Saturday, September 12, 2009
Wednesday, September 9, 2009
And yet, many of the lawmakers who argue that the health care reform legislation is "too costly" are the same lawmakers who supported the Bush tax cuts. Their own voting record demonstrates that health care reform is not a matter of costs, but a matter of priorities.
And yet, many of the lawmakers who argue that the health care reform legislation is "too costly" are the same lawmakers who supported the Bush tax cuts.
Their own voting record demonstrates that health care reform is not a matter of costs, but a matter of priorities.
Great news! After more than a year of planning, it is finally time to
open the new private clinic dedicated to the treatment of patients with
Chronic Fatigue Syndrome (CFS). The new clinic, The Chronic Fatigue &
Immune Disorders Research and Treatment Center will open in October in
The purpose of this email is to share this exciting news and to answer as
many of your questions about the new clinic as I can. In order to see as
many patients as possible and to increase the number of physicians
treating CFS patients, I am making a few changes in my practice.
First and foremost, I will NOT be leaving the University of Miami or the
clinic there. We are hiring a new doctor for the University clinic who
will be able to see more patients by expanding that clinic. Dr. Irma Rey,
a very qualified and trusted colleague of mine, will be a wonderful
addition to the UM CFS Clinic.
• At the new private clinic, patients will see practitioners that I have
fully trained in my methodology and approach to CFS. I will supervise and
review the care, and meet with each patient with the clinic practitioner
to create and implement a customized treatment plan. This method of
treatment and consultation will enable me to train more medical
professionals in the intricacies of CFS as well as to help more patients.
• The new private clinic will be a fee-for-service clinic in regards to
office visits. This means that office visits will need to be paid for at
the time of service. They cannot be billed after the fact. We will,
however, provide you with the paperwork ready to submit to your insurance
carrier for out-of-network reimbursement. At this time, we are unable to
take Medicare at the new clinic.
• The new clinic will offer diagnostic testing helpful in determining the
severity of the illness and the various underlying components of the
illness (immune, autonomic, sleep, etc). Fees for diagnostic tests will be
billed directly to your insurance provider. We will also be able to
provide disability assessments and assist in documenting the severity of
illness for disability claims.
I am thrilled by the excitement and energy being generated by this new
clinic. I hope you are excited as well. Now it is time to really begin
planning. I need the following information from you if you are interested
in becoming a patient at the Chronic Fatigue & Immune Disorders Research
and Treatment Center.
Please email, mail or call us with the following information:
_____ Yes, I want to be a patient in the new clinic.
City State Zip ___________________________________________________________
Phone number (D) _________________________________________________________
_____ new patient, never seen Dr. Klimas
_____ continuing patient
_____ type of insurance, copy of insurance card
Once we are ready to begin scheduling appointments, we will use these
responses as our first calling list. Please let me know if you would like
to become a patient of the new clinic.
Send your response to email@example.com
Thank you all for your patience and support of my work. I am excited to
begin this new clinic and the new help it will bring to all of you. I
look forward to hearing from you.
Nancy G. Klimas, MD
Chronic Fatigue & Immune Disorders Research and Treatment Center
Health debate short on evidence-based science
The public's faith in President Barack Obama's plan for health care reform is fading. Proposals ranging from the public insurance option to reimbursing physicians for end-of-life counseling are mired in a debate that's as overheated as August temperatures. Even the seemingly self-evident idea that the nation has a moral duty to make sure all citizens have basic access to health care is up for grabs. But there's one aspect of health care reform that California voters support almost universally: better medical evidence.
A poll released Sept. 2 shows extraordinary levels of enthusiasm for policies that would help doctors and patients know what works in medicine, what doesn't work and for which patients. In a poll of 800 California voters conducted by Lake Research, 88 percent of respondents said they believe it is important that doctors have access to scientific evidence that compares the effectiveness of different treatments. Nearly half, 46 percent, consider it extremely important.
