Posted by VicPlough on Feb 20, 2012 in
Health
WASHINGTON |
Fri Feb 17, 2012 6:49pm EST
WASHINGTON (Reuters) – The Obama administration on Friday issued 2013 payment and policy guidelines for U.S. health insurers that participate in the Medicare Advantage program, saying the proposed changes would bring lower premiums and stable or improved benefits.
But the documents did not include an official preliminary estimate for the net average percentage change in reimbursements, leaving insurers and financial markets in the dark about the guidelines’ potential impact on the industry.
Analysts said unofficial estimates suggested a possible all-in gain of 2.3 percent, far better than market expectations that had ranged from no change to a decline of 5 percent.
A year ago, the Centers for Medicare and Medicaid Services estimated a 1.6 percent net all-in rise for 2012 but later reduced that to 0.4 percent.
CMS, which oversees the federal healthcare program for the elderly, said on Friday that the 2013 guidelines point to an overall annual growth rate of 2.47 percent and a 2.3 percent per capita growth rate next year. But those figures do not take into account variables such as geographic location.
CMS officials said a net all-in figure for 2013 could be released among final rates due to be published on April 2.
“This positive growth trend will help ensure that beneficiaries maintain a choice of plans without significant increases in premiums or decreases in benefits,” the agency said in a statement.
Medicare Advantage allows the program’s 48 million beneficiaries to purchase private insurance instead of receiving
traditional Part A hospital coverage and Part B physician coverage. Critics say it pays too much to private insurers.
About 25 percent of beneficiaries participate in Medicare Advantage.
Analysts were upbeat about the guidelines.
Ipsita Smolinski, a healthcare analyst with Capitol Street, cited the guidelines’ 2.3 percent national per capita growth as a positive sign for insurers given that Medicare providers are scheduled to receive reimbursement cuts as a result of deficit reduction talks in Congress last year.
Ana Gupte, analyst for Sanford Bernstein, added: It should be good for the health insurers and specifically for the Medicare Advantaged leveraged health insurers.”
Humana Inc. and UnitedHealth Group Inc. are the biggest providers of Medicare Advantage plans and the most exposed. Other providers include Aetna Inc., Cigna Corp., Coventry Health Care Inc., Health Net Inc. and WellPoint Inc..
Analysts believe Medicare Advantage will expand as the Baby Boom generation leaves the workforce and younger retirees opt for private coverage instead of traditional Medicare.
(Reporting By David Morgan. Editing by Gunna Dickson)
Posted by VicPlough on Feb 6, 2012 in
Health Dr. Sanjay Gupta has been following the 2011 season of a North Carolina high school football team. In 2008, a player on the team died after sustaining a head injury during a game. For a closer look at the health and safety issues on the playing field, watch “Dr. Sanjay Gupta Reports: Big Hits, Broken Dreams,” this Saturday night at 8 p.m. ET.
Posted by VicPlough on Feb 1, 2012 in
Health Story By: Talk of the Nation
BP released millions of gallons of dispersants to break up oil from the Deepwater Horizon disaster. But what if dispersants could be sucked up again after doing their job? Chemist Julian Eastoe talks about an iron-containing soap he’s created that can be recaptured using a magnet.
Posted by VicPlough on Sep 21, 2011 in
Health Why are British children so unhappy? Four years after Unicef sparked national soul-searching with analysis showing child well-being in the UK at the bottom of a league of developed nations, the organisation has attempted to explain our problem.
The answer, it seems, is that we put too little store on family time and too much on material goods. Unicef paints a picture of a country that has got its priorities wrong – trading quality time with our children for "cupboards full of expensive toys that aren't used".
"Parents in the UK want to be good parents, but aren't sure how," the research suggests. "They feel they don't have the time, and sometimes the knowledge, and often try to compensate for this by buying their children gadgets and clothes."
The research compares Britain with Sweden and Spain. While the UK languishes in 21st, and last, place in the child well-being table, they come second and fifth respectively.
One reason they perform so much better, according to Unicef, is that in both countries "family time is protected" and children "all have greater access to activities".
"In Sweden their social policy allows family time and their culture massively reinforces it. In Spain fathers do work long hours, but the extended family is still very important and women stay at home to look after their children."
The report argues that the pressure of the working environment and rampant materialism combine to damage the well-being of our children. They want our attention but we give them our money.
"All children interviewed said that material goods did not make them happy, but materialism in the UK seems to be just as much of a problem for parents as children," the research concludes. "Parents in the UK often feel compelled to purchase consumer goods which are often neither wanted or treasured."
It is a profoundly depressing analysis of British life, not least because it rings true.
Time poor
The importance of parents devoting energy and love to the rearing of their children is accepted by political leaders from across the spectrum, but maximising income and encouraging consumption are regarded as vital components for economic growth.
In the UK, the demands of the latter often undermine the former.
Parents work all hours to increase family income but then are too exhausted or too busy to give their children the attention they need and deserve.
