by William Toby Jr., Health Care Consultant, William Toby Health Care Consulting Board Member, Adelphi University Center for Health Innovation Advisory Board
On July 30th, surprisingly Medicare reached its 48th birthday without any fanfare. Yet, it had much to celebrate. For it has transformed the dismal state of the elderly being underinsured prior to 1965 and gave them health security and peace of mind.
The world of 1965 was no bed of roses for the elderly. They were largely underinsured with an outrageously low coverage level of 53% and that coverage was limited to $10 a day. Thus, former President Lyndon Johnson enacted Medicare as an important addition to Social Security whose aim was to help prevent the elderly from becoming destitute after they could no longer work.
The inevitable medical expenses of old age were wiping out the life savings of those whose health insurance coverage ended with their retirement. Together, Social Security and Medicare allowed those who worked all their lives and contributed to the country’s economy a more secure and dignified old age. In short, Medicare coverage transformed the lives of the elderly and is the main reason so many is in the middle class today.
Strikingly, of the 48 million Medicare beneficiaries, patient surveys show 83% of them are satisfied with their coverage and confident in their ability to get care, a figure private insurance cannot match.
It is little understood and appreciated that Medicare is the only stable payor in a fragile health care system dependent on third party payors. It pays every clean claim in 14-days versus 30-days for the private sector and it has the lowest administrative cost. In addition, per beneficiary spending has grown more slowly over time than private insurance premiums for comparable benefits.
Medicare’s impact on our economy is huge. Its annual expenditures of over $522 billion make it the flagship of the American economy representing 3.6 percent of our Gross Domestic Product and 16 percent of the Federal budget.
Many of the nation’s over 800,000 physicians depend on Medicare for their Part B income of over $21 billion. Our more than 5,000 hospitals receive over 28% of Medicare outlays and it finances more than one third of all hospital stays nationally
The assurance of timely and adequate reimbursement for such a large proportion of their patients has allowed hospitals to borrow and invest in infrastructure, new technology and research and has helped enable important advances in medicine.
Our teaching hospitals depend on Medicare subsidies for graduate medical education and high technology services. The subsidies alone for medical students have been estimated to exceed $70,000 per resident per year.
Looking back to 1965, much like the Affordable Care Act (ACA) today, Medicare at birth was met by dire predictions and given little chance of success by health planners, politicians, and the media. It was supposed to be a train wreck, given little chance of success.
Medicare was opposed by the AMA, which called it socialized medicine. But President Johnson outsmarted opponents by adopting two guiding principles of government policy for Medicare implementation: (1) the public required more health services than the private market could provide; (2) the private sector was uniquely qualified to organize health services.
This compromise resulted in Medicare having to use the payment policies of the Aetna Insurance company’s Federal Plan and Blue Cross and Blue Shield based on “usual and customary” charges for non-institutional providers. Hospitals, Skilled Nursing facilities and Home Health Agencies were paid on the basis of reasonable cost.
Looking ahead, there are few challenges greater than improving Medicare for future generations. Yet, it is important to meet those challenges in a way that do not sacrifice Medicare’s essential protections. Indeed, in this current polarized debate over the role of Medicare in deficit and debt reduction the crucial thing to remember is that Medicare actually saves money compared to private insurance and that there are still policies Medicare can adopt that can save money in future years.
For example, a major goal of the new health care law (ACA) that receives too little notice in the media is “to sustain Medicare by reducing program expenditures.” Medicare now has the tools to link payments to the performance of health care providers and to test out new models for payment and service delivery.
Already, the cost controls in ACA are slowing expenditure growth and lowering health care costs. Since enactment the Affordable Care Act, health care spending has grown at the lowest rate in the 52 years since records have been kept. According to the Congressional Budget Office, spending on Medicare and Medicaid last year was five percent lower than they predicted just two years before.
There’s a clear slowdown in health care spending. But we need to do more, and do it faster, to change the way Medicare pays for health care. ACA reforms are a good start and should go forward since they represent new thinking on Medicare.
What I find worrisome about Medicare is that it is too oriented towards acute care when chronic illnesses represent 63 % of its spending. That figure is higher system-wide because we are spending $2 trillion on health care and 75% of the costs and 7 out of 10 deaths are attributable to chronic diseases such asthma, diabetes, heart disease, and cancer.
The lack of care-coordination for chronic care sufferers results in high re-admission to hospitals. And they also end up in expensive hospital emergency rooms, which is the worst place for people with chronic conditions.
Yet, in Medicare today there is no system to manage chronic care cases, but health reform legislation like ACA and the Medicare Advantage program take Medicare in that direction. Thus, for the near term, a focus on chronic conditions is the best policy approach for the future of the program.
From my point of view as a manager of Medicare for 31 years, Medicare at 48 is a great success because even in its present form it has delivered on its promise to provide health security for our elderly and disabled.
It is now up to us to make those policy decisions that will reform the program to protect it for future beneficiaries.
Happy birthday, Medicare!
(William Toby Jr. is a former CMS Administrator who administered the Medicare and Medicaid programs.)
by Diane Dembicki, Ph.D., LMT, CYT, Clinical Associate Professor and Director of the M.S. in Nutrition Program, College of Nursing and Public Health
There was a story reported on NPR from the Washington Associated Press on June 27 that for the first time the Agriculture Department is telling schools what kinds of snacks they can sell. This Department sets nutritional standards for schools that receive federal funds for lunches, which is almost every public school and about half of private ones. These rules are based on a law passed by Congress in 2010 called the Healthy, Hunger-Free Kids Act which was put into place last year. The new federal snack rules go into effect next year. But it’s not without its critics, from Congress to the kids it affects.
I would like to address the criticism mentioned in the story. Some say the government should not be telling kids what to eat. They’re not really, because there is still a lot of choice. The “a la carte” lines and any vending machines now have to offer healthier foods. Students can still choose from those offerings or bring food from home, even birthday cupcakes (food allergies being more of a concern here). One high school student commented that they didn’t think anyone would eat the healthier food. Well, there is a Nutrition scientist up in Cornell, Dr. Brian Wansink, who spends a lot of time studying eating behavior. He is the past president of the Society for Nutrition Education and Behavior, and not only did I have the pleasure of meeting him at our annual conference, but I also agree with what he has to say. That we can try to educate people about healthy habits, and even though they probably know what they should do, the environment has a big influence on what they actually do. This was the very topic which was discussed in this week’s New York Times Sunday Review: “Why Healthy Eaters Fall for Fries”(love that creative food photo). By the way, Dr. Wansink was the one that came up with the 100-calorie snack, manipulating the food environment. I do believe if we offer only healthier snacks, it will be a part of the total picture that adds up to healthier kids.
A couple of students who were interviewed said they didn’t like the new government ruling because they like the taste of sweet. No problem there, they can still have sweet tasting fruit, 100% fruit juice, low-calorie sports drinks, and diet sodas. A director of food services in a school district said the healthier foods are expensive. That may be something the government also needs to address. But I ask, how expensive is obesity? Never mind the comorbidities of cardiovascular disease and diabetes, once considered diseases of adults. The Healthy, Hunger-Free Kids Act is supposed to be part of the solution to the childhood obesity epidemic. Just last week, the AMA classified obesity as a disease. Obesity researcher Dr. James Hill at the University of Colorado welcomed the new classification. I worked with Dr. Hill when I was one of the clinical coordinators for the human clinical trials by the FDA on Procter and Gamble’s fake fat Olestra conducted at Colorado State University. People also like the taste of fat.
But tastes, such as liking sweet and liking fat, and the food environment, are just part of nutrition, the other part is physical activity. And that’s a whole other “Think About It “ blog. The federal snack rule can help, along with other things. As Mrs. Obama says, “Let’s Move!” Yes, let’s be active, and let’s also move on doing the things we need to do to have healthy kids.
by Meghan McPherson, M.P.P., CEM, Coordinator, Center for Health Innovation,
Program Manager, Graduate Programs in Emergency Management
This week is National Hurricane Preparedness Week in preparation for hurricane season officially beginning June 1. The National Oceanic and Atmospheric Administration (NOAA) has predicted an above average Atlantic Hurricane season for 2013. NOAA indicated in its recent hurricane forecast a “70 percent likelihood of 13 to 20 named storms (winds of 39 mph or higher), of which 7 to 11 could become hurricanes (winds of 74 mph or higher), including 3 to 6 major hurricanes (Category 3, 4 or 5; winds of 111 mph or higher). These ranges are well above the seasonal average of 12 named storms, 6 hurricanes and 3 major hurricanes.”
The greater New York area is still in the beginning of what is an unprecedented and massive recovery from Superstorm Sandy. Critical Infrastructure, home owners, hospitals, and community services are still struggling to come back. That fact alone makes the area more vulnerable as hurricane season begins. It is incredibly important to heed warnings when they are given by meteorologists and public officials to evacuate. We have now learned a lesson all too familiar to people of the Gulf Coast. Watch the weather and when you are told to evacuate, do so. By not evacuating, you put yourself, as well as first responders, in danger.
The federal government has an extremely user friendly site, ready.gov, that gives you tips for any type of hazard, how to secure your property, and how to make a plan for your family and loved ones. While planning for an emergency, remember that medical preparedness is also key to successfully surviving a hurricane. Make sure you know what medications you take and their dosages, you have the phone numbers for your doctors, and that you have done the same for elderly members of your family.
By taking simple precautionary steps to prepare your family for hurricanes, you can increase your resiliency in the face of disaster.
by Center for Health Innovation staff
A series of tornadoes in Texas has initially reported at least six people dead, and 37 injured on Thursday, May 16, 2013. The city of Granbury, 35 miles southwest of Fort Worth, appears to have been struck the worst.
The tornado created a mass trauma event, unlike any other ever seen in the area. Dr. Kyle McCombs an emergency room physical and chief of staff at Lake Granbury Medical Center is reported in the The New York Times as saying, “For a hospital of our size, we’ve never seen a mass trauma event like this… we had serious, major trauma, and a lot of it.”
Supporting the continuum of health care in emergency situations, like a tornado, was the focus of a recent Adelphi University symposium. On the heels of Hurricane Sandy, the Adelphi Center for Health Innovation invited a panel of health care experts to share their expertise with attendees. The experts included featured speaker Dr. D. Sean Smith of Joplin, Missouri who like his Texas counter-part, Dr. McCombs, runs an emergency medical facility, Mercy Clinic, that was directly affected by a tornado.
