Managing the Spike in Mental Health Services

Marleen Cross, Amanda Goettl and Melinda Hennies, left to right, who are part of a 13-person ACT Team managing 95 patients with mental health issues, get ready for their daily meeting Thursday, May 23, 2013 at Mental Health Resources in St. Paul. Jennifer Simonson/MPR News

Marleen Cross, Amanda Goettl and Melinda Hennies, left to right, who are part of a 13-person ACT Team managing 95 patients with mental health issues, get ready for their daily meeting Thursday, May 23, 2013 at Mental Health Resources in St. Paul. Jennifer Simonson / MPR News

The Affordable Care Act of 2014 brought with it a major expansion in the coverage of mental illness and addiction, addressing issues of access and parity for people with mental health diagnoses. As a result of this policy change, millions of people have access for the first time to health services for mental illness.

But The New York Times reports that the increased access to services is creating pressure on systems that are not able to handle the load, citing instances where patients have to wait 7 weeks between appointments with their therapists.

Meanwhile, Vox and other media report this week that a new study shows the federal health policy is having an impact on teenagers’ access to mental health care. The report found mental health treatment climbed 5.4 percentage points for 18-25 year olds when compared to a similar group of young adults aged 26-35, who were too old to benefit from the expansion of dependent coverage.

World Health Organization proposes indoor ban on e-cigarettes

A man smokes an E-Cigarette at the V-Revolution E-Cigarette shop in Covent Garden on August 27, 2014 in London, England. Dan Kitwood/Getty Images

A man smokes an E-Cigarette at the V-Revolution E-Cigarette shop in Covent Garden on August 27, 2014 in London, England. Dan Kitwood/Getty Images

The World Health Organization is recommending governments ban the use of electronic cigarettes in public places and outlaw tactics to lure young users.

The organization is proposing the toughest measures yet for e-cigarettes, the battery operated devices that turn chemicals into an aerosol.

But The New York Times reports the WHO recommendation may have little impact.

The proposals by the organization, a United Nations agency, are only recommendations that might have little likelihood of being widely adopted. But health experts said they would serve as an important reference point for policy makers, both nationally and locally, as they try to navigate the complex balance of benefits and risks with very little science on which to base conclusions.

The American Heart Association also spoke out about the devices for the first time. USA Today reports the association pointed to studies suggesting that e-cigarettes, which contain nicotine but no tobacco, could serve as a “gateway” drug for young people.

The devices aren’t currently regulated by the U.S. Food and Drug Administration. The agency only regulates e-cigarettes that are marketed for therapeutic purposes, but last April proposed tougher regulations overall.

That proposal would ban the sale of e-cigarettes to people under the age of 18, but does not address where e-cigarettes should be smoked — that decision is largely left to states and cities.

Taking food health studies with a grain of salt

A Shake Shack burger is displayed on August 18, 2014 in Madison Square Park in New York City.  Andrew Burton/Getty Images

A Shake Shack burger is displayed on August 18, 2014 in Madison Square Park in New York City. Andrew Burton/Getty Images

Eat less salt. Salt is okay in moderation. Eggs are bad for you. Eggs are good for you. Red meat, yea or nay? Too often, conflicting studies make headlines without making sense. And the resulting confusion isn’t just frustrating; it can affect people’s health.

Aaron E. Carroll, a professor of pediatrics at Indiana University School of Medicine, wrote about this in The New York Times using recent studies on salt as an example. Carroll looked at a study in The New England Journal of Medicine that showed that people consuming high levels of sodium had higher rates of heart attacks, heart failures and strokes.

The problem with the way we respond to such information, though, is that we often run too far and too fast in the other direction.

But last year, experts convened by the Institute of Medicine assessed the evidence concerning sodium intake around the world. They agreed that efforts to reduce excessive sodium were warranted. But they cautioned that no such evidence existed to recommend a very low salt diet, Carroll explained. “We’ve seen it with eggs and cholesterol, too. Why experts feel the need to go from one extreme to the other is unclear,” he writes. The key takeaway is one word — moderation.

It’s a cliché but true: In so many things moderation is our best bet. We have to learn that when one extreme is detrimental, it doesn’t mean the opposite is our safest course. It’s time to acknowledge that we may be going too far with many of our recommendations.

ALS in the spotlight: Facts and stories about the disease

Bruce Kramer at home Thursday, Feb. 6, 2014 in Hopkins. Kramer lives with ALS. Jennifer Simonson/MPR News

Bruce Kramer at home Thursday, Feb. 6, 2014 in Hopkins. Kramer lives with ALS. Jennifer Simonson/MPR News

Last week, we talked about the ALS Ice Bucket Challenge. At the time, the viral campaign had raised $30 million for the ALS Association. Now, that number is close to $80 million — and it keeps rising.

Besides raising money, the challenge was designed to raise awareness. Even critics of the challenge have to admit, it’s living up to that expectation as the disease enjoys time in the spotlight it rarely gets.

