StemCell Therapy

More than 116,000 Americans are waiting to receive an organ transplant, and about 20 die each day during the wait. Scientists are eager to find solutions to the organ shortage.

That's why a recent landmark report in the journal Science, which detailed the creation of piglets that could potentially provide organs for human transplants in the future, is being heralded as a real game changer. R esearchers from Harvard University, the biotech company eGenesis and other institutions explained how they used cloning and the gene-editing technology CRISPR to create pigs that may be used for human organ transplants down the lineif further research proves them safe and effective.

The findings have obvious implications for the many people waiting for a transplant. But one of the lead study authors, George Church, a geneticist at Harvard and founder of eGenesis, says the promise of pig organs that are compatible with humans may be even bigger. If pig organs could be engineered to be even healthier and more durable than the average human organwhich Church believes is possiblethey could have a profound effect on human health and longevity, he says.

Pig organ research is still in very early stages, and the researchers, including Church, say they are still years away from fully understanding whether pig organ transplants are even safe.

In this study, Church and his colleagues were able to create piglets free of the viruses that would make them unsuitable for human transplant. Church believes that scientists may be able to take it one step further and engineer pig organs to be free of disease and resistant to cancer and some age-related deterioration. One thing about pig organs that I find even more attractive than just helping the transplantation crisis is that it can be preventive medicine, says Church. People who need an organ transplant who are a high risk for hepatitis B, for example, may benefit from a liver engineered to be resistant to the disease. Cells and organs which are resistant to cancers, pathogens and senescence could be better in a preventative sense than the normal human organs which are being replaced, he says.

They may also be fresher, he says. "Many transplant surgeries are canceled with the patient on the operating table because the replacement organ is a few hours too old.

If the use of pigs as organ donors eventually becomes an approved procedure, Church says it could be possible to keep live pigs on site at a hospital. He believes it may also be possible to engineer their organs to be safely preserved though cryopreservationfreezing tissues for storageor other methods, he says, which could cut down on transplant time.

MORE: The New Transplant Revolution

Church says that pig organs could potentially also be engineered to be better matches for recipients, which may reduce the likelihood that the recipients immune system rejects the organ. Heart valves from pigs have already been successfully transplanted into patients. Organ rejection is currently a serious risk, and people who receive an organ transplant must take potent drugs that suppress their immune system to prevent rejection. But the drugs, which are powerful and taken for a person's entire life, also increase their odds of health problems like infections or heart disease.

Even people who do not need a transplant, but want an elective one, may someday benefit from these porcine organs, Church says, though that is a very long way off. The whole idea that we are not going to enhance anyone, I think, is a fake promise, he says. " It would have to start with augmented or enhanced organs needed to deal with patients in very tough life and death conditions in which 'conventional' organs are likely to fail."

Again, the research is still early. But Church says that clinical trials in humans could start in as soon as two years.

Arthur Caplan, a bioethicist at NYU School of Medicine who has studied and written about the ethics of organ transplantation, says he doesnt see a problem with enhanced organs described by Church, instead calling them highly desirable.

It would open the door to use of organs from cancer victims and reduce risk of transmitting viruses, Caplan said in an email response to TIME. I see no downside.

The biggest priority would be to engineer organs that are less likely to be rejected, Caplan adds. The drugs used now to prevent rejection have terrible side effects, but there is no choice. Disease transmission is a real problem, but engineering a 'universal' supply of organs would reduce terrible toll from rejection and cost of drugs.

Before humans are able to use organs from pigs, Caplan says safety studies are required, recipients should be warned about possible risks and experts need to think about who gets priority. It will still likely be several years until physicians are debating these questions, but its clear at least some scientists are considering the possibility.

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Why People May Have Pig Organs Inside Them One Day - TIME

August 25, 2017 -As value-based care emphasizes preventative medicine, healthcare stakeholders aim to address social determinants of health to improve and maintain outcomes. But the lack of appropriate public health funding at federal, state, and local government levels prevents the healthcare system from developing the necessary infrastructure, a recent Health Affairs blogpost stated.

Former ONC National Coordinator Karen DeSalvo, MD, MSc, and Milken Institute School of Public Health professor Jeffery Levi, PhD, explained in the blogpost that out of the $3 trillion spent on healthcare, only about 3 percent goes to public health.

Public health is the natural and historic bridge between the healthcare system and the community both in terms of linking the healthcare system with services and organizations that address health-related social factors and in creating healthy conditions in the community, they wrote. But the sad truth is, the public health infrastructure is struggling to step up to serve as that bridge. Like other parts of our nations infrastructure, it has been chronically underfunded.

The industry experts added that the differential in healthcare versus public health funding may be even greater. Per capita healthcare spending is about $9,990, CMS estimates. But spending on key public health functions is roughly $109 per capita, including $22.66 of federal sources, $31.26 of state sources, and $55 of local sources.

The healthcare versus public health funding gap equates to over a 90-to-1 differential in spending.

DeSalvo and Levi pointed out that the national data does not reflect variations in state and local funding mechanisms for public health, indicating that the differential will rise according to zip code.

Without appropriate funding, government-based public health initiatives are failing to maintain their statutory responsibilities let alone address the rising demand to address social determinants of health through healthcare system partnerships, they stated.

To advance public health infrastructure and initiatives, DeSalvo and Levi offered four financing models that address the core values of public health, such as providing foundational public health services to all regardless of location, granting flexibilities to communities to meet specific health needs, incentivizing partnerships between public and private entities, and ensuring initiatives are data- and evidence-driven.

First, the federal government could create incentives for developing local public health capacity. Under this option, the federal government would match state investments for federal public health programs.

The financing structure mirrors the federal matching method in the Medicaid program, which aims to incentivize states to act as partners in achieving a shared goal.

Second, policymakers could establish value-based reimbursement models. CMS and CDC would collaborate to create and test value-based reimbursement arrangements that support partnerships between public health and healthcare system entities.

Third, the federal government could promote private sector investments in public health by identifying innovation partnerships between public and private organizations.

There is exciting, but nascent, interest in venture capital approaches to advancing population health and public health capacity through pay-for-success models, including the use of social impact bonds, wrote DeSalvo and Levi. The ability of any governmental agency to take on risk is very limited, but through partnerships with foundations there may be ways to demonstrate value for private sector investment in population and public health.

Fourth, policymakers could widen potential public health revenue sources. For example, a portion of health insurance premiums in each state could be reallocated to public health funds at the state and local level.

The federal government could also use revenue generated from a national sugar-sweetened beverage tax to boost public health financing. The tax would also encourage healthier lifestyles.

The industry experts emphasized that potential public health funding solutions may exist. But until policymakers adopt a financing structure to advance public health, successful initiatives may only be examples, rather than national standards.

At the end of the day, we must acknowledge that public health is part of the vital infrastructure of a modern, secure, economically competitive, and just nation, they stated. This means that public health will need robust, durable, and flexible funding to save lives not just in disaster but also every day.

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Scarce Public Health Funds Block Social Determinants of Health Aid - RevCycleIntelligence.com

Much like the Spanish Inquisition busting through my front door, this was completely unexpected. Square Enix talked a big game when they first announced Final Fantasy XV, pledging a steady support of content for the long-gestating latest entry in the core franchise. Why work on a sequel when you could take a pretty decent game and slot in new adventures ad-hoc for it, right?

If you do that full sequel model of expanding on an IP or a series, its good in certain ways. The negative of that is theres a very large open period where youre not releasing anything, director Hajime Tabata still said to Polygon.

Which makes sense, as Final Fantasy XV is plugging itself into the Animus to bring players all manner of Assassins Creed content in a crossover with Ubisofts premiere franchise of back-stabbery. No really, this is actually happening. August 30 will see the city of Lesatalium put on an Assassins Festival as Noctis and co. suit up in the garb of a familiar brotherhood. Heres a trailer to prove that I havent been smoking medical marijuana again. And even if I had, its for my glaucoma. I know I dont have glaucoma but its preventative medicine, okay?

That looks like a pretty decent slice of crossover action, borrowing quite a few familiar mechanics from the popular series. I kind of dig collaborations like this. Ubisoft has yet to mention if their upcoming return to the world of Assassins Creed will have a few Final Fantasy links, but I wouldnt be surprised if a certain stupidly massive sword or some familiar faces pop up as Easter eggs in that game come October 27.

Read Krillin and Piccolo are joining the roster of Dragon Ball FighterZ

A year on, and the future is still looking bright for Final Fantasy XV with an upcoming PC port and Ignis DLC in December thats keeping Square Enixs biggest franchise relevant in an ever-changing digital landscape.

Last Updated: August 25, 2017

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Final Fantasy XV is heading into the Animus with Assassin's Creed DLC - Critical Hit

When it comes toCBD, or cannabis in general, little research has been done on cats and dogs. Are cannabis preparations safe for use in animals? Does marijuana affect pets the same way as humans? Many pet-owners are looking for something to support their animals health, but there is little quality control with respect to the numerous pet-focusedCBDproducts that are available in the medical marijuana sector and the hempCBDgrey market. And there arent many trusted, educated individuals who can provide professional guidance on cannabinoid therapies forpets.

To help pet-owners become better informed about the use of cannabis for their four-legged companions, Sarah Russo of ProjectCBDspoke withGary Richter,DVM, an integrative medicine veterinarian based in Oakland, Calif. Richter considers cannabis to be part of a holistic approach to animal medicine. Due to marijuanas Schedule I status, veterinarians are not allowed to write letters of recommendation for their clients or tell them where to obtain cannabis medicine. But Richter is able to speak about the benefits ofCBDand cannabis therapeutics forpets.

ProjectCBD:Can you tell us about your work? Based on what youve seen in your practice, what types of conditions may cannabis medicine alleviate inpets?

Richter:My practice applies western, complementary, and alternative approaches. That could include acupuncture, chiropractic, Chinese and western herbs, nutritional supplementation, and more. Animals can benefit from medical cannabis for many of the same reasons it helps peoplefor pain, seizure control, gastrointestinal disorders, anxiety-related issues. Weve also seen positive results withcancer.

