Tuesday, February 26, 2013

Getting "Madder and Madder" About Health Care is Not Enough

"Bitter Pill" author Steven Brill on the "The Daily Show"
By Rajiv Mehta
CEO & Founder of Unfrazzle

As I watched Jon Stewart interview Steven Brill on "The Daily Show" last Thursday evening, I identified with one of Jon Stewart's comments. He said that as he read Brill's epic article "Bitter Pill" in TIME magazine he got "madder and madder each page." 

That was my reaction exactly. In fact, I had to put the article down several times just to regain my composure.

And I still can't quite absorb it.

I was already aware of the terrible economics of our health care system and the fact it is anything but a free market. The insurance companies, as much as it is easy to dislike them, are not in fact the primary "bad guys."  The doctors also are generally not the ones getting rich, though they have been primarily responsible historically for getting us into this mess as laid out by Paul Starr is his Pulitzer Prize-winning The Social Transformation of American Medicine

Brill is correct, the hospitals, private and especially "nonprofit" are the real culprits. His analysis is spot-on. How can anyone defend the price mark-ups that Brill found?

And yet, as Brill notes, these executives and their hospitals are held in high esteem in their communities.  When forced to respond, these executives can and will defend their business practices as being good business, as creating jobs, as being good for their communities, as creating the "best hospitals" for their regions in the ways "best" is currently defined.

What frustrated me the most about "Bitter Pill" are Brill's suggested solutions at the end. They're technocratic solutions, not likely to be adopted because they won't inspire the public to demand them and will be strongly lobbied against by the industry, and would unlikely have much impact anyway.

What do we actually want?

I wish Brill had gone further, and forced us to ask basic questions of what we actually want from our healthcare system.

One of the leading health economists, Princeton professor Uwe Reinhardt, put his finger on the basic problem in a 1997 essay "Wanted: A Clearly Articulated Social Ethic for American Health Care," in which he said:
"Throughout the past 3 decades, Americans have been locked in a tenacious ideological debate whose essence can be distilled into the following pointed question: As a matter of national policy, and to the extent that a nation's health system can make it possible, should the child of a poor American family have the same chance of avoiding preventable illness or of being cured from a given illness as does the child of a rich American family?
The 'yeas' in all other industrialized nations have won that debate hands down decades ago, and these nations have worked hard to put in place health insurance and health care systems to match the predominant sentiment. In the United States, on the other hand, the 'nays' so far have carried the day."
To put it starkly, Reinhardt is basically pointing out that we as a people fundamentally don't care if the poor, if "someone else", can't afford good healthcare. We have regular bouts of public agonizing about the consequences of our crazy healthcare system, but we also don't want to address the fundamental problem.

A faithful reflection

A decade later, Reinhardt was asked by New Jersey Governor Jon Corzine to lead a commission to recommend what the state could do to rationalize its health care resources. They came up with various suggestions, but Reinhardt added a long personal letter to preface their final report. The letter concluded:
"In short ... the extraordinarily expensive, often excellent and just as often dysfunctional, confused and confusing American health system is a faithful reflection of the minds and souls making up America's body politic. ... Alas, no Commission can provide a complete blueprint for a truly rational health system ... until the citizens of this country reach a politically dominant consensus on a more logically consistent set of preferences for their health system ... Until that happens, any attempt at 'health reform' will always degenerate into mere tinkering at the margin ..."
If we as a people reach the same conclusion as the rest of the civilized world -- that every single one of us deserves good care -- then it is already well known (by people like Professors Reinhardt and Starr) what we need to do.  The "right solution" comes in many flavors but boils down to these items:

  • Everyone physically inside the U.S. should have access to healthcare services with only modest fees.
  • This insurance should be run as a cost-plus business with 90-95% passed through to pay for actual treatment, the remaining to pay all insurance overhead and expenses, including salaries.
  • There should be a universal price list for all treatments, drugs, procedures, etc., and it should be transparent. No need to shop around, no haggling over prices, no surprises.
Every other advanced country has such a system. Beyond these three issues the systems vary considerably -- some totally run the government, some almost completely private (private insurance companies, private hospitals, private doctors) -- tailored that country's mindset and historic circumstances. 