The Washington Post published a list of five myths about the disease, including the myths that ALS only affects motor activity and that it’s a disease of “old people.”

Here are some facts about ALS from the ALS Association:

  • ALS is not contagious.
  • It is estimated that ALS is responsible for nearly two deaths per hundred thousand population annually.
  • Approximately 5,600 people in the U.S. are diagnosed with ALS each year.
  • The incidence of ALS is two per 100,000 people, and it is estimated that as many as 30,000 Americans may have the disease at any given time.
  • Although the life expectancy of an ALS patient averages about two to five years from the time of diagnosis, this disease is variable and many people live with quality for five years and more.
  • More than half of all patients live more than three years after diagnosis.
  • About twenty percent of people with ALS live five years or more and up to ten percent will survive more than ten years and five percent will live 20 years.
  • There are people in whom ALS has stopped progressing and a small number of people in whom the symptoms of ALS reversed.
  • ALS occurs throughout the world with no racial, ethnic or socioeconomic boundaries.
  • ALS can strike anyone.
  • The onset of ALS is insidious with muscle weakness or stiffness as early symptoms. Progression of weakness, wasting and paralysis of the muscles of the limbs and trunk as well as those that control vital functions such as speech, swallowing and later breathing generally follows.

If you want to learn more about what it’s like living with this disease, MPR News has a series that tells the powerful story of one man’s experience of ALS.

Bruce Kramer was dean of the School of Education at the University of St. Thomas in Minnesota. He was diagnosed with ALS in 2010. Since then, he has shared his journey with the incurable disease from time to time with MPR Morning Edition host Cathy Wurzer. Listen to their conversations here.

More regulation proposed for medical apps. But how much?

Someone displays the "Health Bracelet" app. Mandy Cheng/AFP/Getty Images

The “Health Bracelet” app, one of thousands prompting regulator scrutiny. Mandy Cheng/AFP/Getty Images

There is a smartphone app for almost everything — and that includes your health. Marketplace reports there are nearly 100,000 health apps from fitness trackers to blood glucose monitors.

The problem is, fewer than 100 of these apps have been cleared by the Food and Drug Administration. That’s about .1 percent. Some lawyers would like to see more regulation.

Nathan Cortez, a law professor at Southern Methodist University in Dallas, wrote an editorial for The New England Journal of Medicine about the risks of medical apps.

For example, a blood glucose app from drug company Sanofi was recalled because it miscalculated insulin doses.

Marketplace reports that right now the FDA categorizes apps on three levels of risk. It only has jurisdiction over the riskiest products, and does not even review all of those. Why? Cortez said it’s mainly politics, and a fear of stifling innovation.

Even some that criticize the FDA for over regulating agree.

Chuck McCoy, head of North Texas Angels Network, told Marketplace he hasn’t heard complaints from investors about too much red tape. “The FDA over regulates in many areas,” he said, “but if you are going to make clinical claims about a device, there has to be some scientific basis for those claims.”

MN State Fair + Health = Tabouli and Fruit Smoothies

Deep Fried Breakfast on a Stick at the State Fair. Tim Nelson / MPR News

Deep Fried Breakfast on a Stick at the MN State Fair. Tim Nelson / MPR News

It’s state fair season in many parts of the country, including in our Minnesota backyard. While issuing warnings about calorie and fat counts just before a trip to the fair can be self-defeating, there are healthier options out there. So, MN fair-goers, if you’re in the mood to decline the deep fried breakfast on-a-stick and waffle ice cream sandwiches, this listicle’s for you. Check out these alternative options on your way to the horse barn, grandstand or midway.

1. Tabouli salad

Where: Middle East Bakery, Holy Land Deli

2. Vegetable kabobs

Where: Minnesota Wine Country

3. Frozen grapes

Where:  Veggie Pie, Bayou Bob’s

4. Fruit pizza

Where: Veggie Pie

5. Natural fruit smoothies

Where: Moe and Joes Coffee

6. Chicken artichoke pita

Where: Mario’s

Physician Memoir Explores Unnecessary Care, Disillusionment

A newly insured patient receives a checkup on April 15, 2014. Joe Raedle/Getty Images

A newly insured patient receives a checkup on April 15, 2014. Joe Raedle/Getty Images

If you’ve ever wondered if the tests your doctor ordered were necessary, you probably aren’t alone. Sandeep Jauhar, a cardiologist at Long Island Jewish Medical Center, noticed the trend as a young doctor working in a teaching hospital. Now, Jauhur has written a widely-noted new memoir about doctors’ growing discontent with the profession, titled “Doctored: The Disillusionment of an American Physician.”

