Now we know…

The Republicans have just floored their health care reform bill. You can read the details all over the internet. But it’s a disaster for rural hospital districts like ours. We have the oldest population of any county in the State and  rely heavily on Medicare reimbursement. We also have a huge poor population, which relies on Medicaid. Let’s just set aside the number of people who come to the food bank weekly.

Our reliance on  Medicare and Medicaid patients being reimbursed from the federal government at rates that make it worthwhile to do the work of caring for them, make it important not to lose what ground has been gained. Before Obamacare we were running a deficit that the taxpayers of this county paid for. Since Obamacare we are running a surplus. Not much, but not in the red. Now this. Who’s going to pay?The general attitude that I hear all the time from acquaintances and on the Internet is that they don’t want more taxes. The poor will come into the emergency rooms regardless if they are covered or not. But if the Feds don’t pay for them, it will be on us. You and I. Or the hospital could eventually close. Just ponder the words of a Kaiser Family Foundation study published in 2016 (JHC is  a 25 bed hospital):

In 2012-2013, rural hospitals had an average of 50 beds and a median of 25 beds. They had an average daily census of 7 patients and 321 employees, and they were 10 years old on average. Compared to urban hospitals, rural hospitals are more likely to be in counties with an elderly and poor population.9 According to The North Carolina Rural Health Research Program (NC RHRP) at the Cecil G. Sheps Center for Health Services Research, which tracks rural hospital closures, there were 72 rural hospital closures between January 2010 and April 2016, compared to 42 closures between 2005 and 2009, and since the 2008-2009 recession, the annual number of closures has increased each year.10 More than half of all rural hospital closures since 2010 were in the South and few Southern states have expanded Medicaid under the ACA.

http://www.kff.org/report-section/a-look-at-rural-hospital-closures-and-implications-for-access-to-care-three-case-studies-issue-brief/

The expectations are that we are in for some very hard times in the years ahead. It will take a lot of effort to keep our hospital running efficiently and staffed appropriately. Even now, we are having a hard time retaining quality medical staff even though we offer competitive salaries to Seattle, according to the hospital administration. Unfortunately, we have not done a great job at looking at foreign trained medical professionals, which are in wide spread use at Harrison and other nearby medical facilities. We also are behind the curve in the use of less expensive mid-levels, ARNPs and PAs. To the hospital district’s credit, the number of those mid-levels is up recently, probably due more to federal requirements and an inability to retain physicians, more  than anything else.

Perhaps if the Democrats win back the House and Senate and eventually the Presidency we can hope for fixes to this awful proposal which was created by a cabal of men behind closed doors. No women, even of their own party, were asked to work with them. It was despicable back room politics of the worse kind. They have even screwed their own constituents in places like Spokane and Wenatchee, as rural hospitals there are even farther from urban centers.  You have to wonder just who they represent? Or maybe we already know and this next four years will finally drive that home to their supporters in places throughout the rural west and south. Or maybe those voters and non-voters are so tuned into Fox News that they can’t connect the dots anymore.

We can only hope that we will get through the next four years without seeing a collapse of our hospital and the services it is offering, even though prices are already causing people who are aware of the high charges to drive closer into Seattle to seek competitive rates for services.

Now more than ever we need engaged, knowledgeable people in the role of Hospital District Commissioner, which is an election that is happening now. We don’t need a rubber stamp for the hospital district administration, we need deeply knowledgeable people who can roll up their sleeves and help, challenge the administration when needed and go advocate for the hospital district in the State and Federal arenas.

We need leadership from skilled medical professionals who have spent time in the trenches, understanding  both the issues of health care administration and the needs of our neighbors because they have sat in the rooms with these patients as they poured out their hearts to them about their medical conditions and their ability to pay for treatment or drugs. People who held them as they cried. Who may have given them free treatment rather than walked away. Who might have sometimes given them hard news. People who know what we have to fight for and can help guide the hospital district administration and our elected officials forward through this coming dark night.

American Cancer Society Journal Promotes Quackery

This article will no doubt shock some, especially in Port Townsend. Some thoughts first to help put context to it.