A great and very readable tour of the many different system employed in other countries is describe in T. R. Reid in The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care.

Each of the players in our system feels he's doing the right thing -- it makes "good business sense", it's not illegal, etc. -- though the net result is awful.

So, I wish Brill had put more passion into helping people envision a better future, something we can really put our energies into. His meticulous presentation of the problem was wonderful, but it is not enough. 

READ these related stories from Unfrazzle:

Monday, February 25, 2013

Facts from "Bitter Pill," TIME's Blockbuster Cover Story

Percentage of the gross domestic product Americans spend on health care, nearly double that of most developed countries. In every measurable way, the results are no better and often worse.

Next 10 Biggest
Americans spend more on health care than Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain and Australia.

$60 Billion
Price tag for cleaning up after Hurricane Sandy and also U.S. weekly health care bill.

25% to 75%
Overcharge Medicare pays for durable medical devices like canes and wheelchairs as mandated by Congress.

Of New York's 18 largest private employers, eight are hospitals and four are banks.

Total compensation paid to Ronald DePinho in 2012. DePinho is President of MD Anderson, a medical center which is part of the University of Texas.

Total compensation paid to William Powers, Jr., in 2012. Powers is President of the entire University of Texas system.

The Bureau of Labor Statistics projects that half of the 20 fastest growing occupations in the U.S. by 2020 are related to health care.

$5.36 Billion
Amount spent on lobbying in Washington since 1998 by the pharmaceutical and health-care-product industries, combined with organizations representing doctors, hospitals, nursing homes, health services and HMOs.

$1.53 Billion
Amount spent on lobbying since 1998 by the defense and aerospace industries.

$1.3 Billion
Amounts spent over the same period by oil and gas interests.

$2.8 Trillion
Americans will spend this much on health care during 2013.

$750 Billion
Amount Americans would save if we spent the same per capita amount on health care as other developed nations.

$800 Billion
Medicare and Medicaid bill for 2013 which keeps rising faster than inflation and the gross domestic product and which drives the federal deficit.

10-to-15 a day
A typical piece of medical equipment will pay for itself in one year if it carries out this number of procedures a day.

7-to-10 years
The expected life span of medical equipment. Combine this fact with the one above and the result is medical tests become highly profitable.

Health care providers in the U.S. conduct this percentage more CT tests per capita than Germany.

$2.586 Billion
2012 revenue of the Montefiore Medical Center, a large nonprofit hospital in the Bronx.

Montefiore Medical Center's revenues is this times as large as the Bronx's most famous enterprise, the New York Yankees.

$4,065,000; $3,243,000; $2,220,000; and $1,798,000
Salaries paid to Monteifiore's CEO, CFO, Executive VP and head of the dental department, respectively.

Percentage of personal bankruptcy filings each year in the U.S. that are related to medical bills.

$2.5 million
Amount paid in 2012 to Marna Borgstrom, CEO of the Yale New Haven Health System.

$1.6 million
Amount paid to Yale University's president.

Average hospital profit on nonemergency outpatient care, which compares to only 2% for inpatient care.

$34 Million
Operating profit from most recent tax return (2011) of Oklahoma City unit of Sisters of Mercy hospital based revenues of $337 million after paying 10 executives more than $300,000 each including $784,000 to the regional president.

$319 Million
Operating profit of Mercy branch in Springfield, Missouri (pop. 160,660) on revenues of $880.7 million.

The actual percentage costs of charity care for the entire Mercy Health chain based on revenues of $4.28 billion.

$800 Million
Amount the four dominate manufactures in the hip-and-knee-replacement industry paid to 6,500 "physician consultants" from 2002 through 2006.

$70 Billion
Estimated amount Americans will spend on lab tests in 2013.

$25 Billion
Amount of over-ordering and overpricing in the above bill.

Doctors' urology groups with their own labs who bill Medicare analyze this many more prostate tissue samples per biopsy while detecting fewer cases of cancer than their counterparts who send specimens to outside labs.