At the Adelphi University program, Dr. Smith spoke of how on May 22, 2011, a tornado caused unprecedented destruction in Joplin, including this country’s first direct hit on an acute care hospital. Smith assisted with the initial Incident Command Functions for St. John’s Regional Medical Center.
In the fall 2012 semester, the Center for Health Innovation (CHI) had released a poll on emergency preparedness. The findings released showed that most Americans were not prepared for a catastrophic event. More than 1,000 adults over the age of 18 were surveyed in the university-sponsored poll with highlights that included: 44 percent don’t have first-aid kits; 48 percent lack emergency supplies; and 53 percent do not have a minimum three-day supply of nonperishable food and water at home. Ironically, soon after the poll was released, the region where CHI and Adelphi University is was critically affected by superstorm Sandy.
Another poll focused on mental health in times of disaster, asking whether professionals in that field were prepared to manage clients in such situations. The Mental Health and Disaster Preparedness Poll found that most mental health professionals felt their communities were only somewhat prepared for a disruptive event.
Adelphi University’s the Center for Health Innovation offers over 55 health-related academic programs across 7 schools and colleges. All contributing to an improved healthcare landscape. The university offers Emergency Management master’s degree and certificate programs online.
by Dr. K.C. Rondello
The recent CHI Symposium served as reminder to all in government, medicine and the emergency services that continuity of care in a crisis can only be secured through collaboration of the participating agencies that cut across the spectrum of public health and medical services. As anyone involved in emergency management will tell you, there is no straightforward disaster response — and as the three speakers appropriately explained, cross-discipline communication and cooperation are essential to meet the ever-changing demands of an evolving healthcare crisis.
In times of non-disaster, the interconnectivity of the public, private and not-for-profit sectors is important – but in times of emergency, it is imperative. In the past, medical disaster responders have too often viewed the continuum of care following emergencies through a single lens, most often through that of their own particular discipline. The problem with such a perspective is that no health or medical concern is unifactorial. In the increasingly complex U.S. healthcare system, patients must routinely rely on the interconnectivity of their healthcare providers. In the same way, in order to optimally address our most vulnerable populations following a disaster, we must employ a more holistic model of disaster healthcare – one that simultaneously considers a patient’s social, behavioral and emotional well being in addition to their physical health.
While this may sound intuitive, this ‘whole patient’ approach has only recently been considered in most disaster plans. In the past, disaster health plans have typically addressed matters of physical health in isolation from other factors. Adaptation of alternate standards of care, the establishment of temporary medical treatment sites and the maintenance of healthcare business continuity are all usually considered, along with plans for addressing mental, behavioral and emotional health independent of one another. But only the most robust plans consider the connectivity of all these elements as they are related on one another in actual practice. It has been said that ‘no man is an island.’ In the same way, in a crisis no responder is an island – and disaster planners must consider this in the next iteration of healthcare emergency plans.
Rarely are personnel from the myriad of government and health response agencies brought together to discuss essential interorganizational cooperation and collaboration. The CHI symposium brought this concern to the forefront by highlighting the degree to which healthcare disaster teams, agencies and businesses are inextricably and forever reliant upon one another. With all the constructive and beneficial information presented by the distinguished speakers, that was perhaps the most valuable lesson of all.
by Philip Alcabes, Ph.D.
In a strong piece at CNN online yesterday, Jen Christensen points out that no European countries expect the entire population to be immunized against flu — unlike the US, where everyone over the age of 6 months is urged to get flu vaccine every year.
A few possibilities:
1. Public health benefit?
No. Over the past twenty years, flu-vaccine coverage — the proportion of the population that is immunized — has been going up progressively. But flu hospitalization and mortality rates have been basically constant. If mass immunization had any public health value, those rates should go down as coverage goes up
(A technical note: this means that coverage remains below the threshold needed to reduce influenza transmission population-wide, i.e., it isn’t high enough for herd immunity. But that’s the point. In order to be of public health benefit, flu vaccine would have to be accepted by almost everybody, every year. And even that might not be enough: For a nice explanation of why the efficacy of flu vaccine is limited, see Vincent Racaniello’s blog post.)
2. Exceptional efficacy of the vaccine?
No. Based on an observational study of acute respiratory illness patients published this month, the effectiveness of this year’s flu vaccine is 55% against illness caused by influenza type A (which accounts for about 80% of flu cases). Effectiveness is 70% against type B. Overall, the chances of being protected against symptomatic flu are less than two out of three.
Jefferson and colleagues found that the overall efficacy of flu vaccines at reducing influenza A or B infection in children aged 2-16 is only about 65%, and that inactivated vaccines (i.e., the usual injection) had little impact on serious illness or hospitalization from flu-like conditions in this age group.
As with this month’s observational study, Jefferson et al.’s meta-analysis of multiple studies on flu immunization found that the inactivated vaccine had about 73% efficacy at preventing infection in healthy adults — but that efficacy can be as low as about 50% in years when the vaccine isn’t well-matched to the season’s circulating viruses.
Importantly, the Jefferson studies found that effectiveness of immunization — the prevention of serious illness or hospitalization from influenza-like illness — is very low.
There’s no sound public health rationale for encouraging everyone to be immunized against flu every year.
People who are likely to develop serious complications if they are infected can benefit from immunization. But for most of us, immunization only reduces (by two-thirds) the already rather small chance of infection with influenza. And it doesn’t protect us much from serious respiratory illness during flu season.
I commented in 2011 on public officials striving to help pharmaceutical companies profit from flu fears. And that’s what we’re seeing again this season — with exaggerated warnings and declarations of flu emergencies. Even though the latest national summary from CDC shows that less than 30% of all influenza-like illness is actually caused by flu this season — and that’s likely an overestimate, since it’s based on testing of more severe cases of acute respiratory illness. And the surveillance data suggest that the season’s flu outbreak might already be past its peak.
Get immunized against flu if you’re worried. But keep in mind that vaccination against flu is not going to help the public’s health, and it isn’t highly likely to help yours — it’s primarily your contribution to the profits of Sanofi-Pasteur, Novartis, GSK, or Merck.
Philip Alcabes is a professor in the Adelphi University School of Nursing and director of the Public Health Program. He is an epidemiologist and has studied the history, ethics, and policy of public health.
by Philip Alcabes, Ph.D.
Don’t miss Paul Campos’s commentary on overweight and obesity in today’s NYT. Responding to the latest report by Katherine Flegal of CDC and coworkers, Campos points out that
If the government were to redefine normal weight as one that doesn’t increase the risk of death, then about 130 million of the 165 million American adults currently categorized as overweight and obese would be re-categorized as normal weight instead.
The report by Flegal et al., published this week in JAMA, is a meta-analysis of 97 studies on body-mass index (BMI) and mortality. This new analysis found that mortality risks for the “overweight” (BMI 25-29.9) was 6% lower than that for “normal” BMI (18.5-24.9) individuals. And those in the “grade 1 obesity” category, with BMIs from 30 to 34.9, were at no higher risk of dying than those in the so-called normal range. Only those with BMIs of 35 and above were at elevated risk of dying, and then only by 29%.
In other words, people who are overweight or obese generally live longer than those who are in the normal range. Only extreme obesity is associated with an increased probability of early death.
Flegal and colleagues already demonstrated most of these findings using administrative data, in an article appearing in JAMA in 2005. There, they reported no excess mortality among people labeled “overweight” by BMI standards, and that about three-quarters of excess mortality among the “obese” was accounted for by those with BMIs above 35.
What’s notable about this week’s publication is that it has attracted the attention of some heavy hitters in the media. Pam Belluck covered the JAMA report for the NYT. Although her article seems more interested in propping up the myths about the dangers of fat than in conveying the main points of the new analysis, Belluck does acknowledge that some health professionals would like to see the definition of normal revised.
Dan Childs’s story for ABC News gives a clear picture of the findings, and allows the obesity warriors, like David Katz of Yale and Mitchell Roslin at Lenox Hill, to embarrass themselves — waving the “fat is bad” banner under which they do battle. MedPage Today gives the story straight up. In NPR’s story, another warrior, Walter Willett of Harvard, unabashedly promoting his own persistently fuzzy thinking, calls the Flegal article “rubbish” — but the reporter, Allison Aubrey, is too sharp to buy it from someone so deeply invested. She ends by suitably questioning the connections of BMI to risk.
Campos’s op-ed piece does the favor of translating the Flegal findings into everyday terms (and without the pointless provisos that burden the NYT’s supposed news story):
This means that average-height women — 5 feet 4 inches — who weigh between 108 and 145 pounds have a higher mortality risk than average-height women who weigh between 146 and 203 pounds. For average-height men — 5 feet 10 inches — those who weigh between 129 and 174 pounds have a higher mortality risk than those who weigh between 175 and 243 pounds.
Is the hysteria about overweight and obesity is over? I’m sure not. In today’s article, Campos — who was one of the first to explode the fiction of an obesity epidemic, with his 2002 book The Obesity Myth – reminds us of a crucial fact about public health:
Anyone familiar with history will not be surprised to learn that “facts” have been enlisted before to confirm the legitimacy of a cultural obsession and to advance the economic interests of those who profit from that obsession.
There’s too much at stake with the obesity epidemic for our culture’s power brokers to give it up so quickly. One day, some other aspect of modernity will emerge to inspire dread (and profits). In the meantime, we might at least hope to see some re-jiggering of the BMI boogeyman.
Philip Alcabes is a professor in the Adelphi University School of Nursing and director of the Public Health Program. He is an epidemiologist and has studied the history, ethics, and policy of public health.
By Jeffrey Weisbord, Adelphi sophomore
In the days of the Soviet Union, my grandmother was the assistant principal of a prominent English language school in Moscow. Many of her students became leaders in business, politics and medicine, and one—Mikhail Prokhorov—even went on to rank among the wealthiest people in the world and own the NBA’s Brooklyn Nets.
My father was one of her students, and grew up seeing his own mother as an authority figure for hundreds of Moscow’s most gifted youths. This image has changed drastically over the last few years, as my grandmother—now in her late 80s—relies on her immediate family simply to survive. Despite various ailments (dementia being the most noticeable), she still lives by herself, albeit with a house attendant who stays with her until 9:00 every night. I make a nightly trip to her apartment to ensure that she’s ready for bed, and my father visits her every day during his lunch break. Her day-to-day life has become very difficult, but it may be even harder for my father to witness his hero fade to a shell of her former self.
