A More Beautiful Life

Not to get all Martha Stewart, but author Mary Callahan had this up on Facebook today, Save Food From the Fridge.

Fridges are big, and energy suckers too. For keeping things cold, they’re great. But for the default food storage? Maybe not. Especially when so many things taste so much better at room temp.

Seems like unwisdom to congeal in the fridge and zap in the microwave. I use my ambient defrosting system (countertop) when I can plan that far ahead. But knowing what’s safe to leave at room temp means getting involved with your food. Maybe a good idea.

I’m on track to screw up the latest weight loss study (not really, they have a mathematical way to screen out the total fails), due to I can’t get started.

I’m reading, Born Round, by Frank Bruni.

Frank Bruni was set up by heredity to crave food and pack it on. His secret–I’ll spoil it– was more exercise and smaller portions. How he got to that point is the interesting part. His book is a love letter to food, fast and slow, haute and low.

So how to get on track, and not a joyless track, is my weight loss challenge.

Women’s Issues and Female Trouble

My state senator is Rhoda Perry. I first knew her as executive director of Thundermist Health Associates– the network of primary care clinics that was founded by volunteers operating out of a triple-decker in Woonsocket. I like her politics, she is a neighbor and an unpretentious, decent person.

I always vote for her, but I like to hear all sides, so in 2004 I attended the debate between Rhoda and her opponent, Barry Fain.

The candidates were cranking along, neither one charismatic enough to make me forget how uncomfortable it is to sit in a folding chair in a church basement. Then it happened.

Barry Fain– making a point that he was the more well-rounded candidate, said that Rhoda was alright on women’s issues, like birth control. He faltered as the audience gasped. I think he knew instantly that he had stepped in it. Rhoda won the election by a wide margin.

That Sunday I ran into Barry Fain when we were both buying newspapers from a guy who sold them out of the back of his car Elmgrove Avenue.

“I saw you and Rhoda” I said.

He shook his head, “That was a brutal debate.”

I laughed to myself. I admire Rhoda Perry, but a brutal debater she is not.

“Mr.Fain”, I said, “I’m not in any position to criticize someone for saying something they wish they hadn’t. I’ve said a lot of things I would say differently if I had a chance. But I am concerned about your plan to cut taxes.

I work, and pay property tax. It’s not my biggest concern. I earn decent money, I can go out to eat, I don’t worry about being able to pay my bills. We’re on Elmgrove Avenue. A few blocks over is Camp Street. People there are struggling. Are you going to cut the safety net give a little extra to the well-off?”

He was non-committal on that, I don’t think I was part of his base.

When he made that remark about birth control, for a moment I felt like I’d been slapped. Slapped back to the recent past when women had a place, and it wasn’t a place in our State House.

Birth control is being put back in its place of female troubles and ladies unmentionables–too indecent to include in wholesome health promotion. It’s a luxury, a vanity expense, a shameful indulgence.

I recall the women of my childhood, worn out from multiple pregnancies, wearing hand-me-downs. The harsh-tempered men, struggling to support their families. It’s not to say that there wasn’t love and happiness too, but few would choose that life given other options. Women and men alike sacrificed to raise their children. Family planning is not just a ‘women’s issue’.

How many children to have, whether to have children at all, when to have children– there aren’t many more important decisions we will make.

In other health decisions– controlling blood pressure, getting exercise, avoiding smoking– we do public education to engage the community in taking care of themselves.

It’s bizarre to single out one important aspect of health care for segregation and de-funding, when there is no public good in promoting unintended pregnancies. Why are we doing it?

Because it’s a women’s issue. Slightly shameful, a female trouble and serves her right. It’s a poor woman’s issue. We can’t be paying for birth control when taxes need to be cut. And those women aren’t the base, anyway.

We had a saying in the second wave of the Women’s Movement– ‘Sisterhood is Powerful’. And there is a vast potential energy in women and men crossing lines and finding common ground. It’s a short walk, after all, from Elmgrove to Camp.

The Religious Right and the conservative activists of the Catholic Church have taken their stand, to support an interpretation of religious liberty that lets religions take liberties with nonbelievers. This is not resistance to change. This is an expansion of organized religion as a political power. I think it’s an over-reach. But it’s discouraging to have to fight these battles again.