ProjectCBD:Why is there a lack of research studies on cannabis in dogs and cats? What areas of cannabinoid medicine in animals would you like to see investigated moredeeply?

Richter:I think ultimately the reason for the lack of therapeutic-oriented research is because cannabis is federally illegal and theres no funding. Generally, its pharmaceutical companies that are putting most of the money into medical research. Once theres a legal pathway and money to be made in veterinary products, that research will happen. I would like to see more general research on the use of cannabis in animals, focusing on some of the ailments that it seems be the most effective forespecially gastrointestinal issues, pain, and inflammation. Many veterinary patients see dramatic effects with cannabis for these ailments. Cancer studies would be a much longer road and more challenging to puttogether.

ProjectCBD:What is your response when veterinarians say: There isnt enough scientific data to show cannabis is safe and effective for treatinganimals.

Richter:In a perfect world, we would benefit from more scientific information. However, the case reports and anecdotal evidence about the efficacy of cannabis medicine are already overwhelming. In veterinary medicine, practitioners typically have no problem using off-label medicationsthose not explicitly approved for use in dogs or cats. But mention medical cannabis, which has a mountain of evidence for efficacy in humans, and they suddenly say, You cant do that, theres been no research on dogs! Itsdisingenuous.

ProjectCBD:Is there a difference between the endocannabinoid system in a dog or a cat as compared to ahuman?

Richter:In the big picture, theyre very similar. One striking difference is there appears to be a greater concentration of cannabinoid receptors in the dogs brain than there are in most other animals. This is significant because it makes dogs more susceptible toTHCoverdose, potentially giving them a certain amount of neurologic impairment in the short-term. This phenomenon is known as static ataxia. Otherwise, when cannabis medicine is used effectively, their endocannabinoid system will act in the same way it would for ahuman.

ProjectCBD:IsTHCcombined withCBDbeneficial for pets? If so, whatCBD:THCratios do you suggest for yourclients?

Richter:It depends on both the condition thats being treated as well as the individual animal. Many people in the cannabis community have heard about theentourage effect. The ratio ofTHCtoCBDis an important part of that. There are conditions that respond better to medicine with a certain amount ofTHCin it. The ratios that I have used include hemp-basedCBDwith very littleTHC, as well asCBD-rich marijuana with a 20:1CBD:THCratio andTHC-dominant medicine with littleCBD. The research suggests that patients with cancer and chronic pain benefit from products that haveCBDandTHC, rather thanCBDalone. It reallydepends.

ProjectCBD:Do you see animals coming into the veterinary hospital after having too muchTHC? How much of a problem isthat?

Richter:Obviously whenever were talking aboutTHCand pets, dosing becomes very important. At no point is the goal for the pet to get stoned. If that happens, then it means theyve gotten too much. The aim is to give them enough cannabis to be effective, but not so much that theyre going to be negatively compromised. It is extremely uncommon to see an animal show negative signs when they have been properly dosed with cannabis as medicine. The worst effect would be drowsiness. If thats that case, the owner may have to decrease the dose. Its not uncommon for a dog, or sometimes a cat, to show up at a veterinary hospital having eaten a cannabis-infused edible that belonged to the owner. The good news is that cannabis toxicity is nonfatal and does not cause long-term effects. However, those animals that get into their owners stash may require immediate medical care. I have seen and heard of a couple of cases where pets did notsurvive.

ProjectCBD:But you just said that cannabis toxicity in nonfatal. Youve seen cases where an animal ate too much cannabis and actuallydied?

Richter:One case that I have personally seen was a dog that got into a bunch of cannabis edibles and the owner didnt bring his dog to the veterinarian immediately. They called us the following day. Unfortunately, the dog had vomited and aspirated while at home, his lungs filled with fluid, and he wound up dying from a systemic infection related to that. To be honest, if this dog had received medical treatment the day he ate cannabis, he almost certainly would have been fine. It was only because the owner waited, and by that time it was too late. It was very sad. But this type of event is really quiterare.

ProjectCBD:Whats your preferred way to administer cannabis medicine toanimals?

Richter:I prefer a liquid preparation, usually an oil. With liquids, its very easy to adjust the dosage. If youre giving something like a pill or an edible, it can be difficult to figure out how to titrate the right amount. Furthermore, theres every reason to believe thatCBDandTHCare going to be partially absorbed directly into the bloodstream through the tissues of the mouth, sublingually. If we put a liquid in an animals mouth, some of the medication will be absorbed directly and has a chance to be moreeffective.

ProjectCBD:A lot of people say they want to start giving cannabis orCBDmedicine to their pet, but theyre not quite sure about the right dose. Is there a good way to calculate the ideal amount for youranimal?

Richter:Theres a dosing range that you could start at. Its best to begin at the low end. Every few days, slowly increase the dose. If youve achieved the desired effect for whatever is being treated, then youre probably done. Just like people, animals will develop a tolerance for the psychoactive effects of theTHC. Over time they will be able to take more medicine without any demonstrable side effects. Medical cannabis is not the answer for all pets. Some animals do better on it than others, just likepeople.

ProjectCBD:In general, how knowledgeable are veterinarians about cannabistherapeutics?

Richter:This is a big problemthe lack of education. The California Veterinary Medical Board is very much against the use of medical cannabis for pets. They dont want veterinarians speaking with pet owners about it at all, except to say that it is bad and not to useit.

ProjectCBD:What is the legal status ofCBDas a medicine foranimals?

Richter:Cannabis is federally illegal across the board, includingCBDfrom hemp. Even in California, a trailblazing medical marijuana state, as a veterinarian Im not able to provide people with a medical marijuana recommendation for their pet. Nor am I able to provide them with cannabis products. But I can talk with people about how medical cannabis might benefit their animals. Unless something dramatic changes on the legal front, theres still going to be access problems for people looking to get medicinal cannabis for theirpets.

ProjectCBD:Any words of advice for someone who wants to treat their pet with cannabis orCBD?

Richter:If at all possible talk to a veterinarian. Cannabis is medicine and its dosing should be carefully calculated. Its important to know the concentration ofTHCandCBDin milligrams for ones pet. Once you have that information, you can look for a product that suits your pets needs. When in doubt, err on the side of under-dosing because you can always slowly increase the dose and monitor the effect. And make sure the medicine is free of mold, pesticides, and othercontaminants.

ProjectCBD:There are many hemp-basedCBDproducts on the market for pets. How do you feel about the quality of these products in general? What are your thoughts about hemp-derivedCBD?

Richter:I dont want to disparage hemp-basedCBDproducts because I think they do have a positive medical effect. Many people start with hemp products because of their relative ease of accessibility. But in many cases, we dont know the source of theCBDin these products. I recommend that people do their due diligence as they should with any vitamin or supplement. Call the company and ask where the product is coming from and how its being produced. There is no government oversight to make sure that these companies are selling authentic and safe products. A pet owners only other option is to get a card and go to a medical marijuana dispensary if they want something that may be more effective than hemp-derivedCBD. Ideally, you would look for a product that is organic and produced locally. You want to know how theCBDwas extracted and the full spectrum of cannabinoids that arepresent.

ProjectCBD:Are there any guidelines or recommendations you have for people who want to make their own cannabis preparations for theirpets?

Richter:Thats tricky. You wont know the concentration of cannabinoids in what you make at home, unless you have it analyzed. If you do use your own preparation, start with extremely minute dosing and slowly work your way up. Youd much rather under-dose thanoverdose.

ProjectCBD:Sometimes people who dont have medical complaints like to take cannabis as preventative medicine to maintain good health and well-being. Would you recommend something like that for ananimal?

Richter:Thats an excellent question I have often asked myself. The purpose of the endocannabinoid system is to maintain homeostasis within the body. Its logical to consider using cannabis as preventative medicine much in the same way that a person would take a multivitamin. If thats the case, I would consider keeping the dosage toward the very low end. We need to see more research on the use of cannabis as preventative medicine in people as well asanimals.

ProjectCBD:Are there any resources for people to educate themselves about cannabis medicine for pets or to find a cannabis friendly veterinarian in theirarea?

Richter:Firstly, I would say talk to your regular veterinarian about cannabis. Even if they cant give you the information, they may know someone in the area that can. Additionally, there is a national organization called the American Holistic Veterinary Medical Association (AHVMA). It isnt a given that a member of theAHVMAincorporates medical cannabis into their practice, but most people who are open to it are also holistically minded. That would be a good place to find a veterinarian and to begin a conversation. For resources, a colleague of mine and I taught anonline course for Greenflower Media. The class provides a comprehensive description of how medical cannabis works in pets, ways to dose, and how to find a good product. And I have a book coming out later this year. Its calledIntegrative Health Care for Dogs and Cats. It has a whole section on medical cannabis, with dosing guidelines. A colleague of mine, Rob Silver, released a book last year calledMedical Marijuana and Your Pet.

ProjectCBD:Thank you for your time andinformation.

Take-Home Message:If you decide to give your pet cannabis medicine, get informed. The medicine you give your animal should have the same standards for anything you would put in your own body. Make sure the product is safe and tested for cannabinoid content, quality, and is free from any contaminants or additives. Seek guidance from a vet, if at all possible. Start your furry friend off on a low dose of cannabis medicine. And monitor the effects that cannabis has on their experience because, as George Eliot wrote, Animals are such agreeable friendsthey ask no questions, they pass no criticisms.

This story was originally published by Project CBD,a California-based nonprofit dedicated to promoting and publicizing research into the medical uses of cannabidiol (CBD) and other components of the cannabis plant.

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One Vet's Opinion On Marijuana As Medicine For Your Pet - The Fresh Toast

Prostate cancer may be the most common non-skin cancer in the human race. Most men, if they live long enough, will develop the disease.

And yet, prostate cancer is also extremely unlikely to kill you. After five years, the survival rate is a whopping 98.6 percent. It's a paradox of medicine that we are only beginning to understand.

