Archive for the ‘Family’ category

COVID VACCINE CHALLENGE

September 23rd, 2020

COVID vaccine challenge
NICK JACOBS
Published Tue Sep 22, 2020 8:48 PM EDT

Besides wearing a mask, which we’ve known since 77AD protects us from the plague, the other best opportunity for stopping the progress of COVID-19 is through the discovery of an effective vaccine.

Rather than getting COVID via the natural infection pathway, a vaccine could produce herd immunity without harming or potentially killing people.

Thousands of Americans seem to have chosen the risk-it-all route as they go without masks, and attend large, unprotected social events and rallies.

Unfortunately, not unlike playing Russian Roulette with your loved ones and friends, this route is filled with potential suffering and an almost complete lack of predictability.

In an article in Time magazine, Alice Parks recounts how it was Edward Jenner who, in 1790, discovered that infecting people with small amounts of smallpox virus could produce immunity. Today, there are more than 100 vaccines being developed in an attempt to provide us with immunity from SARS COVID-19, and across the world, billions of dollars are being pumped into this effort.

There are numerous challenges to be faced in this effort including those of manufacturing and then distributing the vaccine in a humanitarian manner.

The good news is, regardless of political pressure, the major vaccine makers have already pledged to conduct complete safety studies before submitting their vaccines to international regulators. The not-so-good news is HIV/AIDS has been around for nearly 40 years and an effective vaccine is still not available.

Approximately 132,000,000 people in the United States are living with pre-existing health conditions. Thus, the challenge becomes who gets a vaccine and when. These decisions may literally produce a life and death lottery game.

The Time article cited researchers from CUNY’s School of Public Health’s computer simulation that calculated if 75 percent of the world’s population were immunized, to control the ongoing pandemic, vaccines would need to be about 70 percent effective. Any of us who are regular recipients of the annual flu vaccine know that some years it’s effective and some years it’s not.

Consequently, we will be faced with arguments over the world’s current state of nationalism combined with America’s anti-vaccination movement. Plus we still have the challenges of discovery, manufacturing and actual implementation.

Oh, and there’s one more speed bump in that the United States has chosen not to join the other 172 countries of the world in the COVAX initiative on international unity for epidemic preparedness innovations originated by the World Health Organization.

If we prioritize our high-risk populations which include health care employees, first-responders, people with pre-existing conditions, and the elderly living in group environments, and then add critical workers such as teachers, food growers and service providers, people in group homes and the incarcerated, we finally end up getting the vaccines to our most precious hope for the future, young adults and children.

In short, none of this is going to be easy. One batch of improperly manufactured polio vaccine in the 1950s resulted in thousands of children being accidentally infected with polio. and because there are so many variations of vaccines being developed, there is also the risk of triggering excessive immune responses that could end up being more harmful than helpful.

Finally, and this is one more example of the broken public health system in this country, any plans for massive immunizations will be dependent upon public-health initiatives that are appropriately supported and resourced.

Keep in mind many of our states have been seeking leadership, supplies, direction, and funding from the federal government since March. At about $35 per dose and in most cases the vaccines require two doses, herd immunity is not likely to be achieved either quickly or in a cost-effective manner.

One thing is clear, however. An effective plan needs to be implemented to stop this out of control COVID transmission and to produce a clear pathway to normalcy. We need to get back to normal through a national strategy.

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Posted in Current Affairs, Epidemics, Family, Future, Healthcare, Hospital, Hospital Administration, Hospitals, Immunization, Leadership, Medicare, Medicine, Public Health, Uncategorized, workplace

Grandma and Grandpa

June 20th, 2018

A few weeks ago, I got a box of cassette tapes. One of the tapes had “Grandpa and Grandma” on the label. I instantly remembered sitting with my family with my little tape recorder as I interviewed my grandparents for posterity in 1960. Let me share just a few tidbits from those now deceased voices talking, laughing, and telling, in broken English, their story of poverty, struggle, and life. While they spoke I thought about the life of my English grandparents whose families came here in the 1600s. It was like “Downton Abbey” or “Up the Down-staircase.”

