Tag: helath
On The Internet, Nobody Knows You’re A Fraud

On The Internet, Nobody Knows You’re A Fraud

There’s been some tense back-and-forth over the Canadian mother who said she had stopped opposing vaccinations after all seven of her kids came down with whooping cough. Some say we should loudly thank Tara Hills for publicly disowning her anti-vax campaign. Others — me, for instance — are feeling less grateful.

Hills went beyond spreading lies about the “dangers” of vaccinations and exposing her Ottawa neighbors to serious disease. She strongly implied that the best medical authorities are “puppets of a Big Pharma-Government-Media conspiracy,” according to The Washington Post — and on a site demoniacally named TheScientificParent.org.

You’ve probably seen the famous cartoon showing a dog at a computer saying to another dog, “On the Internet, nobody knows you’re a dog.” The word “dog” could have been replaced with “fraud.”

As more Americans turn to online forums for advice on everything from where to eat to whether they need surgery, concerns mount about the quality of the information. Readers often use the consensus of forum participants to bypass the views of recognized experts. And because these forums are usually little-monitored, the “weight of opinion” is often determined by the most verbose and those with too much time on their hands.

Millennials have become especially reliant on (apparent) group consensus, according to a report by PricewaterhouseCoopers on the “sharing economy.” “If trust in individuals and institutions is waning or at best holding steady,” the report notes, “faith in the aggregate is growing.”

That is, consumers who disbelieve a hotel chain’s claims of fine accommodations will show up at the door of a total stranger, renting a room via Airbnb — their trust totally based on reviews submitted by who-knows-who.

As we know, interested parties or crazy people can create a phony consensus. Then you have people like the Ottawa mother, who seemed truly committed to her beliefs but was too lazy or unable to examine expert opinion in reaching them.

In a similar vein, Sarah Watts wrote an interesting essay about her online confab with other millennial new mothers on caring for an infant. At the time, her own mother was on the scene urging her not to worry if baby June cried shortly after a feeding. The crying will stop, the mother’s mother said. That advice turned out to be good.

“I had been scouring message boards and Facebook groups during June’s nursing sessions,” Watts said, “and I had stumbled on discussions of every kind of parenting issue imaginable.” Some were issues she had never heard of, such as cord clamping and vitamin K shots.

Most posted questions, Watts observed, resulted in respondents “bandying conflicting research like a weapon, every one of them armed with a battery of qualifiers to describe her personal parenting philosophy.” (I might take her skepticism one step further and wonder whether the other “moms” were actually mothers or even women.)

We see the clamor of anonymous and inexpert posts on everything from foreign policy to breastfeeding. Certain forums are purposely designed to buttress one point of view. They attract like-minded commenters, who leave the impression of overwhelming support for a position.

It’s crazy out there. Good sites are often so plagued by armies of the uninformed filling their forums with dimwitted comments that smart people stay away. But some well-run forums are hugely interesting.

It’s a sign of the times that Californians trying to tighten the vaccination mandate for schoolchildren now worry that the drawn-out legislative process will open the door to anti-vaxxers intent on poisoning public opinion. In many cases, readers won’t even know who they are. The scary part is many won’t even care.

Follow Froma Harrop on Twitter @FromaHarrop. She can be reached at fharrop@gmail.com. To find out more about Froma Harrop and read features by other Creators writers and cartoonists, visit the Creators Web page at www.creators.com.

Photo: Screengrab of an anti-vaxxer forum on mothering.com

Out From Behind The Counter, Pharmacists Bring Their Own Take To Health Care

Out From Behind The Counter, Pharmacists Bring Their Own Take To Health Care

By Soumya Karlamangla, Los Angeles Times (TNS)

LOS ANGELES — Jose Alvarez clutches a red drawstring bag as he hobbles into a small office. He leans his crutches against the wall and takes a seat in the corner. His seven pill bottles, of varying heights, create a miniature skyline of orange and white.

A heavyset man with a scraggly beard, Alvarez has diabetes, high blood pressure, and asthma. He’s here at this clinic in East Los Angeles for his two p.m. appointment with Sangeeta Salvi.

