Saturday, April 11, 2009

News Clipping Archives

 

Maryland / Regional

Health Department offers shingles vaccine (Carroll County Times)

Lyme disease cases up in Carroll, state (Carroll County Times)

 

National / International

Uptick in Vasectomies Seen as Sign of Recession (New York Times)

As Medical Charts Go Electronic, Rural Doctor Sees Healthy Change (New York Times)

 

Opinion

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Maryland / Regional

 

Health Department offers shingles vaccine

 

By Erica Kritt

Carroll County Times

Saturday, April 11, 2009

 

Painful is the best way to describe shingles, according to Doris Hare, the Carroll County Health Department’s director of communicable diseases.

 

But the skin rash that also inflames the nerves can be prevented or lessened by a vaccine.

 

The Health Department has been giving out the shingles vaccine since fall 2006.

 

The vaccine, which is called Zostavax, was licensed in 2006, according to Hare. It was shown in a study to reduce the occurrence of the disease by 50 percent and it slightly reduced the length of pain in those who did get shingles.

 

Hare said the Health Department decided to carry the vaccine because it could help the community.

 

“It can be a preventable illness,” Hare said.

 

Shingles is a painful skin rash that affects about 1 million Americans a year, according to the Centers for Disease Control and Prevention. Shingles is a reoccurrence of the chickenpox virus, so only people who had chickenpox or had the chickenpox vaccine can get shingles.

 

After a person has chickenpox, which is caused by the varicella zoster virus, that virus lays dormant in the body.

 

“If you are under stress or your immune system is weakened, you could get shingles,” Hare said.

 

The CDC reports that the disease is most common in people who are 50 and older and in people who have cancer.

 

But the vaccine is suggested for people 60 and older. Hare said the Health Department doesn’t stray from that recommendation.

 

The CDC reports that the reason the vaccine is not recommended for people younger than 60 is because the vaccine has not yet been studied in that population.

 

“Maybe, as time goes by, they may lower that age restriction,” Hare said.

 

The vaccine is covered by Medicare part D but not part B, and coverage varies with private insurance, according to the CDC.

 

Hare said the Health Department charges $171 a dose. Recipients receive forms to get reimbursement from their insurance companies, if the companies will cover the vaccine. The vaccine is administered through a shot in the arm.

 

Hare said shots are given at the Health Department by appointment because there is a lot of medical history the nurses at the department need to know before it is determined a person is qualified for the treatment.

 

The vaccine should not be taken by people who have life-threatening allergic reactions to gelatin, neomycin and other components of the vaccine.

 

The vaccine is also prohibited for people who have a disease like HIV/ AIDS that affects the immune system, people who are being treated with drugs like steroids that affect the immune system, people who are undergoing radiation or chemotherapy, or those who have a history of cancer affecting bone marrow or the lymphatic system.

 

Since 2008, the Health Department has given about 100 shots.

 

Hare said most doctors do not carry the vaccine because of its expense, but that other health departments in the area do carry Zostavax.

 

Reach staff writer Erica Kritt at 410-857-7876 or erica.kritt@carrollcountytimes.com.

 

To get a shingles vaccine, call the Carroll County Health Department at 410-857-5000 and make an appointment.

 

Copyright 2009 Carroll County Times.

 

Lyme disease cases up in Carroll, state

 

By Erica Kritt

Carroll County Times

Saturday, April 11, 2009

 

Lyme disease is on the rise in Maryland, but state officials say they cannot be certain it is because of an increase in ticks.

 

The latest statistics show that the number of Lyme disease cases more than doubled from 2006 to 2007.

 

S.B. Wee, chief of the Maryland division of zoonotic diseases, said a number of factors could be contributing to the increase.

 

Wee said both physicians and residents are more aware of the disease.

 

“People know to ask their doctors,” she said.

 

She also said that health departments are following up more on reports of tick bites.

 

Lyme disease is the most common tick-borne infectious disease in the country. It is transmitted to humans by the bite of a black-legged tick infected by the Borrelia burgdorferi bacterium.

 

A tick must be attached to the skin for at least 24 hours for the transmission to occur, according to the Maryland Department of Health and Mental Hygiene.

 

In Carroll County, the incidence of Lyme disease increased by 55 cases, from 197 in 2006 to 252 in 2007.

 

Copyright 2009 Carroll County Times.

 

National / International

 

Uptick in Vasectomies Seen as Sign of Recession

 

By Lesley Alderman

New York Times

Saturday, April 11, 2009

 

Last November I learned, to my great surprise, that I was pregnant. At age 47, I was not exactly trying to conceive.

 

My husband and I were conflicted:

 

Another baby — how wonderful!

 

Another child — how stressful! How risky! How EXPENSIVE!

 

With the economy in a free fall, this seemed no time to have a baby.

 

When the pregnancy ended in a miscarriage at seven weeks, we were sad. But also relieved. My husband’s only half-joking response was, “It’s time for a vasectomy.”

 

Turns out we were not alone in our thinking. Urologists and clinics have noticed an uptick in recent months in the number of men requesting vasectomies.

 

It is too early to proclaim a bona fide trend in elective sterilization, because no organization regularly tracks the number of vasectomies performed on an annual or even a monthly basis. The most recent comprehensive data come from a study published in The Journal of Urology in 2006, which estimated that about 527,000 vasectomies were performed in this country each year.

 

But the recent anecdotal data, if they hold, would have a historical parallel in the Great Depression, when the birth rate fell sharply.

 

As this recession continues, it is understandable that more people might hesitate to expand their families. A baby born in 2006 — the latest year for which data are available — will cost middle-income parents $260,000 by the time the child reaches 17, according to the Agriculture Department. And that doesn’t include college.

 

In Southern California, Planned Parenthood says that compared with last year’s first quarter, requests for vasectomies were up more than 30 percent in the first three months of this year at its clinics in San Diego and Riverside Counties, where 64 of the procedures were done.

 

“The recession has created a new level of urgency among our clients,” said Vince Hall, a spokesman. “We used to have a three- to six-week waiting period. Now men have to wait two-and-a-half months to get an appointment.”

 

Helping spur demand, he said, might be the fact that unemployed men often qualify for free vasectomies under Family PACT, a California family planning program for low-income households.

 

On the Upper East Side of Manhattan, where the financial industry’s collapse has compressed many a household budget, Dr. Marc Goldstein says he has been performing more vasectomies than usual over the last five months.

 

Through most of last year, Dr. Goldstein, who directs male reproductive medicine and microsurgery at the New York-Presbyterian Hospital/Weill Cornell Medical Center, was performing about six vasectomies a month. Then, in November, the number rose to nine, where it was holding steady through the end of March.

 

“I’ve been in practice for 30 years, and I’ve never seen a spike like this,” Dr. Goldstein said. “Many of my clients work in finance and say they feel anxious about the expense of an added child.”

 

In Seattle, Dr. Charles Wilson of the Vasectomy Clinic says that in the last half-year he has performed an average of 123 of the procedures each month — 13 percent above the year-earlier average. “Some come in because they are out of work and have more time on their hands to take care of medical issues,” Dr. Wilson said. “Others are afraid of losing their job and want to get their vasectomy done before they lose their health insurance.”

 

Unemployment was the reason Michael Swogger, 30, went to see Dr. Wilson. Mr. Swogger was laid off in January from his job as a Microsoft software test engineer. With three children and another on the way, he and his wife decided it was time for a vasectomy.

 

“I wanted to get this done before the insurance ran out,” Mr. Swogger said.

 

Meanwhile, visits to Vasectomy.com — a 10-year-old informational site that also markets doctors to patients — were up 17.5 percent in the first quarter, compared with the first three months of last year.

 

And traffic to the site’s physician profile pages was up 40 percent, according to Maya Wank, chief operating officer of the Web site, who said the activity might indicate consumers were not simply gathering information but wanting to take action.

