Their bodies, ourselves
On a recent weekend I saw something spectacular. No superlatives — it really deserves to be called spectacular.
The introduction in the dimly lit anteroom at the Science Museum of Oklahoma pretty much sums up the “Our Body: The Universe Within” exhibit: A detailed look inside the human body is something that historically has been limited to doctors and researchers yet has fascinated man for millennia.
Despite its $23.95 cost per adult, the 13,000-square-foot exhibit is something everyone should see. Go now, go this weekend, go whenever — just go before it closes May 11. If you have ever wanted your child to become a physician, as just about every parent has, roll the dice and take him or her to the museum; there’s a good chance your child will leave with an abiding fascination about anatomy.
The exhibit is thought-provoking, gasp-inducing, and a real coup for the Science Museum, formerly the Omniplex. It features 18 complete bodies and 135 other body-system, anatomical and health-related items.
One of the most striking things is how respectfully the bodies on display have been treated. Even when posed, with muscles splayed, or seated, with veins and nerves hanging like plumb lines from thick rings of flesh, the bodies retain their dignity. The only time I was uncomfortable was with a man on a spinning platform who is holding his own skin in front of him. I’m not sure if I was uncomfortable because he was holding his skin or because his skin looked like a hide from any other animal.
I know how similar man is to lesser species. Anatomically, genetically and physiologically, the similarities far outweigh the differences. Still, it’s disconcerting to see how much man, stripped of speech and conscience, resembles other mammals.
The bodies don’t smell because they have been treated with a special solution that “plasticizes” tissue and renders it odorless.
Two things particularly stood out to me:
- The first was how dense veins, arteries and capillaries are in some parts of the body. One memorable part of the exhibit has legs, or at least the vasculature of the legs. Take the lungs, liver and kidneys — all are stocked for blood transport, per their functions. It’s one thing to see a spongy lung and quite another to see the vessels that deliver the blood that allows us to breathe. It’s this sort of big-picture perspective that was always lacking in school. It’s one thing to study the nephons in the kidneys, for example; it’s another to see how they look together, by the millions, life-size.
- Parts of the exhibit show slices down the sagittal and transverse planes (take a look at the picture above to see what I mean). I was able to understand, for the first time, how the internal organs relate and where they are located in body cavities. I saw the ventricles, or chambers, of the brain, and the pillow the lungs provide the heart.
I got the impression the exhibit attracts doctors as well: After hearing one describe what he looks for when examining someone’s ears, I realized docs must be thrilled to share what they do with loved ones in a way words simply can’t convey. The man described looking at a patient’s ear drum, and how he would see internal structures and note them on the patient’s chart. Hearing about this and looking into an actual ear and skull must have made the woman with him understand his work so much better.
Have you been to the exhibit? What did you think? E-mail me at jraymond@oklahoman.com.
Jeff Raymond, Medical Writer
‘I have always felt different’
A paper in this month’s edition of the Journal of Pediatric Nursing describes ADHD from the perspective of college students who have it and have learned to cope.
The subject is interesting for several reasons, not the least of which because it features 16 adults recalling how ADHD affected their lives as children. Plenty of research exists on child and adolescent ADHD, but there is little out there on how the condition affects and has affected adults.
The study, from the University of North Carolina at Greensboro and Wake Forest University, is poignant in interviewees’ descriptions of how it feels to have ADHD — being called “stupid” or “slow,” not having parents understand why things don’t get finished.
The study noted common feelings among the group of loneliness and isolation.
“Can’t anyone see I’m struggling,” one study participant lamented.
Common threads through participants’ lives were:
- Trouble getting along with parents
“In their view, children with ADHD have more trouble than others,” the authors wrote.
One’s adolescence is rough no matter what, “but it tends to be a little rougher on people with special needs,” a participant noted.
Another participant described the “mass chaos fights” with parents and siblings — often due, participants said, to failing to perform chores within an expected time frame.
“Because of their distractibility and hyperactivity, participants said that they had difficulty completing tasks, causing problems with their parents,” the authors wrote.
Some parents provided support, but it was tough for them as well.
