Showing posts from December, 2017

A 2017 New Year’s wish list for healthcare | Suneel Dhand

My New Year’s Wish List

1. Healthcare information technology

2. Patient safety and healthcare quality

3. Patient satisfaction and improving the hospital experience

4. Direction of healthcare consolidation and private doctors

5. Healthcare costs

None of the above categories are exclusive, nor independent of the others.

Dr Suneel Dhand elaborates in the following video

Suneel Dhand is a physician, author and speaker. He is co-founder at DocsDox and founder at DocSpeak Communications. Learn more about him here.

A 2017 New Year’s wish list for healthcare | Suneel Dhand

Trump administration fires all members of HIV/AIDS advisory council

The remaining members of the Presidential Advisory Council on HIV/AIDS were fired en masse this week. Months after a half-dozen member resigned in protest of the Trump administration's position on health policies, the White House dismissed the rest through a form letter. The notice “thanked me for my past service and said that my appointment […]

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State air board has urged a 500-foot buffer zone but now emphasizes design rather than distance.

Regulators shift focus on housing by freeways

State air board has urged a 500-foot buffer zone but now emphasizes design rather than distance.
By Tony Barboza and David Zahniser

Twelve years ago, California air quality officials delivered a warning to cities and counties: Avoid putting new homes in high-pollution zones within 500 feet of freeways.
That advice, which relied on years of research linking traffic pollution to asthma, heart attacks and other health problems, was aimed at keeping “children and other vulnerable populations out of harm’s way,” according to the state Air Resources Board’s 2005 handbook .

But earlier this year, the air board shifted its stance. It issued a newadvisory that emphasizes design rather than distance, recommending anti-pollution features such as air filters, sound walls and thick vegetation as “promising strategies” to reduce the health risks from freeways.

With those measures, communities can build “while simultaneously reducing exposure to traffic-related pollution,” the air board said.

In making that change, air regulators acknowledged a stark reality: Despite health risks, cities desperate for more housing at a time of soaring rents keep approving homes near traffic pollution. The Times reported earlier this year that residential development along freeways has surged in the decade since the air board issued its warning.

Business leaders and housing advocates have cheered the pivot by the air board, contending limits on home building near freeways will worsen an affordability crisis. The new advisory has also been embraced by state planning officials, who say urban development near transit is essential to fighting climate change by reducing reliance on cars.

But some worry that amid a push to build homes, the air-quality agency has muddied what had been a clear, if controversial, health warning.

Scott Fruin, professor of preventive medicine at USC, said the air board’s latest document presents best-case scenarios and overstates the extent to which air filters and other anti-pollution measures protect residents. By recommending those steps, he said, state regulators “may give the false impression that it is now OK to put schools and residences close to freeways.”

“The best current strategy to reduce near-freeway exposure is not to put schools and residences there in the first place,” said Fruin, who previously worked at the Air Resources Board. “Even with the best reduction measures available, air pollution in these locations will remain unhealthy.”
Air board officials said they prepared the advisory to give policymakers the latest, scientifically based options to reduce pollution exposure at a time when the state is encouraging home construction near transit lines that are often next to freeways and other high-traffic corridors.

Those projects are challenging in cities like Los Angeles, “where freeways and major thoroughfares abound,” air board spokesman Stanley Young said. “In responding to that reality, we felt it was important to give planners and developers information on how to mitigate the impacts,” he added.
Kurt Karperos, a deputy executive officer for the air board, said the April advisory does not change the agency’s 2005 recommendation to avoid siting homes within 500 feet of freeways. “That’s a very basic health position that the agency has taken and we still stand by.”

In recent years, Karperos said, some have suggested the agency replace its recommendation for a 500-foot buffer, since vehicles have become less polluting over the last decade. “We disagreed.”
Still, one official in Gov. Jerry Brown’s administration reached a different conclusion, saying the 2005 recommendation “was replaced” by this year’s advisory on air filters, sound walls and other anti-pollution strategies.

Ken Alex, who directs the governor’s Office of Planning and Research, pointed to the April advisory as he defended the state’s decision to finance affordable housing next to freeways. The air board’s position is “much more nuanced than ‘don’t build’ ” within 500 feet, said Alex, whose agency is responsible for long-range policies on how California grows and develops.