With prostate cancer treatment prone to significant impact to quality of life, a positive diagnosis for prostate-specific antigen, which is currently the disease's clearest marker, raises a difficult question for doctors: Is it wise to aggressively attack the tumor when treatment may be more dangerous than the disease?

With so much confusion about when to test and when to treat, the latest federal recommendations regarding prostate cancer screening from the U.S. Preventive Services Task Force (USPSTF) are incredibly important. They encourage thoughtful, informed conversations between primary care physicians and their patients in regards to the pros and cons of prostate cancer testing, and correct a dangerous trend of ignoring the disease completely.

Avoiding unnecessary risk

If prostate cancer could be treated without causing harm, every male would get tested regularly. Unfortunately, removal of tumors too often leads to impotence, incontinence and a range of other troubling outcomes, including the rare loss of life.

Because testing can also result in false positives, which can in turn lead to aggressive treatment, many men end up suffering from side effects without ever having been at risk for harm.

To help clarify such complex care situations, the U.S. Public Health Service established the USPSTF in 1984. Composed of experts in preventative medicine, the task force regularly evaluates the pros and cons of a wide range of tests and treatments, not just in cancer.

Based on the high risk of side effects that might damage quality of life, and the low risk of death from the cancer, as far back as 2008 the USPSTF recommended against screening for prostate cancer in men aged 75 or older, and in 2012 even recommended most men not get a PSA test. Sadly, in practice, those recommendations have been interpreted too bluntly.

Prostate cancer is deadly, for some

More than 28,000 Americans die from prostate cancer every year.

As an oncologic urologist, I treat prostate cancer patients daily. For those who have metastatic prostate cancer, where it spreads throughout the body, it is a terrible disease.

Recent studies have shown that since the earlier USPSTF recommendations, the number of patients diagnosed with high-risk prostate cancer the ones with advanced disease from day one have started to go up. Tragically, advanced disease is very difficult to cure.

While more data must be gathered, there appears to be an association between the national shift away from prostate cancer screening and a rise in patients diagnosed too late for us to heal them.

Thats why I'm encouraged that the USPSTF has released new draft recommendations, shifting from ruling out screening to advocating for individualized approaches, tailored to each patient, that arise from open conversations between patient and primary-care physician to address all pros and cons.

Those conversations will be important, and that shift towards recognizing the value of monitoring for some patients will encourage insurance companies to cover the test, as some had stopped doing so.

Better knowledge, better care

I regularly use robotic-assisted surgical tools and other techniques to limit side effects from prostate cancer treatment, and work with each patient and our team to develop a cancer plan that heavily weighs quality of life. However, for most prostate cancer patients, careful monitoring is still the best course of action, not treatment.

For those of us in urology, our experiences and a growing data set have convinced us that testing is critical, but the test does not dictate how to proceed. Instead, it informs decisions that also weigh each patient's individual history, genetics and wellbeing.

In the past, oncologists did not understand how to stratify prostate cancer patients according to risk, and we ended up treating too many patients who were never going to have a problem with the disease. Treatments continue to improve, as does the recognition of the critical importance of quality of life for cancer survivors.

All men should have a conversation with their primary care physician and urologist about prostate cancer, and the pros and cons of testing and treatment. With a shift away from urgent cancer removal to monitoring over time, medicine is arriving at a more balanced approach for prostate cancer. The latest USPSTF recommendations are a step in that direction, and a welcome change that, in time, will save lives.

Dr. Ahmad Shabsigh is a board-certified oncologic urologist at The Ohio State University Comprehensive Cancer Center Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. In addition to diseases of the prostate, he treats a wide range of urological cancers.

The views expressed by contributors are their own and not the views of The Hill.

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The latest federal guidelines on prostate cancer screenings are important - The Hill (blog)

I had to fight for my own health and fired many doctors

Conventional medicine refers to the health care system in which medical doctors, nurses, pharmacists, or therapists treat symptoms using drugs, radiation, or surgery. Alternative or complementary medicine, on the other hand, references medical treatments that are not considered orthodox by general medicine, such as herbalism, homeopathy, or acupuncture.

Complementary medicine techniques are the future of medicine at this point as more insurance companies are recognizing the values of preventative medicine, said Anne Williams, physical therapy specialist at Mountainside Physical Therapy and one of many local practitioners in a brisk, thriving alternative medicine community.

Williams believes the biggest problem with traditional medicine is that doctors are under so much stress to see so many patients that some they care for fail to receive the attention they need. This phenomenon may eventually cause a turn toward alternative medicine. Indeed, the National Center for Complementary and Integrative Health estimates that around 38 percent of adults (4 in 10) use some form of alternative medicine.

You have to evaluate the whole person, and that doesnt get done in a regular medicine system, she continued. I always see my patients as an individual puzzle. I try to fix that puzzle.

At Mountainside, Williams makes it her mission to focus on total health and healing, focusing on only one patient per hour, and she espouses a variety of therapy techniques.

Williams practices manual physical therapy, a special type of physical therapy delivered with the hands not a device or machine, as is done in many physical therapy practices. Williams says this technique physically alters patients abilities to perform an exercise or stretch a specific body part. In addition, she often welcomes into her practice those who offer Pilates, dance, aquatics, animal-assisted healing, art healing or nutrition classes to her clients.

Molly Peterson of Heritage Hollow Farms turned to alternative practitioners and doctors outside of her insurance network in her own struggle for wellness.

I had to fight for my own health and fired many doctors, she said. I had to self-research and be fiercely determined to be heard. Most of my health need answers came from beyond traditional medicine and was all out of pocket.

Peterson, who has turned to doctors in Illinois and Arizona as well as local herbalists like Teresa Boardwine of Green Comfort School of Herbal Medicine, says that alternative medicine provides an opportunity for patients to be seen and heard, as well as giving them another route for healing when general medicine fails to provide the answers. At her first consultation with Boardwine, she spent nearly two and a half hours talking about her health history. Teresa knew that all of that matters, Peterson says. Im not saying that general practitioners dont care, because they do. But thinking beyond the norm when you only have seven and a half minutes [with a patient] is hard.

Boardwine, who has owned her business for around 23 years, says herbalism, the study or practice of the medicinal and therapeutic use of plants, is accessible, grounded in the wisdom of the ages, and that traditional medicine can leave one lacking in wellness. Most people in the world turn to whats outside their door first not pharmaceuticals.

Boardwine says clients seek her out for assistance with a variety of self-diagnosed issues, including menopausal balancing, nervous system issues, depression, anxiety, exhaustion, and autoimmune conditions.

Boardwine believes that the beauty of the Blue Ridge Mountains and the rural, agricultural lifestyle of Rappahannock County causes people to seek green ways of living and a holistic approach to healing. It has to be the willingness of an individual to go down that road [of herbalism], Boardwine explains. Clients seek me out because they want to not be overpowered by medication, and they want balance and nourishment.

Boardwine conducts both consultations with patients and hosts many different classes and programs to educate the community about the health benefits of herbs. Her students have included the likes of Colleen OBryant, who now sells her own herb-based products in Sperryvilles Wild Roots Apothecary, and Kathy Edwards, who focuses on naturopathic, or nutrition-based medicine, at her business located in Hearthstone School, Healing With Love and Nature.

Edwards first became interested in nutritional medicine after working at a health foods store and becoming certified by the American Naturopathic Medical Association. She, too, loves to help educate and empower people to take responsibility for their own health.

Holistic healing is not just about the physical. Its about body, mind, and spirit, Edwards explains.

In addition to helping her clients tailor their diets to their own particular medical needs, Edwards has also taught programs on raw food and practiced applied kinesiology, muscle response testing, and Reiki, an energy-based technique for stress reduction performed by laying the hands on or above the patient.

Edwards counsels her clients to eat organic: I always tell my clients to eat as close to nature as they can, she says.

Edwards also believes that people in Rappahannock may be more open to alternatives due to the environment surrounding the region. Its a very progressive area that is into gardening and health and is connected to nature. Its a wonderful community thats open to alternatives.

Cara Cutro, who owns Abracadabra Massage & Wellness in Sperryville, corroborated Edwards thoughts and lamented modern medicines disconnect with the spiritual part of each and every person. Clients come back to me because they get relaxed and connected to themselves [during their massage]. I would call that feeling of connection to life spirituality, and I bring that spirituality to clients through touch.

Teaching tarot card reading classes, specializing in energy healing, and administering massages that incorporate herbalism, Cutro says the concept of spirituality in medicine often gets a bad rap. However, she encourages her clients not to have contempt prior to investigation and to be open to alternative therapies that could bring them healing.

Cutro and many others are witness to the successes of alternative medicine: increased relaxation and self-knowledge of ones own health conditions. Moving forward, it may be a combination of both alternative and general medicine techniques that address the health needs of our community.

Do fight for your health. Do listen to your gut feelings. Do be OK with walking [away] from a doctor who doesnt hear you, see you, Peterson urges.

Williams hopes that all of us doctors, patients, and alternative practitioners and the like can capitalize upon Rappahannocks strong foundations in alternative medicine to fulfill her ultimate vision for the patient recovery process, prescribing: I dream of a community involved place where people could volunteer their time and efforts. Community involvement is important in the rehabilitative process, and people could benefit from rehabilitating others. There needs to be one central place where you can get your body cared for.

Read the rest here:
Alternative medicine: An opportunity for patients to be seen and heard - Rappahannock News

Will McDonald's stay or go at Navicent Health?

Chelsea Beimfohr, WMAZ 11:12 PM. EDT August 21, 2017

After a physicians group urged Navicent Health to consider breaking their lease with McDonald's, a Navicent rep says they are "considering all of their options."

Earlier this month, a registered dietician with The Physicians Committee for Responsible Medicine wrote a letter to the Macon-Bibb County Health Department, urging them to cut ties with fast food restaurants inside the hospital.

Monday night, PCRM attorney Leslie Rudloff presented the letter to the Bibb County Board of Health at a public meeting.

"If McDonald's did leave that space, we're asking that you consider replacing it with healthier options," says Rudloff. "We focus on preventative medicine through a plant based diet."

