Hi baby.

Babies are such a nice way to start people.” – Don Herrold

I’d like to welcome my nephew William Cole Mariotti, born September 14, to the world. We’re really glad you’re here.

 It’s moving east.

Enterovirus D68 is making its way across the country. Enteroviruses are common this time of year, but experts believe this particular type is more serious. EV-D68 starts out like the common cold but can cause breathing difficulties and severe respiratory illness, particularly in children with asthma. As of last week, the CDC confirmed 80 cases in Colorado, Illinois, Iowa, Kansas, Kentucky, and Missouri. The virus is now on the east coast, with over a dozen cases in New York and four cases in Philadelphia.

Proper hygiene helps. Wash your hands. To reduce the spread of germs, cough and sneeze into your arm, not your hand. Then remember to wash your shirt. And stay away from my nephew.

 The Ebola epidemic. The U.S gets involved.

In a push to build clinics, distribute supplies, and train health care workers, the U.S. will dedicate $500 million and 3,000 troops to fight the Ebola epidemic in West Africa. The World Health Organization (WHO) estimates that 5,000 people have been infected with the virus and about half have died. The assistance from the U.S. is welcome. “Today, there is not one single bed available for the treatment of an Ebola patient in the entire country of Liberia,” said Margaret Chan, the WHO’s director-general.

 Obamacare, Explained

This will be a regular section that aims to explain parts of the 11,000-page law. This is a weekly newsletter. It will take years.

 The basics. It goes by several names: The new health care law. The affordable care act (ACA). Most commonly, Obamacare. The law was signed by President Obama in March of 2010.

It includes policies that do two main things: expand access to health insurance and change the way doctors get paid by the federal government.

What’s happening with coverage? As of May 2014, approximately 20 million Americans gained health insurance coverage under the ACA, and the percentage of uninsured Americans dropped from 18% in 2013 to 13.4% in May 2014. Not bad.

 Urgent care on wheels.

A fire rescue team and emergency room doctor teamed up to reduce unnecessary and expensive ambulance rides in the Denver area. “It’s not the prairie and the old West anymore, where you have to be missing a limb to go to the hospital. Now it’s a sore throat, or one day of cold or flu…” The duo created a “mobile care unit” in the form of a station wagon to visit lower acuity patients and treat them on-site. The care unit includes a suture set and miniature medical lab to complete blood tests. Needless to say, the station wagon clinic is far less expensive than the Emergency Room.

Some healthy diversity. 

Latinos comprised 3% of the nursing workforce and 17% of the nation’s population. By 2060, Latinos are projected to comprise nearly one-third of the U.S. population. Campaigns are under way to recruit more Latino nurses, as “having diverse providers makes it possible to deliver health care that’s meaningful, culturally appropriate and patient and family-centered.”

Wash your hands.

Did you know? In just 2-4 hours, virus contamination on a doorknob can spread through the entire room. Hand washing can slow the spread.

 Obesity in America

 Adult obesity rates in the U.S. remain high. According to The State of Obesity: Better Policies for a Healthier America, obesity rates have increased in 6 states – Alaska, Delaware, Idaho, New Jersey, Tennessee, and Wyoming. Socioeconomic disparities exist with people in the lowest income brackets having the highest rates.

Flashback for some perspective. Back in 2005, obesity rates increased in every state. All 50.

If you want more information about your own state, look at these cool graphics.

 Got old drugs?

 Unused prescriptions often sit around in people’s medicine cabinets. The Drug Enforcement Act (DEA) wants to change that. As of this week, the DEA will permit consumers to return pills to the pharmacy. One of the goals of this effort is to reduce the number of painkillers piling up in homes. More than 70% of teenagers say it is easy to get prescription drugs from their parents’ medicine cabinets.


 In his new book “Doctored: The Disillusionment of an American Physician,” Sandeep Juhar writes about the changing nature of medicine and the resulting dissatisfaction amongst doctors. Packed schedules, endless administrative work, and stagnant pay. Dr. Juhar notes, “In the mid-20th century, physicians were the pillars of any community…Today medicine is just another profession, and doctors have become like everybody else: insecure, discontented and anxious about the future.”

 That sounds familiar.

 The Freshman 15. The expression commonly used to refer to the amount of weight in pounds gained during a college student’s first year. The fresh 15 is “largely folklore,” as research shows that the average actual weight gain of college freshman is 2.5 to 6 lbs.

Is that right?

 Cigarettes? Not here. As of last week, all 7,700 CVS stores pulled tobacco products from the shelves. The decision was made back in February as the company tries to position itself as a health care destination. “When you stop selling cigarettes as a retailer, it sends a very big signal to the rest of the health care community that you are in the health care business,” said Tom Charland, the chief executive of Merchant Medicine, a health care research and consulting firm. Tobacco sales at CVS total about $2 billion a year.


