Blue Cross and Blue Shield Institute has started a partnership with the ride sharing company Lyft to provide their members with free rides to pick up their medications. The Blue Cross Blue Shield Institute is a new organization that’s mission is to reduce the barriers of accessing healthcare. One of the largest identified barriers to accessing healthcare is transportation. Last year, their big initiative was a similar program with Lyft to provide free transportation for their patients to their doctors’ appointments. By investing in these types of programs, the organization is hoping to reduce costs in the long -term and improve the health outcomes of their consumers. With this newest imitative they are also partnering with pharmaceutical organization such as CVS Health and Walgreens to increase medication adherence. These programs are still under pilot testing and are currently funded by CVS and Walgreens in Chicago and Pittsburgh with patients who are living in “transportation deserts”. These types of unique partnerships are allowing for creative solutions and addressing the social determinants of health in order to solve the most dire healthcare problems. Let’s hope to see more of these types of collaborations in the future.
In an article published yesterday by BuzzFeed News, it was released that Gay Dating App Grindr has been sharing its users’ HIV status with two outside companies, a move which many consider dangerous to the queer community that the app claims to serve.
The sites, Apptimize and Localytics, work with Grindr to optimize the app and user experience. While it has been noted that these companies do not share information with third parties, there are still concerns with the sharing of sensitive information of a historically vulnerable population. This could raise flags for users sharing their HIV status on the app, which could negatively impact public health interventions that work to reduce HIV transmission and stigma.
Grindr recently announced that they would remind users to get tested for HIV every three to six months, offering a cue to action for users to be more aware of their HIV status. Knowing ones status is a crucial component for reducing the number of new HIV infections, such as by offering the opportunity to those who are living with HIV to be connected to care and achieve viral suppression.
What causes headaches? I find myself Googling this at least once every few months when a particularly nasty or persistent headache of my own decides to show up. And I think it’s because I never really get a satisfying explanation from my searches, likely due to the fact that there are hundreds of headache types and only 10% have a known cause. Let’s focus on primary headaches, ones not caused by an underlying condition.
There are a lot of culprits for primary headaches. Nerves/blood vessels/tissue around the skull, muscles of the head/neck, and chemical changes within the brain can spur on that pain. So what triggers these physical pain signalers? It is probably no surprise that stress or alcohol are included. Skipping meals, poor posture (thanks, laptops), disrupted sleep patterns, and changing weather as well.
Some of these triggers are outside of our control like the weather, but there are measures we can take for prevention. Even though yes, easier said than done, try to avoid known stressors where possible. Eat low-processed meals at regular intervals and prioritize consistent sleep habits. Deficiencies in magnesium may play a role so eat some avocado and nuts. And when all else fails, put the screens away, take a warm shower, apply a soothing compress to the neck, and go the heck to sleep. Admittedly just writing about all the things that I should be doing right now has not made my headache go away, so off to self-care I go.
In the hospital, the nurse told me that by the time I turned 10 they’d have a cure. This voice echoed in my head for years, as I imagined those very doctors and nurses working overtime in their labs, after their long days helping kids like me. Each birthday after the 10th one, I became more and more bitter thinking about that nurse, realizing she had delivered a false promise.
Type 1 diabetes (T1D) is misunderstood, even within the public health field. It’s rare – only 3% of all diabetes cases in the U.S. – and cannot be cured. T1D people live 12 years shorter on average.
T1D is an autoimmune disorder that occurs when the pancreas stops producing insulin. Unlike for Type 2, scientists still aren’t sure why. They have found that some T1D patients share a particular HLA (human leukocyte antigen) complex, but in order for this to trigger an immune response, it has to be triggered by something else, like a viral infection. Because it takes years for the T-cells to completely destroy the beta cells of the pancreas, it can be hard to track.
But this theory checks out for me: I had a nasty virus as an infant, and was diagnosed with T1D 5 years later.
Managing T1D is incredibly difficult. Every variable of everyday life affects blood sugars, and interact with each other such that it’s nearly impossible to know what causes a high or low. Today, by blood sugar was 152 when I woke up, I ate 18 carbs for breakfast, gave 2.1 units of insulin, and remained steady through the morning. Tomorrow, I might wake up at 152, eat 18 carbs, give 2.1 units, and end up with a dangerous low in the middle of an important meeting.
Despite this, I am lucky. I have health insurance, allowing me to have technology that makes it more likely I’ll beat the odds. For the uninsured, the estimated cost of T1D is over $13,000 a year – and that’s just for the bare minimum. What are we doing for the people who need the 6th most expensive liquid on earth to survive, but can’t afford it?
The rise of the opioid epidemic nationwide has led to an increase of attention from both media and policy makers. Here in North Carolina, a recently passed policy is the Strengthen Opioid Misuse Prevention, or STOP Act, which aims to reduce the amount of Opioids prescribed a one approach to tackle the epidemic. The STOP Act was signed into law by Governor Roy Cooper on June 29, 2017, and since then its four stage implementation has been put into effect, which will continue until 2020.
