Policy

Health policy is much more than health care reform

Key topics in this category:

RECENT POSTS

April 29, 2013 | 9:27 AM | By

School-Based Health Centers Serve More Than Just Students

By Chris Richard

At the Manual Arts High School Wellness Center in Los Angeles, pediatric nurse practitioner Jennie Lien gives 15-month-old Andrew Baptist a medical examination. Andrew's great-grandmother, Yvonne Lee (right) says Andrew's entire family relies on the center for medical care.(Photo/Chris Richard)

At the Manual Arts High School Wellness Center in Los Angeles, pediatric nurse practitioner Jennie Lien gives 15-month-old Andrew Baptist a medical examination. Andrew’s great-grandmother, Yvonne Lee (right) says Andrew’s entire family relies on the center for medical care.(Photo/Chris Richard)

When Compton’s Dominguez High School celebrated the opening of a new campus wellness center last month, it was a timeless moment.

The marching band blared and thundered. Drill teams members pranced and whirled, just as they’ve been dancing and high-kicking on high school campuses for generations.

But the scene in the wellness center itself offered a glimpse of what the future could be for school medical services in California.

There was a student in for routine blood work. In the next cubicle, a mother had brought her young son, who had the flu. And neighborhood resident Jonetta Stewart, 76, had come seeking relief from frequent vertigo and headaches.

Physician’s assistant Rachel Damicali checked Stewart’s blood pressure. It was very high.

Some campus-based wellness centers offer free and low-cost services not just to students, but to entire neighborhoods, to people of any age.
Dimacali says she sees a lot of variety in her fast-paced days.

“My last patient was a 4-year-old kid, and now I’m seeing Jonetta for her blood pressure management,” she said. “So, we see a whole range: from chronic disease to urgent care visits to just physical exams.”

Just in time for the implementation of President Obama’s health care overhaul coming Jan. 1, a handful of California schools are starting to open campus-based wellness centers like the one at Dominguez, offering free and low-cost services not just to students, but to entire neighborhoods, to people of any age. Continue reading →

FILED UNDER: Place Matters, Policy, School Health Centers, Science
April 26, 2013 | 2:23 PM | By

Berkeley Journalist Takes On The ‘Feel-Good War on Breast Cancer’

The article asks: (Photo/Getty Images)

(Photo/Getty Images)

I first saw the article Thursday night on Facebook, then stayed up until midnight reading it. In a helluva story, Peggy Orenstein addresses The Feel-Good War on Breast Cancer in this Sunday’s New York Times Magazine.

Orenstein is uniquely situated to write an article she hopes will “help change the national conversation.” She’s been treated for breast cancer twice in the last 15 years, including a mastectomy last fall, and the Times Magazine — for which she writes regularly — is one of the most powerful publications in the world.

Orenstein was first diagnosed with breast cancer in 1997 after her doctor sent her for a screening mammography. “I used to believe a mammogram saved my life,” she writes as the opening line of her piece. Today, she’s not so sure.

As she writes in the Times:

Sixteen years later, my thinking has changed. As study after study revealed the limits of screening — and the dangers of overtreatment — a thought niggled at my consciousness. How much had my mammogram really mattered? Would the outcome have been the same Continue reading →

FILED UNDER: Policy, Breast Cancer, Mammograms, Science
April 24, 2013 | 12:50 PM | By

Are Minority Kids Being Missed In ADHD Diagnosis?

(Getty Images)

(Getty Images)

For years, doctors, teachers and parents have fretted that attention deficit hyperactivity disorder (ADHD) is overdiagnosed and that children are overprescribed the stimulants that treat the brain disorder too often.

But, as EdSource Today reports, that’s not the case in California. According to new data from the National Survey of Children’s Health, California ranks 5th lowest in the country in diagnosis. The national average of children with ADHD is 7.9 percent, but in California, the rate is 5.2 percent.

That 5.2 percent rate may be a low one nationally. But globally, rates vary between 3 and 9 percent, “with the average closer to 5,” Prof. Joshua Israel told EdSource Today.

