Last spring everything changed for Denver resident Matt Larson.

“One day I was fine,” says Larson. “The next I was being rushed by ambulance to Denver Health following two very massive and violent seizures.”

The force of the seizures, from the sheer shaking, fractured and dislocated his shoulders and snapped two bones in his back. Soon his providers had life-altering test results.

“They came back and shut the door and said ‘you have mass on your brain,’ which was tough to hear,” says Larson.

The diagnosis, a malignant brain tumor called an anaplastic oligodendroglioma, rocked his world. Larson, 36, and his girlfriend, Kelly, decided to get married. He says a couple of days later, surgeons cracked open his skull and scooped out part of his brain. Since then he’s endured the tough road of radiation and chemo, with a sobering outlook.

“I have a 50/50 probability that I’m going to live,” says Larson. “I hope to beat the odds. I desperately want to live.”

But Larson has decided that if the brain cancer returns and is incurable, he’d like the option to end his life rather than face the possibility of an agonizing and painful death.

“It would just bring me a ton of peace and comfort now to know that I have this option,” Larson says.

He’s become an advocate for Colorado’s Proposition 106. It would give mentally competent adults the ability to end their lives with a doctor-prescribed drug, generally a sleeping medication called secobarbital.

“We need to help people diminish and assuage their suffering any way we can,” says Dr. David Grube, a family doctor in Oregon, one of five states to allow the practice.

Grube, who retired after practicing for 38 years, is also national medical director for the group Compassion & Choices. He became a proponent of what he calls “death with dignity” shortly before the law passed in Oregon in 1994. He was moved to the position after one of his patients, who was dying from bladder cancer, shot himself to death.

“If I can ever prevent such a violent and tragic end to a person’s life, I should be open to helping people,” Grube says.

Five states — Washington, Oregon, California and Vermont — currently allow the practice. Montana has effectively legalized it, due to a court ruling that protects doctors who help dying patients from prosecution.

Colorado’s proposal is modeled after Oregon’s law. In both, two doctors must determine a patient is mentally capable of making the choice and isn’t under undue influence or coercion. Grube says he has helped about 30 people end their lives, with about a third of those who requested medications deciding not to take them.

“Many more people just want to talk about it, just want to know if it’s a possible option,” says Grube. “Still, in all, it’s quite uncommon.”

According to the Oregon Public Health Division, during 2015, 218 people received prescriptions for lethal medications under the provisions of the state’s Death With Dignity Act. That was up from 155 the prior year. The division has received reports of 132 people who died in 2015 from taking the medications prescribed under the act, a rate of 38.6 per 10,000 patients.

More than 90 percent of those patients died at home and were enrolled in hospice care. Since the Oregon law was passed, 1,545 people have received legal prescriptions; 991 patients died ingesting the medications.

When patients were asked why they decided to consider ending their lives, the most common concerns were that they were less able to engage in activities that make life enjoyable, and that they were losing both autonomy and dignity. Further down the list was inadequate pain control and the financial impact of the treatment.

Doctors As Healers

But Denver physician Alan Rastrelli opposes the proposal. He worries it will erode the public’s trust in doctors as healers.

“Physicians will go towards this philosophy of assisting a patient in their death,” he says. “That will destroy, I think, the patient and physician relationship.”

Rastrelli, who practiced anesthesiology for 28 years, transitioned into hospice and palliative medicine 15 years ago. He says when doctors help patients end their lives it creates a societal and bioethical calamity.

Rastrelli worries about what the initiative doesn’t do, such as require a physician to be present when the person dies. He also said it’s difficult to know about common problems or mistakes are because reporting requirements in Oregon, and in Colorado’s proposal, are weak.

He advocates helping dying patients to use pain relievers and receive spiritual and psychological support to ease suffering.

“Woody Allen said, ‘I’m not afraid of dying, I just don’t want to be there when it happens,’ ” Rastrelli says. “We can help people be okay all the way through to the end.”

That makes a lot of sense to advocates with Not Dead Yet, a national group run by people with disabilities that opposes the proposal.

Anita Cameron, one of the groups board members, says doctors “are humans and they make mistakes.”

Cameron’s mother, Alice, was diagnosed with end-stage chronic lung disease seven years ago. She was given less than six months to live. Today, Cameron’s mother is still alive.

“Had the law been in place, I’m pretty sure those doctors would have convinced my mom to take the pills,” Cameron said. “And she’d be dead.”

Cameron has several disabilities, including multiple sclerosis. She worries the ballot proposal will encourage people with disabilities to kill themselves. She also thinks that in some cases insurers will agree to pay for end-of-life medications, but not for measures to keep someone alive.

“When is it going to be a duty to die?” asks Cameron. “That’s what euthanasia is and when is it going to stop being a choice?”

Battle Draws Big Bucks

The ballot initiative is drawing passion — and plenty of money.

According to the latest filings with the Colorado Secretary of State’s office, backers have raised about $5.3 million, mostly from Compassion & Choices Action Network.

The “No Assisted Suicide Colorado” campaign has raised $1.8 million. That money is primarily coming from the Roman Catholic Archdiocese of Denver, which has donated $1.1 million, as well as other archdioceses around the country.

Both groups have also received numerous smaller donations.

The board of the Colorado Medical Society, the state’s largest physician group, voted to take a neutral position on the measure. President-elect Dr. Katie Lozano calls the proposal “the most personal of decisions that must be left to our patients” to decide.

