proud of my alma mater (x2)

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opinion

This weekend marked the culmination of my graduate education as I accepted my Masters in Public Health degree from my undergrad alma mater, Boston University.  The university hosted its campus wide graduation ceremony on Sunday, with keynote speaker and founder of Teach For America Wendy Kopp and honorary degree recipients Morgan Freeman and Boston Mayor Tom Menino.

With nearly 6,700 graduates, Boston University’s commencement ceremony is the city’s largest each year.  On such a joyous occasion, President Robert Brown stopped and reflected on what has been a trying year for the university.  Since last spring, Boston University has lost 11 students in a series of tragedies including an apartment fire, a biking accident, and the Boston Marathon bombings.  Each of these tragedies struck hard for a large urban school that often lacks the sense of community feeling that is far more common for smaller colleges and universities with a backdrop of rolling green hills and ivy-covered halls.

I’m incredibly proud of my alma mater for awarding posthumous degrees to two of those students who would have graduated this year.  A world class move Boston University; classy indeed.

the days after the weekend

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someecards

haha… love this

overheard

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overread

“Um… that was a stop sign back there.”

“Yeah I know, I totally paused…”

“No… you did the South End shuffle.”

#truth

The arc of the moral universe is long, but it bends toward justice

The race for Boston mayor

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opinion

The race to become Boston’s next mayor is heating up quickly.  Two dozen candidates have announced bids to run for the position that Mayor Tom Menino will be leaving next year.  The next mayor of Boston will be one of the 24 people below who signed up for nomination papers,  but signing up for signature papers is a far cry from becoming an official candidate. Campaigns must gather 3,000 valid signatures by 5 p.m. May 21. Voters can sign multiple nomination papers, but a signature will only count for the first campaign that submits it to City Hall.

I’m certainly happy to see a healthy amount of minority representation among this crowd, although there is no Asian candidate – odd considering almost 10% of Boston’s population is Asian.  But more striking to to me is the three women out of 24 candidates.  Women account for 52% of the city’s population, and 30% of businesses in Boston are owned by women.  Are we fooling ourselves into thinking that women have made a lot of headway?  This field of candidates might suggest otherwise…

On a positive note, one of the lead stories in today’s Boston Globe is about some powerful supporters rallying behind Charlotte Golar Richie.

Lessons from our mothers

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family

This post is a little late for Mother’s Day but since my mom is flying into town tomorrow in order to watch me graduate with a Masters in Public Health, I figured it was still appropriate.

I am currently baking red velvet cupcakes.  Why you ask?  Because I’m going to a graduation reception/party Saturday afternoon following the graduation ceremony.  And clearly, I have to bring something.  I blame my mother.

You see, we all grow up learning little pearls from our parents, but I contend that our mother’s influence on our social graces far exceeds that of our fathers.  For example, my mother always said you can’t show up empty handed to a party that you were invited to.  Hence I’m baking cupcakes.  Could I have made something easier?  Sure, but it just so happens that the Boston University colors are red and white.  (Don’t judge me.  I can feel you judging.)

I don’t think my mother was forced to read Emily Post when she was growing up, but there are many other habits I have because of my mom.  For example, I always return the shopping cart (it happens to be one of my biggest pet peeves when people don’t – and yes, my mother’s biggest pet peeve too).  I always rinse dishes before they go into the dishwasher.  Many of my food and product purchases are from my mom; choosy moms choose JIF and so does this ginger, and Downy is the only acceptable fabric softener.

For better or for worse, she is the voice within my head.  And I suspect I’m not alone.  What social graces and habits have you picked up from your mothers?

Why Jolie’s announcement matters… and also why it doesn’t

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health policy and management, opinion

Angelina Jolie took the media by storm today when she announced in an Op-Ed piece in the New York Times that she had undergone a prophylactic bilateral mastectomy.  She made the bold decision after she discovered she tested positive for a gene mutation that increases the risk of breast cancer.