 

Experts agree that from a practical and financial point of view, vasectomies are an ideal form of birth control. The procedure — which cuts or seals the vas deferens, the tubes that carry sperm from the testicles — typically costs $500 to $1,000, but is usually covered by insurance.

 

The surgery is done in a doctor’s office with local anesthesia and requires less than 20 minutes. Recovery takes a matter of days. It is nearly 100 percent effective. A successful vasectomy renders a man permanently sterile — unless he changes his mind.

 

The possibility that a man might change his mind, in fact, is the reason some doctors who perform vasectomies say men should think twice before having one. Reversing the procedure is a complicated, five-hour task, can cost thousands of dollars and is rarely covered by insurance. And, oh, yes: About half the time it does not work.

 

“Since I spend a lot of time reversing vasectomies, I initially try to talk my patients out of getting one,” says Dr. Harris Nagler, chairman of the Sol and Margaret Berger department of urology at Beth Israel hospital in Manhattan. “If they are convinced that they want a permanent surgical form of contraception, then we go ahead. It is the right decision for many individuals.”

 

Copyright 2009 The New York Times Company.

 

As Medical Charts Go Electronic, Rural Doctor Sees Healthy Change

 

By Milt Freudenheim

New York Times

Saturday, April 11, 2009

 

In Washington, the Obama administration is promising to spend billions to make health care more efficient, but Jennifer Brull, a family doctor in rural Kansas, is already a step or two ahead.

 

A year ago, she switched her 3,000 patients from paper charts to electronic health records, a core feature of most plans for healing the nation’s ailing health system. Now, working with computers and printouts, her staff of part-time nurses and shared front-office workers has more time to help her meet the needs of patients.

 

“I’ll never go back to the old system,” said Dr. Brull, 37, who runs a solo practice in Plainville, Kan. “I can always look at the records by Internet, whether I am seeing patients at the nursing home or a clinic or the hospital, or even when I’m as far away as Florida. The change has been tremendously beneficial for my productivity.”

 

Patients are appreciative, too. Kagay Wheatley brings her 97-year-old neighbor, Charlotte Hayes, to Dr. Brull for blood tests every few weeks. “We do not have to sit and wait while the nurses search for the records,” said Ms. Wheatley, a retired school board aide who is also a patient of Dr. Brull’s. “They find the information right there on the computer, and when we leave, we get a printout of what we did and what she said.”

 

About 42 percent of active family doctors have installed some type of electronic health records, according to surveys and estimates by the American Academy of Family Physicians, a professional and advocacy group. One in four said they did not plan to purchase an electronic system, and many said they could not afford the $30,000 to $50,000 in start-up costs. The academy has 94,600 members, including about 60,000 in active practice.

 

Medical centers like the new 24-bed critical-access hospital in Plainville, connected by a walkway to Dr. Brull’s office, are also rapidly adopting electronic records.

 

“The use of electronic health records and being able to transmit X-rays allows us to be in contact with the whole world,” said Chuck Comeau, a hospital board member who is chief executive of Dessin Fournir, a national furniture design company that moved its head office to Plainville from Los Angeles.

 

Even so, 8 in 10 of all American doctors still labor in a world of paper. And some doctors said they encountered upsetting setbacks when they tried to switch to electronic records.

 

Michael Ferris, a 33-year-old emergency medicine physician in Parsons, Kan., said he had to give up his solo practice after he had invested $38,000 in software for systems that kept crashing and thwarting his attempts to send out electronic bills. “I was spending as much time trying to fix the computer and the billing as actually seeing patients,” he said, “and neither process was generating any revenue for me.”

 

Now, as director of the emergency room at the Labette County hospital in Parsons, Dr. Ferris said, “I get paid by the hour and don’t have to worry if the software is down.” But he said he expected that some day he would have to help the hospital make the transition to electronic records. “I know it is coming.”