A February poll of 618 Colorado physicians before the ballot measure was proposed found support within the group for physician-assisted death in general. Fifty-six percent of medical society members favored it; 35 percent opposed.

Among those who frequently treat patients in later stages of a terminal illness, the gap was smaller, with 50 percent backing physician-assisted death and 41 percent opposing it.

The medical society said there was a consensus that if the law were to pass, the medical society should focus on protecting patients and doctors, and increase awareness of end-of-life choices, emphasizing the importance of palliative and hospice care.

Election ballots will start being mailed next week.

This story is part of a reporting partnership with NPR, Colorado Public Radio and Kaiser Health News.

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Three doctors who have led a task force that evaluates preventive medical services say the group’s recommendations shouldn’t be tied by law to insurance coverage.

The former chairmen of the U.S. Preventive Services Task Force say the link between medical recommendations and insurance coverage leads to financial incentives that can corrupt the process and distort people’s health care decisions.

Under the Affordable Care Act, any preventive service that receives one of the USPSTF’s top two ratings must be covered by insurance without any out-of-pocket cost for the patient. The doctors advice to decouple the task force ratings from insurance coverage would require a change in the health law.

The authors of the commentary, which appears Monday in the Annals of Internal Medicine, point to heavy lobbying by the pharmaceutical company Mylan N.V. to get its anti-allergy device EpiPen deemed a preventive service. They say such lobbying can interfere with the task force’s mission to evaluate medical services to improve the health of the overall population.

“When people try to twist that mission for their own purposes, essentially what they’re doing is violating the integrity of the task force process, and it’s distracting from the mission,” says Dr. Virginia Moyer, the lead author of the commentary. Moyer, a former chairman of the task force, is now a vice president of the American Board of Pediatrics.

The USPSTF is an independent group of volunteer physicians who review the research on preventive medical services, such as vaccines and screenings tests, and recommend who should get them and how often.

Mylan has been lobbying the task force to have the EpiPen listed as a preventive device, even though it is used by people with diagnosed allergies. The EpiPen is an automatic injector that delivers a dose of epinephrine to stop dangerous allergic reactions. A two-pack costs more than $633, according to GoodRx.

The company has been under fire in recent months because it has raised the price of the device more than fivefold since 2007, even though the product has been on the market for decades. Mylan CEO Heather Bresch has blamed the uproar on trends in insurance coverage that leave patients responsible for a larger share of their medical costs.

If EpiPens were covered as preventive medications, patients could get them at no cost. The price increases Mylan has put in place would be invisible to consumers but would have to be borne by insurers.

“What Mylan has done, or what they’re attempting to do with this effort, is use a provision in law, which is intended to give people access to preventive services, and use it to their advantage for something that just plain is not a preventive service,” Moyer says.

That effort by Mylan, which was detailed in a story by The New York Times, spurred Moyer and her two colleagues, Dr. Michael LeFevre and Dr. Ned Calonge, who were also task force leaders, to write the opinion piece that questions the overall idea that insurance coverage should be tied by statute to the recommendations of the volunteer medical group.

The authors say the issues with the link go beyond the problem of lobbying. By putting prevention ahead of treatment of illness by making it free of cost, the system created by the ACA may be making treatment of illness more expensive and putting it out of reach of some patients.

“If such financial access comes at the cost of increased deductibles or copays for equally important services that are not preventive, then we must question whether the link inadvertently discourages other important care,” they write.

“Perhaps it is time for the USPSTF to inform, but not determine, coverage,” they conclude.

A recent survey by the Kaiser Family Foundation shows that more than half of people with insurance through their employer have policies with deductibles of more than $1,000.

Many advocates and economists agree that preventive services can cost more but also can improve the quality of health care. When the Affordable Care Act was being debated, advocates on both sides argued whether or not preventive services would save money in the long run.

“Preventive health services have become quite expensive over time,” says Joe Antos, a resident scholar at the American Enterprise Institute.

He says some preventive services such as vaccines are inexpensive and undoubtedly valuable. Others, such as mammograms, are also medically important but don’t necessarily save money.

When those services are provided free, the costs are spread across all policy holders through premiums and deductibles.

But Antos cautions against blaming rising deductibles and premiums only on preventive care.

“To what extent have preventive services been responsible for the big increase in deductibles and co-payments over the last decade or so?” he asks. “I would argue that they’ve contributed. But we’re really talking about rising health care costs, not just preventive services.”

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When the birth control pill debuted more than 50 years ago, women wanted to know: Is it safe? There wasn’t much evidence to answer that question, but women embraced the Pill as a revolutionary improvement in contraception.

Today, millions of women around the world use hormonal contraceptives that have expanded beyond the Pill to patches, implants, injections and uterine devices. Decades of research support their safety, and serious but very rare side effects such as blood clots are finally much better understood. But other areas of research lag, and we still don’t know as much as we’d like about how these medications affect women’s mental health.

So when a study came out linking hormonal birth control and depression, the headlines went wild. The stories made for good clicks, but not so great science reporting. Insufficient skepticism about a single study makes it easy to imply birth control definitely causes depression when the study shows nothing of the sort.