Dr. Stephen Barrett has been a tireless advocate for exposing fraud and quackery in the medical field. I have read his newsletter for years and have never found myself at odds with his opinions. I’m reposting this here not because I necessarily agree with his opinion on the ACS running this article, but because he points out some very valid questions. While I have witnessed cancer patients, including terminally ill ones, having alternative treatments and “feeling better” none of them that I witnessed ever changed the outcome from terminal to remission. And unfortunately, some of the people promoting these “therapies” are making very good money from promoting them. It is sad but true.

I personally agree with Dr. Barrett’s thoughts that if the therapy ‘makes the patient feel better’ and is not a burden on their families financial situation, then there seems to be no ‘harm’ done. But all too often these are presented as cures.

With that said, here’s the analysis by Dr. Barrett. I am underling what I believe are the key thoughts here.

The American Cancer Society (ACS) has published the Society for Integrative Oncology’s Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment in the May/June 2017 issue of CA: A Cancer Journal for Clinicians. The monograph, whose co-authors include three naturopaths and an acupuncturist, states that its “recommendations” should not be regarded as the standard of care but are warranted as “viable but not singular options for the management of a specific symptom or side effect.” (In other words, they have no effect on the course of cancer but might help some patients feel better.) The “therapies” include acetyl-l-carnitine; acupuncture; acupressure; aloe vera; ginger; ginseng; glutamine; guarana; healing touch; hyaluronic acid cream; hypnosis; laser therapy; manual lymphatic drainage and compression bandaging; massage; meditation; mistletoe; music therapy; reflexology; relaxation techniques; qigong; stress management; soy; and yoga.


In 2014, in response to an earlier edition of the guidelines, David Gorski, M.D., Ph.D., noted:

Treatments that are truly effective and safe do not need the training wheels of a title like “alternative,” “complementary,” or “integrative.” They will stand on their own to scientific testing and should not be used until they have.

The real purpose of the guidelines is to use an ostensibly critical analysis buying into the false dichotomy of “integrative oncology” in order to rebrand potentially science-based modalities as “alternative” or “integrative” and to provide ammunition for advocates of “integrative oncology” to start “integrating” quackery with science-based medicine. [Gorski D. Selling “integrative oncology” as a monograph in JNCI. Science-Based Medicine, Dec 1, 2014]

Tony Deleo calls for more candidates for hospital board

In a strange turn of events, it appears that hospital commissioner Tony Deleo is not going quietly into his retirement. After announcing he isn’t going to run again, and a great candidate in Cheri Van Hoover, a midwife and health care educator stepped forward, we assumed that Tony would endorse her. Instead he writes a letter to the editor calling for others to run against her, and word on the street is that someone is planning on filing against her. If Tony was hoping to go out with a pat on the back for his service, I’m afraid this is not going to help. Why he is uncomfortable with Cheri’s candidacy should be explained to those of us who respect his service, but wonder what is his problem.

Tony has overseen a number of decades where we have built huge wings to the hospital while running a deficit in primary care physicians. Jefferson County residents are being told the waiting list is up to 9 months to see a primary care physician. (I have talked to two just in the last month). Who does Tony think is going to do a better job than Cheri in helping to drive a solution for this problem?  This is a real question and not just a criticism.

Hospital Commissioner Tony Deleo Retires

The Port Townsend Leader is reporting that Tony Deleo has decided to step down after 44 years as Jefferson County Hospital Commissioner. This paves the way for Cheri Van Hoover to run unchallenged, but the filing deadline is still a few weeks away.

Why is this important? Given the impending changes to the health care system under Trump and the Republicans an activist board member is needed now more than ever. While Tony has done a great job over his many terms, it seems that Cheri Van Hoover is a much better fit for the needs of the public of Jefferson County today.

Thank you Tony Deleo for your service to this county! We know that you did it for the good of the community.

Washington state awarded $11M to battle opioid epidemic – KREM and others

Thank you President Obama. It was his administration that set it in motion and Trumps can’t deny that there is an Opioid crisis. Now the problem is what are we going to use for the millions of people in real pain who now can’t get opioids?

WASHINGTON STATE – Washington state is set to receive $11 million to combat the state’s opioid epidemic.

The money comes from a grant, totaling $485 million, awarded to states and territories by the Trump Administration.

The funding will be provided through the State Targeted Response to the Opioid Crisis Grants administered by the Substance Abuse and Mental Health Services Administration.