Of course they do. Patients go to the doctor looking for effective treatment, and this being the 21st century, they assume that their doctors' recommendations will be based on up-to-date science.
Yet all too often that's not the case. According to the prestigious Institute of Medicine, only about half of the treatments, surgeries, tests and minor procedures that doctors recommend are backed up with sound medical evidence. The other half? Doctors have only theory, tradition or marketing by the pharmaceutical and medical device industries to guide them.
This lack of valid science hurts patients and costs the nation billions in wasted dollars annually. Take lumbar fusion surgery for simple lower back pain – pain that isn't caused by cancer or a major accident. Between 1993 and 2003, spending for lumbar fusion rose 500 percent, despite an almost complete lack of sound evidence that this invasive, potentially risky procedure is effective. It might relieve pain for some patients – and worsen it for others. Surgeons and patients simply don't have the information they need to predict ahead of time who is likely to benefit and who will be harmed.
Many, if not most, patients are also in the dark about the very real dangers posed by any hospitalization. Out of the 34 million patients admitted to the hospital each year in the United States, as many as 190,000 die not from their disease but from infections acquired in the hospital or avoidable medical errors. Poor-quality medical care kills more people than AIDS, breast cancer and car accidents combined.
On the flip side, there is inappropriate undertreatment. Even when sound evidence exists, patients don't always get the care they need. About 25 percent of heart attack patients don't receive an aspirin and beta blocker within 24 hours of being admitted to the hospital, despite solid science showing that these drugs can cut the risk of a subsequent heart attack by 20 percent.
The same is true for countless other conditions and tests. In some cases, the root cause is poorly trained doctors, but most of the time, we just don't have effective ways of monitoring quality and providing doctors with timely, reliable evidence.
Voters know that getting care they don't need, and not getting care they do, is bad for their health. According to the poll, 80 percent of voters think it is a serious problem when doctors provide unneeded medical treatments, and 79 percent think it's a serious problem when they don't get needed care. Ninety percent think doctors should be required to tell their patients when there is no scientific evidence to support a treatment recommendation.
Why isn't the issue of medical evidence front and center in the health care debate? Maybe because doctors have not always been truthful in telling people what they know and don't know. Many physicians are either unwilling or unable to take the time needed to fully explain where uncertainty exists. As a result, 65 percent of California voters are under the mistaken impression that most or nearly all of the health care they receive is backed up by scientific studies.
The results of this poll, which was conducted for the Campaign for Effective Patient Care, a nonprofit founded this year with initial support from AARP, California Association of Physician Groups and Blue Shield of California, should embolden legislators and policymakers to forge ahead with legislation that supports medical research aimed at providing practical answers to everyday medical dilemmas. Two of the three health care reform bills wending their way through Congress contain provisions for research that compares the effectiveness of different treatments. The bills would also reinforce the infrastructure that's needed to disseminate results to both doctors and patients.
There's a lot of misinformation being circulated by opponents of comparative effectiveness research. Some are politically motivated and simply want to see Obama and the Democrats fail. Others have a financial interest in keeping patients and doctors in the dark. Either way, Americans deserve better quality health care, and voters know that the only way to get there is through better medical evidence.
Shannon Brownlee is a senior research fellow at the New America Foundation, a nonpartisan thinktank based in Washington, D.C. Dr. Michael Wilkes is the director of global health at the University of California, Davis.
Tuesday, September 8, 2009
Monday, September 7, 2009
That's the reality of life with CFS.
NATIONAL INSTITUTES OF HEALTH NIH News
NIH Office of the Director (OD)
For Immediate Release: Friday, September 4, 2009
CONTACT: Megan Columbus, 301-435-0937,
NEW NIH TOOL MAKES FUNDING DATA,
RESEARCH RESULTS AND PRODUCTS
Comprehensive funding information for NIH grants
and contracts is now available on the NIH Research
Portfolio Online Reporting Tool (RePORT) thanks to a
new, user-friendly system called the RePORT
Expenditures and Results, or RePORTER.
