US Health Care: The Good News

The Dartmouth Atlas Project was created by economists from Dartmouth College that studied millions of healthcare billing records. Through this study, they tracked 20 years of treatment and costs and found that there are huge variations in American medicine for places as small as towns. The healthcare system varies greatly depending on the policies and decisions of that healthcare system. This helped address the topic of the video: creating quality healthcare at reasonable cost for every American.

I think, based on the way that healthcare systems are and on where I live, that access to healthcare is unfortunately a privilege. I do not think it should be a privilege, but the way that it stands, it seems to be that way. In many cases, individuals are not able to have access to healthcare for many reasons - the most pertinent being that they cannot afford it. Therefore, it seems that the more "privileged" people that can afford it, or are covered by their employers, are the ones with access to healthcare. Ideally, however, I believe that access to healthcare should be a right since no human should have to suffer through a disease or some sort of illness simply because they cannot afford to treat the problem.

The medical systems described here were all remarkable in the work that they accomplish. What I noticed from each system described is that there was a genuine care for the people of the community, and the doctors and healthcare professionals felt that they needed to help all patients regardless of their economic standing due to their positions and values as a doctor. In Mesa County, Colorado, I found it interesting how they charged all people the same amount for a particular treatment, rather than changing the amount based on their healthcare providers or economic standing. This was impacting to me because in order for this to happen, doctors had to put a certain amount of their own salaries on the line - a portion that they may not see again - so that those with medicare or medicaid and even no insurance could receive equal treatment. In Seattle, Washington, their Group Health system of Medical Home was innovative because they used technology to their advantage to create other opportunities for patients. By allowing patients to call or email nurses and doctors directly and actually receiving a response, that saves having to actually go see their physician and in turn creates more time so that physicians can see the patients that absolutely have to be seen face to face. This system includes doctors answering emails and calls as part of their job, unlike many systems that have the calls forwarded to a receptionist. In Everett, Washington, the doctors prescribe general medications instead of the popular "brand name" patented medications. These general medications are the same copies but do not have the patent of the "brand name" and are therefore much cheaper for patients to purchase. This in turn saves a lot of money on medication spending. Lastly, Dartmouth Hospital practices shared decision making. Through this, physicians educate and ask patients on their input on a medical treatment that may be suggested. By giving patients a voice, they can comfortably make decisions that will benefit their own lives and their own circumstances. I found it amazing how doctors at this hospital are proud to do this process despite the fact that the incidences of surgeries decrease, meaning they personally earn less money.

I honestly think that the way medical care is delivered in the places visited in the program cannot be duplicated where I am from. That, or it can be duplicated but it will take an extremely long time. I am from Miami, Florida. This is a place where many old people come to retire, is overpopulated, and has a reputation for a healthcare system that continuously drains money from individuals or their insurances for unnecessary procedures. For example, the video said that in a place like Colorado, they may have check-ups every year whilst in Miami, for the same reason, would have a check-up every month which costs a lot of money each time. From personal experience, my grandparents are elderly and often have check-ups. My grandmother, for example, went for a check-up and from that one check-up received about three referrals to four different tests with two different doctors, all for different things that, in the end, resulted in nothing. She has also had many patient stays and both of my grandparents have a pharmacy inside their medicine cabinet with popular prescription medication. I am sure that they are not alone in the way that they are treated. Unfortunately I also believe that some doctors do not hold the patient in their best interest but rather take preference over what can aid them in earning more money. This is not the case for all, but there are some doctors that would rather see me for five minutes and see twenty clients a day then repeat my visit biweekly and accomplish nothing rather than sit and try to solve the problem then and there. Due to the way that the healthcare system is, I think that Miami would be very far from having this happen. 

