Friday Five: Creepy Uncle Sam and Generation Opportunity

This week, the fantastic Phoebe Jones sent me a link to troubling new anti-ACA ads. I got so riled up that this week’s Friday Five is all about Generation Opportunity. Take a look.

http://www.youtube.com/watch?v=R7cRsfW0Jv8

http://www.youtube.com/watch?v=djCftQGTMC8

Of course, I jumped head first into the Generation Opportunity wormhole after seeing those two gems. And lovely readers, I saw some scary things down there. These are five of the more remarkable bits from their sites.

This is how insurance works! The healthy subsidize the sick—and the healthy tend to be young. Unless, of course, you’re insulated from the full cost of your premium because you’re one fortunate enough to be one of the less than 60% of Americans who get their insurance through their employer.

There is no Obamacare insurance. You cannot purchase something called “Obamacare.” We’re still going to dump money into the pockets of health insurance companies, only now they can’t screw us over quite so often. (Pardon my language—you should see my notes for this post.)

This has been debunked for a while now. I just don’t even know what to do with this other than say This Is Still Not True.

That’s all the page says. There’s honestly nothing else on it but the header and sidebar. I’m interested to know what Generation Opportunity means by this—will Obamacare judge quality, quantity, or some mix of both? Is there extra credit?

I would like more information about this important topic. But I sense that Generation Opportunity has a slight obsession with sex and yet can’t quite get their thoughts together about how to link what it loves (horizontal mambo) with what it hates (the Affordable Care Act) and that’s why this page is blank as well.

I’m highlighting the misinformation and combative headlines because we will be able to purchase insurance through the Marketplace (aka websites, phone calls, and paper applications) starting on October 1. This is a big day for the Affordable Care Act, and we will see all kinds of insane stories about how everything is going wrong. We have to remember that many of the reports will be blown out of proportion or just false…but some of the problems will be real. Things will be be rocky for a while. That’s what happens when you make big changes.

One final note: Just to be clear, you cannot purchase something called “Obamacare.” It simply doesn’t exist. If you have health insurance, it will be through Medicare, the VA or other federal programs, Medicaid, or private companies such as Aetna and Coventry. One more time: A plan called “Obamacare” does not exist.

Friday Five: heat, Bloomberg, Texas, heroin, ACA

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Let’s all do the heat wave! Just in case you’ve ignored the Facebook status updates, tweets, and complaints from co-workers, I want to inform you that it is Very Hot Outside. Growing up in Florida gives a person a skewed sense of the appropriate level of summertime heat and humidity, but this week has been tough even for me. In all seriousness, the heat is severe and dangerous, especially because so many people in the affected areas (map) don’t have air conditioning. So follow the heat advisory instructions: stay inside, run that AC (if you have it), drink water, and check in on seniors—they’re especially susceptible to high temperatures. And remember, we’ll all look back fondly this week while we wait for snow plows in January.

Bloomberg’s at it again But this time, he just wants New Yorkers to bypass the elevator and take the stairs instead. Mayor Bloomberg signed an executive order on Wednesday that requires all government building to be laid out using “Active Design” principles in order to promote physical activity like taking the stairs. We often talk in public health about making the healthy choice the easy choice and changing the built environment to encourage physical fitness. Bloomberg’s latest move may spark an interest in healthier buildings. Could Active Design be the new LEED certification?

You haven’t heard the whole story about Texas This was a big week for abortion controversy in Texas, and there’s already extensive coverage of what happened, so here’s some news you may have missed:

  •  You can now purchase Rick Perry voodoo dolls (cultural appropriation isn’t just for Miley Cyrus)
  • Texas Democrat Rep. Harold Dutton introduced a bill that would ban all abortion legislation until the state abolishes the death penalty.
  • The pink running shoes Wendy Davis wore during her filibuster have over 280 positive reviews on Amazon, and not all of them extol the arch support.

What did I miss?

Heroin’s popularity is growing in Northern New England In New Hampshire, the number of fatal heroin overdoses jumped from just seven in 2003 to a surprising 40 in 2012. The increase has also been observed in Vermont, with a 40% increase in heroin addiction treatment, and Maine, which had three times the heroin overdoses in 2012 as in 2011. There are a few factors that may contribute to this growing problem: increased control over prescription painkillers, the relative cheapness of heroin compared to painkillers, and because heroin can be sold at a higher price in rural areas than in urban centers, distributors are incentivized to sell more. Heroin is now taking up most of drug enforcement agents’ time in the area. Controlling infectious diseases like HIV and Hepatitis C will be the next challenge for the area’s public health community.

