White Bread by Ricardo Perina

What you need to know about gluten and celiac disease


By Lola O’Rourke, MS, RD
Valley Medical Center 

Celiac Disease (CD) is the result of an immune system response to the ingestion of gluten, a protein found in wheat, rye and barley.

When people with CD ingest gluten, this auto-immune response causes damage to the small intestine, reducing the body’s ability to absorb nutrients, leading to many of the most common symptoms of CD.

If left untreated, CD can have serious long term health consequences.

The symptoms of CD are extremely varied, and mirror symptoms for other conditions too. This is, in part, why it often takes a long time for CD to be diagnosed – the average length of time it takes for a diagnosis is about four years.

To complicate matters, many people with CD do not have obvious symptoms at all – they may have anemia or low bone density, conditions which may present during a routine medical exam.

Some of the most common symptoms include diarrhea, constipation, bloating, weight loss, anemia, chronic fatigue, infertility, migraines, bone pain and muscle cramps.

It’s estimated that about 1 percent of the U.S. population has Celiac Disease; the vast majority of these cases are undiagnosed. To develop CD, it’s necessary to have a genetic predisposition, to be consuming gluten and to have the disease activated by a triggering event such as surgery, illness, or even stress.

The first step to diagnosing CD is a blood test ordered by your physician which will look for the presence of antibodies that are indicative of CD. If these tests suggest CD, a biopsy of the small intestine is recommended to determine if the intestinal cells show damage consistent with this condition.

The biopsy is considered the “gold standard” for a CD diagnosis. If the biopsy does indicate CD, a gluten-free diet is warranted. Part two of the “gold standard” CD diagnosis is if the patient experiences improvement on a gluten-free diet.

People who experience adverse reactions to gluten but test negative for celiac disease may have a condition called non-celiac gluten sensitivity (NCGS). Symptoms tend to overlap with those of CD, however, in the case of NCGS an intestinal biopsy would be negative.

Treatment for NCGS is also a gluten-free diet. The recognition and classification of NCGS is quite new and more research is needed, but estimates claim the incidence of NCGS is up to 6 or 7 times higher than that of CD.

The “good” news about CD (and NCGS) compared with many other medical conditions is that it can be treated by diet. (Note: In some cases, especially the newly diagnosed, nutritional supplements and/or other medications may be required to treat related conditions: consult with your primary care physician and dietitian.)

What’s sometimes viewed as “bad” news (often for the newly diagnosed) is that it MUST be treated by diet. The only known treatment is a strict gluten-free diet. Although a gluten-free diet may seem restrictive at first, you can still enjoy a wide range of delicious foods, and in time, it will seem second nature.

There is a wealth of good information available to help people live a healthy and satisfying gluten-free life. The Gluten Intolerance Group (GIG) is a non-profit organization that provides an extensive range of educational information on numerous aspects of celiac disease and other gluten-related disorders, including how to eat safely in restaurants, what to do about gluten in medications, and how to use gluten-free grains.

Visit www.gluten.net for information, recipes and listings of certified gluten-free products. GIG also has a network of support groups around the country.

Getting involved with a support group can be very helpful in terms of learning about local gluten-free resources (grocery stores, products, restaurants), as well as for sharing stories and getting support, especially during the early stages of learning about the gluten-free diet.

PHOTO: White bread by Ricardo Perina

A local GIG Branch meets at Valley Medical Center the third Tuesday of every month from 7:00 to 9:00pm. For more information contact Lynn Jameson: Southseattlegfgroup@yahoo.com.

About Lola O’Rourke, MS, RD

Lola O’Rourke is a registered dietitian who specializes in gluten-free eating, weight management and family meal planning. During her twenty-five year career in food and nutrition she has provided nutrition expertise to public health agencies, food businesses, school districts and individuals. Lola is bilingual in Spanish and has lived and worked in Mexico and Latin America. She recently served as a national media spokesperson for the American Dietetic Association and conducted over 300 interviews with venues including The New York Times, MSNBC, USA Today and Latina magazine. She’s been an avid baker and dessert fan since her teens, became gluten-free as an adult and now integrates these interests into healthful and delicious eating plans for her clients.

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Three red and white capsules

Today’s health headlines – August 22, 2012


By Stephanie Stapleton

Today’s early morning highlights from the major news organizations, including political reports related to the abortion debate and Medicare issues.

The New York Times: Patients Would Pay More If Romney Restores Medicare Savings, Analysts Say

Mitt Romney’s promise to restore $716 billion that he says President Obama “robbed” from Medicare has some health care experts puzzled, and not just because his running mate, Representative Paul D. Ryan, included the same savings in his House budgets. ,,,

While Republicans have raised legitimate questions about the long-term feasibility of the reimbursement cuts, analysts say, to restore them in the short term would immediately add hundreds of dollars a year to out-of-pocket Medicare expenses for beneficiaries.

That would violate Mr. Romney’s vow that neither current beneficiaries nor Americans within 10 years of eligibility would be affected by his proposal to shift Medicare to a voucherlike system in which recipients are given a lump sum to buy coverage from competing insurers (Calmes, 8/21).


USA Today: GOP Trying To Keep Focus On Economy Rather Than Abortion

Trying to keep the presidential contest focused on the economy rather than divisive social issues, Republican candidate Mitt Romney joined a growing GOP chorus urging a Missouri Senate candidate to quit the race after inflammatory comments about abortion and rape (Davis, 8/21).