The study, which was conducted in Denmark and published in JAMA Psychiatry, analyzed 14 years’ worth of health data for more than 1 million women from national healthcare systems and databases not available in most other countries. It also measured depression two ways: diagnosis at a psychiatric hospital, which would be quite severe depression, or filling a prescription for antidepressants. Across the whole study, 2 percent of all women ages 15 to 34, were diagnosed with depression at a hospital and 13 percent began taking antidepressants.

Several news stories reported an 80 percent increase in risk of depression in some groups of women, but few noted that was relative risk, which is an expression of proportional increase. An 80 percent relative risk does not mean that 80 percent of women taking hormonal birth control develop depression. It means that if 10 women not taking hormonal birth control develop depression, then 18 women on the birth control will develop depression.

In this study, that 80 percent increase in relative risk referred specifically to the likelihood that those ages 15 to 19 taking combined oral contraceptives — the pill containing both progestin and estrogen — would begin taking antidepressants after going on birth control.

However, looking at absolute risks conveys a less dire interpretation. Among women not taking hormonal birth control, 1.7 percent took antidepressants and 0.28 percent received a depression diagnosis at a psychiatric hospital. By comparison, 2.2 percent of women who started birth control began taking antidepressants afterward, and 0.3 percent were diagnosed with depression at a hospital. Basically, about 0.5 percent of women who began hormonal contraception developed depression who might not have otherwise.

“Therefore for an individual woman, even one using a method of hormonal contraception, the overall probability of experiencing one of these outcomes in this study was still fairly low, particularly for diagnosis of depression,” explains Chelsea Polis, a senior research scientist at the Guttmacher Institute.

Rates of those filling antidepressant prescriptions were higher for other forms of hormonal birth control: 4.1 percent for the patch and 3.2 percent for the vaginal ring in the first year, for example. Psychiatric depression diagnoses occurred in 0.7 percent of patch users and 0.6 percent of vaginal ring users.

Even in terms of relative risk, though, many of the risk increases were modest: Among all women taking the combined pill, the increased risk was 10 percent for depression diagnosis and 20 percent for using antidepressants after statistically adjusting for women’s age, educational level, weight and history of endometriosis or polycystic ovary syndrome, all factors that could influence depression risk.

Other increased risks ranged from 20 to 70 percent for all women, depending on contraception type. The largest increases — up to triple the likelihood of starting antidepressants — occurred among teens using the ring or patch.

Another thing to consider is that these numbers represent correlations — two things occurring at the same time that may or may not be linked.

“Depression is common. Contraception use is common. So both of those things are commonly going to occur together,” explains Jeffrey Jensen, a professor of reproductive & developmental sciences and director of the Women’s Health Research Unit at Oregon Health & Science University in Portland.

The study used several methods to reduce the possibility that other things could be causing depression. Jensen pointed out that women who are more likely to take hormones for contraception would probably also be more likely to take antidepressants for depression, but the authors did a separate analysis to compare women to themselves before and after beginning contraception and still found a depression risk.

None of this means that birth control does not cause depression, but it doesn’t mean it does, either. Since a half percent of millions of women taking birth control adds up, it’s important to know whether such a large number of women could be more susceptible to depression, which can be a very serious illness, after starting hormonal contraception.

But it’s complicated, and subtle.

For example, the study also found that depression risk peaked six months after women began using contraceptives, but then decreased to the point that women using hormonal contraception for four years actually had lower rates of depression than those not taking it. Though this likely resulted from many women with depression stopping their birth control, those findings match up with a previous large study finding a protective effect against depression with hormonal contraception. But the studies were done differently: The earlier study included only sexually active women, unlike the new study.

“Unfortunately, the analysis did not provide information on the frequency of depression diagnoses or antidepressant use among women using nonhormonal methods of contraception, such as copper IUDs,” says Polis. “Such a comparison would help to clarify whether the associations were related to other factors common to women choosing to use contraception, rather than being specifically related to the hormonal content of certain contraceptive methods.”

For example, those who become sexually active in adolescence have a higher risk for depression and anxiety, as previous research has shown. Even among women in their 20s and 30s, the decision to begin hormonal contraception may accompany various other circumstances in their lives that could potentially increase the risk of depression or anxiety — not a stretch when the study identifies just a half percent of women with the increased risk.

But the possibility that sexual initiation might come with mental health risks baffled study co-author Lidegaard. “Sexual relationships are a good experience for the majority of women, so I cannot see why women would get depressed by starting sexual relationships,” Lidegaard said in an interview. He pointed out that women not in relationships may experience loneliness, a risk factor for depression, but when asked about single women having sex, he said he believes “the majority feel more happy by realizing how wonderful sexual experiences can be. Why should women get depressed from that?”

What this study does do is suggest that women may respond differently to hormones and medical treatments.

“Doctors should perhaps be more careful when they prescribe hormonal contraception to young women and get a history of previous depression first,” Lidegaard says.

There’s no question that women are going to respond differently to hormonal contraception. But those differences are not well understood.

“We’re all very, very different, and we’re moving in the direction of precision medicine,” adds Catherine Monk, an associate professor of psychiatry and director of research at the Women’s Program at Columbia University Medical Center. “There are some women who are just much more sensitive to these hormone changes.”

The higher risk of depression found among teenage girls, both Monk and Lidegaard pointed out, might be biological, since teens may be more sensitive to the hormonal changes happening during puberty.

“You need to know yourself and be really informed,” Monk says. “If I were of an age and reading this article right now, I would want to be thinking, ‘Who am I? Am I sometimes who has moodiness around my periods?’ ” She notes the importance of each woman considering these findings in conjunction with what she knows about her own body and her own circumstances.

