Colorectal cancer mortality


While breast and prostate cancer screening have come under fire in recent years, one bright spot in the prevention world has been colorectal cancer.  The incidence of the disease, already on the decline since the 1980′s, fell a further 30% during the last decade for Americans 50 years of age or older.

Why?  More colonoscopies.  The number of Americans who are up-to-date on recommended colon-cancer screening rose from 55% to 65% during the past decade.  The increase in screening has led to increased rates of detecting polyps, thus preventing future cancers.  In fact, increased screening has translated to a drop in deaths from colon cancer as well, falling 3% per year between 2001 and 2010.

Yet there is a lot of work to do.  Colon cancer remains the third most common cancer and the third leading cause of cancer deaths in the United States, after lung cancer and breast/prostate.  More than 136,000 new cases, and 50,000 colon-cancer deaths, are expected this year.

colon cancer screening


travel pet-peeves


I previously posted that I’ve been traveling a lot for fellowship interviews and commented on some of my travel habits and was curious if anyone else has any flying rituals.

Well, after traveling a lot, I’m feeling less than warm and fuzzy toward my fellow travelers and am now on to the things that drive me absolutely crazy.

  1. People slowly walking in the airport.  Um… hello!?  It’s an airport; people have places to go!
  2. The security line – the TSA doesn’t actually bother me at all.  Frankly if they are keeping me safe, I’m all for whatever you need to do.  What drives me crazy are the people in the security line who don’t realize they have to take their laptop and toiletries out and their shoes off.  All of which means that the security line takes long.
  3. The confused look on people’s faces as they try to find their seats.  Um… the seats are in numeric order…
  4. Passengers who put their coats in the overhead bin… immediately after the flight attendants ask passengers NOT to put their coats in overheard bins.
  5. Having to check your carry on baggage at the gate, and then discovering there is ample room in the overhead bins.

I’m sure there are more.  Feel free to chime in!

jerk of the week


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It’s no surprise that I’m not a fan of Michele Bachmann (R-MN).  Her misinformation regarding the HPV vaccine during the last presidential race pretty much destroyed her credibility for me as a physician and public health practitioner.  Her controversial opinions on same-sex marriage, the Constitution, and the President are really just adding more water to the sinking ship that is my taste for Bachmann.

And then… she became the jerk of the week.

During last week’s Conservative Political Action Conference (CPAC), Bachmann sat down with radio host Lars Larson and discussed the recent veto of Arizona bill SB 1062 by Governor Jan Brewer.  Bachmann wasn’t happy with Brewer’s decision and was quick to blame the gay community and LGBT activists for the downfall of the bill.  She states,

There’s nothing about gays in there. But the gay community decided to make this their measure.  I think the thing that is getting a little tiresome, the gay community, they have so bullied the American people, and they’ve so intimidated politicians. The politicians fear them, so that they think they get to dictate the agenda everywhere.

Yes, ladies and gentlemen, the LGBT community is a group of bullies, going out there stealing lunch money from the American people and scaring politicians.  The group as a whole is SO powerful that politicians are shaking in their boots, therefore the gay community can walk all over them.  No folks, the LGBT community are not a victimized minority but rather an intimidating minority dictating the political course of our country.

Which definitely explains why so many states were able to pass laws and constitutional amendments banning marriage equality.  And it definitely explains why Don’t Ask, Don’t Tell and the Defense of Marriage Act were done away with oh so long ago in our nation’s political…

traveling to the United States


I’ve been traveling around the country a lot recently for fellowship interviews, and all that travel got me thinking about vacations.  If you’ve ever been somewhere out of the United States, you’ve likely purchased a travel guide for your destination – something like Fodor’s, Lonely Planet, Frommer’s, or Rick Steeves.

If you’ve ever read these guides, you’ve no doubt noticed that they often warn Americans about some particular local customs, or to be “wary of pick pockets” even in the safest of European cities.

I’ve always wondered what a guide to the United States would say written from the perspective of a foreigner.  Well… I saw this on a friend’s Facebook timeline and I got a chuckle.

Here you go folks.  11 French Tips for Visiting America. I think #11 might be my favorite.

Haiti and the METI Project

Are you a health care professional who has an interest in international health?  Are you interested in improving medical care in Haiti?

Take a look at the great work being done by the METI Project.  You can read about the organization, the help, and the skills they are bringing to St Luke’s Hospital in Port-au-Prince.  Check out their blog to track the journeys from each of the METI teams that have already been to Haiti.