Gain a Child, Lose a Tooth

Pregnancy and childbirth are profound events in the life of women and families, no less physically than spiritually.

‘Gain a child, lose a tooth’, even in 2007, the New York Times Science section concludes that there’s some truth to this old saying.

A recent poll shows that a majority of Catholics support including birth control in health insurance coverage.

I suspect that many Catholics have some firsthand knowledge of the toll repeated pregnancies can take on a woman who is beyond her best physical health or a family that is stretched beyond its means.

Do we really want to limit birth control? To put an extra financial burden on the poorest women? Would it be a better world if women had ‘as many children as God gives them’? Was it a better world for women and children when choices were few and contraception unreliable?

Some of us remember those days, exhausted mothers and families in constant crisis. Yes, it was common for women to lose their teeth to poverty and the strain of repeated, close together pregnancies.

All decisions have consequences. The decision to limit childbearing affects women, families and society. Can we trust those women and families to make that decision? If not, who should we trust?

Gov. Howard Dean Continues to Talk Sense

This past Saturday, February 4, former governor of Vermont and 2004 presidential candidate Dr.Howard Dean spoke at the Providence Public Library for the kickoff of ‘Shape Up RI’.

He was introduced by Brown graduate, Dr. Rajiv Kumar, founder of ‘Shape Up RI’. Dr.Kumar said, “I was a Deaniac, knocking on doors in New Hampshire for Governor Dean’s presidential campaign. Howard Dean had a commitment to health care for all Americans as a human right, and we are the only industrialized nation not providing that care.”

Howard Dean, author of ‘Howard Dean’s Prescription for Real Healthcare Reform: How We Can Achieve Affordable Medical Care for Every American and Make Our Jobs Safer’ was a passionate advocate for health care reform during his tenure as governor of Vermont, and left the state with near-universal health care coverage for pregnant women and children under 18, a model for the country. Vermont is also a model for affordable health insurance for adults.

Howard Dean started with thanks to the bipartisan effort to engage Rhode Islanders in taking charge of our health. He was realistic about the challenges, “it’s incredibly hard from a medical perspective to lose weight.’ but optimistic about our capacity to improve our health “we have an empowered generation on the internet.”

He was critical of the present state of health care, “we have an illness-based system, not a wellness-based system. If you want to focus on preventive care in the present economy, “you are swimming upstream against your wallet. Instead of fee-for-service we have to have a different way of doing this–an incentive to create wellness. Accountable Care Organizations (ACO) vertically integrate care. Financial incentives are beginning to align with wellness.”

Howard Dean took a heavy political hit for his plain-spoken advocacy for universal access to health care. He was at times critical of the ‘Affordable Care Act’ (known by its opponents as Obamacare) for not going far enough, particularly in failing to provide a public option as an alternative to private insurance companies. At Providence Public, he defended the Act as a move in the right direction toward universal health care. He noted that the Affordable Care Act is modeled on MassHealth, which covers 98% of Massachusetts citizens.

Dr.Dean spoke about end of life care and advance directives, and addressed the ‘death panel’ slur that clouded the debate. “Seniors fear loss of control of their dying process. Most will want to die at home.” He said that the seniors who want ‘everything done’ can have their wishes respected, that we have the means to provide that care for those who choose it. I have worked in geriatric care for about 30 years and the vast majority of patients I’ve talked to want to maintain the power to tell their doctors when to stop. The current system will ‘do everything’ unless there is a document or responsible person to say otherwise. That is the reason for an advance directive. “The answer is not rationing–it is to change the incentive to reward wellness. It is to return power to patients at really important parts of their lives.”

Dr.Dean continues to bring common sense and decency to a debate too often muddied by partisan politics.

If our wealth is our people, we cannot continue to waste health and lives by denying health care, especially preventive care, to those who need it the most.

About a hundred people came to hear Dr.Dean speak on Saturday, we’ll continue to hear his message, because this is the future of health care.