The Vaccine War

In Frontline's The Vaccine War, they raise tough questions that millions of parents across America are faced with - are vaccines healthy for my child to receive? Through this video we are able to hear parents from both sides of each viewpoint. Many parents, such as Jenny McCarthy, believe their children became autistic as a result of a series of vaccinations, or have similar negative associations related to vaccinations. Other parents with opposing opinions trust in the studies that have proven that vaccines are safe in relation to not causing autism or having negative effects because of the mercury preservative present in some vaccines. Because of such strong positions that parents have on either end, there is a struggle to decide if public health should intervene and enforce vaccination, or allow parents to make their choice with their children and continue publicizing their opinions through easy  to access media whilst possibly endangering the rest of the population.

The video made me think very differently about vaccinations. I initially thought of them as a mandatory process that was done merely for the individual to not contract the specified disease. However, I did not think about the number of vaccinations that the average child born in the United States received, the age in which they received them, and did not even know that vaccinations affected other people as well as those receiving the vaccine. This leads to the concept of herd immunity, which was also brought up in the video. Herd immunity describes a form of immunity that occurs when the vaccination of a large portion of a population provides a measure of protection for individuals who have not developed immunity. This means that if more people are immune to a certain virus because they have their respective vaccinations, then more people in the population, even if they are not immune, are protected from the disease. This is important for those that are vaccinated and those who are not to have a higher chance of remaining healthy. Not everyone can be vaccinated, and it is not because of their refusal. Chemotherapy patients, immune therapy patients, as well as many others are not physically capable of being safely vaccinated, and they rely on this "herd immunity" to protect them. However, if parents start refusing for their children to be vaccinated, this safety in numbers can diminish and cause outbreaks of certain diseases to occur, in turn, harming those that are not vaccinated.

Vaccination is different from other types of personal health decisions because it is mainly affecting infants and children, non-consenting individuals, so parents must decide whether to administer each child the vaccines or not. Also, this is a different health decision because in the long run, it does not only affect the child not being vaccinated, but it also affects those around them. I understand that a parent wants to have control over what is done to their child and it may seem like a personal decision is rational for their child. On the other hand, when concrete facts are the basis of why things are done, such as the population effect vaccines have and that it is safe regardless of what the media broadcasts, at this point I believe public health policies should intervene and decide what vaccines should be mandatory for a child to receive.

Children may not receive the recommended immunizations for several reasons. Most parents choose not to have their child vaccinated for personal opinions, such as they believe that the amount of vaccines administered are excessive, or the time period in which they're given is too short, or simply that children should get sick and overcome diseases naturally. Other parents may be affected by the media, such as the beliefs that the mercury preservatives within vaccines are extremely detrimental to health, or that vaccines cause autism. Another reason why children may not receive the recommended immunizations is from the patient's personal issues of health in which the healthcare system recognizes that the individuals' immune system is too weak to receive the vaccinations.

I believe the initial public heath response to increase vaccination rates is simply to counteract with the media. If it is publicized that epidemiological studies have failed to reveal a correlation between the mercury preservative and autism as well as no link between autism and the MMR shot, then more parents may listen to the facts and stop relying solely on emotion. Also, along with explaining these facts, explaining concepts such as herd immunization and the consequences that could arise if enough children are not vaccinated and an out-break of a disease does in fact occur could give them a different perspective on vaccines.

Non-smoking wives of heavy smokers have a higher risk of lung cancer: a study from Japan

The British Medical Journal reported on a study in which the non-smoking Japanese wives were tracked for fourteen years and monitored for lung cancer based on the smoking habits of their husbands. Twenty-nine health care center districts followed up on 91,504 wives aged 40 and above for fourteen years. These women were interviewed and followed through a risk-factor linkage  Their death certificates were also taken into account and the resulting mortality rate provided the data to reach the results. The data showed that non-smoking wives of heavy smokers have a higher risk of lung cancer due to the high relative risk reported through the study.

I found important that second-hand smoke has such serious effects on the wives of heavy smokers. The mortality rate was close to one-third to one-half of those of direct smokers - which I found to be a huge number considering it is not a direct inhalation of the tobacco. This called my attention since many smokers may try to argue that second-hand smoke is "not as dangerous" and therefore justify themselves and their families so that they could continue this habit. This article clearly shows results that contradict this. Another point brought up that I found very interesting was that in Japan, the fact that non-smoking wives of heavy smokers have a higher risk of lung cancer is actually more damaging since only 15% of women smoke, but 73% of men smoke. As a result, this second-hand smoke that these men's wives are being exposed to could have a larger impact on mortality rate than the percentage of direct smoking women.

