Brown vs. Board of Nursing

January 21, 2010

Timothy Noah is right. I still may not  feel entirely confident that I know how to use the word ironic correctly, but I think this one’s got irony written all over it, probably in the blood of the uninsured. For those of you who don’t know, Massachusetts is the only state in the country with near-universal health coverage, which was achieved by legislation enacted in 2006. The Massachusetts legislation passed under the stewardship of then-governor Republican Mitt Romney. Jump to three years later, when Obama’s pushing health reform on a national level, and one of health reform’s champions, Democratic Senator Ted Kennedy (from… where else? Massachusetts, duh), dies a politically untimely death in  August 2009. Now here we are in the new year, and Republican  Scott Brown, a  Mass. state senator,  just won Kennedy’s vacant seat in a special election. Brown is the first Republican to occupy the seat in like a billion years or something. As a state senator, he supported health reform for Massachusetts, but now as a United States senator, he opposes national health reform. The voters of the only state with universal health coverage sent a man who opposes health reform to the Senate. The irony of the circumstances, the irony of the timing, the bizarre message this sends… well, I’m at a loss. I’m sad. The watered-down, public option-free, anti-abortion, pro-insurance company, pro-Big Pharma version of heath care reform that the Dems worked so hard to pass in both the House and the Senate may never reach the president’s desk, thanks to an unfortunate death and a fateful election. Even in its flawed state, I wanted that legislation to pass. I really did. Now it probably won’t, and I just have to be sad.

Yet some things still retain the power to make me glad. Check out this sweet article from Kaiser Health News, authored by Dr. Lavizzo-Mourey, president and CEO of the badass Robert Wood Johnson Foundation. The article argues that nurses have the clinical expertise, the patient advocacy background, and enough of the public’s trust to reshape health care for the better, but we lack positions of political influence. So, my dear nurse friends, I hope this inspires you to live up to the public’s high opinion of you. I hope this means you’ll think about organizing and bombarding your senators and representatives over the health reform issue. I hope this means you’ll run for city council, apply for Ph.D. programs, join hospital boards, join nursing organizations, go to law school, and first and foremost, take what you’ve learned at the bedside with you. I know many of you will argue against ever leaving the bedside… after all, patient care is why you became nurses in the first place. I’m not saying everyone in our field needs to start climbing the ladder and grubbing for power.  But I do think that part of patient care is lifting your gaze from the bedside, looking out the dirty hospital window and seeing inequities that either prevent millions of people from ever reaching a much-needed hospital bed or trap countless others in their hospital beds, unable to shake the chronic diseases of our civilization. So although you are desperately needed at the bedside, and much appreciated by your colleagues and your patients, I do believe that most bedsides at least come equipped with a cheap-looking hospital phone from which you can call your senators and representatives and tell them why the both the bed and the bedside are such difficult places to be these days. Don’t forget to dial 9 first.

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Drugz R Us

December 11, 2009

54 children die from tainted medications, Eli Lilly pays NM $10 million in settlement fees for illegally marketing Zyprexa, and Congress considers and amendment to allow importation of FDA-approved prescription medications from abroad. Miss Dx  sure likes her drugs, baby.


News updates and tips that will get you laid

December 10, 2009

Miss Dx updates you on the latest health reform and H1N1 gossip. She also turns health reform into a holiday aphrodisiac. Enjoy!


WICked

October 25, 2009

There were three men in my class during nursing school. One was very handsome and had a master’s in public health, one was a good-lookin’ musician who witnessed the long, painful death of a beloved family member when he was young, and the third guy… well, he ate a lot of cheese. Lots of cheese. Everyday. Like, a pound of cheese in his lunch, alongside a weird variety of other foods.

I asked him what the deal was with all the cheese one day. He looked at me, a little shyly, beneath long eyelashes (why is it that men always get the long, thick lashes?) “Well, my wife applied for WIC awhile back, and one of the few quality things you can buy with WIC is cheese.”