Philosophical differences about medicine may also influence how people interpret these findings in the absence of studies showing causation. Jensen, for example, pointed out that women in developed countries no longer see other women dying during childbirth, illegal, unsafe abortions or other devastating health effects of unplanned pregnancy, and have come to places less value the effectiveness of hormonal birth control.

“Women are more skeptical of using hormonal therapy than ever before,” Jensen says. “It’s a tragedy of the riches. If you really want to be depressed, have an unintended pregnancy.”

Toward the other end of the spectrum, Monk believes we may have gone too far in using hormones to control contraception. “Getting away from barrier methods of contraception is getting away from our bodies,” she says, and she would like to see a much larger range of options for contraception for men and women.

The fact that dissent rages over this issue points out a larger question about women’s health research.

“Understanding women’s health has been neglected, and there’s not enough research into understanding our hormones,” Monk says. “This is partially a story about women’s health research and how we need more of it.”

Tara Haelle is the co-author of The Informed Parent: A Science-Based Resource for Your Child’s First Four Years. She’s on Twitter: @tarahaelle

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Drugmaker Mylan N.V. announced Friday that it had reached a $465 million settlement with the U.S. Justice Department and other government agencies to resolve questions over rebates required by the Medicaid program.

The deal settles allegations by the Centers for Medicare and Medicaid Services that Mylan had misclassified the EpiPen as a generic drug and had not paid the appropriate rebates that are required by law.

Andrew Slavitt, the acting head of CMS, detailed the allegations in a letter to Sen. Ron Wyden, D-Ore., this week.

Slavitt told Wyden that Mylan had misclassified EpiPen as a “non-innovator” or generic drug, when it should have been classified as a brand-name product. Slavitt said the agency had informed Mylan multiple times of the misclassification.

Drugs companies pay rebates to the Medicaid program of 23.1 percent for brand-name drugs and 13 percent for generics. Mylan paid only the 13 percent for $1 billion worth of EpiPens that Medicaid bought between 2011 and 2015. That cost state and federal taxpayers $163 million, he said.

Mylan was facing potentially large penalties. Companies are required to report a drug or device’s correct classification and can be fined up to $100,000 per violation under the terms of the Medicaid Drug Rebate Program.

Mylan has come under increasing scrutiny by lawmakers on Capitol Hill, federal agencies and state attorneys general after the company raised the price for the EpiPen more than 500 percent since 2008. The device is an auto-injector used to reverse serious allergic reactions.

Mylan said the settlement “did not provide for any finding of wrongdoing.”

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Out of 193 countries in the United Nations, only a small handful do not have a national paid parental leave law: New Guinea, Suriname, a few South Pacific island nations and the United States.

In the U.S., that means a lot moms and dads go back to work much sooner after the birth of a baby than they would like because they can’t afford unpaid time off.

Jody Heymann, founding director of the World Policy Analysis Center at UCLA, says the global landscape for paid parental leave looks bright, but the U.S. is far behind.

“The U.S. is absolutely the only high-income country that doesn’t, and as you can tell by the numbers, overwhelmingly the world provides it,” she says. “The world not only provides paid maternity leave, but they provide adequate paid paternity leave.”

Countries first began thinking about paid parental leave during the Industrial Revolution, Heymann says.

“In the 1800s — as soon as women started moving from working at home to working in factories — countries realized they needed to do something to ensure that women could work and care,” she says. “So they started to provide across Europe and across Latin America and elsewhere paid maternity leave — leave that would care for families, for kids and ensure that economies could succeed.”

Later on, representatives from around the world met through the United Nations and agreed to strive for a minimum of 14 weeks of leave, paid at two-thirds of a worker’s salary up to a cap. This was decades ago, and today, most countries meet or exceed that minimum. Heymann says at least 50 countries now provide six months or more of paid maternity leave.

The driving motivation behind setting a global standard for paid parental leave comes down to common sense and economic benefits, Heymann says.

“In most countries, families rely on income from both the mom and dad,” she says. “Families can’t afford to have a lengthy period without income for one of them. At the same time, newborns absolutely need parental care. So this being a fundamental piece of social insurance or what governments do as part of their social security really is common sense.

“The second piece that drives countries is I’ve spoken to finance ministers from around the world who say one of their greatest sources of success economically is getting women into the workforce in equal numbers,” Heymann continues.

Brigitte Beltre, a mother from France, explains a common way that countries pay for this leave.

“You have to know it’s not for free,” she says. “In France, you have to work a certain amount of time to have paid maternity leave. You have to give to the system. It’s like a savings account.”

Governments rely on a social insurance structure, where small contributions create a pool of money that workers can draw from when they need to take leave.

“Those contributions to the government may come from employers, employees and the government’s general revenue, but they pay it through a social insurance system, so that no business has a heavy burden — if they’re a small employer and one person’s out, or if they’re a larger employer, but disproportionately have young parents as employees,” Heymann says. “That’s how they spread the responsibility evenly.”

Canada has a similar set-up to France. Tatiana Mellema in Vancouver says being able to dip into that fund gave her enough time off to bounce back from the major medical event of giving birth.

“Physically the recovery of having a child is huge,” Mellema says. “It took, for me, months.”

She says it also gave her time to care for her new son at his most vulnerable stage.