State air regulators say their 2005 guidelines have not, in fact, been replaced.
Air Resources Board officials said they decided to supplement them in light of new science on freeway pollution and the effectiveness of air filters and other measures. Regulators drafted a report — an appendix to be considered in addition to the 2005 guidelines — and presented it to the air board in January 2016.

At that meeting, air board chair Mary Nichols acknowledged that the push for dense urban development, which can reduce driving and overall emissions, also can “result in increased exposures for people who live or go to school and spend any time outdoors in areas near roadways.”
“Trying to optimize both of these strategies has proven to be somewhat controversial and an interesting challenge,” Nichols said at the meeting.

The final document, published in April, was an advisory. Air quality officials do not have the power to regulate land use. The document said research shows “the public health, climate, financial, and other benefits of compact, infill development along transportation corridors” and found alternatives to distance-based guidelines “that can protect public health while not dictating development patterns.”
Among the suggestions in the report: Lower speed limits to 55 mph or less and install roundabouts to reduce vehicle emissions. Design city streets with parks, bike lanes, wider sidewalks and buildings with “varying shapes and heights” to disperse traffic pollutants.

The Air Resources Board’s influence has grown considerably over the last decade as its core mission — protecting people from pollution — has expanded to include efforts to slash greenhouse gas emissions. That shift has sparked criticism from some environmentalists, who contend that the board has made tackling health threats from local pollution secondary to the global fight against climate change.

The new focus on anti-pollution design puts the air board in closer alignment with the city of Los Angeles, which has adopted stronger filtration requirements but has not imposed limits on how close homes can be built to freeways. That emphasis also drew praise from housing advocates and developers, who viewed the 2005 guidelines skeptically.

Freeway sound barriers

Stuart Waldman, president of the Valley Industry and Commerce Association, said the air board’s latest advisory “just shows that the original policy was unrealistic to begin with.”

Alan Greenlee, executive director of the Southern California Assn. of Non-Profit Housing, said he is happy the state “seems to have moved in the direction of allowing building where previously they weren’t interested.” With filters and other anti-pollution measures, developers “can house people affordably and healthfully in areas where the government says there are air quality issues.”
Some environmentalists view things differently.

Multi-function walls: Solar, sound and pollution barrier

Enivronmental barrier

When the air board’s handbook came out in 2005, “we thought that was a real step forward,” said Bill Magavern, policy director for the Coalition for Clean Air.

Environmental groups have largely favored the state’s push to concentrate new homes near transit, citing the climate benefits. But without limits on home building near freeway pollution, those policies will have unintended health consequences, Magavern said.

“New housing should be well planned so that it’s not putting residents’ health at risk,” Magavern said. “The goal is to have the homes near transit, not near freeways.”

In Southern California, officials with the South Coast Air Quality Management District say they continue to send letters to developers suggesting they increase the distance between new homes and traffic. In the Bay Area, air quality regulators last year published interactive traffic pollution maps and planning guidelines that recommend some of the same design measures as the state.
The Bay Area Air Quality Management District advised communities to put new homes as far from freeway pollution “as is feasible.” The words “as is feasible” were added “at the heavy insistence” of developers and affordable housing advocates, said Jackie Winkel, a principal environmental planner with the agency.

tony.barboza
@latimes.com
Twitter: @tonybarboza
david.zahniser @latimes.com
Twitter: @DavidZahniser

Calcium and vitamin D supplements may not protect against bone fractures

$Calcium and vitamin D supplements may not protect against bone fractures$

One of the most contentious questions in nutrition science over the past decade has been whether older adults should be taking supplemental vitamin D and calcium. As the world's population ages, and broken bones and fractures become even more of a public health concern with huge social and economic consequences, researchers have been trying to make sense of […]

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A boy’s basketball-size tumor is slowly suffocating him. Doctors will attempt a risky removal.