Of course the Swedes and the Spanish are materialistic too, but the researchers found parents in these countries more able to defy the consumer society.
"Parents in the UK⦠don't know how to challenge the materialist culture they see around them. This is in stark contrast to the families the researchers spent time with in Sweden and Spain."
One reason for Britain's poor performance, it is suggested, is that material inequality is much higher here than in other rich countries. The chart above – from another Unicef report card published last November – shows the UK with a far wider gap in material well-being than the OECD average.
The consequence is that poorer families feel they have to struggle even harder to get their children the stuff that is equated to status: the latest computer games, branded trainers and corporate logos.
"Parents and children feel massive external pressure from a materialistic culture, which they know won't bring happiness, but are conforming to none-the-less," the research finds. "Lack of family time and materialism is particularly felt among poorer families in the UK compared to the other countries."
Another problem is that British teenagers do not have enough to do – particularly within the educational arena.
"In the UK, children's time in active creative pursuits diminishes in secondary schools compared to children in Spain and Sweden. This is particularly true among older, deprived children in the UK."
Unicef's remedy is for Britain to look at its priorities. They want politicians to consider specific measures to support families:
Before the last election, David Cameron gave a speech in which he said that "what matters most to a child's life chances is not the wealth of their upbringing but the warmth of their parenting."
Today's Unicef research would seem to concur. If Britain is serious about doing the best for its children, it needs to give them more time not more stuff.
Posted by VicPlough on Sep 3, 2011 in
Health (CNN) — Dr. Caldwell Esselstyn Jr. didn’t become a doctor to change the way America eats. He was a general surgeon.
But researching cancer, he stumbled on a fact that changed his career: Certain cultures around the world do not suffer from heart disease, the No. 1 killer in the Western world.
Esselstyn’s practice took a dramatic turn — from performing surgery to promoting nutrition. For more than 20 years, the Cleveland Clinic doctor has tried to get Americans to eat like the Papua New Guinea highlanders, rural Chinese, central Africans and the Tarahumara Indians of Mexico.
Follow his dietary prescription, the 77-year-old Esselstyn says, and you will be "heart attack proof" — regardless of your family history.
"It’s a foodborne illness, and we’re never going to end the epidemic with stents, with bypasses, with the drugs, because none of it is treating causation of the illness," Esselstyn says.
The Esselstyn diet is tough for most Americans to swallow: no meat, no eggs, no dairy, no added oils.
Bill Clinton’s new vegan diet
Esselstyn has written a book to spread the word, "Prevent and Reverse Heart Disease — The Revolutionary, Scientifically Proven, Nutrition-Based Cure," and he has given talks around the world.
He is also a focus of the new documentary "Forks Over Knives." Esselstyn has won some high-profile allies — such as Dr. T. Colin Campbell, co-author of "The China Study," and Dr. Terry Mason, chief medical officer at Cook County Hospitals in Chicago and the city’s former health commissioner.
"We’ve eaten ourselves into a problem, and we can eat ourselves out of it," Mason says. But Esselstyn’s prescription goes against conventional wisdom, which considers diet only one factor in preventing heart disease.
"Diet alone is not going to be the reason that heart attacks are eliminated," says Nancy Brown, CEO of the American Heart Association.
Ornish: Asking the right health care questions
Other key factors include physical activity, cholesterol, blood pressure and weight, she says. The meat, dairy and egg industries defend the benefits of their protein-rich foods, all of which remain on the U.S. Department of Agriculture’s MyPlate dietary guidelines for healthy eating.
Esselstyn’s plant-based prescription also runs up against a culture where meat is served at most meals.
"Most doctors eat meat because most Americans eat meat, and if they don’t really see for themselves or for their family why it might be a good idea to cut down or even cut meat out of their diet altogether, they might not be so inclined to recommend it to their patients," says Michele Simon, author of "Appetite for Profit."
Tests predict heart attack risks
Even doctors who see the benefits of Esselstyn’s diet may not prescribe it for their patients.
"Anyone who is able to do that diet can have dramatic success. The problem is that many people are unable or unwilling to make these changes so in my practice, I try to take baby steps — one step at a time," says Dr. Erin Michos, a cardiologist at the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins University.
Esselstyn diet worked for me: One patient’s story
To help heart patients and others make the leap to his diet, Esselstyn holds a monthly, five-hour seminar at the Cleveland Clinic Wellness Institute to explain the science behind "plant-based" nutrition.
Esselstyn’s wife, Ann, offers practical advice on how to prepare kale, bok choy, collard greens and other foods that may not be on the typical family’s shopping list.
Esselstyn began recruiting patients in 1985 and says his diet has worked even on people deemed too sick for surgery. Esselstyn has published results from a small group of patients showing how his diet either halted the progression of heart disease or reduced the blockages in the blood vessels leading to the heart.
"We know if people are eating this way they are not going to have a heart attack," says Esselstyn, whose father had a heart attack at 43.