“The financial support was essential to getting us through that year and giving me that time with him,” Mellema says. “Had I not have had it, I probably would have had to go back to work fairly quickly after I had him, which I can’t even imagine doing, because my experience is just having that year with him was so important.”

Heymann says paid parental leave policies have a significant impact on infant and maternal health.

“So there are powerful, long-term studies showing that providing paid maternity leave, for example, lowers infant mortality,” she says. “Beyond this, we know that women who have sufficient paid maternity leave are much more likely to breastfeed, and breastfeeding lowers the risk of all sorts of infectious diseases, it increases and improves cognitive outcomes, and it benefits the woman’s health.”

In Sweden, the government provides almost 16 months of paid leave to be used between two parents.

Per Einarsson, a video game developer who lives in Stockholm, Sweden, says he and his partner, Kristina, split that paid time off evenly when each of their two kids were born. He says that time helped him to be a more engaged dad.

“It was nice to be educated, if you may, to learn how to take care of my children and to bond with them, and then of course it was nice to give Kristina the possibility to get back to her job and focus on her career as well,” he says.

Einarsson says that time set a tone in their home — one that’s felt years later. Their kids are now three and five years old.

“I think in their eyes we were always very equal to them and still are,” he says. “And I think that felt good to us and hopefully to our children as well.”

But Sweden is not the norm. Most countries don’t offer equal leave to men and women. Policies around the world tend to be more centered on moms than dads. But Heymann says the most competitive countries that do provide it show that paid paternity leave is economically possible.

“Overwhelmingly, the most competitive countries in the world — the ones with the strongest economies and the lowest unemployment — do provide paid leave for dads, showing this is feasible,” she says.

And when women do get or take more paid leave than men, there can be an unintended downside: It makes it harder for women of child-bearing age to get hired or promoted.

In China, many mothers experience workplace discrimination after taking maternity leave despite laws that prohibit it.

“Although the labor law forbids the employer to fire female employees in one year after giving birth, the bosses can find ways to let the employee feel uncomfortable,” says Meng Meng, a mother who lives in China.

Lama Dossary of Saudia Arabia says taking paid leave changed how she was treated at work. There, mothers receive 10 weeks of paid time off, and fathers get three days.

“When I went back I did feel like it did affect how I was looked at, how I was treated,” Dossary says. “My promotions got stopped for a while. I wasn’t given the same amount of work, I wasn’t given the same amount of responsibility.

“I don’t know how it would affect things, but I do think that maybe if other people were able to take such leave off — whether to take care of their older parents or a father maybe has to take some time off because he has a child that needs special care for a while — I think that would at least change the perception,” she says.

According to Heymann, the U.S. is an outlier in a few ways when it comes to global parental leave polices.

On one hand, the U.S. is the only developed country without a national paid parental leave policy.

“We urgently need to catch up in the United States,” Heymann says. “For a high-income country, we have some of the worst outcomes for our infants. We have some of the highest rates of infant mortality. We have huge health inequalities.”

But despite this, Heymann says the U.S. stands out in one pretty positive way.

The U.S. Family and Medical Leave Act guarantees 12 weeks of job-protected time off equally to many American moms and dads. People caring for a sick parent or even themselves during a long illness also qualify.

Heymann points to this law as a good starting point because it treats mothers and fathers equally. But this is unpaid leave, and it doesn’t apply to about half of the American work force.

“The problem is the fact that it’s unpaid means it’s unaffordable to many Americans,” Heymann says. “And all of the caveats that come with the Family [and] Medical Leave Act that have to do with how many hours you’ve worked, how big your employer is, etc., means that millions of Americans aren’t covered. So we need to take that basis, make it paid and ensure that all Americans are covered.”

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Note: This episode originally aired in February 2014.

People in La Crosse, Wisconsin are used to talking about death. In fact, 96 percent of people who die in this small, Midwestern city have specific directions laid out for when they pass. That number is astounding. Nationwide, it’s more like 50 percent. La Crosse is such an exception thanks to one guy who decided that people in this town needed to make plans for their death.

In today’s episode, we’ll take you to a place where dying has become acceptable dinner conversation for teenagers and senior citizens alike. It’s a place that also happens to have the lowest Medicare spending of any region in the country.

Music: “See the Future” and “Mabel and Me.” Find us: Twitter/ Facebook.

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A federal health list specifically guarantees some women’s health coverage available without a copay or deductible, so what about men’s health? And what options are available for coverage for people who travel frequently? Here are the answers to some recent questions from readers.

Why aren’t there preventive health recommendations for men like there are for women under the health law? Women and breast cancer get so much attention by the health care community. Heart health, diabetes, prostate cancer and colon cancer are a few examples of opportunities for education and preventive screening for men.

There are many recommendations for men’s preventive care in the health law, although most of the examples you mention apply to women as well. Under the law, services recommended by the U.S. Preventive Services Task Force have to be provided without charging people anything out of pocket. The independent panel of medical experts currently recommends that women and men be screened for high blood pressure, elevated cholesterol and blood sugar levels, and for colorectal cancer.

It advises against routinely screening men for prostate cancer, however, noting that research hasn’t shown it reduces death from the disease. (Medicare covers an annual prostate cancer test, but you may owe a copayment.)

