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Careers with the Highest Suicide Rates

March 20, 2015

In the US, suicide results in roughly 36,000 deaths per year. And since 2009 suicide has been the leading cause of injury-related deaths. A new study published in the American Journal of Preventive Medicine analyzes suicide trends in the workplace, identifying specific occupations with high incidents.

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Occupations with the highest rates?

  • Law enforcement officers (5.3 per million)
  • Farming, fishing, and forestry occupations (5.1 per million)
  • Installation, maintenance, and repair (3.3 per million)

This study compared workplace versus non-workplace suicides in the U.S. between 2003 and 2010. During that time period there were 1700 workplace suicides (a rate of 1.5 per 1 million) with an overall US suicide rate of 144.1 per 1 million. The study used data from the Bureau of Labor Statistics’ (BLS) Census of Fatal Occupational Injury (CFOI) database.

  • The workplace suicide rate was 15 times higher for men than for women, and almost four times higher for workers aged 65-74 than for workers 16-24.

Why the high rates in these particular categories? One hypothesis suggests an increased risk based upon availability and access to lethal means. This would include access to pharmaceuticals for medical doctors and firearms for law enforcement officers.

This might help explain the higher rates of death among members of the second two categories noted (i.e. farmers and maintenance workers) who would routinely work with heavy, potentially dangerous equipment, and would also face workplace stressors such as social isolation, higher rates of chronic injuries and pain, a high risk of financial loss, and chronic exposure to toxic chemicals including many types of pesticides and solvents.

“This upward trend of suicides in the workplace underscores the need for additional research to understand occupation-specific risk factors and develop evidence-based programs that can be implemented in the workplace,” concluded Dr. Hope M. Tiesman, epidemiologist with the Division of Safety Research at the National Institute for Occupational Safety and Health (NIOSH) and lead investigatory for the study.

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A Disease of Time

March 18, 2015

the evil hours

Post Traumatic Stress Disorder is a psychiatric disorder, the fourth-most-common one in America.  Over a decade into the global war on terror, PTSD purportedly afflicts as many as 30 percent of the conflict’s veterans. And the disorder’s reach extends far beyond the armed forces.

David J. Morris, who served in Iraq from 2004 to 2007, provides us with a new understanding in his recently released The Evil Hours: A Biography of Post-Traumatic Stress Disorder. PTSD, he notes, is “in a manner of speaking, a way of institutionalizing moral outrage.”

From Morris’s website is a brief summary of The Evil Hours: Drawing on his own battles with post-traumatic stress, David J. Morris — a war correspondent and former Marine — has written a humane, unforgettable book…Through interviews with people living with PTSD; forays into the rich scientific, literary, and cultural history of the condition; and memoir, Morris crafts a moving work that will speak not only to those with PTSD and their loved ones, but to all of us struggling to make sense of an anxious and uncertain time.

David Morris notes:

I first got interested in PTSD when I read a newspaper article about how some Iraq veterans felt “poisoned” by the war, as if it had fundamentally altered their existential position in the world. I am fascinated by this moral component of survivorship—how events in life can freeze us in time, seeming to render us unfit for the everyday world. This is essentially the same question confronted by Ishmael at the end of Moby Dick, as he looks out on the vast sea from Queequeg’s coffin: How does one live in the aftermath of the impossible?

The Evil Hours has been widely and quite favorably reviewed, from “an eye-opening investigation of war’s casualties” (Kirkus Reviews)  to “Well-integrated autobiographical elements make this remarkable work highly instructive and readable. (Publishers Weekly) Read more…

$30 Billion and Counting

March 12, 2015

digital sharingSince 2009 the American taxpayer, according to Kaiser Health News/NPR/Montana Public Radio, has spent about $30 billion on the installation of electronic records systems in hospitals and doctors’ offices. However, right now the ability of the systems to converse with one another — so that patient records can be tracked from one facility to another — is at about a 2 or 3 on a scale of zero to 10, according to Robert Wachter, a hospitalist at UC San Francisco, and to technology entrepreneur Jonathan Bush.

Wachter has authored the upcoming The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, on information technology in health care.

Up until now, he says, there has been a financial disincentive for doctors and hospitals to share information. For example, if a doctor doesn’t have a patient’s record immediately available, the doctor may order a test that has already been done – and can bill for that test. Keeping EMRs [electronic Medical Records] from talking to each other also makes it easier to keep patients from taking their medical records — and their business — to a competing doctor.

Karen DeSalvo, the federal government’s health IT coordinator, is now working on standards for how to share digital information. 2015 might just be the time to move medicine more into the digital age. Wachter notes that as about a dollar of every $6 in the U.S. economy is spent on health care, a new IT boom in that sector means there are billions of dollars to be made.

