April 05, 2012

Coming to Labels Soon: What Chemicals Are in Cigarettes

Kenneth Spaeth, MD
Director, Occupational and Environmental Medicine Center
Pat Folan, RN
Director, Center for Tobacco Control

Some of the chemical found in cigarettes

Tobacco companies must display the concentration of 20 cancer-causing chemicals in cigarettes on warning labels beginning this June, according to a new requirement enacted by the Food and Drug Administration (FDA). This is the agency’s latest step to make the toxicity of cigarettes more transparent.

While there are more than 7,000 chemicals in cigarettes, 93 of them are proven to be harmful. However, the FDA selected 20 to display because of ease of testing, which ensures compliance. The 20 cigarette chemicals include such well-studied, recognized carcinogens as toluene, formaldehyde and benzene.

Just as nutritional labels on foods list such elements as calories, sodium and fats to help consumers make better-informed, healthier choices, the hope is that displaying the types and amounts of these chemicals on cigarette warning labels will add to the myriad motivators to inspire smokers to quit.

The FDA will also require tighter restrictions on tobacco company claims that characterize some tobacco products as “less risky” to health, including snuff and electronic cigarettes, which have been more heavily marketed in recent years.

Despite great success in the struggle against this scourge, smoking contributes roughly 20 percent of all deaths each year in the United States (more than HIV, drug and alcohol use, motor vehicle accidents, suicides and murders combined) at a cost of about nearly $200 billion. So the more we do to help people quit or never start using tobacco, the better off everyone will all be.

The North Shore-LIJ Center for Tobacco Control offers quit-smoking help. Call us at 516-466-1980.

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March 26, 2012

Breaking Down the Supreme Court, the Affordable Care Act and the Individual Mandate

Bradley Flansbaum, DO

To understand how US Supreme Court arguments over the Patient Protection and Affordable Care Act will be different and why it will dominate the news until the court reaches a decision in June, consider this: The time allotted for arguments--the period in which plaintiffs and defendants present their views to the justices—is six, instead of the usual one. Moreover, the proceedings will transpire in not just one day, but three.

There are several issues up for debate but the most significant, and the one you have likely heard about, is the individual mandate. This Affordable Care Act requires all individuals without health insurance to purchase it or pay a penalty(not a tax). The mandate doesn’t apply to most people, since those with Medicare, Medicaid, or employer-provided insurance already meet the necessary waiver requirements.
 
The five-to-10 percent of the population that doesn’t fulfill the waiver requirements will be able to purchase subsidized insurance, based on household income, through state-based exchanges to open in 2014. Penalties for noncompliance are significantly less than the price of insurance ($695 to $2,000, based on income), and failure to abide will not result in criminal penalties.
 
Why is the individual mandate generating controversy? Twenty-six states challenging the law (along with a business group and four individuals) see the obligation to purchase health insurance very differently than the federal government. Here, very briefly, is the distinction:
 
The government: The US Constitution’s Commerce Clause authorizes the federal government to regulate interstate commerce. Simply, if one state were to create trade barriers with another, the federal government can intervene under the authority granted it in the constitution. Because healthcare is a service that everyone requires at some point, we are already participants in the marketplace. Those who choose to stay out of the system oblige others to pay for the care they eventually need--essentially depending on the support of their neighbors. Though more complicated, but the crux of the matter is this: A functioning national market needs everyone to participate and by virtue of its constitutional powers, the United States government can facilitate the process.
 
The states: The argument against the US Constitution’s Commerce Clause involves a different principle. It is the principle of liberty versus forcing citizens “inactive” in the healthcare marketplace to purchase a product they do not desire. Opponents to the Affordable Care Act are not arguing against universal healthcare* per se. Rather, those against the individual mandate believe the right of the individual “to be left alone” supersedes the right of the government to require purchase of an insurance contract.The plaintiffs also question whether healthcare is different from any other good (e.g., if forced to purchase healthcare, why not cars, food, or any other product).
 
Handicappers are predicting the Supreme Court will uphold the law. Full Post - to Detail View

November 14, 2011

A Healthy Dose of Sanity

Jeremy Boal, MD

From the New York Times: “The Obama administration moved [recently] to roll back numerous rules that apply to hospitals and other healthcare providers after concluding that the standards were obsolete or overly burdensome to the industry.”

As an example, one of the proposed changes would make it easier for patients to self-administer some medications while they are in the hospital. Another would remove redundant regulatory standards on dialysis centers. In addition to saving hospitals more than $1 billion per year, this announcement sends a long overdue and very welcome message to hospitals and doctors that Washington recognizes that regulations can indeed become obsolete and need revisiting on a regular basis. This is a nice start and here’s hoping that these thoughtful approaches continue.
 

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November 04, 2011

Coaches Boost Clinician Effectiveness

Jeremy Boal, MD

“Even Jack Nicklaus needs a coach.” That’s what Kelly Skeff, MD, PhD, told me back in 1998, when I had the good fortune to spend a month with him learning how to be a better teacher. Dr. Skeff is the founder and codirector of Stanford School of Medicine Faculty Development Center for Medical Teachers. In a similar vein, Atul Gawande, MD, just published an article in the New Yorker advocating the use of coaches for clinicians to help them improve their performance.

I couldn't agree more. We have been using executive coaches through the North Shore-LIJ Center for Learning and Innovation to help many of our clinicians become better leaders and have begun to use clinical coaches more formally as well.

This coaching model is also a core component of the new Hofstra North Shore-LIJ School of Medicine curriculum. Every 12 weeks, the students gather at the Center for Learning and Innovation to practice what they have been learning with computerized patient simulators as well as with paid actors. Over the course of a week, they are coached on a daily basis for the sole purpose of improving their performance.
 

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