NPR: GOP Platform Anti-Abortion Language Includes No Exceptions For Rape, Incest

With little discussion, the committee on Tuesday adopted the same anti-abortion language it included in GOP platforms in 2004 and 2008. It seeks passage of a constitutional amendment that would extend legal rights to the unborn, essentially banning abortion (Allen, 8/21).

The Washington Post: Akin Comments Expose GOP Rift Over Abortion

Rep. Todd Akin’s controversial comments on abortion and rape — and the Missouri Republican’s vow Tuesday to continue his U.S. Senate campaign — have given Democrats an opening on an issue on which they enjoy broad public support. In the past two days, party leaders in Washington and their supporters across the country have highlighted Akin’s comments to try to raise money, as part of campaign pitches and to revive the “war on women” theme that emerged this year after some Republicans came out against health-care coverage for contraception (O’Keefe and Helderman, 8/21).

Politico: GOP To Akin: You’re Blowing Our Chance To Repeal ‘Obamacare’

National Republicans on Tuesday gave Rep. Todd Akin another reason to back out of the Missouri Senate race: If he stays in, they say, the repeal of the health care reform law is at risk. “By staying in this race, Congressman Akin is putting at great risk many of the issues that he and others in the Republican Party are fighting for, including the repeal of Obamacare,” Brian Walsh, a spokesman for the National Republican Senatorial Committee, said in a statement (Haberkorn, 8/21).

Los Angeles Times: Texas Can Cut Planned Parenthood Clinic Funding, Judges Rule

Texas can cut off funds for Planned Parenthood clinics before a trial concerning the legality of its ban on funding organizations tied to abortion providers, a federal appeals court ruled Tuesday. The U.S. 5th Circuit Court of Appeals in New Orleans lifted a federal judge’s temporary injunction that had protected the funding pending an October trial (Hennessy-Fiske, 8/21).

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.


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Time to get those back-to-school shots


Every parent’s back-to-school list should include making sure children are up-to-date with their immunizations, including the Tdap booster vaccine to protect against an ongoing whooping cough epidemic, Public Health – Seattle & King County (PHSKC) officials say.

“Whether you’re a parent enrolling your child in school or a student entering college, make sure all immunizations are up-to-date,” Dr. David Fleming Director and Health Officer for Public Health – Seattle & King County.

Health officials pointed to the current whooping cough epidemic to underscore the importance of being up-to-date on immunizations.

So far this year, there have been 560 confirmed cases of whooping cough in King County, compared to 98 cases in all of 2011.

School-age children have been hit particularly hard, PHSKC officials said. Children ages 10-13 have the highest rates of whooping cough in King County.

Failing to get vaccinated not only increases a child’s risk of getting a preventable infection, it also puts others at risk, PHSKC officials warn, an unvaccinated child can also pass an infection on to those particularly vulnerable, like infants, pregnant women or people with weakened immune systems.

Parents who choose not to immunize their children must submit an exemption certificate, signed by a health care provider verifying the provider has shared information on immunization benefits and risks.

But a child who is not fully immunized may be sent home from school during a disease outbreak, PHSKC officials noted.

Parents can find out which vaccines are required for school and child care attendance online.

An electronic screen showing the NEWS

Today’s health headlines – August 21, 2012


By Stephanie Stapleton

Today’s early morning highlights from the major news organizations, including reports from the campaign trail, where House candidates are turning up the Medicare debate; and from the health care marketkplace, where Aetna acquired Coventry Health, a Medicare and Medicaid insurer.

The Associated Press/Washington Post: House Candidates Seek An Edge In The Boisterous Debate Over Medicare

The issue has touched off a flurry of ads and accusations in the presidential race, shifting the focus from the fierce talk about President Barack Obama’s record on jobs and the economy. Medicare now also stands at the forefront of congressional races as candidates seek an edge with 11 weeks to the Nov. 6 elections (8/20).

NPR: Issue Of Abortion Back In Spotlight In Swing States

With women’s issues front and center again in the presidential campaign, a bus tour through several swing states kicked off Monday in opposition to President Obama’s views on abortion. At the same time, the Obama campaign launched a new TV ad — aimed at some of the same voters in some of the same key states — criticizing Republican Mitt Romney and his running mate, Paul Ryan, on the issue (McCammon, 8/20).

The Associated Press/Washington Post: GOP And Democratic Tickets Offer Voters Stark Choice On Gay Marriage And Abortion Rights

Voters in this presidential election may face the starkest choice ever on the hot-button social issues of same-sex marriage, abortion rights and access to birth control. Even as most voters tell pollsters the economy is their chief concern, advocacy groups on the left and right are in high gear — with bus tours, YouTube videos and fundraising — pointing out the sharp differences between the parties in the current phase of the culture wars (8/21).

USA Today: Health Care Enrollment Time Tries Workers

As the open-enrollment season for health benefits approaches, many workers will be making some bad choices, according to a new survey (Dugas, 8/20).

The Associated Press/Wall Street Journal: New Coupons Aim To Keep People Off Generic Drugs

If brand-name prescription medicines cost you as little as generic pills, which would you choose? A few drugmakers are betting Americans will stick with the name they know. They’ve begun offering U.S. patients coupons to reduce copayments on brand-name medicines and compete with new generic versions of the drugs. The medicines include staples in the American medicine cabinet — cholesterol fighter Lipitor, blood thinner Plavix and blood pressure drug Diovan — along with drugs for depression and breast cancer (8/20).