My story is just one among millions. Within the next five years, the number of people who are 65 or older will, for the first time, exceed the number of children on our planet. Aging is an issue that touches all of us. Fittingly, faculty members from Adelphi’s Gordon F. Derner Institute of Advanced Psychological Studies are using their expertise to address the issues surrounding aging and caring for the aged. Their work and that of other Adelphi professors and alumni is covered in the feature story of the Fall 2012 issue of Adelphi University Magazine, “Everyday People, Extraordinary Challenges—A Look at Growing Older in the New Millennium.”
From the Derner Institute, Professor Robert Bornstein, Ph.D., who co-wrote When Someone You Love Needs Nursing Home, Assisted Living, or In-Home Care: The Complete Guide with his wife, psychologist Mary Languirand, offers guidance on not only finding a good nursing home for yourself or a loved one, but also budgeting for elder care before it’s too late.
Assistant Professor Katherine Fiori, Ph.D., has researched the effects social networks have on seniors’ mental and physical health. She comments on the differing effects of networks—with family and with friends. She has found that friend-focused networks are particularly beneficial for mental health, while family-focused ones tend to be better for physical health than mental health.
Associate Professor Francine Conway, M.S. ’92, Ph.D. ’99, has studied grandparents who care for their grandchildren—a growing trend. She has found that the grandparents’ disposition and outlook play crucial roles in their health outcomes. “If they’re able to see this as a benefit to them, then it will be,” she told Adelphi University Magazine.
Whatever your age or outlook on aging, you’ll find credible and valuable faculty and alumni expertise in this Adelphi University Magazine article.
Jeffrey Weisbord, a biology major, is part of Adelphi’s Early Assurance Program with NYU College of Dentistry. He is an avid writer and contributes to various University publications, including Adelphi University Magazine. He has always stayed active by exercising and playing sports, but has recently taken the next step by severely limiting the amount of unhealthy food that he consumes.
by Philip Alcabes, Ph.D.
Last week, the Think About It blog’s Weekly Health Roundup (14 Dec.) moved too fast.
Our bloggers applauded the behavioral policing of NYC’s Bloomberg administration as a factor in two pieces of news: the decline in New York City’s child obesity prevalence and an increase in life expectancy.
The Dec. 14th TAI blog post specifically mentioned four Bloomberg-era innovations: bans on smoking in restaurants, bars, and parks; the ban on trans fats in restaurants; the requirement to post calorie counts at chain restaurants; and the new ban on the sale of sugar-sweetened beverages in large-size cups.
Our bloggers didn’t consider two big problems, though.
First, there has been no convincing evidence that any one of the Bloombergian innovations has led to a reduced rate of disease. The city’s Department of Health and Mental Hygiene has indeed made such claims – but they were based on circumstantial evidence. For instance, evaluators found that people who order lower-calorie options at fast-food restaurants say they had read the posted calorie counts (the NYC health commissioner, Thomas Farley, might well believe that such correlations are evidence of cause-and-effect relations – but intelligent people know better).
Second, the data don’t support the conclusion that obesity prevalence has declined, nor the inference that the increased life expectancy demonstrates reduced risks of dying.
The obesity data are based on what are called “serial cross-sections.” That is, investigators weigh and measure a bunch of children to determine the distribution of BMI, body-mass index. Two years later, they do the same to a new bunch of children. To find that the second batch contains fewer high-BMI kids than did the earlier group tells us nothing about whether the children who were obese the first time around have now slimmed down. Because we don’t know if the children in the first batch even appeared in the second batch, and no individual child is observed at multiple times to track BMI increase or decrease.
These data don’t allow us to conclude anything at all about whether children are getting fatter or slimmer.
And life expectancy, it’s important to know, is just an average age at death. Life expectancy in a population will go up if people live longer, which is the point of measuring life expectancy in the first place. But L.E. will also go up if more wealthy people move into a region (because wealthy people live longer than poor people). And it will go up simply if more older people move in (because adding 70- and 80-year-olds to the population makes the average age at death go up – even though nobody’s chances of dying have changed at all).
In fact, over a short term and with the high rates of in- and out-migration that NYC has, the most likely expectation for the longer life expectancy in NYC isn’t lower risk of dying – it’s that the wealthy have bought up properties that the lower and middle classes can no longer afford.
So there’s no reason to think that the trans fat ban, smoking bans, or big-cups-of-soda ban have made New Yorkers healthier. It’s more likely that Mayor Bloomberg has simply made the city more hospitable to the rich.
Which doesn’t seem to merit applause at all.
Philip Alcabes is a professor in the Adelphi University School of Nursing and director of the Public Health Program. He is an epidemiologist and has studied the history, ethics, and policy of public health.
Three cheers for New York City!
The Bloomberg administration’s longterm focus on public health appears to be paying off, as a pair of reports released this week suggests. The childhood obesity rate in New York declined more than 5% in recent years, and made significant strides in other U.S. cities, including Miami and Philadelphia, as well. The positive news comes with a caveat, as the decrease in New York was less significant among minority and low-income children.
Mayor Bloomberg’s office announced all-time high life expectancy and all-time low infant mortality figures in conjunction with the Health Department this week. Babies born in 2010 have a life expectancy of 80.9 years—more than two years longer than the national average. And New York City’s infant mortality rate fell in 2011 to an all-time low of 4.7 deaths per 1,000 live births, this time with improvements seen across all ethnic groups.
The mayor’s office is quick to claim the positive news as a result of their commitment to public health. Over the span of Bloomberg’s decade-long mayorship, the Big Apple has benefited from several much-imitated health initiatives, including:
While New York City has made significant strides toward healthier living under Bloomberg’s mayorship, a new report from the ocean conservatory group Oceana details fish mislabeling in restaurants and stores in NYC and other cities across the country. Aside from the “bait and switch” economic issue of patrons paying for higher-priced fish than they are consuming, the mislabeling can create significant health hazards for pregnant women, those with food allergies, or for anyone seeking to lower their consumption of mercury and other toxins.
This week saw significant changes announced to the upcoming edition of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) , the comprehensive guide produced by the American Psychiatric Association. The headline-grabber involved the elimination of a separate Asperger’s syndrome and its envelopment into a broader autism spectrum diagnosis. While this was the noisiest change generated, other note-worthy shifts announced include:
Controversy surrounds many of these changes, and for those that expand the current guidelines for diagnosis, there is apprehension surrounding the potential for overmedicating of what some would consider “normal” life chapters (i.e. grief as part of the bereavement process; temper tantrums as part of a child’s development).
And while overmedication is certainly a hazard, a new study published in The Lancet this week reveals that the breast cancer drug tamoxifen has been largely underutilized in post-breast cancer treatment. The study finds that prolonged (ten-year) use of tamoxifen further reduces the risk of breast cancer recurrence, as opposed to the current five-year tamoxifen protocol.
For royal bump watchers, good news from Buckingham Palace came this week in the form of an official announcement of the Duchess of Cambridge’s pregnancy. The happy news came with the more sobering footnote of Kate’s severe morning sickness for which she had been hospitalized, shining light on a rare pregnancy side effect that is generally benign but can produce serious health risks.
And finally, as we close out National Influenza Vaccination Week, we urge you to get the flu shot if you have not done so already. The CDC warned just days ago that this year’s flu season may be a particularly nasty one, having started earlier than usual. If you missed this week’s Flu Clinic, you can still get your flu shot through Health Services (Monday through Thursday from 5:00-7:00 p.m., and Tuesday through Friday from 8:30-10:30 a.m.).
As November winds down, we are turning our focus this week to December 1 and World AIDS Day.
In the days leading up to December 1, The New York Times published a piece exploring how expanding technology has changed the nature of India’s sex industry. Women are experiencing both increased autonomy and financial benefits, since they no longer have to rely on brothels. However, this autonomy may pose long-term problems for a country who was once predicted to ultimately become the “focal point” of the AIDS epidemic, and to see 25 million people with AIDS by 2010. Targeted outreach to high-risk groups, including prostitutes were hallmarks of the country’s success. In addition, foundations such as the World Bank and the Bill and Melinda Gates Foundation, provided ample financial resources in support of these efforts. Today, India is dealing with approximately 1.5 million cases of AIDS, a staggeringly different number from what was predicted. However, Gates foundation funding is poised to stop in the coming months. In addition, the fear is that technology will disperse one of the country’s most vulnerable populations, and make education and prevention almost impossible.
But that doesn’t mean groups will stop trying. Yesterday, US Secretary of State Hillary Clinton released the “PEPFAR Blueprint: Creating an AIDS-free Generation”. The plan’s overall vision is that while “smart investments based on sound science and a shared global responsibility” will be key if we want to “save millions of lives and achieve an AIDS-free generation. The plan sees a path to this vision through five over-arching goals:
We have reason to hope. The PEPFAR blueprint comes on the heels of “Results”, a November 20 report released by UNAIDS that finds, among other things, that “between 2001 and 2011, HIV incidence in 25 countries declined by more than 50 percent and decreased by 20 percent worldwide. Since 2005, the number of AIDS-related deaths has declined by almost one-third.”
A message from Adelphi’s Center for Health Innovation
More than two weeks have passed since the devastation caused by Superstorm Sandy swept through the area. As the region begins to repair and rebuild our altered landscape and tattered neighborhoods, we pause to acknowledge the emotional toll imprinted on the survivors. The superstorm, nor’easter, and their aftereffects damaged more than our powerlines and buildings; they further battered an already hardened New York collective psyche. Yet for many, the most fulfilling path to inner healing is to extend a hand outward to aid our neighbors who have lost so much of their livelihoods.
Adelphi is assisting in disaster relief efforts in many ways, from blood and donation drives that address physical needs, to counseling services to address the psychological aftereffects. The University is coordinating volunteer efforts at hard-hit sites on Long Island and Queens, including Long Beach, Oceanside, Island Park, and Breezy Point (visit the link above, then click How You Can Help, then Volunteering at Disaster Locations for more information).
As we prepare for Thanksgiving next week, many area organizations and businesses are working to bring Thanksgiving meals to many still without power, as well as those displaced by the storm. There are bountiful other opportunities to help our neighbors in need throughout the affected areas.
Wishing you the gifts of health, love, and gratitude this holiday season.
by Philip Alcabes, Ph.D.
The public policy scholar Robert Puentes (a Senior Fellow at the Brookings Institution) has advised that we look at extreme weather events — like last month’s Hurricane Sandy — as part of the “new normal.” To which we can add last year’s Hurricane Irene, the derecho of summer ‘12, a devastating drought in the middle of the country, paralyzing snowstorms in both October 2011 and last week that felled trees and branches that were still in leaf, and so on.