Anthony Yen, an entrepreneur who emigrated from China and came to love the fried foods, meat and desserts of the American diet, adopted the Esselstyn program in 1987 after undergoing bypass surgery.
"I’m still alive because of this diet," Yen says, now 78.
Esselstyn says people shouldn’t hold off on starting his diet until after they develop symptoms of heart disease because most heart attacks strike with no warning.
"The reason you don’t wait until you have heart disease to eat this way is often, sadly, the first symptom of your heart disease may be your sudden death," he says.
Esselstyn says his diet works because it keeps the lining of the blood vessels free of the dangerous blisters or bubbles or cholesterol-laden plaque that causes heart attacks.
Two decades after Esselstyn started trying to spread the gospel of his plant-based diet, the American Heart Association says 83 million Americans have some form of cardiovascular disease and many of the traditional risk factors for heart disease, such as obesity, are at all time highs. The association says the cost of treating heart disease tops $270 billion and is expected to more than double by 2025.
Esselstyn, a member of the U.S. gold medal rowing team at the 1956 Olympics, is not someone who gives up easily.
"We are on the cusp of what could be an absolute revolution in health — not dependent on pills, procedures or operations, but on lifestyle," Esselstyn says.
Watch Sanjay Gupta MD Saturday and Sunday at 7:30am ET. For the latest from Sanjay Gupta MD click here.
Originally Published On: www.cnn.com – Original Article Here
Posted by VicPlough on Sep 3, 2011 in
Health Editor’s note: Coming this fall on CNN, Dr. Sanjay Gupta takes an in-depth look at assisted suicide and families ripped apart by the issue.
Portland, Oregon (CNN) — James Powell could barely speak on the day he died; cancer had confined him to bed and heavy painkillers left him only semi-lucid. Yet the mood was almost celebratory as 25 people — family, friends and volunteers — gathered in a large living room to tell stories and say goodbye on the day Powell chose to end his suffering.
"After he took the medication, he fell asleep really quickly. His body just relaxed. He went into deep snoring. There were tears, but also it felt like a real family gathering of support," his daughter Katy, 61, remembers. "After he died you could pretty much feel the spirit kind of lift in the room. Thank goodness he’s free of that horrible suffering and pain."
Powell, who died at age 82 in 2008, had worked to pass Oregon’s Death With Dignity Act, a law enacted in 1997 that allows terminally ill patients to choose to end their own lives with lethal medications. A similar law was passed in 2009 in Washington. In Montana, the state supreme court ruled in 2009 that doctors in that state cannot be prosecuted for assisting with the death of terminally ill patients, but did not guarantee it as a constitutional right.
This month, in Massachusetts, the Dignity 2012 campaign, which includes members of a local chapter of the national nonprofit group Compassion & Choices, is spearheading a movement to get a Death With Dignity Act on the 2012 ballot. Supporters filed paperwork with the state’s attorney general.
The idea of allowing someone to end his or her own life is undoubtedly controversial. Gallup’s 2011 Values and Beliefs poll found in March that 45% of Americans consider doctor-assisted suicide morally acceptable, and 48% believe it’s morally wrong; the split was closer than on other hot-button issues such as abortion, having a child out of wedlock and cloning animals.
The law is significant for more than just the few people who actually go through the entire process of obtaining lethal medications and taking them, said Barbara Coombs Lee, president of Compassion & Choices.
"End of life care and empowered patients are better for everyone in the state," she said.
But this creates a double standard for the prevention of suicide, argues Stephen Drake, research analyst for the organization Not Dead Yet, a disability advocacy group that opposes physician-assisted suicide.
In his view, the Death with Dignity Act establishes a two-tiered system in which some people’s suicides are more encouraged than others. It’s the idea that young, healthy and nondisabled people should be prevented from dying, while the deaths of the old, ill and disabled should be facilitated, he said.
"When you look at it that way, it doesn’t look so much like empowerment’s at work," Drake said.
There’s a difference between helping a patient feel comfortable at the end of life and "making killing an acceptable part of medical practice," he said. He said he fears advocates will attempt to expand the established law’s requirements to include more and more people, although Coombs Lee said her organization has no interest in broadening the eligibility rules for the Death with Dignity Act.
Groups like Not Dead Yet and the National Council on Disability are also concerned that the top three reasons for people using the law in Oregon are consistently "loss of autonomy," "decreasing ability to participate in activities that made life enjoyable" and "loss of dignity." These reasons seem to be predicated on the notion that a disabled life is viewed as one that is not worth living, opponents of assisted suicide argue. The disability council would like these reasons examined more closely.
The United States Conference of Catholic Bishops recently approved a statement against "doctor-prescribed suicide," which also brings up the issue of disability. The group cautions that the wishes of others may bias a patient’s choice, especially in a society that undervalues the lives of people who are disabled or dependent on others.
"Those who choose to live may then be seen as selfish or irrational, as a needless burden on others, and even be encouraged to view themselves that way," the group wrote.