Percentage of physician practices owned by hospitals in 2012, up from 22% 10 years before, primarily a move to increase the hospitals' leverage in negotiating medical bills with insurers.

As mandated by Congress, Medicare determines the price it pays for drugs by first determining the average market price of the drugs and adding this percentage. Congress prohibits Medicare from negotiating for better prices.

$20 Billion
Estimated amount Medicare will pay for cancer drugs in 2013, up from $11 billion in 2004, $3 billion in 1997.

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Friday, February 22, 2013

TIME for Us to Rise UP Against Absurdly High Health Care Costs?

                      Steven Brill Discusses his TIME cover story 

Why does health care cost so much? Can anyone explain the irrationality of the health care system?

In a blockbuster cover story for TIME magazine, journalist and entrepreneur Steven Brill traces 8 hospital bills to find out "whose getting what money, whose making the profit."

How did we get to a place, he asks, where hospitals charge their patients $77 for a box of guaze pads that cost $1 at the neighborhood drug store?

How can a hospital charge you thousands of dollars for a CAT scan that costs them nothing?

Why are the poorest people who don't have health insurance charged the most?

Why didn't the Affordable Care Act (Obamacare) do anything to address these costs, which are driving so many Americans into bankruptcy?

If you haven't already bought this issue of TIME magazine you can read Steven Brills's article online for free.

After reading the article, if you are outraged like I am, I urge your to call or email your Representative in Congress and your U.S. Senators. 

To find your Representative's email address, click here

For U.S. Senators, click here

--David Bunnell

Wednesday, February 20, 2013

French Film "Amour" Explores the Dark Side of Aging and Death

"Amour" stars legendary actors Jean-Louis Trintignant and Emmanuelle Riva
When Michael Haneke's French language masterpiece about life, deteriorating life and inevitable death was screened at the Cannes Film Festival, where it won the top prize, there was an eerie silence at the end of the screening. People didn't react right away.

Jean-Louis Trintignant told Le Monde newspaper he was convinced the film was a "huge flop."

Problem was the festival-goers were overwhelmed. It took time before they regained their composure and gave the director and actors a standing ovation.

When I recently saw "Amour" at my neighborhood theater, there was no one there to clap for at the end, so the audience, myself and my wife Jackie silently shuffled out the door, all of the us lost in our own thoughts. There was none of the usual chatter you hear after movies. 

To break the tension, I said to the manager, "you should provide drinks to people after watching this."

There was a moment or two of comic relief in the film. However, its heroic portrayal of the loving, orderly world of George and Anne Laurent, both retired piano teachers, whose lives are brutally disrupted when Ann, played by Emmanuelle Riva, has a stroke and another stroke, is mostly stark and tragically honest.

As I sat watching the Trintignant character, George, attend to the ever more demanding needs of his wife, I began to worry about myself and my wife--how might our lives unfold?

When George first pushes Anne around the apartment in her wheelchair and helps her get in and out of bed, I am confident I would be up to this task and my wife would do the same for me. 

Life for George and Anne after the first stroke is demanding, but manageable. 

Ann is paralyzed on one side, but she can sit up in bed and read, she can talk and while she no longer plays Schubert on the piano she sings along with George to the child's song, "Sur Le Pont d'Avignon."

But then out the blue she expresses her wish to die. She mades him promise never to send her again to the hospital (and by implication to an assisted living facility, nursing home or hospice.) 

Anne desperately wants to live out the rest of her days at home.

And then she has her second stroke. She is totally bed-ridden, can't even turn over without assistance, and only with great effort can she mumble and barely be understood. 

George's caregiving tasks become more overwhelming. When he hires a nurse to come by three times a week I wonder if I would be able to afford this. When the nurse shows him how to change Anne's diaper and how to give her a shower, I really start to worry. 

In a horrible moment, George strikes Anne across the face because she persistently refuses to eat. Would I lose my cool in a similar situation? 

As Anne deteriorates, I notice George is also in decline. The slight limp he had earlier on becomes more pronounced. He hallucinates and has difficulty standing.

