June 22, 2009

Student's Thoughts on "Living With Herbie"

Here is another touching essay on "Living with Herbie," written by a student at Strayer University. Thank you to Prof. Abramson and her student for sharing this with us.

Sadness. How could anyone be anything but sad after watching this video? I noticed tears coming to my eyes almost immediately. I stopped and thought, wait, I am a man…I am not supposed to be crying! But, how could I help myself from tearing up? Studying a disease like dementia means nothing until you put a sweet old man’s face to the condition and what it is doing to his family. I have studied dementia before and its effects, but that twelve minute video did more for me than an entire unit in class. The effects that the disease has had on Herbie’s daughter, Julie, on her family, and on Herbie, himself, were the most impactful parts of the video.

In the video, Julie said, “You have to look at care giving as a marathon, not a sprint.” The sacrifice that she is making for her father is remarkable. She recognizes that she will not stop at anything to provide the care that he needs for a better quality of life. She sacrifices time spent with her children, her husband, her friends, and time spent on herself in order to take care of him. I think that the fact that she does not hesitate to do so, and the fact that she is so committed to dedicating herself to whatever time he has left is admirable.
The commitment that Herbie’s son-in-law is making to his wife and to Herbie is also commendable. I was grateful to see that he was honest in the video. It must be so frustrating at times and anyone can see that he is nervous that life might turn out a certain way that he cannot help but become agitated. I am sure that some of his anger stems from that apprehension of growing old and from knowing who Herbie was before the onset of dementia. The honesty that he displays in the video had a huge impact on me, especially when he said, “What will happen when I can’t do twenty push-ups anymore?” I think it is a real fear that people face when they age. However, he stays committed to allowing Herbie a warm home and a beautiful family with whom he can spend his remaining days.

Finally, the impact that has had the most lasting effect on me was how much this must affect Herbie. In his moments of clarity, I wonder what he thinks about his situation. I wonder if he is looking down from the afterlife and feels appreciative or if he feels guilty? It must be such a struggle for someone who, as his girlfriend Ruth said, was as at one time “very, very savvy, and sophisticated,” to realize that he no longer is. It was easy to watch Herbie in the video because is a nice looking man who seems so sweet and sincere, but it was very hard to watch what this man had obviously become.

The effects that this debilitating disease has had on one family made me stop and think. The video gave me a ton of questions that I want answered. It made me wonder how many people would do for their loved ones what this family has done for Herbie.

June 19, 2009

THREE, the multimedia piece

I am thrilled to have my new book featured on the New York Times' blog, LENS, but I want to make sure people look at the moody and magnificent piece that my wife, Julie Winokur, produced as a multimedia companion for the book. The idea of triptychs that formed the book THREE grew from what was really an idea for a print. To transform that initial vision into book form took reinterpretation of the original idea. To create THREE the multimedia piece was a further interpretation of my original idea. Please take a look and if you like it, pass the link on. One of the musical pieces was created by our 11 year old daughter, Isabel, so I am proud of it on multiple levels. Watch, relax and let this piece take you somewhere else.


June 12, 2009

Ed Kashi will be teaching a Documentary Photography Workshop in Colorado in August

Greetings from my last day in the Niger Delta, finishing up on a new film here. I want to mention that I'll be teaching a documentary workshop in August in Fort Collins, Colorado for The Center For Fine Art Photography. I recently juried their photo contest and am looking quite forward to visiting their center and teaching this 3 day workshop. While there I will also be giving a public lecture. If you plan to be in the neighborhood or live close by, please sign up.

Colorado Workshop Info

June 9, 2009

Our broken health care system MUST be mended

Decision Makers Differ on How To Mend Broken Health System

By Ceci Connolly
Washington Post Staff Writer
Tuesday, June 9, 2009

Nowhere else in the world is so much money spent with such poor results.

On that point there is rare unanimity among Washington decision makers: The U.S. health system needs a major overhaul.

For more than a decade, researchers have documented the inequities, shortcomings, waste and even dangers in the hodgepodge of uncoordinated medical services that consume nearly one-fifth of the nation's economy. Exorbitant medical bills thrust too many families into bankruptcy, hinder the global competitiveness of U.S. companies and threaten the government's long-term solvency.

But the consensus breaks down on the question of how best to create a coordinated, high-performing, evidence-based system that provides the right care at the right time to the right people.

During eight years in office, President George W. Bush took an incremental approach, adding prescription drug benefits to the Medicare program for seniors and the disabled and expanding the number of community clinics nationwide. President Obama, like the last Democrat to occupy the White House, contends that was insufficient and is pushing for an ambitious reworking of the entire $2.3 trillion system.

Framed by President Bill Clinton 16 years ago as a moral imperative to deliver health care to all, this summer's historic debate comes against a more urgent backdrop. As the national unemployment rate nears 10 percent and giants such as General Motors crumble, the expensive, inefficient health system has deepened the country's economic woes.

By virtually every measure, the situation has worsened.

Today, about 46 million Americans have no health insurance, so they go without or wait in emergency rooms for expensive, belated care. Everyone else helps pay for that Band-Aid fix in the form of higher taxes and an extra $1,000 a year in insurance premiums.

Pockets of medical excellence dot the landscape, but at least 100,000 people die each year from infections they acquired in the hospital, while 1.5 million are harmed by medication errors. Of 37 industrialized nations, the United States ranks 29th in infant mortality and among the world's worst on measures such as obesity, heart disease and preventable deaths.

