By Cheree Cleghorn, Editor

This is a pre-Thanksgiving special of a totally different kind.

This may seem like an odd book for a health care website to recommend but it really is relevant.

Health is one part of the world’s ways and means or the lack of them. Understand the latter, and the health status of the people starts to become understandable.

My friend, author Laura Sessions Stepp ( Our Last Best Shot and Hooking Up), dragged me into a series by the late Dorothy Dunnett—-which you can begin by reading about an unlikely fellow,Niccolo, in the 14th century. Too many battles, it sounded like to me. As I trust Laura, and as she was brimming over with enthusiasm, the “You have got to read this,” kind, I did. Am I glad I listened to her.

The author wrote the end of the series first but pay no attention to that.

Follow the centuries. Begin in the 1400s, the first time there was a “global” economy—-ships set out to take goods and trade them, bringing home riches never seen.

I will not spoil it by telling you more about these treasures. Also, there are terrible diseases, just to mention health, as well as sanitation (as in little). Plenty of health care topics for us.

Niccolo, the main of hundreds of characters, starts out playing the fool, shows himself to be a financial and political fox, then he appears as a financial genius, all the while making his way through a world which was changing all around him.

We could say Niccolo was a man born to seize every opportunity an emerging global economy could offer. A man who evaded plagues. Escaped danger.

Starting to sound familiar?

Foreign lands, evil opponents, mysterious financial instruments? It’s all there. And, as they say in many product promotions, there is much, much more.

Our time, in many ways, mirrors that time, some 600 years ago. Some devoted fans compare writer Dunnett to Patrick O’Brian, who wrote the incomparable series about the seas, and whose work is much better known. It is that rich.

There is no way to spot the Niccolo of the 21st century yet. There is one out there, somewhere.

Be warned: this is no easy or fast read. I am a voracious reader and the author drove me mad with too many characters, action here and then there. What was this story about? The world. That’s why it was so jangling. The world is much with us.

Magically, if you stay with her, the story lines start to come together, and you likely will be mesmerized. Or not.

While the world is in upheaval, you can sit down with Niccolo and realize…it has happened before. Everything.

And we’re still here.

The first book in the series, out of print, is Niccolo Rising, by Dorothy Dunnett.

It will be a Thanksgiving feast no matter what’s going on outside.

New York Times

“Banning fast food advertisements from children’s television programs would reduce the number of overweight children in the U.S. by 18 percent and decrease the number of overweight teens by 14 percent, economists have estimated in a new study.

“The researchers used several statistical models to link obesity rates to the amount of time spent viewing fast food advertising, finding that viewing more fast food commercials on television raises the risk of obesity in children. The study appears in this month’s issue of The Journal of Law and Economics.

“There is not a lot of evidence that overweight kids are more likely to watch TV than other kids,” said Michael Grossman, professor of economics at the City University of New York. “We’re arguing the causality is how many messages are aired — seeing more of these messages is leading people to put on weight.” The study’s co-authors are Shin-Yi Chou, an economist at Lehigh College, and Inas Rashad, an economist at Georgia State University.”

Source: New York Times, November 20, 2008

Citation Source:  The Journal of Law and Economics, November, 2008.

Thanks to National Public Radio, the below report describes precisely how Big Tobacco keeps on smokin’ even though everyone figured they were finished when the famous lawsuit was settled, which passed on money to states to pursue anti-smoking efforts.

Never, ever, never, ever assume that anyone will outfox, outwit, out-market or in any way finish them off.

No one ever will.

The latest research shows that now slightly under 1 in 5 Americans smoke. That’s about 20%.

NPR

….”In the years since the settlement, tobacco firms have found new ways to reach customers. The companies are barred from sponsoring concerts, but on the Web, Philip Morris sponsors an American Idol-like band contest in a promotion called “The Best of Marlboro Country Music.” There are promotions in night clubs, on college campuses, on the Internet and at the stores where cigarettes are sold.

“It’s evolved to a more focused, direct one-to-one approach,” says Bill Phelps, a spokesman for Altria, the parent company of Philip Morris, which is the world’s top cigarette maker. “When was the last time you saw an ad for Marlboro? Marlboro is the biggest brand in the U.S., as big as the next 10 brands combined. I think there’s still a perception that [people] see Marlboro advertising a great deal, but take a step back and think about it.”

“Phelps says the company tries to prevent exposure for unintended audiences, like children, by relying on direct marketing.