The bishops also argue that patients should receive help, in the form of counseling and medication if needed, to alleviate their desire to end their lives, rather than be granted a prescription for it.
But the bishops do support effective palliative care and do not suggest that patients undergo unduly burdensome medical treatments that prolong suffering at the expense of quality of life. They draw the line at physician-assisted death, pointing to the U.S. Declaration of Independence’s emphasis on the inalienable right to life, and to the Christian belief that life is a gift from God.
"A choice to take one’s life is a supreme contradiction of freedom, a choice to eliminate all choice," they write.
The basics
In order to use the law in Oregon, a patient must be over the age of 18 and have a diagnosis of a terminal illness with six months or less to live. The patient must be a resident of the state and capable of making and communicating his or her own health care decisions.
The patient must give an oral request to an attending physician twice, with at least 15 days in between. A consulting physician must also confirm the diagnosis and prognosis.
It’s usually not possible for a person with dementia to use the law, because the patient must be able to make his or her own decisions. If either the physician or consulting physician feels the patient has depression or other mental illness that might affect judgment, he or she must be sent for a further mental evaluation. Further guidelines are available from the state of Oregon.
In the year 2010, 65 patients died by ingesting prescribed lethal medications in Oregon, according to the state’s public health division, corresponding to about 21 deaths out of 10,000. In the state of Washington, 51 people died after ingesting the medications last year. But more people than that go through the process. A total of 96 prescriptions were written in 2010 in Oregon, and 87 were dispensed in Washington.
Patients may die naturally first or decide not to use the drugs. But having the medication gives the patient and family peace of mind, Coombs Lee said.
"They want to have it the same way you want an umbrella or you want fire insurance or you want a safety blanket of some kind," Coombs Lee said.
Once the patient has the medication, the patient begins to have conversations about intentions with his or her family, said Jason Renaud, executive director of the Oregon chapter of Compassion & Choices. The patient starts to say goodbyes in a much more intentional way, and starts to make amends more intentionally, too.
The system may not be perfect. A 2008 British Medical Journal study, led by Linda Ganzini of Oregon Health and Sciences University, found that the Oregon law may not adequately protect all mentally ill patients, and suggested there should be better tools for screening for depression.
But Renaud takes issue with that research. "Our folks are within weeks of dying, so it’s quite common and normal for them to be sad and worried about their families and about their health," he said.
Patients come to the Oregon chapter of Compassion & Choices by physician referral, Renaud said. Most patients have cancer.
Coombs Lee’s organization counsels about 2,500 people nationwide every year about end of life options. Professional staff and trained volunteers help individuals navigate their state’s systems and, in places where it’s legal, assist them through the process.
Some call that process "assisted suicide," which Drake fears is "making killing an acceptable part of medical practice," but Compassion & Choices calls it "hastening."
Its volunteers help with that hastening. They may be the ones to prepare the lethal medication and stay at the home until the patient goes into a coma; they’ll wait until death if the family wants. Hospice staff is usually there, too, if the patient is in hospice care. Death usually comes within 20 minutes to two hours, although it can take days in some cases. In two cases in Oregon in 2010, patients who took the medication did not die from it, but passed away from their underlying illness, according to the Oregon Public Health Division.
Before giving the medication, a volunteer will ask two questions: Do you know what happens when you take this, and, are you doing this on your own free will? The patient gets the lethal drugs only if he or she says yes to both.
What it means to hasten
Katy Powell is one of those volunteers. A real estate agent in Portland, she doesn’t advertise the time she has put into helping with end of life choices for the past three years, but she is getting more comfortable talking about it.
"I’m not only honoring my dad and wanting to volunteer, but I’m a huge proponent of personal freedom of choice. I don’t care if people don’t want to use the law. We’re here to help them die in any way they want to," she said
She knows how to mix the medication so the family of the person who is hastening doesn’t have to. The main ingredient is usually about 100 capsules of a drug called Seconal that have to be pulled apart and mixed with water. The result is a bitter drink, the way pure aspirin tastes, she says. In a sense, the foul flavor is another safeguard in case the person had any doubts.
"If someone was confused about what in the heck they were doing, and they tasted this, in one sip they would spit it out if they didn’t want to drink it," Powell said. "When people drink this down, gulp after gulp after gulp, they’re very determined. They don’t stop."
Often, the hastening is a sort of "party with tears," Powell said. The mood all depends on family dynamics; in her experience, women who are choosing death often seem happier than men.
"They’re just like, ‘Cheers, I’ll see you in another life,’ and then they have a whiskey chaser or whatever they want to chase the medication with, and people are laughing and crying," she said.
One patient who chose to hasten was a professional belly dancer who taught belly dancing at a local college, Renaud recalled. She had breast cancer in 2008 and survived a double mastectomy, but when the cancer returned she did not want to go through chemotherapy and radiation again. She quickly became terminally ill. A volunteer from Compassion & Choices arrived at 5 p.m. on the day of the hastening to find a party with 45 people, which lasted until midnight, Renaud said.