RePORTER combines NIH project databases and
funding records, PubMed abstracts, full-text articles
from PubMed Central, and information from the U.S.
Patent and Trademark Office with a robust search
engine, allowing users to locate descriptions and
funding details on NIH-funded projects along with
research results that cite the NIH support.
"With the addition of RePORTER, we have taken a
big step toward providing NIH's broad community of
research administrators, science policy makers, and
members of the general public-with richer
information, accessible in a form designed to meet
their diverse set of needs," said Sally Rockey, Ph.D.,
acting deputy director of extramural research.
"In addition to a being a public service to our
stakeholders, it's a good example of the
transparency and openness in government that
the public deserves and has come to expect."
User-defined searches allow the public to refine,
export and analyze results and provide insights into
NIH spending, as well as research results across
NIH-funded projects, institutions, investigators or
Searching for grants funded by the Recovery Act is
made especially easy by a checkbox that limits
searches to that area of interest.
Plans for improvements in RePORTER include
allowing users to personalize their experience. NIH's
goal is to provide users the ability to save favorite
searches, set alerts for new grants, publications and
patents, and even export the entire RePORTER
RePORTER is the newest tool on the RePORT
website, NIH's comprehensive online repository of
reports, data and analyses of research-related
RePORT provides a wealth of data on NIH's
research-related grant and contract funding, including
general reports and statistics, funding by research,
condition and disease categories, new data
visualization tools, and more.
Dynamic reports and geographic mapping tools offer
unparalleled access to information on NIH's Recovery
Act grant funding on an individual project, state or
RePORT is available at: RePORT.nih.gov
The project search tool, RePORTER, is available
through the RePORT site or by going directly to:
The Office of the Director, the central office at NIH,
is responsible for setting policy for NIH, which
includes 27 Institutes and Centers.
This involves planning, managing, and coordinating
the programs and activities of all NIH components.
The Office of the Director also includes program
offices which are responsible for stimulating specific
areas of research throughout NIH. Additional
information is available at:
The National Institutes of Health (NIH) -- The
Nation's Medical Research Agency -- includes 27
Institutes and Centers and is a component of the
U.S. Department of Health and Human Services.
It is the primary federal agency for conducting and
supporting basic, clinical and translational medical
research, and it investigates the causes, treatments,
and cures for both common and rare diseases. For
more information about NIH and its programs, visit:
6 September 2009
However I was reading Cort Johnson recently recount the experience of being overrun by Multiple Sclerosis patients on Capitol Hill a few years back while participating in a CFIDS Associations Lobby Day.(2) The comparison of MS and ME/CFS patients provided me with a lens through which to explore -- and answer -- the question of "where is everybody" with what feels like far more satisfaction.
Let me begin by noting that while there are more people who have ME/CFS than who have MS, only 18% or so of ME/CFS patients have been diagnosed. Thus there are actually more diagnosed MS patients than diagnosed ME/CFS patients.
MS patients have a variety of effective treatments to choose from (that are covered by insurance companies) including anti-virals, interferons, and yes, CBT, including consultations with cognitive psychologists who, through rigorous psychometric testing, can identify for the MS patient his or her cognitive strengths and weaknesses and train the patient to compensate for those weaknesses.
Doctors, insurance companies, families, friends, and communities at large all consider Multiple Sclerosis to be a legitimate, serious, and debilitating disease, meaning that friends and family members are much more willing to advocate for MS patients.(3) Indeed as a child I can remember participating in the annual MS Read-a-thon after reading about it in the back of a young adult novel I had received.
