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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?

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.

... and boy, am I aware. I've gotten bombarded with information today from a wide variety of sources. Some of this will become short items in the paper, some might develop into full-fledged stories and some might show up here in the blog.

According to the American Cancer Society, breast cancer is the most common cancer in women after skin cancer, and more women die of invasive breast cancer than any other cancer except lung cancer.

Some 178,480 women in the United States will be found to have invasive breast cancer in 2007. About 40,460 women will die from the disease this year. Right now there are about 2.5 million breast-cancer survivors in the United States.

The chance of a woman having invasive breast cancer some time during her life is about 1 in 8.

So you should be aware, too.

One way you can do that, if you're a woman, is by being screened regularly. One way you can do that is by taking part in free screening offered by the Guilford County Department of Public Health’s Breast and Cervical Cancer Control Program.

The department's guidelines are that women must be Guilford County residents age 50 or older, not enrolled in Medicare part B or Medicaid, and meet income guidelines for the program. On-site services include blood pressure screening, cholesterol screening, clinical breast exam and Pap smear. The program also refers eligible patients to another facility for mammograms.

Clinics are held Tuesdays at 1100 E. Wendover Ave. in Greensboro and Wednesdays at 501 E. Green Drive in High Point. You can get more information or make an appointment by calling 641-3233.

The Department also offers some tips on reducing your risk of getting breast cancer:

• Control your weight and exercise. Make healthy choices in the foods you eat and the kinds of drinks you have each day. Stay active.


• Know your family history of breast cancer. If you have a mother, sister, or daughter with breast cancer, ask your doctor what is your risk of getting breast cancer and how you can lower your risk.


• Find out the risks and benefits of hormone replacement therapy. Some women use hormone replacement therapy (HRT) to treat the symptoms of menopause. Ask your doctor about the risks and benefits of HRT and find out if hormone replacement therapy is right for you.


• Limit the amount of alcohol you drink.


• Get screened for breast cancer regularly. By getting the necessary exams, you can increase your chances of finding out early on, if you have breast cancer.

A research program that hopes to identify environmental and genetic causes of breast cancer is still looking for subjects as it works toward 50,000 women whose sisters have had breast cancer.

The Sister Study, which would be the largest such project ever, was launched in October 2004. Now, it has 41,000 subjects and continues to seek another 9,000 to fill out the study. Because only about 5,000 are ethnic minorities, the study is particularly interested in finding African American, Hispanic, Native American and Asian women to participate.

Women ages 35 to 74 are eligible if they live in the U.S. or Puerto Rico, have never been diagnosed with breast cancer themselves, and have a sister who has had breast cancer. Participants will be asked to provide samples of blood, urine, toenail clippings and house dust, but they will not be asked to take any medicine, visit a medical center or change their habits, diet or lifestyle.

For more information, visit Sister Study.

Fifty years ago today, the Soviet Union launched the first artificial Earth satellite, Sputnik. The incident so disturbed U.S. leaders that the country began a crash course of encouraging students to study science and math lest we fall behind the Soviets in that Cold War era.

To a certain extent, it worked, at least for a while. One of the most striking things about the astronauts who lost their lives in the Columbia disaster was the level of scientific expertise they represented collectively and individually. If I remember correctly, the least credentialed member of that crew was still an M.D. On the other hand, today we are experiencing a shortage of scientists, and people who misrepresent science, if not actually lie about it, hold sway over a substantial percentage of the population.

Science is more important today than ever, and it would be nice if today's anniversary sparks some discussion about that fact and what we can do to address it.

In keeping with October's designation as Breast Cancer Awareness Month, here's a link to BreastCancerStories.org, which includes stories and photos from more than 125 breast cancer patients and survivors across the nation. It's free.

The last time I came into the room, the man's eyes were open. They were blank as a pair of billiard balls. He was panting, his pulse was 42, and his pressure was dropping. The end was near. I thought to look one more time at his retinas. But as I leaned over him, in both of his open eyes I saw my own reflection hovering, a figure robed in white, immense, hazy, and distorted.

Moses Cone Health System will be giving $333,000 over three years to endow a professorship in nursing at UNCG's nursing school.

The new position will allow the school to expand its capacity; Moses Cone hopes it will lead to a greater supply of hard-to-find nurses. From the news release:

"What's motivating Cone is the shortage of nurses," said Dr. Virginia Karb, associate dean of the nursing school. "They would like us to graduate more nurses and we would like to do that, too, but our facilities and staff are at capacity. This endowment will help us recruit a senior professor for the nursing school, which is tough because there's also a severe shortage of nursing faculty. It's a real challenge to recruit and keep faculty."

The school will apply to the state for matching funds to bring the total endowment to $500,000.

If you've read much about medical research, you've probably come across the term "placebo effect." It refers to the fact that something as simple as a sugar pill (or "placebo"), administered as a drug, may actually have a beneficial effect. It's not entirely clear whether the patient has to believe that the placebo is a real drug for the placebo effect to take place. One 1964 study found that some patients experienced the placebo effect even when they had been told that the pill they were taking wasn't a real drug.

Well, like everyone else, the placebo effect now has a blog of its own. You can actually buy placebos there -- 700-count bottles of sugar pills -- but mainly you'll just want to read some of the clear, and light-hearted, posts about how the placebo effect works and how much we still don't understand about it. Light-hearted though some of the posts may be, the placebo effect is a serious and important factor in such areas of research as whether certain antidepressant medications really work.

Business Week has an interesting article up about how insurers are starting to send patients overseas for certain medical procedures. Even after paying the patient's travel costs and other incidentals, the insurer can still come out ahead having the procedure done someplace other than in the U.S. So you could be getting your bypass done in Bangkok.

Please keep your characters from marching right up to the edge of the page. Many of us still don't have electronic medical records yet, those papers sometimes have to be photocopied and not all photocopiers (even the very good ones) can get every last square micron of the form into their pictures.

Thank you.

This is a tad late for Earth Day, but here's a short piece on why we really need to take care of the species we've got.

It seems the American Red Cross and Johnson & Johnson have been involved in a lawsuit over licensing the red-cross logo. And it seems a judge has told both sides to get over themselves.

Via my colleague Diane Lamb in our news research department comes this article from NewScientist.com:

Blood pressure is not hard to measure, but the necessary equipment for clinically accurate measurements – a cuff, a pump, and stethoscope or electronics – is bulky and heavy.

However, researchers have recently found that a person's "pulse wave velocity" is closely linked to blood pressure. This is the rate at which the pulse pressure wave passes through the blood circulatory system.

Sensors sewn into the waistband of a person's underpants can measure the rate of this wave, consumer electronics company Philips has discovered, and could be used to calculate blood pressure for as long as the garment is worn.

Each sensor continually measures the electrical impedance of the tissue beneath it – a property that changes as the pulse wave passes by. A pair of such sensors can calculate the speed of the pulse wave by timing how long it takes to travel from one sensor to the other.

Once calibrated with a conventional blood-pressure reading, the electrodes can then give accurate blood-pressure readings, while the wearer enjoys the comfort of their own underpants.

Now, whether or not it's a good idea for your underpants to know your blood pressure is for you to decide. I'm trying to decide whether my blood pressure is any of their business.

You've probably heard about cases of criminal suspects who have died after being tasered. Well, courtesy of WSJ.com's Health Blog, comes the story of a criminal suspect whose irregular heartbeat might -- might -- have been restored to normal when he was tasered. (Both medical professionals and the folks who make Tasers caution that there could have been other reasons his heartbeat returned to normal.)