I asked my grandmother what her family told her life was like in the early 1800s she said, “Longa time ago, our family lived in a family cave, and even when we were little, we useda olive oil to light our house with little lanterns.”

Then my granddad who came to America at age 13 said, “ When I was a kid, I had to take care of the cows. My brother and dad would use them to plow the fields, and I had to clean up after them, feed them, and take care of them. I hated that. That’s why I ran away.”

I asked him, “Did you go to school?” And he said, “The old man used to say, ‘Get a book and learn to read.’ So, I taught myself everything.”

Then I asked what he remembered about his mother, and he said, “She went to church every day, and every dime she got, she gave to the priest. She gave him bread all the time even when we were hungry. He had a big belly.” Then I asked him, “Did you ever go to St. Peter’s in Rome?” He said, “When I lived away from home, we went there all the time, but I don’t know whata you people think. The Pope is just an old man.” (Obviously, he wasn’t happy the priest got all the bread.)

Both families had farms close to the town of Alvito between Rome and Naples. Her family’s was three miles away, and both fathers were sharecroppers. Half of what they grew went to the rich men who controlled the land. My grandfather said, “One summer dad cried like a baby because everything dried up, and another summer he didn’t geta good grapes for wine, and he cried even harder that time.”

I asked if they made wine, and my grandmother said, “The mena mada the wine by stomping on a da grape in their bare-feet.” My English mother asked, “Did they wash your feet?” The result of that question was lots of laughter. “The alcohol killed the germs,” my grandfather said laughing between breaths.

“When we were ina this country and was married, I made a jug of wine,” my grandmother said, “and Patsy (my grandfather) tested one time.” Then she said, “My winea was betta than his dad’s wine.” My granddad looked at me, smiled and winked. “Yep, he laughed, yours was better.” (That’s why they were married for so long.)

“Did you wear shoes?” I asked. My grandfather burst into laughter, “The first shoes I have was when I come in America.” “So, what did you do in the winter?” I asked. He said, “We would wrap rags around our feet in the winter time.”

For whatever reason, as a 13-year old boy, I asked, “Did you ever see a wolf?” To which my grandmother said, “My dad had to walka to church one time at 4 in the morning and something came after hima growling. He yelled because he thought it was a wolf, but it was a biga dog.” Then she laughed and laughed. Grandad said he saw wolves.

Then he said something that stuck with me. He said, “We had a lot of fun, but it wasa stupid fun.” From the sound of the laughter on that tape, maybe it wasn’t so stupid.

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Posted in Boomers, Family, Uncategorized

What a weekend

May 13th, 2018

Nina had her piano lesson from the church music director, and when he walked into the room, three-year-old Pete yelled out, “I know him. He’s the guy who played the music when the Lord came out of his cave.” (Pete and Joe were both at Easter mass.)

On Thursday evening we all went to the elementary band and choral concert at my grandkids’ school. We were five minutes late and ended up parking illegally on the grass. When we got inside the auditorium, the real fun began. Trying to keep Pete under control for 90 minutes of really good elementary music is, to quote Jerry Seinfeld, “Like putting a baby goat in a pillow case and hoping it behaves.” His mother ended up taking him into the hallway for at least twenty minutes, and as my long departed father-in-law would say, “ She took him out there to “blow the stink off.” That kid ran up and down the hall at Road Runner speeds until her head was spinning.

Friday evening was birthday party number three for the third grader in Pittsburgh. I’m not sure why, but kids seems to have a minimum of three birthday parties now: close family, full family, and family and friends. Of course there are always presents involved. There was also more cake, and, believe it or not, more Barbie Dolls. I’m happy to report that the dolls have evolved and are now representative of all shapes, colors, and forms. Let your imagination run wild because there’s no limit to the ethnicities of these dolls. It may not be long before there’s a border wall built around the Mattel corporation to limit access to the United States.

