News-Record.com

The Wall Street Journal's health blog has an item about a man who built a Web browser especially for his autistic grandson:

The basic idea is to simplify the user experience and reduce the number of available choices. The browser presents the user with a few large icons (a big soccer ball, a stack of books) that lead to a limited number of sites with activities like music and educational games. It blocks advertisements and other “flashing distractions,” the AP says.

The browser also disables some keys on the keyboard, as well as the right-click button on the mouse, to reduce the chances that a child will hit an incorrect key — which can quickly lead to frustration.

An Associated Press article on the browser is here. Disclaimer: I have not tried the browser so I'm neither endorsing it nor warning you away from it.

One of the key factors contributing to the success of the Veterans Administration health-care system has been a computerized health-records system that VA workers developed themselves and continue to improve. In an era of skyrocketing health-costs, the system, called VistA, has actually helped reduce the VA's health-care costs, as well as improving the accuracy of prescriptions to the point at which it almost literally can't get any better.

If you worked in the government, wouldn't you want to expand this system and make even more and better use of it? One would think. But, as Maggie Mahar reports at the Century Foundation's Health Beat Blog, one would be wrong. The Department of Defense, which must coordinate care for military folks with the VA, has gotten its own, proprietary (read: expensive and less flexible) system from a big military contractor rather than just adopting VistA. What's more, although there are good reasons not to -- and although VistA is actually being adopted in the private sector now -- the VA itself may be moving away from VistA.

Mahar provides some good links, some credible analysis, a warning about what's happening and a pledge to keep following the issue. Go read her.

Back in April I wrote about how autopsies are becoming less common and what that might mean for medical knowledge. Now Maggie Mahar at Health Beat, in Part 2 of a series on the silence surrounding diagnostic errors, wades into the issue of autopsies and says we may be missing even more by not doing autopsies than we thought we were ... and we already thought we were missing a fair bit.

I got a call last week from an individual who said he recently had applied for jobs at two area companies. He said that as part of the application process, both companies had asked him to sign forms authorizing the release of his medical records to the company. He didn't want to do that and wanted to know if the request was legal. He had a copy of only one of the releases he was asked to sign, but he faxed that over, and, yes, it did ask him to authorize release of "medical records" (without any specified limitations).

His concern was well-founded. I talked with Ronald McKinley of Cincinnati, who has served on an expertise panel for the Society for Human Resource Management. He said flatly that such a request is illegal.

"An employer has a right and an obligation to check people's backgrounds -- but not for medical information," he said, adding, "I don't know why an employer would want that, except to discriminate."

The Americans With Disabilities Act does allow an employer to inquire about an employee's ability to perform defined functions relative to a specific job, with or without certain accommodations. But it doesn't allow blanket requests for medical information.

Jose Rosenberg, director of the Greensboro Office of the U.S. Equal Employment Opportunity Commission, drew a distinction between offering someone a job contingent on his passing a physical -- which is legal -- and asking for medical information in general, which is not.

And Burton Garland Jr., a partner in the Lowenbaum Partnership, a St. Louis law firm that represents employers, says he would not advise a client to seek such a blanket release of medical information at any point in the employment process.

Of the two companies mentioned by my caller, one said it did not ever ask for medical records or medical history. (This is the one from whom my caller did not get a copy of the release.) The other acknowledged having formerly included that information in its standard form seeking authorization of information release (along with such standard items as credit histories and arrest records). But it said it has never used that form to actually seek medical records and has now revised the form to eliminate any confusion. It e-mailed me a copy of the revised form, as well.

I see this as less an investigative story than a teachable moment.

If you're applying for a job and the potential employer asks you to authorize a blanket release of your medical records, you do not have to do so. Tell the company that its request is illegal and tell it to contact its lawyers or the EEOC if it doubts you.

And if you're an employer, be very careful about what information you ask your job applicants to authorize to be released, lest you run afoul of the Americans With Disabilities Act and possibly other laws, depending on your state. If you haven't had a lawyer review the paperwork you ask your job applicants to fill out, you should.

Via the Wall Street Journal's Health Blog comes a mixed bag of news about tobacco. According to a report in the Journal of the American Medical Association (behind pay firewall; Harvard news release here), sales of cigarettes are down from 21.1 billion packs in 2000 to 17.4 billion in 2007.

However, sales of snuff, roll-your-own tobacco and small cigares are up by the equivalent of 1.1 billion packs of cigarettes, based on tobacco and nicotine content. So the public health benefits of reduced cigarette smoking are being somewhat diluted.

"The major factor in the apparent switch to non-cigarette products by smokers appears to be price -- with the federal tax on other forms of tobacco 1/10th that of cigarettes -- and the heavy attention given to campaigning against cigarette use but not against other forms of tobacco products in recent years," the news release states. It also points out that raising the price of tobacco has been the most effective way of reducing tobacco use in the U.S.

So don't be surprised if public-health advocates mount an effort to get the feds and states to raise their taxes on non-cigarette forms of tobacco.

The Partnership for a Drug-Free America and the Partnership for a Drug-Free NC have joined in a (duh) partnership to create a Web site to help parents communicate with their teens, particularly about alcohol and drug abuse.

The site is called A Parent's Guide to the Teen Brain and you can visit it at www.drugfree.org/teenbrain. It has all manner of information about brain development, how to talk with your kids about drugs and alcohol and other subjects. (Parent site drugfree.org also has a lot of info about alcohol and drug abuse) Check it out.