“I was in denial for a very long time,” Alvarez, 42, says about his diabetes. Now he comes in every three weeks to discuss his medications, diet and exercise with Salvi.

Despite the white coat slung over the back of her chair, Salvi isn’t a physician, but a pharmacist.

She’s one of a growing number moving out from behind grocery store pharmacy counters across the country and seeing patients in new ways, part of a push to reduce health care costs, address social issues that impede people’s health, and ease a national shortage of primary care physicians.

Steven Chen, a University of Southern California clinical pharmacy professor, runs this pilot initiative at ten clinics belonging to AltaMed, a nonprofit clinic network that serves largely low-income populations in L.A. and Orange counties.

In a health care system that often seems impersonal and intimidating, pharmacists can act as a much-needed sympathetic ear and source of advice, spending extra time with patients.

“That’s the reason why we’ve been very successful,” Chen says, “because someone is taking the time to sit with the patient.”
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Team-based medical care, in which multiple health care professionals work together to treat a patient, is a central feature of the Affordable Care Act. But as different workers collaborate, there’s concern that pharmacists could overstep their bounds.

“Every member of the team is critical but not interchangeable,” says Reid Blackwelder, board chair of the American Academy of Family Physicians.

Pharmacists’ role is fundamentally different from doctors’; whereas doctors try to diagnose a root problem, pharmacists just try to make the symptoms better. Pharmacists are best trained to determine appropriate uses and dosages of medications to help patients with their problems.

Nearly 90 percent of patients with chronic illnesses take medication as the first line of treatment. In the United States, between a third and a half of patients don’t take their medicines properly, which — along with poor prescribing and diagnoses — costs the health care industry as much as $290 billion a year, according to the New England Health Care Institute.

On average, clinical pharmacists in the USC program find ten drug-related problems per patient — things such as taking the wrong dosage or missing a needed medicine.

But they also act as a sort of medical counselor, helping patients with a range of issues, including diet, exercise and stresses of all kinds. Many pharmacists taking part in the USC initiative — funded by a $12-million federal grant — also call insurance companies and drug manufacturers to make sure patients can get needed medications.

“Our patients need that,” says Rosie Jadidian, director of pharmaceutical services for Community Clinic Association of Los Angeles County. “They’re waiting on bus schedules, and their lives are organized in different ways. They need that one-stop shopping.”
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Sitting face-to-face in her cramped office, their knees almost touching, Salvi and Alvarez review the medicines he’s taking.

Three times a day. Eight milligrams. Before meals. When I wake up.

Pharmacists at AltaMed clinics are paired with patients they can help most: those with chronic illnesses.

When Salvi first started treating Alvarez, she realized he was using only a quick-relief inhaler, not one for long-term control.

Now that he’s taking the preventive inhaler regularly, Alvarez, who lives in Boyle Heights, says he hasn’t experienced much shortness of breath.

“It’s only been a month and a half, two months, and I’ve noticed a difference,” he says.

Salvi says the fast-paced work of clinical pharmacy was more appealing than working behind a counter.

“We’re directly involved in their care,” says Salvi, who’s been treating patients at AltaMed clinics for two years. “We develop a strong relationship.”

Patients usually see their pharmacists once a month, while they see their primary care doctors a few times a year. And pharmacist visits are typically longer, lasting up to an hour.

Alvarez has had diabetes for more than ten years. He lost his job as a chef last year because of a foot ulcer that made it impossible for him to stand all day in the kitchen. After he lost a toe in January, he decided to start trying to keep his diabetes under control.

After consulting her notes, Salvi asks Alvarez whether he’s still eating eggs and two pieces of wheat toast for breakfast. He says he’s reduced it to one slice.

“I used to drink a two-liter Coke by myself at lunch,” he says. Now, he has half a 23-ounce Arizona iced tea with his midday meal, but he’s working to cut that out too, he says.
Salvi tells him that breaking a habit cold turkey is always difficult. “Remember to take baby steps,” she says.
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Clinical pharmacists are part of a burgeoning number of recent medical interventions that aim to increase access to medical care. Across the country, patients can see a nurse or a pharmacist at new retail clinics, urgent-care clinics, and kiosks. Some patients can also now talk to a health care professional on video chat.