On Saturday, Nina competed in the State gymnastics tournament and placed second in her age group for the whole State. Five hours to see five minutes! Then the two Pittsburgh girls had their musical, a program they’ve been working on since last fall. This event involved feeding and then transporting every available family member to the show. (Everyone, that is, except Pete.) We recruited our best relocated Johnstown to Pittsburgh friends for extra beds, food, and toys to hold this grand gathering together. The show was great, and, because she was going to miss her acting friends who were moving into seventh grade, Zoey cried for hours after the last curtain call. She had the staring roll as the leading lamb with one line, “Baaaaaaa,” and she managed to steal the show. And Lucy, well, Lucy’s always great.

Sunday morning was the Pittsburgh Marathon, and let’s just say that trying to get around in the City on marathon day is like trying to get out of East Berlin in the early ‘80’s. You could drive in circles, but couldn’t get anywhere. We finally gave up and walked everywhere with a “hangry” little guy who didn’t care about the 40,000 plus runners, the clanging cowbells, or the people around him. He just wanted his mom, and the rest of us were clearly speed bumps in his way.The extenuating circumstance was his mom, big brother, and dad were all in the race and not near him. It was our job to find them, cheer them on, and finally to reunite with them and get them back to the condo for showers. They all did great, but I can only describe this experience as Arrrgh.

After the Johnstown kids were gone, we met the Pittsburgh kids for dinner at a restaurant where the wait would have been three days or longer. So, we headed off to another place, slammed down a salad and went to see our friend’s son, Matt, in “Hamlet.” Truthfully, it brought back lots of memories of advanced high school English. He was amazing. I couldn’t help but think if they had only had psychotropic drugs, no one would have died.

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Posted in Boomers, Children, Family, Sports

Pittsburgh Post Gazette. Op-Ed

December 11th, 2017

Nick Jacobs, among his other affiliations, is an officer of the Integrative Health Policy Consortium, which represents more than 600,000 IHM practitioners; president of the Clinical and Translational Genome Research Institute, which he founded; and a consultant to the Department of Defense in breast cancer research.

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Pennsylvanians received good news recently when the Pennsylvania Health Care Cost Containment Council reported that hospital readmissions and mortality rates continue falling locally and statewide.

The report shows these rates declining for a number of common types of treatments. It gives much of the credit to a “commitment of PA hospitals to provide quality care” and to the Affordable Care Act, which ties reimbursements to that quality care. This, in turn, encourages health care facilities to strive for improved mortality rates because doing so helps keep government funds flowing through their doors.

Regardless of the motivation, this is good news. But it’s not good enough.The mortality rate could be improved even more dramatically if more healthcare administrators and physicians would introduce integrative health and medicine practices into their services.

Integrative health and medicine (IHM), as defined by the American Board of Integrative Medicine and the Academic Consortium for Integrative Medicine & Health, recognizes the importance of the relationship between practitioner and patient. IHM focuses on the whole person, is evidenced-based and employs a wide range of appropriate therapies, healthcare professionals and disciplines to achieve optimal health and healing.

Integrative health practice includes treatments and therapies such as acupuncture; natural products; deep breathing; Tai chi and Qi Gong; meditation; massage; special anti-inflammatory diets; progressive relaxation; journaling; biofeedback; pet, music and dance therapies; hypnosis and guided imagery. When provided by a licensed or certified health care professional, IHM provides numerous benefits. It can decrease chronic pain, post-operative pain and the need for medications. It can improve patient satisfaction and shorten hospital stays. It can lower mortality rates. IHM methods also are relatively inexpensive.

