ACA heads back to court, with health care for millions on the line | MSNBC

Health care hasn’t been a front-burner issue for the political world in recent months, but today in the 5th Circuit Court of Appeals, the fight over the Affordable Care Act returns to the national spotlight.

A panel of federal judges in New Orleans takes up the future of Obamacare on Tuesday, hearing from states that say it’s unconstitutional and from Justice Department lawyers directed by President Donald Trump to oppose the entire law, too.

The Texas v. United States case is as multifaceted as it is important, so let’s dig in with some Q&A.

It’s been a few months since I’ve thought about this and I’m feeling a little rusty. What are we talking about again?

The U.S. Supreme Court already sided with the ACA – twice – but the Republican tax plan changed the policy landscape a bit. As regular readers may recall, when GOP policymakers approved their regressive tax plan, they simultaneously zeroed out the health care law’s individual mandate penalty. And that, in turn, gave several far-right attorneys general an idea: they could once again file suit against “Obamacare,” arguing that the penalty-free mandate is unconstitutional, and given the mandate’s importance to the system, the entire law should be torn down.

That sounds like a rather desperate ploy. Is anyone actually buying this argument?

Yes. Shortly after the 2018 midterm elections, U.S. District Judge Reed O’Connor – a Bush-appointed jurist in Texas – agreed so enthusiastically with the Republican arguments that he struck down the entirety of the Affordable Care Act. That ruling, however, didn’t go into effect, and it’s currently on hold as the appeals process moves forward.

I’ve heard for months that this case was about Republicans trying to get rid of protections for Americans with pre-existing conditions, but it sounds like that ruling was even more sweeping.

Correct. The judge in the case could’ve ruled against the ACA in a narrower way, but he decided instead to take a sledgehammer to the American health care system, because he felt like it, giving Republicans even more than they expected.

Did the ruling make sense?

It did not. Even some conservative legal experts, who’ve been deeply critical of the ACA, have criticized the decision, with one calling it “embarrassingly bad.”

So the 5th Circuit will reverse it, right?

For health-care advocates, that’s certainly the hope. The trouble is, the case will appear before a three-judge panel, and two of the judges were nominated by Republican presidents: one from George W. Bush, the other from Donald Trump. (The third judge in this case was a Carter appointee.)

Didn’t I hear something about a possible standing issue?

The 5th Circuit recently asked both sides in this case to explain why those defending the ACA have the right to participate in the case.

I’m confused. Why wouldn’t they?

Because originally, the case pitted Republican opponents of the health-care law against the Justice Department, which was responsible for defending the ACA. The Trump administration, however, switched sides, endorsed the Republican argument, and asked the judiciary to destroy the existing health care system. Congressional Democrats and several state attorneys general intervened to defend the law, but there’s some question as to whether or not the 5th Circuit will allow them to argue the case.

And if the appeals court rejects the appeal over standing concerns?

Then the lower court ruling would stand and the case would be appealed to the U.S. Supreme Court.

Is that likely?

For now, that’s unclear. It’s possible the 5th Circuit was just being thorough, and once the standing issue is resolved, the case will focus in earnest on the mandate and the question of whether the entirety of the ACA must be torn down. (Even Trump’s Justice Department has conceded that Democrats should be seen as having standing in this case.)

My family has health security because of the ACA and you’re making me awfully nervous.

In the short term, don’t panic. The Affordable Care Act is still the law of the land, the consensus among legal experts is that the case against the law is very weak.

That said, those same legal experts thought no judge in his/her right mind would take the last anti-health-care lawsuit seriously, and three Supreme Court justices endorsed it anyway. The high court is even more conservative now than it was a few years ago.

You’re still not making me feel better.

Well, then let me close with one final observation. The last time the Supreme Court considered the legality of “Obamacare,” it prevailed in a 6-3 ruling. Of the six justices in the majority – Roberts, Kennedy, Ginsburg, Breyer, Kagan, and Sotomayor – five are still on the nine-member bench. It’s why, when push comes to shove, most of the people involved in this fight believe common sense and a sensible approach to the law will ultimately prevail.

Three hours of oral arguments will begin in Louisiana later today.

This content was originally published here.

7 Heart Numbers That Could Reveal Health Risks

Resting heart rate

Your resting heart rate is simply how many times your heart beats per minute while you’re at rest. A lower resting heart rate is associated with a lower risk of death.  That’s because a lower rate is usually a sign of greater cardiovascular fitness. Athletes, for example, are more likely to have a low resting heart rate because they’re in better physical shape. (Certain medications, including beta-blockers used to control blood pressure, can also lower heart rate.) A condition known as bradycardia, in which the heart rate is too slow, occurs most often in older people.

A good time to check your resting heart rate is first thing in the morning, before getting out of bed. Check it regularly; an exercise monitor can help, but you can do it easily without one. Just take your pulse for 15 seconds and multiply by 4. If you notice that the rate is beginning to trend upward, you may need to boost how much you’re exercising. A rise in resting heart rate over a 10-year period was associated with an increased risk of death, according to a study of more than 29,000 participants that was published in the medical journal JAMA. 

For most people, a resting heart rate between 60 and 100 beats per minute is considered normal, but stress, hormones and medication can affect your rate. Although taking a brisk walk, swim or bike ride raises your heart rate temporarily, these activities make the heart more efficient over time. They may also help you lose weight, which can reduce your risk. If you are overweight or obese, your heart has to work to pump extra blood through your larger frame. Over time, an overworked heart muscle gets thicker, which can lead to heart failure. 