The group wants Navicent to break their lease with McDonald's, and promote a fast food-free hospital.

Anita Barkin, with the Department of Public Health, says the letter from PCRM asked the them to put a public statement on their website indicating that they are not in support of the McDonalds.

"It's really not within our jurisdiction to tell Navicent what type of food they should be offering at the Medical Center," says Barkin.

Barkin recommended to the Board of Health that the health department talk to Navicent about having more healthy options inside the hospital.

Board members didn't vote on the issue Monday night, because there weren't enough members present to vote.

But Tim Slocum with Navicent Health says the medical center is looking forward to having that conversation.

"We're all concerned with improving the health of our community, and certainly diet is one of those, so we're considering all of our options at this point," says Slocum.

The Physicians Committee for Responsible Medicine was founded in 1985 and claims 150,000 members worldwide.

According to The Physicians Committee for Responsible Medicine's website, their top priorities include ending the use of animals for medical testing, but they also work to promote healthy diets and lifestyles.

2017 WMAZ-TV

Read the rest here:
Will Navicent McDonalds stay or go? | 13wmaz.com - 13WMAZ

The Trump administration ordered the National Academies of Sciences, Engineering and Medicine to stop studying whether mountaintop removal mining in Central Appalachia poses a health risk to people living nearby.

The U.S. Department of Interiors Office of Surface Mining notified the National Academies in a letter Friday that it is halting the study while it reviews grants of more than $100,000. Regulators permitted the study panel to hold meetings scheduled for this week.

Virginia Tech crop and soil environmental sciences professor Lee Daniels is expected to present research in Lexington, Kentucky on Tuesday.

Last month, Susan Meacham, a professor of preventative medicine at Edward Via College of Osteopathic Medicine in Blacksburg presented findings from yearslong research that compares deaths and diseases in Virginias coalfields with other parts of the state.

The NAS study is serving a very important function in a very balanced and professional process, Meacham said. The NAS committees are highly respected, so we hope they will be able to continue the review and assessment of work currently available on surface mining and human health.

Meacham said listening to other presentations during her July appearance confirmed that there is a dearth of verified research on the effects of coal mining on community health.

A National Academies committee began holding meetings in March and was expected next spring to report on coals impacts on air, water and soil that could lead to health concerns, and to recommend areas of further research.

The committee has been hearing from university researchers and from state and federal regulators.

The Trump administration in May called for slashing tens of billions of dollars from the federal budget, including $122 million from the Interior Department.

The NAS said in a statement that the department cited the budget situation as prompting an agency-wide review of grants of more than $100,000.

The National Academies believes this is an important study and we stand ready to resume it as soon as the Department of the Interior review is completed, William Kearney, executive director, said in a statement. We are grateful to our committee members for their dedication to carrying forward with this study.

Daniels, a professor of crop and soil environmental sciences, is expected to talk with the committee Tuesday . He could not be reached for comment Monday.

The committee is looking at the relationship of surface coal mining with Central Appalachia residents health.

Meachams research initially was funded by the energy industry through the Appalachian Research Initiatives in Environmental Sciences project, which engaged a number of universities to look at different aspects of surface mining. VCOMs research into health differences was a small component.

Meacham said research is limited on the impact of mountaintop removal mining on health.

Her own work has found that deaths and illnesses from most chronic diseases are more prevalent in Virginias southwestern counties. However, that is not enough to say there is a cause and effect.

Rates for most chronic illnesses are higher in southwest Virginia than they are in neighboring counties that are similar geographically, and in other counties that share similar economic difficulties or that are as isolated from the rest of the state.

The environment plays some role in health, but so do other factors such as education, access to doctors, smoking, diet and exercise. She said it is not yet known whether the environment plays a greater role in health in coal-mining counties than elsewhere.

She is continuing to research that as well as look at ways to treat and prevent chronic illnesses in places with high rates.

Go here to see the original:
Trump administration halts study on coal mining's impact on health - Roanoke Times

Deke Eberhard knew as a teen he probably wouldn't work in the lumber business started by his grandfather.

The childhood cancer survivor, who was born and raised in New Braunfels, had a different career path in mind.

He remembers leaving an appointment at a San Antonio hospital where he learned he had officially beat cancer.

"We're driving home and I said, 'Mom, I want to be a doctor,'" he recalled.

He would spend most of his 20s working toward that goal, and this summer, he joined the DeTar Family Medicine Residency program.

The DeTar Healthcare System program is affiliated with the Texas A&M Health Science Center and welcomed its first class of six in 2016.

This year, 2,000 medical school graduates applied for the three-year residency program in Victoria.

One hundred doctors were interviewed, and six physicians were selected.

During the next three years, the doctors work at the DeTar Family Medicine Center clinic as well as rotate through different specialties.

But a rigorous work schedule isn't new for these doctors, 12 now, several of whom earned master's degrees during medical school.

"It's not an easy road," said Eberhard, 32. "It's a lot of gut checking."

He's not the type to give up and advocates for finding a way to do what you love.

That kind of resolve and focus can be found in the doctors who have made it this far.

Dr. Frances Ebo-Anagor, 48, was born and raised in Nigeria to parents who were teachers.

"Education was a top priority," she said. She earned a bachelor's degree in medical lab sciences but didn't like being stuck in a lab.

Ebo and her husband moved to Toronto, and she went to nursing school.

She started working as an ICU nurse until a job fair drew her to move the family to Texas.

The mother of four worked as a nurse in Houston before going to medical school in the Caribbean, which was more affordable.

Ebo said becoming a doctor was always part of the plan, but after the death of her parents, she became more determined.

Her father died in 2009 because of high blood pressure.

"I was a nurse then, and I thought, 'You know what, I can do more,'" she said.

Her passion now is preventative medicine and treating the geriatric population.

The journey included going back to school and sitting in classes with students who were half her age.

But despite the challenges, she loves being a family medicine doctor.

She recently saw a patient in her late 70s who really didn't need another prescription. She was lonely and just wanted someone to listen and help her find ways to make friends.

"I have to be able to connect with them," she said. "You have to be really patient."

William R. Blanchard, CEO of DeTar Healthcare System, said the doctors in the program have expanded patient access to care during the past two years.

As part of the Region 5 Texas 1115 Medicaid Transformation Waiver, DeTar established the residency program to bring primary care physicians to an underserved area.

Blanchard said his goal is to continue the family medicine residency and add more residency programs in the future.

"We're extremely pleased with the quality of the physicians we've been able to supply the community through this residency and other recruitment efforts," he said.

See original here:
Family medicine residents worked their way to Victoria - Victoria Advocate

Names and faces

Shari Risken has joined Opportunity Bank of Montana as executive assistant to the chief executive officer, chief financial officer and chief risk officer. Shari has an executive assistant degree and more than 35 years of experience with an extensive background providing administrative, technical and analytical services in a wide variety of industries. Her job history includes serving in an executive level administrative position for Shodair Childrens Hospital, Providence Health Care Spokane and Washington Trust Bank.

Ruth Mollet, FNP has joined the gastroenterology department at St. Peters Medical Group North. Prior to this position, Mollet was a Same Day Nurse at St. Peters Hospital. She earned her Masters of Science in Nursing (MSN), with a Family Nurse Practitioner Emphasis, from Devry University, Chamberlain College of Nursing in Chicago. She obtained a Bachelor of Science in Nursing (BSN) from Washington State University Intercollegiate College of Nursing, Joint B.S. degree with Eastern Washington University, in Spokane, Wash.

She is a board certified as a Family Nurse Practitioner with the American Association of Nurse Practitioners.

Christopher Lindsay, M.D., has joined the radiology department at St. Peters Hospital. Lindsay earned his Doctor of Medicine from the Creighton University School of Medicine, in Omaha, Neb. He completed his fellowship in body imaging with the Henry Ford Health System and his residency in diagnostic radiology from Wayne State Universitys Detroit Medical Center in Detroit, Mich. He obtained his bachelor of arts, graduating maxima cum laude, in biology, from Carroll College.

Lindsay is a certified Magnetic Resonance Medical Director from the American Board of Magnetic Resonance Safety (ABMRS). He is also a member of the Radiological Society of North America, the American Roentgen Ray Society, and the American College of Radiology.

Prior to joining St. Peters Hospital, Lindsay was the chief of radiology/radiation oncology section and staff radiologist with St. James Healthcare, in Butte. He also served as a staff radiologist with Montana Interventional and Diagnostic Radiology Specialists, PLLC with the VA Montana Healthcare System in Fort Harrison.

Lindsay is originally from Clancy, and a graduate of Jefferson High School.

Helena native, Dillon Ewals has joined Better Body Fitness as the companys operations director. Ewals will focus on creating a consistent customer experience, as well as streamlining day-to-day operations. His professional experience includes retail store management, sales and account management throughout the U.S.

Mikael Bedell, M.D., has joined St. Peters Medical Group North Clinic. His primary focus is comprehensive outpatient and inpatient family medicine.

Bedell earned his Doctor of Medicine at the Albany Medical College in Albany, N.Y. He received his residency at Idaho State University in Pocatello, Idaho, where he served as chief resident in 1998. He received his bachelor of science, cum laude in animal sciences bioscience and technology from the University of New Hampshire, in Durham, N.H.

He is board certified by the American Board of Family Medicine (ABFM). He serves as a clinical instructor for the Albany Medical College, Department of Family and Community Medicine; the University of Washington, Department of Family Medicine; and as an adjunct faculty for the University of Utah, Department of Family and Preventative Medicine.

Prior to joining St. Peters Hospital, Bedell was a staff physician at the Cascade Medical Center in Cascade, Idaho, where he served as medical director and also on the board of trustees.

Becky Schlauch is the new administrator for the Montana Department of Revenue Liquor Control Division. Schlauch has been in state government for more than seven years, previously working as business and financial services division administrator at the Department of Public Health and Human Services. She also worked for several newspapers in accounting, including as controller for the Helena Independent Record. Schlauch grew up in Circle and earned a bachelors degree in business administration and master of business administration degree from the University of Montana.