Many places, including the Cleveland Clinic, have reported cost savings per patient, while also seeing reductions in patient anxiety, pain, and medications. During my tenure as CEO at Windber (Pa.) Medical Center, I worked with physicians, staff, and volunteers to create a healing environment by embracing all methods and therapies used in integrative medicine and combining them with the ambiance of a fine hotel and the amenities of a health spa. We carefully scrutinized and credentialed practitioners specializing in services such as aroma and massage therapy, integrative nutritional counseling, acupuncture, chiropractic manipulation, pet and music therapy, reiki and spirituality, to name a few.

In short, a healing environment permeated our facility.

Yes, we had our share of naysayers and opposition among physicians, allied health care professionals and others, but over time our infection rate dropped below 1 percent and stayed there for a decade. (The national average is 9 percent.) Of our peer hospitals, we had the lowest readmission rates, restraint rates and lengths of stay. Even with a palliative care unit to care for dying patients and their families, we had the lowest death rate among our peer hospitals.

For those who would say it was all coincidence because Windber is a small hospital, I would direct them to the 19,000 papers written supporting the efficacy of acupuncture alone, and then to the thousands of papers written about the healing power of music, massage and so many other treatments dismissed all too readily by traditional practitioners.

IHM practices are not at odds with traditional medical practices; rather, they enhance them. Yet in many hospitals and physicians’ offices, they are ignored, discouraged, even ridiculed. Such negative reactions result from ignorance, misinformation, prejudice and even greed — pharmaceutical companies, for instance, see no profit in promoting most IHM treatments, and some medical practices might earn less if, instead of scheduling patients for costly treatments or surgeries, they instead treated patients with acupuncture, spinal manipulation, massage therapy or even mindfulness.

Resistance to IHM is breaking down, but this shift in attitude needs to be accelerated. If you travel to Europe or Asia, you will see integrative medicine practices thriving because their value is acknowledged and embraced. In America, IHM beachheads are being established in health care systems and universities, thanks to such groups as the Family Medicine Education Consortium, Integrative Health Policy Consortium and the Academy of Integrative Health and Medicine, of which I am a co-founder. The academy includes among its member’s hundreds of licensed physicians who have successfully merged IHM with traditional medical practices.

Much remains to be done to more broadly spread the healing benefits of IHM, which will happen only when more patients take more responsibility for their health and demand IHM treatments, more physicians research and adopt them, and more insurance companies pay for them. When that day comes, there will be a lot more good news about mortality rates and other measures of medical care for Pennsylvanians and people all over the country to celebrate.

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Posted in Boomers, Children, Current Affairs, Diet, Family, Future, Healthcare, Hospital, Hospital Administration, Hospitals, Integrative Health, Leadership, Medicare, Military Medicine, Nutrition, Public Health

Four ways to improve access to Integrative Medicine Practices

November 13th, 2017

Licensure, regulation, medical evidence, and funding are four sure ways to speed up the process needed to allow integrative medicine practices to be embraced. If we begin with the assumption that money has a lot to do with everything medical in the United States, then we must look at the winners and losers and the WIFM’s? (What’s in it for me?) If you’re a practicing surgeon, and acupuncture or chiropractic care results in the patient not needing a surgery, that can be a financial threat to you. Let’s be fair, that probably doesn’t happen that often, but sometimes it does, and when it does, that’s money lost to your practice.

If you’ve spent four years in undergraduate school, four years in medical school, four or five years in a residency, and your educational debts amount to hundreds of thousands of dollars, the last thing you need is a clinical study demonstrating through medical evidence that thousands of patients won’t need your services, and your skills will become exponentially less in the demand.

On the other hand, if, like ophthalmologists who surround their practices with optometrists, orthopods did the same with chiropractors and acupuncturists, could that not create a steady stream of referrals for their practices?

Let’s face it, there is a role for all three of those professions, and there are skill levels in every profession and duties relegated to each that both overlap and potentially conflict. So, wouldn’t it be better to have the three practice as a team of professionals working together to help you?