Choosing Wisely, a project of the ABIM Foundation, recently surveyed physicians in America and found the majority of physicians agreed that overuse of certain medical diagnostics and over-treatment is a serious problem. Sponsored by the Robert Wood Johnson Foundation, the survey included these findings:

  • 73 percent of physicians say the frequency of unnecessary tests and procedures is a very or somewhat serious problem.
  • 66 percent of physicians feel they have a great deal of responsibility to make sure their patients avoid unnecessary tests and procedures.
  • 53 percent of physicians say that even if they know a medical test is unnecessary, they order it if a patient insists.

Juahur recently spoke to NPR’s Terry Gross:

“American medicine is the best in the world when it comes to providing high-tech care,” he says. “If you have an esoteric disease, you want to be in the United States. God forbid you have Ebola, our academic medical centers are second to none. But if you have run-of-the-mill chronic diseases like congestive heart failure or diabetes, the system is not designed to find you the best possible care. And that’s what has to change.”

You can listen to the full interview here.

The ALS Ice Bucket Challenge & Social Media

Justin Rose of England and Brandt Snedeker of the USA take the 'ice bucket challenge' with a bit of help from their caddies Mark Fulcher and Scott Vale after a practice round prior to The Barclays at The Ridgewood Country Club on August 19, 2014 in Paramus, New Jersey. (Photo by Ross Kinnaird/Getty Images)

Justin Rose of England and Brandt Snedeker of the USA take the ‘ice bucket challenge’ with a bit of help from their caddies Mark Fulcher and Scott Vale after a practice round prior to The Barclays at The Ridgewood Country Club on August 19, 2014 in Paramus, New Jersey. Ross Kinnaird / Getty Images

You’ve seen it on Facebook, and you’ve probably been invited to take the Ice Bucket Challenge.

You haven’t escaped watching a few celebrities and friends doing it.

The latest phenomenon in social media activism — sometimes called hashtag activism or slacktivism – is sweeping the nation, but it’s also got critics.

The challenge involves getting a bucket of ice water dumped on you. You film it, and post the video to social media. Then you nominate your friends to take the challenge.

The New York Times reports that as a result donations to The ALS Association have spiked. The association has received $13.3 million in donations since July 29, compared to $1.7 million at the same time last year.

The ALS Association tells the story of one man’s influence on the bucket challenge’s viral path:

Beverly, Mass., resident Pete Frates, along with his family, helped to make the “Ice Bucket Challenge” go viral on the social sites Facebook and Twitter. Frates, 29, has lived with ALS since 2012, and he has worked with The ALS Association’s Massachusetts Chapter. A former Division 1 college athlete with Boston College Baseball, Frates tirelessly spreads awareness of Lou Gehrig’s Disease.

But now some, including Will Oremus, a writer for Slate, aren’t buying the story. He says Matt Lauer and Martha Stewart were among several celebrities who took the challenge before Pete Frates got involved. New York Magazine dissects the phenomenon as classic social media marketing. Still, the Ice Bucket Challenge is going strong, despite the backlash from Oremus and others. The New York Times reports The ALS Association has about 260,000 new donors.

Creating Heart Health

20140814_heartofnewulm01_33[1]

Denise Leitz of New Ulm, Minn., never used to exercise. But after joining the Heart of New Ulm Project she has made it a priority to squeeze in an hour-and-a-half bike ride most days. Lorna Benson / MPR News

MPR News’ Lorna Benson profiles a heart health program in New Ulm, Minnesota that aims to reduce the number of heart attacks with targeted public health efforts to encourage weight loss, diet change, and regular exercise. The Heart of New Ulm Project is 6 years into its 10 year lifespan, and will be recognized this week with a NOVA Award from the American Hospital Association. The program is a collaboration among Allina Health, the Minneapolis Heart Institute Foundation and the community of New Ulm. Benson profiles 56 year old Denise Leitz, who has lost 60 pounds and changed her health habits significantly as a result of the program.

From the article:

The program makes sure that Leitz and others are never alone in their quest to get healthy. Three times a day she receives text messages with healthy meal ideas and exercise tips. She also finds healthy recipes regularly in her local newspaper and on a weekly cable access program called “What’s Cooking New Ulm.”

Leitz said when she eats out, it’s not as hard as it used to be to find healthy meals. Nineteen New Ulm restaurants have added healthier options to their menus or switched to using healthier ingredients since the Heart of New Ulm Project started.

Her neighbors also help, with old fashioned peer pressure.

“People care and they notice,” she said. “And sometimes it’s a little scary because they look at you like, ‘Are you going to eat that?’ And it’s like, ‘Oh you’re right. I shouldn’t be having this anyway.’”

TBT: Fiddling During Brain Surgery

Classical Minnesota Public Radio reminded us of this remarkable 2010 story about a Minnesota Orchestra musician whose essential tremor was corrected by brain surgeons at the Mayo Clinic. Violinist Roger Frisch was awake and aware during the surgery, as doctors sought to identify the precise location within his brain that was causing the neurological disorder. During the procedure they asked Frisch to play his violin to help them determine which areas of the brain to treat. Here’s Mayo Clinic’s video report: