The Health Impact of the Gulf Oil Spill

Last week, the Institute of Medicine held a two-day workshop in New Orleans to discuss the health impact of BP's Deepwater Horizon oil spill in the Gulf of Mexico. The spill began with an explosion on an offshore drilling rig on April 20.

In an NPR article about the New Orleans workshop, Richard Knox pointed out that the effect of oil spills on human health has not been studied much, despite a history of several dozen major spills over the past 50 years. Knox explained that:

Only about a quarter of [the oil spills] have been studied for toxic effects on humans. And the studies that have been done are often small and without comparison between groups of oil-exposed and unexposed people. In addition, none has so far looked at long-term consequences of exposure, such as cancer incidence.

As a result, there are a lot more questions than answers about the short- and long-term health impact of the oil spill. The main health concerns for humans include an oil spill's impact on air quality, the health impact of direct contact with oil and substances used to clean up the oil, and the safety of consuming  fish/shellfish caught in the area. Knox also wrote that some researchers believe that children might be especially susceptible to health problems from exposure the the oil.

A CDC fact sheet about the spill warns that particulate matter in the air from burning oil might harm people with chronic medical conditions, discourages recreational swimming in contaminated areas, and suggests avoiding contact with oil spill dispersants used to treat the oil slick.

Knox wrote that previous large oil spills, such as the Exxon Valdez oil tanker spill in Alaska in 1989, have also had mental health consequences. After the 1989 spill, researchers found increases in problems such as post-traumatic stress disorder and anxiety among residents in the affected areas.

The BP oil spill is also harming local economies, adding to the stresses on Gulf Coast residents. Louisiana Governor Bobby Jindal told the Miami Herald today that Gulf waters off his state provide 30% of U.S. seafood and bring in $3 billion per year in commercial and recreational fishing.

To see the BP oil spill superimposed over the area where you live and get a sense of its scale, visit the interactive map www.ifitwasmyhome.com. The map is based on current National Oceanic and Atmospheric Administration (NOAA) data about the spill. Or you can go straight to NOAA to see where the oil is right now or learn more about previous large oil spills in the Gulf.

Living La Vida Cyber

Is communicating over the Internet good for you? Or is it just a crutch?

Reaching people online is different from print or spoken communication for one main reason: you can use new media such as video, audio, and online links to make your communications richer and more realistic, even if what you create is not actually reality.

I'm not surprised that some people with autism spectrum disorders (ASDs) have been drawn to the virtual social world Second Life, for example. In Second Life, people with ASDs can communicate in ways that are not socially acceptable in the real world, incorporating unusual movements into their Second Life avatars, for example.

"The internet has been to the autistic community what sign language has been to the deaf community: a channel of communication that allows them to speak for themselves," explains the newscaster in a 2007 news clip on this phenomenon.




If modern life is sometimes awkward for those of us with passable social skills, it's surely maddening to people with ASDs who have trouble reading social cues such as facial expressions. Second Life is probably a welcome escape for many of them. Some therapists even use Second Life to help people with ASDs practice social skills necessary in the real world, explains T. DeAngelis in an article for the American Psychological Association:

With a therapist's guidance, patients enter a protected area in Second Life designed to help them practice communicating and negotiating in realistic settings. (The area - which is simply a location within the cyberworld - is secured so patients can't enter the main part of Second Life, which [cognitive neuroscientist Sandra Bond] Chapman believes could be overly confusing and disorienting for them.) As in Second Life, both patient and therapist create avatars, or virtual representations of themselves. 

Chapman was quite optimistic about the ability of moderated Second Life sessions to improve the social skills of her patients.

But the the technologies that help people with ASDs learn to navigate the real world also serve to degrade the social skills of people without ASDs. Laptops, smart phones, iPads, and other gadgets now create a wall between people who are stuck together in the same place - a doctor's waiting room, an airport - as each person retreats into their own technology bubble.

Do airports now have televisions in the waiting areas because people really need to keep up with CNN, or because we want to alleviate the awkwardness of sitting quietly among strangers, as we slowly lose our ability to make small talk - and perhaps discover new connections -  with them? We turn to technologies such as foursquare to find out if any of our friends are in the neighborhood, instead of just looking up from the smart phone screen and looking around, hoping serendipity is on our side today.