Blood glucose level

Your blood sugar level can fluctuate depending on the time of day, what you eat and when you eat. That’s why a fasting blood glucose test is the most commonly used way to take a reading. You want to see a number less than 100. The body’s inability to regulate blood glucose is the primary component of diabetes. As the digestive system breaks down food into sugar, insulin — a hormone made by the pancreas — helps transport blood glucose into your cells. Diabetes develops when there is too much sugar in the blood because the body either fails to make enough insulin or because the body’s cells become resistant to it. Your doctor may also order an A1c blood test, which is the primary screening used in diagnosing and managing diabetes. The A1c test measures a person’s blood sugar levels over the previous three months, and a normal A1c reading is below 5.7 percent.    A low-fat, low-sugar, high-protein diet with plenty of fruits, vegetables and whole grains is the best dietary prescription for keeping blood sugar in check. Ensuring you get enough vitamin D is also critical; in studies, those with the highest levels of vitamin D in their bodies had the lowest risk of developing diabetes. Consider taking a D supplement of between 800 and 2,000 IU per day, and focus on eating high-protein foods such as dairy products fortified with vitamin D. 

Body mass index

Body mass index, or BMI, is a screening tool often used to determine body fat. It’s a ratio of weight to height that, when too high, can classify someone as overweight or obese. The higher the BMI, the greater the risk for heart disease, stroke, high blood pressure, certain cancers and other chronic illnesses. The National Heart, Lung, and Blood Institute offers an online calculator to estimate your BMI. Generally, a BMI score between 18.5 and 24.9 indicates normal weight. Someone with a BMI between 25 and 29.9 is considered overweight; a score of 30 or higher is considered obese, a major risk factor for heart disease. 

But BMI doesn’t always accurately reflect a person’s body composition. Athletes and other people with very muscular builds may have a high BMI but little body fat. On the other end of the spectrum, BMI may underestimate body fat in older individuals who have lost a lot of muscle mass. 

If your BMI is too high, set realistic short- and long-term goals for dropping the excess pounds through healthy eating and exercise. Shedding as little as 5 percent of your body weight can result in significant changes to your health.

Waist circumference

Some experts consider waist circumference a better way to measure body fat than relying on BMI alone, and people who carry fat around their abdomen, instead of on the hips or elsewhere, are at greater risk for heart disease and type 2 diabetes. To measure your natural waist, grab an old- fashioned tape measure and stand without pushing out or sucking in your belly. Wrap the tape measure around your torso just above your hip bones. (If you lean to one side, a crease forms at the point of your natural waist.) Exhale, then measure. In general, men should aim for a waist circumference of less than 40 inches, while women should shoot for less than 35 inches.  


Studies have found that mixing brief bouts of fast walking, running or biking with longer stretches of slower-paced exercise is more effective at burning abdominal fat than only steady-state exercise. 

VO2 max

Unless you’re an athlete, you’ve probably never been tested for VO2 max. But this measurement can give you a unique perspective on your aerobic fitness. The higher the number, the healthier your overall cardiovascular system. (The numbers above represent the 50th percentile of fitness for 70-year-olds in the United States.)

VO2 max is typically measured by having the subject run on a treadmill to the point of exhaustion. But researchers have developed a calculator that allows you to plug in numbers such as your waist circumference and resting heart rate to determine your VO2 max at home. When the researchers tested their calculations against participants’ actual VO2 max tests, the results were remarkably accurate. The online calculator at worldfitnesslevel.org will tell you both your VO2 max score and your “fitness age,” giving you an idea of whether you’re as young as you feel.

Any kind of cardiovascular exercise — whether it’s running, biking, even weight training — done at a high enough intensity will help to improve your overall VO2 max score. 

This content was originally published here.

American Health Care Treats Canadians Who Cannot Wait

Canadian Medicare, our northern neighbor’s universal health care system, generally receives rave reviews from proponents of nationalized or socialized health care, but the Fraser Institute found that more than 63,000 Canadians left their country to have surgery in 2016.

As Americans contemplate overturning our health system in favor of one similar to Canada’s, we must ask why so many leave.

The Canadian system consistently ranks low or lowest across numerous metrics in the Commonwealth Fund’s extensive survey on health care. With regards to specialists and surgeries, the United States ranked best or nearly best.

The Fraser Institute study did not examine where Canadians traveled for surgery, but given proximity and our much better metrics, most probably came here.

Surgeries
are scheduled after patients are seen by the surgeon, and most people see
surgeons only after a referral by either their primary care physician in
America, or their general practitioner in Canada. In the United States, 70% of
patients are able to be seen by specialists less than four weeks after a
referral. In Canada, less than 40% were seen inside of four weeks.

After being advised that they need a procedure done, only about 35% of Canadians had their surgery within a month, whereas in the United States, 61% did. After four months, about 97% of Americans were able to have their surgery, whereas Canada struggled to achieve 80%.

America
is significantly outperforming Canada in surgery wait times even as it’s likely
that tens of thousands of Canadians come here to use the American system.

General surgery, procedures such as appendectomies, cholecystectomies, and hernia repairs, make up the largest portion of those who leave Canada for care. Based on the latest available date from the Organization for Economic Cooperation and Development, the total Canadian case load for many of these procedures is about 10% of America’s.

America’s
health system is certainly flawed and in need of reform, but there is clearly
something working well enough that our system, despite already treating 10
times more cases of appendicitis, can absorb the dissatisfied Canadians.

This
has been a consistent trend since at least 2014, when an estimated 52,513
Canadians left for their medical care. In 2015, the number went down slightly
to 45,619. 2016 exceeded the 2015 number with an estimated 63,459 patients
seeking care elsewhere.

Moreover, both countries have had comparable rates of private health insurance coverage for the past 20 years, roughly 60-70%. But the Canadian private insurance market is entirely supplemental—it covers co-payments for services not covered or not entirely covered by the provincial insurance.

