Calling Dr. Kumar: Real Life "Dirty, Pretty Things"

Sometimes you just hate being right. One of the reasons I got out of clinical nursing was that, as a floating critical care/ER nurse in a busy teaching hospital, I got tired of watching young poor kids come in through the ER with gunshot wounds, end up in a coma in the neuro ICU waiting for the surgeons to harvest their organs to transplant them into the people who could afford them and then care for the organ recipients in the surgical ICU. No matter how many lives are saved by transplants, we have to face the reality that the situation is ripe for exploitation.

Dirty, Pretty Things (2002), winner of the Best Independent British Film, 2003, written by Steven Knight, depicts the plight of illegal immigrants in the UK, who sell their organs in exchange for passports. Fiction?

CNN reported yesterday that police in India have cracked an international organ-trafficking ring. Organs harvested from the poor and sold to the wealthy, one Dr. Amit Kumar, a.k.a. Santosh Rameshwar Raut, the alleged mastermind. This same doctor had a previous arrest in 1994 for running a similar scheme in Bombay. He skipped bail and started up his "practice" in other cities. One doctor and patients were held - including two from the US. ABC reports that the two US citizens, dialysis patients, are forbidden to leave the country because they are suspected of waiting for illegal transplant operations. Dr. Kumar is on the lam and is thought to have fled India. CNN has video of the victims and their surgical wounds. Some were taken by force, being promised jobs, and nurses, doctors and medical technicians were involved in the procedures. Interpol reports that as many as 50 health care workers were involved in the racket. Punishment if a doctor is found guilty of illegal transplants in India? Two years jail time.

The dark side of medical tourism - foreigners travel to India for transplant surgery, because of availability of skilled doctors and lower costs. The sale of human organs is illegal in India. The Organ Transplant Act is being amended to allow only foreigners with medical visas and verified donors to be allowed transplants in India. NDTV.com reports that Dr. Kumar, who may be living in Canada, has eluded authorities for 14 years. Indian police report that the scale of the operation may be much larger than is known at this time. Demand for organs outstrips supplies due to rampant diabetes and hypertension induced kidney failure. Apparently these doctors buy a kidney from the poor for about $1000 and sell it for $50,000. With so many people living in poverty and desperation apparently there is nothing but a strong moral compass to prevent rampant exploitation.

Thank you anaxila for use of photo The Have and Have Nots

Labels: medical tourism, organ transplants

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Watch HBO Tuesday - Baghdad Hospital: Inside the Red Zone

Fulbright scholar Dr. Omer Salih Mahdi filmed inside the ER where he works at Al-Yarmouk hospital in Baghdad, revealing the terrible wounds suffered by Iraqi civilians in the ongoing fighting. As an ER nurse, I got emotional watching as the staff, working without anesthesia in substandard conditions, had to insert an adult size chest tube into the tiny body of a 6 year old boy with shrapnel wounds. Caught in the crossfire between, staff are targets because they treat anyone - Shiites, Sunni, militia, police.

A few of us here at Healthline were involved behind the scenes with 4 year old boy who was injured in the crossfire in Baghdad. He was on his way to buy candy with his uncle when bullets started flying. The two ducked behind a car but the car burst into flames when hit by a bullet. The boy and his uncle survived but were badly burned. The boy's leg is not developing properly due to scar tissue and he was scheduled to have surgery at Shriner's Hospital in Boston next month. The hospital was going to pay for the series of operations and all of the travel expenses. The mother of one of our employees was working with Iraqi refugees in Jordan. She and others involved in the boy's case tried and tried to get the right visa to satisfy US Homeland Security to allow his travel for the surgery. The boy and his father were unable to get the proper G series passport that would allow them to qualify for the humanitarian visa proving they would return to Jordan after the surgery. Disheartened, we received an email from Jordan saying the boy's father stating he was giving up. The surgery was canceled.

The film, which received a 2007 International Emmy Award for Current Affairs, debuts January 29 at 8:30 PM on HBO

Other HBO playdates:

-- Feb. 6 (9:15 a.m., 8 p.m.)
-- Feb. 9 (3:30 p.m.)
-- Feb. 12 (4:30 p.m., 11:45 p.m.)
-- Feb. 17 (12:30 p.m.)
-- Feb. 22 (3:15 p.m.)
-- HBO2 playdate: Jan. 30 (9:45 p.m.)

Today, Dr. Madi is a journalism student at the Institute for International Education at Ball State University in Indiana.

Thank you http://www.thewe.cc/.../r3216879803.jpe for use of image of Injured Iraqi children.

Labels: Baghdad, hospital ER, injuries, Iraqi civilians

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Healthline Analysis Election 2008: Candidates Speak Out on Mental Health

One in four Americans have mental health problems, so the National Alliance on Mental Illness (NAMI) asked them about their positions on the subject.

• Clinton:
• Supports expanding mental health services, preventive mental health services
• Supports mental health parity with other health conditions - co-sponsor of the Mental Health Parity Bill of 2007
  
• favors doing away with discrimination based on pre-existing conditions, including mental health and substance abuse
• Co-sponsored the Healing the Invisible Wounds Act of 2006 in support of ensuring support for our troops mental health care needs
• Introduced the Positive Aging Act 2007 to give mental health parity within Medicare for seniors
• Supports alternatives to inappropriate imprisonment of the mentally ill
• Obama:
• Supports expansion of mental health services and preventive services
• Supports mental health parity with other health conditions - co-sponsor of the Mental Health Parity Bill of 2007
  
• strong supporter of the bipartisan Paul Wellstone Mental Health and Addiction Equity Act of 2007
• has a comprehensive plan for assessing the mental health needs of troops, including National Guardsman, at every stage of deployment, including recruitment and transitioning to return to civilian life
• he was an original cosponsor of legislation supporting a comprehensive TBI plan, including pre and post deployment screenings
• he has committed to fully funding the VA
• supports greater investment in NIMH
• supports a crime policy that ensures that people with mental illness get the treatment they need
• McCain
• supports providing incentives to treating physical and behavioral health together
• design reimbursement models that reward treating the whole person, including mental health and behavioral aspects of mental illness
• emphasis on prevention, especially in children
• advocate for the housing needs of the mentally ill and veterans
• Romney
• has not responded

Thank you bekah stargazing for use of photo...Therapy #8.

Labels: election 2008, mental health, mental illness

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Healthline Analysis: Election 2008 - Follow the Money

In case you missed it, Mitt Romney-R asked, Who let the dogs out?
But if you, like me, want to follow the money:

• Whose campaign has received the most $ from lobbyists?
• Hillary Clinton
• Finance, insurance and real estate sectors are her biggest donors
• Insurance sector like to hedge their bets - donate equally to both parties
  
• Women contribute more to the Democratic candidates than to Republicans
• John Edwards -D is the ONLY major presidential candidate who does not accept money from the tobacco industry
• Rudy Guiliani- R is their biggest beneficiary. Gambling and casinos like him, too.
  
• Surprise! Oil & gas sector favor Clinton-D over McCain-R (?)
• Health professionals donate more to Clinton-D and Obama-D
• Retired people , computers and internet sector and the entertainment sector give more to Obama-D

In the Democratic debate televised on CNN on 1/21/08, Obama said he would "get moving on health care" in his first 100 days in office. None of the other candidates expressed the same urgency.

Thank you sendai 9193 for use of photo Kentucky Tobacco Field.

Labels: campaign money, health care

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We the People want Health Care Reform: A Commonwealth Fund Report

The Commonwealth Fund published a report this week illuminating what We The People want in health care reform. What are we adults over age 19 hoping our presidential candidates can deliver this time next year?

• Candidates views on health care will influence voting
• We want employers to continue contributing financially to cover costs for health care insurance
• We want a requirement that everyone have healthcare insurance
• We want the government to help those who can't afford it
• We believe financing health insurance should be a shared responsibility of government, employers and individuals

The Commonwealth Fund is a think tank dedicated to a high performing health care system. They recommend we use the following criteria to evaluate the candidate's health care plans:

• Access to care: provides equitable insurance coverage for all
• Quality, efficiency and cost control: portability, efficiency
• Financing: Financial equipment to achieving goals

All of the Democratic candidates support universal coverage as a goal. None of the Republicans do. All of the Democratic candidates support continued contributions to pay for health insurance by employers. None of the Republicans do.

We spent $2.1 trillion on health care in 2006: $7000 per person, 16% of the Gross National Product yet we are told we have the worst health outcomes. The US came up at the bottom of the list in preventable deaths. Treatable cancers, cardiovascular disease, diabetes and medical errors account for our poor ranking.

So the system is broken. Americans want it fixed. And we want a strong presidential candidate with the will, determination, intelligence and ability to build consensus to get the job done.

thank you Editor B for use of photo of New Orleans Health Clinic, US, 2007...

Labels: access to care, election 2008, health reform, quality care

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Thank you Alvaro Fernandez of Sharp Brains for Grand Rounds: Briefing the Next US President

My cyberfriend, Alvaro Fernandez, over at the tres cool Sharp Brains put together a timely Grand Rounds of all the things we health care types want to tell the next US President. Are you listening? He kindly included my post Healthline Analysis: Election 2008 - Obama.

Are we ready?





Thank you poppyseed bandit for use of photo.

Labels: Grand Rounds, Obama, presidential election

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Healthline Analysis: Election 2008 - The Romney Plan

Former Governor of Massachusetts Mitt Romney (R) released his health care plan in August 2007. An undergrad of BYU, he went on to pursue advanced degrees from Harvard's Law School and MBA program and was a founder of a successful venture capital company. Here are the salient features of The Romney Plan. The wording is often verbatim from Romney's Power Point Presentation to the Florida Medical Association:

• Use a free market, federalist approach to make quality affordable health insurance available to everyone
• Increase portability (i.e. no loss of insurance with change of job)
• "No more free-riders"
• Emphasis is at the state level and "personal responsibility"
• enable market-driven, high value products
• then require middle income earners to either purchase health insurance or pay for their own health care
• a national system is "bound to fail", ignoring the differences between states and smothering innovations
• offer federal incentives to states to deregulate insurance industry
  
• End Medicaid: Help low income people purchase private insurance vs. receiving government care
• bring everyone into the health care system
  
• provide sliding scale premiums for low-income persons as a step up to self sufficiency
• redirect state and federal spending from payouts to providers to premium assistance for individuals
• a single person making $19,400 per year would pay a monthly premium of $40 for health insurance
• Create a mechanism to control costs and provide sustainability
• First do no harm
• No European-type rationing
• Preserve individual choice
  
• Implement medical liability reforms
• Implement HIT
• Adopt tax reforms
• Change the tax laws offer disincentives for overinsurance and overuse of health care
  

Interesting statistics Romney provided. Of the 45 million uninsured:

• 17 million are middle income individuals
• 12 million are low income individuals
• 14.7 million people who are uninsured are currently eligible for public coverage

That is Romney's rationale for no new taxes or spending - middle income people need to get coverage and those 12 -19 million who need the most help should get it. And while he mandated coverage in his state in Massachusetts, he does not advocate a national mandate for health care coverage. So strongly does he believe in his health care plan, that in December 2007 he told an NPR reporter that "...I am running on my health care plan..." It has been difficult to pin down his views on abortion, but he does admit that his views have evolved over time and he refers to himself as being " a click from center" on a number of issues. Mitt Romney has published his own views on stem cell research in National Review Online. He supports ethical biomedical research and consensus building to promote, protect and save lives. He apparently favors the Iraq war yet has been reticent about veterans and their health care needs.

Thank you daniela Zalcman for use of photo Anderson Cooper interview.

Labels: health care plan, Romney, universal access

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Healthline Analysis: Election 2008 - McCain's Competition & Affordability Health Plan

John McCain, Republican Representative who subsequently became Senator from Arizona, first elected in 1982 has a distinguished record of service to the United States of America. He released his Health Plan in October 2007 and here are some of its features:

• control costs and spending to make health insurance affordable for all
• provide access to care for all
• provide veterans with more freedoms in choice of care
• promote competition between traditional and alternative medicine providers
• promote patient-centric care and emphasize personal responsibility
• require transparency from providers vis a vis outcomes of care, costs, quality and prices
• develop national standards for treatment and outcomes
• promote HIT
  
• give states leeway to experiment with alternative methods of access to care and licensing of providers
• promote reforms for access to cheaper medications
• provide individuals with $2500 tax credit for health insurance
• foster competition, access to and affordability of health insurance
• support public health initiatives to decrease incidence of chronic disease

John McCain advocates overturning Roe vs. Wade and protecting the status of marriage as a sacred bond between one man and one woman. He and his wife have four children, including a daughter they adopted from Mother Teresa's Bangladesh orphanage. (His son Jimmy, 18, is a Marine serving in Iraq.) Together they promote adoption over abortion. He opposes the intentional use of human embryos for research purposes and does not support any research for medical purposes that "sacrifices moral values".

John McCain is a leading advocate for benefits and rights of veterans. His wife, Cindy, has long been an advocate of children's health care needs. She founded and ran the American Voluntary Medical Team (AMVT), providing emergency medical and surgical care to children around the world, from 1988 - 1995. She has a history of prescription drug addiction. She is on the Board of Trustees for HALO (dedicated to removal of landmines and weapons destruction in war torn countries), the Board of Directors for Operation Smile, and the Board of Directors of CARE.

Thank you marcn for use of photo Question about global warming.

Labels: health care, mccain, veterans

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Healthline Analysis: Election 2008 - Clinton's Health Plan

As First Lady in the 1990's, Hillary Clinton introduced an ambitious plan for universal health care coverage as the head of then President Clinton's Task Force On National Health Care Reform. The plan failed for any number of reasons, and Clinton has introduced her America Health Choices Plan. Features are:

• universal coverage
  
• mandatory coverage
• same benefits package that members of Congress receive
• no exclusions due to pre-existing conditions
• tax credits, tax cuts and tax exclusions
• Provides a choice of insurance plans
• keep present insurance plans
• choose from an array of private plans
• choose a public plan (not funded by Medicare)
• Quality Improvements to increase efficiencies and decrease costs
• estimates of savings for adopting healthcare IT (HIT) are $100 billion
• promises to adopt EHR
  
• promote preventive health services
• promote chronic care management programs including "medical homes"
• medical homes are not housing but a conceptual model of comprehensive, coordinated care delivery for persons with catastrophic illness
• Fiscal Responsibility
• phase out over-payments to HMO's
• reduce prescription drug costs
• long-term care plan
• tax credit for family care-givers
• improve quality of SNF's
• Incentivize quality through increased federal payments
  

Senator Clinton's (NY since 2000) top domestic priority is providing high quality health care for every US citizen.

Thank you seiu international for use of photo of Clinton w/nurses in Iowa.

Labels: Clinton, universal health care

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Healthline Analysis: Election 2008 - Huckabee's Health Plan [Hint: he doesn't have one]

Governor Mike Huckabee of Arkansas (served 1996-2007) has opinions and ideas about health care but has not, as of this writing, delivered a health care plan. He lost 110 lbs. when he was diagnosed with diabetes and wrote a book to inspire others, Quit Digging Your Own Grave with a Fork and a Knife. Words of wisdom: "...if it wasn't food 100 years ago, it's not food, it's a product."

Unfortunately, that is not enough to craft a health care policy and plan. Some of the ideas about health care he advocates:

• Preventive health care
• Keep health care in the private sector
• Make health insurance portable from one job to the next
  
• Adopt EHR (electronic health records)
• He is concerned about high costs and advocates a consumer base system vs. an employer based system
• Huckabee does not support a woman's right to terminate a pregnancy. Huckabee advocates punishing doctors who perform abortions.
  

He does not mention the 47 million uninsured in the US.

Thank you Amazon.com for use of image.

Labels: election 2008, health policy, Huckabee, weight loss

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Thank you Trent McBride @ pathtalk.org for GrandRounds

Trent McBride writes pathtalk.org, a weblog about pathology, for those of us who are fascinated by all things micro. This week he hosted Grand Rounds 4.16, an illuminating compilation of the best writing in the medical blogosphere. Thank you so much for including my post, 38th World Conference Lung Health: Cape Town, South Africa. Fascinating reading for those of us who are stuck indoors due to inclement weather...

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Healthline Analysis: Presidential Candidates & Their Health Care Plans - Obama

I will do my best over the coming weeks and months to provide an unbiased analysis of the presidential candidates' positions on health care. Here goes with my first installment with the Democratic front runner, Senator Barack Obama of Illinois (elected 2004). Sen. Obama graduated from Harvard Law School in 1991 and taught constitutional law at the University of Chicago before winning a seat in the state senate. In May 2007 he published a 15 page Plan for a Healthy America: Lowering health care costs and ensuring affordable, high quality health care for all.

Obama proposes building on the strengths of our existing program and tackling its weaknesses through partnerships among state and federal governments, employers, individuals and providers.