“My parents did provide support … with homework; making sure I was on top of things. But it kind of got to the point where it was nagging, but that’s how they got the actual answer from me,” a participant recalled. “They had to play 20 questions. I wasn’t trying to withhold information; it just took 20 questions to get the full description.”
- Missing a lot of material at school
Trouble paying attention and hyperactivity affected participants’ ability to learn.
“In class, I had a kind of lag time, ’cause in-between me figuring out what had been going on, the entire class moved on, so I missed out on information. So that was one of the biggest things — missing out — taking a longer time to get the entire idea,” a participant explained.
Participants learned to cope: They allowed help from their parents, asked for more time on tests or took them in different formats, recorded lectures and re-copied notes after class.
- Feeling different
Children with ADHD felt different in school, and situations such as sitting still and grasping concepts quickly made these differences clear.
“Other kids at school would call them retarded, slow, or stupid, and then ostracize them,” the authors wrote.
As such, they often had trouble making friends, and wondered why people didn’t like them. Social difficulties sometimes persisted into adulthood.
“Not only do I have a tendency to interrupt … but the main problem I have is, you need to think before you say something that can offend other people, or when you ask too many questions … they’ll say it makes them feel uncomfortable,” one participant said.
- Feeling misunderstood
“Friendships for children and adolescents with ADHD were fraught with misunderstandings,” the authors wrote.
One participant described how her friends kidded her about her problem.
“I have friends who say, ‘Oh, it’s my ADD and I don’t want to do my work. It’s my ADD kicking in.’ … and they’ll say it in front of me when they know I have it … and I’ll have it the rest of my life. I’ve gotten very mad at them,” the participant explained.
One participant suggested those with ADHD find friends who understand and will call out their names or tap them on the shoulder when they’re “zoned out.”
In 2003, according to the Centers for Disease Control and Prevention, nearly 8 percent of school-aged children were reported to have ADHD.
I don’t mean to suggest that the themes in the study are unique to those with ADHD, but I do think the research provides a window into how adults with ADHD think and the difficulties they face.
Parents of children with ADHD ought to take a look at it to see what their kids may say about their upbringing a decade from now.
What are your opinions on ADHD? Is it overdiagnosed? E-mail me at jraymond@oklahoman.com.
Check out a blog in The New York Times on the study here. To read the study, click here.
For health and medical news and commentary, read The Medicine Bag blog at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
Hospital tally approaches $1 trillion
U.S. hospitals charged $873 billion in 2005 — a nearly 90 percent increase from the $462 billion charged in 1997 — according to the Agency for Healthcare Research and Quality. The inflation-adjusted 2005 bill represents the amount charged for 39 million hospital stays.
With an average annual growth rate in hospital charges of 4.5 percent, researchers predict the bill will reach $1 trillion by 2008.
AHRQ also found:
-Medicare paid $411 billion of the national bill, followed by private insurance ($272 billion) and Medicaid ($124 billion).
-The uninsured accounted for $38 billion.