"When she died, there were dozens of people in her bedroom. That can’t happen in other states. In other states it’s covert, illegal, frightening," he said.
Why would someone choose to hasten death this way? Pain is part of it, Powell said. Another factor is not wanting to be totally dependent on others, especially strangers if they have to go into a nursing home or other hired-care situation.
"It’s more of just being autonomous and having control over their situation. They don’t want to lose control," she said.
From law to practice
Her father, Jim, wasn’t a control freak, but he was always in charge, she said. He was the head of both a business and a large family, and was a strong leader in his Unitarian church. When he wanted to do something, he was determined and would do it, she said.
Both Powell’s parents were staunch believers in people having freedom of choice in personal matters (Autry, Powell’s mother, is still living, but suffers from Parkinson’s and dementia). The Death With Dignity Act became important to James Powell in particular because he was a friend of the husband of Janet Adkins of Portland, who was the first person Dr. Jack Kevorkian publicly assisted in suicide. At age 54, she had Alzheimer’s disease and was adamant that she did not want it to progress.
"Because of the outrage of what Kevorkian was doing, I think Dad and her husband — they were very educated, intelligent, well-connected people — got these people together and said ‘We need to have a law that legitimizes this.’ "
(The law that was passed, however, would not have applied to Adkins, because she did not have a diagnosis of a terminal illness with six months or less to live).
Powell’s father was on the committee that wrote the law, she said. Still, when he helped pass it in 1997, he probably didn’t think he’d use it himself one day.
"He always knew it was there, and he was probably happy when the time came," she said.
After her father died, Powell waited the recommended few months before beginning to volunteer with Compassion & Choices. At first, she was a lot more emotional about helping people with the hastening process, as if she were reliving what she went through with her father. She still empathizes with the families, she said, but now doesn’t get as stressed or sad about the hastening itself; she is happy for the patients, who always thank her over and over.
"It’s almost like being at a birth, where you’re emotional about that, too, and it’s more joyous, of course, but it’s still that same wonderful awe-inspiring feeling of taking part in something that’s really important," she said.
Originally Published On: www.cnn.com – Original Article Here
Posted by VicPlough on Sep 3, 2011 in
Health Lilongwe, Malawi (CNN) — For one retired midwife, seeing too many mothers die during childbirth led her to quit her job and take on the third highest infant mortality rates in the world.
She could be considered Malawi’s own Florence Nightingale. Using the most basic equipment, Charity Salina has single handedly delivered more than 4,000 babies and recorded no deaths.
The nurse quit her research job at the University of North Carolina in the United States and with her pension and a $600 loan she opened a birth clinic in one of the most impoverished communities in Malawi.
It’s a mission she is passionate about.
"You bring out a live baby and she cries (and) you think ‘wow I’ve given life to this one!’" Salima said.
Salima set up her clinic in the poor urban township known as Area 23 just outside the capital Lilongwe after witnessing too many deaths during childbirth.
But the problem spans the country, with a lack of decent healthcare facilities being blamed for countless tragedies.
"Most of the people don’t have transport to take them to the main hospital," she said. "Sometimes labor starts at night, there is no transport available — what do you do?"
Salima says she would often be contacted to assist at a birth when it was already too late for the baby or the mother.
Her Achikonde birth clinic opened in August 2008. It offers prenatal, birth and post-natal services for free. The center is strategically placed in a highly-populated residential area that women can easily reach by foot.
But Salima nursed her dream of starting a clinic for years until she had money to open it.
"Sometimes you have to start the ball rolling before other people come to help you, so I was buying one pillow keeping it, two blankets keeping it," she said.
There is no fancy equipment or high-tech devices in the scantly resourced clinic. It’s based in a small house that Salima rents and she’s on call 24 hours a day.
Salima credits her training for all her successful deliveries.
"You can have the best resources in the world but if you are not trained properly you can’t give life," she said.
"I am somebody that is qualified enough and I am experienced enough. As soon as I see this is not a condition I can deliver here, there and then I transfer the woman to the main hospital," she continued.
Once the babies are born, Salima tries to discourage mothers from having more children than they can cope with.
There are also services for HIV-positive mothers, who are provided with counseling and given medication to reduce the risk of transferring the virus to their newborns.
Salima’s clinic relies largely on donations — for example the vehicle that’s used to transport patients was donated by nurses from Scotland. Salima says the challenges of running a place like this in one of the poorest countries in the world are enormous.
"Sometimes we have blackouts. As I’m talking now there is no electricity — I would love to have a generator," she said. "We also have water blackouts. There is no water here at the moment — if we had a borehole it would be better."
But despite all the hard work with no pay, it’s the love the midwife has for her community that keeps her going.
"Women … when I die they should remember me and say we had a woman in this community who was so passionate about us, so passionate about our babies and it is our duty to bring live babies to the community, live babies to the country, live babies to Africa," she said.