Los Angeles Times: As Circumcision Declines, Health Costs Will Go Up, Study Projects

Declining rates of circumcision among infants will translate into billions of dollars of unnecessary medical costs in the U.S. as these boys grow up and become sexually active men, researchers at Johns Hopkins University warned (Brown, 8/21).

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

PeaceHealth logo

Catholic Health Initiatives, PeaceHealth agree to form regional health care network


Catholic Health Initiatives and PeaceHealth, two nonprofit health care systems, have signed a non-binding letter of intent to create a new regional health care system in the Northwest, the two health systems have announced,

The partnership will create an integrated health system in the region, combining seven Catholic Health Initiatives hospitals in Washington and Oregon with nine PeaceHealth hospitals in Washington, Oregon and Alaska.

The new organization will include nearly 26,000 employees and about 950 employed physicians serving in hospitals, physician clinics, outpatient care clinics, long-term care facilities, laboratories and private homes across the region.

The new organization will have annual revenues of almost $4 billion.

“Catholic Health Initiatives and PeaceHealth share common cultures and values,” said Kevin E. Lofton, president and chief executive officer of Englewood, Colorado-based CHI, the nation’s second largest faith-based health system. “We see this as a natural evolution – a perfect way to share economies of skill and scale, improve health services and reinforce our common mission to create and nurture healthier communities.”

The nonbinding letter of intent is the first step in the partnership process. Leaders of Catholic Health Initiatives and PeaceHealth expect to form the new system before June 30, 2013, after completing the due diligence and approval process.

The two organizations will be equal partners in the fully integrated health care system serving the northwest region.

Discussions were prompted by a rapidly changing health care environment that demands a more coordinated, integrated approach to the way health and wellness services are delivered to individuals and communities, the systems said in a statement announcing the new agreement.

It also demands the ability to accept more financial risk in caring for defined populations, such as Medicaid recipients, they said.

The size and scale of the new organization will allow it to form additional collaborations and networks of care that will include physicians, hospitals, insurers and other caregivers, increasing access to high-quality health services while reducing costs, they said.

The partners plans to reduce costs by making infrastructure investments more efficiently as a single organization in areas such as information technology systems.

The new organization will include two CHI hospitals in Oregon – Mercy Medical Center, Roseburg; and St. Anthony Hospital, Pendleton – and five facilities in Washington that comprise Tacoma-based Franciscan Health System: St. Joseph Medical Center, Tacoma; St. Francis Hospital, Federal Way; St. Clare Hospital, Lakewood; St. Anthony Hospital, Gig Harbor; and St. Elizabeth Hospital, Enumclaw. Also included are Franciscan Medical Group and Franciscan Hospice and Palliative Care.

PeaceHealth operates four hospitals in Oregon: PeaceHealth Cottage Grove Community Hospital – Cottage Grove; PeaceHealth Peace Harbor Hospital – Florence; PeaceHealth Sacred Heart Medical Center at RiverBend – Springfield; and PeaceHealth Sacred Heart Medical Center, University District – Eugene; three hospitals in Washington: PeaceHealth St. Joseph Medical Center – Bellingham; PeaceHealth St. John Medical Center – Longview; and PeaceHealth Southwest Medical Center – Vancouver, with a fourth, PeaceHealth Peace Island Medical Center – Friday Harbor, scheduled to open in November; and one in Alaska: PeaceHealth Ketchikan Medical Center – Ketchikan.

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My Birth Control Is Free Now. Right?


By Megan Howell
Director of Public Policy and Regulatory Affairs
Group Health Cooperative 

From Group Health Cooperative Innovates blog

As a 30 something mom working at Group Health doing health policy, I’ve had a few friends ask me why we can’t  just go get our FREE birth control.

There’s a lot of confusion and part of it may have to do with the fact that on August 1 every newscast in this nation pretty much told women to go get their FREE birth control and that women’s preventive services were now “free.”

If only life were that simple. While it is true that the Affordable Care Act (ACA) did make access to women’s preventive services easier and without significant costs, there’s some fine print of the law you should know before you head to the pharmacy.

  • You must have health coverage to take advantage of this benefit.
  • If your employer health plan did not start or renew August 1, 2012, you will have to wait until your health plan renews. A popular time is usually Jan. 1, 2013. Group Health non-grandfathered individual health plans currently have this benefit in place.
  • If you are on a “grandfathered” health plan, this new benefit may not apply to you. Group Health members can call customer service at 1-888-901-4636 to see if your plan has the option of covering contraceptives.
  • For birth control pills to be covered at no cost share to the member, they need to be generic if one is available. Additionally, a specific brand name birth control pill may not be covered by your health plan, which will require you to switch brands to be covered at no cost sharing.
  • If you have health care through your employer, and it is a religious organization, you may not receive contraceptive benefits at this time, as there are exemptions for specific religious organizations.
  • You must still comply with all other terms of your health plan’s coverage and contract. For example, you may be required to fill your prescription for birth control pills at a Group Health Pharmacy, or see a Group Health provider to receive other contraceptive services.
  • One final clarification: the ACA did not make women’s preventive services “free” to everyone; they do cost someone- the health plan still has to pay providers and drug manufacturers. Perhaps the more fitting phrase is actually “at no cost sharing to the consumer.”