But the new normal – extreme weather, rising sea levels in the Northeast, higher storm surges, and, as the National Aeronautics and Space Administration (NASA) reported, ecosystem change – isn’t just a matter for transportation and land-use planners.
It means that we need new norms for health – and new ways of protecting the gains in human capacity and longevity won in the course of the previous century.
How will we train a generation of health professionals to be capable of taking on dire problems of tomorrow whose outlines are only beginning to be perceptible today?
Here are five issues to consider in training future health professionals to confront the New Normal:
A cautionary tale on leadership:
Two weeks after Hurricane Sandy, 55,000 NYC residents were still lacking power, many of them in buildings that also lacked running water. The New York City Commissioner of Health and Mental Hygiene, a leader in banning large servings of sugar-sweetened beverages and promoting bicycling, has done almost nothing to mobilize aid for threatened food and water supplies or provide warmth or medical care. Instead, the Department of Health and Mental Hygiene addresses suffering residents solely with warnings: “Never use stove burners or ovens for heat,” “Dry ice: safety tips,” “Hypothermia after Hurricane Sandy,” and other messages populate the website.
Effective leadership in the New Normal will mean being proficient technically, of course. But it will also mean not wasting time and resources preaching about behavioral “improvement.” It will mean recognizing the enormity of suffering and the depth of human needs. And it will mean being able to plan and respond in ways that are both smart and humane.
Acknowledging, with the advent of Sandy, that the New Normal has arrived, we who train health professionals are challenged to produce the right kind of leaders for the future.
by Meghan McPherson, MPP, CEM
In the days leading up to Superstorm Sandy making a direct hit on the New York region, emergency management officials made warning after warning that this was a storm not to take be taken lightly. This storm was destined to be an outlier from recent memory in terms of the amount of heavy damage it would cause. Yet, Long Island Power Authority COO Michael Hervey continues to assert that LIPA had no way of knowing that the effects of the storm would be this catastrophic, with over one hundred thousand still without power 14 days after the storm. One could contend the exact opposite. LIPA certainly did know the likelihood of this type of paralysis, even without the dire warnings from emergency management and public officials.
There have been a lot of comparisons between Hurricane Katrina and Superstorm Sandy in the past two weeks. I personally saw the aftermath of both storms, and I can speak to their similarly devastating impacts on the many sectors critical infrastructure. But from an energy perspective, there is no comparison. The population density and critical infrastructure needed to support that population is second to none in the New York area, and especially on Long Island. The interdependencies of energy sector critical infrastructure and the cascading consequences when the energy sector collapses could be seen coming as a menacing wave long before our homes were flooded.
The concept of energy assurance focuses on this specific issue. The US Department of Energy, Office of Electricity Delivery and Energy Reliability defines energy assurance as “Improving the ability of energy sector stakeholders to prevent, prepare for, and respond to threats, hazards, natural disasters, and other supply disruptions.” With 85% of the national critical infrastructure privately owned, it is crucial for our energy sector stakeholders to develop redundant systems and protocols that will reduce the impact of a major storm and will speed the recovery of the entire region. Long Island’s residents have suffered long enough from the inexcusable power outages and the resulting impact on health care, gasoline availability, heat for our homes, school closures, and business losses. Let this be a wake up call to our region and to energy officials all over the country. The energy infrastructure is old and is being relied upon much beyond its original determined lifetime. If we continue to ignore this issue in light of increasing severity and frequency of major weather events, we will continue to see our entire way of life screech to a grinding halt while power officials tell the public, “It was beyond the magnitude of what anyone expected.”
Meghan McPherson is the Coordinator of Adelphi University’s Center for Health Innovation and the Program Manager of Adelphi University’s Graduate Emergency Management Programs. Before joining Adelphi University in the fall of 2011, Ms. McPherson spent four years as both a grants manager and the Energy Assurance (energy emergency management) Program Manager in the Governor’s Office of Energy and Planning at the State of New Hampshire. Click to read more about Ms. McPherson’s experience.
We’ve seen our share of health news this week—from a malaria outbreak in Greece, thought to be exacerbated by their economic depression, to the roller coaster/soap opera that is Europe’s battle against tobacco.
On the new research front, a recent study from the University of Toronto published in the Proceedings of the National Academy of Science finds that adversity during childhood can yield positive results later in life in the form of persistence and self-control; while a British study soon to be published in Social Indicators Research, finds that fruits and vegetables may not just good for your body, but also for your soul.
But today, we’d like to focus on preparing you and your family for a weather event that is heading up the east coast. Hurricane Sandy is projected to start affecting our area early next week—and we want to make sure you have what you need.
Earlier this year, we shared the results of the inaugural Adelphi University Center for Health Innovation Poll, which found that we just aren’t that prepared for emergencies—mostly because we don’t think we’ll be impacted. According to our poll, 84% of Americans don’t think it’s very likely they will be affected by a disaster. You can hear more from the CHI team about our poll on this podcast.
However, it looks like we may, in fact, be impacted by a weather event in the next few days. We urge you to act upon the poll’s findings and use the time ahead of the storm to prepare yourself and your family. To assist you, here are some important resources from ready.gov: How to build a basic disaster kit for your family ; Creating a Family Emergency Plan; and What to do Before, During, and After a Hurricane.
The U.S. presidential debate dominated media coverage this week, with healthcare taking a backseat to foreign policy, the economy, job creation, and other contentious topics Tuesday night. Nonetheless, you may have caught the candidates’ brief exchanges on women’s health issues, health insurance premiums, and Medicare in between the jabs and hooks.
In honor of World Food Day this week, and at the intersection of food and politics, did you savor Michael Pollan’s article on the political implications of the burgeoning food movement in the New York Times Magazine’s annual Food and Drink issue? Foodies and health-minded individuals will surely pay close mind to California this November as it votes on Proposition 37, requiring genetically modified foods to be appropriately identified and labeled. And speaking of labels, Mark Bittman’s exercise in reimagining a more useful and streamlined food label distills food worthiness down to a numerical score and a traffic light color-coded system. Is this an oversimplification or a step in the right direction?
Peeking ahead to next week, Adelphi relishes National Food Day on October 24 with a series of on-campus events to highlight the need for sustainable, affordable, and healthy food for all. Free events include the Long Island premiere of The Harvest/La Cosecha, the story of migrant child workers working on U.S. farms; a Farmers Market; Iron Chef Competition; and an interactive food memory project. To kick off National Food Day, famed celebrity chef and motivational speaker Chef LaLa brings her cooking show to Adelphi on Tuesday, October 23. Make sure to check out all of our Food Day-related events.
If an apple a day keeps the doctor away, it seems a vitamin may be a worthy substitute. Encouraging news for men who take daily multivitamins came from a paper presented at the American Association for Cancer Research conference. Men taking a daily multivitamin were diagnosed with 8% fewer cancers than their placebo counterparts.
by Dr. Jacques Barber
There is a first time for everything. This will be the first time that I blend my interest in psychology with my interest in a TV series. The series Homeland, which just won several Emmys awards, has many interesting aspects, including many psychological ones. In fact, there are so many psychological angles to focus on that I will have to be selective. I will focus on Carrie and her psychological struggles. At the end of the first season, her bipolar disorder is exacerbated by the stress and complexity of the situation that she is trying to solve. Solving complex problems is stressful; stress and lack of sleep are detrimental to individuals with a tendency to have difficulties maintaining a stable state of mind and emotional balance. My focus on this blog is to discuss her “disease,” how her disease leads Carrie to be mistrusted, and how it is easy for “normal” people to dismiss the views of individuals different from themselves. Furthermore, I will touch on the topic what is “truth” and how do we know it.
The viewer knows that Carrie is onto something when she is suspicious of Brody. Because her behavior is somewhat erratic and her theories are quite unusual if not “crazy,” her colleagues begin to distrust her. In fact, it is heartbreaking to see how easily dismissed somebody who sounds crazy can be. It is easier for those around her to distrust her and to dismiss her Ideas or “hypotheses” than to take them seriously, or even ponder, what she was suggesting. How can an American hero, a Marine, who has survived hardship during years of captivity, betray his country? How could he really plan to murder the Vice President of the USA and his entourage (e.g., the defense secretary)?
Many psychologists and psychiatrists have tried to find deep meaning in human behavior, including abnormal behavior. One of the first was Freud, the father of psychoanalysis, who attempted to explain hysterical symptoms (e.g., hysterical hand paralysis which is a phenomenon that is not consistent with what we know about the neurology of hand function) with a far-reaching theory of the mind. His psychoanalytic theory of the mind, which some people consider quite farfetched, has recently received some support from neuroscience findings. This is happening at a time when the popularity of Freudian therapy is declining around the world. Watching “Homeland” the viewers, however, do not need to understand the deep causes of Carrie’s delusions. This is not necessary as we know that her views are not delusional. This is reminiscent of the non trivial saying “Just because someone is paranoid, it doesn’t mean he’s not being followed.” The viewer knows enough to understand that Carrie’s theories are not off the wall; they are close to reality. Keep in mind also that the reality is evolving as Brody becomes more involved in what could be called anti-American activities (e.g., collecting secret information from the CIA) than he actually planned initially.
If we stick with what is known, are Carrie’s hypotheses farfetched? Is she delusional? Delusions are not a typical feature of bipolar disorder. Systematic delusions like Carrie’s are more a characteristic of paranoia (now called delusional disorders) or to a lesser extent of schizophrenia. But we do not need to be too technical here; after all, it is a TV series. So let’s discuss delusions. Following the work of Fried and Agassi (1976), I will surmise that in paranoia the delusion is very systematic. How do we know when a systematic delusion is true or when is it false? Can we even know when a scientific theory is delusional, or when it is true, for that matter? For example Copernicus was initially dismissed as irrational. Although much has been written about how, and whether, the validity and truth value of scientific theories can be corroborated, there is little work that takes seriously the question, how do we decide that a delusion is indeed delusional? Is it when it does not correspond to reality or to the facts? Do we ever have all the facts? These are very basic questions that mental health experts and epistemologists should grapple with but, for the most part, they have not (exception includes Fried and Agassi). Early in my life these questions occupied much of my thinking, and intellectual energy. The question is: What distinguishes a delusional theory from any kind of theory, including a scientific one? How do we know that a scientific theory is valid while Carrie’s is not?