1. Health Care for All: Universal Coverage by 2012
   
• Obama proposes a new public insurance program to cover people who are not covered by Medicare, SCHIP or their employers.
• Obama proposes creating a National Insurance Exchange for those who want to purchase insurance directly
• Obama proposes mandating coverage for all children
• No one will be denied insurance because of pre-existing conditions or illness
• Obama proposes that the benefits package mirror that received by members of Congress, the Federal Employees Health Benefits Package (FEHBP) [includes preventive care, mental health, maternity, disease management]
2. Improve Quality and Efficiency while reducing Costs
• Reducing costs of catastrophic illnesses to employers and employees
• 75% every health care dollar is spent on chronic health conditions: support disease management programs
• Coordinate and integrate care
• Require transparency about costs and quality
• Promote safety and excellence
• Tackle disparities in health care
• Reform medical malpractice
• Invest in Health IT and EHR
• Increase competition in the insurance and drug industries to reduce costs
3. Strengthen Public Health: Promote Prevention
• Protect and promote healthy behaviors at the federal, state, community, school, employer and family level

Obama's plan differs from the two other leading Democratic candidates in that it is not mandatory for adults - only children. He does not want to force people to break the law over an economic choice. Obama has been outspoken about his support for military troops despite the fact he himself has never served. He has decried the fact that:

• veterans are 7 x more likely than the general population to be homeless
• proposed that all returning troops be screened for PTSD

Obama supports a woman's right to terminate a pregnancy and supports relaxing restrictions on federal financing of embryonic stem cell research. On the global health front, he traveled to his father's native country of Kenya in 2006 and had an HIV/AIDS test to encourage others to be tested. He supports expanded HIV/AIDS research, treatment and access to anti-retroviral medications. Poverty is a major factor in public health and Obama cosponsored the 2005 Multilateral Debt Relief Act.

According to an analysis by The Commonwealth Fund: A Private Foundation Working Toward a High Performing Health Care System, of the three top Democratic candidates, Obama's plan requires the least in expenditures of new revenue:

• Obama: $60 billion
• Edwards, Clinton: $110 billion

A Boston Globe Editorial states that the other two candidates estimates for the costs of insuring 47 million uninsured is "more realistic". The Commonwealth Fund called Obama's plan "comprehensive and multi-pronged." The Kaiser Family Foundation reports that health care is one of the top 5 concerns Americans want to know about from the presidential hopefuls.

Thank you Senator Obama for use of photo Veteran's Speech 4/07 Iowa.

Labels: health care, Obama, policy, universal coverage.

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Healthline in 2008: Dedicated to Improving Health Literacy

The ability to understand and take advantage of all of the advances in medical science has not kept pace with the discoveries themselves. Improving health literacy is a public health priority for the US Surgeon General - and it's a priority for us here at Healthline, too.

Health literacy is a person's ability to understand, access and use healthcare information and services to make appropriate health related decisions. It is estimated that 90 million Americans of all ages, races, socioeconomic and education levels have difficulty understanding and accessing health information. As costs of health care rise, more pressure is put on users of health care to be smart and well-informed. That is where Healthline comes in. We exist to be your partner and help you improve your health literacy for yourself and your loved ones.

In the coming weeks and months, look for announcements about some exciting new products our staff of clinicians and other creative minds have been working hard to develop to make your life easier. I am personally excited about offering some of these products that will go a long way in improving health literacy.

Meanwhile, have you seen or tried our new Tools and Quizzes? I have been a real pain, nagging everyone about getting a BMI calculator onsite since I joined Healthline almost two years ago. Now I have nothing to complain about - we have Risk Assessments A-Z. Be informed before you go into the doctor's office. Be ready to ask smart questions and get good answers. If there is something you don't understand, ask the office staff for further information. And if there is anything we can do to make Healthline better, please let us know. We are here for you.

Thank you Old Shoe Woman for use of photo of doctor's office.

Labels: health literacy, public health

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Healthy Weight 2008

The most important thing about setting a goal to lose weight in '08 is to STICK WITH IT.
To do that - be realistic and set easy target goals. So make your goal

• to lose 5 lbs. for January and each month thereafter until you reach your target weight
• choose any activity that is easy to do and fits into your every day routine - like walking.
  
• Walk up flights of stairs
• Walk to work
• Walk to the store
• Make one healthy dietary change each week
• Example: This week, eat an apple or orange instead of chips for a snack
  
• Every day
• Next week: Eat a salad for lunch
• Every day
• Third week: Skip desserts
• Every day

Taking care of yourself is serious business - it can save you money in terms of health care costs and add years to your life. But don't take yourself too seriously while you are doing it. Have fun, laugh a little. Tell your friends and family - the ones you can trust not to sabotage you! - what your plan is and get their support. Maybe they will join in.

Make '08 the healthiest year ever for you...adding those fruits and vegetables will help decrease your risks of cancer and many other diseases. Take good care of yourself!

Thank you jambo 13 for use of photo Walking in a Winter Wonderland.

Labels: prevention, sickness, weight loss, wellness

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