Primary coverage, which is the predominant form of insurance in America, is all but illegal in Canada, and would be under “Medicare for All” as well.

In the United States, government insurance covers gaps left by the private market. Private insurance is the norm and Medicare and Medicaid provide a health insurance safety net for elderly or low-income Americans.

In Canada, government-provided Medicare is the primary form of insurance, and private plans merely fill in gaps in coverage for those with more disposable income or employee benefits. The two systems are mirror opposites of one another.

Health care is a product of the labor of physicians, nurses, technicians, and a whole ecosystem of health care workers. If making the government the primary payer for these services is so smart, why does the universal system next door shed patients by the tens of thousands to ours?

American health care can be improved and should be; American health care performs about middle-of-the-pack for many other items on the Commonwealth Fund survey. There are many inefficiencies, often government-imposed, that increase the cost of health care and restrict the insurance market.

The administration already has loosened some regulations that will give employers more flexibility in providing health benefits and has begun to push for price transparency, which also should bring down costs.

Whatever the case may be, reforming American health care should focus on enabling our strengths. Under no circumstance should we tear it down and build it anew to resemble the system whose citizens escape by the tens of thousands just to be treated in a timely manner.

The post American Health Care Treats Canadians Who Cannot Wait appeared first on The Daily Signal.

This content was originally published here.

World Health Organization declares Ebola outbreak an international emergency | Science | AAAS

An Ebola victim was laid to rest Sunday in Beni in the Democratic Republic of the Congo.

World Health Organization declares Ebola outbreak an international emergency

The World Health Organization (WHO) today declared that the Ebola outbreak in the Democratic Republic of the Congo (DRC), which surfaced in August 2018, is an international emergency. The declaration raises the outbreak’s visibility and public health officials hope it will galvanize the international community to fight the spread of the frequently fatal disease.

“It is time for the world to take notice and redouble our effort,” said WHO Director-General Tedros Adhanom Ghebreyesus said in a statement. “We all owe it to [current] responders … to shoulder more of the burden.”

As of today, Ebola has infected more than 2500 people in the DRC during the new outbreak, killing more than 1650. By calling the current situation a Public Health Emergency of International Concern (PHEIC), WHO in Geneva, Switzerland, has placed it in a rare category that includes the 2009 flu pandemic, the Zika epidemic of 2016 and the 2-year Ebola epidemic that killed more than 11,000 people in West Africa before it ended in 2016.

The declaration does not legally compel member states to do anything. “But it sounds a global alert,” says Lawrence Gostin, a global health lawyer at Georgetown University in Washington, D.C. During the West African epidemic, for instance, the U.S. Congress supplied $5.4 billion in the months after WHO’s emergency declaration.

Even as they declared the emergency, WHO officials attempted to tamp down reactions they said could harm both the DRC’s economy and efforts to stop the outbreak. “This is still a regional emergency and [in] no way a global threat,” said Robert Steffen, the chair of the emergency committee that recommended the PHEIC designation and an epidemiologist at the University of Zurich in Switzerland, during a press teleconference today. He added in a written statement: “It is … crucial that states do not use the PHEIC as an excuse to impose trade or travel restrictions, which would have a negative impact on the response and on the lives and livelihoods of people in the region.”

The DRC’s minister of health, Oly Ilunga Kalenga, issued a statement accepting the declaration but expressing concern about its motives and the potential impact on his country. “The Ministry hopes that this decision is not the result of the many pressures from different stakeholder groups who wanted to use this statement as an opportunity to raise funds for humanitarian actors,” Kalenga wrote. He said such funds could come “despite potentially harmful and unpredictable consequences for the affected communities that depend greatly on cross-border trade for their survival.”

Steffen’s committee previously declined three times, most recently last month, to recommend that WHO declare the outbreak an international emergency. What changed, he said today, was the 14 July diagnosis of a case of Ebola in the large, internationally connected city of Goma, from which 15,000 people cross the border into Rwanda each day; the murders last weekend of two health workers in the city that is currently the Ebola epicenter of the DRC; a recurrence of intense transmission in that same city, Beni, meaning the disease now has a geographical reach of 500 kilometers; and the failure, after 11 months, to contain the outbreak.

Funding is also at issue. In June, WHO announced its funding to fight the outbreak fell $54 million short; today, accepting the emergency committee’s recommendation, Tedros said the funds needed to stop the virus “will run to the hundreds of millions. Unless the international community steps up and funds the response now, we will be paying for this outbreak for a long time to come.” (A written report from today’s meeting added: “The global community has not contributed sustainable and adequate technical assistance, human or financial resources for outbreak response.”)

When the first known Ebola case in Goma was diagnosed this week, concern spiked about international spread. In addition to being a metropolis of nearly 2 million people where Ebola may spread quickly and be difficult to trace, Goma has an international airport. Separately today, the government of Uganda, in conjunction with WHO, issued a statement describing the case of a fish trader who died of Ebola on 15 July; she had traveled from the DRC to Uganda on 11 July before returning to the DRC.

“Although there is no evidence yet of local transmission in either Goma or Uganda, these two events represent a concerning geographical expansion of the virus,” Tedros said. The risk of spread in DRC, [and] in the region, remains very high. And the risk of spread outside the region remains low.”

Last month, the outbreak’s first known Ebola fatalities outside the DRC were reported in a 5-year-old boy and his grandmother. The two had traveled from the DRC to Uganda after attending the funeral of a relative who died from Ebola.