She is dismissed. It is also interesting that when, as she is going to receive her first ECT, she remembers that Brody knew Abu Nazir’s son and she asks her sister and the nurse to remind her of that after the ECT. However, the nurse dismissed her. Yes, it is common for patients under anesthesia to say things that make no sense. And even if what they express is logical and sensible, how can a nurse or doctor hearing those fragments of thoughts understand them without the context? Furthermore, the anesthesia nurse has heard many depressed patients (depression is one pole of the bipolar disorder spectrum) saying all kinds of things related to their own lives. Likely she long ago stopped trying understanding what the patients are saying, or meaning.
I will bet that most viewers feel sympathy towards Carrie; she cares about her country, and she is extremely dedicated. In fact, she is willing to follow her views in the face of ridicule and adversity. But in the end she gives up. She comes to believe she is wrong, and she feels badly (depressed) about having caused harm to Brody and his family. Is it a coincidence that she is a woman, and that as a woman with mental health issues she is dismissed?
How do we increase tolerance and respect for people who are different from us? I think the first step is to listen to them and not dismiss them automatically. I know that this is hard; it’s hard to listen to somebody from the extreme right, or the left, etc. But one message I take away from the show , even if the writers didn’t intend it, is that it is worth listening to people like Carrie and perhaps even to Brody (note that how his daughter listens to him and the impact it had on him when he decides not to detonate the explosive vest in the bomb shelter). If we listen, we open up the possibility of learning something new.
Fried, Y. & Agassi, J. (1976) Paranoia: a study in diagnosis. Boston Studies in Philosophy of Science, Volume 50. Dordrecht: D. Reidel Publishing Company
Jacques P. Barber, Ph.D., ABPP is the dean of the Derner Institute of Advanced Psychological Studies at Adelphi University and Emeritus Professor, Perelman School of Medicine, University of Pennsylvania and Adjunct Professor of Psychiatry, New York University Medical School.
We’re starting off this week in Kenya, where researchers at the Harvard School of Public Health spent a year collecting data from the 15 million cell phones used in the country. Why? To map how malaria spreads through the country. The results reveal some surprising information. First—and perhaps most distressing—is that mega-cities, like Nairobi, are seeing increased malaria cases, meaning mosquitoes are learning to adapt to big cities. However, the data also provide encouraging opportunities for better focusing malaria control efforts, as well as dispersing outbreak and treatment information to large groups of people at once.
State-side, the US continues to deal with more reported cases of the rare but non-contagious fungal meningitis thought to be caused by contaminated drugs administered via spinal injection. This interactive map from the New York Times provides updated information on reported cases. As the number of cases has risen, media coverage has turned its focus, in part, on exploring spinal injections’ big-picture risks, ones that existed well before this recent outbreak.
And before you start thinking that the news is entirely grim this week, a new report by the Centers for Disease Control might make you feel better. Their data indicate that while the average overall life expectancy in the U.S. has remained the same (78.7 years), death rates overall reached a record low. But the most positive finding was that death rates for five of the top 15 causes of death dropped in 2011. Even more encouraging are the declines in death rates from cancer and heart disease, which together, accounted for close to 50% of all deaths in the United States in 2011. Although HIV is not in the top 15 causes of death, it saw a 7.7% in death rate, but researchers warned that it is still a public health concern particularly among the 15-64-year-old populations.
by Philip Alcabes, Ph.D.
There hasn’t been much hope in the past few years that concord will calm America’s no-holds-barred struggle over abortion. But what if abortion were to become a rare event? There’s reason to hope that a new policy approach might make abortion a non-issue, or at least a less inflammatory one.
This week, the Associated Press reports on a study in St. Louis showing that when women have access to a variety of contraceptives at no cost, abortion rates fall dramatically. In the study of nine thousand women, many of them lacking health insurance, who were given contraceptives of their choice at no cost, only 0.4 to 0.8 percent had abortions per year – far less than the 2 percent per year that, according to the Guttmacher Institute, is the average for women aged 15-44 nationally.
Why does one study signal hope? Because the rules for women’s health services under the new Affordable Care Act (ACA) – the so-called Obamacare law – require that insurance companies cover contraceptive services for women at no out-of-pocket cost.
According to the US Health Resources and Services Administration, insurance plans, except for those sponsored by religious organizations, must cover:
“All Food and Drug Administration approved contraceptive methods, sterilization procedures, and patient education and counseling for all women with reproductive capacity.”
For roughly the past decade, there have been about 1.2 million induced abortions each year in the US. The percentage of women who need to end a pregnancy with abortion has not declined much during the decade, according to Guttmacher.
The St. Louis study suggests that widespread access to free contraception – which the ACA should help extend – might decrease the need for abortions dramatically.
There are caveats, of course. There’s the religious-insurance-plan exemption, which will allow contraception to remain financially out of the reach of some women. There’s the chance that opponents of women’s health within Congress could push through an amendment removing the free-contraceptive-access provision of the ACA.
And there’s the problem of correct use of contraceptives. In surveys of women seeking to terminate unwanted pregnancies in the early 2000s, a high percentage said they had used contraception during the month in which they became pregnant. That is, access to contraceptive methods doesn’t necessarily translate into effective use of those methods. Effective use of contraception has probably improved since the surveys were done – but it’s not clear by how much.
And, it’s possible that the struggle over abortion – embodying as it does a fundamental disagreement as to whether America’s search for justice should be based on deeply held beliefs about good and bad behavior, or on widely shared principles of individual rights – can’t be resolved even if abortion becomes a rare event.
Still, it’s worth wondering whether access to contraception, by dramatically reducing need for abortions, might just allow for the abortion fight to turn into an abortion conversation.
This week brings some encouraging news from the world of epidemiology, where NPR’s health blog reports that scientists recently discovered three new human viruses. What’s so good about that? In these three cases, the viruses were found before impacting more than two or three people. The most recent wide-spread viruses, such SARS—which in 2003 spread to over 8,000 people and caused over 750 deaths—followed a trend of a virus emerging in one location then quickly spreading across the globe. What has changed? In addition to new World Health Organization guidelines on information sharing and advances in genetic sequencing, Dr. John Brownstein of Children’s Hospital in Boston believes that with the social media and communications tools available, that “it’s very difficult to imagine…an important public health event where that information isn’t getting out in some form …I think there’s very few places on Earth where we’re not able to get citizen reporting and information.” He and his colleagues are using tools like HealthMap to keep up-to-the-minute information flowing about outbreaks.
The United States is dealing with outbreak concerns this week, as a form of rare meningitis continues to spread. The New York Times reports that patients are thought to have become ill from a contaminated steroid. This particular form of meningitis does not spread from person to person, although, infection disease professionals do expect additional cases due to where the contaminated drugs have been shipped.
In more domestic news, the Centers for Disease Control reported that in 2011, close to 1 million teens drove drunk. Their report also showed that drunk driving has gone down by 54% since 1991, which seems like an encouraging trend. However, a Los Angeles Times article is quick to point out that this may simply be a function of increased gas prices coupled with fewer opportunities for teens to drive due to drops in employment opportunities for them. The CDC’s report also offers tips on how parents and teens can work together to further decrease rates of drunk driving and the curb behaviors that influence it.
But what really does help when you are trying to modify your behavior? Rewards? Punishments? How can we truly impact behavioral change? Dr. Kent Bottles, a Senior Fellow at The Thomas Jefferson University School of Population Health in Philadelphia, explores a rise in new web tools designed to help us meet our goals. Sites like Stikk have an “anti charity” option that takes money away from you if you don’t stick to your goals, while Aherk exploits user-supplied embarrassing photos as motivation and GymPlant tracks your workouts via smartphone. Could these tools become commonplace, and potentially helpful, for the next generation of teen drivers?
Autism appeared on the international agenda this week when the United Nations 67th General Assembly heard a resolution that “calls for greater participation of the U.N. in recognizing autism as a public health crisis and encourages Member States to tackle developmental disorders at the local, national and international levels.” World leaders also attended Autism Speaks Fifth Annual World Focus On Autism, and further emphasized the importance of raising awareness.
Meanwhile, collection sites across the United States are getting ready for Saturday’s National Take Back Drugs Day, which helps in the safe disposal of expired prescription drugs. The improper disposal of expired or unused medications can pose health risks to children and pets. Adelphi will have a collection site open on Saturday, September 29, from 10:00 am to 2:00 pm in the Ruth S. Harley University Center Lobby, and has an early drop off box available today, in the Public Safety Office, Levermore Hall, lower level.
If you are catching up on the latest fall TV premieres, you may be interested to know that a new study in the Journal of Communication finds that “social bullying is common on TV, even in shows made for kids.” Researcher Nicole Martins, PhD, used Nielsen Media Research data to determine the 50 most popular shows for viewers aged 12 and younger, and watched 3 episodes of each show. Dr. Martins found that “a total of 92% of the viewed episodes included incidents of social aggression, with verbal aggression accounting for about four out of five of these incidents.” She identified this as an opportunity for parents to talk about social bullying with their children.
And finally, we all know it’s rude to “eat and run,” but this week, researchers at the University of Copenhagen discovered that there may be benefits to people who “learn and run.” They asked a group of healthy males to repeatedly complete a complicated motor skill task on a computer, with some of the men exercising before they began, others after they had tried the task several times, and others still not at all; all participants came back a week later to repeat the task. Researchers found that the group who had exercised after learning the task “were noticeably better at remembering the task…which suggests…that physical exercise may help the brain to consolidate and store physical or motor memories.”
See you for next week’s Roundup!
by Bonnie Soman, D.A., CCC-SLP
In September, the Hy Weinberg Center for Communication Disorders (Adelphi University’s Speech and Hearing Center) started a program for individuals with aphasia at our Hauppauge Center. The Center now offers a weekly communication group run by graduate students in the department of Communication Sciences and Disorders under the supervision of Dr. Bonnie Soman, clinic director and licensed speech-language pathologist. This is the first group of its kind in Suffolk County.
Aphasia is a communication disorder resulting from some type of brain injury. Oral communication (speaking and understanding of language), as well as written language (reading and writing) may be affected. Although most typically caused by stroke, aphasia may result from traumatic brain injury or brain tumor. Although more common in older adults, aphasia may occur in individuals of any age. Each year, more than 100,000 people in the United States acquire aphasia.
There are three goals in running our aphasia group:
Aphasia affects not only the individual who acquires this disorder but family members as well. Serving as a caregiver may interfere with work and other family responsibilities. The caregiver often neglects his/her own needs to care for the person with aphasia. To address this, the Hy Weinberg Center in Hauppauge is running a weekly support group for family members.