Originally Published On: www.cnn.com – Original Article Here
Posted by VicPlough on Sep 3, 2011 in
Health Tune in: Dr. Sanjay Gupta investigates 9/11′s toxic dust — what it felt like to breathe it, be enveloped by it, and what the experience means for the next time disaster strikes, in "Terror in the Dust," Wednesday, 11 p.m. ET
New York (CNN) — Firefighters exposed to toxic dust and fumes clogging the air after the World Trade Center towers collapsed 10 years ago are more likely to develop cancer, according to a new study.
When compared with firefighters who did not work at ground zero, firefighters working the pile were 19% more likely to get a cancer diagnosis.
According to the research, published Thursday in the Lancet medical journal, the increase occurred during the first seven years after 9/11.
"We excluded cancers that might have been diagnosed early (that may have existed before the attack) … and we still see a 19% increase," said Dr. David Prezant, chief medical officer at the New York City Fire Department and the study’s lead author, in a recent interview with CNN. "When we put those cancers back in, we see a 32% increase."
It is an unexpected finding considering that for most cancers, the latency period — the time between exposure to a carcinogen and expression of disease — tends to span decades.
"My initial bias was that for the first 10 or 15 years we would not see an increase," said Prezant. "That’s another reason I think our findings are so strong, because I actually thought we would find the opposite."
One theory about how cancer might develop so soon among responders is that the unique characteristics of ground zero dust, and the sheer number of chemicals contained in it, may have accelerated disease in responders.
"Typically for solid tumors we would say there’s a latency period of decades," said Dr. Jacqueline Moline, author of a study about multiple myeloma among responders, during a recent interview with CNN. "Is something about the dust accelerating things much sooner than we would have expected?"
Researchers have reported the presence of hundreds of compounds in ground zero dust, among them known carcinogens. Potential cancer-causing agents such as asbestos that coated the Trade Center buildings’ lower columns, and benzene, a component of jet fuel that caused uncontrollable fires when planes barreled into the twin towers, have been a cancer concern for researchers.
So have the high volume of particulates and gases inhaled by firefighters, said Prezant.
"Those particulates are not just dust, they are dust coated with the same chemicals that were in the air in terms of the gases, sometimes, actually, getting deeper into the lung or better penetrating into the blood circulation because they’re carried on a particle," said Prezant, who is also a pulmonologist with the FDNY.
Moline wrote one of the only other papers — a small case series published in 2009 — suggesting increased cancer risk among responders. It found a small but inordinate number of multiple myeloma cases among responders under age 45. Multiple myeloma is a blood cancer that typically strikes much later in life.
"Because we’re dealing with unprecedented exposures, we need to be vigilant and do regular follow-up of this type of study to see if this effect is changed over time," said Moline, the chair of the Department of Population Health at Northshore LIJ Health System. "The question always is, are we seeing some cancers younger … that you might not expect if (the risk of a particular cancer) increases with age?"
According to Prezant’s study, the overall increase in cancer rates among firefighters is significant, but when the findings are broken down according to specific cancers, the numbers are more modest. There are "trends" — subtle increases — in gastro-esophageal cancers and blood cancers such as multiple myeloma, and non-Hodgkin’s lymphoma, said Prezant, but they are difficult to generalize.
And this is an early study that will require several years of follow-up, said Prezant.
"We’ve just begun to understand what’s happening after the World Trade Center," said Prezant. "We may find that some of our conclusions change over time, get stronger or change entirely."
Firefighter: Bill helping responders needs to cover cancer
What hangs in the balance of studies like this one is medical coverage for cancer.
The James Zadroga 9/11 Health and Compensation Act, passed by Congress in July 2010, is designed to provide medical services and compensation for responders who were exposed to dangerous toxins while working at ground zero.
The bill currently does not cover cancer, and earlier this year, the National Institute for Occupational Safety and Health, the agency evaluating which illnesses will be covered under the Zadroga Act, determined no connection between exposure to cancer and dust.
According to an agency spokesperson, the Lancet study will be included "… in our second periodic review of the medical and scientific evidence related to cancer." That review is expected in 2012. Jeff Stroehlein, a New York firefighter who started working at ground zero three days after the 9/11 attacks and continued there for two weeks, retired in May after being diagnosed with brain cancer. He said Thursday that he believes a link between cancer and exposure to ground-zero toxins is obvious, but he won’t find any satisfaction from the Lancet study "until they put (cancer coverage) in the Zadroga bill."
"It’s a disgrace that it wasn’t put in the Zadroga bill," he said.
Stroehlein, who has been through two rounds of chemotherapy and recently underwent a stem cell bone marrow transplant, said his medical bills total in the hundreds of thousands of dollars. He has insurance, but he said he still has had to pay thousands of dollars.
Other responders, he said, have it far worse.
"There are guys in worse shape than me — they’re dying every week, every month," he said. "It’s a torturing death, and they don’t have the coverage or support they need."
