H1N1 Preparedness At Tufts University

H1N1 Preparedness At Tufts University
by Peter Yeh & Mary Cheng*

Image Credit:jpcolasso (Flickr)

According to an email sent out to the campus from Dr. Margaret Higham, Medical Director of Tufts University Health Service, over forty undergraduate students at Tufts University on the Medford Campus have shown signs of Influenza Like Illness (ILI). Although it is likely that not all of these students actually have H1N1 flu, some of them probably do.

Since the outbreak of the pandemic last year, various departments on Tufts campus have worked collaboratively to ensure students’ health. Health Services, Dining Services, Residential Life, and Public Safety, have all have been actively involved in the prevention process. Michelle Bowdler, the Senior Director of Health & Wellness Services, praised the University’s teamwork. She was especially impressed by the message from President Bacow, who said that the safety and comfort of students come first, even though taking care of these preparations can be costly. “The president has put the students first and has told us to take necessary steps to ensure that we are addressing the flu adequately, “ Bowdler noted.

Students, staff and faculty have been strongly reminded to take extra care of personal hygiene. Health Services disseminated flyers around campus to remind students to wash hands often, sneeze/cough into their sleeves, and refrain from rubbing one’s nose and eyes with one’s hands, which is how virus enters the body. She also suggested that people keep an appropriate social distance like “don’t shake every hand” and “don’t share food” to prevent the transmission of disease.  Even though people should take precautions against the flu and be serious about the impact it could cause, the director emphasized the need not to panic. One of the things that health service has to combat is flu anxiety. According to the director, many people walk into the health service worried, thinking they have swine flu. She said, “If you don’t have a fever, you probably don’t have flu.”  The Health Service is not saying they do not want to see students without fever, but simply wants to acknowledge that there is a significant amount of worry among the student community.

Bowdler also showed solid plans to demonstrate Health Service’s strategies against H1N1. Flu kits filled with masks, ibuprofen (Tylenol), and disposable thermometers are available, as well as several linen packets, each filled with pillows and blankets, ready for who need to sleep in isolation rooms. In all, the director pointed out that she is “impressed with the tremendous amount of planning and forethought that the University and its different departments are contributing to the effort.”

In regards to H1N1 prevention, Dining Services and other departments have also taken their own steps. Along with receiving linen packets, if needed, students placed in isolation rooms have the option to either fill out a form to have a friend deliver their meal for them, or directly call Dining Services at a specified time for an ILI care package. These ILI care packages consist of food and fluids suited for various stages of recovery, ranging from chicken soup and Gatorade to cereal, fruits, microwavable food, pudding, and even different entrees. 

In addition to implementing the new delivery system this semester, Dining Services has taken precaution to a new level. The employees have received extra training and using gloves more frequently.The self-serve utensils are changed more frequently and hand sanitizers have been stationed on the counter next to the dining hall staff members who swipe IDs and handle money. However, the hard work that Dining Services is doing will not suffice if diners do their part. Patti Klos, Director of Dining and Business Services, said “everyone still has to be vigilant, and take extra care.”

The collaboration between Health Service and Dining Services is reinforced by the work from the Department of Public Safety. Furthermore, the Tufts University-wide Task Force continues to monitor the situation, collaborate with other colleges and attend meetings held by outside public health officials. John King, Senior Director of Public and Environmental Safety, said that “Tufts University is doing a fine job addressing the issues and uses the meetings to measure Tufts University’s progress.” The University-Wide Task Force on Pandemic Planning, a specialized organization that President Larry Bacow launched in 2006 and headed by Director John King, meets at least twice a month to discuss potential areas of planning, ensuring the best protective measures for the University.

Besides health issues, another major concern for students is homework and grades. The University works with faculty members to prioritize students’ health above class-work. During the onset of the flu, many students fall ill and miss class. “The professors were really accommodating,” said a junior, who contracted H1N1, at Tufts. “They wanted me to get better first.” The new online Illness Notification Forms also provide students with a more efficient way to communicate with professors. 