Some people who created special effects for such movies as "The Matrix" and "Eraser" have turned their talents to creating artificial organs for doctors to train with. No, really.

Back in January, I invited local doctors and other interested health-care professionals to help the News & Record improve its coverage of medical and health-care issues, via e-mail to me and participation on this blog. Through the good graces of Dr. John Lusk and Wilma Bailess of the Greater Greensboro Society of Medicine, that invitation is being extended more formally today through the society's newsletter.

That participation could take the form of commenting on stories we've published, but I'll also try to post here about stories that I'm working on so that you can offer suggestions on angles to look at, sources to talk to, records to peruse and questions to raise. I am trying to create a dialogue between me and you local health-care professionals to improve our journalism, but I also hope that the dialogue will sometimes take the form of a discussion among commenters, with this blog serving as an online gathering place for you.

The GGSM newsletter goes primarily to doctors, but I'm interested in hearing as well from nurses, office managers, psychologists and anyone else working in the field of health care. You can leave a comment here or e-mail me. I look forward to hearing from you.

Public health insurance, such as Medicaid and State Children's Health Insurance Program, results in significantly lower health-care costs compared with private insurance, even when tax subsidies for the latter are thrown in, according to a study published by the journal Health Affairs. (Abstract here; full text here; chart summary of findings here.)

The savings were of particular advantage to consumers, the study found, because much of the savings occurred in consumers' out-of-pocket costs. But the study also found savings in costs paid by public insurers vs. private insurers.

Take a look and tell me what you think.

(Via Health Affairs blog)

I have been contacted by an area woman whose son, serving in the Army, does not wish to receive the mandatory (for soldiers such as he who are being deployed to high-risk areas) vaccination against anthrax. He is worried not only about reports of problems associated with that vaccine, particularly because he has a history of adverse reactions to other vaccines, including a seizure after a childhood DPT injection, the mother says.

I've found some Web sites and blogs that SAY the vaccination is dangerous, but so far I've not found any journal articles or government reports that address the safety question directly. Meanwhile, the soldier, who has received the first of three injections, is planning to refuse the others even at the risk of likely disciplinary action.

(In case it matters, I should point out that according to the mom, this soldier sought and received a transfer from the reserves to the regular Army specifically because he wanted to serve in Iraq. Not all soldiers must receive the anthrax vaccine, but those being sent to actual or potential trouble spots, such as the Middle East and Korea, must do so. This soldier's mom, however, says the recruiter told her son that the vaccination was purely optional. I have no evidence on that claim either way at this point.)

Can anyone out there point me in the direction of some disinterested research into the issue of anthrax-vaccine safety, or recommend experts to whom I can speak?

Via the Wall Street Journal comes news of a Credit Suisse report noting that as corporations become more aware of the financial implications of fast-growing obesity, investing in companies that, one way or another, fight obesity might be good for your own personal business. In fact, the report authors have created an unofficial stock index called the "Healthier Living 15," whose products and services range from fitness centers to a device used in bariatric surgery.

Given the financial, medical and lifespan implications of obesity, I'll pass on the "growth-industry" puns here. But is this kind of investment morally OK? For that matter, is it good business?

Y'all go have some fun with this. But you'll want to finish lunch first.

My colleague Lorraine Ahearn forwarded to me an e-mail that, to judge from its indenting, has been sent to many places. It says insurance companies are trying to make mastectomies for breast cancer an outpatient procedure. It says women who have undergone such operations experience a great deal of pain and discomfort afterward and need to stay in the hospital at least two days afterward before being sent home. And it asks people to sign a petition in favor of a bill supposedly pending in Congress that would do just that.

I get lots of e-mails seeking signatures on petitions favoring or opposing this issue/bill or that, and a ton of them are hoaxes. (The alleged federal tax on e-mail is one example that still pops up from time to time.) So I wondered: Is this e-mail for real?

More or less, yes.

When I pay attention to mass e-mails at all, my first stop is usually the myth-busting Web site Snopes.com. I searched on the bill name mentioned in the e-mail, "Breast Cancer Patient Protection Act," and sure enough, Snopes had an entry.

There is such a bill, Snopes said, linking to both House and Senate versions. Similar bills have been introduced in previous Congresses but have died in committee. The current versions, H.R. 119 in the House and S. 459, are indeed sitting in committees, with no major action on either since their referral to committees earlier this year.

The petition referred to in the e-mail can be signed on a Web site run by the women-oriented cable network Lifetime TV here. That page also indicates that a House subcommittee had held a hearing on the bill May 21. That hearing is not reflected on the House link above, but that might just mean that that Web site doesn't consider a hearing, without a vote, to be a "major action."

Anyway, the petition is there if you want to sign it. (For the record, being no expert on breast cancer, I have no opinion on the bills.) Snopes also says, and I agree, that if you want movement on the bills, you probably also should get in touch with your congresscritter and senators. If you're not sure who they are, you can find out at House.gov and Senate.gov, respectively.

On Sunday I wrote about a human trial that Wake Forest researchers are about to begin on using a certain type of white blood cell to try to fight cancer. The print edition included a link to a site where you could get more information on being a trial participant or volunteer to be tested as a possible donor for the trial. Unfortunately, the online version didn't include that link, so here it is.