Still, within ethnic groups in California, the diagnosis rates drop dramatically. Kaiser researchers published data earlier this year which showed white children had a 5.6 percent rate — well in line with global averages. But other groups had much lower ADHD diagnosis rates as follows:

  • Black children: 4.1 percent
  • Latino children:  2.5 percent
  • Asian American children: 1.9 percent Continue reading →
FILED UNDER: Place Matters, Policy, ADHD, Overdiagnosis, Science, Underdiagnosis
April 23, 2013 | 5:00 AM | By

‘Cal Enviroscreen’ Ranks Zip Codes Statewide By Pollution

New Screening Tool Provides Broad Snapshot of Total Environmental Burden

Factory in West Fresno. (Sasha Khokha/KQED)

A factory in West Fresno. (Sasha Khokha/KQED)

It’s the first environmental health screening tool of its kind in the country.

California’s Environmental Protection Agency is rolling out “Cal Enviroscreen” which helps pinpoint communities that may be particularly vulnerable to pollution. And it’s not just for wonks. You can look up your own community. Cal Enviroscreen measures a broad range of pollutants and health indicators in every zip code across the state.

The most vulnerable community in the state? West Fresno, one of Fresno’s poorest areas. Other zip codes in the top ten include Bakersfield, Stockton and the Los Angeles-area communities of Vernon, Baldwin Park, and Boyle Heights.

Look up your community’s score by zip code
Toxicologist Dr. George Alexeeff heads the state’s Office of Environmental Health Hazard Assessment. He says California regulators have done a pretty good job of targeting individual pollution problems, like reducing diesel exhaust, or eliminating particular chemicals in drinking water.

But that kind of regulation doesn’t give a broad snapshot of the total environmental burden some communities face. Continue reading →

FILED UNDER: Place Matters, Policy, Cal Enviroscreen, Pollution, Science
April 18, 2013 | 10:28 AM | By

6 Factors That Help Save Lives In A Disaster

From Olympic Park to the Boston Marathon to Texas

The New Yorker’s Atul Gawande writes often and well about medicine. This week, he described how disaster planning and training in hospitals saves lives. This morning he added a series of tweets:

Continue reading →

FILED UNDER: Policy, Patient Safety, Science, Systems
April 18, 2013 | 6:14 AM | By

The View From 30,000 Feet: The Intersection of Medicine, Ethics and Money

(Getty Images)

(Getty Images)

As we’re barreling along toward Jan. 1 and the full implementation of Obamacare, it seems that questions of ethics are embedded in just about every discussion of the practice of medicine and how it will change in the coming years. San Francisco’s Commonwealth Club asked me to explore the issue recently by moderating a discussion featuring three prominent Bay Area physicians that the club had invited to participate.

The formal title of the event was “Improving the Ethics and Practice of Medicine,” but pretty quickly money came right into play.

“We have to come up with the best possible distribution of those resources, so we do the greatest good for the greatest number.”
Dr. Josh Adler, chief medical officer of UCSF, started off by talking about the “age-old principle in care of patients”: Do no harm. And he spoke of patient safety. But then he got right into the cost of health care. We don’t have unlimited resources, ranging from doctors and nurses to hospital beds, he pointed out. “We have to come up with the best possible distribution of those resources, so we do the greatest good for the greatest number.”

He talked about “appropriate stewardship” of limited resources in considering both the health of the individual and the health of broader populations. Continue reading →

FILED UNDER: Policy, Reform, Ethics, Practice of Medicine, Science
April 16, 2013 | 10:30 AM | By

Supreme Court Seems Skeptical of Patenting Human Genes

SCOTUS_SupremeCourtIn arguments at the Supreme Court Monday, justices appeared skeptical about patenting human genes.

The U.S. Patent and Trademark Office has been granting parents on human genes for nearly 30 years. This is the first case questioning that premise to reach the Supreme Court. At the heart of the case are two genes associated with breast cancer, BRCA1 and BRCA 2. People with certain mutations in these genes have a significantly higher risk for breast, ovarian and other cancers.

Opponents of patenting human genes say genes are products of nature and therefore cannot be patented. Myriad Genetics, which holds the patent on the genes, say that once genes are isolated from the body and processed they are no longer a product of nature.

The Associated Press captured the back and forth:

Justices attempted to break the argument down to an everyday level by discussing things like chocolate chip cookies, baseball bats and jungle plants.

