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Welcome to To Your Health, a new N&R blog covering health and medical issues. I'm Lex Alexander, the N&R's health and medical reporter. That is not my picture up there at the top, in case you were wondering.

As do most bloggers, I'd like this to be a conversation. In this case, that'll be essential. I have basically zero background in health and medical affairs, so my learning curve needs to be pretty steep at this point. (Points in my favor: I know the difference between hypothesis and theory and know what a learning curve actually is.)

It's not like there are no interesting topics in this area, so let's get to it, shall we?

We don't do so well here in North Carolina in terms of health literacy, a fact that might well explain our incidence of heart attacks, stroke and infant mortality. At least, that's what a task force has found:

Task Force releases recommendations to address low health literacy among North Carolinians

Roughly half of N.C. adults have trouble understanding basic health information.

A statewide Task Force examining the problem of low health literacy released 14 recommendations today outlining how North Carolina can ensure that people can understand the health information they receive.

Health information can be very technical and hard to understand. Most people have had trouble understanding their doctor's instructions at one time or another. Health literacy is the ability to understand and act upon basic health information.

Literacy is an essential part of health literacy and has been studied more comprehensively in relation to health. The American Medical Association has concluded poor literacy -- not income, age, or race -- is the best predictor of someone's overall health. Estimates project over 50% of adults in North Carolina suffer from low literacy. People with low literacy may have
trouble taking prescription drugs properly, understanding their diagnoses, or choosing the best insurance plan for their specific needs.

The negative effects of low literacy extend to others as well. Children with asthma who
have parents with low literacy are much more likely to miss school than similar children with parents who have adequate literacy skills.

The Task Force released 14 recommendations aimed at improving communication
between patients and their health care teams. The recommendations cover
multiple aspects of the health care system, including:

• training for doctors and other providers on the best way to communicate
  with patients.
  
• modifying the design of prescription drug labels to increase understandability
  
• ensuring that health information is written at appropriate level for
  target audience
  
• developing new and innovative ways to increase understanding of complex
  health information, and
  
• encouraging patients to ask questions and more actively participate in their own health care.

"The health care system is transitioning to a more patient-centered approach, aimed at involving patients more directly in their own care. Helping doctors and other health care providers learn to communicate more effectively is a critical step in that transition," said Tom Bacon,
Co-Chair of the Task Force and Director of the N.C. Area Health Education Centers Program.

If people do not understand the health information they receive, they will have problems managing their care. "Given the complexity of health information, we should not be surprised that so many people have difficulty following their provider's instructions," said Pam Silberman, President and CEO of the North Carolina Institute of Medicine. "We need to do a better
job in communicating health information to patients, to make sure they understand what they need to do to monitor and manage their health problems."

The N.C. Institute of Medicine convened a Task Force of 49 experts and stakeholders from across the state to consider how best to address the problem of low health literacy. The work was funded by the N.C. Division of Public Health, Heart Disease and Stroke Prevention Branch, through a grant from the Centers for Disease Control and Prevention and the N.C. Division of
Medical Assistance. The Task Force was co-chaired by Allen Dobson, Assistant Secretary for Health Policy and Medical Assistance, N.C. Department of Health and Human Services.

The Task Force's report, entitled Just What Did the Doctor Order?:
Addressing Low Health Literacy in North Carolina, and issue brief are
available at the NC IOM's website at http://www.nciom.org.

So, have you ever had trouble understanding your physician's directions or explanations? And if so, what did you do about it?

One thing my story today on infant mortality in North Carolina didn't get into was how the U.S. stacks up against comparable nations. I ran out of time and room, and the report that prompted the story focused on North Carolina, not other states or the nation as a whole.

Problem is, well, there's a problem. The United Health Foundation ranks the U.S. 26th out of 30 industrialized nations in terms of infant mortality. There are a lot of reasons why that might be, of course -- race and class issues, poor lifestyle choices, the lack of national prenatal care and so forth. As a newcomer to covering health, I find it odd that on the national level and in the South, infant mortality doesn't appear to be a particularly high priority in terms of fund-raising and prevention.

P.S.: It looks like I can post but comments aren't showing up. They're working on it. Thanks for your patience.

My answers to readers' questions about the standoff between health system and insurer appeared here on Sunday. Feel free to respond to answers or add your own questions.

UPDATE: Pay charts now online, too.

As readers of the N&R know, Moses Cone Health System and insurer Blue Cross and Blue Shield are in a dispute over the reimbursement rates Cone is seeking and Blue Cross is willing to pay. Cone has canceled its contract with Blue Cross, effective Nov. 1. Blue Cross has refused to negotiate while the cancellation is in effect.

On Sept. 14, Cone President and CEO Tim Rice sent an e-mail to staff physicians, one of whom has passed it along to me. It basically says that the stalemate continues; I pass it on for whatever it might be worth. (The revised offer by Cone mentioned in the e-mail was touched on in my Sept. 9 article, now behind our pay firewall, on the dispute.)