The first step of implementation occurred almost immediately after the law’s passage, on July 1st 2017, requiring Physician Assistants (PAs) and Nurse Practitioners (NPs) to personally consult with a supervising physician. This applied to Pas and NPs at facilities that primarily engage in treating pain, and the prescription will, or is expected to, last longer than 30 days. Additionally, PAs and NPs have to consult with a supervising physician every 90 days for patients for are continuously prescribed opioids. Providers are also required to provide information on the disposal of controlled substances, both written and orally, when a patient concludes a course of treatment. The second aspect, implemented on September 1st, 2017, requires that pharmacies report targeted prescriptions to the North Carolina Controlled Substance Reporting System within a day of the prescription is dispensed.
The most recent aspect of the STOP Act was implemented on January 1st, 2018, and limits the amount of opioids prescribed for acute pain. Practitioners are not able to prescribe more than five days’ worth of any Schedule II or III Opioid or Narcotic, with an exception to things like pain after surgery, where the prescription cannot for longer than seven days. The final part of the law will be implemented on January 1st, 2020, and will require practitioners to electronically prescribed targeted controlled substances, with a few exceptions.
While it is still unclear what impact the law will have on overdose deaths in the state, it appears that the State government is attempting to address this issue. While more resources could be devoted to mental health services, naloxone access and syringe exchanges, and more programs geared toward injecting drug users rather than only those who use prescription drugs, it’s commendable that a joint effort was reached to combat this ongoing epidemic.
Chioma Ihekweazu is a recent doctoral graduate from our very own School of Media and Journalism here at UNC. Not only was I thrilled to see a kind peer’s work showcased in my newsfeed, I was also drawn in by her accurate criticism of how we talk about weight–obesity in particular.
She makes the very important point that while it’s not likely to hear patients who are suffering from cancer referred to as “cancerous” or “diseased”, it is quite common, even among respected news sources, to see the descriptor “obese people”. Chioma advises us to avoid playing into shaming language and “put the person before the condition”.
Please read her article here, though a few key takeaways are outlined below:
Avoid headless imagery (this is a form of shaming)–if needed, use non-stigmatizing stock photos
Recognize that weight loss is influenced by many factors–such as location, time, and access to food/physical activity
Do not use value-laden language; use “classes”, based on BMI, defined by CDC and NIH to talk about obesity
Have an appropriate headline
Report on facts
Chioma also provides some great examples and resources in her article, to not only help writers and reporters change their words, but also to recognize the flaws in our perspective.
2017 has been one for the books! Our country inaugurated a new president, two major hurricanes swept through the South, the first solar eclipse in a 100 years, the riots in Charlottesville, and most importantly the royal engagement of Prince Harry and Meghan Markle. In the health-related realm there were many notably scientific and policy advances that occurred this year. Here is my top 5 list of these occurrences.
US Federal Court requires tobacco companies to put out corrective statements about harmful health effects of smoking as a consequence for misleading the public about this through advertisements
First diagnosis of CTE in an alive patient (traumatic brain injury typically seen in football players)
First baby born from a uterus transplant
Development of a digital ingestion tracking system. This is a new technology with the ability to monitor drug adherence after the pill has been taken
Decrease in daily consumption of sugary beverages consumed by Americans since 2014
There were many more significant health-related achievements over this year. What is your top 5 list?
This past week, music sensation Lady Gaga revealed on her Twitter account that she has been battling fibromyalgia, and was recently taken to the hospital for severe pain, leading her to cancel one of her performances. While it may not have been easy to do, Lady Gaga’s decision to open up about her condition sheds an important light on the debilitating condition that is fibromyalgia.
According to the Centers for Disease Control, fibromyalgia affects about 4 million US adults. It is a chronic condition characterized by widespread pain and can include symptoms of fatigue, depression, and headaches that can negatively affect quality of life. While it is unclear what causes fibromyalgia, some possible risk factors include age, stressful or traumatic experiences, family history, and sex. According to the Centers for Disease Control, women are twice as likely to have fibromyalgia as men.
Treatment for fibromyalgia often involves a team of different health professionals, and can be effectively managed with a combination of medication, exercise, and stress management techniques.
Check out the following resources for more information about fibromyalgia and how you can get involved in raising awareness of this condition:
To understand whether or not your healthy, you have to first understand what it means to be healthy. It seems straightforward, but in the modern age, this is a complex question.
We might at first be inclined to think that being healthy means that you don’t have any illness or injury. But is this always true? What if you have an illness that is managed by medication? What if a person has a disability but the disability doesn’t disrupt their daily life? What if you’ve been diagnosed with pre-hypertension but have no symptoms?
Joseph Dumit, Director of Science and Technology Studies and Professor of Anthropology at the University of California, Davis, discusses various changes to our view of health and illness since the rise of the randomized control trial in his book Drugs for Life: How Pharmaceutical Companies Define Our Health (Duke University Press, 2012). He argues “that being at risk for illness is often treated as if one had a disease requiring lifelong treatments, drugs for life” (6).