If this isn’t clear, then I thought you might like this easy-to-read infographic courtesy of Buzzfeed:

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Twenty-dollar bill in a pill bottle

FAQ: Decoding the $716 billion Medicare cuts


By Mary Agnes Carey
KHN Staff Writer

The structure and financing of Medicare, the federal health insurance program that serves seniors and the disabled, has become a defining issue in the presidential and congressional campaigns since GOP presidential candidate Mitt Romney picked as his running mate Rep. Paul Ryan.

KHN’s Mary Agnes Carey answers some frequently asked questions about the numbers and policy surrounding the Medicare debate.

Q:  Romney and other Republicans over the past two years have criticized President Barack Obama and Democrats for cutting $500 billion from the Medicare program over the next decade as part of the 2010 health care law.  In the past couple of weeks, the number that Romney is using has grown to $716 billion? Which is right?

A: They both are.  The $500 billion figure comes from a March 2010 analysis that estimated the 2010 federal health law’s effects on Medicare spending and was put together by the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT). It covered the budget years 2010-2019.

As part of their efforts to repeal the law, congressional Republicans in July asked the two agencies to estimate the impact of a repeal on Medicare.

That July analysis, which covered the years 2013-2022, determined that the health law is expected to reduce Medicare spending by $716 billion.  It is higher than the previous figure because it covers a later time frame that includes greater Medicare spending reductions.

Q. Is the federal government cutting its spending on Medicare?

A. No. Medicare spending will increase each year but at a slower rate. For example, before the health law was passed, Medicare was expected to grow by 6.8 percent a year for 2010 through 2019.

With the health law, that yearly growth rate is projected to be 5.6 percent during that same time frame, according to an analysis from the Kaiser Family Foundation. (KHN is an editorially independent program of the Foundation).

Q: Where would Medicare spending be reduced?

A: The July report from CBO and JCT found that hospital reimbursements would be reduced by $260 billion from 2013-2022, while federal payments to Medicare Advantage, the private insurance plans in Medicare, would be cut by approximately $156 billion.

Other Medicare spending reductions include $39 billion less for skilled nursing services; $66 billion less for home health and $17 billion less for hospice.

The law does not make any cuts to the amount of benefits beneficiaries receive and adds some new benefits, including closing the “doughnut hole” gap in Medicare prescription drug coverage, and new preventive services, such as an annual wellness visit with a physician.

Medicare’s trustees say the law prolongs the solvency of the Medicare trust fund. In addition, supporters say that hospitals and other health care providers would be able to bear reduced payments because the cuts would be offset somewhat by increased revenues from millions of new customers who would gain health insurance through the law.

They also argue that the Medicare Advantage plans were being overpaid since the cost per beneficiary was higher than what beneficiaries of traditional Medicare cost the government.

But critics and some independent analysts have questioned whether cutting payments to these providers will result in a loss of quality or push some providers to refuse to participate in Medicare.

“The question is whether reductions in payments to health care providers will impair either access to health care services or the quality of those services,” a recent Brookings Institution analysis said.

Q: Rep. Paul Ryan, R-Wis., has a Medicare overhaul plan that includes the Medicare spending reductions, right?

A: Yes, Ryan’s plan would keep the Democrat’s Medicare spending changes, but he says he would use the money to make sure  Medicare remained solvent, rather than directing it toward other areas, including funding the health law’s exchanges or its expansion of Medicaid, the federal-state program for the poor.

Democrats say Ryan would use the Medicare savings to fund other areas of this budget plan, including tax cuts for wealthy Americans and increases in military spending.

In a recent blog post in National Review Online, James Capretta, a fellow at the Ethics and Public Policy Center, a conservative think tank, said it was an “oversimplification” to say that Ryan was keeping the Obama Medicare cuts.

“Ryan’s budget allows the substitution of sensible ways of saving money in Medicare for the arbitrary and harmful cuts contained in Obamacare,” he writes.

Ryan’s plan also calls for an overhaul of the program, offering beneficiaries a set amount of money that they would use toward buying a private plan or traditional Medicare.

Democrats have argued that such a fundamental change could undermine the traditional Medicare program, because private plans might tailor their coverage to attract healthier beneficiaries, leaving sicker beneficiaries in traditional Medicare.

Critics of Ryan’s plan also predict it will force seniors to eventually pay more for their health care because the federal payments will be capped at the rate of gross domestic product plus half a percentage point, an amount that may not keep up with the increase in medical costs.

Under Ryan’s plan, insurers would have to provide benefits that are at least equal the value of those offered in traditional Medicare.

Q: Would Romney’s Medicare plan keep the cuts in place as well?

A: That’s unclear. While Romney has said his Medicare proposal is very similar to Ryan’s, he has also asserted that he would rescind the Medicare funding reductions in the health law.

However he has not said what steps he would take to extend the financial solvency of the program. In a Facebook posting on Thursday, Romney said he and Ryan “are talking about what adjustments we should make to Medicare for young people so that when they come along and become seniors, that they have a program that’s solvent.”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.


Four appointed to Harborview leadership posts.


UW Medicine has appointed four to leadership posts at Harborview Medical Center:

Chief of Trauma: Dr. Eileen Bulger

Harborview Medical Center’s new chief of trauma is Dr. Eileen Bulger, UW professor of surgery. Bulger has more than twenty years of experience working at Harborview as a trauma surgeon and, since 2009, has been the Medical Director of the Emergency Services.

Dr. Bulger has been active in the Washington State Trauma System and serves as the Chair of the Governor’s Steering Committee for EMS and Trauma.