This is taken from the AHRQ report:
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Table 1. Top 20 most expensive conditions treated in U.S. hospitals, 2005 |
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Rank |
Principal diagnosis |
Total national hospital bill (millions) |
Percentage of national hospital bill |
Number of hospital stays (thousands) |
|
1 |
Coronary artery disease |
$45,985 |
5.3% |
1,110 |
|
2 |
Mother’s pregnancy and delivery |
$43,925 |
5.0% |
4,712 |
|
3 |
Newborn infants |
$35,316 |
4.0% |
4,429 |
|
4 |
Acute myocardial infarction (AMI, heart attack) |
$31,946 |
3.7% |
662 |
|
5 |
Congestive heart failure (CHF) |
$30,230 |
3.5% |
1,090 |
|
6 |
Pneumonia |
$29,535 |
3.4% |
1,355 |
|
7 |
Osteoarthritis |
$26,157 |
3.0% |
738 |
|
8 |
Complication of device, implant or graft |
$25,291 |
2.9% |
616 |
|
9 |
Sepsis |
$24,801 |
2.8% |
538 |
|
10 |
Back pain (spondylosis, intervertebral disc disorders, other back problems) |
$20,327 |
2.3% |
647 |
|
11 |
Respiratory failure, insufficiency, arrest (adult) |
$19,723 |
2.3% |
336 |
|
12 |
Cardiac dysrhythmias |
$17,224 |
2.0% |
697 |
|
13 |
Acute cerebrovascular disease (stroke) |
$17,060 |
2.0% |
526 |
|
14 |
Rehabilitation care, fitting of prostheses, and adjustment of devices |
$13,848 |
1.6% |
517 |
|
15 |
Complications of surgical procedures or medical care |
$13,316 |
1.5% |
463 |
|
16 |
Gall bladder disease |
$11,719 |
1.3% |
456 |
|
17 |
Chronic obstructive pulmonary disease (COPD) |
$11,506 |
1.3% |
630 |
|
18 |
Diabetes mellitus with complications |
$11,171 |
1.3% |
491 |
|
19 |
Hip fracture |
$10,869 |
1.2% |
317 |
|
20 |
Nonspecific chest pain |
$10,027 |
1.1% |
825 |
|
Total for top 20 conditions |
$449,976 |
51.5% |
21,155 |
|
|
Total for all hospitalizations |
$873,236 |
100.0% |
39,164 |
|
|
Source: AHRQ, Center for Delivery, Organization, and Markets, Healthcare Cost and Utilization Project, Nationwide Inpatient Sample, 2005. |
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For more health and medical news and commentary, read The Medicine Bag blog at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
Elderly predicted to crowd emergency rooms
Rates of visits by the elderly to emergency rooms are outpacing those of other groups, which could lead to “catastrophic overcrowding,” according to a study this week in the Annals of Emergency Medicine.
“Seniors are using the emergency department more and more frequently, and given the needs of this population and the nature of their medical problems, the current state of overcrowding is likely to continue to escalate dramatically,” Dr. Mary Pat McKay of The George Washington University Medical Center said in a press release. “These patients tend to be sicker and are more likely to be admitted from the emergency department to the hospital, but with many hospitals running a deficit of inpatient beds, I don’t see where these patients are going to go.”
Researchers studied ER visits from 1993 to 2003, and found that visits per 100 people 65 and older increased faster than the visit rate for any other age group, with an overall increase of 26 percent during the study period.
“People aged 65 and older are the fastest growing segment of the U.S. population. As emergency patients, they use the most resources, stay the longest, and are the most likely to be admitted to the hospital of all emergency patients. Researchers conclude that emergency department visits in the United States for patients between 65 and 74 could nearly double from 6.4 million in 2003 to 11.7 million by 2013,” according to the release.
AARP Policy Director John Rother called on elected officials to “heed the warnings” of the report and recognize that the health care system must deliver appropriate, affordable care.
“The trends released today underscore the need to make sure emergency departments can meet the demand for care by older people, but we also need a better understanding of why emergency room use by older people is on the rise and why these patients may not be getting care from their personal physicians,” he said in the release.
The study suggests older Americans are having more genuine emergencies, rather than increasingly visiting the emergency department.
For health and medical news and commentary, visit The Medicine Bag blog at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
What’s your excuse?
The study showed that 94 percent of headache sufferers annually skip a family or social event due to a headache. Additionally, 87 percent of respondents admitted to missing a day of work because of a headache.
However, more than 40 percent of headache sufferers believed that others dismiss a headache as a valid reason to miss an event or work.
About 45 percent of those who missed work or another function because of a headache were not truthful about the reason for their absence. Many were embarrassed to miss events because of their headaches, and because they thought they should be able to “tough it out.”
In fact:
– 45 percent of respondents missed at least five family or social events in the last year because of a headache.
– Nearly 30 percent have missed up to five days of work each month due to headache.
– 25 percent reported that their co-workers resent the time they spend away from work due to a headache.
– 20 percent reported their family and friends tend to resent them for missing events because of headaches.
The National Headache Foundation stresses that a headache is a neuro-biological disease, and nearly 90 percent of men and 95 percent of women have had at least one serious headache a year..The founation wants headaches — particularly migraine headaches — to be diagnosed just like a heart disease, diabetes and epilepsy.