Enrollment is ongoing. For information, contact Dr. Bonnie Soman:
Dr. Bonnie Soman is a speech-language pathologist and Director of the Hy Weinberg Center for Communication Disorders on campus. Her work involves supervising students as they engage in clinical practice coursework. She has worked with clients across the lifespan, but has a particular interest in working with adults with communication problems and their families.
by Caroline T. Roan
When I was invited to post on Think About It, I was reminded of a recent article by Paul Klein on the Forbes CSR Blog, “Defining the Social Purpose of Business.” I was included in interviews he did with business leaders on social purpose and its relationship to a company’s approach to corporate responsibility.
Mr. Klein believes that “every corporation has an overarching social purpose that transcends the operations of corporate social responsibility and, when well understood and effectively integrated, can have profound business and social results.” At Pfizer, we agree with him. The social purpose of our business is to discover and develop new and innovative medicines that prevent and treat disease, allowing individuals to live longer and healthier at every stage of life. That is why my colleagues and I come to work every day.
Corporations have a responsibility to provide value to their shareholders. But these days, the definition of value is expanding. It is more than just monetary. In exchange for providing companies with a license to operate, society has great expectations. Companies are, rightfully, judged on issues far beyond just the profits they make.
Pfizer is one of many companies that now reports on both financial and non-financial performance indicators. Two years ago, we began combining our Annual Report with our Corporate Responsibility Review into a single review. Our web site www.pfizer.com, and our annual integrated report highlight our financial, environmental and social performance. Additionally, we voluntarily participate in various sustainability questionnaires, such as those offered by Carbon Disclosure Project (carbon, water), Bloomberg (Climate Innovation Index), and Newsweek (Green Rankings). We are committed to improving our transparency through reporting.
In order to address current and future public health challenges, everyone involved in the health care dialogue will need to listen with an open mind and commit to working together for a healthier world. That isn’t just our tagline, it is the purpose of our business.
Caroline T. Roan is Vice President of Corporate Responsibility & Reputation at Pfizer Inc, the world’s largest biopharmaceutical company headquartered in New York. She is also President of The Pfizer Foundation. Under Ms. Roan’s leadership, Pfizer continues to be a top corporate donor and has received local, national and international awards and recognition for its corporate responsibility programs. She will be speaking at the Adelphi University President’s Series on Critical Issues on Thursday, September 13, 2012, 8:30 a.m. – 10:00 a.m.
by Roni Berger, Ph.D., LCSW
Most of us heard about the German philosopher’s Nietzsche statement in the title; however, until quite recently, we heard much more about the devastating effects of struggling with highly stressful events.
As communication advances, media and social networks make all of us in the global village involved witnesses to traumatic experiences inflicted on individuals, families and communities around the world as soon as they occur. Natural disasters such as flood, hurricanes, bushfires and earthquakes, as well as human made catastrophes like wars, terrorist attacks, the failure of atomic reactors, and personal assault including rape and abuse, all take their toll in lives, injuries, devastation, psychological, health, social and financial outcomes.
Both those directly exposed and those close to them such as family members or professional service providers are affected. However, while the idea was around for a long time, only in the last three decades, we have reliable evidence that together with negative effects, traumatic exposure may also lead to benefits called posttraumatic growth (PTG). PTG has been documented in different cultural contexts following diverse stressor events. While its nature and manifestation are culture-specific, universally, growth may include different combinations of the core elements of interpersonal relationships, values, and beliefs, attitudes to life and view of self.
It is important to remember several basic facts:
Dr. Roni Berger is a professor in the Adelphi University School of Social Work. She teaches courses in quantitative and qualitative research methods and practice with individuals, families and groups in the M.S.W. and D.S.W. programs, as well as a course on practice with immigrants and refugees. Together with Tzipi Weiss, Roni Berger co-authored the book Post-Traumatic Growth and Culturally Competent Practice.’
Hurricanes, thunderstorms, extreme heat, power outages–it seems disasters are popping up daily, bringing us new challenges to think about and plan for. While we can’t control when emergencies happen, at the very least we can use them to prepare ourselves: or can we?
A new Adelphi University Center for Health Innovation poll finds that most Americans are not only unprepared for emergencies, but also incorrectly assume that they are ready for whatever comes their way.
USA Today’s ”Healthy Perspectives” blog and the Centers for Disease Control’s “Public Health Matters” blog provides a summary of the results as well as a link to a more detailed report of the results. The poll has already ignited debate and discussion among people who are trying to make sense of how to be as prepared as possible for the unexpected.
Visit the Center for Health Innovation’s poll section for information, resources, and stories from people who have first-hand experience about the impact of disasters and the importance of being prepared.
The Adelphi Natural Disaster Survey was conducted by Wakefield Research among 1,003 American adults, ages 18 and older, between May 15th and May 23rd, 2012, using a random-dialing telephone survey. Quotas have been set to ensure reliable and accurate representation of the U.S. adult population ages 18 and older.
by Philip Alcabes, Ph.D.
Although the Justices were expected to strike down the Affordable Care Act, the Obama administration’s health-care financing law passed in 2010, the Supreme Court upheld it in a 5-4 ruling today.
The law has a number of favorable effects, as Josh Levs at CNN cogently explained today.
Most important for students, Americans may now be covered on their parents’ health-insurance policies up to the age of 26. Important for everyone, it will no longer be permissible for insurance companies to refuse to cover young people with so-called pre-existing conditions or, beginning 2014, to refuse to cover anyone with a pre-existing condition.
The most vexatious provision of the law, the mandate that everyone not covered by either Medicaid or Medicare buy an insurance policy, stands for now.
To enforce the mandate, a family can be fined $285 or 1% of income, whichever is greater, if it doesn’t have health insurance in 2014. And the fine would go up to $2085 or 2.5% of income by 2016.
The Obama administration had argued that this financial penalty is okay under the Constitution: it’s a way to force more people to buy health insurance, the administration said, and that is the best way of making insurance less expensive for everyone–the more people who pay premiums to an insurance company, the cheaper the premiums can be. Congress has the right to regulate interstate commerce so, for the administration and its supporters, the Affordable Care Act is constitutional.
Others, including some private companies and 26 states’ attorneys general, had said that the mandate amounts to the federal government forcing citizens to buy a product, and therefore unconstitutional.
The big surprise is that Chief Justice Roberts, who usually sides with Court conservatives, cast the deciding vote and wrote the upholding opinion. The second big surprise is that Roberts’s opinion upholds the law not because Congress can regulate commerce – as Obama had wanted. Instead, he says it’s okay because the mandate is really a tax. And of course Congress is allowed to levy taxes.
What should we make of this? Surely it’s a good thing to make health insurance more available to more Americans. And especially good to stop insurers from refusing to indemnify people who are already sick or injured.
But if the mandate is a tax, then it seems that it’s okay for Congress to tell you to pay a tax either to the federal government (the fine for not having insurance) or to a private company (in the form of insurance premiums).
Wait–is it really okay to have to pay taxes to a private corporation?
Another problem today: the ACA’s expansion of Medicaid–the state-based programs that provide health insurance for the poor–has been questioned by the Supreme Court’s decision.
The Affordable Care Act has lots of good things in it. But it isn’t really health care reform–it’s more of a health care financing law. It doesn’t apply to everyone. And it might not work to create more insurance coverage for the poor.
Plus, the high court’s decision upholding the law seems to break new ground in giving private corporations the power to determine how Americans should look after our health and how much we should pay.
Some people think that’s better than letting governments make those decisions.
What do you think?
by Philip Alcabes, Ph.D.
New York’s mayor Michael Bloomberg announced last week that he is going to ban serving soda or other sweet beverages in large sizes in New York City. The order would limit servings to no more than 16 ounces, basically wiping out the Big Gulp and its super-size friends. It would not affect the sale of big bottles of soda in grocery stores, but would limit consumption in movie theaters, ball parks, and so forth.
Bloomberg is not asking for a new law – since it might not pass, given that a NY1-Marist poll finds that about half of New Yorkers oppose the idea. Instead, he will make it an executive order, which needs only a go-ahead from the city’s eleven-person Board of Health — all appointed by the mayor. And the courts aren’t likely to find it onerous or unjust – since if a New Yorker really, really wants to drink 32 ounces of, say, Mountain Dew all at once, she can just buy two 16-ounce cups.
It’s true that Americans drink a lot of soda. As of 2000, it was estimated that 15% of the average American diet comprised added sugars (i.e., not naturally occurring in foods, like the fructose in apples) – and that about half of the added sugar came from soft drinks. And it’s also true that Americans are heavier now than a generation ago.
So the NYC super-size-soda ban (shall we call it the SSSBan?) is pitched as a public health victory. For instance, Barry Popkin, a professor of nutrition at the UNC-Chapel Hill School of Public Health and a longstanding anti-obesity crusader, says that “controlling sugary beverage portions sizes is critical for reducing weight gain and [the] risks of diabetes in the U.S.”
And Ellen Rautenberg, CEO of Public Health Solutions (a private, nonprofit research firm associated with the NYC Department of Health) points out that limiting portion size is “…one important approach to this multifaceted problem [i.e., obesity] and applying this to sugary drinks, particularly those with no nutritional value, is an excellent place to begin. We went from happily accepting bottles of soda that were 6.5 fluid ounces and have now come to expect that a “regular” drink is 32 ounces.”
(I’m not sure Rautenberg is right that most people think of a quart as a regular-sized portion of soda. But she makes the point about the need for adjusting the landscape of consumption, if we want people to be slimmer.)
And Walter Willett, chair of the nutrition department at the Harvard School of Public Health, says that “New York City’s plan to limit the serving size of soda and other sugar-sweetened beverages sold in restaurants is well-justified by solid evidence. High intakes of these beverages increase the risks of obesity and diabetes and are clearly unsafe for anyone.”
There’s a big problem with the public health argument for the SSSBan, though: it’s probably false.
First, a comprehensive meta-analysis published in 2008 in the American Journal of Clinical Nutrition summarized studies examining consumption of sugar-sweetened beverages in relation to childhood obesity — and found no relationship of sugary-beverage consumption with body mass index.
Willett and his Harvard colleague Frank Hu did their own meta-analysis of studies relating sugary-beverage consumption in children, reporting (Am J Clin Nutr, Jan. 2009) that the average kid who adds one 12-ounce soda to his diet every day would gain 29 kg (64 lbs) per year compared to the same-sized child who does not. But the Willett and Hu results were based only on studies that failed to adjust for total dietary intake. Doing a good analysis of bad science (even at Harvard) doesn’t make the results any more valid.
