sacrificing children for corporate profits

Nice, GW Bush & Co. want fewer middle class children covered under state health insurance programs because he doesn't want those programs competing with the private insurers. Instead, he'd rather see more middle class families in bankruptcy from medical bills -- after all that's the American way!

The Bush administration, continuing its fight to stop states from
expanding the popular Children’s Health Insurance Program, has adopted
new standards that would make it much more difficult for New York, California and others to extend coverage to children in middle-income families," according to the NY Times.

After learning of the new policy, some state officials said
yesterday that it could cripple their efforts to cover more children
and would impose standards that could not be met. “We are
horrified at the new federal policy,” said Ann Clemency Kohler, deputy
commissioner of human services in New Jersey. “It will cause havoc with
our program and could jeopardize coverage for thousands of children.”

The Children’s Health Insurance Program has strong support from governors of both parties, including Republicans like Arnold Schwarzenegger
of California, Tim Pawlenty of Minnesota and Sonny Perdue of Georgia.
When the Senate passed a bill to expand the program this month, 18
Republican senators voted for it, in defiance of a veto threat from Mr.
Bush. The House passed a more expansive bill and will try to work out
differences with the Senate when Congress reconvenes next month.

Bush is also demanding that children go one year without any health insurance before being enrolled in the state programs and is short-funding the program....

The Congressional Budget Office
has said that the president’s budget, which seeks $30 billion for the
program from 2008 to 2012, is not enough to pay for current levels of
enrollment, much less to cover children who are eligible but not
enrolled.

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Diabetes and Metabolic syndrome

I have so many patients with diabetes and metabolic syndrome -- and so many of them don't even understand the disease. Now here is a good article from the New York Times that points out, most diabetics aren't being managed properly if blood sugar is the only focus.

But in focusing entirely on blood sugar, Mr. Smith ended up
neglecting the most important treatment for saving lives — lowering the
cholesterol level. That protects against heart disease, which eventually kills nearly everyone with diabetes. He also was missing a second treatment that protects diabetes patients from heart attacks — controlling blood pressure. Mr. Smith assumed everything would be taken care of if he could just lower his blood sugar level.Blood
sugar control is important in diabetes, specialists say. It can help
prevent dreaded complications like blindness, amputations and kidney
failure. But controlling blood sugar is not enough.

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On the front lines...

Whether we like it or not, it seems we are increasingly going to be relied upon to deliver our own health care in the home setting. In that trend the visiting nurse is invaluable -- and so of course she's paid less and has twice as much responsibility. To get an idea of what home health nurses are up to, check out the great profile by the New York Times, Soldiering On, Home to Home, in a Squeezed Health System.

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No Rest for the Inflicted

Nice little essay from the New York Times about how little rest you get in a hospital. At my hospital most patients get single rooms which helps, but we do tend to bug them at relentless intervals. The computer that times out medications for what seems like every hour is one culprit -- I have often retimed medication passes to cluster my care -- that said, we do tend to gab a bit loud at the nurses station and forget what it is like to be on the other side.

"Every interaction, no matter how brief, takes energy, something many patients have very little of, even while we try to be as pleasant as our pain, weariness and fear allow...

But sleep proved frustratingly elusive. Cellphones rang day and night. Patients, nurses, physicians and visitors talked loudly. Outside our window, cranes whined and clanked on a construction site, and workers’ voices clearly carried up five floors.

Add to this ambient noise the daily crowd moving in and out of our room. Someone asking if I wanted television, phone or Internet service, a chaplain, phlebotomists coming to take blood, the young woman changing our linens, orderlies, the janitor and ever-changing nurses.

Almost everyone had a question that needed answering, and quickly, not easy when you’re scared, tired, in pain or heavily medicated. Each encounter required my attention, a decision and my civility at the least. No one wants to be the monosyllabic “difficult” patient, but it takes a lot of energy to be friendly to so many people... Several of those unplanned visits offered great comfort, like a young male nurse offering me hot tea and a turkey sandwich at 3 a.m. and a gentle 15-year nursing veteran who swaddled my aching chest to ease the pain. But the next time I really need a rest, I’m going to try to stay home."

Kill More MRSA With Honey...

FDA recently approved the use of honey as a topical antibacterial, according to this article in the Washington Post. Of course honey was used for thousands of years for this purpose before antibiotic came along. That said, there are some logical reasons why honey is effective in wound care unlike some other medicinal claims.

"All honey is medicinal to some extent. Its low water content allows it to draw fluid away from wounds; its high sugar content makes it difficult for microorganisms to grow. What's more, worker bees secrete an enzyme, glucose oxidase, into nectar, which releases low levels of the disinfectant hydrogen peroxide when honey makes contact with a damp surface such as a wound.

Not all honeys are equal, though. Manuka appears to have a poorly understood antimicrobial ingredient, dubbed its Unique Manuka Factor (UMF)."

Honey has been in use as a wound application for several years in UK and New Zealand hospital and seems particularly useful in treating MRSA and post surgical infections. Antibacterial resistance is a growing problem and it is hoped honey can fill the void, according to the Washington Post.

"The European Journal of Medical Research reported in 2003 that honey had an 85 percent success rate in treating infected post-op Caesarean wounds, compared with a 50 percent success rate for conventional interventions.

At the May meeting of the European Wound Management Association, researchers presented the results of a small Irish study that compared the effects of manuka honey and a commonly used hydrogel dressing on 100 patients with chronic leg ulcerations. Those patients treated with manuka dressings experienced a higher rate of cleansing and faster healing than those who used the hydrogel dressing. Ten of the patients had ulcers colonized with MRSA. After four weeks, seven of those 10 wounds no longer showed the bacteria's presence."

H2 Blockers and Mental Decline

This story from WebMD is interesting - a correlation of those taking H2 acid blockers and dementia.

According to Indiana University researcher Malaz Boustani, MD, MPH, and colleagues. "Patients had two to two-and-a-half times the odds of having a deficit in their cognitive performance [if they took over the counter H2 blockers]. It ranged from mild to potentially severe dementia similar to Alzheimer's disease."

Boustani, a gerontologist, noticed that his elderly patients sometimes appeared confused after taking over-the-counter H2 blockers.

He's not the first to notice this. Histamine-blocking drugs such as some kinds of antihistamines or H2 blockers often contribute to mental confusion, says neurologist Charles J. Duffy, MD, PhD, director of cognitive and behavioral neurology at the University of Rochester, N.Y. Duffy was not involved in the Boustani study.

"We have known for some time that H2 blockers have an impact on cognitive capacity and can contribute significantly [as one of many factors] in delirium -- particularly in the elderly or in those with brain pathology," Duffy tells WebMD.

Lately I've started to wonder about polypharmacy and the unintended effect of a pill for every ill. In the hospital, my 90+ year olds always seem healthier and mentally more sharp than my 70 and 80 year olds. This could of course be social -- the younger group having drank more alcohol and smoked more cigerettes -- but my 90+ patients also seem to have one other thing in common. They all avoid doctors and at most take a daily aspirin.