A headache is a treatable disease and people should not needlessly suffer, according to foundation officials.
Currently, more than 20 million Americans suffer from migraine headaches, which most commonly experienced between the ages of 15 and 55. Seventy to 80 percent of sufferers have a family history of migraines. yet less than half of all migraine sufferers have received a diagnosis of migraine from their healthcare provider, according to the foundation, which is based in Chicago.
-Jim Killackey, Medical Writer
Diabetes south of the border
During my recent vacation to Guanajuato, Mexico, I learned Oklahoma and Mexico have something unexpected in common: Diabetes now is Mexico’s leading cause of death, ravaging the nation just as it ravages Oklahoma.
Although diabetes is not the leading cause of death in the Sooner State (heart disease is), its toll is huge, especially among minority groups. I didn’t expect a more traditional, less affluent culture would have such a problem.
I thought the disease, at least the type 2 variety, was more of an affliction of rich countries where exercise is insufficient; inexpensive, nutritionally empty food is plentiful; desk jobs are the norm and stress is everywhere.
Sure, Mexican food isn’t always the healthiest cuisine, with its many fried delicacies, fattening sauces and lots and lots of carbohydrates, but people walk more, and fast food is less a part of people’s diets than here. And certainly not all Mexican food is unhealthy.
Granted, Hispanics on the U.S.-Mexico border (and in general) are more likely to have diabetes than whites, but I always figured that was more an issue of poor nutritional knowledge and the difficulty of eating well and working out when raising a family on little money than anything else.
So, I found several stories I read in Mexican newspapers while on vacation interesting. This is from a recent edition of the Mexican newspaper Milenio, handily translated using Google:
Mexico City – The Ministry of Health warned that the lack of prevention and education on diabetes are the leading causes of its growth, (so) it is necessary to work on measures to prevent it, especially in public schools.
The director of the Metabolic Syndrome Clinic at the National Institute of Respiratory Diseases, Guadeloupe Fabian, warned that although the federal agency carries out activities important to control diabetes, it is essential that the Ministry of Education, universities and the pharmaceutical industry get involved.
Otherwise, diabetes … could become a pandemic.
Fabian emphasized that physical inactivity and poor diet are two predominant factors for the development of diabetes, which also affects children, and that 50 percent are related to problems of hypertension.
Sound familiar? Here’s more, from the Nov. 4 edition of El Universal:
Mexico City – Today it is natural to see a young man no more than 20 years old rely on injected insulin or suffer attacks of high blood pressure, conditions that two decades ago were exclusive to adults. The sedentary lifestyle, excess intake of junk food and a lack of natural nutrients are the main factors incidents youth to acquire these pathologies.
In view of Aurora Serralde Zuñiga, medical specialist in clinical nutrition at the National Institute of Medical Sciences and Nutrition Salvador Zubirán (INNSZ), the facilities of modern life based on technological devices promote less physical activity in young people. “On many occasions spend hours, for work or school, sitting in front of a computer or moving car and no longer walk,” he said.
In Mexico there are on average 6.5 million diabetics 20 years old or older.
“The genetic predisposition that the Mexican has the disease, coupled with bad eating habits and physical inactivity, results in juvenile diabetes,” said Jesus Montes Carrizales, a specialist in sports medicine of Tecnologico de Monterrey.
If the family pillar in the development of the young, not teaching good eating habits such as consumption of vegetables, fiber and water, and no physical activity … promotes the consumption of pizza, hamburgers and fries while watching television The young think that it is normal and healthy.
To prevent diabetes, high blood pressure, cholesterol and heart problems at an early age, both specialists invite young people to be physically active constant change the fries and soda for fruit and water, and leave the car for a walk.
And this from the newspaper’s Nov. 3 edition:
Mexico City – Mexico occupies ninth place worldwide in the number of patients with type II diabetes, totaling 6.6 million people with the disease, warned internal medicine specialist Paul Frenk.
If that trend continues in the coming years this figure could more than double, said the expert from the Latin American Society of Internal Medicine (Solami) and the American Diabetes Association.