Other responders convinced cancer ‘widespread’
Ernie Vallebuona, a former vice detective with the New York City Police Department, learned he had aggressive non-Hodgkin’s lymphoma three years after working at ground zero. He says the number of cancer cases he sees among his NYPD colleagues and other first-responders is disconcerting.
"Before 9/11 you might have known one person with cancer," said Vallebuona. "Now it’s like that person in your office has cancer, that one in your detail has cancer, and on and on."
But responders like Vallebuona may not be able to take solace from this study. Prezant said the results are specific to firefighters. Eighty-five percent were present at the Trade Center complex within 48 hours of the towers falling. And as other studies suggest, the earlier a responder arrived at ground zero, the more serious their illness.
"Whether we can say that cancer is increased in other responders or area residents, we have no idea," said Prezant. "This is a study about firefighters, their exposure is so unique."
The cancer question is emotionally fraught for responders like Vallebuona, who also arrived at ground zero within hours of the towers’ collapse, and spent months searching for survivors and cleaning up after the attacks. Many consider the connection between their cancer and exposure and toxics to be irrefutable.
"I believe this is just the tip of the iceberg," said Vallebuona, adding that he believes future studies will prove that the cancer issue is widespread among responders.
"(Cops) were there from the first hours, first minutes when this disaster happened," said Vallebuona. "We all responded just like firefighters, so I don’t think they can say cancer increases just apply to firefighters."
John Feal, founder and president of the FealGood Foundation, which advocates for sick first responders and fought for the Zadroga Act’s passage, said the study counters those who said first responders were crying wolf.
"We don’t need a Ph.D. to tell us that 9/11 and its aftermath cause cancer," Feal said. "We’re sick and dying, but we’re not stupid."
He said he expected his group in the near future will be "going to Congress and asking for more money" for the bill.
"We’re going to need more money in the Zadroga bill to treat and compensate for these cancers," he said.
Responders describe the scientific process for establishing links between cancer and 9/11 dust as slow, and infuriating, but Prezant stressed that scientific inquiry into illnesses emerging from ground zero work must be measured and sound.
"The important thing is that our conclusions, whatever they are, are based on science," said Prezant.
CNN’s Dana Garrett contributed to this report.
Originally Published On: www.cnn.com – Original Article Here
Posted by VicPlough on Sep 3, 2011 in
Health Port-au-Prince, Haiti (CNN) — Five years ago, Patrice Millet learned he was in the advanced stages of a rare bone cancer. A stem cell transplant was his only hope for survival.
The businessman from Haiti underwent the procedure in the United States. After nine months of treatment and recovery, his cancer was in remission. Millet returned home in May 2007 determined to start living the life he’d always wanted: helping children from Haiti’s poorest slums have a brighter future.
"Every day you see so many kids in need — so many bad stories, tragic stories," said Millet, 49. "All my life, I wanted to do something good for my country, for the kids. (So) I said, ‘This is the time. I have nothing to lose.’ "
That summer, Millet sold his construction supply business and started a program called FONDAPS, which stands for Foundation Notre-Dame du Perpétuel Secours (Foundation of Our Lady of Perpetual Help). The program uses soccer to help children stay out of trouble and learn valuable life skills. Millet calls it "education by sport."
"I want the kids to be very good citizens," he said. "In soccer … you need to give, you need to receive, you need team spirit, discipline, sportsmanship. … It’s not all about soccer, it’s about life."
Millet started by focusing his efforts on children from Solino, one of Port-au-Prince’s most dangerous slums. But going into the neighborhood to recruit young participants was risky.
"My wife didn’t want me to go. She said gangs (would) kill me." But Millet was undeterred.
"I said, ‘I’d rather die doing something good than die in bed.’ "
While Millet was first greeted with suspicion, he was eventually accepted by the locals and children flocked to join his program. Today, hundreds of children have benefited from FONDAPS.
Do you know a hero? Nominations are open for 2011 CNN Heroes
Soccer programs for children are rare in Haiti, and players generally must pay to participate. In Millet’s program, the equipment, uniforms, shoes and training are all free for participants. He also pays the transportation and entry fees for players to compete in soccer tournaments.
"When you live in the ghetto, you don’t see the world outside," he said. "I try to bring hope for them, … to show them that (their) life is not only the reality."
Before the earthquake hit Haiti in January 2010, Millet’s program had expanded to three neighborhoods and involved more than 600 children, including more than 150 girls. But the quake devastated Solino and halted FONDAPS’ momentum. One of the children in the program died and many lost friends and family members.
"When the earthquake came … it became harder for the kids," Millet said. "Now, most of them live in tents. … They have to fight for everything."
Two of the three fields where Millet had held soccer practice became large tent cities. His remaining field is located on the outskirts of Port au Prince — too far for many of his former players to walk. But about 200 boys still make the journey. Millet believes that the difficult times have only increased the need for his work.