Montana Department of Revenue contracts officer Brett Boutin becomes one of just two certified public procurement officers in the state of Montana, after earning his Certified Public Procurement Officer (CPPO) credential. As contracts officer, Boutin manages department contracts to ensure effective and efficient use of public funds. Boutin has a 25-year career in state government.

Doney Crowley P.C. has announced the promotion of Jack Connors to senior associate attorney.

Connors holds a Bachelor of Science degree in mathematics from Montana State University and a Juris Doctorate degree with honors from the University of Montana School of Law. Before attending law school, Connors owned and operated a construction company that specialized in building high-end homes in the Big Sky area. His law practice focuses on construction disputes, real property litigation and water law.

Connors works at the firms Helena office, and he can be contacted at either jconnors@doneylaw.com or 443-2211.

News and notes

Montana producers eligible for hay lottery

Producers in Montana affected by drought and fire are now eligible to participate in the first ever hay lottery. Ag Community Relief, is organizing a large-scale hay donation convoy to North Dakota to aid producers in North Dakota, South Dakota and Montana. The first convoy of hay will be delivered in mid-August but more deliveries could arrive as the group continues to fundraise and seek donations and volunteers. The donated hay will be delivered to North Dakota State University (NDSU) in Fargo, N.D. Any other individuals or organizations willing to donate hay or trucking for the hay lottery should call the North Dakota Department of Agricultures Drought Hotline at 701-425-8454.

Livestock producers interested in applying for the hay lottery must submit an application at https://www.nd.gov/ndda/montana-hay-lottery. Each state has its own lottery, although North Dakota will administer the applications. Eligible producers must be from a D2, D3 or D4 or fire-affected county and own at least 25 animal unit equivalents of state-specific livestock. Eligible livestock and a description of animal unit equivalents may be found directly on each states application. The latest drought monitor depicting the drought levels of specific counties may be found at http://droughtmonitor.unl.edu/.

The application deadline is Aug. 31, 2017.

The hay will be distributed in semi-load lots with the first drawing in early September. If additional donations are taken in after that date, more drawings will occur. Producers that are selected will be responsible for arranging hay transportation from the NDSU site.

Questions about filling out the hay lottery application may be directed to 701-328-4764.

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OBrien leaving tourism alliance

The Helena Tourism Alliance/Tourism Business Improvement District (TBID)/Visit Helena Montana announces the resignation of executive director, Heidi OBrien. OBrien has been with the Tourism Business Improvement District since 2010 and was the organizations first employee. OBrien is moving on to a position with AAA Mountain West. Her last day with the TBID is Aug. 16.

Anna Strange, the current TBID programs coordinator, will help maintain office operations and Jennifer Davis will continue with her role as community outreach director. A nationwide search for a new executive director will be announced in the near future.

The Visitor Information Center located at 105 Reeders Alley will continue operation of normal hours: Monday to Friday, 8 a.m. to 7 p.m. and Saturday 10 a.m. to 2 p.m. through the end of August.

DOR certifies property taxable values

The Montana Department of Revenue has announced it has completed its annual requirement to certify taxable values of property in the states 56 counties. This year, department offices in all 56 counties certified the values before or on the Aug. 7 deadline.

Under state law, the departments property assessment offices are responsible for providing the total taxable value of property to each taxing jurisdiction by the first Monday in August. The certified values include mobile homes, personal property business equipment, real property, and centrally assessed properties.

The 2017 certified taxable values for each county taxing jurisdiction are available at property.mt.gov.

Local governments establish their budgets and set their mill levies for property tax calculations and collections based on the certified taxable values provided to each taxing jurisdiction.

Property tax collections are the primary revenue source for local governments to provide public services such as police and fire protection, schools, roads and bridges, and public health and safety.

Guidelines

The IR welcomes reports of hiring, promotions, awards, recognition, learning opportunities and other news from local companies and nonprofits. We accept press releases and photos (digital images at 300 dpi or more are preferred). Email your information to irstaff@helenair.com.

There is no charge for items appearing in the Business Briefcase. Items are run on a space-available basis, and we reserve the right to edit and use information as we see fit.

The deadline is Tuesday at noon to be considered for publication the following Sunday.

Go here to see the original:
Business Briefcase published 08-13-17 - Helena Independent Record

The use of new technologies in geriatric psychiatry shows promise for advancing personalized medicine and improving patient care. A new study in the American Journal of Geriatric Psychiatry describes the successful adaptation of an integrated medical and psychiatric self-management intervention to a smartphone application for middle-aged and older adults with serious mental illness.

Care of middle-aged and older patients with serious mental illness is complicated. Often these patients suffer from other medical conditions and are at increased risk of premature death. They have two to three times higher health costs than individuals in the general population. In order to help patients cope with their illness, researchers from Dartmouth developed a smartphone-based intervention using an adaptive systems engineering framework and principles of user-centered design. They found that even patients with limited technical abilities could use this App successfully. The App and intervention protocol were developed using commercially available products from Wellframe.

"The use of mobile health interventions by adults with serious mental illness is a promising approach that has been shown to be highly feasible and acceptable," explained lead investigator Karen L. Fortuna, PhD, of the Dartmouth Centers for Health and Aging and the Geisel School of Medicine at Dartmouth. "These technologies are associated with many advantages compared with traditional psychosocial interventions, including the potential for individually tailored, just-in-time delivery along with wide dissemination and high population impact. Nevertheless, the process of adapting an existing psychosocial intervention to a smartphone intervention requires adaptation for a high-risk group with limited health and technology literacy."

Following multiple design iterations, investigators tested the App's usability. Ten participants (mean age of 55.3 years) with serious mental illness and other chronic health conditions reported a high level of usability and satisfaction with the smartphone application.

The App takes patients through 10 sessions over a period of approximately three months, covering topics such as stress vulnerability and illness, medication adherence and strategies, and substance and medication abuse. Physicians can remotely monitor App use, and intervene when problems are detected, facilitating telemedicine for less accessible populations.

According to Dr. Fortuna, "Smartphone applications also potentially facilitate patient engagement in participatory, personalized, and preventative care. As the healthcare industry increasingly embraces prevention and illness self-management, it is important for physicians and patients to be actively involved in designing and developing new technologies supporting these approaches."

The use of smart devices is poised to revolutionize how we think about clinical information and facilitate personalized interventions in a way that could not have been conceptualized before these technologies came into existence. This study is part of a special issue of the American Journal of Geriatric Psychiatry that captures an important moment in the evolving relationship between technology and the clinical care of older adults.

"It has often been noted that with the pace of technology development being so rapid, research may not be able to keep up. While this may be true in the most literal sense, this set of nine papers represents a major step in developing a body of research to guide how technologies can interface with clinical care," noted guest editor Ipsit V. Vahia, MD, McLean Hospital, Belmont, MA, and the Department of Psychiatry, Harvard Medical School, Boston, MA.

These papers highlight the potential of technology based-approaches, provide direction on how this area of work needs to develop, and put a spotlight on the major pitfalls that the field must consider in order for technologies realize their full potential. They also address the relative lack of evidence to date supporting use of these technologies and the lack of clarity on data security and privacy related to use of these devices.

Dr. Vahia continued, "While the potential of technology to impact geriatric psychiatry care in this manner has long been recognized, this issue provides substantial evidence to demonstrate that this potential is translating into reality. Simultaneously, it also makes clear that the work is just getting started."

Explore further: Older adults with severe mental illness challenge healthcare system

More information: Karen L. Whiteman et al, Adapting a Psychosocial Intervention for Smartphone Delivery to Middle-Aged and Older Adults with Serious Mental Illness, The American Journal of Geriatric Psychiatry (2017). DOI: 10.1016/j.jagp.2016.12.007

More:
Smartphone app may help older adults manage serious mental illness and chronic health conditions - Medical Xpress

Workdays at Sheridan Medical Group start with "morning scrubs," brainstorming sessions where doctors, physician assistants and their health team gather to talk about ways to best serve the patients they will serve in the coming hours. A physical therapist, nutritionist, behavioral therapist and other workers on the 32-member staff also likely will attend.

This isn't the way traditional offices operated.

It's by design.

Doctors here have been trained to ask more questions, spend a bit more time with patients, and send them down the hallway to talk with preventative health specialists, including physical therapists in the medically oriented gym.

"We believe that we are creating the model for the future," said Jennifer Carlson, clinical director of the Town of Tonawanda practice. "I think this sort of interdisciplinary team is really essential. What we know is what's been happening in the past a physician making decisions on behalf of a patient has failed. We know we in the U.S. have the sickest population that's costing the most amount of money in the entire developed world."

Dr. Richard Carlson Jr., an internist and geriatrician, and Dr. Rajiv Jain, board certified in pediatrics, internal medicine and sports medicine, launched Sheridan Medical 11 years ago. Both doctors have trained and practiced in Buffalo and far-flung places, including Africa. Their fathers were both doctors.

They've enlisted help from their wives in establishing a Sheridan Drive operation that looks to provide cradle-to-grave, community health services in the same building in a patient-centered way.

Aanchal Jain, who has a finance background, is director of business operations. Jennifer Carlson is tasked with making the operation click.

"I see the world through the eyes of a social worker," said Carlson, a graduate of the University at Buffalo School of Social Work who has worked three decades in the field. "Social workers have their roots in transformation. They've been agitators and have sort of an incendiary role because they're sympathetic to the needs of individuals. They are trained to be good communicators and relationship builders and to perceive shortcomings, problems and challenges, then to bring to bear various kinds of forces to help a system become more responsive."

It has been a challenge, she said, but the staff looks to help change health care in Western New York as it goes about its work.