Dr. Bulger has held numerous other leadership positions nationally and regionally, including Chair of the Washington State American College of Surgeons Committee on Trauma, Region Chief for the four states of Region X (Washington, Oregon, Alaska and Idaho) and President of the Washington State Chapter of the American College of Surgeons.

She is known for her research into trauma resuscitation and injury prevention.

Associate Administrator, Chief Nursing Officer: Darcy Jaffee

Darcy Jaffe has been named Associate Administrator, Chief Nursing Officer at Harborview Medical Center, where she will be responsible for the overall accountability for nursing practice across the medical center.

Jaffe has worked at Harborview since 1986 and has provided service in a variety of progressive leadership roles.

She received her undergraduate and graduate degrees in Nursing from the University of Washington and is credentialed as an Advanced Nurse Practitioner.

Assistant Administrator of Finance: Kera Rabbitt

Kera Rabbitt, has been named Assistant Administrator of Finance at Harborview, where she will serve as a financial resource for the medical center’s executive team and as a primary point of integration between Harborview and the UW Medicine health system finance team.

Previously, Rabbitt served as Director of Finance for the Oregon Health and Science University (OHSU) and the Knight Cancer Institute at OHSU, and as Manager of the Finance Division at University Medical Center in Tucson, Arizona.

Rabbitt received her Bachelor of Science degree in Finance from the Eller College of Management at the University of Arizona and her Master’s in Business Administration from the Lundquist College of Business at the University of Oregon.

Associate Administrator for Surgical, Emergent and Integrated Services: Becky Pierce

Becky Pierce has assumed the role of Associate Administrator for Surgical, Emergent and Integrated Services.

She is a registered nurse who has served in a variety of progressive leadership positions during her 22 years at Harborview, including most recently serving as Assistant Administrator, Patient Care Services.

She has published and lectured nationally on topics related to critical care and trauma nursing, and is an advocate for patient and family-centered care.

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Don’t change Medicare, most Republicans say in new poll


By Jay Hancock

As Rep. Paul Ryan’s plan to overhaul Medicare makes campaign headlines, a majority of Republicans oppose changing the government program for seniors, according to  a new poll by the Kaiser Family Foundation and the Washington Post. (KHN is an editorially independent program of the foundation.)

That could spell trouble for presumptive presidential nominee Mitt Romney and his designated  running mate Ryan as voters focus on the Wisconsin congressman’s “premium support” plan.

Pollsters asked whether respondents wanted to continue Medicare’s current defined benefit setup, in which the government pays a specified portion of all medical bills incurred by the patient, or switch to a plan in which seniors get government grants to buy health insurance, as Ryan advocates.

Fifty-five percent of Republicans surveyed preferred the status quo – slightly more than the 53 percent of independents who gave the same response.

Sixty-eight percent of Democrats also chose “Medicare should continue as it is today” as representing their views. The poll was done in late July and early August, before Romney announced Ryan as his choice.

In another poll, released today KFF found that Republicans rated the cost of health care and Medicare as more important to their votes than the 2010 health law that generates so much scorn from Republican politicians.

Jobs are still Republicans’ economic top worry. But when asked how health issues would affect their vote, two-thirds of GOP respondents said the cost of health care and insurance is extremely or very important.

Six in 10 Republicans said Medicare is important, while 54 percent gave the Affordable Care Act the same weight. Most of those interviews were also done before Romney picked Ryan.

Among all respondents, Medicare tied with the cost of health care as the top health issue, with 73 percent saying both would be important in how they vote, followed by the Medicaid program for the poor.

In the KFF/Washington Post poll, jobs were the top economic issue among all those interviewed, with 63 percent of Democrats, 60 percent of independents and 55 percent of Republicans saying jobs were the top worry.

The KFF/Washington Post poll surveyed 3,130 adults from July 25 to Aug. 5 and has a margin of error of +/- 2 percentage points.  The KFF tracking poll surveyed 1,208 adults from Aug. 7 to 12 and has a margin of error of +/- 3 percentage points.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Click Image for More Information about Hepatitis C

All baby boomers should be screened for hepatitis C – CDC


Click Image for More Information about Hepatitis C

All U.S. baby boomers should be tested for the hepatitis C virus, according to final recommendations published today by the Centers for Disease Control and Prevention.

One in 30 baby boomers – the generation born from 1945 through 1965 – has been infected with hepatitis C, and most don’t know it, the CDC says.

Hepatitis C causes serious liver diseases, including liver cancer (the fastest-rising cause of cancer-related deaths) and is the leading cause of liver transplants in the United States.

The final recommendations are published in today’s issue of CDC’s Morbidity and Mortality Weekly Report.

“A one-time blood test for hepatitis C should be on every baby boomer’s medical checklist,” said CDC Director Thomas R. Frieden, M.D., M.P.H.

CDC’s previous recommendations called for testing only individuals with certain known risk factors for hepatitis C infection.

Risk-based screening will continue to be important, but is not sufficient alone, CDC officials said.

More than 2 million U.S. baby boomers are infected with hepatitis C – accounting for more than 75 percent of all American adults living with the virus.

Studies show that many baby boomers were infected with the virus decades ago, do not perceive themselves to be at risk, and have never been screened.

More than 15,000 Americans, most of them baby boomers, die each year from hepatitis C-related illness, such as cirrhosis and liver cancer, and deaths have been increasing steadily for over a decade and are projected to grow significantly in coming years.

CDC estimates one-time hepatitis C testing of baby boomers could identify more than 800,000 additional people with hepatitis C.

And with newly available therapies that can cure up to 75 percent of infections, expanded testing – along with linkage to appropriate care and treatment – would prevent the costly consequences of liver cancer and other chronic liver diseases and save more than 120,000 lives.

For additional information about hepatitis, visit www.cdc.gov/hepatitis

Local Resources:

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Sun Orange Orb by Cris DeRaud

“Excessive Heat Warning” issued for King County


The National Weather Service has issued an Excessive Heat Warning for King County on Thursday, August 16 and Friday, August 17.

High temperatures both days are expected to be in the mid 90s.

Illustration by Cris DeRaud

Here are some tips from the Washington State Department of Health to help you beat the heat:

Cooling Centers: Various cities in the region have opened cooling centers for people affected by the heat. For a list of the centers go  to: www.kingcounty.gov/safety/prepare.aspx

Hot weather precautions to reduce the risk of heat exhaustion and heat stroke

Stay indoors and in an air-conditioned environment as much as possible unless you’re sure your body has a high tolerance for heat.

Drink plenty of fluids but avoid beverages that contain alcohol, caffeine or a lot of sugar.

Eat more frequently but make sure meals are balanced and light.

Never leave any person or pet in a parked vehicle.

Avoid dressing babies in heavy clothing or wrapping them in warm blankets.

Check frequently on people who are elderly, ill or who may need help. If you might need help, arrange to have family, friends or neighbors check in with you at least twice a day throughout warm weather periods.

Make sure pets have plenty of water.

Salt tablets should only be taken if specified by your doctor. If you are on a salt- restrictive diet, check with a doctor before increasing salt intake.

If you take prescription diuretics, antihistamines, mood-altering or antispasmodic drugs, check with a doctor about the effects of sun and heat exposure.

Cover windows that receive morning or afternoon sun. Awnings or louvers can reduce the heat entering a house by as much as 80 percent.

If you go outside

Plan strenuous outdoor activities for early or late in the day when temperatures are cooler; then gradually build up tolerance for warmer conditions.

Take frequent breaks when working outdoors.

Wear a wide-brimmed hat, sun block and light-colored, loose-fitting clothes when outdoors.

At first signs of heat illness (dizziness, nausea, headaches, muscle cramps), move to a cooler location, rest for a few minutes and slowly drink a cool beverage. Seek medical attention immediately if you do not feel better.

Avoid sunburn: it slows the skin’s ability to cool itself. Use a sunscreen lotion with a high SPF (sun protection factor) rating.

Avoid extreme temperature changes. A cool shower immediately after coming in from hot temperatures can result in hypothermia, particularly for elderly or very young people.

If the power goes out or air conditioning is not available

If air conditioning is not available, stay on the lowest floor out of the sunshine.

Ask your doctor about any prescription medicine you keep refrigerated. (If the power goes out, most medicine will be fine to leave in a closed refrigerator for at least three hours.)

Keep a few bottles of water in your freezer; if the power goes out, move them to your refrigerator and keep the doors shut.

For additional information about how to cope with the heat — and other emergencies — visit the website of the King County Office of Emergency Management at: www.kingcounty.gov/safety/prepare.aspx

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What you need to know about HPV


By Monica Richter, MD, PhD

One of the most important recent advances in women’s health is a vaccine against human papillomavirus (HPV). The HPV vaccine protects against serious health problems such as cervical cancer and other less common cancers.

The first HPV vaccine was approved in June of 2006 after testing in thousands of people around the world.

Two HPV vaccines are currently licensed by the FDA and recommended by the Centers for Disease Control and Prevention (CDC): Gardacil is approved for girls or boys ages 9 to 26, and Cervarix is approved for girls 10 through 25 years of age.

HPV is the most common sexually transmitted virus in the United States. More than half of sexually active men and women are infected with the virus at some time in their lives.

In addition to causing cervical cancer, HPV can cause vaginal and vulvar cancer in women, and other types of cancers in both men and women. It can also cause genital warts and warts in the throat.

But good news! The HPV vaccine can prevent most cases of cervical cancer in women. It can also prevent vaginal and vulvar cancer in women and genital warts and anal cancer in both men and women. Protection from the vaccine is long-lasting.

While we all hope that young teens are abstaining from sexual activity, it is important to vaccinate girls long before their first sexual contact.

In addition, the response to the vaccine is stronger in younger girls and for this reason, we recommend vaccinating girls at age 11 or 12 years. The vaccine is given as a 3-dose series over 6 months.

Both vaccines are available for women, but only one of them can be given to men also.

Vaccines have undergone a lot of scrutiny in recent years, but all of the available scientific evidence confirms their safety and efficacy.

In spite of this, many false rumors are circulating and I continue to be confused by the number of parents who decline the vaccine for their daughters. As a mother and a pediatrician,

I gave my daughter the HPV vaccine as soon as it became available and I urge all parents to do the same.

For more information on the HPV vaccine, visit www.cdc.gov/vaccines.

About Monica Richter, MD, PhD

Dr. Monica Richter is a board certified pediatrician with Valley Children’s Clinic. Over the past 18+ years Dr. Richter has helped hundreds of pubescent girls navigate the physical and emotional aspects of their changing bodies and psyches, including menstruation, body changes, sexuality and how babies are conceived, through her free seminar, As Girls Grow Up. She also teaches BodyWorks, an eight-week health education program developed by the Dept. of Health & Human Services. Bodyworks is designed to provide parents and caregivers of teenage girls and boys ages 9 to 16 with tools to improve family eating and activity habits. Originally from Manhattan, Dr. Richter is married with two grown children. In her spare time she enjoys reading and knitting.