Transforming Medicine into an Information Science

March 9, 2015

blogimage_people_(1)Responding to data trends is not a new to the practice of medicine. A quick Google search reminds us that the scientific method itself is defined as “principles and procedures for the systematic pursuit of knowledge involving the recognition and formulation of a problem, the collection of data through observation and experiment, and the formulation and testing of hypotheses.”

But the Icahn School of Medicine at Mount Sinai, New York — along with several other major medical schools — is pushing the concept further. They’re turning directly to data science as a big part of the future of medicine and health care.

Mt. Sinai has recently added Jeffrey Hammbacher to their faculty. Hammerbacher is a number cruncher — a Harvard math major who went from a job as a Wall Street quant to a key role at Facebook to a founder of a successful data start-up. He was recruited by Eric Schadt, a computational biologist at Mt. Sinai who had concluded that medicine was ripe for a data-driven revolution.

Hammbacher leads a team whose objective is to alter how doctors treat patients someday. For example, Mount Sinai medical researchers have done promising work on personalized cancer treatments. It involves the genetic sequencing of a patient’s healthy cells and cancer tumor. Once the misbehaving gene cluster is identified and analyzed, it is targeted with tailored therapies, drugs or vaccines that stimulate the body’s defenses.

Mr. Hammerbacher’s team does not do the basic science. Other researchers do that. His group works on the “computational pipeline,” he said, with the goal of making personalized cancer treatments more automated and thus more affordable and practical. “It’s ultimately what cancer cures are going to look like,” he said. Read more…

One Procedure, Many Prices

March 5, 2015

A new report from Blue Cross Blue Shield, The Health of America analyzed the cost of hip and knee surgeries in 64 areas across the US and found that the amount charged for the same procedure in the same city varied by as much as 313%.high costs

The amount charged by the hospital is different from the amount negotiated by an insurer, which is itself different from the amount owed by a patient. That’s one reason deciphering hospital bills can be complex. It’s also a perfect example of why people can end up buried under a mountain of confusing medical debt if they are uninsured, lack good insurance, or simply don’t understand what their insurance plans actually cover.

“If you are in a plan that charges a $30 copay to see an orthopedist, that is your cost,” explained Dan Mendelson, the CEO of consulting firm Avalere Health and a former associate director for health at the federal Office of Management and Budget. But if you have a high deductible, if your surgery isn’t covered, or if you are uninsured, your already high costs may end up being three times higher just because you chose the wrong hospital.

Would these differentials in price exist if the patients had some skin in the game and they rather than their carriers were paying the bulk of the charge? Or if “skin in the game” meant more than meeting an annual deductible.  Though higher deductibles and co-pays do prompt patients and families to track expenditures and self-ration when possible, it’s not a step in the direction of making prices readily available or easy to understand.  And the disparities begs the question of why carriers like the Blues are willing to pay the higher prices when one of their insureds choose one of those hospitals.

When Does a Behavior Become a Disease?

February 26, 2015

binge eatingThere are plenty of behaviors which are bad for one’s health. Smoking and not getting enough exercise are two things which quickly come to mind. Binge eating. But are these disorders, or is it that their consequences can lead to disorders?

Is it that we create diseases to fit the profitable (and dangerous) cures? If binging is a disease, then so is anything done to excess. Recently binge eating, officially recognized as its own disorder in 2013 by the American Psychiatric Association, has received attention for a media campaign promoting the amphetamine Vyvanse to treat it. Retired tennis player Monica Seles has been hired by pharmaceutical company Shire as a paid spokesperson, appearing on talk shows from “Good Morning America” to “The Dr. Oz Show” to share her personal struggle with binge eating. And to plug Vyvanse.

One prominent eating-disorder specialist said that although Vyvanse showed promise, other treatments, like talk therapy, had more research behind them. And the use of Vyvanse is worrisome, with its classification by the federal government as having a high potential for abuse. In fact for decades, amphetamines, which suppress the appetite, were widely abused as a treatment for obesity.

“Once a pharmaceutical company gets permission to advertise for it, it can often become quite widely prescribed, and even tend to be overprescribed, and that’s a worry,” said Dr. B. Timothy Walsh, professor of psychiatry at the New York State Psychiatric Institute at Columbia University.

A Remarkable Man Confronts His Coming Death

February 20, 2015

By Brian Grant

Oliver sachsI awoke to this op-ed piece in today’s New York Times by Oliver Sachs. Tears formed. Sachs is a man who has contributed to medicine, literature, and entertainment through his writing and clinical care. And he is dying as his article describes. He is 81 and continues to contribute to the world. And when he departs, his legacy will continue with his passing. I will let his article speak for itself. Readers might enjoy clicking on the comments and seeing how other readers value and cherish his many gifts.

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