“Our database has more than 25 million names on it,” he says. “Those are adults who already smoke and have said, ‘I want to be on your database and receive information from you about your cigarette brands.’”

“It all starts at smokersignup.com, which “has a system that enables us to verify who somebody is, who tries to sign up on the database, to make sure they are who they say they are and they are an adult,” Phelps says.

“Philip Morris uses the database to target smokers for discount coupons and even chances to win a vacation in what Phelps calls “experiential programs.”

“Marlboro brand is often associated with Marlboro Country, and the great outdoors and the West,” he says. “We own a ranch, and Marlboro smokers can win an opportunity to visit that ranch and experience Marlboro Country.”

“Marlboro now has a record 41.8 percent share of the U.S. cigarette market, up from 33.8 percent when the settlement was signed. Overall, tobacco companies spend more than $13 billion a year on advertising and promotions, nearly double what they did in 1998.”

If more patients can be diagnosed sooner when they begin to suffer memory impairment, the better their care and quality of life can be.

This is a relatively simple test compared to the one now in use. In this study, diagnosis was accurate 83% of the time.

Families start worrying, sometimes needlessly, about memory loss. A faster, more accessible test can tell them if they have something to worry about or not, an additional benefit which, while not the goal of the study, is helpful to family care-givers.

Medpage Today

“Mild cognitive impairment can be determined in less than five minutes with a three-word memory test and a clock-drawing task, according to researchers here. The words are apple, penny, and table.The new screening tool, called the Mini-Cog, coupled with a Functional Activities Questionnaire, allowed researchers to classify patients with 83% accuracy as cognitively normal, demented, or mildly cognitively impaired, James Lah, M.D., of Emory, and colleagues reported online in the Journal of Alzheimer’s Disease.

“A test like this is key to helping individuals detect this devastating disease earlier and maintain a good quality of life for as long as possible,” Dr. Lah said.

“Current screening for mild cognitive impairment typically requires 40 to 60 minutes of formal neuropsychological testing to achieve 80% accuracy or higher, the researchers said.”

Source: Medpage Today, November 20, 2008

Citation Source: Journal of Alzheimer’s Disease, Online

New York Times

“The health insurance industry said Wednesday that it would support a health care overhaul requiring insurers to accept all customers, regardless of illness or disability. But in return, the industry said, Congress should require all Americans to have coverage.

“The proposals, put forward by the insurers’ two main trade associations, have the potential to reshape and advance the debate over universal health insurance just as President-elect Barack Obama prepares to take office.

“In separate actions, the two trade groups, America’s Health Insurance Plans and the Blue Cross and Blue Shield Association, announced their support for guaranteed coverage for people with pre-existing medical conditions, in conjunction with an enforceable mandate for individual coverage.

“In the absence of such a mandate, insurers said, many people will wait until they become sick before they buy insurance.

“Members of Congress said Wednesday that they wanted to pass legislation next year, as proposed by Mr. Obama, to expand coverage and rein in health care costs.

“The new position taken by the insurance industry — the industry that helped sink President Bill Clinton’s plan for universal health coverage in 1994 — could ease the way for passage of such legislation.” (Emphasis added)

Source: New York Times, November 19, 2008

Even though doctors agree that there is a primary care shortage, primary care and specialists alike are going to limit their hours or shut their doors.

We are not going to have much health care to reform if immediate action is not taken to reduce the preventable frustrations doctors have and to work on sustainable solutions to this crisis. It is real. It is deep. It will take extremely hard work to turn around. Patients can be part of the solution but payers and employers have to do their part, too.

Worse, they would not recommend medicine as a career choice to young people.

Medpage Today

“Nearly half of all practicing physicians, 49%, said that by 2011 they will have limited their practices or quit entirely, according to survey results released today.And 45% said if they had the financial means, they would retire today.

“Yet 78% of the 11,950 physicians who responded to the survey from The Physicians’ Foundation said there is a shortage of primary care physicians in the United States.

“The survey, mailed to 270,000 primary care doctors and 50,000 specialists, had a response rate of 3.7%.

“Importantly, it was mailed from May through July 2008 — before the market meltdown and ongoing worldwide financial crisis.