Curious about what’s happening next with the ACA? Kaiser Family Foundation released a new ACA video starring its charming YouToons. This one, a follow up to 2010’s “Health Reform Meets Main Street,” explains how to “Get Ready for Obamacare.” (Interesting, the change in terminology over three years!) This easy to understand breakdown of the complicated law is accessible to all audiences. Anyone talking to the public should be emulating this kind of clear communication. http://www.youtube.com/watch?v=JZkk6ueZt-U

Friday Five: sterilization, pain robot, brains, surgeons, Sharknado

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Rural women are more likely to be sterilized

Tubal ligation, also known as sterilization or “getting your tubes tied,” is far more common among rural women as compared to urban women. Of rural women, 23% said they had been sterilized; urban women, 13%. There is only speculation about why this difference exists. Some of the theories floating around are: less access to other forms of birth control; piggybacking tubal ligation onto post-partum Medicaid coverage; lower educational level. Importantly, 39% of those rural women regret their decision. We should be asking why they didn’t choose a long-term, reversible birth control such as an IUD or an implant (like Implanon) instead.

Somewhat cute robot helps reduce kids’ pain and suffering during injections

As a needle phobic myself, I was very excited to learn that there’s an innovation in helping kids’ distress during shots. The robot not only talks to the child in order to distract him or her from the scary needle, but encourages exhalation during the injection to help with muscle relaxation (video here). There are two reasons why reducing pain and anxiety for children receiving immunizations is important: excessive worry can make other parts of the exam difficult, and in the future, an adult who had a bad medical experience as a child may be more likely to avoid care. These both have significant health implications. If this robot can help, I say let’s get one in every pediatrician’s office—and maybe in internist’s offices too, for ‘fraidy cats like me.

Brain pathways involved with learning and changing behavior charted

This week the NIH published a study identifying neural pathways associated with learning and changing behavior in mice. The nerves associated with the switch from moderate to compulsive drinking were found to also have a role in learning and decision making. Researchers hope that their insights will be helpful in understanding alcoholism and addiction. Learning more about why some people can use substances in moderation while others become addicted is crucial to improving mental and physical health. Hopefully, these findings will also apply for humans.

Surgery residents operate less often under new rules

Medical residents (doctors who are done with medical school and are completing their practical training) work notoriously long shifts and even longer workweeks. Restrictions created in 2011 limited shifts to 16 hours for first-year residents and 28 hours for the more advanced doctors and everyone’s week is limited to 80 hours. Surgical residents have in turn participated in fewer hours of surgery because of the limits on working hours. Many doctors are concerned that this will put the budding surgeons at risk for not gaining enough experience. There has to be a balance between allowing doctors to get enough rest while also learning enough to practice on one’s own—the question is, how

Kathleen Sebelius may in fact have a sense of humor

Twitter blew up last night with references to Sharknado, a horribly wonderful movie about a tornado that blew sharks into a city. (I don’t know how that works, I didn’t watch it!) Buzzfeed immediately wrote an article claiming “There is no Obamacare coverage for pre-existing Sharknado injuries.” Kathleen Sebelius replied: https://twitter.com/Sebelius/status/355766513334108160 Hey, an ACA joke!

I leave you this weekend with an excellent infographic explaining pretty much everything you need to know about gender, sexual orientation, and the like…The Genderbread Person!

Genderbread-Person

Friday Five: violence, HPV, obesity, smog, Obamacare

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Global rates of violence against women are alarmingly high

This week, the WHO released a study showing that more than 30% of women around the world have been victims of physical or sexual violence, particularly from their spouse or partner. The report also outlines the health issues associated with violence against women: death, depression, alcohol use, STIs, unwanted pregnancies and abortions, low birth weight babies. The WHO recommends that health care providers take violence more seriously. These findings remind us that violence is not a far away issue that impacts other people—all of the WHO regions have violence rates hovering between 23-38% (map). Whether we realize it or not, we all know women who have experienced violence against them, and we are all responsible for ensuring women have the education and mobility they need to keep themselves safe.

 

HPV rates are lower in teen girls thanks to vaccine

And now for some good news: the prevalence (number of cases currently in the population) of vaccine preventable HPV in teen girls has dropped 56% since the introduction of the vaccine. The ultimate goal is to have 80% of American children vaccinated in order to create herd immunity, meaning that enough people are vaccinated so the virus has nowhere to go. However, only about half of teen girls have gotten the necessary three doses of Gardasil or Cervarix. It’s time to stop stalling. Vaccinate kids and help prevent them from developing cervical, anal, or—as Michael Douglas reminded us—throat cancer.

 

AMA declares obesity a disease

The American Medical Association (AMA) voted this week to define obesity as a disease, identifying it as a complex issue that requires therapeutic medical treatment. They hope to reduce stigma and understand obesity to be a disease because it impairs some body functions. Critics denounced the decision, saying that because obesity is defined using BMI, it is not a precise diagnosis and that obesity has no specific symptoms of its own, only that it a contributing factor to other diseases. Although obesity is often characterized as a willpower and laziness issue, the resolution, as quoted in the New York Times, says:

The suggestion that obesity is not a disease but rather a consequence of a chosen lifestyle exemplified by overeating and/or inactivity is equivalent to suggesting that lung cancer is not a disease because it was brought about by individual choice to smoke cigarettes.