So there it is. People with ASDs learn social skills for the real world by practicing them on Second Life, and people without ASDs lose some of their real-world social skills by spending too much time in cyberspace. Ultimately, will these two groups of people converge?

COBRA Bites Back

Unless Congress takes action soon, the federal COBRA health insurance subsidy will run out this month, Kaiser Health News writer Andrew Villegas pointed out recently. For people who were laid off from their jobs or lost health care coverage because their work hours were reduced (a "qualifying event" that makes them eligible for COBRA), the federal subsidy covers 65% of the cost of extending their employer-based coverage for 15 months. This subsidy is only available for employees whose qualifying event occurred before May 31, 2010, however, so people laid off in June are out of luck.

Those who have benefited from the COBRA subsidy since March 2009 also hit the 15-month limit this month, Villegas stated, and now must pay full price for their COBRA benefits for the remaining three months of COBRA coverage (in most cases, COBRA coverage only lasts 18 months).  

Plans offered by employers (and extended by COBRA to unemployed workers) usually provide better coverage than anything available on the individual health insurance market. COBRA can be very expensive, however, as cash-strapped former employees must pick up the full cost of a health plan that their employer used to subsidize, along with a 2% administrative fee. One study found that paying full price for COBRA coverage could consume 84% of a laid off worker's unemployment check, according to MarketWatch reporter Kristen Gerencher. The federal subsidy helps make COBRA an affordable option for laid-off employees and their families.

Like unemployment benefits, COBRA was designed as a stop-gap measure, providing temporary coverage while an employee looks for a new job that will provide more permanent, employer-sponsored health insurance (or pays well enough for the employee to purchase individual health insurance). That formula does not work too well in this stalled economy, however. Because good jobs are hard to find, many people rely on COBRA and unemployment benefits for far longer than they were intended.

A while ago, I wondered whether the federal government might use COBRA as a vehicle for health care reform. What if the federal subsidy for COBRA continued indefinitely, allowing eligible ex-employees to continue to receive health care from high-quality private plans, regardless of whether they found a new job or not?

A COBRA subsidy extension might not happen, however, either in the long- or short-term, because it is both expensive and politically volatile for Congress to pursue. Meanwhile, many long-term or newly unemployed people and their families will need to pay much more for health care coverage under COBRA or individual plans, end up in federal or state programs such as Medicaid or the Children's Health Insurance Program, or go without insurance altogether.

Superfood Burnout

I think that the Baby Boomers, concerned about preserving their health as they age, are responsible for our obsession with "superfoods" that can protect us from disease. A while ago, the superfood of choice was antioxidant-packed pomegranate juice - particularly when marketed as the Pom Wonderful drink - which might prevent hardening of the arteries and prevent Alzheimer's disease (although the Pom Wonderful website is careful not to make these claims).

More recently, the acai berry, whose antioxidants might prevent cancer and heart disease, has pushed aside pomegranates as the food of choice. Other holier-than-thou, nutrient-rich foods that we should be eating include quinoa, spelt, and heirloom tomatoes.


Of course it's important to think about what you eat. This Sunday's New York Times had a cover article on the horrifying amount of salt in many processed foods, and salt's role in increasing the rates of high blood pressure in Americans. The food industry, meanwhile, is fighting to keep the salt in their foods to cover up the true flavor of their products' ingredients.


I support the slow food movement, avoid processed foods, and cook from scratch as much as I can. I prowl for stone fruit, corn on the cob, strawberries, and figs at the local farmers' markets when I have time. I have a budget, though, and I don't have hours to cook, or shop for the perfect ingredients, each day.

When exactly did eating healthy morph into an obsession with eating the perfect foods? I want my family to eat well, but that doesn't mean I'm sprinkling acai berries on their oatmeal in the morning.

And can you really enjoy your meals if you're too busy either feeling guilty for eating the wrong things, or self-righteous for eating the right ones? What does this superfood obsession say about us as Americans, who always seem to demand simple answers for complex problems such as heart disease?

Can We Afford to Keep Our Promises?

