

Ebola is serious, absolutely. But for most Americans, the things most likely to threaten us are right in front of us. So look both ways before you cross the street. Take your blood pressure pills. Eat an apple instead of potato chips.