Tag Archives: newsweek

Disparities in health care complex, hard to correct

Seven years after the landmark IOM study which established that racial minorities had worse health and were getting poorer care than the rest of the population even after other factors had been controlled for, disparities still exist (AHCJ resource). Newsweek‘s Mary Carmichael seeks to explain exactly why health disparities are so difficult to correct.

She discusses study design, classifications for ethnic groups, whether cultural competency training is useful, the quality of care that ethnic groups receive and much more.

Carmichael reports that the medical profession is working to correct disparities, but complex issues like this take time and resources to resolve. Cultural competency training is more common and health care reform proposals include myriad measures intended to help correct disparities. Even if reform doesn’t pass, Carmichael says, those measures could be used as a model for future legislation.

Speaking of solutions, Chris Metinko, of the Oakland Tribune, writes about one effort to address health disparities in some of that city’s poorest areas. Two nurse practitioners and a school board member are working to start a nonprofit organization that “would be a clinic for studying and confronting root causes of health disparities in Oakland and advocating for health equity.” Nurse practitioner Mahedere Solomon “said it would be a place where people could receive health care and where research into some of the area’s most pressing issues could be conducted.” Solomon recently received a 2009-10 Pfizer Community Innovations award, given to nurses who design projects to foster innovation at the local community level.

Meanwhile, HealthLeaders Media reports on a recent study that found nearly half of U.S. doctors say their patient care is being adversely affected by language and other cultural barriers. According to the study, HSC Issue Brief–Modest and Uneven: Physician Efforts to Reduce Racial and Ethnic Disparities, sponsored by the Robert Wood Johnson Foundation, reveals that 48 percent of doctors “reported difficulties communicating with patients because of language or cultural barriers, and said they considered the situation at least a minor problem affecting their ability to provide high-quality care.”

In their series “Shortened Lives,” Suzanne Bohan and Sandy Kleffman profiled people from different (though nearby) ZIP codes, finiding wide disparities in their expected life spans, based on where they live, their social status and the toll of chronic stress. The series explains the effect these disparities have on health care costs, as well as how they are caused and how they might be addressed. Bohan and Kleffman wrote about the project in a piece for AHCJ members and we have included additional resources for those interested in exploring disparities in health care in their own communities.

Hep C emerges from dormancy to hit baby boomers

Newsweek‘s Sarah Kliff looked into hepatitis C, a virus which can be dormant for decades then emerge to cause liver fibrosis and cirrhosis. It affects between 2.7 million and 3.9 million Americans, two-thirds of them baby boomers.

The virus is transferred through contact with infected blood, typically through intravenous drug use or transplants or blood transfusions that occurred before 1992, the year when officials started screening blood for the disease. Because it can remain dormant for so long, many boomers who contracted the disease during their free and easy youth are just starting to show symptoms.

“Even though Boomers moved on with their lives, they could be living with an infection that happened many years ago,” says John W. Ward, division director for the Center for Disease Control’s Division of Viral Hepatitis. “Now, they’re aging into a period of their lives when Hepatitis C could become manifest through physical symptoms.” One study published last May estimates that, in the next 20 years, total medical costs for Hepatitis C patients will nearly triple, from $30 to $85 billion.

Many don’t even know they have the disease, and Kliff writes that general public awareness is lagging.

Despite affecting 1 percent of the population, hepatitis C remains a disease generally misunderstood by the general public with little in financial commitments from the federal government. The CDC’s National Center for HIV/AIDS, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Prevention had a budget of almost $1 billion for 2008. Only 2 percent of that was allocated to hepatitis B and hepatitis C despite both viruses being five times more prevalent.

Because of the stigma associated with a virus often linked to drug use that causes symptoms (chronic liver disease) often associated with alcohol abuse, officials have found it tricky to convince now-affluent and settled boomers to come to terms with their wild past and acknowledge that they may have exposed themselves to the virus. To get past those barriers, officials have even considered comprehensive age-based screening requirements, Kliff writes.

The CDC is considering a blanket, age-based screening recommendation. “We’re launching studies to see if it’s feasible and makes sense,” says Ward, the CDC official. “Just like everyone over 50 should have a check for colon cancer, it might fit into an age-based checklist of preventative services.”


From the Institute of Medicine: Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C (PDF)

Dr. Haig: Patients often demand excessive tests

Doctors are in such a position legally, economically and socially that it is difficult to fight patients’ demands for excessive, well-advertised tests and treatments, Dr. Scott Haig writes in Newsweek. This insatiable, ill-informed demand is a key reason why the consumer, too, is a guilty party when it comes to soaring health care costs.

Haig writes about how, despite the fact that their condition could be easily and accurately diagnosed with no technology at all, two of his patients demanded MRIs for their ruptured Achilles tendons. Their insurance would cover the procedure, and one of them had even seen an advertisement trumpeting the hospital’s fancy new MRI machine. Convincing a pushy patient that the fanciest, most expensive treatment or diagnostic technique isn’t the best one is an often insurmountable challenge, Haig writes, a challenge that becomes ever more significant as pressure to cut health care costs mounts.

Blocking a patient who wants something they saw in an advertisement is time-consuming. Teaching the complex truth one on one is a lot harder than convincing large numbers through eye-catching, sound-biting market psychology. It’s a money loser too. Most of the time, a patient who has been sold on something you don’t want to use will just leave and go to another doctor.

We face this issue every day: the pill they saw on TV or in the magazine, the new scan, the diet supplement, even the specific brand of hip or knee prosthesis are difficult, occasionally impossible, to deny to the folks who ask for them. In the American doctors’ precarious medico-legal (and fiscal-social) position, career success is increasingly built on cooperation with the corporate and government powers that touch us. Playing along with that sketchy (but expensive) new treatment or being a champion of the wacky new state initiative is more likely to help your career than giving an educated but honest appraisal of actual patients’ well being.