Q. This sounds quite a bit different than the top-down medical care many patients know.

If you can't think differently about your role in the lives of patients, you're never going to change the way you're practicing medicine. Patients are going to continue to become overly dependent on you and they're not going to take their responsibility seriously. It's way too easy to take a back seat and let somebody else run the show. You need to make it harder for people to not be in control. If you stop being in control, they can start to pick up the slack

Doctors' offices have historically had a bunch of exam rooms and a receptionist and a waiting room. That's it. We need teaching spaces, places where people can confer. Our reimbursement doesn't match what we know we need to be doing. We're getting paid to take care of diseases. Eighty percent of our reimbursement is dedicated to fee for service but our practice is deeply invested in population health management. We're banking on that flipping and we're going to be ready.

Q. What do you do?

A huge amount of my time is dedicated to teaching the staff and the patients to think differently about care from a preventative standpoint and to take themselves seriously as a member of a team. Historically, all of our nurses and our medical assistants and our dietitians were cued to take orders from the doctor. The doctor has a lot of knowledge about overall health but they don't really know a lot about nutrition. They're very bad social workers. This is not a secret. Our doctors have heard me say this to them. But they're great doctors. Great doctors. It's almost as important knowing what you don't do

That team approach matters. Physician satisfaction has gone down the drain. They're working 18-hour days. Their reimbursement rates are lower than in the past. Their document burden is incredible. People should know that.

Q. And you're seeing more chronically ill patients?

The whole reason reform came into being is that we are sicker than any other country in the entire developed world and we're putting huge amount of money way more than anybody else into maintaining sick people. Our strength as a team is helping not only with medication but poor eating habits or stress management.

Q. You say insurers could be more helpful?

We're absorbing part of the cost to develop the model. People who work here know what works and what doesn't, and how to collaborate, yet there's no reimbursement structure to support some of what we do. Insurers know that to prevent that 80-year-old on multiple medications and with complex health issues from falling, it's really critical they be seen and be given a suitable fitness program. Sending them to the Y is not the same thing as being seen by physical therapist Russ Certo and his team (but he can't get traction with insurance companies on reimbursement). Getting someone in to see a dietitian so we can create a menu that's suitable for whatever it is they're struggling with, rather than have them become diabetic ... would be better but the system is not designed to reimburse those services.

email: refresh@buffnews.com

Twitter: @BNrefresh

Originally posted here:
Tonawanda medical practice thinks holistically, despite insurance challenges - Buffalo News

Primary Care is comprehensive medical care by those specifically trained in first contact and continuing care for patients, serving as the central hub for all of the patients health care needs. Primary Care Providers (PCPs) specialize in the management of chronic medical diseases, treatment of acute issues, and preventative care. A good PCP is an invaluable asset to your health.

Yet somewhere along the way, that value has come into question. HMSA has promoted its new payment transformation model as a way of supporting primary care. But they failed to actually calculate a fair and reasonable wage for such services.

The Big Island is in the midst of a population expansion, in addition to a staggering physician shortage of 33%. In the last 8 months alone, Hilo has lost 6 PCPs, only one of which was not related to income. This magnifies the physician shortage, and not due to the expected upcoming retirements, making the acuity of the situation pronounced and urgent. HMSA advised us that as PCPs we should be able to safely and effectively care for 2,500 patients, an industry standard.

We practice evidence based medicine in my office, and a search of journals revealed that this number was actually a speculative remark in a journal that has since been discounted on numerous occasions. Estimates based on the time required to provide all recommended acute, chronic and preventative care for 2,500 patients is 21.7 hours/day. To manage chronic conditions alone for a panel of patients in whom those conditions are already controlled, it is estimated to take 3.5 hours/day. When those conditions are uncontrolled, the time commitment increased to an estimated 10.6 hours/day.

Other time management studies suggest a conventional medical model of primary care can manage approximately 1,000 patients with appropriate care. Time delegation models validate Team-Based Primary Care, with a PCP supervising a medical team including midlevel providers, nurses, medical assistants and receptionists to maximize high quality care to a larger population of patients. However there needs to be a system in place that allows for appropriate reimbursement of such a model.

With an average reimbursement of $24/month, working 200 hours/month, we need to manage over 1500 patients to pay a fair and reasonable salary to a single physician, and over 2100 patients to support Team-Based care. And that does not include any overhead or supplies; just salaries. There is no change in the HMSA reimbursement, no matter what services the patient requires acute illness or injury, nebulizer for asthma flare-up, routine follow up, skin biopsy to check for cancer. We get the same $24/month.

With this reimbursement model, the PCP actually loses money by offering more to their patients. Patients lose their opportunity to receive the best medical management at a true medical home. Ultimately, the insurance company actually loses more money and worse, patients will visit urgent care and ER more frequently, as more PCPs shut their doors, unable to afford the primary care the patients need and deserve.

Letters, commentaries and opinion pieces are not edited by Big Island Now.

Link:
LETTER: HMSA and Primary Care Physicians - Big Island Now

8 photos: Planning underway for combined medical engagement in Angola with Ohio, Serbia

8 photos: Planning underway for combined medical engagement in Angola with Ohio, Serbia

8 photos: Planning underway for combined medical engagement in Angola with Ohio, Serbia

8 photos: Planning underway for combined medical engagement in Angola with Ohio, Serbia

8 photos: Planning underway for combined medical engagement in Angola with Ohio, Serbia

8 photos: Planning underway for combined medical engagement in Angola with Ohio, Serbia

8 photos: Planning underway for combined medical engagement in Angola with Ohio, Serbia

8 photos: Planning underway for combined medical engagement in Angola with Ohio, Serbia

COLUMBUS, Ohio Representatives of the Serbian and Angolan Armed Forces met with members of the Ohio National Guard in late June to discuss plans for an upcoming Combined Medical Engagement set to take place in Angola later this year. More than 20 planners from all three countries gathered for a week to work through the details for the upcoming event.

The upcoming Combined Medical Engagement will have medical personnel from the three nations provide infectious disease prevention training as well as basic care to four different villages in the area surrounding Caixito, Angola. Local residents will be able to receive preventative medicine as well as see specialists in obstetrics, pediatric care, dermatology and optometry.

The Ohio National Guard has a long-standing relationship with Serbia, having been state partners with the country for more than 10 years as part of the National Guard State Partnership program. Ohio National Guard and Serbian Armed Forces conducted a similar event in Serbia in 2016. Last years event, (see Combined Medical Engagement partners ONG, Serbia, Angola to help citizens in rural Serbia) which included three observers from the Angolan military, was conducted to lay the groundwork for developing a working relationship with Angola in the future.

Read the original:
Planning underway for combined medical engagement in Angola with Ohio, Serbia - U.S. Africa Command (press release)

Aug. 2, 2017 Tommy Thompson, former Wisconsin governor and the U.S. Health and Human Services (HHS) secretary under George W. Bush, says the GOPs inability to enact health care reform creates a golden opportunity for bipartisanship.

Thompson is speaking at the State Bar of Wisconsins upcoming Health, Labor and Employment Law(HLE) Institute, Aug. 17-18, in Wisconsin Dells. Hell talk about the health care political atmospherefrom the perspective of the countrys top health official.

The four-term Republican state governor served as HHS secretary from 2001 to 2005, overseeing the passage of Medicare Part D (prescription drugs), a contentious bill at the time. He also dealt with 9/11, smallpox vaccination, and the AIDS epidemic.

In preparation for his HLE appearance, Thompson reflects on his experience as HHS secretary and where health care could be headed next.

Number one, I think the Republicans really have made some terrible mistakes and should have had a workable plan that had the votes to get through. They didnt, and thats their fault. Secondly, Obamacare is dead. Its not going to go anywhere. Sooner or later, the Democrats will have to realize they should work with the Republicans to get a bipartisan bill done.

Third, the President has the opportunity to either continue the subsidies or not, and to the best ofmy knowledge, he has not made up his mind yet. But all indications are that he will apply pressure and could accelerate the demise of Obamacare and therefore force action.

Looking back at history, you always have Democrats and Republicans working together when you have big social policy. You look back at Social Security, you look back at Medicare, look back at Medicaid, look back on Medicare Part D, which I was responsible for all successful programs by the way and they were all done with bipartisan votes. Never has there been a really big change on social policy in America without bipartisan support. And so I think that the failure of the Republicans to act gives Congress a golden opportunity. Im looking at this optimistically as a way to get a bipartisan health care bill through thats reform minded, thats affordable and accessible, and treats all the states the same on Medicaid.

I think thats doable and its possible, and I think that will be the result when saner minds come back in the fall and realize they have to get something done.

Very contentious. President Bush told me he promised to get drug coverage for seniors and said it was my responsibility to get it done. And so, my department and the White House worked for weeks on getting that done, and I spent months over inCongress working with the House Ways and Means Committee and the House and the Senate Finance Committee to get a bipartisan proposal done. In the Senate, I had John Breaux [Democrat for Louisiana], and Max Baucus [a Democrat from Montana] and got a bipartisan bill done. I also had some outside advice from Ted Kennedy. He didnt vote for it, but he gave me a lot of good advice.

My philosophy never changes. My philosophy is to work with people who want to get things done. I did that as governor and I did it as secretary. If a Democrat wanted to work with me, I said come on in. We did it.

The biggest change in AIDS policy was done under the Department of Health and Human Services. We set up the Global Fund, and with President Bushs leadership, we were able to pass the Presidents Emergency Plan for AIDS Relief (PEPFAR). To this day, he will credit PEPFAR as his No. 1 accomplishment in the social arena.

I had 9/11 on my handsand fears of bioterrorism. I had a shortage of medicine. People were afraid that smallpox was going to be the next big epidemic, and we did not have enough vaccine. We went around and found a cache of smallpox vaccine from the 1950s that was locked up in a room at a pharmaceutical company, and we were able to use that vaccine and divide it up so that we could make more smallpox vaccine.

It was finding that cache and finding a way to use it, it was setting up a public health system that had deteriorated, including adequate antibiotics and vaccines. People were really worried about smallpox and monkey pox, and Severe Acute Respiratory Syndrome (SARS). AIDS was running rampant, especially in Africa. We set up the Global Fund and PEPFAR to fight that. I negotiated with Bayer to buy Cipro, an anthrax vaccine, at a percentage of what they were selling it to the public. To my knowledge, no HHS secretary has negotiated with a pharmaceutical company for lower drug prices.

Getting a health care bill done.

Obamacare is not going to stay. It just isnt. Its falling apart. Congress has got to pass something.

Because they dont understand the importance of it. We spend 91 percent of our health care dollars getting people well after they get sick, and less than 9 percent of that $3 trillion is spent on keeping you well in the first place. We do not have a health system, we have a disease system. I think we should go to a health system.

I was into wellness and prevention when I was governor, but I really got into it when I became HHS secretary and went down to CDC and did something no secretary has ever done. I spent a week at each of the divisions. I found out that we are killing ourselves through obesity and diabetes, and we were not going to be able to afford it. I decided we were going to prevent diabetes, infectious diseases, and chronic illnesses. Alzheimers and diabetes are killing our health care costs. I came to the conclusion that the best way forward was wellness and prevention.

Preventative health has always been a low funding priority. It just always has been. People just dont understand it. They dont understand the connection. One thing is the Congressional Budget Office (CBO) has to put a fiscal estimate on it. The CBO does not score something as esoteric as wellness. They cant score it without a dollar amount.

BadgerCare came as an idea I had when I was sitting on the Joint Finance Committee 50 years ago. I came to the conclusion that if you were middle-income to well-to-do, you could buy a good lawyer if you got in trouble. If you were poor, you got a public defender at the states expense.

If you were, like I was then, just on the verge of making a living, small business people that I represented including farmers working 14 hours per day those poor blokes never had enough money to hire a lawyer or a doctor or go to get your shots. I didnt think it was fair. That carried with me, but I couldnt get anything done while I was in the Assembly because I was always in the minority. That changed when I became governor. That was how BadgerCare came to be.

Find clarity in a chaotic legal and political landscape at the 2017 Health, Labor, and Employment Law Institutein Wisconsin Dells, Aug. 17-18.

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Practical perspectives: Antitrust red flags, pregnancy and work restrictions, managing problem employees, getting difficult cases to mediation, and medical ethics

Register today

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Tommy Thompson: Congress has a Golden Opportunity on Health Care - WisBar

Across Europe, a shift towards greater prevention, earlier diagnosis and treatment is needed in order to contain the growing cost of healthcare.

But how can healthcare systems make this transition and how do pharmaceutical companies play a role in this, while also growing their market?

A forthcoming webinar hosted by pharmaphorum with sponsor PHOENIX group looks at how harnessing the data and expertise of pharmacies, and via greater engagement with patients, consumers and shoppers can meet this emerging need.

Key topics include:

Why watch the webinar?

The expert panel will provide practical advice and real-life examples of how pharmaceutical companies can work with pharmacies to grow their market and better serve patient needs.

Thelive webinar will take place on Wednesday 6 September at 14.00 GMT/15.00 CET/09.00 EST. To register, please click here or on the button above/below.

Participants

John Munson, Head of Global Accounts, MylanJohn Munson is the Head of Global Accounts at Mylan, responsible for the account management of global customers and key European accounts. John joined Mylan in the UK in 2007 as Sales & Marketing Director and moved into the Country Manager role for the UK & IRE before taking up his current position. John has a 20 year history in pharmaceuticals with roles at Astra, Ivax and Ranbaxy and during his time at Mylan he has also held the position of Area Director for Northern and Western Europe. John studied Business, Finance and Marketing in Bournemouth and later gained an MBA from the same college. He is also a Member of the Chartered Institute of Marketing.

Nemanja Jankovic, Head of Commercial Partnerships Europe, PHOENIX groupNemanja Jankovic heads the Commercial Partnerships at PHOENIX group and is responsible for strategic cooperation with the pharmaceutical industry on a European level. After working in the pharmaceutical industry for many years, the experienced market expert joined PHOENIX group four years ago.

Nina Felton, Head of Business Intelligence, PHOENIX groupNina has extensive experience in the healthcare industry,having worked for companies such as Pfizer and Wyeth in marketing and sales roles, which involved the launching of new products. She also worked for over 12 years with IMS Health in their management consulting division. Nina started her career as a biochemist and has gained experience as the Managing Director of a primary market research company, in medical communications and is a qualified psychotherapist and executive coach. She joined the PHOENIX group two years ago and is responsible for developing their new initiatives in Business Intelligence, working across Europe.

Andrew McConaghie,Managing Editor, pharmaphorum (moderator)Andrew is pharmaphorums managing editor, feature media. He writes on a range of topics covering pharmaceutical and biotech R&D, marketing and market access, and issues affecting patients and global healthcare systems, especially the UKs NHS.

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Pharma and proactive, preventative healthcare: how to use the pharmacy channel - pharmaphorum

By Nancy Sarnoff, Houston Chronicle

A rendering of Vivacity at Valley Ranch.

A rendering of Vivacity at Valley Ranch.

A site plan of Valley Ranch.

A site plan of Valley Ranch.

At more than 1.5 million square feet, the retail portion of this development is bigger than the Woodlands Mall and is considered 2016's biggest retail project in the Houston area.

At more than 1.5 million square feet, the retail portion of this development is bigger than the Woodlands Mall and is considered 2016's biggest

An outdoor ampitheater with seating for approximately 10,000 people is in the conceptual phase.

An outdoor ampitheater with seating for approximately 10,000 people is in the conceptual phase.

The entertainment district will also include a splash pad and Cinemark movie theater.

The entertainment district will also include a splash pad and Cinemark movie theater.

Plans for the development's medical district include an acute care hospital and 500,000 square feet in medical office buildings.

Plans for the development's medical district include an acute care hospital and 500,000 square feet in medical office buildings.

The commerce district will include a full-service hotel, conference center and Class-A office space, set to attract a large corporate relocation.

The commerce district will include a full-service hotel, conference center and Class-A office space, set to attract a large corporate relocation.

Academy Sports + Outdoors will be the first business to open at Valley Ranch, with a soft opening on Sept. 23 and a grand opening on Sept. 30, 2016.

Academy Sports + Outdoors will be the first business to open at Valley Ranch, with a soft opening on Sept. 23 and a grand opening on Sept. 30, 2016.

Other businesses moving into the center include Hobby Lobby, Sam's Club, a Kroger Marketplace, an array of fast food restaurants and more.

Other businesses moving into the center include Hobby Lobby, Sam's Club, a Kroger Marketplace, an array of fast food restaurants and more.

The northwest corner of the property will include 500 garden-style, multi-family units.

The northwest corner of the property will include 500 garden-style, multi-family units.

New Caney ISD's Texan Drive football stadium, opened in 2014, is near the town center.

New Caney ISD's Texan Drive football stadium, opened in 2014, is near the town center.

Five home builders have joined Valley Ranch, and developer The Signorelli Co. expects the community to sell out in two to three years.

Five home builders have joined Valley Ranch, and developer The Signorelli Co. expects the community to sell out in two to three years.

The developer boosted the 1,400-acre development's non-residential percentage to 50 percent after realizing the area's demand for entertainment, healthcare and business options.

The developer boosted the 1,400-acre development's non-residential percentage to 50 percent after realizing the area's demand for entertainment, healthcare and business options.

Residents in East Montgomery County fought to change the liquor laws back in 2006, which helped set the stage for new developments.

Residents in East Montgomery County fought to change the liquor laws back in 2006, which helped set the stage for new developments.

CHI St. Luke's heading to Valley Ranch in far northeast Houston area

A local developer has inked a deal with CHI St. Luke's Health to be part of a new medical district proposed in the far northeast corner of the Houston area.

The Signorelli Co. said the "partnership" with the hospital group is a first critical piece in creating a complex that addresses the next generation of health care. Plans for what the hospital would build were not released.

The medical district will comprise 186 acres in Valley Ranch, a 1,400-acre planned community in the New Caney areaat the intersection of Grand Parkway and U.S. 69.

RELATED:Once rural area north of town attracts development

The Woodlands-based developer has branded the project "Vivacity." Its master plan calls for more than 2.5 million square feet of health, wellness and life science facilities along with hospitality, retail and other services.

"Vivacity is focused on becoming the destination where emerging preventative wellness and Personalized Medicine will be brought to the individual in a unique, patient-friendly environment," Signorelli's Tom Wittenberg said in an announcement.

Read more from the original source:
CHI St. Luke's heading to Valley Ranch in far northeast Houston area - Chron.com

Primary care is where preventative medicine takes place. It is the job of your primary care provider or family doctor to help you prevent illness or disease from occurring. Your health and well-being is our No. 1 priority. Our goal is to protect you from disease, promote and maintain your good health and prevent disability or even death. Preventative medicine involves many things from the simple to the complex and from the young to the elderly.

As a primary care provider, it is my responsibility to manage my patients chronic medical conditions and provide information and education on how to prevent chronic illness. This is accomplished through resources and one-on-one teaching about healthy lifestyle choices and preventative screenings.

Starting with the very young, well-child examinations are vital to ensure the child is growing and developing as a normal child should. As a primary care provider, I measure developmental milestones with each year of age. These exams occur from the time the child is born until the adolescent becomes an adult at 18 years of age. Vision and hearing screening as well as immunizations are an important part of preventing disease and keeping children well. Dental screenings are essential to prevent cavities and other more serious mouth issues. Parents are educated on the proper nutrition, activities and healthy habits that will help children learn and grow. This is where prevention starts! Teaching children good healthy habits now prevents them from becoming obese, having type 2 diabetes, joint problems, cavities and many other ailments. Mental health screenings are also performed as children grow and become more like adults during their middle and high school years.

Young adults are the next area of focus for preventative medicine. Similar to children, hearing and vision screenings are performed and good dental health habits are encouraged by keeping regular checkups. Immunizations continue with young adults to include HPV, meningitis, TDAP and annual flu vaccines. Sexually transmitted disease screenings and PAP smears begin with young adults. Educating young adults on alcohol, tobacco and drugs continues. Many aspects of safety to prevent accident or injury are discussed as well. All of the education provided to children continues into adulthood, with emphasis on issues like diet, exercise and avoiding risky behaviors.