The advantage of using this type of study design is that it is cost effective, since it is questioning and following up with the same group of women and collecting their data over time. Also, since it is the same people, it is accurate in terms of time and individual case, since the same people were followed over time and the smoking habits of each wives' husband is able to be accounted for. Documents such as mortality rates are a source of accuracy since they are government documents, so it is unbiased data.

The results of this study support second-hand smoke as a cause of lung cancer since the mortality rate shows a large risk factor associated with the exposures that these wives had with their husband's smoking habits. As earlier stated, lung cancer had about one-third to one-half of the mortality rate of direct smokers, which is a significantly large amount. This was supported through comparing these wives to the wives of non-smoking husbands; they did not show such dramatic responses that resulted in lung cancer. In addition, the quantitative data that an approximate 91-99% of the census population was surveyed makes a huge support through the large sample population. The article also specified that the wives that are exposed to second-hand smoke show to have only lung cancer and do not show significant data in having any other types of cancers. The other negative health habits that husbands may have, such as drinking, also did not show any significant data that displayed an increase in their spouse's risk factor. The specific correlations that have resulted from this study point to these increases in mortality rates to second-hand smokers to be a causal relation.

MMWR: Binge Drinking Among Women and High School Girls

The Center for Disease Control and Prevention's Morbidity and Mortality Weekly Report elaborated on the findings in binge drinking among women and high school aged girls. It is reported that roughly one in eight women and one in five high school girls binge drink. This information was collected from two different sources. The data in women 18+ was analyzed from the 2011 Behavioral Risk Factor Surveillance System, which is an annual random-digit-dialed system that calls and asks health questions to the pertaining information. The data for high school girls was drawn from the Youth Risk Behavior Surveillance System, which was obtained through questionnaires sent to private and public high schools throughout the country. Binge drinking is responsible for several negative health effects which include the contraction of sexually transmitted diseases, the unintentional harm of fetuses, and thousands of cases of death. As a result, preventative measures are being put in place to attempt to reduce binge drinking.

Binge drinking is an important health issue because, as shown by the data, it is done very frequently across the country. Since the purpose of public health is to improve quality of life, working to prevent such large incidences of death caused by binge drinking (23,000 deaths as reported by the CDC) as well as lowering the incidences of cancers, heart disease, hypertension, and even risky behaviors associated with binge drinking such as violence, are steps towards a better quality of life. Binge drinking is also an important public health issue as a college student since the highest prevalence of alcohol consumption is between the ages of 18-24. I also know by personal experience that it is not uncommon for binge drinking to occur on campus, and sadly have also found that it is not uncommon to hear of students having their stomachs pumped or having partaken in negative behaviors that otherwise would not have occurred if they had not been binge drinking. Reducing these incidences would create a larger positive impact for myself and my peers.

I am surprised at the results, not so much on the quantitative data but the data that specifies on the drinking prevalence. I found it very surprising that women with household incomes greater than $75,000 had the highest drinking prevalence, since substance abuse is often considered a problem of lower classes. I also found the correlation between the alcohol consumption of high school girls and women interesting. This shows a societal impact of the decision of older and young women on young girls that are exposed to such behaviors and wish to follow their lead. Since the data source is a survey, there may be many factors that could attribute to issues on self-reporting alcohol consumption due to the fact that the survey may not reach all of the subjects whom the topic pertains to. Moreover, some subjects filling out the survey may lie for personal reasons.

In order to reduce the number of binge drinking occurrences in college or high school aged women, an action towards making this targeted audience aware of the negative effects that binge drinking has on their bodies and on their life should be made. Also, since the women in this age group are young, having the university or the school offer fun alternative activities during popular "drinking times" could give them another source of entertainment that does not engage in binge drinking.