Another concern for Jumbos is what happens off campus. Many out of state students, especially those from other countries, are worried about their travel plans during Thanksgiving and Christmas break. Director Bowdler said “it would be wonderful if we received the H1N1 vaccine and could vaccinate students prior to these holidays, but we believe now that we will be receiving the vaccine somewhere in mid-November.”

Furthermore, people are still worried about the vaccines effectiveness. Even though medical staff assure students that the vaccine is safe the issue is a  “complicated affair,” according to Dr. Rosemary Taylor, an epidemics professor. Due to people’s past experiences and certain ingrained beliefs with vaccinations, not everyone would be willing to be vaccinated. As a result, Director Bowdler highlighted Health Service’s proactive stance in delivering information regarding the swine flu vaccine’s safety to the public. Despite the anxiety, the 2000 students who showed up for the seasonal flu vaccine this fall (some 800 more compared to previous years), serve as a great motivation factor for health service to continue its swine flu vaccination campaign.

The rule of thumb for everyone, including all travelers, is still to take care of personal hygiene.

Editors Notes
1. Type: TuftScope Online Exclusive.
2. Received10.06.09; Published 10.10.09.
3. Author Contact Information: Correspondence to the authors should be addressed to Mary Cheng* at Yuh-Tsyr.Cheng@tufts.edu.
4. Editor: Michael Shusterman.

Read more...

Rachel Maddow Discusses Congressman Mike Ross

Rachel Maddow discusses the purchase of Blue Dog Democrat Mike Ross' pharmacy in his home state of Arkansas by a large drug store company. A strange purchase that was so expensive that Arkansas officials even asked the drug store chain whether they wanted to buy the pharmacy. The entire presentation below:

Read more...

Hollywood Speaks Out for the Insurance Industry

In a satirical and somewhat biased video, various Hollywood stars satirically speak out for supporting and keeping the insurance industry the way it is.

Read more...

"We're Number 37"

A new video relaying the message that the US, according to the World Health Organization, is #37 for healthcare in the world. The video follows:

Read more...

Obama and Clinton Speeches on Healthcare

We present below both President Obama's (9/9/2009) and President Clinton's (10/22/1993) speeches on healthcare for readers:

Obama Speech



Clinton Speech

Read more...

Research Highlights: Clinical Research

Research Highlights

by Michael Shusterman

Significant Discrepancies in Clinical Trials: Mathieu and colleagues report in a JAMA study that the 2005 requirement that clinical trials be registered to publish in most medical journals has been flaunted by investigators. From the 323 reviewed trials, 89 were completely lacking registration, and 31% (46/147) of the properly registered trials showed discrepancies between registered and published outcomes. More so those trials with discrepancies favored statistically significant results. [1]

European Drug makers Ahead of US: Donald Light reexamines 1982 - 2003 chemical research data to find that European drug makers never fell behind US companies in production and innovation. Indeed many of the American innovations like Nexium and Lipitor, cited as models of innovative discoveries, are either imitators (Nexium) or have not been proven to be any more effective than other drugs (Lipitor). Light argues that pharmaceutical companies have produced imitators and incrementally useful (if at all) drugs, instead of funding research into superior clinical treatments. [2]

Vertebroplasty, Just Not that Useful: Kallmes and colleagues show that a common procedure used to seal vertebral fractures with cement is no more effective in relieving pain than a placebo incision and injection with a rapidly acting analgesic. The treatment, known as vertebroplasty, costs between $2,500 - $3,000 dollars and requires an additional $1,000 - $2,000 MRI scan. Currently regional discrepancies in use of the procedure exist, as noted by the accompanying editorial to the study, which can be here. The question is whether this work will lead doctors to change their behavior with regards to the procedure? [3]

Dangers of Medical Imaging - Radiation: In a new NEJM study, Fazel and colleagues used claims data from UnitedHealthcare to perfrom a cohort study on accumulated radiation doses from medical imaging devices that patients received. They found the mean effective dose to be 2.4±6.0 mSv/person/year, and the median effective dose to be 0.1 mSv/person/year. Out of the 952,420 subjects in the study, 655,613 (68.8%) were exposed to some form of radiation through scans over a three year period, with women undergoing more procedures than men. Questions about the accumulated doses from radiation are raised in the paper and the  accompanying editorial. [4]

Quick Highlight

Two New Studies Show 3 Genetic Variants are Linked to Alzheimers Disease. (Harold et al. and Lambert et al.) See the NY Times article for more information. 

References
1. Comparison of Registered and Published Primary Outcomes in Randomized Controlled Trials. JAMA. 2009. 302(9): 977-984.
2. Global Drug Discovery: Europe Is Ahead. Health Affairs. Web Exclusive: August, 25, 2009. doi: 10.1377/hlthaff.28.5.w969
3. A Randomized Trial of Vertebroplasty for Osteoporotic Spinal Fractures. NEJM. Volume 361:569-579.
4. Exposure to Low-Dose Ionizing Radiation from Medical Imaging Procedures. NEJM. Volume 361:849-857.

Read more...

David Goldhill and the Healthcare Crisis

David Goldhill and the Healthcare Crisis
by Michael Shusterman

David Goldhill, CEO of the network former Game Show Network recently wrote an article in The Atlantic on the healthcare crisis. After Goldhill's father died from a hospital acquired infection after checking in with pneumonia, Goldhill spent a year analyzing the healthcare system on his own time to find the faults. He talks about the failings of hospitals to adopt simple reforms like ICU checklists, a lack of patient focus in the system, overconsumption of healthcare in some regions versus others, the use of medical advertising to push for drugs that the consumer may not need and does not directly pay for, and multiple other issues. He acknowledges that these are mostly issues that are well known and have been frequently discussed in the healthcare policy literature. But then he offers his view on the problem.

According to Goldhill the current system has perverse incentives towards spending too much without any consumer directed thought towards what exactly is being gained. So over a lifetime the average person can spend quite a bit on premiums, Medicare taxes, copays, etc. Now you could try to deal with these costs and incentives to overtreat (there are other issues involved) through a more direct single payer approach, which he notes other countries do, but that would lead to "explicit rationing." Not unsurprisingly he quickly moves away from this topic, as I have noted in a previous post about the incalculable desire of Americans to avoid all discussion of the "R" word.

Cost is a problem and Goldhill does not advocate for a system that uses a more top down approach to regulate costs.  The article then moves on to the regulations in the healthcare system that hospitals and insurers have pushed for to avoid competition and gets a little muddled by arguing something along the lines of that hospitals prevent speciality centers from opening and stealing their business (that's actually a huge problem in healthcare and one that is highly detrimental to the system when you have that type of fragmentation, but that's another issue and Goldhill is only using this argument to make a case for the non-free market nature of the healthcare system). The litany of systematic faults goes on to include overuse of scanning technology, failure to cut down costs of said technology, medieval information technology systems, etc. The reader wonders, where is all of this going?

Well, Goldhill finally states that his solution is a fundamental change to the system. Not one that involves insurance regulation, public options, dealing with perverse medical incentives and the medical culture that sponsors it - no his is a consumer driven solution. Here's the solution in brief:

First, we should replace our current web of employer- and government-based insurance with a single program of catastrophic insurance open to all Americans—indeed, all Americans should be required to buy it—with fixed premiums based solely on age. This program would be best run as a single national pool, without underwriting for specific risk factors, and would ultimately replace Medicare, Medicaid, and private insurance. All Americans would be insured against catastrophic illness, throughout their lives.

Proposals for true catastrophic insurance usually founder on the definition of catastrophe. So much of the amount we now spend is dedicated to problems that are considered catastrophic, the argument goes, that a separate catastrophic system is pointless. A typical catastrophic insurance policy today might cover any expenses above, say, $2,000. That threshold is far too low; ultimately, a threshold of $50,000 or more would be better. (Chronic conditions with expected annual costs above some lower threshold would also be covered.) We might consider other mechanisms to keep total costs down: the plan could be required to pay out no more in any year than its available premiums, for instance, with premium increases limited to the general rate of inflation. But the real key would be to restrict the coverage to true catastrophes—if this approach is to work, only a minority of us should ever be beneficiaries.