Anne and George have a daughter Eva but she is too wrapped up in her own life to be much help. When she comes to visit she only gets in the way. 

If need be, would one of our daughters help us? 

On our way home, Jackie says at least we have each other, but wonders about her women friends who live alone. Who will care for them, she asks.

One of these very friends called Jackie the next day. She too had just seen "Amour" and was completely beside herself, depressed, in a state of despair. They talked on the phone for about an hour. 

"Amour" was nominated for an Oscar as the Best Picture, Haneke as Best Director, and Riva as Best Actress, the oldest actress to be honored this way. Trintignant should have been nominated too. 

"Amour" deserved to win Best Picture and was my choice but had little chance. It did pick up the Oscar for Best Foreign Language Film, so that's something. 

Regardless of winning awards or not, "Amour" will live on. It will wind up as one of the great films of this century because better than any other it portrays what it can really be like to get old and die. 

--David Bunnell

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Monday, February 18, 2013

Eldercide on the Rise?

Left uncared for, will more elders turn to suicide?

It makes sense the suicide rate of older people is higher than the rest of the population. In the U.S., people over 65 account for 12 percent of the population but about 20 percent of the suicides.

Declining health, depression, loneliness, and financial difficulties are some of the obvious reasons. 
Seems understandable, but a February 18th article in The New York Times, "As Families Change, Korea's Elderly Are Turning to Suicide," is alarming and has implications for seniors in the U.S. and other parts of the world.

In South Korea the number of people 65 and over committing suicide has recently quadrupled making the country's rate of such deaths the highest in the developed world. And this grim situation is happening at a time when the South Korean economy is booming. 


For centuries, Korean families have functioned according to the "Confucian social compact" whereby, among other things, aging parents lived with their eldest son's family and if they didn't have a son, they adopted one from a relative.

Because of this tradition, the South Korean government has been reticent about providing pensions or welfare to its older citizens based on the notion they will be cared for by their families.

In South Korea, the law actually denies welfare to people whose children are deemed capable of supporting them.

As the South Korean economy grows, as people move from rural areas to cities, and as the western lifestyle takes hold more and more younger Koreans are reluctant to take on the burden of caring for their parents.  

In turn, more and more parents are committing suicide.

Mostly ignored, this problem came to light in a dramatic fashion when a 78-year-old widow staged her death by drinking pesticide in front of the city hall where she lived after government officials stopped her welfare checks. 

In my opinion, in highly competitive societies, the Ayn Rand "virtue of selfishness" concept prevales among too many people who are intensely focused on getting ahead.  

Helping others becomes secondary, even when it's our parents. 

The  competitive effect in South Korea has been more profound than the U.S. because we have Social Security and Medicare. Our laws don't assume the children of aging parents will provide them with all the care they need.

But the political battle over the deficit and the explosive growth of our senior population is putting tremendous strains on our ability to care for our aging citizens.  Professional caregivers are harder to come by and in many communities we are even experiencing a shortage of doctors and nurses. 

As the number of people with serious aliments like Alzheimer's rises, the cost of caring for them rises as well.  

This is to say nothing about the relentless drumbeat of right-wing Republicans to cut what they call "entitlements." 

If Social Security and Medicare are cut and if nothing is done to address the shortages and inflation in healthcare, the pressures on older people will increase--the screws will get tighter and tighter.  

We too will see an alarming growth in eldercide.

--David Bunnell 

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Thursday, February 14, 2013

Preparing to get Alzheimers: "If the Monster wants You, the Monster is going to get You"

Alanna Shaikh's dad was diagnosed with Alzheimer's in 2005. Still alive, he needs help getting dressed, help eating and he doesn't know where he is. 

This has been very hard on Alanna and on other family members.

As she says in this touching video from the 2012 TEDGlobal Conference, there are 35 million people globally living with dementia and this number is expected to double by 2030.

Alanna is doing all the things she knows about to prevent Alzheimer's. She's eating the right foods, exercising and keeping her mind active. But she knows that research shows nothing will 100 percent protect her and that Alzheimers tends to run in families.