Valley Children’s Clinic is located at 4011 Talbot Road S., Suite 220, in Renton. Phone: 425.656.5300; www.valleychildrensclinic.org


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Rep. Paul Ryan meeting with President Obama

FAQ: How Ryan’s plan would change Medicaid


Rep. Paul Ryan meeting with President Obama

By Mary Agnes Carey
KHN Staff Writer 

GOP presidential candidate Mitt Romney’s choice of House Budget Committee Chairman Paul Ryan, R-Wis., as his running mate has brought renewed focus on Ryan’s proposal to overhaul Medicare.

But how would Ryan’s plan to reduce federal spending, which has been approved twice by the GOP-controlled House, change Medicaid?

KHN’s Mary Agnes Carey answers some frequently asked questions about Ryan’s ideas for Medicaid.

Q: What Is Medicaid?

A: It is the shared federal-state health insurance program for low-income and disabled people. It covers about 62 million Americans.

States generally administer the program under broad guidelines from the federal government that include minimum eligibility and benefits standards.

States and the federal government share in the financing of the program.

Q: How Would Ryan’s Plan Change Medicaid?

A: The federal government on average pays 57 cents of every dollar spent on Medicaid.  Some states receive more, some less, with a greater federal share going to the poorest states.

Under Ryan’s plan, the federal share of Medicaid spending would become a block grant indexed for inflation and population growth. States would have more flexibility over who is covered and what benefits are offered.

The block grant would start in 2013. Ryan and his supporters say turning to block grants would both save the federal government money and give states flexibility in who they cover and what benefits are provided.

“States will no longer be shackled by federal determined program requirements and enrollment criteria,” his plan says. Opponents of Ryan’s plan say it would lead states to reduce enrollment, cut benefits or require more cost-sharing from beneficiaries.

Ryan’s plan would also repeal the Medicaid expansion included in the 2010 health law, which if states opted to do it, would provide Medicaid coverage to people under 133 percent of the federal poverty level, or $14,856 for an individual and $30,656 for a family of four according to current guidelines.

The CBO estimates that would affect 11 million people.

Q: How Would Federal Spending Change Under Ryan’s Medicaid Proposal?

A: A Congressional Budget Office analysis of the Ryan plan that the House approved in 2011 found that federal spending for Medicaid would be 35 percent lower in 2022 and 49 percent lower in 2030 than currently projected federal spending.

While Ryan’s Medicare proposal changed slightly in the budget plan that the House passed earlier this year, his Medicaid proposal remained largely the same in both versions.

Q: How Would Ryan’s Plan Impact States’ Medicaid Budgets?

A: In March, the Congressional Budget Office said that if, as Ryan proposes, states had additional flexibility to allocate federal funds for Medicaid and the Children’s Health Insurance program (both programs provide health care for low-income children), states might be able to make their Medicaid programs deliver care more efficiently.

CBO added that the federal spending reductions called for in budget scenarios that Ryan asked CBO to review meant that “states would need to increase their spending on these programs, make considerable cutbacks in them, or both.”

States might have to reduce eligibility, cover fewer services, reduce payments to providers or increase beneficiary cost-sharing, CBO said.

If Ryan’s plan became law, states anticipating large Medicaid expansions under the health law would see some of the largest reductions in federal spending, according to a 2011 Urban Institute analysis that predated the Supreme Court’s June decision making the law’s Medicaid expansion optional for states.

The Urban Institute conducted the study for the Kaiser Commission on Medicaid and the Uninsured, a program of the Kaiser Family Foundation.  (KHN is an editorially independent program of the Kaiser Family Foundation.)

Q: What Would These Changes Mean To Medicaid Enrollment?

A: Under Ryan’s block grant proposal, between 14 million and 27 million fewer people would be covered in 2021 than under Medicaid as it currently exists, according to the Urban Institute analysis. Beneficiaries also might see reductions in benefits and greater cost sharing, among other changes.

If the health law were repealed, as Ryan’s plan calls for, an additional 11 million people would not gain coverage under the statute’s now-optional expansion of Medicaid eligibility.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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Photo by Roger Ramirez, Chariot Photo. License: Creative Commons Attribution ShareAlike 3.0. (Click to access high res version)

Your voice matters: e-Patient Dave talks about empowered patients


The Puget Sound Health Alliance is pleased to host an event featuring Dave deBronkart, better known as e-Patient Dave, about patient empowerment.

The talk, which is free and open to the public, will be held on Tuesday, September 11 from 4 to 6 p.m. Please note that the venue will be World Trade Center Seattle (2200 Alaskan Way, 4th Floor), not Bell Harbor as previously announced.

A powerful speaker, Dave beat stage IV cancer in 2007 and became a blogger, keynote speaker and health policy advisor.

He is today the leading spokesman for patient engagement, attending over 150 conferences and policy meetings internationally in the past two years. He serves as volunteer co-chair of the Society for Participatory Medicine.

e-Patient Dave has appeared in Time, U.S. News, Wired, MIT Technology Review, and the HealthLeaders cover story “Patient of the Future.”