How would we pay for most of our health care? The same way we pay for everything else—out of our income and savings. Medicare itself is, in a sense, a form of forced savings, as is commercial insurance. In place of these programs and the premiums we now contribute to them, and along with catastrophic insurance, the government should create a new form of health savings account—a vehicle that has existed, though in imperfect form, since 2003. Every American should be required to maintain an HSA, and contribute a minimum percentage of post-tax income, subject to a floor and a cap in total dollar contributions. The income percentage required should rise over a working life, as wages and wealth typically do.

All noncatastrophic care should eventually be funded out of HSAs. But account-holders should be allowed to withdraw money for any purpose, without penalty, once the funds exceed a ceiling established for each age, and at death any remaining money should be disbursed through inheritance. Our current methods of health-care funding create a “use it or lose it” imperative. This new approach would ensure that families put aside funds for future expenses, but would not force them to spend the funds only on health care.

And what about anything less than $50,000 that the catastrophic coverage would deal with? Well you can just borrow the money using your credit card, or something similar:

What about care that falls through the cracks—major expenses (an appendectomy, sports injury, or birth) that might exceed the current balance of someone’s HSA but are not catastrophic? These should be funded the same way we pay for most expensive purchases that confer long-term benefits: with credit. Americans should be able to borrow against their future contributions to their HSA to cover major health needs; the government could lend directly, or provide guidelines for private lending. Catastrophic coverage should apply with no deductible for young people, but as people age and save, they should pay a steadily increasing deductible from their HSA, unless the HSA has been exhausted. As a result, much end-of-life care would be paid through savings.

This new consumer driven system will allow for more specialty centers that provide low cost care (again this is not necessarily a good thing), more consumer focus (definitely good) - including better information technology, cheaper medical services, more innovation, etc. Now in principle this sounds good. But here's another perspective by Judy Dugan of the Consumer Watchdog Organization. The salient points are presented below: 

But Goldhill's assertion that if patients had to pay their own bills hospitals would have to fix the problems is wackily off the mark. For one thing, numerous attempts in Congress to strengthen publicly available hospital error reporting have failed under heavy lobbying. State laws vary wildly and depend on self-reporting. Hospitals would certainly not be more forthcoming with the truth if patients were picking and choosing on price.

Even if self-pay did drive down ridiculous initial hospital bills, the price would not go below current Medicare rates. Goldhill is udoubtedly right that there would be less use of medical care, as families carefully hoard their health savings accounts for "a real emergency." It would go something like this:

• A high school student has sudden flu symptoms--maybe swine flu?--hard for Mom to tell. The kid is having a little trouble breathing, but let's give it some time and see if she gets better on her own. (Maybe she'll get better, or maybe she'll get much worse and end up on a respirator, since swine flu appears to be deadliest among young people and pregnant women.)
• A young wife trips and falls and her quckly swelling wrist hurts like heck. She wraps it up, ices it and pops some painkillers. Why pay for the doctor and x-rays if it's just a bad sprain? And since the couple is trying to save enough in their HSA to have a baby... (Maybe it's a sprain. But if delicate wrist bones are broken, days of delay can mean permanent harm or at least a more expensive surgery)
• Junior takes a hard fastball to the head in summer league. He might have been knocked out for a few seconds, but seems OK, if a little woozy, in a few minutes. The coach wants him to go to the hospital, but the family is already saddled with several thousand in medical bills this year. They'll take him home and watch him closely. (Maybe he's his chipper self the next day. Maybe he has a light concussion, making him unknowingly more vulnerable to the next head hit. Or maybe he passes out in agonizing pain from brain swelling a few hours later, and spends weeks in intensive care
• Hmm. Grandma's 76 and needs a hip replacement. Can we talk her out of it? (The incentives of inheritability of the health savings account would be far more effective than supposed government "death panels" in pushing heirs to pull the plug before the HSA is siphoned off.)