“There’s not enough medical evidence” has been the hue and cry of the uninformed for years. Ironically, once traditional medical evidence is thoroughly interrogated, it’s not unusual to find numerous flaws in even the most accepted medical practices. We’ve seen slanted reporting in even the furthermost prestigious journals where various drugs, procedures, and devices have been proven to be ineffective years later.

There are over 19,000 papers that have been written and submitted to medical journals in which acupuncture has been endorsed and proven to be effective, but there never seems to be enough medical evidence for the naysayers.

Credentialing is a very challenging area as well. Not unlike the highly skilled surgeon with her medical degrees from the Sorbonne in Paris that is not permitted to practice medicine in the United States, there are sometimes economic and political reasons to limit the number of practitioners allowed in the United States. In my experience, by creating a hospital-based credentials committee that specializes in integrative medicine, the nay-sayers ability to discredit highly trained practitioners with different skills will become more limited.

Regulation may be the most difficult challenge in this discussion because, as we have come to know very well, political power can come from political contributions, and when it comes to regulations, those with the gold have more clout than those without. That is not to say that our politicians can be encouraged to be more flexible because they can. All it takes is for hundreds of constituents to stand in front of a Congressional office to encourage change to occur.

So, what are we really dealing with here? In 1910, the AMA put out a request for proposal to determine what should be taught in the medical schools of Canada and the United States and no physician would accept that assignment. Consequently, a Ph.D., Abraham Flexner, did, and his approach was to eliminate everything that wasn’t already proven science. From there we have evolved to a “heal to the pill” mentality where words like root cause and placebo have been dropped from the vernacular.

Finally, funding is the key. It has been proven time and again that integrative medicine practices can reduce health care costs exponentially. With that in mind, every bill that comes out of Washington ignores that fact, and funding for many of these well-documented practices is not present. There were over 5000 codes in the Affordable Care Act that were intended to fund such practices as acupuncture, but when the FAQ initially was released, it said, in essence, “Don’t worry about paying these codes.”

If you go almost anywhere in Europe and Asia and you will see integrative practitioners thriving because their value is acknowledged and embraced. Of course, we’re not professing that a massage therapist performs open heart surgery, but we do know that Integrative medicine can help to reduce costs across the board.

There are many good things that can come from Integrative medicine. You just need to be open-minded.

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Posted in Boomers, Communication, Current Affairs, Disability, Energy, Family, Future, Healthcare, Hospital, Hospital Administration, Hospital Blog, Hospitals, inspiration, Integrative Health, Leadership, Medicare, Partnerships, patient-centered care, Public Health, Public Policy, Science, Sports, Systems Medicine, Uncategorized

Warm Memories During The Holidays

December 19th, 2010

On those snow-covered roads of the 50’s and 60’s, the drive to my grandparents was always unforgettable. It seemed that the roads were hardly ever plowed, and there was no salt – just those coal black ashes mixed with tiny pieces of metal that would puncture a tire at least once or twice each winter. The trip to their house really was over the river and through the woods, as we crossed the old wooden plank bridge, and started up the back roads to the park, where they lived.

Dad was not shy about winter driving on snow drift covered roads. As we slid and crashed through the white stuff on those old, back country roads at breakneck speeds, he would laugh as if nature was just something with which to play. Rear wheel drive in those clunky old 50’s cars was just crazy fun, as the Buick turned into a high tech, machine powered sleigh. We would drive into total isolation where no unchained car had gone before us and thrill at making those first tire tracks in that freshly fallen snow. Mom would always be yelling, “Be careful, Charlie, don’t go too fast,” but he just laughed that baritone laugh as he put the pedal to the metal.

After our snow driving fun, we would have our snow playing fun as we romped and rolled in the snow in our grandparents’ yard. That could go on for hours or until our blue jeans were completely frozen. Then we walked like icicles toward the heat of grandma’s kitchen. We were so cold that even our long underwear was frozen. In fact, we looked like cold, hard kid-cicles. Once inside we would peel off layer after layer of wool and cotton until we were down to our frozen long johns.