The impact of this legitimacy on patients cannot be overestimated, even if most MS patients don't even know they should appreciate it. There is no internalized doubt and stigma ("maybe I just really can't handle stress", "maybe I am just weak-willed"). No internalization of an overwhelming narrative that invalidates the seriousness of their illness ("I don't have a real disease like cancer or Rheumatoid Arthritis or AIDS so I shouldn't bother the doctor"). No shame and fear that by admitting their disease - or simply stating the *name* of their disease - they will immediately be labeled histrionic, lazy, and/or hypochondriacal.
And most important of all, patients with Multiple Sclerosis do not have post-exertional malaise. While it is true that chronic fatigue is a very prominent part of having MS -- so much so that some researchers even refer to this aspect of MS as "chronic fatigue syndrome" -- MS patients do not appear to have difficulty metabolizing oxygen. Their VO2 max levels do not drop significantly after engaging in aerobic activity, saving them from the overwhelming lethargy and apathy post-exertional malaise produces.
My best friend and godfather, Talal, has MS. Because he began Avonex (a form of Interferon B) and Amantadine (an anti-viral) within a few years of symptoms appearing, he's still in his PhD program. His primary symptoms are fatigue and cognitive problems -- brain fog, problems with short-term memory/working memory, organization, etc. While he gets tired easily and struggles with sequential tasks like recipes, he does not have problems with post-exertional malaise. He can still read methodology (i.e. dense, esoteric text). He can still write academic prose. He can still teach and make a monthly salary. He can still work an 8-hour day. He can even help friends move with his pick-up. He suffers little to no pain. He walks unaided. He goes to the gym most days. He's currently in the Middle East doing research for his dissertation.
I, on the other hand, had to drop out of my graduate program. I live on $674 of SSI + Food Stamps. For much of the last five years I have not been able to read books (despite owning 1200+), though my reading ability has been improving since increasing my dose of Acetyl L-Carnitine substantially and starting D-Ribose. Methodology, of course, is still out of the question. I too have a hard time following a recipe -- or even just making myself a bowl of cereal in the morning -- because my working memory and sequential tasking are poor. I walk with a cane because my balance is poor (some days I feel almost hemiplegic). I take 120mg of morphine a day plus extra-strength Vicodin (Lortabs) for constant, burning pain. I'm only awake in the evening. I have to have someone come in and do my laundry, cook my meals, and help me bathe -- someone who may or may not understand how sick I am. The only writing I can do is cobbled together blog posts and journaling. My state's form of Medicaid does not cover treatment for CFS, though there is no real standard of care anyway and my doctor knows almost nothing about my disease. I haven't been able to drive for four years now both because of pain that's unrelated to CFS and because of poor spatial perception that is most certainly related to CFS. My boyfriend lives in the UK but I cannot get on a plane to go visit him there because I absolutely must lay down after 3-4 hours, while the flight just to the East Coast is 6 hours, with the UK another 5 hours after that.
It is true that Talal is not necessarily the average MS patient, nor am I the average ME/CFS patient. But I do think the very differences in post-exertional malaise, legitimacy and access to treatment are essential to explaining why MS and ME/CFS patients differ in their abilities to advocate for themselves.
Unfortunately we cannot get legitimacy and access to treatment without advocating for ourselves. Except we cannot advocate effectively for ourselves without legitimacy and access to proper treatment. I still do not have an answer for how to overcome this insidious conundrum. However I am most certain the answer is not to blame the victim, i.e. ME/CFS patients.
Originally posted at http://tiny.cc/50QQg
See also: "Found" at http://tiny.cc/hqrTl
(3) Especially mothers. Some of the staunchest and most effective advocates for ME/CFS have been mothers (Pat Fero, Annette Whittemore, Jill McLaughlin – to name a few). Indeed my own local support group fell apart when one of our members left – taking her mother, our group facilitator, with her. The CFIDS Association may well have made a serious strategic error in not addressing Pediatric ME/CFS more aggressively from the beginning, even if adults are more likely to develop ME/CFS than children.
Read about life behind the surface at http://behindthesurface.blogspot.com