Middle age is another very important era where preventative medicine continues to build. In addition to the preventative topics already shared, patients now become more regularly engaged with regard to routine check-ups to monitor weight, blood pressure and blood work to screen for high cholesterol or even thyroid issues. Mammograms to screen for breast cancer, PSA levels/prostate exams to screen for prostate cancer, PAP smear exams for cervical cancer screening and annual immunizations are done. Chest X-rays and low dose CT scans of the lungs are completed for smokers and smoking cessation options are discussed and encouraged. Screening for alcohol abuse is involved as well.

As we continue to age and approach our senior years of life, preventative medicine remains crucial. Pneumonia and shingles vaccine are very important in this age group as these immunizations can help prevent these infections from occurring or reduces the severity if they do occur. In addition, DEXA scans to monitor bone density looking for osteoporosis begin. This is the top of the pyramid, so to speak, as all of the other things we taught the little ones in the very beginning of life are the base.

Preventative medicine expands throughout the lifespan from infancy to the elderly. There are many areas of prevention that I have not covered in this short article, so it is vital to have an appointment scheduled with your primary care provider or family physician. Your health truly is your wealth. Making routine visits with your primary care provider when you are healthy could prevent you from a long-term chronic illness in the future.

Dr. Lorina Zenz is a certified nurse practitioner with Lima Memorial Internal Medicine & Family Healthcare.

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Prevent issues through lifetime of medical care - Lima Ohio

3 August 2017

Chakras are amazing! If you havent heard about them before here are the top ten things you need to know.

The Little Book of Chakras

Chakras have been known about in India since ancient times possibly for 5,000 years.

Chakras are our vital link to the energy that keeps us alive. In yoga terms this is called Prana.

Like electricity, chakra pranic energy cannot be seen or touched, but lack of it results in increasing levels of physical illness, whilst balanced chakra energies bring vitality, mental strength, management of anger, inner sight, tranquillity and compassion to name just a few qualities.

Looking after our chakras and auric field is preventative medicine, an energy medicine that keeps us well. Imagine these energies playing together in a dance of nourishing rainbow coloured light bringing this essential energy into your body and returning any unwanted or disharmonious thoughts, feelings and energies into the earth.

Chakras do this for us all the time we dont even have to think about it, but if we do it improves our conscious connection to our body, mind and what some call spirit.

Yogic teaching tells us that there are seven major chakras and around twenty-one minor ones.

Focussing upon each of our seven major chakras in turn (from Base to Crown) means that their delicate coloured light frequencies can be fine tuned and balanced, leading to optimum health and wellbeing.

There are many ways to re-balance our chakras, including Yoga asanas, correct breathing, aromatherapy oils, crystals, herbs, mindfulness meditation and other stress reduction techniques.

Our chakras respond to colour, in our environment, in meditational visualization and even in the colours of the clothes we choose to wear.

When our chakras are functioning well, we become like a rainbow of energy to those gifted people who can see auras. Actually, we know our own chakras very well after all they are with us all the time!

Discover all you need to know in Patricia Merciers latest book, The Little Book of Chakras, just published by Gaia/Octopus, brings chakra teachings to life with easy explanations of chakras and prana and how they can be balanced with simple relaxation techniques, colour, essential oils, yoga and meditation. She is also the author of the best-selling The Chakra Bible, The Complete Chakra Workshop, other books on Chakras, New Awareness, Maya Cosmovision, as well as being a trained yoga teacher and holistic healer/practitioner.

Read this article:
10 Things You Never Knew About Chakras By Patricia Mercier - FemaleFirst.co.uk

Before I dissect the Democrats Better Deal for America, which is just repackaging of the same tired socialistic schemes that have always failed and will always fail, I want to address the dysfunction of Republicans in Congress.

It appears our squishy GOP leaders cant find their way out of a sock. What is wrong with you people? Voters gave you the House, the Senate and the White House in November so why are you not getting anything done?

We expected you all to get to work reversing the destructive health care policies, and others, enacted by the Obama Administration. Instead, you wring your hands and offer a Skinny Obamacare Repeal that does nothing. Are you kidding me right now?

The horrible and largely unvetted health care plan approved by Democrats only hours after it was unveiled in 2010 is on life support and you promised to pull the plug.

I suggest Republicans in the Senate review the U.S. Constitution to refresh themselves on its guiding principles. That will probably be much less exciting than planning your next campaign but then, you probably are going to get kicked to the curb if you dont get your act together. Do what you say and say what you mean.

Republicans, you must grow a spine and stand against the craziness being perpetrated by Democrats, who should be ashamed of their infantile behavior. Their obstruction is unprecedented, borders on madness and threatens to unravel the underpinnings of our government.

As just one example, President Obama had 206 of his nominees for judicial and administration positions confirmed by the Senate in the first six months of his administration. Trump has only managed to get 55 nominees throughDemocratic roadblocks, even when the individuals are non-controversial.

Gridlock does not benefit the 323 million Americans that Congress is supposed to represent. Enough of this nonsense.

The Democrats and the left-media are defining the narrative and you, the GOP leaders, are allowing that to happen by not uniting and getting out a clear message about the need for change.

This is the defining battle of our times for the heart and soul of our culture and the Democrats Better Deal clearly outlines how high the stakes are.

As usual, liberals offer three empty slogans: Better jobs, better wages and a better future. Although the rhetoric sounds great, you cannot achieve any of those goals when you are over-regulating businesses and spending more money than the government takes in.

Our national debt is perilously high and our industries are being choked by red tape that is driving them out of the country or out of business.

Nancy Pelosi, the princess of the Democratic Party, gushes about the Better Deal creating 10 million more American jobs in the next five years.

Of course, the way to pay for this is to impose even tougher standards and more regulations on evil corporations, you know, the ones actually creating the jobs.

Democrats seem oblivious to the fact that eight years of excessive regulations was the primary reason for the slowest period of economic growth in our nations history.

There is nothing in the Better Deal about letting the free market create the competition needed to lower prescription drug costs or reverse any of the other failed policies that Americans have rejected at the ballot box.

Every proposal that Democrats have made is the antithesis of what our founders intended for America: Less government, more freedom and more individual rights and responsibilities.

Republicans, the people have nowhere to go to get order restored if you continue to be cowards.

Do something about this mess, and do it now. More than two million soldiers, sailors, airmen and Marines have died to defend our way of life. You owe it to them to do your part in your time.

If the GOP cant get it together, and if Democrats refuse to see that the people dont want their regressive proposals, then there is no hope to stop Americas slide into mediocrity, or worse.

Unless the people finally realize that only term limits will truly drain the swamp of corrupt politicians.

RaeLynn Ricarte

When RaeLynn suggest the Democrat's Better Deal as a crosstalk topic I hadn't heard much about it.

Presented early this week, the Better Deal has three components: raising wages, lowering costs, and giving workers "the tools to succeed."

A quick look below the rhetoric, and there is very little better, and nothing new, in this deal: A major infrastructure overhaul, but with few details as to what that means or how it will be funded; an increase in the minimum wage; and lowering costs (the party promises to "lower the crippling cost of prescription drugs and the cost of a college or technical education that leads to a good job.")

It also says it "will fight for families struggling with high monthly bills like childcare, credit card fees, and cable bills."

In Oregon we have just raised the minimum wage, and for years now the Oregon Health Plan has promised to lower the cost of health care and prescription drugs: The theory was that having more people covered would lower the overall cost of care, preventative medicine being cheaper than emergency care.

Instead, a great deal of money was spent with little or no return and the state is seeking to increase taxes and fees to replace the federal seed money to keep a flawed system afloat.

I'll speak more to this, but since RaeLynn said she was going to start off railing at the Republicans I have to take a moment to speak in their support:

I am pleased to report that, according to New York Times White House correspondent Mark Lander in an interview on National Public Radio's Fresh Air, both the House and Senate have passed legislation meant to tie the hands of President Trump regarding Russian sanctions.

Once reconciled, the bill will go to the president for his signature. Lander noted the president will have little choice but to sign it... although as we have learned you never really know what Trump will do.

In the same interview, Lander reported that suggestions Trump will fire Attorney General Jeff Sessions have also hit opposition from the Republican-controlled House and Senate, whose leadership has threatened to block even a temporary interim replacement.

While I personally think Sessions has his legal head buried in the sand of the mid-1980s with his drug war and three strikes mentality, I find it encouraging that the Republican Party is opposing Trump on these issues.

Where was I? Oh yeah, the economy. The idea of closing the skill's gap in America sounds fine and Democratic, but as Pedro Nicolaci da Costa writes in an opinion piece for the Business Insider, Heidi Shierholz, former chief economist at the Labor Department, has a great saying when it comes to an alleged 'skills gap' in the job market: 'If you hear an employer complain they cant find skilled workers, always ask, at what wage?'

Research shows that if such a gap really existed, wages would be rising more quickly because of a shortage of available workers, and companies would not be shy about investing in training themselves, Costa said.

American companies are rushing to outsource a host of jobs from creative work to product descriptions to English-speaking countries in Africa and elsewhere, where individuals contract to work from home via the internet at fantastically low wages.

I understand you can have an app built for $50, which calculates out to something like 10 cents an hour, according to a friend who does that sort of thing.

Thousands of long-haul semi-truck drivers are looking forward to being replaced by robotic convoys. College graduates struggle to find living-wage employment, skilled though they may be.

We don't need a New Deal re-named to be a Better Deal, with all the economic shadow puppets and hype thrown out by both Republicans and Democrats. We need real solutions focused on real needs and threats to our economy.

We don't have a skill gap, we have a wage and wealth gap, an environmental crisis and we are rapidly approaching a time when the words refugee and immigrant will be used not for those fleeing war or economic collapse abroad but for Americans fleeing economic collapse within America itself.

Mark Gibson

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Crosstalk: It's time to stop the nonsense - Dalles Chronicle