Our grandparents’ house was a place where we were surrounded with more fun, love and craziness than a kid could ever imagine. Oh, and food? There were pots and pans bubbling and jumping on every burner of her old gas fired stove; spaghetti, meat sauce, home grown vegetables, cookies, and every type of Italian fruit or vegetable. In the middle of the table there was always a bowl filled with black gold, those wonderful fat, black olives that became candy to me. When the spaghetti was finally put on the table it was in a serving dish that reminded me of a soup bowl for Jack and the Beanstalk’s Giant. It could have been a bassinet for triplets. There had to have been at least two or three pounds of specially cooked pasta just waiting to become part of our collective muffin tops!

After we said grace (during which Grandma could be heard mumbling in Italian under her breath), Granddad would pass the wine around the room to all of the adult males at the table. His philosophy as he poured his homemade wine from the gallon jug was that warmth, laughter, love and fun came from the fruit of the vine. Throughout the entire meal, they would drink and laugh and sing to the tune of those carefully-cultivated grapes. I loved the lighthearted, happiness of those meals. We never talked about anything serious and if anyone tried to bring up a serious category, granddad would do something just plain crazy like dump his peaches into his coffee cup, and my Grandmother would begin her ritual, a ritual that she surely seemed to enjoy as she scolded him by yelling out, “Patsy, Patsy, you gonna make-a da boys be bad!” He would smile with that knowing smile that seemed to say, “Oh, they’ll be bad, alright, but not because of tonight. It will be because they have my genes!”

We loved the hugs, the love and the laughter. We always left there feeling that total nonjudgmental, complete love that only a grandparent can give.

It was all about that love.

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Posted in Family

Tags: Christmas Family holidays Italian Italy meal memoirs PA pasta Pennsylvania winter

Engage With Grace

November 26th, 2010

Excerpts from: Chapter 18 of “Taking the Hell out of Healthcare“

by Nick Jacobs

When Dying is Finally Enough

The Dichotomy of Death

On Thursday evenings from 1970 until 1975 there was a standing invitation to play pool at Jim’s Dad’s house. Now, the truth of the matter was that, as young school teachers, most of us barely owned houses, let alone a pool table, so one of my colleagues parents’ opened their home to allow us to have some safe recreation. During those innocent days of my mid twenties, many of the world’s problems were solved. Jim’s father was a wise old philosopher in his early sixties, a retired coal miner who loved to be around the kids.

One night, we began discussing religion, faith, and death as we mechanically yelled out lines like “16 in the side pocket.” The discussion became particularly heated when it came to hypocrisy of our healthcare system. We kids or at least this kid listened in amazement as old Carl explained how life was in the old days. His relatives from the old country had salves and ointments, herbs and mustard plasters that took care of virtually every ailment known to man, and when they failed and death was inevitable, death was accepted. He used to laugh and say, “But now, everyone wants to go to heaven, but nobody wants to die.”

It was then that the subject changed to today where there was truly a cure for nearly everything, or so it seemed at age 23. Get sick? Take a pill or get a shot. But then, a few weeks earlier, my father had been diagnosed with lung cancer and was given less than a three percent chance of survival. As Carl and I discussed this situation, he put his arm on my shoulder, and wished me luck. At 58, my dad was still a young man, and neither my education, my prayers, nor my love would be able to save him.

The American way of death seems to be that death is not acceptable at any age, at any time or for any reason. Death is rarely seen as the inevitable future that we all face. Our American system of death is that it should not happen. Death is no longer accepted as part of life. Oh, yes, we hear those words, but when it is our loved one, they are very difficult to embrace or articulate.

Our medical schools, our nursing schools, our technology schools train our students in most cases that death is failure. This is why we have a system of health care that is crumbling under our very eyes. Through drugs, machines, and other advances, we have the ability to allow individuals to live longer than ever in the history of mankind. It is absolute reality that more people will have an opportunity to live longer than 100 years of age than ever in history, but at what cost, and with what degree of quality?