And if you are a RN, PA, PT or MD who would like to get involved, complete the online application here.

Kentucky Attorney General draws the line


Kentucky Attorney General Jack Conway was originally named as one of the defendants in the lawsuit contesting the state’s ban on the recognition of same sex marriages.  A federal judge in Louisville ruled four days ago that the state must recognize same-sex unions performed in other states.  Today, the governor of Kentucky announced he would be seeking outside counsel in order to appeal the judge’s ruling… because Jack Conway decided that he wasn’t going to.

You can read Jack Conway’s announcement below (lifted from his Facebook page).  I, for one, would like to applaud Mr Conway.

Statement from Attorney General Conway: 
As Attorney General, I have vowed to the people of Kentucky to uphold my duty under the law and to do what is right, even if some disagreed with me. In evaluating how best to proceed as the Commonwealth’s chief lawyer in light of Judge Heyburn’s recent ruling, I have kept those promises in mind.When the Governor and I were first named as the technical defendants in this lawsuit, my duty as Attorney General was to provide the Commonwealth with a defense in the federal district court, and to frame the proper legal defenses. Those who passed the statutes and the voters who passed the constitutional amendment deserved that, and the Office of Attorney General performed its duty. However, it’s my duty to defend both the Kentucky Constitution and the Constitution of the United States.

The temporary stay we sought and received on Friday allowed me time to confer with my client and to consult with state leaders about my impending decision and the ramifications for the state. 

I have evaluated Judge Heyburn’s legal analysis, and today am informing my client and the people of Kentucky that I am not appealing the decision and will not be seeking any further stays. 

From a constitutional perspective, Judge Heyburn got it right, and in light of other recent federal decisions, these laws will not likely survive upon appeal. We cannot waste the resources of the Office of the Attorney General pursuing a case we are unlikely to win.

There are those who believe it’s my mandatory duty, regardless of my personal opinion, to continue to defend this case through the appellate process, and I have heard from many of them. However, I came to the inescapable conclusion that, if I did so, I would be defending discrimination.

That I will not do. As Attorney General of Kentucky, I must draw the line when it comes to discrimination. 

The United States Constitution is designed to protect everyone’s rights, both the majority and the minority groups. Judge Heyburn’s decision does not tell a minister or a congregation what they must do, but in government ‘equal justice under law’ is a different matter. 

I am also mindful of those from the business community who have reached out to me in the last few days encouraging me not to appeal the decision. I agree with their assessment that discriminatory policies hamper a state’s ability to attract business, create jobs and develop a modern workforce.

I prayed over this decision. I appreciate those who provided counsel, especially my remarkable wife, Elizabeth. In the end, this issue is really larger than any single person and it’s about placing people above politics. For those who disagree, I can only say that I am doing what I think is right. In the final analysis, I had to make a decision that I could be proud of – for me now, and my daughters’ judgment in the future. 

May we all find ways to work together to build a more perfect union, and to build the future Commonwealth in which we want to live, work and raise all of our families.

Mental health and Medicaid



When the Medicaid expansion portion of the Affordable Care Act was put into place, experts and health policy wonks knew that the expanded insurance coverage for the poor wouldn’t only mean access to hospital based clinical care.  After all, nearly one in five uninsured Americans between the ages of 18 and 34 and making less than 138% of the federal poverty level suffer from mental health and substance abuse disorders.  In states that opt to expand Medicaid under the ACA, those people would be eligible for coverage that includes mental health treatment.

Unfortunately, states that decide not to expand Medicaid under the Affordable Care Act will leave more than 3.7 million Americans with mental illness without health-care coverage, and therefore out in the cold.

mental health coverage medicaid expansion

Medicaid expansion and lost money (and opportunities)


The Huffington Post yesterday pulled some data from the Commonwealth Fund about the amount of money going into Medicaid expansion.  As you may or may not know, the 2012 Supreme Court ruling on the Affordable Care Act (aka Obamacare) made Medicaid expansion optional for the states.  So far, 20 states have opted out of expansion (although a few are renewing their push to expand).

It turns out that rejecting expansion also means rejecting billions of dollars in federal funding.  Two of the states that would have benefited the most? Texas and Florida, who stand to lose more than $9 billion and $5 billion, respectively, by 2022.  If there was anything to make a political campaign on… this just might be one of them…MedicaidMap federal dollars lost if not expanding