Hopefully, the AMA’s decision will lead to increased insurance reimbursement for obesity treatments, including nutritionists and gym memberships, as well as medical interventions and therapy.

 

Singapore is covered with smog

Fires in Indonesia are causing dangerous smog in the country and Singapore. Though no one has fessed up to starting the fires, they are likely due to illegal land clearing practices in Sumatra, which is west of Singapore. Today, Singapore’s Pollution Standards Index (PSI) hit 401, far higher than the “dangerous” level defined by a PSI of 300, and is considered “life-threatening” to the ill and elderly. Smog is a mixture of accumulated greenhouse gases and smoke, and is made worse by the combination of pollutants, sunlight, and heat that creates ozone. Smog causes serious respiratory, eye, and skin problems, and this smog is so thick visibility is seriously impaired.

 

Dems love the term “Obamacare,” Republicans don’t

The Kaiser Family Foundation June tracking poll shows that when referred to as “Obamacare,” 73% of Democrats responded favorably to the Affordable Care Act (ACA), as compared to 58% when the ACA was called “health reform law.” Republicans, however, saw an increase in unfavorable responses when the ACA was called “Obamacare,” from 76% to 86%. Apparently, the pejorative likely coined by none other than Mitt Romney has been successfully appropriated and turned into a rallying point for Democrats in support of the ACA. Obama is a linguistic master, and this shows he can turn even the most negative epithet into a compliment. Take that, Sarah Palin!

It's the first day of summer! This lion knows how to celebrate:

http://www.youtube.com/watch?v=mV1CVTPVAJg

Friday Five: Transplant ethics, Planned Parenthood, Hepatitis C, immigrants, Google

Each Friday, I use five sentences to summarize and comment on five important, interesting, or just plain amusing health stories from the week. Child in dire need of lung transplants starts a debate on ethics

Ten year old Sarah Murnaghan has been waiting for lung transplants for 18 months due to her cystic fibrosis and related lung failure. Doctors say she is not likely to live past the weekend without a transplant, so the severity of her illness placed her at the top of the pediatric list. However, Sarah is on very bottom of the adult list, meaning that any adults in need of lungs will be offered the organs before her, regardless of whether or not their need is as pressing as hers. Since 2005, organs are supposed to be distributed based on need, but that rule applies only to patients over age 12. Sarah’s parents have petitioned Kathleen Sebelius to change the rules to allow pediatric transplants of adult organs based not on age but on medical necessity. Hopefully, Sarah’s dire situation will ignite a conversation on organ donation and the ethics of treating children as if they are adults. (Okay, so this is six sentences but I think it’s worth it.)

Planned Parenthood case will not be heard by the Supreme Court

Indiana tried—and failed—to refuse Medicaid funding to Planned Parenthood. The Supreme Court refused to consider an appeal on behalf of the state to allow Indiana to withhold money from Planned Parenthood because it offers abortion services, even though federal law prohibits Medicaid dollars from being spent on abortion. Hopefully, this development will stall other attacks on low-income women’s right to choose their health care providers. However, the wily anti-choice movement is probably cooking up other ways to deny services to women—Indiana already has a law in place requiring facilities that offer non-surgical abortions to meet the same standards as facilities that perform surgical abortions. The Supreme Court’s choice not to hear the appeal is important, but as usual, fighting against restrictions on this legal medical procedure is a constant battle.

Is the “war on drugs” to blame for millions of Hepatitis C cases?

The Global Commission on Drug Policy called for an end on “the war on drugs,” in part because criminalization of injection drugs has lead to a quiet epidemic of Hepatitis C. The Commission estimates that of the 16 million injecting drug users (IDUs), 10 million are living with Hepatitis C; China, the Russian Federation, and the USA have the highest rates of Hepatitis C among IDUs. Arguing that harsh drug laws dissuade IDUs away from public health efforts such as needle exchanges, the Commission recommends reforming existing drug laws and focusing on health rather than incarceration and forced treatment. While I doubt many countries will decriminalize heroin and other injectable drugs, I’m pleased the Commission is drawing attention to the broader health concerns of IDUs. Regardless of drug use or dependence, a person has a right to access public health initiatives without fearing arrest and imprisonment.