 

Information technology for health care is a $20 billion section of the $787 billion economic stimulus package President Obama signed last month. But only part of the new I.T. financing will help individual doctors who convert to electronic health records, said Dr. Steven Waldren, director of the center for health information technology at the academy of family physicians. Those in rural and underserved areas should benefit the most.

 

“For the vast majority of physicians, there is not going to be upfront money to purchase electronic record systems,” Dr. Waldren said.

 

Dr. Brull, who grew up in Grinnell, Kan., a town with 250 residents, has been an advocate of electronic records since she was in medical school at the University of Kansas in the 1990s. Seven years ago she moved to Plainville, where she rents space in a community-owned medical office building and shares a receptionist and bookkeeping staff with two other family physicians, Dan Sanchez, 45, and Lynn Fisher, 34.

 

They have 8,000 patients in all, including some from neighboring counties. The three doctors together cover a lot of ground: delivering babies, performing colon cancer checkups and staffing the emergency room at the hospital. They refer patients who need intensive care or a specialist to the Hays Medical Center, 23 miles away. Trauma patients are flown to Wichita, a one-hour helicopter ride. Specialists, including a cardiologist, come to Plainville to provide follow-up care.

 

The three are the only doctors in Plainville, a city of 2,500 in Rooks County, a wheat farming and oil-producing area midway between Kansas City and Denver. “We are it,” Dr. Brull said.

 

Dr. Sanchez is a deputy coroner and the ambulance service director and is taking a turn as hospital medical director. Each doctor is a solo practitioner with a separate tax ID. “At the end of the day, our paychecks come from our own business, our own patients,” Dr. Fisher said.

 

They are informal partners, and cover each other’s patients. “We do everything on a handshake,” Dr. Brull said.

 

It took five years for her to persuade the other doctors to make the switch to electronic records. “Dan was our holdout,” she said.

 

Dr. Sanchez explained that, at first, “I was not sure I saw the benefits. Now I’m a very big proponent of it. I’ve gotten to the place where I prefer to get an electronic chart over a paper chart.”

 

Costs, like those to have his dictation transcribed, are down 75 percent. “The volume of paper flowing around has dropped dramatically,” he said. “That alone paid for half the cost of the software in the first year.”

 

They selected a medium-priced system (from e-MDs, based in Austin, Tex.), obtained private financing and invested $45,000 in software. Dr. Brull said she paid “the lion’s share for the equipment — $40,000 or $50,000 for hardware,” which they also share. Staff members were sent out for training, and last March they closed the offices for two days of instruction. When they reopened, a trainer stayed to help.

 

The electronic system helps Dr. Brull with just about every part of her practice. She keeps close watch on 250 patients with high blood pressure and 180 who have diabetes. She pays special attention to people who have both problems, summoning them for blood tests every six weeks

 

The computers make it easier to keep track of them. “We can run a computer report on diabetics who haven’t had appropriate lab work, or people who haven’t had a wellness exam in 10 months or did not have a flu shot,” she said.

 

When she leaves the office to see patients at a nursing home, she said: “I have access to my notes on each one on the laptop. It takes out the guesswork.” For people who pick up their pills at Walgreens or Wal-Mart, the software forwards an electronic prescription. “We are working to persuade the mom-and-pop pharmacies to get on that system,” she said.

 

Dr. Brull said she expected to recoup her investment in five years, perhaps sooner. It did not hurt that two other family doctors left the community last April. “All of a sudden, three or four thousand patients had no doctor,” she said. “We took on a large volume. If you work harder, you get more money.”

 

Still, she said she shared the frustrations of many physicians who say the insurance companies often seem to use delaying tactics to avoid paying for care, even when the bills are delivered to them by computer. “I feel like I spend a lot of time justifying what I do and chasing the dollar,” she said. But despite such concerns, she said, she is too busy to have much time left for complaining. “I am not a very good pessimist,” Dr. Brull said.

 

Copyright 2009 The New York Times Company.

 

Opinion

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