So why does this matter?  Well for one, women who carry these mutations have a highly increased risk of developing breast cancer.  The average woman has a 12% lifetime risk of developing breast cancer, while women who carry the same mutation as Jolie have about a 65 percent risk of developing breast cancer.  Women with the gene mutation are also at increased risk for ovarian cancer, and the breast and ovarian cancers they develop tend to be more aggressive than in women with an average risk for breast cancer.  Advocates for testing point out that knowing one’s mutation status can help make future treatment decisions.  Women of child-bearing age may decide not to delay pregnancy when they test positive for the mutations.  Surgical options for reducing cancer risk include the prophylactic bilateral mastectomy that Jolie chose as well as potentially removing the ovaries.  Regardless of any surgical options, women who test positive for the mutations are likely to undergo more frequent screenings for breast cancer including mammogram, ultrasound, or MRI.

Awareness is arguably the most critical piece of detecting and treating any disease; never underestimate the importance of getting the world out.  An announcement by a high profile celebrity does far more to instantly increase awareness than any foundation or charitable organization.  If you don’t believe me, just look to the media – Jolie’s story was instantly splattered across newspaper websites as well as Facebook, and Angelina Jolie is currently the top trend on Twitter.

But Jolie’s announcement requires a word of caution, as not everyone who is at increased risk will develop breast cancer.  Nor is testing appropriate for everyone.  As she points out, Jolie was at increased risk for the mutations since her mother was diagnosed with breast cancer prior to age 50.  However, most women with breast cancer do not have the BRCA mutations, nor do the vast majority of women in the general population.  While the BRCA genes (conveniently named BRCA1 and BRCA2) account for between 5 and 10% of all breast cancers, estimates are that only 0.11% to 0.12% of women carry one of the mutations.  Look at those numbers closely because that means that 99.88 to 99.89% of women do not carry the gene.  Clearly testing every woman in the United States doesn’t make sense, as the US Preventative Services Task Force has already correctly deduced.  The real question then, who should get tested?

According to the American Society of Breast Surgeons, only high risk individuals should be tested for BRCA1 and 2.  High risk is defined as a greater than 10% chance of cancer.  Patients with multiple risk factors or with borderline risk are often referred to genetic counseling for more information and guidance about testing and what the results mean.  More than one of the following risk factors is needed to achieve that 10% threshold:

1. early onset breast cancer (diagnosed before age 50)
2. two primary breast cancers, either bilateral or ipsilateral
3. a family history of early onset breast cancer
4. male breast cancer
5. a personal or family history of ovarian cancer (particularly non-mucinous types)
6. Ashkenazi (Eastern European) Jewish heritage in the setting of a newly diagnosed breast cancer or family history of breast cancer
7. a previously identified BRCA1 or BRCA2 mutation in the family
8. Early onset breast cancer (diagnosed before age 50)
9. “Triple negative” breast cancer diagnosed prior to age 60 (triple negative refers to three specific markers of certain breast cancer cells including ER, PR and Her2).

Part of why Jolie’s announcement doesn’t matter is that she is certainly not the first woman to undergo a prophylactic bilateral mastectomy.  Nor is she the first celebrity to undergo a double mastectomy; countless others have done so after a unilateral diagnosis of breast cancer, including Christina Applegate and Giuliana Rancic.  Nor is Jolie the first to do so for purely prophylactic reasons, although perhaps not as publicly.  Sharon Osbourne underwent prophylactic bilateral mastectomies last year due to a gene known to cause an increased risk of breast cancer, although it’s not clear if Osbourne carries a different genetic mutation from Jolie.

I could launch into the discussion of money and resources at Jolie’s disposal and how expensive the testing, and subsequent treatment, currently is.  But that could go on for days and will ultimately devolve into a discussion of whether one likes or hates Angelina Jolie.  But more importantly, that discussion degrades the understanding that this decision is faced by thousands of women, and it is a deeply personal decision.  The most important part of Jolie’s announcement may be that once testing is recommended, the decision to test or not is a decision that cannot be made for you.  Nor is it one to be made lightly; the results can be life changing and prompt consideration of the limited available options.  One needs to ask whether knowledge really is power and how that knowledge may permanently alter life’s course.

Land of 10,000 Lakes

Tags

family, gay

The Minnesota Senate today narrowly passed a bill for marriage equality by a vote of 37-30.  The bill was passed last week by the Minnesota House.  Minnesota’s governor Mark Dayton has already promised to sign the bill into law.