I'm writing today to provide you with an update on our contract issue with Blue Cross Blue Shield of North Carolina. There has been a lot of media coverage on this issue, and I want to be sure you have the most current information.

Despite our best efforts, Blue Cross continues to refuse to negotiate, and we are no closer to reaching contract resolution today than when I wrote to you several weeks ago. It's hard to understand why Blue Cross refuses to even talk to us. It seems as if they are digging in their heels no matter how important this is to the community.

To help end this impasse, last week Moses Cone provided Blue Cross with a new contract proposal. A proposal that links some of our reimbursement to quality measures Moses Cone hospitals must meet. We only get paid if we deliver quality, and we know we will. Unfortunately BCBS refuses to discuss this proposal with us. In fact, they refuse to continue negotiations until we remove the November 1st deadline.

Rather than working to reach agreement before November 1st, Blue Cross has decided to use its resources to inform the residents of Greensboro and the surrounding areas that they would be best served by seeking a new doctor in another town, and to travel to another town to receive hospital services. This is causing a great deal of unnecessary unrest and angst for the residents of our community.

Access to Moses Cone is critical to people in our community, and we are willing to tie a portion of our reimbursement to quality measures so we can get a deal done. This will ensure that our patients can have full confidence they will have access to Moses Cone, and we will get the reimbursement we need to continue to support quality care and quality staff at our hospitals.

Moses Cone has a long history of providing the highest quality care to our patients, and we have every bit of confidence that we will meet these quality measures. The hard work of our physicians and hospital staff has helped us to achieve the high level of care we provide now, and we are confident that we will continue to work together to meet our goals. Blue Cross should be willing to pay for quality, unless they are just trying to keep our reimbursements low to make a point.

Our patients are our number one priority, and we are doing everything we can to ensure that every single person who wants access to Moses Cone can do so without penalty from Blue Cross. We will be sure to keep you updated as we await a response from Blue Cross. In the meantime, please do not hesitate to call me directly at (336) 832-9500 if you have any questions. We appreciate your support.

Sincerely,

Tim Rice

President and Chief Executive Officer

As some of you might know, I'm the prime perpetrator of the N&R's annual Strange Days feature, kind of an annual News of the Weird-type thing we do at the end of each year. Readers generally find it amusing, and -- a fact I came to appreciate very much when I worked in Life myself -- it fills an entire Life section front at a time of year when we're short of staff and nothing much is going on.

Problem is, pretty much every item we run in that feature has to have a specific date attached -- either the date it happened or the date it was first reported. Otherwise, we generally can't use it. I've stumbled across an item that appears to lack both but was just too good not to share: man sticks rattlesnake in his mouth to show it's harmless. As Dave Barry says, I am not making this up:

In early August, snake collector Matt Wilkinson of Southeast Portland grabbed a 20-inch rattler off the highway near Maupin in Central Oregon.

Three weeks later, in a show of daring for an ex-girlfriend, Wilkinson stuck the snake in his mouth. He was near death with a tongue swollen to the point it spilled out of his mouth and blocked his throat when emergency room and trauma surgeons at OHSU saved his life.

The 23-year-old became a celebrity of sorts today when broadcast and cable news channels all over the country wondered at his story. On the phone, still out of sorts with sore muscles and nerves from the venom, he sounded circumspect.

Matt. Dude. How?

"You can assume alcohol was involved," he said.

(Big tip o' the rattler-skin hat to Mr. Sun)

As my story today points out, it's getting to be time for flu shots. The disease kills 32,000 Americans yearly, hospitalizes 200,000 and affects between 5 percent and 20 percent of the population, but far less than half of Americans get shots.

Do you make it a point to get a flu shot? (I'm pretty good about it myself, although I slipped up on it last year.) Why or why not?

Downtown restaurant/brewpub Natty Greene's will be holding a one-day fund raises on Friday, Oct.5, from 11 a.m. to 1 a.m. Ten percent of all-day sales will benefit cancer research and education at Wake Forest University School of Medicine's Section on Hematology and Oncology.

The event will include a raffle of the "slightly used" 26-inch LCD flat-screen TV from the players' lounge at the recent 2007 Wyndham Championship golf tournament. It also will feature live music, beer tasting in the restaurant loft and a live broadcast by 98.7 FM.

For more information, visit the Mackay Foundation Web site.

Germs go into space, come back stronger:

It sounds like the plot for a scary B-movie: Germs go into space on a rocket and come back stronger and deadlier than ever. Except, it really happened. The germ: Salmonella, best known as a culprit of food poisoning. The trip: Space Shuttle STS-115, September 2006. The reason: Scientists wanted to see how space travel affects germs, so they took some along - carefully wrapped - for the ride. The result: Mice fed the space germs were three times more likely to get sick and died quicker than others fed identical germs that had remained behind on Earth.

So, inasmuch as you can't sterilize a person (well, you can, but they tend to be sort of unwell afterward), this has ramifications for space travel.

Or perhaps we're worrying too much. To borrow a phrase from Homer Simpson, I, for one, welcome our new bacterial overlords.