“It’s probably exhilarating and also a little overwhelming,” says Dr. Ateev Mehrotra, a Harvard Medical School professor who studies innovations in health care delivery.

Because these innovations often take care out of the hands of doctors, many of them also help with the shortage of providers across the country that worsened with the expansion of health insurance under the Affordable Care Act.

The nationwide shortfall of primary care doctors is expected to grow to about 45,000 by 2020. Almost a quarter of Californians already live in a primary care shortage area, according to state data.

A California law went into effect last year that allows pharmacists to bill for medical care — seen as a step toward solidifying their expanded roles outside pharmacies. Congress is considering a similar bill, but critics say that an already costly health care system can’t afford to pay another provider.

Early data from the AltaMed initiative shows that bringing in a clinical pharmacist saves money overall by reducing hospitalizations and other expensive medical treatments, but initially increases costs both to pay the pharmacists and to provide more medicines.

Historically, that’s made clinical pharmacists a hard sell because clinics haven’t been financially responsible if a patient ends up in the hospital, so there is little incentive to pay for the extra service. That’s slowly changing with the Affordable Care Act, as payment models shift so providers are rewarded if patients stay healthy, and penalized if they don’t.

At AltaMed clinics, pharmacists’ schedules are almost always booked.

Salvi takes Alvarez’s blood pressure one last time. With a smile, she tells him she thinks they’ve covered everything for the day.

She tentatively schedules him an appointment in three weeks, because he’s not sure when he’ll be free next month.

“I’m sure we’ll be calling you anyways,” Salvi says. “You know how we are.”

Photo: Allen J. Schaben via Los Angeles Times/TNS

The Reason Why So Many Kids Aren’t Vaccinated? It’s Not Always Anti-Vaxxers, Some Just Don’t Follow Up

The Reason Why So Many Kids Aren’t Vaccinated? It’s Not Always Anti-Vaxxers, Some Just Don’t Follow Up

By Jenna Chandler and Lauren M. Whaley, The Orange County Register (TNS)

The mother of a California child who exposed 20 infants to measles last year never intended for her baby to go unvaccinated.

“That baby was not in a family that was against vaccinations. The mom … had four children, and was juggling so much, it had simply slipped her mind,” said Southern California pediatrician Jan Johnson.

In the past year, as a measles outbreak has stricken dozens and a whooping cough epidemic has killed two infants and sickened more than 10,000 people, public attention has focused on parents who refuse to immunize their children, often obtaining personal belief or religious waivers to permanently skirt vaccination laws.

Just under 10 percent of elementary school students in California enroll in school without having all of their vaccines. But it may have more to do with caution and time, than ideology.

Many parents are wary of vaccines, even if they understand the necessity. They get an initial round of vaccines, but then purposely delay some of the required follow-up shots designed to fully protect against diseases. Other parents don’t follow through because they lack access to health care; still others are so busy that they either forget or don’t have time to get the required booster shots.

Those children, who may have as few as one dose of each required vaccination, are allowed to enroll in school. But this partial, or conditional, vaccination is supposed to be temporary.

In California, schools are required to follow up with families and eventually exclude students from classes if they fail to get the all of their vaccines by the time they are due.

Unless there’s an outbreak of a disease, however, those students who don’t follow through are rarely, if ever, kicked out. The problem is, officials often don’t know who has followed through.

“The law says schools need to review (immunization) records every 30 days. It does happen, but I’m sure it’s not as often as legally it should,” said Pamela Kahn, a registered nurse overseeing health and wellness for the Orange County Department of Education.

“When our health care staff is out there caring for chronically ill, our acutely ill children, our special education students, this follow-through often does not rise to the priority level that it probably should,” she said. “It’s probably not realistic (given) how schools are staffed right now.”

Photo: Jessica Lucia via Flickr