Noel Zayas paraded his son to a never-ending carousel of Cuban doctors, but none of them would touch the boy. Emanuel Zayas’s basketball-size facial tumor was too complex, they told his family. The surgery to remove it too risky. “I knocked on a lot of hospital doors,” Zayas told the Miami Herald. “To see our son […]

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This flu season could be a potentially harsh one, and experts say the worst time could coincide with the height of the holiday season and start of the new year. “Flu is picking up and picking up early,” said Daniel Jernigan, director of the influenza division at the Centers for Disease Control and Prevention. “A […]

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What’s the most embarrassing way you’ve ever injured yourself?

Louis Greenstein was 28 and working as an extra in a friend’s movie in rural Pottsville, Pa. There was a lot of waiting around, and he noticed an electric cow fence. He picked up a twig and flicked it at the fence. Nothing happened. He “bravely” touched the twig to the wire. Nothing. You can […]

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Someone stole a child's parcel off his porch. It contained his kidney transplant medication.

When Austin Taylor turned 4, his father reminisced about the young life doctors said the boy would likely never have. “1,461. It may seem like an odd number to post on Facebook. But this number holds more meaning to our family then you realize. This is the number of days Austin has gone beyond the doctor's life expectancy,” […]

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WHY MATCHA?

Hiii guys!

Ah, it feels so good to be back on the blog. I know I said I was planning to blog from Bali, but guess what? My laptop crashed and wouldn’t turn on all throughout our trip, so my post from China was the first and last update I was able to write from vacation.

While retrograde hit me hard and I was super bummed at first, it was actually such a blessing in disguise. Without a computer or the ability to do any work, I was able to get so deep into my relaxation and completely check out in the trip, which re-inspired and invigorated me in so many ways.

More to come on all of that. I will do lots and lots of Bali recaps as I finally ease back into real-life over here, but today I wanted to bring you a matcha recipe featuring my FAVORITE new Vital Proteins Matcha Collagen… and I’ll tell you why.

Why Matcha for the Coffee Addict?!

When we were traveling around Bali I allowed myself to pretty much eat and drink whatever I wanted, whenever I wanted. For a control freak with food allergies and a past with eating disorders… food freedom on vacation is always AMAZING for my mind, but very tricky waters for my body.

My body is sensitive AF. I can eat as I please for a few days, which still includes my staple musts like remaining gluten-free, dairy-free, and having no refined sugar. But after a few days, things start to feel funky in my body. My digestion starts going out of whack, my stomach starts hurting, I don’t sleep well, the bloat is out of control, on and on.

So when I am on a 14-day trip eating some of the yummiest foods I’ve ever had in my life, you can imagine things went a little wonky for my bod! I was eating foods I know I have allergies to like eggs, gluten-free toast (#yum), alllll of the coffee, certain veggies, lots of fruits, ridiculously delicious desserts, and more.

And if you’re thinking I’m crazy for doing that while KNOWING how it would make me feel, I probably am. But also, a girl’s gotta live and I do believe in the mental freedom of easing up on our rules every so often, especially in a new country where the food is fresh as can be and MIGHT not cause the same issues, so it’s always worth a shot.

By our 10th, 11th, and 12th days… when we were staying at Nihiwatu, otherwise known as the #1 rated resort in the WORLD (more on that later), my physical reactions to food were getting so bad it was really hindering the trip. My body was freaking out and I had a perpetual migraine / headache that wouldn’t go away.

In other words, I felt like SH*T.

But this was another blessing in disguise, because I finally noticed exactly what kinds of foods I need to stay away from, and which ones I can be more lenient with.

While we were in Ubud and I was eating mostly raw vegan foods, I felt great. I was full of energy and unless I had the random red pepper or mushroom in my meal by accident I was completely fine and felt abundant and wonderful.

But it was when we left Ubud (otherwise known as “the holistic city” #swoon) and I started really loading up on the coffee, getting super lenient with gluten-free breads (all the hotels had SUCH GOOD homemade gluten-free breads!) and eggs and desserts that things started getting real bad.

In Nihiwatu I ate it all, falling back into my old trap of, “Wait, WHY am I feeling this way? I eat so well! This isn’t fair!” But in hindsight I was doing it to myself. It’s unfortunate to have to be so careful, but if I want to feel well then it is an absolute must.