"In Port-au-Prince right now, there is almost no soccer field," he said. "It’s very important for a kid to play. … I try to give them joy, give them their childhood."
The children, ages 9-17, practice five days a week. And Millet often arranges games on Sundays.
"When they win, they are happy and they know that it’s because they worked hard for it. … That is the message I want to tell them," said Millet. "Sometimes you win, sometime you lose. … But this is the way you win in life."
Since many of "his kids," as he calls them, lack father figures, Millet also acts as a role model and mentor. After practice, he and the other coaches regularly talk with the boys about what’s going on in their lives. Millet constantly stresses the importance of education to them, and at times dips into his own pocket to pay their school fees.
"They don’t have to steal … or (join a) gang. They know that they can do something. They know they can believe in themselves," said Millet.
While FONDAPS is basically a one-man operation run on a shoestring budget, Millet is always looking for other ways to help his players. Usually once a week, participants receive packets of pasta, rice and beans to bring home to their families. He is also working on getting a bus to transport children to practice, and he hopes to one day establish his own school with athletic fields and programs in music and art.
Despite the challenges to keep his program going, Millet is not lacking in motivation.
"To see the joy in the face of a kid … and you know what he’s living (through) … that makes me happy," he said. "It’s so wonderful to see the progress they make in soccer, in their own life, in everything."
For Jeff Fouvant, Millet’s program has been a lifeline. The 11-year-old lost his father in the earthquake and is living in a tent with 10 family members. Fouvant’s entire family depends on the food he receives from FONDAPS, and Millet also pays for his school fees.
"Mr. Patrice … he helped us a lot," said Fouvant. "He is a hero."
In 2009, Millet’s cancer returned, but he’s treating it with medication. He recently spent several weeks in the U.S. undergoing radiation treatment, but he insists that he’s feeling good. Though cancer is a reality that Millet can’t escape, he said he’s happier now than he was before his diagnosis. And he’s determined to do as much as he can with whatever time he has left.
"I realized how important life is, every moment," he said. "I am not ready to die yet. I have many, many things to do."
Want to get involved? Check out the FONDAPS website at www.fondaps.com and see how to help.
Originally Published On: www.cnn.com – Original Article Here
Posted by VicPlough on Sep 3, 2011 in
Health Lilongwe, Malawi (CNN) — For one retired midwife, seeing too many mothers die during childbirth led her to quit her job and take on the third highest infant mortality rates in the world.
She could be considered Malawi’s own Florence Nightingale. Using the most basic equipment, Charity Salina has single handedly delivered more than 4,000 babies and recorded no deaths.
The nurse quit her research job at the University of North Carolina in the United States and with her pension and a $600 loan she opened a birth clinic in one of the most impoverished communities in Malawi.
It’s a mission she is passionate about.
"You bring out a live baby and she cries (and) you think ‘wow I’ve given life to this one!’" Salima said.
Salima set up her clinic in the poor urban township known as Area 23 just outside the capital Lilongwe after witnessing too many deaths during childbirth.
But the problem spans the country, with a lack of decent healthcare facilities being blamed for countless tragedies.
"Most of the people don’t have transport to take them to the main hospital," she said. "Sometimes labor starts at night, there is no transport available — what do you do?"
Salima says she would often be contacted to assist at a birth when it was already too late for the baby or the mother.
Her Achikonde birth clinic opened in August 2008. It offers prenatal, birth and post-natal services for free. The center is strategically placed in a highly-populated residential area that women can easily reach by foot.
But Salima nursed her dream of starting a clinic for years until she had money to open it.
"Sometimes you have to start the ball rolling before other people come to help you, so I was buying one pillow keeping it, two blankets keeping it," she said.
There is no fancy equipment or high-tech devices in the scantly resourced clinic. It’s based in a small house that Salima rents and she’s on call 24 hours a day.
Salima credits her training for all her successful deliveries.
"You can have the best resources in the world but if you are not trained properly you can’t give life," she said.
"I am somebody that is qualified enough and I am experienced enough. As soon as I see this is not a condition I can deliver here, there and then I transfer the woman to the main hospital," she continued.
Once the babies are born, Salima tries to discourage mothers from having more children than they can cope with.
There are also services for HIV-positive mothers, who are provided with counseling and given medication to reduce the risk of transferring the virus to their newborns.
Salima’s clinic relies largely on donations — for example the vehicle that’s used to transport patients was donated by nurses from Scotland. Salima says the challenges of running a place like this in one of the poorest countries in the world are enormous.
"Sometimes we have blackouts. As I’m talking now there is no electricity — I would love to have a generator," she said. "We also have water blackouts. There is no water here at the moment — if we had a borehole it would be better."
But despite all the hard work with no pay, it’s the love the midwife has for her community that keeps her going.
"Women … when I die they should remember me and say we had a woman in this community who was so passionate about us, so passionate about our babies and it is our duty to bring live babies to the community, live babies to the country, live babies to Africa," she said.
Originally Published On: www.cnn.com – Original Article Here