The drafters of the health law paid special attention to women’s preventive health needs, creating additional recommendations tailored specifically for them. This was done in part to address recognized gaps in women’s services, especially in the areas of sexual and reproductive health, said Adam Sonfield, senior policy manager at the Guttmacher Institute, a reproductive health research and policy organization.

The federal government is in the process of updating the women’s preventive health guidelines. If it adopts the working group recommendations this fall, insurers will begin to cover condoms and vasectomies for men without charge. Adding this no-cost benefit would address an inequity in current coverage rules and help both women and men avoid unwanted pregnancies.

I am 74 years old and on Medicare. My mother died of ovarian cancer and two maternal aunts and my paternal grandmother had breast cancer. Does Medicare cover BRCA testing?

Medicare generally only covers genetic testing for the two BRCA mutations that are associated with an increased risk of breast and ovarian cancer if you’ve already been diagnosed with cancer and have a family history that indicates testing is appropriate.

Throughout its history, the Medicare program, which provides health benefits for older and disabled Americans, has focused on treating injury and illness, not preventing them. Although the program now covers some cancer screening tests such as mammograms and colonoscopies, those changes were specifically authorized by Congress.

It’s a wrongheaded approach, said Dr. J. Leonard Lichtenfeld, deputy chief medical officer at the American Cancer Society. “I’m incensed that this is not covered.”

The BRCA test results could be important not only to the woman but also to her siblings and children, Lichtenfeld said.

The U.S. Preventive Services Task Force recommends that women who have a family history of breast or ovarian cancers be screened to determine if they’re at higher risk for potentially harmful genetic mutations and, if appropriate, referred for genetic counseling and BRCA testing. Under the health law, private insurers are required to cover such testing without charging women for it. But that provision does not apply to Medicare.

There are non-insurance options for testing, Lichtenfeld noted. Color Genomics, for example, offers a genetic test that analyzes 30 genes associated with hereditary cancers, including BRCA1 and BRCA2, for $249.

Are there any options available for people with marketplace plans who travel regularly? Emergency costs for an accident should be covered, but what about follow-up care after an accident or an illness while traveling? How does this work with increasingly narrow provider networks?

The situation you describe can be tough to manage. Under the health law, an insurer can’t require you to pay more for care in an emergency department that’s not in your provider network than it would have mandated for emergency care in network.

But once you leave the emergency department, you may get hit with out-of-network charges if you’re admitted to the hospital, for example, or need other follow-up care and are far from home.

You have a few options. Individual Blue Cross Blue Shield plans that are sold on many marketplaces may offer access to BCBS providers nationwide and overseas.

Be sure to check with individual Blues plans before signing up if that type of coverage is important to you, said Paul Rooney, vice president of carrier relations at eHealth.com, an online insurance broker.

“Some of the local Blues are pulling [that coverage] from their offerings,” he said.

You might consider buying an accident policy. These plans typically pay a fixed dollar amount to offset your costs if you’re injured in an accident. But they can be tricky, said Nate Purpura, vice president of consumer affairs at eHealth.com. The policies don’t cover preexisting medical conditions, and the insurer might deny a claim that it considers related to an earlier medical problem, he said.

Kaiser Health News is an editorially independent news service that is part of the nonpartisan Henry J. Kaiser Family Foundation. Michelle Andrews is on Twitter: @mandrews110.

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Sitting beside a neatly made crib, 88-year-old Vivian Guzofsky holds up a baby doll dressed in puppy dog pajamas.

“Hello gorgeous,” she says, laughing. “You’re so cute.”

Guzofsky, who has Alzheimer’s disease, lives on a secure memory floor at a home for seniors in Beverly Hills, Calif. She visits the dolls in the home’s pretend nursery nearly every day. Sometimes Guzofsky changes their clothes or lays them down for a nap. One morning in August, she sings to them: “You are my sunshine, my only sunshine. You make me happy when skies are gray.”

No one knows whether she believes she is holding a doll or a real baby. What the staff at Sunrise Senior Living do know is that Guzofsky, who can get agitated and aggressive, is always calm when caring for the dolls.

Doll therapy is catching on at nursing homes and other senior facilities across the country. It’s used to help ease anxiety among residents with dementia, who can experience personality changes, agitation and aggression. But the therapy is controversial.

Supporters say the dolls can lessen distress, improve communication and reduce the need for psychotropic medication. Critics say the dolls are demeaning and infantilize seniors.

Typically, caregivers will give residents the option of holding, changing or dressing the dolls, without saying whether the dolls are babies or toys. Caregivers may also use the dolls to start conversations about the residents’ own children or grandchildren.

Care providers who use the technique say the dolls help engage elderly people who are no longer able to participate in many activities.

“A lot of people with Alzheimer’s are bored and may become depressed or agitated or unhappy because they aren’t engaged,” says Ruth Drew, director of family & information services at the Alzheimer’s Association.

Caregivers aren’t trying to make their charges believe the dolls are real infants, Drew says. They are just “trying to meet them where they are and communicate with them in a way that makes sense to them,” she says.

But some care providers do not like the technique.

“They are adults and we want to treat them like adults,” says Stephanie Zeverino, who works in community relations at a Belmont Village center in Los Angeles. “These are very well-educated residents.”

Staff members there work with residents to play brain games that promote critical thinking, she says. And they use other types of therapy including art and music.

“We want to provide a sense of dignity,” Zeverino says.

Studies on doll therapy are limited, but some research has shown it can reduce the need for medications and lessen agitation, aggression and wandering.