Health officials are also worried about the safety of those battling the outbreak. Since January, WHO has recorded 198 attacks on health facilities and health workers in the DRC, killing seven, including two workers who were murdered during the night of 13-14 July in their home in Beni. The two northeastern DRC provinces that have experienced the outbreak are also plagued by poor infrastructure, political violence, and deep community distrust of health authorities.

Josie Golding, epidemics lead at the Wellcome Trust in London applauded the declaration of the public health emergency. “There is a grave risk of a major increase in numbers or spread to new locations. … This is perhaps the most complicated epidemic the world has ever had to face, yet still the response in the DRC remains overstretched and underfunded.”

Gostin called the declaration “long overdue. Until now the world has turned a blind eye to this epidemic. WHO has been soldiering on alone, bravely alone. And it’s beyond WHO’s capacity to deal with all of this violence and community distrust.”

PHEICs are governed by the International Health Regulations, a global agreement negotiated in the wake of the 2003 SARS outbreak. The regulations, in force since 2007, stipulate that a PHEIC should be declared when an “extraordinary” situation “constitute[s] a public health risk to other States through the international spread of disease” and “potentially require[s] a coordinated international response.”

WHO officials also today addressed the thorny conflict over whether a second, experimental Ebola vaccine, in addition to a Merck vaccine that has already been given to 161,000 people in the DRC, should be deployed there now. Officials worry that Merck’s stockpile—although it is being stretched by reducing the dose of the vaccine being given to each recipient—will be depleted before the outbreak ends. But on 11 July, Kalenga gave a firm “no,” rejecting the use of any new experimental vaccine in the country because of unproven effectiveness and the potential for public confusion. (A Johnson and Johnson [J&J] vaccine that has been shown to be safe in healthy volunteers is waiting in the wings and its use has been advocated for by several infectious disease experts.)

But today, Michael Ryan, the executive director of WHO’s Health Emergencies Programme, said the organization still supports introducing the J&J vaccine if it can win “appropriate national approval.” “The Ministry has expressed concern about introducing a second vaccine … mainly around the issue of confusion in the local population. We are working through those issues about where and when the vaccine could be used,” Ryan said.

David Heymann, an infectious disease epidemiologist at the London School of Hygiene and Tropical Medicine, and formerly WHO’s assistant director-general for Health Security and Environment, said today’s emergency declaration may have set a precedent. “The Emergency Committee appears to have interpreted the need for funding as one of the reasons a PHEIC was called—this has not been done in the past.”

This content was originally published here.

Child detention is a mental health crisis

The children who have been detained in overcrowded, squalid migrant camps at the border aren’t just facing poor living conditions. They are also facing higher risks of serious mental health problems, some of which could be irreparable.

The big picture: Children are fleeing life-or-death situations in their home countries, and instead of healing their psychological and emotional trauma, federal officials are exacerbating the damage through means that the medical community views as flagrant violations of medical ethics.


The literature is clear: People who seek asylum and are detained in immigration camps, especially children, suffer “severe mental health consequences.” Those include detachment, depression and post-traumatic stress disorder, which put them at higher risk for committing suicide.

What they’re saying: Medical professionals remain appalled at what they’ve seen and are raising alarms the U.S. immigration system is still needlessly hurting the already vulnerable mental health of these kids.

  • Marsha Griffin, a pediatrician in Texas, visited the Ursula detention center in late June with colleagues from the American Academy of Pediatrics. She recalled a young boy in a cage crying because his father had been taken to court and he had lost his aunt’s phone number. Another child relinquished his space blanket, saying it led to nightmares. “This is child abuse and medical neglect,” Griffin said.

Between the lines: Parents and other adult caregivers are usually the only source of stability for children. Every expert interviewed said separating them in any capacity is psychologically damaging and morally intolerable.

  • “The children who are separated — I’m speechless,” said Rachel Ritvo, a child psychiatrist who has practiced at Children’s National Medical Center. “That was what was done in slavery. That’s what was done in the Holocaust.”

The bottom line: “Most kids will have lasting scars from what they have seen or are enduring right now,” said Wes Boyd, a psychiatrist and bioethicist at Harvard Medical School who has evaluated more than 100 asylum seekers in the past decade. “They’re going to need as much medical help as they do legal help.”

Go deeper: Growing up, and parenting, as a refugee

This content was originally published here.

A Black Immigrant Woman Is Now the Most Powerful Health Official in California

It was an early summer morning at the San Ysidro Health Center, situated on the Mexican border. A flu outbreak gripped a nearby ICE detention center, where a larger humanitarian crisis continued to unfold, threatening the future of hundreds of children.

In a small conference room, brimming with 20 or so of the San Diego area’s most diverse academic and activist minds, Nadine Burke-Harris sat at the head of the table. The 43-year-old pediatrician from San Francisco was appointed by Gov. Gavin Newsom to become California’s first-ever state surgeon general in February. The role is part policymaker, part spokesperson, and full-time advocate for the state’s public health. All of which were needed to protect children at the border, as Burke-Harris later opined in the Washington Post.

In a country where Black people, immigrants, and women all report being unseen by medicine—in research, in practice, and in policy—Burke-Harris is all three. And she is poised to become one of the most powerful women in U.S. state-level government. Ever.

With that new leverage, Burke-Harris has heaved her political and medical capital not toward the expected battle cries—curing cancer, ending HIV infection, or undoing the opioid crisis—but on an affliction which most people don’t even know they experience: toxic stress. “I am not a surgeon general who is going to just tell people to eat right and exercise,” she said.

To Burke-Harris, toxic stress is not about enduring a long line at Starbucks, being ghosted, gentrification, or negativity. It cannot be cured by a warm bath, a juice cleanse, exercise, or meditation. It’s what she calls “higher allostatic load”: the ongoing wear and tear from structural instability, and it bears heavily on people of color, women, queer people, homeless people, poor people, and anyone whose existence is systematically marginalized. This is called John Henryism or weathering, and is worse than a cradle-to-grave crisis: It’s womb-to-grave.

1563380802783-IMG_9230

Burke-Harris, pictured left, visiting with community members. Image: Office of the Governor

Black women in the U.S. have double to triple the likelihood of giving birth to a premature child as their white counterparts, quadruple the risk of dying in childbirth, and double the risk of their infant dying within the first year after birth. Meanwhile, a 2018 research letter in the Journal of the American Medical Association flagged the suicide risk of black boys aged 5 to 11 as triple that of white boys. Working-class men of color who escape the school-to-prison for-profit pipeline must try 16 times harder to get a therapy appointment than a middle-class white woman. A 2016 Journal of Health and Social Behavior study found that 30 percent of therapists responded to calls for help from middle-class white people, 21 percent to middle-class black women, and 13 percent to middle-class black men.

And on top of it all, a culture of intolerance makes the toxic stress even worse, what with BBQ Beckys, the outcries over a black Little Mermaid, the stigmatization of black athletes and their strength, and the everyday silencing of black pain. And the racial divide is widening.

It’s a good thing, then, that Burke-Harris has been readying herself for a role like this for her whole adult life. Burke-Harris was born in Canada to Jamaican parents; her father brought the family to Palo Alto when he got a Fulbright to teach biochemistry at Stanford. But she knows what it feels like to never feel quite settled in a country. She watched her mother nurse a brother’s 105-degree fever rather than go to the hospital, fearing it might endanger their immigration status. Nonetheless, she climbed quickly: undergrad at Berkeley, medical school at UC Davis, a public health degree at Harvard, and a residency at Stanford, where she was the only black person in her class. In medical school, someone assuming she was a janitor barked that she should “get a mop and mop up that mess.” She declined.

When asked if it’s stressful—as a public official, as a woman, as a minority, as an immigrant—to shoulder California’s hopes, she resists. “Why would I choose that when I can choose joy?” she said.

But Burke-Harris isn’t an advocate in the way one might presume. At the luncheon in San Diego, her telling of a story about an asthmatic 10-year-old girl took a sharp turn from anecdote to diagnosis, casually racing through medical specifications. She paused. “I’m new to public office,” she said unapologetically. “I’m a doctor.” The room erupted in laughter—Burke-Harris’s as well.

She debuted in the national consciousness as many these days do, via a viral video. In her TED talk—watched 2.3 million times since it posted in 2015—she discussed a kind of man-made pathogen tied to 7 out of the top 10 causes of death in the U.S. “Folks who are exposed in very high doses have triple the risk of heart disease and lung cancer,” she said, “and a 20-year difference in life expectancy.” The talk was about childhood trauma and toxic stress, which she later outlined in more detail in her book, The Deepest Well. The clinic she ran in one of the worst neighborhoods in San Francisco has been envied nationally and mimicked—badly—in New York.

But for all her scientific rigor, she is full of surprises. “Did you see Night School?” she asked me in the car, racing between back-to-back meetings. “There’s a scene in there where Tiffany Haddish asks Kevin Hart ‘What happened to you?’ instead of ‘What’s wrong with you?’ I’m probably the only person who cheered the medical accuracy there.”

Her friends say it’s not by chance that she reached this level. “Even back then, it was clear that she was guided by a fierce desire to help those who could not help themselves,” said Vivek Murthy, who, at 37, became the nation’s youngest-ever U.S. Surgeon General in 2014. Murthy and Harris-Burke are fellow alumni in the Soros Fellow program and share a dorky coffee mug with their faces on it. And they are aligned on their approach to health. “For most people and policymakers, prevention is less tangible than treatment,” Murthy said. “It’s much easier to picture treating someone with a heart attack than it is to imagine altering the complex threads that determine whether a future heart attack occurs.”

Kimberlydawn Wisdom is Michigan’s state surgeon general, the first state SG in the country, and a close friend. She said Burke-Harris’ appointment is a dream outcome. “California has the power to change the game as no other state,” Wisdom said. “Suddenly I can picture, in my own lifetime, every state and territory having their own surgeon general. It’s just too bad there’s only one Nadine. She’s proof that we’re evolving as a society to include not just diversity but also different perspectives, the true strength of real diversity.”

In her TED talk—watched 2.3 million times—she discussed a kind of man-made pathogen tied to 7 out of the top 10 causes of death in the U.S.

California’s reputation as a game-changer is well-earned. In 1990, San Luis Obispo, nestled in the central part of the state, became the first city in the world to ban all indoor smoking in public places, including bars and restaurants; California was the first state to ban smoking in the workplace in 1995 and, in June, Beverly Hills became the first U.S. city to ban tobacco sales.

California similarly has been a leader in requiring LGBTQ history in schools and banning gay conversion therapy, pushing for over-the-counter access to PrEP for HIV, legalizing medical and recreational marijuana, and pioneering needle exchanges. Pregnant Californians are entitled to four months of paid leave and new parents get three months (unpaid) to bond with their newborn, compared to the federal law, which doesn’t protect any amount of time. This year, California also passed a law much more revealing of baked-in bigotry: it became the first state to ban race-based hair discrimination.

Back in San Ysidro, Burke-Harris toured a maternal health building, complimenting breastfeeding posters (some in Tagalog), praising a cooking program that teaches recipes based on local grocery coupons, and asking lab technicians what software they’re using. But it was later, meeting with other pediatric activists, that the impact of her training became clear. “Working with children, we’re working with families and working with generations,” she said.”There’s a built-in comprehensiveness.” It makes for one hell of a training ground for public policy.