State passes law giving credence to reflexology and somatic education

The Washington State legislature has updated it’s RCW 18.108 to reflect state credence of the massage techniques of reflexology and somatic education. Both these methods have no basis in proven scientific methods of treatment, and are considered by some in the medical profession to be nothing more than fake medicine. It is disheartening to see the State legislature taking steps to legitimize these massage techniques that come with little or no proof of their ability to treat patients other than that the industry has come up with educational programs to train people in these techniques. While there seems to be nothing more than hearsay to validate their techniques, the legislature abrogates it’s duty to protect the public from non-scientifically valid procedures, and work towards giving these techniques and their practitioners a cloak of medical respectability.

According to information on Quackwatch.com, the leading source for tracking non-scientific health claims in the US:

Many proponents claim that foot reflexology can cleanse the body of toxins, increase circulation, assist in weight loss, and improve the health of organs throughout the body. Others have reported success in treating earaches, anemia, bedwetting, bronchitis, convulsions in an infant, hemorrhoids, hiccups, deafness, hair loss, emphysema, prostate trouble, heart disease, overactive thyroid gland, kidney stones, liver trouble, rectal prolapse, undescended testicles, intestinal paralysis, cataracts, and hydrocephalus (a condition in which an excess of fluid surrounding the brain can cause pressure that damages the brain). Some claim to “balance energy and enhance healing elsewhere in the body.” [2] One practitioner has even claimed to have lengthened a leg that was an inch shorter than the other. There is no scientific support for these assertions.

Reflexology was introduced into the United States in 1913 by William H. Fitzgerald, M.D. (1872-1942), an ear, nose, and throat specialist who called it “zone therapy.” Eunice D. Ingham (1899-1974) further developed reflexology in the 1930s and 1940s, concentrating on the feet [3] Mildred Carter, a former student of Ingham, subsequently promoted foot reflexology as a miraculous health method [4-6]. A 1993 mailing from her publisher stated:

Not only does new Body Reflexology let you cure the worst illnesses safely and permanently, it can even work to reverse the aging process, Carter says. Say goodbye to age lines, dry skin, brown spots, blemishes—with Body Reflexology you can actually give yourself an at-home facelift with no discomfort or disfiguring surgery [7].

You can read the whole overview by Dr. Barrett along with research studies that have been done that conclude that reflexology has no legitimate scientific standing.

http://quackwatch.com/01QuackeryRelatedTopics/reflex.html

Dr. Barrett’s conclusion: “Reflexology is based on an absurd theory and has not been demonstrated to influence the course of any illness. Done gently, reflexology is a form of foot massage that may help people relax temporarily. Whether that is worth $35 to $100 per session or is more effective than ordinary (noncommercial) foot massage is a matter of individual choice. Claims that reflexology is effective for diagnosing or treating disease should be ignored. Such claims could lead to delay of necessary medical care or to unnecessary medical testing of people who are worried about reflexology findings.”

Also from Dr. Barrett’s web site, the definition of “Somatic Therapy” that the state is tacitly supporting:

somatic therapy (somatic disciplines, somatic methods, somatics, somatic techniques, somatic therapies): Field that encompasses aikido, the Alexander Technique, applied kinesiology, Arica, Aston-Patterning, Awareness Through Movement, bioenergetics, Body-Mind Centering®, “Capoeria,” “Continuum,” CranioSacral Therapy, Eutony, Focusing, Functional Integration, Hakomi, Hellerwork, judo, karate, kundalini yoga, kung fu, “Lomi” (see “lomi-lomi” and “Lomi work”), “Oki yoga” (see “Oki-Do”), Process-Oriented Psychotherapy (process psychology), rebirthing, reflexology, Resonant Kinesiology, Rolfing, “Rosen work” (see “Rosen Method”), “sensory awareness,” SHEN, somasynthesis, tai chi, Touch for Health, Trager, “Trans Fiber,” yoga therapy, and Zero Balancing. “Subtle-energy elements” are a commonality of somatic therapies. Thomas Hanna, founder of the journal Somatics, coined the word “somatics.”

While I have no doubt that some of these techniques, such as Capoeria, Akidido, etc. are good exercise and lead to relaxation, by turning these into some kind of pseudo medical technique leads to people thinking it’s a treatment for a disease or condition that should be treated with proven medical techniques. It’s disappointing to see the Washington State Legislature give validity to these marketing tactics for these  techniques.

We can hope the Governor chooses to not sign this update to the RCW.