December Analytical Posting

http://www.medscape.com/viewarticle/856197

Skin cancer has been recently on the rise, especially among young people. Just today, the FDA released new guidelines regarding the use of tanning beds. Specifically, the guidelines would prevent anyone under the age of 18 from using high-powered UV sunlamps. In addition, anyone over the age of 18 will be required to sign a waiver every 6 months that says that they understand that using these lamps has health risks that include burns and skin cancers. According to Dr. Peiris of the FDA’s Center for Devices and Radiological Health, tanning lamps give off ultraviolet radiation that’s 10-15 times stronger than the midday sun. Skin damage from UV radiation is cumulative. In other words, it adds up over the course of one’s lifetime, which implies that the concentrated doses of radiation that are delivered by tanning beds are especially dangerous to children and teens.

These guidelines come approximately 1 year after the FDA reclassified tanning beds from lower risk to moderate risk devices. These very moderate risk devices were subsequently banned from anyone that was either under 18, had open wounds or injuries, or had a family history of skin cancer. The FDA also required that anyone that was regularly using tanning beds should get regular checkups for skin cancer. Although this reclassification initiated the suspicions regarding tanning beds, it was only a month later that the surgeon general publicly singled out tanning beds as a cause of disease.

Understandably, the Indoor Tanning Association (ITA) has been very public about its belief that the decision to use tanning beds should be a personal one, even despite the risks. Of course, it is easy to see the profit incentives driven behind this statement, since teens are the industry’s biggest customers. Nevertheless, 13 states as well as the district of columbia have banned indoor tanning for minors, and 23 other states have requires tanning booth operators to adhere to time limits set by sunlamp manufacturers. While restricting access continues to be the main priority, the FDA also has made suggestions to make tanning beds safer, including improving labeling and eye safety.

Personally, I feel that the tanning bed debate speaks to a broader dilemma within healthcare – that regarding the autonomy of the patient in making individual health choices. It’s been well established that tanning beds pose significant health risks, but does this mean that it is appropriate to restrict access? A similar argument could be made regarding the relationship between smoking and lung cancer and alcohol and drunk driving. The risk is well-defined in these cases, but nothing prohibits Americans from being able to engage in these risky acts. Should tanning beds be treated differently? Given the precedents that have been set, I’m not so sure.

 

 

New Medical Training

This article examined a new plan in medical school training that would get medical school graduates working as physician sooner. Grads would skip residency and go straight to treating patients. This new model would help the physician shortage and get physicians into areas with not enough physicians. Residency programs have limited space so many med school graduates are left with the qualifications, but without residency experience, creating a bottleneck effect. However, people argue that medical school is not intended to prepare you to go into practice, that is what residency is for. Some states are trying to implement a position called a “physician in training” or an “assistant physician” (different from a physician’s assistant) who are people who have graduated from med school, but not completed residency. The job allows them to provide primary care services as long as they are supervised by a physician. These new rules and positions are not planned to take effect until fall 2016.

Final Reflections

At the begging of the semester, this was the class I was most looking forward too. As a future healthcare provider, I feel that it is important to understand the system in which providers work in. While doctors are often thought to reside at the top of the medical hierarchy there are so many individuals and factors behind the scenes that contribute to an effective medical practice. Coming into this class I had a basic understanding of the healthcare system and had read enough articles to know that the although the U.S system was one of the more prominent in the world, there still a few rough patches.

 

Overall, I left this class with an almost melancholy feeling. While I was appreciative of a greater understanding of the U.S healthcare system I could not help but think how bleak the situation had become at times. It’s hard to sugarcoat the fact that Americans are living in a fragmented consumer driven healthcare system. I hope that some day I will be able to utilize the knowledge I have learned in this class to help alleviate alleviate the power as well as profit imbalances in healthcare and overall foster a attitude of altruism.

Process reflection 3

What interests me most throughout the course is how actors such as big pharma, insurance companies, medical providers, policy makers and consumer groups influence the medical landscapes today on a macro level. Unlike most of the premed students in the classroom who resonate with the medical professionals more often, as a business major student I think more about the regulatory environment and sustainable growth for the companies (outside the limitation that defining ourselves by our majors, I surely learned a lot from my classmates and adjusted my opinions along the course). Not surprisingly, the mainstream sentiment in the teaching materials is the anger towards almost all the for-profit entities. But since further commercialization is inevitable in our social development, we need to shift from being angry to collaborating with the businesses with new corporate social responsibilities to create a better healthcare system. Furthermore, policymakers have huge power to allocate the interests among different groups thus shifting the whole landscape. For example, the coverage change in Medicare can transform the model of nursing homes, create a new industry such as Hospice, or significantly impact the life of certain population such as people diagnosed with cancer. Those topics are probably outside the scope of this course, but they could be very good extensions and leave questions for further research. Besides, I have only been in this country for about four months, so all the assumed knowledge towards US healthcare system is very new to me! Therefore, this course has been very eye-opening and rewarding.

Process Reflection: End of Semester

As the semester comes to a close, I feel lucky to have taken this class for a number of reasons. I enrolled in the class as an undeclared sophomore, attempting to decide between a sociology and international relations major. I knew that I wanted to work with people in some practical capacity, and that I was interested in the effect that big systems like healthcare systems had on human life at the most personal and individual level. While I will not be pursuing a public health major or minor at least in undergrad, the knowledge I have gained in this class is something so fundamentally relevant to my own life and the lives of those in the community that I am quite grateful to have taken the course.