Because of that, when we left Nihiwatu I made a promise to myself and to Jonathan (who was so patient and amazing and sweet with me while I complained and cried and laid in bed with a migraine and felt like crap for days on end): No more coffee. No more grains (even g-free grains). No more eggs. No more desserts with real sugar. Until I get this stomach issue back on track.

he is so patient with me

Processed with VSCO with c1 preset

I will share a lot more details when I go into more detail about the trip itself, but THAT, my friends, is why I am on the matcha train right now.

In fact, I have always loved matcha. I usually even drink matcha after having coffee! But my body is really loving and thriving off of cutting it way back on the caffeine train and sticking to matcha.

I use Vital Proteins Matcha Collagen which I am hosting a GIVEAWAY (!!!) for right now on Insta. We are giving away three canisters to YOUUU GUYS as long as you’re in the U.S. and Canada. All you have to do is comment on my photo with the matcha, tag three friends, and tell me why you want to win!

Processed with VSCO with e6 preset

So let’s talk about some matcha facts:

+ matcha green tea is packed with antioxidants, which can help fight free radicals in the body and promote long-term health.

+ rich in fiber, chlorophyll and vitamins

+ enhances mood and aids in concentration

+ calms the mind and relaxes the body

+ the powerful polyphenol EGCG in matcha is known to boost metabolism and burn calories (just an added bonus to the health benefits

+ provides slow & sustained energy versus the jolt and jitters that coffee gives us, so it’s also easier on our adrenals + hormones (the BIGGEST plus for me)

and then the additional health benefits of the Vital Proteins Matcha Collagen are the collagen benefits…

+ the most abundant protein in the body.

+ responsible for the maintenance of healthy connective tissues, such as bones, joints, skin, hair, and nails.

UMMMM, yes please.

My favorite way to enjoy matcha is either with hot water or steamed with warm coconut milk. My favorite yummy matcha holiday recipe is below!

Holiday Coconutty Matcha // TBB Style

Ingredients:

+ 1 scoop Vital Proteins Matcha Collagen

+ 1 cup warm coconut milk (easy to find at Whole Foods or any healthy grocery store), heated up on the stove or in the microwave

+ 1 tablespoon coconut butter

+ a few shakes cinnamon

+ a few shakes pumpkin pie spice

Method:

+ heat the coconut milk on the stove or in the microwave

+ melt the coconut butter if you want it to blend smoothly

+ add all ingredients into a high-speed blender and blend until smooth

ENJOY this creamy and delicious holiday treat! I like to have this first thing in the morning and then have breakfast about an hour or two later.

Matcha is so much easier on our hormones than coffee is, so even though I am saying goodbye to my BELOVED coffee for now… my adrenals, liver, skin, and energy levels will thank me. Trust me, nothing additional needs to be messing with my cortisol levels right now!

I hope you all enjoy this recipe, and I am sending so much love to you this holiday season! Thank you for baring with me while my posting schedule has been all over the place… Spirit Juice and the blog will be much more consistent in 2018 and I can’t wait. <3

And don’t forget to enter the Vital Proteins giveaway on Insta for a chance to win! It will be open until the day after Christmas! Thank you to Vital Protein for sponsoring this post and providing such healthy deliciousness for us all. I continue to feel so lucky to partner with brands I adore. XX

ACA enrollment for 2018 nearly matches last year's, despite Trump administration efforts to undermine it

Nearly 9 million Americans signed up for Affordable Care Act health plans for 2018 in the 39 states relying on the federal HealthCare.gov website, approaching the 2017 total despite an enrollment season cut by half and other tactics by the Trump administration to undermine the law's insurance marketplaces. The figure of approximately 8.8 million sign-ups […]

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How a multimillion-dollar empire built around urine drug tests exposes flaws in California’s rehab laws – Orange County Register

Perhaps one of the most vulnerable groups are those with addiction disorders. This story is about inadequate safeguards as to whom is allowed to operate these 'sober homes' and the poor if not existent record keeping.

The Orange County Register (California) TonySaavedra and Scott Schwebe investigated the Califonia system of recovery and sober homes. The allegations, if true are disturbing.

Philip Ganong, his wife and their 34-year-old son built a fast-growing, multimillion-dollar empire on urine.

They collected it from drug addicts at their chain of Southern California sober living homes. They created labs to test it. And they charged insurance companies to analyze it.