So Alanna is also preparing for the worst. As with all of us, there is a possibility she too will get Alzheimer's. She puts it this way, "If the monster wants you, the monster is going to get you."

Based on what Alanna's learned from taking care of her father, she's focusing on three areas: (1) building up her physical strength and balance, (2) changing what she does for fun and (3) trying to become a better person.

Over 380,000 people have watched Alana's TED video so far, but this is not nearly enough! 

If you worry at all about getting dementia, you should watch this and learn from it, which is why we are posting it here.

About Alanna Shaikh

TED Fellow Alanna Shaikh is a global health and development specilist with a vendetta against jargon. On her blog, Blood and Milk, she aims to make global development issues both accessible and understandable. In her TED Book, What's Killing Us, she explains the biggest challenges in global wellness -- from HIV/AIDS to the diminishing effectiveness of antibiotics -- in a way that anyone can understand. Earlier this year, she co-founded AidSource, a social network for aid workers. She is also the co-founder of the group SMART Aid, which educates donors and start-up projects about international aid.

Alanna Shaikh is especially interested in Alzheimer's, as she has watched her father deteriorate from the disease over the past 12 years. But she says the experience has not sent her into denial—she plans to be prepared for the genetically transmitted disease, should it ever arrive.

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Wednesday, February 13, 2013

Crime of the 21st Century

75% of elder fraud victims do not report the crime
By Robin Roth

Financial exploitation of older adults is becoming the crime of the 21st century. 

The growing population of 
aging boomers along with exponential growth in technology is fueling this billion-dollar industry. Since the beginning of 2011, financial fraud has exceeded $20 billion dollars, affecting many thousands of victims – and these statistics only reflect reported crimes. Elders represent a disproportionate percentage of the fraud victims. 

During the next 15 years, 20% of the American population will be over 65 years old. As the aging population accelerates, so will financial exploitation.

Why are elders targeted?

Older adults are targeted because many have financial reserves (pension, house, savings) and may be 
vulnerable in many key areas: dementia, loneliness, maintaining independence, and lacking technological sophistication. For example, old age dementia may render the victim unable to handle simple financial matters, let alone being able to comprehend complicated investment vehicles. 

In telemarketing scams, lonely elders are preyed on to buy products they don’t need in exchange for talking to “someone nice” on the other end. Many times older victims will not report the crime out of fear they will appear to be incompetent, which may result in being placed in an assisted living facility. 

According to the Attorney General Eric Holder, 3-out-of-4 (75%) of financial fraud victims over 55 years old will not report the crime.

Types of scams

Financial exploitation can take many forms. The following are more commonly perpetrated against

     • Healthcare and insurance fraud
     • Counterfeit prescription drugs
     • Funeral and cemetery scams
     • Fraudulent anti-aging products
     • Telemarketing, internet fraud
     • Investment scams
     • Reverse mortgage scams
     • Sweepstakes and lottery scams
     • The grandparent scam

Who are the perpetrators?

Surprisingly, financial exploitation of elders is not only perpetrated by scam artists, but more 
frequently by family members. 

According the Metlife’s report “Broken Trust: Elders, Family, and Finances,” 55% of fiscal exploitation is committed by someone the victim knows: family member, caregiver, friend, or neighbor. Economic instability has created financial hardships, and for some, a perfect justification for taking money from older family or friends.

My goal

My goal is to fight elder fraud. These predatory practices have to stop. Currently, financial exploitation of the older people is “under-reported, under-recognized, and under-prosecuted.” 

About Robin Roth

Robin has an unusually diverse background and is always coming up with new ideas. She supported herself as a professional drummer while getting a BA in Economics and Research Psychology at Mills College in Oakland, California. In a few months she will complete her MBA in Finance. Previously, she was an IT Operations and project manager for SBC Internet Services. 

Robin's latest venture involves combining her experience and connections in business, music, and technology to develop a “one stop shop” for executives to learn how to play drums, perform live shows, and record songs for iTunes. She volunteers with Centro Community to help empower entrepreneurs grow their businesses and consults with small businesses helping them pursue new entrepreneurial ventures. She is also passionate about the issue of elder fraud and publishes articles on her blog at www.elderfraud.net.