In 2009, HealthLeaders named him and his doctor to their annual list of “20 People Who Make Healthcare Better,” and in 2011 his compelling TEDx Talk “Let Patients Help” went viral globally and is in the top half of the most-watched TED talks of all time.

Please RSVP to Carleen Horton-Pippin at chorton-pippin@pugetsoundhealthalliance.org. Space is limited.

World Trade Center Seattle is wheelchair accessible and ADA compliant.

View directions.

 The Alliance thanks the Robert Wood Johnson Foundation for the grant which makes this event possible.

Photo by Roger Ramirez, Chariot Photo. License: Creative Commons Attribution ShareAlike 3.0.

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PET scan of the brain of a person with Alzheimer's disease howing a loss of function in the temporal lobe

Many people would like to know their risk of developing Alzheimer’s disease


PET scan of the brain of a person with Alzheimer's disease howing a loss of function in the temporal lobeBy Michelle Andrews

Alzheimer’s disease can’t be prevented or cured, and it ranks second only to cancer among diseases that people fear. Still, a study last year found that about two-thirds of respondents would want to know if they were destined to get the disease.

Although there are no definitive tests that predict whether most people will get the disease, people sometimes want such information for legal and financial planning purposes or to help weigh the need for long-term-care insurance.

Current tests to identify the risk of developing Alzheimer’s disease when no symptoms are present provide only limited information, and health insurance generally doesn’t cover them. But that’s not stopping some people from trying to learn more.

Alzheimer’s disease, the most common form of dementia, gradually robs people of their memory and other intellectual capabilities. Most of the 5 million people who have Alzheimer’s developed it after age 60. In these cases, the disease is likely caused by a combination of genetic, lifestyle and environmental factors. About 5 percent of Alzheimer’s patients have inherited an early-onset form that is generally linked to a mutation on one of three chromosomes.

Research suggests that the brain may show signs of Alzheimer’s decades before obvious symptoms appear. Scans can identify the presence of beta-amyloid, a protein that is often deposited in the brains of people with the disease, for example. Changes in proteins in the blood or cerebrospinal fluid may also be associated with Alzheimer’s disease.

But tests to measure these changes are available only in a research setting, and insurance typically doesn’t cover them. James Cross, head of national medical policyand operations for Aetna, says his company “does not consider blood tests or brain scans medically necessary for diagnosing or assessing Alzheimer’s disease in symptomatic or asymptomatic people because the clinical value of these remains unproven.”

Genetic testing is somewhat easier to arrange, but insurers generally won’t pay for it, either.

In addition, genetic counselors caution that long-term-care insurers may use genetic testing results when evaluating whether to issue a policy. The Genetic Information Nondiscrimination Act prohibits health insurers and employers from discriminating against people based on their genetic information. However, life and long-term-care insurers are not covered by the law.

“Before anyone has genetic testing, they should get life insurance and long-term-care insurance,” says Jill Goldman, a certified genetic counselor at the Taub Institute at Columbia University Medical Center.

Genetic testing for late-onset Alzheimer’s involves one gene, the apolipoprotein E (APOE) gene on the 19th chromosome. The gene comes in three different forms – E2, E3 and E4. Everyone inherits one form, or allele, from each parent. Having one or two of the E4 variants can increase a person’s risk of developing Alzheimer’s disease three to 15 times.

About half of those who develop late-onset Alzheimer’s, however, don’t have any E4 alleles at all. Genetic testing in asymptomatic people therefore isn’t definitive or even all that informative, say experts. For late-onset Alzheimer’s, “the predictive value of genetic testing is low,” says Mary Sano, director of the Mount Sinai Alzheimer’s Disease Research Center.

But sometimes people want information, even if it’s inconclusive.

Brian Moore, whose father died of Alzheimer’s at age 89, wanted to know more about his genetic risk for the disease. Moore, 48, was better equipped than most to understand the testing: A neuropathologist who co-chairs the department of pathology at Southern Illinois University’s School of Medicine, he has performed hundreds of autopsies on the brains of people who died of Alzheimer’s disease.

Moore contacted 23andMe, a company that for $299 offers a genetic analysis of a person’s risk for more than 100 diseases and conditions, including Alzheimer’s, based on the APOE gene.

The company sent him a specimen kit with a container for saliva collection that he then sent to a lab for analysis.

About six weeks later, he logged on to the company’s Web site and learned that he has two E3 alleles, the most common variants, which means that his Alzheimer’s risk is average, at least as it relates to the APOE gene.

“It was reassuring,” he says. “I know it’s not determinant, and environment and lifestyle also play a role. But at least I have that base covered.”

The National Society of Genetic Counselors and the American College of Medical Genetics practice guidelines recommend against direct-to-consumer APOE testing for late-onset Alzheimer’s, in part because of difficulty interpreting the results.

Ashley Gould, 23andMe’s vice president of corporate development and chief legal officer, says that if people want help understanding their results, genetic counselors are available. The service is available by phone for a fee based on the level of service.

But in the case of the APOE gene, some experts say, the information isn’t all that helpful.

“The things we know that really impact the disease are related to lifestyle,” says George Perry, dean and professor of biology at the University of Texas at San Antonio, who is the editor-in-chief of the Journal of Alzheimer’s Disease. “Be mentally and physically active, eat a diet rich in fruit and vegetables. These reduce the risk of developing the disease by at least half.”

Please send comments or ideas for future topics for the Insuring Your Health column toquestions@kaiserhealthnews.org.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

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