Amputations Bad–Public Health Good

If you spend a lot of your working time nagging people to keep their blood sugar under control and to take good care of their feet you will appreciate this. From the Centers for Disease Control…

CDC report finds large decline in lower-limb amputations among U.S. adults with diagnosed diabetes

The rate of leg and foot amputations among U.S. adults aged 40 and older with diagnosed diabetes declined by 65 percent between 1996 and 2008, according to a study by the Centers for Disease Control and Prevention and published today in the journal, Diabetes Care. The age–adjusted rate of nontraumatic lower–limb amputations was 3.9 per 1,000 people with diagnosed diabetes in 2008 compared to 11.2 per 1,000 in 1996. Non–traumatic lower–limb amputations refer to those caused by circulatory problems that are a common complication among people with diabetes rather than amputations caused by injuries.

The study, “Declining Rates of Hospitalization for Nontraumatic Lower–Extremity Amputation in the Diabetic Population Aged 40 years or Older: U.S., 1988–2008,” is published in the current online issue of Diabetes Care.

The study also found that among people with diagnosed diabetes in 2008, men had higher age–adjusted rates of leg and foot amputations than women (6 per 1,000 vs. 1.9), and blacks had higher rates than whites (4.9 per 1,000 vs. 2.9). Adults aged 75 years and older had the highest rate – 6.2 per 1,000 – compared to other age groups.

The study authors note that improvements in blood sugar control, foot care and diabetes management, along with declines in cardiovascular disease, are likely to have contributed to the decline in leg and foot amputations among people with diagnosed diabetes.

Awesome. This kind of progress comes from educating the public, engaging health care workers, and lots of government involvement. And everyone knows that it’s better to have legs than not. I see that up close all the time.

When I started out as an aide in a nursing home, back in the mid-80′s, bedsores were common and the general attitude was just beginning to shift from ‘nothing can be done’ to ‘we’d better do something or Medicare is going to whack us.’ It’s no longer routine or accepted that people get bedsores, and the people I see now who have them tend to be very immobile or paralyzed. It’s a terrible problem that is best prevented. But prevention required a big investment of labor and an attitude adjustment. The payoff comes later.

I gotta run to work, I have lots of people to nag. Have a nice day.

Good News Break

Strange weather. The first snowfall hit while the leaves were still green, and this second one late in January. We could get buried before Spring gets here. The Occupation continues, not much noted in the ProJo, though the Boston Globe has covered the negotiations for a homeless day center. Until the ten-year plan to get housing for everyone is complete, people need to be able to get out of the cold and off the streets.

It’s still the dark of the year, and I need to write about some dark things, but first a little good news–

India is about to mark a year without polio…

India, which was once a major polio hotspot, has reported no new cases of the disease in just over 12 months, ever since a two-year old female case on 13th January, 2011, in the state of West Bengal. According to WHO (World Health Organization), India used to be known as the planet’s “epicenter” of polio.

WHO scientists say that as soon as all remaining lab investigations come back negative, India will be officially recognized as a nation that has stopped indigenous transmission of wild poliovirus, leaving just three countries with existing indigenous transmissions – Pakistan, Nigeria and Afghanistan.

If you’re old enough to have a smallpox vaccine scar, or to have peers who got the worst of polio– paralysis and deafness– then you know what a blessing this is.

Good news in the US as well, homicide has dropped off the list of top 15 causes of death. And that’s not all…

—The infant mortality rate dropped to an all-time low of 6.14 deaths per 1,000 births in 2010. It was 6.39 the year before.

—U.S. life expectancy for a child born in 2010 was about 78 years and 8 months, up about a little more than one month from life expectancy for 2009.

—Heart disease and cancer remain the top killers, accounting for nearly half the nation’s more than 2.4 million deaths in 2010. But the death rates from them continued to decline.

Deaths rates for five other leading causes of death also dropped in 2010, including stroke, chronic lower respiratory diseases, accidents, flu/pneumonia and blood infections.

The American body politic needs a checkup and a gym membership– and we could knock these mortality figures down further. But at least we’re not killing each other off as much, and our infant mortality rate is decreasing. According to the CIA world factbook, In 2011 we were just about even with Croatia, just behind New Caledonia, Hungary and Cuba. Gotta call that progress.