If you suspect elder abuse, neglect, or financial exploitation, Click Here for Robin's article on the steps you can take to gather evidence, establish what kind of fraud is being committed and where to report it. 

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Tuesday, February 12, 2013

What's that You Say? The Correlation between Deafness and Dementia

My mother's deafness began when I was 12-years-old. She would have been 41.

At first is wasn't too problematic. She would say, "can you repeat that?" or "can you speak louder." Most of her difficulty was with people who mumbled or with words that weren't correctly enunciated.

But as the years went by, her hearing deteriorated. She learned to read lips. As long as you looked directly at her, she seemed to get the message. This was a good thing, because she worked part-time as a clerk at Howard's Shoe Store in our hometown of Alliance, Nebraska.

During my high school years, I couldn't help but notice my mom quit going to church with my dad and she no longer enjoyed movies or playing bridge with the neighbors. She was gradually becoming socially isolated and I imagine lonely.

Often she was paranoid that people were talking about her.

In particular, she thought the people who worked with my dad, who was the editor of the local newspaper, were making fun of her when they were simply laughing at someone's joke. This made her bitter and she refused to go to Christmas parties or other events held for the newspaper employees.

Mom Becomes Forgetful

By the time I was in college, Mom was wearing a hearing aid and looking into a cochlear implant which she got for one of her ears but not the other. She continued to work at the shoe store, but gradually she became forgetful and the store gave her fewer and fewer hours.

My mom was never diagnosed with Alzheimer's or dementia, but she clearly had this disease. When my dad was sick and in the hospital in 1999, she wandered off from the house and they found her across town, lying on the sidewalk with a broken hip.

After hospitalization, my brother and I put Mom into a nursing home. I lived in San Francisco so I couldn't come out to Nebraska that much, but the first time I went to see her she didn't know who I was.

"Who are you?" she asked. I told her I was her son, David Bunnell.

"If you're David Bunnell," she replied, "take me home right now."

After My Father Died

When my dad died on December 28, we arranged to transport mom to the funeral parlor to view his body. Sitting in a wheelchair she stared at Dad for a few moments, and then with a audible sigh she simply said "Oh" and we knew she recognized him and knew what had happened.

I think Mom realized with Dad's death she would never go home again. For years, he had been her caregiver, making all her meals, helping her get into and out of the bathtub, making sure she didn't leave the house alone. There was no else in the family to fill the void.

A few months later, I got a call from the nursing home. "Your mom passed away," they said. She was doing well, they said, and then she just didn't wake up.

Here it is 13 years later, and today I read in The New York Times Science section that research by an otolaryngologist and epidemiologist at John Hopkins School of Medicine, Dr. Frank Lin, and colleagues, found a strong association between deafness and dementia.

The Worse the Hearing Loss, the Greater the Risk

"Compared to individuals with normal hearing, those individuals with a mild, moderate, and severe hearing loss, respectively, had a 2-, 3- and 5-fold increase risk of developing dementia," Dr. Lin wrote. The worse the hearing loss, the greater the risk.

From the article, I learned the social isolation that comes with hearing loss and which was very much a factor in my mom's case, is a known risk factor for dementia.

In a way I'm relieved to know about the correlation between hearing loss and dementia because my hearing is fine. Since I didn't inherit my mom's hearing problems, I probably won't inherit her dementia. My brother on the other hand, has the same hearing problems my mom had. He has plenty to worry about.

The best advice for my brother and for other people with hearing loss is to invest in a really good hearing aid, not one you buy off the internet, and get it checked frequently. 

Click here to read The New York Times article, "Straining to Hear and Fend Off Dementia."

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Sunday, February 10, 2013

Dementia: The 8-Minute Film that took 5 years of a Broken Heart to Make

Tommy Whitelaw is a fulltime caregiver for his mom, Joan, who has dementia. He describes the disease as a "cruel and all encompassing condition," one that affect the lives of 82,000 in his country, Scotland.