But before launching any new programs, Burke-Harris wants more data, so she helped pass a law requiring all recipients of Medicaid in California to have their Adverse Childhood Experience (ACE) scores evaluated and reported. This provides a metric through which to measure toxic stress.The program is $45 million to implement and $60 million to follow through over three years.

1563381172475-nbh2

Burke-Harris visiting with community members. Image: Office of the Governor

That’s music to Bruce Baldwin’s ears. Baldwin, a 63-year-old tobacco prevention treatment coordinator in California’s rural north, always thought early experimentation with alcohol and stronger drugs—beginning at 12—derailed his life. People would tell him to “be a man, tough it out.” But then he got sober, and his problems remained. It was only with more awareness that he realized his ACE score—the impact of an impoverished childhood without a mother—played a part too. “ACE scores go back further than you can even remember. Your body remembers, though.” He’s hoping Burke-Harris’ impact will help more people like him. “She changed my life with a YouTube video,” he said of her TED talk. “Imagine what she’ll be able to do with real power.”

As both of us packed our things into TSA trays at San Diego’s airport, I asked Burke-Harris to name something she wanted to be common knowledge a generation from now. “Heart attacks start in childhood,” she said without hesitation. “That’s why this is so important. It is the root of the root of pretty much every root. It’s where, how, and why everything begins.”

I asked her about her frequent analogy that toxic stress will be for the 21st century what infectious diseases were to the 20th century. Does that mean her goal is to be the Jonas Salk of our time?

“Yes,” she said with searing determination, her eyes aglow with the superpower of being seen. “That’s exactly what I want to do.”

This content was originally published here.

Study: Psychiatric Diagnoses Are ‘Scientifically Meaningless’ In Treating Mental Health – Study Finds

LIVERPOOL, England — No two people are exactly alike. Therefore, attempting to classify each unique individual’s mental health issues into neat categories just doesn’t work. That’s the claim coming out of the United Kingdom that is sure to ruffle some psychologists’ feathers.

More people are being diagnosed with mental illnesses than ever before. Multiple factors can be attributed to this rise; many people blame the popularity of social media and increased screen time, but it is also worth considering that in today’s day and age more people may be willing to admit they are having mental health issues in the first place. Whatever the reason, it is generally believed that a psychiatric diagnosis is the first step to recovery.

That’s why a new study conducted at the University of Liverpool has raised eyebrows by concluding that psychiatric diagnoses are “scientifically meaningless,” and worthless as tools to accurately identify and address mental distress at an individual level.

Researchers performed a detailed analysis on five of the most important chapters in the Diagnostic and Statistical Manual of Mental Heath Disorders (DSM). The DSM is considered the definitive guide for mental health professionals, and provides descriptions for all mental health problems and their symptoms. The five chapters analyzed were: bipolar disorder, schizophrenia, depressive disorders, anxiety disorders, and trauma-related disorders.

Researchers came to a number of troubling conclusions. First, the study’s authors assert that there is a significant amount of overlap in symptoms between disorder diagnoses, despite the fact that each diagnosis utilizes different decision rules. Additionally, these diagnoses completely ignore the role of trauma or other unique adverse events a person may encounter in their life.

Perhaps most concerning of all, researchers say that these diagnoses tell us little to nothing about the individual patient and what type of treatments they will need. The authors ultimately conclude that this  diagnostic labeling approach is “a disingenuous categorical system.”

“Although diagnostic labels create the illusion of an explanation they are scientifically meaningless and can create stigma and prejudice. I hope these findings will encourage mental health professionals to think beyond diagnoses and consider other explanations of mental distress, such as trauma and other adverse life experiences.” Lead researcher Dr. Kate Allsopp explains in a release.

According to the study’s authors, the traditional diagnostic system being used today wrongly assumes that any and all mental distress is caused by a disorder, and relies far too heavily on subjective ideas about what is considered “normal.”

“Perhaps it is time we stopped pretending that medical-sounding labels contribute anything to our understanding of the complex causes of human distress or of what kind of help we need when distressed.” Professor John Read comments.

The study is published in the scientific journal Psychiatry Research.

This content was originally published here.

Why having a sister is good for your mental health | I Heart Intelligence.com

Sure, she can often drive you crazy by using your stuff without asking permission, singing annoyingly, or taking the last piece of candy. At the same time, however, she is one of your closest, most trusted supporters, a true friend, a play buddy, and a great accomplice in pranks.

Of course, we could be listing such wonderful sister qualities endlessly.

But what many people don’t think about is the connection between having a sister and our mental health.

So, if you haven’t called your sister recently to tell her how much you love her, you are about to be given a good reason to do so. Sisters can improve our mental health, and this is how it all works.

А 2010 Brigham Young University Brigham Young University study discovered having a sibling encouraged children to be more kind and helpful. And apparently, if you have a sister, regardless of the age gap, it’s even better.

The research involved 395 families with two or more children, including at least one child between the ages 10 and 14. The adolescent child was filmed while giving answers to questions about a sibling closest in age. A year later, researchers followed up with the families.

“What we know suggests that sisters play a role in promoting positive mental health,” Alex Jensen, an assistant professor at the School of Family Life at BYU, told Motherly, “and later in life they often do more to keep families in contact with one another after the parents pass.”

In addition, the study discovered that having a sister can help you become a kinder and more giving person.

This is due to the fact that sisters promote positive social behaviors such as altruism and compassion when they show love and affection.

But that doesn’t mean that brothers don’t matter. The study found that loving siblings impact each other positively no matter their gender or age differences.