I believe everyone would benefit from a basic knowledge of the materials learned in this class – no matter their profession or stage in life. Americans particularly live in a healthcare system that is very flawed, and often ends up taking a financial, physical and psychological toll on the people who need it the most. Other countries work as examples for systems functioning more efficiently or more poorly than ours, and educating ourselves about these differences is the first step to positive change. I am especially glad that I took this course at a time when the world is beginning to have more of these conversations – vast changes may be made to these existing systems in just the next few years.

In this class I learned a myriad of things I did not know before – from the consumer-centric and often arbitrarily priced mess of health care services, to conversations around death and dying and the shocking discrepancy between the care Americans want and the care they receive. I am grateful for all of it, and will absolutely consider taking more classes about health care in the future.

ObamaCare News

Hey everyone, just one last quick question regarding some interesting news I heard about this week about ObamaCare. It seems that ObamaCare enrollees will be paying even higher premiums next year, even though the number of applicants has skyrocketed this year. Does anyone have any insight as to why these premiums are rising? I read that the Cadillac Tax is getting cut, which is meant to expand healthcare to those who cannot afford care, so with that tax getting cut and rise of premiums, where is that extra money going?

What Now?

I really enjoyed being in SO215 this semester. I can definitely say that I have learned so many things about our health care system that I was completely unaware of before. I think it was really important for me to take this course because my goal is to one day become a doctor. I believe it’s important to know the origins of the modern health care system and what the current state of affairs is in order for future doctors to be able to bring about effective change. This course has opened my eyes to the imperfections of our health care system but has also shown me that there is hope. There are activists and nations out there who have already begun the next step in our health care system’s evolution and I hope that by the time I enter the medical field, I will be able to do so with pride. I think one of the things I learned about our health care system is that, with the right conditions, reform is possible. I have to say that my least favorite part about this class was learning about the negative aspects of our health care system, simply because I was so unaware of many of these facts before (for example, the existence of the chargemaster). Perhaps one day I will have the chance to be a part of the change that minimizes/eradicates the profit-seeking, corrupt, and unjust aspects of our health care system, and takes it back to its initial beneficent and altruistic roots.

Process Reflection 3

We live in a society where death and dying is better off unmentioned. We understand that everyone lives and imminently, dies but we don’t seem to understand the lurking process of dying. At the start of the semester, I had in my head that my ideal death would be in sleep or while singing at church. I never gave much thought about the present condition of my body before then or the extent that my deteriorating condition would have on my family or even the bills that would need to be paid to sustain me. I never really considered dying as a process that should be planned or even discussed with my family. I just assumed it wasn’t an option. However, I learned in this class that dying can be the most costly and painful experience and that most likely, I will end up dying in a hospital and not the place of my choice with the other 70% of Americans. I learned that I live in a society where the people who should be working to sustain my life can’t even empathize with me and consequently, see me only as a barrage of vital signs. Dying is a time that should be when a person is surrounded by those who care but instead are alone and feel purposeless. I live in a society that would make it hard for me to “age in place” and solely, wants to “make gray gold”; a society that forces young women to be the primary caregiver of her elderly parents because she cannot trust that the people who are trained to take care of her parents would actually take care of them. One thing that is worth taking away from this class is making sure that I know the wishes of my aging family members. Although, having this conversation makes the inevitability of death more real, it can serve to bring our family close together now which is what really matters.

End of Semester Reflection

As some of my classmates have mentioned, I was initially interested in taking a sociology course. Being a psychology major and having done extensive work in social psych, I assumed I already knew everything I needed. I think I may have been unsure about what sociology actually meant, and did not think it would be applicable to my career path.

During the course, I was pleasantly surprised. While there was a lot of reading, a lot of it was really interesting stuff that I would have never been exposed to in other classes. Most of the things we learned can be applied to a vast number of professions in the medical field, and I often found myself thinking about it in specific terms of clinical psychology. I definitely became a lot more educated on the structure (or lack of structure) of the health care system in both the U.S. and in other countries. Though I am not headed to medical school, I enjoyed learning about the hidden curriculum and other aspects of medical education that I was not familiar with. Being a psych major, my favorite conversations were definitely those about stigma and mental health issues.

In closing, I enjoyed the course a lot more than I was expecting to. I learned a lot and I think the course is a valuable one for anyone planning to work in the medical field.

Final Thoughts

Coming into this course I was under the impression that I had a decent amount of knowledge on the current state of our healthcare system….boy, was I wrong. Can we even call what we have right now a healthcare system? When I think of a healthcare system I think of a system that focuses primarily on providing affordable and easily accessible healthcare. Instead, our healthcare system places great emphasis on making money wherever it can, allowing the patient’s (consumer’s?) health to come second. What puzzles me the most is knowing that having somewhat an ideal system is achievable. If Canada, Germany and Great Britain can then why can’t we?

The most shocking issue that we covered was end-of-life care. I never realized the amount of mistreatment and just lack of care the elderly experience. Throughout the time spent on this topic, I found myself questioning whether or not my own relatives had encountered the harsh treatment experienced in these facilities. This course touched upon a great deal of topics that had never crossed my mind. Learning about the effects of SES on healthcare was pretty eye opening as well. I think it should be a mandatory course for anyone considering a career in healthcare. Most universities emphasize the science component behind this field but it goes beyond that. Maybe this is why we see such a great deal of disconnect between a patient and his doctor. I also believe that in order improve the field that you’re entering in, you should make yourself aware of the current issues at hand. My favorite component of the course was discussion. Although information from lecture was often reiterated, your enthusiasm for the content was refreshing and helpful!  This has been one of my favorite courses thus far at BU, and this is coming from someone who could not make it past 3 lectures of SO 100!