The passage of marriage quality in Minnesota is particularly striking since just 6 months ago, voters in the state were debating whether to amend the state constitution to ban same sex marriage.  During the November 2012 election, voters decided against amending the constitution.

Minnesota is the 3rd state this month to pass marriage equality legislation, following in the foot steps of both Rhode Island and Delaware.  Minnesota becomes the 12th state in the nation to affirm the importance of equal rights and marriage equality.

The next question is… will Illinois become the 13th?

Mondays are the worst

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someecards

good luck getting through Monday… every week

Happy Mother’s Day

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family, holidays, someecards

well duh!

overheard

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overheard

“Honey, why aren’t all plumbers gorgeous?”

“Not everyone can be pretty like us.”

Maxim Hot 100

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opinion, ridiculous

I know, this isn’t a topic I normally would post about, but after hearing the top 10 list of Maxim magazine’s 100 hottest female celebrities, I couldn’t help but post.  I mean, who came up with this list exactly?  The fact that both Selena Gomez (#2) and Taylor Swift (#13) beat out someone like Sofia Vergara (#49) is ridiculous.  I’m also a little disturbed by the fact that the oldest woman of the top 10 list (Jennifer Love Hewitt) is only 34.  The youngest btw is 20.

1. Miley Cyrus
2. Selena Gomez
3. Rihanna
4. Mila Kunis
5. Jennifer Lawrence
6. Jennifer Love Hewitt
7. Ashley Tisdale
8. Kate Upton
9. Vanessa Hudgens
10. Elisha Cuthbert

Thoughts?

Angry? Yes. Surprised? Not at all

Tags

health policy and management, opinion, ridiculous

Five different people emailed me regarding the New York Times article about the vast differences in hospital billing to Medicare.

The revelation that hospitals charge vastly different prices shouldn’t surprise you.  For one thing, I’ve commented on this before – here, here, and again here.  (seriously, what have you people been reading?)  Part of the problem is the historical underpinnings of the ways hospitals used to be paid, much of this is due to the fee for service payment system that continues to dominate American healthcare.  But the fact is, we’ve allowed the system to operate this way by championing free markets and allowing hospitals to run like businesses.

Quite frankly, hospital charges are not based on a solid foundation of cost nor are they based on quality of care provided.  There is little to no evidence to support that costs or quality are the basis for what hospitals charge.  Furthermore, when hospitals negotiate with insurers for reimbursements, those negotiations are considered trade secrets;  an insurer cannot tell hospital B what it is reimbursing to hospital A for the same service.  Similarly, hospital X is under no obligation to tell insurer Z what insurer Y is reimbursing.  As the article states, it truly is a cat and mouse game between hospitals and insurers.  And the game is only expected to get worse as hospitals merge and combine into large systems in order to form “accountable care organizations” or ACOs under the Affordable Care Act.

You might think that price transparency might be a solution to this dilemma.  Make hospitals report their prices and that should fix the problem, right?  Patients would naturally switch to lower cost providers, and high cost providers would be forced to lower their prices, regressing toward a new lower average price.  Makes sense…that’s how competition works so this should work, right?  Wrong.  In 2007, New Hampshire did just that after health officials noticed huge variations in the hospitals prices within the state.  Not only did the tactic not work, it had the opposite effect.  Patients had little incentive to shop based on price as those with insurance rarely saw the bills.  Many of the hospitals in the state are in isolated geographic areas and therefore experience little to no competition from other hospitals.  Even more concerning, the lowest reimbursed hospitals raised their prices to match their well reimbursed competitors.  The hospitals regressed toward a new mean price, but that new average price was now higher, not lower.

Some in the health policy community use this evidence to advocate for a single payer system with universal insurance as the only solution to this problem.  Others suggest we adopt payment setting similar to the Maryland all-payer system (you’ll notice that none of the data comes from Maryland).  I’ll admit I’m not a huge single payer fan for too many reasons to details here, but Medicare is about the closest thing we have to a single payer in this country.  As the largest single nationwide insurer, Medicare is in the unique position to provide a stabilizing force to the wide variations (you could argue that the Veterans Administration does this as well, but the VA both finances and delivers care, while Medicare merely finances it.)  But with a myriad number of private insurers out there, the “single payer” Medicare effect gets diluted.