“Sibling affection from either gender was related to less delinquency and more pro-social behaviors like greater kindness and generosity, volunteering, and helping others,” the study’s lead author, BYU professor Laura Padilla-Walker, told ABC News. “Even if there is a little bit of fighting, as long as they have affection, the positive will win out. If siblings get in a fight, they have to regulate emotions. That’s an important skill to learn for later in life.”

Do you have a sibling? If so, how would you describe your relationship? Share your stories with us in the comment section below.

This content was originally published here.

Guns and public health: Applying preventive medicine to a national epidemic – CBS News

It happened again … twice in less than twenty-four hours. Are any of us surprised? And can anybody help?

When a panel of seven doctors was asked how many had seen a gunshot victim within the past week, three hands went up. “I think people think that if their loved one gets to the hospital, that there’s magic there. But sometimes it’s just too much for us,” said Dr. Stephanie Bonne.

If there was ever a time for preventive medicine, it’s now, says a group of doctors. 

“A grandfather was shot yesterday,” said Dr. Roger Mitchell. “A son was shot yesterday. Yesterday – a mother was shot yesterday. And then the day before that, there were five other people that were shot that were connected to Americans in this country.”

They’ve had enough, and seen enough.

“The only thing worse than a death is a death that can be prevented,” said Dr. Ronnie Stewart. “And to go and talk to the mom of a child who was normal at breakfast and now is not here, is the worst possible thing. And honestly, it drives us to address this problem.”

Drs. Stewart, Boone and Mitchell, along with Drs. Albert Osbahr, Niva Lubin Johnson, Chris Barsotti and Megan Ranney were in Chicago this past winter as more than 40 medical organizations, who normally operate separately, joined forces to address the 40,000 firearm-related deaths that occur each year.

Nothing like this has ever happened, they said. “And we recognize that this is an epidemic that we can address,” said Dr. Barsotti.

Their meeting followed a tweet from the National Rifle Association last November that helped fuel a movement: “Someone should tell self-important anti-gun doctors to stay in their lane.”

Someone should tell self-important anti-gun doctors to stay in their lane. Half of the articles in Annals of Internal Medicine are pushing for gun control. Most upsetting, however, the medical community seems to have consulted NO ONE but themselves. https://t.co/oCR3uiLtS7

— NRA (@NRA)

In response, Dr. Bonne, a trauma surgeon in Newark, N.J., snapped a picture pof the waiting room and posted it to Twitter along with this message: “Hey, N.R.A., do you wanna see my lane? Here’s the chair that I sit in when I tell parents that their kids are dead.”

Hey @NRA ! Wanna see my lane? Here’s the chair I sit in when I tell parents their kids are dead. How dare you tell me I can’t research evidence based solutions. #ThisISMyLane #ThisIsOurLane #thequietroom pic.twitter.com/y7tBAuje8O

— Stephanie Bonne (@scrubbedin)

“And you hit send. And then what happens?” asked medical correspondent Dr. Jon LaPook.

“I was part of a chorus,” Dr. Bonne replied.

A chorus of thousands of medical professionals who responded #ThisIsOurLane.

“Our motto is do no harm, for physicians. But I think the community felt that harm was being done to us by that tweet,” said Dr. Lubin-Johnson.

Dr. Ranney said, “I remember sitting there and thinking, how can you lecture docs, many of whom are gun owners, about what we do and don’t know?”

Dr. Ranney is chief research officer for Affirm, an organization trying to address gun violence through the same tools doctors use to combat problems like obesity, the opioid crisis, and heart disease.

This public health approach is not new: in the 1950s, doctors worked with the auto industry to help make cars and roads safer. In the ’60 and ’70s, they spoke out against the dangers of tobacco; and in the ’80s and ’90s, to combat HIV and AIDS, they promoted safe sex and research.

Today, the focus is gun violence in all its forms. It may surprise you to know that mass shootings make up less than 1% of firearm-related deaths. The leading cause is suicide, followed by homicide, and then accidents.

But good answers on how best to prevent these deaths are hard to come by. That’s because of 1996 legislation defunding any research at the Centers for Disease Control and Prevention promoting gun control.

Rep. Jay Dickey (R-Ark.), who appended an amendment to a spending bill disallowing government funds from beings used to, in whole or in part, advocate or promote gun control, told the House, “This is an issue of federally-funded political advocacy … a[n] attempt by the CDC to bring about gun control advocacy all over the United States.” $2.6 million from the CDC’s budget was re-allocated, and it had a chilling effect on almost all firearm research. 

“What was lost was 20-some years of effort to understand and prevent a huge health problem,” said Dr. Garen Wintemute, whose work on handgun violence lost government funding after Congress passed that 1996 legislation. “Consciously, deliberately, repeatedly, over and over, we turned our back on this problem. It’s as if we, as a country, had said, ‘Let’s not study motor vehicle injuries. Let’s not study heart disease or cancer or HIV/AIDS.’

“And the result, I believe, is that tens of thousands of people are dead today whose lives could have been saved if that research had been done.”

In 2018, Congress said government dollars could be used to research gun violence, just not to promote gun control. But Dr. Wintemute says federal research into gun violence is still underfunded.

While private donations for research are now increasing, Dr. Wintemute has over the years spent more than $2 million of his own money to continue his research at the University of California-Davis.

Dr. LaPook asked, “Are you a wealthy man who can afford to just do that, as a rounding error?”

“It’s not rounding error,” he laughed. “But I live a very simple life. I earn an academic sector, ER doc’s salary.”

“So, you are changing your lifestyle in order to fund this research or have in the past?”

“Yes, that’s correct.”

“What drives you to do that?”

“People are dying,” Dr. Wintemute replied. “Given the capacity to do it, how can I not? It really is just that simple.”