Because of our culture, we fight death until we are shocked by it, and the result is that we, as families miss the wonderful opportunity to allow our loved one a peaceful, beautiful, comforting transition.

Palliative care, a.k.a., hospice care, provides that transition. In a hospice program, we experience love in all forms until death. Hospice provides a womb-like environment where love can replace fear, where family can be the center of that love, and where the transition can be a beautiful, healing journey for everyone involved so that it becomes a peaceful transition.

What Can You Do?

Do your personal homework. Begin to talk to your loved ones early on about their wishes. Make those wishes as clear as you can. Do not be fearful that anyone will let you die before your time. Trust that your family or friends can support you in your intentions, and be sure that you put everything in writing that you possibly can. Most importantly, however, try to find peace with yourself.

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Posted in Family, Healthcare, Hospitals

Tags: care consultant consumer driven health care crossing over death dying end of life Engage With Grace F. Nicholas Jacobs FACHE health health 2.0 Healthcare hospice Hospitals life Medicine Nick Jacobs palliatiave speaker speaking SunStone Consulting TEDMed

The Obligation is Real

September 21st, 2010

On Saturday night a group of people will gather at a restaurant for a celebration of life since graduation from high school. I won’t be there. Neither will Joe, Butch, Tommy and half a dozen others, but their absence is for a very different reason: they have passed away. I, on the other hand, will just be passing. So, why not go this year?

Well, it’s a kid thing. You see, part of my birthday present to each of my kids was an overnight stay at a resort with their spouses, and, low and behold, there is no one to watch three of the grandkids and the brand new chocolate lab; no one, that is, but me. Why would I sacrifice the opportunity to hang with my old buddies for the chance to change diapers, mop up housebreaking accidents, and argue over bathing and bedtime issues? Why? Because it was part of the commitment, that kid commitment. They will be my kids until either I die or they do, and with that come certain obligations that are real.

Why bother you with all of this personal blog stuff? It’s about obligations.

The other day, a bright young man met with me at lunch to ask me questions about the American Healthcare System. Interestingly enough, I don’t believe that my answers were what he had expected. You see, we have certain beliefs about our rights to generate, earn, and receive money in this country. What is missing, however, is a realistic reward system that aligns the appropriate reimbursements with the actual needs of the country. When he asked me how many hospitals would invest in purchasing his product, one that might help to eliminate hospital infections, my response was “Not many.”

You see, with obligatory bottom line orientations, many of the hospital CEO’s and CFO’s are not anxious to spend money on a product that might work. More importantly, with a lack of transparency, the public exposure that most organizations have relative to this infection problem is still somewhat limited. It was easy to explain that if “St. Elsewhere” was exposed for having a 24% infection rate, not unlike a five star hotel having bed bugs, you can darn well bet that something would be done and done quickly, but the issue is not so pressing when it is under the basket.

Over the last few years, I have lost some wonderful friends who have had fantastic surgeries at highly respected hospitals. These surgeries would have been impossible to have in a “normal” hospital, but, having said that, two of them died and one lingered near death for two years due to the infections they acquired there.

If this was widely publicized public knowledge, might he be able to sell more product? The question was rhetorical and the answer is absolutely, positively, yes. So, back to obligations. Why is it that we must be exposed in order to become aggressive about serious problems in our systems? The answer is simple: It costs money, and resource allocation is the number one challenge of most hospitals. Hence my point about our financial incentives. If we were reimbursed, rewarded and paid, not in an unconnected, cottage industry manner, our treatment regimes and protocols would change. If we knew that it would be our financial responsibility to amputate limbs for advanced diabetes, would we be more eager to spend money on wellness initiatives?

Truthfully, it’s our obligation, and, as our fellow human beings suffer, we are currently seeing a movement toward political groups intent upon repealing reform measures. That is a backward view of an already complex challenge. It is our obligation to help our fellow man. “Do unto others …or pray you don’t lose your health insurance.”