“Among other findings of the survey:

• 11% of responders said they plan to retire sometime in the next three years
• 13% said they plan to stop clinical practice but want to continue to work in healthcare in a non-clinical capacity
• 82% said proposed cuts in Medicare reimbursement would make their practices unsustainable
• 66% said Medicaid doesn’t pay enough to cover the cost of providing care and 36% said the same of Medicare
• 33% said they no longer accept Medicaid patients and 12% said they would not accept Medicare patients
• only 17% said their practices were financially healthy and profitable (Emphasis added)

“Not surprisingly, doctors said that interacting with patients was what they liked most about medical practice and dealing with paperwork — including payment issues — was the part they liked least.

“And, echoing a finding that has been reported many times in the past 30 years, 60% of doctors said they “would not recommend medicine as a career to young people.”

Source: Medpage Today, November 18, 2008

Citation Source:  The Physician’s Foundation

Wall Street Journal

“Even as employers push a greater share of rising medical costs on to workers, a growing number of companies also are providing services like free check-ups, screening exams and prescription drugs that potentially can save employees hundreds of dollars a year.”

Source:  Wall Street Journal, November 18, 2008

Family care-givers and their own needs have been the topic of Jane Brody’s column, Personal Health.

This is from the second.

New York Times

“Whether you choose to be a family caregiver or the job is thrust upon you by circumstances, your most important responsibility beyond caring for your ill or disabled relative is caring for yourself.

“Self-care is not a selfish act. It’s an essential act, because a caregiver who burns out, who becomes overly stressed, exhausted or ill, is no help to anyone. There are many ways for caregivers to protect their physical and emotional health, and a growing number of organizations that can help. Sometimes all you need to do is ask.

Avoiding Burnout

“While people who work for a living typically get lunch breaks, coffee breaks and weeks of vacation, a family caregiver has no such respite built into the job. Yet it would take a superhuman to meet the demands of caregiving 24 hours a day for any length of time without breaking down.”

Source: New York Times, November 18, 2008

New York Times

PARIS — “Physicians at four European universities have completed what they say is the first successful transplant of a human windpipe using a patient’s own stem cells to fashion an organ and prevent its rejection by her immune system, according to an article in the British medical journal The Lancet. One of the physicians said the surgery could herald a “new age in surgical care.”

“The transplant operation was performed on the patient, Claudia Castillo, in June in Barcelona, Spain, to alleviate an acute shortage of breath caused by a failing airway following severe tuberculosis. It followed weeks of preparation carried out at the universities of Barcelona, Spain, Bristol, England and Padua and Milan in Italy.

“News of the procedure coincided with speculation that President-elect Barack Obama may reverse the Bush Administration’s restrictions on stem cell research, which has been contentious in some European countries, too. Anthony Hollander, a professor at Bristol University, said ethical concerns relating to embryonic stem cell research had not surfaced in the latest procedure because it had used only the patient’s own stem cells. “This was not embryonic stem cell research,” he said in a telephone interview.

Source:  New York Times, November 19, 2008

Citation Source: The Lancet, Early Online Publication, 19 November, 2008doi:10.1016/S0140-6736(08)61598-6

CNN

“An extensive federal report released Monday concludes that roughly one in four of the 697,000 U.S. veterans of the 1990-91 Gulf War suffer from Gulf War illness.

“That illness is a condition now identified as the likely consequence of exposure to toxic chemicals, including pesticides and a drug administered to protect troops against nerve gas.

“The 452-page report states that “scientific evidence leaves no question that Gulf War illness is a real condition with real causes and serious consequences for affected veterans.”

“The report, compiled by a panel of scientific experts and veterans serving on the congressionally mandated Research Advisory Committee on Gulf War Veterans’ Illnesses, fails to identify any cure for the malady.

“It also notes that few veterans afflicted with Gulf War illness have recovered over time.

“Today’s report brings to a close one of the darkest chapters in the legacy of the 1991 Gulf War,” said Anthony Hardie, a member of the committee and a member of the advocacy group Veterans of Modern Warfare.

“This is a bittersweet victory, [because] this is what Gulf War veterans have been saying all along,” Hardie said at a news conference in Washington. “Years were squandered by the federal government … trying to disprove that anything could be wrong with Gulf War veterans.”

“The committee’s report, titled “Gulf War Illness and the Health of Gulf War Veterans,” was officially presented Monday to Secretary of Veterans Affairs James Peak.”

Source: CNN,  November 17, 2008

Citation Source:  Report: Gulf War Illness and the Health of Gulf War Veterans, November 17, 2008