“Having the doll … offers them an anchor or a sense of attachment in a time of uncertainty,” says Gary Mitchell, a nurse specialist at Four Seasons Health Care facilities in Northern Ireland, and author of a new book: Doll Therapy in Dementia Care: Evidence and Practice.

“A lot of people associate the doll with their younger days and having people to care for,” Mitchell says.

However, he acknowledges that doll therapy can perpetuate the stigma associated with dementia that care givers are trying to get away from.

Some families worry about their relatives being laughed at when they engage in doll therapy, Mitchell says. He had the same concerns when he worked at a senior residential center. But when one resident requested that he allow her to continue caring for a doll, he saw the positive impact of the therapy. Mitchell says doll therapy should be used cautiously and more studies are needed.

At Sunrise Beverly Hills, the nursery is set up like a baby’s room. A stuffed bear rests inside the wooden crib. On a shelf above are framed photos of Guzofsky and a few other women who regularly interact with the dolls. A few bottles, a Dr. Seuss book and diapers sit on a nearby changing table.

The nursery is just one of several areas designed to engage residents, says Rita Altman, senior vice president of memory care for Sunrise, which has facilities in the U.S., Canada and the United Kingdom. There are also art centers, offices, gardens and kitchens where residents may find familiar objects from their past.

Altman says the nurseries tend to attract residents who have an instinct to care for babies. Some people may not be able to talk anymore, but still find a sense of security with a doll, she says. “You can read it in their body language when they pick up the doll.”

Sunrise caregivers also use the dolls to spark conversations by asking questions: How many children do you have? Was your first baby a boy or a girl? What are the best things about being a mom?

The executive director of the Beverly Hills facility, Jason Malone, says he was skeptical about the use of dolls when he first heard about them.

“I almost felt like we were being deceitful,” he says. “It didn’t feel like it was real.”

But he quickly changed his mind when he realized that staff could use the dolls respectfully.

“We don’t want to confuse treating our seniors as children,” Malone says. “That’s not what this activity is truly about.”

Guzofsky began caring for the dolls soon after moving into the facility. When asked what she likes about them, she says, “I love babies. I have some very nice ones back where I live now.”

Guzofsky’s daughter, Carol Mizel, says her mom raised three children and volunteered extensively in Colorado and Mexico before being diagnosed with Alzheimer’s about five years ago. Mizel doesn’t see any downside to her mother caring for the dolls.

It is a “creative way of dealing with her where she is now,” she says.

For some residents, including 87-year-old Marilou Roos, holding the dolls is one of the only times they interact with the staff. Roos uses a wheelchair and rarely speaks. She sleeps much of the day.

“There is not much [Marilou] can participate in,” says Vladimir Kaplun, former coordinator of the secure memory floor. “When she spends some time with the babies, she wakes up and she brightens up.”

On a recent day, caregiver Jessica Butler sits next to Roos, who holds a doll against her chest and pats her on the back. She kisses the doll twice.

“The baby’s beautiful like you,” Butler says.

“It’s a boy,” Roos says. “Five months.”

Caring for the dolls is second nature to Roos, who made a career of being a mom to five children, according to her daughter, Ellen Swarts.

It’s been difficult for Swarts to watch the decline of her mother, who hasn’t called her by name in over a year. Watching her with the dolls helps, Swarts says.

“To see the light in her eyes when she has a baby in her arms, I don’t care if it’s real or if it’s pretending,” she said. “If that gives her comfort, I am a-OK with it.”

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.

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People might be forgiven for thinking that the Affordable Care Act is the federal government’s boldest intrusion into the private business of health care.

But few know about a 70-year-old law that is responsible for the construction of much of our health system’s infrastructure. The law’s latest anniversary came and went without much notice in August.

The Hill-Burton Act was signed into law by President Harry S. Truman on August 13, 1946 — and its effect on health care in the U.S. was nothing short of monumental. Perhaps more importantly, it stands as an example, warts and all, of how a bipartisan Congress can forge compromises to bolster American infrastructure and boost the well-being of our people.

Known formally as the Hospital Survey and Construction Act, Hill-Burton started as a Truman initiative. In November 1945, only two months after the official end of World War II, he gave a speech to Congress outlining five goals to improve the nation’s health. The first and least controversial of these called for constructing hospitals and clinics to serve a growing and rapidly demilitarizing population.

Hill-Burton provided construction grants and loans to communities that could demonstrate viability — based on their population and per capita income — in the building of health care facilities. The idea was to build hospitals where they were needed and where they would be sustainable once their doors were open.

Over the subsequent decades, new facilities sprang up all around the country, including many in the 40 percent of U.S. counties that lacked hospitals in 1945.

By 1975, Hill-Burton had been responsible for construction of nearly one-third of U.S. hospitals. That year Hill-Burton was rolled into bigger legislation known as the Public Health Service Act. By the turn of the century, about 6,800 facilities in 4,000 communities had in some part been financed by the law. These included not only hospitals and clinics, but also rehabilitation centers and long-term care facilities.

In 1997, this type of direct, community-based federal health care construction financing came to an end. However, numerous Hill-Burton clinics and hospitals still exist around the country, specifically financed by a part of law to provide care to those unable to afford it.

“After the passage of Medicare and Medicaid, Hill-Burton ranks right up there among the most important pieces of health legislation in the 20th century,” physician and historian Howard Markel told Shots.