WIC, or the Special Supplemental Nutrition for Women, Infants and Children program, is  a program funded by the U.S. Department of Agriculture intended to supplement the diets of low-income moms and kids. A few years ago, people realized that the food packages available through WIC were devoid of key nutrients such as whole grains and fresh produce, so the USDA has recently changed the guidelines for WIC food packages to include healthier options. Through regulation of food packages, WIC aims to affect the dietary quality and habits of participants. WIC is not intended to be the primary source of food or simply general food assistance for participants. “Rather, WIC food benefits are scientifically based and intended to address the supplemental nutritional needs of a specific population–low-income pregnant, breastfeeding, non-breastfeeding postpartum women, infants and children up to five years of age who are at risk”  (USDA, 2007). Food package guidelines are intended to give state’s considerable flexibility in designing food packages to meet their population’s specific needs. In addition to food supplementation, WIC also provides nutritional assessments, counselling, referral, and other services.

The issue of WIC resurfaced recently in my life when a classmate and I discussed a project she’s working on to increase access to locally grown produce and locally produced foods via WIC. This prompted one of those “I know, right?” conversations in which I shared an anecdote of recently noticing that the only WIC-approved cereals at my local grocery stores were chocolate-blasted corn crushers or whatever. After vigorously applauding her efforts, I addressed my mounting curiosity on the subject of WIC-approved foods by consulting a trusted Internet colleague, Dr. Google. A list of currently approved foods for New Mexican WIC participants can be found here, while comparison of old WIC food packages to new WIC food packages is here. And though I’m not claiming that putting cocoa-covered sugared corn bombs into the hands of toddlers is the absolute best use of public money, I did learn that those cereals (which now have to have a whole grain content of at least 51%) are an extremely important source of iron for WIC participants, and so the whole whole-grain-or-not debate is really secondary to the nutritional goal of iron supplementation. Most remarkably, my classmate’s goal of increasing access to healthy, local foods has already begun to surface here in New Mexico with WIC’s farmers market program. I couldn’t find any information on whether or not the farmer’s market program has increased the currently inadequate fresh fruit and vegetable consumption (Ponza et al., 2004) among participants, though.

Now, I am grateful that WIC exists. But, like my classmate, I believe if WIC exists, it should exist in the most effective form possible for participants and for the community. Which means there’s still work to be done. For example, WIC moms are less likely to breastfeed than eligible non-participants (Jacknowitz, Novillo & Tiehen, 2007; Ponza et al., 2004). Whether this is because moms who enroll in WIC are less likely to breastfeed in the first place (perhaps they are more likely to work outside the home than their eligible non-participant counterparts?) or because WIC makes infant formula available is unclear. Much of WIC’s interventional energy is aimed at promoting breastfeeding through support (for instance, moms who breastfeed exclusively receive a heftier food-package benefit than non-breastfeeding moms) and education, so this finding is worrisome. Of course, this begs the question, what is really the best way to promote breastfeeding in this population? Does it have more to do with the available food packages or education/support services or with perhaps with other factors that we can’t hope to address with a program like WIC?

Joyce, Racine & Yunzal-Butler (2008) wrote an illuminating article on the matter of how effective WIC programs actually are in terms of reducing adverse birth events and improving health of women and children. They essentially conclude that, although the success of WIC has been overstated, modest effects on fetal growth and emphasis on positive lifelong habits justify continued funding of the program. They say that more emphasis should be placed on reducing smoking among WIC moms, promoting breastfeeding, establishing positive life-long habits, and providing support— in essence, the educational and social support services are just as important as the food packages provided by WIC.  Which simply illustrates how nutrition doesn’t exist in a vacuum, and seemingly cut-and-dry programs designed to increase the amount of protein available to pregnant or breastfeeding women or calories to growing children must address numerous not-so-cut-and-dry factors like culture preferences/practices, education, and the tendency to select cheese over swiss chard at the grocery store..


Barely Legal

October 16, 2009

Being a nurse can be really fun. You get to watch babies being born. You get to dry a seconds-old human off with a stack of soft receiving blankets fresh from the warmer. You check the first set of post-uterine vitals, clear gunk from the airway, count fingers and toes, adorn the kiddo with her first bling (a hospital I.D. band), and place that slightly smushed pink bundle of joy against her 13-year-old mother’s chest for first the first time.