His work has led to some surprising conclusions. For example, his studies revealed that in some states comprehensive background checks as implemented had no effect on the number of firearm-related deaths. That’s in part because of a lack of communication among agencies.

“We have learned that probably hundreds of thousands of prohibiting events every year do not become part of the data that the background checks are run on,” Dr. Wintemute said.

Consider the 2017 shooting of 46 parishioners at a church in Sutherland Springs, Texas. Due to a domestic violence conviction, the shooter should had been stopped from buying any guns, but that information was never shared with the FBUI, which oversees the background check system.

“So you think, okay, it’s not as effective as we want, but it can become effective if we do A, B, and C?” Dr. LaPook said.

“There’s no question about it,” Dr. Wintemute replied.

But it’s policy proposals from doctors on issues like background checks and registrations that concern gun-rights advocates.

Dr. LaPook said, “The point the N.R.A. was trying to make with its [“stay in your lane”] tweet was, what makes doctors experts on gun policy?”

“Doctors are not experts on gun policy unless they do their homework,” said Dr. Wintemute. “What doctors are experts on is the consequences of violence. If doctors choose to be, they can become experts on policy.”

When asked if advocating for gun control part of the mission of Affirm, Dr. Megan Ranney said no. “This is about stopping shooters before they shoot,” she said.

The NRA did not respond to “Sunday Morning”‘s repeated requests for an on-camera interview. However, in a phone conversation earlier this year, two representatives said the organization does support research into gun-related violence, but expressed concern that – say what they will – the ultimate goal of many who advocate such research is to take away the guns of responsible citizens.

Dr. Ronnie Stewart said, “We’re not well-served by this overly-simplistic view of simply two sides fighting each other. We have to work together. And that includes engaging firearm owners as a part of the solution, not a part of the problem.”

For these doctors, the issue isn’t about whose lane it is; it’s about what they can do.

As Dr. Stephanie Boone said, “I know that the house of medicine can fix this.”

And, Dr. Albert Osbahr added, “Enough is enough.”

       
For more info:

       
Story produced by Dustin Stephens.

This content was originally published here.

How Democrats’ ‘Medicare For All’ Will End Your Health Choices Forever

Half of the Democratic presidential contenders taking this week’s debate stage support Sen. Bernie Sanders’ ambitious government takeover of health care, a plan dubbed “Medicare for All.” Current polls show that as many as 70 percent of Americans are willing to jump on the Medicare for All bandwagon, so they’re just giving the people what they want.

But polls also show that Americans who are more likely to support the proposal are also less likely to understand it. When the nation faces the prospect of a total health care overhaul, that’s a frightening thought.

Many developed nations are struggling with government-managed health care, but Sanders’ proposal goes further toward a reckless single-payer system than anything ever tried around the world. The astronomical $33 trillion price tag alone, which Bernie has no concrete plan to fund, will be paid for by generations of Americans. Costs aside, the rosy benefits under Bernie’s proposal, in which the government supposedly covers everything from surgery to dental care, would prove costly in more ways than one.

While many developed nations are currently struggling with their single-payer systems, no one has ever attempted a program as far-reaching as Sanders’ Medicare for All proposal, which seeks to abolish all private insurance and replace it with a government-managed system that completely pays for all procedures. According to its proponents, including leading presidential candidates Kamala Harris, Cory Booker, Sanders, and Elizabeth Warren, organizing all insurance under the government would reduce administrative costs. But in reality, we’d simply be throwing gasoline on a fire.

For one thing, the U.S. government doesn’t have a stellar record of efficiency or quality in health-care management. Just look at the Department of Veterans Affairs’ utter neglect of veteran’s healthcare. Even if Sanders could miraculously fix government mismanagement, his idea of eliminating all cost-sharing between the insurer and the health-care consumer has been proven to worsen costs.

Already, the majority of our health-care spending goes toward only 5 percent of the population, most of whom suffer from preventable chronic illnesses. When President Obama eliminated surcharges for pre-existing conditions, people lost their financial reward for living healthily. Unsurprisingly, life expectancies have fallen in the past years (due to preventable conditions), and health-care costs have grown. Today, over half of health-care is spent on 5 percent of the population, largely on preventable chronic conditions.

Bernie and co. are now proposing to take this failed idea to an extreme: eliminating all personal responsibility for health care. Under his plan, consumers could get a medical procedure done, or new glasses, orthotics, or teeth cleanings, all for free, whether or not the procedures are medically necessary.

An extensive economic study by the RAND Corporation proved just as much: without cost-sharing, consumers are likely to drive up the tab by getting more care than they need. In other words, Bernie’s plan would cost even more than $33 trillion. Although, at that point, what’s a few trillion dollars anyway—right?

The alternative Bernie could offer—rationing services—would be equally harmful. Many nations with single-payer have already been forced to ration their care due to the overwhelming burden of paying for everyone. In Canada, more than 1 million people are waiting for some type of procedure. In the United Kingdom, people are unable to receive a life-changing corrective surgery for their blindness.

To strike a balance between draconian rationing and prodigal spending, the United States has, for decades, successfully employed a freer system. When people have to pay for their choices, whether that’s the choice to have an elective operation or the choice to live unhealthily, everyone makes the choice right for them—without imposing the cost of their choice on anyone else. While 71 percent of Americans appreciate their current private insurance, under Bernie’s plan, they’d no longer have that choice.

Now that many top Democratic presidential hopefuls have rallied behind Bernie’s radical proposal, the American voter is left with their own choice: Do we want an expensive and deeply flawed overhaul of a life-saving sector, or should we continue to try and fix our free market system, which has produced the best specialty care in the world?

If the folks on this week’s debate stage get their way, this may be the last health-care decision you ever get to make.

This content was originally published here.