Hill-Burton introduced many ideas in health care financing that are still in use today. Chief among them is that hospitals receiving federal monies are obligated to provide free or subsidized care to a portion of their indigent patients. U.S. non-profit hospitals (still the vast majority) must demonstrate evidence of ‘community benefit’ to maintain tax-exempt status. Providing care to the uninsured is one of the most common ways to meet this obligation.

Another idea rooted in Hill-Burton is federal-state matching, meaning that federal appropriations must be matched by dollars from states, which is how Medicaid is financed.

Hill-Burton also has a poorly remembered dark side: Because of its provenance as a bipartisan law named for a Northern Republican (Sen. Harold Burton of Ohio) and a Southern Democrat (Sen. Lister Hill of Alabama), the law codified the idea of “separate but equal” in hospitals and health care facilities.

In order to achieve compromise and the necessary Democratic votes for passage, Southern Democrat segregationists had to be appeased. When this aspect of the law was overturned in a federal court challenge in 1963, Hill-Burton went on to become a major driver of hospital desegregation.

It seems worth noting that Sen. Hill’s surgeon father named him after Dr. Joseph Lister, a pioneer of antiseptic surgery.

A month after enactment of the law, Truman, a Democrat, appointed Republican Sen. Burton to the Supreme Court in a bipartisan gesture that doesn’t seem imaginable in today’s polarized political landscape. And consider this: Burton was unanimously approved by the entire Senate the same day he was appointed. With no committee hearings! He joined the court the very next day.

“Hill-Burton speaks to an earlier time in our history when the American people and those who represented them had confidence that government could do good things,” Markel said. “And that makes it all the more phenomenal to me.”

John Henning Schumann is a writer and doctor in Tulsa, Okla. He serves as president of the University of Oklahoma-Tulsa. He also hosts StudioTulsa: Medical Monday for KWGS – Public Radio Tulsa. You can follow him on Twitter: @GlassHospital.

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Louis Casanova is playing cards with a friend on the back deck of a recovery house in Philadelphia’s northern suburbs.

He’s warm and open as he talks about his past few years. The guy everyone calls Louie started using drugs like Xanax and Valium during his freshman year of high school. At age 18, Casanova turned to heroin. About two years later, the rehab shuffle began.

“I relapsed and then I was just getting high. And then I went to treatment again in February of 2015,” he says. “Then I relapsed again and went back to treatment.”

He’s 23 now. He’s hurt people close to him and his criminal record, fueled by his drug addiction, is long. By Louie’s count, he has been through eight inpatient rehabs. Louis says his stays have ranged from about 18 to 45 days.

“I did 30 days, and after that I came here,” he concludes, talking about his latest visit.

A month’s stay can be pretty typical among people who go to an inpatient facility.

But why?

“As far as I know, there’s nothing magical about 28 days,” says Kimberly Johnson, director of the Center for Substance Abuse Treatment at SAMHSA, the federal agency that studies treatment services.

Anne Fletcher, author of the book Inside Rehab, agrees.

“It certainly is not scientifically based,” she says. “I live in Minnesota where the model was developed and a lot of treatment across the country really stemmed from that.”

She says the late Daniel Anderson was one of the primary architects of the “Minnesota model,” which became the prevailing treatment protocol for addiction specialists. At a state hospital in Minnesota in the 1950s, Anderson saw alcoholics living in locked wards, leaving only to be put to work on a farm.

To find a path for them to get sober and leave the hospital, he came up with the 28-day model.

Marvin Ventrell, executive director of the National Association of Addiction Treatment Providers, has studied the model’s history. He says the month-long standard comes from the notion that when “someone is suffering from addiction — and in the days that this began, we’re pretty much talking about alcoholism — it made sense to people that it took about four weeks to stabilize somebody.”

And then, Ventrell says, “It became the norm because the insurance industry was willing to pay for that period of time.”

Now the model has spread to treatment for opioid addiction, even though recovering from addiction to those powerful drugs may require a different method.

Ventrell admits there isn’t enough research about the most effective length for an inpatient stay for opioid addiction.

“Treatment centers have to step up and say, ‘Just like cancer or heart disease, we’re going to measure our outcomes and show them to you,’ ” he says.

The federal government estimates spending on treatment for all substance abuse will hit a high of $42 billion by 2020. Some people pay tens of thousands of dollars, desperately hoping inpatient treatment will work.

But there’s increasing evidence that medication assisted treatment with the synthetic opioids methadone or suboxone can help those addicted by helping to relieve symptoms of withdrawal and reduce craving, especially when paired with strong outpatient counseling and other support.

Fletcher says it’s important for treatment to move away from the default month-long model.

That may be enough for some people, she says, but it “isn’t the case for most people. It’s like any other chronic disorder, it waxes and wanes.”

After his inpatient stays, Casanova is still trying to break his addiction. While he says recovery largely depends on the person, he preferred longer stays because it gave him more time to learn from other patients in a supportive environment. But Casanova is just one person; others prefer inpatient stays that are shorter than a month, followed by intensive outpatient programs.

Casanova relapsed in February, before I talked to him, and recently had to serve some jail time. But he’s back in the recovery house, and hoping to soon make the leap to the next stage — a house with even more independence.

This story is part of a reporting partnership with NPR, WITF’s Transforming Health and Kaiser Health News.

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