As you try to help the new mother breastfeed her baby, you can’t help but notice that mom seems confused and distracted. “Let’s put the cell phone away for a few minutes so you can hold your baby with both hands,” you gently instruct this lucky young lady. “Hold on, I’m in the middle of a text,” she replies. You wait patiently. Baby yawns. Suddenly a gaggle of middle-school girls barge into the room and flock towards the baby. “Oh, she’s so cute!” they exclaim. “Is it too soon to pierce her ears?” one asks.

Baby’s hungry and starting to fuss. You tell mom that her baby needs to eat. “Can we do it later? My friends are here!” she says.

Now, I’m not relating this anecdote, which I’ve experienced with nearly every young teen mother I’ve taken care of, in order to laugh at the frivolities of teen girls. Nor is this to say that all young moms and dads are too immature to function as parents. Just most of them. Which is why I welcomed Obama’s strategy to prevent teen pregnancy back in May, which put an end to abstinence-only funding and instead focused on evidence-based interventions. Sadly, the fun didn’t last, and I aspirated chunks of my own partially digested freedom fry when I read this a few weeks ago, which says that those rascals over in the Senate Financing Committee voted to reinstate funding for Jesus only abstinence-only education.

For practical purposes, the most important part of the abstinence-only versus comprehensive sex education debate is the evidence demonstrating how woefully ineffective abstinence-only education is (Kohler et al., 2008; Roosa & Christopher, 1990; Underhill, 2008; etc. etc. etc.) and how effective comprehensive sex-education programs can be (Oringanje et al., 2009). Unfortunately, the paucity of well-designed studies from either camp means that there isn’t really strong support for a definitive statement on the matter. Furthermore, pinning the phenomenon of teen pregnancy solely on the shortcomings of sex education is dangerously short-sighted and allows us to conveniently ignore larger cultural, sociopolitical and economic factors that contribute to teen pregnancy. So why am I choking on my own vomit at the thought of funneling $50 million of federal money into abstinence-only education? I don’t know. Maybe it’s because of the subtle and not-so-subtle messages of sexism, racism and classism embedded in most abstinence-only curricula (Froyum, 2009). Maybe it’s because the teen pregnancy rate is rising at the same time that contraceptive use amongst teens is declining (Contraceptive Technology Update, 2008). Maybe it’s because I was socialized to think poorly of early childbearing and think highly of education and financial independence. Maybe it’s because I didn’t learn Jesus and so I believe that teens will do what their healthy, fertile, baby-friendly little bodies tell them to do. I don’t know. Maybe it’s just because one of my little 13-year-old mamas told me she hadn’t heard of condoms before she started having sex. Had she been privy to the forbidden secret of wrappin’ it up, she might not have to face the emotional trauma and economic instability that naturally arises when one attempts to text message and breastfeed at the same time.


The Gatekeepers

September 18, 2009

Though I typically role-play only within the privacy of my own home, I thought we’d try a little exercise here on SEMI. Lets pretend that we’re presented with a group of starving people. Why are they starving? I don’t know. Pick a reason. Ok, let’s go for broke here. Maximum emotional impact. Extreme example. They’re starving because they are in a concentration camp, duh!

“I want to help!” you say. “Let’s get these people some food!” A group of your friends agrees. You go about trying to devise a way to get these poor starving folks some food.

“We’ll give them money, and they can go out and buy food,” offers somebody. Another person points out that, unfortunately, even with all the money in the world, these people will still be burdened by a lack of access to food, seeing as they are, uh, confined to a concentration camp. Not a lot of food providers around these parts.

“Ok, let’s distribute food directly to them,” counters someone else. Someone in your group objects, claiming that they believe your group is too inept to perform such a task yourselves.

As a group you mill over various ways of providing the people in the camp with money, food, and access to food for a while before another person in the back raises his hand and jumps up and down excitedly. “Oh, I got it! I got it!” he shouts. You recognize him. Wow! It’s Republican Senator Grassley from Iowa.”Let’s give money to the people RUNNING the concentration camp! They seem like they know what they are doing! Then people in the camp can apply to these wonderfully organized, efficient camp managers for food!”