The thing is, the Centers for Medicare and Medicaid Services (CMS) looks at the hospital bill, laughs, and then says “here’s what we’re going to pay you”.  The payment is formula based – a base price is set based off of what CMS thinks the average cost of the provided service is and then multiplies that by certain factors such as geographic location, severity of illness, teaching status, etc.  To be fair, there are a lot of factors, but ultimately CMS arrives at a reimbursement which is much less than what the hospitals charge.  So in reality, even though two hospitals across the street from each other taking care of two patients for the exact same condition with the exact same illness severity might charge CMS widely different prices, CMS will reimburse them almost the same amount.

The most important section of the NYTimes article is in fact this one:

Medicare does not actually pay the amount a hospital charges but instead uses a system of standardized payments to reimburse hospitals for treating specific conditions. Private insurers do not pay the full charge either, but negotiate payments with hospitals for specific treatments. Since many patients are covered by Medicare or have private insurance, they are not directly affected by what hospitals charge.

Experts say it is likely that the people who can afford it least — those with little or no insurance — are getting hit with extremely high hospitals bills that may bear little connection to the cost of treatment.

Steven Brill made this exact point in the TIME magazine commentary “Bitter Pill – Why Medical Bills are Killing Us”.  The fact of the matter is, very few people pay those ridiculously high prices, because almost everyone negotiates a lower rate.  But if you are one of those people paying out of pocket, uninsured or with little insurance (what we call underinsured), you should be angry.  Because the price of your care (and therefore the cost to you) may have been dramatically different if you had simply crossed the street.  And don’t for a minute think that the higher price means better quality.  In fact, crossing the street might mean that the quality of that care may have been better too.

Only two types of people use pagers…

Tags

health policy and management, opinion

… doctors and drug dealers.  And I’m guessing even drug dealers have replaced the pager with the pre-paid cell phone.

A new study reveals that not only is pager technology use in health care archaic, it is actually costing the industry billions of dollars.  Physicians and nurses working in hospitals waste an average of 46 minutes a day when they use beepers to exchange information about patients, rather than modern alternatives like texting on smartphones.  That 46 minutes a day adds up… to the tune of more than $8 billion annually for hospitals.

Pagers are still the most commonly used form of communication in hospitals because they are considered more secure than mobile phones, ensuring that doctors and nurses are in compliance with HIPAA.  But replacing pagers with secure text messaging would be an easy solution – allowing doctors and nurses to communicate with technology they already have on them, their personal phones.  The time reduction?  Evidence suggests that patient discharge times could degree by 50 minutes.

Given the rise of mobile phones and healthcare apps, it’s only a matter of time before these communication dinosaurs go extinct – the question is how long will it take and why hasn’t it happened sooner?  I suspect that the next generation of physicians will be the ones to permanently make the switch.

what a jerk

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opinion

This guy may win the award for jerk of the week.  Apparently, he thought it would be funny or cute to display a sign reading “Toronto Stronger” at Game 3 of the Bruins-Maple Leafs playoff series.  You can imagine that the reaction from Bostonians, Americans elsewhere in the country, and some Canadians was less than pleasant.

Incidentally, the Bruins beat the Maple Leafs in Game 3.  So who’s stronger now?

Happy Nurses Week!

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ridiculous, someecards

From one doc to all of the nurses out there, a collection of someecards for Nurses Week!

12 First Date Deal Breakers

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opinion, ridiculous

This story appeared yesterday on The Huffington Post, and I couldn’t help but share.  Christine Gallagher details the twelve things you should never discuss or reveal on a first date.

I happen to agree with most of these, but I’m curious what people think about #3.  Is it really NOT okay to talk about your dog or cat at all during the date?  Yes, clearly there is a danger zone in going overboard, but mentioning you have a dog or cat?  Really?

Btw, as a pescatarian, #5 could be incredibly important – especially if that first date is at a restaurant.  I don’t mind if my date eats steak or pork or some other meat for dinner – but there are a lot of vegetarians/vegans out there who do.  Might be good to know that in advance.  Just saying…

12 Things to Never Mention on a First Date

1. The ex. It’s best not to vomit up what went wrong in your last relationship. If you do, your date will be sure to pick up any information about how you might behave in a relationship with him or her. So zip it. Never share the details, particularly the gory ones, until you know each other a whole lot better.