That our country is making improvements in reducing mortality when our economy is such a mess is a sign of hope. Some good people in public health are doing their jobs right. Thanks, guys.

Forks over Knives and Portlandia

No, they’re not really related, but both are great viewing material. Forks over Knives is sobering and reminds us all to eat our vegetables. Portlandia is just plain hysterical — skits riffing on all the outrageous people in Portland and beyond. BTW, the Mayor of Portland portrayed in the skits has an uncanny likeness to Linc Chafee. He is seen bouncing on his exercise ball, working on his “core” while chatting with young musicians about writing a song to promote about Portland.

Here’s the trailer for Forks and Knives:

Like, Duh

Stop the presses! This just in from Yahoo News. Incredibly, lack of health insurance keeps people from getting care–Diabetes Care Thwarted by Unstable Health Insurance: Study

Among patients with continuous insurance, 48 percent received at least three lipid-screening tests during the three-year study, 25 percent received three or more flu shots, 72 percent received three or more blood glucose screenings, and 19 percent underwent three or more screenings for kidney damage.

Patients with interrupted or no coverage received far fewer of these preventive health services, the investigators found.

“Our study shows that patients need continuous health insurance coverage in order to ensure adequate preventive care, even when that care is provided at a reduced cost,” study author Rachel Gold, an investigator with the Kaiser Permanente Center for Health Research in Portland, Ore., said in a Kaiser Permanente news release.

Even if consigning our fellow citizens to blindness, amputation and early death is the right thing to do in Aynrandia, it’s very bad for the USA. Diabetes, for unclear reasons, is now an epidemic. If the disease were not so ubiquitous and gradual people would be more afraid of it. If mercy is not a word we are allowed to use in political arguments, consider enlightened self-interest. Preventive care today can keep people healthy and working. Neglecting public health leads to suffering and depletes our national strength.

World AIDS Day 2011

Education, Empowerment, Prevention

Our generation has seen the global eradication of one devastating disease, Smallpox, and the emergence of another, Human Immunodeficiency Virus. HIV has been uniquely merciless in its reaping of the young and the healthy in their prime, in its mutations and transformations into a thousand awful ways to die. It was almost two decades into the pandemic before there was a glimmer of hope, with the synthesizing of effective antiviral medications.

After so many lost and so much deepening despair, there is some bright news. The same treatments that save lives reduce the risk of transmission. Although we do not yet have medications that eradicate the virus, we have medications that reduce the viral load. These medications, when used correctly, not only save the lives of those infected, but reduce the incidence of infection between partners and from mother to baby.

This development makes the ambitious goal of ‘getting to zero’ more than a wish.

“Getting to Zero”: UNAIDS Milestones For 2015

Zero vertical transmission and a 50% reduction in AIDS-related maternal death
A 50% reduction in the sexual transmission of HIV
No new HIV infections among drug users
Universal access to antiretroviral therapy for people living with HIV
who are eligible for treatment
A 50% reduction in deaths caused by tuberculosis for people living with HIV
Improved national social protection strategies and access to essential care and support for people with HIV and households affected by HIV
A 50% reduction in the number of countries that have punitive laws and practices around HIV transmission, sex work, drug use or homosexuality that block effective responses
A 50% reduction in the number of countries with HIV-related restrictions on entry, stay and residence
The HIV-specific needs of women and girls are addressed in at least half of all national HIV responses
Zero tolerance for gender-based violence

Social justice is integral to fighting an epidemic on this scale. Prevention is vital. The growing list of effective medications does not change the fact that HIV is a terrible disease that currently has no cure. All the ‘safer sex’, education, vigilant infection control in medical care still stands. In fact, it matters even more, now that we have a hope that this pandemic may finally be defeated.

AIDS Project RI is offering free rapid HIV testing today.

The rapid HIV test is done with a mouth swab with results on the same visit, another small piece of good news. No blood draw, no waiting weeks to find out.

More information may be found at www.aidsprojectri.org, by calling 401-831-5522, or emailing takecharge@aidsprojectri.org.