This proposal receives robust support from the camp managers. Your group of friends cuts a check to them, and everyone goes home.

Is this a poor way to illustrate Sen. Grassley’s proposal mentioned in today’s Washington Post?

“Some Senate Democrats, along with a key moderate Republican, Sen. Olympia J. Snowe (Maine), are now discussing ways to increase assistance for individuals and families who could face premium costs of up to $15,000 per year by 2016. Sen. Charles E. Grassley (Iowa), the ranking Republican on Baucus’s committee, is suggesting government assistance to insurance companies to help them control premium costs.”

Maybe. Is it extreme to compare insurance companies to Nazis? Sure, I suppose. I don’t know. The Nazi/Hitler analogies have been rampant of late, so I’m just jumpin’ on the bandwagon here. But in this case, many people have died from treatable conditions due to denial of coverage. Could this perhaps be because an insurance company’s existence is predicated upon taking money and keeping it?

Another choice quote from todays WaPo article:

Obama sought to ease concerns among young adults, who are now among the least likely to purchase health insurance, but who would be required to do so under the Baucus plan. Healthy 20-somethings are key to successful reform, because their payments to insurance companies would offset the costs of care for older adults.

You know, this is really funny. Like how young workers would pay into social security to offset the costs of all the old folks collecting social security? Except now the young people, like me, get to cushion a private company’s profit margin so that they can continue denying the claims of old or sick people. Fantastic! So here’s my open appeal to old people:

My dearest Old People,

I understand that, through no effort of my own, I am young. I understand that being young furnishes me with responsibilities towards those older folks who built the world in which I am living today, and as such are no longer young. I am prepared to accept this responsibility. But couldn’t I just give y’all the money directly, or couldn’t I just pay taxes and work a job in which I directly care for old and sick people like I’ve been doing for the past five years?

Smooches,

SEMI

P.S. My most precious Old People, I eagerly await your reply.

By the by, I can’t wait to live in a world where we all spend 20% of our income on goddamn “health care”:

For families buying insurance through the exchanges, the expenses are likely to mount even more rapidly, the CBO said. For example, a family of four making $78,000 would face insurance premiums of 13.9 percent of income, or $10,800, in 2016. Add deductibles and co-payments, the cost could rise to $15,300 — just under 20 percent of income.

Note: even a family of four that does not access health services even ONCE during the year is still legally obliged to pay almost $11k for insurance.

So we’ve heard the financial projections on the Washington side: this plan costs about $800 billion over ten years, it doesn’t add to the deficit, and amending the plan will naturally result in a higher price tag. But what about the financial projection for insurance companies and other “industry leaders”? I can’t wait to hear about their third-quarter earnings following enactment of this legislation.


Maxed Out

September 17, 2009

If the very best thing that can be said about your piece of legislation is that it (hopefully) does not add to the federal deficit, I’d say you probably failed to do your job and protect Americans from the ravenous pockets of private insurance execs. In fact, you led your flock to the slaughterhouse by mandating that they purchase health insurance (is this even, like,  constitutional?) while failing to provide a public option or even reasonable subsidies. Though expansion of Medicaid and insurance industry regulation are laudable, the rest of the legislation, including major cuts to Medicare reimbursement, lame insurance cooperatives, and forcing people to give up to 13% of their income to insurance companies, seems pretty  disgusting.

As one of the coveted uninsured, I suppose I’ll be going to jail when I refuse to pay the fine for failing to acquire insurance, because I’ll be damned if I give my money to an industry that has demonstrated its capacity for pure evil time and time again OR a spineless government that spoon-feeds the insurance companies 30 million new customers without providing a viable alternative. The Washington Post notes that Uncle Sam expects to help pay for this program by collecting 50 BILLION dollars from penalties imposed on individuals who don’t purchase mandatory insurance. In other words, the Baucus bill would rather collect $50 billion by fining people who are already unable to afford insurance than by imposing additional taxes on filthy rich people, or even by collecting revenue from a well-run public option (though I admit the notion of revenue from such a program may be wishful…nay, delusional, thinking.) If I’m missing something here, please, enlighten me. Until then, grow a pair, Washington. Then we can talk.