At the very least, there’s reason to question whether it’s soda that makes obese children obese, or general caloric intake, or lack of exercise, or a combination of all of those.
Second, even if the evidence that soda consumption is associated with weight gain is correct, there has never been evidence that limiting soda consumption to 16 ounces (as opposed to 8 ounces, or 6 ounces, or zero!) can prevent or undo obesity.
Third, if soda is a public health enemy, as Popkin and Willett imply, then it’s hard to see how anything is to be gained by getting McDonald’s to sell sodas only in smaller sizes while large bottles are still available in the supermarket or the bodega down the block.
So here are some questions to think about:
So far, the SSSBan is only planned for NYC. But it could go further. How should you decide if it’s the right thing for your community?
by Sarah Eichberg, Ph.D.
The recent media firestorm over the ‘mommy wars,” shows just how socially relevant and significant the debate remains. Yet, as in previous disputes over the contributions of working and stay-at-home mothers, white, affluent women were rhetorically privileged and the varied interests and experiences of all other women ignored.
In their arguments, most politicians and pundits routinely presented a false binary of “choice,” as if mothers act independently of social context and are free to remain at home or in the labor force. But the simple fact is that most American women do not have the luxury to choose.
As they are framed, the mommy war debates deny the multiple constraints women face daily –in and out of the home–which restrict autonomy and create challenges to caring for their families’ economic, psychological and physical well-being.
Today, 70.8% of mothers are in the labor force, either working for pay or looking for a job. The reality is that in most two parent households, it takes two incomes to thrive or even survive. As real wages for men have declined over the past 30-40 years, women’s earning have become critical to even approximating a middle class existence. For many women, it’s either work or lose your home or forego healthcare or endure food insecurity.
What’s more, the “decision” to stay at home is not necessarily born out of a desire to leave a job. Many women are forced out by unfriendly work environments– low pay, inflexible parental leave – and a societal apathy toward affordable childcare that makes it impossible for women to earn a living and care for their children at the same time. As of 2009, there were 5.7 million married stay-at-home mothers in America. Rather than suburban soccer moms, the greatest concentration of married stay at home moms was young, Hispanic, foreign-born and without high school or college degrees. It is quite likely that many of these women need to work but lack the education and skills to find the high wage jobs that cover childcare costs.
The recent conversation about motherhood and choice becomes even more perverse when juxtaposed with current attacks on federal benefits, like the Supplemental Nutrition Assistance Program (SNAP) or Food Stamps, which offer low-income women, married or not, a key means to maintain some degree of economic self-sufficiency, by helping them put food on the table. With the dismantling of welfare in the 1990s, SNAP has become the first-line of defense against poverty. Even reducing these benefits would make millions of mothers and their children vulnerable to hunger, chronic health conditions, and mental distress.
As recent events show, this country remains conflicted about working mothers but not because of a quarrel over choice. Instead, we still have not become reconciled–in belief or in policy–to shifting gender roles (where are the fathers in all these discussions?) or the nation’s profound gap between the haves and the have-nots. As long as we – men and women – accept false narratives of equality and allow politicians and pundits to cynically frame our real life experiences as simple expressions of free-will, we will forever find ourselves trapped in rhetorical mommy wars, while the real issues of gender and economic justice are ignored.
Dr. Sarah Eichberg is the Director of Community Research of Adelphi University’s Institute for Social Research and Community Engagement (iSoRCE), whose mission is is twofold to generate actionable knowledge through collaborative social research, and to use that knowledge to better understand and address Long Island’s critical and enduring social issues.
by Chris Gasiewski
With students aligning the walls of room 228 in Alumnae Hall on March 30, Bridget and Delilah—two Darlington Great Pyrenees—were providing instant gratification to one corner of the room. Orion, their counterpart, was resting comfortably underneath the arm of freshman Brian Hamel.
It wasn’t your typical classroom setting. Instead, it was a glimpse into Dr. Diane Dembicki’s Healing and the Arts course, which is housed in the School of Nursing. The class teaches several different types of therapies, including art, music, dance and drama treatments. And the latest healing demonstration displayed how therapeutic dogs can provide a slice of happiness to hospital patients.
“You don’t get that experience often. Seeing these dogs changed my thinking,” said Brian, a self-proclaimed cat lover. “People were calling me the dog whisperer.”
Maybe so, but the Great Pyrenees were actually trained by Susie Wong, who has raised and specialized in Great Pyrenees for more than 20 years. Primarily, she visits North Shore-Long Island Jewish University Hospital two-to-three times a week, bringing the cuddly canines to several floors and units in the hopes of bringing a smile to the faces of the patients.
“They touch their souls,” said Ms. Wong, who recruited her children, Michael (21), Lauren (19) and Michelle (15) into the family business. “It’s just incredible. People in general forget how lucky we are. Going into the hospital and meeting all kinds of people from all walks of life, it’s just incredible.”
Ms. Wong witnesses the overwhelming joy that her dogs bring almost daily. She’s most fond of the palliative care unit, where her work has been rewarded with seeing great responses out of patients. She also tells the story of a little girl who suffered from a bone disease that resulted in pain when she made facial expressions. However, Ms. Wong’s dogs changed that.
“There were days she would come in and eat, and she would smile,” Ms. Wong said. “She said to me that ‘you are the only one who has ever made me smile.’”
Spring 2012 marked the third straight semester that Dr. Dembicki hosted Ms. Wong and the therapy dogs. Reviving the course after a brief hiatus, Dr. Dembicki has provided her students with an experiential learning experience like no other.
She assigns projects that include viewing various art pieces and sculptures around campus to observe their therapeutic characteristics. On Wednesday, April 4, the class will perform music therapies outdoors. There’s a social commentary component on contemporary arts and healing, as well as folk healing and shamanism. The class also did a community service project and made a voluntary contribution to the Pet Therapy Program, which was founded by Ms. Wong, at North Shore-LIJ Hospital.
“It looks at various therapies in healthcare,” Dr. Dembicki said of the course. “It is an interdisciplinary class, and we have faculty come in from the art department and psychology department. We make use of the computer technology at the University on Moodle, where the students have a weekly discussion forum.”
Mostly, Dr. Dembicki said, the class is popular because it allows students an opportunity to decompress from the rigors of academia. Her students, including Brian, agree.
“This class is really important for everyone to take,” Brian said. “If anything, it’s an escape from the daily stress and you can stimulate your mind in a different way. It’s really, really useful.”
For behind-the-scenes pictures and to find out when our therapy dogs video is ready, follow Adelphi University on Facebook.
Traumatic events bring with them a host of reactions—shock, fear, anger, and an insatiable quest to understand “why here, why now?”. Residents of Chardon, Ohio, are experiencing that range of emotions this week as they grapple with a school shooting that has claimed the lives of three students and wounded two others.
Dr. Jessie Klein, assistant professor in sociology and criminal justice at Adelphi was on CNN this morning to discuss the Ohio shooting incident. Author of the upcoming book The Bully Society: School Shootings, and the Crisis of Bullying in America’s Schools, Dr. Klein focused on the increasing isolation and fear that plague many school-aged children. She advised us to avoid looking for “red flags” in individual students and instead to look for “red flag” schools, whose cultures may promote mistreatment among students. Dr. Klein was also a guest on the Brian Leher show on WNYC, where she offered additional insight into the evolution of bullying and school shooting incidents in the United States, the impact of bullying on children, and schools’ roles in prevention.
The next few weeks will shine an increased spotlight on issues of bullying and violence in schools, as friends, family, and the public-at-large are searching for answers. But is our search helping us prevent future tragedies? Only time will tell.
Have you noticed that things seem a little more pink, cheerful, and flowery lately? That’s because today is Valentine’s Day, a holiday that is as loathed as it is loved. If you’ve turned on a TV or been anywhere online today, you’ve likely come across the most common complaint of day: it’s yet another “Hallmark Holiday” invented as a way to sell trinkets and candy and cards. (If you feel strongly about the day but can’t quite find the right words for your own Facebook or Twitter posts, consider getting some help from trusted status experts.)
There does, however, appear to be at least some historical record of Valentine’s Day. If you want to delve into day’s murky past, The History Channel offers a rather comprehensive explanation of the holiday—while also sharing that approximately 150 million greeting cards are exchanged on the day.
The Rebel Yell, the award-winning official student newspaper of the University of Nevada, Las Vegas offers a different perspective on the holiday. Columnist Doc Bradley says we shouldn’t blame Hallmark for just continuing the tradition of Valentine’s Day as a scam, and advises us to remember “that truth and romance are not necessarily the best of friends.”
Feeling happy and lovey-dovey yet?
Whether created or historic, Valentine’s Day is a holiday you simply can’t escape. Media coverage takes a certain delight in drawing the single vs. non single battle lines, painting each side as worthy of both envy and pity. There are online survival guides that encourage those without a partner to proactively ward off the negative impact of Valentine’s day by making plans, and not defining themselves by their relationship status. A recent counter to Valentine’s Day is Singles Awareness Day. If you’re not sure how to celebrate properly, you can get a quick primer here on all things S.A.D.
If you think being in a couple makes Valentine’s Day all roses: think again. CNN contributor and comedian Dean Obeidallah provides perhaps this year’s most comprehensive perspective on why couples are the big losers on Valentine’s Day. The pressure of the day makes Valentine’s Day “the bully of love,” writes Kelli Forsythe, relationship therapist with Psychological Counseling Services, Ltd. It can also shine an unwelcome spotlight on issues within a couple.
But the recipe for couples’ success on Valentine’s Day is no different from any other day. As renown psychologist Esther Perel notes, “love flourishes in an atmosphere of mutuality and reciprocity.” Later this month, Dr. Perel, an international authority on couple therapy, cross-cultural relations, and culture and sexuality, will be a guest of the Adelphi University School of Social Work Continuing Education and Professional Development program. Her all-day workshop on February 24 will focus on “The Psychology of Erotic Desire in Couples.”
Whether you’re single, paired up, or somewhere in between, perhaps today we should just take a tip from family mental health blogger Erica Krull, and embrace a day that is “about sharing and showing love.” After all, the love of family, friends, and yes, partners is good for us—mentally, physically, and emotionally. Love can keep our blood pressure low, it can reduce stress, and it can bring an added level of fulfillment to our every day lives.
See? No flowers or candy necessary.
This was an eventful week in the world of breast cancer fundraising and healthcare issues. On Tuesday, The Susan G. Komen foundation made public their decision to stop providing grants to Planned Parenthood. According to the New York Times, their decision would impact “breast cancer screening and education programs run by Planned Parenthood affiliates.”