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Posted in Family, Healthcare, Hospitals

Tags: CDC FACHE HAI Healthcare Hospital hygeine incentives infection medical errors MRSA Nick Jacobs nosocomial quality staph

The Fate of Modern Day Gladiators

October 12th, 2009

The warrior in the picture is my buddy and grandson, Jude. He is about to go to war for candy. It’s his Halloween costume, but a fitting example of a warrior, and one that works well for the topic of this blog post.

Jude

When I first saw this picture, it reminded me of my peers who are out there in the day to day fight trying to work their way through the current financial crisis. Then the picture reminded me of a much bigger and more threatening challenge. Last week’s New Yorker ran an article entitled “The Catastrophist” by Elizabeth Kolbert. It was about another type of warrior, James Hensen, Director of NASA’s Goddard Institute for Space Studies. He is fighting for our children and their children’s future. He is the top scientist for NASA who successfully made early recommendations about chlorofluorocarbons creating holes in the Ozone, and was instrumental in getting the world to ban them and stop the holes in the atmosphere from progressing.

For the last several years, he has been fighting a personal war to get the world to take the steps necessary to stop global warming before it is too late. At a recent rally in New Hampshire, he described our situation as a one in which, “climate history is being run in reverse and at high speed, like a cassette tape on rewind. Carbon dioxide is being pumped into the air some ten thousand times faster than natural weathering processes can remove it.”

The world has not yet responded to his and the majority of scientists discoveries, but he fights on for his grandchildren while the pundits say it is all hype and without substance. “The world goes through cycles,” they say, “and this is just another cycle.”

Then, I read a comprehensive article by Malcolm Gladwell in this week’s New Yorker magazine (I know, I know – It’s New York) …entitled “Offensive Play.” Mr. Gladwell examined the realities of professional football, boxing, NASCAR, and the world of fighting dogs that can only be described as painfully chilling. In this treatise, he examined the frequency and degree of damage that professional football players endure from multiple head injuries. In fact, it was not limited to professional football players, but players of all levels.

He met with scientists who have studied the autopsied brains of these men, men who have made their living as modern day gladiators and warriors. Men who, as he described it, “had game.” No matter the degree of injury, they were ready and driven to get back in and play. He likened this attitude to Marines and young doctors and asked the question “If you have people who are willing to march over a cliff for you, you cannot march them close to the edge of the cliff?’

In this analysis, he gave the example of a veteran football player who might be exposed to 18,000 head hits during a ten year period. He also provided example after example of famous NFL players who had tragic endings to their lives because of these injuries. These were often times great player who became abusive toward loved ones or lost their personal direction in life and committed suicide.

These “modern day gladiators,” not unlike boxers, have some degree of information regarding the potential risks that they face. But, also like boxers, about 22% of whom end up with dementia, they will most likely continue to do this work as long as we are willing to pay them millions in order to observe their physical prowess.

NASCAR, on the other hand, has worked year after year to improve survivability of their drivers from even horriffic accidents. NASCAR can make their sport relatively safe, but football has a much greater challenge because helmets don’t really stop the impact of hitting your head at 80 miles or more an hour, the equivalent of going through an automobile windshield at that speed. Yet a NASCAR driver escaped injury in a head on collision of 180 miles an hour last year.

Maybe the idea of having “game” is not limited to football, or soldiering, or medicine. If you look at the level of stress that many executives endure with the blessing and even pressure to do so from their bosses, their stakeholders, and their stockholders, the same type of moral question seems to surface. Kevlar gas tanks keep Grand Prix automobiles from exploding. What keeps modern day gladiators from exploding? Clearly, it is not more Yang.

I’m just the reporter, and this reporter is going to borrow my grandson’s battle gear as I fight on through the economic downturn. By the way, my new book, You Hold Em. I’ll Bite Em. should be out next month. Talk about the result of a head injury. We played without pads or helmets!

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