Frenk warned that more and more young people, including children, are suffering the disease, which has become the common enemy to overcome throughout the world, and “in 2020 Mexico is expected to reach nearly 15 million diabetics.”
Frenk noted that the most regrettable matters is that increasing numbers of children and young people who develop the disease, which only some 15 years ago was designated for the elderly.
“We have the habits of our neighbors to the north, now the games are children via computer and fun is television and movies, and no longer exercise. Is a major problem and that we have to begin to change in the home and school,” he mentioned.
Diabetes is a serious public health problem, which will have an impact on catastrophic costs for both public health services, and for those who suffer and have no insurance or are covered by a social security program.
This due to diseases that develop as a result of diabetes, such as chronic renal failure, blindness and heart disease.
In Mexico diabetic retinopathy is the number one cause of blindness and is the first reason for myocardial infarction (heart attack), and that diabetes causes severe damage to the kidneys.
Any thoughts on diabetes in Mexico or Oklahoma? E-mail me at jraymond@oklahoman.com.
For more health and medical news and commentary, visit The Medicine Bag blog at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
More on being sad….
An interesting question for depression sufferers and their doctors is why antidepressants work for some people and not for others.
If someone is diagnosed with depression, and his or her doctor prescribes a Selective Serotonin Reuptake Inhibitor (SSRI) such as Prozac or Zoloft, only about 2/3 of people respond to a given drug.
The doctor typically will then try another, and another, until the right one is found. Meanwhile, the patient has endured additional weeks of depression and expenses.
Findings from the University of Iowa shed a little light on why these drugs work for some people and not for others.
“The study focused on a gene associated with the availability of serotonin, a chemical that at low levels can affect mood and sleep. The researchers found that among people with a variation in this gene, women were more likely than men to have altered processes related to serotonin,” according to a press release on the study.
The results were based on genetic analysis and depression assessments for 192 individuals and appeared online Wednesday the American Journal of Medical Genetics.
“While the finding is exciting, the researchers caution that they have not found a ‘depression gene,’ as genes alone cannot cause behaviors,” the release continued.
Researchers investigated the function of SLC6A4, a serotonin transporter gene. They found that chemically turning off the gene’s function occurred more often in women with the variant than men with the variant.
“This means that in some women less gene expression resulted in less mRNA, which is the genetic material that helps a gene make a protein,” according to the release.
Genes don’t code for behavior. They allow production of proteins, which may or may not influence behavior, depending on their function.
“The gene variant we studied may make some people more prone to develop depression if they experience more stress or abuse — similar to how, if two people have a genetic risk for osteoporosis, the one who runs may be more likely than the one who swims to actually develop osteoporosis,” one researcher said.
For more health news and commentary, visit The Medicine Bag blog at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
Depression by job
As I looked through the 1,200 e-mail messages I accumulated during my vacation, I ran across this.
According to data from the National Survey on Drug Use and Health released last month, full-time workers ages 18 to 64 in the “personal care” and “service occupations” had the highest rates of depression, followed closely by food service. The survey used 2004-06 data to determine depression rates by occupation.
During this time, an annual average of 7 percent of full-time workers ages 18-64 experienced a “major depressive episode” in the past year.
For women, the highest rates of depression were in food preparation and service occupations — 14.8 percent. For men, the highest rates were in arts, design, entertainment, sports and media — 6.7 percent.
The unemployed had higher rates of depression than did those employed full time and part time.
U.S. companies lost an estimated $30 to $44 billion a year because of depression-related lost productivity, absenteeism and low morale, according to a press release on the study.
And, of course, depression rates vary by occupation and industry. Seems obvious, but it’s interesting to see research bear it out.
Occupations with the lowest rates of depression were engineering, architecture and surveying; life, physical and social sciences; and installation, maintenance and repair.
As this is a health care blog, 9.6 percent of health care practitioners and technical personnel reported being seriously depressed.
I have one observation to make on the men’s end: Many people wind up in arts-entertainment-media jobs straight out of college, with stars in their eyes. When they find out how little money they’ll make, and realize how incredibly competitive the job markets are, they get down.