The lone star tick.

Ticks are known to spread the bacteria that cause Lyme disease, which leads to rash, flu-like symptoms (fever, chills, fatigue), and joint pain. Lyme is treated with antibiotics and typically, patients make a complete recovery.

There’s a new tick in town. The lone star tick does not cause Lyme Disease. It contains a sugar called alpha-gal, which is also present in red meat and some dairy products. It’s fine when consumed in food but their bite triggers an immune reaction. From there, the body perceives the sugar that the tick transmitted as a foreign substance and creates antibodies against it. The next time the infected person eats meat. Bam. Allergic reaction.

This problem was discovered a few years ago but is growing as ticks spread. It’s now found throughout the South and eastern half of the U.S., as this map displays. At this point, it’s not clear if the allergy is permanent.

 One thirsty nut.

A number of studies illustrate the benefits of almond consumption. Almonds are known to provide cardiovascular benefits, help with weight loss and satiety, aid in the prevention of diabetes, and potentially decrease the risk of Alzheimer’s. They recently became the “most-eaten nut” in the U.S., bypassing peanuts.

The problem. The only state that produces almonds is California, where 82% of the world’s almonds originate. Each almond requires 1.1 gallons of water to produce. California is in the middle of a terrible drought. And almonds keep getting more popular.

A trim and a blood pressure reading.

A new program will train barbers in traditionally African-American communities to take their customers’ blood pressures and refer those with elevated readings to doctors. The hope is that the intervention can produce better blood pressure control.

An unconventional approach. High blood pressure disproportionately affects African Americans, who tend to develop it at younger ages and have more complications. It is often without symptoms so screening is important.

Reaching African Americans, particularly low-income men, has traditionally been a challenge for healthcare workers. Dr. Ronald Victor, the director of the Cedar’s Sinai Center for Hypertension in LA who leads the effort, says, “We have to leave the hallowed halls of medicine. Barbershops are the hub of a community.”

That sounds familiar.

Doula. Comes from a Greek word meaning “woman’s servant.” A doula is a non-medical person that provides emotional and physical support to a mom who is expecting, experiencing labor, or has recently given birth. Just this week, an article was published about the positive impact doulas have on C-section rates.

Is that right?

Baby talk is for the birds. A new study published in the journal Infancy found that engaging in conversation with babies could speed up their language development more than just talking at them. That’s right. The theory is that moms who act like they understand what their babies say and respond are introducing the concept that voices are a way to communicate.

Take 1.

Doctor, I think you misspelled abdominal. 

Open Notes, which began in 2010, is a national initiative that gives patients access to read their doctors’ and nurses’ notes about their appointment.

A little history here. Before the Health Insurance Portability and Accountability Act (HIPAA) was enacted in 1996, patients typically had to sue to see their records. Even now, the process can be difficult in many organizations.

How’s it going? Results of the first year are positive. Eighty percent of patients who saw their records reported a better understanding of their medical condition, and two-thirds reported they were better at sticking with their prescriptions. Even though many resisted initially, providers saw the benefit too. None withdrew from the pilot, and participation is growing.

Who is participating? The results started a movement to bring more transparency to medical records. Three million patients now have access to their providers’ notes. Participating sites include MD Anderson Cancer Center at the University of Texas; Beth Israel Deaconess Medical Center in Boston; Geisinger Health System in Danville, PA; and the U.S. Department of Veteran’s Affairs (VA).

 Drug tests for doctors in CA.

If passed, California Proposition 46 will require doctors to undergo random drug and alcohol testing and report positive results to the state’s medical board. It’s on the state ballot on November 4th, and a recent poll suggests it has support. This type of screening does not happen anywhere in the U.S., so CA would be the first state to implement.

Why screen doctors? Other industries, like airlines screen their pilots for drugs and alcohol as a way to keep passengers safe. Doctors have the same rate of abuse and addiction as the rest of the population. The proposition is intended to keep patients free of unnecessary harm. Critics argue that it’s costly and an invasion of privacy. Voters will decide in November.

That sounds familiar.

The July effect. A perceived increase in the risk of medical errors and surgical complications that occurs when U.S. medical school graduates begin their residencies. Usually July 1. A similar period in the United Kingdom is known as the killing season. Ours sounds less dangerous.

Your health matters too.

Smart start. Breakfast has long been considered the most important meal of the day. Until now. New research questions the idea that people who skip breakfast eat more or less healthy foods later in the day. A meta-analysis of studies published last year shows that skipping breakfast doesn’t necessarily lead to weight gain. The conclusion: Don’t force yourself to eat breakfast if you don’t enjoy it.

Is that right?

 200 times.  The August issue of the journal BMJ Open published a study that examined list charges for blood tests in 2011. The average cost for a basic metabolic panel was $371, but prices ranged from a low of $35 to a high of $7,303 (200 times more).