This set off a flurry of reaction—including an outpouring of social media commentary, advocacy, and action. In the wake of this response, the Susan G. Komen foundation reversed their decision and announced today that they would continue to fund the screening and education programs run by Planned Parenthood affiliates.
The Adelphi NY Statewide Breast Cancer Hotline & Support Program has stayed on top of the story as it unfolded and their staff offers “5 Lessons We Have Learned from the Komen/Planned Parenthood Controversy:”
What have you learned from this? Please join the discussion on Facebook.
by Mitch Nagler, M.A. LMHC
The American Psychiatric Association has made what seems to be a confusing and disturbing decision to change how autistic spectrum disorders are going to be defined in the near future. Anyone with a child or family member on the spectrum, especially if they are currently diagnosed with a milder form, such as Asperger Syndrome or PDD-NOS, should be concerned about how these changes are going to impact access to health, educational and social services for their loved ones. It is possible, if not likely, that when these changes are put into effect in 2013, many who qualify for services now, will not meet the new standards, and thus be left without therapeutic options.
What we have learned since the current diagnostic criteria were put into effect in the DSM-IV in 1994, is that early intervention is critical for making positive changes in performance. Diagnostic tools have been developed that now make diagnosis possible as early as 18 months of age. Children and their families that have had access to the creative and important support services in all important areas of life, have made extraordinary improvements. If/when these changes to the DSM-V are put into place, insurance coverage, school services, and institutional support programs are likely all going to be curtailed for many people.
As the Director of the Bridges to Adelphi Program, and as a private practitioner, I have worked with hundreds of high school and college aged individuals with diagnoses of High Functioning Autism, Asperger Syndrome, and PDD-NOS. Most of them came from supportive elementary, middle school and high school environments. Many also received outside support and counseling services. As they have progressed through their lives, whether in their college careers at Adelphi, or elsewhere, I have seen first hand how important the early interventions were in their development. In fact, as we begin to graduate Bridges students from Adelphi, I worry about the younger students that are still in Pre-K or elementary school.
I am worried that if/when these proposed diagnostic changes are put into effect; the developmental future of young individuals with these diagnoses will be negatively impacted. Many who would have been able to build independent, successful lives, and enroll in programs like the Bridges to Adelphi Program, may not be able to do so because they will not have access to the important early interventions and support services.
My advice is to do what I did. Call the American Psychiatric Association, at 703-907-7300, and tell them that you object to these changes. Tell them that you have a family member or loved one who may be excluded from receiving services if these changes go through.
Mitch Nagler, M.A. LMHC, is a private practitioner and an Assistant Director at the Adelphi Student Counseling Center. He is also the Director of the Bridges to Adelphi Program, a multifaceted intervention program that includes coaching, learning strategies, behavioral modeling, and peer mentoring that addresses social, academic and vocational areas.
by Audrey Freshman, Ph.D., LCSW, CASAC
The holidays were busy in unimaginable ways for many families on Long Island. During the Christmas break I fielded 3 separate calls from parents, each resembling the next, and detailing the following request:
My son is a student at a state university. He is currently in the hospital having said that he “tried” some drugs at a party. He almost overdosed. Unbeknownst to us he has become addicted to opiates. He is now ready to be discharged and we need to bring him home. What do we do next?
I need help for my 10 year old who is very anxious and getting in trouble in school. Actually, there is a lot going on in my family. My older child is a nursing student. She is now in a de-tox for the past few days but plans to return to school for the January semester. She is addicted to opiates and other drugs that help her “study.” I feel desperate about her returning home. What should I do now?
My husband has been acting strange. It started last year when he injured his leg and was placed on medication. Now he is slurring, and spends days in the basement. He refuses to stop seeing his doctor who is giving him “the stuff.” He does not think there is anything wrong with him. Is he depressed? What should I do?
The holiday week culminated with the New Years Day reports of yet another Long Island pharmacy death, this time the Seaford shooting. The public is alarmed. Pharmacists are frightened. Lawmakers are calling for action. All of us want to know, “what should we do next?”
From 2007 to 2010, a report cited in the The New York Times released by the New York State Attorney General’s office indicated that oxycodone use has increased 82% in New York State; all other narcotic pain medication increased an additional 36% during the same time period. The National Institute on Drug Abuse (NIDA) notes that there were enough prescription painkillers prescribed “to medicate every American adult around-the-clock for a month.” In spite of this, New York State Senator Charles Schumer had to recently issue a warning to the Food and Drug Administration (FDA) against approving another, and even more powerful version of hydrocodone known as a “super painkiller” according to the Associated Press.
Yet, it is the failure to connect these storylines that remains central to the ongoing plight of opiate addiction on Long Island. The reality behind the distressed phone calls shows us that the face of the “addict” belongs to the student in our high schools and universities, who become exposed to the insidious epidemic of pharmaceutical availability through a friend’s locker or a parent’s medicine cabinet. It is the face of one of the adults in our community who receives a prescription for pain medication from a local physician or pain clinic that paves the way for iatrogenic addiction. It is the face of the younger sibling witnessing the chaos in their family that becomes the next in-line to medicate their fears.
We need to respond by acknowledging that the problem is “ours” and begin to own our “next steps.”
At the Adelphi University School of Social Work’s Department of Continuing Education, our goal is to recognize the contagion of addiction and to elevate the professional workforce capacity to address the urgency of the problem. Our Postgraduate Certificate Program in Addictions will enable interdisciplinary behavioral therapists to receive specialized training in addictions that can lead towards the Credential of Alcoholism and Substance Abuse Counselor in the State of New York. We expect that with additional training these professionals can bring their skills to each and every practice setting from the public health centers, to the criminal justice institutions, to the education systems, and into the private counseling offices.
This spring, our continuing education workshops will look at the co-occurrence of substance abuse and trauma, which is one of the most common overlapping mental disorders. We are continuing our quest to partner with private and nonprofit drug treatment organizations to bring leaders and researchers in the field of addiction to our campus to address issues of drug use in our communities and schools.
The treatment of addiction is complex. It requires an integrative family-based model of treatment along with a contemporary understanding of the current evidence-based research, community resources and supports that are in place to sustain recovery.
Most importantly, it requires a knowledge base that can diagnostically disentangle complex psychological, social, and economic issues in order to best respond to the question, “What do we do next?”
Dr. Audrey Freshman, Ph.D., LCSW, CASAC, is the Director of the Adelphi University School of Social Work Office of Continuing Education and Professional Development. She has nearly 30 years experience in conducting interventions, diagnostic assessment, and treatment of adolescents, adults and families coping with issues of substance use and abuse. Prior to Adelphi, she was the associate director of Tempo Group, a New York State Office of Alcoholism and Substance Abuse (OASAS) agency located on Long Island.
Happy 2012 from Adelphi’s Center for Health Innovation!
The beginning of the year often finds us focused on making new year’s resolutions, which are often be health-related. The top resolutions usually include some variation on improving our fitness and workout habits, losing weight, and quitting smoking. But most resolutions don’t make it past the end of January, which leaves us feeling as if we have missed our big window into making meaningful changes.
But why do resolutions fail? In many cases, it’s fundamentally misunderstanding why we don’t succeed combined with setting unrealistic expectations.
A December 2011 article in the Wall Street Journal reported that “in a survey of 1,134 adults released last month by the American Psychological Association, willpower was the top reason people cited for failing to make positive changes.” But is it really a lack of willpower that has people reaching for their cigarettes and skipping the gym?
Relying on willpower may not be the answer, as “willpower springs from a part of the brain, in the prefrontal cortex, that is easily overloaded and exhausted. What works far better, researchers say, is training other parts of the brain responsible for linking positive emotions to new habits and conditioning yourself to new behaviors.” Researchers recommend visualization and “linking your new habits to other pleasant changes” as more successful strategies.
Understanding what will help you succeed is only half the battle. In many cases, the very nature of the goals we set don’t do us any favors. Dr. Jonathan Jackson, the director of Adelphi’s Center for Psychological Services recently shared his thoughts on the pitfalls of resolutions with the 101.9 FM News audience.
Jackson believes that a resolution “should not be to reverse something, it should be to do things differently.” Many people incorrectly view the new year as a time when we are a blank slate, with a chance to do things over again. But Jackson says “it’s unrealistic to think that you’re ever a blank slate,” and he recommends taking “small steps,” where you can easily see progress and feel a “sense of closure and a sense of triumph” that you have achieved.
If you’re looking to take some small steps this year, Adelphi and the Center for Health Innovation can help put you on the path to a healthy and satisfying 2012.
However you choose to take a small step, the Center for Health Innovation looks forward to being a partner on your path towards increased health and wellness.
President Obama’s October announcement that U.S. troops would return home from Iraq by the end of 2011 has everyone talking and wondering what this means—not only for veterans, but also for the organizations and services that provide training, education, healthcare, and other support for veterans.
As The Gothamist’s Alec Hamilton reports, “Returning veterans can face a wide variety of mental and physical health challenges, and may have unique needs resulting from their service…. Many veterans are returning with the less visible wounds of mental trauma, wounds which can be devastating for the individual as well as their families and communities.” His October article explores whether our region is prepared to help the over 1.3 million veterans in the greater New York City region. Adding Long Island to that mix dramatically increases the numbers of veterans in our region.
In addition to physical and mental health needs, returning veterans will look to join the work force, or return to school. A post on The Hill’s healthcare blog reported that the White House “issued a challenge to community health centers to hire 8,000 veterans… over the next three years. And it said physician assistant programs that help train veterans would get priority grant funding.” That same post noted that the “jobless rate for veterans was 8.7 percent last year, according to the U.S. Bureau of Labor Statistics, adding up to more than 200,000 people.”
So the question remains: Are we prepared to meet the healthcare, training, and education needs of our region’s veterans?
As a recognized Yellow Ribbon school, Adelphi University has a long-standing commitment to our region’s veterans. Adelphi was transformed in the 1940s when the University welcomed WWII veterans to campus. Today, our university president is a veteran and an advocate for the new G.I. Bill, a past board chairman is a veteran, and we have a strong alumni veterans network.
Adelphi remains dedicated to addressing the needs of all veterans through relevant academic programs, as well as training and professional development opportunities for clinicians and practitioners who work with veterans. This fall, Adelphi’s Hudson Valley Center offered a social work conference dedicated to working with veterans, and will continue to explore the questions raised by participants.
If you are a veteran looking to start or continue your education, visit our Veterans and Military Personnel Admissions site for more information.