But the success story was a scam, according to prosecutors, who have accused the Ganongs of fraud. They say the family used a network of doctors and others to bilk insurers out of as much as $22 million for tests that were unnecessary or never performed.

The Ganongs have pleaded not guilty and are awaiting trial.

But the allegations raised in the Ganong case highlight what a growing number of critics say are chronic shortcomings in the oversight of California’s multi-billion-dollar drug rehabilitation industry.

Among the complaints:

Drug counselors and others can run sober living homes and some types of treatment centers without passing any kind of criminal background check. Even people convicted of drug crimes are allowed, under current state law, to get a license to own and/or operate drug and alcohol rehab centers.
Addicts and families considering rehab have no easy way to check the records of treatment centers, recovery homes or their owners or staff.
The state lags behind others in adopting reforms to crack down on treatment center operators who exploit vulnerable addicts and focus more on profits than on effective care.

California is “the wild, wild west right now,” said Kansas Cafferty, a commissioner with the National Certification Commission for Addiction Professionals.

In a state with about 1,800 licensed recovery centers and an unknown number of unlicensed sober living homes and testing labs, Cafferty is among many who believe California needs to get better at rehab regulation.

“There (are) a lot of places committing crimes that authorities are trying to enforce, but they can’t keep up with it.”

Just following the rules

Marlies Perez, chief of the California Department of Health Care Services’ Substance Use Disorder Compliance Division, which licenses rehab treatment centers, said her agency can only do what the state Legislature allows.

The state agency has only a broad guidance system, with few enforceable actions.

It’s not a new problem, and California legislators have fought about it for years. Still, they’ve made only halting progress in beefing up licensing standards and rehab monitoring. That’s partly because of industry lobbying, and because of fears that tighter rules will raise treatment costs or limit the number of rehab beds just when the nation’s opioid crisis is cranking up demand.

This year, State Sen. Pat Bates, R-Laguna Niguel, introduced a bill to reform the system, but it stalled in committee. Today, she describes the state’s oversight of rehab operators, sober living homes and counselors as “troubling.”

operator’s) background,” Bates said. “There’s a culture about giving these people a second chance.”

Still, she insists that background checks and tougher licensing requirements for counselors, employees and rehab operators are vital. “It’s something we need to pursue.”

Putting a face on it. Alex Schmick dies of an overdose while living in a recovery facility. The family sued the facility and the physician who wrote the order for the medication.

California lags other states

Smick is not the first to raise the issue of transparency. A state Senate report in 2012 found a host of oversight problems in the recovery industry, including poor monitoring of rehab centers and inadequate information sharing related to treatment center operators.

Other state officials have pointed to financial abuses in the industry that authorities say bleed millions from public and private pockets. Part of the concern is tied to so-called “junkie hunters,” people who recruit addicts from around the country and bring them to rehab centers in California in return for kickbacks.

One area of the rehab industry – sober living homes – has virtually no oversight.

The homes, where addicts often live for a few months after leaving formal rehab, aren’t required to submit any records of their operations. This is true, in part, because operators aren’t claiming to provide medical treatment and the people living in them, recovering addicts, are protected under the Americans with Disabilities Act.

How a multimillion-dollar empire built around urine drug tests exposes flaws in California’s rehab laws – Orange County Register

FDA approves first gene therapy for an inherited disease

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Lies, Sex and the Affordable Care Act, and the Seven Forbidden Words in Health Care

For my readers. Warning...this post may be offensive to some. It includes language and images that may offend some readers.

CDC gets list of forbidden words: Fetus, transgender, diversity

Policy analysts at the Centers for Disease Control and Prevention in Atlanta were told of the list of forbidden terms at a meeting Thursday with senior CDC officials who oversee the budget, according to an analyst who took part in the 90-minute briefing. The forbidden terms are “vulnerable,” “entitlement,” “diversity,” “transgender,” “fetus,” “evidence-based” and “science-based.”

In some instances, the analysts were given alternative phrases. Instead of “science-based” or “evidence-based,” the suggested phrase is “CDC bases its recommendations on science in consideration with community standards and wishes,” the person said. In other cases, no replacement words were immediately offered.