Dumit discusses a few prediseases in depth, looking at pre-hypertensive, pre-diabetes, and borderline high cholesterol. “Literally, a disease-sounding syndrome is produced by correlating risk factors and naming it in such a way that it becomes common sense to think about treating ‘it’ as a disease in and of itself” (165). Hence, health becomes a matter of risk where we are all bodies constantly at risk of disease. If you have pre-diabetes, are you healthy? How do we understand our health in a risk economy of health?
This intersects interestingly with Donald A. Barr’s claim, in his book Health Disparities in the United States: Social Class, Race, Ethnicity, & Health, that despite investing so much of our economy in health, US health indexes rank rather low; “[p]erhaps, our basic assumption–that more health care will lead, necessarily, to better health–is flawed.”
CDC data estimates that 26.8% of families report significant financial burden due to medical costs (Cohen & Kirzinger, 2014) and this figure is expected to grow as insurance premiums, drug prices, medical procedures, and health facility overhead costs continue to rise each year. In addition, the aging US population is using more health services which drives everyone’s costs higher (Patton, 2015; Mitka, 2013).
Unfortunately, cancer is one of the most common and most expensive medical conditions. Cancer diagnosis, treatment, and rehabilitation are all lengthy, complex processes that require a variety of medical experts (Mitka, 2013). All of the visits, time, supplies, machines, therapies, medicines, personnel, etc. required adds to a patient’s out-of-pocket costs. (Zafar & Abernethy, 2013). However, there are not just monetary costs. Depending on the type and stage of cancer, thousands of dollars of lost wages can accumulate due to the time taken off from work to travel to appointments and receive treatments. This causes more financial stress on the patient because they are earning less income while their expenses are increasing (Zafar & Abernethy, 2013).
In the cancer community, the term financial toxicity has gained popularity. Financial toxicity refers to how the cost of a disease and its treatment impacts quality of life (University of Chicago, 2016), like how chemical toxicity effects health. Financial toxicity encompasses all aspects of wellness: physical, emotional, social, occupational, financial, and spiritual. Increased medical costs, and thus financial toxicity, is associated with decreased treatment adherence, worse patient outcomes, and lower self-reported quality of life (Shankaran & Ramsey, 2015; Zafar & Abernethy, 2013).
Financial toxicity should be treated as a symptom of cancer. Discussing personal finances in America is largely taboo, but this cultural norm should be challenged in the healthcare field. Doctor’s should assess the financial situations of their patients and use that information to help inform what the best mode of treatment will be (Shankaran & Ramsey, 2015). There are numerous ways to treat cancer and some are drastically more expensive than others. People may argue that the price tag of a treatment can never outweigh the price of life and that is valid; however, a health professionals must assess each patient’s priorities, both personally, medically, and financially to determine the healthiest individualized treatment path (Emanuel & Steinmetz, 2013; Shankaran & Ramsey, 2015). This does not necessarily mean that poor patients with receive cheaper and lower quality care. If a doctor is aware of a patient’s financial status, he/she can refer the patient to a hospital social worker who can assist in securing charitable funding or grant money to help pay for treatment (Shankaran & Ramsey, 2015). Until the issues of medical spending and insurance are solved, which will unfortunately not occur overnight, health professionals and patients must communicate more effectively to find the optimal comprehensive treatment to achieve the best overall quality of life for each individual (Emanuel & Steinmetz, 2013).
Cohen, R.A. & Kirzinger, W.K. (2014) Financial burden of medical care: A family perspective. NCHS data brief, no 142. Hyattsville, MD: National Center for Health Statistics.
Emanuel, E.J., & Steinmetz, A. (2013) Will Physicians Lead on Controlling Health Care Costs?. JAMA; 310(4):374-375.
Mitka, M. (2013). IOM Report: Aging US Population, Rising Costs, and Complexity of Cases Add Up to Crisis in Cancer Care. JAMA; 310(15):1549-1550.
Ramsey, S., Blough, D., Kirchhoff, A., Kreizenbeck, K., Fedorenko, C., Snell, K., Newcomb, P., William Hollingworth, W., & Overstreet, K. (2013) Washington state cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff; 10.1377/hlthaff.2012.1263.
Shankaran, V. & Ramsey, S. (2015) Addressing the Financial Burden of Cancer treatment from Copay to Can’t Pay. JAMA Oncol; 1(3):273-274.
Shankaran, V., Jolly, S., Blough, D. & Ramsey, S. (2012). Risk factors for financial hardship in patients receiving adjuvant chemotherapy for colon cancer: A population-bases exploratory analysis. J Clinical Onclology; 14:1608-1614.
Zafar, S.Y. & Abernethy, A.P. (2013). Financial toxicity, part I: A new name for a growing problem. Oncology; 27(2):80-149.