In the things-to-consider-for-the-sake-of-considering-them category, take a gander at this story from the May 27 edition of The Boston Globe: 

After healthcare reform was made law in Massachusetts in 2006, the number of newly insured patients in the state started to grow, and so did the demand for care. The demand, coupled with a longstanding shortage of primary-care physicians, is creating a real crunch for community clinics, say advocates of healthcare reform as well as area medical professionals.

About 80 percent of the new patients at a community health clinic who are covered under the state’s new health insurance program were formerly uninsured, a clinic supervisor told the newspaper. The result is a lengthy waiting list.

Clinics the newspaper contacted have had difficulty recruiting doctors.

‘What Chapter 58 has done is highlighted the crisis and the problem that we have with the primary-care workforce,’ said Dr. Bruce Auerbach, president of the Massachusetts Medical Society. According to a study conducted in 2006 by the society, 53 percent of patients who had an appointment with a primary-care physician were able to see a doctor within a week of initiating contact. Last year, only 42 percent were able to see a doctor within a week. …

Critics have said healthcare reform should not have been attempted without first addressing the workforce shortages, said John E. McDonough, executive director of Health Care for All, an advocacy group that helped craft the healthcare law. …

Healthcare advocates and providers say that the real problem is that the state underestimated the number of residents without health insurance. …

According to Jon Kingsdale, executive director of the Commonwealth Health Insurance Connector Authority, which administers the new health law, 340,000 people who had been mostly uninsured were covered through the state’s program as of Jan. 1. Of that number, about 110,000 have bought private insurance through Commonwealth Choice. But, he said, the remaining 230,000 people have MassHealth or Commonwealth Care, the state’s subsidized health insurance programs.

One thing that’s unclear is why the formerly uninsured choose the types of clinics mentioned in the story when it looks although they could go to any doctor. Maybe they can’t, or maybe the story didn’t address it.

Either way, the unintended consequences of insuring hundreds of thousands of people are worth considering.

Thoughts? Leave a comment on this blog.

Jeff Raymond, Medical Writer

After taking a hiatus from The Medicine Bag, I have returned … with a question.

Do you think it’s fair and/or accurate to see Oklahoma ranked at or near the bottom of, well, just about every study of health that comes our way? We can’t be worst in everything health-related, can we?

I say this after reading about Wednesday’s report from The Commonwealth Fund. The nonprofit ranked children’s health in states on 13 indicators that included access to and quality of care, outcomes, equity and cost.

Oklahoma pulled up the rear. Fifty-first. Behind the District of Columbia and Mississippi. Leading the rankings were Iowa, Vermont, Maine, Massachusetts and New Hampshire.

Now, I know the devil’s in the details, and I admit I haven’t looked at the methodology of this report. I usually do, however, which is why I ask about the fairness of all this. I imagine this report would pass muster if you agree what it measures accurately sums up the state of children’s health.

Ah, here’s where it gets tricky: Are the measures used fair? Are small differences in rates or percentages blown out of proportion? Is the information current, or as current as possible?

See the state’s “scorecard” for yourself here.

The interesting thing about these reports is they are all largely slicing and dicing the same data. Sometimes it gets hard to tell them apart.

Anyone who honestly assesses the state’s health will find huge problems. But last or near-last every time? Perhaps I’m becoming desensitized, but my reaction is getting to be “C’mon!?!”

What’s yours? Tell me what you think by posting a comment on this blog.

Jeff Raymond, Medical Writer

 You can be forgiven for thinking yesterday was anything more than a nice day to watch college hoops.

It was, but it also was National Doctor’s Day.

The American Medical Association uses the day to honor the more than 900,000 physicians in the United States.

“On this day of tribute, Americans can express appreciation for physicians’ continued commitment to providing exceptional medical care,” according to an AMA release.

The nation’s doctors, throughout almost 1 billion patient visits annually, are called to be healers, confidants and advocates, the AMA says.

The organization also says two-thirds of U.S. doctors provide some form of charity care and in 2006 were ranked the nation’s most trusted occupation.

Furthermore, the AMA says:

• Ninety percent of patients say they are very satisfied with their doctor.
• Americans’ life expectancy has increased by seven years since 1960.
• There has been a 77 percent decrease in the infant mortality rate since 1950.
• There has been a 63 percent decrease in the overall death rate for heart disease since 1950.
• There has been a 72 percent decrease in the overall death rate for stroke since 1950.
• There has been a 14 percent decrease in the overall death rates for cancer since 1990.

Do you consider the medical profession admirable and respectable? Do you respect your physician? Are you satisfied with him/her? Drop me a line at The Medicine Bag blog at http://blog.newsok.com/health.  

Now back to basketball!

Jeff Raymond, Medical Writer

USA Today had an interesting story yesterday about how the popularity of angioplasty, a commonly performed procedure in which doctors use a balloon to open blocked coronary arteries, may be eroding.

“The rise of angioplasty procedures has leveled off and appears to be on the decline,” Duke University’s Eric Peterson, who reviewed results of the analysis by the National Cardiovascular Data Registry, told the newspaper.

Three studies in the last two years that indicate that angioplasty may be no more beneficial than medication, and may be riskier. According to the newspaper, the research suggests angioplasty is used too often and its benefits don’t justify the procedure’s $10,000 to $12,000 cost.

The newspaper’s analyses found:

• The number of annual procedures performed each year has declined by 10% to 15% over the last two years.

• Angioplasty and stent use began dropping in June 2006, after two “landmark” studies cast doubt on them. Doctors often implant stents — both bare metal and drug-coated — after angioplasty to keep the artery open.

Angioplasty is used to treat the terrible chest pain, called angina, that comes from a heart without enough oxygen.  The slight decline is important because Centers for Medicare and Medicaid Services guidelines seek to have angioplasty available within 90 minutes of a patient’s arrival at the hospital. This is often called door-to-balloon time.

Many medical authorities tout the benefits of angioplasty.

Because hearts suffer from an inadequate blood supply, Bonnie Weiner, president of the Society for Coronary Angiography, told the newspaper, “(Angioplasty) is very effective at achieving more blood flow to the heart.” 

“I personally wasn’t surprised by the results,” says Michael Rich, a cardiologist at Washington University School of Medicine in St. Louis who will debate the study at the heart meeting.

Michael Rich, a cardiologist at Washington University School of Medicine in St. Louis, said angioplasty won’t prolong a person’s life or decrease the risk of a heart attack but will decrease the symptoms of one.

“The analyses conducted for the newspaper also reflect what may be the beginning of a broader change in medicine: a move toward ‘evidence-based’ care drawing on reams of data from medical research and patient treatment,” USA Today reported.

Jeff Raymond, Medical Writer

Researchers have seen that weight-loss surgery appears to cure type 2 diabetes, which they have attributed to the huge drop in pounds. After all, being overweight is a risk factor for diabetes, and losing weight can effectively take care of the problem.  

An article that appeared in a supplement to last month’s issue of Diabetes Care argues that the bowel is the site of mechanisms that lead to diabetes.

The study’s author, Dr. Francesco Rubino of New York-Presbyterian Hospital/Weill Cornell Medical Center, presents evidence on the mechanisms of diabetes control after surgery.

“Clinical studies have shown that procedures that simply restrict the stomach’s size (i.e., gastric banding) improve diabetes only by inducing massive weight loss. By studying diabetes in animals, Dr. Rubino was the first to provide scientific evidence that gastrointestinal bypass operations involving rerouting the gastrointestinal tract (i.e., gastric bypass) can cause diabetes remission independently of any weight loss, and even in subjects that are not obese,” according to a press release.

Rubino’s previously has shown that the main way gastrointestinal bypass controls diabetes is by skirting the upper small intestine — the duodenum and jejunum.

“It has become increasingly evident that the gastrointestinal tract plays an important role in energy regulation, and that many gut hormones are involved in the regulation of sugar metabolism,” according to the release.

Rubino’s findings suggest bypassing the upper intestine may work by reversing abnormalities of blood glucose regulation.

He guesses the upper intestine of diabetic patients may be the site where an “abnormal signal” is produced that causes or predisposes one to diabetes.

Gastrointestinal surgery offers the possibility of complete disease remission. This is a major shift in the way we consider treatment goals for diabetes. It is unprecedented in the history of the disease,” he said.

What do you think of using surgery to treat diabetes? Have you had an experience with it? Leave me a comment at http://blog.newsok.com/health.

Jeff Raymond, Medical Writer

If you’re interested in keeping tabs on your doctor, HealthGrades now offers a notification service.

The Web site, www.healthgrades.com, is best known for its hospital ratings. But given the information it compiles, a physician notification service is a natural addition.

The “Watchdog” e-mail alert service costs $4.95 a month.  

Notification items include board certification, disciplinary actions, malpractice suits and patient safety reviews.

Would you monitor your doctor? Would you pay to have someone notify you of lawsuits and other information of interest? Leave a comment at The Medicine Bag blog at http://blog.newsok.com/health. I’d like to hear what you think.

HealthGrades maintains quality profiles on almost every practicing physician in the country. The profile includes information on the doctor’s medical training, patient ratings, state and federal sanctions, malpractice judgments (in 15 states), procedure costs and hospital affiliations.

Subscribers to the service receive e-mail alerts when a physician’s information changes. Comprehensive physician profiles cost $29.95.

Jeff Raymond, Medical Writer

I worked for six months or so in the emergency room at Saint Francis Hospital and saw a number of interesting things while I was there. Among them were patients who repeatedly visited the ER complaining of chest pains but who weren’t having heart attacks.

The Agency for Healthcare Research and Quality today reported that such chest pain accounted for 16 million ER visits in 23 states in 2005. I’m not sure if Oklahoma was one of the surveyed states, but it’s nonetheless interesting. About one-fifth of the patients — 345,000 of them — were admitted for observation or treatment. 

“Non-specific” chest pain was the fourth most common cause of visits to the ER. The top three were sprains and strains, bruises and other superficial injuries, and abdominal pain.  

AHRQ also found:

• ER visits were almost twice as likely among those from the poorest communities compared with those from the wealthiest communities.
• Uninsured patients accounted for about 18 percent of visits.

If you ran a hospital, how would you handle an uninsured person who isn’t having a heart attack but may need observation? Visit The Medicine Bag blog at http://blog.newsok.com/health to leave a comment.

Jeff Raymond, Medical Writer

Almost 1 in 3 American woman had babies delivered by C-section in 2005, the Agency for Healthcare Research and Quality reports.

The number of C-sections was 38 percent less in 1995.

AHRQ also found:

 -Vaginal deliveries declined from about 3 million in 1995 to 2.9 million in 2005.
 -Vaginal deliveries among  women who previously had given birth via C-section dropped 60 percent –157,200 in 1995 to 62,300 in 2005.
 -Hospitals charged $17.4 billion for deliveries by C-section in 2005.

The Oklahoman’s Heather Warlick wrote this story about C-sections in September.

Jeff Raymond, Medical Writer

 The need for donor livers outstrips their supply. Each year, about one-third of those with end-stage liver disease who need an organ will receive one. Some die while on the waiting list.

The February issue of Mayo Clinic Proceedings examines how the current system for allocating organs in the United States affects recipients’ outcomes.

The United Network for Organ Sharing (UNOS) oversees organ allocation. With the goal of giving organs to the most critically ill transplant candidates, UNOS adopted the MELD — Model for End-Stage Liver Disease — scoring system in 2002. The score is calculated from the results of three lab tests.

“Unlike past evaluation systems, the MELD score de-emphasizes the length of time a patient has been waiting for a donor organ. … Research has shown that although the donor liver shortage persists, implementing this allocation system has decreased the number of patients who die while waiting for donor organs,” according to a Mayo Clinic press release.

The study looked at the evaluation practices and acceptance criteria for liver transplant used by the Mayo Clinic Jacksonville Transplant Center after implementation of MELD scoring. Researchers examined medical records from 555 patients referred for liver transplants at the Jacksonville center from Jan. 1 through Dec. 31, 2005. Of these patients, 53 percent were denied for a transplant. Half of those denied were considered too early to have the procedure, while the rest were excluded because of medical conditions and psychosocial issues — poor support systems or continuing substance abuse problems, for example.

Many were subsequently accepted.

“Patients seeking referral often undergo repeated assessments by selection committees, as their eligibility can change over time or following treatment and/or changes in conditions that led to their initial exclusion,” according to the release.

Data suggest a “broad range” of patients could benefit from early referral to a transplant center, according to the release.

Basically, management of their disease and other medical and psychosocial conditions could make them transplant candidates sooner.

To read the report, click here.  

People seldom realize transplant waiting lists are anything but static: They constantly change, depending on organ availability and patients’ medical states. They’re definitely moving targets. People move up, they move down; they drop off, they’re added back.

“Our study suggests that early referral for LT (liver transplant) evaluation is beneficial for reasons unrelated to the time patients spend on the LT waiting list. If patients too early for LT were evaluated but not listed, LT centers could initiate management of ESLD (end-stage liver disease) and address psychosocial issues in a sub-group of patients who could also ultimately benefit from LT,” the authors wrote.

Although not exactly the same thing, last month I wrote about this man, Dr. Ludvik Artinyan, left, who registered on organ waiting lists in California and Oklahoma. He was able to receive a liver transplant quicker by traveling to Integris Baptist Medical Center to have the procedure performed rather than having it done in Los Angeles. Because patients’ MELD scores typically are higher in California for various reasons, double-listing likely allowed the Armenia-born physician to shave months off his wait time and perhaps saved his life.

UNOS allows potential transplant recipients to be listed in multiple regions – they must meet each site’s criteria and be ready to respond to the phone call or page when an organ becomes available.

Is the current organ allocation system fair? E-mail me at jraymond@oklahoman.com or post your thoughts at http://blog.newsok.com/health.  

Jeff Raymond, Medical Writer

The Fifteenth Annual Healthy Heart Fair will be from 9 a.m. to 1 p.m. Saturday at the Oklahoma City Community College Union Building, 7777 South May Avenue.

People from across the state are invited to have their cardiovascular health evaluated via a free health screening (fasting is not required for the screening) including cholesterol, blood pressure, glucose and body fat analysis. Attendees can also learn the signs and symptoms of an ailing heart while trained staff will be on-hand to give CPR classes.

An “Ask the Cardiologist” booth will be set up for those that need answers to their heart health questions.

Three one-hour presentations will also be given:

9:30 a.m.
Kris Mullins, M.D.
Heart Checkup: The Many Cardiac Tests Available at Integris Heart Hospital

10:30 a.m.
Terrie Gibson, M.D.
Herbal Medicines: Helpful or Harmful?

11:30 a.m.
Terrie Gibson, M.D.
Health Screenings: Which Ones to Get, Which Ones to Skip

The Healthy Heart Fair is sponsored by Integris Heart Hospital at Baptist Medical Center.

For health and medical news and commentary, visit The Medicine Bag blog at http://blog.newsok.com/health.

Jeff Raymond, Medical Writer