However it is no more offensive that our official government is banning certain words from HHS publications. This seems very similar to the past ban on network television of the seven 'famous' do not say words, in the words of George Carlin which first appeared in "Class Clown" his famous album, published in 1972.

These expletives can truly be assigned to our medical system.

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‘The Woebot will see you now’ — the rise of chatbot therapy
A woman with a transplanted uterus just gave birth — a first for the U.S.

An Illinois doctor traded drugs for sex and cash. He just pleaded guilty.

The first scheme that Constantino Perales ran involved some simple math. He'd provide a drug dealer with hundreds of oxycodone and Xanax pills and the man would pay the doctor $15 to $20 for every tablet he sold, according to federal prosecutors. The second scheme was even simpler, if baser. Perales would write prescriptions for the drugs; […]

Related:
The moral differences between pro- and anti-vaccine parents
‘The Woebot will see you now’ — the rise of chatbot therapy
A woman with a transplanted uterus just gave birth — a first for the U.S.

The moral differences between pro- and anti-vaccine parents

When it comes to persuading parents in the United States who are hesitant about vaccinating their children, the public health messages often rely on facts and science to explain how immunization not only protects those children but also shields other vulnerable people from dangerous infectious diseases. But information campaigns that emphasize fairness or preventing harm […]

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A man claims he went down a ‘Raging Rapids’ ride — and came out with an eye-eating parasite
Quitting smoking is hard. FDA wants new nicotine-replacement therapies to help.
An 84-year-old doctor who refuses to use a computer has lost her medical license

'The Woebot will see you now' — the rise of chatbot therapy

My therapist wanted to explain a few things during our first online session: “I'm going to check in with you at random times, if you can't respond straight away, don't sweat it, just come back to me when you're ready. I'll check in daily.” “Daily?” I asked. “Yup! It shouldn't take longer than a couple […]

Related:
A woman with a transplanted uterus just gave birth — a first for the U.S.
A model tattooed her eyeball purple. She now could lose her eye.
A man collapsed with ‘Do Not Resuscitate’ tattooed on his chest. Doctors didn’t know what to do.

In this undated photo provided by Baylor University Medical Center the first baby born as a result of a womb transplant in the United States lies in the neonatal unit at Baylor University Medical Center in Dallas. (Baylor University Medical Center via AP)

For women with uterine factor infertility who want to be mothers, the calculus has always been heartbreakingly simple: No uterus means no pregnancy. The equation changed drastically in 2014, when Swedish doctors delivered a healthy 3.9-pound baby that was the result of a successful uterus transplant. Now, doctors at Baylor University say a woman born […]

Related:
A model tattooed her eyeball purple. She now could lose her eye.
A man collapsed with ‘Do Not Resuscitate’ tattooed on his chest. Doctors didn’t know what to do.
A man claims he went down a ‘Raging Rapids’ ride — and came out with an eye-eating parasite

A model tattooed her eyeball purple. She now could lose her eye.

A Canadian model who attempted to have her eyeball “tattooed” purple several months ago now says she is at risk of losing her eye entirely, after months of “excruciating” pain and compromised vision. Catt Gallinger was already a fan of extreme body modification when, she said, someone offered to stain her eyeball by injecting ink into the white […]

Related:
A man collapsed with ‘Do Not Resuscitate’ tattooed on his chest. Doctors didn’t know what to do.
A man claims he went down a ‘Raging Rapids’ ride — and came out with an eye-eating parasite
Quitting smoking is hard. FDA wants new nicotine-replacement therapies to help.

A man collapsed with 'Do NOT Resuscitate' tattooed on his chest. Doctors didn't know what to do.

Doctors in Miami faced an unusual ethical dilemma when an unconscious, deteriorating patient was brought into the emergency room with the words “Do NOT Resuscitate” across his chest. The 70-year-old man was transported earlier this year to Jackson Memorial Hospital, where doctors made their startling discovery: A chest tattoo that seemed to convey the patient's end-of-life wishes. […]

Related:
A man claims he went down a ‘Raging Rapids’ ride — and came out with an eye-eating parasite
Quitting smoking is hard. FDA wants new nicotine-replacement therapies to help.
An 84-year-old doctor who refuses to use a computer has lost her medical license