[Gregory A.] Castanias, the Myriad lawyer, argued that the justices could think about the gene question like a baseball bat. “A baseball bat doesn’t exist until it’s isolated from a tree. But that’s still the product of human invention to decide where to begin the bat and where to end the bat,” he said.

That didn’t work for Chief Justice John Roberts. Continue reading →

FILED UNDER: KQED blogs, Policy, Breast Cancer Genes, Patents
April 12, 2013 | 9:36 AM | By

Gene Patent Supreme Court Case Centers Around Two Breast Cancer Genes

It's not the genes themselves, but mutations that can put women at higher risk of breast cancer.(Getty Images)

It’s not the genes themselves, but mutations that can put women at higher risk of breast cancer.(Getty Images)

On Monday, the U.S. Supreme Court will hear oral arguments in a case that asks a central question: Can you patent a human gene?

Are genes naturally occurring and therefore not patentable by law? Or, since DNA must be extracted and processed to be read, is it no longer a natural product and so indeed can be patented, as human genes have been for 30 years?

Over at KQED Science, reporter Lauren Sommer has a great breakdown of the issues in this case – not only the ethical questions but also the business angle, so critical to the Bay Area’s thriving biotechnology industry.

Everyone has these genes — women and men alike — but the question is whether you have a mutation in one or both of these genes that inhibits tumor suppression function.
But let’s take a step back and look at the genes at the heart of the case, BRCA1 and BRCA2. According to the National Cancer Institute, these genes help keep cells’ genetic material in order. They handle what’s called tumor suppression.

Everyone has these genes — women and men alike — but the question is whether you have a mutation in one or both of these genes that inhibits the tumor suppression function. With impaired tumor suppression, you’re at higher risk for cancer. Women with certain types of BRCA mutations are five times more likely to develop breast cancer and at least 10 times more likely to develop ovarian cancer. Both women and men with these mutations are also at increased risk for other cancers, including pancreatic cancer, prostate cancer and melanoma. Continue reading →

FILED UNDER: Policy, BRCA, Breast Cancer Genes, Science
April 10, 2013 | 12:00 PM | By

State Health Agency Directs Insurers to Stop Discriminating Against Transgender People

The state’s Department of Managed Health Care has issued a letter to “remind” health care plans  that discrimination against transgender people is in violation of anti-discrimination laws passed in 2005. The DMHC regulates HMOs in California.

In a release, the Transgender Law Center called the directive “groundbreaking” and said it will save lives. “For years, transgender Californians have been denied coverage of basic care merely because of who we are,” said Masen Davis, executive director of the center. “Discriminatory insurance exclusions put transgender people and our families at risk for health problems and financial hardship. Now we can finally get the care we need.” Continue reading →

FILED UNDER: Policy, Transgender Health
April 9, 2013 | 4:59 PM | By

Unnecessary Early Deliveries Plummet in Multi-State Study, Includes California

American children are less likely to live to age 5 than children in other high-income countries. (Photo: Comstock)

The rate of early elective deliveries dropped from about 28 percent to under 5 percent. (Photo: Comstock)

Hospitals in California were part of a multi-state approach designed to dramatically reduce early elective deliveries of babies. The result? In one calendar year, early deliveries — those without a medical cause for doing so — dropped from about 28 percent to just under 5 percent.

“What everyone is amazed about is we did it in a year,” said Leslie Kowalewski with the California chapter of the March of Dimes, which helped hospitals in setting up the new protocol for the study.

The findings from the study were published this week in Obstetrics and Gynecology. For more than 30 years, the American College of Obstetricians and Gynecologists has recommended that women and their doctors wait until at least 39 weeks of gestation to deliver a baby. Delivering earlier is associated with health complications for the babies, including breathing and developmental problems.

Slippery Slope With Early Deliveries

But a “slippery slope” had developed around early elective deliveries, says Dr. Elliott Main, a high-risk obstetrician and director of obstetrics quality at Sutter Health. “Your due date was 40 weeks, and then we thought 39 was just as good. Then it became 38 and a half, then 38, and that’s the slippery slope.” Continue reading →

FILED UNDER: Policy, Babies, Early Elective Delivery, Pregnancy, Science