Bright young physicians trained at prestigious and expensive universities enter a profession built on perverse financial rewards. They, like assembly-line workers of the past, are paid on a piecemeal basis, earning more money not by doing better but simply by doing more.

Yet more care rarely translates into better health. Extensive research by Dartmouth College has found the exact opposite: Health outcomes are often best in communities that spend less compared with cities such as Boston and Miami where the medical arms race of specialists and high-tech gadgets often leads to greater risks and injuries.

The Institute of Medicine estimates that one-third of all medical care is pure waste, such as duplicate X-rays, repeat lab tests and procedures to fix mistakes.

"Most Americans don't understand how bad health care in the United States is," said Michael F. Cannon, head of health policy at the libertarian Cato Institute. "We need big reforms."

Across the ideological spectrum, the diagnosis is remarkably consistent.

"Sure, some people here have the best health care in the world, but the average American is paying too much and not getting enough in return," said John D. Podesta, who led Obama's transition team and heads the Center for American Progress, a think tank.

Said Sen. Judd Gregg (R-N.H.): "What's tragic is that so much of this spending is on duplicative or unnecessary care that doesn't improve health outcomes."

Simply put, the goal of health reform is to finally get our money's worth, say industry leaders, policymakers, consumers and business executives.

They envision a health-care system that guarantees a basic level of care for everyone, shifts the emphasis to wellness and prevention, minimizes errors, and reduces unnecessary and unproved treatment. Such a system would coordinate care, track patients and doctor performance electronically, and reward good results. The high-value system of the future would be organized "so that people get the care they need and need the care they get," said Elizabeth A. McGlynn, associate director of the health research division of Rand Corp.

Nowadays, that is often not the case.

On average, Americans receive the recommended, proven care 55 percent of the time, according to Rand studies. Sometimes, doctors or nurses overlook a basic but critical step, such as prescribing a beta blocker medication to patients after a heart attack, a therapy shown to significantly reduce the risk of a fatal attack. At other times, patients undergo procedures when there is no evidence that they are any better than a simpler, cheaper alternative.

Ten years ago, in its landmark report "To Err is Human," the Institute of Medicine estimated that 44,000 to 98,000 people die each year from medical mistakes, highlighting the need for improvement. Since then, the tally has risen, said Janet Corrigan, president of the National Quality Forum, a nonprofit membership organization that promotes quality standards.

"We now know estimates of those who die from hospital-acquired infections is upwards of 100,000," she said. "Many of those, if not most, are avoidable and preventable."

Sen. Robert C. Byrd's recent hospital stay, for example, has been extended because the West Virginia Democrat developed a staph infection.

"Everyone agrees that hospitals are hazardous to your health," said Mitchell Seltzer, a consultant who advises large medical institutions. "For every day a patient is in a bed, they are subjected to a higher probability of medical errors, hospital-acquired infections, inappropriate tests that do not have a direct bearing on the medical condition being treated."

Part of the problem is cultural, said Rand's McGlynn.

"People tend to demand the new thing even if there's not much evidence it will make a difference in the length or quality of life," she said.

Few patients or physicians have any idea who delivers good, or bad, care, because few organizations track results. Consumers have more information to evaluate their cars than they do their surgeons.

"It's like a doctor flying the plane without instruments," said James N. Weinstein, a spine surgeon who directs the Dartmouth Institute for Health Policy and Clinical Practice.

Obama set aside $19 billion in his economic stimulus package to promote the use of digital records, on the belief that they reduce duplication, produce more consistent care and cut down on errors.

Because the fee-for-service payment system rewards quantity over quality, there is little incentive -- and there are even disincentives -- for doctors, nurses and hospitals to improve, Corrigan said.

"Is it a surprise we have lots of extra imaging tests and lab tests?" she said. "Not at all."

The consequences are especially glaring in regions with larger numbers of specialists and pricey technology, the Dartmouth data show.

Take the case of Miami vs. La Crosse, Wis. In 2006, using inflation-adjusted figures, Medicare spent $5,812 on the average beneficiary in La Crosse, compared with $16,351 in Miami. Yet an examination of health status in both places, adjusted for age, finds no evidence that the extra spending resulted in better care, Weinstein said.

"That's the enigma here," he said. "Less is more, and more isn't better."

Physician behavior and spending patterns in Medicare have been good indicators of broader trends across the nation, Dartmouth has found.

Even the best physicians cannot stay current with all of the drugs, tests and treatments available today -- another reason to digitize modern medicine, Corrigan said.

Many fear that the push to contain costs will result in rationing.

In today's system, "we don't ration care, we ration people," said Donald M. Berwick, president of the independent Massachusetts-based Institute for Healthcare Improvement. "We know that if you are black and poor or a woman, there are all sorts of effective interventions you are not going to get."

Though the transition would be painful and the politics treacherous, Berwick said it is possible to spend less on medical care and have a healthier nation.

"If we could just become La Crosse, think of how much better off we would be," he said.

The original article at The Washington Post

June 4, 2009

Medical bills cause personal bankruptcy

According to a new report by the American Journal of Medicine, medical bills are involved in 60% of personal bankruptcies in the United States. If you're still not convinced that our nation's health care system is in dire need of a major overhaul, then how about this fact: More than 75% of these bankrupt families HAD health insurance!

Click on the links below to learn more about the AJM study.