On June 1, Congress will decide whether to cut Medicare reimbursements to health care providers. This time, providers are looking at - and fighting - a 21% cut. If the cut goes through, providers who accept Medicare patients will need to choose between getting by with less income (Medicare already reimburses at lower rates than private plans), or dropping Medicare patients.

Realistically, with the powerful American Medical Association and other organizations lobbying hard to block the cuts, Medicare reimbursements probably will not be cut right now. As an alternative, Congress might freeze the current reimbursement rates for five years.

Unfortunately, the drama of threats to cut Medicare and lobbying to restore these cuts has been going on for years in Washington, with three delays in the proposed cut this year alone. Medicare reimbursement rates are based on a much-criticized GDP-based formula. As Robert Lowes explains in a cogent Medscape article on the cuts:

Right now, reimbursement is determined by the so-called sustainable growth rate (SGR) formula, which sets an annual target for Medicare spending on physician services based partly on the growth of the gross domestic product. If actual spending tops the target, Medicare is supposed to decrease physician pay the next year to recoup the difference. Congress has called off annual SGR-triggered cuts going back to 2003, so the gap between actual and targeted spending on physician services has continued to grow, resulting in the 21.2% decrease for 2010.

Congress has been slow to revise this formula to reflect the true cost of providing health care to seniors because it would be expensive to do so.

At the same time, President Obama is spearheading an international health initiative to prevent or treat certain tropical diseases such as river blindness and hookworm, reports Sabin Vaccine Institute President Peter J. Hotez in a New York Times Op-Ed. These "neglected tropical diseases" torment over one billion people in the poorest nations, but they are rare in the developed world, and as a result there has been little financial incentive to eliminate them.

Treating and preventing these diseases is not just an act of altruism. Because these diseases affect children's physical and mental development, preventing the diseases makes it easier for the world's poorest citizens to stay healthy enough to gain an education and care for their families. As a result, the economic and political stability of many troubled regions improves, ultimately improving our own national security.

But can we really have it both ways: provide health care coverage for U.S. seniors and the disabled, and help improve health care for the poor in other countries, while our unemployment rate is 9.9% nationwide, raising taxes scares politicians, and about 80 million Baby Boomers are poised to retire and draw on their federal benefits? Have we promised more than we can deliver? And if we have, what will we change to make it right?

Health IT Hits a Wall

It's hard (for me, at least) not to click on the headline "Up to half of Spanish-translated prescriptions include dangerous mistakes" as a May 12 Fierce Healthcare post declared. The post cited a recent Pediatrics study that found that translation programs used by pharmacies to create Spanish-language instructions for patients were deeply flawed.

The Pediatrics study evaluated Spanish medicine labels from 209 pharmacies in the Bronx, New York; most of the pharmacies used computer programs to translate instructions for patients from English into Spanish. Half of the the translated labels used a mixture of Spanish and English, or had grammatical or spelling mistakes, resulting in "inconsistent and potentially hazardous" translations, according to the authors.

"Phrases that were not translated included 'dropperfuls,' 'apply topically,' 'for 7 days,' 'for 30 days,' 'apply to affected areas,' with juice,' 'take with food,' and 'once a day,'" the Pediatrics study's authors wrote. Mistranslated phrases included the substitution of "eleven times a day" for the phrase "once a day."

The move toward e-prescribing, electronic medical records, and other technological advances is supposed to make the practice of medicine safer and cheaper. The famous 1999 Institute of Medicine report, "To Err is Human: Building a Safer Health System" which found that up to 100,000 people die in hospitals each year from medical errors, helped shift the needle toward more standardization and digitization of medicine.

The Centers for Medicare and Medicaid (CMS) encourages the adoption of electronic medical records (EMR) and will soon provide financial incentives to health care providers who adopt them. In February, FierceHealthIT pointed out that "a healthy $20 billion in IT spending [from the stimulus bill]... will largely be funneled through CMS to provide incentives for EMR adoption."

All good, if you support health care reform and patient safety. But throwing technology at problems has its limitations, as the Pediatrics study makes clear. The study's authors suggested more regulation of and funding for better translation programs. Meanwhile, other unresolved IT issues, such as ensuring the electronic security of patients' health information, will continue to pose challenges for health IT for a long time to come.