Take, for example, a dream job as a trainer with a professional sports team. Now imagine having to deal with the debt of a master’s degree, frequent travel, little respect and a paltry salary. That’s just one example I’m personally familiar with.
Wanna talk? E-mail me at jraymond@oklahoman.com. Also, check out The Medicine Bag blog at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
Americans spend double dose in health care
If you’re an average American adult, about $7,000 is spent annually on your health care, according to a new study. That’s about double what is spent on medical care for patients in other countries, according to the Commonwealth Fund, which surveyed individuals in the United States and six other countries.
The survey also found that U.S. patients are more likely to report experiencing medical errors and to go without care because of costs. U.S. patients, along with Canadians, also are the least likely to be able to get a same-day appointment with their physicians when sick, and the most likely to seek care in emergency rooms as an alternative. The study, published as a “Web Exclusive” in the journal Health Affairs, also finds that U.S. adults have the highest out-of-pocket costs and greatest problems paying medical bills.
Information was gathered from a recemt survey of 12,000 adults in Australia, Canada, Germany, the Netherlands, New Zealand, United Kingdom, and the United States .
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In terms of patient safety, U.S.adults report the highest rates of laboratory-test errors, and among the highest rates of medical or medication errors.
Results from the survey found U.S. adults were most likely to have gone without care because of costs and to have high out-of-pocket costs. About 40 percent of U.S. patients skipped medications, didn’t see a doctor when sick, or skipped recommended care in the past year because of costs.
-Jim Killackey, Medical Writer
Doctors debate Medicare rule changes
When the Centers for Medicare and Medicaid in August announced it wouldn’t pay for hospital mistakes and infections, I expected discussion and debate.
Today’s issue of The New England Journal of Medicine delivered as promised. In it, Meredith Rosenthal, an associate professor of health economics and policy at the Harvard School of Public Health, provided a good, balanced overview of the change’s likely effects.
The rule change, she noted, implemented a congressionally mandated change in hospital reimbursement. It makes the agency’s payment policies “far less passive” than they once were. She further pointed out an interesting — albeit perverse — phenomenon: Hospitals that have improved patient safety and addressed problems such as “nosocomial” (hospital-acquired) infections have seen their Medicare revenues reduced. This she attributed to quirks in the payment system.
I don’t want to go into specifics, and I imagine you’d prefer I don’t.
“The new rule will result in hospitals seeing substantial reductions in payment for the care of individual patients with preventable complications,” Rosenthal wrote. She predicted, however, that the change wouldn’t substantially affect total payments to hospitals because they would be reduced only when the preventable complications were the only factors causing an illness to be reclassified under a more expensive diagnostic code.
Translation: It must be clear that additional problem was related entirely to the hospital stay, and the conditions covered are limited. I imagine proving fault will be a challenge.
The importance of the change is that it tip-toes toward “pay for performance.”
“Hospitals may therefore view the new policy as a harbinger of things to come and act in anticipation of more substantial reimbursement changes,” Rosenthal wrote, predicting hospitals may adopt further quality measures as a result of the new rules and improve reporting.
This began in earnest with reporting a limited number of measures, which the public can view at http://hospitalcompare.hhs.gov.
Today it’s pressure ulcers, bed falls and other things that shouldn’t happen. Tomorrow it’s more complicated stuff.
According to Medical News Today, starting in 2009 Medicare won’t cover “preventable” conditions. Because rules don’t allow hospitals to pass on the cost, they must shoulder the burden. Because Medicare and Medicaid participants make up a large percentage of hospital visitors, the agency has tremendous clout nationally to force changes in the health care system.
The commentary in the medical journal and this week’s news on the prevalence of hospital-acquired infections make this a particularly interesting time. I’ll be curious to see how hospitals respond to the change and if there is an effect on the bottom line.
Because information on hospital-acquired infections isn’t publicly disseminated (at least nowhere I’ve found) or reported to the state, determining the extent of the problem is nearly impossible. Maybe this will shed some light on it.
For more medical news and commentary, check out The Medicine Bag blog at http://blog.newsok.com/health.
Jeff Raymond, Medical Writer