Immigrants subsidize Medicare

A study published in June’s Health Affairs showed that in 2009 naturalized and non-citizen immigrants contributed $33 billion to the Medicare trust fund and received $19 billion in expenditures, creating a surplus of $14 billion. American-born citizens, on the other hand, contributed $192 billion and used $223 billion, creating a deficit of $31 billion. There are a few reasons why immigrants’ contributions lead to surplus: there are 6.5 working immigrants for every one retired immigrant and the cost of care for immigrants is less than the cost of care for the American-born. In a time when immigration and a path to citizenship are pressing issues, focusing on the positive contributions of new residents and citizens can only help decision makers to make choices to encourage new immigration. This study reminds us that immigration is crucial to the success and longevity of the United States, and treating all immigrants with respect and dignity is non-negotiable.

Google nutrition facts and get a clear answer

This coming week, Google is launching a new search feature: type a question about nutrition facts, and it provide you with a precise answer. The screen shots look much like the results when Googling conversions from cups to liters or the definition of a word. The feature is rolling out in the United States over the next ten days, but it shown up yet in Philadelphia so I haven’t been able to give it a try myself. Having the ability to ask direct questions about the nutrient content of food helps demystify some of the complicated information about healthy eating. This is health communication done right!

If you're looking to change up your workout routine this weekend, may I suggest Prancercise?

http://www.youtube.com/watch?v=o-50GjySwew

Why Won't Portland Fluoridate?

Portland, Oregon votes tomorrow on whether or not to fluoridate its water supply. I’m fascinated by the ways people adopt non-mainstream beliefs, so I jumped right into the anti-fluoridation activism vortex and found a culture motivated by fear and a desire for purity. I started with the Fluoride Action Network (FAN). My first thought: these people have money. The site is nicely designed and full of videos so the information is accessible to all. FAN focuses on the idea of “mass medication,” arguing that adding fluoride to the public water supply constitutes forcing drugs on unwilling people. According to FAN, people with kidney disease are at particular risk for fluoride toxicity.   They say, “it is unethical to compromise the health of some members in a population to obtain a purported benefit for another—particularly in the absence of these vulnerable members’ knowing consent.” FAN interprets fluoridation as an attack on personal liberty, a medical harm, and an informed consent issue. They allude to a government conspiracy to medicate and dull the intelligence of the public through fluoride.

Then I found Clean Water Portland, a group dedicated to keeping fluoride out of the city’s water supply. The first reason Clean Water Portland gives for voting no tomorrow is that “Industrial byproducts don’t belong in our water.” The chemical in question is fluorosilicic acid (FSA), a waste product from fertilizer manufacturing. Associating water and fertilizer is a great way to increase skepticism. Just the phrase “industrial byproducts” seems sinister and contaminated.

Clean Water Portland also invokes parents’ anxiety about harming their children by citing the conclusions of a Harvard meta-analysis of Chinese studies on the relationship between fluoride and IQ. The studies found an approximately 7 point drop in IQ when children lived in communities with fluoridated water. The researchers in the Harvard study note that this is a preliminary analysis and that there may be other issues contributing to the IQ drop.

Clean Water Portland frames the link between fluoridated water and IQ by asserting that “in a large population such as Portland, a shift of 5 IQ points would cut the number of geniuses in half and double the number of mentally handicapped.” Whoa! A vote for fluoridation is a vote for robbing your child of genius status. How could you? This shows Clean Water Portland’s inclination toward using parents’ natural desire to protect their children as a means to maintain the “purity” of Portland’s water.

Finally, I arrived at the Facebook page of Fluoride Free Portland. It has 415 likes, and appears to be a somewhat active community of Portlanders sharing links and encouraging people to promote the anti-fluoridation message. “Clean” and “natural” are their most important buzzwords. The posts show the true fear and disgust some Portlanders have for fluoride. The page is littered with photos of FSA tanks labeled “corrosive” and “caution.” Political cartoons, quotations placed over images of pristine lakes, and photos of kids holding anti-fluoride signs adorn the page. Supporters call for their perspective to be included on the Portland Water Board website but get their information about the dangers of fluoride from unreliable sources.

Like other fringe health activist groups—I’m looking at you, anti-vaxxers—the anti-fluoride coalition exists in a world where there is a pure, clean version of life that is endangered by deceptive medicine and industry. While I believe we must have a healthy amount of skepticism, particularly regarding the motivations of corporations, the anti-fluoride groups seem to have abandoned reason. They subvert their own cause by their radical opposition. I think there are plenty of people who would be willing to have a conversation about informed consent and the potential health effects fluoride can have on vulnerable populations. The alarmism and guilt used by these groups makes the rest of us tune out their potentially valuable contributions to the conversation.

Whether Portland starts fluoridating its water is up to the voters. But we should keep an eye on the anti-fluoride movement. Anti-vaccine groups were not taken seriously at first, and now we have outbreaks of pertussis and measles. With the easy communication afforded by the Internet, anti-fluoride could become the next big health movement, and our teeth will suffer.