 Dugan offers her own solutions:

To reduce overconsumption of health care,

• Curb the medical and pharmaceutical advertising that Goldhill points at, but then blames consumers for responding to it.
• Use research to determine best practices and make it all public. Pay primary care doctors more so they can manage common illnesses on their own, instead of dumping time-consuming cases onto specialists, who are vastly more expensive.
• Require payment, as Goldhill himself endorses, to be based on treating a whole illness or surgery, beginning to end, rather than reimbursing every test and visit.

The consumer and market driven nature of Goldhill's proposal has led leading conservatives like David Brook's to suggest that President Obama read the proposal. But one has to wonder, why should the healthcare system be radically changed with suggestions that no other industrialized nation has taken? Should we completely scrap the current bills? Destroy the very same Medicare system that has been so dearly fought over in this debate? It's difficult to find much merit for this solution in the current political climate, even in one in which fundamental reform was possible.

Read more...

Senator Al Franken and the Crowd

Senator Al Franken was met by a crowd of Tea Party Activists opposed to healthcare reform. And yet he managed to calmly explain his position and avoid a dramatic confrontation. Other Congresspeople, take notes:

Read more...

Call for Papers: Fall 2009

Dear Authors,

I am writing to you on behalf of TuftScope: The Interdisciplinary Journal of Health, Ethics, & Policy. TuftScope is a student journal at Tufts University, founded in 2001 to provide an academic forum for discussion of the pertinent healthcare and biosocial debates in today's world. The journal addresses different aspects of healthcare, bioethics, public health, and active citizenship. It is edited and operated by students at Tufts University and is advised by an Editorial Board composed of undergraduates and faculty. The principle objective of TuftScope is to bring together a variety of viewpoints on the health sciences to transform thoughts and ideas into active citizenship and working policies.

We are currently accepting submissions for our Fall 2009 (Volume 9.1) issue from undergraduates, graduate students, and all other individuals who wish to submit work. TuftScope accepts original articles and commentaries on bioethics, healthcare policy, public and community health, medical education, biomedicine, research in these fields, and other issues dealing with the art and science of medicine and health. For the Fall 2009 issue the journal will also be accepting essays (1000 words or less), book reviews (1000 words or less), and science reports. Essays are creative short pieces that touch on the aforementioned fields (e.g. perspectives from personal experiences, views on health policy, etc.). Fictional accounts, poetry, and science fiction implications of biomedicine are encouraged for this section as well. Science Reports are submissions that focus on the science of health from a scientific, rather solely a policy perspective (e.g. physics of MRI Technology, biomedical engineering topics, genomic medicine, etc.). Book reviews will be accepted for a wife range of titles on health, ethics, or policy related topics.

Submissions will be accepted until October 18, 2009. Full and detailed submissions guidelines may be found at www.ase.tufts.edu/tuftscope under the “Submissions” section. Please feel free to contact the Editorial Board regarding any questions you may have. We welcome early submissions. All submissions should be sent to TuftScope@gmail.com.

Sincerely,

Adam Snider
Associate Acquisitions Editor
Tuftscope Editorial Board

Read more...

Rationing Medical Care: Challenges in Bioethics

Rationing Medical Care: Challenges in Bioethics
by Michael Shusterman

One of the most challenging questions that faces modern medical practice is that of rationing. It's an issue that patients, politicians, and doctor like to ignore, but that pervades every pore of medical practice. Daniel Callahan, a bioethics philosopher, has spent much of his life tackling the difficult questions that arise when we ask: What does it mean to ration care. In a recent NY Times article he noted that:

Existing medical care, he said, is “open-ended, progress-oriented and technology dependent.” Are we doomed, he wondered, to a relentless battle against death in which “nothing will ever count as success”? Won’t “aging societies, expensive technologies and rising expectations about the benefits of medicine” add up to “an impossible cost situation”?

As the population ages and our fascination with the newest (and often unproven) medical treatments grows, will our inability to objectively view medical care end up bankrupting the system? Some like Peter Singer have argued that we need to start considering age or quality of life gained from treatments as factors in delivering care (see the linked article for a deeper discussion of the concept). Other argue that we can stave off monetary disaster by constantly innovating our way out of trouble: better records, cheaper drugs, more doctors, more prevention, etc.

In the end we'll have to tackle rationing. Just not today.

Read more...