2. Your finances. There’s a lot of talk right now about people being financially strapped — there’s even a new sitcom about a divorced woman living with her parents. But it’s not sexy, okay? Again, let’s hope that you are so stunning in other ways that your date doesn’t give a damn and is more than happy to sneak in through your childhood bedroom window if things get that far. But don’t count on it. It’s best to tread softly when you reveal financial woes.

3. Beloved pets. Nothing is more unappealing than listening to a new date express undying love for their pet. Keep the iPhone photos to yourself. Don’t share pictures of Fido at the doggie Easter egg hunt. If you have more than two cats, never share that information until you’re on more solid ground. And don’t say you can’t ever have a sleepover because your cat or dog can’t be left alone. As for deceased pets you had in childhood, let them rest in peace.

4. Physical ailments. This is especially important for hypochondriacs. Trust me — only your doctor is interested in a history of your ailments and injuries. And if you have any suspicious rashes, particularly on hidden parts of your body, don’t tell your date, okay?

5. Special diets. If you subscribe to a restricted eating lifestyle, don’t discuss it at length. You may come across as boring, dogmatic or worse. Vegans should go easy, particularly if their date is happily cutting into a big juicy steak. Eccentric eating preferences should also be handled carefully. I once had a date with someone who revealed they only ate white food. I still can’t articulate why, but this was an immediate total turnoff.

6. Your brilliant children. All of us are crazy about our kids.  We think they’re incredibly talented and adore their quirky behavior, but a total stranger has absolutely no need to know the details. Of course, do reveal you have kids. Mention their ages. Then move on.

7. Sexual practices. A first date is never the time to discuss what you like or don’t like in bed. If you have a bag of sex toys in your closet, don’t share. Don’t, under any circumstance, talk about past lovers and their talents and preferences.

8. You don’t like sex. You may get lucky and be dating someone who feels exactly the way you do. But it’s not likely, okay? So save this tidbit for later.

9. Unusual habits. This is a very broad category.  It could be something benign but potentially off putting — like your kids still sleep in a family bed with you, or you have a side business providing custom pet funerals. If you have a hard time gauging if your habits might be “unusual”, ask a candid friend for feedback.

10. Your porn addiction. Okay, so you’ve been single for a while and spending evenings in fantasy porn land. But now you’re out in the real world with a real person. You don’t have to share.

11. Arrest records. Any arrest, even if you were deemed innocent, should not be revealed upfront. It will raise big-time red flags and scare away a lot of people. Same goes for IRS problems, foreclosures, disciplinary hearings etc.

12. How miserable and lonely you are. Chances are your date is equally miserable and lonely, but it’s still a big turnoff and should be kept for your therapist. For your date, put on your best face and keep it in the light zone. And who knows? Maybe a sliver of magic will pass between you.

Misery loves company?

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someecards

Isn’t it comforting to know that while you are suffering at work on Monday, billions of other people are as well?

Boston AIDS 5k Run and Walk 2013

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workout

so it’s that time of year again…

For those who don’t know, I will be running the Boston AIDS 5K Run on June 2nd in order to raise money and awareness of HIV/AIDS.  Some of you may be asking why and thinking that HIV/AIDS is a thing of the past.  Fact: every 11 minutes, someone is newly diagnosed with HIV in the United States, and nearly a quarter of those new infections are among people between the ages of 13 and 24.

Since 1999, new diagnoses of HIV in Massachusetts have gone down by an astounding 53%, translating into less than 650 new HIV diagnoses in Massachusetts per year.  As a result, 5,700 people have remained HIV negative, and $2 billion in HIV related health care costs have been saved.  But with all the success achieved throughout the past several decades, funding cuts threaten to undermine the very programs that keep countless men, women, and children alive.

I’m running because I care, because this is an issue that is important to me.  Because people’s lives are at stake. Because with all the success, there is still much more work to be done.

To donate, visit my page.  Many companies also match gifts!  Remember, every little bit counts.

Cinco de Mayo

Tags

drinking, holidays, someecards

If only I wasn’t at work…