Tommy has made it his mission to raise awareness of dementia. In 2011, he walked across Scotland to meet people who have similar experiences with dementia. He visited workplaces, football teams and met with politicians...but most of all he collected letters and emails from people who are caring, just like him.

"Dementia" is a sad and wonderfully informative film. The shots inside empty football (soccer) stadiums bring home the enormity of dementia and the letters bring home the impact it has on not just the victims but the family caregivers, whose lives, like Tommy's, have been changed forever. 

A few of the quotes that touched me most:    
  • "I look after my husband, the husband I lost, he's not really my husband anymore."
  • "I am the mother figure and Ian is the child, instead of being husband and wife."
  • "I woke up in the morning and my wife asked me who I was."
  • "She can't remember my dad, the man she loved for 44 years."
I urge everyone to watch this film. It only takes 8 minutes. 

Note: If you're a caregiver for someone with dementia, and you'd like to share your story with Tommy, email it to tommy@i-woz-there.com

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Thursday, February 7, 2013

Caregiving can be a Waiting Game

                                    Highland Hospital, Oakland, California
It's been 2 years since our son-in-law Charles, then age 49, was diagnosed with stage 4 rectal cancer. We were lucky he qualified for Medi-Cal because he didn't have health insurance. 

Being a Medi-Cal patient meant that he had to seek treatment at the nearest "safety net" hospital, which turned out to be Highland Hospital in East Oakland. 

Highland Hospital is the location of the award-winning documentary film, "The Waiting Room," which was released in 2012 and is still showing at theaters in the U.S. and Canada. 

Every day, an average of 250 new patients, most of them uninsured, pour into Highland where they are told to take a number and wait to be called. 

When there is an influx of trauma patients, which happens often mostly due to Oakland's high rate of gun violence, the waiting time can stretch into hours and hours and hours.

Still, Charles has received extraordinarily good care at Highland. His oncologist, Dr. Stephen Yee, M.D., is one of the world's best. The saintly staffers in the cancer center where Charles goes for chemotherapy every other week are amazingly cheerful and supportive--especially so, considering the drab, windowless environment.

My wife, Jackie, has gone with Charles to every single chemo appointment where she sits next to him and reads. There are short sessions of only a couple hours and long sessions which can last six hours. 

Getting meds at Highland is logistically challenging as you have to physically pick up the prescriptions from Dr. Yee's office and delivery them by hand to the pharmacy. At the pharmacy they tell you the prescription will be ready in a few hours or the following day. And, by the way, the pharmacy is closed on weekends.

Jackie makes sure Charles gets his meds, takes them as prescribed, and keeps track of them so they don't wind up scattered all around his apartment. Jackie does a million other things, too, and she can't wait for Unfrazzle to be released. 

Our biggest complaint about Highland Hospital isn't the waiting, or the flux of humanity, the shortage of staff, or lack of modern technology...it's the parking. Parking at Highland can be very challenging, especially when the parking garage is full, which seems to happen any time past 10 a.m.  For this reason, I often drive Jackie to Highland and drop her off so she can run inside to pick up a prescription. I drive around the block for 20 minutes and then take her back home. The whole trip takes about 90 minutes. 

The story of Charles and his care is complicated, sometimes sad, but there have been some happy moments as well. Over time, I'm planning to tell more of this story, so please stay tuned. 

Read The New York Times review of "The Waiting Room" here.

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Tuesday, February 5, 2013

4 Steps to a Stronger Heart

The advice for becoming more "heart healthy" may sound familiar: Lose weight, quit smoking, watch your cholesterol and exercise regularly. Yet heart disease remains America's biggest killer, taking more lives than accidents and cancer put together, according to the American Heart Association.

Many people still think of heart disease (particularly heart attacks) as something that mostly affects men, but it is also the number one killer of women. The American Heart Association points out that cardiovascular disease claims the lives of five times as many women as breast cancer.

Because February is the American Heart Association's Heart Health Awareness Month and in solidarity with the Health and Human Service's Departments "Million Hearts" Initiative to prevent one million heart attacks and strokes over 5 years, we're publishing the following "4 Steps to a Stronger Heart" which was originally created by Dr. Frederic Vagnini and David Bunnell for ELDR magazine.


ELEVATED CHOLESTEROL is a risk factor, but not the only one. 

Coronary artery injury, inflammation, hypertension, blood viscosity, insulin resistance, obesity, CHRONIC STRESS, smoking, and POOR AEROBIC CAPACITY are also factors. 

Work with your doctor or cardiologist to establish your risk. Know your total cholesterol, LDL (bad), and HDL (good) numbers. Be aware that optimal LDL is 100 milligrams per deciliter or less, and optimal HDL is 60. For every 1 percent
decrease in total cholesterol, your chances of having a heart attack decrease by 2 to 3 percent. Know your triglyceride number: Below 150 is desirable. 

Ask your doctor to check your homocysteine and C-reactive protein numbers as well as your fibrinogen levels. Know what your BLOOD PRESSURE is and what it should be. Be aware that 25 percent of CVD can be attributed to obesity, and work toward achieving your optimal weight. If you are OBESE, don’t be in denial, as you are three times more likely to have high blood pressure, four times more likely to have diabetes, and twice as likely to die from heart disease. 

Consider a progressive TREADMILL TEST to check your aerobic capacity. Ask your doctor about a HEART SCAN and other tests.


Dr. Frederic Vagnini says, “Three things cause a heart attack: shoveling snow, a fight with your spouse, or an IRS audit,” and he has a point.

UNBRIDLED STRESS causes surges in heart rate and blood pressure, increases in cholesterol and homocysteine, artery-wall inflammation, constricted arteries, heart rhythm irregularities, and increases in blood clotting. People with type-A personalities have a risk of heart attack five to seven times greater than people with type-B. 

Take time out every day to RELAXLearn to BREATH DEEPLY. Try MEDITATIONLearn to reserve judgment. don’t worry about things you have no power over. Be positive. Take a walk. Get plenty of SLEEPDevelop Resiliency. 

If none of these things work, get some therapy.


If you completely ignore every other piece of advice in this poster, don’t skip this one. 

AEROBIC EXERCISE—when you increase your heart rate up to 60 percent to 80 percent of its capacity for a sustained period of 30 minutes or more, three or more times a week—will strengthen your heart and IMPROVE your entire circulatory system. 

It will also increase HDL cholesterol while lowering LDL cholesterol, lower your blood pressure, REDUCE your resting heart rate, improve the efficiency of your heart’s ability to pump blood throughout your body, reduce the risk of blood clots, decrease body fat, lower blood sugar, improve sleep, elevate mood, raise your metabolism, lessen the risk of depression, and make you feel fantastic.
Studies show that people who attain cardiovascular fitness through exercise reduce their risk of a heart attack by 50 percent—more than the best cholesterol drugs can accomplish. About 70 percent of what we think of as normal aging is actually just a result of inactivity.


If you can’t eliminate the following items from your diet, CUT DOWN drastically on them: sugar, white flour, saturated fat (including red meat, cheese, and dairy), trans fat, fast food, fried food, excess salt, French fries, corn syrup, ice cream, other desserts, and starch (including potatoes, white rice, and grits).

Know that consumption of more than one glass of wine or beer or one mixed shot of hard alcohol per day will raise your blood pressure. Eat more COMPLEX CARBOHYDRATES, fresh vegetables and fruit (particularly berries), oatmeal, fish, beans, soy, nuts (especially almonds and walnuts), seeds, low-fat yogurt, olive oil, dark chocolate, garlic, ginger, chili flakes, green chiles, flaxseed, tofu, wild rice, seaweed, and green tea. 

Take OMEGA-3 supplements, antioxidants (including vitamins C and E, selenium, alpha lipoic acid, and curcumin), and the minerals magnesium, potassium, and chromium. Try RED YEAST RICE to lower cholesterol before going on statins. Consider L-carnitine, Coenzyme Q10 (CoQ10) and nattokinase. Check with your doctors about these supplements and, importantly, about a low-dose daily ASPIRIN. Take good care of your teeth and gums.

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